Epilepsy is a common global neurological condition seen not only in adults, but also in children. Many famous figures in the world, such as the Roman emperor Julius Caesar, Joan of Arc, the inventor Nobel, and the novelist Dickens, have suffered from epilepsy. According to WHO, the prevalence of epilepsy in developed, developing and underdeveloped countries is 5‰, 7.2‰ and 11.2‰, respectively, with rural areas slightly higher than urban areas, and more than half of them develop before the age of 15. There are about 30 million epilepsy patients in the world’s 6 billion population, and an estimated 8 million epilepsy patients in China. With such a large number of patients bearing the misfortune and, at the same time, causing a great burden to families and society, it is evident that epilepsy prevention and treatment is a long way to go, and is the common responsibility of doctors, patients, families and the whole society.
What is epilepsy?
Epilepsy is a chronic brain disorder caused by multiple etiologies, characterized by sudden, recurrent and transient central nervous system malfunctions due to excessive neuronal release in the brain. Depending on the site of involvement, the malfunction can manifest as different disorders of motor, sensory, consciousness, behavior, and autonomic function.
Epilepsy is a non-febrile epileptic seizure that can manifest with any type of seizure, usually more than 1 seizure, and may reappear at any time, with each seizure lasting a few seconds, minutes, or ten minutes before it can resolve spontaneously, in a few cases lasting more than half an hour. In the interictal period, the patient is as usual, except for the EEG, which may be abnormal.
Risk factors and possible causes
The etiology of epilepsy is complex and varied, and the pathogenesis is still not well understood. Possible etiologies and risk factors include the following.
1. genetic factors.
2. maternal illness, exposure to toxic substances, and psychological trauma during fetal life
3, pathological factors at birth: obstructed labor, asphyxia, neonatal diseases.
4. previous history of febrile convulsions.
5, neurological disorders and cranial trauma.
6. socioeconomic status.
Epilepsy prevention and control must start in children
The incidence of epilepsy is highest in childhood. Children, especially infants, are a critical period of brain development and are susceptible to seizures, which can cause a range of cognitive and behavioral abnormalities and other psychological problems, thus affecting the patient’s school performance and future quality of life. Seizures can avoid secondary cognitive impairment and, combined with early rehabilitation, can significantly improve the prognosis; therefore, epilepsy treatment should be addressed early and at a young age.
First aid at the scene of a seizure
Generally speaking, hospitalization is not required for epilepsy unless the seizure lasts more than 10 minutes or there are multiple seizures in a day. Prolonged generalized tonic-clonic seizures are sometimes life-threatening and should be treated promptly in hospital. If the child is having a convulsive seizure, he or she should be treated as follows.
1, quickly hold the child to prevent falls, placed on a flat surface or a safe place.
2, untie the collar, cuffs, so that the airway is open, the head, body side to side, so that saliva, mucus and other flows out.
3. Stay by the child’s side and wait for the seizure to stop.
4. Carefully observe which parts of the body twitch during the seizure, whether there is consciousness and perception, and record the duration so that you can describe it to the doctor.
5.After the seizure stops, do a good job of cleaning and comforting the child to eliminate the child’s tension.
6. If the convulsions last for 5 minutes without relief, or if there are multiple seizures within 10 minutes, call for help or send to hospital immediately.
Measures and problems of epilepsy treatment
In developing and underdeveloped countries, the treatment status of epilepsy is very backward, antiepileptic drugs are not promoted in many areas, and patients’ recurrent seizures are not controlled. In China, it is found from the population survey that the 2-year remission rate of treated patients is less than 1/4. Due to the influence of traditional concepts, excessive pessimism about the prognosis, exaggeration and resistance to the side effects of western drugs, lack of confidence and non-compliance of patients, and the confusion of the epilepsy medical market in the society, a large number of patients are nominally seeking treatment everywhere, but in fact they do not receive proper treatment, neither getting rid of the disease bundle, nor carrying Therefore, it is an urgent social problem to understand epilepsy correctly, establish confidence, scientific and standardized management, and improve the treatment status.
The current main methods of treating epilepsy
1.Anti-epileptic drug treatment: It is the main treatment for epilepsy at home and abroad.
2, surgical treatment: only suitable for some patients with epilepsy that is difficult to control by drugs, with certain surgical indications.
3, other treatments: adjuvant treatment for refractory epilepsy, such as: ketogenic diet, vagus nerve stimulation, transcranial magnetic stimulation, etc.
Notes on antiepileptic treatment
1, drug therapy is an important means of seizure control, and is also the basic method of treatment for epilepsy at home and abroad.
2, Anti-epileptic drug treatment program is long-term, reasonable and suitable for individual characteristics, and should be persistent.
3, the choice of drugs: by the doctor according to the type of seizures, age, drug characteristics and side effects reasonable selection of drugs, can not be blindly used indiscriminately.
4. Follow up on a regular basis to monitor the efficacy, drug side effects, intelligence, mental and behavioral, etc., to control seizures without side effects.
5. The medication must be taken on time, in sufficient quantity, regularly and throughout the course, avoiding missed doses.
6. Slowly withdraw medication as prescribed by the doctor, avoid sudden discontinuation or unauthorized withdrawal.
Prognosis of epilepsy
The prognosis is good in 50-70% of children with epilepsy, who are sensitive to antiepileptic drugs and whose seizures are easily controlled and can be successfully withdrawn once in remission. The prognosis is inaccurate in 10 to 20% of epilepsies, where antiepileptic drugs can control seizures, but they will recur after withdrawal and require lifelong medication, which may be improved by surgery. Another 20% or so of children with epilepsy have a poor prognosis. Most have underlying brain disease, where antiepileptic drugs only reduce seizures, and seizures continue despite multiple drug treatments.
Overall, after discontinuation of antiepileptic drugs, about one-third of patients have a recurrence, most occurring within 2 years. Risk factors for relapse: seizure type, etiology, head trauma, intracranial infection, and those with abnormal EEG and neurological examinations.
Focus on the psychological problems of children with epilepsy
Children, especially infants and toddlers, are a critical period of brain development, and recurrent seizures are bound to cause secondary damage to neurons in the brain, causing or aggravating brain dysfunction and leading to a series of psychological problems. Many children with epilepsy have abnormalities in cognition, learning, behavior, and personality development, which can affect academic performance and school performance in mild cases or prevent them from receiving normal education in severe cases. These fundamental problems, which affect the future quality of life of the affected children in the community, are often neglected in the early stages. Therefore, infants and children with epilepsy should be monitored for motor, perceptual, and language development, and older children should have early comprehensive psychological evaluation and early intervention to help children build self-confidence and relieve fear, anxiety, dependence, capriciousness, low self-esteem, and other undesirable attitudes, so that children with epilepsy can have their seizures controlled while other functions of the nervous system are fully developed and lay a high quality survival This will lay a good foundation for quality survival.
In conclusion, the most ideal strategy for children with epilepsy should be: early diagnosis, early treatment, rational use of medication, and regular medication throughout the course – to achieve seizure-free.