Lowering the threshold for convulsive readiness of the brain. Exit from an attack. Methods of treatment of small patients

Convulsive syndrome in children occurs with the development of partial or generalized convulsions of a clonic and tonic nature with or without loss of consciousness. To establish the causes of convulsive syndrome in children, consultations of a pediatrician, neurologist, traumatologist are necessary; conducting EEG, NSG, REG, X-ray of the skull, CT of the brain, etc. Relief of convulsive syndrome in children requires the introduction of anticonvulsants and the treatment of the underlying disease.

Convulsive syndrome in children

Convulsive syndrome in children is a frequent urgent condition of childhood, occurring with the development of convulsive paroxysms. Convulsive syndrome occurs with a frequency of cases per 1000 children: while 2/3 of convulsive seizures in children occur in the first 3 years of life. In children preschool age convulsive syndrome occurs 5 times more often than in the general population. The high prevalence of convulsive syndrome in childhood is due to the immaturity of the nervous system of children, the tendency to develop cerebral reactions and the variety of causes that cause convulsions. Convulsive syndrome in children cannot be considered as the main diagnosis, since it accompanies a wide range of diseases in pediatrics, pediatric neurology, traumatology, and endocrinology.

Convulsive syndrome in children is a polyetiological clinical syndrome. Neonatal convulsions that develop in newborns are usually associated with severe hypoxic CNS damage (fetal hypoxia, neonatal asphyxia), intracranial birth trauma, intrauterine or postnatal infection (cytomegaly, toxoplasmosis, rubella, herpes, congenital syphilis, listeriosis, etc.), congenital anomalies brain development (holoprosencephaly, hydroanencephaly, lissencephaly, hydrocephalus, etc.), alcohol syndrome fetus. Seizures may be a manifestation of the withdrawal syndrome in children born to mothers suffering from alcohol and drug addiction. Rarely, newborns experience tetanus cramps due to infection of the umbilical wound.

Among the metabolic disorders that cause convulsive syndrome, electrolyte imbalance (hypocalcemia, hypomagnesemia, hypo- and hypernatremia) occurring in preterm infants, children with intrauterine malnutrition, galactosemia, phenylketonuria should be distinguished. Separately, among the toxic-metabolic disorders is hyperbilirubinemia and associated nuclear jaundice in newborns. Convulsive syndrome can develop in children with endocrine disorders - hypoglycemia in diabetes mellitus, hypocalcemia in spasmophilia and hypoparathyroidism.

In infancy and early childhood, neuroinfections (encephalitis, meningitis), infectious diseases (ARVI, influenza, pneumonia, otitis media, sepsis), TBI, post-vaccination complications, and epilepsy play a leading role in the genesis of convulsive syndrome in children.

Less common causes of convulsive syndrome in children are brain tumors, brain abscess, congenital heart defects, poisoning and intoxication, hereditary degenerative diseases of the central nervous system, phakomatosis.

A certain role in the occurrence of convulsive syndrome in children belongs to a genetic predisposition, namely, the inheritance of metabolic and neurodynamic features that determine a lower convulsive threshold. Infections, dehydration, stressful situations, sudden excitement, overheating, etc. can provoke seizures in a child.

Classification of convulsive syndrome in children

By origin, epileptic and non-epileptic (symptomatic, secondary) convulsive syndrome in children are distinguished. Symptomatic include febrile (infectious), hypoxic, metabolic, structural (with organic lesions of the central nervous system) convulsions. It should be noted that in some cases, non-epileptic convulsions can turn into epileptic ones (for example, with prolonged, more than 30 minutes, an intractable convulsive seizure, repeated convulsions).

Depending on the clinical manifestations Distinguish between partial (localized, focal) convulsions, covering individual muscle groups, and generalized convulsions (general convulsive seizure). Given the nature of muscle contractions, convulsions can be clonic and tonic: in the first case, episodes of contraction and relaxation of skeletal muscles quickly follow each other; in the second, there is a prolonged spasm without periods of relaxation. In most cases, convulsive syndrome in children occurs with generalized tonic-clonic convulsions.

Symptoms of convulsive syndrome in children

A typical generalized tonic-clonic seizure has a sudden onset. Suddenly the child loses contact with the external environment; his gaze becomes wandering, the movements of the eyeballs become floating, then the gaze is fixed up and to the side.

In the tonic phase of a convulsive attack, the child's head is thrown back, the jaws are closed, the legs are straightened, the arms are bent at the elbow joints, the whole body is tense. Short-term apnea, bradycardia, pallor and cyanosis of the skin are noted. The clonic phase of a generalized convulsive seizure is characterized by the restoration of breathing, individual twitches of facial and skeletal muscles, and the restoration of consciousness. If convulsive paroxysms follow one after another without recovery of consciousness, such a condition is regarded as a convulsive status.

The most common clinical form of convulsive syndrome in children is febrile convulsions. They are typical for children aged 6 months to 3-5 years and develop against the background of a rise in body temperature above 38 ° C. There are no signs of toxic-infectious damage to the brain and its membranes. Duration febrile seizures in children it is usually 1-2 minutes (sometimes up to 5 minutes). The course of this variant of the convulsive syndrome in children is favorable; persistent neurological disorders, as a rule, do not develop.

Convulsive syndrome in children with intracranial trauma occurs with bulging fontanelles, regurgitation, vomiting, respiratory disorders, cyanosis. Convulsions in this case can be in the nature of rhythmic contractions of certain muscle groups of the face or limbs, or a generalized tonic character. With neuroinfections, the structure of the convulsive syndrome in children is usually dominated by tonic-clonic convulsions, there is stiffness of the occipital muscles. Tetany due to hypocalcemia is characterized by convulsions in the flexor muscles ("obstetrician's hand"), facial muscles ("sardonic smile"), pylorospasm with nausea and vomiting, laryngospasm. With hypoglycemia, the development of seizures is preceded by weakness, sweating, trembling in the limbs, and headache.

For the convulsive syndrome in epilepsy in children, the “aura” preceding the attack is typical (feeling of chills, heat, dizziness, smells, sounds, etc.). Actually, an epileptic seizure begins with a cry of a child, followed by loss of consciousness and convulsions. At the end of the attack comes sleep; after awakening, the child is inhibited, does not remember what happened.

In most cases, the establishment of the etiology of convulsive syndrome in children only on the basis of clinical signs is impossible.

Diagnosis of convulsive syndrome in children

Due to the multifactorial nature of the origin of convulsive syndrome in children, pediatric specialists of various profiles can deal with its diagnosis and treatment: neonatologists, pediatricians, pediatric neurologists, pediatric traumatologists, pediatric ophthalmologists, pediatric endocrinologists, resuscitators, toxicologists, etc.

The decisive moment in the correct assessment of the causes of convulsive syndrome in children is a thorough history taking: clarification of hereditary burden and perinatal history, diseases preceding the attack, injuries, preventive vaccinations, etc. It is important to clarify the nature of the convulsive seizure, the circumstances of its occurrence, duration, frequency, output from convulsions.

Important in the diagnosis of convulsive syndrome in children are instrumental and laboratory studies. Conducting an EEG helps to assess changes in bioelectrical activity and identify convulsive readiness of the brain. Rheoencephalography allows you to judge the nature of blood flow and blood supply to the brain. An x-ray of the skull in a child may reveal premature closure of the sutures and fontanelles, divergence of the cranial sutures, the presence of digital impressions, an increase in the size of the skull, changes in the contours of the Turkish saddle, foci of calcification and other signs that indirectly indicate the cause of the convulsive syndrome.

In some cases, neurosonography, diaphanoscopy, CT of the brain, angiography, ophthalmoscopy, and lumbar puncture help to clarify the etiology of convulsive syndrome in children. With the development of convulsive syndrome in children, it is necessary to perform biochemical research blood and urine for calcium, sodium, phosphorus, potassium, glucose, pyridoxine, amino acids.

Treatment of convulsive syndrome in children

If a seizure occurs, the child should be placed on hard surface, turn your head to one side, unbutton the collar, provide fresh air. If the convulsive syndrome in a child has developed for the first time and its causes are unclear, it is necessary to call an ambulance.

For free breathing, mucus, food debris or vomit should be removed from the oral cavity using an electric suction or mechanically, oxygen inhalation should be established. If the cause of seizures is established, then in order to stop them, pathogenetic therapy is carried out (the introduction of calcium gluconate solution for hypocalcemia, magnesium sulfate solution for hypomagnesemia, glucose solution for hypoglycemia, antipyretics for febrile convulsions, etc.).

However, since in an urgent clinical situation it is not always possible to carry out a diagnostic search, symptomatic therapy is carried out to stop the convulsive paroxysm. As a means of first aid, intramuscular or intravenous administration of magnesium sulfate, diazepam, GHB, hexobarbital is used. Some anticonvulsants (diazepam, hexobarbital, etc.) can be administered rectally to children. In addition to anticonvulsants, dehydration therapy (mannitol, furosemide) is prescribed for the prevention of cerebral edema in children.

Children with a convulsive syndrome of unknown origin, convulsions that have arisen on the background of infectious and metabolic diseases, brain injuries are subject to mandatory hospitalization.

Prediction and prevention of convulsive syndrome in children

Febrile seizures usually stop with age. To prevent their recurrence, severe hyperthermia should not be allowed if an infectious disease occurs in a child. The risk of transformation of febrile seizures into epileptic seizures is 2-10%.

In other cases, the prevention of convulsive syndrome in children includes the prevention perinatal pathology fetus, therapy of the underlying disease, observation by pediatric specialists. If the convulsive syndrome in children does not disappear after the cessation of the underlying disease, it can be assumed that the child has developed epilepsy.

Convulsive syndrome in children - treatment in Moscow

Directory of Diseases

Childhood diseases

Last news

• © 2018 "Beauty and Medicine"

is for informational purposes only

and is not a substitute for qualified medical care.

Convulsive syndrome in children: causes, symptoms

Involuntary muscle contractions, manifested in the form of seizures, lasting for various times and are clinical signs damage to the central nervous system is convulsions or a convulsive syndrome. Today, 3-5% of children have this disease. From this article you will learn the main causes and symptoms of the disease.

Causes of convulsive syndrome in children

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

The increased convulsive readiness of the child is associated with incomplete myelination of the pathways and the immaturity of the inhibitory mechanisms of the cerebral cortex. This is also facilitated by the high hydrophilicity of the brain tissue and increased vascular permeability. Under the influence of various toxic and infectious factors, there is a tendency to the rapid development of cerebral edema, one of the manifestations of which is convulsive syndrome in a child.

Its causes are largely related to the age of the child. Most often, in a newborn, muscle contractions are caused by asphyxia, cerebral hemorrhages, less often by hypoglycemia, hypocalcemia, a gross violation of the water and electrolyte balance, and an overdose of medications. Over the age of six months, convulsions in children can be caused by hyperthermic syndrome, meningitis and encephalitis, poisoning, exsicosis, severe infectious diseases, tumors and brain abscesses.

How is convulsive syndrome classified?

These conditions can be divided into several groups:

The pathogenesis of the convulsive syndrome

The mechanism of development depends on the cause that caused the syndrome. So, with asphyxia of newborns, the starting point is the lack of oxygen in the blood and tissues, accompanied by the accumulation of carbon dioxide, the development of respiratory and metabolic acidosis. As a result, blood circulation is disturbed, vascular permeability increases, and cerebral edema occurs.

Convulsive syndrome in infants with intracranial birth trauma is caused by the resulting intracranial hemorrhages, areas of gliosis of the brain tissue in places of previous ischemia and subsequent atrophy of the brain tissue.

In hemolytic disease of the newborn, muscle contractions occur as a result of an antigen-antibody reaction in the cells and due to the development of anoxemia with secondary imbibition of brain tissue by indirect bilirubin.

It often occurs with infectious-toxic diseases that affect the brain tissue and the subsequent development of intracranial hypertension and cerebral edema.

The occurrence may be associated with dehydration of the body and a violation of the water and electrolyte balance.

In acute neuroinfections, it is a manifestation of cerebral disorders, intracranial hypertension and cerebral edema.

What are the symptoms of convulsive syndrome in children?

Clinically, it has very diverse manifestations. Seizures differ in time of occurrence, duration, level of CNS damage, state of consciousness at the time of seizures, frequency, prevalence and form of manifestation. There are clonic and tonic convulsions.

Clonic convulsions- These are fast muscle contractions that follow each other after a short, but not equal, period of time. They can be rhythmic and non-rhythmic and indicate the excitation of the cerebral cortex.

The main symptoms of clonic seizures:

• Clonic muscle contractions begin with twitching of the muscles of the face, then quickly move to the limbs and become generalized.
• Breathing is noisy, wheezing, foam appears on the lips.
• The skin is pale.
• Tachycardia.

Clonic muscle contractions come in different durations. Sometimes they can be fatal.

tonic convulsions in children, these are prolonged muscle contractions. They come on slowly and last for a long time. Tonic convulsions may occur initially, but they also occur immediately after clonic ones (for example, in epilepsy). The convulsive syndrome can be general and localized. The appearance of tonic convulsions indicates the excitation of the subcortical structures of the brain.

Clinical picture convulsive attack is very characteristic:

• The child suddenly loses contact with the external environment.
• The gaze is wandering, the eyeballs first float and then fix up or to the side.
• The main symptoms: the head is thrown back, the arms are bent at the hands and elbows, the legs are extended, the jaws are closed.
• Possible tongue biting.
• Breathing and heart rate slow down, and sleep apnea may occur.

This tonic phase of clonic-tonic convulsions lasts no more than a minute, then the child takes a deep breath.

The clinic of the disease depends on the cause that caused it, and is characteristic of a certain pathological condition.

The syndrome resulting from brain injury is of a clonic-tonic character. At the same time, damage to the cranial nerves can be detected. It is possible that there will be symptoms of nystagmus, anisocoria, an increase in respiratory distress, which indicates compression of the brain stem. The appearance of seizures is possible immediately after the injury, in the early post-traumatic period and within 4 weeks after the injury. If, after the disappearance of the acute picture of the disease, recurrent seizures persist, they speak of post-traumatic epilepsy. In children with seizures in the early post-traumatic period, the following factors indicate an increased risk of developing post-traumatic epilepsy: age under 10 years, open traumatic brain injury (TBI), long-term post-traumatic impairment of consciousness, family predisposition to epilepsy, and hypersynchronized EEG activity. Such patients should receive prophylactic anticonvulsant treatment or at least be closely monitored.

In a septic process due to an acute disorder cerebral circulation develops a stroke. There is a loss of consciousness, clonic or local clonic-tonic convulsions. Hemiplegia is observed on the opposite side of the lesion.

In acute infectious diseases that occur with damage to the central nervous system, convulsions occur at the height of the disease and are tonic or clonic-tonic in nature. In this case, muscle contractions are associated with cerebral disorders and reflect an encephalitic response to microbial invasion. The seizures usually disappear after the temperature drops.

With purulent meningitis, the convulsive syndrome is in the nature of tonic tension in the muscles of the limbs and clonic twitching of the muscles of the face and body. With encephalitis, tremor, trismus and clonic convulsions are observed at the onset of the disease.

How does a convulsive syndrome develop?

Seizures in the clinical picture of brain tumors are characterized by high polymorphism. In most patients, convulsions are of a general, generalized nature with loss of consciousness, foam at the corners of the mouth. In some cases, one patient may experience an alternation of large and small epileptic seizures. For older children, focal seizures are a more characteristic symptom that has a certain topical and diagnostic value. Especially often the symptoms of the syndrome are observed in the first 3 years of life with various localizations and histological structures of the tumor. In this age group, seizures occur in every third child and, as a rule, appear early, in the 1st month of the disease. Distinctive feature convulsions in children early age is the predominance of the tonic component during the seizure and their generalized nature.

Symptom of convulsive syndrome - epilepsy

Separate forms in epilepsy can be combined into a status. It is always life-threatening due to the possibility of pulmonary and / or cerebral edema, circulatory failure, pneumonia and hyperthermia. Prodromal symptoms of irritability, headaches, or aura last for hours or days. In grand mal status epilepticus, the seizure begins with a cry, blanching or cyanosis due to respiratory failure, generalized tonic-clonic convulsions, loss of consciousness and ends with sleep, dilated pupils, a positive Babinsky symptom, and revival of deep reflexes; then the attack is repeated for an hour. The disease can continue throughout the day, bringing the patient to complete exhaustion.

Symptom of the appearance of convulsive syndrome - febrile convulsions

These include seizures that occur in babies aged from several months to 5 years on the background of fever in the absence of signs of neuroinfection. In most cases, they occur between the ages of 1 and 3 years. Febrile seizures are divided into typical (simple) and atypical (complex). Typical are single generalized tonic-clonic or clonic seizures of short duration (3-5 minutes), observed mainly at a body temperature of more than 39 C. Atypical or complex are focal or lateralized convulsions, longer (more than 15 minutes) or recurring in within 1 day: often at a body temperature below 39 C.

Now you know the main causes and symptoms of seizures in children.

Other related articles:

Share a comment:

Top 10 health benefits of life. Sometimes you can!

TOP drugs that can increase the duration of your life

TOP 10 youth prolongation methods: the best means anti aging

What you need to know about convulsive syndrome in children?

Convulsive syndrome in children is involuntary muscle contractions, as a reaction of the body to the actions of external and internal stimuli. Frequent partial or generalized convulsions of a clonic and tonic nature, which may be accompanied by loss of consciousness, are clear signs of the development of a convulsive syndrome in a child.

The reasons

The main causes of neonatal seizures in newborns are:

• severe hypoxic damage to the central nervous system (fetal hypoxia, asphyxia of newborns);
• intracranial birth trauma;
• intrauterine or postnatal infection (for example, toxoplasmosis, rubella, herpes, congenital syphilis, listeriosis, etc.);
• congenital anomalies of brain development (holoprosencephaly, hydroanencephaly, lissencephaly, hydrocephalus, etc.);
• fetal alcohol syndrome.

Often, seizures are a manifestation of withdrawal syndrome in a baby born to a mother suffering from alcohol or drug addiction.

Infection of the umbilical wound can also cause tetanus cramps.

Some metabolic disorders can cause seizures. These include:

• electrolyte imbalance (hypocalcemia, hypomagnesemia, hypo- and hypernatremia) may occur in premature babies with intrauterine malnutrition, galactosemia, phenylketonuria;
• hyperbilirubinemia and kernicterus;
• endocrine disorders (hypoglycemia in diabetes mellitus, hypocalcemia in spasmophilia and hypoparathyroidism).

Genetic predisposition also plays a role in the occurrence of seizures. With such a predisposition, the brought infection, dehydration, stressful situation, sudden excitement, overheating, etc. can become a stimulating factor.

Rarer causes of seizures:

• brain tumor;
• brain abscess;
• congenital heart disease;
• poisoning and intoxication;
• hereditary degenerative disease of the central nervous system;
• phakomatosis.

Symptoms

The main symptom of convulsive syndrome in children is the periodic occurrence of generalized tonic-clonic seizures. These seizures usually start suddenly. There is an instant loss of contact with the external environment. The child's gaze becomes absent, then freezes in a position up and to the side.

The tonic phase of a convulsive attack is characterized by the fact that the child throws his head back, closes his jaws, straightens his legs, bends his arms at the elbows, strains the whole body. There is bradycardia, cyanosis and pallor of the skin.

The clonic phase of a convulsive seizure is the restoration of breathing, individual twitches of facial and skeletal muscles, the restoration of consciousness.

The most common form of convulsive syndrome is febrile convulsions. Occurs in children from 6 months to 3-5 years, accompanied by elevated body temperature (38 ° C and above). There are no signs of toxic-infectious damage to the brain or its membranes. Febrile convulsions last 1-2 minutes (less often - 5 minutes). In this case, neurological disorders do not develop.

Diagnostics

As a rule, in the diagnosis of convulsive syndrome in children, laboratory and instrumental studies are carried out:

• EEG (assessment of changes in bioelectrical activity and detection of convulsive readiness of the brain);
• rheoencephalography (determination of the nature of blood flow and blood supply to the brain);
• x-ray of the skull (detection of premature closure of sutures and fontanelles, divergence of cranial sutures, the presence of digital impressions, an increase in the size of the skull, changes in the contours of the Turkish saddle, foci of calcification, etc.);

Also, the doctor may prescribe to undergo neurosonography, diaphanoscopy, CT of the brain, angiography, ophthalmoscopy, lumbar puncture. An accurate diagnosis requires a biochemical study of blood and urine for the content of elements such as calcium, sodium, phosphorus, potassium, glucose, pyridoxine, and amino acids.

Treatment

Help with a convulsive attack is to carry out the following activities. The child needs:

• lay on a hard surface;
• turn your head to the side;
• unbutton the collar;
• provide fresh air.

If this is the first case of a convulsive syndrome and the causes are unknown, you need to urgently call an ambulance.

In order for the child to breathe freely, it is necessary to remove mucus, food debris or vomit from the mouth. This can be done with an electric pump or mechanically. Then you should adjust the inhalation of oxygen.

Doctors carry out pathogenetic therapy to stop convulsions. It consists in the introduction of a solution of calcium or magnesium sulfate, glucose solution, antipyretics or other substances, depending on the cause of the seizures.

Symptomatic therapy is carried out if it is not possible to establish the cause. Magnesium sulfate, Diazepam, GHB, Hexenal are administered intramuscularly or intravenously. You may also need rectal administration of anticonvulsants (Diazepam, Hexobarbital, etc.).

Dehydration therapy (administration of Mannitol, Furosemide) serves as a prevention of cerebral edema.

In some cases, hospitalization may be necessary.

Febrile seizures may stop with age. To prevent their recurrence, severe hyperthermia should not be allowed if the child has an infectious disease. Since there is a risk (2-10%) that febrile convulsions can transform into epileptic ones.

To prevent the development of a convulsive syndrome, it is necessary to prevent perinatal pathology of the fetus, carefully treat all major diseases, and regularly monitor the baby with pediatric specialists. If the convulsive syndrome does not disappear after the cessation of the underlying disease, the child may have begun to develop epilepsy.

Forums of Izhevsk and Udmurtia Naydem-Vam.ru

Navigation menu

Custom Links

Ad

User information

About seizures in children

• Administrator
• Registered: 04/12/2011
• Invitations: 0
• Posts: 2713
• Respect: [+4/-0]
• Positive: [+7/-0]
• Spent on the forum:

9 months 11 days

Vertebrobasilar insufficiency (VBI) is one of the forms of damage to cerebral vessels. This type of cerebrovascular pathology is characterized by episodes of reversible ischemia of the brain structures, which are supplied with blood by vessels extending from the main and vertebral arteries. These episodes may be repeated. This syndrome also occurs in children.

• The reasons
• Symptoms
• Diagnostics
• Treatment
• Forecast
• Prevention

The reasons

The main reason for the development of VBN is a violation of the patency of the main head arteries. First of all, the extracranial sections of the arteries of the spine are subjected to deviation. The stenosis often involves arterial sites up to the point where the artery enters the bony canal. Sometimes stenosis is localized in the innominate or subclavian arteries. Basically, the vessels are affected due to atherosclerotic stenosis. Congenital abnormalities in the structure of the vascular bed also play an important role. Rarer causes are inflammatory diseases such as arteritis or dissection of the basilar or vertebral artery.

The risk of ischemia in the vertebrobasilar basin increases when the possibility of collateral circulation is limited. This is observed with the following deviations:

• non-closure of the circle of Willis;
• severe hypoplasia of any vertebral artery;
• abnormal origin of small branches from the vertebral and basilar arteries.

It is impossible not to pay attention to the possibility of compression of the vertebral arteries by altered vertebrae, which can occur with spondylosis and osteophyte. This situation can be the main reason for the development of VBI. In addition, collateral circulation in the vertebrobasilar basin has considerable possibilities, which is due to the presence of the Zakharchenko ring where the region of the brain stem is located, the circle of Willis on the brain base, extra-intracranial connections among the arteries and anastomotic systems on the surface of the brain. Such ways of bypass blood circulation make it possible to compensate, in full, for expressed defects in the vascular bed, regardless of what character they have, acquired or congenital.

There are several anatomical factors that predispose to a large compression of the vertebral arteries with the risk of developing severe complications, among which there is also cerebral ischemia, which is clearly visible in the diagnosis:

• exostoses with the formation of a retroarticular canal;
• anomaly Kimmerle;
• other anomalies in the structure of the cervical spine.

If these factors are present in a person, the role of functional factors increases, which include rotation of the cervical vertebrae with arterial compression and displacement, as well as trauma to the cervical spine.

Intracranial arteries may have such a variant of the structure as dolichoectasia. Modern non-invasive and invasive methods for diagnosing the cerebrovascular system have made it possible to detect such anomalies more often. Dolichoectasia is a peculiar combination of signs of ischemia of structures that are supplied with blood from the vertebrobasilar basin and cranial nerve compression.

The cause of VBI may lie in the defeat of small-caliber arteries. This may be due to diabetes mellitus and arterial hypertension, as well as a combination of these two disorders. Sometimes the causes lie in cardiogenic embolisms, which are usually accompanied by occlusion of a large vessel and the development of a severe neurological deficit. A prerequisite for the development of VBN can be circulating aggregates of blood cells and a high ability to aggregate formed elements.

Vascular disorders of the vertebo-basilar system among adults account for 30% of acute cerebral circulatory disorders and 70% of transient disorders. Approximately 80% of strokes are ischemic, and a quarter of them occur in the vertebrobasilar system (VBS). As noted, VBN also occurs among children. With the help of qualitative diagnostics, such a diagnosis is detected in many children from birth, and the cause may be natal damage to the vertebral arteries and spine. Today, the number of such disorders among children and young people is increasing. VBN has chronic.

There are several classifications of this syndrome. One of them was presented in 1989 by Bakulev. He identified three stages in the development of this disorder:

• Stage 1 - compensation, when an asymptomatic course is noted or there are initial manifestations of the syndrome in the form of focal neurological disorders.
• Stage 2 - relative compensation. Here transient ischemic attacks occur, i.e. an acute disorder of cerebral circulation, combined with a rapidly passing cerebral or general symptoms. At the same stage, a small stroke occurs, i.e. completely reversible neurological deficit, and dyscirculatory encephalopathy.
• Stage 3 - decompensation. Here, a completed ischemic stroke occurs, which has varying degrees of severity, as well as dyscirculatory encephalopathy, but already in the third degree, while in the previous stage it had the first or second degree.

In accordance with the neurological classification, 4 stages are distinguished:

1. angiodystonic stage. In this case, subjective clinical symptoms predominate, rather than symptoms of focal brain damage.
2. Angiodystonic-ischemic stage.
3. Ischemic stage, when the symptoms of cerebral ischemia predominate in the vertebrobasilar basin. The vegetative-irritative symptoms practically disappear.
4. The stage of residual phenomena.

Symptoms

Symptoms of VBN can be divided into two groups:

1. Temporary signs usually develop with transient ischemic attacks. Their duration varies from several hours to several days. At the same time, a person complains of pain in the back of the head, which has a pressing character, discomfort in the neck and severe dizziness.
2. Persistent symptoms. They are always present with a person and gradually increase. Exacerbations can occur, in which ischemic attacks come, which can lead to vertebrobasilar strokes. Among the constant signs of the syndrome, frequent headaches in the back of the head, tinnitus, visual impairment and balance, memory loss, increased fatigue, dizziness attacks, fainting, a sensation of a lump in the throat can be distinguished.

The most common manifestation of the syndrome is dizziness, which occurs abruptly. Most patients describe the nature of such dizziness as a feeling of rectilinear movement or rotation of their own body or surrounding objects. This may take several minutes or hours. Dizziness is often combined with hyperhidrosis, nausea, and vomiting.

VBN syndrome can occur even in children aged 3 to 5 years, as well as in the range of 7-14 years, although previously it was considered impossible. Now it is clear that there is no age limit. There are specific signs of VBN in children. If they are observed, it is necessary to urgently contact a medical institution, undergo a diagnosis and begin treatment. It is from timely diagnosis and treatment depends on the future of the child. Signs of the development of the syndrome in children include:

• violation of posture;
• frequent tearfulness, increased drowsiness and fatigue;
• the child does not tolerate stuffiness, which leads to fainting, nausea and dizziness;
• the child sits in an uncomfortable position.

Some diagnoses that are made to children at an early age can provoke the development of the syndrome. These include perinatal encephalopathy and spinal trauma during childbirth or during sports.

Diagnostics

Timely diagnosis helps to start early treatment and avoid serious complications, such as stroke. Diagnosis is of particular importance for children, since timely treatment makes it possible to make a favorable prognosis for the development of VBI.

At the very beginning of the diagnosis, it is important to determine the damage to the vessels of the vertebrobasilar basin based on the clinic and the results of functional tests. All patients need to do auscultation of the projection of the supraclavicular region. You can confirm the lack of blood flow in the pool using several functional tests:

• intensive hand work;
• de Klein test;
• hautant's test, when the patient sits with a straight back and eyes closed;
• vertebral artery test, when the patient is lying on his back;
• dizziness test, when the patient turns his head to the left and right, turns to the sides only with his shoulders.

Based on the patient's condition during these tests, it is possible to confirm a violation of blood flow in the vertebrobasilar basin. Further diagnostics include ultrasound methods, which can be used to determine the localization of the lesion and assess the hemodynamic significance of stenosis or pathological tortuosity of the vessels. Such methods help to determine the functional and structural reserves of compensation.

Angiographic diagnostic methods, such as MRI, CT, X-ray contrast angiography, allow you to accurately determine the type, extent and localization of the lesion, to identify multi-level lesions.

After carrying out all the necessary studies, a diagnosis is made in accordance with the ICD-10, then treatment is prescribed, and the sooner this is done, the better, as it will avoid complications in the form of a stroke and other consequences, and even death.

Treatment

If the syndrome is at the initial stage of development, treatment is carried out on an outpatient basis. If symptoms of acute VBN are clearly manifested, the patient is placed in a hospital for observation and prevention of strokes.

Most often, when prescribing treatment, doctors combine medical methods with physiotherapy. The patient must understand that it is necessary to regularly monitor pressure and follow a diet. Given the chronic nature of the disease, it is important to assess the patient's readiness to systematically use prescribed medications.

Some forms of the disease are not treated with drugs at all. That is why it is necessary to determine the presence of the disease as early as possible. An individual treatment is selected for each patient. When drug treatment is prescribed, drugs from the following groups are selected:

1. Vasodilators, i.e. vasodilators that prevent occlusion. Most often, treatment with these drugs begins in the fall or spring. At first, small doses are prescribed, which are gradually increased. If the expected effect is not observed, the drug is sometimes combined with other drugs of similar action.
2. Antiplatelet agents that reduce blood clotting. It prevents blood clots. The most popular drug from this group is acetylsalicylic acid. For a day, the patient needs to consume 50-100 milligrams. However, patients with gastrointestinal diseases should be careful when taking this drug, because. gastric bleeding may open, and therefore, aspirin is forbidden to be taken on an empty stomach.
3. Nootropic and metabolic drugs that improve brain function.
4. Antihypertensive drugs that regulate blood pressure.
5. Painkillers.
6. Sleeping pills.
7. Antidepressants.
8. Antiemetic drugs.
9. Medicines to reduce dizziness.

The following types of therapies are used:

1. Massage. It improves blood circulation.
2. exercise therapy. Regular therapeutic exercises allow you to get rid of spasms, strengthen the spine and improve posture.
3. Reflexology. It also relieves muscle spasms.
4. Magnetotherapy.

When complex treatment does not give results, surgical treatment is prescribed. The operation is performed to improve blood circulation in the vertebral and basilar arteries. In this case, angioplasty is common, in which a special stent is inserted into the vertebral artery. It does not allow the arterial lumen to close and maintains normal blood circulation. With atherosclerosis, an endarterectomy is performed, the essence of which is to remove an atherosclerotic plaque. Microdiscectomy helps stabilize the spine.

In children, the syndrome is easily corrected. Medical treatment is practically not used. Rarely, when cases are extremely severe, surgery is performed.

Alternative methods of treatment can also be used, but only as an addition to the main treatment and after consultation with a doctor. A positive effect of vitamin C was noted. To prevent thrombosis, it is advised to use viburnum, cranberries, sea buckthorn, currants and other products containing this vitamin.

Forecast

The prognosis of VBI is determined by the nature and severity of the underlying disease and the degree of damage to the vascular bed. If the narrowing of the arteries progresses, there is persistent arterial hypertension and there is no adequate therapy, the prognosis is poor. These patients are at high risk for stroke. They may also develop dyscirculatory encephalopathy.

A favorable prognosis can be made in the case when the state of the vascular system of the head is satisfactory, and the treatment tactics are adequate and effective. Much depends on how the patient follows medical recommendations.

Prevention

The following measures will help prevent the onset of the disease or slow its development:

1. Diet. Must be abandoned white bread, sausages, fatty, fried and smoked, canned food. It is worth eating more low-fat cottage cheese, sour berries, garlic, seafood, tomatoes.
2. Quit smoking and monitor the amount of alcohol consumed so that it does not exceed the norm, it is natural.
3. Reduce salt intake.
4. Exercise moderately.
5. Control blood pressure.
6. Do not sit in one position for a long time.
7. Sleep and sit on a comfortable surface.
8. Avoid stress.
9. Walk more outdoors, swim more.

VBN is a serious syndrome, but with timely treatment and prevention, its sad consequences can be avoided.

By leaving a comment, you accept the User Agreement

• Arrhythmia
• Atherosclerosis
• Varicose veins
• Varicocele
• Haemorrhoids
• Hypertension
• Hypotension
• Diagnostics
• Dystonia
• heart attack
• Ischemia
• Blood
• Operations
• Heart
• Vessels
• angina pectoris
• Tachycardia
• Thrombosis and thrombophlebitis

• heart tea
• Hypertension
• Pressure bracelet
• Normallife
• Allapinin
• Asparkam
• Detralex

Bradycardia: symptoms, treatment

Violations in the occurrence and conduction of a nerve impulse that provides contraction of the heart leads to changes in the heart rhythm - arrhythmias. One of the varieties of such pulse deviations is bradycardia - a decrease in the number of heartbeats to less than 55-60 beats per minute in adults and adolescents over 16 years old, 70-80 in children and 100 in children under one year old. Such a violation of the heart rhythm is not an independent disease. As a symptom, bradycardia can occur with a variety of ailments or appears as a protective physiological reaction in response to external stimuli.

In this article, we will introduce you to the physiological and pathological causes, manifestations, methods for diagnosing and treating bradycardia. This information will help you make the right decision about the need to see a doctor to identify and treat diseases that provoke this symptom.

The reasons

Physiological bradycardia is often found in well-trained individuals.

Changes in heart rate can cause both natural external factors and diseases of internal organs and systems. Depending on this, bradycardia can be physiological and pathological.

Physiological bradycardia

Such a slowdown in the pulse is a variant of the norm, is not dangerous to human health and can occur after exposure to the following external factors and stimuli:

• moderate hypothermia or staying in conditions of high humidity and temperature - the body in such conditions goes into a "saving mode" of energy resources;
• age-related changes - after about 60-65 years, islands of connective tissue appear in myocardial tissues (age-related cardiosclerosis) and the metabolism as a whole changes, as a result, body tissues need less oxygen, and the heart does not need to pump blood with the same blood as before , intensity;
• stimulation of reflex zones - pressure on the eyeballs or pressure on the bifurcation of the carotid arteries when wearing a tie or shirt with a tight collar affects the vagus nerve and causes an artificial slowing of the pulse;
• good physical preparation ("training") - in athletes or during physical labor, the left ventricle increases in volume and is able to provide the body necessary quantity blood and with fewer contractions;
• night sleep - the body is at rest and does not need frequent heartbeats and a large amount of oxygen;
• physical or psycho-emotional overwork - the body, when tired, goes into a “saving mode” of energy resources.

Another type of physiological bradycardia is idiopathic. In such cases, examination of the patient does not reveal any reason for the slowing of the pulse. A person does not go in for sports or physical labor, does not take medications, does not feel the effects of other contributing factors, and his well-being does not suffer from bradycardia in any way, because. it is successfully compensated by the body itself.

Sometimes a decrease in heart rate is considered a physiological norm when taking certain drugs that have a similar side effect. But the slowing of the pulse is considered the norm only in cases where the patient does not feel worse and the drug is not taken for a long time. In other situations, it is advisable to reduce the dosage, cancel or replace the drug with another one.

In the cases described above, the slowing of the pulse is not dangerous to health and does not cause a decrease in the blood supply to the brain and other organs. Treatment to eliminate physiological bradycardia is not required, because. it passes on its own after the exclusion of an external stimulus. However, with prolonged slowing of the pulse that occurs in athletes or people over 60-65 years old, it is recommended dispensary observation by a cardiologist for the timely detection of possible deviations in the state of health.

Pathological bradycardia

Such a slowdown in the pulse is not a variant of the norm, it affects the state of human health and can occur under the influence of the following reasons:

• heart pathology - a slowdown in the pulse can be provoked by ischemic disease, myocardial infarction, focal or diffuse cardiosclerosis, inflammatory diseases (endocarditis, myocarditis), Morgagni-Adams-Stokes syndrome, etc .;
• taking medications (especially Quinidine, beta-blockers, cardiac glycosides, calcium channel blockers, Morphine, Amisulpride, Digitalis and Adenosine) - usually slowing the pulse is caused by improper dosing and taking such drugs, affects the general well-being and can threaten the patient's life;
• poisoning with toxic substances (lead compounds, nicotinic acid and nicotine, narcotic and organophosphorus substances) - under the influence of these compounds, the tone of the parasympathetic and sympathetic nervous system changes, various organs and systems (including cells of the conduction system of the heart, and myocardial cells);
• increased tone of the parasympathetic nervous system - such a reaction can be caused by certain diseases and pathological conditions (neurosis, depression, peptic ulcer, tumors in the mediastinum, traumatic brain injury, hemorrhagic stroke, increased intracranial pressure, neoplasms of the brain, edema after surgical interventions on the neck, head or mediastinal region);
• some infectious diseases - usually infections contribute to the development of tachycardia, but typhoid fever, some viral hepatitis and severe sepsis can cause a slow pulse, in addition, bradycardia can be observed in severe and prolonged infectious diseases leading to exhaustion of the body;
• hypothyroidism - a decrease in the level of thyroxine and triiodothyronine (hormones thyroid gland) leads to a change in the tone of the nervous system, disruption of the heart and slowing of the pulse, attacks of bradycardia in such conditions occur at first sporadically, and then become permanent.

In the cases described above, the slowing of the pulse is dangerous to health and causes a decrease in the blood supply to the brain and other organs. Such bradycardias are a symptom of pathology and require treatment of the underlying disease.

Symptoms

One of the manifestations of bradycardia is dizziness.

The slowing of the pulse affects the general well-being only with pathological bradycardia. In addition to the signs of the underlying disease, the patient has symptoms that indicate a decrease in heart rate, and their severity will depend on the pulse rate.

Almost all signs of bradycardia occur due to oxygen starvation of the organs and tissues of the body. Usually they occur episodically, but even their periodic appearance significantly affects the quality of life and indicates the presence of a disease that needs treatment.

Dizziness

A significant slowdown in the pulse leads to the fact that the heart cannot maintain blood pressure at the proper level. Due to its decrease, the blood supply to many systems and organs is disturbed. First of all, the brain begins to suffer from ischemia and oxygen starvation, and that is why dizziness becomes one of the first signs of bradycardia. Usually this symptom appears episodically and after the stabilization of the number of heart contractions is eliminated.

fainting

The appearance of such a symptom of bradycardia is caused by the same cause as dizziness. The degree of its severity depends on the level of lowering blood pressure. With severe hypotension, the brain seems to be temporarily turned off, which manifests itself in the form of a pre-fainting state or fainting. Especially often, such symptoms occur against the background of mental or physical overwork.

Weakness and fatigue

These symptoms are caused by reduced blood supply to the skeletal muscles that occurs when the heart rate slows down. Muscle cells due to lack of oxygen are not able to contract with the usual force, and the patient feels weakness or reduced tolerance to physical activity.

Pale skin

When the pulse slows down, blood pressure drops and insufficient blood flows to the skin. In addition, it is the skin that is a kind of "depot" of blood, and if there is not enough of it, the body mobilizes it from the skin into the bloodstream. Despite this replenishment of blood vessels, the skin, due to hypotension and slowing of the pulse, continues to suffer from circulatory failure and becomes pale.

Dyspnea

With bradycardia, the blood in the body is pumped more slowly and its stagnation in the lungs can be observed. During physical exertion, the patient develops shortness of breath, because. the vessels of the pulmonary circulation cannot provide a full-fledged gas exchange. In some cases, a dry cough may appear in parallel with respiratory failure.

Chest pain

Severe bradycardia is always accompanied by disturbances in the work of the heart and a deterioration in the blood supply to the myocardium. With a significant slowdown in the pulse, the tissues of the heart muscle do not receive enough oxygen, and the patient develops angina pectoris. Chest pain with bradycardia occurs after physical, psycho-emotional stress or a decrease in heart rate to 40 or less beats per minute.

Complications

The prolonged presence of bradycardia and the delay in the treatment of the underlying disease can cause the following complications:

• the formation of blood clots, which increases the risk of myocardial infarction, ischemic stroke and the development of thromboembolism;
• heart failure, which increases the likelihood of developing coronary disease heart and myocardial infarction;
• chronic attacks of bradycardia, causing weakness, dizziness, deterioration in concentration and thinking.

Diagnostics

The doctor will detect bradycardia by measuring the patient's pulse or by auscultation (listening to sounds) of the heart

Even the patient himself can find out about the presence of bradycardia. To do this, it is enough to feel the pulse on the wrist (radial artery) or on the neck (carotid artery) and count the number of beats per minute. With a decrease in the number of heartbeats according to age norms, it is necessary to contact a general practitioner for a detailed clarification of the causes of bradycardia and treatment.

To confirm the diagnosis, the doctor will conduct the following examinations:

• listening to heart sounds;
• phonocardiography.

To detect pathological bradycardia, the doctor performs the following test: the patient is offered physical activity and the pulse is measured. Its frequency in such cases increases slightly or the patient has an arrhythmia attack.

When pathological bradycardia is confirmed, the following laboratory and instrumental diagnostic methods can be prescribed to identify the cause of cardiac arrhythmias:

• clinical and biochemical blood tests;
• clinical and biochemical analysis of urine;
• blood test for hormones;
• analyzes for toxins;
• bacteriological studies of blood, urine or feces;
• Echo-KG, etc.

The scope of the examination is determined individually for each patient and depends on the accompanying complaints. After staging preliminary diagnosis the patient may be advised to consult a cardiologist, neuropathologist, gastroenterologist, endocrinologist or other specialized specialists.

Urgent care

With a sharp slowing of the pulse and arterial hypotension the patient may appear pre-fainting or fainting. In such cases, he needs to provide first aid:

1. Lay the patient on his back and raise his legs, resting them on a cushion or pillow.
2. Call an ambulance.
3. Remove or unfasten clothing that restricts breathing.
4. Ensure the flow of fresh air and optimal temperature conditions.
5. Try to bring the patient to consciousness: sprinkle his face with cool water, rub his ears and face soaked in cold water towel, lightly pat him on the cheeks. If the measures provided are not enough, then let the patient inhale a remedy with a pungent odor: onion juice, cotton wool soaked in vinegar or ammonia. Remember that with a sharp inhalation of ammonia vapors, bronchospasm or respiratory arrest may develop. To prevent such a complication, cotton wool with ammonia should be brought at a distance from the respiratory tract.
6. If the patient regained consciousness, then you should measure the pulse and give him a drink of warm tea or coffee with sugar. Try to find out what medications he is taking and give them if possible.
7. After the arrival of the ambulance team, tell the doctor about all the circumstances of fainting and the actions performed.

Treatment

Treatment for pathological bradycardia is aimed at treating the underlying disease, leading to a slowing of the pulse. It can be conservative or surgical. Patients with acute forms of bradycardia require hospitalization.

Conservative therapy

In some cases, to eliminate bradycardia that occurs due to an overdose or prolonged use of drugs, it may be sufficient to stop taking the drug or reduce its dosage. For other reasons for slowing the pulse, the treatment plan is drawn up depending on the severity of the underlying disease.

To eliminate bradycardia, such drugs can be used to increase the number of heartbeats:

• ginseng extract - tincture of ginseng, Farmaton vital, Gerbion ginseng, Gerimaks, Doppelgerts ginseng, Teravit, etc.;
• Eleutherococcus extract - Eleutherococcus tincture, Eleutherococcus P (tablets), Eleutherococcus plus (dragee);
• preparations based on belladonna extract - thick or dry belladonna extract, belladonna tincture, Corbella, Becarbon, etc .;
• Atropine;
• Isadrin;
• Isoprenyl;
• Caffeine;
• Eufillin;
• Ephedrine;
• Ipratropium bromide;
• Alupent.

As a rule, taking medication to eliminate bradycardia is recommended when the heart rate drops to 40 or less beats per minute and fainting occurs. The choice of means, its dosing and duration of administration is determined individually for each patient. Self-medication with such drugs is unacceptable, because. their incorrect intake can lead to severe arrhythmias.

In addition to these drugs, patients are prescribed drugs for the treatment of the underlying disease: antibiotics for infections, thyroid hormones for hypothyroidism, drugs for the treatment of heart disease, peptic ulcer, poisoning, tumors, etc. It is the therapy of the root cause of bradycardia that can more effectively eliminate the symptom itself and those unpleasant manifestations that it causes.

Except drug treatment, patients with such pulse disorders should give up bad habits. This is especially true for smoking, because. It is nicotine that significantly affects the heart rate.

With pathological bradycardia, diet is also important. When compiling the menu, patients should be guided by the following principles:

• restriction of products with animal fats;
• exception alcoholic beverages;
• introduction to the diet of vegetable oils and nuts rich in fatty acids;
• the calorie content of food should correspond to energy costs (1500-2000 kcal, depending on the work performed);
• reducing the amount of salt and fluid volume (as recommended by a doctor).

Surgery

Surgical operations to eliminate bradycardia are performed if conservative treatment is ineffective and the underlying disease is accompanied by a pronounced hemodynamic disorder. The technique of such interventions is determined by the clinical case:

• with congenital malformations of the heart - corrective cardiac surgery is performed to eliminate the anomaly;
• with tumors of the mediastinum - interventions are performed to eliminate the neoplasm;
• with severe bradycardia and the ineffectiveness of drug treatment, a pacemaker is implanted (a device for normalizing the number of heartbeats).

ethnoscience

As an addition to the basic plan of drug therapy, the doctor may recommend taking the following folk remedies:

• radish with honey;
• decoction of rose hips;
• decoction of yarrow;
• garlic with lemon juice;
• walnuts with sesame oil;
• tincture of pine shoots;
• tincture of Chinese lemongrass;
• infusion of immortelle flowers;
• decoction of the Tatar, etc.

When choosing a traditional medicine, be sure to take into account possible contraindications and individual intolerance to the components of the recipe.

Bradycardia can be physiological or pathological. This symptom requires treatment only in cases where it is accompanied by a deterioration in well-being and is caused by various diseases or poisoning. The tactics of therapy for pathological bradycardia depends on the clinical case and is determined by the pathology that causes the slowing of the pulse. Treatment of such diseases can be medical or surgical.

Union of Pediatricians of Russia, pediatric cardiologist M.A. Babaykina talks about bradycardia in children:

Watch this video on YouTube

Cardiologist D. Losik talks about bradycardia:

Watch this video on YouTube

Intracranial hypertension: symptoms, causes and treatment

Probably every person, at least sometimes, suffered from headache attacks, whether it is the result of fatigue and overwork, or as a symptom of a cold. But not everyone knows that the main cause of headache is intracranial hypertension.

If the pain is episodic and its cause is more or less known, then there is no reason to worry. But if the head hurts more than it does not hurt, then you should consult a doctor in order to avoid the progression of a much more serious pathology than the common cold.

Mechanism of headache

Our cranium contains, in addition to the brain itself, blood vessels, cerebrospinal fluid, interstitial substance. The cause of intracranial hypertension is the presence of factors in which the volume of at least one component of the brain system increases.

In a healthy person, up to 600 ml of cerebrospinal fluid (CSF) is formed per day, which performs protective, nutritional and communicative functions between brain regions. With edema, enlarged areas of the brain compress the space filled with cerebrospinal fluid and, accordingly, intracranial pressure increases.

If the outflow of cerebrospinal fluid is disturbed or a hematoma forms due to cerebral hemorrhage, hypertension is also observed. The main reasons include neoplasms or inflammation of the brain tissue, which create abnormal pressure in the cranium. And because of the discrepancy between the pressure of different parts of the brain, there is a violation of the function of the central nervous system.

When hypertension occurs not due to some other disease, but due to the influence of objective factors, for example, obesity, side effects from taking medications, then we speak of benign intracranial hypertension. It is also called a false brain tumor. This condition can also occur in children when taking corticosteroid drugs, drugs of the tetracycline group or containing an increased dose of vitamin A are discontinued.

The normal functioning of the brain is provided by the following components:

• unhindered passage of cerebrospinal fluid between the membranes of the brain and through its ventricles;
• good absorption (absorbability) of cerebrospinal fluid into the venous network of the brain;
• full venous outflow of blood from the brain.

Venous intracranial hypertension occurs due to improper outflow of venous blood from the intracranial system due to thrombosis or blockage of the venous ducts, emphysema, or mediastinal tumors that provoke high blood pressure in the chest.

The manifestation of the disease in children and adults

How the syndrome of intracranial hypertension manifests itself depends entirely on the local location of the causative focus and the rate of development of the disease.

The main signs of intracranial hypertension in adults are headache, most often occurring before lunch, nausea and vomiting during meals, visual disturbances with pain in the eyeballs, up to loss of consciousness. The intensity of the pathology can vary from mild lethargy to falling into a coma.

Symptoms of intracranial hypertension of a moderate course are muffled consciousness, when interest in life is lost, bifurcating objects in the eyes, heart sounds that become rare as in bradycardia. This state is especially pronounced with a decrease in pressure in the atmosphere. In addition, sleep disturbance, possible nosebleeds, chin trembling, marbling of the skin, and changes in behavior indirectly complement the signs of intracranial hypertension in adults.

In women, as a rule, this is associated with the onset of menopause or pregnancy, in which there are changes in the cycles of menstruation, as well as with obesity or taking certain medications.

The syndrome of intracranial hypertension in children can be caused by such reasons:

• increased size of the children's skull due to excessive production of cerebrospinal fluid by the body due to hydrocephalus or dropsy of the brain;
• consequences of birth trauma;
• an infectious disease transmitted by the mother during pregnancy.

Intracranial hypertension in infants is diagnosed with developmental delay, too convex frontal part of the head. At the same time, the child does not react in any way to bright light, often rolls his eyes. The place of the fontanel on the head is either tense or swollen, the eyeballs are bulging.

In older children, these manifestations are increased drowsiness, constant or frequent headache, possible strabismus and the inability to catch a visual picture that eludes and is not fixed by sight.

Intracranial hypertension in children, ongoing long time, can cause pathological changes in the development of the brain. Therefore, when a focus of the disease is identified, it is necessary to urgently take all measures for the further treatment of the child in order to avoid the onset of a worse prognosis.

Treatment Methods

Depending on which component common system brain functioning is out of order, dependent symptoms and treatment of intracranial hypertension in adults and children.

So, in order to reduce the amount of cerebrospinal fluid produced, urinary agents are prescribed, and the corresponding set of exercises developed by specialists is designed to reduce intracranial pressure. A special diet and dosage of water consumed per day is compiled for the patient. Attracting a manual specialist and getting acupuncture sessions helps to normalize the amount of CSF.

If the case is severe and the above procedures do not produce the desired effect, resort to surgical method. It consists in the fact that by means of trepanation of the skull, a hole is made in it, through which a special drainage system is implanted. With the help of this system, excess fluid is removed from the cranium.

These methods significantly improve the patient's health, eliminating the signs of intracranial hypertension syndrome in just a few days from the start of treatment. However, it is possible to successfully cure the disease only if the cause of hypertension is completely eliminated.

Treatment of intracranial hypertension in a child's body can be carried out both conservatively and radically. The choice of treatment method depends entirely on the cause that gave rise to the disease.

If the pathology is diagnosed in a newborn, then such babies should be observed by a neurologist from birth, who, if necessary, will correct the treatment at a certain stage in order to avoid serious complications.

In order to eliminate the consequences of the pathology of pregnancy and the severe course of labor, it is necessary to breastfeed the baby for as long as possible, punctually observe the daily routine and, especially, sleep, constantly be in contact with the child both emotionally and in contact in order to avoid nervous stress, regularly take walks on street in any weather.

At the same time, the child should take funds designed to calm the nervous system, improve the circulatory, urinary systems, as well as vitamin preparations to strengthen the immune system.

For older children, the doctor prescribes procedures from the category of physiotherapy, they help well in curing the disease of swimming.

Any anatomical anomalies that interfere with the outflow of cerebrospinal fluid from the brain are solved surgically.

From folk methods, as a supplement to the main treatment, one can single out rubbing lavender oil into the temporal part of the head before going to bed. This tool not only calms the nervous system, but also promotes sound healthy sleep, which significantly speeds up recovery.

Video about intracranial hypertension:

It should not be hidden that the diagnosis of convulsive readiness, few of the parents will not lead to a degree of extreme frustration. Fortunately, in this case, timely detection of the disease, proper treatment and competent specialists will help both desperate parents and a small creature bravely enduring all the hardships of the disease to cope. Convulsive readiness is not a fatal diagnosis. You can fight him. The number of people cured of the disease is increasing every day.

Convulsive readiness of the brain

Due to the immaturity of the nervous system in young children, convulsive readiness of the brain can be diagnosed. The seizures with which it accompanies can occur dozens of times, and can become a single case. Without a full examination, a reliable diagnosis cannot be considered.

Convulsive readiness of the brain is most often diagnosed in children under 5 years of age. It is tolerated by up to 5% of preschool children. In the case of proper treatment and medication, and in some cases with the help of alternative medicine, convulsive readiness disappears without a trace. In the first years of life, nerve endings and parts of the brain are in the process of constant formation, as a result, the blood-brain barrier is very low, as a result, excitability comes faster. The child reacts sharply to irritating factors (external and internal), which leads to convulsive readiness of the brain.

Convulsive readiness: symptoms

The symptoms of the manifestation of the condition are very bright. Often, convulsive readiness has convulsive symptoms. However, they can manifest themselves differently at different stages.

Tonic seizures are characterized by a loss of contact with the outside world. A person does not respond and does not react to any external manifestations. Characteristic muscle contractions can be observed both in one muscle group and throughout the body. The duration of the attack is up to 2 minutes. The head is thrown back, the upper limbs are bent, and the lower ones are fully extended.

After the attack of tonic convulsive readiness is over, clonic convulsions occur. The frequency of movements is greatly increased. Starting from the face, convulsions pass to the whole body. The speed of inhalation and exhalation increases significantly. The skin becomes very white. Often foam appears from the lips. According to the duration of the clonic seizure, convulsive readiness is diagnosed and the severity of the disease is determined.

Threshold of convulsive readiness of the brain

A reduced threshold for convulsive readiness of the brain is typical for young children. For each person, it is individual and decreases under the influence of a number of factors. The most common include:

• severe intoxication;
• heat;
• hereditary predisposition;
• diseases and infections of the brain;
• congenital diseases of the nervous system;
• asphyxia;
• diseases associated with metabolic processes;
• hormonal abnormalities;
• infectious diseases, etc.

Despite the fact that the seizure threshold of the brain is different for each person, an epileptic seizure that is not relieved for more than 30 minutes can lead to serious consequences.

Over time, with proper treatment, the seizure threshold of the brain can rise significantly. But, at the same time, it is necessary to prevent the convulsive syndrome from developing into a serious illness and developing into something more than it actually is in the early stages.

Increased convulsive readiness

As noted above, increased convulsive readiness is characteristic primarily for children. Due to the high permeability of the cerebral vessels, the hydrophilicity of tissues and the unfinished process of brain formation, the child reacts much more strongly to many stimuli. In order for his body to cramp for several minutes, it doesn’t take much. A couple of decades ago, the diagnosis of increased convulsive readiness was made belatedly. At the age of 5-8 years. Due to the inattention of doctors, a person has to take pills all his life and be afraid of a new attack. Now convulsive readiness is just a diagnosis. She is curable. After a well-chosen course of treatment completed within six months, the child may no longer remember his illness.

It is important to remember that a person who has been diagnosed with increased convulsive readiness should not be disturbed in any way. Even a small pathogen in the focus area can lead to prolonged seizures that worsen the patient's condition.

Reduced convulsive readiness

In contrast to the previous diagnosis, a decrease in convulsive readiness indicates that the patient may have an attack at any time. It doesn't need any stimuli. In this case, partial seizures are characteristic. They are shorter and the person remains fully conscious.

The diagnosis of reduced convulsive readiness is often made in adulthood. They are surprised to learn about it when undergoing general examinations or doing an MRI. The causes of the appearance are heredity, transferred infectious diseases, the presence of oncological diseases.

Convulsive readiness in children

It is the young creatures who are most susceptible this disease. As a result of birth trauma, insufficient development nerve endings, brain or heredity, convulsive readiness in children is much more common. As mentioned above, the 5% threshold has not yet been exceeded, but soon everything may change, as this diagnosis is being made more and more often.

In order to verify the diagnosis or, on the contrary, to drive away all doubts, parents can easily check whether there are prerequisites for the fact that convulsive readiness in children is likely.

• Take the baby between the elbow and shoulder joints and squeeze a little with your fingers. If the baby's fingers begin to twitch nervously and cramp them, then the likelihood of convulsive readiness is high.
• Between the cheekbone and the corner of the mouth, tap lightly with your finger. If, during or after tapping, the baby’s face changes twitching in the area of ​​​​the mouth, nose wing and eyelid, then this is a reason to contact the pediatrician and talk about your experiences.

It is unambiguous to draw conclusions that a child has convulsive readiness is never possible. And trusting the health of the child to the opinion of only one specialist is not recommended. It is necessary to pass tests. Convulsive readiness in children is always accompanied by a low level of calcium in the blood serum. Additional Research MRI and EEG are done as prescribed by a neurologist. With a timely and competent approach, when the child is not yet tormented by prolonged seizures and does not lose consciousness, it is very easy to solve the problem. In advanced cases, when parents did not pay due attention to obvious symptoms, babies suffer first, and only then their inattentive relatives.

It is not so easy to prepare for attacks of convulsive readiness. It is more important to deal with them in the early stages. And first of all, parents should take care of the health of their children. Their inattention can result in an unpleasant state when a seemingly healthy person falls in a fit of convulsions. Convulsive readiness is curable, but it needs to be dealt with in time.

Similar articles:

Convulsions at a temperature in a child

Spasticity (spasticity)

Seizures after a stroke

Hormetonia

Febrile convulsions

Syndrome of vertebrobasilar insufficiency

Have you struggled with HYPERTENSION for many years without success?

Head of the Institute: “You will be amazed at how easy it is to cure hypertension by taking it every day…

Vertebrobasilar insufficiency (VBI) is one of the forms of damage to cerebral vessels. This type of cerebrovascular pathology is characterized by episodes of reversible ischemia of the brain structures, which are supplied with blood by vessels extending from the main and vertebral arteries. These episodes may be repeated. This syndrome also occurs in children.

• The reasons
• Symptoms
• Diagnostics
• Treatment
• Forecast
• Prevention

The reasons

The main reason for the development of VBN is a violation of the patency of the main head arteries. First of all, the extracranial sections of the arteries of the spine are subjected to deviation. The stenosis often involves arterial sites up to the point where the artery enters the bony canal. Sometimes stenosis is localized in the innominate or subclavian arteries. Basically, the vessels are affected due to atherosclerotic stenosis. Congenital abnormalities in the structure of the vascular bed also play an important role. Rarer causes are inflammatory diseases such as arteritis or dissection of the basilar or vertebral artery.

Read more here…

The risk of ischemia in the vertebrobasilar basin increases when the possibility of collateral circulation is limited. This is observed with the following deviations:

treatment of hypertension recommended by doctors! …

• non-closure of the circle of Willis;
• severe hypoplasia of any vertebral artery;
• abnormal origin of small branches from the vertebral and basilar arteries.

It is impossible not to pay attention to the possibility of compression of the vertebral arteries by altered vertebrae, which can occur with spondylosis and osteophyte. This situation can be the main reason for the development of VBI. In addition, collateral circulation in the vertebrobasilar basin has considerable possibilities, which is due to the presence of the Zakharchenko ring where the region of the brain stem is located, the circle of Willis on the brain base, extra-intracranial connections among the arteries and anastomotic systems on the surface of the brain. Such ways of bypass blood circulation make it possible to compensate, in full, for expressed defects in the vascular bed, regardless of what character they have, acquired or congenital.

There are several anatomical factors that predispose to a large compression of the vertebral arteries with the risk of developing severe complications, among which there is also cerebral ischemia, which is clearly visible in the diagnosis:

• exostoses with the formation of a retroarticular canal;
• anomaly Kimmerle;
• other anomalies in the structure of the cervical spine.

If these factors are present in a person, the role of functional factors increases, which include rotation of the cervical vertebrae with arterial compression and displacement, as well as trauma to the cervical spine.

Intracranial arteries may have such a variant of the structure as dolichoectasia. Modern non-invasive and invasive methods for diagnosing the cerebrovascular system have made it possible to detect such anomalies more often. Dolichoectasia is a peculiar combination of signs of ischemia of structures that are supplied with blood from the vertebrobasilar basin and compression of the cranial nerves.

The cause of VBI may lie in the defeat of small-caliber arteries. This may be due to diabetes mellitus and arterial hypertension, as well as a combination of these two disorders. Sometimes the causes lie in cardiogenic embolisms, which are usually accompanied by occlusion of a large vessel and the development of a severe neurological deficit. A prerequisite for the development of VBN can be circulating aggregates of blood cells and a high ability to aggregate formed elements.

Vascular disorders of the vertebo-basilar system among adults account for 30% of acute cerebral circulatory disorders and 70% of transient disorders. Approximately 80% of strokes are ischemic, and a quarter of them occur in the vertebrobasilar system (VBS). As noted, VBN also occurs among children. With the help of qualitative diagnostics, such a diagnosis is detected in many children from birth, and the cause may be natal damage to the vertebral arteries and spine. Today, the number of such disorders among children and young people is increasing. VBN is chronic.

There are several classifications of this syndrome. One of them was presented in 1989 by Bakulev. He identified three stages in the development of this disorder:

• Stage 1 - compensation, when an asymptomatic course is noted or there are initial manifestations of the syndrome in the form of focal neurological disorders.
• Stage 2 - relative compensation. Here transient ischemic attacks occur, i.e. acutely developed disorder of cerebral circulation, combined with rapidly passing cerebral or general symptoms. At the same stage, a small stroke occurs, i.e. completely reversible neurological deficit, and dyscirculatory encephalopathy.
• Stage 3 - decompensation. Here, a completed ischemic stroke occurs, which has varying degrees of severity, as well as dyscirculatory encephalopathy, but already in the third degree, while in the previous stage it had the first or second degree.

In accordance with the neurological classification, 4 stages are distinguished:

1. angiodystonic stage. In this case, subjective clinical symptoms predominate, rather than symptoms of focal brain damage.
2. Angiodystonic-ischemic stage.
3. Ischemic stage, when the symptoms of cerebral ischemia predominate in the vertebrobasilar basin. The vegetative-irritative symptoms practically disappear.
4. The stage of residual phenomena.

Symptoms

Symptoms of VBN can be divided into two groups:

1. Temporary signs usually develop with transient ischemic attacks. Their duration varies from several hours to several days. At the same time, a person complains of pain in the back of the head, which has a pressing character, discomfort in the neck and severe dizziness.
2. Persistent symptoms. They are always present with a person and gradually increase. Exacerbations can occur, in which ischemic attacks come, which can lead to vertebrobasilar strokes. Among the constant signs of the syndrome, frequent headaches in the back of the head, tinnitus, visual impairment and balance, memory loss, increased fatigue, dizziness attacks, fainting, a sensation of a lump in the throat can be distinguished.

The most common manifestation of the syndrome is dizziness, which occurs abruptly. Most patients describe the nature of such dizziness as a feeling of rectilinear movement or rotation of their own body or surrounding objects. This may take several minutes or hours. Dizziness is often combined with hyperhidrosis, nausea, and vomiting.

VBN syndrome can occur even in children aged 3 to 5 years, as well as in the range of 7-14 years, although previously it was considered impossible. Now it is clear that there is no age limit. There are specific signs of VBN in children. If they are observed, it is necessary to urgently contact a medical institution, undergo a diagnosis and begin treatment. The future of the child depends on timely diagnosis and treatment. Signs of the development of the syndrome in children include:

• violation of posture;
• frequent tearfulness, increased drowsiness and fatigue;
• the child does not tolerate stuffiness, which leads to fainting, nausea and dizziness;
• the child sits in an uncomfortable position.

Some diagnoses that are made to children at an early age can provoke the development of the syndrome. These include perinatal encephalopathy and spinal trauma during childbirth or during sports.

Diagnostics

Timely diagnosis helps to start early treatment and avoid serious complications, such as stroke. Diagnosis is of particular importance for children, since timely treatment makes it possible to make a favorable prognosis for the development of VBI.

At the very beginning of the diagnosis, it is important to determine the damage to the vessels of the vertebrobasilar basin based on the clinic and the results of functional tests. All patients need to do auscultation of the projection of the supraclavicular region. You can confirm the lack of blood flow in the pool using several functional tests:

• intensive hand work;
• de Klein test;
• hautant's test, when the patient sits with a straight back and closed eyes;
• vertebral artery test, when the patient is lying on his back;
• dizziness test, when the patient turns his head to the left and right, turns to the sides only with his shoulders.

Based on the patient's condition during these tests, it is possible to confirm a violation of blood flow in the vertebrobasilar basin. Further diagnostics include ultrasound methods, which can be used to determine the localization of the lesion and assess the hemodynamic significance of stenosis or pathological tortuosity of the vessels. Such methods help to determine the functional and structural reserves of compensation.

Angiographic diagnostic methods, such as MRI, CT, X-ray contrast angiography, allow you to accurately determine the type, extent and localization of the lesion, to identify multi-level lesions.

After carrying out all the necessary studies, a diagnosis is made in accordance with the ICD-10, then treatment is prescribed, and the sooner this is done, the better, as it will avoid complications in the form of a stroke and other consequences, and even death.

Treatment

If the syndrome is at the initial stage of development, treatment is carried out on an outpatient basis. If symptoms of acute VBN are clearly manifested, the patient is placed in a hospital for observation and prevention of strokes.

Most often, when prescribing treatment, doctors combine medical methods with physiotherapy. The patient must understand that it is necessary to regularly monitor pressure and follow a diet. Given the chronic nature of the disease, it is important to assess the patient's readiness to systematically use prescribed medications.

Some forms of the disease are not treated with drugs at all. That is why it is necessary to determine the presence of the disease as early as possible. An individual treatment is selected for each patient. When drug treatment is prescribed, drugs from the following groups are selected:

1. Vasodilators, i.e. vasodilators that prevent occlusion. Most often, treatment with these drugs begins in the fall or spring. At first, small doses are prescribed, which are gradually increased. If the expected effect is not observed, the drug is sometimes combined with other drugs of similar action.
2. Antiplatelet agents that reduce blood clotting. It prevents blood clots. The most popular drug from this group is acetylsalicylic acid. For a day, the patient needs to consume 50-100 milligrams. However, patients with gastrointestinal diseases should be careful when taking this drug, because. gastric bleeding may open, and therefore, aspirin is forbidden to be taken on an empty stomach.
3. Nootropic and metabolic drugs that improve brain function.
4. Antihypertensive drugs that regulate blood pressure.
5. Painkillers.
6. Sleeping pills.
7. Antidepressants.
8. Antiemetic drugs.
9. Medicines to reduce dizziness.

The following types of therapies are used:

1. Massage. It improves blood circulation.
2. exercise therapy. Regular therapeutic exercises allow you to get rid of spasms, strengthen the spine and improve posture.
3. Reflexology. It also relieves muscle spasms.
4. Magnetotherapy.

When complex treatment fails, surgical treatment is prescribed. The operation is performed to improve blood circulation in the vertebral and basilar arteries. In this case, angioplasty is common, in which a special stent is inserted into the vertebral artery. It does not allow the arterial lumen to close and maintains normal blood circulation. With atherosclerosis, an endarterectomy is performed, the essence of which is to remove an atherosclerotic plaque. Microdiscectomy helps stabilize the spine.

In children, the syndrome is easily corrected. Medical treatment is practically not used. Rarely, when cases are extremely severe, surgery is performed.

Alternative methods of treatment can also be used, but only as an addition to the main treatment and after consultation with a doctor. A positive effect of vitamin C was noted. To prevent thrombosis, it is advised to use viburnum, cranberries, sea buckthorn, currants and other products containing this vitamin.

Forecast

The prognosis of VBI is determined by the nature and severity of the underlying disease and the degree of damage to the vascular bed. If the narrowing of the arteries progresses, there is persistent arterial hypertension and there is no adequate therapy, the prognosis is poor. These patients are at high risk for stroke. They may also develop dyscirculatory encephalopathy.

A favorable prognosis can be made in the case when the state of the vascular system of the head is satisfactory, and the treatment tactics are adequate and effective. Much depends on how the patient follows medical recommendations.

Prevention

The following measures will help prevent the onset of the disease or slow its development:

1. Diet. It is necessary to abandon white bread, sausages, fatty, fried and smoked, canned food. It is worth eating more low-fat cottage cheese, sour berries, garlic, seafood, tomatoes.
2. Quit smoking and monitor the amount of alcohol consumed so that it does not exceed the norm, it is natural.
3. Reduce salt intake.
4. Exercise moderately.
5. Control blood pressure.
6. Do not sit in one position for a long time.
7. Sleep and sit on a comfortable surface.
8. Avoid stress.
9. Walk more outdoors, swim more.

VBN is a serious syndrome, but with timely treatment and prevention, its sad consequences can be avoided.

– by leaving a comment, you accept the User Agreement

IT'S IMPORTANT TO KNOW! The only remedy for treatment of hypertension recommended by doctors! …

• Arrhythmia
• Atherosclerosis
• Varicose veins
• Varicocele
• Haemorrhoids
• Hypertension
• Hypotension
• Diagnostics
• Dystonia
• Stroke
• heart attack
• Ischemia
• Blood
• Operations
• Heart
• Vessels
• angina pectoris
• Tachycardia
• Thrombosis and thrombophlebitis

• heart tea
• Hypertension
• Pressure bracelet
• Normallife
• Allapinin
• Asparkam
• Detralex

Bradycardia: symptoms, treatment

Violations in the occurrence and conduction of a nerve impulse that provides contraction of the heart leads to changes in the heart rhythm - arrhythmias. One of the varieties of such pulse deviations is bradycardia - a decrease in the number of heartbeats to less than 55-60 beats per minute in adults and adolescents over 16 years old, 70-80 in children and 100 in children under one year old. Such a violation of the heart rhythm is not an independent disease. As a symptom, bradycardia can occur with a variety of ailments or appears as a protective physiological reaction in response to external stimuli.

In this article, we will introduce you to the physiological and pathological causes, manifestations, methods for diagnosing and treating bradycardia. This information will help you make the right decision about the need to see a doctor to identify and treat diseases that provoke this symptom.

The reasons

Physiological bradycardia is often found in well-trained individuals.

Changes in the pulse rate can cause both natural external factors and diseases of internal organs and systems. Depending on this, bradycardia can be physiological and pathological.

Physiological bradycardia

Such a slowdown in the pulse is a variant of the norm, is not dangerous to human health and can occur after exposure to the following external factors and stimuli:

• moderate hypothermia or staying in conditions of high humidity and temperature - the body in such conditions goes into a "saving mode" of energy resources;
• age-related changes - after about 60-65 years, islands of connective tissue appear in myocardial tissues (age-related cardiosclerosis) and the metabolism as a whole changes, as a result, body tissues need less oxygen, and the heart does not need to pump blood with the same blood as before , intensity;
• stimulation of reflex zones - pressure on the eyeballs or pressure on the bifurcation of the carotid arteries when wearing a tie or shirt with a tight collar affects the vagus nerve and causes an artificial slowing of the pulse;
• good physical preparation ("training") - in athletes or during physical labor, the left ventricle increases in volume and is able to provide the body with the necessary amount of blood and with fewer contractions;
• night sleep - the body is at rest and does not need frequent heartbeats and a large amount of oxygen;
• physical or psycho-emotional overwork - the body, when tired, goes into a “saving mode” of energy resources.

Another type of physiological bradycardia is idiopathic. In such cases, examination of the patient does not reveal any reason for the slowing of the pulse. A person does not go in for sports or physical labor, does not take medications, does not feel the effects of other contributing factors, and his well-being does not suffer from bradycardia in any way, because. it is successfully compensated by the body itself.

Sometimes a decrease in heart rate is considered a physiological norm when taking certain drugs that have a similar side effect. But the slowing of the pulse is considered the norm only in cases where the patient does not feel worse and the drug is not taken for a long time. In other situations, it is advisable to reduce the dosage, cancel or replace the drug with another one.

In the cases described above, the slowing of the pulse is not dangerous to health and does not cause a decrease in the blood supply to the brain and other organs. Treatment to eliminate physiological bradycardia is not required, because. it passes on its own after the exclusion of an external stimulus. However, with a prolonged slowdown in the pulse that occurs in athletes or people over 60-65 years old, it is recommended to have a follow-up with a cardiologist to timely identify possible deviations in the state of health.

Pathological bradycardia

Such a slowdown in the pulse is not a variant of the norm, it affects the state of human health and can occur under the influence of the following reasons:

For the treatment of hypertension, our readers have successfully used ReCardio. Seeing the popularity of this tool, we decided to bring it to your attention.
Read more here…

• heart pathology - a slowdown in the pulse can be provoked by ischemic disease, myocardial infarction, focal or diffuse cardiosclerosis, inflammatory diseases (endocarditis, myocarditis), Morgagni-Adams-Stokes syndrome, etc .;
• taking medications (especially Quinidine, beta-blockers, cardiac glycosides, calcium channel blockers, Morphine, Amisulpride, Digitalis and Adenosine) - usually slowing the pulse is caused by improper dosing and taking such drugs, affects the general well-being and can threaten the patient's life;
• poisoning with toxic substances (lead compounds, nicotinic acid and nicotine, narcotic and organophosphorus substances) - under the influence of these compounds, the tone of the parasympathetic and sympathetic nervous system changes, various organs and systems are affected (including cells of the conduction system of the heart, and myocardial cells);
• increased tone of the parasympathetic nervous system - such a reaction can be caused by certain diseases and pathological conditions (neurosis, depression, peptic ulcer, tumors in the mediastinum, traumatic brain injury, hemorrhagic stroke, increased intracranial pressure, neoplasms of the brain, edema after surgical interventions on the neck, head or mediastinal region);
• some infectious diseases - usually infections contribute to the development of tachycardia, but typhoid fever, some viral hepatitis and severe sepsis can cause a slow pulse, in addition, bradycardia can be observed in severe and prolonged infectious diseases leading to exhaustion of the body;
• hypothyroidism - a decrease in the level of thyroxine and triiodothyronine (thyroid hormones) leads to a change in the tone of the nervous system, disruption of the heart and slowing of the pulse, attacks of bradycardia in such conditions occur sporadically at first, and then become permanent.

In the cases described above, the slowing of the pulse is dangerous to health and causes a decrease in the blood supply to the brain and other organs. Such bradycardias are a symptom of pathology and require treatment of the underlying disease.

Symptoms

One of the manifestations of bradycardia is dizziness.

The slowing of the pulse affects the general well-being only with pathological bradycardia. In addition to the signs of the underlying disease, the patient has symptoms that indicate a decrease in heart rate, and their severity will depend on the pulse rate.

Almost all signs of bradycardia occur due to oxygen starvation of the organs and tissues of the body. Usually they occur episodically, but even their periodic appearance significantly affects the quality of life and indicates the presence of a disease that needs treatment.

Dizziness

A significant slowdown in the pulse leads to the fact that the heart cannot maintain blood pressure at the proper level. Due to its decrease, the blood supply to many systems and organs is disturbed. First of all, the brain begins to suffer from ischemia and oxygen starvation, and that is why dizziness becomes one of the first signs of bradycardia. Usually this symptom appears episodically and after the stabilization of the number of heart contractions is eliminated.

fainting

The appearance of such a symptom of bradycardia is caused by the same cause as dizziness. The degree of its severity depends on the level of lowering blood pressure. With severe hypotension, the brain seems to be temporarily turned off, which manifests itself in the form of a pre-fainting state or fainting. Especially often, such symptoms occur against the background of mental or physical overwork.

Weakness and fatigue

These symptoms are caused by reduced blood supply to the skeletal muscles that occurs when the heart rate slows down. Muscle cells due to lack of oxygen are not able to contract with the usual force, and the patient feels weakness or reduced tolerance to physical activity.

Pale skin

When the pulse slows down, blood pressure drops and insufficient blood flows to the skin. In addition, it is the skin that is a kind of "depot" of blood, and if there is not enough of it, the body mobilizes it from the skin into the bloodstream. Despite this replenishment of blood vessels, the skin, due to hypotension and slowing of the pulse, continues to suffer from circulatory failure and becomes pale.

Dyspnea

With bradycardia, the blood in the body is pumped more slowly and its stagnation in the lungs can be observed. During physical exertion, the patient develops shortness of breath, because. the vessels of the pulmonary circulation cannot provide a full-fledged gas exchange. In some cases, a dry cough may appear in parallel with respiratory failure.

Chest pain

Severe bradycardia is always accompanied by disturbances in the work of the heart and a deterioration in the blood supply to the myocardium. With a significant slowdown in the pulse, the tissues of the heart muscle do not receive enough oxygen, and the patient develops angina pectoris. Chest pain with bradycardia occurs after physical, psycho-emotional stress or a decrease in heart rate to 40 or less beats per minute.

Complications

The prolonged presence of bradycardia and the delay in the treatment of the underlying disease can cause the following complications:

• the formation of blood clots, which increases the risk of myocardial infarction, ischemic stroke and the development of thromboembolism;
• heart failure, which increases the likelihood of developing coronary heart disease and the onset of myocardial infarction;
• chronic attacks of bradycardia, causing weakness, dizziness, deterioration in concentration and thinking.

Diagnostics

The doctor will detect bradycardia by measuring the patient's pulse or by auscultation (listening to sounds) of the heart

Even the patient himself can find out about the presence of bradycardia. To do this, it is enough to feel the pulse on the wrist (radial artery) or on the neck (carotid artery) and count the number of beats per minute. With a decrease in the number of heartbeats according to age norms, it is necessary to contact a general practitioner for a detailed clarification of the causes of bradycardia and treatment.

To confirm the diagnosis, the doctor will conduct the following examinations:

• listening to heart sounds;
• phonocardiography.

To detect pathological bradycardia, the doctor performs the following test: the patient is offered physical activity and the pulse is measured. Its frequency in such cases increases slightly or the patient has an arrhythmia attack.

When pathological bradycardia is confirmed, the following laboratory and instrumental diagnostic methods can be prescribed to identify the cause of cardiac arrhythmias:

• clinical and biochemical blood tests;
• clinical and biochemical analysis of urine;
• blood test for hormones;
• analyzes for toxins;
• bacteriological studies of blood, urine or feces;
• Echo-KG, etc.

The scope of the examination is determined individually for each patient and depends on the accompanying complaints. After making a preliminary diagnosis, the patient may be recommended to consult a cardiologist, neuropathologist, gastroenterologist, endocrinologist or other specialized specialists.

Urgent care

With a sharp slowdown in the pulse and arterial hypotension, the patient may develop a pre-fainting state or faint. In such cases, he needs to provide first aid:

1. Lay the patient on his back and raise his legs, resting them on a cushion or pillow.
2. Call an ambulance.
3. Remove or unfasten clothing that restricts breathing.
4. Ensure the flow of fresh air and optimal temperature conditions.
5. Try to bring the patient to consciousness: sprinkle his face with cool water, rub the ears and face with a towel soaked in cold water, lightly pat him on the cheeks. If the measures provided are not enough, then let the patient inhale a remedy with a pungent odor: onion juice, cotton wool soaked in vinegar or ammonia. Remember that with a sharp inhalation of ammonia vapors, bronchospasm or respiratory arrest may develop. To prevent such a complication, cotton wool with ammonia should be brought at a distance from the respiratory tract.
6. If the patient regained consciousness, then you should measure the pulse and give him a drink of warm tea or coffee with sugar. Try to find out what medications he is taking and give them if possible.
7. After the arrival of the ambulance team, tell the doctor about all the circumstances of fainting and the actions performed.

Treatment

Treatment for pathological bradycardia is aimed at treating the underlying disease, leading to a slowing of the pulse. It can be conservative or surgical. Patients with acute forms of bradycardia require hospitalization.

Conservative therapy

In some cases, to eliminate bradycardia that occurs due to an overdose or prolonged use of drugs, it may be sufficient to stop taking the drug or reduce its dosage. For other reasons for slowing the pulse, the treatment plan is drawn up depending on the severity of the underlying disease.

To eliminate bradycardia, such drugs can be used to increase the number of heartbeats:

• ginseng extract - tincture of ginseng, Farmaton vital, Gerbion ginseng, Gerimaks, Doppelgerts ginseng, Teravit, etc.;
• Eleutherococcus extract - Eleutherococcus tincture, Eleutherococcus P (tablets), Eleutherococcus plus (dragee);
• preparations based on belladonna extract - thick or dry belladonna extract, belladonna tincture, Corbella, Becarbon, etc .;
• Atropine;
• Isadrin;
• Isoprenyl;
• Caffeine;
• Eufillin;
• Ephedrine;
• Ipratropium bromide;
• Alupent.

As a rule, taking medication to eliminate bradycardia is recommended when the heart rate drops to 40 or less beats per minute and fainting occurs. The choice of means, its dosing and duration of administration is determined individually for each patient. Self-medication with such drugs is unacceptable, because. their incorrect intake can lead to severe arrhythmias.

In addition to these drugs, patients are prescribed drugs for the treatment of the underlying disease: antibiotics for infections, thyroid hormones for hypothyroidism, drugs for the treatment of heart disease, peptic ulcer, poisoning, tumors, etc. It is the therapy of the root cause of bradycardia that can more effectively eliminate the symptom itself and those unpleasant manifestations that it causes.

In addition to drug treatment, patients with such pulse disorders should give up bad habits. This is especially true for smoking, because. It is nicotine that significantly affects the heart rate.

With pathological bradycardia, diet is also important. When compiling the menu, patients should be guided by the following principles:

• restriction of products with animal fats;
• exclusion of alcoholic beverages;
• introduction to the diet of vegetable oils and nuts rich in fatty acids;
• the calorie content of food should correspond to energy costs (1500-2000 kcal, depending on the work performed);
• reducing the amount of salt and fluid volume (as recommended by a doctor).

Surgery

Surgical operations to eliminate bradycardia are performed if conservative treatment is ineffective and the underlying disease is accompanied by a pronounced hemodynamic disorder. The technique of such interventions is determined by the clinical case:

• with congenital malformations of the heart - corrective cardiac surgery is performed to eliminate the anomaly;
• with tumors of the mediastinum - interventions are performed to eliminate the neoplasm;
• with severe bradycardia and the ineffectiveness of drug treatment, a pacemaker is implanted (a device for normalizing the number of heartbeats).

ethnoscience

As an addition to the basic plan of drug therapy, the doctor may recommend taking the following folk remedies:

• radish with honey;
• decoction of rose hips;
• decoction of yarrow;
• garlic with lemon juice;
• walnuts with sesame oil;
• tincture of pine shoots;
• tincture of Chinese lemongrass;
• infusion of immortelle flowers;
• decoction of the Tatar, etc.

When choosing a traditional medicine, possible contraindications and individual intolerance to the components of the recipe must be taken into account.

Bradycardia can be physiological or pathological. This symptom requires treatment only in cases where it is accompanied by a deterioration in well-being and is caused by various diseases or poisonings. The tactics of therapy for pathological bradycardia depends on the clinical case and is determined by the pathology that causes the slowing of the pulse. Treatment of such diseases can be medical or surgical.

Union of Pediatricians of Russia, pediatric cardiologist M.A. Babaykina talks about bradycardia in children:

Watch this video on YouTube

Cardiologist D. Losik talks about bradycardia:

Watch this video on YouTube

Intracranial hypertension: symptoms, causes and treatment

Probably every person, at least sometimes, suffered from headache attacks, whether it is the result of fatigue and overwork, or as a symptom of a cold. But not everyone knows that the main cause of headache is intracranial hypertension.

If the pain is episodic and its cause is more or less known, then there is no reason to worry. But if the head hurts more than it does not hurt, then you should consult a doctor in order to avoid the progression of a much more serious pathology than the common cold.

Mechanism of headache

Our cranium contains, in addition to the brain itself, blood vessels, cerebrospinal fluid, interstitial substance. The cause of intracranial hypertension is the presence of factors in which the volume of at least one component of the brain system increases.

In a healthy person, up to 600 ml of cerebrospinal fluid (CSF) is formed per day, which performs protective, nutritional and communicative functions between brain regions. With edema, enlarged areas of the brain compress the space filled with cerebrospinal fluid and, accordingly, intracranial pressure increases.

If the outflow of cerebrospinal fluid is disturbed or a hematoma forms due to cerebral hemorrhage, hypertension is also observed. The main reasons include neoplasms or inflammation of the brain tissue, which create abnormal pressure in the cranium. And because of the discrepancy between the pressure of different parts of the brain, there is a violation of the function of the central nervous system.

When hypertension occurs not due to some other disease, but due to the influence of objective factors, for example, obesity, side effects from taking medications, then we speak of benign intracranial hypertension. It is also called a false brain tumor. This condition can also occur in children when taking corticosteroid drugs, drugs of the tetracycline group or containing an increased dose of vitamin A are discontinued.

The normal functioning of the brain is provided by the following components:

• unhindered passage of cerebrospinal fluid between the membranes of the brain and through its ventricles;
• good absorption (absorbability) of cerebrospinal fluid into the venous network of the brain;
• full venous outflow of blood from the brain.

Venous intracranial hypertension occurs due to improper outflow of venous blood from the intracranial system due to thrombosis or blockage of the venous ducts, emphysema, or mediastinal tumors that provoke increased pressure in the chest.

The manifestation of the disease in children and adults

How the syndrome of intracranial hypertension manifests itself depends entirely on the local location of the causative focus and the rate of development of the disease.

The main signs of intracranial hypertension in adults are headache, most often occurring before lunch, nausea and vomiting during meals, visual disturbances with pain in the eyeballs, up to loss of consciousness. The intensity of the pathology can vary from mild lethargy to falling into a coma.

Symptoms of intracranial hypertension of a moderate course are muffled consciousness, when interest in life is lost, bifurcating objects in the eyes, heart sounds that become rare as in bradycardia. This state is especially pronounced with a decrease in pressure in the atmosphere. In addition, sleep disturbance, possible nosebleeds, chin trembling, marbling of the skin, and changes in behavior indirectly complement the signs of intracranial hypertension in adults.

In women, as a rule, this is associated with the onset of menopause or pregnancy, in which there are changes in the cycles of menstruation, as well as with obesity or taking certain medications.

The syndrome of intracranial hypertension in children can be caused by such reasons:

• increased size of the children's skull due to excessive production of cerebrospinal fluid by the body due to hydrocephalus or dropsy of the brain;
• consequences of birth trauma;
• an infectious disease transmitted by the mother during pregnancy.

Intracranial hypertension in infants is diagnosed with developmental delay, too convex frontal part of the head. At the same time, the child does not react in any way to bright light, often rolls his eyes. The place of the fontanel on the head is either tense or swollen, the eyeballs are bulging.

In older children, these manifestations are increased drowsiness, constant or frequent headache, possible strabismus and the inability to catch a visual picture that eludes and is not fixed by sight.

Intracranial hypertension in children, which lasts for a long time, can cause pathological changes in the development of the brain. Therefore, when a focus of the disease is identified, it is necessary to urgently take all measures for the further treatment of the child in order to avoid the onset of a worse prognosis.

Treatment Methods

Depending on which component of the overall system of brain functioning is out of order, the symptoms and treatment of intracranial hypertension in adults and children depend.

So, in order to reduce the amount of cerebrospinal fluid produced, urinary agents are prescribed, and the corresponding set of exercises developed by specialists is designed to reduce intracranial pressure. A special diet and dosage of water consumed per day is compiled for the patient. Attracting a manual specialist and getting acupuncture sessions helps to normalize the amount of CSF.

If the case is severe and the above procedures do not produce the desired effect, resort to the surgical method. It consists in the fact that by means of trepanation of the skull, a hole is made in it, through which a special drainage system is implanted. With the help of this system, excess fluid is removed from the cranium.

These methods significantly improve the patient's health, eliminating the signs of intracranial hypertension syndrome in just a few days from the start of treatment. However, it is possible to successfully cure the disease only if the cause of hypertension is completely eliminated.

Treatment of intracranial hypertension in a child's body can be carried out both conservatively and radically. The choice of treatment method depends entirely on the cause that gave rise to the disease.

If the pathology is diagnosed in a newborn, then such babies should be observed by a neurologist from birth, who, if necessary, will correct the treatment at a certain stage in order to avoid serious complications.

In order to eliminate the consequences of the pathology of pregnancy and the severe course of labor, it is necessary to breastfeed the baby for as long as possible, punctually observe the daily routine and, especially, sleep, constantly be in contact with the child both emotionally and in contact in order to avoid nervous stress, regularly take walks on street in any weather.

At the same time, the child should take funds designed to calm the nervous system, improve the circulatory, urinary systems, as well as vitamin preparations to strengthen the immune system.

For older children, the doctor prescribes procedures from the category of physiotherapy, they help well in curing the disease of swimming.

Any anatomical anomalies that interfere with the outflow of cerebrospinal fluid from the brain are solved surgically.

From folk methods, as a supplement to the main treatment, one can single out rubbing lavender oil into the temporal part of the head before going to bed. This tool not only calms the nervous system, but also promotes sound healthy sleep, which significantly speeds up recovery.

Video about intracranial hypertension:

Causes of convulsive syndrome in children and adults

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

A seizure is a sign of increased neurogenic activity. This circumstance may lead to various diseases and states.

Causes leading to seizures:

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

Certain causes of seizures are characteristic of certain age groups.

Types of seizures

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

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

Partial seizures

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

Simple partial seizures

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

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

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

Complex partial seizures

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

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

Sometimes partial seizures transform into generalized ones.

Generalized seizures

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

Generalized seizures can occur in the form of:

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

Tonic-clonic seizures

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

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

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

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

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

Myoclonic seizures

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

Atonic seizures

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

Epileptic status

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

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

Epistatus complications include:

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

Convulsive syndrome in children

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

Febrile convulsions

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

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

There are these types of seizures:

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

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

Affective-respiratory convulsions

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

Spasmophilia

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

There are such forms of spasmophilia:

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

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

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

Diagnostics

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

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

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

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

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

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

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

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

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

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

For myoclonic seizures:

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

Grigorova Valeria, medical commentator

Symptoms of appendicitis in adults

Respiratory failure: classification and emergency care

What to take for food poisoning?

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

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

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

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

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

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

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

Information is provided for informational purposes. Do not self-medicate. At the first sign of disease, consult a doctor. There are contraindications, you need to consult a doctor. The site may contain content prohibited for viewing by persons under 18 years of age.

Source: syndrome in children and adults. First aid for convulsive syndrome

In today's article, we will talk about such a frequent, but rather unpleasant phenomenon as a convulsive syndrome. In most cases, its manifestations look like epilepsy, toxoplasmosis, encephalitis, spasmophilus, meningitis and other diseases. FROM scientific point of vision, this phenomenon is referred to as a disorder of the functions of the central nervous system, which is manifested by joint symptoms of clonic, tonic, or clonic-tonic uncontrolled muscle contraction. In addition, quite often a concomitant manifestation of this condition is a temporary loss of consciousness (from three minutes or more).

Convulsive syndrome: causes

This condition may occur due to the following reasons:

• Intoxication
• Infection.
• Various damage.
• Diseases of the central nervous system.
• A small amount of macronutrients in the blood.

In addition, this condition can be a complication of other diseases, such as the flu or meningitis. Particular attention should be paid to the fact that children, unlike adults, are much more likely to suffer from this phenomenon (at least once every 5). This happens due to the fact that they have not yet fully formed the structure of the brain, and the processes of inhibition are not as strong as in adults. And that is why, at the first signs of such a condition, an urgent need to contact a specialist, as they indicate certain violations in the work of the central nervous system.

In addition, convulsive syndrome in adults can also appear after severe overwork, hypothermia. Also, quite often this condition was diagnosed in a hypoxic state or in alcoholic intoxication. It is especially worth noting that a variety of extreme situations can lead to seizures.

Symptoms

Based on medical practice, we can conclude that convulsive syndrome in children occurs quite suddenly. Appears motor excitement and a wandering look. In addition, there is a tilting of the head and closing of the jaw. A characteristic sign of this condition is flexion of the upper limb in the wrist and elbow joints accompanied by straightening of the lower limb. Bradycardia also begins to develop, temporary respiratory arrest is not excluded. Quite often during this condition, changes in the skin were observed.

Classification

According to the type of muscle contractions, convulsions can be clonic, tonic, tonic-clonic, atonic and myoclonic.

By distribution, they can be focal (there is a source of epileptic activity), generalized (diffuse epileptic activity appears). The latter, in turn, are primary generalized, which are caused by bilateral involvement of the brain, and secondary generalized, which are characterized by local involvement of the cortex with further bilateral distribution.

Seizures can be localized in facial muscles, limb muscles, diaphragm and other muscles of the human body.

In addition, there are convulsions simple and complex. The main difference between the second and the first is that they have no disturbances of consciousness.

As practice shows, the manifestations of this phenomenon are striking in their diversity and can have a different time interval, form and frequency of occurrence. The very nature of the course of seizures directly depends on pathological processes, which can be both their cause and play the role of a provoking factor. In addition, the convulsive syndrome is characterized by short-term spasms, muscle relaxation, which quickly follow each other, which later causes a stereotypical movement that has a different amplitude from each other. It appears due to excessive irritation of the cerebral cortex.

Depending on muscle contractions, convulsions are clonic and tonic.

• Clonic refers to rapid muscle contractions that continuously replace each other. There are rhythmic and non-rhythmic.
• Tonic convulsions include muscle contractions, which are of a longer duration. As a rule, their duration is very long. There are primary, those that appear immediately after the end of clonic convulsions, and localized or general.

You also need to remember that a convulsive syndrome, the symptoms of which may look like convulsions, requires immediate medical attention.

Recognition of convulsive syndrome in children

Numerous studies show that convulsions in infants and young children are tonic-clonic in nature. They appear to a greater extent in the toxic form of acute intestinal infections, acute respiratory viral infections, and neuroinfections.

The convulsive syndrome that developed after a rise in temperature is febrile. In this case, we can say with confidence that there are no patients in the family with a predisposition to seizures. This type, as a rule, can manifest itself in children from 6 months. up to 5 years. It is characterized by low frequency (up to a maximum of 2 times during the entire time of fever) and short duration. In addition, during convulsions, body temperature can reach 38, but at the same time, all clinical symptoms indicating brain damage are completely absent. When conducting an EEG in the absence of seizures, data on seizure activity will be completely absent.

The maximum time for a febrile seizure can be 15 minutes, but in most cases it is a maximum of 2 minutes. The basis for the appearance of such convulsions are the pathological reactions of the central nervous system to infectious or toxic effects. The convulsive syndrome itself in children manifests itself during a fever. His characteristic symptoms it is considered a change in the skin (from blanching to cyanosis) and changes in the respiratory rhythm (wheezing is observed).

Atonic and effective respiratory convulsions

In adolescents who suffer from neurasthenia or neurosis, effective respiratory convulsions can be observed, the course of which is caused by anoxia, due to a short-term sudden onset of apnosis. Such convulsions are diagnosed in individuals whose age varies from 1 to 3 years and are characterized by conversion (hysterical) seizures. Most often they appear in families with overprotection. In most cases, convulsions are accompanied by loss of consciousness, but, as a rule, short-term. In addition, an increase in body temperature has never been recorded.

It is very important to understand that the convulsive syndrome, which is accompanied by a syncope, is not life-threatening and does not provide for such treatment. Most often, these convulsions occur in the process of metabolic disorders (salt exchange).

There are also atonic convulsions that occur during a fall or loss of muscle tone. It can appear in children aged 1-8 years. It is characterized by atypical absence seizures, myatonic falls, and tonic and axial seizures. They appear quite high frequency. Also, status epilepticus appears quite often, which is resistant to treatment, which once again confirms the fact that help for convulsive syndrome should be timely.

Diagnostics

As a rule, the diagnosis of a convulsive symptom does not cause any particular difficulties. For example, to determine a pronounced myospasm in the period between attacks, you need to perform a series of actions aimed at identifying the high excitability of the nerve trunks. For this, tapping with a medical hammer on the trunk of the facial nerve is used before auricle, in the area of ​​\u200b\u200bthe wings of the nose or the corner of the mouth. In addition, quite often a weak galvanic current (less than 0.7 mA) begins to be used as an irritant. Also important is the anamnesis of the patient's life and the definition of concomitant chronic diseases. It should also be noted that after a full-time examination by a doctor, additional studies may be prescribed to clarify the cause of this condition. To such diagnostic measures include: taking spinal tap, electroencephalography, echoencephalography, fundus examination, as well as various examinations of the brain and central nervous system.

Convulsive syndrome: first aid for a person

At the first sign of seizures, the following therapeutic measures are of priority:

• Laying the patient on a flat and soft surface.
• Ensuring fresh air supply.
• Removing nearby objects that can harm him.
• Unbuttoning tight clothing.
• Putting a spoon into the oral cavity (between the molars), after wrapping it in cotton wool, with a bandage or, if they are absent, then with a napkin.

As practice shows, the relief of convulsive syndrome consists in taking drugs that cause the least oppression of the respiratory tract. An example is the active substance Midazolam or Diazepam tablets. Also, the introduction of the drug "Hexobarbital" ("Geksenel") or tipental sodium has proven itself quite well. If there are no positive changes, then you can use ferrous-oxygen anesthesia with the addition of Fluorotan (Halothane) to it.

In addition, emergency care for convulsive syndrome is the introduction of anticonvulsants. For example, intramuscular or intravenous administration of a 20% solution of sodium hydroxybutyrate (mg / kg) or in a ratio of 1 ml to 1 year of life is allowed. You can also use a 5% glucose solution, which will significantly delay or completely avoid the recurrence of seizures. If they continue for a sufficiently long time, then you need to apply hormonal therapy, which consists in taking the drug "Prednisolone" 2-5 M7KG or "Hydrocortisone" 10 m7kg during the day. The maximum number of injections intravenously or intramuscularly is 2 or 3 times. If serious complications are observed, such as disruptions in breathing, blood circulation, or a threat to the life of the child, then the provision of assistance for convulsive syndrome consists in intensive therapy with the appointment of potent anticonvulsant drugs. In addition, for people who have experienced severe manifestations of this condition, mandatory hospitalization is indicated.

Treatment

As shown by numerous studies that confirm the widespread opinion of most neurologists, the appointment of long-term therapy after 1 seizure is not entirely correct. Since single outbreaks that occur against the background of fevers, changes in metabolism, infectious lesions or poisoning are quite easily stopped during therapeutic measures aimed at eliminating the cause of the underlying disease. Monotherapy has proven itself best in this regard.

If people are diagnosed with recurrent convulsive syndrome, treatment consists in taking certain medications. For example, for the treatment of febrile seizures, the best option would be to take Diazepam. It can be used both intravenously (0.2–0.5) or rectally ( daily dose is 0.1–0.3). It should be continued even after the seizures have disappeared. For longer treatment, as a rule, the drug "Phenobarbital" is prescribed. Orally, you can take the drug Difenin (2-4 mg / kg), Suxilep (10-35 mg / kg) or Antelepsin (0.1-0.3 mg / kg during the day).

It is also worth paying attention to the fact that the use of antihistamines and antipsychotics will significantly enhance the effect of the use of anticonvulsants. If during convulsions there is a high probability of cardiac arrest, then anesthetics and muscle relaxants can be used. But it should be borne in mind that in this case the person should be immediately transferred to a ventilator.

With pronounced symptoms of neonatal convulsions, it is recommended to use the drugs Feniton and Phenobarbital. The minimum dose of the latter should be 5–15 mg/kg, followed by 5–10 mg/kg. In addition, half of the first dose may be administered intravenously and the second dose orally. But it should be noted that this drug should be taken under the supervision of doctors, since there is a high probability of cardiac arrest.

Seizures in newborns are caused not only by hypocalcemia, but also by hypomagnesemia, vitamin B6 deficiency, which implies an operational laboratory screening, this is especially true when there is no time left for a full diagnosis. That is why emergency care for convulsive syndrome is so important.

As a rule, with timely first aid and subsequently correctly diagnosed with the appointment of a treatment regimen, the prognosis is quite favorable. The only thing to remember is that with the periodic manifestation of this condition, it is necessary to urgently contact a specialized medical institution. It should be especially noted that persons whose professional activities are associated with constant mental stress should undergo periodic checks with specialists.

Source: syndrome in adults causes

to the doctor, to the clinic Online calculator

cost of medical services Order transcript

ECG, EEG, MRI, analysis Find on the map

doctor, clinic Ask a question

Concept definition

An epileptic (convulsive) seizure is a non-specific reaction of the brain to disorders of various nature in the form of partial (focal, local) or generalized convulsive seizures.

Status epilepticus - a convulsive seizure lasting more than 30 minutes or recurring seizures without full recovery of consciousness between attacks, life-threatening for the patient (in adults, mortality is 6-18% of cases, in children - 3-6%).

Epilepsy as a disease should be distinguished from epileptic syndromes in current organic brain diseases and acute toxic or toxic-infectious processes, as well as epileptic reactions - single episodes under the action of an extreme hazard for a given subject (infection, intoxication).

The reasons

The most common causes of seizures in different age groups are:

Convulsions due to fever (simple or complex)

Congenital metabolic disorders

Phakomatoses (leukoderma and hyperpigmentation of the skin, angiomas and defects of the nervous system)

Infantile cerebral palsy (CP)

Agenesis of the corpus callosum

Residual epilepsy (brain injury in early childhood)

brain tumors

25–60 years (late epilepsy)

Residual epilepsy (brain injury in early childhood)

Inflammation (vasculitis, encephalitis)

Brain tumors, brain metastases

A brain tumor

The most common causes of status epilepticus are:

• discontinuation or irregular use of anticonvulsants;
• alcohol withdrawal syndrome;
• stroke;
• anoxia or metabolic disorders;
• CNS infections;
• a brain tumor;
• overdose of drugs that stimulate the central nervous system (in particular, cocaine).

Seizures occur paroxysmal, and in the interictal period in many patients for months and even years, no violations are detected. Seizures in patients with epilepsy develop under the influence of provoking factors. These same provoking factors can cause a seizure in healthy people. Among these factors are stress, sleep deprivation, hormonal changes during the menstrual cycle. Some external factors (such as toxic and medicinal substances) can also provoke seizures. In a cancer patient, epileptic seizures can be caused by tumor lesion brain tissue, metabolic disorders, radiation therapy, cerebral infarction, drug intoxication and CNS infections.

Epileptic seizures are the first symptom of brain metastases in 6-29% of patients; in about 10% they are observed in the outcome of the disease. When the frontal lobe is affected, early seizures are more common. With damage to the cerebral hemispheres, the risk of late seizures is higher, and seizures are not typical for lesions of the posterior cranial fossa. Epileptic seizures are often observed with intracranial melanoma metastases. Occasionally, epileptic seizures are caused by anticancer drugs, in particular etoposide, busulfan, and chlorambucil.

Thus, any epileptic seizure, regardless of etiology, develops as a result of the interaction of endogenous, epileptogenic and provoking factors. Before starting treatment, it is necessary to clearly establish the role of each of these factors in the development of seizures.

Mechanisms of emergence and development (pathogenesis)

The pathogenesis is not well understood. Uncontrolled electrical activity of a group of neurons in the brain ("epileptic focus") involves significant areas of the brain in the process of pathological excitation. With the rapid spread of pathological hypersynchronous activity to large areas of the brain, consciousness is lost. If pathological activity is limited to a certain area, partial (focal) convulsive seizures develop, which are not accompanied by loss of consciousness. In status epilepticus, incessant generalized epileptic discharges of neurons in the brain occur, leading to depletion of vital resources and irreversible damage. nerve cells, which is the direct cause of severe neurological consequences of the status and death.

A seizure is the result of an imbalance between the processes of excitation and inhibition in the central nervous system. Symptoms depend on the function of the area of ​​the brain where the epileptic focus is formed, and the pathway of the spread of epileptic excitation.

We still know little about the mechanisms of the development of seizures, so there is no generalized scheme for the pathogenesis of seizures of various etiologies. However, the following three points help to understand what factors and why can cause a seizure in this patient:

An epileptic discharge can occur even in a healthy brain; the threshold of convulsive readiness of the brain is individual. For example, a seizure may develop in a child against a high temperature. At the same time, in the future, no neurological diseases, including epilepsy, do not occur. At the same time, febrile seizures develop only in 3-5% of children. This suggests that under the influence of endogenous factors, the threshold of convulsive readiness is lowered in them. One such factor may be heredity - seizures are more likely to develop in individuals with a family history of epilepsy.

In addition, the threshold for convulsive readiness depends on the degree of maturity of the nervous system. Some diseases significantly increase the likelihood of epileptic seizures. One such disease is severe penetrating traumatic brain injury. Epileptic seizures after such injuries develop in 50% of cases. This suggests that trauma leads to such a change in interneuronal interactions, which increases the excitability of neurons. This process is called epileptogenesis, and the factors that lower the threshold for convulsive readiness are called epileptogenic.

In addition to traumatic brain injury, epileptogenic factors include stroke, infectious diseases of the central nervous system, and malformations of the central nervous system. In some epileptic syndromes (for example, benign familial neonatal seizures and juvenile myoclonic epilepsy), genetic disorders; apparently, these disorders are realized through the formation of certain epileptogenic factors.

Clinical picture (symptoms and syndromes)

Classification

Forms of seizures

1. Partial (focal, local) - individual muscle groups are involved in convulsions, consciousness, as a rule, is preserved.

2. Generalized - consciousness is impaired, convulsions cover the whole body:

• primary generalized - bilateral involvement of the cerebral cortex;
• secondary-generalized - local involvement of the cortex with subsequent bilateral spread.

• tonic - prolonged muscle contraction;
• clonic - short muscle contractions immediately following each other;
• tonic-clonic.

• Contraction of individual muscle groups, in some cases only on one side.
• Seizure activity may gradually involve new areas of the body (Jacksonian epilepsy).
• Violation of the sensitivity of certain areas of the body.
• Automatisms (small movements of the hands, champing, inarticulate sounds, etc.).
• Consciousness is often preserved (disturbed in complex partial seizures).
• The patient loses contact with others for 1-2 minutes (does not understand speech and sometimes actively resists the assistance provided).
• Confusion usually lasts 1–2 minutes after the seizure ends.
• May precede generalized seizures (Kozhevnikov epilepsy).
• In case of impaired consciousness, the patient does not remember the seizure.

• Typically occurs in a sitting or lying position.
• Characterized by the occurrence in a dream
• May begin with the aura (discomfort in the epigastric region, involuntary head movements, visual, auditory and olfactory hallucinations and etc.).
• Initial scream.
• Loss of consciousness.
• Fall to the floor. Fall injuries are common.
• As a rule, pupils are dilated, not sensitive to light.
• Tonic convulsions for 10-30 seconds, accompanied by respiratory arrest, then clonic convulsions (1-5 minutes) with rhythmic twitching of the arms and legs.
• Focal neurological symptoms are possible (implying focal brain damage).
• Skin color of the face: hyperemia or cyanosis at the beginning of the attack.
• Characteristic biting of the tongue on the sides.
• In some cases, involuntary urination.
• In some cases, foam around the mouth.
• After the seizure - confusion, completing a deep sleep, often headache and muscle pain. The patient does not remember the seizure.
• Amnesia throughout the seizure.

• Occurs spontaneously or as a result of rapid withdrawal of anticonvulsants.
• Convulsive seizures follow each other, consciousness is not fully restored.
• Patients in a coma objective symptoms seizures can be erased, attention should be paid to twitching of the limbs, mouth and eyes.
• It often ends in death, the prognosis worsens with the lengthening of the seizure for more than 1 hour and in elderly patients.

Convulsive seizures must be differentiated from:

• May occur while sitting or lying down.
• Does not occur in a dream.
• The precursors are variable.
• Tonic-clonic movements are asynchronous, movements of the pelvis and head from side to side, eyes tightly closed, resistance to passive movements.
• Facial skin color does not change or facial redness.
• No biting of the tongue or biting in the middle.
• There is no involuntary urination.
• No fall damage.
• Confusion of consciousness after an attack is absent or is demonstrative.
• Pain in the extremities: various complaints.
• Amnesia is absent.

• Occurrence in a sitting or lying position is rare.
• Does not occur in a dream.
• Harbingers: typical dizziness, darkening before the eyes, sweating, salivation, tinnitus, yawning.
• Focal neurological symptoms are absent.
• Skin color of the face: pallor at the beginning or after convulsions.
• Involuntary urination is not typical.
• Fall damage is not common.
• partial amnesia.

Cardiogenic syncope (Morgagni-Adams-Stokes seizures)

• Occurrence in a sitting or lying position is possible.
• The occurrence in a dream is possible.
• Harbingers: often absent (with tachyarrhythmias, fainting may be preceded by a rapid heartbeat).
• Focal neurological symptoms are absent.
• Tonic-clonic movements may occur after 30 seconds of syncope (secondary anoxic convulsions).
• Skin color of the face: pallor at the beginning, hyperemia after recovery.
• Biting the tongue is rare.
• Involuntary urination is possible.
• Fall damage is possible.
• Confusion of consciousness after an attack is not typical.
• Pain in the limbs is absent.
• partial amnesia.

A hysterical seizure occurs in a certain emotionally intense situation for the patient in the presence of people. This is a spectacle that unfolds with the viewer in mind; When falling, patients never break. Convulsions are most often manifested as a hysterical arc, patients take elaborate poses, tear their clothes, bite. The pupillary response to light and the corneal reflex are preserved.

Transient ischemic attacks (TIAs) and migraine attacks transient disorders CNS functions (usually without loss of consciousness) may be mistaken for focal epileptic seizures. Neurological dysfunction due to ischemia (TIA or migraine) often results in negative symptoms, i.e., symptoms of prolapse (eg, loss of sensation, numbness, visual field limitation, paralysis), while defects associated with focal epileptic activity are usually positive (convulsive twitches, paresthesias, visual distortions, and hallucinations), although this distinction is not absolute. Short-term stereotyped episodes indicating dysfunction in a particular area of ​​the brain blood supply in a patient with vascular disease, heart disease, or risk factors for vascular damage (diabetes, arterial hypertension) are more characteristic of TIA. But, since in older patients, cerebral infarctions in the late period of the disease are a common cause of epileptic seizures, one should search for a focus of paroxysmal activity on the EEG.

Classic migraine headaches with visual aura, unilateral localization and gastrointestinal disturbances are usually easy to distinguish from epileptic seizures. However, in some migraine sufferers, only migraine equivalents, such as hemiparesis, numbness, or aphasia, are observed, and there may not be a headache after them. These episodes, especially in older patients, are difficult to distinguish from TIA but may also represent focal epilepsy. Loss of consciousness after some forms of vertebrobasilar migraine and a high frequency of headaches after epileptic seizures further complicate the differential diagnosis. The slower development of neurological dysfunction in migraine (often within minutes) serves as an effective differential diagnostic criterion. Be that as it may, in some cases, patients who are suspected of having any of the three conditions under consideration, for the diagnosis, it is necessary to conduct an examination, including CT, cerebral angiography and specialized EEG. Sometimes trial courses of antiepileptic drugs should be prescribed to confirm the diagnosis (interestingly, in some patients, such a course of treatment prevents both epileptic and migraine attacks).

Psychomotor variants and hysterical attacks. As noted above, behavioral disturbances are often noted in patients during a complex partial seizure. This is manifested by sudden changes in the structure of the personality, the appearance of a sense of impending death or unmotivated fear, pathological sensations of a somatic nature, episodic forgetfulness, short-term stereotyped motor activity such as ripping off clothes or tapping with a foot. Many patients have personality disorders, in connection with which such patients need the help of a psychiatrist. Often, especially if patients do not experience tonic-clonic seizures and loss of consciousness, but emotional disturbances are noted, episodes of psychomotor seizures are referred to as psychopathic fugues (flight reactions) or hysterical attacks. In such cases, the misdiagnosis is often based on a normal EEG in the interictal period and even during one of the episodes. It should be emphasized that seizures can be generated from a focus that is located deep in the temporal lobe and does not manifest itself during surface EEG recording. This was repeatedly confirmed by EEG recording using deep electrodes. Moreover, deep temporal seizures can manifest only in the form of the above phenomena and are not accompanied by the usual convulsive phenomenon, muscle twitching, and loss of consciousness.

It is extremely rare for patients who are observed for epileptiform episodes to actually have hysterical pseudo-seizures or frank simulation. Often these individuals have indeed had epileptic seizures in the past or have been in contact with people with epilepsy. Such pseudo-seizures can sometimes be difficult to distinguish from true seizures. Hysterical seizures are characterized by a non-physiological course of events: for example, muscle twitches spread from one arm to another without moving to the muscles of the face and legs on the same side, convulsive contractions of the muscles of all limbs are not accompanied by loss of consciousness (or the patient feigns loss of consciousness), the patient tries to avoid trauma , for which, at the time of convulsive contractions, it moves away from the wall or moves away from the edge of the bed. In addition, hysterical seizures, especially in adolescent girls, can be overtly sexual in nature, accompanied by pelvic movements and manipulation of the genitals. If in many forms of seizures in the case of temporal lobe epilepsy the surface EEG is unchanged, then generalized tonic-clonic seizures are always accompanied by EEG disturbances both during and after the seizure. Generalized tonic-clonic seizures (usually) and complex partial seizures of moderate duration (in many cases) are accompanied by an increase in serum prolactin levels (during the first 30 minutes after the attack), while this is not noted in hysterical seizures. Although the results of such analyzes do not have an absolute differential diagnostic value, obtaining positive data can play an important role in characterizing the genesis of seizures.

Diagnostics

Patients with epileptic seizures are admitted to medical institutions as an emergency during an attack, and in planned a few days after the attack.

If there is a history of recent febrile illness accompanied by headaches, mental status changes, and confusion, an acute CNS infection (meningitis or encephalitis) may be suspected; in this case, it is necessary to immediately examine the cerebrospinal fluid. In such a situation, a complex partial seizure may be the first symptom of encephalitis caused by the herpes simplex virus.

The presence of a history of headaches and/or mental changes preceding the attack, in combination with signs of increased intracranial pressure or focal neurological symptoms, rules out a mass lesion (tumor, abscess, arteriovenous malformation) or chronic subdural hematoma. In this case, seizures with a clear focal onset or aura are of particular concern. To clarify the diagnosis, CT is indicated.

General examination can provide important etiological information. Gingival hyperplasia is a common consequence of long-term treatment with phenytoin. Exacerbation of chronic convulsive disease associated with intercurrent infection, alcohol intake, or discontinuation of treatment is a common reason for admission of patients to the emergency department.

When examining the skin on the face, capillary hemangioma is sometimes found - a symptom of Sturge-Weber disease (radiography can reveal cerebral calcifications), stigmas of tuberous sclerosis (adenomas sebaceous glands and pebbled skin patches) and neurofibromatosis (subcutaneous nodules, café-au-lait patches). Asymmetry of the trunk or limbs usually indicates hemihypotrophy of the type of somatic developmental delay, contralateral to congenital or acquired in early childhood focal brain damage.

Data from anamnesis or general examination also allow you to establish signs of chronic alcoholism. In severely alcoholic individuals, seizures are usually caused by withdrawal symptoms (rum seizures), old brain bruises (from falls or fights), chronic subdural hematoma, and metabolic disorders due to malnutrition and liver damage. Epileptic seizures against the background of withdrawal syndrome usually occur 12-36 hours after the cessation of alcohol intake and are short-term tonic-clonic, both single and serial in the form of 2-3 seizures. In such cases, after a period of epileptic activity, there is no need to prescribe treatment to the patient, since seizures usually do not occur in the future. As for patients with alcoholism, in whom epileptic seizures develop at a different time (and not after 12-36 hours), they must be treated, but this group of patients requires special attention due to their lack of complaints and the presence of metabolic disorders that complicate drug therapy. therapy.

Routine blood tests can determine whether seizures are related to hypoglycemia, hypo- or hypernatremia, hypo- or hypercalcemia. It is necessary to determine the causes of these biochemical disorders and correct them. In addition, other less common causes of epileptic seizures are identified with appropriate tests for thyrotoxicosis, acute intermittent porphyria, lead or arsenic intoxication.

In older patients, epileptic seizures may indicate an acute cerebrovascular accident or be a distant consequence an old cerebral infarction (even a silent one). The plan for further examination will be determined by the age of the patient, functional state cardiovascular system and related symptoms.

Generalized tonic-clonic seizures can develop in individuals without abnormalities of the nervous system after moderate sleep deprivation. Such seizures are sometimes noted in persons working in two shifts, in students of higher educational institutions during the examination session and for soldiers returning from short vacations. If the results of all studies conducted after a single seizure are normal, such patients do not need further treatment.

If a patient who has had an epileptic seizure, according to the anamnesis, examination, biochemical blood tests, fails to detect abnormalities, then one gets the impression of an idiopathic nature of the seizure and the absence of a serious CNS lesion underlying it. Meanwhile, tumors and other volumetric formations for a long time can proceed and manifest asymptomatically in the form of epileptic seizures, and therefore further examination of patients is indicated.

EEG is important for the differential diagnosis of seizures, determining their cause, as well as the correct classification. When the diagnosis of an epileptic seizure is in doubt, such as in cases where epileptic seizures are differentiated from syncope, the presence of paroxysmal EEG changes confirms the diagnosis of epilepsy. For this purpose, special activation methods are used (recording during sleep, photostimulation and hyperventilation) and special EEG leads (nasopharyngeal, nasoethmoidal, sphenoidal) for recording from deep brain structures and long-term monitoring even on an outpatient basis. EEG can also detect focal abnormalities (spikes, sharp waves, or focal slow waves) that indicate the likelihood of focal neurological damage, even if the symptomatology of the attack is initially similar to that of generalized seizures. The EEG also helps classify seizures. It makes it possible to distinguish focal secondary generalized seizures from primary generalized seizures and is especially effective in the differential diagnosis of short-term lapses of consciousness. Small seizures are always accompanied by bilateral spike-wave discharges, while complex partial seizures can be accompanied by both focal paroxysmal spikes and slow waves or a normal surface EEG pattern. In cases of small epileptic seizures, the EEG can demonstrate that the patient has many more small seizures than is clinically apparent; thus EEG helps in monitoring antiepileptic drug therapy.

Until recently, lumbar puncture, skull radiography, arteriography, and pneumoencephalography were important additional methods for examining patients with epileptic seizures.

Lumbar puncture is still performed for suspected acute or chronic CNS infections or subarachnoid hemorrhage. Computed tomography and MRI tomography now provide more definite information about anatomical disorders than previously used invasive research methods. All adults with a first epileptic seizure should have a diagnostic CT scan with or without contrast enhancement. If the first studies give normal results, re-examination is carried out after 6-12 months. MRI imaging is especially effective in the early stages of examination in focal epileptic seizures, when it can detect changes of a minor degree better than CT.

Arteriography is performed with serious suspicion and for arteriovenous malformation, even if no changes were detected according to CT, or in order to visualize the vascular pattern in the lesion detected using non-invasive methods.

Treatment

To protect the patient from possible injuries that may occur during a fall and during convulsive twitches of the body, to ensure his safety.

Calm those around you. Put something soft (jacket, hat) under the patient's head to avoid head injury during convulsive movements. Loosen clothing that may make breathing difficult. Between the teeth of the lower and upper jaw you can put a handkerchief twisted into a knot if the attack is just beginning. This is necessary to prevent biting the tongue and damage to the teeth. Turn the patient's head on its side so that saliva can flow freely to the floor. If the patient stops breathing, begin CPR.

After the seizure has stopped, if the seizure occurs outside, arrange for the patient to be transported home or to the hospital. Contact the relatives of the patient to report the incident. As a rule, relatives know what to do.

If the patient does not report that he is suffering from epilepsy, it is better to call an ambulance, since convulsive syndrome can be a sign of a significant amount of even more serious pathology (cerebral edema, intoxication, etc.). Do not leave the patient unattended.

What not to do with an epileptic seizure

• Leave the patient alone during an attack.
• Try to hold the patient (by the arms, shoulders or head) or transfer to another, even more convenient place for him, during a convulsive seizure.
• Try to open the patient's jaws and insert any objects between them in order to avoid a fracture of the lower jaw and injury to the teeth.

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

If the epileptic syndrome is the result of metabolic disorders, such as hypoglycemia or hypocalcemia, then after the restoration of metabolic processes to 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 gliosis and other denervation changes. These changes can lead to the formation of chronic epileptic foci that cannot be eliminated by removing the primary lesion. In such cases, to control the course of epilepsy, surgical extirpation of epileptic areas of the brain is sometimes necessary (see below Neurosurgical treatment for epilepsy).

There are complex relationships between the limbic system and neuroendocrine function that can have a significant impact on epileptic patients. Normal fluctuations in hormonal status affect the frequency of seizures, epilepsy, in turn, also causes neuroendocrine disorders. For example, in some women, significant changes in the pattern of epileptic seizures coincide with certain phases of the menstrual cycle (menstrual epilepsy), in others, changes in the frequency of seizures are due to oral contraceptives and pregnancy. In general, estrogens have the property of provoking seizures, while progestins have an inhibitory effect on them. On the other hand, some patients with epilepsy, especially those with complex partial seizures, may show signs of concomitant reproductive endocrine dysfunction. Disorders of sexual desire, especially hyposexuality, are often observed. In addition, women often develop polycystic ovaries, men - potency disorders. Some patients with these endocrine disorders do not have epileptic seizures clinically, but there are EEG changes (often with temporal discharges). It remains unclear whether epilepsy causes endocrine and/or behavioral disorders, or whether these two types of disorders are separate manifestations of the same neuropathological process underlying them. However therapeutic effects on the endocrine system are in some cases effective in controlling some forms of seizures, and antiepileptic therapy is a good treatment for some forms of endocrine dysfunction.

Pharmacotherapy underlies the treatment of patients with epilepsy. Its goal is to prevent seizures without affecting the normal course of thought processes (or the normal development of the child's intelligence) and without negative systemic side effects. The patient, as far as possible, should be prescribed the lowest possible dose of any one anticonvulsant drug. If the doctor knows exactly the type of seizures in a patient with epilepsy, the spectrum of action of the anticonvulsants available to him and the basic pharmacokinetic principles, he can completely control seizures in 60-75% of patients with epilepsy. However, many patients are resistant to treatment due to the fact that the selected drugs do not correspond to the type (types) of seizures or are not prescribed in optimal doses; they develop unwanted side effects. Determination of the content of anticonvulsants in the blood serum allows the doctor to dose the drug individually to each patient and monitor the administration of the drug. At the same time, in a patient who is prescribed drug treatment, after an appropriate period of reaching an equilibrium state (usually taking several weeks, but not less than a time interval of 5 half-life periods), the content of the drug in the blood serum is determined and compared with the standard therapeutic concentrations established for each drug. By adjusting the prescribed dose, bringing it into line with the required therapeutic level of the drug in the blood, the doctor can compensate for the effect of the factor of individual fluctuations in the absorption and metabolism of the drug.

Long-term intensive EEG studies and video monitoring, careful elucidation of the nature of seizures and the selection of anticonvulsants can significantly increase the effectiveness of seizure control in many patients who were previously considered resistant to conventional antiepileptic therapy. Indeed, often such patients have to cancel several drugs until they can find the most suitable one.

The following categories of patients are subject to hospitalization in the neurological department.

• With a first epileptic seizure.
• With stopped status epilepticus.
• With a series of seizures or status epilepticus, emergency hospitalization in the neurocritical care unit is indicated.
• Patients with TBI are preferably hospitalized in the neurosurgical department.
• Pregnant women with convulsive seizures are subject to immediate hospitalization in an obstetric and gynecological hospital.
• Patients after a single epileptic seizure with an established cause of hospitalization do not require.

With symptomatic status epilepticus (acute TBI, brain tumor, stroke, brain abscess, severe infections and intoxication), pathogenetic therapy of these conditions is simultaneously carried out with a special emphasis on dehydration therapy - due to the severity of cerebral edema (furosemide, uregit).

If epileptic seizures are due to brain metastases, phenytoin is prescribed. Prophylactic anticonvulsant therapy is carried out only at a high risk of late seizures. In this case, the serum concentration of phenytoin is often determined and the dose of the drug is adjusted in a timely manner.

Indications for prescribing specific drugs

The three drugs most effective for generalized tonic-clonic seizures are phenytoin (or diphenylhydantoin), phenobarbital (and other long-acting barbiturates), and carbamazepine. Most patients can be controlled with adequate doses of any of these drugs, although each patient individually may be better affected by a particular drug, phenytoin is quite effective in preventing seizures, its sedative effect is very weak, and it does not cause intellectual impairment. However, in some patients, phenytoin causes gingival hyperplasia and mild hirsutism, which is especially unpleasant for young women. With prolonged use, coarsening of facial features may be observed. The use of phenytoin sometimes leads to the development of lymphadenopathy, and very high doses of it have a toxic effect on the cerebellum.

Carbamazepine is no less effective and does not cause many of the side effects inherent in phenytoin. Intellectual functions not only do not suffer, but remain intact to a greater extent than against the background of taking phenytoin. Meanwhile, carbamazepine is capable of provoking gastrointestinal disorders, bone marrow depression with a slight or moderate decrease in the number of leukocytes in peripheral blood (up to 3.5-4 10 9 / l), which in some cases becomes pronounced, and therefore these changes require careful monitoring . In addition, carbamazepine is hepatotoxic. For these reasons, a complete blood count and liver function tests should be performed prior to initiation of carbamazepine therapy and then at 2-week intervals throughout the treatment period.

Phenobarbital is also effective in tonic-clonic seizures and does not have any of the above side effects. However, at the beginning of the application, patients experience depression and lethargy, which is due to poor tolerance drug. Sedation is dose-dependent, which may limit the amount of drug given to achieve complete seizure control. In the same case, if the therapeutic effect can be achieved with doses of phenobarbital that do not give a sedative effect, then the mildest regimen for long-term use of the drug is prescribed. Primidone is a barbiturate that is metabolized to phenobarbital and phenylethylmalonamide (PEMA) and may be more effective than phenobarbital alone due to its active metabolite. In children, barbiturates can provoke states of hyperactivity and irritability, which reduces the effectiveness of treatment.

In addition to systemic side effects, all three classes of drugs have toxic effects on the nervous system at higher doses. Nystagmus is often observed already at therapeutic drug concentrations, while ataxia, dizziness, tremor, mental retardation, memory loss, confusion, and even stupor can develop with increasing blood levels of drugs. These phenomena are reversible with a decrease in the concentration of the drug in the blood to therapeutic.

Partial seizures, including complex partial seizures (with temporal lobe epilepsy). The drugs widely prescribed for patients with tonic-clonic seizures are also effective in partial seizures. It is possible that carbamazepine and phenytoin are somewhat more effective than barbiturates in these seizures, although this has not been definitively established. In general, complex partial seizures are difficult to correct, requiring more than one drug (eg, carbamazepine and primidone or phenytoin, or any of the first-line drugs in combination with high doses of metsuximide) and, in some cases, neurosurgical intervention. In these forms of seizures, many epilepsy centers are testing new antiepileptic drugs.

Primarily generalized small seizures (absences and atypical). These seizures are amenable to treatment with drugs of various classes, in contrast to tonic-clonic and focal seizures. In simple absences, ethosuximide is the drug of choice. Side effects include gastrointestinal disturbances, behavioral changes, dizziness and drowsiness, but related complaints are rare. For more difficult to control atypical minor and myoclonic seizures, valproic acid is the drug of choice (it is also effective in primary generalized tonic-clonic seizures). Valproic acid can lead to irritation of the gastrointestinal tract, bone marrow depression (especially thrombocytopenia), hyperammonemia and liver dysfunction (including rare cases of progressive liver failure with a fatal outcome, which is more likely a consequence of hypersensitivity to the drug than a dose-dependent effect). A complete blood count with platelet count and liver function tests should be performed before starting therapy and during treatment at two-week intervals for a period sufficient to confirm good tolerability of the drug in a particular patient.

Clonazepam (a benzodiazepine drug) can also be used for atypical minor and myoclonic seizures. Sometimes it provokes dizziness and irritability, but, as a rule, does not give other systemic side effects. One of the first anti-absence drugs was trimethadione, but it is now rarely used due to potential toxicity.

See neurosurgical treatment of epilepsy.

Which doctors to contact in case of

References

1. Emergency Medical Aid: A Guide for the Physician. Under the general editorship. prof. V.V.Nikonova Electronic version: Kharkiv, 2007. Prepared by the Department of Emergency Medicine, Disaster Medicine and Military Medicine of KhMAPO

In contact with

Classmates

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

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

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

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

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

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

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

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

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

Predisposing factors:

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

Epilepsy symptoms

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

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

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

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

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

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

The occurrence of an epileptic seizure depends on a combination of two factors of the brain itself: the activity of the convulsive focus (sometimes also called epileptic) and the general convulsive readiness of the brain. Sometimes an epileptic seizure is preceded by an aura (a Greek word meaning "breeze", "breeze"). The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired (that is, on the localization of the epileptic focus). Also, certain conditions of the body can be a provoking factor 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 blackout. There are also such as: a feeling of a change in the shape of surrounding objects, twitching of the eyelid, tingling in the finger, discomfort in the stomach, short-term inability to speak, leaving home for many days (trances), rotation around its axis, etc.

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

What is an aura?

Aura (a Greek word meaning "breeze", "breeze") is the state that precedes an epileptic seizure. The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired. They can be: fever, anxiety and restlessness, sound, strange taste, smell, change in visual perception, 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) and 20 years of age. It is manifested by lightning-fast twitches (myoclonus), as a rule, of the hands while maintaining consciousness, sometimes accompanied by generalized tonic or tonic-clonic seizures. Most of these attacks occur in the interval of 1-2 hours before or after waking up from sleep. The electroencephalogram (EEG) often shows characteristic changes, 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 can manifest as twitching or discomfort in certain parts of the body, turning the head, discomfort in the abdomen, and other unusual sensations. Often these attacks are similar to an aura.

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

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

What is rolandic epilepsy?

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

What is status epilepticus?

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

What are pseudo-seizures?

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

Pseudo-epileptic seizures are observed:

• in childhood;
• more often in women than in men;
• in families where there are relatives with mental illness;
• with hysteria;
• in the presence of 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 mistakenly regarded as epileptic seizures, and patients begin to receive treatment with specific drugs. Relatives in such cases are frightened by the diagnosis, as a result, anxiety is induced in the family and hyper-custody is formed over a pseudo-sick person.

Convulsive focus

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

Convulsive readiness

Convulsive readiness is the probability of an increase in pathological (epileptiform) excitation in the cerebral cortex above the level (threshold) at which the anticonvulsant system of the brain functions. It can be high or low. With high convulsive readiness, even a small activity in the focus can lead to the appearance of a full-blown convulsive attack. The convulsive readiness of the brain can be so great that it leads to a short-term loss of consciousness even in the absence of a focus of epileptic activity. In this case, we are talking about absences. Conversely, there may be no convulsive readiness at all, and, in this case, even with a very strong focus of epileptic activity, partial seizures occur that are not accompanied by loss of consciousness. The 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 examination, the patient lies or sits in a comfortable diagnostic chair, relaxed, with his eyes closed. Usually, when taking an EEG, so-called functional tests (photostimulation and hyperventilation) are carried out, which are provocative loads on the brain through bright light flashing and increased respiratory activity. If an attack begins during the EEG (this is very rare), then the quality of the examination increases significantly, since in this case it is possible to more accurately determine the area of ​​\u200b\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 it was not detected in the daytime even under the influence of conventional provocative tests. But, unfortunately, such a study requires special conditions and training of medical personnel, which limits the wide application of this method. It is especially difficult to carry it out in children.

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

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

When is video-EEG used?

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

Why is brain mapping done?

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

Is EEG harmful to health?

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

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

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

How to prepare a child for an EEG?

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

CT scan

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

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

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

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

Magnetic resonance imaging

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

Nuclear Magnetic Resonance (NMR)- This is a physical phenomenon based on the properties of some atomic nuclei, when placed in a strong magnetic field, to absorb energy in the radio frequency range and emit it after the cessation of exposure to the radio frequency pulse. 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. The condition of the liver is usually checked, lymph nodes, gums, hair, 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 this includes a traditional examination by a neurologist and an EEG.

Cause of death in epilepsy

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

Two main mechanisms lead to cytotoxic action and necrosis, in which cellular depolarization is maintained by stimulation of NMDA receptors and 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 mixture of them and the dose will be selected by the person himself after leaving the attack. Searching a person in search of instructions and medicines is not worth it, as this is not necessary, but will only cause an unhealthy reaction from others.

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

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

Usually 10 minutes after the attack, the person completely comes to his normal condition 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 the focus of general attention, even if the person emits involuntary convulsive cries when exiting the attack. You could, by holding the person's head, for example, talk calmly to the person, this helps to reduce stress, gives confidence to the person coming out of an attack, and also calms onlookers and encourages them to disperse.

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

In addition, an ambulance should be called if:

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

Epilepsy treatment

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

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

Medical treatment of epilepsy

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

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

Non-drug treatments

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

Epilepsy and driving

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

Most patients with epilepsy, with adequate seizure control, attend school, go to work, and lead a relatively normal life. Children with epilepsy usually have more problems at school than their peers, but every effort should be made to enable such children to study normally by providing them with additional assistance 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 a cause sexual problems with epilepsy. The presence of seizures often leads to a feeling of vulnerability, helplessness, inferiority and interferes with the establishment of a normal relationship with a sexual partner. In addition, many fear that their sexual activity may trigger seizures, especially when the seizures are triggered by hyperventilation or physical activity.

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

Physiological factors:

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

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

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

epilepsy and pregnancy

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

One of the most serious complications of pregnancy, morning sickness, often presents with generalized tonic-clonic seizures in the last trimester. 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 in a large number of patients this will lead to a relapse of seizures, which will later be more detrimental to both mother and child. If the condition of the patient allows to cancel the treatment, then this can be done at a suitable time before the onset of pregnancy. In other cases, it is desirable to carry out maintenance treatment with one drug, prescribing it at the minimum effective dose.

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

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

Affectively - respiratory attacks:

The child begins to cry and at the height of crying stops breathing, sometimes it even goes limp, falls unconscious, there may be twitches. Help with affective attacks very simple. You need to take as much air into your lungs as possible and blow on the child’s face with all your might, or wipe his face 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 of alcohol per day are for men - 2 glasses of wine, for women - 1 glass.

Can I smoke?

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

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

It should not be hidden that the diagnosis of convulsive readiness, few of the parents will not lead to a degree of extreme frustration. Fortunately, in this case, timely detection of the disease, proper treatment and competent specialists will help both desperate parents and a small creature bravely enduring all the hardships of the disease to cope. Convulsive readiness is not a fatal diagnosis. You can fight him. The number of people cured of the disease is increasing every day.

Due to the immaturity of the nervous system in young children, convulsive readiness of the brain can be diagnosed. The seizures with which it accompanies can occur dozens of times, and can become a single case. Without a full examination, a reliable diagnosis cannot be considered.

Convulsive readiness of the brain is most often diagnosed in children under 5 years of age. It is tolerated by up to 5% of preschool children. In the case of proper treatment and medication, and in some cases with the help of alternative medicine, convulsive readiness disappears without a trace. In the first years of life, nerve endings and parts of the brain are in the process of constant formation, as a result, the blood-brain barrier is very low, as a result, excitability comes faster. The child reacts sharply to irritating factors (external and internal), which leads to convulsive readiness of the brain.

Convulsive readiness: symptoms

The symptoms of the manifestation of the condition are very bright. Often, convulsive readiness has convulsive symptoms. However, they can manifest themselves differently at different stages.

Tonic seizures are characterized by a loss of contact with the outside world. A person does not respond and does not react to any external manifestations. Characteristic muscle contractions can be observed both in one muscle group and throughout the body. The duration of the attack is up to 2 minutes. The head is thrown back, the upper limbs are bent, and the lower ones are fully extended.

After the attack of tonic convulsive readiness is over, clonic convulsions occur. The frequency of movements is greatly increased. Starting from the face, convulsions pass to the whole body. The speed of inhalation and exhalation increases significantly. The skin becomes very white. Often foam appears from the lips. According to the duration of the clonic seizure, convulsive readiness is diagnosed and the severity of the disease is determined.

Threshold of convulsive readiness of the brain

A reduced threshold for convulsive readiness of the brain is typical for young children. For each person, it is individual and decreases under the influence of a number of factors. The most common include:

• severe intoxication;
• heat;
• hereditary predisposition;
• diseases and infections of the brain;
• congenital diseases of the nervous system;
• asphyxia;
• diseases associated with metabolic processes;
• hormonal abnormalities;
• infectious diseases, etc.

Despite the fact that the seizure threshold of the brain is different for each person, an epileptic seizure that is not relieved for more than 30 minutes can lead to serious consequences.

Over time, with proper treatment, the seizure threshold of the brain can rise significantly. But, at the same time, it is necessary to prevent the convulsive syndrome from developing into a serious illness and developing into something more than it actually is in the early stages.

Increased convulsive readiness

As noted above, increased convulsive readiness is characteristic primarily for children. Due to the high permeability of the cerebral vessels, the hydrophilicity of tissues and the unfinished process of brain formation, the child reacts much more strongly to many stimuli. In order for his body to cramp for several minutes, it doesn’t take much. A couple of decades ago, the diagnosis of increased convulsive readiness was made belatedly. At the age of 5-8 years. Due to the inattention of doctors, a person has to take pills all his life and be afraid of a new attack. Now convulsive readiness is just a diagnosis. She is curable. After a well-chosen course of treatment completed within six months, the child may no longer remember his illness.

It is important to remember that a person who has been diagnosed with increased convulsive readiness should not be disturbed in any way. Even a small pathogen in the focus area can lead to prolonged seizures that worsen the patient's condition.

Reduced convulsive readiness

In contrast to the previous diagnosis, a decrease in convulsive readiness indicates that the patient may have an attack at any time. It doesn't need any stimuli. In this case, partial seizures are characteristic. They are shorter and the person remains fully conscious.

The diagnosis of reduced convulsive readiness is often made in adulthood. They are surprised to learn about it when undergoing general examinations or doing an MRI. The causes of the appearance are heredity, transferred infectious diseases, the presence of oncological diseases.

Convulsive readiness in children

It is young creatures that are most susceptible to this disease. As a result of birth trauma, insufficient development of nerve endings, brain or heredity, convulsive readiness in children is much more common. As mentioned above, the 5% threshold has not yet been exceeded, but soon everything may change, as this diagnosis is being made more and more often.

In order to verify the diagnosis or, on the contrary, to drive away all doubts, parents can easily check whether there are prerequisites for the fact that convulsive readiness in children is likely.

• Take the baby between the elbow and shoulder joints and squeeze a little with your fingers. If the baby's fingers begin to twitch nervously and cramp them, then the likelihood of convulsive readiness is high.
• Between the cheekbone and the corner of the mouth, tap lightly with your finger. If, during or after tapping, the baby’s face changes twitching in the area of ​​​​the mouth, nose wing and eyelid, then this is a reason to contact the pediatrician and talk about your experiences.

It is unambiguous to draw conclusions that a child has convulsive readiness is never possible. And trusting the health of the child to the opinion of only one specialist is not recommended. It is necessary to pass tests. Convulsive readiness in children is always accompanied by a low level of calcium in the blood serum. Additional MRI and EEG studies are done as prescribed by a neurologist. With a timely and competent approach, when the child is not yet tormented by prolonged seizures and does not lose consciousness, it is very easy to solve the problem. In advanced cases, when parents did not pay due attention to obvious symptoms, babies suffer first, and only then their inattentive relatives.

It is not so easy to prepare for attacks of convulsive readiness. It is more important to deal with them in the early stages. And first of all, parents should take care of the health of their children. Their inattention can result in an unpleasant state when a seemingly healthy person falls in a fit of convulsions. Convulsive readiness is curable, but it needs to be dealt with in time.