What is epilepsy all about?
Epilepsy is a common syndrome of the nervous system. It is caused by recurrent abnormal brain cell discharges that manifest as sudden, temporary brain dysfunction.
This abnormal discharge cannot be felt by the patient himself or seen by others, but it can be detected and can be recorded by EEG. Therefore, patients who are suspected of having epilepsy must have an EEG examination.
The brain dysfunction during seizures is manifested in many different ways, the most common being convulsions (jerking), when the patient loses consciousness and has generalized tonicity, stiffness or twitching of the limbs. Some patients do not have convulsions, but instead show fainting, immobility, abnormal behavior, emotional or mental abnormalities, and some patients (especially children) show symptoms of abdominal pain, headache, vomiting, and other symptoms of vegetative dysfunction.
What are the dangers of epilepsy?
Epilepsy can be very harmful to humans; seizures can cause unexpected events in patients, resulting in disability or even accidental death. Repeated seizures can sometimes result in seizures that are disabling or fatal. Multiple seizures can cause mental retardation, personality changes – epileptic personality, or even epileptic psychosis.
What is the age of prevalence and prevalence of epilepsy?
Epilepsy is prevalent in children, with 70% of epilepsy patients having an onset before the age of 12.
Epilepsy is a common disease, and the prevalence rate is about 5 per 1,000 in the general population, which means that for every 1,000 people, there may be 5 people who have or have had epilepsy, so counting up, there are about 5 million people in China who have epilepsy.
What are the clinical characteristics of epileptic patients? How is it diagnosed?
Although there are many forms of seizures, all epileptic patients have some common features that
(1) A chronic course of recurrent seizures;
(2) Self-remitting, often stopping on their own before they have time to be treated;
(3) stereotyped symptoms, which are basically similar each time;
(4) Intermittent periods are basically normal;
(5) often have impaired consciousness and cannot recall themselves after the seizure.
The diagnosis of epilepsy requires a detailed history or observation of the patient’s seizure performance to see if it is consistent with the clinical features of epilepsy. It is also important to exclude diseases similar to epilepsy and finally supported by EEG.
1. Tonic-clonic seizures (also called grand mal seizures)
①Loss of consciousness and generalized convulsions are the characteristics of seizures;
②The onset is at any age, but the peak of onset is at the age of 1 year and 14-17 years;
③The frequency of seizure is several times a day to once a year, and each seizure lasts about 1 to 3 minutes;
④Loss of consciousness without recovery, with multiple seizures in a row, is considered as persistent status epilepticus;
⑤ EEG shows explosive, high-amplitude fast rhythm during seizures, with intermittent epileptic waves such as spike, sharp wave and spine-slow wave.
2. Simple partial seizures (also called focal or limited seizures)
The seizures are characterized by simple basic motor, sensory or vegetative symptoms;
a. Motor seizures: twitching confined to the face or limbs, called limited motor seizures; head-eye or body turning to one side, called lateral seizures; hands raised to one side outside, called postural seizures; motor aphasia, called aphasic seizures.
b. Sensory seizures: numbness or tingling in one limb, called limited sensory seizures; also manifested as auditory hallucination seizures, visual hallucination seizures, olfactory hallucination seizures and vertigo seizures.
c. Plant nerve seizures: manifested as plant nerve dysfunction, mainly manifested as episodic headache, called headache epilepsy; abdominal pain as the main manifestation, called abdominal pain epilepsy; children and adolescents are more common.
②There is no impairment of consciousness during seizures;
③The patient is completely normal during the interictal period;
④Seizures last for several minutes, and those lasting more than 30 minutes are called status epilepticus with limitation;
(5) Epileptic waves appear on EEG.
3.Complex partial seizures (also known as psychomotor seizures)
① Characterized by seizure disorder of consciousness, often accompanied by psychiatric symptoms and automatism;
②Seizures usually last for a few minutes to relieve, and those lasting more than 30 minutes are called psychomotor status epilepticus;
③Electroencephalography shows epileptic waves in one or both temporal regions.
4, petit mal seizures (also known as aphasic seizures)
①Characterized by brief and frequent loss of consciousness;
Some of them are accompanied by myoclonus, atonic seizures or automatism;
(3) Common in children, with the greatest incidence at the age of 5 to 7 years;
④Several or tens of seizures per day;
(⑤) The seizure usually lasts for a few seconds, not more than 1 minute, and the seizure lasts for more than 30 minutes is called a petit mal state;
(6) EEG shows bilateral symmetrical and synchronized high amplitude 3C/S spike and slow wave rhythm.
5. Minor seizure variants
(1) The seizure form is diverse: including myoclonic seizures, inactive seizures, tonic seizures and atypical petit mal seizures, and the same child may have a mixture of two to three seizures;
Most of the seizures occur before the age of 4 years, with the most frequent occurrence at the age of 1 to 2 years;
③Signs of brain damage and mental retardation are more common;
④Electroencephalogram shows spike and slow waves below 2 and 5C/S.
6. Myoclonic seizures
① Characterized by episodic partial muscle clonus, often followed by 4-5 repeated jerks at 3-5 second intervals after a single jerk;
②There is no impairment of consciousness during seizure;
③The seizures are often combined with grand mal seizures, petit mal seizures or mixed seizures;
④Electroencephalogram (EEG) with multiple spines or multiple spines and slow waves.
7.Infantile spasms (west syndrome)
(1) The disease often starts 3 to 9 months after birth, with a peak incidence at 4 to 6 months, and rarely occurs after 1 year of age; perinatal ischemia and hypoxia, tuberous sclerosis and brain underdevelopment are common causes;
② Characterized by bowing-like, nodding or lightning-like spasms, which may also involve the extremities;
③Each seizure is characterized by a series of multiple spasms, each lasting about 1-15 seconds, and can occur dozens of times a day, most often before bedtime and after waking;
④Mental developmental disorders and neurological signs are associated;
⑤ High-amplitude dysrhythmias appear on the EEG during seizures. These seizures disappear between 2 and 5 years of age, and more than half of them transform into atypical aphasic seizures.
Treatment of epilepsy
Once the diagnosis of epilepsy is established and there is no indication for allopathic treatment, drug therapy should be started. The possible side effects of long-term medication and the need for regular laboratory tests should be explained to the patient and family members to obtain full cooperation.
What is regular treatment?
(1) The medication should be selected according to the type of seizure.
(2) Medication should be administered for a long time without sudden interruption.
(3) The dose of medication should be individualized and should not be given in a thousand times.
(4) First single-use medication.
Oral doses are started at low doses, gradually increased, and the dose is adjusted according to the seizure situation and blood concentration level. Due to pharmacokinetic reasons, there should be 5-7 days of overlapping doses when changing drugs. The time and number of doses per day is determined by the half-life of the drug and the time of seizure onset.
Why do some patients have uncontrolled seizures?
There are many reasons why seizures cannot be controlled, some are refractory epilepsy, but more are not through formal treatment, according to the survey of outpatients: 70% of epileptic patients have received or are receiving informal treatment. This is because of (1) incorrect drug selection (one antiepileptic drug is used for any kind of seizure).
(2) No long-term regular medication; irregular medication; taking medication for several days when seizures occur and not when they do not; stopping medication after months of taking it; frequent medication changes within a short period of time, (often due to lack of understanding or concerns of the patient or family about formal treatment or misinformation by the physician)
(3) Stopping the medication too early, not under the guidance of the doctor to reduce the medication one by one.
(4) unprincipled multi-drug combination, or a variety of Chinese medicine multiple western medicine combination.