Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và đánh giá kết quả điều trị ở bệnh nhân động kinh sau chấn thương sọ não=Clinical, subclinical characteristics and initial results of the treatment of epilepsy after traumatic brain injury

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Thị Vân Hà Dương, Đình Toàn Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Thần kinh học, 2024

Mô tả vật lý: tr.20-30

Bộ sưu tập: Báo, Tạp chí

ID: 225449

Thêm vào giỏ

Động kinh sau chấn thương sọ não (ĐKSCTSN) để lại gánh nặng bệnh tật lớn, làm giảm chất lượng sống của bệnh nhân (BN). Việc hiểu rõ các đặc điểm lâm sàng, cận lâm sàng và đánh giá hiệu quả điều trị góp phần cải thiện chất lượng quản lý ĐKSCTSN. Mục tiêu : 1. Khảo sát đặc điểm lâm sàng và cận lâm sàng của bệnh nhân ĐKSCTSN tại Bệnh viện hữu nghị Việt Nam - Cuba Đồng Hới. 2. Đánh giá kết quả điều trị ĐKSCTSN sau 3 tháng. Đối tượng và phương pháp : Nghiên cứu mô tả cắt ngang, có theo dõi trên 58 BN ĐKSCTSN đến khám và điều trị tại Bệnh viện Hữu nghị Việt Nam - Cuba Đồng Hới từ 4/2022 đến 6/2023. Kết quả : Lâm sàng: Tỷ lệ ĐKSCTSN muộn (sau CTSN >
1 tuần) là 69%
trong đó xuất hiện cơn đầu tiên sau 1 tuần - 6 tháng chiếm 6,9%, từ 6 tháng - 1 năm là 3,4%. Đa số cơn ĐK kéo dài <
5 phút (86,2%) với tần suất ít nhất 1 cơn/tháng là 37,9%
1 cơn/tuần 32,8% và có cơn hàng ngày là 24,1%. Cơn cục bộ chiếm 89,6%, cơn toàn thể 10,4%
có sự khác biệt về hình thái cơn ĐK giữa nhóm ĐK sớm và ĐK muộn. Cận lâm sàng: Điện não đồ (ĐNĐ) bất thường ghi nhận ở 24,1% trường hợp (TH) với các đặc điểm: sóng chậm lan tỏa 2 bán cầu (6,9%), sóng chậm khu trú 1 bán cầu (17,2%). Vị trí tổn thương trên CLVT/CHT: thái dương 53,4% và trán 46,6%. Kết quả điều trị: 87,9% TH CTSN được điều trị bảo tồn và 12,1% được phẫu thuật. Thuốc chống ĐK sử dụng: Depakin (62,5%), Tegretol (13,8%), Phenytoin (13,8%), Keppra (8,6%)
tỷ lệ tuân thủ điều trị 89,7%, tỷ tái phát cơn 37,9%. ĐKSCTSN sớm có tỷ lệ tái phát thấp hơn ĐKSCTSN muộn (22,2% so với 45%). Trong 3 tháng điều trị phần lớn có tần số cơn ĐK từ 1 - 4 lần (72,2%) và 19,0% cần nhập viện lại. Biến chứng thần kinh được ghi nhận ở 12,1% BN. Tỷ lệ BN có triệu chứng dự báo ĐK là 43,1%, cao hơn ở nhóm ĐK muộn (50,0%) so với nhóm ĐK sớm (27,8%). Kết luận : Nên xem xét dự phòng ĐKSCTSN ở BN sau CTSN trên lâm sàng có cơn co giật mà điện não chưa thấy bất thường hoặc BN lớn tuổi có tổn thương thuỳ thái dương và trán.Post-traumatic epilepsy (PTE) results in a huge burden and reduces patients’ quality of life. Understanding clinical, subclinical characteristics and assessing treatment results helps to improve management strategies for epilepsy after traumatic brain injury (TBI).Objectives: 1. To describe clinical and subclinical characteristics of patients with PTE at Vietnam - Cuba Friendship Dong Hoi Hospital. 2. To evaluate initial results of the treatment of PTE after 3 months. Methods: A cross-sectional descriptive study with follow-up on 58 patients with PTE receiving examination and treatment at Vietnam - Cuba Friendship Dong Hoi Hospital from April 2022 to June 2023. Results: Clinical: Late PTE (occurring >
1 week after TBI) accounted for 69% with 6.9% of first seizures occurred from 1 week - 6 months after TBI while 3.4% happened between 6 months - 1 year. Most seizures lasting less than 5 minutes (86.2%)
37.9% had ≥ 1 seizure per month
32.8% had 1 seizure weekly and daily attacks accounted for 24.1%.Focal seizure registered the majority (89.6%) while generalized seizures accounted for 10.4%
there was a difference in type of seizure between early PTE and late PTE. Subclinical: Abnormal electroencephalogram (EEG) was recorded in 24.1% of cases with following characteristics: diffuse slowing in both hemispheres (6.9%), localized slow waves (17.2%). Lesion location on CT/MRI: temple 53.4% and forehead 46.6%. Treatment results: 87.9% of TBI cases were treated conservatively and 12.1% were treated surgically. Antiepileptic medications: Depakin (62.5%), Tegretol (13.8%), Phenytoin (13.8%), Keppra (8.6%)
treatment adherence rate was very high (89.7%). The recurrence rate was 37.9%, this was lower in the group of early PTE compared with late PTE (22.2% versus 45%). During 3 months of treatment, the majority had 1 - 4 seizures (72.2%) and 19.0% needed re-hospitalization. Neurological complications were recorded in 12.1% of cases. Aura happened in 43.1% of cases, more frequently in late PTE when compared with early PTE (50.0% and 27.8%, respectively).Conclusion: Prophylaxis of PTE should be considered in TBI patients having seizures without EEG abnormalities or in elderly patients with temporal and frontal lobe lesions.

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