Epilepsy and epilepsy-like seizures
Introduction
Introduction Epileptic seizures and epilepsy are characterized by a group of diseases and syndromes characterized by transient central nervous system dysfunction caused by recurrent abnormalities in the course of the disease. According to the range of neurons and the extent of discharge diffusion, dysfunction may manifest as different obstacles such as exercise, sensation, consciousness, behavior, autonomic nerve, or both. Each episode or each episode is called a seizure. The patient may have one or several painful epileptic seizures.
Cause
Cause
(1) Idiopathic epilepsy
Also known as primary epilepsy, it is said that relying on current scientific techniques and detection methods can not find that the patient's brain has a structural change or metabolic changes that can lead to seizures, which may be related to genetic factors.
(two) symptomatic epilepsy
1, infection: a variety of bacterial meningitis, brain abscess, granuloma, viral encephalitis, and brain parasitic diseases, such as cerebral cysticercosis, schistosomiasis, toxoplasmosis, etc., in the north of China with more cerebral cysticercosis.
2, craniocerebral injury: craniocerebral injury such as depressed fracture, dural tear, brain trauma, intracerebral hemorrhage, brain surgery, etc., within a few weeks after the injury may produce seizures.
3, brain tumor: in the onset of symptomatic epilepsy in adulthood, in addition to injury, on-screen tumor is also a common cause, especially in the frontal lobe and central retinoblast near oligodendroglioma, meningioma , astrocytoma, metastatic cancer and so on.
4, cerebrovascular disease: cerebrovascular disease after epilepsy is more common in middle and old, such as cerebral embolism, cerebral thrombosis and multiple lacunar infarction, cerebral hemorrhage. Cerebrovascular malformations and subarachnoid hemorrhage are younger than the age of onset, so they are younger at the time of epilepsy. Hypertensive encephalopathy may also be associated with seizures.
5, congenital malformations: such as chromosomal aberrations, congenital hydrocephalus, microcephaly, corpus callosum dysplasia, cerebral cortical hypoplasia.
6, prenatal and perinatal diseases: birth injury is a common cause of symptomatic epilepsy in infancy. Brain contusion, edema, hemorrhage, and infarction caused by childbirth can cause local brain lesions, and epileptic discharges may form in the future. Patients with cerebral palsy are also often associated with epilepsy.
7, other: such as febrile seizure sequelae, especially severe and persistent febrile seizures, lead, mercury, carbon monoxide, ethanol, hibiscus, isoniazid and other poisoning, systemic diseases such as pregnancy-induced hypertension syndrome, uremia, etc. Can cause epilepsy; nutrition, metabolic diseases, children's rickets can also be associated with epilepsy, hypoglycemia caused by islet cell tumor, diabetes, hyperthyroidism, hypoparathyroidism, vitamin B6 deficiency, etc. can occur, And degenerative diseases such as tuberous sclerosis, Alzheimer's disease, and the like.
Examine
an examination
Related inspection
EEG examination of brain CT examination of cerebrospinal fluid lactic acid
First, medical history
The diagnosis of epilepsy is based on a detailed medical history, so history collection and clinical examination are extremely important in the diagnosis of epilepsy. Because of the many types of epilepsy and the complex causes, it is necessary to strive for exhaustiveness.
Because in many epileptic seizures, the patient was unconscious at the time and could not recall afterwards, it was not only important to the patient's medical history, but also to the witnesses to understand the whole episode.
When inquiring about medical history, you should pay attention to whether there are induced factors such as fatigue, hunger, constipation, drinking, emotional impulse, anger, and anxiety during the attack; the environment at the time of attack, the time course of the attack, the presence or absence of limb convulsions and their approximate sequence, and whether or not there is trauma. Urinary incontinence, frequency of attack, duration, interval, whether there are strange behaviors and mental disorders, treatment with unwanted drugs, the use of drugs, medication rules, dosage and usage, and how effective.
For children, patients should pay attention to whether the mother has infection during pregnancy, whether there is no birth injury or craniocerebral trauma during childbirth, whether children have febrile seizures, whether there are infections such as various bacterial meningitis, viral encephalitis, and brain parasitic diseases. Such as cerebral cysticercosis, the family history of the patient and the patient's juvenile medical history.
For adults, attention should be paid to the history of craniocerebral trauma, history of cerebrovascular disease, history of infection, history of parasitic infections, history of other sites, history of poisoning, and the presence or absence of other neurological diseases.
Second, physical examination
Children should pay attention to whether there is intelligence, congenital hydrocephalus, microcephaly, dysplasia, cerebral cortical dysplasia and heart condition, tendency of hand and foot twitching, skin and subcutaneous nodules. In addition to examining the symptoms and signs of the nervous system, adults should also check the general condition, such as tumors, infections, trauma, pregnancy-induced hypertension syndrome, uremia, nutrition, metabolic diseases.
Third, laboratory inspection
1, EEG: the diagnosis of epilepsy is of great significance, about 80% of patients with epilepsy can be found abnormal EEG. EEG examination also contributes to the classification of seizures, such as generalized tonic-clonic seizures, mainly characterized by scattered or continuous spike rhythm, the main god is 3 times / second spike complex, and bilateral symmetric synchronization . Infantile snoring is characterized by a high rhythm, and psychomotor seizures often occur in the temporal lobe, especially in the forehead. EEG examination helps to determine the location of epilepsy. For those who are diagnosing difficulties:
1 Long-term monitoring of EEG, also known as cassette EEG can record EEG conditions for 24h or longer.
2 Video telemetry EEG can determine the type of seizure, the number of statistical episodes, and it is possible to understand the factors that induce seizures and determine the location of the lesions. It is helpful for the identification of epilepsy and non-epileptic seizures.
2, quantitative drug EEG: according to the impact of drugs on EEG activities and different, quantitative EEG research.
Fourth, equipment inspection
1, brain CT examination
Brain CT examination of patients with epilepsy: the abnormal discovery rate is 30%-50%, and the CT scan results are roughly: brain atrophy, brain tumor, encephalitis, brain parasitic disease, and cerebrovascular malformation. Cerebral infarction, traffic hydrocephalus, medial temporal lobe, corpus callosum malformation, brain softening, brain calcification. The abnormal rate of brain CT in children with epilepsy is 33%, the most common is brain atrophy.
2, cerebral blood MRI examination: for patients with epilepsy brain CT and brain MRI found tumors and parasites, MRI also contribute to demyelination and other white matter disease diagnosis.
3. Positron emission tomography (PET): It can measure the local metabolism and blood flow of the brain of patients with epilepsy from various angles. The measurement of physiological items is carried out by means of radionuclides labeled carbon, nitrogen, oxygen, and fluorine. Moreover, pathological changes at different stages of the disease can be determined, and tissue pathological changes can be provided before the tissue has undergone structural changes.
4, single photon emission tomography (SPECT): local blood perfusion reduction in the brain during seizures, SPECT helps to find epileptic foci.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Secondary epilepsy: The so-called secondary epilepsy refers to epilepsy secondary to other diseases (such as: a variety of brain diseases or metabolic abnormalities), that is, epilepsy caused by other diseases, also known as "symptomatic epilepsy" .
2. Absence of seizures: The absence of seizures is dominated by disturbances of consciousness, which is characterized by a sudden onset of seizures without any aura. The patient's ongoing movement is suddenly interrupted, dazed, and can be accompanied by a double eye flip. If the patient is speaking, his speech will slow down or terminate. If he is walking, he may suddenly stand still and stay awake. He may suddenly break free from the hand of the adult and walk a few steps forward. He suddenly cries and looks for his parents. If the chopsticks with food are suddenly stopped in the middle of the mouth when eating, they can't answer the question. Some patients can stop the attack when they talk to them. This episode lasts from a few seconds to 30 seconds, and more than one minute is rare.
3. Generalized tonicity of epilepsy - clonic seizures: generalized tonicity of epilepsy - clonic seizures (secondary generalization): simple partial seizures can develop into complex partial seizures, simple or complex partial seizures can be generalized to comprehensive Tonic-clonic seizures, if the patient remembers a focal episode after waking up, the symptoms are aura. Sudden loss of consciousness without a clear description of aura symptoms, highly suggestive of seizures. Local sensory or motor symptoms, such as involuntary twitching of one limb, paresthesia of one side, and forced head turning, suggest a seizure of the contralateral frontal cortex. Fear, olfactory hallucinations or taste hallucinations, visceral sensations or familiarity often originate from temporal seizures.
4. Epileptic personality changes: a small number of patients after a long-term, repeated seizures, can cause progressive personality changes. 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.
