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
其他诊断因素
- automatismos simples
- declínio recente no desempenho escolar
- automatismos complexos
- início precoce (antes dos 4 anos)
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
诊断性检查
首要检查
- eletroencefalograma (EEG)
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
新兴检查
- análise gênica
治疗流程
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
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
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.
Differentials
- Sonhar acordado
- Transtorno de deficit da atenção com hiperatividade (TDAH)
- Epilepsia parcial complexa de origem no lobo frontal ou temporal
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- Epilepsies in children, young people and adults
- Teratogenesis, perinatal, and neurodevelopmental outcomes after in utero exposure to antiseizure medication
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