Patient: The patient is male, 21 years old. He had an attack in 2007, and in 2008 he had a generalized convulsion with two eyes rolled up, so that the attack was only once. The main symptoms over the years were: at first the consciousness would become blurred, the gaze was dull, there was no way to think, and the environment was unfamiliar to him. There is an indescribable feeling. There is discomfort in the epigastrium (it screams), and there is a lot of saliva in the mouth. Can’t say the name of things you see, no way to have a conversation, or know what people say to you, and lose a sense of cognition of language. You can’t call out any words you used to know, and you feel unfamiliar with familiar things. The above-mentioned feeling will last for a while, and then you will feel a chill, inexplicable loneliness and fear, and a sense of inferiority. After the seizure, you will feel very weak and unmotivated, and you will feel nauseous and want to vomit. There will also be a headache. Images of what happened in the past are repeated in the mind. I can’t think properly and I don’t want to do anything but lie down. The seizures would come three or four times a day and gradually improve within three days. The EEG is moderately abnormal. ct is normal. I have been treated with carbamazepine, oxcarbazepine, Depakene, and Toltea for four years with poor results. I would like to know what is the disease, is it epilepsy? How should it be treated? I’d like to know what is the disease, is it epilepsy?
Wang Aihua, Department of Neurology, Shandong Qianfo Mountain Hospital: According to your description, temporal lobe epilepsy, i.e. psychomotor seizures, should be considered first. It is recommended that you go to the hospital for a cranial coronal MRI to find out whether there is unilateral or bilateral hippocampal degeneration. How long have you been taking oxcarbazepine and what medication are you currently taking? You can try lamotrigine treatment. However, no matter what medication you use, you must insist on taking it regularly and not suddenly switch to other medication or stop it suddenly to avoid continuous status epilepticus.
Patient: I have used oxcarbazepine intermittently for two times, but not for a year. The second time I used oxcarbazepine, I stopped using it during the four years of treatment with Depakene. Now use carbamazepine 0.2g per day with herbal treatment. The effect is better than the previous several effects. However, it still occurs once every two weeks or ten days, but the pain of the attack is less than before.
Wang Aihua, Department of Neurology, Shandong Qianfo Mountain Hospital: If the effect is not satisfactory, you are recommended to add Librium or Keplan treatment. If conditions allow, it is recommended to perform coronal magnetic resonance examination, and if unilateral hippocampal sclerosis is present, surgery may be an option. Be sure to pay attention to the regularity of medication and ensure sufficient sleep.