Epilepsy Knowledge

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Epilepsy (epilepsy) is a chronic disease characterized by sudden abnormal discharge of neurons in the brain, resulting in transient brain dy

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Epilepsy (epilepsy) is a chronic disease characterized by sudden abnormal discharge of neurons in the brain, resulting in transient brain dysfunction. Epileptic seizures (epileptic seizure) is a clinical phenomenon caused by abnormal cerebral neurons and over synchronous discharge. It is characterized by sudden and transient symptoms, due to abnormal discharge of neurons in different parts of the brain, and there are a variety of manifestations.

Etiological classification

Epilepsy is a chronic brain disease caused by multiple factors, which is caused by abnormal discharge of neurons in the brain.

Modern medicine believes that the causes of epilepsy can be divided into two categories: primary (functional) epilepsy and secondary (symptomatic) epilepsy.

Primary epilepsy is also called true or idiopathic or cryptogenic epilepsy. Through the clinical diagnosis and treatment records, we found that the relationship between primary epilepsy and family history was significant.

Secondary epilepsy. Refers to the cause of epilepsy. See the following common causes.

According to the attack, it can be divided into major episodes, minor episodes, psychomotor seizures, localized seizures and complex partial seizures.

(1) big attack, also called generalized seizures, half had threatened, such as dizziness, confusion, abdominal discomfort, visual and olfactory disorders. When seizures (seizures period), some patients before a sharp cry, after both the loss of consciousness and fall, body muscle stiffness, breathing, eye head to one side, a few seconds after the clonic convulsions, seizures gradually increase, for tens of seconds, recovery of clonic period breathing, koutubaimo (such as the tongue there are bite blood). Some patients with incontinence, convulsions after body relaxation or enters (lethargy), then gradually recovered consciousness.

(2) a small episode, short (5~10 seconds) of unconsciousness or loss of consciousness, and no generalized convulsions. There may be multiple episodes of daily, and sometimes rhythmic blinking, lower head, two straight eyes, upper limb spasm.

(3) psychomotor seizures (also known as complex partial seizures) can be characterized by sudden onset, blurred consciousness, irregular and uncoordinated movements (e.g. sucking, chewing, searching, shouting, running, struggling, etc.). The patient's actions are unmotivated, aimless, blind and impulsive, and the attack lasts for hours, sometimes for days, and the patient has no memory of the attack.

(4) partial seizures commonly found in cerebral cortex lesion patients showed unilateral finger or toe angle, paroxysmal tics or abnormal sensation, can spread to the side of the body. When the attack on both sides of the body, can be manifested as a major attack.

Clinical features

Epilepsy is a kind of disease and syndrome, which is characterized by intermittent central nervous system dysfunction caused by repeated sudden discharge of neurons in the brain. It is a kind of disorder that arises from the brain, and the repeated movement sensation, autonomic nerve, consciousness and mental state are different. This definition generalizes the complexity of epilepsy, it summarizes two characteristics of epilepsy, which is repeated and paroxysmal. A callback, refers to the first time after the attack, after the interval, there must be second times, third times that many attacks. Even the most common tic, if only happens once, do not have repeated, is not diagnosed as epilepsy. The so-called paroxysmal, refers to the symptoms appear suddenly, also suddenly stopped. We may have seen some patients walking or eating suddenly collapsed, after a period of time to return to normal. There are some people with abdominal epilepsy in children are happy to play when suddenly severe abdominal pain, crying or fall to the ground, several minutes after completely disappeared and continue to play. No matter how complex the symptoms of epilepsy, must have these two characteristics. This is also an important basis for the diagnosis of epilepsy.

Epilepsy in children

The high incidence of epilepsy in children, have a serious impact on health, due to the physiological characteristics of the newborn, coupled with the neural and humoral aspects of the change, so the clinical features of epilepsy in children and adults are different in some aspects.

(1) gender, age of onset and seizure type: general male more than female, with most children, but also there is a close relationship between the age and the type of attack, such as infantile spasms are almost all in less than 1 years old, seizure incidence in 6 years, the pathogenesis of absence seizures in 1 ~ 8 years old, the other type of epilepsy age of onset is in less than 10 years old. Neonatal epilepsy is often concealed, and the occurrence of focal seizures, convulsions and obvious elderly systemic.

(2) the onset of seizures: the incidence of seizure type varies with age, and its clinical manifestations are closely related to the maturation of the central nervous system. In addition to the common occurrence in any age children's seizures, the clinical manifestations of neonatal seizures are stereotyped repetitive motion, and often accompanied by abnormal eye movements

Clinical manifestation

According to the type of clinical seizure:

A generalized tonic clonic seizures (seizures)

A sudden loss of consciousness, following the first tonic clonic seizures after. Often accompanied by screaming, cyanosis, urinary incontinence, tongue bite, or Xuemo froth at the mouth, mydriasis. For several seconds or minutes after seizures naturally stop, into a trance. Short time after waking, dizziness, irritability, fatigue, on the onset of the process cannot be recalled. If the attack continues, has been in a coma, said the outbreak of a large state, often dangerous and life.

Two absence seizure (seizures)

Sudden interruption, loss of consciousness, mental activity may be associated with myoclonus or automatism. A few seconds to more than ten seconds. EEG appeared 3 times / second spike slow or sharp slow wave synthesis.

Three simple partial seizures

A body part or side of the tonic, clonic seizures, or paresthesia attack, which lasted a short, clear consciousness. If the attack range along the motion area and the other limb or body may be associated with loss of consciousness, Jackson attack (Jack). After the onset of limb may have temporary paralysis, called Todd palsy.

Four complex partial seizures (psychomotor seizures)

Psychomotor, psychomotor and mixed episodes. There are different levels of consciousness disorder and obvious thinking, perception, emotion and mental disorder. A fugue, psychosis automatism night performance. Sometimes in the domination of hallucinations and delusions can occur under assault, injury and other acts of violence.

Five autonomic seizures (cerebral)

Can have a headache, abdominal pain, limb pain, syncope or cardiovascular seizures.

There is no clear cause of primary epilepsy, secondary to intracranial tumors, trauma, infection, parasitic diseases, cerebrovascular disease, systemic metabolic diseases, such as those caused by secondary epilepsy.

Epilepsy complications

A traumatic, advanced idiopathic epilepsy is often accompanied by serious tendency, can attack from the local and the evolution of generalized seizures, severe memory loss, personality disorder, mental retardation and other performance.

Two, the identification of obstacles, the ability to distinguish things, including the dream like state, the perception of time distortion, unreal, isolated state.

Three, emotional disorder, manifested as an unpleasant state, with a sense of inferiority or accompanied by depression.

Four, the language barrier, can produce partial aphasia or repeated language.

Five, memory disorders, familiar with the things that have not experienced the feeling, or things that can not be experienced in the past can not be quickly recalled.

Six, illusion, the performance of the object and the real size, distance, appearance difference.

Seven, can be complicated by penetrating brain injury subdural hematoma and cerebral hematoma brain contusion skull fracture and other diseases.

Eight, illusion, in the absence of any external changes can produce visual, auditory, taste, sense of space and object imaging and other aspects of the change and illusion.

conventional therapy

First, the general drug treatment:

1 according to the drug seizure type and choose safe, effective and cheap and available.

2 drug dosage from the low limit of commonly used, and gradually increased to the seizure control ideal without serious side effects.

3 the number of drug administration should be based on the characteristics and characteristics of the disease.

4 generally do not arbitrarily change, stop, stop western medicine, seizures completely controlled after 2-3 years, and the EEG is normal, can gradually reduce the amount of drug withdrawal.

5 regular drug concentration monitoring, timely adjustment of drug dose.

Two, in the treatment of epilepsy, antiepileptic drugs have special significance. To eliminate or reduce seizure by two ways of anti epileptic drugs, one is the effect of central neurons, to prevent or reduce excessive discharge of their pathology; the second is to increase the excitation threshold of normal brain tissue, decreased the proliferation of excitement lesions, prevent recurrence of epilepsy.

Three, for a clear cause of epilepsy, in addition to effective control of the attack to actively treat the primary disease.

Four, for the treatment of intractable epilepsy intractable stereotactic surgery can damage the brain and the seizure of the relevant areas, the anterior part of the corpus callosum incision or chronic cerebellar stimulation.

Five, treatment of generalized tonic clonic seizure status epilepticus.

1 active and effective control of convulsions:

Diazepam, adult 10-20mg, pediatric 0.25-1mg/kg, slow intravenous injection to twitch stop. The 20-40mg was then added to the glucose solution for intravenous infusion at a rate of 10-20mg per hour for a period of 10-20 hours, and the total daily dose was not more than 120mg.

The 0.5g of adult rats with pentobarbital sodium was dissolved in the water of 10ml injection, and was injected with intravenous injection of 50-100mg/ at a slow rate. Pay attention to the change of breath and heartbeat in injection. After the seizure control should continue oral or nasal feeding of antiepileptic drugs.

2 treatment complications:

To maintain airway patency, diuretic dehydration to reduce brain edema, prevent acidosis, etc.

surgical treatment

Emergency nursing

A patient with an aura of attack

The patient should be prepared, the family or the people around them informed at the same time, because the attack is inevitable, there are conditions and time will help patients to bed, too late to prevent down homeopathy, sudden loss of consciousness and falls, moved around the hard, sharp, reduce the damage to the body of the attack. As the family and the people around, should closely observe the time of onset, duration of each episode (including the loss of consciousness, convulsions, time time) to observe the first twitch site is local or systemic, whether with loss of consciousness and two anoopsia, two incontinence, these findings have certain help to the doctor localization diagnosis. For menstrual seizure, seizure may occur when the emotional injury, wounding, destroy, kill, Dutch act and other excesses, should immediately take emergency control measures to strictly limit its behavior, so as to avoid serious consequences, but intramuscular injection or intravenous injection of diazepam, with aggressive behavior and excited patients using antiepileptic drugs with antipsychotic treatment, such as chlorpromazine and fluoride butanol and other emergency measures. For absence seizures of children, parents and teachers do not think that the child is not careful and careless, blame the child, because sometimes only for children with epilepsy suddenly stop the activity, look at, call not, or hand held by the fall, this is the disease attack, not trouble, naughty children.

(two) nursing care of patients with epilepsy

There threatened, we must first protect the tongue, get in before the attack, will be wrapped with gauze between the plate placed in the patient's upper and lower molars, so as not to bite his tongue, if not put before the attack, to be patient in tonic phase and then into the mouth, clonic period not forced into, so as not to hurt the patient. Attack of the patients supine, loosen the collar, head to the side, in order to facilitate the discharge of respiratory secretions and vomitus, into the trachea to prevent suffocation caused by choking. Large airway secretions, easy to cause respiratory tract obstruction or aspiration pneumonia, convulsions in the mouth does not support anything, do not take medicine to prevent suffocation. Some people see the epileptic twitch when often used pinch in the way, hope to terminate the attack of patients, patients with brain convulsion is excessive discharge, once the attack cannot be controlled, only the end of discharge, convulsions can stop, so the patient encountered seizures, not to pinch the patient in the patient, no benefits. Someone in the limbs of patients on the mandatory clonic period, trying to prevent convulsions and reduce the pain of patients, but the excessive force can cause fractures and muscle injury, but will increase the patient's pain.

(three) nursing of status epilepticus

Status epilepticus is a severe, if not timely treatment can appear cerebral edema, cerebral hernia, respiratory and circulatory failure and death. The family once found the patient had status epilepticus, immediately rushed to the hospital, the hospital before home with phenobarbital injection, injection of diazepam or enema, can be given a drug, and then rushed to the hospital, after the hospital to the pathogenesis of doctor detailed report to dose and time, to help doctors have reasonable. Treatment.

First aid class

1: Western medicine injection, valium (diazepam) 10~20 mg intravenous injection can be stopped immediately! But be careful: the injection speed should not exceed 2 mg / min! If a respiratory depression occurs, stop the injection immediately.

2: acupuncture, attack, fast double arm "Neiguan" 1~1.5 inch needle, will soon be stopped.

basic dos and don'ts

1, can not limit the attack. When the patient twitch, others can not force or buckling of the body. Immediately lay down, will only make the child side or head to the side, the child mouth liquid from the mouth of easy flow.

2, don't try to put anything in the mouth of a patient, such as chopsticks, spoon etc.. Some families worry that patients at the onset of tongue bite, so he will put their fingers in the patient's teeth, this is absolutely prohibited.

3, with a soft cushion to protect the patient's head, prevent accidental injury, remove the surrounding sharp, hard, hot objects, so as not to hurt. Can pillows, quilts and other soft enclosure in children around.

4, after the end of the attack, gently placed the patient in a good recovery position to improve breathing. Without population breathing, especially the mouth to mouth resuscitation, because will vomit into the lungs, causing suffocation.

5, rescuers should wait until the patient fully recovered and then leave. Do not eat or drink anything before the patient is fully recovered.

6, do not take any measures to wake up patients. Unless the attack lasted more than 5 minutes or more when the need for immediate delivery.

Epileptic seizures should be how to observe

1, the attack was clearly not clear. There is no loss of consciousness, call him when there is no response. If the patient is not able to speak, he says, "he can hear, but he cannot speak," which is not a loss of consciousness. During the attack, with people in the cave and pinch needles have no reaction, is not a loss of consciousness.

2 when the twitch, especially the beginning of the twitch of the site, to distinguish between the side or bilateral limbs; the face there is no convulsions, if the face twitch. The form of attack, is not suddenly nodded, bent, arms is raised or drooping, legs twitching hands twitching, landing items without landing, eyes open or closed, the eye to which direction to look: twitch duration is probably a few seconds or a few minutes.

3 the number of attacks, about 1 days a few times. If the course of disease is long, a few months a few times, 1 years, several times.

4 episodes have special action, there is no "automatism" performance; after the onset of the performance, is immediately clear, still have a vague sense of performance, there is no fatigue, headache, lethargy, seizures after a short time without limbs weak or not moving situation.

Life notes for patients with epilepsy

We should avoid fatigue, to ensure adequate sleep, adults at least 7~9 hours of sleep every day to ensure that children at least 8~16 hours. In moderate exercise, such as walking, jogging, badminton, tennis, table tennis, swimming, diving, mountaineering can not participate in other sports, but also try not to ride a bike, to prevent the attack of falls, or traffic accident; watching TV, playing video games is prohibited.

 

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