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Abstract: A 47-year-old female presented with adverse symptoms after exertion due to a cold six months ago, initially with a cough and sputum fever that did not attract the family’s attention, followed by drowsiness and limb twitching. After visiting the hospital, viral encephalitis was considered. After treatment, her condition improved and she was discharged from the hospital, but she was left with sequelae of seizures, often with twitching of the limbs and rolling of the eyes, which improved after active medication.
[Basic information] Female, 47 years old
Type of disease】Ssequelae of viral encephalitis
Hospital】Shandong Provincial Third Hospital
Time of consultation】October 2017
Treatment plan】Medication (sodium valproate extended-release tablets, levetiracetam tablets)
【Treatment cycle】Outpatient consultation, 1 month outpatient follow-up, 3 years follow-up
Treatment effect] Clinical cure
I. Initial consultation
Patient’s description: He had viral encephalitis six months ago and gradually improved after treatment, but had sequelae of epilepsy, which was considered as sequelae of viral encephalitis. The patient has been taking oral sodium valproate extended-release tablets for half a year, but the treatment effect is poor. For the patient’s current condition, the relevant tests need to be improved and the medication adjusted if necessary. After analyzing the patient’s condition with him, the patient and his family agreed to be admitted to the hospital.
The cranial magnetic resonance examination showed multiple abnormal signals in the brain, and plaques of long T2 signals were seen in the left temporal lobe, bilateral ventricles and white matter around the three ventricles. Combined with the medical history, the sequelae of cranial infection were considered. Laboratory tests for routine blood, liver and kidney function, ion, lipids, blood glucose, and blood drug concentration suggested insufficient concentration of sodium valproate.
(Cranial magnetic resonance examination)
II. Treatment history
According to the examination results and detailed inquiry, we learned that the patient had recently gained significant weight, but did not visit the hospital for follow-up and review. Therefore, the dose of sodium valproate extended-release tablets was increased and combined with levetiracetam tablets. The patient was also advised to take the medication on time and in the right amount, to develop good habits, to learn to regulate emotions, to be less angry, and to come to the clinic for a review in 1 month.
III. Treatment effect
After adjusting the dose of medication, the patient’s symptoms improved significantly and the number of attacks decreased. The electroencephalogram was better than before. The patient was instructed to come to the hospital every 3 months for a review to clarify whether the blood pressure concentration was within the therapeutic range and whether there were any side effects of the medication, and the patient expressed his understanding and actively cooperated with the treatment. The patient showed understanding and actively cooperated with the treatment. After taking the drug for about 3 years, the drug was gradually reduced until it was stopped, and the patient reached clinical cure.
IV. Precautions
We are glad to see that the patient is cured after taking the medication persistently. In daily life, patients need to actively regulate the use of drugs under the guidance of professional doctors to facilitate the recovery of the disease. At the same time, do not drink alcohol, avoid staying up late and straining, emotional excitement. If a high fever occurs, attention should be paid to reducing the fever; if diarrhea occurs, attention should be paid to active treatment to avoid triggering seizures. Pay attention to regular review at the hospital and be alert to any side effects of drugs, such as reduced platelets, liver and kidney insufficiency, etc.
V. Personal insight
The patient in this case had seizures caused by the sequelae of viral encephalitis, which is more common in clinical practice. Due to the active early treatment in the hospital, clinical cure was achieved in about 3 years with medication. If medication is taken blindly, or if the patient does not come to the hospital for a long time for follow-up, it may lead to continuous aggravation of the disease. Therefore, when suffering from this disease, regular follow-up visits to the hospital should be made to form a long-term continuous and effective standardized treatment for precise treatment and regulation.