Contents
What is epilepsy?
Epilepsy is a common neuropsychiatric disease with a chronic latent nature of the course. Despite this, the occurrence of sudden epileptic seizures is typical for the disease. They are caused by the appearance of numerous foci of spontaneous excitation (nerve discharges) in certain areas of the brain.
Clinically, such seizures are characterized by a temporary disorder of sensory, motor, mental and autonomic functions.
The frequency of detection of this disease is on average 8-11% (classic expanded attack) among the general population of the population of any country, regardless of climatic location and economic development. In fact, every 12th person sometimes experiences some or other microsigns of epilepsy.
The vast majority of people believe that the disease of epilepsy is incurable, and is a kind of “divine punishment.” But modern medicine completely refutes such an opinion. Antiepileptic drugs help to suppress the disease in 63% of patients, and in 18% to significantly reduce its clinical manifestations.
The main treatment is long-term, regular and permanent drug therapy with a healthy lifestyle.
The causes of epilepsy are different, WHO grouped them into the following groups:
Idiopathic – these are cases when the disease is inherited, often through dozens of generations. Organically, the brain is not damaged, but there is a specific reaction of neurons. This form is inconsistent, and seizures occur for no apparent reason;
Symptomatic – there is always a reason for the development of foci of pathological impulses. These may be the consequences of trauma, intoxication, tumors or cysts, malformations, etc. This is the most “unpredictable” form of epilepsy, since an attack can be triggered by the slightest irritant, such as fright, fatigue or heat;
Cryptogenic – it is not possible to accurately establish the true cause of the occurrence of uncharacteristic (untimely) impulse foci.
When does epilepsy occur?
Seizures in many cases are observed in newly born children with high body temperature. But this does not mean that in the future a person will have epilepsy. This disease can develop in anyone and at any age. However, it is more common among children and adolescents.
75% of people with epilepsy are people under 20 years old. As for people who are over twenty, various kinds of injuries or strokes are usually to blame. Risk group – people over sixty years of age.
Epilepsy symptoms
Symptoms of epileptic seizures may vary from patient to patient. First of all, the symptoms depend on those areas of the brain where the pathological discharge occurs and spreads. In this case, the signs will be directly related to the functions of the affected parts of the brain. There may be movement disorders, speech disorders, an increase or decrease in muscle tone, dysfunction of mental processes, both in isolation and in various combinations.
The severity and set of symptoms will also depend on the specific type of epilepsy.
Jacksonian seizures
Thus, during Jacksonian seizures, pathological irritation covers a certain area of the brain, without spreading to neighboring ones, and therefore the manifestations concern strictly defined muscle groups. Usually psychomotor disorders are short-lived, the person is conscious, but it is characterized by confusion and loss of contact with others. The patient is not aware of dysfunction and rejects attempts to help. After a few minutes, the condition is completely normal.
Convulsive twitches or numbness begin in the hand, foot, or lower leg, but they can spread to the entire half of the body or turn into a large convulsive seizure. In the latter case, they speak of a secondary generalized seizure.
A grand mal seizure consists of successive phases:
Forerunners – a few hours before the onset of an attack, the patient is seized by an alarming state, characterized by an increase in nervous excitement. The focus of pathological activity in the brain gradually grows, covering all new departments;
tonic convulsions – all muscles sharply tighten, the head throws back, the patient falls, hitting the floor, his body is arched and held in this position. The face turns blue due to the stoppage of breathing. The phase is short, about 30 seconds, rarely – up to a minute;
Clonic convulsions – all the muscles of the body are rapidly contracting rhythmically. Increased salivation, which looks like foam from the mouth. Duration – up to 5 minutes, after which breathing is gradually restored, cyanosis disappears from the face;
Stupor – in the focus of pathological electrical activity, strong inhibition begins, all the muscles of the patient relax, involuntary discharge of urine and feces is possible. The patient loses consciousness, reflexes are absent. The phase lasts up to 30 minutes;
Dream.
After waking up the patient for another 2-3 days, headaches, weakness, and motor disorders can torment.
Small attacks
Small attacks proceed less brightly. There may be a series of twitches of facial muscles, a sharp drop in muscle tone (as a result of which a person falls) or, conversely, tension in all muscles when the patient freezes in a certain position. Consciousness is preserved. Perhaps a temporary “absence” – an absence. The patient freezes for a few seconds, may roll his eyes. After the attack, he does not remember what happened. Minor seizures often begin in preschool years.
Status epilepticus
Status epilepticus is a series of seizures that follow each other. In the intervals between them, the patient does not regain consciousness, has reduced muscle tone and lack of reflexes. His pupils may be dilated, constricted or of different sizes, the pulse is either rapid or difficult to feel. This condition requires immediate medical attention, as it is characterized by increasing hypoxia of the brain and its edema. Lack of timely medical intervention leads to irreversible consequences and death.
All epileptic seizures have a sudden onset and end spontaneously.
Causes of epilepsy
There is no single common cause of epilepsy that could explain its occurrence. Epilepsy is not a hereditary disease in the literal sense, but still in certain families where one of the relatives suffered from this disease, the likelihood of the disease is higher. About 40% of patients with epilepsy have close relatives with this disease.
There are several types of epileptic seizures. Their severity is different. An attack in which only one part of the brain is to blame is called a partial or focal attack. If the whole brain is affected, then such an attack is called generalized. There are mixed attacks: they begin with one part of the brain, later they cover the entire organ.
Unfortunately, in seventy percent of cases, the cause of the disease remains unclear.
The following causes of the disease are often found: traumatic brain injury, stroke, brain tumors, lack of oxygen and blood supply at birth, structural disorders of the brain (malformations), meningitis, viral and parasitic diseases, brain abscess.
Is epilepsy hereditary?
Undoubtedly, the presence of brain tumors in ancestors leads to a high probability of transmission of the entire complex of the disease to descendants – this is with the idiopathic variant. Moreover, if there is a genetic predisposition of CNS cells to hyperreactivity, epilepsy has the maximum possibility of manifestation in descendants.
At the same time, there is a dual option – symptomatic. The decisive factor here is the intensity of the genetic transmission of the organic structure of brain neurons (the property of excitability) and their resistance to physical influences. For example, if a person with normal genetics can “withstand” some kind of blow to the head, then another, with a predisposition, will react to it with a generalized seizure of epilepsy.
As for the cryptogenic form, it is little studied, and the reasons for its development are not well understood.
Can I drink with epilepsy?
The unequivocal answer is no! With epilepsy, in any case, you can’t drink alcoholic beverages, otherwise, with a 77% guarantee, you can provoke a generalized convulsive seizure, which can be the last in your life!
Epilepsy is a very serious neurological disease! Subject to all the recommendations and the “right” lifestyle, people can live in peace. But in case of violation of the medicinal regimen or neglect of prohibitions (alcohol, drugs), a condition can be provoked that will directly threaten health!
What examinations are needed?
In order to diagnose the disease, the doctor examines the anamnesis of the patient himself, as well as his relatives. It is very difficult to make an accurate diagnosis. The doctor does a lot of work before this: he checks the symptoms, the frequency of seizures, the seizure is described in detail – this helps to determine its development, because the person who has had a seizure does not remember anything. In the future, do electroencephalography. The procedure does not cause pain – it is a recording of the activity of your brain. Techniques such as computed tomography, positron emission and magnetic resonance imaging can also be used.
What’s the forecast?
If epilepsy is properly treated, then in eighty percent of cases people with this disease live without any seizures and without restrictions in activity.
Many people have to take antiepileptic drugs their entire lives to prevent seizures. In rare cases, a doctor may stop taking medication if a person has not had a seizure for several years. Epilepsy is dangerous because conditions such as suffocation (which can occur if a person falls face down on a pillow, etc.) or falls cause injury or death. In addition, epileptic seizures can occur in succession for a short time, which can lead to respiratory arrest.
As for generalized tonic-clonic seizures, they can be fatal. People who experience these attacks need constant supervision, at least from relatives.
What consequences?
Patients with epilepsy often find that their seizures frighten other people. Children may suffer from being shunned by classmates. Also, young children with such a disease will not be able to participate in sports games and competitions. Despite the correct selection of antiepileptic therapy, hyperactive behavior and learning difficulties may occur.
A person may have to be restricted in some activities – for example, driving a car. People who are seriously ill with epilepsy should monitor their mental state, which is inseparable from the disease.
How to treat epilepsy?
Despite the seriousness and danger of the disease, with timely diagnosis and proper treatment, epilepsy is curable in half of the cases. A stable remission can be achieved in about 80% of patients. If the diagnosis is made for the first time, and a course of drug therapy is immediately carried out, then in two-thirds of patients with epilepsy, seizures either do not recur at all during their life, or fade for at least several years.
Treatment of epilepsy, depending on the type of disease, form, symptoms and age of the patient, is carried out by a surgical or conservative method. More often they resort to the latter, since taking antiepileptic drugs gives a stable positive effect in almost 90% of patients.
Drug treatment of epilepsy includes several main stages:
Differential diagnostics – allows you to determine the form of the disease and the type of seizures in order to choose the right drug;
Establishing causes – in the symptomatic (most common) form of epilepsy, a thorough examination of the brain is necessary for the presence of structural defects: aneurysms, benign or malignant neoplasms;
Seizure Prevention – it is desirable to completely exclude risk factors: overwork, lack of sleep, stress, hypothermia, alcohol intake;
Relief of status epilepticus or single seizures – is performed by providing emergency care and prescribing one anticonvulsant drug or a set of medicines.
It is very important to inform the immediate environment about the diagnosis and the correct behavior during a seizure, so that people know how to protect the patient with epilepsy from injuries during falls and convulsions, to prevent sinking and biting the tongue and stopping breathing.
Medical treatment of epilepsy
Regular intake of prescribed medications allows you to confidently count on a quiet life without seizures. The situation when the patient begins to drink medicines only when an epileptic aura appears is unacceptable. If the pills had been taken on time, the harbingers of the upcoming attack, most likely, would not have arisen.
During the period of conservative treatment of epilepsy, the patient should adhere to the following rules:
Strictly observe the schedule of taking drugs and do not change the dosage;
In no case should you prescribe other medicines on your own on the advice of friends or a pharmacy pharmacist;
If there is a need to switch to an analogue of the prescribed drug due to its lack in the pharmacy network or too high a price, notify the attending physician and get advice on choosing a suitable replacement;
Do not stop treatment upon reaching stable positive dynamics without the permission of your neurologist;
Notify the doctor in a timely manner of all unusual symptoms, positive or negative changes in condition, mood and general well-being.
More than half of patients after the initial diagnosis and prescription of one antiepileptic drug live without seizures for many years, constantly adhering to the chosen monotherapy. The main task of the neuropathologist is to choose the optimal dosage. Begin drug treatment of epilepsy with small doses, while the patient’s condition is carefully monitored. If the seizures cannot be stopped immediately, the dosage is gradually increased until a stable remission occurs.
Patients with partial epileptic seizures are prescribed the following groups of drugs:
Carboxamide – Carbamazepine (40 rubles per package of 50 tablets), Finlepsin (260 rubles per package of 50 tablets), Actinerval, Timonil, Zeptol, Karbasan, Targetol (300-400 rubles per package of 50 tablets);
Valproates – Depakin Chrono (580 rubles per pack of 30 tablets), Enkorat Chrono (130 rubles per pack of 30 tablets), Konvuleks (in drops – 180 rubles, in syrup – 130 rubles), Convulex Retard (300-600 rubles per pack of 30 -60 tablets), Valparin Retard (380-600-900 rubles per pack of 30-50-100 tablets);
Phenytoins – Difenin (40-50 rubles per pack of 20 tablets);
Phenobarbital – domestic production – 10-20 rubles per pack of 20 tablets, foreign analogue Luminal – 5000-6500 rubles.
The first-line drugs in the treatment of epilepsy include valproates and carboxamides, they give a good therapeutic effect and cause a minimum of side effects. The patient is prescribed 600-1200 mg of Carbamazepine or 1000-2500 mg of Depakine per day, depending on the severity of the disease. The dosage is divided into 2-3 doses during the day.
Phenobarbital and phenytoin drugs are considered obsolete today, they give a lot of dangerous side effects, depress the nervous system and can be addictive, so modern neuropathologists refuse them.
The most convenient to use are prolonged forms of valproates (Depakin Chrono, Encorat Chrono) and carboxamides (Finlepsin Retard, Targetol PC). It is enough to take these medicines 1-2 times a day.
Depending on the type of seizures, epilepsy is treated with the following drugs:
Generalized seizures – a complex of valproates with Carbamazepine;
Idiopathic form – valproates;
Absences – Ethosuximide;
Myoclonic seizures – only valproate, phenytoin and carbamazepine have no effect.
The latest innovations among antiepileptic drugs – the drugs Tiagabine and Lamotrigine – have proven themselves in practice, so if the doctor recommends and finances allow, it is better to opt for them.
Discontinuation of drug therapy may be considered after at least five years of stable remission. Treatment of epilepsy is completed by gradually reducing the dosage of the drug until complete failure within six months.
Removal of status epilepticus
If the patient is in a state of epileptic status (an attack lasts many hours or even days), he is intravenously injected with any of the drugs of the sibazon group (Diazepam, Seduxen) at a dosage of 10 mg per 20 ml of glucose solution. After 10-15 minutes, you can repeat the injection if status epilepticus persists.
Sometimes Sibazon and its analogues are ineffective, and then they resort to Phenytoin, Gaxenal or sodium thiopental. A 1-5% solution containing 1 g of the drug is administered intravenously, making three-minute pauses after every 5-10 ml in order to prevent a fatal deterioration in hemodynamics and / or respiratory arrest.
If no injections help to bring the patient out of a state of epileptic status, it is necessary to use an inhaled solution of oxygen with nitrogen (1: 2), but this technique is not applicable in case of shortness of breath, collapse or coma.
Surgical treatment of epilepsy
In the case of symptomatic epilepsy caused by an aneurysm, abscess, or brain tumor, doctors have to resort to surgery to eliminate the cause of the seizures. These are very complex operations, which are usually performed under local anesthesia, so that the patient remains conscious, and according to his condition, it is possible to control the integrity of the brain regions responsible for the most important functions: motor, speech, and visual.
The so-called temporal form of epilepsy also lends itself well to surgical treatment. During the operation, the surgeon either performs a complete resection of the temporal lobe of the brain, or removes only the amygdala and/or the hippocampus. The success rate of such interventions is very high – up to 90%.
In rare cases, namely, children with congenital hemiplegia (underdevelopment of one of the hemispheres of the brain), a hemispherectomy is performed, that is, the diseased hemisphere is completely removed in order to prevent global pathologies of the nervous system, including epilepsy. The prognosis for the future of such babies is good, since the potential of the human brain is huge, and one hemisphere is quite enough for a full life and clear thinking.
With the initially diagnosed idiopathic form of epilepsy, the operation of callosotomy (cutting the corpus callosum, which provides communication between the two hemispheres of the brain), is very effective. This intervention prevents the recurrence of epileptic seizures in about 80% of patients.
First aid
How to help a sick person if he has an attack? So, if a person suddenly fell and began to incomprehensibly jerk his arms and legs, throwing his head back, look and make sure that the pupils are dilated. This is an epileptic seizure.
First of all, move away from the person all objects that he can drop on himself during a seizure. Then turn it on its side and place something soft under the head to prevent injury. If a person is vomiting, turn their head to the side, in this case, this will help prevent the penetration of vomit into the respiratory tract.
During an epileptic seizure, do not try to drink the patient and do not try to forcefully hold him. Your strength is still not enough. Ask others to call a doctor.
First of all, move away from the person all objects that he can drop on himself during a seizure. Then turn it on its side and place something soft under the head to prevent injury. If a person is vomiting, turn their head to the side, in this case, this will help prevent the vomit from entering the respiratory tract.
During an epileptic seizure, do not try to drink the patient and do not try to forcefully hold him. Your strength is still not enough. Ask others to call a doctor.