内科学实习手册.doc

内科学实习手册 CAPTER 7: Neurology System Seizures and Epilepsy 4150 A seizure is a paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of central nervous system (CNS) neurons. Epilepsy describes a condition in which a person has recurrent seizures due to a chronic, underlying process. 1. Diagnosis 1.1 Simple partial seizures Begin with motor, sensory, or autonomic phenomena, depending on the cortical region affected. Consciousness is preserved. The abnormal motor movements may begin in a very restricted region such as the fingers, the face, a limb, or the pharynx. Focal seizure may spread from the distal part of the limb toward the ipsilateral face (jacksonian march). patients may experience a localized paresis (Todds paralysis) for minutes to many hours in the involved region following the seizure. Autonomic symptoms may consist of pallor, flushing, sweating, piloerection, pupillary dilatation, vomiting, borborygmi, and incontinence. Psychic symptoms include distortions of memory, forced thinking or labored thought processes, cognitive deficits, affective disturbances (eg, fear, depression, an inappropriate sense of pleasure), hallucinations, or illusions. 1.2 Complex partial seizures The symptoms are usually stereotyped. Episodes may begin with an aura, epigastric sensations are most common, but affective (fear), cognitive (déjà vu), and sensory (olfactory hallucinations) symptoms also occur. Consciousness is then impaired. Seizures generally persist for less than 30 minutes (on the average, 1–3 minutes). The motor manifestations are characterized by automatism, such as orobuccolingual movements and other facial or neck movements. 1.3 Absence seizures (petit mal) Are characterized by sudden, brief loss of consciousness without loss of postural control. The seizure typically lasts for only seconds, consciousness returns as suddenly as it was lost, and there is no postictal confusion. Absence seizures are usually accompanied by