Recently, Li Wentao, a doctor of the First Affiliated Hospital of Xi ‘an Jiaotong University, treated an old man who fell on the street and convulsed while on vacation in Paris. Out of professional instinct, he initially judged that it was a seizure. At that time, the ambulance had not arrived yet, and the patient was in an emergency. In view of the limited rescue conditions, he first asked the old man to lie on his side to avoid respiratory obstruction, and at the same time pressed people and asked passers-by to help him press the tiger’s mouth. After a few minutes, the old man’s consciousness gradually recovered, and after observation, his heart rate and breathing also returned to normal. Seeing that the old man turned the corner, Li Wentao left by car.
Epilepsy is listed as one of the five most intractable diseases of nervous system by the World Health Organization. According to the latest epidemiological data, there are about 50 million epileptic patients in the world, and there are about 10 million epileptic patients in China, of which at least 6-8 million are children, and children under 15 account for about 40%— 50%。 This year is the 13th International Epilepsy Care Day. The theme of this year is "Epilepsy and Public Health". When we suddenly meet an epileptic on the road, do you feel scared, afraid, avoid it, and stay away? Or lend a helping hand and come forward to rescue? Pinch people, break their mouths, and press their bodies … … Are these popular first aid measures for epilepsy correct? Do you need to call 120 for help in any case? Guan Yuguang, deputy director of the Center for Function and Epilepsy of Sanbo Brain Hospital of Capital Medical University, gave us a professional answer.
Epilepsy patients have irregular seizures.
Epilepsy, commonly known as "epilepsy", convulsions and foaming at the mouth during the attack, is very critical. In fact, epilepsy is a kind of brain disease, which is a common chronic nervous system disease second only to stroke (commonly known as "stroke"). It is characterized by repeated, paroxysmal and paroxysmal central nervous system dysfunction caused by excessive discharge of brain neurons, and it occurs in people of any age, region and race. Epileptic symptoms include not only sudden fainting, general convulsion and foaming at the mouth, but also paroxysmal absence, shouting, auditory hallucination, phantom sniffing, epigastric discomfort, dizziness and so on. The symptoms are varied and varied.
Epilepsy is a sudden, repeated and short-lived partial or whole brain dysfunction caused by excessive excitation and discharge of brain neurons caused by various causes. Therefore, epileptic seizures are generally irregular and will occur at any time and any place. For epileptic patients who have a sudden seizure in public, the first thing to do is not to have any discrimination and prejudice. Most epileptic patients are unconscious when they attack and can’t control their actions and behaviors. What we have to do is to go to the rescue urgently, to keep patients away from danger and to protect patients’ safety.
With standardized and reasonable treatment of epilepsy, about 70% patients’ condition can be controlled. However, due to the lack of correct understanding of epilepsy, most epilepsy patients have not been treated reasonably and effectively.
How to deal with epilepsy patients when they have an attack?
Cardiopulmonary resuscitation for cardiac emergency is something that everyone can master through training, because heart disease is indeed a common disease, and cardiac arrest needs immediate first aid, otherwise the best rescue time will be missed. For epilepsy, most patients with epilepsy have stable life indexes such as breathing and heartbeat, so don’t take it for granted to operate indiscriminately. It is best to keep the patients away from the dangerous state and protect their safety.
In the general cognition of the public, it is wrong to pinch people, break their mouths, press the body and other first-aid measures for epilepsy. Stimulating acupoints such as Hehegu with fingers is easy to pinch the skin, which can leave scars in severe cases; Forcibly stuffing towels and other items into the patient’s mouth is a wrong practice that should be prohibited, because the seizure of epileptic patients is very powerful, forcibly breaking the patient’s mouth and stuffing things into it may lead to fractures of the mandible, dislocation of joints, and easy aspiration into the trachea, which may lead to suffocation; Forcibly pressing the patient’s twitching limb, if the pressure is not properly controlled, may cause the patient’s soft tissue injury, joint dislocation, fracture and other secondary injuries, such as thigh and femur fracture.
Improper handling of first aid measures will not only hurt patients, but also hurt rescuers. There is no way to stop the seizure immediately, and about 90% of the seizures can be relieved naturally within 3 minutes. Therefore, two principles should be observed in the field treatment of epileptic seizures: first, ensure the airway is open and prevent injuries. The correct way is to put the patient in a safe place, away from roads, ponds and other dangerous places, let the patient lie flat, remove the surrounding dangerous goods, loosen the collar, turn his head to one side (in order to let the secretions from the patient’s mouth flow out) to prevent the secretions from blocking the respiratory tract, and take oxygen in time if possible. Second, after the patient wakes up from the attack, don’t feed or take medicine. What the patient needs at this time is rest. In the following cases, you need to get emergency help: the attack time is more than 3 minutes; There are several episodes a day and the interval is very short; Difficulty in breathing or risk of suffocation; Trauma caused during seizures; If there is an attack in the water or during pregnancy, you need to call 120 and send it to the hospital for emergency treatment in time.
Children and adolescents are high-risk groups of epilepsy.
Epilepsy is common in childhood, which is a chronic disease caused by sudden abnormal discharge of brain neurons, which can be captured by EEG.
Yang Guang, deputy director of pediatric internal medicine administration of PLA General Hospital, said that people are most familiar with the genetic factors. In fact, the causes of epilepsy are very complicated. Epilepsy is the result of the interaction between internal genetic factors and external environmental factors, and the proportion of each child to these two factors is different.
The International Anti-Epilepsy League classifies epilepsy into six categories: hereditary, structural, metabolic, immune, infectious and unexplained. According to experts, the heritability of epilepsy can be reduced through prevention. First of all, patients with epilepsy should avoid marrying people with the same family history of epilepsy. Secondly, if the child suffers from epilepsy and parents want a second child, prenatal diagnosis can be made in the early pregnancy, and the child with hereditary epilepsy can be found early to choose to terminate the pregnancy.
It is not that epilepsy will inevitably lead to mental retardation. After reasonable treatment, most children can go to school normally as long as they control epilepsy and have normal intellectual development, and only a small number of children will have some intellectual cognitive backwardness. For any disease, early detection and early treatment are beneficial to the recovery, and epilepsy is the same. Early detection and early intervention can avoid more damage to the brain.
In short, long-term and standardized use of antiepileptic drugs is still the first choice for the treatment of epilepsy in children. Through standardized treatment, most children can return to normal study and life, and parents should have enough confidence in this. However, antiepileptic drugs do have the risk of side effects. Therefore, parents should rationally use drugs and closely monitor the side effects under the guidance of doctors, so as to ensure the efficacy of antiepileptic drugs and the safety of children to the greatest extent.
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Matters needing attention in daily life of children with epilepsy
First of all, we should avoid factors that can trigger children’s seizures, including emotional tension, lack of sleep, overwork, colds and fever. Second, in terms of diet, we advocate a balanced diet and avoid irritating foods such as alcohol and caffeine. Strong tea, coffee, cola and spicy foods should be avoided as much as possible. The so-called "hair" such as beef and mutton, seafood, etc., can be eaten. Third, in daily activities, if children’s seizures have not been well controlled, it is necessary to strengthen supervision and avoid excessive physical activities; If the child’s condition is stable, don’t interfere with his exercise excessively, but extreme sports such as diving and bungee jumping are still not suitable for participation. Fourth, there is no taboo to watch TV every day, but we do not advocate watching scary and exciting content and avoid playing video games for a long time.
3— Vaccination can be given without an attack for 6 months.
Immunization is an important way to prevent childhood diseases, but many vaccine instructions prompt "contraindications for children with epilepsy". According to the Expert Consensus on Vaccination for Children with Special Health Status published by China Journal of Practical Pediatrics in 2019, it is clear that whether children with epilepsy take antiepileptic drugs or not, as long as the seizure control is stable, it is generally 3-mdash; If you don’t have an attack for 6 months, you can vaccinate as planned. If the child has an attack within 6 months, it is necessary to suspend vaccination.
Experts suggest that children should be vaccinated in time after controlling the attack. Even if the attack is triggered after vaccination, it has no obvious effect on the overall prognosis of the child. It should be noted that you should not vaccinate two vaccines at the same time, pay attention to the physical and mental condition of your child, and suspend vaccination if you feel unwell.
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