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Crises de ausência

最后审阅: 20 Aug 2025
最后更新: 07 May 2025

小结

定义

病史和体格检查

关键诊断因素

  • história familiar de convulsões na infância
  • episódio de olhar fixo, que dura de 5 a 10 segundos; várias vezes por dia sem aura/estado pós-ictal
  • início na infância
  • exame físico normal
  • crise induzida por hiperventilação
完整详情

其他诊断因素

  • automatismos simples
  • declínio recente no desempenho escolar
  • automatismos complexos
  • início precoce (antes dos 4 anos)
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危险因素

  • história familiar/genética de epilepsia do tipo ausência da infância ou epilepsia mioclônica juvenil
  • lesão cerebral adquirida: por exemplo, hipóxia-isquemia, trauma, infecção
  • outros defeitos congênitos do metabolismo, defeitos estruturais, anormalidades cromossômicas
  • atraso no desenvolvimento ou deficiência intelectual
  • sexo feminino
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诊断性检查

首要检查

  • eletroencefalograma (EEG)
完整详情

需考虑的检查

  • ressonância nuclear magnética (RNM) cranioencefálica
  • exames para distúrbios metabólicos (por exemplo, aminoácidos séricos, ácidos orgânicos urinários, piruvato de lactato ou testes enzimáticos específicos)
  • líquido cefalorraquidiano e glicose sérica
完整详情

新兴检查

  • análise gênica

治疗流程

急症处理

crises de ausência típica sem história de crises tônico-clônicas generalizadas (epilepsia do tipo ausência da infância)

crises de ausência típica com história de crises tônico-clônicas generalizadas (epilepsia do tipo ausência da infância [EAI], epilepsia do tipo ausência juvenil [EAJ] e epilepsia mioclônica juvenil [EMJ])

crises de ausência atípica

持续性治疗

refratário a tratamento

撰稿人

作者

Judith L. Z. Weisenberg, MD

Assistant Professor of Neurology

Washington University Medical School

St. Louis

MO

利益声明

JLZW states that she has no competing interests.

鸣谢

Dr Judith L. Z. Weisenberg would like to gratefully acknowledge Dr Michael Wong, a previous contributor to this topic.

Disclosures

MW declares that he has no competing interests.

Peer reviewers

Anita Devlin, MBBS, MD

Consultant Paediatric Neurologist

Royal Victoria Infirmary

NHS Foundation Trust

Newcastle-upon-Tyne

UK

Disclosures

AD and two epilepsy nurses from her department have been reimbursed by UCB Pharma, the manufacturer of levetiracetum, for attending several conferences. One of the epilepsy nurses received a one-off sponsorship payment from UCB Pharma to cover the initial set-up costs of the adolescent epilepsy support group. One epilepsy nurse has been reimbursed by Cyberonics, the manufacturer of vagal nerve stimulators, for attending one or more conferences.

Cigdem Akman, MD

Division of Pediatric Neurology

Columbia University College of Physicians and Surgeons

New York

NY

Disclosures

CA declares that he has no competing interests.

Angus A. Wilfong, MD

Associate Professor

Pediatrics and Neurology

Baylor College of Medicine

Medical Director

Comprehensive Epilepsy Program

Texas Children's Hospital

Houston

TX

Disclosures

AAW declares that he has no competing interests.

Helen Cross, MB, ChB, PhD, FRCP, FRCPCH

Head of Neurosciences Unit

The Prince of Wales’s Chair of Childhood Epilepsy

National Centre for Young People with Epilepsy

London

UK

Disclosures

HC has received research funds from HAS, Epilepsy Research UK, SHS, and the Milk Development Council. She has received funding for an epilepsy training fellowship from UCB and Eisai. She has also received travel funding from Eisai, UCB, and GlaxoSmithKline.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017 Apr;58(4):522-30.Full text  Abstract

Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010 Apr;51(4):676-85. Abstract

Rosenow F, Wyllie E, Kotagal P, et al. Staring spells in children: descriptive features distinguishing epileptic and nonepileptic events. J Pediatr. 1998 Nov;133(5):660-3. Abstract

Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010 Mar 4;362(9):790-9.Full text  Abstract

Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia. 2013 Jan;54(1):141-55.Full text  Abstract

Bergey GK. Evidence-based treatment of idiopathic generalized epilepsies with new antiepileptic drugs. Epilepsia. 2005;46 Suppl 9:161-8. Abstract

Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2018 Jun 13;91(2):74-81.Full text  Abstract

Nordli DR Jr. Idiopathic generalized epilepsies recognized by the International League Against Epilepsy. Epilepsia. 2005 Nov 18;46(suppl 9):48-56.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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