Psychological characteristics of children with epilepsy. Consultation on the topic: Recommendations for teachers and parents for the upbringing and development of children with epilepsy

Epilepsy

Psychological research of patients with epilepsy was carried out mainly in the interictal state, with a more or less good subjective state of the patients.

In a psychological study of patients with epilepsy, it was possible to observe a number of children who were similar to each other in all their reactions and mental structure. These children constitute a certain group, they have condensed features that are considered typical for the so-called genuine epilepsy; this similarity is manifested in the forms of both childhood and adolescent epilepsy.

In the structure of the personality of a patient with genuine epilepsy, there is a greatly increased instinct for self-preservation, all their attention is turned to themselves, to their well-being, to their well-being, as a result of which the patient with epilepsy in most cases is a "narrow egoist".

In this regard, they have a very great desire for self-affirmation, and for the assertion of their "I" all means seem good; they tend to constantly emphasize the positive aspects of their behavior and at the same time criticize others.

Patients with epilepsy never lose touch with reality and take into account all the circumstances that are important and beneficial to them.

With strong egoism and a general decrease in intellectual interests, such patients talk a lot about themselves.
With a constant focus on their own personality, patients with epilepsy are very willing to do everything for themselves, and they refuse social work for everyone, even the most developed of them, the most secure.

The structure of the personality of a patient with epilepsy is characterized by slowness, inhibition of all reactions, and in this regard, they have a stable, intense, viscous affect with increased irritability.

Patients are characterized by pedantry, which has its roots in their inertia, as I. P. Pavlov spoke about. They have great difficulty giving up old habits, are attached to one and hardly move on to anything new. In connection with general well-being after a seizure or pre-seizure state, it can be difficult for an epileptic patient to retain in memory what he has just adapted to. The noted features determine the slowness in all intellectual processes in patients with epilepsy.

A patient with epilepsy understands well the meaning of what he perceives, but he understands and conveys the entire content of the story he has seen or heard is slow and very stuck on details. When transmitting, he has breaks (long pauses), which may be due either to the patient's delayed adaptability to the task or, perhaps, depend on small seizures or absences.

It should be noted that during the experiment, the patients often experience absences, but after a second break they return to the interrupted work and continue to perform it as if there was no break.

In the period between seizures, the patient can show good attention span. The literature noted a characteristic feature of the attention of patients with epilepsy; in the most varied work, for example, in crossing out letters in Bourdon's text or in performing arithmetic tasks, patients may make large omissions.

So, they can skip entire lines in tasks or even skip individual tasks; with the phenomena of small seizures, omissions of small areas of work are observed. This phenomenon is not constant, sometimes it is observed in the experiment, sometimes it does not happen; its presence cannot be attributed to a decrease in the patient's volitional effort; it is possible that this phenomenon depends on the general condition of the patient, on the presence of seizures before the experiment or during the experiment.

Patients significantly suffer from switching attention; they hardly break away from one activity and move on to another; for this transition they need a long period. In some cases, even when they have already moved on to a new job, they still cannot forget about the old one and strive to return to it again. Patients with epilepsy cannot interrupt work even at the request of the experimenter; they must complete it without fail; this shows their inherent inertia.

Impaired verbal memory is one of the main disorders in epilepsy.
In the study of verbal memory, such a phenomenon is sometimes noted that the patient not only does not remember the words that were offered to him for memorization, but he does not even remember the very fact of such an experiment.

Some patients with epilepsy reported that they read a lot, but remember the content of what they read very little. When they read a book, when they come to the end, they forget what they read at the beginning. In patients, mainly long-term retention in memory suffers; they cannot remember for a long time, which is why their intellectual baggage is so amazingly poor, their horizon is so narrow, their whole mental life is so poor.

In the experiment, it was difficult for patients to memorize separate, logically unrelated words, a lot of time was spent on memorization, and after a short period of time many of these words were forgotten.

In intellectually intact patients, mediated memory is in the best condition, and the visual image helps memorize words. For example, such connections are well remembered when a picture is selected for the word "light" where a lamp is depicted, for the word "horse" - a picture depicting a cart, etc., and if the word "game" is selected for a picture on which a airplane or knife, then memorization was not carried out, because the ratio was too general ("it can be played"), etc.

In the pictogram, those words that were associated with a particular drawing were also well remembered. For example, if the word "development" had a drawing depicting a tree, then memorization was carried out.

Usually, patients with epilepsy have a very good visual memory, in the experiment they could even after a long time accurately reproduce all the objects shown to them; with such clarity of visual memory, they tend to fix their attention on visual material.

Among the patients, we could observe eidetics, in whom the eidetic image was bright, like a hallucination. Thus, a 13-year-old boy eidetically saw a colored picture for 5 minutes, when it disappeared, he shouted: "Now there is no more." When I memorized numbers from drawings, when I reproduced these drawings, I saw them before my eyes and described them as if I were reading on a piece of paper. In the associative experiment, almost all reactions were accompanied by visual images. It is enough for him to think about some object or person in order to see it with complete clarity in front of him.

The patient noted that he should not think about anything terrible: as he thinks, so he will see. He had vivid visual hallucinations, which stand in connection with his vivid eidetic ability. When at the age of 14 his eidetic ability weakened, visual hallucinations also stopped.

In another case, a 16-year-old boy with a mild eidetic ability reported that in post-seizure states, his painful sensations turn into images of people.
In patients with frequent seizures, the memory process fluctuates due to the general condition of the patient. Sometimes patients show better results with delayed reproduction than immediately after the experiment.

Psychological examination makes it possible to establish a connection between the disorder of verbal memory, speech disorders and disorders of verbal abstract thinking in children with epilepsy.

In the literature, the features of the speech of patients with epilepsy in connection with this phenomenon of speech inhibition are noted - the use of words with the largest number of syllables, namely the use of diminutive words: fish - a fish, sky - a sky, pencil - a pencil, a hand - a hand, a key - a key, grass - grass; or the use of gerunds, for example: past, working, forgetting, etc. (These features of the speech of patients with epilepsy were noted by psychologist A. E. Petrova.)

In children, these phenomena are much less pronounced than in adult patients, but still they sometimes occur. Often patients with epilepsy resort to gestures when they lack words, and they want to express their thoughts with hand movements. When there were not enough words, they also resorted to emotional exclamations: "well... well... well... ta... ta... ta!"

Due to poor memory and general speech difficulty, many patients cannot tell the text they read in their own words. So, a boy of 15 years old (student of the 6th grade) is forced to memorize lessons in history, geography; in German he memorized the interlinear translation. Even the still intact intellectually ill, who have an understanding of an abstract meaning, complain that at school all verbal subjects are difficult for them.

Patients with epilepsy with great difficulty manage to attract previous knowledge to the current task, which is why they formulate their thoughts with such difficulty. In addition, the thinking of patients is saturated with specific images, each word is accompanied by an image associated with this word, and only then the word is understood; it is also reason that the thinking processes of patients flow slowly.

In the experiment with proverbs, still intact intellectual patients can understand and explain the abstract meaning of proverbs and metaphors, but they easily "slip" to their concrete explanation, they constantly need specific illustrations to complete their thoughts. The majority of sick adolescents find it difficult to understand abstract positions and try to concretize the allegorical meaning of proverbs and metaphors.

Some patients with epilepsy found it difficult in the processes of logical thinking when finding similarities in objects.

For example, a 15-year-old boy, a student of the 6th grade, answered the question about the similarity of the sun and the stove that they are both warm, but he did not limit himself to this answer, but spoke more about their dissimilarity; he visually imagined the sun and the stove, and when answering, he could not tear himself away from these visual images.

In working on specific material in the experiment, they showed much greater productivity: they understood the meaning of plot pictures, single and complex, and described them with many details, often dwelling on insignificant details. They combined Link's cube with special eagerness, although they spent a lot of time on this combination, and when combining different colors of the cube, they used exactly the same techniques, without varying them in any way.

The process of generalization in patients is very weak: in the classification they laid out the pictures into many small groups, and when they tried to combine them, they proceeded more from everyday, rather than semantic considerations.

For example, a 16-year-old girl, still intellectually intact, could make the following connections: she connected all people together, added household items to them, declaring that people use them, then attached machines to this group on the grounds that people control machines, and all this group was called "life".

Patients with epilepsy get stuck on separate details and find it difficult to form general concepts, in the perception and processing of the new; they lack an overview of all experience, which forces the essential to be separated from the secondary.

It must be said that individual features epileptic thinking, such as thoroughness, a tendency to repeat and get stuck, perseverativity, the impossibility of brief formulations, difficulty in generalizing, are only typical for patients with epilepsy when they are mutually interconnected and occur against the background of general changes in the patient's personality.

The associative process in patients with epilepsy is very monotonous due to the paucity of words and the difficulty of the thought process.

The main conclusion that can be drawn on the basis of an examination of the mental processes of patients with epilepsy is the following: they adapt to the task for a long time, without losing, however, the purpose of the task. They ask them to repeat the question several times, then they repeat the question themselves, and then they begin to answer, at first they say a lot of unnecessary things, because they cannot immediately formulate their thoughts correctly. This creates a picture of reasoning, which occurs due to the slowness of the thought process, when the whole is missed and the thought begins to stagnate on one insignificant detail. Hence comes the vagueness of the patient's thought process, which comes at the expense of excessive detail, confusing the meaning of the answer.

Often the speaker himself realizes the meaning of what he wants to say only after a long stomping in one place, and even then only relatively. When, in an experiment, adolescents with epilepsy are given a printed text of a task and they themselves read it many times, they understand it better than when listening to it repeatedly.

The imagination of patients with epilepsy is very poor, which is well revealed by experiment. If they are offered an experiment to guess some objects in unfinished drawings, then they guess only when the object is already well designed.

They are completely unable to compose stories on given topics. In order to create a new one from existing elements, it is necessary to quickly compare individual elements, and with the stiffness of the psyche of patients with epilepsy, this operation presents a significant difficulty for them. In addition, memory images serve as the material from which representations are made; with a decrease in memory in patients with epilepsy, imagination suffers.

A moment of emotional dullness always correlates with a poverty of imagination. Since imagination is based on feeling, in this poverty of imagination we see an indirect sign of the lack of the ability to feel in patients with epilepsy.

In the Rorschach test, some patients began to describe the spot in detail, to see various objects in it, and as a result, the spot was perceived as a whole; very often in the spots of Rorschach they saw a butterfly.

One patient in Rorschach spots saw only their color: he was a 16-year-old boy, very affective, his attacks of anger were in the nature of twilight states, when he did not understand at all what he was doing.

Children, aggressive by nature, saw cut animals and blood in the Rorschach spots.

The usual reaction of the majority of patients: they saw in the spots a resemblance to some living creature or object. For the most part, the reactions were very uniform; so, one boy with epilepsy saw a mountain in one spot, a cliff in another, a gorge in the third, so he got stuck on geographical representations.

The emotional-volitional sphere of patients with epilepsy presents significant features: the patient experiences his illness hard, is ashamed of it; he has increased sensitivity, slight vulnerability, a pronounced sense of his inferiority with a desire for compensation.

In the experiment, these features of patients with epilepsy are well manifested: the patients cannot stand censure, from failures many become impatient, angry, irritable, their affect is tense, viscous, and can last a long time.

A teenager with epilepsy told about himself that he is very vindictive, never leaves a grudge unavenged. As he said: "Though in a month, but still I will avenge myself," he also noted great malice in himself and could restrain himself earlier, but now, apparently, in connection with frequent seizures, he himself feels that he has become less able to control himself. His aggression manifests itself in a dream, he sees blood in a dream, sees how he fights.

There are other types of patients with epilepsy, less affective, less irritable, but also viscous, persevering, lacking switchability, lacking initiative; they are very respectful to the experimenter and always greet everyone who enters the room and whom they meet upon leaving the room, but even in such patients negative emotions are notable for considerable strength.

They can remember some petty offense for a very long time and are always ready to avenge it, but always on the sly.

With the team in patients with epilepsy in general a good relationship, but usually they don't have friendships with anyone. In children younger age, patients with epilepsy, motor restlessness and instability are noted; they are prone to sharp outbursts of passion, but their passion ends rather quickly, and they easily pass from malice, rudeness to affection; flattery in young children is very rare.

And genuine epileptics are sometimes struck by activity, purposefulness, good performance, the more they have to do stress to overcome internal obstacles, the more they develop sthenic tendencies, which, with increasing obstacles, can go over
into aggressive ones.

The experiment revealed their stability in work, corresponding to their strengths, their desire to complete the work to the end, even if they spent a lot of time on this work. The protocols often noted that they, especially girls, are very thorough and accurate in their work, with a great sense of duty and responsibility.

During work, such tension is formed that the patient cannot stop working, even despite the request of the experimenter, and if he is transferred from one unfinished work to another, then the patient with epilepsy is so absorbed in the unfinished work that he cannot stop thinking about it and cannot start a new one.

If a patient with epilepsy does not have frequent large convulsive seizures, but only rare small seizures are noted, then this patient does not have a sharp inhibition of mental processes, and if these patients do not have a significant decrease in memory, then their thought processes approach the norm and then they can learn in a public school, especially if they are assiduous and diligent.

Observation I. A 15-year-old boy, a student of the 7th grade. The change in personality and character follows the type of epileptic disease. History of bruises at an early age, infections. He studied well at school, teaching was easy. Seizures began at the age of 14, lately there has been a state of apathy; became irritable, dissatisfied with everything, stubborn, sometimes he could show destructive tendencies and himself said that someone allegedly forced him to do it. Resentful. According to the school's teacher, lately he has had difficulty with oral answers, has difficulty expressing his thoughts, avoids history, geography, and is verbose in written work. Slow. Hard to switch. The new is hard to remember, the old is remembered.

On the psychological examination he made a favorable impression: he behaved confidently, his speech was cultured, with a very slight stutter; rather easily expressed his thoughts; likes to read, remembers what he read and can talk about it.

In the experiment, his verbal memory turned out to be satisfactory, but he himself declared that his visual memory ("visual") was better than his verbal one. He showed good results in those psychological tasks, the solution of which is connected with general development, with culture; so, he commented well on metaphors, proverbs, various abstract positions, and often said: "But we went through this at school."

And at the same time, in the processes of logical thinking in solving those problems that were little known, he was very verbose. For example, he distinguished a board and glass in this way: "The glass is transparent, then the glass breaks, the board is wooden, you can immediately distinguish it, the board has fibers, the glass does not, most importantly, the glass is transparent, but the board is not."

Then he defined the similarity of the sun and the stove in this way: "They have a similarity in the color of the flame, and so the sun and the stove are different objects, nothing similar."

In an experiment on mediated memory, he memorized words well when there was a specific connection between the word and the picture. For example, for the word "fire" I picked up a picture depicting a roof with smoke; to the word "fight" - a picture on which a knife is drawn; to the word "strength" - a horse, etc. I remember these words well.

In the pictogram for the sentence "strict teacher" he drew a fly and explained: "She has such silence in the lesson that you can hear a fly fly by"; to the sentence "the boy is a coward" he began to draw a river, a bank, a wave, a wind that drives the waves, and was so carried away by specific details that he forgot to which sentence he drew all this.

Thus, we can say that concreteness prevails in his thinking, speaking about various objects, he always represents them figuratively, and a generalizing meaning is difficult for him.

He turned out to be very weak in the generalization experiment: when he was asked to classify 75 pictures, he became confused, spent a lot of time trying to cover them, analyze everything, he paid attention to individual elements, dwelled on them for too long, did not cover the whole. He laid out all 75 pictures on the table, looked at them for a long time, and then, first of all, began to select all the pictures depicting iron things (the pictures depicted people, animals, plants and various objects). Couldn't finish the job.

When adding the Link cube, he did not form a plan for the entire operation, but began to fold the side wall by trial and error so that the wall was desired color. He spent a lot of time adding the whole cube, but he did not stop working. This is a strong type, he is active and purposeful; when adding the cube stubbornly sought good results and only in the course of action did he understand the principle of addition, and in the end he began to apply higher methods of work.

What is interesting in his work is not the final result, which is mostly good, but the path of solution, on which he encounters significant difficulties; these difficulties must be overcome, and he overcame them steadily.

The associative process made him very difficult; he spoke whole sentences with ease, but found it difficult to answer in one word.

Such reactions speak of the inertia of his psyche. His attention is limited in scope. Switching is very difficult. The lack of flexibility of his thought process was manifested in his lack of initiative, guesswork, in connection with which he became stumped with every new task.

On the experiment, one could note the great tension that he put into his work, and the constant desire to reveal himself in himself. best light. Due to the great concentration on his "I", with the desire to be dealt with, he asked the experimenter many questions about his performance of the task and was upset when the task did not work out for him.

This case is interesting in that the change in personality is not pronounced here; the boy studies well, diligently, but the change in the character, the pace of the thought process in him goes like an epileptic disease: he has slowness, viscosity of thinking in states of affective tension. Inflexible, hard-to-switch attention. Efficiency, although slow, but purposeful.

Observation II. Boy 10 years old. There was nothing pathological in the anamnesis. Before the onset of seizures, he was mentally developed, affectionate, kind. At the age of 5, he taught himself to read, write and count.

From the age of 7, there are large convulsive seizures (aura, loss of consciousness, fall); minor seizures were also noted. The character has changed since 8 years (one year after the onset of seizures); became quick-tempered, angry, disobedient, persistent; could beat his mother and even bite her, if she forbade him anything, made a suicide attempt. He said about himself that he remembers himself from the age of 4, he was the only child in the family, everyone around him did a lot, as he was very developed, read a lot (there were a lot of books in the house).

His memory was excellent, he knew many poems and reminded everyone in the house what, to whom and when to do. By nature then - he remembers it well - he was kind and affectionate. He was admitted to the hospital at the age of 10 (he had seizures for 3 years).

In psychological studies with him, it turned out that he was naturally endowed with a very good intellect and was placed in conditions favorable for his mental development. He struck with the ease of verbal expression, he could talk endlessly, each question evoked in him a series of considerations, memories. Could write poetry.

In those experiments where it was possible to reveal the vocabulary and acquired knowledge, he gave a result that exceeded his age, and in those experiments where practical orientation is investigated, he showed only good, but not brilliant data.

The child was examined for 2 years, and these studies showed how his attention was disturbed, his memory was weakened. He began to forget old poems and could not memorize new ones. Gradually, oligophasic phenomena increased: he could suddenly forget the name of this or that object, what this or that word means, verbal forms especially began to make it difficult for him.

Very defiantly, the efficiency of his thought process decreased. A year earlier, his verbal responses had been precise and meaningful. For example, he distinguished a pen and a pencil in this way: "You cannot write with a pen without a pen, but black is visible in a pencil to write." The following year, he answered the same question in the following way: “This is a pen with a pen, this is a chemical pencil, this is written with ink, but it’s easy; you can erase it from a pencil, but you can’t erase it from ink, then the pen will not live long, but the pencil will live long.” ".

He distinguished a cow and a horse like this: "The cow is milked, she has horns, and the horse is brown, she is tall, strong, she carries the horse, she does everything to the person, and the cow runs, walks, she is only milked." His verbosity this year is noted in all experiments.

In logical problems, he proceeded not from logical considerations, but from everyday ones, for example, he reasoned as follows about the syllogism:

"All the children in the neighboring school can read, my brother studies in it, can he read or not?" - "The question is, what kind of brother, your brother cannot be small, and if he is 12.15 years old, he can read." And he accompanied all syllogisms with such empty reasoning.

From this example, we can conclude how his intellectual work goes in the direction of empty reasoning.

A conversation was held with him on various issues, and during this conversation he revealed a number of considerations of a formal (one might say, sanctimonious) nature. To the question: "Is it possible to steal?" - he reasoned like this: "You can't steal, they will see you, they will put you in jail." - "And if they don't see it?" “Then you can, however, you can’t steal state-owned, but you can from private individuals, and you can’t from private individuals, they will call the police and find out who stole it.”

When asked about revenge, he reasoned: “You can’t take revenge, you took revenge, and he will strangle you, then the end of your life, you won’t come back.” He himself does not consider himself vindictive, and when he says that he will gouge out the eyes of the offender, it is to frighten him, and adds: “And at night I forgive everyone everything and if someone offends, I again begin to love him.”

At home, he could beat his mother, and in the hospital he exclaimed: "My dear mother, the most best soul in the world, there is no better friend than your own mother! Who will feed me if my mother dies, who will give me candy, no one!"
All these examples also speak of his egocentric attitude, he has no objective attitude towards anything.

He likes to draw attention to himself, melodramatic scenes are not alien to him, when he pathetically exclaimed, fell to his knees.

He was very worried about his illness, his inferiority, as he said: "Now I forget how to name the most precious thing in the world, my mother!"

For the most part, he is in a low mood and rude words hurt him very much, he said: “When they say bold words to me, my heart trembles; I can endure it the first time, but not the fifth or fifteenth time; , then I’m ready to cut people’s throats; when I get excited, I don’t remember anything, but when my thoughts and reflections begin again, and the most unpleasant thing for me is when they say how I misbehaved myself ".

At home, in such cases, he attempted suicide, saying: “As soon as I remember what I did with my mother, I won’t want to live.” In the hospital, he also attempted suicide (he wanted to throw himself under a train); when the children began to throw stones at him, he thought: "I'll be an invalid, it's better to be undead."

He can give all the gifts to himself for affection ("then the heart will take pity"). He said that he could become like a dead man if they kindly told him to lie quietly. Affectionate words, in his opinion, can stop a seizure starting in him. Everything beautiful works well on him; he loves theater more than cinema, because there "beauty is more beautiful." Music also works well for him, as he said: "Music works very well for me."

His psyche is characterized by an attitude towards reality: his thought processes are concrete, his story from the picture is very concrete with many insignificant details. He has good visual memory. Well-preserved speech and a desire to talk make him extremely wordy, he strings one specific detail on another.

Despite all the vulnerability, sensitivity, heightened affectivity, he is completely in the surrounding reality, he needs people to rely on them; he demands participation, and does not withdraw into himself; he must constantly assert himself, attract attention to himself, hence all his importunity and all his conflicts. His aggressiveness manifested itself in his answer to the question "What is a newspaper?". He replied: "Where they write, where who was killed."

This case is interesting in the sense that we are present at the formation of the epileptic psyche.
The boy is mentally well developed, with a good memory, with good speech. After the onset of seizures began to gradually change. His thinking gradually began to acquire a formal character, he became verbose, in his answers he did not distinguish between the essential and the unimportant, and noted all the details that he knew about the question being asked.

His verbal memory began to decline, oligophasic phenomena appeared. It became difficult for him to study, and he began to refuse teaching, especially together with his comrades, so that his failure would not be revealed. Rarely do children develop this kind of epileptic character with sanctimonious statements, with aggression.

Many patients with a symptomatic form of epilepsy were subjected to a psychological experiment; in most cases, these patients in the psyche had many features inherent in epileptic disease (genuine epilepsy); in the history of the disease, marks are frequent in these cases: symptomatic epilepsy, a course of the genuine type.

The psychiatric literature indicates that in cases of symptomatic epilepsy, there is more pronounced stiffness than in epileptic disease, a greater decrease in intelligence with a lack of a critical attitude towards one's own intellectual failure, greater exhaustion and a lack of stability and focus in work.

Let us give two cases of symptomatic epilepsy, and in the first case the features of the epileptic disease are less pronounced than in the second.

Observation III. 14 year old boy, 4th grade student. She has not studied for three years, she helps her mother with the housework. The mother had malaria during pregnancy. The early development of the child is normal, he grew up cheerful, sociable, calm. At school since 7 years, studied well. At the age of 7, after a fright (the guys shouted: "Fire!"), seizures appeared: he does not always lose consciousness, seizures are rare, and he tries to hide them.

By nature, he is kind, careful, not stingy. In the hospital, he is disciplined, prudent, punctually fulfills all appointments. Conscientious. Polite. Robok. Shy. Unsure of yourself. Non-initiative. Interests are limited, he does not like to read, he is willingly engaged in embroidery.

The psychological study showed a very low general development. Low intelligence; concrete-figurative thinking; logical processes are satisfactory in cases with a specific material; abstract concepts are poorly developed, poorly differentiated.

Speech is poor, uncultured; the answers to the questions are not immediately correct, but then after a long deliberation they could improve. Productivity is better in working with concrete visual material, showed constructive ingenuity, understood technical drawings.

Verbal memory is not very high, he memorized slowly, but could remember for a long time. Switched with difficulty: when I got used to drawing triangles in one direction, I could not immediately switch to drawing triangles in the other direction. He easily got stuck on one thing, for example, when he listed the trees, he tried to remember them for a very long time and still could not finish his answer.

The reactions in different experiments are very uniform, for example, in the Rorschach test, I saw the same thing in all spots: 1) the clouds disperse, 2) the clouds begin to converge, 3) the clouds parted, 4) snow clouds. The reactions in the associative process are also very uniform.

The work is easily interrupted, the affect is light, suggestible, subordinate. The experiment revealed psychasthenic components of the psyche: being placed in a situation of choice, he experienced great confusion, hesitated for a long time, doubted what to stop on.

He is diligent in his work, but has little initiative. We tire, due to fatigue, the pace of understanding is sharply disturbed, then it can sit over some task, even quite simple, for a very long time, not understanding it and doing nothing to somehow get out of the difficulty.

At the conference, this case was diagnosed as symptomatic epilepsy, it was pointed out that his sharp lethargy, exhaustion, and, in connection with it, impaired performance were noteworthy.

Observation IV. A 13-year-old girl, a student of the 6th grade. Diagnosis: symptomatic epilepsy. Latent hydrocephalus.

In etiology, natural trauma, the phenomenon of dystrophy. A number of severe injuries. At the age of 6 years, seizures began, first abortive, then of a generalized nature, a severe post-seizure condition. Episodic epileptic psychotic states. The course is progressive. Personality change according to the type of epileptic disease (genuine).

At first she studied well at school, she was disciplined, but at home she is irritable, gloomy, grumpy, explosive, importunate, knitting, clingy. She expressed thoughts about the inappropriateness of life with seizures. She was slow in her studies, she did not understand new things right away and could fall into despair, then nothing reached her and she could do nothing.

She was very busy with herself, loved to be in sight. She did poorly at school, oral subjects were especially bad: Russian, history, geography, she taught lessons at home, and it seemed that she knew everything, and when she was called to the board, she forgot everything. Gradually it became more and more slow, it was difficult to switch, it got stuck in the experience. There were mood disorders with suicidal thoughts. Extremely polite.

The psychological study revealed a low general development, low culture; the girl had no intellectual interests; Orientation was satisfactory only within the limits of concrete-visual experience; it could mark similarities and differences in objects if the subjects of discussion were visual. Understanding abstract positions is not available (she is 14 years old, she studied in the 6th grade); could confuse one concept with another (“hot” is the same as “bitter”).

At a low level, the process of generalization. In the classification, she solved the task in this way: in the first group she put pets, people, plants, furniture, utensils and stated that this is all that a person needs; in the second group she put all the animals of prey, and in the third group all the birds of prey; thus, in the classification, she proceeded from worldly considerations, and not from logical categories.

The associative process is monotonous and slow.

The speech is not smooth, the phenomena of oligophasia were noted. At first she gave obscure answers to questions, but in the process of speaking she gradually improved them. At a very low level, verbal memory: she slowly memorized words and quickly forgot everything she remembered.

Imagination is poor: in the Rorschach test, I saw specific objects in spots; and if the stain did not remind her of anything, then she refused to comment on it. Couldn't make up any story from a picture; describing the picture, listed in order all the people and objects depicted in the picture.

There was a sharp discrepancy between the performance of verbal tasks and concrete visual tasks: she could combine Koss patterns and simple pictures well, but she could not name what she put together; during the combination did a lot of unnecessary adaptive movements. Thinking very slowly, but steadily. I was very tired from all the activities.

Dementia in childhood epilepsy occurs in a fairly large number of patients, but in varying degrees, more or less pronounced. Dementia in epilepsy is a complex formation, its property is an irreversible, progressive defect, which manifests itself in a general decrease in the entire personality, in persistent lesions of the intellect and other mental processes with the inability to navigate in new conditions, in limiting the ability to learn from children and adolescents and take active , creative participation in life.

In dementia epileptics, attention is especially drawn to the ever-increasing slowness, stiffness of all mental processes, memory is decreasing more and more, so that the patient is completely unable to acquire new knowledge and gradually loses what he has acquired. The process of thinking is disturbed, it becomes difficult to distinguish between the essential and the insignificant, the patients become unable to perceive things and phenomena out of touch with the limited situation, in their answers they show a tendency to detail with unnecessary details strung on each other, reflecting the narrowness of the patient's horizons.

Expressed speech disorders are especially common. Patients become more and more viscous, the whole psyche becomes heavy. In some degraded epileptics, the affective sphere is affected towards more and more selfishness, vindictiveness, and cruelty.

Among the degraded epileptics, there are predominantly patients with a symptomatic form of epilepsy.

Observation V. Boy, 16 years old. Diagnosis: symptomatic epilepsy. Residual effects of meningo-encephalitis.

At 11 months, he suffered from severe meningitis. At the age of 3, the first seizure was noted. At the age of 8, seizures became less frequent, 1-2 times a month; along with the big ones, there were also small seizures. Internal open hydrocephalus was found.

Finished 5 classes, arithmetic was difficult. He does not want to study anymore, he wants to get a physical job. There are no expressed interests in anything, the society of teenagers prefers the society of younger children (6-7 years old), tells them fairy tales. By nature, thorough, accurate. Warning, too polite, flattering, obsequious, economic, prudent, stingy.

On a psychological examination, he showed great stupidity in intellectual work, slowness of understanding, a complete lack of initiative. Logical processes are low: comparing objects, pointing out insignificant visual signs (for example, he compared a board and glass like this: "The board is made of wood, and glass is made of glass, it is white, glass").

The understanding of abstract propositions is inaccessible. So he compared deceit and error: "Deceive - impudently say, and mistake - make a mistake, deceive, say with anger." In tasks for understanding metaphors and proverbs, a small differentiation of thought processes was revealed, he understood some metaphors correctly, and when it was necessary to put ready-made explanations, he put a literal explanation to a correctly understood metaphor. For example, the metaphor " poison man"understood like this:" Evil, malicious, wants to do evil" - and put an explanation: "The patient instead of medicine took a sip of poison," etc. Thus, he could simultaneously uncritically understand the metaphor both allegorically and literally.

In speech, he is verbose, especially when describing a picture.

He understood everything slowly, tightly, and at the same time, there was a tendency to hasty conclusions, hasty actions. So, having received the task to put together a picture of many elements, he began to sketch the elements one next to the other, not in accordance with the content, and said: "I want to see what happens, then I can remodel it." From the manner of his work there was an impression that he began to act, not yet understanding what to do; energy went into movement, and thoughts about the content of the work receded into the background.

His memory is reduced, especially verbal, both mechanical and logical; the memory is fuzzy, when playing the given word was replaced by an invented one. Visual memory is better.

He was extremely diligent: he completed any work given to him, spending a lot of time on it, and could not interrupt the work at all.

His affect is not intense, he has no malice at all. When something didn’t work out for him, he didn’t get annoyed, but continued to do it, although slowly but cheerfully, joking all the time (examples of his jokes: “Guilty, guilty, went to the Arbat to catch fat pigs”). Folding the cubes, he spoke to them: "You stand here with me!" Applying a blue cube, he said: "Here we will turn you blue!" (We have often noted such a tendency to playful remarks in hydrocephalus.)

Therefore, there was no tension in relations with him; only his extraordinary courtesy and obsequiousness were unpleasant.

The following case speaks of the extraordinary inertia of his psyche, its weak switchability: he worked in the garden and did not finish the work assigned to him there, when the teacher took him away from the garden. Soon the patient was brought to a psychological study. He was in great anxiety, declared that his head was full of this unfinished business; once he undertook some business, he had to finish it without fail. On this day, he could not be involved in any task, he only talked about his unfinished work.

What is degradation in this case? In an extremely slow mind, in a very large inertia of the psyche, in complete lack of initiative. A bad memory does not make it possible to acquire new information, a decrease in thought processes does not allow one to understand life phenomena. The boy's interests are narrowed; his capacity for work can manifest itself only in performance work, most of all he loves only simple physical work, in this work he asserts himself.

Observation VI. A 14-year-old girl, a student of the 5th grade. Early development is normal. She grew up smart, cheerful, affectionate, sociable. At school from the age of 8, she was an excellent student. At the age of 10, she suffered from typhoid fever with otitis media.

One year after typhoid fever among full health seizures appeared, at first without convulsions, with a fall, loss of consciousness, followed by amnesia. Soon, convulsive seizures began, 1-2 seizures a day. Subsequently, the seizures were in the nature of status epilepticus - up to 20 seizures per day.

From the time the seizures began, the girl became irritable, rude, viscous, vicious, began to collect unnecessary little things, and lost interest in schoolwork. The hospital found that she was behind her age in physical development. In the neurological status, convergence insufficiency, tendon reflexes are greatly increased.

In mental status: lethargic, stunned, confused, not quite oriented in the environment, does not remember her seizures. Perseveres, gets stuck on the same words, repeats the same phrases; importunate, viscous, constantly complains about someone, refers to the conversations of others. Unfriendly and at the same time obsequious, sugary, praises everyone, is pleased with everything. Nothing can be done systematically.

In this case, there is a grossly expressed dementia. Speech disorders play a significant role in the structure of dementia, they are of a diverse nature: there are elements of amnestic aphasia (forgets the name of less commonly used items), as well as paraphasic phenomena: instead of one word, he says another, similar in consonance, for example, instead of "horse" he says "scapula ", instead of "bike" - "verside", "versipe"; instead of "boat" - "beam", etc.

He calls objects by diminutive names - "pencil, ruler, button", etc. Instead of the name of the object, he speaks of its purpose, but from long disuse, he can forget the purpose of the object. For example, she was confused when the question was asked: "What is a fork?" She replied, "I don't know that one." I could not list the insects, because I forgot what they are.

She lost all her skills: she confuses the concept of right - left, her letter corresponds to the letter of a 1st grade student. I forgot multiplication, division. Couldn't remember anything. When she was called words to remember, she repeated several words correctly and several incorrectly, and when she was asked to repeat the given words a second time, she could not do this, since she had forgotten everything. She was not able to memorize the objects shown, because she does not know the names of many objects.

The processes of logical thinking are extremely weak. When she was offered to compare two objects, she repeated the question, but she could not compare the objects, it was very difficult for her to have a common name. I didn’t catch the meaning of the story in 3 lines, I noted only a few details, without any connection.

The pictures were folded very slowly, by trial and error. In combination, she showed lack of initiative, she could repeat the same movement many times, although it clearly did not reach the goal.

Extremely slow: when she received a task, she looked at it for a long time, at first she did not understand anything, only gradually it dawned on her consciousness what was required of her. When answering a question, finding some formulation, I repeated it several times. I could not understand the wrong images, stating: "Once drawn, it means correct."

Very obsequious, thanked all the time, saying: "You told me everything."

In the structure of dementia, it should be noted that due to frequent seizures, the girl was often in a stunned state. From this state she emerged slowly; very slowly understood what was required of her, very slowly and at a low level performed the tasks available to her. Speech disturbances, sharp disturbances of memory leave a special imprint on her entire mental work, hence her weak quick wit in any intellectual work given to her. She is slow, uninitiated, perseverative.

from Natalia Efimenko (Karp).

Hello friends and participants of the "Don't Be Afraid" project.

As part of the educational program, we want to convey the message that many children with epilepsy can study in regular schools and kindergartens.

A sociological survey showed that the majority of teachers are afraid, confused, do not know how to provide first aid in case of an attack.

Most parents are silent about the problem and do not inform class teacher about the disease.

For a school, college, institute, etc., it is very important that the teacher knows as much as possible about this disease and, if necessary, knows how to provide first aid.

Since I care about this problem, I wrote a paper on this topic.

My work was included in a collection of articles for students and teachers of the VEGU Institute, where I study.

I am sending it to you so that psychologists, teachers, educators who visit the site know as much as possible about epilepsy.

N.V. Efimenko

Features of the work of a school teacher with children suffering from epilepsy.

Raising and educating children with epilepsy in our country is fraught with many difficulties. This is due to the fact that the pathogenesis of this disease is still under study, and it is impossible to give detailed advice that is equally suitable for any child suffering from epilepsy. each case is purely individual.

In addition, epilepsy is one of the most stigmatizing neuropsychiatric diseases. The popular belief in society that epilepsy is mental illness, erroneously. According to the International Classification of Diseases, Injuries and Causes of Death (ICD-10), epilepsy is a neurological disorder. Patients may develop secondary (neurosis-like and psychopathic) disorders of mental activity, but in most cases this is not due to the course of the disease, but to psychological and social problems that often lead the epileptic to forced maladaptation. A.V. Ostrovskaya writes: “In some cases, psychological and social problems for patients with epilepsy are more serious than seizures. Often this imposes a restriction on the functioning of the individual and, as a result, leads to a decrease in the quality of life. Lack of awareness among the population about true nature epilepsy leads to such a phenomenon as stigmatization.

It is especially tragic if the disease appeared in childhood, when a person is just forming an attitude towards himself and the world around him. A child with epileptics has distorted ideas about himself and about the picture of the world. He is more likely than others to face ridicule, alienation, neglect, aggression, condescending pity. It is sad that teachers sometimes take the wrong position, refusing to accept such children in kindergartens, schools, trying to transfer them to home schooling. Parents, trying to protect the nervous system of the child from overstrain, also limit his activity, often "going too far."

Unfortunately, all these actions, as practice shows, to a greater extent do not lead to the expected benefits, but only to the development of many complexes, which, in turn, can further lead to self-stigmatization. The child begins to experience shame, difficulties in communication, his self-esteem is lowered. Once faced with the phenomenon of stigma, he subconsciously expects and fears it.

To prevent this, it is necessary to understand that children with epilepsy need not only medical treatment, but also special support from the team, including teachers. Teachers in schools, of course, must be well informed. They should not only correctly navigate in cases where an epileptic seizure occurs, but also be aware of those specific characterological disorders that may occur in children with epilepsy, correctly understand their actions, actions, maintain a healthy emotional atmosphere in the classroom, and prevent aggression. . This is very important, because the formation of the personality, character, attitude of the child to himself and others, and, consequently, his social attitudes and place in society, depends on the teacher.

So what should a teacher do if there is a child diagnosed with epilepsy in his class? First of all, do not be afraid and do not panic. If a child attends a regular (not specialized) school, then this is not contraindicated for him.

First of all, a confidential conversation with the parents of the child is necessary. The teacher must find out how often seizures occur, what character they have, how the course of the disease affects the formation of personality. Also, the teacher needs to know what antiepileptic drugs the child is taking, how to provide first aid in case of an attack, and how to contact parents or next of kin if necessary.

If an epileptic attack did occur, do not be scared and scream. So that the child does not inflict bruises and injuries on himself, he must be laid on something soft, supporting his head with his hands. It is recommended to remove all dangerous objects from the coverage area, and also try, as far as possible, to free the child from clothes (unbutton his shirt, loosen the belt). You can not leave the child alone during an attack.

It is widely believed that in order to avoid biting the tongue, you need to put a spoon or other similar object wrapped in soft cloth. However, in recent years, many experts do not recommend doing this. ON THE. Schneider, professor, doctor of medical sciences, head of the Neurological Center for Epileptology, Neurogenetics and Brain Research, University Clinic of the Krasnoyarsk State Medical University. prof. V.F. Voyno-Yasenetsky, writes: "No need to insert anything between the teeth of a child who is in an attack." Also, do not pour any liquid into your mouth until the attack is over.

It is urgent to call the child's parents or close relatives. call " ambulance"Not always necessary, but only in the following cases:

1) if the duration of the attack exceeds 5 minutes;

2) if there is a violation of respiratory functions;

3) if the recovery to consciousness after an attack is too slow;

4) if attacks occur serially, one after another;

5) if an epileptic seizure occurred in the water;

6) if during an attack the child was injured.

In all other cases, you do not need to contact the ambulance station, you do not need to call a team of doctors, and even more so send the child to the hospital. In addition to the fact that this is not necessary, it has a psychologically depressing effect on patients with epilepsy. Therefore, it is better to call the parents and call them to the scene.

Sleep usually follows. Before the arrival of the parents, the child must be laid in an isolated, quiet room, where there is a sufficient supply of fresh air. But even during sleep, it is desirable that someone watch him, because. the attack may recur, even without awakening.

If the attack occurs in front of other children, you do not need to focus their attention on this. In general, there is no need to once again remind the child of his illness. You should not discuss the fact of the disease with someone in the presence of a sick child. Excessive guardianship and unnecessary restrictions are not recommended. A child suffering from epilepsy should not be "turned off" from society, he can and should participate in sports and mass events to the best of his ability (in agreement with the attending physician).

It is possible to live fully with epilepsy. And you can even, being sick with epilepsy, benefit society. Epilepsy was suffered by Yu. Caesar, Socrates, F.M. Dostoevsky, A. Nobel, V. Van Gogh and many other great people.

I am glad that society is gradually turning its face towards those with epilepsy. In Europe, the program "Epilepsy - out of the shadows" has been operating for several years. In Russia, in 2009, the Don't Be Afraid project was launched, the purpose of which is to increase public awareness of everything related to this disease, to restore a normal social status for patients with epilepsy. This project is working on organizing radio and television programs, publishing articles in newspapers and magazines on this topic. Interaction with this project is undoubtedly beneficial for educators.

The already mentioned N.A. Schneider, in his address to teachers, writes: “A child with epilepsy, in general, does not differ from other children. He is just as smart, handsome, interesting and necessary. He's just as good. He is just as good as all the kids. And the fact that he has seizures from time to time is just one of his individual characteristics, which you just need to understand and accept. And which in no way makes him worse or in some way more limited than other children. He just needs a little more attention and care. Only and everything. And so - he is the same as everyone else.

This is what you must convince yourself, your colleagues, friends of a sick child and, of course, the smallest person who has suffered such suffering.

Know that it is in your power to make a meaningful contribution to ensuring that a child with epilepsy does not grow up withdrawn from life.

Sources and literature:

1. International classification diseases ICD-10 //www.medicalib.ru/

2. Materials of the All-Russian 68th final student scientific conference them. N.I. Pirogova (Tomsk, April 20-22, 2009): Ed. V.V. Novitsky, L.M. Ogorodova. - Tomsk: SibGMU, 2009. - 411 p.

3. Actual issues of epileptology - stigmatization, quality of life and rehabilitation of patients // www.hghltd.yandex.net/

4. Epilepsy in a child: advice to educators and teachers //www.krasmedic.ru/

Epilepsy is manifested by repeated unprovoked seizures, which are in the nature of a variety of sudden and transient pathological phenomena affecting the consciousness, motor and sensory spheres, the autonomic nervous system, and the patient's psyche. Two seizures occurring in a patient within 24 hours are considered a single event.

The clinical manifestations of epilepsy are variable and diverse. They mainly depend on both the form of the disease and the age of the patients. Age aspects epilepsy in child neurology suggest the need for a clear identification of age-dependent forms of this group of diseases.

Clinical manifestations of epilepsy in children and adolescents

The clinical picture of epilepsy includes two periods: seizure and interictal (interictal). The manifestations of the disease are determined by the type of seizures the patient has and the localization of the epileptogenic focus. In the interictal period, neurological symptoms in a patient may be completely absent. In other cases neurological symptoms in children may be due to a disease that causes epilepsy.

Partial Seizures

Manifestations of simple partial seizures depend on the location of the epileptogenic focus (frontal, temporal, parietal, occipital lobes, perirolandic region, etc.). Up to 60-80% of epileptic seizures in children and adult patients are partial. These seizures occur in children with various phenomena: motor (tonic or clonic convulsions in the upper or lower limbs, on the face - contralateral to the existing focus), somatosensory (feeling of numbness or "passage of current" in the limbs or half of the face opposite to the epileptogenic focus), specific sensory (simple hallucinations - acoustic and / or visual), autonomic (mydriasis, sweating, pallor or hyperemia skin, discomfort in the epigastric region, etc.) and mental ( transient disorders speech, etc.).

Clinical manifestations of partial seizures are markers of the topic of the epileptic focus. With localization of foci in the motor cortex, seizures are usually characterized by focal tonic and clonic convulsions - motor seizures of the Jacksonian type. Sensory Jacksonian seizures (focal paresthesias) occur when there is an epileptic focus in the posterior central gyrus. Visual seizures (simple partial), characterized by the corresponding phenomena (sparks of light, zigzags before the eyes, etc.), occur when epileptic foci are located in the occipital cortex. Various olfactory ( bad smell), acoustic (sensation of tinnitus) or taste ( bad taste) phenomena occur when the foci are localized, respectively, in the region of the olfactory, auditory or gustatory cortex. Foci located in the premotor cortex induce adversive seizures (combination of abduction eyeballs and head, followed by clonic twitches); often such attacks are transformed into secondary-generalized ones. Partial seizures are simple and complex.

Simple partial seizures (SPP). Manifestations depend on the localization of the epileptic focus (localization-conditioned). PPP are motor and occur without change or loss of consciousness, so the child is able to talk about his feelings (except when the attacks occur during sleep).

PPP is characterized by the occurrence of seizures in one of the upper limbs or in the face. These seizures lead to a deviation of the head and abduction of the eyes in the direction of the hemisphere, the contralateral localization of the epileptic focus. Focal seizures may begin in a limited area or generalize, resembling secondary generalized tonic-clonic seizures. Paralysis (or paresis) of Todd, expressed in transient weakness for several minutes to several hours, as well as abduction of the eyeballs towards the affected hemisphere, are indications of an epileptogenic focus. These phenomena appear in a patient after PPP (postictal period).

Simple partial autonomic seizures (PPVP). It is proposed to single out this variety of relatively rare epileptic seizures separately. PPVP is induced by epileptogenic foci localized in the orbito-insulo-temporal region. In PPVP, predominate autonomic symptoms(sweating, sudden palpitations, abdominal discomfort, rumbling in the abdomen, etc.). Vegetative manifestations in epilepsy are quite diverse and are determined by digestive, cardiac, respiratory, pupillary and some other symptoms. Abdominal and epigastric epileptic seizures are considered more common in children aged 3 to 7 years, while cardiac and pharyngooral seizures are more common in older children. Respiratory and pupillary PPEPs are characteristic of epilepsy in patients of any age. So, clinically abdominal epileptic seizures are usually characterized by the occurrence of sharp pains in the abdomen (sometimes in combination with vomiting). Epigastric PPVP manifest as various signs of discomfort in the epigastric region (abdominal rumbling, nausea, vomiting, etc.). Cardiac epileptic seizures manifest as tachycardia, increased blood pressure, pain in the heart area (“epileptic angina pectoris”). Pharyngo-oral PPVP are epileptic paroxysms, expressed in hypersalivation, often in combination with movements of the lips and / or tongue, swallowing, licking, chewing, etc. The main manifestation of pupillary PPVP is the appearance of mydriasis (the so-called "pupillary epilepsy"). Respiratory PPVP are characterized by attacks of respiratory failure - shortness of breath ("epileptic asthma").

Complex partial seizures (SPS). The manifestation of SPP is very diverse, but in all cases, patients have changes in consciousness. It is quite difficult to fix violations of consciousness in infants and young children. The onset of SPP may be expressed as a simple partial seizure (SPP) followed by impaired consciousness; changes in consciousness can also occur directly in the attack. SPP often (about half of the cases) begin with an epileptic aura (headache, dizziness, weakness, drowsiness, oral discomfort, nausea, stomach discomfort, numbness of the lips, tongue, or hands; transient aphasia, a feeling of constriction in the throat, difficulty breathing, auditory and / or olfactory paroxysms, unusual perception of everything around, sensations deja vu(already experienced) or jamais vu(for the first time visible, audible and never experienced), etc.), which allows to clarify the localization of the epileptogenic focus. Phenomena such as convulsive clonic movements, violent deviation of the head and eyes, focal tonic tension and / or various automatisms (repetitive non-purposeful motor activity: lip licking, swallowing or chewing movements, fanciful movements of the fingers, hands and facial muscles, in those who started walking - running etc.) may accompany NGN. Automated movements in SPP are not targeted; contact with the patient during the attack is lost. In infancy and early childhood, the described automatisms are usually not expressed.

Partial seizures with secondary generalization (PPVG). Secondary generalized partial seizures are tonic, clonic, or tonic-clonic. PPVG always proceed with loss of consciousness. May occur in children and adolescents after both simple and complex partial seizures. Patients may have an epileptic aura (about 75% of cases) preceding PVG. The aura usually has an individual character and is stereotyped, and depending on the damage to a particular area of ​​the brain, it can be motor, sensory, autonomic, mental or speech.

During PVG, patients lose consciousness; they fall if they are not in lying position. The fall is usually accompanied by a specific loud cry, which is explained by spasm of the glottis and convulsive muscle contraction. chest.

Generalized seizures (primary generalized)

Like partial (focal) epileptic seizures, generalized seizures in children are quite diverse, although they are somewhat more stereotypical.

clonic seizures. Expressed in the form of clonic convulsions that begin with sudden onset hypotension or a short tonic spasm, followed by bilateral (but often asymmetric) twitching, which may predominate in one limb. During an attack, there are differences in the amplitude and frequency of the described paroxysmal movements. Clonic convulsions are commonly seen in neonates, infants, and young children.

Tonic attacks. These convulsive seizures are expressed in a short-term contraction of the extensor muscles. Tonic seizures are characteristic of the Lennox-Gastaut syndrome, they are also observed in other types of symptomatic epilepsy. Tonic seizures in children occur more frequently during non-REM sleep than when awake or during REM sleep. With concomitant contraction of the respiratory muscles, tonic convulsions may be accompanied by the development of apnea.

Tonic-clonic seizures (TCP). They are expressed in the form of convulsions, proceeding according to the grand mal type. TST is characterized by a tonic phase lasting less than 1 minute, accompanied by an upward eye movement. At the same time, there is a decrease in gas exchange due to tonic contraction of the respiratory muscles, which is accompanied by the appearance of cyanosis. The clonic convulsive phase of the attack follows the tonic and is expressed in clonic twitching of the limbs (usually within 1-5 minutes); gas exchange at the same time improves or normalizes. TST may be accompanied by hypersalivation, tachycardia, and metabolic and/or respiratory acidosis. In TST, the postictal state often lasts less than 1 hour.

Absence seizures (absences). They proceed according to the type of petit mal (“small epileptic seizure”) and represent a short-term loss of consciousness followed by amnesia (“fading”). Absences may be accompanied by clonic twitching of the eyelids or limbs, dilated pupils (mydriasis), changes in muscle tone and skin color, tachycardia, piloeresis (contraction of the muscles that raise the hair) and various motor automatisms.

Absences are simple and complex. Simple absences are attacks of short-term loss of consciousness (with characteristic slow waves on the EEG). Complex absence seizures are disturbances of consciousness, combined with atony, automatisms, muscle hypertonicity, myoclonus, attacks of coughing or sneezing, as well as vasomotor reactions. It is also customary to single out subclinical absences, that is, transient disorders without pronounced clinical manifestations, noted during neuropsychological examination and accompanied by EEG-study slow-wave activity.

Simple absences are much less common than complex ones. If the patient has an aura, focal motor activity in the extremities and postictal weakness, fading is not regarded as absences (in such cases one should think of complex partial seizures).

Pseudo-absences. This type of seizure is described by H. Gastaut (1954) and is difficult to distinguish from true absences. With pseudo-absences, there is also a short-term shutdown of consciousness with a stoppage of gaze, but the onset and end of the seizure are somewhat slowed down. Pseudo-absence seizures themselves are longer in time and are often accompanied by paresthesias, déjà vu, pronounced autonomic disorders, often postictal stupor. Pseudo-absences are partial (focal) temporal paroxysms. EEG research is of decisive importance in differentiating pseudo-absences from true absences.

Myoclonic seizures (epileptic myoclonus). Myoclonic twitching may be isolated or recurrent. Myoclonus is characterized by short duration and rapid bilateral symmetrical muscle contractions, as well as the involvement of various muscle groups. Myoclonus is commonly seen in children with benign or symptomatic epilepsy. In the structure of the group of symptomatic epilepsies, myoclonias can be observed both in various non-progressive forms of the disease (Lennox-Gastaut syndrome, etc.), and in relatively rare progressive forms of myoclonus-epilepsy (Lafort disease, Unferricht-Lundborg disease, MERRF syndrome, neuronal ceroid lipofuscinosis and etc.). Sometimes myoclonic activity is associated with atonic seizures; while children can fall when walking.

atonic seizures. They are characterized by a sudden fall of a child who can stand and / or walk, that is, the so-called “drop attack” (drop-attack) is noted. With an atonic attack, there is a sudden and pronounced decrease in tone in the muscles of the limbs, neck and trunk. During an atonic seizure, the onset of which may be accompanied by myoclonus, the child's consciousness is disturbed. Atonic seizures are more common in children with symptomatic generalized epilepsy, but are relatively rare in primary generalized forms of the disease.

akinetic seizures. They resemble atonic seizures, but, unlike them, with akinetic seizures, the child has a sudden immobility without a significant decrease in muscle tone.

Thermopathological manifestations of epilepsy

Back in 1942, A. M. Hoffman and F. W. Pobirs suggested that attacks of excessive sweating are a form of "focal autonomic epilepsy." H. Berger (1966) first described fever (hyperthermia) as an unusual manifestation of epilepsy, and subsequently D. F. Сohn et al. (1984) confirmed this thermopathological phenomenon, calling it "thermal epilepsy" . The possibility of manifestation of intermittent fever or "febrile cramps" in epilepsy is reported by S. Schmoigl and L. Hohenauer (1966), H. Doose et al. (1966, 1970) and K. M. Chan (1992).

T. J. Wachtel et al. (1987) consider that generalized tonic-clonic seizures can lead to hyperthermia; in their observations, 40 patients out of 93 (43%) had a rise in temperature above 37.8 °C at the time of the attack. J. D. Semel (1987) described a complex partial status epilepticus manifesting as "fever of unknown origin".

In some cases, epilepsy can manifest itself in the form of hypothermia. R. H. Fox et al. (1973), D. J. Thomas and I. D. Green (1973) described spontaneous intermittent hypothermia in diencephalic epilepsy, and M. H. Johnson and S. N. Jones (1985) observed status epilepticus with hypothermia and metabolic disorders in a patient with agenesis of the corpus callosum. W. R. Shapiro and F. Blum (1969) described spontaneous recurrent hypothermia with hyperhidrosis (Shapiro's syndrome). In the classical version, Shapiro's syndrome is a combination of agenesis of the corpus callosum with paroxysmal hypothermia and hyperhidrosis (cold sweat), and is pathogenetically associated with the involvement of the hypothalamus and other structures of the limbic system in the pathological process. Shapiro's syndrome is referred to by various researchers as "spontaneous intermittent hypothermia" or "episodic spontaneous hypothermia". A description of spontaneous intermittent hypothermia and hyperhidrosis without corpus callosum agenesis is presented. K. Hirayama et al. (1994), and then K. L. Lin and H. S. Wang (2005) described "reversible Shapiro syndrome" (agenesis of the corpus callosum with intermittent hyperthermia instead of hypothermia) .

In most cases, paroxysmal hypothermia is considered to be associated with diencephalic epilepsy. Although, according to C. Bosacki et al. (2005), the hypothesis of "diencephalic epilepsy" in relation to episodic hypothermia is not convincing enough, the epileptic origin of at least some cases of Shapiro's syndrome and similar conditions is confirmed by the fact that antiepileptic drugs prevent the development of attacks of hypothermia and hyperhidrosis.

Hyperthermia or hypothermia cannot be clearly attributed to focal or generalized paroxysms, but the very possibility of epileptic seizures in children in the form of pronounced temperature reactions (in isolation or in combination with other pathological phenomena) should not be ignored.

Mental characteristics of children with epilepsy

Many mental changes in children and adolescents with epilepsy remain unnoticed by neurologists, if they do not reach significant severity. However, without this aspect, the picture of the clinical manifestations of the disease cannot be considered complete.

The main types of mental disorders in children with epilepsy, as numerous and diverse as the paroxysmal manifestations of the disease, can be schematically classified into one of 4 categories: 1) asthenic conditions (neurotic reactions of the asthenic type); 2) disorders of mental development (with varying severity of intellectual deficit); 3) deviant forms of behavior; 4) affective disorders.

Most typical changes personality with a certain duration of the course of epilepsy, the polarity of affect is considered (a combination of affective viscosity of the tendency to “get stuck” on certain, especially negatively colored, affective experiences, on the one hand, and affective explosiveness, impulsivity with a large affective discharge, on the other); egocentrism with the concentration of all interests on one's own needs and desires; accuracy, reaching pedantry; exaggerated desire for order, hypochondria, a combination of rudeness and aggressiveness towards one with obsequiousness and subservience to other persons (for example, to elders on whom the patient depends).

In addition to this, children and adolescents with epilepsy are characterized by pathological changes in the sphere of instincts and drives (increased self-preservation instinct, increased drives, which are associated with cruelty, aggressiveness, sometimes increased sexuality), as well as temperament (slowing the pace of mental processes, the predominance of gloomy and gloomy mood).

Less specific in the picture of persistent personality changes in epilepsy are violations of intellectual-mnestic functions (slowness and stiffness of thinking - bradyphrenia, its perseverativity, a tendency to detail, memory loss of an egocentric type, etc.); the described changes become more noticeable in children who have reached the age of onset schooling.

In general, among mental disorders characteristic of epilepsy, the following disorders appear: receptor disorders, or sensopathies (senestopathies, hyperesthesia, hypesthesia); perception disorders (hallucinations: visual, extracampal, auditory, gustatory, olfactory, tactile, visceral, hypnagogic and complex; pseudohallucinations); psychosensory disorders (derealization, depersonalization, change in the speed of events in time); affective disorders (hyper- and hypothymia, euphoria, ecstatic states, dysphoria, parathymia, apathy; inadequacy, dissociation and polarity of affect; fears, affective exceptional state, affective instability, etc.); memory disorders or dysmnesia (anterograde, retrograde, anteroretrograde and fixative amnesia; paramnesia); impaired attention (disorders of concentration of attention, "stuck" attention, narrowed attention); intellectual disorders (from tempo retardation of psychomotor development to dementia); motor disorders (hyper- and hypokinesia); speech disorders (motor, sensory or amnestic aphasia; dysarthria, oligophasia, bradyphasia, speech automatism, etc.); the so-called "disorders of urges" (motivation): hyper- and hypobulia; attraction disorders (anorexia, bulimia, obsessions); sleep disturbances or dyssomnias (hypersomnia, hyposomnia); psychopathic disorders (characterological disturbance of emotional-volitional functions and behavior); various forms of disorientation (in time, environment and self).

Almost all of the disorders described above can lead to or be accompanied by certain disturbances of consciousness. Therefore, in "epileptopsychiatry" A. I. Boldarev (2000) first of all considers syndromes of changes in consciousness: a syndrome of increased clarity of consciousness and syndromes of decreased clarity of consciousness (partial and generalized).

Clarity-enhancing syndrome (or hyper-wakefulness syndrome). It occurs in epilepsy quite often, although it remains poorly understood. The content of the syndrome of increased clarity of consciousness is determined as follows: clarity, liveliness and distinctness of perception; quick orientation in the environment, instantaneous and vivid memories, ease of resolving the situation that has arisen, the rapid flow of thought processes, sensitive responsiveness to everything that happens. It is believed that the syndrome of increased clarity of consciousness manifests itself most clearly in hyperthymia, as well as in hypomanic and ecstatic states.

Syndromes of reduced clarity of consciousness are partial. In epilepsy, they are transitional states between the patient's intact and deeply disturbed consciousness. They can occur in pre-, inter- or post-attack periods and are quite diverse (decrease in the susceptibility of external stimuli and stimuli, violations of their associative processing, lethargy varying degrees severity, transient decrease in intelligence, slowness of reactions and mental processes, decreased sociability, dulling of emotions, narrowing of the scope of attention, impaired memories, as well as a partial disorder of orientation in time, environment and self, etc.). TO " special conditions consciousness "A. I. Boldarev (2000) refers psychosensory disorders and changes in perception over time (including phenomena deja vu and jamais vu). In epilepsy, sleep-like states ( dream states) are a common variant of a partial disorder of consciousness (according to the type jamais vu or deja vu); their duration varies from a few seconds or minutes to several hours/days. Sleep-like states are characteristic of temporal lobe epilepsy. Epileptic trances - unmotivated and unreasonable movement of the patient from one place to another, occurring against the background of a partial disorder of consciousness and outwardly ordered behavior, as well as subsequent incomplete amnesia. Trances of various duration (from several hours to several weeks) can be provoked by emotional stress and / or acute somatic pathology (ARI, etc.).

Syndromes of decreased clarity of consciousness, generalized comparatively numerous . These include the following psychopathological phenomena: stupefaction (difficulty and slowdown in the formation/reproduction of associations); delirium (a disorder of consciousness saturated with visual and / or auditory hallucinations followed by incomplete amnesia); oneiroid (a dreamlike state in which dream-like events occur in a subjective unreal space, but are perceived as real); sleepy states (change of consciousness and incomplete orientation in what is happening or lack of orientation and wakefulness after waking up); somnambulism (walking at night in a state of incomplete sleep); simple psychomotor seizures (short-term - for a few seconds, single automatic actions with loss of consciousness) and complex psychomotor seizures (longer - up to 1 minute or more, attacks of automatism with loss of consciousness, resembling short-term twilight states); twilight states of consciousness (complete disorientation of the patient, affective tension, hallucinations, delusional interpretation of what is happening, excitement, inadequate and unmotivated behavior); amental states (profound disorientation in the environment and one's own personality, combined with an inability to form and reproduce associations; after the patient exits the amental state, complete amnesia is noted); soporous state (profound impairment of consciousness, from which the patient can be brought out for a short time by sharp irritation - a short-term partial clarification of consciousness; upon exiting the soporous state, anterograde amnesia is noted); coma (deep unconsciousness with no response to external stimuli - pupillary and corneal reflexes are not determined; after leaving the coma, anterograde amnesia occurs); undulating disorder of consciousness (intermittent fluctuations of consciousness - from clear to complete shutdown).

Other psychiatric disorders in epilepsy occurring in childhood are presented the following violations: derealization syndrome (violations of spatial perception during seizures); Syndromes of disturbance of perception in time ( déja vu, jamais vu, déja entendu(already heard)); Syndrome of a combination of psychosensory disorders with a partial change in consciousness, impaired perception in time and an ecstatic state (psychosensory disorders - depersonalization and derealization, including violations of the body scheme, ecstatic state, unreality of time, etc.); syndrome of psychosensory disorders and oneiroid state (complex syndrome of gross derealization, depersonalization and oneiroid); the syndrome of uncertainty of subjective experiences (the inability to concretize one's own subjective feelings and experiences, sometimes with auditory or visual hallucinations); dissociation syndrome between objective and subjective experiences (denial by the patient of the presence of multiform or abortive epileptic seizures, observed both at night and in the daytime); complex syndromes (complex seizures with a combination of various sensations, viscerovegetative manifestations, affective disorders and other symptoms) delusional syndromes (paranoid, paranoid or paraphrenic); catatonic substuporous state (incomplete immobility in protracted and chronic epileptic psychoses, often combined with partial or complete mutism, muscle hypertonicity and negativism phenomena); catatonic syndromes (catatonic excitation - impulsiveness, mannerisms, unnaturalness, motor excitation, or stupor - mutism, catalepsy, echolalia, echopraxia, stereotypy, grimacing, impulsive acts); Kandinsky-Clerambault syndrome or mental automatism syndrome (pseudo-hallucinations, mental automatisms, delusions of persecution and influence, a sense of mastery and openness; 3 variants of mental automatism are possible: associative, kinesthetic and senestopathic); mental disinhibition syndrome or hyperkinetic syndrome (general disinhibition with rapidly changing movements, restlessness, inability to concentrate, increased distractibility, inconsistency in actions, disturbances in logical construction, disobedience).

Cognitive impairment in epilepsy

Impairments of cognitive functions are found in partial and generalized forms of epilepsy. The nature of the cognitive "epileptic" deficit can be acquired, fluctuating, progressive, chronic and degrading (leading to the development of dementia).

T. Deonna and E. Roulet-Perez (2005) distinguish 5 groups of main factors potentially explaining cognitive (and behavioral) problems in children with epilepsy: 1) brain pathology (congenital or acquired); 2) epileptogenic damage; 3) epilepsy as the basis of electrophysiological dysfunction; 4) the effect of drugs; 5) impact psychological factors.

The structure of the intellect in patients with epilepsy is characterized by impaired perception, reduced concentration of attention, short-term and operative memory, motor activity, hand-eye coordination, constructive and heuristic thinking, speed of skills formation, etc., which causes difficulties in social integration in patients and education, reducing the quality of life. Negative influence on the cognitive functions of the early onset of epilepsy, refractoriness to ongoing therapy, and the toxic level of antiepileptic drugs in the blood have been demonstrated by many researchers.

Symptomatic epilepsies due to organic CNS damage are also serious factor risk for cognitive impairment. Violations of higher mental functions in epilepsy, they depend on the localization of the focus of epileptic activity and / or structural damage to the brain. With left-sided damage in children with frontal epilepsy, there is a lack of determination, verbal long-term memory, and difficulties in visual-spatial analysis. Their frequent attacks affect the level of attention and the ability to inhibit impulsive responses; patients with the onset of epilepsy before the age of 6 years are not capable of building a behavioral strategy.

In generalized epilepsy, epileptiform changes on the EEG cause transient impairment of cognitive functions (prolongation of reaction time, etc.).

Severe impairments of cognitive functions are characteristic of epileptic encephalopathies of early childhood (early myoclonus encephalopathy, Otahara, West, Lennox-Gastaut syndromes, etc.). Complex partial seizures, right-hemispheric localization of the epileptogenic focus reduce the maintenance (stability) of attention, and the phenomenon of the EEG pattern of continued peak-wave activity in the phase of slow-wave sleep affects the selectivity and distribution of attention.

Progressive neuronal ischemia is one of the prerequisites for epileptogenesis as a consequence of chronic vascular insufficiency. Changes in cerebral perfusion can serve as a functional substrate for impaired cognitive/psychophysiological functions.

Most antiepileptic drugs can cause psychotropic effects (anxiety and mood disturbances that indirectly impair cognitive function). The negative effects of these drugs are a decrease in attention, deterioration in memory and speed of mental processes, etc. T. A. Ketter et al. (1999) hypothesized different antiepileptic and psychotropic action profiles (sedative, stimulant or mixed) of drugs used in the treatment of epilepsy.

Continue reading the article in the next issue.

Literature

1. Epilepsy in neuropediatrics (collective monograph) / Ed. Studenikina V.M.M.: Dynasty. 2011, 440 p.
2. Epileptic syndromes in infancy, childhood and adolescence (Roger J., Bureau M., Dravet Ch., Genton P. et al., eds.). 4th ed. (with video). Montrouge (France). John Libbey Eurotext. 2005. 604 p.
3. Encyclopedia of basic epilepsy research / Three-volume set (Schwartzkroin P., ed.). vol. 1-3. Philadelphia. Elsevier/Academic Press. 2009. 2496 p.
4. Chapman K., Rho J. M. Pediatric epilepsy case studies. From infancy and childhood through infancy. CRC Press/Taylor&Francis Group. Boca Raton London. 2009. 294 p.
5. Berger H. An unusual manifestation of epilepsy: fever // Postgrad. Med. 1966 Vol. 40. P. 479-481.
6. Lin K.L., Wang H.S. Reverse Shapiro's syndrome: an unusual cause of fever of unknown origin // Brain Dev. 2005 Vol. 27. P. 455-457.
7. Dundar N. O., Boz A., Duman O., Aydin F. et al. Spontaneous periodic hypothermia and hyperhidrosis // Pediatr. Neurol. 2008 Vol. 39. P. 438-440.
8. Kovalev V.V. Epilepsy. Chapter XIX. In: Childhood Psychiatry: A Guide for Physicians. 2nd ed., revised. and additional M.: Medicine. 1995. S. 482-520.
9. Dunn D.W. Neuropsychiatric aspects of epilepsy in children // Epilepsy Behav. 2003 Vol. 4. P. 98-100.
10. Austin J.K., Dunn D.W. Progressive behavioral changes in children with epilepsy // Prog. Brain Res. 2002 Vol. 135. P. 419-427.
11. Boldarev A.I.Mental features patients with epilepsy. M.: Medicine. 2000. 384 p.
12. Balkanskaya S.V. Cognitive aspects of epilepsy in childhood. In: Problems of Child Neurology / Ed. G. Ya. Khulupa, G. G. Shanko. Minsk: Harvest. 2006. S. 62-70.
13. Deonna T., Roulet-Perez E. Cognitive and behavioral disorders of epileptic origin in children. London. Mac Keith Press. 2005. 447 p.
14. Sanchez-Carpintero R., Neville B. G. Attentional ability in children with epilepsy // Epilepsia. 2003 Vol. 44. S. 1340-1349.
15. Tromp S. C., Weber J. W., Aldenkamp A. P., Arends J. et al. Relative influence of epileptic seizures and of epilepsy syndrome on cognitive function // J. Child Neurol. 2003 Vol. 18. P. 407-412.
16. Aldenkamp A.P. Effects of antiepileptic drugs on cognition // Epilepsia. 2001 Vol. 42. Suppl. 1. S. 46-49.
17. Ketter T. A., Post R. M., Theodore W. H. Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders // Neurology. 1999 Vol. 53. P. 53-67.

V. M. Studenikin, doctor of medical sciences, professor, academician of the Russian Academy of Natural Sciences

FSBI "NTsZD" RAMS, Moscow

March 26 is celebrated annually as Epilepsy Day. It is also called Purple Day. This name was invented by one girl (Cassidy Megan), who has epilepsy. She saw that she was treated not quite adequately, almost like crazy. To dispel the myths about the disease, Cassidy came up with Purple Day in 2008. Her initiative was picked up by the Association of Epileptologists in Scotland, and soon the whole world.

Epilepsy needs to be understood. “We all swim in the same sea, but in the same school each fish has its own individual characteristics.” A separate role in ensuring that a child with epilepsy grows up as comfortably and safely as possible belongs to educators and teachers.

Illness is not a death sentence

Epilepsy is a disease in which the environment of a sick person is extremely important for him. It is on those who are nearby that it depends on how he feels himself in this world: whether he feels like a full-fledged member of society, or vice versa - he has complexes, considering himself "somehow not like that."

Especially the attitude of others is significant for a child suffering from epilepsy. With what ideas about himself and with what perception of his illness he will grow, largely depends on the adults, in front of whom he happened to get acquainted with life and look for his place in it.

For example, with widespread among children preschool age With childhood absence epilepsy, the child's intellect and psychomotor development do not suffer, and with adequate treatment, it is possible to achieve a complete remission of the disease and even a cure. In a number of forms of childhood epilepsy, for example, in Rolandic epilepsy, seizures are rare and are predominantly nocturnal. Rolandic epilepsy is also successfully treated under the supervision of a pediatric neurologist-epileptologist, and the intellectual and psychomotor development of the child with it corresponds to his gender and age. Children with these forms of epilepsy, as a rule, do not need any restrictions in terms of attending a children's institution.

With a delay in psychomotor development, which is observed in some forms of symptomatic or presumably symptomatic (so-called cryptogenic) epilepsy, the attending physician determines for a sick child the type of specialized preschool (school) institution and the amount of optimal educational and physical activity.

It should be remembered that mental activity and development fine motor skills fingers in a child with epilepsy contribute to a milder course of the disease and increase the success of drug therapy. This is due to the fact that the cortex of the frontal lobe of the cerebral hemispheres, where the cortical centers are located abstract thinking, construction, etc., as well as a motor analyzer, belongs to the antiepileptic system and, with sufficient activity, is capable of performing reverse inhibitory control of epileptic discharges emanating from other parts of the brain.

When visiting with a child kindergarten it is desirable that teachers school institution Participated in seizure diary.

It is worth noting that any teacher should know the rules for providing first aid in the event of an epileptic seizure, since an epileptic seizure can occur in a child attending your group (class), not only against the background of a current illness, but also for the first time.

What should I do if an attack occurs while my child is in school?

If an epileptic seizure occurred in front of other children, then their attention should not be focused on this situation. It is necessary to try to alleviate the embarrassment of a sick child as much as possible (especially in the case of involuntary urination).

The following picture (done by a healthy child attending preschool) shows one of the rules for helping a sick child in the event of a tonic-clonic seizure: a girl with blond hair intends to insert a spoon between the teeth of a boy in an attack, and a dark-haired girl corrects her and explains, that this cannot be done.

In Western Europe and the United States, children at risk of developing epileptic seizures wear special bracelets (tags) that contain brief information about the nature of their illness, emergency care rules and telephone numbers to contact the child's parents (guardians) or with the attending physician. doctor.

The child may also carry a large, thick card with information about himself, the medications he takes, and contact numbers parents/guardians or doctors.

On the reverse side of such a card, you can read a typical instruction for helping with an epileptic seizure.

"I'm just like everyone else..."

Many great people suffered from epilepsy: J. Caesar, Socrates, F.M. Dostoevsky, A. Nobel, V. Van Gogh, Joan of Arc, G. Flaubert, Alexander the Great, Napoleon Bonaparte, St. Paul…

It is important for a child with epilepsy not to be seen as limited in some way. epileptic seizures for most children - only temporary episodes in the rest of the normal life.

A child with epilepsy can and should participate in sports and mass events to the best of his ability (in agreement with the attending physician). Adequately selected physical activity and active communication with peers and teachers cannot adversely affect the course of the disease.

Very important

The percentage of children with epilepsy subject to disqualification is exceptionally low. The major social problems that these children have due to the fact that their environment does not accept them cause them much more grief than the seizures themselves.

And always remember...

A child with epilepsy is generally no different from other children. He is just as smart, handsome, interesting and necessary. He's just as good. He is just as good as all the kids.

And the fact that he has seizures from time to time is just one of his individual characteristics, which you just need to understand and accept. This feature in no way makes him worse or in some way more limited than other children. He just needs a little more attention and care. Only and everything. And so - he is the same as everyone else.

EPILEPSY

Epilepsy is either the result of an organic brain lesion or is of genuin origin. In addition to epileptic seizures, which exhaust and injure the patient, the disease is often accompanied by persistent mental changes affecting both cognitive processes and the nature of the patient.

When examining children with epilepsy, children suffering from genuin epilepsy are allocated to a special group. In the personality structure of these children, an increased instinct for self-preservation, a great desire for self-assertion, and pronounced selfishness are often noted.

Genuine epilepsy - is a form of epilepsy that occurs with primary generalized seizures, not associated with overt organic lesion brain or identified metabolic disorder.

Children with epilepsy never lose touch with reality and strive to take into account the circumstances and influence them in their favor.

In the structure of the personality of a child with epilepsy, slowness, inhibition of all reactions, as well as the viscosity of manifestations in the affective sphere, are revealed first of all. Patients are pedantic, petty, difficult to switch. They pay a lot of attention to the minor details of the problem and get stuck in them.

During the implementation of any activity, patients may experience absences (from the French.I'absense-absence) - short-term switching off of consciousness, manifested in a frozen look, sometimes rhythmic twitching of the eyeballs or eyelids.

In children with epilepsy, as well as in children with schizophrenia, there are features of the flow of higher mental processes. In the period between attacks, sick children can have a good and stableAttention.However, they can make a large number of gaps when performing various activities, for example, in proofreading tests, writing, reading, embroidering, etc. Such gaps can vary in length: from several letters, numbers to several lines. The attention of patients with epilepsy is also characterized by very poor switching and getting stuck on the previous way of carrying out activities or “slipping” to minor details. The inertia characteristic of the attention of such children is manifested in their obligatory desire to finish the activity they have begun.

One of the main disorders in epilepsy ismemory impairment. In sick children, there is a disorder in the process of preserving the memorized material. Children forget what they read or heard in class. Sometimes they can't even remember the very fact that they were given instructions to memorize. Such children memorize words better through direct mediation by their picture, for example, for the word "reading" they select a picture with a textbook depicted on it, and for the word "products" - a picture on which eggs, milk, bread are drawn. The same regularity is also manifested when examining children using the pictogram method, those words that were associated with a particular drawing are better remembered. Separately taken words that are not logically connected are practically not remembered, or their retention in memory turns out to be short-term.

Among children suffering from epilepsy, there are many who have good visual memory, bordering on eidetic memory (a kind of figurative memory). In some of these children, the eidetic image approaches the hallucinatory one. It should be emphasized that the state of memory as a mental process depends on the general condition of the sick child. In children suffering from frequent seizures, the memorization process is deformed,

Psychological examination of children with epilepsy makes it possible to establish a relationship between the disorders of verbal thinking, verbal memory and speech disorders.

Among speech disorders most commonoligophasia(from Greek. oligos- small, phase- speech), at which the rate of speech slows down, the child forgets the necessary words and often stops to find them. It is possible to forget some separate parts of speech (only verbs or only nouns). Patients often begin to draw out words ("book-and-g a "). This state gives the impression of stuttering. Children may also use gestures and emotional exclamations when looking for the right word.

A feature of speech disorders in epilepsy is also the frequentuse in speech sick diminutive suffixes: instead of “spoon”, “spoon” is used, instead of “book” - “booklet”, as well as “dictionary”, “bookmark”, etc.

Features of thinking children with epilepsy are expressed in slowness, inertness in the flow of thought processes. This is due to the saturation of mental operations with candy images and the difficulties that arise in their operation. The abstract meaning of proverbs and sayings is inaccessible to children, and they easily "slide" to a specific explanation; some sick children also find it difficult to find similarities and differences between objects, in the selection of analogies.

Working with visual material, children demonstrate greater productivity and success in completing tasks. However, even here the features of their mental activity are manifested. Patients understand the meaning of plot pictures, but when explaining them, they include numerous details and essential details. The generalization operation causes particular difficulties. By classifying subject pictures, children split the material into many small groups. If, after stimulation, they unite him into large groups, then such an association occurs at the level of everyday concepts, and not semantic and logical ones. The process of generalization is hampered by the fact that children with epilepsy get stuck on separate details of objects and “slip” to secondary (rather than main) characteristics, which does not allow the formation of generalized ideas.

Characterizing in general the features of thinking in epilepsy, one should note such characteristics as thoroughness, a tendency to repeat, stuckness, perseverance, difficulty in generalizations and brief formulations. Often these processes are combined with general changes personality of the sick child.

It should be noted that during the examination, sick children must be given time to "adjust" to the task. Preparing for the task, they ask to repeat the question, sometimes they repeat it several times themselves, “slip” to secondary signs or simply “strangers”. This creates a picture of reasoning, which is formed on the basis of inert thought processes. The children's answers acquire an approximate meaning and are drowned in numerous unnecessary details.

Imaginationchildren with epilepsy is characterized by poverty and specificity of images. They have difficulty guessing images in unfinished drawings or writing stories on given topics. The compilation of any story is based on the specific material stored in their memory. This material serves as the basis for the emergence of ideas. However, a decrease in the rate of formation of mnemonic traces, and thus ideas, does not allow this process to be fully carried out, which leads to the development of emotional dullness and impoverishment of the imagination of sick children.

In the study of the imagination of children with epilepsy, the Rorschach method revealed a tendency to see in the depicted only integral concrete objects (butterfly, cliff, gorge, various animals). Some children in a state of affective attack may see only color or cut animals and blood in the stain.

Emotional-volitional sphere Patients with epilepsy are distinguished by certain features: viscosity, tension, and the duration of negative experiences. These children are easily vulnerable and hard to endure their condition. They are easily offended and do not tolerate censure. The emotional sphere of children with epilepsy is characterized by the same inertness and viscosity as other mental processes. Therefore, the negative experiences of such children are firmly fixed in the minds and acquire inadequate forms. From failure, they become irritable, angry, and sometimes angry. When hurt, primary school children and teenagers may harbor a desire to retaliate against the offender. However, such a feature as vindictiveness may not manifest itself in these children openly, but secretly, on the sly.

At the same time, children and adolescents with epilepsy are characterized by respect for elders or significant adults, which can sometimes turn into flattery and obsequiousness. Some children show malice towards relatives (mother, grandmother, etc.), especially at home. In the presence of strangers, such children can demonstrate false feelings (“How can I be without my mother! Who will feed and water me?”, - says a 13-year-old teenager who raised his hand to his mother and sister more than once at home). Unlike teenagers junior schoolchildren motor disturbances and instability of manifestation of affective reactions are more characteristic. At rest, they are affectionate, and their emotional sphere close to normal.

Children suffering from genuin epilepsy are characterized by good working capacity, activity and purposefulness. However, these processes in them can be accompanied by an increase in aggression if there are obstacles to the implementation of a particular activity. These children show a special desire to complete, to bring to the end the work begun. At the same time, they demonstrate special accuracy, a sense of duty and responsibility.

Features of children with epilepsy who do not have a decrease in intellectual activity

In some children with epilepsy, for whom frequent seizures are not typical, and mental activity is close to normal, there may be no decrease in intellectual activity. These children usually continue their education in a public school. However, they also have some manifestations of the pathological development of the psyche.

A distinctive feature of such children is well-developed speech, replete with numerous details, down to the smallest details. These children have better developed visual memory compared to auditory. An analysis of the mediated memory of such children indicates a strong attachment of the word image to a specific picture (for example, when examining the pictogram method, a 14-year-old girl selects a picture with the image of a fly for the phrase “strict teacher”; she explains her actions by the fact that in the lesson her teacher has such silence that a fly will not fly). Despite the proximity to normative mental operations, they need a specific representation, and the operation of generalization can cause special difficulties. Logical conclusions are often replaced by worldly ones. There are minor difficulties in the implementation of the associative process. In general, these features indicate a mild degree of disturbance in the dynamics of the course of mental processes in children. At the same time, there are no violations at the level of personality.

Adolescents, even with normal development, are characterized by a special sensitivity to the impact on them of the world around them. Some children with epilepsy are especially vulnerable at this age. They are sensitive and highly affective. These children have a need for self-affirmation and constant attention. Hence the manifestation of their importunity and some aggressiveness.

Features of children with organic epilepsy

In the practice of a pathopsychologist, patients often meetwith organic epilepsy. In most cases, these patients show the same features that are inherent in genuin epilepsy. However, there are also differences. Organic epilepsy is accompanied by more pronounced stiffness, significant decline intellect with a lack of a critical attitude to their own intellectual insolvency, pronounced exhaustion, lack of stability and focus in work. In the implementation of any activity, such children do not show initiative. Attention is drawn to a sharp violation of their performance.

Features of the course of the dementia process in epilepsy

Mental disorders in epilepsy in some children cause the disintegration of higher mental functions.dementiawith epilepsy, this is a complex formation, its feature is an irreversible, progressive defect, which manifests itself in a general decline in personality, in a persistent lesion of the intellect and other mental processes, in a decrease in the ability of children to continue learning.

In demented children suffering from epilepsy, stiffness and slowness of all mental processes are more pronounced. Memory is noticeably reduced, a sick child is deprived of the opportunity to acquire new knowledge and gradually loses what has already been acquired. Mental operations are destroyed, which are manifested in a violation of the distinction between the main and secondary essences of the phenomenon. Perception of the surrounding world occurs only in connection with a specific situation. In the responses of patients, an ever-increasing tendency to detail minor details is found, reflecting the narrowness of the horizons of a sick child. Decrease in all thought processes and bad memory do not allow a sick child to correctly understand the phenomena of life. Logical relationships are destroyed and the process of comparison or generalization is reduced to listing numerous minor features.

Speech disorders are becoming more and more pronounced. They are diverse in nature: there are elements of amnestic aphasia (the child forgets the names of less common objects and describes another object instead), as well as paraphasic phenomena (instead of one word, he says another, similar in sound, for example, instead of “blade”, he says “horse”, instead of "fork" - "nail file", etc.). The use of diminutive suffixes becomes the most striking feature of speech: a pencil, a ruler, a notebook, a backpack, a shoe, etc.

Decreased performance. The child turns out to be capable of showing activity only in performing activities. Become characteristic personality disorders and a sharp narrowing of interests. The affective sphere is struck in the direction of ever greater selfishness, vindictiveness and cruelty. Among personality-reduced patients with epilepsy, there are predominantly dementia patients.