Paolucci S, Silvestri G, Lubich S, Pratesi L, Traballesi M, Gigli G L
IRCCS S. Lucia, Rome, Italy.
Epilepsia. 1997 Mar;38(3):266-70. doi: 10.1111/j.1528-1157.1997.tb01115.x.
This study was designed to (a) identify the prevalence of poststroke late seizures in a population of patients admitted to rehabilitation of neurologic sequelae of their first stroke, (b) recognize reliable prognostic factors associated with the occurrence of poststroke late seizures, and (c) evaluate the impact of seizures on the results of rehabilitation treatment.
In a prospective study of 306 consecutive patients admitted to a rehabilitation hospital for sequelae of their first stroke, we assessed the relation among 15 independent variables and the development of seizures by using multiple regression analysis (forward stepwise). In addition, we evaluated the impact of occurrence of poststroke seizures on both efficiency and effectiveness of rehabilitation and length of stay.
Poststroke late seizures occurred in 46 (15.03%) patients, with a mean interval from stroke of 101.98 +/- 37.96 days. In multiple regression analysis, putaminal and lobar hemorrhages showed a significant positive association with the development of seizures (p < 0.005), whereas high scores on the Canadian Neurological Scale (CNS) (indicating less severe strokes) and increasing age were negatively associated (p < 0.01 and p < 0.05, respectively). Patients with putaminal and lobar hemorrhages and patients with severe stroke (CNS score at admission, <7) were at significantly greater relative risk of seizures [relative risk (RR) = 1.99, 95% confidence interval (CI), 1.11-1.39; RR = 3.00, CI, 1.06-1.13; and RR = 2.41, CI, 1.01-1.27, respectively). No significant association was found between poststroke seizures and results of rehabilitation.
Poststroke late seizures occurred mainly in patients with putaminal and lobar hemorrhagic strokes but, if treated, did not affect rehabilitation therapy.
本研究旨在（a）确定首次中风后遗留神经功能障碍并入住康复机构的患者群体中中风后迟发性癫痫的患病率；（b）识别与中风后迟发性癫痫发生相关的可靠预后因素；（c）评估癫痫发作对康复治疗结果的影响。
在一项对306例因首次中风后遗症入住康复医院的连续患者的前瞻性研究中，我们采用多元回归分析（向前逐步法）评估了15个独立变量与癫痫发作发生之间的关系。此外，我们还评估了中风后癫痫发作的发生对康复效率和效果以及住院时间的影响。
46例（15.03%）患者发生了中风后迟发性癫痫，距中风的平均间隔时间为101.98±37.96天。在多元回归分析中，壳核和脑叶出血与癫痫发作的发生呈显著正相关（p<0.005），而加拿大神经功能量表（CNS）高分（表明中风较轻）和年龄增加呈负相关（分别为p<0.01和p<0.05）。壳核和脑叶出血患者以及重度中风患者（入院时CNS评分<7）发生癫痫的相对风险显著更高[相对风险（RR）分别为1.99，95%置信区间（CI）为1.11 - 1.39；RR = 3.00，CI为1.06 - 1.13；RR = 2.41，CI为1.01 - 1.27]。未发现中风后癫痫发作与康复结果之间存在显著关联。
中风后迟发性癫痫主要发生在壳核和脑叶出血性中风患者中，但如果进行治疗，并不影响康复治疗。
