İnme sonrası epileptik nöbetler: Türk çok merkezli inme çalışması

Çalışmamızın amacı ülkemizde inme sonrası epileptik nöbet görülme oranını ve risk faktörlerini saptamaktır. Bu amaçla bir yıl süre ile ülkemizin değişik 40 Nöroloji kliniğinde inme tanısı konulmuş birbirini izleyen 2231 hasta değerlendirildi. Hastaların 54'ü erkek, 58'i kadın olmak üzere toplam 112'sinde (% 5.02) epileptik nöbet saptandı. Hastaların 38'i (% 34) uykuda, 74'ü (% 66) uyanık iken nöbet geçirmişti. Vasküler patolojiye göre sınıflandırıldığında; birinde (% 0.89) geçici iskemik atak, 53'ünde (% 47.32) iskemik inme, 58'inde (% 51.78) hemorajik inme vardı. Nöbet geçiren olgularda inme risk faktörlerinden 85'inde (% 75.9) hipertansiyon, 32'sinde (% 28.6) eski inme, 18'inde (% 16.1) diabetes mellitus saptandı. Epileptik nöbet yönünden hastalarda yaş ve cinsiyet arasında fark saptanmadı (p>0.05). Hemorajik inmeler iskemik olanlardan daha fazla epileptik nöbet riski taşıyordu (p0.05). Ayrıca diabetes mellitus nedeniyle düzenli antidiabetik kullananlarda inme sonrası epileptik nöbet görülme riski yüksek bulundu (p0.05).

Poststroke seizures: Turkish multicentric stroke trial results

The aim of the study was to evaluate the prevalence and some risk factors for poststroke seizures. 2231 consecutive patients who were diagnosed with stroke in 40 different Neurology Clinics in our country in one year period were included in this study. Epileptic seizures were only developed in 54 male and 58 female patients (% 5.02). In 38 (% 34) of those patients seizures occured during sleep and while 78 (% 66) of them presented seizure while awake. According to vascular pathology; one patient (% 0.89) had transient ischemic attack, 53 (% 47.32) had ishemic stroke and 58 (% 51.78) had hemorrhagic stroke. Of the patients, 32 (% 28.6) had previous stroke story, 85 (% 75.9) had hypertension and 18 (% 16.1) had diabetes mellitus. There is no statistical differencies according to sex and age (p>0.05). Hemorrhagic stroke had higher risk for poststroke seizures than ischemic stroke (p<0.05). Although hypertention, diabetes mellitus and previous stroke story were important risk factors for stroke, they -were not found as a risk factor for poststroke seizures (p>0.05). On the other hand, poststroke seizures were observed higher frequency in regular antidiabetic drug user patients with diabetes and stroke (p<0.05). Contrary to this result, poststroke seizures were lower incidence at regular antihypertensive drug user patients with stroke and hypertention (p>0.05).

Kaynakça

1. Daniele O, Mattaliano A, Tassinari CA, Natale E. Epileptic seizures and cerebrovascular disease. Acta Neurol Scand 1989; 80: l7-22.

2. Kilpatrick CJ, Davis Hopper JL, Rossiter SC. Early Seizures After Acute Stroke: Risk of late Seizures. Arch Neurol 1992; 49: 509-511.

3. Lesser RP, Lüders H, Dinner DS, et al. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985; 26: 622-630.

4. Lo-YK, Yiu CH, Hu HH, Su MS, la euchli-SC. Frequency and characteristics of early Seizures in Chinese acute stroke. Acta Neurol Scand 1994; 90: 8.

5. Labovitz DL, Hauser A, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology 2001; 57: 200-206.

6. Shiozawa R, Uchigata M. Clinical Study of Convulsive Seizures in Cerebrovascular Disease. Advances in Epileptology 1987; 16: 241-243.

7. Shinton RA, Gill JS, Zezulka AV, Beavers DG. The frequency of epilepsy preceding stroke. Case control study in 230 patients. Lancet 1987; 1: 11-13.

8. Lancman ME, Golimstok A, Norscini J, Granillo R. Risk factors for Developing Seizures After a Stroke; Epilepsia 1993; 34: 141-143.

9. Olsen TS, Hogenhaven H, Thage O. Epilepsy after Stroke. Neurology 1987; 37: 1209-1211.

10. Yakıt A, Akyüz A, Dener Ş, Topalkara K, Topaktaş S. Serebrovasküler Hastalıklar ve Epilepsi, Türk Nöroloji Dergisi 1995; 4: 186-189.

11. Özkara Ç, Yılmaz N, Demir H, Küçükoglu H, Baybaş S. Serebrovasküler Hastalıklara Bağlı Gelişen Epilepsi Nöbetleri. Epilepsi 1995; 1: 23-27.

12. Uzuner N, Erdinç 0 0, Akdemir H, Onuk B, Ugur C, Özdemir G. Strok Sonrası gelişen Epilepsi Nöbetleri ile Vasküler Olayın ilişkisi. Epilepsi 1995; 1: 117-122.

13. Velioğlu SK, Boz C, Alioğlu Z, Yalman B, Özmenoğlu M. Serebrovasküler olay sonrası gelişen epilepsi nöbetleri. Epilepsi 2000 (supp); 6: 52.

14. Özdemir G, Özkan S, Uzuner N, Özdemir Ö, Gücüyener D. Türkiye’de beyin damar hastalıkları için major risk faktörleri: Türk çok merkezli inme çok merkezli inme çalışması. Türk Beyin Damar Hastalıkları Dergisi 2000; 6; 2: 31-35.

15. Bornstein NM, Aronovich BD, Karepov VG, Gur AY, Traves A, Oved M, Korczyn AD. The Tel Aviv Stroke Registry. 3600 consecutive patients. Stroke 1996; 27: 1770-1773.

16. Brown RD, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996; 27: 373-380.

17. Kay R, Woo J, Kreel L, Wong HY, Teoh R, Nicholls MG. Stroke subtypes among Chinese living in Hong Kong: The Shatin Stroke Registry. Neurology 1995; 42: 985-987.

18. Kelly-Hayes M, Wolf PA, Kase CS, Brand FN, McGuirck JM, D’Agostino RB. Temporal patterns of stroke onset. The Framingham Study. Stroke 1995; 26: 1343-1347.

19. Yamanouchi H, Shimada H, Kuramoto K. Subtypes and proportions of cerebrovascular disease in an autopsy series in a Japanese geriatric hospital. Klin Wochenschr 1990; 68: 1173-1177.

20. Kotila-M; Waltimo-O. Epilepsy after stroke. Epilepsia 1992; 33: 495-498. 21. Gupta SR, Naheedy MH, Elias D, Rubina FA. Postinfarction Seizures; A Clinical Study. Stroke 1988; 19: 1477-1481.

22. Baranska M, Mendel T. Ischemic stroke in patients under 50 years of age with special reference to its aetiology and risk factors. Neurol Neurochir-Pol 1992; 26: 311-318.

23. Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers I, Lebrun L, Pirisi A, Norris JW. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000; 57: 1617-1622.

24. Dhanuka AK, Misra UK, Kalita J. Seizures after stroke: a prospective clinical study. Neurol India 2001; 49: 33-36.

25. Giroud M, Gras P, Fayolle-H, Andre N, Soichot P, Dumas R. Early Seizures after acute stroke; a study of 1640 cases. Epilepsia 1994; 35: 959-964.

26. Milandre L, Broca P, Sambuc R, Khalil R. Epileptic crisis during and after cerabrovascular diseases. A clinical analysis of 78 cases. Rev Neurol Paris 1992; 148: 767-72.

27. Berger AR, Lipton RB, Lesser ML, Lantos G, Portenay RK. Early seizures following intracerebral haemorrhage: Implications for therapy. Neurology 1988; 38: 1363-1365.

28. Kilpatrick CJ, Davis SM. Tress BM. Epileptic Seizures in Acute Stroke. Arch Neurol 1990;47:157-160.

29. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982; 13: 189-95.

30. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease. Epilepsia 1954; 3: 49-74.

31. Giroud M, Dumas R. Role of associated cortical lesions in motor partial seizures and lenticulostriate infarcts. Epilepsia 1995; 36: 465-70.

32. Hesdorffer DC, Hauser WA, Annegers JF, Rocca WA. Severe uncontrolled hypertension and adult onset seizures; a case-control study in Rochester, Minnesota. Epilepsia 1996; 37: 736–41.

33. Ng SK, Hauser WA, Brust JC and Susser M. Hypertension and the risk of new-onset unprovoked seizures. Neurology 1993; 43: 425-428.

34. Mc Areavay MJ, Ballinger BR, Fenton GW. Epileptic seizures in elderly patients with dementia. Epilepsia 1992; 33: 657-660.

35. Mendez MF, Catanzaro P, Doss RC. Seizures in Alzheimer’s disease: Clinicopathologic study. J Geriatr Psychiatry Neurol 1994; 7: 230-233.

36. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire community stroke project. BMJ 1997; 315: 1582-1587.

37. So EL, Annegers JF, Hauser WA, O’Brien PC, Whisnant JP. Population-based study of seizure disorders after cerebal infarction. Neurology 1996; 46: 350-355.

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