Santamarina E, Sueiras M, Toledo M, Guzman L, Torné R, Riveiro M, Quintana M, Salas Puig X, Sahuquillo J, Álvarez Sabín J
Epilepsy Unit, Department of Neurology, Hospital Vall Hebron, Barcelona, Spain; Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain.
Universitat Autònoma Barcelona (UAB), Barcelona, Spain; Neurotraumatology and Neurosurgery Research Unit (UNINN), University Hospital Vall Hebron, Barcelona, Spain; Department of Neurophysiology, Hospital Vall Hebron, Barcelona, Spain.
Epilepsy Res. 2015 May;112:130-6. doi: 10.1016/j.eplepsyres.2015.02.016. Epub 2015 Mar 10.
Patients with malignant middle cerebral artery (MCA) infarctions who have undergone craniectomy are susceptible to the development of vascular epilepsy. Our objective was to study the factors that might influence the occurrence of seizures in this group of patients.
All patients who developed malignant MCA infarction and had undergone decompressive craniectomy in our center between November 2002 and January 2014 were evaluated. In the subsequent follow-up, we evaluated the clinical outcomes and attempted to identify the factors that were related to the occurrence of seizures.
We evaluated a total of 80 patients. The median time at which the craniectomy was performed was 40.5h after the stroke. Seizures occurred in 47.5% of all patients. The mortality rate within the first week was 16%, and of those who survived 53.7% developed seizures; 9% of these seizures were acute symptomatic, and 44.8% were remote. The median onset of remote seizures was seven months, and the majority of these were motor seizures with generalization. Notably, the patients with seizures exhibited longer delays from stroke to craniectomy, greater involvements of the temporal lobe and a higher rate of post-craniectomy recanalization of the occluded artery. Regarding the timing of the surgeries, a significantly greater proportion of those who underwent surgery more than 42h after the stroke developed epilepsy (p=0.004). Logistic regression revealed that only prolonged delay (>42h) independently predicted the development of epilepsy (OR 5.166; IC 95% 1.451-18.389; p=0.011).
More than half of patients with malignant MCA infarcts who underwent decompressive craniectomy developed epilepsy. The occurrence of seizures in these patients was related to the delay to the performance of the craniectomy.
接受颅骨切除术的恶性大脑中动脉（MCA）梗死患者易发生血管性癫痫。我们的目的是研究可能影响该组患者癫痫发作的因素。
对2002年11月至2014年1月在我们中心发生恶性MCA梗死并接受减压颅骨切除术的所有患者进行评估。在随后的随访中，我们评估了临床结局，并试图确定与癫痫发作相关的因素。
我们共评估了80例患者。颅骨切除术的中位时间为卒中后40.5小时。所有患者中有47.5%发生癫痫发作。第一周内的死亡率为16%，存活患者中有53.7%发生癫痫发作；这些癫痫发作中9%为急性症状性发作，44.8%为远期发作。远期癫痫发作的中位起病时间为7个月，其中大多数为伴有泛化的运动性发作。值得注意的是，癫痫发作患者从卒中到颅骨切除术的延迟时间更长，颞叶受累更严重，闭塞动脉颅骨切除术后再通率更高。关于手术时机，卒中后超过42小时接受手术的患者中发生癫痫的比例显著更高（p=0.004）。逻辑回归显示，只有延长延迟时间（>42小时）独立预测癫痫的发生（OR 5.166；95%置信区间1.451-18.389；p=0.011）。
接受减压颅骨切除术的恶性MCA梗死患者中，超过一半发生癫痫。这些患者癫痫发作的发生与颅骨切除术的延迟有关。
