Epilepsy

Epilepsy is a condition characterized by recurrent epileptic seizures, the causes of which are still not completely clear. By itself, an epileptic seizure is a clinical manifestation of a special category of brain neurons that are in excess, and cause various kinds of pathological phenomena, among which the most obvious are: changes in consciousness, motor and sensory disorders, failures in the autonomic system.

The content of the article:
Classification of epilepsy attacks
Diagnosis of epilepsy
Clinical picture of epilepsy
Scheme of a secondary generalized attack
Differential diagnosis
Treatment of epilepsy
Prognosis for epilepsy
Prevention of epilepsy
Epilepsy
It is a mistake to believe that epileptic seizures are the cause or provoking factor of brain tumors.

Classification of epilepsy attacks
According to the international classification of epilepsy, there are two large categories of epileptic seizures: partial (which in turn are divided into focal and local); generalized.

Partial seizures are divided into two types:

Simple: they occur without any serious disturbances of consciousness, but with obvious motor, mental and vegetative symptoms of epilepsy;
Complex: occur with a clear deviation in the patient’s consciousness.
As for primary generalized seizures, they cover two hemispheres of the brain at once. Among the most common types of seizures are:

clonic;
absences (atypical and typical);
myoclonic;
tonic;
atonic;
tonic-clonic seizures.
It should also be said about epileptic seizures, the signs of which do not lend themselves to classification, since they do not fall under any of the types described above. Such atypical seizures include non-tonal seizures in the form of involuntary rhythmic eye movement or chewing movements.

In a separate category, there are such repeated epileptic seizures as accidental, cyclical or provoked. Prolonged seizures include epileptic status.

Diagnosis of epilepsy
Diagnosis of epilepsy is based on various medical history data, as well as on physical examination, EEG, CT, and MRI data obtained. First of all, the presence of epileptic seizures by a diagnostic doctor is determined based on the patient’s medical history and clinical data, as well as on the results of various studies (primarily instrumental and laboratory).

The second important step will be to conduct a differential diagnosis with the ability to find out exactly the type of epileptic seizure and its form. The doctor must necessarily inform the patient about what kind of daily routine he needs to follow, what medications to take, and whether there is a need for surgical treatment.

Although the diagnosis of epilepsy is based on the obtained clinical data, it should be known that in the absence of a clinic characteristic of epilepsy, the appropriate diagnosis will not be made only by the revealed epileptiform activity detected on the EEG.

EEG diagnostics
Usually the diagnosis is made by epileptologists or neurologists. The main method of examination of patients with this diagnosis is considered to be EEG. As is known, this method has no contraindications, it is carried out to all patients with suspected epilepsy in order to confirm or refute the fact of epileptic activity.

Among the most common types of epileptic activity, there are acute wave types, spikes and two complexes: peak and slow wave; acute wave and slow wave.

To date, diagnostic methods using computer EEG help to identify the exact localization of the pathological source. For example, at the time of an attack, the EEG helps to register epileptic activity, whereas in the interictal period, such activity is detected only in 50-55% of patients.

The EEG, together with the functional tests carried out, helps to detect changes occurring in the patient’s body. It should be said that if no epileptic activity was detected during the EEG, this does not mean that the patient does not have epilepsy. In this case, patients are assigned to conduct an additional examination, or alternatively, video monitoring after an EEG.

MRI diagnostics
In the diagnosis of this disease, neuroimaging methods are of great importance, presented in the form of MRI, shown to everyone without exception, especially to those patients who have a local onset of an epileptic seizure. It is the MRI that helps to confirm the appropriate diagnosis, as well as to identify the causes that provoked the disease.

MRI results indicate the presence of etiological factors of epilepsy. Patients who have been diagnosed with pharmacoresistant epilepsy are shown to undergo surgical treatment. They also undergo MRI, which allows them to determine the exact location of the affected areas of the central nervous system. Often, elderly patients are prescribed additional diagnostic methods, which may be blood tests, ECG or fundus examination.

Clinical picture of epilepsy
The epilepsy clinic talks about three periods:

ictal (the moment of the attack);
postictal (the moment following the attack; during this period, the symptoms of the disease may be completely absent, except for those symptoms that clearly indicate epilepsy: ischemic stroke, traumatic brain injury));
interictal (the time between seizures).
In addition to periods of epileptic seizures, there are several types of auras that accompany a partial epileptic seizure, among such auras: motor, speech, vegetative, mental, sensory.

Among the most typical symptoms of epilepsy are:

nausea;
headache;
dizziness;
general weakness;
feeling of compression in the throat and chest area;
numbness of the lips and tongue;
feeling of constant drowsiness;
sound hallucinations;
feeling of a lump in the throat;
paroxysms of an olfactory nature.
As is known, partial seizures of a complex type most often occur with the performance of so-called automated movements, which are characteristic of patients with epilepsy. In such cases, communicating normally with the patient will not work or is quite difficult.

Scheme of a secondary generalized attack
If we talk about a secondary generalized attack, then it begins very abruptly and spontaneously. The patient feels the aura for only a few seconds, after which loss of consciousness occurs and the patient falls. The patient falls to the floor with a cry inherent in him, which is explained by a spasm of the glottis and a strong convulsive contraction of the muscles located in the chest.
After that comes the tonic phase, which is so called because of tonic seizures. This type of convulsions stretches the trunk and limbs of a patient with a strong characteristic of epilepsy muscle tension. At the same time, the head usually tilts back or turns to the side, breathing slows down, the veins in the neck area become swollen, the face turns pale, cyanosis slowly appears, the patient’s jaw is tightly compressed.
The duration of this period is about 20 seconds. After that, a phase of a true epileptic seizure occurs, which is accompanied by clonic-type convulsions, noisy breathing and often foaming from the mouth appears in patients. The duration of this phase is 3 minutes. Before its completion, the frequency of seizures begins to decrease noticeably, and as a result, the muscles completely relax, until the patient is unable to respond to an external stimulus. After an attack, the pupils remain dilated, but there is no reaction to light radiation, as well as there are no tendon reflexes.
It should also be said about two special varieties of primary generalized seizures, which are characterized by the involvement of two hemispheres of the brain. We are talking about absences and tonic-clonic seizures. Usually absences are inherent in epilepsy in children. They are characterized by a sharp but quick stop of the child’s activity (for example, during a conversation, learning or playing). With absences, the child suddenly freezes and stops responding to external stimuli, stops responding, but after a few seconds he continues to do what he was doing before the attack. Children usually do not realize that something has happened to them, they do not remember their seizures. By their frequency, absences can reach 10-20 times a day.

Differential diagnosis
Epileptic seizures should be differentiated from non-epileptic conditions, which are fainting, vegetative disorders and psychogenic seizures.

Treatment of epilepsy
Any treatment chosen by a specialist for a patient, first of all, will be aimed at relieving epileptic seizures, as well as improving the patient’s life. In the future, at the stage of remission, the doctor will wean the patient from taking medications.

With timely and proper treatment, in most cases (70-75%), the patient recovers — epilepsy attacks stop. Before prescribing a whole list of medications, doctors conduct a thorough examination, analyze the obtained MRI or EEG data.

Usually, doctors always inform not only the patient, but also his family members about how to take medications correctly and about their possible side effects. Hospitalization will be necessary only if an epileptic seizure has developed for the first time in life or if there is already an epileptic status. They are also hospitalized if surgical intervention is necessary.

Monotherapy is important for drug treatment — when a single drug is prescribed that must be taken in minimal doses with its further increase until the complete relief of epileptic seizures. If the dosages of such a drug are not enough, then the doctor checks whether this medication is suitable for this patient, and if necessary, increases the dosage or prescribes another drug.

The use of any drug prescribed against epileptic seizures obliges the patient to undergo regular examination in order to determine the level of its concentration in the blood. Usually the most common drugs will be: pregabalin, valproic acid, levetiracetam, topiramate, lamotrigine, carbamazepine. The use of all these drugs is prescribed with minimal doses.

If epilepsy has been diagnosed for the first time, then traditional drugs such as carbamazepine or valproic acid are prescribed for treatment. Recently, antiepileptic drugs such as levetiracentam, topiramate and oxcarbazelin have become very popular. They are prescribed as part of monotherapy.

Choosing between traditional and modern medicines, one should remember about the individual characteristics of a person, about his individual tolerance, age-sex indicators.

If we talk about the therapy of epileptic seizures of unidentified genesis, then most often in this case the use of valproic acid is prescribed. However, no matter what medication is prescribed, doctors always strive to prescribe it in minimal doses and with a minimum frequency of administration (as a rule, no more than 2 times a day).

Due to the constant concentration of the drug used in the patient’s plasma, its effect is more effective. As is known, the dose injected into the body of an elderly patient differs in a much higher concentration than the same dose, but applicable to a young or middle-aged patient. In any case, monotherapy will begin with minimal doses and with their further titration. Cancel the drug as gradually as it is administered. The duration of monotherapy will depend on the form of epilepsy itself, the prognosis for recovery and the prognosis for the resumption of epileptic seizures.

This type of epilepsy, as pharmacoresistant (it is characterized by prolonged seizures), should be examined additionally in order to prescribe the correct treatment in the future. Pharmacoresistant epilepsy is not amenable to monotherapy, taking antiepileptic drugs is also ineffective. Surgical intervention is required here.

Before the operation, doctors conduct an additional examination using an EEG in order to register seizures and obtain accurate data on the location and individual characteristics of the epileptogenic zone. The latter can also be found out during an MRI of the brain.

Based on the results of the examination, doctors finally determine the nature of the disease and what type of surgery will be necessary in this case. Among the most common operations:

removal of epileptogenic brain tissue (by cortical topectomy, hemispherectomy or lobectomy);
callosotomy;
selective surgical intervention (for example, amygdalo-hippocampectomy);
stereotactic intervention;
vagus-stimulation.
There are certain indications and contraindications for each type of surgical intervention. It is possible to carry out one of the above operations only in specialized clinics, in neurosurgical departments, where there is appropriate equipment, and where highly qualified specialists in their field work.

Prognosis for epilepsy
The prognosis for recovery and further work activity of the patient will depend on the frequency of seizures. As practice shows, at the stage of remission, epileptic seizures rarely appear, most often at night. In most cases, the patient remains capable and able-bodied, can return to his usual activities and live a normal life. Having had epilepsy, it is very undesirable to work at night and go on business trips. From time to time, daytime seizures may resume, which are accompanied by loss of consciousness, thereby limiting a person’s habitual ability to work.

Epilepsy has a negative impact on all spheres of human life, so today this disease is considered one of the most significant socio-medical problems of mankind.

A big disadvantage for modern medicine is the fact that very little is still known about the nature of epilepsy, which means that it is also impossible to inform the patient properly.

The overwhelming majority of patients who have received proper and timely treatment continue to lead a normal life.

Prevention of epilepsy
First of all, preventive measures for epilepsy include the prevention of TBI, timely treatment of infectious diseases, intoxication, proper lowering of body temperature in case of fever, which is often a harbinger of the first epileptic attack.

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