What is epilepsy?
Many people will answer in the affirmative: “Epilepsy is a convulsion, which is a crohn’s disease.” This is both a correct and incorrect answer. Yes, a convulsion or lambda is a very common type of epilepsy, but not all people with epilepsy have convulsions. Some patients have an onset of only sensory, behavioral, and mental abnormalities without limb twitching, but they are also epileptic.
So what exactly is epilepsy?
A better definition is now considered to be that epilepsy is a group of diseases and syndromes characterized by intermittent central nervous system dysfunction caused by repeated and sudden over-discharge of neurons in the brain, and is a disease that originates in the brain and has recurrent seizures. Depending on the site involved in the abnormal neuronal discharges and the extent of the spread of abnormal discharges, patients may have transient motor, sensory, consciousness, and vegetative neurological impairments of varying degrees.
The propagation of epileptic abnormal electrical activity in the cerebral cortex has no clear direction and is determined mainly by inter-synaptic connections, which are random in nature. Once the impulse enters the anatomical conduction pathway of brain tissue (mainly nerve fibers) and propagates, this is called the diffusion pathway of epilepsy (subcortical contact fibers such as: superior longitudinal bundle, inferior longitudinal bundle, sulcus bundle, cingulate bundle, corpus callosum, internal capsule, etc.), it will transmit the epileptiform signal to the limb effector organs according to the inherent anatomical conduction pathway of human body. This results in clinical manifestations of transient motor, sensory, consciousness, and vegetative disorders of varying degrees.
What is the incidence of this “epilepsy” disease?
According to epidemiological surveys worldwide, the incidence rate is about 35/100,000 per year, and the prevalence rate is about 5 per 1,000, with about 50 million epileptic patients worldwide. There are about 450,000 new epilepsy patients occurring in China every year, and the total number is about 6.5 million, of which about 1.5 million are refractory epilepsy, accounting for about 23% of the total number of epilepsy.
What is refractory epilepsy?
It is also known as intractable epilepsy, which is epilepsy that does not respond well to conventional treatment, and refers to patients whose epileptic seizures cannot be completely controlled by antiepileptic drugs.
The following conditions are considered to be refractory epilepsy.
(1) The duration of epilepsy is more than 2-4 years;
(2) The seizures occur more than 2-4 times per month;
(3) The epilepsy is not controlled by long-term, systematic treatment with multiple antiepileptic drugs, even after the blood concentration has reached the high limit of the therapeutic blood concentration.
Why are there so many patients with intractable epilepsy?
There are two major causes of intractable epilepsy.
1. Human factors; such as incorrect diagnosis, neglect of contributing factors, neglect of etiologic drug use (treatment) inappropriate;
The more important reason is the complexity of the disease itself. In recent years, with the in-depth study of these diseases, a large number of findings have shown that it is not the epileptic foci in the brain that directly cause seizures, but the epileptogenic foci.
What are epileptic foci? Epileptic foci
is a neuropathological concept that refers to a morphological abnormality in the brain that can indirectly or directly lead to epileptic discharges on the EEG and clinical manifestations of epilepsy. Within and adjacent to these foci or more distant cortical sites, one or several functional foci, known as epileptogenic foci, remain, which directly cause epileptic seizures.
What is an epileptogenic focus? Epileptogenic foci
It is a neurophysiological concept that refers to the site or sites where one or more of the epileptic discharges appear most clearly on the EEG, i.e., the site that directly causes epileptic seizures. It may be formed by local cortical neuronal reduction and gliosis due to extrusion of epileptic foci, local ischemia, etc.
Question Answering Area.
What are the common causes of epilepsy?
A Congenital malformations: such as chromosomal malformations, congenital hydrocephalus, microcephaly, cortical dysplasia, etc.
B Perinatal disorders: birth injuries are a common cause of secondary epilepsy in infancy.
C Brain injury.
D Infection: seen in various bacterial, viral, and fungal meningitis, encephalitis, brain abscess, and brain parasitic diseases.
E Poisoning: lead, mercury, carbon monoxide, ethanol (alcohol) and various drugs poisoning can cause epilepsy.
F Intracranial tumors: such as meningioma, glioblastoma and metastases.
G Cerebrovascular diseases: cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, cerebrovascular malformation and hypertensive encephalopathy, etc.
H Genetic factors
H Nutritional and metabolic diseases: rickets, hypoglycemia, diabetes mellitus, hyperthyroidism, hypoparathyroidism, vitamin B6 deficiency, etc.
I Degenerative diseases: such as Alzheimer’s disease (ALZHEIMER) .
How is epilepsy diagnosed?
The diagnosis of epilepsy relies on clinical manifestations, abnormal EEG waveforms and the effects of antiepileptic drugs. For each patient, the initial diagnosis does not require all three conditions to be necessary, but all three are important in the diagnostic process for different patients, especially in the establishment of the final diagnosis, which is essential for most patients.
What is an electroencephalogram?
EEG is the spontaneous, rhythmic bioelectrical activity of a population of brain cells recorded through electrodes. The difference in potential between two points on the scalp or between the scalp is electronically amplified and recorded, using the biological potential of the brain cells as the vertical axis and time as the horizontal axis.
What is dynamic EEG?
Dynamic EEG (also known as EEG Holter) is a new type of EEG that uses an electronic computer to data the EEG signal and record the EEG for a long time based on the conventional EEG.
Ambulatory EEG monitoring is a very useful tool for the diagnosis of seizure disorders and epilepsy. What we commonly refer to as 24-hour ambulatory EEG is a portable EEG recording system that records for more than 24 hours. For most patients, daily life is not affected while recording EEG and the test is performed in a natural environment.
Routine EEG is the primary means of determining cortical discharges in patients with epilepsy. Due to the seizure nature of epilepsy, abnormal EEG discharges also appear to be transient, and patients come to the hospital only after a seizure. The time and place of EEG examination are restricted, and it is difficult to capture epileptic waves, and the detection rate is only about 20%. In contrast, dynamic EEG is a real-time test that records EEG while the patient is having a seizure, which is very important in the diagnosis of epilepsy. 24-hour long-term recording can greatly increase the chance of detecting abnormal brain waves, and the detection rate is about three times higher than that of conventional tests.
The indications for dynamic EEG examination are.
(1) To assist in the diagnosis of epilepsy.
(2) To assist in the classification of epilepsy.
(3) Identification of pseudoepilepsy.
(4) Localization of focal epilepsy.
(5) To guide surgical treatment and prognosis estimation.
(6) Quantitative observation of seizure wave emission.
(7) Guidance on the use of antiepileptic drugs and assistance in deciding whether to discontinue antiepileptic drugs.
What is video EEG?
Video electroencephalography (VEEG) is based on dynamic EEG monitoring, using a camcorder to record the patient’s daily activity images simultaneously. When playing back the EEG, the doctor can observe the patient’s activity simultaneously while observing the brain waves.
About 40% of conventional EEGs in epileptic patients are negative, and it is difficult to record seizures. The detection rate of 24-hour dynamic EEG is significantly improved, but there is also a disadvantage that the patient’s situation and EEG changes during seizures cannot be observed simultaneously. In contrast, video EEG essentially not only extends the EEG recording time, but also adopts the method of recording system and EEG synchronous labeling to detect the EEG activities of patients in various states, and shows the whole process of patients’ seizures and EEG records during seizures to doctors at the same time, which can record EEG and video synchronously for a long time and identify artifacts, greatly improving the ability to diagnose epilepsy.
In the past, doctors rarely witnessed the seizure process of patients, and the diagnosis of epilepsy was mostly based on the narratives of patients’ relatives and colleagues, and the details of patients’ seizure-related symptoms were often ignored, so the clinical diagnosis of generalized tonic clonic seizures was more frequent, and less complex focal epilepsy. However, there was a decrease in the former and an increase in the latter after video EEG monitoring.
Therefore, video EEG is of great value for diagnosis, typing and localization of epilepsy, guiding clinical medication and clinical evaluation and treatment of refractory epilepsy, differentiation from non-epileptic seizure disorders and exclusion of epilepsy.
How to make the treatment of refractory epilepsy less difficult?
In addition, the treatment of patients with refractory epilepsy is no longer difficult by using the new modern epileptogenesis theory system and surgical intervention.
What is the principle of surgical treatment of epilepsy?
Experimental and clinical studies in recent decades have shown that all types of seizures have one or more epileptogenic foci in the brain, and if these foci can be surgically removed, the seizures can be stopped. In the epileptogenic foci, there are several nerve cells that are easily stimulated to discharge spontaneously, which are called type І neurons or starting neurons.
When the amount of firing reaches the epileptogenic threshold, a seizure is triggered. This is called the diffusion pathway of epilepsy. By surgically blocking or destroying this diffusion pathway, the number of firing neurons can be greatly reduced, thus blocking the seizures.
In addition, there is experimental evidence that there are seizure-prone and seizure-inhibiting areas in the brain. By surgically eliminating the activity of the seizure-prone area or strengthening the activity of the seizure-inhibiting area, seizures can be suppressed and thus seizures can be reduced or stopped clinically. These theories provide the basis for the surgical treatment of epilepsy, which is the rationale for the surgical treatment of epilepsy.
What are the surgical treatments for epilepsy?
Surgical treatment of epilepsy can be divided into three main categories.
(1) Removal of the epileptogenic lesion and epileptogenic area;
(2) Blocking the diffusion pathways or conduction pathways of epileptic discharges, raising the threshold of epilepsy, removing or destroying the excitatory structures of epilepsy or the epileptic prone areas in the brain;
(3) Stimulating the inhibitory structures of epilepsy, such as chronic cerebellar electrical stimulation; vagus nerve stimulation, etc.
The specific methods of surgery can be used according to the location and nature of the epileptogenic focus. The most commonly used surgical procedures are as follows.
(1) cortical resection of the epileptogenic focus.
(2) anterior temporal lobectomy.
(3) Selective amygdala and hippocampal resection.
(4) Hemispheric cortical resection.
(5) corpus callosotomy, or anterior commissurotomy
(6) Multiple submural transverse fiber dissection.
(7) Stereotactic dissection.
(8) Cortical surface thermal cautery.
(9) chronic cerebellar electrical stimulation
(10) Gamma knife radiosurgery.
(11) Vagus nerve stimulation, etc.
Who is suitable for surgical treatment in epilepsy?
Not all epilepsy is clinically amenable to surgical treatment. A significant proportion of patients with epilepsy can achieve satisfactory clinical control with regular drug therapy. Surgical treatment is mainly indicated for intractable epilepsy that is difficult to control with medication, focal epilepsy, brain lesions that cause epileptic symptoms and can be removed (secondary epilepsy), and even generalized intractable epilepsy and intractable epilepsy located in non-functional areas.
The surgical treatment of different types of seizures is clinically appropriate, which means that different types of epilepsy surgical methods have their corresponding surgical indications.
How to choose the timing of surgery for epilepsy patients?
The basic principle is that surgery can be considered when medication has clearly shown that seizures cannot be effectively controlled, so that patients can resume their normal life and social activities as soon as possible. However, epilepsy often varies with the degree of brain development, so it is important to be certain that the patient’s seizures are well established before surgery. This usually requires years of observation before a positive determination can be made.
In children with refractory epilepsy who are still living well, it is best to wait until the age of 15-16 years to consider surgery, because by this time the child’s brain development is largely mature and the patient is more cooperative, allowing surgery to be performed under local anesthesia, and it is easier to observe the surgical results after surgery.
For traumatic epilepsy, surgery should not be decided too early because the maturation rate of the epileptogenic foci varies, so the patient should be carefully observed for seizures and considered for surgery if the seizures are confirmed to be established. This condition usually takes 2-3 years. Most clinical seizures after brain injury do not appear until about 2 years after the injury, so the vast majority of traumatic epilepsy is treated surgically until about 5 years after the injury.
In infantile cerebral palsy, hemispheric corticotomy can reduce seizures without aggravating hemiplegia. As the inhibitory influence from the diseased side of the brain is eliminated, the function of the healthy hemisphere can be restored and normal development can be achieved, and the use of antiepileptic drugs can be reduced accordingly due to the reduction of seizures, and the intellectual development of the child can be improved. In such cases, early surgery is advisable, usually preferably before school age, to bring out the potential function of the healthy side of the brain as early as possible.
In symptomatic epilepsy, surgery should be performed early after identifying the nature and location of the brain lesion in order to stop the development of the lesion and further aggravate the brain damage.
Febrile convulsions in problematic selective areas
In any pediatric febrile illness, any convulsion caused by abnormal neurogenic discharge in the brain at a temperature of 38 degrees or more is considered a febrile convulsion. Because the vast majority of children have seizures when their body temperature increases suddenly and significantly, the name febrile convulsions is customarily used in China. It is the most common neurological disorder in infants, and although most have a good outcome, the incidence of later epilepsy is significantly higher than in the general pediatric population.
What is the connection and difference between febrile convulsions and epilepsy?
Febrile convulsions are not epilepsy, but it is still an epileptic form of seizure, and a proportion of children with complex febrile convulsions can be converted to epilepsy. Throughout childhood, age, genetic factors and pre-convulsive seizure growth and development are the main factors influencing the prevalence of the disease.
The main clinical manifestations are: typical seizures tend to occur when there is a sudden rise in body temperature at the beginning of the primary illness, and the temperature at the time of seizure is mostly 39-40 degrees or higher. The main form of generalized seizures is tonic-clonic convulsions, or only tonic or paroxysmal seizures. Very rarely, the seizures are atonic, without aura. Most seizures last only a few minutes and stop within 15 minutes. After a convulsive seizure, most children are awake within a few minutes, leaving no abnormal neurological signs.
Numerous studies have confirmed that the EEG has no prognostic value within 1 week after the seizure. EEG should be considered clinically mainly for atypical seizures (complex febrile convulsions) and should be scheduled 10-14 days after the seizure. If there are limited abnormalities in the EEG at this time (limited slow waves or spikes and sharp waves), obvious generalized slow wave rhythm or spike and slow complex waves, the likelihood of clinical transformation to epilepsy or persistent EEG abnormalities is greater in the future than in those with normal EEG. However, those with a normal EEG still have the possibility of turning into epilepsy.
Febrile convulsions can be divided into simple febrile convulsions and complex febrile convulsions.
The clinical manifestations of simple febrile convulsions are.
(1) seen only in infants and children from 6 months to 3 years of age.
(2) Typical seizures tend to occur when there is a sudden rise in body temperature, which is mostly above 39-40 degrees.
(3) The form of seizure is mostly tonic clonic seizures, and a few are tonic, clonic or aphasic seizures without aura, usually in one seizure. Fever. (3) The seizure form is mostly tonic-clonic seizures, a few are tonic, clonic or atonic, without aura, usually in a fever.
(4) EEG examination, non-specific increased slow activity is seen in 20-60% of children within 1 week of the seizure, and returns to normal after 1 week.
The clinical manifestations of complex febrile convulsions have the following characteristics compared with simple febrile convulsions: seizures with low fever (less than 38 degrees), longer duration, abnormal neurological signs after the seizure, recurrent seizures, and EEG remains significantly abnormal 7-10 days after the seizure has stopped. 50% can be converted into epilepsy.
To prevent recurrence, domestic and foreign scholars unanimously advocate the use of antiepileptic drugs, and the main target of preventive medication is children with febrile convulsions who are at risk of recurrence.
Does epilepsy cause mental retardation?
Does epilepsy have any effect on the patient’s intelligence? What is the extent of the effect? This has always been a great concern for patients and their families, especially for children, and parents are even more worried.
From a large number of clinical studies at home and abroad in recent years, not all patients with epilepsy have lower than normal intelligence, but it is true that some patients with epilepsy have low intelligence. So, what factors are at play? Can we reduce the incidence of dementia?
In some patients with secondary epilepsy, the brain itself can be affected by the primary disease, metabolic diseases are often associated with mental retardation, and secondary epilepsy that occurs because of specific lesions in the brain, such as having had encephalitis, birth injuries, or suffering from congenital genetic disorders, can almost always affect intellectual development; while primary epilepsy for which no cause can be found, only 1/3 of patients may develop mental retardation.
In addition, different types of seizures have different effects on intellectual development; infantile spasmodic epilepsy, psychomotor epilepsy, and partial seizures affect more than half of intellectual development, with the most severe being infantile spasmodic epilepsy, which can affect up to 91% of intellectual development. The least impact on intellectual development was seen in petit mal seizures, with only 23%.
The number of seizures also affects the level of intelligence. The cortical neurons are irreparably lost with each seizure, and the health of the cortical cells directly affects intelligence. It is observed that 67.5% of patients with more than one seizure per day have low intelligence; 54.1% have 1-20 seizures per month; and only 28.4% have 0-11 seizures per year. Early treatment of any disease is better than late treatment, and epilepsy is no exception. The closer formal and effective treatment is to the first seizure, the less likely it is that intelligence will be impaired. If available, an electroencephalogram (EEG) should be performed. Most people with normal EEG are not affected by their intellectual development, while those with abnormal EEG have a higher likelihood of intellectual impairment, and this is related to the severity of the EEG abnormality.
Current research shows that part of the clinical mental retardation in epileptic patients is caused by antiepileptic drugs, especially the excessive dosage of some drugs or unreasonable combination of drugs. In other words, part of the mental retardation in epilepsy patients is caused by the lack of adequate understanding of the toxic effects of antiepileptic drugs by physicians and inappropriate use of medications.
What are the dietary contraindications for epilepsy patients?
The patient with epilepsy should have a good routine and eating habits, avoiding overfilling, overfed, and overdrinking. The actual fact is that you will be able to get a lot more than just a few of the most popular and popular items. Drinking alcohol can induce seizures. The main component of alcohol is ethanol, which has a direct inhibitory effect on higher neural activity and makes the brain work less well.
Seizures are caused by a “stagnant foci of pathological excitation” in the cerebral cortex. When the excitement spreads to a motor area of the cortex, it causes a limb or even a generalized seizure.
Chronic ethanol (alcohol) intoxication can cause structural and functional changes in the cerebral cortex, resulting in seizures; long-term alcohol addicts can also experience seizures when they quit drinking. In patients who are taking antiepileptic drugs, ethanol can induce the proliferation of liver drug metabolizing enzymes, which accelerates the metabolism of antiepileptic drugs, making it easy for the drug concentration to decrease, reducing the efficacy and causing seizures. Thus, patients with epilepsy should abstain from taking all alcohol and beverages containing ethanol (alcohol).
When a loved one has a seizure, how do family members rescue them?
Grand mal seizures are often preceded by prodromal and aura symptoms. The prodromal symptoms are generalized discomfort, irritability, restlessness, depression, bad mood, picking on or complaining about others, etc. Hours or days before a grand mal seizure; the aura symptoms are hallucinations, delusions, automaticity or localized myoclonic jerking in the seconds before a grand mal seizure.
When the prodromal symptoms appear, the patient’s family should, on the one hand, be psychologically prepared to help stabilize the patient’s mood so as not to cause trouble; on the other hand, the dose of the original antiepileptic drug can be temporarily increased, or a certain amount of diazepam (Valium) or phenobarbital can be temporarily added on top of the original drug to prevent seizures.
When the aura symptoms appear, it is too late to take any measures to prevent seizures. The only way to prepare for grand mal seizure care is to ensure that the patient does not injure the head, tongue, trunk, or limbs during a seizure.
For transient psychomotor epilepsy, such as seizures with simple disorders of consciousness, seizures with simple memory impairment, and compulsive thinking, there are usually no serious behavioral problems, and they do not cause damage to the patient or to the people or objects around them, so they generally do not require special care; more complex seizures, such as nocturnal or roaming, have behaviors that are not necessarily purposeful and sometimes lack the ability to protect themselves; their behavior should be restricted; if they cannot be forcibly restricted If the seizure cannot be forcibly restrained, at least someone should follow their actions to prevent accidents; psychomotor seizures produce pathological passions, which can lead to sudden outbursts of impulsive behavior, sometimes self-injury, injury, destruction of objects, suicide, or homicide. In case of such seizures, emergency control measures should be taken immediately to strictly limit their actions to avoid serious consequences.
What should be noted when rescuing?
The following aspects of care should be done in case of grand mal seizure.
(1) Protect the tongue. It is best to place a gauze tongue depressor between the upper and lower molars of the patient when aura symptoms appear to prevent the patient from biting his or her tongue during the clonic phase. If it cannot be put on during the aura period, it should be put in during the tonic period when the patient opens his mouth, but not during the clonic period. The tongue depressor can also prevent the tongue from falling back and blocking breathing.
(2) When an aura is detected, the patient should be quickly laid flat on the bed or on a flat place nearby. If it is too late to make the above arrangement, when you find that the patient is going to fall, you should quickly hold the patient and let him/her fall down in a smooth manner to prevent him/her from suddenly falling down and injuring his/her head or body by himself/herself.
(3) Patients in the ankylosing phase have their heads tilted back excessively and their jaws over-open, which can cause cervical compression fractures or dislocation of the jaws. At this time, one hand should hold the patient’s occiput with slight force to stop his neck from over-extending, and one hand should hold the jaw to counteract his jaw over-extension.
(4) There are more respiratory secretions during grand mal seizures, which can easily cause respiratory obstruction or aspiration pneumonia. From the beginning of a grand mal seizure, the patient’s head should be turned sideways to one side so that secretions can flow out naturally. In addition, it is best to unbutton the patient’s neck to ensure a clear airway.
(5) During the clonic phase, the muscles of the limbs contract, which can easily cause joint dislocation and limb abrasions. At this time, you can press the large joints of the extremities (such as shoulder, elbow, hip and knee) with appropriate force to limit their jerking amplitude. At this time, do not use excessive force and forceful pressure, so as not to cause artificial injury or fracture of muscles and joints.
(6) The seizure should also be unbuckled from its belt, and should be removed when there are added teeth.
(7) After the grand mal seizure has stopped, the patient can only return to normal after a few minutes, tens of minutes or even a few hours. Some patients are in a drowsy state during this time, so just let them sleep comfortably and quietly. Other patients are in a hazy state and can have some unconscious and purposeless impulses, destruction, suicide, killing and destroying things. At this time, in addition to immediately give the patient intramuscular or intravenous sedation such as phenobarbital (luminal) or diazepam (Valium), the patient’s behavior should be strictly limited to ensure safety.
Here to remind a word, many patients’ families often pinch the patient’s “human center” point when the patient has a grand mal seizure, and sometimes even pinch blood, the seizure still does not stop. The actual seizures are caused by abnormal brain discharges, and there is no way to stop the seizures that have already started. There is no point in pinching the “human center” point, and it is detrimental to the patient’s health.
What should I know about epilepsy?
To ensure safety, patients with epilepsy should carry a “seizure card” with them when they go out, work or study, so that they can give first aid and contact their families in case of a sudden seizure. It is best not to travel until the seizures are under basic control. If the seizures are basically controlled, you can travel, but it is best to be accompanied by a family member who understands the condition and knows how to care for it. Bring enough regular antiepileptic medication with you when you go out, and have some medications that can work quickly, such as phenobarbital injection and diazepam (Valium) injection, just in case. If you miss a dose of medication once in a while, you should make it up the next time you take it. It is important to ensure enough sleep, not to be overly tired, not to be too full, too hungry, and not to drink too much water.
What are the precipitating factors for epilepsy patients?
Sleep deprivation, excessive physical work, overstressed mental work, strenuous sports, hunger, overfullness, drinking a lot of water at one time, constipation, drinking alcohol, drinking strong tea, using a lot of caffeinated food (such as chocolate, etc.), mental tension, sadness, sorrow, emotional impulsiveness, cold, fever, menstruation in female patients, and various transient metabolic disorders and allergic reactions can trigger seizures in patients. Hyperventilation has a triggering effect for akathisia seizures, excessive water intake for tonic clonic seizures, and flashing lights for myoclonic seizures.
Some patients have seizures only under certain conditions, such as flashing lights, music, mental arithmetic, reading, writing, playing chess, playing cards, bathing, brushing teeth, starting, and external ear canal stimulation, which are collectively referred to as reflex epilepsy.
Can people with epilepsy get married?
People with epilepsy will not have mental and intellectual impairment as long as they receive early systematic and regular treatment. They can work, live and study exactly as normal people do. They should also enjoy love and family happiness as normal people do. Therefore, patients with epilepsy whose seizures have been completely controlled or basically controlled should not be discriminated against in terms of marriage.
For some people with epilepsy who are of marriageable age, but whose seizures are not yet well controlled, it is better not to get married for the time being. Wait until the seizures are completely controlled or basically stable before getting married.
For some people with epilepsy who are severely mentally or intellectually impaired due to delayed treatment in the past, they cannot afford family responsibilities and are not capable of having and raising children and should not get married. If two people with epilepsy will be set up for marriage in order not to dislike each other, it is better not to have children.