医学精品课件：09.惊厥.ppt

1、Acute convulsion in ChildrenJIANG LiProfessor,Doctorial tutorDepartment of NeurologyChildrens Hospital of CMUcontents Definitions Causes of acute convulsion Febrile seizures Exams and Tests for convulsion Treatment of acute convulsionAcute convulsion in ChildrenDefinitionsEpileptic Seizures（癫痫发作，痫性发

2、作癫痫发作，痫性发作）transient excessive abnormal electrical activity of cortical neurons manifestation depends on the areas of the brain affected (motor,sensory,autonomic,cognitive,or psychic disturbance)manifestation is apparent either to the subject or an observerBe divided into partial seizures(affect onl

3、y a part of the body)and generalized seizures(affect the whole body)Acute convulsion in ChildrenClassification of seizures (International League against Epilepsy,1981)SeizuresPartial Simple Partial Complex Partial secondary generalisationGeneralizedAbsenceTonic-clonicTonicClonicMyoclonicAtonic Infan

4、tile spasmsUnclassifiedDefinitions Convulsive seizures(惊厥性癫痫发作惊厥性癫痫发作，convulsion 惊厥惊厥):a subtype of epileptic seizure,violent uncontrollable contractions of muscles Epilepsy（癫痫）（癫痫）:a chronic disorder of the brain characterized by recurrent,unprovoked epileptic seizures.Acute convulsion in Childrenl

5、大脑皮层神经元异常同步放电引起的暂时性脑功能异常 临床可有多种发作症状（包括运动、感觉异常、行为认知、植物神经功能障碍等）l分为惊厥性痫样发作（惊厥）、非惊厥性痫样发作l发作性、并有自限性、大多短暂l可发生于急性疾病、慢性疾病惊厥惊厥（Convulsion）excessive abnormal discharges of cortical neuronsEpileptic Seizuresconvulsive seizure(convulsion)nonconvulsive seizureAcute epileptic seizure(provoked in acute disorders)e

6、pilepsy(recurrent,unprovoked epileptic seizures)Acute convulsion in Children癫痫发作、惊厥、癫痫癫痫发作、惊厥、癫痫 癫痫发作癫痫发作(Epileptic Seizures)：发作性大脑皮层功能异常所引起的多种临床症状 惊厥惊厥(convulsion)：伴有骨骼肌强烈、不自主收缩的痫性发作 癫痫癫痫(epilepsy)：临床呈长期反复痫性发作的疾病过程Acute convulsion in ChildrenCharacteristics of acute convulsion in childrenHigh incid

7、ence:4-6%in the children younger than 6yrEasily with prolonged convulsion or status convulsion Status convulsion（惊厥持续状态（惊厥持续状态):a convulsion lasting longer than 30 minutes or repeated convulsion without a return to normal in between them Usually with minim or subtle seizure in the babies Etiological

8、 factors are variedAcute convulsion in Childrencontents Definitions Causes of acute convulsions Exams and Tests for convulsion Treatment of acute convulsionAcute convulsion in ChildrenCommon causes of acute convulsionCNS infection:Meningitis or encephalitisFebrile convulsions（Head traumaCNS malforma

9、tionsBrain tumorsMetabolic disorders:Hypoglycemia,Hyponatremia,hypernatremia,Hyperosmolar states,HypocalcemiaIdiopathic or cryptogenic epilepsy Acute convulsion in ChildrenInfectionNon-infectionIntra-cranialMeningitisEncephalitisHead traumaCerebral dysgenesis/malformationCerebral tumourHypoxic-ischa

10、emic encephalopathyHaemorrhage/IschaemiaEpilepsyExtra-cranialFebrile SeizuresInfectious-toxic encephalopathyMetabolic:Hypoglycaemia Hypocalcaemia Hypomagnesaemia Hypo/hypernatraemiaPoisons/toxinsCauses of ConvulsionIntracranial infectionUsually with infectious symptoms（fever、drowsiness、irritation、de

11、lirium）Recurrent,severe,prolonged seizure Common occur in early stage or the most serious stage of diseaseUsually with the disturbance of impairment of consciousnessWith the manifestations of intracranial hypertensionUseful lab test:CSF Causes of acute seizurescontents Definitions Causes of acute co

12、nvulsion Exams and Tests for convulsion Treatment of acute convulsionAcute convulsion in ChildrenFebrile seizures An event in infancy or childhood usually occurring between three months and five years of age,associated with fever,but without evidence of intracranial infection or an identifiable neur

13、ological disorder”Febrile seizuresMost common seizure disorder in childhood（25%），usually with good prognosisAge dependent:6mon-5yr(peak age of onset:6mo-3yr)Genetic predisposition gene location:SFS:19p 13-3;FS with TLE:8q 13-21;FS+:2q21-q33,19q13.1 Associated with febrile illness：upper respiratory i

14、nfection,otitis media,viral syndromeWithout evidence of brain infection,severe metabolic disturbance,or other known neurological cause，no afebrile seizure historyDivided into simple febrile seizures,complex febrile seizuresSimple febrile Seizure(SFS)Age of seizure onset:6 months to 5 years Type of s

15、eizure:generalized(tonic-clonic)Duration of seizure:a few seconds to 15min Only has once or twice of seizures during a period of disease Complex febrile Seizure(CFS)Age of seizure onset:5yrs Type of seizure:focal seizure Duration of seizure:prolonged,more than 15 min Repeated convulsions during a fe

16、brile period(multiple seizures occur in close succession).Recurrent seizure(5 times)Simple FS Complex FS incidence 8020Age 6 mo to 5 yr 5 yrOnset timeIn 24 hr after fever onset24 hr after fever onsetSeizure typeGeneralized Partial Duration 15 min 15 min FrequencyNo recurrence in 24 h Recurs in 24 h

17、Post neurological abnormalitiesNo May abnormalNeurological developmentNormalMay abnormalClassification of FSRisk factors for recurrent febrile seizures Young age at time of first febrile seizure:15mo or 18mo Family history of a febrile seizure in a first degree relative Complex febrile Seizure Brief

18、 duration between fever onset and initial seizure Risk factors for epilepsy Complex febrile seizure(a prolonged,or focal,or recur seizure in the same illness)Family history of epilepsy Neurological abnormality,and developmental delay.Management Identification and treatment of underlying infection Ke

19、eping the patient cool with regular antipyretics Termination of a prolonged convulsion(diazepam,iv or rectally)Parental education Effective drugs for preventing recurrent febrile seizure:Phenobarbital,Sodium valproate,diazepamInfectionNon-infectionIntra-cranialMeningitisEncephalitisHead traumaCerebr

20、al dysgenesis/malformationCerebral tumourHypoxic-ischaemic encephalopathyHaemorrhage/IschaemiaEpilepsyExtra-cranialFebrile SeizuresInfectious-toxic encephalopathyMetabolic:Hypoglycaemia Hypocalcaemia Hypomagnesaemia Hypo/hypernatraemiaPoisons/toxinsCauses of Convulsioncontents Definitions(Seizure,Co

21、nvulsion,Epilepsy)Causes of acute convulsion Febrile seizures Exams and Tests for convulsion Treatment of acute convulsion History of patientThe course of current seizure activity Time and nature of onset of seizure activity Involvement of extremities or other body parts Nature of movements(eg,eye m

22、ovements,flexion,extension,stiffening of extremities),including any focal movements and details of postictal neurologic deficit Incontinence Cyanosis(perioral or facial)Duration of seizure activity prior to medical attention Mental status after cessation of seizure activityExams and TestsHistory of

23、patient Fever or intercurrent illnesses Prior history of seizures Head injury(recent and remote)CNS infection or disease(eg,meningitis,neurocutaneous syndrome)Intoxication or toxic exposure Birth history and developmental delay Exams and TestsPhysical Examination Obtain temperature and vital signs(i

24、mportant in the initial evaluation)Examine for signs suggestive of trauma or the presence of an intracranial shunt Examine for papilledema(suggesting increased intracranial pressure)Examine for nuchal rigidity(suggesting meningitis)Exams and Tests for seizuresPhysical Examination Examine skin for fi

25、ndings suggestive of neurocutaneous syndrome Examine features of appropriate neurodevelopment Identify any focal neurologic deficits(may be indicative of an underlying focal structural lesion or postictal Todd paresis)Exams and Tests for seizuresHistory：Age relatedageCommon causesneonateTrauma,Metab

26、olic,CNS infection,Cerebral malformation16 moCNS infection,Hypocalcaemia,etc7mo3yrFebrile Seizures,CNS infection,Infectious-toxic encephalopathy3yrCNS infection,Infectious-toxic encephalopathy,TraumaDiagnosis病因学诊断提示病因学诊断提示 新生儿期：颅脑损伤、颅内畸形、颅内感染、代谢紊乱 1-6月：颅内感染、低钙、婴儿痉挛-3岁：热性惊厥、颅内感染、中毒性脑病、癫痫 3岁以上：颅内感染、中毒

27、性脑病、癫痫、颅脑外伤病因学诊断提示病因学诊断提示 夏秋季节：中毒性痢疾 流行性乙型脑炎 低血糖症 冬春季节：流行性脑脊髓膜炎 肺炎中毒性脑病 VitD缺乏性低钙惊厥病因学诊断提示病因学诊断提示Lab investigation Routine analysis of blood,urine,and stool Blood test:selective metabolic screening(glucose,electrolytes,calcium,and magnesium and toxicology studies)Analysis of CSF EEG(electroencephalo

28、-graph)Neuroimaging:head CT or MRI Exams and Tests病因学诊断提示病因学诊断提示contents Definitions(Seizure,Convulsion,Epilepsy)Causes of acute convulsion Febrile seizures Exams and Tests for convulsion Treatment of acute convulsion0.10.11515202020202 250501001006 61010101030302020303012122424242448481414242410010

29、0数小时数小时无无可数日可数日心脏病者心脏病者Treatment of seizuresprompt cessation of seizure activity Diazepam -Intravenously administered(0.3-0.5 mg/kg/dose)-Rapid onset and short duration of seizure control -Injection speed shall not exceed 1mg/min -Monitor for respiratory depression acute seizures治疗治疗-惊厥的急救惊厥的急救Treat

30、ment of seizuresprompt cessation of seizure activity Phenobarbital -Slow onset and long duration of seizure control;-Major disadvantages are significantly depresses mental status and causes respiratory difficulty Diazepam+Phenobarbital acute seizuresTreatment of seizuresOthers Secure the airway Administer supplemental 100%oxygen Infuse intravenous fluids and glucose Increased intracranial pressure controlling Identification and treatment of underlying diseaseacute seizures