国际抗癫痫联盟对癫痫发作及癫痫的分类
- Authors
- Christian M Korff, MD
Christian M Korff, MD
- Head, Pediatric Neurology
- Geneva University Hospitals
- Elaine Wirrell, MD
Elaine Wirrell, MD
- Professor of Neurology and Director of Pediatric Epilepsy
- Mayo Clinic
- Section Editors
- Timothy A Pedley, MD
Timothy A Pedley, MD
- Editor-in-Chief — Neurology
- Section Editor — Epilepsy
- Henry and Lucy Moses Professor of Neurology
- Columbia University College of Physicians and Surgeons
- Douglas R Nordli, Jr, MD
Douglas R Nordli, Jr, MD
- Section Editor — Pediatric Neurology
- Chief of Neurology
- Children’s Hospital Los Angeles
- Vice Chair of Neurology
- USC Keck School of Medicine
- Deputy Editor
- April F Eichler, MD, MPH
April F Eichler, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Neurology and Sleep Medicine
- Assistant Professor of Neurology
- Harvard Medical School
- Translators
- 王赞, 副主任医师
王赞, 副主任医师
- 吉林大学第一医院神经内科
引言
在过去几十年，神经影像学、基因组技术和分子生物学方面的重大进展提高了人们对癫痫发作和癫痫发病机制的认识。此外，许多癫痫综合征已被描述。因此，国际抗癫痫联盟(International League Against Epilepsy, ILAE)对癫痫发作和癫痫的现存分类系统已经过时且不恰当[1,2]。
ILAE分类和术语委员会在2010年公布了对之前系统的修订版本[3]。该报告不是一个新的分类系统，而是应用一套新的概念来组织现有的知识。为了获得更加科学的准确分类，认为该方案需持续进行修订。
本文将介绍最近ILAE提议中形成的最重要概念。儿童与成人癫痫发作和癫痫的评估与诊断将单独讨论。 (参见“婴儿和儿童惊厥发作的临床和实验室诊断”和“Seizures and epilepsy in children: Classification, etiology, and clinical features”和“儿童癫痫综合征”和“成人首次癫痫发作的评估”和“老年患者癫痫发作和癫痫的病因、临床表现和诊断”)
癫痫发作起始方式
在以前的分类中，癫痫发作被分为部分性发作和全面性发作[1,2]。这个分类对某些癫痫发作类型是不合适的，例如痉挛，尽管其由局灶性病灶引起，但可能会表现为全面性发作。在2010年的提议中，癫痫发作起始方式被细分为全面性、局灶性和未知性，后者包括痉挛(表 1)[3]。
全面性发作 — 全面性癫痫发作的概念是起源于分布在双侧大脑半球网络中的某一点，并快速扩散，这个双侧分布的网络可以是皮质下或皮质结构。然而，全面性癫痫发作不一定包括整个皮质，其可不对称。重要的是，全面性表现仍可起源于局灶性病变，并且不排除手术治疗的可能性。
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- Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1989; 30:389.
- Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia 2010; 51:676.
- Blume WT, Lüders HO, Mizrahi E, et al. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001; 42:1212.
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