| Objective This study aimed to explore the timing of the long-term antiepileptic drug therapy and to study the treatment outcome of AEDs in patients with post-stroke epilepsy.Methods Study one: We enrolled the patients with post-stroke seizures who diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital and at least one seizure and followed up for at least 12 months from September 2014 to August 2016.The patients were divided into early-onset seizure group(occurring within 2 weeks of stroke)and late-onset seizure group(occurring after 2 weeks of stroke).Basic dates including age,gender,acute stroke time,stroke type and epilepsy related information including the time distance from first seizure to stroke,seizure type,Epileptic course,the long-term regular AEDs treatment is given or not after the first time of post-stroke seizure,drugs,dosage,medication compliance of patients and so on from epilepsy clinic and telephone follow-up were collected in patients with post-stroke seizures and the electronic medical records management system was established.The two groups were subdivided into treated and untreated group after the first seizure.The recurrence rate and predilection time of second seizures were observed and compared between the two groups or subgroups at different time points.Study two: We enrolled the patients with post-stroke epilepsy who diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital and who were at least two seizures after stroke and consistent with the definition of post-stroke epilepsy and long-term used AEDs and followed up for at least 12 months from September 2014 to March 2017.we defined at least 12 m had no seizures as seizure free,the effective rate of treatment was over more than or equal to 50% seizure reduction than baseline seizure frequency(3 times of the longest attack interval or the total number of seizures in one year)but not no seizures as effective treatment and the total effective rate of treatment included no seizure rate and effective rate.Basic dates including age,gender,follow-up time,stroke type and epilepsy related information including,seizure type,seizure frequency,epileptic course,drugs,dosage,abnormal distribution of EEG and so on from epilepsy clinic and telephone follow-up were collected.we aimed to evaluate the outcome of AEDs by no seizure rate,effective rate,total effective rate and analysis the use of AEDs in patients with no seizure.The SPSS21.0 was used for statistical analysis.Result Study one: 90 patients with post-stroke seizures were recruited and the patients were followed up for 12m-96m(median 20m).31 patients in ES group,19 of which in treated group and 12 of which in untreated group.59 patients in LS group,36 of which in treated group and 23 of cases in untreated group.The recurrence rate of second seizures occurred in each group and the comparison between the subgroups in the 3rd,6th,9th and 12 th mouth of follow-up as follows.(1)LS group compared with the group of ES,the recurrence rate of second seizures was high(25.81%~38.71% vs.49.15%~69.49%),and there was statistical difference(p<0.05).(2)The recurrence rate of ES in untreated group was lower than that in untreated LS group(16.77% ~ 33.33% vs.56.52% ~73.91%),but only in 3m and 12 m the difference was statistically significant(p<0.05).(3)There was on statistically significant different in ES treated group compared to untreated group,LS treated group compared to untreated group,ES treated group compared to LS treated group(p>0.05).Both in group of ES and LS,the recurrence rate was highest at the time of 3m,3m~6m followed,within six months respectively as high as 91.67% and 76.59%.Study two: A total of 79 patients with post-stroke epilepsy were recruited and the patients were followed up for 12m-100m(median 23m).The number of seizures was from 0.36 to 15 times per year(median 2 years).All patients were treated with 1 to 3 AEDs:(1)Monotherapy and Combined treatment: The no seizure rate was 40.51%(32/79),Effective rate was 48.10%(38/79),Total effective rate was 88.61%(70/79);(2)Monotherapy: The no seizure rate was 27.85%(22/79),Effective rate was 27.85%(22/79),Total effective rate was 55.70%(44/79);(3)Combined treatment: The no seizure rate was 33.33%(10/30),Effective rate was 53.33%(16/30),Total effective rate was 86.67%(26/30);(4)The whole follow-up period,the patients were treated with valproic acid in 40 cases,levetiracetam in 44 cases.Taking valproate as an example,1)Monotherapy: The no seizure rate was 25%(10/40),Effective rate was 17.5%(7/40),Total effective rate was 42.5%(17/40);2)Combined treatment: The no seizure rate was 28.57%(6/21),Effective rate was 57.14%(12/21),Total effective rate was 85.71%(18/21).Taking levetiracetam as an example,1)Monotherapy: The no seizure rate was 27.27%(10/40),Effective rate was 25.00%(11/44),Total effective rate was 52.27%(23/44);2)Combined treatment: The no seizure rate was 42.86%(9/21),Effective rate was 42.86%(9/21),Total effective rate was 85.71%(18/21).(5)The duration of no attack was mainly from 1 to 2 years(81.25%).(6)In the patients of no attack with monotherapy were in 22/32 cases(68.75%),two AEDs were in 10/32 cases(31.25%),of which valproate monotherapy was in10/32 cases(32.25%)and the no seizure treatment dose of 500-1000mg/d was in 9/10 cases(90%),of which valproate combined treatment was in 6/32 cases(18.75%)and the no seizure treatment dose of 500-1000mg/d was in 5/6 cases(83.33%),of which levetiracetam monotherapy was in12/32 cases(37.50%)and the no seizure treatment dose of 500-1000mg/d was in 11/12 cases(91.67%),of which levetiracetam combined treatment was in 9/32 cases(28.13%)and the no seizure treatment dose of 500-1000mg/d was in 7/9 cases(77.78%).Conclusions 1.Only one early-onset seizure after stroke can be suspended long-term AEDs treatment,once it recurred that indicates the need for treatment.However,the recurrence rate of late-onset seizure was higher than that of early-onset seizure and it should be given long term AED treatment after the first seizure.2.The EEG of post-stroke epilepsy showed mainly no involved the change of the background and the epileptic wave and slow wave were mainly detected and the slow wave response to a certain degree of brain damage.After AEDs treatment of patients with PSE,the annual frequency is lower(two times per year)and the seizures can get better control even long-time no seizures with the dose of AEDs smaller. |
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