Epilepsy

Introduction to epilepsy Epilepsy, commonly known as "shofar wind" or "sheep epilepsy", is a chronic disease that causes transient brain dysfunction due to sudden abnormal discharge of brain neurons. Due to the difference in the initial location and mode of delivery of abnormal discharge, the clinical manifestations of seizures are complex and diverse, which can be manifested as paroxysmal movement, sensation, autonomic nerve, consciousness and mental disorder. The causes of epilepsy are diverse. Patients with epilepsy are treated with regular anti-epileptic drugs. About 70% of patients can be controlled by episodes. 50% to 60% of patients can be cured after 2-5 years of treatment. Patients can work like normal people. life. According to the latest epidemiological data in China, the overall prevalence of epilepsy in China is 7.0, the annual incidence rate is 28.8/100,000, and the prevalence of active epilepsy within one year is 4.6. Based on this, it is estimated that there are about 9 million epilepsy patients in China, of which 5-6 million are active epilepsy patients, and about 400,000 new epilepsy patients are added each year. In China, epilepsy has become the second most common neurological department after headache. disease. basic knowledge The proportion of illness: 0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: acute renal failure

Epilepsy

Brain damage and brain damage (30%):

Brain damage and brain damage, viral infection during embryonic development, radiation dysplasia or other causes of embryonic dysplasia can cause epilepsy in the fetal production process, birth injury is also a major cause of epilepsy can also cause epilepsy.

Self factor (30%):

In patients with epilepsy, fever, systemic infection, surgery, high mental stress and excessive fatigue can induce a sustained state even if the effective blood concentration is maintained. Food poisoning, drug poisoning, drinking, overwork, pregnancy, childbirth, etc. are common causes of epileptic seizures. In addition, water, electrolyte disorders, congenital metabolic abnormalities, etc. can also lead to the occurrence of epileptic seizures.

Brain disease (15%):

Other diseases of the brain, brain tumors, cerebrovascular diseases, intracranial infections, etc.

Genetic factors (10%):

Male patients are slightly more than female patients, and the incidence rate in rural areas is higher than that in cities. In addition, fever and mental stimulation are also the causes of epilepsy.

Genetic factors (15%):

Epilepsy is prevalent in a family of patients with a history of epilepsy or a congenital central nervous system or cardiac malformation.

Epilepsy prevention

Daily prevention

Prevention of epilepsy is very important. Prevention of epilepsy is not only related to the medical field, but also to the whole society. Prevention of epilepsy should focus on three levels: one is to focus on the cause, to prevent the occurrence of epilepsy; the second is to control the seizure; the third is to reduce the adverse effects of epilepsy on the physical, psychological and social aspects of patients.

1. Prevent the occurrence of epilepsy

Pay attention to prenatal and postnatal care, and prohibit close relatives from getting married. During the first trimester of pregnancy, be sure to stay away from radiation and avoid viral and bacterial infections. Regular pregnancy test, avoid fetal hypoxia, asphyxia, birth injury and so on during childbirth. When children have fever, they should seek medical treatment in time to avoid high fever and convulsions and damage brain tissue. You should also take care of your child and avoid head trauma. Young people, middle-aged people and the elderly should pay attention to ensuring a healthy lifestyle to reduce the incidence of encephalitis, meningitis and cerebrovascular diseases.

Genetic factors make certain children convulsive and produce seizures under the triggering of various environmental factors. In this regard, special emphasis should be placed on the importance of genetic counseling. Family surveys should be conducted in detail to understand whether there are seizures and seizures in the parents, siblings and close relatives of the patients, and some serious hereditary diseases that can cause mental retardation and epilepsy. Prenatal diagnosis or screening during neonatal screening should be performed to determine termination of pregnancy or early treatment.

For secondary epilepsy, it should be prevented from its specific specific cause, prenatal care for maternal health, reduction of infection, nutritional deficiencies and various systemic diseases, so that the fetus is less affected. Prevention of childbirth accidents, neonatal birth injury is one of the important reasons for the onset of epilepsy, avoiding birth injury is important to prevent epilepsy. If the pregnant woman can be regularly checked, the new method is delivered, and the dystocia is dealt with in time, the birth injury can be avoided or reduced. Pay attention to the febrile seizures in infants and young children, try to avoid seizures, and immediately control the medication. Active prevention, timely treatment and reduction of sequelae in children with central nervous system diseases.

2, control the attack

Mainly to avoid the predisposing factors of epilepsy and comprehensive treatment to control the onset of epilepsy. Statistics show that after the first seizure, the recurrence rate is 27%-82%. It seems that most patients will relapse after a single episode. Therefore, it is particularly important to prevent the recurrence of epileptic symptoms.

Patients with epilepsy should be diagnosed promptly and treated early. The earlier the treatment, the smaller the brain damage, the less the recurrence, and the better the prognosis. To correctly and rationally use the medicine, adjust the dosage in time, pay attention to individual treatment, the treatment course should be long, the withdrawal process should be slow, and the medication should be adhered to regularly, and the efficacy evaluation and blood concentration monitoring should be carried out when necessary. Do not arbitrarily administer drugs and not regulate drugs. Removal or reduction of primary diseases that cause epilepsy, such as intracranial space-occupying diseases, metabolic abnormalities, infections, etc., are also important for recurrent episodes.

3, reduce the sequelae of epilepsy

Epilepsy is a chronic disease that can last for years, even decades, and can have serious adverse effects on the patient's physical, mental, marital, and socioeconomic status. In particular, deep-rooted social prejudice and public discriminatory attitudes, patients' misfortunes and frustrations in family relations, school education and employment, and restrictions on cultural and sports activities can not only cause stigma and pessimism, but also seriously affect patients' physical and mental health. A family, a teacher, a doctor, a nurse, and even the society itself that develops and plagues patients. Therefore, many scholars have emphasized that the prevention of sequelae of epilepsy is as important as the prevention of the disease itself. The sequela of epilepsy is both the patient's body and the whole society. This requires the community to understand and support people with epilepsy. Minimize the social sequelae of epilepsy.

Publicity and education

1, psychological guidance

Epilepsy is a chronic disease with recurrent episodes. Therefore, patients often have anxiety and inferiority. Nurses should patiently explain the condition, encourage patients to maintain optimism, eliminate tensions, fears and other uneasy factors, build confidence and develop good habits.

2, diet guidance

Eat a regular diet, eat every meal on time, avoid hunger and overeating. For patients with a strong-straight-line episode, do not drink too much at a time to avoid induction. Eat light, digestible, nutritious foods, eat more fruits and vegetables, avoid spicy and irritating foods, and quit smoking.

3, rest, activity guidance

Seizure control, symptom relief, no mental abnormalities can be appropriate activities and work. Those who have more frequent episodes should be restricted to indoor activities, and if necessary, rest in bed and guardrails to prevent falls.

Epilepsy complications Complications acute renal failure

Often complicated by acute renal failure, acute promyelocytic leukemia, and mental depression.

Acute renal failure (ARF) is referred to as acute renal failure and is a clinically critical disease. The disease is an acute kidney damage caused by a variety of causes, which can make the nephron regulating function drastically decrease within a few hours to several days, so that the body fluid electrolyte balance and excretion of metabolites cannot be maintained, resulting in hyperkalemia and metabolic acid. Poisoning and acute uremia syndrome, this syndrome is clinically known as acute renal failure.

Acute promyelocytic leukemia (APL) is a special type of acute myeloid leukemia (AML), which is classified as acute myeloid leukemia M3 by the FAB collaborative group.

Depression is a common mood disorder, which can be caused by various reasons. The main and clinical features are characterized by significant and persistent low mood, and the mood is not commensurate with its situation. In severe cases, suicidal thoughts and behaviors can occur. Most cases have a tendency to recurrent, most of which can be relieved, and some may have residual symptoms or become chronic.

Epilepsy Symptoms Common Symptoms Palmats atd angles... Imitative autonomic calcium influx body shakes both eyes upwards gaze pathological paradoxes epileptic seizures gastrocnemius tonic contraction... pulsating headache abdominal pain

Epilepsy can be seen in all ages. The incidence of epilepsy in children is higher than that in adults, and the incidence of epilepsy decreases with age. In the old age (after 65 years old), the incidence of epilepsy has increased due to increased cerebrovascular disease, Alzheimer's disease and neurodegenerative diseases. The clinical manifestations of seizures are complex and diverse due to the difference in the initial location and mode of delivery of abnormal discharges.

1, comprehensive tonic - clonic seizures (large episodes) : characterized by sudden loss of consciousness and generalized rigidity and convulsions, typical seizures can be divided into strong period, clonic period and late stage. The duration of an episode is generally less than 5 minutes, often accompanied by tongue bites, urinary incontinence, etc., and is prone to suffocation and other injuries. Ankylosing-clonic seizures can be found in any type of epilepsy and epilepsy syndrome.

2, absence of seizures (small episodes) : typical disappointment manifested as sudden occurrence, action stop, gaze, called not, may have blinking, but basically without or accompanied by mild motor symptoms, the end is also sudden. Usually lasts 5-20 seconds, rarely more than 1 minute. Mainly seen in children with epilepsy.

3, tonic attack : manifested as a sudden sustained contraction of the paroxysmal whole body or bilateral muscles, muscle stiffness, so that the limbs and body are fixed in a certain tension posture, such as axial body extension dorsiflexion or flexion. It usually lasts from a few seconds to tens of seconds, but generally does not exceed 1 minute. Tonic attacks are more common in patients with epilepsy with diffuse organic brain damage, usually marked by severe conditions, mainly in children, such as Lennox-Gastaut syndrome.

4, myoclonic seizures : is a rapid and short contraction of muscle burst, which is similar to the body or limb electric shock-like shaking, sometimes several times in a row, more often after awakening. It can be a whole body movement or a partial movement. Myoclonus is common in clinical practice, but not all myoclonus is a seizure. There are both physiological myoclonus and pathological myoclonus. At the same time, the myoclonus associated with the EEG multi-spindle slow wave is a seizure, but sometimes the slow wave of the EEG may not be recorded. Myoclonic seizures can be found in some patients with idiopathic epilepsy with good prognosis (such as infant benign myoclonic epilepsy, juvenile myoclonic epilepsy), and some poor prognosis with diffuse brain damage. In epilepsy syndrome (such as early myoclonic encephalopathy, infant myoclonic epilepsy, Lennox-Gastaut syndrome, etc.).

5, : refers to the baby sputum, manifested as a sudden, short-lived torso muscle and bilateral limbs of tonic flexion or extensibility contraction, more manifested as paroxysmal nod, occasional paroxysm. The entire process of muscle contraction is about 1-3 seconds, often clustered. Common in West syndrome, other infant syndromes are sometimes seen.

6, the onset of tension : due to bilateral or part of the muscle tension suddenly lost, resulting in the inability to maintain the original posture, the occurrence of tripping, limb fall and other performance, the attack time is relatively short, lasting for a few seconds to more than 10 seconds more common, attack Short durations are often accompanied by significant disturbances of consciousness. Symptoms of tension and seizures occur alternately with episodes of atypical seizures and atypical absences in epilepsy with diffuse brain damage, such as Lennox-Gastaut syndrome, Doose syndrome (myoclonus-standing absent epilepsy), subacute sclerosing whole brain Early in the inflammation, etc. However, some patients have only seizures and their causes are unknown.

7, simple partial seizures : clear consciousness at the time of onset , duration of seconds to more than 20 seconds, rarely more than 1 minute. Depending on the origin of the discharge and the location of the lesion, a simple partial seizure may manifest as motility, sensory, autonomic, and psychiatric. The latter two appear less alone, often developing a complex partial seizure.

8, complex partial seizures (psychomotor episodes) : seizures with varying degrees of disturbance of consciousness. The performance is that the sudden movement stops, the two eyes are straight, and they are called, they should not fall, and the face does not change. Some patients may have autonomic symptoms, such as involuntary and unconscious movements, such as rubbing lips, pouting, chewing, swallowing, groping, wiping face, clapping hands, walking aimlessly, talking to themselves, etc., after the episode can not recall. Most of it originates from the medial or marginal system of the temporal lobe, but it can also originate from the frontal lobe.

9, secondary generalized seizures : simple or complex partial seizures can be followed by a generalized seizure, the most common secondary generalized tonic-clonic seizures. Partial seizures followed by generalized seizures are still in the category of partial seizures. They are significantly different from the comprehensive seizures in terms of etiology, treatment and prognosis. Therefore, the identification of the two is particularly important in clinical practice.

Examination of epilepsy

1, EEG, BEAM, Holter (EEG, EEG topographic map, dynamic EEG monitoring): visible pathological waves, spikes, spikes, spines - slow waves or sharp - slow waves.

2, if secondary epilepsy should be further head CT, head MRI, MRA, DSA and other tests can find the corresponding lesions.

3, waist wear CSF inspection, there may be changes.

Diagnosis of epilepsy

diagnosis

After the diagnosis of epilepsy is determined, try to find out the cause. In the medical history, you should ask whether there is a family history, birth and growth, whether there is any history of encephalitis, meningitis, brain trauma. Check for signs of nervous system, systemic diseases, etc. Then select relevant tests, such as head magnetic resonance (MRI), CT, blood glucose, blood calcium, cerebrospinal fluid examination, etc., to further identify the cause.

Differential diagnosis

Should be identified with syncope, pseudo seizures, narcolepsy, hypoglycemia. According to EEG, medical history, symptoms and signs are not difficult to identify.

(1) narcolepsy:

It is an unexplained sleep disorder in which unrestrained sleep occurs at times and places where sleep should not occur. Its sleep is the same as normal sleep and can be awakened. Most patients may be accompanied by one or several other symptoms, including cataplexy, sleep apnea and sleep illusion, also known as narcolepsy. The onset age is mostly 10-20 years old, the incidence of both sexes is the same, and individual cases have a positive family history.

The main symptoms are irresistible sleep, especially in various sitting conditions, or after meals and afternoons. Most patients feel drowsiness before the attack, or have tried hard to resist. Only a few patients suddenly enter the state of relative waking. Sleep, each episode lasts for a few seconds to several hours, about 10 minutes, the degree of sleep is not deep, easy to wake up, generally feel clear after waking up, may occur many times a day.

The main clinical symptoms of this disease should be differentiated from epileptic seizures. The onset age of epileptic seizures is earlier than that of narcolepsy. Children are more common. The episodes are sudden loss of consciousness rather than sleep, and some are accompanied by loss of tension, but the duration is short, usually only a few seconds. EEG 3C/S The spine-slow complex wave is a characteristic change in epileptic seizures.

(2) syncope (with syncope and large seizures, small seizure identification):

This is a group of symptoms caused by a variety of reasons for the temporary lack of blood supply to the brain, resulting in a high degree of inhibition of the cerebral cortex and a sudden loss of consciousness. Clinical according to the principle of the disease and the causes of syncope are as follows: 1 Reflex syncope: including vascular decompression syncope, orthostatic hypotension, carotid sinus syndrome, swallowing syncope, urinary syncope, coughing syncope, supine Hypotension syndrome. 2 cardiogenic syncope: including arrhythmia, sick sinus syndrome, aortic stenosis, congenital heart disease, primary pulmonary hypertension, angina pectoris and acute myocardial infarction. 3 brain-derived syncope: including blood circulation disorders of the brain, local blood supply deficiency, nerve tissue itself, brain injury.

In summary, the difference between syncope and epileptic seizures is: 1 There is often no aura in syncope episodes, and there are many auras in epileptic seizures. 2 The syncope caused by syncope is a generalized paralysis of the angled arch, and occurs mostly when the loss of consciousness is more than 10 seconds. The seizure caused by epilepsy is clonic and lasts longer before the loss of consciousness. 3 When the syncope occurs, it is rare to bite the tongue or incontinence, but it is more common in epileptic seizures. 4 syncope recovery is faster, no obvious sequelae, and recovery after epileptic seizures is slow, often left with sleepiness, headache and confusion.

The difference between syncope and epileptic seizures: 1 more syncope episodes accompanied by falls, while epileptic seizures did not. 2 The blood pressure decreased when the syncope occurred, and the complexion was pale and continued to the late stage of syncope, while the epileptic seizures showed no significant changes in blood pressure and complexion. 3 The onset and termination of syncope is slower than that of epileptic seizures; 4 systemic weakness after syncope episodes, and can continue to be active after epileptic seizures.

(3) Migraine:

Typical migraine accounts for about 10% of migraine headaches. Generally, the onset of puberty, family history, strong emotional stimulation, alcohol, menstrual cramps, and certain hormones acting on blood vessels are common predisposing factors for this disease. There are aura symptoms before the onset of headache, such as flashing illusion, flashing dark spots, Venus, etc., and reach a peak before the onset of headache, and then disappear.

Ordinary migraine is the most common type of headache in the clinic, with no clear aura symptoms. Some people have mental disorders, gastrointestinal symptoms, headaches, and traits with typical migraine headaches several hours before or even a few days ago. However, the duration is longer than typical migraine headaches. It can last for several days. The headache can be double. Laterality, there may also be a family history.

Special type migraine is relatively rare in clinical practice. Among them, ophthalmoplegia and hemiplegic migraine are mostly young people. Occurrence of eye muscle paralysis or unilateral numbness on the contralateral side of the headache or aphasia on the contralateral side after the onset of the attack may disappear temporarily or last for a long time. Positive family history is more. Basilar arterial migraine is more common in women, and seizures are related to menstruation. There are many positive family history. The typical manifestations are pre-existing symptoms of visual disturbance and brainstem dysfunction before the onset. Sympathy occurs after several minutes. After recovery of consciousness, pulsating pain occurs on one side of the head or occiput, accompanied by nausea and vomiting, which often lasts for several hours.

In summary, all types of migraine are mostly unilateral or bilateral pulsatile headaches, which may be accompanied by visual or gastrointestinal symptoms. The seizure process is much slower than seizures and lasts longer, often for half an hour to several tens of hours. EEG is mostly slow wave activity, and most patients have a positive family history. In the acute phase, paracetamol and ergotamine can be relieved. Usually, propranolol, cyproheptadine or sibutramine can prevent seizures. Helps identify with seizures.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.