Abstract: Objective To explore the risk factors for epilepsy associated with ischemic stroke in order to strengthen the early prevention, guide clinical treatment and improve prognosis. Methods One hundred and one patients with epilepsy associated with ischemic stroke within 24 hours and 101 ischemic stroke patients without epilepsy were randomly treated in Tianjin Huanhu Hospital from May 2007 to January 2009. According to the development of seizures they were divided into 2 groups: epilepsy group and stroke group. The score of clinical neurologic function deficiency was assessed according to the Scandinavian Stroke Scale (SSS) at the time of admission. All the patients accepted computerized tomography (CT) or magnetic resonance imaging (MRI) within 48 h after onset. Recorded age, gender, past history which included hypertension, coronary heart disease, atrial fibrillation, Type Ⅱ diabetes and hyperlipidemia, serum electrolyte (potassium ion, sodium ion and chloridion), disease status (quiet or active), ischemic stroke subtype which included atherosclerotic thrombotic cerebral infarction, cerebral embolism and lacunar infarct, angiorrhea after cerebral infarction, affected lobar or basal ganglia, affected hemisphere (left, right or bilateral), brain atrophy, white matter demyelination and neurological deficit scores. Unconditional multivariate Logistic regression analysis was performed for those factors which were significant after univariate analysis. Results The univariate analysis on epilepsy group and stroke group showed that significant differences in ischemic stroke subtype (cerebral embolism), angiorrhea after cerebral infarction, lesion location, especially affected frontal which achieved 48.72%, affected right hemisphere and neurological deficit scores (the SSS) were seen between the two groups (P ≤ 0.05, for all). Age, gender, past history which included hypertension, coronary heart disease, atrial fibrillation, diabetes and hyperlipidemia, serum electrolyte (potassium ion, sodium ion and chloridion), disease status (quiet or active), brain atrophy and white matter demyelination presented no significant differences (P > 0.05, for all). In unconditional multivariate Logistic regression analysis, cerebral embolism (OR = 0.152, 95% CI: 0.065-0.496; P = 0.011), angiorrhea after cerebral infarction (OR = 0.105, 95% CI: 0.020-0.549; P = 0.008), lobar cortical location (OR = 0.099, 95%CI:0.044-0.225; P = 0.000) and the SSS < 30 (OR = 0.145, 95%CI: 0.062-0.337; P = 0.000) were the main risk factors for epilepsy associated with ischemic stroke, whereas, affected right hemisphere (OR = 0.638, 95%CI: 0.311-1.308; P = 0.220) may not increase the probability of epilepsy associated with ischemic stroke. Conclusion Ischemic stroke patients who have cerebral embolism, angiorrhea after cerebral infarction, cortical location (especially affected frontal), the SSS < 30 are prone to develop epilepsy associated with ischemic stroke.

Key words: Brain ischemia, Epilepsy, Prognosis

摘要： 目的   探讨缺血性卒中伴发癫痫的危险因素，以加强早期预防并改善预后。方法   根据斯堪地那维亚卒中评分（SSS）对101 例发病< 24 h 的缺血性卒中伴发癫痫患者进行神经功能缺损程度评价，同时记录患者性别，年龄，既往史（高血压、冠心病、心房纤颤、2 型糖尿病、高脂血症），电解质（血清钾、钠、氯），发病状态（安静、活动），缺血性卒中亚型（动脉粥样硬化性血栓性脑梗死、脑栓塞、腔隙性梗死），脑梗死后渗血，病灶部位（脑叶、基底节区），受累大脑半球侧别（左侧、右侧、双侧），脑萎缩及脑白质脱髓鞘病变等临床资料，分别进行单因素分析和多因素非条件Logistic 回归分析。结果   单因素分析显示，与单纯缺血性卒中患者相比，缺血性卒中伴发癫痫者缺血性卒中亚型（脑栓塞）、脑梗死后渗血、病灶部位（脑叶，其中额叶所占比例达48.72%）、受累大脑半球侧别（右侧），以及神经功能缺损程度（SSS 评分< 30 分）均存在明显差异（均P ≤ 0.05）；而性别、年龄、既往史、电解质指标、发病时状态、脑萎缩程度、脑白质脱髓鞘病变等因素，两组差异无统计学意义（均P > 0.05）。多因素非条件Logistic 回归分析表明，脑栓塞（OR = 0.152，95%CI：0.065 ~ 0.496；P = 0.011）、脑梗死后渗血（OR = 0.105，95%CI：0.020 ~ 0.549；P = 0.008）、脑叶皮质受累（OR = 0.099，95%CI：0.044 ~ 0.225；P = 0.000）、SSS 评分< 30 分（OR = 0.145，95%CI：0.062 ~ 0.337；P = 0.000）等因素为缺血性卒中伴发癫痫的主要危险因素，而右侧大脑半球受累（OR =0.638，95%CI：0.311 ~ 1.308；P = 0.220）则不增加缺血性卒中伴发癫痫的风险。结论   具有脑栓塞、脑梗死后渗血、病灶位于脑叶（特别是额叶）、SSS评分< 30分等因素的缺血性卒中患者易伴发癫。

关键词: 脑缺血, 癫痫, 预后