癫痫的定义.ppt

Status Epilepticus and Serial seizures 神經科 黃子軒 051007 癲癇的定義 1925, 英人 J Hughling Jackson: 腦部神經細胞不正常放電 癲癇是由許多先天或後天的因素所引起的慢性腦病，其特徵是由於腦細胞的過度放電(excessive discharge)所引起的反覆性發作(epileptic seizure)，伴隨多種類型的臨床表現 Seizure (癲癇發作): 腦部異常放電 症狀 每個人都有可能(alcohol, drug, infection, exciting etc...) Epilepsy(癲癇症): 反覆發作 疾病狀態 癲癇的定義 Aura: 前兆，希臘語 “颱風前之微風”，發作前之警告，seizure的一部分，本身就是simple partial seizure。 Automatism: 自動症，automatic behavior during seizure with altered consciousness. Fit: 發作。 Ictus: 發作。 Ictal: related to seizure itself. Postictal: immediately after seizure. Interictal: between attacks of seizure, often symptom free. 癲癇的流行病學 盛行率 0.3 - 0.7% (平均每兩百人中一個) 發生率 30-70/100000 (每年新增病例) 每九到十人中，有一人其一生中發生過一次或多次的癲癇發作(epileptic seizure) 癲癇發作(seizure)的分類International Classification of Epileptic Seizure Partial (local onset) 局部發作 Simple partial seizure 單純局部發作 Complex partial seizure 複雜局部發作 Partial seizure with secondary generalization 局部發作演變成次發性全身發作 Generalized (bilaterally symmetric without local onset) 全身發作 GTCS, Absence….etc 癲癇(epilepsy)的分類International Classification of Epilepsies and Epileptic Syndrome Idiopathic epilepsy syndromes (focal or generalized) Benign neonatal convulsions Benign childhood epilepsy Childhood/juvenile absence epilepsy Juvenile myoclonic epilepsy unspecified Symptomatic epilepsy syndromes ( focal or generalized) West syndrome (infantile spasms) Lennox-Gastaut syndrome Epilepsia partialis continua Other epilepsy syndromes of uncertain or mixed classification Simple Partial Seizure 單純局部發作 Consciousness not impaired意識清楚 With Motor symptoms: simple clonic convulsion, Jacksnoian marching, adversion… Somatosensory or special sensory symptoms: paresthesia, auditory or visual hallucination… Autonomic symptoms: abdominal cramp, vomiting, vertigo… Psychic symptoms: déjà vu, jamai vu, fear, anxiety… Complex Partial Seizure 複雜局部發作 (Psychomotor seizure, temporal epilepsy) Consciousness impaired Limbic cortex involved Amnesia Two subtypes Simple