How Do I Become an Epileptologist?

The clinical manifestations of seizures are complex and diverse due to the different origins and transmission methods of abnormal discharges, which can be manifested as seizures, sensations, autonomic nerves, consciousness, and mental disorders. The causes of epilepsy are diverse. Patients with epilepsy are treated with regular antiepileptic drugs. About 70% of their epilepsy can be controlled. Among them, 50% to 60% of patients can be cured after 2 to 5 years of treatment. Patients can work like normal people and life.
Epilepsy generally refers to epilepsy (illness)

Wang Yuping	(Chief physician)	Department of Neurology, Xuanwu Hospital, Capital Medical University
Lin Hua	(Deputy Chief Physician)	Department of Neurology, Xuanwu Hospital, Capital Medical University

Epilepsy (epilepsy), commonly known as "shorn horn wind" or "sheep epilepsy", is a chronic disease that causes sudden abnormal discharges of neurons in the brain, causing transient brain dysfunction. According to the latest epidemiological data in China, the overall prevalence of epilepsy in China is 7.0 , the annual incidence is 28.8 / 100,000, and the prevalence of active epilepsy with seizures within 1 year is 4.6 . According to this estimate, there are about 9 million epilepsy patients in China, of which 5-6 million are active epilepsy patients. At the same time, about 400,000 new epilepsy patients are added every year. In China, epilepsy has become the second most common after neurology in China. disease.

Western Medicine Name: epilepsy
English name: epilepsy
Other name: Shofar wind

Affiliated Department: Internal Medicine-Neurology
Disease site: Brain
Contagious: Non-contagious
Whether to enter health insurance: Yes

Introduction to epilepsy

Classification of epilepsy diseases

Epilepsy Seizure Classification

At present, the seizure classification scheme proposed by the International Antiepileptic Coalition in 1981 is commonly used. Seizures are classified as partial / focal, general, and unclassified. In 2010, the International Antiepileptic Coalition proposed the latest seizure classification scheme, which reclassified and supplemented seizures. Although the new scheme summarizes the progress of epilepsy research in recent years, it is more comprehensive and complete.

Partial / focal seizures: Seizures that begin with seizures and EEG changes suggesting that "certain neurons in a certain part of the hemisphere are activated first". Including simple partial seizures, complex partial seizures, and secondary general seizures.

Generalized seizures: Seizures that begin with seizures and changes in EEG that indicate "simultaneous bilateral hemisphere involvement". Includes absence, myoclonus, tonicity, clonics, tonic-clonics, and tonic seizures .

Unclassified seizures: seizures that cannot be classified due to insufficient or incomplete information, or cannot be classified in the current classification criteria (such as spastic seizures).

The newly confirmed types of seizures in recent years include myoclonus loss, negative myoclonus, eyelid myoclonus, and laughter.

Classification of epilepsy syndrome

According to the cause of epilepsy, it can be divided into idiopathic epilepsy syndrome, symptomatic epilepsy syndrome, and possible symptomatic epilepsy syndrome. The new scheme proposed by the International Antiepileptic Coalition in 2001 also defined or standardized some key terms, including reflex epilepsy syndrome, benign epilepsy syndrome, and epileptic encephalopathy.

Idiopathic epilepsy syndrome: Syndrome without structural damage to the brain and other neurological symptoms and signs other than epilepsy. It usually starts before puberty and has a good prognosis.

Symptomatic epilepsy syndrome: Central nervous system disease or abnormality caused by various reasons, including abnormal brain structure or various factors affecting brain function. With the advancement of medicine and the continuous development and enrichment of examination methods, more and more epilepsy cases can be found.

Possible symptomatic epilepsy syndrome or cryptogenic epilepsy: considered symptomatic epilepsy syndrome, but the cause is unknown.

Reflex epilepsy syndrome: Refers to almost all seizures caused by specific sensations or complex cognitive activities, such as reading epilepsy, startle epilepsy, visual reflex epilepsy, hot bath epilepsy, card epilepsy, etc. After removing the predisposing factors, the seizures also disappeared.

Benign epilepsy syndrome: refers to an epilepsy syndrome that is easy to treat or can be completely relieved without treatment, leaving no sequelae.

Epileptic encephalopathy: refers to the progressive brain dysfunction caused by epilepsy abnormality itself. The cause is mainly or entirely due to seizures or frequent seizures during the seizure period. Most are neonatal, infant, and childhood. The EEG was obviously abnormal, and the drug treatment effect was poor. Including West syndrome, LGS, LKS, Otahara syndrome, Dravet syndrome and so on.

Causes of epilepsy

The causes of epilepsy are complex and diverse, including genetic factors, brain disorders, and systemic or systemic diseases.

Genetic factors of epilepsy

Genetic factors are an important cause of epilepsy, especially idiopathic epilepsy. Molecular genetic studies have found that part of the molecular mechanisms of hereditary epilepsy are structural or functional changes in ion channels or related molecules.

Epilepsy brain disease

Congenital brain dysplasia: gray matter ectopic brain, perforation of the brain, nodular sclerosis, cerebral hemangiomas, etc.

Brain tumors: primary or metastatic tumors

Intracranial infections: various encephalitis, meningitis, brain abscess, cerebral cysticercosis, cerebral toxoplasmosis, etc.

Craniocerebral trauma: birth injury, intracranial hematoma, cerebral contusion and laceration, and various craniocerebral injuries

Cerebrovascular disease: cerebral hemorrhage, subarachnoid hemorrhage, cerebral infarction and cerebral aneurysm, cerebral arteriovenous malformations, etc.

Degenerative diseases: Alzheimer's disease, multiple sclerosis, Pick's disease, etc.

Epilepsy systemic or systemic disease

Hypoxia: asphyxia, carbon monoxide poisoning, after cardiopulmonary resuscitation, etc .;

Metabolic diseases: hypoglycemia, hypocalcemia, phenylketonuria, uremia, etc .;

Endocrine diseases: hypoparathyroidism, insulinoma, etc .;

Cardiovascular diseases: Alzheimer's syndrome, hypertensive encephalopathy, etc .;

Toxic diseases: organophosphorus poisoning, certain heavy metal poisoning, etc .;

Others: such as hematological diseases, rheumatic diseases, eclampsia, etc.

The cause of epilepsy is closely related to age, and different age groups often have different etiology ranges (see Table 1).

Table 1 Common causes of different age groups

Newborn and Infant	Congenital and perinatal factors (hypoxia, asphyxia, head injury), genetic metabolic diseases, abnormalities caused by abnormal cortical development, etc.
Children and adolescence	Idiopathic (related to genetic factors), congenital and perinatal factors (hypoxia, asphyxia, head injury), central nervous system infection, abnormal brain development, etc.
Adulthood	Head trauma, brain tumor, central nervous system infectious factors, etc.
Old age	Cerebrovascular accident, brain tumor, metabolic disease, degenerative disease, etc.

Epilepsy Pathogenesis

The pathogenesis of epilepsy is very complex. The imbalance between central nervous system excitation and inhibition leads to seizures, which are mainly related to changes in ion channel neurotransmitters and glial cells.

Epilepsy ion channel dysfunction

Ion channels are the basis of excitability regulation of excitable tissues in the body, and mutations in the encoding genes can affect ion channel functions, leading to the occurrence of certain genetic diseases. At present, many human idiopathic epilepsy are thought to be ion channel diseases, that is, defective genes encode defective ion channel proteins to develop disease. Among them, the research on the correlation between sodium ion, potassium ion, calcium ion channel and epilepsy is relatively clear.

Epilepsy neurotransmitter abnormality

Epileptic discharge is closely related to neurotransmitters. Under normal circumstances, excitability and inhibitory neurotransmitters maintain a balanced state, and the neuronal membrane is stable. When there are too many excitatory neurotransmitters or too few inhibitory transmitters, it can make the imbalance between excitation and inhibition, make the membrane unstable and produce epileptic discharge.

Epilepsy glial cell abnormalities

The electrolyte balance of the neuron microenvironment is the basis for maintaining the normal excitability of the neuron. Glial cells play an important role in maintaining the survival environment of neurons. Seizures can occur when astrocytes change their ability to take up glutamate or gamma aminobutyric acid.

Epilepsy pathophysiology

The brain of patients with idiopathic epilepsy does not have structural changes or metabolic abnormalities that can explain the symptoms, and its incidence is closely related to genetic factors. Symptomatic epilepsy has various brain lesions and metabolic disorders, and there are epileptic foci in the brain. The epilepsy focus neuron is suddenly and frequently repetitively abnormally discharged at high frequency, and can continuously propagate to the surrounding cortex until the suppression effect terminates the seizure, resulting in the sudden abrupt termination of the seizure.

Clinical manifestations of epilepsy

Epileptic group

Epilepsy can be seen in all ages. The incidence of epilepsy in children is higher than that in adults, and the incidence of epilepsy decreases with age. In the elderly (after age 65), the incidence of epilepsy has increased again due to increased cerebrovascular disease, dementia and degenerative neurological diseases.

Epilepsy symptoms

The clinical manifestations of seizures are complex and diverse due to the different onset sites and transmission methods of abnormal discharges.

General tonic-clonic seizures : characterized by sudden loss of consciousness and generalized tonicity and convulsions, the typical seizure process can be divided into tonic, clonic and late seizures. The duration of an attack is usually less than 5 minutes, often accompanied by tongue bite, urinary incontinence, etc., and it is easy to cause suffocation and other injuries. Tonic-clonic seizures can be seen in any type of epilepsy and epilepsy syndrome.

Absence of seizures: Typical absences are sudden occurrences, suspension of movements, staring, refraining, and blinking, but they are basically not accompanied by or accompanied by slight motor symptoms, and the end is abrupt. It usually lasts 5-20 seconds, and rarely exceeds 1 minute. Mainly seen in children with epilepsy.

Tonic seizures: manifested by a strong and continuous contraction of paroxysmal whole or bilateral muscles, muscle stiffness, and fixation of limbs and body in a certain tense posture, such as axial body extension, dorsiflexion or forward flexion. It usually lasts several seconds to tens of seconds, but generally does not exceed 1 minute. Tonic seizures are more common in epilepsy patients with diffuse organic brain damage. They are generally a sign of severe disease, mainly in children, such as Lennox-Gastaut syndrome.

Myoclonic seizures are sudden, short and rapid contractions of muscles that appear similar to electrical shocks in the body or limbs, sometimes several times in a row, and most often occur after awakening. It can be a whole body action or a local action. Myoclonus is clinically common, but not all myoclonus are seizures. There are both physiological myoclonus and pathological myoclonus. At the same time, myoclonus with EEG multispike slow wave synthesis is a seizure, but sometimes the slow wave of EEG may not be recorded. Myoclonic seizures can be seen in some patients with idiopathic epilepsy with good prognosis (such as benign myoclonic epilepsy in infants, juvenile myoclonic epilepsy), but also in some patients with poor prognosis and diffuse brain damage. Epilepsy syndrome (such as early myoclonic encephalopathy, infantile myoclonic epilepsy, Lennox-Gastaut syndrome, etc.).

Spasticity: refers to infantile spasms, manifested as sudden, transient trunk muscles and bilateral tonic flexion or extension of the limbs, mostly manifested as paroxysmal nods, with occasional paresis. The whole process of muscle contraction is about 1 to 3 seconds, often in clusters. Common in West syndrome, other infant syndromes are sometimes seen.

Asthenic seizures: due to the sudden loss of bilateral or part of the whole body's muscle tension, the original posture cannot be maintained, and symptoms such as sudden collapse and limb fall occur. The seizure time is relatively short, lasting for several seconds to more than 10 seconds, and the seizure duration Most of the short ones are not accompanied by obvious conscious disturbances. Seizures often occur with epilepsy with diffuse brain damage, such as Lennox-Gastaut syndrome, Doose syndrome (myoclonic-stable insufficiency epilepsy), and subacute sclerosing whole brain. Early inflammation. However, there are some patients who have only seizures and their etiology is unknown.

Simple partial seizures: clear consciousness at the time of the seizure , lasting from several seconds to more than 20 seconds, rarely exceeding 1 minute. Depending on the origin and location of the discharge, simple partial seizures can be manifested as motor, sensory, autonomic, and mental. The latter two rarely occur alone and often develop into complex partial seizures.

Complex partial seizures: The seizures are accompanied by varying degrees of disturbance of consciousness. Appears as a sudden stop of action, eyes straight, which should not be called, do not fall, no change in complexion. Some patients may develop autonomic disorder, which is some involuntary and unconscious movements, such as licking lips, pouting, chewing, swallowing, groping, rubbing their face, clapping hands, walking aimlessly, talking to themselves, etc., which cannot be recalled after the attack. Most of them originate from the medial or limbic system of the temporal lobe, but can also originate from the frontal lobe.

Secondary generalized seizures: simple or complex partial seizures can be secondary to generalized seizures, the most common secondary generalized tonic seizures. Partial seizures and general seizures still belong to the category of partial seizures, which are significantly different from general seizures in terms of etiology, treatment and prognosis, so the identification of the two is particularly important clinically.

Epilepsy Disease Hazards

As a chronic disease, epilepsy does not have much effect on patients in the short term, but long-term frequent seizures can lead to serious effects on patients' physical, mental and intellectual.

1. Hazards to life: Patients with epilepsy often have sudden seizures at any time, place, and environment and cannot control themselves. They are prone to falls, burns, drowning, and traffic accidents.

2. Mental hazards. Epilepsy patients are often discriminated against by the society. They experience difficulties in employment, marriage, and family life. Patients are depressed and their physical and mental health is greatly affected.

3. Cognitive impairment is mainly manifested in patients with memory impairment, mental decline, personality changes, etc., and finally gradually loses the ability to work or even live.

Diagnosis and differential diagnosis of epilepsy

Epilepsy Diagnosis

1. Determine whether it is epilepsy. Asking patients, their relatives, or colleagues and other eyewitnesses in detail to obtain a detailed and complete seizure history as much as possible is the key to accurate diagnosis of epilepsy. Electroencephalography is the most important means of diagnosing seizures and epilepsy, and helps to classify seizures and epilepsy. EEG should be performed in clinically suspected cases of epilepsy. It should be noted that the abnormal rate of general EEG is very low, about 10-30%. The standardized EEG, due to its appropriate extension of the tracing time, guarantees various induction tests, especially sleep induction, and adds sphenoidal electrode tracing if necessary, so it significantly improves the detection rate of epilepsy discharge and can increase the positive rate to About 80%, and significantly improve the accuracy of epilepsy diagnosis.

2 Types of seizures

The judgment is mainly based on detailed medical history data, standardized EEG examination, and video EEG detection if necessary.

3 Causes of epilepsy

After the diagnosis of epilepsy has been determined, a cause should be identified. In the medical history should be asked if there is a family history, birth and growth and development status, encephalitis, meningitis, brain trauma and other medical history. Examination for signs of nervous system and systemic diseases. Then select relevant examinations, such as skull magnetic resonance (MRI), CT, blood glucose, blood calcium, cerebrospinal fluid examination, etc., to further identify the cause.

Differential diagnosis of epilepsy

There are a variety of clinical seizures, including both seizures and non-seizures. Non-seizures can occur at all ages (see Table 2). Non-seizures include multiple causes, some of which are disease states such as syncope, transient ischemic attack (TIA), and episodic motor-induced dyskinesia. , Sleep disorders, multiple tic disorders, migraine, etc., and some other physiological phenomena, such as breath holding, sleep myoclonus, night terrors, etc.

During the differential diagnosis, the seizure history should be asked in detail, and efforts should be made to find the cause of the seizure. In addition, EEG monitoring, especially video EEG monitoring, is of great value in distinguishing seizures from non-seizures. Cases that are difficult to diagnose can be referred to a specialist.

Table 2 Common non-epileptic seizures by age

Newborn	Periodic breathing, non-convulsive apnea, tremor
Infants	Breathing seizures, non-epileptic tonic seizures, affective cross leg rubbing action, excessive panic disorder
child	Sleep myoclonus, night terrors, nightmares and sleepwalking, narcolepsy, multiple tics Paroxysmal dyskinesia
adult	Syncope, rickets, transient ischemic attack, migraine, psychotic attack

First aid for epilepsy

Patients with threatened attacks should inform their family members or those around them in a timely manner. The patient can be assisted to the bed with conditions and time. Those who are too late can lie down to prevent sudden loss of consciousness and injury. Quickly remove the surrounding hard objects and sharps , Reduce the harm to the body during the attack. Quickly loosen the collar of the patient and turn his head to one side to facilitate the discharge of secretions and vomitus from the mouth, to prevent inhalation and choking from flowing into the trachea. Do not put anything in the patient's mouth, do not pour medicine, and prevent suffocation. Don't go to the patient's person, it will not benefit the patient. Do not forcefully press the patient's limbs during convulsions. Excessive force can cause fractures and muscle strains, increasing the patient's pain. Seizures usually resolve on their own within 5 minutes. If the episodes are continuous or frequent, the patient should be promptly taken to the hospital.

Epilepsy Treatment

Current treatments for epilepsy include medication, surgery, and neuromodulation.

Epilepsy medication

At present, the treatment of epilepsy at home and abroad is mainly based on drug therapy. Patients with epilepsy are treated with regular antiepileptic drugs. About 70% of patients have seizures that can be controlled. Among them, 50% to 60% of patients can be cured after 2 to 5 years of treatment. work and life. Therefore, reasonable and regular antiepileptic drug treatment is the key.

1. Indications for the use of antiepileptic drugs: Once the diagnosis of epilepsy is established, antiepileptic drugs should be applied in time to control the seizures. However, those with first episodes, predisposing factors or rare episodes can be considered as appropriate.

2. General principles when choosing antiepileptic drugs: Correct classification of seizures and epilepsy syndromes is the basis for rational drug selection. In addition, the patient's age (child, adult, elderly), gender, concomitant diseases, and potential side effects of antiepileptic drugs may affect the patient's future quality of life. If infants and young children do not swallow the tablets, the application of syrup preparations is not only convenient for children, but also convenient for dose control. Children should pay attention to choosing drugs that have no effect on cognitive function, memory, and attention when choosing drugs. The elderly suffer from more comorbidities, more medications, and more drug-drug interactions, and the elderly are more sensitive to antiepileptic drugs and have more prominent side effects. Therefore, elderly patients with epilepsy must consider side effects and drug interactions when choosing antiepileptic drugs. For women of childbearing age with epilepsy, attention should be paid to the effects of antiepileptic drugs on hormones, sexual desire, female characteristics, pregnancy, fertility and teratogenicity. Although traditional antiepileptic drugs (such as phenytoin sodium and phenobarbital) have certain clinical effects, they have many side effects such as gingival hyperplasia, increased hair, high teratogenicity, hyperactivity, and inattention, which are difficult for patients to tolerate. New antiepileptic drugs (such as lamotrigine, levetiracetam, topiramate, oxcarbazepine, etc.) not only have a positive clinical effect, but also have small side effects and are easily tolerated by patients.

3. Antiepileptic drug therapy should be treated with monotherapy as much as possible until the effective or maximum tolerated amount is reached. Combination therapy can be used after single-drug treatment fails. Try to use drugs with different mechanisms of action, with little or no drug interaction. Reasonable compatibility and use of drugs should aim at the best clinical effect and the least financial burden on patients.

4. In the course of antiepileptic drug treatment, routine monitoring of blood concentrations of antiepileptic drugs is not recommended. Only consider the blood concentration when you suspect that the patient did not take the drug or had a toxic reaction, use of other drugs that affect drug metabolism, and there are special clinical conditions (such as persistent epilepsy, liver and kidney disease, pregnancy), etc. monitor.

5. Antiepileptic treatment requires continuous medication and should not be easily discontinued. It is currently considered that the drug can be gradually discontinued when there are no seizures for at least 3 years. During the discontinuation of the drug, only one drug can be stopped at a time, and it takes about 1 year to gradually stop the drug.

Drug treatment for epilepsy is a long-term practice process. Doctors, patients and their families must have sufficient patience and love. Patients should be re-examined regularly. Doctors should perform individualized treatment according to the specific conditions of each patient, supplemented by a scientific life. Guidance, the two sides fully cooperate to achieve satisfactory results.

It should be noted that some patients and their families have some misunderstandings in the treatment of epilepsy. If they are sick, they will be treated as cruel rumors. They are afraid that anti-epileptic western medicines will "stimulate the brain". Long-term use will be "stupid". Epilepsy drugs. And blindly seeking medical advice, looking for "ancestral secret recipes", "pure traditional Chinese medicine", and credulous advertisements of "baozhi" and "radical cure" not only cost a lot of time and money, epilepsy was still not effectively controlled, and it was delayed. The best effective time for treatment is to artificially turn the patient into refractory epilepsy.

Epilepsy surgery

After regular antiepileptic drug treatment, about 20% to 30% of patients still have drug-refractory epilepsy. Surgical treatment of epilepsy provides a new treatment for this group of patients. It is estimated that about 50% of patients with drug-refractory epilepsy can control or cure the seizure through surgery, which improves the refractory epilepsy to a certain extent. Prognosis.

Indications for surgery

(1) Drug-refractory epilepsy that affects daily work and life;

(2) For partial epilepsy, the epilepsy source area is clearly located, and the lesion is single and limited;

(3) Surgical treatment will not cause loss of important functions.

In recent years, the practice of epilepsy surgery has shown that the surgical treatment of some diseases or syndromes has a positive effect and can be actively sought for surgery. Such as temporal lobe epilepsy with hippocampal sclerosis, if the positioning is accurate, its effective rate can reach 60% ~ 90%. Catastrophic epilepsy in infants or children such as Rasmussen syndrome, which seriously affects brain development, should be actively operated, the sooner the better. Others, such as cortical developmental abnormalities, benign low-grade tumors, cavernous hemangioma, arteriovenous malformations, hemiplegia, hemiplegia, and epilepsy syndromes, are good indications for surgical treatment.

Strict grasp of the indications for surgery is a prerequisite for good results in surgery. First, the patient must be truly drug-resistant epilepsy. If the disease is not cured due to a wrong diagnosis, improper drug selection, or taking the so-called "traditional Chinese medicine", and it is mistaken for refractory epilepsy, and then surgery, it is completely wrong. Secondly, some patients with epilepsy mistakenly believe that epilepsy is a life-long disease, and the side effects of antiepileptic drugs are excessively feared and exaggerated. They mistakenly believe that surgery can cure epilepsy, and actively require surgery. For these patients, we must be careful. Third, it should be emphasized that surgery is not a panacea, and not every patient can achieve the goal of eradicating attacks after surgery. Although most of the drug-refractory epilepsy can be controlled or cured by surgery, some of the intractable epilepsy are not ideal even after surgery, and may even bring some new problems.

Preoperative positioning

Precise positioning of epileptic foci and brain functional areas is the key to successful surgical treatment. At present, scholars at home and abroad agree that comprehensive diagnosis procedures should be adopted for the preoperative positioning of epileptic foci and brain functional areas. The most commonly used and better method is the comprehensive evaluation by stages, that is, the non-invasiveness of the initial stage (I) Examination and stage II invasive examination. Non-invasive examination, including history collection and neurological examination, video scalp EEG, skull MRI, CT, SPECT, PET, MRS, fMRI, magnetoencephalography and specific neuropsychological examinations. If accurate localization is still not possible through various non-invasive tests, invasive tests are still needed, including intracranial subdural strip or mesh electrodes and deep electrode monitoring and evoked potentials, Wada test, etc., to further locate epileptic focus and Brain functional area.

Neuromodulation therapy for epilepsy

Neuromodulation therapy is a new neuroelectrophysiological technique, and neuromodulation therapy for epilepsy has become the most promising treatment method in foreign countries. Currently includes: repetitive transcranial magnetic stimulation (rTMS); central nervous system electrical stimulation (deep brain electrical stimulation, epilepsy cortical stimulation, etc.); peripheral nerve stimulation (vagus nerve stimulation).

Repetitive Transcranial Magnetic Stimulation (rTMS)

rTMS uses a pulsed magnetic field to act on the cerebral cortex to tune the brain's bioelectric activity, cerebral blood flow and metabolism, thereby regulating brain function. Low frequency magnetic stimulation treatment can reduce the excited state of the cerebral cortex, reduce the frequency of epileptic seizures, improve abnormal EEG discharge, and repair the brain damage caused by epilepsy, so as to achieve the purpose of treating epilepsy.

rTMS has a good effect on a variety of chronic brain diseases such as epilepsy, there is no damage to the human body caused by drugs or surgery, has no effect on cognitive function, high safety, little side effects, low treatment costs, and easy acceptance by patients. Multi-course rTMS can significantly reduce the frequency and severity of seizures. Therefore, rTMS is expected to become a potential and unique new treatment for epilepsy.

Advantages of rTMS: the regulatory effect is reversible; the patient's needs are different and the effect parameters can be adjusted; stimulating a single target can also affect multiple epilepsy foci; functional epilepsy foci can also be treated with neuromodulation.

Which epilepsy patients are more suitable for rTMS treatment: epilepsy patients with cortical dysplasia or epileptic foci located in the cortex are more effective and can significantly reduce the number of seizures (71% of seizures during treatment), and even some patients (66%) can Achieve complete seizure-free.

Safety of rTMS: Most patients are well tolerated, and the reported adverse reactions are usually mild and transient, such as headache, dizziness, and non-specific discomfort. No reports of rTMS-evoked status epilepticus or life-threatening seizures have been found.

Vagus nerve stimulation (VNS)

In July 1997, the US FDA approved its use for the treatment of refractory epilepsy. To date, more than 60,000 patients in more than 75 countries around the world have received vagus nerve stimulation. The vagus nerve stimulator is buried under the skin of the chest and connected to the vagus nerve through a wire extension. After VNS is implanted, it will stimulate the vagus nerve with a certain intensity and frequency, thereby preventing the occurrence of epilepsy. This method can be considered for patients who are not effective with multiple antiepileptic drugs or other forms of surgery. ^[1]

Prognosis of epilepsy

Patients with epilepsy are treated with regular antiepileptic drugs. About 70% of their epilepsy can be controlled. Among them, 50% to 60% of patients can be cured after 2 to 5 years of treatment. The patients can work like normal people. And life. Surgical treatment and neuromodulation treatment can control or cure the seizures in some patients with drug-resistant epilepsy, and improve the prognosis of intractable epilepsy to a certain extent.

Epilepsy disease prevention

The following aspects should be paid attention to in preventing the occurrence of epilepsy

Eugenics and births are forbidden to marry close relatives. During the first trimester of pregnancy, keep away from radiation to avoid viral and bacterial infections. Regular pregnancy test to avoid fetal hypoxia, suffocation and birth injury during delivery

Children should see a doctor promptly when they have a fever to prevent the child from developing fever convulsions and damaging brain tissue. The child should also be taken care of to avoid head trauma.

Young people, middle-aged people, and old people should pay attention to ensuring a healthy lifestyle to reduce the incidence of diseases such as encephalitis, meningitis, and cerebrovascular disease.

Epilepsy Care

To prevent the recurrence of seizures, the following aspects should be paid attention to:

Regular life, rest on time, ensure adequate sleep, avoid staying up late, fatigue and so on. Avoid watching TV and playing games for a long time.

Light diet, eat more fruits and vegetables, avoid coffee, cola, spicy and other exciting drinks and food, quit smoking and alcohol. Avoid taking medicines containing caffeine and ephedrine. Penicillin or saracin drugs can sometimes induce seizures.

Take the medicine on time and regularly, and follow up regularly.

It is forbidden to drive a car; it is forbidden to swim by the sea or in the river; it is not advisable to work at high altitudes or operate machinery.