Epilepsy - one of the most widespread diseases of nervous system which because of the characteristics represents a serious medical and social problem. Among the children's population the frequency of epilepsy is 0.75-1%, from them 65% can live practically without attacks provided that they undergo the corresponding medical examination and receive appropriate treatment. Epilepsy - the brain disease which is characterized by attacks of disturbances of motive, sensitive, vegetative or cogitative functions. At the same time during the period between attacks the patient can be absolutely normal, not different from other people. It is important to note that the single attack is not epilepsy yet. Only repeated attacks - the basis for establishment of the diagnosis of epilepsy. In epilepsy the attacks also have to be spontaneous, i.e. to be provoked by nothing; they appear always unexpectedly. The attacks arising at a temperature (febrile spasms), a fright at blood draw, as a rule, have no relation to epilepsy.
Modern classification of epileptic seizures
I. Partial (focal, local) attacks.
A. Simple partial attacks.
3. Vegetative and visceral (with autonomous symptoms).
4. With disturbance of mental functions.
B. Difficult (complex) partial attacks.
1. Began with simple partial attacks.
2. Began with consciousness disturbance.
B. Partial attacks with secondary generalization (secondarily generalized).
II. Generalized attacks.
A. Absentias epileptica.
B. Myoclonic attacks.
B. Clonic attacks.
G. Tonic attacks.
D. Toniko-klonichesky attacks.
E. Atonic (astatic) attacks.
III. Not classified attacks.
Manifestations of epileptic seizures vary from generalized spasms to hardly noticeable to surrounding people of changes of internal state of the patient.
Allocate the focal attacks connected with emergence of electric discharge in a certain limited site of a cerebral cortex and generalized attacks at which both parencephalons are at the same time involved in the category. At focal attacks spasms or peculiar feelings (for example, numbness) in certain parts of a body can be observed (a face, hands, legs, etc.). Also focal attacks can be shown by short attacks of visual, auditory, olfactory or flavoring hallucinations. Consciousness at these attacks can be kept, in that case the patient in details describes the feelings. Duration of partial attacks usually no more than 30 sec.
Generalized attacks divide into convulsive and convulsiveless (absentias epileptica).
For people around the most frightening are generalized convulsive attacks. At the beginning of an attack (tonic phase) there is tension of all muscles, a short-term apnoea, the shriek is often observed, tongue biting is possible. Later 10-20 sec. there comes the clonic phase when reductions of muscles alternate with their relaxation. At the end of a clonic phase the urine incontinence is often observed. Spasms usually stop spontaneously in a few minutes (2-5 min.). Then there comes the postpristupny period which is characterized by drowsiness, confusion of consciousness, a headache and approach of a dream.
Convulsiveless generalized attacks carry the name of absentias epileptica. They arise almost only at children's age and early youth. The child suddenly fades and stares in one point, the look seems absent. Covering of eyes, trembling a century, an easy zaprokidyvaniye of the head can be observed. Attacks proceed only several seconds (5-20 sec.) and often remain unnoticed.
Diagnosis of epilepsy
At diagnosis "epilepsy" important is to establish its character – idiopathic or secondary (i.e. to exclude presence of a basic disease against the background of which epilepsy develops) and also attack type. It is necessary for purpose of optimum treatment. The patient often does not remember as as happened to him during an attack. Therefore those data which the patient's relatives who were near him during manifestations of a disease can provide are very important.
- The electroencephalography (EEG) – registers the changed electric activity of a brain. During change attacks are always present at EEG, but between attacks in 40% of cases EEG meets standard therefore repeated inspections, provocative tests and also video-EEG-monitoring are necessary.
- Computer (KT) or magnetic resonance imaging (MRI) of a brain
- The general and developed biochemical analysis of blood
- At suspicion of a certain basic disease in symptomatic epilepsy – necessary additional examinations are performed
Treatment of epilepsy
In a disease the epilepsy, treatment consists of various components. Highlights at selection of therapy of epilepsy can be considered, first, identity of a dosage of drugs, starting with the smallest and also mix of antiepileptic drugs, secondly — duration of course treatment.
Therapy of convulsive paroxysms. Here one of fixed assets is luminal (phenobarbital). Daily doses fluctuate from 0.05 to 0.15-0.2 g. It is necessary to remember that at overdose and prolonged use there can be collateral manifestations in the form of headaches, drowsiness, dizziness, constipations, rashes on a body. Phenobarbital is often combined with caffeine, it is also the main component of such mixes as Sereysky, Brodsky, Vorobyov's mix, etc.
Dipheninum, as well as luminal, possesses anticonvulsive action, is shown at treatment of big convulsive attacks on 0.2-0.3 g/days Difenin is contraindicated in diseases of a cardiovascular system.
The hexamidine is a reliable antikonvulsant, it is less effective in abortive attacks. Daily dose of a hexamidine from 1.0 to 1.5 g.
Benzonal which is applied to treatment and big and small attacks as well in jacksonian paroxysms possesses more broad spectrum of activity. Benzonal it is possible to treat also convulsiveless attacks and dysphoria. Daily doses from 0.3 to 0.9 g. Begin therapy with a small dose (0.1-0.2 g/days). At permanent improvement of a state the dose of benzonal is reduced to single 0.1 g a day and apply a long time.
Chloraconum is also appointed for treatment of small and big attacks. The daily dose of drug reaches 2-4 g a day.
Now also the new drugs for treatment of epilepsy are administered. These are valproic acid derivatives: Depakinum, Convulexum, dipro-pier, etc.
Treatment of epilepsy Depakinum begins with a dosage of 0.3 g 3 times a day with the subsequent increase by 0.2 g to the maximum dose of 2.6 g a day.
Lamiktal (lamotrigin) is effective at all types of paroxysmal disorders of various genesis. A daily dose of 100-200 mg, maximum — up to 600 mg/days.
Carbamazepine (Tegretolum, Finlepsinum) possesses a broad spectrum of activity. It is applied to treatment of big convulsive attacks, psychomotor and focal attacks. In small attacks it is insufficiently effective, but removes dysphoric manifestations, irritability, importunity. The daily dose of drug makes from 0.2 to 1.2 g. It is usually well transferred, can be combined with neuroleptics.
For stopping of twilight conditions of consciousness, at difficulties of behavior the patient with epilepsy appoint aminazine intramusculary. At the same time it is necessary to watch arterial blood pressure in view of a possibility of its sharp decrease. At the significant affective disturbances are shown Seduxenum, lorafen, Phenazepamum.
If treatment is effective, paroxysms disappear. Reduction of a dose of protivoepyleptichesky drugs needs to be made gradually not earlier than in four-five years after an initiation of treatment.
Treatment of the epileptic status. This state is urgentny, life-threatening, demanding emergency aid.
Urgent administration intravenously slowly of diazepam, Seduxenum, a lorafen, etc. is necessary. Introduction in an enema of 15-20 ml of 6% - a leg of solution of Chlorali hydras and 20-30 ml of 2% - a solution leg barbital-sodium is in certain cases shown. At their inefficiency hexenal (1 g) in the form of freshly cooked 10% solution is shown. After administration of hexenal it is necessary to enter intravenously magnesium sulfate solution (5-10 ml of 25% solution on 40% solution of glucose); it extends and deepens effect of hexenal. As a last resort apply a spinal puncture with deflation of cerebrospinal fluid to 20 ml. If all specified actions do not help, it is necessary to transfer the patient to the managed breath using a local hypothermia of a brain. From cardiacs enter Cordiaminum and caffeine.
Organization of the mode. Dietotherapy. The organization of healthy nutrition and mode is of great importance for treatment of epilepsy. With the medical purpose offer patients four types of a diet: hungry, electrolyte-deficient, with sharp restriction of liquid and proteins (ketogenic diet). Hard liquors (strong tea, coffee) are not recommended, it is necessary to exclude alcohol categorically. Though practically all feeding schedules can not always be executed in practice, it is necessary to adhere to restriction of liquids, in this regard not to use hot and salty dishes, restrictions of proteinaceous food, especially meat, keeping to a milk and vegetable diet. Patients with epilepsy are forbidden to work about moving mechanisms, at height, at fire and water. If the disease proceeds without frequent attacks, also brainwork can be recommended feasible physical. Through work which is specially picked up taking into account a condition of patients it is possible to carry out a social readaptation of patients with epilepsy most fully.
Examination. The numerous offenses committed by patients with epilepsy most often happen during development in them of twilight stupefaction or equivalents (trances, etc.). In this case the patient cannot be responsible for the acts and is recognized court as deranged. If offense is committed out of an attack of the dulled consciousness or disturbance of mood, then when determining insanity the extent of decrease in level of the personality, weak-mindedness is considered. Over patients with epilepsy in a condition of weak-mindedness the guardianship is established.
Epilepsy at children
If made to your child the diagnosis epilepsy – be not frightened - it is not a sentence yet. Many of you will tell now: "It is easy to speak". Yes, it is possible, your fear also is reasonable. To see how the child suddenly falls, and his body fights in spasms, really terribly. Many centuries ago the given disease was connected directly with magic and magic. People just could not explain so strange behavior of a human body. They considered that in a human body at such moments the evil spirit is installed. The modern medicine on other looks at manifestation of epilepsy.
Modern researches proved that attacks arise as result of disturbances of processes of excitement and braking which happen in cells of a cerebral cortex. There is a lot of causes of epilepsy at the child. It is possible to refer genetic predisposition, congenital anomalies of development of a brain, pre-natal infections, chromosomal syndromes, hereditary diseases of a metabolism, patrimonial injuries of the central nervous system, craniocereberal injuries to them and so on. Brain tumors – one more rather frequent reason of development of epilepsy.
Epilepsy can have an effect on any age. If to speak about children, then their attacks of epilepsy can appear in the first month of life. Yes, it is terrible. However if to trust statistical data, then they claim that in most cases epilepsy occurs in children aged up to fifteen years. Especially often spasms are noted aged from one year up to nine years.
If to speak about epilepsy attack duration, then it, as a rule, lasts from several seconds to five minutes. Single and short attacks are considered to be rather safe. They, most often, stop independently. Attacks can sometimes be repeated and follow, almost, one by one. In case the child in intervals between epileptic attacks recovers consciousness, such attacks carry the name of serial. If in an interval between attacks the consciousness of the child is not restored, and duration of each attack is not less than fifteen minutes, then it is accepted to call a similar course of spasms "the epileptic status". At such moments the life of the child is in big danger.
Let's stop a little on consequences of epileptic attacks for children. Consequences of such attacks can be different. If an attack short-term, then it does not do harm to the child. If the attack long, then leads of it to death of neurons of a brain. It should be noted that children are exposed to the greatest danger during a sudden loss of consciousness. The fact is that at such moments children can suffer very serious injuries.
Treatment of epilepsy is based, first of all, on use of anticonvulsant medicines. It is also very important that these drugs were taken by the child regularly. Completely it is required to get rid of epilepsy about three years of regular use of medicines. Yes, it is rather long term, but effective.
Along with medicines rather often also special dietary supplements of Tyansha are offered the child. Use of such dietary supplements as Biokaltsy for improvement of brain activity, Biotsink, Icahn, Weikan and some other will help to restore microcirculation of brain tissue of the child and also to support normal metabolism of nervous tissue.
Epilepsy attack it is really terrible. However parents should not forget that at such moments the life of the child is in their hands. Be not lost, gather and help your kid! Do not leave the child at all until the attack does not stop completely!