epileptic disorder
Introduction
Introduction to epilepsy Epilepsy is a transient, recurrent clinical syndrome caused by abnormal over-discharge of brain cells due to a variety of causes. Due to different abnormal discharge sites, clinical manifestations are also different. The common features are sudden, transient, and repetitive. When seizures occur, they appear as sudden, transient and recurrent brain dysfunction. Mental disorder disorder ( mentaldisorderinepilepsy), also known as epilepsy caused by mental disorders, both primary and symptomatic epilepsy can occur mental disorders. Patients with epilepsy show abnormal mental activity before, during, or after seizures, and some patients even show persistent mental disorders. Symptoms vary depending on the location involved and the pathophysiological changes. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: indigestion, somatosensory disturbance
Cause
Epileptic disorder
(1) Causes of the disease
Clinically, epilepsy is often divided into primary and secondary. Primary epilepsy is also called true epilepsy or idiopathic epilepsy or occult epilepsy. The etiology is not clear. Secondary epilepsy is also called symptomatic epilepsy. Find the cause, often secondary to brain diseases, brain tumors, craniocerebral trauma, intracranial infections, cerebrovascular diseases, brain degenerative diseases, etc., in hypoxia, metabolic diseases, cardiovascular diseases, toxic diseases, etc. It can also occur during illness.
The pathogenesis of epilepsy is complex and has not yet been elucidated. At present, it is attributed to excessive synchronous discharge of neurons. Molecular genetic research has made breakthroughs, such as clear primary systemic epilepsy and epilepsy with mental retardation. The hereditary mode is autosomal recessive inheritance, and epilepsy with hallucinatory features is autosomal dominant inheritance.
Seizures are a clinical manifestation of cerebral cortical neuronal dysfunction. The first cause of seizures can be:
Symptomatic epilepsy (20%):
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 disorders, 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. 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 is highly correlated with past brain injury. Sex, its seizure may be only 1 time, but more common it will recur epilepsy, also symptomatic epilepsy (symptomatic epilepsy).
Primary epilepsy (25%):
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 the more common one is recurrent. Become epilepsy.
Cryptogenic epilepsy (15%):
Although there has not been any history of brain damage in the past, according to clinical data, it is suspected that there may be seizures caused by hidden brain damage or brain dysfunction, called cryptogenic epilepsy.
Reflex epilepsy (18%):
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 the relevant incentives or receive sensitive treatment, then less Hair, called reflex epilepsy.
(two) pathogenesis
1. The fundamental cause of neurophysiological seizures is the abnormal discharge of brain neurons. The abnormal discharge of epilepsy can occur in the ictal discharge or in the interictal discharge, which leads to this abnormal discharge. The reasons can be varied, but so far, little is known about the nature of abnormal discharge. With the development of science and technology, there may be a clearer understanding of the causes of epilepsy. According to current research, there are various factors. The potential of a group of brain cell membranes is abnormally depolarized and synchronized to form the kinetic effect of peripheral neurons. There are various theories of electrophysiological abnormalities in brain neurons, which are generally considered to be related to ion abnormalities of the membrane potential. It is thought to be related to the imbalance of excitatory amino acids (glutamate, etc.) and inhibitory amino acids (GABA, etc.) in the brain's nervous media. In short, seizures are the result of abnormal brain cells and excessive discharge.
2. Neuropathology The pathogenesis of idiopathic epilepsy is very complicated and has not been fully elucidated. It has been extensively studied for the pathology of partial symptomatic epilepsy. In animal experiments, cobalt hydroxide is applied to the brain tissue of monkeys. Glial sputum is gradually formed around, and partial seizures occur after 4 to 12 weeks. The epileptic discharge of partial epilepsy usually starts near the epileptic lesions, and also starts from the distant or unrelated lesions. The septum, such as the right amygdala on the right side of the cat, caused a seizure discharge on the left amygdala. Johnson et al found that the cerebral cortex, the subcortical structure, and even the cerebral palsy threshold of the entire brain were reduced in animals with epileptic scars. Neurons that are anatomically related to the damage caused by epilepsy may have increased excitability, but there is no organic damage. This is an important concept, that is, scattered spikes on the EEG or Rhythmic epileptic discharge can be used as a diagnostic evidence for partial epilepsy, but it is not certain that the epileptic seizure is in the same site. It is generally considered that mental disorders associated with epilepsy patients, such as paranoia. 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 uncontrollable strong emotional and behavioral disorders, known as episodes of poor control Episodic dyscontrol syndrome may be associated with abnormal discharge of the amygdala.
Prevention
Epileptic mental disorder prevention
The most prominent features of patients with mental disorders caused by epilepsy are irritability, impulsivity and personality changes, and their aggressive behavior often appears suddenly and without purpose. Attack tools often come with them, thus causing difficulties in prevention. The pathogenic factors are not clear, so there is no targeted preventive measure for mental disorders caused by epilepsy. However, the indifference of relatives, discrimination of others, personality disorder, etc. are often the causes of attacks, so scientific understanding Epilepsy disease, correct treatment of patients with epilepsy, to reduce the social pressure of patients with epilepsy, is conducive to reducing the occurrence of mental disorders caused by epilepsy, preventive measures for epileptic patients with aggressive behavior as follows:
1. Countermeasures
First of all, it is necessary to find out in time, stop as soon as possible, and do not wait until the injury is caused. In order to avoid the escalation of the conflict, the party that is prone to attack should be biased when persuading, not to talk about who is in front of the two patients. Who is not, after the two sides have stabilized their emotions, they should patiently ask the patient and solve the problem psychologically.
2. Ask about the medical history, understand the condition should be patiently asked if there has been an aggressive behavior, especially for patients with serious aggressive behavior, should be the focus, many attacks have no obvious reasons, the more the cause of the attack, the more the attack should be caused Pay attention to the symptoms, hallucinations, delusions, delusions and other symptoms of patients with epilepsy and mental disorders, which are more likely to lead to aggression. It is necessary to strengthen the observation of changes in the condition, carefully understand the patient's psychological state, and seriously attack the behavior. The patient can be sent to the hospital in time, or temporarily taken care of by a special person to prevent attacks.
3. Dealing with patient quarrels in a timely manner Many serious attacks are caused only by small quarrels. Timely handling is an important part of preventing aggressive behavior. Patients should be encouraged to speak their own dissatisfaction, so as to avoid impulsive behavior caused by dissatisfaction.
4. Establish a good relationship Because patients lose their self-knowledge during the illness, they often don't understand the concerns of the people around them. They should pay attention to language and art when they talk to patients, try to meet their reasonable requirements and establish a good relationship with them.
Complication
Epileptic disorder Complications, dyspepsia, somatosensory disturbance
Concurrent depression, sensory disturbance, indigestion.
Symptom
Symptoms of epilepsy mental disorder Common symptoms Suffered delusions between mental disorders Dementia, severe mental retardation, epilepsy, neurosis, paroxysmalism, amnesty, amnesty, autopsy, seizure, epilepsy, personality change
1. Classification of epilepsy The classification of epilepsy is proposed by the International League Against Epilepsy (ILAE). The most commonly used classification is the classification of seizures (1981) and epilepsy and Classification of epilepsy syndrome (1989).
(1) International classification of seizures:
1 partial seizures: partial seizures refers to clinical manifestations of focal or partial symptoms, EEG suggests a local or one-sided hemisphere origin of epilepsy discharge.
A. Simple partial seizures: The patient's consciousness exists at the time of onset. Simple partial seizures include: a. exercise type, b. feeling or special feeling type, c. autonomic type, d. mental or emotional change.
It is currently believed that the so-called "aura" that occurs before other episodes is a simple partial seizure.
B. Complex partial seizures: for the onset of local origin, the patient is accompanied by disturbance of consciousness at the time of onset. This disturbance of consciousness can occur at the beginning of the onset of the disease, or it can be developed from a simple partial seizure. Obstacles are accompanied by perceptions, emotions, memories, illusions, hallucinations, etc. At the same time, involuntary groping actions, such as automatism or psychomotor seizure.
C. Partial seizures are secondary and comprehensive: the above two partial seizures may also evolve into generalized tonic clonic seizures or commonly known as grand mals, sometimes difficult to distinguish from generalized seizures, in fact, this is a partial Secondary generalized tonic-clonic seizure.
2 comprehensive seizures: generalized seizure refers to clinical and EEG changes from the beginning of the attack at the same time and bilateral cerebral hemisphere, clinical symptoms are bilateral symmetry, most of them have loss of consciousness or disturbance of consciousness.
A. Absence seizure: more common in children, more girls, clinical manifestations of short-term loss, this time should not call, the eyes are straight, sometimes with blinking or mild auto-inflammatory action, usually lasts for a few seconds Or more than ten seconds, more than 10 times or dozens of episodes in a day, EEG can be seen in the intermittent interval of the episodes of irregular three times per second slow wave synthesis, the attack is bilateral symmetric synchronization 3 times per second A comprehensive rhythm of the spine slow wave, a long-range burst occurs.
B. myoclonic seizure: clinical systemic seizures, manifested as a momentary systemic myoclonus-like movements, EEG can be seen in the intermission period, multiple spikes or a single multi-spine slow wave synthesis, The episode is a transient multi-spindle slow wave synthesis rhythm that occurs symmetrically.
C. Tonic seizure: The body is stretched and accompanied by loss of consciousness, often screaming at the same time, sometimes the patient falls, and most of the tonic occurs in sleep.
D. Clonic seizure: occurs mostly in children and young children, manifested as clonic convulsions on both limbs and often combined with disturbance of consciousness.
E. Tonic-clonic seizure: It is a so-called large seizure. Its clinical manifestation is sudden loss of consciousness and generalized convulsions. It usually includes the initial strong period and the subsequent occurrence of the clonic period, lasting 1~ After 2 minutes, the patient's body was weak and sluggish, and he was awake. After waking up, he had headache, general weakness, soreness and other symptoms.
F. Aonic seizure: A fall that often manifests as a loss of tension, typically a sudden collapse. The EEG at the time of the attack is only a single-shot, slow-wave synthesis, in many cases. It is often not possible to see a clear specific discharge or only an action artifact.
3 unclassified seizures.
(2) Classification of epilepsy and epilepsy syndrome: The International Association for the Prevention of Epilepsy (ILAE) published an international classification of epilepsy and epilepsy syndrome in 1989. Although it is quite different from the past classification, the basic principle is The same is divided into idiopathic and symptomatic and cryptogenic according to the cause, and is divided into generalized and localized-related by location.
1 cause classification:
A. Idiopathic epilepsy (idiopathic epilepsy): a large group of epilepsy syndrome, its main features are: a. incidence and age-related, childhood and adolescent onset; b. relatively rare attacks; c. EEG Check background activity is normal; d. generally no neurological positive signs, mental motor development and mental normal; e. neuroimaging no abnormalities; f. self-healing tendency, generally recovered before and after puberty.
B. Symptomatic epilepsy (symptomatic epilepsy): clinically has the following characteristics: a. age-related is not as strong as primary; b. relatively clear cause; c. relatively more episodes, even continuous state of epilepsy; d. Figure check background activity is not normal; e. There may be positive signs of neurological system and imaging abnormalities, f. Some patients have psychomotor disorders and mental abnormalities; g. Some patients are refractory.
C. Cryptogenic epilepsy refers to a group of symptomatic epilepsy of unknown cause.
2 parts classification:
A. generalized epilepsy: refers to the EEG has a common, bilaterally symmetric epileptiform discharge, clinically as a generalized seizure, that is, the attack is bilaterally symmetrical from the beginning, Such as loss of mind, myoclonus, generalized tonic and seizures.
B. Localization-related epilepsy: refers to epilepsy consisting of a focal episode of a brain origin and a partial seizure. The clinical manifestations of various partial epilepsy are diverse.
After the seizure is determined and the type of seizure is known, and then the cause can be confirmed, the initial age of the patient's seizure must be added, the neurological examination, neuroimaging, the cause of the seizure, and the course of the disease. Then classify epilepsy or epilepsy syndrome.
There are 34 epilepsy syndromes in the 1989 classification, which are mainly divided into the following categories: idiopathic generalized epilepsy; symptomatic generalized epilepsy; cryptogenic generalized epilepsy ( Cryptogenic generalized epilepsy); idiopathic partial epilepsy; symptomatic partial epilepsy; cryptogenic partial epilepsy; undetermined epilepsy; Special syndromes.
2. Classification and performance of mental disorders caused by epilepsy
(1) According to different stages of seizures (currently used classification methods):
1 preictal disorder: pre-existing mental disorder refers to some patients with anxiety, nervousness, irritability, impulsivity, depression, apathy or a period of stupid or autonomic dysfunction before seizures, such as appetite Precursor symptoms such as diminution, paleness, flushing and indigestion can be divided into aura (aura) - seconds or minutes before seizures, and prodroma (prodromata) - hours to days before seizures, often a few minutes before the onset The same symptoms appear in hours or days, causing the patient to feel that the onset is about to come, called the prodromal symptoms. The current mechanism of this phenomenon has not yet been elucidated. In the past, it was called "aura" before the attack. Symptoms can be manifested in various types of mental disorders, such as emotional, emotional, cognitive aspects of the sensory symptoms, "aura" has a great positioning value to determine the origin of the source of epilepsy, "aura" must be The prodromal symptoms are differentiated, the latter is the symptoms within hours or days before the onset, and the "aura" is actually the beginning of the clinical attack, the patient's consciousness It may be recalled and described, and must be familiar with the characteristics of various auras, because some patients may have the only symptoms of epilepsy in a long period of time, often overlooked, and are only taken seriously after the emergence of a systemic episode. Similarly, After the major episode is controlled by anti-epileptic drugs, the "aura" can still be retained and become the only symptom.
2 disorders associated with ictal (disorder associated with ictal): mental disorders at the time of seizure mainly include psychomotor seizures, paroxysmal affective disorders and transient schizophrenia-like episodes, also known as psychomotor seizures or temporal lobe epilepsy can be a precursor , can also occur alone, more common in the cortical lesions caused by the local lesions, and the various symptoms at the time of the attack is determined by the location of the lesion, most of the lesions in the temporal lobe, and some in the frontal or marginal lobe, at the time of onset For a transient psychiatric experience, there are many conscious disturbances at the time of onset. The common mental disorders are mainly the following:
A. Perception barrier: mostly original illusion.
a. Visual episode: This episode is mainly caused by abnormal discharge of the occipital visual cortex, but it can also be caused by other cortical parts. This is a common sensory symptom, such as seeing fire, flashing, black Mongolian, but also You can see very complicated and complete scenes, or the reappearance of past experiences, sometimes illusions or perceived comprehensive obstacles, the latter often being visually ill, visual dysfunction and visual distortion, in addition, patients You can also have your own illusion or autopsy.
b. Auditory episode: This is due to abnormal discharge near the auditory cortex of the temporal lobe or the first paralysis. What appears to be monotonous auditory hallucinations, such as tinnitus, sometimes accompanied by dizziness, such as the lesion approaching the posterior The content that is listened to can also be speech sounds, such as hearing a call or a piece of music or song.
c. Olfactory seizures: mainly due to hooking and abnormal discharge around the amygdala, the patient can smell an unpleasant smell, sometimes like a burnt rubbery smell, a simple olfactory episode is less common, and most of the temporal lobe attacks The merger appears.
d. Taste episode: caused by abnormal discharge in the cortical taste zone, the patient may taste some unpleasant or special taste, which often occurs in combination with olfactory episodes and temporal lobe episodes.
B. Memory Disorder: The patient can experience a memory disorder that exhibits likelihood or old things like new symptoms, such as sudden familiarity with certain familiar names, or a seemingly past in a new environment. The feeling that has already been experienced, called familiarity (also known as deja vu), or in a familiar environment seems to have a completely strange feeling, called strangeness (also known as old things like new feelings).
C. Thinking disorder: There may be interruption of thinking, forced thinking, etc. The patient feels that his or her thoughts suddenly stop or the patient's thoughts are not subject to their own will, and they are forced to flood into the brain and often lack each other. Contact, this symptom may be due to frontal lobe lesions, as well as compulsive recall, some people think it is related to abnormal discharge on the upper side of the temporal lobe.
D. Affective disorders: mostly fear or happiness, but also depression, anxiety, but a small number, occasionally self-laughing, can have horror, depression, joy and anger episodes, terrorist attacks are emotional episodes The most common one, the degree can be light and heavy, the content is different, the paroxysmal emotional disorder has no obvious mental factors, sudden onset, short time, repeated clinical symptoms of the same content, sometimes seizures often and illusions, illusion coexist.
E. Autonomic dysfunction: refers to the spontaneous autonomic seizures, clinically visible headache, head swelling, abdominal pain, nausea, salivation, vomiting, palpitations, rapid pulse, shortness of breath or pause, sweating, pale or flushing, body temperature Changes in other symptoms, these have fewer spontaneous autopsy episodes, mostly combined with other seizures, and often appear before complex partial seizures, the duration of psychomotor seizures is often short, often several seconds, minutes, Occasionally for a few hours.
F. Automated disease: automatism is a common manifestation of complex partial seizures. About 75% of temporal lobe epilepsy has an autopsy, but temporal lobe epilepsy is not only an automatic disease, but often accompanied by a major episode. Other forms of seizures.
The core symptom is disturbance of consciousness, but it is often difficult to understand the action or behavior with unclear purpose in the case of confusion. It is not suitable for the situation at the time. The whole attack process usually lasts for half a minute to several minutes. For a long time, the complex partial seizure (CPS) can be divided into two types according to the episode. The first type begins with any episode of simple partial seizure (SPS), which is followed by a disturbance of consciousness. The evolution of the whole process is SPSCPS. At the beginning of the second category, there are disturbances of consciousness. Some only have disturbances of consciousness, while others combine automatic symptoms in the process of attack. The so-called automatic syndrome refers to patients who do not appear in the disturbance of consciousness. Appropriate rudeness, or purposeless, inefficient repeated meaningless movements, the main actions are repeated chewing, pouting, swallowing, licking tongue and even coughing, spitting, grimacing, repeated turning of the search or doubt, or no target Walking, running, playing with clothes, beheading, moving things, etc., in addition to repeating the language or talking to each other, asking patients during this period, can not get quickly The answer, if patients stop, even against the action will occur, but rarely aggressive behavior, attack near the end of the patient's state of consciousness gradually returned, but often do not know what just happened, summarized as follows:
a. Attack aura: Most patients have aura of attack, clinical manifestations of somatosensory abnormalities or illusions, hallucinations, perceptual comprehensive disorders, thinking disorders.
b. Seizure process: Suddenly, the patient's consciousness is blurred, often making some incomprehensible automatic movements, sometimes simpler movements, such as stretching the tongue, rubbing lips, chewing, swallowing, pouting, groping, walking, running , nodding, rotating, etc., and some are more complex movements, such as undressing, dressing, unbuttoning, buttoning, combing, tearing clothes, moving animals, making beds, etc. Some patients continue to attack after the onset of autopsy Previous work, such as walking, cycling, etc.
c. Speech autonomic disorder: Some epilepsy autopsy manifests as speech automatism, that is, verbal repetition, stereotype, seizure usually lasts for a few seconds, several minutes, occasionally for those who last for tens of minutes, and the consciousness is completely forgotten after recovery.
d. Diverse manifestations: According to the performance of the episode, nodding epilepsy, running epilepsy, laughing epilepsy, snoring, sleepwalking, etc. can be seen.
G. state: twilight state is the most common paroxysmal disorder in patients with epilepsy. The clinical manifestations are more complicated, the degree of disturbance of consciousness is different, from absent-mindedness, unresponsiveness, disordered thinking to completely ignoring the surrounding environment. External stimuli are unresponsive, often with severe mental retardation and abnormalities, which can occur in a variety of situations, including complex partial seizures, seizures before and after seizures, complex partial seizure persistence states, and seizure persistence states, etc. Sometimes it can occur after one or more epileptic seizures, or it may end in a generalized tonic-clonic seizure. It is characterized by reduced consciousness, reduced consciousness, poor orientation to the surrounding environment, and significant psychomotor activity. Hysteresis, unresponsiveness, sometimes emotional abnormalities such as horror, anger, vivid, vivid hallucinations, mostly illusion, often accompanied by impulsive behaviors and other atrocious behaviors caused by emotional outbursts, patients may also have mental disorders, messy content and Fragmental delusions, etc., in the paralyzed state, the patient may have dilated pupils and respond to light Blunt, drooling, sweating, hyperreflexia, gait instability, etc., patients may also be indifferent, silent, slow-moving, no response to the surrounding or staying in bed, appearing illegal, waxy flexion, clinical performance is similar Schizophrenia is a state of tension, called epileptic stupor state. The duration of the sputum state is uncertain. It can often be 1 to 2 hours, and it can be as long as 1 to 2 weeks or longer. At the end of the attack, the consciousness suddenly wakes up. The situation may be partially recalled or completely forgotten. The EEG can see the continuous high-amplitude abnormal rhythm or the spine slow wave comprehensive rhythm, which is summarized as follows:
a. Sudden onset, unconsciousness, poor orientation to the surrounding environment, unclear perception of things, and inability to contact them normally. At this time, the patient is very dangerous.
b. There are vivid hallucinations, mostly illusions, which can produce fragmentary delusions, few words or no words, or repeated language, and the mind is often chaotic.
c. Affective Disorder: Performance of fear, anger, behavioral disorder, lack of purpose, impulsive injury, destruction, irritability, and even brutal behavior such as murder.
d. status: epileptic sputum status can be expressed as deep disturbance of consciousness, rich, vivid, vivid hallucinations, patients can have emotional disorders, such as fear, anger, or dangerous behaviors such as murder, suicide, illusion or Imaginary sometimes has superstition or religious color.
e. Stiff state: epileptic stupor state may appear to be similar to schizophrenia, tension, stiffness, and parasitic, waxy buckling, etc., lasting for hours to days, then suddenly awake and forgotten.
H. Sustained state of autonomic symptoms: status epilepticus of automatism refers to a specific seizure state, clinical manifestations of deeper disturbance of consciousness, significant loss of orientation, distraction, Difficulties in understanding things around, accompanied by vivid, vivid, horrible illusions and hallucinations, such as seeing fierce ghosts rushing toward themselves, or hearing the sound of guns, fighting around the people as an enemy or winning the window Escape, patient thinking is incoherent, and there may be fragmentary delusions, etc., quiet and indifferent patients may suddenly be excited, and even suddenly attack and destruction behavior, when the autonomic symptoms persist, the EEG shows one or both sides of the sputum There are persistent abnormal rhythmic activities in the lead. The main lesions in the brain are in the hippocampus, amygdala, hook back, frontal lobe, cingulate gyrus, and sphenoid electrode leads often show focal anterior sacral fossa. Spikes or spikes are continuously released.
3 post-mental disorder: post-seizure mental disorder after epileptic seizures, confusion, disorientation, slow response, or vivid visual hallucinations, automatic symptoms and incitement to violent behavior, generally lasts for several minutes to several hours; For those who last for a few days or weeks, it can occur in patients of any age, but most commonly in the 30 to 40 years old, the state of seizures after seizures often occurs after generalized tonic-clonic seizures and partial seizures. In particular, after the onset of generalized tonic-clonic seizures, symptoms such as confusion, disorientation, hallucinations, delusions and excitement may occur after seizures. Exciting and confusion are common symptoms, sometimes visual hallucinations or auditory hallucinations. And delusions are obvious. Visual hallucinations often have a complete structure and persecution, so that patients attempt to escape, accidentally accidents, after which the patient can fall asleep or gradually reduce consciousness until it is fully restored, each time lasting 5 to 10 minutes to several Hours or longer, recurrence of a systemic episode may also terminate the post-onset mental disorder, after the onset of mental disorder EEG mainly for high-amplitude rhythm, gradually returned to normal basic rhythm.
4 Interictal disorder: This type of mental disorder refers to a group of unconscious disorders, but the period of mental symptoms is protracted and can last for several months to several years, including chronic psychiatric state-like psychosis, nerve Symptomatic symptoms, personality changes, intelligent defects and sexual dysfunction, etc., interictal psychosis occurs between the two episodes, and is not directly related to the seizure itself, and relatively rare in the onset and after the onset of mental disorders, in Non-selected cases account for about 10% to 30%, however, in terms of severity and duration, clinically more obvious than onset and after the onset of mental disorders, the latter usually short-lived, and often self-limiting Sexual.
A. Chronic schizophrenia-like psychosis: This refers to chronic illusory delusional psychosis in patients with chronic epilepsy, especially in temporal lobe epilepsy, or "chronic epilepsy delusional psychosis", accounting for about 1% of patients with epilepsy. After 10 to 20 years of seizures, schizophrenia-like symptoms appear, mostly chronic, and can last for several months to several years. All major symptoms of schizophrenia can occur, but they are more common in chronic paranoid hallucinations, such as relationship delusions. Suffering delusions, being controlled, thinking is captured, but also thinking interruptions, new words, compulsory thinking and other forms of thinking, about half of them have auditory hallucinations, content is persecution or imperative, often with religious superstition, can also appear Illusion, illusion and illusion, emotional abnormalities are mostly irritability, depression, fear, anxiety, occasional euphoria, but also can express emotional apathy, Pond has described chronic paranoid hallucinatory psychosis in chronic epilepsy patients as An independent clinical disease unit, Slater believes that if there is no seizure, the patient's mental disorder may be diagnosed as schizophrenia, but also There is a clear distinction between schizophrenia and epilepsy-like schizophrenia-like psychosis, which has certain characteristics such as emotional retention, frequent delusions and mysterious religious experiences, and fewer motor symptoms in epilepsy. Among mental disorders, negative symptoms are rare and lack of true thinking disorder and tension. Mckenna et al. pointed out that visual hallucinations are more prominent than auditory hallucinations. Tellenbach believes that delusional content is lack of organization and organization, and is generally considered epilepsy. There is no psychopathological difference between schizophrenia and Slater. Slater believes that the long-term prognosis of epilepsy is better than that of schizophrenia. After he was followed by the patient, he found that although it was chronic, the mental symptoms gradually disappeared. Trends and few personality disorders, the authors also believe that the overall prognosis of epilepsy psychosis is good, but there is no long-term subsequent longitudinal comparative study between epilepsy and schizophrenia.
B. Manic depressive psychosis: patients can suffer from depression or anxiety alone, but in most cases the above symptoms coexist at the same time. Once the above symptoms are mild, it is difficult to distinguish the two clinically. Epilepsy may cause the above two symptoms due to the destruction of the normal life of the patient. At the same time, the occurrence of the above symptoms may also be related to the change of the living environment of the patient, the presence of epilepsy and the treatment of antiepileptic drugs. Psychiatric symptoms may occur, and people may prejudically think that they are associated with epilepsy or other external factors that cause emotional instability in patients. Mild depressive symptoms can manifest as subjective fatigue, depression, dissatisfaction, and Sadness, etc., is different. Physiologically depressed patients are often able to understand their emotional state. The symptoms of anxiety disorders are more psychological, such as fearful expectations, irritability and anxiety, sympathetic Some of the physical symptoms and increased muscle tone, etc., may be in some patients with severe anxiety symptoms. There are symptoms such as excessive ventilation, which is often mistaken for seizures by the patient or doctor, and also has dysphoria. The patient suddenly has depression, anxiety, irritability, nervousness, depression without obvious incentives. , fear, dissatisfaction with everything around, picky and sly, blaming others, sometimes tyrannical, fierce, hostile, can appear aggressive behavior.
C. Neurosis associated with epilepsy: Pond et al reported that about 1/2 of patients with epilepsy with psychological factors have neurosis, and that patients with epilepsy with neurosis pay attention to the treatment of epilepsy because of emotional stability to epilepsy The control of seizures can play an important auxiliary role. The social stress problems related to epilepsy can be traced back to 2000. Epilepsy was considered a horrible disease as early as the Hippocratic era. Since then, there have been a lot of epilepsy. An article on social stress issues, today, even in our era of clear understanding of epilepsy, this serious problem still exists. The education of epilepsy, family and the public about epilepsy is the most common social prejudice. One of the effective methods is the social humiliation, discrimination, employment difficulties, unpredictable sudden disturbance of consciousness in the participation in group activities, social pressure and the feeling of not being able to fully control their own lives. It has a very close correlation with the occurrence of depression in a patient. A diagnosis of 2601 cases was diagnosed in the past 3 years. A psychological survey conducted by patients with epilepsy found that about 80% of patients usually have the most worrying problem of seizures. Secondly, about 69% of patients often have self-social stigma caused by epilepsy in their usual work. At the same time, the more frequent the seizures of patients, the more obvious the above psychological symptoms, which indicates that in the early stage of epilepsy, the medical conditions available to patients have a certain relationship with the various psychological stress they suffer. The author of the study also It is further believed that the psychological stress caused by patients with epilepsy is lighter than the psychological and social factors caused by epilepsy. It also points out that it takes a long time to follow up the investigation and research methods to further clarify the chronic epilepsy. How the pathological process leads to the psychological development of the patient and how various social pressures are formed in psychology. Sometimes it may be accompanied by anxiety physiological symptoms such as palpitations, nausea, abdominal discomfort, dizziness, unreality, Occlusion and shortness of breath, OCD is a common psychiatric symptom, and its main feature is repeated Current paranoia and compulsive behavior that cannot be rid of self, paranoia refers to a persistent, intrusive and inappropriate thought, thought, impulse or influence from the outside, and forced to mean repetition. Sexual behavior (such as repeated cleaning or repeated examinations) or psychological procedures (such as constant counting, etc.), forced behavior often occurs to neutralize anxiety caused by paranoia, patients often feel forced Or being driven to engage in some kind of compulsive movement, and think that the self is hard to resist and may also aggravate one's own anxiety. Some repetitive, stereotyped and uncontrollable thoughts or behaviors described by the patient may be Some symptoms in partial seizures are confused.
D. Sexual dysfunction: Sexual dysfunction is more common in patients with epilepsy. Many reports of sexual dysfunction are common in patients with temporal lobe epilepsy. The sexual desire and sexual intercourse ability of male patients with epilepsy are the most common symptoms of sexual dysfunction. Some scholars believe that The cause of sexual dysfunction is due to the decrease of serum free testosterone concentration caused by antiepileptic drugs. Some people think that hyperprolactinemia can affect sexual intercourse, and there are few studies on sexual dysfunction in female patients with epilepsy, but Herzog found Abnormal discharge of right temporal lobe epilepsy is particularly prone to cause coldness. It is also believed that many epilepsy patients have immature sexual psychology, strong dependence, lack of sexual intercourse skills and poor social adaptability are the causes of sexual dysfunction.
E. Epileptic personality changes: There have been many reports on the relationship between symptoms such as personality disorder in patients with epilepsy, especially temporal lobe epilepsy. Epidemiological investigations have shown that only a few low-energy epilepsy patients have serious personality disorder. Therefore, personality disorder is not an inevitable consequence of seizures. Personality changes often cause difficulties in interpersonal communication and employment, and are prone to judicial problems. The characteristic clinical manifestations include intelligence and emotion. It is generally believed that there is epilepsy and mental decline. People have different levels of personality change, and personality changes are most obvious with emotional reactions, which can be "two polar", such as irritability, brutality, fierceness, stubbornness, hostility, hatred, impulsivity, sensitivity and suspiciousness; On the other hand, it is characterized by excessive politeness, docility, kindness and praise. Patients may have a certain tendency in different time periods, but they also have two extreme characteristics. Patients often have conflicts and aggressive behaviors due to trivial matters. In addition, the patient's mental retardation, viscous and poor content, the viscosity or explosiveness of epileptic personality changes Brain organic personality changes are more obvious.
In the past few decades, there has been a heated debate about the existence of "epileptic personality", most modern epilepsy scientists are negative, and some people strongly oppose the attempt to explain the personality characteristics of patients with epilepsy, It is precisely because for centuries, people with epilepsy have been considered untrustworthy and even dangerous. They believe that they are riddled with evil and are evaded and ridiculed by most people, including doctors. Epilepsy patients are often forced to form. Various strange and abnormal behaviors, which easily lead to misunderstandings as they have mental disorders. In addition, early anti-epileptic drugs (such as bromine, phenytoin, barbiturates) may cause cognitive and behavioral aspects. Side effects, therefore, even in the case of better control of seizures, patients with epilepsy are still treated differently, there is still prejudice for patients with epilepsy, only through joint efforts, can change this situation, so that patients with epilepsy enjoy full Social rights, at present, the direct negation of "epileptic personality" is out of this effort.
There has been a long debate about the relationship between violent behavior and epilepsy. Some prison reports indicate that the prevalence of epilepsy in prisons is statistically higher than that of the general population, but further research has found that epilepsy itself and crime Sexual violence has not been confirmed to be closely related, but the proportion of people with epilepsy in the criminal population is only slightly higher than the normal population.
However, in recent re-examination of this issue, it has been found that among some of the criminals, it is because they have driven themselves to think that they have epilepsy.
Regarding the aggressive behavior that occurs during seizures, an international working group has been set up to conduct in-depth research. The results of the study suggest that the aggressive behavior that occurs during seizures is generally sudden and unplanned. The duration is about 29 s, which occurs mostly in complex partial seizures. The appearance of aggressive behavior may be due to the fear of the patient during the episode, or may be a reaction to some restrictive behavior from the outside. Direct aggression in seizures is rare, and some so-called criminal murders, indiscriminate slaughter, and uncontrollable psychomotor autonomic symptoms are almost impossible, as listed in the study. Some diagnostic criteria to identify whether these violent behaviors are due to seizures, Devinsky and Bear's detailed observations of five patients with temporal lobe epilepsy with a history of aggressive behavior suggest that aggressive behavior during seizures It is very rare, and it is observed in their research that it is really frequent and has clinical Aggressive behavior of significance rarely occurs during seizures.
F.Lennox190522%12%2%2/3;1/712638(30.6%)8(6.35%)-
(2)
Examine
EEG examination
(1)()---;;
(2)20%24h
2. Special inspection
CTMRIPETSPECT
CT63%78%22%
MRI
PET
Diagnosis
Diagnostic criteria
1.
60%90%50%(video-EEG)
;(febrileconvulsion);
[()](MEG)(MRI)(SPECT)(PET)
2.
(1)
(2)
(3);
(4)
Differential diagnosis
(narcolepsy)(cataplexy)(impulsive outbursts)(breath holding)23
()
1.
2.
3.;
4.
5.;
6.;;
