Epilepsy is not only in China
and even around the world
have become increasingly becoming
A serious public health issue of great concern
and one of the social issues
Due to the fact that people have epilepsy
Lack of correct understanding and influence of traditional customs
Add to this the lack of medical resources and their uneven distribution
Especially in remote rural areas
The level of diagnosis and treatment is limited
Most people with epilepsy
Lack of reasonable and effective treatment
Make epilepsy
There is a large "treatment gap"
Guest of this issue
Dang Jing, deputy head of Mindong District of Minhang District Medical Emergency Center and emergency doctor
What is epilepsy?
Epilepsy, commonly known as "epilepsy", is a sudden, recurrent, and transient brain dysfunction caused by abnormal electrical discharges of nerve cells in the brain, which can manifest as dysfunction in movement, sensation, consciousness, and spirit.
From an electrophysiological point of view, a seizure is an abnormally synchronized discharge of the brain. The brain is like a complex network of computers connected by electrical circuits, with neuronal cells at the nodes and nerve fibers at the intermediate. Brain cells are connected and communicate with each other through electrical activity, and when the electrical circuit is abnormal or there is an abnormal discharge in the brain, a local or whole brain burst of discharge will occur, and finally lead to clinical seizures.
What are the causes of epilepsy?
Epilepsy can be divided into primary and secondary epilepsy.
Among them, the cause of primary epilepsy is unknown, it may be related to genetics, and it is more common in adolescents.
The causes of secondary epilepsy are clear, such as encephalitis, meningitis, cerebral parasitic diseases and other inflammation, cerebrovascular diseases, brain tumors, brain trauma, abnormal brain development, poisoning, metabolic and endocrine diseases that invade the brain and cause epilepsy.
What are the triggers for epilepsy?
Heredity: The prevalence of close relatives in patients with primary epilepsy is 15‰, which is higher than that of the general population. This suggests that genetic factors play an important role in the development of epilepsy.
Sleep: Sleep deprivation may exacerbate seizures, which are closely related to the sleep-wake cycle. Therefore, maintaining good sleep habits is essential to manage epilepsy symptoms.
Changes in the internal environment: endocrine disorders, electrolyte imbalances and metabolic abnormalities, excessive fatigue, alcohol consumption, etc., can affect the neuronal firing threshold, leading to seizures, which occur only during menstruation or pregnancy in a few women. Therefore, it is very important to pay attention to the internal environment and avoid excessive fatigue and irregular lifestyle to prevent seizures.
Age: Some seizure types are closely related to age, such as infantile spasms that begin within 1 year of age, childhood absence epilepsy peaks between 6 and 7 years of age, and myoclonic epilepsy that begins around puberty. The etiology of epilepsy varies by age, and targeted treatment and preventive measures need to be taken into account.
In addition to the above, there are drug or alcohol withdrawal, intoxication, hereditary metabolic diseases, cerebrovascular malformations, autoimmune diseases, cerebral palsy, brain surgery, etc. In daily life, these triggers should be known and avoided to reduce the incidence of epilepsy.
What are the clinical signs of seizures?
Seizures are generally thought of as sudden loss of consciousness, falling to the ground, eyes turning up, trismus, foaming at the mouth, convulsions of the limbs, and incontinence. In fact, there are many manifestations of epilepsy, this is just one of them, and there are many seizures that do not smoke, such as being stunned, just in a daze, which lasts for a few seconds and returns to normal, but his head is blank. Some patients will have drooling, sucking, bending movements, and even headaches, vomiting, etc. Different types of epilepsy can be characterized by sudden cessation of movements, hollow eyes that persist for 5 to 10 seconds, and abnormalities in hearing and smell, and even changes in heart rate. Epilepsy manifests itself in a variety of ways, and symptoms are present in a brain area that is activated by electrical discharges in the brain.
So what are the damages of seizures?
There are two types of seizure damage:
One is secondary accidental damage, which can cause physical injuries due to loss of consciousness during the attack, and limb convulsions will lead to abrasions and bruises, and even other accidental injuries, such as car accidents caused by seizures while driving, accidental falls during sudden attacks during aerial work, and because of this potential risk, it can lead to a kind of anxiety in the patient's psychology and affect his social behavior and activities.
The other is stealth, slow-occurring damage. Apnea during seizures can lead to a lack of oxygen to the brain tissue, and at the same time, the high-frequency discharge of brain nerve cells directly causes damage to the brain, which will lead to memory loss and mental reduction over time, affecting the patient's life, study and work. Because each seizure, just like a short circuit in a wire, because the seizure is a synchronous discharge of the whole brain, it takes time to repair the cells after depolarization, and if the seizures are repeated, especially in a short period of time, there will be brain degeneration, memory and intelligence decline.
So what should you do when you have a seizure?
Seizures can stop on their own and generally do not require resuscitation. Many people see seizures and tend to do bad things with good intentions. But if there are people around you who often have seizures, then you need to know some first aid methods for epilepsy, so as to better protect the patient. So what should you do to help him when he has a seizure?
1. Keeping patients safe: During a seizure, the first priority is to ensure the safety of the patient. Remove sharp objects around you that could injure the patient and move them to a safe place to avoid falling or injuring the person.
2. Let the patient lie down quickly: once the patient is found to have a seizure, let him lie down immediately, it is best to have a bed, and find a flat place for him to lie down if there is no bed to prevent the patient from falling and injuring himself. After lying down, the patient's clothes are untied, and the patient's glasses and dentures are removed.
3. Observation and recording: During a seizure, observe and record the time, duration, and symptoms of the seizure. This information helps doctors assess the type and severity of the attack to determine the appropriate treatment plan.
4. Stay calm: When having a seizure, it is important to stay calm, avoid over-interfering with the seizure process, and try not to prevent the patient from moving.
5. Make sure the airway is clear: Place the patient on a flat ground and keep it in the lateral decubitus position so that it can breathe easily. If conditions permit, the patient can be given oxygen, and it should be noted that it is not appropriate to feed water or feeding, so as not to cause choking or suffocation.
6. Avoid excessive force: Avoid suppressing the patient's limbs or forcibly opening the teeth, which may cause the patient to be injured, causing soft tissue damage, and even fractures and joint dislocations, it is recommended to be patient and wait quietly for the seizure to end, remember not to do cardiopulmonary resuscitation, the seizure patient only loses consciousness, and the heartbeat does not stop.
When should I see a doctor?
It is generally not necessary to take a person to the hospital when the seizure is occurring, and should be taken to the hospital immediately unless:
1. The patient has convulsions for the first time, and should go to the hospital for a clear diagnosis.
2. Status epilepticus refers to the patient's continuous convulsions for more than 5 minutes, or the inability to recover consciousness during multiple convulsions, which is likely to endanger the patient's life and requires urgent medical attention.
3. Trauma. When epilepsy is in a grand mal seizure, if the patient does not take appropriate care measures during the convulsions. If you have a fall, tongue bite, fracture, head injury, etc., you should also be sent to the hospital in time.
4. If there is unconsciousness and fever after the seizure, the patient should be considered whether there are other diseases other than epilepsy, and the patient should go to the hospital for a clear diagnosis.
5. Seizures in special patients, such as pregnant women: This may be a sign of eclampsia, which can endanger the life of the pregnant woman and the fetus.
6. Have been diagnosed with epilepsy, and have another seizure in a short period of time or an increase in the frequency of seizures and more severe symptoms. Neurology, emergency department, or pediatrician care is recommended.
What is the prognosis for epilepsy?
In patients with untreated epilepsy, the 5-year spontaneous remission rate is about 25%. About 70% of patients can completely control seizures with antiepileptic drugs, and about 50% of patients will never have seizures again for life after regular dose reduction. Therefore, epilepsy is not terrible, it is just an ordinary and common disease, as long as the diagnosis is clear and the regular treatment is carried out according to the doctor's instructions, most of them can be controlled.
Preventive measures: 1. Pay attention to protect yourself in daily life to avoid the occurrence of head trauma. 2. Actively treat the underlying disease. 3. Eat less raw food and do not drink raw water to avoid parasitic infections. 4. Pay attention to rest and ensure adequate sleep. 5. In daily life, relax your mind and maintain a good mood. 6. Pay attention to daily health care during pregnancy to prevent epilepsy caused by childbirth.
Reporter: Gao Shanshan
Editor: Ye Mei
Preliminary review: Tang Jingxian review: Yao Yiying final review: Xu Leibing reprint, please indicate that it is from Minhang's official WeChat today