Idiopathic generalized epilepsy: symptoms, description, diagnosis, treatment and prevention of attacks

Causes of epilepsy

As mentioned above, epilepsy is divided into 2 main types: Idiopathic and symptomatic.
Idiopathic epilepsy is most often generalized, and symptomatic epilepsy is partial. This is due to various reasons for their occurrence. In the nervous system, signals are transmitted from one nerve cell to another using an electrical impulse that is generated on the surface of each cell. Sometimes unnecessary excess impulses arise, but in a normally functioning brain they are neutralized by special anti-epileptic structures. Idiopathic generalized epilepsy develops as a result of a genetic defect in these structures. In this case, the brain cannot cope with the excessive electrical excitability of the cells, and it manifests itself in convulsive readiness, which can at any moment “capture” the cortex of both hemispheres of the brain and cause an attack. In partial epilepsy, a focus with epileptic nerve cells is formed in one of the hemispheres. These cells generate excess electrical charge. In response to this, the remaining antiepileptic structures form a “protective wall” around such a focus. Up to a certain point, convulsive activity can be restrained, but the climax comes, and epileptic discharges break through the boundaries of the shaft and manifest themselves in the form of the first attack. The next attack will most likely not be long in coming - because... The “path” has already been paved.

Such a focus with epileptic cells is most often formed against the background of some disease or pathological condition. Here are the main ones:

1. Underdevelopment of brain structures - does not arise as a result of genetic rearrangements (as in idiopathic epilepsy), but during fetal maturation, and can be seen on MRI;
2. Brain tumors;
3. Consequences of stroke;
4. Chronic alcohol use;
5. Infections of the central nervous system (encephalitis, meninoencephalitis, brain abscess);
6. Traumatic brain injuries;
7. Drug addiction (especially amphetamines, cocaine, ephedrine);
8. Taking certain medications (antidepressants, antipsychotics, antibiotics, bronchodilators);
9. Some hereditary metabolic diseases;
10. Antiphospholipid syndrome;
11. Multiple sclerosis

Factors in the development of epilepsy

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

Treatment of epilepsy

Both medications and surgery are used to treat and prevent the disease. Non-pharmacological methods are also widely used, but they can only be used to establish a prophylactic regimen to prevent seizures. Each method is worth considering separately:

Use of drugs

Remember, amateur actions can lead to undesirable consequences, follow the contents of the doctor’s prescription and dosage regimen. When avoiding advertising/copyright infringement, you should avoid drug names and concentrate on the composition and pharmacological properties.

The basis of all medications is Trimethadone and Etouximide, coupled with substances that suppress excessive brain activity and vitamin supplements (including Omega-3).

Non-drug methods

Biofeedback. This therapy is based on the development of adaptations in the body to irritating factors. Allows you to develop the patient’s self-regulation skills of brain activity through the analysis of specific situations. The results of the studies cannot be classified as unambiguous, but a decrease in the frequency of seizures is observed in most cases.

Hormones. We are talking about melatonin, which is a regulator of biological rhythms and processes in the body. Research results are also mixed.

High dosage of vitamins and nutrients. For epileptics, an increased dietary content of vitamin D, calcium and the already mentioned Omega-3 is recommended. The minimum dosage is determined by the attending physician and often involves additional sources.

Surgical intervention

Surgery can be prescribed only in cases where the diagnosis of the disease reveals specific permanent areas of increased brain activity. Individual areas of the brain are removed only in cases where they are not involved in vital processes and are not associated with the senses. And if the area is inoperable, a technique can be used to create incisions between the lobes of the brain to prevent spread.

In addition to parts of the brain, surgical intervention is required for tumors that cause seizures and deformations of the skull that create pressure on the cerebral cortex.

Symptoms of epileptic seizures

How to recognize? Different types of generalized epilepsy have different symptoms. Thus, absence seizures are characterized more by loss of consciousness, lethargy, and loss from real life. Short, repetitive, habitual movements are possible (flexes and extends fingers, or one finger, etc.)

Tonic-clonic seizures are characterized by 2 phases of symptom development. First, immobilization, straightening of the entire body, a posture characteristic of tetanus. Breathing stops. The victim turns pale.

Then cramps of all muscles begin, gradually decreasing and disappearing completely.

Starts to breathe deeply. Foam appears at the mouth, often mixed with blood, because the cheeks, tongue, and lips are damaged.

Muscle relaxation, involuntary urination and defecation. Then the person falls asleep.

Myoclonic seizures are more characterized by small muscle contractions of individual muscle bundles. But they are always symmetrical. Involuntary movements of the arms and legs may be observed.

The patient often falls. Consciousness is not lost, but apathy, indifference, and loss of attention are revealed.

What is epilepsy: types and symptoms of the disease

So what is epilepsy, and why are the symptoms of this disease such a concern?

Epilepsy (from the Greek epilepsia - to take, to grasp) is a chronic disease manifested by convulsive and non-convulsive seizures, mental disorders and specific personality disorders. This disease was also called “sacred” (due to frequent psychoses of a religious nature), “lunar” (due to sleepwalking - sleepwalking), and “epileptic”.

What types of epilepsy are there, and what are the characteristics of each type of this disease?

There is a distinction between true (idiopathic) epilepsy as an independent disease and symptomatic - as an epileptic syndrome with an underlying disease, be it the consequences of traumatic brain injury, neuroinfection, vascular, tumor damage to the brain or manifestations of intoxication, for example, in alcoholism. In the latter cases, a change in metabolism occurs in the brain due to its swelling, due to irritation of its membranes, due to malnutrition or destruction of its cells, and so on. Here, treatment of the underlying disease plays an important role, which often eliminates attacks or makes them less frequent.

True epilepsy can develop for no apparent reason, so many believe that it is based on hereditary factors. The body's predisposition to seizures is associated with hereditarily determined changes in metabolism. But even here, in many cases, it is still necessary to realize this hereditary predisposition with the participation of various factors acting during the period of intrauterine development, during childbirth and immediately after it (infections, intoxication, trauma).

When signs of epilepsy appear, electroencephalography of the brain is performed to diagnose the disease. This method allows, based on the electrical activity of the brain, to identify a decrease in the threshold of convulsive readiness and an epileptic focus.

Everyone has convulsive readiness, that is, the brain’s readiness to respond to a stimulus with an epileptic discharge. But for a healthy person, this irritant must be of extreme strength, for example, a body temperature of 40 degrees against the background of severe dehydration, an electric shock.

And for a patient with epilepsy, sometimes emotional stress, loud noise, bright light, and more often even without provocation are enough. He has already formed an autonomous pathological epileptic system, consisting of an epileptic focus (a group of nerve cells that are constantly excited), electrical discharge pathways and brain structures that activate the focus (limbic-reticular and thalamic systems, responsible for human biological rhythms, body homeostasis ). Therefore, often the symptoms of epilepsy appear only at night, or during the full moon, or only during menstruation.

In contrast to the epileptic system, there is also an anti-epileptic system with its own inhibitory centers and substances that extinguish many discharges along the way, preventing them from resulting in an attack.

Epilepsy: general characteristics

In the classical definition, epilepsy is a mental illness manifested in the form of periodic paroxysmal seizures, which is most often accompanied by neurological and somatic pathologies and a personality tendency towards concentric dementia. From a clinical point of view, epilepsy is characterized by chronic psychoses and other personality disorders. Seizures occur as a result of sudden synchronous activity of neural connections called discharges. The characteristic features of paroxysms, as well as symptoms, directly depend on the type and form of manifestation of the disease.

Types and forms of epilepsy in children

For children, traditional types of epilepsy are also typical - reflex, temporal, frontal and Lennox-Gastaut syndrome, but below we consider exclusively the forms characteristic of minors.

Febrile seizures.

Age – up to 6 years.

High body temperature is a serious stressor for a child. It is characterized by severe, prolonged convulsions and loss of consciousness by the child. Febrile epilepsy is often confused with chills or symptoms of fever.

Infantile spasms.

Age – up to 2 years.

Manifested by a sudden raising of the head or limbs by the child. They can be repeated many times even throughout the day. Accompanied by a delay in the intellectual development of the baby. At 2-3 years, infantile spasms stop, most often the disease develops into Lennox-Gastaut syndrome.

Rolandic epilepsy.

From 2 to 13 years.

Attacks manifest themselves in the form of numbness in one part of the face, tongue and lips. Speech is difficult, sometimes the child cannot remember the name of this or that thing. Consciousness is preserved. Other types of spasms may also occur.

Myoclonic epilepsy.

Puberty

Atonic and tonic-clinical seizures with loss of consciousness most often occur in the morning or under the influence of sudden and unexpected irritating factors. Deviations in intelligence are not noticed in adolescents with such a deviation.

Types of seizures in children

There are dozens of different types of epileptic seizures, but the most common, especially among children, are the following 3 types:

1. Atonic attacks. They imply a sharp simultaneous relaxation of muscles. Very similar to normal fainting.
2. Tonic-clinical seizure. Most often, its effect is directly associated with epilepsy. A seizure is expressed in loss of consciousness and simultaneous convulsions of the whole body. Usually lasts only a few minutes.
3. Absence seizures. It is quite difficult to notice the signs of this form. During an attack, a person simply freezes. May be accompanied by eyelid tic. It lasts only 3-4 seconds, during the attack the patient does not react to what is happening.

Epileptic signs are not necessarily associated with loss of consciousness, for example, with fibrous, rolandic and myoclonic forms of the disease, the child will fully or partially retain consciousness and even the perception of temperature and pain.

Symptomatic epilepsy

Traumatic brain injury can cause the development of symptomatic epilepsy.
The causes of this form of epilepsy include traumatic brain injuries, tumors, birth injuries, infectious-toxic lesions of the brain, arteriovenous malformations, etc.

Symptoms depend on the topical location of the epileptic focus in the brain. The following types of symptomatic epilepsies are distinguished:

• Kozhevnikov epilepsy.

Represents simple motor seizures: convulsions in the hand or face, the intensity of which may vary. A special feature of Kozhevnikov epilepsy is the duration of the attack, which can last several days and leaves behind paresis (weakness) of the part of the body where the twitching occurred. During sleep, twitching may decrease or disappear. As a rule, only one side of the body is involved in the process (left arm and left leg, right half of the face, etc.). Absence seizures do not occur in Kozhevnikov epilepsy.

In children, the disease most often occurs after encephalitis of unknown etiology. Treatment is primarily aimed at eliminating the cause and prescribing anticonvulsants. For this type of epilepsy, there is also a surgical treatment method, which is used when conservative therapy is ineffective and the disease is severe.

• Frontal lobar epilepsy.

Epilepsy is one of the most diverse in clinical manifestations. Characterized by a sudden onset of an attack that lasts no more than 30 seconds. and also ends suddenly. The attack consists of excessive movements and gestures. Sometimes before an attack a person may feel a sensation of warmth, cobwebs on the body. The attacks are characterized by emotional overtones, and there may be involuntary urination. Frontal epilepsy most often manifests itself as simple and complex (see above) partial seizures, as well as myoclonic seizures (twitching of individual muscle groups). Seizures tend to generalize the process and form status epilepticus; they occur more often at night.

• Temporal lobe epilepsy.

The nature of the seizures can be different - from simple motor ones (grabbing others, scratching oneself, cramps in the arm or leg) to secondary generalized ones. Appears at any age. A person is worried about illusions, a feeling of unreality of what is happening, since the focus is in the temporal lobe, olfactory and gustatory hallucinations may appear (a feeling of salt on the tongue, a feeling of the smell of rot). A frozen gaze, oroalimentary automatisms (smacking, licking lips, sticking out the tongue), fear, and panic appear. The timbre of the voice may change, and incoherent speech appears. The attack lasts about 2 minutes. The drugs of choice for treatment are valproate and carbamazepine. In 30% of cases, epilepsy cannot be treated with antiepileptic drugs.

• Parietal epilepsy.

Tumors and traumatic brain injuries (consequences) are common causes of parietal epilepsy. A person is bothered by sensory seizures, which have polymorphic clinical manifestations (sensations of cold, burning, itching, tingling, numbness, etc.), hallucinations (cannot feel his body, a feeling of incorrect placement of body parts, for example, a hand “coming out” of the stomach). During an attack, disorientation in space occurs if the epileptic focus is in the non-dominant hemisphere. The seizure itself lasts no more than 2 minutes, but can be repeated many times, several times a day. Treatment is primarily aimed at eliminating the cause of the disease.

• Occipital epilepsy.

The causes are also different (arteriovenous malformation, tumor, trauma). In the occipital lobe there is a zone of the visual analyzer, therefore in the clinic of occipital epilepsy there are simple seizures in the form of visual impairment up to blindness, photo flashes, visual hallucinations, loss of visual fields. Often simple partial seizures develop into generalized convulsions. In some cases, there may be fluttering of the eyelids, turning the head and eyes to the side. In the post-seizure period there is a headache and general fatigue. Anticonvulsants are used in treatment.

• Infantile spasms.

The disease occurs in children in the first year of life against the background of brain developmental defects, birth trauma, etc. The clinical picture is represented by twitching of the trunk muscles, which occurs in series. During an attack, the child turns his head, bends his arms and legs, and bends “like a penknife” due to contractions of the abdominal muscles. Mental retardation develops.

Absence epilepsy

This type of disease has its own distinctive features. It is a subclass of the idiopathic generalized form. Occurs mainly in young children. This type of epilepsy has a specific clinical picture. It is characterized by a sudden and short-term loss of consciousness. The child seems to fall out of reality. His gaze turns to the side, his eyes glaze over, he stops reacting to the world around him.

The attack lasts 10-15 seconds. Outwardly, everything looks as if the child was thinking. This type of absence is called simple. Often it goes unnoticed both for the baby, since the child does not remember what happened, and for the parent. However, there are also pronounced forms in which the attack is accompanied by a severe clinical picture.

Throwing the head back may be added to the above. The child drops from his hands what he was holding. These actions are accompanied by automatisms in the form of nodding, licking, smacking, and repeating sounds. This kind of absence is called complex. Atypical manifestations of an attack are rarely observed when the child loses consciousness. With simple and complex absence seizures, fainting never occurs.

The atypical form lasts for a longer period of time. After the attack, the child will be weak and drowsy. Prognostically, this form of epilepsy is more unfavorable than simple absence seizure. This pathology is diagnosed by recording symptomatic manifestations and electroencephalography (EEG).

This form of epilepsy does not affect the child’s intellectual abilities or his neurological component. This form is not uncommon and accounts for 20% of all cases of the disease in children, mainly between the ages of 3 and 8 years. More often observed in girls.

Nonconvulsive epilepsy

This form is a common variant of the development of the disease. Symptoms are expressed in personality changes. It can last from several minutes to several days. It disappears as suddenly as it begins.

In this case, an attack is understood as a narrowing of consciousness, while the patient’s perception of the surrounding reality is focused only on phenomena that are emotionally significant for him.

The main symptom of this form of epilepsy is hallucinations that have a frightening overtone, as well as the manifestation of emotions to the extreme degree of their expression. This type of disease accompanies mental disorders. After attacks, a person does not remember what happened to him, only sometimes residual memories of events may arise.

What is it: definition of the disease

What does epilepsy mean: is it a mental or neurological disease of a person?
Epilepsy is a neurological disease in which the patient regularly experiences seizures.

Two conditions contribute to the appearance of a seizure: the presence of a focus of epileptic activity in the brain and the readiness of the brain to respond to neuronal irritation.

According to ICD 10, epilepsy in adults is designated G40.

The diagnosis is made if the patient has had 2 or more seizures; a single seizure is not epilepsy.

The disease is neurological in nature, not mental. Approximately 20% of those affected have mental disorders, but these are more often associated with another brain disease.

In severe cases of the disease, the patient may develop a mild mental disorder in the form of deterioration of memory and attention; severe neuroses, psychoses, and depression are very rare.

What is epilepsy? Find out from the video:

Myoclonic form of the disease

Myoclonic epilepsy affects both sexes. One of the most common types. The disease debuts between the ages of 10 and 20 years. Symptoms include epileptic seizures.

Over time, myoclonus occurs - involuntary muscle contractions. Mental changes occur very often.

The frequency of attacks can be completely different. They can happen every day, several times a month or even less often. Along with seizures, disturbances of consciousness may occur. However, this form of the disease is the easiest to treat.

Symptoms of epilepsy in children

Epilepsy in childhood has its own symptoms, in comparison with epilepsy in adults.
In a newborn baby, it often manifests itself as simple physical activity, which makes diagnosing the disease at this age difficult. Especially when you consider that not all patients suffer from seizures, especially children, which makes it difficult to suspect a pathological process for a long time. To understand exactly what symptoms may indicate childhood epilepsy, it is important to carefully monitor the child’s condition and behavior. Thus, children's nightmares, accompanied by frequent hysterics and screams, may indicate this disease

Children with epilepsy may sleepwalk and not respond when spoken to. Children with this disease may experience frequent and severe headaches with nausea and vomiting. The child may also experience short-term speech disorders, which are expressed in the fact that, without losing consciousness and motor activity, the child simply cannot say a word at some point.

All of the above symptoms are very difficult to detect. It is even more difficult to identify its relationship with epilepsy, since all this can occur in children without significant pathologies. However, if such symptoms occur too frequently, it is necessary to show the child to a neurologist. He will make a diagnosis based on electroencephalography of the brain and computer or magnetic resonance imaging.

What types of generalized epilepsy is divided into?

Pathology is classified into three types: idiopathic, symptomatic and cryptogenic. What is idiopathic epilepsy? This form is caused by congenital developmental abnormalities. Often the onset of generalized pathology of the idiopathic type is observed in patients under the age of 21, so idiopathic epilepsy in children is not uncommon.

With this form, accompanying clinical symptoms are not diagnosed, with the exception of neurological seizures. Sometimes scattered phenomena occur. In rare cases, focal (localized) symptoms are disturbing. With generalized idiopathic epilepsy, the patient retains clarity of thought and other cognitive functions. However, it is possible that there are some intellectual disorders that disappear over time. On average, such disorders are observed in 3-10% of patients.

Secondary epilepsy (symptomatic) occurs at any age, which is explained by the cause of the disease. If the pathology is caused by congenital malformations, then the first attacks occur in childhood.

In symptomatic generalized epilepsy, seizures are part of a larger clinical picture.

The cryptogenic form is diagnosed in cases where it is impossible to establish the causes of the development of a neurological disorder.

Symptoms of epilepsy

Mental disorders of patients with epilepsy are determined by:

• organic brain damage underlying the disease epilepsy;
• epilepsy, that is, the result of the activity of an epileptic focus,
• depend on the location of the outbreak;
• psychogenic, stress factors;
• side effects of antiepileptic drugs - pharmacogenic changes;
• form of epilepsy (absent in some forms).

structure of mental disorders in epilepsy

features of personality changes in epilepsy

1. Characterological:

• egocentrism;
• pedantry;
• punctuality;
• rancor;
• vindictiveness;
• hypersociality;
• attachment;
• infantilism;
• a combination of rudeness and obsequiousness.

2. Formal thinking disorders:

• bradyphrenia (stiffness, slowness);
• thoroughness;
• penchant for detail;
• concrete descriptive thinking;
• perseveration.

3. Permanent emotional disorders:

• the viscosity of affect;
• impulsiveness;
• explosiveness;
• defensiveness (softness, obsequiousness, vulnerability);

4. Decrease in memory and intelligence:

• mild cognitive impairment;
• dementia (epileptic, egocentric, concentric dementia).

5. Change in the sphere of drives and temperament:

• increased instinct of self-preservation;
• increased drives (slow pace of mental processes);
• predominance of a gloomy, gloomy mood.

Symptoms

The main manifestation of Kozhevnikov epilepsy is the development of hyperkinesis syndrome. The patient often experiences twitching of several muscle groups at once. The muscles of the face and hands may be simultaneously affected by spasms. Other localization of areas in which twitching is present is also possible.

In severe cases, against the background of an increase in the number of paroxysms, the development of muscle paralysis on the side opposite to the focus of brain damage is observed. Muscle cramps are present in patients even during sleep. However, they may weaken only slightly during this period.

A patient with this form of epilepsy can independently note symptoms that may indicate an approaching seizure, including:

• increased seizures;
• sense of anxiety;
• irritability;
• fear.

In most cases, patients present with simple partial seizures. They are accompanied by freezing, attacks of depression or aggressive behavior, and reflex movements. In this case, the patient does not lose consciousness.

In severe cases, generalized attacks may occur. Such seizures are accompanied by convulsions affecting all muscle groups. The patient falls and throws his head back. White foam often comes out of the mouth. Involuntary shouting is possible.

In addition, the characteristic manifestations of Kozhevnikov epilepsy include the following signs:

• coordination problems;
• memory impairment;
• decreased intellectual abilities;
• learning difficulties in children;
• depression;
• phobias;
• decreased sensitivity of the limbs;
• amyotrophy;
• increased salivation;
• frequent swallowing movements;
• stomach ache;
• asymmetry of tendon reflexes;
• hallucinations;
• sleep disorders.

In especially severe cases, patients with epilepsy may experience schizophrenia-like manifestations.

Precursors of seizures

Aura (from the Greek - “blow”) is a harbinger of an epileptic attack and precedes loss of consciousness, but not in any form of the disease. The aura can manifest itself with various symptoms - the patient may begin to sharply and frequently contract the muscles of the limbs and face, he may begin to repeat the same gestures and movements - running, flapping his arms. Various paresthesias can also act as an aura. The patient may feel numbness in various parts of the body, a crawling sensation on the skin, and some areas of the skin may burn. There are also auditory, visual, gustatory or olfactory paresthesias. Mental precursors can manifest themselves in the form of hallucinations, delusions, which are sometimes called preconvulsive insanity, a sharp change in mood towards anger, depression, or, conversely, bliss.

In a particular patient, the aura is always constant, that is, it manifests itself in the same way. This is a short-term state, lasting a few seconds (rarely more), while the patient is always conscious. An aura occurs when an epileptogenic focus in the brain is irritated. It is the aura that can indicate the dislocation of the disease process in the symptomatic type of epilepsy and the epileptic focus in the genuine type of the disease.

Diagnosis of epilepsy

To understand how to treat epilepsy, to outline certain steps that will promote prolonged remission, first of all, it is necessary to exclude other pathologies and establish the type of disease. For this purpose, the first step is to collect an anamnesis, that is, a thorough interview of the patient and his relatives is carried out. When collecting an anamnesis, every little detail is important: does the patient feel the approach of a seizure, does a loss of consciousness occur, does convulsions begin in four limbs at once or in one, which is felt after a convulsive attack.

Epilepsy is considered a rather insidious disease, which can often go unrecognized for a long time.

Can epilepsy be cured? Doctors are often asked this question because people are afraid of this disease. Any treatment begins with a diagnosis, so the doctor can ask many questions to the patient himself and his immediate environment to obtain the most accurate description of the pathology. The survey helps determine the form and type of attack, and also allows you to presumably establish the area of ​​cerebral damage and areas of further spread of pathological electrical activity. Possible help for epilepsy and the choice of an adequate treatment strategy depend on all of the above. After the history is completed, a neurological examination is carried out, the purpose of which is to identify the following neurological symptoms in the patient: headache, unsteady gait, unilateral weakness (hemiparesis) and other manifestations indicating organic pathology of the brain.

Diagnosis of epilepsy includes magnetic resonance imaging. It helps to exclude the presence of dysfunctions and pathologies of the nervous system that cause seizures, such as brain tumors, abnormalities of capillaries and brain structures. Magnetic resonance imaging is considered an important part of the process of diagnosing epilepsy and is performed when the first seizure occurs.

Electroencephalography is also a necessary diagnostic method. Electrical brain activity can be recorded using electrodes placed on the patient's head. Outgoing signals are magnified many times and recorded by a computer. The study is carried out in a darkened room. Its duration is approximately twenty minutes.

If the disease is present, electroencephalography will show transformations called epileptic activity. It should be noted that the presence of such activity on the electroencephalogram does not yet mean the presence of epilepsy, since 10% of the completely healthy population of the planet can have various electroencephalogram disorders. At the same time, in many epileptics, the electroencephalogram between attacks may not show any changes. In such patients, one of the possibilities for making a diagnosis of epilepsy would be the provocation of pathological electrical signals in the brain. For example, encephalography can be performed while the patient is sleeping, since sleep causes an increase in epileptic activity. Other ways to induce epileptic activity on the electroencephalogram are photostimulation and hyperventilation.

Diagnostics

What to do if you have symptoms? In any case of seizures, you should consult a doctor. The doctor who deals with such conditions is a neurologist.

A more specialized specialist is a neurologist - epileptologist. A neurophysiologist is also involved in the diagnosis.

Diagnosis of epilepsy begins with a general examination and identification of the causes. It is necessary to collect a full medical history and ask about the characteristics of the attack that occurred.

The next step the doctor will take is taking an electroencephalogram (EEG). This is a procedure in which the electrical potentials of the brain are recorded.

Electrodes placed on the scalp record these potentials and transform them into various vibrations.

The procedure requires 12 hours of preparation. Avoid taking medications as prescribed by your doctor, do not eat chocolate, do not drink coffee, or energy drinks.

You should not be nervous during the procedure. Children need to be explained in advance the course of the study, practice putting on a cap, calm the child down, and take a toy, book, and drink with them.

To detect hidden epilepsy, various tests are used (bright light, loud sound, sleep, deep breathing).

EEG can be carried out in conjunction with video recording for a detailed description of the convulsive syndrome, its duration, and nature.

Another method for indirect diagnosis is CT and MRI of the brain. With these studies, it is possible to suspect the underlying cause, the pathology in which the seizures could occur.

If a hereditary form is suspected, consult a geneticist. Differentiation from focal forms, fainting, mental disorders (hysteria) is necessary.

Lifestyle of sick men and women

Thanks to the capabilities of modern medicine, epileptics can lead a normal life. However, he must follow some rules to prevent the development of a seizure:

1. Avoid places with large crowds of people, climate changes, time zones.
2. Avoid stress.
3. Don't drink alcohol.

Do not stay in the sun for a long time, in a bathhouse, or a sauna, so as not to provoke overheating. Maintain a daily routine. Good sleep, alternating work and rest, and proper nutrition are important for the patient. Patients can play sports, but participation in competitions is prohibited.

As for pregnancy and childbirth, there is no clear opinion on this matter. According to statistics, 90% of women suffering from epilepsy normally carry and give birth to healthy children.

Absolute contraindications to pregnancy are:

1. Frequent generalized attacks that are not amenable to drug treatment.
2. Visible personality disorders of a woman.
3. Epistatus.

In other cases, pregnancy is not contraindicated. Six months before conception, a woman should undergo a full examination and discuss pregnancy management tactics and possible risks with her doctor.

The issue of military service with this disease is relevant. Young people with epilepsy can be drafted into the army as Category B4 (fit with minor restrictions) if they are not taking anti-seizure drugs and have not had a seizure in the last five years.

In other cases, the conscript falls under category B and is transferred to the reserve.

Drug treatment of epilepsy.

The history of the treatment of epilepsy begins with the advent of bromine salts, which were first used by Charles Lecoq in 1857. Since 1912, barbiturates have become the only drugs for the relief of epileptic seizures. They were created and introduced into clinical practice by Adolf von Bayer, professor of organic chemistry at the Berlin Industrial Academy, in 1863 and named after his wife Barbara. In 1904, Emil Fischer and Joseph Mehring discovered barbituric acid salts (barbital and phenobarbital). Barbital later received the name “veronal” in honor of the city of Verona (Northern Italy), where the tragedy of Romeo and Juliet took place - this was the name of the sleepy drink that the monk gave to Juliet. Since 1938, after clinical testing of hydantoins (phenytoin, dilantin, diphenin), and then other antiepileptic drugs (trimidone, trimethathion, trimethine, 1946), primidone (hexamidine, 1952), ethosuximide (suxilep, 1960). ) new possibilities for influencing epileptic seizures have emerged. Since that time, the stage of polypharmacy in the treatment of epilepsy began, in which the tactics of prescribing several antiepileptic drugs simultaneously (the “shrapnel shot” method) became a priority. The trend towards polypharmacy has led to the use of various combinations of antiepileptic drugs. Most often, barbiturates, which suppress epileptic activity at the cortical level, were combined with hydantoins, which act at the level of the brain stem formations, adding a stimulating substance to them in order to reduce the sedative effect (caffeine, ephedrine, phenamine, strychnine). Such medicinal mixtures were named after the names of the authors who proposed them (Sereysky, Vorobyov, Racine, Karmanova, Brodsky). Polypharmacy as the main method of treating epilepsy was used until the 60–70s of the twentieth century, because it was considered necessary to use several antiepileptic drugs simultaneously (Remezova E.S., 1954; Sereysky M.Ya., 1955; Vorobyov S.P., 1958; Khodos H.D., 1964; Abramovich G.B., Kharitonov R.A. ., Tets I.S., 1965; Vaintrub M.Ya., 1979 and others).

In 1964, carbamazepine (Finlepsin, Tegretol) was introduced into clinical practice, and in 1967, valproates (Depakine, Convulex, Convulsofin). This gradually changed the perception of the primacy of combination therapy for the treatment of epilepsy. As a result, monotherapy (the use of one drug) became the “gold standard” in the treatment of epilepsy in the late 1980s, and polytherapy (the use of two or more anticonvulsants) began to be used only when adequate monotherapy was impossible.

Epilepsy treatment strategy

1. Establishing a diagnosis of epilepsy

(anatomical-electro-clinical, i.e. with the mandatory use, in addition to clinical research, of the results of an electroencephalogram and magnetic resonance imaging).

2. Choice of AED

in accordance with the form of epilepsy and the type of seizures.

3. Start of treatment

with a drug with the widest therapeutic range and minimal likelihood of complications.

4. AED dose

should not be lower than the recommended therapeutic value based on mg/kg body weight per day or mg/day for a given age.

5. Start with monotherapy

with bringing the dose to an effective one. Only at the maximum permissible dose and in the absence of a positive effect, switch to a second-choice AED, preferably the latest generation (alternative monotherapy).

6. If there is no effect

from alternative monotherapy - rational polytherapy (a combination of two, at least three AEDs) with the mandatory inclusion of AEDs of the latest generation.

7. Regularity of taking AEDs

.

8. Duration of AED use

depending on the form of epilepsy and the effectiveness of treatment.

Choice of antiepileptic drug (AED) depending on the type of epileptic seizure (in descending order)

How to be treated

Treatment of epilepsy includes several areas - providing first aid, preventing the occurrence of new attacks and complications. For this purpose, non-drug methods, medications, and in some cases surgical intervention are used.

First aid

During an epileptic attack, it is necessary to protect the person from possible damage and complications (injury from a fall, asphyxia). The main thing to do is to soften the fall during a seizure. If a person begins to lose consciousness, you must try to catch him and place a soft object under his head. If an attack is accompanied by excessive salivation, you need to turn the person on his side, this will prevent him from choking.

What you should absolutely not do:

• forcefully restrict the patient’s convulsive movements;
• try to open the jaw;
• give water or medicine.

Drug treatment

Specific drug treatment consists of taking anticonvulsants. Treatment should be selected by a doctor after a full examination, but medications can be taken at home.

An important principle of epilepsy treatment is monotherapy, that is, if possible, treatment is carried out with one drug. The main antiepileptic drugs are valproate (valproic acid derivatives) and carbamazepine. Derivatives of valproic acid are used advantageously in the generalized form of epilepsy, and carbamazepine - in the partial form.

Carbamazepine is one of the drugs used to treat epilepsy

Other, more modern anticonvulsants can be used to treat epilepsy:

• pregabalin (trade name Lyrica);
• lamotrigine (Lamictal, Lamitor);
• topiramate (Topamax);
• gabapentin (Neurontin).

Drugs are selected depending on the form of epilepsy. The patient’s age, the presence of concomitant diseases and drug tolerance are also taken into account. Taking the antiepileptic drug begins with a minimum dose, gradually increasing it.

Causes

Of course, the question is quite logical: what causes epilepsy and what factors contribute to its occurrence? The issue is especially acute for parents who are worried about their children. To understand why epilepsy may occur, it is necessary to determine whether there is a possible hereditary predisposition to the disease. If there is none, an examination is necessary to find out the actual causes.

Idiopathic cause

Perhaps your parents or grandparents suffered from epileptic seizures, the causes of which were unknown. If such cases have occurred in your family, there is a high probability that this is the root of the problem for you or your child. This reason is characterized by the absence of changes in the brain.

Symptomatic cause

The examination may reveal a number of characteristic signs. These include a cyst, a cerebral hemorrhage. A tumor may also be a structural defect.

Cryptogenic reason

There are times when it is not possible to determine what causes epilepsy. Despite this, it is necessary to be under the supervision of a doctor.

Diagnosis

It is mistakenly believed that epilepsy is limited to a few types. Today, medicine identifies 40 forms of various attacks of this disease. Naturally, a certain type of treatment has its own method of treatment.

Therefore, it is necessary to understand how important it is to find out in time what causes epilepsy and in what form.

The main diagnostic method today is magnetic resonance or computed tomography, as well as electroencephalography (EEG). Mass studies are usually carried out using EEG (called a routine examination method). The procedure takes place within 15 minutes. A long-term study lasting 1-12 hours is called EEG monitoring. Both the waking time and the sleep period are taken into account.

Thus, answering the question of where epilepsy begins, we can say – with diagnosis. Having noticed the first symptoms, you must immediately sign up for a diagnosis. There is no need to be afraid or ashamed of your problem; medicine is developing and makes it possible to quickly and accurately diagnose diseases in order to select methods to solve the problem.

Epilepsy concept

The onset of a single attack characteristic of epilepsy is possible due to the specific reaction of a living organism to the processes that have occurred in it. According to modern concepts, epilepsy is a heterogeneous group of diseases, the clinical picture of chronic cases of which is characterized by convulsive repeated attacks. The pathogenesis of this disease is based on paroxysmal discharges in the neurons of the brain. Epilepsy is characterized mainly by typical repeated seizures of various types (there are also equivalents of epileptic seizures in the form of sudden onset mood disorders (dysphoria) or characteristic disorders of consciousness (twilight stupefaction, somnambulism, trances), as well as the gradual development of personality changes characteristic of epilepsy and (or ) characteristic epileptic dementia. We are talking about epilepsy only if these mental changes occur, which happens in a minority of cases. In some cases, epileptic psychoses are also observed, which occur acutely or chronically and are manifested by such affective disorders as fear, melancholy, aggressiveness or increased -ecstatic mood, as well as delirium, hallucinations. If the occurrence of epileptic seizures has a proven connection with somatic pathology, then we are talking about symptomatic epilepsy. In addition, within the framework of epilepsy, so-called temporal lobe epilepsy is often distinguished, in which the convulsive focus is localized in the temporal lobe. This identification is determined by the characteristics of clinical manifestations characteristic of the localization of the seizure focus in the temporal lobe of the brain.

In some cases, seizures complicate the course of a neurological or somatic disease or brain injury.

Attitude to epilepsy

The ancient Greeks and Romans attributed epilepsy to divine intervention - "Hercules' disease", "divine disease", "epileptic disease". Also, one of the medieval manuals for summoning spirits says that if the preparation for the ritual is improper, the magician can die, experiencing an epileptic and apoplectic stroke. People with epilepsy continue to be widely stigmatized. This can affect people economically, socially and culturally. Until 1970, the UK had laws that prevented people with epilepsy from getting married. Even now, many countries do not allow people, even with well-controlled epilepsy, to drive a car or choose various professions without good reason. In developed countries, people with well-controlled epilepsy can usually work as teachers, health care workers and as actors. In Russia, this diagnosis is an absolute contraindication for work in these areas

Terminology

• The term epilepsy
  refers to recurrent seizures, which have been defined as sudden, excessive excitation of neurons in the cerebral cortex.
• A convulsive attack
  is manifested by motor disturbances.
• Epileptic seizures
  is the most appropriate term, since seizures are purely sensory (akinetic, that is, without motor disturbances).

Classification of attacks

Epileptic seizures can have different manifestations depending on the etiology, localization of the lesion, and EEG characteristics of the level of maturity of the nervous system at the time of the attack. Numerous classifications are based on these and other characteristics. However, from a practical point of view, it makes sense to distinguish two categories:

Primary generalized seizures

Primary generalized seizures are bilaterally symmetrical, without focal manifestations at the time of occurrence. These include two types:

• tonic-clonic seizures (grand mal)
• absence seizures (petit mal) are short periods of loss of consciousness.

Partial seizures

Partial or focal seizures are the most common manifestation of epilepsy. They arise when nerve cells are damaged in a specific area of ​​one of the brain hemispheres and are divided into simple partial, complex partial and secondary generalized.

• simple - with such seizures there is no impairment of consciousness
• complex - attacks with a disturbance or change in consciousness, caused by areas of overexcitation of various localizations and often become generalized.
• secondary generalized seizures - typically begin in the form of a convulsive or non-convulsive partial seizure or absence seizure, followed by a bilateral spread of convulsive motor activity to all muscle groups.

What is an epileptic seizure?

This word refers to a condition when an abnormal “focus” is formed in the brain. Neurons form a zone of pathological excitation, which leads to disruption of the entire central nervous system. The seizure is accompanied by a disorder of consciousness, convulsive contractions of the body muscles, and a sensitivity disorder.

Epilepsy is a chronic disease. To make a diagnosis, the patient must have two or more unprovoked seizures. The time period between them should be at least a day. Seizures have a similar clinical picture and occur against a background of well-being.

Epilepsy is of the following types:

• Idiopathic (occurring against the background of complete health and without an apparent organic cause);
• Symptomatic (manifested by seizures against the background of a serious pathology - stroke, tumor);
• Cryptogenic (the causes of the disease have not been established).

Classification of seizures

Seizures differ in their manifestations. There are several types of seizures. We describe their main differences below.

With a generalized onset

1. Originate from both hemispheres;
2. There is no awareness of actions after the onset of a seizure;
3. Consciousness is impaired.

Among seizures with a generalized onset, there are motor and non-motor manifestations.

Motor types of seizures

Non-motor species

Addition! Petite seizures include propulsive and retropulsive seizures. In the first case, uncontrolled forward movements of the body appear, in the second case, backward movements.

Seizures with focal manifestations

• The focus of excitation occurs only in one hemisphere;
• Symptoms appear discretely.

Focal/local/partial seizures can occur with loss of consciousness (complex partial seizures) or without loss of consciousness (simple partial seizures). Focal or local seizures can be classified by type of seizure (tonic, clonic) or by clinical manifestations:

• Vegetative problems (hot flashes, feeling hot/cold, agitation);
• Lethargy (temporary cessation of motor activity);
• Cognitive disorders (déjà vu, hallucinations, illusions);
• Emotional dysfunction (fear, anxiety, joy for no reason);
• Sensory attacks (violation of visual, auditory, olfactory, taste sensations).

Addition! There are partial seizures with secondary generalization. The seizure begins as a focal one, and then becomes tonic-clonic (excitation spreads to both hemispheres).

ICD 10

The classification of epilepsy is very complex. Every year, the approach to this issue is discussed at conferences and neurological forums. Here we present the classification of the disease code presented in ICD 10. It serves to facilitate international understanding of the cause and form of pathology.

Attention! The condition following other types of seizures is classified as “convulsive syndrome” and has a code of 56.8.