"He is the main labor force in the family, and he usually has a lot of strength, and he can easily pick up a burden of one or two hundred catties. However, for about a few hours after the onset of the disease, he was unable to do heavy work at all. ”

"Since I saw his illness, I was very nervous, and I took him to our local hospital many times, saw many doctors, and did many tests, but none of the results were obtained, and his condition did not improve."

He is indispensable for the family's farm work, and he refuses to stop. I had to accompany him to the field so that I could take care of him. After a long time, I found a rule, when the weather is cool, there is basically no disease, and when the sun is fierce, almost every time. ”

The patient's wife described the situation very clearly and vividly.

"Has he ever had this situation before?"

"Nope."

"Every time you have a seizure, don't you have twitching of your hands and feet?"

"No, never."

"Have you ever had a seizure at home?"

"No, never had a seizure at home."

"Usually, does he eat a lot?"

"Not much, from the onset to the present, when he eats at home, there is nothing abnormal."

"Okay, thank you!" After listening to this, Lin Lin already knew it in her heart.

Lin Lin routinely did a complete set of nervous system physical examination, the purpose of which was to let the intern see how the complete nervous system physical examination should be done.

Yes, Lin Lin did not miss any opportunity to teach the students. Whether the students can learn Lin Lin's skills from it depends on their understanding and "cultivation".

Back in the office, Lin Lin looked relaxed.

"Okay, let's discuss and discuss, let's start with Dr. Dong." Lin Lin went straight to the point.

"Okay, let me tell you what I think." Dong Huayu is very calm.

"The patient is a middle-aged male, and it has been more than 4 years since the onset of the disease, showing a stereotypical seizure, and each episode has a fixed trigger, that is, the exposure of sunlight."

"At present, the patient's physical examination and auxiliary examinations have not found any abnormalities."

"From the characteristics of the medical history, the patient has an episodic disorder. At such an age, with such a characteristic seizure, I consider that seizures are the most likely. ”

However, the patient repeated the EEG several times, and no abnormalities were found. Head MRI was also done a few times, again with no abnormalities. ”

"For more than 4 years, the patient's seizure pattern has not changed, and I am still not sure about this, I am not sure that it is a seizure."

"Therefore, this patient needs to rule out whether there is a hysterical attack, or whether it will be a hypoglycemic attack, which causes the patient to eat a lot to be relieved."

"I basically agree with Dr. Dong's opinion, and I am more inclined to have hypoglycemic episodes. If possible, do not do a glucose tolerance test. Li Yun'e couldn't say anything more.

"When I was doing my rounds, I also tended to have a high chance of seizures. It's just that I feel very confused, for more than 4 years, the patient is limited to one form of seizure, and all the tests are normal, and it is really difficult to draw conclusions. ”

"Once the diagnosis of epilepsy is made, the patient has to take medication for more than two years, so we have not dared to make this diagnosis easily." Don't look at Ding Feng's popularity, but he is very careful in his work.

"I've been practicing medicine for decades and I've seen many types of seizures, but I haven't seen this form of seizure. Therefore, it is better to be careful when making a diagnosis of epilepsy. "Ling Xiaoyun's level has long stopped.

"This patient, I am inclined to Director Ding's opinion, and it is more likely to be epilepsy. As for the next step of diagnosis and treatment, we can only hope for our almighty Dean Lin. In Ye Xiu's eyes, Lin Lin is omnipotent.

"Everyone discussed it well, and it can be seen that everyone has read a lot of books and consulted a lot of information, especially Dr. Dong, and the way he thinks about problems is commendable."

"This patient is indeed very special, but it is precisely because of his special that I can find the basis for diagnosis."

"The patient has a middle-aged onset of seizures, and the seizures are extremely regular, and they only work in the fields on sunny days. In fact, we can diverge to think about this question, if on a sunny day, let him go outside for a while, will he have a seizure? ”

Everyone listened and nodded frequently.

"yes, why didn't we think of that. Dean Lin, you are so godly that you can get to the bottom of the problem in one sentence. Ding Feng suddenly realized.

yes, isn't that a good way to induce? Why didn't they think of it? It is precisely because of this that many tests cannot be carried out in a targeted manner.

"That's right, Dean Lin, if you say a word, we will know what to do next." Dong Huayu became excited.

"Well, Dr. Dong, tell me what you think."

"We can get in touch with the EEG room and then induce him to have a seizure and give him an EEG right away. At this time, the positive rate of the test will be greatly increased. Dong Huayu said excitedly.

"Yes, yes." Lin Lin appreciated.

"Dean Lin, what do you mean, this patient has no problem diagnosing epilepsy." Ling Xiaoyun asked

"Yes, I think that there is no doubt about the diagnosis of epilepsy in this patient, and it can be diagnosed as complex partial seizures, which are also called limbic lobe seizures."

"I have a few questions for Dean Lin." Li Yun'e's interest also came up.

"Teacher Li, please speak."

"First, there are many triggers for epilepsy, such as staying up late, drinking, sound and light stimulation, and so on. Why does this patient only develop the disease when exposed to sunlight? If it is related to light, when it is cloudy, there is also light, why not get sick? ”

"Second, for such a long time, without any anti-epileptic treatment, the patient's seizure type has not changed, why, this patient's seizures are so stereotypical?"

"Thirdly, for such a long time, if it is a seizure, why is every EEG test normal."

"Also, Dean Lin doesn't suspect that this patient's seizure is related to hypoglycemia? These questions are what I am more confused about, and I would like to ask Dean Lin to help answer them. ”

"Mr. Li's questions are very good, and every question asks the 'pain points'. I guess this is also a question that many people have in their minds, and I am also confused by some questions. However, I would like to discuss and discuss with you. ”

"First of all, on the question of the causes of epilepsy. When Mr. Li asked a question just now, he had already said the common triggers. ”

"These triggers are common, and they are the ones we see the most in books and literature. In addition to these common, how many rare triggers are there that we have not seen or even known? I think it's a worldwide problem. ”