Epilepsy. Causes, symptoms and signs, diagnosis and treatment of pathology
Exam questions (therapeutic):
2.26. Epilepsy: etiology, pathogenesis, classification (types of seizures and forms of epilepsy). Epistatus.
2.27. Partial epilepsies: etiology, clinical picture, treatment, examination of work ability
2.28. Epilepsy: clinical picture of generalized forms, principles of therapy.
Epilepsy and epileptic syndromes
Epilepsy- a chronic polyetiological disease of the brain, characterized by repeated unprovoked epileptic seizures (convulsive or non-convulsive), resulting from excessive electrical activity of a group of neurons that spontaneously arise in various parts of the cerebral cortex and are accompanied by a variety of clinical and paraclinical symptoms. Prevalence in the population - 0.8-1.2%
Epilepsy- a chronic disease of the brain, characterized by repeated unprovoked attacks of disturbances in motor, sensory, autonomic, mental or mental functions resulting from excessive neural discharges (Mukhin, Petrukhin).
1. Terminology:
- Epileptic reaction- an epileptic seizure that occurs in response to extreme influences or situations.
- Epileptic syndrome- repeated epileptic seizures occurring against the background of an actual brain disease
- Epileptic seizure consists of:
1) Aura is the earliest stage of an attack and the only one that the patient remembers
2) Ictal period (ictus - attack, seizure) - clinical convulsions directly
3) Postictal period - the period immediately after seizures
4) Interictal period - the interval between seizures
- Epileptic aura -
1) signs:
Directly precedes loss of consciousness and which the patient remembers after his recovery
- short duration(a few seconds - a few minutes),
- specificity symptoms indicating the involvement of a specific area of the brain in the process - somatosensory, visual, auditory, olfactory, gustatory, epigastric, mental.
- stereotypicality
2) types:
Somatosensory - paresthesia, numbness,
Visual - photopsia, hallucinations
Auditory - ocoasmas, hallucinations
Olfactory;
Flavoring;
Dizziness;
Epigastric (unpleasant sensations in the epigastrium)
Mental (anxiety, fears, complex hallucinations)
- Generalized attack- epileptic seizure due to initially generalized bilateral neural discharges without an epileptic focus,
- Partial (focal, focal, local) attack- an epileptic attack due to focal neuronal discharges from a more or less localized area (epileptic focus) of one hemisphere.
- Automatisms- coordinated involuntary motor act, stereotypic behavior during an attack:
1) oroalimentary(repeated opening or closing of the mouth, chewing, smacking, swallowing, licking lips),
2) facial expressions(grimaces, smile, forced laughter - gelastic attack),
3) gesture(usually in the hands in the form of grasping, rolling movements),
4) outpatient(movements of the trunk or the whole body - repeatedly sits down, stands up, can run or walk),
5) verbal(vocalization or stopping of speech),
6) pedaling.
2. Etiology:
Genetic;
Brain dysgenesis;
Mesial temporal sclerosis (hippocampal sclerosis);
Vascular diseases of the brain;
Pre- and perinatal lesions of the nervous system;
Traumatic brain injury;
Brain tumors;
Degenerative diseases of the central nervous system;
Infections;
Metabolic disorders, intoxication.
Effect of toxic substances and allergens
Hereditary diseases (neurofibromatosis, tuberous sclerosis)
3. Pathogenesis:
- Phases of epileptogenesis - formation of an epileptogenic focus - formation of a primary epileptic focus - formation of epileptic systems - epileptization of the brain:
- Increased excitability and spontaneous depolarization of neurons:
1) channelopathies Ca++, Na+, K+, Cl-
2) excessive synthesis and release of glutamate and aspartate, formation of autoantibodies to non-NMDA (N-methyl-D-aspertate) glutamate receptors,
3) reduction in the synthesis and release of GABA into the synaptic cleft, mechanical damage to GABA-A receptors
4. Classification of epileptic seizures:
- International Classification of Epileptic Seizures (ILAE, 1981):
1) Partial (focal, local) seizures- start locally
1. Simple partial seizures occurring without impairment of consciousness (!)
- Motor seizures: 1) focal motor without march; 2) focal motor with march (Jacksonian); 3) adversive (tonic abduction of the head and eyes); 4) postural; 5) phonatory (positive - vocalization, speech automatisms or negative - speech cessation, paroxysmal dysarthria/aphasia)
- Sensory seizures or seizures with special sensory symptoms (simple hallucinations): 1) somatosensory; 2) visual; 3) auditory; 4) olfactory; 5) taste; 6) dizzy
- Seizures with vegetative-visceral manifestations(accompanied by epigastric sensations, sweating, redness of the face, constriction and dilation of the pupils)
- Seizures with mental dysfunction(changes in higher nervous activity); rarely occur without impairment of consciousness, more often they manifest themselves as complex partial seizures: 1) dysphasic; 2) dysmnestic (for example, a feeling of “already seen”); 3) with impaired thinking (for example, a dreamy state, impaired sense of time); 4) affective (fear, anger, etc.); 5) illusory (for example, macropsia); 6) complex hallucinatory (for example, music, scenes, etc.)
2. Complex partial seizures(with impaired consciousness (!), can sometimes begin with simple symptoms).
- Simple partial seizure followed by loss of consciousness: 1) begins with a simple partial seizure followed by loss of consciousness; 2) simple partial seizure with automatisms
- Actually complex partial seizure(starts with a disturbance of consciousness): 1) simple partial seizure + disturbance of consciousness, 2) simple partial seizure + motor automatism.
3. Partial seizures with secondary generalization(tonic-clonic, tonic, clonic).
- Simple
- Complex partial seizures turning into generalized ones
- Simple partial seizures, turning into complex and then generalized
2) Generalized seizures (convulsive and non-convulsive ) - bilateral symmetrical and without focal onset
1. Absence seizures(petit mal)
- Typical absence seizures- generalized attacks, accompanied by a short-term loss of consciousness, arrest of gaze and the presence on the EEG of specific patterns in the form of generalized regular “spike-wave” complexes with a frequency of 3 Hz (the beginning and end of the attack is sudden, the aura is not, the automatisms are simple, the disturbance of consciousness is deep , postictal state - normal, duration - up to 20 seconds)
- Atypical absence seizures - changes in tone are more pronounced than with typical absence seizures, the onset and (or) cessation of seizures does not occur suddenly, but gradually; on the EEG - irregular slow peak-wave activity with a frequency of less than 2.5 Hz, generalized, but asymmetrical (the onset and end of the attack is gradual, aura - often, automatisms - complex, stereotypical, impaired consciousness - partial, postictal state - confusion, duration - more than 20 sec)
2. Myoclonic seizures- rapid single or repeated twitching of individual muscle groups (myoclonus) of the head, neck, and limbs.
3. Clonic seizures- rhythmic twitching of limbs or various muscle groups.
4. Tonic seizures- fixed posture with flexion of the upper limbs and extension of the lower or focal in the form of tonic tension of the head, flexion or extension of one limb, tonic rotation of the eyes.
5. Tonic-clonic seizures(grand mal) - sudden loss of consciousness, screaming, then apnea, tongue biting, tonic, then clonic convulsions, in the relaxation phase - loss of urine. The duration of the attack is usually no more than 1.5-2 minutes, after which there is a confused state of consciousness, sleep for several hours, amnesia, psychomotor agitation, and a twilight state of consciousness. The EEG shows rhythmic discharges with a frequency of 8-14 per second, initially low and then high amplitude, phenomena such as peak-wave, polypeak-wave.
6. Atonic (astatic) seizures- a sudden decrease in muscle tone throughout the body or individual parts of the body, which may be accompanied by a fall
3) Unclassified epileptic seizures(seizures that cannot be included in any of the above groups due to lack of necessary information, as well as some neonatal seizures, for example, rhythmic eye movements, chewing, spitting movements)
4) Long-lasting or repeated attacks ( status epilepticus)
- Report Commission on Classification and Terminology (ILAE, 2001)
1) Cself-limitingattacks:
1. Generalized:
Tonic-clonic (including variants of onset with clonic or myoclonic phase)
Clonic (with or without a slight tonic component)
Tonic
Atonic
Typical absence seizures
Atypical absence seizures
Myoclonic absence seizures
Epileptic spasms
Epileptic myoclonus
Eyelid myoclonus (with or without absence seizures)
Myoclonic-atonic (myatonic)
Negative myoclonus
Reflex generalized
2. Focal:
Focal sensory (with simple symptoms associated with irritation of the occipital or parietal lobe or with complex symptoms associated with irritation of the temporo-parietal-occipital cortex)
Focal motor: clonic, asymmetric tonic (associated with irritation of the additional motor area), with typical automatisms, with hyperkinetic automatisms, with focal negative myoclonus, inhibitory
Gelastic
Hemiclonic
Secondarily generalized
Reflex focal
2) Continued attacks.
1. Generalized status epilepticus
Status of generalized tonic-clonic seizures
Status of clonic seizures
Absence status
Tonic seizure status
Myoclonic seizure status
2. Focal status epilepticus.
Kozhevnikovskaya epilepsy
Continued aura
Status of limbic seizures (psychomotor status)
Hemiconvulsive status with hemiparesis
3) Provoking factors during reflex attacks.
Visual stimuli: flickering light (preferably specify color), photosensitivity pattern, other visual stimuli
Thought Process
Execution of movements
Somatosensory stimuli
Proprioceptive stimuli
Hot water
Sharp sound (startl - attacks)
5. Classifications of epilepsies and epileptic syndromes
- ILAE, 1989 (New Delhi, USA)
1) Epilepsy and epileptic syndromes associated with a specific localization of the epileptic focus (focal, local, partial epilepsy):
1.1. Idiopathic locally caused epilepsy (associated with age-related characteristics) - for example. Rolandic.
1.2. Symptomatic locally - caused epilepsy - eg. Kozhevnikovskaya.
1.3. Cryptogenic locally - caused epilepsy.
2) Generalized epilepsy and epilepticsyndromes:
2.1. Idiopathic generalized epilepsy (associated with age features) - e.g. juvenile myoclonus epilepsy.
2.2. Generalized cryptogenic epilepsy (associated with age features) - e.g. Lennox-Gastaut, Vesta.
2.3. Generalized symptomatic epilepsy and epileptic syndromes:
2.3.1. Generalized symptomatic epilepsy of nonspecific etiology (associated with age-related characteristics).
2.3.2. Specific syndromes.
3) Epilepsy or epileptic syndromes that cannot be classified as focal or generalized:
3.1. Epilepsy or epileptic syndromes with generalized And focal seizures - eg. Landau-Kleffner.
3.2. Seizures that cannot be clearly defined as generalized or focal.
4) Special syndromes:
4.1. Seizures associated with a specific situation - e.g. febrile seizures.
4.2. Single seizures or status epilepticus.
- ILAE, 2001 (Buenos Aires, Argentina)
1) Idiopathic focal epilepsies of infancy and childhood.
1. Benign infantile seizures (non-familial)
2. Benign childhood epilepsy with central temporal spikes (rolandic)
3. Benign occipital epilepsy of childhood with early onset (Panayotopoulos type)
4. Benign occipital epilepsy of childhood with late onset (Gastaut type)
2) Familial (autosomal dominant) focal epilepsies.
1. Benign familial seizures of newborns
2. Benign familial attacks of infancy
3. Autosomal dominant nocturnal frontal lobe epilepsy
4. Familial temporal lobe epilepsy
5. Familial focal epilepsy with variable focus (*)
3) Symptomatic (or probably symptomatic) focal epilepsy.
1. Limbic epilepsy
Mesial temporal lobe epilepsy with hippocampal sclerosis
Mesial temporal lobe epilepsy due to specific etiology
2. Neocortical epilepsy
Rasmussen syndrome
Hemiconvulsive-hemiplegic syndrome
Migratory partial seizures of early infancy (*)
Other forms of specific localization and etiology
4) Idiopathic generalized epilepsy.
1. Benign myoclonic epilepsy of infancy
2. Epilepsy with myoclonic-astatic seizures
3. Childhood absence epilepsy
4. Epilepsy with myoclonic absence seizures
5. Idiopathic generalized epilepsy with variable phenotype
Juvenile absence epilepsy
Juvenile myoclonic epilepsy
Epilepsy with isolated generalized tonic-clonic seizures
6. Generalized epilepsy with febrile seizures plus *
5) Reflex epilepsy.
1. Idiopathic photosensitivity occipital epilepsy
2. Other forms of epilepsy with seizures arising from visual stimulation
3. Primary reading epilepsy
4. Startle epilepsy
6) Epileptic encephalopathy(in which epileptiform activity on the EEG can lead to the progression of neurological disorders).
1. Early myoclonic encephalopathy
2. Ohtahara syndrome
3. West syndrome
4. Dravet syndrome
5. Myoclonic status in non-progressive encephalopathies (*)
6. Lennox-Gastaut syndrome
7. Landau-Kleffner syndrome
8. Epilepsy with continued spike-wave activity during slow-wave sleep
7) Progressive myoclonus epilepsy - with specific diseases (such as Lafora, Unferricht-Lundborg diseases, neuronal ceroid lipofuscinosis, etc.)
8) Seizures for which the definition of “epilepsy” is not necessary.
Benign seizures in newborns
Febrile seizures
Reflex attacks
Seizures associated with alcohol withdrawal
Seizures caused by drugs or other chemical agents
Seizures occurring immediately after or early in the course of traumatic brain injury
Single attacks or single series of attacks
Rarely recurring seizures (oligoepilepsy)
6. Additional research data:
- EEG. The most characteristic pattern of pathological changes in the EEG for epilepsy are peaks, sharp waves, and peak-wave complexes. Pathological bioelectrical activity, as a rule, appears during a seizure, and in the interictal period under normal recording conditions it is recorded in 60-70% of patients. The use of various methods of provocation (rhythmic light stimulation, hyperventilation, administration of convulsive drugs, and especially daily sleep deprivation) increases the number of patients with an epileptic EEG pattern to 80-90%.
- Neuroimaging methods(MRI) - in the diagnosis of symptomatic epilepsy, however, visualization of brain structures often reveals local changes (atrophy, cysts, etc.) in idiopathic or locally caused cryptogenic form;
Ophthalmological examination;
Experimental psychological research.
7. Stages of establishing a diagnosis.
Description of the paroxysmal event (possibly based on history)
Classification of the attack (history, visual observation, EEG)
Diagnosis of a form of epilepsy (clinical + EEG + neuroimaging)
Establishment of etiology (MRI, karyotype)
Diagnosis of concomitant diseases and determination of the degree of disability
8. Differential diagnosis
- Identification of the symptomatic nature of epilepsy:
1) Idiopathic forms
Genetic predisposition and 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
Relatively favorable prognosis with therapeutic remission achieved in the vast majority of cases
2) Symptomatic forms
Presence of an underlying disease
Focal neurological symptoms
The presence of cognitive or intellectual-mnestic impairments in patients
Regional (especially prolonged) slowing on the EEG
Local structural abnormalities in the brain on neuroimaging
Relatively poor prognosis
- Differentiation of an epileptic seizure and non-epileptic paroxysm:
A) syncope of various etiologies(reflex, cardiogenic, with hyperventilation syndrome, caused by circulatory insufficiency in the vertebral-basilar basin, with the syndrome of progressive autonomic failure, dysmetabolic, etc.) - always situationally confined (fright, the sight of blood, stuffy room), precursors in the form of general autonomic disorders, traumatic body damage is rare, gradual recovery from the attack with general vegetative symptoms
b) demonstrative hysterical attack;
c) endocrine disorders (hypoglycemia, etc.);
d) tetany;
e) febrile convulsions.
9. Epilepsy therapy
- Basic principles of pharmacotherapy for epilepsy:
1) continuity;
2) duration(at least 3-5 years after the last seizure);
3) differentiated selection of antiepileptic drugs (AEDs), taking into account their primary effectiveness for various types of seizures;
4) complexity treatment (a combination of anticonvulsants with the psychostimulant sydnocarb, biostimulants, vitamins, and, if necessary, detoxification therapy).
- Indications for hospitalization:
1) first-time epileptic seizures in an adult (to identify etiological factors, clarify the nature of the frequency of seizures, select drugs, develop an adequate treatment regimen);
2) decompensation - a sharp increase in seizures; serial seizures, status epilepticus, twilight disorder of consciousness;
3) the need for surgical treatment (in a neurosurgical hospital).
- Drugs of choice depending on the type of seizure:
1) Partial: 1) Carbamazepine, Valproate, Lamotrigine, 2), Gabapentin, Phenytoin, 3) Topiramate
2) Primary generalized:
Tonic-clonic: 1) Valproate, Lamotrigine, 2), Carbamazepine, Phenobarbital, 3) Topiramate, Benzdiazepines
Myoclonic: 1) Valproate, 2) Topiramate, 3) Benzdiazepines
Absence seizures: 1) Valproate, 2) Ethosuximide, 3) Topiramate, Benzdiazepines
3) Secondary generalized: 1) Carbamazepine, Valproate, Lamotrigine, 2) Phenytoin, 3) Topiramate, Benzdiazepines
4) Undifferentiated: 1) Valproate, 2) Topiramate, 3) Benzdiazepines
Status epilepticus
Status epilepticus- a condition that occurs after multiple repeated and much less often - against the background of one ongoing seizure. Factors contributing to the emergence of the status: infectious and somatic diseases, alcohol intoxication (withdrawal period), sudden interruption in the treatment of epilepsy, sleep disturbance, etc. In the case of a major seizure, each subsequent attack occurs against the background of impaired consciousness. The status of seizures can be generalized, partial one-sided, accompanied by severe respiratory distress, increased blood pressure, tachycardia, and hyperthermia. Possible coma.
Epistatus therapy:
0. IV administration: Depakine - 400 - 800 mg
1. IV drip administration: Diazepam 100 mg per 500 ml of 5% glucose
2. IM administration: sodium thiopental, sodium hydroxybutyrate 100 mg/10 kg body weight
3. IV administration: lidocaine 100 ml per 250 ml 5% glucose
4. Inhalation anesthesia with muscle relaxants
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 convulsive attack can be caused by various factors, such as intoxication, high temperature, 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 be observed in people who do not suffer from the disease in question. According to the evidence of most scientists, epileptic signs in humans appear only when a certain area of the brain is damaged. Affected, but retaining some vitality, brain structures turn into sources of pathological discharges, which cause epilepsy. 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 event 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 epileptic seizures 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 in 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 (for example, hypoxia) or premature birth and associated low birth weight of the newborn;
- thromboembolism;
- abnormalities of brain structures or cerebral vessels at birth;
- brain bleeding;
- cerebral palsy;
- 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 different classifications of 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, mood and speech disturbances 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 of the eyeballs or twitching of the eyelids, vegetative-vascular dysfunction (dilated pupils, increased heart rate and breathing, pale skin) may be noted. 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 disturbance or changes 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 should you do in this case, how can you help him avoid serious 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 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, laboratory tests and a medical opinion are necessary, and if it is a repeated attack, 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;
- changes 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: an individual approach, differentiated selection of pharmacopoeial agents 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 medications with 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 the beginning of treatment, 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.
Today it is no longer a secret how the symptoms of epilepsy manifest themselves in general: a seizure is really easy to distinguish from a stroke, migraine attack and other brain diseases. However, often the symptoms do not manifest themselves in full, they are preceded by an aura; in men, epileptic seizures themselves may occur more often than in women, while in young children, Rolandic or another form of epilepsy does not cause an attack at all. It will be useful to read about all the symptoms and remember how certain signs differ.
General facts about epilepsy
- Epilepsy comes from the Greek epilepsia - “caught, taken by surprise.”
- Another name for an epileptic seizure is “falling”.
- This disease affects not only people, but also animals: dogs, cats, and mice also exhibit epilepsy.
- The first cases were recorded in ancient times; it is known that Julius Caesar suffered from it.
- Many brilliant people suffered from epilepsy from the initial to the final stage, and even died from it: Napoleon Bonaparte, Peter the Great, the creator of Alice - Lewis Carroll and Fyodor Dostoevsky, the great scientists Alfred Nobel and Nostradamus, politicians Alexander the Great and Winston Churchill.
- They say that Joan of Arc saw her divine visions during an epileptic attack.
People called the signs of epilepsy God's mark in children, although many adults were sent to the stake for it during the Holy Inquisition. The fact is that although the symptoms have been studied, the nature of the disease is not fully understood, that is, it is not always clear what can cause epilepsy. For example, it is considered post-traumatic if it occurs after a traumatic brain injury, but most cases of partial epilepsy, that is, localized, are still genetically determined.
Types of epilepsy and their symptoms
This is not to say that the disease is not treatable. Timely administration of medications allows 65% of patients, both men and women, to be cured without residual manifestations. Of course, a 100% guarantee of treatment is given at the initial stage, when the symptoms are not yet sufficiently developed.
It has been established that epilepsy manifests itself even in sleep and can be transmitted, most often through the male line, although it happens after several generations. There is a risk that the child will receive signs of the disease if the adults had infectious diseases, syphilis, or were intoxicated at the time of conception.
However, many cases of partial epilepsy manifest themselves as a result of acquired factors - after a bruise or stroke, severe cerebral vascular disease, post-traumatic picture, infections or blood poisoning with toxins, etc. We wrote in detail about the reasons separately.
Doctors distinguish several types of epileptic seizures, or rather the disease itself, depending on how its symptoms manifest themselves and what the causes are:
- Idiopathic - primary.
- Cryptogenic - the cause has not been fully established.
- Symptomatic – secondary, its signs have been established.
- Generalized – affecting all parts of the brain.
- Focal – affecting one part of the brain.
Signs of epilepsy can often, but not always, be learned from family history. As a rule, the first symptoms make themselves felt already in childhood, although if the disease is caused by secondary factors, as in the post-traumatic picture, then it may well occur in adults. In any case, congenital epilepsy cannot be fully studied and diagnosed until a person reaches adulthood.
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Big picture symptoms
Perhaps it’s worth starting here with the fact that the patient himself is not fully aware of what is happening to him: an attack can lead to affect or fainting; there are known cases of an attack in a dream. Only with the help of eyewitnesses can one collect symptoms and describe the characteristic picture of the disease.
Epilepsy does not necessarily manifest itself only in the form of a seizure. It happens that the disease has a so-called aura, after which convulsions may not occur at all.
Aura (Greek “blow”) is a state that precedes the onset of a seizure. Manifestations depend on the location of the lesion and are individual in each case. For example, symptoms of temporal lobe epilepsy can cause problems of anxiety and undue worry. Among the signs of an aura are hallucinations, a characteristic déjà vu syndrome, and possible taste, auditory and olfactory hallucinations. Body temperature also increases, pressure and other characteristics of our body change.
In fact, experts classify the disease into three types of seizures, and the clinical manifestations of epilepsy may vary depending on the stage of development of the disease.
Generalized seizure
Also called major, it can occur as a result of a post-traumatic picture, a major stroke, or be genetically determined. From the outside, the symptoms of an attack are described as follows: the patient suddenly freezes, perhaps mid-sentence, then sharply screams or wheezes. His body begins to convulse, and the person does not necessarily lose consciousness. Usually the eyes roll back or are closed as if sleeping, and breathing may be delayed. This attack lasts from a few seconds to 5 minutes.
Then the person regains consciousness, but at the same time he is characterized by involuntary relaxation of the intestines and urination. These seizures are more common in adults than in young children. Absence seizures are more common in babies.
Absence is a type of generalized attack of a short-term nature, lasting up to 30 seconds. Characterized by a loss of consciousness, an “unseeing gaze.” It seems as if the person is in a stupor or deep in thought. The frequency of seizures can vary from one to hundreds per day. An aura is not typical for absence seizures, but can sometimes be accompanied by twitching of a part of the body, an eyelid, or a change in complexion.
Partial seizure
With this type of attack, only part of the brain is involved, which is why it is also called focal. Since increased electrical activity accompanies only a separate focus (for example, in post-traumatic epilepsy with a bruise in one area), the seizures are localized in one part of the body. Or a certain system of the body fails - vision, hearing, etc.:
- The leg may sway rhythmically and the fingers may twitch.
- The hand and foot rotate involuntarily in the joint.
- A person can repeat small movements, especially those that he stopped at before the seizure - adjusting clothes, continuing to walk, repeating the same word, winking, etc.
- A characteristic feeling of confusion and fearfulness appears, which persists after the attack.
How to determine epilepsy: it happens that the seizure is complex. Electroencephalography and MRI are required to determine how many lesions there are and where they are located.
Seizure without convulsions
There is also this type of epilepsy in adults, although it is more common in children. It is distinguished by the absence of convulsions, in which outwardly the person appears frozen, that is, absence seizure occurs. At the same time, other characteristics of the attack may be added, which lead to complex epilepsy and manifest themselves depending on the affected area of the brain.
Usually no attack lasts longer than 3-4 minutes, especially without convulsions. But it can appear several times during the day, which certainly cannot lead to a normal existence. Attacks occur even in a dream, and this is dangerous because a person may choke on saliva or vomit, and his breathing may stop.
Pseudo-seizures and status epilepticus
Status epilepticus is a state of prolonged seizures that follow one after another. There may be pauses between them, or perhaps not. Often occurs in post-traumatic form of the disease.
A few more words about another type of seizure: a state of convulsions deliberately caused by the body, which is staged in nature. It happens that a child tries to attract attention to himself or a person feigns a disability. One way or another, it is possible to distinguish a “pseudo-attack” from a real one. Firstly, no matter how skillfully a person feigns symptoms, after an attack there is always a phase of return to normal. It manifests itself in psycho-emotional lability, which can be seen in the facial muscles. Also, in a state of convulsive seizure, traces of bruises and injuries rarely appear on the body, even if the person hits the ground. Finally, a priori a person cannot be irritable, consciously thinking and demanding something immediately after a seizure. Not to mention the increase in heart rate, blood pressure, and body temperature - it is very difficult to fake such characteristics.
EEG helps to accurately and quickly identify the focus of epilepsy. In order to prevent a pseudo-patient from being treated with specific medications that can bring serious changes to the body, and to provide the real patient with the necessary help, a full examination should be carried out at the first symptoms of the disease.
By the way, doctors do not advise surrounding a person with excessive attention during the treatment process, literally “shaking” over him. Children especially must adapt normally to society, get an education and learn to cope with their illness on their own.
The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question on the topic "frequency of epilepsy attacks" and get a free online doctor’s consultation.
Ask your questionQuestions and answers on: frequency of epilepsy attacks
2012-05-23 17:01:02
Victoria asks:
Good day. My husband has Epilepsy. Over the past year, attacks have become more frequent (once a month). We are seen by a neurologist at our place of residence. Every time after an attack I have to call an ambulance because the hospital cannot prescribe Sibazon. When contacting the PND, they are again sent to the clinic at the place of residence. At the same time, the ambulance is not eager to leave after the first attack, and if they come, they often administer magnesium, after which the attacks are repeated. The attacks are severe. The state of the aura continues from the morning until the last attack (when, after all), sibazon is administered.
Disability is not registered, because the frequency of attacks is “insufficient”. It is also difficult to get a job with such a diagnosis...
Basic questions:
1. Do the clinics have the right to refuse to prescribe sibazon for such a diagnosis?
2. Where in Zaporozhye can you go with questions about treatment. My husband is 28 years old. Effective treatment was possible at his age.
3. Can epilepsy be inherited?
Answers:
Hello, Victoria. I use Sibazon not to treat epilepsy, but to relieve seizures. They will not prescribe him to clinics. Quite often the attacks are difficult to cope with. It is necessary to continue to select the dosage and drug. There is a method for determining the concentration of the drug in the blood. This is important to determine, since you can drink a fairly large dosage, but there will be a minimal amount in the blood, and the attacks will continue. If your attending physician cannot cope with the situation, ask him for a referral to a city or regional specialist. A predisposition to epilepsy can be inherited.
2012-05-04 09:04:23
ELENA asks:
GOOD AFTERNOON.
MY HUSBAND, AFTER AN ISCHEMIC STROKE, APPEARED EPILEPSY ATTACKS. THE FREQUENCY OF ATTACKS IS 3-4 TIMES A YEAR.
WE TAKE FINLEPSIN 2 TIMES 200 PER DAY.
ALSO PRESCRIBED DIACARB. TO TAKE 5 DAYS A MONTH. WHAT CAN YOU REPLACE DIACARB?. IT IS NOT POSSIBLE TO BUY IN MOSCOW.
Answers Maykova Tatyana Nikolaevna:
Elena, Diacarb is not prescribed for such disorders. If the attacks continue, you need to tell the doctor who prescribed the treatment about it. He will either change the dosage or prescribe another drug.
2015-10-04 18:49:27
Angelina asks:
Good afternoon. Tell me what to do... I have no strength to watch the child suffer... My daughter was diagnosed with Rolandic epilepsy in early August. The EEG records the focus of epileptiform oscillations along the left central-temporal branches in the form of an acute-slow wave complex, followed by a slowdown in the rhythm to the theta and delta wave ranges. The first night attack was recorded in March 2015 during the flu (the child woke up at 4 in the morning, his nose was very stuffy, Nazivin was dropped, the daughter fell asleep, 15 minutes later we woke up from quiet sobs - the daughter was lying with her head thrown back and was suffocating, her face was very . pale, there was a gurgle in her throat, after the attack the daughter could not speak normally for about 1 minute) the pediatrician diagnosed this as laryngospasm, the second attack with the addition of vomiting happened at the beginning. August of this year - lasting about 5 minutes. We went to the doctor and did an EEG, which confirmed our fears. MRI is clear. Ospolot 150 therapy was prescribed for a weight of 22,500 kg. After a week of taking the drug, behavior problems began to clearly manifest themselves: she does not particularly respond to commands, is very whiny, apathetic, and sometimes touchy for no reason. Appointed + Ignacia. At night, 10 twitches of the limbs began to be observed. And it started to worsen - nightly distortions of the mouth and tongue spasms appeared. During wakefulness, drowsiness and apathy. On September 18, there was an attack with multiple convulsions on the right side of the face, which began with twitching of the mouth, wings of the nose and spread to the eye. Specific wheezing and shortness of breath appeared. After this, the night twitches became more frequent up to 30-40 per night (mainly when falling asleep and before waking up in the morning). A few days later at 4 am there was a strong attack of the larynx, tongue and whole body with shortness of breath and loss of speech ability for 1-2 minutes. after an attack (duration 5 minutes). This is against the background of a sluggish current acute respiratory infection with nasal congestion and Nazivin drops. We contacted the doctor several times, she convinced me that this is possible with EC, but as far as I understand, such a course of the disease is not typical for classical EC. After overnight monitoring (“in a state of drowsiness, epipatterns sharply increase in frequency to the status course”), therapy with ospolot was determined to be ineffective and the drug Convulex ratord was prescribed, 500 per night, once a day. days. 4 days ago we began a smooth transition from one medication to the second, but the frequency of night twitching increased greatly, frequent twitching of the eyelids appeared (20 minutes with a break of 15 minutes), chewing of the tongue, sharp turns in sleep of both the whole body and the head. Small twitches are characteristic of the period after falling asleep, and after 2 am, almost continuous convulsive manifestations begin. The child wakes up tired, sleepy all day, apathetic, does not want to communicate with children, reacts sharply to every irritant, with screams, sometimes begins to confuse letters in words without paying attention to it, grimaces, chews his lips (this is almost a year now, pulls earrings) . Everything is happening with a rapid increase... Today I called the doctor, the doctor said that I need to quickly switch to Convulex within 2 days. Please tell me if this is possible with RE, I have very serious doubts about this. Comment on the decision regarding rapid switching, drug, and dose. What other tests can be done for the cause of E and where (the doctor does not support me in this endeavor)... How effective is the ketone diet and what are its consequences for a child with an enlarged thyroid. glands, moderate heart failure, pancrenopathy... We so need hope...
Answers Starish Natalya Petrovna:
In this case, it makes sense to consider switching to another drug as more effective in your case. I can’t write you a dose on the Internet - it would be wrong and unprofessional. The ketone diet is not entirely appropriate for your concomitant pathology; it is possible to use some of its elements under the supervision of doctors, but not on your own! In order to decide on further examination, answer my questions: How old is the child? How was the pregnancy, what was the birth like? Was there intrauterine umbilical cord entanglement?
2013-11-25 13:38:55
Marina asks:
Hello. My son is 21 years old and has been suffering from epilepsy since he was 5 months old. The attacks were generalized with loss of consciousness. They were repeated every 2 months, i.e. then at 7,9,11 months. It was not big t37.8
After a year, the attacks became more frequent and without fever. At the beginning, they took phenoborbital for 10 days after the attack and that’s it.
Subsequently there were: finlepsin, antilepsin, depakine, convulex, lamictal, carbamazepine and God knows what else. The frequency of seizures was 1-2 per week. The full moon and new moon always influence. At 2 years old they were in Moscow at the institute of pediatrics and surgery in the department .genetics. Discharged with nothing!!!Drink FINLEPSIN.
In Barnaul, they underwent a Holter examination and were prescribed Depakine 300. They took 3 tablets. 3p/d
At the moment we are in Crimea.
He was repeatedly in a hospital in Simferopol for a selection of medications, he was loaded to the fullest, i.e. he could not move, talk, and was nauseous. The selection did not lead to anything. MRI - without deviations, EEG shows convulsive readiness and adhesions.
Wow. What should I do???? Where can I find a specialist or just get a good examination?
Every month they take him to the ambulance, he falls and breaks, they stitch him up. Mainly his right eye and eyebrow... everything has been stitched up, his nose is broken, his tooth is broken...
A local neurologist advised me to buy KEPRA, it’s an expensive drug, but what if it doesn’t help again???
Today, for a couple of months, we have been taking CARBOMOSEPINE for ourselves as a distraction, because... it's cheap...
Help! Tell me where to go? Maybe surgery?
He is registered with a psychiatrist. D/D-dementia as a result of epilepsy, schizophrenia.
For 21 years we have not been able to find medications.
Longest interval between seizures: 10 days
Answers Kachanova Victoria Gennadievna:
Hello, Marina. The situation is complicated. I can recommend Professor Stanislav Konstantinovich Yevtushenko in Donetsk. He has a website on the Internet where you will find contact numbers.
2013-05-08 11:22:43
Olga asks:
Hello, I'm 23 years old. 04/5-6/2013, in a dream it happened, as they wrote to me in the ambulance, “convulsive syndrome of unspecified origin”, this was the first attack, it lasted for about a minute, I bit my lip, I felt pain, after that the muscles of my legs hurt, and there was either drooling or something foam from the mouth, the ambulance took me, the pressure was normal, they released me, my health the next day was normal. I did a CT scan of the brain: no foci of pathological density were detected, an almost symmetrical slight expansion of the cerebellar systems: bodies of the lateral ventricles 11 mm, convexital intrathecal spaces 6 mm (mainly over the fronto-parietal regions, cerebellar hemispheres up to 2 mm), Sylvian fissures 6 mm. The 3rd ventricle of the brain is not dilated, the 4th is slightly dilated (index 14.8 is normal to 13). Skull without destruction. Conclusion: CT signs of encephalopathy (discircular), atrophic changes in the cerebrum and cerebellum (as the neurologist later said, he looked at the disc and he didn’t see any atrophy there). I also did two EEGs (from different doctors)… 1st: regional features are somewhat smoothed out. Alpha-like activity with a frequency of 9 Hz and an amplitude of up to 50 microvolts is unmodulated and expressed in the caudal leads. The reaction to afferent stimuli is somewhat smoothed out. As a result of hyperventilation, several flashes of waves in the theta range lasting 1 second ampl. were recorded. up to 140 MKV with an emphasis either in the left or in the right caudal region. There is no clear evidence for seizure activity. On the EEG, against the background of mild general cerebral changes in the biocurrents of the brain, dysfunction of deep structures. 2nd: the background recording is dominated by regular alpha rhythms (9-10 Hz, up to 60-80 μV) and low-amplitude beta, with the preservation of regional features and the reaction of rhythms to afferent stimulation. On hyperventilation – moderate diffuse disorganization of rhythms. No paroxysmal activity or focal changes were detected. Conclusion: some dysfunction of the deep structures of the brain. After the attack, she didn’t take anything, and then exactly a month later the attack happened again in the middle of the day (they wrote an epileptic attack of a generalized nature), I bought it at the market, cramps, muscles hurt, bit my cheeks, then my head hurt badly and that’s it. day as if slow. I'm confused! They prescribed me Depakine-Chrono 500, 1.5 t at night and a healthy lifestyle, a month later, check the concentration of the drug in the blood and repeat the EEG. But I don’t know the reason, where did it come from!!!??? There were no injuries, no serious illnesses, I play sports, study well, graduate from college (maybe this is due to nervousness? ....although I didn’t notice that I was particularly worried...)!!! A year ago I noticed such a momentary state, I can go on public transport, read shop windows, talk, watch TV, the words in my head begin to get confused, I can’t say anything, I’m in a stupor, after a minute everything goes away…. Can you somehow comment on my condition? Is the treatment prescribed correctly? I really want to know the reason why epilepsy comes from??! Thank you =)
Answers Maykova Tatyana Nikolaevna:
Olga, the cause of epilepsy is the innate ability of brain neurons to simultaneously excite. There are several more subtle mechanisms, but we can only influence them with the help of medications. Therefore, do not bother looking for the cause; no one can cure epilepsy, but it can go away on its own. Get treatment, the treatment is correct, just split your depakine intake into 2 doses.
2012-07-28 10:36:49
Sergey asks:
Hello. I had a head injury 10 years ago. severe craniocerebral. After it, 5 years later, I had one attack similar to epilepsy. There were no more such strong attacks, but there were still incomprehensible ones during which you get lost for 10-20 seconds. I am aware of where I am and who is nearby, but it’s hard to say anything on the topic. I went to the doctors and they said epilepsy. I had all the MRI done and was prescribed carbamazepine. I’ve been taking it for a year now. These attacks have decreased in frequency and now occur once every 2-3 months, but they still exist. Doctors say take pills and that’s it. What to do and maybe it’s not epilepsy?
Answers Yatsenko Ekaterina Valentinovna:
Dear Sergey, after a severe traumatic brain injury, episyndrome quite often occurs. To stop seizures, it is necessary to select a combination and dosage of anticonvulsants (this is the competence of a neurologist).
2010-11-23 19:23:28
Elena asks:
I have had epilepsy since I was 13.5 years old (this is the doctors’ diagnosis). Now I’m 26. I took all kinds of pictures of my head (REG, EEG, NMR, etc.) Shows that everything is in order. I took Finlepsin for several years, but came off it on my own because... I started having liver problems. The drug did not produce any results, the attacks were repeated with varying frequencies.
I want to get pregnant. Are there any specialists I could see in Mariupol? What is the likelihood of deformities?
Answers Kachanova Victoria Gennadievna:
Hello, Elena. The situation is complicated. Your antiepileptic drug and dose have not been selected. It’s bad that you were self-medicating. You do not write with what frequency the attacks occur. I don’t have information about specialists in Mariupol. There are epileptologists in Donetsk who deal with this problem. Any antiepileptic drug has a teratogenic effect on the fetus, to a greater or lesser extent. Everything is decided individually.
2010-09-11 18:16:47
Anna, 26 years old, asks:
It all started with a moment of insanity in childhood, but I did not lose consciousness. Two years ago, seizures similar to epilepsy began. I was in the hospital twice, they gave me IVs, but nothing helped. Conducted examinations: EEG, MRI, computer. brain tomography. - Everything is normal, no abnormalities or pathologies were found, the diagnosis is healthy. The attacks continued, and later in another clinic a diagnosis was made: arachnoencephalitis. For a year, as prescribed by doctors, I took benzonal and still don’t remember anything strong. The attacks continued without reducing their frequency and intensity. After a year of treatment, I became desperate and voluntarily stopped taking the medications - it became a little easier, but the attacks continued. I discovered a pattern: the first attack occurs exactly two weeks after the start of menstruation. Then, the attacks continue for about a week, gradually weakening. Then they are completely gone until the next repetition. During an attack, the face turns blue, saliva is released and consciousness completely disappears, accompanied by severe convulsions with the head thrown back. The period of onset of attacks is accompanied by severe headaches in the temples and eyes. Doctors contradict each other, make contradictory diagnoses and cannot help. Help, please, if you know what's going on here?
