Epilepsy. Grand mal seizure: attack: symptoms. What are partial seizures

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(lat. Epilepsia - seized, caught, caught) - one of the most common chronic neurological diseases in humans, manifested in the body’s predisposition to the sudden onset of seizures. Other common and commonly used names for these sudden attacks are epileptic seizure, epileptic seizure. Epilepsy affects not only people, but also animals, for example, dogs, cats, mice. Many great ones, namely Julius Caesar, Napoleon Bonaparte, Peter the Great, Fyodor Dostoevsky, Alfred Nobel, Joan of Arc, Ivan IV the Terrible, Vincent Van Gogh, Winston Churchill, Lewis Carroll, Alexander the Great, Alfred Nobel, Dante Alighieri, Fyodor Dostoevsky , Nostradamus and others suffered from epilepsy.

This disease was called “God’s mark,” believing that people with epilepsy were marked from above. The nature of the appearance of this disease has not yet been established; there are several assumptions in medicine, but there is no exact data.

The common belief among people that epilepsy is an incurable disease is wrong. The use of modern antiepileptic drugs can completely relieve seizures in 65% of patients and significantly reduce the number of seizures in another 20%. The basis of treatment is long-term daily drug therapy with regular follow-up studies and medical examinations.

Medicine has established that epilepsy is a hereditary disease, it can be transmitted through the mother’s line, but more often it is transmitted through the male line, it may not be transmitted at all or may appear after a generation. There is a possibility of epilepsy in children conceived by parents who were drunk or suffering from syphilis. Epilepsy can be an “acquired” disease as a result of severe fright, head injury, maternal illness during pregnancy, due to the formation of brain tumors, cerebral vascular defects, birth injuries, infections of the nervous system, poisoning, neurosurgery.

An epileptic attack occurs as a result of simultaneous excitation of nerve cells that occurs in a certain area of ​​the cerebral cortex.

Based on their occurrence, epilepsy is classified into the following types:

1. symptomatic- a structural defect of the brain can be detected, for example, a cyst, tumor, hemorrhage, developmental defects, manifestation of organic damage to brain neurons;
2. idiopathic- there is a hereditary predisposition, and there are no structural changes in the brain. Idiopathic epilepsy is based on channelopathy (genetically determined diffuse instability of neuronal membranes). There are no signs of organic brain damage in this type of epilepsy, i.e. the patients' intelligence is normal;
3. cryptogenic- the cause of the disease cannot be identified.

Before each epileptic attack, a person experiences a special state called an aura. The aura manifests itself differently in each person. It all depends on the location of the epileptogenic focus. The aura can be manifested by increased temperature, anxiety, dizziness, the patient feels cold, pain, numbness of some parts of the body, strong heartbeat, a feeling of unpleasant odor, the taste of some food, and sees a bright flickering. It should be remembered that during an epileptic attack, a person not only does not realize anything, but also does not experience any pain. An epileptic attack lasts several minutes.

Under a microscope, during an epileptic seizure, cell swelling and small areas of hemorrhage are visible in this place of the brain. Each seizure makes it easier to carry out the next one, forming permanent seizures. This is why epilepsy must be treated! Treatment is strictly individual!

Predisposing factors:

• change in climatic conditions,
• lack or excess of sleep,
• fatigue,
• bright daylight.

Symptoms of epilepsy

Manifestations of epileptic seizures vary from generalized convulsions to changes in the patient’s internal state that are barely noticeable to people around. There are focal seizures associated with the occurrence of an electrical discharge in a certain limited area of ​​the cerebral cortex and generalized seizures, in which both hemispheres of the brain are simultaneously involved in the discharge. During focal attacks, convulsions or peculiar sensations (for example, numbness) in certain parts of the body (face, arms, legs, etc.) may be observed. Focal seizures may also involve short bouts of visual, auditory, olfactory, or taste hallucinations. Consciousness during these attacks can be preserved; in this case, the patient describes his sensations in detail. Partial or focal seizures are the most common manifestation of epilepsy. They occur when nerve cells are damaged in a specific area of ​​one of the brain hemispheres and are divided into:

1. simple - with such seizures there is no disturbance of consciousness;
2. complex - attacks with a disturbance or change in consciousness, caused by areas of overexcitation of various localizations and often become generalized;
3. secondary generalized seizures - typically begin in the form of a convulsive or non-convulsive partial seizure or absence seizure, followed by a bilateral spread of convulsive motor activity to all muscle groups.

The duration of partial attacks is usually no more than 30 seconds.

There are states of the so-called trance - externally ordered actions without conscious control; upon returning consciousness, the patient cannot remember where he was and what happened to him. A type of trance is sleepwalking (sometimes of non-epileptic origin).

Generalized seizures can be convulsive or non-convulsive (absence seizures). For others, the most frightening ones are generalized convulsive seizures. At the beginning of the attack (tonic phase), tension of all muscles occurs, short-term cessation of breathing, a piercing cry is often observed, and tongue biting is possible. After 10-20 seconds. the clonic phase begins when muscle contractions alternate with their relaxation. At the end of the clonic phase, urinary incontinence is often observed. Convulsions usually stop spontaneously after a few minutes (2-5 minutes). Then comes the post-attack period, characterized by drowsiness, confusion, headache and the onset of sleep.

Non-convulsive generalized seizures are called absence seizures. They occur almost exclusively in childhood and early adolescence. The child suddenly freezes and stares intently at one point, his gaze seems absent. Closing of the eyes, trembling of the eyelids, and slight tilting of the head may be observed. The attacks last only a few seconds (5-20 seconds) and often go unnoticed.

The occurrence of an epileptic attack depends on a combination of two factors in the brain itself: the activity of the seizure focus (sometimes also called epileptic) and the general convulsive readiness of the brain. Sometimes an epileptic attack is preceded by an aura (a Greek word meaning “breeze” or “breeze”). The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired (that is, on the localization of the epileptic focus). Also, certain conditions of the body can be a provoking factor for an epileptic seizure (epileptic seizures associated with the onset of menstruation; epileptic seizures that occur only during sleep). In addition, an epileptic seizure can be provoked by a number of environmental factors (for example, flickering light). There are a number of classifications of characteristic epileptic seizures. From a treatment point of view, the most convenient classification is based on the symptoms of seizures. It also helps to distinguish epilepsy from other paroxysmal conditions.

Types of epileptic seizures

What are the types of seizures?

Epileptic seizures are very diverse in their manifestations - from severe general seizures to imperceptible loss of consciousness. There are also such as: a feeling of a change in the shape of surrounding objects, twitching of the eyelid, tingling in the finger, discomfort in the stomach, short-term inability to speak, leaving the house for many days (trances), rotation around its axis, etc.

More than 30 types of epileptic seizures are known. Currently, the International Classification of Epilepsy and Epileptic Syndromes is used to systematize them. This classification identifies two main types of seizures - generalized (general) and partial (focal, focal). They, in turn, are divided into subtypes: tonic-clonic seizures, absence seizures, simple and complex partial seizures, as well as other attacks.

What is an aura?

Aura (Greek word meaning “breeze” or “breeze”) is a condition that precedes an epileptic seizure. The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired. They can be: increased body temperature, feelings of anxiety and restlessness, sound, strange taste, smell, changes in visual perception, unpleasant sensations in the stomach, dizziness, states of “already seen” (deja vu) or “never seen” (jamais vu) , a feeling of inner bliss or melancholy, and other sensations. A person's ability to correctly describe their aura can be of significant help in diagnosing the location of changes in the brain. An aura can also be not only a harbinger, but also an independent manifestation of a partial epileptic seizure.

What are generalized seizures?

Generalized seizures are attacks in which paroxysmal electrical activity covers both hemispheres of the brain. And additional brain studies in such cases do not reveal focal changes. The main generalized seizures include tonic-clonic (generalized convulsive seizures) and absence seizures (short-term blackouts). Generalized seizures occur in about 40% of people with epilepsy.

What are tonic-clonic seizures?

Generalized tonic-clonic seizures (grand mal) are characterized by the following manifestations:

1. blackout;
2. tension in the trunk and limbs (tonic convulsions);
3. twitching of the torso and limbs (clonic convulsions).

During such an attack, breathing may be held for some time, but this never leads to the person’s suffocation. Usually the attack lasts 1-5 minutes. After an attack, sleep may occur, a state of stupor, lethargy, and sometimes a headache.

In the case when an aura or focal attack occurs before an attack, it is regarded as partial with secondary generalization.

What are absence seizures?

Absence seizures (petit mal) are generalized attacks with a sudden and short-term (from 1 to 30 seconds) loss of consciousness, not accompanied by convulsive manifestations. The frequency of absence seizures can be very high, up to several hundred seizures per day. They are often not noticed, believing that the person is lost in thought at that time. During an absence seizure, movements suddenly stop, the gaze stops, and there is no reaction to external stimuli. There is never an aura. Sometimes there may be eye rolling, eyelid twitching, stereotypical movements of the face and hands, and changes in facial skin color. After the attack, the interrupted action is resumed.

Absence seizures are typical for childhood and adolescence. Over time, they can transform into other types of seizures.

What is adolescent myoclonic epilepsy?

Adolescent myoclonic epilepsy begins between the onset of puberty (puberty) and 20 years of age. It manifests itself as lightning-fast twitching (myoclonus), usually of the hands while maintaining consciousness, sometimes accompanied by generalized tonic or tonic-clonic seizures. These attacks most often occur within 1-2 hours before or after waking up from sleep. Electroencephalogram (EEG) often reveals characteristic changes, may be noted increased sensitivity to light flickering (photosensitivity). This form of epilepsy is highly treatable.

What are partial seizures?

Partial (focal, focal) seizures are seizures caused by paroxysmal electrical activity in a limited area of ​​the brain. This type of seizure occurs in approximately 60% of people with epilepsy. Partial seizures can be simple or complex.

Simple partial seizures are not accompanied by impaired consciousness. They can manifest themselves in the form of twitching or discomfort in certain parts of the body, turning of the head, discomfort in the abdomen and other unusual sensations. Often these attacks are similar to an aura.

Complex partial seizures have more pronounced motor manifestations and are necessarily accompanied by one or another degree of change in consciousness. Previously, these seizures were classified as psychomotor and temporal lobe epilepsy.

In case of partial seizures, a thorough neurological examination is always performed to rule out ongoing brain disease.

What is Rolandic epilepsy?

Its full name is “benign epilepsy of childhood with central temporal (rolandic) peaks.” Already from the name it follows that it responds well to treatment. The attacks appear in early school age and stop in adolescence. Rolandic epilepsy usually manifests as partial seizures (eg, unilateral twitching of the corner of the mouth with drooling, swallowing), which usually occur during sleep.

What is status epilepticus?

Status epilepticus is a condition in which epileptic seizures follow each other without interruption. This condition is dangerous to human life. Even with the modern level of development of medicine, the risk of death of the patient is still very high, so a person with status epilepticus must be immediately taken to the intensive care unit of the nearest hospital. Seizures that are repeated so often that the patient does not regain consciousness between them; distinguish between status epilepticus of focal and generalized seizures; very localized motor seizures are termed “persistent partial epilepsy.”

What are pseudoseizures?

These conditions are intentionally caused by a person and look like seizures. They can be staged in order to attract additional attention or to avoid any activity. It is often difficult to distinguish a true epileptic seizure from a pseudoepileptic one.

Pseudoepileptic seizures are observed:

• in childhood;
• more often in women than in men;
• in families where there are relatives with mental illness;
• with hysteria;
• if there is a conflict situation in the family;
• in the presence of other brain diseases.

Unlike epileptic seizures, pseudo-seizures do not have a characteristic post-seizure phase, a return to normal occurs very quickly, the person smiles often, there is rarely damage to the body, irritability rarely occurs, and more than one attack rarely occurs within a short period of time. Electroencephalography (EEG) can accurately detect pseudoepileptic seizures.

Unfortunately, pseudoepileptic seizures are often mistakenly regarded as epileptic, and patients begin to receive treatment with specific drugs. In such cases, relatives are frightened by the diagnosis, as a result, anxiety is induced in the family and overprotection is formed over the pseudo-sick person.

Convulsive focus

A seizure focus is the result of organic or functional damage to an area of ​​the brain caused by any factor (insufficient blood circulation (ischemia), perinatal complications, head injuries, somatic or infectious diseases, brain tumors and abnormalities, metabolic disorders, stroke, toxic effects various substances). At the site of structural damage, a scar (which sometimes forms a fluid-filled cavity (cyst)). In this place, acute swelling and irritation of the nerve cells of the motor zone may periodically occur, which leads to convulsive contractions of skeletal muscles, which, in the case of generalization of excitation to the entire cerebral cortex, result in loss of consciousness.

Convulsive readiness

Convulsive readiness is the probability of an increase in pathological (epileptiform) excitation in the cerebral cortex above the level (threshold) at which the anticonvulsant system of the brain functions. It can be high or low. With high convulsive readiness, even slight activity in the focus can lead to the appearance of a full-blown convulsive attack. The convulsive readiness of the brain can be so great that it leads to a short-term loss of consciousness even in the absence of a focus of epileptic activity. IN in this case We are talking about absence seizures. Conversely, convulsive readiness may be absent altogether, and, in this case, even with a very strong focus of epileptic activity, partial seizures occur that are not accompanied by loss of consciousness. The cause of increased convulsive readiness is intrauterine brain hypoxia, hypoxia during childbirth or hereditary predisposition (the risk of epilepsy in the offspring of patients with epilepsy is 3-4%, which is 2-4 times higher than in the general population).

Diagnosis of epilepsy

There are about 40 different forms of epilepsy and different types seizures. Moreover, each form has its own treatment regimen. That is why it is so important for a doctor not only to diagnose epilepsy, but also to determine its form.

How is epilepsy diagnosed?

Complete medical examination includes collecting information about the patient’s life, the development of the disease and, most importantly, very detailed description attacks, as well as conditions preceding them, by the patient themselves and eyewitnesses of the attacks. If seizures occur in a child, the doctor will be interested in the course of pregnancy and childbirth in the mother. A general and neurological examination and electroencephalography are required. Special neurological studies include nuclear magnetic resonance imaging and computed tomography. The main task of the examination is to identify current diseases of the body or brain that could cause the attacks.

What is electroencephalography (EEG)?

Using this method, the electrical activity of brain cells is recorded. This is the most important test in diagnosing epilepsy. An EEG is performed immediately after the first seizures appear. In epilepsy, specific changes (epileptic activity) appear on the EEG in the form of discharges of sharp waves and peaks of higher amplitude than normal waves. During generalized seizures, the EEG shows groups of generalized peak-wave complexes in all areas of the brain. In focal epilepsy, changes are detected only in certain, limited areas of the brain. Based on EEG data, a specialist can determine what changes have occurred in the brain, clarify the type of seizures, and, based on this, determine which drugs will be preferable for treatment. Also, with the help of EEG, the effectiveness of the treatment is monitored (especially important for absence seizures), and the issue of stopping treatment is decided.

How is an EEG performed?

EEG is a completely harmless and painless study. To carry it out, small electrodes are applied to the head and secured to it using a rubber helmet. The electrodes are connected via wires to an electroencephalograph, which amplifies the electrical signals of brain cells received from them by 100 thousand times, records them on paper or enters the readings into a computer. During the examination, the patient lies or sits in a comfortable diagnostic chair, being relaxed, with eyes closed. Usually, when taking an EEG, so-called functional tests (photostimulation and hyperventilation) are performed, which are provocative loads on the brain through bright flashing light and increased respiratory activity. If an attack begins during an EEG (this happens very rarely), then the quality of the examination increases significantly, since in this case it is possible to more accurately determine the area of ​​impaired electrical activity of the brain.

Are changes in the EEG grounds for identifying or excluding epilepsy?

Many EEG changes are nonspecific and provide only supporting information for the epileptologist. Only on the basis of the identified changes in the electrical activity of brain cells, one cannot speak of epilepsy, and, conversely, this diagnosis cannot be excluded with a normal EEG if epileptic seizures occur. Epileptic activity on the EEG is regularly detected in only 20-30% of people with epilepsy.

Interpreting changes in the bioelectrical activity of the brain is, to some extent, an art. Changes similar to epileptic activity may be caused by eye movement, swallowing, vascular pulsation, respiration, electrode movement, electrostatic discharge, and other causes. In addition, the electroencephalographer must take into account the patient's age, since the EEG of children and adolescents differs significantly from the electroencephalogram of adults.

What is a hyperventilation test?

This is frequent and deep breathing for 1-3 minutes. Hyperventilation causes pronounced metabolic changes in the brain due to intensive removal of carbon dioxide (alkalosis), which, in turn, contribute to the appearance of epileptic activity on the EEG in people with seizures. Hyperventilation during EEG recording makes it possible to identify hidden epileptic changes and clarify the nature of epileptic seizures.

What is EEG with photostimulation?

This test is based on the fact that flashing lights can trigger seizures in some people with epilepsy. During EEG recording, a bright light flashes rhythmically (10-20 times per second) in front of the eyes of the patient being studied. Detection of epileptic activity during photostimulation (photosensitive epileptic activity) allows the doctor to choose the most appropriate treatment tactics.

Why is an EEG with sleep deprivation performed?

Sleep deprivation for 24-48 hours before EEG is carried out to identify hidden epileptic activity in difficult to recognize cases of epilepsy.

Sleep deprivation is a fairly strong trigger for attacks. This test should only be used under the guidance of an experienced physician.

What is EEG during sleep?

As is known, in certain forms of epilepsy, changes in the EEG are more pronounced, and sometimes can only be perceptible during a study during sleep. Recording EEG during sleep makes it possible to detect epileptic activity in the majority of those patients in whom daytime it was not detected even under the influence of ordinary provocative tests. But, unfortunately, such a study requires special conditions and trained medical personnel, which limits the widespread use of this method. It is especially difficult to carry out in children.

Is it right not to take antiepileptic drugs before an EEG?

This should not be done. Abruptly stopping the medication provokes seizures and can even cause status epilepticus.

When is video EEG used?

This very complex study is carried out in cases where it is difficult to determine the type of epileptic seizure, as well as in the differential diagnosis of pseudo-seizures. Video-EEG is a video recording of an attack, often during sleep, with simultaneous EEG recording. This study is carried out only in specialized medical centers.

Why is brain mapping done?

This type of EEG with computer analysis of the electrical activity of brain cells is usually performed for scientific purposes. Applications this method in epilepsy it is limited to identifying only focal changes.

Is EEG harmful to health?

Electroencephalography is an absolutely harmless and painless study. EEG is not associated with any effect on the brain. This study can be carried out as often as necessary. Carrying out an EEG causes only minor inconvenience associated with putting a helmet on the head and slight dizziness that may occur during hyperventilation.

Do EEG results depend on what device the study is used on?

Equipment for conducting EEG – electroencephalographs, produced by different companies, are not fundamentally different from each other. Their difference lies only in the level of technical service for specialists and in the number of recording channels (electrodes used). EEG results in to a greater extent depend on the qualifications and experience of the specialist conducting the research and analysis of the data obtained.

How to prepare a child for an EEG?

The child must be explained what awaits him during the examination and convinced that it is painless. The child should not feel hungry before the test. The head should be washed clean. With small children, it is necessary to practice the day before in putting on a helmet and remaining motionless with your eyes closed (you can pretend to play as an astronaut or tank driver), and also teach them to breathe deeply and often under the commands “inhale” and “exhale.”

CT scan

Computed tomography (CT) is a method of studying the brain using radioactive (X-ray) radiation. During the study, a series of images of the brain are taken in different planes, which allows, unlike conventional radiography, to obtain an image of the brain in three dimensions. CT allows you to detect structural changes in the brain (tumors, calcifications, atrophy, hydrocephalus, cysts, etc.).

However, CT data may not have informative value for certain types of attacks, which include, in particular:

any epileptic seizures for a long time, especially in children;

generalized epileptic seizures with the absence of focal changes in the EEG and indications of brain damage during a neurological examination.

Magnetic resonance imaging

Magnetic resonance imaging is one of the most accurate methods for diagnosing structural changes in the brain.

Nuclear magnetic resonance (NMR) is a physical phenomenon based on the properties of certain atomic nuclei when placed in a strong magnetic field, absorb energy in the radio frequency range and emit it after the cessation of exposure to the radio frequency pulse. According to their own diagnostic capabilities NMR is superior to computed tomography.

The main disadvantages usually include:

1. low reliability of calcification detection;
2. high price;
3. impossibility of examining patients with claustrophobia (fear of closed spaces), artificial pacemakers (pacemakers), large metal implants made of non-medical metals.

Is a medical examination necessary in cases where there are no more attacks?

If a person with epilepsy has stopped having seizures, but the medications have not yet been stopped, then it is recommended that he undergo a control general and neurological examination at least once every six months. This is especially important for control side effect antiepileptic drugs. Usually the condition of the liver, lymph nodes, gums, hair is checked, as well as laboratory blood tests and liver tests. In addition, it is sometimes necessary to monitor the amount of anticonvulsants in the blood. A neurological examination includes a traditional examination by a neurologist and an EEG.

Cause of death in epilepsy

Status epilepticus is especially dangerous due to pronounced muscle activity: tonic-clonic convulsions of the respiratory muscles, inhalation of saliva and blood from the oral cavity, as well as delays and arrhythmias of breathing lead to hypoxia and acidosis. Cordially - vascular system experiences exorbitant loads due to gigantic muscular work; hypoxia increases cerebral edema; acidosis increases hemodynamic and microcirculation disorders; secondly, the conditions for brain function are increasingly deteriorating. When status epilepticus is prolonged in the clinic, the depth of the comatose state increases, convulsions become tonic in nature, muscle hypotonia is replaced by atony, and hyperreflexia is replaced by areflexia. Hemodynamic and respiratory disorders. The convulsions may stop completely, and the stage of epileptic prostration begins: the eye slits and mouth are half open, the gaze is indifferent, the pupils are wide. In this condition, death can occur.

Two main mechanisms lead to cytotoxicity and necrosis, in which cellular depolarization is maintained by stimulation of NMDA receptors and key point is the launch of a cascade of destruction inside the cell. In the first case, excessive neuronal excitation results from edema (fluid and cations entering the cell), leading to osmotic damage and cell lysis. In the second case, activation of NMDA receptors activates calcium flux into the neuron with accumulation of intracellular calcium to a level higher than the cytoplasmic calcium binding protein can accommodate. Free intracellular calcium is toxic to the neuron and leads to a series of neurochemical reactions, including mitochondrial dysfunction, activates proteolysis and lipolysis, which destroy the cell. This vicious circle and underlies the death of a patient with status epilepticus.

Prognosis for epilepsy

In most cases, after a single attack, the prognosis is favorable. Approximately 70% of patients undergo remission during treatment, that is, they are seizure-free for 5 years. In 20–30 %, seizures continue; in such cases, simultaneous administration of several anticonvulsants is often required.

First aid

Signs or symptoms of an attack are usually: convulsive muscle contractions, respiratory arrest, loss of consciousness. During an attack, those around you need to remain calm - without panic or fuss, provide the correct first aid. The listed symptoms of an attack should go away on their own within a few minutes. People around you most often cannot speed up the natural cessation of the symptoms accompanying an attack.

The most important goal of first aid during an attack is to prevent harm to the health of the person experiencing the attack.

The onset of an attack may be accompanied by loss of consciousness and a person falling to the floor. If you fall from the stairs, near objects protruding from the floor level, head bruises and fractures are possible.

Remember: an attack is not a disease transmitted from one person to another; act boldly and correctly when providing first aid.

Entering into an attack

Support the falling person with your hands, lower him to the floor or sit him on a bench. If a person is in a dangerous place, for example, at an intersection or near a cliff, lift his head, take him under the armpits, and move him a little away from the dangerous place.

Beginning of the attack

Sit down next to the person and hold the most important thing - the person’s head; it is most convenient to do this by holding the head of the person lying between your knees and holding it on top with your hands. The limbs need not be fixed, they will not make amplitude movements, and if initially the person lies quite comfortably, then he will not be able to injure himself. No other people are needed nearby, ask them to move away. The main phase of the attack. Holding the head, have a folded handkerchief or part of the person's clothing ready. This may be needed to wipe away saliva, and if the mouth is open, a piece of this material, folded in several layers, can be inserted between the teeth, this will prevent biting the tongue, cheek, or even damaging the teeth against each other during cramps.

If the jaws are closed tightly, there is no need to try to open the mouth by force (this most likely will not work and can injure the oral cavity).

If salivation increases, continue to hold the person's head, but turn it to the side so that saliva can flow onto the floor through the corner of the mouth and not enter the respiratory tract. It's okay if a little saliva gets on your clothes or hands.

Recovery from an attack

Remain completely calm, an attack with respiratory arrest can last several minutes, remember the sequence of symptoms of an attack so that you can later describe them to your doctor.

After the end of the convulsions and relaxation of the body, it is necessary to put the victim in a recovery position - on his side, this is necessary to prevent the root of the tongue from retracting.

The victim may have medications with him, but they can only be used at the direct request of the victim, otherwise criminal liability for causing harm to health may follow. In the vast majority of cases, recovery from an attack should occur naturally, and the correct medicine or mixture and dose will be selected by the person himself after recovery from the attack. Searching a person for instructions and medications is not worth it, as this is not necessary and will only cause an unhealthy reaction from others.

In rare cases, recovery from an attack may be accompanied by involuntary urination, while the person still has convulsions at this time, and consciousness has not fully returned to him. Politely ask other people to move away and disperse, support the person's head and shoulders, and gently discourage them from standing up. Later, the person will be able to cover himself, for example, with an opaque bag.

Sometimes, when recovering from an attack, even with rare convulsions, a person tries to get up and start walking. If you can control the person’s spontaneous impulses from side to side, and the place does not pose any danger, for example, in the form of a road nearby, a cliff, etc., allow the person, without any help from you, to stand up and walk with him, holding him firmly. If the place is dangerous, then do not allow him to get up until the convulsions completely stop or consciousness returns completely.

Usually 10 minutes after the attack, the person completely returns to his normal state and no longer needs first aid. Let the person decide for himself about the need to seek medical help; after recovering from the attack, this is sometimes no longer necessary. There are people who have attacks several times a day, and yet they are completely full-fledged members of society.

Often young people are inconvenienced by the attention of other people to this incident, much more than the attack itself. Cases of an attack under certain irritants and external circumstances can occur in almost half of the patients; modern medicine does not allow pre-insurance against this.

A person whose attack is already ending should not be the focus of general attention, even if, when recovering from the attack, the person emits involuntary convulsive screams. You could, for example, hold the person's head while talking calmly to the person, this helps reduce stress, gives confidence to the person coming out of the attack, and also calms onlookers and encourages them to disperse.

An ambulance must be called in the event of a second attack, the onset of which indicates an exacerbation of the disease and the need for hospitalization, since the second attack in a row may be followed by further ones. When communicating with the operator, it is enough to indicate the gender and approximate age of the victim, in response to the question “What happened?” answer “repeated attack of epilepsy”, give the address and large fixed landmarks, at the request of the operator, provide information about yourself.

In addition, an ambulance should be called if:

• attack lasts more than 3 minutes
• after an attack, the victim does not regain consciousness for more than 10 minutes
• the attack occurred for the first time
• the attack occurred in a child or an elderly person
• the attack occurred in a pregnant woman
• During the attack, the victim was injured.

Treatment of epilepsy

Treatment of a patient with epilepsy is aimed at eliminating the cause of the disease, suppressing the mechanisms of seizure development and correcting the psychosocial consequences that may occur as a result of the neurological dysfunction underlying the disease or in connection with a persistent decrease in working capacity.

If the epileptic syndrome is the result of metabolic disorders, such as hypoglycemia or hypocalcemia, then after the metabolic processes are restored to normal levels, the seizures usually stop. If epileptic seizures are caused by an anatomical lesion of the brain, such as a tumor, arteriovenous malformation or brain cyst, then removal of the pathological focus also leads to the disappearance of seizures. However, long-term lesions, even those that do not progress, can cause the development of various negative changes. These changes can lead to the formation of chronic epileptic foci, which cannot be eliminated by removing the primary lesion. In such cases, control is needed, and sometimes surgical extirpation of epileptic areas of the brain is necessary.

Drug treatment of epilepsy

• Anticonvulsants, also known as anticonvulsants, reduce the frequency, duration, and in some cases completely prevent seizures:
• Neurotropic drugs - can inhibit or stimulate the transmission of nervous excitation in various parts of the (central) nervous system.
• Psychoactive substances and psychotropic drugs affect the functioning of the central nervous system, leading to changes in mental state.
• Racetams are a promising subclass of psychoactive nootropic substances.

Antiepileptic drugs are chosen depending on the form of epilepsy and the nature of the attacks. The drug is usually prescribed in a small initial dose with a gradual increase until the optimal clinical effect occurs. If the drug is ineffective, it is gradually discontinued and the next one is prescribed. Remember that under no circumstances should you change the dosage of the medicine or stop treatment on your own. A sudden change in dose can provoke a worsening of the condition and an increase in attacks.

Non-drug treatments

• Surgery;
• Voight method;
• Osteopathic treatment;
• Studying the influence of external stimuli that influence the frequency of attacks and weakening their influence. For example, the frequency of attacks may be influenced by the daily routine, or it may be possible to establish an individual connection, for example, when wine is consumed and then washed down with coffee, but this is all individual for each organism of a patient with epilepsy;
• Ketogenic diet.

Epilepsy and driving

Each state has its own rules for determining when a person with epilepsy can obtain a driver's license, and several countries have laws requiring physicians to report patients with epilepsy to the registry and inform patients of their responsibility for doing so. In general, patients can drive a car if they have been seizure-free for 6 months to 2 years (with or without drug treatment). In some countries, the exact duration of this period is not defined, but the patient should obtain a doctor's report that the seizures have stopped. The doctor is obliged to warn the patient with epilepsy about the risk he is exposed to when driving with such a disease.

Most people with epilepsy, with adequate seizure control, attend school, enter the workforce, and lead relatively normal lives. Children with epilepsy tend to have more problems at school than their peers, but every effort should be made to enable these children to learn well through additional support in the form of tutoring and counseling.

How is epilepsy related to sex life?

Sexual behavior is an important but very private part of life for most men and women. Studies have shown that approximately a third of people with epilepsy, regardless of gender, have sexual problems. The main causes of sexual dysfunction are psychosocial and physiological factors.

Psychosocial factors:

• limited social activity;
• lack of self-esteem;
• rejection by one of the partners of the fact that the other has epilepsy.

Psychosocial factors invariably cause sexual dysfunction in various chronic diseases, and are also a cause of sexual problems in epilepsy. The presence of attacks often leads to a feeling of vulnerability, helplessness, inferiority and interferes with the establishment of normal relationships with a sexual partner. In addition, many fear that their sexual activity may trigger attacks, especially when attacks are triggered by hyperventilation or physical activity.

There are even known forms of epilepsy when sexual sensations are a component of an epileptic attack and, as a result, form a negative attitude towards any manifestations of sexual desires.

Physiological factors:

• dysfunction of brain structures responsible for sexual behavior (deep brain structures, temporal lobe);
• changes in hormonal levels due to attacks;
• an increase in the level of inhibitory substances in the brain;
• decreased levels of sex hormones due to medications.

Decreased sexual desire occurs in approximately 10% of people receiving antiepileptic drugs, and is more pronounced in those taking barbiturates. A rather rare case of epilepsy is increased sexual activity, which is an equally serious problem.

When assessing sexual disorders, it is necessary to take into account that they can also be the result of improper upbringing, religious restrictions and negative experiences of early sexual life, but the most common cause is a violation of the relationship with a sexual partner.

Epilepsy and pregnancy

Most women with epilepsy are able to carry an uncomplicated pregnancy and give birth to healthy children, even if they are taking anticonvulsants at this time. However, during pregnancy, the course of metabolic processes in the body changes, Special attention Blood levels of antiepileptic drugs should be monitored. Sometimes relatively high doses must be prescribed to maintain therapeutic concentrations. Most affected women whose condition was well controlled before pregnancy continue to feel well during pregnancy and childbirth. Women whose seizures are not controlled before pregnancy are at higher risk of developing complications during pregnancy.

One of the most serious complications pregnancy, toxicosis, often manifests itself as generalized tonic-clonic convulsions in the last trimester. Such seizures are a symptom of a severe neurological disorder and are not a manifestation of epilepsy, occurring no more often in women with epilepsy than in others. Toxicosis must be corrected: this will help prevent the occurrence of seizures.

The offspring of women with epilepsy have a 2-3 times increased risk of embryonic malformations; This appears to be due to a combination of the low incidence of drug-induced malformations and genetic predisposition. Congenital defects observed include fetal hydantoin syndrome, characterized by cleft lip and palate, heart defects, digital hypoplasia, and nail dysplasia.

The ideal for a woman planning a pregnancy would be to stop taking antiepileptic drugs, but it is very likely that in a large number of patients this will lead to a recurrence of seizures, which in the future will be more detrimental to both mother and child. If the patient's condition allows discontinuation of treatment, this can be done at a suitable time before pregnancy. In other cases, it is advisable to carry out maintenance treatment with one drug, prescribing it in the minimum effective dose.

Children chronically exposed to barbiturates in utero often present with transient lethargy, hypotension, restlessness, and often exhibit signs of barbiturate withdrawal. These children should be included in the risk group for the development of various disorders during the neonatal period, slowly removed from the state of barbiturate dependence, and their development should be closely monitored.

There are also seizures that are similar to epileptic, but are not. Increased excitability with rickets, neurosis, hysteria, disturbances of the heart and breathing can cause similar attacks.

Affective - respiratory attacks:

The child begins to cry and at the height of the crying stops breathing, sometimes he even goes limp, falls unconscious, and there may be twitching. Help for affective attacks is very simple. You need to take as much air into your lungs as possible and blow on the child’s face with all your might, or wipe his face with cold water. Reflexively, breathing will be restored and the attack will stop. There is also yactation, when a very small child rocks from side to side, it seems as if he is rocking himself to sleep before going to bed. And those who already know how to sit rock back and forth. Most often, yactation occurs if there is no necessary emotional contact (happens in children in orphanages), rarely - due to mental disorders.

In addition to the listed conditions, there are attacks of loss of consciousness associated with disturbances in the activity of the heart, breathing, etc.

Impact on character

Pathological excitation of the cerebral cortex and seizures do not go away without leaving a trace. As a result, the psyche of a patient with epilepsy changes. Of course, the degree of mental change largely depends on the personality of the patient, the duration and severity of the disease. Basically, there is a slowdown in mental processes, primarily thinking and affects. As the disease progresses, changes in thinking progress; the patient often cannot separate the important from the unimportant. Thinking becomes unproductive, has a concrete-descriptive, stereotyped character; Standard expressions predominate in speech. Many researchers characterize it as “labyrinthine thinking.”

According to observational data, according to the frequency of occurrence among patients, character changes in epileptics can be arranged in the following order:

• slowness,
• viscosity of thinking,
• heaviness,
• hot temper,
• selfishness,
• rancor,
• thoroughness,
• hypochondriacity,
• quarrelsomeness,
• accuracy and pedantry.

The appearance of a patient with epilepsy is characteristic. Slowness, restraint in gestures, taciturnity, sluggish facial expressions, lack of expression on the face are striking; you can often notice a “steel” shine in the eyes (Chizh’s symptom).

Malignant forms of epilepsy ultimately lead to epileptic dementia. In patients with dementia, it manifests itself as lethargy, passivity, indifference, and resignation to the disease. Sticky thinking is unproductive, memory is reduced, vocabulary is poor. The affect of tension is lost, but obsequiousness, flattery, and hypocrisy remain. The result is indifference to everything except one’s own health, petty interests, and egocentrism. Therefore, it is important to recognize the disease in time! Public understanding and full support are extremely important!

Is it possible to drink alcohol?

Some people with epilepsy choose not to drink alcohol at all. It is well known that alcohol can provoke seizures, but this is largely due to individual susceptibility, as well as the form of epilepsy. If a person with seizures is fully adapted to full life in society, he will be able to find a reasonable solution to the problem of drinking alcohol. Acceptable doses of alcohol consumption per day are for men - 2 glasses of wine, for women - 1 glass.

Is it possible to smoke?

Smoking is harmful - it is well known. There was no direct connection between smoking and the occurrence of attacks. But there is a fire hazard if an attack occurs while smoking unattended. Women with epilepsy should not smoke during pregnancy, so as not to increase the risk (already high) of malformations in the child.

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-medication are unacceptable!

According to the World Health Organization (WHO), today epilepsy is one of the most common causes of diseases of the nervous system. In a third of the population, diagnosed epilepsy is a lifelong disease and in 30% of cases leads to death during. Every fifth person suffers at least one epileptic seizure during his life.

Basic Concepts

Epilepsy is chronic illness nervous system, characterized by repeated epileptic seizures in the form of motor, sensory, autonomic and mental manifestations.

An epileptic seizure (attack) is a transient condition that occurs as a result of the development of electrical activity of nerve cells (neurons) in the brain and is manifested by clinical and paraclinical symptoms, depending on the location of the source of the discharge.

The basis of any epileptic seizure is the development of abnormal electrical activity of nerve cells that form a discharge. If the discharge does not go beyond its focus or, spreading to neighboring areas of the brain, encounters resistance and is extinguished, then in these cases partial seizures (local) develop. In the case when electrical activity affects all parts of the central nervous system, a generalized attack develops.

In 1989, an international classification of epilepsies and epileptic syndromes was adopted, according to which epilepsies are divided according to the type of attack and etiological factor.

1. Local (focal, localization, partial) epilepsies:

• Idiopathic (rolandic epilepsy, reading epilepsy, etc.).
• Symptomatic (Kozhevnikov’s epilepsy, etc.) and cryptogenic.

This type of epilepsy is diagnosed only if, during examination and obtaining electroencephalogram data (), the local nature of paroxysms (attacks) is revealed.

1. Generalized epilepsy:

• Idiopathic (benign familial seizures of newborns, childhood absence epilepsy, etc.).
• Symptomatic (West syndrome, Lennox-Gastaut syndrome, epilepsy with myoclonic-astatic seizures, with myoclonic absences) and cryptogenic.

Seizures in this form of epilepsy are generalized from the very beginning, which is also confirmed by clinical examination and EEG data.

1. Indeterminate epilepsy (neonatal seizures, Landau-Kleffner syndrome, etc.).

Clinical manifestations and changes in the EEG have features of both local and generalized epilepsies.

1. Special syndromes (seizures that occur during acute metabolic or toxic disorders).

Epilepsy is considered idiopathic if an external cause has not been identified during examination, so it is also considered hereditary. Symptomatic epilepsy is diagnosed when structural changes in the brain and diseases are found, the role of which in the development of epilepsy has been proven. Cryptogenic epilepsies are epilepsies for which the cause could not be identified, and there is no hereditary factor.

Risk factors for developing epilepsy

• Hereditary history (the role of genetic factors in the development of epilepsy has been reliably established);
• Organic brain damage (intrauterine infection of the fetus, intrapartum asphyxia, postnatal infections, exposure to toxic substances);
• Functional brain disorders (impaired sleep/wake ratio);
• Electroencephalogram (EEG) changes;
• Febrile seizures in childhood.

The clinical picture of any epilepsy consists of seizures, which are diverse in their manifestations. There are two main types of seizures: generalized and partial (motor or focal).

In order not to describe repeatedly clinical picture the same seizures various types epilepsy, let's look at them first.

Generalized seizures

1. Generalized tonic-clonic seizures.

They begin with loss of consciousness, falling and arching of the body, then convulsions of the whole body join. The man rolls his eyes, his pupils dilate, and a cry appears. Due to the convulsive spasm, apnea (stopping breathing) develops for a few seconds, so the patient turns blue (cyanosis). There is increased salivation, which in some cases occurs in the form of bloody foam due to tongue bite, and involuntary urination. During an attack, when you fall unconscious, you can get seriously injured. After a seizure, a person usually falls asleep or becomes lethargic and exhausted (post-seizure period).

This type of paroxysms (attacks) more often occurs in hereditary forms of epilepsy or against the background of toxic brain damage by alcohol.

1. Myoclonic seizures.

Myoclonus is jerky muscle twitching lasting several seconds and can be rhythmic or non-rhythmic. This type of attack is characterized by muscle twitching, which can affect individual areas of the body (face, arm, torso) or be generalized (over the entire body). In the clinic, these attacks will appear in the form of shrugging the shoulders, waving the arm, squatting, squeezing the hands, etc. Consciousness is often preserved. Occurs in most cases in childhood.

1. Absence seizures.

This type of attack occurs without convulsions, but with a short-term loss of consciousness. The person becomes like a statue with empty eyes open, does not make contact, does not answer questions and does not react to others. The attack lasts on average 5 seconds. up to 20 seconds, after which the person comes to his senses and continues the interrupted activity. He remembers nothing about the attack itself. Falls during typical absence seizures are not typical for the patient. Absence seizures that are short in duration may go unnoticed by the person himself or the people around him. More often, this type of seizure is observed in idiopathic epilepsy in childhood from 3 to 15 years. In adults, as a rule, they do not begin.

There are also atypical absence seizures, which last longer and can be accompanied by falls and involuntary urination. They occur mainly in childhood with symptomatic epilepsy (severe organic brain damage) and are combined with mental and intellectual development disorders.

1. Atonic or akinetic seizures.

A person sharply loses tone, resulting in a fall, which often leads to head injuries. There may be a loss of tone in certain parts of the body (head drooping, lower jaw drooping). With absence seizures, there can also be a loss of tone, but it occurs more slowly (the person subsides), and in this case it is a sharp, rapid drop. Atonic attacks last up to 1 minute.

World statistics show that from 0.8 to 1.2 people per 1 thousand population, i.e. Approximately 1% of the entire world population suffers from epilepsy. Every year, as experts commented, due to improved diagnostic quality, an increasing number of patients are being identified

Epilepsy (falling sickness) is a chronic disease of the human brain, characterized mainly by repeated seizures, as well as gradual development personality changes. This is one of the most common neuropsychiatric diseases: according to various sources, up to 1% of the population suffers from epilepsy! Among the causes of its occurrence, brain injuries play an important role; in this case, we are talking about post-traumatic epilepsy. Trauma causes damage to the cortex and underlying layers of the brain. All stages of inflammation develop in the damaged area: hyperemia, then edema, followed by tissue compaction (infiltrate), then necrosis (necrosis). Dead tissue is eaten by wandering cells (phages). A scar or fluid-filled cavity (cyst) forms at the site of the defect. Microcirculation of blood and lymph is disrupted. Acute swelling and irritation of the nerve cells of the motor zone are periodically associated, which leads to convulsive contractions of skeletal muscles and loss of consciousness. The attack ends with extreme inhibition of the cerebral cortex and deep sleep. Based on the pathogenesis (mechanism of development) of epilepsy and convulsive seizures, it is necessary to prescribe anti-inflammatory and anticonvulsant drugs, as well as drugs that improve microcirculation, for prevention and treatment.

Epilepsy

What it is?

Epilepsy has been known since ancient times. In ancient Greece and Rome, epilepsy was associated with witchcraft and magic and was called a “sacred disease.” It was believed that the gods sent this disease to a person leading an unrighteous life. Already in 400 BC. Hippocrates wrote the first treatise on epilepsy, On the Sacred Disease. The greatest physician of antiquity believed that attacks were provoked by the sun, winds and cold, which changed the consistency of the brain. In the Middle Ages, epilepsy was feared as an incurable disease transmitted through the patient’s breath during an attack. At the same time, they worshiped her, since many great people, saints and prophets, suffered from epilepsy. Nowadays, epilepsy is a fairly common disease, affecting about 40 million people around the world.

Why does this happen?

We now know that an epileptic seizure is the result of a burst of electrical activity in a separate area of ​​the brain - the epileptogenic focus. The cause of such an area may be a head injury (for example, concussion), stroke, meningitis, multiple sclerosis, alcoholism(every tenth alcoholic suffers from epileptic seizures), addiction and many other reasons. It is also known that a predisposition to epilepsy can be inherited.

In 2/3 of people with epilepsy, their first seizure develops before the age of 18.

A hysterical seizure should not be confused with epilepsy. Convulsions during hysteria develop most often after any strong experiences associated with grief, resentment, fear, and, as a rule, in the presence of relatives or strangers. A person may fall, but tries not to cause serious harm to himself and remains conscious. The duration of a hysterical attack is 15-20 minutes, less often - up to several hours. When a person returns to a normal state, he does not feel a state of stupor or drowsiness, as is usually the case with epilepsy.

What's happening?

Mild attacks of epilepsy may appear as a momentary, short-term loss of connection with the outside world. Attacks may be accompanied by slight twitching of the eyelids and face and are often invisible to others. You may even get the impression that the person seemed to be thinking for a second. Everything happens so quickly that those around you don’t notice anything. Moreover, even the person himself may not know that he has just had an epileptic attack.

An epileptic attack is often preceded by a special condition called an aura (in Greek - a breath, a breeze). The manifestations of the aura are very diverse and depend on the area of ​​the brain in which the epileptogenic focus is located: it can be fever, anxiety, dizziness, a state of “never seen” or “already seen”, etc.

It is important to understand that during an attack a person is not aware of anything and does not experience any pain. The attack lasts only a few minutes.

What to do during an attack

do not try to forcibly restrain convulsive movements;

do not try to unclench your teeth;

do not perform artificial respiration or cardiac massage

lay the person with seizures on a flat surface and place something soft under his head;

do not move the person from the place where the attack occurred, unless it is life-threatening;

turn the head of a lying patient to the side to prevent the tongue from sinking and saliva entering the respiratory tract, and in cases of vomiting, carefully turn the entire body on its side.

After the attack ends, you need to give the person the opportunity to calmly come to their senses and, if necessary, get some sleep. Often, after the attack ends, confusion and weakness may occur, and it will take some time (usually 5 to 30 minutes) before the person can get up on their own.

Of particular danger are several large convulsive seizures, following one after another without a break. This condition is called status epilepticus. It is deadly because the patient stops breathing and may die from suffocation. Status epilepticus is the leading cause of death in patients with epilepsy and requires immediate medical attention.

Diagnosis and treatment

If you or your loved ones have had an epileptic seizure, you should contact them as soon as possible. neurologist. To create a more complete picture of the causes and nature of the attack, you will also need to consult with epileptologist And psychiatrist. A method to accurately determine the presence of this disease is encephalography. To determine the location of the epileptogenic focus, use methods of magnetic resonance imaging and computed tomography. Often, various non-epileptic conditions are disguised as epileptic seizures, for example, some fainting, sleep and consciousness disorders. In this case, video EEG monitoring is used to clarify the diagnosis.

Modern drug treatment allows in 70% of cases to completely free a person from seizures. If treatment of epilepsy with drugs fails, surgery may be prescribed.

Nervous mental illnesses

"EPILEPSY ”

CONCEPT EPILEPSY

EPILEPSY is a chronic brain disease characterized by repeated seizures that arise as a result of excessive neural activity and are accompanied by various clinical and paraclinical manifestations.

Epilepsy is based on increased neural activity with high-voltage hypersynchronous discharges (epileptic focus). Epileptic seizures most often occur in childhood. Seizures in children are characterized not only by high frequency, but also by greater severity. It is during the period when intensive brain development occurs that seizures can lead to secondary changes in the child’s psyche. This makes clear the need for early specialized medical and social assistance for such children.

Unfortunately, society has a negative attitude towards people with epileptic seizures and their problems, which is expressed in the words usually used in relation to them: “seizure”, “epileptic”, “epileptic”, as well as the existence of a number of unjustified social restrictions. These problems are being solved quite successfully in the world. In most countries there are regional organizations of a public or state-public type that deal with issues of social assistance to people with epileptic seizures.

In children, various convulsive conditions occur 5-10 times more often than in adults, which is obviously associated with the peculiarities of the structure and function of the brain, with tension and imperfection of metabolic regulation, lability and a tendency to irradiate excitation, with increased vascular permeability, hydrophilicity brain, etc. In the origin of epilepsy, the interaction of hereditary predisposition and brain damage is of primary importance. In most forms of epilepsy, polygenic heredity is noted, and in some cases it has greater, in others less significance. When analyzing heredity, it is necessary to take into account, first of all, the obvious signs of the disease, giving certain importance to such manifestations as stuttering, and taking into account the characterological characteristics of the individual (conflict, malice, pedantry, importunity). Predisposing factors include organic cerebral defects of a perinatal or acquired nature (after neuroinfections or traumatic brain injury).

The pathogenesis of epilepsy includes a number of mechanisms. This is primarily focality, which is characteristic not only of partial epilepsy, but also of primary generalized seizures. Most often, generalized seizures occur with focal lesions of the mediobasal temporal and orbitofrontal localization. As the disease progresses, an epileptic system is formed and the process spreads to the entire brain. The biochemical mechanisms of epilepsy are associated with a disorder of ionic, mediator and energy processes. Thus, ionic shifts lead to an increase in membrane permeability and, as a result, increased depolarization of neurons and their hyperexcitability. A decrease in glucose reserves and the accumulation of lactic acid in the brain tissue during an attack are the cause of acidotic changes; aggravating hypoxia and reducing the level of phosphate compounds. Metabolic alkalosis is often detected before an attack. Immunological reactions with the formation of anti-brain antibodies during repeated attacks, circulatory disorders and other factors that expand the affected area are also important. No specific pathological changes are found in epilepsy. At the same time, the epileptic process can cause severe dystrophic changes and a decrease in the number of ganglion cells, progressive gliosis, especially in the temporal lobes.

The clinical picture of epilepsy in children has some characteristic features. These include polymorphism and age-related transformation of attacks, a high proportion, the frequency of abortive forms, the presence of syndromes that are not found in adults, and the frequent development of post-attack symptoms of focal brain damage.

INCIDENCE AND AGE OF ONset EPILEPSY .

Regardless of ethnic and geographic characteristics, epilepsy occurs in 1-2% of people. This means that in Russia this figure is 1.5-3 million. However, convulsive conditions occur much more often. Approximately 5% of people have at least one epileptic seizure in their life. These conditions occur as a result of provoking causes, for example, high fever, long-term chronic alcoholism - convulsive withdrawal attacks, or chronic drug addiction - convulsions caused by drug deficiency. From this we conclude that only 20% of all people who have had at least one seizure in their life develop epilepsy. It is very difficult to obtain accurate figures for the prevalence of epilepsy due to the lack of a unified record, as well as the fact that this diagnosis is often not specifically or erroneously established and passes under the guise of other diagnoses (episyndrome, convulsive syndrome, various paroxysmal conditions, convulsive readiness, some types of febrile seizures etc.), which are not taken into account by the general statistics of epilepsy.

About 75% of people with epilepsy begin having seizures in the first 20 years of life.

During the first two years of life - 17%

preschool age - 13%

early school age - 34%

adolescence - 13%

after 20 years of life - 16%

middle and older age - 2-5%

SPONSORY TERMINATION OF EPILEPTIC SEIZURES

It's possible. Not all people with epileptic seizures consult a doctor and remain under his supervision. This usually occurs when the attacks stop either as a result of treatment or spontaneously without treatment. Since contact with such people is lost, information on the number of cases of self-healing is not sufficiently accurate. After a series of studies that also included patients who did not seek medical attention, it must be recognized that in a significant proportion of these people, approximately half, with or without initial treatment, attacks cease, even without further treatment. This applies to most forms of epileptic seizures. However, it should be borne in mind that the causes of attacks are different, and therefore you should not count on the fact that they will go away without treatment for you.

You need to find out the opinion of your doctor, contact a self-help group - this will help right choice behavioral tactics. Almost all people with epileptic seizures have gone through a period of confidence in the possibility of spontaneous cessation of seizures and have their own judgment about it.

Some believe that epileptic seizures that begin at school age may themselves end with the end of puberty. Indeed it is. But the reason is not that the end of puberty somehow affects the attacks, it’s just that the percentage of those cured for the most part falls at this age. In no case should one expect that once this period is reached, epilepsy will go away on its own.

CAUSES EPILEPSY

The cause of this disease, like other great diseases, is the brain.

Hippocrates

There is hardly any brain damage that would not have the property under certain conditions to cause epilepsy.

With sufficiently strong exposure, epileptic activity, as one of the ways brain cells react, can appear in any person. However, in “healthy” people this requires a fairly strong impact - for example, alcohol withdrawal or severe traumatic brain injury. In young children, the ability of brain cells to react with excessive excitation to an irritating factor is more pronounced than in adults, so at high temperatures they may develop an epileptic attack. In approximately 1-2% of people, the activity of brain cells is so great that epileptic seizures occur on their own (spontaneously), for no apparent reason.

The reasons for the development of epileptic activity in the brain, unfortunately, are not yet clear enough, but are presumably related to the structure of the brain cell membrane, as well as the chemical characteristics of these cells. The complex range of causes of epileptic seizures cannot be reduced to any one factor. In approximately 70% of cases, the cause of seizures remains unknown, despite a special neurological examination, since there are no obvious or suspected signs of an underlying brain disease. Depending on the age at which the attacks began, one or another reason should be assumed. If they appear before age 20, the cause is more likely to be brain damage during pregnancy and childbirth than, for example, a brain tumor. If epilepsy occurs after 25 years, the most common cause is usually a brain tumor, and in older people - cerebral circulatory disorders (stroke). It has been established that the cause of focal seizures is much more often a primary dysfunction of one or several areas of the brain than with generalized ones. However, with any attacks it is necessary to conduct a thorough examination and establish the cause that is causing them.

PERINATAL COMPLICATIONS

Perinatal complications are the main cause of seizures in children. Injuries, both birth and prenatal, cause brain hypoxia (oxygen starvation of the brain). In fact, most congenital brain disorders are related to its oxygen starvation. Fortunately, as obstetric technology improves, the risk of such complications is decreasing. However, some experts believe that 20% of epilepsy cases fall into this category.

HEAD INJURY

Head injuries are the cause of another 5-10% of epilepsy cases. Post-traumatic epilepsy can follow a traumatic brain injury as a result of a severe injury, a traffic accident, child abuse, a gunshot wound, etc. Post-traumatic seizures sometimes develop immediately after the injury, and sometimes appear several years later. Experts believe that anyone who has suffered a brain injury that results in prolonged loss of consciousness has an increased likelihood of developing epilepsy.

Epilepsy very rarely occurs after minor head injuries. All parents know that falls and bruises are as integral a part of growth as childhood illnesses, so there is no need to live in constant fear that the child may trip. In addition, we must understand that not every epileptic seizure is caused by a fall. However, it should be borne in mind that children are very vulnerable. Even severe motion sickness of a child, especially an infant, can harm his mental and physical health and lead to epileptic seizures or mental retardation. If your child experiences seizures immediately or several hours after a head injury, you can be reassured by the fact that these seizures are rare. However, seizures that occur months or years after brain injury are much more likely to recur. Post-traumatic seizures develop most slowly in children. They can appear even 25 years after a head injury.

SOMATIC AND INFECTIOUS DISEASES

Repeated epileptic seizures are observed in many diseases, including childhood cerebral paralysis. In this case, often the same brain injury provokes both seizures and a concomitant disease. Cancers that affect the brain and central nervous system infections such as meningitis and encephalitis can also cause recurrent attacks.

Vascular diseases are also a common cause of epilepsy and epileptic seizures. Sometimes convulsions are the first sign of systemic lupus erythematosus (observed in approximately 15% of patients).

TUMORS AND ANOMALIES OF THE BRAIN

About 35% of brain tumors provoke recurrent seizures. However, brain tumors themselves account for less than 15% of all seizures. Most people with epilepsy have no visible brain abnormalities.

Cerebral arteriovenous dysplasia is a congenital defect that usually results in recurrent seizures. Unfortunately, surgery in this case can provoke epileptic seizures.

METABOLISM DISORDERS

Epilepsy can be caused by both hereditary metabolic disorders and acquired ones, for example, lead poisoning. These are the causes of 10% of epilepsy cases.

Eating foods rich in calories (carbohydrates, fats) can affect metabolism and trigger seizures in almost anyone. Both people with and without diabetes sometimes have epileptic seizures when their blood sugar levels rise significantly. They can also accompany kidney and liver diseases. Individual seizure thresholds are influenced by genetic factors. If seizures recur due to a metabolic disorder, epilepsy may be diagnosed, although such manifestations often disappear with successful treatment of the underlying disease.

STROKE

During a stroke, cerebral circulation is disrupted, resulting in short-term or long-term disturbances in speech, thinking and movement (depending on which parts of the brain are affected). Perhaps due to the increasing number of older people, epilepsy has become more common in this age group. Typically, strokes do not cause epileptic seizures - only 4-5% of patients develop chronic seizures. Seizures that result from a stroke usually respond well to treatment.

EXPOSURE TO MEDICINES OR INSECTICIDES

Attacks can be caused by the action of insecticides, drugs, for example, cocaine (as well as “withdrawal”) and cessation of the use of barbiturates, benzodiazepines (Valium, Librium, Dalman), and alcohol. Skipping a dose of your prescribed antiepileptic drug (AED) can also trigger an attack. It should be kept in mind that seizures do not only occur due to drug abuse. In individuals with low threshold they can be caused by strong neuroleptics (for example, aminazine, tricyclic antidepressants (such as amitriptyline) and monamine oxidase inhibitors (nialamide, etc.), amidopyrine, drugs of the penicillin group. Sometimes the interaction of antiepileptic drugs with other drugs also provokes an attack.

SELF-VOLUNTARY (GENUINE) EPILEPSY

This applies to cases where there is no reason to suspect a primary brain disease. This group, in addition to generalized seizures, includes myoclonic seizures during puberty, generalized nocturnal seizures, as well as some forms of epilepsy with myoclonic-astatic focal seizures.

Another name for spontaneous epilepsy is idiopathic.

EPILEPSY AND HERITANCE

If one of the parents has epilepsy, then the probability of their child developing it is about 6%, i.e. 3 to 6 times more than for most people. At the same time, this suggests that 94% of children will not have epilepsy. If both parents have epilepsy, then the risk for the child increases to 10 - 12%. The most common occurrence of epilepsy in a child is if the parents’ epileptic seizures were not focal, but generalized.

This information is general in nature and in each specific case can be supplemented during a consultation with an epileptologist or geneticist. It should be taken into account that the characteristics of brain activity, processes of excitation and inhibition, increased readiness for paroxysmal forms of the brain’s response to changes in internal and external factors, and not epilepsy itself, are inherited. In most cases, epilepsy appears in children much earlier than in parents. For example, if a mother has had epileptic seizures since the age of 15, then her child may develop them, for example, at the age of 5.

PROVOKATION OF EPILEPTIC ATTACK. STOP TAKING OR REDUCING THE DOSAGE OF DRUGS

If there are no attacks for a long time, some people find it possible to stop treatment on their own or reduce the dose of drugs in order to avoid their side effects. In these cases, there is often a resumption of attacks in a more severe form, and often the development of status epilepticus. Abrupt cessation of taking phenobarbital and benzodiazepine drugs is especially dangerous.

INSUFFICIENT SLEEP AND SLEEP DISORDERS

Sometimes, if a person with epilepsy falls asleep 2-3 hours later, he may have a seizure. If he decides to make up for these hours by waking up later, then this will not only not help, but may do harm. The fact is that what is important here is not the duration of sleep, but its regularity (the same time of falling asleep and waking up). If a person with epilepsy does not get enough sleep, a seizure may occur during a later awakening or a sudden awakening due to the intervention of someone close to them.

ALCOHOL CONSUMPTION

States of severe intoxication lead to sleep disturbances, metabolic changes and a decrease in the compensatory capabilities of the brain. More often, attacks appear the next day after intoxication. A special form of epilepsy is described - alcoholic epilepsy.

STRESS AND STRONG EMOTIONS.

Positive or negative stress rarely leads to attacks. however, in each specific case, you should pay attention to whether there is a connection between strong excitement and an attack. Be sure to note this on your attack calendar and tell your doctor in detail. If the cause of the stress-causing arousal, or the person's own attitude towards it, can be changed, then the number of attacks may decrease. Knowing the causes of attacks can be important information for psychotherapy.

LIGHT.

Often, epileptic seizures arise directly from specific stimuli from the external environment. Most often, the causes of attacks can be very contrasting light stimuli of the “light-dark” type, which appear, for example: when driving along an alley, if the sun is shining from the side, or past a fence through which the sun shines through from the side, on tree leaves moving in the wind, glowing the waves of the lake in the sun, looking at the rotating blades of a helicopter, the blinking lights at the disco, a faulty TV. When using a TV, people with a photosensitive form of attacks should take into account the following: if the image jumps, in no case should you approach it, but adjust it with a remote device (or someone around you). A color TV is preferable, as there are fewer black and white contrasts that cause attacks. When approaching the TV to turn it on or off, you need to cover one eye with your hand. It’s good when the dim ambient light is on when the TV is on - this reduces the contrast between the glowing screen and the room. If you have photosensitivity, glasses with tinted protective lenses can help. Much less often, the cause of attacks can be bright multi-colored objects or brightly lit text or a painting.

READING.

Reading is a very rare cause of seizures. However, if you read for a long time (overwork), when your head starts to hurt and spots appear before your eyes, you should stop this activity, as this can cause a convulsive attack.

Even the simplest sounds: a motor, a bell, the croaking of frogs, or the end of some long sound cause attacks, but, of course, these are very rare cases.

SELF-PROCOCATION OF SEIZURES.

Seizures that occur from external stimuli, such as contrasting light, images or touch, can be caused by the patient himself. Most often this concerns children with delays mental development, less often in children and adults with normal development. An internal need, similar to “mania,” to cause an attack and, rarely, pleasant sensations during the pre-attack state may play a certain role here. Sometimes people with epilepsy self-provoke them to relieve quite severe internal discomfort that appears before an attack, and after an attack they may experience a state of emotional uplift and mental comfort.

Epilepsy attack in humans- These are sudden, rarely occurring, spontaneous seizures. Epilepsy is a brain pathology, the main symptom of which is convulsions. The described disease is considered a very common disorder that affects not only human subjects, but also animals. According to statistical monitoring, every twentieth person suffers a single epileptic attack. Five percent of the total population experienced a first seizure of epilepsy, followed by no further seizures. A seizure can be caused by various factors, such as intoxication, heat, stress, alcohol, sleep deprivation, metabolic disorders, overwork, long-term computer games, prolonged viewing of TV shows.

Causes of epilepsy attacks

Until now, experts are struggling to find out the exact reasons that provoke the occurrence of epileptic seizures.

Epilepsy attacks can periodically occur in people who do not suffer from the disease in question. According to the evidence of most scientists, epileptic signs in humans appear only if a certain area of ​​the brain is damaged. Affected, but retaining some vitality, brain structures turn into sources of pathological discharges, which cause epileptic illness. Sometimes the consequence of an epileptic attack can be new brain damage, leading to the development of new foci of the pathology in question.

Scientists to this day do not know with absolute certainty what it is, why some patients suffer from its attacks, while others have no manifestations at all. They also cannot find an explanation for why seizures are an isolated incident in some subjects, while in others they are a recurring symptom.

Some experts are convinced that the occurrence of epilepsy attacks is genetic. However, the development of the disease in question may be of a hereditary nature, as well as be a consequence of a number of diseases suffered by the epileptic, exposure to aggressive environmental factors and injuries.

Thus, among the causes of epileptic attacks, the following diseases can be identified: tumor processes in the brain, meningococcal infection and brain abscess, encephalitis, vascular disorders and inflammatory granulomas.

The causes of the occurrence of the pathology in question in early age or puberty are either impossible to establish, or they are genetically determined.

The older the patient, the more likely it is that epilepsy attacks develop against the background of severe brain damage. Often, convulsions can be caused by a feverish state. Approximately four percent of those who experience a severe febrile condition subsequently develop epilepsy.

The true cause of the development of this pathology is electrical impulses arising in the neurons of the brain, which cause conditions, the appearance of convulsions, and the individual performing actions that are unusual for him. The main cerebral areas of the brain do not have time to process electrical impulses sent to large quantities, especially those responsible for cognitive functions, as a result of which epilepsy arises.

The following are typical risk factors for epileptic seizures:

— birth injuries(eg hypoxia) or premature birth and associated low birth weight;

- thromboembolism;

- abnormalities of brain structures or cerebral vessels at birth;

- brain bleeding;

- cerebral paralysis;

- presence of epilepsy in family members;

- abuse of alcoholic beverages or use of narcotic substances;

Symptoms of epilepsy attacks

The appearance of epileptic seizures depends on a combination of two factors: the activity of the epileptic (convulsive) focus and the general convulsive readiness of the brain.

An attack of epilepsy can often be preceded by an aura (“breeze” or “breath” translated from Greek). Its manifestations are quite varied and are determined by the localization of the brain area whose functioning is impaired. In other words, the manifestations of the aura depend on the location of the epileptic focus.

In addition, some conditions of the body can become “provocateurs” that cause an epileptic seizure. For example, an attack may occur due to the onset of menstruation. There are also seizures that occur only during dreams.

In addition to physiological conditions, epileptic seizures can be triggered by a number of external factors (for example, flickering light).

Seizures in epilepsy are characterized by a variety of manifestations, which depend on the location of the lesion, etiology (causes of occurrence), electroencephalographic indicators of the degree of maturity of the patient’s nervous system at the time of the attack.

There are many various classifications epileptic seizures, which are based on the above and other characteristics. There are about thirty types of seizures. The international classification of epileptic seizures distinguishes two groups: partial seizures of epilepsy (focal seizures) and generalized convulsions (spread to all areas of the brain).

A generalized seizure of epilepsy is characterized by bilateral symmetry. At the time of occurrence, no focal manifestations are observed. This category of seizures includes: major and minor tonic-clonic seizures, absence seizures (short-term periods of loss), vegetative-visceral seizures and status epilepticus.

Tonic-clonic convulsions are accompanied by tension in the limbs and torso (tonic convulsions) and twitching (clonic convulsions). In this case, consciousness is lost. It is often possible to hold your breath for a short time without causing suffocation. Usually the seizure lasts no more than five minutes.

After an attack of epilepsy, the patient may fall asleep for a while, feel stunned, lethargic, and, less often, pain in the head.

A grand mal tonic-clonic seizure begins with a sudden loss of consciousness and is characterized by a short tonic phase with muscle tension in the trunk, face, and limbs. The epileptic falls as if knocked down; due to contraction of the muscles of the diaphragm and spasm of the glottis, a groan or cry occurs. The patient's face first becomes deathly pale, and then acquires a bluish tint, the jaws are tightly clenched, the head is thrown back, there is no breathing, the pupils are dilated, there is no reaction to light, the eyeballs are either turned up or to the side. The duration of this phase is usually no more than thirty seconds.

When the symptoms of a full-blown grand mal tonic-clonic seizure escalate, the tonic phase is followed by a clonic phase, lasting from one to three minutes. It begins with a convulsive sigh, followed by clonic convulsions that appear and gradually intensify. In this case, breathing is rapid, hyperemia replaces cyanosis of the facial skin, and there is no consciousness. During this phase, the patient may bite the tongue, involuntary urination and defecation.

An epileptic attack ends with muscle relaxation and deep sleep. In almost all cases, such attacks are noted.

After convulsions, weakness, headaches, decreased performance, muscle aches, and disturbances in mood and speech may occur for several hours. In some cases, confusion of consciousness, a state of stunned state, or, less often, twilight remains for a short time.

A grand mal seizure may have warning signs that herald the onset of a seizure. These include:

- malaise;

- change in mood;

- headache;

— somatovegetative disorders.

Usually, the precursors are characterized by stereotypicality and individuality, that is, each epileptic has his own precursors. In some cases, the type of attack in question may begin with an aura. It happens:

- auditory, for example, pseudohallucinations;

— vegetative, for example, vasomotor disorders;

- taste;

- visceral, for example, discomfort inside the body;

- visual (either in the form of simple visual sensations, or in the form of complex hallucinatory pictures);

- olfactory;

- psychosensory, for example, sensations of changes in the shape of one’s own body;

- mental, manifested in changes in mood, inexplicable;

- motor, characterized by convulsive oscillatory contractions of individual muscles.

Absences are short-term periods of loss of consciousness (lasting from one to thirty seconds). With minor absence seizures, the convulsive component is absent or weakly expressed. At the same time, they, as well as other epileptic paroxysms, are characterized by a sudden onset, a short duration of the attack (limited in time), a disorder of consciousness, and amnesia.

Absence seizures are considered the first sign of the development of epilepsy in children. Such short-term periods of loss of consciousness can occur several times a day, often reaching up to three hundred seizures. At the same time, they are practically invisible to others, since people often attribute such manifestations to a pensive state. This type of attack is not preceded by an aura. During a seizure, the patient’s movement stops abruptly, the gaze becomes lifeless and empty (as if freezing), and there is no response to the outside world. Sometimes there may be rolling of the eyes and a change in the color of the skin on the face. Following this kind of “pause”, the person continues moving as if nothing had happened.

Simple absence is characterized by a sudden loss of consciousness lasting a few seconds. At the same time, the person seems to freeze in one position with a frozen gaze. Sometimes rhythmic contractions may be noted eyeballs or twitching of the eyelids, vegetative-vascular dysfunction (dilated pupils, increased heart rate and breathing, pale skin). At the end of the attack, the person continues the interrupted work or speech.

Complex absence seizure is characterized by changes in muscle tone, movement disorders with elements of automatism, and autonomic disorders (pallor or flushing of the face, urination, coughing).

Autonomic-visceral attacks are characterized by various vegetative-visceral disorders and vegetative-vascular dysfunction: nausea, pain in the peritoneum, heart, polyuria, changes in blood pressure, increased heart rate, vasovegetative disorders, hyperhidrosis. The end of the attack is as sudden as its debut. Malaise or stupor does not accompany an epileptic attack. Status epilepticus manifests itself as epileptic seizures following each other continuously and is characterized by a rapidly increasing coma with vital dysfunctions. Status epilepticus occurs as a result of irregular or inadequate treatment, abrupt withdrawal of long-term medications, intoxication, and acute somatic diseases. It can be focal (unilateral convulsions, often tonic-clonic) or generalized.

Focal or partial seizures of epilepsy are considered the most common manifestations of the pathology in question. They are caused by damage to neurons in a specific area of ​​one of the cerebral hemispheres. These seizures are divided into simple and complex partial convulsions, as well as secondary generalized seizures. During simple seizures, consciousness is not impaired. They manifest themselves as discomfort or twitching in certain areas of the body. Often simple partial convulsions are similar to an aura. Complex attacks are characterized by a disturbance or change in consciousness, as well as severe motor disturbances. They are caused by areas of overexcitation that are diverse in location. Often complex partial seizures can transform into generalized ones. This type of convulsions occurs in approximately sixty percent of people suffering from epilepsy.

A secondary generalized attack of epilepsy initially has the form of a convulsive or non-convulsive partial seizure or absence seizure, then a bilateral spread of convulsive motor activity develops.

First aid for an epileptic attack

Epilepsy is one of the most common neurological diseases today. It has been known since the time of Hippocrates. As we studied the symptoms, signs and manifestations of this “epileptic” disease, epilepsy became surrounded by many myths, prejudices and secrets. For example, until the seventies of the last century, British laws prevented people with epilepsy from getting married. Even today, many countries do not allow people with well-controlled epilepsy to choose certain professions or drive a car. Although there is no reason for such prohibitions.

Since epileptic seizures are not uncommon, every person needs to know what can help an epileptic during a sudden attack, and what will harm.

So, if a colleague or passerby has an epileptic attack, what to do in this case, how to help avoid it severe consequences? First of all, you need to stop panicking. It is necessary to understand that the health and further life of another person depends on the calmness and clarity of mind. In addition, it is necessary to note the time of the onset of the seizure.

First aid for an epilepsy attack includes the following actions. You should look around. If there are objects that can injure an epileptic during an attack, they should be removed at a sufficient distance. If possible, it is better not to move the person himself. It is recommended to put something soft under his head, for example, a cushion of clothing. You should also turn your head to the side. It is impossible to keep the patient motionless. The muscles of an epileptic are tense during a seizure, so holding the person’s body motionless by force can lead to injury. The patient's neck should be freed from items of clothing that may impede breathing.

Contrary to previously accepted recommendations and popular opinions on the topic “epilepsy attack, what to do,” you should not try to forcefully open a person’s jaws if they are clenched, since there is a risk of injury. Also, you should not try to insert hard objects into the patient’s mouth, as there is a possibility of causing harm by such actions, including breaking teeth. There is no need to try to force someone to drink. If an epileptic has fallen asleep after a seizure, then you should not wake him up.

During convulsions, it is necessary to constantly monitor the time, because if the seizure lasts more than five minutes, then you should call an ambulance, since prolonged attacks can lead to irreversible consequences.

The person should not be left alone until his condition improves to normal.

All actions aimed at providing assistance during epileptic seizures must be quick, clear, without unnecessary fuss and sudden movements. It is necessary to be nearby throughout the entire epilepsy attack.

After an attack of epilepsy, you should try to turn the patient on his side to avoid the weakened tongue from sinking. For the psychological comfort of a person who has suffered a seizure, it is recommended to clear the room of outside observers and “onlookers.” Only those persons who are able to provide real assistance to the victim should remain in the room. After an attack of epilepsy, minor twitching of the torso or limbs may be observed, so if a person tries to stand up, he needs to be helped and held while walking. If a seizure occurs in an epileptic area of ​​increased danger, for example, on a steep river bank, then it is better to convince the patient to maintain a supine position until the twitching completely stops and consciousness returns.

To achieve normalization of consciousness, it usually takes no more than fifteen minutes. Upon returning consciousness, the epileptic can decide for himself whether he needs to be hospitalized. Most patients have thoroughly studied the features of their condition and disease and know what they need to do. You should not try to feed a person medicinal drugs. If this is the first attack of epilepsy, then a thorough diagnosis is necessary, laboratory research and a medical opinion, and if repeated, then the person himself is well aware of what medications to take.

There are a number of precursors that signal the imminent onset of an attack:

- increased human;

- change in habitual behavior, for example, excessive activity or excessive sleepiness;

- dilated pupils;

- short-term, self-limiting muscle twitches;

- lack of response to others;

- tearfulness and anxiety are rarely possible.

Providing incorrect or untimely assistance during a seizure is quite dangerous for an epileptic. The following dangerous consequences are possible: entry of food, blood, saliva into the respiratory canals, due to difficulty breathing - hypoxia, impaired brain function, with prolonged epilepsy - coma, and death is also possible.

Treatment of epilepsy attacks

A lasting therapeutic effect in the treatment of the pathology in question is achieved mainly through medication. The following basic principles of adequate treatment of epileptic seizures can be distinguished: individual approach, differentiated selection pharmacopoeial drugs and their doses, duration and continuity of therapy, complexity and continuity.

Treatment of this disease is carried out for at least four years; discontinuation of medications is practiced only when the electroencephalogram parameters are normalized.

For the treatment of epilepsy, it is recommended to prescribe medicines different spectrum of action. In this case, it is necessary to take into account certain etiological factors, pathogenetic data and clinical indicators. It is mainly practiced to prescribe such groups of drugs as corticosteroids, neuroleptics, antiepileptic drugs, antibiotics, substances with dehydrating, anti-inflammatory and absorbable effects.

Among anticonvulsants, derivatives of barbituric acid (for example, Phenobarbital), valproic acid (Depakine), and hydantoic acid (Difenin) are successfully used.

Treatment of epilepsy attacks must begin with the selection of the most effective and well-tolerated drug. The construction of a treatment regimen should be based on the nature of the clinical symptoms and manifestations of the disease. For example, for generalized tonic-clonic convulsions, the use of Phenobarbital, Hexamidine, Diphenin, Clonazepam is indicated, and for myoclonic convulsions - Hexamidine, valproic acid preparations.

Treatment of an epileptic attack should be carried out in three stages. In this case, the first stage involves the selection of drugs that will meet the required therapeutic effectiveness and will be well tolerated by the patient.

At first therapeutic measures it is necessary to adhere to the principles of monotherapy. In other words, one drug should be prescribed in a minimum dosage. As the pathology develops, combinations of drugs are prescribed. In this case, it is necessary to take into account the mutually potentiating effect of the prescribed drugs. The result of the first stage is the achievement of remission.

At the next stage, therapeutic remission must be deepened through the systematic use of one or a combination of drugs. The duration of this stage is at least three years under the control of electroencephalography indicators.

The third stage is to reduce the doses of drugs, subject to normalization of electroencephalography data and the presence of stable remission. The drugs are gradually withdrawn over ten to twelve years.

If negative dynamics appear on the electroencephalogram, the dosage should be increased.

Epilepsy has always excited people's thoughts. This disease is described in many ancient texts, including the Bible. The word itself "epilepsy" comes from the Greek epilambáno, which means “I grab”, “I attack”. And, really, what could our unenlightened ancestors think when they witnessed an epileptic attack? It is not otherwise that the devil has entered into a person and completely controls his body. And they treated epilepsy according to the ideas - “driving out spirits.”

Nowadays, medicine has made great progress in understanding the causes and mechanisms of the disease, and modern medications can completely get rid of attacks in 75% of patients.

General information

Epilepsy is one of the most common neurological diseases, a chronic brain disease, the main manifestation of which is spontaneous, short-term, rarely occurring epileptic seizures. This disease occurs in every hundredth person on Earth.

Most often, epilepsy is congenital, so the first attacks appear in childhood (5-10 years) and adolescence (12-18 years). During the study, damage to brain substances is not detected; only the electrical activity of nerve cells is changed and the threshold of excitability of the brain is lowered. Such epilepsy is called primary or idiopathic, has a benign course, responds well to treatment: with age, the patient can completely stop taking pills.

The other type is secondary (symptomatic), it develops after damage to the structure of the brain or a metabolic disorder in it. This can occur as a result of a number of factors, such as underdevelopment of brain structures, traumatic brain injuries, infections, strokes, tumors, alcoholism, drug addiction, etc. This form of epilepsy can develop at any age and is more difficult to treat. But if you manage to cope with the underlying disease, a complete cure is possible.

International classification of epilepsies and epileptic syndromes

LOCALIZATION-BASED (FOCAL, PARTIAL) EPILEPSY AND SYNDROMES

• Benign epilepsy of childhood with central temporal peaks;
• childhood epilepsy with occipital paroxysms;
• primary reading epilepsy.

• Chronic progressive permanent epilepsy of childhood (Kozhevnikov syndrome);
• syndromes with seizures provoked by specific factors (including partial seizures due to sudden awakening or emotional influence): epilepsy of the temporal, frontal, parietal or occipital lobes.

GENERALIZED EPILEPSY AND SYNDROMES

• Benign familial neonatal seizures;
• benign idiopathic neonatal seizures;
• benign myoclonic epilepsy of early childhood;
• childhood absence epilepsy;
• juvenile absence epilepsy;
• juvenile myoclonic epilepsy;
• epilepsy with major seizures on awakening;
• epilepsy with seizures provoked specific types provocations (reflex seizures);
• other idiopathic generalized epilepsies (not listed above).

• West syndrome (infantile spasms);
• Lennox-Gastaut syndrome;
• epilepsy with myoclonic absence seizures;
• epilepsy with myoclonic-astatic seizures.

• Nonspecific etiology;
• early myoclonic encephalopathy;
• early infantile epileptic encephalopathy with burst-suppression complexes on the EEG;
• other symptomatic generalized epilepsies.

There are also other forms of epilepsy, without clear signs of generalization or focality, which are characterized by the following specific syndromes:

• Seizures associated with a specific situation;
• febrile seizures;
• convulsions that occur during acute metabolic disorders;
• isolated convulsions or isolated status.

EPILEPSY AND SYNDROMES WITH SIGNS OF FOCAL AND GENERALIZED

• neonatal seizures;
• severe myoclonic epilepsy of early childhood;
• epilepsy with prolonged peak-wave complexes during slow sleep;
• acquired epileptic aphasia (Landau-Kleffner syndrome).

How to cure epilepsy

After diagnosis, treatment can be carried out both in neurological hospitals and departments, and forcibly in psychiatric hospitals - in cases where a patient with epilepsy commits socially dangerous actions during an attack or is declared insane (epileptic dementia, delusional symptom complexes). IN Russian Federation compulsory hospitalization must be authorized by a court. In especially severe cases, this is possible before the judge makes a decision. Patients forcibly placed in a psychiatric hospital are recognized as incapacitated for the entire period of their stay in the hospital and enjoy the rights of a patient on a general basis.

Types of epileptic seizures

Epilepsy can manifest itself in completely different types of seizures. These types are classified:
due to their occurrence (idiopathic and secondary epilepsy);
at the location of the original focus of excessive electrical activity (cortex of the right or left hemisphere, deep parts of the brain);
according to the development of events during an attack (with or without loss of consciousness).

Thus, a simplified classification of epileptic seizures looks like this.

• Generalized seizures
• Partial seizures
• Tonic-clonic
• Simple
• Absence seizures
• Complex
• Seizures with secondary generalization

Generalized attacks occur with a complete loss of consciousness and control over one’s actions. This occurs as a result of excessive activation of deep parts and further involvement of the entire brain. This condition does not necessarily lead to a fall, because Muscle tone is not always impaired. During a tonic-clonic attack, at the beginning there is a tonic tension of all muscle groups, a fall, and then clonic convulsions - rhythmic flexion and extension movements in the limbs, head, jaw. Absence seizures occur almost exclusively in children and are manifested by a suspension of the child's activity - he seems to freeze in place with an unconscious gaze, sometimes his eyes and facial muscles may twitch.

80% of all epileptic seizures in adults and 60% of seizures in children are partial. Partial seizures occur when a focus of excessive electrical excitability forms in a specific area of ​​the cerebral cortex. Manifestations of a partial attack depend on the location of such a focus - they can be motor, sensitive, vegetative and mental. During simple attacks, a person is conscious, but does not control a certain part of his body or experiences unusual sensations. During a complex attack, a disturbance of consciousness occurs (partial loss), when a person does not understand where he is, what is happening to him, and at this time it is not possible to make contact with him. During a complex attack, just as during a simple one, uncontrolled movements occur in any part of the body, and sometimes this can even be an imitation of a purposeful movement - a person walks, smiles, talks, sings, “dives”, “hits” ball” or continues the action started before the attack (walking, chewing, talking). Both simple and complex partial seizures can result in generalization.
All types of attacks are short-term - lasting from a few seconds to 3 minutes. Almost all seizures (except absence seizures) are accompanied by post-attack confusion and drowsiness. If the attack proceeded with complete loss or impaired consciousness, then the person does not remember anything about it. One patient may have a combination of different types of attacks, and the frequency with which they occur may vary.

Interictal manifestations of epilepsy

Everyone knows such manifestations of epilepsy as epileptic seizures. But, as it turned out, increased electrical activity and convulsive readiness of the brain do not leave sufferers even in the period between attacks, when, it would seem, there are no signs of the disease. Epilepsy is dangerous due to the development of epileptic encephalopathy - in this condition, mood deteriorates, anxiety appears, and the level of attention, memory and cognitive functions decreases. This problem is especially relevant in children, because can lead to developmental delays and interfere with the formation of speech, reading, writing, counting skills, etc. Also, abnormal electrical activity between attacks can contribute to the development of such serious diseases as autism, migraine, attention deficit hyperactivity disorder.

Causes of epilepsy

As mentioned above, epilepsy is divided into 2 main types: Idiopathic and symptomatic. Idiopathic epilepsy is most often generalized, and symptomatic epilepsy is partial. This is due to various reasons for their occurrence. In the nervous system, signals are transmitted from one nerve cell to another using an electrical impulse that is generated on the surface of each cell. Sometimes unnecessary excess impulses arise, but in a normally functioning brain they are neutralized by special anti-epileptic structures. Idiopathic generalized epilepsy develops as a result of a genetic defect in these structures. In this case, the brain cannot cope with the excessive electrical excitability of the cells, and it manifests itself in convulsive readiness, which can at any moment “capture” the cortex of both hemispheres of the brain and cause an attack.

In partial epilepsy, a focus with epileptic nerve cells is formed in one of the hemispheres. These cells generate excess electrical charge. In response to this, the remaining antiepileptic structures form a “protective wall” around such a focus. Up to a certain point, convulsive activity can be restrained, but the climax comes, and epileptic discharges break through the boundaries of the shaft and manifest themselves in the form of the first attack. The next attack will most likely not be long in coming - because... The “path” has already been paved.

Such a focus with epileptic cells is formed, most often, against the background of some disease or pathological condition. Here are the main ones:
Underdevelopment of brain structures - does not arise as a result of genetic rearrangements (as in idiopathic epilepsy), but during fetal maturation, and can be seen on MRI;
Brain tumors;
Consequences of stroke;
Chronic alcohol use;
Infections of the central nervous system (encephalitis, meninoencephalitis, brain abscess);
Traumatic brain injuries;
Drug addiction (especially amphetamines, cocaine, ephedrine);
Taking certain medications (antidepressants, antipsychotics, antibiotics, bronchodilators);
Some hereditary diseases metabolism;
Antiphospholipid syndrome;
Multiple sclerosis .

Factors in the development of epilepsy

It happens that the genetic defect does not manifest itself in the form of idiopathic epilepsy and the person lives without the disease. But when “fertile” soil arises (one of the above diseases or conditions), one of the forms of symptomatic epilepsy may develop. In this case, epilepsy is more likely to develop in young people after traumatic brain injury and alcohol or drug abuse, and in older people - due to brain tumors or after a stroke.

Living with Epilepsy

Contrary to popular belief that a person with epilepsy will have to limit himself in many ways, that many roads in front of him are closed, life with epilepsy is not so strict. The patient himself, his loved ones and those around him need to remember that in most cases they do not even need to register a disability. The key to a full life without restrictions is the regular, uninterrupted use of medications selected by a doctor. The brain, protected by drugs, becomes less susceptible to provoking influences. Therefore, the patient can lead an active lifestyle, work (including on the computer), do fitness, watch TV, fly airplanes and much more.
But there are a number of activities that are essentially a “red rag” for the brain of a patient with epilepsy. Such actions should be limited:
Car driving;
Working with automated mechanisms;
Swimming in open water, swimming in a pool without supervision;
Self-cancellation or skipping pills.
There are also factors that can cause an epileptic attack even in a healthy person, and they should also be wary of:
Lack of sleep, night shift work, 24-hour work schedule.
Chronic use or abuse of alcohol and drugs

Epilepsy and pregnancy

Children and adolescents who develop epilepsy eventually grow up and face the pressing question of contraception. Women taking hormonal contraceptives should be aware that some antiepileptic drugs may reduce their blood levels and lead to unwanted pregnancy. Another question is if, on the contrary, procreation is desirable. Although epilepsy occurs due to genetic reasons, it is not passed on to offspring. Therefore, a patient with epilepsy can safely have a child. But it must be borne in mind that before conceiving, a woman must achieve long-term remission with the help of medications and continue taking them during pregnancy. Antiepileptic drugs slightly increase the risk of abnormal intrauterine development of the fetus. However, you should not refuse treatment, because... If an attack occurs during pregnancy, the risk to the fetus and mother significantly exceeds the potential risk of developing abnormalities in the child. To reduce this risk, it is recommended to take folic acid continuously during pregnancy.

Symptoms of epilepsy

Mental disorders of patients with epilepsy are determined by:
organic brain damage underlying the disease epilepsy;
epilepsy, that is, the result of the activity of an epileptic focus,
depend on the location of the outbreak;
psychogenic, stress factors;
side effects of antiepileptic drugs - pharmacogenic changes;
form of epilepsy (absent in some forms).
structure of mental disorders in epilepsy

1. Mental disorders in the prodrome of a seizure
1. Precursors in the form of affective disorders (mood fluctuations, anxiety, fear, dysphoria), asthenic symptoms (fatigue, irritability, decreased performance)
2. Auras (somatosensory, visual, auditory, olfactory, gustatory, mental)
2. Mental disorders as a component of an attack
1. Syndromes of changes in consciousness:
a) loss of consciousness (coma) - with generalized seizures and secondary generalized ones
b) special states of consciousness - with simple partial seizures
c) twilight stupefaction - with complex partial seizures
2. Mental symptoms (disturbances of higher cortical functions): dysmnestic, dysphasic, ideational, affective, illusory, hallucinatory.
3. Post-attack mental disorders
1. Syndromes of altered consciousness (stupor, stupor, delirium, oneiroid, twilight)
2. Aphasia, oligophasia
3. Amnesia
4. Autonomic, neurological, somatic disorders
5. Asthenia
6. Dysphoria
4. Mental disorders in the interictal period
1. Personality changes
2. Psychoorganic syndrome
3. Functional (neurotic) disorders
4. Mental disorders associated with the side effects of antiepileptic drugs
5. Epileptic psychoses

features of personality changes in epilepsy
1. Characterological:
egocentrism;
pedantry;
punctuality;
rancor;
vindictiveness;
hypersociality;
attachment;
infantilism;
a combination of rudeness and obsequiousness.
2. Formal thinking disorders:
bradyphrenia (stiffness, slowness);
thoroughness;
penchant for detail;
concrete descriptive thinking;
perseveration.
3. Permanent emotional disorders:
the viscosity of affect;
impulsiveness;
explosiveness;
defensiveness (softness, obsequiousness, vulnerability);
4. Decrease in memory and intelligence:
mild cognitive impairment;
dementia (epileptic, egocentric, concentric dementia).
5. Change in the sphere of drives and temperament:
increased instinct of self-preservation;
increased drives (slow pace of mental processes);
predominance of a gloomy, gloomy mood.

Types of epilepsy

IDIOPATHIC FORMS OF EPILEPSY
genetic predisposition (often a family history of epilepsy);
limited age of disease onset;
no changes in neurological status;
normal intelligence of patients;
preservation of the basic rhythm on the EEG;
absence of structural changes in the brain during neuroimaging;
drugs of choice in treatment are valproic acid derivatives;
relatively favorable prognosis with therapeutic remission achieved in the vast majority of cases;
IDIOPATHIC PARTIAL EPILEPSY

Benign partial epilepsy of childhood with centrotemporal adhesions (rolandic epilepsy) (G 40.0)

Diagnosis criteria:
- age of manifestation: 3-13 years (peak 5-7);
- clinical symptoms attacks: simple partial (motor, sensory, vegetative), secondary generalized (nocturnal);
- rare frequency of attacks;
- EEG in the interictal period: normal basic activity and peak-wave activity in the central temporal areas of the cortex;


- prognosis: favorable, after 13 years complete spontaneous remission;
- therapy: 1) basic drug: valproate (30 mg/kg/day - 40-50 mg/kg/day); 2) drug of choice: carbamazepine (15-20 mg/kg/day), sulthiam (ospolot) (4-6 mg/kg/day), phenytoin (diphenin 3-5 mg/kg/day).
Idiopathic partial epilepsy with occipital
paroxysms (Gastaut epilepsy) (G 40.0)

Diagnosis criteria:
- age of manifestation: 2-12 years (peak debut at 5 and 9 years);
- clinical symptoms: a) simple paricial seizures - motor (adversive), sensory (visual) - amaurosis, photopsia, hemianopsia, macro-, micropsia, metamorphopsia, illusions and hallucinations, vegetative (epigastric) sensations - vomiting, headache, dizziness; b) complex partial (psychomotor); c) secondary generalized;
- provoking factors: a sharp change in illumination when moving from a dark room to a light one;
- EEG during an attack: high-amplitude peak-wave activity in one or both occipital leads, possibly extending beyond the initial localization;
- EEG outside the attack: normal basic activity with high-amplitude focal spikes, spike-wave complexes in the occipital lead, occurring when the eyes are closed and epi-activity disappears when the eyes are opened;
- neurological status: without features;
- mental status: without features;
- prognosis: favorable, remission in 95% of cases;
- treatment: 1) basic drug: carbamazepine (20 mg/kg/day); 2) drug of choice: valproate (30-50 mg/kg/day), phenytoin (3-7 mg/kg/day), sulthiam (5-10 mg/kg/day), lamotrigine (5 mg/kg/day).
IDIOPATHIC GENERALIZED EPILEPSY

Childhood absence epilepsy (G 40.3)

Diagnosis criteria:
- age of manifestation: from 2 to 10 years (peak 4-6 years), predominance of girls by gender;
- clinical symptoms of attacks: typical (simple and complex) absences with a high frequency of attacks and in 1/3 of patients generalized tonic-clonic paroxysms, rare;
- provoking factors: hyperventilation, sleep deprivation, emotional stress;
- EEG during an attack: the presence of generalized bilateral synchronous spike-wave complexes with a frequency of 3 Hz;

- neurological status: without features;
- mental status: without features;
- prognosis: favorable
- therapy: 1) basic drug: ethosuximide (suxilep) (15 mg/kg/day) or valproate (30-50 mg/kg/day); in the presence of generalized tonic-clonic seizures, in resistant cases polytherapy: valproate with succinimides, valproate with lamotrigine.
Juvenile absence epilepsy (G 40.3)

Diagnosis criteria:
- age of manifestation: 9-12 years (peak at 12 years);
- clinical symptoms of attacks: typical simple absences (short, rare) and generalized tonic-clonic paroxysms (80%) upon awakening or during sleep;
- provoking factors: hyperventilation (in 10% of patients) provokes absence seizures, sleep deprivation (in 20% of patients) - generalized tonic-clonic seizures;
- EEG during an attack: the presence of generalized bilateral synchronous spike-wave complexes with a frequency of 3 Hz or more (4-5 per second);
- EEG outside the attack: may be within normal limits or diffuse changes in the form of bilateral synchronous slow, sharp waves, spike-wave complexes;
- neurological status: without features;
- mental status: without features;
- prognosis: favorable;
- therapy: 1) basic drug: valproate 30-50 mg/kg/day, if there is no effect, combination with succinimides (20 mg/kg/day) or lamictal (1-5 kg/mg/day).
Juvenile myoclonic epilepsy (Jantz syndrome) (G 40.3)

Diagnosis criteria
- age of manifestation: 12-18 years (peak 15 years, predominance of female patients);
- clinical symptoms of attacks: myoclonic paroxysms, bilaterally synchronous, mainly in the arms and shoulder girdle(usually in the morning); myoclonic-astatic - with involvement of the legs (squats or falls) - with preserved consciousness; generalized tonic-clonic (in 90%) predominantly waking up or falling asleep; complex absence seizures with a myoclonic component;
- provoking factors: sleep deprivation, rhythmic light stimulation, alcohol, physical and mental stress;
- neurological status: without features, sometimes local microsymptoms;
- mental status: absence of intellectual impairment;
- EEG during an attack: generalized, high-amplitude “spike-wave” or “polyspike-wave” complexes with a frequency of 3-5 Hz and higher;
- EEG outside an attack: may be normal or represented by generalized peak-wave activity;
- prognosis: favorable (subject to compliance with the regimen and therapy);
- treatment: 1) basic drug valproate (30-50 mg/kg/day); in resistant cases - valproate with ethosuximide (15 mg/kg/day), valproate with clonazepam (0.15 mg/kg/day), valproate with barbiturates (1-3 mg/kg/day), valproate with lamictal (1- 5 mg/kg/day).
Epilepsy with isolated generalized
convulsive attacks (G 40.3)

Diagnosis criteria:
- age of manifestation: any, peak debut during puberty;
- clinical symptoms: generalized tonic-clonic seizures timed to the sleep-wake rhythm with two peaks - a period of awakening and falling asleep with a low frequency of attacks (once a year - once a month);
- provoking factors: sleep deprivation;
- EEG during an attack: generalized peak-wave activity with a frequency of 3 Hz and higher;
- EEG outside of an attack: may be within normal limits;
- neurological status: without features;
- mental status: a decrease in intelligence is not typical, characterological features, emotional lability are possible;
- prognosis: remission is achieved in 60-80%;
- treatment: 1) basic drug: carbamazepine (15-25 mg/kg/day); 2) drugs of choice: valproate (20-50 mg/kg/day), barbiturates (1.5-3.0 mg/kg/day), phenytoin (4-8 mg/kg/day). In resistant cases, combination: carbamazepine + valproates, carbamazepine + lamotrigine, carbamazepine + barbiturates.
SYMPTOMATIC FORMS OF EPILEPSY
combination of epilepsy with focal neurological symptoms;
the presence of cognitive or intellectual-mnestic impairments in patients;
regional (especially prolonged) slowing in the EEG;
local structural abnormalities in the brain on neuroimaging;
the need for surgical treatment in many cases.
CRYPTOGENIC OR SYMPTOMATIC GENERALIZED EPILEPSY
West syndrome (G 40.4)

Diagnosis criteria:
- age of manifestation: 4-7 months;
- clinical symptoms of attacks: sudden bilateral, symmetrical contractions of axial muscle groups - head, neck, torso, limbs (flexor, extensor, flexor-extensor), serial attacks, short, often during awakening;
- EEG outside an attack: hypsarrhythmia - high-amplitude irregular, poorly synchronized arrhythmic slow waves with spike discharges;
- mental status: severe mental retardation;
- neurological status: various disorders in motor sphere(ataxia, hemiplegia, diplegia);
- etiology: peri- and postnatal changes in the brain, a) malformations of the brain, b) intrauterine infections, c) metabolic disorders, d) traumatic changes in the brain, e) tumors;
- forms: cryptogenic, symptomatic;
- prognosis: unfavorable (transformation into other forms of epilepsy, delayed psychomotor development);
- treatment: 1) basic drugs: valproate (50-70 mg/kg/day), vigabatrin (Sabril) (100 mg/kg/day), ACTH - 0.1 mg/kg/day, or prednisolone - 2-5 mg/kg/day Combinations of basic drugs with lamotrigine, carbamazepine or benzodiazepines.
Lennox-Gastaut syndrome (G 40 .4)

Diagnosis criteria:
- age of manifestation: 2-8 years (peak on average 5 years), boys are more often affected;
- clinical symptoms of attacks (frequent, severe, polymorphic): a) tonic (axial, axorizomelic, general) with autonomic disorders (tachycardia, apnea, facial redness, cyanosis, salivation, lacrimation), occur more often at night; b) attacks of falling (myoclonic, myoclonic-astatic, atonic); c) atypical absence seizures (incomplete impairment of consciousness, slow onset and termination of the attack, pronounced motor phenomena, serial increase in frequency after awakening);
- mental status: from mild cognitive impairment to severe mental retardation; various manifestations of psychoorganic syndrome (neurosis-like, behavioral disorders);
- neurological status: coordination disorders, symptoms of pyramidal insufficiency, cerebral paresis;
- EEG during an attack: generalized spikes and sharp waves, spike-wave complexes;
- EEG outside the attack: slowing of background activity, irregular generalized slow peak-wave activity with a frequency of 1.5-2.5 Hz; short rhythmic discharges of generalized and polyspikes with a frequency of 10 Hz - during sleep;
- neuroimaging: local structural disorders in the cerebral cortex;
- forms: symptomatic and cryptogenic;
- prognosis: unfavorable, in 2/3 of cases - resistance to therapy;
- treatment: valproate (30-100 mg/kg/day, average dose - up to 50 mg/kg/day), often in combination with lamictal (1-5 mg/kg/day), suxilep (for atypical absence seizures), carbamazepine (with tonic 15-30 mg/kg/day), benzodiazepines (clobazam, radedorm, antelepsin).
- reserve methods: corticosteroids, immunoglobulin, ketogenic diet, surgical treatment.
SYMPTOMATIC PARTIAL EPILEPSY
(G 40.1 - G 40.2)
A heterogeneous group of diseases of established etiology, in which the initial clinical and electrophysiological manifestations indicate the focal nature of epileptic paroxysms.
Classification of symptomatic partial epilepsies by anatomical location:
Frontal;
Temporal;
Parietal;
Occipital.
Frontal epilepsy

Clinical characteristics (Luders, 1993; Chauvel, Bancaud, 1994)
pronounced stereotypicality of attacks;
sudden onset of attacks (usually without an aura);
high frequency of attacks with a tendency to be serial;
short duration of attacks - 30-60 seconds;
pronounced, often unusual motor phenomena (foot pedaling, chaotic movements, complex gestural automatisms);
absence or minimal postictal confusion;
often occur in a dream;
rapid secondary generalization.
Symptomatic frontal lobe epilepsy
Form
Localization
Clinical symptoms
Motor
Anterior central gyrus
a) precentral zone

b) premotor zone
- simple partial seizures occurring contralateral to the lesion, predominantly clonic in nature (march type)
- tonic seizures in the upper extremities, tonic turns of the head and eyes.
Post-ictal limb weakness (Todd's palsy)
Opercular
Opercular zone of the inferior frontal gyrus at the junction with the temporal lobe
- simple oroalimentary automatisms (sucking, chewing, swallowing movements, smacking, licking, coughing)
- hypersalivation
- ipsilateral facial muscle twitching
- speech or vocalization problems
Dorsolateral
Superior and inferior frontal gyri

Posterior parts of the inferior frontal gyrus (Broca's area)
- adversive attacks (forced turning of the head and eyes) contralateral to the source of irritation
- attacks of motor aphasia
Orbitofrontal
Orbital cortex of the inferior frontal gyrus
- vegetative-visceral attacks (epigastric, cardiovascular, respiratory)
- pharyngo-oral automatisms with hypersalivation
- psychomotor seizures (gesture automatisms)
Anterior frontopolar
Pole of the frontal lobes
- simple partial seizures with mental dysfunction
Cingular
Anterior cingulate cortex of medial frontal lobes
- simple partial seizures (dysphoric)
- complex partial seizures (automatic gestures),
- facial flushing, fear, ipsilateral blinking movements, clonic convulsions of the contralateral limb
Originating from the supplementary motor area
Additional motor area
- simple partial seizures, nocturnal (motor, speech, sensory)
- attacks of archaic movements at night
Median (medial)
Median parts of the frontal lobes
- “frontal absences” (atypical absences) disturbance of consciousness, sudden interruption of speech, gestural automatisms, motor activity
- complex partial seizures

Temporal lobe epilepsy

Clinical characteristics (Kotagal, 1993; Duncan, 1995)
onset of the disease at any age;
predominance of psychomotor seizures;
isolated auras in 75% of cases;
oroalimentary and carpal automatisms;
secondary generalization in 50% of cases;
lack of diagnostic significance of routine EEG examination.
Forms of temporal lobe epilepsy
Amygdalo-hippocampal (medio-basal, paliocortical)
- complex partial (psychomotor) seizures - loss of consciousness with amnesia, lack of response to external stimuli, automatisms
- simple partial seizures (motor, sensory, vegetative-visceral, with impaired mental functions)
Lateral (neocortical)
- auditory hallucinations
- visual hallucinations
- attacks of dizziness
- seizures with speech impairment
- "temporal syncopation"

Parietal epilepsies

Clinical manifestations.
Parietal epilepsies can manifest in both childhood and adults (Williamson et al, 1992). The initial clinical manifestations of parietal paroxysms are characterized mainly by subjective sensations (somatosensory paroxysms).
Somatosensory paroxysms: are not accompanied by a disturbance of consciousness and, as a rule, are caused by the involvement of the postcentral gyrus in the epileptic process (Sveinbjornnsdottir, Duncan, 1993). Somatosensory paroxysms have a short duration - from a few seconds to 1-2 minutes. Clinical manifestations of somatosensory paroxysms include:
elementary paresthesia;
pain;
disturbances in temperature perception;
"sexual" attacks;
ideomotor apraxia;
violations of the body diagram.
Occipital epilepsies.

Clinical characteristics
simple visual hallucinations;
paroxysmal amaurosis;
paroxysmal visual field disturbances;
subjective sensations in the area of ​​the eyeballs;
blinking;
deviation of the head and eyes.
Treatment of symptomatic epilepsies

I. Basic drug: carbamazepine (30 mg/kg/day).
II. Drug of choice:
Valproate (40-70 mg/kg/day).
Phenytoin (8-15 mg/kg/day).
Phenobarbital (5 mg/kg/day).
Polytherapy: carbamazepine + lamictal (5-10 mg/kg/day), carbamazepine + Topamax (5-7 mg/kg/day).
III. Surgery.

Epileptic psychoses

Acute psychoses
With confusion (up to several days)
Twilight states:
after a series of tonic-clonic seizures;
lasts up to several days;
hallucinatory and delusional disorders;
psychomotor agitation, aggression;
Epileptic delirium;
Epileptic oneiroid.
Without confusion (more than 24 hours)
Acute paranoid (acute sensual delusion);
Dysphoric psychosis

Chronic epileptic psychoses (schizophrenia-like)

General characteristics:

develop 10-15 years or more after the onset of the disease;
at progressive flow epilepsy;
in the presence of gross personality changes, intellectual decline;
occur in most cases against the background of preserved consciousness;
duration from several months to several years;
more often develop with temporal localization of the lesion.
Paranoid;
Hallucinatory-paranoid;
Paraphrenic;
Catatonic.

Diagnosis of epilepsy

When diagnosing epilepsy, it is important to establish its nature - idiopathic or secondary (i.e., exclude the presence of an underlying disease against which epilepsy develops), as well as the type of attack. This is necessary to prescribe optimal treatment. The patient himself often does not remember what and how happened to him during the attack. Therefore, the information that can be provided by the patient’s relatives who were near him during the manifestations of the disease is very important.

Necessary examinations:
Electroencephalography EEG - records altered electrical activity of the brain. During attacks, changes in the EEG are always present, but between attacks in 40% of cases the EEG is normal, so repeated examinations, provocative tests, and video-EEG monitoring are necessary.
Computerized (CT) or magnetic resonance imaging MRI of the brain
General and detailed biochemical blood test
If a certain underlying disease is suspected in symptomatic epilepsy, the necessary additional examinations are carried out
INTERNATIONAL CLASSIFICATION OF EPILEPTIC SEIZURES (ILAE, 1981)
I. Partial (focal, local) epileptic seizures
A. Simple partial seizures (consciousness is not impaired)
1. With motor symptoms
a) focal motor with march;
b) focal motor without march (Jacksonian);
c) versive;
d) postural;
f) phonatory (vocalization or stopping of speech).
2. With somatosensory or specific sensory symptoms
a) somatosensory;
b) visual;
c) auditory;
d) olfactory;
e) taste;
f) attacks of dizziness.
3. With vegetative symptoms (sensations in the epigastrium, pallor, sweating, redness of the face, dilated pupils).
4. C mental symptoms(disturbances of higher cortical functions):
a) dysphasic;
b) dysmnestic (for example, deja vu);
c) cognitive (dreaming states, disturbances in the sense of time);
d) affective (fear, anger, etc.);
e) illusions (eg macropsia);
f) structural hallucinations (eg music, scenes).

B. Complex partial seizures (consciousness is impaired).
1. Beginning as simple partials followed by loss of consciousness:
a) with signs of simple partial seizures (A.1-A.4) and subsequent impairment of consciousness;
b) with automatisms.
2. Beginning with a disturbance of consciousness:
a) only with impaired consciousness;
b) with automatisms.

C. Partial seizures with secondary generalization.
Simple partial seizures (A) with secondary generalization.
2. Complex partial seizures (B) with secondary generalization.
3. Simple partial seizures, turning into complex partial ones, followed by secondary generalization.

II. Generalized epileptic seizures.

A. Absence seizures:
a) only impairment of consciousness;
b) with a clonic component;
c) with an atonic component;
d) with a tonic component;
e) with automatisms;
f) with vegetative symptoms.
B. Myoclonic seizures.
C. Clonic seizures.
D. Tonic seizures.
E. Tonic-clonic seizures.
F. Atonic (astatic) attacks.

BASIC PRINCIPLES OF CLASSIFICATION OF EPILEPSY AND EPILEPTIC SYNDROMES

1. Principle of etiology:
Idiopathic:
- there is no evidence of central nervous system disorders;
- known or possible genetic predisposition.
Symptomatic:
- known etiology and verified morphological disorders.
Cryptogenic.
- the reason is unknown, hidden;
- syndromes do not meet the criteria for idiopathic forms;
- no evidence of symptomatic nature.
2. Localization principle:
- localization-related (focal, local, partial);
- generalized forms;
- forms that have features of both partial and generalized.
3. Age of onset of attack:
- shapes of newborns;
- infants;
- children's;
- youthful.
4. The main type of attacks that determines the picture of the syndrome:
- absence seizures;
- myoclonic absence seizures;
- infantile spasms, etc.
5. Flow features and forecasts:
- benign;
- severe (malignant).

INTERNATIONAL CLASSIFICATION OF EPILEPSY AND EPILEPTIC SYNDROMES (recommended in 1989 by the International League Against Epilepsy).

1. LOCALIZATION-DETERMINED (FOCAL, PARTIAL) EPILEPSY AND SYNDROMES.
1.1. Idiopathic forms (the onset of attacks is associated with age):
- benign epilepsy of childhood with central-temporal spikes;
- epilepsy of children with occipital paroxysms on EEG;
- primary reading epilepsy.
1.2 Symptomatic forms:
- chronic progressive partial epilepsy of children (Kozhevnikov syndrome);
- syndromes with specific causes of seizure provocation (reflex epilepsy);
- frontal, temporal, parietal, occipital lobar epilepsy.
1.3. Cryptogenic forms ( indeterminate forms).

2. EPILEPSY AND SYNDROMES WITH GENERALIZED SEIZURES.
2.1. Idiopathic (the onset of attacks is associated with age):
- benign familial neonatal seizures;
- benign idiopathic neonatal seizures;
- benign infant myoclonic epilepsy;
- epilepsy with pycnoleptic absences (pycnoleptic, absence epilepsy in children);
- childhood absence epilepsy;
- juvenile myoclonic epilepsy;
- epilepsy with generalized tonic-clonic convulsions upon awakening;
- other forms of generalized idiopathic epilepsy;
- epilepsy with specific provoking factors (reflex and start-epilepsy).
2.2 Cryptogenic or symptomatic forms (related to the age of onset of attacks):
- West syndrome (infantile spasms);
- Lennox-Gastaut syndrome;
- epilepsy with myoclonic-astatic seizures;
- epilepsy with myoclonic absence seizures.
2.3 Symptomatic forms:
2.3.1. Nonspecific etiology:
- early myoclonic encephalopathy;
- infantile encephalopathy with areas of isoelectric EEG;
- other symptomatic generalized forms of epilepsy;
2.3.2 Specific syndromes
3. EPILEPSY AND SYNDROMES UNCERTAIN AS TO WHETHER THEY ARE FOCAL OR GENERALIZED
3.1. Together generalized and focal seizures:
- seizures of newborns;
- severe myoclonic epilepsy of early childhood;
- epilepsy with long peak waves on the EEG during the slow phase of sleep;
- aphasia-epilepsy syndrome (Landau-Kleffner);
- other unspecified forms of epilepsy.
3.2. Without certain generalized and focal signs (many cases of generalized tonic-clonic seizures, which, according to clinical data and EEG, cannot be attributed to other forms of epilepsy of this classification, as well as many cases of grand mal seizures during sleep).
4. SPECIAL SYNDROMES
4.1. Situational (random) attacks:
- Febrile convulsions.
- Attacks associated exclusively with the acute effects of metabolic or toxic factors, as well as sleep deprivation, alcohol, medications, eclampsia, etc.
4.2. Isolated seizures or isolated status epilepticus

CLASSIFICATION OF EPILEPSY AND EPILEPTIC SYNDROMES ACCORDING TO ICD No. 10

G40 Epilepsy.
Excluded:
- Landau-Kleffner syndrome (F80.3x);
- convulsive seizure NOS (R56.8);
- status epilepticus (G41.-);
- Todd's palsy (G83.8)
G40.0 Localized (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures with focal onset
Included:
- benign childhood epilepsy with EEG peaks in the central-temporal region;
- childhood epilepsy, with paroxysmal activity on the EEG in the occipital region.
G40.1. Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures
Included:
- attacks without changes in consciousness;
- simple partial seizures, developing into secondary generalized seizures.
G40.2 Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures
Included:
- attacks with changes in consciousness, often with epileptic automatism;
- complex partial seizures, developing into secondary generalized seizures.
G40.3 Generalized idiopathic epilepsy and epileptic syndromes
Included:
- benign myoclonic epilepsy of early childhood;
- benign minor seizures (familial);
- childhood epileptic absence seizures (pycnolepsy);
- epilepsy with grand mal seizures on awakening;
- juvenile absence epilepsy;
- juvenile myoclonic epilepsy (juvenile petit mal seizure, grand mal);
- nonspecific epileptic seizures, atonic;
- nonspecific epileptic clonic seizures;
- nonspecific epileptic myoclonic seizures;
- nonspecific tonic epileptic seizures;
- nonspecific epileptic seizures, tonic-clonic.
G40.4 Other types of generalized epilepsy and epileptic syndromes
Included:
- epilepsy with myoclonic absence seizures;
- epilepsy with myoclonic-astatic absence seizures;
- baby spasms;
- Lennox-Gastaut syndrome;
- Salaam teak;
- symptomatic early myoclonic encephalopathy;
- West's syndrome.
G40.5 Specific epileptic syndromes
Included:
- partial continuous epilepsy (Kozhevnikova);
- epileptic seizures associated with alcohol consumption;
- epileptic seizures associated with the use of drugs;
- epileptic seizures associated with hormonal changes;
- epileptic seizures associated with sleep deprivation;
- epileptic seizures associated with exposure to stress factors.
G40.6 Grand mal seizures, unspecified (with or without petit mal)
G40.7 Petit mal, unspecified without grand mal seizures
G40.8 Other specified forms of epilepsy
Included:
- epilepsy and epileptic syndromes not defined as focal or generalized.
G40.9 Epilepsy, unspecified
Included:
- epileptic convulsions NOS;
- - epileptic seizures NOS;
- - epileptic seizures NOS.
G41.1 Status epilepticus
G41.0 Status epilepticus grand mal (convulsive seizures)
Included:
- tonic-clonic status epilepticus.
Excluded:
- partial continuous epilepsy (Kozhevnikova) (G40.5).
G41.1 Status epilepticus retit mal (minor seizures)
Included:
- absence seizure status epilepticus.
G41.2 Complex partial status epilepticus
G41.8 Other specified status epilepticus
G41.9 Status epilepticus, unspecified

Treatment of epilepsy

Treatment of epilepsy is aimed at normalizing the electrical activity of the brain and stopping seizures. Antiepileptic drugs stabilize the membrane of nerve cells in the brain and thus increase the seizure threshold and reduce electrical excitability. As a result of this effect of drugs, the risk of a new epileptic attack is significantly reduced. And valproates and laxmictal can also reduce interictal excitability of the brain, which makes it possible to further stabilize the condition and prevent the development of epileptic encephalopathy.
Use:
Antiepileptic drugs - carbamazepine (Finlepsin), valproate (Depakine Chrono), Lamictal, Topamax, gabapentin, clonazepam, etc. - the doctor selects the drug and its dose individually
In case of secondary epilepsy, the underlying disease is additionally treated
Symptomatic treatments - such as drugs to improve memory or reduce depression
Patients with epilepsy are forced to take antiepileptic drugs for a long time for their own protection. Unfortunately, such drugs can cause side effects (decreased cognitive activity, lethargy, hair loss, decreased immunity). In order to identify undesirable effects in a timely manner, an examination of the organs concerned is carried out every six months (general and biochemical blood tests, ultrasound of the liver and kidneys).
Despite all the difficulties encountered on the path to curbing epilepsy, the effort and time spent are rewarded handsomely: 2.5-3 years after the last attack, a comprehensive examination is once again carried out (video-EEG monitoring, MRI of the brain) and a gradual dose reduction begins antiepileptic drug, ending with its complete withdrawal! The patient continues to lead the same lifestyle, using the same small precautions as before, but he is no longer tied to constantly taking pills. And such a cure became possible in 75% of cases!
General principles of treatment of epilepsy:

Treatment of epilepsy should begin after a recurrent attack.
The principle of monotherapy.
Antiepileptic drugs (AEDs) are prescribed strictly in accordance with the form of epilepsy and the nature of the attacks.
Treatment of epilepsy should begin with small doses of the drug and gradually increase the dosage until complete control of seizures is achieved. Therapy must be individual and continuous.
If one drug is ineffective, it should be gradually replaced by another AED that is effective for this form of epilepsy. If one AED is ineffective, you cannot immediately add a second drug to it, that is, switch to polytherapy without using all the reserves of monotherapy.
Gradual withdrawal of drugs when seizure control is achieved (2-4 years of seizure freedom).
If necessary, comprehensive therapy (etiopathogenetic approach).
Continuity of therapy.
Improving quality of life.
Necessary measures before starting anticonvulsant therapy:

Assess and document the patient's status before starting therapy: physical examination, laboratory tests, EEG (including sleep EEG), neuroradiological examination (if necessary), assessment of cognitive functions.
Discuss therapy, prognosis and social consequences (school, sports, eliminating precipitating factors, cost of treatment) with parents.
Agreeing with parents about the goals of therapy.
Selection of an adequate anticonvulsant (taking into account the epileptic syndrome, type of seizures, possible side effects of the drug).
Explain to parents the potential risks of using the chosen drug and when they need to see a doctor.
Main indications for use:
anticovulsants:

1. Treatment of patients with exactly established diagnosis“epilepsy” (presence of repeated unprovoked seizures, exclusion of seizures of non-epileptic origin)
2. Treatment of patients with one paroxysm (presumptive diagnosis of epilepsy) with a combination of the following symptoms:
· The patient has a history of febrile seizures;
· Presence of a family history of epilepsy;
· Impaired mental function;
· Focal neurological symptoms;
· When identifying “epileptiform” EEG patterns.
3. Treatment of patients with one or more provoked attacks due to an acute disease or condition (encephalitis, withdrawal syndrome, use of convulsants) - while treatment of the underlying disease continues
4. Preventative treatment patients with diseases or conditions that have high probability occurrence of seizures or epilepsy (cranial trauma, neurosurgical intervention, stroke, encephalitis) - anticonvulsant therapy should be started only when epileptic paroxysms occur

Selection of antiepileptic drugs depending on the types of seizures

possible worsening or worsening of seizure frequency with the use of certain antiepileptic drugs (pERUCCA ET AL., 1998)

A drug
Syndrome
Seizures that may worsen
Carbamazepine
Absence epilepsy
Juvenile myoclonic epilepsy
Progressive myoclonic epilepsy
Rolandic epilepsy Absences, myoclonus
Myoclonic seizures
Myoclonus
Peak-wave complexes during slow-wave sleep, negative myoclonus
Phenytoin
Absence epilepsy
Progressive myoclonic epilepsy Absence seizures
Cerebellar symptoms
Phenobarbital
Absence epilepsy
Absence seizures - in the presence of high doses
Benzodiazepines
Lennox-Gastaut syndrome
Tonic seizures
Lamotrigine
Severe myoclonic epilepsy
Juvenile myoclonic epilepsy When given in high doses
Myoclonic seizures
Vigabatrin Absence epilepsy

Myoclonus
Gabapentin
Absence epilepsy
Epilepsy with myoclonus Absence seizures
Myoclonus