MindMap Gallery Medicine - Epilepsy Mind Map
·Epilepsy is a syndrome of chronic recurrent transient brain dysfunction. It is characterized by repeated epileptic seizures caused by abnormal discharge of brain neurons. Epilepsy is one of the common diseases of the nervous system, and its prevalence is second only to stroke. ·The incidence of epilepsy is related to age. It is generally believed that the prevalence is highest within 1 year of age, followed by a gradual decrease after 1 to 10 years of age. The male-to-female ratio in my country is 1.15:1 to 1.7:1, and there is no significant difference in racial prevalence. ·Drawing is not easy, I hope you will be happy, thank you❤️
Edited at 2023-12-07 10:34:23One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
epilepsy
Overview
●Chronic brain disease with recurring epileptic seizures ●Most patients can control their condition without long-term medication. ● During an acute attack, prevention of injury is most important ● Adult patients need to avoid driving, working at heights and underground
What is epilepsy?
Epilepsy is a chronic disorder characterized by recurrent epileptic seizures Brain disease, which can occur suddenly and for no apparent reason, at any age It can occur in any population and is one of the most common neurological diseases.
Epileptic seizures are caused by "abnormal discharges" of neurons in the brain. It is repetitive and transient and is the main symptom of epilepsy. However, people who experience seizures do not necessarily have epilepsy.
What is the incidence of epilepsy in the population?
Epilepsy affects more than 70 million people around the world, and the incidence rate in China is between 5‰ and 7‰. There are 6.5 million to 9.1 million patients nationwide. Every year, 400,000 to 600,000 people are newly identified in our country. Diagnosed as a patient with epilepsy. Epilepsy can occur in people of all ages, but children and the elderly patients are relatively common. Among pregnant women, the proportion of epileptic seizures is 0.3% to 0.7%.
What types of epilepsy are there?
The classification of epilepsy is very complex. In 2017, internationally, according to different mechanisms of epileptic seizures, Epilepsy is divided into four categories: focal, generalized, generalized combined with focal, and unknown types.
Chinese scholars call epilepsy with a clear cause "secondary epilepsy"; If the cause is unknown, we call it "idiopathic epilepsy"; For those whose symptoms at onset are characteristic of secondary epilepsy but whose cause is Epilepsy that is not yet clear is called cryptogenic epilepsy.
Regardless of how scientists classify epilepsy, these are merely generalized terms of the disease. method does not change the characteristics of epilepsy. Patients only need to understand that epilepsy has There are multiple categories, and there are more detailed categories under different categories. The doctor will help you determine the specific type and provide you with the best diagnosis and treatment plan.
Cause
The causes of secondary epilepsy are mostly clear, but the causes of idiopathic epilepsy are not. The findings may be genetic. To date, idiopathic epilepsy has not been found The patient has structural damage or biochemical abnormalities in the brain that are sufficient to cause epileptic seizures.
Causes of secondary epilepsy
cortical developmental disorder
This refers to abnormal lesions in the cerebral cortex. Related to developmental disorders. Eventually leading to recurring seizures of epilepsy.
brain tumor
Some people with head trauma may be more susceptible to epilepsy. For adults, These reasons include but are not limited to violent impacts in car accidents and falls from high altitudes. Brain injury, epilepsy after brain surgery, etc.; for infants and young children, The use of midwifery forceps during delivery can easily induce head trauma epilepsy in infants and young children.
head trauma
central nervous system infection
This is a general term for a large group of diseases, including tuberculous meningitis, Neurosyphilis, viral meningitis, etc. In some human immunodeficiencies Seizures may also occur in people infected with HIV.
cerebrovascular disease
This category of diseases includes many diseases, but not all cerebrovascular diseases can cause epileptic seizures. Some patients with cerebrovascular disease have bleeding within two weeks Epilepsy may occur later, which belongs to post-cerebrovascular epilepsy.
parasitic infection
Certain types of parasites can trigger seizures. In my country, The upper reaches of the Yangtze River are dominated by cerebral paragonimiasis infections, while those in the middle and lower reaches of the Yangtze River are Schistosomiasis is the main cause in the south, and cysticercosis is the main cause in the north.
With the prevention of parasitic diseases, it is now relatively rare in our country, but doctors are still confirming the diagnosis The patient's place of residence will also be considered to rule out epileptic seizures caused by such causes.
Inherited metabolic diseases
neurodegenerative diseases
For example, in the late stages of Alzheimer's disease and Parkinson's disease, epileptic seizures may occur.
secondary brain injury
other
For patients with systemic lupus erythematosus, 8% to 20% will develop epilepsy; Diabetes can also cause epilepsy; certain medications and vaccinations can also cause epilepsy.
What are the triggering factors for epilepsy?
Predisposing factors have a strong correlation with the occurrence of epilepsy and will not occur when alone. Causes epileptic seizures, but under certain circumstances can induce or exacerbate epilepsy.
There are four main related causes:
Endocrine related
Some women's epileptic seizures are related to their menstrual period. Some are related to pregnancy and some are related to hormones.
sleep related
Many patients with epilepsy only experience seizures during sleep. Lack of sleep may also exacerbate epilepsy.
Genetically related
age related
Certain types of epilepsy occur more frequently in children, This type of epilepsy will resolve on its own when the child becomes an adult.
symptom
Most types of epilepsy occur suddenly, last for a short period of time, and then recover quickly. The patient behaves normally between attacks and is not very different from a normal healthy person.
Different types of epilepsy have different seizure characteristics. However, the performance of the same patient is similar every time he attacks. That is to say, the symptoms of each epileptic seizure are unlikely to be significantly different.
In addition, epileptic seizures have a repetitive nature, that is, A single seizure should not be readily diagnosed as epilepsy.
What are the typical symptoms of epilepsy?
Early symptoms
Before an epileptic seizure occurs, some patients can foresee it hours or even days in advance. Until he is about to get sick. These premonitions may include abnormal sensations in the limbs, Or some unspeakable abnormal feeling. There are also some people who experience taste problems, Changes in sense of smell and hearing. Some patients may have trouble seeing clearly.
These early symptoms are not necessarily related to epileptic seizures; But these premonitions can help patients prepare for epileptic seizures in advance. Such as taking anti-epileptic drugs in advance, avoiding putting yourself in dangerous situations, Be prepared to prevent injury in the event of an illness.
epileptic seizure symptoms
Different types of epilepsy have different symptoms and characteristics, which will be systematically introduced below:
1. Self-limited generalized seizures
Patients with this type of epilepsy often have You will lose consciousness and be completely unaware of what is happening to you.
Segmentation types will also have their own corresponding characteristics:
·Generalized tonic-clonic seizures
In the early stages of the attack, patients not only lose consciousness but also fall. At this time, most patients will scream, twitch all over the body, and continue to After 10 to 20 seconds, clonus occurs. Every clonus has a During the intermittent period, the frequency of attacks gradually becomes slower and the intermittent periods become longer and longer.
After a bout of severe clonus, the seizure ceased. At this time, the patient's pupils will be observed to be dilated. Increased salivary secretions, etc., and respiratory arrest. The patient will then slowly recover, The above physical signs gradually return to normal, and the whole process takes about 5 to 15 minutes. Some patients also develop trismus and incontinence during attacks.
After patients wake up, they usually feel a headache, body aches, and want to sleep.
It is worth noting that patients should never be forcibly restrained during an epileptic seizure. To avoid accidental injury to yourself, and to avoid causing fractures and dislocations of the patient.
·Tonic seizures
This type of patient is more common in patients with diffuse brain injury. The attack may be caused by strong and sustained contraction of local or systemic skeletal muscles. Able to fix the patient in a specific position.
·Clonic seizures
This type is mainly seen in newborns and infants, and children will lose consciousness during the attack.
·Absence seizures
The sudden onset and rapid termination of loss of consciousness are the main features of this type of epileptic seizure. The patient may suddenly stop moving, be in a daze, or drop the object in his hand to the floor. No response to other people's calls. Some patients may also mechanically repeat the original simple movements.
Each attack lasts for a few seconds and may occur dozens or even hundreds of times a day. The patient wakes up quickly after the attack and does not feel uncomfortable. After waking up, I can't recall what just happened to me.
Some atypical absence seizures start and end slowly, In addition to loss of consciousness, there are also other muscle-related symptoms, such as unsteadiness.
·Myoclonic seizures
This is a sudden electric shock For the same involuntary movements, the onset time is generally short.
·Atonic seizures
Patients in this category often fall suddenly, and some are less serious. The patient will suddenly lower his head and his arms will suddenly droop.
· Ocular myoclonic seizures with or without absence
The attacks of such patients are mainly eye-related, and most of the eyelids suffer from constant light exposure. Occurring after closure, epileptic seizures may also be induced by intermittent flash stimulation. When an attack occurs, The patient's eyes appear to be half-open and half-closed, and sometimes there is twitching of the hands.
2. Self-limited focal seizures
Patients in this category are conscious during epileptic seizures. After the attack, I can describe what just happened to me.
·Focal motor seizures
When a patient has an epileptic seizure, it is usually an involuntary twitching of a certain body part. It may be one eyelid, corner of the mouth, hand or toe, or one side of the face or limb. In severe cases, patients may experience temporary limb paralysis after the attack.
Some patients also experience abnormal movements related to the human body's movement system. Such as involuntary repetition of words or single syllables before the attack, Accompanied by body or eye rotation, etc.
·Focal sensory seizures
Patients in this category often experience sensory abnormalities during attacks. Such as abnormalities in taste, smell, hearing, hallucinations, etc.
·Automatism
The main characteristic of this category is that the patient has disturbance of consciousness, Will do some actions that seem to have a purpose, but actually have no purpose, Such as chewing repeatedly, rubbing hands repeatedly or opening doors aimlessly, Closing the door, etc., and being unable to recall the details of the attack after the attack.
·Focal secondary generalized seizures
It refers to the situation where the patient first develops the above symptoms and then progresses to a systemic attack.
3. Other self-limiting seizures
Some epileptic seizure symptoms are related to laughter, and patients have unprovoked, Stereotyped and repetitive laughter, and some patients also have crying as the main manifestation. This category falls under the category of "giggling attacks".
In addition, there is a type of hemiclonic seizure, which is limited to the muscles on one side of the body. Rhythmic and repetitive contractions, with an attack frequency of 2 to 3 times per second, and the attack time may be longer.
Epilepsy is a disease that includes many subtypes. With the continuous advancement of medicine, There will be more and more detailed classifications to help us understand epilepsy more comprehensively.
Post-seizure symptoms
After the epileptic seizure ends, some patients can return to their normal state immediately. Others may take minutes or hours to recover. There are some differences between different types of epilepsy.
Seek medical advice
There are many types of epileptic seizures, and if they are less serious types, patients can seek elective treatment after the seizure.
Patients with the following conditions require prompt medical attention in the emergency department:
·The seizure lasts for more than 5 minutes;
·After the epileptic seizure stops, the patient's breathing and consciousness do not return to normal;
· One epileptic seizure is followed immediately by a second;
·Fever or febrile convulsions;
·Pregnant;
·Suffer from diabetes;
· Injuries during epileptic seizures.
Diagnosis process
The diagnosis of epilepsy mainly consists of the following three steps:
Eliminate interfering factors and diagnose epilepsy
During this process, the doctor may ask the patient whether he or she lost consciousness when the epilepsy occurred. Can you remember the onset of the disease at the time, whether there was a sudden fall, etc. At the same time, patients will also be recommended to undergo an electroencephalogram (EEG) examination.
Identify the type of epileptic seizure
If the doctor believes that the patient does have epilepsy, this step is to clarify what type of epilepsy the patient has. There are many subdivided types of epilepsy, which require comprehensive judgment by experienced professional doctors. Some types of epilepsy, Patients resolve spontaneously without treatment, but some types require further determination of the cause.
Determine the cause
When the doctor determines that the patient has secondary epilepsy, the cause needs to be determined. at this time, Doctors may recommend that patients undergo imaging examinations such as head CT, MRI, and digital subtraction angiography (DSA). Patients may also be advised to undergo blood tests to determine whether an infection is related.
Which department should I go to for treatment for epilepsy?
Neurology. Go to the emergency department when an emergency occurs.
What are the related tests for epilepsy?
Relevant examinations for patients with epilepsy can be divided into two categories. One is ordinary examinations, such as blood tests; The other type is special examinations for epilepsy patients, such as electroencephalogram examinations, MRI examinations, etc. The doctor will combine the patient's medical history and recommend that the patient undergo one or more examinations. Here, we focus on the special types of tests for epilepsy.
·Electroencephalogram examination
The characteristics of epileptic discharges in EEG are important evidence for the diagnosis of epilepsy. Therefore, most doctors will recommend that patients undergo this examination.
Fortunately, the entire procedure is painless.
·Electromyography examination
For some patients after a seizure, the doctor may recommend that the patient undergo an electromyogram. This is done to assess the nerve function of the muscles and to assess whether skeletal muscle damage has occurred after a seizure.
This test can be stressful and painful for patients.
·Cranial CT examination
Head CT is mainly used to determine whether the patient has space-occupying lesions, infarction or hemorrhage in the brain. At the same time, it has more advantages than MRI in detecting tumor bleeding.
This examination will contain a certain amount of radioactivity, and it is not recommended for patients preparing for pregnancy or during pregnancy to undergo this examination.
·MRI examination
If conditions permit, the doctor will recommend that the patient undergo an MRI examination. The cost of this examination is more expensive than a head CT, and the examination method is similar to a head CT.
What diseases should be distinguished from epilepsy?
Fainting
Syncope usually manifests as instantaneous loss of consciousness and falling, often with obvious triggers. For example, standing for a long time, severe pain, emotional agitation, severe cold, etc., or cough, It can be triggered by crying, laughing, straining, holding your breath, defecation, and urination. At the same time, there are often auras such as nausea, dizziness, weakness, tremor, abdominal heaviness or darkening of the eyes.
An onset of syncope, relatively slower than epilepsy, causing consciousness Loss rarely lasts longer than 15 seconds, and consciousness is quickly restored and awakened.
specific identification
(Key points of identification) (Syncope) (Elepsy attack)
inducement
Mental stress, painful stimulation, etc.
Nothing
prodromal symptoms
Yes, it can be longer
None or short
The relationship between seizures and posture
More common in standing or sitting position
irrelevant
skin color
pale
normal or cyanotic
Seizure companion urinary incontinence and tongue bites
Rare
common
after attack Confusion and automatisms
None or rarely
common
Interictal EEG abnormalities
rare
common
pseudoepileptic seizure
This type of attack is also called hysterical attack and is mostly caused by psychological disorders.
specific identification
(Characteristics) (Epileptic seizures) (Pseudo-epileptic seizures)
Occasion of attack
in any circumstances
There are mental triggers and someone is present
Attack characteristics
Sudden stereotypic attack
Seizures occur in various forms, Have strong self-expression, Such as closing eyes and crying, Twitching of the hands and feet and hyperventilation, etc.
eye position
Lift the upper eyelid and move the eyeball upward or deflect to one side
Eyelids are closed tightly and eyeballs move randomly
Complexion and mucous membranes
Cyanosis
Paleness or redness
pupil
Diffusion and loss of light reflection
Normal, light reflex exists
against passive movement
cannot
Can
Fall, tongue bite, urinary incontinence
may have
none
Duration and termination method
About 1 to 2 minutes, Stop on its own
Can last for several hours, Need comfort and hints
pyramidal tract sign
Babinski sign (+)
(-)
Migraine
specific identification
(item) (migraine) (epileptic seizure)
Aura symptoms
lasts longer
relatively short
visual hallucination
Mostly flashes, dark spots, Hemianopia, blurred vision
Except for flashes and dark spots, Some are complex visual hallucinations
The main symptoms
Severe headache, often accompanied by nausea and vomiting
tonic-clonic seizures
disorder of consciousness
Rare
Common
seizure duration
longer, hours or days
Short, a few minutes
mental memory disorder
None or rarely
Common
electroencephalogram
nonspecific slow waves
epileptiform discharges
tics
specific identification
(item) (tics) (myoclonic seizures)
Age of onset
5-10 years old
any age
Clinical features
one or more muscle groups, Repetitive and stereotyped involuntary tics, Usually non-rhythmic, Commonly seen on the face, neck, shoulders and upper limbs
Focal: repetitive rhythmic tics; Multifocal: involves rapid twitching of multiple groups of muscles, synchronicity
controlled by consciousness
May be effective for a short time
invalid
sleep
Symptoms reduce or disappear
Basically no impact
Emotional stress and psychological stimulation
May be aggravated
May be aggravated
state of consciousness during attack
clear
clear, dull or lost
Accompanied by neurological symptoms
attention deficit, learning difficulties, Forced behavior or obscene language
No or encephalopathic changes
electroencephalogram
Normal or background slow waves not associated with tics
Slow wave or epileptiform discharge
transient ischemic attack
Transient ischemic attack (TIA) is more common in the elderly, often with arteriosclerosis, coronary heart disease, hypertension, Basic diseases such as diabetes can cause sudden loss of sensation, paralysis, twitching, etc. Symptoms generally last from 15 minutes to several hours, and there are no obvious epileptic discharges on the electroencephalogram.
Hypoglycemia
Hypoglycemia occurs when the blood sugar level is lower than 2 mmol/L, and may cause local epileptic twitching or limb rigidity. Accompanied by loss of consciousness, it is common in patients with insulinoma or diabetes, and medical history is very important for identification.
treat
The ideal state of treating epilepsy is to completely control the patient's epileptic seizures, There are only mild or no side effects during drug treatment. Let patients achieve a normal quality of life.
For patients with a clear cause, first treat the cause, such as removing the brain tumor, Anti-parasitic treatment, etc.; for patients with no clear cause, or although clear findings When the cause is found but cannot be eradicated, drug treatment needs to be considered.
How to treat epilepsy in its acute phase?
In the event of an epileptic seizure, medication is not necessary, and family members or those nearby It is even more important to help patients take some measures to prevent injury:
·Help the patient loosen his collar and belt to keep breathing smooth;
·Place clothing on the patient’s joints to prevent the patient from being bruised;
·Remove chairs and other items around the patient to prevent injuries;
·Do not press the patient's body forcefully to avoid fractures and dislocations.
What medications are available for epilepsy?
Due to large individual differences, there is no absolute best, fastest or most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected based on the individual situation under the guidance of a doctor.
For the treatment of patients with epileptic seizures, Doctors’ drug treatment mainly follows these principles:
There is still some controversy over when to use medication after a patient has an initial attack and is diagnosed. For those with rare attacks that occur more than once every 6 months, The doctor will comprehensively evaluate the side effects and efficacy of the drug and choose it as appropriate.
The doctor will decide based on the patient’s seizure type, drug side effects, Drug source, price, patient age, gender and other factors come from The main basis for giving a treatment plan is the type of epileptic seizure.
If the drug is not chosen properly, not only will the treatment be ineffective, but it may even aggravate the seizure. Therefore, patients must not take medicine without authorization. They must go to a regular hospital for medical treatment and take medicine as directed by the doctor.
Commonly used anti-epileptic drugs
(Classification) (Traditional anti-epileptic drugs) (New anti-epileptic drugs)
partial seizures and Partial secondary generalized seizures
carbamazepine, valproic acid, Phenytoin, Phenobarbital
Levetiracetam, lamotrigine, Topiramate, oxcarbazepine
Generalized tonic-clonic seizures
Valproic acid, carbamazepine, Phenytoin
Topiramate, lamotrigine, oxcarbazepine, Gabapentin, levetiracetam
tonic seizure
Phenytoin, valproic acid
Topiramate, lamotrigine, Zonisamide, levetiracetam
clonic seizures
carbamazepine, valproic acid
Levetiracetam, topiramate, lamotrigine, oxcarbazepine
Typical absence and atypical absence seizure
ethosuximide, valproic acid, Clonazepam
lamotrigine
myoclonic seizures
Valproic acid, clonazepam
Levetiracetam, topiramate
Doctors generally advise patients to start taking medication at a low dose and gradually increase the dose. If the drug effect is not satisfactory, the treatment plan needs to be adjusted. Priority will be given to options with fewer drug side effects, while considering the effectiveness of treatment.
What surgical treatments are available for epilepsy?
Surgical treatment of epilepsy mainly focuses on treating the cause. If the seizure is caused by a tumor, then with the tumor removed, The symptoms of epilepsy will then ease or disappear. There are also novel treatments, but their effectiveness needs further evaluation.
How is epilepsy treated with traditional Chinese medicine?
There is currently no evidence-based medical evidence to support the TCM treatment of this disease. However, some traditional Chinese medicine treatments or medicines can relieve symptoms. It is recommended to go to a regular medical institution and receive treatment under the guidance of a physician.
prognosis
25% of epilepsy patients can spontaneously remit without treatment. 50% of patients will not have symptoms for life after receiving formal treatment. Therefore, most patients do not need long-term medication to control their condition.
Most antiepileptic drugs have varying degrees of side effects, But generally speaking, there is no impact on lifespan. but, Be sure to be alert to unexpected events that may occur during an epileptic seizure. After all, some accidents can be life-threatening.
daily
People with epilepsy should try to avoid engaging in occupations such as high-altitude operations, underground operations, and driving. It is also necessary for patients’ family members to learn home care knowledge to help patients reduce the risk of injury.
How to care for epilepsy at home?
When a patient has an epileptic seizure, The main thing family members can do is to protect the patients and prevent them from accidental injuries. At the same time, you need to pay attention to rest, activities, diet, etc. after recovery.
What should patients with epilepsy pay attention to in their daily life management?
Tips for daily life
·Get enough sleep
·Avoid drinking alcohol
·Avoid driving
·Avoid skiing, diving and other dangerous sports
Rest and activities
Epilepsy patients should maintain a healthy and regular life, Particular care needs to be taken to avoid sleep deprivation, overeating, and overexertion. For patients whose disease triggers have been identified, special attention should be paid to eliminating or avoiding these factors.
Diet therapy
The ketogenic diet is a high-fat, low-carbohydrate, and moderately protein diet. Before starting ketogenic diet treatment, doctors will conduct a comprehensive clinical and nutritional evaluation of the patient. Assessment of the patient's condition to determine the patient's seizure type and thereby exclude patients with contraindications.
Patients suitable for this diet:
·Refractory childhood epilepsy
·Glucose transporter I deficiency
·Pyruvate dehydrogenase deficiency
Epilepsy patients with fatty acid transport and oxidation disorders should not adopt a ketogenic diet.
What indicators need to be monitored daily for epilepsy?
It is recommended that patients with epilepsy regularly record the time and date of their epileptic seizures. The duration, whether you can recall the scene at the time, the interval between two attacks, This can help doctors better understand your condition and even help adjust treatment plans.
How to prevent epilepsy?
The prevention of epilepsy mainly focuses on the prevention of the cause. For example, do not drink raw water or eat unclean food to avoid parasite infection. Vaccination of children to prevent central nervous system infections, Protect the brain in accidental impacts to avoid head trauma and more.
There is currently no effective preventive method for idiopathic epilepsy of unknown etiology.
For patients diagnosed with epilepsy, it is recommended to ensure adequate sleep and physical and mental well-being. (Patients who are in a state of anxiety, tension, and mental stress may be more likely to induce epileptic seizures.)