Types of epilepsy. How is epilepsy related to sex life? Damage in the temporal lobe

Epilepsy is a chronic nervous disease that manifests itself in convulsions, seizures and is often accompanied by loss of consciousness.

To understand how to treat this disease, it is necessary to study the types of epilepsy and the symptoms of the disease, as well as the reasons for the development of this type of pathology.

To understand why epilepsy appears, it is necessary to understand its nature. As you know, the transmitters of signals in the nervous system are electrical impulses. "Extra" impulses can also appear in normal conditions, however, the structures located in the brain do an excellent job with the task of "repaying" them.

The cause of congenital epilepsy is the genetic defects of these structures.

Such genetic defects do not appear by themselves.

Their reasons lie in:

• birth trauma Oh;
• infections in the prenatal period (toxoplasmosis, herpes, rubella);
• hypoxia during pregnancy.

The cause of acquired epilepsy is the effect on the brain negative factors. The result of such exposure is the formation of an epileptic focus, which generates an excessive electrical impulse.

For some time, antiepileptic structures manage to “extinguish” the impulse, but after that the protection weakens, and the disease makes itself felt with the first attack. Over time, seizures appear more and more often.

Causes of acquired epilepsy include:

• traumatic brain injury;
• drug addiction, chronic alcoholism;
• multiple sclerosis;
• side effects of certain drugs (antidepressants, antipsychotics, antibiotics);
• stroke;
• neoplasms in the brain;
• infectious lesions of the nervous system (encephalitis, meningitis);
• underdevelopment of some brain structures, acquired in the prenatal period and not considered within the framework of congenital epilepsy.

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hereditary factor

Epilepsy is a disease that can be inherited.

Moreover, only the congenital form of the disease is transmitted from parents to children. The disorders that cause acquired epilepsy are not remembered at the gene level.

If the disease is congenital, the person's offspring inherit the gene for the disease. However, in this case, children can remain healthy.

The fact is that the gene determines the readiness of the brain for convulsive activity, but here other acquired and hereditary factors should be taken into account.

So a person suffering from a congenital form of epilepsy can have absolutely healthy children. It often happens that the disease reminds of itself after several generations. If both parents are carriers of the gene, the likelihood of the disease in the child increases.

The possibility of the appearance of the disease also depends on the psychotype of a person, his lifestyle. For a detailed consultation, you should talk to a neurologist and undergo a complete diagnosis.

epileptic seizure

An epileptic seizure is a convulsive attack, accompanied by a loss / impairment of consciousness, which occurs when there is a violation electrical activity brain.

It is generally accepted that during an attack a person slides to the ground, begins to convulse. However, this is not always the case.

Light seizures can remain invisible to others and to the patient himself. In this case, barely noticeable signs “speak” about the attack - twitching of the face and eyelids.

Often a seizure is preceded by a condition called an aura. The manifestations of this condition depend on where in the brain the epileptogenic focus is located. As a rule, the aura makes itself felt by fever, numbness of body parts, anxiety, hallucinations, dizziness, etc.

In some cases, epileptic seizures are accompanied by urinary incontinence, temporary lack of breathing, foam from the mouth, inarticulate screams, salivation. It is important to understand that during an attack the patient does not feel pain and is not aware of anything.

A particular danger lies in several seizures following one after another. This condition is called status epilepticus. It is deadly and requires immediate medical attention. Status epilepticus can cause lethal outcome: during attacks, a person stops breathing, which is fraught with suffocation.

First aid for a seizure

Procedure during an attack:

• place the patient on a flat surface, raise his head and put it on something soft;
• turn the person's head to the side to prevent saliva from entering the Airways and falling of the tongue;
• when vomiting occurs, turn the entire body of the patient on its side;
• do not massage the heart and artificial respiration;
• do not try to restrain convulsions by force;
• do not unclench your teeth;
• if the jaws are unclenched, put a tissue folded several times between them;
• do not move the patient from the place where he had an attack (with the exception of places that are dangerous to life and health, for example, the roadway);
• call an ambulance (medical intervention will be required in case of a prolonged attack or several seizures following one after another).

After an attack, a person experiences headache and weakness, which may be accompanied by confusion. It is necessary to provide the patient with rest for 5-30 minutes.

Types of epileptic seizures

Science knows at least 30 different seizures (seizures) of epilepsy. All of them are included in two main groups - focal and generalized.

The cause of focal seizures is abnormal impulses in one part of the brain.

With simple seizures, a person does not lose consciousness, but experiences unusual sensations (inexplicable joy, anger, fear, longing).

In complex seizures, there is a violation / loss of consciousness. It may seem to others that the patient is thinking or sleeping. Often there are strange blinking, twitching, walking in circles, mouth movements. Such repetitive movements are called automatism.

Generalized seizures occur due to abnormal neural activity in two parts of the brain. Often seizures are accompanied by fainting, loss of consciousness, severe muscle spasms.

The most common types of epilepsy

It is characterized by a benign course, as well as a favorable prognosis. The brain substance in this case is not damaged.

The reason for the attacks lies in the increase in the electrical activity of neurons and, accordingly, the excitability of the brain. The hallmark of congenital epilepsy is total loss consciousness during seizures.

Acquired epilepsy can appear at any age. It develops under the influence of external factors that provoke the occurrence of structural / metabolic disorders of the brain. Attacks of symptomatic epilepsy are not accompanied by loss of consciousness, but the person loses the ability to control some parts of his body.

Today, about 50 million people worldwide suffer from epilepsy. In 70% of cases, the disease is successfully treatable. With the help of special drugs, doctors are able to fully control epileptic seizures.

According to statistics, after the age of 45, many people begin to complain of memory problems. It may be associated with both diseases and age-related changes in the brain. help to forget about this problem.

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Chronic progressive epilepsy is one of the variants of focal motor seizures.

The location of the epileptogenic focus is the primary zone of the motor cortex.

The main symptom that allows diagnosing this subspecies of the disease is epilepsia partialis continua.

Frontal

Frontal epilepsy is characterized by the location of the affected area of ​​the brain, provoking the appearance of seizures in its frontal lobes. With this type of disease, the attack manifests itself mainly during sleep. It is accompanied by automatic gestures and slurred speech.

The nocturnal form of frontal epilepsy stands out separately, which has the following options:

• sleepwalking;
• enuresis;
• parasomnia.

Parietal

The parietal form of epilepsy is the most rare. Signals that provoke seizures come from the parietal part of the brain.

There are such manifestations:

• sensations in the body of burning and tingling, similar to the action of an electric current discharge;
• false sensation of movement of the arm or leg;
• attacks of impaired speech with full preservation of consciousness;
• bouts of dizziness.

temporal

Temporal lobe epilepsy occurs when the lesion is located in the temporal lobes of the brain.

Symptoms of the disease manifest themselves in the form of polymorphic paroxysms, which are expressed as:

• false sensations of damage to internal organs;
• visual and olfactory disorders;
• derealization of reality;
• changes in the realism of consciousness;
• performing unmotivated actions.

Occipital

With the occipital form of the disease, an epileptic seizure occurs as a result of a signal coming from the occipital region of the brain.

Clinical symptoms appear as:

• visual disturbances;
• oculomotor disorders;
• autonomic disorders;
• associative phenomena.

Often, occipital epilepsy is accompanied by visual defects.

idiopathic

The idiopathic form of epilepsy is caused by a change in the work of neurons, based on an increase in their level of excitability and activity.

The main reasons that can cause the development of this type of disease are:

• genetic predisposition;
• transferred neuropsychiatric diseases, after a stroke;
• the presence of congenital anomalies of the brain;
• result of toxicity medicines or alcohol.

Rolandic

Rolandic epilepsy is a type of idiopathic form and is provoked by signals from the Rolandic sulcus of the cerebral cortex.

The main manifestation is convulsions affecting the muscles of the pharynx and face. Sometimes unilateral cramps of the legs or arms, increased salivation, or loss of speech are possible.

Harbingers may be a feeling of numbness or tingling in the lips, tongue, cheeks. Most often, seizures occur at night. There is a complete preservation of consciousness.

Gastaut's syndrome

Gastaut's syndrome occurs when neurons in the occipital region of the cerebral cortex are activated.

Accompanied by rapidly developing visual attacks:

• elementary hallucinations;
• short-term blindness;
• sensory illusions of eye movement;
• blinking.

During and after an attack, a headache may appear, especially in the area of ​​\u200b\u200bthe eye orbits.

Cryptogenic

If it is not possible to determine the cause of epilepsy, we are talking about cryptogenic epilepsy. This is not an uncommon diagnosis, since it is often difficult to understand the etiology of seizures.

To confirm the cryptogenic form of epilepsy, it is necessary to completely exclude the belonging of the identified symptoms to the previous types of the disease.

As a result of continuous improvement of methods for diagnosing epilepsy, the number of cases of diagnosing cryptogenic epilepsy is gradually decreasing.

Generalized forms

Generalized forms of epilepsy are manifested by seizures caused by an epileptogenic focus, which quickly spreads to both hemispheres of the brain. In this case, there are more prolonged extensive seizures, turning into convulsions.

The patient's condition is more threatening. With generalized epilepsy, a loss of consciousness occurs during an attack, and the person does not remember what happens to him during this period.

During convulsions are fixed:

• twitching of the limbs;
• foaming from the mouth;
• pallor of the skin;
• shallow breathing;
• high blood pressure;
• involuntary urination and bowel movements.

There is also a non-convulsive form of generalized epilepsy, in which during a seizure a person freezes and does not react to light and sound stimuli. During this period, the patient can maintain balance and perform certain actions.

The generalized form, like the focal form, is divided into three main subspecies. On the background overall picture development of a generalized epileptic seizure, there are basic features taken as a guideline for defining each type.

Unclassifiable forms

In some cases, there is not enough information available to determine the type of epilepsy. This is due to the receipt of an incomplete or inadequate description symptomatic picture illness.

Such types of disease are classified as unclassified forms.

Situational epileptic seizures

A separate section in the International Classification of Epilepsy identifies special syndromes, which include situationally determined epileptic seizures.

They are characterized by the appearance of episodic seizures resulting from a specific situation.

Despite the practical identity of an epileptic seizure, such conditions are not a consequence of the manifestation of epilepsy, but can be caused by:

• alcohol or drug intoxication;
• poisoning with psychotropic or hallucinogenic drugs, barbiturates;
• acute period of development of traumatic brain injury;
• acute toxic encephalopathies;
• renal and hepatic insufficiency;
• severe brain damage;
• high degree of hypothermia or overheating;
• electrical injuries;
• exposure to ionizing radiation.

The main distinguishing feature of SUEP is the singularity of such episodes.

Diagnosis of epilepsy

For proper treatment epilepsy, it is important to accurately determine the type of disease, because otherwise, therapy can have sharply negative consequences. This is what is main goal when diagnosing this disease.

Anamnesis

At the first stage of diagnosis, the doctor conducts a study of the anamnesis of the disease. This is one of the main medical research methods. The collection of information occurs through a thorough survey of both the patient himself and his immediate environment.

History taking involves the use of many detailed, specific questions and includes information about:

• seizure frequency;
• their duration;
• time of most frequent occurrence;
• the presence of an aura or harbingers;
• the presence of cases of loss of consciousness;
• types of body movements and sensations during an attack, etc.

A large role in this technique is played by the establishment of close contact and complete trust between the doctor and the patient.

Examination by a neurologist

Some neuralgic diseases, such as multiple sclerosis or a brain tumor, have symptoms similar to epilepsy.

These include:

• headache;
• muscle weakness that is felt only on one side of the body;
• gait instability.

When diagnosing epilepsy, it is necessary to accurately establish the etiology of this condition. This is facilitated by a professional examination by a neurologist.

How to prevent an attack

Epilepsy has a latent course and may not manifest itself long time. And with the help of the use of modern antiepileptic drugs, the occurrence of the symptoms of this disease can be almost completely controlled.

Moreover, in recent years, the emergence of new AEDs with increased efficiency has been noted. As a result, in 75 - 85% of patients with epilepsy, a stable therapeutic effect is observed during treatment, remission is achieved.

On the this moment epilepsy is not an indicator of the restriction of labor and daily life. Compliance with a few basic rules helps in most cases to prevent the onset of an attack.

1. Constantly visit your doctor and strictly follow all medication prescriptions.
2. Adhere to the dosage and regularity of taking medications. Can't stop taking medical preparations if there is a long period of "calm" of the disease. It is strictly forbidden to independently change the dosage or the list of prescribed drugs.
3. Always have a stock essential medicines. Accept additional drugs only after consulting a doctor.
4. Constantly monitor and record the frequency and features of the manifestation of seizures. It is best to always have such records with you. It will also be useful to wear a tag indicating the diagnosis of epilepsy in a conspicuous place.
5. Monitor sleep regularity. Prevent chronic sleep deprivation.
6. Refuse to drink alcohol.
7. Avoid contact with bright flickering light sources.

It should be remembered that epilepsy is by no means a disease that makes the patient an outcast in society. Timely diagnosis and correct spot treatment will allow the patient to lead an absolutely normal life.

In addition, modern medicine is actively searching for an effective method to completely cure epilepsy, and is quite close to achieving this goal.

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Epilepsy is a chronic neuropsychiatric disease characterized by the periodic occurrence of exacerbations (seizures) in a patient. During the disease, electrical dysfunction of brain cells is detected, which leads to neuropsychiatric abnormalities. Symptoms In most cases, symptoms ...

Epilepsy is a multifactorial disease. At present, despite the improvement in the quality of life, this disease has not become less common, and only its symptoms have become less intense due to early diagnosis and improved therapy. Risk factors First of all, to the risk factors ...

Epilepsy is a fairly common disease in our time. According to statistics, it affects from one to five people per 1000 population. It is also called the “sacred disease”, “falling disease”, “black disease”, “Hercules disease”, because, according to legend, the hero of ancient myths suffered from it.

Symptoms of a disease caused by damage to the central nervous system can occur at any age, from infancy to old age. But mostly it falls on a young age up to 20-25 years. The clinical picture of epilepsy is diverse. Its peculiarity lies in the suddenness of the manifestation of most of the symptoms, one of which is a seizure. However, this is a very long-term disease, characterized by persistent disorders and changes in the personality of a person. This distinguishes epilepsy from other types of seizures, which are sometimes very useful to distinguish.

Types of seizures in epilepsy

One of obvious signs epilepsy is a convulsive seizure that occurs abruptly, like a bolt from the blue or after harbingers. Quite often convulsive attacks go one after another, without clarification of consciousness between them. This condition is called status epilepticus and is life-threatening, as cerebral edema and respiratory center depression occur. In epilepsy, the following types of seizures are distinguished:

Grand mal seizure

Occurs in several stages: precursor, aura, phase of clonic or tonic convulsions, post-seizure coma, sleep. A few days before the seizure, the patient develops malaise, headache, irritability, decreased performance, decadent mood, and a feeling of discomfort. Aura (breath) - this is already the beginning of a seizure, it occurs when consciousness is not yet turned off, so most patients remember it. The aura is hallucinogenic in nature. Before an attack, an epileptic sees various frightening pictures, blood, murder, an ax or some people. For example, one patient, before an attack, saw a small black woman fly into her room, jump on her, tear the clothes on her chest and take out her heart. Before attacks, patients often hear church singing, distant steps, voices, music, or feel certain smells, often unpleasant. Often during the aura, unpleasant sensations begin in the stomach, cramps, spasms, and constriction. Before a person falls to the ground, his orientation in his own body is disturbed, the body scheme is confused, and depersonalization disorders occur. Sometimes there are reverse cases, when a patient has a clarity of consciousness, an incredible rise in energy, bliss, ecstasy before an attack.

A grand mal seizure is further divided into generalized seizures and focal seizures.

Psychomotor seizures are expressed in aimlessly committed movements. They are divided into the following varieties:

Fugues- seizures of body rotation around its axis, rapid running forward or in a circle.

Ambulatory automatisms- patients run away from the premises, wander around the city, and then do not remember where they went.

Shemales- patients are not talkative, drowsy, self-absorbed, often tend to travel in public transport in an unknown direction. According to Jung, archetypal complexes of a person for nomadism are released in trances.

Gesture automatisms- short seizures, during which the patient performs meaningless uncoordinated movements: rubbing hands, rearranging furniture from place to place, urinating in front of everyone, pulling objects out of pockets, or, conversely, aimlessly stuff everything that comes to hand into pockets. Patients can jump out of the car on the move, eat threads from clothes, break stationery, medical instruments.

Speech automatisms- aimless prolonged pronunciation of the same phrases, curses, recitation of poems. The patient may emit wild laughter for a long time or hysterical crying.

Complex automatisms- a type of seizure in which the patient can do difficult work, but not be aware of either the process or the product of labor. For example, draw a picture, take an exam. Along with these disorders, the patient may also develop manic-depressive states, epileptic mania.

ideational seizures- seizures, accompanied by either a stop of thoughts or a violent flow of thoughts.

amnestic seizures- loss of memory.

Ekmnestic seizures- hallucinations, violent memories of the real past.

Seizure equivalents

Along with epileptic seizures, there are other types of seizures, often of hysterical origin, but similar in symptoms. To the group painful symptoms includes mood disorders and disorders of consciousness. How to distinguish a hysterical seizure from an epileptic one?

In patients with epilepsy, mood disorders are most often manifested in attacks of a melancholy-evil mood, when they are picky, irritable, gloomy, dissatisfied, express complaints of a delusional and hypochondriacal nature. Often the delusional state turns into fear. The period of dysphoria usually lasts a very long time - several days. Rarely there are bouts of euphoria. The disorder of consciousness is expressed in the appearance of a twilight state. Consciousness at the same time narrows, there are hallucinations, crazy ideas, visions: blood, fire. In this state, patients become aggressive and prone to destructive actions.

If during an epileptic seizure the disturbances are of an organic nature, then in a hysterical one they are psychoneurological. Patients are excitable, unbalanced, aggressive, aimed at obtaining personal gain. In hysteria, a person can also fall to the floor, but when falling, he lowers his body prudently carefully so as not to get injured. At the same time, he does not foam at the mouth, never bites his tongue, does not disturb breathing, pupils react to light, and there is no involuntary urination or defecation. Consciousness is preserved, the observed convulsive movements are theatrical in nature, the person remembers the events that took place before and after the seizure, does not fall into a coma and does not fall asleep. In addition, a hysterical fit does not last long, the duration depends on how much attention is paid to the patient. After an attack of hysteria is over, a person can continue to engage in their activities, which is not observed in an epileptic seizure. However, with both seizures, the mandatory presence of one of the adults is necessary to provide timely assistance.

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

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

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

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

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

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

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

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

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

Predisposing factors:

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

Epilepsy symptoms

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

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

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

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

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

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

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

Types of epileptic seizures

What are the types of seizures?

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

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

What is an aura?

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

What are generalized seizures?

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

What are tonic-clonic seizures?

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

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

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

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

What are absences (fading)?

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

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

What is juvenile myoclonic epilepsy?

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

What are partial seizures?

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

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

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

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

What is rolandic epilepsy?

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

What is status epilepticus?

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

What are pseudo-seizures?

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

Pseudo-epileptic seizures are observed:

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

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

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

Convulsive focus

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

Convulsive readiness

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

Diagnosis of epilepsy

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

How is epilepsy diagnosed?

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

What is electroencephalography (EEG)?

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

How is an EEG performed?

An EEG is a completely harmless and painless test. To conduct it, small electrodes are applied to the head and fixed on it with the help of a rubber helmet. Electrodes are connected by wires to an electroencephalograph, which amplifies the electrical signals of brain cells received from them by 100 thousand times, writes them down on paper or enters readings into a computer. During the study, the patient lies or sits in a comfortable diagnostic chair, being relaxed, with eyes closed. Usually, when taking an EEG, so-called functional tests (photostimulation and hyperventilation) are carried out, which are provocative loads on the brain through bright light flashing and increased respiratory activity. If an attack begins during the EEG (this is very rare), then the quality of the examination increases significantly, since in this case it is possible to more accurately determine the area of ​​\u200b\u200bdisturbed electrical activity of the brain.

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

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

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

What is a hyperventilation test?

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

What is photostimulation EEG?

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

Why is an EEG with sleep deprivation performed?

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

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

What is an EEG in sleep?

As is known, in certain forms of epilepsy, changes in the EEG are more pronounced, and sometimes only able to be perceptible during a study in a dream. EEG recording during sleep makes it possible to detect epileptic activity in most of those patients in whom daytime it did not come to light even under the influence of usual provocative tests. Unfortunately, such a study requires special conditions and preparedness of medical personnel, which limits the widespread use of this method. It is especially difficult to carry it out in children.

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

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

When is video-EEG used?

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

Why is brain mapping done?

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

Is EEG harmful to health?

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

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

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

How to prepare a child for an EEG?

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

CT scan

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

However, CT data may not be informative when certain types seizures, which include:

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

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

Magnetic resonance imaging

Magnetic resonance imaging is one of the most precise methods diagnosis of structural changes in the brain.

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

The main disadvantages usually include:

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

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

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

Cause of death in epilepsy

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

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

Epilepsy prognosis

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

First aid

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

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

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

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

Getting into an attack

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

The beginning of the attack

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

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

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

Exit from attack

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

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

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

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

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

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

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

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

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

In addition, an ambulance should be called if:

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

Epilepsy treatment

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

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

Medical treatment of epilepsy

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

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

Non-drug treatments

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

Epilepsy and driving

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

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

How is epilepsy related to sex life?

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

Psychosocial factors:

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

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

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

Physiological factors:

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

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

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

epilepsy and pregnancy

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

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

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

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

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

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

Affectively - respiratory attacks:

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

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

Influence on character

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

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

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

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

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

Can I drink alcohol?

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

Can I smoke?

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

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

TOPIC: EPILEPSY.

Epilepsy(G40 ) is a disease that develops on the basis of a genetically determined predisposition, the manifestation of which in most cases requires the influence of exogenous factors that determine its clinical manifestation. One of the main genetically determined factors in the development of epilepsy is the synchronization of neuronal activity in all frequency ranges. A paroxysmal depolarization shift in their membrane potential is a pathognomonic feature of epileptic neurons. A paroxysmal depolarization shift causes the neuron to generate an action potential of significantly greater amplitude, duration, and frequency than normal. Without this, further stages of epileptogenesis are impossible. A factor contributing to the occurrence of seizures is the presence of organic disorders in the brain.

Epilepsy- a condition characterized by repeated (2 or more) epileptic seizures, not provoked by any immediately identifiable causes.

epileptic seizure(epileptic seizure) - a clinical manifestation of an abnormal and excessive discharge (hypersynchronous electrical discharge) of neurons in the cerebral cortex. The clinical picture is represented by sudden and transient pathological phenomena (changes in consciousness, motor, sensory, vegetative and mental symptoms noted by the patient or the observer).

The international classification of epilepsy and epileptic syndromes is based on two principles: 1) determining whether epilepsy is focal or generalized, 2) distinguishing: idiopathic, symptomatic, cryptogenic.

Localization-conditioned (focal, local, partial) epilepsy:

idiopathic;

symptomatic (epilepsy of the frontal, temporal, parietal, occipital lobe);

cryptogenic.

Generalized epilepsy:

Idiopathic (including childhood absence and juvenile absence epilepsy);

symptomatic;

Cryptogenic.

3. Non-deterministic epilepsy:

Special syndromes (febrile convulsions).

The pathogenesis of epilepsy.

The mechanism of development of epilepsy consists of the formation of an epileptic focus, the formation of epileptic systems in the brain and epileptization of the brain.

Epileptogenesis develops at the level of the neuroglial complex with a certain role of the epileptic neuron. epileptic neuron characterized by membrane instability, a pronounced tendency to its depolarization, membrane potential lability epileptic focus- a group of neurons with pathological electrogenesis that generates excessive neural discharges, leading to hypersynchronization of surrounding neurons. The formation (generation) of epileptic activity is associated mainly with the bodies of neurons, and the distribution (generalization) with dendrites and membranes. The main hypothesis is the imbalance between excitatory (glutamate, aspartate) and inhibitory (GABA, taurine, glycine, norepinephrine, dopamine, serotonin) mediators. The main cause of damage to nerve cells is associated with the activation of the "glutamate cascade" with excessive release of glutamate. The accumulation of glutamate leads to the degeneration of glutamate receptors, activation of Na + and Ca ++ - channels, accumulation of Na + and Ca ++ ions inside the cell, and K ions in the extracellular fluid. This, in turn, promotes the release of Ca ++ from the intracellular depot and the activation of enzymes (phospholipases, proteases, etc.), the accumulation of arachidonic acid, increased lipid peroxidation and destruction of cell membranes. Other causes of epileptic seizures are a change in the concentration of H-ions, acetylcholine, serotonin, a change in the permeability of K-channels. In the theory of epileptogenesis, a significant role is given to the membrane theory: the trigger factor for epileptization of neurons is structural rearrangements of neuronal membranes, including synapses, which induce inactivation of ion pumps and activation of ion channels, which leads to persistent depolarization of neuron membranes and their pathological hyperactivity. The instability of neuronal membranes leads to an abnormal concentration of K + , Na + , Cl - ions. Excitatory neurotransmitters (glutamate, aspart) act through various receptor subtypes, the structure of which determines their selective ion permeability and the kinetics of associated ion fluxes. Pathological cell metabolism determines a certain level of cerebral blood flow. Violation of the function of glutamate receptors and the formation of autoantibodies to these receptors leads to the development of epileptic paroxysms. The destruction of cell membranes contributes to the formation of new foci of epileptogenesis with the formation of pathological interneuronal connections, leading to epileptization of the brain. The neurophysiological mechanisms associated with epileptogenesis are expressions of the expression of genes that control biochemical processes, receptor activity, and neurotransmitter interactions.

The formation of epileptic systems is due to the formation of pathological connections between the epileptic focus and structures capable of activating epileptogenesis: the visual tubercle, the limbic brain, the reticular formation of the midbrain. The caudate nucleus, the cerebellum, and the fronto-orbital cortex of the brain are systems that inhibit epileptogenesis.

Clinic epilepsy is represented by paroxysmal and non-paroxysmal symptoms. Paroxysmal states are manifested by variants of epileptic seizures (see classification).

Classification of epileptic seizures:

I. Partial seizures (G40.0)

Simple (not accompanied by loss of consciousness) partial seizures ( G40.1 ):

With motor features

With somatosensory (feeling of numbness, passage of "current" in the contralateral focus of the extremities or half of the face) or specific sensory symptoms (simple hallucinations)

With autonomic symptoms or signs

With mental symptoms

2. Complex partial seizures ( G40.2 ) are accompanied by a change in consciousness: the beginning can be with a simple partial seizure, followed by a violation of consciousness or with a violation of consciousness in a seizure.

II. generalized seizures ( G40.3)

absences and atypical absences;

myoclonic;

clonic;

tonic;

tonic-clonic;

atonic;

Unclassified.

Non-paroxysmal symptoms are represented by changes in the patient's personality (pathological thoroughness of thinking, stiffness of mental processes, viscosity, resentment, tendency to detail, flattery, obsequiousness, egocentrism, dysphoria) and cognitive impairment (dementia development).

The factors provoking the onset of a seizure are: alcohol, violation of the work and rest regime, high body temperature, insolation, reduction / cancellation of the antiepileptic drug, surgical interventions.

Clinical picture of a generalized convulsive seizure:

The initial phase - loss of consciousness, falling, crying, convulsive contractions of the chest muscles.

Tonic phase: 15-20 sec., tonic muscle tension, head tilts back, opisthotonus, apnea.

Clonic phase: 2-3 minutes: clonic contractions of the muscles of the limbs, torso, noisy breathing, tongue bite.

Post-seizure phase: pupils are dilated, there is no reaction to light, muscle hypotension, absence of tendon reflexes, there may be involuntary urination, disorientation, there may be sleep. The total duration of the seizure is 4-5 minutes.

Diagnosis: carried out in accordance with the classification based on anamnesis, physical, neuropsychological examination, EEG, MRI.

Differential Diagnosis: with paroxysmal states of a non-epileptic nature, psychogenic seizures, fainting, autonomic crises, states of altered consciousness in mental illness.

Differential diagnosis of epileptic seizures

Identification of genes that determine the development of epilepsy - promising direction in epileptology, allowing to identify individuals predisposed to the development of epilepsy, their early treatment, and possibly prevention.

Classification of paroxysmal disorders of consciousness

non-epileptic nature (syncope)

1. Reflex (neurogenically conditioned) syncopal states (SS):

Vasovagal

Carotid node hypersensitivity symptom

Situational.

2. Cardiogenic SS: ischemic heart disease, heart rhythm disorders.

3. SS in orthostatic hypotension.

4. SS in cerebrovascular insufficiency in the vertebrobasilar basin.

5. Dysmetabolic SS.

6. Psychogenic SS: hysteria, panic attacks, emotional stress reactions

7. SS under the influence of extreme factors.

Diagnosis is based on:

Exclusion of current brain disease

Identification of specific changes in the EEG (sharp waves, spikes, polyspikes; "sharp-slow wave" complexes).

Principles of antiepileptic therapy:

1. Early prescription of antiepileptic drugs (AEDs)

2. Preferably monotherapy

3. Choice of AED according to the type of epileptic seizure

4. The use of polytherapy only in the absence of the effect of monotherapy.

Appointment of AED in adequate doses, providing a therapeutic effect.

One-time cancellation or replacement of AED is unacceptable.

The duration and continuity of AED therapy with the gradual withdrawal of the drug only when complete remission is achieved.

Conducting repeated courses of therapy with drugs that have a positive effect on various pathogenetic mechanisms.

Drugs of choice in the treatment of epilepsy depending on the types of seizures / epileptic syndrome

Note. VA-valproic acid, GBP-gabapentin, CBZ-carbamazepine, CLBZ-clobazam, CLRP-clonazepam, LTD-lamotrigine, LTC-levetiracetam, CBZ-oxacarbazepine, TPM-topamax, ESM-ethosuximide.

Epileptic status(ES) [ G41 ] - a fixed epileptic state that occurs as a result of a prolonged seizure or seizures that recur at short time intervals. With ES in the interictal period, consciousness is not restored. In ES of Jacksonian seizures, consciousness may be preserved. Variants of ES correspond to the types of epileptic seizure.

If consciousness is restored between seizures, this is called a series of convulsive seizures. ES is a medical emergency that requires prompt and intensive treatment to prevent significant brain damage and death.

ES treatment:

Free the oral cavity from foreign objects

Enter air duct

Intravenous injection of 20 mg slowly diazepam in 20 ml of 20% glucose solution, the standard dose is 0.15-0.25 mg / kg

If necessary, drain the upper respiratory tract

Normalize intracranial pressure (saluretics, lumbar puncture).

Phenytoin is the next-line drug of choice, administered intravenously 15-20 mg/kg

Sodium thiopental or hexenal(1 ml of a 10% solution per 10 kg of body weight) - in the absence of effect (a means of the third stage), it is administered intravenously intravenously, in a stream, slowly.

Introduction of antihypoxants(drugs like GHB (sodium oxybutyrate)

at the rate of 20-30 mg / 1 kg of weight). It should be remembered that this calculated

the dose should be administered in saline, intravenously, drip, slowly over

15-20 minutes.

If seizures continue:

Give inhalation anesthesia: nitrous oxide with oxygen

Depakine (in 4 ml 400 mg) intravenously by stream or intravenous drip in isotonic sodium chloride solution.

Fight against metabolic acidosis (intravenously drip sodium bicarbonate solution)

Restoration of electrolyte balance

Relief of cerebral edema: osmodiuretics or saluretics

(lasix - 1 mg / 1 kg of weight, urea - 1-1.5 g / 1 kg of patient weight)

Glossary.

1. Anticonvulsants - anticonvulsant drugs

2. Aura - any sensation or experience that regularly precedes an epileptic seizure

3. Idiopathic epilepsy - there are no diseases that can cause epilepsy, an independent disease.

4. Cryptogenic epilepsy - the cause of the disease remains hidden, unclear.

5. Partial seizure - the result of coverage of a limited area of ​​the cortex by epileptic excitation.

6. Symptomatic epilepsy is a consequence of acquired, congenital, hereditary brain lesions.

7. An epileptic neuron is characterized by membrane instability, a pronounced tendency to its depolarization, and membrane potential lability.

8. Epileptic focus - a group of neurons with pathological electrogenesis, generating excessive neural discharges, leading to hypersynchronization of surrounding neurons.

9. An epileptic seizure is a clinical manifestation of an abnormal and excessive discharge of neurons.