McAbee G N, Wark J E
University of Medicine and Dentistry of New Jersey, Stratford, USA.
Am Fam Physician. 2000 Sep 1;62(5):1109-16.
Uncomplicated seizures and epilepsy are common in infants and children. Family physicians should be aware of certain epilepsy syndromes that occur in children, such as febrile seizures, benign focal epilepsy of childhood, complex partial epilepsy, juvenile myoclonic epilepsy and video game-related epilepsy. Not all uncomplicated childhood seizures require neuroimaging or treatment. Febrile seizures, rolandic seizures and video game-related seizures are childhood epileptic syndromes that are typically not associated with brain structural lesions on computed tomography or magnetic resonance imaging, and are often not treated with anticonvulsant drugs. Juvenile myoclonic epilepsy does not require neuroimaging but does require treatment because of a high rate of recurrent seizures. Complex partial epilepsy often requires both neuroimaging and treatment. Although seizures are diagnosed primarily on clinical grounds, all children with a possible seizure (except febrile seizures) should have an electroencephalogram. Interictal EEGs may be normal. Computed tomography has demonstrated abnormalities in 7 to 19 percent of children with new-onset seizures. The yield of magnetic resonance imaging for specific childhood seizure types is not known, but it is the preferred modality of neuroimaging for many clinical presentations. Most children's seizures treated with anticonvulsants are controlled by the first drug selected. The value of "therapeutic' serum drug levels is questionable in the management of uncomplicated childhood seizures.
单纯性癫痫发作和癫痫在婴幼儿及儿童中很常见。家庭医生应了解儿童中出现的某些癫痫综合征，如热性惊厥、儿童良性局灶性癫痫、复杂部分性癫痫、青少年肌阵挛性癫痫以及与电子游戏相关的癫痫。并非所有单纯性儿童癫痫发作都需要进行神经影像学检查或治疗。热性惊厥、罗兰多癫痫发作以及与电子游戏相关的癫痫发作是儿童癫痫综合征，通常在计算机断层扫描或磁共振成像上与脑结构病变无关，且通常不使用抗惊厥药物治疗。青少年肌阵挛性癫痫不需要进行神经影像学检查，但由于复发率高，确实需要治疗。复杂部分性癫痫通常既需要神经影像学检查也需要治疗。虽然癫痫发作主要根据临床症状进行诊断，但所有可能患有癫痫发作的儿童（热性惊厥除外）都应进行脑电图检查。发作间期脑电图可能正常。计算机断层扫描显示，7%至19%的新发癫痫发作儿童存在异常。磁共振成像对特定儿童癫痫发作类型的检出率尚不清楚，但它是许多临床表现首选的神经影像学检查方式。大多数接受抗惊厥药物治疗的儿童癫痫发作可通过所选的第一种药物得到控制。在单纯性儿童癫痫发作的管理中，“治疗性”血清药物水平的价值存在疑问。
