Epilepsy self-management knowledge questions and answers

Can epilepsy be cured?

About 2/3 of epilepsy patients can be well controlled through drug treatment, and another 1/3 of patients can also be effectively treated with epilepsy surgery (including neuromodulation), ketogenic diet, etc.; some pediatric patients have age-related/self-limited epilepsy syndromes, and the cure rate is higher. Most epilepsy patients are no different from normal people when they are not having an attack, and can work and live normally.

Is epilepsy hereditary?

Most epilepsy is not inherited. A small number of epilepsy cases have clear pathogenic genes, and the probability of inheritance is higher, but it is not certain to be inherited. It is recommended to conduct genetic counseling based on the clear cause of the disease.

How to provide home first aid?

① Stay calm. Most attacks will resolve on their own within 1 to 2 minutes.

② Assist the patient to lie down, and put something soft under the head to protect it to avoid injury during convulsions. Untie the tight collar and trouser belt, and tilt the head to one side to allow secretions to flow out naturally to keep the airway open.
③ Remove dangerous objects (glasses, metal headwear and other sharp objects, etc.), stay away from dangerous environments (electrical appliances, oil pans, heights, waterside, fire sources, etc.), and protect patients from accidental injuries.
④ Take a video of the seizure process as much as possible, remove the blanket and other covering items when shooting, and shoot the whole body, the sequence of convulsions, and close-up of the face. Video footage of the seizure can help doctors diagnose and formulate treatment plans.
⑤ If the convulsions do not stop for more than 5 minutes, or if there are multiple convulsions in succession, or if there are injuries, you should call 120 immediately or seek medical attention in time.

Which practices are wrong?

① Pinching the Ren Zhong point: It will not shorten the duration of convulsions. Using too much force may cause skin trauma, which is not worth the loss.
② Feeding water: It will not shorten the duration of convulsions and can easily lead to choking and even pneumonia.
③ Oral/drenching medication: When taking medication orally orally during an attack, the medication may not be absorbed and the convulsion may have stopped. This may cause aspiration and lead to pneumonia.
④ Pressing the convulsion site: It cannot shorten the duration of convulsion. Using too much force when fighting against the convulsing patient may cause trauma or even fracture.
⑤ Insert a tongue depressor or spoon: When the teeth are tightly closed during an attack, forcibly prying the mouth open to place a tongue depressor can easily cause the teeth to loosen or fall out; if it is in the early stage of an attack, when the patient has a premonition of an attack and the mouth can open and close freely, a dental pad can be placed to protect the mouth and tongue. Do not put fingers or towels in the mouth to avoid suffocation.

What are the principles of safe medication for epilepsy?

Anti-epileptic drugs should be used according to the doctor's advice. The principle is to take medication for a long time and in a standardized manner. Do not stop, reduce or change medications at will due to excessive concerns about side effects. If you encounter possible adverse reactions, consult a doctor in a timely manner and adjust the medication plan according to the doctor's advice.

Is vaccination possible?

The incidence of adverse reactions to vaccination in patients with epilepsy is comparable to that in the general population. Vaccination may cause fever, which will lower the threshold for epileptic seizures and even induce seizures. Body temperature should be closely monitored 48 hours after vaccination. If fever occurs, routine use of antipyretics (such as acetaminophen) can reduce the risk of epileptic seizures.

It is recommended to postpone vaccination in the following situations and wait until the situation returns to normal before vaccination: temporary frequent attacks; ongoing infection or fever; acute attack of immune diseases. People who are allergic to vaccine ingredients or allergic to the first dose of vaccine should stop vaccination. The above suggestions also apply to the new coronavirus vaccine. It is particularly important to remind that after vaccination, you still need to wear a mask and maintain social distance to prevent new coronavirus infection.

What are the precautions before and after the operation?

Patients with epilepsy can undergo surgery, but they need to provide the doctor with their epilepsy history and diagnosis and treatment, and be prepared for epileptic seizures. Try to avoid factors that may induce epileptic seizures, such as tension, insomnia, anxiety, and anti-epileptic drug withdrawal caused by fasting and water. Sedatives can be taken temporarily before surgery to reduce insomnia and anxiety.

To prevent perioperative epileptic seizures, anti-epileptic drugs should be taken normally before surgery. On the day of surgery, the perioperative fasting time should be shortened as much as possible. If oral medication is not possible, injectable anti-epileptic drugs should be selected after surgery. Once you can eat, resume oral anti-epileptic drugs as soon as possible.

Can I find a job?

Most patients can work and live normally. The working environment should be relatively safe and quiet, and try to avoid noisy environments, high altitudes, driving motor vehicles, electronic games, etc.; avoid contact with water, fire, electricity, dangerous goods, and work that significantly reduces sleep time.

Can we get married?

Under the premise of abiding by the law, epileptic patients can get married. They should choose an appropriate time before marriage to tell their spouse about their condition so that they can understand and help them in the future. Couples are encouraged to strengthen caring exchanges.

Can I get pregnant?

Women with epilepsy during childbearing age are encouraged to plan pregnancy to avoid unwanted pregnancies. Before preparing for pregnancy, consult an epilepsy specialist and obstetrician to understand pregnancy complications and the possible teratogenic risks of anti-epileptic drugs, and develop an individualized medication plan. With the guidance of a doctor, most women can have normal pregnancy and childbirth after their seizures are well controlled.

For patients whose seizures have been completely controlled for 2 to 5 years, they can try to reduce or withdraw medication before becoming pregnant. For patients whose epilepsy has been under control for less than 2 years or who have failed to reduce or withdraw medication, it is necessary to evaluate the treatment plan before pregnancy and switch to medication with a lower teratogenicity rate. For patients with frequent seizures and poor control, the anti-epileptic drug treatment plan should be actively adjusted to achieve ideal control before becoming pregnant.

Female patients should supplement at least 0.4 mg of folic acid per day before and during pregnancy. Patients who use enzyme inducers (such as carbamazepine) can increase the folic acid dose appropriately, and it is recommended to reach 1 mg. Pay attention to supplementing foods high in folic acid (green leafy vegetables, breakfast cereals and brown rice, etc.) on a regular basis.

Is it possible to give birth naturally?

Natural childbirth may be a trigger for epileptic seizures. The risk of epileptic seizures during caesarean section is low, but obstetricians and gynecologists believe that natural childbirth is more beneficial to mother and baby. Therefore, before giving birth, inform the obstetrician of the history of epilepsy and decide the method of delivery based on your own condition and the doctor's advice.

Can I breastfeed? What are the precautions?

Given the advantages of breastfeeding, breastfeeding is generally recommended for patients with epilepsy. However, most anti-epileptic seizure drugs can penetrate into breast milk, and the amount of drug intake by the infant is related to the maternal serum drug concentration. During breastfeeding, pay attention to the infant's condition. If the infant is sedated for a long time, is not interested in feeding, and does not gain weight, breastfeeding should be stopped. If breastfeeding causes lack of sleep, which in turn induces frequent seizures, it is recommended to stop breastfeeding.

Patients who increase the dose of anti-epileptic drugs during pregnancy can gradually reduce the dose according to the doctor's advice after delivery, and should not quickly reduce or stop anti-epileptic drugs on their own. Frequent postpartum seizures may be related to lack of sleep or poor medication compliance. Blood drug concentrations should be tested regularly and the dosage should be adjusted according to the seizure situation and blood drug concentration.

What are the dietary precautions?

Epilepsy patients should avoid alcohol, coffee, strong tea, and less cola and carbonated drinks. They should have a balanced diet, avoid being too full or too hungry, too thirsty, or drinking too much water. If a certain type of food is repeatedly associated with inducing epileptic seizures, it should be avoided.

What are the precautions when taking the medicine?

Try not to use penicillins (such as amoxicillin) and quinolones (such as ciprofloxacin, levofloxacin, etc.). For cold medicines containing caffeine, pay attention to the drug ingredients and instructions before taking them, and avoid using drugs that may induce epileptic seizures.

Can I drive a motor vehicle?

Compared with the general population, people with epilepsy have a significantly increased risk of traffic accidents when driving. We should raise awareness, strengthen management and education, and prevent problems before they happen. You must never conceal your history of epilepsy when applying for a motor vehicle driver's license. If you have not had a seizure for 10 years, including 5 years after stopping taking anti-epileptic drugs, it can be considered that epilepsy does not exist.

What are the precautions for exercising and traveling?

Due to the suddenness of epileptic seizures and the possibility of loss of consciousness, someone should accompany you during physical exercise and travel, do not miss medication, and avoid overexertion. It is recommended to put documents with medical conditions and medication information in your pocket to facilitate others to provide necessary assistance.

What are the comorbidities of epilepsy?

Comorbidity refers to two or more diseases that are not causally related. Common comorbidities of epilepsy include migraine, tics, autism, attention deficit hyperactivity disorder, affective disorders, etc. If comorbidity occurs, it will seriously affect the quality of life of epilepsy patients. Identifying preventable risk factors and conducting standardized treatment can significantly improve the prognosis.