Summary Of Experience In Treating Refractory Epilepsy With The Method Of Extinguishing Wind And Removing Phlegm

Obj ective:To analyze the clinical manifestations of 31 patients with IE and the changes of seizure-related indicators after treatment.And to summarize professorZhu’s clinical experience in treating IE.Method:Clinical case analysis:(1)To develop research programs based on the research contents;(2)To collect IE patients’ medical records from Dec.1,2016 to Dec.31,2018 in Professor Zhu’s outpatient clinic according to the standards of research programs;(3)To extract patient’s medical records information,preserve and preliminary collation;(4)Statistical analysis of case data;(5)To evaluate Professor Zhu’s clinical use of extinguishing wind and resolving phlegm;(6)To summarize professorZhu’s clinical experience in treating IE from the aspects of etiology,pathogenesis,treatment ideas and methods.Result:Clinical case analysis:(1)General information:Among 31 patients with IE,there are 16 male patients(51.61%)and 15 female patients(48.39%).And there are 16 patients aged 18-33 years,12 patients aged 34-49 years,3 patients aged 50-62 years old.The average age is34.35±9.79 years old.(2)Prevalence:For the onset ages among 31 patients with IE,20 patients with an onset age of 11 to 22 years old and the remaining grouping segments are less than 5 patients.The average onset age was 16.42±7.97 years old.For the duration of disease,9 patients have had the disease 3-11 years,10 patients have had 12-19 years,5 patients have had 20-27 years,7 patients have had 28-35 years,with an average duration of 17.90±9.86 years.In terms of the average duration of epileptic seizures,14 patients less than 1 minute,7 patients 1-2 minutes,5 patients 2-3 minutes,the remaining grouping segments are less than 2 patients,with an average duration of 2.29±1.88 minutes.In terms of clinical sympto-ms,there are 31 cases with convulsions,30 cases with binocular vision,28 cases with closed teeth,28 cases with sudden coma,18 cases with foaming at mouth,12 cases with fecal incontinence,8 cases with grotesque calls in mouth,3 cases with trance,4 cases with precursors of onset and 2 cases with incentives for onset.17 cases are focal seizures,14 cases are general seizures,13 cases are clonic type(41.49%),7 cases are rigid type(22.58%),7 cases are rigid-clonic type(22.58%)and 4 cases are myoclonic type(12.90%).All patients had abnormal electroencephalogram(EEG),including 15 mild,13 moderate and 3 severe abnormalities.There are 10 cases of wind-phlegm syndrome,7 cases of phlegm-fire syndrome,6 cases of liver-depression syndrome,the other three syndromes are less than 4 cases but there are 9 cases with Yang deficiency syndrome.(3)The improvement of seizure frequency:The 31 patients with IE had epileptic seizures 4.10±2.21 times per month before treatment and 2.81±1.78 times per month after treatment.The total effective rate of improvement of seizure frequency was 58.06%.Specifically,3 cases(9.68%)were complete controlled,4 cases(12.90%)were moderately improved and11 cases(35.48)were slightly improved.(4)Changes of other indicators after treatment:For the items of severity of seizures,there are significant differences in fall,recovery time,injury,incontinence and total score after treatment,and there are no significant differences in convulsions,conscious precursors of seizures and automatism after treatment.There are no statistical differences in EEG scores after treatment and have statistical differences in all dimensions and total scores of quality of life scale after treatment.One patient had gastrointestinal reaction and another patient had subcutaneous hematoma after acupuncture.Their symptoms gradually improved after symptomatic treatment and all of the patients had no other adverse reactions.(5)Analysis of Chinese Medicine Used:It was included 9 kinds of phlegm-relieving cough and asthma drugs,9 kinds of tonic drugs,8 kinds of Liver-Calming drugs,8 kinds of blood-activating and Stasis-Resolving drugs,6 kinds of tranquilizing drugs and 6 kinds of heat-clearing drugs and all of other drugs are less than or equal 3 kinds.Scorpion,liquorice,gastrodia,Acorus tatarinowii,Poria cocos,Poly gala,Dannanxing,Salvia miltiorrhiza,Pinellia ternata,centipede,tangerine peel,Fritillaria thunbergii,Ophiopogon japonicus and Ziziphus jujube seeds were used more than 20 times.And the other drugs were used less than 17 times.The higher frequency added drugs for wind-phlegm obstruction syndrome were Daphnia rhamnoides,Bombyx bassiana and Uncaria.Bambusae caulis im taeniam was mostly added for phlegm-fire retention syndrome.And Bupleurum chinense,Curcuma,Paeonia lactiflora,silkworm and alum were mostly used for liver stagnation and fire dispersion syndrome.(6)Acupoint selection:There are 7 acupoints belong to Du meridian and Stomach meridian,5 acupoints belong to Ren meridians and the remaining meridians were less than 4 acupoints had been selected;Fenglong,Baihui,Dazhui,Fengchi,tendons contraction,dovetail,Zusanli,Taichong,Yanglingquan,Yintang,Quchi,Sanyinjiao and Zhongwan were used more than 28 times,while the other acupoints were used less than 22 times;Wind-phlegm obstruction syndrome was mainly added Guanyuan,Fengfu,Qihai,Zhaohai,and Waiguan.Phlegm-fire retention syndrome was mainly added Shenmen,Tianshu,Hegu,Zhaohai;Liver stagnation and fire dispersion syndrome was mainly added Qimen,Danzhong,Xingjian,Shenmen,Sishencong and Hegu.Conclusion:1.IE patients have no sex difference,the onset age is concentrated in 11-22 years old.The main clinical symptoms are convulsion,binocular vision,closed teeth;sudden coma and foaming at mouth.A few patients have onset incentives and precursors,accompanied by abnormal electroencephalogram.Wind-phlegm syndrome,phlegm-fire syndrome,phlegm-fire disturbance syndrome and liver-depression-fire syndrome were the main kinds of TCM syndromes.Some patients also have Yang Deficiency syndrome.Follow-up studies may consider setting up Yang deficiency syndrome separately.2.The method of extinguishing wind and resolving phlegm has certain effect in treating IE.It can reduce the frequency of epilepsy seizures,reduce the severity of epilepsy seizures,improve the quality of life of IE patients,and have fewer adverse reactions.3.Professor Zhu believes that the pathogenesis of IE is mainly in the wind,phlegm,fire,blood stasis,depression and deficiency,etc,especially in the wind and phlegm.Clinically,it is advocated to use traditional Chinese medicine syndrome differentiation method for diagnosis.The main treatment method is to eliminate wind and phlegm,and to use the combination of acupuncture and medicine with main prescription to treat the main disease.