I. What is epilepsy?
Epilepsy is a common disease, which is a sudden, recurrent and transient brain dysfunction caused by abnormal discharges of nerve cells in the brain, which can manifest as motor, sensory, consciousness, mental and other dysfunctions.
Second, the incidence and prevalence of epilepsy?
Epilepsy is an important public health problem in both developed and developing countries. The International Health Organization estimates that there are approximately 50 million people with epilepsy worldwide. According to the latest domestic statistics, the incidence of epilepsy is 28.8/100,000 per year and the prevalence rate is 6.8‰, so there are about 9 million people with epilepsy in China.
Mechanisms of seizures
In general, all seizures are caused by transitional discharges of neurons in the brain. The prevailing view is that different types of epilepsy have different pathogenesis. It is related to the person’s immune system, genetics, neurotransmitters, electrophysiological characteristics of the nerves, and other factors. Experts need to analyze their own etiology and seizure mechanism for different patients.
Third, common triggers of seizures?
Factors that can cause altered conditions in the body, such as infection, poisoning, fatigue, alcoholism, lack of sleep, allergic reactions, fever, mood swings, etc., may precipitate seizures. Gonadal function also has an effect on seizures. Various types of seizures are often more frequent in women during the premenstrual period than usual, and some patients have seizures only 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 are common triggers for increased seizures.
Fourth, the clinical manifestations of seizures?
There are many different forms of seizures, and one type of epilepsy can also have multiple seizure forms. The most understood are tonic-clonic seizures (originally also known as grand mal seizures) and atonic seizures (originally known as petit mal seizures). Tonic-clonic seizures can be seen in any type of epilepsy and are characterized by loss of consciousness and generalized convulsions.
The seizure process can be divided into three phases
(1) Tonic phase: The main manifestations are continuous contraction of skeletal muscles throughout the body, strong straightening of limbs, eye rolling up, respiratory pauses, waiting spasms, grunting, teeth clenching, loss of consciousness, lasting about 10-20 seconds and then a subtle tremor appears.
(2) Clonic phase: continuous, short, violent generalized flexion spasms appear, the frequency of the clonic peaks and then gradually slows down to stop, usually lasting about 30 seconds.
(3) Late seizure: there is a 5~8 seconds muscle retardation period after the clonus stops, breathing is restored first, heart rate, blood pressure and pupils return to normal, urinary and fecal incontinence can be found, and consciousness is fully restored only after 5~10 minutes. Many patients turn into a drowsy state after the impairment of consciousness is reduced, and some of them appear automatic behavior and wander around.
The typical aphasic episode is a brief loss of consciousness (usually 2-15 seconds), common in children, with sudden onset of aphasia, abrupt suspension, interruption of activities and speech, staring with both eyes, occasionally with both eyes rolled up, sometimes pale, rarely with aura, some may also be accompanied by myoclonus, loss of muscle tone and fall. Due to the short duration of seizures, they are often ignored by parents for a long time.
Some seizure types may be accompanied by hallucinations, delusions, mental abnormalities, memory impairment, etc., in addition to impairment of consciousness. In some cases, there is no loss of consciousness, but only localized twitching of the body, abnormal sensation, or even periodic and recurrent headache and abdominal pain. In a few cases, specific forms of epilepsy are induced by visual, auditory, olfactory, and mental stimuli only under certain conditions. In conclusion, the penumbral manifestations of seizures are varied and need to be clearly diagnosed by a specialist in time for medical consultation.
Current status of surgical treatment of epilepsy
There are nearly 9 million epileptic patients in China, and about 300,000 new patients each year. Not only are the patients themselves extremely distressed, but they also place a heavy burden on society and families. At least half of these patients can be cured by surgery or controlled with antiepileptic drugs. However, only a small number of patients undergo surgery each year in our country, and many of these procedures are still low level or even wrong surgical treatments. Therefore, it is necessary to make an objective understanding of the unit personnel engaged in epilepsy surgery along with regular medication to avoid stepping into misconceptions.
V. What is the purpose of surgical treatment of epilepsy?
The purpose of surgical treatment is to completely control or relieve seizures. Complete control means that the seizures are completely stopped without taking antiepileptic drugs, which means that the seizure producing tissue is completely removed; while remission means that the seizure producing tissue is not or cannot be completely removed, but only the seizure conduction pathway or the amplified structure of the seizure discharge is destroyed, and the seizures are reduced to varying degrees after surgery, and medication or surgery is needed.
Which epilepsy patients are suitable for surgical treatment?
In principle, surgery can be considered when regular medication under the guidance of a specialist is ineffective and the seizures seriously affect the quality of life of the patient.
Doctors have strict selection criteria based on the type of seizures, whether the medication is ineffective, whether the seizures seriously affect the patient’s quality of life, whether the patient’s physical and mental state can cooperate with the preoperative examination and postoperative rehabilitation, whether the seizure focus can be located by CT, MRI, EEG, etc., whether the seizure focus is in an important functional area of the brain, whether the surgery will cause significant disability, etc. In addition, we should select the indications for surgery based on strict control of the indications. In addition, we will select different surgical methods according to the patient’s condition.