Clinical Features And Outcomes Of Anti-epileptic Drugs Therapy In Patients With Post-stroke Epilepsy

Objective To investigate the clinical features of post-stroke seizures and Anti-epileptic drugs(AEDs) therapy outcome, relapse factors and cause of death,guide prevention and treatment of epilepsy after stroke, then help the management of post-stroke epilepsy and improve the quality of life in epileptics.Methods Patients with post-stroke seizures diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital from September 2014 to January 2016 were recruited.According to the first on-set time of seizures after stroke, they were divided into early-onset epilepsy group(epileptic occurring within 2weeks) and late-onset epilepsy group(epileptic occurring after 2 weeks). The record was collected,including patients’ demographics and clinical presentation, all cases were stratified two groups according to the corresponding standard.Study One is retrospective study,collecting patients’ general data, the location of lesion, the type of stroke, the type of seizures and epilepsy presentation, building electronic medical records management system. The location of lesion, the type of stroke, the type of seizures, the risk factor of stroke and abnormality of electroencephalograph(EEG)were compared.Study Two use clinical therapy and phones to collect follow-up results after AEDs therapy and cause of death. Patients had the disease for more than six months and had been taking AEDs for more than six months were selected, AEDs therapy outcome and relapse factors were compared. The SPSS18.0 was used for statistical analysis.Result Study One: 1. A total of 133 patients with post-stroke seizures were recruited, an early-onset epilepsy group of 54 patients and late-onset epilepsy group of 79 patients. There were no significant differences in sex and age. In early-onset epilepsy group, the first on-set time of seizures within 24 hours after stroke account for 51.8%, between 24 hours and 48 hours is 20.4%; in early-onset epilepsy group,the first on-set time of seizures between six mouth to two years is account for 57.0%.2. Between the early-onset epilepsy and late-onset epilepsy groups, there were no significant differences in the type of stroke( c 2=1.313,P>0.05). 3. The location of lesions related to post-stroke seizures are cortical(60.9%), sub-cortical(27.8%),thalamus(6.8%) and so on. There was no significant difference between the two groups( c 2=1.084,P>0.05). 4. The patients in the early-onset epilepsy group were mainly partial seizures, accounting for 57.4%; The patients in the late-onset epilepsy group were mainly generalized tonic-clonic seizures, accounting for 64.6%. 5. The risk factors of stroke were not statistically different between the two groups. 6.Between the early-onset epilepsy and late-onset epilepsy groups, there were no significant differences in the rate of abnormal results and epileptiform discharges of long-term video EEG(LVEEG)and routine EEG(REEG), while the rate of abnormal results and epileptiform discharges monitoring by LVEEG was higher than that by REEG( c 2=4.212,7.774,P<0.05).Study Two: 1. A total of 80 patients who had the disease for more than six months and had been taking AEDs for more than six months, including early-onset epilepsy group of 29 patients and late-onset epilepsy group of 51 patients. There were no significant differences in sex, age, course of the disease and AEDs therapy. 2. The rate of seizure-free and efficiency in early-onset epilepsy group was higher than late-onset epilepsy group(P < 0.05). 3. In the two groups, 57 patients were effective after therapy, the rate of single drug treatment was not statistically different between the two groups( ? 2=0.315,P>0.05). 4. As for recurrent seizures, there were no obvious precipitating factors for 30.0% patients, 70.0% were connected with precipitating factors, mainly including favor, irregular medication, unhealthy living habits, mood and stroke. 5. 17 of 133 patients died, the causes of death were lung infection,coronary heart disease, recurrent of stroke, accidental cause and unknown reasons.Conclusions 1. Early-onset epilepsy were mainly partial seizures, while late-onset epilepsy group were mainly generalized tonic-clonic seizures. The rate of epileptiform discharges monitoring by LVEEG was higher than that by REEG, which should be wildly used to diagnose post-stroke epilepsy. Cortex, sub-cortical stroke patients and patients whose EEG shows epileptiform discharges should be alert to seizures and recurrent seizures. 2. Patients whose first on-set time of seizures after stroke before two weeks are effective after AEDs therapy. Seizures again after the first attack, should consider taking anti-epileptic drugs regularly, and try to avoid recurrent incentive.