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Epilepsy. Etiology. Pathogenesis. Convulsive Giving help. Non-convulsive equivalents of epileptic seizures. Twilight stupefaction. Trances. Ambulance

Epilepsy is one of the most common diseases of the nervous system, which, due to its characteristic features, presents a serious medical and social problem. Among the children’s population, the frequency of epilepsy is 0.75-1%, of which 65% can live without attacks, provided that they undergo an appropriate medical examination and receive appropriate treatment.

Epilepsy is a brain disease characterized by attacks of impaired motor, sensory, autonomic or mental functions. Moreover, in the period between attacks, the patient can be absolutely normal, no different from other people. It is important to note that a single attack is not yet epilepsy. Only repeated seizures are the basis for establishing a diagnosis of epilepsy. In epilepsy, seizures should also be spontaneous, i.e. do not provoke anything; they always appear unexpectedly. Attacks that occur when the temperature (febrile seizures), fear, when taking blood, as a rule, are not related to epilepsy.

The causes of epilepsy depend on age. In young children, the most common causative factor of acquired epilepsy is oxygen starvation during pregnancy (hypoxia), as well as congenital malformations of the brain, intrauterine infections (toxoplasmosis, cytomegaly, rubella, herpes, etc.); less commonly, birth trauma. There are also forms of epilepsy with a hereditary predisposition (for example, juvenile myoclonic epilepsy). With these forms, the risk of having a sick child if one of the parents is ill with epilepsy is low and amounts to no more than 8%. Extremely rare are progressive hereditary forms of epilepsy, mainly in families with a consanguineous marriage or in certain ethnic groups (for example, among the Finno-Ugrian population). In these families, the risk of having a sick child can be very high and reach 50%.

Thus secrete

“Symptomatic” epilepsy (when a structural defect in the brain can be detected),

idiopathic epilepsy (when there is a hereditary predisposition and there are no structural changes in the brain) and

cryptogenic epilepsy (when the cause of the disease cannot be identified).



Types of Attacks

1. Focal (partial, focal, local) seizures in which convulsions or peculiar sensations (for example, numbness) in certain parts of the body can be observed; most often in the face or limbs, especially in the hands.

Focal seizures may also occur.

? short bouts of visual, auditory, olfactory, or taste hallucinations;

? short-term sensation of pain or discomfort in the abdomen;

? an influx of thoughts with the inability to concentrate;

? a feeling of "already seen" or "never seen";

? bouts of unmotivated fear.

Consciousness during these attacks is usually preserved (simple partial attacks), and the patient describes his feelings in detail.

It is possible to turn off consciousness without falling and spasms (complex partial seizures). In this case, the patient continues to automatically perform the interrupted action. At this moment, automatisms can occur: swallowing, chewing, stroking the body, rubbing the palms, etc. At the same time, it seems that the person is simply absorbed in his activity. The duration of partial seizures is usually not more than 30 seconds. After complex partial attacks, short-term confusion, drowsiness are possible.



2. Generalized attacks:

a) convulsive and

b) non-convulsive (absences).



a) Generalized convulsive tonic-clonic seizures - the most serious, shocking, frightening type of seizures of parents and others, not the most difficult one.

Sometimes, several hours or even days before an attack, patients experience some phenomena called precursors:

general discomfort, anxiety, aggression, irritability, insomnia, sweating, a feeling of heat or cold, etc.

If the patient immediately feels an aura (discomfort in the abdomen, visual sensations, unreality of the environment, etc.), and then loses consciousness and falls in convulsions, then this attack is called secondary-generalized.

During the aura, some patients manage to protect themselves by calling for help from others or reaching the bed.

With primary generalized convulsive attacks, the patient does not feel an aura; these attacks are especially dangerous for their suddenness. The favorite time for their occurrence is the period shortly after the awakening of patients.

Phase:

At the beginning of the attack (tonic phase), muscle tension occurs and a piercing scream is often observed. During this phase, biting the tongue is possible. Short-term respiratory arrest develops, followed by the appearance of cyanosis (cyanosis of the skin).

Then the clonic phase of the attack develops: rhythmic twitching of the muscles occurs, usually with the involvement of all limbs. At the end of the clonic phase, urinary incontinence is often observed. Convulsions usually stop spontaneously after a few minutes (2-5 minutes).

Then comes the post-attack period, characterized by drowsiness, confusion, headache and the onset of sleep.



b) Non-convulsive generalized attacks are called absences. They occur almost exclusively in childhood and early adolescence. The child suddenly freezes (turning off consciousness) and stares intently at one point; the gaze seems absent. Covering the eyes, trembling of the eyelids, slight tipping of the head can be observed. Attacks last only a few seconds (5-20 seconds) and often go unnoticed. These attacks are very sensitive to hyperventilation - they are provoked by deep forced breathing for 2-3 minutes.



3. Myoclonic seizures: involuntary contraction of the muscles of the whole body or its parts, for example, hands or head, while the patient can throw away objects in his hands. These attacks often occur in the morning, especially if the patient does not get enough sleep. Consciousness is preserved with them.



4. Atonic seizures are characterized by a sudden complete loss of muscle tone, as a result of which the patient drops sharply. Convulsive contractions are absent.



5. In children of the first year of life, a special type of severe seizure occurs - infantile cramps. These attacks occur serially in the form of nods, folding the body, bending the arms and legs. Children with this type of seizure usually lag behind in motor and mental development.



There are about 40 different forms of epilepsy and various types of seizures. The doctor must conduct the necessary examination and accurately diagnose the form of epilepsy and the nature of the attacks. Moreover, for each form there is a certain antiepileptic drug and its own treatment regimen.



The course and forms of epilepsy

Paroxysm - an increase in any painful seizure to the highest degree; sometimes this word also refers to periodically recurring bouts of the disease.

Depending on the rate of increase in paroxysmal activity and the deepening of mental changes,

1. slowly and acutely current forms (Mnukhin S. S.)

2. slow, subacute, combined and remitting types of flow (Polybina M.N., Shubina S.A.)

3. continuously-progressive, remitting and stable type of course (G. Sukhareva)

The severity of epileptic disease is determined by the interaction of three main groups of factors:

1) the localization and activity of the epileptic focus;

2) the state of the protective and compensatory properties of the organism, its individual and age-related reactivity;

3) the influence of environmental factors.

There is no doubt also that the course of the disease is largely determined by the time of its onset, the regularity and adequacy of antiepileptic treatment and rehabilitation measures.




Of great importance for the formation of the clinical picture and the course of the disease is the localization of the epileptic focus. In accordance with this, some clinical forms of epilepsy are distinguished - temporal, diencephalic, etc.



Temporal (psychomotor) epilepsy. With this form of the disease, the epileptic focus in the temporal lobe of the brain is not always manifested by anatomical changes [Penfield W., Jasper H.].

Clinical features.

1. Seizures begin with a pronounced aura.

? this is a sensory aura (such as senestopathic, olfactory) +

? a complex mental aura, (in the form of verbal hallucinosis or conditions with a sharp change in the perception of the environment. It seems to the patient alienated, intimidating, threatening, sometimes comical, unreal, fuzzy).

2. Unconvulsive paroxysms with various variants of twilight conditions, in particular in the form of phenomena of psychic automatism, as well as the occurrence of conditions in these patients that are psychopathologically similar to the aura preceding convulsive paroxysms. A. Matthes (1977) describes paroxysms in temporal epilepsy in the form of more or less complex motor acts, often with aggressiveness, affective disorders, and autonomic disorders; moreover, in some cases, automatisms were combined with tonic convulsions or a sharp decrease in muscle tone.

The presence of the described paroxysmal conditions without confusion, convulsive paroxysms with twilight disorder of consciousness, the development of twilight states after seizures made it possible to call this variant of the disease “psychomotor epilepsy”. Describing the course of such epilepsy, A. Matthes emphasizes the frequency of seizures, their highest frequency at the age of 20–40 years, a combination of the described paroxysms with typical convulsive seizures during the first 3 years of illness.

It is believed that temporal lobe epilepsy is accompanied by the most profound and typical personality changes.

Surgical removal of the epileptic focus in most cases leads to the disappearance of paroxysms.



Diencephalic (vegetative) epilepsy. This form of the disease is studied mainly by neuropathologists, but patients with diencephalic epilepsy often turn out to be patients of psychiatric dispensaries and hospitals.



In the structure of periodically occurring paroxysms in diencephalic epilepsy, the main place is occupied by various autonomic disorders.

Paroxysms in autonomic (diencephalic) epilepsy go through several successive stages.



1. Paroxysms are usually preceded by a prodrome (several hours to a day):

har no:

mood changes, most often approaching dysphoria,

headache,

increased thirst or increased appetite.

2. The initial signs of paroxysm: vague fear, anxiety, discomfort in the epigastric region.

3. Actually, paroxysm manifests itself extremely varied - chills, hyperemia or pallor of the skin, salivation, lacrimation, tinnitus, adynamia, shortness of breath, tachycardia, increased blood pressure. Tonic convulsions are relatively common.

4. Paroxysm results in sweating, urinary retention or increased urination, frequent urge to defecate, drowsiness, increased appetite, and thirst. Paroxysms can be accompanied by confusion or loss of consciousness.

Along with the described paroxysms in the clinical picture of diencephalic epilepsy, narcoleptic and cataleptic seizures, as well as paroxysms accompanied by tonic convulsions, are relatively common. In general, the course of the disease process with localization of the focus in the diencephalic regions of the brain is relatively favorable.



The second part of the question:

Unconvulsive equivalents of epileptic seizures

The initial non-convulsive forms are described.

• paroxysmal sleep disorders,

• attacks of loss of consciousness with a violation of statics,

• absences,

• headache,

• viscerovegetative and psychosensory paroxysms,

• paresthesia,

• dizziness,

• affective and verbal paroxysms,

• amaurosis,

• stereotyped violent memories, etc.



Seizures with impaired (confused) consciousness: oneiroid, delirium, twilight dizziness, motor, expressive automatisms (fugues, transes, ambulatory automatisms).



Along with seizures during which productive psychopathological symptoms occur, paroxysms with negative symptoms are observed. These are, for example, seizures with stunning inquiries (absences, complex partial seizures), stupor and coma (non-convulsive seizures), amnestic seizures, and attacks based on sperprings. Probably, this does not exhaust all variants of “negative” epileptic paroxysms.



Special states of consciousness (similar paroxysms are described under other names: psychosensory seizures, like-like conditions, temporal pseudo-absences) differ from absences in a relatively slow beginning and end, longer (minutes, tens of minutes), and the presence of various psychopathological symptoms. Observed phenomena

autometamorphopsia (macrosomia, microsomy, etc.),

metamorphopsies (macropsy, micropsy, porropsy, etc.),

impaired perception of time,

derealization

the phenomena of “already seen, heard, experienced” and “never seen, not heard, not experienced”,

impaired perception of color quality,

single hallucinations

fragments of fantastic dreamlike nonsense,

fear, longing, perplexity,

massive vegetative disorders.

During and after the seizure, an understanding of the state of pain is maintained. The memories of the subjective experiences of this period are quite full, and external events are fragmentary or absent. Amnesia of a part (at the beginning, in the middle, at the end) of an attack is possible, to which confusion of consciousness is confined. In this case, the seizure, according to currently accepted terminology, is referred to as a complex partial seizure. Attention should be paid to the fact that in their reports, patients sometimes only mention “outages”, which can create an erroneous impression of absense. Complex partial seizures differ from abscesses in structural complexity, duration (several minutes, up to 10 or more), as well as the absence of typical discharges on the EEG — three peak-wave complexes per second.



Quite short-term seizures are ptimali (petit mal - fr.). It seems that for a moment the patient froze, froze - then the activity returns. Ptimal - short-term confusion. By time, ptimal (petit mal), as Latin names small seizures, are shorter than large ones and last for a second. The patient suddenly turns off consciousness. After a few seconds, consciousness returns and the person, as if nothing had happened, continues the action or work that he was busy with before the attack. However, some patients with small seizures feel and understand that something happened to them. For small seizures, a high frequency is characteristic: from several times to tens and hundreds of times a day.



Ambulatory automatisms - seizures with automatisms of walking. Patients wander around the city, go to unfamiliar places, and when they wake up, they don’t remember where they were and how they ended up here.



Transas are multi-day attacks during which patients make long journeys using modern types of vehicles. Patients attract the attention of others, perhaps only by increased drowsiness, reticence, distraction, as if immersed in some kind of reflection, but in general, external behavior remains orderly. It seems that the ancient, according to Jung's terminology, archetypal wandering complexes are released in trance.
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Epilepsy. Etiology. Pathogenesis. Convulsive Giving help. Non-convulsive equivalents of epileptic seizures. Twilight stupefaction. Trances. Ambulance

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