gesture automatism
Introduction
Introduction Gesture Automated Disorder: Simple gestures such as wiping, pouting, licking, twisting, grasping objects and genitals, or doing puzzles or comprehension-like movements; complex gestures such as buttoning or undressing, flipping pockets, whisking Or organize clothes, carry furniture, turn over beds or perform some professional activities. This symptom can occur in patients with epilepsy.
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 tumors: In the symptomatic epilepsy that begins in adulthood, in addition to the injury, on-screen tumors are also common causes; especially oligodendrogliomas and meningiomas that grow in the frontal and central retinois. , astrocytoma, metastatic cancer and so on.
4, cerebrovascular disease: cerebrovascular disease after epilepsy is more common in middle and old age, such as cerebral embolism, cerebral thrombosis and multiple lacunar infarction, cerebral hemorrhage, etc.; cerebral vascular malformation and subarachnoid hemorrhage due to the younger age of onset , so the age of epilepsy is lighter. 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 with rickets can also be associated with epilepsy; hypoglycemia caused by islet cell tumor, diabetes, hyperthyroidism, hypoparathyroidism, vitamin B6 deficiency can cause seizures; And degenerative diseases such as tuberous sclerosis, Alzheimer's disease, and the like.
Examine
an examination
Related inspection
EEG examination CT examination of gestational estriol (E3)
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 have difficulty in diagnosis: 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: The abnormal detection rate of brain CT examination in patients with epilepsy is 30%-50%. 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 is normal and brain MRI found tumors and parasites, MRI also contribute to the diagnosis of demyelination and other white matter diseases.
3. Positron emission tomography (PET) can measure local metabolism and blood flow in 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) reduces local blood perfusion in the brain during seizures, and SPECT helps to detect epileptic foci.
Diagnosis
Differential diagnosis
The diagnosis of epilepsy is a serious problem, because once the diagnosis of epilepsy is established, many patients need long-term treatment and follow-up, and may also affect the life and work of patients. The history of the diagnosis is extremely important, especially the situation at the time of the attack and the information provided by the eyewitness is extremely meaningful, based on the diagnosis of the medical history. Diagnosis should also be based on laboratory findings, especially EEG data and imaging studies. If the clinical data does not match the laboratory results, the latter should be the main one.
For an epileptic seizure, it should be judged whether it is epilepsy, if it is epilepsy, what type of epilepsy is, whether it is primary or secondary, and the etiology. Should be identified with the following diseases:
First, the classification of epilepsy
(a) partial seizures
1, simple partial seizures, without disturbance of consciousness 1 those with motor symptoms such as localized seizures, Jackson epilepsy, rotatory seizures, postural seizures, developmental seizures. 2 those with physical or special sensory symptoms, such as sonic seizures, visual seizures, auditory seizures, olfactory episodes, gustatory episodes, vertigo episodes, etc. 3 people with autonomic symptoms, such as rising stomach, vomiting, sweating, pale, flushing, bowel, vertical hair. Pupil enlargement, urinary incontinence, etc. 4 people with mental symptoms, such as speech disorders, memory disorders (commonly known as deja vu, that is, experienced strange things; experienced discomfort, that is, familiar with familiar things) emotional seizures, illusion seizures, compound Hallucinogenic seizures.
2, complex partial seizures with conscious disturbances 1 first simple partial seizures, such as only conscious disturbances, there are automatic symptoms, 2 beginning with conscious disturbances, only conscious disturbances and automatic symptoms.
3, partial seizures develop into a generalized seizure which may manifest as a tonic-clonic seizure, a tonic attack, or a clonic seizure. Such as a partial seizure followed by a generalized seizure, a complex partial seizure followed by a generalized seizure, a simple partial seizure developed into a complex partial seizure, and then a comprehensive seizure.
(two) comprehensive seizures
1. Absence of seizures is mainly caused by disturbance of consciousness: such as a typical absence of seizures, also known as minor episodes with only disturbance of consciousness, which may be accompanied by mild clonic components, tension-free components, tonic components, autopsy or autonomic symptoms. 2 atypical absence of seizures.
2, myoclonic seizures: sudden, short, rapid muscle contraction. It can be spread throughout the body, or it can be limited to the face, trunk, limbs or individual muscle groups. Can occur individually, but is common with rapid recurrent episodes. Morning wake up and will occur most often when sleeping; autonomous movements can also be induced.
3, tonic seizures: the body into the human tonic tendon. The limbs are stretched straight, and the head is biased toward one side or the back; the torso of the torso causes the horn to reverse. Often accompanied by autonomic symptoms such as pale, flushing, pupil dilation and so on.
4, tonic - clonic seizures: also known as large seizures, characterized by loss of consciousness and body convulsions. The seizure can be divided into three phases.
(1) Tonic period: All skeletal muscles exhibit sustained contraction. The upper jaw lifted up and the eyeballs groaned. The throat is screaming and screaming. The mouth is first strong and then closed, and may bite the tip of the tongue. The neck and trunk are flexed first and then reversed. The upper limbs are lifted up and then rotated, and converted into adduction and pronation. The lower extremity changes from self-buckling to strong straightening. After the tense period lasts for 10-20 s, there is a slight tremor on the extremities.
(2) Circumcision: until the tremor increases and extends to the whole body, becoming an intermittent sputum, that is, entering the sputum period. Each time, there is a short relaxation of muscle tension; the frequency of clonic gradual slowing down; the relaxation period is gradually prolonged. This issue lasts for approximately 30 s-1 min. After the last strong convulsion, the convulsion suddenly terminated. In the above two phases, accompanied by increased heart rate, increased blood pressure, increased sweat, saliva and bronchial secretion, and dilated pupils and other autonomic signs. The breathing was temporarily interrupted and the skin turned from pale to hair. The pupil disappears from light reflection and deep and shallow reflection; the road reflects extensibility.
(3) Late seizures: After the clonic period, there is still a short period of strong sputum, resulting in closed jaws and incontinence. Respiratory first recovery: the mouth and nose sprayed foam or blood, heart rate, blood pressure, pupils, etc. returned to normal. Relaxation of muscle tone; consciousness gradually awakens. The recovery from consciousness to consciousness is about 5-10 minutes. After waking up, I feel headache, body aches and fatigue, and I have no memory for convulsions. Many patients become drowsy after the disturbance of consciousness is alleviated. Individual patients have autonomic or emotional changes, such as anger and horror, before they are fully awake. The EEG chart is now a diffuse 10 Hz/sec wave with increasing amplitude, and the ablation period is a diffuse slow wave that is gradually slowing down, accompanied by intermittent clustering of spikes, which is recorded as a low level in the late stage of seizures.
5, clonic seizures: and the previous difference, only repeated body palsy, the frequency gradually slows down and the intensity does not change, the late convulsion is generally shorter. EEG sees fast activity, slow waves, and occasional spine-slow waves. This seizure accidentally caused a sudden burst of sputum, forming a clonic-strength-clonic attack.
6, no tension episodes.
(3) Unclassified episodes.
Second, differential diagnosis
(a) syncope
Due to insufficient blood perfusion of the brain. There is a short-term disturbance of consciousness, occasionally accompanied by a short burst of two upper limbs. Need to be identified with a variety of absence seizures. Before vasovagal syncope, most have a history of emotional stimulation or pain stimulation. Most of the syncope due to venous return occurs during prolonged standing, dehydration, bleeding, or urination or coughing. Most of the orthostatic hypotension syncope occurs when it suddenly stands up. Cardiac syncope is more common when you are struggling or running. Before the occurrence of syncope, there are symptoms such as dizziness, chest tightness, and blackness. The recovery of consciousness and physical strength is slower. It does not happen suddenly and the recovery is faster.
Children between the ages of 6 months and 6 years of age sometimes get stunned with a breath after a big cry. At this time, there is loss of consciousness, mild twitching of the limbs or short-term rigidity, and obvious suffocation and cyanosis before fainting. When the stun of the breath occurs frequently, the loss of consciousness after fainting is long, and the loss of suffocation and consciousness occurs immediately after crying. The symptoms of rigidity and convulsions gradually increase.
(2) Transient cerebral dysfunction (TLL)
A transient dysfunction caused by insufficient perfusion of the brain. Most of the focal symptoms and signs that appear as sudden episodes last for several minutes to several hours, and most of them recover completely within 24 hours, which can be repeated. Common symptoms of TIA in the basilar artery system are dizziness, nystagmus, diplopia, sensory and motor symptoms and signs, and rare symptoms of transient memory loss, hallucinations, behavioral abnormalities and transient loss of consciousness, and falls. TIA is common in middle-aged and elderly patients; it has obvious signs of cerebrovascular disease, and normal EEG helps to distinguish from epilepsy.
(three) migraine
It can be recurrent, often accompanied by visual symptoms, and sometimes with signs of the body. It is often common in children from 4 years of age to adolescence. Migraine is often accompanied by symptoms of the autonomic nervous system such as pale, dilated pupils and visual symptoms. Biliary arterial migraine often occurs in young women. The headache is bilateral, accompanied by dizziness, ataxia, blurred vision of both eyes or eye movement disorder. EEG can also have spikes in the occipital region.
(4) false seizures
Also known as a mental attack. If epilepsy patients have it at the same time, there is a diagnosis difficulty, and about 20% of refractory epilepsy belongs to this category. Attacks are often caused by tension or suggestion; motor symptoms are not synchronized and symmetrical in generalized convulsions. Pseudo-sex has a strong self-expression, a history of mental stimulation, a crying and sweating. Closed eyes and blinking are their characteristics. However, accurate diagnosis often requires television monitoring.
(5) Sleep disorders
Repeated paroxysmal episodes may occur in natural sleep, and may also be accompanied by some autopsy, during which the patient may be unresponsive to the environment or may not remember the episode. There are several common conditions that must be differentiated from epilepsy:
l, narcolepsy: narcolepsy is an unexplained sleep disorder, there are several different forms of expression, including cataplexy, sleep apnea, sleep illusion and irresistible drowsiness, also known as episodes Sleeping quadruple syndrome. The onset age is 10-20 years old. A few patients have a history of encephalitis or brain injury, and some have a family history. (1) Paroxysmal sleep: The patient is generally in a state of constant and fluctuating alertness when awake, especially in the afternoon. When the degree of lethargy increases, a short sleep occurs. Most patients feel drowsiness before the attack, and a few people suddenly sleep in a relatively awake state. The onset of a typical case can occur in a variety of activities, such as eating, speaking, operating a machine, and the like. Each episode lasts for a few seconds to a few hours, mostly about ten minutes. The degree of sleep is not deep and easy to wake up. After waking up, I generally feel temporarily clear. It may occur several times a day.
(2) Broken disease: Most patients are accompanied by it, often occurring several to several decades after onset. Under strong emotional stimuli, such as joy, anger and surprise, especially in laughter, sudden short-term muscle loss occurs, knee flexion occurs slightly, neck forward, fist can not, facial muscles relax, sudden fall suddenly . Symptoms disappear after the emotion has subsided or after the patient is touched. It usually lasts for about 1-2 minutes, and the consciousness is always awake.
(3) Sleeping snoring: 20%-30% of narcolepsy cases are accompanied by or may occur alone. Sudden sleepiness occurs occasionally when you wake up or sleep. The patient's consciousness is clear, but it can't move or make a sound. It is often accompanied by anxiety and hallucinations. After a few seconds to a few minutes, it can be touched for a few hours. If a person touches his body or talks to him, he can stop the attack.
(4) Before going to sleep hallucinations: About 30% of patients have hallucinations between awakening and sleep, which may involve visual and auditory senses such as facial features and touch and pain.
2, night terror (dream fear): manifested as sleep violent screams, shouting, accompanied by autonomic signs such as heartbeat, rapid breathing and sweating, as well as strong fear, anxiety and suffocation, occasionally accompanied Illusion. More common in children 3-7 years old, more often appear in fever, each time after 1-2 minutes of waking up, there is generally no memory. Children can also coexist with sleepwalking, mostly self-healing after growing up. Adults with this disease have many mental disorders.
3, sleepwalking: is an automatic movement in sleep. Children are more common, self-healing after adulthood, and often accompanied by mental illness in adults. Sleepwalking is dramatic. When sleepwalking, children are often sleepy. They blink slowly, have simple reaction to the environment, have some conscious behavior, have no active communication, and can be called back to bed or go back to bed. Each episode lasts for a few minutes and there is no memory afterwards. Before the sleepwalking EEG, there was a paroxysmal high-potential activity, which was in the phase II and III of the dream. Patients with temporal lobe epilepsy rarely experience sleepwalking; their automatic movements are generally only seen during the day.
4, sleeping in the molars: about 15% of people in the 3-17 years of age have a phenomenon of sleeping teeth. It is the rhythmic contraction of the masseter muscle during sleep, accompanied by body turnover and heart rate acceleration. There is often a family history.
5, nighttime myoclonus: for repetitive lower limb contraction during sleep, up to hundreds of times per night, the performance of one or both legs quickly twitch, each twitch lasts 15-45 S, once every 20 S Ticitation, more common in the second phase of sleep, witnessing the tics of the patient helps to identify seizures.
