Martinez-Juarez I E, Moreno J, Ladino L D, Castro N, Hernandez-Vanegas L, Burneo J G, Hernandez-Ronquillo L, Tellez-Zenteno J F
Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico DF, Mexico.
Hospital Pablo Tobon Uribe, Medellin, Colombia.
Rev Neurol. 2016 Aug 16;63(4):165-75.
Epileptic seizures are one of the main reasons for neurological visits in an emergency department. Convulsions represent a traumatic event for the patient and the family, with significant medical and social consequences. Due to their prevalence and impact, the initial management is of vital importance. Although following the first epileptic seizure, early recurrence diminishes after establishing treatment with antiepileptic drugs, the forecast for developing epilepsy and long-term outcomes are not altered by any early intervention. Detailed questioning based on the symptoms of the convulsions, the patient's medical history and a full electroencephalogram and neuroimaging study make it possible to define the risk of recurrence of the seizure and the possible diagnosis of epilepsy. Epileptic abnormalities, the presence of old or new potentially epileptogenic brain lesions, as well as nocturnal seizures, increase the risk of recurrence. Physicians must assess each patient on an individual basis to determine the most suitable treatment, and explain the risk of not being treated versus the risk that exists if treatment with antiepileptic drugs is established.
癫痫发作是急诊科神经科就诊的主要原因之一。惊厥对患者及其家属来说是一个创伤性事件，会带来重大的医学和社会后果。由于其普遍性和影响，初始治疗至关重要。虽然在首次癫痫发作后，在用抗癫痫药物进行治疗后早期复发率会降低，但任何早期干预都不会改变癫痫发展的预测和长期预后。基于惊厥症状、患者病史以及完整的脑电图和神经影像学检查进行详细询问，有助于确定癫痫发作复发的风险以及癫痫的可能诊断。癫痫异常、存在新旧潜在致痫性脑病变以及夜间发作都会增加复发风险。医生必须对每位患者进行个体化评估，以确定最合适的治疗方法，并解释不治疗的风险与使用抗癫痫药物治疗存在的风险。
