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成人全面性癫痫发作

最后审阅: 10 Nov 2024
最后更新: 14 Mar 2024

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
完整详情

其他诊断因素

  • 神经性疾病的神经皮肤检查
完整详情

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
完整详情

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
完整详情

需考虑的检查

  • 颅脑 MRI 扫描
  • 腰椎穿刺术:
  • 血清肌酸激酶 (CK)
完整详情

治疗流程

急症处理

急性反复性癫痫发作:在社区内

急性反复性癫痫发作:院内

持续性治疗

≥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.

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