What Is a Seizure Threshold?

Sudden epilepsy is a sudden, unexpected, with or without eyewitness, nontraumatic or drowning death in patients with epilepsy, with or without seizures, the status of epilepsy must be ruled out, and no structural or toxic lethal factors are found at autopsy .

Sudden epilepsy is a sudden, unexpected, with or without eyewitness, nontraumatic or drowning death in patients with epilepsy, with or without seizures, the status of epilepsy must be ruled out, and no structural or toxic lethal factors are found at autopsy .

Chinese name

Sudden Epilepsy

Foreign name

Sudden death from epilepsy

Sudden Epilepsy I. Causes and Common Diseases:

1. Cardiac dysfunction:

Seizures can cause various cardiac abnormalities, such as prolonged QT interval, tachycardia, bradycardia, and apical torsional ventricular tachycardia. Changes in electrolytes and blood pH and the release of catecholamines alter cardiac excitability and may cause arrhythmias. Cardiac arrest is a pathogenesis of sudden epilepsy or at least part of it.

2. Respiratory depression:

Respiratory depression during epileptic seizures is very common and severe. Hypoxemia can occur, which can lead to autonomic dysfunction and fatal arrhythmias, which can lead to sudden epilepsy.

3. Autonomic dysfunction:

Autonomic dysfunction can occur during seizures, which is closely related to sudden epilepsy. Autonomic nerves regulate cardiovascular and respiratory function, and the effect on heart function can be evaluated by heart rate variability. Reduced heart rate variability can increase the risk of sudden death. Chronic epilepsy patients with reduced heart rate variability during seizures may lead to an increased incidence of sudden epilepsy.

Sudden epilepsy 2. Differential diagnosis:

1. Seizures need to be distinguished from various seizures:

Hysteria; Syncope; Hyperventilation Syndrome; Migraine; Transient ischemic attack; Symptomatic sleep sickness. In addition, epilepsy should be distinguished from episodic psychiatric symptoms and other visceral symptoms.

2. Identification of the etiology of symptomatic epilepsy and epilepsy syndrome:

(1) Systemic diseases that cause epilepsy Hypoglycemia; Hypocalcemia; Amino aciduria.

(2) Whether the brain diseases that cause epilepsy have a history of birth injury, a history of febrile seizures, a history of brain trauma, and a history of stroke. During physical examination, if localized signs of intracranial tumors and optic disc edema, brain noise of cerebral arteriovenous malformations, and subcutaneous nodules of cysticercosis (cysticercosis) of the brain are found.

Cerebral angiography, radionuclide brain scan, CT, MRI and other tests can help identify.

Sudden Epilepsy III. Examination:

(1) Neuro-physiological examination:

Traditional EEG recording. For example, subdural electrodes include wire electrodes and grid electrodes placed in the brain, which may be areas of epilepsy.

(B) neuroimaging examination:

CT and MRI have greatly improved the diagnosis of structural abnormalities of epilepsy lesions. Brain function tests currently in clinical use include cation diffraction tomography (PET), single photon diffraction tomography (SPECT), and MRI spectroscopy (MRS). PET can measure changes in brain blood flow and neurotransmitter function by metabolism of sugar and oxygen in the brain. SPECT can also measure changes in cerebral blood flow, metabolism, and neurotransmitter function, but it is not as accurate as PET in quantification. MRS can measure changes in certain chemicals such as acetylaspartic acid, choline-containing substances, creatine and lactic acid in the area of epilepsy.

(Three) neurochemical examination:

Ion-specific electrodes and microdialysis probes that are in use today can be placed in the epilepsy area of the brain to measure certain biochemical changes between, during and after seizures.

(D) Neuropathological examination:

It is a pathological examination of the surgical removal of epilepsy lesions. It can be determined that the cause of epilepsy is caused by brain tumor scars, vascular malformations, sclerosing inflammation, abnormal development or other abnormalities.

(5) Neuropsychological examination

This test assesses cognitive impairment and can determine which side of the brain the epilepsy lesion or area is.

Sudden epilepsy 4. Principles of treatment:

(A) surgical treatment:

For patients with refractory epilepsy, surgical treatment can better control their seizures than medication alone. If there are no seizures after surgery, the risk of sudden epilepsy will be significantly reduced. Surgical treatment may reduce the risk of sudden epilepsy by reducing the number of seizures or other mechanisms.

(II) Patient education:

Doctors should advise patients to avoid the predisposing factors of epilepsy, such as lack of sleep, drinking alcohol, taking drugs that lower the seizure threshold, sudden change of anti-epileptic drugs, etc., develop good living habits and take drugs on time.