From the Stroke Outcome Research Center (G.S.), Division of Neurology, Department of Medicine (J.Z.W., M.V.V.), University of Toronto; and Epilepsy Program, Department of Clinical Neurological Sciences (J.G.B.), Schulich School of Medicine, Western University, London, Canada.
Neurology. 2017 Sep 19;89(12):1220-1228. doi: 10.1212/WNL.0000000000004407. Epub 2017 Aug 23.
We conducted a meta-analysis of the incidence of early and late seizures following ischemic stroke as well as a systematic review of their pharmacologic treatment.
Observational studies that reported incidence of seizures following ischemic stroke and those that reported treatment response to any particular antiepileptic drugs (AEDs) were included. Risk of bias was assessed by predefined study characteristics. Random effects meta-analysis was conducted for all studies where data were available for the incidence of early and late stroke-related seizures. Heterogeneity was measured with statistic and sensitivity analyses were performed using prespecified variables. A qualitative synthesis of studies reporting use of AEDs for stroke-related seizures was performed.
Forty-one studies from 10,554 articles were identified; 35 studies reported incidence of stroke-related seizures and 6 studies reported effects of specific AEDs. Most studies were of low to moderate quality. Rate of early seizures was 3.3% (95% confidence interval 2.8%-3.9%, = 92.8%), while the incidence of late seizures or epilepsy was 18 per 1,000 person-years (95% confidence interval 1.5-2.2, = 94.1%). The high degree of heterogeneity could not be explained from the sensitivity analyses. For management of stroke-related seizures, no single AED was found to be more effective over others, though newer AEDs were associated with fewer side effects.
The burden of stroke-related seizures and epilepsy due to ischemic stroke is substantial. Further studies are required to determine risk factors for epilepsy following ischemic stroke and optimal secondary prevention.
我们对缺血性脑卒中后早期和晚期发作的发生率进行了荟萃分析，并对其药物治疗进行了系统评价。
纳入了报告缺血性脑卒中后癫痫发作发生率的观察性研究，以及报告任何特定抗癫痫药物（AED）治疗反应的研究。通过预先定义的研究特征评估偏倚风险。对于有早期和晚期与中风相关的癫痫发作发生率数据的所有研究，进行了随机效应荟萃分析。使用 统计量测量异质性，并使用预先指定的变量进行敏感性分析。对报告用于中风相关癫痫发作的 AED 使用情况的研究进行了定性综合。
从 10554 篇文章中确定了 41 项研究；35 项研究报告了中风相关癫痫发作的发生率，6 项研究报告了特定 AED 的效果。大多数研究的质量为低到中等。早期癫痫发作的发生率为 3.3%（95%置信区间 2.8%-3.9%， = 92.8%），而晚期癫痫发作或癫痫的发生率为每 1000 人年 18 例（95%置信区间 1.5-2.2%， = 94.1%）。无法从敏感性分析中解释这种高度异质性。对于中风相关癫痫发作的治疗，没有一种 AED 被发现比其他 AED 更有效，尽管新型 AED 与较少的副作用相关。
由于缺血性脑卒中引起的中风相关癫痫发作和癫痫的负担相当大。需要进一步研究确定缺血性脑卒中后癫痫的危险因素和最佳二级预防措施。
