Neurological diseases are sometimes similar to each other in external signs, but epilepsy is such a bright and different disease from other ailments that even a person without a medical education can recognize its signs.
This pathology manifests itself in different ways and can manifest itself at any age. Unfortunately, it is impossible to cure the disease, but modern therapy can prolong remission for many years, which will allow a person to live a full life.
We will talk further about how epileptic attacks manifest themselves in an adult, what kind of convulsions an epileptic seizure begins with, and why this condition is dangerous.
Symptoms of the disease
The main symptoms of epilepsy are seizures. There are about 40 different types of seizures, depending on the area of the brain affected.
People with epilepsy can have any variety of seizures, but most have a consistent pattern of symptoms.
Doctors who treat epilepsy classify seizures according to the degree of brain damage. There are:
- Partial seizures, when only a small part of the brain is affected.
- Generalized seizures that affect most or all of the brain. Such attacks are more common in congenital epilepsy.
- taste, sound, visual and auditory hallucinations;
- a feeling of repetition of events (déjà vu);
- tingling hands and feet;
- sudden strong emotions, such as fear or joy;
- stiffness in the muscles of the arms, legs, or face;
- twitching on one side of the body;
- strange behavior (rubbing hands, fiddling with clothes, chewing, unusual posture, etc.).
- blackout of consciousness for up to 20 seconds, the person seems to “freeze”;
- convulsions similar to electric shocks;
- sudden relaxation of all muscles;
- muscle stiffness;
- involuntary urination.
Symptoms of partial seizures include:
These seizures account for 2 in 10 of all seizures experienced by people with epilepsy.
In most cases, a person loses consciousness during a generalized seizure. Other symptoms of such attacks include:
Other contributing factors and reflex epilepsy - provoke the appearance of an epileptic attack
More specific than any of the factors discussed above are the irritants that lead to the development of so-called reflex epilepsy. Some young people experience seizures when they see flashing lights, such as in a discotheque, and in this case it is possible to study seizures using EEG. When a light flashes in front of the eyes, most people can see a clear wave on the EEG taken from the back of the head (occipital zone). With repeated flashes, such waves follow with a frequency equal to the frequency of the flashes. When the critical frequency is reached, young people with photogenic epilepsy experience a completely different reaction in the form of multiple peaks and waves on the EEG - a photoconvulsive reaction - and a seizure may follow. In this case, we are dealing with a laboratory situation, but in children suffering from photogenic epilepsy, the appearance of a seizure may be triggered by flickering light reflected from water or the disappearance of steady light visible through trees while driving a car.
The most common type of photosensitivity condition today is television epilepsy. Experiments have shown that it is based on the movement of spots that form the picture from side to side and down along the surface of the television tube, and not at all on interference in the vertical or horizontal image. Sensitive children are at greatest risk when the screen takes up a significant portion of the visual field (which happens when the screen is large) and the child sits next to it or moves closer to change the program. You are less likely to have a seizure if you sit far away from the screen. Sometimes it helps to reduce the contrast between the illumination of surrounding objects on the screens, for which you should place a lamp next to the TV. It has also been shown that a photoconvulsive reaction is not possible if a flickering light is viewed with only one eye. Therefore, it is advisable for sensitive children to cover one eye with something when they approach the TV. These children benefit from using a remote program switch with infrared control. Seizures can be triggered by either color or black-and-white television images. Such seizures are always generalized, although sometimes they can be very short-lived and consist of only a few myoclonic movements of the arms and trunk muscles. Video games can also speed up the onset of seizures. However, although such seizures are sometimes associated with the image of text on a computer screen, the danger in this case is much less: reports of such seizures are very rare.
One more type of visual reflex epilepsy should be mentioned. Seizures in such epilepsy occur if a person examines any patterns, for example, squares on a linoleum floor. This type of pathology can be regarded as typical of highly specific reflex epilepsy, observed in those few people in whom seizures can be caused, for example, by reading, listening to music (sometimes only one specific phrase) or arithmetic in the head. When such external stimuli are perceived, a special type of nerve cell activity should occur, presumably related to some extent to the recognition of melodies and words. One can only theoretically imagine that this special type of activity in susceptible people serves as a specific model that (like a key in a lock) gives release to the impulse leading to an attack.
Nonspecific stimuli such as a loud noise or startle, regardless of their source, can cause myoclonic jerking movements and sometimes generalized tonic-clonic seizures. This type of epilepsy is regarded as an inherited trait in some strains of mice and serves as a model for studying the physiology of such seizures and testing the potential effectiveness of new antiepileptic drugs.
Causes of epilepsy
Is it possible to acquire epilepsy? The answer to this question is positive. Epilepsy can be acquired or congenital. The brain works thanks to the delicate communication between neurons (brain cells) that occurs through electrical impulses carried by neurotransmitters. Any damage can disrupt their function and cause seizures.
Congenital epilepsy often develops due to genetic abnormalities. And acquired can occur at any age for a number of reasons. Head injuries, infections, tumors - all this can lead to the development of epilepsy. In old age, cerebrovascular disease is also a common risk factor and accounts for more than half of the cases of epilepsy in this age group.
Acquired or congenital epilepsy is the most common neurological condition. If left untreated, the disease has a high risk of mortality.
Causes of acquired epilepsy include:
Epilepsy
Epilepsy
is a condition characterized by repeated (more than two) epileptic seizures that are not provoked by any immediately identifiable causes.
An epileptic seizure is a clinical manifestation of an abnormal and excessive discharge of brain neurons, causing sudden transient pathological phenomena (sensory, motor, mental, vegetative symptoms, changes in consciousness).
It should be remembered that several epileptic seizures provoked or caused by any distinct causes (brain tumor, head injury) do not indicate the presence of epilepsy in the patient.
Epilepsy is a condition characterized by repeated (more than two) epileptic seizures that are not provoked by any immediately identifiable causes.
An epileptic seizure is a clinical manifestation of an abnormal and excessive discharge of brain neurons, causing sudden transient pathological phenomena (sensory, motor, mental, vegetative symptoms, changes in consciousness).
It should be remembered that several epileptic seizures provoked or caused by any distinct causes (brain tumor, head injury) do not indicate the presence of epilepsy in the patient.
Epilepsy
According to the international classification of epileptic seizures, partial (local, focal) forms and generalized epilepsy are distinguished.
Attacks of focal epilepsy are divided into: simple (without disturbances of consciousness) - with motor, somatosensory, autonomic and mental symptoms, and complex - accompanied by disturbances of consciousness.
Primary generalized seizures occur with the involvement of both hemispheres of the brain in the pathological process. Types of generalized seizures: myoclonic, clonic, absences, atypical absences, tonic, tonic-clonic, atonic.
There are unclassified epileptic seizures - which do not fit into any of the types of seizures described above, as well as some neonatal seizures (chewing movements, rhythmic eye movements). There are also repeated epileptic seizures (provoked, cyclic, random) and prolonged seizures (status epilepticus).
In the clinical picture of epilepsy, three periods are distinguished: ictal (attack period), postictal (post-ictal) and interictal (interictal). In the postictal period, there may be a complete absence of neurological symptoms (except for the symptoms of the disease that causes epilepsy - traumatic brain injury, hemorrhagic or ischemic stroke, etc.).
There are several main types of aura that precede a complex partial attack of epilepsy - autonomic, motor, mental, speech and sensory.
The most common symptoms of epilepsy include: nausea, weakness, dizziness, a feeling of constriction in the throat, a feeling of numbness of the tongue and lips, chest pain, drowsiness, ringing and/or tinnitus, olfactory paroxysms, a feeling of a lump in the throat, etc.
In addition, complex partial seizures are in most cases accompanied by automated movements that seem inappropriate. In such cases, contact with the patient is difficult or impossible.
A secondary generalized attack usually begins suddenly. After a few seconds, which the aura lasts (each patient has a unique course of the aura), the patient loses consciousness and falls. The fall is accompanied by a kind of cry, which is caused by a spasm of the cleft and convulsive contraction of the chest muscles.
Next comes the tonic phase of an epileptic attack, named after the type of seizure.
Tonic convulsions - the torso and limbs are stretched in a state of extreme tension, the head is thrown back and/or turned to the side contralateral to the lesion, breathing is delayed, the veins in the neck swell, the face becomes pale with slowly increasing cyanosis, the jaws are tightly clenched. The duration of the tonic phase of the attack is from 15 to 20 seconds.
Then comes the clonic phase of an epileptic attack, accompanied by clonic convulsions (noisy, hoarse breathing, foam at the mouth). The clonic phase lasts from 2 to 3 minutes.
The frequency of seizures gradually decreases, after which complete muscle relaxation occurs, when the patient does not respond to stimuli, the pupils are dilated, there is no reaction to light, and protective and tendon reflexes are not evoked.
The most common types of primary generalized seizures, characterized by the involvement of both hemispheres of the brain in the pathological process, are tonic-clonic seizures and absence seizures.
The latter are more often observed in children and are characterized by a sudden short-term (up to 10 seconds) stop of the child’s activity (games, conversation), the child freezes, does not respond to a call, and after a few seconds continues the interrupted activity.
Patients are unaware of and do not remember seizures. The frequency of absence seizures can reach several dozen per day.
Diagnosis of epilepsy should be based on medical history, physical examination of the patient, EEG data and neuroimaging (MRI and CT scan of the brain).
It is necessary to determine the presence or absence of epileptic seizures according to the medical history, clinical examination of the patient, results of laboratory and instrumental studies, and also to differentiate between epileptic and other seizures; determine the type of epileptic seizures and the form of epilepsy; familiarize the patient with the recommendations for the regimen, assess the need for drug therapy, its nature and the likelihood of surgical treatment. Despite the fact that the diagnosis of epilepsy is based primarily on clinical data, it should be remembered that in the absence of clinical signs of epilepsy, this diagnosis cannot be made even in the presence of epileptiform activity detected on the EEG.
Neurologists and epileptologists diagnose epilepsy. The main method of examining patients diagnosed with epilepsy is EEG, which has no contraindications. An EEG is performed on all patients without exception in order to detect epileptic activity.
More often than others, such variants of epileptic activity are observed as sharp waves, spikes (peaks), complexes “peak - slow wave”, “sharp wave - slow wave”. Modern methods of computer analysis of EEG make it possible to determine the localization of the source of pathological bioelectrical activity.
When conducting an EEG during an attack, epileptic activity is recorded in most cases; in the interictal period, the EEG is normal in 50% of patients.
On EEG in combination with functional tests (photostimulation, hyperventilation), changes are detected in most cases. It must be emphasized that the absence of epileptic activity on the EEG (with or without the use of functional tests) does not exclude the presence of epilepsy. In such cases, a repeat examination or video monitoring of the EEG performed is performed.
In the diagnosis of epilepsy, the greatest value among neuroimaging research methods is MRI of the brain, which is indicated for all patients with local onset of an epileptic seizure.
MRI allows you to identify diseases that affect the provoked nature of seizures (aneurysm, tumor) or etiological factors of epilepsy (mesial temporal sclerosis). Patients diagnosed with pharmacoresistant epilepsy in connection with subsequent referral for surgical treatment also undergo MRI to determine the location of the central nervous system lesion.
In some cases (elderly patients), additional studies are necessary: biochemical blood test, fundus examination, ECG.
Seizures of epilepsy must be differentiated from other paroxysmal conditions of non-epileptic nature (fainting, psychogenic seizures, vegetative crises).
All treatment methods for epilepsy are aimed at stopping seizures, improving quality of life and stopping taking medications (in remission). In 70% of cases, adequate and timely treatment leads to the cessation of epilepsy attacks.
Before prescribing antiepileptic drugs, it is necessary to conduct a detailed clinical examination and analyze the results of MRI and EEG. The patient and his family should be informed not only about the rules for taking medications, but also about possible side effects.
Indications for hospitalization are: the first epileptic seizure in life, status epilepticus and the need for surgical treatment of epilepsy.
One of the principles of drug treatment of epilepsy is monotherapy. The drug is prescribed in a minimum dose and then increased until the attacks stop. If the dose is insufficient, it is necessary to check the regularity of taking the drug and find out whether the maximum tolerated dose has been reached.
The use of most antiepileptic drugs requires constant monitoring of their concentration in the blood.
Treatment with pregabalin, levetiracetam, valproic acid begins with a clinically effective dose; when prescribing lamotrigine, topiramate, carbamazepine, it is necessary to slowly titrate the dose.
Treatment of newly diagnosed epilepsy begins with both traditional (carbamazepine and valproic acid) and newer antiepileptic drugs (topiramate, oxcarbazepine, levetiracetam), registered for use as monotherapy. When choosing between traditional and new drugs, it is necessary to take into account the individual characteristics of the patient (age, gender, concomitant pathology). Valproic acid is used to treat unidentified epileptic seizures.
When prescribing this or that antiepileptic drug, you should strive for the minimum possible frequency of taking it (up to 2 times a day). Due to stable plasma concentrations, long-acting drugs are more effective.
A dose of the drug prescribed to an elderly patient creates a higher concentration in the blood than a similar dose of the drug prescribed to a young patient, so it is necessary to start treatment with small doses and then titrate them.
The drug is discontinued gradually, taking into account the form of epilepsy, its prognosis and the possibility of resumption of attacks.
Surgery
Drug-resistant epilepsy (continuing seizures, ineffectiveness of adequate antiepileptic treatment) requires additional examination of the patient to decide on surgical treatment.
Preoperative examination should include video-EEG recording of seizures, obtaining reliable data on the localization, anatomical features and nature of the spread of the epileptogenic zone (MRI).
Based on the results of the above studies, the nature of the surgical intervention is determined: surgical removal of epileptogenic brain tissue (cortical topectomy, lobectomy, hemispherectomy, multilobectomy); selective surgery (amygdala-hippocampectomy for temporal lobe epilepsy); callosotomy and functional stereotactic intervention; vagus stimulation.
There are strict indications for each of the above surgical interventions. They can only be carried out in specialized neurosurgical clinics that have the appropriate equipment, and with the participation of highly qualified specialists (neurosurgeons, neuroradiologists, neuropsychologists, neurophysiologists, etc.).
The prognosis for disability in epilepsy depends on the frequency of attacks. At the remission stage, when attacks occur less frequently and at night, the patient’s ability to work is maintained (with the exception of night shift work and business trips). Daytime epilepsy attacks accompanied by loss of consciousness limit the patient’s ability to work.
Epilepsy affects all aspects of a patient’s life, and therefore is a significant medical and social problem.
One of the facets of this problem is the paucity of knowledge about epilepsy and the associated stigmatization of patients, whose judgments about the frequency and severity of mental disorders accompanying epilepsy are often unfounded.
The vast majority of patients who receive proper treatment lead normal lives without seizures.
Prevention of epilepsy includes the possible prevention of head injuries, intoxications and infectious diseases, the prevention of possible marriages between patients with epilepsy, and an adequate reduction in temperature in children in order to prevent fever, the consequence of which can be epilepsy.
Source: https://www.KrasotaiMedicina.ru/diseases/zabolevanija_neurology/epilepsy
Provoking factors
Various circumstances can lead to seizures, such as skipping medications or stressful situations. In addition, there are other triggers of the disease, for example:
Treatment of acquired epilepsy
The main therapy is aimed at eliminating the cause of the disease, in some cases it is possible to achieve a complete cessation of negative paroxysmal activity. The main method of treatment is medication, which includes:
- anticonvulsants, which help relieve or prevent paroxysms; with their help, muscle spasms are relieved and pain during a seizure is reduced or completely eliminated;
- nootropics - stimulate mental activity, activate cognitive functions, improve memory and increase learning ability, and also increase the brain’s resistance to various harmful influences: hypoxia and excessive nervous stress;
- psychotropic drugs - have a beneficial effect on mental processes, they suppress excitement, eliminate depressed mood, improve thinking;
- vitamin complexes - are a good help for improving the body's resistance and enhancing immunity;
- tranquilizers - eliminate feelings of anxiety and stabilize the psycho-emotional background, they have a slight sedative effect, anticonvulsant effect, and help stabilize the autonomic nervous system.
In addition, intramuscular and intravenous administration of drugs is prescribed to stabilize brain activity.
Seriously?
Diagnosis of the disease
Epilepsy is a congenital or acquired disease that is sometimes difficult to diagnose because other diseases have similar symptoms. These include, for example, migraines or panic attacks. A doctor who specializes in diseases of the nervous system, including epilepsy, is a neurologist. To make a diagnosis, a specialist will collect information. He will ask the patient if he remembers the seizure? Were there any previous symptoms or signs? What kind of lifestyle does the patient lead? The doctor will also find out if there are any concomitant diseases or heredity.
Based on the information received, the neurologist can make a preliminary diagnosis. To confirm it, you will need to conduct some additional research, for example:
Types and classification of epilepsy
Epilepsy is a chronic brain disease, the main symptoms of which are epileptic seizures and seizures. The frequency of convulsions and seizures depends on the cause of the disease, treatment method, and compliance with medical recommendations. The disease is more common in adults. According to ICD-10, epilepsy is classified as episodic and paroxysmal disorders and has code G40-G41.
In medicine, a special classification of epilepsy has been adopted, which helps to correlate the types of epilepsy with the symptoms and causes of the disease. Epilepsy happens:
- Idiopathic and symptomatic. These include primary and secondary epilepsy. The primary form of the disease is a deviation in which the causes of brain damage are not established, the disease is congenital, and the first manifestations of seizures and convulsions can occur in childhood. Primary epilepsy, in turn, includes types such as cryptogenic or hidden epilepsy (a disease whose cause is difficult to determine), and genuine epilepsy (caused by an impulse exchange disorder). Secondary or acquired epilepsy occurs against the background of infections, injuries, or abnormalities. For example, this form includes post-traumatic epilepsy, which occurs as a result of traumatic brain injury, catamenial epilepsy, which occurs in some adult women during menstruation.
- Depending on the affected area. There is an epileptic lesion of the cerebellum, brainstem, left or right hemisphere.
- Depending on the presence of attacks and convulsions. Not all forms of epilepsy manifest themselves through seizures.
- With generalized or partial seizures. Generalized seizures mean a complete loss of control over the body, a clouded mind. This condition occurs in patients who are susceptible to a disease with deep brain damage, for example, this may be photosensitivity epilepsy. Partial seizures are divided into several categories, and depending on the severity of the seizures, they manifest as temporary damage to a specific area of the body.
- Depending on the cause of the attacks. For example, photosensitivity epilepsy begins to manifest itself in bright flashes of light.
Drug therapy
There is currently no medicine that completely cures epilepsy. About 70% of people can only control their seizures with medication. The goal of treatment for acquired epilepsy is to achieve maximum seizure freedom with minimal side effects. In this case, the lowest possible dose of the drug should be used.
There are many drugs to control epilepsy (Benzonal, Carbamazepine, Finlepsin, Clonazepam, etc.). Their action is based on controlling electrical impulses between neurons in the brain. Thus, the chance of developing a seizure syndrome is reduced.
As you take the medication, some side effects may occur, which disappear after a few days or when the dosage is reduced. For example:
First aid for an epileptic seizure
It is not always possible to predict a seizure, so it is very important to have information on the topic of “epileptic seizure first aid.”
The disorder in question is one of a small number of ailments, attacks of which often cause stupor and panic among people around. This is partly due to a lack of knowledge about the pathology itself, as well as about the possible measures that need to be taken during an epileptic attack.
Help for an epileptic attack includes, first of all, a number of rules, following which will allow the epileptic to survive the attack with the least loss for himself. So, in order to avoid unnecessary injuries and bruises, the sick individual should be laid on a flat plane, with a soft cushion under his head (can be constructed from improvised materials, for example, from clothing). Then it is necessary to rid the person of constricting items of clothing (untie a tie, unwind a scarf, unfasten buttons, etc.), remove from him all nearby things that could injure him. It is recommended to turn the patient's head to the side.
Contrary to popular belief, it is not necessary to put foreign objects into the mouth in order to avoid the tongue getting stuck, because if the jaws are closed, then there is a possibility of breaking them, knocking out the patient’s teeth, or losing one’s own finger (during a seizure, the jaws interlock very tightly).
First aid for an epileptic seizure involves staying next to the epileptic until the seizure is completely over, keeping the person trying to help calm and collected.
During an attack, you should not try to give the patient something to drink, hold him by force, try to provide resuscitation measures, or give medications.
Often after an epileptic seizure a person becomes sleepy, so it is necessary to provide conditions for sleep.
Surgical intervention
An alternative treatment option for acquired epilepsy is surgery. It is worth noting that it can only be performed if removing the area of the brain where epileptic activity begins will not cause additional damage or lead to disability. In order to find out whether surgical treatment is possible, it is necessary to undergo various brain scans, memory tests, and psychological tests.
Like all types of surgery, this procedure carries risks. These include:
It is worth noting that approximately 70% of people stop having seizures after surgery. The recovery period takes up to 2-3 months.
What medications are there for epilepsy?
In order for the medications prescribed by the doctor to help get rid of epilepsy attacks, the patient must follow the following rules:
- Use them according to the schedule and dosage strictly prescribed by a specialist.
- If a patient needs to change a medication to a similar drug, then to perform this action, he needs to contact a specialist.
- The patient should not cancel, increase or decrease the dosage on his own.
- If the patient has mood swings or changes in general health, then he needs to inform his doctor about all changes.
Remember that by following the recommendations described above, you can quickly get rid of epilepsy attacks and use only one medication in the future.
What is used when attacks occur?
Initially, the patient is prescribed antiepileptic medications in a small dosage. If a person continues to have seizures and his health does not return to normal, the doctor will increase the prescribed dose. It should be used until the patient’s health condition improves.
Partial seizures are treated:
- Carbamezapine. In this case, the following are used: Finlepsin, Carbamazepine, Zeptol, Timonil, Tegretol, Karbasan, Actinerval.
- Valproate. Drugs: Konvulex, Konvulex Retard, Depakin Chrono, Encorat-Chrono, Valparin Retard.
- Phenytoins: Diphenine.
- Phenobarbitals: Luminal.
Carbamezapines and valproates are considered the medications that are prescribed first. Phenotoins and phenobarbitals have a large number of contraindications, so they are used by doctors very rarely.
Carbamazepines are used at 600-1200 mg, and valproates at 1000-2500 mg. The latter medications should be taken 2-3 times a day.
In addition, the patient is prescribed long-acting retard medications. These drugs are used 1-2 times a day. These include: Depakin Chrono, Tegretol-PC, Finlepsin Retard.
If a person experiences generalized seizures, he is prescribed valproate and carbamazepine. When idiopathic generalized epilepsy occurs, valproate is used.
Ethosuximide is used to relieve absence seizures. If a myoclonic seizure occurs, then Carbamazepine and phenytoin are not used, as there will be no effect from such treatment.
Doctors are now using new antiepileptic drugs. These are: Lamotrigine, Tiagabine.
Remember that if epileptic seizures have disappeared and do not appear within 5 years, then medication is no longer required. But we should not forget that the dosage is reduced gradually.
When a patient develops status epilepticus, he is treated with drugs such as Seduxen and Diazepam. They need to be administered intravenously. But before administration, 10 mg of the drug is diluted in 20 ml of 40% glucose solution. The second time the drug is administered 10-15 minutes after the first injection.
If sibazon does not have the desired effect, then Hexenal, Phenytoin, and sodium thiopental are used. Remember that 1 gram of the latter drug dissolves in 1-5% saline solution. After 5-10 ml of medication has been administered, you should pause for 1 minute and then continue administration. This will help prevent the risk of respiratory arrest and hemodynamics.
If the intravenous use of medications does not produce the desired effect, then inhalation anesthesia is used. However, we should not forget that it is extremely undesirable for people who are in a coma and have impaired breathing.
Brain stimulation
Another treatment option for acquired epilepsy may be to place a small device, similar to a pacemaker, under the skin of the chest. It sends electrical impulses to the brain, stimulating the vagus nerve. This therapy will help reduce the frequency and intensity of seizures. If the patient feels a seizure is coming, he can activate the impulse additionally to prevent it.
Some patients may experience side effects from this type of treatment, such as:
Epilepsy attack
Neurological diseases are sometimes similar to each other in external signs, but epilepsy is such a bright and different disease from other ailments that even a person without a medical education can recognize its signs.
This pathology manifests itself in different ways and can manifest itself at any age. Unfortunately, it is impossible to cure the disease, but modern therapy can prolong remission for many years, which will allow a person to live a full life.
We will talk further about how epileptic attacks manifest themselves in an adult, what kind of convulsions an epileptic seizure begins with, and why this condition is dangerous.
What is an epileptic seizure
Epilepsy is characterized by recurrent seizures, which can manifest in different ways.
A single epileptic seizure can happen to a completely healthy person, after overwork or intoxication.
But it is the attacks of epilepsy that are recurrent in nature, and are not influenced by external factors in any way.
Where does it start and how long does it last?
Under the influence of certain risk factors, a group of neurons appears in the brain that easily become excited, reacting to the most insignificant process in the brain.
Doctors call this the formation of an epileptic focus. The nerve impulse arising in this focus expands to neighboring cells and forms new foci.
Constant connections are created between the foci, which is expressed by protracted, varied attacks: the affected motor neurons cause repetitive movements or, on the contrary, freezing of movements. Visuals provoke hallucinations.
An epileptic attack develops suddenly and cannot be predicted or stopped. It can occur with complete loss of consciousness, with a picture of a person struggling on the ground, foaming at the mouth. Or without loss of consciousness.
A major generalized attack is characterized by convulsions, hitting the head on the floor, and foaming at the mouth. The episode lasts no more than a few minutes, then the convulsions subside, replaced by noisy breathing.
All muscles relax and urination is possible.
The patient falls into a sleep that lasts from several minutes to several hours.
If the patient does not fall asleep, he gradually comes to his senses.
The memory of the episode is not retained. The person feels overwhelmed and complains of headache and drowsiness.
How often do they happen
Epilepsy attacks have a certain frequency, which is taken into account by the doctor when prescribing treatment and analyzing the effectiveness of the therapy.
Seizures that occur once a month are considered rare, and those that occur 2 to 4 times are considered moderate. Frequent epilepsy attacks - more than 4 per month.
This pathology progresses, so the frequency increases over time, and only well-chosen medications can help here.
Causes of occurrence in an adult
The first attacks of epilepsy in adults can appear for a number of reasons, and you can never predict what will serve as a catalyst for the manifestation of the disease.
The hereditary factor is most often cited, but it is not at all necessary that it will play a role. The tendency to disease is encoded in genes and is passed on to the next generation. When unfavorable conditions are created, it turns into a disease.
After a binge
Ethyl alcohol is a strong poison.
In chronic alcoholism, delivered by blood to brain cells, it causes oxygen starvation and death.
Irreversible pathological processes begin in the cerebral cortex, leading to seizures.
The first attack occurs during alcohol intoxication and lasts a few seconds, but with systematic heavy drinking, short episodes occur more often and last longer.
Most often, among the ancestors of such a patient one can find people who suffered from chronic alcoholism or epilepsy.
After injuries
This is a rare but treatable disease. Treatment is complicated by severe complications that join the underlying pathology, which most often appears after trauma to the cerebral cortex, or a violation of the blood supply.
After a stroke
Epilepsy is not uncommon after a stroke, when the brain of an elderly person is very worn out and cannot cope with the consequences of tissue infarction.
The likelihood of its occurrence during a hemorrhagic stroke is twice as high as during an ischemic stroke.
Epilepsy almost always occurs if the cerebral cortex is damaged and almost never when the cerebellum, hypothalamus and deep layers of the brain are damaged.
Other factors
It is customary to distinguish between two sets of causes: primary and secondary.
The primary ones may be:
- heredity;
- intrauterine infection;
- birth injury.
Secondary develops after a negative external influence on the brain. These reasons include:
- infections (meningitis, encephalitis);
- tumors;
- cerebral vascular abnormalities;
- overwork and stress.
How epileptic seizures manifest themselves
Signs of the disease in adults are very diverse. There are cases when there are no seizures at all.
The main symptoms of the onset of an epilepsy attack include:
- Changes in taste and smell;
- Visual hallucinations;
- Changes in psyche and emotions;
- Strange sensations in the stomach;
- Changes in pupils;
- Loss of contact with reality;
- Uncontrolled movements (twitching);
- Loss of movement, fixation of gaze;
- Confused consciousness;
- Cramps.
These conditions may occur before or instead of attacks. At first they last no more than a few seconds. The most striking manifestation of epilepsy is considered to be a seizure.
Classification
First of all, attacks of the disease are distinguished by the degree of damage:
- Partial seizures (local) - caused by a lesion in one hemisphere of the brain.
There is no danger to life, the degree of intensity is not too high.These episodes, coupled with absence seizures, are referred to as petit mal seizures.
- Generalized seizure – the entire brain is involved. High intensity. There is a complete loss of consciousness. Such an attack is life-threatening.
Partial (small)
It manifests itself in different ways, depending on which system of the body is affected.
| Type of attack | Characteristic |
| Motor | Spontaneous, uncontrollable movements of small areas of the body, shouting words or sounds due to spasm of the larynx. Possible loss of consciousness. |
| Sensory | Unusual sensations: burning of the skin, ringing in the ears, tingling of the body, phantom odors or heightened sense of smell. Sparkles in the eyes, taste sensations. |
| Vegetative-visceral | Feelings of emptiness in the stomach, or movement of internal organs. Increased thirst and salivation. Increase in blood pressure. There is usually no loss of consciousness. |
| Mental |
|
These episodes can last for hours, or even days, when the patient performs the right actions in a complete absence of consciousness. Upon returning consciousness, he remembers nothing about the attack itself.
Partial seizures can result in secondary generalization, with convulsions and complete loss of consciousness.
This is usually evidenced by motor, sensory, autonomic and mental paroxysms that occur a few minutes before an epileptic seizure.
This state is called aura. Since recurring episodes are usually of the same type, it is the aura that can help prepare for an attack, ensuring safety for yourself: lie down on something soft or call for help.
Generalized (large)
This form of seizures poses a direct threat to the patient’s life. Since the entire brain is captured, consciousness is lost completely.
| Type of attack | Time | What are the characteristics of seizures? |
| Simple absence seizure | 2-10 sec | Loss of consciousness for a few seconds. |
| Complex absence seizure | 2-10 sec | Accompanied by movement (gestures, rapid breathing). |
| Myoclonic | Up to 10 sec | Muscle contractions: head movement, shrugging, squatting, arm swings. |
| Tonic | Up to 30 sec | Flexion-extension of the limbs. |
| Clonic | Up to a few minutes | Vibration of the limbs (epileptic convulsions), foam at the mouth, redness of the face. |
| Tonic-clonic | A couple of minutes | Contraction of the muscles of the larynx, foam (sometimes with blood from biting the tongue), redness of the face. The mortality rate from this attack reaches 50%. |
| Atonic | Few seconds | Loss of tone of any part of the body (body falling, head falling to one side). |
Any of these seizures can lead to status epilepticus, an extremely life-threatening condition.
Usually they are of the same nature (only motor or sensory paroxysms), but as epilepsy progresses, new types appear.
First aid
From the outside, a seizure may look scary, but there is nothing dangerous about it, since it ends quickly and spontaneously.
At this moment, the patient only needs the attention of others so that he does not harm himself by losing consciousness.
A person’s life will depend on correct and simple actions.
The first aid algorithm is quite simple:
- Do not panic if you witness epilepsy.
- Grab the person so that he does not fall, help him smoothly lower to the ground, and lay him on his back.
- Remove objects that could hit him. Not looking for medicine in his things is useless. When he comes to his senses, he will take his pills himself.
- Record the time of the onset of the attack.
- Place something under your head (at least a bag or clothing) to soften head impacts. As a last resort, hold your head with your hands.
- Free your neck from the collar so that nothing interferes with your breathing.
- Turn your head to the side to prevent tongue retraction and asphyxia with saliva.
- Do not try to hold the limbs that are contracting in convulsions.
- If your mouth is slightly open, you can put a folded cloth or at least a handkerchief there to prevent biting your cheek or tongue. If the mouth is closed, do not try to open it - you may lose fingers or break the patient's teeth.
- Check the time: if the convulsions last more than two minutes, you need to immediately call an ambulance - intravenous administration of anticonvulsant and antiepileptic drugs is required.
- After the attack is over, help the person come to his senses, explain what happened and calm him down.
- Help him take his medications.
For patients with epilepsy, there are special bracelets that contain all the necessary information. When calling an ambulance, this bracelet will help doctors.
After the incident, the patient falls into deep sleep; there is no need to prevent this. It is better to accompany you home and put you to bed . At first, he should not consume foods that stimulate the central nervous system.
It is imperative to call an ambulance if the patient injures himself while unconscious, if the attack lasts more than two minutes, and if it recurs on the same day.
Ketogenic diet
In some cases, prescribing a special diet can help reduce symptoms of acquired epilepsy. It is based on eating foods with an increased fat content and a reduced amount of carbohydrates and proteins. By changing chemical changes in the brain, a balanced diet can reduce the intensity of attacks. Contraindications are diabetes and cardiovascular diseases.
Classification
Typing is carried out based on the extent of the focus of abnormal electrical activity. Stand out:
- Symptomatic focal epilepsy. The classic type, in which there is a clear focus. It is located in one lobe or at the junction of regions of the brain. The topography is clarified using MRI and electroencephalography. Does not always produce symptoms characteristic of symptomatic epilepsy. There may be focal neurological signs without seizures or loss of consciousness.
- Symptomatic epilepsy with generalized seizures. Corresponds to people's understanding of this disease. Accompanied by loss of consciousness and convulsions. The entire brain is involved and the signal is diffusely amplified. It is impossible to accurately determine the original source (although it is always there: the disorder begins in one area, then in the course of a chain reaction the entire brain is involved).
A more detailed classification based on the exact location of the lesion is possible. Symptomatic partial epilepsy (the frontal lobe is involved), symptomatic temporal lobe epilepsy, occipital, parietal forms stand out as the main ones.
Symptomatic epilepsy with secondary generalized seizures is distinguished as a separate type of disorder. It is characterized by progressive disorders, as the name implies. It is possible to qualitatively diagnose the exact abnormal focus only at the beginning of a seizure. In the early period before diagnosis is made, it is recommended to observe such patients in a hospital.
Classifications are used to clarify the nature of the disorder, develop approximate therapeutic tactics, and assess the prospects for recovery.
Pregnancy
Women with acquired epilepsy can carry and give birth to healthy children. Of course, there is a higher risk of complications. However, with forward planning they can be minimized.
Taking some medications for epilepsy can affect the development of the fetus. The risks of developing birth defects, such as cleft palate or lip, and heart problems can be avoided by reducing the dosage of medications taken.
If pregnancy occurs, you should not stop taking prescribed medications. The risk to a child from uncontrolled seizures is much greater than any associated with medications.
Treatment methods
In 70% of cases, drug therapy helps to get rid of epilepsy attacks. All treatment of the disease in question is divided into 2 groups - medicinal and surgical. In addition, you can additionally use physical therapy, psychological personality correction, bioacoustic correction of the brain and other techniques.
Pathology surgery is resorted to in cases where drug therapy for a long time does not bring positive results, as well as in cases of focal epilepsy, in epilepsy provoked by tumors in the brain, aneurysm, and other abnormalities in the structures of brain activity.
In patients, excitation and inhibition in the cerebral cortex are not balanced. For this purpose, physical therapy can be used, which helps stimulate the normalization of these processes. Rhythmic movements and complex breathing exercises have a positive effect on nerve cells, harmonize the mental state, and prevent stress and illness.
Genetics
The question of whether acquired epilepsy is inherited or not often worries future parents. However, specialists studying this disease have clear information on this topic. If one or both parents have epilepsy, the child can inherit it only in one case, when the disease is caused by genetic abnormalities, that is, congenital. Consequently, the statement that acquired epilepsy resulting from trauma or other damage to the brain is inherited is fundamentally incorrect.
Seizures and children
The anatomy of children is such that they react very sharply to changes in the external and internal environment. Due to this, even a normal increase in temperature can trigger the development of epilepsy in them. Doctors have noted that children are 3 times more likely to suffer from seizures compared to adults. This occurs due to prenatal and perinatal trauma and its consequences. These include:
- head injury received by a baby during childbirth;
- development of brain hypoxia;
- manifestation of infectious diseases during pregnancy: development of toxoplasmosis, cytomegaly, rubella. The infection can be transmitted to the baby from the mother.
Remember that if a child has had an epileptic attack for the first time, there is a very high chance of its reoccurrence. Therefore, parents of a newborn should immediately contact a specialist for emergency help when the first attack occurs. If treatment is not carried out, this will lead to repeated seizures, exacerbation of the symptoms that have arisen, and even the death of the baby.
Parents should also remember that frequent seizures in newborn children of varying degrees can provoke the development of epilepsy.
Parents often ask the doctor the question of how epilepsy manifests itself in young children? In general, the first signs of epilepsy in children are as follows:
- the child loses consciousness;
- he has convulsions all over his body;
- he may involuntarily begin to urinate or have bowel movements;
- All the baby’s muscles become overstrained, the legs can suddenly straighten and the arms bend;
- he begins to move all parts of his body chaotically: jerking his arms and legs, wrinkling his lips, rolling his eyes.
In addition to the appearance of a convulsive syndrome in a child, he may also be bothered by absence seizures, atonic seizures, infantile spasms and juvenile myoclonic seizures.
Let's look at these syndromes in more detail.
When absence seizures occur, neither an adult nor a child loses balance and does not have convulsions. With this syndrome, the patient can only change his behavior sharply: freeze for a while, his gaze becomes detached, and there is no reaction to the influence. This stage lasts from 2 to 30 seconds.
Absence epilepsy often appears in little girls after 6 to 7 years of age. As the child’s body grows, attacks occur less frequently and develop into another type of illness.
An atonic attack is characterized by loss of balance and relaxation of the entire body. The patient feels lethargic and drowsy. Excessive activity causes him to fall and hurt his head. Patients often confuse the symptoms of atonic syndrome with a common fainting condition.
The development of infantile spasm is characterized by the following signs: the baby puts his hands on his chest, tilts his head and whole body forward, sharply straightens his lower limbs. Such spasms appear in children under 3 years of age, mainly in the first half of the day, after the baby wakes up.
The development of juvenile myoclonic seizures is typical for adolescents aged 13 to 15 years. With them, the patient experiences involuntary twitching of the lower and upper extremities, especially this occurs 1 hour before waking up.
Children and epilepsy
Many children with well-controlled epilepsy can learn and participate in school activities, regardless of their condition. Others may need additional support. It is recommended to tell the teacher about the child’s illness, as well as what to do in case of a seizure and the medications needed to relieve seizures.
Symptoms of epilepsy
Anyone who has ever heard of epilepsy imagines a person who suffers from convulsions and seizures.
Indeed, convulsive attacks occur in many patients, but a non-convulsive form of the disease also occurs. In this case, the symptoms of the disease are: confusion, hallucinations, dulling of sensitivity, and various mental disorders often appear. The main manifestations of the disease are generalized and partial seizures. The first are accompanied by prolonged and persistent clouding of consciousness, convulsions leading to biting the tongue, and loss of control over one’s actions. Pallor occurs, followed by blueness of the skin, breathing becomes uneven. Some people lose control of their bladder, causing involuntary urination.
With partial seizures, a slight clouding of consciousness occurs, the skin turns pale, the gaze becomes empty, there may be numbness of any part of the body, its convulsions, sometimes leading to chaotic movements. In this case, the person often remains on his feet, which makes it difficult for strangers to detect seizures, which means that providing first aid becomes impossible.
Symptoms also depend on the type of disease. In addition to convulsions and seizures, various vegetative manifestations of the disease occur in adults. For example, diencephalic epilepsy causes chills, redness or paleness of the skin, a decrease or increase in body temperature, difficulty breathing, pain in the heart and other organs.
There are also forms of epilepsy in which symptoms often do not appear for many years. Photosensitive epilepsy, being a genetic disease, can remain asymptomatic throughout the patient's life.
Attacks, treatment
All types of epilepsy have similar features. Each of them is characterized by identical manifestations of attacks and their main components. At the same time, first aid and treatment for most types of illness are also very close. Therefore, everyone who wants to protect themselves from such a disease should know them.
Seizures
Seizures become the basis of the clinical picture of epilepsy. They may manifest themselves in different ways or have additional symptoms, but it is customary to generalize the disease based on them.
Sometimes a person can independently determine how long it will take for an attack to occur. In such cases, primary symptoms appear a few hours or 1-2 days before the attack. These may include headaches, loss of appetite, poor sleep or nervousness. Immediately before an attack, you can recognize the approach of epilepsy by the appearance of an aura. It lasts a few seconds and is determined for each patient by its own special sensations. But the aura may not exist, and the seizure will occur suddenly.
An epileptic attack begins with a loss of consciousness and a fall, which is often accompanied by a slight cry, which causes a spasm when the diaphragm and muscle tissue inside the chest contract. The initial convulsions in epilepsy are the same in the description: the torso and limbs are brought together and stretched, while the head bends back. They appear immediately after the fall and last no more than 30 seconds. During muscle contraction, breathing stops, the veins in the neck swell, the skin of the face turns significantly pale, and the jaw clenches. Then tonic convulsions are replaced by clonic convulsions. Convulsions become repetitive and jerky, affecting the torso, all limbs and neck. They can last several minutes, while the person breathes hoarsely, he may foam at the mouth with blood particles. Gradually, the attack weakens, but at this time the epileptic does not react to people or any external stimuli, his pupils enlarge, protective reflexes do not appear, and sometimes accidental urination may occur. After this, the patient regains consciousness, but does not understand that something has happened.
First aid
Providing first aid is of great importance. Therefore, you should not pass by a person who has fallen on the street with such an attack. Some cannot look at convulsions of this nature and are capable of losing consciousness themselves - then you should call another passerby for help. The action plan is as follows:
- Lay the patient horizontally and as level as possible.
- Place his head on something soft.
- Separate the jaws with a soft cloth.
- Tilt the patient onto his side and open his mouth slightly.
- Ensure that this position is maintained until the ambulance arrives.
You should not squeeze the patient, trying to prevent convulsions, because it will cause even more harm. If there is no one to call an ambulance, then this must be done in parallel with first aid so that the doctors arrive as quickly as possible.
Treatment
Before starting treatment, it is very important to establish the exact type of epilepsy and the root cause of its occurrence. EEG and MRI are used for this.
A conversation is also held with the patient himself and his relatives. Additionally, you will need to undergo an examination by a neurologist. Only after this will it be possible to make a final diagnosis and proceed to treatment.
Therapy for epilepsy is always long-term. The disease does not go away quickly, which is why patients have to take medications for many years. They will ensure an improvement in the condition and will also help to avoid new attacks. Some types of disease cannot be treated at all, and taking medications becomes the only way to maintain a normal life.
Epileptics are prescribed drugs of three groups:
- Anticonvulsants;
- Antibiotics;
- Vitamin complexes.
Doctors often have to spend a long time selecting medications for each patient individually. In most cases, one of the following drugs is prescribed: Diphenin, Hexamidine, Diazepam, Encorat, Chlorakon.
Also, epileptics should avoid serious mental and physical stress, drinking alcohol and strong medications against other diseases. A diet is also recommended for them. It involves reducing the amount of salt and seasonings consumed, as well as a ban on coffee and cocoa.
What it is
This is an endogenous organic disorder of the central nervous system, characterized by convulsive seizures and pathocharacterological changes in personality. Epilepsy occurs not only in people, but also in animals (mice, cats, dogs). Epilepsy includes a number of syndromes and disorders associated with functional disorders of the central nervous system. At the same time, various psychopathological syndromes and sympomocomplexes are diagnosed, which gradually develop in the patient.
External signs of epilepsy in adults do not always include loss of consciousness and convulsions. The disease can occur differently, manifested by absent-mindedness, weak muscle contractions of the limbs, and freezing.
The essence of the disease is a disruption of excitation processes in the main organ of the nervous system, as a result of which a paroxysmal focus is formed: a chain of repeated discharges in neurons, which leads to the onset of an attack.
For the first time, Hippocrates gave a clear description of this disease. He classified epilepsy as a disease of the brain, closely linking it with impaired activity of the nervous system.
What can trigger an attack?
Most often, attacks begin and end spontaneously
An attack of epilepsy is provoked by certain factors affecting the patient from the inside or outside. All causes of exacerbation of the disease have one thing in common - they affect the functioning of the nervous system, which contributes to improper activity of neurons in the affected area of the brain.
The main provoking factors for epilepsy are:
- flickering light (for example, when watching TV or playing on the computer)
- loud or intermittent sound
- sleep problems, lack of sleep
- frequent stress and depression
- other psycho-emotional disorders
- taking certain medications
- alcohol consumption
- unnatural breathing (too deep, rapid)
- some types of physical therapy (for example, electrotherapy)
As for the development of epilepsy itself, the list of possible causes is wider. In modern medicine, there are cases when the formation of a lesion in the brain tissue occurs under the influence of a huge number of factors. Most often, the onset of epilepsy begins due to:
- congenital abnormalities in brain development
- past infectious diseases
- traumatic brain injuries
- diseases of the cardiovascular or nervous system
- genetic predisposition
Often the development of epilepsy occurs due to acquired pathologies of the body. Despite the high level of medical technology, it is not possible to determine the root cause of epileptic seizures in every patient. According to official statistics, every 3rd person with epilepsy has an illness of unknown origin.
How to help a sick person?
During an attack, a person needs to ease their breathing as much as possible and turn their head to the side.
It was previously noted that an epileptic attack manifests itself in different ways. It is often aggressive in nature and manifests itself in convulsions or loss of consciousness. Less commonly, an attack is expressed in absence seizure, in which a person seems to be alienated from the world around him and does not react at all to what is happening around him.
Regardless of the nature of the manifestations of epilepsy, they require due attention. Naturally, the patient himself cannot control the situation, so outside help is important.
If you witness an epileptic attack, you must act in the following order:
First of all, stop panicking and prepare mentally for the implementation of certain measures
There is not much time to prepare for assistance, so you must act quickly. After this, it is important to analyze the situation around the person having an attack. At a minimum, the patient must be isolated from dangerous or potentially dangerous surrounding objects (knives, scissors, sharp edges of furniture, etc.). Then, if the patient has not yet fallen, he should be placed on his back on the bed or even the floor
In this case, it is important to position the head to one side to avoid problems with aspiration of saliva, vomit or blood that appears when biting the tongue. Next, the patient must be freed from tight clothing, belts, bras and similar items.
At the final stage of providing assistance, it is enough to note the duration of the attack and carefully monitor the patient’s condition. If necessary, the following is carried out:
- freeing the oral cavity from vomit and other foreign bodies
- protecting the patient from external objects during convulsions
- elimination of tongue retraction
- pillow for a patient's head
- administration of rectal medications prescribed by the doctor (their effect is usually observed 5-10 minutes after application)
During an epileptic attack it is not allowed:
- give the patient drinks or oral medications
- allowing him to hold something in his hands or take any objects
- make noise, further irritating the human nervous system
After the attack ends, it is important to put the patient to bed and monitor how sleep progresses. At a minimum, he needs to sleep 3-4 hours
After this, the patient should be shown to a doctor. If this is the first attack, such a measure is mandatory. In other circumstances, a visit to the clinic is at the discretion of the patient and his relatives.
