小儿急性惊厥(英文).ppt

Seizures Prof JiangLiDepartmentofNeurologyChildren sHospitalofCHUMS Definitions Seizure 发作 asuddenattack spasm orconvulsion asinepilepsyoranotherdisorderEpilepticseizure 癫痫样发作 atransientepisodeofabnormalandexcessiveneuronalactivityinthebrainthatisapparenteithertothesubjectoranobserver Epilepsy 癫痫 achronicdisorderofthebraincharacterizedbyrecurrent unprovokedepilepticseizures Featuresofepilepticseizures Theabnormalneuronalactivityduringanepilepticseizuremaybemanifestedasamotor sensory autonomic cognitive orpsychicdisturbance Theneurophysiologicalbasisisinferredonclinicalgrounds Aconvulsionisasubtypeofseizureinwhichmotoractivityoccurs Canbeprovokedinindividualswhodonothaveepilepsy examplesofprovokinginsultsincludingfever trauma hypoglycaemiaandhypoxia Therearemanyparoxysmaldisturbances funnyturns thatmimicepilepticseizures Differentdiagnosisofepilepticseizures Breath holdingattacks provokedbytemperorfrustration thescreamingtoddleholdstheirbreathinexpiration goesblue thenlimp andthenmakesarapidspontaneousrecovery Reflexanoxicseizures provokedbypainorfear theinfantortoddlerbecomespaleandlosesconsciousness reflectingsyncope secondarytovagal inducedbradycardia Thesubsequenthypoxiamayinducedatonic clonicseizure Vasovagalsyncope simplefaints usuallyoccursinteenagers provokedbyemotion hotenvironment precededbynauseaanddizziness suddenlossofconsciousnessandposture rapidrecovery Rigors transientexaggeratedshiveringinassociationwithhighfever Classificationofepilepticseizures Generalizedseizures thefirstclinicalchangeindicatesinitialinvolvementofbothcerebralhemispheresPartialseizures thereisinitialactivationofpareofonecerebralhemisphere Generalizedseizures Absenceseizure briefunawarenesslastingafewseconds nolossofposture immediaterecovery maybeveryfrequent associatedwithautomatisms Myoclonicseizures repaid brief usuallyisolatedjerksofthelimbs neckortrunk Tonicseizures ageneralisedincreaseintoneTonic clonicseizures tonicphaseofrigiditywithlossofposturefollowedbyclonicmovementsofallfourlimbs lossofconsciousness duration2 20minutes postictaldrowsiness Atonicseizures atrainsientlossofmuscletonecausedasuddenfalltothefloorordropofthehead Partialseizures SimplePartialseizures whenthechildwillretainawarenesswithconsciousnessunpairedComplexPartialseizures whenthereisanalteredconsciousstateorconfusionduetotheabnormalelectricaldischargespreadingfromtheoriginatingsitetobecomegeneralisedPartialseizureswithsecondarygeneralisation whenthereisafocalseizuremanifestclinicallyoronanictalEEGfollowedbyageneralisedtonicclonicseizure Causesofepilepticseizures FebrileseizuresacuteseizureassociatedwithfeverintheabsenceofintracranialinfectionoranidentifiableneurologicaldisorderEpilepsychronicdisorderofthebraincharaterizedbyrecurrent unprovokedepilepticseizures FebrileSeizure FS associatedwitharapidlyrisingtemperature usuallydevelopwhenthecoretemperaturereaches390Corgreater occurwiththediseasesoutsidetheCNSagedependent 6mon 3mon 6mon peakageofonset 14 18moofage WithnormalCNSstructureandfunctionNono febrileseizurehistoryGeneticpredisposition ClinicalManifestationofSimplefebrileSeizure SFS Occursinthechildren 6moto5yrofageTypicallygeneralizedseizure tonic clonic Duration afewsecondsto10 minOnlyhasonceortwiceofseizuresduringaperiodofdisease ClinicalManifestationofSimplefebrileSeizure SFS Ageofseizureonset 6yrsSeizurepersistingformorethan15minRepeatedconvulsionsduringafebrileperiodAfocalseizure AnEEGisindicatedforatypicalfebrileseizuresorforthechildatriskfordevelopingepilepsy Informationforparentsaboutferibleseizures Willithappenagain aboutonethirdchildrenhaverecurrentfebrileseizures recurrenceismorelikelymorelikelyifthefirstseizureoccursundertheageof18monthsorifthereisafamilyhistoryCanIpreventfurtherepisodes duringfebrileillness thechildshouldbekeptcoolwithantipyretics removalofclothing andtepidspongingWhatshouldIdoifaconvulsionoccurs placechildinrecoveryposition toadministerrectaldiazepamifaseizurelastslongerthan5minutesIsitepilepsy febrileseizuresarenotclassifiedasepilepsy about3 ofchildrenwithFSgoontodevelopafebrilerecurrentseizures epilepsy riskfactorsforepilepsyinclude seizuresthatarefocal prolonged 15mins orrecurinthesameillness first degreerelativewithepilepsy neurologicalabnormality Classificationofepilepsies Accordingtotheseizuretype Generalizedepilepsiesandsyndromes Localization relatedepilepsiesandsyndromesAccordingtoaetiology Idiopathic orprimary inwhichthereisnoapparentcauseexceptperhapsforgeneticpredisposition Symptomatic inwhichthecauseisknownorsuspected Diagnosisofepilepsy Acarefulandcompletehistory detaileddescriptionoftheeventsbefore during andafterasuspectedseizureEEG routineinterictalEEG ambulatoryEEGmonitoring VideoEEGrecordingNeuroimaging CT MRI partialseizures Intractable difficulttocontrolseizures Afocalneurologicaldeficit Evidenceofaneurocutaneoussyndromeorneurodegeneration Managementofepilepsy Educations aboutthecondition theprognosis andthenatureoftheparticularepilepsyorepilepsysyndrome Specialprecautions Swimming acompetentadultswimmershoukdbepresenttoprovidesupervision Domesticbathing patientsshouldbesupervisedinthebath Cycling ahelmetmustbewornandtrafficavoided Climbing climbingtreesandrocksisbestavoided Managementofepilepsy Useofanti epilepsydrugs AEDs NotallthechildrenrequireAEDstreatment ChoiceofAEDsbasedonthetypeofseizure first linedrugsforgeneralizedepilepsy Sodiumvalproate first