【摘要】 目的:研究探讨高龄继发性癫痫患者的主要临床特点及治疗方法。方法:选择本科2008年1月-2012年12月住院的高龄继发性癫痫患者54例,回顾性分析患者的基本临床资料、病史资料、发作特点以及影像学检查结果、治疗情况等,总结其临床特征,探讨有效的防治措施。结果:54例患者全部为继发性癫痫,46例(85.2%)为脑卒中后继发性癫痫,其中缺血性脑卒中38例,包括脑梗死33例、脑栓塞5例,出血性脑卒中8例,包括脑出血7例、蛛网膜下腔出血1例。缺血性脑卒中所占比例明显高于出血性脑卒中。其余患者分别为脑外伤3例,脑肿瘤(本组病例中均为脑转移瘤)2例,代谢性脑病2例,颅内感染1例;全身强直阵挛性发作即大发作28例(51.9%),癫痫持续状态2例(3.7%),单纯部分性发作9例(16.7%),复杂部分性发作11例(20.4%),不能分类发作4例(7.4%),提示高龄继发性癫痫以全身强直阵挛性发作为最常见类型。38例缺血性卒中患者中,迟发性癫痫(卒中2周后恢复期及后遗症期发生的癫痫)29例,早发性癫痫9例,其中1例以癫痫为首发症状。而出血性卒中患者8例中,早发性癫痫5例,提示脑出血患者发病后48 h内继发癫痫者居多,原发病类型直接影响继发性癫痫发作时间。全部患者均有头颅CT或MRI资料,以多灶性腔隙性梗死、脑萎缩及脑白质脱髓鞘样改变、脑出血、脑转移瘤等表现。结论:高龄继发性癫痫患者以脑卒中为发生率最高的原发病,病因明确,但原发病不同,发作时间不同。要根据患者的原发病、发作类型、发作时间等给予相应的治疗。早期将抗惊厥治疗为重点,症状控制后也需要给予长期口服抗癫痫药物进行维持,降低死亡率。更多还原

【Abstract】 Objective: To investigate the main clinical features and treatment of elderly patients with epilepsy secondary effect. Method: Our department of elderly patients with epilepsy from January 2008 to December 2012 54 patients hospitalized, the basic clinical data were retrospectively analyzed patients, medical history, as well as the onset of characteristic radiographic findings, treatment, etc., summary the clinical features, explore effective control measures. Result: 54 patients cause categories of secondary epilepsy, 46 cases(85.2%) for secondary epilepsy after stroke, 38 cases of cerebral ischemic stroke, including 33 cases of cerebral infarction, cerebral embolism in 5 cases, 8 cases of hemorrhagic stroke, including 7 cases of brain hemorrhage, subarachnoid hemorrhage in 1 case. Proportion of ischemic cerebral apoplexy was significantly higher than hemorrhagic stroke. The remaining patients respectively, 3 cases of traumatic brain injury, brain tumor(incidence of brain metastases) in 2 cases, metabolic encephalopathy in 2 cases, intracranial infection, 1 case. General stiffness matrix that big twin sex seizures 28 cases(51.9%), status epilepticus in 2 cases(3.7%), 9 cases of simple partial seizure(16.7%), complex partial seizure in 11 cases(20.4%), 4 cases were not classified attack(7.4%), tip- secondary epilepsy with systemic rigidity matrix twin sex hair as the most common type. 38 ischemic stroke patients, late-onset epilepsy(2 weeks after stroke recovery and sequelae of epilepsy) 29 cases, 9 cases of early-onset epilepsy, including 1 case with epilepsy as first symptoms. In 8 patients with hemorrhagic stroke, the early onset of epilepsy in 5 cases within 48 h after the onset of patients with cerebral hemorrhage, tended to secondary epilepsy, directly affects the primary disease type secondary epilepsy onset time. Are head CT or MRI data, all patients with multifocal lacunar infarction, brain atrophy and brain white matter demyelination changes, such as cerebral hemorrhage, cerebral metastases performance. Conclusion: Elderly patients with secondary epilepsy highest incidence of stroke as the primary disease, the cause clear, but the primary disease is different, a different time of onset. To give appropriate treatment according to the patient’s primary disease, seizure type, seizures time. Early anticonvulsant therapy will focus on controlling symptoms also need to be given to maintain long-term oral antiepileptic drugs reduce mortality.更多还原