Beghi Ettore, De Maria Giovanni, Gobbi Giuseppe, Veneselli Edvige
Department of Clinical Neurology, University of Milano Bicocca, Monza, and Institute, Mario Negri, Milan, Italy.
Epilepsia. 2006;47 Suppl 5:2-8. doi: 10.1111/j.1528-1167.2006.00869.x.
The diagnosis and treatment of a first epileptic seizure are made by physicians with different types of expertise. Heterogeneous patterns of care are thus expected, which explain the need for shared patterns of care. These guidelines were developed by a group of experts from the Italian League against Epilepsy (LICE) in accordance with the requirements of evidence-based medicine. An accurate assessment of the seizure is required, with active questioning about circumstances of occurrence, clinical manifestations, and postictal symptoms. For seizures with loss of consciousness, the presence of cyanosis, hypersalivation, tongue biting, and postictal disorientation has a specific diagnostic value. Laboratory tests and toxicological screening should be performed only in the presence of circumstances suggesting a metabolic or toxic encephalopathy. Elevated prolactin levels 10-20 min. after the event help in differentiating generalized tonic-clonic or partial seizures from psychogenic nonepileptic seizures. Except for infants less than six months of age, CSF examination is recommended only when a cerebral infection is suspected. An EEG should be performed within 24 h. after a seizure, particularly in children. If the EEG is normal during wakefulness, a sleep EEG is recommended. A CT scan is strictly indicated when a severe structural lesion is suspected or when the etiology is unknown. MRI may not be indicated in the emergency room, but it should be preferred to CT as part of the diagnostic assessment. The added value of other diagnostic tools (neuropsychological tests, ambulatory EEG, functional MRI, SPECT, and PET) is as yet unknown. These tests may be used on a case-by-case basis. In the presence of an acute symptomatic seizure, treatment of the cause is recommended. Symptomatic therapy is not justified unless the seizure has the characteristics of status epilepticus. Long-term treatment may be considered in patients with abnormal EEG and imaging data and after consideration of the social, emotional, and personal implications of seizure relapse.
首次癫痫发作的诊断和治疗由具备不同专业技能的医生进行。因此，预期会出现护理模式的异质性，这也解释了为何需要共享护理模式。这些指南由意大利抗癫痫联盟（LICE）的一组专家根据循证医学的要求制定。需要对发作进行准确评估，积极询问发作情况、临床表现和发作后症状。对于伴有意识丧失的发作，发绀、流涎过多、咬舌和发作后定向障碍的存在具有特定的诊断价值。仅在存在提示代谢性或中毒性脑病的情况下才应进行实验室检查和毒理学筛查。发作后10 - 20分钟催乳素水平升高有助于区分全身性强直阵挛发作或部分性发作与心因性非癫痫性发作。除了小于6个月的婴儿外，仅在怀疑有脑部感染时才建议进行脑脊液检查。癫痫发作后应在24小时内进行脑电图检查，尤其是儿童。如果清醒时脑电图正常，建议进行睡眠脑电图检查。当怀疑有严重结构性病变或病因不明时，严格指征进行CT扫描。在急诊室可能不建议进行MRI检查，但作为诊断评估的一部分，它应优先于CT检查。其他诊断工具（神经心理学测试、动态脑电图、功能MRI、SPECT和PET）的附加价值尚不清楚。这些检查可根据具体情况使用。在存在急性症状性发作时，建议对病因进行治疗。除非发作具有癫痫持续状态的特征，否则对症治疗是不合理的。对于脑电图和影像学数据异常的患者，以及在考虑癫痫复发的社会、情感和个人影响后，可考虑进行长期治疗。
