Maciel Carolina B, Gilmore Emily J
Department of Neurology, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, U.S.A.
J Clin Neurophysiol. 2016 Jun;33(3):183-95. doi: 10.1097/WNP.0000000000000268.
In subarachnoid hemorrhage (SAH), seizures are frequent and occur at different time points, likely reflecting heterogeneous pathophysiology. Young patients, those with more severe SAH (by clot burden or presence of severe mental status changes at onset or focal neurologic deficits at any time), those with associated increased cortical irritation (by infarction or presence of underlying hematoma), and patients undergoing craniotomy are at higher risk. Advanced neurophysiologic monitoring allows for seizure burden quantification, identification of subclinical seizures, and interictal patterns as well as neurovascular complications that may have an independent impact on the outcome in this population. Practice regarding seizure prophylaxis varies widely; its institution is often guided by the risk-benefit ratio of seizures and medication side effects. Newer anticonvulsants seem to be equally effective and may have a more favorable profile. However, questions regarding the association of seizures and vasospasm, the therapeutic dosing, timing, and duration of antiepileptic treatment and the impact of seizures and antiepileptics on the outcome remain unanswered. In this review, we provide a broad overview of the work in this area and offer a diagnostic and therapeutic approach based on our own expert opinion.
在蛛网膜下腔出血（SAH）中，癫痫发作频繁且发生在不同时间点，这可能反映了异质性的病理生理学。年轻患者、SAH更严重的患者（根据血凝块负荷或发病时严重精神状态改变或任何时候的局灶性神经功能缺损）、伴有皮质刺激增加的患者（因梗死或存在潜在血肿）以及接受开颅手术的患者风险更高。先进的神经生理学监测可对癫痫发作负荷进行量化、识别亚临床癫痫发作和发作间期模式以及可能对该人群预后产生独立影响的神经血管并发症。关于癫痫预防的做法差异很大；其实施通常以癫痫发作和药物副作用的风险效益比为指导。新型抗惊厥药似乎同样有效，且可能具有更有利的特征。然而，关于癫痫发作与血管痉挛的关联、抗癫痫治疗的治疗剂量、时机和持续时间以及癫痫发作和抗癫痫药对预后的影响等问题仍未得到解答。在本综述中，我们对该领域的工作进行了广泛概述，并根据我们自己的专家意见提供了一种诊断和治疗方法。
