What to do after an attack? Epilepsy. characteristic of disability
Exam questions (therapeutic):
2.26. Epilepsy: etiology, pathogenesis, classification (types of seizures and forms of epilepsy). Epistatus.
2.27. Partial epilepsies: etiology, clinic, treatment, examination of work capacity
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 departments cerebral cortex and accompanied by a variety of clinical and paraclinical symptoms. Prevalence in the population - 0.8-1.2%
Epilepsy - chronic disease brain, characterized by repeated unprovoked attacks of motor, sensory, autonomic, mental or mental functions, arising as a result of 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 - the most early stage 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 ( discomfort 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, stereotypical 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 nervous system;
Traumatic brain injury;
Brain tumors;
Degenerative diseases of the central nervous system;
Infections;
Metabolic disorders, intoxication.
Action 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 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 seizures accompanied by short-term loss consciousness, gaze arrest 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, automatisms are simple, disturbance of consciousness is deep, the postictal state is normal, duration - up to 20 sec)
- 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 bending upper limbs and extension of the lower or focal ones 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, scream, then apnea, tongue bite, tonic, then clonic seizures, 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 is noted, psychomotor agitation, 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- sudden decline 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 debut(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. Family 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
Migrating partial seizures 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 medicines 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 for epilepsy pathological changes EEG - peaks, sharp waves, peak-wave complexes. Pathological bioelectrical activity, as a rule, appears during a seizure, and in the interictal period during normal conditions records are 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 damage in the brain during 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 (fear, the sight of blood, stuffy room), precursors in the form of general autonomic disorders, traumatic injuries bodies are rare, gradual recovery from the attack with general vegetative symptoms
b) demonstrative hysterical attack;
V) 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, clarifying the nature of the frequency of seizures, selecting medications, developing 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), a sudden break 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 unilateral, accompanied by severe respiratory distress, increased blood pressure, tachycardia, hyperthermia. Maybe coma.
Epistatus therapy:
0. IV administration: Depakine - 400 - 800 mg
1. IV drip administration: Diazepam 100 mg per 500 ml 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
First aid is needed mainly by patients who experience not single epileptic seizures, but their series, the so-called status epilepticus. In this article we will tell you how to properly provide first aid during an epileptic seizure.
First aid for epilepsy
Help with a single epileptic seizure:
- protect from bruises,
- make breathing easier,
- unbutton the collar
- remove the belt
- In order to prevent tongue biting, a corner of a towel or the handle of a tablespoon wrapped in a bandage should be inserted between the molars.
Attention!
It is absolutely unacceptable to place a metal object between the teeth: when the jaws are convulsively brought together, the tooth can break and, if it gets into the larynx, cause serious complications. After the end of an epileptic seizure, you should not wake the patient or administer any medications.
What to do if you have an epileptic attack?
First aid for status epilepticus:
- First aid for epilepsy should begin on the spot, continue in the ambulance and in the hospital,
- in case of epilepsy, the patient’s oral cavity should be freed from foreign objects(food, removable dentures, etc.),
- provide free breathing,
- to eliminate convulsions, 20 mg (4 ml of 0.5% solution) of seduxen in 20 ml of 40% glucose solution is administered intravenously slowly, over 5-10 minutes (too rapid administration of seduxen can lead to a decrease in blood pressure and respiratory arrest), seizures usually stop during the infusion or in the next 3-5 minutes,
- if a single infusion of seduxen solution turns out to be ineffective and epilepsy convulsions continue, you can re-introduce the drug after 10-15 minutes,
- if double administration of seduxen is unsuccessful, its further use is inappropriate, but if there is at least an unstable effect, you should try to stop the seizures reintroduction Seduxen solution 10 mg intravenously or administer 30 mg of the drug in 150 ml of 10-20% glucose solution intravenously by drip ( daily dose seduxen for adults in some cases can be increased to 60 mg),
- if there is no effect from seduxen in epilepsy, it is necessary to administer sodium thiopental intravenously (solutions of 1% (for children and the elderly) and 2-2.5% are prepared immediately before use (diluted sterile water for injection), administered intravenously slowly (no more than 1 ml per minute) 5-10-30 ml of 2-2.5% solution for adults. For children under the age of 3 years, when providing first aid for epilepsy, 0.04 g per year of life is administered, from 3 to 7 years - 0.05 g per year of life, or 5-10 ml of 10% hexenal solution is administered slowly intravenously . They should be administered slowly under monitoring of breathing, pulse and pupil status. Constriction of the pupils and slowing of breathing to 16-18 per minute are objective indicators of achieving a sufficient depth of anesthesia. At the same time, 5 ml of 10% sodium thiopental or hexenal solution can be administered intramuscularly,
- in some cases the seizures stop after lumbar puncture usually carried out in a hospital setting. In most cases, these measures can stop seizures,
- simultaneously, 5-7 ml of 25% magnesium sulfate solution or 5-10 ml of calcium gluconate are administered intravenously or intramuscularly, or 5 ml of 10% calcium chloride is administered intravenously,
- after 1-2 hours, you can use lytic mixtures: 0.5-1 ml of a 2.5% solution of aminazine and 2% promedol solution with 0.3-0.7 ml of 25% diphenhydramine solution intramuscularly,
- if there are signs of heart failure, in first aid for epilepsy, cardiac glycosides are administered: strophanthin - 0.5-0.75 ml of a 0.05% solution or korglykon 1 ml of a 0.06% solution in 10-20 ml of isotonic sodium chloride solution intravenously slowly.
- at sharp decline AD it is necessary to administer intravenously 0.3-1 ml of 1% mezaton solution in 40 ml of 20-40% glucose solution or 0.5 ml of 0.2% norepinephrine solution in 5% glucose solution,
- the fight against cerebral edema in epilepsy involves prescribing Lasix or Uregit intramuscularly and intravenously,
- administration of ATP and 25,000-50,000 units of trasylol in 300-500 ml of isotonic sodium chloride solution intravenously is indicated,
- during development acute failure adrenal glands, glucocorticoid hormones are administered intravenously (hydrocortisone 0.2 mg per 1 ml of solution, 50-100 mg in total).
Hospitalization for an epileptic seizure
If the patient has a history of single seizures that do not develop into status epilepticus, then hospitalization is not required. If an epileptic seizure appears for the first time in an adult patient, the patient is sent for examination to the neurological department. A patient in status epilepticus is subject to urgent hospitalization to the neurological or intensive care unit. Now you know exactly what to do during an epileptic attack.
Symptoms of epilepsy
A full-blown seizure may begin suddenly or may be preceded by an aura, certain neurological symptoms, indicating from which area of the brain the initial pathological excitation comes. Such a harbinger of an epileptic attack can be photopsia (visual aura), olfactory or auditory hallucinations, mood disorders, and peresthesia. Following the aura or in its absence, consciousness suddenly turns off. The patient falls, often receiving bodily injuries. Sometimes at this moment an inarticulate cry breaks out - the result of a tonic contraction respiratory muscles and vocal cords. Breathing stops, the patient's face first turns pale and then gradually becomes cyanotic.
The tonic phase of an epileptic seizure develops: the arms are tense, bent, the head is thrown back or to the side, the torso is extended, the legs are extended and tense. The eyes are dilated, the pupils do not react to light, the jaws are clenched tightly. At this stage the seizure may occur involuntary urination, less often defecation. The tonic phase lasts 1/2 _ 1 min.
Then the tonic tension ends abruptly, a short-term relaxation of the muscles occurs, after which the muscles of the trunk and limbs tense again. This alternation of tension and relaxation characterizes the clonic stage of a seizure. At this time, breathing is restored, it becomes noisy, wheezing, cyanosis disappears, foam, often stained with blood, is released from the mouth. The seizures occur less and less often and finally stop. The patient is in a soporous state for some time, which then passes into sleep. Upon awakening, the patient usually vaguely remembers or does not remember what happened at all. Only general weakness, malaise, pain in the bitten tongue remind of another seizure. Immediately after a seizure, it is sometimes possible to detect pathological foot reflexes; deep reflexes may be suppressed.
In some cases, grand mal seizures follow each other so often that the patient does not regain consciousness. Status epilepticus develops, which, if not adequately treated, can lead to fatal outcome due to swelling of the brain and lungs, exhaustion of the heart muscle or respiratory paralysis.
Much less frequently than with epilepsy, generalized epileptic seizures can develop with other diseases - brain tumors, brain abscess, cysticercosis, traumatic brain injury (symptomatic epilepsy), as well as with intoxication - alcohol, carbon monoxide, toxicosis of pregnancy, hypoglycemic coma ( epileptiform seizures).
Exercise for epilepsy
According to advice family doctor A 16-year-old diver suffering from epilepsy came to us. With the exception of grand mal epileptic seizures, the young man's health was normal. The brain scan was normal, while the encephalogram showed a type 1 abnormality with focal spikes in temporal region. In more early age To relieve attacks, the young man took phenobarbitone, and then sodium phenytoin. Other oral anticonvulsants have caused side effects. Over the past 12 months. the athlete had two epileptic attacks. Both happened while on vacation for no reason. In both cases these were typical grand mal seizures lasting approximately 30 s; The duration of the post-ictal state was 10 - 15 minutes. Serum phenytoin levels were within therapeutic limits.
The athlete did not want to give up diving. His doctor feared that he would not be able to provide first aid and that the young man might be injured if a seizure occurred on the tower or before diving into the water.
Minor, major, and focal motor seizures pose risks for people who play sports. For example, if an epileptic seizure occurs while climbing a platform or tower, the athlete risks serious injury if he falls. There is also a risk of injury to other athletes.
The traditional approach to people suffering from epilepsy, which consisted of limiting physical activity, turned out to be not entirely correct. Thus, the results of a number of studies show that the seizure threshold in patients with epilepsy increases during exercise. physical activity. Additionally, resting hyperventilation, a factor known to cause grand mal seizure, is not a problem during exercise physical activity. Of greatest concern is the potential for injury during activities involving lifting (eg, diving board), equipment (eg, weightlifting, javelin), or changing conditions environment(e.g. ultra-distance swimming).
When making a decision, the doctor must:
- make an accurate diagnosis; Although the most typical diagnosis is idiomatic epilepsy, the physician must be sure that no other disease processes are contributing to the seizures;
- carefully study the frequency of previous seizures of epilepsy, which will predict the period of onset of future seizures and is a very important determinant when deciding to participate in competitions;
- take into account the maturity and responsibility of the athlete's parents;
- check serum anticonvulsant levels to maintain within normal limits. If necessary, consider the advisability of using additional or other medicines for the treatment of epilepsy;
- openly discuss possible risks with the athlete, parents and coaches;
- accept everything possible measures precautions, such as gymnastics and swimming insurance.
Most athletes with epilepsy can continue to play their sport. However, in some cases it is necessary to modify activities to reduce the likelihood of seizures.
In our example, the athlete was advised to continue jumping only from a 1-3 meter springboard. His serum phenytoin levels were within therapeutic limits, and he was prescribed another medication (valproic acid) to better control his epileptic seizures.
Epilepsy has been known since ancient times, its first description was given by Hippocrates, in Russia the disease was called “falling disease.” To date, developed effective schemes treatment of epilepsy. The prevalence of the disease is 16.2 per 100,000 population, which is sufficient in a global sense large percentage, which does not decrease over the years. Patients with epilepsy require constant, expensive treatment and monitoring by a neurologist throughout their lives.
How to recognize an epileptic seizure?
Having seen an epileptic attack once, a person will never forget it and will be able to recognize it in any situation. Those around them are often frightened by the picture they see, and they do not know how to help a person in such a state. The correct tactics of assistance will not eliminate the symptom, but will only allow the patient to endure the attack much easier.
Epileptic seizures are divided into partial and generalized.
A partial attack is accompanied by convulsive twitching in a certain part of the body or the development of disorders of the autonomic nervous system - nausea, vomiting, dizziness, headache. In this case, a certain limited area of the brain is excited.
A generalized seizure is accompanied by a loss of consciousness and involvement of the entire body in the attack; it includes absence seizures and a major tonic-clonic seizure. Excitation affects all neurons of the brain simultaneously short period time.
Manifestations of a grand mal seizure
The most significant is a grand mal seizure. It begins suddenly, sometimes there are precursors in the form of redness of the face, headache. The patient loses consciousness, and the whole body is initially seized by tonic convulsions, while the muscles are tense and hard, the patient is constrained, and he freezes in a certain position. During the tonic phase, patients turn blue due to spasm of peripheral vessels, and white foam is released from the mouth.
Phases of an epileptic seizure
The tonic phase is replaced by clonic muscle contractions. The patient's body twists under the influence of convulsions, and thus the patient can injure himself on surrounding objects. Characteristic symptoms are wide open eyes and rolling pupils. Breathing becomes intermittent and difficult; the situation is further aggravated by increased secretion of saliva, which the patient is unable to spit out.
The duration of the seizure is no more than 30 seconds, rarely up to 60 seconds; if the time exceeds these indicators, there is a danger of developing status epilepticus and asphyxia - in this case, emergency medical care is necessary. After the seizure ends, patients experience involuntary urination and sometimes bowel movements. As the convulsions pass, it develops deep sleep, similar to a comatose state, after which the patient comes to his senses, and the time of the seizure is completely erased from his memory.
The main components of an attack are:
- Cramps.
- Loss of consciousness.
- Breathing problems.
Algorithm for providing assistance
An epileptic attack looks threatening and scary outwardly, but it does not require special help, since it ends spontaneously. The patient suffers more from indifference and inappropriate behavior those around you than from the attack itself. Emergency pharmacological assistance is not required; it is important to be close to the patient and monitor his condition - this is the main thing that a person providing assistance can do.
Algorithm of actions for providing first aid for epilepsy:
A severe complication of a seizure is the development of status epilepticus.
Epistatus is a condition in which one seizure begins before the end of the previous one. If the attack lasts more than 2 minutes, status epilepticus should be suspected and medical help should be sought. This complication does not go away on its own; administration is necessary. anticonvulsants to relieve the condition. Its danger lies in the possibility of asphyxia and death from suffocation. This is a serious complication requiring hospitalization in the neurological department.
During absence seizures, the patient is helped according to the same algorithm; these conditions do not last long and go away on their own. The patient must be kept safe during a seizure, and it is the responsibility of others to ensure this.
What to do after an attack?
After a seizure, patients fall asleep in a deep sleep; there is no need to disturb them in this. If this happened on the street, it is necessary to take the patient home and put him to bed. Avoid eating foods that have a stimulating effect on the central nervous system: coffee, black and green tea, smoked meats, spicy and salty dishes.
When the patient has rested, you need to ask him in detail about what happened, whether he remembers anything, and tell him what he saw. Find out whether this attack was different from the previous ones, and how often they began to appear. All this will help to find out how much the disease has begun to progress. If there are no changes, the patient should continue the previously prescribed therapy. In case of significant differences, you should consult a doctor to adjust the treatment.
When is it necessary to see a doctor?
In most cases, with epileptic seizures, cause " ambulance"not necessary. But there are a number of situations when during an attack it is necessary to seek specialized medical help:
- If you stranger there is a seizure on the street and it is difficult for a non-medical worker to determine what exactly is happening.
- If you have an attack loved one developed for the first time.
- The duration of the seizure is more than two minutes.
- Convulsive contractions are observed in children, the elderly and pregnant women.
- If the victim has serious injuries received during an attack.
- Repeated seizure that occurred after short time on the same day.
The main research method for epilepsy is electroencephalography
If the patient feels a deterioration in the condition or an increase in attacks, it is necessary to consult a neurologist to undergo medical examination and adjustments to therapy.
Consultation with an ENT doctor, pulmonologist, gastroenterologist.
Depending on the location of the lesion, the patient develops an aura (vegetative, motor, mental, speech, sensory) of a stereotypical nature, which lasts several seconds. The patient falls down and loses consciousness. There may be a loud cry (spasm of the glottis and diaphragm muscles). Tonic convulsions appear (the torso and limbs are stretched, the head is thrown back, breathing is held, the veins in the neck swell, the face is cyanotic, the jaw clenches convulsively) for 15-20 seconds. Then clonic convulsions appear in the form of jerky contractions of the muscles of the limbs, neck, and torso (up to 2-3 minutes). Breathing is hoarse, noisy due to the accumulation of saliva and retraction of the tongue, cyanosis disappears, bloody foam appears from the mouth (due to biting the tongue). Then comes muscle relaxation and the patient does not respond to external influences(pupils are dilated, do not react to light; deep and protective reflexes are not evoked; + Babinsky’s symptom, involuntary urination, soporous consciousness, then deep sleep sets in. After the seizure, the patient feels weak, lethargic, drowsiness, does not remember anything about the seizure (amnesia).
Complaints and anamnesis
Complaints: 1-2 days before the attack occurs, patients complain of feeling unwell, headache, sleep and appetite disturbances, irritability.
Anamnesis: Nature of the onset and manifestation of the disease: Constitutional predisposition, violation of adaptive capabilities against the background of acute and chronic stress, chronic organic somatic diseases, especially with alcoholism of the individual, metabolic diseases, organic diseases nervous system, previous traumatic brain injuries (history of PEP), vitamin deficiency, intoxication.
Physical examination:
From the nervous system, focal symptoms.
Neurological status: Breathing is hoarse, noisy due to the accumulation of saliva and retraction of the tongue, cyanosis disappears, bloody foam appears at the mouth (due to biting the tongue). Then muscle relaxation occurs and the patient does not respond to external influences. The pupils are dilated and do not react to light; deep and protective reflexes are not evoked; + Babinski's symptom, + foot signs, involuntary urination, stuporous consciousness, then deep sleep sets in. After the attack, weakness. Lethargy, drowsiness, does not remember anything about the seizure (amnesia).
From the outside cardiovascular system: increased blood pressure, change in heart rate.
From the autonomic nervous system: autonomic asymmetries, sweating, vasomotor lability, impaired thermoregulation, edema syndrome.
UAC - a tendency to increase ESR, increase leukocytes and erythrocytes, leukopenia, lymphopenia, eosinophilia,
Tendency to acidosis, hypocalcemia, increased creatinine, decreased acetylcholine and cholesterol.
