癫痫发作和癫痫的管理的更新.ppt

Seizures Epilepsy:Update on Management Bassel F. Shneker, MD Comprehensive Epilepsy Program The Ohio State University E-mail: shneker.1@osu.edu September 8, 2006 Outline Definition Etiology Classification Differential Diagnosis Treatment of Epilepsy Definition of Seizures Time-limited paroxysmal events that result from abnormal, involuntary, rhythmic neuronal discharges in the brain Seizures are usually unpredictable Seizures usually brief ( 5 minutes) and stop spontaneously Convulsion, ictus, event, spell, attack and fit are used to refer to seizures Right Temporal Lobe Seizure Etiology of Seizures Seizures are either provoked or unprovoked Provoked Seizures: Triggered by certain provoking factors in otherwise healthy brain Metabolic abnormalities (hypoglycemia and hyperglycemia, hyponatremia, hypocalcemia) Alcohol withdrawal Acute neurological insult (infection, stroke, trauma) Illicit drug intoxication and withdrawal Prescribed medications that lower seizure threshold (theophylline, TCA) High fever in children Unprovoked Seizures: Occur in the setting of persistent brain pathology Definition of Epilepsy A disease characterized by spontaneous recurrence of unprovoked seizures (at least 2) Seizures are symptoms, while epilepsy is a disease, so those terms should not be used interchangeably Epilepsy = “seizure disorder” Epilepsy is a syndromic disease Each epilepsy syndrome is determined based on; Type of seizures, age at seizure onset, family history, physical exam, EEG findings, and neuroimaging Etiology of Epilepsy Any process that alters the structure (macroscopic or microscopic) or the function of the brain neurons can cause epilepsy Processes that lead to structural alteration include; Congenital malformation Degenerative disease Infectious disease Trauma Tumors Vascular process In majority of patients, the etiology is proposed but not found Classification of Seizures Traditionally divided into “ grand mal” and “petit mal” seizures ILAE classificat