Здрасти!
Подруга ищет реферат на тему "Постинсультная эпелепсия" страниц на 20-30, может у кого есть?
Delsol
11.03.2007, 06:43
The epıdemıology of post-stroke epılepsy accordıng to stroke subtypes Authors: Benbir, G.; Ince, B.; Bozluolcay, M.
Source: Acta Neurologica Scandinavica, Volume 114, Number 1, July 2006, pp. 8-12(5)
Abstract:
Strokes represent the most common etiology of epilepsy in patients over the age of 60 years, with an incidence of 2-4% occurring in different studies. Materials and Methods:
In this observational study, 1,428 patients were included who had stroke and were admitted to our Stroke Unit between the years 1996 and 2005.
Results:
Overall, 51 patients had post-stroke epilepsy (3.6%). Post-ischemic epilepsy occurred in 70.6% of the patients, post-hemorrhagic epilepsy occurred in 21.6% of the patients and epilepsy following venous infarctions occurred in 7.8% of all post-stroke epilepsy patients. Of 1,327 patients having ischemic stroke, 36 patients (2.7%), 11 out of 86 patients with hemorrhagic stroke (12.8%) and 4 of 15 patients with venous infarctions (26.6%) developed epilepsy. Compared with stroke patients without epilepsy, hemorrhagic (P < 0.001) and venous infarctions were more common in patients with post-stroke epilepsy (P < 0.001). The right hemisphere and the middle cerebral artery (MCA) territory were most commonly observed in ischemic and hemorrhagic stroke patients.
Conclusions:
Our results indicate that post-stroke epilepsy is more common among patients who have experienced venous infarctions. Hemorrhagic and venous infarctions are more commonly encountered in post-stroke epilepsy patients. Atherosclerotic and cardioembolic strokes were similar to those that occurred in post-stroke epilepsy patients. Localizations in post-stroke epileptic patients showed that the majority occurred in the right hemisphere, in the territory of the MCA. However, prospective, multicentered studies are needed for a better understanding of the epidemiology and social impact of post-stroke epilepsy.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
From the Department of Medicine (Neurology) (O.C., L.B.G.), the Duke Center for Cerebrovascular Disease (O.C., L.B.G.), and the Stroke Policy Program (O.C.), Center for Clinical Health Policy Research, Duke University, Durham, NC; and the Durham VA Medical Center (O.C.), Durham, NC.
Correspondence to Dr Larry B. Goldstein, Director, Duke Center for Cerebrovascular Disease, Head, Stroke Policy Program, Center for Clinical Health Policy Research Box 3651, Duke University Medical Center Durham, NC 27710. E-mail [Ссылки могут видеть только зарегистрированные и активированные пользователи]
Background— Although a long-recognized clinical phenomenon, there remain many questions regarding the epidemiology of seizures and epilepsy after ischemic stroke, their effect on outcome, and their treatment.
Summary of Review— Interpretation of the various studies that have been conducted of postischemic stroke seizures and epilepsy are complicated by their heterogeneous designs, inconsistent uses of terminology, small sample sizes, different periods of follow-up, and ambiguities in seizure identification and classification. Estimates of the rate of early postischemic stroke seizures range from 2% to 33%. The rates of late seizures vary from 3% to 67%. The rate of postischemic stroke epilepsy is 2% to 4% and is higher in those who have a late seizure. Data reflecting seizure subtypes are limited. Aside from cortical location and, possibly, stroke severity, no other risk factors for postischemic stroke seizures have been consistently demonstrated. Results regarding the impact of postischemic stroke seizures on outcome are inconsistent.
Conclusions— Much additional work is needed to better understand the epidemiology and social impact of postischemic stroke seizures and epilepsy, their prevention, and optimal management.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
REVIEW
Post-stroke seizure and post-stroke epilepsy
P K Myint1,2,3, E F A Staufenberg2,4 and K Sabanathan1,2
1 Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Norwich, UK
2 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
3 Clinical Gerontology Unit and Lewin Stroke Unit, Addenbrooke’s Hospital, Cambridge, UK
4 Norwich Epilepsy Clinic, Little Plumstead Hospital, Little Plumstead, Norwich, UK
Correspondence to:
Dr P K Myint
Clinical Gerontology Unit, Level 2, F&G Block, Box 251, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK; [Ссылки могут видеть только зарегистрированные и активированные пользователи]
Post-stroke seizure and post-stroke epilepsy are common causes of hospital admissions, either as a presenting feature or as a complication after a stroke. They require appropriate management and support in long term. With an increasingly ageing population, and age itself being an independent risk factor for stroke, the incidence and prevalence of post-stroke seizure and post-stroke epilepsy is likely to increase. This article examines aetiology, clinical presentation, and presents a management outline of these conditions with particular focus on adults. The aim of this review article is to provide the clinicians with background information and recommendations.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Address correspondence and reprint requests to Dr. David J. Gladstone, Division of Neurology and Regional Stroke Centre, A442, Sunnybrook and Women’s College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5; e-mail: [Ссылки могут видеть только зарегистрированные и активированные пользователи]
Seizures during thrombolytic therapy for ischemic stroke have not previously been described as a favorable prognostic sign. We report three patients with severe stroke (NIH Stroke Scale [NIHSS] score 15 to 20) who experienced a seizure during tissue plasminogen activator (tPA) infusion. While initially raising alarm about possible hemorrhage, the seizures heralded dramatic recovery (an immediate 15-point NIHSS score improvement after tPA; NIHSS score 0 or 1 at 24 hours). We propose that the seizures during thrombolysis may indicate cortical reperfusion and/or hyperperfusion due to early recanalization of an acutely occluded intracranial artery.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Address correspondence and reprint requests to Dr. Emmanuel Carrera, Department of Neurology, BH 13, 1011 Lausanne-CHUV, Switzerland; e-mail: [Ссылки могут видеть только зарегистрированные и активированные пользователи]
Objective: To determine the incidence and risk factors of electrical seizures and other electrical epileptic activity using continuous EEG (cEEG) in patients with acute stroke.
Methods: One hundred consecutive patients with acute stroke admitted to our stroke unit underwent cEEG using 10 electrodes. In addition to electrical seizures, repetitive focal sharp waves (RSHWs), repetitive focal spikes (RSPs), and periodic lateralized epileptic discharges (PLEDs) were recorded.
Results: In the 100 patients, cEEG was recorded for a mean duration of 17 hours 34 minutes (range 1 hour 12 minutes to 37 hours 10 minutes). Epileptic activity occurred in 17 patients and consisted of RSHWs in seven, RSPs in seven, and PLEDs in three. Electrical seizures occurred in two patients. On univariate Cox regression analysis, predictors for electrical epileptic activity were stroke severity (high score on the National Institutes of Health Stroke Scale) (hazard ratio [HR] 1.12; p = 0.002), cortical involvement (HR 5.71; p = 0.021), and thrombolysis (HR 3.27; p = 0.040). Age, sex, stroke type, use of EEG-modifying medication, and cardiovascular risk factors were not predictors of electrical epileptic activity. On multivariate analysis, stroke severity was the only independent predictor (HR 1.09; p = 0.016).
Conclusion: In patients with acute stroke, electrical epileptic activity occurs more frequently than previously suspected.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Optimizing therapy of seizures in stroke patients
Philippe Ryvlin, MD, PhD, Alexandra Montavont, MD and Norbert Nighoghossian, MD
From the Service de Neurologie Fonctionnelle et d'Epileptologie and CTRS-IDEE (Drs.Ryvlin and Montavont), and Service d'Urgence Neurovasculaire (Dr. Nighoghossian), Hospices Civils de Lyon et Université Claude Bernard Lyon 1, Lyon, France.
Address correspondence and reprint requests to Dr. Philippe Ryvlin, Unité 301, Hôpital Neurologique, 59 bd Pinel, 69003 Lyon, France; e-mail: [Ссылки могут видеть только зарегистрированные и активированные пользователи]
Stroke is the leading cause of symptomatic epilepsy in adults, accounting for up to one-third of newly diagnosed seizures among the elderly. About 3% to 5% of stroke patients will suffer a remote seizure, 54% to 66% of whom will develop epilepsy. Thus far, the optimal timing and type of antiepileptic treatment for patients with post-stroke seizure and epilepsy have not been specifically assessed. Although several studies suggest that seizures alter the functional recovery after a stroke, it remains difficult to determine whether or not the occurrence of a second seizure in an untreated stroke patient might hamper the overall outcome. The decision to initiate antiepileptic drug (AED) treatment after a first or a second post-stroke seizure should therefore be individualized, primarily based on the functional impact of the first seizure episode and the patient's preference. Several converging findings suggest that the majority of first-generation AEDs, particularly phenytoin, are not the most appropriate choice in stroke patients because of their potential harmful impact on functional recovery and bone health, their suboptimal pharmacokinetic profile and interaction with anticoagulants or salicylates, their greater likelihood to be poorly tolerated, and the lack of level A evidence regarding their specific use in elderly patients. Among the new-generation AEDs that do not interact with anticoagulants, antiplatelet agents, or bone health, lamotrigine and gabapentine are the only two drugs that proved to be more effective than immediate-release carbamazepine in elderly patients, providing level A evidence for their use in this indication. In addition, gabapentin remains the only drug that has been specifically evaluated in stroke patients, demonstrating a high rate of long-term seizure freedom. At present, low-dose lamotrigine or gabapentin appears to represent the optimal first-line therapy for post-stroke seizure and epilepsy in elderly patients or in younger patients requiring anticoagulants. However, low-dose extended-release carbamazepine might be a reasonable and less expensive option in patients with appropriate bone health who do not requiring anticoagulation.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Delsol
11.03.2007, 06:50
Arch Neurol. 2000 Nov;57(11):1617-22. Links
Seizures after stroke: a prospective multicenter study.
Bladin CF, Alexandrov AV, Bellavance A, Bornstein N, Chambers B, Cote R, Lebrun L, Pirisi A, Norris JW.
Department of Neuroscience, Box Hill Hospital, Nelson Road, Box Hill 3128, Melbourne, Australia.
BACKGROUND: Studies of seizures after stroke have largely been retrospective, with small patient numbers and limited statistical analysis. Much of the doctrine about seizures after stroke is not evidenced based. OBJECTIVE: To determine the incidence, outcome, and risk factors for seizures after stroke. DESIGN: International, multicenter, prospective, analytic inception cohort study conducted for 34 months. PATIENTS AND SETTING: There were 2021 consecutive patients with acute stroke admitted to university teaching hospitals with established stroke units. After exclusion of 124 patients with previous epilepsy or without computed tomographic diagnosis, 1897 were available for analysis. Mean follow-up was 9 months. MAIN OUTCOME MEASURES: Occurrence of 1 or more seizures after stroke, stroke disability, and death after stroke. RESULTS: Seizures occurred in 168 (8.9%) of 1897 patients with stroke (28 [10.6%] of 265 with hemorrhagic and 140 [8.6%] of 1632 with ischemic stroke). On Kaplan-Meier survival analysis, patients with hemorrhagic stroke were at significantly greater risk of seizures (P =.002), with an almost 2-fold increase in risk of seizure after stroke (hazard ratio [HR], 1.85; 95% confidence interval [CI], 1.26-2.73; P =.002). On multivariate analysis, risk factors for seizures after ischemic stroke were cortical location of infarction (HR, 2.09; 95% CI, 1. 19-3.68; P<.01) and stroke disability (HR, 2.10; 95% CI, 1.16-3.82; P<.02). The only risk factor for seizures after hemorrhagic stroke was cortical location (HR, 3.16; 95% CI, 1.35-7.40; P<.008). Recurrent seizures (epilepsy) occurred in 47 (2.5%) of 1897 patients. Late onset of the first seizure was an independent risk factor for epilepsy after ischemic stroke (HR, 12.37; 95% CI, 4.74-32.32; P<. 001) but not after hemorrhagic stroke. CONCLUSIONS: Seizures occur more commonly with hemorrhagic stroke than with ischemic stroke. Only a small minority later develop epilepsy. Patients with a disabling cortical infarct or a cortical hemorrhage are more likely to have seizures after stroke; those with late-onset seizures are at greater risk of epilepsy.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Neurology. 2003 Feb 11;60(3):400-4. Links
Comment in:
Neurology. 2003 Feb 11;60(3):365-6.
Early and late seizures after cryptogenic ischemic stroke in young adults.
Lamy C, Domigo V, Semah F, Arquizan C, Trystram D, Coste J, Mas JL; Patent Foramen Ovale and Atrial Septal Aneurysm Study Group.
Neurology Department, Sainte-Anne Hospital, Paris, France.
OBJECTIVES: To assess the incidence and predictive factors of early and late seizures after ischemic stroke in young adults. METHODS: A total of 581 patients (aged 18 to 55 years) with recent cryptogenic ischemic stroke were prospectively enrolled at 30 neurology departments and followed for 37.8 +/- 9.7 months. Early seizures (occurring within 7 days of stroke) were assessed by chart review and late seizures were prospectively recorded at each follow-up visit. Clinical and brain imaging findings were reviewed by two neurologists and two neuroradiologists who were blinded to the occurrence of seizures. RESULTS: Fourteen of the 581 patients (2.4%) developed early seizures, 71% of which occurred within the first 24 hours. Rankin scale >or=3 (odds ratio [OR] 3.9, 95% CI 1.2 to 12.7) and cortical involvement (OR 7.7, 95% CI 1.0 to 61.1) were independently associated with early seizures. Late seizures occurred only in patients with hemispheric stroke (n = 20). The risk of first late seizure was 3.1% (95% CI 1.4 to 4.8) within 1 year and 5.5% (95% CI 3.1 to 7.9) within 3 years. The mean delay between stroke and first late seizure was 12.9 months (0.3 to 33.9). Late seizures were associated with early seizure (hazard ratio [HR] 5.1, 95% CI 1.8 to 14.8), cortical signs (HR 4.5, 95% CI 1.6 to 13.1), and size of infarct superior to one-half hemisphere (HR 9.7, 95% CI 3.1 to 30.8). Eleven of the 20 patients with late seizure experienced recurrences (multiple in eight) on antiepileptic drug treatment. Most of them were seizure free at the end of the follow-up. CONCLUSION: Epilepsy is rarely a major problem in young cryptogenic ischemic stroke survivors. Early seizures are associated with stroke disability and cortical involvement. Early seizures, cortical signs, and large infarct are independent risk factors for late seizures.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Delsol
11.03.2007, 06:51
Stroke. 2001 May;32(5):1169-72. Links
Status epilepticus after stroke.
Velioglu SK, Ozmenoglu M, Boz C, Alioglu Z.
Karadeniz Technical University, Medical Faculty, Neurology Department, Trabzon, Turkey. [Ссылки могут видеть только зарегистрированные и активированные пользователи]
BACKGROUND AND PURPOSE: objective of our study was to determine the risk and predictive factors of status epilepticus (SE) after stroke. METHODS: From 1988 to 2000, 1174 patients were admitted to the Department of Neurology at the Karadeniz Technical University Farabi Hospital with first-time strokes. Of these, 180 patients had poststroke first-time seizures (PFSs). We followed these 180 PFS patients for an average of 3.7 years or until death to determine the occurrence rate of SE. By comparing these data with those of PFS patients without SE, we investigated whether there were significant differences. RESULTS: A total of 17 of the 180 PFS patients (9%) had SE. There was no relationship between the occurrence of SE and stroke risk factors, stroke type (ischemic or hemorrhagic stroke), stroke topography and cause, cortical involvement, size of lesion, seizure type, or electroencephalographic findings. SE occurred more frequently among patients with a higher disability rating (Rankin scale >3; odds ratio, 4.36). Recurrent SE was identified in 5 of 17 patients with SE. In all 5 of these patients, the first episode of SE occurred within the first 7 days after stroke (early-onset SE). Statistical analysis demonstrated that early-onset SE was associated with a higher risk for SE recurrence (P=0.003) and a higher mortality rate (P=0.04). CONCLUSIONS: SE was not associated with a higher mortality rate but with higher functional disability. We also found that early-onset SE (within the first 7 days after stroke) was associated with a higher risk for SE recurrence and a higher mortality rate than late-onset SE (after 7 days after stroke).
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Epilepsia. 2006 Dec;47(12):2020-6. Links
Status epilepticus after stroke is associated with increased long-term case fatality
.Knake S, Rochon J, Fleischer S, Katsarou N, Back T, Vescovi M, Oertel WH, Reis J, Hamer HM, Rosenow F.
Department of Neurology, Interdisciplinary Epilepsy Center, University Hospital Giessen and Marburg, Marburg, Germany.
PURPOSE: The aim of this study was to determine the long-term case fatality of patients with a first episode of status epilepticus (SE group) of cerebrovascular etiology, as compared with that in acute stroke patients without SE (AS group). METHODS: Patients with SE who had been prospectively admitted to an epidemiologic study were retrospectively compared with a cohort of patients from the local stroke registry. The main outcome end point was overall survival. Survival curves were generated according to the Kaplan-Meier method and compared by using the log-rank test. An extended Cox model was used to examine the impact of patient group on the risk of death. Covariates considered potential confounders included age at diagnosis, sex, type of stroke, affected hemisphere, and localization of lesions. RESULTS: Of 166 patients who entered the study, 93 patients were in the SE group, and 73 patients were in the AS group; 53 SE patients and 35 AS patients died during the study. Patient group (SE vs. AS) showed no significant impact on survival (p=0.0832) in univariate analysis. In contrast, the results from a multivariable analysis suggest that after 6 months, patients with SE were at about twice the risk of death as were patients with AS [hazard ratio of 2.12 with 95% confidence interval, 1.04-4.32, p=0.0392]. CONCLUSIONS: The occurrence of SE in patients with cerebrovascular disease indicates a high risk of death within 3 years. In contrast, the case fatality risk attributable to recurrent status or seizures is lower.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Seizure. 2003 Jan;12(1):23-7. Links
Stroke and status epilepticus: stroke type, type of status epilepticus, and prognosis.
Afsar N, Kaya D, Aktan S, Sykut-Bingol C.
Department of Neurology, Marmara University School of Medicine, Tophanelioglu Cad. Altunizade, Istanbul 81190, Turkey.
Even though stroke is known to be a common cause of status epilepticus (SE), the types of stroke or SE that may be associated are not yet clearly defined. The aims of this study were to assess the timing and type of SE in stroke patients and to observe the effects of stroke and the type of SE on the response to treatment and mortality.From May 1998 to May 2001 a total of 121 patients were admitted with SE. Among these, 30 cases (24.8%) of poststroke SE were identified and evaluated. There were 20 early-onset, and 10 late-onset SE. All stroke types were evenly distributed within the early-onset group, whereas only ischaemic stroke was found in the late-onset group. Posterior cerebral artery (PCA) infarcts were significantly more common within the latter (P: 0.0017). Nonconvulsive SE (NCS) was more frequent than convulsive SE (CS) in the early-onset group (P: 0.0352). There was a delay in the time-to-treatment for NCS compared to CS (P: 0.0007). Without, however any effect on the rate of response to first step treatment (intravenous diazepam and phenytoin; P: 0.6334). Thirteen patients died (43.3%) during hospitalisation. Disability was significantly associated with higher mortality in the early-onset group (P: 0.0201). As a conclusion, NCS seems to be an important issue in stroke, thus requiring a high degree of suspicion in an acute stroke setting to avoid further neuronal injury and morbidity.
[Ссылки могут видеть только зарегистрированные и активированные пользователи]
Delsol
11.03.2007, 07:00
реферат на тему "Постинсультная эпелепсия" страниц на 20-30Достаточно ли вашей подруге вышеприведенных статей для реферата? Там процитированы абстракты. Но в большинстве случаев есть доступ к полнотекстовым статьям. Удачи вашей подруге. :)
Shi
11.03.2007, 09:37
Спассибо большое!
Я сама очень далека от медицины, покажу ей то что вы дали, правда не очень уверена что она владеет языком:( Но все равно - огромное спасибо!
audovichenko
11.03.2007, 09:39
Пусть учится! Современная медицина без английского языка - не существует!