Differential diagnosis and drug treatment of epilepsy

Epilepsy is a chronic brain disease caused by a variety of causes.
The excessive discharge of brain neurons leads to repetitive, paroxysmal and transient central nervous system dysfunction
.

Differential diagnosis

Differential diagnosis

1.
False seizures

Also known as hysteria-like seizures, it is a non-epileptic seizure disease, abnormal brain function caused by mental disorders rather than brain electrical disorders
.

There may be seizure-like symptoms such as movement, sensation, and confusion, which are difficult to distinguish

2.
Convulsive syncope

It is caused by diffuse brain ischemia and hypoxia
.

It is often differentiated from loss of consciousness, falls, and the appearance of rigid or spastic seizures of the limbs

3.
Hypertensive encephalopathy

Different degrees of consciousness disturbance, severe headache, nausea and vomiting, and convulsions are the three main brain symptoms of hypertensive encephalopathy.
The gradual disappearance of symptoms with the decrease of blood pressure is an important basis for distinguishing from epileptic seizures
.

4.
Febrile seizures

Febrile convulsions are closely related to epilepsy.
There is a high chance of epileptic seizures after complex febrile convulsions.
Although all manifested as convulsions, febrile convulsions are not epilepsy.
Febrile convulsions are the characteristics of epilepsy
.

5.
Hyperventilation syndrome

Hyperventilation syndrome is mainly caused by psychological factors and induced by inappropriate excessive breathing.
Many of these patients have chronic anxiety disorders
.

The paroxysmal symptoms, transient loss of consciousness, and limb twitching caused by hyperventilation syndrome need to be distinguished from automatism, absence seizures, and generalized seizures of epilepsy, respectively

6.
Transient ischemic attack (TIA)

TIA is more common in the elderly.
It often has a history of arteriosclerosis, coronary heart disease, hypertension, diabetes, etc.
, and the duration ranges from several minutes to several hours.
Epilepsy can be seen at any age, mostly in adolescents.
The aforementioned risk factors are not prominent , The onset time is mostly a few minutes, rarely more than 5 minutes
.

On the surface, the twitching of the limbs of TIA patients is similar to epilepsy, but most patients have no family history of epilepsy, the twitching of the limbs is irregular, and there is no head and neck rotation

medical treatement

medical treatement

The goal of treatment should be complete control of epileptic seizures, with no or only minor adverse drug reactions, and as little as possible affecting the patient's quality of life
.

For a first-diagnosed epilepsy patient, clinicians often spend a lot of time and energy to ask about the medical history, try to let the patient or witness describe the symptoms of the seizure, and do everything possible to obtain the video recording and EEG data of the seizure.

Table 1 Choose drugs according to the type of attack

Table 1 Selection of drugs according to the type of seizure Table 1 Selection of drugs according to the type of seizure

Table 2 Epilepsy Syndrome Drug Selection

Table 2 Selection of drugs for epilepsy syndrome Table 2 Selection of drugs for epilepsy syndrome

General principles of drug therapy

General principles of drug therapy

1.
Determine whether to use medication: The probability of one or several epilepsy in a person's life is as high as 5%, and 39% of patients with epilepsy have a tendency to spontaneous remission, so not every patient with epilepsy needs medication
.

Generally speaking, if the seizure occurs more than 2 times within half a year, once the diagnosis is clear, drugs should be used

2.
The correct choice of drugs: according to the type of epileptic seizures and epilepsy syndrome types to choose medication
.

70%~80% of newly diagnosed epilepsy patients can control their seizures by taking an anti-epileptic drug, so the initial choice of drugs for treatment is very important, which can increase the possibility of successful treatment; if the drug is selected incorrectly, the treatment will not only be ineffective, but also Causes seizures to worsen

3.
How to decide the dose of the drug: Start with a small dose and gradually increase it to achieve the skills to effectively control the attack, and until there are obvious adverse reactions
.

If this goal cannot be achieved, it is better to meet partial control than adverse reactions

4.
Single or combined medication: Single-drug treatment is the basic principle that should be followed.
If the treatment is ineffective, another single-drug can be used, but there should be a transition period of 5-10 days during the dressing change
.
Reasonable multi-drug therapy can be considered for the following situations: ①There are multiple types of seizures, such as ophthalmic myoclonic seizures with absence seizures, epilepsy syndromes with multiple types of seizures, etc.
; ②For the special conditions of patients, such as Patients with menstrual epilepsy can be added with acetazolamide before and after menstruation to improve the clinical efficacy; (3) Combination medication may be considered for some patients who do not respond to monotherapy; (4) Epilepsy that requires combination medication has been proven by clinical practice
.

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