Vercueil Laurent
EFSN, UF épilepsie et malaises neurologiques, CHU de Grenoble, Grenoble.
Presse Med. 2007 Jan;36(1 Pt 2):176-81. doi: 10.1016/j.lpm.2006.11.001. Epub 2006 Dec 11.
Seizures and status epilepticus may be an early (<7-14 days) or late (>14 days) complication of acute stroke. Epilepsy, defined by at least two unprovoked epileptic seizures, may also be a late complication. Several risk factors have been identified for early and late seizures. Early seizures are more frequent in severe and disabling ischemic strokes, hemorrhagic strokes and those with cortical involvement. The risk of epilepsy is higher for patients with early seizures or cortical infarctions and in severely handicapped patients. Overall, approximately 4% of patient with an acute stroke will have at least one seizure in the early or late period, and half of them will develop epilepsy. Neither early nor late seizures appear to have a significant impact on mortality, although status epilepticus remains a life-threatening and often fatal event. The decision whether to start antiepileptic treatment after a first seizure or wait for a recurrence remains controversial. Risk of drug interactions and adverse effects in stroke patients must be kept in mind when prescribing antiepileptic drugs.
癫痫发作和癫痫持续状态可能是急性中风的早期（<7 - 14天）或晚期（>14天）并发症。癫痫定义为至少两次无诱因的癫痫发作，也可能是晚期并发症。已确定了早期和晚期癫痫发作的几个危险因素。早期癫痫发作在严重致残性缺血性中风、出血性中风以及累及皮质的中风中更为常见。早期癫痫发作或皮质梗死患者以及严重残疾患者患癫痫的风险更高。总体而言，约4%的急性中风患者在早期或晚期会至少发作一次癫痫，其中一半会发展为癫痫。早期和晚期癫痫发作似乎对死亡率均无显著影响，尽管癫痫持续状态仍然是危及生命且常致命的事件。首次癫痫发作后是否开始抗癫痫治疗还是等待复发的决定仍存在争议。在开具抗癫痫药物时，必须牢记中风患者发生药物相互作用和不良反应的风险。
