【摘要】 目前国际上尚无关于缺血性卒中患者再灌注治疗后癫痫诊断和治疗的统一指南与共识，本文从定义、机制等方面对其进行综述。缺血性卒中再灌注治疗后癫痫定义为接受了静脉溶栓和（或）机械取栓等血管内治疗的脑梗死患者，无其他明确原因或卒中前癫痫病史，脑梗死7 d后出现2次或以上痫性发作，或脑梗死30 d后出现1次或以上痫性发作。静脉溶栓后癫痫的发病率约为6.4%～20.6%，动脉机械取栓后癫痫的发病率约为5%。再灌注治疗卒中后癫痫的病理生理学机制可能与局部高灌注、溶栓药物本身致痫性及出血转化相关。较高的卒中严重程度、大脑皮质病灶、大脑中动脉供血区梗死及卒中后早发性发作可能是再灌注治疗卒中后癫痫的预测因素。左乙拉西坦及拉莫三嗪可能是缺血性卒中再灌注治疗后癫痫的有效药物，溶栓后持续痫性发作可能增加患者的死亡风险。更多还原

【Abstract】 There is no unified international guidelines or consensus on seizures and epilepsy following acute stroke reperfusion therapy so far. In this review, we briefly summarize its definitions and mechanisms. Post stroke epilepsy after reperfusion treatment is defined as patients with ischemic stroke who have received intravenous thrombolysis and/or endovascular therapy, without other definitive causes or epilepsy history before stroke, have at least two epileptic seizures occurred within 7 days of stroke onset, or at least one epileptic seizures occurred within 30 days of stroke onset. The incidence rate of epilepsy after intravenous thrombolysis is about 6.4%-20.6%, and arterial thrombectomy is about 5%.The pathophysiological mechanism of post stroke epilepsy after reperfusion treatment may be related to local hyperfusion,epileptogenic properties of tPA and hemorrhagic transformation. Higher stroke severity, cortical involvement, middle cerebral artery infarction, and early post-stroke seizures may be predictive factors for post-stroke epilepsy after reperfusion therapy. Levetiracetam and lamotrigine may be effective drugs for post-stroke epilepsy after reperfusion therapy. Sustained seizures after thrombolysis may increase the risk of death.更多还原