急性梗塞型腦中風不同治療的中風後癲癇發生率

研究目的：急性梗塞型腦中風的治療近十年內有顯著的變化，因靜脈血栓溶解劑治療以及動脈取栓術的進步，截至今日，世界各國針對急性梗塞型腦中風的治療指引，都修正為傾向積極的治療。然而在這些積極治療下，中風後癲癇比例似乎有上升的情形，但因相關研究甚少，且現今研究結果並無定論，因此我們想針對此主題，加以研究與討論。研究方法及資料：我們收錄了2019年至2024年，於中山醫學大學腦中風中心登錄的急性梗塞型腦中風，且符合本實驗收案條件者共1990人，並將其分成口服藥物、靜脈血栓溶解劑(IV r-tPA)、動脈取栓術(IAT)以及靜脈血栓溶解劑加上動脈取栓術四組，分析此四組病人在急性梗塞型腦中風期，接受了不同治療後，中風後癲癇發生率有無顯著不同。研究結果：依據本研究結果顯示，接受再灌流治療的病人（靜脈血栓溶解術、動脈取栓術、靜脈血栓溶解術合併動脈取栓術）中風後癲癇發生率相較於口服藥物組病人顯著較高，其中靜脈血栓溶解術合併動脈取栓術組的病人，在急性中風後癲癇（中風後24小時內發生癲癇）的比例最高。結論與建議：因為在積極治療的組別，中風後癲癇發生率顯著增加，尤其是以非抽搐型癲癇的比例較高，因此我們建議針對積極治療的病人，在中風後早期，若有注意到異常不自主動作或是意識及認知的變化，應及早安排腦波檢查，以其早期診斷癲癇，早期給予治療，改善病人預後。

Study Objective: The treatment of acute ischemic stroke has evolved significantly over the past decade. The new treatment for acute ischemic stroke such as intravenous thrombolytic therapy and arterial embolectomy have led to a shift in treatment guidelines worldwide favoring aggressive therapies. Some studies indicated these aggressive therapies co-related with increase the incidence of post-stroke epilepsy. However, due to limited research and inconclusive results, we sought to investigate and discuss this topic.Study Methods and Data: We enrolled 1,990 eligible patients with acute ischemic stroke who were admitted to the Stroke Center of chung-shan medical University hospital between 2019 and 2024. These patients were divided into four groups: oral medication, intravenous thrombolytics (IV r-tPA), intraarterial thrombectomy (IAT), and IV r-tPA plus IAT. We analyzed whether the incidence of post-stroke epilepsy differed significantly among these four groups after receiving different treatments during the acute ischemic stroke.Research Results: This study showed that the incidence of post-stroke epilepsy was significantly higher in patients receiving reperfusion therapy (IV r-tPA, IAT or combined IV r-tPA and IAT) compared with patients receiving oral medication. Among patients receiving combined combined IV r-tPA and IAT, the highest rate of acute post-stroke epilepsy (epilepsy occurring within 24 hours of stroke) was observed.Conclusions and Recommendations: Because the incidence of post-stroke epilepsy was significantly increased in the IV r-tPA, IAT and combined IV r-tPA and IAT group. We recommend those patients should complete EEG examination as soon as possible after stroke if patients have abnormal involuntary movements or changes in consciousness or cognition. This allows for early diagnosis of epilepsy, early treatment, and improved patient’s prognosis.