小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 局灶性神经功能障碍
- 局灶性神经症状（发作前或后）
- 感觉先兆或体验（害怕、上腹不适感、似曾相识、陌生感）
- 暂时性轻偏瘫
- 短暂失语
- 发热、颈强直、精神状态改变
其他诊断因素
- 神经性疾病的神经皮肤检查
危险因素
- 全面发作性癫痫的家族史（扩展的或直系的）
- 早期中枢神经系统 (CNS) 感染
- 头部外伤
- CNS 病变
- 卒中
- 产前或围产期脑损伤
- 智力残疾
- HIV
- 既往发作事件或疑似发作事件
- 物质使用史
- 早产
- 多次或复杂性热性惊厥
诊断性检查
首要检查
- 脑电图 (EEG)
- 血糖
- 全血细胞计数 (FBC)
- 电解质检查
- 毒理学筛查
- 头部 CT
需考虑的检查
- 颅脑 MRI 扫描
- 腰椎穿刺术：
- 血清肌酸激酶 (CK)
治疗流程
急性反复性癫痫发作：在社区内
急性反复性癫痫发作：院内
≥2 次无诱因的全面强直阵挛发作 (GTCS) 且无综合征诊断
≥2 次无诱因 GTCS 伴局灶性癫痫发作
≥2 次的无诱因 GTCS 伴全面性癫痫发作
撰稿人
作者
Abdulrahman Alwaki, MD
Assistant Professor of Neurology
Emory University School of Medicine
Atlanta
GA
利益声明
AA declares that he has no competing interests.
Daniel Winkel, MD
Assistant Professor of Neurology
Emory University School of Medicine
Atlanta
GA
利益声明
DW receives consulting fees from NextSense, Inc.
鸣谢
Dr Abdulrahman Alwaki and Dr Daniel Winkel would like to gratefully acknowledge Dr Vikram R. Rao, Dr John D. Hixson, and Dr Daniel H. Lowenstein, previous contributors to this topic.
利益声明
VRR has served as a paid consultant for NeuroPace, Inc., manufacturer of the Responsive Neurostimulation (RNS) System. VRR is also an author of several references cited in this topic. JDH has received research funding and consultancy funds from UCB Inc. DHL declares that he has no competing interests.
同行评议者
Mauricio F. Villamar, MD, FACNS
Assistant Professor of Neurology and Clinician Educator
The Warren Alpert Medical School of Brown University
Providence
RI
利益声明
MFV declares that he has no competing interests.
Ranmal Samarasinghe, MD, PhD
Assistant Professor
Department of Neurology
David Geffen School of Medicine
UCLA
Los Angeles
CA
利益声明
RS declares that he has no competing interests.
Edward Barry Bromfield, MD
Chief
Division of Epilepsy and Sleep
Department of Neurology
Brigham and Women's Hospital
Associate Professor of Neurology
Harvard Medical School
Boston
MA
利益声明
EBB has received speaking fees from ICR Pharma, Novartis, Abbott Laboratories, GlaxoSmithKline, and Pfizer. He has received consulting fees from ICR Pharma, Genzyme, and Spherics, and research funding from UCB Pharma. Unfortunately we have since been made aware that EBB is deceased.
Roderick Duncan, MD, PhD, FRCP
Honorary Clinical Senior Lecturer
University of Glasgow
Institute of Neurological Sciences
Glasgow
UK
利益声明
Not disclosed.
鉴别诊断
- 功能性发作（非癫痫性发作）
- 抽搐性晕厥
- 心律失常
更多 鉴别诊断指南
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- 妊娠期癫痫（Green-top 指南第 68 号）
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