Epilepsy is a common psychoneurological disease that has a chronic latent nature of the course. Despite this, for the disease is typical the occurrence of sudden epileptic seizures. They are caused by the appearance of numerous foci of spontaneous excitation (nerve discharges) in certain areas of the brain.
Clinically, such seizures are characterized by a temporary disorder of sensory, motor, mental and autonomic functions.
The frequency of detection of this disease is an average of 8-11% (classic inverted seizure) among the general population of any country, regardless of climate and economic development. In fact, every 12th person sometimes experiences certain micro-signs of epilepsy.
The overwhelming number of people believe that epilepsy is incurable, and is a kind of "divine punishment". But modern medicine completely refutes this opinion. Antiepileptic drugs help to suppress the disease in 63% of patients, and in 18% - significantly reduce its clinical manifestations.
The main treatment is a long, regular and constant medication with a healthy lifestyle.
The reasons for the development of epilepsy are different, WHO grouped them into the following groups:
- Idiopathic is a case when the disease is transmitted by inheritance, often through dozens of generations. Organically, the brain is not damaged, but there is a specific neuronal response. Such a form is fickle, and seizures arise without an explicable reason;
- Symptomatic - there is always a reason for the development of foci of pathological impulses. This may be the effects of trauma, intoxication, tumor or cyst, developmental malformations, etc. This is the most "unpredictable" form of epilepsy, since an attack can be triggered by the slightest irritant, for example, fright, fatigue or heat;
- Cryptogenic - it is not possible to establish precisely the true cause of the appearance of uncharacteristic (untimely) impulse foci.
When does epilepsy occur?
Seizures in many cases are observed in newly born children at high body temperature. But this does not mean that in the future the person will have epilepsy. Such a disease can develop in any person and at any age. But still, children and adolescents often face it.
75% of people with epilepsy are people under 20 years old. As for people who are over twenty, it is usually the fault of various kinds of injuries or strokes. Risk group - people over sixty years of age.
Symptoms of epilepsy
Manifestations of epileptic seizures may differ in different patients. First of all, the symptoms depend on those areas of the brain where the pathological discharge arises and spreads. In this case, the signs will be directly related to the functions of the affected parts of the brain. There may be movement disorders, speech disorders, buildup or decline of muscle tone, dysfunction of mental processes, both in isolation and in various combinations.
Expression and a set of symptoms will also depend on the specific type of epilepsy.
Thus, with Jackson's attacks, pathological irritation spans a certain area of the brain, not spreading to neighboring ones, so the manifestations concern strictly defined groups of muscles. Usually psychomotor disorders are short, the person is conscious, but it differs confusion and loss of contact with others. The patient is unaware of the impairment of functions and rejects attempts at help. After a few minutes the condition is fully normalized.
Convulsive twitching or numbness begins with a hand, foot or shin, but they can spread to the entire body half or go into a big convulsive fit. In the latter case, they speak of a secondary generalized attack.
Large convulsive seizure consists of successively alternating phases:
- Harbinger - a few hours before the onset of the attack of the patient embraces an anxious state, characterized by a buildup of nervous excitement. The focus of pathological activity in the brain gradually grows, embracing all the new departments;
- Tonic cramps - all muscles tighten, head throws back, the patient falls, hitting the floor, his body arched and held in this position. Because of stopping breathing, the face turns blue. The phase is short, about 30 seconds, rarely - up to a minute;
- Clonic convulsions - all the muscles of the body quickly rhythmically contract. Increased salivation, which looks like foam from the mouth. Duration - up to 5 minutes, after which the breathing is gradually restored, cyanosis comes off the face;
- Stupor - in the hearth of pathological electrical activity begins strong inhibition, all the muscles of the patient relax, possibly involuntary departure of urine, feces. The patient loses consciousness, there are no reflexes. The phase lasts up to 30 minutes;
After awakening the patient 2-3 more days can be tormented by headaches, weakness, impellent disorders.
Small seizures flow less brightly. There can be a series of twitches of facial muscles, a sharp drop in muscle tone (as a result, a person falls) or, conversely, the strain of all muscles, when the patient freezes in a certain position. Consciousness persists. Perhaps a temporary "absence" is an absense. The patient stops for a few seconds, can roll his eyes. After the attack, he does not remember what happened. Small seizures often begin at preschool age.
Epileptic status is a series of seizures that follow one another. In between, the patient does not regain consciousness, has a reduced muscle tone and lack of reflexes. His pupils can be enlarged, narrowed or of different sizes, the pulse either quickened or hardly probed. This condition requires immediate medical attention, since it is characterized by increasing brain hypoxia and its edema. The absence of timely medical intervention leads to irreversible consequences and a lethal outcome.
All epileptic seizures have a sudden onset and end spontaneously.
Causes of epilepsy
There is no common cause of epilepsy, which could explain its appearance. Epilepsy is not a hereditary disease in the literal sense, but still in certain families, where one of the relatives suffered from this disease, the probability of the disease is higher. About 40% of patients with epilepsy have close relatives with this disease.
There are several types of epileptic seizures. Their severity is different. An attack in which only one part of the brain is to blame is called partial, or focal. If the whole brain suffers, then such a seizure is called generalized. There are mixed seizures: they start with one part of the brain, later they cover the entire organ.
Unfortunately, in seventy percent of cases the cause of the disease remains unclarified.
Often there are the following causes of the disease: traumatic brain injury, stroke, brain tumors, lack of oxygen and blood supply at birth, brain structure (malformation), meningitis, viral and parasitic diseases, brain abscess.
Is epilepsy inherited?
Undoubtedly, the presence of brain tumors in ancestors leads to a high probability of transmission of the entire complex of the disease to descendants - this is with idiopathic variant. Moreover, if there is a genetic predisposition of CNS cells to hyperreactivity, epilepsy has the maximum possibility of manifestation in offspring.
At the same time, there is a dual option - symptomatic. The decisive factor here is the intensity of genetic transfer of the organic structure of brain neurons (the property of excitability) and their resistance to physical influences. For example, if a person with normal genetics can "sustain" any blow to the head, then another, with a predisposition, will respond to it with a generalized seizure of epilepsy.
As for the cryptogenic form, it has been little studied, and the reasons for its development are not sufficiently understood.
Is it possible to drink with epilepsy?
The unequivocal answer is no! With epilepsy, in any case, you can not drink alcoholic beverages, otherwise with a 77% guarantee, you can provoke a generalized seizure, which may be the last in your life!
Epilepsy is a very serious neurological disease! With all the recommendations and the "right" way of life, people can live peacefully. But with a violation of the drug regimen or neglect of prohibitions (alcohol, drugs), you can provoke a condition that will directly threaten your health!
What surveys are needed?
In order to diagnose the disease, the doctor examines the anamnesis of the patient himself, as well as his relatives. It is very difficult to make an accurate diagnosis. The doctor before this does a lot of work: checks the symptoms, the frequency of seizures, the attack is described in detail - it helps to determine its development, because the person who has suffered a seizure does not remember anything. In the future, electroencephalography is done. The procedure does not cause pain - it is a record of the activity of your brain. Techniques such as computer, positron emission and magnetic resonance imaging can also be used.
If epilepsy was correctly treated, then in eighty percent of cases people with such a disease live without any seizures and without restrictions in activity.
Many people have to take anti-epileptic drugs all their life, in order to prevent seizures. In rare cases, the doctor may cancel the medication if the person has not experienced seizures for several years. Epilepsy is dangerous because conditions such as choking (which can occur if a person falls face down on a pillow, etc.) or falls entail injuries or death. In addition, epileptic seizures can occur in a row in a short time, which can lead to a stopping of breathing.
As for the generalized tonic-clonic seizures, they can end in a fatal outcome. People who experience these attacks need constant supervision, at least from relatives.
Epilepsy patients often face the fact that their attacks scare other people. Children may suffer from the fact that they will be avoided by classmates. Also, small children with such a disease can not participate in sports games and competitions. Despite the correct selection of anti-epileptic therapy, there may be the emergence of hyperactive behavior and learning difficulties.
A person may have to limit in any type of activity - for example, driving a car. People who are seriously ill with epilepsy should monitor their mental state, which is inseparable from the disease.
How to treat epilepsy?
Despite the seriousness and danger of the disease, provided that the diagnosis and treatment are timely, epilepsy can be cured in half the cases. And to achieve a stable remission is possible in about 80% of patients. If the diagnosis is made for the first time and a course of drug therapy has been performed immediately, in two-thirds of patients with epilepsy, seizures during life are either not repeated at all or are attenuated for at least several years.
Treatment of epilepsy, depending on the type of disease, form, symptomatology and age of the patient is carried out by a surgical or conservative method. Most often resort to the latter, since the use of antiepileptic drugs gives a stable positive effect in almost 90% of patients.
Medical treatment of epilepsy includes several main stages:
- Differential diagnosis - allows you to determine the form of the disease and the type of seizures in order to choose the right drug;
- Determination of causes - with symptomatic (most common) form of epilepsy, a thorough examination of the brain is necessary for structural defects: aneurysms, benign or malignant neoplasms;
- Prevention of seizures - it is desirable to completely eliminate risk factors: overwork, lack of sleep, stress, hypothermia, alcohol intake;
- Cessation of epileptic status or single seizures - is made by providing emergency care and the appointment of one anticonvulsant drug or a set of medications.
- It is very important to inform the nearest entourage about the diagnosis and correct behavior during the seizure so that people know how to protect the patient from epilepsy from injuries from falling and convulsions, to prevent sagging and biting the tongue and stopping breathing.
Medication for epilepsy
Regular intake of prescribed medications allows you to confidently rely on a quiet life without attacks. The situation when the patient starts to drink medicines only at occurrence of an epileptic aura is inadmissible. If the pills were taken on time, the harbingers of the coming attack would most likely not have arisen.
During the period of conservative treatment of epilepsy, the patient should adhere to the following rules:
- Strictly observe the schedule of taking medications and do not change the dosage;
- Do not prescribe yourself other medicines on the advice of friends or a pharmacist;
- If there is a need to switch to an analogue of the prescribed drug because of its absence in the pharmacy network or too high a price, notify the attending physician and get advice on choosing a suitable replacement;
- Do not stop treatment after achieving a stable positive dynamics without the permission of your neurologist;
- Timely inform the doctor about all unusual symptoms, positive or negative changes in the state, mood and overall well-being.
More than half of patients after primary diagnosis and prescription of one antiepileptic drug live without seizures for many years, constantly adhering to the chosen monotherapy. The main task of a neuropathologist is to select the optimal dosage. Begin the drug treatment of epilepsy from small doses, while the patient is carefully monitored. If the attacks can not be stopped immediately, the dosage is gradually increased until a stable remission occurs.
Patients with partial epileptic seizures are prescribed the following groups of drugs:
- Carboxamides - Carbamazepine (40 rubles per package 50 tab.), Finlepsin (260 rubles per packing 50 tab.), Actinerval, Timonil, Zeptol, Karbasan, Targetol (300-400 rubles per packing 50 tab.);
- Valproate - Depakin Chrono (580 rubles per packing 30 tab.), Enkorat Chrono (130 rubles per packing 30 tab.), Konvuleks (in drops - 180 rubles, in syrup - 130 rubles), Konvuleks Retard (300-600 rubles per packing 30-60 tab.), Valparin Retard (380-600-900 rubles per packing 30-50-100 tablets);
- Phenytoins - Diphenine (40-50 rubles per packing 20 tab.);
- Phenobarbital - domestic production - 10-20 rubles per package 20 tab., Foreign analog Luminal - 5000-6500 rubles.
For drugs of the first stage in the treatment of epilepsy are valproate and carboxamide, they provide a good therapeutic effect and cause a minimum of side effects. In a day, the patient is prescribed 600-1200 mg of carbamazepine or 1000-2500 mg of Depakin, depending on the severity of the disease. Dosage is divided into 2-3 doses per day.
Phenobarbital and phenytoin drugs are considered obsolete to date, they give a lot of dangerous side effects, depress the nervous system and can be addictive, so modern neuropathologists refuse them.
The most convenient in use are prolonged forms of valproates (Depakin Chrono, Choro's Encolate) and carboxamides (Finlepsin Retard, Targetol PC). These medications are enough to take 1-2 times a day.
Depending on the type of seizures, epilepsy is treated with the following drugs:
- Generalized seizures - a complex of valproates with carbamazepine;
- Idiopathic form - valproate;
- Absensia - Ethosuximide;
- Myoclonic seizures - only valproate, phenytoin and carbamazepine do not give effect.
The latest novelties among antiepileptic drugs - drugs Tiagabine and Lamotrigine - have proven themselves in practice, so if the doctor recommends and finances allow, it is better to stop your choice on them.
The termination of drug therapy can be thought after at least five years of persistent remission. Treatment of epilepsy is completed, gradually reducing the dosage of the drug until complete failure within six months.
Withdrawal of epileptic status
If the patient is in a state of epileptic status (the attack lasts many hours or even days), he is injected intravenously with any of the preparations of the sibazone group (Diazepam, Seduxen) in a dosage of 10 mg per 20 ml of the glucose solution. After 10-15 minutes, you can repeat the injection if the status epilepticus is preserved.
Sometimes Sibazon and its analogues are ineffective, and then they resort to Phenytoin, Gaxenal, or thiopental sodium. Intravenously inject 1-5% solution containing 1 g of the drug, making three-minute pauses after every 5-10 ml to prevent fatal deterioration of hemodynamics and / or stopping breathing.
If no injections help to get the patient out of epileptic status, an inhalation solution of oxygen with nitrogen (1: 2) should be used, but this technique is not applicable in case of shortness of breath, collapse or coma.
Surgical treatment of epilepsy
In case of symptomatic epilepsy caused by an aneurysm, an abscess or a brain tumor, doctors have to resort to surgery to eliminate the cause of seizures. These are very complex operations that are usually performed under local anesthesia so that the patient remains conscious, and by his condition, it was possible to control the integrity of the brain areas responsible for the most important functions: motor, speech, visual.
The so-called temporal form of epilepsy is also very amenable to surgical treatment. During surgery, the surgeon either performs a complete resection of the temporal lobe of the brain, or removes only the amygdala and / or the hippocampus. The success rate of such interventions is very high - up to 90%.
In rare cases, namely, children with congenital hemiplegia (hypoplasia of one of the cerebral hemispheres) undergo a hemisferectomy operation, that is, completely remove the affected hemisphere in order to prevent global pathologies of the nervous system, including epilepsy. The prognosis for the future in these kids is good, because the potential of the human brain is huge, and one hemisphere is enough for a full life and clear thinking.
With the initially diagnosed idiopathic form of epilepsy, the operation of callosotomy (cutting the corpus callosum, which provides a link between the two hemispheres of the brain) is very effective. Such intervention prevents the occurrence of epileptic seizures in about 80% of patients.
How to help a sick person if he has an attack? So, if a person suddenly falls and starts to jerk with his hands and feet unconsciously, throwing his head back, look and make sure that the pupils are dilated. This is an attack of epilepsy.
First, move away from the person all the items that, during a seizure, he can drop on himself. Then turn it on its side and place something soft under your head to prevent injury. If a person has vomiting, turn his head on his side, in this case it will help prevent penetration of vomit into the respiratory tract.
During epileptic seizure, do not try to give a drink to a sick person and do not seek to force him. Your strength is still not enough. Ask others to call a doctor.