Neurology:癫痫发作复发对卒中后癫痫患者1年功能结局和死亡率的影响

2022-06-27 Naomi MedSci原创

卒中后癫痫患者(post-stroke epilepsy,PSE)的功能结果和死亡率尚未在前瞻性研究中进行评估。PSE患者的1年功能预后差,死亡率高。癫痫发作复发与功能结局显著相关,但与死亡率无关。

卒中后癫痫患者(post-stroke epilepsy,PSE)的功能结果和死亡率尚未在前瞻性研究中进行评估。先前的报告已经表明,PSE患者可能在癫痫发作后遭受长期的功能恶化。近日,一项发表在Neurology上的研究前瞻性地调查了癫痫患者的功能结果和死亡率,并分析了癫痫复发对结果的影响。

该研究是脑卒中后癫痫预后研究的一部分,是一项多中心前瞻性观察性队列研究,其中392例PSE患者(在最后一次症状性卒中发作后7天后出现至少一次无缘癫痫发作)在日本8家医院随访至少1年。目前的研究仅包括有史以来第一次癫痫发作的PSE患者,并评估了他们在1年时的功能衰退和死亡率。功能下降被定义为改良 Rankin 量表(mrs)评分在1年比基线增加,不包括死亡。统计分析癫痫复发与预后的关系。

结果:

  • 共有211名患者(平均年龄75岁,平均mrs评分3分)被确定。
  • 1年观察节点时,50例(23.7%)癫痫发作复发。结局方面,有25例(11.8%)出现功能下降,20例(9.5%)死亡。
  • 大多数患者死于肺炎或心脏病(每个患者7例) ,没有已知的死亡原因与反复发作直接相关。癫痫发作复发与功能下降显著相关(比值比2.96[95% ci 1.25-7.03] ,p = 0.01) ,即使调整了潜在的混杂因素(校正比值比3.26[95% ci 1.27-8.36] ,p = 0.01) ,但与死亡率无关(比值比0.79[95% ci 0.18-2.61] ,p = 0.79)。
  • 此外,复发性癫痫发作较多的患者更可能出现功能下降(0次、1次和2次或更多次癫痫发作分别为8.7% ,20.6% 和28.6% ; p = 0.006)。

PSE患者的1年功能预后差,死亡率高。癫痫发作复发与功能结局显著相关,但与死亡率无关。需要进一步研究,以确定早期和充分的抗癫痫治疗是否可以防止功能恶化的PSE患者。

文献来源:Yoshimura H, Tanaka T, Fukuma K, et al. Impact of Seizure Recurrence on 1-Year Functional Outcome and Mortality in Patients With Poststroke Epilepsy [published online ahead of print, 2022 May 4]. Neurology. 2022;10.1212/WNL.0000000000200609. doi:10.1212/WNL.0000000000200609

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    2023-03-28 yinhl1978
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    2022-06-27 ms5000000518166734

    学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习学习

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【热点解读分享】儿童癫痫急性发作院外管理的最佳证据总结

本研究总结了儿童癫痫急性发作院外管理的最佳证据,可为本土化儿童院外惊厥急性发作行动计划制定提供参考,为医护人员开展儿童癫痫急性发作院外管理健康教育提供循证依据。

JAMA子刊:患有癫痫的母亲在妊娠期间使用抗癫痫药物,会不会提高其后代发生癫痫的风险?

孕期母亲使用ASM可能不会增加儿童的癫痫风险,超出与母亲癫痫本身相关的风险。这些发现对于需要在孕期接受ASM治疗的女性来说是令人放心的。

Cell Discov:再添好处!复旦大学赵世民团队发现生酮饮食可以减轻/减少癫痫发作

该研究报告了KD产生的β-羟基丁酸(BHB)通过增加脑γ-氨基丁酸(GABA)和GABA/谷氨酸比值以抑制癫痫。

Neurology病例:见于视觉障碍儿童的针状枕部棘波

我们报道1例患有双侧视神经发育不良和皮质视觉障碍的8岁男孩,伴ASTN1(OMIM#600904)突变。出于筛查目的行脑电图检查,本身没有癫痫发作/癫痫病史。脑电图可见缺乏后头部优势节律(poster

BMJ Neurology:儿科急性癫痫发作患者的临床特征和预后: 坦桑尼亚一家三级医院城市急诊科的前瞻性队列研究 

本研究结果显示儿童癫痫发作的发生率高于高收入国家和其他低收入和中等收入国家的报告。病情敏感度高,死亡率为16.7% 。发热、精神状态改变、缺氧、钾水平异常和脑膜炎诊断与死亡风险较高有关。

抗LGI1相关脑炎:面臂肌张力障碍发作 (FBDS)

面臂肌张力障碍发作是新近描述的癫痫类型,被认为与 LGI1 抗体介导的边缘性脑炎有关,LGI1 与脑的电压门控钾离子通道复合体有关。