Equivalents of convulsive seizures. Epileptic seizures and their equivalents

This group of painful symptoms includes paroxysmal mood disorders and consciousness disorders.

The term “psychic equivalents” (mental disorders that appear to be “equivalent” to him in place of a seizure) is not entirely accurate, since the same mood or consciousness disorders can also appear in connection with a seizure - before or after it.

Mood disorders.  In patients with epilepsy, mood disorders are most often manifested in attacks of dysphoria - a dreary-spiteful mood.

In such periods, patients are dissatisfied with everything, picky, gloomy and irritable, often present various hypochondriacal complaints, in some cases forming even into delusions of a hypochondriacal nature. Delusions in such cases appear paroxysmal and exist as long as the period of dysphoria lasts, from several hours to several days. Often fear is mixed with a melancholy-evil mood, sometimes dominating the clinical picture. Much less often, periodic mood disorders in patients with epilepsy are expressed in attacks of euphoria - a magnificent, inexplicable mood.

Some patients during bouts of dreary-spiteful mood begin to abuse alcohol or go to wander “wherever they look.” Therefore, a part of patients suffering from dipsomania (drunken drunkenness) or dromomania (desire to travel) are patients with epilepsy.

Disorders of consciousness. These disorders are expressed in paroxysmal appearance twilight state of consciousness.In this case, the patient’s consciousness narrows as if concentrically, and from the whole diverse external world he perceives only some part of phenomena and objects, mainly those that affect him emotionally at the moment. Figuratively, such a state is compared with the state of a person walking along a very narrow corridor: there is a wall on the right and left and only some light flickers in front. In addition to changes in consciousness, patients also have hallucinations and delusions. Hallucinations are most often visual and auditory, usually of a frightening nature.

Visual hallucinations are often colored in red and black and blue. The patient sees, for example, a black ax, stained with blood, and around the chopped parts of the human body. The delusions that arise in this case (most often persecution, less often - greatness) determine the behavior of the patient.

Patients in the twilight state of consciousness are very aggressive, attack others, kill, rape or, conversely, hide, run away, try to commit suicide. The emotions of patients in the twilight state of consciousness are extremely stormy and mostly negative in nature: a state of rage, horror, despair.

Twilight states of consciousness with experiences of delight, joy, ecstasy, with delusional ideas of greatness are much less likely.

At the same time, hallucinations are pleasant for the patient; he hears “magnificent music”, “enchanting singing”, etc.

Twilight states of consciousness arise suddenly, lasting from several minutes to several days and just as suddenly end, and the patient completely forgets everything that happened to him.

In rare cases, the patient can still tell something about his painful experiences. This happens either with the so-called “island recall” (Meli), or with the phenomena of delayed, retarded amnesia (Ottolengi). In the first case, the patient recalls some excerpts from his painful experiences, in the second - amnesia does not occur immediately, but some time after clarification of consciousness.

Sometimes after passing the twilight state of consciousness for some time delusional ideas of persecution or greatness are delayed (residual delirium).

Patients in the twilight state of consciousness are prone to destructive actions and can be dangerous for themselves and for others. The murders committed during this time are striking in their unmotivated and extreme cruelty.

In addition to their own twilight states of consciousness, the so-called ordered twilight states,denoted as state of outpatient automatism,or psychomotor paroxysms.It is also a paroxysmally arising state of narrowed (twilight) consciousness, but without delirium, hallucinations and pronounced emotional reactions. The behavior of such patients is more or less streamlined; there are no conspicuous absurdities in the statements and actions characteristic of patients with a twilight state. Patients in a state of outpatient automatism, not understanding everything that is happening around them, understand only some individual points, otherwise using the usual, already automated actions. For example, a patient without any purpose enters someone else’s apartment, having previously wiped his legs and phoned, or gets into the first oncoming transport, completely not knowing where and why he is going. Outwardly, such a patient may give the impression of an absent-minded, tired, or slightly tipsy person, and sometimes not even draw attention to himself. Conditions of outpatient automatism also last from a few minutes to several days and end in complete amnesia.

Twilight states of consciousness can arise not only during the day, but also at night, in the middle of sleep. In this case, they talk about sleepwalking (somnambulism).However, it should be remembered that not all manifestations of sleepwalking are related to epilepsy. These may be cases of twilight consciousness of hysterical origin, or just a partial dream.

Some similarities with twilight states of consciousness have the so-called special conditions(M.O. Gurevich), which "roughly relate to twilight states of consciousness, like a Jacksonian seizure to the generalized epileptic."

In special conditions, there are no pronounced changes in consciousness and subsequent amnesia, but changes in mood, mental disorders, and especially disturbances in perception in the form of a so-called sensory synthesis disorder are characteristic. The patient is confused, fearful, it seems to him that the surrounding objects have changed, the walls are hesitating, moving, his head has become unnaturally huge, his legs disappear, etc. Patients can experience states such as deja vu, jamais vu, depersonalization, change in the sense of time etc.

The duration of special states is the same as twilight states.

Epilepsy in its manifestations is not limited to the symptoms of large and small seizures. Sometimes with epilepsy there are clinical phenomena that are a substitute for seizures. They are called mental equivalents (epileptic seizures). After the epileptic psychic equivalent, complete amnesia is usually observed for a period of upset consciousness, and at the end of the episode the patient falls asleep. It should be noted: those mental equivalents, after which amnesia is not observed, many authors do not refer to the concept of an epileptic mental equivalent. In addition, some authors attribute dysphoria to epileptic psychic equivalents.

First of all, epileptic mental equivalents include twilight disorder of consciousness. The term “twilight dizziness” (synonym - “twilight state”) is understood to mean a psychopathological disorder characterized by a sudden and short-term loss of clarity of consciousness with complete detachment from the environment or with its fragmentary and distorted perception while maintaining the usual actions. Sometimes such forms of the epileptic psychic equivalent, which end with a deep sleep and are accompanied by complete amnesia, are called a simple form, in contrast to the psychotic form, which arises gradually and is accompanied by hallucinations, delusions and altered affect. But in any case, it should be borne in mind that the states that the patient forgets and the states that the patient remembers are qualitatively different states.

Twilight dizziness, in turn, is divided into the following conditions:

Ambulatory automatism

Outpatient automatisms are manifested in the form of automated actions performed by patients with complete detachment from the environment. They distinguish oral automatisms (bouts of chewing, smacking, licking, swallowing), rotator automatisms ("vertigo") with automatic uniform rotational movements in one place. Often the patient, being estranged from the surrounding reality, automatically shakes off something. Sometimes automatisms are more complex, for example, the patient begins to undress, sequentially taking off his clothes. Outpatient automatisms also include the so-called fugues, when patients, being in a state of dull consciousness, rush to run; the flight lasts for some time, and then the sick come to their senses. In cases of outpatient automatism, cases of long migrations (trances) are known, but more often these wanderings are relatively short and are expressed in the fact that patients pass the stop they need, pass by their house, etc.

Outpatient automatisms can manifest themselves in short-term conditions with outwardly relatively correct behavior, which suddenly end with aggressive acts or antisocial actions. In these cases, the behavior of patients is determined by the presence in the structure of the twilight state of affective disorders, delirium and hallucinations. Often it is necessary to observe a variety of outpatient automatisms in the form of short-lived states of extreme chaotic motor excitement with aggression, destructive tendencies and the patient’s complete detachment from the environment.

Somnambulism (sleepwalking)

In this case, twilight disorder occurs during sleep and more often occurs in children and adolescents. Patients, without external necessity, get up at night, perform some organized actions, and after a few minutes, sometimes hours, return to bed or fall asleep in some other place.

Epileptic delirium

It is an influx of brightly colored visual hallucinations, accompanied by tension of passion, fear, an experience of horror, fragmentary delusions of persecution. Patients see blood painted in bright colors, corpses and other terrifying hallucinations. They are "haunted" by people who threaten to kill, violence, arson. Patients are extremely excited, screaming, fleeing. Attacks end suddenly with complete or partial amnesia of the experienced.

Epileptic paranoid

Against the background of twilight disorder of consciousness and dysphoria, delusions come to the forefront, usually wearing vivid sensory experiences. In patients, delusions of persecution, greatness are observed. Often there is a combination of these delusional disorders. For example, the ideas of persecution are combined with delusions of greatness. An epileptic paranoid, like the other equivalents of epilepsy, develops paroxysmally. Attacks are usually accompanied by disturbances in perception, the appearance of visual, olfactory, less often auditory hallucinations.

Epileptic onyroid

It is characterized by a sudden influx of fantastic hallucinations. The environment is perceived by patients with illusory-fantastic shades. Patients consider themselves direct participants in apparent events, and their facial expressions and behavior reflect their experiences. With this disorder, amnestic disorders are absent.

Epileptic stupor

There are phenomena of mutism, the absence of a pronounced reaction to the environment, despite the stiffness of the movements. Against the background of this sub-stuporous state, it is possible to establish the presence of delusional and hallucinatory experiences. Amnestic disorders in this disorder are absent.

Epilepsy- a chronic neuropsychic disease, which is characterized by sudden-onset disorders in the form of various convulsive seizures, as well as a number of other mental disorders.

Men suffer from epilepsy somewhat more often than women.

The clinic of epileptic disease is very diverse, its manifestations can be divided into three groups of conditions:

1) short-term convulsive and non-convulsive paraxism; 2) acute and protracted psychoses; 3) personality changes and dementia. The disease occurs in the form of seizures, which in epilepsy are large and small.

With a large epileptic seizure in several hours or days, precursors of the seizure arise - anxiety, irritability, a feeling of twitching of individual muscles of the face and body. There may be a heartbeat, a feeling of heaviness in the head, photophobia, impaired hearing, smell and taste.

About a half of patients with epilepsy have an aura before a seizure (Greek aura - breath). Aura is different. Various sensations can occur in the senses - sensory aura, for example, when the visual one flashes of light or objects become unusually brightly colored, when the patient is auditory, they hear sounds that actually are not. The aura lasts a few seconds. Usually, experienced patients already know that a seizure will follow, and can even suppress its development, causing severe pain irritations, straining all the muscles of the body, inhaling deeply and holding their breath.

After the aura, a tonic phase of an epileptic seizure occurs, which is manifested by a sharp tension of the entire musculature. The patient may make a characteristic cry due to the expulsion of air through a convulsively narrowed glottis. During a seizure, the patient falls to the floor, the ground, objects, most often face forward. During a seizure, fractures, dislocations and bruises are possible. Usually his eyes are open, the pupils are dilated, breathing stops, cyanosis of the face and skin, involuntary urination occur.

The tonic phase lasts about 30 s. Then comes the phase of clonic seizures. Convulsive contractions occur alternately between the flexor and extensor muscles of the trunk, arms and legs. Husky, bubbling breathing, cyanosis gradually passes. The patient's eyes roll back. There is a bite of the tongue and mucous membrane of the mouth, because of this a bloody foam appears on the lips. After 1-2 m, the cramps subside, and then pass.

The post-seizure state lasts from several minutes to 1–2 hours. The patient’s gaze is wandering, the consciousness is unclear, he is poorly aware of the environment, speech is incoherent, then sleep occurs, but some patients can get up after a seizure.

When seizures follow one after another and in between the patient does not regain consciousness, a dangerous condition develops called an epileptic status.

Small seizures are short-term, no more than 10 s, loss of consciousness, convulsive disorders are insignificant. The patient does not fall, and others may not even notice a seizure.

A variety of small seizure is absence (fr. - absence). The patient, for a few seconds, turns off, becomes silent, or mumbles indistinctly, and then continues the interrupted conversation.

Mental disorders in epilepsy can be in the form of mental equivalents, which seem to be a substitute for seizures, as well as in the form of gradually increasing chronic changes in mental activity - changes in the patient's personality, his character and intelligence.

Dysphoria- a dreary-angry mood that arises for no reason. The patient is gloomy, gloomy, dissatisfied with everything, can be aggressive. Dysphoria can last several hours or days and ends as suddenly as it arose. During the period of dysphoria, an uncontrollable attraction to alcohol can occur - dipsomania, periodic binge.

Twilight Consciousness Disorder  - violation of consciousness, in which the environment is perceived in a distorted form.

Fear, anger, aggressiveness, desire to run somewhere appear. There are delusions and hallucinations. Because of these experiences, patients can commit socially dangerous acts, including murder.

Amnesia for the entire period of the twilight state of consciousness is characteristic of this severe violation. Amnesia is also observed with other mental equivalents upon exiting a state of impaired consciousness.

Ambulatory automatism accompanied by a twilight disorder of consciousness, but externally, the patient's behavior may look focused and orderly, and others may not notice anything. The patient’s behavior and actions are automated and focused on a certain range of phenomena. In this condition, the patient is able to make long trips: he buys a ticket and gets on the train, but when he arrives in another city and wakes up, he does not understand how he got there.

Somnambulism  (sleepwalking, sleepwalking) most often occurs in children and adolescents and is considered the equivalent of a seizure. Patients get up at night, walk, can go to the balcony, walk along the ledge, climb the roof. Then they return to bed or fall asleep on the street, waking up, do not remember anything.

Chronic mental disorders are manifested in the form of impaired character, impaired thinking and the development of epileptic dementia.

With a long course of the disease, epileptic dementia develops.

Forensic psychiatric assessment of mental disorders inherent in epileptic disease is complex. Difficulties arise in the diagnosis of this disease, which is usually carried out retrospectively, since during the examination, even inpatient, it is not always possible to observe epileptic seizures and its equivalents. In such cases, experts use medical documentation and laboratory test data. An electroencephalographic study allows in a large percentage of cases to reveal the presence of specific epileptic bioelectric activity of the brain, which may be present in patients with epilepsy even during treatment.

With a diagnosis, it is necessary to prove the presence or absence of certain convulsive seizures or states of impaired consciousness at the time the offense was committed. In this regard, major and minor seizures, as well as twilight conditions, are of the greatest forensic psychiatric importance. In the expert assessment of the driver’s condition during a traffic accident, it is important to state a large, small seizure or state of absences at the time of the accident. Persons who have committed these unlawful acts in these conditions are considered insane, as they fall under the concept of a temporary disorder of mental activity - a medical criterion of art. 21 of the Criminal Code, and the presence of impaired consciousness deprives them of the opportunity to realize the factual nature and social danger of their actions and to direct them. The capacity of patients with epilepsy is determined on the basis of determining the degree of epileptic personality changes. Severe dementia, significant emotional-volitional disorders and prolonged psychoses are signs of severe personality changes that require recognition of patients as legally incompetent and in need of custody.

(Hoffmann F., 1862). Paroxysmally occurring, short-term disorders of mental activity occurring without tonic-clonic seizures. Most often - dysphoria, twilight and special conditions, the phenomena of ambulatory automatism, poriomania (an irresistible desire for aimless wandering), attacks of visual and auditory hallucinations. They are not always a substitute for an epileptic seizure, in some cases, according to modern data, the described phenomena play the role of an aura or are observed after a seizure. The concept of ee recently significantly narrowed: small seizures (absences) were removed from it.

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•   - Unconscious actions leading to mental or physical self-destruction of a person. Synonym: Self-destructive behavior ...

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•   - See Equivalents Depressive ...
•   - one. . Paroxysmal conditions characterized by somatic complaints that are satellites of hypotension, but not the main and leading symptom of cyclotymic depression ...

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•   - Stereotypical epileptic automatisms ...

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•   - coefficients that make it possible to quantitatively compare among themselves different types and kinds of fuel. T. e. divided into: a) high-calorie, comparing fuels by their calorific value ...

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•   - that is, equivalent quantities are such weight quantities in which the bodies enter into chemical compounds or replace each other, moreover, one weight part is taken as the unit of comparison ...

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•   - see Epilepsy ...

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•   - in the theory of regular correspondences, constant and equivalent correspondences between the units of II and PU, which do not depend on the context. See also equivalent ...

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•   - 1) in chemistry - weight parts expressing the number of bodies replacing each other in compounds. So for example, 28 weights. parts of iron are replaced in compounds of 31.7 of the same parts by weight of copper, hence 28 weights ...

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This group of painful symptoms includes paroxysmal mood disorders and consciousness disorders. The term “psychic equivalents” (mental disorders that appear to be “equivalent” to him in place of a seizure) is not entirely accurate, since the same mood or consciousness disorders can also appear in connection with a seizure - before or after it.

Mood disorders. In patients with epilepsy, mood disorders are most often manifested in attacks of dysphoria - a dreary-spiteful mood. In such periods, patients are dissatisfied with everything, picky, gloomy and irritable, often present various hypochondriacal complaints, in some cases forming even into delusions of a hypochondriacal nature. Delusions in such cases appear paroxysmal and exist as long as the period of dysphoria lasts, from several hours to several days. Often fear is mixed with a melancholy-evil mood, sometimes dominating the clinical picture. Much less often, periodic mood disorders in patients with epilepsy are expressed in attacks of euphoria - a magnificent, inexplicable mood.

Some patients during bouts of dreary-spiteful mood begin to abuse alcohol or go to wander. Therefore, a part of patients suffering from dipsomania (drunken drunkenness) or dromomania (desire to travel) are patients with epilepsy.

Disorders of consciousness. These disorders are expressed in the paroxysmal appearance of a twilight state of consciousness. In this case, the patient’s consciousness narrows as if concentrically, and from the whole diverse external world he perceives only some part of phenomena and objects, mainly those that affect him emotionally at the moment. Figuratively, such a state is compared with the state of a person walking along a very narrow corridor: there is a wall on the right and left and only some light flickers in front. In addition to changes in consciousness, patients also have hallucinations and delusions. Hallucinations are most often visual and auditory, usually of a frightening nature. Visual hallucinations are often colored in red and black and blue. The patient sees, for example, a black ax, stained with blood, and around the chopped parts of the human body. The delusions that arise in this case (most often persecution, less often - greatness) determine the behavior of the patient.

Patients in the twilight state of consciousness are very aggressive, attack others, kill, rape or, conversely, hide, run away, try to commit suicide. The emotions of patients in the twilight state of consciousness are extremely stormy and mostly negative: a state of rage, horror, despair. Twilight states of consciousness with experiences of delight, joy, ecstasy, with delusional ideas of greatness are much less likely. At the same time, hallucinations are pleasant for the patient, he hears “magnificent music”, “enchanting singing”, etc. Twilight states of consciousness arise suddenly, last from several minutes to several days and just as suddenly end, and the patient completely forgets what he was.

In rare cases, the patient can still tell something about his painful experiences. This happens either with the so-called "island recall", or with the phenomena of delayed, retarded amnesia. In the first case, the patient recalls some excerpts from his painful experiences, in the second - amnesia does not occur immediately, but some time after clarification of consciousness. Sometimes after passing the twilight state of consciousness for some time delusional ideas of persecution or greatness are delayed (residual delirium).

Patients in the twilight state of consciousness are prone to destructive actions and can be dangerous for themselves and for others. The murders committed during this time are striking in their unmotivated and extreme cruelty.

In addition to their own twilight states of consciousness, the so-called ordered twilight states, designated as the state of ambulatory automatism, or psychomotor paroxysms, are also characteristic of patients with epilepsy. It is also a paroxysmally arising state of narrowed (twilight) consciousness, but without delirium, hallucinations and pronounced emotional reactions. The behavior of such patients is more or less streamlined; there are no conspicuous absurdities in the statements and actions characteristic of patients with a twilight state. Patients in a state of outpatient automatism, not understanding everything that is happening around them, understand only some individual points, otherwise using the usual, already automated actions. For example, a patient without any purpose enters someone else’s apartment, having previously wiped his legs and phoned, or gets into the first oncoming transport, completely not knowing where and why he is going. Outwardly, such a patient may give the impression of an absent-minded, tired, or slightly tipsy person, and sometimes not even draw attention to himself. Conditions of outpatient automatism also last from a few minutes to several days and end in complete amnesia.

Twilight states of consciousness can arise not only during the day, but also at night, in the middle of sleep. In this case, they talk about sleepwalking (somnambulism). However, it should be remembered that not all manifestations of sleepwalking are related to epilepsy. These may be cases of twilight consciousness of hysterical origin, or just a partial dream.

Some similarities with twilight states of consciousness have so-called special states, which "roughly relate to twilight states of consciousness, like the Jacksonian seizure to the generalized epileptic." In special conditions, there are no pronounced changes in consciousness and subsequent amnesia, but changes in mood, mental disorders, and especially disturbances in perception in the form of a so-called sensory synthesis disorder are characteristic. The patient is confused, fearful, it seems to him that the surrounding objects have changed, the walls are hesitating, moving, his head has become unnaturally enormous, his legs are disappearing, etc.