Epilepsy diagnosis. How is epilepsy related to sex life? General facts about epilepsy

However, often the symptoms do not fully manifest themselves; they are preceded by an aura; in men, the cases themselves may occur more often epileptic seizure 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 in the stage epileptic seizure.

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 partial epilepsy, that is, localized and still determined genetically.

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:

1. Idiopathic - primary.
2. Cryptogenic - the cause has not been fully established.
3. Symptomatic – secondary, its signs have been established.
4. Generalized – affecting all parts of the brain.
5. 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.

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.
• Appears characteristic sensation confusion, fearfulness, 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 following 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 intentionally 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 treatment of a pseudo-patient with specific medications that can bring serious changes to the body, and to provide treatment to a real patient necessary help, at the first symptoms of the disease you should undergo a full examination.

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.

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The information presented on the site is for informational purposes only and does not replace qualified medical care and is not intended for self-diagnosis and self-treatment. Selection and purpose medicines, treatment methods, as well as control over their use can only be carried out by the attending physician. Be sure to consult a specialist.

Epilepsy

Epilepsy

Epilepsy is a condition characterized by repeated (more than two) epileptic seizures that are not provoked by any immediately identifiable causes. An epileptic seizure is a clinical manifestation of an abnormal and excessive discharge of brain neurons, causing sudden transient pathological phenomena (sensory, motor, mental, vegetative symptoms, changes in consciousness). It should be remembered that several epileptic seizures provoked or caused by any distinct causes (brain tumor, head injury) do not indicate the presence of epilepsy in the patient.

Classification of epilepsy attacks

According to international classification Epileptic seizures are divided into partial (local, focal) forms and generalized epilepsy. Attacks of focal epilepsy are divided into: simple (without disturbances of consciousness) - with motor, somatosensory, autonomic and mental symptoms, and complex - accompanied by disturbances of consciousness. Primary generalized seizures occur with the involvement of both hemispheres of the brain in the pathological process. Types of generalized seizures: myoclonic, clonic, absences, atypical absences, tonic, tonic-clonic, atonic.

There are unclassified epileptic seizures - which do not fit into any of the types of seizures described above, as well as some neonatal seizures (chewing movements, rhythmic eye movements). There are also repeated epileptic seizures (provoked, cyclical, random) and prolonged seizures ( status epilepticus).

Clinical picture of epilepsy

In the clinical picture of epilepsy, three periods are distinguished: ictal (attack period), postictal (post-ictal) and interictal (interictal). In the postictal period, there may be a complete absence of neurological symptoms (except for the symptoms of the disease causing epilepsy - traumatic brain injury, hemorrhagic or ischemic stroke, etc.).

There are several main types of aura that precede a complex partial attack of epilepsy - vegetative, motor, mental, speech and sensory. The most common symptoms of epilepsy include: nausea, weakness, dizziness, a feeling of constriction in the throat, a feeling of numbness of the tongue and lips, chest pain, drowsiness, ringing and/or tinnitus, olfactory paroxysms, a feeling of a lump in the throat, etc. In addition Moreover, complex partial seizures are in most cases accompanied by automated movements that seem inadequate. In such cases, contact with the patient is difficult or impossible.

A secondary generalized attack usually begins suddenly. After a few seconds, which the aura lasts (each patient has a unique course of the aura), the patient loses consciousness and falls. The fall is accompanied by a peculiar cry, which is caused by a spasm of the glottis and convulsive contraction of the chest muscles. Next comes the tonic phase of an epileptic attack, named after the type of seizure. Tonic convulsions - the torso and limbs are stretched in a state of extreme tension, the head is thrown back and/or turned to the side contralateral to the lesion, breathing is delayed, the veins in the neck swell, the face becomes pale with slowly increasing cyanosis, the jaws are tightly clenched. The duration of the tonic phase of the attack is from 15 to 20 seconds. Then comes the clonic phase of an epileptic attack, accompanied by clonic convulsions (noisy, hoarse breathing, foam at the mouth). The clonic phase lasts from 2 to 3 minutes. The frequency of seizures gradually decreases, after which complete muscle relaxation occurs, when the patient does not respond to stimuli, the pupils are dilated, there is no reaction to light, and protective and tendon reflexes are not evoked.

The most common types of primary generalized seizures, characterized by the involvement of both hemispheres of the brain in the pathological process, are tonic-clonic seizures and absence seizures. The latter are more often observed in children and are characterized by a sudden short-term (up to 10 seconds) stop of the child’s activity (games, conversation), the child freezes, does not respond to a call, and after a few seconds continues the interrupted activity. Patients are unaware of and do not remember seizures. The frequency of absence seizures can reach several dozen per day.

Diagnosis of epilepsy

Diagnosis of epilepsy should be based on medical history, physical examination of the patient, EEG data and neuroimaging (MRI and CT scan of the brain). It is necessary to determine the presence or absence of epileptic seizures according to the medical history, clinical examination of the patient, results of laboratory and instrumental studies, and also to differentiate epileptic and other seizures; determine the type of epileptic seizures and the form of epilepsy. Familiarize the patient with the recommendations for the regimen, assess the need for drug therapy, its nature and the likelihood of surgical treatment. Despite the fact that the diagnosis of epilepsy is based primarily on clinical data, it should be remembered that in the absence of clinical signs epilepsy, this diagnosis cannot be made even in the presence of epileptiform activity detected on the EEG.

Neurologists and epileptologists diagnose epilepsy. The main method of examining patients diagnosed with epilepsy is EEG, which has no contraindications. An EEG is performed on all patients without exception in order to detect epileptic activity. More often than others, such variants of epileptic activity are observed as sharp waves, spikes (peaks), complexes “peak - slow wave”, “sharp wave - slow wave”. Modern methods Computer analysis of EEG allows us to determine the localization of the source of pathological bioelectrical activity. When conducting an EEG during an attack, epileptic activity is recorded in most cases; in the interictal period, the EEG is normal in 50% of patients. On EEG in combination with functional tests (photostimulation, hyperventilation), changes are detected in most cases. It must be emphasized that the absence of epileptic activity on the EEG (with or without the use of functional tests) does not exclude the presence of epilepsy. In such cases, a repeat examination or video monitoring of the EEG performed is performed.

In the diagnosis of epilepsy, the greatest value among neuroimaging research methods is MRI of the brain, which is indicated for all patients with local onset of an epileptic seizure. MRI allows you to identify diseases that affect the provoked nature of seizures (aneurysm, tumor) or etiological factors of epilepsy (mesial temporal sclerosis). Patients diagnosed with pharmacoresistant epilepsy in connection with subsequent referral for surgical treatment also undergo MRI to determine the location of the central nervous system lesion. In some cases (patients old age) additional research is needed: biochemical analysis blood, fundus examination, ECG.

Epilepsy attacks must be differentiated from others paroxysmal conditions non-epileptic nature (fainting, psychogenic seizures, vegetative crises).

Treatment of epilepsy

All treatments for epilepsy aim to stop seizures, improve quality of life and stop taking medicines(at the stage of remission). In 70% of cases, adequate and timely treatment leads to the cessation of epilepsy attacks. Before prescribing antiepileptic drugs, it is necessary to conduct a detailed clinical examination and analyze the results of MRI and EEG. The patient and his family should be informed not only about the rules for taking medications, but also about possible side effects. Indications for hospitalization are: the first epileptic seizure in life, status epilepticus and the need for surgical treatment of epilepsy.

One of the principles of drug treatment of epilepsy is monotherapy. The drug is prescribed in a minimum dose and then increased until the attacks stop. If the dose is insufficient, it is necessary to check the regularity of taking the drug and find out whether the maximum tolerated dose has been reached. The use of most antiepileptic drugs requires constant monitoring of their concentration in the blood. Treatment with pregabalin, levetiracetam, valproic acid begins with a clinically effective dose; when prescribing lamotrigine, topiramate, carbamazepine, it is necessary to slowly titrate the dose.

Treatment of newly diagnosed epilepsy begins with both traditional (carbamazepine and valproic acid) and newer antiepileptic drugs (topiramate, oxcarbazepine, levetiracetam), registered for use as monotherapy. When choosing between traditional and the latest drugs it is necessary to take into account the individual characteristics of the patient (age, gender, concomitant pathology). Valproic acid is used to treat unidentified epileptic seizures. When prescribing this or that antiepileptic drug, you should strive for the minimum possible frequency of taking it (up to 2 times a day). Due to stable plasma concentrations, long-acting drugs are more effective. A dose of the drug prescribed to an elderly patient creates a higher concentration in the blood than a similar dose of the drug prescribed to a young patient, so it is necessary to start treatment with small doses and then titrate them. The drug is discontinued gradually, taking into account the form of epilepsy, its prognosis and the possibility of resumption of attacks.

Drug-resistant epilepsies (continuing seizures, ineffectiveness of adequate antiepileptic treatment) require additional examination of the patient to resolve the issue of surgical treatment. Preoperative examination should include video-EEG recording of seizures, obtaining reliable data on localization, anatomical features and the nature of the spread of the epileptogenic zone (MRI). Based on the results of the above studies, the nature of the surgical intervention is determined: surgical removal of epileptogenic brain tissue (cortical topectomy, lobectomy, hemispherectomy, multilobectomy); selective surgery(amygdala-hippocampectomy for temporal lobe epilepsy); callosotomy and functional stereotactic intervention; vagus stimulation.

There are strict indications for each of the above surgical interventions. They can only be carried out in specialized neurosurgical clinics that have the appropriate equipment, and with the participation of highly qualified specialists (neurosurgeons, neuroradiologists, neuropsychologists, neurophysiologists, etc.)

Prognosis for epilepsy

The prognosis for disability in epilepsy depends on the frequency of attacks. At the remission stage, when attacks occur less frequently and at night, the patient’s ability to work is maintained (with the exception of night shift work and business trips). Daytime epilepsy attacks accompanied by loss of consciousness limit the patient’s ability to work.

Epilepsy affects all aspects of the patient’s life and is therefore significant medical and social problem. One of the facets of this problem is the paucity of knowledge about epilepsy and the associated stigmatization of patients, whose judgments about the frequency and severity of mental disorders accompanying epilepsy are often unfounded. The vast majority of patients who receive proper treatment lead normal lives without seizures.

Prevention of epilepsy

Prevention of epilepsy includes the possible prevention of head injuries, intoxications and infectious diseases, the prevention of possible marriages between patients with epilepsy, and an adequate reduction in temperature in children in order to prevent fever, the consequence of which can be epilepsy.

Epilepsy - treatment in Moscow

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How to identify epilepsy

It is extremely important to determine the type of epilepsy. This can only be done by a highly qualified specialist. Treatment tactics and prognosis of the disease depend on the correct diagnosis. Epilepsy can be determined by the symptoms of an attack. But other research methods also play a big role.

How to Determine Epilepsy by Questioning the Patient

A lot of time is spent interviewing the patient and relatives when diagnosing epilepsy. Therefore, be prepared to give truthful information to your doctor about many things. It is advisable to prepare before consulting with a specialist and write down the answers to the following questions. The doctor will be interested in the smallest details.

1. When did the first epileptic seizures appear? What could have caused the first attack of epilepsy?

2. What provokes an epileptic attack during illness? This may be overwork (both physical and emotional), high temperature (especially in children), lack of sleep, sun glare (flashing different objects before the eyes, for example, riding a carousel), watching TV or computer games, menstruation.

3. Does a seizure attack appear suddenly or gradually?

4. Does the attack occur at a certain time? For example, immediately after waking up or before going to bed, during the day or at night, at home or while walking?

5. Is there a prodromal period (precursor period) in the form of drowsiness, irritability, excitability?

6. What are the manifestations of an attack? Be especially careful here. Every little detail is important: what is the position of the head during an attack, what is the color of the skin, are there eye movements, what are the pupils - are they enlarged, is the body tense or relaxed, are there movements of the arms and legs?

7. How long does the attack last? Is the report in minutes, seconds or hours?

8. How does the patient feel after the attack? Is there vomiting? Does he fall asleep after an attack? Is he relaxed or excited? Is there depression in the post-attack period?

9. What do you usually do to relieve a patient's attack? Do you turn your head to the side? Are you holding your arms and legs? Are you ensuring airway patency? Are you unbuttoning your clothes? Are you opening the window? Are you administering medications?

In addition to interviewing the patient, additional examinations are needed to determine epilepsy.

Laboratory research methods for determining epilepsy

Laboratory tests do not play as big a role in determining epilepsy as instrumental tests, but they also influence the correct diagnosis; they are also necessary during the period anticonvulsant treatment and during the observation period of the patient.

1. Biochemical research blood. Biochemical research is necessary to determine electrolytes, urea, protein, calcium, hormones thyroid gland, glucose, etc.

2. Clinical blood test. In the blood, the doctor will be interested in hemoglobin, the number of leukocytes, platelets, folic acid, blood clotting and vacuolization of lymphocytes and urine.

3. Protein, glucose, hematuria, ketones are determined in urine

4. Genetic research in the form of determining the chromosome set, DNA analysis.

Instrumental research methods for determining epilepsy

Already at the end of the 20th century, new and very informative methods diagnosis and definition of epilepsy, which made a real revolution in medicine. One of the most necessary examinations to determine epilepsy is electroencephalography.

Electroencephalography is an accessible and necessary method for assessing the electrical activity of the brain. EEG allows you to register pathological activity brain and understand what the nature of the convulsions is, is the attack generalized or partial? Thanks to the electroencephalogram, it is possible to determine the effectiveness of the treatment prescribed by the doctor. An electroencephalogram is done during an attack, outside an attack - during sleep and wakefulness. In the non-attack period, the encephalogram may be unchanged. Recently, a method such as electroencephalography-video monitoring has become popular, when an EEG is recorded and a video recording of an epilepsy attack occurs at the same time.

Computed tomography and magnetic resonance imaging of the brain also help to recognize structural changes in the brain (tumor, injury, developmental defects), provoking epileptic attacks.

One of the newest invasive methods Determining epilepsy makes it possible to identify the source of the disease through the introduction of deep electrodes into the patient’s brain. Thanks to modern computer navigation equipment, this study is as accurate as possible, and the technique ensures a high degree of safety for the patient.

Your questions will be answered by:

Tatyana Vezirova - chief coordinator for work with patients

How to identify epilepsy

Hello! Please help, my ex-husband has had epilepsy since childhood and my husband’s father also had epilepsy, I found out about this recently, my ex-husband didn’t tell me anything, we have an 8-year-old son, I’m very worried about how you can determine whether a child is susceptible to epilepsy or not! At birth we were diagnosed with Hypoxic-ischemic paralysis of the central nervous system, does this have anything to do with epilepsy and is it hereditary?

Hello! Yes, epilepsy can be inherited. If one parent has epilepsy, then the chance of their child developing it is about 6%, which is much higher than for most people. At the same time, this suggests that 94% of children will not have epilepsy. Most often, epilepsy develops in a child if the parents’ epileptic seizures were not focal, but generalized.

Hypoxic-ischemic damage to the central nervous system is not directly related to epilepsy, but may be a predisposing factor for its development, taking into account hereditary predisposition at your child.

Depending on the origin, there are three types of epilepsy:

Symptomatic epilepsy is another name for acquired epilepsy. This type of epilepsy can appear in a person due to brain damage due to traumatic brain injury or brain intoxication, infection, congenital defects brain development. This also includes hypoxic-ischemic damage to the central nervous system. Symptomatic epilepsy can appear at any age. It is difficult to treat, but complete healing is possible if its cause is eliminated.

Genuine (idiopathic) epilepsy - this type of epilepsy is inherited. It is not possible to identify the cause, since there is no definite organic damage to the brain. This epilepsy is inherited, but it is not always transmitted and does not have clear transmission mechanisms. Hereditary epilepsy is very difficult to diagnose, so only a geneticist can identify it.

Cryptogenic epilepsy - the causes of this type have not been precisely determined to date. It is possible that this is simply a gene mutation.

Epilepsy cannot be predicted, even if you know that the inherited gene exists. No one will be able to accurately determine whether the disease gene will be passed on from generation to generation, when and where it will manifest itself. Sometimes additional conditions such as trauma, alcoholism, or a severe infection are necessary to activate a pathogenic gene.

Electroencephalography (EEG) is used to diagnose epilepsy. To determine the location of the epileptogenic focus, magnetic resonance and computed tomography methods are used. You may also need to consult a neurologist, epileptologist and geneticist.

Epilepsy, epileptic seizure: causes, signs, first aid, how to treat

Epilepsy is as old as the hills. About her another 5000 years before the birth of Christ, advanced minds ancient egypt left your messages. Not considering it sacred, but associating it with brain damage (BM), strange disease 400 years BC, the great physician of all times, Hippocrates, described it. Many individuals recognized as extraordinary suffered from epileptic seizures. For example, a man endowed with numerous talents - Gaius Julius Caesar, who entered our world 100 years before the start of the new chronology, is known not only for his exploits and achievements, he also did not pass this cup, he suffered from epilepsy. Over the course of many centuries, the list of “friends in misfortune” was replenished by other great people, for whom illness did not prevent them from engaging in public affairs, making discoveries, and creating masterpieces.

In short, information about epilepsy can be gleaned from many sources that have very little to do with medicine, but, nevertheless, refute the established opinion that this disease necessarily leads to personality changes. Somewhere it does, but somewhere it doesn’t, so the concept of epilepsy hides a far from homogeneous group of pathological conditions, united by the presence of a periodically recurring characteristic symptom - a convulsive attack.

Hearth plus readiness

In Russia, epilepsy is called epileptic disease, as has been the tradition since ancient times.

In most cases, epilepsy manifests itself as periodic attacks of loss of consciousness and convulsions. However, the symptoms of epilepsy are diverse and are not limited to the two mentioned symptoms; moreover, seizures occur only with a partial loss of consciousness, and in children they often occur in the form of absence seizures (short-term disconnection from the outside world without convulsions).

What happens in a person’s head when he loses consciousness and begins to have convulsions? Neurologists and psychiatrists point out that the development of this disease is due to two components - the formation of a focus and the readiness of the brain to respond to irritation of neurons localized in this focus.

The focus of convulsive readiness is formed as a result various lesions some area of ​​the brain (trauma, stroke, infection, tumor). A scar or cyst in the brain formed as a result of damage or surgery irritates the nerve fibers, they become excited, which leads to the development of seizures. The spread of impulses to the entire cerebral cortex turns off the patient’s consciousness.

As for convulsive readiness, it can be different (the threshold is high and low). High convulsive readiness of the cortex will manifest itself with minimal excitation in the focus or even in the absence of the focus itself (absence seizures). But there may be another option: the lesion is large, and convulsive readiness is low, then the attack occurs with fully or partially preserved consciousness.

The main thing from a complex classification

Epilepsy according to the International Classification includes more than 30 forms and syndromes, therefore it (and syndromes) is distinguished from epileptic seizures that have the same or more more options. We will not torment the reader with a list complex names and definitions, but let’s try to highlight the main thing.

Epileptic seizures (depending on their nature) are divided into:

• Partial (local, focal). They, in turn, are divided into simple ones, which occur without any special disturbances in brain function: the attack has passed - the person is of sound mind, and complex ones: after the attack, the patient is still disoriented in space and time for some time, and, in addition, he has symptoms functional disorders depending on the affected area of ​​the GM.
• Primary generalized, occurring with the involvement of both hemispheres of the brain, the group of generalized seizures consists of absences, clonic, tonic, myoclonic, tonic-clonic, atonic types;
• Secondary generalized seizures occur when partial seizures are already in full swing; this occurs because focal pathological activity, not limited to one area, begins to affect all areas of the brain, leading to the development of convulsive syndrome and autonomic disorders.

It should be noted that when severe forms disease, individual patients often experience the presence of several types of seizures at once.

Classifying epilepsy and syndromes based on electroencephalogram (EEG) data, the following options are distinguished:

1. Separate form (focal, partial, local). The development of focal epilepsy is based on a violation of the processes of metabolism and blood supply in a particular area of ​​the brain; in this regard, they distinguish between the temporal (impaired behavior, hearing, mental activity), frontal (problems with speech), parietal (motor disorders predominate), occipital (coordination and visual impairment).
2. Generalized epilepsy, which, based on additional studies (MRI, CT), is divided into symptomatic epilepsy (vascular pathology, brain cyst, extensive education) and idiopathic form (the cause has not been established).

Seizures following each other for half an hour or more, which do not allow the patient with epilepsy to return to consciousness, create a real threat to the patient’s life. This condition is called status epilepticus, which also has its own varieties, but the most severe of them is the tonic-clonic epistatus.

Causal factors

Despite the advanced age of epilepsy and good knowledge, the origin of many cases of the disease still remains unclear. Most often its appearance is associated with:

• In newborns and children under one year old, the causes of epilepsy are seen as complications perinatal period, after birth injuries, hypoxia conditions, not excluding genetic factor(metabolic abnormalities).
• U one-year-old babies In older children, epilepsy is often caused by infectious diseases that affect the nervous system (eg encephalitis). An attack of febrile convulsions, which occurs in children at a relatively low temperature (about 38°C), as a rule, tends to recur. In addition, the cause of epileptic seizures in young children, as well as in older children and adolescents, can be traumatic brain injuries and severe stress.
• In people of adolescence and in the prime of life, the appearance of seizures with convulsions and loss of consciousness is often a consequence of traumatic brain injury (TBI), and, either immediately after it, or in distant times, that is, a history of TBI predisposes to the development of epileptic disorders in for many years. Seizures of epilepsy in young people who have crossed the age of 20 and consider themselves absolutely healthy are often the first sign of the development of a bad process - a brain tumor. In such cases they speak of symptomatic epilepsy. The cause of convulsive syndrome, or, as it is called, alcoholic epilepsy, in people who show an immoderate craving for strong drinks, of course, is both alcohol itself and excessive love for it.

4 main causes of severe epilepsy

In adult patients who have reached pre-retirement and retirement age, epilepsy attacks most often occur as a result of vascular pathology central nervous system. Degenerative changes in patients who have suffered an acute cerebrovascular accident, on average in 8% of cases lead to the development of a condition called epileptic syndrome. The disease may develop in patients suffering from osteochondrosis of the cervical spine with the development of vertebrobasilar insufficiency (compression of the arteries and obstruction of blood supply to the brain).

Among all the causes of epilepsy, a genetic factor is also called - cases in the family increase the likelihood of becoming a victim of epilepsy. Currently, thanks to scientific research, the location of the culprit of some variants of this pathology has been found - the gene responsible for the development of convulsive seizures.

It is obvious that, based on the reasons, almost all forms are acquired, the only exception being a proven variant of family pathology (the gene responsible for the disease). The origin of almost half (about 40%) of all reported cases of epileptic disorders or related conditions remains a mystery. Where they came from, what caused the epilepsy, one can only speculate. This form, which develops for no apparent reason, is called idiopathic, while a disease whose connection with other somatic diseases clearly indicated, called symptomatic.

Harbingers, signs, aura

An epileptic patient appearance(V calm state) it is not always possible to stand out from the crowd. It's another matter if a seizure begins. There will be competent people here who can make a diagnosis: epilepsy. Everything happens because the disease occurs periodically: the period of the attack (bright and stormy) is replaced by a lull (the interictal period), when the symptoms of epilepsy disappear altogether or remain as clinical manifestations of the disease that led to the seizures.

The main sign of epilepsy, recognized even by people far from psychiatry and neurology, is considered grand mal seizure, which is characterized by a sudden onset not associated with certain circumstances. Occasionally, however, it is possible to find out that a couple of days before the attack the patient had bad feeling and mood, headache, loss of appetite, it was difficult to sleep, but the person did not perceive these symptoms as harbingers of an impending seizure. Meanwhile, the majority of patients with epilepsy, who have an impressive history of illness, still learn to predict the approach of an attack in advance.

And the attack itself proceeds like this: first (within a few seconds), an aura usually appears (although the attack can begin without it). It always has the same character only in one specific patient. But a large number of patients and different zones of irritation in their brain, giving rise to an epileptic discharge, also create different types of aura:

1. Mental is more typical for damage to the temporo-parietal region, clinical: the patient is frightened of something, horror freezes in his eyes or, conversely, his face expresses a state of bliss and joy;
2. Motor – all kinds of movements of the head, eyes, limbs appear, which clearly do not depend on the patient’s desire (motor automatism);
3. The sensory aura is characterized by the most various disorders perception;
4. Autonomic (damage to the sensory-motor area) is manifested by cardialgia, tachycardia, suffocation, hyperemia or pallor skin, nausea, abdominal pain, etc.
5. Speech: speech is filled with incomprehensible shouts, meaningless words and phrases;
6. Auditory - we can talk about it when a person hears anything: yelling, music, rustling, which in fact simply does not exist;
7. The olfactory aura is very characteristic of temporal lobe epilepsy: extremely bad smell mixes with the taste of substances that do not constitute normal human food (fresh blood, metal);
8. Visual aura occurs when the occipital zone is affected. A person has visions: flying bright red sparks, shiny moving objects, like New Year's balls and ribbons, people's faces, limbs, animal figures can appear before the eyes, and sometimes the fields of vision fall out or complete darkness sets in, that is, vision is completely lost;
9. The sensitive aura “deceives” the patient with epilepsy in its own way: he becomes cold in a heated room, goosebumps begin to crawl throughout his body, and his limbs go numb.

Classic example

Many people themselves can talk about the symptoms of epilepsy (they have seen them), since it happens that an attack catches a patient on the street, where there is no shortage of eyewitnesses. In addition, patients suffering from severe epilepsy usually do not go far from home. In the area where they live, there will always be people who recognize their neighbor in the convulsing person. And we, most likely, can only recall the main symptoms of epilepsy and describe their sequence:

• The aura ends, the patient loses consciousness, emits a piercing scream (spasms and convulsive contractions of individual muscles) and, under the weight of his body, collapses with a roar to the ground (on the floor).
• Tonic convulsions immediately appear: the whole body tenses, the head is thrown back, the jaws close convulsively. The patient's breathing seems to stop, the face first acquires a white tint, then quickly turns blue, swollen spots are clearly visible on the neck. blood vessels. This is the tonic phase of an epileptic seizure, which usually lasts seconds.
• The clonic phase of a seizure begins with the appearance clonic seizures(jerky contractions of the muscles of the whole body - arms, legs, torso, neck). The patient's hoarse breathing may indicate some kind of obstruction in the respiratory tract (saliva, sunken tongue), which can be very dangerous, therefore, when helping the patient, you need to remember this and try to hold his head during an attack. Meanwhile, after a couple of minutes, the blueness from the face begins to go away, foam appears from the patient’s mouth, often Pink colour(this means that during the attack the patient bit his tongue), the frequency of convulsive contractions subsides and the patient relaxes.
• With muscle relaxation the world for the patient ceases to exist, he does not react to anything: a beam of light directed into the eye does not cause the dilated pupils to narrow at least a little, a prick with a needle or exposure to another painful stimulus does not cause even the slightest movement similar to a reflex, and involuntary urination often occurs.

Gradually the person comes to his senses, consciousness returns and (very often) the person with epilepsy is immediately forgotten deep sleep. Having woken up lethargic, broken, not rested, the patient cannot say anything intelligible about his seizure - he simply does not remember it.

This is the classic course of a generalized epileptic seizure, but, as mentioned above, partial variants can occur in different ways, their clinical manifestations are determined by the zone of irritation in the brain cortex (characteristics of the focus, its origin, what happens in it). During partial seizures, there may be extraneous sounds, flashes of light (sensory signs), stomach pain, sweating, changes in skin color ( vegetative signs), as well as various mental disorders. In addition, attacks can occur only with a partial impairment of consciousness, when the patient to some extent understands his condition and perceives the events occurring around him. Epilepsy is diverse in its manifestations...

Table: how to distinguish epilepsy from fainting and hysteria

The worst form is temporal

Of all the forms of the disease, temporal lobe epilepsy causes the most trouble for both the doctor and the patient. Often, in addition to peculiar attacks, it has other manifestations that affect the quality of life of the patient and his relatives. Temporal lobe epilepsy leads to personality changes.

This form of the disease is based on psychomotor seizures with a preceding characteristic aura (the patient is seized with sudden fear, disgusting sensations appear in the stomach area and the same disgusting smell around, there is a feeling that all this has already happened). Seizures manifest themselves in different ways, but it is obvious that various movements, increased swallowing and other symptoms are absolutely not controlled by the patient, that is, they occur on their own, regardless of his will.

Over time, the patient’s relatives increasingly notice that conversation with him becomes difficult, he becomes fixated on little things that he considers important, and displays aggression and sadistic tendencies. Ultimately, the patient with epilepsy completely degenerates.

This form of epilepsy more often than others requires radical treatment, otherwise it simply cannot be dealt with.

Witnessing a seizure - help with an epileptic attack

important rules during an attack

Having witnessed an epileptic seizure, any person is obliged to provide assistance; perhaps the life of a patient with epilepsy depends on it. Of course, no action can be taken to abruptly stop an attack once it has begun to develop, but this does not imply help with epilepsy; the algorithm may look like this:

1. It is necessary to protect the patient as much as possible from injury during falls and convulsions (remove piercing and cutting objects, place something soft under the head and torso);
2. Quickly free the patient from oppressive accessories, remove the belt, belt, tie, unfasten the hooks and buttons on clothes;
3. To avoid tongue retraction and suffocation, turn the patient’s head and try to hold his arms and legs during a convulsive attack;
4. Under no circumstances should you try to open your mouth by force (you may get hurt yourself) or insert any hard objects (the patient can easily bite through them, choke or get hurt), you can and should put a rolled up towel between your teeth;
5. Call an ambulance if the attack drags on and signs that it is going away do not appear - this may indicate the development of epistatus.

If there is a need to provide assistance for epilepsy in a child, then the actions are, in principle, similar to those described, however, it is easier to lay him on a bed or other upholstered furniture, and to hold him too. The strength of an epileptic seizure is great, but in children it is still less. Parents who are not seeing an attack for the first time usually know what to do or not do:

• It needs to be laid on its side;
• Do not try to force open your mouth or perform artificial respiration during convulsions;
• If you have a fever, quickly place a rectal antipyretic suppository.

An ambulance is called if this has not happened before or the attack lasts more than 5 minutes, as well as in case of injury or breathing problems.

Video: first aid for epilepsy - Health program

EEG will answer questions

focal and generalized epilepsy on EEG

All attacks with loss of consciousness, whether they occurred with convulsions or without them, require studying the state of the brain. The diagnosis of epilepsy is made after a special study called Electroencephalography (EEG), and modern computer technologies make it possible not only to detect pathological rhythms, but also to determine the exact localization of the focus of increased convulsive readiness.

To clarify the origin of the disease and confirm the diagnosis, patients with epilepsy often expand the range of diagnostic measures by prescribing:

Meanwhile, it is very bad when a person receives such a diagnosis when in fact he does not have any epilepsy. Attacks can be rare, and the doctor, sometimes playing it safe, does not dare to completely dismiss the diagnosis.

What is written with a pen cannot be cut out with an ax

Most often, falling illness is accompanied by convulsive syndrome, but the diagnosis of epilepsy and the diagnosis of convulsive syndrome“are not always identical to each other, because seizures can be caused by certain circumstances and occur once in a lifetime. Just healthy brain reacted very strongly to a strong stimulus, that is, this is his response to some other pathology (fever, poisoning, etc.).

Unfortunately, convulsive syndrome, the occurrence of which is due to various reasons (poisoning, heat stroke), can sometimes turn a person’s life around, especially if he is male and 18. A military ID issued without military service (history of convulsive syndrome), completely deprives you of the right to obtain a driver's license or be admitted to certain professions (at heights, near moving machinery, near water, etc.). Walking through the authorities rarely produces results, it can be difficult to remove an article, disability “does not shine” - this is how a person lives, feeling neither sick nor healthy.

In people who drink, convulsive syndrome is often called alcoholic epilepsy, which is easier to say. However, probably everyone knows that convulsions in alcoholics appear after a long binge and such “epilepsy” goes away when a person completely stops drinking, so this form of the disease can be cured by reculturation or another method of fighting the green serpent.

But a child may outgrow

Childhood epilepsy is more common than established diagnosis of this disease in adults, in addition, the disease itself also has a number of differences, for example, other causes and different course. In children, symptoms of epilepsy can only manifest as absence seizures, which are frequent (several times a day) very short-term loss consciousness without falling, convulsions, foam, drowsiness and other signs. The child, without interrupting the work he has started, switches off for a few seconds, his gaze turns to one point or rolls his eyes, freezes, and then, as if nothing had happened, continues to study or talk further, not even suspecting that he was “absent” for 10 seconds.

Childhood epilepsy is often considered a seizure disorder caused by fever or other causes. In cases where the origin of the seizures is established, parents can count on a complete cure: the cause is eliminated - the child is healthy (although febrile seizures do not require any separate therapy).

The situation is more complicated with childhood epilepsy, the etiology of which remains unknown, and the frequency of attacks does not decrease. Such children will have to be constantly monitored and treated for a long time.

As for absence forms, girls more often have them, they get sick somewhere before school or in the first grade, they suffer for some time (5-6-7 years), then they begin to have attacks less and less, and then they go away completely (“children outgrow,” people say). True, in some cases, absence seizures are transformed into other variants of the “epileptic” disease.

Video: seizures in children - Dr. Komarovsky

It is not that simple

Is epilepsy curable? Of course, it is being treated. But whether in all cases we can expect complete elimination of the disease is another question.

Treatment of epilepsy depends on the causes of seizures, the form of the disease, the localization of the pathological focus, therefore, before proceeding with the task, the patient with epilepsy is thoroughly examined (EEG, MRI, CT, ultrasound of the liver and kidneys, laboratory tests, ECG, etc.) . All this is done in order to:

1. Identify the cause - perhaps it can be eradicated quickly if the seizures are caused by a tumor, aneurysm, cyst, etc.
2. Determine how the patient will be treated: at home or in a hospital setting, what measures will be aimed at solving the problem - conservative therapy or surgical treatment;
3. Select medications, and at the same time explain to relatives what the expected result may be and what side effects should be avoided when taking them at home;
4. To fully provide the patient with conditions to prevent an attack, the patient must be informed what is good for him, what is harmful, how to behave at home and at work (or study), what profession to choose. As a rule, the attending physician teaches the patient to take care of himself.

In order not to provoke seizures, a patient with epilepsy should sleep enough, not get nervous over trifles, and avoid unnecessary influence high temperatures, do not overwork and take the prescribed medications very seriously.

Pills and radical elimination

Conservative therapy consists of prescribing antiepileptic pills, which the attending physician prescribes on a special form and which are not sold freely in pharmacies. This may be carbamazepine, convulex, diphenine, phenobarbital, etc. (depending on the nature of the seizures and the form of epilepsy). The tablets have side effects, cause drowsiness, inhibit, reduce attention, and their abrupt cancellation (on one’s own initiative) leads to an increase in frequency or resumption of attacks (if, thanks to drugs, the disease was managed).

One should not think that determining the indications for surgical intervention is simple task. Of course, if the cause of epilepsy is an aneurysm of a cerebral vessel, a brain tumor, or an abscess, then everything is clear: a successful operation will relieve the patient of an acquired disease - symptomatic epilepsy.

It is difficult to solve the problem with convulsive attacks, the occurrence of which is due to a pathology invisible to the eye, or even worse, if the origin of the disease remains a mystery. Such patients, as a rule, are forced to live on pills.

Alleged surgery– hard work for both the patient and the doctor, you need to undergo examinations that are carried out only in specialized clinics (positron emission tomography to study brain metabolism), develop tactics (craniotomy?), and involve related specialists.

The most common candidate for surgical treatment is temporal lobe epilepsy, which is not only severe, but also leads to personality changes.

Life should be fulfilling

When treating epilepsy, it is very important to bring the patient’s life as close as possible to a full and eventful one, rich in interesting events, so that he does not feel inferior. Conversations with a doctor, correctly selected medications, and attention to the patient’s professional activities greatly help solve such problems. In addition, the patient is taught how to behave so as not to provoke an attack:

• They talk about the preferred diet (milk-vegetable diet);
• Prohibit the consumption of alcoholic beverages and smoking;
• Not recommended frequent use strong “teas and coffees”;
• It is advised to avoid all excesses that have the prefix “over” (overeating, hypothermia, overheating);

Particular problems arise when the patient is employed, because the disability group is given to people who can no longer work (frequent convulsive seizures). Many patients with epilepsy are capable of performing work that is not related to heights, mechanisms in a state of motion, at elevated temperatures, etc., but how will this be combined with their education and qualifications? In general, it can be very, very difficult for a patient to change or find a job; doctors are often afraid to sign a piece of paper, and the employer doesn’t want to take it at his own risk either... But according to the rules, ability to work and disability depend on the frequency of attacks, the form of the disease, the time of day, when a seizure occurs. For example, a patient who suffers from seizures at night is exempted from night shifts and business trips, and the appearance of seizures in daytime limits professional activity(a whole list of restrictions). Frequent seizures with personality changes raise the question of obtaining a disability group.

We will not be disingenuous if we say that life for a patient with epilepsy is really not easy, because everyone wants to achieve something in life, get an education, start a career, build a house, earn money material goods. Many people, who in their youth, due to some circumstances, were stuck with “epi” (and there was only a convulsive syndrome), are forced to constantly prove that they are normal, that there have been no seizures for 10 or 20 years, but they persistently write that you cannot work near water, near fire, and so on. Then you can imagine what it’s like for a person when these attacks do occur, so treatment should not be avoided; it would be better if this disease were deeply hidden if it cannot be completely eradicated.

Epilepsy is a condition characterized by repeated epileptic seizures, the causes of which are still not completely clear. An epileptic attack itself is a clinical manifestation of a special category of brain neurons that are in excess number and cause various kinds of pathological phenomena, among which the most obvious are: changes in consciousness, motor and sensory disorders, disruptions in the autonomic system.

Classification of epilepsy attacks

According to the international classification of epilepsy, there are two large categories of epileptic seizures: partial (which in turn are divided into focal and local); generalized.

Partial seizures are divided into two types:

• Simple: occur without any serious disturbances of consciousness, but with obvious motor, mental and vegetative symptoms epilepsy;
• Complex: occur with a clear deviation in the patient’s consciousness.

As for primary generalized seizures, they affect two hemispheres of the brain at once. The most common types of seizures include:

• clonic;
• absence seizures (atypical and typical);
• myoclonic;
• tonic;
• atonic;
• tonic-clonic seizures.

It should also be said about epileptic seizures, the symptoms of which cannot be classified, since they do not fall under any of the types described above. Such atypical seizures also include neotonal seizures in the form of involuntary rhythmic eye movements or chewing movements.

Diagnosis of epilepsy

Diagnosis of epilepsy is based on various medical history data, as well as on a physical examination, EEG, CT, and MRI data. First of all, the presence of epileptic seizures is determined by a diagnostician based on the patient’s history and clinical data, as well as on the results of various studies (primarily instrumental and laboratory).

The second important step will be to conduct a differential diagnosis with the ability to determine exactly the type of epileptic seizure and its form. The doctor must inform the patient about what daily regimen he needs to follow, what medications to take, and whether there is a need for surgical treatment.

Although the diagnosis of epilepsy is based on the clinical data obtained, you should be aware that in the absence of a clinical picture characteristic of epilepsy, the appropriate diagnosis will not be made solely based on the identified epileptiform activity detected on the EEG.

EEG diagnostics

Usually the diagnosis is made by epileptologists or neurologists. The main method of examining patients with this diagnosis is considered conducting an EEG. As is known, this method has no contraindications; it is performed on all patients with suspected epilepsy in order to confirm or refute the fact of epileptic activity.

Among the most common types of epileptic activity, they speak of acute wave types, spikes and two complexes: peak and slow wave; sharp wave and slow wave.

Today, diagnostic methods using computer EEG help to identify the exact localization of the pathological source. For example, at the time of an attack, the EEG helps to register epileptic activity, whereas during the interictal period such activity is detected only in 50-55% of patients.

EEG, together with functional tests, helps to detect changes occurring in the patient’s body. It should be said that if an EEG did not reveal epileptic activity, this does not mean that the patient does not have epilepsy. In this case, patients are prescribed additional examination, or, as an option, video monitoring after an EEG.

MRI diagnostics

When diagnosing this disease, neuroimaging methods, presented in the form of MRI, are of great importance, shown to everyone without exception, especially to those patients who have been diagnosed with a local onset of an epileptic seizure. It is MRI that helps confirm the appropriate diagnosis, as well as identify the causes that provoked the disease.

MRI results indicate the etiological factors of epilepsy present. Patients who have been diagnosed with pharmacoresistant epilepsy are indicated to undergo surgical treatment. They also undergo an MRI, which allows them to determine the exact location of the affected areas of the central nervous system. Elderly patients are often prescribed additional diagnostic methods, which may include blood tests, an ECG, or a fundus examination.

Clinical picture of epilepsy

In the epilepsy clinic they talk about three periods:

• ictal (moment of attack);
• postictal (the moment following the attack; during this period, the symptoms of the disease may be completely absent, except for those symptoms that clearly indicate epilepsy: ischemic stroke, traumatic brain injury));
• interictal (time between attacks).

In addition to periods of epileptic seizures, there are several types of auras that accompany a partial epileptic seizure, among these auras: motor, speech, vegetative, mental, sensory.

Among the most typical symptoms of epilepsy are:

• nausea;
• headache;
• dizziness;
• general weakness;
• a feeling of squeezing in the throat and chest;
• numbness of lips and tongue;
• feeling of constant drowsiness;
• sound hallucinations;
• feeling of a lump in the throat;
• paroxysms of an olfactory nature.

As is known, partial seizures of a complex type most often occur with the performance of so-called automated movements, which are characteristic of patients with epilepsy. In such cases, it will not be possible or quite difficult to communicate normally with the patient.

Scheme of a secondary generalized attack

• If we talk about a secondary generalized attack, then it begins very abruptly and spontaneously. The patient feels the aura for just a few seconds, after which loss of consciousness occurs and the patient falls. The patient falls to the floor with his usual scream, which is explained by a spasm of the glottis and a strong convulsive contraction of the muscles located in the chest.
• After this, the tonic phase begins, which is so named because of the tonic convulsions. This type of seizure stretches the torso and limbs of a patient with a strong characteristic of epilepsy muscle tension. In this case, the head is usually thrown back or turned to the side, breathing slows down, the veins in the neck become swollen, the face turns pale, cyanosis slowly appears, the patient’s jaw is clenched tightly.
• The duration of this period is about 20 seconds. After this, the phase of a true epileptic attack begins, which is accompanied by clonic-type convulsions, noisy breathing, and patients often foam at the mouth. The duration of this phase is 3 minutes. Before its completion, the frequency of seizures begins to noticeably decrease, and as a result, the muscles completely relax, until the patient is unable to respond to an external stimulus. After an attack, the pupils remain dilated, but there is no reaction to light radiation, just as there are no tendon reflexes.

It should also be said about two special types of primary generalized seizures, which are characterized by the involvement of two hemispheres of the brain. We are talking about absence seizures and tonic-clonic seizures. Absence seizures are usually associated with epilepsy in children. They are characterized by a sharp but quick stop in the child’s activity (for example, during a conversation, learning or playing). With absence seizures, the child suddenly freezes and stops responding to external stimuli, stops responding, but after a few seconds he again continues to do what he was doing before the attack. Children usually do not realize that something has happened to them; they do not remember their seizures. The frequency of absence seizures can reach 10-20 times a day.

Differential diagnosis

Epileptic seizures should be differentiated from conditions of a non-epileptic nature, which are fainting, autonomic disorders and attacks of a psychogenic nature.

Treatment of epilepsy

Any patient treatment chosen by a specialist will, first of all, be aimed at stopping epileptic seizures, as well as improving the patient’s life. In the future, at the stage of remission, the doctor will wean the patient off medications.

With timely and correct treatment, in most cases (70-75%), the patient recovers - epilepsy attacks stop. Before prescribing a whole list of medications, doctors conduct thorough examination, analyze the obtained MRI or EEG data.

Typically, doctors always inform not only the patient, but also his family members about how to take medications correctly and about their possible side effects. Hospitalization will be necessary only if an epileptic attack has developed for the first time in life or if status epilepticus already exists. They are also hospitalized if surgery is necessary.

Monotherapy is important in drug treatment - when a single drug is prescribed, which must be taken in minimal doses with its further increase until the complete relief of epileptic seizures. If the dosage of such a drug is not enough, then the doctor checks how suitable this medication is for a given patient, and, if necessary, increases the dosage or prescribes another drug.

The use of any drug prescribed against epileptic seizures requires the patient to undergo regular examinations to determine the level of its concentration in the blood. Typically, the most common drugs will be: pregabalin, valproic acid, levetiracetam, topiramate, lamotrigine, carbamazepine. The use of all these drugs is prescribed with minimal doses.

If epilepsy has been diagnosed for the first time, then traditional drugs such as carbamazepine or valproic acid are prescribed for treatment. Recently, antiepileptic drugs such as levetiracetam, topiramate and oxcarbaseline have become very popular. They are prescribed as part of monotherapy.

When choosing between traditional and modern medicines, you should remember individual characteristics a person, about his individual tolerance, age and gender indicators.

If we talk about the treatment of epileptic seizures of unidentified origin, then most often in this case the use of valproic acid is prescribed. However, no matter what medication is prescribed, doctors always strive to prescribe it in minimal doses and with minimum frequency reception (usually no more than 2 times a day).

Due to the constant concentration of the drug used in the patient’s plasma, its effect is more effective. As is known, the dose administered into the body of an elderly patient differs much more high concentration than the same dose, but applicable to a young or middle-aged patient. In any case, monotherapy will begin with minimal doses and with their further titration. The drug is withdrawn as gradually as it was administered. The duration of use of monotherapy will depend on the form of epilepsy itself, the prognosis for recovery and the prognosis for the resumption of epileptic seizures.

This type of epilepsy, such as drug-resistant (characterized by prolonged attacks), should be examined additionally in order to prescribe the correct treatment in the future. Drug-resistant epilepsy cannot be treated with monotherapy, and antiepileptic drugs are also ineffective. This requires surgery.

Before the operation, doctors conduct an additional examination using EEG in order to record seizures and obtain accurate data on the location and individual characteristics of the epileptogenic zone. The latter can also be determined during an MRI of the brain.

Based on the examination results, doctors finally determine the nature of the disease and what type of surgical intervention will be necessary in this case. Among the most common operations:

• removal of epileptogenic brain tissue (by cortical topotomy, hemispherectomy or lobectomy);
• callosotomy;
• selective surgery (for example, amygdala-hippocampectomy);
• stereotactic intervention;
• vagus stimulation.

There are certain indications and contraindications for each type of surgical intervention. One of the above operations can be carried out only in specialized clinics, in neurosurgical departments, where there is the appropriate equipment and where highly qualified specialists in their field work.

Prognosis for epilepsy

The patient's prognosis for recovery and future work will depend on the frequency of attacks. As practice shows, at the stage of remission, epileptic seizures rarely appear, most often at night. In most cases, the patient remains competent and able to work, can return to his usual activities and live ordinary life. For those who have had epilepsy, it is very undesirable to work at night and go on business trips. Periodically, daytime attacks may recur, which are accompanied by loss of consciousness, thereby limiting the person’s usual ability to work.

Epilepsy has a negative impact on all areas of human life, so today this disease is considered one of the most significant socio-medical problems of humanity.

A big disadvantage for modern medicine is the fact that very little is still known about the nature of epilepsy, which means it is also impossible to properly inform the patient.

The vast majority of patients who received correct and timely treatment continue to lead normal lives.

Prevention of epilepsy

First thing, preventive measures for epilepsy, they include the prevention of head injury, timely treatment of diseases infectious nature, intoxication, proper lowering of body temperature in case of fever, which is often a harbinger of the first epileptic attack.

Human diseases, manifested in the body's predisposition to sudden emergence convulsive attacks. These seizures occur as brief, involuntary seizures in one part of the body (partial seizures) or throughout the body (generalized seizures) and are sometimes accompanied by loss of consciousness and loss of bowel control or Bladder. The diagnosis is made if seizures recur and are accompanied by other symptoms characteristic of epilepsy. In most cases, epilepsy affects children and the elderly, but can also occur in young and old adults.

Key facts:

• One single seizure does not indicate epilepsy (worldwide, up to 10% of people have had one seizure during their lifetime). The definition of epilepsy applies to 2 or more unprovoked seizures.
• Worldwide, approximately 50 million people suffer from epilepsy, one of the most common neurological diseases globally.
• Almost 80% of people with epilepsy live in low- and middle-income countries.
• Epilepsy is treatable in approximately 70% of cases.
• However, three quarters of people suffering from the disease in developing countries do not receive the treatment they need.

Epilepsy is a chronic disease. During epilepsy, there are non-convulsive periods and epileptic seizure- they alternate. At proper therapy the duration of remission can be significantly increased. The disease develops due to a disturbance in the electrical activity of the brain. Epilepsy has many varieties with different courses.

Epilepsy is so complex and complex disease that a special direction has even emerged in neurology - epileptology. Epileptologists study the patterns of occurrence, clinical course diseases, are looking for new approaches to treatment and prevention. For treatment, you can contact a neurologist or a highly specialized epileptologist.

Seizures

There are dozens of types of attacks. Therefore, here we describe only the most typical varieties. Most common generalized tonic-clonic seizure. This is what they call convulsions with loss of consciousness. The attack is accompanied by twitching of the limbs and muscle tension. It's pretty severe course seizure, this is how epilepsy is usually presented.

There are myoclonic seizures. They are distinguished by clear consciousness and manifest themselves in twitching of any limb or part of the body, less often of the whole body. If at the time of an attack the patient is holding something in his hands, then he may drop this object. If the twitching affects the lower limbs, the patient loses balance.

Tonic seizures– these are attacks with prolonged tension in a separate part of the body. Externally manifested by trembling of this part of the body. At the same time, speech is normal, consciousness is clear.

There are attacks that occur mainly in children - they look like short tremors. They may be accompanied by unnatural spreading of the arms or legs to the sides. Sometimes the child, on the contrary, seems to shrink into a ball. In this case, periods of tension alternate with muscle relaxation throughout the attack.

Another type of childhood epileptic seizures is absence seizures. This is what they call freezing in any position with a lack of reaction to addressing the child. The main signs are trembling of any limb with asymmetric muscle tension. If asymmetrical tremors are noticeable during an attack, the doctor should suspect damage to a specific area of ​​the brain.

Seizures and epilepsy

Contrary to popular belief, seizures do not always accompany epilepsy. Seizures are a separate symptom characteristic of many diseases. They occur when the temperature rises, and are especially often observed in children of the first years of life - febrile. Seizures accompany various infectious and non-communicable diseases, are observed in case of poisoning, against the background of dehydration, with head injuries, acute circulatory disorders of the brain.

It is sometimes difficult to distinguish seizures from others by external signs movement disorders, from loss of consciousness, from migraine aura, from manifestation psychiatric diseases. The main difference between an epileptic attack and a paroxysm characteristic of any other disease is spontaneity. With epilepsy, an attack can be triggered by almost anything: from bright lights and flashing lights to deep breathing.

Behavior during an attack

Most attacks end safely on their own, without causing harm to the patient. The average seizure lasts from a few seconds to several minutes. The very first thing you can do to help the patient (no matter how bad it looks) is to call an ambulance, ensure free breathing and protect yourself from injury. Ambulance It makes sense to call strangers. It is important to remember all the details of the seizures; if possible, it is worth recording the symptoms on video. This will make it very easy for the doctor to make a specific diagnosis and diagnose the form of epilepsy. If an attack occurs in a friend who knows about his illness and does not consider it necessary to call a doctor, then there is no need to call the emergency room.

If possible, the patient should be moved or taken away from sharp, piercing objects, unstable or dangerous structures. Ideally, the patient sits or lies on a flat, safe horizontal surface. The patient cannot be restrained by force. To provide normal breathing, it must be placed on its side and ensure free access of air.

The most popular advice given by ordinary people is to unclench your jaw. In fact, doctors warn that you should never try to do this, especially with a hard object. The risk of injury is extremely high.

After the attack ends, the patient often experiences drowsiness, fatigue, and a desire to rest. It is important to make sure that the person is clear-headed, understands what happened and can get home independently. It is recommended to check speech and limb movements. To assess the patient’s condition, it is enough to ask him simple questions, ask him to give his name, age, address. Along the way, you need to evaluate the clarity of movements. If there are any signs of impaired consciousness or motor impairment, the patient should not be allowed to drink, eat, or go home on their own.

Some seizures, such as absence seizures, do not require emergency treatment. It is enough to wait until the attack is over.

Diagnosis of epilepsy

First of all, the diagnosis is assumed based on the clinical picture during examination by a neurologist. The main diagnostic tool is electroencephalography (EEG). An EEG records the electrical activity of the brain. This examination allows not only to determine the presence of epilepsy, but also to diagnose a specific form.

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Treatment of epilepsy

Treatment begins only after diagnosis. In case of a single attack, therapy is not prescribed, since there is a high probability that this is an isolated episode.

Therapy consists of taking anticonvulsants. These are specific potent drugs that are prescribed only for full confidence in the diagnosis. If the diagnosis is inaccurate, and in the non-convulsive period the patient feels normal, then the doctor makes an individual decision. There are situations in which it is acceptable not to carry out therapy. In this case, it is prescribed dynamic observation. Usually, in difficult situations, additional examinations are prescribed. Diagnosis can be carried out even with frequent exacerbations. There is evidence that the effectiveness of therapy is not affected by urgent prescription of drugs - it is much more important to accurately select the drug.

Treatment of epilepsy start with one drug. If broad-spectrum medications do not help, then more specific medications are prescribed. Then the resulting effect is evaluated. If there is no effect or it is insufficient, then another antiepileptic drug is prescribed. Selecting therapy can take a long time. If there are no exacerbations during treatment for several years, then the medications can be discontinued.

In difficult cases, when standard treatment is not enough, the treatment regimen includes steroid hormones, a special ketogenic diet. In special cases, the patient is offered a neurosurgical operation.

In some cases, epilepsy goes away on its own. This is sometimes observed with teenage attacks. But the fact that epilepsy sometimes (not always) goes away on its own does not eliminate the need for treatment. Suitable therapy allows you to get rid of attacks and reduce the likelihood of complications. There is no prevention of the disease.

Treatment of epilepsy and all necessary examinations are carried out at the CELT clinic. Getting treatment from professionals is a smart choice. Trust your health only to experienced and qualified specialists from the CELT clinic. Attentive and friendly doctors will help you recover faster and enjoy life again.

Today it is no longer a secret how the symptoms of epilepsy manifest themselves in general view: 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:

1. Idiopathic - primary.
2. Cryptogenic - the cause has not been fully established.
3. Symptomatic – secondary, its signs have been established.
4. Generalized – affecting all parts of the brain.
5. 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 following 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 intentionally 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 person suddenly loses consciousness, after which the seizure with motor manifestations (convulsions). But in some patients (about every fifth) various phenomena occur within a few days, hours or minutes that foreshadow a seizure. The epileptic aura received a complex of such phenomena. Signs of an epileptic aura include: flames, sensory disturbances, changes or taste sensations, sudden

The seizure itself begins with loss of consciousness, then the patient suddenly experiences muscle twitching or rhythmic movements of the limbs, quickly turning into sharp muscle spasms.

Before an attack, a person may scream. Saliva begins to come out of the mouth, often during an attack the patient bites his tongue, and the saliva becomes bloody. Possible involuntary urination.

Along with the characteristic picture of the disease, a small one with a complete absence of seizures is distinguished. It is typical for her special condition– absence seizures. Be wary if a person suddenly stops activity, his gaze stops, and mechanical movements appear (twitching or chewing). This state may last only a few moments.

Based on the clinical picture, an experienced epileptologist (as specialists in the treatment of epilepsy are called) may suspect this diagnosis. But to confirm it modern medicine uses the method of studying electrical activity of the brain (EEG), the method of magnetic nuclear resonance and the most modern - EEG/video monitoring, which allows you to confirm the epileptic nature of seizures.

Epilepsy is chronic disease. It affects the brain. Unfortunately, in most cases the disease manifests itself at an early age, before reaching 20 years of age. Discover epilepsy possible in a row characteristic features.

Instructions

Please note that after a seizure, a person with epilepsy does not remember the seizure.

Remember that in the case of a minor attack, convulsions may be minor or absent altogether. Loss of consciousness is short-term and is not necessarily accompanied by a fall.

Sometimes seizures can be long-term and last from several hours to several days. All this time they are accompanied by convulsions.

Pay attention to behavior. A patient with epilepsy is characterized by a twilight disorder of consciousness. His attention is concentrated only on emotionally significant events. Possible, when combined with a state of anxiety and anger, can cause suicide attempts or violent aggression towards others. If the disorder is of a shallow nature, then the behavior practically does not cause suspicion. Pay close attention to the patient's concentration and detachment. Such twilight states occur spontaneously and can last for several days. Coming out of them, a person does not remember anything about it.