癫痫EPILEPSY（双语）.ppt

EPILEPSY 赵迎春 教授 病因分类 特发性（原发性）癫痫及癫痫综合征 症状性癫痫及癫痫综合征 隐源性癫痫，即临床怀疑症状性癫痫，但未找到明确病因 状态关联性癫痫发作（如高热、睡眠剥夺等）通常不诊断为癫痫 国际抗癫痫联盟（1981）痫性发作分类 部分性发作 局部其始⑴单纯性： 无意识障碍，可分运动、体感或特殊感觉、自主神经和精神症状⑵复杂性：有意识障碍⑶继发泛化： 全面性发作 双侧对称性发作，有意识障碍，包括失神、肌阵孪、强直-阵孪、阵孪、失张力发作 不能分类的癫痫发作 病因及影响发作因素 遗传因素 离子通道蛋白，突变受体通道钙离子内流减少，导致突触前末梢释放抑制性神经递质GABA减少，突触抑制功能降低而引发癫痫发作 脑损伤如细胞膜结构缺损、抑制性神经元功能减退 影响发作因素 ①年龄：如婴儿痉挛症多在1周岁内起病，儿童失神癫痫多在6~7岁时起病 ②内分泌：如少数病人仅在月经期或妊娠早期发作 ③睡眠：某些GTCS常在晨醒后发生， ④缺睡、疲劳、饥饿、便密、饮酒、感情冲突和一过性代谢紊乱等都能诱发，过度换气对失神发作、闪光对肌阵挛发作有诱发作用 Partial seizures(Focal epilepsy) Simple partial seizures（consciousness not impaired） With motor symptoms, Jacksonian march, Todd’s paralysis With somatosensory or special symptoms With autonomic symptoms With psychic symptoms Complex partial seizures（Temporal lobe epilepsy,Psychomotor seizures） Epigastric sensation fear ,cognitive,hallucination Loss of memory during the attack Strong and prolonged feeling of the place， face，have all happen before Diminished contact with the environment Repetitive utterances Lip-smacking，Sniffing movement Absence seizures(Petit mal) Whole attack lasts less than 10 seconds Young person Sudden onset,sudden end,switch-like Unaware,still ,staring May occur several times a day EEG of Petil mal EEG of Petit mal Generalized tonic-clonic seizure(Grand mal) No warning Tonic phase Clonic phase Coma Confusion,headache Hour Possibility of sore tongue or lip,aching limbs, Tonic of Grand mal Usually less than 1min Loss of consciousness Tonic contraction of all muscles No breathing…cyanosis A cry ，a fall，stiffen Pupil Clonic of Grand mal Several min Still unconsis Convulsive movement Self –injure，incontinence of urine Irregular breathing…，cyanosis EEG of GTCS EEG of EP Coma of Grand mal Several min Still unconscious Flaccid paralysis of all limbs Regular breathing Colour improve EEG of GTCS AID DIAGNOSIS EEG（ECG EKG EMG EOG EGG） CT MRI PET CSF SPECT Diagnosis Clinical history and the imp