traumatic epilepsy
Introduction
Introduction to traumatic epilepsy Traumatic epilepsy refers to epileptic seizures secondary to craniocerebral injury, more common in young adult males, with a family history of epilepsy more likely to occur, can occur at any time after the injury, it is difficult to predict, early in the immediate after injury Appearance, the late can be suddenly attacked after the head injury has been cured for many years, however, not all patients with brain trauma are complicated by epilepsy, according to the time of the first seizure can be divided into early, middle and late epilepsy. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in young adult males Mode of infection: non-infectious Complications: personality disorder, mental retardation
Cause
Causes of traumatic epilepsy
Exogenous craniocerebral injury (50%):
Traumatic seizures are more common in young adult males. Those with a family history of epilepsy are more likely to occur. They can occur at any time after the injury. The early ones appear immediately after the injury, and the late ones can suddenly start after many years after the head injury has healed. However, not all patients with traumatic brain injury have epilepsy, which can be divided into early, middle and late epilepsy according to the time of the first seizure.
Early traumatic epilepsy: epilepsy occurring within 24 hours after injury, common causes are brain contusion, intracranial hematoma, depressed fractures, ischemia of local brain tissue, edema, biochemical changes, etc.
Mid-term epilepsy: epilepsy occurring within 24h to 1 month after injury, common causes are brain contusion, intracranial hematoma, cerebral edema, cerebral ischemia and softening, intracranial infection, foreign body, etc.;
Late epilepsy: epilepsy occurring after 1 month of injury, common causes are degenerative brain lesions, meningeal scars, brain penetrating malformations, intracranial foreign bodies, fracture signs, and advanced brain abscesses.
Pathogenesis:
Early epilepsy (immediate or recent episodes) accounts for about 30%, which may be related to brain parenchymal injury, intracranial hemorrhage, sag fracture or local brain ischemia, edema and biochemical changes, of which 30% occur within 1 hour after injury. Especially in children, often for partial seizures, some people think that early epilepsy, often predicts the possibility of causing advanced habitual epilepsy, mid-term epilepsy (delayed or late episodes) accounted for about 13%, mostly due to brain tissue contusion, Intracranial hemorrhage, cerebral edema swelling and softening and other pathological changes, especially in the cerebral cortex front-top central region of the injury is particularly prone to epilepsy, and second, the temporal lobe lesions, including hippocampus, amygdala and other epilepsy prone areas, A small chemical change in the nerve cells caused by the injury, a metabolic disorder and an electrophysiological change leading to seizures.
The above-mentioned early and mid-stage epilepsy mainly originates from acute brain parenchymal injury, intracranial hematoma, especially acute subdural hematoma, or from the secondary tissue reaction and wound healing process after brain injury. Such pathophysiological changes can be in certain During the period, it gradually relieves and recovers, so it does not necessarily lead to recurrent epilepsy, and it is often a partial seizure. If it responds well to drug treatment or can relieve itself, there is no need for surgery, and an appropriate amount of anti-epileptic drugs should be given to prevent it. Or control episodes, late epilepsy (long-term or habitual seizures) accounted for about 84%, often recurrent or habitual seizures, the incidence of such epilepsy is difficult to predict, the symptoms of amnesia after traumatic brain extension and early Patients with convulsions are more likely to develop advanced epilepsy.
Jennett (1975) pointed out that patients with acute intracranial hematoma accounted for 31% of patients with advanced epilepsy, 25% of patients with early convulsions after craniocerebral trauma, and 15% of those with sag fractures. Open head injury, especially firearm injuries, due to hard Cerebral rupture, brain parenchyma and foreign body retention are more likely to cause epilepsy. More than half of the late epilepsy occurs within 1 year after injury. About one-fifth of the patients have seizures in 4 years after injury. The latter often More stubborn, most of the types of late-stage traumatic epilepsy are localized seizures, accounting for about 40%, and temporal lobe epilepsy accounts for about 25%. The causes are often associated with meningeal cerebral scars, intracerebral cysts, brain penetrating malformations, brain abscesses and intracranial Hematoma, foreign body, and fracture piece are related. Because these lesions are compressed, pulling and stimulating adjacent normal or partially damaged brain tissue, it causes epileptic discharge of nerve cells and causes seizures.
Prevention
Traumatic epilepsy prevention
1. Open craniocerebral injury should strive for early and complete removal, remove hematoma, inactivated brain tissue, foreign bodies, debris, concave bone fragments to be removed or removed, suture the ruptured dura mater, preventive application of antibiotics Prevention of intracranial infections.
2. Closed craniocerebral injury has surgical indications, early surgery to reduce cerebral ischemia and hypoxia and the opportunity for brain degeneration, surgery should be careful, to minimize damage to surrounding brain tissue.
3. Prophylactic administration, phenytoin 0.1g, 3 times / d or combined with phenobarbital can be used alone.
Complication
Traumatic epilepsy complications Complications, personality disorder, mental retardation
1. Late epilepsy often has a tendency to increase, from local seizures to systemic seizures, and severe memory loss, personality disorder, mental retardation and other manifestations.
2. May be complicated by penetrating brain injury, subdural hematoma and intracerebral hematoma, brain contusion, skull fracture and other diseases.
Symptom
Traumatic epilepsy symptoms Common symptoms Green vision eating-like autonomic memory impairment Epilepsy personality changes Cochlear myoclonic epilepsy autonomic seizures
Seizure form
Except for small episodes and bilateral severe myoclonus, any type of epilepsy can occur, and the frontal meningeal epilepsy often causes a large episode without aura;
The lesion in the central region of the frontal top often causes contralateral limb movement or sensory localized seizures;
The temporal lobe lesions cause psychomotor seizures, and the occipital lobe lesions have more visual auras. Most patients have more fixed seizure types, and a few may have changes. Early and mid-term epilepsy is about 25% of patients in 2 years or slightly over time. Long period of self-remission and stop, but late epilepsy often has a tendency to increase, from local seizures to systemic seizures, severe memory loss, personality disorder, mental retardation and other performance.
2. Symptoms and signs of craniocerebral injury
Patients with early epilepsy have brain contusion and laceration, intracranial hematoma, skull fracture, and patients with advanced epilepsy have brain degeneration, scar formation, patients may have signs of focal nerve loss, and brain abscess also has its special clinical manifestations.
Examine
Examination of traumatic epilepsy
1. Skull X-ray film examination: suspected skull fracture should be positive, lateral position, occipital force injury plus the amount of occipital position (Tang's position), concave fracture, tangential position, suspected optic nerve injury The optic nerve hole was taken, and the orbital fracture was taken by Korot's slice.
2. Lumbar puncture: understand the degree of subarachnoid hemorrhage and intracranial pressure, severe intracranial hypertension or severe cerebral palsy signs are contraindicated.
3. CT scan: It is an important basis for assisting diagnosis of craniocerebral injury. It can show skull fracture, brain contusion, intracranial hematoma, subarachnoid hemorrhage, ventricular hemorrhage, gas skull, brain edema or brain swelling, cerebral pool And the ventricle is subjected to pressure displacement and deformation, and the midline structure is shifted. When the condition changes, CT examination should be performed.
4.MRI: Patients with acute craniocerebral injury usually do not have MRI, but have stable axonal injury, cerebral hemisphere bottom, brain stem, focal contusion and small hemorrhage, and other subacute subacute intracranial Hematoma, etc., MRI is often better than CT scan.
5. EEG: Epileptic waves originating from the cerebral cortex are often high-amplitude spikes, spikes, sharp slow waves or spine slow waves, and the phases are generally negative; if the lesion is deep, the waveform is mostly sharp or The combination of sharp and slow waves, low amplitude, sometimes negative, sometimes positive, localization of epileptic foci, in addition to waveform, amplitude and phase, should also pay attention to the synchronization of epileptic waves, more than two synchronized epileptic waves, sometimes From the same lesion, there is a paroxysmal slow wave with bilateral synchronization, which is generally considered to be a central system episode, or an old epilepsy.
Diagnosis
Diagnosis and diagnosis of traumatic epilepsy
The patient has no history of epileptic seizures, but seizures occur after the injury. For patients with localized seizures of brain tissue lesions and epileptic foci, and no history of epilepsy before injury, it is not difficult to diagnose, except for clinical manifestations and characteristics. , still need to rely on EEG examination, EEG examination, can find slow waves, spikes, spine slow waves and other localized abnormalities, CT examination can show abnormal changes in the brain, thus confirming the location of epileptic foci, In addition to waveforms, amplitudes and phases, attention should be paid to the synchrony of epileptic waves. Two or more synchronized epileptic waves, sometimes from the same lesion, present a bilaterally synchronized paroxysmal slow wave, which is generally considered to be a central system. Attack, or old epilepsy. In addition, brain CT or MRI scans can also help to understand the location and nature of the lesion.
Traumatic epilepsy has a history of head trauma, whether it is closed or open craniocerebral injury, different types of seizures appearing at different stages after injury, especially localized seizures in which the brain tissue injury site coincides with epileptogenic focus. Patients with no history of epilepsy before injury are not difficult to diagnose, so there is no need to distinguish them from primary epilepsy.
