Scarpino Maenia, Grippo Antonello, Campagnini Silvia, Hakiki Bahia, Maiorelli Antonio, Sodero Alessandro, Guolo Erika, Mannini Andrea, Macchi Claudio, Cecchi Francesca
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Epilepsy Behav Rep. 2024 Sep 23;28:100713. doi: 10.1016/j.ebr.2024.100713. eCollection 2024.
In stroke survivors, persistent seizure activity could be associated with poor functional outcomes. At the same time, antiepileptic over-treatment could hamper post-stroke recovery. We systematically investigated the occurrence of seizures, the prevalence of epileptic discharges, and delta slow waves on electroencephalogram (EEG) and anti-seizure medication (ASM) management in relation to clinical manifestations and EEG abnormalities. This was a multi-centre prospective study involving two intensive rehabilitation units (IRUs). Clinical and EEG data were acquired at admission to the IRU, discharge (T1), and six-month follow-up (T2). A total of 163 patients underwent EEG recording upon admission to the IRU, while 149 were available for analysis at discharge from the IRU. Eighteen patients were treated with ASMs upon IRU admission despite only five of these patients having early seizures. Among the 145 patients not treated upon admission to the IRU, eight had late seizures, of which six were during the IRU stay, while two were after discharge from the IRU. During IRU stay, ASMs were generally discontinued in patients with no early seizures reported and were started in patients with late seizures. Among the 18 patients treated with ASMs at admission to the IRU, only six maintained the therapy also at T2. Our results suggest that post-acute inpatient rehabilitation is a proper setting to observe patients treated with ASMs after stroke and provide personalized post-stroke epilepsy management.
在中风幸存者中，持续性癫痫活动可能与功能预后不良有关。同时，抗癫痫药物过度治疗可能会阻碍中风后的恢复。我们系统地研究了癫痫发作的发生情况、癫痫放电的患病率、脑电图（EEG）上的δ慢波以及抗癫痫药物（ASM）的管理与临床表现和脑电图异常的关系。这是一项涉及两个强化康复单元（IRU）的多中心前瞻性研究。在入住IRU时、出院时（T1）和六个月随访时（T2）获取临床和脑电图数据。共有163例患者在入住IRU时接受了脑电图记录，而149例在从IRU出院时可供分析。18例患者在入住IRU时接受了ASM治疗，尽管其中只有5例患者有早期癫痫发作。在145例入住IRU时未接受治疗的患者中，8例出现了晚期癫痫发作，其中6例在IRU住院期间发作，2例在从IRU出院后发作。在IRU住院期间，未报告早期癫痫发作的患者通常停用ASM，而晚期癫痫发作的患者则开始使用ASM。在入住IRU时接受ASM治疗的18例患者中，只有6例在T2时也维持了治疗。我们的结果表明，急性后期住院康复是观察中风后接受ASM治疗的患者并提供个性化中风后癫痫管理的合适环境。
