[1]向凤,张旭,时霄冰,等.脑卒中后癫痫患者耐药性预测因素研究[J].卒中与神经疾病杂志,2025,32(02):101-105,121.[doi:10.3969/j.issn.1007-0478.2025.02.001]
　Xiang Feng,Zhang Xu,Shi Xiaobing,et al.Study on Predictors of Drug Resistance in Patients with Post-Stroke Epilepsy[J].Stroke and Nervous Diseases,2025,32(02):101-105,121.[doi:10.3969/j.issn.1007-0478.2025.02.001]
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脑卒中后癫痫患者耐药性预测因素研究()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第32卷
期数:
2025年02期
页码:
101-105,121
栏目:
癫痫
出版日期:
2025-04-20

文章信息/Info

Title:
Study on Predictors of Drug Resistance in Patients with Post-Stroke Epilepsy
文章编号:
1007-0478(2025)02-0101-06
作者:
向凤; 张旭; 时霄冰; 李杨; 兰晓阳; 张世敏; 王湘庆
100853 北京,解放军总医院第一医学中心神经内科[向凤 张旭 时霄冰 李杨 兰晓阳 张世敏 王湘庆(通信作者)]
Author(s):
Xiang Feng;  Zhang Xu;  Shi Xiaobing;  et al.
Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853
关键词:
脑卒中 癫痫 耐药性癫痫
Keywords:
Stroke Epilepsy Drug-Resistant Epilepsy
分类号:
R742.1
DOI:
10.3969/j.issn.1007-0478.2025.02.001
文献标志码:
A
摘要:
目的 探究脑卒中后癫痫(Post-Stroke Epilepsy, PSE)患者耐药性的独立预测因素。方法 回顾性分析2000年1月1日-2022年12月31日于解放军总医院第一医学中心神经内科癫痫门诊就诊的成年PSE患者的临床资料; 根据对抗癫痫发作药物(Antiseizure medications, ASMs)的治疗反应筛选出耐药性癫痫(Drug-resistant epilepsy,DRE)患者,并通过logistic回归分析其耐药性产生的预测因素。结果 最终纳入355例PSE患者,其中男258例(72.7%),脑卒中平均发病年龄(51.6±15.2)岁。PSE患者中缺血性脑卒中223例(62.8%),出血性脑卒中132例(37.2%); 轻-中度脑卒中293例(82.5%),重度脑卒中62例(17.5%); PSE平均潜伏期(6.8±9.1)个月,127例(35.8%)患者出现早期发作; 27例(7.6%)患者出现癫痫持续状态,32例(9.0%)患者出现丛集性癫痫发作; 癫痫发作类型中局灶性发作183例(51.55%),局灶进展到双侧的强直阵挛发作112例(31.55%),全面性发作或不明起始部位发作60例(16.9%)。其中,71例(20.0%)PSE患者发展为DRE。在众多预测因素中合并焦虑/抑郁(OR=4.89,95%CI=1.82～13.16,P=0.002)、出血性脑卒中(OR=1.74,95%CI=1.03～2.95,P=0.040)、重度脑卒中(OR=1.96,95%CI=1.05～3.64,P=0.034)、癫痫持续状态(OR=6.98,95%CI=2.87～17.00,P<0.001)和局灶进展到双侧的强直阵挛发作(OR=2.53,95%CI=1.41～4.54,P=0.002)是DRE的独立预测因素。结论 出血性脑卒中、重度脑卒中、合并焦虑/抑郁、癫痫持续状态和局灶进展到双侧的强直阵挛发作是DRE的独立预测因素。
Abstract:
ObjectiveTo explore the clinical predictors of drug resistance in patients with post-stroke epilepsy(PSE).Methods The clinical data of adult PSE patients who visited the epilepsy clinic of Neurology Department of the First Medical Center of PLA General Hospital from January 1, 2000 to December 31, 2022 were retrospectively analyzed. The study outcome was the occurrence of drug-resistant epilepsy(DRE)based on response to antiseizure medications(ASMs). Logistic regression analysis was performed to investigate the predictors of DRE.Results A total o f 355 patients with PSE were included in the analysis, of whom 258 were male(72.7%). The mean age at stroke onset was 51.6±15.2 years. Ischemic stroke occurred in 223 patients(62.8%)and hemorrhagic stroke in 132 patients(37.2%). A total of 293 patients(82.5%)had mild to moderate stroke, and 62(17.5%)had severe stroke. The mean latency of PSE was 6.8±9.1 months. Early seizures occurred in 127 patients(35.8%). Status epilepticus occurred in 27(7.6%)and cluster seizures in 32(9.0%)patients. Regarding seizure types, 183 patients(51.55%)had focal onset seizures, 112 patients(31.55%)had focal to bilateral tonic-clonic seizures, and 60 patients(16.9%)had generalized or unknown onset seizures. Among these, 71 patients(20.0%)developed DRE. Independent predictors for DRE included anxiety/depression(OR=4.89, 95% CI=1.82～13.16, P=0.002), hemorrhagic stroke(OR=1.74, 95% CI=1.03～2.95, P=0.040), severe stroke(OR=1.96, 95%CI=1.05～3.64, P=0.034), status epilepticus(OR=6.98, 95%CI=2.87～17.00, P<0.001), and focal to bilateral tonic-clonic seizures(OR=2.53, 95% CI=1.41～4.54, P=0.002).Conclusion Hemorrhagic stroke, severe stroke, anxiety/depression, status epilepticus, and focal to bilateral tonic-clonic seizures are independent predictors of drug resistance in patients with PSE.

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更新日期/Last Update: 2025-04-20