Simple focal seizure: the epileptic discharge is limited to a relatively limited area of ​​one cerebral hemisphere, the onset time is short (<1min), there is no disturbance of consciousness, and the seizure process can be fully recalled. The specific performance depends on site of epileptic discharge

Complex focal seizures (CPS)/psychomotor seizures/temporal lobe epilepsy: most common in adults; mostly originate from the temporal lobe; accompanied by impaired consciousness, unresponsive to external stimuli during the attack, and unable/partially unable to retell the details of the attack after the attack ;Includes three stages

Focal seizure followed by generalized seizure: with disturbance of consciousness

Generalized tonic-clonic seizure (GTCS): characterized by loss of consciousness and bilateral symmetrical convulsions

Absence seizure

Myoclonic seizure: sudden electric shock-like contraction of the whole body/part of the skeletal muscles, often manifested as sudden nodding, leaning forward, leaning back, and rapid raising of both arms; most likely to occur when waking up in the morning and just falling asleep; typical EEG manifests as spiny-slow waves

Tonic seizure: During the attack, there is strong tonic contraction of the whole body muscles accompanied by disturbance of consciousness (the child can be fixed in a certain posture), often accompanied by obvious autonomic symptoms (bruising of the face, apnea, dilated pupils); trunk Tonic seizures can cause opisthotonus; typical EEG manifestations are fulminant polyspike waves; a characteristic manifestation of Lennox-Gastaut syndrome

Clonic seizure: repetitive clonic twitching of muscles throughout the body accompanied by loss of consciousness, without a tonic period before; almost always occurs in infants and young children; EEG shows fast activity, slow waves and irregular spike-slow complex waves

Atonic seizure: a sudden temporary loss of muscle tone somewhere in the body/body, causing a change in posture, often manifested as head droop, shoulders/limbs suddenly drooping, hip and knee flexion, and falling; wake up and stand up immediately after the attack ; EEG shows polyspiny-slow complex or low-potential fast activity; more common in severe symptomatic epilepsy, suggesting diffuse brain damage and unclassified epileptic seizures

EEG: an important method; during the first EEG examination during the onset period, the detection rate of epileptiform discharges is <50%; however, various stimulation methods can be used to promote the occurrence of epileptic discharges

Neuroimaging: CT, MRI, SPECT/PET; applicable to: ① Any age, medical history or EEG suggesting focal seizures; ② Unclassified seizures within 1 year of age/adults/obvious generalized seizures; ③ Nervous/neurophysiological evidence of localized damage; ④ first-line anti-epileptic drugs cannot control seizures; ⑤ anti-epileptic drugs cannot control seizures/changes in seizure type and possible progressive disease

Pseudo-epileptic seizures/hysterical seizures/psychogenic seizures

Syncope: There are often obvious triggers; there are often symptoms such as nausea, dizziness, fatigue, tremor, and darkening of the eyes; the fall is slow, manifested by paleness, sweating, and may be accompanied by twitching and urinary incontinence; the loss of consciousness rarely exceeds 15 seconds. Rapid recovery and full consciousness without postictal confusion

Migraine: Especially when there is visual aura and occasional limb paresthesia, it should be distinguished from focal attack; the aura symptoms of migraine last for a long time, followed by a severe headache attack, accompanied by nausea and vomiting; often History of headache attacks and family history of migraines

TIA: more common in the elderly, often with related risk factors; irregular limb twitching, no head and neck rotation; duration 15 minutes to several hours; no obvious epileptic discharge in EEG

When to start taking medication: ① For those who have had two or more seizures within half a year, the medication will be used once the diagnosis is clear; ② For those who have had the first seizure/one seizure for more than six months, they can be informed of the possible side effects of anti-epileptic drugs and the possible consequences of not treating them. Next, according to the wishes of the patient and his family, he or she can choose to use or not use anti-epileptic drugs as appropriate.

① Newly diagnosed patients: ① The diagnosis must be confirmed and "diagnostic treatment" is not allowed; ② Drug selection is based on the type of epileptic seizure and type of epilepsy/epileptic syndrome; ③ First-line monotherapy is preferred, starting with a low dose and slowly increasing to a lower maintenance dose , evaluate the efficacy; if the seizure cannot be controlled, gradually titrate to a higher maintenance dose (monitor blood drug concentration if necessary); if the seizure is still not controlled, the diagnosis and classification of epilepsy should be reconsidered, and necessary examinations should be performed to rule out potential progressive lesions. , and at the same time determine medication compliance and refer to an epilepsy specialist

Patients with chronic epilepsy: re-judge the diagnosis, etiology, and classification of epilepsy, review previous treatment drugs, and re-formulate individualized treatment plans

A single drug should be used at the beginning of treatment; if necessary, combined drug treatment can be reasonably carried out

Principles for increasing or decreasing drugs, discontinuing drugs, and changing drugs

Closely observe adverse reactions: monitor blood and urine routine, liver and kidney function before and after medication; adverse reactions include specific, dose-related, chronic and teratogenic adverse reactions

The necessity of long-term use of drugs, possible adverse reactions and precautions should be explained to patients and their families

Traditional AEDs

New AEDs: topiramate (TPM), lamotrigine (LTG), gabapentin (GBP), etc.

Definition: Frequent epileptic seizures at least 4 times a month, regular treatment with appropriate AEDs and drug concentration within the effective range, observation for at least 2 years, still uncontrollable and affecting daily life, no progressive central nervous system disease or intracranial disease space occupying lesions

Features: There is a certain degree of resistance to AEDs with different mechanisms of action.

Indications: ① long-term formal monotherapy is ineffective; ② consecutive use of two AEDs to the maximum tolerated dose is ineffective; ③ a formal and combined treatment is still ineffective

Conditions for resection of epileptic lesions: ① The epileptogenic focus is clearly located; ② The resected lesions should be relatively limited; ③ There is no risk of serious functional impairment after surgery