In symptomatic partial forms of epilepsy, structural changes in the cerebral cortex are detected.

The reasons that determine the development of these forms of the disease are diverse, among them the leading place is occupied by:
violations of organogenesis and histogenesis;
mesial temporal sclerosis;
brain tumors;
neuroinfections;
organic acidemia;
intrauterine infections;
traumatic brain injury, etc.

Structure of partial epilepsies: temporal lobe accounts for 44%, frontal lobe 24%, multifocal lobe 21%, symptomatic occipital lobe 10% and parietal lobe 1%.

Features of epilepsy in children: in them, even partial forms have the features of generalized ones, and partial epilepsy is often hidden under the mask of West's syndrome.

Seizure onset in symptomatic partial epilepsy is variable, the maximum number is observed at preschool age. As a rule, these are simple and complex partial seizures, as well as secondary generalized convulsive paroxysms.

Symptoms depend on the location of the epileptogenic focus, neuroimaging determines structural changes in the corresponding area of ​​the brain. On the EEG, peak-wave activity or regional deceleration is recorded.

Variants of complex partial seizures with isolated disorder of consciousness:
switching off consciousness with freezing (staring) and a sudden interruption of motor activity;
turning off consciousness without interrupting motor activity (with automatisms);
turning off consciousness with a slow fall without convulsions (temporal syncope).

FRONTAL EPILEPSY

The clinical symptoms of frontal epilepsy are diverse; disease manifests itself:
simple partial seizures
complex partial seizures
secondary generalized paroxysms
a combination of the above attacks

Attacks (their duration is 30-60 s) have a high frequency with a tendency to seriality and often occur at night. All forms of epilepsy are often complicated by status epilepticus. At a half of patients manifestation of attacks is noted without the previous aura.

The nosological independence of frontal epilepsy is determined by a number of common distinctive clinical features:
all frontal seizures, as a rule, are short in time (do not exceed 1 minute);
complex partial seizures generated in the frontal regions of the brain are characterized by minimal post-seizure confusion;
very fast secondary generalization of seizures, even exceeding that of temporal lobe epilepsy;
pronounced demonstrative and sometimes unusual motor phenomena (pedaling by the type of trampling on the spot, gestural automatisms
de novo, etc.), accompanying seizures, pronounced motor manifestations, including atypical settings such as bilateral or unilateral tonic postures and / or atonic episodes;
high frequency of automatisms in the initial phase of seizures;
frequent sudden falls.

The following forms of frontal epilepsy are distinguished:
motor (Jacksonian)- characteristic clonic convulsions in the extremities contralateral (distal) to the focus of the ascending or descending type of distribution, the presence of a somatosensory aura, secondary generalization often develops, Todd's paralysis is possible;
frontopolar (anterior)- accompanied by painful memories, a change in the sense of time, a failure or influx of thoughts;
cingular - affective, hypermotor seizures, ipsilateral blinking, facial hyperemia are observed;
dorsolateral– distinctive features of this form of frontal epilepsy: adversion of the eyes and head contralateral to the focus, speech cessation, bilateral proximal tonic seizures are possible, secondary generalization often occurs;
opercular;
orbitofrontal;
additional motor zone.

!!! a large proportion of psychomotor seizures in the structure of frontal epilepsy complicates the diagnosis due to the mistaking them for psychogenic seizures

TEMPORAL EPILEPSY

Temporal lobe epilepsy manifests itself:
simple partial seizures;
complex partial seizures;
secondary generalized seizures;
a combination of the above attacks.

!!! especially characteristic of temporal lobe epilepsy is the presence of complex partial seizures occurring with a disorder of consciousness, in combination with automatisms

In some cases, atypical febrile convulsions precede the development of the disease (debut before 1 year and after 5 years, high duration, partial component, previous neurological and intellectual deficit, etc.).

The presence of an aura is very characteristic of temporal lobe epilepsy.:
somatosensory;
visual;
olfactory;
taste;
auditory;
vegetative-visceral;
mental.

!!! the aura cannot be regarded only as a harbinger, it is a paroxysmal phenomenon

Temporal lobe epilepsy is divided into:
amygdalo-hippocampal (paleocortical)- you can observe the freezing of patients with a motionless face, wide-open eyes and a gaze fixed at one point (the patient seems to be staring); seizures occur, accompanied by a blackout without interruption of motor activity (button picking) or a slow fall without convulsions (temporal syncope);
lateral (neocortical)- Manifested by seizures with impaired hearing, vision and speech; characteristic is the appearance of bright colored structural (unlike occipital epilepsy) visual, as well as complex auditory hallucinations.

Differential clinical signs of right-sided and left-sided temporal lobe epilepsy:
time interval between attacks:
- right-sided: deficit of spatial visual memory;
- left-sided: deficit of verbal memory;
time interval - during an attack:
- right-sided: stereotypical movement of the right hand, dystonia of the left hand, stereotypical repeated phrases;
- left-sided: stereotyped movement of the left hand, dystonia of the right hand, unintelligible speech automatisms;
time interval - after the attack:
- right-sided: noisy clapping with the right hand, increasing deficit of spatial visual memory;
- left-sided: deficit of verbal memory, aphasia.

In temporal lobe epilepsy, the EEG records peak-wave, often persistent regional slow-wave (theta) activity in the temporal leads, usually spreading anteriorly. In 70% of patients, a pronounced slowdown in the main activity of background recording is detected.

parietal and occipital epilepsy

The clinical picture of parietal epilepsy is characterized by:
elementary paresthesia;
pain sensations;
violation of temperature perception;
"sexual" attacks;
idiomotor apraxia;
violation of the body scheme.

With occipital epilepsy simple visual hallucinations, paroxysmal amaurosis, paroxysmal visual field disturbances, subjective sensations in the eyeballs, blinking, deviation of the head and neck are noted.

TREATMENT

Among the methods of treatment of symptomatic partial forms of epilepsy drug therapy comes first., and its inefficiency is the main criterion for referral of a patient for surgical treatment.

You can talk about resistance lack of effectiveness of therapy with a basic antiepileptic drug in age dosages, a decrease in the number of seizures by less than 50%, lack of control over seizures when using two basic antiepileptic drugs as monotherapy or in combination with one of the new generation drugs.

With symptomatic partial forms of epilepsy:
the base drug is carbamazepine (20-30 mg/kg/day);
drugs of choice are:
- depakine (30-60 mg/kg/day)
- topiramate (5-10 mg/kg/day)
- lamotrigine (5 mg/kg/day); in children under 12 years of age, it can only be used in combination with other antiepileptic drugs.

The most effective combination for temporal lobe epilepsy depakine with carbamazepine, with frontal - successfully use depakine with topiramate, with the occipital - in most cases, monotherapy with carbamazepine is sufficient.

FORECAST

The prognosis of epilepsy depends on the nature of the structural brain damage; complete remission can be achieved in 35-65% of cases. About 30% of patients are resistant to conventional antiepileptic drug therapy. Frequent seizures significantly impair the social adaptation of patients; such patients can be considered candidates for neurosurgical treatment.

reference Information
(clinical manifestations and topical diagnosis of partial seizures)

Simple partial seizures

Motor partial seizures

Frontal lobe (motor cortex)- Simple muscle contractions contralateral to the focus (cramps in the limbs, face, hand, foot, motor Jacksonian march). After a seizure, there may be Todd's palsy - transient paresis in the limb involved in the seizure

Frontal lobe (premotor cortex)- Combined rotation of the head and eyeballs (adversive seizure), or an attack of epileptic nystagmus, or tonic abduction of the eyeballs in the opposite direction to the focus (oculomotor seizure). May be accompanied by rotation of the body (versus seizure) or secondary localized convulsions.

Amygdala, opercular zone, speech zones- Chewing movements, drooling, vocalization or speech cessation (phonatoric seizures).

Sensory seizures

Parietal lobe (sensory cortex, postcentral gyrus)- Localized sensory disturbances (paresthesias (tingling, tingling) or numbness in a limb or half of the body, sensory Jacksonian seizure).

Occipital lobe - Visual hallucinations (unformed images: zigzags, sparks, scotoma, hemianopsia).

Anteromedial temporal lobe- Olfactory hallucinations.

Insula (islet, area of ​​the cortex below the frontal and parietal lobes)- Unusual taste sensations (dysgesia).

Autonomic seizures

Orbitoinsulotemporal region- Visceral or vegetative manifestations (epigastric seizures (feeling of tightness and heaviness in the epigastric region approaching the throat), abdominal seizures (unpleasant sensations or pain in the epigastric and umbilical region, rumbling in the abdomen with gas discharge), salivation).

Mental seizures(more commonly referred to as complex seizures)

Temporal lobe - Complex behavioral automatisms.

Posterior temporal lobe or amygdala-hippocampus- Visual hallucinations (formed images).

Complex partial seizures

Complex partial seizures account for 30-40% of all seizures. They are characterized by more pronounced clinical manifestations than for simple ones, and a violation (change) of consciousness in the form of the inability to make contact with the patient, confusion, disorientation. The patient is aware of the course of the attack, but cannot follow commands, answer questions, or does it automatically, without realizing what is happening, followed by amnesia for what happens during the attack. Complex seizures are caused by electrical stimulation of the cerebral cortex, which occurs in one of the lobes of the brain and usually involves both hemispheres. The duration of an attack ranges from 2 to 3 minutes, the post-seizure period lasts from a few seconds to tens of minutes.

Complex partial seizures are characterized by:

Cognitive impairment:
derealization (feeling of alienation of the external world, unreality of what is happening) or depersonalization (unreality, alienation of internal sensations);
ideational disorders: forced thinking in the form of attacks of obsessive thoughts, both subjective (thoughts about death) and objective (fixation on previously heard words, thoughts);
dysmnestic disorders: paroxysmal memory impairment (dj vu - the feeling of what has already been seen (the new environment seems familiar), jamais vu - the feeling of never seen (the familiar environment seems unfamiliar)), the feeling of already experienced or never experienced in combination with affective changes of a negative type ( sadness, anxiety).

Epileptic automatisms- coordinated motor acts carried out against the background of a change in consciousness during or after an epileptic seizure, and subsequently amnesiac (psychomotor seizure); unlike the aura, they do not have a topical meaning.

Distinguish automatisms:
food automatisms - chewing, lip licking, swallowing;
mimic automatisms reflecting the emotional state of the patient - a smile, fear;
gestural automatisms - rubbing with hands;
verbal automatisms - repetition of sounds, words, singing;
ambulatory automatisms - the patient moves on foot or by transport at various distances, the duration of the attack is minutes.

For complex partial seizures of frontal genesis, it is characteristic:
bilateral tonic spasms;
bizarre poses;
complex automatisms (imitation of spanking, hitting the ball, sexual movements), vocalization.

With damage to the pole of the medial parts of the frontal lobes“frontal absences” are possible: they manifest themselves in the form of bouts of fading (disturbance of consciousness and cessation of all activity for 10-30 seconds)

Complex partial seizures with secondary generalization

Complex partial seizures with secondary generalization begin as simple or complex partial seizures and then progress to generalized tonic-clonic (secondary generalized seizures). The duration of the seizure is up to 3 minutes, the post-seizure period is from several minutes to hours. In cases where the patient retains memories of the onset of the seizure before losing consciousness, they speak of the aura of the seizure.

Aura - the initial part of the seizure, indicates partial epilepsy with secondary generalization and allows you to establish a topical verification of the focus of epilepsy.

Allocate motor, sensory, sensitive (visual, olfactory, auditory, gustatory), mental and autonomic aura.

Violations can be caused by various reasons. The appearance of specific neurological symptoms observed during a seizure makes it possible to determine the area of ​​the cortex responsible for its development.

Partial seizures can be simple if their development is not accompanied by a violation of consciousness or orientation, and complex if such signs are present.

Simple seizures

The development of simple seizures is preceded by the appearance of an aura. In neurology, its character greatly helps in identifying the location of the focus of the primary lesion. For example, the appearance of a motor aura, which is characterized by letting a person run or whirl; the appearance of a visual aura - sparks, flashes; auditory aura.

From this it follows that the presence of an aura can characterize the development of a simple seizure without loss of consciousness or is considered the level of occurrence of a secondary spreading convulsive seizure.

At the same time, the last sensations before the onset of the disappearance of consciousness are stored in the memory. The aura lasts up to a few seconds, therefore, patients do not have time to protect themselves from possible injuries after losing consciousness.

It is important for a practicing neurologist to diagnose simple partial vegetative-visceral seizures without delay, which can occur as isolated forms and develop into complex seizures or are harbingers of secondary generalized convulsive seizures.

There are several options:

• visceral, characterized by unpleasant sensations in the epigastrium;
• sexual are accompanied by the formation of an indomitable physiological attraction, erection, orgasm;
• vegetative are determined by the development of vasomotor phenomena - reddening of the skin of the face, fever, chills, thirst, polyuria, increased heart rate, increased sweating, appetite disorders (bulimia or anorexia), arterial hypertension, allergies and other symptoms.

Quite often, development is defined as symptoms of the development of vegetovascular or neurocirculatory dystonia, or other neurological pathologies, which leads to the appointment of incorrect treatment.

Criteria determining their presence:

• the rare presence of provoking factors;
• short duration;
• the presence of convulsive twitches;
• serial flow;
• post-paroxysmal stupor and disorientation;
• combined course with other forms of seizures;
• the development and course of all attacks is the same;
• identification of specific changes on the EEG between attacks - hypersynchronous discharges, bilateral flashes with high amplitude, peak wave complexes.

aphatic seizures

The appearance of aphasia refers to the first manifestation of the pathology, while the symptoms of speech disorders develop over months.

At first, patients do not respond to speech appeals to them, then simplified phrases begin to predominate in the conversation, and with a progressive course, individual words or in general they stop pronouncing words. If auditory verbal agnosia is added to this, then patients are mistakenly diagnosed with early childhood autism or hearing loss.

The appearance of epileptic seizures is noted several weeks after the onset of speech impairment. Further progression causes the appearance of behavioral anomalies - hyperactivity, irritability and sometimes aggressiveness.

When removing the EEG, high-amplitude multifocal spikes or peak wave complexes are determined in the centrotemporal and centrofrontal regions of both the dominant and subdominant hemispheres. During sleep, the inclusion of foci of epileptic activity is noted, which leads to a generalization of the pathological process in the hemispheres.

Dysmnesic seizures

This course is characterized by the development of paroxysm:

1. “Already seen” - at the same time, it seems to the patient that he has already seen it, it is familiar to him, that is, a repetition of what has already been seen. In such cases, the situation in the past seems to be repeated, it seems that the surrounding is exactly repeated, as if it was captured in a photograph in the past and transferred to the present. In this case, it is possible to reflect visual and auditory impressions, aromas, thoughts, actions and deeds.
2. "Already heard" - there is a duplication of feelings that are close to the patient's personality, that is, not events are repeated, but a mood that, under the influence of a lived moment, becomes consonant with the present.
3. "Already experienced" - the words of songs or conversations that he hears or takes part in seem familiar to the patient.

At the same time, patients seek to restore in memory a “familiar moment” from life, sounds or words. If they fail to remember, then they are inclined to think that they saw it in a dream. Such seizures are distinguished by their paroxysmal nature, stereotyped and exact reproducibility, so they are thoroughly exactly similar to each other. During the seizure, the patient seems to fall into another dimension, so they freeze, hear the conversation, but do not understand its meaning, the gaze is motionless and fixed on one point. At the end of the attack, they feel unwell and sleepy.

ideational seizures

Such seizures are accompanied by strange or forced thoughts, which is why the patient scrolls the same thought in the brain and cannot switch.

The described sensations of patients at this moment are in many ways reminiscent of schizophrenia, so this course of epilepsy must be differentiated from it.

Emotionally affective seizures

They are characterized by unreasonable and sudden fear combined with the idea of ​​self-blame and other psychovegetative crises with the dominance of panic attacks.

Rarely, attacks with positive emotions, such as happiness, are noted.

Illusory seizures

With their development, the appearance of illusions is not noted, since this pathology refers to psychosensory disorders. Varieties:

1. Attacks of metamorphopsia are accompanied by spontaneous experiences due to a change in the shape of surrounding objects: stretching, twisting, changing the place of habitual placement, being in constant motion or circling, falling furniture and other signs.
2. Attacks accompanied by a violation of the "body schema" are characterized by the appearance of a feeling of increase in the size of body parts, rotation, lengthening, shortening and curvature.
3. Attacks of autopsychic depersonalization are accompanied by the development of alienation of the perception of the individual and the creation of a barrier from the outside world. In such cases, it is difficult for patients to perceive unity with surrounding objects and even their own reflection. In severe cases, the syndrome of autometamorphosis develops with the appearance of fear of reincarnation into another person.
4. Derealization paroxysms are accompanied by a feeling of ephemeralness and isolation from life. Because of this, all objects in the perception of the patient are not real, the situation is fantastic, unreal, and the meaning of what is happening around them is barely realized.

hallucinatory seizures

The development of such seizures may be accompanied by olfactory, gustatory, auditory and visual hallucinations:

1. With olfactory hallucinations, there is a sensation of smells: gasoline, paint, or feces, which do not exist during the development of the seizure. Sometimes the smell is undifferentiated, that is, difficult to describe.
2. With taste hallucinations, a disgusting taste of metal, bitterness or burnt rubber appears in the oral cavity.
3. Auditory are divided into elementary and verbal.
4. Visual ones can be elementary - flashes of light, dots and others, and complex with a panoramic image of people, animals and their movement. Sometimes the appearance of pictures reminiscent of the development of the plot, as in a movie, is noted. A distinctive feature is the development of ekmnestic hallucinations, that is, the emergence of images and scenes from the past of patients.

Complex partial seizures

The appearance of complex partial seizures with automatisms is mainly noted. Their development is accompanied by involuntary motor activity with the performance of actions of varying complexity against the background of twilight clouding of consciousness. On average, they last 30 minutes and end with complete amnesia.

Depending on the dominant automatism, there are oralimentary and sexual seizures, automatism of gestures, speech and ambulatory automatisms, sleepwalking.

On the causes and general manifestations in passing

To provoke the development of partial seizures can:

The severity of the clinic depends on the volume of suddenly excited neurons in the cerebral cortex. Manifestations also depend on the location of the epileptogenic focus in the brain.

The attack is manifested by disorders of the musculoskeletal system, speech, lack of reaction to surrounding events, spasms, convulsions, numbness in the body.

The development of an attack may be preceded by an increase in body temperature, dizziness, confusion and anxiety - an aura, which depends on the localization of the lesion of the cerebral cortex.

With the development of a mild attack, the neurons of one area are suddenly activated, its symptoms are not always noticed by others. What can not be said with extensive excitation of neurons, because it introduces noticeable discomfort into the patient's habitual lifestyle.

What does medicine offer?

Medical treatment consists in prescribing:

• anticonvulsants - Phenobarbital, Difenin, Carbamezepine;
• neurotropic agents;
• psychoactive and psychotropic drugs.

Other treatments include:

With a correct description of the symptoms of the aura and the attack, it is easier for the attending physician to identify the type of provocative pathology and prescribe adequate treatment.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Causes of convulsive syndrome in children and adults

Cramps are involuntary muscle contractions caused by neuronal hyperactivity or irritation. Seizures occur in approximately 2% of adults, with most having one seizure in their lifetime. And only a third of these patients have recurrent seizures, which makes it possible to diagnose epilepsy.

A seizure is a separate episode, and epilepsy is a disease. Accordingly, any convulsive seizure cannot be called epilepsy. In epilepsy, seizures are spontaneous and recurrent.

Causes

A seizure is a sign of increased neurogenic activity. This circumstance can provoke various diseases and conditions.

Causes leading to seizures:

1. Genetic disorders - lead to the development of primary epilepsy.
2. Perinatal disorders - exposure to the fetus of infectious agents, medications, hypoxia. Traumatic and asphyxic lesions during childbirth.
3. Infectious lesions of the brain (meningitis, encephalitis).
4. The action of toxic substances (lead, mercury, ethanol, strychnine, carbon monoxide, alcohol).
5. withdrawal syndrome.
6. Eclampsia.
7. Taking medications (chlorpromazine, indomethacin, ceftazidime, penicillin, lidocaine, isoniazid).
8. Traumatic brain injury.
9. Violations of cerebral circulation (stroke, subarachnoid hemorrhage, as well as acute hypertensive encephalopathy).
10. Metabolic disorders: electrolyte disorders (eg, hyponatremia, hypocalcemia, hyperhydration, dehydration); disorders of carbohydrate (hypoglycemia) and amino acid metabolism (with phenylketonuria).
11. Tumors of the brain.
12. Hereditary diseases (for example, neurofibromatosis).
13. Fever.
14. Degenerative diseases of the brain.
15. Other reasons.

Certain causes of seizures are characteristic of certain age groups.

Types of seizures

In medicine, attempts have been repeatedly made to create the most appropriate classification of convulsive seizures. All types of seizures can be divided into two groups:

Partial seizures are triggered by the firing of neurons in a specific area of ​​the cerebral cortex. Generalized seizures are caused by hyperactivity in a large area of ​​the brain.

Partial seizures

Partial seizures are called simple if they are not accompanied by a violation of consciousness and complex if they are present.

Simple partial seizures

They proceed without disturbance of consciousness. The clinical picture depends on in which part of the brain the epileptogenic focus has arisen. The following symptoms may be observed:

• Cramps in the limbs, as well as turning the head and torso;
• Feelings of crawling on the skin (paresthesia), light flashes before the eyes, a change in the perception of surrounding objects, a sensation of an unusual smell or taste, the appearance of false voices, music, noise;
• Mental manifestations in the form of deja vu, derealization, depersonalization;
• Sometimes different muscle groups of one limb are gradually involved in the convulsive process. This state is called the Jacksonian march.

The duration of such a seizure is only from a couple of seconds to several minutes.

Complex partial seizures

Accompanied by impaired consciousness. A characteristic sign of a seizure is automatism (a person can lick his lips, repeat some sounds or words, rub his palms, walk along one path, etc.).

The duration of the seizure is one to two minutes. After a seizure, there may be a short-term clouding of consciousness. The person does not remember the event.

Sometimes partial seizures transform into generalized ones.

Generalized seizures

Occur against the background of loss of consciousness. Neurologists distinguish tonic, clonic and tonic-clonic generalized seizures. Tonic convulsions - persistent muscle contraction. Clonic - rhythmic muscle contractions.

Generalized seizures can occur in the form of:

1. Major seizures (tonic-clonic);
2. Absences;
3. myoclonic seizures;
4. Atonic seizures.

Tonic-clonic seizures

The person suddenly loses consciousness and falls. There comes a tonic phase, the duration of which is seconds. Extension of the head, flexion of the arms, stretching of the legs, tension of the torso are observed. Sometimes there is a kind of scream. The pupils are dilated, do not respond to light stimulus. The skin takes on a bluish tint. Involuntary urination may occur.

Then comes the clonic phase, characterized by rhythmic twitching of the whole body. There is also rolling of the eyes and foaming at the mouth (sometimes bloody if the tongue is bitten). The duration of this phase is one to three minutes.

Sometimes with a generalized seizure, only clonic or tonic convulsions are observed. After an attack, a person’s consciousness is not restored immediately, drowsiness is noted. The victim has no memory of what happened. Muscle pain, the presence of abrasions on the body, bite marks on the tongue, and a feeling of weakness allow suspecting a seizure.

Absences

Absences are also called petty seizures. This state is characterized by a sudden shutdown of consciousness for just a few seconds. The person falls silent, freezes, the gaze is fixed at one point. The pupils are dilated, the eyelids are slightly lowered. There may be twitching of facial muscles.

It is characteristic that a person does not fall during an absence. Since the attack is short-lived, it often goes unnoticed by other people. After a few seconds, consciousness returns and the person continues to do what he did before the attack. The person is not aware of the event.

Myoclonic seizures

These are seizures of short-term symmetrical or asymmetrical contractions of the muscles of the trunk and limbs. Convulsions may be accompanied by a change in consciousness, but due to the short duration of the attack, this fact often goes unnoticed.

Atonic seizures

It is characterized by loss of consciousness and decreased muscle tone. Atonic seizures are a faithful companion of children with Lennox-Gastaut syndrome. This pathological condition is formed against the background of various anomalies in the development of the brain, hypoxic or infectious brain damage. The syndrome is characterized not only by atonic, but also by tonic seizures with absences. In addition, there is a mental retardation, paresis of the limbs, ataxia.

Epileptic status

This is a formidable condition, which is characterized by a series of epileptic seizures, between which a person does not regain consciousness. This is a medical emergency that can result in death. Therefore, status epilepticus should be stopped as early as possible.

In most cases, status epilepticus occurs in people with epilepsy after stopping the use of antiepileptic drugs. However, status epilepticus can also be the initial manifestation of metabolic disorders, oncological diseases, withdrawal symptoms, traumatic brain injury, acute disorders of cerebral blood supply, or infectious brain damage.

Epistatus complications include:

1. Respiratory disorders (respiratory arrest, neurogenic pulmonary edema, aspiration pneumonia);
2. Hemodynamic disorders (arterial hypertension, arrhythmias, cardiac arrest);
3. Hyperthermia;
4. Vomit;
5. Metabolic disorders.

Convulsive syndrome in children

Convulsive syndrome among children is quite common. Such a high prevalence is associated with the imperfection of the structures of the nervous system. Convulsive syndrome is more common in premature babies.

Febrile convulsions

These are convulsions that develop in children aged six months to five years against a background of body temperature above 38.5 degrees.

You can suspect the onset of a seizure by the wandering gaze of the baby. The child ceases to respond to sounds, flickering of hands, objects in front of his eyes.

There are these types of seizures:

• Simple febrile seizures. These are solitary convulsive seizures (tonic or tonic-clonic), lasting up to fifteen minutes. They do not have partial elements. After the seizure, consciousness is not disturbed.
• Complicated febrile seizures. These are longer seizures that follow one after another in the form of series. May contain a partial component.

Febrile seizures occur in about 3-4% of babies. Only 3% of these children develop epilepsy later. The likelihood of developing the disease is higher if the child has a history of complicated febrile seizures.

Affective-respiratory convulsions

This is a syndrome characterized by episodes of apnea, loss of consciousness, and convulsions. The attack is provoked by strong emotions, such as fear, anger. The baby begins to cry, sleep apnea occurs. The skin becomes cyanotic or purple in color. On average, the apnea period lasts seconds. After that, loss of consciousness, limpness of the body may develop, followed by tonic or tonic-clonic convulsions. Then there is a reflex breath and the baby comes to his senses.

Spasmophilia

This disease is a consequence of hypocalcemia. A decrease in calcium in the blood is observed with hypoparathyroidism, rickets, diseases accompanied by profuse vomiting and diarrhea. Spasmophilia is registered among children aged from three months to one and a half years of age.

There are such forms of spasmophilia:

An explicit form of the disease is manifested by tonic convulsions of the muscles of the face, hands, feet, larynx, which are transformed into generalized tonic convulsions.

It is possible to suspect a latent form of the disease by characteristic signs:

• Trousseau's symptom - muscle cramps of the hand that occur when the neurovascular bundle of the shoulder is squeezed;
• Khvostek's symptom - contraction of the muscles of the mouth, nose, eyelid, arising in response to tapping with a neurological hammer between the corner of the mouth and the zygomatic arch;
• Lust's symptom - dorsiflexion of the foot with the leg turned outward, which occurs in response to tapping with a mallet along the peroneal nerve;
• Maslov's symptom - when the skin tingles, a short-term breath holding occurs.

Diagnostics

Diagnosis of convulsive syndrome is based on the clarification of the patient's history. If it is possible to establish a connection between a specific cause and convulsions, then we can talk about a secondary epileptic seizure. If seizures occur spontaneously and recur, epilepsy should be suspected.

For diagnosis, an EEG is performed. Registering electroencephalography directly during an attack is not an easy task. Therefore, the diagnostic procedure is carried out after the seizure. In favor of epilepsy, focal or asymmetric slow waves may testify.

Note: Often, electroencephalography remains normal even when the clinical picture of the convulsive syndrome does not allow doubting the presence of epilepsy. Therefore, EEG data cannot play a leading role in determining the diagnosis.

Treatment

Therapy should be focused on eliminating the cause that caused the seizure (removal of the tumor, elimination of the consequences of the withdrawal syndrome, correction of metabolic disorders, etc.).

During an attack, a person must be laid in a horizontal position, turned on its side. This position will prevent choking on gastric contents. Put something soft under your head. You can hold the head, the body of a person a little, but with moderate force.

note: During a convulsive attack, you should not put any objects into a person’s mouth. This can lead to injury to the teeth, as well as stuck objects in the airways.

You can not leave a person until the moment of complete restoration of consciousness. If a seizure occurs for the first time or a seizure is characterized by a series of seizures, the person must be hospitalized.

For a seizure lasting more than five minutes, the patient is given oxygen through a mask, as well as ten milligrams of diazepam on glucose for two minutes.

After the first episode of seizures, antiepileptic drugs are usually not prescribed. These medications are prescribed in cases where the patient is definitively diagnosed with epilepsy. The choice of medication is based on the type of seizure.

With partial, as well as tonic-clonic convulsions, use:

For myoclonic seizures:

In most cases, the expected effect can be achieved during therapy with one drug. In resistant cases, several drugs are prescribed.

Grigorova Valeria, medical commentator

Asphyxia in a newborn: degrees, consequences, first aid for asphyxia

Pulmonary edema: symptoms, causes and emergency care

Hello. Tell me, please. What pain medications, fever medications and antibiotics can be taken with Carbamazepine?

When taken simultaneously with Carbamazepine, the toxic effect of other drugs on the liver increases, so you need to discuss the issue of compatibility only with your doctor. I would definitely not recommend taking Analgin and Paracetamol. Ibuprofen is questionable. Antibiotics - strictly prescribed by the attending physician.

Hello! I was diagnosed with epilepsy, but they can’t determine the cause in any way, I take phenobarbital, convulsions appear intermittently for half a year or even more, can I switch to another drug - Depatin Krono?

Hello. Online consultants do not have the right to prescribe or cancel / replace drugs as part of a remote consultation. You need to ask this question to your doctor.

Hello. How to find the cause of tonic-clonic seizures. My daughter had such convulsions a year and a half ago. There were 3 times during the first six months. Encorat chrono was immediately prescribed. But the reason was never found. They do an EEG, there are waves and continued treatment. They did a CT scan, they found chiari 1. None of the relatives had this, there were no head injuries either. How can you determine the cause? Thanks.

Hello. It is a pity that you did not indicate the age of the child and the size of the prolapse of the tonsils. In addition to EEG and CT, only X-rays can be prescribed (only if there was a suspicion of injury). In your case, you need to pay attention to the anomaly of Arnold Chiari, despite the mild degree, in rare cases (!) It can provoke, incl. and convulsive syndrome. Given that we are talking about a child, you need to look for an answer not on the Internet, but with a competent pediatric neurologist (it is advisable to visit 2-3 doctors to get a collegiate opinion).

Hello, I have a daughter, now she is three years old. Doctors diagnosed. PPNS with convulsive syndrome ZPRR. How to treat it? She is now taking conuvulex syrup.

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Partial seizures

Etiology and pathophysiology

Pathological electrical discharges emanating from focal lesions of the brain cause partial convulsions, which can manifest themselves in different ways.

Specific manifestations depend on the localization of damage (pathology of the parietal lobe can cause paresthesia on the opposite limb when walking, with pathology of the temporal lobe, bizarre behavior is observed).

The causes of focal brain damage can be stroke, tumor, infectious process, congenital malformations, arteriovenous malformations, trauma.

The disease can begin at any age, as this type of epilepsy is acquired.

Often debuts in adults, usually the cause is a cerebrovascular pathology or neoplasm.

In adolescents, the most common cause is head trauma or an idiopathic form of the disease.

Simple partial convulsions are focal sensory or motor disturbances that are not accompanied by loss of consciousness.

During complex partial seizures, there is a brief loss of consciousness, often accompanied by bizarre sensations or actions (eg, dreams, automatism, olfactory hallucinations, chewing or swallowing movements); this usually occurs against the background of pathology of the temporal or frontal lobes.

All partial seizures can lead to secondary generalized tonic-clonic seizures.

Transient global amnesia.

Simple partial convulsions are not accompanied by loss of consciousness.

Classified according to clinical manifestations, including: focal motor seizures, focal sensory seizures and seizures accompanied by mental disorders.

Mental disorders: deja vu (from the French “already seen”), jamais vu (from the French “never seen”), depersonalization, a feeling of unreality of what is happening.

Often progress to complex partial seizures.

During complex partial seizures, a short-term loss of consciousness (30-90 s) occurs, followed by a postconvulsive period lasting 1-5 minutes.

Automatism - aimless actions (pinching clothes, smacking lips, swallowing movements).

Diagnosis is often based on an eyewitness account.

With complex partial convulsions, the patient does not remember the attack; the witness describes the patient's gaze into nowhere and slight manifestations of automatism.

Simple partial seizures are self-reported by the patient, with focal twitching of a limb, focal sensory disturbances occurring most often on one side of the body or one limb, or mental symptoms such as deja vu.

The EEG often shows focal abnormalities, including focal slow or spiked wave discharges.

Multiple EEG monitoring may be required.

In unclear cases, in order to fix the attack, long-term video surveillance of the patient may be required.

MRI allows you to determine focal pathology.

There are many drug therapy options, including phenytoin, carbamazepine, oxcarbazepine, phenobarbital, primidone, zonisamide, topiramate, lamotrigine, tiagabine, and levetiracetam.

The choice of drug is most often determined by possible side effects and additional data (for example, the likelihood of pregnancy, drug interactions, age and sex of the patient).

It is necessary to periodically monitor the level of the drug in the blood, the results of a clinical blood test, platelets and liver function tests.

If drug therapy is ineffective, other methods of treatment are used: surgical removal of the focus of convulsive activity or installation of a vagus nerve stimulator.

Simple and complex partial convulsions very often recur, these convulsions often turn out to be refractory to drug therapy, even combined.

Remission is possible, but it is difficult to predict how often disease-free periods will occur; the likelihood of remission is higher in patients with a rapid response to drug therapy and minor EEG changes. The prognosis also depends on the etiology of the seizures, with more severe injuries and strokes being associated with more resistant seizures.

In refractory seizures, surgical treatment in 50% of cases improves the results of drug therapy.

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(lat. Epilepsia - seized, caught, caught) - one of the most common chronic human neurological diseases, manifested in the body's predisposition to the sudden onset of convulsive seizures. Other common and commonly used names for these sudden attacks are an epileptic seizure, "falling." Epilepsy affects not only people, but also animals, such as dogs, cats, mice. Many great ones, namely Julius Caesar, Napoleon Bonaparte, Peter the Great, Fyodor Dostoevsky, Alfred Nobel, Joan of Arc, Ivan IV the Terrible, Vincent van Gogh, Winston Churchill, Lewis Carroll, Alexander the Great, Alfred Nobel, Dante Alighieri, Fyodor Dostoevsky , Nostradamus and others suffered from epilepsy.

This disease was called "God's mark", believing that people with epilepsy are marked from above. The nature of the appearance of this disease has not yet been established, there are several assumptions in medicine, but there is no exact data.

The popular belief that epilepsy is an incurable disease is wrong. The use of modern antiepileptic drugs can completely eliminate seizures in 65% of patients and significantly reduce the number of seizures in another 20%. The basis of treatment is long-term daily drug therapy with regular follow-up studies and medical examinations.

Medicine has established that epilepsy is a hereditary disease, it can be transmitted through the mother's line, but more often it is transmitted through the male line, it may not be transmitted at all or it may manifest itself through the generation. There is a possibility of epilepsy in children conceived by parents in a drunken state or with syphilis. Epilepsy can be an "acquired" disease, as a result of severe fright, head injury, mother's illness during pregnancy, due to the formation of brain tumors, cerebrovascular malformations, birth injuries, infections of the nervous system, poisoning, neurosurgery.

An epileptic seizure occurs as a result of the simultaneous excitation of nerve cells, which occurs in a certain area of ​​​​the cerebral cortex.

Epilepsy is classified into the following types based on its occurrence:

1. symptomatic- it is possible to detect a structural defect of the brain, for example, a cyst, a tumor, a hemorrhage, malformations, a manifestation of organic damage to brain neurons;
2. idiopathic- there is a hereditary predisposition, and there are no structural changes in the brain. The basis of idiopathic epilepsy is channelopathy (genetically determined diffuse instability of neuronal membranes). There are no signs of organic brain damage in this variant of epilepsy; the intelligence of patients is normal;
3. cryptogenic- the cause of the disease cannot be identified.

Before each epileptic seizure, a person experiences a special condition called an aura. The aura manifests differently in each person. It all depends on the location of the epileptogenic focus. The aura can be manifested by fever, anxiety, dizziness, the patient feels cold, pain, numbness of some parts of the body, strong heartbeat, an unpleasant smell, taste of some food, sees a bright flicker. It should be remembered that during an epileptic attack, a person not only is not aware of anything, but also does not experience any pain. An epileptic seizure lasts for several minutes.

Under a microscope, during an epileptic seizure, swelling of cells, small areas of hemorrhages are visible in this place of the brain. Each seizure facilitates the next one by forming permanent seizures. That's why epilepsy needs to be treated! Treatment is strictly individual!

Predisposing factors:

• change in climatic conditions,
• lack or excess of sleep,
• fatigue,
• bright daylight.

Epilepsy symptoms

Manifestations of epileptic seizures vary from generalized convulsions to changes in the patient's internal state that are barely noticeable to others. There are focal seizures associated with the occurrence of an electrical discharge in a certain limited area of ​​​​the cerebral cortex and generalized seizures, in which both hemispheres of the brain are simultaneously involved in the discharge. With focal seizures, convulsions or peculiar sensations (for example, numbness) in certain parts of the body (face, arms, legs, etc.) can be observed. Also, focal seizures can be manifested by short attacks of visual, auditory, olfactory, or gustatory hallucinations. Consciousness during these attacks can be preserved, in which case the patient describes in detail his feelings. Partial or focal seizures are the most common manifestation of epilepsy. They occur when nerve cells are damaged in a specific area of ​​one of the hemispheres of the brain and are divided into:

1. simple - with such seizures there is no disturbance of consciousness;
2. complex - seizures with a violation or change in consciousness, are caused by areas of overexcitation that are diverse in localization and often turn into generalized ones;
3. Secondary generalized seizures - characterized by the onset in the form of a convulsive or non-convulsive partial seizure or absence, followed by a bilateral spread of convulsive motor activity to all muscle groups.

The duration of partial seizures is usually no more than 30 seconds.

There are states of the so-called trance - outwardly ordered actions without consciousness control; upon the return of consciousness, the patient cannot remember where he was and what happened to him. A kind of trance is sleepwalking (sometimes not of epileptic origin).

Generalized seizures are convulsive and non-convulsive (absences). For others, the most frightening are generalized convulsive seizures. At the beginning of an attack (tonic phase), there is a tension of all muscles, a short-term cessation of breathing, a piercing cry is often observed, biting of the tongue is possible. After 10-20 sec. the clonic phase begins, when muscle contractions alternate with their relaxation. Urinary incontinence is often observed at the end of the clonic phase. Seizures usually stop spontaneously after a few minutes (2-5 minutes). Then comes the post-attack period, characterized by drowsiness, confusion, headache and the onset of sleep.

Non-convulsive generalized seizures are called absences. They occur almost exclusively in childhood and early adolescence. The child suddenly freezes and gazes intently at one point, the look seems to be absent. Covering the eyes, trembling of the eyelids, slight tilting of the head can be observed. Attacks last only a few seconds (5-20 seconds) and often go unnoticed.

The occurrence of an epileptic seizure depends on a combination of two factors of the brain itself: the activity of the convulsive focus (sometimes also called epileptic) and the general convulsive readiness of the brain. Sometimes an epileptic seizure is preceded by an aura (a Greek word meaning "breeze", "breeze"). The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired (that is, on the localization of the epileptic focus). Also, certain conditions of the body can be a provoking factor in an epileptic seizure (epileptic seizures associated with the onset of menstruation; epileptic seizures that occur only during sleep). In addition, an epileptic seizure can provoke a number of environmental factors (for example, flickering light). There are a number of classifications of characteristic epileptic seizures. From the point of view of treatment, the classification based on the symptoms of seizures is most convenient. It also helps to distinguish epilepsy from other paroxysmal conditions.

Types of epileptic seizures

What are the types of seizures?

Epileptic seizures are very diverse in their manifestations - from severe general convulsions to an imperceptible blackout. There are also such as: a feeling of a change in the shape of surrounding objects, twitching of the eyelid, tingling in the finger, discomfort in the stomach, short-term inability to speak, leaving home for many days (trances), rotation around its axis, etc.

More than 30 types of epileptic seizures are known. Currently, the International Classification of Epilepsy and Epileptic Syndromes is used to systematize them. This classification distinguishes two main types of seizures - generalized (general) and partial (focal, focal). They, in turn, are divided into subspecies: tonic-clonic seizures, absences, simple and complex partial seizures, as well as other seizures.

What is an aura?

Aura (a Greek word meaning "breeze", "breeze") is the state that precedes an epileptic seizure. The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired. They can be: fever, anxiety and restlessness, sound, strange taste, smell, change in visual perception, discomfort in the stomach, dizziness, "already seen" (deja vu) or "never seen" (jamais vu) states , a feeling of inner bliss or longing, and other sensations. The ability of a person to correctly describe his aura can be of great help in diagnosing the localization of changes in the brain. The aura can also be not only a harbinger, but also an independent manifestation of a partial epileptic seizure.

What are generalized seizures?

Generalized seizures are seizures in which paroxysmal electrical activity covers both hemispheres of the brain. And additional brain studies in such cases do not reveal focal changes. The main generalized seizures include tonic-clonic (generalized convulsive seizures) and absences (short-term blackouts). Generalized seizures occur in about 40% of people with epilepsy.

What are tonic-clonic seizures?

Generalized tonic-clonic seizures (grand mal) are characterized by the following manifestations:

1. turning off consciousness;
2. tension of the trunk and limbs (tonic convulsions);
3. twitching of the trunk and limbs (clonic convulsions).

During such an attack, breathing may be held for a while, but this never leads to suffocation of a person. Usually the attack lasts 1-5 minutes. After an attack, sleep, a state of stupor, lethargy, and sometimes a headache may occur.

In the event that an aura or a focal attack occurs before an attack, it is regarded as partial with secondary generalization.

What are absences (fading)?

Absences (petite mal) are generalized seizures with a sudden and short-term (from 1 to 30 seconds) loss of consciousness, not accompanied by convulsive manifestations. The frequency of absences can be very high, up to several hundred seizures per day. They are often not noticed, believing that the person was thinking at that time. During an absence, movements suddenly stop, the gaze stops, and there is no reaction to external stimuli. Aura never happens. Sometimes there may be eye rolling, twitching of the eyelids, stereotyped movements of the face and hands, and discoloration of the skin of the face. After the attack, the interrupted action resumes.

Absences are characteristic of childhood and adolescence. Over time, they can transform into other types of seizures.

What is juvenile myoclonic epilepsy?

Adolescent myoclonic epilepsy begins between the onset of puberty (puberty) and 20 years of age. It is manifested by lightning-fast twitches (myoclonus), as a rule, of the hands while maintaining consciousness, sometimes accompanied by generalized tonic or tonic-clonic seizures. Most of these attacks occur in the interval of 1-2 hours before or after waking up from sleep. The electroencephalogram (EEG) often shows characteristic changes, and there may be an increased sensitivity to light flicker (photosensitivity). This form of epilepsy responds well to treatment.

What are partial seizures?

Partial (focal, focal) seizures are seizures caused by paroxysmal electrical activity in a limited area of ​​the brain. This type of seizure occurs in about 60% of people with epilepsy. Partial seizures can be simple or complex.

Simple partial seizures are not accompanied by impaired consciousness. They can manifest as twitching or discomfort in certain parts of the body, turning the head, discomfort in the abdomen, and other unusual sensations. Often these attacks are similar to an aura.

Complex partial seizures have more pronounced motor manifestations and are necessarily accompanied by one or another degree of change in consciousness. Previously, these seizures were classified as psychomotor and temporal lobe epilepsy.

In partial seizures, a thorough neurological examination is always performed to rule out underlying brain disease.

What is rolandic epilepsy?

Its full name is "benign childhood epilepsy with central-temporal (rolandic) peaks." Already from the name it follows that it responds well to treatment. Seizures appear in early childhood and stop in adolescence. Rolandic epilepsy usually presents with partial seizures (eg, unilateral twitching of the corner of the mouth with salivation, swallowing) that usually occur during sleep.

What is status epilepticus?

Status epilepticus is a condition where epileptic seizures follow each other without interruption. This condition is life threatening. Even with the current level of development of medicine, the risk of death of the patient is still very high, so a person with status epilepticus must be taken without delay to the intensive care unit of the nearest hospital. Seizures recurring so frequently that between them the patient does not regain consciousness; distinguish epileptic status of focal and generalized seizures; very localized motor seizures are termed "permanent partial epilepsy".

What are pseudo-seizures?

These states are deliberately caused by a person and outwardly look like seizures. They can be staged in order to attract additional attention to themselves or to avoid any activity. It is often difficult to distinguish a true epileptic seizure from a pseudoepileptic one.

Pseudo-epileptic seizures are observed:

• in childhood;
• more often in women than in men;
• in families where there are relatives with mental illness;
• with hysteria;
• in the presence of a conflict situation in the family;
• in the presence of other brain diseases.

Unlike epileptic seizures, pseudo-seizures do not have a characteristic post-seizure phase, a return to normal occurs very quickly, the person smiles often, there is rarely damage to the body, irritability rarely occurs, and more than one attack rarely occurs in a short period of time. Electroencephalography (EEG) can accurately identify pseudoepileptic seizures.

Unfortunately, pseudoepileptic seizures are often mistakenly regarded as epileptic seizures, and patients begin to receive treatment with specific drugs. Relatives in such cases are frightened by the diagnosis, as a result, anxiety is induced in the family and hyper-custody is formed over a pseudo-sick person.

Convulsive focus

A convulsive focus is the result of organic or functional damage to a part of the brain caused by any factor (insufficient blood circulation (ischemia), perinatal complications, head injuries, somatic or infectious diseases, brain tumors and anomalies, metabolic disorders, stroke, toxic effects of various substances). At the site of structural damage, a scar (which sometimes forms a fluid-filled cavity (cyst)). In this place, acute swelling and irritation of the nerve cells of the motor zone can periodically occur, which leads to convulsive contractions of the skeletal muscles, which, in case of generalization of excitation to the entire cerebral cortex, end in a loss of consciousness.

Convulsive readiness

Convulsive readiness is the probability of an increase in pathological (epileptiform) excitation in the cerebral cortex above the level (threshold) at which the anticonvulsant system of the brain functions. It can be high or low. With high convulsive readiness, even a small activity in the focus can lead to the appearance of a full-blown convulsive attack. The convulsive readiness of the brain can be so great that it leads to a short-term loss of consciousness even in the absence of a focus of epileptic activity. In this case, we are talking about absences. Conversely, there may be no convulsive readiness at all, and, in this case, even with a very strong focus of epileptic activity, partial seizures occur that are not accompanied by loss of consciousness. The reason for increased convulsive readiness is intrauterine cerebral hypoxia, hypoxia in childbirth or hereditary predisposition (the risk of epilepsy in the offspring of patients with epilepsy is 3-4%, which is 2-4 times higher than in the general population).

Diagnosis of epilepsy

In total, there are about 40 different forms of epilepsy and different types of seizures. At the same time, for each form, its own treatment regimen has been developed. That is why it is so important for a doctor not only to diagnose epilepsy, but also to determine its form.

How is epilepsy diagnosed?

A complete medical examination includes the collection of information about the life of the patient, the development of the disease and, most importantly, a very detailed description of the attacks, as well as the conditions that preceded them, by the patient himself and by eyewitnesses of the attacks. If seizures occur in a child, then the doctor will be interested in the course of pregnancy and childbirth in the mother. Necessarily carried out a general and neurological examination, electroencephalography. Special neurological studies include nuclear magnetic resonance imaging and computed tomography. The main task of the examination is to identify current diseases of the body or brain that could cause seizures.

What is electroencephalography (EEG)?

Using this method, the electrical activity of brain cells is recorded. This is the most important test in the diagnosis of epilepsy. An EEG is performed immediately after the onset of the first seizures. In epilepsy, specific changes (epileptic activity) appear on the EEG in the form of discharges of sharp waves and peaks of higher amplitude than ordinary waves. In generalized seizures, the EEG shows groups of generalized peak-wave complexes in all areas of the brain. With focal epilepsy, changes are detected only in certain, limited areas of the brain. Based on the EEG data, a specialist can determine what changes have occurred in the brain, clarify the type of seizures, and, based on this, determine which drugs will be preferable for treatment. Also, with the help of EEG, the effectiveness of the treatment is monitored (especially important for absences), and the issue of stopping treatment is decided.

How is an EEG performed?

An EEG is a completely harmless and painless test. To conduct it, small electrodes are applied to the head and fixed on it with the help of a rubber helmet. Electrodes are connected by wires to an electroencephalograph, which amplifies the electrical signals of brain cells received from them by 100 thousand times, writes them down on paper or enters readings into a computer. During the examination, the patient lies or sits in a comfortable diagnostic chair, relaxed, with his eyes closed. Usually, when taking an EEG, so-called functional tests (photostimulation and hyperventilation) are carried out, which are provocative loads on the brain through bright light flashing and increased respiratory activity. If an attack begins during the EEG (this is very rare), then the quality of the examination increases significantly, since in this case it is possible to more accurately determine the area of ​​\u200b\u200bthe disturbed electrical activity of the brain.

Are EEG changes grounds for the detection or exclusion of epilepsy?

Many EEG changes are nonspecific and provide only supporting information for the epileptologist. Only on the basis of the detected changes in the electrical activity of brain cells, one cannot speak of epilepsy, and, conversely, this diagnosis cannot be ruled out with a normal EEG if epileptic seizures occur. EEG activity is regularly detected in only 20-30% of people with epilepsy.

Interpretation of changes in the bioelectrical activity of the brain is, to some extent, an art. Changes similar to epileptic activity can be caused by eye movement, swallowing, vascular pulsation, respiration, electrode movement, electrostatic discharge, and other causes. In addition, the electroencephalographer must take into account the age of the patient, since the EEG of children and adolescents differs significantly from the electroencephalogram of adults.

What is a hyperventilation test?

This is frequent and deep breathing for 1-3 minutes. Hyperventilation causes pronounced metabolic changes in the substance of the brain due to the intensive removal of carbon dioxide (alkalosis), which, in turn, contribute to the appearance of epileptic activity on the EEG in people with seizures. Hyperventilation during EEG recording allows revealing latent epileptic changes and clarifying the nature of epileptic seizures.

What is photostimulation EEG?

This trial is based on the fact that flashes of light can cause seizures in some people with epilepsy. During the recording of the EEG, a bright light flashes rhythmically (10-20 times per second) in front of the eyes of the patient under study. Detection of epileptic activity during photostimulation (photosensitive epileptic activity) allows the doctor to choose the most correct treatment tactics.

Why is an EEG with sleep deprivation performed?

Sleep deprivation (deprivation) for 24-48 hours before the EEG is performed to detect latent epileptic activity in cases of epilepsy that are difficult to recognize.

Sleep deprivation is a fairly strong trigger for seizures. This test should only be used under the guidance of an experienced physician.

What is an EEG in sleep?

As is known, in certain forms of epilepsy, changes in the EEG are more pronounced, and sometimes only able to be perceptible during a study in a dream. EEG recording during sleep makes it possible to detect epileptic activity in most of those patients in whom it was not detected during the daytime even under the influence of conventional provocative tests. But, unfortunately, such a study requires special conditions and training of medical personnel, which limits the wide application of this method. It is especially difficult to carry it out in children.

Is it right not to take antiepileptic drugs before an EEG?

This should not be done. Abrupt discontinuation of drugs provokes seizures and can even cause status epilepticus.

When is video-EEG used?

This very complex study is carried out in cases where it is difficult to determine the type of epileptic seizure, as well as in the differential diagnosis of pseudo-seizures. A video EEG is a video recording of an attack, often during sleep, with simultaneous EEG recording. This study is carried out only in specialized medical centers.

Why is brain mapping done?

This type of EEG with computer analysis of the electrical activity of brain cells is usually carried out for scientific purposes. The use of this method in epilepsy is limited to detecting only focal changes.

Is EEG harmful to health?

Electroencephalography is an absolutely harmless and painless study. EEG is not associated with any effect on the brain. This study can be done as often as necessary. The EEG only causes a slight inconvenience associated with the wearing of a helmet on the head and slight dizziness, which may occur during hyperventilation.

Do the EEG results depend on the device used for the study?

EEG devices - electroencephalographs, manufactured by various companies, do not fundamentally differ from each other. Their difference is only in the level of technical service for specialists and in the number of registration channels (electrodes used). The EEG results largely depend on the qualifications and experience of the specialist conducting the study and analysis of the data obtained.

How to prepare a child for an EEG?

The child must be explained what awaits him during the study, and convinced of his painlessness. The child before the study should not feel hungry. The head must be clean. With young children, it is necessary to practice on the eve of putting on a helmet and staying still with your eyes closed (you can stage a game of an astronaut or a tanker), as well as teach you to breathe deeply and often under the “inhale” and “exhale” commands.

CT scan

Computed tomography (CT) is a method of examining the brain using radioactive (X-ray) radiation. During the study, a series of images of the brain is taken in different planes, which, unlike conventional radiography, allows you to get an image of the brain in three dimensions. CT allows to detect structural changes in the brain (tumors, calcifications, atrophies, hydrocephalus, cysts, etc.).

However, CT data may not be informative for certain types of seizures, which include, in particular:

any epileptic seizures for a long time, especially in children;

generalized epileptic seizures with no focal EEG changes and no evidence of brain damage on neurological examination.

Magnetic resonance imaging

Magnetic resonance imaging is one of the most accurate methods for diagnosing structural changes in the brain.

Nuclear Magnetic Resonance (NMR)- This is a physical phenomenon based on the properties of some atomic nuclei, when placed in a strong magnetic field, to absorb energy in the radio frequency range and emit it after the cessation of exposure to the radio frequency pulse. In terms of its diagnostic capabilities, NMR is superior to computed tomography.

The main disadvantages usually include:

1. low reliability of detection of calcifications;
2. high price;
3. the impossibility of examining patients with claustrophobia (fear of closed spaces), artificial pacemakers (pacemaker), large metal implants made of non-medical metals.

Is a medical examination necessary in cases where there are no more seizures?

If a person with epilepsy has stopped seizures, and the drugs have not yet been canceled, then he is recommended to conduct a control general and neurological examination at least once every six months. This is especially important for controlling the side effects of antiepileptic drugs. Usually, the condition of the liver, lymph nodes, gums, hair is checked, as well as laboratory blood tests and liver tests. In addition, sometimes it is necessary to control the amount of anticonvulsants in the blood. Neurological examination at the same time includes a traditional examination by a neurologist and an EEG.

Cause of death in epilepsy

Status epilepticus is especially dangerous due to pronounced muscle activity: tonic-clonic convulsions of the respiratory muscles, inhalation of saliva and blood from the oral cavity, as well as delays and arrhythmias of breathing lead to hypoxia and acidosis. The cardiovascular system is experiencing exorbitant loads due to the gigantic muscular work; hypoxia increases cerebral edema; acidosis enhances hemodynamic and microcirculation disorders; Secondly, the conditions for brain functioning worsen more and more. With prolonged epileptic status in the clinic, the depth of the coma increases, convulsions take on a tonic character, muscle hypotension is replaced by their atony, and hyperreflexia by areflexia. Growing hemodynamic and respiratory disorders. Convulsions can completely stop, and the stage of epileptic prostration sets in: the palpebral fissures and mouth are half open, the gaze is indifferent, the pupils are wide. In this state, death can occur.

Two main mechanisms lead to cytotoxic action and necrosis, in which cellular depolarization is supported by stimulation of NMDA receptors and the key point is the launch of a destruction cascade inside the cell. In the first case, excessive neuronal excitation is the result of edema (fluid and cations enter the cell), leading to osmotic damage and cell lysis. In the second case, activation of NMDA receptors activates the flow of calcium into the neuron with the accumulation of intracellular calcium to a level higher than the cytoplasmic calcium binding protein can accommodate. Free intracellular calcium is toxic to the neuron and leads to a series of neurochemical reactions, including mitochondrial dysfunction, activates proteolysis and lipolysis, destroying the cell. This vicious circle underlies the death of a patient with status epilepticus.

Epilepsy prognosis

In most cases, after a single attack, the prognosis is favorable. Approximately 70% of patients undergo remission during treatment, that is, there are no seizures for 5 years. Seizures continue in 20-30%, in such cases, the simultaneous administration of several anticonvulsants is often required.

First aid

Signs or symptoms of an attack are usually: convulsive muscle contractions, respiratory arrest, loss of consciousness. During an attack, others need to remain calm - without showing panic and fuss, provide the correct first aid. These symptoms of an attack should go away on their own within a few minutes. To accelerate the natural cessation of the symptoms that accompany an attack, others most often cannot.

The most important goal of first aid in a seizure is to prevent harm to the health of the person who has had a seizure.

The onset of an attack may be accompanied by loss of consciousness and a person falling to the floor. When falling from the stairs, next to objects that stand out from the floor level, bruises of the head and fractures are possible.

Remember: an attack is not a disease transmitted from one person to another, act boldly and correctly, providing first aid.

Getting into an attack

Support the falling person with your hands, lower him here on the floor or seat him on a bench. If a person is in a dangerous place, for example, at a crossroads or near a cliff, raising his head, taking him under the armpits, move him a little away from the dangerous place.

The beginning of the attack

Sit next to the person and hold the most important thing - the head of the person, it is most convenient to do this by holding the head of the person lying between your knees and holding it from above with your hands. The limbs can not be fixed, they will not make amplitude movements, and if initially a person lies comfortably enough, then he will not be able to inflict injuries on himself. Other people are not required nearby, ask them to move away. The main phase of the attack. While holding your head, prepare a folded handkerchief or part of the person's clothing. This may be required to wipe saliva, and if the mouth is open, then a piece of this matter, folded in several layers, can be inserted between the teeth, this will prevent biting the tongue, cheeks, or even damage to the teeth against each other during cramps.

If the jaws are tightly closed, do not try to open the mouth by force (this most likely will not work and may injure the oral cavity).

With increased salivation, continue to hold the person's head, but turn it to the side so that saliva can drain to the floor through the corner of the mouth and does not enter the respiratory tract. It's okay if a little saliva gets on your clothes or hands.

Exit from attack

Remain completely calm, an attack with respiratory arrest can last several minutes, memorize the sequence of symptoms of an attack in order to describe them to the doctor later.

After the end of convulsions and relaxation of the body, it is necessary to put the victim in a recovery position - on his side, this is necessary to prevent the root of the tongue from sinking.

The victim may have medicines, but they can be used only at the direct request of the victim, otherwise criminal liability for causing harm to health may follow. In the vast majority of cases, the exit from the attack should occur naturally, and the right medicine or mixture of them and the dose will be selected by the person himself after leaving the attack. Searching a person in search of instructions and medicines is not worth it, as this is not necessary, but will only cause an unhealthy reaction from others.

In rare cases, the exit from the attack may be accompanied by involuntary urination, while the person still has convulsions at this time, and consciousness has not fully returned to him. Politely ask other people to move away and disperse, hold the person's head and shoulders and gently prevent him from getting up. Later, a person will be able to cover himself, for example, with an opaque bag.

Sometimes at the exit from an attack, even with rare convulsions, a person tries to get up and start walking. If you can keep spontaneous impulses from side to side of the person, and the place is not dangerous, for example, in the form of a road nearby, a cliff, etc., let the person, without any help from you, stand up and walk with him, holding him tightly. If the place is dangerous, then until the complete cessation of convulsions or the complete return of consciousness, do not allow him to get up.

Usually 10 minutes after the attack, the person completely returns to his normal state and he no longer needs first aid. Let the person make the decision on the need to seek medical help; after recovering from an attack, this is sometimes no longer necessary. There are people who have seizures several times a day, and at the same time they are completely full members of society.

Often, young people are uncomfortable with the attention of other people to this incident, and much more than the attack itself. Cases of an attack under certain stimuli and external circumstances can occur in almost half of the patients; modern medicine does not allow to insure against this beforehand.

A person whose attack is already ending should not be made the focus of general attention, even if the person emits involuntary convulsive cries when exiting the attack. You could, by holding the person's head, for example, talk calmly to the person, this helps to reduce stress, gives confidence to the person coming out of an attack, and also calms onlookers and encourages them to disperse.

An ambulance should be called in case of a repeated attack, the onset of which indicates an exacerbation of the disease and the need for hospitalization, since further attacks may follow a second attack in a row. When communicating with the operator, it is enough to indicate the gender and approximate age of the victim, to the question “What happened?” answer “a repeated attack of epilepsy”, name the address and large fixed landmarks, at the request of the operator, provide information about yourself.

In addition, an ambulance should be called if:

• seizure lasts more than 3 minutes
• after an attack, the victim does not regain consciousness for more than 10 minutes
• attack occurred for the first time
• the seizure occurred in a child or an elderly person
• a seizure occurred in a pregnant woman
• during the attack, the victim was injured.

Epilepsy treatment

Treatment of a patient with epilepsy is aimed at eliminating the cause of the disease, suppressing the mechanisms of seizure development and correcting the psychosocial consequences that may occur as a result of the neurological dysfunction underlying the diseases or in connection with a persistent decrease in working capacity.

If the epileptic syndrome is the result of metabolic disorders, such as hypoglycemia or hypocalcemia, then after the restoration of metabolic processes to a normal level, the seizures usually stop. If epileptic seizures are caused by an anatomical lesion of the brain, such as a tumor, an arteriovenous malformation, or a brain cyst, then removal of the pathological focus also leads to the disappearance of seizures. However, long-term even non-progressive lesions can cause the development of various negative changes. These changes can lead to the formation of chronic epileptic foci that cannot be eliminated by removing the primary lesion. In such cases, control is needed, sometimes surgical extirpation of the epileptic areas of the brain is necessary.

Medical treatment of epilepsy

• Anticonvulsants, another name for anticonvulsants, reduce the frequency, duration, and in some cases completely prevent seizures:
• Neurotropic drugs - can inhibit or stimulate the transmission of nervous excitation in various parts of the (central) nervous system.
• Psychoactive substances and psychotropic drugs affect the functioning of the central nervous system, leading to a change in mental state.
• Racetams are a promising subclass of psychoactive nootropics.

Antiepileptic drugs are chosen depending on the form of epilepsy and the nature of the seizures. The drug is usually prescribed in a small initial dose with a gradual increase until the optimal clinical effect appears. If the drug is ineffective, it is gradually canceled and the next one is prescribed. Remember that under no circumstances should you independently change the dosage of the medicine or stop treatment. A sudden change in dose can provoke a deterioration in the condition and an increase in seizures.

Non-drug treatments

• Surgery;
• Voight method;
• osteopathic treatment;
• The study of the influence of external stimuli that affect the frequency of attacks, and the weakening of their influence. For example, the frequency of seizures may be influenced by the daily regimen, or it may be possible to individually establish a connection, for example, when wine is consumed, and then it is washed down with coffee, but this is all individual for each organism of a patient with epilepsy;
• Ketogenic diet.

Epilepsy and driving

Each state has its own rules for determining when a person with epilepsy can obtain a driver's license, and several countries have laws requiring physicians to report epilepsy patients to the registry and inform patients of their responsibility for doing so. In general, patients can drive a car if within 6 months - 2 years (with or without drug treatment) they have not had seizures. In some countries, the exact duration of this period is not defined, but the patient must obtain a doctor's opinion that the seizures have stopped. The doctor is obliged to warn the patient with epilepsy about the risks that he is exposed to while driving with such a disease.

Most patients with epilepsy, with adequate seizure control, attend school, go to work, and lead a relatively normal life. Children with epilepsy usually have more problems at school than their peers, but every effort should be made to enable these children to learn normally by providing them with extra help in the form of tutoring and psychological counseling.

How is epilepsy related to sex life?

Sexual behavior is an important but very private part of life for most men and women. Studies have shown that about a third of people with epilepsy, regardless of gender, have sexual problems. The main causes of sexual disorders are psychosocial and physiological factors.

Psychosocial factors:

• limited social activity;
• lack of self-esteem;
• rejection by one of the partners of the fact that the other has epilepsy.

Psychosocial factors invariably cause sexual dysfunction in various chronic diseases, and are also the cause of sexual problems in epilepsy. The presence of seizures often leads to a feeling of vulnerability, helplessness, inferiority and interferes with the establishment of a normal relationship with a sexual partner. In addition, many fear that their sexual activity may trigger seizures, especially when the seizures are triggered by hyperventilation or physical activity.

Even such forms of epilepsy are known, when sexual sensations act as a component of an epileptic seizure and, as a result, form a negative attitude towards any manifestations of sexual desires.

Physiological factors:

• dysfunction of brain structures responsible for sexual behavior (deep structures of the brain, temporal lobe);
• hormonal changes due to seizures;
• increase in the level of inhibitory substances in the brain;
• a decrease in the level of sex hormones due to the use of drugs.

A decrease in sexual desire is observed in about 10% of people receiving antiepileptic drugs, and to a greater extent it is expressed in those taking barbiturates. A rather rare case of epilepsy is increased sexual activity, which is no less a serious problem.

When evaluating sexual disorders, it must be taken into account that they can also be the result of improper upbringing, religious restrictions and negative experiences of early sexual life, but the most common cause is a violation of relationships with a sexual partner.

epilepsy and pregnancy

Most women with epilepsy are able to carry an uncomplicated pregnancy and give birth to healthy children, even if they are taking anticonvulsants at this time. However, during pregnancy, the course of metabolic processes in the body changes, special attention should be paid to the levels of antiepileptic drugs in the blood. Sometimes relatively high doses have to be administered to maintain therapeutic concentrations. The majority of sick women, whose condition was well controlled before pregnancy, continue to feel satisfactory during pregnancy and childbirth. Women who fail to control seizures before pregnancy are at higher risk of developing complications during pregnancy.

One of the most serious complications of pregnancy, morning sickness, often presents with generalized tonic-clonic seizures in the last trimester. Such seizures are a symptom of a severe neurological disorder and are not a manifestation of epilepsy, occurring in women with epilepsy no more often than in others. Toxicosis must be corrected: this will help prevent the occurrence of seizures.

In the offspring of women with epilepsy, the risk of embryonic malformations is 2-3 times higher; apparently, this is due to a combination of low frequency of drug-induced malformations and genetic predisposition. Congenital malformations observed include fetal hydantoin syndrome, characterized by cleft lip and palate, heart defects, finger hypoplasia, and nail dysplasia.

The ideal for a woman planning a pregnancy would be to stop taking antiepileptic drugs, but it is very likely that in a large number of patients this will lead to a relapse of seizures, which will later be more detrimental to both mother and child. If the condition of the patient allows to cancel the treatment, then this can be done at a suitable time before the onset of pregnancy. In other cases, it is desirable to carry out maintenance treatment with one drug, prescribing it at the minimum effective dose.

Children exposed to chronic intrauterine exposure to barbiturates often have transient lethargy, hypotension, restlessness, and signs of barbiturate withdrawal are often observed. These children should be included in the risk group for the occurrence of various disorders in the neonatal period, slowly removed from the state of dependence on barbiturates and carefully monitored for their development.

There are also seizures that look like epileptic seizures, but are not. Increased excitability in rickets, neurosis, hysteria, disorders of the heart, breathing can cause such attacks.

Affectively - respiratory attacks:

The child begins to cry and at the height of crying stops breathing, sometimes it even goes limp, falls unconscious, there may be twitches. Help with affective seizures is very simple. You need to take as much air as possible into your lungs and blow on the child's face with all your might, or wipe his face with cold water. Reflexively, breathing will be restored, the attack will stop. There is also yactation, when a very small child sways from side to side, it seems that he is rocking himself before going to bed. And who already knows how to sit, sways back and forth. Most often, yactation occurs if there is no necessary spiritual contact (it happens in children in orphanages), rarely - due to mental disorders.

In addition to the listed conditions, there are attacks of loss of consciousness associated with a violation of the activity of the heart, breathing, etc.

Influence on character

Pathological excitation of the cerebral cortex and seizures do not pass without a trace. As a result, the psyche of the patient with epilepsy changes. Of course, the degree of change in the psyche largely depends on the personality of the patient, the duration and severity of the disease. Basically, there is a slowdown in mental processes, primarily thinking and affects. With the course of the disease, changes in thinking progress, the patient often cannot separate the main from the secondary. Thinking becomes unproductive, has a concrete descriptive, stereotyped character; standard expressions predominate in speech. Many researchers characterize it as "labyrinth thinking".

According to the observations, according to the frequency of occurrence among patients, character changes in epileptics can be arranged in the following order:

• slowness,
• viscosity of thinking,
• heaviness,
• short temper,
• selfishness,
• rancor,
• thoroughness,
• hypochondria,
• quarrelsomeness,
• accuracy and pedantry.

The appearance of a patient with epilepsy is characteristic. Slowness, restraint in gestures, reticence, lethargy of facial expressions, inexpressiveness of the face are striking, you can often notice the "steel" gleam of the eyes (a symptom of Chizh).

Malignant forms of epilepsy eventually lead to epileptic dementia. In patients, dementia is manifested by lethargy, passivity, indifference, humility with the disease. Viscous thinking is unproductive, memory is reduced, vocabulary is poor. The affect of tension is lost, but obsequiousness, flattery, hypocrisy remain. In the outcome, indifference to everything except one's own health develops, petty interests, egocentrism. Therefore, it is important to recognize the disease in time! Public understanding and comprehensive support are extremely important!

Can I drink alcohol?

Some people with epilepsy choose not to drink alcohol at all. It is well known that alcohol can provoke seizures, but this is largely due to the individual susceptibility of the person, as well as the form of epilepsy. If a person with seizures is fully adapted to a full life in society, then he will be able to find for himself a reasonable solution to the problem of drinking alcohol. Permissible doses of alcohol per day are for men - 2 glasses of wine, for women - 1 glass.

Can I smoke?

Smoking is bad, it's common knowledge. There was no direct relationship between smoking and seizures. But there is a risk of fire if a seizure occurs while smoking unattended. Women with epilepsy should not smoke during pregnancy, so as not to increase the risk (and already quite high) of malformations in the child.

Important! Treatment is carried out only under the supervision of a physician. Self-diagnosis and self-treatment are unacceptable!

Partial seizures develop when the neurons of one limited area of ​​the cortex are excited. The appearance of certain clinical manifestations is due to the mobilization of the matching area of ​​the cortex, which reflects the development of pathological changes in it.

Violations can be caused by various reasons. The appearance of specific neurological symptoms observed during a seizure makes it possible to determine the area of ​​the cortex responsible for its development.

Partial seizures can be simple if their development is not accompanied by a violation of consciousness or orientation, and complex if such signs are present.

Simple seizures

The development of simple seizures is preceded by the appearance of an aura. In neurology, its character greatly helps in identifying the location of the focus of the primary lesion. For example, the appearance of a motor aura, which is characterized by letting a person run or whirl; the appearance of a visual aura - sparks, flashes; auditory aura.

From this it follows that the presence of an aura can characterize the development of a simple seizure without loss of consciousness or is considered the level of occurrence of a secondary spreading convulsive seizure.

At the same time, the last sensations before the onset of the disappearance of consciousness are stored in the memory. The aura lasts up to a few seconds, therefore, patients do not have time to protect themselves from possible injuries after losing consciousness.

It is important for a practicing neurologist to diagnose simple partial vegetative-visceral seizures without delay, which can occur as isolated forms and develop into complex seizures or are harbingers of secondary generalized convulsive seizures.

There are several options:

• visceral, characterized by unpleasant sensations in the epigastrium;
• sexual accompanied by the formation of an indomitable physiological attraction, erection, orgasm;
• vegetative are determined with the development of vasomotor phenomena - reddening of the skin of the face, fever, chills, thirst, polyuria, increased heart rate, increased sweating, appetite disorders (bulimia or anorexia), arterial hypertension, allergies and other symptoms.

Quite often, development is defined as symptoms of development or neurocirculatory dystonia, or other neurological pathologies, which leads to the appointment of the wrong treatment.

Criteria determining their presence:

aphatic seizures

Rarely, attacks with positive emotions, such as happiness, are noted.

Illusory seizures

With their development, the appearance of illusions is not noted, since this pathology refers to psychosensory disorders. Varieties:

hallucinatory seizures

The development of such seizures may be accompanied by olfactory, gustatory, auditory and visual hallucinations:

1. At olfactory hallucinations there is a sensation of smells: gasoline, paint or feces, which do not exist during the development of the seizure. Sometimes the smell is undifferentiated, that is, difficult to describe.
2. At taste hallucinations a disgusting taste of metal, bitterness or burnt rubber appears in the oral cavity.
3. Auditory divided into elementary and verbal.
4. visual can be elementary - flashes of light, dots and others, and complex with a panoramic image of people, animals and their movement. Sometimes the appearance of pictures reminiscent of the development of the plot, as in a movie, is noted. A distinctive feature is the development of ekmnestic hallucinations, that is, the emergence of images and scenes from the past of patients.

Complex partial seizures

The appearance of complex partial seizures with automatisms is mainly noted. Their development is accompanied by involuntary motor activity with the performance of actions of varying complexity against the background of twilight clouding of consciousness. On average, they last 30 minutes and end with complete amnesia.

Depending on the dominant automatism, there are oralimentary and sexual seizures, automatism of gestures, speech and ambulatory automatisms, sleepwalking.

On the causes and general manifestations in passing

To provoke the development of partial seizures can:

The severity of the clinic depends on the volume of suddenly excited neurons in the cerebral cortex. Manifestations also depend on the location of the epileptogenic focus in the brain.

The attack is manifested by disorders of the musculoskeletal system, speech, lack of reaction to surrounding events, spasms, convulsions, numbness in the body.

The development of an attack may be preceded by an increase in body temperature, confusion and anxiety - an aura, which depends on the localization of the lesion of the cerebral cortex.

With the development of a mild attack, the neurons of one area are suddenly activated, its symptoms are not always noticed by others. What can not be said with extensive excitation of neurons, because it introduces noticeable discomfort into the patient's habitual lifestyle.

What does medicine offer?

Medical treatment consists in prescribing:

• anticonvulsants - Phenobarbital, Difenin, Carbamezepine;
• neurotropic agents;
• psychoactive and psychotropic drugs.

Other treatments include:

• Voight method;
• elimination of provoking factors;
• osteopathic treatment.

With a correct description of the symptoms of the aura and the attack, it is easier for the attending physician to identify the type of provocative pathology and prescribe adequate treatment.

With epilepsy, metabolic processes in the patient's brain are disturbed, and this leads to epileptic seizures. Seizures are divided into generalized and partial. They differ in clinic and mechanism of development. An attack occurs when pathological excitation in the brain dominates the processes of inhibition. A generalized epileptic seizure differs from a partial seizure by the presence of an abnormal process in both hemispheres. With partial seizures, the focus of excitation is formed in only one area of ​​the brain, spreading to neighboring tissues. Treatment of the disease depends on the type and nature of the attack.

What is epilepsy?

Partial is a type of epilepsy in which a specific part of the brain is damaged, neurons give pathological signals with impaired intensity and spread to all abnormal cells. The result is an attack. The classification of partial epilepsy according to the location of the affected focus is as follows:

• temporal - is one of the most common types of epilepsy, it is detected in almost half of all patients who turn to the doctor;
• frontal - observed in a third of patients;
• occipital - accounts for only 10% of cases;
• parietal - is rare and is detected in less than 1% of patients.

The peculiarity of partial epilepsy is that the disease is formed in a separate part of the brain, all other parts of it remain intact. Most often, partial epilepsy occurs in children due to intrauterine anomalies in the development of the fetus or born after prolonged oxygen starvation as a result of difficult childbirth. In adults, epilepsy can occur as a secondary ailment after an illness or brain injury. In this case, epilepsy is called symptomatic.

Causes of the disease

Symptomatic epilepsy develops as a result of acquired or congenital diseases. It occurs for the following reasons:

• hematomas;
• stroke;
• malignant and benign neoplasms;
• circulatory disorders in the cerebral cortex;
• staphylococcal, streptococcal and meningococcal infections;
• abscess;
• herpes virus;
• encephalitis and meningitis;
• postpartum trauma;
• congenital pathological changes;
• the body's response to long-term medication;
• traumatic brain injury.

In addition, metabolic disorders in the body, various endocrine diseases, syphilis, tuberculosis, rubella measles, prolonged use of alcoholic beverages and drugs can contribute to epilepsy. Can provoke the disease:

• wrong way of life;
• pathological pregnancy;
• severe stressful situation.

Symptoms of partial epilepsy

Symptoms of partial seizures depend on the area of ​​brain damage. It is expressed as follows:

• Temporal - this lobe of the brain is responsible for emotional processes. The patient may experience anxiety, euphoria, or anger. There is a violation of the perception of sound, memory is distorted. The individual hears music or certain sounds. He is able to recall long-forgotten events.
• Frontal - manages motor processes. During the procedure, the patient makes stereotypical movements with the tongue or lips. His limbs involuntarily twitch, his hands and fingers move. On the face, facial expressions change, the eyeballs move from side to side.
• Occipital - in it there is a processing of visual signals. The patient during an attack sees colored spots, flies appear before his eyes, flashing lights appear. In addition, he may not see some of the objects and phenomena, they simply disappear from the field of view. After a partial seizure, the patient is tormented by severe headaches resembling a migraine.
• Parietal - causes sensory seizures. The person feels warm, cold, or tingly in some part of the body. Often there is a feeling that part of the patient's body separates or increases in size.

Sometimes, after partial epilepsy, generalized epilepsy can immediately begin. The patient develops convulsions, paralysis occurs, muscle tone is lost.

Diagnosis of the disease

To make a diagnosis, the doctor performs the following activities:

• Listens to the story of a witness who was present during the attack of the victim. The patient himself with complex partial convulsions often does not remember the attack. In simple cases, the patient himself can tell about his state of health during a seizure.
• A neurological examination is performed. The patient is checked for coordination of movements, the performance of a finger-nose test, questions are asked to test intelligence, and simple logical problems are solved.
• MRI is necessary for the diagnosis of epilepsy with congenital pathologies of the structure and various brain tumors, cystic formations, diseases of the head vessels, multiple sclerosis.
• EEG (electroencephalogram) - determine the location of the focus and the form of epilepsy. In some cases, the examination is carried out several times.

Taking into account all the data that were obtained during the study, as well as the causes and symptoms of partial epilepsy, the doctor builds a tactic for treating the patient.

Therapy of the disease

In the treatment of symptomatic epilepsy, an integrated approach is used. To do this, carry out:

• timely and accurate diagnosis of the disease;
• monotherapy - one effective drug is used;
• experimental way of drug selection;
• the dose of the drug is increased until the symptoms of the disease disappear;
• selection of another drug in the absence of effect.

Stop then the treatment of partial epilepsy, signs and symptoms when they cease to appear for a long period of time. Therapy is carried out on an outpatient or inpatient basis, depending on the severity of the symptoms. The goals of treatment are:

• prevent new attacks;
• reduce the duration and frequency of seizures;
• reduce the side effects of drugs;
• achieve drug withdrawal.

For treatment use:

• nootropics - affect the nerve impulse of the brain;
• anticonvulsants - reduce the duration of the attack;
• psychotropic drugs - neutralize the effects of neurological disorders.

In some cases, long-term use of drugs does not give a positive effect, then surgery is performed. It is shown at:

• tumors;
• cysts;
• abscess;
• hemorrhage;
• aneurysm.

With the help of the operation, a section is made that connects both hemispheres, cysts, tumors are removed, sometimes one of the hemispheres is removed. The prognosis of surgical intervention is positive, most of the patients get rid of the symptoms of focal epilepsy.

What are partial seizures?

Focal or partial seizures are characterized by localization in one part of the brain. The location of the focus can be suggested by the symptoms that are present during the attack. They come with and without loss of consciousness. With a simple partial seizure, the individual does not lose consciousness, various emotions and sensations are inherent in him. Suddenly he has a feeling of joy, sadness or anger. He feels various tastes and smells, hears and sees what is not in reality. With a complex partial seizure, the patient changes or completely loses consciousness.

The condition is accompanied by convulsions, there is a convulsive curvature of the lips, frequent blinking begins, he can walk in a circle. In this case, the patient continues to perform the same actions that were started before the attack. Sometimes, a particularly difficult attack begins with an aura. These are sensations characteristic of a particular individual: an unpleasant smell or fear. The aura is a warning to the patient about the occurrence of an attack. Therefore, he or his relatives are quite capable of taking certain actions aimed at reducing the likelihood of injury. Each time the attack manifests itself in approximately the same way.

Types of partial seizures

All seizures are divided into:

1. Simple. The patient during these attacks does not lose consciousness. The following paroxysms belong to this group:

• Motor - characterized by muscle cramps, various twitches, body and head rotations, lack of speech or pronunciation of sounds, chewing movements, lip licking, smacking are possible.
• Sensory - manifested by a tingling sensation, the presence of goosebumps or numbness of some part of the body, a feeling of an unpleasant aftertaste in the mouth, a disgusting smell, visual impairment: flashes before the eyes.
• Vegetative - there is a change in skin color: redness or blanching, a rapid heartbeat appears, the value of blood pressure and the pupil changes.
• Mental - there is a feeling of fear, speech changes, pictures that were previously heard or seen are reproduced, objects and parts of the body may seem to be of a completely different shape and size than they really are.

2. Complex. This occurs when a simple partial seizure is accompanied by a disturbance of consciousness. The person is aware that he has had an attack, but cannot make contact with other people. All the events that happen to the patient, he forgets. He has a feeling of unreality of the events taking place.

3. With secondary generalization. Seizures begin with simple or complex partial seizures and progress to generalized seizures that last no more than three minutes. After their completion, the patient, as a rule, falls asleep.

Features of simple focal seizures

As noted earlier, with simple partial or focal epileptic seizures, the patient is conscious. Epilepsy attacks last no more than five minutes. They are characterized by the following symptoms:

• Rhythmic convulsive muscle contractions with varying strength of manifestation. Spread on the upper and lower limbs, as well as the face.
• Violation of the functions of the respiratory system.
• Blueness of the lips.
• Profuse salivation.

In addition, vegetative signs are inherent in seizures:

• frequent heartbeat;
• heavy sweating;
• sensation of a lump in the throat;
• depression, the appearance of fear or drowsiness.

Simple seizures are accompanied by sensory reflexes: auditory, gustatory and visual hallucinations occur, and sudden numbness of body parts occurs.

Features of complex symptomatic seizures

Complex ones are much more severe than simple attacks. The main syndrome of partial epileptic seizures of a complex type is a violation of the patient's consciousness and the following characteristic features:

• the patient becomes inhibited, inactive, mentally depressed;
• the gaze rushes to one point;
• no external stimuli are perceived;
• there is a repetition of the same actions: stroking or marking time;
• no memory of what happened. After an attack, the patient may continue to do what he did before and not notice the attack.

A complex partial seizure can turn into a generalized one, in which the focus of excitation is formed in both hemispheres of the brain.

Seizure classification

More than thirty types of epileptic seizures are known, which differ in character. There are two main types of seizures:

1. Partial (focal or focal) occur in a limited part of the brain.
2. Generalized, or general, cover both hemispheres.

Partial seizures include:

• Simple - consciousness never turns off, accompanied by unpleasant sensations in one part of the body.
• Complex - expressed by motor manifestations, they are accompanied by a change in consciousness.

The following subspecies belong to the generalized ones:

• Tonic-clonic - are manifested by a blackout of consciousness, twitching of the torso and limbs, the tongue is often bitten, urinary incontinence occurs, sometimes the breath is held, but suffocation does not occur.
• Absences - consciousness is instantly turned off for up to 30 seconds, movement stops abruptly, there is no reaction to external stimuli, eyes can roll, eyelids and facial muscles twitch, then there are no convulsions. The attack occurs up to a hundred times a day. More common in teenagers and children.
• Myoclonic - attacks last a few seconds, are manifested by jerky muscle twitches.
• Atonic or akinetic - a sharp loss of tone of the whole body or a separate part of it. In the first case, a person falls, in the second, the head or lower jaw hangs down.

All types of partial and generalized seizures can occur unexpectedly and at any time, so patients always remember this.

Prevention

There are no specific methods to prevent the development of epilepsy. The disease often occurs spontaneously and is difficult to diagnose during the latent stage of the course. The following recommendations will help reduce the risk of developing the disease:

• strict observance of the daily regimen, good sleep and rest;
• timely treatment of brain diseases and infectious diseases;
• careful therapy of craniocerebral injuries;
• refusal to use alcohol and drugs;
• consultation with a geneticist when planning a pregnancy;
• a calm lifestyle: if possible, eliminate stressful situations, depression.

The prognosis of the disease is favorable, up to 80% of all patients live a full life and forget about partial convulsive seizures if they receive appropriate therapy in a timely manner and follow all the doctor's recommendations. Expectant mothers should pay special attention to their health; lately, epilepsy often occurs in childhood due to intrauterine anomalies.

Conclusion

Patients suffering from epileptic seizures strive to get good medical care and get rid of seizures in the future. Medicine is able to provide all patients with the necessary drug treatment, with which it is possible to achieve positive dynamics. During the rehabilitation period, it is necessary to follow all the recommendations of the doctor, maintain a proper diet and a healthy lifestyle.