儿科英文课件：癫痫Epilepsy

EpilepsyGeneralConsiderationsAseizureisasudden,transientdisturbanceofbrainfunction,manifestedbyinvoluntarymotor,sensory,autonomic,orpsychicphenomena,aloneorinanycombination,oftenaccompaniedbyalterationorlossofconsciousness.Aseizuremayoccurafterametabolic,traumatic,anoxic,orinfectiousinsulttothebrain.Repeatedseizureswithoutevidentcausejustifythelabelofepilepsy.GeneralConsiderationsIncidenceisgreatestinearlyandlatelife,withaprevalenceofapproximately3～6‰.Chanceofhavingasecondseizureafteraninitialunprovokedepisodeis30%.Chanceofremissionfromepilepsyinchildhoodis80%.GeneralConsiderationsRecurrencerateafterthewithdrawalofdrugsisabout30%.Idiopathicorgeneticepilepsymostoftenappearsbetweenages4and16yaers.GeneralConsiderationsFactorsadverselyinfluencingrecurrenceinclude:DifficultyingettingtheseizuresundercontrolNeurologicdysfunctionormentalretardationAgeatonsetunder2yearsAbnormalEEGatthetimeofdiscontinuingmedicationTypeofepilepsyEtiologyGeneticfactorBraindamageanddysmetabolismInbornAcquiredCausativefactorClassificationClassifiedbyetiologyIdiopathic(essential)epilepsySymptomatic(secondary)epilepsyCryptogenicepilepsyClassificationClassifiedbyepilepticseizuresPartial(foal,local)seizuresSimplepartialseizures,withoutimpairmentofconsciousnessWithmotorsignsWithsomatosensoryorspecial-sensorysymptomsWithautonomicsymptomsorsignsWithpsychicsymptomsClassificationClassifiedbyepilepticseizuresComplexpartialseizures,withimpairmentofconsciousnessPartialseizuresevolvingtosecondarilygeneralizedseizuresClassificationClassifiedbyepilepticseizuresGeneralizedseizuresAbsenceseizuresTypicalabsenceAtypicalabsenceMyoclonicseizuresClonicseizuresTonicseizuresTonic-clonicseizuresAtonicseizuresInfantspasm,tonic-spasmUnclassifiedepilepticseizuresClassificationClassificationofepilepsyandepilepsysyndromesBenignchildrenepilepsywithcentrol-temporalspikeLennox-GastautsyndromeInfantilespaamsJuvenilemyoclonicClinicalmanifestationPartialepilepsyFocalepilepsymayarisefromanintracerebralstructuraldefect,causingmotororsensorysymptomslocalizedtoonebodypart,whichmaythenspreadstocontiguousregionsofthecortex(e.g.jacksonianseizures).Therearesimplepartialseizureswithoutimpairmentofconsciousness.Complexpartialseizuresassociatedwithdisturbanceofconsciousnessusually

ariseinthetemporallobe.ClinicalmanifestationPartialepilepsySeizuresarisinginthemedialtemporallobemayproducedisturbancesofsmellandtaste,visualhallucinations.Thesemayevolvetoatonic-clonicseizures(secondarygeneralization).Weaknessfollowingtheeventmayoccurforminutesorhours(todd’sparesis).ClinicalmanifestationGeneralizedseizuresAbsenceattacksusuallyconsistofabriefinterruptionofactivity,sometimeswithcomplexmotoractivity(suchasfumblingwithclothes),butwithoutcollapse.EEGduringthiseventshowsathree-per-secondspike-and-waveactivity.ClinicalmanifestationGeneralizedseizuresInageneralizedtonic-clonicseizures,thetonicphaseisasuddentoniccontractionofmusclesusuallywithupwardeyedeviation.Theclonic(‘withclonus-typeactivity’)phasefollows.InitialEEGchangesareoftenbilateral.Thisconditionusuallyhasitsonsetinchildhood.DiagnosisofepilepsyTheintegratediagnosisshouldincludeseizuretype,anatomy,etiologyandconcomitantmentaldisorders.Forexample:Epilepsy--grandmal—secondary(symptomatic)—mentalretardationEpilepsy—centrotemporalspikewave--benignchildhoodepilepsy第一课件网站

DiagnosisofepilepsyClinicalpictureClinicalhistoryDescriptionofSzSymptomatologyPhysical/NeurologicexaminationTherapy

EEGBackgroundactivityEpileptiformactivityInterictalIctalPostictalLaboratorytestsNeuroimagingDifferenialdiagnosisFebrileSeizures

Ages3monthsto5yearsFeverNon-CNSinfectionGeneralizedseizuresLastlessthan5

minutesMigrainePositivefamilyhistory.PulsatileheadacheManifestationsofautonomicnervedisorderVisualdisorderSensorydisturbance

DifferenialdiagnosisBreath-holdingspellsAge6monthsto3years,Cry,lossofconsciousnessApneaandcyanosisFamilyhistorypositivein30%NormalEEG.Sleepingdisturbance

Sleepwalking,NightmareNightterrors

DifferenialdiagnosisMasturbationConsciousnessnotimpairedNormalEEGPseudoseizuresEffectual

Suggestivetherapy

NormalEEGTourettesydromeSimpleorcompletestereotypedjerksormovementsCoughandgruntNormalEEGPositiveFamilyhistory

AnapproachtoSeizuresTreatmentofepilepsyTherapeuticprincipleofntiepilepsydrugs(AEDs)EarlytreatmentTreatmentasthetypesofepilepticseizureTreatmentwithonedrugIndividualtherapyLongcourseoftreatmentSlowdrugwithdrawalPeriodicre-examination

Treatmentofepilepsy

AEDsselectionontypesofepilepticseizure

typesdrugsTonic-clonicseizuresVPA,PB,CBZ,PRMorPHTAbsenceseizuresVPA,ES,

CNPMyoclonicseizuresVPA,CNP,PRM,TopamaxPartialseizuresCBZ,VPA,PB,PHT,PRM,T