癫痫的定义PPT课件.ppt

* * * * * * * Insomnia etc 3% …..60yr, vascular..brain tumor..trauma..metabolic..infection * * * * * * * * * * * * * * * * * * * Prepare: ABC / ABG, TDM, MAR / Glucose, thiamine * * * *61M Epilepsia Partialis ContinuaT2WI EEG Map SPECT Classification of Seizure Based on Ictal Symptoms Sensorial sphere (“aura”) Autonomic sphere (“autonomic seizure”) Consciousness (“dialeptic seizures”) Motor phenomenon (“motor seizure”) 癲癇症的治療 I (原則) 治療可能的病因 metabolic disorders, infection, tumor etc... 根據癲癇類型選擇藥物 儘可能減少藥物種類，單一處方優於複方 簡化給藥方式與劑量 教導面對癲癇的正確態度 家庭、學校與社會的支持 癲癇症的治療 II (case by case) Give drug ??? First attack : trauma, stroke, idiopathic Stop drug ??? months, years, forever 病史Ⅲ 家族史 家族中其他人是否患有癫痫症？ 遗传型发作： 1、常染色体显性遗传夜间额叶癫痫 2、良性家族性新生儿惊厥 3、良性家族性婴儿惊厥 4、部分发作性癫痫（带听觉综合症） 5、常染色体显性遗传进行性额叶癫痫（带智力缺陷） 6、常染色体显性遗传热痉挛 Good prognostic factors for stopping AEDs Idiopathic epilepsy Childhood onset Easy to control with AEDs Normal neurological exam, normal intelligence Normal EEG Seizure free3year Antiepileptic drugs Antiepileptogenesis: prevent kindling Antiepileptic activity: fully kindled can be treated (seizure control) --- Block voltage-gated Na+ channels Block voltage-gated Ca2+ channels Increasing GABA transmission Decreasing Glutamate transmission Drug choice Idiosyncratic reactions are not dose related; rather they arise either from an immune-mediated reaction to the drug or from poorly defined individual factors, largely genetic, that convey an unusual sensitivity to the drug. 病史Ⅲ 家族史 家族中其他人是否患有癫痫症？ 遗传型发作： 1、常染色体显性遗传夜间额叶癫痫 2、良性家族性新生儿惊厥 3、良性家族性婴儿惊厥 4、部分发作性癫痫（带听觉综合症） 5、常染色体显性遗传进行性额叶癫痫（带智力缺陷） 6、常染色体显性遗传热痉挛 Dosing intervals should usually be less than one-third to one-half the drug’s half-life to minimize fluctuations between peak and trough blood concentrations. 癲癇重積症；持續性癲癇狀態(Status epilepticus) 連續發作超過10分鐘，反復