《Epilepsy癫痫》PPT课件.ppt

Chapter 12. Epilepsy THE FIRST AFFILIATED HOSPITAL, SUN YET-SEN UNIVERSITY PROF. ZHOU LIE MIN lm_ KEY WORDS: Epilepsy(癫痫) Epileptic Seizure (癫痫发作) Electroencephalograph(EEG,脑电图 ) Epileptiform Discharge(痫性放电) Antiepileptic Drugs(抗癫痫药) EPILEPSY The Stress on the Chapter: 1. To comprehend the epileptic definition. 2. To understand and have a good command of epilepsy with generalized tonic-clonic seizure, absence seizure, complex partial seizure and Jacksonian epilepsy. West syndrome and Lennox-Gastaut syndrome. 3. To understand and have a good command of epileptic diagnoses 4. To understand and have a good command of distinguishing between generalized tonic-clonic seizure and hysteria, absence seizure and syncope. 5. To understand and have a good command of definition and treatment principle on status epilepsy with generalized tonic- clonic seizure. 6. To comprehend the principle in using antiepileptic drugs. Ronaldo Vincent van Gogh Seizure Epilepsy Epileptic Seizure Epilepsy is characterized by which sudden recurrent and transient disturbances of mental function or movements and sense of the body are resulted from abnormal neuronal discharges in brain.(used to) Part 1. DEFINITION Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure. (new concept) OUTLINE: Course: Course: the recurrence of epileptic seizures Location: usually arising from the cerebral cortex Pathogenesis: abnormal neuronal discharges Clinical signs: transient disturbances of cerebral function Part 1. DEFINITION Part 2. ATIOLOGY AND BASIC MECHANISMS OF EPILEPTOGENESIS, THE INDUCING ELEMENTS Symptomatic . Congenital diseases Structural Lesion of the Brain: Epilepsy . Brain trauma 1. Remarkable decrease in the . Infection of CN synaptic from GABA. . Brain tumor 2.Disorder of blood-brain barrier . Cerebrovascular D Biochemical Aspects: Decrease . Degenrative D in synthetic GABA and increase . Toxicosis in excitatory transmitter. . Nutritive and Electrophysiological Aspects: metabolic disturbance Paroxysmal depolarization . The others shift (PDS) discovered Atiology Pathogenesis Primary epilepsy Inheritance Mutation in Ion Channel (Idiopathic) (Usually no brain damage) cryptogenic ep unclear cannot be discoveried Mutation in Ion Channel ADNFLE The Elements of Interfering with Epilepsy Inheritance: Be susceptible to epilepsy or epileptic predisposition ( abnormal EEG) Environmental Influences: Fatigue or hunger, Hyperventilation The Others: Age, Endocrinosis, Sleep Disturbance (Dysfunction) Part 2. ATIOLOGY AND BBASIC MECHANISMS OF EPILEPTOGENESIS, THE INDUCING ELEMENTS Part 2. BBASIC MECHANISMS OF EPILEPTOGENESIS Inheritance or acquired factors Abnormal gene expression Neurotransmitter and modulator dysfunction Structure and function disorder of Ion-channel Neuronal discharge Epileptic seizure or epilepsy Part 3: Clinical Manifestations of Epileptic Seizures Classification of Epileptic Seizures (The 1981 International Classification of Epileptic Seizures) I. Partial seizures(seizures beginning locally) II. Generalized Seizures . Unclassified epileptic seizures Part 3: Clinical Manifestations of Epileptic Seizures I. Partial seizures(seizures beginning locally) A. Simple partial seizures ( consciousness not impaired) With motor symptoms With somatosensory or special sensory symptoms With autonomic symptoms With psychic symptoms Classification of Epileptic Seizures (The 1981 International Classification of Epileptic Seizures) 顶叶 B. Complex partial seizures (with impairment of consciousness) Beginning as simple partial seizures and progressing to impairment of consciousness With no other features With features as in A.1-4 With automatisms impairment of consciousness at onset With no other features With features as in A.1-4 With automatisms C . Partial seizures secondarily generalized seizure Classification of Epileptic Seizures II. Generalized Seizures (bilaterally symmetrical and without local onset) Absence seizures(Typical or Atypical AS) Myoclonic seizures Clonic seizures Tonic seizures Tonic-clonic seizures Atonic seizures . Unclassified epileptic seizures ( Inadequate or incomplete data) Classification of Epileptic Seizures Simple partial seizures With motor symptoms Complex partial seizures Absence seizures(Typical absence seizure) Generalized Tonic-clonic seizures Well focus our discussion on- Status Epilepticus with GTCS Focal Focal EpEp IdiopathicIdiopathic SynptomaticSynptomatic BRE, benign childhood occipital epilepsy, P Reading benign childhood occipital epilepsy, P Reading EpEp FrontalFrontal L, parietal L, Occipital L, Temporal L Ep GeneralizedGeneralized IdiopathicIdiopathic SynptomaticSynptomatic benign neonatal benign neonatal familialfamilial convulsions et al convulsions et al West SWest S、LGS et alLGS et al Early Early myoclonicmyoclonic encephalopathy encephalopathy , et al SynptomaticSynptomatic the legs usually extend and the arms flex partially. This phase usually last 10-20 seconds and the EEG show 10Hz multiple spikes. Clinical Manifestations of Generalized Tonic-Clonic Seizures(Three Phases) This is epileptic patient with generalized tonic-clonic seizure. Her tougue was bited during a epileptic seizure 1.1-2 Convulsion Phase (Tonic-Clonic Phase) Tonic Phase: As the patient falls, the body stiffens because of genera- lized tonic contraction of the axial and limb muscles. Eyes: upward eye deviation and pupillary dilation. Mouth: to be forced closure of the mouth, which sometimes produces oral trauma. “Epileptic cry”: to be caused by forcible expiration against opposed vocal cords, which results from sudden involuntary contraction of the respiratory and laryngeal muscles. Limbs: to be tonic flexion or extension of the axial musculature; the legs usually extend and the arms flex partially. This phase usually last 10-20 seconds and the EEG show 10Hz multiple spikes. Clinical Manifestations of Generalized Tonic-Clonic Seizures(Three Phases) 尖波 棘波 Clonic Phase: The transition from the tonic to the clonic phase is gradual, not sharply demarcated. After the tonic stage, jerking or clonic ( interrupted tonic ) movements occur in all limbs for less than a minute. This phase usually last 30 seconds to 1 minute and the EEG show multiple spikes-wave complexes and spike-wave complex. Clinical Manifestations of Generalized Tonic-Clonic Seizures(Three Phases) 1.1-2 Convulsion Phase (Tonic-Clonic Phase) Clinical Manifestations of Generalized Tonic-Clonic Seizures(Three Phases) Associated With Signs in the Tonic-Clonic Phase : Autonomic Disorders: Heart rate and blood pressure may be increased more than double, increased salivation and breathing may cause frothing at the mouth, urinary incontinence may occur, pupillary dilatation with loss of reactivity to light may be seen Respiration System: Respiration stops and pallor or cyanosis may be seen. Reflex: physiological reflex disappear and pathological reflex may be seen. Clinical Manifestations of Generalized Tonic-Clonic Seizures(Three Phases) 1.1-3 Immediate Postictal Phase (Recovery Phase): Recovery of respiration function recovery of autonomic function recovery of consciousness (sleep-confusion-normal) This phase usually last 4-9 minutes and the EEG show low-voltage slow waves, and then recovery of normal background waves 1.1-4 Status Epilepticus with GTCS Definition: Repepetitive tonic-clonic convulsions, in which the patient does not recover normal alert state between attacks, is status epilepticus with GTCS. These patients are usually associated with high fever, dehydration, aspiration pneumonitis, loss of acid - base balance, water and electrolytic disorder, brain edema, and so on. Clinical Manifestations We have to emphasize it is one of the emergencies and severe case This seizures are short interruptions of consciousness that last from 3 to 15 seconds , less than 30 seconds each, and begin and end abruptly as well as recur from a few to several hundred times per day. The patients may show ongoing behavior stopping, inconspicuous flickering of the eyelids or eyebrows at about times/second, partial atony, partial muscle stiffness and autonomic signs. EEG of this type show bilaterally synchronous 3 Hz spike- wave complex. 1.2 Absence Seizures 1.Generalized Seizures: EEG of the patient with AS show 3 Hz spike-wave complex. 2.1 Simple Partial Seizure (SPS) They are characterized by which I. symptoms often indicated the area of the brain, II. the clinical sign are only partial dysfunction, III. consciousness is not impairment. They are divided into four types: partial motor attacks, somatosensory attacks 、 and special sensory attacks，autonomic attacks， as well as attacks with psychic symptoms. Second: Clinical Manifestations of Epileptic Seizures 2. Partial Seizure 2.1-1 Partial Motor Seizure: Involve motor activity from any area of the body. Usually, they involve the limbs, face, or head and sometimes cause speech arrest. Jacksonian Seizure: If a PMS progresses with sequential involvement of parts of the body that are represented by contiguous cortical areas, it is known as a _. Todd Paralysis: Localized paralysis or weakness that may last for minutes or days after a partial motor seizure is called _. Second: Clinical Manifestations of Epileptic Seizures 2.1-1 Partial Motor Seizure: Involve motor activity from any area of the body. Usually, they involve the limbs, face, or head and sometimes cause speech arrest. Jacksonian Seizure: If a PMS progresses with sequential involvement of parts of the body that are represented by contiguous cortical areas, it is known as a _. Todd Paralysis: Localized paralysis or weakness that may last for minutes or days after a partial motor seizure is called _. Second: Clinical Manifestations of Epileptic Seizures (used to be called psychomotor seizures) Characteristically, complex partial seizure begin with emotional, psychic, illusory, hallucinatory, or special sensory symptoms. These are followed by clouding or unconsciousness with automatic behavior and amnesia(遗忘）. Complex partial seizure usually begin in the temporal lobe, but may originate from the frontal, parietal, or occipital areas. 2.2 Complex Partial Seizures Second: Clinical Manifestations of Epileptic Seizures Clinical Manifestation: Unconsciousness include confusion or somnolism or Somnambulance, twilight state朦胧状态, and is not coma. Automatisms are apparently purposeless and mechanical activity, such as picking at clothes, examining near by objects, simply walking about, chewing, swallowing, licki