临床药理学癫痫.pptVIP

2021/1/12 Question 2: What is the evidence that the new AEDs are effective in adults or children with primary or secondary generalized epilepsy? Conclusions. Lamotrigine is effective in children with newly diagnosed absence seizures. Summary of findings. Lamotrigine is effective in the treatment of children with newly diagnosed absence seizures. At present, there is insufficient evidence to determine effectiveness in newly diagnosed primary or secondary generalized epilepsy for topiramate, oxcarbazepine, tiagabine, zonisamide, or levetiracetam. 2021/1/12 Recommendation. 1. Lamotrigine can be included in the options for children with newly diagnosed absence seizures (Level B). 文献来源： 2021/1/12 Table 6 Summary of AAN evidence-based guidelines level A or B recommendation for use  Drug Newly diagnosed monotherapy partial/mixed Newly diagnosed absence Gabapentin Yes* No Lamotrigine Yes* Yes* Topiramate Yes* No Tiagabine No No Oxcarbazepine Yes No Levetiracetam No No Zonisamide No No * Not Food and Drug Administration-approved for this indication. * 临床药理学癫痫 临床药理学癫痫临床药理学癫痫癫痫发作分型全面性发作 (Generalized-onset seizures ) 均有意识障碍及双例大脑半球同时受累，脑电固呈双侧同步对称异常电活动。 (1)失神发作：①典型失神发作：②非典型失神发作； (2)肌阵挛发作 (3)阵挛发作 (4)强直发作 (5)强直-阵挛发作(典型大发作) (6)失张力发作 部分性发作(局灶性发作, Partial-onset seizures ) (1)单纯部分性发作：无意识障碍 (2)复杂部分性发作：有意识障碍 (3)部分发作开展到全身强直一阵挛发作2021/1/122 2021/1/12 癫痫发作分型 全面性发作 (Generalized-onset seizures ) 均有意识障碍及双例大脑半球同时受累，脑电固呈双侧同步对称异常电活动。 (1)失神发作：①典型失神发作：②非典型失神发作； (2)肌阵挛发作 (3)阵挛发作 (4)强直发作 (5)强直-阵挛发作(典型大发作) (6)失张力发作 部分性发作(局灶性发作, Partial-onset seizures ) (1)单纯部分性发作：无意识障碍 (2)复杂部分性发作：有意识障碍 (3)部分发作开展到全身强直一阵挛发作 2021/1/12 大发作(Tonic-Clonic Seizures)：突然意识丧失，倒地抽搐，面色青紫，口吐白沫，经数分钟后深睡1小时左右后清醒。 如大发作频繁，间隔甚短，持续昏迷，称癫痫持续状态(Status epilepticus)。 小发作(Absence Seizures)：突然意知消失，动作中断，目瞪直视，不倒地抽搐。小孩多见每天可发作数十—数百次。 2021/1/12 精神运动性发作(Complex partial seizures 的一种)：阵发性精神失常，伴有无意识动作，持续时立数分钟至数日不等。EEG为每秒4周的高幅方形波。 局限性发作(Simple partial seizures )：