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

摘要：

目的　探讨卡马西平联合通窍活血汤治疗缺血性脑卒中（CIS）后继发性癫痫（SE）的临床疗效。方法　采用前瞻性研究，选取2021年6月至2023年6月西安中医脑病医院收治的CIS后SE患者180例，随机数字表法将其分为西药组和研究组，各90例。西药组男67例，女23例，年龄（52.56±6.22）岁，距离最近一次癫痫发作病程（3.23±0.66）d；癫痫发作严重程度：轻度32例，中度45例，重度13例；给予卡马西平治疗。研究组男65例，女25例，年龄（52.74±6.44）岁，距离最近一次癫痫发作病程（3.11±0.56）d；癫痫发作严重程度：轻度28例，中度47例，重度15例；在西药组的基础上加用通窍活血汤治疗。两组患者均连续治疗16周，在治疗结束后通过复查、电话随访等形式随访3个月。比较两组临床疗效，治疗前与治疗后3个月癫痫发作情况、脑电图指标，治疗前与治疗结束时的认知功能、神经功能，统计两组不良反应发生情况。采用χ²检验、t检验与秩和检验进行统计分析。结果　180例患者中，有2例患者因依从性不佳，1例失访未纳入本研究，最终纳入CIS后SE患者177例，其中研究组89例、西药组88例。研究组治疗总有效率高于西药组［89.89%（80/89）比69.32%（61/88）］，差异有统计学意义（P<0.05）。两组治疗结束后3个月的癫痫发作次数、发作持续时间、累及导联数、痫样放电与治疗结束时的美国国立卫生院脑卒中量表（NIHSS）评分均低于治疗前（均P<0.05），治疗结束时的蒙特利尔认知评估量表（MoCA）评分高于治疗前（均P<0.05）；且研究组治疗后癫痫发作次数、发作持续时间、累及导联数、痫样放电、NIHSS评分均低于西药组［（1.76±0.24）次/d比（2.45±0.44）次/d、（1.13±0.32）min/次比（1.63±0.51）min/次、（3.67±1.20）180 s比（4.89±1.57）180 s、（7.22±2.11）t/180 s比（10.72±3.36）t/180 s、（7.44±1.23）分比（9.63±1.48）分］，MoCA评分高于西药组［（24.45±4.37）分比（18.33±4.44）分］，差异均有统计学意义（均P<0.05）。研究组、西药组不良反应发生率比较，差异无统计学意义（P<0.05）。结论　卡马西平联合通窍活血汤治疗CIS后SE疗效显著，可以控制癫痫发作，降低痫样放电及其累及范围，有助于改善患者的认知功能和神经功能，具有一定安全性。

关键词:

缺血性脑卒中, 继发性癫痫, 卡马西平, 通窍活血汤