Stroke Unit, Department of Neurology, Ege University Faculty of Medicine, Izmir, Turkey.
Eur Neurol. 2013;69(4):200-6. doi: 10.1159/000345360. Epub 2013 Jan 10.
The impact of poststroke seizures on the neurological deficits related to ischemic stroke is not well known. It has been reported that following poststroke epilepsy, transient or long-lasting worsening of the poststroke sequelae may develop, but the underlying mechanism of deficit worsening has not been systematically studied by magnetic resonance diffusion-weighted imaging (MRI-DWI).
From 2008 to 2009, 1,010 ischemic stroke patients were admitted to our stroke unit at the Ege University Hospital with first-time strokes. Of these, 76 (7.5%) patients developed delayed seizures in a follow-up period of 18 months. We extracted the clinical and imaging data of the patients from our Stroke Registry databases and other medical records, and evaluated brain MRI, including spin-echo DWI with apparent diffusion coefficient (ADC) maps, FLAIR and T2-weighted images.
There were 15 (20%) patients who had long-lasting worsening of the previous neurological sequelae, which we called long-lasting neurological worsening (LLW); 38 (50%) had transient neurological worsening (TNW) and 23 (30%) were without neurological worsening (WNW) after poststroke seizures. DWI findings were present in 3/23 (13%) patients with simple partial-type seizure, in 4/17 (29%) patients with complex partial-type seizure, and in 7/13 (54%) patients with generalized toni-clonic type seizure (p = 0.002). Patients with LLW showed more frequent changes on DWI than those with TNW (53 vs. 16%; p = 0.009). Forty percent of patients with LLW and 5% of those with TNW had ADC decrease (p = 0.004). Patients with LLW had DWI changes in the occipital region more frequently than those with TNW (57 vs. 18%; p = 0.05). Correlation analysis found a significant association between LLW and DWI changes, multiple DWI lesions, ADC decrease, and recurrent seizures. In the control MRI-DWI 1 month after the poststroke seizure, no signal abnormalities were detected in neuroimaging studies of all patients. Despite no functional outcome differences between the groups before the seizure, the functional scales 1 week after the seizure (National Institutes of Health Stroke Scale, Modified Rankin Scale and Barthel Index) showed significantly worse neurological functional statements in the patients with LLW than those with TNW and WNW (p = 0.001).
Poststroke seizures may affect poststroke sequelae transiently, which we see more often, but some seizure types may prolong the duration of deficits. Multiple DWI changes and LLW following recurrent and longer poststroke seizures were strongly associated, and this may be due to the effect of seizures causing additional metabolical changes.
脑卒中后癫痫发作对缺血性脑卒中相关神经功能缺损的影响尚不清楚。据报道，脑卒中后癫痫发作后，可能会出现短暂或长期的脑卒中后遗症恶化，但磁共振弥散加权成像（MRI-DWI）并未系统研究其潜在的缺损恶化机制。
2008 年至 2009 年，1010 例首次发生脑卒中的缺血性脑卒中患者入住爱琴海大学医院的脑卒中病房。其中，76 例（7.5%）患者在 18 个月的随访期间发生迟发性癫痫发作。我们从我们的脑卒中登记数据库和其他病历中提取了患者的临床和影像学数据，并评估了脑 MRI，包括自旋回波 DWI 与表观弥散系数（ADC）图、FLAIR 和 T2 加权图像。
有 15 例（20%）患者出现先前神经后遗症的长期恶化，我们称之为长期神经恶化（LLW）；38 例（50%）患者出现短暂性神经恶化（TNW），23 例（30%）患者在脑卒中后癫痫发作后无神经恶化（WNW）。单纯部分性发作患者中有 3/23（13%）出现 DWI 异常，复杂部分性发作患者中有 4/17（29%）出现 DWI 异常，全面强直阵挛性发作患者中有 7/13（54%）出现 DWI 异常（p=0.002）。LLW 患者的 DWI 异常发生率高于 TNW 患者（53% vs. 16%；p=0.009）。LLW 患者中有 40%（15/38）出现 ADC 降低，而 TNW 患者中有 5%（2/38）出现 ADC 降低（p=0.004）。LLW 患者的 DWI 异常更常见于枕叶区域，而 TNW 患者则更常见于颞叶区域（57% vs. 18%；p=0.05）。相关性分析发现，LLW 与 DWI 变化、多发病灶、ADC 降低和复发性癫痫发作之间存在显著相关性。在脑卒中后癫痫发作后 1 个月的对照性 MRI-DWI 中，所有患者的神经影像学研究均未发现信号异常。尽管在癫痫发作前各组之间的功能预后无差异，但癫痫发作后 1 周的功能量表（国立卫生研究院脑卒中量表、改良 Rankin 量表和巴氏指数）显示，LLW 患者的神经功能状态明显较 TNW 和 WNW 患者差（p=0.001）。
脑卒中后癫痫发作可能会短暂影响脑卒中后遗症，但某些癫痫发作类型可能会延长缺损的持续时间。复发性和较长时间的脑卒中后癫痫发作后的多发病灶和 LLW 与癫痫发作引起的代谢变化有关。
