Fisher Robert S, Leppik Ilo
Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.
Epilepsia. 2008 Dec;49 Suppl 9:7-12. doi: 10.1111/j.1528-1167.2008.01921.x.
Epilepsy recently has been defined conceptually as a condition of at least one seizure, with an enduring predisposition to have seizures. It is not yet clear how to make this definition operational and practical. A diagnosis of epilepsy has potentially serious consequences for health, psychosocial well-being, and economics, and, therefore, it should be made with a high level of certainty. A definite diagnosis of epilepsy can be made with two unprovoked seizures at least 24 h apart. This method has the benefit of simplicity and consistency with past epidemiologic studies. Nevertheless, certain circumstances suggest a high likelihood of having a second seizure, as evidenced by common clinical practice of considering treatment after a first unprovoked seizure in conjunction with additional risk factors (surrogate markers). One unifying approach is an operational definition of "definite epilepsy" after two unprovoked seizures at least 24 h apart. An operational definition of "probable epilepsy" can be established with one unprovoked seizure and clinical, electroencephalography (EEG), neuroimaging, genetic, or other information to suggest greater than a 50% chance of having another seizure. "Possible epilepsy" operationally would exist with a single unprovoked seizure and insufficient evidence to predict a high likelihood of recurrence. Future clinical and epidemiologic evidence would allow refinements of the operational definitions.
癫痫最近在概念上被定义为至少发生一次癫痫发作，且具有持续的癫痫发作易感性。目前尚不清楚如何使这一定义具有可操作性和实用性。癫痫诊断对健康、心理社会福祉和经济可能产生严重后果，因此，应在高度确定的情况下做出诊断。明确的癫痫诊断可在至少间隔24小时的两次无诱因发作后做出。这种方法具有简单性，且与过去的流行病学研究一致。然而，某些情况表明发生第二次癫痫发作的可能性很高，首次无诱因发作后结合其他危险因素（替代标志物）考虑治疗的常见临床实践就证明了这一点。一种统一的方法是在至少间隔24小时的两次无诱因发作后对“明确癫痫”进行操作性定义。对于一次无诱因发作且有临床、脑电图（EEG）、神经影像学、遗传学或其他信息提示再次发作可能性大于50%的情况，可建立“可能癫痫”的操作性定义。对于单次无诱因发作且没有足够证据预测高复发可能性的情况，在操作上则存在“可能癫痫”。未来的临床和流行病学证据将使操作性定义更加完善。
