癫痫症状学详尽讲解课件

SemiologyofSeizuresRevisedby

ZhangJG

YangACWrittenby

ShiLin●

Symptoms●

Auras●

Progression●

FourStages●

Classification●

Diagnosis●

AdvancedSemiology●

AbsencevsCPS●

FLSvsTLS●

HTSvsEHTSSemiologyofSeizuresRevisedb1INTRODUCTIONINTRODUCTION2癫痫症状学详尽讲解课件3SEIZE----SEIZUREWhatisseizure?

seizure≠epilepsytoomanycellsexcitedsimutaneouslyNormalINFOtransmissionSEIZE----SEIZUREWhatisseizur41SYMPTOMS1SYMPTOMS5癫痫症状学详尽讲解课件6癫痫症状学详尽讲解课件72

AURAS2AURAS8Aura:predictor,bode,indicator.

UnusualFeeling:physical,sensory,visceral,experiential

ASmallSeizure:notspreadintoanobservableseizure.IndicatingSeizureFocus.UsuallyinTemporalLobeSeizure.numbnessheadachedizzinesslight-headednessAura:predictor,bode,indica93PROGRESSION3PROGRESSION10MTlfocusIpslmflCntrlmflCntrlmtl1,PositiveEffectsVSNegativeEffects2,Non-FunctionalAreas.InferredFocus≠ExactFocus3,ThumbClonicMovement------Head/EyeDeviation

------GastricRising------AbnormalTastesMTlfocusIpslmflCntrlmflCntr114FOURSTAGES4FOURSTAGES12SEIZUREPHASESICTALPHASE:ICTUS

POST-ICTAL:RECOVERYPRE-ICTAL:PRODROMEICTALONSET:AURAPre-IctalProdromeFever/Sleepless/MenstruationEnvironmentToExcludePseudoseizuresTimeofDay/SleepMyoclonic/Rolandic/FrontalPrecipitantsPhotosensitiveEPIctusProgressionInvolvedBrainRegionsAphasiaDominantHemisphereConsciousnessABSENCE/CPS/GTCSDurationStatusEpilepticusIctalOnsetAuraLobeofOriginFocalOnsetLateralization&LocalizationPost-IctusConfusionCPS/GTCSUnilateralHeadacheIPSLOriginTodd’sParesisCNTRLHemisphereOriginVisualFieldDefectOccipitalInvolvementSEIZUREPHASESICTALPHASE:ICT135

CLASSIFICATION5CLASSIFICATION14SingleMotor:Jerk,HeadTurning,RigiditySensory:UnusualTaste,HearingAutonomic:StomachSensationPsychological:Memory,

EmotionalComplexAutomatism;Aura;ConsciousnessGeneralizationPartial,EvolvesintoGrand-MalGTCSUnconscious,Rigidity+JerkingAbsenceBriefUnconsciousandStaring,VentilationMyoclonicSuddenContraction(400ms)ClonicRepetitive,JerkingMovementsTonic20s,ContinuousContractAlongBodyAxisAtonicLossofMuscleTensionCPSABSENCEGTCSATONICMotor:Jerk,HeadTurning,Rig156

DIAGNOSIS6DIAGNOSIS16+PSEUDOSEIZURE?EmotionalSyncope(Prodrome,Tongue)FeverConvulsionSEIZURE?VSPROVOKED?EPILEPTIC?VSTYPE?LOCATION?+PSEUDOSEIZURE?SEIZURE?VSPROV177

ADVANCEDSEMIOLOGY7ADVANCEDSEMIOLOGY18Semiology:AUTOMATISMsignificanceOralAutomatismTL(Hippocampal)UnilateralLimbAutomatismIPSL(FL,TL,Limbic)100%UnilateralEyeBlinkingIPSL(FL)BipedAutomatismFLIctalSpittingorDrinkingRightTLIctalLaughter(Gelastic)Hypothalamus,MTLPostictalNoseWipingIPSL(FL/TL)PostictalCoughTLSemiology:AUTOMATISMsignifica19Semiology:MOTORsignificanceForcedSustainedHead/Eye/MouthTurn+GnrlznCNTRL,FL/TL94-100%ReproductiveNonforcedHead/EyeTurn-GnrlznIPSLFL/TL(BSLGN)80%FocalClonicJerkingCNTRL,Rolandic(4)>95%UnilateralIctalParesisCNTRLFrequentBrief

HyperkineticMovementsMesialPartofTL/FLAsymmetricClonicEndingIPSL,

TL/FL80%UnilateralDystoniaCNTRL,TL/FL(BSLGN)93%FencingPostureCNTRL,FLPostictalTodd’sParesisCNTRL,FLIctalEyeClosureNonepilepticFigure4SignCNTRLtoExtendedLimb,TLSemiology:MOTORsignificanceFo20Semiology:SPEECHsignificanceIctalSpeechArrestDominantTemporalInfluencedIctalSpeechPreservationDominantTemporalSpaired

PostictalDysphasiaDominantHemisphereIctusVomitingRightTLIctusUrinaryUrgeRightTLHairErectionLeftTLSemiology:FEELsignificanceWell-definedSomatosensorySymptomsCNTRLRolandic(1,2,3)90%UnilateralElementaryVisualPhenomenaCNTRLOccipital80%AscendingVisceralFeelingsMesialTemporal,

Premotor(6),InsulaForcedThinkingDominantFrontal/MesiotemporalIctalFearAmygdala,HippocampusSemiology:SPEECHsignificanceI218

ABSENCE

vs

CPS8ABSENCEvsCPS22AbsenceCPSSleepActivationNoneCommonHyperventilationActivaingNoneFrequencyMany/DayLessOnsetAbruptSlowAuraNoneCommonAutomatismNoneCommonProgressionNoneCommonCyanosisNoneCommonMotorSignsRareCommonDurationBriefMinutesPost-IctalConfussionNoneCommonPost-IctalDysphasiaNoneCommon(Dominant)AbsenceCPSSleepActivationNone239FLSvsTLS9FLSvsTLS24TLSFLSFrequency●●●●SleepActivition●OnsetSlowAbruptProgressionSlowQuickMotionless

Staring●●●●Automatism●●●●BipedalAutomatism-ComplexPosturesLate/LessEarly/FrequentHyperkineticMotor●●●●SpeechVerbalization(NonDominant)VocalizationDurationLongBriefGeneralization●●●●Post-IctalConfution●●●●Post-IctalDysphasia●●●●Post-IctalWeakness●●●●TLSFLSFrequency●●●●SleepActiv2510

HTSvsEHTS10HTSvsEHTS26HTSEHTSConvulsionHistoryYes(13/16)No(19/19)AurasEpigastric,Gustatory,Fear,SmellDéjàVu,Somatic,SeeingHimself,VoiceinTunel,DreamlikeStateEarlyAutomatismsOral(11/16)UpperLimb(11/19)Oral(2/19)MRINormal(13/16)

HippocampalAtrophy(3/16)Tumor(19/19)PathologyNormal(9/16)

MTS(7/16)Glioma(16/19)

Hamartoma(1/19)

CA(2/19)HTSEHTSConvulsionHistoryYes(27semiologyMRISummaryAuras&FourStagesClassificationDiagnosisLocalizationDifferentiation:

AbsencevsCPS

FLSvsTLS

HTSvsEHTSsemiologyMRISummaryAuras&Fou28THANKYOU!THANKYOU!29SemiologyofSeizuresRevisedby

ZhangJG

YangACWrittenby

ShiLin●

Symptoms●

Auras●

Progression●

FourStages●

Classification●

Diagnosis●

AdvancedSemiology●

AbsencevsCPS●

FLSvsTLS●

HTSvsEHTSSemiologyofSeizuresRevisedb30INTRODUCTIONINTRODUCTION31癫痫症状学详尽讲解课件32SEIZE----SEIZUREWhatisseizure?

seizure≠epilepsytoomanycellsexcitedsimutaneouslyNormalINFOtransmissionSEIZE----SEIZUREWhatisseizur331SYMPTOMS1SYMPTOMS34癫痫症状学详尽讲解课件35癫痫症状学详尽讲解课件362

AURAS2AURAS37Aura:predictor,bode,indicator.

UnusualFeeling:physical,sensory,visceral,experiential

ASmallSeizure:notspreadintoanobservableseizure.IndicatingSeizureFocus.UsuallyinTemporalLobeSeizure.numbnessheadachedizzinesslight-headednessAura:predictor,bode,indica383PROGRESSION3PROGRESSION39MTlfocusIpslmflCntrlmflCntrlmtl1,PositiveEffectsVSNegativeEffects2,Non-FunctionalAreas.InferredFocus≠ExactFocus3,ThumbClonicMovement------Head/EyeDeviation

------GastricRising------AbnormalTastesMTlfocusIpslmflCntrlmflCntr404FOURSTAGES4FOURSTAGES41SEIZUREPHASESICTALPHASE:ICTUS

POST-ICTAL:RECOVERYPRE-ICTAL:PRODROMEICTALONSET:AURAPre-IctalProdromeFever/Sleepless/MenstruationEnvironmentToExcludePseudoseizuresTimeofDay/SleepMyoclonic/Rolandic/FrontalPrecipitantsPhotosensitiveEPIctusProgressionInvolvedBrainRegionsAphasiaDominantHemisphereConsciousnessABSENCE/CPS/GTCSDurationStatusEpilepticusIctalOnsetAuraLobeofOriginFocalOnsetLateralization&LocalizationPost-IctusConfusionCPS/GTCSUnilateralHeadacheIPSLOriginTodd’sParesisCNTRLHemisphereOriginVisualFieldDefectOccipitalInvolvementSEIZUREPHASESICTALPHASE:ICT425

CLASSIFICATION5CLASSIFICATION43SingleMotor:Jerk,HeadTurning,RigiditySensory:UnusualTaste,HearingAutonomic:StomachSensationPsychological:Memory,

EmotionalComplexAutomatism;Aura;ConsciousnessGeneralizationPartial,EvolvesintoGrand-MalGTCSUnconscious,Rigidity+JerkingAbsenceBriefUnconsciousandStaring,VentilationMyoclonicSuddenContraction(400ms)ClonicRepetitive,JerkingMovementsTonic20s,ContinuousContractAlongBodyAxisAtonicLossofMuscleTensionCPSABSENCEGTCSATONICMotor:Jerk,HeadTurning,Rig446

DIAGNOSIS6DIAGNOSIS45+PSEUDOSEIZURE?EmotionalSyncope(Prodrome,Tongue)FeverConvulsionSEIZURE?VSPROVOKED?EPILEPTIC?VSTYPE?LOCATION?+PSEUDOSEIZURE?SEIZURE?VSPROV467

ADVANCEDSEMIOLOGY7ADVANCEDSEMIOLOGY47Semiology:AUTOMATISMsignificanceOralAutomatismTL(Hippocampal)UnilateralLimbAutomatismIPSL(FL,TL,Limbic)100%UnilateralEyeBlinkingIPSL(FL)BipedAutomatismFLIctalSpittingorDrinkingRightTLIctalLaughter(Gelastic)Hypothalamus,MTLPostictalNoseWipingIPSL(FL/TL)PostictalCoughTLSemiology:AUTOMATISMsignifica48Semiology:MOTORsignificanceForcedSustainedHead/Eye/MouthTurn+GnrlznCNTRL,FL/TL94-100%ReproductiveNonforcedHead/EyeTurn-GnrlznIPSLFL/TL(BSLGN)80%FocalClonicJerkingCNTRL,Rolandic(4)>95%UnilateralIctalParesisCNTRLFrequentBrief

HyperkineticMovementsMesialPartofTL/FLAsymmetricClonicEndingIPSL,

TL/FL80%UnilateralDystoniaCNTRL,TL/FL(BSLGN)93%FencingPostureCNTRL,FLPostictalTodd’sParesisCNTRL,FLIctalEyeClosureNonepilepticFigure4SignCNTRLtoExtendedLimb,TLSemiology:MOTORsignificanceFo49Semiology:SPEECHsignificanceIctalSpeechArrestDominantTemporalInfluencedIctalSpeechPreservationDominantTemporalSpaired

PostictalDysphasiaDominantHemisphereIctusVomitingRightTLIctusUrinaryUrgeRightTLHairErectionLeftTLSemiology:FEELsignificanceWell-definedSomatosensorySymptomsCNTRLRolandic(1,2,3)90%UnilateralElementaryVisualPhenomenaCNTRLOccipital80%AscendingVisceralFeelingsMesialTemporal,

Premotor(6),InsulaForcedThinkingDominantFrontal/MesiotemporalIctalFearAmygdala,HippocampusSemiology:SPEECHsignificanceI508

ABSENCE

vs

CPS8ABSENCEvsCPS51AbsenceCPSSleepActivationNoneCommonHyperventilationActivaingNoneFrequencyMany/DayLessOnsetAbruptSlowAuraNoneCommonAutomatismNoneCommonProgressionNoneCommonCyanosisNoneCommonMotorSignsRareCommonDurationBriefMinutesPost-IctalConfussionNoneCommonPost-IctalDysphasiaNoneCommon(Dominant)AbsenceCPSSleepActivati