卒中后癫痫的诊断与治疗

1、 Bladin CF, Alexandrov AV, Bellavance A, et al. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000;57:16171622. Benbir G, Ince B, Bozluolcay M. The epidemiology of post-stroke epilepsy according to stroke subtypes. Acta Neurol Scand 2006;114:812.Scandinavian Stroke Scale score

2、低于30 预示卒中后癫痫发生风险OR.为4.9 Lossius MI, Ronning OM, Slapo GD, Mowinckel P, Gjerstad L. Poststroke epilepsy:occurrence and predictorsa long-term prospective controlled study (Akershus Stroke Study). Epilepsia 2005;46:12461251nSibel K. Veliog lu, MD; Mehmet zmenog lu, MD; Cavit Boz, MD; Zekeriya Aliog lu,

3、 MD. Status Epilepticus After Stroke. Stroke. 2001;32:1169-1172.Ca2+i增加及钙稳态机制的失常等nLate seizures 目前认为源自神经胶质增生和脑膜脑瘢痕形成有关。细胞膜生理特性改变，神经元选择性丢失、神经元活动同步化等导致痫性发作。另外受损神经元长期保持了 Ca2+i及钙稳态机制改变的可塑性变化也是一个重要原因卒中后癫痫发作急性期远期再次发作首次癫痫持续状态考虑：代谢或其他原因，包括治疗的风险开始AED卡马西平，苯妥英，丙戊酸或新型AED再发癫痫发作？维持AED2-3年逐渐减量超过6-12月第一阶段：安定或者劳拉西泮（

4、IV）第二阶段：苯妥英或磷苯妥英第三阶段：巴比妥酸盐再发首次发作开始AED考虑：AED的副作用和预防复发的风险等待再发作后使用AED卡马西平或苯妥英或丙戊酸或新型AED是否再发癫痫？否是改变其他类型AED，增加第二代AED，包括新型AED卒中后癫痫发作治疗卒中后癫痫发作治疗流程图流程图唑尼沙胺、左乙拉西坦、托吡酯等，这在动物脑梗死模型得到证实n另一方面，某些抗癫痫药物如苯二氮卓类药物影响脑梗死预后n旧的抗癫痫药物存在与其他药物如华法林，肝素等相互作用n新一代抗癫痫药物如拉莫三嗪，加巴喷丁，奥卡西平，妥吡酯，左乙拉西坦等不存在这种现象Garcia-Escriva, A., Lopez-Herna

5、ndez, N. The use of levetiracetam in monotherapy in post-stroke seizures in the elderly population. REVISTA DE NEUROLOGIA ,2007,45:523-525.n 国际抗癫痫联盟推荐拉莫三嗪和加巴喷丁作为老年人部分性发作起始癫痫的一线单药治疗药物nRowan AJ, Ramsay RE, Collins JF, et al., and the VA Cooperative Study 428 Group. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology 2005;64:18681873.nSaetre E, Perucca E, Isoja rvi J, Gjerstad L. An international multicenter double-blind double-dummy randomised trial comparing lamotrigine and slow-release carbamazepine for treating newly diagno