One Monday afternoon, Zhuo Yiming admitted a patient to the outpatient clinic. That day, it happened to be Liu Yulan on duty, and this patient naturally fell into the hands of Liu Yulan.

This is a young man with "seizures", who has been treated in the outpatient clinic for a period of time, various examinations have been done, and a lot of drugs have been used, but the seizures cannot be well controlled.

Zhuo Yiming's meaning was that he wanted to be admitted to the ward and adjust the medicine under the observation of the doctor.

Since the last time she dealt with patients with "status epilepticus", Liu Yulan once told Lin Lin that she was very afraid of receiving patients with epilepsy, and always felt that the treatment of epilepsy was very complicated and difficult to control.

Liu Yulan was afraid of epilepsy, but this epilepsy patient fell into her hands.

After asking for her medical history, doing a physical examination of her nervous system, she returned to the doctor's office with all the information given to her by the patient.

She repeatedly looked at the medication in the outpatient clinic and didn't know how to start. After thinking about it for a while, she simply did not change the current treatment plan, and wrote the outpatient plan on the doctor's order as it was.

Her idea is very simple, since the patient is hospitalized, she will adjust the medication while observing. It's really not good, take it out and discuss it in the whole department.

Liu Yulan's heart has neither confidence nor confidence.

For the next three days, the patient had daily seizures, all of which were tonic-clonic seizures.

This seizure is characterized by stiff convulsions of the limbs, loss of consciousness, upturned eyes, voice in the larynx, foaming at the mouth, and purple face. The whole process made people who don't know how to medicine feel very frightened and worried.

The patients who live in the same room as the patients are of course terrified and worried when they see such seizures every day.

On Thursday, Liu Yulan saw that no other doctor had brought up the patient she was in charge of for discussion, and she took the initiative to make this patient with epilepsy a case to be discussed as a difficult case in the general practice tomorrow.

The next morning, the discussion of difficult cases began on time, and Liu Yulan introduced the patient who gave her a headache.

"The patient is a male, 31 years old, teacher. Because of episodic limb twitching, he was unconscious for 3 years and was admitted to the hospital at home for 2 months. ”

"Three years ago, the patient, without any trigger, suddenly had convulsions of his limbs, became unconscious, foamed at the mouth, and had a cyanotic attack on his face."

"After the seizure, I had an electroencephalogram and head CT examination in Yingzhou People's Hospital. There was no abnormality on the CT examination of the head, and the ordinary electroencephalogram showed mild abnormality, and after the addition of 'sphenoid electrode', it showed moderate abnormality, and the sharp wave and sharp and slow composite waves emitted could be seen. ”

"In our outpatient clinic, carbamazepine, phenytoin, phenobarbital and valproate were used successively, and the symptoms were not well controlled. There are multiple episodes per year. ”

"In the last 2 months, the patient's seizures have become more frequent, almost every day, and the nature is the same as before."

"At present, all the anti-epileptic drugs in our hospital pharmacy have been used on patients without any effect."

"After admission, the patient's blood routine and liver function tests were normal, and other biochemical tests showed no abnormalities. Because the treatment effect is very poor, I would like to ask the teachers to give valuable medical advice. ”

Liu Yulan's report is very detailed, telling the patient's current predicament and her predicament.

"I'll say a few words." A voice that no one expected sounded, and Jian Sandian spoke for the first time since he entered the neurology department to participate in difficult cases.

"I think there is no doubt about the diagnosis of seizures in this patient. However, epilepsy is just a set of symptoms that manifest when the brain is stimulated. Behind this set of symptoms, there must be a reason for it to happen. ”

"For this patient, the treatment effect is not good, and the seizures are difficult to control, indicating that the brain lesions are relatively obvious. Therefore, I recommend that in the absence of better medication, further tests, such as CT scans, be done to see what is going on in the brain, hoping to find out the lesions that caused the seizures. ”

"This patient's EEG also supports my point of view. Ordinary EEG showed only mild abnormalities, but after the addition of 'sphenoid electrodes', obvious epileptic waves were found. This indicates that there should be a definite lesion in the brain. ”

It seems that Jane Triassic has some research on neuroelectrophysiology. For this patient, he also put a certain amount of effort, including consulting books, checking patients, etc.

Among the doctors here, except for Ma Shuiyuan, the others are no strangers to epilepsy. It can be said that little is known about the disease of epilepsy.

"I, as the doctor in charge, would like to share my opinion."

"First of all, this patient's seizures have been going on for more than three years now, and the control has been unsatisfactory, and I think it can be classified as refractory epilepsy."

"Also, I don't agree that this patient had a clear, CT-visible lesion in the brain. For more than three years, if there is really a lesion like this, the patient's symptoms should not be limited to seizures alone. ”

"I remember Dr. Lim successfully treating a patient with intractable status epilepticus in the past, and I learned a lot from it. Specific to this patient, will it lead to a local acid-base imbalance in the brain due to repeated attacks? ”

"Because, the acid-base balance of the whole body is still maintained at a very good level. If there is, it can only be considered locally in the brain. If this problem exists, it can go some way to explaining why this patient's seizures are so difficult to control. ”

"What puzzles me the most is, if that's the case, what can we do about it? In this regard, I would like to ask the director and Dr. Lin for advice. Liu Yulan's original intention was to consult Lin Lin, but she was afraid of offending Ling Xiaoyun and involved her.

"I think the speeches of Dr. Jian and Dr. Liu are very reasonable." Li Yun'e's opening remarks made people speechless.

Liu Yulan negated Jian Sandie's point of view, but Li Yun'e thought that both of them were reasonable, obviously making peace with the mud, and neither side should be offended.

"Dr. Li, Dr. Liu's remarks just now have denied Dr. Jian's view. Now that you think they all have a point, what exactly do you want to say? ”

Now that he has torn his face, with Ling Xiaoyun's character, he will definitely not show mercy to Li Yun'e's subordinates.

"What I mean is very clear, Dr. Jane's point of view may be right, and Dr. Liu's point of view may also be right. In this patient, both conditions can occur at the same time. "Li Yun'e is desperate to support Jian Sandie.