Idiopathic epilepsy syndrome

Introduction to idiopathic epilepsy syndrome Epilepsy syndrome (epilepsysyndrome) is a group of symptoms, signs of specific epilepsy, not just the type of seizure. Idiopathic epilepsy syndrome (age-dependent onset) has also been referred to as "primary epilepsy" in the past. It is currently a diagnosis of epilepsy that does not have a clear cause. This does not mean "no cause", only yet Finding pathogens, most with a single genetic background, to determine the pathogenic genes and functions is the basis for exploring the prevention and treatment of epilepsy syndrome. The clinical type of idiopathic epilepsy syndrome has both partial seizure and generalized seizure. Mainly include benignrolanticepilepsyofchildhood (BRE), absence seizures, benign familial neonatal convulsions (BFNC), juvenile myoclonicepilepsy (JME) and generalized tonic-clonic seizures (generalizedtonic- Clonicseizure, GTCS), etc., GTCS has been introduced in the section on generalized epileptic seizures, and will not be repeated here. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious complication:

Idiopathic epilepsy syndrome

(1) Causes of the disease

It is currently believed that most of the idiopathic epilepsy syndrome has a single genetic background.

1. Benign familial neonal evulsion (BFNC) is an autosomal dominant inheritance with genetic heterogeneity. In the 1980s, gene linkage analysis of multiple pedigree genes was located on chromosome 20, 20q13.3, 20th century. In the 1990s, a Mexican-American origin family was diagnosed with a long arm of chromosome 8, and 20q was named EBN1, and 8q was named EBN2. Family studies showed that the benign familial epilepsy gene was located on the short arm of chromosome 19.

2. Benign rolantic epilepsy of childhood (BRE), also known as benign childhood epilepsy with centro-temporal spike (BECTS), is idiopathic partial Epilepsy is an autosomal dominant inheritance.

3. Benign occipital lobus epilepsy of childhood is an autosomal dominant inheritance, which may be a variant of benign central temporal lobe epilepsy.

4. Childhood absence epilepsy (childhood deficiency epilepsy), also known as intensive epilepsy (pyknolepsy), is autosomal dominant, with penetrance incomplete, accounting for 5% to 15% of all patients with epilepsy.

5. Juvenile absence epilepsy and myoclonic absence epilepsy may be heterogeneous. Some cases may be hereditary and some may be symptoms of certain encephalopathy.

6. Juvenile myoclonic epilepsy (JME) In recent years, hundreds of JME family surveys have found that 80% of the proband's siblings have symptoms. In addition to the performance of JME, family members may have seizures and GTCS, 115 The linkage analysis of JME family genes revealed that the related gene was closely linked to the short arm of chromosome 6 6p21.3 and named EJM1, suggesting that the disease is autosomal recessive.

(two) pathogenesis

Single-gene or multi-gene inheritance can cause epileptic seizures. More than 150 rare gene-deficient syndromes are known to present epileptic seizures or myoclonic seizures, of which 25 are autosomal dominant genetic diseases, such as tuberous sclerosis. Neurofibromatosis, etc., about 100 kinds of autosomal recessive diseases, such as familial black montery dementia, spheroid cell type white matter dystrophy, and more than 20 kinds of sex chromosome genetic defect syndrome.

For the general pathogenesis of epilepsy syndrome, please refer to the relevant content of this system "seizure and epilepsy syndrome".

Idiopathic epilepsy syndrome prevention

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

1. Prevent the occurrence of epilepsy

Genetic factors make certain children convulsive and produce seizures under the trigger of various environmental factors. To this end, special emphasis should be placed on the importance of genetic counseling. Family surveys should be conducted in detail to understand patients' parents, siblings and close relatives. Whether there are seizures and their seizure characteristics, for some serious hereditary diseases that can cause mental retardation and epilepsy, prenatal diagnosis or neonatal screening should be carried out to decide to terminate pregnancy or early treatment.

For secondary epilepsy should prevent its specific cause, prenatal attention to maternal health, reduce infection, nutritional deficiencies and various systemic diseases, so that the fetus is less adversely affected, prevent birth accidents, neonatal birth injury is an important cause of epileptic seizure One of them, avoiding birth injury is of great significance in preventing epilepsy. If you can regularly check pregnant women, implement new methods, and deal with dystocia in time, you can avoid or reduce the birth injury of newborns, and pay enough attention to the febrile seizures in infants and young children. Try to avoid seizures, and should be controlled immediately when the attack occurs. It is necessary to actively prevent various diseases of the central nervous system in children, timely treatment, and reduce sequelae.

2. Control the onset

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 patient's recurrence rate is 27% to 82%, it seems that most patients after a single episode It will recur, so it is especially important to prevent the recurrence of epileptic symptoms.

For patients with epilepsy, timely diagnosis, early treatment, the earlier the treatment, the smaller the brain damage, the less the recurrence, the better the prognosis, the correct and rational use of drugs, timely adjustment of dosage, attention to individual treatment, long course of treatment, slow withdrawal process, And should adhere to regular medication, if necessary, evaluate the efficacy of the drugs used and blood drug concentration monitoring, avoid drugs indiscriminately, do not regulate the use of drugs, remove or reduce the primary disease causing epilepsy, such as intracranial space-occupying diseases, metabolic abnormalities, Infection, etc., is also important for recurrent cases.

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 body, mind, marriage, and socioeconomic status, especially deep-rooted social prejudice and public discrimination. Attitude, patient's misfortunes and frustrations in family relations, school education and employment, restrictions on cultural and sports activities, etc., can not only cause disgrace and pessimism, but also seriously affect the patient's physical and mental development, and will disturb the patient's family, teachers , doctors and nurses, and even the society itself, so 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, which requires society. All walks of life to understand and support patients with epilepsy, to minimize the social sequelae of epilepsy.

Idiopathic epilepsy syndrome complications Complication

It is currently believed that epileptic disease is a clear pathological state caused by a single specific cause, not just the type of seizure. Epileptic encephalopathy is an epileptic discharge that causes progressive brain dysfunction. Therefore, different causes And the brain dysfunction caused by the attack is different, the clinical complications are also different, but the common point is that there may be accidents such as trauma or asphyxia caused by the attack.

Symptoms of idiopathic epilepsy syndrome common symptoms convulsion dysfunction dysfunction infantile snoring urinary incontinence involuntary motor consciousness loss illusion single dysphagia dysphagia

Benign familial neonmal convulsions (BFNC)

It is a idiopathic epilepsy syndrome, and 10% to 14% of children can develop adult epilepsy. Family studies have shown that benign familial infantile epilepsy genes are located on the short arm of chromosome 19.

Newborns develop 2 to 3 days after birth, stop at about 6 months, for focal or systemic myoclonic seizures, with apnea, good prognosis, no sequelae, no mental retardation, benign family Sexual infantile epilepsy usually occurs 3.5 to 12 months after birth, mainly for focal seizures. EEG examination often has no characteristic changes.

2. Children with benign central temporal epilepsy

Also known as benign childhood epilepsy with central-ankle spine, 30% to 40% of siblings may have the same EEG abnormalities, about 10% have clinical attacks, and 40% of close relatives have febrile seizures.

(1) 18 months to 13 years old, 5 to 10 years old is the peak of the disease, 14 to 15 years old stop the attack, more boys, the attack is common in the sleep and wake up, about 70% only in the sleep, 15% only When awake, 15% of the attacks occurred during waking and sleep. If left untreated, 10% only had one episode, 70% had a seizure for several months or years, 20% had frequent seizures, and the seizures were significantly reduced after treatment.

(2) Typical episode performance: the child wakes up from sleep, and the mouth feels abnormal on one side, followed by the ipsilateral mouth, pharyngeal and facial convulsions, often accompanied by tongue stiffness, speech can not, difficulty swallowing, rogue Etc., but the consciousness is clear, the episode lasts for 1 to 2 minutes. The daytime episode usually does not generalize to the whole body. The nighttime episode of children under 5 years old often extends to the ipsilateral limb, and can even be extended to GTCS. The neurological examination and neuroimaging are normal. EEG shows high-amplitude spikes in the contralateral central and/or temporal region, followed by slow activity. Interictal EEG can show spikes in one or both central or central sacs, typical high-wave spines Waves, drowsiness and sleep can be induced.

3. Children with benign occipital epilepsy

Also known as childhood epilepsy with occipital paroxysmal discharge, is an autosomal dominant inheritance, may be a variant of benign central temporal lobe epilepsy.

(1) The age of onset is 15 months to 17 years old, more than 4 to 8 years old, males are slightly more, about 1/3 have a family history of epilepsy, often benign central temporal epilepsy (BRE), patients are awake Or when sleeping, the most when falling asleep, flash stimulation or game machine can be induced, there are visual auras in the attack, including visual hallucinations such as flash or bright spots, transient vision loss or dark spots in the field of vision, blind or hemianopia, etc. The illusion, such as visual dysfunction, visual dysfunction or visual distortion, can also have two or more harbingers at the same time. The patient has a clear consciousness or varying degrees of consciousness disorder or even loss of consciousness, followed by a side array. Spastic seizures, complex partial seizures such as autonomic syndrome, can also be extended to GTCS, individual patients with language disorders or other paresthesia, 30% of cases after the onset of headache, nausea and vomiting, should be noted with the identification of migraine.

(2) The EEG visible on one side or bilateral occipital region was rapidly released during the attack period. The interictal period was normal background activity, and the high amplitude 1.5-2.5 Hz spine slow wave or tip appeared on one or both sides of the occipital and posterior iliac crest. The wave is distributed, synchronized or not synchronized, disappears when blinking, and repeats after 1 to 20 seconds of closed eyes. Excessive ventilation or flash stimulation is rarely induced. Sometimes short-range bilateral synchronous slow-spinning waves or multi-spine slow-wave diffuse episodes are seen. Occasionally, the sacral leaf spurs can be seen. 30% to 50% of the children only change EEG after falling asleep. When the disease is suspected and the EEG is normal, the sleep EEG can be diagnosed, but some seizures also have interictal intervals. The performance was similar to EEG and the MRI examination was normal.

4. Epilepsy with generalized tonic-clonic seizure on awaking when awakening

Is the most common idiopathic generalized epilepsy, the disease has a genetic predisposition, patients often have a history of juvenile myoclonus or absence of seizures, mostly in the onset of 10 to 20 years old, accounting for 27% to 31% of juvenile and adult epilepsy, 90% occur during daytime or nighttime sleep awakening, a small number of episodes of sleep relaxation, absent sleep can be induced, EEG changes consistent with idiopathic generalized seizures, sensitive to light stimulation.

5. Childhood absence epilepsy (childhood absence epilepsy)

Also known as intensive epilepsy (pyknolepsy), is autosomal dominant, with penetrance incomplete, accounting for 5% to 15% of all patients with epilepsy, children 6 to 7 years old onset, more girls, frequent performance loss Attacks, several times to dozens of times a day, gestational GTCS or loss of seizures can occur, a very small number of episodes of seizure duration is the only type of seizure, EEG is bilateral symmetric synchronization 3 times / s spin wave synthesis (slow and spike waves , SSW), the background is normal, excessive ventilation can be induced.

6. Juvenile absence epilepsy (juvenile absence epilepsy)

In puberty, the frequency of absence seizures is low, and the retreat action is rare at the time of onset. It is often accompanied by GTCS or myoclonic seizures during awakening. The EEG can see a slow wave frequency of >3 times/s, and the patient responds very well to AEDs.

7. Myoclonic absence epilepsy

It is a rare epilepsy syndrome, accounting for 0.5% to 1.0% of all epilepsy. 85% of the children are male. It is considered to be an intermediate type of idiopathic and symptomatic epilepsy. The cause may be heterogeneous. In some cases May be hereditary, and some may be symptoms of a certain encephalopathy.

(1) The onset age is 2 to 12 years old, the peak incidence is 7 years old, 25% of cases have a family history of epilepsy, 40% of patients have abnormal intelligence before onset, characterized by absence of limbs with bilateral limb rhythmic tics, frequent episodes, daily Several times, each time 10 ~ 60s, excessive ventilation can be induced, early sleep can also occur, the degree of disturbance of consciousness is different at the time of attack, the light performance is difficult to talk with people, the consciousness of the heavy is lost, the myoclonus is shoulder and upper, Lower extremity twitching, also facial (hyposis and mouth) muscle twitching, diaphragmatic twitching is rare, neurological examination is more normal, children often accompanied or have mental retardation before the disease, may have autonomic symptoms such as apnea and urinary incontinence, The episode lasts into adulthood and sometimes ends automatically.

(2) EEG background wave is normal during the interictal period, bilateral symmetrical synchronous 3Hz spine slow wave, sudden sudden arrest, EEG abnormal discharge 1s after the myoelectric image shows tonic contraction, multi-channel recorder can accurately record EEG and deltoid myoelectric The graph is abnormally synchronized, and the diagnosis is mainly based on the clinical features of both absence and myoclonic episodes and the typical 3 Hz spine wave of EEG.

8. Juvenile myoclonic epilepsy (JME)

Also known as impulsive petit mal, myoclonic seizures are short-term muscle involuntary contractions that may represent a seizure such as infantile spasms, or a physiological reaction after being scared or falling asleep, or Independent involuntary movements with tonic-clonic seizures have led to investigations in hundreds of JME families in recent years, suggesting that the disease is autosomal recessive.

(1) more than 12 to 15 years old, accounting for 3% of children with epilepsy, adult epilepsy more than 10%, no gender differences, patients may be associated with GTCS, myoclonus absthetics or absence of seizures, seizures may be lack of sleep, fatigue, drinking, Wake up, flash stimulation or closed eye induction, particularly easy to appear in the morning, showing short-term rapid contraction of the forearm flexor, symmetrical or asymmetrical irregular arrhythmia, recurrence, rapid contraction involving the lower limbs causing the patient to fall, patient Consciousness retention, can feel the onset of myoclonus, most patients have GTCS 2 to 3 years after onset, sometimes combined with GTCS at the beginning of the attack, about 1/3 of patients have seizures, and there is always another type of seizure in adulthood. possibility.

(2) EEG is issued in a wide range of multiple spine slow waves, followed by a slow wave; interictal EEG may be normal or show a 3.5 to 6 Hz multi-spin slow complex.

Examination of idiopathic epilepsy syndrome

Routine inspection

1. Blood, urine, routine examination of stool and blood sugar, electrolyte (calcium, phosphorus) determination.

2. Genetic testing has a certain significance for diagnosis.

Auxiliary inspection

Electrophysiological examination

Conventional EEG and EEG monitoring technology, including portable cassette recording (AEEG), video EEG and multi-channel radio telemetry, can observe the awake and sleep EEG in natural state for a long time, and the detection rate is increased to 70%~ 80%, 40% of patients can record the onset waveform, which is helpful for the diagnosis, classification and location of epilepsy.

2. Neuroimaging

X-ray plain film of the lateral side of the skull, CT, MRI examination has important differential diagnosis significance.

3. Single photon emission tomography

(SPECT) can detect the decrease of blood flow in the epileptic foci during the intermittent period, increase the blood flow during the episode, and the positron emission tomography (PET) can detect the complex partial seizure-induced epileptic foci, the intermittent glucose metabolism is reduced, and the metabolic metabolism increases.

Diagnosis and diagnosis of idiopathic epilepsy syndrome

Diagnostic points

1. Is the patient's paroxysmal symptoms epileptic?

Most of the patients were in the intermittent period of the attack, and there was no abnormality in the physical examination. Therefore, the diagnosis was based on the medical history, but the patient had more loss of consciousness in addition to the simple partial seizure at the time of the attack. It is difficult to read the condition and can only rely on witnessing. The relatives of the patient's attack, or others, describe the performance at the time of the attack and the entire episode, including the circumstances at the time, the time course of the attack, the posture at the time of the attack, the complexion, the sound, the presence or absence of limb convulsions and their approximate sequence, and the presence or absence of weird behavior. And mental disorders, etc., to understand the unconscious loss of seizures is very critical for the diagnosis of comprehensive tonic-clonic seizures, and its indirect evidence includes tongue bites, urinary incontinence, possible falls and wake-up headaches, myalgia, etc., but others The narrative observation is often not detailed enough. If the doctor can witness the seizure of the patient, it has a decisive effect on the diagnosis. Epilepsy has two most important characteristics, namely, seizure and repetitiveness. The seizure is sudden, abruptly suspended; repetitive That is, after an episode, the EEG phenomenon suddenly starts after a certain interval, and suddenly stops at the frequency, waveform, and amplitude. The aspect is different from the background, and it is prominent in the background. The content of the explosion can be high amplitude slow wave, high amplitude fast wave or even alpha wave; it can also be epileptic wave, but the conventional EEG has limited recording time (20~30min) Only 20% to 30% of patients with definite epilepsy can record epileptic waves or bursts, and 30% to 40% are non-specific changes such as slow wave increase, which is not helpful for the diagnosis of epilepsy. There are still 20% to 30%. % EEG is normal. The portable electroencephalography (TEEG) technology applied to the clinic since the 1970s can continuously monitor for more than 24 hours, and can improve the positive rate of epileptic waves or bursts by more than 80%, especially video and Electroencephalogram monitoring (TEEG-VR) can simultaneously monitor the patient's seizure and the EEG changes at that time. It is important for the diagnosis, differential diagnosis and classification of epilepsy, such as TEEG- for 40 cases of refractory epilepsy. VR monitoring found that 47.5% of past classifications were incorrect, 20% proved to be mixed seizures rather than single type seizures, and 30% were psychiatric seizures (sicknesses) rather than epilepsy, which not only corrected past diagnosis errors but also improved efficacy .

2. If it is epilepsy, what is the type of seizure, whether it is idiopathic epilepsy syndrome

If you can grasp the characteristics of each type of seizure, by carefully asking about the medical history and careful analysis, the judgment of the type of seizure of most patients is not difficult, but there are a few patients whose seizure types are difficult to get a clear answer from the medical history. TEEG-VR monitoring This is very helpful.

3. Clinical consideration should be based on the following aspects: idiopathic epilepsy

For example, family history, age of onset, seizures [such as a large seizure without a precursor and/or head of secondary GTCS, ocular deviation, loss of consciousness occurs very early], EEG recording (non-specific diffuse rhythm disorder or normal; EEG is also commonly used to distinguish between seizures and transient complex partial seizures, as well as normal signs. Symptomatic epilepsy can be found in both medical history and physical examination. In terms of medical history, such as perinatal abnormalities, head trauma, encephalitis, History of meningitis, etc., or other neurological symptoms such as severe headache, hemiplegia or monosexuality, and mental retardation, etc., may also have systemic symptoms such as hypoglycemia episodes, metabolic or endocrine disorders, A-S syndrome, parasites such as Schistosomiasis, paragonimiasis, swine mites, etc. For patients with a disease age of more than middle age, even if no abnormalities are found in the physical examination and EEG, symptomatic epilepsy cannot be completely ruled out. Follow-up examination is needed, and other auxiliary examinations are needed if necessary.

4. For symptomatic epilepsy, the cause should be differentiated from a brain disease or a systemic disease.

Differential diagnosis

1. Seizure (seizure) needs to be differentiated from various seizure diseases

(1) snoring: snoring sometimes manifests as irregular contraction of the whole body muscle, and it occurs repeatedly, and it must be differentiated from the tonic-clonic seizure. The medical history can be found that the snoring episode occurs when someone is present and emotionally stimulated. Long, lasting for tens of minutes or hours, or even all day and night, often accompanied by crying and screaming, unconscious loss and incontinence, no bruises, if examined during the attack, muscle contraction can be seen Does not conform to the law of tonic-clonic, pupil, corneal reflex and tendon reflex do not change.

It is worth noting that some epileptic seizure patients, especially chronic patients, have different degrees of mental abnormalities, including emotional reactions, so the color of snoring can not rule out epilepsy, if prompted for psychomotor seizures According to the basis, further inspection is still required.

(2) syncope: syncope is also a short-term disturbance of consciousness, sometimes accompanied by a short-onset upper limb cramps, which needs to be differentiated from various seizures. Before vasopressive syncope, most have a history of emotional stimulation or pain stimulation; syncope due to reduced venous return More often standing, dehydration, bleeding or urination, coughing; erect hypotension stun occurs more when suddenly standing up; cardiogenic syncope occurs more often when running or running, most of the syncope before the onset of dizziness, Chest tightness, black eyes and other symptoms, not like the sudden onset of absence, the recovery of consciousness and physical strength is far slower.

(3) Hyperventilation syndrome: Anxiety and other neurosis patients may have numbness or paresthesia of the mouth and extremities due to active hyperventilation, which may be accompanied by dizziness and hand and foot convulsions. Excessive ventilation test to see if the same symptoms can be repeated.

(4) Migraine: Headache epilepsy must be differentiated from migraine. The headache of the former is sudden, the duration is not long, and it lasts for a few minutes. It is rarely accompanied by gastrointestinal symptoms such as nausea and vomiting. EEG can record Epileptic discharge, start and end have obvious boundaries, need continuous treatment of anti-epilepsy can be effective, and migraine attacks are gradual, often unilateral, mostly volatility headache, more long duration, usually several hours Or 1 to 2 days, often accompanied by nausea, vomiting and other gastrointestinal symptoms, EEG can not record epileptic discharge, mostly non-specific slow wave, migraine initially with tartaric acid tartaric caffeine can control seizures.

(5) Transient ischemic attack (TIA): TIA refers to a transient blood supply to the carotid or vertebral-basal artery system, resulting in focal neurological dysfunction in the blood supply area, corresponding symptoms and signs, general symptoms Within 5 minutes, the peak is reached. One episode usually lasts for 5-20 minutes, and the longest is no more than 24 hours, but it can be repeated. This disease should be differentiated from localized seizures. TIA is more common in the elderly, often with arteriosclerosis, hypertension. Risk factors such as coronary heart disease and diabetes mellitus, the duration of symptoms varies from a few minutes to several hours. Symptoms are limited to one limb, face, etc., and can be recurrent. Physical examination shows signs of cerebral arteriosclerosis, EEG examination is normal, cranial Brain CT scan is normal, a few can have lacunar infarction, and epilepsy can be seen in various ages. Except for epilepsy secondary to cerebrovascular disease in the elderly, the aforementioned risk factors are not prominent in patients with epilepsy, and seizures persist. The time is usually a few minutes, rarely more than half an hour. The symptoms of localized epilepsy begin to extend to the whole body after an upper limb. There is no abnormality in the physical examination after the attack. EEG can find limitations. Or epileptiform EEG waves, CT can be found in brain lesions.

(6) narcolepsy: narcolepsy is a type of sleep disorder, an unexplained sleep disorder, manifested as paroxysmal irresistible sleep, may be accompanied by cataplexy, sleep paralysis and sleep illusion, etc. , manifested as quarantine sleeping quadruple syndrome, only 10% of patients have all the symptoms of the above four signs, the disease mostly in childhood and adolescent onset, the most from 10 to 20 years old, each episode lasts for several minutes Up to 10 hours, usually 10 to 20 minutes, automatically awake and immediately resume work, several times a day, more normal neurological examination, a small number of patients with obesity and hypotension, sleep monitoring can find specific abnormalities, daytime seizures fall asleep Rapid eye movement sleep (REM); nighttime sleep is different from healthy people, the sleep cycle starts from REM, while healthy people start with non-rapid eye movement sleep (NREM). This disease should be differentiated from absence seizures, loss of dementia. The age of onset of epilepsy is earlier than that of narcolepsy. Children are more common. Absence epilepsy is a sudden loss of consciousness rather than sleep. Some episodes of absence epilepsy are accompanied by loss of tension, but the duration is short, usually only a few seconds. EEG See 3 / s of spike - slow wave synthesis, absence epilepsy is a characteristic change, there are important differential value.

In addition, epilepsy should be differentiated from paroxysmal psychosis and paroxysmal other visceral symptoms.

2. Symptomatic (epilomatic) epilepsy and the etiology of epilepsy syndrome

(1) Systemic diseases that cause epilepsy:

1 low glycemic: after the onset of fasting or strenuous exercise, usually first heart palpitations, dizziness, sweating, nausea, irritability and other symptoms, and even behavioral disorders, those with a history of these should do fasting blood glucose measurement for further diagnosis.

2 hypocalcemia: for patients with hand and foot convulsions, long-term diarrhea, steatorrhea or thyroid surgery, or patients with rickets deformed in the physical examination, blood calcium and phosphorus should be measured.

3 Amino aciduria: For children with mental dysplasia, pale skin color, increased muscle tone, or accompanied by tremors and hand and foot movements, suspected phenylketonuria, urine test, other rare There are many types of urine with different colors, odors, and when necessary, do the corresponding biochemical tests.

4 acute intermittent blood porphyria: abdominal pain, vomiting, diarrhea and peripheral neuropathy associated with epilepsy, should be done urine or blood tests.

(2) Brain diseases that cause epilepsy: medical history (history of birth injury, history of febrile seizures, history of encephalitis meningitis, history of traumatic brain injury, history of stroke, etc.) and age of onset can provide some evidence, such as intracranial tumors found in physical examination Localization signs and optic disc edema, head murmurs of cerebral arteriovenous malformations, subcutaneous nodules of cysticercosis (cysticercosis), etc., can provide clues to the cause, the cause is unknown, except for those with obvious diffuse encephalopathy In addition, it is often necessary to do further examinations, such as cerebral angiography, nuclear scanning, CT, MRI and so on.

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