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

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

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

Hearth plus readiness

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

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

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

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

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

The main thing from a complex classification

Epilepsy according to the International Classification includes more than 30 forms and syndromes, therefore, it (and the syndromes) are distinguished from epileptic seizures, which have the same or even more variants. We will not torment the reader with a list of complex names and definitions, but will try to highlight the main thing.

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

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

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

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

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

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

Causal factors

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

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

Harbingers, signs, aura

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

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

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

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

Classic example

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

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

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

Table: how to distinguish epilepsy from fainting and hysteria

The worst form is temporal

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

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

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

This form of epilepsy more often than others requires radical treatment, otherwise it is simply impossible to cope with it.

Witnessing a seizure - help with an epileptic attack

important rules during an attack

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

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

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

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

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

Video: first aid for epilepsy - “Health” program

EEG will answer questions

All attacks with loss of consciousness, whether they occurred with convulsions or without them, require studying the state of the brain. The diagnosis of epilepsy is made after a special study called, moreover, modern Computer techologies allow not only to detect pathological rhythms, but also to determine the exact localization of the focus of increased convulsive readiness.

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

• Consultations with an ophthalmologist (examination of the condition of the fundus vessels);
• Biochemical laboratory tests and ECG.

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

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

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

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

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

But a child may outgrow

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

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

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

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

Video: seizures in children - Dr. Komarovsky

It is not that simple

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

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

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

In order not to provoke attacks, a patient with epilepsy should sleep enough, not get nervous over trifles, avoid excessive exposure to high temperatures, not overwork, and take prescribed medications very seriously.

Pills and radical elimination

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

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

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

The proposed surgical operation is hard work for both the patient and the doctor; you need to undergo examinations, which are carried out only in specialized clinics(positron emission tomography to study brain metabolism), develop tactics (craniotomy?), involve related specialists.

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

Life should be fulfilling

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

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

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

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

Video: epilepsy in the program “About the Most Important Thing!”

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

ICD-10

G40

General information

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

Classification

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

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

Symptoms of epilepsy

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

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

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

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

Diagnostics

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

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

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

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

Treatment of epilepsy

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

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

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

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

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

Prognosis and prevention

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

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

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

World statistics show that from 0.8 to 1.2 people per 1 thousand population, i.e. Approximately 1% of the entire world population suffers from epilepsy. Every year, as experts commented, due to the improvement in the quality of diagnostics, more and more larger number sick

Epilepsy (falling sickness) is a chronic disease of the human brain, characterized mainly by repeated seizures, as well as the gradual development of personality changes. This is one of the most common neuropsychiatric diseases: according to various sources, up to 1% of the population suffers from epilepsy! Among the causes of its occurrence, brain injuries play an important role; in this case, we are talking about post-traumatic epilepsy. Trauma causes damage to the cortex and underlying layers of the brain. All stages of inflammation develop in the damaged area: hyperemia, then edema, followed by tissue compaction (infiltrate), then necrosis (necrosis). Dead tissue is eaten by wandering cells (phages). A scar or fluid-filled cavity (cyst) forms at the site of the defect. Microcirculation of blood and lymph is disrupted. Acute swelling and irritation of the nerve cells of the motor zone are periodically associated, which leads to convulsive contractions of skeletal muscles and loss of consciousness. The attack ends with extreme inhibition of the cerebral cortex and deep sleep. Based on the pathogenesis (mechanism of development) of epilepsy and convulsive seizures, it is necessary to prescribe anti-inflammatory and anticonvulsant drugs, as well as drugs that improve microcirculation, for prevention and treatment.

Epilepsy

What it is?

Epilepsy has been known since ancient times. In ancient Greece and Rome, epilepsy was associated with witchcraft and magic and was called a “sacred disease.” It was believed that the gods sent this disease to a person leading an unrighteous life. Already in 400 BC. Hippocrates wrote the first treatise on epilepsy, On the Sacred Disease. The greatest physician of antiquity believed that attacks were provoked by the sun, winds and cold, which changed the consistency of the brain. In the Middle Ages, epilepsy was feared as an incurable disease transmitted through the patient’s breath during an attack. At the same time, they worshiped her, since many great people, saints and prophets, suffered from epilepsy. Nowadays, epilepsy is a fairly common disease, affecting about 40 million people around the world.

Why does this happen?

We now know that an epileptic seizure is the result of a burst of electrical activity in a separate area of ​​the brain - the epileptogenic focus. The cause of such an area may be a head injury (for example, concussion), stroke, meningitis, multiple sclerosis, alcoholism(every tenth alcoholic suffers from epileptic seizures), addiction and many other reasons. It is also known that a predisposition to epilepsy can be inherited.

In 2/3 of people with epilepsy, their first seizure develops before the age of 18.

A hysterical seizure should not be confused with epilepsy. Convulsions during hysteria develop most often after any strong experiences associated with grief, resentment, fear, and, as a rule, in the presence of relatives or strangers. A person may fall, but tries not to cause serious harm to himself and remains conscious. The duration of a hysterical attack is 15-20 minutes, less often - up to several hours. When a person returns to a normal state, he does not feel a state of stupor or drowsiness, as is usually the case with epilepsy.

What's happening?

Mild attacks of epilepsy may appear as a momentary, short-term loss of connection with the outside world. Attacks may be accompanied by slight twitching of the eyelids and face and are often invisible to others. You may even get the impression that the person seemed to be thinking for a second. Everything happens so quickly that those around you don’t notice anything. Moreover, even the person himself may not know that he has just had an epileptic attack.

An epileptic attack is often preceded by a special condition called an aura (in Greek - a breath, a breeze). The manifestations of the aura are very diverse and depend on the area of ​​the brain in which the epileptogenic focus is located: it can be fever, anxiety, dizziness, a state of “never seen” or “already seen”, etc.

It is important to understand that during an attack a person is not aware of anything and does not experience any pain. The attack lasts only a few minutes.

What to do during an attack

do not try to forcibly restrain convulsive movements;

do not try to unclench your teeth;

do not perform artificial respiration or cardiac massage

lay the person with seizures on a flat surface and place something soft under his head;

do not move the person from the place where the attack occurred, unless it is life-threatening;

turn the head of a lying patient to the side to prevent the tongue from sinking and saliva getting into the Airways, and in cases of vomiting, carefully turn the whole body on its side.

After the attack ends, you need to give the person the opportunity to calmly come to their senses and, if necessary, get some sleep. Often, after the attack ends, confusion and weakness may occur, and it will take some time (usually 5 to 30 minutes) before the person can get up on their own.

Of particular danger are several large convulsive seizures, following one after another without a break. This condition is called status epilepticus. It is deadly because the patient stops breathing and may die from suffocation. Status epilepticus is the leading cause of death in patients with epilepsy and requires immediate medical attention.

Diagnosis and treatment

If you or your loved ones have had an epileptic seizure, you should contact them as soon as possible. neurologist. To create a more complete picture of the causes and nature of the attack, you will also need to consult with epileptologist And psychiatrist. A method to accurately determine the presence of this disease is encephalography. To determine the location of the epileptogenic focus, use methods of magnetic resonance imaging and computed tomography. Often, various non-epileptic conditions are disguised as epileptic seizures, for example, some fainting, sleep and consciousness disorders. In this case, video EEG monitoring is used to clarify the diagnosis.

Modern drug treatment allows in 70% of cases to completely free a person from seizures. If treatment of epilepsy with drugs fails, surgery may be prescribed.

Nervous mental illnesses

"EPILEPSY ”

CONCEPT EPILEPSY

EPILEPSY is a chronic brain disease characterized by repeated seizures that arise as a result of excessive neural activity and are accompanied by various clinical and paraclinical manifestations.

Epilepsy is based on increased neural activity with high-voltage hypersynchronous discharges (epileptic focus). Epileptic seizures most often occur in childhood. Seizures in children are characterized not only by high frequency, but also by greater severity. It is during the period when intensive brain development occurs that seizures can lead to secondary changes in the child’s psyche. This makes clear the need for early specialized medical and social assistance for such children.

Unfortunately, society has a negative attitude towards people with epileptic seizures and their problems, which is expressed in the words usually used in relation to them: “seizure”, “epileptic”, “epileptic”, as well as the existence of a number of unjustified social restrictions. These problems are being solved quite successfully in the world. In most countries there are regional organizations of a public or state-public type that deal with issues of social assistance to people with epileptic seizures.

In children, various convulsive conditions occur 5-10 times more often than in adults, which is obviously associated with the peculiarities of the structure and function of the brain, tension and imperfection of metabolic regulation, lability and a tendency to irradiate excitation, increased vascular permeability, hydrophilicity brain, etc. In the origin of epilepsy, the interaction of hereditary predisposition and brain damage is of primary importance. In most forms of epilepsy, polygenic heredity is noted, and in some cases it has greater, in others less significance. When analyzing heredity, it is necessary to take into account, first of all, the obvious signs of the disease, giving certain importance to such manifestations as stuttering, and taking into account the characterological characteristics of the individual (conflict, malice, pedantry, importunity). Predisposing factors include organic cerebral defects of a perinatal or acquired nature (after neuroinfections or traumatic brain injury).

The pathogenesis of epilepsy includes a number of mechanisms. This is primarily focality, which is characteristic not only of partial epilepsy, but also of primary generalized seizures. Most often, generalized seizures occur with focal lesions of the mediobasal temporal and orbitofrontal localization. As the disease progresses, an epileptic system is formed and the process spreads to the entire brain. The biochemical mechanisms of epilepsy are associated with a disorder of ionic, mediator and energy processes. Thus, ionic shifts lead to an increase in membrane permeability and, as a result, increased depolarization of neurons and their hyperexcitability. A decrease in glucose reserves and the accumulation of lactic acid in the brain tissue during an attack are the cause of acidotic changes; aggravating hypoxia and reducing the level of phosphate compounds. Metabolic alkalosis is often detected before an attack. Immunological reactions with the formation of anti-brain antibodies during repeated attacks, circulatory disorders and other factors that expand the affected area are also important. No specific pathological changes are found in epilepsy. At the same time, the epileptic process can cause severe dystrophic changes and a decrease in the number of ganglion cells, progressive gliosis, especially in the temporal lobes.

The clinical picture of epilepsy in children has some characteristic features. These include polymorphism and age-related transformation of attacks, a high proportion, the frequency of abortive forms, the presence of syndromes that are not found in adults, and the frequent development of post-attack symptoms of focal brain damage.

INCIDENCE AND AGE OF ONset EPILEPSY .

Regardless of ethnic and geographic characteristics, epilepsy occurs in 1-2% of people. This means that in Russia this figure is 1.5-3 million. However, convulsive conditions occur much more often. Approximately 5% of people have at least one epileptic seizure in their life. These conditions occur as a result of provoking causes, for example, high fever, long-term chronic alcoholism - convulsive withdrawal attacks, or chronic drug addiction - convulsions caused by drug deficiency. From this we conclude that only 20% of all people who have had at least one seizure in their life develop epilepsy. It is very difficult to obtain accurate figures for the prevalence of epilepsy due to the lack of a unified record, as well as the fact that this diagnosis is often not specifically or erroneously established and passes under the guise of other diagnoses (episyndrome, convulsive syndrome, various paroxysmal conditions, convulsive readiness, some types of febrile seizures etc.), which are not taken into account by the general statistics of epilepsy.

About 75% of people with epilepsy begin having seizures in the first 20 years of life.

During the first two years of life - 17%

preschool age - 13%

early school age - 34%

adolescence - 13%

after 20 years of life - 16%

middle and older age - 2-5%

SPONSORY TERMINATION OF EPILEPTIC SEIZURES

It's possible. Not all people with epileptic seizures consult a doctor and remain under his supervision. This usually occurs when the attacks stop either as a result of treatment or spontaneously without treatment. Since contact with such people is lost, information on the number of cases of self-healing is not sufficiently accurate. After a series of studies that also included patients who did not seek medical attention, it must be recognized that in a significant proportion of these people, approximately half, with or without initial treatment, attacks cease, even without further treatment. This applies to most forms of epileptic seizures. However, it should be borne in mind that the causes of attacks are different, and therefore you should not count on the fact that they will go away without treatment for you.

You need to find out the opinion of your doctor, contact a mutual aid group - this will help you make the right choice of behavior tactics. Almost all people with epileptic seizures have gone through a period of confidence in the possibility of spontaneous cessation of attacks and have their own judgment about it.

Some believe that epileptic seizures that begin at school age may themselves end with the end of puberty. Indeed it is. But the reason is not that the end of puberty somehow affects the attacks, it’s just that the percentage of those cured for the most part falls at this age. In no case should one expect that once this period is reached, epilepsy will go away on its own.

CAUSES EPILEPSY

The cause of this disease, like other great diseases, is the brain.

Hippocrates

There is hardly any brain damage that would not have the property under certain conditions to cause epilepsy.

With sufficiently strong exposure, epileptic activity, as one of the ways brain cells react, can appear in any person. However, in “healthy” people this requires a fairly strong effect - for example, alcohol withdrawal or severe traumatic brain injury. In young children, the ability of brain cells to react with excessive excitation to an irritating factor is more pronounced than in adults, so at high temperatures they may develop an epileptic attack. In approximately 1-2% of people, the activity of brain cells is so great that epileptic seizures occur on their own (spontaneously), for no apparent reason.

The reasons for the development of epileptic activity in the brain, unfortunately, are not yet clear enough, but are presumably related to the structure of the brain cell membrane, as well as the chemical characteristics of these cells. The complex range of causes of epileptic seizures cannot be reduced to any one factor. In approximately 70% of cases, the cause of seizures remains unknown, despite a special neurological examination, since there are no obvious or suspected signs of an underlying brain disease. Depending on the age at which the attacks began, one or another reason should be assumed. If they appear before age 20, the cause is more likely to be brain damage during pregnancy and childbirth than, for example, a brain tumor. If epilepsy occurs after 25 years, the most common cause is usually a brain tumor, and in older people - cerebral circulatory disorders (stroke). It has been established that the cause of focal seizures is much more often a primary dysfunction of one or several areas of the brain than with generalized ones. However, with any attacks it is necessary to conduct a thorough examination and establish the cause that is causing them.

PERINATAL COMPLICATIONS

Perinatal complications are the main cause of seizures in children. Injuries, both birth and prenatal, cause brain hypoxia (oxygen starvation of the brain). In fact, most congenital brain disorders are related to its oxygen starvation. Fortunately, as obstetric technology improves, the risk of such complications is decreasing. However, some experts believe that 20% of epilepsy cases fall into this category.

HEAD INJURY

Head injuries are the cause of another 5-10% of epilepsy cases. Post-traumatic epilepsy can follow a traumatic brain injury as a result of a severe injury, a traffic accident, child abuse, a gunshot wound, etc. Post-traumatic seizures sometimes develop immediately after the injury, and sometimes appear several years later. Experts believe that anyone who has suffered a brain injury that results in prolonged loss of consciousness has an increased likelihood of developing epilepsy.

Epilepsy very rarely occurs after minor head injuries. All parents know that falls and bruises are as integral a part of growth as childhood illnesses, so there is no need to live in constant fear that the child may trip. In addition, we must understand that not every epileptic seizure is caused by a fall. However, it should be borne in mind that children are very vulnerable. Even severe motion sickness of a child, especially an infant, can harm his mental and physical health and lead to epileptic seizures or mental retardation. If your child experiences seizures immediately or several hours after a head injury, you can be reassured by the fact that these seizures are rare. However, seizures that occur months or years after brain injury are much more likely to recur. Post-traumatic seizures develop most slowly in children. They can appear even 25 years after a head injury.

SOMATIC AND INFECTIOUS DISEASES

Repeated epileptic seizures are observed in many diseases, including cerebral palsy. In this case, often the same brain injury provokes both seizures and a concomitant disease. Cancers that affect the brain and central nervous system infections such as meningitis and encephalitis can also cause recurrent attacks.

Vascular diseases are also a common cause of epilepsy and epileptic seizures. Sometimes convulsions are the first sign of systemic lupus erythematosus (observed in approximately 15% of patients).

TUMORS AND ANOMALIES OF THE BRAIN

About 35% of brain tumors provoke recurrent seizures. However, brain tumors themselves account for less than 15% of all seizures. Most people with epilepsy have no visible brain abnormalities.

Cerebral arteriovenous dysplasia is a congenital defect that usually results in recurrent seizures. Unfortunately, surgery in this case can provoke epileptic seizures.

METABOLISM DISORDERS

Epilepsy can be caused by both hereditary metabolic disorders and acquired ones, for example, lead poisoning. These are the causes of 10% of epilepsy cases.

Eating foods rich in calories (carbohydrates, fats) can affect metabolism and trigger seizures in almost anyone. Both people with and without diabetes sometimes have epileptic seizures when their blood sugar levels rise significantly. They can also accompany kidney and liver diseases. Individual seizure thresholds are influenced by genetic factors. If seizures recur due to a metabolic disorder, epilepsy may be diagnosed, although such manifestations often disappear with successful treatment of the underlying disease.

STROKE

During a stroke, cerebral circulation is disrupted, resulting in short-term or long-term disturbances in speech, thinking and movement (depending on which parts of the brain are affected). Perhaps due to the increasing number of older people, epilepsy has become more common in this age group. Typically, strokes do not cause epileptic seizures - only 4-5% of patients develop chronic seizures. Seizures that result from a stroke usually respond well to treatment.

EXPOSURE TO MEDICINES OR INSECTICIDES

Attacks can be caused by the action of insecticides, drugs, for example, cocaine (as well as “withdrawal”) and cessation of the use of barbiturates, benzodiazepines (Valium, Librium, Dalman), and alcohol. Skipping a dose of your prescribed antiepileptic drug (AED) can also trigger an attack. It should be kept in mind that seizures do not only occur due to drug abuse. In individuals with low threshold they can be caused by strong neuroleptics (for example, aminazine, tricyclic antidepressants (such as amitriptyline) and monamine oxidase inhibitors (nialamide, etc.), amidopyrine, drugs of the penicillin group. Sometimes the interaction of antiepileptic drugs with other drugs also provokes an attack.

SELF-VOLUNTARY (GENUINE) EPILEPSY

This applies to cases where there is no reason to suspect a primary brain disease. This group, in addition to generalized seizures, includes myoclonic seizures during puberty, generalized nocturnal seizures, as well as some forms of epilepsy with myoclonic-astatic focal seizures.

Another name for spontaneous epilepsy is idiopathic.

EPILEPSY AND HERITANCE

If one of the parents has epilepsy, then the probability of their child developing it is about 6%, i.e. 3 to 6 times more than for most people. At the same time, this suggests that 94% of children will not have epilepsy. If both parents have epilepsy, then the risk for the child increases to 10 - 12%. The most common occurrence of epilepsy in a child is if the parents’ epileptic seizures were not focal, but generalized.

This information is general in nature and in each specific case can be supplemented during a consultation with an epileptologist or geneticist. It should be taken into account that the characteristics of brain activity, processes of excitation and inhibition, increased readiness for paroxysmal forms of the brain’s response to changes in internal and external factors, and not epilepsy itself, are inherited. In most cases, epilepsy appears in children much earlier than in parents. For example, if a mother has had epileptic seizures since the age of 15, then her child may develop them, for example, at the age of 5.

PROVOKATION OF EPILEPTIC ATTACK. STOP TAKING OR REDUCING THE DOSAGE OF DRUGS

If there are no attacks for a long time, some people find it possible to stop treatment on their own or reduce the dose of drugs in order to avoid their side effects. In these cases, there is often a resumption of attacks in a more severe form, and often the development of status epilepticus. Abrupt cessation of taking phenobarbital and benzodiazepine drugs is especially dangerous.

INSUFFICIENT SLEEP AND SLEEP DISORDERS

Sometimes, if a person with epilepsy falls asleep 2-3 hours later, he may have a seizure. If he decides to make up for these hours by waking up later, then this will not only not help, but may do harm. The fact is that what is important here is not the duration of sleep, but its regularity (the same time of falling asleep and waking up). If a person with epilepsy does not get enough sleep, a seizure may occur during a later awakening or a sudden awakening due to the intervention of someone close to them.

ALCOHOL CONSUMPTION

States of severe intoxication lead to sleep disturbances, metabolic changes and a decrease in the compensatory capabilities of the brain. More often, attacks appear the next day after intoxication. A special form of epilepsy is described - alcoholic epilepsy.

STRESS AND STRONG EMOTIONS.

Positive or negative stress rarely leads to attacks. however, in each specific case, you should pay attention to whether there is a connection between strong excitement and an attack. Be sure to note this on your attack calendar and tell your doctor in detail. If the cause of the stress-causing arousal, or the person's own attitude towards it, can be changed, then the number of attacks may decrease. Knowing the causes of attacks can be important information for psychotherapy.

LIGHT.

Often, epileptic seizures arise directly from specific stimuli from the external environment. Most often, the causes of attacks can be very contrasting light stimuli of the “light-dark” type, which appear, for example: when driving along an alley, if the sun is shining from the side, or past a fence through which the sun shines through from the side, on tree leaves moving in the wind, glowing the waves of the lake in the sun, looking at the rotating blades of a helicopter, the blinking lights at the disco, a faulty TV. When using a TV, people with a photosensitive form of attacks should take into account the following: if the image jumps, in no case should you approach it, but adjust it with a remote device (or someone around you). A color TV is preferable, as there are fewer black and white contrasts that cause attacks. When approaching the TV to turn it on or off, you need to cover one eye with your hand. It’s good when the dim ambient light is on when the TV is on - this reduces the contrast between the glowing screen and the room. If you have photosensitivity, glasses with tinted protective lenses can help. Much less often, the cause of attacks can be bright multi-colored objects or brightly lit text or a painting.

READING.

Reading is a very rare cause of seizures. However, if you read for a long time (overwork), when your head starts to hurt and spots appear before your eyes, you should stop this activity, as this can cause a convulsive attack.

Even the simplest sounds: a motor, a bell, the croaking of frogs, or the end of some long sound cause attacks, but, of course, these are very rare cases.

SELF-PROCOCATION OF SEIZURES.

Seizures that occur from external stimuli, such as contrasting light, images or touch, can be caused by the patient himself. Most often this concerns children with mental retardation, less often children and adults with normal development. An internal need, similar to “mania,” to cause an attack and, rarely, pleasant sensations during the pre-attack state may play a certain role here. Sometimes people with epilepsy self-provoke them to relieve quite severe internal discomfort that appears before an attack, and after an attack they may experience a state of emotional uplift and mental comfort.

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 by specific types of provocation (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 public acts. dangerous actions during an attack or declared insane (epileptic dementia, delusional symptom complexes). IN 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 a psychiatric hospital are recognized as incapacitated for the entire period of their 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 total loss 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 seizures, the person is conscious but not in control. certain part his body or he 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. Particularly relevant this problem 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 diseases as autism, migraine, 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. The key to a 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 conduct active image life, work (including on the computer), exercise, 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 healthy person, and they should also be feared:
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 grow up over time and face challenges urgent question about contraception. Women taking hormonal contraceptives, you should be aware that some antiepileptic drugs can reduce their levels in the blood 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 of the 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 continuously take folic acid 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 (absent in some forms).
structure mental disorders for epilepsy

1. Mental disorders in the prodrome of a seizure
1. Precursors in the form of 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 (disturbances of 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 the side effects of 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: abrupt change 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 the morning); 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 upper limbs, 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 epilepsies can manifest in both childhood and adults (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 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 necessary to prescribe 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. C 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 reasons provocation of seizures (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 spent are rewarded handsomely: 2.5-3 years after the last attack, a comprehensive examination is once again carried out (video-EEG monitoring, MRI of the brain) and a gradual dose reduction begins antiepileptic drug, 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 high probability occurrence of seizures or epilepsy (cranial trauma, neurosurgical intervention, 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 with 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 necessary, identify medicine 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. The 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 inner surface 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 and 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 devote to their “I” Special attention. 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 Phenobarbital does not cause intoxication. Sometimes, if you feel drowsy, add small doses of Caffeine (0.01-0.02 g) to Phenobarbital.

For major seizures positive action provides 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 good effect gives 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 of epilepsy: with 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 a therapeutic effect is achieved; 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 more late dates 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 blood 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 over a long period of time) reuse) 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 origins(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 (antiepileptic) and moderate degree antidepressant and mood-improving (mood-improving) effects.

Indications for use: with psychomotor epilepsy, grand mal seizures, mixed forms (mainly with a combination of grand mal seizures with 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) are possible. A decrease or disappearance of side effects occurs when the drug is temporarily stopped or the dose is reduced. There is also evidence of 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 lobe form and epilepsy 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, the above-ground part of the plant is used 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!