儿科学英文课件：09 惊厥

1、Acute convulsion in ChildrencontentsDefinitionsCauses of acute convulsion Febrile seizuresExams and Tests for convulsionTreatment of acute convulsionAcute convulsion in ChildrenDefinitionsEpileptic Seizures（癫痫发作） manifestation of transient excessive abnormal hypersynchronous discharges of cortical n

2、eurons Clinical signs or symptoms of seizures depend on the location of the epileptic discharges in the cortex and the extent and pattern of the propagation of the epileptic discharge in the brain. May be manifested as a motor, sensory, autonomic, cognitive, or psychic disturbance manifestation is a

3、pparent either to the subject or an observerDifferent types of seizures may occur in different parts of the brain and may be localized (affect only a part of the body) or widespread (affect the whole body).Acute convulsion in ChildrenDefinitionsConvulsive seizures (惊厥性癫痫发作，convulsion 惊厥): is a subty

4、pe of epileptic seizure in which abnormal motor activity occurs, noted by uncontrollable muscle jerking Epilepsy（癫痫）: a chronic disorder of the brain characterized by recurrent, unprovoked epileptic seizures.Acute convulsion in Children癫痫发作（痫性发作，epileptic seizures 或 seizures）大脑皮层神经元异常同步放电引起的暂时性脑功能异常

5、 临床可有多种发作症状（包括运动、感觉异常、行为认知、植物神经功能障碍等）分为惊厥性痫样发作（惊厥）、非惊厥性痫样发作发作性、并有自限性、大多短暂可发生于急性疾病、慢性疾病惊厥（Convulsion）神经元异常放电：起源于大脑皮层运动区脑功能障碍基本表现：抽搐（全身或局部骨骼肌的不自主收缩）可伴有不同程度意识障碍定 义excessive abnormal discharges of cortical neuronsEpileptic Seizuresconvulsive seizure (convulsion) nonconvulsive seizureAcute epileptic seiz

6、ure(provoked in acute disorders) epilepsy (recurrent, unprovoked epileptic seizures)Acute convulsion in Children癫痫发作、惊厥、癫痫癫痫发作(Epileptic Seizures)：发作性大脑皮层功能异常所引起的多种临床症状惊厥(convulsion) ：伴有骨骼肌强烈、不自主收缩的痫性发作癫痫(epilepsy) ：临床呈长期反复痫性发作的疾病过程Acute convulsion in ChildrenCharacteristics of acute convulsion in c

7、hildrenHigh incidence: 4-6% in the children younger than 6yrEasily with prolonged convulsion or status convulsion Status convulsion（惊厥持续状态): a convulsion lasting longer than 30 minutes or repeated convulsion without a return to normal in between them usually with minim or subtle seizure in the babie

8、s Seizures may occur for many causesAcute convulsion in ChildrencontentsDefinitions (Seizure, Convulsion, Epilepsy) Causes of acute convulsions Febrile seizuresExams and Tests for convulsionTreatment of acute convulsionAcute convulsion in ChildrenCommon causes of acute convulsionCNS infection: Menin

9、gitis or encephalitisFebrile convulsions（ Febrile seizures）Head traumaCNS malformationsBrain tumorsMetabolic disorders: Hypoglycemia, Hyponatremia, hypernatremia, Hyperosmolar states, HypocalcemiaIdiopathic or cryptogenic epilepsy Acute convulsion in ChildrenClassification of the causes of convulsio

10、n infectious diseases other disordersIntracranialdiseaseBacterial Meningitis, Tuberculous meningitis, Viral meningitis/encephalitis fungal meningitis, parasitic disease,brain abscessHead traumaCNS malformationsBrain tumorsepilepsyExtracranialdiseaseFebrile convulsionsInfectious-toxic encephalopathy

11、Anoxia, ischemiaMetabolic disorders: Hypoglycemia Hyponatremia Hypernatremia HypocalcemiaToxicosis rodenticide organic pesticideAcute convulsion in ChildrenIntracranial infectionUsually with infectious symptoms（fever、drowsiness、irritation、delirium）Recurrent, severe, prolonged seizure Common occur in

12、 early stage or the most serious stage of diseaseUsually with the disturbance of impairment of consciousnessWith the manifestations of intracranial hypertensionUseful lab test: CSF Causes of acute seizures颅外感染中毒性脑病大多见于严重细菌感染过程中与感染和毒素导致的脑水肿有关临床特征：原发疾病极期 反复惊厥发作 伴有意识障碍与颅内压增高症状 脑脊液检查仅压力增高惊厥病因-感染性content

13、sDefinitions (Seizure,Convulsion,Epilepsy) Causes of acute convulsion Febrile seizures（热性惊厥）Exams and Tests for convulsionTreatment of acute convulsionAcute convulsion in ChildrenGeneral IntroductionAn event in infancy or childhood usually occurring between three months and five years of age, associ

14、ated with fever, but without evidence of intracranial infection or an identifiable neurological disorder”Febrile seizures are the most common seizure disorder in childhood, affecting 25% of children. Febrile seizuresGeneral IntroductionAssociated with upper respiratory infection, otitis media, viral

15、 syndromeGenetic predisposition clearly contributes to the occurrence of this disorderBe divided into simple febrile seizures, complex febrile seizuresAmong children with febrile seizures, about 70-80% have only simple febrile seizures, others have complex febrile seizuresFebrile seizuresFeatures of

16、 Febrile SeizureMost common cause of seizures in childhood, usually with good prognosisAssociated with fever, usually occur when body temperature rises rapidlyFebrile seizuresFeatures of Febrile SeizureOccur in the absence of intracranial infection or an identifiable neurological disorder.Age depend

17、ent: 6mon-3yr ( peak age of onset:18-22mo of age)With normal CNS structure and functionFebrile seizuresFeatures of Febrile SeizureNo afebrile seizure historyMost underlying infection cause the fever may be a viral infection Genetic predisposition gene location: SFS: 19p 13-3; FS with TLE: 8q 13-21;

18、FS+: 2q21-q33 , 19q13.1 Febrile seizuresSimple febrile Seizure (SFS)The setting is fever in a child aged 6 months to 3 yearsTypically seizure is generalized (tonic-clonic)Duration of seizure: a few seconds to 15minOnly has once or twice of seizures during a period of disease Febrile seizuresComplex

19、febrile Seizure(CFS)Age of seizure onset: 6 months to 5 years; 6yrsprolonged seizure: persisting for more than 15 min Repeated convulsions during a febrile period (multiple seizures occur in close succession).A focal seizure.Recurrent seizure ( 5 times) Febrile seizures单纯性FS（SFS）复杂性FS（CFS）发病率FS中80%F

20、S中20%发作形式全身性发作，发作后不留任何异常神经征局限性或不对称性发作。发作后可留异常神经征发作次数在一次热程中仅有一次惊厥发作（2/3）， 少数2次（1/4-1/3）反复多次（丛集式发作：24小时内反复发作2次）持续时间发作时间短暂，多数515分钟内。发作时间长（ 15分钟）复发总次数4次以内5次以上 热性惊厥的分类及基本临床特征Risk factors for recurrent febrile seizuresYoung age at time of first febrile seizure: 15mo or 18moFamily history of a febrile seiz

21、ure in a first degree relative Complex febrile SeizureBrief duration between fever onset and initial seizure Patients with all 4 risk factors have greater than 70% chance of recurrence. Patients with no risk factors have less than a 20% chance of recurrence.Febrile seizuresRisk factors for epilepsyC

22、omplex febrile seizure (a prolonged, or focal, or recur seizure in the same illness) Family history of epilepsyNeurological abnormality, and developmental delay. Children with a febrile seizure have a slight increase in the incidence of epilepsy compared with the general population (1% vs 0.5%). Pat

23、ients with 2 risk factors have up to 10% chance of developing afebrile seizures.Febrile seizuresManagementIdentification and treatment of underlying infectionKeeping the patient cool with regular antipyreticsTermination of a prolonged convulsion ( diazepam, iv or rectally) Parental educationEffectiv

24、e drugs for preventing recurrent febrile seizure: Phenobarbital, Sodium valproate, diazepamFebrile seizuresClassfication of the causes of convulsion infectious diseases other disordersIntracranialdiseaseBacterial Meningitis, Tuberculous meningitis, Viral meningitis/encephalitis fungal meningitis, pa

25、rasitic disease,brain abscessHead traumaCNS malformationsBrain tumorsepilepsyExtracranialdiseaseFebrile convulsionsInfectious-toxic encephalopathy Anoxia, ischemiaMetabolic disorders: Hypoglycemia Hyponatremia Hypernatremia HypocalcemiaToxicosis rodenticide organic pesticideAcute convulsion in Child

26、rencontentsDefinitions (Seizure, Convulsion, Epilepsy) Causes of acute convulsion Febrile seizuresExams and Tests for convulsionTreatment of acute convulsion History of patientThe course of current seizure activity Time and nature of onset of seizure activity Involvement of extremities or other body

27、 parts Nature of movements (eg, eye movements, flexion, extension, stiffening of extremities), including any focal movements and details of postictal neurologic deficit Incontinence Cyanosis (perioral or facial) Duration of seizure activity prior to medical attention Mental status after cessation of

28、 seizure activityExams and Tests for seizuresHistory of patientFever or intercurrent illnesses Prior history of seizures Head injury (recent and remote) CNS infection or disease (eg, meningitis, neurocutaneous syndrome) Intoxication or toxic exposure Birth history and developmental delay Exams and T

29、ests for seizuresPhysical ExaminationObtain temperature and vital signs ( important in the initial evaluation) Examine for signs suggestive of trauma or the presence of an intracranial shuntExamine for papilledema (suggesting increased intracranial pressure)Examine for nuchal rigidity (suggesting me

30、ningitis) Exams and Tests for seizuresPhysical ExaminationExamine skin for findings suggestive of neurocutaneous syndromeExamine features of appropriate neurodevelopmentIdentify any focal neurologic deficits (may beindicative of an underlying focal structural lesionor postictal Todd paresis)Exams an

31、d Tests for seizures病因学诊断提示病史-年龄新生儿期：颅脑损伤、颅内畸形、颅内感染、代谢紊乱1-6月：颅内感染、低钙、婴儿痉挛-3岁：热性惊厥、颅内感染、中毒性脑病、癫痫3岁以上：颅内感染、中毒性脑病、癫痫、颅脑外伤病因学诊断提示病史-季节夏秋季节：中毒性痢疾 流行性乙型脑炎 低血糖症冬春季节：流行性脑脊髓膜炎 肺炎中毒性脑病 VitD缺乏性低钙惊厥病因学诊断提示病史-是否伴发热无热者大多非感染性，但3月幼婴、新生儿以及休克者例外发热者大多为感染性，但惊厥持续状态可致体温升高病史-惊厥严重程度Laboratory EvaluationInitial laboratory e

32、valuation can include: blood analysis (WBC count), urinalysis , stool examination Serum studies for glucose, electrolytes, calcium, and magnesium and toxicology studies Exams and Tests for seizuresLaboratory EvaluationPerform a CT scan or MRI if the patient has had a recent head trauma, significantl

33、y altered mental status, a significant headache, papilledema, ora bulging fontanel.Consider a lumbar puncture (LP) in patients who have fever and a stiff neck or who have fever and are unconscious. Others: EEG Exams and Tests for seizures病因学诊断提示实验室检查三大常规：白细胞计数、大便（中毒性菌痢）选择性生化检查：血糖、Ca+、Mg+、Na+、 肝肾功能脑脊液检查：疑有颅内病变者其它：EEG、头CT/MRIcontentsDefinitions(Seizure,Convulsion,Epilepsy) Causes of acute convulsion Febrile seizuresExams and Tests for convulsionTreatment of acute convulsionDZP（地西泮，安定）LZP（劳拉西泮，氯羟安定） PHT（苯妥因）PB（苯巴比妥）成人（mg/kg)iv0.150.2