Romaniak A, Barańska-Gieruszczak M
Zakładu Neurofizjologii Klinicznej, Instytutu Psychiatrii i Neurologii w Warszawie.
Neurol Neurochir Pol. 1998 May-Jun;32(3):603-13.
The frequency of cerebrovascular aetiology of epilepsy is estimated at 3-30%, and the rate is significantly higher in studies carried out in developed world. Early seizures, variously defined by different authors (usually as those occurring within first week or first two weeks after stroke) occur in 2.5-6% of patients, in most of them within the first 24 hours after stroke. Early seizures constitute a major risk factor of poststroke epilepsy, but in many patients seizures do not recur after acute phase of stroke. The pathophysiology of poststroke seizures is not fully elucidated, probably it is different for early and late seizures. Several investigations evaluated the connection between seizures and localization of vascular foci, the results are not consistent; most investigators believe that seizures occur more frequently in cases of cortical localization of the focus. Seizures are more common in haemorrhagic than in ischaemic strokes. The most common type of seizures are simple partial seizures, the rarest are complex partial seizures. The prognostic value of EEG is of little importance: nevertheless, in poststroke patients who had at least one seizure, diffuse slowing of background activity or PLED are associated with increased risk of seizure recurrence. Early seizures do not require long-term antiepileptic treatment; late seizures usually well respond to treatment.
癫痫的脑血管病因发生率估计为3% - 30%，在发达国家开展的研究中该比例显著更高。不同作者对早期癫痫发作有不同定义（通常指中风后第一周或前两周内发生的癫痫发作），2.5% - 6%的患者会出现早期癫痫发作，其中大多数在中风后24小时内发作。早期癫痫发作是中风后癫痫的主要危险因素，但许多患者在中风急性期后癫痫不再复发。中风后癫痫的病理生理学尚未完全阐明，早期和晚期癫痫发作的情况可能有所不同。多项研究评估了癫痫发作与血管病灶定位之间的关联，结果并不一致；大多数研究者认为病灶位于皮质时癫痫发作更为频繁。出血性中风比缺血性中风更易发生癫痫发作。最常见的癫痫发作类型是简单部分性发作，最罕见的是复杂部分性发作。脑电图的预后价值不大：然而，在至少有一次癫痫发作的中风患者中，背景活动弥漫性减慢或周期性一侧性癫痫样放电与癫痫复发风险增加有关。早期癫痫发作不需要长期抗癫痫治疗；晚期癫痫发作通常对治疗反应良好。
