Many people are not unfamiliar with epilepsy, which is usually called “sheep epilepsy” or “crohn’s disease”. Medically speaking, epilepsy is a syndrome of recurrent seizures characterized by disorders of consciousness, convulsions, perceptual disturbances, sensory abnormalities, and even mental, behavioral, emotional, and visceral dysfunction. It is also a relatively common disease, according to the World Health Organization (WHO), 5.0 per 1,000 in developed countries; 6.1 per 1,000 in countries with economies in transition; 7.2 per 1,000 in developing countries; and 11.2 per 1,000 in underdeveloped countries. Our statistics 4.4‰, on average, there will be another 20-50 new epilepsy patients per 100,000 population each year, our country is a large population, which shows the number of patients.
In our daily life and work, various speech, mannerisms and thinking activities are generated in the brain, and these signals are transmitted to various organs through nerve fibers. These signals are transmitted to various organs through nerve fibers. The transmission of various signals takes place mainly in the form of tiny electrical currents, and there are also chemicals produced in the brain that play an important regulatory role. Epilepsy arises as a result of abnormal synchronous overdischarge of large groups of nerve cells in the brain. A variety of factors can cause excessive nerve cell firing, such as congenital genetic factors, brain injury before and after birth, encephalitis, traumatic brain injury, hemorrhage, brain tumors, congenital malformations, and certain metabolic disorders. The main risk factors that predispose to epilepsy are.
(1) Genetic factors.
(2) Factors suffered by the patient’s mother during fetal life.
(3) Factors suffered by the patient at birth.
(4) Previous history of febrile convulsions in the patient.
(5) neurological disorders.
From the onset of exogenous etiology to the onset of clinical symptoms of epilepsy, months or years may elapse, and the patient’s presentation at the onset of seizures is varied. The clinical manifestations vary depending on the origin of the seizure discharge, the extent of propagation, and the form of propagation. It is important to know in detail the state of the patient at the time of the seizure. In general, based on the patient’s presentation and EEG indices, seizures are divided into two major categories: partial (focal) and generalized, which are subdivided into several subtypes. Currently, the following seizure classification methods are commonly used in China.
1. Partial seizures (partial seizures)
(1) Simple partial seizures. No impairment of consciousness. Motor [limited extension (Jacksonian) rotation, etc.], sensory (somatic and specific sensations), autonomic seizures. For psychiatric symptoms, see complex partial seizures.
(2) Complex partial seizures (commonly known as psychomotor seizures or temporal lobe epilepsy). With impaired consciousness, including impaired consciousness only, psychiatric symptoms (perception, emotion, memory, delusion, hallucination, etc.), and automatism.
(3) Partial seizures progress to generalized seizures.
2. Generalized seizures, non-limiting start
(1) generalized tonic-clonic seizures (grand mal seizures).
(2) Aphasic seizures (petit mal seizures), typical or atypical.
(3) Others. Myoclonic seizures, clonic seizures, tonic seizures, atonic seizures.
(3) Cannot be classified: seizures that cannot be classified into the above categories due to insufficient information or
From the point of view of the disease itself, the impact of seizures on human health is not very serious (of course, repeated seizures can cause significant loss of intelligence and other brain functions, and severe persistent status epilepticus can be directly life-threatening), but more importantly, it is the impact on the patient’s psychology, family, and work. Therefore, along with active treatment, all aspects of society need to be taken care of.
In terms of treatment, currently about half of the patients can be controlled by regular medication, and a significant number of patients with ineffective medication may be transformed into what is clinically referred to as refractory epilepsy. The factors that tend to lead to becoming refractory epilepsy are.
(1) Complex partial seizures, infantile spasms, and Lennox-Gastaut syndrome.
(2) Frequent seizures, several times a day.
(3) The presence of persistent status epilepticus.
(4) Misjudgment of seizure frequency.
(5) Delayed treatment after onset.
(6) Inappropriate combination of multiple medications, including herbal medicine.
(7) Application of different treatment plans in several medical units at the same time
(8) Inadequate recognition of comorbid psychiatric disorders
(9) A clear etiology, especially congenital metabolic abnormalities, intracranial developmental disorders, and traumatic brain injury. For refractory epilepsy, we recommend surgical treatment (including partial brain tissue resection, stereotactic surgical disruption, and stereotactic radiosurgery). Although traditional surgical and stereotactic surgical methods can enable some patients to be effectively controlled, they can also cause some damage to the brain, and some of them can leave serious complications or even endanger life.
In fact, the application of radiosurgery to treat epilepsy has been proposed for a long time. In 1959, Talairach et al. started to implant 12-18 Yttrium-90 spheres through the middle temporal gyrus with a total radiation dose of 25 Gy to create a necrotic zone of 2-2.5 cm in the epileptogenic area in 15 patients with epileptic foci located in the hippocampal complex on the dominant side. ceased, 2 cases were reduced, and 4 cases were unchanged, but the procedure failed to become widespread in the clinic due to its complexity. By the mid-1980s, Barcia-Salorio et al. conducted animal experiments in which cobalt hydride was buried subdurally in the left frontal lobe of cats to induce seizures. Seizures disappeared and EEG improved after administration of 10 Gy of target irradiation, and a small number of clinical cases were treated with the same therapeutic effect, which laid the foundation for low-dose irradiation for epilepsy. In the last decade or so, the sudden progress in radiosurgery (Gamma Knife) has led to promising results in the treatment of epilepsy. Early on, it was found in the application of Gamma Knife in the treatment of some patients with tumors or vascular malformations that, as the primary lesion improved, the seizure symptoms that had accompanied the patient disappeared. Later, for epileptic patients with clear epileptogenic foci (such as intracranial congenital developmental malformations, calcified foci or softening foci found through CT and MRI examinations) using gamma knife low-dose irradiation, the same satisfactory results were achieved. In recent years, with the improvement of electrophysiological and cerebral metabolic examinations, especially the clinical application of dynamic EEG, video EEG, single photon emission computed tomography (SPECT) and positron emission tomography (PET), abnormal brain tissue areas have been detected, and for the so-called “primary epilepsy” in the past, a clear epileptogenic focus has been found. The definite epileptogenic foci were found, and the treatment with Gamma Knife was very effective. From the treatment process and follow-up of patients, the advantages of Gamma Knife treatment for epilepsy are that the patient does not need to be hospitalized, can be treated on an outpatient basis, non-invasive, highly accurate treatment, and the efficacy is certain.
The exact mechanism of gamma knife treatment of epilepsy is not yet clear, but experimental studies and experience of clinical cases at home and abroad have shown the following theories.
(1) Epileptogenic nerve cells are more sensitive to radiation, and a lower dose of irradiation can cause their activity to be inhibited.
(2) The conduction of the epileptogenic nerve is blocked by a certain dose of radiation exposure.
(3) Radiation irradiation can cause fewer epilepsy-initiating nerve cells and reduced excitability.
The important conditions for epileptic patients suitable for gamma knife treatment are
(1) Refractory epilepsy with a history of more than two years and ineffective with regular regular drug therapy.
(2) The origin of the epilepsy can be seen in the brain by various tests (either metabolic abnormalities of brain tissue or other lesions).
(3) The patient’s age is usually not limited, but if the patient is too young, the brain is immature, and the type of epilepsy is not fixed, he or she can be treated a little later.
(4) From the current experience, simple partial seizures with fixed seizure types and complex partial seizures with lesions in one temporal lobe work well.
Although the application of gamma knife in China only five years, but due to the extensive attention of the medical community, has achieved a large number of clinical experience in the treatment of epilepsy has also been the treatment norms and improved, I believe that this new means of treatment will bring new hope for the majority of epilepsy patients.