Psychology of diseases: Epilepsy. Mental disorders in epilepsy Need help studying a topic

Over the centuries, epilepsy has had many names: “divine”, “demonic”, “lunar”, “bad”, “black infirmity”, “shaking”, “sorrowful suffering”, “punishment of Christ” and others. Worldwide, about 50 million people suffer from this disease, according to data from the World Health Organization (WHO).

Interestingly, up to 10% of people in the world have ever experienced such a seizure. However, according to doctors, the only case does not mean anything. The disease is diagnosed if attacks recur. Even though epilepsy is one of the oldest recognized conditions in the world, there is still a lot of rumors surrounding it.

“In many countries around the world, people with epilepsy and their families may be subject to stigma and discrimination,” confirm WHO experts.

AiF.ru spoke with the chief freelance specialist of the Ministry of Health of the Russian Federation for child rehabilitation, president of the National Association of Children's Experts cerebral palsy and related diseases, member of the Presidium of the All-Russian Society of Neurologists Tatyana Batysheva, to dispel the 10 most common myths about epilepsy.

A new series of educational events for patients and their relatives “Attention - epilepsy!”, organized by the Russian Anti-Epileptic League (RAEL) and the Non-Profit Partnership “Association of Epileptologists and Patients”, has started in Russia. The main goal of the project is to improve the health and quality of life of patients suffering from epilepsy, as well as help them adapt to society. In total, more than 400 schools will be held in Russia in 2015. Events for adults and children will be held separately. This is due to the fact that different age groups differ from each other in the characteristics of the course of the disease and social problems that they have to face.

Myth 1. Epilepsy is a mental illness

Until about 30 years ago, it was believed that people diagnosed with epilepsy should be treated by psychiatrists. However, thanks to the efforts of the All-Russian Society of Neurologists, the disease is now classified in the field of neurology.

“Epilepsy is not a psychiatric disease. The disease is based on pathological paroxysmal activity of neurons in the cerebral cortex, which results in periodic epileptic seizures,” noted a freelance specialist from the Ministry of Health.

According to the expert, there are several forms of epilepsy.

“There are many forms of the disease with different origins. The risk of inheritance always depends on the form of epilepsy. For example, with idiopathic (hereditary) forms, the risk is much higher than with symptomatic forms caused by an acquired structural defect of brain tissue,” said the neurologist.

Myth 2. All patients with epilepsy have mental disorders and suffer from dementia

In the intervals between attacks, the frequency of which depends on the specific case, most patients with epilepsy are no different from other people. suffered from this disease Socrates, Gaius Julius Caesar, Fedor Dostoevsky, Leonardo da Vinci,Lord Byron, Agatha Christie,Alfred Nobel and many others famous people, for whom this diagnosis did not prevent them from achieving great success in their industry.

Of course, there are some activities that are not available to people with this diagnosis. So, if you have epilepsy, you should not drive a car, you should avoid serving in the police, fire departments, guarding important facilities, as well as professions where you need to operate moving mechanisms or work with chemicals, near water bodies.

“Epilepsy in many cases is not accompanied by mental and intellectual disorders. In cases where epilepsy is combined with mental retardation or mental disorders, these changes are usually due to either the main serious illness brain, or because antiepileptic drugs (AEDs) are not effective enough,” Batysheva explained.

Myth 3. Epilepsy is an incurable disease. If you get epilepsy, it’s “for life”

Another common misconception about epilepsy is that there is no cure for the disease.

“In approximately 70% of patients it is possible to achieve complete clinical-electroencephalographic remission. In half of them, doctors manage to completely cancel treatment. However, it is worth noting that prerequisite to achieve remission is adherence to the prescribed treatment,” says the expert.

Myth 4. Epilepsy is a “contagious” disease

During the Middle Ages, people believed that epilepsy could be contracted during an attack through the patient's breathing. Now such prejudices seem strange, but there are still people who believe that epilepsy is not inherited from one person to another.

“Epilepsy cannot be ‘infected’; it is not an infectious disease,” noted a member of the Presidium of the All-Russian Society of Neurologists.

Myth 5. An epileptic seizure is a loss of consciousness, convulsions, foam at the mouth and biting the tongue.

Epilepsy attacks are often completely different from what we are used to seeing in the movies. Sometimes the person himself does not know that he has just had an attack. With mild forms of epilepsy, a person may simply lose touch with the outside world for a short time.

“A generalized seizure is just one of many types of epileptic seizures. In addition to it, there are absence seizures - short episodes of blackout with freezing of the gaze, which are not accompanied by either a fall or convulsions, the patient himself does not notice them, and others can simply take them for thoughtfulness. Partial seizures are very diverse. These include convulsions in a certain muscle group without loss of consciousness, and hallucinations in the form unpleasant odors, sounds, circles and geometric shapes before my eyes, flashes of light. The attacks can look like attacks of abdominal pain, panic, a feeling of “already seen,” high spirits, and even such psychomotor attacks, when the patient performs seemingly quite meaningful actions while in an altered state of consciousness. An epileptic attack can be any condition that is repeated several times, always the same, spontaneously and briefly,” Batysheva said.

Myth 6. Antiepileptic drugs have many side effects and are dangerous to take.

Antiepileptic drugs are used to prevent various seizures. They are also often used to treat bipolar disorders.

“Indeed, drugs for the treatment of epilepsy are quite serious, but seizures are much more dangerous. In addition, patients tolerate it more easily modern medicines. The drugs do not affect mental functions and are not addictive. The dose is slowly increased from minimal to effective to reduce the likelihood adverse reactions", the expert explained.

Myth 7. If a child is excitable, has frequent tantrums and “rolls up” when crying, this means that he will develop epilepsy

According to the neurologist, this myth is quite common among doctors, but it is not true.

“This misconception is widespread even among pediatricians, and in Russian clinics, children with affective-respiratory attacks are often prescribed anticonvulsants. In fact, excitability and loss of consciousness when crying have nothing to do with epilepsy. Excitable children are just as likely to develop epilepsy as anyone else. Epilepsy is a well-studied disease, and treatments have been developed to combat it. effective medicines. People with epilepsy can understand the nature of their disease and learn to cope with it. Nowadays, epilepsy is no longer an obstacle to a full life,” the doctor is sure.

Myth 8. You can only get epilepsy in childhood.

There are those who are sure that epilepsy is a childhood disease and adults are not susceptible to it. However, this is not entirely true.

Myth 9. Only brightly flickering light can provoke an attack

Flickering light is not the only environmental irritant that can trigger an epileptic attack. Moreover, most of the factors that provoke seizures and other manifestations of the disease can be controlled by a person independently.

“In addition to brightly flickering light, attack provocateurs can be stress and anxiety, alcohol abuse and hangover, drug use, some medicines, such as antidepressants, antipsychotics, anxiolytics, fatigue, lack of sleep, big break between meals, leading to a decrease in blood glucose levels, a rise in body temperature, menstruation,” Batysheva listed the factors.

Myth 10. Women with epilepsy should not give birth

Experts say that a woman who regularly takes anti-epileptic drugs is 95% likely to give birth healthy child. At the same time, the disease does not affect how childbirth proceeds, and pregnancy itself does not worsen the condition expectant mother. Moreover, in some forms of epilepsy, pregnancy even benefits the body - attacks become less frequent, experts say.

“Most women with epilepsy have normal, healthy children. Although for women with epilepsy, compared with the general population, the risk birth defects increases in children, but overall risk remains low. Risks can be minimized through close collaboration with a neurologist and obstetrician,” the doctor explained.

Bipolar disorder- a mental illness that is characterized by sudden and uncontrollable changes in mood.

Doctors made the diagnosis of epilepsy back in ancient times. The manifestations of the disease and the patterns of its development have been very well studied. However, for non-specialists this disease still remains mysterious. There are many misconceptions associated with epilepsy, which sometimes has a very unpleasant effect on the quality of life of the patients themselves and their loved ones. In this article we will try to dispel the most famous of these myths.

Source: depositphotos.com

Epilepsy is a mental disease

Epilepsy is a chronic neurological disease that periodically manifests itself primarily as loss of consciousness or short-term loss of self-control. This is a physical problem, not a mental one; it is based on the pathological activity of neurons in the cerebral cortex. Patients are treated and registered not with psychiatrists, but with neurologists and neurologists.

All epileptics suffer from dementia

The statement is absolutely false. Most people with epilepsy do not show any signs of decreased intelligence or difficulty mental activity. In the intervals between attacks, they live normally, work actively and achieve considerable professional success. It is enough to note that many great writers, artists, scientists, politicians and generals were epileptics.

For some severe lesions brain, manifested by dementia, are observed and epileptic seizures, but in these cases they will be a concomitant condition and not a cause of mental retardation.

Epilepsy is incurable

This is wrong. With correctly prescribed treatment and patients carefully following doctors’ recommendations, in 70% of cases the condition improves so significantly that in the future patients can live without taking antiepileptic drugs.

Epilepsy can be infected

Probably the reason for the misconception was the fact that epilepsy in newborns sometimes develops as a result of intrauterine infection. For example, a sick child may be born to a woman who suffered from rubella or toxoplasmosis during pregnancy.

But the disease itself has nothing to do with infections. It is impossible to become infected with it.

The main signs of an attack are convulsions combined with foam at the mouth

The name “epilepsy” unites about 20 conditions, only a small part of which manifest themselves in this way. For many epileptics, seizures are not at all spectacular. Most often, patients simply lose touch with reality for a few seconds or minutes. At the same time, others may not notice anything unusual, mistaking the person’s immobility and absent gaze for signs of deep thoughtfulness. In other patients, the disease leads to cramps of certain muscle groups without loss of consciousness. Many epileptics report visual, auditory or olfactory hallucinations, panic attacks or, on the contrary, unreasonable mood swings and even feelings of “déjà vu”.

There are also seizures during which patients, being in a state of loss of contact with reality, commit complex actions, externally appearing to be meaningful, but are unaware of their purpose and consequences.

It's easy to predict when a seizure is coming

Epileptics sometimes actually experience characteristic sensations that can be used to determine the approach of a seizure a few seconds before its onset. Unfortunately, such a premonition happens rarely and has virtually no effect on the quality of life, since the patient will still not be able to prevent an attack. That is why certain types of activities are contraindicated for people suffering from epilepsy (driving a car, working near bodies of water, etc.).

Antiepileptic drugs are very dangerous

Modern drugs against epilepsy are serious drugs that have contraindications and side effects. The choice of medication should be made by a doctor. Typically, treatment with such drugs begins with a minimum amount per dose, gradually increasing the dose until therapeutic effect. Medicines are used for a long time. It is impossible to interrupt the course without consulting a specialist; this is fraught with intensification of the disease and the development of life-threatening conditions.

Epilepsy develops in people who were easily excitable in childhood

This is a very old misconception, which is sometimes observed even among doctors. Pediatricians susceptible to it sometimes prescribe anticonvulsants to overly excitable children.

In fact, the inability to concentrate, mood swings, tendency to tantrums and other qualities characteristic of some restless children have nothing to do with the reasons for the development of epilepsy. This does not mean that such a child does not need the help of a neurologist or child psychologist.

All epileptics suffer from the disease from an early age

Epilepsy can appear at any age, but about 70% of cases occur in people who become ill early childhood or in old age. In babies, the disease develops due to hypoxia suffered during intrauterine development or during birth, as well as due to congenital diseases brain. In older people, the development of epilepsy is often caused by strokes and brain tumors.

The main factor that provokes an attack is flickering light

This is wrong. The list of factors that can cause an epileptic seizure includes:

• decreased blood glucose levels (for example, due to long break between meals);
• lack of sleep, fatigue;
• stress, anxiety;
• alcohol intake, hangover syndrome;
• use of narcotic drugs;
• taking certain medications (including antidepressants);
• increased body temperature;
• menstruation.

Women with epilepsy should not become pregnant

The presence of the disease does not affect the ability to become pregnant and give birth to a child. On the contrary, during the period of gestation, the condition of expectant mothers suffering from epilepsy improves, seizures almost stop. The disease is not inherited. About 95% of pregnancies in epileptic women result in the birth of healthy babies.

Epilepsy is a mental illness manifested by seizures or seizures. seizures or seizure equivalents, under acute and prolonged psychotic disorders and specific personality changes, in severe cases up to dementia.

WHO definition: epilepsy is a chronic disease of the human brain, characterized by repeated seizures that arise as a result of excessive neural discharges and are accompanied by a variety of clinical and paraclinical symptoms.

Convulsive and other paroxysmal conditions characteristic of epilepsy occur with a wide variety of organic lesions of the central nervous system. Genuine (true, based on a hereditary predisposition) epilepsy is distinguished from so-called symptomatic epilepsy (traumatic, infectious, vascular, alcoholic and other origins) and conditions with epileptiform manifestations. As scientific data on the genesis of genuine epilepsy accumulated, its scope gradually narrowed. Increasingly, as a cause of epileptic symptoms, protrusion

whether focal brain lesions: birth and postpartum injuries, asphyxia, fetal development abnormalities, etc. However, in many cases the cause of epilepsy remains unclear. A major role in the origin of the disease is assigned to increased convulsive readiness, which occurs as a result of both hereditary predisposition and changes in the functional state of the central nervous system and metabolism acquired during life.

The prevalence of epilepsy in the population is 0.8-1.2%.

A significant number of patients with epilepsy are children. Typically, the first seizure occurs before the age of 20. In newborns and infants, the most common reasons seizures - severe hypoxia, genetic metabolic defects, as well as perinatal lesions. IN childhood seizures in many cases are caused by infectious diseases of the nervous system. There is a fairly clearly defined syndrome in which seizures develop only as a consequence of fever - febrile seizures. It is known that 19-36 children out of 1000 have experienced convulsions at least once in their lives when their temperature rises. In about half of them, a second seizure should be expected, and in a third of this half, three or more such episodes are possible. Predisposition to febrile seizures is inherited. In approximately 30% of patients, such seizures are identified in the anamnesis of one of the family members. It is children who have severe, treatment-resistant forms of epilepsy: Lennox-Gastaut syndrome, West syndrome.

In young people, the main identified cause of epileptic disorders is traumatic brain injury. In this case, one should remember about the possibility of developing seizures both in the acute period of traumatic brain injury and in a later period.

IN last years In all developed countries, there is a significant increase in the incidence of epilepsy in older age groups. Demographic studies in our country and abroad, conducted over the past 20 years, show that life expectancy in economically developed countries has increased significantly. Due to the trend towards “aging” of the population of most large cities of the world, increasing working life expectancy and special attention paid to quality of life, the problem of epilepsy in adults and elderly people is of particular importance: the prevalence of epilepsy in older people age groups can reach 1.5-2%.

In patients over 50 years of age among etiological factors epilepsy should, first of all, indicate vascular and degenerative diseases of the brain. Epileptic syndrome develops in 6-10% of patients who have undergone ischemic stroke, and most often outside acute period diseases. The problem of epilepsy in elderly patients includes critical issues gerontology, epileptology and cardiovascular pathology.

Epilepsy, how independent disease, characterized by periodically occurring convulsive and non-convulsive paroxysmal states with varying degrees of loss of consciousness, often occurs progressive course, which is determined by an increasing change in personality up to the emergence of specific dementia. Epilepsy is clinically manifested by various paroxysms, most often grand mal seizures.

Grand mal seizure. It often begins with distant precursors, which manifest themselves in the fact that a few hours before the onset of the attack, and sometimes several days before, the patient begins to feel unwell, expressed in a state of general discomfort. The immediate warning sign of a seizure is an aura (breathing sound). Each patient always has the same aura. Its nature may indicate the localization of an area with pathological activity. The sensory aura can be paresthesia, olfactory hallucinations, a feeling of heaviness, transfusion, burning. Mental aura is expressed in the appearance of various psychopathological disorders. Sensory synthesis disorders, hallucinatory and delusional experiences may occur. When the motor analyzer is irritated, a motor aura is observed. Following the aura, the tonic phase of the seizure begins. Consciousness is impaired to the point of coma, there is a sharp tension in the entire striated muscles, breathing stops due to spasm of the intercostal muscles, there is involuntary urination, tongue biting, foam at the mouth. The state of muscle spasm persists for 30-50 seconds, after which muscle tension slowly, gradually weakens, and a variable contraction is observed various groups muscles, breathing is restored - clonic phase. This lasts 1-2 minutes, then consciousness gradually returns, coma turns into stupor and sleep. Sometimes a seizure can end in the aura or tonic phase, these are so-called abortive seizures. In severe cases, large convulsive attacks can follow one after another, and the patient does not have time to regain consciousness. This condition is called status epilepticus. If there are clear intervals of clear consciousness between seizures, then this condition is classified as a series of seizures.

A minor seizure is a sudden and short-term loss of consciousness without a convulsive component. Varieties of minor seizures: absence, propulsive (nods, pecks, salaam bows) and retropulsive seizures.

Status epilepticus is major or minor epileptic seizures following each other, lasting for several hours, with consciousness not restored between seizures. This condition is based on increasing cerebral edema, and in the absence of adequate treatment The patient's death occurs due to excessive inhibition of vital centers (respiratory, vasomotor).

Relief of status epilepticus: intravenous administration large doses(6-10 ml) of seduxen or relanium (after 30 minutes if there is no effect, the infusion can be repeated), emergency transportation of the patient to intensive care unit where treatment is carried out aimed at relieving cerebral edema (spinal puncture, intravenous drip administration mannitol, urea), as well as therapy aimed at maintaining function of cardio-vascular system(cardiac glycosides).

Psychic equivalents. This group of painful phenomena includes mood disorders and disorders of consciousness.

Dysphoria is attacks of causeless sad-angry mood.

Twilight state - it is characterized by a combination of disorientation in the environment with the preservation of interrelated actions and behaviors. The behavior of patients is dictated by hallucinatory and delusional experiences occurring against the background of a pronounced affect of fear. Distinctive feature twilight state - desire for aggression, rage, anger. Patients do not retain memories of this period.

Outpatient automatisms (involuntary wandering). It is based on twilight stupefaction, but there is no fear and hallucinatory-delusional experiences. During these attacks, patients make unconscious journeys. Outwardly, they give the impression of being somewhat confused, immersed in their thoughts. Particularly distinguished are short-term states of ambulatory automatism - fugues and trances.

Special conditions belong to the so-called mental equivalents. In these conditions there is no deep violation consciousness and amnesia, but characterized by mood changes and sensory synthesis disturbances.

Epileptic psychosis occurs, as a rule, against the background of the absence of convulsive seizures. They can be acute, protracted and chronic, occurring without clouding of consciousness. Delusional forms are more common. Acute epileptic paranoid can develop against the background of dysphoria or following states of confusion without complete amnesia ( special conditions, epileptic oneiroid). Conditions with anxious-depressive affect, poorly systematized delusions of persecution, poisoning and hypochondriacal delusions are more common in paranoids with expansive delusions.

Protracted and chronic delusional epileptic psychoses often differ only in duration. The mechanism of their occurrence, as well as the symptoms, are similar. They can develop as a residual condition or against the background of recurrent acute paranoids, less often they appear as if they were primary.

There are paranoid, paranoid and paraphrenic pictures. In some cases, the clinical manifestations of psychosis are constant, in others they tend to gradually become more complex. Paranoid states are often accompanied by ideas of material damage, witchcraft, and everyday relationships. At paranoid syndromes delirium of influence is often accompanied by vivid pathological sensations. Paraphrenic states are characterized by religious and mystical delirium. Acute paranoids last for days and weeks; protracted and chronic paranoids last for months and years.

Equivalents and especially epileptic psychoses more often appear at distant stages of the disease, with a decrease or even complete disappearance of paroxysmal convulsive disorders. In those rare cases when the manifestations of epilepsy are limited to only equivalents or psychoses, they speak of hidden, masked, or mental epilepsy.

Personality changes. In addition to paroxysmal-convulsive disorders, equivalents and psychoses without stupefaction, epilepsy is characterized by personality changes, especially disturbances in the affective sphere. The emerging affect prevails for a long time, and therefore new impressions cannot displace it - the so-called viscosity of affect. This applies not only to negatively colored affects, such as irritation, but also to the opposite affects - feelings of sympathy, joy. Thought processes are characterized by slowness and stiffness—heaviness of thinking. The speech of patients is detailed, verbose, full of unimportant details while at the same time inability to highlight the main thing. The transition from one set of ideas to another is difficult. The verbal composition is poor (oligophasia), and what has already been said is often repeated (perseveration). The use of formulaic phrases, diminutive words, and definitions containing an affective assessment is typical - “good, wonderful, disgusting.” The patient’s own “I” always remains the center of attention. In the statements, the foreground is himself, his illness, his daily affairs, as well as loved ones, about whom the patient speaks with respect and emphasis on their positive properties. Patients with epilepsy are great pedants, especially in everyday trifles, “supporters of truth and justice.” They are prone to banal edifying teachings, they love to patronize, which makes their family and friends very burdensome. Despite the fact that patients with epilepsy consider their illness to be serious and willingly undergo treatment, the belief in recovery does not leave them even in the late stages of the disease (epileptic optimism).

In some patients, these changes are combined with increased irritability, pickiness, a tendency to quarrel, and outbursts of anger, which are often accompanied by dangerous and cruel actions directed at others. For others, on the contrary, timidity, timidity, a tendency to self-abasement, exaggerated courtesy, flattery and servility, deference and affectionate behavior predominate. These polar character traits can coexist. It is often impossible to predict how the patient will behave, since “the intermittency of mental phenomena in the sphere of feeling and character is an outstanding feature in the character of epileptics.” If these characterological changes are partial and weakly expressed, professional and life adaptation is preserved, then they speak of an epileptic character. Sharp characterological changes, accompanied by distinct changes in memory, primarily for facts that have nothing to do with the patient, make it possible to diagnose epileptic concentric dementia. Patients with epilepsy also experience some nonspecific somatoneurological symptoms: body dysplasticity, slowness, clumsiness, clumsiness of motor skills, pronunciation defects. After seizures, pathological reflexes are revealed, paralysis and paresis of the limbs, and speech disorder (aphasia) are possible.

Basic principles and tactics of treatment of epilepsy. The treatment of epilepsy differs from the treatment of other diseases due to the characteristics of its manifestations and course, so it is necessary to follow the basic principles and rules.

1. When a diagnosis of epilepsy is made, treatment must be started immediately to avoid progression of the disease and prevent subsequent seizures.

2. The purpose, meaning and features of therapy must be explained to the patient and his relatives.

3. Taking medications should be regular and long-term. Arbitrary withdrawal of medications may cause sharp deterioration condition.

4. Drugs are prescribed depending on the nature of seizures and other mental disorders.

5. The dose of medication depends on the frequency of seizures, duration of the disease, age and body weight of the patient, as well as individual tolerance to the drugs.

6. The dose is adjusted in such a way that, with a minimum set of agents and minimum doses, the maximum therapeutic effect is achieved, i.e. complete disappearance of seizures or their significant reduction.

7. If treatment is ineffective or severe side effects medications are replaced, but this is done gradually, preferably in a hospital setting.

8. If treatment results are good, reduce the dose of drugs, doing this carefully, under the control of an electroencephalographic study.

9. It is necessary to monitor not only the mental, but also physical condition patient, regularly check blood and urine tests.

10. In order to prevent attacks, the patient should avoid exposure to factors and situations that provoke an attack: drinking alcohol, overheating in the sun, swimming in cold water(especially in the river, in the sea), being in a stuffy, humid atmosphere, physical and mental overstrain.

Treatment for epilepsy is usually complex and includes the prescription of various groups of drugs: directly anticonvulsants, psychotropic drugs, vitamins, nootropics, aloe injections, vitreous fluid, bijoquinol. To reduce intracranial pressure use intravenous infusions of magnesium sulfate with glucose, diacarb.

In the treatment of grand mal seizures, carbamazepine (finlepsin), benzonal, hexamidine, chloracone, primidone (milepsin, liscantil), and sodium valproate are used. For the treatment of minor seizures and absences, hexamidine, diphenine, trimethine, suxilep (pycnolepsin) are recommended.

Currently, third generation anticonvulsants are used for the treatment of epileptic paroxysms - vigabatin (UK license, 1989), lamotrigine (UK license, 1991), gabopentin (UK license, 1993), topiramate (license

UK, 1995), tiagabine (UK license, 1998). These drugs are not only effective, but also have a better safety profile and interact less with other drugs.

Finlepsin (Tegretol) is effective for almost all types of paroxysms, including twilight disorder of consciousness and dysphoria. In recent years, tranquilizers with a muscle-relaxing effect (seduxen, phenazepam, clonazepam) have been widely used. For severe dysphoria, neuroleptics are added (aminazine, sonapax, neuleptil).

Treatment of epilepsy should be supplemented correct mode work and rest, following a diet with limited water, salt, spicy foods, and the complete exclusion of alcohol.

Indications for discontinuation of antiepileptic drugs: if seizures and other paroxysms are absent for 5 years and a stable normal picture is noted on the EEG (including during functional loads), then the drugs can be gradually discontinued.

The course of epilepsy is usually chronic. The onset of seizures most often occurs in childhood and adolescence; less commonly, the disease debuts after 40 years of age (so-called late-onset epilepsy). The appearance of the first seizure in life sometimes coincides with the influence of provoking factors (head injury, infection, mental trauma, etc.).

Mental illness with paroxysmal disorders, progressive course, increasing mental changes. Epilepsy is based on organic changes in the brain.

The epilepsy clinic is characterized by convulsive and non-convulsive seizures, personality changes of the epileptic type, as well as acute or chronic psychoses. To the number seizures(paroxysms) include major and minor convulsive seizures.

A grand mal seizure begins with a lightning loss of consciousness, a tonic muscle spasm, and a fall of the body. Breathing stops and severe cyanosis sets in. The tonic phase lasts several seconds. Then “clonic convulsions occur with rhythmic twitching of the whole body. During the clonic phase, the patient loses urine and feces; secretion increases salivary glands, foam begins to form in the mouth. After 1-2 minutes, clonic convulsions stop. Breathing is gradually restored. The patient remains in comatose with complete areflexia. The coma gradually turns into stupor, reflexes are gradually restored. Then comes sleep, which lasts several hours. After a seizure and sleep, the patient feels weak and asthenic disorders. Often the development of a major seizure is preceded by an aura - confusion of consciousness, accompanied by vegetative, less often motor disturbances, massive senestopathies, and visual hallucinations.

A minor convulsive seizure is characterized by a sudden loss of consciousness, the presence of rudimentary (either tonic or clonic) seizures, and is sometimes accompanied by a fall.

Nonconvulsive paroxysms (equivalents) occur with and without clouding of consciousness. Paroxysmal clouding of consciousness occurs with the patient’s detachment from his surroundings, with the presence of vivid visual hallucinations, delusions, affects of fear, but with the preservation of automated actions or sharp psychomotor agitation, which is sometimes dangerous for others.

Outpatient automatism is also characterized by instant confusion and sudden agitation (patients either spin around their axis, or run somewhere, or “get around”). Sometimes they wander for several hours. Stupefaction and ambulatory automatism end in critical sleep.

Nonconvulsive paroxysms without stupefaction occur in the form of affective paroxysms and cataplexin. Affective paroxysms most often manifest as dysphoria; Patients suddenly develop an angry, melancholy mood with aggressive tendencies, in some cases with suspicion, sometimes with an attraction to alcohol and arson. Ends suddenly. Nonconvulsive paroxysms include transient aphasia, narcolepsy (sudden irresistible drowsiness), cataplexy; the latter occurs in connection with affective experiences: muscle tone is suddenly lost and patients fall.

Muscle tone is also restored suddenly after a few moments.

Paroxysms can occur with different frequencies and at different intervals. The frequency of seizures may increase as the disease progresses. Seizures can be series, with restoration of consciousness in the interictal state, or occur in the form of status epilepticus (seizures follow one after another against the background of comatose stupefaction). Epileptic mental changes are characterized by stiffness, viscosity, slowness mental processes

The course of epilepsy. The disease begins in childhood or young adulthood, but there are also cases of so-called late-onset epilepsy.

The frequency of seizures and non-convulsive paroxysms varies - from daily to extremely rare, occurring only a few times in life. In isolated cases, epilepsy occurs almost without paroxysmal disorders (one or two seizures throughout the entire illness) and is expressed in progressive changes in the psyche of the epileptic type, in the increase in epileptic dementia (this form is called mental epilepsy). In some cases, the development of epilepsy is preceded by night terrors, sleepwalking, and bedwetting. The phenomena of sleepwalking (somnambulism) are more common in children. Early epilepsy can lead to the development of mental retardation. In some cases, personality changes are extremely rudimentary and dementia does not occur.

Treatment of epilepsy. The basis of therapy is the use of anticonvulsants - phenobarbital 0.1 g 2-3 times a day, diphenine 0.1 g 2-4 times a day, trimethin, hexamidine - according to the scheme. Seduxen has an anticonvulsant effect, which is especially indicated for epilepsy in children. In some cases, a combination of anticonvulsants with borax and caffeine (Sereysky mixture) is used.

Sereysky mixture No. 1: phenobarbital - 0.05 g, bromural - 0.2 g, caffeine - 0.015 g, papaverine - 0.03 g, calcium gluconate - 0.5 g. In Sereysky mixture No. 2 and 3, the dose of phenobarbital is increased . Long-term and systematic use of anticonvulsants is necessary. Sudden withdrawal of drugs can cause a sharp increase in seizures and status epilepticus - frequent convulsive seizures, during the intervals between which the patient is in a twilight or comatose state.. For twilight stupefaction with psychomotor agitation, chloral hydrate in an enema and hexenal injections are recommended.

It is prohibited to work in transport, near moving machines, in hot shops, or near furnaces. Swimming in the sea is not recommended.

Symptomatic epilepsy occurs with organic and toxic lesions brain associated with head trauma, meningitis, encephalitis, with the development of a brain tumor, residual changes after a violation cerebral circulation, toxoplasmosis, syphilis, alcoholism, hypoglycemia, etc.

Clinical picture characterized by a combination of convulsive paroxysms and mental changes of a psychoorganic type. Clinical manifestations of convulsive paroxysms are similar to those with true epilepsy. In some cases, the characteristics of seizures depend on the location of the lesion in the brain. There are subcortical epilepsy, temporal lobe epilepsy , brainstem epilepsy. In some cases, partial seizures develop. These include a Jacksonian seizure, which begins in a specific muscle group, then the spasms become generalized and loss of consciousness occurs. An aggressive convulsive seizure is associated with damage to the frontal lobe of the brain, begins with a slow tonic phase, with a turn of the whole body to the side, and then with the development clonic seizures

. A tonic postural seizure is associated with damage to the brain stem and occurs without clonic Treatment. In the presence of scars, adhesions, tumors, it is indicated surgical removal . For toxoplasmosis, syphilis, hypoglycemia - treatment of the underlying disease. As symptomatic remedy

carry out anticonvulsant and dehydration therapy. The appearance of attacks of this type, especially if temporary paresis or paralysis develops after the attack, requires examination of the patient in a neurological hospital. This also applies to patients with generalized seizures if they began in middle age and are accompanied by symptoms of focal brain damage.

Epilepsy as a disease has been known since the times of Ancient Rome. It was called the “falling sickness” and was considered a divine punishment.

Currently, epilepsy occurs in every fifth person; in approximately 30% of those affected, the disease remains for life.

Death occurs in 1 patient out of 1000, the cause of death is.

The success of treatment depends on the age at which the disease manifests itself and the presence of concomitant diseases.

Epilepsy in adults - what is it, how does it manifest itself, is it treated, how can it be dangerous? All the most important things about epilepsy are further in the article.

What does epilepsy mean: is it mental or neurological disease person?

Epilepsy is a neurological disease in which the patient regularly experiences seizures.

Congenital is a consequence of the transmission of genetic information in the family. This form is considered to manifest in childhood and is easier to treat.

The patient's brain integrity is not impaired, only increased activity neurons.

Acquired occurs due to exposure external factors that disrupt brain structures(injuries, infections, tumors).

Etiology and pathogenesis

To date, the exact details have not been established. The leading factor is hereditary predisposition.

If immediate relatives suffer from this disease, then the likelihood of occurrence increases to 30%.

Scientists have discovered that the appearance of focal epilepsy is associated with a mutation in the DEPDC5 gene. However, the child does not inherit the disease itself, but a predisposition to it.

Factors that can increase the risk of developing the disease are:

The causes of acquired epilepsy are:

• head injuries;
• neuroinfections (encephalitis, meningitis);
• stroke;
• endocrine disorders;
• autoimmune diseases;
• alcoholism, drug addiction;
• brain tumors.

Diagnosis of the disease

It begins with collecting a family history. Information about the illness of close relatives is important.

Leading and reliable diagnostic method is an electroencephalogram. Electrodes are attached to the patient's head to record brain activity.

The study is often carried out during sleep, since many patients have attacks that begin at night.

To identify structural changes MRI of the brain is performed. Magnetic resonance imaging can detect tumors, hematomas, and consequences of head injury.

MRI is also used to differentiate epilepsy from other diseases. Biochemical analysis blood helps to identify hypoglycemia, sodium and potassium deficiency, which can cause seizures.

Hormone levels are also examined if endocrine disorders are suspected.

Treatment

Treatment of the disease is aimed at reducing the frequency of attacks and preventing complications.

Treatment includes the following methods:

• drug therapy;
• psychological assistance;

to treat the disease:

1. (Carbamazepine, valproic acid). Reduce pathological brain activity.
2. Nootropics(Vinpocetine, ) improves cerebral circulation.
3. Psychotropic drugs are prescribed for the combination of epilepsy with mental disorders.

Surgery is used in cases of drug resistance and in the absence of effect from other methods.

Conduct the following types operations:

1. Lobectomy (temporal lobe resection).
2. Lesinectomy (removal of a damaged area of ​​the brain).
3. Callosotomy (dissection of the corpus callosum).
4. Vagus nerve stimulation.
5. Hemispherectomy (removal of the hemisphere).
6. Neurostimulator implantation.

TO unconventional methods therapies include:

Disability

At severe course diseases, the epileptic is assigned a group. If the patient can perform work duties with some restrictions, then he is given group 3.

The second non-working group is assigned in the following cases:

1. Frequent seizures that interfere with the performance of work duties.
2. Complications of epilepsy.
3. No improvement after surgery.
4. Development of mental defects.
5. Motor disorders (paresis, paralysis, changes in movement coordination).

The first group is given if the patient has completely lost self-care skills, he has significant violations psyche.

Lifestyle of sick men and women

Thanks to the possibilities modern medicine, epileptics can behave normally. However, he must follow some rules to prevent the development of a seizure:

As for, there is no clear opinion on this matter. According to statistics, 90% of women suffering from epilepsy normally carry and give birth to healthy children.

Absolute contraindications to pregnancy are:

1. Frequent generalized attacks that are not amenable to drug treatment.
2. Visible personality disorders of a woman.
3. Epistatus.

In other cases, pregnancy is not contraindicated. Six months before conception, a woman must undergo full examination and discuss pregnancy management tactics and possible risks with your doctor.