小儿急性惊厥(英文)PPT课件.ppt

1、 SeizuresProf. Jiang LiDepartment of NeurologyChildrens Hospital of CHUMSDefinitionsSeizure （发作）（发作）: a sudden attack, spasm, or convulsion, as in epilepsy or another disorder Epileptic seizure（癫痫样发作）（癫痫样发作）: a transient episode of abnormal and excessive neuronal activity in the brain that is appare

2、nt either to the subject or an observer. Epilepsy（癫痫）（癫痫）: a chronic disorder of the brain characterized by recurrent, unprovoked epileptic seizures.Features of epileptic seizuresThe abnormal neuronal activity during an epileptic seizure may be manifested as a motor, sensory, autonomic, cognitive, o

3、r psychic disturbance. The neurophysiological basis is inferred on clinical grounds.A convulsion is a subtype of seizure in which motor activity occurs.Can be provoked in individuals who do not have epilepsy ( examples of provoking insults including fever,trauma, hypoglycaemia and hypoxia) There are

4、 many paroxysmal disturbances (funny turns) that mimic epileptic seizures. Different diagnosis of epileptic seizuresBreath-holding attacks: provoked by temper or frustration;the screaming toddle holds their breath in expiration,goes blue, then limp, and then makes a rapid spontaneous recovery.Reflex

5、 anoxic seizures: provoked by pain or fear; the infant or toddler becomes pale and loses consciousness( reflecting syncope, secondary to vagal-induced bradycardia); The subsequent hypoxia may induced a tonic-clonic seizure.Vasovagal syncope (simple faints): usually occurs in teenagers; provoked by e

6、motion, hot environment; preceded by nausea and dizziness; sudden loss of consciousness and posture; rapid recovery.Rigors: transient exaggerated shivering in association with high fever.Classification of epileptic seizuresGeneralized seizures: the first clinical change indicates initial involvement

7、 of both cerebral hemispheresPartial seizures: there is initial activation of pare of one cerebral hemisphereGeneralized seizuresAbsence seizure: brief unawareness lasting a few seconds; no loss of posture; immediate recovery; may be very frequent; associated with automatisms.Myoclonic seizures: rep

8、aid, brief, usually isolated jerks of the limbs, neck or trunk.Tonic seizures: a generalised increase in toneTonic-clonic seizures: tonic phase of rigidity with loss of posture followed by clonic movements of all four limbs; loss of consciousness; duration 2-20minutes; postictal drowsiness.Atonic se

9、izures: a trainsient loss of muscle tone caused a sudden fall to the floor or drop of the head.Partial seizuresSimple Partial seizures: when the child will retain awareness with consciousness unpairedComplex Partial seizures: when there is an altered conscious state or confusion due to the abnormal

10、electrical discharge spreading from the originating site to become generalisedPartial seizures with secondary generalisation: when there is a focal seizure manifest clinically or on an ictal EEG followed by a generalised tonic clonic seizure.Causes of epileptic seizures Febrile seizures acute seizur

11、e associated with fever in the absence of intracranial infection or an identifiable neurological disorder Epilepsy chronic disorder of the brain charaterized by recurrent, unprovoked epileptic seizuresFebrile Seizure(FS)associated with a rapidly rising temperature (usually develop when the core temp

12、erature reaches 390C or greater )occur with the diseases out side the CNSage dependent: 6mon-3mon-6mon ( peak age of onset:14-18mo of age)With normal CNS structure and functionNo no-febrile seizure historyGenetic predispositionClinical Manifestation of Simple febrile Seizure(SFS)Occurs in the childr

13、en:6mo to 5 yr of ageTypically generalized seizure (tonic-clonic)Duration: a few seconds to 10-minOnly has once or twice of seizures during a period of disease Clinical Manifestation of Simple febrile Seizure(SFS)Age of seizure onset: 6yrsSeizure persisting for more than 15 min Repeated convulsions

14、during a febrile period A focal seizure. An EEG is indicated for atypical febrile seizures or for the child at risk for developing epilepsyInformation for parents about ferible seizuresWill it happen again? about one third children have recurrent febrile seizures; recurrence is more likely more like

15、ly if the first seizure occurs under the age of 18 months or if there is a family historyCan I prevent further episodes? during febrile illness, the child should be kept cool with antipyretics, removal of clothing, and tepid spongingWhat should I do if a convulsion occurs? place child in recovery po

16、sition to administer rectal diazepam if a seizure lasts longer than 5 minutesIs it epilepsy? febrile seizures are not classified as epilepsy, about 3% of children with FS go on to develop afebrile recurrent seizures ( epilepsy) risk factors for epilepsy include: seizures that are focal, prolonged (1

17、5mins) or recur in the same illness; first-degree relative with epilepsy; neurological abnormalityClassification of epilepsiesAccording to the seizure type Generalized epilepsies and syndromes Localization-related epilepsies and syndromesAccording to aetiology Idiopathic ( or primary) -in which ther

18、e is no apparent cause except perhaps for genetic predisposition Symptomatic-in which the cause is known or suspectedDiagnosis of epilepsyA careful and complete history: detailed description of the events before, during, and after a suspected seizureEEG:routine interictal EEG;ambulatory EEG monitori

19、ng; Video EEG recordingNeuroimaging (CT, MRI) partial seizures Intractable, difficult to control seizures A focal neurological deficit Evidence of a neurocutaneous syndrome or neurodegenerationManagement of epilepsyEducations: about the condition, the prognosis, and the nature of the particular epil

20、epsy or epilepsy syndrome.Special precautions: Swimming: a competent adult swimmer shoukd be present to provide supervision. Domestic bathing: patients should be supervised in the bath Cycling: a helmet must be worn and traffic avoided Climbing: climbing trees and rocks is best avoidedManagement of

21、epilepsyUse of anti-epilepsy drugs (AEDs) Not all the children require AEDs treatment Choice of AEDs based on the type of seizure first-line drugs for generalized epilepsy: Sodium valproate first-line drugs for partial epilepsy; Carbamazepine monitoring the serum anticonvulsant levels if toxicity is suspected to check compliance with multiple drug therapy in children who are severely disabled, when toxicity is difficult to recognise Withdrawal of AEDS after 2 years free of seizures, slowly, recurrence of seizure