少数可遗留癫痫反复发作.PPTVIP

不伴有严重内科疾患的老年病人癫痫的类型一线用药特发性全面强直阵挛发作拉莫三嗪丙戊酸症状性部分性发作拉莫三嗪加巴喷丁卡马西平奥卡西平LemetiracetamStevenKarceski,MarthaMorrell,DanielCarpenter.TheExpertConsensusGuidelineSeriesTreatmentofEpilepsy.EpilepsyBehavior2,A1-A50(2001).伴有抑郁症的患者癫痫的类型一线用药特发性全面强直阵挛发作丙戊酸拉莫三嗪症状性部分性发作卡马西平奥卡西平拉莫三嗪症状性全面强直阵挛发作丙戊酸拉莫三嗪StevenKarceski,MarthaMorrell,DanielCarpenter.TheExpertConsensusGuidelineSeriesTreatmentofEpilepsy.EpilepsyBehavior2,A1-A50(2001).TherpyDose:Beginwithsmalldose,usetheminimumdosetogetseizurefree.Carbamazepine:therapydoserange:0.3-1.0/day.Beginwith0.2/day,increasethedoseslowlyiftheseizureisnotfree.effectivedoseconcentrationis4-12/L.valproicacid:0.6-1.6/day,beginwith0.6/day,theeffectivedoseconcentrationis50-100mg/L.Phenytoin:0.3/day,beginwith0.2/day,theeffectivedoseconcentrationis10-20mg/L.Drugcombination:whentheepilepsyisconsiderrefractoryepilepsy,whichcan’tgetseizurefreebyusingmono-drugandreacheffectiveplasmaconcentration,usuallyconsidertocombinatetwoormoreanti-epilepsydrugs.Itisnotappropriatetocombinateanti-epilepsydrugswiththesamesideeffectandsamemechanism.联合用药一线：卡马西平 拉莫三嗪 丙戊酸 Levetiracetam 托吡酯StevenKarceski,MarthaMorrell,DanielCarpenter.TheExpertConsensusGuidelineSeriesTreatmentofEpilepsy.EpilepsyBehavior2,A1-A50(2001).联合用药一线：丙戊酸卡马西平Levetiracetam拉莫三嗪奥卡西平苯妥英一线：拉莫三嗪卡马西平Levetiracetam托吡酯丙戊酸苯妥英StevenKarceski,MarthaMorrell,DanielCarpenter.TheExpertConsensusGuidelineSeriesTreatmentofEpilepsy.EpilepsyBehavior2,A1-A50(2001).七、阵发性或爆发性活动阵发性或爆发性活动：亦称发作性节律波。即于原有脑电图背景上出现阵发性高波幅节律。其成分为δ节律、θ节律、α节律和β节律，多呈高波幅发放，明显区别于背景脑电图，突然出现，突然消失。多源于中央脑系统病灶发出，但诊断价值不如上述放电波形。癫痫发作期的脑电图表现与发作间期痫样放电相似，是这种发作间期痫性放电的延续。有些则与发作间期的脑电图表现完全不同，出现一种全新的脑电图模式。1．发作初期：此期由于病人尚无临床发作，很少有伪迹干扰，分析上较方便，因而对利用脑电图来判断癫痫放电的起源有重要意义