School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Epilepsia. 2024 Nov;65(11):3244-3254. doi: 10.1111/epi.18117. Epub 2024 Sep 10.
With global aging, the occurrence of stroke and associated outcomes like dementia are on the rise. Seizures and epilepsy are common poststroke complications and have a strong connection to subsequent dementia. This study examines the relationship between poststroke seizures (PSS) or poststroke epilepsy (PSE) and dementia using a national health care database.
We conducted a retrospective study using data from the Taiwan National Health Insurance Research Database from 2009 to 2020. We identified acute stroke patients from 2010 to 2015, excluding those with pre-existing neurological conditions. Based on age, sex, stroke severity level, and the year of index stroke, patients with PSS or PSE were matched to those without. The main outcome was incident dementia.
This study included 62 968 patients with an average age of 63 years, with males accounting for 62.9%. Of them, 60.3% had ischemic strokes, and 39.7% had hemorrhagic strokes. After an average follow-up period of 5.2 years, dementia developed in 15.9% of patients who had PSS or PSE, as opposed to 8.4% of those without these conditions. A time-dependent Fine and Gray competing risk analysis showed that PSS and PSE were significantly associated with dementia across all stroke types. Subgroup analyses revealed significantly increased risk of dementia across all age groups (<50, 50-64, and ≥65 years), sexes, and various stroke severity levels. The link between PSS or PSE and dementia was particularly pronounced in men, with a less distinct correlation in women.
The risk of incident dementia was higher in patients with PSS or PSE. The potential for therapeutic interventions for seizures and epilepsy to reduce poststroke dementia underscores the importance of seizure screening and treatment in stroke survivors.
随着全球人口老龄化，中风的发病率及其相关后果（如痴呆）呈上升趋势。中风后癫痫发作和癫痫是常见的并发症，与随后的痴呆有很强的关联。本研究使用国家医疗保健数据库研究中风后癫痫发作（PSS）或中风后癫痫（PSE）与痴呆之间的关系。
我们使用了 2009 年至 2020 年台湾全民健康保险研究数据库的数据进行回顾性研究。我们从 2010 年至 2015 年确定了急性中风患者，排除了有既往神经疾病的患者。根据年龄、性别、中风严重程度水平和指数中风年份，将 PSS 或 PSE 患者与无 PSS 或 PSE 患者相匹配。主要结局是新发痴呆。
这项研究包括 62968 名平均年龄为 63 岁的患者，其中 62.9%为男性。他们中 60.3%患有缺血性中风，39.7%患有出血性中风。平均随访 5.2 年后，PSS 或 PSE 患者中有 15.9%发生痴呆，而无这些情况的患者中痴呆发生率为 8.4%。时间依赖性 Fine 和 Gray 竞争风险分析显示，PSS 和 PSE 与所有类型中风患者的痴呆均显著相关。亚组分析显示，所有年龄组（<50 岁、50-64 岁和≥65 岁）、性别和各种中风严重程度水平的痴呆风险均显著增加。PSS 或 PSE 与痴呆之间的关联在男性中更为明显，而在女性中则不太明显。
PSS 或 PSE 患者发生痴呆的风险较高。对癫痫发作进行治疗干预以降低中风后痴呆的潜在可能性突出了对中风幸存者进行癫痫发作筛查和治疗的重要性。
