Problems that should be noted in epilepsy diagnosis and treatment

  The latest guidelines for the diagnosis and treatment of epilepsy in China suggest that: 1. Five steps are required for the diagnosis of epilepsy: first, to determine whether the seizure event is a seizure; second, to determine the type of seizure; third, to determine the type of epilepsy and epilepsy syndrome; fourth, to determine the cause; and finally, to determine the presence of disabilities and co-morbidities. This relies on a complete and reliable history, physical examination, and ancillary tests (especially long-range video EEG monitoring has been used as the “gold standard” for seizure diagnosis).  Once the diagnosis is clear, the medication chosen for each patient should be based on the type of seizure or syndrome, and should also take into account special populations, such as newborns, infants, women of childbearing age, the elderly, and the presence of comorbidities.  3. Monotherapy should be used first.  4. Any drug should be started at a small dose and slowly increased until the seizure is controlled or the maximum tolerable dose is reached.  5. The course of medication should be adequate and withdrawal should be slow; most patients who are completely seizure-free for 2-5 years with medication can be considered for discontinuation; however, whether and how to reduce discontinuation should be fully considered with regard to the patient’s etiology and syndrome diagnosis; before deciding whether to discontinue medication, the possibility of another seizure should be evaluated, and EEG has a reference value for reducing discontinuation of antiepileptic drugs; meanwhile, the withdrawal process should be slow and may last for several months If a seizure occurs during withdrawal, the withdrawal should be stopped and the drug dose should be restored to the closest dose observed at the time of the seizure.  Finally, self-management of epilepsy patients also plays an important role in the success or failure of treatment. Try to avoid some seizure-inducing factors, such as lack of sleep, excessive stress, excessive alcohol consumption, and avoid taking excitatory drugs such as caffeine.