*For medical professionals for reference
23-year-old guy is trouble for several years,When nicotine uses it immediately, is it a psychological cause or a problem with the mind?
Written article: Pine cypress
A 23 -year -old boy, who has frequently appeared in night epilepsy since his youth,, And often occur in sleep, the most often occur 30 times a night!The strange thing is that the symptoms after using the nicotine patch disappeared immediately. Is it a psychological cause or a problem?Lets look down.
Case sharing
Todays protagonist is a 23 -year -old young man.Frequent convulsions at night, the characteristics of the attack are mainly sudden, short (& lt; 2 minutes), especially in the sleeping dream. I went to the hospital for diagnosis of epilepsy and prescribed medicine., Topimate, Romorizine, chlorolisi, Okasipipiping, Gaba spray diced, chlorophara, but these medicines are not available, epilepsy is still frequently occur, and at most, it can occur 30 times a night!The frequency of this hair is quite scary.
In the case of coincidence, he and his mother saw similar cases in the news. The protagonist in the news was controlled after using the nicotine patch, so he held the symptoms, so he huggedThe mentality of trying to try also began to use nicotine patch (7 mg/d). You dont need to know. When you are frightened, you havent had a attack for 3 years!
After the symptoms are controlled, he thinks that he may be able to stop the drug. During the use of nicotine, the young man feels obvious heart palpitations, anxiety, and insomnia.Reduced the nicotine patch and changed to half a day (3.5mg/d) a day, but the good times did not last long.The previous dose (7 mg/d) was restored, and it started taking phenobabs 4 days ago to reduce epileptic seizures.
The family thinks that although this medicine is useful, Nicotine does not sound like a good thing, will it be addicted?Whats more, there are so many side effects, you still have to go to the hospital to see, so under the strong request of his mother, the young man went to the hospital again.
After admission, the doctor asked the medical history in detail, and the doctor could not rule out whether there were psychological factors and whether there was drug addiction.However, the guys situation is similar to a case he had been diagnosed a few years ago. It is also frequent at night, which is invalid for a variety of antiepileptic drugs. The last diagnosis is sleep -related excessive sporty epilepsy (SHE), but this disease is relatively rare.It is really hard to say whether this patient is also the disease.So he gave him an EEG examination, and ordered him to stop the nicotine patch and phenobennine to see if there was an abnormality in the electrocardiogram.
On the first night, EEG monitored 25 bureau-conscious seizures during the Non-Rem sleeping period.The seizure is mainly manifested in awakening, non -purposeful, non -biased limbs movement, open eyes and occasional bilateral arms muscle tension disorders, and the duration is 9 to 49 seconds (most of them are 10 to 20 seconds).
EEG display the front forehead area (F3/F4/FZ) 10-12 Hz rhythmic alpha wave activity, accompanied by occurring and slowing and suppressing after occurrence (Figure 1).
Figure 1: EEG
The doctor opened the Nigotine post againThe film was posted on his arm. Within 1 hour, epilepsy stopped attacking.In the early morning of the next day, the young man told the doctor that he felt a little uncomfortable and a little palpitated, so he removed the nicotine patch.However, during the nap of the evening of the day, epilepsy took place again, which lasted about 9 seconds, and then used the nicotine patch. In the next 3 days, epilepsy was not onset.The MRI and PET examination of the brain during the hospitalization period is also performed. The MRI shows normal, and the craniocerebral brain PET shows physiological fluorescent dehydration glucose (FDG) intake (physiological FDG intake refersIn imaging, some normal tissues or organs show high FDG high intake phenomena displayed by their normal metabolic activity, which is not caused by lesions).
At the same time, epilepsy gene test (including 302 genes) was also performed, but no pathogenic mutation gene was found, and only a number of unknown mutations (VUS) were identified.The subsequent complete genome sequencing (WGS) did not provide diagnostic results.
Integrate the results of the above inspection, as well as the medical history and response to the drug, the final diagnosis is SHE. Although the nicotine patch has a significant effect on the guy, the side effects are also very significant, so the hospitalization is hospitalized, so the hospitalization is hospitalized.During this period, I tried to use the Puklor and Gaba Tadin to reduce the side effects, but the effect was still not obvious.So after trying to change the position of the patch, after moving the position of the patch from the glory muscle to the proximal thigh, it was surprising that the side effects were improved and the curative effect was not reduced.
Case discussion
How much do you know about she?Why is Nigerine so strange for this guy?What inspiration can we get from this case?
References:
[1] .spencer nam, md, Erica l.Von Stein, MD, Kimford J. Meador, MD, ET Al.neurogy 2024; 103: E209790.DOI: 10.1212/WNL.00000000000000209790
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