Epilepsy - Causes, Symptoms and Treatment .MF .
Epilepsy - a chronic disease of the brain, the main manifestation of which are spontaneous, transient, rarely seizures.Epilepsy - one of the most common neurological diseases.Every hundredth person in the world are epileptic seizures.
Most often epilepsy is congenital in nature, so the first seizures occur in children (5-10 years) and adolescents (12-18 years) age.In this case, the substance of the brain damage is not defined, modified only by the electrical activity of nerve cells, and lowered the threshold of brain excitability.This is called primary epilepsy (idiopathic) flows benign, respond well to treatment, and with the age of the patient may completely abandon the pills.
Another epilepsy type - Secondary (symptomatic), it develops after damage brain structure or metabolic disorders in it - as a result of a number of pathological effects (underdevelopment of brain structures, traumatic brain injuries, infections, strokes, tumors, alcohol and Drug Treatmentand dependence al.).Such forms of epi
types of epileptic seizures
Epilepsy may appear quite different types of attacks.These types are classified:
- because of their origin (idiopathic and secondary epilepsy );
- on the location of the initial outbreak of excessive electrical activity (bark right or left hemisphere, the deep parts of the brain);
- the embodiment of events during an attack (with or without loss of consciousness).
Thus, a simplified classification of epileptic seizures is as follows.
attacks with secondary generalization
Generalized seizures occur with complete loss of consciousness and control over their actions.This occurs as a result of excessive activation of deep divisions and further involve the whole brain.Such a condition does not necessarily lead to a fall, becausenot always disturbed muscle tone.During a tonic-clonic seizure occurs at the beginning of tonic tension of all muscle groups, the fall, and then clonic spasms - rhythmic flexion and extension movements of the limbs, head and jaw.Absence seizures occur almost exclusively in children and manifest suspension of activity of the child - it is as if the freezes in place an unconscious gaze, sometimes at the same time he can twitch his eyes and facial muscles.
80% of epileptic seizures in adults and 60% of episodes in children are partial.Partial seizures occur when excess electricity is generated center excitability in any particular area of the cerebral cortex.Manifestations of partial seizures depend on the locations of the outbreak - they can be motor, sensory, autonomic, and mental.During simple attacks the person is conscious, but not control a certain part of his body or his unusual sensations arise.When complex attack is a violation of consciousness (partial loss), when a person does not know where he is, what happens to him at this time to make contact with them is not possible.During a complex attack, as well as during a simple, involuntary movements occur in kakoy-libo parts of the body, and sometimes it can even be an imitation of purposeful movement - people walking, smiling, talking, singing, "dives", "has aball "or continues to attack initiated action (walking, chewing, talking).And the simple and complex partial seizure may end generalization .
all types of attacks are short-lived - lasts from a few seconds to 3 minutes.Almost all attacks (except absences) are accompanied by a confusion of poslepristupnoy and sleepiness.If the attack was characterized by a complete loss or impairment of consciousness, the person does not remember anything about it.One patient may combine different types of attacks may change and frequency with which they occur.
interictal manifestations of epilepsy
Everyone is familiar with such manifestations of epilepsy , as epileptic seizures.But, as it turned out, the increased electrical activity and convulsive readiness of the brain do not leave sufferers even between attacks, when it would seem, there are no signs of illness.Epilepsy is dangerous development of epileptic encephalopathy - in this condition worsens mood, there is anxiety, reduced level of attention, memory and cognitive functions.Especially urgent the problem in children, becausemay lead to delays in the development and hinder the formation of speech skills, reading, writing, counting, and others. And abnormal electrical activity between attacks may contribute to the development of serious diseases such as autism, migraine, attention deficit hyperactivity disorder.
Causes of epilepsy
As mentioned above, epilepsy is divided into 2 main types: idiopathic and symptomatic.Idiopathic epilepsy is most often generalized and symptomatic - partial.This is due to different causes.In the nervous system the signals from one nerve cell to another are transmitted by an electrical pulse which is generated on the surface of each cell.Sometimes there are the unnecessary redundant impulses, but in normal working brain, they are neutralized by special antiepileptic structures.Idiopathic generalized epilepsy is caused by a genetic defect of these structures.In this case, the brain can not cope with excessive electrical excitability of cells, and it manifests itself in the seizure, which may at any time to "seize" crust of both hemispheres of the brain and cause an attack.
In partial epilepsy formed center with epileptic nerve cells in one of the hemispheres.These cells generate excess electrical charge.In response, the anti-epileptic preserved structures form around this hearth "protective wall".Up to a certain point, seizure activity to be contained, but there comes a climax, and epileptic discharges break through the boundaries of the shaft and are manifested in the form of the first attack.The next attack probably will not take long - as"Track" is already laid.
This hearth with epileptic cells formed, often, against any disease or condition.Here are the main ones:
- Underdevelopment brain structures - there is not a result of genetic mutations (as in idiopathic epilepsy), and during the period of gestation, and can be seen on MRI;
- brain tumors;
- consequences of stroke;
- Chronic use of alcohol;
- infections of the central nervous system (encephalitis, meninogoentsefality, brain abscess);
- Head injuries;
- Drug dependence (especially amphetamines, cocaine, ephedrine);
- Taking certain medications (antidepressants, antipsychotics, antibiotics, bronchodilators);
- Some inherited diseases of metabolism;
- Antiphospholipid syndrome;
- Multiple Sclerosis
Factors epilepsy development
It so happens that a genetic defect is not manifested in the form of idiopathic epilepsy and a person lives without the disease.But when a "fertile" soil (one of the aforementioned diseases or conditions) can develop a form of symptomatic epilepsy .In this case, young people often formed epilepsy after traumatic brain injury and abuse of alcohol or drugs, and the elderly - in the background of a brain tumor or a stroke.
Complications of epilepsy
Status epilepticus - a condition where the epileptic seizure lasts more than 30 minutes or when one attack follows another, and the patient does not come to mind.By status often results in sudden discontinuation of anti-epileptic drugs.As a result of status epilepticus in a patient 's heart, broken breath, vomit can get into the respiratory tract and cause pneumonia, coma may occur against the background of cerebral edema and possible death.
Living with epilepsy
Contrary to popular belief that a person with epilepsy have largely limited themselves that many roads are closed in front of him, living with epilepsy not so strict.To the patient, his relatives and associates must be remembered that in most cases they do not need, even in the design of disability.The key to a full life without limitations is a regular uninterrupted reception physician selected drugs.Secure Drug brain becomes less susceptible to provocative actions.Therefore, the patient can lead an active life, work (including a computer), do fitness, watching TV, fly on airplanes and more.
But there are a number of lessons, which are essentially "red flag" for the brain of a patient with epilepsy.Such actions shall be limited to:
- work with automated mechanisms;
- Swimming in open water, swimming in the pool without supervision;
- Self canceling or skipping a dose.
And there are also factors that can cause an epileptic seizure, even in a healthy person, and they must also be wary of:
- Lack of sleep, working night shifts, daily operation.
- Chronic use or abuse of alcohol and drugs
Epilepsy and Pregnancy
Children and adolescents who develop epilepsy over time grow, and before them raises pressing questions about contraception.Women taking hormonal contraceptives, should be aware that some antiepileptic drugs can reduce their content in the blood and lead to unwanted pregnancies.Another question, if, on the contrary, it is desirable to procreation.While epilepsy arises from genetic reasons, it is not transmitted to offspring.Therefore, patients with epilepsy can safely have a child.But keep in mind that before conception a woman should achieve long-term remission with drugs and continue taking them during pregnancy gestation.Antiepileptic drugs significantly increase the risk of improper fetal development.Nevertheless, we should not abandon the treatment becausein case of an attack during pregnancy, the risk to the fetus and the mother greatly outweighs the potential risk of abnormalities in the baby.To reduce this risk is constantly recommended to take folic acid during pregnancy.
Symptoms of epilepsy
Mental patients with epilepsy are defined:
- organic brain damage, the underlying disease of epilepsy;
- epileptization, that is the result of the activities of the epileptic focus,
- depend on the localization of the hearth;
- psychogenic, stress factors;
- side effects of antiepileptic drugs - farmakogennye change;
- form of epilepsy (at the individual forms are not available).
structure of mental disorders in epilepsy
1. Mental disorders in seizure prodrome
1. Forerunners as affective disorders (mood swings, anxiety, fear, dysphoria), asthenic symptoms (fatigue, irritability, decreased performance)
2. Aura (somatosensory, visual, auditory, olfactory, gustatory, psychic)
2. Mental disorders as a component attack
1. Syndromes change of consciousness:
a) shutdown of consciousness (coma) - with generalized seizures and secondarily generalized
b) a special state of consciousness - in simple partial seizures in
) clouded state - with complex partial seizures
2. Psychiatric symptoms (disorders of highercortical functions): dismnesticheskie, disfazicheskie, ideatornye, affective, illusory, hallucinatory.
3. Postpristupnye mental disorders
1. Syndromes change of consciousness (stupor, torpor, delirium, oneiric, twilight)
2. Aphasia, oligofaziya
4. Vegetative, neurological, somatic disorders
4. Mental disorders in the interictal period
1. personality changes
2. Psychoorganic syndrome
3. Functional (neurotic) disorders
4. Mental disorders associated with the side effect of antiepileptic drugs
5. epileptic psychosis
particular personality change in epilepsy
- combination of brutality and servility.
2. Formal thought disorder:
- bradifreniya (stiffness, slowness);
- penchant for detail;
- concrete descriptive thinking;
3. Permanent emotional disorders:
- affect viscosity;
- defenzivnye (softness, suppleness, vulnerability);
4. Reduced memory and intelligence:
- mild cognitive impairment;
- dementia (epileptic, egocentric, concentric dementia).
5. Changes in the scope of instincts and temperament:
- increased survival instinct;
- raising drives (slow rate of mental processes);
- predominance sullen, surly mood.
- genetic predisposition (often the presence of family cases of epilepsy);
- limited age disease debut;
- no change in neurological status;
- normal intelligence patients;
- preservation of the basic rhythm in the EEG;
- absence of structural changes in the brain in neuroimaging;
- drugs of choice in the treatment - derivatives of valproic acid;
- relatively good prognosis with the achievement of therapeutic remission in the majority of cases;
idiopathic partial epilepsy
Benign partial epilepsy of childhood with centrotemporal spikes (rolandic epilepsy) ( G 40.0)
criteria for diagnosis:
- age of onset: 3-13 years (peak 5-7);
- clinical symptoms of seizures: simple partial (motor, sensory, autonomic), secondary generalized (night);
- a rare frequency of attacks;
- EEG interictal period: normal basal activity and the peak wave in the central-temporal regions of the cortex;
- neurological status: without features;
- mental status: without features;
- Forecast: favorable, after 13 years of complete spontaneous remission;
- Therapy: 1) the basic preparation: valproate (30 mg / kg / day - 40-50- mg / kg / day);