概述

Explaining epilepsy

Listen to specialist Lily Wong-Kisiel, M.D., walk through the epilepsy basics.

Hi, I'm Dr. Lily Wong-Kisiel, a pediatric neurologist at Mayo Clinic. In this video, we'll cover the basics of epilepsy. What is it? Who gets it? The symptoms diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. First of all, epilepsy is common. Around 3 million people in the U.S. have epilepsy, making it the fourth most common neurological disease after migraine, stroke and Alzheimer's. Epilepsy happens as a result of abnormal electrical brain activity, also known as a seizure, kind of like an electrical storm inside your head. And because your brain controls so much, a lot of different things can go wrong. You may have periods of unusual behaviors, feelings and sometimes loss of awareness. There are many types of seizures, including two main categories: focal, meaning they start in a particular part of your brain, or generalized, meaning the seizures initially involve all areas of the brain. There are some myths about epilepsy we can dismiss. If you are with someone experiencing a seizure, don't put anything in their mouth. They can't actually swallow their tongue. Don't restrain them. And don't worry, epilepsy isn't contagious, so you can't catch it.

Although children or older adults are more susceptible, anyone can develop epilepsy. When epilepsy is diagnosed in older adults, it's sometimes from another neurological issue, like a stroke or a brain tumor. Other causes can be related to genetic abnormalities, prior brain infection, prenatal injuries or developmental disorders. But in about half of people with epilepsy, there's no apparent cause.

Because they happen in the brain, seizures can affect any process your brain handles. Therefore, symptoms can vary. Many individuals with epilepsy tend to have the same type of seizure each time. However, some will have more than one type. So, how do you recognize a seizure? Keep an eye out for temporary confusion, a staring spell, uncontrollable jerking, loss of consciousness, fear, anxiety or deja vu.

Let's talk about the two types of seizures again: focal and generalized. Focal seizures happen one of two ways: without loss of awareness or with impaired awareness. In those where you remain conscious, you may experience altered emotions or change in sensation like smell, sound or taste. You may also have dizziness, tingling or see flashing lights. You could also experience involuntary jerking of body parts like your arm or your leg. When you lose or have altered awareness, you can pass out or stare into space and not really respond normally. Hand rubbing, chewing, swallowing or walking in circles can happen in this kind of seizure. Because these symptoms overlap with migraine or other neurological disorders, heart problems or psychiatric conditions, tests are needed for a diagnosis. Generalized onset seizures, the ones that happen across all areas of the brain, show up in a variety of ways. Absence seizures are marked by staring absently into space. Blinking and lip smacking can also happen. Tonic seizures involve a stiffening of the back, arm and legs. The opposite of tonic seizures are atonic seizures, which result in a loss of muscle control. Instead of going stiff, everything goes slack. Clonic seizures usually affect the neck, face and arms with repeated jerking movements. Similar to clonic seizure, myoclonic seizures involve sudden brief jerks or twitches of the arms. Lastly, there are tonic-clonic seizures. Like the name suggests, these involve parts of both tonic and clonic signs. Body stiffening and shaking, loss of bladder control or biting your tongue can also happen. Knowing the kind of seizure you have is key to treatment.

Even after having a single seizure, sometimes the diagnosis of epilepsy can't be made. Regardless, if you do have something that seems like a first-time seizure, see a physician. Your doctor may assess your motor abilities, mental function and other areas to diagnose your condition and determine if you have epilepsy. They may also order additional diagnostic tests. They could include neurological exam, blood tests, EEG, CT scan, brain imaging and sometimes neuropsychological tests. Because your brain is such a complicated piece of machinery, neurologists, epileptologists, neurosurgeons, neuroradiologists, mental health specialists, and other professionals all work together to provide exactly the care you need.

The best care starts with an accurate diagnosis. The medications we have for epilepsy are incredibly effective. More than half of the cases are seizure-free after their first medication. But when medication does not work at stopping seizures completely, there are other emerging ways of treating epilepsy, including surgery and brain stimulation. And a comprehensive level 4 epilepsy center can help find you the best way to manage your care. For patients undergoing treatment, it's important to keep a detailed seizure journal. Each time you have a seizure, write down the time, the type and how long it lasted, making note of anything out of the ordinary, like missed medication, sleep deprivation, increased stress, menstruation, or anything else that could trigger it.

Though we don't always know why people suffer from epilepsy, ongoing research continues to build our knowledge and improve treatment options. And better treatment means happier patients. If you'd like to learn even more about epilepsy, watch our other related videos or visit mayoclinic.org. We wish you well.

癫痫是一种中枢神经系统(神经)障碍,该疾病下的脑活动变得异常,会引起癫痫发作或一段时间的异常行为、感觉,有时甚至丧失意识。

任何人都可能患上癫痫。癫痫累及所有种族、民族背景和年龄的男性和女性。

癫痫发作症状差异很大。一些癫痫患者在癫痫发作时只是呆呆地盯几秒钟,而另一些人会反复抽动手臂或腿。一次癫痫发作并不意味着您患有癫痫。通常需要至少两次无端癫痫发作才能诊断为癫痫。

对于大多数癫痫患者来说,药物治疗(有时也可以是手术)可以控制癫痫发作。有些人需要终身治疗来控制癫痫发作,但对另一些人来说,癫痫最终会消失。一些患有癫痫的儿童可能随着年龄增长而自愈。

症状

由于癫痫由异常脑活动引起,故癫痫发作可累及经大脑协调的任何过程。癫痫发作的体征和症状可能包括:

  • 暂时性意识混乱
  • 目光呆滞
  • 胳膊和腿部不受控制的抽搐
  • 意识或认知丧失
  • 有诸如恐惧、焦虑或记忆错乱的精神症状

症状因癫痫发作的类型而有所不同。大多数情况下,癫痫患者通常每次出现相同的发作类型,因而症状在每次发作时都很相似。

根据异常脑活动开始的方式,医生一般会将癫痫发作分为局部发作或全身发作。

局灶性癫痫发作

当癫痫发作似乎是由于大脑某个区域的异常活动引起时,称为局灶性(部分性)发作。这些癫痫发作分为两类:

  • 无意识丧失的局灶性癫痫发作。这些癫痫发作曾被称为单纯部分性发作,不会导致意识丧失。它们可能会导致患者情绪改变或对事物外观、气味、感觉、味道或声音的改变。它们还可能导致身体某个部位(例如手臂或腿部)的不自觉抽搐,以及自发的感觉症状,例如刺痛、头晕和闪光。
  • 局灶性意识受损癫痫发作。这些癫痫发作曾被称为复杂部分性发作,涉及意识或认知的改变或丧失。在复杂部分性发作期间,患者可能会凝视着某个空间,对周围环境没有正常反应,也可能会进行重复性的动作,例如搓手、咀嚼、吞咽或绕圈行走。

局灶性癫痫发作的症状可能会与其他神经系统疾病相混淆,例如偏头痛、发作性睡病或心理疾病。为了区分癫痫和其他疾病,需要进行彻底的检查和检测。

全身性发作

累及大脑所有区域的癫痫发作称为全身性发作。有六种类型的全身性发作。

  • 失神发作。失神发作,以前称为癫痫小发作,常发生于儿童,表现为凝视半空或有细微的身体动作,如眨眼或咂嘴。这些癫痫发作可能会陆续出现,并导致短暂的意识丧失。
  • 强直发作。强直发作会导致肌肉僵硬。这些癫痫发作通常会影响背部、手臂和腿部的肌肉,并可能导致您跌倒在地。
  • 失张力发作。失张力发作,也称为跌倒发作,会导致肌肉失控,从而可能导致突然虚脱或跌倒。
  • 阵挛发作。阵挛发作与反复或有节律的肌肉抽搐运动有关。这些癫痫发作通常影响颈部、面部和手臂。
  • 肌阵挛发作。肌阵挛发作通常表现为手臂和腿部突然短暂抽搐。
  • 强直阵挛性发作。强直阵挛性发作,以前称为癫痫大发作,是癫痫发作中最显著的类型,可导致突然意识丧失、身体僵硬和颤抖,有时还会导致膀胱失控或咬舌。

何时就诊

如出现下列任一情况,请立即就医:

  • 癫痫发作持续五分钟以上。
  • 癫痫发作停止后没有恢复呼吸或意识。
  • 第二次癫痫发作紧随其后。
  • 您出现高热。
  • 您正在经历热衰竭。
  • 您怀孕了。
  • 您有糖尿病。
  • 您在癫痫发作期间受伤。

如果您首次出现癫痫发作,请就医。

Get the latest epilepsy information from Mayo Clinic delivered to your inbox.

Subscribe for free and receive the latest on epilepsy treatment, care and management.

I would like to learn more about:

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information, and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

病因

约有一半的癫痫患者找不到病因。而另一半患者中,该疾病可归因于多种因素,包括:

  • 遗传影响。有些类型的癫痫(根据您经历的癫痫发作的类型或受影响的脑区域进行分类)会在家族中遗传。在这些病例下,可能有遗传影响。

    研究人员已经将某些类型的癫痫与特定基因联系在一起,但是对于大多数人而言,基因只是导致癫痫的一部分病因。某些基因可能会使人对引发癫痫发作的环境条件更加敏感。

  • 头部外伤。交通事故或其他外伤性损伤所致的头部外伤可导致癫痫。
  • 脑部疾病。导致脑部损伤的脑部疾病,例如脑肿瘤或卒中,可能导致癫痫。卒中是 35 岁以上成人患癫痫的主要病因。
  • 传染病。脑膜炎、艾滋病和病毒性脑炎等传染病可能引起癫痫。
  • 产前损伤。在出生前,婴儿对脑损伤很敏感,脑损伤可能是由多种因素引起的,例如母体感染、营养不良或缺氧。这种脑损伤可导致癫痫或脑瘫。
  • 发育障碍。癫痫有时可能与发育障碍相关,例如自闭症和神经纤维瘤病。

风险因素

可能会增加癫痫患病风险的一些因素有:

  • 年龄。癫痫发作最常见于儿童和老年人,但任何年龄都可能患病。
  • 家族史。如果您有癫痫家族史,则您患癫痫发作症的风险可能会增加。
  • 头部受伤。头部受伤是某些癫痫发作的原因。您可以在开车时系好安全带,或在骑自行车、滑雪、骑摩托车或从事其他容易造成头部受伤的活动时佩戴好安全帽,以降低头部受伤的风险。
  • 卒中和其他血管疾病。卒中和其他血管疾病可能造成脑损伤,进而可能引发癫痫。您可采取多种措施来降低患上这些疾病的风险,包括限制饮酒、避免吸烟、饮食健康以及定期运动等。
  • 痴呆。痴呆会增加老年人患癫痫的风险。
  • 脑部感染。脑膜炎等感染会引起脑或脊髓炎症,进而增加患病风险。
  • 童年时期惊厥。童年时期出现高烧症状有时可能与癫痫发作有关。因高烧引起癫痫发作的儿童通常不会发展为癫痫病。如果儿童长期癫痫发作、有其他神经系统疾病或有癫痫家族病史,则癫痫的患病风险会增加。

并发症

在某些时候,癫痫发作可能让您自己或他人处于危险境地。

  • 跌倒。如果您在癫痫发作过程中跌倒,可能导致头部受伤或骨折。
  • 溺水。如果您患有癫痫,由于在水中时出现癫痫发作的可能性,您在游泳或洗澡时溺水的概率是其他人群的 15 至 19 倍。
  • 交通事故。如果在驾驶汽车或操作其他设备时,癫痫发作导致意识或控制力丧失,可能造成危险。

    许多州都有与驾驶员控制癫痫发作的能力有关的驾照限制,对驾驶员在获准开车前的无癫痫发作最短时限予以规定,具体从数月到数年不等。

  • 妊娠并发症。怀孕期间癫痫发作会使母亲和胎儿处于危险之中,并且某些抗癫痫药物会增加出生缺陷的风险。如果您患有癫痫并正在考虑怀孕,在计划怀孕时请咨询医生。

    大多数癫痫女性患者可以怀孕并生下健康的宝宝。在整个怀孕期间,医生需要对您仔细监测,并可能需要调整药物。您要与医生一起计划您的怀孕,这一点非常重要。

  • 情绪健康问题。癫痫患者更可能出现心理健康问题,尤其是抑郁症、焦虑症、自杀想法和行为。这些问题可能是病情本身应对困难以及药物副作用的结果。

其他危及生命的癫痫并发症并不常见,但可能会发生,包括:

  • 癫痫持续状态。如果处于持续癫痫发作状态超过 5 分钟或者如果癫痫发作频繁复发,两次发作之间未完全恢复意识,则会发生这种医疗状况。癫痫持续状态患者出现永久性脑损伤和死亡的风险增加。

  • 癫痫不明原因猝死(SUDEP)。癫痫患者还有较小的意外猝死风险。原因尚不清楚,但一些研究表明它可能由心脏或呼吸问题引起。

    频繁出现强直阵挛性癫痫发作者或者癫痫发作未经药物控制者可能有较高风险发生 SUDEP。总体而言,约 1% 的癫痫患者死于 SUDEP

在 Mayo Clinic 治疗

Oct. 07, 2021
  1. The epilepsies and seizures: Hope through research. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through. Accessed June 3, 2021.
  2. Schachter SC. Evaluation and management of the first seizure in adults. https://www.uptodate.com/contents/search. Accessed June 3, 2021.
  3. Get seizure smart. Centers for Disease Control and Prevention. https://www.cdc.gov/features/getseizuresmart/index.html. Accessed June 3, 2021.
  4. Daroff RB, et al. Epilepsies. In: Bradley's Neurology in Clinical Practice. 8th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed June 3, 2021.
  5. Wilfong A. Seizures and epilepsy in children: Classification, etiology, and clinical features. https://www.uptodate.com/contents/search. Accessed June 3, 2021.
  6. Simon RP, et al. Seizures & syncope. In: Clinical Neurology. 10th ed. McGraw Hill; 2018. https://accessmedicine.mhmedical.com. Accessed June 3, 2021.
  7. Ferri FF. Seizures, generalized tonic clonic. In: Ferri's Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed June 3, 2021.
  8. Schachter SC. Overview of the management of epilepsy in adults. https://www.uptodate.com/contents/search. Accessed June 3, 2021.
  9. Who gets epilepsy? Epilepsy Foundation. http://www.epilepsy.com/learn/epilepsy-101/who-gets-epilepsy. Accessed June 3, 2021.
  10. Schachter SC. Sudden unexpected death in epilepsy. https://www.uptodate.com/contents/search. Accessed June 3, 2021.
  11. Neurological diagnostic tests and procedures fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. Accessed June 4, 2021.
  12. Haider HA, et al. Neuroimaging in the evaluation of seizures and epilepsy. https://www.uptodate.com/contents/search. Accessed June 4, 2021.
  13. Karceski S. Initial treatment of epilepsy in adults. https://www.uptodate.com/contents/search. Accessed June 4, 2021.
  14. Wilfong A. Seizures and epilepsy in children: Initial treatment and monitoring. https://www.uptodate.com/contents/search. Accessed June 4, 2021.
  15. Crepeau AZ, et al. Management of adult onset seizures. Mayo Clinic Proceedings. 2017; https://doi.org/10.1016/j.mayocp.2016.11.013.
  16. Lyons MK. Deep brain stimulation: Current and future clinical applications. Mayo Clinic Proceedings. 2011; https://doi.org/10.4065/mcp.2011.0045.
  17. Schachter SC. Comorbidities and complications of epilepsy in adults. https://www.uptodate.com/contents/search. Accessed June 4, 2021.
  18. Englot DJ, et al. Seizure outcomes in nonresective epilepsy surgery: An update. Neurosurgical Review. 2017; doi:10.1007/s10143-016-0725-8.
  19. External trigeminal nerve stimulation. Epilepsy Foundation. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices/external-trigeminal-nerve-stimulation. Accessed June 4, 2021.
  20. Riggin EA Allscripts EPSi. Mayo Clinic, Rochester, Minn. Jan. 22, 2020.
  21. Fisher RS, et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for classification and terminology. Epilepsia. 2017; doi:10.1111/epi.13670.
  22. Lundstrom BN, et al. Chronic subthreshold cortical stimulation: A therapeutic and potentially restorative therapy for focal epilepsy. Expert Review of Neurotherapeutics. 2017; doi:10.1080/14737175.2017.1331129.
  23. Van Gompel JJ (expert opinion). Mayo Clinic, Rochester, Minn. May 30, 2018.
  24. Moeller J, et al. Video and ambulatory EEG monitoring in the diagnosis of seizures and epilepsy. https://www.uptodate.com/contents/search. Accessed June 4, 2021.
  25. Burkholder DB (expert opinion). Mayo Clinic. July 20, 2021.
  26. Labiner DM, et al. Essential services, personnel, and facilities in specialized epilepsy centers – Revised 2010 guidelines. Epilepsia. 2010; doi:10.1111/j.1528-1167.2010.02648.x.
  27. Find an epilepsy center. National Association of Epilepsy Centers. https://www.naec-epilepsy.org/about-epilepsy-centers/find-an-epilepsy-center/. Accessed June 4, 2021.
  28. Nair DR, et al. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020; doi:10.1212/WNL.0000000000010154.
  29. Monteith S, et al. Transcranial magnetic resonance–guided focused ultrasound for temporal lobe epilepsy: A laboratory feasibility study. Journal of Neurosurgery. 2016; doi:10.3171/2015.10.JNS1542.
  30. Fregni F, et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in patients with refractory epilepsy. Annals of Neurology, 2006; doi:10.1002/ana.20950.

相关