脑卒中后发作与青年脑卒中幸存者痴呆风险。

Poststroke Seizures and the Risk of Dementia Among Young Stroke Survivors.

机构信息

From the Department of Neurology (A.L., C.N.), Penn State University, Hershey Medical Center; Department of Public Health Sciences (D.M.B., G.L., D.L.L., C.M.V.), Penn State College of Medicine, Hershey; and Department of Neurology (L.B.), Medical University of South Carolina, Charleston.

出版信息

Neurology. 2022 Jul 25;99(4):e385-e392. doi: 10.1212/WNL.0000000000200736.

DOI:10.1212/WNL.0000000000200736

PMID:35584925

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9421769/

Abstract

BACKGROUND AND OBJECTIVES

The effect of new-onset seizures in young stroke survivors on the subsequent development of dementia is poorly understood. This study aimed to assess the association between new onset of seizure and dementia in a population-based study of patients with stroke.

METHODS

The IBM Watson Health MarketScan Commercial Claims and Encounters database for the years 2005-2014 served as the data source for this study. Using the (), we identified patients aged 18-60 years with ischemic strokes (ISs; 433.x1, 434.x1, and 436) and hemorrhagic strokes (HSs; 430, 431, 432.0, 432.1, and 432.9) between January 1, 2006, and December 31, 2009, which constituted our baseline study cohort. At baseline, all included participants were free of claims for dementia, brain tumors, toxin exposure, traumatic brain injury, and neuroinfectious diseases, identified using codes. They had at least 1-year continuous enrollment before the index stroke diagnosis and 5 years after, with no seizure claims within 1 year after the index date. The exposure of interest was seizures: a time-dependent variable. The study outcome of interest was dementia (: 290.0, 290.10-13, 290.20-21, 290.3, 290.40-43, 291.2, 292.82, 294.10-11, 294.20-21, 294.8, 331.0, 331.11, 331.19, and 331.82), which occurred during the follow-up period from January 1, 2010, to December 31, 2014. A Cox proportional hazards regression model was applied to calculate the hazard ratio (HR) and 95% CI for the independent association of seizures with the occurrence of dementia.

RESULTS

At the end of the baseline period, we identified 23,680 patients with stroke (IS: 20,642 and HS: 3,038). The cumulative incidence of seizure was 6.7%, 6.4%, and 8.3% for all strokes, IS, and HS, respectively. The cumulative incidence of dementia was 1.3%, 1.4%, and 0.9% for all strokes, IS, and HS, respectively. After multivariable adjustment, young patients with stroke who developed seizures had a greater risk of dementia compared with those without seizures (all strokes adjusted HR: 2.53, 95% CI 1.84-3.48; IS: 2.52, 1.79-3.53; HS: 2.80, 1.05-7.43).

DISCUSSION

These findings suggest that the onset of seizures in young stroke survivors is associated with a 2.53 times increased risk of developing dementia.

CLASSIFICATION OF EVIDENCE

This study provides Class II evidence that poststroke seizures increase the probability of dementia in young stroke survivors.

摘要

背景与目的

新发生的癫痫发作对年轻卒中幸存者随后发生痴呆的影响知之甚少。本研究旨在评估人群中卒中患者新发癫痫与痴呆之间的相关性。

方法

本研究的数据来源于 2005-2014 年 IBM Watson Health MarketScan 商业索赔和就诊数据库。使用 ( ), 我们确定了年龄在 18-60 岁之间的缺血性卒中和出血性卒中患者（433.x1、434.x1 和 436；430、431、432.0、432.1 和 432.9）。2006 年 1 月 1 日至 2009 年 12 月 31 日为基础研究队列。基线时，所有纳入的参与者均未出现痴呆、脑肿瘤、毒素暴露、创伤性脑损伤和神经传染性疾病的理赔记录，这些疾病通过代码进行识别。他们在指数性卒中诊断前至少有 1 年的连续参保，且在诊断后 5 年内连续参保，并且在索引日期后 1 年内没有癫痫理赔记录。我们感兴趣的暴露因素是癫痫发作：一个时间依赖性变量。我们感兴趣的研究结果是痴呆症（：290.0、290.10-13、290.20-21、290.3、290.40-43、291.2、292.82、294.10-11、294.20-21、294.8、331.0、331.11、331.19 和 331.82），这些疾病发生在 2010 年 1 月 1 日至 2014 年 12 月 31 日的随访期间。我们应用 Cox 比例风险回归模型来计算癫痫发作与痴呆发生之间的独立关联的风险比（HR）和 95%置信区间（CI）。

结果

在基线期末，我们确定了 23680 例卒中患者（IS：20642 例和 HS：3038 例）。所有卒中、IS 和 HS 的癫痫发作累积发生率分别为 6.7%、6.4%和 8.3%。所有卒中、IS 和 HS 的痴呆累积发生率分别为 1.3%、1.4%和 0.9%。经过多变量调整后，与无癫痫发作的患者相比，发生癫痫发作的年轻卒中患者发生痴呆的风险更高（所有卒中调整后的 HR：2.53，95%CI 1.84-3.48；IS：2.52，1.79-3.53；HS：2.80，1.05-7.43）。