英语版医疗资料.ppt
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1、SEIZURESSEIZURESDef:Paroxysmalinvoluntarydisturbanceinbrainfunctionmanifestedasimpairmentorlossofconsciousness,abnormalmotoractivity,behavioralabnormalities,sensorydisturbances,orautonomicdysfunction.Epilepsyisdiagnosedwhen2ormoreunprovokedseizuresoccuratintervalgreaterthan24hoursapartTypesofepileps
2、yTherearetwobasictypesofseizurescausedbyTherearetwobasictypesofseizurescausedbyepilepsyepilepsy:1-PARTIALSEIZURES:begininaspecific1-PARTIALSEIZURES:begininaspecificlocationinthebrain.Partialseizuresmayaffectlocationinthebrain.Partialseizuresmayaffectawarenessoronlyonesideorpartofthebody,awarenessoro
3、nlyonesideorpartofthebody,buttheymayalsoprogresstoaffecttheentirebuttheymayalsoprogresstoaffecttheentirebodybody.2-GENERALIZEDSEIZURES:beginovertheentiresurfaceofthebrainandmayaffecttheentirebody.Inpeoplewhohavegeneralizedseizures,itisimpossibletopinpointaspecificlocationinthebrainthatisthesourceoft
4、heseizure.Thedifferenceisimportant,becausepartialseizuresandgeneralizedseizuresareoftentreateddifferently.Thedistinctionisakeyfactoringuidingtreatment.InternationalclassificationofepilepticseizuresPARTIALSEIZURESPARTIALSEIZURES:SIMPLEPARTIALSIMPLEPARTIALMotorMotorSensorySensoryAutonomicAutonomicPsyc
5、hicPsychicCOMPLEXPARTIALCOMPLEXPARTIALPARTIALSEIZURESWITH2ryPARTIALSEIZURESWITH2ryGENERALIZATIONGENERALIZATIONGENERALIZEDSEIZURES:GENERALIZEDSEIZURES:ABSENCESABSENCESTypicalTypicalAtypicalAtypicalGENERALIZEDTONICCLONICGENERALIZEDTONICCLONICTONICTONICCLONICCLONICMYOCLONICMYOCLONICATONICATONICINFANTIL
6、ESPASMSINFANTILESPASMSUNCLASSIFIEDSEIZURESUNCLASSIFIEDSEIZURESCriterionCriterion SPSSPS CPS CPSConsciousnessConsciousnessRetainedRetainedimpairedimpairedAuraAuraMaybepresentMaybepresentAlwaysindicatesAlwaysindicatesAfocalonsetAfocalonset(1/3)(1/3)AutomatismAutomatismNoNo50-75%50-75%DurationDuration1
7、0-20sec10-20sec1-2min1-2minPATHOPHYSIOLOGYTwosetsofchangescandeterminetheepileptogenicpropertiesofneuronaltissues.Abnormalneuronalexcitabilityisthoughttooccurasaresultofdisruptionofthedepolarizationandrepolarizationmechanismsofthecell(thisistermedtheexcitabilityofneuronaltissue).Aberrantneuronalnetw
8、orksthatdevelopabnormalsynchronizationofagroupofneuronscanresultinthedevelopmentandpropagationofanepilepticseizure(thisistermedthesynchronizationofneuronaltissue).Ahyperexcitabilityofneuronsthatresultsinrandomfiringofcells,byitself,maynotleadtopropagationofanepilepticseizure.Indeed,bothnormalandabno
9、rmalpatternsofbehaviorrequireacertaindegreeofsynchronizationoffiringinapopulationofneurons.Epilepticseizuresoriginateinasettingofbothalteredexcitabilityandalteredsynchronizationofneurons.Theexcitabilityofindividualneuronsisaffectedby:cellmembranepropertiesandthemicroenvironmentoftheneuronintracellul
10、arprocessesstructuralfeaturesofneuronalelementsinterneuronalconnectionsBenignRolandicEpilepsyBenignRolandicepilepsy(alsoknownasbenignpartialepilepsyofchildhood)accountsformorethanone-thirdofallcasesofepilepsythatbegininmiddlechildhood,accountingfor16percentofthosebeginningbeforeage15.Thereisafamilyh
11、istoryin18percentofcasesandtheconditionisprobablygeneticallydetermined.RasmussensSyndromeRasmussenssyndrome,alsoknownasRasmussensencephalitis,beginsinchildhoodandproducesaslowdeteriorationofonewholeside(hemisphere)ofthebrainwithlossoffunctionontheoppositesideofthebody.Anautoimmuneresponsetoaviralinf
12、ectionhasbeensuggestedasapossiblecause.Varioustypesoftreatmenthavebeentried,includingsurgicalremovaloftheaffectedsideofthebrain.Inchildren,theremaininghemispheremaycompensateforfunctionslost,butweaknessontheaffectedsidewillremain.ChildhoodAbsenceEpilepsyChildhoodAbsence40%outgrowseizuresI.Q.scores10
13、%abovenormalProbablyinheritedGeneralizedtonic-clonicin50%Childrenwiththissyndromeareotherwisenormal;40percentoutgrowtheseizures,andasagrouptheirI.Q.scoresare10pointsaboveaverage.Thesyndromeisinherited(probablyautosomaldominanttraitwithage-dependentexpression).Childhoodabsenceepilepsy(alsocalledpetit
14、malepilepsy,pyknolepsy)accountsfor2to4percentofallcasesofepilepsyinchildren.Seizuresarenon-convulsivestaringspellsassociatedwithadistinct3persecondspikeandwaveEEGpattern.Theseizurestendtooccurinclusters(hencepyknolepsy-derivedfromtheGreekwordforcluster).Despiteitsoverallbenignnature,approximatelyhal
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