What is epilepsy? What is intractable epilepsy? Epilepsy is a chronic brain dysfunction syndrome caused by a variety of causes. It is a seizure, sudden, transient brain dysfunction caused by repeated hyper-synchronous discharges of nerve cells in the brain. Refractory epilepsy is defined as epilepsy that has not been treated with regular antiepileptic drugs. Some patients who are diagnosed with epilepsy and receive regular antiepileptic treatment under the guidance of a physician still have frequent seizures and cannot be effectively controlled; some patients, who are anxious to seek medical help, do not receive regular treatment and eventually become intractable epilepsy. What causes can cause epilepsy? Many causes can cause epilepsy, especially lesions in the cerebral cortex. It is generally considered to be related to the following four factors: 1. Genetic factors. A predisposition to epilepsy in some families of patients with a history of epilepsy or congenital central nervous system or heart malformations; 2. Brain damage and brain injury. Viral infection, radiation exposure or other causes of embryonic dysplasia during embryonic development can cause epilepsy; birth injuries during fetal delivery are also a major cause of epilepsy; cranio-cerebral trauma can also cause epilepsy; 3. Other diseases of the skull and brain. Brain tumors, cerebrovascular disease, intracranial infections, etc.; 4. Environmental factors; there are slightly more male patients than female patients, and the incidence is higher in rural areas than in cities, and fever and mental stimulation are also triggers for epilepsy. Some modern lifestyles can also be the cause of epilepsy, such as epileptic patients playing computers, playing games, watching TV for a long time, drinking and smoking, and being overly tired are all causes of the increased incidence of epilepsy. The main reason for this is that it is not only a good idea to have a good time. This is a typical manifestation; there are also some manifestations of partial seizures, such as unilateral limb or facial convulsions, some manifestations of disorienting seizures, such as sudden pauses in movement and loss of consciousness; there are also manifestations of seizure headache, seizure abdominal pain, sleepwalking, etc. There are also some special types of epilepsy such as musical epilepsy, reading epilepsy, photosensitive epilepsy, etc. How to confirm the diagnosis of epilepsy? The first step is to have the clinical manifestation of seizures, and to ask the medical history carefully, whether there is birth injury, hypoxia, infection, traumatic brain injury and family history, etc.; CT or MRI examination should also be done, which can help to diagnose the cause of epilepsy, such as vascular malformation, tumor, brain structural dysplasia, etc. The most important examination is the examination of brain electrophysiology, and various EEG examinations combined with clinical can confirm the diagnosis. How is epilepsy treated? There are two main methods of treatment for epilepsy: one is medication and the other is surgical treatment. Drug therapy is the preferred treatment. Epilepsy is a chronic disease, therefore, drug treatment is also a long-term process and it is impossible to achieve immediate results. A large number of studies at home and abroad have proved that 80% of patients can be effectively controlled if they receive regular antiepileptic drug treatment. Another 17-20% of patients have difficulty in fully controlling their seizures with antiepileptic drugs due to persistent causes, and these patients are called refractory (intractable) epilepsy. There are nearly 2 million patients with intractable epilepsy in China, most of whom can have their seizures controlled or cured by surgical treatment. How is epilepsy treated surgically? Surgical eradication of the epileptogenic lesion has been used to treat epilepsy for more than 50 years. With the advent of new surgical techniques and new preoperative techniques for precise localization of the epileptogenic lesion, more and more epileptic patients are being treated surgically, and the success rate has taken a quantum leap. Surgery can be used for patients of any age, but not all patients with epilepsy and not all patients with uncontrollable epilepsy are suitable for surgical treatment. In a sense, epilepsy surgery does not guarantee that the patient will be seizure-free or will not need to take antiepileptic medication to control the seizures. However, most patients who undergo epilepsy surgery show some degree of improvement after surgery, and many patients stop having seizures. The purpose of epilepsy surgery is to address the origin of the epilepsy by examining it and being able to determine the location of the epileptic lesion, which can then be removed. In addition, it can cut off the propagation of epileptic discharges, stop the spread of abnormal discharges, and also reduce the excitability of the cerebral cortex. The surgical treatment of epilepsy is divided into three steps: preoperative evaluation of epilepsy, precise localization of the epileptic foci, and appropriate surgical plan. 1. Precise localization of the epileptic focus before surgery The origin of the abnormal discharge of the epileptogenic focus can be clarified by repeated examination with dynamic EEG and video EEG. 3. Minimally invasive surgery to remove the lesion or block the epileptic discharge The surgeon can remove the lesion or block the conduction under the microscope according to the marked minefield to ensure that the epileptic lesion is removed with minimal damage to the brain. How effective is epilepsy surgery? The Epilepsy Surgery Center of the hospital has operated on hundreds of patients with refractory epilepsy since its establishment in 2003, and has done a summary analysis of the effects of applying the new technology for epilepsy surgery. 90% or more of the patients have obtained better results, and more than 50% of them can stop seizures or have very few seizures. It is believed that the development of this technology will bring hope for more patients with intractable epilepsy. However, surgical treatment is not an absolute cure for epilepsy, and patients with epilepsy must still take medication for more than two years after surgery. One reason is that epilepsy has recurrent seizures for a long time, abnormal discharges are more diffuse, and after removal of the primary focus, there may still be abnormal discharges in other parts; secondly, after surgical treatment, brain function is temporarily out of balance. Later, it will be slowly stabilized. After two years of medication, if there are no seizures, the medication can be slowly reduced to stop.