小儿急性惊厥(英文)

1、Seizures,Prof. Jiang Li Department of Neurology Childrens Hospital of CHUMS,Definitions,Seizure （发作）: a sudden attack, spasm, or convulsion, as in epilepsy or another disorder Epileptic seizure（癫痫样发作）: a transient episode of abnormal and excessive neuronal activity in the brain that is apparent eith

2、er to the subject or an observer. Epilepsy（癫痫）: a chronic disorder of the brain characterized by recurrent, unprovoked epileptic seizures.,Features of epileptic seizures,The abnormal neuronal activity during an epileptic seizure may be manifested as a motor, sensory, autonomic, cognitive, or psychic

3、 disturbance. The neurophysiological basis is inferred on clinical grounds. A convulsion is a subtype of seizure in which motor activity occurs. Can be provoked in individuals who do not have epilepsy ( examples of provoking insults including fever,trauma, hypoglycaemia and hypoxia) There are many p

4、aroxysmal disturbances (funny turns) that mimic epileptic seizures.,Different diagnosis of epileptic seizures,Breath-holding attacks: provoked by temper or frustration;the screaming toddle holds their breath in expiration,goes blue, then limp, and then makes a rapid spontaneous recovery. Reflex anox

5、ic seizures: provoked by pain or fear; the infant or toddler becomes pale and loses consciousness( reflecting syncope, secondary to vagal-induced bradycardia); The subsequent hypoxia may induced a tonic-clonic seizure. Vasovagal syncope (simple faints): usually occurs in teenagers; provoked by emoti

6、on, hot environment; preceded by nausea and dizziness; sudden loss of consciousness and posture; rapid recovery. Rigors: transient exaggerated shivering in association with high fever.,Classification of epileptic seizures,Generalized seizures: the first clinical change indicates initial involvement

7、of both cerebral hemispheres Partial seizures: there is initial activation of pare of one cerebral hemisphere,Generalized seizures,Absence seizure: brief unawareness lasting a few seconds; no loss of posture; immediate recovery; may be very frequent; associated with automatisms. Myoclonic seizures:

8、repaid, brief, usually isolated jerks of the limbs, neck or trunk. Tonic seizures: a generalised increase in tone Tonic-clonic seizures: tonic phase of rigidity with loss of posture followed by clonic movements of all four limbs; loss of consciousness; duration 2-20minutes; postictal drowsiness. Ato

9、nic seizures: a trainsient loss of muscle tone caused a sudden fall to the floor or drop of the head.,Partial seizures,Simple Partial seizures: when the child will retain awareness with consciousness unpaired Complex Partial seizures: when there is an altered conscious state or confusion due to the

10、abnormal electrical discharge spreading from the originating site to become generalised Partial seizures with secondary generalisation: when there is a focal seizure manifest clinically or on an ictal EEG followed by a generalised tonic clonic seizure.,Causes of epileptic seizures,Febrile seizures a

11、cute seizure associated with fever in the absence of intracranial infection or an identifiable neurological disorder Epilepsy chronic disorder of the brain charaterized by recurrent, unprovoked epileptic seizures,Febrile Seizure(FS),associated with a rapidly rising temperature (usually develop when

12、the core temperature reaches 390C or greater ) occur with the diseases out side the CNS age dependent: 6mon-3mon-6mon ( peak age of onset:14-18mo of age) With normal CNS structure and function No no-febrile seizure history Genetic predisposition,Clinical Manifestation of Simple febrile Seizure(SFS),

13、Occurs in the children:6mo to 5 yr of age Typically generalized seizure (tonic-clonic) Duration: a few seconds to 10-min Only has once or twice of seizures during a period of disease,Clinical Manifestation of Simple febrile Seizure(SFS),Age of seizure onset: 6yrs Seizure persisting for more than 15

14、min Repeated convulsions during a febrile period A focal seizure. An EEG is indicated for atypical febrile seizures or for the child at risk for developing epilepsy,Information for parents about ferible seizures,Will it happen again? about one third children have recurrent febrile seizures; recurren

15、ce is more likely more likely if the first seizure occurs under the age of 18 months or if there is a family history Can I prevent further episodes? during febrile illness, the child should be kept cool with antipyretics, removal of clothing, and tepid sponging What should I do if a convulsion occur

16、s? place child in recovery position to administer rectal diazepam if a seizure lasts longer than 5 minutes Is it epilepsy? febrile seizures are not classified as epilepsy, about 3% of children with FS go on to develop afebrile recurrent seizures ( epilepsy) risk factors for epilepsy include: seizure

17、s that are focal, prolonged (15mins) or recur in the same illness; first-degree relative with epilepsy; neurological abnormality,Classification of epilepsies,According to the seizure type Generalized epilepsies and syndromes Localization-related epilepsies and syndromes According to aetiology Idiopa

18、thic ( or primary) -in which there is no apparent cause except perhaps for genetic predisposition Symptomatic-in which the cause is known or suspected,Diagnosis of epilepsy,A careful and complete history: detailed description of the events before, during, and after a suspected seizure EEG:routine in

19、terictal EEG;ambulatory EEG monitoring; Video EEG recording Neuroimaging (CT, MRI) partial seizures Intractable, difficult to control seizures A focal neurological deficit Evidence of a neurocutaneous syndrome or neurodegeneration,Management of epilepsy,Educations: about the condition, the prognosis, and the nature of the particular epilepsy or epilepsy syndrome. Special precautions: Swimming: a competent adult swimmer shoukd be present to provide supervision. Domestic bathing: patients should be su