脑炎后癫痫：临床特征和预测因素。

Postencephalitic epilepsy: clinical characteristics and predictors.

机构信息

Department of Neurology, Mayo Clinic, Rochester, Minnesota, U.S.A.

出版信息

Epilepsia. 2015 Jan;56(1):133-8. doi: 10.1111/epi.12879. Epub 2014 Dec 19.

DOI:10.1111/epi.12879

PMID:25523929

Abstract

OBJECTIVE

To describe the etiologies, clinical presentations, outcomes, and predictors of postencephalitic epilepsy (PE) in a large series of adult patients with acute encephalitis.

METHODS

We conducted a retrospective review of patients diagnosed with acute encephalitis at Mayo Clinic, Rochester, between January 2000 and December 2012. The patients were categorized into two groups based on the presence or absence of PE at last follow-up. Multivariate logistic regression analysis was used to analyze factors associated with PE.

RESULTS

We identified 198 consecutive patients (100 [50.5%] male and 98 [49.5%] female) with a median age of 58 years (range 41.8-69). Etiologies included viral infection (n=95, 48%), autoimmune (n=44, 22%), and unknown/others (n=59, 30%). During hospitalization, seizures were seen in patients with autoimmune encephalitis (n=24, 54.5%), unknown/others (n=20, 33.9%), and viral encephalitis (n=23, 24.2%). Interictal epileptiform discharges on electroencephalography (EEG) were present in 34 (54%), whereas periodic lateralized epileptiform discharges (PLEDs) and generalized periodic discharges (GPDs) were seen in 14 (41.2%) and 2 (5.9%) patients. Forty-six patients with seizures (70.8%) had fluid-attenuated inversion recovery (FLAIR)/T2 abnormalities, 20 (31.3%) diffusion abnormalities, and 43 (66.2%) cortical involvement. Good outcome at discharge among patients with seizures was seen in 8/23 patients with viral etiology (34.8%), 10/24 patients with autoimmune encephalitis (45.5%), and 12/20 patients with unknown cause (60%). PE was present in 43 patients (29.9%). On multivariate regression analysis, the factors associated with PE were generalized seizures during hospitalization (p=0.03), focal seizures (p≤0.001), and the presence of FLAIR/T2 abnormalities on brain magnetic resonance imaging (MRI) (p=0.003).

SIGNIFICANCE

The presence of seizures during hospitalization and an abnormal brain MRI are the strongest predictors of the development of PE. The etiology of encephalitis, presence of focal neurologic deficits, and interictal EEG abnormalities did not influence the development of PE.

摘要

目的

在一系列急性脑炎的成年患者中，描述脑炎后癫痫（PE）的病因、临床表现、结局和预测因素。

方法

我们对 2000 年 1 月至 2012 年 12 月期间在梅奥诊所诊断为急性脑炎的患者进行了回顾性分析。根据最后一次随访时是否存在 PE，将患者分为两组。采用多变量逻辑回归分析与 PE 相关的因素。

结果

我们确定了 198 例连续患者（100 例[50.5%]为男性，98 例[49.5%]为女性），中位年龄为 58 岁（范围 41.8-69 岁）。病因包括病毒感染（n=95，48%）、自身免疫性疾病（n=44，22%）和未知/其他（n=59，30%）。在住院期间，自身免疫性脑炎患者（n=24，54.5%）、未知/其他（n=20，33.9%）和病毒性脑炎患者（n=23，24.2%）出现癫痫发作。脑电图（EEG）存在发作间期癫痫样放电的患者有 34 例（54%），而出现周期性侧化癫痫样放电（PLEDs）和全面性周期性放电（GPDs）的患者分别有 14 例（41.2%）和 2 例（5.9%）。46 例有癫痫发作的患者（70.8%）FLAIR/T2 异常，20 例（31.3%）弥散异常，43 例（66.2%）皮质受累。病毒性病因（n=23）的患者中，癫痫发作患者出院时预后良好的有 8 例（34.8%），自身免疫性脑炎（n=24）的患者中有 10 例（45.5%），病因不明（n=20）的患者中有 12 例（60%）。有 43 例患者（29.9%）出现 PE。多变量回归分析显示，与 PE 相关的因素是住院期间出现全身发作（p=0.03）、局灶性发作（p≤0.001）和脑磁共振成像（MRI）上存在 FLAIR/T2 异常（p=0.003）。