seizures新生儿惊厥（ppt55）课件

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1、NEONATALSEIZURESMariaTheresaM.Villanos,MDPL-2DefinitionAstereotypic,paroxysmalspellofalteredneurologicfunction(behavior,motor,and/orautonomicfunction)DefinitionNeonatalperiodlimitedto:-first28daysforterminfants-44weeksgestationalageforpre-termFrequencyInUS–incidencehasnotbeenestablishedcle

2、arlyEstimatedfrequencyof80-120per100,000neonates/year1-5:1000livebirthsFrequency0.5%incidence-NationalCollaborativePerinatalProject(population-basedstudyon54,000FTandPTinfants)0.23%incidence-Scher,etal(populationof41,00infants)Incidenceofseizureshigherintheneonatalperiodthaninanyotheragegr

3、oupWhydoneonatalseizureshavesuchunusualpresentations?ImmatureCNScannotsustainasynchronized,wellorchestratedgeneralizedseizurePerinatalAnatomicalandPhysiologicalFeaturesofImportanceinDeterminingNeonatalSeizurePhenomenaANATOMICALNeuriteoutgrowth—dendriticandaxonalramifications—inprocessSynap

4、togenesisnotcompleteDeficientmyelinationincorticalefferentsystemsVolpeJJ.NeonatalSeizures:NeurologyoftheNewborn.4thed.PerinatalAnatomicalandPhysiologicalFeaturesofImportanceinDeterminingNeonatalSeizurePhenomenaPHYSIOLOGICALInlimbicandneocorticalregions—excitatorysynapsesdevelopbeforeinhibi

5、torysynapses(N-methyl-D-aspartatereceptoractivity,gamma-aminobutyricacidexcitatory)ImmaturehippocampalandcorticalneuronsmoresusceptibletoseizureactivitythanmatureneuronsDeficientdevelopmentofsubstantianigrasystemforinhibitionofseizuresImpairedpropagationofelectricalseizures,andsynchronous

6、dischargesrecordedfromsurfaceelectroencephalogrammaynotcorrelatewithbehavioralseizurephenomena______________________________________________________________________VolpeJJ.NeonatalSeizures.In:NeurologyoftheNewborn.4thed.ProbableMechanismsofSomeNeonatalSeizuresPROBABLEMECHANISMDISORDERFailu

7、reofNa+-K+pumpsecondarytoHypoxemia,ischemia,adenosinetriphosphateandhypoglycemiaExcessofexcitatoryneurotransmitter(eg.glutamicacid—excessiveexcitation)Hypoxemia,ischemiaandhypoglycemiaDeficitofinhibitoryneurotransmitterPyridoxinedependency(i.e.,relativeexcess