Department of Neurology, University Hospital, Ghent, Belgium.
Acta Neurol Belg. 2009 Dec;109(4):271-6.
Although general guidelines exist for the diagnosis and the treatment of epilepsy, no specific recommendations are available concerning the management of seizures related to cerebrovascular disease. The incidence of seizures after stroke was found to be 8.9% in the only published prospective study. This is an underestimation as seizures occurring at stroke onset were not taken in to account and non-convulsive spells are rarely recognized as such. Risk factors, diagnosis, management and treatment will be different according to the time of onset of the seizures in relation to the stroke. As, on one hand, repeated seizures and status epilepticus worsen the neurological and the mental condition of stroke patients and, on the other hand, antiepileptic drugs (AEDs) can also increase cognitive impairment, the main questions to be answered are for which patients AEDs should be prescribed and which drug should be preferred.
尽管存在用于癫痫诊断和治疗的一般指南，但对于与脑血管疾病相关的癫痫发作的管理，尚无具体的建议。唯一发表的前瞻性研究发现，中风后癫痫发作的发生率为 8.9%。这是一种低估，因为中风发作时的癫痫发作未被考虑在内，并且非惊厥性发作很少被识别为癫痫发作。根据癫痫发作与中风的时间关系，风险因素、诊断、管理和治疗将有所不同。一方面，反复癫痫发作和癫痫持续状态会使中风患者的神经和精神状况恶化，另一方面，抗癫痫药物（AEDs）也会导致认知障碍，因此需要回答的主要问题是，对于哪些患者应该开 AEDs，以及应该首选哪种药物。
