What is epilepsy
Epilepsy is a disease caused by abnormal discharges of neuronal groups in the brain due to multiple causes, including abnormalities in motor, sensory, consciousness, mental and vegetative functions. It is divided into generalized seizures, focal seizures and so on.
Most focal seizures have aura, such as fear, epigastric discomfort, sensory numbness in hands and feet, abnormal vision, hearing and smell, while generalized seizures have no aura. In a grand mal seizure, some patients start with a sharp scream, lose consciousness and fall, have generalized muscle tonicity, respiratory arrest, head and eyes can be tilted to one side, after a few seconds there are clonic convulsions, convulsions gradually increase, lasting for tens of seconds, respiratory recovery during the paroxysmal period, foaming at the mouth (if the tongue is bitten and blood foam appears). Some patients have urinary and fecal incontinence, general relaxation after convulsions or go into drowsiness (lethargic phase), after which consciousness gradually returns. Grand mal seizures can be a manifestation of generalized seizures or the result of focal seizures after generalization due to EEG. For patients with onset after adolescence, the majority of grand mal seizures are secondary to focal epilepsy, and most of these seizures have aura. However, a significant percentage of patients have seizures that do not appear or rarely appear as generalized convulsions, but instead show confusion, mental abnormalities, or a partial body convulsion, or show abnormalities in hearing, vision, and smell, etc. Improving awareness of these seizure symptoms helps to correctly identify and diagnose them early to avoid delaying treatment.
Informal treatment is harmful
Many epilepsy patients and their families lack understanding of epilepsy, think “can’t be cured”, and turn to seek secret recipes, prescriptions, and rush to the doctor, which is precisely into the wrong area. This is not only delaying the regular treatment, but also may cause bad consequences affecting health.
The majority of patients with epilepsy can be controlled by regular medication, some patients can take medication for a less long time, one or two years without seizures can be reduced and stopped, some patients may take medication for a longer time, and sometimes even need to take medication for life. The most common type of epilepsy is drug-refractory epilepsy, which is tricky to treat, and this gives some unscrupulous people the opportunity to take advantage of it. Most of the advertisements promoting epilepsy treatment on the Internet are not credible. For example, claiming high-tech technology, they often use technological buzzwords such as gene, nano, ion, superconductor, and transplant, thereby confusing many patients. In fact, these technological terms have nothing to do with epilepsy. There is no mature gene therapy technology, much less clinical treatment. Stem cell therapy is still in the basic research stage, and is still quite far from being introduced into the clinic. In addition, advertisements claiming that “several doses will help” and infinitely exaggerated efficacy are not credible. There are also informal drugs that have neither batch numbers nor relevant certificates, which should not be used indiscriminately. If patients use this kind of informal treatment, not only will delay the disease, and even serious cases can cause drug poisoning. In some cases, the condition of benign epilepsy syndromes that are curable may be complicated by irregular treatment and become medically refractory; in many cases, the long-term medication is ineffective, resulting in delay in the best time for surgery, and there may be a lot of unnecessary costs. The most important thing is that it is not easy to find the right solution for the problem.
The “good door” for formal treatment
So, what is the formal treatment for epilepsy patients?
Drug therapy
Currently, medication is the most important treatment for epilepsy. 50% of newly diagnosed patients with epilepsy can have their seizures controlled with a single antiepileptic drug, so it is important to choose the right drug for initial treatment to increase the success rate. Drug selection based on seizure type and syndrome classification is a basic principle of epilepsy treatment.
Three questions must be clarified before selecting a medication.
1. Are the seizure symptoms seizures?
2. What type of epilepsy is it?
3. What kind of epilepsy syndrome does it belong to?
The prognosis is different for each patient with different conditions and different drugs. The first thing you need to do is to take your own medication, and you should be careful not to be biased, stop the medication at will, or change the medication on your own.
Surgical treatment
After 3 to 5 years of regular medication, most patients can stop taking their medication and stop having seizures after evaluation by the doctor. Patients with “drug-refractory epilepsy” who have been on regular medication for more than two years but are not effective can choose surgical treatment after a multidisciplinary evaluation by a qualified and qualified epilepsy center. Surgery is one of the most common treatments for epilepsy, and its efficacy, especially in refractory epilepsy, has been widely demonstrated clinically, and it is the only treatment for some patients with epilepsy. Most refractory epilepsies can be cured or remitted (by reducing the number of seizures and lowering the dose of antiepileptic drugs) through surgery. Du Hao points out that epilepsy surgery is an intervention for people with drug-refractory epilepsy that uses surgical procedures to improve or control seizures. For patients with refractory epilepsy, appropriate surgical treatment can not only reduce, decrease, or even will completely control seizures, but to some extent can also improve the patient’s neuropsychological function.
There are various surgical treatment modalities for epilepsy, which are summarized in three main types.
1. excisional surgery of epileptic foci, the best results of such surgery.
2. surgery to block the propagation of epileptic discharges, which can also be done in patients who cannot undergo resection surgery, but is significantly less effective than resection surgery.
3, electrical stimulation surgery, deep brain nucleus electrical stimulation for epilepsy is still in the clinical exploration stage, is the future direction of epilepsy treatment. Vagus nerve electrical stimulation has been approved by the FDA for clinical use and is an option for patients who cannot easily locate the epileptogenic focus or who are afraid of the risks of surgery, and is less effective than excisional surgery.
There is no technique that can directly locate the epileptic focus, but only through a combination of techniques. For patients with no abnormalities in imaging examinations, they mainly rely on EEG and symptoms for localization, and even need to use intracranial electrode embedding to finally locate the location of the epileptic focus, which obviously increases the treatment cost and patient’s pain, but its efficacy is the best and the only choice for many epilepsy surgeries.