Department of Neurological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
Cerebrovasc Dis. 2011;31(2):191-8. doi: 10.1159/000321872. Epub 2010 Dec 11.
The rate of early post-stroke epileptic seizures ranges from 2 to 33%. This wide range is likely due to differences in study design, patient selection and type of neurophysiological monitoring. Electroencephalography (EEG), which is not used in the routine work-up of acute stroke, is the best neurodiagnostic technique for detecting epileptic activity, especially in patients with non-convulsive post-stroke epileptic activity. The aim of this study was to analyze patterns on EEGs performed within 24 h of stroke onset, and to investigate correlations between these patterns and the occurrence of early epileptic seizures and status epilepticus (SE), vascular risk factors, stroke subtypes and short-term outcome.
We prospectively studied 232 patients (mean age 71 ± 12 years; 177 ischemic strokes and 55 hemorrhagic). EEG recording was performed within 24 h from hospitalization. The follow-up lasted 1 week.
Fifteen patients (6.5%) had early seizures within 24 h; 10 of these patients had focal SE with or without secondary generalization. EEG revealed sporadic epileptiform focal abnormalities in 10% and periodic lateralized epileptiform discharges (PLEDs) in 6%. SE was recorded in 71.4% of patients with PLEDs. At the multivariate analysis, only early epileptic manifestations (p < 0.001) were independently associated with PLEDs.
Our study confirms that seizures are not frequent in the early phase of acute stroke and occur prevalently as focal SE at onset. EEG may help to detect specific patterns, such as PLEDs, that are closely related to early seizures. EEG monitoring should be performed in order to detect purely electrographic seizures.
早期卒中后癫痫发作的发生率为 2%至 33%。这种广泛的差异可能是由于研究设计、患者选择和神经生理监测类型的不同所致。脑电图（EEG）并未用于急性卒中的常规评估，但它是检测癫痫活动的最佳神经诊断技术，特别是在非惊厥性卒中后癫痫活动的患者中。本研究旨在分析卒中发作后 24 小时内进行的 EEG 模式，并探讨这些模式与早期癫痫发作和癫痫持续状态（SE）、血管危险因素、卒中亚型和短期预后之间的相关性。
我们前瞻性研究了 232 例患者（平均年龄 71 ± 12 岁；177 例缺血性卒中和 55 例出血性卒）。入院后 24 小时内进行 EEG 记录。随访时间为 1 周。
15 例患者（6.5%）在 24 小时内发生早期癫痫发作；其中 10 例为局灶性 SE，伴有或不伴有继发性全面性发作。10%的患者脑电图显示散在的癫痫样局灶性异常，6%的患者显示周期性偏侧性癫痫样放电（PLEDs）。PLEDs 患者中 71.4%记录到 SE。多变量分析显示，只有早期癫痫表现（p < 0.001）与 PLEDs 独立相关。
本研究证实，在急性卒中的早期阶段，癫痫发作并不常见，且多为局灶性 SE 发作。EEG 可能有助于检测到与早期癫痫发作密切相关的特定模式，如 PLEDs。应进行 EEG 监测以检测纯电发作。
