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Epilepsy

Epilepsy — the state which is characterized by the repeated (more than two) epileptic attacks which are not provoked by any immediately defined reasons. An epileptic attack — clinical manifestation of the abnormal and excess category of neurons of the brain causing sudden tranzitorny pathological phenomena (sensitive, motive, mental, vegetative symptoms, consciousness changes). It is necessary to remember that several provoked or caused any distinct reasons (a tumor of a brain, ChMT) of epileptic attacks do not confirm presence at the patient of epilepsy.

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Epilepsy

Epilepsy — the state which is characterized by the repeated (more than two) epileptic attacks which are not provoked by any immediately defined reasons. An epileptic attack — clinical manifestation of the abnormal and excess category of neurons of the brain causing sudden tranzitorny pathological phenomena (sensitive, motive, mental, vegetative symptoms, consciousness changes). It is necessary to remember that several provoked or caused any distinct reasons (a tumor of a brain, ChMT) of epileptic attacks do not confirm presence at the patient of epilepsy.

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Classification of attacks of epilepsy

According to the international classification of epileptic attacks allocate partial (local, focal) forms and generalizirovanny epilepsy. Attacks of focal epilepsy subdivide on: simple (without consciousness violations) — with motor, somatosensorny, vegetative and mental symptoms and difficult — are followed by consciousness violation. Primary and generalized attacks happen to involvement in pathological process of both hemispheres of a brain. Types of generalizirovanny attacks: mioklonichesky, clonic, absansa, atypical absansa, tonic, toniko-clonic, atonichesky.

There are not classified epileptic attacks — not suitable under one of the above described types of attacks, and also some neonatal attacks (the chewing movements, the rhythmical movements of eyes). Allocate also repeated epileptic attacks (provoked, cyclic, casual) and long attacks (the epileptic status).

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Clinical picture of epilepsy

In a clinical picture of epilepsy allocate three periods: iktalny (attack period), postiktalny (postpristupny) and interiktalny (mezhpristupny). In the postiktalny period perhaps total absence of neurologic symptomatology (except symptoms of the disease causing epilepsy — a craniocereberal trauma, a hemorrhagic or ischemic stroke, etc.).

Allocate several main types of the aura preceding a difficult partial attack of epilepsy — vegetative, motor, mental, speech and touch. Treat the most frequent symptoms of epilepsy: nausea, weakness, dizziness, feeling of a sdavleniye in a throat, feeling of a sleep of language and lips, breast pains, drowsiness, a ring and/or noise in ears, olfactory paroxysms, feeling of a lump in a throat, etc. Besides, difficult partial attacks in most cases are followed by the automated movements, the seeming inadequate. In such cases the contact with the patient is complicated or impossible.

Secondary the attack begins, as a rule, suddenly. After several seconds which the aura lasts (at each patient the course of aura is unique), the patient faints and falls. Falling is followed by a peculiar shout which is caused by a spasm of a glottis and convulsive reduction of muscles of a thorax. Further there comes the tonic phase of an attack of epilepsy called so as spasms. Tonic spasms — a trunk and an extremity are extended in a condition of the strongest tension, the head is thrown back and/or turns aside, contralateral to the defeat center, the breath is held, veins on a neck bulk up, the person becomes pale with slowly accruing cyanosis, jaws are densely compressed. Duration of a tonic phase of an attack — from 15 to 20 seconds. Then there comes the clonic phase of an attack of epilepsy which is followed by clonic spasms (noisy, hoarse breath, foam from a mouth). The clonic phase proceeds from 2 to 3 minutes. Frequency of spasms gradually decreases then there occurs full muscular relaxation when the patient does not react to irritants, pupils are expanded, their reaction to light is absent, protective and tendinous reflexes are not caused.

The most widespread types primary the attacks differing in involvement in pathological process of both hemispheres of a brain — toniko-clonic attacks and absansa. The last are more often observed at children and characterized sudden short-term (up to 10 seconds) a stop of activity of the child (games, a conversation), the child fades, does not react to a call, and in several seconds continues the interrupted activity. Patients do not realize and do not remember attacks. Frequency of absans can reach several ten a day.

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Diagnosis of epilepsy

Diagnosing of epilepsy has to be based on data of the anamnesis, fizikalny inspection of the patient, data of EEG and neurovisualization (brain MPT and KT). It is necessary to define existence or lack of epileptic attacks according to the anamnesis, clinical examination of the patient, to results of laboratory and tool researches, and also to differentiate epileptic and other attacks; to define type of epileptic attacks and a form of epilepsy. To inform the patient of recommendations about the mode, to estimate need of medicamentous therapy, its nature and probability of surgical treatment. In spite of the fact that diagnosis of epilepsy is based, first of all, on clinical data, it is necessary to remember that in the absence of clinical symptoms of epilepsy this diagnosis cannot be made even with the epileptiformny activity revealed on EEG.

Neurologists and epileptolog are engaged in diagnosis of epilepsy. By the main method of inspection of patients with the diagnosis "epilepsy" is EEG which has no contraindications. EEG carry out to one and all patients for detection of epileptic activity. More often than others such options of epileptic activity as sharp waves, solderings (peaks), the complexes "peak — a slow wave", "sharp wave — a slow wave" are observed. Modern methods of the computer analysis of EEG allow to define localization of a source of pathological bioelectric activity. When carrying out EEG during an attack epileptic activity is registered in most cases, in the interiktalny period of EEG normal at 50% of patients. On EEG in combination with functional tests (photostimulation, a hyperventilation) of change reveal in most cases. It is necessary to emphasize that lack of epileptic activity on EEG (with application of functional tests or without them) does not exclude existence of epilepsy. In such cases conduct repeated examination or video monitoring of the carried-out EEG.

In diagnosis of epilepsy among neurovisualization methods of a research brain MRT which carrying out is shown to all patients with the local beginning of an epileptic seizure is of the greatest value. MRT allows to reveal the diseases which affected the provoked character of attacks (aneurism, a tumor) or etiologichesky factors of epilepsy (a mezialny temporal sclerosis). To patients with the diagnosis "pharmakorezistetny epilepsy" in connection with the subsequent direction on surgical treatment also carry out MRT for definition of localization of defeat of TsNS. In some cases (patients of old age) carrying out additional researches is necessary: biochemical blood test, survey of an eye bottom, ECG.

Attacks of epilepsy need to be differentiated with other paroksizmalny conditions of not epileptic nature (faints, psychogenic attacks, vegetative crises).

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Treatment of epilepsy

All methods of treatment of epilepsy are directed to the termination of attacks, improvement of quality of life and the termination of reception of medicines (at a remission stage). In 70% of cases adequate and timely treatment leads to the termination of attacks of epilepsy. Before appointing antiepileptic medicines it is necessary to conduct detailed clinical examination, to analyse results of MRT and EEG. The patient and his family have to be informed not only on Regulations of Admission of medicines, but also on possible side effects. Indications to hospitalization are: for the first time in life the developed epileptic attack, the epileptic status and need of surgical treatment of epilepsy.

One of the principles of drug treatment of epilepsy is monotherapy. Medicine is appointed in the minimum dose with the subsequent its increase up to the termination of attacks. In case of insufficiency of a dose it is necessary to check a regularity of reception of medicine and to find out whether the most transferable dose is reached. Use of the majority of antiepileptic medicines demands continuous monitoring of their concentration in blood. Treatment pregabaliny, levetiratsetamy, with valproyevy acid is begun with clinically effective dose, at purpose of a lamotridzhin, topiramat, carbamazepine it is necessary to carry out slow titration of a dose.

Treatment for the first time of the diagnosed epilepsy is begun as with traditional (carbamazepine and valproyevy acid), and with the latest antiepileptic medicines (, , to levetiratseta) registered for application in the monotherapy mode. At the choice between traditional and latest medicines it is necessary to take specific features of the patient (age, sex, the accompanying pathology) into account. Apply valproyevy acid to treatment of not identified attacks of epilepsy. At purpose of this or that antiepileptic medicine it is necessary to aspire to minimum possible frequency of its reception (to 2 times/days). Due to stable concentration in plasma medicines of the prolonged action are more effective. The medicine dose appointed to the elderly patient creates higher concentration in blood, than the similar dose of medicine appointed to the patient of young age therefore it is necessary to begin treatment with small doses with the subsequent their titration. Cancellation of medicine is carried out gradually, considering an epilepsy form, its forecast and a possibility of renewal of attacks.

Pharmakorezistentny epilepsies (the proceeding attacks, inefficiency of adequate antiepileptic treatment) demand additional inspection of the patient for the solution of a question of expeditious treatment. Preoperative inspection has to include video EEG registration of attacks, receiving reliable data about localization, anatomic features and the nature of distribution of an epileptogenny zone (MRT). On the basis of results of above-mentioned researches the nature of surgery is defined: surgical removal of epileptogenny tissue of brain (kortikalny topetomiya, lobectomy, gemisferektomiya, multilobectomy); selective operation (an amigdalo-gippokampektomiya at temporal epilepsy); kallozotomiya and functional stereotaksichesky intervention; vagus-stimulation.

There are strict indications to each of above-mentioned surgical interventions. Their carrying out is possible only in the specialized neurosurgical clinics having the corresponding equipment and with the assistance of highly qualified specialists (neurosurgeons, neuroradiologists, a neuropsychology, neurophysiologists, etc.)

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The forecast at epilepsy

The forecast for working capacity at epilepsy depends on the frequency of attacks. On remission stages when attacks arise more and more seldom and at night, working ability of the patient remains (in the conditions of a work exception during a night shift and business trips). The day attacks of epilepsy which are followed by consciousness loss limit working ability of the patient.

Epilepsy exerts impact on all aspects of life of the patient therefore is a significant medico-social problem. One of sides of this problem — scarcity of knowledge of epilepsy and the stigmatization of patients connected with it which judgments of frequency and expressiveness of the mental violations accompanying epilepsy are often unreasonable. The vast majority of the patients receiving the correct treatment lead a usual life without attacks.

Prevention of epilepsy

Prevention of epilepsy provides possible prevention of ChMT, intoxications and infectious diseases, the prevention of possible marriages between patients with epilepsy, adequate decrease in temperature at children for the purpose of prevention of fever which consequence can be epilepsy.

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Epilepsy - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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