preface
Epilepsy is a chronic neurological disorder with a persistent tendency to epilepsy, with different etiological bases and different clinical manifestations, and recurrent seizures are their common features. The incidence of epilepsy is high and has a great impact on individuals, families and society.
Worldwide, epilepsy has attracted much attention as a mental and neurological disease that needs to be prioritized. It can be seen that seizures can cause sleep disorders, and sleep disorders can also affect the control of seizures.
For the classification of epilepsy, a distinction is made between primary epilepsy (epilepsy of unknown etiology) and secondary epilepsy (aetiology-based but primarily associated with nerve damage) and partial or generalized epilepsy (depending on the clinical presentation at the time of the seizure).
"Partial" means that the onset of epilepsy begins in a focal area of the brain and is determined based on the characteristics of symptoms or assessment of clinical manifestations, and generalized epilepsy refers to the absence of a clear single foci of initiation in the brain.
Clinicians are not limited by the influence of epilepsy theory discussion and epilepsy classification discussion, and clinically focus on epilepsy patients and make appropriate diagnoses. As with other neurologic diagnostic methods, diagnosis is based on clinical features (i.e., seizures), followed by central nervous system localization, search for underlying causes, and comorbidities.
One." Epilepsy" is recognized
1. Western medical disease name and classification
In the cuneiform medical literature of ancient Babylon, epilepsy was originally referred to as "fall disease." This is related to the early symptoms of sudden fainting when seizures are observed. In the 5th century BC, Hippocrates recorded in his writings that epilepsy was called a "sacred disease."
Hippocrates pioneered the idea that epilepsy was not a mysterious disease, but a disease that involved the brain and could be genetically related.
In Roman times, epilepsy was considered a bad omen, and patients were usually moved to desert islands. By the 18th century, France was extremely discriminatory against people with epilepsy, forbidding them to sell food. Between 1037 and 980 BC, Averina first coined the name "epilepsy". Since then, the name "epilepsy" has continued to this day.
British scholar Jackson was the first to summarize the difference between epilepsy and seizures. Research advances in neurophysiology, pathological anatomy, and brain surgery have affirmed the correctness of Jackson's research, and Jackson's epilepsy theory is still the basis for modern scholars to understand epilepsy. The term "epilepsy" originally described the disease itself and the characteristics of the seizures.
2. The history of Chinese medicine disease names
The earliest surviving TCM work containing the name of the disease "inter (epilepsy)" is Mawangdui Han's tomb book "Fifty-two Sick Formulas".
Among them, there are records such as "infant sickness", "human illness sheep are not between sheep" and "human illness is not between horses", and there is a monograph on "infant sickness (epilepsy)", describing the symptoms of epilepsy as: "between (epilepsy), the body is hot and frightened, the neck spine is strong and complex (abdomen) is large", which is the earliest record of "seizure symptoms" in the history of Chinese medicine.
However, the description of the symptoms and treatment of epilepsy is very simple, and at this time, "epilepsy" and "shock" are not distinguished. It was not until the advent of the "Yellow Emperor's Internal Canon" that there was a detailed discussion of "epilepsy". There are as many as 9 names related to epilepsy, such as the "Suwen Daqi Theory": "Two Yin Urgency is epilepsy".
Two. Pathogenesis and clinical treatment status of Western medicine
1. Mechanism of status epilepticus
The mechanism of status epilepticus involves two fundamental questions: (1) why seizures do not stop spontaneously, and why is status epilepticus more difficult to terminate with antiepileptic drugs than single? (2) Is the underlying neuronal network susceptible to status epilepticus due to the above cause, or is the dynamic change of the neuronal network leading to its progression?
2. Research progress in diagnostic techniques for epilepsy
A thorough clinical history of a patient with epilepsy and an accurate description of seizures have been the basis for the diagnosis of epilepsy. At the same time, auxiliary examinations also play an important role, common auxiliary examinations such as brain mapping and MRI.
With the advancement of science and technology, auxiliary examination methods have gradually increased, which is convenient for accurate and effective diagnosis of epilepsy. In neuroimaging, there are MRI advanced functional sequences (diffusion tensor imaging and magnetic resonance wave imaging, functional imaging (functional magnetic resonance imaging, magnetoencephalography, positron emission computed tomography, single-photon emission computed tomography, ultra-high field magnetic resonance imaging).
Three. Current status of clinical treatment of epilepsy
1. Medication
The primary goal of antiepileptic drugs is to control seizures (reduce the frequency and severity of seizures), and the secondary goal is to suppress epileptic activity, prevent epileptogenic effects, and minimize the incidence of adverse drug reactions.
The use of monotherapy is one of the important principles of drug treatment, and doctors must fully understand the interactions and mechanisms between various drugs. There are generally three generations of drugs, the first generation of drugs mainly include carbamazepine, phenytoin, and valproic acid, but the pharmacokinetic properties of these drugs vary too greatly between patients, and the therapeutic index is narrow.
Prolonged use of a drug alone will result in reduced clinical efficacy and increased incidence of adverse effects.
2. Surgical intervention
Nearly half of patients with refractory epilepsy can control seizures with surgical treatments such as cutting off the seizure neural pathways or removing the epileptic foci.
Studies have shown that patients with positive PET localization will significantly reduce postoperative complications after epilepsy if surgery is performed early, regardless of whether there are lesion abnormalities on MRI. However, due to uncertainties such as surgical risks, indications, and postoperative outcomes, most patients cannot undergo surgical treatment.
3. Ketogenic diet therapy
As a high-fat, low-protein, low-carbohydrate therapy, ketogenic diet has a mechanism of action related to the neurotransmitter regulation function of ketone bodies, and is the first-line treatment for children and adolescents with refractory epilepsy. However, because it is often accompanied by adverse reactions such as digestive tract symptoms, acidosis and hypoglycemia, its application and promotion need to be considered.
4. Physical stimulation therapy
Compared with surgery, physical stimulation therapy has a higher safety factor and fewer adverse effects, and has gradually become a new choice for patients with epilepsy. However, the limitations are the high cost, and the long-term efficacy has yet to be verified because foreign body implantation may induce rejection and infection.
5. Traditional Chinese medicine treatment
Scholars combined disease discrimination-body discrimination-differentiation-symptom discrimination, and used the treatment of activating blood and opening the body, invigorating qi and raising yang, nourishing blood and soft liver, and using the Tongjiao Blood Tang Heyi Qi Smart Tong plus small red ginseng as the basis to achieve good results.
There are also other scholars who believe that the pathogenesis of refractory epilepsy lies in the spleen deficiency and phlegm, liver qi accumulation and hyperactivity, phlegm upward flushing the brain, blocking the brain network, then the magic machine is useless, which advocates that the treatment is mainly to regulate the liver and spleen, and the application of "latent seizures and seizures, phlegm circulation" as the core treatment, self-proposed "epilepsy promotion formula", cure many cases of epilepsy patients.
6. Acupuncture therapy
Modern researchers use acupuncture and moxibustion combined with ear acupuncture to cure a child with early-onset epilepsy. They treated three groups of epilepsy patients with EEG-guided scalp acupuncture with body acupuncture.
The body was treated with ordinary body acupuncture for the photo group, and the western medicine control group was not acupuncture to evaluate the clinical efficacy, and the changes before and after treatment were observed by electroencephalogram and EEG topography detection. The results showed that the directed acupuncture group had a more significant effect on improving EEG power spectrum than the in the body group.
Four. Quality of life issues in people with epilepsy
Factors that affect a patient's quality of life include age at diagnosis, intellectual development, education level, seizure frequency, seizure duration, and number of antiepileptic drugs used.
Age at seizures, unpredictability of seizures, and fear of injury were all significantly associated with quality of life. Perceived side effects and the number of antiepileptic drugs had a greater impact on women's quality of life, while anxiety and epilepsy-related variables had a greater impact on men's quality of life.
Anxiety, depression, and sleep disturbances have a greater effect on the quality of life of people with epilepsy compared with short-term epilepsy control. In adults with epilepsy without seizures, those who stopped using antiepileptic drugs had a better quality of life than those who continued antiepileptic drugs.
The available data do not provide an extensive assessment of sexual dysfunction in people with epilepsy. Studies have reported that most women with epilepsy have some physiological dysfunction, mainly related to low economic status, anxiety, and poor medication adherence.
Children with childhood absence epilepsy or benign childhood epilepsy with central temporal spikes exhibit cognitive deficits in intellectual and executive function, but have normal language abilities. Visual attention impairment is characteristic of children with absence epilepsy, and impaired spatial ability is characteristic of children with benign epilepsy with central temporal spikes.
School-age children with idiopathic or symptomatic epilepsy may have severe ecological executive dysfunction, including aspects such as behavioral modulation index, inhibition, and working memory, which are significantly associated with reduced social adaptation.
Five. Problems at this stage
Although information technology is widely used in the research of famous and old Chinese medicine ideas and diagnosis and treatment experience, there are still many problems and shortcomings. There are more research on the management of data and information, and there are fewer methods and paths to explore inheritance from the perspective of knowledge management.
The existing various data mining methods mainly focus on the mining of medical cases, medicinal flavors, prescriptions, prescriptions, etc., and the mining depth of a large number of tacit knowledge in the ideas of famous and old Chinese medicine techniques is not enough. Attach importance to the innovation of information technology and ignore the main role of people in inheritance.
Overemphasis is placed on the large amount of data, there is a lack of unified standards for the collection and collation of medical cases, and the combination of theory and practical research is not close enough.
At present, many studies use the clinical cases of many famous and old Chinese medicine practitioners as the data source, construct data sets, and use data mining methods to analyze the experience prescriptions, common drugs, and the relationship between drugs and symptoms, drugs and syndrome types of famous and old Chinese medicine practitioners, so as to reveal the common rules of famous and old Chinese medicine practitioners during clinical evidence, but lose their individualized characteristics.
Famous old Chinese medicine practitioners have their own system for diagnosing and treating diseases in the process of their practice. For the same patient, the diagnosis and treatment ideas of famous and old Chinese medicine practitioners are different. Integrating the medical cases of different famous Chinese medicine practitioners or the medical cases of one famous old Chinese medicine practitioner treating a certain disease or a certain symptom into a single data set for mining does not seem to reflect the individual differences in the diagnosis and treatment characteristics of famous and old Chinese medicine practitioners.
Therefore, the research on the diagnosis and treatment experience of famous and old Chinese medicine should be based on the three dimensions of time, space and medical family, only in this way can the practicability and reliability of the research results be ensured, and the diagnosis and treatment experience of famous and old Chinese medicine can only be developed in comparison, including ancient and modern comparison, comparison between different regions, and comparison between doctors, so as to obtain more effective information.
epilogue
Epilepsy is a clinically refractory disease, and TCM has unique advantages in treating epilepsy with rich theories, precise curative effects. The idea of famous and old Chinese medicine and its diagnosis and treatment experience are the core of the inheritance of famous and old Chinese medicine experience.
After the integration of generations of medical practitioners and long-term clinical practice, the examination cases that have been handed down to this day are valuable materials that need to be excavated, inherited and developed, which have far-reaching value for enlightening future learning, and are conducive to better realizing the goal of "inheriting the essence and keeping the right innovation" in the cause of Chinese medicine.
Relying on the advancement of information technology, the mode of inheritance of the experience of famous and old Chinese medicine practitioners has gradually developed from the previous case reports, medical case analysis and case discussion to the construction of standardized database of medical cases, and then used machine learning, deep learning and other means to explore the speculative law of the experience of famous and old Chinese medicine.
Especially in the era of big data, with the emergence of new technologies and tools, data mining methods are more diverse, which is convenient for in-depth mining of the dialectical ideas, diagnosis and treatment characteristics and medication rules of famous and old Chinese medicine practitioners from multiple angles and levels.
The research on the diagnosis and treatment experience of famous and old Chinese medicine practitioners should be based on the three dimensions of time, space and medical family, which is conducive to ensuring the practicality and reliability of the research results, and the diagnosis and treatment experience of famous and old Chinese medicine practitioners can be better developed in the comparison, and then more effective information can be obtained.