Epilepsy is a chronic disease in the human brain, the manifestation of which is directly related to the occurrence of recurrent epileptic seizures, accompanied by various clinical manifestations and specific symptoms. Doctors call characteristic changes in the psyche among the complementary clinical manifestations of pathology, and among specific symptoms there are specific changes relating to the bioelectric activity of the brain, detected during electroencephalography.
The progress of pathology is associated with the development of an epileptic focus. An epileptic focus is a group of nerve cells that have an increased excitability and the ability to generate sudden, excessive neural discharges. Such discharges can spread to a part of the brain or the whole brain from the focal zone and cause an epileptic seizure, which is characterized by transient functional impairments in the brain.
Seizure Classification (Seizures)
Convulsions with synchronization of discharges in both hemispheres of the brain are generalized. When they occur during the onset of attacks, the entire cerebral cortex is simultaneously involved in the process. Usually, it is possible to verify the occurrence of such attacks by electroencephalography. In the case of generalized seizures in patients there are no precursors (auras), people lose consciousness immediately when the seizure begins.
Generalized seizures have several types. Most often, among generalized epileptic seizures, tonic-clonic, clonic, atonic, tonic, myoclonic and absans are found in medical practice.
Tonic-clonic and clonic
The traditional name for tonic-clonic epileptic seizures is “major epileptic seizure” or and mal. Such seizures are usually accompanied by aura, unconsciousness, a fall in its process. The tonic stage lasts up to 20 seconds, then it is followed by the clonic stage, which lasts a little longer. In a patient with clonic convulsions, simultaneous twitching of the muscle fibers of the body and all the extremities occurs. After the end of these two stages, the post-convulsive period begins, the duration of which usually takes several hours.
Tonic-clonic epileptic seizures can be characterized by a genetic nature, peak-wave complexes are noticeable on electroencephalography. Most often, such convulsions disturb patients in the mornings immediately after awakening. It happens so that myoclonic twitches precede such convulsions.
If the disease is acquired, then generalized seizures are perceived as secondary on the basis of primary partial seizures. However, their cause may be brain damage - trauma, stroke, infection, tumor.
Another cause of tonic-clonic epileptic seizures may be drug addiction or alcoholism and their withdrawal symptoms. Metabolic disorders such as hyponatremia, hypocalcemia, uremia, and liver failure may predispose to this pathology.
Tonic-clonic seizures can occur at any age. Most often the first time generalized seizures occur in children under 2 years old, and the development of pathology gets to the age of twenty. Or the manifestation and development of the disease begin after 60 years.
Tonic and Atonic
Tonic and atonic seizures of epilepsy are very rare types of generalized seizures, constituting only 1% of all possible in the human population. Most often they occur in some severe epileptic forms, the development of which occurs in early childhood, for example, in Lennox-Gastaut syndrome, myoclonical-astatic epilepsy.
Atonic attacks are sometimes called drop attacks or akinetic attacks. With them, postural muscle tone is suddenly lost, which leads to the patient falling to the ground or floor. Convulsions in such attacks is not observed. The seizures themselves end very quickly, with the absence of postictal symptoms.
With tonic seizures, the muscle tone of the body suddenly increases, with the result that the patient falls back. In both of these attacks, severe damage to the brain is possible.
In childhood, akinetic epilepsy can be expressed by hypertonic seizures that look like extension, flexion, rotation of the limbs, trunk, and head.
Under myoclonic seizures refers to involuntary short flexor contractions involving the part and the whole body (arms, head). Myoclonic seizures can cause a fall in patients, which immediately stops the seizure. Sometimes myoclonus does not belong to epilepsy. Non-epileptic myoclonus may occur as a consequence of various neurological pathologies, such as injuries of the spinal cord or spinal cord.
Most often, myoclonia is accompanied by such conditions as brain ischemia, acute brain hypoxia, Creutzfeldt-Jakob disease, and other degenerative brain processes. Also, myoclonic seizures occur in healthy people as night jerks, which is quite normal physiological processes.
Abscesses for epilepsy
Also among the generalized epileptic seizures is present and non-convulsive type. Such attacks are called absansy. Abscesses are short-lived, their duration is only 3-5 seconds, and are more common in childhood. Absences turn off the mind and the patient freezes in a posture of movement that is interrupted. A person's face takes a frozen form, meaninglessness is seen in his eyes, he rushes to one point. Rarely, among the symptoms, pallor or flushing of the face, drooping up of the eyeballs, the head is thrown back. When consciousness returns, the patient can calmly continue the interrupted action. Usually, people around the absences may not notice and perceive them as absent-mindedness, high distractibility in children.
Absences are typical and atypical. Typical used to be called the term "petit mal", their peculiarity consists exclusively in children's affiliation. The maximum when typical absences can begin is adolescence. They are characterized by the occurrence of generalized epilepsy such as children's or adolescent absence-epilepsy. Absansy is associated with an electroencephalographic pattern - generalized peak-wave three-hertz discharges, which can be provoked by hyperventilation, which is an excellent diagnostic technique for this condition.
With atypical absansy, the onset is less sudden, and the violation of muscle tone is more pronounced. With him, electroencephalography shows a slow and irregular peak-wave two-hertz activity of a generalized form, but more often asymmetric. Atypical absansy occur most often in severe epileptic forms - Lennox-Gastaut syndrome.
Partial (focal) attacks
If the discharge of an epileptic seizure originates in a localized area of the cerebral cortex, then this is called a partial or focal seizure. In this case, the focus of epileptic activity is single or few, and later this activity is able to spread to other areas of the cortex. With the spread of activity throughout the area of the cerebral cortex, an attack is considered to be secondary-generalized.
With simple partial seizures, consciousness is fully preserved, and the epileptic discharge does not extend beyond the localization site. When conducting an electroencephalography attack, it is possible to note the localization of the epileptic discharge, which begins in a certain area of the cerebral cortex. The clinic of attack will depend on the zone where the discharge is localized. In one patient, usually simple partial seizures always appear in the same form.
As an example of the clinical symptoms of simple partial seizures, local involuntary disorders of movements (clonic or tonic convulsions), disturbances of a vegetative nature, mental disorders or sensory disorders can be mentioned. However, simple partial seizures can turn into complex or secondary-generalized seizures.
For complex partial seizures, symptoms of simple partial seizures with obligatory loss of consciousness are characteristic. Such phenomena are also called in medicine psychomotor attacks. Most often they begin in the frontal or temporal lobes, with the beginning there may be two varieties. In the first variety, attacks of a complex nature begin as simple and progress, and in the second, they immediately begin with loss of consciousness.
When complex partial seizures often occur automatically or altered patient behavior, he begins to turn objects in his hands, pulling at his clothes, wandering aimlessly, perform strange movements or actions. Also in various combinations one can observe smacking, chewing movements, undressing, grimacing.
When complex partial attacks in the post-attack period, confusion always occurs. Also, such convulsions may develop to the state of a secondary generalized seizure.
In modern medicine, there is confidence that epilepsy is the result of a single-step, abnormal, strongest excitation of neurons in a separate area of the cerebral cortex - the epileptogenic focus. These processes are triggered by imbalances in the balance between inhibition and excitation at the localization of the focus. Neurons begin to transform the excitement perceived by the human sense organs into electrical impulses. For an organism, these impulses can be compared with lightning during a thunderstorm in nature.
The causes of epileptogenic lesions are:
- disorders of cerebral circulation (stroke, for example);
- physical head injuries and concussions;
- chronic pathologies of the nervous system (for example, multiple sclerosis);
- infections related to the meninges (meningitis and others);
- drug addiction, alcoholism;
- pathological development of the fetus in utero;
- hereditary factors;
- brain tumors;
- metabolic dysfunction;
- parasitic pathologies of the brain.
Most patients experience the first manifestations of epilepsy before the age of 18 years; at a later age, the development of the disease is much less common.
An epileptic seizure should not be confused with hysterical seizures. When the latter bright emotional reactions in the presence of relatives or friends become a source of pathological behavior. Also, hysterical seizures can be provoked by fright, resentment, grief. In this case, the man himself does not harm and is well aware of what is happening. A tantrum lasts about 20 minutes, on average, while epilepsy in a single form never lasts more than 1-2 minutes. After a hysterical seizure, the person does not feel sleepy, stunning, unlike epileptic.
Symptoms of the disease and manifestations of attacks
The symptoms that are characteristic of the disease in question are highly variable and may depend, first of all, on the part of the brain that is damaged and the extent of the spread of the disease. Temporary symptoms may also occur, for example, loss of consciousness, loss of orientation, disturbed sensations and movements, moods, failures in other cognitive functions.
Patients with convulsions most often have other pathologies with health, for example, bruises, injuries. They are characterized by a variety of psychological disorders, depression. The risk of dying prematurely with seizures is very high. It exceeds a similar risk in healthy people 3 times. Residents of those countries where there is a very low social standard of living and there are no conditions for comfortable living have the highest risks. Also, epilepsy is more developed in rural areas than in urban areas. Causes of death in epileptics in countries with a low standard of living are drowning, falling, burns, prolonged seizures, leading to complications and physical damage.
Stage of the disease
There are several options for the development of epilepsy. The disease begins with a convulsive generalized attack, which over the next years, decades, no longer manifests itself. However, when the second case occurs, the seizures become more frequent. Sometimes the disease develops with frequent generalized seizures with a high intensity of manifestations.
The second variant of the development of epilepsy is the occurrence of small seizures, which gradually intensify and flow into local large convulsive seizures. Some types of epilepsy can manifest for a very long time only with slight hallucinations, dizziness, absences. The intensity of development, the increase in symptoms in each case is individual.
Consciousness in the course of the development of the disease is broken gradually. At first its violation is very easy, and in the end it leaves the person completely for a certain time. More often attacks occur in men. Hallucinations, dizziness over time become more intense. In women, epilepsy has its own characteristics associated with cyclical endocrine changes. At the same time during menstruation all the symptoms of epileptic seizures are exacerbated.
The most important manifestations of epilepsy are mental changes of a chronic and periodic nature. Periodic changes in epilepsy are represented by a variety of dysphoria or severe mood changes, expressed in anxiety, anguish, anxiety, anger, and epileptic psychosis. Chronic changes include pedantry, thoroughness, intrusiveness, a narrow circle of interests, egocentrism.
Status epilepticus is the most severe of the manifestations of this disease. With status, epilepsy convulsions replace each other continuously, the patient does not have time to regain consciousness between them. This situation carries a threat to the life of the patient, requires resuscitation measures.
It is important to understand that a single seizure is not epilepsy. Only the recurrence of the disease allows us to talk about such a diagnosis. Epilepsy does not include reactive convulsions for strong for a particular person impact. Reactive seizures include seizures that often occur during sudden increases in body temperature — febrile seizures, seizures from alcohol intake or deficiency, and seizures in sleep disorders. If you remove the provoking effect, then the attacks will be eliminated, so they do not require specific therapy.
But treating true epilepsy is extremely important.Epiprips each time damage the brain, carry a threat to human health and even life (at the time of driving a car, swimming, etc.), drastically reducing the quality of life of the patient, imposing certain restrictions on it. Epileptics have high psychosocial vulnerability. If the disease is not treated, it will develop to an epileptic, life-threatening status.
Diagnosis of the disease
Electroencephalography is widely used to diagnose the pathology under consideration. Focal peak-wave complexes — asymmetrical slow waves indicating the epileptic focus and the place of its localization — are of paramount importance in the diagnosis. The high index of convulsive readiness of the brain as a whole and the absences are indicated by generalized “peak-waves”. However, it is important to understand that the electroencephalogram does not indicate the presence of epilepsy in the body, but only demonstrates the functionality of the human brain (active or passive wakefulness phase, sleep phase) and can show results within the normal range even in the case of frequent attacks. By analogy, the presence of epileptiform changes on an electroencephalogram does not necessarily indicate epilepsy, which means that according to this diagnostic alone it is impossible to draw conclusions about the presence of the disease. But at the same time, an electroencephalogram, under certain medical conditions, can be the reason for prescribing a number of anticonvulsant drugs even without obvious symptoms and attacks.
In 70% of cases, drug therapy helps to get rid of epilepsy attacks. All treatment of the disease under consideration is divided into 2 groups - medical and surgical. In addition, therapeutic exercise, psychological correction of the personality, bioacoustic correction of the brain, and other techniques can be used additionally.
Pathology surgery is resorted to when medical therapy for a long time does not bring positive results, as well as in cases of focal epilepsy, with epilepsy provoked by neoplasms in the brain, aneurysm, other anomalies in the structures of brain activity.
In patients, excitation and inhibition in the area of the cerebral cortex are not balanced. For this purpose, physical therapy can be applied, which allows you to stimulate the normalization of these processes. Rhythmic movements, complex breathing exercises positively affect the nerve cells, harmonize the mental state, prevent stress and disease.
Limitations and Recommendations
To excite the entire nervous system, it is enough for a person to drink just a cup of coffee. The caffeine from this drink uses and over-excites, among other things, the neurons of the cerebral cortex, which suffer from over-stimulation in epileptic patients. Coffee enhances the nerve impulse, which, on the contrary, is required to be reduced, promotes the acceleration of nerve impulses between neurons, which provokes an invigorating effect. However, the overestimation of neuronal nerve impulses in the epileptic focus provokes a new epileptic seizure and levels the effect of anticonvulsants. In addition to all of the above, taking caffeinated beverages (tea, coffee, cocoa) over a long period can even in a healthy person cause the destruction of neurons in the brain.
Since alcohol affects the human brain is destructive and it is very often the cause of the formation of an epileptic seizure in an alcoholic, the question of the advisability of drinking alcohol during epilepsy disappears by itself. However, it is important to understand that alcoholism itself is a terrible disease, no less serious than epilepsy. Congenital epilepsy lies in the symptomatology of epileptic brain readiness - in the freelance functionality of neurons, which wears and destroys them. When neurons die in the brain, important functional interactions are interrupted, which causes the patient to degrade. The use of alcohol provokes an increase in the death of neurons, which leads to the loss of personal human qualities in alcoholics.
Acquired epilepsy does not occur sharply due to a single strong libation or from periodic meager doses of alcohol, which some people allow themselves to drink, it is triggered by regular body poisoning with toxins of ethyl alcohol, consumed in large quantities. Alcoholics with diseases of the central nervous system are dependent on alcoholic beverages, but the use of alcohol provokes an acceleration of personality degradation, increases the occurrence of seizures and contributes to the speedy death of an alcoholic. That is why patients with epilepsy should not drink alcohol.
When choosing a profession and future work, restrictions for patients are associated with the possibility of seizures, under which they can harm people around you. Such people are forbidden to drive vehicles (especially passenger traffic, since the management of personal cars is permitted in some states), work at height, near unprotected mechanisms, water bodies, pass urgent or contractual service in the army or navy, be a police officer, fire brigade, prisons, security organizations, ambulance. It is very dangerous to work with moving machinery, chemicals, fragile items.
To determine the level of efficiency, it is necessary to determine the type of epilepsy, as well as the severity of the pathology, comorbid diseases of the patient, the presence of intellectual or physical disorders in him, the extent to which the patient can control the occurring seizures. Shift work for people with epilepsy is often not harmful, because it allows you to get enough sleep and regularly take medications prescribed by your doctor.
Regarding driving, it is worth saying that, for example, in America, legislation regarding people with epilepsy is different even in different states. According to statistics, road traffic accidents caused by patients with epilepsy occur somewhat more often than the fault of healthy people, however, this incidence forms similar statistics with patients with cardiovascular pathologies and significantly lower than that shown by people who are intoxicated.
The main criteria for road safety is the time that has passed for the patient since the last attack. In a number of countries, the management of personal cars has been prohibited since the first epileptic seizure - in Russia, Greece, Japan, Brazil, and India. In Canada and America, a patient may be allowed to drive a car if 3 months have passed since the last attack.
Most cases of epilepsy do not exclude the possibility of family living with persons of opposite sexes, the birth of children. During pregnancy, you must undergo a comprehensive medical examination and all the time before the birth of the child is carefully monitored by a doctor.
Unified nutritional scheme for epilepsy is not recognized by doctors. The fact is that some theoretically resolved foods can provoke migraine attacks in patients, so they must be privately excluded from the menu. With a parallel course of diabetes, a patient may have new seizures when using sugar-containing products. Often, milk-plant food is recommended for these patients, but meat and other proteins cannot be excluded from the menu either. This rule is important to observe when consuming hexamidine, which affects the general protein starvation. When eating protein, it is necessary to eat boiled meat and fish in equal quantities.
If a patient takes medication for a long time, he begins to lack folic acid, homocysteine, vitamin B12. If this need is not promptly met, the patient may begin schizophrenic complications.
Efficiency in epilepsy is demonstrated by the ketogenic diet, in which 1/3 of proteins and carbohydrates with 2/3 of fats should be combined in the patient’s diet. Such a diet is highly effective in the treatment of children. After inpatient treatment and fasting for three days, this diet is recommended for children. With its normal perception by the body for several days, the patient can then most often be transferred to a normal diet.
With the ineffectiveness of anticonvulsant therapy, doctors recommend to follow a starvation diet. The fact is that people with epilepsy always experience improvements if they observe fasting or with prolonged fasting, but this method can be used for therapy only for a limited time. Supplying the body with vital nutrients is essential for any disease.
The diet of the patient should be varied. It should contain foods rich in fiber, fruits, vegetables. They create conditions for normal intestinal peristalsis, preventing constipation. Dinner for epilepsy is not recommended later than 2 hours before bedtime.
Life with epilepsy
Early mortality in patients with the disease in question is not uncommon. In almost half of the cases, mental disorders that arose against the background of the disease are to blame. The main causes of death are suicides and injuries that people receive during seizures.
Life expectancy in patients with epilepsy is less than in healthy people, since with this pathology there is a high risk of joining and other pathologies as complications. Very often among these complications are chronic pulmonary pathologies, cardiovascular problems, and neoplasms in the human brain.
Russian experts do not consider injuries from falls in the event of a seizure or suffocation during this period as the main causes of early death. In severe pathological conditions on the eve of seizures, patients feel the aura period - a set of symptoms warning of the onset of an attack. That is why a person can always take steps to prevent various injuries.
What is dangerous disease
Mild forms of epilepsy have virtually no effect on the normal course of life for patients, since seizures in such cases are extremely rare and brain cells do not undergo rapid destruction. In severe types of the disease, generalized seizures often occur, the duration of which ranges from 30 to 40 minutes. These periods can make a person helpless, since they provoke failures of the whole organism, and respiratory arrest can occur.
If patients do not have secondary pathologies, the main danger for them will be various falls. Not every patient is able to recognize the aura, resulting in injury and injury. This is the reason for the restriction of certain types of work and driving vehicles.
Encephalopathy of epileptic nature in young children can lead to impaired cognitive functions and a change in behavioral responses. In children, memory deteriorates, concentration decreases, brain activity decreases, sudden mood swings can begin.
Living with epilepsy is not easy, but to alleviate the condition requires social and personal adaptation with the adoption of his illness. If you comply with all medical prescriptions, then you can fully live, work, build a family and practically do not deny yourself anything.
Assignment of disability
Epilepsy limits normal human life, and therefore serves as a basis for disability. If you need to register a disability, you should, first of all, visit the attending physician. Based on indications of a medical nature, he will be able to give the patient a referral to undergo a medical and social examination ... If the doctor refuses to issue a referral to ITU, the patient can get it in the department of social protection of the population at the place of residence. The main criteria for conducting medical and social expertise are the inability to work, as well as the progressive course of the epileptic process, which leads to mental disorders and personality changes. Compulsory examinations of a medical nature for the registration of a disability group in epilepsy include urinalysis, complete blood count, a survey X-ray of the skull in two projections, studies of the visual field and fundus, Echo-EG, computed tomography and electroencephalography of the brain. You must have a certificate from a psychiatrist about the state of health.
Disability of various groups in epilepsy can be obtained on the basis of the severity of the pathology. Thus, the third group of disability is given with minor disability in a patient, with relative or absolute contraindications to work and education. The basis for the third group of disability are mid-frequency epileptic seizures and small changes in personal characteristics.
The second group of disability is assigned to patients with obvious signs of limited life due to epilepsy, which are based on frequent seizures and the inability to fully control them.
With severe convulsions, severe dementia, frequent relapses, patients are assigned the first category of disability. If disability is persistent, and rehabilitation measures are useless after 5 years of medical control, the disability is given to patients for an indefinite period.
Specialty: pediatrician, infectious diseases specialist, allergist-immunologist.
Total experience: 7 years.
Education: 2010, SSMU, pediatric, pediatrics.
Experience infectious diseases more than 3 years.
He has a patent on the topic “A method for predicting a high risk of the formation of a chronic pathology of the adeno-tonsillar system in frequently ill children”. As well as the author of publications in the journals of the Higher Attestation Commission.