Bentes Carla, Rodrigues Filipe B, Sousa Diana, Duarte Gonçalo S, Franco Ana C, Marques Raquel, Nzwalo Hipólito, Peralta Ana R, Ferro José M, Costa João
1Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria - CHLN, Lisboa, Portugal.
2EEG/Sleep Laboratory, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria - CHLN, Lisboa, Portugal.
Eur Stroke J. 2017 Dec;2(4):361-368. doi: 10.1177/2396987317731004. Epub 2017 Sep 13.
Cerebrovascular diseases are the most frequent risk factor for epilepsy in the elderly, and epileptic phenomenon following stroke is known to worsen the prognosis. Although electroencephalography is the gold standard epilepsy biomarker, it is rarely used in post-stroke studies, and the frequency of post-stroke epileptiform activity is still uncertain.
We analysed studies indexed to MEDLINE, Embase, Web of Science, PsycINFO and OpenGrey (up to March 2015), reporting post-stroke electroencephalographic epileptiform activity frequency in adults. Epileptiform activity was classified as ictal (electrographic seizures) and interictal (non-periodic spikes and sharp waves). Data selection, extraction and appraisal were done in duplicate. Random-effects meta-analysis was used to pool frequencies.
The pooled frequency of post-stroke ictal and interictal epileptiform activity was 7% (95% CI 3%-12%) and 8% (95% CI 4%-13%), respectively. The use of continuous electroencephalogram was not associated with an increased frequency of electrographic seizures ( = 0.05), nor did the management setting (Intensive Care Unit versus non- Intensive Care Unit, = 0.31). However, studies with continuous electroencephalogram showed a higher frequency of interictal epileptiform activity ( = 0.01).
This study provides the best available estimates of the frequency of post-stroke electroencephalographic epileptiform activity. Due to detection bias, it was not possible to correlate clinical and electrographic seizures.
The frequency of ictal and interictal epileptiform activity in the electroencephalogram was comparable with previous frequency analyses of clinical seizures. The frequency of ictal epileptiform activity did not change with continuous record or clinical setting, while the frequency of interictal epileptiform activity increased with continuous record.
脑血管疾病是老年人癫痫最常见的危险因素，中风后出现的癫痫现象会使预后恶化。虽然脑电图是癫痫生物标志物的金标准，但在中风后研究中很少使用，中风后癫痫样活动的频率仍不确定。
我们分析了MEDLINE、Embase、Web of Science、PsycINFO和OpenGrey（截至2015年3月）索引的研究，这些研究报告了成人中风后脑电图癫痫样活动频率。癫痫样活动分为发作期（脑电图癫痫发作）和发作间期（非周期性棘波和尖波）。数据选择、提取和评估均重复进行。采用随机效应荟萃分析汇总频率。
中风后发作期和发作间期癫痫样活动的汇总频率分别为7%（95%可信区间3%-12%）和8%（95%可信区间4%-13%）。使用连续脑电图与脑电图癫痫发作频率增加无关（P=0.05），管理环境（重症监护病房与非重症监护病房）也无关（P=0.31）。然而，采用连续脑电图的研究显示发作间期癫痫样活动频率更高（P=0.01）。
本研究提供了中风后脑电图癫痫样活动频率的最佳可用估计值。由于检测偏倚，无法将临床癫痫发作与脑电图癫痫发作相关联。
脑电图中发作期和发作间期癫痫样活动的频率与先前临床癫痫发作的频率分析结果相当。发作期癫痫样活动的频率不会因连续记录或临床环境而改变，而发作间期癫痫样活动的频率会随着连续记录而增加。
