方德

摘要：脑卒中是神经科常见病，具有发病率高、致残及病死率高的特点，而卒中后癫痫是脑卒中常见的并发症，约占脑卒中7.5%，同时也是占60岁以上新发癫痫患者的50%，随着人口老龄化和近年来临床对脑卒中疾病管理方面取得明显进步，中风后幸存者增加及存活时间的延长，罹患脑卒中后癫痫的患者将不断增加。脑卒中后癫痫发作不仅影响患者功能及预后，同时抗癫痫药物造成的不利因素可能远超治疗所带来的获益，目前临床上尚缺乏高质量的循证依据和可靠指南。本文就近几年来脑卒中后癫痫的流行病学、诊断、治疗、预防及预后等方面研究进展进行综述。

关键词：脑卒中 癫痫 癫痫发作

【中图分类号】R322.81 【文献标识码】A 【文章编号】1673-9026（2021）05-356-02

ABSTRACT Stroke is a common disease in neurology，which is characterized by high incidence，disability and fatality rate.Post-stroke epilepsy is a well-known complication of stroke，occurring in 7.5% of the patients and 50% of the patients aged 60 years and older.With the aging of the population and the remarkable progress in the clinical management of stroke in recent years，the number of post-stroke survivors with the prolonged survival time has been increased，so the number of patients suffering from post-stroke epilepsy will also increase.The post-stroke seizures not only affect the function and prognosis of patients，but also bring out the adverse factors by using anti-epileptic drugs，which may greatly exceeds the benefits brought about by the treatment.At present，there is a lack of high-quality evidence-based basis and reliable guidelines in clinical practice.In this review，we will describe new aspects emerging from research into post-stroke epilepsy，including epidemiology，diagnosis，treatment，prevention and prognosis for post-stroke epilepsy.

[Keywords]Stroke ;Epilepsy ;Epileptic seizure

腦卒中是神经科常见病，具有发病率高、致残和致死率高的特点[1]，而癫痫是脑卒中常见的并发症，脑卒中后癫痫（post-stroke epilepsy，PSE）约占60岁以上新发癫痫患者的50%[2-3]。其作为脑卒中患者的常见并发症，常导致误吸诱发感染、加重脑水肿，不仅影响患者神经功能恢复，影响脑卒中的疗效和病人的康复[4-5]。随着世界人口老龄化和脑卒中管理取得明显进步，脑卒中幸存者增多，生存期延长。罹患PSE的人数预计也将随之增加，脑卒中也将成为导致中老年人罹患癫痫最常见的原因[6]。本文就PSE的流行病学、诊断、治疗、预防及预后等方面进行综述。

1 定义及诊断标准

PSE是指脑卒中后出现两次及以上的非诱发性癫痫发作，通常脑卒中前无癫痫病史，在脑卒中后一定时间内出现癫痫发作，排除脑部和其他代谢性病变，一般脑电监测到的痫性放电与脑卒中部位具有一致性，是一种具有持久致痫倾向的脑部疾病。……