What to do if your child has abnormal brain waves

When I took my child to check his brain waves, the doctor said that there were abnormalities in his brain waves. In this case, we first need to eliminate the interference factors of the child. If the child is emotionally unstable and frequently scratches his head, it will also affect the frequency of brain waves. In addition to worrying about whether the child has epilepsy, epileptic patients will have abnormal brain waves to a large extent, but it is not a 100% phenomenon, so continued observation and other examinations are needed. This article introduces the relevant knowledge about epilepsy. Let’s learn about it together.

Epilepsy, commonly known as "epilepsy" or "epilepsy", is a chronic disease in which brain neurons suddenly discharge abnormally, leading to temporary brain dysfunction. According to the latest epidemiological data in China, the overall prevalence of epilepsy in the country is 7.0‰, the annual incidence is 28.8/100,000, and the prevalence of active epilepsy with attacks within one year is 4.6‰. Based on this estimate, there are approximately 9 million epilepsy patients in China, of which 5 to 6 million are active epilepsy patients. At the same time, there are approximately 400,000 new epilepsy patients each year. In China, epilepsy has become the second most common disease in neurology after headache.

Classification of epileptic seizures

The epileptic seizure classification scheme currently in widespread use is the one proposed by the International League Against Epilepsy in 1981. Epileptic seizures are classified into partial/focal seizures, generalized seizures, and unclassifiable seizures. In 2010, the International League Against Epilepsy proposed the latest classification scheme for epileptic seizures, which reclassified and supplemented epileptic seizures. Although the new program summarizes the progress of epilepsy research in recent years, it is more comprehensive and complete.

Partial/focal seizures: refers to seizures in which the initial symptoms and EEG changes indicate that "neurons in a certain part of the cerebral hemisphere are activated first." Includes simple partial seizures, complex partial seizures, and secondary generalized seizures.

Generalized seizure: refers to a seizure in which the initial symptoms and EEG changes indicate that "both cerebral hemispheres are affected simultaneously." Includes absence, myoclonic, tonic, clonic, tonic-clonic, and atonic seizures.

Unclassifiable seizures: seizures that cannot be classified due to insufficient or incomplete data or that cannot be classified in the current classification criteria (such as convulsive seizures).

New types of seizures confirmed in recent years include absence myoclonus, negative myoclonus, eyelid myoclonus, and gelastic seizures.

Classification of epilepsy syndromes

Depending on the cause of epilepsy, it can be divided into idiopathic epilepsy syndrome, symptomatic epilepsy syndrome and possible symptomatic epilepsy syndrome. The new scheme proposed by the International League Against Epilepsy in 2001 also defined or standardized some key terms, including reflex epilepsy syndrome, benign epilepsy syndrome, and epileptic encephalopathy.

Idiopathic epilepsy syndrome: A syndrome in which, apart from epilepsy, there is no structural brain damage or other neurological symptoms and signs. The disease usually starts before puberty and has a good prognosis.

Symptomatic epilepsy syndrome: central nervous system lesions or abnormalities caused by various reasons, including abnormal brain structure or various factors affecting brain function. With the advancement of medicine and the continuous development and enrichment of examination methods, more and more epilepsy cases can find the causes.

Possible symptomatic epilepsy syndrome or cryptogenic epilepsy: It is considered to be a symptomatic epilepsy syndrome, but the cause is currently unknown.

Reflex epilepsy syndrome: refers to epilepsy in which almost all seizures are triggered by specific senses or complex cognitive activities, such as reading epilepsy, startle epilepsy, visual reflex epilepsy, hot bath epilepsy, card epilepsy, etc. If the triggering factors are removed, the attacks will disappear.

Benign epilepsy syndrome: refers to an epilepsy syndrome that is easy to treat or can be completely relieved without treatment and leaves no sequelae.

Epileptic encephalopathy: refers to the progressive brain dysfunction caused by the epileptic abnormality itself. The main or entire cause is due to epileptic seizures or frequent epileptic discharges during the intervals between seizures. Most of the cases occur in newborns, infants and children. The EEG was obviously abnormal and the drug treatment was ineffective. Including West syndrome, LGS, LKS, Ohtawara syndrome, Dravet syndrome, etc.

Disease treatment

Current treatments for epilepsy include medication, surgery, and neuromodulation therapy.

Drug treatment

At present, the treatment of epilepsy at home and abroad mainly relies on drug therapy. After regular anti-epileptic drug treatment, the seizures of about 70% of epilepsy patients can be controlled, and 50% to 60% of them can be cured after 2 to 5 years of treatment. Patients can work and live like normal people. Therefore, reasonable and regular anti-epileptic drug treatment is the key.

1. Indications for the use of anti-epileptic drugs: Once the diagnosis of epilepsy is established, anti-epileptic drugs should be used promptly to control seizures. However, it may be considered for patients with first attack, attack with precipitating factors or rare attacks.

2. General principles for selecting anti-epileptic drugs: Correct classification of epileptic seizures and epilepsy syndromes is the basis for rational drug selection. In addition, factors such as the patient's age (children, adults, the elderly), gender, concomitant diseases, and the potential side effects of antiepileptic drugs that may affect the patient's future quality of life should also be considered. If infants and young children cannot swallow tablets, the use of syrup preparations is both easier for the children to take and convenient for controlling the dosage. When choosing medications for children, they should try to choose medications that have no effect on cognitive function, memory, and attention. The elderly have more comorbidities, take more concomitant medications, and have more drug interactions. They are also more sensitive to anti-epileptic drugs and the side effects are more prominent. Therefore, when elderly patients with epilepsy choose anti-epileptic drugs, they must consider drug side effects and drug interactions. Female epilepsy patients of childbearing age should pay attention to the effects of anti-epileptic drugs on hormones, sexual desire, female characteristics, pregnancy, fertility and teratogenicity. Although traditional anti-epileptic drugs (such as phenytoin sodium and phenobarbital) have certain clinical efficacy, they have many side effects such as gingival hyperplasia, increased hair growth, high teratogenicity, hyperactivity, and inattention, which are difficult for patients to tolerate. New anti-epileptic drugs (such as lamotrigine, levetiracetam, topiramate, oxcarbazepine, etc.) not only have definite clinical efficacy, but also have few side effects and are easily tolerated by patients.

3. Anti-epileptic drug treatment should be used as a single drug as much as possible until the effective or maximum tolerated dose is reached. When monotherapy fails, combination therapy can be used. Try to use drugs with different mechanisms of action and little or no drug interactions. The ultimate goal of rational drug combination should be to achieve the best clinical effect and the lightest economic burden on patients.

4. During antiepileptic drug treatment, routine monitoring of antiepileptic drug blood concentrations is not recommended. Blood drug concentration monitoring should only be considered when it is suspected that the patient has not taken the medication as directed or has drug toxicity, is taking other drugs that affect drug metabolism, or has special clinical conditions (such as status epilepticus, liver and kidney disease, pregnancy).

5. Anti-epileptic treatment requires continuous medication and should not be stopped easily. It is currently believed that only when there has been no epileptic seizure for at least 3 years can we consider gradually stopping the medication. During the medication discontinuation process, only one drug can be stopped at a time, and it will take about a year to gradually stop using the drug.

Drug treatment of epilepsy is a long-term practical process. Doctors, patients and their families must have sufficient patience and love. Patients should have regular follow-up visits. Doctors should provide individualized treatment based on the specific circumstances of each patient, supplemented by scientific life guidance. Only when both parties fully cooperate can satisfactory results be achieved.

It should be noted that some patients and their families have some misunderstandings about epilepsy treatment, such as seeking medical treatment at random, believing in rumors, fearing that Western anti-epileptic drugs "will irritate the brain" and will make them "stupid" if taken for a long time, and dare not take effective anti-epileptic drugs. However, people blindly seek medical treatment, look for "secret recipes handed down from ancestors" or "pure Chinese medicine" everywhere, and believe in all kinds of advertisements that claim "cure" or "radical cure". This not only wastes a lot of time and money, but also makes epilepsy still not under effective control. It also delays the best and most effective time for treatment, and artificially turns patients into those with refractory epilepsy.