Epilepsy is an ancient disease that has been present since the birth of mankind. It is a chronic brain disorder caused by multiple etiologies. It is characterized by intermittent dysfunction of the central nervous system due to repeated and sudden excessive discharges of the nervous system in the brain and can manifest itself in a variety of ways, including physical convulsions, mental disorders, and sensory disturbances. Liu Dihui, Department of Pediatrics, Guangzhou United Family Hospital
The causes of epilepsy are complex and are summarized as follows.
1, endogenous causes: genetic factors or idiosyncratic constitutionally determined low threshold for cerebral convulsions, as a susceptible population for epilepsy.
2. Exogenous causes: brain damage due to various causes, including
① Abnormal brain formation during embryonic period.
② birth injury asphyxia, forceps, suction, severe infection, etc.
③ Cerebrovascular disease
④ Traumatic brain injury: accidental injury or brain surgery.
⑤ brain infection: various kinds of encephalitis, meningitis, brain abscess, etc. and their sequelae
(6) Poisoning: often various drugs poisoning.
(7) Metabolic disorders: glucose metabolism disorders, hypoglycemia, uremia, hepatic coma, etc.
3. Causes.
① Excessive fatigue.
② Hunger.
③ overeating.
④ Mental stimulation, shock and fear.
⑤ fever.
⑥ insomnia.
(vii) Hyperventilation.
⑧ Alcohol consumption.
⑨ Induction by certain drugs.
⑩ Excessive sound, light, electricity, and odor stimulation.
In the past, for typical seizures, we could diagnose epilepsy simply by asking for a history, but now specialists are required to make a clear diagnosis of seizure classification in epileptic patients because the choice of medication is different for different types of epilepsy.
The EEG is a very important tool for diagnosing and typing epilepsy. Its importance is reflected in several ways.
1. To assist in the diagnosis: seizures are abnormal discharges of neurons in the brain, which are expressed as “abnormal waves” on the EEG. The form of the “abnormal waves” is different for different types of epilepsy. This is why EEG is so critical to the diagnosis of epilepsy and its subtypes. However, these “abnormal waves” do not occur continuously 24 hours a day, and they can occur with or without seizures. Therefore, a single normal EEG does not indicate the absence of epilepsy, and sometimes repeated EEGs are required before a diagnosis can be made. In contrast, video EEG is more accurate for diagnosis and typing of epilepsy because it can analyze the relationship between clinical actions and EEG simultaneously.
If the EEG shows scattered “abnormal waves”, the dose can be increased slightly and some patients can be controlled. For some patients with benign epilepsy, even if there are more “abnormal waves” on the EEG several times, there is no need to increase the dose, and the seizures can be controlled with a small dose of medication.
3. To help determine when to stop the medication: If the epileptic patient is seizure-free after 2 to 5 years of regular medication, a reduction in medication can be considered after a comprehensive evaluation by a specialist, but the dosage can be gradually reduced only after the EEG has not shown any “abnormal waves” for several times before the reduction.
The key to surgical treatment is to identify the epileptic foci. EEG is very important for the localization of epileptic foci.
When diagnosing epilepsy, in addition to an EEG, the doctor may recommend that the child have a CT or MR of the head, as well as tests for metabolic aspects. This is necessary because it is an important tool to identify the cause of the epilepsy. Because some children have seizures due to certain intracranial lesions, a cranial CT, especially MR, can reveal changes in brain tissue structure and brain cells in a timely manner, and sometimes seizures are a manifestation of some metabolic disease, which is important to find the cause of epilepsy.
With regard to treatment, different seizure types should be treated with different medications. However, no matter which medication is used, it does not happen overnight, and whether a medication is effective or not is observed for at least 3 months to 6 months. Therefore, it is very important for parents and children to cooperate with the treatment. This includes 1) taking the medication on time and according to the dosage, not reducing or stopping the medication because the seizures do not stop or because of fear of side effects; 2) carefully observing the seizure process, including the trigger of each seizure, the starting site of the seizure, the performance and duration of the seizure, the eye movement during the seizure, etc., and keeping records to provide to the doctor at the follow-up visit as a basis for assessing the next stage of treatment. This will be used as an important basis for the next stage of treatment.
The side effects of medication are the most important concern for parents because of the long-term use of medication. It is understandable that all drugs are toxic, but parents should understand that the damage caused by seizures to the child is far greater than the side effects of the drugs. Not to mention that the incidence of the so-called side effects of medication is very low. All medications are carefully weighed by the doctor to determine that the benefits outweigh the harms for the child before they are implemented. During the course of treatment, the doctor will observe the side effects of the medication by various means and deal with them as soon as they occur. Therefore, it is very important to follow up with the doctor regularly for routine blood tests, liver and kidney functions and drug concentrations. We have attached the instructions of the medication taken by the child at the end, which is to let parents know what possible side effects the medication has, and to carefully observe these side effects in daily life, and to follow up promptly once they occur, so that the doctor can deal with them properly.
After a certain period of regular and systematic drug treatment for 2-5 years, epileptic patients no longer have seizures, they can generally reduce their medication until it is discontinued. If there are no seizures within 3 years after stopping the medication, it is considered cured. Therefore, although epilepsy is difficult to treat, it is not incurable. A lot of information shows that as long as the treatment is timely, the method is appropriate, and the cooperation is good, 70% to 80% of the patients can be completely controlled and cured.
In general, most people no longer have seizures after systematic treatment, but not everyone no longer has seizures, and it has been observed that within 10 years of clinical cure, 15% of the patients have seizures again. Therefore, patients who are cured should pay attention to maintenance and prevent any triggering factors, such as absolute abstinence from smoking and alcohol, prevention of excitement or anger and excessive fatigue. In addition, try to watch less TV, play less video games, use less computers and cell phones, and try not to play chess or mahjong, etc.
Regarding the learning of children with epilepsy, as long as there is no serious mental disorder or intellectual disability, it is generally not affected. However, in order to avoid seizures induced by excessive learning stress and fatigue, schools and parents are advised not to be too demanding or too strict with children with epilepsy, and not to cause excessive mental stress and fatigue in the affected children. A specific learning plan should be developed based on their past learning and physical ability to cope.
After entering school, the child’s condition should be presented to the classroom teacher truthfully in order to obtain the teacher’s understanding and help, and should be made clear to the classmates through the teacher so that they will not be afraid. In particular, they should not let their classmates discriminate or alienate them, but should help them enthusiastically so that the students with epilepsy have a warm and friendly living and learning environment. Research has proven that the prognosis of the mental state of epileptic patients is greatly influenced by the good or bad external environment. When the child with epilepsy has poor test scores and poor learning, he or she should not be reprimanded or scolded, but should be patiently induced and inspired, and praised for slight progress. At the same time, do not drop out of school or suspend the child from school because of several seizures. The child is locked up at home without contact with the outside world, which is more detrimental to the treatment of the disease, and is detrimental to physical and mental health.