Epileptic personality changes

Introduction A small number of patients can cause progressive personality changes after long-term, repeated seizures. This change has two different extremes of viscous and explosive. The thinking is sticky, the words are ambiguous, the behavior is rigid, and it is difficult to adapt to the new environment. Because of the narrowness of intelligence, only pay attention to things directly related to oneself and become self-centered. Emotional changes are emotional eruptions, stubborn temper, resentment, sensitivity, suspiciousness, right and wrong, lying, jealousy, hateful and difficult to disappear for small things, can be accompanied by self-defense, often for cruel revenge.

Cause

(1) Causes of the disease

Epilepsy is often divided into primary and secondary clinically. Among them, primary epilepsy is also called true epilepsy or idiopathic epilepsy or occult epilepsy, and its etiology is not clear. Secondary epilepsy, also known as symptomatic epilepsy, can be found in the brain, often secondary to brain diseases, brain tumors, craniocerebral trauma, intracranial infections, cerebrovascular diseases, and brain degenerative diseases. It can also occur in systemic diseases such as hypoxia, metabolic diseases, cardiovascular diseases, and toxic diseases.

The pathogenesis of epilepsy is complex and has not yet been elucidated. It is currently attributed to excessive synchronous discharge of neurons. Molecular genetic research has made breakthroughs. For example, the genetic pattern of primary systemic epilepsy and epilepsy with mental retardation is autosomal recessive inheritance, and epilepsy with hallucinatory features is autosomal dominant. Genetics, etc.

Seizures are a clinical manifestation of cerebral cortical neuronal dysfunction. The cause of the first seizure can be:

1. Reactive epileptic seizure caused by acute brain functional disorders such as high fever, metabolic disorders, or structural disorders such as central nervous system infections, cerebrovascular diseases, head trauma or brain tumors ). The prognosis varies according to the cause of seizures. It may be the only time in life, but it may also be epileptic seizures after the acute phase, which is symptomatic epilepsy.

2. Because there have been various types of brain injuries in the past, or congenital brain injury or deformity, although there was no seizure at that time, seizures occurred later, and according to the clinical examination results, it can be speculated that this seizure has a high degree of brain injury in the past. Relevance. There may be only one episode, but the more common one is recurrent epilepsy, which is also symptomatic epilepsy.

3. There has not been any brain damage in the past, and according to clinical data, it is speculated that the first epileptic seizure may be idiopathic epilepsy, which is more related to hereditary factors. The episode may be only one episode, but more common Repeated episodes of epilepsy.

4. Although there has not been any history of brain damage in the past, according to clinical data, it is suspected that there may be hidden brain damage or brain dysfunction causing seizures, called cryptogenic epilepsy.

5. Seizures only occur when directly exposed to external or due to internal stimuli, such as intermittent light stimulation, sound stimulation, etc., such as calculation, thinking, etc., if you can avoid related incentives or receive sensitive treatment, Less recurrence, called reflex epilepsy.

(two) pathogenesis

Neuroelectrophysiology

The underlying cause of seizures is the abnormal discharge of brain neurons, which can occur in the ictal discharge or in the interictal discharge. The causes of this abnormal discharge can vary, but so far, little is known about the nature of abnormal discharges. With the development of science and technology, it is possible to have a clearer understanding of the causes of epilepsy. According to current research, various factors may cause abnormalities in the depolarization of a group of brain cell membranes, and synchronization to form the skinning of peripheral neurons. There are various theories about electrophysiological abnormalities in brain neurons, which are generally thought to be related to ion abnormalities of the mesangial potential. It is also believed that the brain's neuronal mediators are excitatory amino acids (glutamate, etc.) and inhibitory amino acids (GABA, etc.). Balanced. In short, seizures are the result of abnormal, over-discharge of nerve cells in the brain.

2. Neuropathology

The pathogenesis of idiopathic epilepsy is complex and has not yet been fully elucidated. For the pathology of partial symptomatic epilepsy, extensive research has been carried out. In animal experiments, cobalt hydroxide is applied to the brain tissue of monkeys, and glial sputum gradually forms around, and partial seizures appear after 4 to 12 weeks. Epileptic discharges of partial epilepsy usually begin near the site of the epileptic seizure, and also originate from distant sites that are related or completely unrelated to the lesion. If the right amygdala of the cat is damaged, it causes a seizure discharge of the left amygdala. Johnson et al found that in animals with epileptic seizures, the cerebral cortex, subcortical structure, and even the entire brain had a reduced threshold of convulsions. Neurons that are anatomically related to the damage caused by epilepsy may have increased excitability but have no organic damage. This is a very important concept, that is, the scattered spike or rhythmic epileptic discharge on the EEG can be used as a diagnostic evidence for partial epilepsy, but it is not certain that the epilepsy damage is in the same place. It is generally believed that mental disorders associated with epilepsy patients, such as paranoid state, schizophrenia-like state, and aggressive personality disorder, are associated with lesions in the dominant hemisphere of the brain, while depression is associated with non-dominant hemispheric lesions. Clinically manifested as an uncontrollable strong emotional and behavioral disorder called episodic dyscontrol syndrome, which may be associated with abnormal discharge of the amygdala.

an examination

Related inspection

Cerebrospinal fluid lactic acid electroencephalography

In addition to collecting detailed medical history, the body and nervous system and EEG examination are very important. If necessary, CT, MRI and SPECT examinations can be performed.

Differential diagnosis

1. Syncope: for a brief loss of consciousness, should be identified with a small attack. Some small episodes only show loss of consciousness, fall, body toughness, no convulsions in the body, quite like syncope. Most of the syncope is caused by cerebral ischemia caused by unstable vasodilation, weak constitution or temporary hypotension caused by other diseases. There are many symptoms such as dizziness, chest tightness, nausea, and black eyes before the attack. The episode was accompanied by autonomic symptoms such as pale complexion, weak pulse, sweating, and hypotension. EEG had no epileptic activity.

2. Hysteria: Patients with snoring can have symptoms of seizures and schizophrenia, such as hallucinations, disturbances of consciousness, etc., irregular muscle twitching, often repeated. However, the symptoms of hysteria lack sufficient specificity, the symptoms of mental illness and obvious psychological stress factors, the consciousness is not lost, there is no organic evidence, often accompanied by crying or screaming, the action and posture with snoring is contrived, dramatic It has language suggestion, symptom variability, rich expression, no change in pupil and tendon reflex, muscle twitching, no rhythm, limb turbulence, seizures lasting several minutes to several hours, and it is not difficult to identify with large seizures. A detailed inquiry into the history of previous episodes and the predisposing factors and suggestive treatments for each episode will help to identify. It is worth noting that some patients with epilepsy may also have seizures under the influence of mental factors. Should be carefully considered, do not easily rule out the diagnosis of epilepsy, so as not to delay diagnosis and treatment.

3. Sleepwalking: also known as "sleeping sickness". It is a form of sleep disorder that is common in children. But children's sleep can be awakened, and people with epilepsy can't be awakened by consciousness. Sleepwalking symptoms of neurosis can also be awakened, and the behavior of the episodes is easy to be understood by people; while epileptic sleepwalking is mostly violent and dangerous, often leading to trauma.

4. Infectious and toxic psychosis: Epilepsy is not easy to distinguish from the sputum state during infection and poisoning. Epileptic hernia is paroxysmal, with a short duration, no infection, history of poisoning and positive findings of EEG before the attack. A history of previous seizures and detailed physical examinations and EEG examinations can be helpful in identifying toxic sputum infections.

5. Schizophrenia: Chronic epilepsy schizophrenic psychosis can have symptoms similar to schizophrenia, such as hallucinations, delusions, and compulsory thinking. The identification points are mainly based on the diagnosis basis of epilepsy, such as medical history, EEG and so on. The status of epileptic stupor can be very similar to that of tense schizophrenia, but the former has a disturbance of consciousness during the attack and is forgotten after the attack, so it can be identified.

Chronic schizophrenic state is similar to paranoid schizophrenia, but the former lacks introversion, no coordination between mental activities, and schizophrenia. In addition, the history of seizures, epileptic personality changes and EEG findings can also help to differentiate the diagnosis. It is worth noting that patients with epilepsy have the possibility of having schizophrenia, but the chances are very low.

6. Affective disorder: Epileptic pathological mood is different from depression. Although its mood is low, it is depressed, nervous, dissatisfied, and there is no real depression, self-blame, slow thinking and decreased activity. Epilepsy Sexual euphoria is often accompanied by tension and mischief, not real emotional upswing, and there is no quick thinking activity, vivid expression and flexibility of movement, and it happens suddenly, duration is short, and can be mixed with mania Identification.

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