Nakamura A, Ohira T, Ishihara M, Kobayashi M, Shiobara R, Toya S, Takakura K, Ohwada T, Murase I, Ichikizaki K
Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
No To Shinkei. 1995 Dec;47(12):1170-6.
A multicenter cooperative study was conducted to investigate factors influencing posttraumatic epilepsy (PTE) and to evaluate the prophylactic effect of anticonvulsants. A retrospective study of 102 PTE patients revealed the following typical clinical features: occurrence in young males, traffic accidents, contusion and/or cerebral hematoma. The latent period after the injury was longer in children. The percentage of EEG paroxysmal activity gradually increased as the generalized abnormality diminished. A retrospective-prospective study of 1998 patients who suffered a head injury between 1984 and 1988 was conducted till 1994. During the follow-up period, 62 patients (3.1%) developed PTE. The drop-out cases were excluded, and the 154 cases followed at least two years were analyzed. Statistical analysis of differences between patients with and without PTE suggested following factors: young, immediate early epilepsy (within 24 hours after injury; IMEE) and early epilepsy (within one week after injury). The risk with the highest relative risk rate was early epilepsy. Multiple regression analysis revealed that three factors, IMEE, early epilepsy and young age, contributed to the prediction of PTE. There was no significant difference in the percentage of patients having PTE in the group treated with anticonvulsants and the untreated group. Anticonvulsant treatment after head injury was unlikely to have a prophylactic effect on the development of PTE.
开展了一项多中心合作研究,以调查影响创伤后癫痫(PTE)的因素,并评估抗惊厥药物的预防效果。对102例PTE患者进行的回顾性研究揭示了以下典型临床特征:多见于年轻男性、交通事故、挫伤和/或脑血肿。儿童受伤后的潜伏期较长。随着全身性异常的减轻,脑电图阵发性活动的百分比逐渐增加。对1984年至1988年间头部受伤的1998例患者进行了一项回顾性前瞻性研究,直至1994年。在随访期间,62例患者(3.1%)发生了PTE。排除失访病例,对至少随访两年的154例病例进行分析。对有和无PTE患者之间差异的统计分析提示了以下因素:年轻、即刻早期癫痫(受伤后24小时内;IMEE)和早期癫痫(受伤后一周内)。相对风险率最高的风险是早期癫痫。多元回归分析显示,IMEE、早期癫痫和年轻这三个因素有助于预测PTE。接受抗惊厥药物治疗组和未治疗组发生PTE的患者百分比无显著差异。头部受伤后使用抗惊厥药物治疗不太可能对PTE的发生有预防作用。