缺血性中风溶栓治疗后癫痫的危险因素：一项队列研究
Risk Factors for Epilepsy After Thrombolysis for Ischemic Stroke: A Cohort Study.
作者信息
Brondani Rosane, de Almeida Andrea Garcia, Cherubini Pedro Abrahim, Secchi Thaís Leite, de Oliveira Marina Amaral, Martins Sheila Cristina Ouriques, Bianchin Marino Muxfeldt
机构信息
Graduate Program in Medicine: Medical Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
Basic Research and Advanced Investigations in Neurology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
出版信息
Front Neurol. 2020 Jan 23;10:1256. doi: 10.3389/fneur.2019.01256. eCollection 2019.
The effects of thrombolysis in seizure and epilepsy after acute ischemic stroke have been poorly explored. In this study, we examine risk factors and consequences of intravenous rt-PA for treatment of acute ischemic stroke. In a retrospective cohort study we evaluate risk factors for seizure and epilepsy after stroke thrombolysis, as well as the impact of seizures and epilepsy in outcome of stroke patients. In our cohort, mean age of patients was 67.2 years old ( = 13.1) and 79 of them (51.6%) were male and. Initial NIHSS mean score were 10.95 ( = 6.25). Three months NIHSS mean score was 2.09 ( = 3.55). Eighty seven (56.9%) patients were mRS of 0-1 after thrombolysis. Hemorrhagic transformation was observed in 22 (14.4%) patients. Twenty-one (13.7%) patients had seizures and 15 (9.8%) patients developed epilepsy after thrombolysis. Seizures were independently associated with hemorrhagic transformation (OR = 3.26; 95% CI = 1.08-9.78; = 0.035) and with mRS ≥ 2 at 3 months after stroke (OR = 3.51; 95% CI = 1.20-10.32; = 0.022). Hemorrhagic transformation (OR = 3.55; 95% CI = 1.11-11.34; = 0.033) and mRS ≥ 2 at 3 months (OR = 5.82; 95% CI = 1.45-23.42; = 0.013) were variables independently associated with post-stroke epilepsy. In our study, independent risks factors for poor outcome in stroke thrombolysis were age (OR = 1.03; 95% CI = 1.01-1.06; = 0.011), higher NIHSS (OR = 1.08; 95% CI = 1.03-1.14; = 0.001), hemorrhagic transformation (OR = 2.33; 95% CI = 1.11-4.76; = 0.024), seizures (OR = 3.07; 95% CI = 1.22-7.75; = 0.018) and large cortical area (ASPECTS ≤ 7) (OR = 2.04; 95% CI = 1.04-3.84; = 0.036). Concluding, in this retrospective cohort study, the neurological impairment after thrombolysis (but not before) and hemorrhagic transformation remained independent risk factors for seizures or post-stroke epilepsy after thrombolysis. Moreover, we observed that seizures emerged as an independent risk factor for poor outcome after thrombolysis therapy in stroke patients (OR = 3.07; 95% CI = 1.22-7.75; = 0.018).
急性缺血性卒中后溶栓治疗对癫痫发作和癫痫的影响尚未得到充分研究。在本研究中，我们探讨了静脉注射重组组织型纤溶酶原激活剂（rt-PA）治疗急性缺血性卒中的危险因素及后果。在一项回顾性队列研究中，我们评估了卒中溶栓后癫痫发作和癫痫的危险因素，以及癫痫发作和癫痫对卒中患者预后的影响。在我们的队列中，患者的平均年龄为67.2岁（标准差=13.1），其中79例（51.6%）为男性。美国国立卫生研究院卒中量表（NIHSS）初始平均评分为10.95（标准差=6.25）。三个月时NIHSS平均评分为2.09（标准差=3.55）。87例（56.9%）患者溶栓后改良Rankin量表（mRS）评分为0-1。22例（14.4%）患者出现出血性转化。21例（13.7%）患者出现癫痫发作，15例（9.8%）患者溶栓后发生癫痫。癫痫发作与出血性转化独立相关（比值比[OR]=3.26；95%置信区间[CI]=1.08-9.78；P=0.035），且与卒中后3个月mRS≥2独立相关（OR=3.51；95%CI=1.20-10.3；P=0.022）。出血性转化（OR=3.55；95%CI=1.11-11.34；P=0.033）和卒中后3个月mRS≥2（OR=5.82；95%CI=1.45-23.42；P=0.013）是与卒中后癫痫独立相关的变量。在我们的研究中，卒中溶栓预后不良的独立危险因素为年龄（OR=1.03；95%CI=1.01-1.06；P=0.011）、较高的NIHSS评分（OR=1.08；95%CI=1.03-1.14；P=0.001）、出血性转化（OR=2.33；95%CI=1.11-4.76；P=0.024）、癫痫发作（OR=3.07；95%CI=1.22-7.75；P=0.018）和大面积皮质区域（脑梗死早期CT评分[ASPECTS]≤7）（OR=2.04；95%CI=1.04-3.84；P=0.036）。总之，在这项回顾性队列研究中，溶栓后（而非溶栓前）的神经功能缺损和出血性转化仍然是溶栓后癫痫发作或卒中后癫痫的独立危险因素。此外，我们观察到癫痫发作成为卒中患者溶栓治疗后预后不良的独立危险因素（OR=3.07；95%CI=1.22-7.75；P=0.018）。
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