Frequency of epileptic seizures and their classification. External factors contributing to the development of epilepsy

Epilepsy- a chronic disease 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. Its descriptions are found among Egyptian priests (about 5000 BC), doctors of Tibetan medicine, Arabic-language 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 have not been sufficiently studied.

In newborns and infants, the most common causes of seizures are severe hypoxia, genetic metabolic defects, and perinatal lesions. In childhood, seizures are in many cases caused by infectious diseases of the nervous system. There is a fairly clearly defined syndrome in which seizures develop only as a consequence of fever - febrile seizures. 5% of children have experienced seizures at least once in their lives when their body temperature rises, and in about half of them repeated seizures should be expected.

IN at a young age the main cause of epileptic disorders is traumatic brain injury, and one should remember the possibility of developing seizures both in the acute and in a later period. In people over 20 years of age, especially if there is no history of epileptic seizures, a possible cause of epilepsy is a brain tumor.

In patients over 50 years of age among etiological factors epilepsy should first of all indicate vascular and degenerative diseases brain. Epileptic syndrome develops in 6-10% of patients who have suffered an ischemic stroke, 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 seizure development 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, the leading role is played by changes in the neuronal activity of the brain, which, due to pathological factors, becomes excessive and periodic. Characteristic is a sudden pronounced depolarization of neurons in the brain, which is either local and occurs in the form of partial seizures, or becomes generalized. 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 a lack of inhibitory neurotransmitters, primarily GABA.

Pathomorphology. In the brains of deceased patients with epilepsy, dystrophic changes in ganglion cells, karyocytolysis, shadow cells, neuronophagia, glial hyperplasia, disorders in the synaptic apparatus, swelling of neurofibrils, the formation of “windows” of desolation in nerve processes, and “swelling” of dendrites are detected. These changes are more noticeable in the motor zone of the cerebral cortex, sensitive zone, hippocampal gyrus, amygdala, nuclei reticular formation. Residual changes in the brain associated with past infections, injuries, developmental defects. These changes are not specific.

Symptoms of Epilepsy:

The clinical picture of epilepsy is divided into the seizure period, or attack, and the interictal period. It should be emphasized that in the interictal period, neurological symptoms may be absent or determined by the disease causing epilepsy (traumatic brain injury, stroke, etc.). The most characteristic sign of epilepsy is grand mal seizure . Usually it begins suddenly, and its onset is not associated with any external factors. Less commonly, distant warning signs of a seizure can be identified. In these cases, 1-2 days before it, poor health, headache, sleep disturbance, appetite disturbance, and increased irritability are noted. In most patients, a seizure begins with the appearance of an aura, which in the same patient is of a stereotypical nature. Depending on the irritation of the area of ​​the brain from which the epileptic discharge begins, several main types of aura are distinguished: vegetative, motor, mental, speech and sensory. After the aura, which lasts several seconds, the patient loses consciousness and falls as if knocked down. The fall is accompanied by a kind of loud cry caused by a spasm of the glottis and convulsive muscle contraction chest. Convulsions immediately appear, initially tonic: the torso and limbs are stretched out in a state of tension, the head is thrown back and sometimes turned 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 clenched 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, and torso. During the clonic phase of a seizure lasting up to 2-3 minutes, breathing is often hoarse and 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, general muscle relaxation occurs. During this period, the patient does not react even to the strongest irritants, the pupils are dilated, there is no reaction to light, tendon and protective reflexes are not evoked, and involuntary urination is often noted. Consciousness remains soporous and only after a few minutes it gradually clears up. Often, emerging from a soporotic state, the patient plunges into deep sleep. After the attack ends, they complain more about weakness, lethargy, and drowsiness, but they don’t remember anything about the attack itself.

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

Symptoms of partial seizures are determined by the syndrome of irritation of any zone of the diseased brain cortex. 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.

Complex seizures are characterized by varying degrees of impairment of consciousness. In this case, consciousness may not be completely lost; the patient partially understands what is happening around him. Often complex partial seizures are caused by a focus in the temporal or frontal lobe and begin with the aura.

Sensory auras include a variety of perceptual disturbances. Visual aura, which occurs when the occipital lobe is damaged, 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 size of objects changes (macro- or micropsia). Sometimes visual fields fall out (hemianopsia), and complete loss of vision (amaurosis) is possible. With olfactory aura (temporal lobe epilepsy), patients are haunted by a “bad” smell, often combined with taste hallucinations (taste of blood, bitterness of metal, etc.). The auditory aura is characterized by the appearance of various sounds: noise, crackling, rustling, music, screams. For the psychic aura (with damage to the parieto-temporal region), experiences of fear, horror or bliss, joy, and a peculiar perception of “what has already been seen” are typical. The vegetative aura is manifested by changes in the functional state of the internal organs: palpitations, chest pain, increased intestinal peristalsis, the urge to urinate and defecate, epigastric pain, nausea, salivation, a feeling of suffocation, chills, paleness or redness of the face, etc. Motor aura (if affected) sensorimotor area) is expressed in various kinds of motor automatisms: throwing back or turning the head and eyes to the side, automated movements of the limbs, which have a natural distribution pattern (leg - torso - arm - face), while sucking and chewing movements appear. A speech aura is accompanied by the utterance of individual words, phrases, meaningless exclamations, etc. With a sensitive aura, patients experience paresthesia (a feeling of 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 - and a secondary generalized seizure develops.

With primary generalized seizures, both hemispheres of the cerebrum are initially involved in the pathological process. The following types of generalized seizures are distinguished:

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

Children with epilepsy often experience absence seizures, which are characterized by a sudden and very short-term cessation of activity (play, conversation), freezing, and lack of response to calls. The child does not fall and after a few seconds (no more than 10) continues the interrupted activity. On the EEG of patients during absence seizure, characteristic peak-wave activity with a frequency of 3 Hz is usually recorded. The patient is unaware and does not remember the seizure. The frequency of absence seizures sometimes reaches several dozen per day.

The international classification of epilepsy and epileptic syndromes should be distinguished from the classification of epileptic seizures, since in a number of cases the same patient, especially with severe epilepsy, has different seizures.

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

Sometimes seizures occur so frequently that a life-threatening condition called status epilepticus develops.

Status epilepticus - 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 types of epileptic activity are the following: sharp waves, peaks (spikes), peak-slow wave complexes, sharp wave-slow wave. Often the focus of epileptic activity corresponds to the clinical features of 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 clear relationship between EEG pattern and seizure type; at the same time, generalized high-amplitude peak-wave complexes with a frequency of 3 Hz are often recorded during absence seizures. Epileptic activity is usually noted on encephalograms recorded during a seizure. Quite often it is determined on the so-called interictal EEG, especially when conducting functional tests(hyperventilation, photostimulation). It should be emphasized that the absence of epileptic activity on the EEG does not exclude the diagnosis of epilepsy. In recent years, so-called multi-hour EEG monitoring and parallel video and EEG monitoring have begun to be used.

When examining patients with epilepsy, it is necessary to carry out computed tomography, preferably MRI examination; Fundus examination, biochemical blood test, and electrocardiography are advisable, especially in the elderly.

In recent years, the method of recording evoked visual potentials for checkerboard pattern reversal has begun to be used as an additional method to study the state of visual afferentation pathways in patients with epilepsy. Specific changes in the shape of the visual potential and sensory afterdischarge were identified in the form of their transformation into a phenomenon similar in shape to the “spike-wave” complex.

Treatment of Epilepsy:

The purpose of treatment are the cessation of epileptic seizures with minimal side effects and the management of the patient in such a way that his life is 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 analysis of ECG, kidney and liver function, blood, urine, and CT or MRI data. The patient and his family should receive instructions about taking the drug and be informed both about the actually achievable results of treatment and about possible side effects.

Modern treatment tactics for patients with epilepsy include the following:

• identifying those causes of seizures that are treatable (tumor, aneurysm, etc.);
• eliminating factors that provoke seizures (lack of sleep, physical and
• mental stress, hyperthermia);
• correct diagnosis type of epileptic seizures and epilepsy;
• prescribing adequate drug therapy (inpatient or outpatient);
• attention to education, employment, recreation of patients, social problems patient with epilepsy.

Principles of treatment of epilepsy:

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

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

The dose is increased if there are no side effects and seizures persist overall. For partial seizures, carbamazepine (Tegretol, Finlepsin, Karbasan, Timonil), valproates (Depakine, Convulex), phenytoin (Difenin), phenobarbital (Luminal) are effective. The first line drugs are carbamazepine and valproate. The average therapeutic dose of carbamazepine is 600-1200 mg per day, valproate - 1000-2500 mg per day. The daily dose is divided into 2-3 doses. The so-called retard drugs, or long-acting drugs, are very convenient for patients. They are prescribed 1-2 times a day (Depakine-Chrono, Finlepsin-Petard, Tegretol-CR). The side effects of phenobarbital and phenytoin determine their use only as second-line drugs.

For generalized seizures, the patterns of drug prescription are as follows. For generalized tonic-clonic seizures, valproate and carbamazepine are effective. For absence seizures, ethosuximide and valproate are prescribed. Valproate is considered the drug of choice for patients with idiopathic generalized epilepsy, especially myoclonic seizures and absence seizures. Carbamazepine and phenytoin are not indicated for absence seizures and myoclonic seizures.

In recent years, many new antiepileptic drugs have appeared (lamotrigine, tiagabine, etc.), differing more high efficiency and better tolerability.

Treatment of epilepsy is a long process. The question of gradual cessation of taking 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.).

For status epilepticus, sibazon (diazepam, seduxen) is used: 2 ml of a solution containing 10 mg of the drug (administered slowly intravenously with 20 ml of 40% glucose solution). Repeated administration is permissible no earlier than 10-15 minutes. If there is no effect from sibazon, phenytoin, hexenal or sodium thiopental are administered. 1 g of the drug is dissolved in an isotonic solution of sodium chloride and administered very slowly intravenously as a 1-5% solution. In this case, there is a danger of respiratory and hemodynamic depression, so the drugs should be administered with minute pauses after infusion of every 5-10 ml of solution. In cases where seizures continue and their frequency is high, inhalation anesthesia with nitrous oxide mixed with oxygen (2:1) should be used. Anesthesia is contraindicated in cases of deep coma, severe respiratory distress, or collapse.

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

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

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

Due to the complexity and responsibility, making a decision on the advisability of surgical intervention, examining patients and performing 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 (for now, such studies are only possible in certain specialized centers).

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

If surgical treatment is contemplated, there is often a need 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), indications may arise for its removal.

In certain cases, such operations are performed under local anesthesia in order 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 occurs after a traumatic brain injury, the meningeal adhesions are separated, cysts and glial scars are removed from the brain tissue, according to the location of the epileptogenic focus, and 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, the occurrence of which is often based on birth trauma with the formation of foci of gliosis in the hippocampus and medial sections 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, unpleasant sensations in the epigastric region, feel unusual, often unpleasant odors, the experience of “already seen.” Seizures can be of the nature of motor restlessness, uncontrolled movements, licking, and forced swallowing. The patient becomes aggressive. Over time, personality degradation occurs

For temporal lobe epilepsy long time Resection of the temporal lobe was used with some success. Recently, a more gentle operation has been used - selective removal of the hippocampus and amygdala. The cessation 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 that cannot be corrected with medication, in some cases there are indications for removal of the entire affected hemisphere (hemispherectomy).

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

Prevention of Epilepsy:

It is recommended to avoid drinking alcohol, smoking, strong coffee and tea, overeating, hypothermia and overheating, staying at high altitudes, as well as other adverse environmental influences. A dairy-vegetable diet, prolonged exposure to air, light physical exercise, and adherence to a work-rest regime are recommended.

Work ability. Often depends on the frequency and timing of seizures. In case of rare seizures that occur at night, the ability to work is maintained, but business trips and night work are prohibited. Seizures with loss of consciousness during the daytime limit the ability to work. It is prohibited to work at heights, near fire, in hot shops, on water, near moving mechanisms, on all types of transport, in contact with industrial poisons, with a fast rhythm, neuropsychic stress and frequent switching of attention.

Which doctors should you contact if you have Epilepsy:

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Other diseases from the group Diseases of the nervous system:

Absence epilepsy Kalpa

Brain abscess

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Exposure to ultra-high frequency electromagnetic fields

Effects of noise on the nervous system

Eastern equine encephalomyelitis

Congenital myotonia

Secondary purulent meningitis

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Generalized idiopathic epilepsy and epileptic syndromes

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Hyperkalemic form of paroxysmal myoplegia

Hypokalemic form of paroxysmal myoplegia

Hypothalamic syndrome

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Decompression sickness

Childhood epilepsy with paroxysmal activity on EEG in the occipital region

Cerebral palsy

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Benign childhood epilepsy with EEG peaks in the central temporal region

Benign familial idiopathic neonatal seizures

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Epilepsy is a disease that affects the brain and is accompanied by repeated attacks of seizures - epileptic seizures.

Approximately 5-10 people out of 1000 have epilepsy. This is the most common chronic disease of the nervous system. 5% of the population suffers an epileptic seizure once in their life.

Epilepsy can develop at any age, although it most often appears in children. It is not always possible to determine the specific cause of the disease, but in some cases (especially in adults), the development of epileptic seizures is associated with brain damage. For example, epilepsy may appear after a stroke, brain tumor, or severe traumatic brain injury. In some cases, the disease may be caused by genetic changes in the brain inherited from parents.

Brain cells (neurons) transmit electrical signals to each other using chemical compounds called neurotransmitters. During a seizure, neurons generate a large number of electrical impulses, a zone of increased excitation is formed in the brain - a focus of epilepsy, which is accompanied by the appearance of symptoms in the form of seizures, impaired sensitivity, perception of the outside world, or loss of consciousness.

Some people only have one seizure in their entire life. If the examination does not find causes or risk factors for the development of the disease, the diagnosis of epilepsy is not made. Often the disease is diagnosed after several seizures, since single epileptic seizures are very common. The most important thing for making a diagnosis is the description of the seizure by the person himself and the witnesses of what happened. In addition, a study of brain function is carried out, a search for a possible source of epilepsy and the probable causes of the disease.

There are various antiepileptic drugs that help reduce the frequency and severity of seizures. Selection the right remedy and its dosage may take some time. IN in rare cases requires surgery to remove a section of the brain or installation of a special electrical device that helps prevent seizures

Symptoms of epilepsy

A symptom of epilepsy is the periodic occurrence of seizures. Seizures are sudden changes in behavior, movement, or well-being. Most often, an epileptic seizure is accompanied by convulsions and loss of consciousness, but other manifestations are also possible, which depend on in which part of the brain the source of excitation is located. Most often, throughout a person’s life, the type and manifestations of an epileptic seizure do not change.

Seizures can occur while you are awake, asleep, or immediately after waking up. Sometimes, before a seizure, a patient with epilepsy experiences special sensations by which he can guess that an attack is approaching and take certain measures. Such sensations are called an aura. The appearance of the aura during different seizures is also different. The most common aura symptoms are:

• nausea or abdominal discomfort;
• weakness, dizziness, headache;
• speech disorder;
• numbness of lips, tongue, hands;
• "lump in the throat;
• chest pain or feeling short of breath;
• drowsiness;
• ringing or noise in the ears;
• the feeling of something already seen or never seen;
• distortion of sensations (smell, taste, touch), etc.

All types of seizures in epilepsy are usually divided into groups, according to which part of the brain the excitation is distributed to. If a small area of ​​the brain is affected, partial (focal, partial) seizures. If arousal affects a significant part of the brain, we speak of generalized seizure. Often an epileptic seizure, starting as a partial seizure, then becomes generalized. Some seizures cannot be classified - seizures of unknown etiology.

Simple partial seizures

During a simple partial seizure, the person remains conscious. Depending on the area of ​​brain damage during a seizure, sensory symptoms- changes in vision, hearing, taste in the form of hallucinations, motor symptoms - muscle twitching of one part of the body or vegetative symptoms - associated with unusual sensations. The most common signs of a simple partial seizure in patients with epilepsy may be:

• a strange sensation throughout the body that is difficult to describe;
• a feeling as if something was “rising” in the stomach, sucking in the pit of the stomach, as if during strong excitement;
• feeling of déjà vu;
• auditory, visual or olfactory hallucinations;
• tingling sensation in the limbs;
• strong emotions: fear, joy, irritation, etc.;
• stiffness or twitching of muscles in a specific part of the body, such as the arm or face.

Complex partial seizures

With a complex partial seizure, a person loses his sense of reality and contact with the outside world. After such a seizure, a patient with epilepsy does not remember what happened to him.

During a complex partial seizure, a person unconsciously repeats any stereotypical movements or strange body movements, for example:

• smacks lips;
• rubs his hands;
• makes sounds;
• waves his arms;
• shakes off or picks off clothes;
• twirls something in his hands;
• freezes in an unusual position;
• makes chewing or swallowing movements.

Sometimes these seizures can be accompanied by very difficult activities, such as driving a car or playing a musical instrument. However, during a complex partial seizure, a person does not react to others, and after that he does not remember anything.

Grand mal seizure

A grand mal seizure (tonic-clonic seizure) is the most common manifestation of the disease. Exactly this type seizure is associated in people with epilepsy. A grand mal seizure is already a generalized seizure.

A grand mal seizure may occur suddenly or after an aura. The man loses consciousness and falls. Sometimes a fall is accompanied by a loud cry, which is associated with contraction of the muscles of the chest and glottis. After the fall, convulsions begin. At first they are tonic, that is, the body is extended, the head is thrown back, breathing stops, the jaw clenches, the face becomes pale, then cyanosis appears.

This state lasts for several seconds. Then clonic convulsions begin, when the muscles of the body, arms and legs alternately contract and relax, as if the person is being electrocuted. The clonic phase lasts several minutes. The person wheezes when breathing, and blood-stained foam may appear at the mouth (if the mucous membrane of the cheeks, lips or tongue has been damaged). Gradually, the convulsions slow down and stop, the patient with epilepsy freezes in a motionless position and does not react to others for some time. Possible involuntary emptying of the bladder.

Absence seizures (minor epileptic seizures)

Absence seizures are the second most common type of seizure in epilepsy and are classified as generalized seizures. Absence seizures occur most often with epilepsy in children, but they also occur in adults. In this case, a short-term loss of consciousness occurs, usually no more than 15 seconds. A person freezes in one position with a frozen gaze, although rhythmic twitching is sometimes observed eyeballs or lip smacking. After the seizure stops, the person remembers nothing about it.

Absence seizures can occur several times a day, negatively affecting a child's performance at school. They can also be life-threatening if they occur, for example, when a person crosses the road.

Other types of generalized seizures

Myoclonic seizures- short involuntary contractions of the muscles of certain parts of the body, for example, a person throws aside an object he was holding in his hand. These seizures last only a fraction of a second and the person usually remains conscious. As a rule, myoclonic seizures occur in the first hours after sleep and are sometimes accompanied by generalized seizures of other types.

Clonic seizures- twitching of the limbs, as with myoclonic seizures, but the symptoms last longer, usually up to two minutes. They may be accompanied by loss of consciousness.

Atonic seizures are accompanied by a sudden relaxation of all the muscles of the body, which can cause a person to fall and get injured.

Tonic seizures- a sharp tension in all the muscles of the body, which can cause you to lose your balance, fall and get injured.

Status epilepticus

Status epilepticus is a severe condition when a seizure lasts more than 30 minutes and the person does not regain consciousness. Another option for the development of epistatus is when epileptic seizures follow each other, and in the intervals between them consciousness does not return to the patient. In this case, emergency medical attention is required. Call the ambulance number - 03 from a landline phone, 112 or 911 from a mobile phone.

Causes of epilepsy

In approximately half of the cases, the cause of the disease cannot be determined. Then they talk about primary or idiopathic epilepsy. It is believed that this type of epilepsy can be inherited.

In many cases, the cause of epilepsy cannot be determined due to imperfect medical equipment, which cannot detect certain types of brain lesions. In addition, many researchers believe that genetic defects in the brain may cause the disease. Attempts are currently being made to determine which gene defects can disrupt the transmission of electrical impulses in brain cells. It has not yet been possible to identify a clear relationship between individual genes and the development of epilepsy.

Other cases of epilepsy are usually associated with various changes in the brain. This is called secondary (symptomatic) epilepsy. The brain is a complex and very sensitive mechanism, the work of which involves nerve cells, electrical impulses and chemicals - neurotransmitters. Any damage can potentially impair brain function and cause seizures.

Possible causes of symptomatic epilepsy:

• cerebrovascular accident, for example due to stroke or subarachnoid hemorrhage;
• a brain tumor;
• severe traumatic brain injury;
• alcohol abuse or drug use;
• infectious diseases affecting the brain, such as meningitis;
• birth injuries, causing oxygen deficiency in the child, for example, when the umbilical cord is compressed or entangled during childbirth;
• intrauterine developmental disorder of certain areas of the brain.

Some of these causes can cause epilepsy early in life, but symptomatic epilepsy is more common in older people, especially those over 60 years of age.

Factors contributing to the occurrence of epileptic seizures

For many people, seizures occur under the influence of a specific factor - a trigger. The most common ones are:

• stress;
• lack of sleep;
• drinking alcohol;
• some medications and drugs;
• menstruation in women;
• flashes of light (a rare factor that causes seizures in only 5% of people - so-called photogenic epilepsy).

A diary will help to identify the triggers of attacks, in which you need to record each attack and a description of the events that preceded it. Over time, it is possible to identify the stimuli that trigger seizures so that you can avoid them later.

Can a person with epilepsy drive a car?

According to the Decree of the Government of the Russian Federation dated December 29, 2014 No. 164 “On lists medical contraindications, medical indications and medical restrictions on driving,” epilepsy is a contraindication to driving.

Diagnosis of epilepsy

As a rule, epilepsy is difficult to diagnose, since many other conditions, such as migraine or panic disorder, have similar symptoms. Most often, the diagnosis can only be confirmed after several seizures. A neurologist diagnoses epilepsy.

To make a diagnosis, a detailed description of the seizure by the person himself or his loved ones is extremely important. The doctor asks questions about what the person remembers, what symptoms preceded the attack, whether there was an aura, and how the attack itself occurred. The doctor also asks the person about their medical history and whether they are currently taking any medications, drugs, or drinking alcohol.

To confirm the diagnosis, additional examinations are prescribed, for example, an electroencephalogram (EEG) or magnetic resonance imaging (MRI). If no abnormalities are found during the examination, the doctor may still diagnose epilepsy.

This is an examination method that allows you to identify abnormalities in the functioning of the brain. To do this, electrodes are attached to the scalp, which record the electrical activity of the brain. During the examination, you need to breathe deeply and close your eyes, or the doctor will ask you to look at the flashing light. If the doctor thinks that this may provoke a seizure, he immediately stops the procedure.

In some cases, EEG may be done while you are asleep (sleep EEG) or with a small, wearable device that records your brain activity for 24 hours (ambulatory EEG monitoring).

Magnetic resonance imaging (MRI) is a type of examination that uses strong magnetic fields and radio waves to create a detailed image internal structure body. MRI may be used if epilepsy is suspected, as MRI can often detect structural changes in the brain or tumor).

A magnetic resonance imaging scanner is a large tube (tunnel) with powerful magnets installed in it, in which a person is in a lying position.

First aid for an epileptic seizure

If someone is having an epileptic seizure, there are some simple steps you can take:

• support a person during a fall, sit or lay down;
• remove all objects that can injure a patient with epilepsy, place your hands or something soft under his head;
• transfer a person only if his life is in danger;
• unbutton the top button of your clothing or loosen your tie;
• after the end of the convulsions, lay the person on his side to avoid saliva getting into the respiratory tract.

What not to do:

• with effort to hold the person, trying to counteract the convulsions;
• putting objects in your mouth, trying to unclench your jaws.

Stay with the person throughout the attack until he finally comes to his senses. In most cases, an epileptic seizure ends on its own and the person fully recovers after 5-10 minutes. If this is not the first attack and the person already knows about his illness, then medical assistance, as a rule, is not required.

If you are helping a stranger on the street, you are not sure that this is an epileptic attack, especially if the victim is a child, a pregnant woman or an elderly person, it is better to immediately call an ambulance. In addition, medical assistance will be required in the following cases:

• the seizure lasts more than five minutes;
• several seizures occurred, between which the person did not come to his senses;
• This is the first time something like this has happened to your loved one;
• the victim was injured;
• a person behaves inappropriately after a seizure.

Treatment of epilepsy and prevention of seizures

Currently, epilepsy is considered a chronic disease, but by following certain rules and medical recommendations, in most cases it is possible to completely control the course of the disease and effectively prevent attacks. According to statistics, about 70% of patients with epilepsy cope with their disease with the help of medications. The ability to avoid provoking factors and maintain a healthy lifestyle further increases the effectiveness of treatment.

Drug treatment of epilepsy

Most cases of epilepsy respond well to treatment with antiepileptic drugs. These drugs cannot cure the disease completely, but they help prevent seizures. There are different types of antiepileptic drugs available. Most of them change the concentration of chemical compounds in the brain that conduct electrical impulses.

The choice of which type of drug to use depends on a number of factors, including the type of seizures, the person's age, underlying medical conditions, and the use of other medications (including birth control). Therefore, only a doctor should prescribe treatment.

Medicines for epilepsy are available in various forms: tablets, capsules, syrup or solution. It is necessary to comply with the dosage regimen and dosage of the drug. You should not stop taking it abruptly, as this may trigger a seizure.

A low dose of the drug is initially prescribed and then gradually increased until the seizures stop or side effects occur. If seizures continue while taking the medication, the doctor prescribes another drug, gradually increasing its dosage and at the same time reducing the dosage of the first.

Ideally, a drug should treat seizures as effectively as possible with a minimum number of side effects and in the minimum dosage. If the medicine does not help, it is recommended not to increase the dosage, but to switch to a different type of medicine, although sometimes it may be necessary to take several medicines in combination at the same time.

Many antiepileptic drugs can interact with other drugs, as well as herbal remedies, for example, St. John's wort. Therefore, during treatment, it is forbidden to take other medications without consulting a doctor. This may reduce the effectiveness of treatment and trigger a seizure.

Some medications for epilepsy are contraindicated during pregnancy as they can cause deformities in the fetus. Therefore, you should inform your doctor if you are planning to have a baby. In other cases, reliable contraception is recommended during treatment. If there have been no new seizures for more than two years, the medication can be stopped under the supervision of a doctor.

When starting to take antiepileptic drugs, symptoms often occur. side effects, which usually go away within a few days. Below are the most common ones:

• drowsiness;
• prostration;
• excitation;
• headache;
• tremor (involuntary oscillatory movements limbs);
• hair loss or unwanted hair growth;
• swelling of the gums;
• rash.

The appearance of a rash may be a sign of an allergy to the drug, which should be reported to your doctor immediately. Sometimes, if the dosage of the drug is exceeded, symptoms similar to intoxication may appear - unsteady gait, absent-mindedness and vomiting. In this case, you should immediately consult a doctor to reduce the dosage. For more information about the side effects of various antiepileptic drugs, see the package insert that comes with your drug.

Surgical treatment of epilepsy

If medications do not give the desired result, the doctor may write a referral for hospitalization in a specialized neurosurgical clinic in preparation for surgical treatment. The clinic conducts a thorough examination to confirm the indications for surgery, as well as to determine the exact location of the epilepsy focus, the state of memory, psyche and general health.

Removing the part of the brain where the lesion occurs increased excitability - a common type of surgery for epilepsy. Such an operation is resorted to only when the cause of epilepsy is damage to a small area of ​​the brain (a person has partial seizures), and the removal of this part of the nervous tissue will not entail a significant change in brain function.

As with any surgery, there are risks of complications such as memory loss and stroke, but approximately 70% of cases are seizure-free after surgery. Before starting it, the surgeon should talk about its benefits and risks. Typically, recovery from surgery takes a few days, but in some cases a person may not be allowed to return to work until several months later.

Vagus nerve stimulation (VNS therapy)- another type of intervention for epilepsy. The mechanism by which VNS therapy works is not fully understood, but stimulation of the vagus nerve is thought to alter chemical transmission in the brain.

With VNS therapy, a small electrical device, similar to a pacemaker. From him to vagus nerve An electrode is connected to the left side of the neck. The device sends electrical signals to the nerve and thus stimulates it. This helps reduce the frequency and severity of seizures. A person can activate an additional “discharge” of the stimulant and avoid a seizure if signs of an aura appear.

In most cases, you will still need to take anti-epileptic drugs after the procedure. VNS therapy has mild side effects, including hoarseness, sore throat, and coughing when using the device. The battery of the device lasts for an average of ten years, after which it needs to be replaced.

Deep brain stimulation (DBS)- is currently a rare operation in Russia. With DBS, electrodes are implanted in specific areas of the brain to reduce the abnormal electrical activity associated with seizures. The operation of the electrodes is controlled from a device that is inserted under the skin of the chest. It's always on. Deep brain stimulation can reduce the frequency of seizures, but there is a risk of severe complications associated with blood pressure, cerebral hemorrhage, depression and memory problems.

Adjuvant treatment of epilepsy

Ketogenic diet- This is a diet rich in fats with limited consumption of proteins and carbohydrates. It is believed to help reduce the frequency of seizures by changing brain chemistry. Before the invention of antiepileptic drugs, the ketogenic diet was one of the main treatments for epilepsy, but it is currently not recommended for adults due to the risk of diabetes and cardiovascular disease.

It is sometimes prescribed to children for seizures that are difficult to treat, as the ketogenic diet has been shown to reduce the number of seizures in some cases. The diet is prescribed only under the supervision of a neurologist and nutritionist.

There are other methods alternative treatment, which are used for epilepsy, but the effectiveness of none of them has been clinically proven. The decision to stop taking epilepsy medications, reduce the dosage, and switch to alternative methods Treatment can only be administered by the attending physician - a neurologist. Stopping medication on your own can cause seizures.

You should also be careful with herbal treatments, as some of their components may interact with medications for epilepsy. St. John's wort, used for mild depression, is not recommended for epilepsy, as it can alter the concentration of antiepileptic drugs in the blood and cause seizures.

In some cases, a seizure may be triggered by stress. In this case, stress-relieving and relaxation techniques such as yoga and meditation can help.

Epilepsy and pregnancy

If you have epilepsy, there are no contraindications for pregnancy, but it is better to plan ahead due to the slightly increased risk of complications. If you prepare for pregnancy in advance, the likelihood of complications can be reduced.

The main risk is that some epilepsy medications increase the likelihood of severe fetal development problems such as spina bifida (incomplete closure of the fetus). spinal canal), cleft lip (cleft lip) and congenital heart defects. The specific risks depend on the type of drug and its dosage.

When planning a pregnancy, you should consult with a specialist in the treatment of epilepsy (neurologist), who can select a different drug. It is usually prescribed in minimal doses, and they try to avoid combining different drugs for epilepsy. To reduce the risk of congenital anomalies in a child, a doctor may prescribe a woman to take folic acid daily.

You cannot stop taking antiepileptic drugs completely during pregnancy. An uncontrolled seizure by the mother is much more dangerous for the health of the fetus than the medications she takes. Medicines can also be continued while breastfeeding.

Epilepsy and contraception

Some epilepsy medications may reduce the effectiveness of contraceptive methods, including the following:

• contraceptive injections;
• contraceptive patch;
• combined oral contraceptives (COCs);
• “mini-pill” - progestin tablets;
• contraceptive implants.

If you are sexually active, you should consult your doctor about the possible effects of the anti-epileptic drug on contraception. You may need to use another type of contraception, such as a condom or intrauterine device. There is evidence that some medications for epilepsy reduce the effectiveness of emergency contraception. Instead, an intrauterine device is used. Sometimes the opposite effect is observed: some contraceptives reduce the effect of epilepsy drugs. Additional advice can be obtained from a gynecologist.

Epilepsy in children

With proper treatment, many children with epilepsy can go to school and participate in all school activities along with other children. However, some children require additional help. Children with epilepsy are more likely to have learning difficulties and need support. Teachers should know about the child's illness and what medications he is taking.

If a child has severe epilepsy, seizures occur frequently, and serious difficulties arise in mastering basic school curriculum, parents can transfer him to study in correctional school. When you feel better and the disease progresses to a more light form You can go back to regular school.

Sudden death syndrome in epilepsy (SUDEP)

Sudden death syndrome in epilepsy (SUDEP) is the death of a patient with epilepsy without any apparent cause. The exact cause of SUDEP is unclear and it cannot be predicted. According to one theory, a seizure causes breathing and heartbeat to stop. Possible causes of SUDEP:

• seizures with loss of consciousness, when all the muscles of the body tense and begin to contract (grand mal seizures);
• lack of proper treatment for epilepsy, non-compliance with the regimen of taking medications for epilepsy;
• frequent and sudden changes in medications for epilepsy;
• age 20–40 years (especially men);
• seizures during sleep;
• seizures during which the person is alone;
• overuse alcohol.

If you have any doubts about the effectiveness of treatment, you should consult your doctor. He may schedule an examination at a specialized epilepsy clinic.

Which doctor should I see for epilepsy?

If you suspect epilepsy in yourself or a loved one, find a good neurologist. Some neurologists deal only with epilepsy problems and receive the qualification of an epileptologist, who can be found using the NaPopravku service. Typically, such doctors work in specialized epileptology centers, where they treat children and adults with epilepsy.

A disease such as epilepsy is chronic, and it is characterized by the manifestation of spontaneous, rarely occurring, short-term attacks of epileptic seizures. It should be noted that epilepsy, the symptoms of which are very pronounced, is one of the neurological diseases the most common type - for example, every hundredth person on our planet experiences periodic epileptic seizures.

Epilepsy: main features of the disease

When considering cases of epilepsy, it can be noted that it itself is in the nature of a congenital disease. For this reason, its first attacks occur in childhood and adolescence, 5-10 and 12-18 years, respectively. In this situation, no damage is detected in the brain substance - only the electrical activity characteristic of nerve cells changes. There is also a decrease in the threshold of excitability in the brain. Epilepsy in this case is defined as primary (or idiopathic), its course is benign, and, in addition, it can also be effectively treated. It is also important that with primary epilepsy developing according to this scenario, the patient with age can completely eliminate taking pills as a necessity.

Another form of epilepsy is secondary (or symptomatic) epilepsy. Its development occurs after damage to the brain and its structure in particular, or when there is a metabolic disorder in it. In the latter variant, the emergence of secondary epilepsy is accompanied by a complex number of pathological factors (underdevelopment of brain structures, previous traumatic brain injuries, addiction in one form or another, tumors, infections, etc.). The development of this form of epilepsy can occur regardless of age; in this case, the disease is much more difficult to treat. Meanwhile, complete cure is also a possible outcome, but only if the underlying disease that caused epilepsy is completely eliminated.

In other words, epilepsy is divided into two groups according to its occurrence - acquired epilepsy, the symptoms of which depend on the underlying causes (listed injuries and diseases) and hereditary epilepsy, which, accordingly, occurs due to the transfer of genetic information to children from parents.

Types of epilepsy attacks

Manifestations of epilepsy appear, as we noted, in the form of seizures, and they have their own classification:

• Based on the cause of occurrence (primary epilepsy and secondary epilepsy);
• Based on the location of the original focus, characterized by excessive electrical activity (deep parts of the brain, left or right hemisphere);
• Based on a variant that shapes the development of events during an attack (with or without loss of consciousness).

In a simplified classification of epileptic seizures, seizures are distinguished generalized partial.

Generalized seizures are characterized by attacks in which there is a complete loss of consciousness, as well as control over the actions performed. The reason for this situation is excessive activation, characteristic of the deep parts of the brain, which subsequently provokes the involvement of the entire brain. The result of this condition, expressed in a fall, is not at all necessary, because muscle tone is disturbed only in rare cases.

As for this type of seizures, such as partial seizures, it can be noted that they are characteristic of 80% of the total number of adults and 60% of children. Partial epilepsy, the symptoms of which manifest themselves when a focus with excessive electrical excitability forms in a particular area in the cerebral cortex, directly depends on the location of this focus. For this reason, manifestations of epilepsy can be motor, mental, autonomic or sensory (tactile) in nature.

It should be noted that partial epilepsy, like localized and focal epilepsy, the symptoms of which represent a separate group of diseases, are based on metabolic or morphological damage to a specific area of ​​the brain. They can be caused by various factors (brain injuries, infections and inflammatory lesions, vascular dysplasia, acute type cerebrovascular accidents, etc.).

When a person is conscious, but with a loss of control over a certain part of the body or when he experiences previously unusual sensations, we are talking about simple attack. If there is a disturbance of consciousness (with partial loss of it), as well as a person’s lack of understanding of where exactly he is and what is happening to him at the moment, if entering into any contact with him is not possible, then this is already complex attack. As with a simple attack, in this case uncontrolled movements are made in one or another part of the body, and imitation of specifically directed movements often occurs. Thus, a person can smile, walk, sing, talk, “hit a ball,” “dive,” or continue the action that he began before the attack.

Any type of attack is short-term, and their duration is up to three minutes. Almost every attack is accompanied by drowsiness and confusion after its completion. Accordingly, if during an attack there was a complete loss of consciousness or its disturbances occurred, the person does not remember anything about it.

Main symptoms of epilepsy

As we have already noted, epilepsy in general is characterized by the occurrence of an extensive convulsive seizure. As a rule, it begins suddenly, and without any logical connection with external factors.

In some cases, it is possible to determine the time of the imminent onset of such a seizure. Within one or two days, epilepsy, the early symptoms of which are expressed in general malaise, also indicates disturbances in appetite and sleep, headaches and excessive irritability as its early warning signs. In many cases, the appearance of a seizure is accompanied by the appearance of an aura - for the same patient its character is defined as stereotypical in display. The aura lasts for several seconds, followed by loss of consciousness, possibly a fall, often accompanied by a kind of scream, which is caused by a spasm that occurs in the glottis when the muscles of the chest and diaphragm contract.

At the same time, tonic convulsions occur, during which both the torso and limbs, being in a state of tension, are stretched and the head is thrown back. Breathing is delayed, and the veins in the neck swell. The face becomes deathly pale, the jaws tighten under the influence of a spasm. The duration of the tonic phase of the seizure is about 20 seconds, after which clonic convulsions occur, manifested in jerky contractions of the muscles of the trunk, limbs and neck. During this phase of the attack, which lasts up to 3 minutes, breathing often becomes hoarse and noisy, which is explained by the accumulation of saliva, as well as the recession of the tongue. There is also a discharge of foam from the mouth, often with blood, which occurs due to biting the cheek or tongue.

Gradually, the frequency of cramps decreases, their end leads to comprehensive muscle relaxation. This period is characterized by a lack of reaction to any stimuli, regardless of the intensity of their impact. The pupils are dilated and there is no reaction to exposure to light. Reflexes of a deep and protective type are not evoked, but involuntary urination occurs quite often. Considering epilepsy, one cannot help but note the vastness of its varieties, and each of them is characterized by the presence of its own characteristics.

Epilepsy in newborns: symptoms

In this case, neonatal epilepsy, the symptoms of which occur against a background of elevated temperature, is defined as intermittent epilepsy. The reason for this is the general nature of the seizures, in which the spasms move from one limb to another and from one half of the body to the other.

Foam formation, which is usual for adults, as well as tongue biting, are usually absent. At the same time, it is also extremely rare that epilepsy and its symptoms in infants are defined as actual phenomena characteristic of older children and adults, and expressed in the form of involuntary urination. There is also no post-attack sleep. After consciousness returns, it is possible to identify characteristic weakness in the left or right side body, its duration can be up to several days.

Observations indicate in epilepsy in infants the symptoms that foreshadow an attack, which include general irritability, headache and appetite disturbances.

Temporal lobe epilepsy: symptoms

Temporal lobe epilepsy occurs due to a certain number of causes, but there are primary factors that contribute to its formation. So, this includes birth injuries, as well as brain damage that develops from an early age due to injuries received, including inflammatory and other processes.

Temporal lobe epilepsy, the symptoms of which are expressed in polymorphic paroxysms preceded by a peculiar aura, has a duration of manifestations of the order of several minutes. Most often it is characterized by the following features:

• Abdominal sensations (nausea, abdominal pain, increased peristalsis);
• Cardiac symptoms (palpitations, heart pain, );
• Difficulty breathing;
• The occurrence of involuntary phenomena in the form of sweating, swallowing, chewing, etc.
• The occurrence of changes in consciousness (loss of connection of thoughts, disorientation, euphoria, calm, fears);
• Performing actions dictated by a temporary change in consciousness, lack of motivation in actions (undressing, collecting things, trying to escape, etc.);
• Frequent and severe personality changes, expressed in paroxysmal mood disorders;
• Significant types of autonomic disorders that occur between attacks (changes in pressure, impaired thermoregulation, various types of allergic reactions, metabolic-endocrine disorders, disorders of sexual function, disorders of water-salt and fat metabolism etc.).

Most often, the disease has a chronic course with a characteristic tendency towards gradual progression.

Epilepsy in children: symptoms

A problem such as epilepsy in children, the symptoms of which you already know in their general form, has a number of its own characteristics. Thus, it occurs much more often in children than in adults, and its causes may differ from similar cases. adult epilepsy, and, finally, not every seizure that occurs among children is classified as a diagnosis such as epilepsy.

The main (typical) symptoms, as well as signs of epileptic seizures in children are expressed as follows:

• Convulsions, expressed in rhythmic contractions characteristic of the muscles of the body;
• Temporary holding of breath, involuntary urination, and loss of feces;
• Loss of consciousness;
• Extremely strong muscle tension in the body (straightening legs, bending arms). Irregularity of movements of any part of the body, expressed in twitching of the legs or arms, wrinkling or pursing of the lips, throwing back the eyes, forcing the head to turn to one side.

Besides typical forms, epilepsy in children, as, in fact, epilepsy in adolescents and its symptoms, can be expressed in forms of a different type, the features of which are not immediately recognized. For example, absence epilepsy.

Absence epilepsy: symptoms

The term absence is translated from French as “absence”. In this case, during an attack there are no falls or convulsions - the child simply freezes, ceasing to react to the events that are happening around. Absence epilepsy is characterized by the following symptoms:

• Sudden freezing, interruption of activity;
• Absent or intent gaze, concentrated at one point;
• Inability to attract the child's attention;
• Continuation of an action started by a child after a seizure, excluding the period of time with the seizure from memory.

This diagnosis often appears around 6-7 years of age, with girls getting sick about twice as often as boys. In 2/3 of cases, children have relatives with this disease. On average, absence epilepsy and symptoms last up to 6.5 years, then becoming less frequent and disappearing, or developing over time into another form of the disease.

Rolandic epilepsy: symptoms

This type of epilepsy is one of its most common forms, relevant for children. It is characterized by manifestation mainly at the age of 3-13 years, with the peak of its manifestation occurring at the age of about 7-8 years. The onset of the disease for 80% of the total number of patients occurs at 5-10 years, and, unlike the previous absence epilepsy, it differs in that about 66% of patients with it are boys.

Rolandic epilepsy, the symptoms of which are essentially typical, manifests itself in the following conditions:

• The appearance of somatosensory aura (1/5 of the total number of cases). It is characterized by paresthesia (an unusual sensation of numbness of the skin) of the muscles of the larynx and pharynx, cheeks when localized on one side, as well as numbness of the gums, cheeks, and sometimes the tongue;
• The occurrence of clonic unilateral, tonic-clonic seizures. In this case, the facial muscles are also involved in the process; in some cases, cramps can spread to the leg or arm. Involvement of the tongue, lips and pharyngeal muscles leads to the child describing sensations in the form of “shifting to the side of the jaw”, “chattering of teeth”, “trembling of the tongue”;
• Difficulty in speech. They are expressed in the exclusion of the possibility of pronouncing words and sounds, while speech cessation can occur at the very beginning of the attack or manifests itself during its development;
• Excessive salivation (hypersalivation).

A characteristic feature of this type of epilepsy is also that it mainly occurs at night. For this reason, it is also defined as nocturnal epilepsy, the symptoms of which in 80% of the total number of patients occur in the first half of the night and only 20% in the state of wakefulness and sleep. Night cramps have certain features, which, for example, lie in their relative short duration, as well as in the tendency to subsequent generalization (spread of the process throughout an organ or organism from a focus that has a limited scope).

Myoclonic epilepsy: symptoms

A type of epilepsy called myoclonic epilepsy, the symptoms of which are characterized by a combination of jerking movements during severe epileptic seizures, is also known as myoclonus epilepsy. Amazes this type diseases of both sexes, while morphological cellular studies of cells of the spinal cord and brain, as well as the liver, heart and other organs in this case reveal carbohydrate deposits.

The disease begins between the ages of 10 and 19 years, characterized by symptoms in the form of epileptic seizures. Later, myoclonus also occurs (involuntary muscle contractions in full or partial volume with or without causing a motor effect), which determines the name of the disease. Mental changes often appear as a debut. As for the frequency of seizures, it varies - it can occur either daily or at intervals of several times a month or less (with appropriate treatment). Impairments in consciousness along with seizures are also possible.

Post-traumatic epilepsy: symptoms

In this case, post-traumatic epilepsy, the symptoms of which are characterized, as in other cases, by seizures, is directly related to brain damage resulting from head trauma.

The development of this type of epilepsy is relevant for 10% of those people who have experienced severe head injuries, with the exception of penetrating brain injuries. The likelihood of epilepsy with penetrating brain injury increases to 40%. The manifestation of characteristic symptoms is possible even after several years from the moment of injury, and they depend directly on the area with pathological activity.

Alcoholic epilepsy: symptoms

Alcoholic epilepsy is a complication characteristic of alcoholism. The disease manifests itself in convulsive seizures that occur suddenly. The onset of the attack is characterized by loss of consciousness, after which the face becomes very pale and gradually turns blue. Often foam appears from the mouth during a seizure and vomiting occurs. The cessation of seizures is accompanied by a gradual return of consciousness, after which the patient often falls into a sleep lasting up to several hours.

Alcoholic epilepsy is expressed in the following symptoms:

• Loss of consciousness, fainting;
• Convulsions;
• Severe pain, “burning”;
• Muscle contraction, feeling of squeezing, tightening of the skin.

The occurrence of a seizure can occur within the first few days after stopping drinking alcohol. Often attacks are accompanied by hallucinations characteristic of alcoholism. The cause of epilepsy is long-term alcohol poisoning, especially when using surrogates. An additional impetus can be a previous traumatic brain injury, an infectious type of disease, etc.

Nonconvulsive epilepsy: symptoms

The nonconvulsive form of seizures in epilepsy is a fairly common variant of its development. Nonconvulsive epilepsy, the symptoms of which can be expressed, for example, in twilight consciousness, appears suddenly. Its duration ranges from several minutes to several days with the same sudden disappearance.

In this case, a narrowing of consciousness occurs, in which, of the various manifestations characteristic of the external world, the patient perceives only that part of the phenomena (objects) that are emotionally significant for them. For the same reason, hallucinations often occur, various crazy ideas. Hallucinations have an extremely frightening character when their visual form is painted in dark tones. This condition can provoke an attack on others causing injury; often the situation boils down to fatal outcome. This type of epilepsy is characterized by mental disorders; accordingly, emotions are manifested in the extreme degree of their expression (rage, horror, less often - delight and ecstasy). After attacks, patients forget what is happening to them, and residual memories of events may appear much less frequently.

Epilepsy: first aid

Epilepsy, the first symptoms of which can frighten an unprepared person, requires certain protection of the patient from possible injury during a seizure. For this reason, for epilepsy, first aid involves providing the patient with a soft and flat surface under him, for which soft things or clothing are placed under the body. It is important to free the patient’s body from constricting objects (primarily this concerns the chest, neck and waist). The head should be turned to the side, giving the most comfortable position for exhaling vomit and saliva.

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

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

General information

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

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

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

International classification of epilepsies and epileptic syndromes

LOCALIZATION-BASED (FOCAL, PARTIAL) EPILEPSY AND SYNDROMES

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

2. Symptomatic:

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

3. Cryptogenic

GENERALIZED EPILEPSY AND SYNDROMES

1. Idiopathic (with age-dependent onset):

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

2. Cryptogenic and/or symptomatic (with age-dependent onset):

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

3. Symptomatic:

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

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

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

EPILEPSY AND SYNDROMES WITH SIGNS OF FOCAL AND GENERALIZED

With generalized and focal seizures:

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

How to cure epilepsy

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

Types of epileptic seizures

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

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

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

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

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

Interictal manifestations of epilepsy

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

Causes of epilepsy

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

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

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

Factors in the development of epilepsy

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

Living with Epilepsy

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

Epilepsy and pregnancy

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

Symptoms of epilepsy

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

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

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

Types of epilepsy

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

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

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


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

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

Childhood absence epilepsy (G 40.3)

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

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

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

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

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

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

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

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

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

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

Temporal lobe epilepsy

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

Parietal epilepsies

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

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

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

Epileptic psychoses

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

Chronic epileptic psychoses (schizophrenia-like)

General characteristics:

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

Diagnosis of epilepsy

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

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

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

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

II. Generalized epileptic seizures.

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

BASIC PRINCIPLES OF CLASSIFICATION OF EPILEPSY AND EPILEPTIC SYNDROMES

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

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

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

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

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

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

Treatment of epilepsy

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

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

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

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

Selection of antiepileptic drugs depending on the types of seizures

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

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

Myoclonus
Gabapentin
Absence epilepsy
Epilepsy with myoclonus Absence seizures
Myoclonus

Epilepsy – « epilepsy", occurs in children and adults. Translated from Greek, the word means “ fall suddenly" The disease manifests itself as periodically recurring large convulsive seizures with loss of consciousness or very short-term (seconds) loss of consciousness.

In some cases, with epilepsy, a decrease in intelligence is observed, character changes (the so-called “epileptic character”) and mental disorders may gradually develop.

Today we will look at the causes, symptoms, signs and treatment of epilepsy in children and adults using official drugs, medicines and folk remedies at home. You can read how to provide first aid for an epileptic seizure here:.

Epilepsy: causes, symptoms, signs

The clinical picture of the disease is very diverse. All painful manifestations can be divided into four main groups:

1. seizures,
2. disorders of consciousness,
3. mood disorders,
4. epileptic personality changes with a significant decrease in intelligence.

To date, the specific cause of an epilepsy attack has not been clarified. The disease is not always inherited, although 40 out of 100 people suffering from epilepsy have this disease in their family tree.

There are different types of epileptic seizures, the severity of each type is different.

When a seizure occurs due to problems with one part of the brain, it is called partial. If the entire brain is affected, the attack is called generalized. There are mixed types of seizures.

The causes of epilepsy may be the following:

1. brain abscess;
2. viral diseases;
3. meningitis;
4. hereditary predisposition.
5. lack of oxygen and blood supply during birth;
6. pathological changes in the structure of the brain;
7. brain damage from cancerous tumors;
8. traumatic brain injury;

Epileptic seizures in children occur due to maternal seizures during pregnancy. They form pathological changes in children in the womb:

1. Epilepsy in children, cerebral internal hemorrhages;
2. hypoglycemia in newborns;
3. severe form of hypoxia;
4. chronic form of epilepsy.

The main causes of epilepsy in a child are identified:

1. meningitis;
2. toxicosis;
3. thrombosis;
4. hypoxia;
5. embolism;
6. encephalitis;
7. concussion.

Provokes the development of seizures in adults:

1. brain tissue injuries - bruises, concussions;
2. infection in the brain - rabies, tetanus, meningitis, encephalitis, abscesses;
3. organic pathologies of the head zone - cyst, tumor;
4. taking certain medications - antibiotics, axiomatics, antimalarials;
5. pathological changes in the blood circulation of the brain - stroke; multiple sclerosis;
6. congenital pathologies of brain tissue;
7. antiphospholipid syndrome;
8. lead or strychnine poisoning;
9. drug addict;
10. abrupt cessation of sedatives and sleeping pills, alcoholic drinks.

Symptoms of epilepsy in children and adults depend on the form of the attack. There are:

1. partial seizures;
2. complex partials;
3. tonic-clonic seizures;
4. absence seizure

Epilepsy code according to ICD 10 in detail: G40

Excluded:

1. Landau-Kleffner syndrome (F80.3),
2. seizure NOS (R56.8),
3. status epilepticus (G41.),
4. Todd's palsy (G83.8).

G40.0: Localized (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures with focal onset.

1. Benign childhood epilepsy with EEG peaks in the central temporal region.
2. Childhood epilepsy with paroxysmal activity and EEG in the occipital region.

G40.1: Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures.

1. Seizures without changes in consciousness.
2. Simple partial seizures, developing into secondary generalized seizures.

G40.2: Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures.

1. Seizures with consciousness, often with epileptic automatism.
2. Complex partial seizures developing into secondary generalized seizures.

G40.3: Generalized idiopathic epilepsy and epileptic syndromes.

1. Benign(s): myoclonic epilepsy of early childhood; neonatal seizures (familial).
2. Childhood epileptic absence seizures [pycnolepsy].
3. Epilepsy with grand mal seizures on awakening Juvenile: absence epilepsy, myoclonic epilepsy [impulsive petit mal].
4. Nonspecific epileptic seizures: atonic, clonic, myoclonic, tonic, tonic-clonic.

G40.4: Other types of generalized epilepsy and epileptic syndromes.

1. Epilepsy with: myoclonic absences, myoclonic-astatic seizures.
2. Baby spasms.
3. Lennox-Gastaut syndrome.
4. Salaam's tick.
5. Symptomatic early myoclonic encephalopathy West syndrome.

G40.5: Specific epileptic syndromes

1. Epilepsy partial continuous [Kozhevnikova].
2. Epileptic seizures associated with: alcohol consumption, medication use, hormonal changes, sleep deprivation, exposure to stress factors.

If it is necessary to identify the drug, use an additional code for external causes (class XX).

G40.6: Grand mal seizures, unspecified (with or without petit mal seizures).

G40.7: Minor seizures, unspecified, without grand mal seizures.

G40.8: Other specified forms of epilepsy.

Epilepsy and epileptic syndromes not defined as focal or generalized.

G40.9: Epilepsy, unspecified.

Epileptic: convulsions NOS, seizures NOS, seizures NOS.

Epilepsy attack

Grand mal seizure: attack: symptoms

Most often it occurs suddenly and without any apparent reason.

The patient simply loses consciousness and falls. Sometimes, before the onset of a seizure, some patients note the appearance of so-called precursors of an attack - “aura”. These include visual and olfactory hallucinations, when the patient begins to clearly feel some smells that actually do not exist, or see something that others do not see.

The patient's fall can be explained by the fact that almost all the muscles of his body sharply contract tonically, usually unevenly, and the patient often falls forward or to the side.

Often the fall is accompanied by a scream. Tonic convulsions begin. Arms and legs are extended in a state of sharp muscle tension, the muscles of the torso are sharply contracted. After 30–40 seconds, tonic convulsions give way to clonic (rhythmic muscle contractions), the face becomes pale, then acquires a bluish tint, and the pupils dilate. The patient usually does not react to any stimuli. Foam appears from the mouth, often stained with blood (due to biting the tongue or the inner surface of the cheeks). Sometimes involuntary urination or bowel movements occur. The seizure usually lasts 3–5 minutes. After it, the patient most often falls into deep sleep.

Most often, patients do not remember their seizure and only guess about it by a bitten tongue, bruises, and traces of urine on their underwear.

Some patients have seizures more often during the day, while others have seizures more often at night. The frequency of seizures also varies, from one or two per month to several per day.

Petite epileptic seizures: attack, symptoms

Characterized by temporary loss of consciousness (for one to two seconds) without falling to the floor or convulsions. With minor seizures, those around you may only notice a blank expression on the patient’s face or a short break in the actions he performs.

With this type of epilepsy, the patient’s face suddenly turns pale, becomes empty and unintelligible, and his gaze is fixedly fixed on space.

In some types of epilepsy, seizures are so frequent that patients do not have time to regain consciousness. This condition is called status epilepticus and is often fatal.

After a seizure, some patients experience a condition in which they cannot remember the names of certain household items or the names of loved ones. This condition is called oligophasia and usually goes away within 1–2 hours.

Other symptoms and signs of epilepsy

Mood disorders (dysphoria)

With epilepsy, they are expressed in the sudden appearance of melancholy, causeless anger, and sometimes gaiety. States of this kind appear suddenly and end suddenly. Their duration can vary from several hours to several days. When patients are in a depressed mood, it is not melancholy that predominates, but irritability. They can be angry, begin to find fault with others for no reason, overwhelm them with useless requests and complaints, and can be aggressive.

Mental disorders

In epilepsy, they manifest themselves as changes in the entire personality structure of the sick person, as well as various psycho-emotional states.

Personality changes

They are characterized by irritability, pickiness, a tendency to quarrel, outbursts of rage, sometimes accompanied by dangerous aggressive actions.

Along with these traits, there may be diametrically opposed character traits - timidity, a tendency to self-humiliation, exaggerated courtesy, reaching the point of sweetness, exaggerated deference and affectionate behavior. The mood of patients is subject to frequent changes: from gloomy-irritable to extremely carefree. The intellectual abilities of patients with epilepsy are also variable. They complain of slow thoughts, inability to concentrate on something, and decreased performance. Other patients may, on the contrary, be overly active, talkative and fussy.

The intermittency of mental phenomena in the sphere of mood and mental abilities is one of the most important features in the character of patients with epilepsy. They are characterized by poverty of speech, frequent repetition of what has already been said, the use of template phrases and phrases, diminutives and definitions.

Often the speech of patients with epilepsy is melodious. They pay special attention to their “I”. Therefore, in the foreground of their interests and statements are their own experiences, their own illness, their own interests.

Patients with epilepsy are always supporters of truth, justice, order, especially when it comes to everyday trifles. Characterized by their love for treatment, belief in the possibility of recovery, and optimistic attitude towards the future.

All indicated symptoms, characterizing the clinic of epilepsy, can be observed in the same patient, but it also happens that only some of them occur.

In cases where the listed signs appear only partially, they speak of an epileptic nature. The severity of these signs, accompanied by memory changes of varying depth, suggests the presence of epileptic dementia. The rate of increase in personality and memory changes depends on many reasons, including the duration of the disease itself, the nature of paroxysmal disorders and their frequency.

In some patients, seizures come first, in others, disorders of consciousness, in others, mood disorders, and, finally, in fourths, personality changes. It may also be that at the beginning of the disease, epileptic seizures appear, and then they disappear, and one or another of the symptom complexes described above appears.

Epilepsy: treatment and first aid in children and adults

In the interictal period, sedatives are prescribed for epilepsy:

1. Phenobarbital,
2. Bromine preparations (sodium, potassium, calcium bromine salts or mixtures thereof),
3. Difenin,
4. Benzonal,
5. Trimethine.

For rare major and minor seizures, it is prescribed sodium borate(2–4 g per day).

The main drug used to treat grand mal seizures is Phenobarbital. Its dosage depends on the frequency and severity of seizures.

For adults Usually they give 0.05 g of Phenobarbital 2-3 times a day, less often they prescribe 0.1 g 2-3 times a day, but not more than 0.5 g per day. Children up to 8 years of age receive a dose of 0.01 to 0.03 (up to 0.1 g per day) depending on age and frequency of seizures. At this dosage, even very long-term use of Phenobarbital does not cause intoxication. Sometimes, if you feel drowsy, add small doses of Caffeine (0.01-0.02 g) to Phenobarbital.

In case of major seizures, it has a positive effect Difenin. The optimal dose is 0.1 g per dose three times a day. Children over 6 years of age are prescribed half the dose (0.03 g).

For minor epilepsy it has a good effect Trimethine. The usual daily dose for adults – from 0.9 to 1.2 g, for children up to 2 years – 0.3 g per day, from 2 to 5 years – 0.6 g and over 5–0.9 g.

Patients suffering from epileptic seizures should not take medications that stimulate the nervous system (aminalon, nootropil).

Anticonvulsants

Acediprol

Pharmachologic effect: broad-spectrum antiepileptic drug.

Indications for use: in adults and children with different types epilepsy: for various forms of generalized seizures - small (absences), large (convulsive) and polymorphic; with focal seizures (motor, psychomotor, etc.). The drug is most effective for absence seizures (short-term loss of consciousness with complete loss of memory) and pseudo-absences (short-term loss of consciousness without memory loss).

Directions for use and dosage: orally during or immediately after meals. Start by taking small doses, gradually increasing them over 1–2 weeks until therapeutic effect; then an individual maintenance dose is selected.

Daily dose for adults at the beginning of treatment is 0.3–0.6 g (1–2 tablets), then it is gradually increased to 0.9–1.5 g. Single dose – 0.3–0.45 g. Highest daily dose – 2 ,4 g.

Dose for children selected individually depending on age, severity of the disease, therapeutic effect. Typically, the daily dose for children is 20–50 mg per 1 kg of body weight, the highest daily dose is 60 mg/kg. Treatment is started with 15 mg/kg, then the dose is increased weekly by 5–10 mg/kg until the desired effect is achieved. The daily dose is divided into 2-3 doses. It is convenient for children to prescribe the drug in the form of a liquid dosage form - Acediprol syrup.

Acediprole can be used alone or in combination with other antiepileptic drugs.

For minor forms of epilepsy, they are usually limited to using only Acediprol.

Contraindications. The drug is contraindicated in cases of liver and pancreas dysfunction, hemorrhagic diathesis (increased bleeding). The drug should not be prescribed in the first 3 months of pregnancy (in later periods it is prescribed in reduced doses only if other antiepileptic drugs are ineffective). The literature provides data on cases of teratogenic (damaging to the fetus) effect when using Acediprol during pregnancy. It should also be taken into account that in breastfeeding women the drug is excreted in milk.

Benzobamyl

Pharmachologic effect: has anticonvulsant, sedative (calming), hypnotic and hypotensive (lowering arterial pressure) properties. Less toxic than Benzonal and Phenobarbital.

Indications for use: epilepsy, mainly with subcortical localization of the focus of excitation, “diencephalic” form of epilepsy, status epilepticus in children.

Directions for use and dosage: inside after meals. Doses for adults – 0.05-0.2 g (up to 0.3 g) 2-3 times a day, for children depending on age – from 0.05 to 0.1 g 3 times a day. Benzobamil can be used in combination with dehydration (dehydration), anti-inflammatory and desensitizing (preventing or inhibiting allergic reactions) therapy. In case of addiction (weakening or lack of effect with prolonged repeated use), benzobamyl can be temporarily combined with equivalent doses of Phenobarbital and Benzonal, followed by replacing them again with Benzobamyl.

Contraindications: damage to the kidneys and liver with impairment of their functions, decompensation of cardiac activity.

Release form: tablets of 0.1 g in a package of 100 pieces.

Storage conditions: List B. In a tightly sealed container.

Benzonal

Pharmachologic effect - has a pronounced anticonvulsant effect; unlike Phenobarbital, it does not have a hypnotic effect.

Indications for use: convulsive forms of epilepsy, including tanning epilepsy, focal and Jacksonian seizures.

Directions for use and dosage: inside. Single dose for adults – 0.1–0.2 g, daily – 0.8 g, for children depending on age - one-time 0.025-0.1 g, daily - 0.1-0.4 g. The most effective and tolerable dose of the drug is determined individually. Can be used in combination with other anticonvulsants.

Side effect: drowsiness, ataxia (impaired coordination of movements), nystagmus (involuntary rhythmic movements of the eyeballs), dysarthria (speech disorder).

Hexamidine

Pharmachologic effect: has a pronounced anticonvulsant effect, its pharmacological activity is close to Phenobarbital, but does not have a pronounced hypnotic effect.

Indications for use: epilepsy of various genesis (origin), mainly grand mal seizures. When treating patients with polymorphic (various) epileptic symptoms, it is used in combination with other anticonvulsants.

Directions for use and dosage: orally 0.125 g in 1–2 doses, then the daily dose is increased to 0.5–1.5 g. Higher doses For adults : one-time – 0.75 g, daily – 2 g.

Side effect: itching, skin rashes, mild drowsiness, dizziness, headache, ataxia (impaired coordination of movements), nausea; with long-term treatment, anemia (decrease in the number of red blood cells in the blood), leukopenia (decrease in the level of leukocytes in the blood), lymphocytosis (increase in the number of lymphocytes in the blood).

Difenin

Pharmachologic effect: has a pronounced anticonvulsant effect; There is almost no hypnotic effect.

Indications for use: epilepsy, mainly grand mal seizures. Diphenine is effective in some forms of cardiac arrhythmias, especially arrhythmias caused by overdose of cardiac glycosides.

Directions for use and dosage: orally after meals, half a tablet 2-3 times a day. If necessary, the daily dose is increased to 3-4 tablets. Highest daily dose for adults – 8 tablets.

Side effect: tremor (hand trembling), ataxia (impaired coordination of movements), dysarthria (speech disorder), nystagmus (involuntary movements of the eyeballs), eye pain, increased irritability, skin rashes, sometimes fever, gastrointestinal disorders, leukocytosis (increased number leukocytes in the blood), megaloblastic anemia.

Carbamazepine

Pharmachologic effect: has a pronounced anticonvulsant (anti-epileptic) and moderate antidepressant and normothimic (mood-improving) effect.

Indications for use: with psychomotor epilepsy, grand mal seizures, mixed forms(mainly with a combination of grand mal seizures and psychomotor manifestations), local forms(post-traumatic and post-encephalitic origin). It is not effective enough for minor seizures.

Directions for use and dosage: inside (during meals) adults , starting with 0.1 g (half a tablet) 2–3 times a day, gradually increasing the dose to 0.8–1.2 g (4–6 tablets) per day.

Average daily dose for children is 20 mg per 1 kg of body weight, i.e., on average, under the age of 1 year - from 0.1 to 0.2 g per day; from 1 year to 5 years – 0.2–0.4 g; from 5 to 10 years –0.4–0.6 g; from 10 to 15 years – 0.6–1 g per day.

Carbamazepine can be prescribed in combination with other antiepileptic drugs.

Just as with the use of other antiepileptic drugs, the transition to carbamazepine treatment should be gradual, with a reduction in the dose of the previous drug. Treatment with carbamazepine should also be stopped gradually.

There is evidence of the effectiveness of the drug in a number of cases in patients with various hyperkinesis (violent automatic movements due to involuntary muscle contractions). The initial dose of 0.1 g was gradually (after 4–5 days) increased to 0.4–1.2 g per day. After 3–4 weeks. the dose was reduced to 0.1–0.2 g per day, then the same doses were prescribed daily or every other day for 1–2 weeks.

Side effect: The drug is usually well tolerated. In some cases, loss of appetite, nausea, and rarely - vomiting, headache, drowsiness, ataxia (impaired coordination of movements), impaired accommodation (impaired visual perception). A decrease or disappearance of side effects occurs when the drug is temporarily stopped or the dose is reduced. There is also data on allergic reactions, leukopenia (decrease in the level of leukocytes in the blood), thrombocytopenia (decrease in the number of platelets in the blood), agranulocytosis (sharp decrease in granulocytes in the blood), hepatitis (inflammation of liver tissue), skin reactions, exfoliative dermatitis (inflammation of the skin). If these reactions occur, stop taking the drug.

The possibility of the occurrence of mental disorders in patients with epilepsy treated with carbamazepine should be taken into account.

Methindione

Pharmachologic effect: an anticonvulsant that does not depress the central nervous system, reduces affective (emotional) stress and improves mood.

Indications for use: epilepsy, especially in the temporal form and epilepsy of traumatic origin (origin).

Directions for use and dosage: orally (after meals) adults 0.25 g per dose. For epilepsy with frequent seizures, 6 times a day at intervals of 1½–2 hours (daily dose 1.5 g). For rare seizures, take the same single dose 4–5 times a day (1–1.25 g per day). For seizures at night or in the morning, an additional 0.05-0.1 g of Phenobarbital or 0.1-0.2 g of Benzonal is prescribed. For psychopathological disorders in patients with epilepsy, 0.25 g 4 times a day. If necessary, treatment with Methindione is combined with Phenobarbital, Seduxen, Eunoctine.

Contraindications: pronounced anxiety, tension.

Folk remedies for treating epilepsy at home

Treatment of epilepsy at home should be carried out only under supervision and with the recommendations of the attending physician!

Peony evasive(Maryin root). Tincture Prepare this way: pour 1 tablespoon of finely crushed peony roots with 3 cups of boiling water, leave for 30 minutes in a tightly sealed container. Take 1 tablespoon 30 minutes before meals 3 times a day. When preparing the infusion, you can also use peony root and herb in equal parts.

Panzeria woolly. IN folk medicine use the above-ground part of the plant during flowering. For epilepsy it is used as an analgesic and sedative. Liquid extract, tincture, and decoction have a calming effect on the central nervous system and promote the rapid removal of toxic substances from the body. Method of preparation: pour 2 teaspoons of herbs (fresh or dried) with a glass of boiling water, boil over low heat for 5 minutes, cool, strain. Take a tablespoon 3 times a day before meals.

Motherwort. Bulgarian pharmacologists recommend motherwort as an additional remedy for seizures, in particular epilepsy.

1. 2 parts, or 2 tbsp. spoons of crushed raw materials (aerial flowering part), pour 200 ml of cold boiled water and leave for 8 hours. Take the dose throughout the day.
2. 2 tbsp. Leave spoons of crushed raw materials in 500 ml of boiling water for 2 hours. Drink a glass of the prepared infusion 4 times a day before meals.

blue cyanosis(born-herb, overcome-herb, Greek valerian). Roots, rhizomes, herbs are used for insomnia, epilepsy, fear, as a sedative. Pour 3-6 g of crushed rhizomes with a glass of boiling water and boil for 30 minutes, cool, strain. Drink 1 tbsp. spoon 3-5 times a day after meals.

Periwinkle(roundleaf wintergreen, wild apple tree). For epilepsy, the leaves and flowers of the plant are used in the form of infusion, tea, or decoction. 1 tbsp. Pour a glass of boiling water over a spoonful of dry herbs, leave for two hours, and strain. Take 2 tbsp. spoons 3 times a day.

Cleavers. In Bulgarian folk medicine, the juice of fresh bedstraw grass is used for epilepsy. One of the recipes: pour 2 teaspoons of tenacious bedstraw with 2 cups of boiling water. When the infusion has cooled, strain. Drink the resulting medicine throughout the day.

Tansy. Pour 1 glass of boiling water over 10 tansy flower baskets, leave for 1 hour, strain. Drink 1 tablespoon three times a day.

Chernobyl(common wormwood). Pour one teaspoon of chopped dry herb into a glass of boiling water, cool, and strain. Drink one third of a glass three times a day. Or this: pour 1 tablespoon of crushed roots into 0.5 liters of kvass, boil over low heat for 10 minutes, strain. Drink half a glass in the morning and afternoon, at night - only 1 glass per day.

It is said that many epilepsy sufferers get rid of it if they completely switch to vegetarian food. Complete fasting - 2-3 days every two weeks.

A little help for an epileptic: when an attack begins, place the epileptic’s left hand on the floor and press the little finger of the left hand. The attack ends quickly.

Video on the topic

Epilepsy: causes, symptoms, treatment, first aid for an attack

Epilepsy is one of the most common chronic neurological diseases in humans, manifested in the body’s predisposition to the sudden onset of seizures. The historical Russian name for the disease is “epileptic”.

Another common and common name for these sudden attacks is epileptic seizure. Epilepsy affects not only people, but also animals. Fragment from the program “About the Most Important Thing.”

Providing first aid for an epileptic attack, cardiac arrest: Ed Khalilov

On the video channel “Science of Victory”. Saving a person in theory or in pictures looks very simple. But in life it is not so simple and not so romantic. Ed Khalilov, the head trainer of the “Science of Defeating Ed Khalilov” project, shows what to do in case of an epileptic seizure.

Each of you may encounter a situation where you may need to provide first aid, just on the street. After all, an epileptic attack or cardiac arrest are completely life-like phenomena.

And it is important to know how to do it correctly, and what mistakes can be fatal.

Watch the video from certified rescuer of the Ministry of Emergency Situations Ed Khalilov and you will find out:

1. signs of an epileptic seizure
2. a misconception that can cost a person his life,
3. how to determine cardiac arrest,
4. how to do artificial respiration correctly,
5. how to transfer an unconscious person in the easiest way.

Don't rely on others! It is important to take control of the situation in time.

My review: one of the best videos on this topic: help with an epileptic seizure, plus artificial respiration and indirect external cardiac massage.

Emergency care for an epileptic seizure

In this video we will tell you how to provide emergency care for an epileptic seizure. What is epilepsy? How does an epileptic seizure develop? All this and much more - in our new video!