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 is not felt by the patient and not seen by others, but can be recorded by EEG. The most common clinical symptom is convulsions (jerking), a sudden loss of consciousness, generalized tonicity, stiffness, or twitching of the limbs during a seizure. There are also many patients with epilepsy who do not have convulsions at the onset of the seizure but present with fainting, immobility, abnormal behavior, emotional or mental abnormalities, and some patients present with symptoms of vegetative dysfunction such as abdominal pain, headache, and vomiting.
There are many types of epilepsy and a variety of symptoms, so you cannot diagnose epilepsy based on only one manifestation. For example, convulsions are a common symptom of epilepsy, but there are many causes of convulsions, such as high fever, hypoxia, low blood calcium, low blood sugar, etc., which may cause convulsions. None of these conditions can be diagnosed as epilepsy. The physician has to take a detailed history, physical examination, and perform necessary laboratory and laboratory tests (e.g., EEG) to confirm the diagnosis, and sometimes even experimental treatment is required to make the diagnosis.
Recurrent seizures are an important feature of epilepsy, and although there are various forms of seizures, they are similar for each patient for each seizure. It has been suggested that only one seizure does not confirm a diagnosis of epilepsy and that at least two seizures are required to be considered epilepsy.
Epilepsy is a chronic condition, and a few cases are difficult to treat or even extend over a lifetime, but most children with epilepsy can be treated or have their symptoms improved with long-term, reasonable regular treatment.
Can epilepsy be cured?
For epilepsy, a patient is said to be cured when he or she stops having seizures after reasonable and patient treatment. Secondly, the cure of epilepsy is conditional and needs to be observed over a longer period of time. It is irresponsible and dangerous to rashly declare that a patient is cured if he or she has no seizures after 2 to 3 months of some kind of treatment.
In recent years, the level of diagnosis and treatment of epilepsy has been greatly improved, and antiepileptic drugs have been continuously developed, which has led to a great improvement in the treatment of epilepsy.
Some foreign studies point out that in addition to drug factors, there are also some factors related to the following. The first is the cause of the disease. If the epilepsy is caused by acute head trauma, when the trauma is cured, the epilepsy can also improve, but if the epilepsy is caused by brain tumor or cerebrovascular disease, there are often still seizures after the tumor is removed. If the epilepsy is caused by congenital abnormal brain development, the prognosis is also bad. In addition, the prognosis varies between different types of epilepsy. In the case of aphasic petit mal seizures, the number of seizures gradually decreases with age, and about half of the patients stop having seizures completely by adolescence. In the other type of epilepsy, infantile spasms, the prognosis is very poor, and most of them will turn into frequent or long duration of each seizure, and the prognosis is not good. In addition, the age of onset is an important factor in the prognosis, with the younger the age, the worse the prognosis, and those with onset of seizures during the neonatal period often cause death. Even if the patient survives, various neurological sequelae are often left behind.
What are the indications for surgical treatment of epilepsy?
Surgical treatment should only be considered for epilepsy if the following conditions are met.
1. The most prominent indication for surgery is partial epilepsy. It is mostly secondary (symptomatic) epilepsy with an identified foci of seizure origin.
2. It must be drug-refractory intractable epilepsy, where seizures cannot be controlled by treatment with any antiepileptic drug and are poorly treated with one to two or three first-line antiepileptic drugs.
3. The seizures must be disablingly frequent, more than 3 to 4 per month (some scholars advocate 1 per month), and affect the individual’s quality of life (daily life, school and work, and social contact).
4. The minimum disease duration before surgery should be 2 years (except for structural lesions and early diagnosis of medial temporal lobe epilepsy).
5. For infants and children, especially in catastrophic epilepsy affecting the developing brain, the concept of disabling does not apply to this group and surgery should be performed earlier, the sooner the better.
6. Surgical treatment does not cause important functional deficits.
7. Patients and families who can understand and have a strong request for treatment must recognize that postoperative treatment with antiepileptic drugs is still required.
Can epilepsy be inherited?
In recent years, a large number of genetic studies have shown that epilepsy is indeed a genetic disorder, both primary and secondary, and that genetics is the main internal cause of epilepsy; damage to the brain caused by various factors from the embryo to the onset of epilepsy is the main external cause. Studies of twins with epilepsy have shown that children with epilepsy have genetic susceptibility; analysis of epilepsy patients plus lineage and epidemiological surveys have shown that the prevalence of epilepsy in relatives with idiopathic epilepsy is 3.8% to 10.8%, with individual prevalence as high as 19.8% to 35%, which is significantly higher than that of symptomatic epilepsy (1% to 4.6%), which in turn is 0.3% to 0.6% higher than that of the general population, and the closer the patient is to the blood, the higher the prevalence. The closer the blood relationship, the higher the prevalence. Family members of epileptic patients are four to seven times more likely to develop epilepsy than the normal population. The chance of epilepsy is even greater in close relatives of epileptic patients. A survey of more than 3,000 relatives of people with epilepsy found that 22.8% of biological siblings of people with epilepsy had epilepsy, compared with only 2.3% of cousins.
This has also been demonstrated in studies of twins, where in dizygotic twins (born with two placentas, the sexes may not be the same and the appearance may not be the same), one has epilepsy and the other also has epilepsy in 5% to 20% of cases.
In the case of monozygotic twins (born with one placenta, two sexes, and the same appearance), the chance of the other having epilepsy is about 40% to 90%. Because monozygotic twins develop from a single fertilized egg that divides, the genetic idiosyncrasies are very similar, so when one has epilepsy, the other has a much greater chance of having epilepsy.
It has also been found that if one parent has primary epilepsy (epilepsy with no obvious cause), 2.4% to 4.5% of their children have epilepsy, which is more than 10 times higher than the general population. If both parents have epilepsy, their children are about 20 times more likely to have epilepsy than the normal population. If both parents have epilepsy and already have a child with epilepsy, the prevalence of epilepsy is up to 20% if a child is born again.
Recent studies on EEG also indicate that epilepsy is hereditary. A child in a family with epilepsy has about 8% of her siblings with abnormal EEG performance, although they do not show signs of epilepsy.
There is a genetic predisposition to epilepsy, but it does not mean that the child will be born with epilepsy if the parents have epilepsy. Some epilepsy does not show up until after the child is 4-5 years old.
Epilepsy is associated with genetics. It does not mean that if one parent has epilepsy, their child must have epilepsy; it just means that there is a tendency to have epilepsy in the family.
Genetic influences are complex and can be inherited in a variety of ways, including single-gene inheritance, chromosomal inheritance,
mitochondrial inheritance, and polygenic inheritance. The above information indicates that epilepsy has a genetic predisposition, but this only means that people with genetic qualities have a low seizure threshold and a high susceptibility to seizures when they encounter a certain contextual factor, while the onset of epilepsy is determined by both internal and external factors. In reality, seizures caused by genetic factors account for only a small proportion of all epilepsy. In two groups of cases reported in China, only 2.7% and 3.2% had a family history. Therefore, patients should not be overly concerned about the genetic predisposition to epilepsy.
Can people with epilepsy get married?
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, in a few cases, epilepsy has an irregular genetic impact, and for most people it has little impact. The size of the impact is mainly related to the cause of the disease. The incidence of patients is 3% to 4% in relatives of primary patients and 0% to 1% in secondary patients, indicating that the primary impact is large, and the closer the blood relationship the higher the incidence. If both parents have epilepsy or have a child with epilepsy, the incidence rate of the third generation is 20%. Therefore, although primary patients can marry, they should limit their fertility. When choosing a spouse for an epileptic patient, do not choose someone who has had epilepsy or has a family history of the disease; the more distant the blood relationship, the better. Second, epilepsy patients began to pregnant, 45% of people with increased seizures, especially taking Western medicine, through the liver metabolism, fetal tissue and placenta easy to reduce the serum concentration of antiepileptic drugs, and can not control seizures, if the dose is increased, the mother and fetus are used to affect. Thirdly, the incidence of fetal teratogenicity of anti-epileptic drugs, especially western anti-epileptic drugs, is 2.2% to 13.8%. The common malformations include cleft palate, cleft lip and heart anomaly. The incidence of teratogenicity is related to the mother’s age, family history, medical history (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 medicines, symptom control should be more than 3 years, and the age should not exceed 35 years. Patients or family members with teratogenic genetic disorders should not have children, and patients who have had miscarriages, stillbirths or have produced abnormal babies should be extra careful with re-births. Patients of appropriate age with epilepsy can marry if both men and women agree when their condition is stable. The reason for this is that primary epilepsy is related to inheritance and there are more carriers of the gene that causes the disease in their relatives. If both parents have epilepsy, the chance of having a child with epilepsy is about 20 times higher than in the normal population. There are no genetic tests to prevent the development of epilepsy in the offspring. In order to reduce the incidence of epilepsy in the offspring, it is important to avoid choosing a spouse. If a physician certifies that his or her epilepsy is hereditary, in order to protect the health of the nation, our marriage law states that no one with a hereditary disease may have an heir. There is no doubt that this law is correct and must be observed by all. Here we must look at marriage and childbirth as two different things, not to be confused with each other. To be clear, people with hereditary epilepsy can also marry and enjoy family life, but they must be required to be sterilized and not pass the disease on to their offspring.
How long is the duration of antiepileptic drugs? How do I reduce and stop the medication?
The following principles should be followed for the duration of medication and its reduction and discontinuation.
1. 2-5 years after complete control of primary grand mal seizures and simple partial seizures.
2. After 6 months or more of complete control of anaphylactic seizures.
3. Complex partial seizures require long-term treatment.
4. EEG has the tendency to develop without stopping the medication.
5. Anti-epileptic drug reduction should follow the principle of gradual dose reduction, and the whole process of dose reduction and discontinuation should not be less than 3 months in practice.
What should I do if I have a recurrence of epilepsy after stopping the medication?
If the seizures recur after discontinuation, the original antiepileptic drug should be taken. The principle of taking the drug is to start with a small dose and gradually increase the dose to the lowest dose that can control the seizures without toxic side effects.