Epilepsy - Causes, symptoms and treatment. MF.

Epilepsy is a chronic disease of the brain, the main manifestation of which are spontaneous, short-term, rarely occurring epileptic seizures. Epilepsy is one of the most common neurological diseases. Every hundredth person on the earth has epileptic seizures.

Most often, epilepsy is congenital, so the first attacks appear in children( 5-10 years) and adolescence( 12-18 years).In this case, brain damage is not detected, only the electrical activity of nerve cells is changed, and the threshold of brain excitability is lowered. This epilepsy is called primary( idiopathic), flows benignly, is well treatable, and with age, the patient can completely stop taking pills.

Another type of epilepsy is secondary( symptomatic), it develops after damage to the structure of the brain or a metabolic disorder in it - as a result of a number of pathological influences( underdevelopment of brain structures, craniocerebral trauma, infections, strokes, tumors, alcohol and drug addictionand etc.).Such forms of epilepsy can develop at any age and are more difficult to cure. But sometimes a complete cure is possible if it is possible to cope with the underlying disease.

Types of epileptic seizures

Epilepsy can manifest itself in completely different types of seizures. These types are classified:

1. because of their occurrence( idiopathic and secondary epilepsy );
2. at the location of the original hotbed of excessive electrical activity( cortex of the right or left hemisphere, deep sections of the brain);
3. on the variant of development of events during the attack( with loss of consciousness or without).

Thus, a simplified classification of epileptic seizures looks like this.

Generalized seizures proceed with complete loss of consciousness and control over their actions. This occurs as a result of excessive activation of deep sections and further involvement of the entire brain. Such a state does not necessarily lead to a fall, becausenot always broken muscle tone. During the tonic-clonic seizure, the tonic tension of all muscle groups, falling, and then clonic convulsions - rhythmic flexion and extensor movements in the limbs, head, jaw, begin in the beginning. Absenses occur almost exclusively in children and are manifested by the suspension of the child's activity - it seems to freeze on the spot with an unconscious glance, sometimes, at the same time, his eyes and facial muscles can be twitching.

80% of all epileptic seizures in adults and 60% of seizures in children are partial. Partial seizures occur when a hot spot of excessive electrical excitability is formed in some particular area of ​​the cerebral cortex. Manifestations of a partial attack depend on the location of such a focus - they can be motor, sensitive, autonomic and mental. During the of simple attacks, a person is conscious, but does not control a certain part of his body or has unusual sensations. With the , a complex attack occurs a violation of consciousness( partial loss), when a person does not understand where he is, what happens to him, at this time to come into contact with him is not possible. During a complex attack, just as during a simple one, uncontrollable movements occur in any part of the body, and sometimes it can even be an imitation of a purposeful movement - a person walks, smiles, talks, sings, dives,ball "or continues the action begun before the attack( walking, chewing, talking).Both a simple and complex partial attack can be completed by by the generalization of .

All types of seizures are short-lived - lasting from a few seconds to 3 minutes. Almost all seizures( except absences) are accompanied by post-confusion and drowsiness. If the attack occurred with complete loss or with a violation of consciousness, then the person does not remember anything about him. One patient can combine different types of seizures, and the frequency with which they occur can vary.

Interstitial manifestations of epilepsy

All manifestations of epilepsy are known to all as epileptic seizures. But, as it turned out, increased electrical activity and convulsive readiness of the brain do not leave sufferers even in the period between attacks, when it would seem that there are no signs of illness. Epilepsy is dangerous by the development of epileptic encephalopathy - in this state the mood worsens, anxiety appears, the level of attention, memory and cognitive functions decreases. This problem is particularly relevant for children, becausemay lead to developmental lag and impede the formation of speech, reading, writing, counting skills, and the like. Incorrect electrical activity between seizures can contribute to the development of such serious diseases as autism, migraine, attention deficit hyperactivity disorder.

Causes of epilepsy

As already mentioned above, epilepsy is divided into 2 main types: Idiopathic and symptomatic. Idiopathic epilepsy is most often generalized, and symptomatic - partial. This is due to different reasons for their occurrence. In the nervous system, signals from one nerve cell to another are transmitted by an electrical impulse, which is generated on the surface of each cell. Sometimes unnecessary excess impulses arise, but in a normally working brain they are neutralized by special antiepileptic structures. Idiopathic generalized epilepsy of develops as a result of the genetic defect of these structures. In this case, the brain does not cope with excessive electrical excitability of cells, and it manifests itself in a convulsive readiness, which can at any time "grab" the cortex of both hemispheres of the brain and cause an attack.

With partial epilepsy , a focus with epileptic nerve cells in one of the hemispheres is formed. These cells generate an excessive electrical charge. In response, the preserved antiepileptic structures form a "protective shaft" around such a focus. Until a certain moment convulsive activity can be restrained, but the culminating moment comes, and epileptic discharges break through the boundaries of the shaft and manifest as a first attack. The next attack, most likely, will not keep you waiting. The "path" has already been laid.

Such a focus with epileptic cells is formed, most often, against a background of some disease or pathological condition. Here are the main ones:

1. Underdevelopment of brain structures - does not arise as a result of genetic rearrangements( as in idiopathic epilepsy), but during the ripening of the fetus, and can be seen on the MRI;
2. Tumors of the brain;
3. Consequences of stroke;
4. Chronic use of alcohol;
5. Infections of the central nervous system( encephalitis, meningeencephalitis, brain abscess);
6. Craniocerebral injury;
7. Drug addiction( especially from amphetamines, cocaine, ephedrine);
8. Some medications( antidepressants, antipsychotics, antibiotics, bronchodilators);
9. Some hereditary metabolic diseases;
10. Antiphospholipid syndrome;
11. Multiple sclerosis

Factors for the development of epilepsy

It happens that the genetic defect does not appear in the form of idiopathic epilepsy and, the person lives without disease. But with the emergence of "fertile" soil( one of the above diseases or conditions), one of the forms of symptomatic epilepsy may develop. In this case, epilepsy is formed more often in young people after traumatic brain injury and alcohol or drug abuse, and in elderly people - against a background of brain tumors or after a stroke.

Complications of epilepsy

Epileptic status is a condition where an epileptic attack lasts more than 30 minutes or when one attack follows another and the patient does not regain consciousness. To the status most often leads to a sharp discontinuation of antiepileptic drugs. As a result of epileptic status, the patient may stop the heart, breathing, vomit can get into the airways and cause pneumonia, a coma may occur on the background of cerebral edema, and death may occur.

Life with epilepsy

Contrary to the popular belief that a person with epilepsy will have to limit himself in many ways, that many roads in front of him are closed, life with epilepsy is not that strict. The patient, his family and others need to remember that in most cases they do not need even a disability registration. The guarantee of a full-fledged life without restrictions is the regular uninterrupted reception of the medications chosen by the doctor. The drug-protected brain becomes less susceptible to provoking effects. Therefore, the patient can lead an active lifestyle, work( including at the computer), engage in fitness, watch TV, fly on airplanes and much more.

But there are a number of classes that are essentially a "red rag" for the brain in a patient with epilepsy. Such actions should be restricted:

1. Driving a car;
2. Working with automated mechanisms;
3. Swimming in open water, swimming in the pool unattended;
4. Self-cancel or skip the reception of tablets.

And there are factors that can cause an epileptic attack even in a healthy person, and they too need to be feared:

1. Lack of sleep, night shift work, daily working schedule.
2. Chronic use or abuse of alcohol and drugs

Epilepsy and pregnancy

Children and adolescents who develop epilepsy grow up over time, and they face a pressing question of contraception. Women taking hormonal contraceptives, you should know that some antiepileptic drugs can reduce their content in the blood and lead to an unwanted pregnancy. Another issue, if, on the contrary, the continuation of the family is desirable. Despite the fact that epilepsy occurs for genetic reasons, it is not transmitted to the offspring. Therefore, a patient with epilepsy can safely have a child. But it must be taken into account that before conception a woman should achieve a long-term remission with the help of drugs and continue their reception during pregnancy. Antiepileptic drugs slightly increase the risk of infertile fetal development. Nevertheless, it is not necessary to refuse treatment, tk.in the event of an attack during pregnancy, the risk to the fetus and mother significantly exceeds the potential risk of developing anomalies in the child. To reduce this risk, it is recommended to constantly take folic acid during pregnancy.

Symptoms of epilepsy

Mental disorders of epilepsy patients are determined:

• by organic brain damage underlying the epilepsy;
• epileptization, that is, the result of the activity of the epileptic focus,
• depends on the location of the focus;
• by psychogenic, stress factors;
• as a side effect of antiepileptic drugs - pharmacogenous changes;
• form of epilepsy( with separate forms not available).

structure of mental disorders in epilepsy

1. Mental disorders in the seizure prolongation	1. Harbinger in the form of affective disorders( mood swings, anxiety, fear, dysphoria), asthenic symptoms( fatigue, irritability, decreased performance) 2. Auras( somatosensory, visual, auditory, olfactory,gustatory, psychic) ​​
2. Mental disturbances as a component of the	attack 1. Consciousness change syndromes: a) disabling of consciousness( coma) - with generalized seizures and secondary generalized b) special conditions withmeaning - with simple partial seizures c) twilight confusion of consciousness - with complex partial seizures 2. Mental symptoms( disorders of higher cortical functions): dysmic, dysphasic, ideator, affective, illusory, hallucinatory.
3. Postpristupnye mental disorders	1. Syndromes change of consciousness( stupor, stunning, delirium, oneiric, dusk) 2. Aphasia, oligofaziya 3. Amnesia 4. Autonomic, neurological, somatic disorders 5. Asthenia 6. Dysphoria
4. Mental disorders in the interstitial period	1. Personality changes 2. Psycho-organic syndrome 3. Functional( neurotic) disorders 4. Mental disorders associated with the side effect of antiepileptic drugs 5.Epileptic psychoses

features of personality changes in epilepsy

1. Characterological:

• egocentrism;
• pedantry;
• punctuality;
• is a grudge;
• vindictiveness;
• hyper-sociality;
• attachment;
• infantilism;
• a combination of rudeness and obsequiousness.

2. Formal thinking disorders:

• bradyphrenia( stiffness, slowness);
• thoroughness;
• propensity for detail;
• specific descriptive thinking;
• perseveration.

3. Permanent emotional disorders:

• Viscosity of affect;
• impulsivity;
• Explosiveness;
• defensiveness( softness, obsequiousness, vulnerability);

4. Decreased memory and intelligence:

• mild cognitive impairment;
• dementia( epileptic, egocentric, concentric dementia).

5. Changing the sphere of drives and temperament:

• increased instinct of self-preservation;
• increased drive( slow pace of mental processes);
• predominance of gloomy, moody mood.

Species of epilepsy

IDIOPATHIC FORMS OF EPILEPSY

• genetic predisposition( often the presence of family cases of epilepsy);
• is the limited age of debut of the disease;
• no change in neurological status;
• normal patient intelligence;
• safety of the main rhythm on the EEG;
• absence of structural changes in the brain during neuroimaging;
• preparations of choice in the treatment - derivatives of valproic acid;
• is a relatively favorable prognosis with the achievement of therapeutic remission in the vast majority of cases;

IDIAPATIC PARTIAL EPILEPSIES

Benign partial epilepsy of childhood with centro-temporal adhesions( Rolandic epilepsy)( G 40.0)

Diagnosis criteria:

- age of manifestation: 3-13 years( peak 5-7);

- clinical symptoms of seizures: simple partial( motor, sensory, vegetative), secondary generalized( nocturnal);

is a rare frequency of seizures;

- EEG in the interictal period: normal primary activity and peak-wave activity in the central temporal regions of the cortex;

- neurological status: without features;

- mental status: without special features;

- prognosis: favorable, after 13 years, complete spontaneous remission;

- therapy: 1) basic drug: valproate( 30 mg / kg / day - 40-50 mg / kg / day);2) the drug of choice: carbamazepine( 15-20 mg / kg / day), sultium( ospolot)( 4-6 mg / kg / day), phenytoin( diphenin 3-5 mg / kg / day).

Idiopathic partial epilepsy with occipital

paroxysms( Gastaut's epilepsy)( G 40.0)

Diagnosis criteria:

- age of manifestation: 2-12 years( peak of debut at 5 and 9 years);

- clinical symptomatology: a) simple parietal attacks - motor( adversive), sensory( visual) - amaurosis, photopsy, hemianopsia, macro, micropsia, metamorphopsia, illusions and hallucinations, vegetative( epigastric) sensations - vomiting, headache, dizziness;b) complex partial( psychomotor);c) secondary generalized;

- provoking factors: a sharp change in illumination in the transition from a dark room to a light one;

- EEG during an attack: high amplitude peak-wave activity in one or both occipital leads, possibly with prevalence beyond initial localization;

- EEG beyond the seizure: normal primary activity with high-amplitude focal spikes, spike-wave complexes in the occipital leads, resulting from the closing of the eyes and the disappearance of epi-activity when opening the eyes;

- neurological status: without features;

- mental status: without features;

- prognosis: favorable, remission in 95% of cases;

- treatment: 1) basic drug: carbamazepine( 20 mg / kg / day);2) the drug of choice: valproate( 30-50 mg / kg / day), phenytoin( 3-7 mg / kg / day), sultiam( 5-10 mg / kg / day), lamotrigine( 5 mg / kg / day).

IDI GENERALIZED EPILEPSIES

Pediatric non-sense epilepsy( G 40.3)

Diagnosis criteria:

- age of the manifestation: from 2 to 10 years( peak 4-6 years), predominance by sex of girls;

- clinical symptoms of seizures: typical( simple and complex) absences with a high incidence of attacks and in 1/3 of patients generalized tonic-clonic paroxysms, rare;

- provoking factors: hyperventilation, sleep deprivation, emotional stress;

- EEG during an attack: the presence of generalized bilaterally synchronous complexes spike-wave frequency of 3 Hz;

- EEG beyond the seizure: may be within normal limits or diffuse changes in the form of bilateral-synchronous slow, acute waves, spike-wave complexes;

- neurological status: without features;

- mental status: no features;

- prognosis: favorable

- therapy: 1) the base preparation: ethosuximide( sulexil)( 15 mg / kg / day) or valproate( 30-50 mg / kg / day);in the presence of generalized tonic-clonic seizures, in resistant cases, polytherapy: valproate with succinimides, valproate with lamotrigine.

Juvenile Absence Epilepsy( G 40.3)

Criteria for diagnosis:

- age of the manifestation: 9-12 years( peak at 12 years);

- clinical symptoms of seizures: typical simple absences( short, rare) and generalized tonic-clonic paroxysms( in 80%) upon awakening or during sleep;

- provoking factors: hyperventilation( in 10% of patients) provokes absence, sleep deprivation( in 20% of patients) - generalized tonic-clonic seizures;

- EEG during an attack: the presence of generalized bilaterally synchronous spike-wave complexes with a frequency of 3 Hz and more( 4-5 s);

- EEG beyond the seizure: may be within the norm or diffuse changes in the form of bilateral-synchronous slow, acute waves, spike-wave complexes;

- neurological status: without features;

- mental status: without features;

- forecast: favorable;

- therapy: 1) basic preparation: valproate 30-50 mg / kg / day, in the absence of effect combination with succinimides( 20 mg / kg / day) or lamitcal( 1-5 kg ​​/ mg / day).

Juvenile myoclonic epilepsy( Yantsz syndrome)( G 40.3)

Diagnosis criteria

- age of manifestation: 12-18 years( peak 15 years, predominance of female patients);

- clinical symptoms of seizures: myoclonic paroxysms bilaterally synchronous, mainly in the arms and shoulder girdle( often in the morning hours);myoclonic-astatic - with the involvement of the legs( squats or falls) - with the consciousness retained;generalized tonic-clonic( in 90%) predominantly awakening or falling asleep;absences complex with myoclonic component;

- provoking factors: sleep deprivation, rhythmic light stimulation, alcohol, physical and mental load;

- neurological status: without features, sometimes local microsymptomatics;

- mental status: absence of intellectual disturbances;

- EEG during an attack: generalized, high-amplitude "spike-wave" or "polyspike-wave" complexes with a frequency of 3-5 HZ and higher;

- EEG outside the attack: may be normal or represented by generalized peak-wave activity;

- prognosis: favorable( with compliance with the regime and therapy);

- treatment: 1) the base preparation of valproate( 30-50 mg / kg / day);with resistant cases, valproates with ethosuximide( 15 mg / kg / day), valproate with clonazepam( 0.15 mg / kg / day), valproate with barbiturates( 1-3 mg / kg / day), valproate with lactamol( 1-5 mg / kg / day).

Epilepsy with isolated generalized

convulsive seizures( G 40.3)

Diagnosis criteria:

- age of manifestation: any, peak of debut during puberty;

- clinical symptomatology: generalized tonic-clonic seizures confined to the rhythm of sleep-wake with two peaks - the period of awakening and falling asleep with a low frequency of attacks( once a year - once a month);

- provoking factors: deprivation of sleep;

- EEG during an attack: generalized peak-wave activity with a frequency of 3 Hz and higher;

- EEG outside the seizure: may be within normal limits;

- neurological status: without features;

- mental status: not characterized by a decrease in intelligence, possible characterological features, emotional lability;

- prognosis: remission is achieved in 60-80%;

- treatment: 1) basic drug: carbamazepine( 15-25 mg / kg / day);2) drugs of choice: valproate( 20-50 mg / kg / day), barbiturates( 1.5-3.0 mg / kg / day), phenytoin( 4-8 mg / kg / day).In resistant cases, the combination: carbamazepine + valproate, carbamazepine + lamotrigine, carbamazepine + barbiturates.

SYMPTOMATIC FORMS OF EPILEPSIA

• combination of epilepsy with focal neurologic symptoms;
• presence in patients of cognitive or intellectual-mnestic disorders;
• regional( especially - continued) deceleration of the EEG;
• local structural disorders in the brain during neuroimaging;
• the need for surgical treatment in many cases.

CRYPTOGENIC OR SYMPTOMATIC GENERALIZED EPILEPSIES

Syndrome Vesta( G 40.4)

Diagnosis criteria:

- age of manifestation: 4-7 months;

- clinical symptomatology of attacks: sudden bilateral, symmetrical contraction of axial muscle groups - head, neck, trunk, limbs( flexor, extensor, flexor-extensor), seizures are serial, short, more often during arousal;

- EEG beyond the seizure: gipsaritmiya - high-amplitude irregular, poorly synchronized arrhythmic slow waves with discharge spikes;

- mental status: marked retardation of mental development;

- neurological status: various disorders in the motor sphere( ataxia, hemiplegia, diplegia);

- etiology: peri-and postnatal changes in the brain, a) developmental defects of the brain, b) intrauterine infections, c) metabolic disorders, d) traumatic changes in the brain, e) tumors;

- forms: cryptogenic, symptomatic;

- prognosis: unfavorable( transformation into other forms of epilepsy, delay of psychomotor development);

- treatment: 1) basic preparations: valproate( 50-70 mg / kg / day), vigabatrin( Sabril)( 100 mg / kg / day), ACTH 0.1 mg / kg / day, or prednisolone 2-5 mg / kg / day. Combinations of basic drugs with lamotrigine, carbamazepine or benzodiazepines.

Lennox-Gastaut syndrome( G40 . 4)

Criteria for diagnosis:

- age of manifestation: 2-8 years( peak on average 5 years), boys are more likely to get sick;

- clinical symptoms of seizures( frequent, severe, polymorphic): a) tonic( axial, axorizomelic, general) with vegetative disorders tachycardia, apnea, facial flushing, cyanosis, salivation, lacrimation) occur more often at night;b) Attacks of fall( myoclonic, myoclonic-astatic, atonic);c) atypical absences( incomplete impairment of consciousness, slow onset and end of attack, motor phenomena are expressed, serial increase after awakening);

- mental status: from mild cognitive impairment to severe mental retardation;various manifestations of psycho-organic syndrome( neurosis-like, behavioral disorders);

- neurological status: coordination disorders, symptoms of pyramidal insufficiency, cerebral paresis;

- EEG during the attack: generalized spikes and sharp waves, spike-wave complexes;

- EEG beyond attack: slowing of background activity, irregular generalized slow peak-wave activity with a frequency of 1.5-2.5 Hz;short rhythmic discharges of generalized and polyspikes with a frequency of 10 Hz - during sleep;

- neuroimaging: local structural disorders in the cerebral cortex;

- forms: symptomatic and cryptogenic;

- prognosis: unfavorable, in 2/3 cases - resistance to therapy;

- treatment: valproate( 30-100 mg / kg / day, average dose - up to 50 mg / kg / day), more often in combination with lactamol( 1-5 mg / kg / day), sukslepom( atypical absences), carbamazepine( with tonic 15-30 mg / kg / day), benzodiazepines( clobazam, radedorm, antepsin).

- reserve methods: corticosteroids, immunoglobulin, ketogenic diet, surgical treatment.

SYMPTOMATIC PARTIAL EPILEPSIES

( G 40.1 - G 40.2)

A heterogeneous group of diseases of established etiology in which the initial clinical and electrophysiological manifestations attest to the focal nature of epileptic paroxysms.

Classification of symptomatic partial epilepsy by anatomical location:

• Frontal;
• Temporal;
• Dark;
• Nuchal.

Frontal epilepsies

Clinical characteristics( Luders , 1993; Chauvel , Bancaud , 1994)

• marked stereotyped seizures;
• sudden onset of attacks( more often - without aura);
• high frequency of seizures with a tendency to sericity;
• short duration of seizures - 30-60 seconds;
• marked, often unusual motor phenomena( foot pedaling, chaotic movements, complex gestural automatisms);
• absence or minimal post-confusion confusion;
• often occurs in a dream;
• fast secondary generalization.

Symptomatic frontal epilepsy

Form	Localization	Clinical symptomatology
Motor	Anterior central gyrus ( a) Precentral zone b) PROMOTOR zone	- simple partial seizures emerging contralateral to the focus, predominantly clonic in nature( march type) - tonic seizures inupper limbs, tonic turns of the head and eyes. Posterior limb weakness in the limbs( Todd's paralysis)
OPERCULAR	OPERCULAR area of ​​the inferior frontal gyrus at the junction with the temporal lobe	- simple oroalientatory automatisms( sucking, chewing, swallowing, smacking, licking, coughing) - hypersalivation - ipsilateral twitching of the facial muscles - speech impairment or vocalization
Dorsolateral	Upper and lower frontal gyrus Rear sections of lower frontal gyrus( Broca center)	- adversiveAttacks( violent turn of the head and eyes) contralateral to the center of irritation - attacks of motor aphasia
Orbito-frontal	Orbital cortex of lower frontal gyrus	- vegetative-visceral seizures( epigastric, cardiovascular, respiratory) - pharyngoal automatisms with hypersalivation - psychomotor seizuresautomatism of gestures)
Front frontal polar	Pole of frontal lobes	- simple partial seizures with disturbance of mental functions
Cingular		- simple partial seizures( dysphoric) - complex partial seizures( automatic gestures), - facial redness, fright, ipsilateral fibrillation, clonic convulsions of the contralateral limb
Coming from the additional motor zone	motor zone	- simple partial attacks, nocturnal( motor, speech, sensory) - attacks of archaic movements at night
Median	Median parts of the frontal lobes of the	- "frontal absences"( atypical absence), impaired consciousness, sudden interruption of speech, gestural automatisms, motor activity - complex partial seizures

Temporal epilepsies

Clinical characteristics( Kotagal, 1993; Duncan, 1995 )

• debut disease at any age;
• prevalence of psychomotor seizures;
• isolated auras in 75% of cases;
• oralistic and carpal automatisms;
• secondary generalization in 50% of cases;
• no diagnostic significance of the routine EEG study.

Forms of temporal epilepsy

Amygdalo-hippocampal( medio-basal, paliocortical)	- complex partial( psychomotor) attacks - switching off consciousness with amnesia, lack of response to external stimuli, automatisms - simple partial attacks( motor, sensory, vegetative visceral,with violation of mental functions)
Lateral( neocortical)	- auditory hallucinations - visual hallucinations - dizziness attacks - attacks with speech violation - "viz.juicy syncopation "

Dark epilepsy

Clinical manifestations.

Dark epilepsy can manifest in both childhood and adults( Williamson et al, 1992).The initial clinical manifestations of parietal paroxysms are characterized mainly by subjective sensations( somatosensory paroxysms).

Somatosensory paroxysms: are not accompanied by a disorder of consciousness, and are usually due to the involvement of the postcentral gyrus in the epileptic process( Sveinbjornnsdottir, Duncan, 1993).Somatosensory paroxysms have a short duration - from a few seconds to 1-2 minutes. Clinical manifestations of somatosensory paroxysms include:

• elementary paresthesia;
• painful sensations;
• violation of temperature perception;
• "sexual" seizures;
• ideomotor apraxia;
• violation of the body scheme.

Nuchal epilepsy.

Clinical characteristics

• simple visual hallucinations;
• paroxysmal amaurosis;
• paroxysmal infringements of fields of vision;
• subjective sensations in the field of eyeballs;
• blinking;
• deviation of the head and eyes.

Treatment of symptomatic epilepsy

I. Base preparation: carbamazepine( 30 mg / kg / day).

II.The drug of choice:

1. Valproates( 40-70 mg / kg / day).
2. Phenytoin( 8-15 mg / kg / day).
3. Phenobarbital( 5 mg / kg / day).
4. Polytherapy: carbamazepine + lamiktal( 5-10 mg / kg / day), carbamazepine + topamax( 5-7 mg / kg / day).

III.Surgery.

The main etiological factors of epilepsy

Etiological factors of epilepsy	Frequency of occurrence( %)
Genetic	65,5
Vascular diseases of the brain	10,9
Pre-perinatal nervous system lesions	8.0
Craniocerebral injury	5,5
Brain tumors	4, 1
Degenerative diseases of the central nervous system	3,5
Infections	2,5

Epileptic psychoses

Acute psychoses

With confusion of consciousness( up to several days)	Twilight states: after a series of tonic-clonictheir seizures; lasts for several days; hallucinatory and delusional disorders; psychomotor agitation, aggression; Epileptic delirium; Epileptic onyeroid.
Without confusion of consciousness( more than a day)	Acute paranoid( acute sensual delirium); Dysphoric psychosis

Chronic epileptic psychoses( schizophreniform)

General characteristics:

• develops after 10-15 years or more after the onset of the disease;
• in the progression of epilepsy;
• in the presence of gross personality changes, intellectual decline;
• occur in most cases against a background of conserved consciousness;
• duration from several months to several years;
• develop more often with temporal localization of the focus.

1. Paranoid;
2. Hallucinatory and paranoid;
3. Paraffin;
4. Catatonic.

Diagnosis of epilepsy

When diagnosing epilepsy, it is important to establish its nature - idiopathic or secondary( ie exclude the presence of the underlying disease, against which epilepsy develops), and also the type of attack. This is necessary for the purpose of optimal treatment. The patient often does not remember what and how it happened during the attack. Therefore, it is very important that the information that can be given to the patient close to him, who were next to him during manifestations of the disease.

Necessary Examinations:

1. Electroencephalography( EEG) - Records altered electrical activity of the brain. During the seizures, EEG changes are always present, but between seizures in 40% of cases EEG is normal, therefore, repeated examinations, provocative tests, and video EEG monitoring are necessary.
2. Computer( CT) or magnetic resonance imaging( MRI) of the brain
3. General and detailed biochemical analysis of the blood
4. If you suspect a certain underlying disease with symptomatic epilepsy - the necessary additional tests are performed