Patient's question:
Hello, doctor, could you please confirm what tests are needed for epilepsy? Thank you---Doctor's answer:
Epilepsy is a disease and syndrome characterized by intermittent dysfunction of the central nervous system due to repeated, sudden, excessive discharge of brain neurons. It is a condition originating in the brain, with recurrent degrees of motor, sensory, autonomic, conscious, and mental disturbances. This definition summarizes the complexity of epilepsy symptoms and more broadly outlines its two fundamental features: recurrence and repetition.The term "recurrence" refers to the certainty of a second, third, or multiple recurrences after the first episode, even if the most common seizure occurs only once, it does not meet the criteria for 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, continuous crying, or sudden collapse during play, which disappears completely within minutes or tens of minutes before they resume playing. Regardless of how complex epilepsy symptoms may be, they must possess these two features, which are also important criteria for diagnosis.
Guidance: The incidence of epilepsy in children is relatively high, and it has a severe impact on health. Due to the physiological characteristics of newborns and changes in the nervous and humoral systems, the clinical features of pediatric epilepsy differ in some aspects from those of adults.
(1) Gender, age of onset, and recurrence types: Males are generally 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 are most common between the ages of one and eight, and other types of epilepsy usually have an onset before the age of 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 are closely related to the maturity of the central nervous system. In addition to the common grand seizures that can occur at any age in children, neonatal epilepsy typically presents as stereotyped repetitive movements, often accompanied by abnormal eye movements.
Lifestyle care:
I. Clinical manifestations: Epilepsy is classified based on recurrence types:
1. Generalized tonic-clonic seizures (grand seizures): Sudden loss of consciousness, followed by tonic and then clonic convulsions. Often accompanied by screaming, bluish complexion, incontinence, bitten tongue, foaming at the mouth, dilated pupils. The convulsions last for tens of seconds or minutes before stopping naturally, followed by a state of drowsiness. Upon waking, there may be temporary dizziness, irritability, fatigue, and amnesia of the episode. If the seizures persist without interruption, leading to a continuous state of unconsciousness, it is called a status epilepticus, which can be life-threatening.
2. Absence seizures (petit seizures): Sudden interruption of mental activity, loss of consciousness, which may be accompanied by myoclonus or automatisms. Each episode lasts from a few seconds to a dozen seconds. EEG shows 3 Hz spike-wave or sharp-slow complexes.
3. Simple partial seizures: Tonic-clonic or sensory abnormal seizures in a localized area or one limb, 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 (Jackson). Temporary paralysis of the affected limb after the seizure is called 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 thinking, perception, emotion, and psychomotor function. Automatisms such as psychomotor wandering or night wandering 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): Headache-type, abdominal pain-type, limb pain-type, syncope-type, or cardiovascular-type seizures. Epilepsy with no clear cause is called primary epilepsy, while epilepsy secondary to intracranial tumors, trauma, infection, parasitic diseases, cerebrovascular diseases, or systemic metabolic diseases is called secondary epilepsy.
II. Auxiliary examinations for epilepsy:
1. EEG, BEAM, Holter (brain, brain electric mapping, ambulatory EEG monitoring): Clear pathological waves, spikes, sharp waves, spike-slow waves, or sharp-slow waves can be observed.
2. If secondary epilepsy is suspected, further examinations such as cranial CT, MRI, MRA, and DSA should be performed to identify 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.