兒科學(xué)英文課件：09 驚厥

1、Acute convulsion in ChildrencontentsDefinitionsCauses of acute convulsion Febrile seizuresExams and Tests for convulsionTreatment of acute convulsionAcute convulsion in ChildrenDefinitionsEpileptic Seizures（癲癇發(fā)作） manifestation of transient excessive abnormal hypersynchronous discharges of cortical n

2、eurons Clinical signs or symptoms of seizures depend on the location of the epileptic discharges in the cortex and the extent and pattern of the propagation of the epileptic discharge in the brain. May be manifested as a motor, sensory, autonomic, cognitive, or psychic disturbance manifestation is a

3、pparent either to the subject or an observerDifferent types of seizures may occur in different parts of the brain and may be localized (affect only a part of the body) or widespread (affect the whole body).Acute convulsion in ChildrenDefinitionsConvulsive seizures (驚厥性癲癇發(fā)作，convulsion 驚厥): is a subty

4、pe of epileptic seizure in which abnormal motor activity occurs, noted by uncontrollable muscle jerking Epilepsy（癲癇）: a chronic disorder of the brain characterized by recurrent, unprovoked epileptic seizures.Acute convulsion in Children癲癇發(fā)作（癇性發(fā)作，epileptic seizures 或 seizures）大腦皮層神經(jīng)元異常同步放電引起的暫時(shí)性腦功能異常

5、 臨床可有多種發(fā)作癥狀（包括運(yùn)動(dòng)、感覺異常、行為認(rèn)知、植物神經(jīng)功能障礙等）分為驚厥性癇樣發(fā)作（驚厥）、非驚厥性癇樣發(fā)作發(fā)作性、并有自限性、大多短暫可發(fā)生于急性疾病、慢性疾病驚厥（Convulsion）神經(jīng)元異常放電：起源于大腦皮層運(yùn)動(dòng)區(qū)腦功能障礙基本表現(xiàn)：抽搐（全身或局部骨骼肌的不自主收縮）可伴有不同程度意識(shí)障礙定 義excessive abnormal discharges of cortical neuronsEpileptic Seizuresconvulsive seizure (convulsion) nonconvulsive seizureAcute epileptic seiz

6、ure(provoked in acute disorders) epilepsy (recurrent, unprovoked epileptic seizures)Acute convulsion in Children癲癇發(fā)作、驚厥、癲癇癲癇發(fā)作(Epileptic Seizures)：發(fā)作性大腦皮層功能異常所引起的多種臨床癥狀驚厥(convulsion) ：伴有骨骼肌強(qiáng)烈、不自主收縮的癇性發(fā)作癲癇(epilepsy) ：臨床呈長(zhǎng)期反復(fù)癇性發(fā)作的疾病過程Acute convulsion in ChildrenCharacteristics of acute convulsion in c

7、hildrenHigh incidence: 4-6% in the children younger than 6yrEasily with prolonged convulsion or status convulsion Status convulsion（驚厥持續(xù)狀態(tài)): a convulsion lasting longer than 30 minutes or repeated convulsion without a return to normal in between them usually with minim or subtle seizure in the babie

8、s Seizures may occur for many causesAcute convulsion in ChildrencontentsDefinitions (Seizure, Convulsion, Epilepsy) Causes of acute convulsions Febrile seizuresExams and Tests for convulsionTreatment of acute convulsionAcute convulsion in ChildrenCommon causes of acute convulsionCNS infection: Menin

9、gitis or encephalitisFebrile convulsions（ Febrile seizures）Head traumaCNS malformationsBrain tumorsMetabolic disorders: Hypoglycemia, Hyponatremia, hypernatremia, Hyperosmolar states, HypocalcemiaIdiopathic or cryptogenic epilepsy Acute convulsion in ChildrenClassification of the causes of convulsio

10、n infectious diseases other disordersIntracranialdiseaseBacterial Meningitis, Tuberculous meningitis, Viral meningitis/encephalitis fungal meningitis, parasitic disease,brain abscessHead traumaCNS malformationsBrain tumorsepilepsyExtracranialdiseaseFebrile convulsionsInfectious-toxic encephalopathy

11、Anoxia, ischemiaMetabolic disorders: Hypoglycemia Hyponatremia Hypernatremia HypocalcemiaToxicosis rodenticide organic pesticideAcute convulsion in ChildrenIntracranial infectionUsually with infectious symptoms（fever、drowsiness、irritation、delirium）Recurrent, severe, prolonged seizure Common occur in

12、 early stage or the most serious stage of diseaseUsually with the disturbance of impairment of consciousnessWith the manifestations of intracranial hypertensionUseful lab test: CSF Causes of acute seizures顱外感染中毒性腦病大多見于嚴(yán)重細(xì)菌感染過程中與感染和毒素導(dǎo)致的腦水腫有關(guān)臨床特征：原發(fā)疾病極期 反復(fù)驚厥發(fā)作 伴有意識(shí)障礙與顱內(nèi)壓增高癥狀 腦脊液檢查僅壓力增高驚厥病因-感染性content

13、sDefinitions (Seizure,Convulsion,Epilepsy) Causes of acute convulsion Febrile seizures（熱性驚厥）Exams and Tests for convulsionTreatment of acute convulsionAcute convulsion in ChildrenGeneral IntroductionAn event in infancy or childhood usually occurring between three months and five years of age, associ

14、ated with fever, but without evidence of intracranial infection or an identifiable neurological disorder”Febrile seizures are the most common seizure disorder in childhood, affecting 25% of children. Febrile seizuresGeneral IntroductionAssociated with upper respiratory infection, otitis media, viral

15、 syndromeGenetic predisposition clearly contributes to the occurrence of this disorderBe divided into simple febrile seizures, complex febrile seizuresAmong children with febrile seizures, about 70-80% have only simple febrile seizures, others have complex febrile seizuresFebrile seizuresFeatures of

16、 Febrile SeizureMost common cause of seizures in childhood, usually with good prognosisAssociated with fever, usually occur when body temperature rises rapidlyFebrile seizuresFeatures of Febrile SeizureOccur in the absence of intracranial infection or an identifiable neurological disorder.Age depend

17、ent: 6mon-3yr ( peak age of onset:18-22mo of age)With normal CNS structure and functionFebrile seizuresFeatures of Febrile SeizureNo afebrile seizure historyMost underlying infection cause the fever may be a viral infection Genetic predisposition gene location: SFS: 19p 13-3; FS with TLE: 8q 13-21;

18、FS+: 2q21-q33 , 19q13.1 Febrile seizuresSimple febrile Seizure (SFS)The setting is fever in a child aged 6 months to 3 yearsTypically seizure is generalized (tonic-clonic)Duration of seizure: a few seconds to 15minOnly has once or twice of seizures during a period of disease Febrile seizuresComplex

19、febrile Seizure(CFS)Age of seizure onset: 6 months to 5 years; 6yrsprolonged seizure: persisting for more than 15 min Repeated convulsions during a febrile period (multiple seizures occur in close succession).A focal seizure.Recurrent seizure ( 5 times) Febrile seizures單純性FS（SFS）復(fù)雜性FS（CFS）發(fā)病率FS中80%F

20、S中20%發(fā)作形式全身性發(fā)作，發(fā)作后不留任何異常神經(jīng)征局限性或不對(duì)稱性發(fā)作。發(fā)作后可留異常神經(jīng)征發(fā)作次數(shù)在一次熱程中僅有一次驚厥發(fā)作（2/3）， 少數(shù)2次（1/4-1/3）反復(fù)多次（叢集式發(fā)作：24小時(shí)內(nèi)反復(fù)發(fā)作2次）持續(xù)時(shí)間發(fā)作時(shí)間短暫，多數(shù)515分鐘內(nèi)。發(fā)作時(shí)間長(zhǎng)（ 15分鐘）復(fù)發(fā)總次數(shù)4次以內(nèi)5次以上 熱性驚厥的分類及基本臨床特征Risk factors for recurrent febrile seizuresYoung age at time of first febrile seizure: 15mo or 18moFamily history of a febrile seiz

21、ure in a first degree relative Complex febrile SeizureBrief duration between fever onset and initial seizure Patients with all 4 risk factors have greater than 70% chance of recurrence. Patients with no risk factors have less than a 20% chance of recurrence.Febrile seizuresRisk factors for epilepsyC

22、omplex febrile seizure (a prolonged, or focal, or recur seizure in the same illness) Family history of epilepsyNeurological abnormality, and developmental delay. Children with a febrile seizure have a slight increase in the incidence of epilepsy compared with the general population (1% vs 0.5%). Pat

23、ients with 2 risk factors have up to 10% chance of developing afebrile seizures.Febrile seizuresManagementIdentification and treatment of underlying infectionKeeping the patient cool with regular antipyreticsTermination of a prolonged convulsion ( diazepam, iv or rectally) Parental educationEffectiv

24、e drugs for preventing recurrent febrile seizure: Phenobarbital, Sodium valproate, diazepamFebrile seizuresClassfication of the causes of convulsion infectious diseases other disordersIntracranialdiseaseBacterial Meningitis, Tuberculous meningitis, Viral meningitis/encephalitis fungal meningitis, pa

25、rasitic disease,brain abscessHead traumaCNS malformationsBrain tumorsepilepsyExtracranialdiseaseFebrile convulsionsInfectious-toxic encephalopathy Anoxia, ischemiaMetabolic disorders: Hypoglycemia Hyponatremia Hypernatremia HypocalcemiaToxicosis rodenticide organic pesticideAcute convulsion in Child

26、rencontentsDefinitions (Seizure, Convulsion, Epilepsy) Causes of acute convulsion Febrile seizuresExams and Tests for convulsionTreatment of acute convulsion History of patientThe course of current seizure activity Time and nature of onset of seizure activity Involvement of extremities or other body

27、 parts Nature of movements (eg, eye movements, flexion, extension, stiffening of extremities), including any focal movements and details of postictal neurologic deficit Incontinence Cyanosis (perioral or facial) Duration of seizure activity prior to medical attention Mental status after cessation of

28、 seizure activityExams and Tests for seizuresHistory of patientFever or intercurrent illnesses Prior history of seizures Head injury (recent and remote) CNS infection or disease (eg, meningitis, neurocutaneous syndrome) Intoxication or toxic exposure Birth history and developmental delay Exams and T

29、ests for seizuresPhysical ExaminationObtain temperature and vital signs ( important in the initial evaluation) Examine for signs suggestive of trauma or the presence of an intracranial shuntExamine for papilledema (suggesting increased intracranial pressure)Examine for nuchal rigidity (suggesting me

30、ningitis) Exams and Tests for seizuresPhysical ExaminationExamine skin for findings suggestive of neurocutaneous syndromeExamine features of appropriate neurodevelopmentIdentify any focal neurologic deficits (may beindicative of an underlying focal structural lesionor postictal Todd paresis)Exams an

31、d Tests for seizures病因?qū)W診斷提示病史-年齡新生兒期：顱腦損傷、顱內(nèi)畸形、顱內(nèi)感染、代謝紊亂1-6月：顱內(nèi)感染、低鈣、嬰兒痙攣-3歲：熱性驚厥、顱內(nèi)感染、中毒性腦病、癲癇3歲以上：顱內(nèi)感染、中毒性腦病、癲癇、顱腦外傷病因?qū)W診斷提示病史-季節(jié)夏秋季節(jié)：中毒性痢疾 流行性乙型腦炎 低血糖癥冬春季節(jié)：流行性腦脊髓膜炎 肺炎中毒性腦病 VitD缺乏性低鈣驚厥病因?qū)W診斷提示病史-是否伴發(fā)熱無熱者大多非感染性，但3月幼嬰、新生兒以及休克者例外發(fā)熱者大多為感染性，但驚厥持續(xù)狀態(tài)可致體溫升高病史-驚厥嚴(yán)重程度Laboratory EvaluationInitial laboratory e

32、valuation can include: blood analysis (WBC count), urinalysis , stool examination Serum studies for glucose, electrolytes, calcium, and magnesium and toxicology studies Exams and Tests for seizuresLaboratory EvaluationPerform a CT scan or MRI if the patient has had a recent head trauma, significantl

33、y altered mental status, a significant headache, papilledema, ora bulging fontanel.Consider a lumbar puncture (LP) in patients who have fever and a stiff neck or who have fever and are unconscious. Others: EEG Exams and Tests for seizures病因?qū)W診斷提示實(shí)驗(yàn)室檢查三大常規(guī)：白細(xì)胞計(jì)數(shù)、大便（中毒性菌?。┻x擇性生化檢查：血糖、Ca+、Mg+、Na+、 肝腎功能腦脊液檢查：疑有顱內(nèi)病變者其它：EEG、頭CT/MRIcontentsDefinitions(Seizure,Convulsion,Epilepsy) Causes of acute convulsion Febrile seizuresExams and Tests for convulsionTreatment of acute convulsionDZP（地西泮，安定）LZP（勞拉西泮，氯羥安定） PHT（苯妥因）PB（苯巴比妥）成人（mg/kg)iv0.150.2