第二篇常见内科疾病第十四章神经系统疾病 癫病（二）(课件）-高一《临床疾病概要（第4版）》同步教学（人卫版）

癫痫 (Epilepsy) 诊 断 癫痫的诊断 确定是否为癫痫发作 ； 确定病人发作的类型及可能属于哪种癫痫综合征 ； 确定病因 。 Determine whether an episodic disorder of nervous function is indeed a seizure. Determine the seizure pattern and determine which kind of epileptic syndrome it belongs to Search and define the cause. 全面性发作的诊断 主要依据发作史及其表现，了解发作时有无意识丧失对诊断GTCS是关键性的，舌咬伤和尿失禁是间接证据，发生跌伤及醒后头痛、肌痛也有参考意义。 失神发作有特征性脑电表现，结合相应的临床表现易于诊断。 辅助检查： EEG, lumbar puncture, CT, MRI Determine if the spell is a seizure first: Particular history Investigative examination：EEG, lumbar puncture, CT, MRI Differentiation： Hysteri (Table 12-2 请链接) Syncope hyperventilation syndrome migraine 癫痫的诊断方法 癫痫的临床诊断主要根据癫痫患者发作的病史，特别是可靠目击者所提供的详细发作过程和表现，辅以脑电图痫性放电即可确诊。 The diagnosis can be made mainly depended upon detailed, reliable history of the spells, and supported by positive findings of EEG EEG is the most common used test in distinguishing seizures from other causes of consciousness. However, a normal or nonspecifically abnormal EEG never excludes the diagnosis of seizures. 脑电图是癫痫诊断最常用的一种辅助检查方法。尖波、棘波、尖-慢波或棘-慢波等癎样放电。EEG正常或非特异性改变不能排除癫癎的诊断。正常脑电图 神经影像学：确定脑结构性异常或损害，MRI较CT为更敏感。 治 疗 癫痫的治疗-一般原则 1、确定诊断、确定发作类型；首次发作的患者在调查病因之前，不宜过早用药，应等到下次发作再决定是否用药 2、已知病因的应针对病因治疗 Therapy should be directed toward the cause of the seizure, if known. Establish the diagnosis and the types of epilepsy before starting drug therapy. Anticonvulsant drug treatment for a single seizures is not recommend unless an underlying cause is found that is not correctable and is likely to produce recurrent seizures. General principles of the use of antiepileptic drugs. Choose the right drug for the seizures type. (见表12-3) Dosage of commonly used and adverse effects (见表12-4)： Control of seizures is achieved at different levels in different patients . therapeutic drug monitoring, TDM，即测定血药浓度，可提高用药的有效性和安全性 3、根据发作类型选择AEDs，癫痫类型与药物治疗的关系密切 4、常用剂量和不良反应：由于药物吸收、分布及代谢的个体差异可影响药物的疗效，用药应采取个体化原则。即应进行药物监测，即测定血药浓度，严密观察不良反应。 5、坚持单药治疗原则：小剂量开始应用 6、联合治疗：一种药物出现不良反应时才能或仍不能控制发作时。化学结构相同的药物不宜联合应用。 7、长期坚持