Epilepsy is a chronic disease of the central nervous system of various etiologies, manifested in the body’s predisposition to the spontaneous development of repeated unprovoked convulsive and non-convulsive paroxysms.
This pathology is characteristic not only of people, but also of animals.
An important element of the clinical picture of epilepsy (not obligate!) are mental changes:
- paroxysmal - these are components of focal paroxysm or its only manifestation (fear, delight, forced thinking, violent memories); this also includes psychomotor agitation or confusion after an attack;
- periodic - severe mood changes (dysphoria) that last up to several weeks; less often - epileptic psychoses;
- chronic mental disorders are typical for incurable patients; manifest themselves in a narrowing of the range of interests, pathological thoroughness, pedantry, importunity, and other changes, up to epileptic dementia.
The international classification of epilepsy, approved in 1989, identifies three main forms of this disease(by origin).
Classification of epileptic seizures
There is an opinion that epilepsy is necessarily a classic, “expanded” convulsive seizure, accompanied by loss of consciousness; in reality, epilepsy can also manifest itself non-convulsive seizures(eg absence symptomatic epilepsy in children).
Epilepsy seizures can look different; it depends on the origin of the disease, the location of the outbreak, and individual characteristics.
Seizures that recur throughout the day are considered a single event.
All seizures in epilepsy can be classified into two large groups: primary generalized seizures and partial (focal) seizures.
An epileptic attack occurs (provided the person is predisposed to this phenomenon) as a result of excessive discharges of neurons in the epileptic focus. Such “epileptic” neurons are located, as a rule, on the periphery of an epileptogenic focus resulting from trauma, perinatal lesions, a tumor process, or for other reasons. A seizure occurs when a discharge from a pathological focus spreads to the entire brain (this is how a generalized seizure is formed) or part of it (then a partial seizure occurs).
Repeated epileptic seizures both focal and generalized, may depend on various factors:
Partial seizures (focal, local seizures)
Symptoms are determined by the localization of the pathological focus. The most typical are motor (with damage to the precentral gyrus) Jacksonian seizures, affecting the part of the body corresponding to the affected area of the gyrus, or sensory Jacksonian paroxysms (with a focus in the postcentral gyrus) in the form of paresthesia, photopsia, auditory or olfactory hallucinations.
- Simple partial seizures- occur without a change in consciousness. Depending on the manifestations, motor, somatosensory, and vegetative-visceral are distinguished.
- Complex partial seizures. The main components are derealization, depersonalization, hallucinations, automatisms. The attacks either begin simply and may be accompanied by automatisms, or they immediately begin with a change in consciousness. Attacks of perception disturbance in the form of visual or auditory hallucinations, depersonalization (unusual perception of sensations coming from the body that the patient cannot describe) or derealization (unusual perception of the environment “objects have changed”, “everything is somehow different”, “everything is dim) are possible. ", "everything is motionless", "everything is unusual"). Often during such an attack, familiar things become unrecognizable.
- Secondary generalized partial seizures ends in generalized convulsions
Generalized seizures
Clinically characterized by loss of consciousness and severe massive vegetative manifestations. May be accompanied by motor phenomena involving the muscles of both sides. The electroencephalogram shows symmetrical, synchronous bilateral epileptic discharges.
Generalized tonic-clonic seizure (« expanded», grand mal) manifests itself in the form of tonic-clonic seizures. It is characterized by pronounced autonomic disorders (the most significant of which is apnea). The pulse is frequent, blood pressure is increased, hyperhidrosis, mydriasis, areflexia of the pupils to light. At the end of the attack - involuntary urination due to severe general atony and relaxation of the sphincters.
Each phase of a generalized tonic-clonic seizure has corresponding electroencephalographic phenomena: low-amplitude rhythm in the initial phase, progressive increase in the amplitude of island-wave discharges in clonic phase, joining each peak of a slow wave (forming a peak wave) in a tonic. The seizure ends with a slowdown in electrical activity or the appearance of slow waves that replace epileptic discharges.
Initial phase of the seizure lasts a few seconds. Characterized by loss of consciousness, dilated pupils, and bilateral muscle twitching.
Tonic phase. Lasts up to 20 seconds. Convulsive tension is expressed throughout the skeletal muscles, and more so in the extensor muscles. The eyes may be open, with the eyeballs tilted upward and laterally.
Clonic phase. Duration 30 to 40 seconds. Generalized spasm is periodically interrupted by episodes of muscle relaxation, which initially last for several seconds and gradually lengthen. This phase is characterized by tongue bite and intermittent vocalization (“clonic wheeze”). Progressively lengthening, pauses of relaxation turn into atony (epileptic coma) - the patient cannot be awakened during this period.
The return of consciousness occurs after a few minutes, unevenly, appearing and disappearing again. Possible twilight state of consciousness, disorientation.
Unexpanded convulsive seizure manifests itself either only tonic or clonic convulsions. Coma does not develop at the end of such an attack; the patient either immediately returns to consciousness or after a period of excitement.
In a newborn child, an undeveloped seizure may be characterized by asynchronization of seizures on the right and left sides of the body; In addition, the child’s attack is sometimes accompanied by vomiting.
Absence (petit mal, non-convulsive, petit mal seizure).
Simple absence seizure
lasts seconds and therefore often goes unnoticed; characterized by interruption of movement (“the patient resembles a statue with a blank look”); there is no consciousness, there is a moderate dilation of the pupil, pallor or hyperemia of the face. The patient himself is not aware of absence seizures; he may not even know about them.
Complex absence seizure is characterized by the fact that the clinical picture of simple absence is accompanied by elementary automatisms (rolling the eyes, fidgeting with the fingers ( "absence of automatisms"), myoclonus of the muscles of the shoulder girdle or eyelids ( "myoclonic absence"), or a fall due to muscle atony ( "atonic absence").
Unclassified epileptic seizures
This group includes all types of epileptic seizures that cannot be included in any of the above categories due to the lack of necessary information; This also includes some cases of neonatal seizures (in a newborn child they can be manifested, in particular, by rhythmic movements of the eyeballs, “chewing” or “spitting” movements).
Diagnostics
Electroencephalography has become widespread for diagnosing epilepsy. Peak-wave complexes or asymmetrical slow waves, which indicate the presence of an epileptogenic focus and its localization.
Epileptiform changes on the encephalogram are not always the basis for the diagnosis of epilepsy, but in some cases they may be a justification for prescribing anticonvulsant therapy.
Treatment
Basic strategic provisions in the treatment of epilepsy:
Tactics - maximum individualization of the approach to each patient.
The main goal of antiepileptic therapy is improving the patient's quality of life.
Before prescribing antiepileptic drugs, all factors provoking seizures in the patient should be eliminated: for a child prone to febrile seizures, immediately administer an antipyretic; in case of reflex attacks, avoid provocations.
When choosing an antiepileptic drug, one should be guided by the form of epilepsy and the type of epileptic seizure.
For symptomatic and cryptogenic epilepsy, barbiturates (in particular, phenobarbital), valproate, lamotrigine, and carbamazepine are effective. It should be remembered that phenobarbital can cause a state of hyperactivity in a child).
For secondary generalized seizures, it is advisable to use valproic acid drugs.
For absence epilepsy The drugs of choice are succinimides, in particular ethosuximide, possibly in combination with valproate.
Diacarb is effective as an additional remedy for all types of seizures (especially for epileptic seizures in a child), since in addition to the dehydration effect, it also has true antiepileptic activity.
The dosage regimen and dosage depend on the following factors:
Question about stopping antiepileptic therapy is decided strictly individually. The basis for revising the treatment regimen is the complete absence of epileptic seizures. Only in this case is it permissible to reduce the dose of antiepileptic drugs.
Status epilepticus requires emergency assistance. At this stage, to relieve convulsive syndrome (symptomatic therapy), diazepam is slowly administered intravenously (it is safer for the child to administer diazepam rectally; this will not reduce the effectiveness).
Successful treatment is possible only with a committed partnership between the doctor and the patient.
Epilepsy- a chronic progressive disease that occurs most often in childhood and adolescence, is characterized by brain damage, the presence of seizure disorders, personality changes, and leads to dementia over time. There are idiopathic (primary) and symptomatic (secondary) epilepsy. Idiopathic epilepsy is an epileptic disease in which there is no organic damage to the central nervous system and is hereditary.
Etiology and pathogenesis
Epilepsy is a disease with many causes. Heredity is of great importance; if there are people in the family with this disease, then the likelihood of developing epilepsy in the child is high. The process of pregnancy and childbirth in the mother, infectious diseases, and head injuries are affected.
It is widely believed that the cause is a pathology of the membranes of neurons in the central nervous system.
The pathogenesis of the idiopathic generalized form of epilepsy lies in the pathological excitability of the cerebral cortex, the cause of such excitability is associated with genetic factors. An abnormal impulse occurs that is not suppressed due to instability of the neuron membranes. It spreads along the nervous system and leads to symptoms of the disease.
In the local form of idiopathic epilepsy, an abnormal focus forms in the brain, which emits signals that cause paroxysms of epilepsy.
Types of seizures
To select a treatment method, it is determined which type of seizure predominates in an epileptic attack.
Focal (local) types of seizures:
- Simple without impairment of consciousness. They are divided into: motor (motor); for seizures with sensory symptoms (illusions, hallucinations); with vegetative signs (abdominal pain, sweating).
- Simple with impaired consciousness (damage to speech, thinking, perception, emotions).
- Difficult with impaired consciousness.
Generalized:
- absence seizures, typical and atypical;
- myoclonic spasms;
- clonic seizures;
- tonic.
Generalized seizures
Generalized seizures are severe types of paroxysms, accompanied by a short-term loss of consciousness.
Absence seizures- common types of attacks of idiopathic generalized epilepsy. They manifest themselves as attacks with loss of consciousness, a small amount of motor activity, and freezing. Absence seizures are divided into simple And complex. Simple ones include freezing without physical activity. Complex ones include an attack with low rates of movement.
Absence seizures with IGE begin with freezing with tonic movements: throwing back the head, rolling the eyes. Then myoclonic (trembling of the eyelids, nose, shoulders) and atonic (head drooping) phenomena may join.
There is also a vegetative component of absence seizure: change in skin color, involuntary urination. The attacks last from 2 to 30 seconds.
Another type - seizures with generalized tonic-clonic manifestations and the presence of an aura. The aura begins before attacks. Manifested by vegetative changes: fever, change in complexion, nausea, vomiting. There are hallucinations, elevated mood, feelings of fear, and anxiety.
Seizures are associated with waking up and falling asleep. Cramps can be triggered by a decrease in sleep duration, falling asleep late and waking up at an unusual time. The attack lasts from 30 seconds to 10 minutes.
Tonic phenomena consist of a strong tone of all groups of skeletal muscles, clonic - in the contraction of individual muscles, unilateral or bilateral. After regaining consciousness, the muscles return to normal.
Forms of the disease in children
There are several forms of epilepsy in children.
Benign local epilepsy
Otherwise called Rolandic epilepsy, it is manifested by pharyngeal-oral and unilateral facial motor seizures that occur during falling asleep and waking up. This is a common type of paroxysm in children. The disease manifests itself in childhood from 2 to 14 years. Mostly boys are affected.
It is characterized by simple partial paroxysms that appear during falling asleep and waking up. It all starts with paresthesia, loss of sensitivity in the oropharynx, gums, and tongue.
Then the children make sounds like when gargling, a large amount of saliva is released. Twitching of the facial muscles appears: clonic, tonic and clonic-tonic convulsions of the muscles of the mouth, pharynx, and facial muscles. In some patients, the cramps spread to an arm or leg. Attacks can develop into generalized paroxysms.
Benign myoclonic epilepsy of newborns
These are generalized paroxysms in the form of myoclonic convulsions. It begins between the age of three months and the age of four years. It is manifested by nodding movements of the head and lifting of the torso and shoulders, movements of the elbows to the sides. Consciousness is preserved, attacks gradually become more frequent.
In such children, muscle tone is reduced, the psyche develops normally.
Doose syndrome
Doose syndrome - myoclonic-astatic paroxysms. It begins in children from one year of age to 5 years. Manifested by asynchronous contraction of the muscles of the limbs. The attacks are short-lived. Nodding movements with lifting of the body may appear. Consciousness is preserved.
Seizures occur frequently, sometimes several per minute, called status epilepticus.
In such children, coordination of movements is impaired, the central nervous system is affected, and they are lagging behind in mental development.
Childhood and juvenile absence seizure
Juvenile and childhood absence seizures are generalized seizures lasting several seconds, with absence, freezing, and a small number of motor contractions.
Rare forms of the disease
Panayiotopoulos syndrome- benign childhood idiopathic partial epilepsy with occipital seizures and early onset in the period from 1 year to 13 years. Attacks in this form are severe.
Characterized by autonomic disorders and a long absence of consciousness, they occur during sleep: first vomiting, then the head and eyes turn in one direction. Paroxysms become generalized. Attacks occur rarely, 1-2 times throughout the entire medical history.
Gastaut syndrome- benign epileptic syndrome with occipital seizures and late onset from the age of three to 15 years. The attacks are simple, lasting from several seconds to several minutes, during which visual hallucinations occur. After the attack, patients experience severe headache with nausea and vomiting.
Diagnostics
For treatment to be effective, it is necessary to detect the disease in the early stages of its development.
First, the cause of epilepsy is determined - whether it is hereditary or developed after suffering injuries or diseases. The doctor interviews the patient and his relatives, conducts a neurological and mental examination.
There are a number of methods for diagnosing epileptic seizures to clarify the diagnosis and select a treatment method:
- EEG - electroencephalography. Allows you to determine convulsive readiness, epilepsy activity, and the location of pathological impulses.
- EEG monitoring - recording an electroencephalogram for several days with video recording of the patient's behavior.
- CT scan of the head (computed tomography). Conducted to diagnose formations in the brain and previous traumatic brain injuries.
- Magnetic resonance examination. Superficial brain damage is detected.
- Rheoencephalographic study (REG) is used to diagnose the condition of the vessels of the head and neck.
Treatment
Therapy is selected and carried out by a neurologist together with a psychiatrist. Treatment of idiopathic epilepsy takes place in the neurological department of a hospital or in a clinic on an outpatient basis.
Drug therapy should be long-term and continuous, i.e. about 5 years after the last attack, it should be carried out with appropriate medications.
Treatment begins with doses of anticolvulsants appropriate to the type of attack. If necessary, therapy is carried out with several types of drugs. Patients take complex vitamins, biostimulants, and follow a diet.
If conservative therapy is ineffective, surgical treatment is started. Highlight resective operations and functional.
Indications for resective types of operations for idiopathic epilepsy are a confirmed diagnosis of drug-resistant epilepsy and visualization of pathogenic foci in the brain.
Functional Operations- palliative. Indications for these types of operations are the impossibility of resective surgical interventions for intractable epilepsy and the high risk of complications after surgery.
Forecast
The prognosis for epileptic disease varies. A complete recovery, an outcome with changes in the brain, or death are possible. The risk of complications is higher in young children, since their nervous system is not perfect.
CT and MRI scans in patients with epilepsy reveal changes in the form of atrophy of the cerebral cortex.
Mortality is 18% for somatic epilepsy and 1% for idiopathic epilepsy.
Generalized epilepsy, also known as primary generalized epilepsy or idiopathic epilepsy, is a form of epilepsy that is characterized by generalized seizures without an obvious etiology.
Generalized epilepsy, unlike partial epileptic seizures, is a type of seizure that reduces the patient's consciousness and distorts the electrical activity of all or most of his brain.
Generalized epilepsy causes epileptic activity in both hemispheres of the brain, which can be recorded on electroencephalography (EEG).
Generalized epilepsy is a primary condition, as opposed to secondary epilepsy, which occurs as a symptom of a disease.
Types of attacks
Seizures of generalized epilepsy can manifest as absence seizures, myoclonic seizures, clonic seizures, tonic-clonic seizures, or atonic seizures in various combinations.
Generalized epilepsy seizures can occur in a variety of seizure syndromes, including myoclonic epilepsy, familial neonatal seizures, absence epilepsy, infantile spasms, childhood myoclonic epilepsy, and Lennox-Gastaut syndrome.
Forms of the disease
During attacks of generalized epilepsy, a person usually loses consciousness. But sometimes an attack can be so short that the patient does not notice it. During an attack, the patient's body muscles may tense and/or begin to twitch, and the person may fall unexpectedly.
The different types of generalized seizures include:
- tonic-clonic seizures;
- tonic seizures;
- atonic seizures;
- myoclonic seizures;
- absence seizures.
Symptoms
Tonic-clonic seizures
There are two phases in tonic-clonic seizures – tonic (tonic) seizures and clonic.
During the tonic phase, a person loses consciousness, his body becomes uncontrollable and he falls.
During the clonic phase, the patient's limbs begin to twitch, bladder or bowel control may be lost, the tongue or inner cheek may be bitten, and teeth may be clenched.
The person may stop breathing or have difficulty breathing, and the person may develop blue circles around the mouth.
After a tonic-clonic seizure, the patient may experience headaches, fatigue, and feel very unwell.
The symptoms of a tonic seizure appear as tonic-clonic seizures. However, in a tonic seizure, it does not reach the muscle twitching stage (clonic stage).
During atonic seizures, a person loses the tone of all muscles and falls. These seizures are very short and usually allow the person to get up immediately. However, physical injury can also occur during these seizures.
Myoclonic seizures
Myoclonic seizures typically involve isolated or brief muscle jerks that can affect some or all parts of the body.
Seizures are usually very short (lasting a fraction of a second) to affect a person's consciousness. Muscle twitching can range from mild to very strong.
Absence seizures
Absence seizures in generalized epilepsy usually develop in children and adolescents. The two most common types of absence seizures are typical and atypical absences.
Typical absence seizures
In a typical absence seizure, the person's unconscious state usually lasts only a few seconds. He seems to be lost in thought, or "switched off" for a second. Minor twitching of the body or limbs may occur. With prolonged absence seizures, a person may perform brief, repetitive actions. During an attack, a person does not know what is happening around him and cannot be brought out of this state. Some people experience up to hundreds of absence seizures per day.
Atypical absence seizures
This type of absence seizure is similar to typical absence seizures, but they last longer.
In atypical absence seizures, there is less loss of consciousness and less change in muscle tone.
The person can move around, but becomes clumsy and needs help.
During atypical absence seizure, a person may be unable to respond to stimuli.
Diagnostics
Generalized tonic-clonic seizures occur in many different types of epilepsy, and it is difficult to establish an accurate diagnosis of generalized epilepsy based solely on the descriptive or even observational portion of the seizure.
The first difference is determining whether there is actually an event that triggered the attack.
If the inciting stimulus cannot be identified, the second step to determine whether underlying idiopathic generalized epilepsy is present is to conduct appropriate investigations.
The result can be achieved by carefully monitoring the patient's medical history and using EEG and/or MRI studies, with periodic Video-EEG monitoring to fully characterize the epileptic syndrome.
If studies determine that presenting features reflect idiopathic generalized epilepsy, additional studies will be required based on careful assessment of seizure types, age of onset, family history, response to therapy, and ancillary data.
The disease can be analyzed for the absence of myoclonic, tonic-clonic, atonic, tonic and clonic seizures.
The patient may experience one type of seizure or a combination of several, depending on the underlying disease syndrome. As a result, the picture of the disease can be very different, and a full cycle of studies is required to make the correct diagnosis.
Treatment and therapy
There are seven main antiepileptic drugs recommended for the treatment of primary generalized epilepsy:- Felbamate;
- Levetiracetam;
- Zonisamide;
- Topiramate;
- Valproate;
- Lamotrigine;
- Perampanel.
Valproate is a relatively old drug that has shown high efficacy and is often considered a first-line treatment. However, its association with fetal malformations when taken during pregnancy limits its use in young women.
All antiepileptic drugs, including those listed above, can be used in cases of partial attacks of generalized epilepsy.
Conclusion
Generalized epilepsy often begins in childhood. For some patients, this type of epilepsy disappears during adolescence and they no longer require any treatment. But, in some cases, this condition remains with the patient for life, which requires lifelong treatment and monitoring by specialists.
Video on the topic
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Protocols for diagnosis and treatment of the Ministry of Health of the Republic of Kazakhstan (2006, outdated)
Generalized idiopathic epilepsy and epileptic syndromes (G40.3)
general information
Short description
Generalized epilepsy(HE) is a chronic brain disease characterized by repeated attacks with impairment of motor, sensory, autonomic, mental or mental functions, resulting from excessive neural discharges in both hemispheres of the brain.
GE is a single disease, representing separate forms with electro-clinical features, approach to treatment and prognosis.
Protocol code: 01-009a "Generalized epilepsy in children, acute period"
Profile: pediatric
Stage: hospital
Purpose of the stage:
1. Reducing the frequency of attacks.
2. Achieving remission.
Period of occurrence
Duration of treatment: 14 days
Classification
According to the International Classification of 1989 (International League Against Epilepsy), generalized epilepsy is based on the generalization of epileptic activity.
Within GE, forms are distinguished: idiopathic, symptomatic and cryptogenic.
Generalized types of epilepsy and syndromes:
1. Idiopathic (with age-dependent onset) - ICD-10: G40.3:
- benign familial neonatal seizures;
- benign idiopathic neonatal seizures;
- benign myoclonic epilepsy of early childhood;
- childhood absence epilepsy - ICD-10: G40.3;
- juvenile absence epilepsy;
- juvenile myoclonic epilepsy;
- epilepsy with awakening seizures;
- other types of idiopathic generalized epilepsy - ICD-10: G40.4;
- epilepsy with seizures provoked by specific factors.
2. Cryptogenic and (or) symptomatic (with age-dependent onset) - ICD-10: G40.5:
- West syndrome (infantile spasms);
- Lennox-Gastaut syndrome;
- epilepsy with myoclonic-astatic seizures;
- epilepsy with myoclonic absence seizures.
3. Symptomatic:
3.1 Nonspecific etiology:
- early myoclonic encephalopathy;
- early infantile epileptic encephalopathy with “flare-suppression” complexes on the EEG;
- other types of symptomatic generalized epilepsy.
3.2 Specific syndromes.
Risk factors and groups
Perinatal pathology (hypoxic-ischemic, traumatic encephalopathy, intrauterine infections, dysmetabolic factors);
Genetic disposition;
Congenital malformations of the central nervous system;
CNS infections;
Pathology of cerebral vessels;
Brain tumors;
Brain injuries.
Diagnostics
Diagnostic criteria:
Presence of seizures;
The nature of the attacks;
Family predisposition;
Age of debut;
EEG data;
Duration of the attack;
Course and prognosis.
List of main diagnostic measures:
1. Echoencephalography.
2. General blood test.
3. General urine analysis.
List of additional diagnostic measures:
1. Computed tomography of the brain.
2. Nuclear magnetic resonance imaging of the brain.
3. Consultation with a pediatric ophthalmologist.
4. Consultation with an infectious disease specialist.
5. Consultation with a neurosurgeon.
6. Analysis of cerebrospinal fluid.
7. Biochemical blood test.
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Treatment
The first doctor who detects an epileptic seizure should describe it in detail, including the signs that preceded the seizure and occurred after it ended.
Patients should be referred for a complete neurological examination to confirm the diagnosis and determine the etiology.
Treatment of epilepsy begins only after an accurate diagnosis has been established. According to most experts, treatment for epilepsy should begin after a recurrent attack.
Treatment of epilepsy should be carried out depending on the form of epilepsy, and then on the nature of the attacks - with the basic drug for this form of epilepsy. The starting dose is approximately 1/4 of the average therapeutic dose. If the drug is well tolerated, the dosage is increased to approximately 3/4 of the average therapeutic dose over 2-3 weeks.
If there is no or insufficient effect, the dose is increased to the average therapeutic dose.
If there is no effect from the therapeutic dose within 1 month, a further gradual increase in the dose is necessary until a pronounced positive effect is obtained or side effects appear.
In the absence of a therapeutic effect and signs of intoxication appear, the drug is gradually replaced with another.
If a pronounced therapeutic effect is obtained and side effects are present, it is necessary to assess the nature and severity of the latter, then decide whether to continue treatment or replace the drug.
Replacement of barbiturates and benzodiazepines should be done gradually over 2-4 weeks or more due to the presence of severe withdrawal syndrome. Replacement of other antiepileptic drugs (AEDs) can be carried out more quickly - in 1-2 weeks. The effectiveness of the drug can be assessed only no earlier than 1 month from the start of its use.
Antiepileptic drugs used for generalized seizuresseizures and gastrointestinal tract
|
Epileptic seizures |
Antiepileptic drugs |
||
|
1st choice |
2nd choice |
3rd choice |
|
|
Tonic-clonic |
Valproate |
Difenin Phenobarbital Lamotrigine |
|
|
tonic |
Valproate |
Difenin Lamotrigine |
|
|
clonic |
Valproate |
Phenobarbital |
|
|
myoclonic |
Valproate |
Lamotrigine Suximides Phenobarbital |
Clonazepam |
|
atonic |
Valproate |
Clobazam |
|
|
Absence seizures Typical Atypical Myoclonic |
Valproate Suximides Valproate Lamotrigine Valproate |
Clonazepam Clobazam Clonazepam Clobazam Clonazepam |
Ketogenic diet |
|
Individual forms epileptic syndromes and epilepsy |
|||
|
Neonatal myoclonic encephalopathy |
Valproate Carbamazepines |
Phenobarbital Corticotropin |
|
|
Infantile epileptic encephalopathy |
Valproate Phenobarbital |
Corticotropin |
|
|
Complicated febrile seizures |
Phenobarbital |
Valproate |
|
|
West syndrome |
Valproate |
Corticotropin Nitrazepam |
Large doses pyridoxine Lamotrigine |
|
Lennox syndrome- Gastaut |
Valproate |
Lamotrigine Immunoglobulins |
Ketogenic diet |
|
Lennox syndrome- Gastaut with tonic attacks |
Valproate Topiramate Lamotrigine Felbamate |
Carbamazepines Succinimides Benzodiazepines Hydantoids |
Corticosteroids hormones Immunoglobulins Thyrotropin - releasing hormone |
|
Myoclonic astatic epilepsy |
Valproate |
Clobazam Corticotropin |
Ketogenic diet |
|
Absence sickness for children |
Suximides |
Valproate |
Clonazepam |
|
Absence sickness for children combined with generalized tonic-clonic attacks |
Valproate |
Difenin Lamotrigine |
Acetazolamide (diacarb) |
|
Absence teenage |
Valproate |
Valproate in combined with suximides |
|
|
Myoclonic juvenile benign |
Valproate |
Lamotrigine |
Difenin |
|
Epilepsy waking up with generalized tonic-clonic attacks |
Valproate Phenobarbital |
Lamotrigine |
|
List of essential medications:
1. *Valproic acid 150 mg, 300 mg, 500 mg tab.
2. Clobazam 500 mg, 1000 mg tablet.
3. Hexamidine 200 tablets.
4. Ethosuximide 150-300 mg tablet.
5. *Clonazepam 25 mg, 100 mg tablet.
6. Carbamazepines 50-150-300 mg tablet.
7. *Acetozolamide 50-100-200 mg tablet.
List of additional medications:
1. *Difenin 80 mg tablet.
2. *Phenobarbital 50 mg, 100 mg tablet.
3. *Lamotrigine 25 mg, 50 mg tablet.
Criteria for transfer to the next stage of treatment - outpatient:
Reduction of attacks;
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Generalized epilepsy
Generalized epilepsy is one of the types of neurological disorder in which the patient temporarily loses consciousness during epileptic attacks. In most cases, this form of the disease is congenital (occurs when the brain is damaged in newborns). However, a symptomatic variant of the development of generalized epilepsy cannot be excluded.
The disease is characterized by multiple symptoms. Symptomatic epilepsy is treated mainly with medication.
If children in the first few years of life experience bilateral seizures (convulsions affecting the right and left limbs) and a short-term loss of consciousness is noted, this is idiopathic generalized epilepsy. This disease is chronic, but if diagnosed early, it can be easily corrected.
Neurological disorder occurs under the influence of various factors. Idiopathic epilepsy develops against the background of a genetic predisposition. Moreover, the likelihood of such a pathology occurring in children whose parents suffer from generalized epilepsy is 10%.
The development of the disease after a person’s birth is due to the following factors:
- traumatic brain injury;
- infectious diseases affecting the brain (meningitis, encephalitis and others);
- brain tumors of various types;
- feverish state (more often provokes epileptic seizures);
- some hereditary pathologies.
In children, secondary (symptomatic) generalized epilepsy occurs against the background of birth injuries, infection during intrauterine development, abnormal brain structure, and fetal hypoxia.
What types of generalized epilepsy is divided into?
Pathology is classified into three types: idiopathic, symptomatic and cryptogenic. What is idiopathic epilepsy? This form is caused by congenital developmental abnormalities. Often the onset of generalized pathology of the idiopathic type is observed in patients under the age of 21, so idiopathic epilepsy in children is not uncommon.
With this form, accompanying clinical symptoms are not diagnosed, with the exception of neurological seizures. Sometimes scattered phenomena occur. In rare cases, focal (localized) symptoms are disturbing. With generalized idiopathic epilepsy, the patient retains clarity of thought and other cognitive functions. However, it is possible that there are some intellectual disorders that disappear over time. On average, such disorders are observed in 3-10% of patients.
Secondary epilepsy (symptomatic) occurs at any age, which is explained by the cause of the disease. If the pathology is caused by congenital malformations, then the first attacks occur in childhood.
In symptomatic generalized epilepsy, seizures are part of a larger clinical picture.
The cryptogenic form is diagnosed in cases where it is impossible to establish the causes of the development of a neurological disorder.
Clinical picture of symptomatic epilepsy
There are two most common forms of symptomatic epilepsy, which can become generalized: partial and temporal lobe.
The first type of disease manifests itself in the form of simple seizures, during which twitching of the limbs is noted. In symptomatic partial epilepsy, convulsive movements are usually performed by the arms and legs. As the generalized pathology progresses, muscle twitching is observed in other parts of the body. In extreme cases, the disease causes loss of consciousness.
The following signs of symptomatic epilepsy of a generalized nature are less commonly diagnosed:
- the patient sees surrounding objects in a curved projection;
- presenting pictures that do not correspond to reality;
- lack of speech while maintaining the integrity of the corresponding muscles;
- illusions (incorrect perception of reality) and hallucinations (rare).
Temporal and parietal localization of the pathological focus is more typical for children. The manifestation of an epileptic seizure is often preceded by an aura, in which the patient experiences headaches and deterioration in general condition. Subsequently, attacks of generalized epilepsy occur with accompanying symptoms such as loss of consciousness, convulsions and other phenomena.
In the symptomatic form of the disease, signs of neurological symptoms in the interictal period are often absent. In the absence of seizures, clinical phenomena characteristic of concomitant pathologies that provoked epilepsy come to the fore.
Symptoms depending on the type of seizure
There are three types of epileptic seizures:
- typical absence seizures;
- tonic-clonic;
- myoclonic.
Typical absence seizures most often appear in childhood. This form of attack is characterized by a temporary loss of consciousness. From the outside, absence seizure looks as if the patient has frozen and his gaze remains motionless. Also, during an attack of this type, the skin of the face often turns red or pale.
Complex absence seizures are characterized by muscle twitching, involuntary rolling of the eyes, and other actions that the patient does not control. During prolonged attacks, the patient loses orientation in space and is not aware of what is happening around. It is impossible to force the patient out of this state. The number of attacks during the day can reach 100.
There is such a thing as atypical absence seizure. This attack lasts longer, but the intensity of general symptoms (changes in muscle tone, duration of unconsciousness) is lower than with other forms of seizures. With atypical absence seizures, the patient retains some motor activity and the ability to respond to external stimuli.
During tonic-clonic seizures, all muscle groups first tense (tonic phase), after which convulsions occur (clonic phase). These phenomena occur against the background of complete loss of consciousness.
The tonic phase lasts about 30-40 seconds, the clonic phase – up to 5 minutes.
The onset of an epileptic attack following this scenario is indicated by the following signs:
- complete loss of consciousness (the patient falls);
- clenched teeth;
- bitten lips or inner cheeks;
- breathing is difficult or absent;
- blue skin around the mouth.
At the end of the clonic phase, involuntary urination often occurs. As soon as the attack ends, patients usually fall asleep. After waking up, you may experience headaches and severe fatigue.
Myoclonic seizures involve involuntary and localized muscle twitching. Convulsions are observed both in individual areas and throughout the body. An important feature of myoclonic seizures is symmetrical muscle twitching. During the attack, the patient remains conscious, but some hearing loss (temporary deafness) is possible. Myoclonic seizures usually last no more than one second.
Pediatric generalized epilepsy
Generalized epilepsy in children is predominantly idiopathic in nature. At the same time, in this category of patients, various factors can provoke epileptic seizures, including:
- allergic reactions;
- helminthic infestations;
- elevated body temperature and other childhood diseases.
Idiopathic epilepsy with generalized convulsive seizures in childhood occurs mainly in the form of absence seizures, which are characterized by temporary shutdown (but not loss) of consciousness. The presence of symptomatic epilepsy in children may be indicated by:
- regular visits to everything;
- sudden attacks of fear;
- unexpected mood changes;
- causeless pain in various parts of the body.
Symptomatic epilepsy with rare generalized seizures in children has a complicated history. The disease is difficult to correct due to the fact that it develops due to congenital anomalies.
In medical practice, it is customary to distinguish two syndromes characteristic of epilepsy in children:
- West syndrome;
- Lennox-Gastaut syndrome.
The first syndrome is more often detected in infants. It is characterized by muscle spasms that cause uncontrollable nodding. West syndrome mainly develops with organic brain damage. In this regard, the prognosis for the development of the disease is unfavorable.
Lennox-Gastaut syndrome first manifests itself after two years and is a complication of the previous one. The pathological deviation causes atypical absence seizures, which over time can cause a generalized attack of epilepsy. With Lennox-Gastaut syndrome, dementia develops very quickly and there is a lack of coordination of movements. The disease in this form is not amenable to drug treatment due to complications that arise, which lead to changes in the patient’s personality.
Diagnosis of generalized epileptic seizures
To establish what symptomatic epilepsy is, the doctor interviews, first of all, the patient’s close relatives in order to find out the presence of certain symptoms, the nature of the attacks and other information. Based on this, diagnostic measures are selected.
Generalized idiopathic epilepsy and accompanying syndromes (if we are talking about children) are diagnosed using an electroencephalogram. This method allows not only to determine the presence of the disease, but also to identify the localization of pathological foci in the brain.
Generalized epileptiform activity on the EEG is characterized by a change in the normal rhythm. The peculiarity of this form of the disease is the presence of several pathological foci, which are shown by an electroencephalogram.
To exclude other types of epilepsy, diagnose MRI and CT scan of the brain. Using these methods, it is possible to identify the localization of pathological foci. If generalized epilepsy of the idiopathic form is determined, consultation and examination with a geneticist will be required to detect congenital pathologies.
How to treat?
If symptomatic epilepsy is suspected, the doctor determines what it is and how to treat the disease. Self-diagnosis in this case will not lead to the desired results, since the pathology is characterized by symptoms characteristic of cardiac and pulmonary dysfunction, hypoglycemia, psychogenic paroxysms, and somnambulism.
The basis for the treatment of symptomatic epilepsy is valproic acid preparations:
- "Lamorigine";
- "Felbamat";
- "Carbamazepine";
- "Topiomat" and others.
Taking most valproic acid medications is contraindicated for pregnant women. Epilepsy of any type is well controlled with Clonezepam. However, this medicine becomes addictive relatively quickly, and therefore the effectiveness of drug therapy decreases over time. In children, Clonezepam provokes impairment of cognitive functions, which manifests itself in developmental delays.
As soon as generalized epilepsy begins, it is important to immediately remove hard and sharp objects from the patient and place the patient on something soft. If the duration of an epileptic attack exceeds 5 minutes, it is necessary to call a medical team. In other cases, the patient's condition returns to normal without outside intervention.
Generalized epilepsy in children is treated through a combination of surgery, which involves removing the lesion in the brain, and drug therapy.
Forecast
The prognosis for generalized epilepsy depends on the form of the disease. The idiopathic type, in the absence of adequate and timely treatment, provokes a delay in intellectual development. Generalized attacks in this form of pathology occur after reducing the dosage or discontinuing anticonvulsants.
After successful neurosurgical intervention, the likelihood of relapse according to the prognosis of idiopathic epilepsy is minimized.
The prognosis for the symptomatic form is determined by the characteristics of the concomitant pathology that caused disturbances in brain activity. For congenital malformations, treatment gives positive results in rare cases due to the body's high resistance to medications. If therapy for concomitant pathologies is successful, then a favorable outcome cannot be ruled out.