From the Department of Neurology (H.Y., M. Kawamoto), Kobe City Medical Center General Hospital; Department of Neurology (T.T., K.F., M.I.), National Cerebral and Cardiovascular Center, Suita; Department of Neurology (S. Matsubara), Graduate School of Medical Sciences, Kumamoto University; Department of Neurology and Brain Bank for Aging Research (R. Motoyama, S. Murayama), Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology; Department of Neurology (M.M.), Nakamura Memorial Hospital, Sapporo; Minami-ichijyo Neurology Clinic (M.M.), Sapporo; Department of Neurology (T.M.), St. Mary's Hospital, Fukuoka; Department of Neurology (Y.M.), National Hospital Organization Okayama Medical Center; Department of Neurology (J.S.), Toyota Memorial Hospital; Department of Neurology (K.K., A.S., R.T.), Kyoto University Graduate School of Medicine; Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Suita; Department of Medical Informatics and Clinical Epidemiology (D.O.), Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Cerebrovascular Medicine (M. Koga, K.T.), National Cerebral and Cardiovascular Center, Suita; Brain Bank for Neurodevelopmental, Neurological and Psychiatric Disorders (S. Murayama), Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Suita; Division of Neurology (R. Matsumoto), Kobe University Graduate School of Medicine; and Department of Epilepsy, Movement Disorders and Physiology (A.I.), Kyoto University Graduate School of Medicine, Japan.
Neurology. 2022 Jul 26;99(4):e376-e384. doi: 10.1212/WNL.0000000000200609. Epub 2022 May 4.
The functional outcome and mortality of patients with poststroke epilepsy (PSE) have not been assessed in a prospective study. Previous reports have suggested that patients with PSE may suffer from prolonged functional deterioration after a seizure. In this study, we prospectively investigated the functional outcome and mortality of patients with PSE and analyzed the effect of seizure recurrence on the outcomes.
This is part of the Prognosis of Post-Stroke Epilepsy study, a multicenter, prospective observational cohort study, where 392 patients with PSE (at least 1 unprovoked seizure more than 7 days after the onset of the last symptomatic stroke) were followed for at least 1 year at 8 hospitals in Japan. This study included only PSE patients with a first-ever seizure and assessed their functional decline and mortality at 1 year. Functional decline was defined as an increase in modified Rankin Scale (mRS) score at 1 year compared with baseline, excluding death. The associations between the seizure recurrence and the outcomes were analyzed statistically.
A total of 211 patients (median age of 75 years; median mRS score of 3) were identified. At 1 year, 50 patients (23.7%) experienced seizure recurrence. Regarding outcomes, 25 patients (11.8%) demonstrated functional decline and 20 (9.5%) had died. Most patients died of pneumonia or cardiac disease (7 patients each), and no known causes of death were directly related to recurrent seizures. Seizure recurrence was significantly associated with functional decline (odds ratio [OR] 2.96, 95% CI 1.25-7.03, = 0.01), even after adjusting for potential confounders (adjusted OR 3.26, 95% CI 1.27-8.36, = 0.01), but not with mortality (OR 0.79, 95% CI 0.25-2.48, = 0.68). Moreover, there was a significant trend where patients with more recurrent seizures were more likely to have functional decline (8.7%, 20.6%, and 28.6% in none, 1, and 2 or more recurrent seizures, respectively; = 0.006).
One-year functional outcome and mortality of patients with PSE were poor. Seizure recurrence was significantly associated with functional outcome, but not with mortality. Further studies are needed to ascertain whether early and adequate antiseizure treatment can prevent the functional deterioration of patients with PSE.
前瞻性研究尚未评估卒中后癫痫（PSE）患者的功能结局和死亡率。先前的报告表明，PSE 患者在癫痫发作后可能会经历长期的功能恶化。在这项研究中，我们前瞻性地研究了 PSE 患者的功能结局和死亡率，并分析了癫痫发作复发对结局的影响。
这是多中心前瞻性观察队列研究——卒中后癫痫预后研究的一部分，该研究纳入了日本 8 家医院的 392 名 PSE 患者（最后一次症状性卒中后至少 7 天发生至少 1 次未诱发性癫痫发作），至少随访 1 年。本研究仅纳入首次发作的 PSE 患者，并评估他们在 1 年内的功能下降和死亡率。功能下降定义为与基线相比，1 年时改良 Rankin 量表（mRS）评分增加，排除死亡。使用统计学方法分析癫痫发作复发与结局之间的关系。
共纳入 211 名患者（中位年龄 75 岁；中位 mRS 评分 3 分）。1 年后，50 名患者（23.7%）出现癫痫发作复发。关于结局，25 名患者（11.8%）出现功能下降，20 名患者（9.5%）死亡。大多数患者死于肺炎或心脏病（各 7 例），没有已知的死亡原因与复发性癫痫发作直接相关。癫痫发作复发与功能下降显著相关（比值比[OR]2.96，95%置信区间[CI]1.25-7.03， = 0.01），即使在调整了潜在混杂因素后（调整后的 OR 3.26，95%CI 1.27-8.36， = 0.01）也是如此，但与死亡率无关（OR 0.79，95%CI 0.25-2.48， = 0.68）。此外，癫痫发作复发次数较多的患者更有可能出现功能下降（无、1 次和 2 次或更多次复发的患者分别为 8.7%、20.6%和 28.6%； = 0.006），存在显著趋势。
PSE 患者 1 年的功能结局和死亡率较差。癫痫发作复发与功能结局显著相关，但与死亡率无关。需要进一步研究以确定早期和充分的抗癫痫治疗是否可以防止 PSE 患者的功能恶化。
