Sansevere Arnold J, Avalone Jennifer, Strauss Lauren Doyle, Patel Archana A, Pinto Anna, Ramachandran Maya, Fernandez Ivan Sanchez, Bergin Ann M, Kimia Amir, Pearl Phillip L, Loddenkemper Tobias
1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
2 Department of Neurology, Wake Forest Baptist Health, Wake Forest Medical School, Winston Salem, NC, USA.
J Child Neurol. 2017 Jul;32(8):774-788. doi: 10.1177/0883073817706028. Epub 2017 May 14.
By definition, unprovoked seizures are not precipitated by an identifiable factor, such as fever or trauma. A thorough history and physical examination are essential to caring for pediatric patients with a potential first unprovoked seizure. Differential diagnosis, EEG, neuroimaging, laboratory tests, and initiation of treatment will be reviewed. Treatment is typically initiated after 2 unprovoked seizures, or after 1 seizure in select patients with distinct epilepsy syndromes. Recent expansion of the definition of epilepsy by the ILAE allows for the diagnosis of epilepsy to be made after the first seizure if the clinical presentation and supporting diagnostic studies suggest a greater than 60% chance of a second seizure. This review summarizes the current literature on the diagnostic and therapeutic management of first unprovoked seizure in children and adolescents while taking into consideration the revised diagnostic criteria of epilepsy.
根据定义，特发性癫痫发作并非由可识别的因素诱发，如发热或外伤。对于疑似首次特发性癫痫发作的儿科患者，全面的病史和体格检查对于护理至关重要。将对鉴别诊断、脑电图、神经影像学、实验室检查及治疗的启动进行综述。治疗通常在2次特发性癫痫发作后开始，或在某些患有特定癫痫综合征的患者首次发作后开始。国际抗癫痫联盟（ILAE）最近对癫痫定义的扩展使得在首次发作后，如果临床表现和辅助诊断研究表明第二次发作的可能性大于60%，即可诊断为癫痫。本综述总结了关于儿童和青少年首次特发性癫痫发作的诊断和治疗管理的当前文献，同时考虑了癫痫的修订诊断标准。
