Symptoms of epilepsy are a combination of neurological factors, as well as signs of a somatic and other nature, which indicate the occurrence of a pathological process in the field of human brain neurons. Epilepsy is characterized by chronic excessive electrical activity of the brain neurons, which is expressed by periodic convulsions. In the modern world, epilepsy suffers around 50 million people (1% of the world's population). Many people believe that during epilepsy a person must fall on the floor, fight in convulsions, and foam should flow from his mouth. This is a common misconception imposed by television rather than reality. Epilepsy has a lot of different manifestations that you should be aware of in order to be able to help a person at the time of an attack.
Harbingers of seizures
Aura (from the Greek - "breath") is a precursor of an attack of epilepsy, preceded by loss of consciousness, but not for any form of the disease. Aura can manifest itself with various symptoms - the patient may begin to sharply and often contract the muscles of the limbs, faces, he can begin to repeat the same gestures and movements - running, waving his arms. Also, various paresthesias can also act as an aura. The patient may feel numbness in various parts of the body, feeling of crawling goose bumps on the skin, some areas of the skin can burn. There are also auditory, visual, gustatory or olfactory paresthesias. Mental precursors can manifest themselves in the form of hallucinations, delusions, which are sometimes called pre-convulsive insanity, a sharp change in mood towards bitterness, depression or, conversely, bliss.
In a particular patient, the aura is always constant, that is, it manifests itself in the same way. This is a short-term state, the duration of which is a few seconds (rarely more), while the patient is always conscious. There is an aura with irritation of the epileptic focus in the brain. It is the aura that can indicate the dislocation of the disease process in the symptomatic type of epilepsy and the epileptic focus in the genuin type of the disease.
What are the convulsions in epilepsy
Seizures when changing in parts of the brain
Local, partial or focal seizures are the result of pathological processes in one of the parts of the human brain. Partial seizures can be of two varieties - simple and complex.
Simple partial seizures
With simple partial convulsions, patients do not lose consciousness, however, the present symptoms will always depend on what part of the brain is affected and what exactly it controls in the body.
Simple seizures have a duration of about 2 minutes. Their symptoms are usually expressed in:
- a sudden causeless change in a person's emotions;
- the occurrence of twitches in different parts of the body - limbs, for example;
- deja vu feelings;
- difficulty in understanding speech or pronunciation of words;
- sensory, visual, auditory hallucinations (flashing lights before your eyes, tingling in limbs, etc.);
- unpleasant sensations - nausea, goose bumps, a change in heart rate.
Complicated Partial Seizures
In complex partial convulsions, by analogy with simple, symptoms will depend on the area of the brain that is affected. Complicated seizures affect a larger part of the brain than simple ones, provoking a change of consciousness, and sometimes its loss. The duration of a complex attack is 1-2 minutes.
Among the signs of complex partial seizures, doctors distinguish:
- the patient's gaze is hollow
- the presence of aura or unusual sensations that occur immediately before the seizure;
- patient's cries, repetition of words, crying, laughter for no reason;
- meaningless, often repetitive behavior, automatism in actions (walking in a circle, chewing movement without being tied to food, etc.).
After an attack, the patient becomes disoriented. He does not remember the attack and does not understand what happened and when. A complicated partial seizure can begin with a simple one, and then develop and sometimes go into generalized seizures.
Generalized seizures are a seizure that occurs when the patient’s pathological changes occur in all parts of the brain. All generalized convulsions are divided into 6 types - tonic, clonic, tonic-clonic, atonic, myoclonic and absans.
Tonic seizures got their name because of the special effects on a person’s muscle tone. Such cramps provoke muscle tension. Most often it concerns the muscles of the back, limbs. Tonic convulsions usually do not provoke fainting. Such attacks occur in the process of sleep, they last no more than 20 seconds. However, if the patient is standing during their onset, he will most likely fall.
Clonic convulsions are quite rare compared with other types of generalized convulsions, and they are characterized by rapid alternate relaxation and muscle contraction. This process provokes the rhythmic movement of the patient. Most often it occurs in the hands, neck, face. To stop such a movement by holding the jerking part of the body will not work.
Tonic-clonic seizures are known in medicine under the name of grand mal, the "big disease." This is the most typical type of seizure in epilepsy. Their duration is usually 1-3 minutes. If a tonic-clonic seizure lasts longer than 5 minutes, this should be the signal for an emergency medical emergency call.
Tonic-clonic seizures have several phases. In the first, tonic phase, the patient loses consciousness and falls to the ground. This is followed by a convulsive phase or a clonic one, since the attack will be accompanied by twitching, similar to the rhythm of clonic seizures. If tonic-clonic seizures occur, a number of actions or events may occur:
- the patient may begin increased salivation or frothiness from the mouth;
- the patient may accidentally bite the tongue, leading to the formation of bleeding from the bite site;
- a person who is not in control of himself during convulsions may be injured or hit against surrounding objects;
- patients may lose control of the excretory functions of the bladder and intestines;
- the patient may experience blueness of the skin.
After the end of tonic-clonic convulsions, the patient is weakened and does not remember what was happening to him.
Atonic or astatic seizures, including short-term deprivation of consciousness by the patient, got their name due to loss of muscle tone and strength. Atonic seizures most often last up to 15 seconds.
When atonic seizures occur in patients in a sitting position, both a fall and a nodding of the head may occur. When the body tension in the event of a fall is worth talking about a tonic fit. At the end of an atonic seizure, the patient does not remember what happened. Patients prone to atonic seizures may be advised to wear a helmet, since such attacks can cause head injuries.
Myoclonic seizures are most often characterized by rapid twitching in some parts of the body, like small jumps within the body. Myoclonic seizures relate mainly to the arms, legs, upper torso. Even those people who do not suffer from epilepsy may experience myoclonic convulsions when falling asleep or waking up in the form of twitches or jerks. Also referred to myoclonic convulsions hiccups. In patients with myoclonic seizures, they touch both sides of their body. Attacks last a few seconds, do not provoke loss of consciousness.
The presence of myoclonic seizures may indicate several epileptic syndromes, for example, juvenile or progressive myoclonic epilepsy, Lennox-Gastaut syndrome.
Absans or petit mal occurs more often in childhood and is a short-term loss of consciousness. The patient may stop, look into the void and not perceive the surrounding reality. With complex absences, a child has some muscle movements, for example, quick blinks of the eyes, movements of the hands or jaw as chewed. Abscesses last up to 20 seconds with muscle cramps and up to 10 seconds when they are absent.
With a short duration, absences can occur many times over even for 1 day. They can be suspected if the child is sometimes able to switch off as it were and does not react to the treatment of other people.
Symptoms of epilepsy in children
Epilepsy in childhood has its own symptoms, compared with adult epilepsy. In a newborn baby, it often manifests as simple physical activity, which makes it difficult to diagnose the disease at that age. Especially if we take into account that not all patients suffer from convulsive seizures, especially children, which makes it difficult to suspect the pathological process for a long time.
To understand exactly what symptoms may indicate childhood epilepsy, it is important to closely monitor the condition and behavior of the child. So, children's nightmares, accompanied by frequent tantrums, screams, may indicate the disease. Children with epilepsy may walk in their sleep and not respond to a conversation with them. In children with this disease may experience frequent and sharp headaches with nausea, vomiting. Also, a child may experience short-term speech disorders, which are expressed in the fact that, without losing consciousness and physical activity, the child simply cannot say a word at some point.
All of the above symptoms are very difficult to detect. It is even more difficult to identify its relationship with epilepsy, since all this can occur in children without significant pathologies. However, with too frequent manifestations of such symptoms, it is necessary to show the child to a neurologist. He will make a diagnosis based on an electroencephalography of the brain and a computer or magnetic resonance imaging.
Symptoms of nocturnal epilepsy
Epileptic seizures in the process of sleep occur in 30% of patients with this type of pathology. In this case, seizures are most likely the day before, during sleep, or before immediate awakening.
Sleep has a fast and slow phase, during which the brain has its own particular functioning.
During the slow phase of sleep, the electroencephalogram records an increase in the excitability of nerve cells, an index of activity for epilepsy, and the likelihood of an attack. During the fast phase of sleep, the synchronization of bioelectric activity is disturbed, which leads to the suppression of the distribution of electricity discharges to neighboring brain regions. This, in general, reduces the likelihood of an attack.
When shortening the fast phase, the threshold for seizure activity decreases. Sleep deprivation, on the contrary, increases the likelihood of frequent seizures. If a person does not get enough sleep, he becomes drowsy. This condition is very similar to the slow carotid phase, which provokes the pathological electrical activity of the brain.
Also attacks are provoked by other problems with sleep, for example, even a single sleepless night can be the cause of the development of epilepsy for someone. Most often, if there is a predisposition to the disease, a period during which the patient had a clear lack of normal sleep affects development. Also, in some patients, the severity of seizures may increase due to disturbances in sleep patterns, too sudden awakenings, from taking sedatives or overeating.
The symptomatology of night epilepsy attacks, regardless of the patient's age, can be varied. Most often, seizures, tonic, clonic seizures, hypermotor actions, repetitive movements are characteristic of nighttime seizures. In case of frontal autosomal nocturnal epilepsy during attacks, the patient can walk in a dream, talk, without waking up, and experience fear.
All of the above symptoms can manifest themselves in various combinations in different patients, so there may be some confusion when making a diagnosis. Sleep disturbances are typical manifestations of various pathologies of the central nervous system, and not just epilepsy.
In 2-5% of chronic alcoholics, alcoholic epilepsy occurs. This pathology is characterized by severe personality disorders. It occurs in adult patients suffering from alcoholism for more than 5 years.
Symptoms of the alcoholic form of the disease are very diverse. Initially, the patient has signs of an approaching attack. This happens a few hours or even days before it starts. Precursors in this case can last a different amount of time, depending on the individual characteristics of the organism. However, if timely detect the precursors, the attack can be prevented.
So, when the precursors of an alcoholic epileptic seizure, as a rule, arise:
- insomnia, decreased appetite;
- headache, nausea;
- weakness, weakness, longing;
- soreness in different parts of the body.
Such precursors are not an aura, which is the beginning of an epileptic seizure.
The aura cannot be stopped, nor can the seizure that follows. But precursors detected in a timely manner, you can begin to heal, thereby preventing the occurrence of seizures.
About half of epileptic seizures begin with non-convulsive symptoms. After them, all kinds of motor disorders, generalized or local seizures, disorders of consciousness can be added.
Among the main non-convulsive manifestations of epilepsy stand out:
- all sorts of vegeto-visceral phenomena, failure of heart rhythm, belching, episodic fever, nausea;
- nightmares with sleep disorders, talking in a dream, shouts, enuresis, somnambulism;
- increased sensitivity, deterioration of mood, fatigue and weakness, vulnerability and irritability;
- sudden awakenings with fear, sweating, and palpitations;
- loss of ability to concentrate, reduced performance;
- hallucinations, delirium, loss of consciousness, pallor of the skin, a sense of deja vu;
- motor and speech inhibition (sometimes - only in a dream), bouts of stupor, disturbance in the movement of the eyeball;
- dizziness, headaches, memory loss, amnesia, lethargy, tinnitus.
Duration and frequency of seizures
Most people believe that an epileptic seizure looks like this - a patient's cry, loss of consciousness and falling of a person, muscle contraction with convulsions, shaking, subsequent calm and restful sleep. However, not always convulsions can affect the whole body of a person, as well as not always the patient loses consciousness during attacks.
Severe seizures may be evidence of a generalized convulsive epileptic status with tonic-clonic seizures lasting more than 10 minutes and a succession of 2 or more seizures between which the patient does not regain consciousness.
To increase the percentage of diagnostics of epileptic status, the duration of more than 30 minutes, which was previously considered normal for him, was decided to be reduced to 10 minutes in order to avoid wasted time. With untreated generalized status, lasting an hour or more, there is a high risk of irreversible damage to the patient's brain and even death. This increases the heart rate, body temperature. Generalized status epilepticus is able to develop for several reasons at once, including head injuries, rapid withdrawal of anticonvulsant drugs, and so on.
However, the vast majority of epileptic seizures are resolved within 1-2 minutes. After the completion of a generalized attack, the patient is able to develop the postictal state with deep sleep, confusion, headache and muscle pain, lasting from a couple of minutes to several hours. Sometimes there is Todd's paralysis, which is a neurological deficit of a transient nature, expressed by weakness in the limb, which is opposite in location to the center of electrical pathological activity.
In most patients in the periods between attacks it is impossible to find any neurological disorders, even if the use of anticonvulsants actively inhibits the function of the central nervous system. Any decrease in mental functions is primarily associated with neurological pathology, which led initially to the occurrence of seizures, and not by the seizures themselves. Very rarely, there are cases of non-stop seizures, as in the case of epileptic status.
Behavior of patients with epilepsy
Epilepsy affects not only the patient's state of health, but also his behavioral qualities, character and habits. Mental disorders in epileptics occur not only because of seizures, but also on the basis of social factors that are caused by public opinion, warning against communicating with such people of all healthy.
Most often, epileptics change character in all areas of life. The most likely occurrence of slowness, slow thinking, heaviness, hot temper, bouts of manifestation of selfishness, rancor, thoroughness, hypochondriacity of behavior, quarreliness, pedantry and neatness. The appearance also features characteristic of epilepsy. A person becomes restrained in gestures, slow, laconic, his facial expression becomes impoverished, facial features become a little expressive, there is a symptom of Chizh (steel glint of eyes).
In malignant epilepsy, dementia gradually develops, expressed in passivity, lethargy, indifference, and humility with its own diagnosis. The person begins to suffer lexicon, memory, in the end, the patient feels a complete indifference to everything around, in addition to their own interests, which is expressed by increased egocentrism.
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 the 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.