Patient's question:
Hello, doctor, may I ask what tests are required to confirm epilepsy? Thank you---Doctor's answer:
Epilepsy is a disease and syndrome characterized by intermittent dysfunction of the central nervous system caused by repeated, sudden, excessive discharge of brain neurons. It is a condition originating in the brain, with recurrent degrees of impairment in motor, sensory, autonomic nervous system, and mental and spiritual states. This definition summarizes the complexity of epilepsy symptoms and more broadly outlines its two fundamental characteristics: recurrence and repetition.The term "recurrence" refers to the certainty of a second, third, or multiple recurrences after the first episode, with a certain interval between them. Even the most common seizures, if they occur only once, do not exhibit recurrence and cannot be diagnosed as epilepsy.
The term "repetition" refers to the sudden onset and abrupt termination of symptoms. We may have witnessed patients suddenly collapsing and seizing while walking or eating, only to return to normal after a period. Some children with abdominal epilepsy may experience severe abdominal pain, incessant crying, or collapse during play, which completely disappears within minutes or tens of minutes before they resume playing. Regardless of how complex epilepsy symptoms may be, they must possess these two characteristics, which are also important criteria for diagnosis.
Guidance: The incidence of epilepsy in children is relatively high, and it has a significant impact on health. Due to the physiological characteristics of newborns, combined with changes in the nervous and humoral systems, the clinical features of pediatric epilepsy differ in some aspects from those of adults.
(1) Gender, onset age, and recurrence types: Generally, males are more affected than females, with the highest incidence in infants. The age of onset is closely related to the type of recurrence. For example, infantile spasms almost always occur before the age of one, motor recurrences typically begin before the age of six, absence recurrences most commonly occur between the ages of one and eight, and other types of epilepsy often have an onset age under ten. Neonatal epilepsy is often hidden and tends to be focal, while older children exhibit more obvious seizures that are generalized.
(2) Recurrence manifestations: The incidence rates of different epilepsy recurrence types vary with age, and their clinical manifestations are closely related to the maturation of the central nervous system. In addition to the common grand seizures that can occur at any age in children, neonatal epilepsy typically presents with stereotyped repetitive movements and often accompanied by abnormal eye movements.
Lifestyle care:
I. Clinical manifestations: Epilepsy is classified based on clinical recurrence types:
1. Generalized tonic-clonic seizures (grand seizures): Sudden loss of consciousness, followed by tonic and then clonic convulsions. Often accompanied by screaming, cyanosis, incontinence, tongue bite, frothing at the mouth, or blood foam, with dilated pupils. The convulsions last for tens of seconds or minutes before subsiding naturally, followed by a state of drowsiness. Upon waking, there may be short-term dizziness, irritability, fatigue, and amnesia of the episode. If the seizures persist continuously, leading to a state of coma, it is referred to as a status epilepticus, which is often life-threatening.
2. Absence seizures (petit seizures): Sudden interruption of mental activity, loss of consciousness, accompanied by myoclonus or automatisms. Each episode lasts from a few seconds to over ten seconds. An EEG may show 3 Hz spike-and-wave or sharp-and-slow wave complexes.
3. Simple partial seizures: Tonic or clonic seizures in a localized part or one limb, or sensory abnormality, lasting briefly with clear consciousness. If the seizure spreads from the motor area to other limbs or the whole body, accompanied by loss of consciousness, it is called Jacksonian seizure (J). After the seizure, the affected limb may experience temporary paralysis, known as Todd's paralysis.
4. Complex partial seizures (psychomotor seizures): Psychosensory, psychomotor, or mixed seizures. These often involve varying degrees of consciousness impairment and significant disturbances in thought, perception, emotion, and psychomotor activity. Automatisms such as psychomotor wandering or sleepwalking may occur. In some cases, under the influence of hallucinations or delusions, violent behaviors such as harming others or oneself may occur.
5. Autonomic seizures (mesial): May include headache-type, abdominal pain-type, limb pain-type, syncope-type, or cardiovascular-type seizures. Epilepsy with no clear cause is primary epilepsy, while epilepsy secondary to intracranial tumors, trauma, infection, parasitic diseases, cerebrovascular diseases, or systemic metabolic disorders is referred to as secondary epilepsy.
II. Auxiliary examinations for epilepsy:
1. EEG, BEAM, Holter (Electroencephalography, Brain Electric Activity Mapping, Ambulatory EEG Monitoring): Clear pathological waves, spikes, sharp waves, spike-and-wave, or sharp-and-slow waves can be observed.
2. If secondary epilepsy is suspected, further examinations such as cranial CT, MRI, MRA, or DSA may reveal corresponding lesions.
3. Epilepsy and biochemistry: Epilepsy has a close relationship with various chemical substances in the human body. Neurobichemistry plays an important role in elucidating the pathogenesis of epilepsy at the molecular level.