Epilepsy, commonly known as “goat madness”, is a condition in which the patient suddenly falls to the ground with a cry, foaming at the mouth, eyes rolled up, limbs twitching, body stiffening, sometimes combined with incontinence, and the seizure is very frightening, but after the seizure stops, the patient may walk away like nothing happened. This disease, which comes and goes quickly, is a type of epilepsy. Although epilepsy may not seem life-threatening, it is very likely to be life-threatening if seizures occur while riding a bike or doing dangerous work. Moreover, frequent seizures can affect the physical and mental health of the patient, and each seizure can lead to a severe lack of oxygen to the brain once, which can lead to gradual degeneration and necrosis of brain cells in the long run, so patients with long-term seizures are found to be not very intelligent and Their mental condition and overall condition are worse.
In rural areas, it is very difficult for young men or girls with epilepsy to find a good match, and their families often go out of their way to see a doctor for them for their lifelong importance, believing in the boasts of various newspapers and magazines, and spending a lot of money. In fact, epilepsy is not an incurable disease, as long as the diagnosis is correct and treatment is timely and appropriate, about 75% of patients can be well controlled, and about 20% of patients with epilepsy that is difficult to control with drugs can also seek the help of surgical procedures to reduce seizures, or even no seizures. The cost of formal treatment is not really that high.
Epilepsy (epilepsy) is actually a chronic disease in which sudden abnormal discharges of neurons in the brain cause transient brain dysfunction. Epileptic seizure is a clinical phenomenon caused by abnormal and excessive hyper-synchronized discharge of neurons in the brain. They are characterized by sudden and transient symptoms and have a variety of presentations depending on the location of the abnormally discharged neurons in the brain. It can be motor-sensory or autonomic with or without changes in the level of consciousness or alertness.
I. Classification of epilepsy.
Modern medicine believes that the causes of epilepsy can be divided into two categories: primary (functional) epilepsy and secondary (symptomatic) epilepsy.
(a) Primary epilepsy: also known as true or idiopathic or cryptogenic epilepsy. The true cause is unknown. The true cause is unknown and cannot be clarified despite modern diagnostic tests.
(b) Secondary epilepsy: also known as symptomatic epilepsy. It refers to epilepsy for which the cause can be found. See common causes below.
According to the seizures, they can be divided into grand mal, petit mal, psychomotor seizures, limited seizures and complex partial seizures.
( 1) Grand mal seizures, also known as generalized seizures, half of them have aura such as dizziness, confusion, epigastric discomfort, visual, auditory and olfactory disturbances. During the seizure (spasmodic seizure period), some patients first let out a sharp cry, then both loss of consciousness and fall, there is a general muscle tonic, respiratory arrest, head and eyes can deviate to one side, a few seconds later there is a clonic jerk, jerk gradually aggravated, lasting tens of seconds, the clonic period breathing recovery, foaming at the mouth (such as tongue was bitten to appear blood foam). Some patients have urinary and fecal incontinence, general relaxation after convulsions or go into drowsiness (lethargic phase), after which consciousness gradually returns.
( 2) Petit mal seizures, which can be brief (5-10 seconds) with loss of consciousness or loss of consciousness without generalized spasms. There may be multiple seizures per day, sometimes with rhythmic blinking, head bowing, straightening of both eyes, and upper limb twitching.
( 3) Psychomotor seizures may be characterized by sudden onset, blurred consciousness, irregular and uncoordinated movements (e.g., sucking, chewing, searching, shouting, running, struggling, etc.). The patient’s movements are unmotivated, aimless, blind, and impulsive, and the seizures last for several hours or sometimes days. The patient has no memory of the seizure.
( 4) Restricted seizures, usually seen in patients with organic damage to the cerebral cortex, are characterized by episodic twitching or sensory abnormalities in the corners of the mouth, fingers or toes, and can spread to one side of the body. When the seizure involves both sides of the body, it can be manifested as a grand mal seizure.
( 5) Complex partial seizures, subtype of seizures with impaired consciousness and inability to recall the seizure, may also manifest as staring and automatisms such as smacking, chewing, groping, wandering, fiddling, humming, mumbling or other symptoms and signs.
Second, the etiology of epilepsy.
Symptomatic epilepsy is due to a variety of brain lesions and metabolic disorders, such as congenital disorders, prenatal and perinatal disorders (birth injury is a common cause of epilepsy in infancy), sequelae of febrile convulsions, trauma, infection, poisoning, intracranial tumors, cerebrovascular disease, and nutritional metabolic disorders.
The brain in idiopathic epilepsy does not have structural changes or metabolic abnormalities that can explain the symptoms, but is more closely related to genetic factors.
III. Influencing factors
(i) Heredity: The genealogy, twin and EEG studies and epidemiological surveys have fully demonstrated that primary epilepsy has heredity, either monogenic or polygenic, but not always with clinical seizures.
(ii) Age: Age has an impact on the incidence, seizure type, etiology and prognosis of epilepsy. The age of first onset of epilepsy is 60% to 80% before the age of 20. Mobile partial seizures are often seen in neonates, and febrile convulsions are common from 6 months to 5 years of age. Benign central-temporal spike-wave focal epilepsy in children tends to begin between 4 and 10 years of age and resolves spontaneously after adolescence. Adulthood is mostly characterized by partial seizures or secondary generalized seizures. The first seizures in infancy are mostly organic brain disease, especially in the prenatal period, and the subsequent seizures are often primary until the age of 20.
（Some patients with generalized tonic-clonic seizures have seizures in the morning after waking up and in the evening, called waking epilepsy; some have seizures after sleeping and before waking up, called sleep epilepsy; those with seizures during both waking and sleeping are called irregular epilepsy. The latter are mostly symptomatic epilepsy. Infantile spasms also occur before going to sleep and after waking up. Seizures at night should be careful not to sleep in a higher bed to prevent injuries from falling out of bed.
(iv) Endocrine changes: Changes in gonadal function have an effect on epilepsy. The seizures of generalized tonic-clonic seizures and partial seizures often develop during the first menstrual period, and some seizures increase in frequency or intensify before or during menstruation. A small number of seizures occur only during premenstruation or menstruation and are called menstrual epilepsy. Pregnancy can increase the number of seizures and worsen symptoms, or seizures can occur only during pregnancy. The latter is called pregnancy epilepsy.
(v) Triggering factors.
1. Fever, excessive water intake, hyperventilation, alcohol consumption, lack of sleep, overwork and hunger can trigger seizures. Certain drugs such as meprobamate, promethazine, pentazocine or sudden withdrawal of antiepileptic drugs can also lead to seizures.
2, sensory factors: some patients are more sensitive to certain sensations such as vision, hearing, smell, taste, vestibular, somatosensory, etc., when stimulated can cause different types of seizures, called reflex epilepsy.
3, mental factors: some patients in strong emotional activity, mental excitement, frightened, calculation, chess, playing cards, etc. can promote seizures, called mental reflex epilepsy.
Four, how to diagnose epilepsy.
(A) According to clinical manifestations.
According to the clinical seizure types are divided into.
1, generalized tonic-clonic seizures (grand mal seizures).
Sudden loss of consciousness, followed by tonic and then clonic spasms. It is often accompanied by screaming, cyanosis, incontinence, tongue bite, foaming at the mouth or blood, dilated pupils. The spasms last for tens of seconds or minutes and then stop spontaneously and enter a state of drowsiness. After waking up, there is a short period of dizziness, irritability and fatigue, and the seizure process cannot be recalled. If the seizure continues, the person who has been in a coma state is called grand mal seizure persistent state, often life-threatening.
2.Aphasic seizures (petit mal).
Sudden interruption of mental activity, loss of consciousness, may be accompanied by myoclonus or autonomic. A seizure lasts from a few seconds to more than 10 seconds. The EEG shows 3 times/sec spikes and slow or sharp and slow waves.
3. Simple partial seizures.
Tonic or clonic seizures in one part or one limb, or abnormal sensory seizures, which last for a short time and are clearly conscious. If the seizure extends to other limbs or the whole body along the motor area, it can be accompanied by loss of consciousness, called Jackson seizure (Jack). After the seizure, there may be temporary paralysis of the affected limb, called Todd’s palsy.
4. Complex partial seizures (psychomotor seizures).
Psychosensory, psychomotor and mixed seizures. Most of them have different degrees of consciousness impairment and obvious thinking, perception, emotion and psychomotor impairment. There may be autonomic manifestations such as neurosis and nocturnal travel. Sometimes, under the domination of hallucinations and delusions, violent acts such as wounding and self-injury may occur.
5.Vegetational seizures (mesencephalic).
There may be headache type, abdominal pain type, limb pain type, syncope type or cardiovascular seizures.
Those without a clear cause are primary epilepsy, and those secondary to intracranial tumors, trauma, infections, parasitic diseases, cerebrovascular disease, and systemic metabolic diseases are secondary epilepsy.
The physiological characteristics of children are different from those of adults, such as the neurological function of children is not yet complete, the subcortical inhibition of the cerebral cortex is not yet perfect, the power stereotype is not firmly established and the internal inhibition process is reduced. Therefore, children are prone to strong reactions to smaller stimuli, especially sensitive to the effects of external adverse factors, and the neurological changes, so children’s epilepsy is different from adults in some aspects.
(ii) Based on auxiliary examinations.
1, EEG, BEAM, Holter (EEG, EEG topography, 24-hour ambulatory EEG monitoring): clear pathological waves, spike waves, sharp waves, spike-slow waves or spike-slow waves are seen. About 30-50% of epileptic patients have normal findings on the first routine EEG recording in the interictal period, which requires several examinations, some of which are best recorded to the seizure-time EEG, especially when considering surgery for refractory epilepsy must be recorded to the seizure-time EEG, because the surgical site is chosen to be the starting part of the seizure-time EEG.
1.1. Special surface electrodes To increase the chance of obtaining epileptiform discharges, unconventional surface electrodes such as nasopharyngeal electrodes and pterygoid electrodes are often used in addition to conventional scalp electrodes.
1.2. Intracranial electrodes Most patients with interictal and ictal epileptiform discharges appear on the side where the epileptiform discharges start, but because of the well-developed brain contact fibers, one side of the discharge can rapidly conduct to the other side or even lead to whole brain discharge.
If the seizure is secondary, further head CT, head MRI, MRA, DSA, etc. should be performed to detect the corresponding lesions.
3. PET-CT of the head can detect hypoglucose metabolism in the epileptogenic foci; SPECT can detect abnormal changes in local blood perfusion.
V. How to treat.
(A) General drug treatment.
1. Select safe, effective, inexpensive and easily available drugs according to the type of seizure.
Phenobarbital 90-300mg/d, sodium valproate 0.6-1.2/d, carbamazepine 600-1200mg/d, etc. are used for grand mal seizures.
②Complex partial seizures: phenytoin sodium 0.2-0.6/d, carbamazepine 0.2-1.2/d.
③Absence seizures: Clonidine, daily oral dose: infants 2.5-7.5mg, toddlers 5-15mg, school-age children 5-30mg, adults 15-30mg, divided into 2-3 doses. Start with half of the therapeutic dose, then increase to the therapeutic dose if there are no significant side effects. Andine 7.5-40 mg/d.
④Continued status epilepticus:Prefer Valium 10-20mg/d sedation.
2. The dose of the drug should start from the low limit of the usual amount and gradually increase to the ideal seizure control without serious toxic side effects.
3. The number of doses should be determined by the characteristics of the drug and the seizure.
4, generally do not change or intermittently, after 2-3 years of complete seizure control and normal EEG, the drug can be gradually reduced and discontinued (should be done under the guidance of a doctor).
5. Regular drug concentration monitoring should be performed (once a month for six months in the early stage, and once every six months thereafter, and if there is a seizure, the drug dose should be adjusted at any time).
(B) Anti-epileptic drugs can eliminate or reduce seizures in two ways: one is to affect central neurons to prevent or reduce their pathological transitional discharges; the other is to increase the excitation threshold of normal brain tissue and attenuate the spread of focal excitation to prevent seizure recurrence.
Generally, the antiepileptic drugs synthesized before the 1960s such as: sodium phenytoin, carbamazepine, ethosuximide and sodium valproate are called old antiepileptic drugs, among which phenobarbital, sodium phenytoin, carbamazepine and sodium valproate are the first-line antiepileptic drugs widely used at present.
However, in some developed countries, due to some side effects of phenobarbital and phenytoin sodium, they have been included in the second-line antiepileptic drugs. Only carbamazepine and sodium valproate are listed as first-line antiepileptic drugs. Newer antiepileptic drugs such as gabapentin, lamotrigine, aminoglutethimide, topiramate, etc., are relatively new at present, such as levetiracetam tablets.
(c) For epilepsy with a clear cause, in addition to effective seizure control, the primary cause should be actively treated.
（If the epileptogenic foci are clear, resection of the epileptogenic foci is feasible. If there is no clear epileptogenic foci in the whole brain, selective corpus callosotomy, chronic cerebellar stimulation and vagus nerve stimulation are feasible.
(E) Treatment of generalized tonic-clonic seizure persistence
1, active and effective control of convulsions.
①Valium, 10-20mg for adults, 0.25-1mg/kg for children, slowly injected intravenously until the convulsions stop. Subsequently, add 20-40mg into glucose solution at the rate of 10-20mg per hour intravenously for 10-20 hours, with the total daily amount not exceeding 120mg.
② Sodium isopentobarbital Adult 0.5g dissolved in 10ml of water for injection, slowly injected intravenously at the rate of 50-100mg/min until the seizure stops. Pay attention to respiratory and heart rate changes during injection. After seizure control, continue to administer intranasal or oral antiepileptic drugs.
2. Manage complications.
Keep the airway unobstructed, diuretic dehydration to reduce cerebral edema, correct acidosis, etc.
(6) The root of epilepsy (clinical treatment of a few can not be completely cured, need to take drugs for life to be like normal people.) (f) Radical cure of epilepsy
People who are suitable for surgery
1. Seizures are caused by lesions in the brain. The most important thing is that it is not only a good idea to use the same procedure, but also a good idea to use the same procedure to treat the brain. The majority of them can receive better results by using different surgical treatment methods for the lesions.
2.Patients with intractable epilepsy whose long-term systemic treatment with antiepileptic drugs does not work well and even has a tendency to aggravate
3.Patients with frequent seizures that cause progressive decline in intelligence and affect normal life, work or study
4. If neuroimaging examinations reveal a clear epileptogenic focus in the brain, surgery should be performed as soon as possible.
5. If the epileptogenic foci are not in the important functional areas of the brain, the surgical results will be better and will not cause significant disability to the patient.
Surgical efficacy.
In patients with intractable partial seizures, unilateral hippocampal atrophy with ipsilateral epileptiform discharges can be completely controlled in 80-90% of patients who undergo surgery.
A large foreign study showed that 66% of patients with temporal lobe epilepsy had disappeared after surgery; 46% of patients with occipital and parietal lobe epilepsy had no seizures after surgery, and 27% of patients with frontal lobe epilepsy had seizure control after surgery, suggesting that temporal lobe epilepsy surgery is the most effective.
VII. Daily precautions
1. Seizures cannot be restricted. Bystanders should not press or flex the patient’s body when he or she is convulsing.
2. Do not try to put anything in the patient’s mouth, such as placing wooden chopsticks, spoons, etc. Some family members are worried about the patient biting his tongue during a seizure, so they put their fingers between the patient’s teeth in a hurry, which is absolutely forbidden.
3.Protect the patient’s head with a soft cushion.
4.After the seizure is over, gently place the patient in a good recovery position to improve breathing.
5. The rescuer should wait until the patient has fully recovered before leaving. Do not give the patient anything to eat or drink until he or she has fully recovered.
6. Do not take any measures to try to wake up the patient.
Eight, daily dietary regimen
Daily dietary attention, for the recovery of the disease is a certain degree of help, you can pay appropriate attention to the following points.
1, appropriate to limit the intake of starchy, sugary foods. The amount of calories and proteins required by epileptic patients is the same as that of normal people, while carbohydrates do not need too much, and it is appropriate to not exceed 300 grams per day; appropriately increase the supply of fat, which should account for about 60% of the total calories; limit water, not more than 1000 ml per day; salt not more than 3 grams per day; adequately supply vitamins and minerals, especially iron and calcium; prohibit the consumption of foods containing more sugar and Stimulating food.
The first thing you need to do is to take a look at the following Patients with epilepsy caused by traumatic brain injury and patients taking sedative drugs for a long time are prone to dehydration, anemia, leukopenia, malnutrition, etc. Serious patients may develop electrolyte metabolism disorders (hyperkalemia). When the diet contains too much potassium, it will increase the patient’s blood potassium level, so the potassium intake of epilepsy patients should not exceed 3 grams per day.
Foods with low potassium salts include rape hearts, baby carrots, white radishes, celery, pumpkin, tomatoes, eggplant, scallions, cucumbers, winter squash, loofahs, zucchini, duck pears, apples, grapes and pineapples.
3, epilepsy patients should increase the intake of magnesium. Epilepsy patients often lack magnesium, especially patients who need long-term drug therapy, such as long-term use of sodium phenytoin, prone to osteoporosis, in addition to giving a high-calcium diet, should also pay attention to the intake of magnesium. Adult body contains 20-25 grams of magnesium, about half of the set in the bone, the magnesium in the bone can not supply the body cells to use. If magnesium deficiency, in addition to the impact of bone formation, but also can lead to muscle tremors, mental tension.
Magnesium-rich foods are millet, corn, red lentils, soybeans, dried tofu, green vegetables, celery, beef liver, chicken and so on. Adult men need 350 mg per day to maintain magnesium balance.
Nine, epilepsy couple considerations
(1) From the eugenic point of view, patients with primary epilepsy should consider prohibiting childbirth.
(2) Both parties are close relatives of patients with primary epilepsy should also be considered to prohibit childbirth.
(3) A family history of epilepsy on both sides should be considered to prohibit childbirth.
(4) A ban on childbearing should be considered when one partner is epileptic and the other has only an EEG abnormality.
(5) If one partner has a family history of epilepsy and has had a child with epilepsy, a second child should not be born.
(6) Women with epilepsy who have a clear family history of epilepsy should be considered forbidden to have children if they are married.
(7) Patients with generalized seizures who have extensive abnormalities in the EEG and whose siblings also have similarly manifested EEGs should be considered prohibited from having children.
(8) Patients with epilepsy with no family history and abnormal EEG in the family line can have children after 1 year of curing epilepsy (including EEG return to normal) during the reproductive age.
Frequently Asked Questions
Can people with epilepsy get married and have children?
From the eugenic point of view, marriage and childbirth should be prohibited in patients with primary epilepsy, but there are no clear rules in China, the following points are for reference.
(1) Marriage of close relatives should be prohibited, especially for those who have primary epilepsy.
(2) Marriage of unrelated patients with primary epilepsy should be discouraged, especially if one or both parties have a family history of epilepsy, and birth should be prohibited if they are already married.
(3) If one or both parents of a patient with epilepsy have epilepsy, and the patient has had a child with epilepsy, the birth of a second child should be prohibited.
(4) Patients with generalized grand mal seizure type epilepsy who also have extensive spike-slow complex waves or multifocal spike-wave EEG manifestations and who have similar EEG abnormalities in their siblings may marry normal people, but should be prohibited from having children.
Epilepsy is mostly seen in adolescents, and once they reach the age of marriage, whether they can get married and have children is a great concern for patients and their relatives. The concerns are threefold: ① Will epilepsy be inherited to the next generation? (2) Does pregnancy have any effect on epilepsy? (3) Will taking epilepsy medication affect the fetus?
First, epilepsy has an irregular genetic impact in a few cases, and has little impact on most. The size of the impact is mainly related to the cause of the disease. The incidence of patients is 3%-4% in relatives of primary patients and 0-1% in secondary patients, indicating that the primary effect is high and the closer the blood relationship the higher the incidence. The prevalence of epilepsy in the third generation is 20% when both parents have epilepsy or have a child with epilepsy, therefore, primary patients can marry but should be restricted from having children. The more distant the family history, the better. Second, 45% of people with epilepsy have an increased number of seizures after pregnancy, especially when taking western drugs, which are metabolized through the liver, fetal tissue and placenta are susceptible to reduced serum concentrations of antiepileptic drugs, which cannot control seizures, and if the dose is increased, it has an effect on both the mother and fetus. Thirdly, especially for western anti-epileptic drugs, the incidence of fetal teratogenicity is 2.2%~13.8%. Cleft palate, cleft lip, and cardiac anomalies are common. The incidence of teratogenicity is related to the mother’s age, family history, medical history (such as diabetes) on the one hand, and the drugs used, especially some western drugs, on the other. In order to prevent fetal teratogenesis, it is better to take herbal medicine, and the symptoms should be controlled for more than 3 years, and the age should not exceed 35 years. Patients or those with malformed genetic disorders in their family should not have children. Patients who have had miscarriages, stillbirths or have produced abnormal babies should be extra careful in re-births.
How are medications adjusted in patients with epilepsy who are already pregnant?
Children born to mothers taking antiepileptic drugs are 2-3 times more likely to have malformations than the normal population. Anti-epileptic drugs are only one aspect of this risk. The health status of the mother is also an important factor. More than 90 percent of women taking antiepileptic drugs have perfectly normal children.
Continuation of antiepileptic drug therapy: Except for a few patients whose seizures have stopped for many years before the planned pregnancy and whose ancillary tests are no longer abnormal, antiepileptic drugs can be tapered and discontinued before conception, most patients should continue antiepileptic drug therapy during conception and pregnancy because seizures during pregnancy, especially tonic seizures, have the potential to cause maternal trauma and lead to miscarriage or other damage to the fetus.
Simplifying treatment medications: It is best to use single-drug low-dose therapy because no antiepileptic drug is completely safe for the fetus, so the principle of drug selection remains based on the patient’s seizure type and the drug that is most effective in controlling seizures. Monotherapy can significantly reduce the incidence of fetal malformations.
Take adequate amounts of vitamins, inorganic salts, trace elements and folic acid, ensure adequate nutrition and sleep, avoid taking other medications as much as possible, and prohibit alcohol consumption.