Epilepsy, commonly known as epilepsy or epilepsy, is a chronic disease in which brain neurons suddenly discharge abnormally, causing temporary brain dysfunction. What are the Chinese medicine prescriptions for treating epilepsy? Below is the information I compiled on Chinese medicine prescriptions for treating epilepsy. Welcome to read.
Traditional Chinese Medicine Prescriptions for Treating Epilepsy
Ginseng and Antelope Horns Treat Epilepsy
Its main functions are to calm the liver, remove phlegm, and awaken the spleen. Treat epilepsy.
The folk recipe consists of 5 grams of ginseng, 1 gram of antelope horn (all packaged), 15 grams each of Bupleurum, turmeric, Uncaria, Tianlanhuang, Pinellia, Yunzhi, white peony root and Atractylodes, and Salvia miltiorrhiza. , calamus, Dannanxing, gastrodia elata, and angelica 10 grams each.
Usage and Dosage: Take 1 dose per day, decoct 300 ml of liquid in water, take orally in 3 times, 2 months is a course of treatment.
For those with epilepsy, add amber, whole scorpion, and cinnabar; for those with epilepsy, add Jihu, Jiao hawthorn, and toodandan; for those with phlegm pain, add Dannanxing, Pinellia ternata; for those with epilepsy caused by wind , increase the amount of Uncaria, add Gastrodia elata and Bombyx mori.
Case verification: 62 patients were treated with this prescription, of which 48 were clinically cured, 10 were markedly effective, 3 were effective, and 1 was ineffective. The total effective rate was 98.4.
Agarwood Divine Comedy Cake treats epilepsy
Functions: Mainly treats epilepsy.
The folk recipe consists of 9 grams each of agarwood, binanxing, sea pumice, green vine stone, and miduoseng, 60 grams of Shenqu, 15 grams of pinellia, and 22.5 grams each of black and white Chou (raw and stir-fried).
Usage and Dosage Grind the medicinal powder into fine powder, add 500 grams of fine white flour, add an appropriate amount of water, knead into dough pieces, and bake into 10 coke cakes (you can add a small amount of sugar or sesame seeds). Adults should take 1 tablet every morning on an empty stomach. For children, reduce the dosage.
Case verification: 16 patients with epilepsy were treated with the drug, of which 11 were cured and 3 were ineffective. 2 cases were not followed up. Take at least 1 dose and maximum 3 doses. Among the 16 cases, a few cases developed nausea, anorexia or loose stools after taking 3 to 5 cakes. The symptoms disappeared after the dosage was reduced.
Pueraria lobata and turmeric treat epilepsy
Functions: It mainly treats emotional stimulation, meningitis sequelae, and epilepsy caused by congenital inheritance.
The folk recipe consists of 30 grams each of kudzu root, turmeric, costus, cyperus rotundus, salvia miltiorrhiza, and bile nanxing, and 15 grams each of white pepper, alum, sapodilla kernel (stir-fried and grinded), and cinnabar.
Usage and Dosage Grind the medicine into powder and mix well, then bottle it for later use. Children under 7 years of age take 1.5 grams each time, those over 7 years old take 3 grams each time, and those over 16 years old take 7 grams each time, once in the morning and once in the evening. A course of treatment is 30 days, usually two courses are enough. After taking one course of treatment, stop taking it for 10 days before starting the second course of treatment.
It is advisable not to use white pepper for children under 7 years old. During the medication period, avoid emotionally stimulating, strong tea, tobacco, alcohol, coffee, white radish, eggplant, and raw and cold products.
Case verification: Ma, female, 14 years old. He suffered from meningitis when he was 7 years old. He became pale, dull, and numb in his right arm. He often had irregular convulsions. During the attack, he suddenly fainted. His eyes looked up, his head tilted back, his mouth shut, he gritted his teeth, he drooled, and he screamed strangely. There is a sound of phlegm in the throat, twitching of the limbs, and spasm of the gastrocnemius muscle. After the attack, he gradually regained consciousness, then fell into drowsiness, dizziness and fatigue. No desire to eat, weight loss, red lips, pale tongue without coating, and slow and thready pulse. I got sick during the day a year ago, and now my limbs twitch, chew, gastrocnemius spasms, and cry every time I fall asleep. Diagnosed with epilepsy in a hospital. Chinese and Western medicines have been used in the past but were ineffective. I tried this recipe, taking 4 grams each time, twice a day. After taking 2 ingredients of the medicine, the twitching of the legs no longer occurred, and the remaining symptoms were less severe than before. After taking 6 ingredients, all symptoms disappeared, epilepsy did not occur again, intelligence was as normal as normal people, diet increased greatly, face was rosy, weight increased, and body recovered.
Realgar Uncaria treats epilepsy
Functions include clearing phlegm and resuscitating the mind, lowering phlegm and relieving spasm, calming the nerves and calming epilepsy. Treat epilepsy.
The folk recipe consists of 25 grams each of realgar, uncaria and frankincense, 19 grams each of amber, geranium yellow, gastrodia elata, whole scorpion, galanthemum, turmeric, coptis, and agarwood, Schizonepeta paniculata and alum. , 13 grams each of licorice, 5 grams of cinnabar, 2 grams each of pearl powder and borneol, and 200 grams of mung beans.
Usage and Dosage: In addition to realgar and cinnabar, grind the medicine into fine powder. Make water pills as big as mung beans. Grind realgar and cinnabar into fine powder and make a coat. Take it 2 times a day with warm water in the morning and evening. Adults take 4 to 6 grams per day, and children take 1 to 1.5 grams each time for 1 week. The dosage can be increased or decreased according to age and physical condition, and a course of treatment is 3 months.
It is advisable to avoid getting angry, smoking, alcohol, spicy, and fishy food while taking the medicine; after taking the medicine to stop the attack, you must continue to take the medicine for more than 100 days, and those who are seriously ill can stop taking the medicine for more than 1 year to avoid recurrence. ; During the period of taking the medicine, avoid heavy physical exertion or excessive mental work, and sexual intercourse is prohibited. If you take phenytoin, luminal and other medicines before taking the medicine, or those who have a long course of disease or severe attacks, you can continue to take this medicine together for about 1 month. After obvious improvement, the medication may be reduced or discontinued.
Case verification: Zheng, male, 6 years old, had high fever and convulsions six months ago, and was cured. After more than a month, he suddenly fainted and fell to the ground, unconscious, locking his teeth, salivating at the mouth, and looking up. He lasted for several minutes and then woke up; then fell asleep, and woke up as usual. The coating is white and greasy, and the fingerprints are blue and purple. The evidence is epilepsy. Make 100 grams of this prescription into pills, take it twice a day, 1 gram each time, and decoct 3 grams of Bupleurum in water. After taking the medicine, there was no recurrence and the patient recovered. During 18 years of follow-up, there was no recurrence of the disease. Introduction to epilepsy disease
Due to the different starting sites and transmission methods of abnormal discharges, the clinical manifestations of epileptic seizures are complex and diverse, and can manifest as paroxysmal motor, sensory, autonomic nervous system, consciousness and mental disorders. There are many causes of epilepsy. After regular anti-epileptic drug treatment, about 70% of patients with epilepsy can have their seizures under control, and 50 to 60% of them can be cured after 2 to 5 years of treatment. The patients can work and live like normal people.
Disease classification
Epileptic seizure classification
Currently, the epileptic seizure classification scheme proposed by the International League Against Epilepsy in 1981 is commonly used. Epileptic seizures are divided into partial/focal seizures, generalized seizures, and unclassifiable seizures. In 2010, the International League Against Epilepsy proposed the latest classification scheme for epileptic seizures. The new scheme reclassified and supplemented epileptic seizures. Although the new protocol summarizes the progress of epilepsy research in recent years, it is more comprehensive and complete.
Partial/focal seizures: refer to seizures in which the initial symptoms and electroencephalogram changes indicate that neurons in a certain part of the cerebral hemisphere are first activated. Including simple partial seizures, complex partial seizures, and secondary generalized seizures.
Generalized seizure: refers to a seizure in which the initial symptoms and electroencephalogram changes suggest that both cerebral hemispheres are affected at the same time. Including absence, myoclonic, tonic, clonic, tonic-clonic, and atonic seizures.
Unclassifiable seizures: seizures that cannot be classified due to insufficient or incomplete data, or that cannot be classified within current classification criteria (such as convulsive seizures).
Newly recognized seizure types in recent years: including myoclonic absence, negative myoclonus, eyelid myoclonus, giggly seizures, etc.
Classification of epilepsy syndromes
According to the different causes of epilepsy, it can be divided into idiopathic epilepsy syndrome, symptomatic epilepsy syndrome and possible symptomatic epilepsy syndrome. The new plan proposed by the International League Against Epilepsy in 2001 also defined or standardized some key terms, including reflex epilepsy syndromes, benign epilepsy syndromes, and epileptic encephalopathy.
Idiopathic epilepsy syndrome: A syndrome in which, other than epilepsy, there is no structural damage to the brain and other neurological symptoms and signs. It usually begins before puberty and has a good prognosis.
Symptomatic epilepsy syndrome: Central nervous system lesions or abnormalities caused by various reasons, including brain structural abnormalities or various factors that affect brain function.
With the advancement of medicine and the continuous development and enrichment of examination methods, more and more cases of epilepsy can be found to cause the disease.
Possible symptomatic epilepsy syndrome or cryptogenic epilepsy: It is considered to be a symptomatic epilepsy syndrome, but the cause is currently unknown.
Reflex epilepsy syndrome: refers to epilepsy in which almost all seizures are induced by specific sensations or complex cognitive activities, such as reading epilepsy, startle epilepsy, visual reflex epilepsy, and heat bath epilepsy. , card epilepsy, etc. Remove the trigger and the attack disappears.
Benign epilepsy syndrome: refers to an epilepsy syndrome that is easy to treat or can be completely relieved without treatment without leaving sequelae.
Epileptic encephalopathy: refers to progressive brain dysfunction caused by the epileptic abnormality itself. The cause is mainly or entirely caused by epileptic seizures or frequent epileptic discharges between seizures. Most of them occur in newborns, infants and children. The electroencephalogram was obviously abnormal, and the effect of drug treatment was poor. Including West syndrome, LGS, LKS, Ohtawara syndrome, Dravet syndrome, etc. Causes of epilepsy
The causes of epilepsy are complex and diverse, including genetic factors, brain diseases, systemic or systemic diseases, etc.
Genetic factors
Genetic factors are an important cause of epilepsy, especially idiopathic epilepsy. Molecular genetic studies have found that some of the molecular mechanisms of hereditary epilepsy are structural or functional changes in ion channels or related molecules.
Brain diseases
Congenital brain developmental abnormalities: cerebral gray matter heterotopia, penetrating brain malformation, tuberous sclerosis, cerebrofacial angiomatosis, etc.
Brain tumors: primary or metastatic tumors
Intracranial infections: various encephalitis, meningitis, brain abscess, neurocysticercosis, cerebral toxoplasmosis, etc.
Brain trauma: birth trauma, intracranial hematoma, cerebral contusion and various combined craniocerebral injuries, etc.
Cerebrovascular disease: cerebral hemorrhage, subarachnoid hemorrhage, cerebral infarction, cerebral aneurysm, cerebral infarction, etc. Arteriovenous malformations, etc.
Degenerative diseases: Alzheimer's disease, multiple sclerosis, Pick's disease, etc.
General or systemic diseases
Hypoxia: Asphyxia, carbon monoxide poisoning, after cardiopulmonary resuscitation, etc.;
Metabolic diseases: hypoglycemia, hypocalcemia, phenylketonuria, uremia, etc.;
Endocrine diseases: parathyroid glands Functional hypofunction, insulinoma, etc.;
Cardiovascular diseases: Alzheimer's syndrome, hypertensive encephalopathy, etc.;
Toxic diseases: organophosphorus poisoning, certain heavy metal poisoning, etc.;
Others: such as blood system diseases, rheumatic diseases, eclampsia, etc.
The causes of epilepsy are closely related to age, and different age groups often have different causes (see Table 1).
Table 1 Common causes of disease in different age groups
Neonatal and infancy
Congenital and perinatal factors (hypoxia, asphyxia, head trauma) , hereditary metabolic diseases, malformations caused by abnormal cortical development, etc.
Children and adolescence
Idiopathic (related to genetic factors), congenital and perinatal factors (hypoxia , asphyxia, head birth trauma), central nervous system infection, brain development abnormalities, etc.
Adult period
Head trauma, brain tumors, central nervous system infectious factors, etc.
Old age
Cerebrovascular accidents, brain tumors, metabolic diseases, degenerative diseases, etc.
Pathogenesis
The pathogenesis of epilepsy is very complex.
The imbalance between excitation and inhibition in the central nervous system leads to epileptic seizures, which is mainly related to changes in ion channel neurotransmitters and glial cells.
Ion channel dysfunction
Ion channels are the basis for regulating the excitability of excitable tissues in the body. Mutations in their coding genes can affect ion channel function, leading to the risk of certain hereditary diseases. occur. It is currently believed that many human idiopathic epilepsy are caused by ion channelopathies, that is, defective genes encoding defective ion channel proteins. Among them, the research on the correlation between sodium ion, potassium ion, and calcium ion channels and epilepsy is relatively clear.
Abnormal neurotransmitters
Epileptic discharges are closely related to neurotransmitters. Under normal circumstances, excitatory and inhibitory neurotransmitters maintain a balance, and neuronal membranes are stable. When there are too many excitatory neurotransmitters or too few inhibitory neurotransmitters, there can be an imbalance between excitation and inhibition, causing membrane instability and producing epileptic discharges.
Abnormal glial cells
The electrolyte balance of the neuronal microenvironment is the basis for maintaining normal excitability of neurons. Glial cells play an important role in maintaining the living environment of neurons. Seizures can occur when astrocytes' ability to uptake glutamate or aminobutyric acid is altered.
Pathophysiology
Patients with idiopathic epilepsy have no structural changes or metabolic abnormalities in the brain that can explain the symptoms, and their onset is closely related to genetic factors. Symptomatic epilepsy is caused by various brain lesions and metabolic disorders, and there are epileptogenic lesions in the brain. The sudden high-frequency repetitive abnormal discharge of the epileptogenic focus neurons can continue to propagate to the surrounding cortex until the inhibitory effect terminates the seizure, resulting in sudden and sudden seizures.
Clinical manifestations
Frequent groups
Epilepsy can occur in all age groups. The incidence of epilepsy in children is higher than that in adults. As age increases, the incidence of epilepsy decreases. Entering old age (after 65 years old), the incidence of epilepsy increases again due to the increase in cerebrovascular diseases, Alzheimer's disease and degenerative diseases of the nervous system.
Disease symptoms
The clinical manifestations of epileptic seizures are complex and diverse due to differences in the starting location and transmission mode of abnormal discharges.
Generalized tonic-clonic seizure: characterized by sudden loss of consciousness and generalized tonicity and convulsions. The typical seizure process can be divided into tonic phase, clonic phase and post-ictal phase. An attack usually lasts less than 5 minutes, is often accompanied by tongue bites, urinary incontinence, etc., and can easily cause injuries such as suffocation. Tonic-clonic seizures can occur in any type of epilepsy and epilepsy syndromes.
Absence seizures: Typical absence seizures occur suddenly, with movement cessation, staring, and yelling not responding. There may be blinking, but it is basically not accompanied by or with mild motor symptoms, and it ends suddenly. Usually lasts 5-20 seconds, rarely more than 1 minute. Mainly seen in childhood absence epilepsy.
Tonic seizure: manifested by episodic strong and sustained contraction of whole body or bilateral muscles, muscle stiffness, fixing the limbs and body in a certain tense posture, such as axial body extension, dorsiflexion or forward flexion . It usually lasts from several seconds to tens of seconds, but generally does not exceed 1 minute. Tonic seizures are more common in epilepsy patients with diffuse organic brain damage, and are generally a sign of serious illness, mainly in children, such as Lennox-Gastaut syndrome.
Myoclonic seizure: It is a sudden, rapid and short contraction of muscles, which is similar to electric shock-like shaking of the body or limbs. Sometimes it can occur several times in a row, and it usually occurs after awakening. It can be a full body movement or a local movement. Myoclonus is common clinically, but not all myoclonus is epileptic seizure. There are both physiological myoclonus and pathological myoclonus. Myoclonus accompanied by EEG polyspike and slow wave syndrome is an epileptic seizure, but sometimes the spikes and slow waves of the EEG may not be recorded.
Myoclonic seizures can be seen not only in some idiopathic epilepsy patients with a good prognosis (such as benign myoclonic epilepsy in infants, juvenile myoclonic epilepsy), but also in some patients with a poor prognosis and diffuse brain damage. In epilepsy syndromes (such as early myoclonic encephalopathy, infantile myoclonic epilepsy gravis, Lennox-Gastaut syndrome, etc.).
Spasm: refers to infantile spasms, which are characterized by sudden and short-lived tonic flexion or extension contractions of trunk muscles and bilateral limbs. They are often characterized by paroxysmal nodding and occasionally episodic leaning back. The entire process of muscle contraction takes about 1 to 3 seconds and often occurs in clusters. Common in West syndrome, but sometimes seen in other infantile syndromes.
Atonic attack: It is due to the sudden loss of muscle tone in part or all of the body, resulting in the inability to maintain the original posture, cataplexy, limb drop and other symptoms. The attack time is relatively short, lasting from a few seconds to more than 10 years. It is more common in seconds, and those with short duration of attacks are often not accompanied by obvious disturbance of consciousness. Atonic seizures often alternate with tonic seizures and atypical absence seizures in epilepsy with diffuse brain damage, such as Lennox-Gastaut syndrome, Doose syndrome (myoclonus-astatic epilepsy), subacute sclerosing whole-brain syndrome Early stage of inflammation etc. However, some patients have only atonic seizures whose cause is unknown.
Simple partial seizure: The seizure is clear and lasts from a few seconds to more than 20 seconds, rarely exceeding 1 minute. Depending on the origin of the discharge and the involved parts, simple partial seizures can manifest as motor, sensory, autonomic, and psychiatric seizures. The latter two rarely occur alone and often develop into complex partial seizures.
Complex partial seizure: The attack is accompanied by varying degrees of disturbance of consciousness. The symptoms include sudden stop of movements, straight eyes, no response to calls, no falling, and no change in complexion. Some patients may develop automatisms, which are involuntary and unconscious actions, such as licking lips, smacking lips, chewing, swallowing, groping, wiping face, clapping, walking aimlessly, talking to themselves, etc., and cannot recall them after the attack. They mostly originate in the medial temporal lobe or limbic system, but can also originate in the frontal lobe.
Secondary generalized seizures: Simple or complex partial seizures can be secondary to generalized seizures, and the most common secondary generalized tonic-clonic seizures. Partial seizures followed by generalized seizures still belong to the category of partial seizures, which are significantly different from generalized seizures in terms of etiology, treatment methods, and prognosis, so the identification of the two is particularly important clinically.
Disease hazards
Epilepsy is a chronic disease. Although it does not have much impact on the patient in the short term, long-term and frequent attacks can cause serious impacts on the patient's physical, mental and intellectual abilities. .
1. Hazards to life: Epilepsy patients often have sudden attacks at any time, place, and environment and cannot control themselves. They are prone to falls, burns, drowning, traffic accidents, etc.
2. Mental harm. Epilepsy patients are often discriminated against by society and encounter difficulties in employment, marriage, family life, etc. The patients are mentally depressed and their physical and mental health is greatly affected.
3. Cognitive impairment, which mainly manifests as memory impairment, mental decline, personality changes, etc., and eventually the patient gradually loses the ability to work and even live.
Diagnosis and differential diagnosis
Diagnosis of epilepsy
1. To determine whether it is epilepsy, ask the patient and his relatives or colleagues and other witnesses in detail to obtain as much detailed information as possible A complete seizure history is the key to accurately diagnosing epilepsy. EEG is the most important tool for diagnosing and classifying seizures and epilepsy. All cases with clinical suspicion of epilepsy should undergo electroencephalography. It should be noted that the abnormality rate of conventional EEG is generally very low, about 10 to 30.
Standardized electroencephalography, because it appropriately extends the tracing time, ensures various induction tests, especially sleep induction, and adds sphenoid electrode tracing when necessary, thus significantly improving the detection rate of epileptic discharges, and the positive rate can be increased to Around 80, and the accuracy of epilepsy diagnosis is significantly improved.
2. Types of epileptic seizures
Judgment is mainly based on detailed medical history, standardized EEG examination, and video EEG examination if necessary.
3. Causes of epilepsy
After the diagnosis of epilepsy is confirmed, efforts should be made to find out the cause. In the medical history, questions should be asked about family history, birth and growth and development, and whether there is a history of encephalitis, meningitis, brain trauma, etc. Check whether there are neurological signs, systemic diseases, etc. during physical examination. Then select relevant examinations, such as cranial magnetic resonance imaging (MRI), CT, blood sugar, blood calcium, cerebrospinal fluid examination, etc., to further identify the cause.
Differential Diagnosis
Clinically, there are a variety of ictal events, including both epileptic and non-epileptic seizures. Non-epileptic seizures can occur in all ages (see Table 2) and include a variety of causes, some of which are disease states, such as syncope, transient ischemic attack (TIA), and paroxysmal dyskinesia. , sleep disorders, multiple tics, migraines, etc. Others are physiological phenomena, such as breath-holding attacks, sleep myoclonus, night terrors, etc.
During the differential diagnosis process, detailed inquiries about the seizure history should be made and efforts should be made to find the cause of the seizure. In addition, EEG, especially video EEG monitoring, is of great value in distinguishing epileptic seizures from non-epileptic seizures. Cases that are difficult to diagnose can be referred to a specialist. Treatment methods for epilepsy
Current treatments for epilepsy include drug treatment, surgical treatment, neuromodulation treatment, etc.
Drug treatment
At present, the treatment of epilepsy at home and abroad is mainly based on drug treatment. After regular anti-epileptic drug treatment, about 70% of patients with epilepsy can have their seizures under control, and 50 to 60% of them can be cured after 2 to 5 years of treatment. The patients can work and live like normal people. . Therefore, reasonable and regular anti-epileptic drug treatment is key.
1. Indications for the use of anti-epileptic drugs: Once the diagnosis of epilepsy is established, anti-epileptic drugs should be used promptly to control seizures. However, for those who have a first attack, have precipitating factors, or have rare attacks, they may be considered as appropriate.
2. General principles when selecting anti-epileptic drugs: Correct classification of epileptic seizures and epilepsy syndromes is the basis for rational drug selection. In addition, factors such as the patient's age (children, adults, elderly), gender, concomitant diseases, and the impact of potential side effects of antiepileptic drugs on the patient's future quality of life must also be considered. If infants and young children cannot swallow tablets, the use of syrup preparations is both beneficial to the children and convenient for dosage control. When selecting drugs for pediatric patients, attention should be paid to choosing drugs that have no impact on cognitive function, memory, and attention. Elderly people have more diseases, take more concomitant medications, and have more interactions between drugs. Moreover, the elderly are more sensitive to anti-epileptic drugs and have more prominent side effects. Therefore, when elderly patients with epilepsy choose anti-epileptic drugs, drug side effects and drug interactions must be considered. Female epilepsy patients of childbearing age should pay attention to the effects of anti-epileptic drugs on hormones, sexual desire, female characteristics, pregnancy, fertility and teratogenicity. Although traditional anti-epileptic drugs (such as phenytoin and phenobarbital) have certain clinical effects, they have many side effects, such as gingival hyperplasia, increased hair, high teratogenic rate, hyperactivity, and inattention, etc., and are not easily tolerated by patients. New anti-epileptic drugs (such as lamotrigine, levetiracetam, topiramate, oxcarbazepine) not only have positive clinical efficacy, but also have few side effects and are easily tolerated by patients.
3. Anti-epileptic drug treatment should be monotherapy as much as possible until the effective or maximum tolerated dose is reached. After single drug treatment fails, combined drugs can be used.
Try to combine drugs with different mechanisms of action and little or no drug-drug interactions. The ultimate goal of rational drug combination should be to achieve the best clinical effect and minimize the economic burden on patients.
4. During anti-epileptic drug treatment, routine monitoring of the blood concentration of anti-epileptic drugs is not recommended. Only when it is suspected that the patient has not taken the medication as prescribed or has drug toxicity, is taking other drugs that affect drug metabolism, or has special clinical conditions (such as status epilepticus, liver and kidney disease, pregnancy), etc., should a blood drug concentration test be considered. monitor.
5. Anti-epileptic treatment requires continuous medication and should not be stopped easily. It is currently believed that only when the patient has been seizure-free for at least 3 years can the drug be gradually discontinued. During the withdrawal process, only one drug can be stopped at a time, and it takes about a year to gradually stop using it.
The drug treatment of epilepsy is a long-term practice process. Doctors, patients and family members must have sufficient patience and love. Patients should be reviewed regularly. Doctors should provide individualized treatment according to the specific conditions of each patient. , supplemented by scientific life guidance, both parties must fully cooperate to achieve satisfactory results.
It should be noted that some patients and their families have some misunderstandings about the treatment of epilepsy. If they are sick, they seek medical treatment indiscriminately, believe in rumors, and are afraid that anti-epileptic western medicines will stimulate the brain, and long-term use will make them stupid. ?, afraid to take effective anti-epileptic drugs. Blindly seeking medical treatment, searching everywhere for "ancestral secret recipes", "pure Chinese medicine", and credulously believing in various advertisements for "guaranteed cure" and "radical cure" not only cost a lot of time and money, but epilepsy still cannot be effectively controlled, and it is also delayed. The best and most effective time for treatment artificially causes patients to become refractory to epilepsy.
Surgical treatment
After regular anti-epileptic drug treatment, about 20 to 30 patients still have drug-refractory epilepsy. Surgical treatment of epilepsy provides a new treatment method for this group of patients. It is estimated that about 50% of patients with drug-refractory epilepsy can have their seizures controlled or cured through surgery, which improves the symptoms of refractory epilepsy to a certain extent. Prognosis.
Indications for surgery
(1) People with drug-refractory epilepsy that affects daily work and life;
(2) For partial epilepsy, the source of the epilepsy The location of the area is clear, and the lesion is single and localized;
(3) Surgical treatment will not cause important functional loss.
In recent years, the practice of epilepsy surgery has shown that the surgical treatment effect of some diseases or syndromes is certain, and surgery can be actively pursued. For example, if temporal lobe epilepsy is accompanied by hippocampal sclerosis, the effective rate can reach 60-90% if the positioning is accurate. Catastrophic epilepsy in infants or children, such as Rasmussen syndrome, seriously affects brain development and requires active surgery, the sooner the better. Others such as cortical developmental malformations, benign low-grade tumors, cavernous hemangiomas, arteriovenous malformations, and hemiconvulsions-hemiplegia-epilepsy syndrome are all good indications for surgical treatment.
Strictly grasping the indications for surgery is the prerequisite for achieving good results. First, the patient must have true drug-refractory epilepsy. If the condition is delayed due to incorrect diagnosis, improper drug selection, or taking so-called "traditional Chinese medicine", and the patient is mistakenly thought to be refractory epilepsy and then undergoes surgery, that is completely wrong. Secondly, some epilepsy patients mistakenly believe that epilepsy is a lifelong disease, are overly fearful and exaggerate the side effects of anti-epileptic drugs, mistakenly believe that surgery can cure epilepsy, and actively request surgery. We must be cautious about these patients. Third, it should be emphasized that surgery is not a panacea, and not every patient can achieve the goal of eradicating attacks after surgical treatment. Although most cases of drug-refractory epilepsy can be controlled or cured through surgery, there are still some cases of refractory epilepsy that do not have satisfactory results even if they undergo surgery, and may even cause some new problems.
Preoperative positioning
Accurate positioning of epileptogenic lesions and brain functional areas is the key to successful surgical treatment.
At present, domestic and foreign scholars agree that comprehensive diagnostic procedures should be used for preoperative localization of epileptogenic lesions and brain functional areas. The most commonly used and better method is staging comprehensive assessment, that is, non-invasive early stage (stage I) examinations and stage II invasive examinations. Non-invasive examinations include medical history collection and neurological examination, video scalp EEG, brain MRI, CT, SPECT, PET, MRS, fMRI, magnetoencephalography and specific neuropsychological examinations. If the precise location cannot be achieved through various non-invasive examinations, invasive examinations are still needed, including intracranial subdural strip or mesh electrodes and deep electrode monitoring and evoked potentials, Wada test, etc., to further locate the epileptogenic focus and Brain functional areas.
Neuromodulation treatment
Neuromodulation treatment is a new neuroelectrophysiological technology. Neuromodulation treatment of epilepsy has become the most promising treatment method abroad. Currently, it includes: repetitive transcranial magnetic stimulation (rTMS); central nervous system electrical stimulation (deep brain stimulation, epileptic focus cortical stimulation, etc.); peripheral nerve stimulation (vagus nerve stimulation).
Repetitive transcranial magnetic stimulation (rTMS)
rTMS applies pulsed magnetic fields to the cerebral cortex to tune the brain’s bioelectrical activity, cerebral blood flow and metabolism, thereby regulating Brain functional status. Low-frequency magnetic stimulation therapy achieves the purpose of treating epilepsy by reducing the excitement of the cerebral cortex, reducing the frequency of epileptic seizures, improving abnormal electroencephalographic discharges, and repairing brain damage caused by epilepsy.
rTMS has good curative effect on a variety of chronic brain function diseases such as epilepsy. There is no damage to the human body caused by drugs or surgical treatments. It has no impact on cognitive function. It is highly safe, has minimal side effects, and is therapeutic. The cost is low and easy for patients to accept. Multiple courses of rTMS can significantly reduce the frequency and severity of epileptic seizures. Therefore, rTMS is expected to become a new and unique method of treating epilepsy with great potential.
Advantages of rTMS: The regulatory effect is reversible; the patient's needs are different, and the action parameters can be adjusted; stimulating a single target may also affect multiple epileptogenic foci; the epileptogenic foci in functional areas can also be neurologically stimulated Regulatory treatment.
Which epilepsy patients are more suitable for rTMS treatment: Epilepsy patients with cortical dysplasia or epileptogenic focus located in the cortex have better curative effect, and can significantly reduce the number of epileptic seizures (71 seizures can be reduced during treatment), and even some Patients (66) were able to achieve complete seizure freedom.
Safety of rTMS: Most patients tolerate it well, and the reported adverse reactions are usually mild and short-lived, such as headache, dizziness, non-specific discomfort, etc. No reports of rTMS provoking status epilepticus or life-threatening seizures were found.
Vagus Nerve Stimulation (VNS)
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