Department of Clinical Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, CHUV BH-07, 1011, Lausanne, Switzerland.
J Neurol. 2013 Jan;260(1):55-61. doi: 10.1007/s00415-012-6583-6. Epub 2012 Jun 29.
Seizures appear at stroke presentation, during the acute phase or as a late complication of stroke. Thrombolysis has not been investigated as a risk factor despite its potential neurotoxic effect. We try to identify risk factors for seizures during the acute phase of ischemic stroke in a cohort including thrombolysed patients. We undertook a case-control study at a single stroke center using data from Acute Stroke Registry and Analyse of Lausanne (ASTRAL). Patients with seizure occurring during the first 7 days following stroke were retrospectively identified. Bi-variable and multivariable statistical analyses were applied to compare cases and randomly selected controls. We identified 28 patients experiencing from seizures in 2,327 acute ischemic strokes (1.2 %). All seizures occurred during the first 72 h. Cortical involvement, thrombolysis with rt-PA, arterial recanalization, and higher initial NIHSS were statistically associated with seizures in univariated analysis. Backward linear regression identified cortical involvement (OR 7.53, 95 % CI 1.6-35.2, p < 0.01) and thrombolysis (OR 4.6, 95 % CI 1.6-13.4, p = 0.01) as being independently associated with seizure occurrence. Overall, 3-month outcome measured by the modified Rankin scale (mRS) was comparable in both groups. In the subgroup of thrombolysed patients, outcome was significantly worse at 3 months in the seizure group with 9/12 (75 %) patients with mRS ≥ 3, compared to 6/18 (33.3 %) in the seizure-free group (p = 0.03). Acute seizures in acute ischemic stroke were relatively infrequent. Cortical involvement and thrombolysis with rt-PA are the principal risk factors. Seizures have a potential negative influence on clinical outcome in thrombolysed patients.
发作可出现在脑卒中发作时、急性期或脑卒中的晚期并发症。尽管溶栓可能具有神经毒性作用，但尚未对其进行研究以确定其是否为危险因素。我们试图在包括溶栓患者的队列中识别急性缺血性脑卒中急性期发生癫痫的危险因素。我们在一个卒中中心进行了病例对照研究，该研究使用了急性卒中登记处和洛桑分析（ASTRAL）的数据。我们回顾性地识别了在卒中后 7 天内发生癫痫的患者。对病例和随机选择的对照进行了双变量和多变量统计分析。我们在 2327 例急性缺血性脑卒中患者中发现了 28 例（1.2%）有癫痫发作。所有癫痫发作均发生在 72 小时内。皮质受累、rt-PA 溶栓、动脉再通和较高的初始 NIHSS 在单变量分析中与癫痫发作有关。向后线性回归确定皮质受累（OR 7.53，95%CI 1.6-35.2，p<0.01）和溶栓（OR 4.6，95%CI 1.6-13.4，p=0.01）与癫痫发作独立相关。总体而言，两组患者的 3 个月改良 Rankin 量表（mRS）评分结果相当。在溶栓患者亚组中，癫痫组 9/12（75%）患者 mRS≥3，而无癫痫组 6/18（33.3%）患者 mRS≥3（p=0.03），3 个月结局明显更差。急性缺血性脑卒中急性发作相对少见。皮质受累和 rt-PA 溶栓是主要危险因素。癫痫发作可能对溶栓患者的临床结局产生负面影响。
