De Reuck Jacques, Van Maele Georges
Department of Neurology, University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
Clin Neurol Neurosurg. 2010 May;112(4):328-31. doi: 10.1016/j.clineuro.2010.01.004. Epub 2010 Feb 4.
Early intravenous treatment with recombinant tissue plasminogen activator (rt-PA) improves the outcome of patients with an acute ischemic stroke. This retrospective observational study analyses whether rt-PA treatment also prevents the occurrence of early- and late-onset seizures.
Thirty-eight patients treated with rt-PA were compared to 269 receiving anticoagulants (ACs) and 769 on antithrombotics (ATs) for an acute cardiac- or thrombo-embolic stroke. The epidemiological and clinical data, and the vascular risk factors were determined in the three groups. The incidence, onset and types of seizures were compared.
The patients treated with rt-PA had more severe stroke signs on admission and remained more dependent than those treated with ACs and ATs. The appearance of early-onset seizures was related to the severity of the stroke. The incidence of the late-onset ones tended to be low in the rt-PA group. None of the patients developed status epilepticus or epilepsy.
The occurrence of early-onset seizures in the rt-PA treated group is related to the severity of the stroke and not to the treatment modality. Thrombolysis prevents partly the occurrence of late-onset seizures, probably, by a better reperfusion of the ischemic brain regions.
早期静脉注射重组组织型纤溶酶原激活剂（rt-PA）可改善急性缺血性脑卒中患者的预后。这项回顾性观察性研究分析了rt-PA治疗是否也能预防早发性和迟发性癫痫的发生。
将38例接受rt-PA治疗的患者与269例接受抗凝剂（ACs）治疗以及769例接受抗栓药物（ATs）治疗的急性心脏或血栓栓塞性脑卒中患者进行比较。测定三组患者的流行病学和临床数据以及血管危险因素。比较癫痫的发病率、发作时间和类型。
与接受ACs和ATs治疗的患者相比，接受rt-PA治疗的患者入院时卒中症状更严重，且依赖性更强。早发性癫痫的出现与卒中严重程度有关。rt-PA组迟发性癫痫的发病率趋于较低。所有患者均未发生癫痫持续状态或癫痫。
rt-PA治疗组早发性癫痫的发生与卒中严重程度有关，而非与治疗方式有关。溶栓治疗可能通过更好地再灌注缺血性脑区，部分预防了迟发性癫痫的发生。
