癫痫发作概述

go to our full topic on 癫痫持续状态

癫痫持续状态是一种危及生命的神经系统疾病，定义为癫痫发作持续 5 分钟或以上，或是反复癫痫发作且两次发作之间意识未完全恢复。[4]Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia. 1999 Jan;40(1):120-2. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1528-1157.1999.tb02000.x?sid=nlm%3Apubmed http://www.ncbi.nlm.nih.gov/pubmed/9924914?tool=bestpractice.com 轻微和明显亚型的全面惊厥性癫痫持续状态是最常见的变异型。疾病识别很重要，因为快速终止癫痫发作有助于预防严重脑损伤，尤其对于有意识障碍的患者。治疗包括采用分步式药物治疗，目的是中止临床表现的和脑电图显示的癫痫发作。

go to our full topic on 成人全身发作性癫痫

全面性发作（全身强直阵挛发作 [generalised tonic-clonic seizures，GTCS]）通常包括意识丧失和肢体阶段性强直僵硬，随后反复出现阵挛性抽搐。多数 GTCS 为自限性，无需进行干预。脑电图（electroencephalogram，EEG）显示两侧大脑半球双侧同步癫痫样活动。[5]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;51:676-685. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2010.02522.x http://www.ncbi.nlm.nih.gov/pubmed/20196795?tool=bestpractice.com GTCS 见于多种不同类型的癫痫。使用抗癫痫药物是所有类型癫痫的主要治疗。[6]Bergey GK. Evidence-based treatment of idiopathic generalized epilepsies with new antiepileptic drugs. Epilepsia. 2005;46(suppl 9):161-168. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2005.00328.x http://www.ncbi.nlm.nih.gov/pubmed/16302891?tool=bestpractice.com [7]French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy. Epilepsia. 2004;45:401-409. http://www.neurology.org/content/62/8/1252.full http://www.ncbi.nlm.nih.gov/pubmed/15101821?tool=bestpractice.com 无癫痫个体也可能因损伤引起 GTCS。

go to our full topic on 儿童期全身发作性癫痫

痫样发作可能以独立事件发作，也可能为复发性的。危险因素包括围产期损伤（例如，窒息）或热性惊厥既往病史；遗传易感性或家族史；神经系统变性疾病；感染；代谢或免疫疾病；颅脑创伤；以及中枢神经系统结构异常。[8]Vestergaard M, Pedersen CB, Sidenius P, et al. The long-term risk of epilepsy after febrile seizures in susceptible subgroups. Am J Epidemiol. 2007;165:911-918. https://academic.oup.com/aje/article/165/8/911/184889/The-Long-Term-Risk-of-Epilepsy-after-Febrile http://www.ncbi.nlm.nih.gov/pubmed/17267419?tool=bestpractice.com [9]Daoud AS, Batieha A, Bashtawi M, et al. Risk factors for childhood epilepsy: a case-control study from Irbid, Jordan. Seizure. 2003 Apr;12(3):171-4. https://www.sciencedirect.com/science/article/pii/S1059131102001942?via%3Dihub http://www.ncbi.nlm.nih.gov/pubmed/12651084?tool=bestpractice.com EEG 是标准的诊断性检查，而头颅 CT 或 MRI 也可能有所帮助。[10]Gaillard WD, Chiron C, Cross JH, et al; ILAE, Subcommittee for Pediatric Neuroimaging. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia. 2009;50:2147-2153. http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2009.02075.x/full http://www.ncbi.nlm.nih.gov/pubmed/19389145?tool=bestpractice.com 主要的治疗选择取决于癫痫综合征，具体包括抗惊厥药、生酮饮食、迷走神经刺激或生活方式改变措施。[11]Hirtz D, Berg A, Bettis D, et al. Practice parameter: treatment of the child with a first unprovoked seizure. Neurology. 2003;60:166-175. http://www.neurology.org/content/60/2/166.full http://www.ncbi.nlm.nih.gov/pubmed/12552027?tool=bestpractice.com

go to our full topic on 热性惊厥

在没有颅内感染、代谢紊乱证据或无热惊厥病史的情况下，发生于 6-60 月龄发热儿童的痫样发作。[12]Capovilla G, Mastrangelo M, Romeo A, et al. Recommendations for the management of "febrile seizures": Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia. 2009 Jan; 50(suppl 1):S2-6. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2008.01963.x http://www.ncbi.nlm.nih.gov/pubmed/19125841?tool=bestpractice.com 根据临床评估作出诊断，如果怀疑脑膜炎或脑炎，可行腰椎穿刺进行排除。[13]Subcommittee on Febrile Seizures. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127:389-394. http://pediatrics.aappublications.org/content/127/2/389.long http://www.ncbi.nlm.nih.gov/pubmed/21285335?tool=bestpractice.com 多数热性惊厥可自行消退，不需要紧急或长期进行抗惊厥治疗。

go to our full topic on 失神发作

通常表现为活动和反应突然停止，持续 5-10 秒，有细微的伴随动作，双眼凝视发作，无先兆/发作后状态。典型的失神发作可能由过度通气和光刺激诱发。EEG 是确诊性检查。对于多数典型失神发作，进行药物治疗有效，而儿童失神癫痫（childhood absence epilepsy，CAE）通常在成年期缓解。对于 CAE 的典型失神发作、青少年失神癫痫和青少年肌阵挛性癫痫，使用抗惊厥药物进行治疗。[14]Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010;362:790-799. http://www.nejm.org/doi/full/10.1056/NEJMoa0902014 http://www.ncbi.nlm.nih.gov/pubmed/20200383?tool=bestpractice.com 非典型失神发作开始和结束时不太明显，通常不会因过度通气诱发。非典型失神发作通常难以用药物治疗，并且与认知障碍有关。

go to our full topic on 局灶性癫痫发作

局灶性（部分性）发作为大脑部分受累所致痫样发作的电流和临床表现。它们可能发生于某种潜在脑部结构异常的情况下，也可能为特发性的。EEG 通常显示发病部位出现局部放电。颞叶是局灶性癫痫发作的最常见发病位置，但是它们可起源于任何脑叶。局灶性意识正常型痫样发作患者可能保留意识，而局灶性意识障碍型痫样发作的特征包括事件发生时记忆缺失或反应性受损。[2]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;58:522-530. http://onlinelibrary.wiley.com/doi/10.1111/epi.13670/full http://www.ncbi.nlm.nih.gov/pubmed/28276060?tool=bestpractice.com 局灶性发作可能会变为继发性全面发作。 抗癫痫药单药治疗是首选初始治疗。

go to our full topic on 婴儿痉挛

癫痫综合征通常发生在婴儿期，病因各异。痉挛可以是屈肌、伸肌或屈肌伸肌混合型，可以是对称或不对称发作，通常丛集性发生。EEG 的典型特征是高峰节律紊乱，但并非在任何时候都普遍存在。婴儿痉挛症通常与某种基础疾病有关。如果未发现基础病因（10％-40％ 的患儿）并且发病前发育正常，预后趋于更好。[15]Pellock JM, Hrachovy R, Shinnar S, et al. Infantile spasms: a U.S. consensus report. Epilepsia. 2010 Oct;51(10):2175-89. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2010.02657.x http://www.ncbi.nlm.nih.gov/pubmed/20608959?tool=bestpractice.com 治疗选择包括激素治疗（促肾上腺皮质激素或皮质类固醇）或氨己烯酸。[16]Go CY, Mackay MT, Weiss SK, et al. Evidence-based guideline update: medical treatment of infantile spasms. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2012;78:1974-1980. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369510/ http://www.ncbi.nlm.nih.gov/pubmed/22689735?tool=bestpractice.com

go to our full topic on 晕厥的评估

鉴别晕厥和癫痫发作有时会具有挑战性。 颤搐和抽搐常见于迷走血管性晕厥或心源性晕厥，可以与强直阵挛性发作中所有肢体出现节律性抽搐相区别。 癫痫发作中常见的肠道和膀胱失控很少见于晕厥。 发作后精神错乱是癫痫发作的关键区别因素之一.[17]Huff JS, Decker WW, Quinn JV, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49:431-444. http://www.ncbi.nlm.nih.gov/pubmed/17371707?tool=bestpractice.com 存在先兆症状以及无意识持续时间＞5 分钟是痫样发作更典型的特征。