重庆医科大学：《儿科学》课程教学资源（PPT课件）Seizures

Seizures Prof Jiang Li Department of Neurology Childrens Hospital of cHUMs

Seizures Prof. Jiang Li Department of Neurology Children’s Hospital of CHUMS

Definitions ◆ Seizure(发作): a sudden attack, spasm,or convulsion, as in epilepsy or another disorder ◆ Epileptic seizure(癫痫样发作): a transient episode of abnormal and excessive neuronal activity in the brain that is apparent either to the subject or an observer ◆ Epilepsy(癫痫): a chronic disorder of the brain characterized by recurrent, unprovoked epileptic seizures

Definitions  Seizure （发作）: a sudden attack, spasm, or convulsion, as in epilepsy or another disorder  Epileptic seizure（癫痫样发作）: a transient episode of abnormal and excessive neuronal activity in the brain that is apparent either to the subject or an observer.  Epilepsy（癫痫）: a chronic disorder of the brain characterized by recurrent, unprovoked epileptic seizures

Features of epileptic seizures The abnormal neuronal activity during an epileptic seizure may be manifested as a motor, sensor autonomic, cognitive. or psychic disturbance. The neurophysiological basis is inferred on clinical grounds o a convulsion is a subtype of seizure in which motor activity occurs Can be provoked in individuals who do not have epilepsy( examples of provoking insults including fever, trauma, hypoglycaemia and hypoxia) There are many paroxysmal disturbances( funny turns)that mimic epileptic seizures

Features of epileptic seizures  The abnormal neuronal activity during an epileptic seizure may be manifested as a motor, sensory, autonomic, cognitive, or psychic disturbance. The neurophysiological basis is inferred on clinical grounds.  A convulsion is a subtype of seizure in which motor activity occurs.  Can be provoked in individuals who do not have epilepsy ( examples of provoking insults including fever,trauma, hypoglycaemia and hypoxia)  There are many paroxysmal disturbances (‘funny turns’) that mimic epileptic seizures

Different diagnosis of epileptic seizures Breath-holding attacks: provoked by temper or frustration the screaming toddle holds their breath in expiration, goes blue, then limp, and then makes a rapid spontaneous recovery Reflex anoxic seizures: provoked by pain or fear; the infant or toddler becomes pale and loses consciousness( reflecting syncope secondary to vagal-induced bradycardia), The subsequent hypoxia may induced a tonic-clonic seizure Vasovagal syncope(simple faints ) usually occurs in teenagers; provoked by emotion, hot environment preceded by nausea and dizziness; sudden loss of consciousness and posture, rapld recovery 9 Rigors: transient exaggerated shivering in association with high fever

Different diagnosis of epileptic seizures  Breath-holding attacks: provoked by temper or frustration;the screaming toddle holds their breath in expiration,goes blue, then limp, and then makes a rapid spontaneous recovery.  Reflex anoxic seizures: provoked by pain or fear; the infant or toddler becomes pale and loses consciousness( reflecting syncope, secondary to vagal-induced bradycardia); The subsequent hypoxia may induced a tonic-clonic seizure.  Vasovagal syncope (simple faints): usually occurs in teenagers; provoked by emotion, hot environment; preceded by nausea and dizziness; sudden loss of consciousness and posture; rapid recovery.  Rigors: transient exaggerated shivering in association with high fever

O Classification of epileptic seizures e Generalized seizures. the first clinical change indicates initial involvement of both cerebral hemispheres e Partial seizures. there is initial activation of pare of one cerebral hemisphere

Classification of epileptic seizures  Generalized seizures: the first clinical change indicates initial involvement of both cerebral hemispheres  Partial seizures: there is initial activation of pare of one cerebral hemisphere

Generalized seizures Absence seizure: brief unawareness lasting a few seconds, no loss of posture, immediate recovery; may be very frequent; associated with automatisms Myoclonic seizures: repaid, brief, usually isolated jerks ofthe limbs. neck or trunk Tonic seizures: a generalised increase in tone Tonic-clonic seizures: tonic phase of rigidity with loss of posture followed by clonic movements of all four limbs; loss of consciousness, duration 2-20minutes; postictal drowsiness t Atonic seizures: a trainsient loss of muscle tone caused a sudden fall to the floor or drop of the head

Generalized seizures  Absence seizure: brief unawareness lasting a few seconds; no loss of posture; immediate recovery; may be very frequent; associated with automatisms.  Myoclonic seizures: repaid, brief, usually isolated jerks of the limbs, neck or trunk.  Tonic seizures: a generalised increase in tone  Tonic-clonic seizures: tonic phase of rigidity with loss of posture followed by clonic movements of all four limbs; loss of consciousness; duration 2-20minutes; postictal drowsiness.  Atonic seizures: a trainsient loss of muscle tone caused a sudden fall to the floor or drop of the head

Partial seizures o Simple partial seizures: when the child will retain awareness with consciousness unpaired Complex partial seizures: when there is an altered conscious state or confusion due to the abnormal electrical discharge spreading from the originating site to become generalised . Partial seizures with secondary generalisation when there is a focal seizure manifest clinically or on an ictal EEG followed by a generalised tonic clonic seizure

Partial seizures  Simple Partial seizures: when the child will retain awareness with consciousness unpaired  Complex Partial seizures: when there is an altered conscious state or confusion due to the abnormal electrical discharge spreading from the originating site to become generalised  Partial seizures with secondary generalisation: when there is a focal seizure manifest clinically or on an ictal EEG followed by a generalised tonic clonic seizure

Causes of epileptic seizures ◆ Febrile seizures acute seizure associated with fever in the absence of intracranial infection or an identifiable neurological disorder Epilepsy chronic disorder of the brain charaterized by recurrent. unprovoked epileptic seizures

Causes of epileptic seizures  Febrile seizures acute seizure associated with fever in the absence of intracranial infection or an identifiable neurological disorder  Epilepsy chronic disorder of the brain charaterized by recurrent, unprovoked epileptic seizures

Febrile seizure(FS) associated with a rapidly rising temperature (usually develop when the core temperature reaches 39C or greater t occur with the diseases out side the CNs age dependent: 6mon-3mon-6mon( peak age of onset: 14-18mo of age) With normal cns structure and function o No no-febrile seizure history Genetic predisposition

Febrile Seizure(FS)  associated with a rapidly rising temperature (usually develop when the core temperature reaches 390C or greater )  occur with the diseases out side the CNS  age dependent: 6mon-3mon-6mon ( peak age of onset:14-18mo of age)  With normal CNS structure and function  No no-febrile seizure history  Genetic predisposition

Clinical Manifestation of Simple febrile Seizure sFS) Occurs in the children: 6mo to 5 yr of age Typically generalized seizure(tonic-clonic t Duration: a few seconds to 10-min o Only has once or twice of seizures during a period of disease

Clinical Manifestation of Simple febrile Seizure(SFS)  Occurs in the children:6mo to 5 yr of age  Typically generalized seizure (tonic-clonic)  Duration: a few seconds to 10-min  Only has once or twice of seizures during a period of disease