Epilepsy In Adults - Causes, Signs And Symptoms Of Epilepsy, Consequences

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Causes, signs and symptoms of epilepsy

Content:

• What is epilepsy?
• When does epilepsy occur?
• Epilepsy symptoms
• Epilepsy causes
• What examinations are needed?
• What's the forecast?
• What consequences?
• How is epilepsy treated?
• First aid

What is epilepsy?

Epilepsy is a common neuropsychiatric disease with a chronic latent course. Despite this, the onset of sudden epileptic seizures is typical for the disease. They are caused by the appearance of numerous foci of spontaneous excitation (nerve discharges) in certain parts of the brain.

Clinically, such seizures are characterized by a temporary disorder of sensory, motor, thinking and autonomic functions.

The frequency of detection of this disease is on average 8-11% (classic advanced attack) among the general population of the population of any country, regardless of climatic location and economic development. In fact, every 12th person sometimes experiences some micro-signs of epilepsy.

The overwhelming majority of people believe that epilepsy is incurable, and is a kind of "divine punishment". But modern medicine completely refutes this opinion. Antiepileptic drugs help suppress the disease in 63% of patients, and in 18% - significantly reduce its clinical manifestations.

The main treatment is long-term, regular and continuous drug therapy with a healthy lifestyle.

The reasons for the development of epilepsy are different, the WHO grouped them into the following groups:

• Idiopathic - these are cases when the disease is inherited, often after tens of generations. The brain is not organically damaged, but there is a specific reaction of neurons. This form is unstable, and seizures occur for no explainable reason;

• Symptomatic - there is always a reason for the development of foci of pathological impulses. These can be the consequences of trauma, intoxication, tumors or cysts, malformations, etc. This is the most "unpredictable" form of epilepsy, since an attack can be triggered by the slightest irritant, for example, fright, fatigue or fever;
• Cryptogenic - it is not possible to accurately establish the true cause of the occurrence of uncharacteristic (untimely) impulse foci.

When does epilepsy occur?

Seizures in many cases are observed in newly born children with a high body temperature. But this does not mean that the person will have epilepsy in the future. Such a disease can develop in any person and at any age. Still, children and adolescents encounter it more often.

75% of people with epilepsy are people under 20 years of age. As for people who are over twenty, then various kinds of injuries or strokes are usually to blame. Risk group - persons over sixty years old.

Epilepsy symptoms

The manifestations of epileptic seizures may differ from patient to patient. First of all, the symptoms depend on those areas of the brain where the pathological discharge arises and spreads. In this case, the signs will be directly related to the functions of the affected parts of the brain. Movement disorders, speech disorders, an increase or decrease in muscle tone, and dysfunction of mental processes can occur, both in isolation and in various combinations.

The severity and set of signs will also depend on the specific type of epilepsy.

Jacksonian attacks

So, with Jackson's attacks, pathological irritation covers a certain area of the brain, without spreading to neighboring ones, therefore, the manifestations relate to strictly defined muscle groups. Usually psychomotor disorders are short-lived, the person is conscious, but it is characterized by confusion and loss of contact with others. The patient is not aware of the dysfunction and rejects attempts to help. After a few minutes, the condition is completely normalized.

Twitching or numbness begins in the hand, foot, or lower leg, but it can spread to the entire half of the body or develop into a large seizure. In the latter case, they speak of a secondary generalized attack.

A large convulsive seizure consists of successively replacing phases:

• Harbingers - a few hours before the onset of the attack, the patient is covered with an anxiety state, characterized by an increase in nervous excitement. The focus of pathological activity in the brain is gradually expanding, covering all new sections;
• Tonic convulsions - all muscles tense sharply, the head tilts back, the patient falls, hitting the floor, his body is arched and held in this position. Due to respiratory arrest, the face turns blue. The phase is short, about 30 seconds, rarely - up to a minute;
• Clonic seizures - all muscles in the body contract rapidly and rhythmically. Increased salivation, which looks like foam from the mouth. Duration - up to 5 minutes, after which breathing is gradually restored, cyanosis disappears from the face;
• Stupor - in the focus of pathological electrical activity, strong inhibition begins, all the patient's muscles relax, possibly involuntary discharge of urine and feces. The patient loses consciousness, reflexes are absent. The phase lasts up to 30 minutes;
• Sleep.

After the patient wakes up, headaches, weakness, and movement disorders may torment another 2-3 days.

Small seizures

Small seizures are less pronounced. A series of twitching of facial muscles, a sharp drop in muscle tone (as a result of which a person falls), or, conversely, tension of all muscles when the patient freezes in a certain position can occur. Consciousness is preserved. Perhaps a temporary "absence" - absence. The patient freezes for a few seconds, may roll his eyes. After the attack, he does not remember what happened. Small seizures often start in preschool years.

Status epilepticus

Status epilepticus is a series of seizures that follow one after the other. In between, the patient does not regain consciousness, has reduced muscle tone and lack of reflexes. His pupils can be dilated, narrowed or of different sizes, the pulse is either rapid or difficult to palpate. This condition requires immediate medical attention, as it is characterized by increasing cerebral hypoxia and edema. The lack of timely medical intervention leads to irreversible consequences and death.

All epileptic seizures have a sudden onset and end spontaneously.

On the subject: All forms of epilepsy

Epilepsy causes

There is no single common cause of epilepsy to explain its occurrence. Epilepsy is not a hereditary disease in the literal sense, but nevertheless, in certain families, where one of the relatives suffered from this disease, the probability of the disease is higher. About 40% of people with epilepsy have close relatives with the disease.

There are several types of epileptic seizures. Their severity is different. A seizure in which only one part of the brain is to blame is called partial, or focal. If the whole brain is affected, then such a seizure is called generalized. There are mixed seizures: they begin in one part of the brain, later they cover the entire organ.

Unfortunately, in seventy percent of cases, the cause of the disease remains unclear.

The following causes of the disease are common: traumatic brain injury, stroke, brain tumors, lack of oxygen and blood supply at birth, disorders of the brain structure (malformations), meningitis, viral and parasitic diseases, brain abscess.

Is epilepsy inherited?

Undoubtedly, the presence of brain tumors in ancestors leads to a high probability of transmission of the entire complex of the disease to descendants - this is in the idiopathic variant. Moreover, if there is a genetic predisposition of CNS cells to hyperreactivity, epilepsy has the maximum possibility of manifestation in offspring.

At the same time, there is a dual option - symptomatic. The decisive factor here is the intensity of the genetic transfer of the organic structure of brain neurons (property of excitability) and their resistance to physical influences. For example, if a person with normal genetics can "withstand" some blow to the head, then another, with a predisposition, will react to it with a generalized seizure of epilepsy.

As for the cryptogenic form, it has been little studied, and the reasons for its development are not well understood.

Can I drink for epilepsy?

The unequivocal answer is no! With epilepsy, in any case, you cannot drink alcoholic beverages, otherwise, with a 77% guarantee, you can provoke a generalized convulsive seizure, which can be the last in your life!

Epilepsy is a very serious neurological disease! Subject to all the recommendations and the "correct" lifestyle, people can live in peace. But in case of violation of the drug regimen or neglect of prohibitions (alcohol, drugs), you can provoke a condition that will directly threaten your health!

What examinations are needed?

In order to diagnose the disease, the doctor examines the history of the patient himself, as well as his relatives. It is very difficult to make an accurate diagnosis. Before this, the doctor does a lot of work: he checks the symptoms, the frequency of seizures, the seizure is described in detail - this helps to determine its development, because the person who has had a seizure does not remember anything. In the future, electroencephalography is done. The procedure is painless - it is a recording of your brain activity. Techniques such as computed tomography, positron emission tomography and magnetic resonance imaging can also be used.

What's the forecast?

If epilepsy is properly treated, then in eighty percent of cases, people with this disease live without any seizures and without restrictions in activity.

Many have to take antiepileptic drugs all their lives in order to prevent seizures. In rare cases, the doctor may stop taking the medication if the person has not had a seizure for several years. Epilepsy is dangerous because conditions such as choking (which can occur if a person falls face down on a pillow, etc.) or falls lead to injury or death. In addition, epileptic seizures can occur in a row for a short time, which can lead to respiratory arrest.

As for generalized tonic-clonic seizures, they can be fatal. People who experience these seizures need constant supervision, at least from relatives.

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What consequences?

People with epilepsy often find that their seizures scare other people. Children can suffer from being avoided by their classmates. Also, young children with such a disease will not be allowed to participate in sports games and competitions. Despite the correct selection of antiepileptic therapy, hyperactive behavior and learning difficulties may occur.

The person may have to be restricted in some activities - for example, driving a car. People who are seriously ill with epilepsy should monitor their mental state, which is inseparable from the disease.

How is epilepsy treated?

Despite the severity and danger of the disease, provided that timely diagnosis and proper treatment are provided, epilepsy is curable in half of the cases. A stable remission is achieved in about 80% of patients. If the diagnosis is made for the first time, and a course of drug therapy is immediately carried out, then in two-thirds of patients with epilepsy, seizures during their life either do not recur at all, or they subside for at least several years.

Treatment of epilepsy, depending on the type of disease, form, symptomatology and age of the patient, is carried out by a surgical or conservative method. They often resort to the latter, since the use of antiepileptic drugs gives a persistent positive effect in almost 90% of patients.

Medical treatment for epilepsy includes several main stages:

• Differential diagnosis - allows you to determine the form of the disease and the type of seizures in order to choose the right drug;
• Establishing the causes - in symptomatic (most common) form of epilepsy, a thorough examination of the brain is necessary for the presence of structural defects: aneurysms, benign or malignant neoplasms;
• Prevention of attacks - it is advisable to completely eliminate risk factors: overwork, lack of sleep, stress, hypothermia, alcohol intake;
• Relief of status epilepticus or single seizures is performed by providing emergency care and prescribing one anticonvulsant drug or a set of medications.

It is very important to inform the immediate environment about the diagnosis and correct behavior during a seizure, so that people know how to protect an epileptic patient from injuries during falls and convulsions, to prevent sinking and biting the tongue and stopping breathing.

Medical treatment for epilepsy

Regular intake of prescribed medications allows you to confidently count on a calm life without seizures. It is unacceptable for the patient to start taking medicine only when an epileptic aura appears. If the pills were taken on time, the harbingers of an impending attack, most likely, would not have arisen.

During the period of conservative treatment of epilepsy, the patient should adhere to the following rules:

• Strictly adhere to the drug intake schedule and do not change the dosage;
• In no case should you prescribe other medications for yourself on the advice of friends or a pharmacy pharmacist;
• If there is a need to switch to an analogue of the prescribed drug due to its absence in the pharmacy network or too high a price, notify the attending physician and get advice on choosing a suitable replacement;
• Do not stop treatment when a stable positive dynamics is achieved without the permission of your neurologist;
• Timely notify the doctor about all unusual symptoms, positive or negative changes in condition, mood and general well-being.

More than half of patients after initial diagnosis and administration of one antiepileptic drug live without seizures for many years, constantly adhering to the chosen monotherapy. The main task of the neuropathologist is to find the optimal dosage. Medication for epilepsy is started with low doses, while the patient's condition is carefully monitored. If attacks cannot be stopped immediately, the dosage is gradually increased until a stable remission occurs.

Patients with partial epileptic seizures are prescribed the following groups of drugs:

• Carboxamides - Carbamazepine (40 rubles per package of 50 tablets), Finlepsin (260 rubles per package of 50 tablets), Actinerval, Timonil, Zeptol, Karbasan, Targetol (300-400 rubles per package of 50 tablets);
• Valproates - Depakin Chrono (580 rubles per package of 30 tablets), Enkorat Chrono (130 rubles per package of 30 tablets), Konvulex (in drops - 180 rubles, in syrup - 130 rubles), Konvulex Retard (300-600 rubles per package 30-60 tablets), Valparin Retard (380-600-900 rubles per package 30-50-100 tablets);
• Phenytoins - Diphenin (40-50 rubles per pack of 20 tablets);
• Phenobarbital - domestic production - 10-20 rubles per pack of 20 tablets, foreign analogue Luminal - 5000-6500 rubles.

The first-line drugs in the treatment of epilepsy include valproates and carboxamides, they provide a good therapeutic effect and cause a minimum of side effects. The patient is prescribed 600-1200 mg of Carbamazepine or 1000-2500 mg of Depakine per day, depending on the severity of the disease. The dosage is divided into 2-3 doses per day.

Phenobarbital and drugs of the phenytoin series are considered obsolete today, they give a lot of dangerous side effects, depress the nervous system and can be addictive, so modern neuropathologists refuse them.

The most convenient to use are prolonged forms of valproate (Depakin Chrono, Enkorat Chrono) and carboxamides (Finlepsin Retard, Targetol PC). It is enough to take these medicines 1-2 times a day.

Depending on the type of seizure, epilepsy is treated with the following drugs:

• Generalized seizures - a complex of valproate with carbamazepine;
• Idiopathic form - valproate;
• Absances - Ethosuximide;
• Myoclonic seizures - only valproate, phenytoin and carbamazepine have no effect.

The latest novelties among antiepileptic drugs - the drugs Tiagabin and Lamotrigine - have worked well in practice, so if the doctor recommends and finances allow, it is better to opt for them.

Cessation of drug therapy can be considered after at least five years of sustained remission. Treatment of epilepsy is completed by gradually decreasing the dosage of the drug until complete failure within six months.

Removal of status epilepticus

If the patient is in a state of epilepticus (an attack lasts many hours or even days), he is injected intravenously with any of the drugs of the Sibazone group (Diazepam, Seduxen) at a dosage of 10 mg per 20 ml of glucose solution. After 10-15 minutes, you can repeat the injection if status epilepticus persists.

Sometimes Sibazon and its analogs are ineffective, and then they resort to Phenytoin, Gaxenal or sodium thiopental. A 1-5% solution containing 1 g of the drug is injected intravenously, making three-minute pauses after every 5-10 ml, in order to prevent fatal hemodynamic deterioration and / or respiratory arrest.

If no injections help bring the patient out of status epilepticus, an inhaled solution of oxygen with nitrogen (1: 2) must be used, but this technique is not applicable in case of difficulty breathing, collapse or coma.

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Surgical treatment of epilepsy

For symptomatic epilepsy caused by an aneurysm, abscess, or brain tumor, doctors must resort to surgery to correct the cause of the seizures. These are very complex operations, which are usually performed under local anesthesia, so that the patient remains conscious, and according to his condition, it was possible to control the integrity of the brain regions responsible for the most important functions: motor, speech, visual.

The so-called temporal lobe epilepsy also responds well to surgical treatment. During the operation, the surgeon either performs a complete resection of the temporal lobe of the brain, or removes only the amygdala and / or hippocampus. The success rate of such interventions is very high - up to 90%.

In rare cases, namely, children with congenital hemiplegia (underdevelopment of one of the cerebral hemispheres) undergo a hemispherectomy operation, that is, the diseased hemisphere is completely removed in order to prevent global pathologies of the nervous system, including epilepsy. The prognosis for the future of such babies is good, since the potential of the human brain is enormous, and one hemisphere is quite enough for a full life and clear thinking.

With the initially diagnosed idiopathic form of epilepsy, the operation of callesotomy (cutting the corpus callosum, which provides a connection between the two hemispheres of the brain) is very effective. This intervention prevents the recurrence of epileptic seizures in about 80% of patients.

First aid

How to help a sick person if he has an attack? So, if a person suddenly fell and began to jerk his arms and legs incomprehensibly, throwing his head back, look and make sure that the pupils are dilated. This is an epileptic seizure.

Find out more: First aid for epilepsy, what to do?

First of all, move away from the person all objects that he can drop on himself during a seizure. Then turn it over on its side and place something soft under its head to prevent injury. If a person is vomiting, turn their head to the side, in this case, this will help prevent the penetration of vomit into the respiratory tract.

During an epileptic seizure, do not try to water the patient or try to forcibly restrain him. Your strength is still not enough. Ask others to call a doctor.

Find out more: First aid for epilepsy, what to do?

First of all, move away from the person all objects that he can drop on himself during a seizure. Then turn it over on its side and place something soft under its head to prevent injury. If a person is vomiting, turn their head to the side, in this case, this will help prevent the vomiting from entering the airways.

During an epileptic seizure, do not try to water the patient or try to forcibly restrain him. Your strength is still not enough. Ask others to call a doctor.

Author of the article: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".