Today's outpatient clinic received a patient, Mr. Zhang, who complained of recurrent convulsions in the past year, feeling dizzy and palpitating before each attack, followed by convulsions of limbs and spitting in the mouth

Today's outpatient clinic received a patient, Mr. Zhang, who complained of recurrent convulsions in the past year, feeling dizzy and palpitating before each attack, followed by limb twitching and foaming at the mouth, which lasted for several minutes and gradually regained consciousness. The frequency of seizures gradually increased, from once a month to once a week, seriously affecting work and life.

History of present illness:

The patient first had a seizure a year ago, when he suddenly fainted at work and had convulsions in his limbs, and was rushed to the hospital by a colleague. Since then, similar symptoms have recurred with no apparent cause. The patient has self-medicated antiepileptic medications, but they do not respond well and their symptoms gradually worsen.

Anamnesis:

The patient was in good health in the past, with no history of major diseases, no history of surgery, and no family history of genetic disease. Denial of chronic diseases such as high blood pressure and diabetes.

Physical examination:

The patient is generally well, conscious, and fluent in language. Neurological examination showed no significant abnormalities. Cardiopulmonary and abdominal examination showed no abnormalities.

INVESTIGATIONS:

Electroencephalogram (EEG) showed abnormal discharge waveforms such as spikes and sharp waves during the seizure, which was consistent with the typical presentation of epilepsy. MRI of the brain showed no obvious abnormalities and excluded structural lesions. Laboratory tests such as blood routine, liver and kidney function were all within the normal range.

Diagnosis:

The diagnosis of epilepsy was based on the patient's chief complaint, present medical history, past medical history, physical examination, and ancillary examinations.

Treatment Recommendations:

Adjust the antiepileptic drug regimen, choose the appropriate drug for the patient, and gradually adjust the dose to achieve the best treatment effect.

Electroencephalogram (EEG) examinations are performed regularly to monitor changes in the condition and evaluate the effectiveness of treatment.

Strengthen the life management of patients and avoid predisposing factors such as overwork and emotional agitation.

Provide psychological support to help patients relieve anxiety and increase confidence.