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儿童非痫性阵发性疾病

Authors
Thien T Nguyen, MD, PhD
Peter W Kaplan, MB, FRCP
Angus Wilfong, MD
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
陈燕惠, 主任医师，教授

引言

癫痫是一种以反复癫痫发作为特征的疾病。术语癫痫发作指的是由于大脑神经元异常过度活动引起的短暂性出现的体征和/或症状。许多儿童癫痫中心发现，至少20%的转诊患者并无癫痫发作[1-4]。其中许多儿童被转诊以对其疾病发作进行评估，这些疾病之后被确认为是乱发脾气、对立违抗性行为和注意力缺陷障碍/注意力缺陷多动障碍(attention deficit disorder/attention deficit hyperactivity disorder, ADD/ADHD)。其他儿童存在看似可能是癫痫发作的刻板性阵发性疾病，甚至可能出现意识丧失和不寻常的运动现象。少数儿童存在初始听上去像真正的癫痫发作的行为，但视频脑电图(electroencephalogram, EEG)监测证实为非痫性。在儿童中，非痫性阵发性事件并不少见，在确定正确的诊断之前，这些事件可导致多次尝试使用抗癫痫药物。

在儿童中与癫痫发作类似的常见的非痫性疾病将总结在此。可帮助鉴别真正癫痫发作和非痫性事件的临床现象和既往现象的更详细讨论，以及儿童和青少年晕厥的紧急评估将单独讨论。 在婴儿和青少年中更常见的非痫性阵发性事件参见其他专题。 (参见“Seizures and epilepsy in children: Classification, etiology, and clinical features”和“儿童及青少年晕厥的紧急评估”和“婴儿非癫痫性阵发性疾病”和“青少年及成人中的非痫性发作性疾病”)

偏头痛综合征

存在偏头痛家族史的反复头痛极少出现诊断困难。然而，不伴严重头痛的急性神经系统事件，尤其是那些伴意识丧失或意识改变的事件，可被误诊为癫痫发作。偏头痛发作可能以神经系统的症状为主要表现，包括视幻觉、意识模糊、昏睡和昏迷、全盲、轻偏瘫或脑干征象(包括复视、眩晕和共济失调)，即所谓的基底动脉型偏头痛。 (参见“儿童偏头痛分类”和“脑干先兆偏头痛(基底型偏头痛)”)

创伤后偏头痛是一种定义明确的综合征，其特征主要为在相对轻微的头部外伤后出现的神经系统体征。某些被诊断为脑震荡的儿童实际上是偏头痛发作。

真正的癫痫发作很少是由偏头痛引起的，在癫痫发作之前出现头痛的情况不常见。更常见的是在癫痫发作后出现一种偏头痛样头痛。后一种相关性在全面强直-阵挛性发作时和起源于枕区的部分性发作后尤为常见。 如果儿童发作时出现呕吐、有严重头痛的病史但无神经系统症状，或有典型的头痛家族史，应怀疑偏头痛[5-9]。

               

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Literature review current through: 2017-07 . | This topic last updated: 2015-04-28.
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