1. Brain injury and brain injury:
Brain injury, brain injury, virus infection in embryonic development, radiation or other causes of embryonic dysplasia can all cause epilepsy. In the process of fetal production, birth injury is also a major cause of epilepsy. Craniocerebral trauma can also cause epilepsy.
2. Brain diseases:
Other brain diseases, brain tumors, cerebrovascular diseases, intracranial infections, etc.
3. Self-factors:
When epilepsy patients have fever, systemic infection, surgery, high mental stress and excessive fatigue, even maintaining effective blood drug concentration can induce status quo. Food poisoning, drug poisoning, drinking, overwork, pregnancy and childbirth are the common causes of status epilepticus. In addition, water and electrolyte disorders and congenital metabolic abnormalities can also lead to the occurrence of status epilepticus.
4. Genetic factors:
Epilepsy is hereditary. 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 inducement of epilepsy. Some families of patients with epilepsy or congenital central nervous system or cardiac malformation are prone to epilepsy.
symptom
Symptoms of epilepsy
Epilepsy occurs in all ages. The clinical manifestations of epileptic seizures are complex and varied because of the different starting sites and conduction modes of abnormal discharges.
1. Full-scale tonic-clonic seizure (grand seizure): characterized by sudden loss of consciousness, general rigidity and convulsions. The duration of the attack is generally less than 5 minutes, often accompanied by tongue biting and urinary incontinence. And it is easy to cause suffocation and other injuries. Tonic clonic seizures can be seen in any type of epilepsy and epilepsy syndrome.
2. Absence attack (mini-attack): The typical absence performance is sudden onset, pause and fixation, which is called no response, and there may be blinking, but it is basically not accompanied or accompanied by mild motor symptoms, and the end is also sudden. It usually lasts for 5-20 seconds, and rarely exceeds 1 minute. Mainly seen in children's absence epilepsy.
3. Tonic seizure: It is characterized by intense and continuous contraction of the whole body or bilateral muscles, and muscle stiffness, which often lasts for several seconds to tens of seconds, but generally does not exceed 1 minute. Tonic seizures are more common in epileptic patients with diffuse organic brain injury, and are generally signs of serious diseases, mainly in children, such as Lennox-Gastaut syndrome.
4, myoclonic seizure: it is a sudden rapid and short-term contraction of muscles, similar to the electric shock-like jitter of the body or limbs, sometimes several times in a row, mostly after awakening. It can be a full-body action or a local action.
5. Spasm: refers to infantile spasms, characterized by sudden and short-term rigid flexion or extension and contraction of trunk muscles and bilateral limbs, mostly manifested as paroxysmal nodding and occasional paroxysmal prostration. The whole process of muscle contraction is about 1 ~ 3 seconds, which often occurs in clusters. It is common in western syndrome, and sometimes other infant syndromes can be seen.
6, flaccid seizures: due to the sudden loss of muscle tension, can not maintain the normal posture of the body, there is a sudden collapse, limb falls and other performances. The attack time is relatively short, lasting several seconds to 10 second, and most of them are not accompanied by obvious disturbance of consciousness.
7. Simple partial seizure: conscious during the seizure, lasting for several seconds to more than 20 seconds, rarely exceeding 1 minute. According to the origin of discharge and different parts involved, simple partial seizures can be characterized by locomotion, sensation, autonomy and spirituality. The latter two rarely appear alone and often develop into complex partial seizures.
8. Complex partial seizure (psychomotor seizure): manifested as sudden stop of movement, straight eyes, no barking, no falling, and no change in complexion. Some patients may have automatism, which is involuntary and unconscious actions, such as licking lips, smacking lips, chewing, swallowing, groping, wiping face, clapping hands, walking aimlessly, talking to oneself, etc. , and cannot be recalled after the attack.
9. Partial secondary complete seizure: Simple or complex partial seizure can be secondary to complete seizure, and the most common is secondary complete tonic-clonic seizure. Full-scale attack secondary to partial attack still belongs to the category of partial attack, which is obviously different from full-scale attack in etiology, treatment and prognosis, so the differentiation between them is particularly important in clinic.
cheque
Epilepsy examination
The examination items of epilepsy include the following:
1. EEG
It is the most important auxiliary examination method to diagnose epilepsy. The shape and position of epileptic discharge are also the basis of epilepsy classification, which is helpful to choose antiepileptic drugs. Focal epileptic discharge often suggests partial epilepsy. Systemic discharge suggests generalized epilepsy. Repeated EEG examination or prolonged recording time, application of hyperventilation, flash stimulation, sleep deprivation and other activation methods can improve the chances of epileptic discharge recording. Some patients have abnormalities such as slow background activity or localized slow waves, which is also helpful for the diagnosis and qualitative diagnosis of epilepsy.
2. Video EEG
It can monitor and record patients' seizures and corresponding EEG changes simultaneously. If seizures can be recorded, it is very helpful for diagnosis and classification. The EEG changes of different types of generalized seizures have certain specificity, such as continuous multiple spikes in tonic seizures, multiple spikes and slow waves in myoclonic seizures. There are many changes in EEG of partial seizures, and the specificity is not strong, but the origin is valuable for localization.
3. Neuroimaging examination
It can determine the abnormal or pathological changes of brain tissue structure, which is helpful for the diagnosis and classification of epilepsy and epilepsy syndrome, and sometimes it can make etiological diagnosis, such as intracranial tumor and gray matter heterotopia. MRI is sensitive, especially the measurement of coronary and hippocampal volume can show temporal lobe and hippocampal lesions well.
diagnose
Diagnosis of epilepsy
After EEG examination, ask the patient's development history, medication history, childhood history and family convulsion history. Ask if there are signs of nervous system and systemic diseases. Then, select relevant examinations, such as magnetic resonance imaging, ct, blood sugar, blood calcium and cerebrospinal fluid examination. To diagnose epilepsy and find out the cause.
treat cordially
Treatment of epilepsy
Western medicine treatment of epilepsy;
At present, western medicine treatment of epilepsy includes drug treatment, surgical treatment and nerve control treatment.
(A), drug therapy
At present, the treatment of epilepsy at home and abroad is mainly drug treatment. .
1. Indications for the use of antiepileptic drugs: Once epilepsy is diagnosed, antiepileptic drugs should be used in time to control the seizure. However, for the first attack, there are predisposing factors or rare authors, they can be considered as appropriate.
2. The principle of choosing antiepileptic drugs: To correctly classify epileptic seizures and epilepsy syndrome, we should also consider the age (children, adults, the elderly), gender, accompanying diseases and the potential side effects of antiepileptic drugs on the quality of life of patients in the future. Children patients should pay attention to choose drugs that have no effect on cognitive function, memory and attention. The elderly suffer from a variety of diseases, combined medication and drug interaction, the elderly antiepileptic drugs are more sensitive, and the side effects are more prominent. Therefore, the elderly patients with epilepsy must consider the side effects and drug interactions when choosing antiepileptic drugs. For female epileptic patients of childbearing age, we should pay attention to the effects of antiepileptic drugs on hormones, sexual desire, female characteristics, pregnancy, delivery and teratogenesis.
3. Antiepileptic drugs should be treated as single drug as possible until they are effective or maximum tolerated. After the failure of single drug treatment, combined drugs can be used. Try to use drugs with different mechanisms of action and little or no interaction between drugs. The ultimate goal of rational drug compatibility should be the best clinical effect and the lightest economic burden for patients.
4. During the treatment of antiepileptic drugs, it is not recommended to routinely monitor the blood concentration of antiepileptic drugs. Only when it is suspected that the patient has not taken the medicine according to the doctor's advice or has a drug toxic reaction, combined with other drugs that affect drug metabolism and special clinical conditions (such as status epilepticus, liver and kidney diseases, pregnancy). Monitoring of blood drug concentration should be considered.
5. Anti-epileptic treatment needs continuous medication and should not be stopped easily. At present, it is considered that if there is no attack for at least 3 years, it is possible to consider whether the drug can be stopped gradually. During drug withdrawal, only one drug can be stopped at a time, and it takes about 1 year to stop gradually.
(2), surgical treatment
After regular antiepileptic drug treatment, about 20% ~ 30% patients still have drug-resistant epilepsy. Surgical treatment of epilepsy provides a new treatment for these patients. It is estimated that about 50% patients with drug-resistant epilepsy can control or cure their seizures through surgery, which improves the prognosis of refractory epilepsy to some extent.
1, surgical indication
(1) Drug-refractory epilepsy affects people's daily work and life.
(2) For partial epilepsy, the location of epileptic source is clear, and the focus is single and limited.
(3) Surgical treatment will not cause the loss of important functions.
The practice of epilepsy surgery in recent years shows that the surgical treatment of some diseases or syndromes is effective, and we can actively strive for surgical treatment. Such as temporal lobe epilepsy with hippocampal sclerosis, if the location is accurate, its effective rate can reach 60%~90%. Catastrophic epilepsy in infants or children, such as Rasmussen syndrome, seriously affects the development of the brain and should be operated as soon as possible. Others, such as cortical dysplasia, benign low-grade tumor, cavernous hemangioma, arteriovenous malformation, hemiconvulsion-hemiplegia-epilepsy syndrome, are all good indications for surgical treatment.
Strict control of surgical indications is the premise of good curative effect. First of all, the patient must be truly drug-resistant epilepsy. If the patient's condition is delayed because of misdiagnosis, improper drug selection or taking so-called "traditional Chinese medicine", it is completely wrong to mistake it for intractable epilepsy and then perform surgery. Secondly, some epilepsy patients mistakenly believe that epilepsy is a lifelong disease, and the side effects of antiepileptic drugs are too fearful and exaggerated. They mistakenly believe that surgery can cure epilepsy and ask for surgery on their own initiative. We must treat these patients with caution. Thirdly, it should be emphasized that surgery is not a panacea, and not every patient can achieve the goal of eradicating epileptic seizures after surgery. Although most seizures of drug-resistant epilepsy can be controlled or cured by surgery, there are still some intractable epilepsy, even if surgery, the effect is not ideal, and may even bring some new problems.
2, preoperative positioning
Accurate location of epileptogenic focus and brain functional area is the key to successful surgical treatment. At present, scholars at home and abroad agree that comprehensive diagnostic procedures should be used to locate epileptic foci and brain functional areas before operation, and the most commonly used and better method is comprehensive evaluation in stages, that is, noninvasive examination in the initial stage (stage I) and invasive examination in the second stage. Noninvasive examination, including medical history collection and nervous system examination, video scalp EEG, skull MRI, CT, SPECT, PET, MRS, fMRI, magnetoencephalography and specific neuropsychological examination. If we can't locate accurately through various non-invasive tests, we still need invasive tests, including intracranial subdural strip or mesh electrodes and deep electrode monitoring and evoked potentials, Wada test and so on. To further locate epileptic focus and brain functional area.
(3) Neurocontrol Therapy
Neuromodulation therapy is a new neurophysiological technique, which has become the most promising treatment method for epilepsy abroad. At present, it includes: repetitive transcranial magnetic stimulation (RTMS); Electrical stimulation of central nervous system (deep brain stimulation, cortical stimulation of epileptic focus, etc.). ); Peripheral nerve stimulation (vagus nerve stimulation).
1, repetitive transcranial magnetic stimulation (rTMS):
RTMS is to apply pulsed magnetic field to the cerebral cortex, so as to tune bioelectric activity, cerebral blood flow and brain metabolism, and then adjust the functional state of the brain. Low-frequency magnetic stimulation therapy can treat epilepsy by reducing the excitement of cerebral cortex, reducing the frequency of epileptic seizures, improving the abnormal discharge of EEG and repairing the brain damage caused by epilepsy.
RTMS has a good therapeutic effect on chronic brain functional diseases such as epilepsy. There is no harm to human body caused by drugs or surgical treatment, and it has no effect on cognitive function. High safety, little side effect, low treatment cost and easy acceptance by patients. Multi-course rTMS can significantly reduce the frequency and severity of epileptic seizures. Therefore, rTMS is expected to be a new, unique and potential treatment for epilepsy.
Advantages of rTMS: the adjustment is reversible; The patient's needs are different, and the motion parameters can be adjusted; Stimulating a single target may also affect multiple epileptic foci; Epileptic foci in functional areas can also be treated by neuromodulation.
Which epilepsy patients are more suitable for rTMS treatment: Epilepsy patients with cortical dysplasia or epileptic foci in cortex have better curative effect, which can significantly reduce the number of seizures (765,438+0% seizures during treatment), and even some patients (66%) can achieve complete seizure-free.
Safety of rTMS: Most patients can tolerate it well, and the reported adverse reactions are usually mild and short-lived, such as headache, dizziness and nonspecific discomfort. There are no reports of rTMS triggering status epilepticus or life-threatening seizures.
2. Vagal nerve stimulation (VNS):
In July, 1997, FDA approved it for the treatment of intractable epilepsy. So far, more than 60,000 patients in more than 75 countries have received vagal nerve stimulation. The vagus nerve stimulator is buried under the chest skin and connected with the vagus nerve through wire extension. After VNS implantation, vagus nerve will be stimulated with certain intensity and frequency, thus preventing epilepsy. This method can be considered for those who do not respond to various antiepileptic drugs or other forms of surgery.
Traditional Chinese medicine treatment of epilepsy;
Traditional Chinese medicine believes that the occurrence of epilepsy is due to the imbalance of heart, liver, spleen, kidney and dirty qi caused by wind, fire, phlegm and blood stasis. Yin deficiency of liver and kidney leads to hyperactivity of yang, hyperactivity of yang leads to internal movement of liver wind, excessive heat leads to excessive fire, excessive heat leads to excessive fire, wind and fire support each other, spleen deficiency loses its transport, clear qi does not rise, turbid qi decreases, and phlegm and saliva accumulate and become turbid. According to the pathogenesis, it is often used for treating epilepsy, calming the liver and purging fire, resolving phlegm and inducing resuscitation, promoting blood circulation and removing blood stasis.
Relieve epilepsy and wind
Traditional Chinese medicine believes that the onset of epilepsy is mainly caused by "wind phlegm", and the wind is shaking, so convulsions and excessive phlegm are chaotic. Epilepsy is the disharmony between qi and blood, which leads to the loss of liver nourishment and easy internal movement and wind generation. If qi is out of harmony, it turns into fire, and liquid into phlegm, which is easy to form a fight between phlegm and fire, strangulation, phlegm can be turned into heat, heat can be turned into fire, and fire generates wind.
Calming the liver and purging fire.
Epilepsy is a mental disorder, and fierce fire is often the main inducing cause. Generally, excessive five goals or house fatigue will lead to endogenous depression, depression and anxiety will lead to liver fire, damage kidney yin, and excessive heart fire due to insufficient kidney water. On the one hand, fire evil refines body fluid and produces hot phlegm, on the other hand, it touches the potential phlegm turbidity, so that phlegm can not escape with the fire rising, and the fire rising blocks the pericardium, leading to epileptic seizures. So calming the liver and calming the wind is also one of the commonly used methods to treat epilepsy.
Resolving phlegm and inducing resuscitation
Epilepsy is mainly caused by phlegm turbidity and accumulation of phlegm turbidity. In ancient times, there was a saying, "Don't limp, don't use phlegm". Epilepsy begins with phlegm, so the treatment should first eliminate phlegm. The phlegm of epilepsy is different from the general phlegm evil. Phlegm of epilepsy has the characteristics of gathering wind and dispersing, and it is difficult to solidify. Every time a patient accumulates phlegm, if he encounters panic, eating disorder, fatigue, high fever, etc., he will be "dirty." Sputum is condensed by body fluid and gas for a long time, which is the trend of sticking glue, and the pathological basis of epilepsy patients' continuous recovery and persistence for a long time is precisely the "stubborn phlegm" fixed in the chest. Phlegm pathogen is the fundamental cause of epilepsy, so phlegm pathogen is the most important, so resolving phlegm and inducing resuscitation is the consistent rule for treating epilepsy.
Promoting blood circulation and removing blood stasis
Blood stasis is the direct cause of epilepsy, and blood stasis is one of the main reasons for meridian obstruction. Epilepsy has a saying of blood stasis in ancient times, and "Babies Ask" has a record that "blood stays in the heart, pathogenic factors in the heart, and convulsions become epilepsy". Modern medical research also found that promoting blood circulation and removing blood stasis can improve the microcirculation of whole blood, improve the oxygen supply and blood supply to the brain, change the rheology of blood, and be beneficial to the control of epilepsy. The brain is the mansion of Yuan God. If the brain is injured or qi stagnation and blood circulation is not smooth, blood stagnation and poor blood flow will lead to mental loss and epilepsy. In addition, phlegm and blood stasis can interact with each other, which can lead to poor circulation of qi and blood, qi stagnation and blood stasis can hinder the flow of body fluids and become phlegm and blood stasis, which can lead to epilepsy recurrence. Therefore, promoting blood circulation and removing blood stasis is one of the most important methods to treat epilepsy.
Traditional Chinese medicine treatment prescription:
(1) Grind Radix Aconiti Lateralis Preparata and Evodia rutaecarpa into fine powder, mix it with vinegar to make a thick paste, make a cake, and apply it to Yongquan point of nose, foot and heart, and change the dressing once a day for 14 days.
② Radix Astragali, Radix Paeoniae Rubra, Radix Saposhnikoviae and Scolopendra. Decoct the first three herbs, grind centipede into powder, and take it once a day. For 30 days.
③ Black ugliness and white ugliness are equally divided, and honey is made into pills, 3g each, twice a day for 3 months. The formula of white pepper and ochre is 2: 1, and * * * is fine powder. 4 grams each time, twice a day, white radish soup or warm water.
④ Periostracum Cicadae, Rhizoma Typhonii, Bombyx Batryticatus, Rhizoma Gastrodiae, Ramulus Uncariae cum Uncis, Scorpio and Cinnabaris. Mix the drugs into fine powder, bottle and seal for later use. When in use, 0.5g/kloc-0 is taken orally at one year old, and 1g is taken at two years old. Take 1.5g at 2 ~ 4 years old. Take it with boiled water twice a day. 14 days is a course of treatment.
(5) Rhizoma Gastrodiae, Radix Saposhnikoviae, Asari, Radix et Rhizoma Rhei, Rhizoma Chuanxiong, Radix Glycyrrhizae (parched), Radix Aconiti Lateralis Preparata, Moschus and Scolopendra. The medicine is grinded into powder, honey is pills, each pill is 2g, twice a day, and ginger soup is mixed.
keep fit
Health care of epilepsy
Symptom nursing
1. First, start the treatment with a single drug and a small dose. If it is uncontrollable, gradually increase the dose or change the medicine, and combine the drugs.
2, antiepileptic drugs for several years, generally 2-5 years after the last seizure control can be stopped gradually according to the doctor's advice. The withdrawal period is not less than 3 months.
3, drug withdrawal or dressing change should be carried out under the guidance of a doctor, don't stop drug suddenly, so as not to cause recurrence.
4. Pay attention to the side effects: ① Phenytoin sodium is the first choice for the treatment of grand mal's disease and localized seizures, which may cause early allergic reactions such as fever rash. If it appears, stop taking the medicine temporarily and try again carefully after the reaction subsides. If exfoliative dermatitis and lymphadenopathy occur, they need to be replaced. Gastrointestinal reactions (such as nausea, vomiting, anorexia), insomnia, hair growth, etc. may also occur, which generally does not affect the treatment. Take medicine after meals to relieve symptoms. ② Carbamazepine is the first choice for patients with psychomotor attacks. Symptoms such as drowsiness, dizziness, diplopia and leukopenia may occur during taking the medicine. You should report to the doctor in time, and check the blood picture (once a month) and liver and kidney function (once a quarter) regularly. (3) Sodium valproate is mostly used for various types of epilepsy that other antiepileptic drugs are ineffective. Gastrointestinal reactions are common, and a few of them have hepatotoxicity. If you find fatigue, drowsiness, nausea, epigastric discomfort and other reactions, you should report to the doctor for treatment.
Nursing in attack period
1, pay attention to the safety of patients and move patients away from dangerous places such as fire, water, heat, electricity and machinery to prevent injuries and accidents.
2, the patient lie flat, head to one side, try to make saliva or vomiting logistics exports, in case of suffocation and aspiration pneumonia.
3, untie the collar and belt, in order to facilitate the smooth respiratory tract.
4. Fold towels and handkerchiefs into strips or clamp tongue depressors or chopsticks wrapped in gauze between upper and lower molars to prevent the tongue from being bitten.
5, don't press the patient's limbs, beware of fracture or dislocation.
6, for some patients with psychomotor seizures, to prevent their self-harm, injury or destruction.
7, status epilepticus, must keep the respiratory tract unobstructed, at the same time give oxygen and protection, intravenous diazepam 10-20mg, within 5- 10 minutes, stop the attack as soon as possible; Because status epilepticus is often accompanied by fever, vomiting, leukocytosis and acidosis, blood should be taken at the same time to check sugar, calcium, urea nitrogen and electrolyte, correct blood electrolyte disorder in time and prevent brain edema; Coma, high fever patients timely sputum aspiration, body surface cooling; If dyspnea and cyanosis occur, prepare for tracheotomy and artificial respiration machine to assist breathing.
Post-discharge nursing
1. Take the medicine continuously for 2-5 years. In order to prevent forgetting, put the medicine in a fixed place and take it at a fixed time every day.
2. Develop good living habits, rest on time, ensure adequate sleep, and avoid overwork and eating irritating food. Avoid catching a cold, getting caught in the rain and showering with cold and overheated water.
3. You need someone to accompany you when you go out. If there is a premonition of an attack, you should find a safe place to lie flat as soon as possible and bite it between your upper and lower teeth with gauze and handkerchief. Usually carry a disease treatment card at any time to facilitate timely rescue and treatment when an attack occurs.
4, should not be engaged in high altitude, water, furnace, driving or high pressure machine room and other dangerous work, should not participate in strenuous exercise and heavy physical labor.
5, try to avoid some special factors, such as flash, music, fright, etc. Reduce the sound and light stimulation, such as using curtains and sound filters, not going to noisy places such as lasers and karaoke bars, and keeping the environment quiet.
Daily health care of epilepsy
1, some minerals are helpful to some patients, and magnesium (rich in whole wheat flour, millet, figs, meat, fish, nuts and beans); Zinc (found in meat, livestock offal, malt, nuts, crabs, oysters and lentils) and calcium (calcium-containing foods) (mainly found in milk and dairy products) help some people prevent convulsions.
2. Mixing salad and raw fruit (fruit food) can reduce the frequency and degree of disease.
3, should eat home-cooked meals, food should be diversified, rice, pasta, fat, lean meat, eggs, milk, fruits (fruit food), vegetables (vegetable food), fish, shrimp and so on.
4. Seizures of epilepsy are mostly empirical. Those who are physically strong or have a lot of wind and phlegm should have a light and nutritious diet and eat more rice, noodles and vegetables.
5. People with asthenia or physical weakness should be partial to foods that nourish liver and kidney, strengthen spleen and help transport, and replenish qi and blood. You can eat lean pork, pig heart, pig liver, animal brain, longan, lotus seeds, medlar and so on.
6, you can eat more foods that moisten the intestines (such as honey, bananas, walnuts, almonds, spinach, etc.). ) keep the stool unobstructed.
prevent
Prevention of epilepsy
Prevention of epilepsy should pay attention to the following aspects:
(1) Good prenatal and postnatal care, and consanguineous marriage is prohibited. Be sure to stay away from radiation in the first three months of pregnancy to avoid virus and bacterial infection. Regular pregnancy check-up to avoid fetal hypoxia, asphyxia and birth injury.
② Children with fever should see a doctor in time to avoid febrile convulsion and brain injury. Children should also be taken care of to avoid head injuries.
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.
complication
Epilepsy complication
Often complicated with acute renal failure, acute promyelocytic leukemia, depression.
Acute renal failure, referred to as acute renal failure, is a clinically critical disease. The disease is an acute renal damage caused by many reasons, which can make the regulation function of nephron drop sharply within several hours to several days, making it impossible to maintain the balance of body fluids and electrolytes and excrete metabolites, thus leading to hyperkalemia, metabolic acidosis and acute uremia syndrome, which is clinically called acute renal failure.
Acute myeloid leukemia (APL) is a special type of acute myeloid leukemia, which is classified as M3 by FAB collaboration group.
Depression is a common emotional disorder, which can be caused by many reasons. The main clinical feature is significant and persistent depression, and depression is not commensurate with its situation. In severe cases, suicidal thoughts and behaviors will occur. Most cases have the tendency of recurrent attacks, most of which can be relieved every time, and some may have residual symptoms or become chronic.