中风后癫痫：从临床预测因素到可能的机制

Post-stroke epilepsy: From clinical predictors to possible mechanisms.

作者信息

Freiman Sofia, Hauser W Allen, Rider Flora, Gulyaeva Natalia, Guekht Alla

机构信息

Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation; Laboratory of Functional Biochemistry of the Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation.

Gertrude H. Sergievsky Center, College of Physicians and Surgeons, New York, USA.

出版信息

Epilepsy Res. 2024 Jan;199:107282. doi: 10.1016/j.eplepsyres.2023.107282. Epub 2023 Dec 15.

DOI:10.1016/j.eplepsyres.2023.107282

PMID:38134643

Abstract

BACKGROUND

Stroke is the most common cause of newly diagnosed epilepsy in the elderly, ahead of degenerative disorders, brain tumors, and head trauma. Stroke accounts for 30-50% of unprovoked seizures in patients aged ≥ 60 years. This review discusses the current understanding of epidemiology, risk factors, mechanisms, prevention, and treatment opportunities for post-stroke epilepsy (PSE).

METHODS

We performed a literature search in the PubMed and Cochrane Library databases. The keywords "stroke, epilepsy", "stroke, seizure", "post-stroke seizure", "post-stroke epilepsy" were used to identify the clinical and experimental articles on PSE. All resulting titles and abstracts were evaluated, and any relevant article was considered. The reference lists of all selected papers and reference lists of selected review papers were manually analyzed to find other potentially eligible articles.

RESULTS

PSE occurs in about 6% of stroke patients within several years after the event. The main risk factors are cortical lesion, initial stroke severity, young age and seizures in acute stroke period (early seizures, ES). Other risk factors, such as a cardioembolic mechanism or circulation territory involvement, remain debated. The role of ES as a risk factor of PSE could be underestimated especially in young age. Mechanism of epileptogenesis may involve gliosis scarring, alteration in synaptic plasticity, etc.; and ES may enhance these processes. Statins especially in the acute period of stroke are possible agents for PSE prevention presumably due to their anticonvulsant and neuroprotection effects. Antiepileptic drugs (AED) monotherapy is enough for seizure prevention in most cases of PSE; but no evidence was found for its efficiency against epileptic foci formation. The growing interest in PSE has led to a notable increase in the number of published articles each year. To aid in navigating this expanding body of literature, several tables are included in the manuscript.

CONCLUSION

Further studies are needed for better understanding of the pathophysiology of PSE and searching the prevention strategies.

摘要

背景

在老年人中，中风是新诊断癫痫最常见的病因，超过退行性疾病、脑肿瘤和头部外伤。中风占60岁及以上患者不明原因癫痫发作的30 - 50%。本综述讨论了目前对中风后癫痫（PSE）的流行病学、危险因素、机制、预防和治疗机会的认识。

方法

我们在PubMed和Cochrane图书馆数据库中进行了文献检索。使用关键词“中风，癫痫”、“中风，发作”、“中风后发作”、“中风后癫痫”来识别关于PSE的临床和实验文章。对所有检索到的标题和摘要进行评估，并考虑任何相关文章。对所有选定论文的参考文献列表和选定综述论文的参考文献列表进行人工分析，以找到其他可能符合条件的文章。

结果

约6%的中风患者在发病后的几年内会发生PSE。主要危险因素包括皮质病变、初始中风严重程度、年轻以及急性中风期发作（早期发作，ES）。其他危险因素，如心源性栓塞机制或循环区域受累，仍存在争议。ES作为PSE危险因素的作用可能被低估，尤其是在年轻人中。癫痫发生机制可能涉及胶质瘢痕形成、突触可塑性改变等；而ES可能会增强这些过程。他汀类药物，尤其是在中风急性期，可能是预防PSE的药物，大概是由于其抗惊厥和神经保护作用。在大多数PSE病例中，抗癫痫药物（AED）单药治疗足以预防发作；但未发现其对癫痫病灶形成有效的证据。对PSE的兴趣日益增加，导致每年发表的文章数量显著增加。为了帮助梳理这一不断扩展的文献，本文包含了几个表格。