Sudden fall to the ground, limb twitching, big mouth breathing, should not cry... Many people immediately think of epilepsy (commonly known as epilepsy) seizures, but in fact, these symptoms are not necessarily epilepsy.
According to Professor Zhou Limin, president of Guangdong Anti epilepsy Association and chief physician of the Department of Neurology of the First Affiliated Hospital of Sun Yat sen University, epilepsy is still commonly misdiagnosed, including two cases: one is that non epilepsy is misdiagnosed as epilepsy, the other is that epilepsy is misdiagnosed as other diseases, and one of them belongs to the category of missed diagnosis, that is, epilepsy has not been diagnosed, This situation is more common in elderly patients.
Beware of misdiagnosis, mistreatment and pseudo epilepsy
Since epilepsy is a chronic brain disease caused by a variety of causes, which is characterized by recurrent dysfunction of the central nervous system caused by excessive synchronized discharge of brain neurons, it is sometimes difficult to judge whether epilepsy is based on symptoms alone, which requires the combination of EEG and other auxiliary inspection means. Pseudoepilepsy is something that doctors and patients' families need to be vigilant in the process of diagnosis.
A 15-year-old female patient was accompanied by her mother to find Professor Zhou Limin. According to her mother, she had seen doctors in many hospitals before, but still had frequent "seizures". Through observation, Zhou Limin suspected that the "seizure" in the mouth of the patient's mother was not a real seizure, because according to clinical experience, if the patient had frequent seizures and took drugs for a long time, he would often have some symptoms such as slow reaction, poor speech expression, but the patient's intelligence and mental state were very good. Later, the patient had an EEG, and there was no abnormal discharge in the brain, so it was finally determined to be "pseudo epilepsy". Through understanding with the patient and his mother, Professor Zhou learned that the patient was afraid of losing his mother because of growing up in a single parent family, and had to pretend to attack in order to attract attention and get love. Professor Zhou said that there are many incentives for pseudo epilepsy, but the incentives for children are usually simple, sometimes just to get attention or to meet unreasonable requirements.
Professor Zhou Limin said that there are four main types of misdiagnosis and mistreatment of epilepsy in general: first, epilepsy, which is missed or misdiagnosed for other diseases; The second type is not epilepsy, which is misdiagnosed as epilepsy and treated as epilepsy; The third is curable epilepsy. Improper medication or overtreatment, and some even choose surgery or gamma knife treatment, which causes harm to patients; The fourth is that because the diagnosis and classification are unknown, drugs unsuitable for this kind of epilepsy are used. If the patient does not use the drug properly, it will have adverse consequences. Not only will the attacks not be reduced, but also will increase the number of attacks, and even will induce new attack types, resulting in aggravation of the disease.
If non epileptic patients are misdiagnosed as epilepsy and receive treatment wrongly, it will not only bring about adverse drug reactions, but also have a great negative impact on their psychology. Similarly, if epilepsy is misdiagnosed as other diseases or is not diagnosed, delaying treatment, it will also bring serious consequences. "Because epilepsy is not effectively controlled, each seizure will cause new lesions, affect brain development, and cause language, intelligence and other functional defects.". Professor Zhou took a 3-year-old patient he met more than a decade ago as an example. The patient had seen Professor Zhou for eight years before he saw him. Although his condition was effectively controlled later, the patient's mental development was finally abnormal due to improper drug use during the eight years and delayed the best treatment opportunity.
The patient should record the change of condition
Although it is said that the diagnosis of epilepsy can only be made by specialists after combining clinical data with EEG and other auxiliary examinations (cranial CT and/or MRI). However, this does not mean that symptoms are not important for the diagnosis, for example, the specific symptoms of the patient's seizure are crucial for the diagnosis of epilepsy. Professor Zhou Limin reminded that it is better to have witnesses accompanying the patients when they go to see the doctor. Or, it is better for the family to take a video when the patient has an attack, so as to avoid possible omissions or errors in the description, which is more helpful for the doctor to judge whether he or she really has epilepsy.
Since the treatment of epilepsy is a long-term and meticulous process, the treatment scheme can be interpreted in a myriad of ways in different patients, and every omission of details may lead to the recurrence and aggravation of epilepsy. Therefore, in addition to the profound professional level of doctors, the treatment of epilepsy also requires patients and their families to keep an eye on the changes in their condition. For patients who have been diagnosed with epilepsy, in order to get rid of the trouble of the disease as soon as possible, they or their families should form a "log" to record the changes in the condition, and report to the doctor in charge at the time of return visit. The doctor will make necessary adjustments to the treatment plan.
Professor Zhou said that there is no "cure" for epilepsy, and only the remission rate of seizures can be used to judge the recovery. Therefore, it is particularly important to observe the changes of the disease. After unremitting antiepileptic treatment, according to the degree of recovery, there may be four results. The first is remission after drug withdrawal. After reasonable drug treatment, patients usually stop taking drugs for 5 years or even 10 years without onset; The second is the remission under the control of drugs. The patient will not attack after taking drugs for more than a year or two, but further treatment is needed if he wants to transition to the degree of not taking drugs and not having attacks; The third is the reduction of seizures under drug control; The fourth is the frequent attack under the drug state, which requires surgery, vagus nerve stimulation and other treatments. The operation should preferably be performed in functional neurosurgery to ensure that the epileptogenic focus is removed as far as possible and the brain function is preserved completely.
Compliance is the key to overcome epilepsy
The treatment cycle of most epilepsy patients is long, the process is complex, and the seizure can not be completely controlled in a short time, so it is easy to lead to non-standard treatment of patients, and even lead to iatrogenic drug refractory epilepsy. Professor Zhou Limin analyzed and said that among these patients, doctors' improper drug selection, insufficient dosage, frequent drug change, premature drug reduction, drug withdrawal, and insufficient communication and guidance with patients were the main factors; In terms of patients, the main problem is poor compliance, that is, they can not cooperate with the doctor's treatment and do not take the medicine according to the doctor's advice, which often makes the treatment process more efficient and faster. From the latter point of view, seeking patients' compliance and cooperation is a key link in the treatment process.
The patient's poor compliance is manifested in the clinical treatment errors, which are as follows: First, the patient acts on his own: he does not follow the doctor's advice or ask the doctor's advice, returns to the doctor irregularly, and adjusts the antiepileptic drugs on his own initiative; Or because of short-term control of seizures, fear of side effects of drugs and self withdrawal, often lead to prolonged seizures; Second, eager for success, in order to "quickly" control the attack, "visiting famous doctors" or looking for "folk prescriptions" and "secret prescriptions" everywhere, while quacks turn to their own devices and cheat patients with the so-called "traditional Chinese medicine (actually mixed with western medicine with no fixed variety and dosage)" and "high-tech", which is harmful to people's wealth and has poor effect; Third, patients lose confidence in treatment, abandon themselves, do not recognize the curability of the attack, feel hopeless, and there are many people who give up treatment or treat casually.
Professor Zhou said that patients who make their own decisions tend to get twice the result in the treatment process. During the treatment process, patients should give full trust to the doctors and not change doctors at will. Because the treatment plan for epilepsy will be "different from person to person" in both medical practice and patients. Similarly, taking medicine according to the doctor's advice, not making decisions, increasing or decreasing the dosage at will or stopping the medicine are also very important for the therapeutic effect.
In addition to antiepileptic drugs, there are also surgery, neuromodulation therapy (such as vagal nerve stimulation) and ketogenic diet therapy for epilepsy. However, no matter which treatment method is adopted, whether doctors and patients can trust and cooperate with each other during the implementation process will also affect the effect of treatment.
Southern Daily reporter Li Jie intern Ding Zaitsun Correspondent Li Shaobin Peng Fuxiang
