The first misconception is that epilepsy is an incurable disease.
The majority of patients with epilepsy can work, study and live like normal people after reasonable medication. At present, about 20% of epilepsy is refractory epilepsy, mostly temporal lobe epilepsy, which is poorly treated with existing drugs, but this group of patients can be treated with surgical methods with very satisfactory results, and most patients can be cured. A middle-aged male epileptic patient, when the onset of epilepsy, unbuckle, undress, urinate and defecate anywhere, almost every day, the patient and family members are very painful, has been diagnosed as refractory epilepsy in Beijing, Shanghai and other large hospitals, taking Tolte, carbamazepine, sodium valproate have no effect, later by cranial magnetic resonance (MRI) examination, found the right hippocampal sclerosis, the diagnosis of temporal lobe epilepsy, the effect of surgery is very good. The patient has been seizure-free for 2 years of follow-up. Therefore, most epilepsies can be cured and are not “incurable”. Wang Aihua, Department of Neurology, Shandong Qianfo Mountain Hospital
The second misconception is that patients with convulsions are epileptic and those without convulsions are not epileptic.
The first thing you need to do is to get a good idea of what you are doing. Other diseases can also cause convulsions, such as hysterical convulsions, hypocalcemic convulsions, hypoglycemic convulsions, drug delayed dyskinesia convulsions, etc. are not part of epilepsy. Hysterical convulsions often occur in young women, mostly with a history of emotional stimulation, which can be called out and twitching of the limbs, but the patient’s consciousness is clear and can be relieved by comfort treatment; hypoglycemic convulsions are caused by diabetic patients who take a lot of hypoglycemic drugs when they vomit, have diarrhea or eat less, and their blood sugar is mostly lower than normal, and the convulsions can be relieved after the correction of hypoglycemia; students who come to the emergency room with sudden limb convulsions are often seen. The most common cause of these seizures is to stay up late playing games on the Internet, which is called epileptic seizures and is not epilepsy, and the seizures can be stopped without antiepileptic drugs by removing the trigger. Therefore, convulsions may not always be due to epilepsy. Convulsions should not be equated with epilepsy. On the contrary, many types of epilepsy do not present with convulsions. Some epileptic patients present with shouting, running naked, urinating and defecating anywhere, shopping, and night swimming, etc. This type of epileptic patients are mistaken for psychiatric patients and are seen in psychiatric hospitals. There was a middle-aged female patient who had a seizure onset, i.e., shouting, babbling, and sometimes getting on tables and climbing windowsills. She had been diagnosed with psychosis, and her family and she were in great distress, and finally diagnosed with temporal lobe epilepsy, and no further seizures occurred after surgery. There was also a female college student who took out the clothes of students in the same dormitory to wash them at night when she had a seizure, and continued to sleep afterwards. At first, they all thought that someone was playing a prank, and after several repetitions, her classmates found out that it was her, but she herself did not even know that she did it, and could not recall it afterwards. Other patients experience phantom smells, hallucinations, and dazedness. So it does not mean that it is not epilepsy without convulsions.
The third misconception is that large convulsive movements are grand mal seizures and small movements are petit mal seizures.
It is usually said that grand mal seizures are generalized tonic-clonic seizures and petit mal seizures are disoriented seizures. The size of the seizure is not distinguished by the magnitude of the jerking action. A grand mal seizure has generalized twitching of the limbs, while a typical petit mal seizure has only a brief (no more than 1 minute) loss of consciousness and no convulsive movements. Outpatients often encounter parents who bring their children to the clinic, saying that recently their children’s academic performance has decreased, they often wander off in class, sometimes mischievous, drop dishes and food on the floor during meals, etc. The examination reveals that the child’s intelligence and physical ability are normal, but through hyperventilation and electroencephalography, the diagnosis is typical aphasic seizures. This type of epilepsy is generalized epilepsy, which is benign and very well treated with medication. The clinician should make accurate typing and rational drug selection according to the patient’s medical history, onset symptoms and EEG in order to receive better results. Some patients or family members identify all forms of seizures other than generalized grand mal seizures as petit mal seizures, which is obviously incorrect.
The fourth misconception is that patients have loss of consciousness when they have a seizure.
The vast majority of seizure patients have loss of consciousness with their seizures. However, some types of epilepsy, such as limited seizures, myoclonic epilepsy and other patients are clearly conscious during seizures. Some patients have seizures with twitching and numbness on one side of the mouth, face and limbs, and some patients hear the sound of horses’ hooves, cicadas or smell aromatic odor or burnt odor at the onset of seizures, which are all partial seizures, without loss of consciousness, but they cannot control themselves. Therefore, the diagnosis of epilepsy should not be denied and treatment should not be delayed because the patient does not lose his or her consciousness.
Myth 5: Primary epilepsy is related to genetics, while secondary epilepsy is not related to genetics
A large number of surveys of epileptic patients and their blood relatives found that not only primary epilepsy is related to heredity, but the incidence of secondary epilepsy in the immediate family is much higher than in the general population. From a clinical analysis, patients who have had traumatic brain injury, had encephalitis, meningitis, or a history of birth asphyxia do not always develop epilepsy. This suggests that the occurrence of epilepsy depends not only on the strength of environmental factors, but is importantly determined by congenital genetic factors. The lower the threshold, the more likely epilepsy will occur. If the intensity of environmental factors exceeds the convulsive threshold, epilepsy will occur. This means that not only primary epilepsy, but also secondary epilepsy has a certain heredity.
Myth 6: Epilepsy is hereditary and epileptic patients should not have children.
Although epilepsy is hereditary, the effect on the next generation is not 100%. In general, only 5% of the children of epileptic patients have epilepsy, so epileptic patients can have children. The law in China does not explicitly forbid people with epilepsy from having children. However, from a eugenic point of view, it is best for epileptics to avoid marrying people with low convulsive thresholds (including epileptics and those with a history of febrile convulsions), and epileptics should have children after their condition has stabilized and their seizures have been largely controlled. Epileptics should be counseled at the appropriate specialist clinic before conception. Patients and their husbands should be aware that children born to mothers taking antiepileptic drugs are 2 to 3 times more likely to have malformations than the normal population. Antiepileptic drugs are only one aspect that contributes to this risk. The health status of the mother is also an important factor. Details should be obtained about whether there is a gene in the family that predisposes to malformations. More than 90% of women who take antiepileptic drugs have completely normal children.
Myth 7. A normal EEG does not diagnose epilepsy.
The EEG has a very important value for the diagnosis and differential diagnosis of epilepsy and is an essential auxiliary test for the diagnosis of epilepsy. According to statistics, 80% of epileptic patients have abnormal EEG, while about 5-20% of epileptic patients have normal EEG examination between seizures, and there are some people with abnormal EEG who never have seizures. Therefore, the diagnosis of epilepsy cannot be ruled out clinically because the EEG is normal, nor can the diagnosis of epilepsy be made because of an abnormal EEG. Doctors must combine medical history and clinical seizure performance to make a comprehensive analysis in order to make a correct diagnosis.
The first thing you need to do is to take a look at the results.
One of the principles of antiepileptic medication is to advocate a single medication. In recent years, studies have found that the vast majority of epileptic patients can satisfactorily control their seizures by taking an appropriate dose of an antiepileptic agent under blood concentration monitoring, and there is no need to take multiple antiepileptic agents at the same time. The combination of drugs can easily lead to chronic toxicity, drug interactions affect the efficacy of drugs, increase toxic side effects, and make seizures more frequent, increasing the economic burden of patients. If a single drug cannot control seizures, the reason should be analyzed and a combination of drugs should be chosen under the guidance of a doctor.
Myth 9, “Chinese medicine” treatment is effective and has little toxic side effects.
The only way to get rid of epilepsy is through regular treatment, but for a long time, people have misunderstandings about epilepsy patients, so that the first consultation after the onset of the patient is not in a regular hospital. The epilepsy center of the Affiliated Hospital of Henan Medical University surveyed 500 patients and found that 80% of the patients’ first targets were individual clinics or informal hospitals, which, according to experts, do not have “formal treatment” at all, especially those “pure Chinese medicine” mixed with anti-epileptic drugs. “The first target of patients is individual clinics or informal hospitals. The former head of the Chinese Society of Neurology Epilepsy, Professor Wu Xun of Peking University Hospital told us that they had tested more than 40 such “traditional Chinese medicines”, none of which were adulterated with western drugs, the maximum adulterated with four or five, not only to generalize the condition, but also to make the patient drug poisoning, aggravating the seizures.
Myth ten, physical exercise, high fat diet can cause seizures to worsen.
In the past, many people believe that epilepsy patients should be sedentary, can not participate in sports activities, worrying that physical exercise is dangerous and can cause seizures. There are also many people who worry that if a patient has a seizure during exercise it will cause the patient to feel embarrassed or even injured. Some parents of patients with epilepsy take excessive care of their patients and do not allow them to engage in any household and social activities, or even go to school or work, making them overly dependent on their parents and creating a sense of depression, low self-esteem, and isolation. However, recent studies have found that normal physical exercise and daily activities can reduce seizures and make patients have less low self-esteem and more self-confidence, which is beneficial to psychological health and recovery from epilepsy. In addition, in addition to drug and surgical treatment, epileptic patients can also apply diet therapy to assist in the treatment of epilepsy. diet therapy is the ketogenic diet (KD), mainly used for the treatment of refractory epilepsy, first proposed by Wilder in 1921, the efficacy of the exact. kD is designed to imitate the development of ketosis state when starving, is a diet high in fat, low in protein and low in carbohydrates. Traditionally, KD fats are mainly derived from animal fats. Therefore, the concern that consuming too much fat such as beef and lamb will aggravate seizures is not scientific.