Zelano Johan
Department of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, SE41345 Gothenburg, Sweden.
Ther Adv Neurol Disord. 2016 Sep;9(5):424-35. doi: 10.1177/1756285616654423. Epub 2016 Jun 24.
Stroke is among the most common causes of epilepsy after middle age. Patients with poststroke epilepsy (PSE) differ in several respects from patients with other forms of structural-metabolic epilepsy; not least in age, age-related sensitivity to side effects of antiepileptic drugs (AEDs), and specific drug-drug interaction issues related to secondary-stroke prophylaxis. Encouragingly, there has lately been remarkable activity in the study of PSE. Three developments in PSE research deserve particular focus. First, large prospective trials have established the incidence and risk factors of PSE in the setting of modern stroke care. Stroke severity, cortical location, young age, and haemorrhage remain the most important risk factors. Second, although more studies are needed, epidemiological data indicate that the risk of PSE may be influenced, for instance, by statin treatment. Third, studies are emerging regarding the treatment and prognosis of PSE. Levetiracetam and lamotrigine may be well tolerated treatment options and seizure freedom is achieved in at least a similar proportion of patients as in other epilepsies. Furthermore, new animal models such as photothrombotic stroke gives hope of a more clear understanding of PSE epileptogenesis in the near future. In summary, PSE shows indications of maturing into an independent epilepsy research field. This review summarizes recent advances in our understanding of PSE and provides an update on management issues such as diagnosis, AED selection, and prognosis. Finally, future research challenges in the field are outlined.
中风是中年后癫痫最常见的病因之一。中风后癫痫（PSE）患者在几个方面与其他形式的结构 - 代谢性癫痫患者不同；尤其是在年龄、与年龄相关的对抗癫痫药物（AEDs）副作用的敏感性以及与二级中风预防相关的特定药物相互作用问题上。令人鼓舞的是，最近在PSE研究方面有显著进展。PSE研究中的三个进展值得特别关注。首先，大型前瞻性试验已经确定了现代中风护理背景下PSE的发病率和危险因素。中风严重程度、皮质位置、年轻和出血仍然是最重要的危险因素。其次，尽管还需要更多研究，但流行病学数据表明，PSE的风险可能受到例如他汀类药物治疗的影响。第三，关于PSE的治疗和预后的研究正在出现。左乙拉西坦和拉莫三嗪可能是耐受性良好的治疗选择，并且至少与其他癫痫患者中达到无癫痫发作的比例相似。此外，新的动物模型如光血栓性中风让人们有望在不久的将来更清楚地了解PSE的癫痫发生机制。总之，PSE显示出发展成为一个独立癫痫研究领域的迹象。这篇综述总结了我们对PSE理解的最新进展，并提供了关于管理问题如诊断、AED选择和预后的最新信息。最后，概述了该领域未来的研究挑战。
