Surgery to “subdue” intractable epilepsy when drugs don’t work

  Although Zhang is only 18 years old, he has been suffering from epilepsy for 15 years and has been taking a variety of anti-epileptic drugs for the past 15 years, yet he still has seizures without any signs or occasion, and they are becoming more and more frequent and severe. Patients who are on long-term medication and cannot control their seizures are most likely to have intractable epilepsy, which requires surgical treatment if necessary.  The monitoring system helps to make accurate judgments: epilepsy is the most common chronic disorder among functional neurological diseases, and was once listed by the World Health Organization as one of the five most intractable diseases in the nervous system. According to epidemiological surveys, the overall prevalence of epilepsy in China is 7.0‰, and it is estimated that there are about 9 million patients with epilepsy. Nowadays, epilepsy has become the second most common disease in neurology after headache.  Epilepsy is a chronic disease in which sudden abnormal synchronous discharges of neurons in the brain result in transient neurological dysfunction of the brain. Seizures are clinical symptoms caused by synchronous brain neural discharges. Patients may suddenly lose consciousness, fall to the ground, twitch their limbs, foam at the mouth, bite their tongue, and become incontinent.  The clinical diagnosis of the above-mentioned typical seizure manifestations is relatively easy; however, it is more difficult to diagnose patients with atypical or special types of epilepsy, such as headache-type epilepsy, abdominal pain epilepsy, etc. Professor Wu Jingwen pointed out that for patients with suspected seizures, the correct diagnosis can only be made based on their clinical seizure symptoms, combined with dynamic video EEG and related examinations. With the visualized epilepsy EEG monitoring system, patients can be monitored for 24 hours or more continuously to detect epileptic foci and give precise localization, which provides an important reference basis for assessing epilepsy, treatment effect and prognosis.  Refractory epilepsy is treated surgically: The main treatment for epilepsy is medication. Standardized and appropriate drug therapy can effectively control seizures in most patients, and about 80%-90% of patients can be better controlled by regular antiepileptic drug therapy; however, for patients with severe epilepsy, drug therapy is less effective, and about 10%-20% of patients are patients with refractory epilepsy.  It is generally considered that patients with more than three years of disease duration and more than two years of systematic and regular treatment with multiple antiepileptic drugs (to maintain effective blood levels) still have at least one seizure per month, which is considered refractory epilepsy. These patients can opt for surgical treatment through a rigorous preoperative examination and evaluation, if their physical condition allows.  Surgical treatment of epilepsy is a major advancement in modern medicine. Neuromodulation is currently a minimally invasive surgical technique for the treatment of intractable epilepsy. It controls seizures by destroying or inhibiting the neural conduction pathways of epileptic activity in the brain and blocking epileptic diffuse whole-brain discharges through destruction or in vitro neuromodulation. This procedure is minimally invasive, safe, effective, and suitable for many types of epilepsy populations.  With the development of clinical medicine, epilepsy is also becoming more controllable and treatable. Most people with epilepsy can work and live like normal people if they are strong and optimistic about the disease, receive timely standardized and reasonable treatment, and maintain a healthy lifestyle.