Early Warning And Prevention Of Poststroke Epilepsy

Objective:This thesis aims to observe cerebrovascular patients’ general situation, pastmedical history, clinical data and changes of neurotransmitter amino acid（GABA, Glu） and Ca²⁺in the plasma of stroke patients, explore the susceptiblefactors of PSE, and analyze the influence of seizures on neurotransmitter aminoacid and Ca²⁺in the plasmas. Besides, the significance of drug intervention onplasma neurotransmitter amino acids and Ca²⁺changes will be discussed, so asto find out the means of preventing poststroke epilepsy.Method:In this research, the patients are divided into two separated groups, namelyepilepsy （EP） group and no epilepsy （NEP） group. Further, no epilepsy groupincludes control group, GABA intervention group and calcium interventiongroup. All patients belong to our patients attacked by acute cerebrovasculardisease in our hospital from May2011to August2012. In all the cases, patientsare sent to the hospital within72hours，which is in accordance with thediagnostic criteria passed in the fourth National Cerebrovascular DiseaseConference in1996. And epilepsy group is confirmed by head CT or MRI,which is approved to be coincident with the definitions of epilepsy in theInternational League Against Epilepsy （ILAE） in1989. Statistical analysis willbe done on patients in aspects of gender, age, past medical history, thestroke-type, number of lesions and position and stroke severity. Then theirforearm vein blood on an empty stomach will be gathered, and highperformance liquid chromatography （HPLC） will be used to measure GABA,Glu and Ca²⁺concentration in plasma. Next, they will receive14days’ drugintervention. And after one month of drug withdrawal, again GABA, Glu and Ca²⁺concentration in plasma are measured and compared. By statisticalanalysis of SPSS17.0software and normality test, all data obey normaldistribution. When data is tested by paired t, variances are not equal. And if it istested by t’, the concentration of plasma amino acid and Ca²⁺could beexpressed by the formula that mean adds or subtracts standard deviation （x士s）.And if it is not completely obey normal distribution data, rank sum test will beutilized. It is believed that data represents the usage of the median of M （QL,QU）. The comparison of ratios will be tested byχ2.Result:There is little statistical significance in the research on sex ratio and averageage of both EP and NEP group; in EP groups, the number of previous strokehistory were significantly more than others, which has statistical significance（P=0.022）; constituent ratio of the infarction of EP group was obviously higherthan that of NEP group, which also has statistical difference （P=0.028）;compared with the NEP group, in EP group, multiple lesions occupied70%,and statistical difference exists（P=0.03）. The lesion was located in the cortex（65%）, so it has statistical difference （P<0.001）; the severer the stroke was（SSS<30）, the more ratio the patients got seizures （P=0.028）.By comparison of EP and NEP, when Glu concentration rises, Ca²⁺concentration decreased（P<0.05）. However, in GABA intervention group，Glu concentration decline after intervention. Compared with before, GABAconcentration increased after the intervention. So both are statisticallysignificant （P<0.05）. Besides, Ca²⁺concentration increased slightly earlier afterintervention, and there is no statistical difference （P>0.05）. Therefore, it isproved that oral GABA can increase amount of GABA, reduce the content ofGlu, which can play an important role in the inhibition of epileptic seizures. In CCB group, Glu declined after intervention, and the concentration of GABAincreased after intervention. Thus, both of them has little statistical differences（P>0.05）. Ca²⁺concentration became higher than before after the intervention,which was also statistically significant （P<0.05）.Therefore, oral nimodipine canmake Ca²⁺concentration of patients with acute cerebrovascular disease inplasma increase. And indirectly it indicates that it can inhibit the flow of Ca²⁺,so as to avoid the occurrence of epilepsy.Conclusion:Seizures can increase Glu concentration and decrease Ca²⁺concentration inplasma of the cerebrovascular patients; past history of stroke, stroke lesionsinvolving cortex, multiple lesions, greater stroke severity （SSS<30） are allindependently susceptible factors of PSE, as the early warning of PSE. What’smore, oral GABA can increase the concentration of GABA and reduce theconcentration of Glu. And oral calcium antagonists can inhibit the flow of Ca²⁺,which is important for early prevention and treatment.