Clinical Observation Of Modified Ditan Decoction’ S Efficacy In Generalized Tonic-clonic Seisure Accompanied By Cognitive Dysfunction With Phlegm-stasis Blocking Collateral Type

BackgroundEpilepsy,a common neurological disorder,is a clinical syndrome characterized by transient central nervous system dysfunction caused by highly synchronous abnormal discharge of neurons in the brain due to various reasons.The etiology of epilepsy is extremely complex,such as genetic factors,birth injuries,cortical dysplasia,brain inflammation,brain trauma,cerebrovascular disease,brain tumors,neurodegeneration and so on.Cognitive dysfunction is a common concomitant symptom of epileptic patients,which may show long-term problems in the cognitive fields of attention memory,thinking speed,language,executive function and social interaction.Generalized tonic-clonic seizure are the most severe type of epilepsy for cognitive dysfunction.Seizures cause great pain to patients physically and mentally,significantly reduce the quality of life of patients,and cognitive function decline will further reduce the quality of life,what is more,there will be self-harm and harm to society,and a serious negative impact on patients’ families and society.At present,the main way to treat epilepsy is the rational use of antiepileptic drugs.Antiepileptic drugs themselves can have adverse effects on many aspects of cognitive function,especially the traditional antiepileptic drugs.Therefore,it is of great significance and social significance to find a more effective treatment for epilepsy associated with cognitive dysfunction.Because the mechanism of action of traditional Chinese medicine is different from that of western medicine,it has achieved good efficacy in the treatment of epilepsy and cognitive dysfunction.Some studies have shown that the decrease of IGF-1 BDNF level is related to the occurrence of cognitive dysfunction in patients with epilepsy.In this study,traditional Chinese medicine(TCM)was used to treat cognitive dysfunction in patients with generalized tonic-clonic seizure,and the possible mechanism was discussed.ObjectiveTo investigate the clinical effect of modified Ditan decoction in generalized tonic-clonic seisure accompanied by cognitive dysfunction with phlegm-stasis blocking collateral type and the effect of insulin-like growth factor-1(IGF-1)and brain derived neurotrophic factor(BDNF).Methods85 patients with cognitive dysfunction in epilepsy of phlegm-stasis blocking collateral type were selected.These patients were randomly divided into experimental group(n=43)and control group(n=42).The control group was treated with sodium valproate,and the experimental group was treated with the treatment on the basis of sodium valproate,treatment of 6 months,recorded before and after treatment in patients with seizure frequency and seizure duration;Both two groups were evaluated with Montreal cognitive assessment scale(MoCA)and Quality of Life in Epilepsy-31(QOLIE-31)before and after treatment.Serum IGF-1 and serum BDNF levels were detected before and after treatment.ResultsAfter treatment,the attack frequency decreased significantly(P<0.05),and the duration of attack was shortened(P<0.01).After treatment in the experimental group,the frequency reduction was significantly higher than that in the control group(P<0.05),and the reduction of seizure duration after treatment was significantly higher than that in the control group(P<0.01).After treatment,the total score of MoCA was significantly increased(P<0.01),and the sub-item scores except for the naming and abstract generalization ability were significantly increased(P<0.05),and the total score of MoCA was decreased after treatment in the control group(P<0.01).After treatment in the experimental group,the total score of QOLIE-31 was significantly increased(P<0.01),and the increase of QOLIE-31 score was significantly higher than that in the control group(P<0.01).Both IGF-1 and BDNF levels increased after treatment in the experimental group(P<0.01),and the level of IGF-1 was decreased after treatment in the control group(P<0.05),BDNF level was slightly increased,but there was no significant difference before and after treatment,with no statistical significance.ConclusionModified Ditan decoction is a good clinical effect for the treatment of generalized tonic-clonic seisure accompanied by cognitive dysfunction with phlegm-stasis blocking collateral type,which may be related to the increase of IGF-1 and BDNF levels.