Epilepsy is a chronic brain disorder characterized by sudden, recurrent and transient central nervous system malfunctions caused by excessive neuronal discharges in the brain, although the causes are different. Depending on the location of the attacked neurons and the extent of the discharges, the malfunction may manifest as motor, sensory, consciousness, vegetative, psychiatric, or both. Each seizure or each type of seizure is called an epileptic seizure. The age of epilepsy in China is mostly in childhood and young adulthood, and it increases with age to the highest in middle age, and decreases in the elderly. Seizures are more common in men than in women.
The mortality rate of epilepsy patients varies from 9/100,000 per year in China to 111/100,000 per year in the United States.
1. Etiology and pathogenesis
1.1.1 The causes of epilepsy can be divided into two categories: idiopathic epilepsy and symptomatic epilepsy. In idiopathic epilepsy, there are no structural changes or metabolic abnormalities in the brain that could explain the symptoms, and they are more closely related to genetic factors. Common causes of symptomatic epilepsy include congenital disorders, prenatal and perinatal disorders, craniocerebral trauma, central nervous system infections, poisoning, intracranial tumors, and nutritional and metabolic disorders. Factors affecting epileptic seizures can be divided into genetic and environmental factors. The prevalence of idiopathic epilepsy in close relatives is 2% to 6%, higher than that of the general population. In women
In women, seizures of any type are usually more frequent during menstrual ovulation, indicating that low estrogen and a sharp drop in luteinizing hormone are most likely to trigger seizures. If the seizure occurs only during menstruation, it is called menstrual epilepsy; if the seizure occurs only in early pregnancy, it is called pregnancy-related epilepsy. The seizures can be triggered by lack of oxygen, fatigue, hunger, constipation, alcohol consumption, and emotional impulses, which are also called triggers. If an epileptic seizure occurs only under certain conditions (e.g., flashing lights, fright, playing chess, playing cards, etc.), it is called reflex epilepsy.
1.1.2 Pathogenesis
The exact mechanism of epilepsy pathogenesis is not known, but it is believed that epileptic seizures are caused by pathological neuronal discharges.
2. Clinical manifestations
The clinical manifestations of epilepsy are complex, and can be manifested as a single consciousness, psychomotor, sensory or autonomic dysfunction, or two or even less than two symptoms at the same time, but all tend to have recurrent seizures and have certain characteristics.
2.1.1 Grand mal seizures are characterized by loss of consciousness and generalized convulsions. Clinical manifestations can be divided into 3 phases.
2.1.1.1.1 In the tonic phase, all bony muscles contract continuously, the upper eyelids are raised, the eyes move upward, the larynx spasms, shouting, sometimes biting the tongue, the neck and trunk are first flexed and then recoiled, lasting 10-20 seconds.
2.1.1.1.2 In the clonic phase, the tremor amplitude increases and extends to the whole body, followed by a brief relaxation of muscle tone, the spasm frequency gradually decreases, the relaxation period gradually lengthens, and the convulsion is terminated, lasting 0.15-1 minutes. Positive.
2.1.1.1.3 There is a brief tonic spasm at the end of the convulsion, resulting in clenching of the teeth and incontinence. The whole seizure lasts for 5-10 minutes. After waking up, the patient cannot recall the seizure and feels headache and body aches. Some patients may be drowsy for a certain period of time; some patients may have autonomic symptoms.
2.1.2 Petit mal seizures are characterized by transient impairment of consciousness and are usually seen in children and adolescents.
2.1.2.1.1 Disoriented petit mal seizures are sudden onset and resting disorders of consciousness, lasting only 5-30 seconds at a time, with no response to call, eyes staring, trembling eyelids or upper limbs, and falling objects. There may be several to hundreds of episodes per day, and there is no memory of the episodes.
2.1.2.1.2 Myoclonic petit mal seizures are short (1-2 seconds) bilateral myoclonic episodes.
2.1.2.1.3 Localized seizures are characterized by localized symptoms, and most of the seizures are short, from a few seconds to tens of minutes. If the seizure does not extend to a grand mal seizure, there is no impairment of consciousness. It is characterized by motor seizures and sensory seizures.
2.1.4 Psychomotor seizures are limited seizures with complex symptoms, including various types of amnesia, hallucinations, delusions, emotional abnormalities, etc. They are often combined with secondary grand mal seizures. It is often combined with secondary grand mal seizures.
2.1.5 Persistent status epilepticus includes a seizure lasting more than 30 minutes or multiple seizures in a row, with no recovery of consciousness between seizures. From this concept, any type of epilepsy can produce this type of status epilepticus. In the case of persistent status epilepticus, there is often hyperthermia, dehydration, and leukocytosis.
The diagnosis and differential diagnosis of epilepsy
The diagnosis is not difficult for those with typical clinical seizures; however, for those with various or atypical seizure forms, careful history taking, physical examination and ancillary tests are often required before a clear diagnosis can be made.
3.1.1 Hysteria often develops suddenly on the basis of a special character, manifested by irregular jerking or straightening of the limbs, interspersed with strange screams or cries, but with normal pupil size, no loss of consciousness, no incontinence or bruises; the duration of the seizure, closely related to the attitude of the surrounding people, can be as short as a few minutes or as long as several days. The suggestive manifestations are not difficult to distinguish from epilepsy.
3.1.2 The differentiation of syncope and epilepsy should be based on a detailed history, clinical manifestations and auxiliary examinations. In general, seizures are triggered by pain, prolonged standing or change in position. The diagnosis of syncope is supported by pallor, sweating, absence of tonic 2 clonus and tongue bite during seizure, and quick recovery after seizure.
4. Treatment and first aid of seizures
4.1.1 Treatment of seizures Seizures are very little life threatening at the time. Suffocation or aspiration pneumonia may occur only in isolated grand mal seizures. Occasionally, fractures and bruises may occur. If seizures are not controlled in time, they can cause cerebral edema, acidosis and electrolyte disturbance and lead to death. Once the clinical diagnosis of epilepsy is established, medication should be administered promptly to control seizures, regardless of whether etiologic treatment is indicated. Because of the long duration of antiepileptic drug therapy, some toxic side effects may occur during the course of administration, and regular clinical and laboratory tests are often required. The treatment of epilepsy is essential to control the seizures, and timely and appropriate treatment can achieve good results in more than 90% of cases. The general principle of epilepsy pharmacotherapy is to use the least amount of drugs and the smallest dose of drugs to completely control seizures without significant toxic side effects during the application of drugs.
4.1.2 Emergency treatment of persistent epilepsy
4.1.2.1.1 General measures: Place the seizure patient on his or her back or side with the pillow removed, and untie any clothing, such as a tie. Stimulate or apply pressure to such points as Renzhong, Hegu, Shusanli and Yongquan. Do not forcibly restrain the patient’s shaking limbs to avoid injuries such as fractures and soft tissue injuries.
4.1.2.1.2 Keep the patient’s head tilted to one side to facilitate the flow of secretions to avoid accidental aspiration. If there are dentures, they should be removed in time. For those who are in continuous coma, oropharyngeal tube ventilation should be given, tracheotomy should be performed if necessary, and sputum should be suctioned diligently. If ventilation is found to be insufficient, give artificial ventilation in time.
4.1.2.1.3 Application of antiepileptic drugs Valium 10-20 mg intravenously at a rate of no more than 2 mg/min. can be repeated after half an hour in case of recurrence, or 100-200 mg dissolved in 5% glucose solution can be given slowly intravenously over 12 hours. If it does not work, phenytoin sodium injection of 10-20 mg/kg diluted in saline can be used for intravenous injection at a rate of not more than 50 mg/min. If it does not work, sodium isopentobarbital 015 g dissolved in 10 mL of water for injection can be used for intravenous injection at a rate of not more than 011 g/min. The dose for children is 011 g for 1 year old and 012 g for 5 years old. Chloral hydrate 20-30 mL (015 mL/kg for children) as a reserved enema.
4.1.2.1.4 Active management of complications Physical cooling is feasible in case of hyperthermia, and acid-base balance and electrolyte disturbance should be corrected promptly. In the presence of cerebral edema, mannitol should be given, and pulmonary infection should be prevented. Symptomatic epilepsy should be treated according to the cause. After the convulsions stop, phenobarbital 012 g can be given intramuscularly once in 8-12 hours to maintain control, and after waking up, oral antiepileptic drugs should be given. In addition, it should be noted that patients with epilepsy should have a good lifestyle and diet, avoiding overexertion, sleep deprivation, and emotional impulsivity, as well as abstaining from smoking and alcohol and spicy food. Avoid taking part in dangerous jobs and activities such as climbing, swimming, driving, working next to fireplaces and high voltage motors. Relieve the mental burden and increase the confidence to overcome the disease.