Epilepsy Pathology

Epilepsy Pathology Introduction

Learn about the causes, symptoms, diagnosis, and treatment of epilepsy

What is Epilepsy?

Epilepsy is a common neurological disorder characterized by recurrent seizures. Seizures are brief episodes of abnormal brain activity, resulting in changes in consciousness, movement, sensation, behavior, or autonomic function.

Epilepsy can affect people of any age, from infants to the elderly. According to the World Health Organization, approximately 50 million people worldwide have epilepsy, making it one of the most common neurological disorders.

Epilepsy is not a single disease but a group of syndromes with varying causes and clinical manifestations. Diagnosis requires a combination of medical history, electroencephalography (EEG), and imaging studies.

Causes of Epilepsy

The causes of epilepsy are complex and diverse, including:

  • Genetic factors: Certain types of epilepsy are associated with genetic mutations, and individuals with a family history of epilepsy have a higher risk.
  • Structural or metabolic abnormalities: Such as brain tumors, cerebrovascular disease, traumatic brain injury, encephalitis, meningitis, brain developmental abnormalities, hypoglycemia, hypocalcemia, etc.
  • Infectious diseases: Such as viral encephalitis, tuberculous meningitis, brain abscess, etc.
  • Immune disorders: Such as autoimmune encephalitis, multiple sclerosis, etc.
  • Unknown causes: Approximately 30-40% of epilepsy cases have no identifiable cause, known as idiopathic or cryptogenic epilepsy.

Symptoms of Epilepsy

The symptoms of seizures depend on the location and spread of abnormal electrical activity in the brain, and can be classified into the following types:

1. Generalized Seizures

  • Tonic-clonic seizures: Commonly known as grand mal seizures, characterized by loss of consciousness, tonic followed by clonic muscle contractions, foaming at the mouth, tongue biting, and urinary incontinence.
  • Absence seizures: More common in children, characterized by sudden brief loss of consciousness, cessation of ongoing activities, and staring, lasting for a few seconds before recovery.
  • Tonic seizures: Characterized by sustained muscle contraction, fixing the limbs in a rigid posture.
  • Clonic seizures: Characterized by rhythmic clonic muscle contractions throughout the body.
  • Myoclonic seizures: Characterized by sudden, brief, electric shock-like muscle contractions.

2. Focal Seizures

  • Simple focal seizures: Occur with preserved consciousness, manifesting as localized muscle twitching, sensory disturbances, autonomic symptoms, or psychic symptoms.
  • Complex focal seizures: Occur with impaired consciousness, often accompanied by automatisms such as lip smacking, chewing,摸索, or wandering.
  • Focal seizures evolving to bilateral convulsive seizures: Focal seizures that progress to generalized seizures.

Diagnosis of Epilepsy

Diagnosis of epilepsy requires consideration of the following factors:

  • Medical history: Detailed inquiry about seizure manifestations, frequency, triggers, past medical history, and family history.
  • Electroencephalography (EEG): The most important auxiliary examination for epilepsy, which can detect epileptiform discharges.
  • Imaging studies: Such as cranial CT, MRI, which can detect structural abnormalities in the brain.
  • Laboratory tests: Such as blood routine, blood glucose, electrolytes, liver and kidney function, cerebrospinal fluid examination, etc., to rule out other causes.
  • Neuropsychological assessment: Evaluation of cognitive function, emotional state, etc.

Treatment of Epilepsy

The goal of epilepsy treatment is to control seizures and improve quality of life. Treatment methods include:

1. Medication

The first-line treatment for epilepsy, approximately 70% of patients can control seizures with medication. Commonly used antiepileptic drugs include:

  • Traditional antiepileptic drugs: Phenytoin sodium, carbamazepine, sodium valproate, phenobarbital, etc.
  • New antiepileptic drugs: Oxcarbazepine, lamotrigine, topiramate, levetiracetam, etc.

Medication should follow the principle of individualization, starting with a small dose and gradually increasing, mainly monotherapy, and combined medication if necessary.

2. Surgical Treatment

For patients with drug-refractory epilepsy, surgical treatment can be considered. Surgical methods include:

  • Epilepsy focus resection
  • Lobectomy
  • Callosotomy
  • Vagus nerve stimulation
  • Deep brain stimulation

3. Other Treatment Methods

  • Ketogenic diet: A high-fat, low-carbohydrate, moderate-protein diet, mainly used for children with refractory epilepsy.
  • Neuromodulation therapy: Such as transcranial magnetic stimulation, transcranial direct current stimulation, etc.
  • Psychological therapy: Helping patients overcome anxiety, depression, and other psychological problems.

Life Management for Epilepsy Patients

Epilepsy patients need to pay attention to the following points in daily life:

  • Take medications regularly, do not arbitrarily increase, decrease, or stop medications.
  • Avoid bad habits such as drinking alcohol, smoking, and staying up late.
  • Avoid dangerous work such as high-altitude operations, driving, and swimming.
  • Maintain a good mindset, avoid mental tension and excessive pressure.
  • Regularly review EEG, liver and kidney function, etc.
  • Carry an epilepsy emergency card with name, contact information, disease diagnosis, and commonly used medications.