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Abstract: An 18-year-old boy came to the hospital for sleepwalking. His mother described that her child had been sleepwalking since childhood, often getting up at night to turn on the light and brush his teeth, and then going back to sleep, with no relevant memory after waking up, but recently the symptoms gradually worsened and he came to the neurology department. After completing an EEG examination, it was suggested that abnormal brain discharges were present at the time of sleepwalking, and the diagnosis was made of autonomic disorder due to epilepsy. After standard treatment with topiramate tablets, the patient’s condition was stabilized and the symptoms of sleepwalking at night gradually decreased.
Basic information】Male, 18 years old
Type of disease】Autonomia
Hospital】Shandong Provincial Third Hospital
Date of consultation】August 2016
Treatment plan】Topiramate tablets
Treatment Period】Outpatient consultation, follow-up after 1 month of medication
Effectiveness】Stable condition, and the symptoms of sleepwalking at night were significantly reduced.
I. Initial consultation
An 18-year-old boy came to the clinic because of sleepwalking. His mother described that her child had been sleepwalking since he was a child, often getting up at night to turn on the light and brush his teeth, and then going back to sleep, with no memory after waking up. The patient was introverted and wanted to be prescribed some medication to calm her mind and reduce sleepwalking. However, after listening to the patient’s complaints, he was advised to improve intracranial related examinations to assess the intracerebral situation before making a decision. Cranial magnetic resonance examination did not show any obvious abnormality, EEG suggested temporal lobe epileptic waves, which did not exclude epileptic seizures, and the possibility of automatism was considered. It was suggested to improve video dynamic EEG examination, and spike and spike waves of temporal lobe were detected at night when symptoms appeared to confirm the diagnosis of automatism due to epilepsy.
Second, treatment after
Automatism is a type of seizure that is easily overlooked by the crowd and can be manifested as doing some stereotypic movements in a blurred state of consciousness, like sleepwalking, which seems to have a purpose but the patient is actually in a blurred state of consciousness and cannot recall the situation afterwards. In view of the patient’s frequent episodes, oral treatment with topiramate tablets was recommended, and the patient’s nighttime “sleepwalking” was gradually reduced after 1 month of medication. The patient was advised to pay attention to good work and rest habits and to visit the neurology department of the hospital every 3 months for a review, and not to stop the medication.
Treatment effect
The patient’s symptoms improved after taking topiramate tablets for 1 month, and the “sleepwalking” at night gradually decreased. The patient is advised to take topiramate tablets for 2-3 years, and then gradually reduce the medication until it is discontinued after the condition is stable and seizure-free. During this period, patients should go to the hospital for regular review, which can be done every 3 months. After 1 year of taking Topiramate, the patient has no special discomfort and nocturnal symptoms basically do not appear again.
IV. Precautions
The patient’s condition was relieved after taking the medication regularly, and he gradually stopped being troubled by the “sleepwalking” caused by autism. Patients with autism take medication for a longer period of time and may experience side effects such as white blood cell suppression, gastrointestinal symptoms, liver and kidney insufficiency, etc. Therefore, patients need to follow the doctor’s instructions and visit the hospital regularly to avoid side effects that may damage the health of the body. During the medication period, it is necessary to live a regular life and avoid overworking the body, because the body is in a situation of extreme fatigue to take medication is also ineffective, which can easily lead to recurrence of symptoms. Avoid staying up late, quit smoking and drinking, and exercise more.
V. Personal insight
At present, medicine is more and more developed, many diseases can be detected and treated in time, if no further examination, directly give patients tranquilizing drugs for empirical treatment, may delay the patient’s treatment, resulting in aggravation of the disease. Therefore it is very necessary to think more, analyze more, make differential diagnosis and improve the diagnosis rate of the disease. In addition, family members should also pay more attention to their children’s health. If there are repeated abnormal manifestations, they need to consider whether they are caused by the disease and need to take their children for timely medical consultation.