【正文】 d know : ? where epileptic seizure is, ? how long the seizure continue, ? what signs there are during seizure, ? and we should also know the patients’s consciousness during seizure.Part 5: Diagnosis and Differential Diagnosis Physical Examination: for the symptomatic ep.Part 5: Diagnosis and Differential Diagnosis Laboratory Test:Which one is important for epilepsy in lab test ?Diagnosis of EpilepsyEEGCT or MRI+MRSSPECT or PETDSAMEGPart 5: Diagnosis and Differential Diagnosis Differential Diagnosis GTCS and Hysteria Absence Seizure and Syncope Idiopathic and Symptomatic Epilepsy Table 1. General Differentiation of GTCS from Hysteria Characteristic GTCS Hysteria Seizure Triggers Unmon Emotional disturbance Diurnal pattern Day or night Usually day, never during sleep Convulsion Stereotypic synchro Atypical, irregular movements nous Movements Forced eye closure , Crying Consciousness Unconsciousness(a) Confusion, Twilight state Pupillary and Dilatation Dilatation or normal Reactivity to light Loss Normal Physiological reflex Disappear Normal Babinski reflex (+) () Enuresis (+) () Part 5: Diagnosis and Differential DiagnosisPart 5: Diagnosis and Differential Diagnosis Table 2. General Differentiation of Absence Seizure from SyncopeCharacteristic Absence Seizure SyncopeCauses Unclear(Inheritance) Vasodepressor syncope Orthostatic hypotension Cardiac origin Hypoglycemia Aura No Dizziness, Visual blurring or loss Palpitation(心悸 ), Short of breath Onset Sudden Gradual Facial color Normal Pallor Drop attack No More monPart 5: Diagnosis and Differential DiagnosisDiagnosis of EpilepsyAnswer Question1. Whether the seizure is epilepsy or not types of epilepsy3. Idiopathic or Symptomatic or Cryptogenic EpilepsyPart 5: Diagnosis and Differential DiagnosisDiagnosis of EpilepsyAnswer some question2. Which types of epilepsy? An attempt should be made at the same time to categorise the seizure according to classification,because it is greatly important for correct therapy. The Type of Epileptic Seizure Have to Be Diagnosis for Treatment.Part 5: Diagnosis and Differential DiagnosisPartial seizures(seizures beginning locally) A. Simple partial seizures B. Complex partial seizures C . Partial seizures secondarily generalizedGeneralized Seizures A. Absence seizures B. Tonicclonic seizuresPart 5: Diagnosis and Differential DiagnosisDiagnosis of EpilepsyAnswer Question1. Whether the seizure is epilepsy or not types of epilepsy3. Idiopathic or Symptomatic or Cryptogenic Epilepsy Differentiation of Primary Epilepsy from Sympt or Crypt Epilepsy Characteristic Primary Epilepsy Secondary Epilepsy Causes Unknown Often found Age of onset Usually,520yrs, Any age 30yrs Family history Often found Less mon Types of seizure PGTCS and AS PS, SGTCS Duration of onset 10 –30 seconds in AS 10 minutes 5–10 minutes in PGTCS PE (–) Positive signs related primary disease ( infective disease) EEG Bilaterally synchronous Focally abnormal EEG epileptic discharges Other Laboratory Usual normal Usual abnormal Test Part 5: Diagnosis and Differential DiagnosisPart 6: Prevention and Treatment of Epilepsy Prevention of Risk Factors Identification and Elimination of Factors Principles of Anticonvulsant Therapy Treatment on The OnsetPart 6: Prevention and Treatment of Epilepsy Prevention of Risk Factors It is the most important preventive measure to prevent brain trauma, infective disease, high fever and so on. Identification and Elimination of Factors The elimination of factors that cause seizures requires the identification and treatment of structural or physiologic abnormalities discovered in the examination. Examples include removal of an operable brain tumor or vascular malformation, treatment of infectionsPart 6: Prevention and Treatment of Epilepsy The need for medication to be taken regularly should be stressed, and the patient advised of the risk of withdrawal seizures if medication is abruptly withdrawal. According to the specific type of seizure disorder and toxic side effects of the drugs, the choice of antiepileptic drugs should be done. Principles of Anticonvulsant Therapy★Part 6: Prevention and Treatment of Epilepsy Principles of Anticonvulsant TherapyEthosuximide(乙琥胺 ) Valproa