Cordonnier Charlotte, Hénon Hilde, Derambure Philippe, Pasquier Florence, Leys Didier
Department of Neurology, University of Lille, Lille, France.
J Neurol Neurosurg Psychiatry. 2007 May;78(5):514-6. doi: 10.1136/jnnp.2006.105080.
Subclinical vascular or degenerative lesions occur in the brain before the clinical expression of dementia. Those lesions in a brain that just experienced a stroke may have lower thresholds for early epileptic seizures. Therefore, epileptic seizures may be a marker of subclinical brain lesions, which may lead to dementia.
To test the hypothesis that patients with stroke who have epileptic seizures without dementia have an increased risk of new-onset dementia.
169 consecutive patients with stroke without pre-existing dementia recruited in the Lille Stroke/Dementia Study were investigated (90 men; 150 ischaemic strokes; median age 73 years). Pre-stroke cognitive functions were evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), with a cut-off of 104 for the diagnosis of dementia. The patients were followed up over a 3-year period. Dementia was diagnosed with International Classification of Diseases, 10th revision criteria in survivors who underwent neurological visits, and with the IQCODE score in those who could not. The relationship between epileptic seizures and new-onset dementia was studied within 3 years, using life-table methods.
9 patients (5.3%; 95% CI 2.9 to 8.7%) had early seizures. Epileptic seizures were independent predictors of new-onset dementia within 3 years after stroke (HR 3.81; 95% CI 1.13 to 12.82), with increasing age (HR 1.04; 95% CI 1.01 to 1.08), IQCODE scores at admission (HR 1.08; 95% CI 1.02 to 1.13) and diabetes mellitus (HR 3.52; 95% CI 1.46 to 8.47).
Patients with stroke who have epileptic seizures may be at increased risk of dementia. Whether cognitive follow-up should be systematically performed in those patients remains to be validated.
在痴呆临床表现出现之前，大脑中就会发生亚临床血管性或退行性病变。刚经历中风的大脑中的这些病变可能对早期癫痫发作的阈值较低。因此，癫痫发作可能是亚临床脑病变的一个标志，而亚临床脑病变可能会导致痴呆。
检验如下假设：无痴呆的中风后癫痫发作患者新发痴呆的风险增加。
对里尔中风/痴呆研究中招募的169例无既往痴呆史的连续中风患者进行调查（90例男性；150例缺血性中风；中位年龄73岁）。采用老年人认知功能下降知情者问卷（IQCODE）评估中风前的认知功能，诊断痴呆的临界值为104。对患者进行了为期3年的随访。对于接受神经科就诊的幸存者，根据《国际疾病分类》第10版标准诊断痴呆；对于无法就诊的患者，则根据IQCODE评分诊断痴呆。采用生命表法研究3年内癫痫发作与新发痴呆之间的关系。
9例患者（5.3%；95%可信区间2,9%至8.7%）出现早期癫痫发作。癫痫发作是中风后3年内新发痴呆的独立预测因素（风险比3.81；95%可信区间1.13至12.82），此外还有年龄增长（风险比1.04；95%可信区间1.01至1.08）、入院时IQCODE评分（风险比1.08；95%可信区间1.02至1.13）和糖尿病（风险比3.52；95%可信区间1.46至8.47）。
中风后癫痫发作的患者可能有更高的痴呆风险。这些患者是否应系统地进行认知随访仍有待验证。
