【後遺症】認識中風後癲癇

封面圖片
 (圖片來源:https://www.medscape.com/viewarticle/849067)

什麼是中風後癲癇(Poststroke Epilepsy)

中風後癲癇,顧名思義,是任何發生在腦中風後的非誘發性癲癇(unprovoked seizure)。腦中風是中年後發生癲癇最常見原因之一,據統計,大概3% 30% 的腦中風患者在中風後發生癲癇。其中,依中風型態不同,約8.6%阻塞性中風及10.6% 出血性中風患者產生中風後癲癇[1]

中風後癲癇好發於兩個時期,第一個是中風後前兩週,尤其是前24小時;另一個高峰時期為中風後半年至一年[2]。根據一份至今追蹤最久的研究報告指出,即使發生中風後十年,癲癇的機率仍然較一般人高,而且風險隨著時間累積增加[3]

中風後癲癇症狀

中風後癲癇與一般癲癇症狀相同,大部分是以突發性抽搐為主(partial seizures)。可能是從單側肢體、肩膀、或臉龐抽搐開始;有時迅速擴散至對側,甚至引發全身抽搐(secondarily generalized seizures)及失去意識[4]。另外,也有單純以意識障礙作為臨床表現者[5]

可能會有全身抽搐的現象
(圖片來源:http://www.riskcomthai.org/en/news/newspaper-detail.php?id=31550&pcid=71&pcpage=887)

雖然中風後癲癇不屬罕見,但進展成持續發作的癲癇重積狀態(status epilepticus) 很少。值得注意的是,中風後癲癇較常好發於[6]
1) 嚴重中風
2) 中風位置靠近大腦皮質
3) 腦出血
4) 前循環腦中風
5) 較年輕及
6) 早期癲癇發作患者

中風後癲癇預防方法

然而,至今仍未有效預防中風後癲癇方法。鑑於長期使用抗癲癇藥物的潛在副作用,加上相對的低發生率及無法準確預測發生,在未癲癇前使用預防性藥物仍屬爭議[7]。改善腦中風急性期照顧似乎也無法減少中風後癲癇的發生率[8]

中風後癲癇處理原則

萬一遇到癲癇發作,應保持冷靜。應移除患者口中異物,以維持呼吸道暢通,切勿以物品塞入口中或餵食藥物。保持患者側躺姿勢,避免吸入嘔吐物引發吸入性肺炎,並陪伴患者直至清醒。
中風後癲癇發作,應採取側躺姿勢

首次並單次性中風後癲癇患者,除非是腦出血或大範圍中風,原則上不一定會長期使用抗癲癇藥物[2]。但如出現一次以上者,或合併上述中風後癲癇好發因子時,應按患者個人狀況選擇合適之抗癲癇藥物[7]



References
  1. Bladin, C.F., et al., Seizures after stroke: a prospective multicenter study. Arch Neurol, 2000. 57(11): p. 1617-22.
  2. Pitkanen, A., R. Roivainen, and K. Lukasiuk, Development of epilepsy after ischaemic stroke. Lancet Neurol, 2016. 15(2): p. 185-197.
  3. Graham, N.S., et al., Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke, 2013. 44(3): p. 605-11.
  4. Roivainen, R., et al., Young adult ischaemic stroke related acute symptomatic and late seizures: risk factors. Eur J Neurol, 2013. 20(9): p. 1247-55.
  5. Belcastro, V., et al., Non-convulsive status epilepticus after ischemic stroke: a hospital-based stroke cohort study. J Neurol, 2014. 261(11): p. 2136-42.
  6. Zhang, C., et al., Risk factors for post-stroke seizures: a systematic review and meta-analysis. Epilepsy Res, 2014. 108(10): p. 1806-16.
  7. Zelano, J., Poststroke epilepsy: update and future directions. Ther Adv Neurol Disord, 2016. 9(5): p. 424-35.
  8. Gensicke, H., et al., Long-term outcome in stroke patients treated with IV thrombolysis. Neurology, 2013. 80(10): p. 919-25.




作者簡介



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名稱

上肢功能評估,1,中風復健黃金期,3,中風復健觀念建立,1,公益講座,1,分享專區,2,心理支持,1,文章/書籍分享,1,生理層面,3,自我評估,1,住院/復健治療須知,1,步態,1,亞急性期,4,其他相關知識,1,物理治療,2,知覺認知功能相關,2,面對腦中風後遺症,1,案例分享,2,病理機轉,1,副木/輔具,1,動作功能相關,3,復健介入,1,給親友,2,腦中風復健,5,腦中風復健評估,4,認識復健評估,3,認識腦中風,1,認識腦中風後遺症,4,語言治療,3,職能治療,7,關於腦中風,2,
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腦中風安心復健園地: 【後遺症】認識中風後癲癇
【後遺症】認識中風後癲癇
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腦中風安心復健園地
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