Benninger F, Holtkamp M
Klinik für Neurologie, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Medizinische Fakultät, Tel Aviv University, Tel Aviv, Israel.
Epilepsie-Zentrum Berlin-Brandenburg, Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Nervenarzt. 2017 Oct;88(10):1197-1207. doi: 10.1007/s00115-017-0358-3.
Following stroke, 3-6% of patients develop acute symptomatic seizures within the first 7 days. The rate is higher after cerebral haemorrhage compared to ischaemia. In 10-12% of patients, after more than 7 days unprovoked seizures occur. Due to these low incidence rates, primary prophylaxis with antiepileptic drugs is generally not necessary. Following one acute symptomatic seizure, recurrence risk within the first 7 days post-stroke is 10-20%, generally arguing against secondary prophylaxis with an antiepileptic drug. In clinical practice however, antiepileptic drug treatment in this constellation is often initiated. If this is done, the antiepileptic drug should be withdrawn soon after the acute phase, as the long-term risk for manifestation of an unprovoked seizure is approximately 30%. Following one post-stroke unprovoked seizure, recurrence risk within the next 10 years is more than 70%, this defines epilepsy. In this case, antiepileptic drug treatment is regularly recommended.
中风后，3%至6%的患者在最初7天内会出现急性症状性癫痫发作。与缺血性中风相比，脑出血后的发生率更高。10%至12%的患者在7天之后会出现无诱因癫痫发作。由于这些发病率较低，一般无需使用抗癫痫药物进行一级预防。发生一次急性症状性癫痫发作后，中风后7天内的复发风险为10%至20%，这通常不支持使用抗癫痫药物进行二级预防。然而，在临床实践中，这种情况下往往会开始使用抗癫痫药物治疗。如果这样做了，抗癫痫药物应在急性期后不久停用，因为无诱因癫痫发作的长期风险约为30%。发生一次中风后无诱因癫痫发作后，未来10年内的复发风险超过70%，这就定义为癫痫。在这种情况下，通常建议进行抗癫痫药物治疗。
