Classification of epileptic seizures and the choice of drugs - Causes, Symptoms and Treatment .MF .
INTERNATIONAL CLASSIFICATION seizures (ILAE, 1981)
I. Partial (focal, local) seizures
A. Simple partial seizures (consciousness is not broken)
1. with motor symptoms
a) focal motor with the march;
b) without focal motor march (Jackson's);
c) the reversing;
e) fonatornye (vocalization or speech stop).
2. With somatosensory or specific sensory symptoms
f) dizzy spells.
3. With autonomic symptoms (epigastric sensations, paleness, sweating, flushing, dilated pupils).
4. With psychic symptoms (disorders of higher cortical functions):
b) dismnesticheskie (eg, deja vu);
c) cognitive (snovidnye condition, disorder, sense of time);
d) affective (fear, anger, etc.);
e) illusions (eg, macropsia);
f) structural hallucinations (eg, music, scenes).
B. Complex partial seizures (consciousness disturbed).
1. Beginning as a simple partial, followed by loss of consciousn
a) with the signs of simple partial seizures (A.1-A.4) and subsequent disturbance of consciousness;
b) with automatic.
2. Beginning with impaired consciousness:
a) only in violation of consciousness;
b) with automatic.
C. Partial seizures with secondary generalization.
Simple partial seizures (A) with secondary generalization.
2. Complex partial seizures (B) with secondary generalization.
3. Simple partial seizures, complex partial passing in a subsequent secondary generalization.
II. Generalized seizures.
a) only a violation of consciousness;
b) a clonic component;
c) with atopic component;
d) component with tonic;
e) to automatisms;
f) with autonomic symptoms.
B. Myoclonic seizures.
S. clonic seizures.
D. tonic seizures.
E. tonic-clonic seizures.
F. Atonic (astatic) seizures.
SIGNIFICANT CLASSIFICATION epilepsy and epileptic syndromes
1. principle etiology:
- there are no evidence-based CNS disorders;
- known or possible genetic predisposition.
- known etiology and veracity of morphological violations.
- the cause is unknown, hidden;
- syndromes do not meet the criteria for idiopathic forms;
- there is no evidence of symptomatic character.
2. localization principle:
- localization-conditioned (focal, local, partial);
- generalized forms;
- forms having features of both partial and generalized.
3. Age attack debut:
- forms newborns;
4. main type of attacks that determines picture syndrome:
- myoclonic absences;
- infantile spasms and other
5. Features current and forecast:
- severe (malignant).
International Classification of epilepsy and epileptic syndromes (recommended in 1989 by the International League Against Epilepsy).
1. localization-mediated (Focal, the partial) epilepsy syndrome.
1.1.Idiopathic forms (early episodes associated with age):
- benign epilepsy of childhood with central temporal spikes;
- epilepsy children with occipital paroxysms in the EEG;
- primary reading epilepsy.
1.2 Symptomatic form:
- progression of chronic partial epilepsy children (Kozhevnikov Syndrome);
- syndromes with specific causes provoking attacks (reflex epilepsy);
- fronto, temporomandibular, temenno-, occipital-lobar epilepsy.
1.3.Cryptogenic form (indeterminate form).
2. epilepsy syndrome with generalized seizures.
2.1.Idiopathic (early episodes associated with age):
- benign familial neonatal convulsions;
- benign idiopathic neonatal convulsions;
- benign infantile myoclonic epilepsy;
- piknolepticheskimi epilepsy with absences (piknolepticheskaya, absence epilepsy in children);
- childhood absence epilepsy;
- juvenile myoclonic epilepsy;
- epilepsy with generalized tonic-clonic seizures on awakening;
- other forms of generalized idiopathic epilepsy;
- epilepsy with specific provoking factors (reflex and start-epilepsy).
2.2 cryptogenic or symptomatic forms (age-related occurrence of seizures):
- West syndrome (infantile spasms);
- syndrome Lennox-Gastaut;
- epilepsy with myoclonic-astatic seizures;
- epilepsy with myoclonic absences.
2.3 Symptomatic form:
- early myoclonic encephalopathy;
- infant encephalopathy with portions of the isoelectric EEG;
- simtomaticheskie other generalized forms of epilepsy;
2.3.2 Specific syndromes
3. epilepsy syndromes, uncertainty as to whether they are focal or generalized
3.1.However, generalized and focal seizures:
- severe myoclonic epilepsy in infancy;
- epilepsy with long-peak waves in the EEG during slow-wave sleep;
- aphasia-epilepsy syndrome (Landau-Kleffner);
- other unspecified forms of epilepsy.
3.2.Without certain generalized and focal symptoms (many cases of generalized tonic-clonic seizures, which according iEEG clinic can not be attributed to other forms of the classification of epilepsy, as well as many cases of large seizures during sleep).
4. SPECIAL SYNDROMES
4.1.Situational (random) attacks:
- Febrile convulsions.
- Seizures svyazannyeisklyuchitelno with acute exposure to toxic or metabolic factors, as well as deprivation (deprivation) of sleep, alcohol, drugs, eclampsia, etc.
4.2.Isolated seizures or isolated status epilepticus
CLASSIFICATION epilepsy and epileptic syndrome by the MKB№10
- Landau-Kleffner syndrome (F80.3h);
- seizure NOS (R56.8);
- status epilepticus (G41.-);
- Todd paralysis (G83.8)
G40.0 localized (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures with focal beginning
- benign childrenepilepsy with spikes on the EEG in the central-temporal region;
- children's epilepsy with paroxysmal activity on EEG in the occipital region.
G40.1 .The localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures
- attacks without changes in consciousness;
- simple partial seizures, passing into secondarily generalized seizures.
G40.2 localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures
- attacks with a change of consciousness, often with epileptic automatism;
- complex partial seizures, passing into secondarily generalized seizures.
G40.3 Generalized idiopathic epilepsy and epileptic syndromes
- benign myoclonic epilepsy in infancy;
- benign minor seizures (family);
- epileptic children's absences (piknolepsiya);
- epilepsy with grand mal seizures (grand mal) on waking;
- juvenile absence epilepsy;
- juvenile myoclonic epilepsy (juvenile small seizure, grand mal);
- nonspecific seizures atonic;
- clonic seizures nonspecific;
- nonspecific myoclonic seizures;
- nonspecific tonic seizures;
- nonspecific epileptic seizures tonic-clonic.
G40.4 Other generalized epilepsy and epileptic syndromes
- epilepsy with myoclonic absences;
- myoclonus epilepsy with absences, astatic;
- infantile spasms;
- syndrome Lennox-Gastaut;
- Salaam tick;
- Symptomatic early myoclonic encephalopathy;
- West syndrome.
G40.5 Special epileptic syndromes
- Continuous epilepsy partial (Kozhevnikova);
- seizures related to alcohol;
- seizures associated with use of drugs;
- seizures related to hormonal changes;
- seizures related to sleep deprivation;
- seizures associated with exposure to stress factors.
G40.6 grand mal seizures, unspecified (with small seizures (petit mal) or without them)
G40.7 Small seizures (petit mal) seizures, unspecified, without grand mal
- epilepsy and epileptic syndromes that are not defined as a focal or generalized.
G40.9 Epilepsy unspecified
- epileptic convulsions NOS;
- - epileptic seizures NOS;
- - seizures NOS.
G41.1 Status epilepticus
G41.0 Status epilepticus grand mal (seizures)
- tonic-clonic status epilepticus.
- Continuous epilepsy partial (Kozhevnikova) (G40.5).
G41.1 Status epilepticus retit mal (small seizures)
- status epilepticus absences.
G41.2 complex partial status epilepticus
G41.8 Other specified status epilepticus
G41.9 Status epilepticus, unspecified
Epilepsy Treatment is aimed at the normalization of brain electrical activity and cessation of attacks.Antiepileptic drugs stabilize the membrane of nerve cells in the brain and thus increase the seizure threshold and reduce the electrical excitability.As a result of the impact of drugs the risk of new epileptic seizure is significantly reduced.A valproate and lakmiktal able to reduce and interictal brain excitability, which allows further stabilize and prevent the onset of epileptic encephalopathy.
- antiepileptic drugs - carbamazepine (finlepsin), valproate (Depakine chrono), lamictal, Topamax, gabapentin, clonazepam, etc. - medication and the dose the doctor selects individually
- In the case of secondary epilepsy additionally treats the underlying disease
- Symptomatic treatment - for example, drugs that improve memory and reduce depression
Patients with epilepsy have to for their own protection taking antiepileptic drugs for a long time.Unfortunately, these drugs may cause side effects (reduction of cognitive activity, lethargy, hair loss, decreased immunity).In order to timely detect undesired, held every six months the authorities concerned examination (general and biochemical blood tests, ultrasound of the liver and kidneys).
Despite all the difficulties encountered on the way to curb epilepsy, spent time and effort lavished handsomely: in 2.5-3 years after the last attack once again conducted a comprehensive survey (video-EEG monitoring, MRI of the brain) and gradually beginsreducing the dose of the antiepileptic drug, ending its complete abolition!The patient continues to lead the former way of life, using the same small precautions as before, but he was not tied to a permanent acceptance of tablets.And a cure was possible in 75%!
General principles of treatment of epilepsy:
- treatment of epilepsy should be initiated after repeated attacks.
- monotherapy principle.
- Antiepileptic drugs (AEDs) are assigned strictly in accordance with the form of epilepsy and character of attacks.
- epilepsy should start with small doses and gradually increase the dosage to achieve complete seizure control.Therapy should be individualized, continuous.
- In case of failure of one drug, it must be gradually replaced with other antiepileptic drugs, effective in this form of epilepsy.With the ineffectiveness of AEP can not just add to it a second drug, that is, to move to polytherapy, not using all the reserves alone.
- Phase-out preparations when the control seizures (2-4 years of absence seizures).
- If necessary, the complexity of care (Etiopatogenetichesky approach).
- Continuity of therapy.
- Improving the quality of life.
Necessary actions before anticonvulsant therapy:
- Assessment and documentation of patient status before treatment: a physical examination, laboratory tests, EEG (including sleep EEG), neuroradiological examination (if necessary), the assessment of cognitivefunctions.
- Talk therapy, prognosis and social consequences (school, sports, the elimination of triggering factors, the cost of treatment) with parents.
- Coordination with parents therapy purposes.Selection of adequate
- anticonvulsant (given epileptic syndrome, such as seizures, possible side effects of the drug).
- Explanation of potential risks to parents when applying the selected drug and situations where they need to go to the doctor.
main indications are:
1. Treatment of patients with accurately diagnosed "epilepsy" (presence not provoked by repeated attacks, the exclusion of non-epileptic seizures