关键词:

缺血性脑卒中, 继发性癫痫, 卡马西平, 通窍活血汤

Abstract:

Objective　To investigate the clinical efficacy of carbamazepine combined with Tongqiao Huoxue Decoction in the treatment of secondary epilepsy (SE) after cerebral ischemic stroke (CIS). Methods　One hundred and eighty patients with SE after CIS treated at Xi'an Traditional Chinese Medicine Brain Disease Hospital from June 2021 to June 2023 were selected for the prospective study, and were divided into a western medicine group and a study group by the random number table method, with 90 cases in each group. In the western medicine group, there were 67 males and 23 females; they were (52.56±6.22) years old; the course of the latest seizure was (3.23±0.66) d; 32 cases had mild seizures, 45 cases moderate, and 13 cases severe; they were treated with carbamazepine. In the study group, there were 65 males and 25 females; they were (52.74±6.44) years old; the course of the latest seizure was (3.11±0.56) d; 28 cases had mild seizures, 47 cases moderate, and 15 cases severe; they were treated with Tongqiao Huoxue Decoction and carbamazepine. Both groups were treated for 16 weeks. After the treatment, all the patients were followed up for 3 months by recheck, telephone, etc. The clinical efficacies, epileptic seizures and electroencephalogram indicators before and 3 months after the treatment, cognitive function and neurological function before and after the treatment, and incidence rates of adverse reactions were compared between the two groups by χ² test, t test, and rank sum test. Results　Among the 180 patients, 2 cases were excluded from the study because of poor compliance, and 1 case was excluded because of being out of follow-up; 177 cases were included,including 89 cases in the study group and 88 cases in the western medicine group. The total effective rate of the study group was higher than that of the western medicine group [89.89% (80/89) vs. 69.32% (61/88)], with a statistical difference (P<0.05). The number of epileptic seizures, duration of seizures, number of affected leads, and epileptic discharge 3 months after the treatment and the score of National Institutes of Health Stroke Scale (NIHSS) after the treatment were lower than those before the treatment in both groups (all P<0.05), while the scores of Montreal Cognitive Assessment Scale (MoCA) after the treatment were higher (both P<0.05). After the treatment, the number of epileptic seizures, duration of seizures, number of affected leads, epileptic discharge, and score of NIHSS in the study group were lower than those in the western medicine group [(1.76±0.24) times/d vs. (2.45±0.44) times/d, (1.13±0.32) min/time vs. (1.63±0.51) min/time, (3.67±1.20) 180 s vs. (4.89±1.57) 180 s, (7.22±2.11) t/180 s vs. (10.72±3.36) t/180 s, and 7.44±1.23 vs. 9.63±1.48], but the score of MoCA was higher (24.45±4.37 vs. 18.33±4.44), with statistical differences (all P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the study group and the western medicine group (P<0.05). Conclusion　Carbamazepine combined with Tongqiao Huoxue Decoction for patients with SE after CIS is effective and safe, and can control their epileptic seizures, reduce epileptic discharge and involvement range, and improve their cognitive and neurological functions.

Key words:

Cerebral ischemic stroke, Secondary epilepsy, Carbamazepine, Tongqiao Huoxue , Decoction