Epilepsy is a chronic neurological disorder, also known as “goat’s horn” and “sheep’s epilepsy” in China. There are currently more than 9 million people with epilepsy in China, and the onset of epilepsy can occur from infancy to old age, but more worryingly, data show that only nearly half of China’s epilepsy patients receive regular treatment. The long duration of the disease, the high disability rate, and the irregularity of treatment impose a heavy burden on the patient’s body, mind, family and even society.
A. Eliminate prejudice, epilepsy is not uncontrollable
Some people in China not only lack understanding of epilepsy, but also have prejudice and discrimination. Some people with epilepsy have a sense of shame and are afraid of being known by others, and even gradually become paranoid and depressed. The doctor called for the elimination of prejudice and the correct understanding of epilepsy. He pointed out that although epilepsy is a chronic disease with a long course, some patients even need to take medication for life. However, through regular treatment, most patients can completely control their condition and achieve clinical cure. Patients can work and live like normal people.
Ten causes of epilepsy
Why does epilepsy occur? The pathological basis of epilepsy is that the nerve cells in a certain part of the brain become necrotic, absent, structurally abnormal, or have an impaired blood supply, which decreases the ability of brain cells to maintain the stability of their own potential and is in an unstable state. In other words, patients with epilepsy have paroxysmal over-discharge of nerve cells in the brain at the onset of the disease, while exhibiting seizure symptoms such as dizziness, convulsions and foaming at the mouth.
Epilepsy can be divided into two categories: primary epilepsy and secondary epilepsy, where secondary epilepsy is mainly caused by a variety of organic lesions of brain disease or metabolic disorders. Some patients with seizures have aura symptoms, such as dizziness, stomach discomfort, etc., mostly belong to secondary epilepsy.
Third, epilepsy occurs because of the following ten main etiological factors.
1, genetic factors. Epilepsy has a certain degree of heritability, and primary epilepsy mostly has genetic factors. The offspring of people with epilepsy have a higher chance of developing epilepsy than normal people.
2, birth injury. Birth injuries are a common cause of secondary epilepsy in infancy. There are many reasons for birth injuries, such as abnormal fetal position, oversized fetus, forceps assisted delivery, fetal head suction device attraction, etc. The contusions, edema, and hemorrhage suffered by the infant during delivery may lead to local cerebral sclerosis and the formation of epileptic foci several years later.
3. Trauma. Trauma is mostly seen in various accidents such as traffic accidents, etc. When traumatic injuries such as skull fractures and dural tears occur, the sequelae of epilepsy are more common. This is also a major cause of secondary epilepsy.
4, hyperthermia convulsions. Severe and prolonged febrile convulsions can lead to brain damage including neuronal loss and gliosis, mainly in the medial temporal lobe, especially in the hippocampus.
5. Infections. Various bacterial meningitis, brain abscesses, sarcoidosis, viral encephalitis, and parasitic diseases may induce epilepsy.
6, poisoning. Lead, mercury, carbon monoxide, ethanol, fenugreek, isocarbohydrazide poisoning, and systemic diseases such as gestational hypertensive syndrome, uremia, etc. may induce epilepsy.
7. Intracranial tumors. Clinical intracranial tumors with epilepsy are more common.
8, cerebrovascular disease. Except for cerebrovascular malformations and subarachnoid hemorrhage which produce epilepsy at a younger age, post-stroke epilepsy is more common in middle-aged and elderly people, especially cerebral embolism, cerebral thrombosis and multiple cavernous seizures. Hypertensive encephalopathy is also often associated with epilepsy.
9. Metabolic diseases. Hypoglycemia due to islet cell tumors, diabetes, hyperthyroidism, hypoparathyroidism, and vitamin B6 deficiency can lead to seizures.
10. Degenerative diseases. Epilepsy is one of the main manifestations of tuberous sclerosis. Alzheimer’s disease is also often associated with epilepsy.
Out of misconceptions Epilepsy needs formal treatment At present, the proportion of epilepsy patients with formal treatment in China is still low, which is very unfortunate. Professor Wang points out that many patients have taken a wrong turn in their medical treatment due to social prejudices and misconceptions about epilepsy. Some patients are reluctant to admit that they have a disease and are afraid of long-term medication, stopping it on their own when their symptoms improve slightly; some patients are in a hurry to seek medical help, pursuing the “cure”, seeing various prescriptions and small advertisements, trying various drugs and treatments, resulting in a more complex and difficult treatment.
The most important thing is to make sure that the patient is treated properly. The main treatment options for epilepsy include medical treatment and surgical treatment.
1. Do I have to take medicine for epilepsy?
In principle, medical medication should be started after a seizure in order to control the condition and prevent another seizure. However, there is a tendency in the medical community to believe that if a patient has no more than 2 seizures in 6 months, he or she can temporarily stop taking medication and start with lifestyle prevention combined with clinical observation of changes in the condition.
Lifestyle prevention should mainly pay attention to: avoid over-stimulating sports, too intense sports may induce seizures; avoid risky work, because seizures may cause patients to become unconscious or fall, and accidents may occur, so avoid such as waterfront, high-altitude work, also should not be a driver, electrician, etc.; diet to avoid tobacco and alcohol, do not drink strong tea, strong coffee, nicotine, alcohol, caffeine, etc., on the The first thing you need to do is to avoid the use of a ketogenic diet, i.e., a diet high in fat, low in carbohydrates and appropriate protein; avoid staying up late and being overly fatigued.
2. Does epilepsy require lifelong medication?
Once you start using medication to control your epilepsy, is it impossible to stop taking it? It is not absolute. In most patients, the condition is usually controlled clinically for 4-5 years, i.e., no excessive discharge and no clinical seizure symptoms are confirmed by brain wave examination, if medical advice is strictly followed. At this time, under the guidance of a professional physician, the drug can be gradually reduced and discontinued over a period of six months to one year until the disease is still under control without seizures after complete discontinuation. It should be noted that the adjustment of drugs must be guided by a professional physician, not to think that the control is very good during this period of time and do not eat. Otherwise, it is easy to relapse again. Of course, there are still some patients who need to take medication for life. It is also important to remind patients that epilepsy treatment is a long-term process that requires patience and confidence, and that they should not be impatient just because they occasionally have a relapse.
In the period of taking medication, including the reduction stage and the early stage of stopping medication, it is necessary to review regularly, and the number of check-ups should be more frequent at the beginning, usually once every half month. After the disease is under control, the examination is usually done once every 1-2 months, including blood tests to check the damage of the drug on the liver and kidneys, any other side effects, etc., monitoring whether the blood concentration is within the normal range, and also checking the electroencephalogram. These tests can help doctors and patients understand whether the drugs are working and whether they should be added or changed.
3. Can epilepsy be cured?
After regular medical treatment, 70% of patients with epilepsy can be cured clinically. However, for patients with poor drug control, are there other treatments available? Is it reasonable for some patients to be anxious to “cure” epilepsy?
With the rapid development of EEG and neuroimaging technology, neurosurgical treatment of epilepsy is now a reality. Current surgical procedures include: corticotomy (including temporal lobe and extra-temporal lobe corticotomy), functional cerebral hemispherectomy, corpus callosotomy, multiple subcallosal transection, brain stereotactic surgery (destruction of targets, mainly amygdala and vault), and chronic cerebellar stimulation. In recent years, intermittent stimulation of the vagus nerve has shown some efficacy in intractable partial seizures of unknown origin.
Of course, it is important to note that both medical and surgical treatments are not 100% effective. There are both “medically refractory epilepsy” and “surgically refractory epilepsy” in epilepsy patients, which requires further research by the medical community in order for more epilepsy patients to benefit from it.
The new policy of “two separate children” has started to be implemented nationwide in 2014. However, for many people with epilepsy, childbirth has become a “hurdle” in their lives.
The most important thing is to make sure that you have a good idea of what you are doing.
1. Is epilepsy hereditary?
It should be said that people with epilepsy can have children, but there are certain risks. Generally speaking, children born with epilepsy are 1-2 times more likely to have epilepsy than normal people, and the chance of fetal malformation is 2 times higher than normal people. If both parents have epilepsy of unknown origin, the likelihood of the child having the disease increases. This should be taken into account before a person with epilepsy decides to have a baby.
2. Do medications affect the fetus?
A variety of epilepsy medications can increase the risk of fetal malformations, so it is recommended that people with epilepsy, both men and women, should avoid medication for six months before planning a pregnancy. However, if the medication is suddenly stopped, it may lead to another seizure, and a grand mal seizure may cause hypoxia in the fetus, which is extremely dangerous. Therefore, in principle, it is recommended to control epilepsy to the “clinically cured” stage and then stop taking medication for six months before pregnancy. If you want to get pregnant when your epilepsy is not well controlled, you should communicate with your epilepsy doctor in time and adjust the dosage to the lowest controllable range under the supervision and guidance of the doctor to prevent the seizures from affecting the health of mother and child during pregnancy.
3. What should be noted about birth and breastfeeding for mothers with epilepsy?
If a mother with epilepsy has frequent seizures, it is safer to choose a caesarean section for delivery. It is recommended to choose a hospital with experience in high-risk pregnancies for delivery. Considering the potential effects of medications, it is best for pregnant women to avoid epilepsy medications until they finish breastfeeding. If the condition is not controlled during breastfeeding, family members should take precautions to avoid injury to the baby during a seizure.