juvenile epilepsy
Introduction
Introduction to adolescent epilepsy Adolescent epilepsy refers to epilepsy patients between the ages of 13 and 20 years old. Epilepsy, commonly known as "epilepsy, shofar wind", is a chronic disease in which sudden abnormal discharge of brain neurons leads to transient brain dysfunction. Epileptic seizure (epilepticseizure) refers to the clinical phenomenon caused by abnormal brain neurons and excessive hypersynchronous discharge. It is characterized by sudden and transient symptoms, and there are various manifestations of abnormally discharged neurons in the brain. basic knowledge The proportion of sickness: 0.01% Susceptible people: teenagers Mode of infection: non-infectious Complications: epilepsy
Cause
Adolescent epilepsy etiology
First, congenital factors
Congenital factors of adolescent epilepsy include congenital diseases such as brain malformation, hydrocephalus, chromosomal abnormalities, or damage to the mother before birth. It can cause abnormal brain development and epileptic seizures after birth.
Second, genetic factors
Some epilepsy does have a genetic predisposition, but heredity is not very certain. Studies on epilepsy in twins have shown that children with epilepsy have genetic susceptibility. Family analysis and epidemiological survey of patients with epilepsy indicate that the prevalence of epilepsy in children with idiopathic epilepsy is 3.8%-10.8%, up to 19.8%. ~35%, significantly higher than 1% to 4.6% of symptomatic epilepsy, the latter is 0.3%~0.6% higher than the average person, and the closer to the patient's blood relationship, the higher the prevalence.
Third, the acquired factors
Birth injury: It is a common cause of symptomatic epilepsy in infants and young children. The causes of birth injury are birth forceps, midwife suction, head basin disproportionation, fetal position abnormality, fetal oversize, long labor, and primipara age. Large, tight birth canal, etc.; brain hypoplasia, brain development retardation, brain atrophy, various encephalitis, meningitis, brain abscess patients after the death of some people may have evidence of epilepsy; cerebral schistosomiasis, cerebral cysticercosis can cause epilepsy; Nutritional metabolic diseases: hypoglycemia, diabetic coma, vitamin B6 deficiency, hyperthyroidism, etc. can cause epileptic seizures.
Prevention
Adolescent epilepsy prevention
1, adolescent epilepsy patients diet, should avoid spicy food, quit smoking and alcohol to avoid over-satisfaction, eat more soy products, fresh fruits and vegetables, dairy products, and high protein and phospholipid-rich foods.
2, adolescent epilepsy patients should avoid overwork and tension, avoid mental stimulation, stress, to prevent induction and deterioration.
3, epileptic patients once the disease, should immediately use a towel or handkerchief and other soft objects into the patient's molars, hand chin to prevent damage to the tongue and teeth, and then untie the clothes, belts to prevent airway obstruction.
4. When adolescent epilepsy occurs, if there are limbs twitching, you can use the bedding or hand to protect the limbs to prevent joint dislocation and fracture. Once the convulsion stops, the breathing is not smooth, help the patient to do artificial respiration and restore normal breathing.
5. Adolescents are in a strong growth and development, and should be given high-calorie, high-vitamin, digestible fluid or semi-liquid food. Usually drink plenty of warm water to keep the mucous membranes moist.
6, such as adolescent continuous convulsions can increase the basal metabolic rate of brain tissue, brain tissue oxygen demand increased, leading to increased brain edema. Therefore, cooling is a necessary measure to reduce brain edema and protect brain tissue. Physical cooling is usually applied to children with body temperature above 38.5 °C. For example, use 30% to 50% alcohol to rub the bath or put an ice pack on the head.
7. If the seizures of adolescent epilepsy continue, the consciousness is unclear, and the secretions of the respiratory tract are increased, it is necessary to suck in time to remove oral secretions and prevent the occurrence of aspiration pneumonia and asphyxia.
Complication
Adolescent epilepsy complications Complications
Influence on intelligence
As a chronic brain disease, epilepsy is caused by abnormal brain power generation. Therefore, epileptic seizures can cause harm to children in the period of growth and development, affecting the normal development of children's intelligence, serious children, and even intelligence. Low, learning hardships, stupid things, etc. To this end, parents must pay attention to it, can not let the moment neglect, let the child stay on the starting line forever. If the child is found to be ill, he should be taken to the hospital in time. The sooner the treatment is better.
Psychological impact
The location, nature, and probability and time of epileptic seizures can cause psychological disorders of different natures and degrees. Frequent seizures often lead to excitement or depression, excessive activity, disobedience, and poor learning. Psychomotor epilepsy can be characterized by abnormal seizure behavior, paroxysmal focal or other emotional experience, and sudden strangeness of seizures. There may be a period of paralysis after a major seizure.
Changes in neurotransmitters
Epilepsy experts said that one of the pathophysiological mechanisms of epilepsy is caused by insufficient inhibitory neurotransmitters, excessive excitatory neurotransmitters or imbalance between the two. These neurotransmitters also have a great impact on behavioral cognition. Excitatory neurotransmitters such as acetylcholine, glutamate, and brain peptides are closely related to maintaining behavior and activation of EEG, promoting memory and learning, and affecting mood.
Effect of antiepileptic drugs
Up to now, various types of anti-epileptic drugs have certain effects on cognition and behavior. For example, prolonged use of phenytoin can cause mental retardation, long-term use of carbamazepine, primidone, ethosin, valproic acid, etc. It can have adverse effects on children's behavior and learning, and can cause irritability, inattention, slight disorientation, etc., but must not refuse anti-epileptic drug treatment.
Symptom
Adolescent epilepsy symptoms Common symptoms Epilepsy body stiffness... Oral vomiting, white foam, convulsions, loss of consciousness, seizures, missed episodes, frequent foaming
The symptoms of adolescent epilepsy are mainly divided into epileptic seizures and epileptic seizures:
A small epileptic seizure is also called a seizure, and the disturbance of consciousness is short-lived and frequent. The typical manifestation is that the patient has a transient loss of consciousness, most of the consciousness is completely lost, and occasionally the consciousness disorder is shallow, and there is some understanding of the surroundings, can hear the question, but can not answer.
Clinical manifestations of epileptic seizures: manifested as sudden interruption of speech and activity, gaze in both eyes, occasionally upturned, sometimes pale, without aura. Holding the object in the hand, sometimes breaking the rice bowl, after the attack stops, continue the original activity. Most of the episodes occur 2-15 seconds, no more than 1 minute, several times a day to dozens of times. Suddenly, suddenly terminated.
A seizure episode is also called a systemic tonic-clonic attack, characterized by loss of consciousness and generalized convulsions. Clinical studies have found that epileptic seizures account for about 50% of seizures, mostly between 1 year old or 14-17 years old.
Clinical manifestations of epileptic seizures: large episodes can be divided into four periods: (1) aura: dizziness, stomach discomfort. (2) Strong period: Sudden loss of consciousness, falling to the ground, head tilting, limb rigidity, due to diaphragmatic spasm, the patient issued a "lamb" like screaming, face bruising, pupil dilated, apnea, lasting for tens of seconds. (3) sputum period: the whole body muscles have rhythmic twitching, often bite the tongue, foaming at the mouth, may be accompanied by incontinence, usually lasting 1-3 minutes. (4) Recovery period: It usually takes tens of minutes to wake up. The patient can't recall the attack process, and the whole body is painful and weak. Individual patients have madness, chaos, and destruction of people during the recovery period.
Examine
Examination of adolescent epilepsy
Laboratory inspection
Blood biochemical examination: According to age, condition, differential diagnosis needs to choose different items. Generally, there are blood calcium, magnesium, sodium, blood sugar, blood bilirubin, blood gas analysis, blood lactic acid, blood ammonia, liver function and the like.
Cerebrospinal fluid examination
Mainly to exclude diseases such as intracranial infection, intracranial hemorrhage. In addition to conventional, biochemical, bacterial culture smears, it should also be used for pathological examination of mycoplasma, toxoplasma, cytomegalovirus, herpes simplex virus, cysticercosis and attention to cytological examination of abnormal white blood cells. Examination of other metabolic abnormalities, such as renal function, blood amino acid analysis, etc.
EEG examination
EEG not only has important diagnostic value for determining epileptic seizures and judging the type of epilepsy, but also has practical significance for the etiological diagnosis of epilepsy.
Film degree exam
CT and MRI examination: the clinical application of CT has become an important means of diagnosis of epilepsy. According to the large case data report, the positive rate of CT lesions in non-selective epilepsy patients is generally above 50%. MRI is more valuable for the diagnosis of epilepsy than CT.
Diagnosis
Diagnosis and diagnosis of adolescent epilepsy
At present, the basis for the diagnosis of epilepsy in adolescents mainly depends on clinical manifestations. The typical seizure is decisive for definitive diagnosis, so detailed, complete, accurate and clear medical history, EEG examination, brain CT, blood concentration detection and other related examinations are all Can be used as a necessary basis for the diagnosis of epilepsy. However, the following questions should be clarified when adolescents are diagnosed with epilepsy:
1 whether the paroxysmal symptoms are epilepsy.
2 If it is epilepsy, what type of seizure is a special epileptic syndrome.
3 If it is epilepsy, whether there is epileptogenic lesions, whether there are predisposing factors, and to know what the incentives are. Because most people with epilepsy have certain disturbances of consciousness during the attack, the patient can not express the episode itself, and because the doctor rarely sees the seizure process of the patient, the detailed medical history data is mainly based on the patient's family or witnesses, and closely cooperates. Physicians do the right diagnosis so that they can get effective treatment in time to prevent further aggravation. In addition, some adolescent epilepsy patients are normal when doing EEG examination, then the doctor should use clinical symptoms as a basis for diagnosis.
Diagnosis of adolescent epilepsy:
1, the clinical manifestations of sudden onset, sudden termination, short duration, repeated attacks, and clinical symptoms are mostly stereotyped, most of the attacks have no obvious incentives. Although clinical manifestations can be classified as a type of seizure. However, the same patient may have one or more types of seizures. Secondary episodes may have focal signs of the nervous system or mental retardation. These characteristic clinical manifestations are often the primary basis for the diagnosis of epilepsy.
2, anti-epileptic drug effect correct drug treatment can control the seizures of most adolescents with epilepsy, some of which can be completely controlled. For cases with atypical clinical manifestations and no Epileptic waves in EEG, anti-epileptic drug treatment is often the main basis for diagnosis.
3, EEG is the gold standard for the diagnosis of epilepsy, EEG abnormal waveform, epileptic wave has a special diagnostic significance, EEG should have the possibility of epilepsy when there is a special epileptic wave. However, the clinical diagnosis of epilepsy cannot be based solely on epileptic waves, which only indicates that the risk of seizures is higher than that of healthy people with EEG. Conversely, patients with typical clinical manifestations and normal EEG cannot rule out epilepsy.
