Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.
Department of Neurology, CUB Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.
Clin Neurophysiol. 2019 Dec;130(12):2282-2286. doi: 10.1016/j.clinph.2019.09.005. Epub 2019 Sep 21.
Despite improvement in acute stroke care, almost 40% of patients with ischemic stroke present neurological deterioration. Neurological deterioration is associated with higher death and dependency rates. Neurological deterioration mechanisms are unknown, and half of neurological deterioration remains unexplained. We postulate that a substantial proportion of neurological deterioration in ischemic stroke is associated with periodic discharges/non-convulsive seizures that negatively impact the recovery of ischemic stroke and worsen symptoms.
Retrospective review of 24 h continuous EEG monitoring (cEEG) performed for neurological deterioration in the stroke unit of a tertiary academic centre.
Eighty-one patients were included. cEEG detected epileptic activities in 44% of cases (Non-convulsive seizures/non-convulsive status epilepticus: 10/81 (12%), periodic discharges: 17/81 (21%) and sporadic epileptiform discharges in 14/81 (17%)). The proportion of patients who did not receive recanalization therapy was significantly higher in the NCSE/NCSz/PDs group than in the group devoid of NCSE/NCSz/PDs: 17/22 (77%) vs 13/59 (22%); p < 0,001. Treatment of Non-convulsive seizures /non-convulsive status epilepticus and periodic discharges was followed by EEG improvement in respectively 7/8 and 10/16 of treated patients.
Non-convulsive seizures /non-convulsive status epilepticus /periodic discharges are associated to neurological deterioration after ischemic stroke.
Treatment of Non-convulsive seizures /non-convulsive status epilepticus and periodic discharges, if such patterns are detected, could help prevent adverse metabolic consequences of epileptic activities on ischemic brain tissue.
尽管急性脑卒中治疗有所改善，但仍有近 40%的缺血性脑卒中患者出现神经功能恶化。神经功能恶化与更高的死亡率和依赖性相关。神经功能恶化的机制尚不清楚，一半的神经功能恶化仍无法解释。我们假设，缺血性脑卒中患者中相当一部分神经功能恶化与周期性放电/非惊厥性癫痫发作有关，这些癫痫发作会对缺血性脑卒中的恢复产生负面影响，并使症状恶化。
回顾性分析在一家三级学术中心的卒中单元进行的用于神经功能恶化的 24 小时连续脑电图监测（cEEG）。
共纳入 81 例患者。cEEG 在 44%的病例中检测到癫痫活动（非惊厥性癫痫发作/非惊厥性癫痫持续状态：10/81（12%）、周期性放电：17/81（21%）和散发性癫痫样放电：14/81（17%））。未接受再通治疗的患者中，NCSE/NCSz/PDs 组的比例明显高于无 NCSE/NCSz/PDs 组：17/22（77%）与 13/59（22%）；p < 0.001。分别有 7/8 和 10/16 的治疗患者在治疗非惊厥性癫痫发作/非惊厥性癫痫持续状态和周期性放电后脑电图改善。
非惊厥性癫痫发作/非惊厥性癫痫持续状态/周期性放电与缺血性脑卒中后神经功能恶化有关。
如果检测到这些模式，治疗非惊厥性癫痫发作/非惊厥性癫痫持续状态和周期性放电可能有助于防止癫痫活动对缺血性脑组织产生不利的代谢后果。
