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Abstract: Epileptic seizures are transient brain dysfunction caused by excessive synchronization of neuronal discharges in the brain, usually referring to a single seizure process, and some patients with epileptic seizures may have only one seizure in their lifetime. The patient in this case was a 24-year-old young female with high mental stress and had one convulsive seizure before admission, which was manifested by shaking of the limbs and upward rolling of the eyes, resembling a seizure. After admission, no seizure could be diagnosed, and only one epileptic seizure was given with medication for symptom relief.
[Basic information] Female, 24 years old
Type of disease】Epileptic seizure
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (Awakening Brain Jing Injection + Glycerol Fructose Injection + Baili Sleep Capsule + Haloperidol Melitrexin Tablets)
Treatment period】6 days of inpatient treatment, 1 month of outpatient follow up in case of further attacks
Effectiveness of treatment] Relief of shaking hands and feet
I. Initial interview
The patient presented with episodic convulsions one day before admission, manifested as trembling of limbs, upturned eyes, centered eyes, accompanied by shouting, no symptoms of foaming at the mouth, tongue bite, urinary incontinence, the seizure lasted about 2 minutes and gradually relieved, the consciousness was hazy after relieving, about 20 minutes later the consciousness turned clear, still had headache, dizziness, no limb weakness, upper limbs could be lifted, no numbness of hands and feet. The patient’s family was particularly concerned about this and came to the hospital. After being asked about the patient’s recent study stress, poor sleep and emotional stress, the patient was admitted to the hospital for further examination. The patient denied any previous disease and was initially diagnosed as having an epileptic seizure.
II. Treatment history
On examination after admission, the patient was conscious, with normal speech, body temperature of 36.5℃, blood pressure of 120/80mmHg, heart rate of 60 beats/min, respiration of 16 breaths/min, negative cervical tonicity, negative Creutzfeldt-Jakob sign, negative Brønsted sign, normal movement of hands and feet, and negative pathological signs of both lower limbs. Head MRI showed no abnormalities, DWI showed no acute ischemic lesions, and EEG showed no significant abnormalities. The patient was emotionally stressed, anxious, and had poor sleep with a Hamilton Anxiety Scale score of 16.
The patient’s family was explained to the patient that the symptoms of this attack were similar to grand mal seizure, which could be relieved normally after the attack, and the symptoms were not considered serious, probably related to poor mood and rest, which was the cause of the triggering of the disease attack. Therefore, the patient was given wake-up call injection for cerebral protection, glycerol fructose injection for dehydration to reduce intracranial pressure, oral Baili sleep capsule to improve sleep, and flupirtine melitrexin tablets for anti-anxiety.
III. Treatment effect
After 6 days of medication and daily check-ups, the patient’s tension was relieved and the quality of sleep at night was improved, with 5-6 hours of sleep per day. At the same time, the patient was advised to self-regulate, divert attention, combine work and study, and breathe more fresh air. The patient was discharged from the hospital with no further seizures and was allowed to follow up in the outpatient clinic for one month, and to seek medical attention in case of further seizures.
IV. Notes
We are glad that after treatment, the patient’s symptoms such as shaking of the limbs have been relieved. If the patient has another seizure after discharge, prevent tongue bite and fall, pay attention to rest and sleep in general, avoid catching cold, flu, anxiety and fire, avoid spicy and stimulating food, quit smoking and alcohol, and do not drink strong tea, coffee and other stimulating drinks. If there is only one seizure in six months, you can observe without medication. If there is another seizure after discharge, you need to go to the hospital to review the video EEG as soon as possible to clarify the type of seizure and use antiepileptic drugs under the guidance of the doctor. The cause of seizures should be further clarified by lumbar puncture, and attention should also be paid to whether there are some atypical seizures, such as sudden transient loss of consciousness, dazedness, and aphasic fall.
V. Personal insight
This patient had a high level of mental stress, resulting in symptomatic seizures, while a cold, fever, electrolyte disturbance, drug overdose, long-term alcohol withdrawal and sleep deprivation in normal people can sometimes induce an epileptic seizure, which cannot be diagnosed as epilepsy and is generally not a big problem. However, if continuous seizures or incomplete remission between seizures, further examination is needed to clarify the cause, oral medication if necessary, and usually pay attention to maintaining an optimistic state of mind, communicating more with friends and family, and combining work and study with work and rest.