癫痫诊疗常规课件.ppt

癫痫诊疗常规 北京天坛医院癫痫中心 丁成赟 有关癫痫的基本概念 癫痫:多种病因-大脑-慢性疾病,神经元过度电位发放-临床反复 短暂 刻板发作性症状 癫痫: 癫痫是一种脑部疾患,特点是持续存在能产生癫痫发作的脑部持久性改变,并出现相应的神经生物学,认识,心理及社会学等方面的伴随症状.诊断癫痫至少需要一次临床癫痫发作. 发作:一次短暂突然 开始和迅速结束的症状.可为癫痫性或非癫痫性 发放:神经元或一群神经元反复去极化引起的异常放电,是癫痫发作和脑电图异常的基础 癫痫的流行病学 患病率:7.2‰ 发病率:中国城市35/10万/年,中国农村25/10万/年 发病率与年龄相关:1岁以内,60岁以上 发病率与发作类型:部分性-全面性 死亡率:1.3~1.6/10万,(普通人群2~3倍) 癫痫的病因 特发性---症状性---隐原性 1年龄因素: (新生儿,婴幼儿,儿童及青少年,成人,老年人) 2遗传因素: 3大脑发育异常 4颞叶内侧硬化 5颅脑损伤 6中枢神经系统感染 7脑肿瘤 8脑血管病 9药物 10代谢障碍 11神经系统变性及脱髓鞘疾病 癫痫的发病机制 神经元电位异常 离子通道异常 中枢神经系统递质异常 免疫功能异常 细胞形态及功能异常 癫痫的分类及临床表现 一 ILAE癫痫发作的临床分类(1981) 二 ILAE癫痫及癫痫综合症的分类(1989) International classification of epileptic seizures I. Partial (focal, localized) seizures Simple partial seizures(with motor signs, with somatosensory or special sensory systems,with autonomic symptoms or signs, with psychic symptoms) Complex partial seizures(simple partial onset followed by impairment of consciousness, with impairment of consciousness at onset) Partial seizures evolving to secondarily generalized seizures(SPS evolving to generalized seizures, CPS evolving to generalized seizures, SPS evolving to CPS evolving to generalized seizures, ) II. Generalized seizures (convulsive or nonconvulsive) Absence seizure(typical or atypical absence seizures) Myoclonic seizures Clonic seizures Tonic seizures Tonic-clonic seizures Atonic seizures (astatic seizures) III. Unclassified epileptic seizures International classification of epilepsies, epileptic syndromes, and related seizure disorders I. Localization-related (focal, local,partial) Idiopathic (primary):(Benign childhood epilepsy with centrotemporal spikes; Childhood epilepsy with occipital paroxysms; Primary reading epilepsy) Symptomatic (secondary)(Temporal; Frontal; Parietal; Occipital lobe epilepsy;) Cryptogenic (defined by seizure type, clinical features, etiology, antomic localization) International classification of epilepsies, epileptic syndromes, and related seizure disorders II. Generalized Idiopa