EpilepsyEpilepsyYangmeiChenYangmeiChenDepartmentofNeurology,SecondAffiliatedDepartmentofNeurology,SecondAffiliatedHospitalofChongqingMedicalUniversityHospitalofChongqingMedicalUniversityFactsaboutepilepsyFactsaboutepilepsy●VeryCommon:►►50millionpeopleworldwidehaveepilepsymakingitthemostcommonseriousneurologicalconditionglobally►►1in20peoplewillhaveaseizureintheirlifetime●olddisease:●isharmfulforthesocietyhurtthehealthofothershurthimselfDefinitionsDefinitions●Epilepsy►Achronicneurologicaldiseasecharacterizedbyaparoxysmal,self-limitedchangeinbehaviorassociatedwithexcessiveelectricaldischargefromthebrain.Itisarecurrent（repetitive）andtime-limitedattack、stereotyped►Theclinicalmanifestationsrangefromamajormotorconvulsiontoabriefperiodoflackofawareness.Thestereotypedanduncontrollablenatureoftheattacksischaracteristicofepilepsy.RobertS.FisherDepartmentofNeurology&NeurologicalSciences,StanfordUniversitySchoolofMedicineOperational(practical)clinicaldefinitionofOperational(practical)clinicaldefinitionofepilepsyepilepsy●Epilepsyisadiseaseofthebraindefinedbyanyofthefollowingconditions:►Atleasttwounprovoked(orreflex)seizuresoccurring>24hapart►Oneunprovoked(orreflex)seizureandaprobabilityoffurtherseizuressimilartothegeneralrecurrencerisk(atleast60%)aftertwounprovokedseizures,occurringoverthenext10years►Diagnosisofanepilepsysyndrome●Epilepsyisconsideredtoberesolvedforindividualswhohadanage-dependentepilepsysyndromebutarenowpasttheapplicableageorthosewhohaveremainedseizure-freeforthelast10years,withnoseizuremedicinesforthelast5years.DefinitionsSeizure●asudden,involuntary,transientalterationinbehavior,duetoabnormalsynchronousneuronaldischarges.●Aseizureisasudden,transientdisturbanceofbrainfunction,manifestedbyinvoluntarymotor,sensory,autonomic,orpsychicphenomena,aloneorinanycombination,oftenaccompaniedbyalterationorlossofconsciousness.●atransientoccurrenceofsignsandsymptomsduetoabnormalexcessiveorsynchronousneuronalactivityinthebrainDefinitionsDefinitionsASS(acutesymptomaticseizure):aseizuremayoccurafterametabolic,traumatic●Provoked:anoxic,orinfectiousinsulttothebrain(precipitatingfactor)●Unprovoked:changeless、lastingfactorSEIZUREreflexEtiologyofAcuteSymptomaticEtiologyofAcuteSymptomaticSeizuresSeizuresStroke40-54%Toxic-metabolic15-30%Neoplasm8-10%Trauma4-10%Alcohol3-5%CNSinfection2-3%●Incidence:50-70/100,000/year.●Prevalence:about7‰.●Thereareabout900,000patientswithEPinourcountry.EpidemiologyEpidemiologyEpidemiologyEpidemiology●Incidenceisgreatestinearlyandlatelife,withaprevalenceofapproximately>7‰.●Incidencevariesgreatlywithage,withhighratesinearlychildhood,lowlevelsinearlyadultlifeandasecondpeakinpeopleagedover65yearsold●Chanceofhavingasecondseizureafteraninitialunprovokedepisodeis30%.EpidemiologyEpidemiology●Newlyonsetpatients:650,000~700,000/year.●75%ofthemshowsgoodresponsetoanticonvulsantsoffirstchoice.EpidemiologyEpidemiology●About25%ofthemshowsrefractoryseizures.●Thereareatleast1,500,000patientswithrefractoryseizuresnationalwide.EpidemiologyEpidemiologyEpilepsyisagroupofdisordersorsyndromesclassifiedintothreetypesaccordingtoetiology:●Idiopathic–nostructuralcause,probablygenetic.60%●Symptomatic–structuralcause.35%●Cryptogenic–nostructuralcausefound,butonesuspected.5%EtiologyIdiopathicepilepsyIdiopathicepilepsy●Lowseizurethresholdcanbeinhe...
