孙薇

[摘要] 目的 研究腦卒中后癫痫患者二次癫痫发作的危险因素。 方法 回顾性收集本院神经内科2017年2月至2019年9月收诊的300例脑卒中后首次癫痫发作患者的临床资料，随访12个月，根据患者是否出现二次癫痫发作分为复发组（n=118，出现二次癫痫发作）和未复发组（n=182，未出现二次癫痫发作），对比两组患者的性别、年龄、首次癫痫发作时间、合并症等，并进行二次癫痫发作危险因素的多因素回归分析。 结果 复发组与未复发组患者的年龄、性别、卒中范围、癫痫发作额叶受累、饮酒史、吸烟史、合并高脂血症、合并高血压、合并冠心病以及早期是否应用抗癫痫药物治疗资料比较，差异均无统计学意义（P>0.05）;复发组的脑出血、卒中累及皮层、NIHSS评分≥15分、部分性癫痫发作、晚发型癫痫发作、合并糖尿病、合并心房颤动的概率均高于未复发组（P<0.05）;回归分析显示，部分性癫痫发作、晚发型癫痫发作、脑出血、卒中累及皮层、合并心房颤动、NIHSS评分≥15分都是影响二次癫痫发作的危险因素（P<0.05）。 结论 脑卒中后癫痫患者发生二次癫痫的危险因素众多，临床医师应注意早期筛查脑卒中后癫痫患者二次癫痫发作的危险因素，对患者进行危险分层，从而制定科学合理的干预方案，预防二次癫痫发作。

[关键词] 脑卒中后癫痫;二次癫痫发作;复发;危险因素

[中图分类号] R742.1          [文献标识码] B          [文章编号] 1673-9701（2021）32-0047-04

[Abstract] Objective To study the risk factors of secondary epileptic seizures in patients with post-stroke epilepsy. Methods The clinical data of 300 patients with the first epileptic seizure after stroke admitted to the Department of Neurology of our hospital from February 2017 to September 2019 were retrospectively collected. Follow-up was performed for 12 months. According to whether the patients had secondary epileptic seizure， they were divided into the recurrent group（n=118， with the secondary epileptic seizure） and the non-recurrent group（n=182， without secondary epileptic seizure）.The gender，age，time of first epileptic seizure and complications of the two groups were compared， and multivariate regression analysis was carried out on the risk factors of secondary epileptic seizure. Results There were no significant differences in age，gender，stroke range，frontal lobe involvement of epileptic seizure，drinking history，smoking history， hyperlipidemia， hypertension， coronary heart disease and whether antiepileptic drugs were used in the early stage between the recurrent group and the non-recurrent group （P>0.05）. The probability of cerebral hemorrhage， stroke involving cortex，NIHSS score over 15 points，and rates of partial epilepsy，late epilepsy，diabetes and atrial fibrillation were all higher in the recurrent group than those in the non-recurrent group（P<0.05）.Regression analysis showed that partial epilepsy， late onset epilepsy， cerebral hemorrhage，stroke involving cortex， complicated atrial fibrillation and NIHSS score over 15 were all risk factors for secondary epilepsy（P<0.05）. Conclusion There are many risk factors for secondary epilepsy in patients with post-stroke epilepsy. Clinicians should pay attention to early screening of risk factors for secondary epilepsy in patients with post-stroke epilepsy， and carry out risk stratification for patients，so as to formulate scientific and reasonable intervention programs to prevent secondary epilepsy.

[Key words] Epilepsy after stroke; Second epileptic seizure; Recurrence; Risk factors

脑卒中是癫痫的主要诱发因子之一，脑卒中后癫痫患者约占癫痫患者的11%，多数情况下能检出癫痫样放电区域与脑卒中灶区一致[1]。……