顽固性癫痫的诊断和治疗指南

顽固性癫痫的诊断和治疗指南

一、认识癫痫

1、何谓癫痫

癫痫是一种常见且病因比较复杂的慢性临床症侯群，俗称“羊癫风”、“发羊吊”、“猪头风”，患者因脑部突然强烈异常放电，引起脑功能失调，常表现为惊厥（“抽风”），突然意识丧失，全身发硬或抽动，也可表现为短暂发呆，或全身肌肉快速收缩等。单次或偶尔的痫性发作以及那些在急性病期间出现的发作均不在癫痫之列。这里强调了癫痫是“慢性脑部疾患”，本质是“异常放电”，并具有“反复发作性”。由于脑内异常放电的部位不同，临床上可表现相应的运动、感觉、意识、精神、行为及自主神经的不同表现。

2、癫痫的常见病因主要有如下13种

（１）.遗传（２）.颅脑外伤（３）.脑肿瘤（４）颅脑手术（５）.颅内感染（６）.脑血管病（７）.产前与产时损伤（８）.代谢障碍（９）.中毒（１０）.缺氧（１１）.先天性疾病（１２）.遗传性疾病（1３）.脱髓鞘疾病。

3、癫痫的发病率如何

癫痫系多发病之一，在我国发病率约为37/10万，患病率为3‰～7‰。我国现有癫痫患者近600万，且以27万/年的速率增长。本病常在儿童期和青春期发病，因病程长，给患者带来的痛苦很大

二、治疗癫痫

调查资料显示，国际上癫痫治疗方法是药物治疗，药物疗法虽然可使65%—70%的病人发作缓解获得到控制，但仍有30%—35%的病人服用效果不佳而成为药物难治性癫痫。且长期服用抗癫痫药物会带来较大的副作用，治疗效果将会逐渐降低。临床研究表明，通过各种不同的手术治疗可以使药物难治性癫痫的症状缓解或停止发作，并改善患者精神症状及其社会适应能力。癫痫的外科治疗是指采用外科手术的方法去除病灶、阻断癫痫传导通路或降低皮层兴奋性，从而达到减少或消除癫痫发作的治疗方法。具体治疗术式的选择主要依据病人的病灶部位、功能情况、病人发作情况来进行，其关键在于是癫痫灶的精确定位。

三、癫痫注意事项

1、女性癫痫患者当注意：

1）月经来潮可以诱发癫痫或使癫痫加重；2）妊娠可以诱发癫痫或使癫痫加重；3）绝经后癫痫会有好转，不主张进行激素替代治疗；4）抗痫药物可以进入胎儿体内，并对胎儿产生一定影响；5）产后要进行不断时间母乳喂养，防止断乳综合症；6）因口服避孕药与部分抗痫药有相互拮抗作用，尽可能不用口服避孕药；

Refractory epilepsy diagnosis and treatment guidelines

First, awareness of epilepsy

1, What is epilepsy

Epilepsy is a common cause and more complicated chronic clinical syndrome, commonly known as "epilepsy Wind," "epileptic" and "pig head wind", as a result of the brain in patients with abnormal discharge all of a sudden strong, caused by brain dysfunction, Usually convulsions ( "ventilation"), all of a sudden loss of consciousness, body fat or hard-tic, but also for the

short-term performance in a daze, or whole body muscle contraction, and so fast. The one-time or occasional seizures, as well as those in the acute period of the attack did not appear in epilepsy. Epilepsy is here stressed the "chronic disease of the brain," is the essence of the "abnormal discharge" and "recurrent." Due to abnormal brain in different parts of the discharge, the clinical performance of the corresponding movement, feeling, consciousness and spirit of the act and the different performance of the autonomic nervous system.

2, epilepsy as a result of the major diseases of the following 13

(1). Genetic (2). Traumatic brain injury (3). Brain tumors (4) brain surgery (5). Intracranial infection (6). Cerebrovascular disease (7). Prenatal and birth injury time (8 ). Metabolic disorder (9). Poisoning (10). Hypoxic (11). Congenital diseases (12). Hereditary diseases (13). Demyelinating diseases.

3, the incidence of epilepsy how

Department of epilepsy frequently-occurring one in our country the incidence rate is about 37/10 million, the prevalence rate of 3 ‰ ~ 7 ‰. China's current nearly 6,000,000 patients with epilepsy, and to 270,000 / year growth rate. In the regular session of the disease in childhood and adolescent onset, as a result of a long course of disease, for patients with pain caused by a large

Second, the treatment of epilepsy

Survey data show that the international community is the treatment of epilepsy drug treatment, drug therapy can Although 65% -70% of the patients to control access to alleviate the attack, but there is still 30% -35% of the patients became ill effects of drug resistant Epilepsy. And long-term use of antiepileptic drugs will bring more side effects, treatment will be gradually reduced. Clinical studies have shown that through a variety of different surgical treatment can make refractory epilepsy drug to ease symptoms or to stop attacks and improve symptoms in patients with mental and social adaptability. Surgical treatment of epilepsy is the use of surgery to remove the lesions, epilepsy block the pathway, or reduce the excitability of the cortex, an effort to reduce or eliminate epileptic seizures treatment. Specific surgical treatment of choice mainly based on the patient's lesion site, function, the patient to attack the situation, the key result in the accurate location of the foci.

Third, epilepsy Notes

1, female patients with epilepsy when:

1) Lai Chao menstruation can be induced by epilepsy or seizures increase; 2) Pregnancy can be induced epilepsy or seizures increase; 3) postmenopausal epilepsy will be better, do not advocate for hormone replacement therapy; 4) anti-epileptic drugs can enter the fetal body and Have an impact on the fetus; 5) to carry out post-natal period continued breast-feeding, weaning the prevention of SARS; 6) as a result of oral contraceptives and anti-epileptic drugs are part of the mutual antagonism, oral contraceptives do not have as much as possible;