First: What is epilepsy all about?
Epilepsy is a common syndrome of the nervous system. Caused by recurrent abnormal brain cell discharges, it manifests as sudden, transient brain dysfunction. This abnormal discharge is not felt by the patient and not seen by others, but can be recorded by EEG. The most common symptom of temporary brain dysfunction in clinical practice is seizure, which is characterized by sudden unconsciousness, general rigidity or twitching of the limbs.
There are various symptoms of epilepsy, and it is not easy to diagnose epilepsy based on only one manifestation. For example, seizures are a common symptom of epilepsy, but there are many causes of seizures, such as hyperthermia, hypoxia, hypocalcemia, hypoglycemia, etc., which may cause seizures. And none of these conditions can be diagnosed as epilepsy. Therefore, the diagnosis of epilepsy can only be determined after detailed history taking, careful physical examination and EEG and other tests by epileptologists.
Epilepsy is a chronic disease, and most patients can be cured with long-term, reasonable and regular treatment. The majority of patients with epilepsy can be cured with long-term, reasonable and regular treatment.
Epilepsy is a common disease, with a prevalence of about 7 per 1,000 people in the population. When someone in the family has epilepsy, the family members are very distressed and have many concerns. The series of popular lectures will be held in conjunction with the audience. This series of scientific lectures will discuss these issues with patients and their families, and we hope that patients and their families will cooperate with each other and the medical staff so that patients can recover as soon as possible. We also hope that through this lecture, you will have a preliminary understanding of epilepsy and be able to treat patients with epilepsy and this disease correctly.
Second: What are the causes of epilepsy?
The causes of epilepsy are complex, and many central nervous system or systemic diseases can cause epilepsy. Those for which a clear cause can be found are called secondary epilepsy or symptomatic epilepsy.
Secondary epilepsy can be caused by congenital disorders or by various disorders at or after birth.
Some congenital genetic disorders such as tuberous sclerosis, cerebral facial angiomatosis, and neurofibromatosis have lesions in the brain that can cause seizures. These disorders are often seen as abnormal pigmented spots or hemangiomas on the skin.
Infection of the mother with rubella, cytomegalovirus, herpes virus during pregnancy, especially early pregnancy. or other bacterial infections that affect the fetus in utero; maternal exposure to large amounts of radiation can also cause abnormal fetal brain development, resulting in epilepsy.
Various birth injuries, asphyxia, intracranial hemorrhage, and forceps assisted delivery can cause brain damage and later epilepsy.
Various types of encephalitis and meningitis after birth may also cause seizures after a period of time after the acute phase has healed. Parasitic diseases of the brain, such as eating pork contaminated with tapeworm eggs that have not been cooked sufficiently, can also cause seizures when cysticercus larvae are parasitized in the brain.
Traumatic brain injury is also a common cause of epilepsy in adults. It is usually the more severe traumatic brain injury that causes epilepsy. Generally speaking, the more severe the traumatic brain injury, the greater the chance of epilepsy, such as traumatic brain injury combined with infection and skull fracture. Brain tumors can also cause seizures, but are mainly seen in adults. Stroke is a more common cause of epilepsy in the elderly, with some seizures occurring during the acute phase of the stroke and others occurring only after the acute phase.
In conclusion, there are many causes of epilepsy, and it is impossible to list them all here. Any disease affecting the brain may cause epilepsy, and for a specific patient, the cause should be determined by the epileptologist based on the history, signs, and the necessary ancillary tests.
However, in many patients, the cause cannot be found despite the application of various methods, and this type of epilepsy is medically known as primary epilepsy. Those who are presumed to be symptomatic, but the cause is not yet clear, are called cryptogenic epilepsy.
Third: One of the manifestations of seizures
–Generalized tonic-clonic seizures
This is the most familiar form of seizure. During the seizure, the patient suddenly loses consciousness, falls to the ground, the whole body muscles stiffen, the head tilts back, the lower limbs straighten, the upper limbs bend with force; due to the strong contraction of respiratory muscles, the air in the lungs is pressed out with force, the airflow passes through the larynx, and a sharp scream is issued; due to the tonic contraction of respiratory muscles, respiration stops temporarily, resulting in a general lack of oxygen, and the face and lips turn purple. This period is medically known as the tonic period, which lasts from a few seconds to tens of seconds. This is followed by the clonic phase, which is characterized by rhythmic jerking of the whole body and sometimes biting of the lips or tongue due to the jerking of the masticatory muscles; incontinence of urine due to contraction of the abdominal and bladder muscles; and foaming at the mouth due to increased salivation and excessive breathing movements. This phase usually lasts for one to three minutes and then stops. After the clonic phase, the patient often falls into a state of drowsiness and wakes up after a short period of more than 10 minutes or a long period of several hours.
In some patients, the seizure can only have a tonic phase without a clonic phase, which is called a tonic seizure; while other patients can also only have a clonic phase without an obvious tonic phase, which is called a clonic seizure.
Patients with generalized tonic – clonic seizures, if they occur during the day, especially when the patient is in the state of working at height, machine operation, driving a vehicle or in the environment such as near the water or fire, the patient has considerable danger, this is one of the common causes of death in epileptic patients, should cause patients and their families to pay great attention.
Fourth: The second manifestation of seizures
–The first thing you need to do is to get a good idea of what you are doing.
Aphasic seizures are a form of seizure mainly seen in children. It is usually onset after four to five years old, the seizures are all in the waking hours, manifested as a sudden stop of the ongoing activities, but not fall, eyes straight, if holding something in the hand, usually will not fall on the ground, sometimes eyelids slightly shaking, hands also slightly shaking, but not jerking. One episode of disorientation usually lasts only ten seconds or so, after which the original stopped activity continues. If the attack occurs while speaking, the speech is suddenly interrupted and then resumes after ten seconds or so. Aphasic seizures may occur several to a dozen times a day, and individual children may have hundreds of seizures a day. Aphasic seizures can be combined with other forms of seizures, which are easily noticed by others, while aphasic seizures are often ignored. The prognosis is good, does not affect the intellectual development, generally with age and with the right treatment and gradually reduce, most of the seizures stop before adulthood.
In the clinic, there is another kind of seizure called “atypical aphasic seizure”, also mainly seen in children, but this is different from aphasic seizures, although this kind of seizure also shows episodes of dazed, two eyes straight, etc., but its duration is longer than aphasic seizures, combined with other types of seizures are also far more than aphasic seizures, EEG performance is also very different from aphasic The prognosis of atypical aphasic seizures is worse than that of aphasic seizures, and treatment is more difficult, often accompanied by intellectual impairment.
There is also a type of seizure called “pseudo-ataxia”, which is more common in adults. The lesion is located in the temporal lobe of the brain, and the duration of the seizure is longer than that of the aphasic seizure. The treatment of “pseudo-anhedonia” seizures is also relatively difficult.
The three seizures mentioned above are often confused, but the treatment and prevention of the three seizures are very different. The exact identification should be determined by the epileptologist based on the clinical characteristics of the patient and the EEG performance.
Fifth: The third form of seizure presentation
–myoclonic seizures and atonic seizures
Myoclonic seizures are the most common form of seizures in children and adolescents. These seizures are often more frequent in the early morning shortly after waking up. The seizures are characterized by sudden, rapid, powerful jerking of a part of the body, caused mainly by sudden muscle contractions in these areas. Depending on the part of the jerk, the patient may show a sudden nodding, bending or leaning back, or the whole body may suddenly lean back or fall to one side, or some do not fall to the ground, but only show a “jolt”. When the attack falls, the two hands will not hold the ground, there is usually no aura before the attack, some suddenly lower the head, so that the forehead or jaw often bruised. If the muscles of the limbs suddenly contract, they often show a sudden shaking of the limbs, and the things in the hands will fall out. There is no loss of consciousness before and after the twitch, and the person can stand up quickly after falling. Sometimes after a myoclonic seizure, there is another seizure a few seconds or minutes later, several times in a row. Some patients can have as many as several dozen seizures a day. Myoclonic seizures are often combined with other types of seizures. It should be noted that many normal people may have sudden shaking of the limbs at night after going to sleep, and some even wake up because of the sudden shaking, which is a normal physiological condition and cannot be misdiagnosed as a seizure.
Atonic seizures are a special type of seizure. It is not a seizure in which the limbs are not twitching, but a sudden loss of muscle tone, manifested by sudden general weakness and inability to maintain normal posture. If the patient is standing at the time of seizure, he or she suddenly lowers the head, drops the shoulders, spreads the fingers, and bends the knees, and then falls down. If the seizure occurs while sitting, the head is bowed and the patient does not necessarily fall. If the attack occurs while lying down, it is often not visible because it does not fall. There is a brief loss of consciousness during the seizure, but it quickly recovers. The person is able to stand up immediately after falling. Sometimes the seizure is aborted when the knee is flexed and the lower limb is bent when it is about to fall, and consciousness is restored, at which time the patient can stand up immediately. Sometimes some patients can show continuous seizures, showing a sudden fall, stand up, fall again, stand up again ……, and stop the seizure several times. The most common type of seizure is the myoclonic seizure, and some patients may also have intellectual disability.
Sixth: seizure manifestations of the fourth
–Simple partial seizures
This kind of seizure is mostly caused by a part of the brain lesion. It is characterized by clear consciousness during seizures and complete perception of seizure performance. The performance varies depending on the location of the lesion. In some cases, the motor seizure is a twitching of an upper or lower limb or any part of the body, and the twitching can be extended from one limb to other limbs. “Some seizures are called “postural seizures”; some seizures are called “articulatory seizures” when speech is interrupted. Some of them are numbness or pins-and-needles sensation in one part of the body. Occasionally, some patients may experience vertigo, where the body seems to be falling downward in the air or floating on a boat. Patients often experience epigastric discomfort, abdominal pain, nausea, vomiting, pale or flushed face, etc. Mental seizures are mainly manifested as mental activity disorders, such as memory disorders, which can be manifested as familiarity with people or environments that you have never seen before, which is called “déjà vu”, or very familiar people or environments that you do not know, which is called “strangeness “In the case of cognitive disorder, the symptoms may include dream-like state, unreality and time distortion; in the case of emotional disorder, the symptoms may include episodes of unpleasantness, fear, depression, low self-esteem, etc. The symptoms may also include sudden onset and rapid disappearance of unexplained anger.
Simple partial seizures, due to its various manifestations during the seizure, it is very easy to cause misdiagnosis or omission, such as many other diseases of the nervous system can also show a limb twitching, vertigo, etc. Visual and auditory disorders are common symptoms of many ophthalmology and ophthalmology diseases, abdominal pain, nausea, vomiting is the most common symptoms of digestive system diseases, as for emotional disorders, thought disorders in the symptoms of psychiatric diseases. It is even more common, so attention should be paid to the differentiation of these manifestations. Generally speaking, epileptic seizures are characterized by seizures, repetition, and stereotypes, occurring and disappearing suddenly, lasting from a few seconds to a few minutes, with repeated seizures and basically the same performance each time, often described by the patient as “coming without shadow, going without trace”, “ghostly “The diagnosis is generally not difficult when combined with EEG examination, and if necessary, the patient can seek help from an epileptologist.
Seventh: The fifth form of seizure presentation
–Complex partial seizures
This type of seizure, like the simple partial seizure described in the previous one, is also mostly caused by a lesion in a part of the brain. The difference is that this type of seizure is accompanied by impaired consciousness, and after the seizure subsides, the patient cannot recall the situation during the seizure. In other words, all of the simple partial seizures mentioned in the previous category are complex partial seizures if they are accompanied by impaired consciousness. Another kind of seizure called “automatism” is also a common form of complex partial seizure. (1) Eating automatism: The patient does not have anything in the mouth, but repeatedly chews or swallows, as if he or she is eating, and eating automatism is the most common form of automatism. (2) Imitative automatism: It is the imitation of various emotional states without any reason, such as fear-like, depression-like, panic-like, etc. (3) Postural automatism: It is the second most common form of automatism after eating automatism. It manifests itself in various postures that are common in daily life, such as unbuttoning clothes, fumbling with clothes or bedding, touching a part of the body, raising the hand in the air, etc. (4) Walking automatism: It is manifested as purposeless actions, such as walking indoors and outdoors, riding a bicycle, taking a bus, or even driving a motor vehicle, but often violating traffic rules. Like simple partial seizures, complex partial seizures are also clinically prone to misdiagnosis or omission due to their diverse manifestations and the fact that the duration of their seizures can last for hours or even days. In the case of automatic seizures, although the movements seem to have a purpose and seem to be coordinated and flexible, careful observation will reveal that the patient gives a feeling of “unclear and confused” during the seizure, and the movements are more monotonous and stereotypical. In case of diagnostic difficulties, an epileptologist can be consulted and a standardized EEG can be performed.
Eighth: How to reflect the epilepsy patient’s condition to the physician
A comprehensive and detailed understanding of the condition is the first step in the diagnosis of the disease by the physician. Epilepsy is a seizure disorder, and in most cases, the physician cannot witness the patient’s seizure performance during the visit. Therefore, it is important to understand the condition. In addition, because a significant number of patients with epilepsy are unconscious during the onset of seizures and are completely unaware of their seizure performance after the seizure has subsided, most epileptic patients rely on family members or other witnesses to provide information about their condition.
It is important to be truthful about the condition to the physician, neither concealing it nor exaggerating it. If you do not remember or see something, you should answer: “I don’t know, I don’t remember, I didn’t pay attention”, etc. You should never reflect your condition to the physician based on your own speculation and imagination.
Generally speaking, the physician wants to know the following things. The performance of the seizure, including whether there is loss of consciousness, whether there is awareness of peripheral activities, whether there is speech, whether there is a change in facial color, and whether the limbs are twitching. If there is twitching, whether it is in one limb, one side of the limb, or all four limbs, whether the twitching starts in one limb or all four limbs at the same time, whether there is twitching in the face, whether there is urinary incontinence or tongue biting, and how long the twitching lasts. In some cases, the seizures do not appear as twitches, but as episodes of numbness, dizziness, dazedness, dazedness, hallucinations, hallucinations, hallucinations, hallucinations, etc., as described in our previous two lectures. The timing and frequency of the seizures are also more important, such as several times a day. If the seizures are related to sleep, fatigue, anger, etc., and if the seizures are related to the menstrual cycle in female patients after puberty, it is important to note the situation before and after the seizures. The situation before and after the attack should also be noted. Some patients have some kind of aura a few seconds, minutes or hours before the attack, which makes the patient anticipate that he or she is going to have an attack. The aura may be dizziness, a feeling of gas in the upper abdomen, or difficulty in the heart; after the attack, some patients return to normal soon after the attack, while others have dizziness, headache, drowsiness, or temporary paralysis of the twitching limb after the attack. Previous diagnosis and treatment should also be fully reflected, what drugs have been used, dosage, efficacy, side effects, etc., what tests have been done in the past such as EEG, cranial CT, cranial MR, etc., what are the results, it is best to bring the original EEG records and CT and MR films. It is worth reminding that some patients’ families, although they have been seen and examined in several hospitals, deliberately do not say anything, as if to “test” the physician, which is very wrong, one is to delay the diagnosis, the second may increase the unnecessary economic burden, and the third is to affect the treatment.
In short, the family should reflect the condition objectively and accurately, but also comprehensively and in detail, so that the physician can accurately diagnose and treat the patient in a timely manner.
Ninth: Epilepsy and electroencephalography
We talked about in the first lecture that epilepsy is caused by abnormal discharge of brain cells in recurrent seizures, which cannot be felt by the patient and seen by others. In fact, the voltage and power of these discharges are very weak, and it is through modern science and technology that the EEG amplifies this very weak electrical activity by more than a million times and records it on a drawing. This becomes what we usually refer to as an EEG.
Since EEG reflects the basic mechanism of epilepsy pathogenesis, i.e. abnormal discharge of brain cells, it is of great value in the diagnosis, identification, typing, evaluation of efficacy, reduction and discontinuation of medication. In epilepsy itself, the value of EEG examination is much greater than any other examination.
To make a diagnosis of epilepsy, two basic conditions must be present: the presence of clinical seizures and evidence of abnormal brain cell discharge, i.e., the presence of an epileptic waveform on the EEG. There must be abnormal discharges during a seizure, while there may be equally abnormal discharges when there is no seizure, the latter condition being medically called clinical underdischarge. In fact, it is difficult for most patients to do an EEG during seizures, so the vast majority of patients are clinically caught with abnormal discharges when there are no seizures, i.e., subclinical discharges, as a basis for diagnosis. The abnormal discharges in epileptic patients are random, either during the day or at night, and the duration of each discharges is often extremely short, mostly tens of milliseconds to a few seconds, which is sufficient to illustrate the difficulty of capturing abnormal discharges, but the ability to capture such abnormal discharges plays a decisive role in the diagnosis and even the typing of patients. The first is to ensure the tracing time each time, the second is to repeat the tracing several times, and the third is to use some methods to “induce” abnormal discharge, such as sleep tracing, flash stimulation, big mouth gasping, etc. To draw an analogy, the reason is very simple, abnormal discharge is “thief”, EEG is “The longer the “police squatting” time, the more times, the greater the possibility of catching the “thief”. The longer and more often the “police” squat, the greater the possibility of catching the “thief”, and if you can give the “thief” a little “bait”, the possibility of catching will be even greater. We require that the EEG examination of epileptic patients must be standardized. The so-called standardization is to ensure that time and various methods of inducing abnormal discharges are implemented. Including awake EEG, sleep EEG, etc., a standardized EEG examination should take about 90 minutes. It is worth mentioning that currently some epilepsy patients have only about 20 minutes or even only about 15 minutes of EEG examination, so it is conceivable that such examination has little or no value for epilepsy diagnosis. At present, regular epilepsy treatment centers, in addition to conventional EEG, also carry out dynamic EEG monitoring and long-range video EEG monitoring, which greatly improve the EEG diagnosis of epileptic patients.
Tenth: What to pay attention to when checking EEG
EEG examination has a pivotal value for epilepsy diagnosis, typing, and efficacy evaluation. It should be clear that EEG examination is a non-invasive and painless examination. As mentioned in the previous lecture, in order to catch the abnormal discharges of brain cells and to make a clear diagnosis, sometimes the test can be repeated several times, and patients and their families do not need to have any concerns. However, once the diagnosis is confirmed, during the treatment period, if there is no special need, it is sufficient to recheck the EEG once in three months to six months. Generally, when the patient’s condition improves, the EEG will also improve. Of course, there are some exceptions, where the seizures are completely controlled, but the EEG still fails to return to normal.
You should wash your hair the day before you do the EEG, and do not apply head oil or other fatty cosmetics after washing. Eat normally before the examination, do not starve, so as not to affect the EEG with hypoglycemia. Patients who are under treatment do not need to stop their medication; sudden stopping of medication can cause frequent seizures, and that is dangerous. If you have a seizure, you should generally check it about a week after the seizure. It is not very meaningful to check the EEG immediately after the seizure.
Sleep EEG is of great value for epilepsy diagnosis. A sleep EEG is necessary for a formal epilepsy EEG because many patients with epilepsy only have EEG abnormalities during sleep or mainly during sleep. The sleep EEG usually requires the patient to go to bed as late as possible the day before the examination, such as 11:00 pm or even after 12:00 pm, and to wake up at 4-5:00 pm on the day of the examination, if it is an afternoon examination. In this way, it is easy to perform sleep EEG in a soundproof examination room with the necessary medication.
Video EEG is a very advanced EEG examination technique mainly used for epilepsy diagnosis. Although its examination cost is higher than that of ordinary EEG, it is equipped with an advanced camera system to analyze and process the EEG signal synchronously with the patient’s image signal because it adopts the international common examination method for epilepsy patients. Therefore, its diagnostic value for epilepsy is also incomparable to that of ordinary EEG. With the development of computer technology, video EEG monitoring can be performed for 24 hours, 48 hours, 72 hours, or even longer, depending on the patient’s condition. Although video EEG monitoring takes longer and is more expensive than general EEG, its value is also significantly greater than that of general EEG. Whenever possible, video EEG monitoring should be used in patients with epilepsy to provide more valuable diagnostic information.
Eleventh: Epilepsy and CT and MR examinations
CT stands for Computed Tomography, and MR stands for Magnetic Resonance Imaging. These two tests are extremely important imaging methods in current medicine and play a pivotal role in the diagnosis of many diseases. However, because of their relatively expensive cost, a cautious attitude should be taken when deciding whether to do CT or MR examinations in patients with epilepsy to avoid adding unnecessary financial burden to the patient.
In general, both CT and MR examinations are of little significance in determining the diagnosis of epilepsy and are mainly used to find the cause of epilepsy in patients who have been diagnosed with epilepsy. This is because many diseases that cause epilepsy can have specific changes on CT or MR. For example, among the causes of epilepsy we mentioned in the second lecture, congenital brain malformations, brain tumors, brain abscesses, brain hemorrhage, brain infarction, brain parasites, brain trauma, and brain atrophy can not only reveal some characteristic changes on CT or MR, but can also help to determine the location of the lesion.
However, there are also some patients with epilepsy that are not caused by these aforementioned causes, and CT or MR often have no specific findings. In general, in clinical practice, CT or MR examinations are usually not necessary when primary epilepsy is considered, while CT or MR examinations are often required when secondary epilepsy is considered; it is not necessary in patients with generalized seizures identified, while patients with partial seizures identified often suggest an abnormality in a part of the brain, and CT or MR examinations are then very necessary; in addition, if the patient is well treated, CT or MR examination can be suspended if the patient is well treated, while in patients with refractory epilepsy it is necessary to examine to understand the intracranial situation.
Therefore, CT or MR examinations are valuable in finding the cause of epilepsy in patients with epilepsy, but not every patient needs to have a CT or MR examination.
The difference between CT and MR exams is that MR can detect smaller lesions and show lesions more clearly than CT, but it is also more expensive than CT, and in some aspects MR is not as good as CT.
Can epilepsy be cured?
When a family member suffers from epilepsy, they always hope to be cured as soon as possible, so they seek medical help. In clinical practice, we often hear family members ask such questions as “Can this disease be cured?”, “Can this disease be cured? This is the main concern of patients and their families. This is the most important question for patients and their families, but it is also a difficult question for physicians to answer.
First of all, we need to understand the concept of “cure” correctly. In clinical practice, some diseases, such as tuberculosis and bacillary dysentery, have a clear cause, and as long as they are effectively treated and the causative bacteria are eliminated, the patient will soon recover and the disease will be completely “cured. However, there are some clinical diseases where the cause is not clear, such as hypertension, chronic gastritis, etc. It is difficult to remove the “root” of the disease, and the physician can only use drugs to control the symptoms so that it does not manifest itself. A significant proportion of epilepsy falls into the latter category. In addition, for epilepsy, the cure is conditional on the absence of clinical seizures and EEG changes after a long period of observation. It is irresponsible to declare that epilepsy is cured after six months or a year or after a few months without seizures.
For a specific patient, whether epilepsy can be cured or not is mainly related to the following factors. The first is the cause, such as epilepsy caused by cranial trauma, after the trauma is cured, after reasonable treatment, epilepsy is also mostly improved; similarly, epilepsy caused by stroke, after the acute stage, the condition is stable, plus effective antiepileptic treatment, most patients’ seizures can be controlled; while epilepsy caused by brain tumor, without removing the tumor, obviously epilepsy is impossible to cure; epilepsy caused by congenital brain insufficiency often does not work well. The prognosis of primary generalized epilepsy with aphasic seizures and primary partial epilepsy with BECCT (benign partial epilepsy in children with central mesial temporal discharges) is quite good, with most seizures stopping before puberty, while secondary generalized epilepsy with Lennox syndrome in children and secondary partial epilepsy with temporal lobe epilepsy in adults have a relatively poor prognosis and are often refractory to treatment. The third is the choice of drugs for treatment. The third is the choice of drugs for treatment. The principle of drug selection for modern epilepsy treatment is mainly based on the typing of epilepsy, which is mainly based on clinical seizure performance and EEG examination, and the kind of diagnosis of epilepsy without epilepsy typing that starts the selection of drugs for treatment is wrong and blind.
In recent years, the diagnosis and treatment techniques of epilepsy have been greatly improved, and foreign information shows that about 80% of epilepsy patients can be cured by reasonable treatment.
Thirteenth: How to treat epilepsy
The treatment of epilepsy is a big topic, what we call epilepsy here refers to the chronic disease state with seizures as the main manifestation, those acute or progressive brain diseases with seizures are not in the scope of this discussion, such as brain tumors, encephalitis, meningitis, stroke, etc. can have seizures, the main cause of these diseases is the treatment, after the cause is removed seizures can mostly improve, of course, if If you have frequent seizures after removing the cause and entering the recovery period or even the sequelae period, you should undergo regular anti-seizure crippling treatment.
The main treatment for epilepsy is currently recognized at home and abroad. Currently, the commonly used antiepileptic drugs include phenytoin sodium, carbamazepine, phenobarbital, sodium valproate, etc. New drugs such as lamotrigine, topiramate, oxcarbazepine, and levetiracetam have been introduced in recent years. Drug therapy should follow the principle of monotherapy whenever possible, and the choice of drug is mainly based on the type of seizure and type of epilepsy syndrome of the patient. In addition, some special epilepsy syndromes have special drug selection, such as acquired aphasic epilepsy (LKS), which can be treated with adrenocorticotropic ho