儿童期癫痫发作课件.ppt

Neurology Chapter of IAP Seizures in Childhood Reference Paediatrics Child health Coovadia and Wittenberg p.477-483 Lecture on AED Introduction Convulsion associated with febrile disease 2-4% of all children before the age of 5 years Symptomatic seizures 0.5-1% Epilepsy: Recurrent unprovoked seizures First year of life: 1,2/1 000 Childhood and adolescents: 0,5-1/10000 Aetiology of Epilepsy Specific aetiology Identifiable in only 30% of cases Idiopathic 67.6% Congenital 20% Trauma HIE Congenital brain anomalies Trauma 4.7% Infection 4.0% Vascular 1.5% Neoplastic 1.5% Degenerative 0.7% Seizure type Epilepsy classification Clinical presentation is quite variable age of onset seizure type interictal condition EEG Outcome Evaluate the: the epileptic syndrome Possible aetiology The seizure type and syndrome type determine the Specific appropriate treatment Further evaluation Main Periods according to Age Neonates Subtle, erratic, non-febrile Infancy and early childhood 3 months to 3 years Febrile seizures Infantile spasms Lennox Gastaut Myoclonic seizures Status epilepticus Partial complex Main Periods according to Age Childhood to early adolescence Cryptogenic Absences Benign rolandic epilepsy Nine years to adulthood Primary generalized epilepsy Focal epilepsy with brain injury Neonatal seizures Subtle seizures Deviation of the eyes Eyelids are flickering Swimming or pedaling movements Apnoeic spells Tonic Clonic Myoclonic Seldom tonic clonic seizures Aetiology of neonatal seizures Perinatal: HIE ICH Metabolic Hypoglycemia, hypocalcemia hypomagnesemia Other Infections Structural abnormalities Drug withdrawal Treatment of neonatal seizures Optimize ventilation, cardiac output, BP, glucose, electrolytes and pH. Treat the underlying disease Intravenous line is essential Treat the seizures promptly and vigorously Phenobarbitone Phenytoin Non-epileptic paroxysmal events in childhood Syncope Breath-holding spells Pallid: Vagal asystole Cyanotic: Cerebra ischaemia