EpilepsyEpilepsy

ⅠⅠDefinitionDefinition

Epilepsy is a chronic disease of Epilepsy is a chronic disease of recurrent paroxysmal abnormal recurrent paroxysmal abnormal discharges of the brain neurons .It discharges of the brain neurons .It is characterized by transient is characterized by transient paroxysmal disorders of cerebral paroxysmal disorders of cerebral function, such as function, such as motor motor 、、 sensation sensation 、、 consciousneconsciousnessss 、 、 behaviorbehavior 、 、 autonomic autonomic function and so on .function and so on .

ⅡⅡ.Classification.Classification

1.primary epilepsy(idiopathic epilepsy)1.primary epilepsy(idiopathic epilepsy)

2.secondary epilepsy(symptomatic 2.secondary epilepsy(symptomatic epilepsy)epilepsy)

ⅢⅢ.Etiology .Etiology 1.heredity 1.heredity ↘↘ → →recurrent paroxysmal →seizuresrecurrent paroxysmal →seizures2.brain lesions 2.brain lesions ↗ abnormal discharges↗ abnormal discharges

ⅣⅣ.Factors influencing seizures.Factors influencing seizures1.heredity1.heredity2.environmental factors2.environmental factors(1).age(1).age(2).endocrine:menstrual epilepsy(2).endocrine:menstrual epilepsy pregnancy epilepsypregnancy epilepsy(3).sleep(3).sleep(4).precipitating factors: fatigue; (4).precipitating factors: fatigue; emotional impulseemotional impulse

ⅥⅥ.Clinical features.Clinical features

SeizuresSeizures

epilepsyepilepsy

Classification of seizuresClassification of seizures

1.partial seizures1.partial seizures(1)simple partial seizures (1)simple partial seizures (2)complex partial seizures (2)complex partial seizures (3)secondary generalization of(3)secondary generalization of partial seizurespartial seizures2.generalized seizures2.generalized seizures3.unclassified seizures3.unclassified seizures

1.partial seizures1.partial seizures

(1)simple partial seizures(1)simple partial seizuresa.partial motor seizuresa.partial motor seizuresrecurrent contractions of partial limbsrecurrent contractions of partial limbsJacksonian epilepsyJacksonian epilepsyTodd’s paralysisTodd’s paralysisepilepsia partialis continuaepilepsia partialis continua

b.somesthetic seizures or b.somesthetic seizures or special sensory seizures special sensory seizures stabbing sensation; numbness; stabbing sensation; numbness; visual hallucination;visual hallucination; auditory hallucination; auditory hallucination; vertiginous feelings;vertiginous feelings; olfactory hallucinationolfactory hallucinationc. Autonomic seizuresc. Autonomic seizuresd. psychic seizuresd. psychic seizures

(2).complex partial seizures (2).complex partial seizures (psychomotor seizures) (psychomotor seizures)

Aura Aura ↗ unconsciousness ↗ unconsciousness(special sensory or(special sensory or

psychic symptoms)psychic symptoms) →→ automatism automatism

↘ ↘ amnesiaamnesia

(3)secondary generalized tonic-clon(3)secondary generalized tonic-clonic seizures of partial seizuresic seizures of partial seizures

Simple partial seizure ↘Simple partial seizure ↘

→ → generalizedgeneralized

complex partial seizure ↗ seizurescomplex partial seizure ↗ seizures

(aura)(aura)

2.generalized seizures2.generalized seizures(1).absence seizures((1).absence seizures(petit malpetit mal)) transient cessation of consciousnesstransient cessation of consciousness(2).generalized tonic- clonic seizures (2).generalized tonic- clonic seizures ((GTCSGTCS)()(grand malgrand mal)) 1)characteristics1)characteristics a.sudden loss of consciousness a.sudden loss of consciousness b.generalized symmetric convulsionb.generalized symmetric convulsion

2)2)phasephase(5-10 min)(5-10 min) a.a.tonic phasetonic phase ↘ ↘ BpBp,HR,HR,dilated pupil, pupil ,dilated pupil, pupil (10-20 sec) reaction to light(-)(-),(10-20 sec) reaction to light(-)(-), → → respiratory cessation, cyanosis,respiratory cessation, cyanosis,

BabinskiBabinski’’s sign(+)(+), deeps sign(+)(+), deep

bb.clonic phase ↗.clonic phase ↗ and superficial reflexes(-)(-). and superficial reflexes(-)(-). (0.5-1 min)(0.5-1 min)

c.post-convulsive phasec.post-convulsive phase

ⅦⅦ.Diagnosis.Diagnosis(1)whether the attacks are epilepsy(1)whether the attacks are epilepsya.history:mainly a.history:mainly b.EEG:80% b.EEG:80% abnormal EEG: spike wave ;sharp wave; abnormal EEG: spike wave ;sharp wave; slow waves slow waves 24h EEG24h EEG precipitating methods:overventilationprecipitating methods:overventilation flashing stimulationflashing stimulation deprivation of sleepdeprivation of sleep

ⅦⅦ.Diagnosis.Diagnosis (2)decide the cause of epilepsy(2)decide the cause of epilepsy a.idiopathic epilepsya.idiopathic epilepsy b.symptomatic epilepsyb.symptomatic epilepsy generalized diseases :hypoglycemiageneralized diseases :hypoglycemia hypocalcemiahypocalcemia cerebral diseases: CT,MRI,CSFcerebral diseases: CT,MRI,CSF

ⅧⅧ.Differential Diagnosis.Differential Diagnosis

1.migraine1.migraine2.TIA2.TIA3.syncope3.syncope4.narcolepsy4.narcolepsy5.pseudoepileptic seizures5.pseudoepileptic seizures

ⅨⅨ.Treatment.Treatment1.etiological therapy1.etiological therapy2.drug control of epilepsy2.drug control of epilepsygeneral principlegeneral principle(1)If the diagnosis is correct and there is n(1)If the diagnosis is correct and there is no etiological therapy, the AEDS should be o etiological therapy, the AEDS should be given in timegiven in time(2)choice of AEDs according to seizure typ(2)choice of AEDs according to seizure typee

(3).dose of drugs and side -effects(3).dose of drugs and side -effects Individual principleIndividual principle

begin with small dose→maintenance begin with small dose→maintenance dosedose

therapeutic drug monitoring(TDM)therapeutic drug monitoring(TDM)

(4)single drug treatment(4)single drug treatment

(5)combined usage of drugs(5)combined usage of drugs

(6)long-term taking medicine principle(6)long-term taking medicine principle

(7)principle of termination of drugs(7)principle of termination of drugs

3.surgical treatment:intractable epilepsy3.surgical treatment:intractable epilepsy

Status epilepticusStatus epilepticus

ⅠⅠDefinitionDefinition a seizure lasting over 30 minutes or ra seizure lasting over 30 minutes or recurrent persistent seizures without recurrent persistent seizures without recovery of consciousness and neural fecovery of consciousness and neural function between attacks ,is defined aunction between attacks ,is defined as Status epilepticuss Status epilepticus

ⅡⅡ.Etiology.Etiology

1.incorrect cessation of AEDs1.incorrect cessation of AEDs

2.irregular administration of AEDs2.irregular administration of AEDs

3.precipitating causes: infection ; 3.precipitating causes: infection ; nervousness; fatigue; pregnancy; nervousness; fatigue; pregnancy; drinkingdrinking

ⅢⅢ.Classification and treatment.Classification and treatment

1.convulsive generalized status1.convulsive generalized status epilepticusepilepticus2.unconvulsive generalized status2.unconvulsive generalized status epilepticusepilepticus3.simple partial status epilepticus3.simple partial status epilepticus4.complex partial status epilepticus4.complex partial status epilepticus

TreatmentTreatment1.symptomatic therapy1.symptomatic therapy(1)protection(1)protection(2)unobstructed airway(2)unobstructed airway(3)20% Mannitol 250 ml iv drop(3)20% Mannitol 250 ml iv drop(4)antibiotic drugs(4)antibiotic drugs(5)physical cooling(5)physical cooling(6)regulation of metabolic disturbance(6)regulation of metabolic disturbance2.stop attack:first-choice:Diazepam2.stop attack:first-choice:Diazepam3.maintenance treatment :luminal3.maintenance treatment :luminal