癫痫与癫痫合并症- Guerrini.pptVIP

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy Autosomal dominant; penetrance 75% Marked intra-familial variation in severity Inheritance easily overlooked as relatives may be mildly affected COMPONENTS OF THE OUTPATIENT EPILEPSY ENCOUNTER Seizure rate and severity assessment Screen for adverse AED effects Assess physical fitness activity Screen for depression and anxiety Review symptoms of endocrine dysfunction Review sleep hygiene Screen for headache symptoms Assess any other patient or family concern From Gilliam et al, 2005, modified Co-occurrence: because they are not asociated by chance but because share common pathophysiological mechanisms, whether we understand them or not. * Epilepsy and comorbid conditions Renzo Guerrini Clinical Neurology Unit Pediatric Hospital A. Meyer and University of Florence, FLORENCE, ITALY Differential diagnosis Diagnostic pitfalls when one disorder is mistaken for the other Diagnosis of co-occurrence Epilepsy and neurological comorbidities: Poor physical fitness, fatigue, obesity Sleep dysfunction Depression and anxiety Migraine Movement disorders Epilepsy and comorbidities Physical fitness Body mass index, aerobic and muscle strength endurance, and physical flexibility are significantly worse in epilepsy patients Physical activity and aerobic capacity reduced Reduced bone health in women, children and men, with increased risk of fracture Obesity associated with AED intake (valproate, carbamazepine) Steinhoff et al, 1996; Bjorholt, 1990; Souverain, 2005 Obesity associated with AEDs intake Retrospective studies are not powered to detect increased body weight associated with AED intake However, patients with epilepsy have an increased risk for obesity, cardiovascular disease, insulin resistance, reproductive disorders Awareness is a possible cause of noncompliance, especially in adolescents Specific studies show that weight gain occurs in 50% of VPA treated and in