World Journal of
Clinical Medicine and Pharmacy02
3 Diagnosis and
differential diagnosis of patients with primary PKD clinical characteristics of
the analysis and found that 79% of patients have similar clinical
manifestations, Bruno so for the clinical diagnosis of primary PKD criteria:
The exact onset
of the movement triggered by the onset of short duration (1 minute); the onset
of unconsciousness without pain, excluding other organic diseases, neurological
examination is normal; trial with phenytoin or card Mazepine can control
seizures; ⑥ in the absence
of family history, onset age of 1 to 20 years old.
Secondary PKD
may be considered by the symptoms of PKD possibility, after finding the primary
cause, but also try small doses of antiepileptic drug treatment to observe the
reaction. Clinically, attention should be paid to seizure identification, so as
to avoid a small number of patients with PKD is not easy to control the pursuit
of too much control, long-term large-scale use of antiepileptic drugs and
increase the risk of unwanted adverse drug reactions. Identification of points:
seizures and more without a clear predisposing factors, seizures and more
performance of limb convulsions and loss of consciousness, seizures EEG
epileptiform discharge wave can be identified with the PKD. Long-range video
EEG monitoring can record the performance of patients with seizures, but also
the simultaneous recording of EEG, PKD and seizure of the identification of an
important value.
Other diseases
identified with PKD include:
① frightened syndrome: the disease onset of the neonatal period, the
accidental stimulation of excessive fright, especially the auditory stimuli,
the performance of the body for a wide range of limb stiffness, stiffness and
fall by the body without loss of consciousness.
② hysteria: The disease is more common in female patients, more
emotional attack when the incentive, and sometimes crying, shouting,
suffocation, for several minutes to several hours, suggesting that treatment is
effective.
4 treatment of
PKD although the cause is not clear, severe seizures frequent up to 100 times a
day, but a good response to antiepileptic drugs. At present, most scholars have
given anti-epileptic drugs such as carbamazepine, phenytoin or phenobarbital
and other effects have been affirmed. One of the most commonly used drugs for
carbamazepine, the effect is obvious, lower than the dose of epilepsy can
achieve satisfactory results. In addition to the use of antiepileptic drugs are
sodium valproate, lamotrigine, topiramate and oxcarbazepine, have also been
reported spinal cord injury, central nervous system demyelinating disease
caused by secondary PKD combined acetazolamide treatment is better . In
addition, there are cases of treatment with levodopa, but the efficiency is
lower than antiepileptic therapy. Recent reports of oxcarbazepine treatment are
also effective, which can avoid predisposing factors (such as sudden movement,
shock, etc.) also help to control seizures. Chillag and so on by the treatment
of 4 cases of primary PKD monotherapy low dose of oxcarbazepine in the
treatment of PKD satisfactory results, the dose of 5 to 20 mg / kg, 1 case of 2
weeks after treatment of allergic skin rash , And the remaining 3 cases were
no, thus that oxcarbazepine may be effective drug for the treatment of PKD.
Huang et al in the treatment of 8 patients with single-dose topiramate, the
daily dose of 100 ~ 200 mg in the follow-up investigation of 8 months to 2
years, all patients began to no longer attack, and topiramate adverse
reactions, Topiramate treatment of PKD is effective. Once the correct diagnosis
of PKD, to give low-dose antiepileptic drugs can mostly reduce the frequency of
seizures, drug maintenance for some time to complete control of seizures. But
if the withdrawal will soon relapse, reduction of drugs and disable the method,
the literature rarely reported. Recurrence after the re-rule medication can
still control seizures. Primary PKD has a tendency to spontaneous remission
with age, has been reported in 2 cases of primary PKD without drug treatment at
the age of 30 and 35 years of age were completely eliminated.
5 Conclusion PKD
in the clinical relatively rare, but with the clinicians to gradually deepen
their understanding, more and more patients have been misdiagnosed as epilepsy
and other diseases PKD patients get the correct diagnosis. The etiology and
pathogenesis of PKD has not yet been studied thoroughly, there are a variety of
theories and hypotheses. PKD on drug reactivity is very good, low-dose antiepileptic
drugs can be quickly controlled seizures, such as relapse after drug withdrawal
can be re-administered is still effective, disease prognosis is good. Primary
anti-epilepsy drug treatment of PKD, low-dose antiepileptic drugs,
carbamazepine, topiramate and phenytoin can effectively reduce or control
seizures, carbamazepine which the best effect. The treatment of secondary PKD
is mainly in the treatment of primary disease based on the addition of
antiepileptic drugs. There is no unified guide to the treatment of PKD
guidelines, neurological researchers and clinicians to work together to develop
guidelines to guide PKD medication indications, drug selection and dosage and
drug reduction and withdrawal of the program.
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