神经内科学：癫痫.ppt

Treatment of status epilepticus： Stop the seizure as quickly as possible: intravenous diazepam , phenytoin, clonazepam, phenobarbital 。 Keep the open of air way, give oxygen。 Decrease the cerebral pressure. Infection precaution . Keep the balance of water, salt, acid-base and allopathy. 对症处理: 防治脑水肿:20%甘露醇快速静脉滴注 控制感染 处理高热 纠正代谢紊乱 控制发作:迅速控制发作是治疗的关键. 静脉注射抗癫痫药物是唯一可行有效的方法. 1)安定: 0.25mg/kg 2)罗拉(Lorazepam): 0.1mg/kg 3) 静脉丙戊酸的应用: 3)氯硝安定,副醛,苯妥英钠,异戊巴比妥钠,水合氯醛,利多卡因. 4)无效则可在心肺功能监测下用硫喷妥钠麻醉. 持续状态的治疗 For refractory seizure, need intubation, EEG monitoring 咪达唑仑(Midazolam )0.15-0.20 mg/kg loading, then 0.06-1.1 mg/kg/hr drip 异丙汾(Propofol )1-2 mg/kg loading, then 3-10 mg/kg/hr drip to produce a EEG with no electrographic seizure or burst suppression pattern. 难治性癫痫持续状态的治疗 颞叶癫痫手术 耐药癫痫的手术治疗 Wiebe et al., 2001 New England Journal of Medicine 王晓丹 * 冯小亚 * The main characteristics of FCD on T1-weighted images are * Figure 2 | High-resolution 3 T MRI of a 16-year-old patient with drug-resistant cryptogenic frontal lobe epilepsy. Repeated 1.5 T MRI scans were reported to be normal. visual evaluation of the volumetric FLAIR sequence with a | isotropic 1 mm3 voxels revealed a subtly increased white matter signal extending from the bottom of a sulcus into the depth, towards b | the margin of the lateral ventricle (arrows in magnified panel). c | This transmantle sign was not visible on T1- weighted images. Focal cortical dysplasia Palmini type IIa was diagnosed on histological examination of the resected tissue. The patient has remained completely seizure free with a postsurgical follow- * 潘晓庆 * 王晓丹 * （孔玲娟） * Startle epilepsy is characterized by seizures induced by sudden and unexpected stimuli, usually a sudden sound (Alajouanine and Gastaut 1955). Most patients with startle epilepsy are sensitive to only one sensory modality, but the unexpected nature of the stimulus rather than the sensory modality is the distinguishing feature. The seizure