1. What is epilepsy?
Epilepsy is a clinical syndrome or disease. It is characterized by recurrent, abnormal discharges of nerve cells in the brain resulting in brain dysfunction. It is characterized by disorders of motor, sensory, consciousness, mental, and vegetative nerves.
2. What is the incidence and prevalence of epilepsy?
According to domestic statistics, the incidence of epilepsy is 7.6/100,000-40/100,000 per year, and foreign reports are 17/100,000-70/100,000 [published by Medical Education Network]. Most are in the range of 20/100,000-500/100,000. Its prevalence is 3.5‰-4.8‰. The prevalence of epilepsy varies by age, with the highest prevalence at 1-10 years of age, especially within 1 year of age, slightly lower at 10-19 years of age, and lower thereafter, but increases again after 60 years of age, associated with some diseases that increase with age.
3. What is the classification of seizures?
The classification of seizures is complicated, so here is a brief description of the common domestic classification.
(1) Partial seizures
① Simple partial seizures, motor, sensory and autonomic seizures without impairment of consciousness. Source:Medical Education Network
②Complex partial seizures with disorders of consciousness, including only disorders of consciousness, psychiatric symptoms, and automaticity.
③Partial seizures extended to generalized seizures.
(2) Generalized seizures
①Generalized tonic-clonic seizures (grand mal seizures)
②Absorption seizures (petit mal seizures)
③Other: myoclonic seizures, clonic seizures, tonic seizures, atonic seizures.
(3) Seizures that cannot be classified
Seizures that cannot be classified into the above categories due to insufficient information or
4. What is primary epilepsy?
Primary epilepsy: This includes idiopathic and cryptogenic epilepsy. These patients do not have structural changes or metabolic abnormalities in the brain that can cause symptoms. Seizure types are limited to grand mal, classic petit mal, or large myoclonic seizures. Seizures are more susceptible to physical and environmental influences. A small number of patients have a significant family history.
5. What is secondary epilepsy? What are the common causes?
Secondary epilepsy is caused by a variety of organic brain diseases or metabolic disorders, also known as symptomatic epilepsy. The common causes are.
(1) Congenital disorders: such as congenital malformations of brain development and fetal infections.
(2) Cranio-cerebral trauma: including birth injuries.
(3) Infections: such as various brain infections or systemic infections with cases of toxic encephalopathy, may lead to epilepsy. It is more common in children.
(4) Tumors: Intracranial tumors are a common cause in cases of seizures starting in adults, especially those close to the cerebral cortex.
(5) Vascular diseases: such as cerebrovascular malformations, cerebral hemorrhage, cerebral infarction, etc.
(6) Degenerative diseases: such as multiple sclerosis and brain atrophy caused by degenerative diseases can lead to seizures.
(7) Metabolic disorders: such as hypoglycemia, hypocalcemia, phenylketonuria, uremia, etc.
(8) Brain parasitic diseases: such as cerebral cysticercosis, cerebral schistosomiasis, etc.
6, seizures common triggering factors?
There are physiological and environmental factors, including infection, poisoning, fatigue, alcoholism, lack of sleep, allergic reactions, fever, mood swings, etc., which may precipitate seizures. Gonadal function also has an effect. In women with PMS, various types of seizures are often more frequent than usual, and some patients have seizures only in the premenstrual period or during menstruation (menstrual epilepsy). Many patients have seizures related to the sleep-wake cycle, with some having seizures only or mostly during the daytime and some at night. In addition, sudden discontinuation or change of antiepileptic drugs or even increase in dosage is a common trigger for increased seizures.
7. Diagnosis of epilepsy?
If you suspect that you or a family member has epilepsy, you should take the initiative to seek medical advice about diagnosis and treatment and actively treat it. The most important thing is to make sure that you have a good understanding of the situation. This is not only a waste of time but also a financial burden, even some fake drugs make the patient’s family in debt, while the patient has serious toxic side effects. Therefore, it is important to go to an epilepsy specialist or neurologist at a regular hospital according to your specific condition, and those who are suitable for surgery should be treated with surgery as soon as possible.
What is the value of EEG in the diagnosis of epilepsy?
When diagnosing epilepsy clinically, in addition to detailed medical history and seizure performance, the first thing that should be done is EEG examination, which is an extremely valuable diagnostic aid. Even during the interictal period, about 80% of patients usually have a positive EEG abnormality, and the positive rate can increase to about 90%-95% if the test is repeated and appropriate evoked. However, a minority of patients have only EEG abnormalities and no clinical seizures, and these patients are not yet diagnosed as having epilepsy. In the case of 5-20% of epileptic patients with normal EEG, if there are typical clinical seizures, and if antiepileptic drugs are effective and other diseases can be excluded, the diagnosis of epilepsy cannot be arbitrarily denied. A review or long-range EEG monitoring to capture seizures can be performed to clarify the diagnosis.
What is the significance of video EEG for epilepsy?
Nowadays, high-quality video EEG can be monitored for 24 hours or even days, displaying and storing the patient’s recorded video and EEG data on the same screen. The video data of seizures can be repeatedly replayed and analyzed, providing an objective basis for the diagnosis, classification, and comparison of the efficacy of epilepsy, as well as helping in the differential diagnosis of non-epileptic seizures. Especially for various types of refractory and occult epilepsy, long-range video EEG plays a decisive role. The abnormal performance of EEG helps to classify epilepsy, localize and characterize the epileptogenic foci, and provide a reliable basis for surgical removal of epileptogenic foci.
What is the significance of CT and MRI (magnetic resonance imaging) for epilepsy diagnosis?
The current accepted view is that; CT and MRI are of great value in clarifying the cause of most secondary epilepsies. Both are imaging examinations that can detect organic or structural lesions such as brain tumors, vascular malformations, brain cysts, abnormal calcifications, and developmental malformations of the brain. Combined with EEG, they can diagnose epilepsy and localize the epileptogenic focus.
What is PET scan?
Positron Emission Tomography, or PET, is known as the latest technology for studying physiological processes in the human body. Unlike CT and MRI, PET is not only a structural image, but more importantly, a functional image. It is able to reflect the physiological and biochemical changes in brain tissue. Many epileptic patients do not have organic brain changes or structural abnormalities, but only brain dysfunction, and PET is the best tool to study their dysfunction.
8.Medication
Why is medication necessary?
Epilepsy, whether primary or secondary, can cause neuronal damage, mental retardation, trauma, and even sudden and unexpected death. The most important goal of treatment is to control seizures and maintain normal neuropsychiatric function, and the main means of seizure control is drug therapy. With the regular application of available antiepileptic drugs, about 70%-80% of epileptic patients can be controlled, and many patients can be cured for life. Patients with definite lesions, those for whom drug therapy is ineffective, or those who develop intolerable toxicities need to be considered for surgical treatment.
What are the first-line antiepileptic drugs?
Phenytoin sodium (dalantin), carbamazepine, sodium valproate, paroxetine, ethosuximide, clonidine, and phenobarbital are commonly used as first-line drugs.
What are the new antiepileptic drugs?
Toltea, lamotrigine, gabapentin, anhydrocortisone, oxcarbazepine, and fexofenpropathrin, etc. Please choose them as prescribed by your doctor.
What should I pay attention to before medication?
Before drug treatment, the first diagnosis should be determined beyond doubt, and it is clear that the treatment of epilepsy is a rather long process to understand the toxic side effects of drugs and the precautions in life. The purpose of treatment is to let patients live like healthy people, so it is important to respect patients’ personality while strictly following medical advice.
What are the principles of medication for antiepileptic treatment?
The basic principles of epilepsy medication are.
(1) Choose the most suitable medication to control this type of seizure.
(2) Start with a small dose and gradually increase it until the seizures are controlled or there are obvious toxic side effects of the drug. Timely detection of blood levels facilitates medication adjustment.
(3) If one drug does not control the seizure satisfactorily, add a second drug under the guidance of the doctor and try to gradually reduce the dosage of the first drug after the seizure is controlled.
(4) Apply monotherapy as much as possible.
What are the factors affecting the unsatisfactory effect of drug therapy?
The effect of drug therapy may be unsatisfactory when there are the following conditions.
(1) There is significant structural brain damage.
(2) Seizures have started from infancy.
(3) Suffering from multiple types of seizures.
(4) Mental underdevelopment.
Reasons for treatment failure?
(1) Blood concentration is below the therapeutic range.
(2) Unreasonable drug selection.
(3) Failure to take the medication as prescribed by the doctor.
(4) Incomplete response of the patient and family.
(5) Development of drug resistance.
(6) Complicated progressive neurological disease.
(7) Single medication may be inferior to combination medication.
What is the importance of measuring serum concentrations of antiepileptic drugs?
The relationship between active drug concentrations in the serum of epileptic patients and efficacy and side effects is closer than that between dose and effect, so it is important to monitor serum drug concentrations.
(1) Each drug has a range of optimal therapeutic concentrations in the serum. Within this range, most patients show the best therapeutic effect and the least toxic side effects.
(2) Many antiepileptic drugs have a narrow therapeutic range, with a small safety margin between efficacy and toxic serum levels.
(3) Serum drug levels obtained with drugs administered per kilogram of body weight may vary markedly from patient to patient.
(4) The efficacy of the same drug varies from patient to patient, even if the seizure type is the same. When the drug is not effective, it should first be clear that the serum concentration of the drug has reached the optimal therapeutic level.
(5) When multiple drugs are used in combination, it is likely to cause drug-drug interactions, which may affect the metabolism and therapeutic effect of the drug.
(6) When combining drugs or reducing or stopping drugs, drug concentration check is also necessary.
(7) Other diseases can also affect the absorption and excretion of antiepileptic drugs and alter serum drug levels.
When to measure the serum concentration of antiepileptic drugs?
(1) When starting medication, adjusting the dose or adding other drugs, 2-3 weeks after the start of treatment, when the estimated drug concentration reaches steady state.
(2) When treatment has failed or when toxic side effects are evident.
(3) When the patient is combined with other diseases that affect the use of medication.
(4) During pregnancy, in order to control the attack and reduce the toxic side effects of the drug to the pregnant woman and the fetus.
(5) When there is a change in clinical symptoms.
All of the above should be tested for serum drug concentration. And we must know the patient’s age, weight, gender, liver and kidney function, and medication consumption, etc. Specimen collection is best done in the morning before the first dose of medication.
How to determine whether the dose can be reduced or stopped?
(1) Patients who have been seizure-free for at least 2 years may have their dosage gradually reduced to discontinuation according to the EEG.
(2) If the EEG has a tendency to progress, the medication cannot be stopped.
(3) The medication should not be discontinued if the brain disease is still active.
(4) Prepubertal patients should take medication until after puberty.
(5) Do not discontinue medication if you have experienced recurrent seizures or if you are considering a recurrence that is difficult to manage.
(6) If the epileptogenic foci are satisfactorily removed by surgery, the medication can be reduced or stopped at an early stage if the EEG is free of epileptiform seizure waves after 1 year.
9.Surgical treatment?
Current status of epilepsy surgery
The number of epileptic patients in China is more than 5 million, and there are about 300,000 new patients each year, which is not only extremely painful for the patients themselves, but also a heavy burden to the society and families. Although new anti-epileptic drugs are constantly appearing and their efficacy is improving, most patients need to take medication for life and are troubled by the side effects of medication. At least half of these patients can be cured surgically or controlled with antiepileptic drugs. Approximately 25,000-30,000 epilepsy patients require surgery each year in China, but only a minority undergo surgery each year, and the vast majority are treated at low levels, or even incorrectly. Therefore, it is necessary to have an objective understanding of epilepsy surgery along with medical treatment of epilepsy to avoid stepping into misconceptions.
What are the goals of surgical treatment of epilepsy?
Complete control or remission of seizures. Complete control means complete cessation of seizures without the use of antiepileptic drugs, meaning that the seizure-producing tissues are completely removed surgically, while remission means that the seizure-producing tissues are not completely removed, but only the conduction pathways or amplified structures of the seizure discharges are destroyed.
What types of epileptic patients are suitable for surgical treatment?
In the past, the criteria of ineffectiveness of regular medication, duration of disease over 4 years, and at least 4 episodes per month were used as measurement criteria. This is no longer the case, and the criteria are whether the seizures affect the patient’s quality of life. The general selection criteria for surgical patients are.
(1) Limited seizures;
(2) Ineffective regular drug therapy with no trend of remission for more than 2 years;
(3) Seizures seriously affect the patient’s quality of life;
(4) The patient’s physical and mental status can cooperate with the preoperative evaluation and postoperative rehabilitation;
(5) The epileptogenic lesions are not in the important functional areas of the brain, and the surgery will not cause significant disability to the patient.
(6) Those with clear lesions in the brain found by CT, magnetic resonance imaging (MRI), etc., and those whose epileptogenic foci can be localized by EEG and can be removed by surgery. On the basis of strict control of the indications for surgery, different surgical methods are selected according to the different conditions of the patient.
What are the common surgical methods?
If there are obvious occupying lesions in the brain, such as tumor, brain abscess, inflammatory lesions, vascular malformation, brain cyst, etc., the epileptogenic foci and lesions can be removed by EEG monitoring, and about 60%-90% of epilepsy can be cured after surgery.
(2) Anterior temporal lobectomy: the most used surgical method at present, if the positioning is accurate more than 80% of patients can have their seizures completely stopped. And it rarely causes functional damage.
(3) Selective amygdala and hippocampal resection: selective removal of the amygdala and hippocampus to avoid damage to the temporal cortex. The complete control rate of epilepsy is 42.85%, and the effective rate is 85.71%.
(4) Hemispherectomy: For patients with intractable epilepsy, with epileptogenic foci involving most or all of one hemisphere, with functional compensation on the contralateral side, and with Wada confirmed speech center in the healthy hemisphere. The seizure control and efficiency is nearly 100%.
The purpose of cutting it is to restrict the epileptic discharge to the abnormal side and not to spread the epilepsy. There is also an increase in seizures.
(6) Multiple submembranous transverse fiber resection: The transverse fibers of neurons are cut under multiple soft meninges to block the spread of synchronous discharges of neurons in the epileptic foci. It is mainly indicated for refractory epilepsy in major functional areas.
(7) Stereotactic surgery; the advantage of this procedure is that it does not require craniotomy and has little damage to brain tissue, but requires a high degree of accuracy in positioning. The aim of the procedure is to destroy the epileptogenic nuclei and block the spread of epileptic discharges through the production of body orientation, and temporal lobe epilepsy is particularly suitable for this procedure.
(8) Chronic cerebellar stimulation and vagus nerve stimulation: This procedure involves placing special deep brain stimulation electrodes in the anterior or posterior lobes of the bilateral cerebellar cortex, and stimulating the cerebellum by connecting the radio receivers buried under the skin to reduce the number of seizures. Vagus nerve stimulation is performed by implanting a miniature stimulator in the subcutaneous tissue under the left clavicle and introducing electrodes through a subcutaneous tunnel into the lower part of the neck and wrapping them around the vagus nerve. Seizures are suppressed by stimulation. The effectiveness rate varies from 50-75%.
How effective is the surgery?
Epilepsy has always been a class of intractable diseases that plague neurologists, seriously threatening the health of patients and affecting social and family life. Currently, there are various surgical procedures such as anterior temporal lobectomy, selective amygdala hippocampal resection, cortical resection of epileptogenic foci, brain stereotactic surgery, cerebral commissurotomy, submural transverse fiber cut, cerebral hemisphere resection and chronic cerebellar stimulation. The cure rate, efficiency rate, disability rate and mortality rate vary among different surgical procedures, with an overall cure rate of 60%-80%, efficiency rate of 71%-95%, disability rate of 5%-17% and mortality rate of 0-4%. The key to successful surgery is the precise location of the epileptogenic focus, complete resection, and the effective and rational application of antiepileptic drugs. Due to the individual differences of each patient and the severity of the disease, the specific efficacy may vary. Under the leadership of Professor Li Yongjie, Director of Beijing Institute of Functional Neurosurgery and Director of Functional Neurosurgery, we use the most advanced international video EEG monitoring, dipole localization, cortical and deep electrode techniques combined with magnetic resonance imaging (MRI) and positron emission tomography (PET) to precisely locate the epileptic focus and select the appropriate surgical method. The treatment results are more precise, reliable and safer than conventional surgery.
About the cost of surgery?
(1) Prepayment of hospitalization fee of 35,000 yuan, including treatment, bed, medication, laboratory tests and examinations.
(2) Pre-operative, intra-operative and post-operative video EEG examinations are required. Individual patients may require multiple video EEG examinations and analysis before surgery, and those who cannot be clearly localized may require stereotactic surgery to bury deep electrodes to locate the epileptogenic focus, which may increase the cost by 10 to 20 thousand RMB.
(3) Patients with important organ diseases or those requiring special examinations will also respond to increased costs.
(4) Fees for those outside the country are in accordance with the relevant national regulations.
What are the risks of surgery?
Most epileptic patients require general anesthesia and craniotomy, which is a complex and lengthy operation and may result in complications, even disability or death. The procedure may vary from patient to patient and will be explained to you in detail by your supervising physician. Patients with poor general health, those who cannot cooperate with the surgery and those with chronic diseases such as hypertension, heart disease and diabetes are at increased risk of surgery. However, with our renowned domestic and foreign neurosurgeons, EEG specialists, anesthesia experts, and well-trained nursing team, we use advanced techniques such as microsurgery and intraoperative EEG monitoring, and the risk of surgery will be minimized.
How long is the hospital stay?
If the surgery can be determined and completed on a regular basis as expected, and if no special circumstances such as complications occur for the patient after surgery, the stitches will be removed 7-10 days after surgery, for a total hospital stay of about 20 to 30 days.
What is the need for strict compliance with medical advice after surgery?
Because seizures can cause injury to the patient and may accidentally injure others, repeated seizures can cause serious physical and psychological damage to the patient and make it more difficult to control the epilepsy. Therefore, it is necessary for the patient and family members to strictly follow the doctor’s orders. After discharge from the hospital, please continue to take antiepileptic drugs on time and according to the dosage, and regularly check the blood picture, liver function and blood drug concentration. Do not discontinue or reduce your medication on your own. Seek medical consultation for special conditions. To ensure a smooth recovery and future treatment, please visit the hospital for review 3 months, 6 months, 1 year, 2 years and 3 years after surgery according to the medical protocols.
10.Tips for daily life?
General precautions for daily life of epileptic patients?
Patients who appear to have low intelligence and mental abnormalities should not be ridiculed, teased or even scolded. The patient’s reasonable requests should be met, and unreasonable ones should be patiently explained, but they should never be unprincipledly accommodated, perfunctory or deceitful, not to mention conflicting. Patients who cannot take care of themselves should be bathed and have their hair cut regularly, and their clothes should be increased or decreased in time when the climate changes. For those patients who are depressed and suspicious, they should be encouraged and led to carry out cultural and sports activities or participate in simple physical labor, which can help stabilize their emotions. In addition, a reasonable work and rest schedule should be arranged, sleep should be sufficient, and not lying in bed all day. Those who have a habit of smoking and drinking should try to quit.