张运阁，李春晓，管国富，吕铭，蔡剑虹，程荷英

（常州市德安医院司法鉴定所，江苏常州213003）

外伤性癫痫法医学评定100例分析

张运阁，李春晓，管国富，吕铭，蔡剑虹，程荷英

（常州市德安医院司法鉴定所，江苏常州213003）

目的探讨颅脑外伤后癫痫的法医学评定要点，提出外伤性癫痫的法医学评定依据。方法对100例颅脑损伤后癫痫患者门诊及住院病历，结合临床脑电图（EEG）结果、CT片、MRI片等影像学资料，进行了回顾性分析。结果依据GBl8667-2002《道路交通事故受伤人员伤残评定》标准有关颅脑损伤后癫痫发作类型、发作频率的相关条款规定，Ⅲ级伤残8人，Ⅴ级伤残10人，Ⅶ级伤残22人，Ⅸ级伤残40人，Ⅹ级伤残20人。误工期限、营养期限和护理期限评定结论时间长短差异较大，具有个体化特征。结论外伤后癫痫常继发于严重的颅脑损伤，其发作特点决定于颅脑外伤的部位和程度，外伤性癫痫法医学鉴定必须以外伤史及既往史为基础，结合电生理及影像学检查，综合癫痫发作类型、频率及药物控制情况作出正确的伤残等级及误工期限、护理期限、营养期限的鉴定结论。

法医临床学；颅脑外伤；癫痫；伤残等级；误工期限；护理期限；营养期限

Abstract：Objective To study the forensic assessment points about traumatic brain injury induced epilepsy，and to provide a basis for forensic assessment.Methods Data from 100 cases with traumatic brain injury induced epilepsy，including outpatient and inpatient medical records，clinical EEG，CT and MRI films，were collected and statistically analyzed.Results According to the statements on the type and the frequency of epileptic seizures in“standard for impairment assessment in road traffic accidents”（GBl8667-2002），3rd grade injury was sustained in 8 cases，5th grade injury in 10 cases，7th grade injury in 22 cases，9th grade injury in 40 cases and 10th grade injury in 20 cases.Assessments of the loss of working time，nursing time and nutrition time were quite different，showing individuality aspects.Conclusions Traumatic epilepsy was secondary to severe traumatic brain injury，the nature of the attack depended on the location and extent of brain injury.Right conclusions of the disability grade need full consideration of the trauma and past history，electrophysiological and imaging examination results，seizures type，frequency and drug control situation.

Key words：forensic clinical medicine；brain injury；epilepsy；disability identification；loss of working time；care time；nutrition time

颅脑损伤在法医临床学鉴定中较为常见，其病理机制较为复杂，时有遗留肢体运动功能障碍、精神障碍，乃至引发癫痫等后遗症。各种类型的颅脑损伤都有导致癫痫的可能，而且损伤后癫痫发作的时间及发作类型也各不相同[1]。目前法医学文献中对外伤性癫痫的论述较少，临床诊断亦缺少统一标准，因此，颅脑损伤后所致癫痫的伤残等级的鉴定及其误工、护理、营养期限的评定是法医临床学中一大难题，鉴定结论易引发争议。……