St Louis Erik K, Cascino Gregory D
Continuum (Minneap Minn). 2016 Feb;22(1 Epilepsy):15-37. doi: 10.1212/CON.0000000000000284.
This review identifies the diverse and variable clinical presentations associated with epilepsy that may create challenges in diagnosis and treatment.
Epilepsy has recently been redefined as a disease characterized by one or more seizures with a relatively high recurrence risk (ie, 60% or greater likelihood). The implication of this definition for therapy is that antiepileptic drug therapy may be initiated following a first seizure in certain situations.EEG remains the most commonly used study in the evaluation of people with epilepsy. Routine EEG may assist in diagnosis, classification of seizure type(s), identification of treatment, and monitoring the efficacy of therapy. Video-EEG monitoring permits seizure classification, assessment of psychogenic nonepileptic seizures, and evaluation of candidacy for epilepsy surgery. MRI is pivotal in elucidating the etiology of the seizure disorder and in suggesting the localization of seizure onset.
This article reviews the new International League Against Epilepsy practical clinical definition for epilepsy and the differential diagnosis of other physiologic paroxysmal spells, including syncope, parasomnias, transient ischemic attacks, and migraine, as well as psychogenic nonepileptic seizures. The initial investigational approaches to new-onset epilepsy are considered, including neuroimaging and neurophysiologic investigations with interictal and ictal video-EEG. Neurologists should maintain a high index of suspicion for epilepsy when children or adults present with a single paroxysmal spell or recurrent episodic events.
本综述确定了与癫痫相关的多样且多变的临床表现，这些表现可能给诊断和治疗带来挑战。
癫痫最近被重新定义为一种以一次或多次发作且复发风险相对较高（即60%或更高可能性）为特征的疾病。该定义对治疗的意义在于，在某些情况下，首次发作后即可开始抗癫痫药物治疗。脑电图（EEG）仍然是评估癫痫患者最常用的检查方法。常规脑电图有助于诊断、癫痫发作类型分类、确定治疗方案以及监测治疗效果。视频脑电图监测可对癫痫发作进行分类、评估精神性非癫痫发作，并评估癫痫手术的候选资格。磁共振成像（MRI）对于阐明癫痫发作障碍的病因以及提示癫痫发作起始部位至关重要。
本文综述了国际抗癫痫联盟关于癫痫的新实用临床定义，以及对其他生理性发作性疾病的鉴别诊断，包括晕厥、异态睡眠、短暂性脑缺血发作和偏头痛，以及精神性非癫痫发作。还考虑了新发癫痫的初始调查方法，包括神经影像学和发作间期及发作期视频脑电图的神经生理学检查。当儿童或成人出现单次发作性疾病或反复发作性事件时，神经科医生应高度怀疑癫痫。
