UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

儿童癫痫发作和癫痫：初始治疗和监测

Author
Angus Wilfong, MD
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
俞丹, 副主任医师，副教授

引言

癫痫儿童，尤其是婴儿，与成人的区别不仅体现在癫痫发作的临床表现上，也体现在其独特的脑电图(electroencephalogram, EEG)形式、病因及对抗癫痫药物治疗的反应。不成熟的大脑，尤其是新生儿及小婴儿，在癫痫发生的基础机制和发作的传播方面与成人大脑不同。不成熟大脑更容易出现癫痫发作，但发作也更倾向于随着儿童成长而消失。

本专题将概述儿童癫痫发作及癫痫综合征的治疗。新生儿癫痫发作的治疗和具体癫痫综合征的治疗，参见其他专题。 (参见“Seizures and epilepsy in children: Classification, etiology, and clinical features”和“婴儿和儿童惊厥发作的临床和实验室诊断”和“儿童癫痫综合征”和“儿童良性局灶性癫痫”和“新生儿惊厥的治疗”)

何时开始抗癫痫药物治疗

儿童的首次癫痫发作可能由急性疾病导致，如代谢紊乱或感染性疾病，可能不会复发，或可能代表着癫痫的开始。如果评估未能发现潜在可逆的急性病因，则必须做出关于是否启动长期抗癫痫药物治疗的决定。 (参见“婴儿和儿童惊厥发作的临床和实验室诊断”和“婴儿和儿童惊厥发作的临床和实验室诊断”，关于‘发作时的环境情况’一节)

首次无诱因癫痫发作 — 首次无诱因癫痫发作后的儿童是否该接受抗癫痫药物治疗视具体情况而定，医生需要权衡癫痫发作复发的风险与抗癫痫药物治疗的潜在风险和益处并综合考虑患者的价值取向和偏好。

“无诱因癫痫发作”是指病因不明的癫痫发作以及与预先存在的脑病变或进行性神经系统病变相关的癫痫发作(常称为远期症状性发作)。无诱因癫痫发作不同于由急性病症(如中毒性或代谢性紊乱、发热、头部创伤或急性脑卒中)引起的癫痫发作(即，急性症状性发作)。 (参见下文‘急性症状性癫痫发作’)

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-07 . | This topic last updated: 2017-04-21.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Hirtz D, Berg A, Bettis D, et al. Practice parameter: treatment of the child with a first unprovoked seizure: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2003; 60:166.
  2. Wilmshurst JM, Gaillard WD, Vinayan KP, et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia 2015; 56:1185.
  3. Shinnar S, Berg AT, Moshé SL, et al. Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics 1990; 85:1076.
  4. Shinnar S, O'Dell C, Berg AT. Mortality following a first unprovoked seizure in children: a prospective study. Neurology 2005; 64:880.
  5. Arthur TM, deGrauw TJ, Johnson CS, et al. Seizure recurrence risk following a first seizure in neurologically normal children. Epilepsia 2008; 49:1950.
  6. Berg AT, Shinnar S, Levy SR, Testa FM. Status epilepticus in children with newly diagnosed epilepsy. Ann Neurol 1999; 45:618.
  7. Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015; 84:1705.
  8. Musicco M, Beghi E, Solari A, Viani F. Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy. First Seizure Trial Group (FIRST Group). Neurology 1997; 49:991.
  9. Marson A, Jacoby A, Johnson A, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet 2005; 365:2007.
  10. Martin ET, Kerin T, Christakis DA, et al. Redefining outcome of first seizures by acute illness. Pediatrics 2010; 126:e1477.
  11. Glauser T, Ben-Menachem E, Bourgeois B, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2006; 47:1094.
  12. Arya R, Glauser TA. Pharmacotherapy of focal epilepsy in children: a systematic review of approved agents. CNS Drugs 2013; 27:273.
  13. Thomas P, Valton L, Genton P. Absence and myoclonic status epilepticus precipitated by antiepileptic drugs in idiopathic generalized epilepsy. Brain 2006; 129:1281.
  14. Benbadis SR, Tatum WO 4th, Gieron M. Idiopathic generalized epilepsy and choice of antiepileptic drugs. Neurology 2003; 61:1793.
  15. Genton P, Gelisse P, Thomas P, Dravet C. Do carbamazepine and phenytoin aggravate juvenile myoclonic epilepsy? Neurology 2000; 55:1106.
  16. Osorio I, Reed RC, Peltzer JN. Refractory idiopathic absence status epilepticus: A probable paradoxical effect of phenytoin and carbamazepine. Epilepsia 2000; 41:887.
  17. Perucca E. Treatment of epilepsy in developing countries. BMJ 2007; 334:1175.
  18. Tomson T, Marson A, Boon P, et al. Valproate in the treatment of epilepsy in girls and women of childbearing potential. Epilepsia 2015; 56:1006.
  19. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021014s035,021285s030lbl.pdf.
  20. Christensen J, Petrenaite V, Atterman J, et al. Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial. Epilepsia 2007; 48:484.
  21. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. Early release - May 28, 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0528a1.htm (Accessed on May 28, 2010).
  22. Sheinberg R, Heyman E, Dagan Z, et al. Correlation between efficacy of levetiracetam and serum levels among children with refractory epilepsy. Pediatr Neurol 2015; 52:624.
  23. Camfield P, Camfield C, Dooley J, et al. Routine screening of blood and urine for severe reactions to anticonvulsant drugs in asymptomatic patients is of doubtful value. CMAJ 1989; 140:1303.
  24. Pellock JM, Willmore LJ. A rational guide to routine blood monitoring in patients receiving antiepileptic drugs. Neurology 1991; 41:961.
  25. Dreifuss FE, Santilli N, Langer DH, et al. Valproic acid hepatic fatalities: a retrospective review. Neurology 1987; 37:379.
  26. Kuo RL, Moran ME, Kim DH, et al. Topiramate-induced nephrolithiasis. J Endourol 2002; 16:229.
  27. Kossoff EH, Pyzik PL, Furth SL, et al. Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Epilepsia 2002; 43:1168.
  28. Wall M, Baird-Lambert J, Buchanan N, Farrell G. Liver function tests in persons receiving anticonvulsant medications. Seizure 1992; 1:187.
  29. Mendis GP, Gibberd FB, Hunt HA. Plasma activities of hepatic enzymes in patients on anticonvulsant therapy. Seizure 1993; 2:319.
  30. Dreifuss FE, Langer DH. Hepatic considerations in the use of antiepileptic drugs. Epilepsia 1987; 28 Suppl 2:S23.
  31. Seetharam MN, Pellock JM. Risk-benefit assessment of carbamazepine in children. Drug Saf 1991; 6:148.
  32. Mukhin NA, Kozlovskaia LV, Bobkova IN, et al. [The key role of tubulointerstitium remodeling in progression of chronic renal diseases]. Arkh Patol 2004; 66:16.
  33. Takeoka M, Riviello JJ Jr, Pfeifer H, Thiele EA. Concomitant treatment with topiramate and ketogenic diet in pediatric epilepsy. Epilepsia 2002; 43:1072.
  34. McSherry E. Renal tubular acidosis in childhood. Kidney Int 1981; 20:799.
  35. Brenner RJ, Spring DB, Sebastian A, et al. Incidence of radiographically evident bone disease, nephrocalcinosis, and nephrolithiasis in various types of renal tubular acidosis. N Engl J Med 1982; 307:217.
  36. Willmore LJ, Abelson MB, Ben-Menachem E, et al. Vigabatrin: 2008 update. Epilepsia 2009; 50:163.
  37. Vestergaard P. Effects of antiepileptic drugs on bone health and growth potential in children with epilepsy. Paediatr Drugs 2015; 17:141.
  38. Wilson SJ, Baxendale S, Barr W, et al. Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013-2017. Epilepsia 2015; 56:674.
  39. http://www.fda.gov/cder/drug/InfoSheets/HCP/antiepilepticsHCP.htm (Accessed on January 31, 2008).
  40. Davies S, Heyman I, Goodman R. A population survey of mental health problems in children with epilepsy. Dev Med Child Neurol 2003; 45:292.
  41. Sherman EM, Slick DJ, Connolly MB, Eyrl KL. ADHD, neurological correlates and health-related quality of life in severe pediatric epilepsy. Epilepsia 2007; 48:1083.
  42. Thome-Souza S, Kuczynski E, Assumpção F Jr, et al. Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy? Epilepsy Behav 2004; 5:988.
  43. Hesdorffer DC, Ludvigsson P, Olafsson E, et al. ADHD as a risk factor for incident unprovoked seizures and epilepsy in children. Arch Gen Psychiatry 2004; 61:731.
  44. Gonzalez-Heydrich J, Whitney J, Waber D, et al. Adaptive phase I study of OROS methylphenidate treatment of attention deficit hyperactivity disorder with epilepsy. Epilepsy Behav 2010; 18:229.
  45. Koneski JA, Casella EB, Agertt F, Ferreira MG. Efficacy and safety of methylphenidate in treating ADHD symptoms in children and adolescents with uncontrolled seizures: a Brazilian sample study and literature review. Epilepsy Behav 2011; 21:228.
  46. Santos K, Palmini A, Radziuk AL, et al. The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies. Dev Med Child Neurol 2013; 55:654.
  47. Gucuyener K, Erdemoglu AK, Senol S, et al. Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities. J Child Neurol 2003; 18:109.
  48. Gross-Tsur V, Manor O, van der Meere J, et al. Epilepsy and attention deficit hyperactivity disorder: is methylphenidate safe and effective? J Pediatr 1997; 130:670.
  49. Wroblewski BA, Leary JM, Phelan AM, et al. Methylphenidate and seizure frequency in brain injured patients with seizure disorders. J Clin Psychiatry 1992; 53:86.
  50. Fosi T, Lax-Pericall MT, Scott RC, et al. Methylphenidate treatment of attention deficit hyperactivity disorder in young people with learning disability and difficult-to-treat epilepsy: evidence of clinical benefit. Epilepsia 2013; 54:2071.
  51. Salpekar JA, Mishra G. Key issues in addressing the comorbidity of attention deficit hyperactivity disorder and pediatric epilepsy. Epilepsy Behav 2014; 37:310.
  52. Radziuk AL, Kieling RR, Santos K, et al. Methylphenidate improves the quality of life of children and adolescents with ADHD and difficult-to-treat epilepsies. Epilepsy Behav 2015; 46:215.
  53. Modi AC, Rausch JR, Glauser TA. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. JAMA 2011; 305:1669.
  54. Modi AC, Rausch JR, Glauser TA. Early pediatric antiepileptic drug nonadherence is related to lower long-term seizure freedom. Neurology 2014; 82:671.
  55. Al-Aqeel S, Al-Sabhan J. Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy. Cochrane Database Syst Rev 2011; :CD008312.
  56. Greenwood RS, Tennison MB. When to start and stop anticonvulsant therapy in children. Arch Neurol 1999; 56:1073.
  57. Sillanpää M, Schmidt D. Prognosis of seizure recurrence after stopping antiepileptic drugs in seizure-free patients: A long-term population-based study of childhood-onset epilepsy. Epilepsy Behav 2006; 8:713.
  58. Strozzi I, Nolan SJ, Sperling MR, et al. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database Syst Rev 2015; :CD001902.
  59. Camfield P, Camfield C. The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy. Neurology 2005; 64:973.
  60. Shinnar S, Berg AT, Moshé SL, et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol 1994; 35:534.
  61. Peters AC, Brouwer OF, Geerts AT, et al. Randomized prospective study of early discontinuation of antiepileptic drugs in children with epilepsy. Neurology 1998; 50:724.
  62. Dooley J, Gordon K, Camfield P, et al. Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: a prospective study. Neurology 1996; 46:969.
  63. Geerts AT, Niermeijer JM, Peters AC, et al. Four-year outcome after early withdrawal of antiepileptic drugs in childhood epilepsy. Neurology 2005; 64:2136.
  64. Delgado MR, Riela AR, Mills J, et al. Discontinuation of antiepileptic drug treatment after two seizure-free years in children with cerebral palsy. Pediatrics 1996; 97:192.
  65. Ranganathan LN, Ramaratnam S. Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Database Syst Rev 2006; :CD005003.
  66. Krauss GL, Ampaw L, Krumholz A. Individual state driving restrictions for people with epilepsy in the US. Neurology 2001; 57:1780.
  67. Capovilla G, Kaufman KR, Perucca E, et al. Epilepsy, seizures, physical exercise, and sports: A report from the ILAE Task Force on Sports and Epilepsy. Epilepsia 2016; 57:6.