Zöllner Johann Philipp, Konczalla Jürgen, Stein Marco, Roth Christian, Krakow Karsten, Kaps Manfred, Steinmetz Helmuth, Rosenow Felix, Misselwitz Björn, Strzelczyk Adam
Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany.
Epilepsy Res. 2020 Mar;161:106286. doi: 10.1016/j.eplepsyres.2020.106286. Epub 2020 Feb 5.
Risk factors for acute symptomatic seizures after stroke demonstrated in retrospective analyses should be confirmed in large population studies. While seizures following ischemic stroke have been studied intensively, less is known about seizure predictors in hemorrhagic stroke. This study sought to identify risk factors of acute symptomatic seizures and to elucidate associated short-term (in-hospital) morbidity and mortality rates in primary intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).
We determined the frequency of all acute symptomatic seizures perceived by clinical staff after hemorrhagic stroke in a large population-based registry in a central European region between 2004 and 2016. Further, we analyzed risk factors for seizure occurrence, morbidity, and mortality in univariate and multivariate analyses.
Of 297,120 stroke patients, 19,331 experienced a hemorrhagic stroke. Frequency of acute seizures (without semiological differentiation) in this subpopulation was 4% (4.0% in ICH and 3.6% in SAH). The risk for acute symptomatic seizures was significantly increased in both stroke types in the presence of an acute non-neurological infection (odds ratio: 2.0 for ICH and 4.2 for SAH). A lower premorbid functional level also significantly increased the seizure risk (odds ratio: 2.0 for ICH and 3.1 for SAH). The odds of in-hospital mortality in the presence of acute seizures were significantly reduced in ICH patients (odds ratio: 0.7) but not in SAH patients.
Acute symptomatic seizures are equally common in ICH and SAH patients in this registry. Seizure risk is invariably increased in the presence of acute non-neurological infection. Mortality is reduced in ICH patients with seizures, but the exact reason for this relationship is not clear and might represent a biased finding.
回顾性分析中显示的卒中后急性症状性癫痫发作的危险因素应在大规模人群研究中得到证实。虽然缺血性卒中后的癫痫发作已得到深入研究，但对于出血性卒中的癫痫发作预测因素了解较少。本研究旨在确定急性症状性癫痫发作的危险因素，并阐明原发性脑出血（ICH）和蛛网膜下腔出血（SAH）相关的短期（住院期间）发病率和死亡率。
我们在一个基于人群的大型登记处中，确定了2004年至2016年期间中欧地区出血性卒中后临床工作人员所察觉到的所有急性症状性癫痫发作的频率。此外，我们在单因素和多因素分析中分析了癫痫发作、发病率和死亡率的危险因素。
在297,120例卒中患者中，19,331例发生了出血性卒中。该亚组中急性癫痫发作（无发作症状学区分）的频率为4%（ICH为4.0%，SAH为3.6%）。在两种卒中类型中，急性非神经系统感染的存在均显著增加了急性症状性癫痫发作的风险（比值比：ICH为2.0，SAH为4.2）。病前功能水平较低也显著增加了癫痫发作风险（比值比：ICH为2.0，SAH为3.1）。ICH患者在出现急性癫痫发作时的院内死亡率显著降低（比值比：0.7），但SAH患者并非如此。
在本登记处中，急性症状性癫痫发作在ICH和SAH患者中同样常见。急性非神经系统感染的存在总是会增加癫痫发作风险。有癫痫发作的ICH患者死亡率降低，但这种关系的确切原因尚不清楚，可能是一个有偏差的发现。
