RÉSUMÉ
@#Objective To investigate the risk factors and seizure types of secondary seizures in elderly patients with acute ischemic stroke(AIS),and to screen the effective indicators for predicting Post-stroke seizures(PSS). Methods Elderly patients who were hospitalized in Henan Provincial People's Hospital from January 2019 to June 2020 and diagnosed with AIS for the first time were consecutively collected. The patients were followed up for 1 year and divided into the observation group and the control group according to whether they developed secondary PSS,and the patients in the observation group were divided into subgroups according to the time of secondary PSS. The demographic and clinical characteristics of the patients were recorded,and the National Institutes of Health Stroke Scale(NIHSS) score and Modified Rankin Scale(mRS) score were used to assess stroke severity and outcome at discharge,respectively. Univariate and multivariate Logistic regression analyses were used to identify the independent risk factors for PSS. Results (1)Comparison of general information:There were statistically significant differences in gender,lesion location,hemorrhagic transformation(HT),NIHSS score ≥11,hypertension,cardiac cerebral embolism(CE) and baseline NIHSS score between the observation group and the control group(P<0.05). (2)Results of Multivariate Logistic regression analysis:Cortical infarction(OR=1.702,95%CI 1.172-2.471,P=0.005),HT(OR=2.384,95%CI 1.605-3.434,P<0.001) and NIHSS scores ≥11(OR=1.723,95%CI 1.188-2.500,P=0.004) were independent risk factors for PSS,and the differences were statistically significant. (3)Comparison of early-onset seizures(ES) and late-onset seizures(LS):Focal progression to bilateral tonic-clonic seizures(46.8%) was the most common seizure type in this group and the most common seizure type in the LS group(50.4%). The most common seizure type in ES group was focal seizure(47.8%). In addition,the proportion of negative emotions(65.2%) and mRS Score[2(3,4)]in ES group were higher than those in LS group[37.4%,2(2,3)],and the differences were statistically significant. Conclusion Cortical infarction,HT and NIHSS score ≥11 were independent risk factors for PSS. Focal progression to bilateral tonic-clonic seizures is the most common seizure type and is a common seizure type of LS,The common seizure type of early seizures is focal seizures,which are associated with negative mood and a worse prognosis.
RÉSUMÉ
Objective:To assess the predictive factors and prognosis of post-stroke seizures.Methods:A total of 315 inpatients with acute anterior circulation cerebral infarction from January 2018 to December 2018 were retrospectively collected, including 95 patients with PSS as observation group and 220 patients without PSS as control group.Clinical characteristics of the patients were recorded, including gender, age, lesion specificity, imaging features, past history, and the time and type of seizures.The Alberta stroke program early CT score (ASPECTS) was used to assess the extent of infarction, the national institutes of health stroke scale (NIHSS) and the modified rankin scale (MRS) were used to assess the severity and prognosis of cerebral infarction.The hemorrhage transformation of cerebral infarction was graded according to the European cooperative acute stroke study Ⅲ(ECASS Ⅲ) classification system.SPSS 21.0 software was used for data analysis.Chi-square test was used for categorical variables and t-test or non-parametric test was used for continuous variables. Results:The observation group had lower ASPECTS scores compared with the control group (5(4, 7), 7 (5, 8)), the presence of atrial fibrillation, hemorrhage transformation, laminar necrosis(LN) and hemosiderin deposition (31.6%, 45.3%, 24.2%, 26.3%) were higher than those of control group (20.9%, 28.2%, 9.1%, 16.4%), and the differences were statistically significant (all P<0.05). In multivariate analysis, ASPECTS score ( OR=0.658, 95% CI=0.556-0.778, P<0.001), hemorrhage transformation ( OR=2.307, 95% CI=1.311-4.059, P=0.004), LN ( OR=2.530, 95% CI=1.250-5.123, P=0.010) and hemosiderin deposition ( OR=2.308, 95% CI=1.201-4.436, P=0.012) were the influencing factors of PSS.Partial secondary generalized seizures was the most common type of seizures, and in this group it accounted for 42.1% (40/95), simple partial seizures and complex partial seizures accounted for 12.6% (12/95)respectively, and generalized seizures accounted for 32.6% (31/95). The mean follow-up time of the two groups was 24.1 months and 24.6 months, respectively.The scores of MRS at the last follow-up and discharge (3(2, 4), 2(1, 4)) of the observation group were better than those of the control group (2(1, 3), 1(1, 3)), and the differences were statistically significant(both P<0.05). Conclusions:PSS after cerebral infarction can affect the prognosis of patients, and the large infarction scope, hemorrhage transformation, LN and hemosiderin deposition are the high risk factors of PSS.