Epilepsy Epilepsy

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

Ⅱ.Classification 1.primary epilepsy(idiopathic epilepsy) 2.secondary epilepsy(symptomatic epilepsy)

Ⅲ.Etiology 1.heredity ↘ →recurrent paroxysmal →seizures →recurrent paroxysmal →seizures 2.brain lesions ↗ abnormal discharges

Ⅳ.Factors influencing seizures 1.heredity 2.environmental factors (1).age (2).endocrine:menstrual epilepsy pregnancy epilepsy pregnancy epilepsy(3).sleep (4).precipitating factors: fatigue; emotional impulse emotional impulse

Ⅵ.Clinical features Seizures Seizures epilepsy epilepsy

Classification of seizures 1.partial seizures (1)simple partial seizures (2)complex partial seizures (3)secondary generalization of partial seizures partial seizures 2.generalized seizures 3.unclassified seizures

1.partial seizures (1)simple partial seizures a.partial motor seizures recurrent contractions of partial limbs Jacksonian epilepsy Todd’s paralysis epilepsia partialis continua

b.somesthetic seizures or special sensory seizures stabbing sensation; numbness; stabbing sensation; numbness; visual hallucination; visual hallucination; auditory hallucination; auditory hallucination; vertiginous feelings; vertiginous feelings; olfactory hallucination olfactory hallucination c. Autonomic seizures d. psychic seizures

(2).complex partial seizures (psychomotor seizures) Aura ↗ unconsciousness Aura ↗ unconsciousness (special sensory or psychic symptoms) → automatism psychic symptoms) → automatism ↘ amnesia ↘ amnesia

(3)secondary generalized tonic-clonic seizures of partial seizures Simple partial seizure ↘ → generalized → generalized complex partial seizure ↗ seizures (aura) (aura)

2.generalized seizures (1).absence seizures(petit mal) transient cessation of consciousness transient cessation of consciousness (2).generalized tonic- clonic seizures (GTCS)(grand mal) (GTCS)(grand mal) 1)characteristics 1)characteristics a.sudden loss of consciousness a.sudden loss of consciousness b.generalized symmetric convulsion b.generalized symmetric convulsion

2) phase(5-10 min) a. tonic phase ↘ Bp ,HR ,dilated pupil, pupil a. tonic phase ↘ Bp ,HR ,dilated pupil, pupil (10-20 sec) reaction to light(-)(-), (10-20 sec) reaction to light(-)(-), → respiratory cessation, cyanosis, → respiratory cessation, cyanosis, Babinski ’ s sign(+)(+), deep Babinski ’ s sign(+)(+), deep b.clonic phase ↗ and superficial reflexes(-)(-). b.clonic phase ↗ and superficial reflexes(-)(-). (0.5-1 min) (0.5-1 min) c.post-convulsive phase c.post-convulsive phase

Ⅶ.Diagnosis (1)whether the attacks are epilepsy a.history:mainlyb.EEG:80% abnormal EEG: spike wave ;sharp wave; abnormal EEG: spike wave ;sharp wave; slow waves slow waves 24h EEG 24h EEG precipitating methods:overventilation precipitating methods:overventilation flashing stimulation flashing stimulation deprivation of sleep deprivation of sleep

Ⅶ.Diagnosis (2)decide the cause of epilepsy (2)decide the cause of epilepsy a.idiopathic epilepsy a.idiopathic epilepsy b.symptomatic epilepsy b.symptomatic epilepsy generalized diseases :hypoglycemia generalized diseases :hypoglycemia hypocalcemia hypocalcemia cerebral diseases: CT,MRI,CSF cerebral diseases: CT,MRI,CSF

Ⅷ.Differential Diagnosis 1.migraine2.TIA3.syncope4.narcolepsy 5.pseudoepileptic seizures

Ⅸ.Treatment 1.etiological therapy 2.drug control of epilepsy general principle (1)If the diagnosis is correct and there is no etiological therapy, the AEDS should be given in time (2)choice of AEDs according to seizure type

(3).dose of drugs and side -effects Individual principle Individual principle begin with small dose→maintenance dose begin with small dose→maintenance dose therapeutic drug monitoring(TDM) therapeutic drug monitoring(TDM) (4)single drug treatment (5)combined usage of drugs (6)long-term taking medicine principle (7)principle of termination of drugs 3.surgical treatment:intractable epilepsy

Status epilepticus Status epilepticus Ⅰ Definition a seizure lasting over 30 minutes or recurrent persistent seizures without recovery of consciousness and neural function between attacks,is defined as Status epilepticus a seizure lasting over 30 minutes or recurrent persistent seizures without recovery of consciousness and neural function between attacks,is defined as Status epilepticus

Ⅱ.Etiology 1.incorrect cessation of AEDs 2.irregular administration of AEDs 3.precipitating causes: infection ; nervousness; fatigue; pregnancy; nervousness; fatigue; pregnancy; drinking drinking

Ⅲ.Classification and treatment 1.convulsive generalized status epilepticus epilepticus 2.unconvulsive generalized status epilepticus epilepticus 3.simple partial status epilepticus 4.complex partial status epilepticus

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