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1、Epilepsy癫痫Mytrainingexperience2004-2005, National Epilepsy Centre, Shizuko Japan2010-2011, Clinical Fellow, Westmead Hospital, Sydney AustraliaFebruary-July 2011, Research Fellow, University Hospital, Cleveland Ohio USAGaiusJuliusCaesar,BC102/07/1244/03/15VincentVanGogh,1853/03/301890/07/29NapolonBo
2、naparte，1769/08/151821/05/055古罗马帝国古罗马帝国恺撒大帝，恺撒大帝，军事家军事家拿破仑，拿破仑，诺贝尔奖金创立者诺贝尔奖金创立者诺贝尔，诺贝尔，哲学家哲学家苏格拉底，苏格拉底，伊斯兰教创始人伊斯兰教创始人穆罕默德，穆罕默德，英国诗人英国诗人拜伦、狄更斯，拜伦、狄更斯，圣女圣女贞德，贞德，美术家美术家梵高，梵高，音乐家音乐家亨德尔亨德尔,俄罗斯文学家俄罗斯文学家陀斯妥耶夫斯基陀斯妥耶夫斯基Definition（定义）（定义）EPILEPSY: A chronic brain disorder of various etiologies characterized b
3、y recurrent seizures due to excessive discharge of cerebral neurons.癫痫癫痫:一组一组反复发作反复发作的神经元异常放电所致的神经元异常放电所致的中枢神经系统功能失常的的中枢神经系统功能失常的慢性慢性疾病。疾病。Definition（定义）（定义）SEIZURE (Epileptic Seizure):The recurrent attacks due to excessive discharge of cerebral neurons. Motor (convulsion), sensory, psychic, autonom
4、ic symptoms, or a disturbance of high brain function, or loss of consciousness, or a combination of them.痫性发作痫性发作:中枢神经细胞异常放电引起的反复临床发作。中枢神经细胞异常放电引起的反复临床发作。根据神经元的部位和放电扩散的范围，功能失常可能表根据神经元的部位和放电扩散的范围，功能失常可能表现为现为运动、感觉、意识、行为、自主神经运动、感觉、意识、行为、自主神经等不同障碍，等不同障碍，或兼有之。每次发作或每种发作称为痫性发作。或兼有之。每次发作或每种发作称为痫性发作。Characte
5、ristics of Seizures: Paroxysmal, transient, recurrent, stereotyped 痫性发作的特点：痫性发作的特点：发作性，短暂性，重复性，刻板性发作性，短暂性，重复性，刻板性Incidence(发病率病率)andPrevalence(患病率患病率) INCIDENCE: 50 122 per 100,000(1/1000) population per year. (1,000,000 new patients per year in China)PREVALENCE: The active epilepsy is 5-8 per 1000
6、population(58). (6-8million patients in China)OCCASIONAL SEIZURE: 3-5% of the general population.Etiology (病因分类病因分类)Any factors which could cause the structural damage or functional disturbance of brain. 1)Idiopathic epilepsies and syndromes (特发性癲痫特发性癲痫) 2)Symptomatic epilepsies and syndromes (症状性癲痫
7、症状性癲痫) 3)Cryptogenic epilepsies and syndromes (隐源性癲痫隐源性癲痫) 4) Situation-related seizures (状态关联性癲痫发作状态关联性癲痫发作)ClinicalManifestations（临床表现）临床表现）Characteristic Manifestations: Seizures Motor symptoms (convulsion) Sensory symptoms Psychic symptoms Autonomic symptoms Disturbances of high brain function L
8、oss of consciousness Or, a combination of them.痫性发作临床表现痫性发作临床表现运动症状运动症状(惊厥惊厥)感觉症状感觉症状精神症状精神症状自主神经症状自主神经症状大脑高级功能紊乱大脑高级功能紊乱意识丧失意识丧失或或,以上症状的组合以上症状的组合ClassificationofEpilepticSeizures（痫性发作分类）（痫性发作分类）Bases of classification: Clinical manifestations and EEG changes. (the originating, speed and extent of s
9、pread of the discharges.) Generalized Seizures（全面性发作）（全面性发作） Partial Seizures（部分性发作）（部分性发作） Unclassified Epileptic Seizures（未能分类的发作）（未能分类的发作）GeneralizedSeizures (全面性发作）全面性发作）Tonic-clonic Seizure ( 强直强直-阵挛性发作）阵挛性发作） Tonic Seizure (强直性发作）强直性发作） Clonic Seizure (阵挛性发作）阵挛性发作） Myoclonic Seizure (肌阵挛性发作）肌阵
10、挛性发作） Absence (失神性发作）失神性发作） Atonic Seizure (失张力性发作）失张力性发作）ClassificationofEpilepticSeizures Generalized Seizures (全面性发作）全面性发作） 1. Tonic-clonic Seizure ( 强直强直-阵挛性发作）阵挛性发作） ClassificationofEpilepticSeizuresGeneralized Seizures (全面性发作）全面性发作）2.Tonic Seizure (强直性发作）强直性发作）ClassificationofEpilepticSeizures
11、Generalized Seizures (全面性发作）全面性发作）3.Clonic Seizure (阵挛性发作）阵挛性发作）ClassificationofEpilepticSeizuresGeneralized Seizures (全面性发作）全面性发作）4.Myoclonic Seizure (肌阵挛性发作）肌阵挛性发作）ClassificationofEpilepticSeizuresGeneralized Seizures (全面性发作）全面性发作）5.Absence (失神性发作）失神性发作）ClassificationofEpilepticSeizuresGeneralized
12、 Seizures (全面性发作）全面性发作）6.Atonic Seizure (失张力性发作）失张力性发作）ClassificationofEpilepticSeizures Partial Seizures: according to whether consciousness is impaired or not during attack： Simple Partial Seizure（SPS） Complex Partial Seizure（CPS）部分性发作部分性发作:根据发作时有无神志意识的根据发作时有无神志意识的缺损分为缺损分为:单纯部分性发作单纯部分性发作(SPS)复杂部分性
13、发作复杂部分性发作(CPS)Simple Partial Seizure（单纯部分性）（单纯部分性）Partial motor（运运动动性性）seizure，Jacksonian seizurePartial sensory（感觉性）感觉性）seizurePartial autonomic（植物神经性）植物神经性）seizure Partial psychic（精神性）精神性）seizure Complex Partial Seizure（复杂部分性）复杂部分性） Aura（先兆）（先兆）Impairment of consciousness（意识障碍意识障碍）Automatism （自动症）
14、（自动症） or other motor symptoms部分性发作部分性发作1、单纯部分性单纯部分性运动性运动性感觉性感觉性植物神经性植物神经性精神性精神性2、复杂部分性复杂部分性（先兆）（先兆）+意识障碍意识障碍+（自动症）（自动症）全面性发作全面性发作强直强直-阵挛阵挛强直强直阵挛阵挛肌阵挛肌阵挛失神失神失张力失张力放放电电起起源源意意识识障障碍碍Diagnosis（诊断）（诊断）1. Differentiation from events mimicking epileptic seizures 1)Syncope 2)Psychogenic attack (pseudoseizure
15、s)2. Classification of seizures3. Diagnosis of epilepsies and epileptic syndromes 1) Childhood Absence Epilepsy 2) West Syndrome 4. Determination of etiology 癲痫的癲痫的诊断诊断1.是否为癲痫发作是否为癲痫发作鉴别鉴别:1)晕厥晕厥2)精神心理性发作精神心理性发作(假假性发作性发作)2.发作类型的诊断发作类型的诊断3.癲痫的诊断（癫痫综合征的诊断）癲痫的诊断（癫痫综合征的诊断）4.病因诊断病因诊断癲痫的癲痫的诊断诊断1.是否为癲痫发作是否
16、为癲痫发作鉴别鉴别:1)晕厥晕厥FeatureSyncopeSeizurePostureuprightany posturePallor and sweatingcommonuncommonOnsetgradualsudden/auraInjuryrarenot uncommonConvulsive jerksrarecommonIncontinencerarecommonUnconsciousnesssecondsminutesRecoveryrapidoften slowPostictal confusionrarecommonFrequencyinfrequentmay be frequ
17、entPrecipitating factorsCrowded places, lack of food, unpleasant circumstancesrareInterictal EEGnormalabnormalDifferences between syncope and seizures临床特点床特点晕厥厥 痫性性发作作体位体位直立直立 任何体位任何体位苍白和出汗白和出汗常常见 不常不常见开始开始逐逐渐的的 突然突然/先兆先兆受受伤很少很少 非少非少见肢体抽搐肢体抽搐很少很少 常常见遗尿尿很少很少 常常见意意识障碍障碍数秒数秒 数分数分钟恢复恢复快快 较慢慢发作作频率率不不频繁繁
18、可以可以频繁繁诱发因素因素人多人多、饥饿、不愉快不愉快 较少少发作作间期期脑电图正常正常 多数不正常多数不正常晕厥与痫性发作的鉴别晕厥与痫性发作的鉴别癲痫的癲痫的诊断诊断1.是否为癲痫发作是否为癲痫发作鉴别鉴别:2)精神心理性发作精神心理性发作(假性发作假性发作)FeatureEpileptic seizurePseudoseizureOnsetsuddenmay be gradualRetained consciousness in prolonged seizurevery rarecommonPelvic thrustingrarecommonFlailing, thrashing, a
19、synchronous limb movementsrarecommonRolling movementsrarecommonMovements“waxing and waning”rarecommonCyanosiscommonunusualTongue biting and other injurycommonless commonStereotypical attacksusualuncommonDurationseconds or minutesoften many minutesGaze aversionrarecommonResistance to passive limb mov
20、ement or eye-openingunusualcommonPrevention of hand falling on faceunusualcommonInduced by suggestionrarelyoftenPostictal drowsiness or confusionusualoften absentIctal EEG abnormalityAlmost alwaysAlways neverPostictal EEG abnormality(after seizure with impairment of consciousness)usuallyrarely Diffe
21、rences between epileptic seizures and pseudoseizure特征特征痫性性发作作假性假性发作作起病起病突然突然可以是逐可以是逐渐的的发作中的意作中的意识保留保留很少很少常常见骨盆甩骨盆甩动少少见常常见非同步动作非同步动作少少见常常见翻翻滚动作作少少见常常见“赢亏亏”征征少少见常常见紫紫绀常常见不多不多见舌咬舌咬伤或其它或其它损伤常常见不常不常见发作形式固定作形式固定基本是基本是不常不常见发作作时间几秒或几分几秒或几分钟经常常较长凝凝视回避回避很少很少常常见对外界干外界干扰的抵抗的抵抗少少见常常见手或手或脸跌落的防跌落的防备少少见常常见接受暗示接受暗示少
22、少见常常见发作后作后头晕或迷惑或迷惑常常见几乎没有几乎没有发作期作期EEG异常异常几乎都有几乎都有几乎没有几乎没有发作后作后EEG异常异常常常见罕罕见痫痫性性发发作作与与假假性性发发作作的的鉴鉴别别Diagnosis1. Differentiation from Events Mimicking Epileptic Seizures2. Classification of Seizures3. Diagnosis of Epilepsies and Epileptic Syndromes4. Determination of EtiologyGeneralized Seizures (全面性发
23、作）全面性发作） Tonic-clonic Seizure ( 强直强直-阵挛性发作阵挛性发作） Tonic Seizure (强直性发作强直性发作） Clonic Seizure (阵挛性发作阵挛性发作） Myoclonic Seizure (肌阵挛性发作肌阵挛性发作） Absence (失神性发作失神性发作） Atonic Seizure (失张力性发作失张力性发作）Simple Partial Seizure（单纯部分性）（单纯部分性）Partial motor（运动性）运动性）seizure，Jacksonian seizurePartial sensory（感觉性）感觉性）seizu
24、rePartial autonomic（植物神经性）植物神经性）seizure Partial psychic（精神性）精神性）seizureComplex Partial Seizure (复杂部分性复杂部分性)Diagnosis1. Differentiation from Events Mimicking Epileptic Seizures2. Classification of Seizure3. Diagnosis of Epilepsies and Epileptic Syndromes4. Determination of EtiologyChildhoodAbsenceEpi
25、lepsy(儿童失神性癫痫儿童失神性癫痫)l Typical absences, generally begin between age 3-10 years.l lMultiple attacks tend to occur in the same day.l lGenetic predisposition.l lPatients are otherwise neurologically normal.l lMore common in female.l l EEG demonstrates regular 3Hz spike and wave activity, normal backgr
26、ound.l l Usually response to valproate (VPA).ChildhoodAbsenceEpilepsy(儿童失神性癫痫儿童失神性癫痫)典型失神发作典型失神发作,起病年龄多在起病年龄多在3-10岁岁同一天内多次发作同一天内多次发作遗传倾向遗传倾向其它神经系统发育基本正常其它神经系统发育基本正常女性多见女性多见典型典型EEG表现为正常背景活动中阵发出现规则表现为正常背景活动中阵发出现规则3Hz棘慢复合波棘慢复合波对丙戊酸有效对丙戊酸有效Westsyndrome(婴儿痉挛婴儿痉挛)Age of onset: mainly 3-7 Months of age. Bo
27、y: 60%Psychomotor deterioration: loss of visual contact, axial hypotoniaSeizure: isolated spasm typical spasms in clustersFrequency of seizures: several - ten series/dayInter-ictal EEG: hypsarythmia(高峰失律高峰失律); Ictal EEG: variableEvolution of spasms spontaneous remission in a few weeks or months (6-1
28、5%), spasms free at 5Y (72-99%)Prognosis: seizure (50-60%), Mental retardation (71-81%).Westsyndrome(婴儿痉挛婴儿痉挛)发病年龄发病年龄:3-7月月,男孩稍多男孩稍多:60%精神运动发育迟滞精神运动发育迟滞:无眼神交流无眼神交流,轴性肌张力低轴性肌张力低典型发作典型发作:痉挛痉挛(孤立孤立成簇的成簇的)发作频率发作频率:每日数每日数-数十次数十次发作间期发作间期EEG:高峰失律高峰失律,发作期发作期EEG:多种多样多种多样痉挛的发展痉挛的发展:几周几周-几月自然停止几月自然停止(6-15%)5岁
29、时痉挛停止岁时痉挛停止(72-99%)预后预后:持续发作持续发作(50-60%),发育迟滞发育迟滞(71-8%)Lennox-GastautSyndromel l Usually onset in childhood (1-8 years of age).l l Multiple seizure types, including atonic, axial tonic, myoclonic, atypical absence, tonic-clonic.l l Mental retardation.l l Multiple causes.l l EEG: abnormal background
30、 and abundant slow spike and wave activity (1.0-2.5 Hz); 10 Hz rapid rhythms during sleep.l l Usually resistant to antiepileptic drugs (AEDs).Lennox-GastautSyndrome儿童期起病儿童期起病(1-8岁岁)多种发作形式多种发作形式:失张力、轴性强直、肌阵挛、非典失张力、轴性强直、肌阵挛、非典型失神、强直型失神、强直-阵挛阵挛精神发育迟滞精神发育迟滞多种病因多种病因EEG:背景异常背景异常,棘慢复合波棘慢复合波(1.0-2.5 Hz)多多,睡
31、眠中睡眠中10 Hz快节律快节律对多种对多种AEDs无效无效Diagnosis1. Differentiation from Events Mimicking Epileptic Seizures2. Classification of Seizure3. Diagnosis of Epilepsies and Epileptic Syndromes4. Determination of EtiologyHowtomakeadiagnosis?Combination of clinical manifestations and EEG (electroencephalogram)Other e
32、xaminations: CT, MRI, SPECT, PET, etc.结合临床表现和脑电图结合临床表现和脑电图其它辅助检查其它辅助检查Treatment（癲痫的治疗）癲痫的治疗）1. Etiological treatment（病因治疗）病因治疗）2. Avoiding of precipitations（诱发因素的预防）诱发因素的预防）3. Antiepileptic drugs therapy（药物治疗）药物治疗）DecisionofinitiationofAEDs(是否用药是否用药?)No AEDs treatment currently: First seizure 、norma
33、l EEG & MRI Sporadic or situation-related seizures Rare seizures and severe side-effect during AEDs therapy暂时不用药：暂时不用药：第一次发作、脑电图正常、第一次发作、脑电图正常、MRI无致痫灶无致痫灶偶发或状态关联性癲痫发作偶发或状态关联性癲痫发作发作少而治疗时有不可耐受的副作用发作少而治疗时有不可耐受的副作用Treatment(治疗治疗)When should further observation be needed: Only few seizures, occasional no
34、cturnal seizures, benign syndromes, seizures with apparent precipitations, or non-disabling brief simple partial seizures When should an antiepileptic drug be considered: Two or more unprovoked seizures have occurred within a short interval Additional considerations: EEG foci or organic lesionsTreat
35、ment(治疗治疗)继续观察继续观察发作少发作少,偶然夜间发作偶然夜间发作,良性综合征良性综合征,明显诱因明显诱因,不造不造成功能缺损的短暂的简单部分性发作成功能缺损的短暂的简单部分性发作考虑用药考虑用药在短期内有两次无诱因的发作在短期内有两次无诱因的发作其它考虑其它考虑脑电图或结构上的局灶损害脑电图或结构上的局灶损害Listofantiepilepticdrugs:AEDsOld传统药传统药First year marketedChinaPhenobarbital苯巴比妥苯巴比妥1912Phenytoin苯妥英苯妥英钠1938Primidone扑扑痫酮1952Ethosuximide乙琥胺乙
36、琥胺1960Diazepam安定安定1963Carbamazepine卡卡马西平西平1974Clonazepam氯硝安定硝安定1975Valproate丙戊酸丙戊酸1978Piracetam吡拉西坦吡拉西坦Zonisamide唑尼沙胺尼沙胺Clobazam氯巴巴唑New新药新药First year marketedChinaLorazepam罗拉西半拉西半1977Vigabatrine氨己氨己烯酸酸1989Lamotrigine拉莫三拉莫三嗪1991Gabapentin加巴加巴喷丁丁1993Felbamate非氨非氨酯1993Topiramate妥比妥比酯1995Fosphenytoin磷苯妥
37、英磷苯妥英1996Tiagabine替加替加宾1997Levetiracetam左乙拉西坦左乙拉西坦1999Oxcarbazepine奥卡西平奥卡西平2000Stiripentol司替戊醇司替戊醇2001Pregabalin普瑞巴林普瑞巴林2005AEDs作作 用用 机机 制制AEDsTmax(hour)T1/2(hour)Protein binding (%)苯巴比妥苯巴比妥(PB)(PB)1-375-12045-60苯妥英苯妥英钠(PHT)(PHT)8-127-4270-95卡卡马西平西平(CBZ)(CBZ)4-85-2675丙戊酸丙戊酸(VPA)(VPA)1-84-1285-95拉莫三拉
38、莫三嗪(LTG)(LTG)1-33055妥比妥比酯(TPM)(TPM)218-2315坐乙拉西坦坐乙拉西坦(LEV)(LEV)0.6-1.36-820-25苯巴比妥苯巴比妥15-2540-50扑扑痫酮5-1215卡卡马西平西平6-1015乙琥胺乙琥胺40-100150丙戊酸丙戊酸50-100氯硝安定硝安定0.02-0.070.08唑尼沙胺尼沙胺15-4040氯巴巴唑0.05-0.3AEDs的治疗药物浓度监测的治疗药物浓度监测Treatment(治疗治疗)Choice of AEDs (Choose AEDs on seizure classification) Idiopathic, Gene
39、ralized Seizure:VPA(丙戊酸丙戊酸),LTG(拉莫三嗪拉莫三嗪)Symptomatic, Partial Seizure: CBZ(卡马西平卡马西平),TPM(妥吡酯妥吡酯) Other AEDS: phenytoin(PHT), phenobarbitone(PB), clonazepam(CNZ)(苯妥因钠，苯妥因钠，苯巴比妥苯巴比妥,氯硝安定氯硝安定)选药原则选药原则症状性症状性部分性发作：部分性发作：卡马西平，妥吡酯卡马西平，妥吡酯特发性特发性泛化性发作：泛化性发作：丙戊酸，拉莫三嗪丙戊酸，拉莫三嗪其他药物：其他药物：氯硝安定，苯妥因钠，苯巴比妥氯硝安定，苯妥因钠，苯
40、巴比妥Treatment(治疗治疗)Principles during drug treatment: uMonotherapy should be used if possibleuStart with low doseu Increase the dosage gradually u Monitor side effects, and serum levels when necessarilyu Beware of interactions with all other drugsuDesign the schedule ofchanging, or discontinuing drugs
41、 carefully用药注意用药注意u单药治疗单药治疗u小剂量开始小剂量开始u逐渐增量逐渐增量u监测药物副作用和药物浓度监测药物副作用和药物浓度u注意药物之间相互作用注意药物之间相互作用u药物和剂量调整要谨慎药物和剂量调整要谨慎StatusEpilepticus(癫痫持续状态癫痫持续状态)Status epilepticus (SE) can be defined as recurrent epileptic seizures lasting more than 30 min. A practical classification includes the following seizure
42、types: Tonic-clonic Absence Myoclonic Complex partial Focal motor (epilepsia partialis continua, EPC)StatusEpilepticus(癫痫持续状态癫痫持续状态)定义定义:癫痫连续发作之间意识尚未恢复又频繁再癫痫连续发作之间意识尚未恢复又频繁再发发,或癫痫反复发作持续超过或癫痫反复发作持续超过30分钟未自行停止分钟未自行停止.SE可以包括如下的发作类型可以包括如下的发作类型:强直强直-阵挛阵挛失神失神肌阵挛肌阵挛复杂部分性复杂部分性局灶运动性局灶运动性(EPC)ManagementofSE(持
43、续状态的控制持续状态的控制)SE治疗的目的治疗的目的:保证生命体征稳定保证生命体征稳定尽快终止发作尽快终止发作寻找并祛除诱因寻找并祛除诱因处理并发症处理并发症TCSE produces a characteristic pattern of changes which, ultimately, cause irreversible brain damage and potentially fatal systemic complications. SE会导致大脑不可逆性损伤和致命性的多会导致大脑不可逆性损伤和致命性的多系统并发症系统并发症, 因此必须立即尽快治疗因此必须立即尽快治疗!一般措施一
44、般措施保证呼吸道通畅保证呼吸道通畅,监测生命体征监测生命体征尽早建立静脉通道尽早建立静脉通道防治并发症防治并发症:脑水肿、感染、降体温、电脑水肿、感染、降体温、电解质紊乱、营养等解质紊乱、营养等ManagementofTCSE p.r., per rectum, an important alternative route of administration in children when intravenous access is difficult or impossibleStage of SETreatmentFirst choice AlternativesEarly(0-30 m
45、in)lorazepam i.v./p.r rectaldiazepam i.v./p.rparaldehyde(副醛副醛)Established(30-60 min)phenytoin i.v. fosphenytoin(磷苯磷苯 妥英钠妥英钠) i.v.phenobartitone i.v. chlormethiazole(氯氯乙噻唑乙噻唑)Refractory(60-90 min)thiopentone(硫喷妥钠硫喷妥钠) i.v. propofol(丙泊酚丙泊酚) i.v.Pentobarbitone(戊巴戊巴比妥比妥) i.v.Drugtherapy(药物治疗药物治疗)首选安定首选安
46、定10-20mg(儿童用量儿童用量:0.25-0.5mg/Kg)静脉静脉推注推注,如有效如有效,再用安定再用安定60-100mg加入加入5%GNS中中缓慢静脉滴注缓慢静脉滴注,一般不要持续使用超过一般不要持续使用超过24小时小时在早期在早期SE,静推安定的有效控制率为静推安定的有效控制率为70-80%,但但10-15%有呼吸抑制和有呼吸抑制和/或低血压的副作用或低血压的副作用Drugtherapy(药物治疗药物治疗)其它其它(二线二线)药物药物:苯妥英钠苯妥英钠、10%水合氯醛水合氯醛(灌肠灌肠)等等常规常规SE治疗方案治疗方案: 安定静推安定静推+静脉滴注静脉滴注; 苯巴比妥苯巴比妥0.1-
47、0.2g肌注肌注, q8-12h; 口服口服/胃管入胃管入AEDs 以上三措施一般同时使用以上三措施一般同时使用, 大部分大部分SE都可有效控制都可有效控制, 如仍不能控制则要进入难治性如仍不能控制则要进入难治性SE治疗程序治疗程序RefractorySE(难治性难治性SE)定义定义:持续的癫痫发作持续的癫痫发作,对初期的一线药物无效对初期的一线药物无效,连续发作连续发作1小时以上。小时以上。治疗治疗:1.异戊巴比妥异戊巴比妥,0.25-0.5g/次次, iv2.咪唑安定咪唑安定,0.15-0.2mg/Kg, iv继继0.06- 0.6mg/(Kg.h)静滴静滴3.丙泊酚丙泊酚、利多卡因、利多
48、卡因、硫喷妥钠硫喷妥钠、氯氨酮等、氯氨酮等Surgicaltreatment(手术治疗手术治疗)Surgical intervention is now accepted as a realistic therapeutic option for many patients with medically refractory seizures.外科手术目前是作为药物难治性癫痫患者的理想外科手术目前是作为药物难治性癫痫患者的理想选择选择Surgical procedures for refractory epilepsiesFunctioal surgeryResective surgerySt
49、ereotactic lesionsTemporal lobe resections subcorticalneocorticectomytemporalanterior temporal lobectomyDisconnection proceduresamygdalohippocampectomycorpus callosotomyExtratemporal resectionsmultiple subpial transectionsfrontalcentroparietaloccipitalMajor resectionsmultilobarhemispherectomyFundame
50、ntal consideration before surgery1. Appropriate diagnosis with multimodal evaluation.2. Intractability against more than two trials with appropriate major drugs. 3. More than two years under medically intractable condition. 4. QOL is impaired by the habitual seizures.5. Informed consent by both pati
51、ent and their family.术术前前准准备备1.经过多项评估的正确诊断经过多项评估的正确诊断2.对主要抗癫痫药物治疗失败对主要抗癫痫药物治疗失败3.超过超过2年药物难治性年药物难治性4.生活质量受习惯性发作影响生活质量受习惯性发作影响5.病人及其家属都关注病人及其家属都关注TakehomemessagesDefinition/定义定义癫痫癫痫, 痫性发作痫性发作Seizure types/发作类型发作类型全面性全面性、部分性发作部分性发作Diagnosis/诊断诊断临床和脑电图的结合临床和脑电图的结合First choice of AEDs首选药物首选药物Definition of SE持续状态定义持续状态定义Management of SE控制持续状态控制持续状态
