神经病学课件 4.3 癫痫

Hydrocephalus, intracerebral hemorrhage and infaction which caused by头吸(head aspiration )or产钳 (obstetrical forceps), can make the局部脑软化(focal brain malacoma), and those may become seizure focus several。
（4） After febrile convulsion：
Serious and lasting febrile convulsion can result in neuron hypoxia → impairments of neuron→ proliferation of gliocyte → seizure focus.
That are charcterized by recurrent 、 spontaneous、transient 、paroxysms.
癫 痫（Epilepsies）
Because of different position and diffuse extent of abnormal neuronal discharge, the neurologic malfunction may reflect motor, sensation, consciousness, behavior and autonomic nerve and so on.
癫 痫（Epilepsies）
癫 痫（Epilepsies）
definition:
Epilepsy is a group of chronic disorders characterized by recurrent seizure, which is a transient disturbance of cerebral function caused by an abnormal neuronal discharge.
nine subtypes（三大类九亚型）.
单纯部分发作 （simple partial seizure）
Partial seizure 复杂部分性发作 （complex partial seizure）
继发全面发作 （secondary generalized
seizure）
癫 痫（Epilepsies）
4、轴突发芽：可能是神经元异常放电的形态学基础。
癫 痫（Epilepsies）
classifications of seizure:
According to that discharge originate from unilateral or bilateral (EEG), consciousness is exist or not, seizures are classified three types
Medial temporal lobe is sensitive to hypoxia, which
lead to切迹硬化(incisure sclerosis)
癫 痫（Epilepsies）
（5）Infections:
meninges or encephalon is infected by kinds of bacteria、 virus、 paresites, and then lead to encephalitis, meningitis, cerebral abscess.
（10） Degeneral, demyelinating diseases:
AD, tuberous sclerosis, multiple sclerosis.
Pick病等。
癫 痫（Epilepsies）
影响癫痫发作的因素：
Heredity:
often involve many genes, which are only for预致性 (theprediction) or 敏感性(sensitivity )of seizure. The penetrance is limited by ages.
seizure
Epilepsy
epileptic syndromes

癫 痫（Epilepsies）
classification by etiology:
1、Idiopathic epilepsy
for which most common in children and adolescent, No obviously structural change and metabolic abnormality that induce seizure are found in patients’ brain.
misconception(错觉), complicated hallucination, feelings of familiarity and unfamiliarity , et al.
癫 痫（Epilepsies）
complex partial seizure: or psychomotor seizure.
It may be closely related to heredity.
prevalence rate of close relative is high to 2-6%, which is 70% in monovular twins.
癫 痫（Epilepsies）
2、Symptomatic epilepsy:
（6）Toxicosis: CO、汞（ hydrargyri, ）、乙醇（ alcohol）、灭鼠药
（ deratization durgs）等，以及尿毒症（ uremia）、妊娠 中毒症(toxenia of pregnancy )。
（7） Cerebrovascular diseases:
subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction, vascular malformation, et al.
unclassified seizure
癫 痫（Epilepsies）
simple partial seizure:
Motor symptoms : focal limbs（thumb or face) ，Jacksonian
epilepsy (march), Todd ,s paralysis, epilepsia partialis status。
enviroments:
endocrine ,如经期性癫痫(menstrual epilepsy),妊娠性癫痫 (gravid epilepsy), sleep。
causative factors ，如flashing --myoclonus, overventilation--absence seizure, over hydroposia--tonic clonic seizure。
nausea(呕心） , vomiting(恶吐）, 烦渴 （ polydipsia）、排尿欲（urination desire）， sweating（出汗），cardiac arrhythmia, 等。
Psychic symptoms : amnestic disorder, sentiment abnormality(情感异常)、
常染色体显性遗传夜间发作性额叶癫痫 （autosomal dominant nocturnal frontal lobe epilepsy)， 位于20q13.2。
少年肌阵挛癫痫已发现3个基因位点，分别被定位于 6p21.3、15q14和8q24。
儿童失神癫痫的基因定位于8q24。 良性家族性婴幼儿惊厥的基因被定位于19q。
（2）： Cerebral trauma:
凹陷性骨折（ depressed fracture ）、硬脑膜撕裂 （ meninx fibrosa laceration ）、脑挫裂伤（ contusion and laceration of brain）等。
癫 痫（Epilepsies）
（3） Diseases in antenatal period and perinatal diseases: are the most causes of infant epilepsy。
generalized
seizure
失神发作 （absence seizure） 肌阵挛发作（ myoclonic seizure） 阵挛性发作 （clonic seizure） 强直性发作（ tonic seizure）
强直－阵挛发作 （tonic-clonic seizure） 无张力性发作（ atonic seizure）
Sensation symptoms : general sensation (numbness, pricking pain)，
Jackson感觉性癫痫。特殊感觉（嗅-olfactory、味 -gustateory、听-sounds、视-vision）。
癫 痫（Epilepsies）
Autonomic symptoms :
It may be increase of neuron excitation or decrease of inhibition, and abnormality of membrane.
癫 痫（Epilepsies）
1、 Change of biochemistry:
excitatory amino acids (aminoglutaminic acid, aminosuccinic acid) are excitatory transmitters, which make calcium and sodium ions get in cell, destroy the stability of membrane, prolong the unpolarized time course.