Can epilepsy go away with age? Myths and truth about the “moon” disease. Therapeutic exercises for epilepsy Can epileptics play sports?

Epilepsy is one of the most common diseases of the central nervous system. Neurological manifestations are associated with disruption of bursts and signals in the functioning of neurons.

The disease is chronic and does not depend on the age and gender of the patient. To date, there is no cure for this serious illness. However, with a mild form of the course, long-term remission is possible. Taking into account and following all recommendations and carrying out a set of therapies.

Episyndrome is the occurrence of all manifestations of epilepsy without disturbances in the functioning of neurons and caused by a completely different disease. Episyndrome has a second name: symptomatic epilepsy, due to similar symptoms. It can be chronic and can be treated depending on the original disease that caused the episyndrome.

Only by learning the characteristics of the course and occurrence of diseases can one determine the difference between epilepsy and episyndrome.

Episyndrome is not a reason for exemption from military conscription. And it is not regulated by Article 21 of the schedule of diseases. Epilepsy is regulated, and an epileptic is not drafted into the army.

Episyndrome often occurs in patients with schizophrenia and manifests itself. Epilepsy is excluded in this case. It is unknown for what reasons, these diseases do not affect the central nervous system at the same time.

The causes of episyndrome can be:

Mechanical head injuries;
Tumor diseases of the brain;
Inflammatory processes in the brain;
Birth injuries;
Age-related changes in the vascular system;
Diseases associated with pathologies of neurons and the nervous system;

If symptoms occur, a person needs first aid. The symptoms of episyndrome manifest themselves depending on the area of pathology in the brain. There are 3 main types:

The parietal type of episyndrome is in turn divided into posterior, anterior and inferior affected areas. Manifests itself in numbness of the limbs, loss of orientation and balance, confusion and consciousness;
The frontal type of episyndrome manifests itself in painful movements of the fingers, convulsions and numbness of the limbs, foaming and rolling of the eyeballs. Before the symptom, the patient may experience various odors in the form of a hallucination. Speech disorders, convulsive stuttering and frontal epilepsy originate from pathologies in one area of the brain;
The temporal type of episyndrome is expressed in visual and olfactory hallucinations, loss of coordination, feelings of euphoria and apathy, loss of reality, nausea, abdominal pain, sleepwalking, fever;

Symptoms of episyndrome in children are usually more pronounced due to imperfect development of the nervous and vascular systems. If episyndrome occurs in children, the doctor prescribes measures such as:

Establishing potassium-calcium metabolism in the body;
Following a diet with high fat and low protein intake;
Taking antipyretic drugs;
Treatment with decoctions, herbs and homeopathic therapy;
Procedures in the physiological room;

Sport

Is it possible for a child to study? With epilepsy and episyndrome, sport will only be beneficial. However, combat, aggressive and extreme sports should be avoided. To prevent a blow or surge of adrenaline from triggering a seizure. When choosing a sport, you must follow the recommendations of your doctor.

Episyndrome

When episyndrome occurs in adults, tranquilizers against spasms and sometimes surgical intervention are also used.

A complete cure for episyndrome is possible only if the primary disease is identified and cured.

Causes and manifestations

Epilepsy is often a congenital disease and is characterized by a genetic predisposition. If one of the parents has the disease, the probability of the diagnosis repeating in the child is 40%.

Less commonly, the disease is acquired in nature and occurs when there is a disruption in the functioning of neurons as a result of acquired pathologies of the nervous system. Development may be influenced by factors such as:

Alcohol addiction;
Brain injuries;
Infectious diseases of the brain;
Inflammatory processes;
Stroke;
Encephalopathy and other diseases of the nervous system;
Diabetes mellitus and the development of epilepsy are directly related to sugar consumption. The more sugar a patient eats, the more frequent the attacks or the risk of developing epilepsy in diabetes;

Epilepsy attacks can have severe or mild symptoms. More or less pronounced expression. Common signs include:

Hallucinations and confusion about reality4
Numbness of the limbs and increased muscle tone;
Loss of consciousness. Up to falling into a coma;
Pupil dilation;
Throwing back the head;
Foaming at the mouth and vomiting;
Urinary incontinence;
Convulsions of the limbs and other organs. Including;

Due to the development and area of influence, the disease can be divided into several types:

Temporal lobe epilepsy;
Idiopathic;
Cryptogenic;
Symptomatic;
Alcoholic;

Video

Epileptic seizures are a consequence of paroxysmal pathological discharges in the brain, and this is not at all uncommon - the probability of an epileptic seizure throughout life is ten percent, and epilepsy itself - up to two percent. Despite this, the interaction between epilepsy and the activity of a person’s lifestyle, for example, playing sports, has not yet been sufficiently studied.

Although there is a possibility of seizures or exacerbation of epilepsy during sports activities, it is believed that the risk here is not too great. Although temporary convulsive activity can be initiated by traumatic brain injury, it is not considered a serious risk factor for the activation of epilepsy.

Sports and epilepsy

On the other hand, a reduction in the frequency of seizures has been proven during exercise and active sports. Previously, it was clearly considered a contraindication to sports activities, but research in recent years has made it possible to significantly not only soften the recommendations, but also welcome physical activity.

Currently, most experts believe that playing sports is acceptable provided that appropriate anticonvulsant treatment is carried out in parallel. Consultations with a doctor are required, but the essence of these consultations should mainly boil down to choosing the appropriate sport.

For example, a number of experts insist on excluding underwater sports, parachuting and mountaineering, but not because this can provoke a seizure, but because of the extreme danger of the seizure itself occurring in the conditions of these sports processes. Activities of other types, of course, should also be coordinated with a doctor, and each time the issue of this particular lifestyle should be decided individually.

The benefits of physical activity

Movement is absolutely necessary for a person. This is not only a serious factor in promoting health, but also a source of positive emotions, fighting depression, bad mood and irritability. A large number of people who are forced to exclude physical activity due to their illness do not easily tolerate this condition, which, in turn, worsens the patient’s condition in the form of negative emotional stress.

This also includes epilepsy. Refusal to exercise due to epilepsy especially affects children. Certificates exempting children suffering from epilepsy from physical education lessons are a blow to their own health; another thing is that we may be talking about some special selection of exercises, which, by the way, may not exclude the amount of physical activity necessary for a healthy child.

After all, a baby with epilepsy is an ordinary child with the same childhood needs for running, movement and development. The nature of epilepsy is such that it seems to be on its own, and life is on its own, and it is extremely difficult to provoke it. In other words, with epilepsy you can do anything and take part in sports, provided that at the time of the attack the athlete does not find himself in a situation where it will be extremely difficult, or even impossible, for him to provide help.

What sports can you do?

There are no restrictions, for example, on athletics. The patient will only benefit from running, jumping and aerobic exercise. Badminton and tennis, team games, skiing, aerobics, yoga, you can do all this. If an attack occurs during exercise, the likelihood of injury will be the same as in normal life. The occurrence of injuries during an attack is more likely in equestrian sports, cycling, skating and roller skating.

However, if attacks are rare or occur only at night, it is quite possible to engage in such activities. Simply, you should only ride a bicycle away from roads, in a pedestrian area, with a helmet, and the instructor should be aware of the cyclist’s condition.

The same can be said about swimming; you should not do it alone if you have epilepsy. Unfortunately, hockey, football, gymnastics, mountaineering, alpine skiing, parachuting and scuba diving are contraindicated for this disease.

Epilepsyrepresents chronic disease, characterized by repeated, predominantly unprovoked attacks with impairment of motor, sensory, autonomic, mental or mental functions resulting from excessive neural discharges in the gray matter of the cerebral cortex.

Epilepsy - one of the most common diseases in neurology, especially in childhood and adolescence. The incidence (the number of cases of newly diagnosed epilepsy - repeated unprovoked seizures - in 1 year) ranges from 41 to 83 cases per 100,000 children, with a maximum among children of the first year of life - from 100 to 233 cases per 100,000. The prevalence (“cumulative incidence” - the number of patients with active epilepsy at the moment per 1000 population) of epilepsy in the population is high and reaches from 5 to 8 cases per 1000 among children under 15 years of age, and in some regions up to 1%. Studies in recent years have shown the prevalence of epilepsy in the Moscow region - 2.4, in the Leningrad region - 3.0 per 1000 of the total population, and in the Republic of Sakha (Yakutia) - 5.5 per 1000 child population [Guzeva V.I., 2007] .

It has now been established that epilepsy is not a single disease with various attacks, but is divided into separate forms - epileptic syndromes. Epileptic syndromes characterized by a stable relationship between clinical, electrical and anatomical criteria; vary in response to antiepileptic therapy and prognosis. In this regard, in 1989, the International Classification of Epilepsies, Epileptic Syndromes and Similar Diseases was developed. For the first time, the classification was based on a syndromic principle, and not on division into individual attacks. This classification is well known to practical doctors. It should be noted, however, that over the past 18 years, the imperfection of this classification is clearly visible. And in 2001, the International Commission on Classification and Terminology released a draft new classification of epileptic seizures And epileptic syndromes (Epilepsy. - 2001. - V. 42. - N 6. - P. 796-803). This project has not yet received final approval, but is currently recommended for use in clinical practice.

In recent decades Significant progress has been made in the study, diagnosis and treatment of epilepsy. This progress is associated with changes in approaches to the classification of epilepsy and epileptic seizures, with the improvement of methods for diagnosing epilepsy (especially the development of video-EEG monitoring and high-resolution MRI), as well as with the emergence of more than ten new antiepileptic drugs, the creation of which was based on the principles of high efficiency and safety .

Due to progress in the study and treatment of epilepsy, epilepsy is now classified as a curable disease, and in most patients (65-70%) it is possible to achieve cessation of attacks or a significant reduction in their frequency, however, about 30% are cases of epilepsy that are difficult to treat. The persistence of a significant proportion of treatment-resistant epilepsy requires further study of this disease and improvement of methods for its diagnosis and treatment.

Treatment of a patient with epilepsy is a complex and lengthy process, the basic principle of which can be formulated as the desire to achieve maximum effectiveness ( minimizing epileptic seizures or their cessation) and the best possible tolerance of therapy ( minimum side effects). Doctors should know about the latest advances in the field of epileptology, about modern approaches to the diagnosis and treatment of epilepsy. In this case, the maximum effect in treating the patient can be achieved.

However, very much of the treatment of epilepsy depends on effective collaboration between doctor and patient and family members of the patient, from the correct implementation of medical prescriptions, adherence to the regimen, and a positive attitude toward recovery.

This site was created both for doctors and for patients and their loved ones. The purpose of creating the site is to provide doctors with the most complete information on all sections of epileptology, as well as to familiarize patients and their loved ones with the basics of the disease, the principles of its treatment, the requirements for the regimen, the problems faced by the patient and his family members and the possibilities for solving them, and also getting answers to the most important questions about epilepsy .

With deep respect, Professor, Doctor of Medical Sciences, Head of the Clinic of the Institute of Child Neurology and Epilepsy named after St. Luke,

Konstantin Yurievich Mukhin

Epilepsy is a disease known since ancient times. Epilepsy (or, as it was popularly called, falling sickness) is a common disease in childhood. According to statistics, 1% of the population suffers from this disease, and among the pediatric population the prevalence is even higher.

For many years, epilepsy was considered an incurable disease. Currently, due to the advent of new drugs, it is believed that in 60-70% of cases it is possible to achieve a positive result in treatment or completely get rid of this disease. In addition, many benign forms have now been described, in which recovery is always achieved. But along with this, 20-30% of patients have severe malignant forms of epilepsy that cannot be controlled. In this case, the patient’s seizures recur, and, despite all the efforts of doctors, the child may become classified as a disabled child. As a rule, such severe forms of the disease are associated with congenital malformations of the brain, as well as severe congenital and acquired diseases of the nervous system. But still, in general, the prognosis of the disease is favorable, and it largely depends on how aware parents are of this disease and how correctly they follow doctors’ recommendations. The course of epilepsy often depends on the mutual understanding of the doctor and parents. Therefore, it is very important that parents of children suffering from epilepsy know as much as possible about this disease and act as a doctor's assistant. Only through joint efforts can a positive result be achieved.

What is epilepsy?

Epilepsy currently includes a brain disease manifested by repeated epileptic seizures. It must be especially emphasized that epilepsy is not a mental illness, but a brain disease. Many parents are afraid of the diagnosis of epilepsy and prefer to hide it, considering this disease shameful for themselves and others. Actually this is not true. History knows many famous names among people suffering from epilepsy - these are Macedonian, Caesar, Avicenna, Socrates, Peter the Great, Dostoevsky, Nobel, and others. Seizures were not an obstacle to their activities. Epilepsy still affects many people today and does not interfere with their full and fruitful lives. The prerequisite for this is regular visits to the doctor and strict adherence to medical prescriptions and regimen.

The main manifestation of the disease is epileptic seizures. However, not all epileptic seizures are epilepsy. A child may experience epileptic seizures due to fever, which is referred to as febrile seizures, after vaccination, or with severe traumatic brain injury. If you have a single seizure, you should determine its cause and ask your doctor whether it is possible for the seizures to turn into epilepsy. In 20% of children, seizures occur once and subsequently do not transform into epilepsy. But for some children such a transition may occur. Therefore, a child with a single epileptic seizure should be under medical supervision for a long time.

What are the possible causes of epilepsy?

The range of diseases in which the development of seizures is possible is extremely diverse and includes both genetically determined diseases and the consequences of various infections, intoxications, injuries, etc.

The structure of diseases in which the development of convulsive conditions is possible is very extensive:

Congenital brain abnormalities (cerebral dysgenesis).
Intrauterine infections: cytomegaly, toxoplasmosis, syphilis, rubella, herpes and others.
Chromosomal syndromes: Down's disease and others.
Hereditary metabolic defects - aminoacidopathy (phenylketonuria, hyperglycinemia, leucinosis), organic aciduria and acidemia, mitochondrial encephalomyopathy, peroxisomal diseases, hereditary diseases of lipid and carbohydrate metabolism, pyridoxine-dependent seizures, biotinidase deficiency and others.
Hereditary neurocutaneous syndromes - tuberous sclerosis, neurofibromatosis and others.
Perinatal lesions of the nervous system: hypoxic-ischemic encephalopathy, intracranial hemorrhage and others.
Neuroinfections (meningitis, encephalitis, meningoencephalitis).
General infectious diseases (influenza, pneumonia, acute respiratory infection, sepsis and others).
Post-vaccination convulsive conditions.
Traumatic brain injury.
Metabolic disorders: hypoglycemia, hypocalcemia, hypomagnesemia, hyperbilirubinemia and others.
Toxic effects on the central nervous system - acute poisoning with carbon monoxide, poisonous mushrooms; bilirubin encephalopathy, withdrawal syndrome associated with a pregnant woman taking narcotic drugs.
Vascular diseases of the central nervous system (stroke, aneurysms).
Brain tumors.

All of the above conditions can cause the development of seizures and epilepsy. Therefore, the child needs a full examination in connection with the development of an epileptic seizure and consultation with many specialists (geneticist, infectious disease specialist and others). However, the scope of the necessary examination is determined by an epileptologist or neurologist.

If, as a result of the examination, it is possible to establish the cause of the seizures, then in this case we are talking about symptomatic seizures or symptomatic epilepsy. The doctor decides on the tactics of patient management in the future. But in some patients it is not possible to determine the cause of the disease. In this case, these forms of the disease are called idiopathic (when the main role in the development of the disease is played by hereditary predisposition) or cryptogenic (when any disorders are clinically determined, but nothing is detected during examination).

Thus, finding the cause of epilepsy is quite difficult and requires considerable effort on the part of the doctor and parents. It is currently believed that the development of epilepsy in most cases is associated with a hereditary predisposition to this disease, which occurs as a result of adverse effects on the child, such as damage to the nervous system during pregnancy and childbirth, the influence of past infections, injuries, intoxications, etc. These diseases seem to be triggers for the development of epilepsy, but they are not its true cause.

How does epilepsy manifest itself?

According to clinical manifestations, all convulsive paroxysms are divided into generalized and partial (focal).

Generalized seizures characterized by clinical signs indicating involvement of both hemispheres of the brain in the pathological process.

For partial seizures clinical signs indicate damage to a specific area or areas of one hemisphere of the brain.

Generalized convulsive paroxysms, in turn, are divided into

absence seizures,
myoclonic,
clonic,
tonic,
tonic-clonic and
atonic (astatic) attacks.

In most cases, generalized attacks occur with loss of consciousness.

Absence seizures (previously called “small attacks”, petit mal) are characterized by a sudden onset and end, complete but short-term (5-15 s) loss of consciousness; stopping gaze; interruption of voluntary motor activity.

Myoclonic seizures manifest themselves in the form of sudden, rapid contractions of individual muscles or muscle groups. Severe myoclonic twitching of the muscles of the limbs or trunk can sometimes lead to the patient falling or pronounced flexion of the body (“Salaam nods” or infantile spasms in young children).

Clonic paroxysms characterized by repeated rhythmic twitching of the limbs, facial muscles or torso. During the attack, the frequency of twitching decreases, while the amplitude remains constant.

Typical for tonic attacks is a pronounced involuntary muscle contraction that fixes the limbs in a tense position. Usually there is a deviation of the eyes and head to one side, and this may be accompanied by a rotation of the entire body.

Tonic-clonic seizures , previously called “grand attacks” (grand mal), are characterized by a sudden loss of consciousness, often falling and screaming, rolling of the eyes, as well as a tonic phase with muscle tension of the whole body with stretching of the limbs and cyanosis of the face, biting the tongue. Then comes the clonic phase - rhythmic twitching of the upper and lower extremities and post-attack sleep.

Atonic attacks characterized by a sudden decrease in muscle tone throughout the body or individual parts of the body, which may be accompanied by a fall.

Partial paroxysms are divided into simple and complex.

Simple partial seizures occur with preserved consciousness and can be accompanied by motor (clonic twitching of the muscles of the face and limbs, turning the head and eyes to the side, stopping speech), autonomic (pallor, redness of the face, vomiting, sweating, dilated pupils) and somatosensory (numbness, a feeling of “crawling goosebumps” ", dizziness, visual, auditory, olfactory, gustatory phenomena) symptoms.

Main clinical manifestations complex partial paroxysms are : complete or partial loss of consciousness, the presence of an aura and automatisms, as well as a variety of motor, sensory, mental (illusions, hallucinations, dream-like states, disturbances of perception) and affective (fear, anger, etc.) symptoms. Aura refers to the part of the attack that precedes the loss of consciousness, which the patient remembers after its recovery.

It is very important for parents to correctly describe the seizure that occurred in their child, because the prescription of treatment and, ultimately, the outcome of the disease depend on this.

A detailed description of an epileptic attack is carried out according to the following scheme:

the patient's behavior before the onset of the attack;
onset of attack (sudden, gradual);
the presence of an aura (premonition of an attack);
time of occurrence of paroxysm (sleep, wakefulness, the first hours after awakening, etc.);
course of the attack (position of the head, eyes, movements of the limbs, changes in muscle tone, changes in complexion, pupil size);
the presence of stereotypical movements (automatisms);
state of consciousness at the time of the attack;
end of the attack (sudden, gradual);
duration of paroxysm;
the patient’s behavior after the attack (confusion, disorientation, sleep);
frequency of attacks.

Often parents are confused and cannot accurately describe the seizure. In this case, it is necessary to ask everyone around who saw how the attack proceeded, and pass this information on to the treating doctor.

Often, during the course of the disease, epileptic seizures can change their manifestations, so it is very important for parents to record all incomprehensible symptoms and report this to the doctor in time.

What tests are done for epilepsy?

The diagnosis of epilepsy is established on the basis of the clinical picture - the presence of epileptic seizures. In a number of patients, the diagnosis is established based on the parents' story about how the attacks proceeded. And in some patients it is necessary to resort to video recording of seizures to ensure the correct diagnosis. Therefore, the doctor often asks parents to carefully observe the child at home and record all manifestations that are incomprehensible from their point of view on a video camera in order to watch them together with the doctor.

The diagnosis of epilepsy also requires the recording of an electroencephalogram (EEG). EEG is a method of recording the patient’s own bioelectrical activity of the brain. It is an absolutely harmless method that allows you to establish the correct form of epilepsy and monitor the effectiveness of treatment. The EEG is recorded while the child is awake; if necessary, recording is carried out during sleep, during an attack or in the interictal period.

Currently, devices have appeared that are capable of simultaneous recording of EEG and video recording of the patient. This allows the doctor to objectively see epileptic seizures and analyze EEG data during this period. This diagnostic method is called video-EEG monitoring. Fortunately, this diagnostic method has now become available to most patients. It should be emphasized that video-EEG monitoring is not necessary for every patient, but only in complex diagnostic cases. In most cases, the correct diagnosis can be made by analyzing clinical data and EEG examination data.

In addition to the above-mentioned neurophysiological research methods, each patient with a single epileptic seizure or epilepsy undergoes neuroimaging research methods to see the structure of the brain. These methods include computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. The above methods allow us to see brain tumors, cysts, congenital malformations and other structural changes that may cause epilepsy. If focal changes are detected during a neuroimaging examination, the issue of patient management tactics and the possibility of neurosurgical treatment is decided together with a neurosurgeon.

If, according to neuroimaging studies, there are no changes in the brain, then this indicates a more benign course and favorable prognosis of epilepsy.

In some cases, it is necessary to carry out other research methods - biochemical, genetic, etc., in order to find the causes of epilepsy. The range of necessary examination methods is determined by an epileptologist in each specific case.

Treatment of epilepsy

One of the fundamental questions is: Who should treat a patient with seizures? As is known, in pediatric practice, when parents experience seizures in their child, they turn to a pediatrician or neurologist. This doctor takes responsibility for the fate of the child when deciding on treatment. Children with epilepsy receive the main treatment on an outpatient basis. Highly qualified medical care for patients in need of inpatient treatment is provided in the neurological departments of children's hospitals, where issues of diagnosis and treatment of the disease are resolved.

In many countries of the world, epileptology has become an independent discipline. Accordingly, the specialty of an epileptologist has been identified. Epileptologists, as a rule, work in antiepileptic centers, which are created to provide highly qualified care to patients with epilepsy. The work of the centers makes it possible to create a standard approach to the diagnosis and treatment of this pathology.

It should immediately be emphasized that antiepileptic centers do not replace the work of existing treatment and preventive institutions providing care to patients with epilepsy. The centers coordinate the activities of all levels of pediatric and neurological services, neurologists at children's clinics in the city, providing services to patients with epilepsy and other convulsive conditions. On the basis of antiepileptic centers, highly specialized advisory, therapeutic and psychological assistance is provided to patients with epilepsy and other convulsive conditions, a full diagnostic examination of patients is organized, issues are resolved regarding the referral of patients with drug-resistant forms of epilepsy for treatment in large specialized centers of the Russian Federation, as well as for neurosurgical treatment.

The antiepileptic center provides inpatient treatment and examination, as well as advisory assistance. In this case, the diagnosis of the disease and the organization of the treatment process are carried out jointly with a neurologist at the children's clinic. In order to clarify the genesis of the disease, its severity, characteristics of the course and identify concomitant pathologies, specialized pediatric services are involved. The recommendations of the World Anti-Epileptic League for the diagnosis and treatment of epilepsy are accepted as criteria for developing a treatment strategy for patients with epilepsy.

Thus, the patient is under the supervision of a neurologist at children's clinics together with an epileptologist at the antiepileptic center.

How is epilepsy treated?

Epilepsy is treated only with antiepileptic drugs (AEDs)! All parents should know about this; there are no alternative treatments for the disease. Alternative methods include only neurosurgical treatment in special cases. Taking medications for a patient should become a matter of course.

Treatment of a single attack with anticonvulsants is not carried out. Prescription of antiepileptic drugs for the purpose of prevention is not indicated! The terms “pre-epilepsy” and “preventive treatment of epilepsy” are not currently used and are considered absurd.

Treatment with AEDs in the case of a first epileptic seizure is possible only in rare cases and should be strictly justified. The attending physician decides to prescribe therapy immediately after the first attack if there are certain indications.

Treatment of epilepsy is carried out in accordance with international standards presented below.

Treatment of epilepsy begins after an accurate diagnosis has been established, i.e. after a repeated unprovoked epileptic seizure.
Treatment is prescribed depending on the form of epilepsy and the nature of the attacks.
Treatment begins with monotherapy (i.e. treatment with one drug).
Treatment should be carried out using age-appropriate dosages of AEDs.
If the drug is ineffective, it should be gradually discontinued and replaced with another.
If monotherapy is ineffective, they switch to polytherapy (i.e., combined prescription of 2 or even 3 drugs).

The goals of therapy are:

Complete cessation of seizures.
Minimum side effects when using therapy.
Improve the quality of life of a sick child.

The selection of AEDs should not be empirical. The success of epilepsy treatment is largely determined by the accuracy of syndromological diagnosis. Treatment is prescribed depending on the form of epilepsy and the nature of the attacks. In this regard, it is important to correctly determine the nature of the attacks. The attacks should be carefully described by the parents or presented to the doctor in the form of a video recording.

The principle of monotherapy. Relief of epileptic seizures should be carried out primarily with one drug. Polytherapy, i.e. the prescription of two or even three drugs is justified only in the case of resistant (not responding to treatment with one drug) forms of epilepsy and no more than three AEDs at the same time.

Treatment should be carried out using age-appropriate dosages . AEDs are prescribed starting with a small dose, with a gradual increase until a therapeutic effect is achieved or the first signs of side effects appear. In this case, the clinical effectiveness and tolerability of the drug are decisive.

If one drug is ineffective, it should be gradually replaced by another AED that is effective for this form of epilepsy. A gradual transition to monotherapy with another AED when one of the AEDs is ineffective is called alternative monotherapy.

Cancellation of the anticonvulsant drug should be gradual, taking into account the form of epilepsy and prognosis, the possibility of resumption of seizures, and the individual characteristics of the patient.

Cancellation of AED therapy is usually carried out no less than 2–4 years after the complete cessation of seizures. The leading criterion is the clinical one.

If there is epiactivity on the EEG in the absence of seizures for 3 years, the withdrawal of antiepileptic therapy can be delayed for a period of 6 months - 1 year. If the EEG does not normalize, AEDs should still be discontinued no later than 4 years of complete remission.

In most idiopathic forms of epilepsy, drug withdrawal can be carried out after 2.5 - 3 years of remission. In severe resistant forms (Lennox–Gastaut syndrome, symptomatic partial epilepsy), as well as in juvenile myoclonic epilepsy, this period increases to 3–4 years.

With complete therapeutic remission within 4 years, treatment should be discontinued in all cases.

The presence of changes in the EEG and puberty of patients is not a contraindication to discontinuation of AEDs in the absence of attacks for more than 4 years.

Cancellation of AEDs at the end of treatment can be carried out either gradually over 1-12 months or simultaneously.

Epilepsy is a disease that requires emergency care. Therefore, parents should be able to provide first aid to their child if an epileptic seizure occurs.

There are certain rules of behavior for parents during an epileptic attack in a child. When an attack occurs:

unbutton the collar and free yourself from tight clothing;
remove foreign objects from the oral cavity;
put the child on his back and turn his head to the side;
do not try to unclench your jaws using any objects;
do not give any medications or liquids by mouth;
measure temperature;
carefully monitor the course of the attack;
stay near the child until the attack completely stops.

People around you should not react to a seizure with fear or agitation. In most cases, the child does not remember what happened to him during the seizure; the confusion of those around him when he regains consciousness is completely incomprehensible to him.

If an attack occurs, you must immediately call an ambulance and hospitalize the child in a hospital. If the attack lasts more than 15 minutes, this is a serious symptom; in this case, status epilepticus may develop - a condition that threatens the life of the child. Therefore, it is necessary to deliver the child to the hospital as quickly as possible to provide specialized care.

Parents must record each seizure in a child in a special “Seizure Diary.” It notes the date and time of the seizure, and also describes in detail the nature of the seizure; the last column indicates what medications the child receives and in what doses. This diary should be kept throughout your life. Such recording of attacks allows for more effective therapy for this patient. In order not to remind the child of his illness and not to create a constant painful dominant, it is better for parents to keep a diary of epileptic seizures.

The following seven life rules should help you better cope with attacks.

Visit your healthcare provider regularly.

Your visits to the doctor should be regular. Follow his instructions exactly.

Keep a careful calendar of attacks.

Carry it with you. It is an important document for providing correct assistance.

Regular use of medications is crucial.

Any independent changes in dose or omissions of medications cause worsening attacks. Always have a supply of medications. Do not take other medications without consulting your doctor. They can reduce the effect of antiepileptic drugs and, as a result, this provokes seizures. Monitor side effects of medications and tell your doctor promptly if they occur.

Sleep should be sufficient.

Lack of sleep, frequent changes in the time of falling asleep and waking up, as well as excessive sleep can intensify attacks.

Don't drink alcohol.

Alcohol alters the effects of antiepileptic drugs and impairs sleep quality.

Avoid bright, flickering light sources.

Seizures can be caused by: damaged televisions; during a quick transition from darkness to a bright room; glare on the surface of the water; photo effects at the disco; some computer games.

Do not drive vehicles until the attacks stop. People with epilepsy cannot drive a car if they have seizures.

The modern approach to the problem of epilepsy involves solving a wide range of issues: upbringing, education, choice of profession and employment, education and family. This is not a complete list of issues closely related to successful treatment. In recent years, emphasis has been placed on improving the quality of life of patients with epilepsy, reducing their “stigmatization” and discrimination. Therefore, below we present to your attention answers to the most frequently asked questions from parents of children suffering from epilepsy.

How to help the correct social development of a child with epileptic seizures?

Give your child as much independence as possible, as this is the foundation of his future adult life. Of course, it is calmer when the child is always “in front of your eyes,” but it is much more important than your complacency to give your child a chance to become a full-fledged person in the future, who does not need the constant care of loved ones. Just as healthy children independently explore the world and act based on their own experience, children with epilepsy should also explore the world, no matter how difficult it may be for their parents to come to terms with this.

You should never use epilepsy as a reason to avoid any unpleasant or simply undesirable actions for you or your child. In the family, do not make concessions to a child with seizures and do not put him in an exclusive position compared to his brothers and sisters. He can also carry out errands around the house - help with cleaning, washing dishes, etc. Seizures should not be used as a reason for avoiding unpleasant responsibilities. Otherwise, having gotten used to such tricks in childhood, he will continue to want to use them in difficult situations, which, in turn, can lead to mental problems associated with the reluctance to “part with” attacks.

What kind of sport can you do?

Sport is an important and necessary component in the life of any person. Sport is an opportunity for broad contacts with other people, an opportunity to feel and evaluate one’s own strength, dexterity, and skill. In addition, this is a significant step in the formation of independence and vital activity.

However, the decision to engage in a particular sport should be made taking into account not so much their positive aspects as the frequency of attacks, the time of their occurrence and the degree of danger in this regard of the sports discipline itself. If you have frequent attacks, you should not engage in sports that involve the risk of injury, such as gymnastics, acrobatics, boxing, wrestling, horse riding, cycling, diving, scuba diving, alpine skiing, mountaineering. If attacks occur during sleep or upon awakening, you can compromise and choose a sport with a minimal degree of risk, for example, rhythmic gymnastics, aerobics, sports games (football, volleyball, handball).

At school, during physical education lessons, if the child does not have seizures, you can do physical education under the supervision of the teacher.

When is swimming allowed?

For people with epilepsy, swimming activities are significantly limited due to their incompatibility with possible seizures. Having an attack in water is certainly life-threatening, but it should be noted that this happens quite rarely. When allowing a person with epilepsy to swim, the following points must be taken into account:

you should not swim if you have frequent uncontrollable attacks, general malaise, or a premonition of an attack;
Swimming in cold water is not recommended;
you cannot jump into the water from a tower or dive;
it is necessary to choose a quiet time in the pool and avoid large crowds of people and various celebrations on the water;
It is advisable to have a brightly colored swimming cap, which makes it easier to observe those swimming in the water;
Swimming lessons for a person with epilepsy are recommended to be carried out in pairs with another person (the so-called “twin method”) or under someone else’s supervision.

If the observer is not able to provide assistance on the water, then it is preferable to swim in places with shallow depth and at the edge of the pool.

Is it harmful to watch TV?

Watching TV can trigger seizures in about 1% of people with epilepsy who are hypersensitive to light. Such attacks are called photosensitivity. If they are difficult to treat, then when watching TV the following rules must be observed:

be located no closer than 2 meters from the screen;
give preference to smaller TV screen sizes;
use televisions with a high scanning frequency (100 Hz);
position yourself while viewing so that your eye level is not higher than the screen level;
close one eye when viewing kaleidoscopic footage, flashes, flashing pictures to reduce the flickering effect;
Use the remote control to control the TV.

Is it possible to visit discos?

Most young people with epileptic seizures can attend discos. Conventional color-musical effects are safe for them. Seizures can only be triggered by stroboscopic (often flickering) bright lights in a darkened room in people with a photosensitive form of epilepsy. The likelihood of an attack directly depends on the frequency of flickering and the brightness of lighting effects. In addition, it must be remembered that such constant companions of discos as lack of sleep, fatigue and alcohol can also contribute to the occurrence of attacks.

Are video games harmful for children with epilepsy?

Although most experts believe that video games themselves do not cause seizures, games that use high-contrast lighting effects may cause seizures in people with increased sensitivity to flashes of light. During the game, the same rules must be followed as when watching TV or when working on a computer display.

Is it dangerous to work on a computer?

Assumptions about the provoking effect of computer work on attacks are greatly exaggerated. However, for people with increased sensitivity to light flickers, such fears are justified, although they are not a categorical contraindication for working with a computer. With the right treatment and compliance with a number of protective measures, you can not deprive a person of the pleasure (or need) of working at a computer. In this case, it is advisable to follow some rules:

The distance from the eyes to the monitor screen should be at least 35 cm (for 14-inch screens).
The monitor screen should be clean with correctly adjusted image settings.
The computer should be installed in a bright room.
The monitor should be positioned to avoid glare from windows or other light sources.
When choosing a monitor, give preference to the SVGA standard with a scan frequency of at least 60 Hz.
Exclude other monitors or TVs from view.
Avoid programs that use most of the screen as a light background, or reduce the working window of the program by changing the background of the window to a less contrasting one (preferably with green tones).
Avoid looking at small details of the image on the screen at close range.
Try not to work at the computer when excited or overtired, lacking sleep, or under the influence of alcohol.

It should be borne in mind that the computer can become an important factor in the social development of a person with epileptic seizures. A computer makes it possible to work with educational and creative programs, obtain information of interest, communicate with peers and much more, without which it is difficult to imagine modern life. In addition, computer skills have increasingly become a job requirement in recent years.

Is it possible to drink alcohol?

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

Is it possible to smoke?

Smoking is harmful - it is well known. There was no direct connection between smoking and the occurrence of attacks. But there is a fire hazard if an attack occurs while smoking unattended. Women with epilepsy should not smoke during pregnancy, so as not to increase the risk (already high) of malformations in the child.

What behavioral problems may occur?

The first place in frequency of occurrence in children suffering from epilepsy is occupied by asthenic conditions (weakness, fatigue, decreased performance, etc.).

In second place are behavioral disorders.

The next group consists of so-called affective disorders, i.e. state of excitement.

The types of disorders listed above can be combined in one patient, or they can act as a single manifestation.

Let's look at behavioral disorders in more detail.

Behavioral disorders in children with epilepsy are associated, on the one hand, with the disease, and on the other hand, due to the characteristics of upbringing and the child’s family. Frequent conflicts in the family, lack of coordinated actions of parents in raising a child can lead to behavioral disorders.

For a child with epilepsy, ordinary stimuli can be overwhelming and throw him off balance. Often, even a minor reason can lead to an inappropriate emotional outburst. Young children are often capricious, cry, and at an older age they are rude, sometimes commit destructive actions and aggressive acts.

The most common behavior disorder is disinhibition: children are irritable, agitated, restless, overly mobile, and do not remain quiet for a minute. Everything that is in their field of vision does not go unnoticed. Sometimes it's hard to understand what they want.

Disinhibition manifests itself not only in movements, but also in speech, desires, emotions, and in all behavior. These violations manifest themselves even more strongly when there are defects in upbringing - the fulfillment of all the desires and whims of the child immediately.

In some cases, disinhibition reaches such a degree that patients cannot be left unattended for a minute.

The opposite form of behavior disorder is hypoactivity. These children are inactive. They have difficulty adapting to life. Even in simple life situations they find themselves helpless.

There may be a variant of contrasting behavior of the child. At school the patient is obedient, but at home he is disinhibited and despotic.

In adolescents, behavioral disorders can reach a significant degree of severity. In this case, an abnormal personality is formed, selfish, with an overestimation of one’s self. Such teenagers demand that their parents buy expensive fashionable things, although they themselves have not yet earned money.

Some of the teenagers, considered “difficult” at home, are transformed in the hospital, imitate those around them, and carry out all medical prescriptions.

Others behave as “difficult” not only at home, but also at school and in hospital. Such children are uncontrollable and conflict over trifles. They can tune other children in their own way. Their behavior is the result not so much of illness as of promiscuity, a lack of respect for others.

Behavioral disorders sometimes develop as a result of misconceptions about epilepsy as an incurable disease.

For example, when patients are told that they will have to take medications for the rest of their lives and strictly adhere to numerous restrictions, they often experience depression, i.e. persistent depression of mood. Sometimes patients refuse treatment altogether, which is dangerous for their lives. Parents, due to misconceptions about epilepsy, sometimes paint a gloomy picture of their child’s future, excessively pity and care for him, which also affects his behavior.

Behavioral disorders act as a factor complicating the treatment of epilepsy, thereby aggravating its course.

Taking into account all of the above, the child’s behavior is largely determined by the parents. Whether the patient develops behavioral disorders or not depends, first of all, on the family in which the child is raised.

Therefore, parents should establish a trusting relationship with the child’s attending physician. They must clearly understand that epilepsy is a disease like many others. None of the family members are to blame for the child’s illness.

There is absolutely no point in complaining all the time. If a child is sick, everything must be done to help him. You should not emphasize the child's shortcomings. It is unacceptable to shout at him or use corporal punishment. But one cannot forgive him for his misdeeds. Only an even, calm attitude towards the child will allow parents to avoid manifestations of behavior disorders in him. It is necessary to adapt the child to the team. Most children with epilepsy can and should receive education.

Parents should remember that constant guardianship leads to the development of selfishness in the child. Therefore, it is very important to instill in your child kindness and care for others. If there are younger children in the family, it is necessary to involve the child in their care. If the patient is the only child in the family, then it is important to instill in him a love of birds and animals. Help and care, feeding and caring for animals are a good way to prevent selfishness and aggressiveness in children.

Children with epilepsy are often sensitive. Some parents make it worse by isolating their children from their peers and not allowing them to play with other children for fear of an attack. Removing children from games, entertainment, and depriving them of communication with peers contributes to mental devastation.

If a teenager has epilepsy, then it is very important for parents to correctly explain to him the essence of the disease and the need to follow certain rules in life. Persuasion and conversation “on equal terms” are more convincing than an imperative tone. Everything must be reasoned, clearly formulated, so that it is extremely clear to the teenager: this is possible, but this really is not possible.

Parents must remember that all education begins with the example they set. No matter what parents and educators say, no matter what noble thoughts and beliefs they develop, these thoughts and beliefs will not have a beneficial effect on the child if they are not reinforced by the appropriate behavior of others.

In order to significantly reduce the number of restrictions and prohibitions established for children with epilepsy, it is necessary, first of all, to increase the level of education of both the family and society as a whole. It is necessary to constantly encourage children to engage in various active activities that do not pose a danger to their health.

What are self-help groups for?

Self-help groups exist in many countries. They unite both the people themselves and their close relatives.

Interaction with people who have a similar illness reduces the feeling of rejection, loneliness, isolation, and also solves the problem of contacts. One of the most important goals that self-help groups for patients with epilepsy set for themselves is their psychological adaptation in life.

In this regard, as part of the work to optimize care for children with epilepsy in Nizhny Novgorod, since March 2000, an educational program for parents has been conducted - “School for parents of children suffering from epilepsy.” The goal of this educational program is to improve the quality of life of children with epilepsy.

The main objectives of the school are to achieve more complete control over the patient’s condition; acquaintance of parents of a child with epilepsy with the causes of this disease, its signs and treatment options.

The role of parents in the fight against this disease is extremely responsible. It would not be an exaggeration to say that the success of treating a child with epilepsy depends no less on the parents than on the doctor. Treatment of this disease requires long-term coordinated efforts of the doctor and parents. Parents should be well aware of their role in teaching and raising a child with epilepsy. By immaculately carrying out everything that is necessary in connection with the child’s illness, parents fulfill their noble duty to their children.

During classes at school, parents get acquainted with modern data about epilepsy, treatment options for the disease, and learn the correct actions in case of a sudden epileptic attack in a child. Classes are taught by highly qualified pediatric neurologists, employees of the Nizhny Novgorod State Medical Academy. After attending a full cycle of classes, parents are given a certificate and a passport of a patient with epilepsy (at the request of the parents).