Epilepsy (Dianxian): Symptoms, First Aid, and Acupuncture Treatment

Epilepsy is a chronic disease characterized by recurrent episodes of disturbance of consciousness.

Epilepsy can be divided into two major categories: primary and secondary.

I. Primary

Also known as functional, cryptogenic, or idiopathic; its etiology remains unclear and may be related to genetic factors. The incidence ratio between individuals with a family history of epilepsy and the general population is approximately 4–7.2:1. There are two peak ages of onset: one in childhood (around age 5) and the other in adolescence. Absence seizures (petit mal) are the most common type.

II. Secondary

Also known as organic, symptomatic, or acquired. It is often secondary to various brain or systemic diseases.

1. **Brain disorders**: Such as congenital malformations and abnormal brain development; craniocerebral injuries, including birth canal injuries and traumatic brain injuries; intracranial infections caused by bacteria, viruses, fungi, or parasites, where scars formed between the meninges and cortex most readily trigger epileptic seizures; cerebrovascular diseases such as stroke and cerebral atherosclerosis; intracranial tumors, such as supratentorial tumors or brain metastases; and degenerative diseases like Alzheimer’s disease and progressive myoclonic epilepsy.

2. Systemic diseases: Various poisonings (carbon monoxide, alcohol, lead, mercury, isoniazid, and sedative-hypnotic drugs, etc.); metabolic and endocrine disorders such as uremia, hepatic coma, hypoglycemia, and hypocalcemia; cardiovascular diseases including hypertensive encephalopathy and complete atrioventricular block; others such as eclampsia, febrile convulsions, vitamin deficiency, and rickets can all trigger epileptic seizures.

3. **Triggering Factors:** Epileptic seizures are often triggered by fatigue, sleep deprivation, hunger, overeating, fright, infection, intoxication, hyperventilation, and the onset of menstruation. However, many patients experience seizures without any identifiable precipitating cause.

The pathogenesis of epilepsy remains unclear. In normal individuals, neurons in the brain generally exhibit spontaneous discharges at a rate of 10–20 times per second. During an epileptic seizure, however, sudden abnormal discharges often occur at a rapid frequency (700–1000 times per second), which are attributed to a sustained depolarization state of neurons in the epileptic foci. Some researchers believe that the irregular abnormal discharges of neurons result from the weakening or loss of inhibitory effects of the diencephalon and cortex on neurons following cortical damage. When this paroxysmal discharge reaches a certain intensity, it can spread to adjacent cortex, thalamus, and brainstem, as well as propagate downward via spinal tracts and reticulospinal tracts to the motor neurons in the anterior horn of the spinal cord, thereby causing generalized tonic convulsions.

Key Diagnostic Points

Clinically, there are many forms of epileptic seizures, and the following four are the most common:

1. Grand Mal Seizure

Characterized by sudden loss of consciousness and generalized convulsions, it can be divided into four stages: ① Prodromal stage: The incidence is relatively low, with about 15% having prodromes, commonly including upper abdominal discomfort, dizziness, emotional instability, paresthesia, etc. ② Tonic stage: Sudden loss of consciousness, falling to the ground, generalized tonic muscle contraction, head extended backward, bilateral upper limbs flexed and rigid, sometimes accompanied by a loud cry.

Sound, dilated pupils, elevated blood pressure, followed by respiratory arrest, cyanosis of the lips and generalized skin. This phase lasts for about tens of seconds, then the clonic phase begins. ③ **Clonic phase**: Rhythmic convulsions of the whole body muscles, initially rapid and gradually slowing down, then abruptly stopping. This phase typically lasts 1–3 minutes. ④ **Recovery phase**: Respiration recovers first, then heart rate, blood pressure, and pupils return to normal. The patient enters a deep sleep and regains consciousness after several minutes to tens of minutes. Upon waking, there is no memory of the seizure. Limb soreness and weakness usually resolve within about 3 days.

II. Absence Seizure (Xiaofazuo)

Characterized by episodic brief impairment of consciousness, it is most common in children and rare after the age of 15. The following types are recognized:

1. Absence seizure: Manifests as sudden onset and cessation of consciousness disturbance, each episode lasting tens of seconds, occurring ten to over a hundred times daily. The eyes may stare blankly or roll upward, complexion becomes pallid, activity and speech are interrupted, the patient is unresponsive to calls, rarely falls, and has no memory of the episode upon recovery.

2. Myoclonic Seizures: Brief, bilateral myoclonus lasting 1–2 seconds. Most commonly observed in the flexor muscles of the face, upper limbs, neck, and trunk. The majority are complicated by generalized tonic-clonic seizures (grand mal), while a minority are accompanied by absence seizures (petit mal).

### 3. Atypical Absence Seizures Most cases involve diffuse encephalopathy, and over half of the patients have intellectual disabilities. Onset typically occurs between 1 and 3 years of age. The seizures resemble typical absence seizures but are of shorter duration, with less impairment of consciousness, and both the onset and recovery are slower.

3. Focal Seizures

Characterized by focal symptoms lasting from a few seconds to tens of seconds. If there is no secondary generalization or generalized seizure, there is no significant disturbance of consciousness. It includes the following two types:

1. Motor Seizures: ① Clonic Seizure: Manifested as localized paroxysmal twitching, often seen at one corner of the mouth, eyelid, finger, or toe, and may also involve one side of the face or distal limbs. For example, Jacksonian epilepsy. ② Aphasic Seizure: Brief paroxysmal motor aphasia. ③ Versive Seizure: The head and eyes turn to one side, sometimes the body also turns to one side, or rotates in a circular motion. Most such seizures tend to progress into generalized tonic-clonic seizures.

2. Sensory seizures: ① Somatic sensory seizures: Paroxysmal numbness, tingling, etc., confined to one side of the mouth, tongue, face, or limbs. ② Special sensory seizures: Manifested as various paroxysmal hallucinations.

**Psychomotor Seizure (Jingshen Yundongxing Fazuo)**

Onset can occur at any age, but tends to be later than in other types. The following symptoms may appear individually or in succession: ① Disturbance of consciousness: some patients experience only episodic loss of consciousness, but most have it in combination with other symptoms. ② Psychiatric symptoms: diverse and complex manifestations, such as varied hallucinations and illusions, often accompanied by a rising sensation of “stomach qi,” déjà vu, derealization, obsessive thoughts, as well as fear, euphoria, anger, etc. ③ Automatisms: unconscious actions performed by the patient, such as sucking, chewing, throat-clearing, hand-rubbing, undressing, groping, running, talking to oneself, or boarding a vehicle.

Examination:

**EEG:** Most cases show epileptiform waveforms, including spike waves, sharp waves, spike‑slow wave complexes, sharp‑slow wave complexes, polyspike‑slow wave complexes, and bursts of high‑amplitude rhythmic activity.

CT scans and MRI (Magnetic Resonance Imaging) have significant value in diagnosing the etiology of epilepsy.

Treatment

Group 1:

**Jijiuxue (Emergency Point):** Indicated for emergency treatment during an acute episode; do not use when the condition is not active.

1. **GV26 (Renzhong – Shuigou)**: Located on the upper lip, at the junction of the upper 1/3 and middle 1/3 of the philtrum. Use a 30-gauge, 1-cun filiform needle. After routine local disinfection, insert obliquely upward approximately 0.6 cun. Needle sensation: local distension and pain.

2. Shixuan (EX-UE11): Located at the tips of the ten fingers, 0.1 cun from the nail base. Use 10 filiform needles of gauge 30, length 0.5 cun. Perform routine local disinfection. Insert each needle approximately 0.3 cun. Needling sensation: local stabbing pain.

**Method:** The patient is placed in a supine position. Insert the aforementioned acupoints according to the standard needling technique. Apply strong stimulation with twisting (rotating) manipulation in rotation at each point until the patient regains consciousness, then remove the needles. This procedure is intended for emergency use only and should not be employed in routine practice.

**Pre-onset Acupoint Selection**: Suitable for patients with frequent epileptic seizures (several times daily, once daily, several times weekly, once weekly, or monthly onset before menstruation). Do not use during the seizure episode. For the first acupuncture session, choose a timing several hours before the expected onset, or one week before, or one week before menstruation. Do not use if the onset time cannot be estimated accurately.

1. **GV14 (Dazhui)**: Located in the depression below the spinous process of the 7th cervical vertebra. Sterilize a three-edged needle and perform routine disinfection of the local area. The practitioner holds a sterile gauze pad and applies a parallel triple-puncture technique. First, insert the needle perpendicularly into the center of the point to a depth of approximately 0.5 cun, with swift insertion to minimize the patient’s discomfort. After withdrawal, insert the needle again at two positions 1 cm lateral to the center point (left and right), each to a depth of about 0.5 cun, using the same technique. After the three punctures, use the left-hand gauze pad to press the local area to induce slight bleeding. Then apply a new sterile gauze pad, fix it with adhesive tape, and remove the gauze after 10 hours. The local area should avoid contact with water for at least 36 hours.

2. **Shen Dao (GV11)** – Located in the depression below the spinous process of the 5th thoracic vertebra. Use a three-edged needle; after routine local disinfection, quickly insert perpendicularly to a depth of 0.3 cun and withdraw the needle. Gently squeeze a small amount of blood out with a sterile gauze pad, then replace with a fresh gauze pad and keep it covered for 10 hours before removing. Avoid contact with water at the site for 36 hours.

3. **GV1 (Changqiang)**: Located in the depression inferior to the tip of the coccyx. Use a three-edged needle. After routine local disinfection, apply a plum-blossom five-point needling technique centered on GV1, with each point spaced 1.5 cm apart. When needling, pinch up the local skin, and insert each needle to a depth of 6–9 mm. After needling, press with a sterile gauze pad to squeeze out a small amount of blood, then replace with a fresh gauze pad, apply adhesive tape, and remove after 10 hours. Keep the local area dry for 36 hours.

**Method:** The patient is placed in a prone position with a pillow under the lower abdomen. After acupuncture, the patient rests in a side-lying position in bed for 10 minutes before getting up. The treatment is administered once per week, with 10 sessions constituting one course. If there is no effect, treatment is discontinued, or rest for one month before resuming acupuncture.

Group 3:

**Recovery-stage acupoints:** Suitable for patients with milder conditions, such as petit mal seizures, abdominal epilepsy, etc.; or applied to consolidate the therapeutic effect after the second group of acupoints has brought the seizures under control through acupuncture.

1. TE17 (Yifeng) (bilateral): Located in the depression between the earlobe and the angle of the mandible. Using two filiform needles (gauge 30, 2 cun), after routine local disinfection, insert approximately 1.6 cun inward and posteriorly toward the interior of the mandible. Needling sensation: local distension and pain.

2. PC6 (Neiguan) (bilateral): Located 2 cun proximal to the palmar wrist crease, between the tendons of palmaris longus and flexor carpi radialis. Use two filiform needles of gauge 30, 1.5 cun in length. After routine local disinfection, insert perpendicularly to a depth of approximately 1.3 cun, directing the needle toward the opposite TE5 (Waiguan). Needling sensation: local distension and pain, or radiation toward the dorsum of the hand and the middle finger.

**3. CV15 (Jiuwei):** Located on the anterior midline, 0.5 cun below the xiphoid process and 7 cun above the umbilicus. Using a No. 28 filiform needle, 4 cun in length, after routine local disinfection, insert the needle downward at a 25-degree angle to the skin to a depth of approximately 3.8 cun. Needling sensation: local distension and pain.

4. **LR2 (Xingjian)** (bilateral): Located on the dorsum of the foot, in the web space between the 1st and 2nd toes, at the junction of the red and white skin. Prepare two 30-gauge, 2-cun filiform needles. After standard local disinfection, insert obliquely upward about 1.8 cun. Needling sensation: local distension and pain.

**Method:** The patient is placed in a supine position. The aforementioned acupoints are inserted using the standard technique. The needles are retained for 1 hour without twirling. Treatment is administered once daily, with 10 sessions comprising one course. A 5-day rest period is taken before the next course begins.

Commentary

Epilepsy has diverse and complex etiologies, and its clinical manifestations are also intricate, making it one of the more difficult stubborn disorders to treat in clinical practice. The three groups of acupoints introduced above have shown certain therapeutic effects for this condition, with better results in patients with milder symptoms or regular patterns of seizure onset. For patients with secondary epilepsy, the underlying lesions (such as intracranial tumors, intracranial metastatic carcinoma, early-stage cerebral hemorrhage, and mild early-stage traumatic brain injury) should first be ruled out. The short-term efficacy of the above method is relatively satisfactory. Most patients can delay seizure recurrence by 1–3 years through treatment. For patients with a long disease history who have been continuously using antiepileptic and sedative medications, and whose dosage has gradually increased to the point where seizures can no longer be controlled, the above method offers some benefit, though the results are less ideal. For patients who were receiving antiepileptic drugs prior to treatment, once improvement begins during the treatment period, the medication should be gradually withdrawn to avoid rebound seizures. During the treatment period, electroencephalography (EEG) should be performed for clinical reference.

Recognizing Epilepsy: Signs and Symptoms in Children

Epilepsy, known in some contexts as Dianxian, is a chronic neurological disorder characterized by recurrent, unprovoked seizures. The signs and symptoms of epilepsy in children can be particularly diverse, often making early diagnosis challenging. In pediatric populations, seizures may manifest as brief staring spells (absence seizures), sudden jerking movements (myoclonic seizures), or generalized convulsions involving loss of consciousness and rhythmic limb movements. Less obvious presentations include sudden falls (atonic seizures) or episodes of altered awareness without convulsions (focal impaired awareness seizures). Importantly, children may also exhibit subtle behavioral changes, such as confusion, unresponsiveness, or unusual sensations like déjà vu. The clinical presentation often varies with age; infants may present with spasms or repetitive movements, while older children more commonly display generalized tonic-clonic seizures. Recognizing these varied manifestations is critical for prompt diagnosis and management, as delayed treatment can adversely affect neurodevelopmental outcomes. A thorough evaluation, including electroencephalography and neuroimaging, is essential to confirm the diagnosis and differentiate epilepsy from other paroxysmal disorders such as febrile seizures or syncope.

The Natural Course: Can Epilepsy Go Away on Its Own?

A common question among patients and families is whether can epilepsy go away on its own. The answer depends on the underlying etiology and age of onset. In primary (idiopathic) epilepsy, often with a genetic basis and childhood onset, spontaneous remission is possible. Studies indicate that approximately 50–60% of children with new-onset epilepsy will eventually become seizure-free without long-term medication, especially if seizures are well-controlled early and no structural brain abnormality exists. For example, childhood absence epilepsy has a high remission rate, with many children outgrowing seizures by adolescence. However, secondary epilepsy due to structural causes such as brain injury, infection, or malformation is less likely to resolve spontaneously. Even in cases where seizures cease, the underlying predisposition may persist, and epilepsy is considered a chronic condition requiring lifelong surveillance. Thus, while some patients experience a spontaneous remission, it is not predictable and should not be assumed; appropriate medical management remains crucial. Decisions to discontinue medication must be guided by careful risk–benefit analysis and neurological follow-up, as relapse can occur.

Emergency Response: Epilepsy First Aid – What to Do During a Seizure

Knowing epilepsy first aid what to do during seizure episodes is essential for caregivers and the public to prevent injury and complications. When witnessing a generalized tonic-clonic seizure, the primary goals are to protect the individual and maintain the airway. First, remain calm and note the time the seizure began. Clear the area of hard or sharp objects, and place a soft object (e.g., folded jacket) under the head. Do not restrain the person or insert anything into the mouth, as this can cause dental damage or aspiration. Instead, gently roll the person onto their side (recovery position) if possible, to allow saliva to drain and keep the airway clear. Loosen tight clothing around the neck. Do not attempt to hold the tongue; it is physically impossible to swallow the tongue during a seizure. After the convulsive activity stops (usually within 1–3 minutes), the person may be confused or drowsy—stay with them and provide reassurance. Call emergency medical services if the seizure lasts longer than 5 minutes, repeats without full recovery, or occurs in water, or if the person has difficulty breathing or is injured. Proper first aid can significantly reduce the risk of secondary harm.

Beyond Pharmacology: Epilepsy Treatment Without Medication

For patients who do not achieve seizure control with antiepileptic drugs or experience intolerable adverse effects, epilepsy treatment without medication offers alternative strategies. The ketogenic diet—a high-fat, low-carbohydrate regimen—is a well-established non-pharmacological therapy, particularly effective in children with drug-resistant epilepsy. This diet alters brain metabolism and reduces excitability, often leading to a significant reduction in seizure frequency. Surgical interventions, such as resective surgery for focal epilepsy (e.g., temporal lobectomy) or corpus callosotomy, can provide long-term seizure freedom in carefully selected candidates. Vagus nerve stimulation (VNS) and responsive neurostimulation (RNS) are implantable devices that modulate neural activity and are used as adjunctive therapies. Additionally, behavioral approaches like biofeedback and cognitive-behavioral therapy may help manage seizure triggers. It is important to note that these treatments are not a substitute for medication in all cases, but they represent valuable options when medication fails or is contraindicated. Each approach requires multidisciplinary evaluation and tailored implementation, with ongoing monitoring of efficacy and safety.

Long-Term Considerations: Epilepsy Medication Side Effects Long Term

Patients and clinicians must carefully weigh epilepsy medication side effects long term when planning chronic therapy. While antiepileptic drugs (AEDs) are essential for seizure control, prolonged use can be associated with a range of adverse effects. Common long-term side effects include cognitive impairment (e.g., memory problems, slowed processing speed), dizziness, ataxia, and sedation, particularly with older drugs like phenytoin and phenobarbital. Metabolic disturbances are also notable: weight gain (valproate), osteoporosis (enzyme-inducing AEDs), and folate deficiency can develop over years. Some medications carry risks of teratogenicity in women of childbearing age (e.g., valproate). Chronic use of certain AEDs may also affect liver function, bone marrow, or renal health, necessitating regular laboratory monitoring. Newer agents such as levetiracetam and lamotrigine generally have more favorable long-term profiles, but side effects like mood changes or rash remain possible. Patients require ongoing assessment to balance seizure control with quality of life. Dose adjustments, drug switching, or concurrent non-pharmacological interventions may be needed to minimize cumulative toxicity. Long-term follow-up is integral to epilepsy management, ensuring that the benefits of medication outweigh its potential harms.