From the Epilepsy Program, Department of Clinical Neurological Sciences (C.-W.H., D.A.S., J.G.B.), Western University, London, Canada; Department of Neurology (C.-W.H.), National Cheng Kung University Hospital, School of Medicine, National Cheng Kung University, Tainan, Taiwan; University of Toronto (G.S.), St Michael's Hospital; and Institute for Clinical Evaluative Sciences (G.S., J.F.), Toronto, Canada.
Neurology. 2014 Mar 4;82(9):768-76. doi: 10.1212/WNL.0000000000000166. Epub 2014 Jan 31.
We compared clinical characteristics of seizures at ischemic stroke presentation (SSP) to seizures during hospitalization post ischemic stroke (SDH), and their impacts on stroke outcome, using the Registry of the Canadian Stroke Network (RCSN) database.
This cohort study included consecutive patients from the RCSN who had an acute ischemic stroke between July 2003 and March 2008. Outcome measures included morbidity, mortality, length of hospital stay, and discharge disposition. Clinical variables for either SSP or SDH were investigated and the stroke outcome was stratified by stroke severity.
The study included 10,261 patients with ischemic strokes: 157 patients (1.53%) had SSP and 208 patients (2.03%) had SDH. Compared to stroke patients without seizures, patients with SSP and SDH were younger, had more severe strokes (p < 0.001), a higher admission rate to the intensive care unit (p < 0.001), higher morbidity, and higher mortality (p < 0.05). SSP was associated with female sex and less limb weakness, while SDH was associated with pneumonia and the presence of hemineglect. Importantly, patients with less severe strokes had higher morbidity and mortality (p < 0.005) if SDH occurred. Variables predicting overall mortality were SDH, older age, higher Charlson-Deyo index, more severe strokes, and nonalert status on arrival (all p < 0.001).
SSP and SDH have different characteristics. SDH indicates a poorer prognosis in patients. Increased awareness of SSP and efforts to prevent SDH may be important in improving outcomes following clinical stroke care.
我们利用加拿大卒中网络注册（RCSN）数据库，比较了缺血性卒中发病时的癫痫发作（SSP）和缺血性卒中后住院期间的癫痫发作（SDH）的临床特征及其对卒中结局的影响。
本队列研究纳入了 2003 年 7 月至 2008 年 3 月期间 RCSN 连续收治的急性缺血性卒中患者。结局测量指标包括发病率、死亡率、住院时间和出院去向。对 SSP 或 SDH 的临床变量进行了调查，并根据卒中严重程度对卒中结局进行了分层。
研究纳入了 10261 例缺血性卒中患者：157 例（1.53%）患者发生 SSP，208 例（2.03%）患者发生 SDH。与无癫痫发作的卒中患者相比，发生 SSP 和 SDH 的患者年龄更小，卒中更严重（p < 0.001），入住重症监护病房的比例更高（p < 0.001），发病率和死亡率更高（p < 0.05）。SSP 与女性和较轻的肢体无力有关，而 SDH 与肺炎和存在偏盲有关。重要的是，如果发生 SDH，病情较轻的患者发病率和死亡率更高（p < 0.005）。预测总死亡率的变量有 SDH、年龄较大、Charlson-Deyo 指数较高、卒中更严重和入院时无警觉状态（均 p < 0.001）。
SSP 和 SDH 具有不同的特征。SDH 表明患者预后较差。提高对 SSP 的认识并努力预防 SDH，可能对改善临床卒中治疗后的结局具有重要意义。
