Definition of seizures and epilepsy
• Epilepsy epidemiological profile
• Classification of seizures
• Classification of etiology of epilepsy
• Common misconceptions about epilepsy
The social harms of epilepsy
Emotional, marital, maternal, driving, working, financial burdens
Overview of epilepsy
• Epilepsy is an ancient disease that was recorded in ancient Babylon 4,000 years ago.
2,500 years ago, there were similar records in ancient medical books on the mainland
• In China, it is commonly known as "sheep's horn wind", "sheep epilepsy wind", "sow wind", etc
Epilepsy definition
◆ A group of neurons in the brain caused by known or unknown etiologies, highly synchronized, and
Usually self-limiting, abnormal discharges, with recurrent, transient,
It is usually a syndrome characterized by stereotypical central nervous system dysfunction
◆ Manifested by abnormal motor, consciousness, sensory, behavioral or/and autonomic nerve function
◆ Epilepsy is characterized by the persistence and occurrence of a predisposition to epileptic seizures
Corresponding neurobiological, cognitive, psychological, and social consequences.
◆ At least one seizure is required to diagnose epilepsy.
What is a seizure?
◆ Transient brain dysfunction caused by over-synchronized firing of neurons in the brain
◆ Usually refers to a seizure
◆ It can be caused by a variety of reasons
Seizures ≠ epilepsy
Epilepsy definition
1. At least two unprovoked (or reflex) seizures, with an interval of more than 24 hours between the two seizures
2. The likelihood of recurrence within 10 years after one unprovoked (or reflex) episode is comparable to the risk of recurrence after two unprovoked episodes (at least 60%)
3. Diagnosed with epilepsy syndrome
Epidemiological features of epilepsy
Approximately 65 million people worldwide have epilepsy, with active epilepsy in the general population
The proportion of epilepsy is 4-10 per thousand, compared to 6-10 per thousand in developing countries
The prevalence in mainland China is 7 ‰, and there are about 9 million people with epilepsy
About 400,000 new epilepsy patients every year
FYI
Historical cases are for reference only
Clinical features of epilepsy
Epilepsy is an episodic disorder that is sudden, transient, stereotyped, and recurrent
The specific clinical manifestations of epilepsy are related to the functional areas of the brain involved by the abnormal discharge, and the clinical manifestations vary depending on the location of the discharge
Basis for diagnosis
◆ History of present illness
– The witness describes in detail the circumstances at the time of the seizure, the duration of the seizure, and the frequency of the seizure
– (Recording the seizure process through a smartphone, photo/video is very helpful for the diagnosis of the first seizure)
– Treatment history: which treatment or medication is effective
◆ Past History
– Perinatal and postnatal development, whether there are major diseases (e.g. perinatal abnormalities, head trauma, encephalitis, cerebrovascular disease, etc.)
◆ Family history
– Whether there is a similar disease in the family, or other genetic diseases
Basis for diagnosis
• MRI, through multi-directional and multi-sequence imaging, can discover abnormal subtle structures of the brain, such as hippocampal sclerosis, focal cortical dysplasia, etc., which plays an important role in the diagnosis of epilepsy etiology, surgical evaluation, and prognosis
• EEG, which records the spontaneous and rhythmic electrical activity of neurons in the cerebral cortex, is a very important test tool in the diagnosis and identification of epilepsy
• Laboratory tests, including genetic, metabolic, immunological/inflammatory, etc., enable the diagnosis and treatment of some inherited metabolic disorders that cause seizures
Clinical manifestations and classification of seizures
The International League Against Epilepsy publishes a new classification of epilepsy
The above information is for reference only
The above information is for reference only, the basic framework of the 2017 ILAE classification of seizures
病例1 强直阵挛发作(Tonic-clonic)
● A woman wakes up to find her husband having a seizure in bed, the onset of which is not visible, but she is able to describe the patient's bilateral limb stiffness followed by bilateral shaking. EEG and MRI are normal
● New classification: bilateral tonic-clonus of unknown origin. There is no additional information to determine whether it is focal or comprehensive
● In the old category: Cannot be classified
Case 2 Focal evolved into bilateral tonic-clonic seizures
● Changing the scenario of Case 1, the EEG showed clear localized slowwave activity in the upper right end.
MRI shows cortical dysplastic FCD in the right top right. In this case, although no seizure initiation was observed, it can be classified as a focal evolution to bilateral tonic-clonic seizures due to the discovery of a focal etiology, most likely of focal origin
● The old classification was: partial secondary comprehensiveness
Misconceptions about epilepsy
1. Awareness of seizure symptoms and diagnosis of epilepsy - Myths
• "Convulsions" are epilepsy, and those who do not "convulsions" are not epilepsy
Correct interpretation:
1. Convulsions are only an episodic symptom, and there are many reasons for the so-called "convulsions", such as hypoglycemia, hypocalcium, pseudoseizures, etc., which may cause "convulsions" symptoms, but they are not seizures;
2. The clinical manifestations of seizures are varied, and not all seizures manifest as convulsions;
3. The diagnosis of epilepsy can only be made by a specialist after a detailed medical history, electrophysiological imaging and laboratory tests.
2. Dealing with Seizures - Misunderstandings
• When the patient has a seizure of consciousness and falls to the ground and has convulsions, family members often use pinching the middle of the person, stuffing a towel in the mouth and other objects to press the patient's convulsive limbs to prevent tongue bites and stop the seizure;
3. Common sense of epilepsy - misunderstandings
1. Epilepsy patients should not eat "hair products" such as carp, mutton, beef, female pork, and spicy food;
2. Epilepsy is passed on to the next generation;
3. Anti-epileptic drugs should not be used during pregnancy, otherwise it will cause fetal malformations
4. Driving on the road despite recent seizures
Correct interpretation:
1. Epilepsy has nothing to do with eating female pork, etc., and the so-called hair has no scientific basis and will not induce epilepsy
2. Most epilepsy is acquired or of unknown etiology and is not inherited;
3. Most anti-epileptic drugs are safe and will not increase the incidence of fetal malformations, while epilepsy may lead to mental retardation and other problems in offspring if it is not controlled;
4. Driving by car in patients with active seizures is a major hidden danger of traffic accidents
Fourth, the "stigma" and the surrounding discrimination are serious - misunderstandings
• Patients are embarrassed to describe their illness, often unable to work or study due to illness, discriminated against in employment and mate selection, and some children drop out of school because of seizures
Correct interpretation:
• Epilepsy is a common disease, and most patients have the same interictal period as normal
5. Lack of formal diagnostic procedures - misunderstanding
Most patients with epilepsy and their families often have incomplete descriptions of clinical symptoms at the time of onset, and due to limited medical conditions or cognitive problems, the necessary electrophysiological and imaging examinations are not performed, and some patients still lack video EEG and head MRI examinations for several years, which seriously affects the diagnosis of seizure type and etiology by epilepsy specialists.
Correct interpretation:
• Is it a seizure?→ Is it epilepsy?→ is it an epilepsy syndrome?→ need to treat the cause?→ imaging (MRI)/EEG/laboratory tests
6. Misjudging the results of the inspection - misunderstanding
The patient thinks the diagnosis of epilepsy is wrong or unclear because the EEG or MRI results are normal.
Correct interpretation:
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