小兒急性驚厥(英文)課件

SeizuresProf.JiangLiDepartmentofNeurologyChildren’sHospitalofCHUMS小兒急性驚厥(英文)DefinitionsSeizure（發(fā)作）:asuddenattack,spasm,orconvulsion,asinepilepsyoranotherdisorder

Epilepticseizure（癲癇樣發(fā)作）:atransientepisodeofabnormalandexcessiveneuronalactivityinthebrainthatisapparenteithertothesubjectoranobserver.Epilepsy（癲癇）:achronicdisorderofthebraincharacterizedbyrecurrent,unprovokedepilepticseizures.小兒急性驚厥(英文)FeaturesofepilepticseizuresTheabnormalneuronalactivityduringanepilepticseizuremaybemanifestedasamotor,sensory,autonomic,cognitive,orpsychicdisturbance.Theneurophysiologicalbasisisinferredonclinicalgrounds.Aconvulsionisasubtypeofseizureinwhichmotoractivityoccurs.Canbeprovokedinindividualswhodonothaveepilepsy(examplesofprovokinginsultsincludingfever,trauma,hypoglycaemiaandhypoxia)Therearemanyparoxysmaldisturbances(‘funnyturns’)thatmimicepilepticseizures.小兒急性驚厥(英文)DifferentdiagnosisofepilepticseizuresBreath-holdingattacks:

provokedbytemperorfrustration;thescreamingtoddleholdstheirbreathinexpiration,goesblue,thenlimp,andthenmakesarapidspontaneousrecovery.Reflexanoxicseizures:

provokedbypainorfear;theinfantortoddlerbecomespaleandlosesconsciousness(reflectingsyncope,secondarytovagal-inducedbradycardia);Thesubsequenthypoxiamayinducedatonic-clonicseizure.Vasovagalsyncope(simplefaints):

usuallyoccursinteenagers;provokedbyemotion,hotenvironment;precededbynauseaanddizziness;suddenlossofconsciousnessandposture;rapidrecovery.Rigors:

transientexaggeratedshiveringinassociationwithhighfever.小兒急性驚厥(英文)ClassificationofepilepticseizuresGeneralizedseizures:thefirstclinicalchangeindicatesinitialinvolvementofbothcerebralhemispheresPartialseizures:thereisinitialactivationofpareofonecerebralhemisphere小兒急性驚厥(英文)GeneralizedseizuresAbsenceseizure:

briefunawarenesslastingafewseconds;nolossofposture;immediaterecovery;maybeveryfrequent;associatedwithautomatisms.Myoclonicseizures:

repaid,brief,usuallyisolatedjerksofthelimbs,neckortrunk.Tonicseizures:

ageneralisedincreaseintoneTonic-clonicseizures:

tonicphaseofrigiditywithlossofposturefollowedbyclonicmovementsofallfourlimbs;lossofconsciousness;duration2-20minutes;postictaldrowsiness.Atonicseizures:

atrainsientlossofmuscletonecausedasuddenfalltothefloorordropofthehead.小兒急性驚厥(英文)PartialseizuresSimplePartialseizures:whenthechildwillretainawarenesswithconsciousnessunpairedComplexPartialseizures:whenthereisanalteredconsciousstateorconfusionduetotheabnormalelectricaldischargespreadingfromtheoriginatingsitetobecomegeneralisedPartialseizureswithsecondarygeneralisation:whenthereisafocalseizuremanifestclinicallyoronanictalEEGfollowedbyageneralisedtonicclonicseizure.小兒急性驚厥(英文)CausesofepilepticseizuresFebrileseizures

acuteseizureassociatedwithfeverintheabsenceofintracranialinfectionoranidentifiableneurologicaldisorderEpilepsy

chronicdisorderofthebraincharaterizedbyrecurrent,unprovokedepilepticseizures小兒急性驚厥(英文)FebrileSeizure(FS)associatedwitharapidlyrisingtemperature(usuallydevelopwhenthecoretemperaturereaches390Corgreater)occurwiththediseasesoutsidetheCNSagedependent:6mon-3mon-6mon(peakageofonset:14-18moofage)WithnormalCNSstructureandfunctionNono-febrileseizurehistoryGeneticpredisposition小兒急性驚厥(英文)ClinicalManifestationofSimplefebrileSeizure(SFS)Occursinthechildren:6moto5yrofageTypicallygeneralizedseizure(tonic-clonic)Duration:afewsecondsto10-minOnlyhasonceortwiceofseizuresduringaperiodofdisease

小兒急性驚厥(英文)ClinicalManifestationofSimplefebrileSeizure(SFS)Ageofseizureonset:<6moor>6yrsSeizurepersistingformorethan15minRepeatedconvulsionsduringafebrileperiodAfocalseizure.AnEEGisindicatedforatypicalfebrileseizuresorforthechildatriskfordevelopingepilepsy小兒急性驚厥(英文)InformationforparentsaboutferibleseizuresWillithappenagain?★aboutonethirdchildrenhaverecurrentfebrileseizures;★recurrenceismorelikelymorelikelyifthefirstseizureoccursundertheageof18monthsorifthereisafamilyhistoryCanIpreventfurtherepisodes?★duringfebrileillness,thechildshouldbekeptcoolwithantipyretics,removalofclothing,andtepidspongingWhatshouldIdoifaconvulsionoccurs?★placechildinrecoveryposition★toadministerrectaldiazepamifaseizurelastslongerthan5minutesIsitepilepsy?★febrileseizuresarenotclassifiedasepilepsy,about3%ofchildrenwithFSgoontodevelopafebrilerecurrentseizures(epilepsy)★riskfactorsforepilepsyinclude:seizuresthatarefocal,prolonged(>15mins)orrecurinthesameillness;first-degreerelativewithepilepsy;neurologicalabnormality小兒急性驚厥(英文)ClassificationofepilepsiesAccordingtotheseizuretype

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Generalizedepilepsiesandsyndromes

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Localization-relatedepilepsiesandsyndromesAccordingtoaetiology

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Idiopathic(orprimary)---inwhichthereisnoapparentcauseexceptperhapsforgeneticpredisposition

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Symptomatic---inwhichthecauseisknownorsuspected小兒急性驚厥(英文)DiagnosisofepilepsyAcarefulandcompletehistory:detaileddescriptionoftheeventsbefore,during,andafterasuspectedseizureEEG:routineinterictalEEG;ambulatoryEEGmonitoring;VideoEEGrecordingNeuroimaging(CT,MRI)

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partialseizures

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Intractable,difficulttocontrolseizures

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Afocalneurologicaldeficit

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Evidenceofaneurocutaneoussyndromeorneurodegeneration小兒急性驚厥(英文)ManagementofepilepsyEducations:

aboutthecondition,theprognosis,andthenatureoftheparticularepilepsyorepilepsysyndrome.Specialprecautions:

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Swimming:acompetentadultswimmershoukdbepresenttoprovidesupervision.

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Domesticbathing:patientsshouldbesupervisedinthebath

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Cycling:ahelmetmustbewornandtrafficavoided

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Climbing:climbingtreesandr