When it comes to epilepsy, people immediately think of tonic clonic grand mal seizures, a horrible manifestation of so-called “crohn’s disease”. However, according to Dr. Wang Wei of the Department of Neurosurgery at Guangzhou General Hospital of the Guangzhou Military Region, no two people in the world have the same seizure presentation, and other seizure types such as “disoriented seizures” are rarely associated with epilepsy because they are not typical.
The timely detection and active management of epilepsy in childhood can prevent a lifetime of misfortune, otherwise it becomes not only a personal tragedy, but also a burden to the family and society. The prevalence of epilepsy in the population is reported to be 7 per 1,000, with more than 10 million patients in China, who not only lose their labor force, but also require long-term care, causing a financial burden second only to lung cancer among men and to breast cancer among women.
Epilepsy has many “atypical” symptoms
The “automatic” phenomena such as giggling at people, grinding teeth unconsciously, smacking your lips, spitting habitually, sleepwalking at night, suddenly not understanding what people say when talking, suddenly holding up chopsticks when eating, and even poor memory and sleep, can all be epileptic seizures. Wang Wei has also seen strange behavior that cannot be explained by common sense, such as suddenly taking off one’s pants to pee in public and singing at the top of one’s lungs inappropriately, which was found to be caused by epilepsy.
Many teenagers have convulsions after long hours of surfing the Internet, some are triggered by flashing car lights, and others have convulsions during the excitement of watching the World Cup or total solar eclipse. Wang Wei said that the definition of epilepsy now emphasizes “onset without external stimulation”, so the above situation may not necessarily be the case and requires careful examination to clarify the diagnosis.
The test: long-range EEG monitoring makes it easier to “catch” abnormal brain waves
The company’s main business is the development of a new product, which is a new product for the company. Specialties in developed countries require epilepsy consultations to last more than 40 minutes, which helps catch clues of epilepsy. “But few domestic doctors currently see patients with such detailed knowledge. It is estimated that more than a quarter of epilepsy patients are missed or misdiagnosed.” He said.
Epilepsy patients are routinely examined with an electroencephalogram, but only about one-third of the brain wave map abnormalities can be detected in a 10-minute outpatient EEG. Wang Wei recommends that patients suspected of having epilepsy have long-range, 24-hour EEG monitoring, which can increase the detection rate to 80 percent. What about the remaining 20 percent of patients? According to Wang, only longer-term monitoring can make the diagnosis clear for some patients.
According to Wang, most epilepsy has a pathological basis, meaning that the brain has undergone organic changes. Even if the epilepsy has only had one seizure, you should get an MRI to check for the presence of a lesion. Because the lesion is objectively present, there is no need to wait until the patient has a seizure to be examined, but it takes an experienced physician to see the subtle changes in the brain tissue on the film.
The “golden age” for treatment is before age 7
According to Wang Wei, epilepsy mostly occurs in children and the elderly. Children’s nervous systems are not well developed, and there is a peak incidence before the age of 10. Some children’s seizures are not powerful or even obvious, but the brain keeps firing internally, which slowly kills the normal development of the brain. Wang Wei reminded, “Before the age of 7 is the ‘golden period’ for treatment, and a significant number of people who have organic brain lesions can even have their cerebral hemispheres cut out and later develop fully with the remaining cerebral hemispheres available to compensate for all functions.”
If middle-aged people suddenly develop epilepsy, it is likely that clear organic lesions have occurred, such as gliomas and meningiomas. degenerative lesions gradually occur in the human brain after the age of 60, and injuries caused by hemangiomas and strokes are also likely to cause abnormal brain discharges.
Treatment: Classical drugs are the essence of treatment
According to Wang Wei, epilepsy treatment is currently based on medical medication, supplemented by surgical treatment.
The internal medicine is based on the typing of epilepsy according to the EEG test. There are more than 10 new drugs in China in the past decade or so, but Wang Wei recommends more than 10 classic drugs for first-line treatment, such as sodium valproate, carbamazepine and phenytoin sodium. Because the study found that more than a dozen new drugs only increased the cure rate by 8 percent, but they are relatively expensive and the risk of side effects is still being evaluated.
He said, “It is enough to take the medication regularly for a long period of time and in sufficient quantity under the guidance of an experienced specialist, and not to believe in the ‘secret recipes’ of charlatans.” He and his colleagues found through laboratory tests that the so-called “secret recipe” was originally a mixture of several cheap Western drugs – a violation of the principle of “single drugs first, then combined drugs” in epilepsy medical treatment. This violates the principle of “single drug first, then combined drug” in epilepsy treatment, disrupting the natural course of the disease and increasing drug side effects.
Surgery may be performed if organic lesions are found
About one-third of epilepsy does not respond to medications, and MRI can detect developmental brain disorders and hippocampal sclerosis, which can be completely cured by surgically removing or destroying the lesions that cause epilepsy. According to Wang Wei, a patient in Huadu took medication for 18 years to control his condition, and the side effects of the medication caused damage to several organs, which were later found to be organic lesions on MRI, “If the surgery had been done earlier, he would not have had to suffer so much.”
But not everyone needs to be operated on. For example, patients who have one or two seizures a year do not need to be over-treated at all, as the treatment may cause more damage to the patient.
Reminder: epilepsy patients caution under the pool
Wang Wei introduced foreign surveys found that a quarter to a third of people who drowned in swimming pools were caused by seizures. For people with epilepsy that is not fully controlled, swimming, driving vehicles and other “no-fail” activities can be avoided.
If you find someone around you having a seizure, first try to get them to lie on their side so that they don’t die of asphyxiation from saliva and other aspirations into their airways. To prevent the patient from closing his teeth and biting his tongue, you should find a spoon wrapped in cloth and stuff it into his mouth, but never put your hand in it to avoid being bitten off.