Perron A D, Brady W J, Huff J S
Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA.
Acad Emerg Med. 2001 Mar;8(3):296-8. doi: 10.1111/j.1553-2712.2001.tb01312.x.
Immediate concussive convulsions are an unusual but dramatic sequela to head injuries. Previously believed to be an epileptic phenomenon, they are now thought to be a brief traumatic functional decerebration that results from loss of cortical inhibition. With concussive convulsions generally occurring within seconds of head impact and lasting up to several minutes, patients are initially in a tonic phase, followed by a clonic convulsion. A postictal phase is generally brief if it occurs at all with these episodes. Patients with isolated concussive convulsions have no evidence of structural brain injury as assessed with neuroimaging studies or physical examination. Neuropsychological testing often demonstrates transient cortical dysfunction consistent with the concussive episode. The long-term outcome for patients with isolated concussive convulsion is universally good, with no long-term neurologic sequelae and no increased incidence of early or late posttraumatic epilepsy. Emergency department management should focus on evaluation of the associated concussive injury. The concussive convulsion requires no specific therapy, and antiepileptic medication is not indicated.
即刻震荡性惊厥是头部损伤后一种不常见但很显著的后遗症。以前被认为是一种癫痫现象，现在则被认为是由于皮质抑制丧失导致的短暂创伤性功能性去大脑状态。震荡性惊厥通常在头部撞击后数秒内发生，持续长达数分钟，患者最初处于强直期，随后是阵挛性惊厥。如果这些发作出现发作后阶段，通常很短暂。经神经影像学研究或体格检查评估，孤立性震荡性惊厥患者没有脑结构损伤的证据。神经心理学测试常常显示与震荡发作一致的短暂皮质功能障碍。孤立性震荡性惊厥患者的长期预后普遍良好，没有长期神经后遗症，早期或晚期创伤后癫痫的发病率也没有增加。急诊科的处理应着重于对相关震荡性损伤的评估。震荡性惊厥不需要特殊治疗，也不建议使用抗癫痫药物。
