Epilepsy is a type of epilepsy characterized by syncope. and convulsions throughout the body which will last for a few minutes and then regain consciousness Symptoms usually occur from time to time. People with this condition should see a doctor for a diagnosis. If the treatment continues properly The patient will be able to lead a normal life. but if the lack of treatment Allowing to cause frequent seizures It may be dangerous from accidents during symptoms such as falling from a height, drowning, car crashes, etc.
*Thai name : epilepsy
* English name : Epilepsy, Grand mal
* cause :
Most of them occur with no apparent cause. believe there is Depletion of certain chemicals that control electrical currents in the brain. (While the structure of the brain is normal) causes the function of the brain to lose balance. There is an abnormal electrical discharge of brain cells. provoke seizures and momentarily lost consciousness These patients tend to have their first symptoms between the ages of 5-20 and may have a history of having a parent or sibling with the condition.
A minority may be caused by abnormalities in brain structures (eg congenital cerebral palsy, cerebral palsy). The brain was affected during childbirth. Cerebral palsy after infection Brain scar after surgery Brain abscess Brain tumor parasitic disease in the brain cerebral hemorrhage) hypoglycemia Hypocalcemia, alcoholism, drug abuse (eg amphetamine overdose), poisoning from overdose of certain drugs, etc. The first seizure is most common in children under the age of 2, and in older people. more than 25 years
* symptom :
The patient was suddenly unconscious. The wind suddenly collapsed to the ground. Along with symptoms of muscle spasms all over the body, difficulty breathing, green face, which lasts for a few seconds to 20 seconds. And there are symptoms of squint, jaundice at the beginning, often convulsions and then gradually decreases, respectively, until the spasm stops. During this period, there may be saliva, foaming in the mouth, and possibly bleeding from biting the lips. or the tongue itself There may also be symptoms of urination or faeces.
The seizure lasts for about 1-3 minutes (some may take 5-15 minutes) and then wakes up with a feeling of numbness, fatigue, and some may fall asleep for hours.
Patients often do not remember falling down.
After falling asleep and waking up, you may experience headaches, dizziness, confusion, weakness, yawning, forgetfulness, and possibly doing something you don’t remember later.
Some may have warning symptoms or aura (aura) brought before the loss of consciousness, such as numbness or twitching of one arm or leg, or they may see flashes, smell, taste, or hear loud noises. or feeling unreasonable fear etc. Patients may have seizures during the day or after going to bed at night Some of them occur without triggering reasons. Sometimes the causes that provoke seizures are found, such as sleep deprivation, hunger, overeating, overwork, overthinking, drinking, taking sedatives, constipation, menstruation, high fever, being in noisy or brightly lit places. baking play computer games rapid breathing, etc.
* Disease isolation :
Syncope and spasms may have other causes, such as:
Infectious diseases of the brain (eg encephalitis, meningitis), the patient will have high fever, headache, vomiting, lethargy, later become unconscious and convulsive.
♦ Febrile seizures occur in children aged 6 months to 5 years. Children develop a fever and convulsive seizures lasting 2-3 minutes (up to 5-15 minutes) and then regain consciousness. Patients with unconsciousness and convulsions, irrespective of any cause should immediately see a doctor to detect the cause and provide treatment according to the cause
* Diagnosis :
Your doctor will usually send you some special tests for a definitive diagnosis, such as electroencephalogram (EEG), lumbar puncture, magnetic resonance imaging (MRI), or computed tomography.
* Self care :
1. When the patient is found to be unconscious and convulsive Should provide first aid before sending the patient to the hospital as follows:
(1.) prevent danger or injury by having the patient lie in an open and safe area There were no obstructions or clutter at my side. (If there are belongings around the area The patient should move away) Be careful of falling from a height. and keep away from water and fire
(2.) Loosen clothing, belts, clothing.
(3.) Place the patient in a sideways position. to keep the airway open (by pushing the patient’s body not pulling the patient’s arm May cause the shoulder to dislocate). Have the patient support a pillow or blanket.
(4.) If there are food scraps, phlegm or dentures, remove them from the mouth. If the patient wears glasses, they should be removed.
(5.) Do not use objects (such as sticks, spoon handles, pens, pencils) inserted into the patient’s mouth to prevent biting the tongue. because in addition to not being as useful as they should It can also injure the mouth and teeth.
(6.) Do not bind or bind the patient. may cause injury to the patient
(7.) Do not leave the patient alone. until healed
(8.) Do not let the patient eat anything during a seizure. or after a new seizure may cause the patient to choke
2. When diagnosed as having epilepsy Patients should know how to take care of themselves as follows:
(1.) The use of drugs should be carried out as follows:
♦ Take an anticonvulsant every day. according to the size recommended by the doctor Keep a journal of your medication intake and doctor’s appointments to avoid forgetting.
♦ Do not stop the medication or adjust the dosage. or buy pills for yourself
♦ If you forget to take only one meal or a day Start eating at the next meal as usual.
♦ Avoid using other drugs with anticonvulsants. without consulting a doctor or pharmacist Because some drugs may oppose the effect of anticonvulsants. can exacerbate seizures Some may enhance the effect of anticonvulsants. can cause poisoning
♦ Side effects caused by anticonvulsants should be noted, such as drowsiness, nausea, vomiting, staggered gait, rash, blistering skin, swollen gums, jaundice, fever, etc. If found, inform your doctor. to consider the appropriate adjustments In some cases, the doctor may require periodic blood tests to assess side effects on the liver, kidneys, red blood cells, white blood cells.
♦ Some anticonvulsants may oppose the effect of oral contraceptives. making some contraceptives ineffective The type can result in fetal malformations or miscarriage. Patients taking oral contraceptives or planning to become pregnant should consult their doctor. In order to continue proper care, such as in the case of taking sodium valproate. or carbamazepine The doctor will prescribe the patient to take 1 mg of folic acid tablets per day. since before pregnant and during pregnancy to reduce the risk of developing neural tube defects
♦ If you are pregnant or have other illnesses should inform the treating physician. And bring the medicine that you are taking to the doctor as well.
♦ In the case of changing treatment sites You should also bring your history and medications you are taking to your doctor.
(2.) Once the disease has been properly treated and the disease is controlled, the patient can work, study, play sports or go out of society normally. including being able to marry
(3.) Guidelines for the patient To be safe and to avoid convulsive triggers Patients should get enough sleep, do not sleep deprivation, do not work too tired. Don’t overthink it. Avoid trauma. Don’t starve. Be careful not to get constipated. Do not drink alcohol or take sedatives. Do not go into noisy or bright lights, flashing lights, as these can trigger seizures. Also avoid dangerous actions and environments such as swimming, climbing, being near lights. Near water, working with machinery, driving a car, driving a boat, walking alone across the road, etc. if swimming is necessary. There should be someone else with you at all times.
In some countries, patients are allowed to have a driver’s license. After at least 1 year free of seizures
(4.) Patients should disclose to their friends at work or at school about the disease that is so that when a seizure does not panic and find a way to help to be safe. Parents, relatives and friends should have a knowledge and understanding of the nature of the disease and how to help the sick. should not show disgust should encourage the patient and to participate in everyday activities like everyone else
* Treatment :
Your doctor will treat you as follows:
1. When epilepsy is diagnosed with an underlying cause (eg brain tumor, intracranial hemorrhage), causal correction (eg surgery) may be given and may be necessary. The patient also took anticonvulsants.
2. In the case of epilepsy of the type that does not detect the cause If you have only had one seizure, it is often recommended to the patient behaves avoiding triggers and continue to monitor for symptoms without drug treatment because of the patient This group may not have seizures forever. (The chance of recurrence is found about 30-60%), which is not worth the side effects of the drug.
Anticonvulsants may be considered for patients with a second relapse, starting with a basic antiepileptic (i.e. phenobarbital, phenobarbital). and phenytoin) which will choose only one type first, which will gradually adjust the dose gradually until the symptoms can be controlled. If that doesn’t work, they’ll switch to another basic drug. if still not working You may need to switch to an advanced anticonvulsant medication such as sodium valproate, carbamazepine. carbama-zepine, topiramate, etc. Most patients can control the symptoms. relapsed with only one drug There are few cases that may require a combination of 2 or more drugs. Once the medication is adjusted until the disease is controlled, the patient will have to take the drug in that size continuously. For several years until seizure-free, 2-3 years (children) and 5 years (adults) begin to stop the drug, with a gradual decrease. Do not stop the drug abruptly. Persistent epilepsy can be dangerous.
when reducing or stopping the drug recurrent seizures (found in about 25% in children and 40-50% in adults) will return to the original dose. In those who had good control of their symptoms, but later had seizures despite not reducing the medication. Your doctor may also need to increase the dose or adjust the new medication. until the symptoms are controlled
3. In cases where the drug is ineffective or unable to tolerate side effects May need to consult a medical professional to perform a more complicated diagnosis and may require treatment with brain surgery or use a brain stimulator
* Complications :
Loss of consciousness, collapse and convulsions can cause injuries to the patient, such as body wounds. Wounds from biting one’s tongue, broken bones, head injuries etc. is important May cause an accident while driving. work on machines while playing or swimming Climb or be in high places near the stove hot water or hot This can lead to serious and even fatal injury, possibly causing the aspiration of food particles into the lungs. Pneumonia can occur in people with frequent seizures. May cause obstacles to daily activities studying and work in cases of persistent epilepsy If the correct and timely treatment is not received. It may die or be disabled. This condition has a mortality rate of up to 100 percent. 10-20 Some people with severe epilepsy may experience sudden death in epilepsy while having an exacerbation. Even symptoms that occur while in a safe place (such as in bed) are thought to be due to cardiac arrhythmias, pulmonary edema, and asphyxia. Suffocation during seizures usually occurs in people whose seizures are not well controlled and who lack medication. The mood and cognitive impairments seen in some epilepsy patients It’s usually not a direct result of epilepsy. but caused by causes or brain abnormalities that are common with epilepsy
* Disease progression :
If treated properly and continuously for the period recommended by the doctor Most patients are able to control their symptoms well and lead normal lives.
Patients may need medication for at least 2-3 years (children) or 5 years (adults). Some people may need to take medication to control their symptoms for the rest of their lives, while those who have taken medications that are effective but lack medication ( If the drug is stopped abruptly, seizures lasting 20-30 minutes or repeated seizures may occur several times in succession, known as status epilepticus, which is a serious condition.
* Protection :
Most of this disease occurs for unknown reasons. When a seizure has occurred You should find a way to prevent symptoms from recurring. by taking anticonvulsants in the dosage recommended by the doctor and the patient must avoid the cause that provokes the exacerbation.
* Prevalence :
This disease is found in approximately 0.5-1% of the general population. It can be found in people of all ages. But it usually occurs for the first time between the ages of 5-20 years.