Epilepsy after first–ever cerebral infarction : Occurrence, predictor and treatment

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  • 初発脳梗塞後のてんかん：発症率・危険因子・治療

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<p>We retrospectively studied the occurrence of convulsive seizure after first–ever cerebral infarction to elucidate whether a single unprovoked seizure (US) can be diagnosed as poststroke epilepsy. The subjects were 2071 patients who were admitted to our hospital for acute first–ever cerebral infarction. We ascertained all episodes of convulsive seizure in our 5–year observation. Data on age, gender, status epilepticus (SE), cortical lesion, Oxford classification and deep white matter lesion on MRI and subsequent episodes of recurrent US were collected. The cumulative risk at 3 months and 1, 2, and 5 years were 2.0% (95% CI ; 2.0–2.6), 4.4% (3.9–4.9), 5.2% (4.7–5.7), and 7.7% (7.0–8.4), respectively. The occurrence rate of recurrent US in patients with US without anti–epileptic drug (AED) treatment was 74%, which was significantly higher than those with AED treatment. The occurrence rate of SE in patients without AED treatment was significantly higher than in those with AED treatment. On multivariate analysis, cortical lesion (OR＝4.0 ; CI 1.2–13.6), TACI (OR＝9.0 ; 2.9–28.7), PACI (OR＝3.6 ; 1.3–10.6), DSWMH (grade 3 or 4) (OR＝3.9 ; 1.6–5.5), and age＜75 (OR＝0.55 ; 0.35–0.96) remained the significant predictors of US. These findings demonstrate that a single US after cerebral infarction can be diagnosed as poststroke epilepsy. Moreover, AEDs do not only prevent recurrent US but also reduce the risk of SE when recurrent US occurs.</p>

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