Epilepsy in adults

Seizures in epilepsy occur suddenly, sometimes in the most inappropriate places and situations. And often people who are around try to give a person first aid, but they do it wrong and can do harm.

What is epilepsy?

“According to the definition,” says neurologist Pavel Dynin, – proposed in 2005 by the International Anti-Epileptic League, epilepsy (Old Greek “epilambo” – “grab, grab, catch”) is a disease that includes two main aspects:

• pathological predisposition of the brain to the generation of epileptic seizures (attacks);
• the presence of neurobiological, cognitive, psychological and social consequences of this condition.

One of the first descriptions of epilepsy belongs to Hippocrates, who called it a “sacred disease”, believing that the main influence on the development of seizures is exerted by external influences on the brain, such as air temperature, wind, sunlight. According to historical evidence, most likely, many famous personalities suffered from epilepsy, such as Julius Caesar, Napoleon Bonaparte, Van Gogh. There is the concept of “Dostoevsky’s epilepsy”, which is characterized by an “aura of ecstasy”.

Causes of epilepsy in adults

– Every year, 50-70 people out of 100000 of the population are diagnosed with epilepsy, adds neurologist Pavel Dynin. – The epileptic seizures themselves occur as a result of excessive discharges of brain neurons associated with a violation of the mechanism of excitation and inhibition of neurons.

However, epileptic seizures may be the result of a number of conditions in which the diagnosis of epilepsy is not made, such as:

• extreme situation (stress);
• increased body temperature;
• poisoning;
• lack of sleep.

This happens more often in children, since the mechanisms of regulation of the physiology of the brain in them are at the stage of formation. In addition, an attack can occur during the acute period of a traumatic brain injury, an infectious disease of the brain, in the presence of tumors, metastases.

There are 3 types of epilepsy:

• hereditary (genetic metabolic defects);
• congenital (pathology at any stage of intrauterine development – infection, birth trauma);
• acquired (a consequence of trauma, stroke, tumor) predisposition to the development of epilepsy.

Symptoms of epilepsy in adults

During epilepsy, 3 periods are distinguished:

• attack or ictal period;
• postictal or postictal;
• interictal or interictal.

Before an attack, the so-called aura may appear. It can be in the form of autonomic changes, motor disorders, sensory sensations, mental or speech changes. Often, an epileptic attack can begin with nausea, dizziness, severe weakness, chest pain, sensation of a lump in the throat, drowsiness, numbness of the tongue or lips, noise, squeaking or ringing in the ears, olfactory distortions.

If these are complex seizures (the so-called partial ones), they may be accompanied by automatisms (absurd, pretentious movements). Contact with a person at this point can be very difficult.

Secondary generalized seizures may begin suddenly. For a few seconds, while the aura lasts, the patient is conscious, then he falls and suddenly loses consciousness. Against the background of a fall, a specific cry arises due to a spasm of the glottis with convulsive contractions of the muscles in the chest area.

This is followed by the tonic phase of the seizure. With it, the body and limbs are stretched due to severe muscle spasms, the head is thrown back, turning it to the side that is opposite to the focus in the brain. Breathing may stop, the veins in the neck swell, the face first turns pale, then turns blue, the jaws tighten. The phase lasts up to 20 seconds.

It is followed by clonic convulsions with noisy and hoarse breathing, the appearance of foam at the mouth. This phase can last up to 2-3 minutes. The frequency of convulsive twitches gradually decreases, the muscles completely relax, there are no reactions to stimuli, the pupils dilate, there is no reaction to light, it is impossible to cause reflexes – tendon, protective.

In the post-attack period, neurological symptoms may be absent or there may be only those that provoked seizures (signs of traumatic brain injury, strokes, etc.).

Types of epilepsy in adults

– Types of epileptic seizures are diverse, – emphasizes neurologist Pavel Dynin. – From the most common, accompanied by loss of consciousness, convulsions and tonic contractions of the trunk and limbs, to absences (French “absence” – “absence”) – non-convulsive episodes of “falling out” of reality for a few seconds, often not even noticed by others. There are epileptic seizures without loss of consciousness in the form of flashes before the eyes, noise, pain and tactile sensations, etc.

The consistent development of epileptic seizures in a limited period of time is called status epilepticus and requires emergency specialized care.

Treatment of epilepsy in adults

It is important to treat epilepsy, even if the seizures are rare and do not greatly limit the patient’s usual life. This disease is dangerous for its unpredictable complications and can lead to death.

Diagnostics

Diagnosing epilepsy is not always easy. The doctor will study the data of the medical history in detail, carefully record all the symptoms. Additionally, a number of instrumental examinations are needed, which will confirm the foci of epileptic activity in the brain, fix their pathological activity and localization.

The diagnosis is made by a neurologist or epileptologist, the main method for determining pathology is EEG. According to the examination, foci of pathological activity in the brain are revealed – waves, peaks or complexes of peaks and slow waves or sharp and slow waves. With the help of computer analysis, the source of activity is determined, sometimes functional tests are needed to identify it – irritation with flashes or forced breathing with hyperventilation.

MRI of the brain is also important to determine the possible causes of seizures – tumors, injuries, aneurysms. An ECG, an ophthalmologist’s consultation, blood and urine tests may also be shown.

Modern treatments

Neurologist Pavel Dynin says that each subsequent epileptic seizure and the lack of adequate treatment lead to an aggravation of the disease and the death of brain neurons. Situations in which an attack occurs can be life-threatening in themselves (driving a car, swimming, being at height). Therefore, the most important thing is to immediately consult a doctor.

The treatment of epilepsy is exclusively medical (or surgical, if we are talking about oncological pathology). Currently, there are several main groups of drugs, such as valproic acid, oxcarbazepine, levitiracetam, carbamazepine, etc.

Self-medication in the case of epilepsy is unacceptable, since the appointment of each drug has its own indications and contraindications, determined by the doctor.

Physiotherapeutic procedures for epilepsy are limited in their use, since a number of them are associated with the influence of electrical impulses. The appointment of massage, physiotherapy exercises depends, in particular, on the degree of correction of seizures with drugs, as well as the absence of provocation of seizures in the patient by physical activity.

Prevention of epilepsy in an adult at home

According to neurologist Pavel Dynin, we can not talk about the prevention of epilepsy, as such. The fact is that the changes visible when performing a special study – electroencephalograms – can also be found in a healthy person. Deviations from the standard alpha rhythm can be caused by stress, lack of sleep, medication, certain foods, etc.

If typical epileptiform activity is detected, the risks of provoking an epileptic seizure may be daily work, alcohol abuse, energy drinks, long-term frequent bright multi-colored flashes (movies, computer games), etc.

The decision to prescribe therapy in this case is made only by a specialist. In a number of situations, in addition to a routine study of brain activity, video-EEG monitoring (electroencephalography for several hours, up to a day) can be shown, in which brain activity can be assessed during wakefulness and sleep.

Popular questions and answers

We discussed the problem of epilepsy, its possible complications and limitations that it brings to the lives of patients, as well as the possibility of self-treatment with neurologist Pavel Dynin.