Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria - CHLN, Lisbon, Portugal.
Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Eur J Neurol. 2017 Jul;24(7):929-934. doi: 10.1111/ene.13310. Epub 2017 May 12.
Although cerebrovascular disorders are the main cause of epilepsia partialis continua (EPC) in adulthood, the frequency of EPC after stroke is unknown. The aim was to prospectively ascertain its frequency 1 year after an ischaemic stroke.
This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, previously independent, with an admission National Institutes of Health Stroke Scale score ≥4, an acute ischaemic lesion on imaging and no previous epileptic seizures. During admission patients received standardized diagnostic and medical care and were submitted to a neurophysiological evaluation protocol. One year after stroke, patients were re-evaluated by an epilepsy expert neurologist and performed a video-electroencephalogram with electromyography co-registration whenever myoclonus was observed during neurological examination for jerk-locked back averaging analysis (JLBA). EPC was defined as continuously repeated fragments of epileptic seizures, with preserved consciousness, lasting at least 1 h, and representing locally restricted epileptic activity.
In all, 151 acute anterior circulation stroke patients were consecutively included and prospectively evaluated, but 23 died in the first year. One year after stroke, from 127 patients alive, 117 (92.1%) underwent clinical and neurophysiological evaluation. In two (1.7%) patients, EPC diagnosis was made both by clinical and electroencephalographic criteria, namely JLBA. Both patients had a history of remote symptomatic seizures and one of them acute symptomatic seizures and non-convulsive status epilepticus criteria during the first 7 days after stroke.
Despite its low frequency, the high stroke incidence makes post-stroke EPC relevant. This study draws attention to this recognizable condition with therapeutic and eventually prognostic implications.
尽管脑血管疾病是成人部分连续性癫痫（EPC）的主要原因，但中风后 EPC 的频率尚不清楚。目的是前瞻性确定缺血性中风后 1 年的频率。
这是一项连续前瞻性研究，纳入了先前独立、入院时 NIHSS 评分≥4 分、影像学上有急性缺血性病灶且无先前癫痫发作的急性前循环缺血性中风患者。入院期间，患者接受了标准化的诊断和医疗护理，并接受了神经生理评估方案。中风后 1 年，由癫痫专家神经科医生对患者进行重新评估，并在神经科检查中观察到肌阵挛时进行视频-脑电图与肌电图配准进行 jerk-locked back averaging 分析 (JLBA)。EPC 定义为持续重复的癫痫发作片段，意识保持清醒，持续至少 1 小时，代表局部局限的癫痫活动。
共连续纳入 151 例急性前循环中风患者进行前瞻性评估，但 23 例在第 1 年内死亡。中风后 1 年，从 127 例存活患者中，有 117 例（92.1%）接受了临床和神经生理评估。在 2 例（1.7%）患者中，EPC 诊断同时符合临床和脑电图标准，即 JLBA。这 2 例患者均有既往症状性癫痫发作史，其中 1 例在中风后第 7 天出现急性症状性癫痫发作和非惊厥性癫痫持续状态标准。
尽管 EPC 发生率较低，但高发生率的中风使其具有相关性。本研究提请注意这种可识别的情况，具有治疗和最终预后意义。
