20140822卒中及癫痫(陈阳美).ppt

卒中与癫痫 Operational (practical) clinical definition of epilepsy ● Epilepsy is a disease of the brain defined by any of the following conditions: ? At least two unprovoked (or reflex) seizures occurring 24 h apart ? One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years ? Diagnosis of an epilepsy syndrome ● Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years. 癫痫的定义 ●根据新的定义，癫痫是由以下标准定义的脑部疾病： ?1.间隔超过24小时发生的、至少2次的非诱发性（或反射性）痫性发作； ? 2. 未来10年内，与2次非诱发性痫性发作总体再发风险（至少60%）有近似再发可能性的、单次非诱发性（或反射性）痫性发作； ? 3. 诊断为癫痫综合征。 Case Example 1 ●Two seizures. A 25-year-old woman has two unprovoked seizures, 1 year apart. ● Comment: This person has epilepsy, according to both the old and new definitions. Case Example 2 ● Stroke and seizure A 65-year-old man had a left middle cerebral artery stroke 6 weeks ago and now presented with an unprovoked seizure ● Comment: With a seizure in this time relation to a stroke (or brain infection or brain trauma) the literature suggests a high (70%) risk of another unprovoked seizure Therefore, in the new (but not the old) definition, this man would have epilepsy. Case Example 3 ● Photic seizures A 6-year-old boy has had two seizures 3 days apart while playing a videogame involving flashing lights. There have been no other seizures. EEG shows an abnormal photoparoxysmal response. ● Comment: This boy has epilepsy according to the new definition (but not the old), even though the seizures are provoked by lights, since there is an abnormal enduring predisposition to have seizures with light flashes. Case Example 4 ● Benign Epilepsy with Centrotemporal Spikes (BECTS). A 22-year-old man had seizures with face twitching when