アブストラクト
Japanese
| Title | 脳卒中における急性症候性発作の臨床神経生理 |
|---|---|
| Subtitle | 特集 「救急医療と神経生理」 |
| Authors | 松原崇一朗, 中島誠 |
| Authors (kana) | |
| Organization | 熊本大学病院 脳神経内科 |
| Journal | 臨床神経生理学 |
| Volume | 50 |
| Number | 3 |
| Page | 84-88 |
| Year/Month | 2022 / |
| Article | 報告 |
| Publisher | 日本臨床神経生理学会 |
| Abstract | 「要旨」急性期脳卒中には, しばしばてんかん発作(seizure)が合併する. 発症早期のearly seizureは, 近年は国際抗てんかん連盟の定義に基づいて急性症候性発作(acute symptomatic seizure)と呼称されることが増えてきている. 急性症候性発作は脳卒中の病態を修飾することで転帰の悪化につながる他, 脳卒中後てんかん発症のリスクにつながる可能性がある. 急性期の病態悪化に関連する病態として, てんかん重積状態(SE)があり, 中でも検出が遅れ重篤化しやすい非けいれん性てんかん重積状態(NCSE)の合併も稀ではない. NCSEを含む長時間遷延したSEは, てんかん発症のリスクであることが近年報告された. コントロール不良のSEは二次性脳損傷を引き起こす可能性があり, 脳卒中を含む神経疾患では, 本病態のコントロールが患者の転帰を改善するために重要であることが, 神経集中治療領域で注目されている. 一方慢性期脳卒中の合併症である脳卒中後てんかんの発症に関連する因子については, 様々な観察研究が行われ, 大脳皮質病変, 病変の大きさ, 若年, 出血性病変, 高い重症度に加え, 急性症候性発作が高リスク因子として認識されている. 近年では, 脳卒中後てんかんの発症を予測するため, これらの因子を統合したスコアが提唱されており, 脳梗塞においてはSeLECTスコア, 脳出血においてはCAVEスコアが, それぞれ高いてんかん発症の予測精度を示すことが報告されている. これらのスコアに基づく高リスク症例においては, 早期の治療介入が脳卒中後てんかん発症抑制に期待されている. 近年急性期脳卒中診療は目まぐるしい発展を見せているが, 急性期からのてんかん原性抑制や転帰改善のための治療について, 今後のエビデンス集積が期待される. |
| Practice | 臨床医学：内科系 |
| Keywords | stroke, epilepsy, acute symptomatic seizure, electroencephalography, status epilepticus |
English
| Title | Clinical neurophysiology of acute symptomatic seizure in stroke patients |
|---|---|
| Subtitle | |
| Authors | SOICHIRO MATSUBARA, MAKOTO NAKAJIMA |
| Authors (kana) | |
| Organization | Department of Neurology, Kumamoto University Hospital |
| Journal | Japanese Journal of Clinical Neurophysiology |
| Volume | 50 |
| Number | 3 |
| Page | 84-88 |
| Year/Month | 2022 / |
| Article | Report |
| Publisher | Japanese Society of Clinical Neurophysiology |
| Abstract | Patients with acute stroke sometimes develop epileptic seizures, which are recently called acute symptomatic seizures (ASS). ASS is quite important in two ways as follows. First, it could pathologically affect the brain condition after stroke, thereby worsening the functional outcome; second, ASS itself could be a risk for post-stroke epilepsy. Status epilepticus (SE) including nonconvulsive status epilepticus (NCSE) can be associated with clinical deterioration after acute stroke. Especially, although being easily overlooked, NCSE is not a rare complication in acute stroke. Prolonged SE including NCSE has also recently been reported to be a risk for development of epilepsy. Because poorly controlled SE can cause secondary brain damage, the importance of controlling this condition to improve the outcome of patients with neurological diseases, including stroke, is a focus of attention in the field of neurointensive care. Various observational studies have identified acute symptomatic seizures as a high-risk factor for developing epilepsy after stroke. Recently, high accuracy in prediction of developing epilepsy was reported in the SeLECT score for cerebral infarction and the CAVE score for cerebral hemorrhage. Early intervention to suppress epileptogenesis would be crucial to reduce the incidence of post-stroke epilepsy in high-risk patients identified based on these scores. |
| Practice | Clinical internal medicine |
| Keywords | stroke, epilepsy, acute symptomatic seizure, electroencephalography, status epilepticus |
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残りの24件を表示する
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