脑卒中后癫痫2014.ppt

脑电图 Generalized slow waves : 39.0% Focal slowing : 19.5% Focal sharp and slow waves:9.8% Focal spikes slow waves:4.9% Focal sharp waves:4.9% Focal spike waves:2.4% PLEDS : 2.4% Normal EEG 17.1% Maimoona Siddiqui, Urooj Yaqoob, Asia Bano, et al. EEG findings in post stroke seizures: an observational study. Pak J Med Sci, 2008 . 24(3): 386-389. 23.4% 10% 20% 100% 5% 78% EEG---PLED Silverman IE，Restrepo L,. Mathews G.Poststroke Seizures.Arch Neurol. 2002;59:195-202 Subacute Seizure Incidence in Thrombolysis-treated Ischemic Stroke Patients Canada Of 400 eligible patients, 4% developed post-stroke seizures: 62.5% within one week (early) and 37.5% after 1?week but within the hospital stay (late). Atrial fibrillation was more common in those with (56.3%) than without (36.1%) seizures (P?=?0.04). Death during admission was more likely in those who sustained seizures (37.5%) compared to those without seizures (17.6%) (P?=?0.03) . Couillard P, et al. Neurocrit Care. 2011 Dec 13. [Epub ahead of print] Antidepressant use and risk of adverse outcomes in older people: population based cohort study UK 54,038 (89.0%) patients received at least one prescription for an antidepressant during follow-up. epilepsy/seizures (2.24, 1.60 to 3.15) Trazodone Mirtazapine Venlafaxine Coupland C, et al. BMJ, 2011, 2: 343 神经外科 颈动脉内膜切除术痫性发作是颈动脉内膜切除术围手术期并发症，发生率为0.4%-1%，显著低于卒中后的发生率。 病理生理机制：①手术部位的栓子引起皮质缺血性梗死；②内膜切除导致慢性脑血管自动调节障碍，突然变化的结果引起局部的高灌注，局部痫性发作阈值可能减低。 再灌注损伤诱发癫痫持续状态 Silverman IE，Restrepo L,. Mathews G.Poststroke Seizures.Arch Neurol. 2002;59:195-202 Carotidartery stenting: Seizures are related predominantly to hypoperfusion and also occur in 1% of cases. Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms. Of the 931 patients, 548 (59%) were clipped and 383 (41%) coiled. Compared with patients with coiled aneurysms, patients with clipped aneurysms had a higher incidence of in-hospital complications (37.2%