1. Diagnostic errors
Misdiagnosis of epilepsy as a non-epileptic seizure disorder or misdiagnosis of a non-epileptic disease disorder as epilepsy: Thus, there are two important points in epileptology.
(1) not all seizure disorders are epilepsy.
(2) Not every seizure in an epileptic patient is a seizure.
Characteristics of epilepsy
Characteristics of human epilepsy: epileptiform discharges on the EEG!
Clinical seizures in epilepsy
The main clinical symptoms caused by seizures are
(1) Loss of consciousness
(2) Generalized convulsions
(3) Falling seizures
(4) Motor seizures
(5) Sensory seizures
(6) Facial and oculomotor movements
(7) Emotional experience
(8) Explosive verbal or aggressive behavior
(9) Seizure phenomena during sleep
(10) Mental confusion or delirium
Characteristics of clinical seizures.
Commonalities of epilepsy: seizures, transient
Stereotypy, repetitiveness
Individuality of epilepsy: characteristics of different types of seizures
Avoiding misdiagnosis can be done by.
(1) Suspecting the diagnosis of epilepsy in any patient who has failed to respond to antiepileptic drug therapy.
(2) Re-evaluation of the diagnosis of epilepsy is necessary in patients with doubts, where the most useful tool is the video EEG.
(3) Pay special attention to the coexistence of epilepsy and non-epileptic seizure disorders.
(4) All patients diagnosed with epilepsy should undergo a systematic neurological physical examination and regular antiepileptic drug treatment, and the diagnosis should be revised based on the results of the examination and treatment
(5) Rational application of two important biochemical tests.
Convulsive syncope, pseudo seizures, migraine, and TIA are all non-epileptic seizure disorders that are highly susceptible to misdiagnosis as epilepsy, while temporal lobe epilepsy and post-head injury epilepsy with prominent psychiatric symptoms are the types of epilepsy most likely to be misdiagnosed as non-epileptic seizure disorders.
2. Errors in judgment of seizure types
(1) Anti-epileptic drugs can treat epilepsy and can also cause seizures.
(2) The most important measure to avoid seizures caused by antiepileptic drugs is to choose different antiepileptic drugs according to different types of epilepsy.
Differentiation between aphasic seizures and complex partial seizures
Typical aphasia Complex partial seizures
Age of onset Child or early adult Any age
Etiology Primary localized lesion or unknown cause
Local anatomy None Olfactory brain (hippocampus, amygdala)
Neocortex
Duration
Short (usually <30S) Long, usually minutes
Other clinical symptoms
Mild May be obvious
(including aura, autism blurred consciousness headache mental abnormalities)
Frequency
Frequent or clustered Low frequency
EEG
3HZ spike-slow waves Different local disturbances
Hyperventilation effect
Often increased No or mildly increased
3. No distinction between epilepsy or epilepsy syndrome
Epilepsy syndrome is a disease with different etiology, different pathogenesis, different evolution, and needs to be treated by different methods. If the epilepsy syndrome is mistaken as general epilepsy, wrong treatment may be chosen, such as infant wandering partial seizure preferred drug should be clonazepam combined with stilbestrol, if only see the patient has tonic seizures and choose carbamazepine, it will surely cause the failure of treatment.
4. The effective dose is determined incorrectly
In the study of refractory epilepsy, it was found that a significant proportion of refractory epilepsy was formed with the selection of inappropriate doses of antiepileptic drugs
The dose is too small to be effective
The dose is too large to cause poisoning
reactions.
Phenytoin sodium
(1) Intoxication leads to generalized tonic-clonic seizures evolving into corneal-like manifestations.
(2) Complex partial seizures or generalized tonic-clonic seizures caused by drug overdose, which improve after dose reduction and do not leave obvious other symptoms of toxicity.
Carbamazepine overdose
(1) An increase in partial seizures may be a manifestation of carbamazepine toxicity, which can dramatically improve after reducing the drug dose.
(2) Carbamazepine poisoning can cause seizures or status epilepticus
(3) Phenobarbital poisoning can cause non-convulsive status epilepticus
(4) Valproic acid poisoning can cause myoclonus.
(5) Oral clonazepam may also cause exacerbation of tonic seizures.
Basic principles for determining drug dose
Start with a small dose and gradually increase the dose to achieve effective seizure control and no side effects. If the above purpose cannot be achieved, it is better to meet partial control without side effects.
If necessary, the drug blood concentration monitoring should be used to discriminate
5. Failure to correctly determine the side effects of antiepileptic drugs
(1) Discontinuing medication at a time when it should not be discontinued, resulting in failure of treatment.
(2) Failure to discontinue the drug when it should be discontinued, causing the seizures to become heavy.
6. Inappropriate early discontinuation of medication
(1) The onset of action of carbamazepine and phenytoin sodium is mostly in 3 weeks, not 3-7 days.
(2) The onset of action of valproic acid is more in 2 weeks.
(3) The onset of action of phenobarbital is mostly in 2-3 weeks.
(4) The onset of action of Tolterol is at 4 weeks.
(5) Intravenous preparations can take effect in a very short time.
7.Inappropriate combination of drugs
(1) Unreasonable application of multiple drugs.
(2) Combination with non-antiepileptic drugs is not reasonable.