Previously, epilepsy was called a divine disease or epilepticus, and people in whom it manifested itself were stigmatized, that is, they were given a psychological stigma in society, and in most cases it was negative. Even in our space age, in some countries people who are diagnosed with generalized or focal epilepsy are not allowed to work in many professions, drive a car, or engage in certain types of leisure activities, for example, diving.
There is a popular belief that an epileptic seizure always looks like this: a patient falls to the ground, begins to cramp, and foam appears from his mouth. If a person is covered with dark cloth at this moment, the attack passes, and the patient falls asleep. In fact, epilepsy can manifest itself in different ways, and they treat it in specialized medical institutions. One of the best in Russia is ankylosing spondylitis, which uses modern methods of diagnosis and treatment. Patients and their relatives have a lot of questions regarding focal epilepsy: where does it come from, is it inherited, is it contagious, why are small children suffering from epilepsy, can it be cured completely, what is it fraught with, how much is life-threatening and many others. In this article we will try to give complete information about this disease.
Epilepsy is ...
To begin with, we will explain what kind of ailment it is - focal epilepsy. In the human nervous system there are microscopically small structural and functional formations called neurons. Their specific structure allows them to store and transmit information from other same units, as well as from muscles and glands. In fact, any body reaction is determined by the behavior of these tiny particles. In the human brain, there are more than 65 billion of them. Many of them intertwined and created the so-called neural network. Figuratively, they can be represented as a kind of harmonious system that lives according to its own laws. Epileptic seizures appear when sudden (paroxysmal) electrical discharges occur in neurons that disrupt their work. This can occur with many diseases, most of which are related to neuroses of various etiologies. There is focal epilepsy and generalized. The word "focal" comes from the Latin "focus". Epilepsy is considered focal when the excitation of neurons is focused in one place (focus) or, quite simply, there is a lesion of a certain part of the brain. Epilepsy is considered generalized (general) when a lesion either immediately affects both hemispheres of the brain, or, having arisen in a certain place, spreads to the entire brain.
Classification
In 1989, the preexisting classification of focal epilepsy and its symptoms was updated. Now, in the framework of this pathology, the following syndromes are distinguished:
1. Idiopathic.
2. Symptomatic.
3. Cryptogenic.
In generalized syndromes of idiopathic and symptomatic epilepsy are distinguished.
There are also a number of conditions where both focal and generalized signs are present.
Idiopathic focal epilepsy
This type of pathology develops when brain neurons begin to work more actively than necessary. In this case, a so-called epileptic focus is formed, in which excessive electrical discharges are generated, but the patient does not have structural brain lesions. At first, the body in response to this creates a kind of protective shaft around the focus. When the discharges acquire an intensity that allows them to escape beyond its limits, a person has an epileptic seizure. The cause of idiopathic epilepsy in the vast majority of cases is a congenital mutation in the genes, so it can be hereditary. This pathology can manifest itself at any age, but often its first signs are observed in children. By contacting specialists in a timely manner, the disease can be eliminated, and without proper treatment, patients begin structural changes in the cerebral hemispheres, which leads to various neurological disorders, including mental activity. Epilepsy in children is benign because there is no threat to life. It is classified by the location of the focus of active neurons and it happens:
- temporal lobe;
- occipital;
- primary reading epilepsy.
Symptoms and clinic of temporal lobe epilepsy
As the name implies, this type of pathology is diagnosed if the focus of too active neurons is concentrated in the temple area. Temporal focal epilepsy can occur in infancy for the following reasons:
- perinatal (birth) injury;
- lack of oxygen in the blood (hypoxemia) that occurs for various reasons, one of which is fetal asphyxiation during childbirth;
- post-traumatic gliosis in the temporal region.
In adults, pathology can develop for the following reasons:
- disorders in the cerebral vessels;
- cerebral infarction;
- injuries.
With this pathology, an epileptic attack passes without loss of consciousness, and its precursors (aura) may be present or absent. Patients may experience auditory, gustatory or visual hallucinations, dizziness, sometimes pain in the peritoneum, nausea, discomfort in the heart, suffocation, chills, arrhythmia, fear, thoughts of changing the course of time, feelings of one's own body.
If the excitation of neurons leaves the focal area and spreads to both hemispheres of the brain, that is, epilepsy passes from focal to generalized, seizures can occur with loss of consciousness, impaired memory, falling, but without seizures. Also, in this phase of the disease, patients may experience repeated actions - patting hands, scratching, sobbing, repeating some sounds, blinking.
With the progression of temporal lobe epilepsy, seizures called secondary generalized are observed. They are characterized by loss of consciousness, falling patient, cramps in any muscles.
The main cure for this form of epilepsy is the carbamazepine preparation, and if there is no effect, replacement therapy is carried out. In extremely severe cases, surgical intervention is indicated.
Clinic and symptoms of occipital epilepsy
This pathology is also considered benign and occurs at any age, but in 76% of cases, its manifestations are recorded in babies aged 3 to 6 years. Occipital focal epilepsy in children is characterized by the fact that attacks with it can occur with large differences and can be short (about 10 minutes) or long (more than 30 minutes, sometimes several hours).
Approximately 10% of patients have only autonomic disorders (nausea, usually ending with vomiting, headache, poor health, lethargy, high sweating, pallor, or, conversely, redness of the skin, cough, impaired cardiac function, myiasis, mydriasis, urinary incontinence , temperature rise).
Approximately 80% of patients experience deviation (incorrect position) of the eyes. Most often, the child looks away.
In 26% of reported cases, hemiclonia (erratic muscle twitching) is observed.
And finally, in 90% of cases, autonomic symptoms may be accompanied by loss of consciousness.
1/5 of children may experience convulsions, Jackson's march, and some may have blindness or bright hallucinations.
At the end of the attack, the child feels normal, without neurological symptoms and intellectual problems.
The duration of the attacks and vegetative symptoms very frighten the parents, who think that the child may die. However, help with an epileptic seizure of short duration is not required. If the attack in the occipital epilepsy is protracted and has pronounced autonomic symptoms, emergency care consists of injecting intravenously benzodiazepines. If a child’s seizures often occur, prophylactic treatment with carbamazepine is carried out.
Primary reading epilepsy
The most rare manifestation of the disease that occurs in boys compared to girls in a 2: 1 ratio. This form of epilepsy manifests itself in early school age. Attacks begin with chin trembling, twitching of the muscles of the lower jaw, less commonly observed difficulty in breathing, sensory deviations during reading, especially if done out loud. When the first precursors appear, the child should stop reading, otherwise the attack can develop into a strong fit. Some parents, and teachers, too, do not take this condition of the child seriously, but reading epilepsy must be treated, since in the future attacks may begin to appear during games, when talking or eating. The main cure for this form of epilepsy is Valproate. Also, doctors can prescribe "Flunarizin" and "Clonazepam."
Symptomatic focal epilepsy
This pathology is diagnosed when there are structural disorders in the cerebral cortex, the cause of which is reliably determined. Symptomatic epilepsy is recorded in adults and children with approximately the same frequency. The causes of its occurrence may be:
- traumatic brain injuries of any etiology;
- infectious diseases;
- viral diseases;
- cervical dysplasia;
- hypertension;
- spinal osteochondrosis;
- defects of the nervous system;
- oxygen starvation (asphyxia);
- many diseases of the internal organs;
- newborns have birth injuries.
Symptomatic epilepsy can manifest itself even several years after injuries or diseases.
Classification of symptomatic epilepsy
In this pathology, four forms are distinguished, depending on the location of structural changes:
- temporal lobe;
- parietal;
- occipital;
- frontal.
Also in this group, Kozhevnikovsky syndrome (chronic and simultaneously progressive epilepsy) and a syndrome in which focal epilepsy attacks begin due to any external stimuli, for example, after a sudden awakening, are distinguished.
Symptomatic temporal epilepsy is characterized by impaired hearing, logical thinking, and behavior.
When frontal, speech disorders, memory loss, quick wit, and other cognitive deviations from age norms are most often observed.
Occipital epilepsy entails visual impairment, fatigue, impaired coordination of movements.
The parietal has in the asset of its symptoms convulsions, paresis, impaired motor functions.
Attacks with symptomatic epilepsy can be simple (minor autonomic, motor and sensory deviations with a working consciousness), complex (impaired consciousness and internal organs) and secondarily generalized (loss of consciousness, convulsions, significant autonomic disorders).
With symptoms of epilepsy, you need to contact a neurologist or psychiatrist in your clinic. An excellent reputation is enjoyed by the Bekhterev Clinic in St. Petersburg, where, among others, the Department of Neurology and Child Psychiatry operates. There is a modern diagnostic base, biochemical, hormonal, general studies of the material are carried out, the factors of coronary risk are determined, drugs are monitored, functional diagnostics, ultrasound, ECG, and vascular examination are performed.
Cryptogenic focal epilepsy
The word "cryptogenic" is derived from the Greek "crypto", which means "hidden", "hidden". The diagnosis of cryptogenic epilepsy is made when the cause of the disease cannot be identified. Quite often, such a pathology is observed in people over 16 years old. Possible causes may include various head injuries, tumors, many diseases, and circulatory disorders. The uncertainty of the cause of the disease makes it difficult to treat. In this case, if possible, it is advisable to contact the central clinics, where there is a diagnostic base with modern advanced equipment, for example, the Brain Institute (St. Petersburg). Here, experienced specialists carry out an expanded study of blood vessels in the head, electroencephalography, electroneuromyography, studies of brain potentials and a whole range of biochemical and laboratory analyzes.
The clinical picture of seizures with cryptogenic epilepsy can be very different. Attacks with this pathology are observed with or without loss of consciousness, with symptoms of autonomic disorders, with or without seizures, seizures of varying intensity and duration, or simply minor motor and / or sensory disturbances.
The following forms are distinguished at the focus site of the focus of overexcited neurons:
- in the right hemisphere;
- in the left hemisphere;
- in the deep segments of the brain;
- cryptogenic focal frontal epilepsy.
Cryptogenic epilepsy may also be accompanied by Lennox-Gastaut syndrome. It is observed more often in boys from 4 to 6 years old and consists in involuntary flinching, loss of muscle tone, fall and loss of consciousness.
Treatment
First aid for an epileptic seizure should be provided by relatives and others, on whose eyes this happened. What to do? The algorithm is as follows:
- protect the patient from dangerous objects so that he does not accidentally get injured;
- if a person falls, put something soft under his head;
- loosen the fasteners (buttons, zipper) on the neck and chest;
- after the patient has come to his senses, heal the wounds, if any;
- call an ambulance.
What not to do:
- keep a person convulsing;
- open the patient's teeth;
- try to give him water or medicine.
The treatment of epilepsy is carried out after establishing the cause of the disease and making an accurate diagnosis, therefore, if possible, it is advisable to contact specialized clinics, for example, the Institute of the Brain (St. Petersburg), the Clinic for Restorative Neurology (Moscow) and other specialized medical institutions where there are epileptologists.
The treatment of epilepsy is carried out in several directions:
- a decrease in the frequency and duration of seizures;
- preventing the appearance of new attacks;
- anesthesia;
- achievement of the patient's condition, in which you can cancel the medicine.
In some cases, compulsory treatment in specialized psychiatric clinics may be used. Treatment methods include medication, diet, osteopathy, Voight's method, and in complex cases, surgery.