Stroke Center, Department of Neurology, Neurological Hospital, Hospices Civils de Lyon, University of Lyon, 59 boulevard Pinel, 69677, Bron cedex, France.
Research On Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France.
J Neurol. 2021 Jul;268(7):2605-2615. doi: 10.1007/s00415-021-10439-3. Epub 2021 Feb 10.
Seizures are common after intracerebral hemorrhage, occurring in 6-15% of the patients, mostly in the first 72 h. Their incidence reaches 30% when subclinical or non-convulsive seizures are diagnosed by continuous electroencephalogram. Several risk factors for seizures have been described including cortical location of intracerebral hemorrhage, presence of intraventricular hemorrhage, total hemorrhage volume, and history of alcohol abuse. Seizures after intracerebral hemorrhage may theoretically be harmful as they can lead to sudden blood pressure fluctuations, increased intracranial pressure, and neuronal injury due to increased metabolic demand. Some recent studies suggest that acute symptomatic seizures (occurring within 7 days of stroke) are associated with worse functional outcome and increased risk of death despite accounting for other known prognostic factors such as age and baseline hemorrhage volume. However, the impact of seizures on prognosis is still debated and it remains unclear if treating or preventing seizures might lead to improved clinical outcome. Thus, the currently available scientific evidence does not support the routine use of antiseizure medication as primary prevention among patients with intracerebral hemorrhage. Only prospective adequately powered randomized-controlled trials will be able to answer whether seizure prophylaxis in the acute or longer term settings is beneficial or not in patients with intracerebral hemorrhage.
脑出血后常发生癫痫发作，发生率为 6-15%，大多发生在脑出血后 72 小时内。当通过连续脑电图诊断出亚临床或非惊厥性癫痫发作时，其发生率达到 30%。已经描述了一些癫痫发作的危险因素，包括脑出血的皮质位置、存在脑室内出血、总出血量和酒精滥用史。脑出血后癫痫发作可能会带来危害，因为它们会导致血压突然波动、颅内压升高和神经元损伤，从而增加代谢需求。一些最近的研究表明，急性症状性癫痫发作（在中风后 7 天内发生）与较差的功能预后和更高的死亡风险相关，尽管考虑了其他已知的预后因素，如年龄和基线出血量。然而，癫痫发作对预后的影响仍存在争议，目前尚不清楚治疗或预防癫痫发作是否会改善临床预后。因此，目前的科学证据并不支持将抗癫痫药物常规用于脑出血患者的一级预防。只有前瞻性、充分有力的随机对照试验才能回答在脑出血患者中，急性或更长期使用抗癫痫药物预防是否有益。
