Epilepsy

Symptoms

The main clinical manifestation of epilepsy is epileptic paroxysms: seizures that occur due to a pathological (too intense or too slow) electrical discharge in the brain. The attack is usually brief, stereotypical (has characteristic repetitive features) and is manifested by a violation of behavior, emotions, motor or sensory functions.
According to the duration and possible cause of occurrence, there are:
•    Long-term (status epilepticus);
•    Random (occurring unexpectedly and without a provoking factor);
•    Cyclic (occurring at periodic intervals of time);
•    Provoked epileptic paroxysms (arising from exposure to exogenous or endogenous factors or caused by sensory stimulation).
 
An epileptic seizure can occur singly or in a series of seizures, between which a person does not come to his senses and does not fully recover. The attack may be accompanied by convulsions or proceed without them.

According to clinical manifestations, generalized and partial seizures are distinguished.
•    The most common type of generalized seizures is a tonic-clonic (convulsive) seizure. Against the background of complete health, a person loses consciousness, falls, the body arches - there is a symmetrical tonic tension of the body, there may be a bite of the tongue, a short delay in breathing, then the muscles begin to twitch (clonic convulsions), sometimes there is involuntary urination or defecation. The duration of the attack is up to 5 minutes.

•    Clonic seizures. They are rare and are manifested by muscle spasms - repetitive twitches.

•    Tonic seizures. They are manifested by a sudden paroxysmal muscle tension, breathing becomes difficult due to overstrain and the patient rolls his eyes and falls (if the attack caught him in a standing position). Falling may cause injury.

•    Atonic (astatic) seizures are characterized by non-convulsive loss of consciousness with a sudden loss of muscle tone and the same rapid recovery.

•    In children, absences are most often detected: the child freezes for a few seconds, but at the same time can make some movements.

•    For atypical absences, unlike classical absences, a gradual onset and end are characteristic. Most often they are accompanied by head nods, torso tilts, cascading falls. Muscle twitches are usually minimal.

•    Myoclonus is manifested by short-term non-rhythmic twitching of a group of muscles.
 
Partial seizures are also called focal or localized seizures. Seizures can occur in different ways, depending on which part of the brain is affected and how far it spreads. Symptoms include loss of orientation, disturbances in movement, sensation (including vision, hearing, and taste), mood, or other cognitive functions.
Unclassified epileptic seizures include seizures with clinical manifestations not included in the above categories, such as seizures with rhythmic eye movement, chewing movements of the jaws and swimming movements of the limbs.
 

Causes

The emergence of spontaneous bioelectrical activity (neuronal discharges), which results in repeated epileptic seizures, is caused by a variety of reasons.Epilepsy can be brought on by structural, genetic, infectious, metabolic, immunological, and unidentified etiological factors, such as:
•    Some genetic diseases;
•    Brain damage in the prenatal period and during birth (hypoxia or birth trauma, low birth weight);
•    Congenital malformations of the brain;
•    Head injury;
•    Stroke;
•    Infections - meningitis, encephalitis, neurocysticercosis;
•    Brain tumors.
Provoke an attack of epilepsy in some of its types can be sleep deprivation, alcohol intake, hyperventilation, sensory (sensory stimuli): flashing lights, temperature changes, loud sounds.
Depending on what exactly causes epileptic seizures, there are several types of pathology:
•    Idiopathic (primary, or congenital);
•    Symptomatic (secondary, or focal);
•    Cryptogenic epilepsy (seizures occur in the absence of focal changes in the brain according to electroencephalography, do not meet the criteria for an idiopathic form, but there is no evidence of their symptomatic nature).
In the case of idiopathic epilepsy, there is always a hereditary predisposition to seizures: the disease was diagnosed in blood relatives, or there were repeated loss of consciousness, fading, prolonged enuresis. 
Clinical manifestations of idiopathic epilepsy begin in childhood. Most often, there are no structural changes in the brain, but there is a high activity of neurons. There is also no significant cognitive defect. The prognosis for this form of epilepsy is often favorable, patients feel good on antiepileptic drugs, which significantly reduce the number of seizures and achieve long-term remission.
With symptomatic epilepsy, there is always an organic cause - cysts, brain tumors, malformations, neurological infections, strokes, and brain changes as a result of drug or alcohol addiction.
It should be understood that the appearance of a single convulsive attack, although it is a warning symptom, does not always indicate the presence of epilepsy. The doctor has the right to consider this diagnosis if the patient has had two or more attacks

Treatment

The treatment of epilepsy is a complex, long and dynamic process, the main goal of which is to prevent the development of seizures. It must comply with the following principles: individuality, duration, regularity, continuity, dynamism and complexity.
Drug therapy
Anticonvulsants take the first place in the complex treatment of epilepsy. The basis of the treatment of patients with epilepsy is the long-term use of anticonvulsants - drugs of various pharmacological groups that contribute to the relief and further prevention of epileptic seizures. These drugs include, for example, carbamazepine and benzonal.
However, the target of therapeutic activity is not only a seizure, but also mental disorders in a patient with an organic brain disease. Of considerable interest is the use of the latest generation of antiepileptic drugs (for example, valproates), which, in addition to anticonvulsant action, have neuroprotective and neurometabolic properties, which is especially important in the treatment of epilepsy with comorbid mental disorders.
Treatment of comorbid disorders. Since epilepsy is very often accompanied by mental disorders (more often cognitive dysfunction), it is advisable to carry out maintenance therapy at least twice a year, including neuroprotective (for example, Mexidol), fluid-correcting (Diacarb) and metabolic drugs - neurometabolics (nootropics, for example, pantogam and nootropil), however their appointment must be justified. The effectiveness and justification of prescribing nootropics is now disputed due to insufficient evidence of the effect. The appointment of such a course is possible only after receiving the dynamic results of the survey.

Tests Required for Diagnosis

Diagnostic possibilities are currently very wide, they allow you to accurately determine whether the patient suffers from epilepsy or the attack is the result of another disorder. For this, first of all, instrumental examinations are carried out, which are of decisive importance in the diagnosis and determination of the type of seizure.
Electroencephalography, or EEG, is the primary diagnostic technique. Even when epileptic patients are not having seizures, variations in the nature of brain waves are observed in these patients. To properly pinpoint the cause of paroxysms during the initial course of therapy, night time EEG video monitoring is advised. A routine EEG, performed at least once every six months, will be adequate for the doctor with additional dynamic observation. 
CT and MRI of the brain. The fundamental methods for diagnosing epilepsy are visual diagnostic methods - computed and magnetic resonance imaging, as well as PET - positron emission tomography. They allow you to identify the patient's organic substrate (tumors, cysts, vascular malformations or aneurysms), evaluate its function and structure, and sometimes identify foci of abnormal electrical activity that occur in epilepsy.
MEG (magnetoencephalography), the method is a type of encephalography that allows you to evaluate the structure and function of the brain. MEG records the magnetic signals of neurons, which makes it possible to observe brain activity from different points in time. This method does not require the use of electrodes, and also allows you to evaluate signals from deep brain structures, where the EEG is ineffective. Also used is a method such as resonance spectroscopy, which allows you to detect violations of biochemical processes in the brain tissue. This survey is carried out once every 3-4 years, sometimes more often if it is necessary to monitor the dynamics of the development of education.
The anamnesis of the disease is very important, which allows, on the basis of questioning the patient, to find out the details of the onset and development of the disease, its duration, the nature of the course, and the presence of a hereditary predisposition to epilepsy. It is extremely important to describe the paroxysms themselves, their frequency, description, and the presence of factors that contribute to the occurrence of seizures. Such questioning allows the doctor to determine the type of seizures, as well as to suggest which area of the brain may be affected.
Blood tests should be carried out at least once every 3 months in order to assess the effect of antiepileptic drugs on the body of a patient with epilepsy. In addition, patients taking valproic acid salts must monitor the value of platelets, since thrombocytopenia (a decrease in their number) is one of the possible side effects observed when taking valproates. Blood tests help the doctor assess the effect of other etiological factors (infection, lead poisoning, anemia , diabetes mellitus), and also help in assessing the contribution of genetic factors.
Neuropsychological testing should be performed at least once a year to assess the contribution of comorbid mental disorders and to determine the type of disease. Tests evaluate the properties of memory, speech, and attention, speed of thinking, the patient's emotional sphere and other cognitive functions.

Useful info

First aid for an epilepsy attack:
Actions that should never be performed during an epileptic attack (despite common stereotypes):
•    Use objects (spoon, spatula) to open the jaws of a person with an attack;
•    Give medicines and liquids during an attack by mouth;
•    Try to forcibly restrain convulsive movements;
•    Hit the victim on the cheeks, pour water;
•    Perform artificial respiration and heart massage. 
An epileptic attack is a reason to call an ambulance. Stay with the person until the moment he regains consciousness, then offer your help - he will feel confused.
Safety precautions for patients with epilepsy:
It is recommended to use a mouth guard, an anti-suffocating pillow while sleeping. Instead of taking a bath, take a shower, as one of the most common causes of death for patients with epilepsy is bathtub drowning. Other recommendations for patients with epilepsy:
•    keep a medication diary;
•    wear an information bracelet and first aid instructions;
•    activate the SOS function in the smartphone, wear a fall sensor, transmit the GPS position to relatives;
•    wear an epicap or protective headband;
•    underwater sports and martial arts are prohibited;
•    swimming and fishing must be in a life jacket under supervision.