Centro Integral de Neurología Vascular, Fleni. Ciudad Autónoma de Buenos Aires, Argentina.
Centro de Rehabilitación de Adultos - CR Escobar, Fleni. Buenos Aires, Argentina.
J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106858. doi: 10.1016/j.jstrokecerebrovasdis.2022.106858. Epub 2022 Nov 4.
Ischemic stroke is one of the most common causes of epilepsy in adults. The incidence of post-stroke epilepsy (PSE) is approximately 7%. Risk factors are higher stroke severity, cortical localization, higher National Institute of Health Stroke Scale (NIHSS) upon admission and acute symptomatic seizures. We analyzed the predictive factors of PSE development in our population.
Retrospective observational cohort of adult patients (age ≥ 18 years) with ischemic stroke assessed between January 2012 and June 2020. Patients with personal history of epilepsy and potentially epileptogenic structural injury other than acute or chronic stroke were excluded. Demographic, clinical and imaging variables were evaluated in a multivariate analysis for independent risk factors associated with PSE.
Medical records of 1586 stroke patients were reviewed, 691 met the inclusion criteria and had at least one year of follow-up. Of them, 428 (61.9%) were males. During follow-up, 6.2% had diagnosis of PSE (42/691) with a higher frequency of: previous ischemic stroke, higher NIHSS upon admission, treatment with rt-PA, higher Fazekas scale grade, cortical involvement, hemorrhagic transformation, acute symptomatic seizures, longer hospitalization and higher modified Rankin Scale (mRS) at discharge compared to the group without PSE. In a multivariate analysis, acute symptomatic seizures (OR=3.22, p: 0.033), cortical involvement (OR=0.274, p < 0.05), Fazekas scale score (OR=0.519, p < 0.05) and mRS at discharge (OR=1.33, p: 0.043) were independent risk factors.
The variables related to higher risk of PSE were similar to those reported in the literature, highlighting the importance of neuroimaging findings, acute symptomatic seizures during hospitalization and neurological deficit at discharge. The data obtained will serve as the basis for construction of predictive models, allowing to individualize PSE probability in our population.
缺血性脑卒中是成人癫痫最常见的病因之一。卒中后癫痫（PSE）的发病率约为 7%。危险因素包括更严重的卒中、皮质定位、入院时更高的国立卫生研究院卒中量表（NIHSS）评分和急性症状性癫痫发作。我们分析了本地区人群 PSE 发生的预测因素。
回顾性观察性队列研究纳入了 2012 年 1 月至 2020 年 6 月期间评估的成年缺血性脑卒中患者（年龄≥18 岁）。排除有癫痫个人史和除急性或慢性卒中外的潜在致痫结构性损伤的患者。对人口统计学、临床和影像学变量进行多变量分析，以确定与 PSE 相关的独立危险因素。
共回顾了 1586 例脑卒中患者的病历，其中 691 例符合纳入标准且至少随访 1 年。其中，428 例（61.9%）为男性。随访期间，6.2%的患者诊断为 PSE（42/691），其具有更高的：既往缺血性脑卒中、入院时更高的 NIHSS 评分、接受重组组织型纤溶酶原激活剂（rt-PA）治疗、更高的 Fazekas 评分等级、皮质受累、出血性转化、急性症状性癫痫发作、更长的住院时间和出院时更高的改良 Rankin 量表（mRS）评分。多变量分析显示，急性症状性癫痫发作（OR=3.22，p：0.033）、皮质受累（OR=0.274，p<0.05）、Fazekas 评分（OR=0.519，p<0.05）和出院时的 mRS（OR=1.33，p：0.043）是独立的危险因素。
与 PSE 风险增加相关的变量与文献报道的相似，突出了神经影像学表现、住院期间急性症状性癫痫发作和出院时神经功能缺损的重要性。获得的数据将作为构建预测模型的基础，从而能够在本地区人群中对 PSE 的发生概率进行个体化预测。
