Zhongguo cuzhong zazhi (Apr 2024)
高原地区卒中后癫痫的临床及预后特征 Clinical and Prognostic Characteristics of Post-Stroke Epilepsy at High Altitude
Abstract
目的 探讨高原地区居民卒中后癫痫（post-stroke epilepsy，PSE）的临床、治疗和预后特征，并分析影响PSE预后的风险因素，为制定高原地区PSE临床诊疗策略提供一定依据。 方法 回顾性连续纳入2019年1月—2023年6月在西藏自治区人民医院住院治疗的高原地区PSE患者。根据PSE类型分为早发性（卒中后≤7 d）PSE组和迟发性（卒中后＞7 d）PSE组，于2023年9月通过电话和门诊相结合的方式进行随访，获取患者的功能预后（mRS评分）情况。比较两组患者的性别、年龄、卒中类型分布、卒中严重程度（发病时mRS评分）、实验室检查等基线资料，以及随访功能预后的差异，分析预后不良（随访mRS评分≥3分）的影响因素。 结果 共纳入符合入组标准的PSE患者89例，占同期住院高原卒中患者的4.2%，患者发病年龄中位数为55（44～69）岁，男性59例（66.3%），藏族87例（97.8%），发病时mRS评分为3（1～4）分。入组患者中早发性PSE组49例（55.1%），迟发性PSE组40例（44.9%）。卒中亚型分布中脑出血所占比例最高，为39.3%（35例）。最常见的癫痫发作类型为全面起源性发作，共69例（77.5%）。36例（40.4%）PSE患者合并癫痫持续状态。影像学检查显示卒中病灶中最常见的为皮质病灶，共48例（53.9%）。治疗方面85例（95.5%）PSE患者接受了抗癫痫药物治疗，其中79例（88.8%）患者接受单药治疗，最常应用的抗癫痫药物是奥卡西平/卡马西平（36例，40.4%）。PSE患者的院内死亡率为10.1%（9例）。随访时间中位数为27（15～40）个月，预后不良患者占56.7%（38/67），死亡率为35.8%（24/67）。与早发性PSE组相比，迟发性PSE组男性比例更高（78.6% vs. 56.6%，P=0.043）且有癫痫家族史比例更高（10.0% vs. 0，P=0.037）。两组间的卒中类型分布（P=0.040）和应用抗癫痫药物类型分布（P=0.047）差异有统计学意义。多因素回归分析显示，卒中症状严重（发病时mRS评分高）是PSE预后不良的独立危险因素（OR 1.691，95%CI 1.245～2.297，P＜0.001）。 结论 PSE在高原地区住院卒中患者中的发生率为4.2%。高原地区PSE患者发病时临床症状重，40.4%的患者合并癫痫持续状态。高原地区PSE患者预后不良，致残率和死亡率高。 Abstract: Objective To explore the clinical, therapeutic, and prognostic characteristics of post-stroke epilepsy (PSE) among residents at high altitude, and to analyze the risk factors affecting the prognosis of PSE, which might provide a certain basis for formulating clinical diagnosis and treatment strategies in PSE at high altitude. Methods The PSE patients at high altitude who were hospitalized in the Tibet Autonomous Region People’s Hospital from January 2019 to June 2023 were included retrospectively. According to the type of PSE, patients were divided into two groups: early-onset (≤7 days after stroke) PSE group and late-onset (>7 days after stroke) PSE group. Follow-up was conducted in September 2023 through a combination of telephone and outpatient service to obtain the patients’ functional prognosis (mRS score). The differences in clinical data, such as gender, age, type of stroke distribution, stroke severity (mRS score at onset) and laboratory examination, and functional prognosis during follow-up were compared between the two groups, and the influencing factors of poor prognosis (mRS score≥3 at follow-up) were analyzed. Results A total of 89 PSE patients who met the inclusion criteria were included, accounting for 4.2% of hospitalized stroke patients during the same period. Among PSE patients, the median age of onset was 55 (44-69) years, with 59 males (66.3%) and 87 Tibetans (97.8%). The mRS score of PSE patients at onset was 3 (1-4) points. Among the enrolled patients, 49 cases (55.1%) were in the early-onset PSE group and 40 cases (44.9%) were in the late-onset PSE group. Among the type of stroke in PSE patients, intracerebral hemorrhage accounted for the highest proportion, accounting for 39.3% (35 cases). The most common type of epileptic seizure was comprehensive origin (69 cases, 77.5%). A total of 36 cases (40.4%) of PSE patients complicated with status epilepticus. Imaging showed that the most common lesion of stroke was cortical lesion, accounting for 53.9% (48 cases). In terms of treatment, 85 (95.5%) PSE patients received antiepileptic drugs, of which 79 cases (88.8%) received monotherapy. The most commonly used antiepileptic drug was oxcarbazepine/carbamazepine (36 cases, 40.4%). The in-hospital mortality of PSE patients was 10.1% (9 cases). The median follow-up time was 27 (15-40) months. The patients with poor prognosis accounted for 56.7% (38/67) and the mortality was 35.8% (24/67). Compared with the early-onset PSE group, the late-onset PSE group had a higher proportion of males (78.6% vs. 56.6%, P=0.043) and a higher proportion of family history of epilepsy (10.0% vs. 0, P=0.037). There were significant differences in the distribution of stroke types (P=0.040) and the distribution of antiepileptic drug types (P=0.047) between the two groups. Multivariate regression analysis showed that severe symptom of stroke (high mRS score at onset) was an independent risk factor for poor prognosis of PSE (OR 1.691, 95%CI 1.245-2.297, P<0.001). Conclusions The incidence of PSE in hospitalized stroke patients at high altitude was 4.2%. Patients with PSE in high altitude areas had severe clinical symptoms at onset, with 40.4% of patients coexisting with status epilepticus. Patients with PSE in high altitude areas had poor prognosis, with a high risk of disability and mortality.
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