Abstract
Poststroke epileptic seizures are detected in 30–40% of patients over 60 years of age. Objective : to explore the clinical features of epileptic seizures in stroke, risk factors for their development to form the bases for prediction and elaboration of optimal therapy. Patients and methods. 468 patients with ischemic stroke were examined. A study group included 265 patients (176 men and 89 women) aged 31–89 years with epileptic seizures; a control group comprised 203 non-epileptic patients (126 men and 77 women) aged 31–91 years. The patients of both groups were matched for age, clinical characteristics, and pathogenetic subtypes of stroke. Instrumental examinations were performed in the attack-free interval. Neurological status was evaluated using the conventional procedure (the National Institute of Health Stroke Scale); brain magnetic resonance imaging (MRI), magnetic resonance angiography, electroencephalography, extraand transcranial duplex sound of cerebral vessels, by estimating the level and degree of stenosis and cerebrovascular responsiveness. Results and discussion. Focal seizures were noted to more frequently develop with a preponderance of simple partial seizures within the first 7 days of stroke, with neurological worsening in the acute period of the disease. Stroke in the left carotid and vertebrobasilar beds may provoke the development of early seizures. The cortical localization of ischemic foci and pre-stroke chronic brain ischemia with the signs of circulatory comorbidity in the anterior and posterior circulatory systems may be a risk factor of epileptic seizures. There was an association of the type of an epileptic seizure and the size of an ischemic focus, as evidenced by MRI, with a tendency towards the generalization of seizures in the extensive ischemic foci. A tendency toward the generalization of epileptic seizures was established in the development of stroke in the left carotid bed, as well as in critical stenoses and occlusions of the great cerebral vessels.
Highlights
После инсульта эпилептические приступы выявляются у 30–40% пациентов старше 60 лет
Poststroke epileptic seizures are detected in 30–40% of patients over 60 years of age
Objective: to explore the clinical features of epileptic seizures in stroke, risk factors for their development to form the bases for prediction and elaboration of optimal therapy
Summary
После инсульта эпилептические приступы выявляются у 30–40% пациентов старше 60 лет. Установлена тенденция к генерализации эпилептических припадков при развитии инсульта в левом каротидном бассейне, а также в условиях критических стенозов и окклюзий магистральных сосудов головного мозга. A tendency toward the generalization of epileptic seizures was established in the development of stroke in the left carotid bed, as well as in critical stenoses and occlusions of the great cerebral vessels. Кардиоэмболический подтип инсульта установлен у 27,2% больных основной и 25,1% контрольной группы, лакунарный инсульт – соответственно у 11,7 и 10,8% пациентов. У мужчин не выявлено достоверных различий в частоте развития разных типов приступов в зависимости от патогенетического подтипа инсульта, в то же время у женщин СП (50%) достоверно чаще развивались при лакунарном инсульте, а ПП (65,6%) и ГП (57,1%) – при атеротромботическом подтипе (χ2=26,4; p=0,009). Частота развития разных типов эпилептических припадков у пациентов с ишемическим инсультом в разных сосудистых бассейнах (χ2=15,6; p=0,048)
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