Estudo de fatores clínicos preditivos para crises epilépticas após acidente vascular cerebral isquêmico

Fukujima, Marcia Maiumi; Cardeal, Jose Osmar; Lima, Jose Geraldo de Camargo

doi:10.1590/S0004-282X1996000200005

Resumos

Apresentamos aspectos clínicos de 35 pacientes com acidente vascular cerebral isquêmico que evoluíram com crises epilépticas (Grupo 1), comparando-os a 35 pacientes com AVCI sem crises epilépticas (Grupo 2). A comparação das idades entre os grupos não mostrou diferença significante. O sexo masculino e a raça branca predominaram em ambos os grupos. Diabetes melito, hipertensão arterial, ataque isquêmico transitório, acidente vascular cerebral pregresso, enxaqueca, doença de Chagas, embolia cerebral cardiogênica e uso de anticoncepcional oral não diferiram significantemente entre os grupos. Tabagismo e etilismo foram significantemente mais freqüentes no Grupo 1 (p<0,05). O quadro neurológico predominante foi motor, sugerindo comprometimento hemisférico em todos os casos do Grupo 1 e nenhum comprometimento isolado da fossa posterior neste grupo.

acidente vascular cerebral; infarto cerebral; epilepsia; crises epilépticas; etilismo; tabagismo

Preditive clinical factors for epileptic seizures after ischemic stroke. Clinical features of 35 patients with ischemic stroke who developed epilepsy (Group 1) were compared with those of 35 patients with ischemic stroke without epilepsy (Group 2). The age of the patients did not differ between the groups. There were more men than women and more white than other races in both groups. Diabetes melitus, hypertension, transient ischemic attack, previous stroke, migraine, Chagas disease, cerebral embolism of cardiac origin and use of oral contraceptive did not differ between the groups. Smokers and alcohol users were more frequent in Group 1 (p<0,05). Most patients of Group 1 presented with hemiparesis; none presented cerebellar or brainstem involvement. Perhaps strokes in smokers have some different aspects, that let them more epileptogenic than in non smokers.

stroke; cerebral infarction; epilepsy; epileptic seizure; alcoholism; smoking

Estudo de fatores clínicos preditivos para crises epilépticas após acidente vascular cerebral isquêmico

Preditive clinical factors for epileptic seizures after ischemic stroke

Marcia Maiumi Fukujima^I; Jose Osmar Cardeal^II; Jose Geraldo de Camargo Lima^III

^IMestre em Neurologia pela EPM-UNIFESP

^IIProfessor Adjunto da Disciplina de Neurologia da EPM-UNIFESP

^IIIProfessor Titular da Disciplina de Neurologia da EPM-UNIFESP. Estudo realizado no Setor de Doenças Neurovasculares da Disciplina de Neurologia da EPM-UNIFESP

RESUMO

Apresentamos aspectos clínicos de 35 pacientes com acidente vascular cerebral isquêmico que evoluíram com crises epilépticas (Grupo 1), comparando-os a 35 pacientes com AVCI sem crises epilépticas (Grupo 2). A comparação das idades entre os grupos não mostrou diferença significante. O sexo masculino e a raça branca predominaram em ambos os grupos. Diabetes melito, hipertensão arterial, ataque isquêmico transitório, acidente vascular cerebral pregresso, enxaqueca, doença de Chagas, embolia cerebral cardiogênica e uso de anticoncepcional oral não diferiram significantemente entre os grupos. Tabagismo e etilismo foram significantemente mais freqüentes no Grupo 1 (p<0,05). O quadro neurológico predominante foi motor, sugerindo comprometimento hemisférico em todos os casos do Grupo 1 e nenhum comprometimento isolado da fossa posterior neste grupo.

Palavras chave: acidente vascular cerebral, infarto cerebral, epilepsia, crises epilépticas, etilismo, tabagismo.

ABSTRACT

Preditive clinical factors for epileptic seizures after ischemic stroke. Clinical features of 35 patients with ischemic stroke who developed epilepsy (Group 1) were compared with those of 35 patients with ischemic stroke without epilepsy (Group 2). The age of the patients did not differ between the groups. There were more men than women and more white than other races in both groups. Diabetes melitus, hypertension, transient ischemic attack, previous stroke, migraine, Chagas disease, cerebral embolism of cardiac origin and use of oral contraceptive did not differ between the groups. Smokers and alcohol users were more frequent in Group 1 (p<0,05). Most patients of Group 1 presented with hemiparesis; none presented cerebellar or brainstem involvement. Perhaps strokes in smokers have some different aspects, that let them more epileptogenic than in non smokers.

Key words: stroke, cerebral infarction, epilepsy, epileptic seizure, alcoholism, smoking.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Agradecimento - Agradecemos ao Prof. Dr. Neil Ferreira Novo à e Profa. Dra. Yara Juliano pela orientação da análise estatística.

Aceite: 22-fevereiro-1996.

Este estudo faz parte da Tese de Mestrado "Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes"¹⁰, aprovada no curso de pós-graduação da Neurologia da Escola Paulista de Medicina (EPM) da Universidade Federal de São Paulo (UNIFESP).

Dra. Mareia Maiumi Fukujima - Disciplina de Neurologia, Escola Paulista de Medicina UNIFESP - Rua Botucatu 740 - 04023-900 São Paulo SP - Brasil. FAX 011 575 5240. E-Mail: maiumi@sti.com.br

1. Advaloff W. Cerebral atrophy and alcohol-withdrawal epilepsy: a clinical and computer tomography study. In Meinsardi H, Rowan A (eds). Advances in epileptology. Amsterdam: Swets and Zeitlinger, 1978:389-393.
2. Cerebral Embolism Study Group. Immediate anticoagulation of embolic stroke: a randomized trial. Stroke 1983;14:668-676.
3. Cerebral Embolism Study Group. Immediate anticoagulation of embolic stroke: brain hemorrhage and management options. Stroke 1984;15:779-789.
4. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189-195.
5. Courjon J, Artru F, Zeskov P. A propos des crises d'epilepsie apparaissant aprés 60 ans observées en clientele de neurologie dans un service de neurochirurgie. Sem Hop Paris 1970;46:3129-3132.
6. Dams AM, Fuglsang-Frederickson A, Svarre-OIsen U, Dam M. Late onset epilepsy, etiologies, types of seizure and value of clinical investigation, EEG and CT scan. Epilepsia 1986;26:227-231.
7. Davis KR, Taveras JM, New PFJ. Cerebral infarction diagnosis by computerized tomography. Am J Roentgenol 1975;124:643-660.
8. Engel J. Seizures and epilepsy. Philadelphia: Davis, 1989:112-134.
9. Fuerstein J, Weber M, Kurtz D, Rohmer F. Etude statistique des crises épileptiques apparaisant apres Page de 60 ans. Sem Hop Paris 1970;46:3125-3128.
10. Fukujima MM. Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes. Tese de Mestrado, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 1994.
11. Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1953 through 1967. Epilepsia 1975;16:1-66.
12. Holmes GL. The electroencephalogram as a predictor of seizures following cerebral infarctions. Clin Electroencephalogr 1980;11:83-86.
13. Janz D, Masuhr KF. Epilepsia tarda: a clinical, EEG and neuro-radiological study (taking in consideration cranial computerized tomography). Epilepsia 1978;19:110.
14. Lesser R, Luders H, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985;26:622-630.
15. Luhdorf F, Jensen LK, Plesner A. Etiology of seizures in the elderly. Epilepsia 1986;27:458-463.
16. Meyer JS, Charney JZ, Riviera VM, Mathew NT. Cerebral embolization: prospective clinical analysis of 42 cases. Stroke 1971;2:541-554.
17. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL. The Harvard cooperative stroke registry: a prospective registry. Neurology 1978;28:754-762.
18. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-1211.
19. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease: a study of the incidence and nature of 104 consecutive proven cases of cerebral infarction and hemorrhage. Epilepsia 1954;3:49-74,
20. Ron MA, Acker W, Shaw GK, Lishman WA. Computerized tomography of the brain in chronic alcoholism: a survey and follow up study. Brain 1982;105:497-514.
21. Scheuer ML, Cohen J. Seizures and epilepsy in the elderly. Neurol Clin 1993;11:787-804.
22. Shinton RA, Gill JS, Zezulka AV, Beevers DG. The frequency of epilepsy preceding stroke: case control study in 230 patients. Lancet 1987;1:11-12.
23. Siegel S. Estadistica no parametrica. México: Trillas, 1975.
24. Torvick A, Klindboe CF, Rodge S. Brain lesions in alcoholics: a neuropathological study with clinical correlation. J Neurol Sci 1982;56:233-248.
25. Victor M, Brausch C. The hole of abstinence in the genesis of alcoholic epilepsy. Epilepsia 1967;8:1-20.
26. Whisnant JP, Basford JR, Bernstein EF, Cooper ES, Dyken ML, Easton JD, Little JR, Marler JR, Millikan CH, Petito CK, Price TR, Raichle ME, Robertson JT, Thiele B, Walker MD, Zimmerman RA. Special report from the National Institute of Neurological Disorders and Stroke: Classification of Cerebrovascular Disease HI. Stroke 1990;21:637-676.

Datas de Publicação

Publicação nesta coleção
06 Dez 2010
Data do Fascículo
Jun 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Advaloff W. Cerebral atrophy and alcohol-withdrawal epilepsy: a clinical and computer tomography study. In Meinsardi H, Rowan A (eds). Advances in epileptology. Amsterdam: Swets and Zeitlinger, 1978:389-393.

[2] 2. Cerebral Embolism Study Group. Immediate anticoagulation of embolic stroke: a randomized trial. Stroke 1983;14:668-676.

[3] 3. Cerebral Embolism Study Group. Immediate anticoagulation of embolic stroke: brain hemorrhage and management options. Stroke 1984;15:779-789.

[4] 4. Cocito L, Favale E, Reni L. Epileptic seizures in cerebral arterial occlusive disease. Stroke 1982;13:189-195.

[5] 5. Courjon J, Artru F, Zeskov P. A propos des crises d'epilepsie apparaissant aprés 60 ans observées en clientele de neurologie dans un service de neurochirurgie. Sem Hop Paris 1970;46:3129-3132.

[6] 6. Dams AM, Fuglsang-Frederickson A, Svarre-OIsen U, Dam M. Late onset epilepsy, etiologies, types of seizure and value of clinical investigation, EEG and CT scan. Epilepsia 1986;26:227-231.

[7] 7. Davis KR, Taveras JM, New PFJ. Cerebral infarction diagnosis by computerized tomography. Am J Roentgenol 1975;124:643-660.

[8] 8. Engel J. Seizures and epilepsy. Philadelphia: Davis, 1989:112-134.

[9] 9. Fuerstein J, Weber M, Kurtz D, Rohmer F. Etude statistique des crises épileptiques apparaisant apres Page de 60 ans. Sem Hop Paris 1970;46:3125-3128.

[10] 10. Fukujima MM. Crises epilépticas após acidente vascular cerebral por infarto cerebral: estudo de 35 pacientes. Tese de Mestrado, Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo, 1994.

[11] 11. Hauser WA, Kurland LT. The epidemiology of epilepsy in Rochester, Minnesota, 1953 through 1967. Epilepsia 1975;16:1-66.

[12] 12. Holmes GL. The electroencephalogram as a predictor of seizures following cerebral infarctions. Clin Electroencephalogr 1980;11:83-86.

[13] 13. Janz D, Masuhr KF. Epilepsia tarda: a clinical, EEG and neuro-radiological study (taking in consideration cranial computerized tomography). Epilepsia 1978;19:110.

[14] 14. Lesser R, Luders H, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985;26:622-630.

[15] 15. Luhdorf F, Jensen LK, Plesner A. Etiology of seizures in the elderly. Epilepsia 1986;27:458-463.

[16] 16. Meyer JS, Charney JZ, Riviera VM, Mathew NT. Cerebral embolization: prospective clinical analysis of 42 cases. Stroke 1971;2:541-554.

[17] 17. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL. The Harvard cooperative stroke registry: a prospective registry. Neurology 1978;28:754-762.

[18] 18. Olsen TS, Hogenhaven H, Thage O. Epilepsy after stroke. Neurology 1987;37:1209-1211.

[19] 19. Richardson EP, Dodge PR. Epilepsy in cerebral vascular disease: a study of the incidence and nature of 104 consecutive proven cases of cerebral infarction and hemorrhage. Epilepsia 1954;3:49-74,

[20] 20. Ron MA, Acker W, Shaw GK, Lishman WA. Computerized tomography of the brain in chronic alcoholism: a survey and follow up study. Brain 1982;105:497-514.

[21] 21. Scheuer ML, Cohen J. Seizures and epilepsy in the elderly. Neurol Clin 1993;11:787-804.

[22] 22. Shinton RA, Gill JS, Zezulka AV, Beevers DG. The frequency of epilepsy preceding stroke: case control study in 230 patients. Lancet 1987;1:11-12.

[23] 23. Siegel S. Estadistica no parametrica. México: Trillas, 1975.

[24] 24. Torvick A, Klindboe CF, Rodge S. Brain lesions in alcoholics: a neuropathological study with clinical correlation. J Neurol Sci 1982;56:233-248.

[25] 25. Victor M, Brausch C. The hole of abstinence in the genesis of alcoholic epilepsy. Epilepsia 1967;8:1-20.

[26] 26. Whisnant JP, Basford JR, Bernstein EF, Cooper ES, Dyken ML, Easton JD, Little JR, Marler JR, Millikan CH, Petito CK, Price TR, Raichle ME, Robertson JT, Thiele B, Walker MD, Zimmerman RA. Special report from the National Institute of Neurological Disorders and Stroke: Classification of Cerebrovascular Disease HI. Stroke 1990;21:637-676.