Help on Tele2, tariffs, questions

The classification of partial epilepsy is based on identifying an area in the brain with increased activity during an attack. By the way, the picture of a particular seizure will largely be determined by the location of the focus of pathological excitability of neurons.

Possible localization of the outbreak:

1. Temporal. This is the most common type of partial epilepsy (about 50% of all cases of the disease are provoked by the pathological activity of neurons in the temporal zone).
2. Frontal. It deservedly ranks second in frequency of cases (24-27%).
3. Occipital(about 10% of all patients with this form of epilepsy).
4. Parietal. Occurs least often (1%).

How to determine the exact location of the outbreak? Now this is very easy to do. An EEG will help ().

Diagnosis is most often carried out during the period when the patient is at rest or asleep (). But the most accurate result is given by an EEG directly during the next attack. It is almost impossible to wait for it. Therefore, an attack is provoked by the introduction of special drugs.

Types of attacks and their symptoms

Partial epilepsy in each patient manifests itself in purely individual attacks. But there is an accepted classification of their main types. In simple partial attacks, the patient’s consciousness is retained completely or partially. This condition has different forms of manifestation:

• one can observe not very intense contractions of the muscles of the legs, arms, facial muscles, the patient feels numbness, tingling, so-called “goosebumps” on his skin;
• the patient turns his eyes, head, and sometimes his entire body in a certain direction;
• there is drooling;
• the patient performs chewing movements and grimaces;
• the speech process stops;
• pain appears in the epigastric area, heartburn, heaviness, peristalsis increases, flatulence appears;
• hallucinations may be observed: gustatory, olfactory, visual.

About a third of patients experience complex partial seizures, in which the person loses consciousness. Such patients are often fully aware of what is happening, but are not able to speak or answer the questions posed.

Often after another attack the patient experiences amnesia. He forgets everything that happened.

It often happens that epilepsy begins with a partial form, and then both hemispheres of the brain suffer. This becomes the cause of the development of a secondary seizure, generalized. It often makes itself felt in the form of severe cramps.

Symptoms of complex partial seizures:

1. The patient appears severe anxiety, fear of death.
2. He concentrates on events that have happened or words heard, experiences strong feelings because of them.
3. The patient begins to perceive a completely familiar environment as unfamiliar to him. Or maybe, on the contrary, pursue a feeling "deja vu".
4. The patient perceives what is happening as something unreal. He may perceive himself as the hero of a book, a movie he has seen, or even observes himself as if from the outside.
5. Automatisms. These are certain obsessive movements. What specific movement a patient will experience depends on which area of ​​his brain is affected.
6. In the short periods between seizures, a person at the initial stage of development of partial epilepsy feels quite normal. But over time, symptoms of brain hypoxia or underlying pathology become more and more apparent. Sclerosis appears, personality changes, dementia (dementia) is observed.

Let us consider the manifestation of each type of disease in more detail.

Damage to the frontal lobes of the brain

Partial epilepsy in the frontal lobes has characteristic symptoms:

• simple seizures;
• complex seizures;
• secondary generalized paroxysms;
• a combination of these attacks.

Seizures last for 30-60 seconds and are often repeated. You can observe their seriality. They often happen at night. In 50% of patients, the seizure begins without an aura before it begins.

Frontal lobe epilepsy has its own characteristics:

• seizures are quite short-lived (up to 1 minute);
• after the end of complex attacks there is a minimum of confusion;
• secondary attacks occur very quickly;
• motor disturbances can often be observed (uncharacteristic automatic gestures, trampling in one place);
• at the beginning of a seizure, automatisms are very common;
• the patient often falls.

Forms of frontal lobe epilepsy:

1. Motor. It manifests itself in the form of convulsions in the limbs, an aura before an attack, Todd's paralysis may occur, and secondary generalization often occurs.
2. Anterior (frontopolar). It manifests itself in the form of painful memories, the sense of time changes, thoughts come flooding in, and memory lapses often occur.
3. Cingular. Characterized by hyperemia of the facial area, increased motor skills, blinking, and a state of passion.
4. Dorsolateral. The patient turns his eyes, head and even torso in one direction, loses the ability to speak during the attack, and secondary generalization often occurs.
5. Orbitofrontal.
6. Opercular.
7. Additional motor area.

Temporal form of the disorder

Temporal partial epilepsy manifests itself in the following seizures:

• simple;
• complex;
• secondary generalized;
• their combinations.

Very often, with the temporal form, complex partial seizures with automatisms and upset consciousness are observed.

Very often, before attacks in the case of the temporal form, the patient feels an aura:

Types of temporal lobe epilepsy:

1. Paleocortical. The patient may freeze with a completely motionless face, his eyes remain wide open, directed at one point. There is a feeling that he is simply “staring” at something. Consciousness may turn off, but motor activity may remain. For example, the patient may be fiddling with his buttons on his clothes. Often the patient can simply fall without the appearance of convulsions (temporal syncope).
2. Lateral. During seizures, speech, vision, and hearing are impaired, and auditory and visual hallucinations appear.

Patients with occipital epilepsy suffer from visual hallucinations, impaired visual field, discomfort in the eyeballs, curvature (deviation) of the neck, and they experience frequent blinking.

Complex of therapeutic measures

Partial epilepsy is an incurable disease. The essence of treatment is to reduce attacks. To achieve remission, antiepileptic drugs are prescribed (Carbamazepine (a standard drug for all possible forms of epilepsy), Lamictal, Depakine, Topiramate).

To get maximum results, the doctor can combine drugs. If drug treatment does not work, perform.

Surgery is resorted to only if all conservative treatment methods have failed and the patient suffers from frequent seizures.

A craniotomy is performed in the area that caused the epilepsy. The neurosurgeon carefully excises everything that irritates the cerebral cortex - membranes that are changed by scars, exostoses. This operation is called meningoencephalolysis.

The Horsley procedure is performed less frequently. Her technique was developed by the English neurosurgeon Horsley back in 1886. In this case, the affected cortical centers are scooped out.

If partial seizures of epilepsy are provoked precisely by scars on the substance or membranes of the brain, then the results of such an operation do not bring the desired result.

When the irritating effect of scarring on the brain is eliminated, seizures may stop for a while. But very quickly, scars form again in the area of ​​the operation, and they are even more massive than the previous ones.

After Horsley's operation, monoparalysis of the limb from which the motor centers were removed may occur. At the same time, the seizures stop. Over time, the paralysis passes and is replaced by .

The patient always has some weakness in this limb. Most often, seizures reappear over time. Therefore, surgery is not the first choice for partial epilepsy. Conservative treatment is preferable.

The essence of prevention of all types of epilepsy is as follows:

• should be avoided;
• intoxication should be avoided;
• it is necessary to treat infectious diseases in a timely manner;
• You should not have children if both parents suffer from epilepsy (this greatly increases the risk of developing diseases in their children).

In contact with

Classmates

(lat. Epilepsia - seized, caught, caught) is one of the most common chronic neurological diseases of humans, manifested in the body’s predisposition to the sudden occurrence of convulsive attacks. Other common and commonly used names for these sudden attacks are epileptic seizure, epileptic seizure. Epilepsy affects not only people, but also animals, for example, dogs, cats, mice. Many great ones, namely Julius Caesar, Napoleon Bonaparte, Peter the Great, Fyodor Dostoevsky, Alfred Nobel, Joan of Arc, Ivan IV the Terrible, Vincent Van Gogh, Winston Churchill, Lewis Carroll, Alexander the Great, Alfred Nobel, Dante Alighieri, Fyodor Dostoevsky , Nostradamus and others suffered from epilepsy.

This disease was called “God’s mark,” believing that people with epilepsy were marked from above. The nature of the appearance of this disease has not yet been established; there are several assumptions in medicine, but there is no exact data.

The common belief among people that epilepsy is an incurable disease is wrong. The use of modern antiepileptic drugs can completely relieve seizures in 65% of patients and significantly reduce the number of seizures in another 20%. The basis of treatment is long-term daily drug therapy with regular follow-up studies and medical examinations.

Medicine has established that epilepsy is a hereditary disease, it can be transmitted through the mother’s line, but more often it is transmitted through the male line, it may not be transmitted at all or may appear after a generation. There is a possibility of epilepsy in children conceived by parents who were drunk or suffering from syphilis. Epilepsy can be an “acquired” disease as a result of severe fright, head injury, maternal illness during pregnancy, due to the formation of brain tumors, cerebral vascular defects, birth injuries, infections of the nervous system, poisoning, neurosurgery.

An epileptic attack occurs as a result of simultaneous excitation of nerve cells that occurs in a certain area of ​​the cerebral cortex.

Based on their occurrence, epilepsy is classified into the following types:

1. symptomatic- a structural defect of the brain can be detected, for example, a cyst, tumor, hemorrhage, developmental defects, manifestation of organic damage to brain neurons;
2. idiopathic- there is a hereditary predisposition, and there are no structural changes in the brain. Idiopathic epilepsy is based on channelopathy (genetically determined diffuse instability of neuronal membranes). There are no signs of organic brain damage in this type of epilepsy, i.e. the patients' intelligence is normal;
3. cryptogenic- the cause of the disease cannot be identified.

Before each epileptic attack, a person experiences a special state called an aura. The aura manifests itself differently in each person. It all depends on the location of the epileptogenic focus. The aura can be manifested by increased temperature, anxiety, dizziness, the patient feels cold, pain, numbness of some parts of the body, strong heartbeat, a feeling of unpleasant odor, the taste of some food, and sees a bright flickering. It should be remembered that during an epileptic attack, a person not only does not realize anything, but also does not experience any pain. An epileptic attack lasts several minutes.

Under a microscope, during an epileptic seizure, cell swelling and small areas of hemorrhage are visible in this place of the brain. Each seizure makes it easier to carry out the next one, forming permanent seizures. This is why epilepsy must be treated! Treatment is strictly individual!

Predisposing factors:

• change in climatic conditions,
• lack or excess of sleep,
• fatigue,
• bright daylight.

Symptoms of epilepsy

Manifestations of epileptic seizures vary from generalized convulsions to changes in the patient’s internal state that are barely noticeable to people around. There are focal seizures associated with the occurrence of an electrical discharge in a certain limited area of ​​the cerebral cortex and generalized seizures, in which both hemispheres of the brain are simultaneously involved in the discharge. During focal attacks, convulsions or peculiar sensations (for example, numbness) in certain parts of the body (face, arms, legs, etc.) may be observed. Focal seizures may also involve short bouts of visual, auditory, olfactory, or taste hallucinations. Consciousness during these attacks can be preserved; in this case, the patient describes his sensations in detail. Partial or focal seizures are the most common manifestation of epilepsy. They occur when nerve cells are damaged in a specific area of ​​one of the brain hemispheres and are divided into:

1. simple - with such seizures there is no disturbance of consciousness;
2. complex - attacks with a disturbance or change in consciousness, caused by areas of overexcitation of various localizations and often become generalized;
3. secondary generalized seizures - typically begin in the form of a convulsive or non-convulsive partial seizure or absence seizure, followed by a bilateral spread of convulsive motor activity to all muscle groups.

The duration of partial attacks is usually no more than 30 seconds.

There are states of the so-called trance - externally ordered actions without conscious control; upon returning consciousness, the patient cannot remember where he was and what happened to him. A type of trance is sleepwalking (sometimes of non-epileptic origin).

Generalized seizures can be convulsive or non-convulsive (absence seizures). For others, the most frightening ones are generalized convulsive seizures. At the beginning of the attack (tonic phase), tension of all muscles occurs, short-term cessation of breathing, a piercing cry is often observed, and tongue biting is possible. After 10-20 seconds. the clonic phase begins when muscle contractions alternate with their relaxation. At the end of the clonic phase, urinary incontinence is often observed. Convulsions usually stop spontaneously after a few minutes (2-5 minutes). Then comes the post-attack period, characterized by drowsiness, confusion, headache and the onset of sleep.

Non-convulsive generalized seizures are called absence seizures. They occur almost exclusively in childhood and early adolescence. The child suddenly freezes and stares intently at one point, his gaze seems absent. Closing of the eyes, trembling of the eyelids, and slight tilting of the head may be observed. The attacks last only a few seconds (5-20 seconds) and often go unnoticed.

The occurrence of an epileptic attack depends on a combination of two factors in the brain itself: the activity of the seizure focus (sometimes also called epileptic) and the general convulsive readiness of the brain. Sometimes an epileptic attack is preceded by an aura (a Greek word meaning “breeze” or “breeze”). The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired (that is, on the localization of the epileptic focus). Also, certain conditions of the body can be a provoking factor for an epileptic seizure (epileptic seizures associated with the onset of menstruation; epileptic seizures that occur only during sleep). In addition, an epileptic seizure can be provoked by a number of environmental factors (for example, flickering light). There are a number of classifications of characteristic epileptic seizures. From a treatment point of view, the most convenient classification is based on the symptoms of seizures. It also helps to distinguish epilepsy from other paroxysmal conditions.

Types of epileptic seizures

What are the types of seizures?

Epileptic seizures are very diverse in their manifestations - from severe general seizures to imperceptible loss of consciousness. There are also such as: a feeling of a change in the shape of surrounding objects, twitching of the eyelid, tingling in the finger, discomfort in the stomach, short-term inability to speak, leaving the house for many days (trances), rotation around its axis, etc.

More than 30 types of epileptic seizures are known. Currently, the International Classification of Epilepsy and Epileptic Syndromes is used to systematize them. This classification identifies two main types of seizures - generalized (general) and partial (focal, focal). They, in turn, are divided into subtypes: tonic-clonic seizures, absence seizures, simple and complex partial seizures, as well as other seizures.

What is an aura?

Aura (Greek word meaning “breeze” or “breeze”) is a condition that precedes an epileptic seizure. The manifestations of the aura are very diverse and depend on the location of the part of the brain whose function is impaired. They can be: increased body temperature, feelings of anxiety and restlessness, sound, strange taste, smell, changes in visual perception, unpleasant sensations in the stomach, dizziness, states of “already seen” (deja vu) or “never seen” (jamais vu) , a feeling of inner bliss or melancholy, and other sensations. A person's ability to correctly describe their aura can be of significant help in diagnosing the location of changes in the brain. An aura can also be not only a harbinger, but also an independent manifestation of a partial epileptic seizure.

What are generalized seizures?

Generalized seizures are attacks in which paroxysmal electrical activity covers both hemispheres of the brain. And additional brain studies in such cases do not reveal focal changes. The main generalized seizures include tonic-clonic (generalized convulsive seizures) and absence seizures (short-term blackouts). Generalized seizures occur in about 40% of people with epilepsy.

What are tonic-clonic seizures?

Generalized tonic-clonic seizures (grand mal) are characterized by the following manifestations:

1. blackout;
2. tension in the trunk and limbs (tonic convulsions);
3. twitching of the torso and limbs (clonic convulsions).

During such an attack, breathing may be held for some time, but this never leads to the person’s suffocation. Usually the attack lasts 1-5 minutes. After an attack, sleep may occur, a state of stupor, lethargy, and sometimes a headache.

In the case when an aura or focal attack occurs before an attack, it is regarded as partial with secondary generalization.

What are absence seizures?

Absence seizures (petit mal) are generalized attacks with a sudden and short-term (from 1 to 30 seconds) loss of consciousness, not accompanied by convulsive manifestations. The frequency of absence seizures can be very high, up to several hundred seizures per day. They are often not noticed, believing that the person is lost in thought at that time. During an absence seizure, movements suddenly stop, the gaze stops, and there is no reaction to external stimuli. There is never an aura. Sometimes there may be eye rolling, eyelid twitching, stereotypical movements of the face and hands, and changes in facial skin color. After the attack, the interrupted action is resumed.

Absence seizures are typical for childhood and adolescence. Over time, they can transform into other types of seizures.

What is adolescent myoclonic epilepsy?

Adolescent myoclonic epilepsy begins between the onset of puberty (puberty) and 20 years of age. It manifests itself as lightning-fast twitching (myoclonus), usually of the hands while maintaining consciousness, sometimes accompanied by generalized tonic or tonic-clonic seizures. These attacks mostly occur within 1-2 hours before or after waking up from sleep. The electroencephalogram (EEG) often shows characteristic changes, and there may be increased sensitivity to flickering lights (photosensitivity). This form of epilepsy is highly treatable.

What are partial seizures?

Partial (focal, focal) seizures are seizures caused by paroxysmal electrical activity in a limited area of ​​the brain. This type of seizure occurs in approximately 60% of people with epilepsy. Partial seizures can be simple or complex.

Simple partial seizures are not accompanied by impaired consciousness. They can manifest themselves in the form of twitching or discomfort in certain parts of the body, turning of the head, discomfort in the abdomen and other unusual sensations. Often these attacks are similar to an aura.

Complex partial seizures have more pronounced motor manifestations and are necessarily accompanied by one or another degree of change in consciousness. Previously, these seizures were classified as psychomotor and temporal lobe epilepsy.

In case of partial seizures, a thorough neurological examination is always performed to rule out ongoing brain disease.

What is Rolandic epilepsy?

Its full name is “benign epilepsy of childhood with central temporal (rolandic) peaks.” Already from the name it follows that it responds well to treatment. The attacks appear in early school age and stop in adolescence. Rolandic epilepsy usually manifests as partial seizures (eg, unilateral twitching of the corner of the mouth with drooling, swallowing), which usually occur during sleep.

What is status epilepticus?

Status epilepticus is a condition in which epileptic seizures follow each other without interruption. This condition is dangerous to human life. Even with the modern level of development of medicine, the risk of death of the patient is still very high, so a person with status epilepticus must be immediately taken to the intensive care unit of the nearest hospital. Seizures that are repeated so often that the patient does not regain consciousness between them; distinguish between status epilepticus of focal and generalized seizures; very localized motor seizures are termed “persistent partial epilepsy.”

What are pseudoseizures?

These conditions are intentionally caused by a person and look like seizures. They can be staged in order to attract additional attention or to avoid any activity. It is often difficult to distinguish a true epileptic seizure from a pseudoepileptic one.

Pseudoepileptic seizures are observed:

• in childhood;
• more often in women than in men;
• in families where there are relatives with mental illness;
• with hysteria;
• if there is a conflict situation in the family;
• in the presence of other brain diseases.

Unlike epileptic seizures, pseudo-seizures do not have a characteristic post-seizure phase, a return to normal occurs very quickly, the person smiles often, there is rarely damage to the body, irritability rarely occurs, and more than one attack rarely occurs within a short period of time. Electroencephalography (EEG) can accurately detect pseudoepileptic seizures.

Unfortunately, pseudoepileptic seizures are often mistakenly regarded as epileptic, and patients begin to receive treatment with specific drugs. In such cases, relatives are frightened by the diagnosis, as a result, anxiety is induced in the family and overprotection is formed over the pseudo-sick person.

Convulsive focus

A seizure focus is the result of organic or functional damage to an area of ​​the brain caused by any factor (insufficient blood circulation (ischemia), perinatal complications, head injuries, somatic or infectious diseases, tumors and abnormalities of the brain, metabolic disorders, stroke, toxic effects of various substances). At the site of structural damage, a scar (which sometimes forms a fluid-filled cavity (cyst)). In this place, acute swelling and irritation of the nerve cells of the motor zone may periodically occur, which leads to convulsive contractions of skeletal muscles, which, in the case of generalization of excitation to the entire cerebral cortex, result in loss of consciousness.

Convulsive readiness

Convulsive readiness is the probability of an increase in pathological (epileptiform) excitation in the cerebral cortex above the level (threshold) at which the anticonvulsant system of the brain functions. It can be high or low. With high convulsive readiness, even slight activity in the focus can lead to the appearance of a full-blown convulsive attack. The convulsive readiness of the brain can be so great that it leads to a short-term loss of consciousness even in the absence of a focus of epileptic activity. In this case we are talking about absence seizures. Conversely, convulsive readiness may be absent altogether, and, in this case, even with a very strong focus of epileptic activity, partial seizures occur that are not accompanied by loss of consciousness. The cause of increased convulsive readiness is intrauterine brain hypoxia, hypoxia during childbirth or hereditary predisposition (the risk of epilepsy in the offspring of patients with epilepsy is 3-4%, which is 2-4 times higher than in the general population).

Diagnosis of epilepsy

There are about 40 different forms of epilepsy and different types of seizures. Moreover, each form has its own treatment regimen. That is why it is so important for a doctor not only to diagnose epilepsy, but also to determine its form.

How is epilepsy diagnosed?

A complete medical examination includes the collection of information about the patient’s life, the development of the disease and, most importantly, a very detailed description of the attacks, as well as the conditions preceding them, by the patient themselves and eyewitnesses of the attacks. If seizures occur in a child, the doctor will be interested in the course of pregnancy and childbirth in the mother. A general and neurological examination and electroencephalography are required. Special neurological studies include nuclear magnetic resonance imaging and computed tomography. The main task of the examination is to identify current diseases of the body or brain that could cause the attacks.

What is electroencephalography (EEG)?

Using this method, the electrical activity of brain cells is recorded. This is the most important test in diagnosing epilepsy. An EEG is performed immediately after the first seizures appear. In epilepsy, specific changes (epileptic activity) appear on the EEG in the form of discharges of sharp waves and peaks of higher amplitude than normal waves. During generalized seizures, the EEG shows groups of generalized peak-wave complexes in all areas of the brain. In focal epilepsy, changes are detected only in certain, limited areas of the brain. Based on EEG data, a specialist can determine what changes have occurred in the brain, clarify the type of seizures, and, based on this, determine which drugs will be preferable for treatment. Also, with the help of EEG, the effectiveness of the treatment is monitored (especially important for absence seizures), and the issue of stopping treatment is decided.

How is an EEG performed?

EEG is a completely harmless and painless study. To carry it out, small electrodes are applied to the head and secured to it using a rubber helmet. The electrodes are connected via wires to an electroencephalograph, which amplifies the electrical signals of brain cells received from them by 100 thousand times, records them on paper or enters the readings into a computer. During the examination, the patient lies or sits in a comfortable diagnostic chair, relaxed, with his eyes closed. Usually, when taking an EEG, so-called functional tests (photostimulation and hyperventilation) are performed, which are provocative loads on the brain through bright flashing light and increased respiratory activity. If an attack begins during an EEG (this happens very rarely), then the quality of the examination increases significantly, since in this case it is possible to more accurately determine the area of ​​impaired electrical activity of the brain.

Are changes in the EEG grounds for identifying or excluding epilepsy?

Many EEG changes are nonspecific and provide only supporting information for the epileptologist. Only on the basis of the identified changes in the electrical activity of brain cells, one cannot speak of epilepsy, and, conversely, this diagnosis cannot be excluded with a normal EEG if epileptic seizures occur. Epileptic activity on the EEG is regularly detected in only 20-30% of people with epilepsy.

Interpreting changes in the bioelectrical activity of the brain is, to some extent, an art. Changes similar to epileptic activity may be caused by eye movement, swallowing, vascular pulsation, respiration, electrode movement, electrostatic discharge, and other causes. In addition, the electroencephalographer must take into account the patient's age, since the EEG of children and adolescents differs significantly from the electroencephalogram of adults.

What is a hyperventilation test?

This is frequent and deep breathing for 1-3 minutes. Hyperventilation causes pronounced metabolic changes in the brain due to intensive removal of carbon dioxide (alkalosis), which, in turn, contribute to the appearance of epileptic activity on the EEG in people with seizures. Hyperventilation during EEG recording makes it possible to identify hidden epileptic changes and clarify the nature of epileptic seizures.

What is EEG with photostimulation?

This test is based on the fact that flashing lights can trigger seizures in some people with epilepsy. During EEG recording, a bright light flashes rhythmically (10-20 times per second) in front of the eyes of the patient being studied. Detection of epileptic activity during photostimulation (photosensitive epileptic activity) allows the doctor to choose the most appropriate treatment tactics.

Why is an EEG with sleep deprivation performed?

Sleep deprivation for 24-48 hours before EEG is carried out to identify hidden epileptic activity in difficult to recognize cases of epilepsy.

Sleep deprivation is a fairly strong trigger for attacks. This test should only be used under the guidance of an experienced physician.

What is EEG during sleep?

As is known, in certain forms of epilepsy, changes in the EEG are more pronounced, and sometimes can only be perceptible during a study during sleep. Recording an EEG during sleep makes it possible to detect epileptic activity in the majority of those patients in whom it was not detected during the daytime, even under the influence of ordinary provocative tests. But, unfortunately, such a study requires special conditions and trained medical personnel, which limits the widespread use of this method. It is especially difficult to carry out in children.

Is it right not to take antiepileptic drugs before an EEG?

This should not be done. Abruptly stopping the medication provokes seizures and can even cause status epilepticus.

When is video EEG used?

This very complex study is carried out in cases where it is difficult to determine the type of epileptic seizure, as well as in the differential diagnosis of pseudo-seizures. Video-EEG is a video recording of an attack, often during sleep, with simultaneous EEG recording. This study is carried out only in specialized medical centers.

Why is brain mapping done?

This type of EEG with computer analysis of the electrical activity of brain cells is usually carried out for scientific purposes. The use of this method in epilepsy is limited to identifying only focal changes.

Is EEG harmful to health?

Electroencephalography is an absolutely harmless and painless study. EEG is not associated with any effect on the brain. This study can be carried out as often as necessary. Carrying out an EEG causes only minor inconvenience associated with putting a helmet on the head and slight dizziness that may occur during hyperventilation.

Do EEG results depend on what device the study is used on?

Equipment for conducting EEG – electroencephalographs, produced by different companies, are not fundamentally different from each other. Their difference lies only in the level of technical service for specialists and in the number of recording channels (electrodes used). EEG results largely depend on the qualifications and experience of the specialist conducting the study and analyzing the data obtained.

How to prepare a child for an EEG?

The child must be explained what awaits him during the examination and convinced that it is painless. The child should not feel hungry before the test. The head should be washed clean. With small children, it is necessary to practice the day before in putting on a helmet and remaining motionless with your eyes closed (you can pretend to play as an astronaut or tank driver), and also teach them to breathe deeply and often under the commands “inhale” and “exhale.”

CT scan

Computed tomography (CT) is a method of studying the brain using radioactive (X-ray) radiation. During the study, a series of images of the brain are taken in different planes, which allows, unlike conventional radiography, to obtain an image of the brain in three dimensions. CT allows you to detect structural changes in the brain (tumors, calcifications, atrophy, hydrocephalus, cysts, etc.).

However, CT data may not have informative value for certain types of attacks, which include, in particular:

any epileptic seizures for a long time, especially in children;

generalized epileptic seizures with the absence of focal changes in the EEG and indications of brain damage during a neurological examination.

Magnetic resonance imaging

Magnetic resonance imaging is one of the most accurate methods for diagnosing structural changes in the brain.

Nuclear magnetic resonance (NMR) is a physical phenomenon based on the properties of some atomic nuclei, when placed in a strong magnetic field, to absorb energy in the radio frequency range and emit it after the cessation of exposure to the radio frequency pulse. In its diagnostic capabilities, NMR is superior to computed tomography.

The main disadvantages usually include:

1. low reliability of calcification detection;
2. high price;
3. impossibility of examining patients with claustrophobia (fear of closed spaces), artificial pacemakers (pacemakers), large metal implants made of non-medical metals.

Is a medical examination necessary in cases where there are no more attacks?

If a person with epilepsy has stopped having seizures, but the medications have not yet been stopped, then it is recommended that he undergo a control general and neurological examination at least once every six months. This is especially important for monitoring the side effects of antiepileptic drugs. Usually the condition of the liver, lymph nodes, gums, hair is checked, as well as laboratory blood tests and liver tests. In addition, it is sometimes necessary to monitor the amount of anticonvulsants in the blood. A neurological examination includes a traditional examination by a neurologist and an EEG.

Cause of death in epilepsy

Status epilepticus is especially dangerous due to pronounced muscle activity: tonic-clonic convulsions of the respiratory muscles, inhalation of saliva and blood from the oral cavity, as well as delays and arrhythmias of breathing lead to hypoxia and acidosis. The cardiovascular system experiences extreme stress due to enormous muscular work; hypoxia increases cerebral edema; acidosis increases hemodynamic and microcirculation disorders; secondly, the conditions for brain function are increasingly deteriorating. When status epilepticus is prolonged in the clinic, the depth of the comatose state increases, convulsions become tonic in nature, muscle hypotonia is replaced by atony, and hyperreflexia is replaced by areflexia. Hemodynamic and respiratory disorders increase. The convulsions may stop completely, and the stage of epileptic prostration begins: the eye slits and mouth are half open, the gaze is indifferent, the pupils are wide. In this condition, death can occur.

Two main mechanisms lead to cytotoxicity and necrosis, in which cellular depolarization is supported by stimulation of NMDA receptors and the key point is the initiation of a cascade of destruction within the cell. In the first case, excessive neuronal excitation results from edema (fluid and cations entering the cell), leading to osmotic damage and cell lysis. In the second case, activation of NMDA receptors activates calcium flux into the neuron with accumulation of intracellular calcium to a level higher than the cytoplasmic calcium binding protein can accommodate. Free intracellular calcium is toxic to the neuron and leads to a series of neurochemical reactions, including mitochondrial dysfunction, activates proteolysis and lipolysis, which destroy the cell. This vicious circle underlies the death of a patient with status epilepticus.

Prognosis for epilepsy

In most cases, after a single attack, the prognosis is favorable. Approximately 70% of patients undergo remission during treatment, that is, they are seizure-free for 5 years. In 20–30 %, seizures continue; in such cases, simultaneous administration of several anticonvulsants is often required.

First aid

Signs or symptoms of an attack are usually: convulsive muscle contractions, respiratory arrest, loss of consciousness. During an attack, those around you need to remain calm - without panic or fuss, provide the correct first aid. The listed symptoms of an attack should go away on their own within a few minutes. People around you most often cannot speed up the natural cessation of the symptoms accompanying an attack.

The most important goal of first aid during an attack is to prevent harm to the health of the person experiencing the attack.

The onset of an attack may be accompanied by loss of consciousness and a person falling to the floor. If you fall from the stairs, near objects protruding from the floor level, head bruises and fractures are possible.

Remember: an attack is not a disease transmitted from one person to another; act boldly and correctly when providing first aid.

Entering into an attack

Support the falling person with your hands, lower him to the floor or sit him on a bench. If a person is in a dangerous place, for example, at an intersection or near a cliff, lift his head, take him under the armpits, and move him a little away from the dangerous place.

Beginning of the attack

Sit down next to the person and hold the most important thing - the person’s head; it is most convenient to do this by holding the head of the person lying between your knees and holding it on top with your hands. The limbs need not be fixed, they will not make amplitude movements, and if initially the person lies quite comfortably, then he will not be able to injure himself. No other people are needed nearby, ask them to move away. The main phase of the attack. Holding the head, have a folded handkerchief or part of the person's clothing ready. This may be needed to wipe away saliva, and if the mouth is open, a piece of this material, folded in several layers, can be inserted between the teeth, this will prevent biting the tongue, cheek, or even damaging the teeth against each other during cramps.

If the jaws are closed tightly, there is no need to try to open the mouth by force (this most likely will not work and can injure the oral cavity).

If salivation increases, continue to hold the person's head, but turn it to the side so that saliva can flow onto the floor through the corner of the mouth and not enter the respiratory tract. It's okay if a little saliva gets on your clothes or hands.

Recovery from an attack

Remain completely calm, an attack with respiratory arrest can last several minutes, remember the sequence of symptoms of an attack so that you can later describe them to your doctor.

After the end of the convulsions and relaxation of the body, it is necessary to put the victim in a recovery position - on his side, this is necessary to prevent the root of the tongue from retracting.

The victim may have medications with him, but they can only be used at the direct request of the victim, otherwise criminal liability for causing harm to health may follow. In the vast majority of cases, recovery from an attack should occur naturally, and the correct medicine or mixture and dose will be selected by the person himself after recovery from the attack. Searching a person for instructions and medications is not worth it, as this is not necessary and will only cause an unhealthy reaction from others.

In rare cases, recovery from an attack may be accompanied by involuntary urination, while the person still has convulsions at this time, and consciousness has not fully returned to him. Politely ask other people to move away and disperse, support the person's head and shoulders, and gently discourage them from standing up. Later, the person will be able to cover himself, for example, with an opaque bag.

Sometimes, when recovering from an attack, even with rare convulsions, a person tries to get up and start walking. If you can control the person’s spontaneous impulses from side to side, and the place does not pose any danger, for example, in the form of a road nearby, a cliff, etc., allow the person, without any help from you, to stand up and walk with him, holding him firmly. If the place is dangerous, then do not allow him to get up until the convulsions completely stop or consciousness returns completely.

Usually 10 minutes after the attack, the person completely returns to his normal state and no longer needs first aid. Let the person decide for himself about the need to seek medical help; after recovering from the attack, this is sometimes no longer necessary. There are people who have attacks several times a day, and yet they are completely full-fledged members of society.

Often young people are inconvenienced by the attention of other people to this incident, much more than the attack itself. Cases of an attack under certain irritants and external circumstances can occur in almost half of the patients; modern medicine does not allow pre-insurance against this.

A person whose attack is already ending should not be the focus of general attention, even if, when recovering from the attack, the person emits involuntary convulsive screams. You could, for example, hold the person's head while talking calmly to the person, this helps reduce stress, gives confidence to the person coming out of the attack, and also calms onlookers and encourages them to disperse.

An ambulance must be called in the event of a second attack, the onset of which indicates an exacerbation of the disease and the need for hospitalization, since the second attack in a row may be followed by further ones. When communicating with the operator, it is enough to indicate the gender and approximate age of the victim, in response to the question “What happened?” answer “repeated attack of epilepsy”, give the address and large fixed landmarks, at the request of the operator, provide information about yourself.

In addition, an ambulance should be called if:

• attack lasts more than 3 minutes
• after an attack, the victim does not regain consciousness for more than 10 minutes
• the attack occurred for the first time
• the attack occurred in a child or an elderly person
• the attack occurred in a pregnant woman
• During the attack, the victim was injured.

Treatment of epilepsy

Treatment of a patient with epilepsy is aimed at eliminating the cause of the disease, suppressing the mechanisms of seizure development and correcting the psychosocial consequences that may occur as a result of the neurological dysfunction underlying the disease or in connection with a persistent decrease in working capacity.

If the epileptic syndrome is the result of metabolic disorders, such as hypoglycemia or hypocalcemia, then after the metabolic processes are restored to normal levels, the seizures usually stop. If epileptic seizures are caused by an anatomical lesion of the brain, such as a tumor, arteriovenous malformation or brain cyst, then removal of the pathological focus also leads to the disappearance of seizures. However, long-term lesions, even those that do not progress, can cause the development of various negative changes. These changes can lead to the formation of chronic epileptic foci, which cannot be eliminated by removing the primary lesion. In such cases, control is needed, and sometimes surgical extirpation of epileptic areas of the brain is necessary.

Drug treatment of epilepsy

• Anticonvulsants, also known as anticonvulsants, reduce the frequency, duration, and in some cases completely prevent seizures:
• Neurotropic drugs - can inhibit or stimulate the transmission of nervous excitation in various parts of the (central) nervous system.
• Psychoactive substances and psychotropic drugs affect the functioning of the central nervous system, leading to changes in mental state.
• Racetams are a promising subclass of psychoactive nootropic substances.

Antiepileptic drugs are chosen depending on the form of epilepsy and the nature of the attacks. The drug is usually prescribed in a small initial dose with a gradual increase until the optimal clinical effect occurs. If the drug is ineffective, it is gradually discontinued and the next one is prescribed. Remember that under no circumstances should you change the dosage of the medicine or stop treatment on your own. A sudden change in dose can provoke a worsening of the condition and an increase in attacks.

Non-drug treatments

• Surgery;
• Voight method;
• Osteopathic treatment;
• Studying the influence of external stimuli that influence the frequency of attacks and weakening their influence. For example, the frequency of attacks may be influenced by the daily routine, or it may be possible to establish an individual connection, for example, when wine is consumed and then washed down with coffee, but this is all individual for each organism of a patient with epilepsy;
• Ketogenic diet.

Epilepsy and driving

Each state has its own rules for determining when a person with epilepsy can obtain a driver's license, and several countries have laws requiring physicians to report patients with epilepsy to the registry and inform patients of their responsibility for doing so. In general, patients can drive a car if they have been seizure-free for 6 months to 2 years (with or without drug treatment). In some countries, the exact duration of this period is not defined, but the patient should obtain a doctor's report that the seizures have stopped. The doctor is obliged to warn the patient with epilepsy about the risk he is exposed to when driving with such a disease.

Most people with epilepsy, with adequate seizure control, attend school, enter the workforce, and lead relatively normal lives. Children with epilepsy tend to have more problems at school than their peers, but every effort should be made to enable these children to learn well through additional support in the form of tutoring and counseling.

How is epilepsy related to sex life?

Sexual behavior is an important but very private part of life for most men and women. Studies have shown that approximately a third of people with epilepsy, regardless of gender, have sexual problems. The main causes of sexual dysfunction are psychosocial and physiological factors.

Psychosocial factors:

• limited social activity;
• lack of self-esteem;
• rejection by one of the partners of the fact that the other has epilepsy.

Psychosocial factors invariably cause sexual dysfunction in various chronic diseases, and are also a cause of sexual problems in epilepsy. The presence of attacks often leads to a feeling of vulnerability, helplessness, inferiority and interferes with the establishment of normal relationships with a sexual partner. In addition, many fear that their sexual activity may trigger attacks, especially when attacks are triggered by hyperventilation or physical activity.

There are even known forms of epilepsy when sexual sensations are a component of an epileptic attack and, as a result, form a negative attitude towards any manifestations of sexual desires.

Physiological factors:

• dysfunction of brain structures responsible for sexual behavior (deep brain structures, temporal lobe);
• changes in hormonal levels due to attacks;
• an increase in the level of inhibitory substances in the brain;
• decreased levels of sex hormones due to medications.

Decreased sexual desire occurs in approximately 10% of people receiving antiepileptic drugs, and is more pronounced in those taking barbiturates. A rather rare case of epilepsy is increased sexual activity, which is an equally serious problem.

When assessing sexual disorders, it is necessary to take into account that they can also be the result of improper upbringing, religious restrictions and negative experiences of early sexual life, but the most common cause is a violation of the relationship with a sexual partner.

Epilepsy and pregnancy

Most women with epilepsy are able to carry an uncomplicated pregnancy and give birth to healthy children, even if they are taking anticonvulsants at this time. However, during pregnancy, the course of metabolic processes in the body changes; special attention should be paid to the levels of antiepileptic drugs in the blood. Sometimes relatively high doses must be prescribed to maintain therapeutic concentrations. Most affected women whose condition was well controlled before pregnancy continue to feel well during pregnancy and childbirth. Women whose seizures are not controlled before pregnancy are at higher risk of developing complications during pregnancy.

One of the most serious complications of pregnancy, toxicosis, often manifests itself as generalized tonic-clonic seizures in the last trimester. Such seizures are a symptom of a severe neurological disorder and are not a manifestation of epilepsy, occurring no more often in women with epilepsy than in others. Toxicosis must be corrected: this will help prevent the occurrence of seizures.

The offspring of women with epilepsy have a 2-3 times increased risk of embryonic malformations; This appears to be due to a combination of the low incidence of drug-induced malformations and genetic predisposition. Congenital defects observed include fetal hydantoin syndrome, characterized by cleft lip and palate, heart defects, digital hypoplasia, and nail dysplasia.

The ideal for a woman planning a pregnancy would be to stop taking antiepileptic drugs, but it is very likely that in a large number of patients this will lead to a recurrence of seizures, which in the future will be more detrimental to both mother and child. If the patient's condition allows discontinuation of treatment, this can be done at a suitable time before pregnancy. In other cases, it is advisable to carry out maintenance treatment with one drug, prescribing it in the minimum effective dose.

Children chronically exposed to barbiturates in utero often present with transient lethargy, hypotension, restlessness, and often exhibit signs of barbiturate withdrawal. These children should be included in the risk group for the development of various disorders during the neonatal period, slowly removed from the state of barbiturate dependence, and their development should be closely monitored.

There are also seizures that are similar to epileptic, but are not. Increased excitability due to rickets, neurosis, hysteria, disturbances of the heart and breathing can cause such attacks.

Affective - respiratory attacks:

The child begins to cry and at the height of the crying stops breathing, sometimes he even goes limp, falls unconscious, and there may be twitching. Help for affective attacks is very simple. You need to take as much air into your lungs as possible and blow on the child’s face with all your might, or wipe his face with cold water. Reflexively, breathing will be restored and the attack will stop. There is also yactation, when a very small child rocks from side to side, it seems as if he is rocking himself to sleep before going to bed. And those who already know how to sit rock back and forth. Most often, yactation occurs if there is no necessary emotional contact (happens in children in orphanages), rarely - due to mental disorders.

In addition to the listed conditions, there are attacks of loss of consciousness associated with disturbances in the activity of the heart, breathing, etc.

Impact on character

Pathological excitation of the cerebral cortex and seizures do not go away without leaving a trace. As a result, the psyche of a patient with epilepsy changes. Of course, the degree of mental change largely depends on the personality of the patient, the duration and severity of the disease. Basically, there is a slowdown in mental processes, primarily thinking and affects. As the disease progresses, changes in thinking progress; the patient often cannot separate the important from the unimportant. Thinking becomes unproductive, has a concrete-descriptive, stereotyped character; Standard expressions predominate in speech. Many researchers characterize it as “labyrinthine thinking.”

According to observational data, according to the frequency of occurrence among patients, character changes in epileptics can be arranged in the following order:

• slowness,
• viscosity of thinking,
• heaviness,
• hot temper,
• selfishness,
• rancor,
• thoroughness,
• hypochondriacity,
• quarrelsomeness,
• accuracy and pedantry.

The appearance of a patient with epilepsy is characteristic. Slowness, restraint in gestures, taciturnity, sluggish facial expressions, lack of expression on the face are striking; you can often notice a “steel” shine in the eyes (Chizh’s symptom).

Malignant forms of epilepsy ultimately lead to epileptic dementia. In patients with dementia, it manifests itself as lethargy, passivity, indifference, and resignation to the disease. Sticky thinking is unproductive, memory is reduced, vocabulary is poor. The affect of tension is lost, but obsequiousness, flattery, and hypocrisy remain. The result is indifference to everything except one’s own health, petty interests, and egocentrism. Therefore, it is important to recognize the disease in time! Public understanding and full support are extremely important!

Is it possible to drink alcohol?

Some people with epilepsy choose not to drink alcohol at all. It is well known that alcohol can provoke seizures, but this is largely due to individual susceptibility, as well as the form of epilepsy. If a person with seizures is fully adapted to a full life in society, then he will be able to find a reasonable solution to the problem of drinking alcohol. Acceptable doses of alcohol consumption per day are for men - 2 glasses of wine, for women - 1 glass.

Is it possible to smoke?

Smoking is harmful - it is well known. There was no direct connection between smoking and the occurrence of attacks. But there is a fire hazard if an attack occurs while smoking unattended. Women with epilepsy should not smoke during pregnancy, so as not to increase the risk (already high) of malformations in the child.

Important! Treatment is carried out only under the supervision of a doctor. Self-diagnosis and self-medication are unacceptable!

Partial seizures make up a significant portion of epileptic seizures in childhood - up to 40% in some studies. Partial seizures are divided into simple and complex; During simple partial seizures, consciousness is preserved; complex partial seizures are accompanied by impaired consciousness. Simple partial seizures.

Motor manifestations- the most common symptom of simple partial seizures. Motor manifestations of seizures include asynchronous clonic or tonic seizures with a tendency to involve muscles of the face, neck, and extremities. Reversible seizures involve a combination of head and eye rotation and are a particularly common type of simple partial seizure. Automatisms are uncommon in simple partial seizures, but some patients report an aura (eg, chest discomfort and headache) that may be the only manifestation of the attack.

Children experience have difficulty describing the aura and often express their sensations as a “strange feeling”, saying “I felt bad” or “something is crawling inside me.” On average, the attack lasts for 10-20 seconds. A distinctive characteristic of simple partial seizures is the preservation of consciousness and speech function during the attack. In addition, the attack is not accompanied by post-attack symptoms. Simple partial seizures can be mistaken for tics; however, tics manifest themselves in the form of shrugging the shoulders, blinking the eyes, and the appearance of grimaces on the face and primarily involve the muscles of the face and shoulder girdle.

Patient may suppress tics for a short time, but simple ones cannot be controlled. During simple partial seizures, the EEG may show uni- or bilateral spikes or a pattern of multifocal spikes.

Complex partial seizures may debut as simple partials in combination with or without an aura, followed by impairment of consciousness; in other cases, consciousness may be impaired already at the beginning of a complex partial seizure. An aura, which is a vague unpleasant sensation, epigastric discomfort, or fear, is observed in approximately 1/3 of children with simple and complex partial seizures. The presence of an aura always indicates a partial type of attack. Partial seizures are difficult to diagnose clinically in infants and older children, and their frequency may be underestimated.

U babies and children, it is difficult to determine a violation of consciousness, since it can manifest itself in the form of a short-term freezing of the child with an empty, fixed gaze, a sudden cessation or interruption of his activity; Often such episodes go unnoticed by parents. In addition, in most cases, the child is not able to inform adults about these conditions and describe them. Finally, periods of altered consciousness may be short and infrequent, and only an experienced observer or EEG results can identify these episodes.

Automatisms- a common symptom of complex partial seizures in infancy and childhood, occurring in 50-75% of cases; The older the child, the higher the frequency of automatisms. They arise after a disturbance of consciousness and can also persist in the post-attack phase, but the child does not remember about them. In infants, nutritional automatisms are pronounced: lip licking, chewing, swallowing and excessive salivation. Such motor manifestations can occur in normal infants, so they are difficult to differentiate from automatisms in complex partial seizures.

Prolonged or repeated automatisms in combination with a fixed “absent” gaze or lack of response to others and loss of contact almost always indicate complex partial seizures in young children. In older children, there are involuntary, uncoordinated, chaotic gestural automatisms (the child fiddles with, sorts through clothes or linen, rubs, strokes objects), automatisms in the form of undirected walking or running; the movements can be repetitive and often have an intimidating effect.

Spread of epileptiform discharge during complex partial seizures can lead to their secondary generalization into tonic-clonic seizures. When epileptiform activity spreads to the opposite hemisphere, the head turns in the opposite direction, dystonic attitudes may appear, as well as tonic or clonic convulsions in the limbs and face, including blinking of the eyes. The average duration of a complex partial seizure is 1-2 minutes and significantly exceeds the duration of a simple partial seizure or absence seizure.

During the interictal period in children with complex partial seizures, the EEG often shows sharp waves or focal spikes in the anterior temporal region and multifocal spikes. Approximately 20% of infants and children with complex partial seizures have an interictal routine EEG without pathology. In these patients, it is possible to use various methods of provoking epileptiform activity (spikes and sharp waves) on the EEG, including recording after sleep deprivation, the use of zygomatic electrodes, long-term EEG monitoring, video-EEG study in the hospital after temporary withdrawal of anticonvulsants.

In addition, some children with complex partial seizures, spikes and sharp waves on the EEG are recorded in the frontal, parietal or occipital leads. When using neuroimaging methods (CT and, especially, MRI) in children with complex partial seizures, pathological changes are most often found in the temporal lobes and represent mesial temporal sclerosis, hamartoma, postencephalitic gliosis, barachnoid cyst, infarction, arteriovenous malformations and slowly growing glioma.

Etiology and pathophysiology
Pathological electrical discharges emanating from focal brain lesions cause partial seizures, which can manifest themselves in different ways.
- Specific manifestations depend on the location of the damage (pathology of the parietal lobe can cause paresthesia on the opposite limb when walking; with pathology of the temporal lobe, bizarre behavior is observed).
The causes of focal brain damage can be stroke, tumor, infectious process, congenital defects, arteriovenous malformations, trauma.
The disease can begin at any age, since this type of epilepsy is acquired.
Often onset in adults, the cause is usually cerebrovascular pathology or neoplasm.
In adolescents, the most common cause is head injury or an idiopathic form of the disease.
Simple partial seizures are focal sensory or motor disturbances that are not accompanied by loss of consciousness.
During complex partial seizures, a brief loss of consciousness occurs, often in the presence of bizarre sensations or actions (eg, dreams, automaticity, olfactory hallucinations, chewing or swallowing movements); This usually occurs against the background of pathology of the temporal or frontal lobes.
All partial seizures can lead to secondary generalized tonic-clonic seizures.

Differential diagnosis
Absence.
TIA/stroke.
Migraine.
Psychogenic conditions.
Pseudoconvulsions.
Transient global amnesia.

Symptoms
Simple partial seizures are not accompanied by loss of consciousness.
- Classified according to clinical manifestations, including: focal motor seizures, focal sensory seizures, and seizures accompanied by mental disorders.
- Mental disorders: deja vu (from the French “already seen”), jamais vu (from the French “never seen”), depersonalization, a feeling of the unreality of what is happening.
- Often progress to complex partial seizures.
During complex partial seizures, a short-term loss of consciousness occurs (30-90 s), followed by a post-convulsive period lasting 1-5 minutes.
- Automaticity - aimless actions (pinching clothes, smacking lips, swallowing movements).

Diagnostics
The diagnosis is often made based on a witness's account.
- With complex partial seizures, the patient does not remember the attack; The witness describes the patient's gaze into nowhere and minor manifestations of automatism.
- Simple partial seizures are self-described by the patient, noting focal twitching of a limb, focal sensory disturbances occurring most often on one side of the body or one limb, or mental symptoms such as deja vu.
The EEG often shows focal abnormalities, including focal slow or spiky wave discharges.
Multiple EEG monitoring may be required.
In unclear cases, long-term video monitoring of the patient may be required to record an attack.
MRI allows you to determine focal pathology.

Treatment
There are many drug therapy options, including phenytoin, carbamazepine, oxcarbazepine, phenobarbital, primidone, zonisamide, topiramate, lamotrigine, tiagabine, and levetiracetam.
- The choice of drug is most often determined by possible side effects and additional data (for example, the likelihood of pregnancy, drug interactions, age and gender of the patient).
- It is necessary to periodically monitor the level of the drug in the blood, the results of a clinical blood test, platelets and liver function indicators.
If drug therapy is ineffective, other treatment methods are used: surgical removal of the focus of seizure activity or installation of a vagus nerve stimulator.

Important Notes
Simple and complex partial seizures very often recur; these variants of seizures are often refractory to drug therapy, even combined.
Remission is possible, but it is difficult to predict how often disease-free periods will occur; the likelihood of remission is higher in patients with a rapid response to drug therapy and minor changes in the EEG. The prognosis also depends on the etiology of the seizures, with more severe injuries and strokes being accompanied by more resistant seizures.
For refractory seizures, surgical treatment improves the results of drug therapy in 50% of cases.

Epilepsy is considered a polyetiological disease, since there are many different causes of its occurrence. The lesion may affect the entire brain or individual parts of it.

Partial seizures occur in the presence of psychoneurological diseases, characterized by high electrical activity of neurons and a prolonged course of the disease.

Features of the disease

Partial epileptic seizures can occur at any age. This occurs due to the fact that structural changes lead to disturbances in the psychoneurotic status of a person. There is also a decrease in intelligence.

Partial seizure in epilepsy is a neurological diagnosis that indicates the chronic course of brain diseases. The main feature is the occurrence of convulsions of varying strength, shape, as well as the nature of the course.

Main classification

Partial seizures are characterized by the fact that they affect only a certain part of the brain. They are divided into simple and complex. Simple ones, in turn, are divided into sensory and vegetative.

Sensory hallucinations are mainly accompanied by hallucinations, which can be:

• auditory;
• visual;
• taste.

It all depends on the location of the lesion in certain parts of the brain. In addition, there is a feeling of numbness in a certain part of the body.

Autonomic partial seizures occur when the temporal region is damaged. Among their main manifestations it should be noted:

• rapid heartbeat;
• heavy sweating;
• fear and depression.

Complex partials are characterized by a slight impairment of consciousness. The lesion extends to areas responsible for attention and consciousness. The main symptom of this disorder is stupor. In this case, a person literally freezes in one place; in addition, he can make various involuntary movements. When he regains consciousness, he does not understand what is happening to him during the attack.

Over time, partial seizures may develop into generalized seizures. They form completely suddenly, since both hemispheres are affected simultaneously. With this form of the disease, examination will not reveal foci of pathological activity.

Simple seizures

This form is characterized by the fact that a person’s consciousness remains normal. Simple partial seizures are divided into several types, namely:

• motor;
• sensory;
• vegetative.

Motor seizures are characterized by simple muscle contractions and limb spasms. This may be accompanied by involuntary turns of the head and torso. Chewing movements worsen and speech stops.

Sensory seizures are characterized by numbness in the limbs or half of the body. If the occipital region is affected, there may be visual hallucinations. In addition, unusual taste sensations may appear.

Vegetative seizures are characterized by the occurrence of unpleasant sensations, salivation, the release of gases, and a feeling of tightness in the stomach.

Complex seizures

Such violations occur quite often. They are characterized by much more pronounced symptoms. Complex partial seizures are characterized by a change in consciousness and the inability to make contact with the patient. In addition, spatial disorientation and confusion may occur.

The person is aware of the course of the attack, but at the same time cannot do anything, does not react to anything, or makes all movements involuntarily. The duration of such an attack is 2-3 minutes.

This condition is characterized by the following symptoms:

• rubbing hands;
• involuntary licking of lips;
• fear;
• repetition of words or sounds;
• a person moves to different distances.

There may also be complex seizures with secondary generalization. The patient fully retains all memories of the onset of the attack right up to the moment of loss of consciousness.

Causes

The causes of partial epileptic seizures are not yet fully known. However, there are certain provoking factors, in particular such as:

• genetic predisposition;
• neoplasms in the brain;
• traumatic brain injuries;
• developmental defects;
• cysts;
• alcohol addiction;
• emotional shock;
• drug addiction.

Often the underlying cause remains unidentified. The disease can occur in a person at any age, but teenagers and the elderly are at particular risk. For some, epilepsy is not very severe and may not manifest itself throughout life.

Causes in children

Partial motor seizures can occur at any age in both infants and adolescents. Among the main reasons it is necessary to highlight the following:

• injuries received during childbirth;
• intrauterine negative factors;
• cerebral hemorrhages;
• chromosomal pathologies;
• brain damage and injury.

It is worth noting that with timely treatment, the prognosis is quite favorable. By about 16 years of age, you can completely get rid of the disease. Treatment of children is carried out through surgery, medication or a special diet. Proper nutrition will allow you to get the desired result and get rid of the disease much faster.

In some cases, epileptic seizures appear during the first 3 months of a child's life. The symptoms are similar to cerebral palsy. Seizures are mainly caused by various genetic defects. The disease can lead to dangerous developmental defects. It is worth noting that many children suffering from this disease die.

Main symptoms

Symptoms of partial seizures in all patients are purely individual. The simple form is characterized by the fact that it occurs with preservation of consciousness. This form of the disease mainly manifests itself in the form of:

• unnatural muscle contractions;
• simultaneous turning of the eyes and head in one direction;
• chewing movements, grimaces, drooling;
• stopping speech;
• feeling of heaviness in the stomach, heartburn, flatulence;
• olfactory, visual and gustatory hallucinations.

Complex attacks occur in approximately 35-45% of affected people. They are predominantly accompanied by complete loss of consciousness. A person understands exactly what is happening to him, but at the same time he is simply not able to respond to someone addressing him. At the end of the attack, complete amnesia is generally observed, and then the person does not remember what exactly happened to him.

Often, the resulting focal pathological activity covers both hemispheres of the brain at once. In this case, a generalized seizure begins to develop, which often manifests itself in the form of a convulsion. Complex forms of the disease manifest themselves as:

• the emergence of negative emotions in the form of severe anxiety and fear of death;
• experiencing or concentrating on events that have already occurred;
• feelings of unreality of what is happening;
• emergence of automatism.

Being in a familiar environment, a person may perceive it as unfamiliar, which causes a feeling of panic. The patient can observe himself as if from the outside and identify with the characters of recently read books or watched films. He can also constantly repeat monotonous movements, the nature of which is determined by the area of ​​brain damage.

In the period between attacks at the initial stage of the disorder, a person may feel quite normal. However, after some time, symptoms begin to progress and brain hypoxia may occur. This is accompanied by the appearance of sclerosis, headaches, and personality changes.

If partial convulsive seizures occur very often, then you must know how to provide first aid to a person. If an attack occurs, you must:

• make sure that it is really epilepsy;
• place the person on a flat surface;
• turn the patient's head to the side to avoid suffocation;
• do not move a person or do so if there is danger for him.

You should not try to control the convulsions, and it is strictly forbidden to perform artificial respiration or chest compressions. After the end of the attack, you need to give the person the opportunity to come to his senses and urgently call an ambulance and hospitalize the patient in a hospital. It is imperative to provide timely assistance to the victim, since such seizures can lead to the death of the patient.

To make a diagnosis of complex partial seizures, the neurologist prescribes a thorough examination, which necessarily includes:

• taking anamnesis;
• carrying out an inspection;
• conducting ECG and MRI;
• study of the fundus;
• conversation with a psychiatrist.

To detect damage to the subarachnoid region, asymmetry or deformation of the ventricles of the brain, pneumoencephalography is indicated. Seizures of partial epilepsy must be differentiated from other forms of the disorder or severe disease. That is why the doctor may prescribe additional research techniques that will help make a more accurate diagnosis.

Features of treatment

Treatment of partial seizures must begin with a comprehensive diagnosis and identification of the causes that provoked the attack. This is required to eliminate and completely stop epileptic seizures, as well as to minimize side effects.

It is worth noting that if the disease occurs in adulthood, it cannot be cured. In this case, the essence of therapy is to reduce attacks. To achieve stable remission, antiepileptic drugs are prescribed, in particular, such as:

• "Lamictal".
• "Carbamazepine".
• "Topiramate."
• "Depakine."

To get the best possible result, your doctor may prescribe combination medications. If drug therapy does not bring the required result, then neurosurgical surgery is indicated. Surgical intervention is resorted to if conservative treatment methods do not bring the required result, and the patient suffers from frequent seizures.

When performing meningoencephalolysis, craniotomy is performed in the area that caused the epilepsy. The neurosurgeon very carefully excises everything that irritates the cerebral cortex, namely the membrane, which is changed by scar tissue, and exostoses are also removed.

Horsley surgery is sometimes performed. Her technique was developed by an English neurosurgeon. In this case, the affected cortical centers are removed. If attacks provoke the formation of scar tissue on the membranes of the brain, then such an operation will not produce any results.

After eliminating the irritating effect of scars on the brain, the seizures will stop for a while, but very quickly scars will form again in the area of ​​the operation, which will be much larger than the previous ones. After Horsley's operation, monoparalysis of the limb whose motor centers were removed may occur. In this case, the seizures immediately stop. Over time, the paralysis goes away on its own and is replaced by monoparesis.

The patient permanently retains some weakness in this limb. Often, over time, seizures reappear, which is why surgery is prescribed as a last resort. Doctors prefer to initially carry out conservative treatment.

For minor epilepsy that is not provoked by serious pathologies, treatment is possible by eliminating irritants using osteopathic techniques. For this purpose, massage or acupuncture treatment is indicated. Physiotherapeutic techniques and adherence to a special diet also provide good results.

It is worth noting that the disease manifests itself much weaker and less frequently in the absence of stress, normal nutrition, and adherence to a daily routine. It is also important to give up bad habits that are strong provoking factors.

Forecast

The prognosis of epilepsy can be very different. Often the disease is treated quite effectively or goes away on its own. If the disease occurs in older people or has a complex course, the patient is under the supervision of a doctor throughout his life and must take special medications.

Most types of epilepsy are completely safe for human life and health, but during attacks the possibility of accidents must be excluded. Patients learn to live with the disease, avoid dangerous situations and provoking factors.

Epilepsy is very rare and is associated with severe brain damage, which can cause dangerous damage to internal organs, changes in consciousness, loss of connection with the outside world, or paralysis. During the course of the disease, the prognosis depends on many different factors, namely:

• area of ​​focus of convulsive activity and its intensity;
• causes;
• presence of concomitant diseases;
• patient's age;
• the nature and level of changes in the brain;
• reaction to drugs;
• type of epilepsy.

Only a qualified specialist can give an accurate prognosis, therefore it is strictly forbidden to self-medicate. It is important to immediately consult a doctor when the first signs of illness appear.

Prevention

Prevention of any type of epilepsy is to maintain a healthy lifestyle. To prevent frequent recurrence of seizures, you need to completely give up smoking, drinking alcohol, and caffeine-containing drinks. It is strictly forbidden to overeat, and you should also avoid exposure to harmful, provoking factors.

It is important to strictly adhere to a certain daily routine, as well as follow a special diet. In order to prevent the occurrence of partial seizures after head injuries and operations, a course of antiepileptic drugs is prescribed.