It is about 0.05% (after the first year of life, when it occurs more often), the prevalence is 0.5%. This means that in most large secondary schools there are about 6 children with childhood or juvenile epilepsy.

In practice, an international classification is applied epilepsy. AT in general terms seizures are classified as follows:
generalized - impulsation from both hemispheres;
focal (also called focal or partial) - seizures develop from one hemisphere or its separate area. Generalized seizures include:
absences;
myoclonus;
tonic;
tonic-clonic;
astatic seizures.

Manifestation of focal seizures depends on the area of ​​the brain from which pathological discharges originate:
frontal seizures - the motor cortex is involved. There are clonic twitches that spread in the proximal direction (Jacksonian march), asymmetric tonic convulsions, which may be accompanied by bizarre hyperkinesis, which can be mistaken for non-epileptic seizures;
temporal seizures, the most common epileptic seizures, manifest as an aura, or strange antecedent sensations of smell, taste, or distortion of sounds and images. When the focus spreads to the premotor cortex, licking of the lips, tearing off clothes, aimless walking (automatisms) are observed. Deja-vu jamais-vu (feeling already experienced in the past or never experienced) are described. Consciousness may be disturbed, the attack lasts longer than the usual absence;
occipital paroxysms cause visual distortion;
parietal paroxysms cause contralateral dysesthesia (changes in sensitivity) and a distorted perception of one's body.

Partial convulsions are also subdivided depending on the level of consciousness:
to simple ones - consciousness is preserved;
complex - consciousness is impaired, however, in children with complex partial convulsions, memory during an attack may be partially preserved;
with secondary generalization - after a partial seizure, generalized tonic-clonic convulsions develop.

Often difficult distinguish simple seizures from complex partial seizures, hence the new term "unclassified seizure".

Generalized epilepsy in children

I. With generalized seizures:
always losing consciousness
lack of forerunners
symmetrical spasms,
synchronous bilateral activity on the EEG

II. Absences:
- Transient loss of consciousness, sudden onset and cessation, with no motor component except for blinking and a slight change in muscle tone.
- Absences are typical (petit mal), atypical and can often be stopped by hyperventilation

III. Myoclonic spasms: short, repetitive, jerky movements of the limbs, neck, or trunk

IV. Tonic convulsions: generalized increase in tone

V. Tonic-clonic convulsions:
- Rhythmic contractions of muscle groups following the tonic phase
- During the rigid tonic phase, the child may fall to the floor, sometimes resulting in injury. He is not breathing and becomes cyanotic. This is followed by a tonic phase with jerky movements of the limbs. Breathing is irregular, cyanosis persists, and saliva may accumulate in the mouth. The child may bite the tongue, sometimes there is involuntary urination. The attack usually lasts a few seconds to minutes, followed by unconsciousness or deep sleep for several hours.

VI. Atonic seizures:
Often associated with myoclonic twitches, followed by a transient loss of muscle tone, the child suddenly falls to the floor or drops his head Non-epileptic myoclonus can be physiological in the form of hiccups (diaphragmatic myoclonus) or during the second stage of sleep (sleep myoclonus)

Focal (partial) seizures in children

I. Partial convulsions in children:
begin in a relatively small group of neurons with impaired function in one of the cerebral hemispheres,
may be preceded by an aura indicating a focus,
there may be changes in consciousness or more widespread twitches

II. Simple partial seizures: the child is lucid

III. Complex partial seizures: an altered state of consciousness or confusion due to abnormal electrical activity spreading from the focus

IV. Secondary generalized partial seizures: focal seizure manifests clinically or on EEG alone, followed by generalized tonic-clonic seizures

episyndromes

a) Generalized convulsions:
- Infantile spasms
- Childhood absence epilepsy
- Lennox-Gastaut syndrome
- Juvenile myoclonic epilepsy

b) Partial convulsions in children:
- Benign childhood epilepsy with central parietal adhesions (BCECTS)
- Epilepsy of childhood with occipital paroxysms

Epileptic syndromes in children

A. Generalized epilepsy in children:
I. Infantile spasms. 4-6 months Severe flexion spasms of the head, trunk and limbs, followed by extension of the arms (the so-called Salaam convulsions). Flexor spasms last 1-2 seconds, often multiple series of 20-30 spasms occur on awakening, but may be repeated many times a day. Spasms can be mistaken for colic. An important detail of the anamnesis is the degradation of the psyche.
- Many reasons, 2/3 of the cause is neurological. On the EEG - hypsarrhythmia, a chaotic picture of high-voltage slow waves and multifocal sharp-wave impulses. Treatment with vigabatrin or glucocorticoids. good effect- in 30-40%, but side effects are often observed. The majority - the subsequent loss of skills, ability to learn, the development of epilepsy.

II. Lennox-Gastaut syndrome. 1-3 years. Multiple types of seizures, but mainly sudden falls (drop attacks, astatic seizures), tonic seizures and atypical absences. Also delay or degradation of mental development and behavioral disorders
- A history of various complex neurological disorders or infantile spasms is often noted.
- The prognosis is unfavorable.

III. Typical absences (petit rnal). 4-12 years old. For a moment - stopping the gaze, fading, there may be blinking and small movements of the hands. It lasts only a few seconds, but no more than 30. During the attack, the child does not react, after regaining consciousness, he realizes that he missed something and looks confused or apologizes. Development is normal, but seizures can affect schooling. Only accounts for 2% of childhood epilepsy
- 2/3 of patients are girls.
Seizures can be triggered by hyperventilation, for which the child is asked to blow on a piece of paper or a windmill for 2-3 minutes, a useful test for the outpatient clinic. EEG reveals up to 3 generalized spikes per second and wave disturbances that are bilaterally synchronized during and sometimes between attacks. The prognosis is favorable, remission in 95% of adolescents. 5-10% may develop tonic-clonic seizures during puberty.

IV. Juvenile myo-clonic epilepsy. Puberty and adults. Myoclonus, but there may be generalized tonic-clonic seizures and absence seizures, mostly immediately after waking. Typical history: Scatters drinks and popcorn in the morning due to onset of myoclonus. Does not affect learning
- Characteristic EEG.
- Usually a good response to therapy, but the treatment is lifelong.
- Identified genetic disorders

B. Focal epilepsy in children:
I. Benign Roland epilepsy, also known as BCECTS. 4-10 years. Tonic-clonic seizures during sleep or simple partial seizures with awareness of pathological sensations in the tongue and distortion of the face (innervated from Roland's sulcus brain).
- Accounts for 15% of all childhood epilepsy.
- EEG: focal sharp waves from the roland or central parietal region. It is important to understand that this is a benign situation and does not always require treatment. In puberty, almost everything passes.

II. Benign childhood epilepsy with occipital paroxysms. 1-14 years old. In younger children, periods of no contact, eye deviation, vomiting, and autonomic symptoms. In older children, headache and visual disturbances, including image distortion and hallucinations.
- Rare form.
- EEG: spikes in the occipital region.
- Stops in childhood

Focal seizures (also called partial seizures) are seizures that are localized in only one part of the brain. Approximately 60% of people with epilepsy suffer from these seizures.

Partial seizures are most often described in relation to the area of ​​the brain in which they are localized - for example, a patient may be hospitalized with a focal frontal lobe seizure.

In a simple focal seizure, the person remains conscious but experiences unusual sensations and emotions, such as sudden and inexplicable feelings of joy, anger, sadness, or nausea. He can also see and hear what is not there, feel a strange taste or smell.

In a complex partial seizure, the patient experiences changes in consciousness or loss of consciousness. People who experience a complex focal seizure may experience symptoms such as convulsions, lip twitching, walking in circles, and very fast blinking. Such movements are called automatisms. More complex actions that may seem deliberate and purposeful may also be unintentional. In this case, patients can continue to perform activities that began before the onset of the seizure - for example, wash the same dish. These seizures usually last only a few seconds.

A number of patients with focal (especially complex focal) seizures may experience auras - unusual sensations that occur shortly before the attack. At their core, such auras are simple partial seizures in which a person remains conscious. The symptomatic manifestations of an attack and their progression are stereotypical - each time the disease manifests itself in approximately the same way.

Symptoms of focal seizures are nonspecific and can easily be confused with symptoms of other disorders. For example, the distorted perception of reality that occurs with a complex partial seizure can easily be confused with headaches that occur with migraine. Strange behaviors and sensations may be symptomatic of narcolepsy, fainting, or a psychiatric disorder. In order to accurately determine the cause of the violations, a fairly large number of analyzes and studies may be required.

Generalized Seizures

Generalized seizures are the result of abnormal neuronal activity on both sides of the brain. Such seizures can cause loss of consciousness, a fall, or a massive muscle spasm.

There are many types of generalized seizures. In an absence seizure, a “nowhere” look and / or twitching of any muscles is observed. Such seizures are in some cases called "small seizures" - this is an outdated term. Tonic seizures are characterized by tension in the muscles of the back, arms and legs. Clonic seizures cause convulsions on both sides of the body. Myoclonic seizures cause cramps or convulsions in the arms, legs, and muscles of the upper half of the body. Atonic seizures result in a loss of normal muscle tone - characterized by falling, inadvertent lowering of the head, etc. Tonic-clonic seizures are characterized by a mixed set of symptomatic manifestations, including muscle tension, cyclic arm/leg cramps, loss of consciousness. Tonic-clonic seizures are sometimes referred to by the obsolete term grand mal seizures.

Not all seizures can easily and unambiguously be classified as focal or generalized. Some patients have seizures that begin as partial seizures but subsequently spread throughout the brain. Also, a number of patients have both types of seizures.

The lack of understanding of the causes of epileptic seizures by other people is one of the most significant problems that have a negative impact on the lives of patients with epilepsy. It is often difficult for people watching a seizure to understand that what appears to be intentional behavior is not really under the patient's control. In some cases, the seizure still leads to the arrest or placement of the patient in a psychiatric hospital.

/ Shpora_psikh / Private / Epilepsy

Epilepsy is a chronic, endogenous-organic, polyetiological, progressive disease of the brain, manifested by repeated convulsive or non-convulsive seizures with or without impaired consciousness and the formation of specific personality changes and dementia.

Epilepsy is a chronic brain disease characterized by repeated unprovoked seizures with impaired motor, sensory, autonomic, mental or mental functions resulting from excessive neural discharges in the cerebral cortex.

Endogenous factors: hereditary predisposition (increased convulsive readiness of the GM) and constitutional personality traits.

Exogenous factors: implements predisposition: prenatal pathology, birth trauma, intrauterine organic brain damage, infections and injuries in the first and subsequent years of life.

Pathogenesis. The established pathogenetic mechanisms of epilepsy can be divided into 2 groups: those related to the actual cerebral processes and associated with general somatic changes in the body.

The central place in the cerebral mechanisms of epilepsy is assigned to the epileptoid and epileptic foci. The epileptoid focus is a local structural change in the brain - a source of pathological excitation of the surrounding neurons, as a result of which they begin to produce focal epileptic discharges. The development of convulsive discharges is due to the simultaneous excitation of a large number of neurons in the epileptic focus. Structural restructuring, which causes convulsive readiness, occurs in the outer zones of the epileptic focus, i.e. in the vicinity of the affected tissue, the coarse damaged elements of which are not able to realize an increased function (convulsive activity). There is also a hypothesis of "chain pathogenesis of epilepsy", according to which a hereditary convulsive predisposition, exogenous damaging effect and an external trigger factor are involved in the development of epilepsy.

Classification by etiological factor:

Genuine (hereditary or congenital predisposition, constitutional features);

Exogenous-organic (TBI, infections, intoxications).

By flow type:

With a predominance of convulsive seizures;

With a predominance of non-convulsive seizures.

According to the frequency and rhythm of paroxysms:

Epilepsy with frequent and rare seizures;

Epilepsy with intermittent, increasing and irregular rhythm of seizures.

By the time of occurrence of paroxysms:

By age at onset:

According to the localization of the epileptic focus:

Diencephalic, etc.

A grand mal seizure is manifested by a sudden loss of consciousness with a fall, a characteristic change of tonic and clonic convulsions, and subsequent complete amnesia. Seizure duration from 30 s to 2 min. The tonic phase is manifested by a sudden loss of consciousness and tonic convulsions. Signs of turning off consciousness are the loss of reflexes, reactions to extraneous stimuli, the absence of pain sensitivity (coma). Tonic convulsions are manifested by a sharp contraction of all muscle groups and a fall. If there was air in the lungs at the time of the seizure, a sharp cry is observed. With the onset of a seizure, breathing stops. The face first turns pale, and then cyanosis increases. Duration of the tonic phase The clonic phase also proceeds against the background of switched off consciousness and is accompanied by simultaneous rhythmic contraction and relaxation of all muscle groups. During this period, urination and defecation are observed, the first respiratory movements appear, but full breathing is not restored and cyanosis persists. Air pushed out of the lungs forms foam, sometimes stained with blood due to biting of the tongue or cheek. Duration up to 1.5 min. The attack ends with the restoration of consciousness, but for several hours after this there is a somnolence.

Absences (minor seizures).

There is a division of absences, or small seizures (petits maux), into simple and complex. There may not be a clear boundary between them.

Absence simple- short-term (several seconds) loss of consciousness followed by amnesia. Absence suddenly overtakes the patient during any of his activities or conversation, which he usually resumes as soon as the paroxysm ends. During an absence, the face becomes slightly pale, the gaze is fixed in one direction; sometimes the eyeballs slightly move upward; barely noticeable blinking movements of the eyelids can be observed. The end of the paroxysm is instantaneous; as a rule, symptoms of stunning or malaise are not observed. Only after repeated absences several times in a row does some lethargy appear.

Absence complex- short-term loss of consciousness, accompanied by rudimentary convulsive components, movements or actions.

Absence myoclonic- a kind of complex absence: the loss of consciousness is accompanied by bilateral muscle twitches (myoclonus), mainly the muscles of the face and upper limbs; there may be a loss of objects from the hands, sometimes there is a sudden bending of the head and usually outstretched arms; with myoclonus, capturing the muscles of the lower extremities, a fall is possible.

Myoclonic (impulsive) seizures are clinically manifested by sudden jerks or jerky movements of certain muscle groups. Most often, the muscles of the upper limbs are involved, there is a rapid dilution or convergence of the hands, while the patient drops objects from the hands. With very short attacks, consciousness may not be disturbed, with longer ones it turns off for a short time.

Impulsive seizures occur, as a rule, in the form of series or "volleys" (5-20 in a row), separated from each other by an interval of several hours. Characterized by the occurrence of seizures in the morning.

Impulsive seizures are provoked by a number of moments (insufficient sleep, abrupt awakening, alcoholic excesses).

Akinetic (propulsive) seizures are characterized by a variety of forward movements (propulsion). Movement of the head, trunk, or whole body during propulsive seizures is due to a sudden decrease in postural muscle tone. Propulsive seizures are characteristic of early childhood (up to 4 years). At an older age, along with propulsive seizures, patients, as a rule, also have large convulsive seizures.

A variety of propulsive seizures are nods - a series of nodding head movements and pecks - sharp tilts of the head forward and down(at the same time, patients can hit their faces on objects in front of them). Nods and pecks are typical for children aged 2-5 months.

Salaam-fits so named because the movements made by patients during a seizure are vaguely reminiscent of bows during a Muslim greeting (the body leans forward, the head falls down, and the arms spread up and to the sides); such a seizure is not accompanied by a fall.

Lightning seizures differ from salaam-seizures by faster development. It should only be noted that due to the rapid and sharp movement of the body forward, patients often fall.

Visceral (cortical) seizures are paroxysms, most often affecting the gastrointestinal tract in one way or another. In the region of the xiphoid process, the navel and below, less often in the mouth or throat, there are sensations of tightness, emptiness, burning, pain. When such sensations arise in the region of the epigastrium and somewhat lower, they are accompanied, especially in children, by a feeling of nausea, rumbling of the intestines, flatulence, and salivation. Swallowing and chewing movements may be observed. The sensation that has arisen does not remain localized, but rises upward - to the neck and head. In the latter case, loss of consciousness and a generalized seizure usually occur. As options for visceral seizures, there are:

Chewing fit(masticatory seizure) - a paroxysm of involuntary rhythmic chewing movements with profuse salivation; in some cases, there is a bite of the tongue.

A fit of salivation- paroxysm of hypersalivation; saliva is poured out of the mouth or swallowed.

Seizure pharyngooral- paroxysm of rhythmic movements of the lips and tongue, combined with acts of swallowing (the patient resembles a person while eating); at the same time, hypersalivation and chewing movements can be observed.

FOCAL (FOCAL) SEIZURES.

Jacksonian (somatomotor) seizures . differs from the classical epileptic in that the tonic and clonic phases are limited to a certain group of muscles and only in some cases does the seizure generalize. Partial seizures may be limited to the muscles of the upper or lower limb, the muscles of the face. Spasms of the muscles of the extremities spread in the proximal direction. The difference is only in the known predominance of convulsive phenomena on one side of the body. Generalization of partial seizures in most cases is accompanied by loss of consciousness. Seizure generalization can be observed with focal epileptic seizures in facial muscles, but never develops with focal seizures in the arm or leg. Jacksonian seizures are often accompanied by symptoms of paresis or paralysis of the muscles of that part of the body in which the convulsive phenomena initially occurred. The duration of convulsions is tens of seconds to a minute; occasionally there is a slow spread of seizures localized in one area of ​​the body. Jacksonian seizures can occur in series, including with the development of status epilepticus.

Adversive seizure may begin with loss of consciousness, followed by a tonic turn towards first the eyeballs, and then the head, limbs and trunk; in this case, raising and abducting towards the half-bent arm is often observed; the initial tonic convulsions are replaced by clonic ones, in connection with which the clinical picture becomes very similar to a grand mal seizure. With an adversive seizure, the rotation of the eyeballs, head, limbs and torso occurs in the direction opposite to the epileptic focus. An adversive seizure also occurs against the background of a clear consciousness. In these cases, it is limited only to a tonic turn of the eyeballs to the side and their clonic twitching - an oculoclonic seizure or epileptic nystagmus.

Tonic postural seizure- a short-term (5–20 sec) paroxysm of bilateral tonic convulsions of predominantly postural muscles that occurs against the background of loss of consciousness with the development of opisthotonus.

In some cases, focal motor seizures are manifested by speech disorders.

Aphasic seizure- transient complete or partial aphasia - motor or sensory. Motor aphasia is accompanied by the disappearance of inner speech.

Seizure of speech- the inability to articulate words while maintaining internal speech.

Seizure pallial- paroxysm of repeated repetition of a word or phrase.

This group includes paroxysms of various manifestations. A significant part of them manifests itself in the form of illusions and hallucinations. Sensory seizures, especially of a complex structure, relatively rarely alone exhaust the picture of paroxysm. Usually they represent an aura (symptom-signal) that precedes a focal, secondarily generalized seizure.

affective seizure- the occurrence of pronounced affective disorders, primarily fear or horror; occasionally there are states of high mood, in particular, in the form of ecstasy.

taste attack- a paroxysm of taste sensations (bitter, sour, salty), manifested spontaneously (hallucinatory gustatory seizure) or when eating food that has a different taste (illusory gustatory seizure).

hallucinatory seizure- a paroxysm of either relatively simple (olfactory, gustatory, visceral, auditory), or rather complex, in particular scene-like (visual, auditory) hallucinations.

Hallucinatory seizure- a paroxysm of scene-like visual and less often auditory hallucinations, which have past life events as their content.

Seizure dysmnestic(paramnestic seizure) includes disorders such as deja vu, jamais vu and all similar phenomena related to this, as well as visual hallucinations that occur during an extremist seizure.

Visual seizure- the occurrence in the form of a paroxysm of elementary visual sensations in the form of illusions or photopsies and scene-like visual hallucinations (visual hallucinatory seizure).

Seizure of ideas- a paroxysm of violent thoughts and ideas.

Seizure olfactory- a paroxysm of olfactory illusions or olfactory hallucinations that occurs against the background of hyperosmia; illusions and hallucinations of smell are almost always unpleasant: the smell of urine, burning, mold, excrement. Hyperosmia is a painful exacerbation of the sense of smell. (

psychosensory seizure- paroxysm in the form of macro- or micropsia, dysmegalopsia (metamorphopsia) or body schema disorders (autometamorphopsia).

Auditory seizure- a paroxysm of elementary auditory hallucinations (acoasma), deafness, auditory illusions (auditory illusory seizure) or more complex auditory, in particular verbal hallucinations (auditory hallucinatory seizure).

Somatosensory seizure- paroxysms of unpleasant or painful sensations (tingling, crawling, pain, numbness) that occur in the skin or in the internal organs and cavities of the body.

Seizures with psychopathological phenomena.

It may be more appropriate to designate this group as "non-convulsive forms of paroxysms" since. the latter name emphasizes its significant difference from previous track groups. The clinical picture of paroxysms belonging to this group includes a variety of productive psychopathological disorders that psychiatrists encounter in the study of endogenous and somatically conditioned psychoses. These include affective, illusory, hallucinatory, delusional, stuporous disorders, as well as states of stupefaction, various in their psychopathological manifestations.

Affective paroxysms occupy the first place in frequency. Among them, dysphorias of various structure dominate. Much less commonly, affective disorders occur in the form of hypomanic and manic states. Both of them can be accompanied by either ecstatic or heightened goofy (morio-like) coloring.

Among the paroxysms accompanied by stupefaction, the first place in frequency is occupied by twilight states of various psychopathological structures. In cases where successively changing scene-like visual hallucinations dominate in the picture of clouding of consciousness, one speaks of epileptic delirium or delirious confusion. The presence of delusional and hallucinatory disorders of fantastic content in the structure of the clouded consciousness and the absence of their memorization after the end of the paroxysm makes it possible to diagnose epileptic oneiroid. The latter is often replaced by persistent residual delirium.

Special states - dream-like states (dreamy states) - a kind of oneiric clouding of consciousness; with it, fantastic experiences are combined with pronounced affective disorders (fear, anxiety, ecstasy, confusion), disorientation in the environment (with the preservation of autopsychic orientation), disturbances in the perception of time, which seems either endlessly long, or is perceived as one instant; symptoms of "already seen", "never seen" and their other equivalents, disorders of the body scheme, optic-vestibular disorders, states of immobility. Psychic auras can also be attributed to special states, in any case, to non-convulsive forms of paroxysms. Against the background of a simple form of twilight stupefaction, various motor disorders arise, united by the term "automatisms". These include:

Ambulatory automatism - involuntary wandering with ordered behavior and often with the performance of complex actions that occur spontaneously or as a reaction to external stimuli; the duration of ambulatory automatism minutes-hours; occasionally - days - weeks;

Oral automatisms - bouts of chewing, smacking, licking, swallowing

Somnambulism (sleepwalking, sleepwalking) - ambulatory automatism that occurs during sleep; accompanied by the performance of habitual movements and actions;

Fugue, trance - short-term (fugue) or longer (trance), a state of ambulatory automatism, accompanied by impulsive actions: the patient suddenly begins to undress; urinates on people; rushes to run somewhere; commits rotational movements body. All ambulatory automatisms are accompanied by complete amnesia.

Viscero-vegetative seizures. Visceral (cortical) seizures are paroxysms most often affecting the gastrointestinal tract. In the region of the xiphoid process, navel, lower abdomen, less often in the mouth or throat, there is a feeling of tightness, emptiness, burning, pain. In connection with the localization of sensations, most of the visceral seizures are described under the general name of epigastric or abdominal. As options for visceral seizures, there are: Chewing (masticator) seizure. An attack of salivation. Paroxysm of hypersalivation. Saliva is poured out of the mouth or swallowed. Pharyngo-oral seizure. Paroxysm of rhythmic movements of the lips and tongue, combined with acts of swallowing (the patient resembles a person while eating). At the same time, hypersalivation and chewing movements can be observed.

Focal epilepsy: variety of seizures and their therapy

Epilepsy is a chronic pathology due to which an increase in electrical excitability occurs in the cerebral cortex. At the same time, a person has attacks of a spontaneous nature, that is, not provoked by anything.

Focal epilepsy is a form of the disease characterized by a heterogeneous origin. It differs in that during manifestation, it is possible to accurately determine the cortical focus of excitation. This focus, in this case, is the so-called "pacemaker".

It is in it that a hypersynchronous discharge occurs, which spreads to the near areas of the brain. This impulse affects a fairly large number of neurons in the cerebral cortex.

Focal epilepsy is manifested in children at an early age. More precisely, in 75% of patients with epilepsy, it manifests itself in childhood. And it is one of the most common childhood neurological pathologies.

Statistics say that 70-80% of patients with focal epilepsy show partial symptoms, since in this case only part of the cerebral cortex is affected. That is, in humans, seizures occur much less frequently.

This disease has not been fully studied to date. Despite the fact that it is quite ancient, since Hippocrates first described it.

What Causes Violation

The causes of focal epilepsy can be various factors:

• traumatic brain injury (concussion, severe head contusion);
• inflammation of the brain tissue (meningitis, encephalitis);
• birth trauma in children;
• viral infections;
• hypertonic disease;
• osteochondrosis of the cervical type, or another type, in which there is an acute violation of the blood circulation of the brain;
• dysgenesis of nervous tissue;
• stroke, aneurysm, development of neoplasms;
• as well as diseases of the internal organs.

Various diseases of the internal organs, as well as diseases of a viral and infectious nature, often provoke the onset of epilepsy if they were transferred on the legs or were not treated at all.

It can be concluded that the cause of manifestation of focal epilepsy is metabolic disorders in certain areas of the brain, and then an epileptic focus begins to form. And the causes of metabolic disorders are already the above factors.

Focal epilepsy has several types, namely:

Symptomatic form

Symptomatic focal epilepsy always occurs due to other diseases of the nervous system. These include metabolic encephalopathy, hemorrhagic strokes and impaired blood circulation in the main vessels of the brain.

Often, symptomatic epilepsy is caused by various neoplasms of the brain, abscesses, cysts and dysgenesis. As well as injuries, bruises of the head and disturbed work of the heart.

For the symptomatic form, it is characteristic that convulsive seizures occur spontaneously, but their nature depends on which part of the brain is affected.

With frontal epilepsy, seizures most often last up to 30 seconds. A person at this moment performs strange movements and can talk violently.

If the focus is localized in the frontal part, then such violations can be observed:

1. There is a spasm of the muscles of the limbs, neck, face, body and entire torso. Hand hypertonicity is also possible.
2. The patient averts and / or rolls his eyes, can imitate chewing, smacking, while saliva is abundantly secreted. They can also shake their heads.
3. Manifestations of vegetative symptoms, automatism and hallucinations are possible.

For frontal epilepsy, the manifestation of nocturnal seizures is characteristic, they pass in a mild form. Since in this case, the excitation passes precisely through the focus, and does not diverge to other parts of the brain. At the same time, sleepwalking, parasomnia and enuresis are manifested.

If the focus is localized in the temporal region, then there are:

1. Various hallucinations (auditory, visual or olfactory). Visual hallucinations can be colorful and have a frightening effect on the patient. In this case, the patient may freeze with wide eyes.
2. Pronounced symptoms from the autonomic system - palpitations, bouts of nausea, excessive sweating, a feeling of heat.
3. Euphoria and recurring obsessive thoughts.
4. Sleepwalking.

If the focus is in the occipital region, then the optic nerve is affected. Namely, there is a temporary loss of focus of vision, circles appear before the eyes and even the eyeballs tremble. These are the initial symptoms.

But more serious disorders can also appear, such as blindness, the field of vision narrows, the eyeball can turn towards the lesion. And also all this is accompanied by such symptoms as nausea, vomiting, pallor of the face and headaches.

An attack, while it can last several minutes. But since this species is classified as progressive, over time, with attacks, pronounced vegetative disorders and disturbances in the social adaptation of a person appear.

Epileptic lesions of the parietal lobe are diagnosed very rarely. In this case, impaired sensitivity is observed. There is also a burning sensation, pain and discomfort that spread from the hand to the face. Sometimes the pain extends to the groin area, thighs.

Hallucinations and/or illusions may also occur. It may seem to a person that large objects have become small and vice versa. Perhaps a violation of speech, loss of the ability to count, but consciousness is preserved. These attacks can last up to 2 minutes and are usually during the day.

Cryptogenic form

Cryptogenic focal epilepsy differs in that there are no known real reasons occurrence of the disease. That is, when, when carrying out all possible diagnostic methods, it is not possible to determine the cause of the onset of epileptic seizures. This form of epilepsy is considered latent.

Seizures can occur due to such factors:

• bad habits, namely, the use of drugs, alcohol;
• external factors: bright light, too loud sounds, temperature changes;
• head injury;
• viral infectious diseases;
• impaired functioning of the liver and kidneys.

Cryptogenic epilepsy is drug resistant. At the same time, rapid changes occur in the metabolism. The metabolism of fats is stable, and the amount of water is constantly increasing and accumulating in the body. As a result, an epileptic seizure occurs.

A seizure of the cryptogenic type is accompanied by loss of consciousness, apathy, and neurological disorders also appear. After regular seizures, a person begins to develop mental disorders.

Cryptogenic brain damage can also be manifested by prolonged attacks. There are always certain harbingers before them. For example:

• insomnia;
• tachycardia;
• headache;
• hallucinations, which are characterized by the vision of fire, sparks, etc.

Idiopathic form

For idiopathic focal epilepsy, it is characteristic that seizures occur, but there are no structural changes in the brain. Causes this disease are most often a genetic predisposition, as well as if there are congenital anomalies in the development of the brain and neuropsychiatric diseases.

The idiopathic form can also develop due to toxic effects on the body, this can be with the use of alcohol, drugs or certain medications.

In idiopathic focal epilepsy, the focus of excitation is formed in one of the hemispheres of the brain. But the body gives defensive reaction and a protective shaft is formed around the focus, which is able to hold an excessive electrical discharge. For a long time this is not enough and the discharge still passes the protective boundaries. It is at this moment that the first epileptic seizure occurs.

A feature of this form of the disease is that it is easily amenable to therapeutic therapy. And with the right approach, medication intake is reduced to a minimum.

A set of diagnostic measures

Diagnosis begins with an examination of the patient by a neurologist. In this case, the specialist studies the anamnesis. He definitely needs to clarify the data on the nature of the attacks, their duration, the sensations that the patient experiences at the same time, what factors become the trigger for an attack, etc.

It is also important for the doctor to know exactly which drugs facilitated the patient's condition. Sometimes relatives are better able to answer such questions, since often a person at the time of an attack is unconscious, with confused consciousness, etc.

To confirm the diagnosis, instrumental methods for examining the brain are always prescribed. These include:

It is with the help of MRI that it is possible to carry out all measurements of the brain, visualize it, which is very important in this case. And the EEG will show the state of electrical impulses and disturbances in the process of their conduct.

Other studies are also being carried out. Namely, it is important to check the work of internal organs and examine muscle tone.

The patient must pass a general blood test. With it, you can determine the presence of infections in the body, as well as find out the indicators of glucose, electrolytes, etc.

Additional instrumental methods are magnetic resonance spectroscopy and positron emission CT.

The nature of therapy

It should be understood that drug therapy in a patient with epilepsy will last a lifetime. In this regard, dosages are prescribed minimal (if possible) to reduce the likelihood of manifestation side effects and then gradually increase them.

In this case, antiepileptic drugs are prescribed. If the disease has arisen recently, then doctors prescribe monotherapy, that is, treatment with one drug.

Antiepileptic drugs include:

Epilepsy can also be treated with surgery. It is prescribed if the patient's condition worsens and the attacks become stronger and more frequent. And this has a very negative effect on the brain.

The appointment of surgical treatment can only be if it is clearly diagnosed where the focus is located. And at the same time, it does not affect the areas of the brain that are responsible for vital functions. During the operation, the affected areas are removed.

It is assumed that after this the seizures are significantly reduced or completely disappear.

But surgery can also be performed on vital areas of the brain. In this case, the doctor makes incisions that prevent the spread of electrical discharges. These operations are called corpus callosum commissurotomy and functional hemispherectomy.

Complications and prognosis

Epilepsy can be complicated by the following conditions:

1. Status epilepticus is a series of seizures between which a person remains unconscious.
2. Cerebral edema.
3. Injuries. A person is injured when a seizure occurs, as he can fall, hit, have an accident while driving, etc. All this is fraught with fractures, concussion, injuries of the tongue, lips, and even death.
4. Mental disorders.
5. Aspiration pneumonia and neurogenic pulmonary edema.
6. Arrhythmia.

With the right medication, seizures are eliminated in 50% of cases. In 35% of patients, the number of seizures becomes less.

In this disease, the prognosis can be favorable only if there is no organic brain damage.

In 70% of patients who do not require treatment in a hospital, mental abnormalities are not noted. 20% of patients due to epilepsy have a slight decrease intellectual abilities. And only 10% have severe mental health disorders.

How not to aggravate the condition

The main measures to prevent epilepsy are:

• do not drink alcohol, drugs;
• it is not recommended to overheat, overcool, overeat, etc.;
• you need to adhere to a diet and observe the regime of the day (rest and work regimen);
• work at night is prohibited;

People with epilepsy must always take medications prescribed by a doctor. And do not cancel them yourself, even if there have been no seizures for a long time.

Encyclopedia

Epileptic seizure, partial (focal)

The pathological discharge causes convulsions, loss of consciousness, or other manifestations of an epileptic seizure. In focal seizures, when the discharge is localized in a certain area of ​​the cortex, the manifestations of the attack depend on the localization of the discharge. This is due to the fact that different areas of the cortex perform different functions. For example, if a discharge occurs in the areas responsible for the processing of visual information, during an attack the patient “sees the world differently” - he has visual illusions, it may seem to him that objects have become too large, or too small, that they are stretched, turn over; visual hallucinations may also occur - from simple ones (luminous snakes and circles) to complex ones - complex visual images and actions resembling frames from films), etc. In this case, the patient may be conscious, and after an attack he remembers and can describe his feelings.

The focal (partial) nature of the attack and the localization of the focus can often be assumed depending on clinical symptoms present during an attack, preceding it or arising after an attack, and confirm with EEG data.

In some patients, a partial seizure begins with an aura. "Aura" - these are unusual, but characteristic sensations for a particular patient, which are the initiation (beginning) of an attack (for example, visual illusions, an unpleasant smell, fear, etc.). The aura is the result of the occurrence of a pathological discharge in a certain area of ​​the cortex and depends on the function that this part of the cortex performs. If the epileptic discharge remains localized, consciousness is preserved during the further development of the attack, since the epileptic activity does not affect other areas of the cortex, and they continue to function normally. With the further spread of the discharge to other areas, other symptoms are observed, and consciousness may be disturbed. If the discharge extends to the cortex of both hemispheres of the brain, there is a loss of consciousness and convulsions. Another sign that indicates the local nature of the attack is the occurrence of post-seizure neurological disorders (for example, transient weakness in the limbs on one side of the body, blindness or speech impairment). In many cases, EEG can play an important role in determining the localization of the focus in partial epilepsy.

aura has a very importance, as it indicates the local nature of the attack and suggests the localization of the epileptic focus in the cerebral cortex. Therefore, always inform the doctor about the presence of an aura in a patient and about its manifestations. In addition, the aura has a "protective" function, as it warns the patient that an attack will occur, due to the fact that the patient or loved ones can take precautions to reduce the likelihood of injury during an attack.

Focal seizures are divided into three groups: simple focal seizures, complex focal seizures, and secondary generalized focal seizures.

In simple focal seizures, the patient's consciousness is completely preserved, the epileptic discharge remains localized and does not spread to other areas of the cortex. On the EEG during an attack, an epileptic discharge is recorded in the corresponding area of ​​\u200b\u200bthe cerebral cortex. The clinical manifestations of an attack depend on the area of ​​the cortex in which the discharge occurs. Examples include localized convulsions (eg, in the face, in the arm), autonomic disturbances (flushing or pallor of the face, pain, shortness of breath, increased sweating, dizziness), and sensory disturbances (unusual visual, auditory, gustatory, olfactory, tactile sensations, illusions or hallucinations) or mental disorders (unusual thoughts, fears, aggression, a change in the reality of what is happening, etc.). Simple focal seizures can transform (move) into complex focal (and possibly secondary generalized seizures).

In some cases, simple focal seizures may manifest as auditory, olfactory, or visual hallucinations. In such cases, it becomes necessary to distinguish epilepsy from mental illness. The epileptic nature of hallucinations is indicated by their stereotypical (the same from time to time) character and the persistence of criticism (the patient usually understands that his sensations are manifestations of the disease, he is aware of their unreality). On the contrary, in mental illness (schizophrenia) episodes of hallucinations do not have a stereotypical character and there is no criticism of the patient to his condition.

Simple focal seizures may be the only manifestation of epilepsy. Due to the fact that simple focal seizures do not significantly affect the ability of patients to work, they occur much more often than they are diagnosed. However, when detecting any focal seizures, including simple focal seizures, it is necessary to find out their etiology (origin), primarily in order to exclude progressive organic brain damage. Therefore, patients with focal seizures need a neuroradiological study (MRI or CT) of the brain.

Identification of focal seizures requires clarification of their etiology (origin)

Complex focal seizures may have manifestations characteristic of simple focal seizures, but they are always accompanied by loss of consciousness. In most cases, such attacks originate in the temporal or frontal lobes of the brain. It is not always possible to accurately establish that consciousness is lost during an attack. However, one should be guided by the following signs: the patient does not remember the attack, does not follow commands during the attack, does not respond, does not answer questions; if during an attack you ask the patient to remember a certain word or an object shown to him, after an attack he does not remember and will not be able to repeat this information. The planned revision of the classification of focal epileptic seizures does not provide for their division into simple and complex.

A patient during a complex focal seizure can fiddle with clothes, turn objects in his hands, wander aimlessly (“automatic” behavior or “automatisms”). Lip smacking or chewing, mumbling, grimacing, undressing, and aimless activities may occur in isolation or in various combinations. Complex focal seizures may develop into secondary generalized seizures.

Focal seizures with secondary generalization (secondary generalized seizures) are focal seizures (simple or complex), in which an epileptic discharge spreads to the cortex of both hemispheres of the brain with the development of a generalized seizure with the appearance of seizures (more often tonic-clonic, less often other types convulsions), urinary incontinence and loss of consciousness. If the discharge spreads very quickly, then by external manifestations a secondary generalized attack can be difficult to distinguish from a primary generalized one. In these cases, only EEG (video-EEG monitoring) will help clarify the type of attack. Sometimes in such cases, the so-called post-attack symptoms of prolapse can "signal" the doctor about the focal nature of the attack - this is, for example, Todd's paralysis (decrease in muscle strength and impaired movement) in the limbs on the one hand, which, especially at the onset of the disease, can be perceived as a manifestation of a stroke; speech impairment, prolonged confusion and others.

Most often, the focus of epileptic activity is located in the temporal lobes (60-70%). Seizures originating in the frontal lobes are also common (20-30%). Less often, the location of the focus of epileptic activity is determined in the parietal (10-15%) and occipital (10-15%) lobes.

Focal seizures most commonly originate in the temporal and frontal lobes.

focal epilepsy

Focal epilepsy is a type of epilepsy in which epileptic seizures are caused by a limited and clearly localized area of ​​increased paroxysmal activity brain. It is often secondary. It is manifested by partial complex and simple epiparoxysms, the clinic of which depends on the location of the epileptogenic focus. Focal epilepsy is diagnosed according to clinical data, EEG results and MRI of the brain. Antiepileptic therapy and treatment of causative pathology are carried out. According to the indications, it is possible to surgically remove the zone of epileptic activity.

focal epilepsy

The concept of focal epilepsy (FE) unites all forms of epileptic paroxysms, the occurrence of which is associated with the presence of a local focus of increased epi-activity in the cerebral structures. Starting focally, epileptic activity can spread from the focus of excitation to the surrounding brain tissue, causing a secondary generalization of the epileptic seizure. Such paroxysms of FE should be distinguished from attacks of generalized epilepsy with a primary diffuse character of excitation. In addition, there is a multifocal form of epilepsy, in which there are several local epileptogenic zones in the brain.

Focal epilepsy accounts for about 82% of all epileptic syndromes. In 75% of cases, it makes its debut in childhood. Most often, it occurs against the background of brain development disorders, traumatic, ischemic or infectious lesions. Such secondary focal epilepsy is detected in 71% of all patients with epilepsy.

Causes and pathogenesis of focal epilepsy

The etiological factors of FE are: malformations of the brain affecting its limited area (focal cortical dysplasia, arteriovenous malformations of the brain, congenital cerebral cysts, etc.), traumatic brain injury, infections (encephalitis, brain abscess, cysticercosis, neurosyphilis ), vascular disorders (past hemorrhagic stroke), metabolic encephalopathy, brain tumors. The cause of focal epilepsy may be acquired or genetically determined disorders in the metabolism of neurons in a certain area of ​​the cerebral cortex, not accompanied by any morphological changes.

Among the etiological factors for the occurrence of focal epilepsy in children, there is a high proportion of perinatal CNS lesions: fetal hypoxia, intracranial birth trauma, neonatal asphyxia, intrauterine infections. The emergence of a focal epileptogenic focus in childhood is associated with a violation of the maturation of the cortex. In such cases, epilepsy is temporary age-dependent.

The pathophysiological substrate of FE is the epileptogenic focus, in which several zones are distinguished. The zone of epileptogenic damage corresponds to the area of ​​morphological changes in the cerebral tissue, which in most cases are visualized using MRI. The primary zone is the area of ​​the cerebral cortex that generates epi-discharges. The area of ​​the cortex, during the excitation of which an epileptic seizure occurs, is called the symptomatogenic zone. There is also an irritative zone - the area that is the source of epi-activity recorded on the EEG in the interictal period, and a functional deficit zone - the area responsible for neurological disorders associated with epileptic seizures.

Classification of focal epilepsy

It is customary for neurologists to distinguish between symptomatic, idiopathic, and cryptogenic forms of focal epilepsy. With a symptomatic form, it is always possible to establish the cause of its occurrence and identify morphological changes, which in most cases are visualized during tomographic studies. Cryptogenic focal epilepsy is also called probably symptomatic, which implies its secondary nature. However, with this form, no morphological changes are detected by modern methods of neuroimaging.

Idiopathic focal epilepsy occurs in the absence of any changes in the central nervous system that could lead to the development of epilepsy. It may be based on genetically determined canal and membranopathies, disorders of the maturation of the cerebral cortex. Idiopathic FE is benign. It includes benign rolandic epilepsy, Panagiotopoulos syndrome, Gastaut's childhood occipital epilepsy, benign infantile episyndromes.

Symptoms of focal epilepsy

The leading symptom complex of PE is recurrent partial (focal) epileptic paroxysms. They can be simple (without loss of consciousness) and complex (accompanied by loss of consciousness). Simple partial seizures by their nature are: motor (motor), sensitive (sensory), vegetative, somatosensory, with a hallucinatory (auditory, visual, olfactory or gustatory) component, with mental disorders. Complex partial epileptic seizures sometimes begin as simple ones, and then there is a violation of consciousness. May be accompanied by automatisms. In the period after the attack, there is some confusion.

Secondary generalization of partial seizures is possible. In such cases, the epileptic seizure begins as a simple or complex focal, as it develops, excitation diffusely spreads to other parts of the cerebral cortex and the paroxysm takes on a generalized (clonic-tonic) character. A single patient with PE may have different types of partial paroxysms.

Symptomatic focal epilepsy, along with epileptic seizures, is accompanied by other symptoms corresponding to the main brain lesion. Symptomatic epilepsy leads to cognitive impairment and decreased intelligence, to mental retardation in children. Idiapathic focal epilepsy is distinguished by its benign nature, is not accompanied by neurological deficit and disorders of the mental and intellectual spheres.

Features of the clinic depending on the localization of the epileptogenic focus

Temporal focal epilepsy. The most common form with localization of the epileptogenic focus in the temporal lobe. For temporal epilepsy, sensorimotor seizures with loss of consciousness, the presence of an aura and automatisms are most characteristic. The average duration of an attack. In children, oral automatisms predominate, in adults - automatisms by the type of gestures. In half of the cases, paroxysms of temporal FE have a secondary generalization. With a lesion in the temporal lobe of the dominant hemisphere, post-attack aphasia is noted.

Frontal focal epilepsy. The epicenter located in the frontal lobe usually causes stereotypical short-term paroxysms with a tendency to seriality. Aura is not typical. Often there is a turn of the eyes and head, unusual motor phenomena (complex automatic gestures, foot pedaling, etc.), emotional symptoms (aggression, screaming, excitement). With a focus in the precentral gyrus, motor paroxysms of Jacksonian epilepsy occur. Many patients experience epileptic seizures during sleep.

Occipital focal epilepsy. When the focus is localized in the occipital lobe, epileptic seizures often occur with visual impairment: transient amaurosis, narrowing of visual fields, visual illusions, ictal blinking, etc. The most common type of paroxysm is visual hallucinations lasting up to 13 minutes.

Parietal focal epilepsy. parietal lobe- the most rare localization of the epicenter. It is mainly affected by tumors and cortical dysplasia. As a rule, simple somatosensory paroxysms are noted. After an attack, short-term aphasia or Todd's paralysis is possible. When the zone of epiactivity is located in the postcentral gyrus, sensory Jacksonian seizures are observed.

Diagnosis of focal epilepsy

For the first time, a partial paroxysm is a reason for a thorough examination, since it can be the first clinical manifestation of a serious cerebral pathology (tumor, vascular malformation, cortical dysplasia, etc.). During the survey, the neurologist finds out the nature, frequency, duration, sequence of development of the epileptic seizure. The abnormalities revealed during the neurological examination indicate the symptomatic nature of FE and help to establish the approximate localization of the lesion.

Diagnosis of epileptic brain activity is carried out using electroencephalography (EEG). Often, focal epilepsy is accompanied by epi-activity recorded on the EEG even in the interictal period. If the usual EEG turns out to be uninformative, then an EEG is performed with provocative tests and an EEG at the time of the attack. The exact location of the epicenter is established during subdural corticography - EEG with the installation of electrodes under the dura mater.

Identification of the morphological substrate underlying focal epilepsy is performed by MRI. To detect the slightest structural changes, the study should be carried out with a small thickness of sections (1-2 mm). With symptomatic epilepsy, MRI of the brain makes it possible to diagnose the underlying disease: focal lesion, atrophic and dysplastic changes. If abnormalities were not detected on MRI, then the diagnosis is idiopathic or cryptogenic focal epilepsy. Additionally, PET of the brain can be performed, which reveals an area of ​​cerebral tissue hypometabolism corresponding to an epileptogenic focus. SPECT in the same area determines the zone of hyperperfusion during an attack and hypoperfusion - in the period between paroxysms.

Treatment of focal epilepsy

Therapy for focal epilepsy is carried out by an epileptologist or neurologist. It includes the selection and constant use of anticonvulsants. The drugs of choice are carbamazepine, valproic derivatives, topiramate, levetiracetam, phenobarbital, etc. With symptomatic focal epilepsy, the main point is the treatment of the underlying disease. Usually, pharmacotherapy is quite effective in occipital and parietal epilepsy. With temporal lobe epilepsy, often after 1-2 years of treatment, resistance to ongoing anticonvulsant therapy is noted. No effect from conservative therapy is an indication for surgical treatment.

Operations are performed by neurosurgeons and can be aimed at both removal of a focal formation (cysts, tumors, malformations) and resection of an epileptogenic area. Surgical treatment epilepsy is advisable with a well-localized focus of epi-activity. In such cases, focal resection is performed. If individual cells adjacent to the epileptogenic zone are also a source of epiactivity, extended resection is indicated. Surgery is carried out taking into account the individual structure of the functional zones of the cortex, established using corticography.

Prognosis of focal epilepsy

In many respects, the prognosis of PE depends on its type. Idiopathic focal epilepsy is characterized by a benign course without the development of cognitive impairment. Its outcome is often the spontaneous cessation of paroxysms when the child reaches adolescence. The prognosis of symptomatic epilepsy is determined by the underlying cerebral pathology. It is most unfavorable for tumors and severe malformations of the brain. Such epilepsy in children is accompanied by mental retardation, which is especially pronounced in the early onset of epilepsy.

Among patients who underwent surgical treatment, 60-70% had no or significant decrease in epiparoxysms after surgery. The final disappearance of epilepsy in the long-term period was observed in 30%.

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Focal epilepsy is a type of brain disease known since ancient times, which manifests itself in specific convulsive seizures called epileptic seizures. For ignorant people in the modern world, the contemplation of such attacks is terrifying and numb. Although in ancient times this disease was considered sacred due to the fact that the disease manifested itself in many great people of that time, who were ranked among the saints and prophets.

What is focal epilepsy?

The human nervous system is a complex mechanism, the activity of which is based on the processes of excitation and inhibition due to stimulation of neurons by external or internal factors. Thus, our body reacts to changes occurring within it or in the surrounding space.

All sensory receptors on the human body, the network of nerve fibers, and the brain are supplied with neurons. It is thanks to these electrically excitable cells that we are able to feel, feel, perform purposeful actions and be aware of them.

Excitation is the process by which a neuron transmits energy through the nervous system, which transmits a signal ( electrical impulse) to the brain or in the opposite direction (to the periphery). In a healthy person, the process of excitation of neurons occurs under the influence of irritating factors. They say about epilepsy if foci of pathological excitation are found in the brain, the neurons of which come into a state of alert spontaneously without serious reasons with the formation of an excessively high charge.

Foci of increased excitability of the brain can have various shapes and sizes. Foci can be either single, clearly limited (localized form of the disease), or multiple, scattered in different parts of the brain (generalized form).

ICD-10 code

G40 Epilepsy

Epidemiology

In Ukraine, according to statistics, 1-2 people out of a hundred suffer from epilepsy. More than 70% of cases of diagnosing epilepsy fall on the congenital form of pathology. This is a vivid example of a generalized form of the disease, the causes of which most likely lie in a genetic anomaly. However, there is a certain percentage of patients who are diagnosed with idiopathic focal epilepsy with a well-defined focus of excitation in one specific area of ​​the brain.

Causes of focal epilepsy

Focal epilepsy is classified as chronic neurological diseases. It can be congenital without any anatomical defects in the structure of the brain. In this case, only disturbances are noted on the part of neurons that give incorrect signals to the periphery, as a result of which the appearance of pathological phenomena of a different nature is noted.

Symptoms of primary (idiopathic) epilepsy can be observed already in early childhood and adolescence. It responds well to drug therapy and over time, the frequency of epileptic seizures decreases.

The processes of excitation in the brain constantly alternate with the inhibition of the nervous system, thus, the controlling structures of the brain give it the opportunity to calm down and rest. If the control is not at the proper level, the brain is forced to constantly be in an excited state. This phenomenon is called increased convulsive readiness, which is typical for epilepsy.

The cause of genetic failures can be oxygen starvation at different stages of fetal development, intrauterine infections, intoxication, fetal hypoxia during childbirth. Incorrect genetic information can also be passed on to subsequent generations that have not been exposed to the above factors.

But the disease can also occur later. This form of pathology is called acquired (secondary, symptomatic), and its symptoms can appear at any age.

The causes of the development of symptomatic focal epilepsy lie in organic brain lesions caused by:

• (moreover, the manifestations of the disease may occur in the coming months after the injury, for example, a concussion, or be delayed, reminding of oneself several years later),
• internal bacterial and viral infections (the risk factors in this case are: untimely or incomplete treatment of the disease, ignoring bed rest in the acute stage of the pathology, ignoring the very fact of the disease),
• previous meningitis or encephalitis (inflammation of brain structures),
• acute disorders cerebral circulation, resulting in hypoxia of brain tissues, ischemic and hemorrhagic strokes,
• cervical osteochondrosis, which can provoke circulatory disorders in the brain area,
• malignant and benign tumors in the brain, aneurysms,
• chronic alcoholism (focal epilepsy in alcoholism is caused by toxic damage to the brain and metabolic disorders in its tissues, which is a consequence of regular alcohol abuse).

But various defects (dysgenesis) of the nervous system are more characteristic of idiopathic focal epilepsy.

There is also an intermediate form of the disease, which is called focal epilepsy associated with BEPD (benign epileptiform patterns of childhood). BEPD is diagnosed in 2-4% of children under 14 years of age. Every tenth such child is diagnosed with epilepsy.

Doctors consider birth trauma to be the cause of this form of focal epilepsy. organic brain lesions received by the child during childbirth. So the mistake of doctors can cause epileptic seizures in a child without congenital pathologies.

Pathogenesis

The basis of the pathogenesis of focal epilepsy is also uncontrolled spontaneous excitation of brain neurons, but in this form of the disease, such a pathological focus has a limited size and a clear localization. Thus, focal epilepsy should be understood as a localized form of the disease, the symptoms of which are less pronounced than in generalized seizures, when excitation occurs in different parts of the brain. Accordingly, the frequency of seizures in this case is less.

An epileptic seizure is often associated with a seizure, although in fact there may be a whole range of symptoms preceding unusual seizures. An excessive discharge of brain neurons provokes the occurrence of short-term pathological conditions characterized by impaired sensitivity, motor activity, mental processes, the appearance of vegetative symptoms and impaired consciousness.

The most unusual thing about this pathology is that patients most often cannot remember the details of the attack, because they do not even realize what happened to them. In a simple attack, the patient may remain conscious, but not control their reactions and actions. He realizes that he had a seizure, but cannot describe the details. Such an attack usually lasts no more than 1 minute and is not accompanied by serious consequences for a person.

In a complex epileptic seizure, there is a short-term loss or confusion of consciousness. And when a person comes to his senses, he cannot understand what happened to him if he suddenly finds himself in the wrong position or in the wrong place where he was caught by an attack. The duration of such an attack can vary from 1 to 3 minutes, after which the patient can poorly navigate the terrain for several more minutes, get confused in events, spatial and temporal coordinates.

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Symptoms of focal epilepsy

Speaking about the clinical picture of focal epilepsy, it must be remembered that we are dealing with a small limited epileptogenic focus in the brain, and depending on the localization of this focus, the symptoms of the disease will change. And yet, a distinctive feature of any type of epilepsy is the presence of recurrent epileptic seizures that develop progressively, but end within a short period of time.

As we have already mentioned, simple attacks pass without loss of consciousness by the patient, while complex ones are characterized by disturbances and confusion. Most often, complex epileptic seizures occur against the background of simple ones, and then there is a violation of consciousness. Sometimes there are automatisms (multiple monotonous repetitions of words, movements, actions). With secondary generalization, complex seizures occur against the background of a complete blackout of consciousness. Initially, symptoms of a simple attack appear, and when the excitation spreads to other parts of the cerebral cortex, a tonic-clonic (generalized) attack occurs, which is stronger than a focal one. In the event of a violation or blackout of consciousness, the patient feels a certain inhibition of reactions for another hour, and does not think well.

Simple epileptic paroxysms can occur with motor, sensory, vegetative, somatosensory disorders, occur with the appearance of visual and auditory hallucinations, changes in smell and taste, and even with mental disorders.

But these are all common phrases. What symptoms can manifest certain forms and types of focal epilepsy?

Idiopathic focal epilepsy characterized by rare attacks that have unilateral motor and (or) sensory symptoms. Attacks most often begin with speech disorders, numbness of the tissues of the tongue and mouth, spasms of the pharynx, etc. Patients often experience decreased tone muscular system, jerky movements of the body and limbs, impaired coordination of movement and orientation in space, malfunctions of the visual system.

Focal epilepsy in children in most cases is congenital and has idiopathic symptoms. In infants, the disease can manifest itself in the form of trembling of the eyelids, a glazed, frozen look, fading, tilting the head, arching the body, and spasms. Involuntary defecation and urination are not a reason to diagnose the disease if they are observed in children under 2 years of age.

The first signs of an approaching attack in a child may be the following symptoms: the baby’s sleep is disturbed, increased irritability appears, he begins to act up for no reason. In early childhood, seizures are often accompanied by loss of consciousness, whims, increased tearfulness of the baby.

Older children may experience sudden freezing with a lack of reaction to the environment and stimuli, a gaze frozen at one point. With focal epilepsy, visual, gustatory and auditory disturbances often appear. At the end of the attack, the baby continues to go about his business, as if nothing had happened.

Epileptic convulsions in children do not have to be accompanied by convulsions. Seizures without seizures (aka absences), lasting less than 30 seconds, are often observed in girls between 5 and 8 years.

In adolescence, epileptic seizures are often accompanied by biting the tongue and foaming at the mouth. After the attacks, the child may become sleepy.

Symptomatic form of the disease has a clinical picture corresponding to the localization of the affected area in the brain, because different parts of the brain are responsible for different aspects of our life.

If the zone of increased excitability of neurons is located in the temple area (temporal epilepsy), the epileptic seizure has a short duration (half a minute - a minute). The attack is preceded by a bright aura: the patient may complain of vague pain in the abdomen, semi-real illusions (pareidolia) and hallucinations, impaired sense of smell, spatio-temporal perception, awareness of one's location.

Seizures can take place both with loss of consciousness and with its preservation, but the awareness of what is happening remains blurred. The manifestations of the disease will depend on the location of the epileptogenic focus. If it is located in the medial zone, then there is a partial shutdown of consciousness, i.e. a person can freeze for a while.

After an abrupt stop of motor and speech activity in adults, predominantly motor automatisms occur. In other words, a person can repeatedly unconsciously repeat some simple actions or gestures. Oral automatisms predominate in children (pulling out the lips, imitation of sucking, clenching the jaws, etc.).

Temporary mental disturbances can be observed: a feeling of unreality of what is happening with memory impairments, self-perception disorders, etc.

The lateral location of the focus in the temporal zone of a person is tormented by nightmarish hallucinations (visual and auditory), anxiety increases, dizziness that is not systemic, temporary blackout and loss of balance without the appearance of convulsions (temporal syncope).

If the lesion is found in the dominant hemisphere of the brain, after the end of the attack, speech (aphasia) disturbances may be observed for some time.

If the disease progresses, then at a certain stage, secondary generalized seizures may appear, which happens in 50% of patients with focal temporal lobe epilepsy. In this case, in addition to loss of consciousness, tonic-clonic seizures are observed, with which we usually associate the concept of epilepsy: numbness of the limbs in an extended state, throwing back of the head, a loud violent cry (sometimes as if growling) with active exhalation, then there are twitching of the limbs and body, spontaneous exit of urine and feces, the patient can bite his tongue. At the end of the attack, speech and neurological disorders are observed.

In the later stages of the disease, the personality characteristics of the patient may change, which may become more conflicting and irritable. Over time, thinking, memory are disturbed, slowness and a tendency to generalize appear.

focal temporal lobe epilepsy one of the most common types of symptomatic form of the disease, which is diagnosed in every fourth patient.

For focal frontal epilepsy, which is rightfully considered the most popular type of pathology, the appearance of an aura is not typical. The attack usually proceeds against the background of preserved consciousness or in a dream, has a short duration, but is prone to seriality (repeated seizures).

If the epileptic seizure began in daytime you can notice uncontrolled movements of the eyes and head, the appearance of complex motor automatisms (a person begins to move his arms and legs, imitating walking, running, cycling, etc.) and psycho-emotional disorders (aggressiveness, nervous excitement, throwing, shouting, etc. .).

If the epileptogenic focus is located in the precentral gyrus, sudden motor disturbances of a tonic-clonic nature with localization on one side of the body may occur, usually occurring against the background of preserved consciousness, although an attack is sometimes generalized. First, the person freezes for a moment, and then almost immediately muscle twitches are noted. They always begin in the same place and spread to the half of the body where the attack began.

You can prevent the spread of seizures by holding the limb where they started. True, the initial focus of the attack can be located not only on the limbs, but also on the face or body.

If seizures occur in a person during sleep, then short-term disorders such as sleepwalking (sleep walking), parasomnias (limb movement and involuntary muscle contractions in a sleeping person), and nighttime urinary incontinence may occur. This is a fairly mild form of the disease, in which increased excitability of neurons is observed in a limited area and does not spread to other areas.

Focal occipital epilepsy manifested mainly by visual disturbances. These can be both involuntary eye movements and visual disturbances: its deterioration, temporary blindness, the appearance of visual hallucinations and illusions of a different nature and complexity, narrowing of the field of vision, the formation of a slope (empty areas in the field of vision), the appearance of flashing lights, flashes, patterns before your eyes.

With regard to motor visual impairment, there may be trembling of the eyelids, rapid oscillatory eye movements up and down or from side to side (nystagmus), a sharp narrowing of the pupils of the eyes (miosis), rolling the eyeball, etc.

Most often, such an attack is observed against the background of a migraine-like headache, pallor skin. In children and some adults, they may be accompanied by bouts of abdominal pain and vomiting. The duration of the attack can be quite long (10-13 minutes).

Focal parietal epilepsy- the rarest type of symptomatic form of the disease, usually occurring due to tumor and dysplastic processes in the brain. Patients complain of a violation of sensitivity with characteristic symptoms: tingling, burning, acute short-term pain in the area of ​​numbness. It may seem to a person that the numb limb is absent altogether or is in an uncomfortable position, dizziness and confusion may appear.

Most often, loss of sensation occurs on the face and hands. If the epileptogenic focus is located in the region of the paracentral flowing gyrus, numbness can also be felt in the groin, thighs and buttocks. With damage to the postcentral gyrus, symptoms appear in a limited area and gradually spread to other areas.

If the posterior parietal zone is affected, then the appearance of visual hallucinations and illusory pictures, a violation of the visual assessment of the size of objects, the distance to them, etc. is quite likely.

With the defeat of the parietal zone of the dominant hemisphere of the brain, speech and oral counting disorders occur. Orientation disorders in space are observed when the focus is localized in the non-dominant hemisphere.

Attacks occur mainly during the day and last no more than 2 minutes. But the frequency of their occurrence may be higher than in other localizations of the pathological focus.

Cryptogenic focal epilepsy with an unclear genesis can occur against the background of alcoholism and drug addiction, and also be a consequence of head injury, viral pathologies, disorders of the liver and kidneys. Usually, seizures occur spontaneously in epilepsy, but with this form of pathology, they can be triggered by bright lights, loud sounds, a sharp temperature drop, a sudden awakening, an event that caused a surge of emotions, etc.

It is believed that the disease is accompanied by metabolic disorders. The content of fats in the body remains at the same level, but the level of water is constantly growing and it begins to accumulate in tissues, including brain tissue, which provokes the onset of an attack.

Quite often, seizures of varying duration occur with loss of consciousness and neurological disorders. Their regular repetition can lead to mental disorders.

Harbingers of a severe and prolonged attack are: the appearance of insomnia, tachycardia, headaches, bright visual hallucinations with flashing lights.

For focal epilepsy with secondary generalization of seizures, the following manifestations are characteristic:

• First, an aura appears within a few seconds, the symptoms of which are unique, i.e. different people may experience different symptoms of a seizure
• Then the person loses consciousness and balance, muscle tone decreases and he falls to the floor, while emitting a specific cry due to the difficulty in passing air through the suddenly narrowed glottis with a sudden contraction of the muscles of the chest. Sometimes the muscle tone does not change and the fall does not occur.
• Now the phase of tonic convulsions begins, when the human body freezes for 15-20 seconds in an unnatural position with elongated limbs and a head thrown back or turned to one side (it turns in the direction opposite to the lesion). Breathing stops for a while, there is swelling of the veins in the neck and pallor of the face, which can gradually take on a bluish tint, tight compression of the jaws.
• After the tonic phase, the clonic phase occurs with a duration of about 2-3 minutes. During this phase, twitching of muscles, limbs, rhythmic flexion and extension of the arms and legs, oscillatory movements of the head, movements of the jaws and lips are observed. The same paroxysms are characteristic of a simple or complex attack.

Gradually, the strength and frequency of convulsions decreases, and the muscles completely relax. In the post-epileptic period, there may be a lack of response to stimuli, dilated pupils, no reaction of the eyes to light, no tendon and protective reactions.

Now some information for alcohol lovers. There are frequent cases of development of focal epilepsy against the background of abuse alcoholic drinks. Usually seizures are caused by head trauma, which often happens in a state of alcohol intoxication, withdrawal syndrome, a sharp rejection of alcohol.

Symptoms of alcoholic epilepsy can be considered: fainting and loss of consciousness, the appearance of convulsions, burning pains, feelings of squeezing or twisting of the muscles in the limbs, hallucinations, vomiting. In some cases, a burning sensation in the muscles, hallucinations, delusional states are observed even the next day. After attacks, sleep disturbances may occur, irritability and aggressiveness occur.

Further exposure to alcohol toxins on the brain leads to an increase in epileptic episodes and personality degradation.

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Forms

Focal epilepsy is a generalized name for diseases with a well-defined zone of excessive excitation of neurons, characterized by recurrent epileptic seizures. Since this is a disease of the neurological sphere, experts in this field distinguish 3 forms of focal epilepsy: idiopathic, symptomatic and cryptogenic.

Idiopathic focal epilepsy, which we have already mentioned, is a type of disease, the causes of which have not been fully understood. But scientists suggest that it all comes down to violations of brain maturation in the prenatal period, which are genetically determined. At the same time, devices for instrumental diagnostics brain (MRI and EEG machines) do not show any changes.

The idiopathic form of the disease is also called benign focal epilepsy. It is about this form that we are talking about when the doctor makes a diagnosis:

• benign childhood (rolandic) epilepsy or epilepsy with central temporal peaks,
• benign occipital epilepsy early manifestations(Panayotopoulos syndrome, occurs before the age of 5 years),
• benign occipital epilepsy, manifesting at a later age (Gastaut-type epilepsy is diagnosed in children older than 7 years),
• primary epilepsy of reading (the rarest type of pathology with localization of the epileptogenic focus in the parietal-temporal zone of the hemisphere of the brain, which is more responsible for speech, is more characteristic of the male population with alphabetic writing),
• autosomal dominant frontal epilepsy with nocturnal paroxysms,
• familial temporal lobe epilepsy
• non-familial and familial benign epileptic seizures in infancy,
• familial temporal lobe epilepsy, etc.

Symptomatic focal epilepsy, on the contrary, has specific causes, consisting in various organic brain lesions and detected during instrumental studies in the form of interconnected zones:

• anatomical lesion zone (direct focus of brain damage resulting from a head injury, circulatory disorders, inflammatory processes, etc.),
• zone of formation of pathological impulses (area of ​​localization of neurons with high excitability),
• symptomatic zone (the area of ​​​​distribution of excitation, which determines the clinical picture of an epileptic seizure),
• irritative zone (brain area where increased electrical activity is detected by EEG outside of seizures),
• a zone of functional deficiency (the behavior of neurons in this area provokes neurological and neuropsychic disorders).

In the symptomatic form of the disease include:

• Permanent partial epilepsy (synonyms: cortical, continual, kovzhevnikovskaya epilepsy), characterized by constant twitching of the muscles of the upper body (mainly on the face and arms).
• Epileptic syndromes provoked by certain factors, for example, seizures of partial (focal) epilepsy that occur during a sudden awakening or under the influence of strong psycho-emotional factors.
• Focal temporal epilepsy, in which the temporal zone of the brain is affected, which is responsible for thinking, logic, hearing, behavior. Depending on the localization of the epipathological focus and the symptoms that appear, the disease can occur in the following forms:
  • amygdala,
  • hippocampal,
  • lateral (posterior temporal),
  • insular.

If both temporal lobes are affected, we can talk about bilateral (bitemporal) temporal lobe epilepsy.

• Focal frontal epilepsy, which is characterized by damage to the frontal parts of the brain with impaired speech activity and serious behavioral disorders (Jacksonian epilepsy, sleep epilepsy).
• Focal parietal epilepsy, characterized by a decrease in the sensitivity of one half of the body.
• Focal occipital epilepsy, which occurs at different ages and is characterized by visual impairment. There may also be problems with coordination of movement, increased fatigue. Sometimes the process also goes to the frontal lobes, making it difficult to diagnose.

A special type of the disease is multifocal epilepsy, when mirror-like epileptogenic foci are successively formed in opposite hemispheres of the brain. The first focus usually appears already in infancy and affects the electrical excitability of neurons in the symmetrical region of the other hemisphere of the brain. The appearance of the second focus leads to violations of psychomotor development, work and structure of internal organs and systems.

Sometimes, with obvious symptoms of epilepsy in adults, doctors cannot determine the cause of the disease. Diagnosis does not reveal organic brain damage, but the symptoms suggest otherwise. In this case, the diagnosis is "cryptogenic focal epilepsy", i.e. epilepsy proceeding in a latent form.

Cryptogenic and symptomatic focal epilepsy can occur with secondary generalization, when both cerebral hemispheres are included in the process. In this case, along with focal (partial) seizures, generalized complex seizures appear, which are characterized by a complete blackout of consciousness and the presence of vegetative manifestations. In this case, the presence of convulsions is not necessary.

Some syndromes can occur with two types of seizures (focal and generalized):

• neonatal seizures in infants,
• severe myoclonic epilepsy that develops in early childhood,
• sleep epilepsy, which occurs during non-REM sleep and is characterized by prolonged peak and wave complexes,
• Landau-Kleffner syndrome or secondary epileptic aphasia, which develops at the age of 3-7 years and is characterized by symptoms of aphasia (receptive speech disorder) and speech expressiveness disorders (speech underdevelopment), the EEG reveals epileptic paroxysms, and the patient also has simple and complex epileptic seizures ( in 7 out of 10 patients).

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Complications and consequences

Despite the fact that focal epilepsy is considered a milder form of the disease than generalized, its symptoms not only look very unsightly, but also pose a certain danger to the patient. Of course, seizures do not appear so often and are less pronounced than in generalized ones, but even these infrequent seizures pose a high risk of injury with a sudden decrease in tone and falling to the floor, especially if there was no person nearby who could support in such a situation.

Another big danger is the high probability of asphyxia due to the ingress of vomit into the respiratory tract or blocking the air flow by the tongue of the patient sunken inside. This can happen if there is no person nearby who will turn the patient's body during an attack on its side. Asphyxia, in turn, can lead to the death of the patient, regardless of the cause and type of epilepsy.

The inhalation of vomit that occurs during a seizure can provoke the development of acute inflammatory process in lung tissues (aspiration pneumonia). If this happens regularly, the disease can have a complicated course, the lethality of which is about 20-22 percent.

In frontal focal epilepsy, paroxysms can occur serially for half an hour with a short interval between attacks. This condition is called status epilepticus. The appearance of serial seizures can also be a complication of other types of epilepsy.

The human body simply does not have time to recover during the intervals. If at the same time there is a delay in breathing, this can lead to brain hypoxia and related complications (with a total duration of attacks of more than half an hour, the development of oligophrenia, mental retardation in children, death of the patient with a probability of 5-50%, behavioral disorders). Convulsive status epilepticus is especially dangerous.

If the disease is not treated, then many patients develop mental instability. They are characterized by outbursts of irritability, aggression, they begin to conflict in the team. This affects the relationship of a person with other people, creates interference in work and life. In some cases, a neglected disease leads not only to emotional lability, but also to serious mental disorders.

Especially dangerous is focal epilepsy in children, since regular seizures can lead to mental retardation, speech and behavioral disorders, which presents certain difficulties during learning and communication with peers, teachers, parents, and reduced school performance.

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Diagnosis of focal epilepsy

The diagnosis of "focal epilepsy" is made by doctors on the basis of recurrent epileptic seizures. Single paroxysms are not considered a reason to suspect serious illness. Nevertheless, even such attacks are a sufficient reason to consult a doctor, whose task is to detect the disease at an early stage of its development and prevent the progression of symptoms.

Even a single focal paroxysm can be a symptom of a severe cerebral disease, which are tumor processes in the brain, vascular malformation, cortical dysplasia, etc. And the sooner the disease is detected, the more likely it is to win.

Such a problem should be addressed to a neurologist who will conduct a physical examination of the patient, carefully listen to the patient's complaints, paying attention to the nature of the symptoms, the frequency of their repetition, the duration of the attack or attacks, the symptoms preceding the epileptic seizure. The sequence of development of an epileptic attack is very important.

It must be understood that the patient himself often remembers little about the symptoms of an attack (especially a generalized one), so the help of relatives or eyewitnesses of a seizure who can provide details may be needed.

It is mandatory to study the patient's history and family history to identify episodes of epilepsy in the patient's family. The doctor will definitely ask the patient (or his relatives, if this is Small child), at what age the seizures or symptoms corresponding to absences appeared, as well as the events preceding the seizure (this will help to understand what provoked the excitation of brain neurons).

Laboratory tests in the case of focal epilepsy are not important diagnostic criteria. A general analysis of urine and blood, which a doctor can prescribe in this case, is more likely to be needed to identify comorbidities and determine the performance of various organs, which is important for prescribing medication and physical procedures.

But without instrumental diagnostics, an accurate diagnosis is impossible, because on the basis of the above, the doctor can only guess in which area of ​​\u200b\u200bthe brain the epileptogenic focus is located. The most informative in terms of diagnosing epilepsy are:

• EEG (electroencephalogram). This simple study sometimes makes it possible to detect increased electrical activity in epi-foci even between attacks, when a person goes to the doctor (in decoding, it is shown in the form of sharp peaks or waves of greater amplitude than the rest)

If the EEG does not show anything suspicious in the interictal period, provocative and other studies are carried out:

• EEG with hyperventilation (the patient needs to breathe quickly and deeply for 3 minutes, after which there is an increase in the electrical activity of neurons,
• EEG with photostimulation (using flashes of light),
• Sleep deprivation (stimulation of neuron activity by refusing to sleep for 1-2 days),
• EEG at the time of the attack
• Subdural corticography (a method that allows you to determine the exact localization of the epileptogenic focus)

• MRI of the brain. The study allows to identify the causes of symptomatic epilepsy. The thickness of the slices in this case is minimal (1-2 mm). If structural and organic changes are not found, the doctor makes a diagnosis of cryptogenic or idiopathic epilepsy, based on the history and complaints of the patient.
• Positron emission tomography (PET of the brain). It is used less frequently, but it helps to identify metabolic disorders in the tissues of the epicenter.
• . It is carried out with injuries or the impossibility of conducting other studies.

Additionally, a biochemical blood test, a blood test for sugar and infections, a tissue biopsy and subsequent histoscopic examination (if there is a suspicion of an oncological process) may be prescribed.

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Differential Diagnosis

Differential diagnosis helps to determine the form of the disease (focal or generalized), make an accurate diagnosis, taking into account the localization of the lesion, differentiate single epileptic seizures provoked by emotional states, and directly epilepsy, as a chronic disease and recurrent seizures.

Treatment of focal epilepsy

Treatment for the patient can be prescribed by a neurologist or epileptologist, if there is such a specialist in a medical institution. The basis of therapy for focal epilepsy is medication, while physiotherapy for this pathology is not prescribed at all, so as not to provoke an attack, or is carried out with extreme caution (usually these are special exercise therapy exercises that help balance the processes of excitation and inhibition in the brain) . You need to immediately tune in that taking medication will not be temporary, but permanent throughout the patient's life.

Homeopathy

Probably, adherents of folk treatment will have it easier than fans of homeopathy. The fact is that in our country, few homeopaths undertake to treat patients diagnosed with generalized or focal epilepsy. And there are not so many drugs that help with this pathology.

To improve the condition and functioning of the brain, you can take the homeopathic preparation Cerebrum compositum. But such treatment alone will not help get rid of the attacks of the disease.

epileptic seizures at night and during menstruation, as well as seizures aggravated by heat, are in the pathogenesis of the homeopathic preparation Bufa Rana, made from toad venom.

Nux vomica can be used to treat nocturnal seizures. Cuprum also has a beneficial effect on the nervous system, therefore it is also used to treat epilepsy, accompanied by convulsive seizures with a preceding cry.

Applying homeopathic preparations(and they should be prescribed by a homeopathic doctor) for the treatment of epilepsy, you need to understand the principle of their action. Taking drugs first worsens the condition of patients. BUT this is a temporary situation, followed by a decrease in the number of attacks and a decrease in their intensity.

Prevention

As for the prevention of the disease, it all depends on the form of the disease. Timely treatment of the underlying disease that causes seizures, good nutrition, a healthy and active lifestyle will help prevent the symptomatic form of the disease.

To prevent the occurrence of an idiopathic form of the disease in a child, expectant mother it is worth giving up smoking, drinking alcohol and drugs during pregnancy and on the eve of conception. This does not give an absolute guarantee that the child will not experience such a deviation, but it will reduce the likelihood of such an outcome. It is also recommended to provide the baby with proper nutrition and rest, protect the head from overheating and injuries, contact the pediatrician in a timely manner if any unusual symptoms appear and not panic if a seizure occurs, which does not even always indicate an illness.

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With appropriate treatment, in half of the patients the seizures are gradually reduced to zero, and another 35% note that the number of paroxysms has decreased markedly. Serious mental disorders are observed in only 10% of patients, while 70% of patients do not have intellectual disabilities. Surgical treatment guarantees almost one hundred percent relief from seizures in the near future or in the long term.

In symptomatic epilepsy, the prognosis depends on the pathology causing the onset of epileptic seizures. The easiest to treat is frontal epilepsy, which has a milder course. The prognosis of treatment for alcoholic epilepsy is highly dependent on whether a person can stop drinking alcohol.

In general, the treatment of any form of epilepsy involves the rejection of nervous system stimulating drinks (alcohol and caffeinated liquids), the use of large amounts of clean water and protein-rich foods: nuts, chicken meat, fish, vitamin foods and dishes high in polyunsaturated fatty acids. It is not desirable for epileptics to work the night shift.

The established diagnosis of focal or generalized epilepsy entitles the patient to receive a disability. Any epileptic with moderate-intensity seizures can qualify for a Group 3 disability that does not limit their ability to work. If a person has simple and complex seizures with loss of consciousness (in pathology with secondary generalization) and a decrease in mental abilities, he can even be given group 2, because employment opportunities in this case are limited.

Focal epilepsy is a disease that is milder than the generalized form of the disease, and yet, epileptic seizures can somewhat reduce the patient's quality of life. The need to take medication, seizures that pose a risk of injury, possible complications and suspicious looks (and sometimes stupid, tactless questions) of others who witnessed the attack can affect the patient's attitude towards himself and life in general. Therefore, much depends on the relatives and friends of the epileptic, who can raise a person's self-confidence and encourage him to fight the disease. A person should not take illness as a sentence. It is rather a feature of a person and a test of his will and desire to live a healthy, fulfilling life.

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Paroxysms are called short-term sudden onset and abruptly stopping disorders, prone to reappearance.

Epileptiform paroxysms include short-term seizures with a very different clinical picture, directly related to organic brain damage.

The presence or absence of focal (focal) manifestations is the most important principle of the International Classification of epileptiform paroxysms. In accordance with the International Classification, seizures are divided into generalized (idiopathic) and partial (focal).

Generalized seizures are always accompanied by a gross disorder of consciousness and complete amnesia. Since the seizure immediately disrupts the work of all parts of the brain at the same time, the patient cannot feel the approach of the attack, the aura is never observed. Absences and other types of petty seizures are typical examples of generalized seizures. Grand mal seizures are classified as generalized only if they are not accompanied by an aura.

A small seizure is a short-term shutdown of consciousness followed by complete amnesia. A typical example of a small seizure is an absence during which the patient does not change position. Turning off the consciousness is expressed in the fact that it stops the initiated action, the gaze becomes floating, meaningless; face turns pale. After 1-2 seconds, the patient comes to his senses and continues the interrupted action, not remembering anything about the seizure. Other variants of small seizures are complex absences, accompanied by abortive convulsive movements forward (propulsion) or backward (retropulsion), inclinations like an oriental greeting (salam-seizures). At the same time, patients may lose their balance and fall, but they immediately get up and regain consciousness. Minor seizures are never accompanied by an aura or precursors.

Focal (partial) seizures may not be accompanied by complete amnesia. Their psychopathological symptoms are diverse and exactly correspond to the localization of the focus. Typical examples of partial seizures are special states of consciousness, dysphoria, Jacksonian seizures (motor seizures with localization in one limb, occurring against a background of clear consciousness). Quite often, local epileptic activity later spreads to the entire brain. This corresponds to loss of consciousness and the occurrence of clonic-tonic convulsions. Such variants of partial seizures are referred to as secondary-generalized. Examples of these are grand mal attacks, preceded by warnings and an aura. The division of seizures into generalized and partial is essential for diagnosis. So, generalized seizures (both grand mal and petit mal) mainly serve as a manifestation of the actual epileptic disease (genuine epilepsy). Partial seizures, on the contrary, are very non-specific and can occur with a wide variety of organic diseases of the brain (trauma, infection, vascular and degenerative diseases, eclampsia). Thus, the appearance of partial seizures (secondary generalized, Jacksonian, twilight states, psychosensory disorders) at the age of more than 30 years is often the first manifestation of intracranial tumors and other volumetric processes in the brain. Epileptiform paroxysms are a frequent complication of alcoholism.

A grand mal seizure is manifested by a sudden loss of consciousness with a fall, a characteristic change of tonic and clonic convulsions, and subsequent complete amnesia. Seizure duration from 30 s to 2 min. The tonic phase is manifested by a sudden loss of consciousness and tonic convulsions. Signs of turning off consciousness are the loss of reflexes, reactions to extraneous stimuli, the absence of pain sensitivity (coma). Tonic convulsions are manifested by a sharp contraction of all muscle groups and a fall. If there was air in the lungs at the time of the seizure, a sharp cry is observed. With the onset of a seizure, breathing stops. The face first turns pale, and then cyanosis increases. The duration of the tonic phase is 20-40 s. The clonic phase also proceeds against the background of switched off consciousness and is accompanied by simultaneous rhythmic contraction and relaxation of all muscle groups. During this period, urination and defecation are observed, the first respiratory movements appear, but full breathing is not restored and cyanosis persists. Air pushed out of the lungs forms foam, sometimes stained with blood due to biting of the tongue or cheek. Duration up to 1.5 min. The attack ends with the restoration of consciousness, but for several hours after this there is a somnolence.

Psychosensory seizures are manifested by the feeling that the surrounding objects have changed size, color, shape or position in space. Sometimes there is a feeling that parts of one's own body have changed (body schema disorders). Derealization and depersonalization in paroxysms can be manifested by bouts of deja vu and jamais vu. In all these cases, patients retain fairly detailed memories of painful experiences. Real events at the time of the seizure are remembered somewhat worse.

Viscero-vegetative seizures.

Visceral (cortical) seizures are paroxysms, most often affecting the gastrointestinal tract in one way or another. In the region of the xiphoid process, the navel and below, less often in the mouth or throat, there are sensations of tightness, emptiness, burning, pain. When such sensations arise in the region of the epigastrium and somewhat lower, they are accompanied, especially in children, by a feeling of nausea, rumbling of the intestines, flatulence, and salivation. Swallowing and chewing movements may be observed. The sensation that has arisen does not remain localized, but rises upward - to the neck and head. In the latter case, loss of consciousness and a generalized seizure usually occur. As options for visceral seizures, there are:

Chewing seizure (masticatory seizure) - a paroxysm of involuntary rhythmic chewing movements with profuse salivation; in some cases, there is a bite of the tongue.

An attack of salivation - a paroxysm of hypersalivation; saliva is poured out of the mouth or swallowed.

Pharyngooral seizure - a paroxysm of rhythmic movements of the lips and tongue, combined with acts of swallowing (the patient resembles a person while eating); at the same time, hypersalivation and chewing movements can be observed.

HEMICONVULSIVE SEIZURES.

Paroxysms of myoclonic convulsions of one half of the body, accompanied by a blackout of consciousness and autonomic disorders. They can occur in the form of status epilepticus, leaving behind symptoms of hemiparesis. Seen in early childhood. In some cases, seizures disappear, in others they are replaced by motor paroxysms, mainly of the Jacksonian type.

Aura - short-term (seconds), clouding of consciousness, in which various senestopathic, psychosensory, depersonalization, affective, hallucinatory disorders occur, remaining in the patient's memory, while what is happening around the patient is not perceived and remembered.

Aura classifications.

The first is divided into viscerosensory, visceromotor, sensory, impulsive and mental aura.

Viscerosensory aura (epigastric) - painful phenomena begin with an unpleasant sensation in the epigastric region with nausea. This sensation rises, the patient feels a blow to the head and loses consciousness.

The visceromotor aura is a pupillary aura (either constriction or dilation of the pupil), followed by a major convulsive seizure. The vascular aura also refers, consisting in the alternation of a sharp reddening of the skin with a feeling of a surge of heat and blanching of the skin with chills. Also included are the gastrointestinal aura (pain, rumbling in the abdomen, a sharp increase in peristalsis, diarrhea, turning into a convulsive seizure) and pilomotor aura - the appearance of "goosebumps" and raising hair on the skin. Frequent blinking movements preceding a convulsive seizure also apply.

The sensory aura is the somatosensory, visual, auditory, olfactory, and Ménière-like aura.

Somatosensory aura - abundant and varied senestopathic disorders (feeling of numbness, tingling, compression, stretching). Sometimes it is manifested by hallucinations of a general feeling (unpleasant sensations in the body, under the skin, in the internal organs, caused, according to the patient, by any particular object).

The visual aura is expressed in elementary visual hallucinations - photopsies (sparks, bright red, blue or green flashes) or a sudden sharp deterioration in vision up to complete blindness.

The auditory aura is manifested by acoasms (knocks, noises, rattles).

The olfactory aura is characterized by a sudden sensation of unpleasant odors: burning, smoke, decaying garbage. Sometimes patients feel pleasant smells of flowers, aromatic substances.

Attacks of sudden dizziness - they are accompanied by a feeling of unsteadiness and rotation in the head.

The impulsive aura is expressed in motor acts resembling pictures of ambulatory automatisms, but not accompanied by amnesia. The impulsive aura includes walking or running, violent screaming, violent singing, turning into a convulsive seizure.

The impulsive aura also includes impulsive violent excitement with aggressive tendencies towards others and destructive actions, which are very similar to twilight clouding of consciousness, but are not accompanied by amnesia.

The impulsive aura also includes episodes of exhibitionism, kleptomaniac and pyromanic acts, which also end in convulsive seizures.

Psychic aura. It includes a hallucinatory, ideational aura, an aura with a slight stupefaction of consciousness close to oneiroid, states with psychosensory disorders, phenomena of derealization and depersonalization, as well as an aura with a sensation of something that has never been seen before and has already been seen before. The hallucinatory aura is manifested by an aura with visual hallucinosis: patients see scenes of manifestations, holidays, disasters, fires. Ideator aura - it reveals certain disorders of thinking, including interruptions in the flow of thoughts ("blockage of thoughts", "stopping of thinking"). Following these phenomena comes a seizure. The ideational aura can be expressed in the sudden appearance in the patient's head of thoughts from outside, violent thoughts. The ideational aura may be accompanied by involuntary thoughts and speeding up of thinking, as well as violent memories with panoramic pictures of a past life. In this case, as in the case of violent thoughts, there is no sensation of extraneous influence. Ideatorny aura is in the form of short-term memory lapses. Difficult psychopathological assessment of the aura with blurred clouding of consciousness, approaching oneiroid. At the same time, the surroundings are perceived unusually, often fantastically. Otho is also considered a psychic aura. The stupefaction of consciousness is accompanied by the affect of fear and anxiety. Often, micro- and macropsias, metamorphopsias occur simultaneously, everything around is perceived as very reduced or sharply increased. Sometimes patients notice a sharp acceleration in the movements of others, cars, or they feel that buildings, structures are tilting, starting to break, and this whole avalanche is falling on them.

Epilepsy - chronic, endogenous-organic polyetiological, progressive disease of the brain, manifested by repeated convulsive or non-convulsive seizures with or without impaired consciousness and the formation of specific personality changes and dementia.

Epilepsy - a chronic brain disease characterized by repeated unprovoked seizures with impaired motor, sensory, autonomic, mental or mental functions resulting from excessive neural discharges in the cerebral cortex.

Etiopathogenesis of epilepsy.

Endogenous factors: hereditary predisposition (increased convulsive readiness of the GM) and constitutional personality traits.

Exogenous factors: implements predisposition: prenatal pathology, birth trauma, intrauterine organic brain damage, infections and injuries in the first and subsequent years of life.

Pathogenesis. The established pathogenetic mechanisms of epilepsy can be divided into 2 groups: those related to the actual cerebral processes and associated with general somatic changes in the body.

The central place in the cerebral mechanisms of epilepsy is assigned to the epileptoid and epileptic foci. The epileptoid focus is a local structural change in the brain - a source of pathological excitation of the surrounding neurons, as a result of which they begin to produce focal epileptic discharges. The development of convulsive discharges is due to the simultaneous excitation of a large number of neurons in the epileptic focus. Structural restructuring, which causes convulsive readiness, occurs in the outer zones of the epileptic focus, i.e. in the vicinity of the affected tissue, the coarse damaged elements of which are not able to realize an increased function (convulsive activity). There is also a hypothesis of "chain pathogenesis of epilepsy", according to which a hereditary convulsive predisposition, exogenous damaging effect and an external trigger factor are involved in the development of epilepsy.

Classification of epilepsy.

Classification by etiological factor:

Genuine (hereditary or congenital predisposition, constitutional features);

Mixed genesis;

Exogenous-organic (TBI, infections, intoxications).

By flow type:

With a predominance of convulsive seizures;

With a predominance of non-convulsive seizures.

According to the frequency and rhythm of paroxysms:

Epilepsy with frequent and rare seizures;

Epilepsy with intermittent, increasing and irregular rhythm of seizures.

By the time of occurrence of paroxysms:

Epilepsy awakening;

Nocturnal epilepsy.

By age at onset:

Children's;

Late.

In terms of progression:

benign;

Malignant.

According to the localization of the epileptic focus:

Cortical;

Temporal;

Diencephalic, etc.

GENERALIZED SEIZURES.

Grand mal seizure manifested by a sudden loss of consciousness with a fall, a characteristic change of tonic and clonic convulsions and subsequent complete amnesia. Seizure duration from 30 s to 2 min. tonic phase manifested by sudden loss of consciousness and tonic convulsions. Signs of turning off consciousness are the loss of reflexes, reactions to extraneous stimuli, the absence of pain sensitivity (coma). Tonic convulsions are manifested by a sharp contraction of all muscle groups and a fall. If there was air in the lungs at the time of the seizure, a sharp cry is observed. With the onset of a seizure, breathing stops. The face first turns pale, and then cyanosis increases. The duration of the tonic phase is 20-40 s. Clonic phase also proceeds against the background of switched off consciousness and is accompanied by simultaneous rhythmic contraction and relaxation of all muscle groups. During this period, urination and defecation are observed, the first respiratory movements appear, but full breathing is not restored and cyanosis persists. Air pushed out of the lungs forms foam, sometimes stained with blood due to biting of the tongue or cheek. Duration up to 1.5 min. The attack ends with the restoration of consciousness, but for several hours after this there is a somnolence.

Absences (minor seizures).

There is a division of absences, or small seizures (petits maux), into simple and complex. There may not be a clear boundary between them.

Absence simple - short-term (several seconds) loss of consciousness followed by amnesia. Absence suddenly overtakes the patient during any of his activities or conversation, which he usually resumes as soon as the paroxysm ends. During an absence, the face becomes slightly pale, the gaze is fixed in one direction; sometimes the eyeballs slightly move upward; barely noticeable blinking movements of the eyelids can be observed. The end of the paroxysm is instantaneous; as a rule, symptoms of stunning or malaise are not observed. Only after repeated absences several times in a row does some lethargy appear.

Absence complex - short-term loss of consciousness, accompanied by rudimentary convulsive components, movements or actions.

Absence myoclonic - a kind of complex absence: the loss of consciousness is accompanied by bilateral muscle twitches (myoclonus), mainly the muscles of the face and upper limbs; there may be a loss of objects from the hands, sometimes there is a sudden bending of the head and usually outstretched arms; with myoclonus, capturing the muscles of the lower extremities, a fall is possible.

Myoclonic (impulsive) seizures are clinically manifested by sudden shudders or jerky movements of certain muscle groups. Most often, the muscles of the upper limbs are involved, there is a rapid dilution or convergence of the hands, while the patient drops objects from the hands. With very short attacks, consciousness may not be disturbed, with longer ones it turns off for a short time.

Impulsive seizures occur, as a rule, in the form of series or "volleys" (5-20 in a row), separated from each other by an interval of several hours. Characterized by the occurrence of seizures in the morning.

Impulsive seizures are provoked by a number of moments (insufficient sleep, abrupt awakening, alcoholic excesses).

Akinetic (propulsive) seizures characterized by a variety of forward-directed movements (propulsion). Movement of the head, trunk, or whole body during propulsive seizures is due to a sudden decrease in postural muscle tone. Propulsive seizures are characteristic of early childhood (up to 4 years). At an older age, along with propulsive seizures, patients, as a rule, also have large convulsive seizures.

A variety of propulsive seizures are nods - a series of nodding head movements and pecks - sharp tilts of the head forward and down(at the same time, patients can hit their faces on objects in front of them). Nods and pecks are typical for children aged 2-5 months.

Salaam-fits so named because the movements made by patients during a seizure are vaguely reminiscent of bows during a Muslim greeting (the body leans forward, the head falls down, and the arms spread up and to the sides); such a seizure is not accompanied by a fall.

Lightning seizures differ from salaam-seizures by faster development. It should only be noted that due to the rapid and sharp movement of the body forward, patients often fall.