Earlier, epilepsy was called a divine disease or epilepsy, and people who had it were stigmatized, that is, they were psychologically stigmatized in society, and in most cases negative. Even in our space age, in some countries, people diagnosed with generalized or focal epilepsy are not allowed to work in many professions, drive a car, and engage in certain leisure activities, such as diving.
There is an opinion among the people that an epileptic seizure necessarily looks like this: the patient falls to the ground, begins to convulse, foam appears from his mouth. If a person is covered with a dark cloth at this moment, the attack passes, and the patient falls asleep. In fact, epilepsy can manifest itself in different ways, and it is treated in specialized medical facilities. One of the best in Russia is the Bekhterev clinic, which uses modern methods of diagnosis and treatment. Regarding focal epilepsy in patients and their relatives, there are manyquestions: where does it come from, is it inherited, is it contagious, why do small children suffer from epilepsy, is it possible to cure it completely, what is it fraught with, how life-threatening and many others. In this article we will try to give complete information about this disease.
Epilepsy is…
To begin with, let's explain what kind of ailment this is - focal epilepsy. In the human nervous system there are microscopically small structural and functional formations called neurons. Their specific structure allows them to store and transmit information from other such units, as well as from muscles and glands. In fact, any reaction of the body is determined by the behavior of these tiny particles. There are more than 65 billion of them in the human brain. Many of them intertwined with each other and created the so-called neural network. Figuratively, they can be represented as a kind of well-coordinated system that lives according to its own laws. Epileptic seizures occur when sudden (paroxysmal) electrical discharges occur in neurons, disrupting their work. This can happen in many diseases, most of which relate to neuroses of various etiologies. There is focal epilepsy and generalized. The word "focal" comes from the Latin "focus". Epilepsy is considered focal when the excitation of neurons is focused in one place (focus) or, simply speaking, there is a lesion in a certain area of the brain. Epilepsy is considered generalized (general) when the lesion either immediately affectsboth hemispheres of the brain, or, having arisen in a certain place, spreads to the entire brain.
Classification
In 1989, the previous classification of focal epilepsy and its symptoms was updated. Now, within the framework of this pathology, the following syndromes are distinguished:
1. Idiopathic.
2. Symptomatic.
3. Cryptogenic.
In generalized, syndromes of idiopathic and symptomatic epilepsy are distinguished.
There are also a number of conditions where both focal and generalized features are present.
Idiopathic focal epilepsy
This type of pathology develops when the neurons of the brain begin to work more actively than necessary. In this case, a so-called epileptic focus is formed, in which excessive electrical discharges are generated, but the patient does not have structural brain lesions. At first, the body, in response to this, creates a kind of protective shaft around the focus. When the discharges acquire an intensity that allows them to break out of it, a person has an epileptic seizure. The cause of idiopathic epilepsy in the vast majority of cases is a congenital mutation in the genes, so it can be hereditary. This pathology can manifest itself at any age, but often its first signs are observed in children. With timely access to specialists, the disease can be eliminated, and without proper treatment, patients begin structural changes in the cerebral hemispheres, which leads to various neurological disorders.character, including mental activity. Epilepsy in children is benign because there is no threat to life. It is classified according to the location of the focus of active neurons and happens:
- temporal;
- occipital;
- primary epileptic reading.
Symptoms and clinic of temporal lobe epilepsy
As the name implies, this type of pathology is diagnosed if the focus of too active neurons is concentrated in the temples. Focal temporal lobe epilepsy can occur in infancy for the following reasons:
- perinatal (birth) trauma;
- lack of oxygen in the blood (hypoxemia) due to various reasons, one of which is fetal asphyxia during childbirth;
- post-traumatic gliosis in the temporal region.
In adults, pathology can develop for the following reasons:
- disturbances in cerebral vessels;
- cerebral infarction;
- injuries.
With this pathology, an epileptic seizure passes without loss of consciousness, and its precursors (aura) may or may not be present. Patients may experience auditory, gustatory or visual hallucinations, dizziness, sometimes pain in the peritoneum, nausea, discomfort in the heart, suffocation, chills, arrhythmia, fear, thoughts about changing the passage of time, sensations of one's own body.
If the excitation of neurons leaves the focus area and spreads to both hemispheres of the brain, that is, epilepsy from focal passes intogeneralized, seizures can pass with loss of consciousness, memory impairment, falling, but without convulsions. Also in this phase of the disease, patients may experience repetitive actions - clapping hands, scratching, sobbing, repeating certain sounds, blinking.
With the progression of temporal lobe epilepsy, seizures are observed, which are called secondary generalized. They are characterized by loss of consciousness, falling of the patient, convulsions in any muscles.
The main drug for epilepsy of this form is the drug "Carbamazepine", and in case of no effect, substitution therapy is carried out. In extremely severe cases, surgery is indicated.
Clinic and symptoms of occipital epilepsy
This pathology is also considered benign and occurs at any age, but in 76% of cases its manifestations are recorded in babies aged 3 to 6 years. Occipital focal epilepsy in children is characterized by the fact that seizures with it can occur with great differences and are short (about 10 minutes) or long (more than 30 minutes, sometimes several hours).
Approximately 10% of patients have only vegetative disorders (nausea, usually ending in vomiting, headache, feeling unwell, lethargy, excessive sweating, pallor, or, conversely, reddening of the skin, cough, cardiac dysfunction, myiasis, mydriasis, urinary incontinence, fever).
Approximately 80% of patients have deviation (incorrectposition) eye. Most often, the child looks away.
26% of reported cases have hemiclonia (random muscle twitching).
And finally, in 90% of cases, vegetative symptoms may be accompanied by loss of consciousness.
1/5 children may experience convulsions, a Jacksonian march, and some may experience blindness or vivid hallucinations.
At the end of the attack, the child feels normal, without neurological symptoms and intellectual problems.
The duration of seizures and autonomic symptoms are very scary for parents who think that the child may die. However, help with an epileptic seizure of short duration is not required. If the attack with occipital epilepsy is prolonged and has pronounced vegetative symptoms, emergency care is provided, consisting of intravenous injections of benzodiazepines. If a child has frequent seizures, prophylactic treatment with Carbamazepine is carried out.
Primary reading epilepsy
The rarest manifestation of the disease, occurring in boys compared to girls in a ratio of 2:1. This form of epilepsy appears in early school age. Seizures begin with trembling of the chin, twitching of the muscles of the lower jaw, less often there is difficulty in breathing, sensory deviations during reading, especially if it is done aloud. When the first harbingers appear, the child must stop reading, otherwise the attack may develop into a severe seizure. Someparents, and teachers, too, do not take this condition of the child seriously, however, reading epilepsy must be treated, since in the future attacks may begin to appear during games, when talking or eating. The main medicine for this form of epilepsy is Valproate. Doctors may also prescribe Flunarizine and Clonazepam.
Symptomatic focal epilepsy
This pathology is diagnosed when there are structural disorders in the cerebral cortex, the cause of which is reliably determined. Symptomatic epilepsy is recorded in adults and children with approximately the same frequency. The reasons for its occurrence can be:
- traumatic brain injury of any etiology;
- infectious diseases;
- viral diseases;
- cervical vascular dysplasia;
- hypertension;
- osteochondrosis of the spinal column;
- defects of the nervous system;
- oxygen starvation (asphyxia);
- many ailments of internal organs;
- birth trauma in newborns.
Symptomatic epilepsy can manifest itself even several years after an injury or illness.
Classification of symptomatic epilepsy
In this pathology, four forms are distinguished, depending on the location of structural changes:
- temporal;
- parietal;
- occipital;
- frontal.
Also in this group, Kozhevnikovsky syndrome is distinguished (chronic and simultaneously progressive epilepsy)and a syndrome in which focal epileptic seizures are triggered by some external stimulus, such as after a sudden awakening.
Temporal symptomatic epilepsy is characterized by impaired hearing, logical thinking, and behavioral characteristics.
When frontal most often observed speech disorders, memory loss, quick wits and other cognitive deviations from age norms.
Occipital epilepsy entails visual impairment, fatigue, impaired coordination of movements.
The parietal has in its assets convulsions, paresis, impaired motor functions.
Seizures in symptomatic epilepsy can be simple (minor autonomic, motor and sensory abnormalities while the mind is working), complex (impaired consciousness and functioning of internal organs) and secondarily generalized (loss of consciousness, convulsions, significant autonomic disorders).
If you have symptoms of epilepsy, you should contact a neurologist or psychiatrist in your clinic. An excellent reputation is enjoyed by the Bekhterev Clinic in St. Petersburg, where, among others, there is a department of neurology and child psychiatry. There is a modern diagnostic base here, biochemical, hormonal, general material studies are carried out, coronary risk factors are determined, drug monitoring is performed, functional diagnostics, ultrasound, ECG, vascular examination are carried out.
Cryptogenic focal epilepsy
The word "cryptogenic" is derived from the Greek "kryfto", which means "hidden", "hidden". Diagnosis"cryptogenic epilepsy" is diagnosed when the cause of the disease cannot be identified. Quite often, this pathology is observed in people older than 16 years. Possible causes include various head injuries, tumors, many diseases, and circulatory disorders. Uncertainty about the cause of the disease makes it difficult to treat. In this case, if possible, it is advisable to contact the central clinics, where there is a diagnostic base with modern advanced equipment, for example, the Institute of the Brain (St. Petersburg). Here, experienced specialists perform an advanced study of blood vessels in the head area, electroencephalography, electroneuromyography, studies of brain potentials and a range of biochemical and laboratory tests.
The clinical picture of seizures in cryptogenic epilepsy can be very different. Seizures in this pathology are observed with and without loss of consciousness, with symptoms of autonomic disorders, convulsions or without them, seizures of varying intensity and duration, or simply minor motor and / or sensory disturbances.
According to the focus of the focus of overexcited neurons, the following forms are distinguished:
- in the right hemisphere;
- in the left hemisphere;
- in deep brain segments;
- cryptogenic focal frontal lobe epilepsy.
Also, cryptogenic epilepsy may be accompanied by Lennox-Gastaut syndrome. It is observed more often in boys from 4 to 6 years old and consists of involuntary shivering, loss of muscle tone, falling and loss of consciousness.
Treatment
First aid for an epileptic seizure should be provided by relatives and others in whose eyes it happened. What to do? The algorithm is as follows:
- protect the patient from dangerous objects so that he is not accidentally injured;
- if a person has fallen, put something soft under his head;
- loosen fasteners (buttons, zipper) on the neck and chest;
- after the patient comes to his senses, treat his wounds, if any;
- call an ambulance.
What not to do:
- hold the convulsing man;
- open the patient's teeth;
- try to give him water or medicine.
Treatment of epilepsy is carried out after establishing the cause of the disease and an accurate diagnosis, therefore, if possible, it is advisable to contact specialized clinics, for example, the Brain Institute (St. Petersburg), the Clinic for Restorative Neurology (Moscow) and other specialized medical institutions where there are epileptologists.
Epilepsy is treated in several ways:
- reduce frequency and duration of seizures;
- preventing new seizures;
- pain relief;
- reaching the state of the patient, in which it is possible to stop the medication.
In some cases, compulsory treatment in specialized psychiatric clinics may be used. Treatment options include medication, diet, osteopathy, the Voight Method and, in difficult cases, surgery.
