癲癇中醫(yī)本科

1、名人癲癇患者,拿破侖,凱撒大帝,先知穆罕默德,圣女貞德,蘇格拉底,柯棣華,諾貝爾,梵高,狄更斯,陀斯妥耶夫斯基,拜倫,莫泊桑,癲癇 —— 僅次于中風(fēng)的第二大神經(jīng)系統(tǒng)疾病,估計(jì)我國(guó)約有600萬以上癲癇患者 每年新發(fā)病人65-70萬,More than 2 million people in the United States have been diagnosed with epilepsy or have experienced a

2、seizure.,什么是癇性發(fā)作？,腦神經(jīng)元過度同步放電 → 一次短暫的腦功能障礙（一種癥狀的描述）,——癇性發(fā)作(seizure),During a seizure, the person has movements or feelings that he or she cannot control.The person may cry, fall unconscious, or twitch involuntarily.,什么是癲

3、癇？,各種腦病所致慢性反復(fù)發(fā)生的癇性發(fā)作多次 （兩次以上）綜合征 （發(fā)生癇性發(fā)作的疾?。?——癲癇(epilepsy),A person has epilepsy when he or she has seizures more than once because of a brain disorder. Sometimes people use the term seizure to indicate epilepsy .1 s

4、eizure – just 1 seizureMultiple seizures – epilepsy,國(guó)際抗癲癇聯(lián)盟(2005)的最新定義,癲癇是一種大腦功能障礙，其特征為臨床發(fā)作由腦內(nèi)慢性持久性異常所致，伴隨相應(yīng)的神經(jīng)生物學(xué)、認(rèn)知、精神心理及行為等多方面的功能障礙，并至少有一次癇性發(fā)作,國(guó)際抗癲癇聯(lián)盟,I L A E,癲癇是怎樣發(fā)生的？,特發(fā)性癥狀性隱源性（可能癥狀性）狀態(tài)關(guān)聯(lián)性,About 1/2 of all seizu

5、res have no known cause. The other 1/2 are linked to a disease or injury of the brain.,有某些特定的遺傳傾向在某一特定年齡段起病具特征性臨床表現(xiàn)及腦電圖改變有較明確的診斷標(biāo)準(zhǔn),特發(fā)性,癥狀性,有明確的大腦器質(zhì)性疾病或損傷上述疾病或損傷是癲癇發(fā)作的原因,癲癇發(fā)作與某些特殊狀態(tài)相關(guān)狀態(tài)解除即不再發(fā)作,狀態(tài)關(guān)聯(lián)性,隱源性（可能癥狀性）,臨床表現(xiàn)高度

6、提示為癥狀性，但暫未找到明確病因多發(fā)于某一年齡段一般無特征性臨床表現(xiàn)及腦電圖改變,致癇灶(seizure focus)：癲癇樣放電的部位癲癇病理灶(lesion)： 病變部位,癲癇樣放電的起源,CA1、CA3和CA4區(qū)錐體細(xì)胞減少 CA2區(qū)不受影響齒狀回顆粒細(xì)胞局灶性減少,難治性癲癇的常見病理改變——海馬硬化(AHS),,病變側(cè)海馬萎縮，顳葉內(nèi)側(cè)容積變小 病變側(cè)側(cè)腦室下角擴(kuò)大顳葉內(nèi)側(cè)異常信號(hào),海馬硬化(AHS)的MRI表

7、現(xiàn),延長(zhǎng)的去極化漂移：神經(jīng)細(xì)胞靜息膜電位變化,某些神經(jīng)元存在恒定的短間隙放電，發(fā)作前放電頻率顯著增高，發(fā)作中呈明顯同步化并導(dǎo)致周圍神經(jīng)元同步活動(dòng)。,神經(jīng)遞質(zhì)與突觸傳遞改變：抑制性神經(jīng)遞質(zhì)GABA與興奮性神經(jīng)遞質(zhì)谷氨酸異常,癲癇發(fā)作的發(fā)生機(jī)制,離子通道病變,癲癇發(fā)作的擴(kuò)散機(jī)制,離子通道病變,基因異常,離子通道蛋白,自身免疫異常,離子通道結(jié)構(gòu)與功能異常,Na+、K+、Ca++等通道,,,,先天性離子通道病 ——特發(fā)性癲

8、癇,獲得性離子通道病,良性家族性新生兒癲癇 良性家族性新生兒嬰兒癲癇 伴熱性癲癇發(fā)作的全面性癲癇附加癥 嬰兒重癥肌陣攣癲癇 常染色體顯性遺傳性夜發(fā)性額葉癲癇 青少年肌陣攣性癲癇(JME) 常染色體遺傳性伴聽覺特征的部分性癲癇,單基因異常離子通道病所致特發(fā)性癲癇,腦外傷腦血管病腫瘤中樞神經(jīng)系統(tǒng)感染寄生蟲感染遺傳代謝性疾病皮質(zhì)發(fā)育異常中樞神經(jīng)系統(tǒng)變性疾病藥物和毒物其他,癥狀性癲癇的常見原因,During dev

9、elopment and the first few years of childhood, the brain undergoes a lot of growth. During this growth, the brain is at danger of certain diseases due to infections, poor nutrition, and poor supply of oxygen. Some of the

10、se diseases are associated with epilepsy.,兒童發(fā)育的起初數(shù)年，其大腦快速發(fā)展。在其生長(zhǎng)發(fā)育過程，大腦處于感染、營(yíng)養(yǎng)不良、缺氧等特定病態(tài)的危險(xiǎn)之中。其中的某些疾病與癲癇有關(guān)。,The neurons of the brain develop into complex webs of wires. Defects in wiring during brain development could le

11、ad to epilepsy.,大腦的神經(jīng)元發(fā)展成復(fù)雜的線路交通網(wǎng)絡(luò)。大腦發(fā)育過程中線路交通的缺失可以導(dǎo)致癲癇。,After a head injury due to an accident or a stroke, the brain repairs itself by making new wiring.If the new wiring is abnormal, it could cause seizures.,事故或中風(fēng)所致的

12、頭部創(chuàng)傷之后，大腦通過重建新的線路交通來修復(fù)自身。這時(shí)如果新的線路交通不正常，亦可引起癇性發(fā)作。,Disease of the brain, such as hydrocephalus and meningitis, could cause epilepsy.,大腦的疾病，如腦積水、腦膜炎等，可以引起癲癇。,Poisoning of the brain, such as lead and carbon monoxide poisonin

13、g, could lead to seizures.,大腦的中毒，如鉛和一氧化碳中毒，可以導(dǎo)致癇性發(fā)作。,Exposure to street drugs and overdoses of antidepressants could also lead to seizures.,吸毒、抗抑郁藥過量也可導(dǎo)致癇性發(fā)作。,Older people sometimes develop diseases of the brain, such as

14、 brain tumors, strokes, infections and bleeding. There types of diseases could lead to epilepsy.,年齡較大者有時(shí)會(huì)發(fā)生一些腦部疾病，如腦腫瘤、中風(fēng)、感染和出血。這些疾病類型可導(dǎo)致癲癇。,Some types of epilepsy lend to run in families, suggesting hereditary causes.,某

15、些類型的癲癇呈家族性發(fā)生，提示遺傳因素病因。,癲癇有哪些類型？,國(guó)際抗癲癇聯(lián)盟,I L A E,1981分類：1. 部分（局灶）發(fā)作單純性、復(fù)雜性、繼發(fā)泛化2. 全面（泛化）發(fā)作包括強(qiáng)直－陣攣、強(qiáng)直、陣攣、肌陣攣、失神、失張力等3. 不能分類的癲癇發(fā)作,國(guó)際抗癲癇聯(lián)盟,I L A E,2001分類：1. 特發(fā)性嬰兒和兒童局灶性癲癇……2. 家族性（常顯）局灶性癲癇……3. 癥狀性（或可能的）局灶性癲癇……

16、4. 特發(fā)性泛化性癲癇……5. 癲癇性腦病…… ……等等,臨床常見癲癇發(fā)作及癲癇綜合征,泛化性強(qiáng)直－陣攣發(fā)作(generalized tonic-clonic seizure, GTCS)強(qiáng)直性發(fā)作；陣攣性發(fā)作；肌陣攣性發(fā)作典型與非典型失神發(fā)作(absence)失張力性發(fā)作(atonic seizure)單純部分性運(yùn)動(dòng)性發(fā)作；單純部分性感覺性發(fā)作；復(fù)雜部分性發(fā)作

17、 West綜合征（嬰兒痙攣癥） Lennox-Gastaut綜合征青少年肌陣攣癲癇(JME)伴中央顳區(qū)棘波的兒童良性癲癇(BECTS),Due to complexity of the brain and its function, there are more than 32 types of seizures. There are many different words used to describe seizures,

18、some of them include: convulsions, epileptic attacks, tonic-clonic seizures.由于大腦及其功能的復(fù)雜性，癲癇發(fā)作的類型超過32種之多。有許多不同的名詞用于描述癲癇發(fā)作，其中包括：抽搐、癇性發(fā)作、強(qiáng)直-陣攣發(fā)作等。,癲癇有哪些常見的表現(xiàn)？,泛化性強(qiáng)直－陣攣發(fā)作(GTCS),以全身肌肉強(qiáng)直和陣攣為主要表現(xiàn)、伴有意識(shí)喪失及自主神經(jīng)功能紊亂的一種發(fā)作，俗稱大發(fā)作，是常

19、見的發(fā)作類型可見于各種類型的癲癇和癲癇綜合征,發(fā)作前期發(fā)作期：強(qiáng)直期 陣攣期發(fā)作后期,發(fā)作過程：,★視頻1,★視頻2,★視頻3,強(qiáng)直性發(fā)作,多見于有彌漫性腦損傷的癲癇病人，以兒童為多，睡眠中發(fā)作較多，是病情嚴(yán)重的標(biāo)志,發(fā)作表現(xiàn)：,★強(qiáng)直性發(fā)作視頻,全身或部分肌肉的持續(xù)、強(qiáng)烈、非震顫性收縮，使患者的頭、眼及肢體固定于某一位置，軀干呈角弓反張；伴意識(shí)障礙、呼吸困難及瞳孔散在,陣攣性發(fā)作,幾乎只見于低齡兒童，一般是嬰兒及新生兒,發(fā)作表現(xiàn)

20、：,★陣攣性發(fā)作視頻,意識(shí)喪失，伴突然的肌張力降低，或短暫的肌陣攣樣全面性強(qiáng)直性痙攣，猝倒在地，繼而出現(xiàn)雙側(cè)肌陣攣，持續(xù)約1至數(shù)分鐘,肌陣攣性發(fā)作,見于任何年齡，自發(fā)性常于入睡或清晨將醒時(shí)多發(fā)，誘發(fā)性多于閃光刺激或運(yùn)動(dòng)刺激后發(fā)生,發(fā)作表現(xiàn)：,★肌陣攣發(fā)作視頻1,全身性或相對(duì)局限性的突發(fā)、短暫、震顫樣的肌肉收縮,★肌陣攣發(fā)作視頻2,失神發(fā)作(absence),突發(fā)短暫的意識(shí)障礙,典型失神：兒童或某些良性特發(fā)性癲癇患者，突發(fā)短暫的意識(shí)喪失，

21、凝視，運(yùn)動(dòng)中止，腦電圖典型的3Hz棘慢波,★典型失神發(fā)作視頻,★非典型失神發(fā)作視頻,非典型失神：彌漫性腦病患者，發(fā)生和停止較典型者慢，腦電圖發(fā)作波不規(guī)則,失張力發(fā)作,肌力張力突然降低，累及全身可跌倒，累及部分肌群可導(dǎo)致頭、肢體下垂，持續(xù)數(shù)秒可迅速恢復(fù),★失張力發(fā)作視頻,可單純失張力，亦可伴發(fā)于彌漫器質(zhì)性腦病,發(fā)作表現(xiàn)：,單純部分性運(yùn)動(dòng)性發(fā)作,局部的抽動(dòng)，如口角、眼瞼、一側(cè)面部、某一指或趾、某一肢體等，有時(shí)表現(xiàn)言語中斷,★單純部分性運(yùn)動(dòng)性

22、發(fā)作視頻,致癇灶累及一側(cè)中央前回附近，限于局部未擴(kuò)散,發(fā)作表現(xiàn)：,部分性發(fā)作繼發(fā)泛化,先有局灶性癲癇發(fā)作表現(xiàn)，繼而發(fā)展至全身性發(fā)作并伴意識(shí)喪失,★部分性發(fā)作繼發(fā)泛化視頻,部分性發(fā)作發(fā)展為泛化性強(qiáng)直－陣攣性發(fā)作、強(qiáng)直性發(fā)作或陣攣性發(fā)作,發(fā)作表現(xiàn)：,復(fù)雜部分性發(fā)作,又稱精神運(yùn)動(dòng)性發(fā)作或顳葉發(fā)作,發(fā)作表現(xiàn)：,★復(fù)雜部分性發(fā)作視頻1,先兆、意識(shí)障礙、自動(dòng)癥、運(yùn)動(dòng)癥狀,★復(fù)雜部分性發(fā)作視頻2,Most seizures last from a f

23、ew seconds to a few minutes and stop naturally.大部分癲癇發(fā)作持續(xù)幾秒鐘到幾分鐘不等，常自然終止。,臨床表現(xiàn)要點(diǎn)總結(jié),Seizures that limit themselves to one part of the brain are called partial seizures. These seizures are usually labeled using the area o

24、f the brain that they started from. In partial seizures, the person may experience sudden feelings of joy or sadness or sudden sensations of smell, hearing, or vision.局限于大腦某一個(gè)部位的癲癇發(fā)作稱為部分性發(fā)作。這類癲癇發(fā)作常以其起源的大腦區(qū)域命名。發(fā)生部分性發(fā)作時(shí)，

25、患者可體驗(yàn)到突然出現(xiàn)的愉悅或悲傷感受，或突然出現(xiàn)的嗅、聽、視感覺。,Another kind of partial seizure is called a complex partial seizure. During this kind of seizure, the patient may display abnormal repetitive behaviors, such as blinking, moving in a cir

26、cle, striking out at walls or moving an arm or leg without being able to control the movement.另一種部分性發(fā)作稱為復(fù)雜部分性發(fā)作。發(fā)生這種發(fā)作，病人可表現(xiàn)不正常的重復(fù)行為，如眨眼、轉(zhuǎn)圈、擊打墻壁或無法控制地移動(dòng)單個(gè)肢體。,Seizures that spread to the rest of the brain are called gen

27、eralized seizures. These seizures may cause the person to: - lose consciousness- fall- have muscle spasms- have jerking muscles all over the body or - stare into space, losing contact with reality for a few sec

28、onds.,癲癇發(fā)作擴(kuò)散到其余腦區(qū)稱為全面泛化性發(fā)作。這類癲癇發(fā)作可造成患者： 意識(shí)喪失、跌倒、肌肉痙攣、全身肌肉抽搐或凝視、失神幾分鐘,Not all people who have a seizure have epilepsy. Some people have just one seizure at some point in their life and never have another one.1 sei

29、zure – just 1 seizureMultiple seizures – epilepsy并不是所有有過一次癇性發(fā)作的人都是癲癇。某些人只是在他們一生當(dāng)中的某一時(shí)候有過一次癇性發(fā)作而再無另一次。,Sometimes a child may have a seizure during an illness with a high fever. Most of the time, these seizures do not r

30、ecur unless there has been damage to the brain.有時(shí)一個(gè)兒童可能在患高熱性疾病時(shí)有過一次癇性發(fā)作。大部分時(shí)候這些發(fā)作不會(huì)再復(fù)發(fā)，除非疾病損傷到大腦。,Some people can tell when they are about to have a seizure because they have a specific feeling before the seizure start

31、s; this is called an “aura.” The most common aura is the smell of burnt rubber.有些人癲癇發(fā)作前有某種特別的感覺，因而能說出將要發(fā)作的時(shí)間；這稱為“先兆”。最常見的先兆是嗅到燒焦的橡膠味。,癲癇綜合征,West綜合征（嬰兒痙攣癥）,圍產(chǎn)期損傷1歲以內(nèi)發(fā)病痙攣性發(fā)作：一連串的強(qiáng)直痙攣智能低下腦電圖高幅失節(jié)律,癲癇綜合征,Lennox-Gastaut綜

32、合征,圍產(chǎn)期損傷1-7歲，男多于女多種類型的癲癇發(fā)作并存發(fā)作頻繁，開始即難以控制精神發(fā)育遲滯及人格障礙腦電圖彌漫性慢棘慢波,癲癇如何診斷？,是癲癇嗎？有原因嗎？屬于哪種發(fā)作類型？,診斷依據(jù),詳盡的病史腦電圖、腦磁圖頭顱CT及頭顱MRISPECT或PET腦組織活體檢查,病史要點(diǎn),癲癇發(fā)作的過程 患者背景資料以往就醫(yī)情況,任何一位從事神經(jīng)科專業(yè)的醫(yī)師絕不應(yīng)該放過可能的親自觀察患者發(fā)作過程的機(jī)會(huì)。以專業(yè)的眼光描述的癲

33、癇發(fā)作肯定比病人及其家屬所述更有價(jià)值,A test commonly used to diagnose epilepsy is called an electroencephalogram, or EEG. This tests records brain waves. In most cases of epilepsy a doctor can determine if the brain has abnormal electrica

34、l activity associated with a seizure by reading the EEG.腦電圖(EEG)是一種常用于診斷癲癇的檢查。這種檢查記錄腦波。對(duì)于大多數(shù)癲癇病人，醫(yī)生都可以通過腦電圖確定其大腦是否有與癇性發(fā)作相關(guān)的異常電活動(dòng)。,During an EEG, electrodes are placed on the scalp and brain waves are measured. The test

35、 is painless. The doctor may also want to do an EEG while the patient is sleeping.作腦電圖檢查時(shí)，將電極置放于頭皮表面，檢測(cè)腦波。檢查是無痛性的。醫(yī)生還可以在患者睡眠時(shí)作腦電圖檢查。,腦電圖癲癇樣放電,棘波 尖波棘慢復(fù)合波尖慢復(fù)合波多棘波多棘慢波高幅失節(jié)律發(fā)作性節(jié)律,A doctor may use a magneto-encephalo

36、gram, or MEG. The purpose of this test is similar to the EEG, except that it measures magnetic signals in the brain instead of electrical signals. Because of this difference, it does not require electrodes and can detect

37、 signals from deeper areas of the brain than the EEG can.醫(yī)生可以使用腦磁圖(MEG)檢查。這種檢查的目的與腦電圖相似，唯一區(qū)別是它測(cè)量大腦的磁信號(hào)而不是電信號(hào)。由于這一差異，它不需要安裝電極，可以檢測(cè)出腦電圖難以達(dá)到的大腦深部的信號(hào)。,The doctor may also request a brain scan in order to see structures ins

38、ide the brain. Examples of brain scans are MRI, CT, and PET scans. These allow the doctor to see structures, such as tumors or cysts, which could be causing the seizures.醫(yī)生還可能要求一個(gè)腦部掃描以觀察大腦內(nèi)在結(jié)構(gòu)的改變。腦掃描的例子是核磁共振(MRI)、CT和PE

39、T等。這些可讓醫(yī)生了解患者大腦構(gòu)造上的改變，如腫瘤或囊腫，那可以引起癲癇發(fā)作。,鑒別診斷,假性發(fā)作暈厥短暫性腦缺血發(fā)作偏頭痛抽動(dòng)障礙面肌痙攣睡眠障礙,Some people have seizure-like behavior without any abnormal electrical activity. These are called non-epileptic seizures or pseudo-seizures

40、. They may occur due to psychological reasons, such as stress or need for attention.有些人有類似癇性發(fā)作行為而沒有不正常的電活動(dòng)。這稱為非癲癇性發(fā)作或假性發(fā)作。這些發(fā)作可能是由于某些心理原因，如應(yīng)激或渴望關(guān)注。,★假性發(fā)作視頻,癇性發(fā)作與假性癲癇發(fā)作鑒別,暈厥,各種原因所致短暫性全腦血流灌注不足突然短暫的意識(shí)喪失和跌倒常見原因?yàn)榉瓷湫?、心源性、腦

41、源性常有焦慮、疼痛、寒冷、高溫等誘發(fā)因素低血壓、低血糖、心律失常等表現(xiàn)腦電圖常正?；騼H有慢波,短暫性腦缺血發(fā)作(TIA),缺血性腦血管意外（小中風(fēng)）24小時(shí)內(nèi)可完全恢復(fù)老年人，中風(fēng)危險(xiǎn)因素兒童見于血管畸形等毀壞性癥狀為主，少有刺激性癥狀持續(xù)時(shí)間較長(zhǎng)腦電圖無癲癇樣放電,偏頭痛,顱內(nèi)外神經(jīng)－血管功能障礙反復(fù)發(fā)作的偏側(cè)或雙側(cè)劇烈頭痛，跳痛感先兆以單純視幻覺為主少有意識(shí)障礙腦電圖無癲癇樣放電對(duì)麥角胺類制劑有效,抽動(dòng)障

42、礙,兒童抽動(dòng)－穢語綜合征心理障礙性肌肉刻板抽動(dòng)類似癲癇發(fā)作伴穢語、重復(fù)或模仿語言睡眠時(shí)可減輕或消失腦電圖無癲癇樣放電對(duì)氟哌啶醇有效,面肌痙攣,中老年、女性多發(fā)面神經(jīng)機(jī)械性刺激或壓迫所致陣發(fā)性、快速不規(guī)則的面肌抽動(dòng)僅限于面肌，不累及頭、頸、肩等腦電圖正常,睡眠障礙,睡驚癥睡行癥發(fā)作性睡病睡眠中周期性腿動(dòng),癲癇有哪些治療方法？,首先必須強(qiáng)調(diào)的是：超過80%的癲癇患者可以通過抗癲癇藥物(AEDs)加以控制。,傳統(tǒng)抗癲

43、癇藥： 苯妥英鈉、苯巴比妥、丙戊酸、卡馬西平、撲癇酮、乙琥胺、氯硝安定等等。新一代抗癲癇藥： 拉莫三嗪、托吡酯、加巴噴丁、氨己烯酸等等。,選藥依據(jù),不同的發(fā)作類型或綜合征患者的依從性醫(yī)療條件,循證醫(yī)學(xué)證據(jù),常見發(fā)作類型及綜合征的初始單藥治療選擇國(guó)際抗癲癇聯(lián)盟2006.9,患者的依從性及醫(yī)療條件,年齡全身狀況處境對(duì)藥物的耐受性當(dāng)?shù)啬芊袢菀踪I到價(jià)格,藥物治療要注意,盡量精簡(jiǎn)用藥種類，最好單藥治療使用能控

44、制癲癇發(fā)作的最小劑量長(zhǎng)期規(guī)律用藥嚴(yán)密監(jiān)測(cè)不良反應(yīng),服藥突然中斷有可能導(dǎo)致更多的發(fā)作并難以控制?。?！,停藥,經(jīng)藥物治療已無臨床癲癇發(fā)作達(dá)2-3年經(jīng)腦電圖監(jiān)測(cè)無異常電活動(dòng)減量過程中無再發(fā)用半年時(shí)間減量,有些癲癇患者可能不得不終身服藥！??！,換藥,某種藥物已接近極限劑量而未能有效控制癲癇發(fā)作 某種藥物發(fā)生患者不能耐受的不良反應(yīng) 某種藥物盡管有效且未出現(xiàn)明顯不良反應(yīng)，但患者處境變化（如懷孕等）后有潛在的風(fēng)險(xiǎn)換藥時(shí)前后兩種藥物應(yīng)有

45、約1周左右的重疊用藥期，然后漸增新藥，漸減舊藥,聯(lián)合用藥（添加治療）,常用于癲癇綜合征等較難控制的發(fā)作 注意配伍原則：同一作用機(jī)制不宜搭配，毒副作用相近者不宜搭配，藥效下降者不宜搭配丙戊酸＋卡馬西平 不好的搭配丙戊酸＋拉莫三嗪 較佳,要引起重視的毒副作用：肝腎毒性過敏：卡馬西平——?jiǎng)兠撔云ぱ讓?duì)兒童認(rèn)知功能的影響對(duì)生育的影響：丙戊酸——多囊卵巢綜合征抗癲癇藥物加重癲癇發(fā)作抗癲癇藥物所致腦病,注意：迄今為

46、止，沒有任何證據(jù)證明中醫(yī)中藥能夠控制癲癇發(fā)作?。?！,復(fù)發(fā)的風(fēng)險(xiǎn),起病年齡：越大越易復(fù)發(fā) 既往史：有CNS病損史者復(fù)發(fā)機(jī)會(huì)增加 腦電圖：停藥前不正常者易復(fù)發(fā)不同發(fā)作類型復(fù)發(fā)率不同，各種綜合征復(fù)發(fā)率高,難治性癲癇,一個(gè)存在爭(zhēng)議的概念 藥物治療無效——藥物抗性癲癇 30-35%所有方法均無效——難治性癲癇 25%,用任何三種一線抗癲癇藥物仍不能控制發(fā)作，同時(shí)排除誤診、選藥不當(dāng)和用藥劑量不足等因素,醫(yī)源性難治性癲癇的常見原因,診斷錯(cuò)誤

47、 發(fā)作分型不確切選藥不當(dāng)用藥劑量不足病人依從性差錯(cuò)誤的治療方式,In some cases of childhood seizures, a special diet that is rich in fat and low in sugar can help to reduce the frequency of seizures. This type of treatment should be done under the

48、supervision of a healthcare provider to make sure the child gets proper nutrition.某些兒童癲癇患者，一種特別的高脂肪低糖飲食能夠幫助減少癲癇發(fā)作的次數(shù)。但這種治療方法應(yīng)該在衛(wèi)生保健提供者的監(jiān)護(hù)下進(jìn)行，以保證兒童獲得合適的營(yíng)養(yǎng)。,When medical treatment fails to control the seizures, a brain s

49、urgery may be considered. Brain surgery for seizures tries to remove the part of the brain that is responsible for abnormal electrical signals; this is the part that causes the seizures. However, these operations only wo

50、rk in less than 1/2 of all seizure patients.當(dāng)藥物治療控制癲癇發(fā)作失敗后，可以考慮腦外科手術(shù)。癲癇的外科治療試圖切除大腦與不正常電活動(dòng)相關(guān)的引起癲癇發(fā)作的部分。然而，這些手術(shù)只在所有癲癇病人中不到一半的病人身上有效。,外科手術(shù)治療,,嚴(yán)格掌握適應(yīng)癥：藥物抗性癲癇；局灶性發(fā)作其他因素：年齡(15-50)，除外精神障礙 致癇灶定位：影像學(xué)檢查，腦磁圖，PET等術(shù)式選擇：皮質(zhì)病灶切除，前顳

51、葉切除，選擇性杏仁－海馬切除，多處軟膜下橫纖維切斷，大腦半球切除，胼胝體切開，腦立體定向損毀等等,Another operation, called a vagal nerve stimulator, may be suggested. During this operation the surgeon inserts an electonic device under the skin in the upper left chest.

52、The device stimulates a big nerve in the neck. This nerve is known as the vagus nerve. The stimulation is not ideal for all seizure patients.另一種稱為迷走神經(jīng)刺激器的手術(shù)可被推薦。這種手術(shù)中，外科醫(yī)生在患者左上胸部皮下置入一個(gè)電子設(shè)備。這個(gè)設(shè)備刺激頸部的一個(gè)大神經(jīng)，即迷走神經(jīng)。但這種刺激并

53、不對(duì)所有癲癇病人都理想。,發(fā)生癇性發(fā)作時(shí)如何應(yīng)對(duì)？,Seizures can last from just a few seconds up to a few minutes. The greatest majority of seizures stop on their own. 癲癇發(fā)作可以持續(xù)幾秒鐘到幾分鐘。絕大多數(shù)癲癇發(fā)作自行停止。,If you notice a person having a seizure, prote

54、ct the person from harm until he or she regains awareness and control.如果你見到有人發(fā)生癇性發(fā)作，保護(hù)這個(gè)人免受傷害直到他或她恢復(fù)知覺和自控。,The following are some tips that can decrease the chances of injury during a seizure：Lower the patient into a r

55、eclining position on the floor or a flat surface；Put something soft under their head；Turn the head gently to one side to prevent any vomit from being sucked into the lungs as the person breathes.以下是一些注意點(diǎn)，可以減少癇性發(fā)作時(shí)的傷害機(jī)會(huì)

56、：將病人放低到地板上或一個(gè)平面上有依靠的位置；在其頭底下放置一些軟物；將頭輕柔地轉(zhuǎn)向一側(cè)以防嘔吐物在呼吸時(shí)被吸入肺。,If the person is confused during a seizure and is moving around, remove anything from the area that may cause injury to the patient or to others, such as a pan o

57、f boiling water or a hot iron.如果病人在癇性發(fā)作時(shí)迷惑并走來走去，應(yīng)移走周圍任何會(huì)傷害到病人或他人的東西，如一鍋沸水或熾熱的熨斗。,During a seizure, do NOT do the following:- Do not force anything into their mouth.- Do not give them water or medicine until the sei

58、zure is over.- Do not try to stop the jerking movement.病人癇性發(fā)作時(shí)，不應(yīng)該做以下事情：不要強(qiáng)行塞入任何東西到病人口中。發(fā)作停止前不要給予水或藥物。不要試圖阻止抽搐活動(dòng)。,怎樣指導(dǎo)癲癇病人的日常生活？,When seizures are controlled, most epileptic patients can have a normal life. How

59、ever, patients with seizures that are not well controlled need to take precautions that may affect their daily living.癲癇發(fā)作控制后，大部分患者可以有一個(gè)正常的生活。然而，那些發(fā)作控制不好的患者需要注意防范其對(duì)日常生活的影響。,Patients with uncontrolled seizures may not b

60、e able to drive, or operate hazardous machinery. Most states will not issue a driver’s license to someone with epilepsy unless the person can document that he or she has been seizure-free for a certain period of time. Th

61、e length of this period varies from state from state.未控制發(fā)作的癲癇病人不可以駕車，或操作危險(xiǎn)的機(jī)器。在美國(guó)，許多州不會(huì)發(fā)駕照給癲癇病人，除非該病人提供文件證明他或她已經(jīng)有一定時(shí)期不再有癲癇發(fā)作。這一時(shí)期的長(zhǎng)度每個(gè)州不太一樣。,Jobs and hobbies may have to be limited to those that are not dangerous to th

62、e person in case he or she loses consciousness or attention for a few moments. Examples of jobs and hobbies that may need to be avoided are: flying an airplane；motor racing；skydiving；mountain climbing.職業(yè)和業(yè)余愛好不得不限定在對(duì)患者沒

63、有危險(xiǎn)的范圍內(nèi)，以防其發(fā)生一過性的意識(shí)或注意力喪失。應(yīng)該避免的職業(yè)和業(yè)余愛好例如：駕駛飛機(jī)；賽車；跳傘；登山 。,Other activities and sports may be possible with supervision, such as:- swimming- sailing- riding bicycles.其他可以在監(jiān)護(hù)下進(jìn)行的活動(dòng)和運(yùn)動(dòng)例如：游泳航行騎自行車。,A lot of ac

64、tivities and sports are safe for a person with epilepsy, like jogging and volleyball. Contact sports should be avoided, since even minor trauma could set off a seizure. Therefore, it might not be wise for seizures patien

65、ts to play football or hockey.大量的活動(dòng)和運(yùn)動(dòng)對(duì)癲癇病人是安全的，如慢跑和排球。身體接觸的體育項(xiàng)目應(yīng)該避免，因?yàn)榧词箻O小的創(chuàng)傷亦可引發(fā)癇性發(fā)作。因此，對(duì)于癲癇病人來說，玩足球或曲棍球可能是不明智的。,The effects of uncontrolled seizures are more distinct in children and young adults who may not be able

66、 to proceed with their education in a normal manner. Since some anti-epilepsy medications interfere with memory and concentration, children with epilepsy may need extra time to learn and complete their homework.未能控制癲癇發(fā)

67、作對(duì)兒童和年輕人的影響尤其明顯，因?yàn)樗麄冊(cè)谀撤N常規(guī)意義上可能無法繼續(xù)其學(xué)業(yè)。由于一些抗癲癇藥物干擾記憶和注意力，癲癇兒童可能需要額外的時(shí)間來學(xué)習(xí)和完成家庭作業(yè)。,Women with a seizure disorder can get pregnant. However, they should stay on the medication prescribed by their doctor throughout the pregn

68、ancy. The neurologist should be made aware of an upcoming planned pregnancy. He or she may switch anti-epileptic medications, as some of these medications are known to increase the risks of abnormalities in the baby.癲癇