Epilepsy. Epilepsy: types, causes, symptoms, diagnosis, treatment

Epilepsy

What is Epilepsy -

Epilepsy- chronic illness, manifested by repeated convulsive or other seizures, loss of consciousness and accompanied by personality changes.

The disease has been known for a very long time. His descriptions are found among Egyptian priests (about 5000 BC), doctors of Tibetan medicine, Arabic medicine, etc. Epilepsy in Russia is called epilepsy, or simply epilepsy. The disease is common: 3-5 cases per 1000 population.

What provokes / Causes of Epilepsy:

Despite the long period of study, the etiology and mechanisms of the disease are not well understood.

In neonates and infants, the most common causes of seizures are severe hypoxia, genetic metabolic defects, and perinatal lesions. In childhood, seizures in many cases are due to infectious diseases of the nervous system. There is a fairly well-defined syndrome in which convulsions develop only as a result of fever - febrile convulsions. In 5% of children, convulsions were observed at least once in their lives with an increase in body temperature, about half of them should be expected to have recurrent seizures.

At a young age, the main cause of epileptic disorders is a craniocerebral injury, while one should be aware of the possibility of developing seizures both in acute and in more severe cases. late period. In persons older than 20 years, especially in the absence of a history of epileptic seizures, possible cause epilepsy is a brain tumor.

In patients older than 50 years, among the etiological factors of epilepsy, vascular and degenerative diseases brain. Epileptic syndrome develops in 6-10% of patients with ischemic stroke, and most often outside acute period diseases.

It is important to emphasize that in 2/5 patients the cause of the disease cannot be established with sufficient evidence. In these cases, epilepsy is regarded as idiopathic. Genetic predisposition plays a role in some types of epilepsy. Patients with a family history of epilepsy have more high risk seizures than in the general population. Currently, the localization of genes responsible for some forms of myoclonic epilepsy has been established in the human genome.

Pathogenesis (what happens?) during Epilepsy:

In the pathogenesis of epilepsy, a change in the neuronal activity of the brain plays a leading role, which, due to pathological factors, becomes excessive, periodic. Characteristic is a sudden pronounced depolarization of neurons in the brain, which is either local and is realized in the form of partial seizures, or acquires a generalized character. Significant disturbances in the processes of thalamocortical interaction and an increase in the sensitivity of cortical neurons have been established. The biochemical basis of seizures is the excessive release of excitatory neurotransmitters - aspartate and glutamate - and the lack of inhibitory neurotransmitters, primarily GABA.

Pathomorphology. In the brain of deceased patients with epilepsy, dystrophic changes ganglion cells, karyocytolysis, shadow cells, neuronophagia, glial hyperplasia, disturbances in the synaptic apparatus, swelling of neurofibrils, formation of "windows" of desolation in the nerve processes, "swelling" of dendrites. These changes are more marked in the motor area of the cerebral cortex. big brain, sensitive zone, hippocampal gyrus, amygdala, nuclei of the reticular formation. Residual changes in the brain associated with past infections, traumas, and malformations are also detected. Mentioned changes are not specific.

Symptoms of Epilepsy:

AT clinical picture epilepsy distinguish the period of a seizure, or an attack, and the interictal period. It should be emphasized that in the interictal period, neurological symptoms may be absent or may be determined by the disease causing epilepsy (traumatic brain injury, stroke, etc.). Most hallmark epilepsy is grand mal seizure . It usually starts suddenly, and its onset is not associated with any external factors. Less often, distant harbingers of a seizure can be established. In these cases, 1-2 days before it, poor health is noted, headache, sleep disturbance, appetite, increased irritability. In most patients, the seizure begins with the appearance of an aura, which in the same patient is stereotyped. Depending on the stimulation of the brain area from which the epileptic discharge begins, several main types of aura are distinguished: autonomic, motor, mental, speech and sensory. After the aura has passed, which lasts for several seconds, the patient loses consciousness and falls as if knocked down. The fall is accompanied by a peculiar loud cry due to spasm of the glottis and convulsive muscle contraction. chest. Convulsions immediately appear, initially tonic: the trunk and limbs are stretched in a state of tension, the head throws back and sometimes turns to the side, breathing is held, the veins in the neck swell, the face becomes deathly pale, with gradually increasing cyanosis, the jaws are convulsively compressed Tonic the seizure phase lasts 15-20 s. Then clonic convulsions appear in the form of jerky contractions of the muscles of the limbs, neck, torso. During the clonic phase of a seizure lasting up to 2-3 minutes, breathing is often hoarse, noisy due to the accumulation of saliva and retraction of the tongue, cyanosis slowly disappears, foam is released from the mouth, often stained with blood due to biting the tongue or cheek. The frequency of clonic convulsions gradually decreases, and at the end of them, a general muscle relaxation. During this period, the patient does not respond even to the strongest stimuli, the pupils are dilated, their reaction to light is absent, tendon and protective reflexes are not evoked, it is often noted involuntary urination. Consciousness remains soporous and only after a few minutes gradually clears up. Often, leaving soporous condition the patient falls into a deep sleep. At the end of the seizure, they complain more about weakness, lethargy, drowsiness, but they don’t remember anything about the seizure itself.

The nature of epileptic seizures can be different. According to the International Classification of Epileptic Seizures, there are partial (focal, local) and generalized seizures. Partial seizures are further subdivided into simple, complex, occurring with impaired consciousness, and secondarily generalized.

Symptoms in partial seizures are determined by the syndrome of irritation of any area of the cortex of the diseased brain. Among simple partial seizures, the following can be distinguished: with motor signs; with somatosensory or specific sensory symptoms(sounds, flashes of light or lightning); with vegetative symptoms or signs (peculiar sensations in the epigastrium, pallor, sweating, redness of the skin, piloerection, mydriasis); With mental symptoms.

For complex seizures, this or that degree of disturbance of consciousness is characteristic. At the same time, consciousness may not be completely lost, the patient partially understands what is happening around. Often complex partial seizures are due to a focus in the temporal or frontal lobe and begin in the aura.

The sensory aura includes a variety of perceptual disturbances. The visual aura that occurs when the occipital lobe is affected is usually manifested by the vision of bright sparks, shiny balls, ribbons, bright red coloring of surrounding objects (simple visual hallucinations) or in the form of images of some faces, individual parts of the body, figures (complex visual hallucinations) . The sizes of objects change (macro- or micropsia). Sometimes visual fields fall out (hemianopsia), complete loss of vision (amaurosis) is possible. With an olfactory aura (temporal epilepsy), patients are haunted by a "bad" smell, often in combination with gustatory hallucinations (the taste of blood, the bitterness of metal, etc.). The auditory aura is characterized by the appearance of various sounds: noise, cod, rustle, music, screams. For the mental aura (with the defeat of the parietal-temporal region), experiences of fear, horror or bliss, joy, a peculiar perception of "already seen" are typical. The vegetative aura is manifested by changes functional state internal organs: palpitations, pain behind the sternum, increased peristalsis intestines, urge to urinate and defecate, pain in the epigastrium, nausea, salivation, a feeling of suffocation, chills, blanching or redness of the face, etc. Motor aura (with damage to the sensorimotor region) is expressed in various kinds motor automatisms: tilting or turning the head and eyes to the side, automated movements of the limbs, which have a regular distribution pattern (leg - torso - arm - face), while sucking and chewing movements appear. The speech aura is accompanied by the pronunciation of individual words, phrases, meaningless exclamations, etc. With a sensitive aura, patients experience paresthesia (feeling cold, crawling, numbness, etc.) in certain parts of the body. In some cases, with partial seizures, simple or complex, pathological bioelectrical activity, initially focal, spreads throughout the brain - while developing a secondary generalized seizure.

In primary generalized seizures pathological process both cerebral hemispheres are initially involved. There are the following types of generalized seizures:

absences and atypical absences;
myoclonic;
clonic;
tonic;
tonic-clonic;
atonic.

In children with epilepsy, absence seizures are often observed, which are characterized by a sudden and very short-term cessation of activity (games, conversation), fading, and lack of response to a call. The child does not fall and after a few seconds (no more than 10) continues the interrupted activity. On the EEG of patients during an absence, as a rule, a characteristic peak-wave activity with a frequency of 3 Hz is recorded. The patient is unaware and does not remember the seizure. The frequency of absences sometimes reaches several tens per day.

The international classification of epilepsy and epileptic syndromes should be distinguished from the classification of epileptic seizures, since in some cases of the same patient, especially with severe epilepsy, there are various seizures.

The classification of epilepsy is based on two principles. The first is whether the epilepsy is focal or generalized; the second - whether any pathology is determined in the patient's brain (according to MRI, CT studies, etc.); respectively distinguish symptomatic or idiopathic epilepsy.

Sometimes the seizures happen so often that it develops life threatening condition - status epilepticus.

Epileptic status - a condition in which the patient does not regain consciousness between seizures or the seizure lasts more than 30 minutes. The most common and severe is tonic-clonic status epilepticus.

Diagnosis of Epilepsy:

In the presence of seizures with loss of consciousness, regardless of whether they were accompanied by convulsions or not, all patients should undergo an electroencephalographic examination.

One of the main methods for diagnosing epilepsy is electroencephalography. The most typical variants of epileptic activity are the following: sharp waves, peaks (spikes), "peak-slow wave" complexes, "acute wave-slow wave" complexes. Often the focus of epileptic activity corresponds to clinical features partial seizures; the use of modern methods of computerized EEG analysis allows, as a rule, to clarify the localization of the source of pathological bioelectrical activity.

There was no distinct relationship between the EEG pattern and the type of seizure; at the same time, generalized high-amplitude "peak-wave" complexes with a frequency of 3 Hz are often recorded with absences. Epileptic activity is usually noted on encephalograms recorded during a seizure. Quite often, it is also determined on the so-called interictal EEG, especially during functional tests (hyperventilation, photostimulation). It should be emphasized that the absence of epileptic activity on the EEG does not exclude the diagnosis of epilepsy. AT last years began to use the so-called multi-hour EEG monitoring, parallel video and EEG monitoring.

When examining patients with epilepsy, it is necessary to conduct computed tomography preferably an MRI scan; expedient study of the fundus, biochemical blood tests, electrocardiography, especially in the elderly.

In recent years, the method of recording visual evoked potentials for reversal of the chess pattern has been used as an additional method for studying the state of visual afferent pathways in patients with epilepsy. Specific changes in the form of the visual potential and sensory post-discharge were revealed in the form of their transformation into a phenomenon similar in form to the "spike-wave" complex.

Epilepsy Treatment:

The goal of treatment are the cessation of epileptic seizures with minimal side effects and leading the patient in such a way that his life was as full and productive as possible. Before prescribing antiepileptic drugs, the doctor must conduct a detailed examination of the patient - clinical and electroencephalographic, supplemented by an analysis of the ECG, kidney and liver function, blood, urine, CT or MRI data. The patient and his family should receive instructions on taking the drug and be informed about both the actual achievable results of treatment and possible side effects.

Modern tactics for the treatment of patients with epilepsy include the following:

identification of those causes of seizures that can be treated (tumor, aneurysm, etc.);
elimination of factors provoking seizures (lack of sleep, physical and
mental strain, hyperthermia);
correct diagnosis types of epileptic seizures and epilepsy;
appointment of adequate drug therapy (inpatient or outpatient);
attention to education, employment, rest of patients, social problems of a patient with epilepsy.

Principles of epilepsy treatment:

compliance of the drug with the type of seizures and epilepsy (each drug has a certain selectivity for one or another type of seizures and epilepsy);
if possible, the use of monotherapy (the use of one antiepileptic drug).

Conservative treatment. Treatment should begin with the appointment of a small dose of an antiepileptic drug recommended for this type of seizure and form of epilepsy.

The dose is increased in the absence of side effects and the preservation of seizures in general. With partial seizures, carbamazepine (tegretol, finlepsin, carbasan, timonil), valproates (depakin, convulex), phenytoin (difenin), phenobarbital (luminal) are effective. The first-line drugs are carbamazepine and valproate. Medium therapeutic dose carbamazepine is 600-1200 mg per day, valproate - 1000-2500 mg per day. daily dose divided into 2-3 doses. The so-called retard preparations, or prolonged action agents, are very convenient for patients. They are prescribed 1-2 times a day (depakin-chrono, finlepsin-petard, tegretol-CR). The side effects of phenobarbital and phenytoin determine their use only as second line drugs.

With generalized seizures, the patterns of prescribing drugs are as follows. In generalized tonic-clonic seizures, valproate and carbamazepine are effective. With absences, ethosuximide and valproate are prescribed. Valproates are considered the drugs of choice for patients with idiopathic generalized epilepsy, especially those with myoclonic seizures and absences. Carbamazepine and phenytoin are not indicated for absences, myoclonic seizures.

In recent years, many new antiepileptic drugs (lamotrigine, tiagabine, etc.) have appeared that are more effective and better tolerated.

The treatment of epilepsy is a long process. The question of the gradual cessation of antiepileptic drugs can be raised no earlier than 2-5 years after the last seizure (depending on the age of the patient, the form of epilepsy, etc.).

With epileptic status, sibazon (diazepam, seduxen) is used: 2 ml of a solution containing 10 mg of the drug (intravenously administered slowly in 20 ml of 40% glucose solution). Re-introduction permissible not earlier than after 10-15 minutes. If there is no effect from sibazon, phenytoin, hexenal or thiopental-sodium is administered. 1 g of the drug is dissolved with isotonic sodium chloride solution and administered as a 1-5% solution very slowly intravenously. In this case, there is a danger of respiratory depression and hemodynamics, so the drugs should be administered with minute pauses after infusion of every 5-10 ml of the solution. In cases of continued seizures and their high frequency, use inhalation anesthesia nitrous oxide mixed with oxygen (2:1). Anesthesia is contraindicated in deep coma, severe respiratory disorders, collapse.

Surgery. With focal epilepsy, indications for surgery are determined primarily by the nature of the disease that caused epileptic seizures (tumor, abscess, aneurysm, etc.).

More often in these cases, the need for surgery is determined not by the presence of an epileptic syndrome in the patient, but by the danger to his health and life of the disease itself, which led to the onset of seizures. This applies primarily to brain tumors, abscesses and some other volumetric formations of the brain.

It is more difficult to determine the indications in cases where the epileptic syndrome is caused by the consequences of an injury, an inflammatory process, or there is no obvious cause of epilepsy, it is difficult to detect using special methods. In these cases, the main method of treatment is medication. Only in a relatively small number of patients with seizures that are not amenable to medical correction, and with progressive degradation of the personality, does the need for brain surgery arise.

Due to the complexity and responsibility, the decision on the advisability of surgical intervention, the examination of patients and the operation itself should be carried out in specialized centers.

Of particular importance in clarifying the nature of epilepsy is the study of brain metabolism using positron emission or single-photon tomography (so far such studies are possible only in certain specialized centers).

A special place in the examination of patients suffering from epilepsy is the monitoring of their condition, behavior and directed study of the bioelectrical activity of the brain.

If surgical treatment is planned, then it often becomes necessary to use electrodes implanted in the deep structures of the brain for long-term recording of the electrical activity of these structures. For the same purpose, multiple cortical electrodes can be used, the installation of which requires craniotomy.

If using the above methods it is possible to detect a focus of pathological electrical activity (epileptic focus), there may be indications for its removal.

In certain cases, such operations are carried out under local anesthesia to be able to control the patient's condition and not cause damage to functionally significant areas of the brain (motor, speech areas).

In case of focal epilepsy that occurred after a traumatic brain injury, the meningeal adhesions are separated, cysts are removed, glial scars from the brain tissue, respectively, in the area where the epileptogenic focus is located, subpial removal of the cortex is performed.

One of the particular forms of focal epilepsy that is subject to surgical treatment is temporal lobe epilepsy, which is often based on birth injury with the formation of foci of gliosis in the hippocampus and medial parts of the temporal lobe.

The basis of temporal lobe epilepsy is psychomotor seizures, the appearance of which is often preceded by a characteristic aura: patients may experience a feeling unreasonable fear, discomfort in the epigastric region, to feel unusual, often unpleasant odors, the experience of "already seen". Seizures may be restlessness, uncontrolled movements, licking, forced swallowing. The patient becomes aggressive. Over time, the degradation of the individual

With temporal lobe epilepsy long time temporal lobe resection has been used with some success. Recently, a more gentle operation has been used - selective removal of the hippocampus and amygdala. Termination or weakening of seizures can be achieved in 70-90% of cases.

In children with congenital underdevelopment of one of the hemispheres, hemiplegia, and epilepsy not amenable to medical correction, in some cases there are indications for the removal of the entire affected hemisphere (hemispherectomy).

In primary generalized epilepsy, when it is not possible to identify an epileptogenic focus, the intersection of the corpus callosum (callesotomy) is indicated. During this operation, interhemispheric connections are broken and generalization does not occur. epileptic seizure. In some cases, stereotaxic destruction of the deep structures of the brain (almond-shaped complex, cingulate gyrus), which are links of the "epileptic system", is used.

Epilepsy Prevention:

It is recommended to avoid alcohol, smoking, strong coffee and tea, overeating, hypothermia and overheating, staying at high altitude, as well as other adverse environmental influences. Showing a milk-vegetarian diet, prolonged exposure to air, lungs physical exercises, compliance with the regime of work and rest.

Employability. Often depends on the frequency and timing of seizures. With rare seizures that occur at night, the ability to work is preserved, but business trips and work at night are prohibited. Seizures with loss of consciousness daytime limit work capacity. It is forbidden to work at height, near fire, in hot shops, on water, near moving mechanisms, on all modes of transport, in contact with industrial poisons, with a fast rhythm, mental stress and frequent switching of attention.

Which doctors should you contact if you have Epilepsy:

Are you worried about something? Do you want to know more detailed information about Epilepsy, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study external signs and help identify the disease by symptoms, advise you and provide needed help and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
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If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific symptoms, characteristic external manifestations- so called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent terrible disease but also to maintain a healthy mind in the body and the body as a whole.

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Other diseases from the group Diseases of the nervous system:

Absence epilepsy Kalpa

brain abscess

Australian encephalitis

Angioneuroses

Arachnoiditis

Arterial aneurysms

Arteriovenous aneurysms

Arteriosinus anastomoses

Bacterial meningitis

amyotrophic lateral sclerosis

Meniere's disease

Parkinson's disease

Friedreich's disease

Venezuelan equine encephalitis

vibration sickness

Viral meningitis

Exposure to microwave electromagnetic field

Effects of noise on the nervous system

Eastern equine encephalomyelitis

congenital myotonia

Secondary purulent meningitis

Hemorrhagic stroke

Generalized idiopathic epilepsy and epileptic syndromes

Hepatocerebral dystrophy

herpes zoster

Herpetic encephalitis

Hydrocephalus

Hyperkalemic form of paroxysmal myoplegia

Hypokalemic form of paroxysmal myoplegia

hypothalamic syndrome

Fungal meningitis

Influenza encephalitis

decompression sickness

Pediatric epilepsy with paroxysmal EEG activity in the occipital region

Cerebral palsy

Diabetic polyneuropathy

Dystrophic myotonia Rossolimo-Steinert-Kurshman

Benign childhood epilepsy with EEG peaks in the central temporal region

Benign familial idiopathic neonatal seizures

Benign recurrent serous meningitis Mollare

Closed injuries of the spine and spinal cord

Western equine encephalomyelitis (encephalitis)

Infectious exanthema (Boston exanthema)

Hysterical neurosis

Ischemic stroke

California encephalitis

candidal meningitis

oxygen starvation

Tick-borne encephalitis

Coma

Mosquito viral encephalitis

Measles encephalitis

Cryptococcal meningitis

Lymphocytic choriomeningitis

Pseudomonas aeruginosa meningitis (pseudomonous meningitis)

Meningitis

meningococcal meningitis

myasthenia gravis

Migraine

Myelitis

Multifocal neuropathy

Violations of the venous circulation of the brain

Spinal circulatory disorders

Hereditary distal spinal amyotrophy

trigeminal neuralgia

Neurasthenia

obsessive-compulsive disorder

neuroses

Neuropathy of the femoral nerve

Neuropathy of the tibial and peroneal nerves

Neuropathy of the facial nerve

Ulnar nerve neuropathy

Radial nerve neuropathy

median nerve neuropathy

Spina bifida and spinal hernias

Neuroborreliosis

Neurobrucellosis

neuroAIDS

Normokalemic paralysis

General cooling

burn disease

Opportunistic diseases of the nervous system in HIV infection

Tumors of the skull bones

Tumors of the cerebral hemispheres

Acute lymphocytic choriomeningitis

Curb the black sickness!

A brain disease characterized by recurrent seizures is perceived by most of us as severe. incurable disease. However, this opinion, entrenched in the mass consciousness, is refuted by Dr. medical sciences, corresponding member of the Russian Academy of Medical Sciences, member of the Medical Society of Great Britain and the New York Academy of Sciences Vladimir Alekseevich Karlov in his article on the role of treatment-related factors in the complex of modern antiepileptic therapy.

Don't encourage illness!
As you know, "the retinue plays the king." This expression also applies to epilepsy, whose seizures are often provoked by her "companions". Excitation of brain cells leads to their excessive bioelectrical activity. It causes a variety of seizures, similar to those that arise from electrical discharges. The most severe seizures. Depending on the part of the brain where the discharge occurs, muscle tension is replaced by convulsions, the patient's face becomes bluish (hence the old name " black sickness"). Provocateurs can be overexcitation, overwork, stress, lack of sleep, alcohol. It is they who often play a role trigger for the onset of the next attack of epilepsy.
Lack of sleep - at first glance, this is a mere trifle, nothing. However, for an epileptic, the normal eight-hour night rest - the most needed medicine. Therefore, you will need evening walks on fresh air, otherwise - taking sedatives - valocordin, infusion of valerian, wild peony. But discos, with their loud rhythmic music, flickering light, crush, are clearly contraindicated.
Sun glare on the waves of the sea, the flickering of bright flashes of light outside the window of a moving train also serve as risk factors for some forms of epilepsy. Naturally, they are easy to avoid, for example, with the help of tinted or special glasses, and those who suffer from epilepsy are better off avoiding overheating in the sun. And many hours of sitting at a computer or in front of an ordinary TV, with its flashing frames, will also have to be left.
In physical education, certain restrictions are also needed. Climbing, swimming, including scuba diving, boxing are contraindicated. It is better to give preference to walking, gymnastics and weightlifting, which contribute to the suppression of the epileptoid activity of the brain.
Seizures are also stimulated by malnutrition. "Vodohlebam" should reduce fluid intake. An addiction to spicy, salty foods usually increases fluid intake. There is a delay in the body and swelling of the brain tissue, growing intracranial pressure and then another attack follows. But the worst enemy of epileptics is alcohol. That is why doctors advise using decoctions for treatment, and tinctures and extracts in alcohol must be diluted.

Herbs, herbs...
Sick epilepsy herbal preparations are shown that have a calming and mild effect.
Novopassit, for example, is a complex of dry or liquid extracts lemon balm, hawthorn, valerian, black elderberry, passionflower and excipient guaifenesin, which reduces the state of mental tension, as well as fear. Novopassit is taken 1 tablet or 1 teaspoon with juice, tea three times a day.
An extract is prepared from the shoots of passionflower (meat red passion flower), which has a sedative effect on the central nervous system, has an anticonvulsant effect. It is usually prescribed for 20-30 days, 20-40 drops three times a day.
Traditional medicine recommends different ways help these patients. Collections of various medicinal plants provide a versatile and mild effect, complementing the basic therapy and helping to reduce the dosage of pharmaceuticals. For the most part, these are collections of 6-8 plants, including calamus, yarrow, tansy and viburnum, St. John's wort, licorice, blue cyanosis, lemon balm, plantain. To prepare the infusion 1-2 tbsp. spoons of raw materials are poured into a glass of water, kept in a water bath for 15 minutes. Reception - 1/3 cup three times a day. Course - 3-6 months.
Has soothing properties, for example, infusion of roots: 1 tbsp. a spoonful of crushed roots is poured into 1 glass of cold boiled water, insist 6-8 hours, drink 1 tbsp. spoon (children - 1 teaspoon) three times a day. The course is 1.5-2 months. In addition, every other day take a 15-minute bath before going to bed from a decoction of valerian roots (a handful of roots per 1 liter).
The motherwort has also proven itself well: 2 teaspoons of the crushed above-ground flowering part are poured into 0.5 liters of boiling water and insisted for 2 hours. Drink 1-2 tbsp. spoons before meals 4 times a day.
With increased excitability, insomnia, an infusion of evading peony roots (marina root) is prepared: 1 teaspoon of crushed raw materials is poured with boiling water, insisted for 30 minutes in a tightly closed container and taken 1 tbsp. spoon three times a day 10-15 minutes before meals. An overdose is dangerous. If there is no wild peony, you should use a pharmacy tincture (30-40 drops three times a day, the course is 30 days) or, at worst, take a dark red garden specimen of the plant. In the latter case, fresh petals and leaves (100 g each) are infused in 200 ml of alcohol for 2 weeks and 10-15 drops are taken, diluted with water, three times a day for half an hour before meals.
In Siberia, Transbaikalia and Primorye as anticonvulsant often used in the form of a powder and in a decoction, the rhizome of the Baikal skullcap or. single dose is 3-10 g. Usually, 20 g of the branches of this evergreen shrub collected during flowering are infused for 1 hour in a glass of boiling water and then drunk 1/3-1/2 cup before meals three times a day. Chernobyl roots collected during flowering are suitable for the same purpose: 30 g of roots are poured into 0.5 liters of beer and boiled for 5 minutes, drunk until the sweat stops.
Compliance with the simple rules that I have listed allows you to most often achieve improvement. For most patients, the disease does not interfere with life at all. full life and work productively. However, those who have lived without seizures for at least 3-4 years and whose electroencephalography confirms the absence of epileptoid brain activity can consider themselves cured.

Only together
Friendly association "doctor, patient and environment of the patient" - necessary condition success in the fight against epilepsy. Everyone on the team has a role to play. The doctor determines the strategy drug treatment. Note that a universal remedy that can eliminate all types of epileptic seizures has not yet been found. But an effective combination different medicines, if necessary, is realistic, although it requires careful selection of combined drugs that affect the concentration of anticonvulsants in the blood.
Modern medicine can reduce the frequency of seizures and even stop them completely. Now about 20 drugs are used, the selection usually begins with the appointment of one of the basic ones (finlepsin, valproate, tegretol, depakine).
Despite their high effectiveness, anticonvulsant drugs have side effects: drowsiness, lethargy, allergic rash and others. And here the patient himself, strictly following medical recommendations, should act as a partner of the doctor. And the patient, it happens, stops taking the pills, becoming a violator of the much-needed continuous and long-term treatment. Deviations can exacerbate the disease and even lead to the so-called status epilepticus, that is, attacks that repeat one after another or one, but protracted, and sometimes with a fatal outcome.
I advise you to cook in the evening, in advance necessary pills the next day. In addition, an alarm clock or cell phone call can serve as an assistant reminding you of the time to take the medicine.
The help of relatives and friends of the patient is also an important component of the treatment program. The complicity of others is simply necessary so that the patient does not feel isolated, cut off from other people and does not suffer from an inferiority complex.
In everyday life, it is important to know how to properly provide first aid to the patient. During an attack with loss of consciousness, do not try to hold it and move it to another place. To prevent a person from injuring himself, to avoid injury, put something soft under his head, unbutton clothes that make it difficult to breathe. And don't try to open your jaw, put pills in your mouth, or pour in water.
If the attack lasts more than 5 minutes or recurs, medical attention is required.

Doctor of Medical Sciences, Vladimir Alekseevich Karlov

According to the magazine " healthy image life" №12 for 2008

Enlargement of the thyroid gland (called a goiter) is quite common. There are many reasons for this. In some cases, the thyroid gland is enlarged due to a lack of iodine in food (compensatory increase), in others, an increase in the gland is a symptom of the disease of this organ. Most often, female representatives are ill. Enlargement of the thyroid gland in men is several times less common. Treatment of an enlarged thyroid gland depends on the causes and manifestations of this reaction of the body.

The fact is that an increase in this organ may not lead to a violation of its functions (hormones are normal - euthyroidism), but may be accompanied by an increase (hyperthyroidism) or a decrease (hypothyroidism) in the function of the gland. Depending on the diagnosis and the results of clinical tests, the treatment of an enlarged thyroid gland is prescribed.

Degrees of enlargement of the thyroid gland

An important factor in treatment is determining the degree of organ enlargement. The thyroid gland consists of two lobes and an isthmus, most often an increase in the share of the thyroid gland occurs on one side.

It is customary to distinguish the following degrees:

Enlargement of the thyroid gland of the 1st degree is characterized by the fact that it is possible to probe its isthmus, sometimes slightly enlarged lobes. Visually, no changes are detected.
Enlargement of the thyroid gland of the 2nd degree is well defined by palpation, during swallowing movements it becomes noticeable.
Enlargement of the thyroid gland of the 3rd degree is already clearly visible with a cursory glance at the patient.
At 4 and 5 degrees, the configuration of the neck changes, it is deformed, the goiter interferes with the normal process of swallowing and breathing.

Of course, with the last two degrees, as a rule, surgical intervention is indicated. However, the fourth and fifth degrees are rare today because modern medicine identifies the problem earlier. Quite often, an increase in the thyroid gland is detected during preventive examinations or visiting a doctor for another reason.

Forms of thyroid disease

According to the state of the tissues of the gland, it can be:

Diffuse enlargement - the gland is evenly enlarged,
Nodular enlargement - one or more nodules are formed in the tissues of the gland. They can be tiny, then they are just kept under control. If the nodes increase more than 1 cm in diameter or there are several of them, a biopsy is prescribed, since there is a threat of their degeneration into malignant neoplasms.
mixed form. It begins with a diffuse increase followed by the formation of nodes.

For the reasons for the development of diseases:

Endemic goiter (lack of iodine in water and food),
Sporadic goiter (occurs under the influence of adverse factors),
Thyroiditis (inflammatory processes),
Congenital goiter.

The choice of treatment tactics

Very important comprehensive examination, which reveals the cause of the enlargement of the gland, the degree of violation of its functions. Treatment of an enlarged thyroid gland is primarily aimed at normalizing hormonal background. If the hormones are normal, then the patient is simply observed, periodically monitoring the level of production of thyroid hormones.

Extreme cases of gland enlargement are a surgical operation, after which it is most often necessary to take drugs containing thyroid hormones for the rest of your life.

Except surgical treatment apply:

Hormone replacement therapy (for hypothyroidism),
Therapy that inhibits the production of hormones by the gland,
Treatment radioactive iodine.

Hormone replacement therapy is carried out, as a rule, with the help of the drug L-thyroxine. The dosage is selected individually. Begin treatment with small doses, gradually increasing them towards the middle of the course of treatment, after which the doses are gradually reduced until the drug is completely discontinued. Treatment can take from a month to one and a half to two years. Treatment with hormonal drugs, normalizing the function of the gland, leads to a decrease in its size. In the absence of nodes, it is quite possible to restore normal sizes.

Such treatment is prescribed for children and adolescents who, during a period of rapid development, may suffer from reduced thyroid function. Today, our children in schools and kindergartens regularly preventive examinations. If a child has an enlarged thyroid gland, then this is detected in the early stages and can be treated. An increase in the thyroid gland in children is especially dangerous, because it entails problems in the intellectual, behavioral sphere, growth and sexual development disorders.

In hyperthyroidism, agents are prescribed that inhibit the production of hormones (propylthiouracil, mercazolil, metizol, thiamazole, tyrosol). If the effect is insufficient, surgery or, alternatively, radioactive iodine is indicated.

Treatment with radioactive iodine is a single (rarely double) dose of the drug. In this case, the function of the thyroid gland is suppressed due to its destruction. The difficulty lies in correct selection doses. The attitude to this method is ambiguous, since in 25% of cases, in addition to normalizing the size of the gland, hypothyroidism is observed, which remains for life and requires hormonal adjustment.

A condition characterized by recurrent (more than two) epileptic seizures not provoked by any immediately identifiable cause. epileptic attack - clinical manifestation 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 clear causes (brain tumor, TBI) do not indicate the presence of epilepsy in the patient.

Classification of epileptic seizures

According to international classification epileptic seizures distinguish partial (local, focal) forms and generalized epilepsy. Attacks of focal epilepsy are divided into: simple (without impairment of consciousness) - with motor, somatosensory, vegetative and mental symptoms and complex - accompanied by impaired 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 - not suitable for any of the above types of seizures, as well as some neonatal seizures (chewing movements, rhythmic eye movements). There are also repeated epileptic seizures (provoked, cyclic, random) and prolonged seizures (status epilepticus).

Clinical picture of epilepsy

In the clinical picture of epilepsy, three periods are distinguished: ictal (the period of an attack), 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 that causes epilepsy - traumatic brain injury, hemorrhagic or ischemic stroke, etc.).

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

The secondary generalized attack begins, as a rule, suddenly. After a few seconds of the aura (each patient has a unique 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 muscles of the chest. Next comes the tonic phase of an epileptic seizure, named after the type of seizures. Tonic convulsions - the trunk and limbs are stretched in a state of extreme tension, the head throws back and / or turns 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 compressed. The duration of the tonic phase of an attack is from 15 to 20 seconds. Then comes the clonic phase of an epileptic attack, accompanied by clonic convulsions(noisy, hoarse breathing, foaming at the mouth). The clonic phase lasts 2 to 3 minutes. The frequency of convulsions gradually decreases, after which complete muscle relaxation occurs, when the patient does not respond to stimuli, the pupils are dilated, their reaction to light is absent, protective and tendon reflexes are not caused.

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 absences. 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 not aware of or remember seizures. The frequency of absences can reach several tens per day.

Diagnosis of epilepsy

Diagnosis of epilepsy should be based on the history, physical examination of the patient, EEG data and neuroimaging (MRI and CT of the brain). It is necessary to determine the presence or absence of epileptic seizures according to the anamnesis, clinical examination the patient, the results of laboratory and instrumental studies, as well as to differentiate epileptic and other seizures; determine the type of epileptic seizures and the form of epilepsy. Familiarize the patient with the recommendations on the regimen, assess the need 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 of epilepsy, this diagnosis cannot be made even in the presence of epileptiform activity detected on the EEG.

Epilepsy is diagnosed by neurologists and epileptologists. The main method of examination of patients diagnosed with epilepsy is EEG, which has no contraindications. EEG is carried out for all patients without exception in order to detect epileptic activity. More often than others, such variants of epileptic activity as sharp waves, spikes (peaks), complexes "peak - slow wave", "acute wave - slow wave" are observed. Modern methods EEG computer analysis allows 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 the 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 functional tests) does not exclude the presence of epilepsy. In such cases, a re-examination or video monitoring of the EEG performed is carried out.

In the diagnosis of epilepsy, MRI of the brain is the most valuable among neuroimaging research methods, which is indicated for all patients with a local onset of an epileptic seizure. MRI can detect diseases that influenced the provoked nature of seizures (aneurysm, tumor) or etiological factors epilepsy (mesial temporal sclerosis). Patients diagnosed with drug-resistant epilepsy in connection with subsequent referral for surgical treatment also undergo MRI to determine the localization of the CNS lesion. In some cases (elderly patients), it is necessary to additional research: biochemical blood test, fundus examination, ECG.

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

Epilepsy treatment

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

One of the principles drug treatment epilepsy is monotherapy. The drug is prescribed in minimum dose with its subsequent increase until the cessation of seizures. In case of insufficient dose, 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 the latest antiepileptic drugs (topiramate, oxcarbazepine, levetiracetam), registered for use in monotherapy. When choosing between traditional and the latest drugs it is necessary to take into account the individual characteristics of the patient (age, gender, comorbidities). Valproic acid is used to treat unidentified seizures of epilepsy. When prescribing one or another antiepileptic drug, one should strive for the minimum possible frequency of its administration (up to 2 times / day). Due to stable plasma concentrations, long-acting drugs are more effective. The dose of the drug prescribed to an elderly patient creates more high 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, followed by their titration. The abolition of the drug is carried out gradually, taking into account the form of epilepsy, its prognosis and the possibility of resuming seizures.

Pharmacoresistant epilepsies (ongoing seizures, failure of adequate antiepileptic treatment) require additional examination patient to address the issue of surgical treatment. Preoperative examination should include video-EEG registration of seizures, obtaining reliable data on the localization, anatomical features and the nature of the distribution of the epileptogenic zone (MRI). Based on the results of the above studies, the nature of surgical intervention: surgical removal epileptogenic brain tissue (cortical topectomy, lobectomy, hemispherectomy, multilobectomy); selective operation(amygdalo-hippocampectomy for temporal lobe epilepsy); callosotomy and functional stereotaxic intervention; vagus stimulation.

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

Epilepsy prognosis

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

Epilepsy affects all aspects of a patient's life, therefore it is a significant medical and social problem. One facet of this problem is the paucity of knowledge about epilepsy and the resulting stigmatization of patients whose judgments about frequency and severity mental disorders accompanying epilepsy are often unfounded. The vast majority of patients receiving proper treatment lead a normal life without seizures.

Prevention of epilepsy

Prevention of epilepsy involves the possible prevention of TBI, intoxication and infectious diseases, prevention of possible marriages between patients with epilepsy, adequate temperature reduction in children in order to prevent fever, the consequence of which may be epilepsy.