藍(lán)色簡(jiǎn)約腦卒中后癲癇發(fā)作類型與臨床治療介紹

腦卒中后癲癇腦卒中后癲癇發(fā)作類型與臨床治療typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafterstroke宣講人：XXX時(shí)間：20XX.XX目錄01基本概述02發(fā)病因素03常見關(guān)系04類型表現(xiàn)05治療預(yù)防基本概述第一部分typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafter基本概述01自1864年Jackson首次報(bào)道腦血管疾病與癲癇的關(guān)系以來,人類已認(rèn)識(shí)到腦血管疾病,特別是腦卒中是癲癇最為常見的病因之一。腦卒中病程中的各種類型癲癇發(fā)作特別是強(qiáng)直-陣攣發(fā)作持續(xù)狀態(tài)對(duì)患者的病程進(jìn)展和預(yù)后存在不良影響。因此,在臨床工作中腦卒中與癲癇,應(yīng)給予足夠的關(guān)注和重視。02最近的研究表明，與對(duì)照組相比，這個(gè)結(jié)果支持了老年人中的癲癇發(fā)作可能是其他潛在腦血管疾病的早期表現(xiàn)的假說。卒中后癲癇發(fā)作是否增加腦梗死再發(fā)的風(fēng)險(xiǎn)仍然是一個(gè)有待解決的問題。觀察病例致使某些類型的癲癇可能被漏診，卒中后癲癇的實(shí)際發(fā)生率可能要比所報(bào)道的高國(guó)內(nèi)外研究卒中后癲癇的方法不同，國(guó)外偏重于研究卒中后癇性發(fā)作和癲癇并將二者分為兩個(gè)問題來探討，國(guó)內(nèi)偏重于探討卒中后癲癇的發(fā)病率。研究則主要以院內(nèi)資料的回顧性研究主要是以醫(yī)院為核心的層級(jí)單位的回顧。基本概述將腦卒中后癲癇進(jìn)行早發(fā)性和遲發(fā)性分類,因其根本的原因是兩者的預(yù)后不同。絕大部分早發(fā)性癇性發(fā)作隨著原發(fā)病的緩解和病程的進(jìn)展會(huì)自動(dòng)緩解,而遲發(fā)性則絕大多數(shù)會(huì)反復(fù)發(fā)作,且需要抗癲癇藥物(AEDs)的長(zhǎng)期干預(yù)。一項(xiàng)2021例的隨訪觀察,只有3%的患者最終反復(fù)發(fā)作成為癲癇。因此,早發(fā)性癲癇準(zhǔn)確的表述應(yīng)以腦卒中后早發(fā)性癇性發(fā)作更為恰當(dāng)。4周后出現(xiàn)的癲癇發(fā)作,絕大部分會(huì)反復(fù)發(fā)作,所以,對(duì)卒中后遲發(fā)性癲癇定義的爭(zhēng)議不多。基本概述發(fā)病因素第二部分typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafter發(fā)病因素進(jìn)行社區(qū)對(duì)照研究，對(duì)1897例急性卒中患者隨訪9個(gè)月，回歸分析發(fā)現(xiàn)，出血性卒中并發(fā)癲癇是缺血性卒中的2倍。對(duì)1197例連續(xù)住院的卒中患者進(jìn)行了7年的隨訪，發(fā)現(xiàn)出血性卒中易于并發(fā)癲癇(OR3.3;95%CI1.3-8.6)，有早期癲癇發(fā)作者，遲發(fā)性癲癇發(fā)作的發(fā)生率明顯提高（OR4.5;95%CI1.3-16.0）。第一次遲發(fā)性癲癇發(fā)作后發(fā)生第二次癲癇發(fā)作的風(fēng)險(xiǎn)為54-66%，這一數(shù)字在第一次早發(fā)性癲癇發(fā)作后約為43%。對(duì)照研究常見關(guān)系第三部分typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafter常見關(guān)系殼核和丘腦出血很少引起癲癇發(fā)作，腦葉出血常并發(fā)癲癇顳葉41%，頂葉41%，枕葉22%，額葉12%，島葉10%AVM及動(dòng)脈瘤破裂引起的皮層型腦出血極易伴發(fā)早期癲癇類型表現(xiàn)第四部分typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafter類型表現(xiàn)單純部分性發(fā)作：61%部分繼發(fā)全面性發(fā)作：28%癲癇持續(xù)狀態(tài)：9%部分性發(fā)作占42%-89%復(fù)雜部分性發(fā)作占3%-14.3%癲癇狀態(tài)占4%-10%遲發(fā)性癲癇中則以全身強(qiáng)直-陣攣性發(fā)作多見EEG正常的患者癲癇發(fā)作的風(fēng)險(xiǎn)分別為20%類型表現(xiàn)腦電圖：78%呈局灶行棘波者臨床有癇性發(fā)作；呈局灶性慢波、彌散性慢波和EEG正常的患者癲癇發(fā)作的風(fēng)險(xiǎn)分別為20%、10%和5%神經(jīng)影像學(xué)：皮層受累是癲癇發(fā)生的高危因素基礎(chǔ)疾病、致癇藥物、撤藥反應(yīng)（如苯二氮卓類）、代謝紊亂（如血糖異常）類型表現(xiàn)頸動(dòng)脈內(nèi)膜切除術(shù)癇性發(fā)作是頸動(dòng)脈內(nèi)膜切除術(shù)圍手術(shù)期并發(fā)癥，發(fā)生率為0.4%-1%，顯著低于卒中后的發(fā)生率。病理生理機(jī)制：手術(shù)部位的栓子引起皮質(zhì)缺血性梗死；內(nèi)膜切除導(dǎo)致慢性腦血管自動(dòng)調(diào)節(jié)障礙，突然變化的結(jié)果引起局部的高灌注，局部癇性發(fā)作閾值可能減低。治療預(yù)防第五部分typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafter治療預(yù)防積極對(duì)腦血管疾病進(jìn)行一級(jí)、二級(jí)預(yù)防以降低腦卒中發(fā)病率是預(yù)防腦卒中后癲癇最有效的措施（2010中國(guó)急性缺血性卒中診治指南）發(fā)現(xiàn)缺血性卒中早期癲癇發(fā)作接受2年治療的患者癲癇再發(fā)的風(fēng)險(xiǎn)下降，但停止治療后癲癇風(fēng)險(xiǎn)與未接受治療的患者比較無顯著差異。治療預(yù)防AEDs藥物影響卒中后恢復(fù)的可能性：苯妥英和苯二氮卓類藥物可能影響腦梗死后的功能預(yù)后。AEDs與抗凝藥和抗血小板藥物之間的相互作用：第一代AEDs與缺血性卒中二級(jí)預(yù)防藥物之間存在藥物間相互作用。苯巴比妥、苯妥英和卡馬西平均是肝酶誘導(dǎo)劑，而苯妥英、苯二氮卓類藥物和丙戊酸與血漿蛋白高度結(jié)合，從而導(dǎo)致下列現(xiàn)象的發(fā)生：苯妥英和華法林的血漿濃度相互影響，從而使兩種藥物均很難維持在穩(wěn)定的治療范圍。治療預(yù)防目前缺乏卒中后是否需預(yù)防性使用抗癲癇藥或治療腦卒中后癲癇的證據(jù)不推薦預(yù)防性應(yīng)用抗癲癇藥物（Ⅳ推薦，D級(jí)證據(jù)）孤立發(fā)作一次或急性期的癇性發(fā)作控制后，不建議長(zhǎng)期使用抗癲癇藥物（Ⅳ推薦，D級(jí)證據(jù)）建議按癲癇的常規(guī)治療進(jìn)行長(zhǎng)期藥物治療（Ⅰ推薦D級(jí)證據(jù)）卒中后癲癇持續(xù)狀態(tài)，可按癲癇持續(xù)狀態(tài)的治療原則進(jìn)行處理（Ⅰ推薦，D級(jí)證據(jù)）腦血管畸形手術(shù)切除的適應(yīng)證藥物不能控制的癲癇頻繁發(fā)作治療預(yù)防目前缺乏卒中后是否需預(yù)防性使用抗癲癇藥或治療腦卒中后癲癇的證據(jù)不推薦預(yù)防性應(yīng)用抗癲癇藥物（Ⅳ推薦，D級(jí)證據(jù)）孤立發(fā)作一次或急性期的癇性發(fā)作控制后，不建議長(zhǎng)期使用抗癲癇藥物（Ⅳ推薦，D級(jí)證據(jù)）治療及預(yù)防建議按癲癇的常規(guī)治療進(jìn)行長(zhǎng)期藥物治療（Ⅰ推薦D級(jí)證據(jù)）卒中后癲癇持續(xù)狀態(tài)，可按癲癇持續(xù)狀態(tài)的治療原則進(jìn)行處理（Ⅰ推薦，D級(jí)證據(jù)）腦血管畸形手術(shù)切除的適應(yīng)證藥物不能控制的癲癇頻繁發(fā)作治療及預(yù)防腦卒中后癲癇腦卒中后癲癇發(fā)作類型與臨床治療typesandclinicaltreatmentofepilepsyafterstroketypesandclinicaltreatmentofepilepsyafterstroke宣講人：XXX時(shí)間：20XX.XX醫(yī)療護(hù)理PPT模板Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.適用于工作匯報(bào)/會(huì)議報(bào)告/個(gè)人競(jìng)聘/述職報(bào)告/比賽匯報(bào)人：xxx添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.目錄CONTENTS此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

01此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.

添加標(biāo)題添加標(biāo)題關(guān)鍵詞添加副標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.添加標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.醫(yī)療健康此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

02Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞添加副標(biāo)題Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.85%KEYWORDS此處添加相關(guān)標(biāo)題010203Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.添加標(biāo)題此處添加相關(guān)標(biāo)題關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞添加副標(biāo)題關(guān)鍵詞添加副標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題01020304關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

03此處添加相關(guān)標(biāo)題關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.關(guān)鍵詞Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.此處添加相關(guān)標(biāo)題2020202220242026專業(yè)團(tuán)隊(duì)專屬定制Audiencecrowd:Universitystudentswhoarerequiredbytheteachertodemonstratethecurriculum.Newcomerswhowanttostandoutfromthecompetitionjustaftergraduation.Needtousethedemonstrationtoenhancethepersuasiveworkman.此處添加相關(guān)標(biāo)題添加標(biāo)題添加標(biāo)題關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞專業(yè)團(tuán)隊(duì)專屬定制Eventplanningisaneffectivebehaviortoincreasemarketshare.此處添加相關(guān)標(biāo)題點(diǎn)擊此處添加相關(guān)主要內(nèi)容Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandreputation.PART

04此處添加相關(guān)標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞Eventplanningisaneffectivebehaviortoincreasemarketshare.關(guān)鍵詞標(biāo)題Eventplanningisaneffectivebehaviortoincreasemarketshare.Anactionplanwithexecutable,actionableandcreativeideascaneffectivelyenhancethecompany'sreputationandbrandre