Clinical and Prognostic Characteristics of Post-Stroke Epilepsy at High Altitude
Ciyang, HU Yaxiong, WANG Qiqi, LIAN Yuqing, CHEN Yuxiu, ZHOU Lixin, ZHAO Yuhua
2024, 19(4):
423-430.
DOI: 10.3969/j.issn.1673-5765.2024.04.005
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Objective To explore the clinical, therapeutic, and prognostic characteristics of post-stroke epilepsy (PSE) among residents at high altitude, and to analyze the risk factors affecting the prognosis of PSE, which might provide a certain basis for formulating clinical diagnosis and treatment strategies in PSE at high altitude.
Methods The PSE patients at high altitude who were hospitalized in the Tibet Autonomous Region People’s Hospital from January 2019 to June 2023 were included retrospectively. According to the type of PSE, patients were divided into two groups: early-onset (≤7 days after stroke) PSE group and late-onset (>7 days after stroke) PSE group. Follow-up was conducted in September 2023 through a combination of telephone and outpatient service to obtain the patients’ functional prognosis (mRS score). The differences in clinical data, such as gender, age, type of stroke distribution, stroke severity (mRS score at onset) and laboratory examination, and functional prognosis during follow-up were compared between the two groups, and the influencing factors of poor prognosis (mRS score≥3 at follow-up) were analyzed.
Results A total of 89 PSE patients who met the inclusion criteria were included, accounting for 4.2% of hospitalized stroke patients during the same period. Among PSE patients, the median age of onset was 55 (44-69) years, with 59 males (66.3%) and 87 Tibetans (97.8%). The mRS score of PSE patients at onset was 3 (1-4) points. Among the enrolled patients, 49 cases (55.1%) were in the early-onset PSE group and 40 cases (44.9%) were in the late-onset PSE group. Among the type of stroke in PSE patients, intracerebral hemorrhage accounted for the highest proportion, accounting for 39.3% (35 cases). The most common type of epileptic seizure was comprehensive origin (69 cases, 77.5%). A total of 36 cases (40.4%) of PSE patients complicated with status epilepticus. Imaging showed that the most common lesion of stroke was cortical lesion, accounting for 53.9% (48 cases). In terms of treatment, 85 (95.5%) PSE patients received antiepileptic drugs, of which 79 cases (88.8%) received monotherapy. The most commonly used antiepileptic drug was oxcarbazepine/carbamazepine (36 cases, 40.4%). The in-hospital mortality of PSE patients was 10.1% (9 cases). The median follow-up time was 27 (15-40) months. The patients with poor prognosis accounted for 56.7% (38/67) and the mortality was 35.8% (24/67). Compared with the early-onset PSE group, the late-onset PSE group had a higher proportion of males (78.6% vs. 56.6%, P=0.043) and a higher proportion of family history of epilepsy (10.0% vs. 0, P=0.037). There were significant differences in the distribution of stroke types (P=0.040) and the distribution of antiepileptic drug types (P=0.047) between the two groups. Multivariate regression analysis showed that severe symptom of stroke (high mRS score at onset) was an independent risk factor for poor prognosis of PSE (OR 1.691, 95%CI 1.245-2.297, P<0.001).
Conclusions The incidence of PSE in hospitalized stroke patients at high altitude was 4.2%. Patients with PSE in high altitude areas had severe clinical symptoms at onset, with 40.4% of patients coexisting with status epilepticus. Patients with PSE in high altitude areas had poor prognosis, with a high risk of disability and mortality.
