Focal seizures in children and adults

Focal epilepsy is a kind of brain disease known since ancient times, which manifests itself in specific convulsive attacks, called epileptic ones. To ignorant people in the modern world, the contemplation of such attacks is horrifying and stupefying. Although in ancient times this disease was considered sacred due to the fact that the disease manifested itself in many great people of that time, who were considered to be saints and prophets.

What is focal epilepsy?

The human nervous system is a complex mechanism whose activity is based on the processes of excitation and inhibition due to the stimulation of neurons by external or internal factors. Thus, our body reacts to changes that arise within it or in the surrounding space.

Neurons are provided with all sensitive receptors on the human body, a network of nerve fibers, the brain. It is thanks to these electrically excitable cells that we are able to feel, sense, produce purposeful actions and realize them.

Excitation is the process of transmission by the neuron through the nervous system of energy, which transmits a signal (electric impulse) to the brain or backwards (to the periphery). In a healthy person, the process of excitation of neurons occurs under the influence of irritating factors. Epilepsy is said to occur if foci of pathological excitement are found in the brain, the neurons of which come to the state of alert spontaneously, without serious causes, with the formation of an excessively high charge.

Foci of increased excitability of the brain can have different shapes and sizes. Foci can be either single, clearly limited (localized form of the disease), or multiple, scattered in different parts of the brain (generalized form).

Epidemiology

In Ukraine, according to statistics, 1-2 people out of a hundred suffer from epilepsy. More than 70% of cases of diagnosing epilepsy occur precisely in the congenital form of pathology. This is a vivid example of the generalized form of the disease, the causes of which are likely to lie in the genetic abnormality. Nevertheless, there is a certain percentage of patients who are diagnosed with idiopathic focal epilepsy with a clearly defined foci of excitation in one particular part of the brain.

[1], [2], [3], [4], [5]

Causes of the focal epilepsy

Focal epilepsy refers to the category of chronic neurological diseases. It can be congenital without any anatomical defects in the structure of the brain. In this case, only violations from neurons that give incorrect signals to the periphery are noted, as a result of which appearance of pathological phenomena of various nature is noted.

Symptoms of primary (idiopathic) epilepsy can be observed already in early childhood and adolescence. It does not lend itself to medical therapy and, over time, the frequency of the appearance of epicasis decreases.

The processes of excitation in the brain constantly alternate with the inhibition of the nervous system, so the controlling structures of the brain give him the opportunity to calm down and rest. If the control is not at the proper level, the brain must constantly be in an excited state. This phenomenon is called increased convulsive readiness, which is characteristic of epilepsy.

The cause of genetic failures can be oxygen starvation at different stages of fetal development, intrauterine infections, intoxication, fetal hypoxia during childbirth. Incorrect genetic information can also be transmitted to subsequent generations who have not been exposed to the above factors.

But the disease can also occur later. This form of pathology is called acquired (secondary, symptomatic), and its symptoms can appear at any age.

The causes of the development of symptomatic focal epilepsy lie in organic brain lesions caused by:

• craniocerebral trauma (the manifestations of the disease may occur in the coming months after trauma, for example, concussion, or be delayed, reminiscent of yourself after a few years),
• internal bacterial and viral infections (risk factors in this case are: untimely or incomplete treatment of the disease, ignoring bed rest in the acute stage of pathology, ignoring the fact of the disease),
• transferred meningitis or encephalitis (inflammation of the structures of the brain),
• acute violations of cerebral circulation, resulting in hypoxia of brain tissue, ischemic and hemorrhagic stroke,
• cervical osteochondrosis, which can provoke a violation of blood circulation in the brain,
• malignant and benign tumors in the brain, aneurysms,
• arterial hypertension,
• chronic alcoholism (focal epilepsy due to alcoholism is caused by toxic brain damage and metabolic disorders in its tissues, which is a consequence of regular alcohol abuse).

But various vices (dysgenesia) of the nervous system are more characteristic of idiopathic focal epilepsy.

There is also an intermediate form of the disease, which is called focal epilepsy, associated with DAPD (benign epileptiform patterns of childhood). DEDD is diagnosed in 2-4% of children under the age of 14 years. Every tenth such a child is diagnosed with epilepsy.

The cause of this form of focal epilepsy is considered by doctors as birth trauma, i.e. Organic brain damage received by the child during childbirth. So the mistake of doctors can cause epileptic attacks in a child without congenital pathologies.

[6], [7], [8], [9]

Pathogenesis

The basis of the pathogenesis of focal epilepsy is also uncontrolled spontaneous excitation of neurons of the brain, but with this form of the disease, this pathological focus is of limited size and precise localization. Thus, focal epilepsy should be understood as a localized form of the disease, the symptoms of which are less pronounced than in generalized seizures, when excitation occurs in different parts of the brain. Accordingly, the frequency of seizures in this case is less.

An epileptic seizure in many people is associated with a convulsive fit, although in fact there can be a whole complex of symptoms preceding unusual convulsions. Excessive discharge of brain neurons provokes the emergence of short-term pathological conditions characterized by impaired sensitivity, motor activity, mental processes, the emergence of vegetative symptoms and impaired consciousness.

The most unusual thing in this pathology is that patients often can not remember the details of the attack, because they do not even realize what happened to them. With a simple attack, the patient can remain conscious, but not control his reactions and actions. He realizes that he had an attack, but he can not describe the details. Such an attack lasts usually not more than 1 minute and is not accompanied by severe consequences for a person.

With a complex epiprust of a short-term loss or confusion. And when a person comes to, he can not understand what happened to him if he suddenly finds himself in the wrong position or in the place where the attack occurred. The duration of such an attack can vary from 1 to 3 minutes, after which the patient may still have a poor understanding of the terrain for a few more minutes, get confused in events, spatial and temporal coordinates.

[10], [11], [12], [13], [14], [15], [16]

Symptoms of the focal epilepsy

Speaking about the clinical picture of focal epilepsy, one must remember that we are dealing with a small limited epileptogenic focus in the brain, and depending on the localization of this focus, the symptoms of the disease will change. And yet the distinctive feature of any kind of epilepsy is the presence of recurring epileptic seizures that develop incrementally, but end in a short period of time.

As we have already mentioned, simple attacks take place without loss of consciousness by the patient, while complex ones are characterized by disturbances and confusion of consciousness. Most often, complex epistemics occur against the background of simple, and then there is a disturbance of consciousness. Sometimes there are automatisms (multiple monotonous repetitions of words, movements, actions). With secondary generalization, complex attacks occur against the background of a complete blackout of consciousness. At first, the symptoms of a simple attack appear, and when the excitation spreads to other parts of the cerebral cortex, a tonic-clonic (generalized) attack occurs, which is stronger than the focal one. In the event of a violation or disconnection of consciousness, the patient still feels an inhibition of reactions for an hour, he does not understand well.

Simple epileptic paroxysms can occur with motor, sensory, vegetative, somatosensory disorders, proceed with the appearance of visual and auditory hallucinations, changes in smell and taste sensations, and even with mental disorders.

But these are all common phrases. What kind of symptoms can manifest individual forms and types of focal epilepsy?

Idiopathic focal epilepsy is characterized by rare attacks with unilateral motor and (or) sensory symptoms. Seizures often begin with speech disorders, numbness of the tissues of the tongue and mouth, spasms of the pharynx, etc. Patients often have a weakening of the tone of the muscular system, jerky movements of the body and limbs, impaired coordination of movement and orientation in space, disruptions in the work of the visual system.

Focal epilepsy in children is mostly congenital in nature and has idiopathic symptoms. In infants, the disease can manifest itself in the form of trembling eyelids, glazed stare, fading, tilting the head, bending the body, spasms. Involuntary defecation and urination are not an occasion to diagnose the disease if they are observed in children under 2 years of age.

The first signs of an approaching attack in a child may be such symptoms: the baby is disturbed by sleep, there is increased irritability, he begins without a reason to be capricious. In younger children, seizures are often accompanied by loss of consciousness, whims, increased crying of the baby.

Older children may experience sudden congestion with a lack of response to the surrounding and irritants, frozen at one point look. With focal epilepsy, visual, taste and auditory disorders often occur. At the end of the attack, the kid continues to do his own business, as if nothing happened.

Epileptic seizures in children do not necessarily have to be accompanied by cramps. Seizures without seizures (they are absences), lasting less than 30 seconds, are often observed in girls between 5 and 8 years.

In adolescence, epileptic seizures are often accompanied by a snacking of the tongue and the appearance of foam at the mouth. After a fit, the baby can be sleepy.

The symptomatic form of the disease has a clinical picture, corresponding to the localization of the affected area in the brain, because different parts of the brain are responsible for different aspects of our life.

If the area of increased excitability of neurons is in the temple area ( temporal epilepsy ), the epileptic attack has a short duration (half a minute - a minute). The attack is preceded by a bright aura: the patient can complain about undefined abdominal pain, semireal illusions (pareidolia) and hallucinations, impaired sense of smell, spatial-temporal perception, awareness of the location of his location.

Attacks can take place with loss of consciousness, and with its preservation, but the awareness of what is happening remains blurred. Manifestations of the disease will depend on the location of the epileptogenic focus. If it is located in the medial zone, then there is a partial deactivation of consciousness, i.e. A person can be frozen for a while.

After a sharp stoppage of motor and speech activity in adults, motor automatisms arise predominantly. In other words, a person can repeatedly repeat unconsciously some simple actions or gestures. In children, oral automatisms predominate (stretching of the lips, imitation of sucking, compression of the jaws, etc.).

There may be temporary mental disorders: a sense of unreality of what is happening with memory impairments, self-perception disorder, etc.

The lateral location of the focus in the temporal zone of the person is tormented by nightmarish hallucinations (visual and auditory), anxiety, dizziness, which are not of a systemic nature, temporary deactivation of consciousness and loss of balance without the appearance of convulsions (temporal syncopation).

If the lesion locus is found in the dominant hemisphere of the brain, after the end of the attack, speech ( aphasia ) disorders can be observed for some time .

If the disease progresses, then at a certain stage it may appear secondary generalized seizures, which happens in 50% of patients with focal temporal epilepsy. In this case, in addition to loss of consciousness, there are tonic-clonic seizures with which we usually associate the concept of epilepsy: numbness of the limbs in the unfolded state, tilting the head, loud violent cry (sometimes as if growling) with active exhalation, then twitching of limbs and body, spontaneous release of urine and feces, the patient can bite the tongue. At the end of the attack, verbal and neurological disorders are observed.

In later stages of the disease, the personality characteristics of the patient may change, which can become more controversial and irritable. Over time, thinking and memory are disturbed, slowness and a tendency to generalization appear.

Focal temporal epilepsy is  one of the most common types of symptomatic disease that is diagnosed in every fourth patient.

For  focal frontal epilepsy, which is by right considered the most popular type of pathology, the appearance of an aura is not characteristic. The attack usually takes place against the background of the preserved consciousness or in a dream, has a short duration, but is prone to seriality (repeated seizures).

If the epileptic seizure started in the daytime you can notice uncontrolled movements of the eyes and head, the appearance of complex motor automatisms (the person starts moving his arms and legs, imitating walking, running, riding a bicycle, etc.) and psychoemotional disorders (aggressiveness, nervous excitement, throwing, shouting, etc.).

If the epileptogenic focus is located in the precentral gyrus, sudden tonic-clonic impairment may occur with localization on one side of the body, usually taking place against the background of the preserved consciousness, although the generalization of the attack sometimes occurs. At first, the person stops for a moment, and then almost immediately jerks of muscles are noted. They always start in the same place and spread to the half of the body where the attack began.

Prevent the spread of seizures by clutching the limb where they started. True, the initial focus of an attack can be located not only on the limbs, but also on the face or body.

If seizures occur in a person during sleep, then there may be such short-term abnormalities as sleepwalking (walking in a dream), parasomnia (limb movement and involuntary muscle contractions in a sleeping person), bedwetting. This is a fairly easy form of the disease, in which the increased excitability of neurons is observed in a restricted area and does not extend to other areas.

Focal occipital epilepsy  manifests itself mainly as visual disturbances. It can be both involuntary movements of the eyes and visual impairments: its deterioration, temporary blindness, the appearance of visual hallucinations and illusions of various nature and complexity, narrowing the field of view, the formation of ramp (empty areas in the field of view), the appearance of flashing lights, flashes, patterns before your eyes.

As for motor impairment, eyelid twitching, rapid vibrational movements of the eyes up and down or from side to side (nystagmus), sharp narrowing of the pupils of the eyes (miosis), rolling of the eyeball, etc. Can be observed here.

Most often, such an attack is observed against a background of migraine-like headache, pallor of the skin. In children and some adults, they can be accompanied by attacks of abdominal pain and vomiting. The duration of the attack can be quite large (10-13 minutes).

Focal epilepsy of the parietal zone is the rarest type of symptomatic form of the disease, which usually arises from the cause of tumor and dysplastic processes in the brain. Patients complain of a sensitivity disorder with characteristic symptoms: tingling, burning, acute short-term pain in the area of numbness. It may seem to a person that the numb limb is not at all or is in an uncomfortable position, dizziness and confusion may arise.

Most often, loss of sensitivity occurs on the face and hands. If the epileptogenic focus is located in the area of the paracentral flowed gyrus, numbness can be felt also in the groin, thighs and buttocks. With the defeat of the postcentral gyrus, the symptoms appear on a limited area and gradually spread to other areas.

If the posterior parietal zone is affected, then visual hallucinations and illusory pictures are quite likely, a violation of the visual assessment of the size of objects, the distance to them, etc. Is likely.

When the parietal zone of the dominant hemisphere of the brain is damaged, speech and oral counts are disturbed. Disorders of orientation in space are observed when the focus is localized in the non-dominant hemisphere.

Seizures usually occur during the day and last no more than 2 minutes. But the frequency of their appearance may be higher than with other localizations of the pathological focus.

Cryptogenic focal epilepsy  with an unclear genesis can occur against the background of alcoholism and drug addiction, and also result from head trauma, viral pathologies, liver and kidney disorders. Usually epilepsy occurs spontaneously, but with this form of pathology, they can be triggered by bright light, loud sounds, sudden temperature changes, sudden awakening, an event that caused a surge of emotions, etc.

It is believed that the disease is accompanied by a metabolic disorder. The content of fats in the body remains at the same level, but the water level is constantly growing and it begins to accumulate in tissues, including brain tissue, which provokes the appearance of an attack.

Quite often, seizures of different duration occur with loss of consciousness and neurological disorders. Regular repetition of them can lead to mental disorders.

Precursors of a severe and prolonged attack are: the appearance of insomnia, tachycardia, headaches, bright visual hallucinations with flashing lights.

For focal epilepsy with secondary generalization of attacks characterized by the following manifestations:

• First, for a few seconds an aura appears, the symptoms of which are unique, i.e. Different people can feel the various symptoms that indicate the onset of a seizure,
• Further, the person loses consciousness and balance, the muscle tone decreases and he falls to the floor, issuing a specific cry due to the difficult passage of air through the suddenly narrowed voice gap with a sudden contraction of the muscles of the chest. Sometimes the tone of the muscles does not change and the fall does not occur.
• Now comes the phase of tonic convulsions, when the human body for 15-20 seconds freezes in an unnatural position with elongated limbs and thrown back or turned head to the side (it turns in the opposite direction to the lesion). Breathing temporarily stops, swelling of the veins on the neck and pallor of the face, which can gradually take a bluish tinge, tight compression of the jaws.
• After the tonic phase comes the clonic with a duration of about 2-3 minutes. During this phase, twitching of the muscles, limbs, rhythmic bending and extension of the arms and legs, vibrating movements of the head, movements of the jaws and lips are observed. These same paroxysms are typical for a simple or complex attack.

Gradually the strength and frequency of seizures decreases, and the muscles completely relax. In the post-epileptic period, there may be a lack of response to stimuli, dilated pupils, lack of eye reaction to light, tendon and protective reactions.

Now a bit of information for fans of alcohol. Frequent cases of focal epilepsy develop against the background of alcohol abuse. Usually seizures are caused by head injuries, which often happens in a state of alcoholic intoxication, withdrawal syndrome, a sharp refusal of alcohol.

Symptoms of alcoholic epilepsy can be considered: fainting and loss of consciousness, the appearance of seizures, burning pains, feelings of squeezing or twisting muscles in the limbs, hallucinations, vomiting. In some cases, a burning sensation in the muscles, hallucinations, delusions are observed even the next day. After the attacks, sleep disorders may occur, irritability and aggressiveness occur.

The further impact on the brain of alcohol toxins leads to an increase in the episodes of the occurrence of epicasis and personality degradation.

[17], [18], [19], [20]

Forms

Focal epilepsy is a generalized name for diseases with a clearly defined zone of excessive excitation of neurons characterized by recurrent epileptic seizures. Since this is a disease of the neurological sphere, specialists in this field distinguish 3 forms of focal epilepsy: idiopathic, symptomatic and cryptogenic.

Idiopathic focal epilepsy, which we have already mentioned, is a kind of disease, the causes of which have not been fully explored. But scientists suggest that everything comes down to violations of the maturation of the brain in the intrauterine period, which have a genetically determined nature. In this case, instruments for instrumental diagnosis of the brain (MRI and EEG apparatus) do not show any changes.

Idiopathic form of the disease is also called benign focal epilepsy. It is about this form that we are talking about when a doctor makes a diagnosis:

• benign childhood (Rolandic) epilepsy or epilepsy with central-temporal peaks,
• benign occipital epilepsy, which has early manifestations (Panayotopulos syndrome, occurs before the age of 5 years),
• benign occipital epilepsy, manifested at a later age (epilepsy type Gasto is diagnosed in children older than 7 years),
• primary epilepsy of reading (the rarest variety of pathology with the localization of the epileptogenic focus in the parieto-temporal zone of the cerebral hemisphere, more responsible for speech, is more inherent in the male population with alphabetic writing)
• autosomal dominant frontal epilepsy with nocturnal paroxysms,
• family temporal epilepsy 
• non-family and family benign epicas in infancy,
• family temporal epilepsy, and others.

Symptomatic focal epilepsy, on the contrary, has specific causes, consisting in all possible organic lesions of the brain and revealed during instrumental studies in the form of interconnected zones:

• zone of anatomical lesion (direct focus of brain damage, resulting from head trauma, circulatory disorders, inflammatory processes, etc.)
• zone of formation of pathological impulses (region of localization of neurons with high excitability),
• a symptomatic zone (area of excitation, which causes a clinical picture of epileptic seizure),
• an irritive zone (a region of the brain in which increased electrical activity is detected by means of an EEG outside seizures)
• zone of functional deficiency (the behavior of neurons in this area provokes neurological and neuropsychic disorders).

The symptomatic form of the disease is:

• Constant partial epilepsy (synonyms: cortical, continual, Kovzhevnik epilepsy), characterized by constant twitching of the muscles of the upper body (mainly on the face and hands).
• Epileptic syndromes, provoked by certain factors, for example, seizures of partial (focal) epilepsy, arising from sudden awakening or under the influence of strong psychoemotional factors.
• Focal temporal epilepsy, in which the temporal region of the brain is affected, responsible for thinking, logic, hearing, behavior. Depending on the localization of the epipathological focus and the emerging symptoms, the disease can occur in such forms:
  • amygdalar,
  • hippocampal,
  • lateral (posterior-temporal),
  • insular.

If both temporal lobes are affected, one can speak of bilateral (temporal) temporal epilepsy.

• Focal frontal epilepsy, which is characterized by damage to the frontal parts of the brain with impaired speech activity and serious behavioral disorders (Jackson epilepsy, sleep epilepsy).
• Focal parietal epilepsy, characterized by a decrease in the sensitivity of one half of the body.
• Focal occipital epilepsy, occurring at different ages and characterized by visual disturbances. There may also be problems with coordination of motion, increased fatigue. Sometimes the process goes to the frontal lobes, making diagnosis difficult.

A particular type of disease is multifocal epilepsy, when in the opposite hemispheres of the brain sequentially formed mirror-located epileptogenic foci. The first focus usually appears already in infancy and affects the electrical excitability of neurons in the symmetrical region of the other hemisphere of the brain. The appearance of the second focus leads to violations of psychomotor development, work and structure of internal organs and systems.

Sometimes, with obvious symptoms of epilepsy in adults, doctors can not determine the cause of the disease. Diagnosis does not detect organic brain damage, but the symptoms suggest the opposite. In this case, the diagnosis is "cryptogenic focal epilepsy", i.e. Epilepsy, which proceeds in a latent form.

Cryptogenic and symptomatic focal epilepsy can occur with secondary generalization, when both brain hemispheres are involved in the process. In this case, along with focal (partial) attacks, there are generalized complex attacks, for which a complete deactivation of consciousness and the presence of vegetative manifestations are characteristic. In this case, the presence of seizures is not necessary.

Some syndromes can occur with two kinds of attacks (focal and generalized):

• neonatal convulsions in infants,
• severe myoclonic epilepsy, developing in early childhood,
• epilepsy in a dream, arising in the phase of slow sleep and characterized by prolonged complexes of peaks and waves,
• Landau-Kleffner syndrome or secondary epileptic aphasia, developing at the age of 3-7 years and characterized by symptoms of aphasia (a disorder of receptive speech) and speech impairment (hypoplasia of speech), EEG reveals epileptic paroxysms, and the patient has simple and complex epileptic seizures in 7 out of 10 patients).

[21], [22], [23]

Complications and consequences

Despite the fact that focal epilepsy is considered an easier form of the disease than generalized, its symptoms not only look very unattractive, but also pose a certain danger to the patient. Of course, seizures do not appear so often and are less pronounced than in generalized seizures, but even these infrequent seizures pose a high risk of injury with sudden loss of tone and falling to the floor, especially if there was not a person nearby who could support in such a situation.

Another great danger is the high probability of asphyxiation due to ingestion of vomit into the respiratory tract or the overlapping of the air flow with the patient's tongue sinking inside. This can happen if there was not a person nearby who would turn the patient's body during an attack on his side. Asphyxia, in turn, can lead to the death of the patient, regardless of the cause and type of epilepsy.

The ingression of vomitive masses during the seizure may provoke the development of an acute inflammatory process in the lung tissue ( aspiration pneumonia ). If this happens regularly, the disease can have a complicated course, the lethality of which is about 20-22 percent.

With frontal focal epilepsy, paroxysms can occur serially within half an hour with a small interval between attacks. This condition is called epileptic status. The appearance of serial seizures may be a complication of other types of epilepsy.

The human body just does not have time to recover during the time intervals. If there is a delay in breathing, this can lead to brain hypoxia and related complications (with the total duration of seizures for more than half an hour, development of oligophrenia, mental retardation in children, death of the patient with a probability of 5-50%, behavioral disorders may occur). Especially dangerous is a convulsive status epilepticus.

If the disease is not treated, then many patients develop mental instability. They are characterized by outbursts of irritability, aggression, they begin to clash in the team. This affects the relationship of a person with other people, creates interference in work and life. In some cases, the neglected disease leads not only to emotional lability, but also to serious mental disorders.

Especially dangerous is focal epilepsy in children, since regular seizures can lead to mental retardation, speech and behavioral disorders, which presents certain difficulties during training and communication with peers, teachers, parents, and the decline in school performance.

[24], [25], [26], [27]

Diagnostics of the focal epilepsy

The diagnosis of "focal epilepsy" doctors put on the basis of recurring epicas. Single paroxysms are not considered a reason to suspect a serious illness. Nevertheless, even such seizures are a sufficient reason to call a doctor, whose task is to identify the disease as early as possible and prevent the progression of symptoms.

Even a single focal paroxysm can be a symptom of a severe cerebral disease, which are tumor processes in the brain, vascular malformation, dysplasia of the cortical zone, etc. And the earlier the disease is revealed, the more likely it is to be defeated.

This problem should be addressed to a neurologist who will conduct a physical examination of the patient, listen carefully to the patient's complaints, paying attention to the nature of the symptoms, the frequency of their recurrence, the duration of the attack or seizures, the symptoms preceding the epileptic attack. The sequence of epileptic seizures is very important.

It should be understood that the patient himself often does not remember much about the symptoms of the attack (especially generalized), so you may need the help of relatives or eyewitnesses of the seizure, who can provide details.

It is mandatory to study the patient's history and family history to identify episodes of epilepsy in the genus of the patient. The doctor will necessarily ask the patient (or his family if it is a small child), from what age there were convulsive seizures or symptoms corresponding to absences, and also events preceding the seizure (that will help to understand what triggered the excitation of neurons of the brain).

Laboratory tests for focal epilepsy are not important diagnostic criteria. The general analysis of urine and blood, which can appoint a doctor in this case, is needed sooner to identify concomitant pathologies and determine the performance of different organs, which is important for the appointment of drug treatment and physical procedures.

But without an instrumental diagnosis, an exact diagnosis is impossible, because on the basis of the above, the doctor can only guess in which area of the brain the epileptogenic focus is located. The most informative from the point of view of the diagnosis of epilepsy are:

• EEG (electroencephalogram). This simple study can sometimes reveal increased electrical activity in epi-foci, even between attacks, when a person turns to the doctor (in deciphering it is shown as sharp peaks or waves of greater amplitude than the rest)

If the EEG shows nothing suspicious in the interictal period, provocative and other studies are carried out:

• EEG with hyperventilation (the patient needs to breathe quickly and deeply for 3 minutes, after which there is an increase in the electrical activity of neurons,
• EEG with photostimulation (using light flashes),
• Deprivation of sleep (stimulation of neuronal activity by refusing sleep for 1-2 days),
• EEG at the time of the attack,
• Subdural corticography (a method that allows to determine the exact location of an epileptogenic focus)

• MRI of the brain. The study reveals the causes of symptomatic epilepsy. The thickness of the slices in this case is minimal (1-2 mm). If structural and organic changes are not detected, the physician diagnoses cryptogenic or idiopathic epilepsy, based on the history and complaints of the patient.
• Positron Emission Tomography (PET of the brain). It is used less often, but helps to detect metabolic disturbances in the tissues of the epic-focus.
• X-ray of the skull. Carried out with injuries or the inability to conduct other studies.

In addition, a biochemical blood test, a blood test for sugar and infections, a tissue biopsy and a subsequent histological examination (if there is a suspicion of an oncological process) can be prescribed .

[28], [29], [30], [31], [32], [33]

Differential diagnosis

Differential diagnosis helps to determine the form of the disease (focal or generalized), to make an accurate diagnosis in view of the localization of the lesion, to differentiate the individual epileptic seizures provoked by emotional states, and directly epilepsy, as a chronic disease and recurring attacks.

Treatment of the focal epilepsy

Treatment can be prescribed by a neurologist or epileptologist, if such a specialist is in a medical institution. The basis for the therapy of focal epilepsy is the intake of medications, while physiotherapy treatment for this pathology is not prescribed at all in order not to provoke an attack, or is carried out with extreme caution (usually these are special exercises of exercise therapy that help balance the processes of excitation and inhibition in the brain) . It is necessary at once to be adjusted, that reception of medicines will be not temporary, and constant throughout all life of the patient.

The main antiepileptic drugs are anticonvulsants (anticonvulsants): "Karmazepine", "Clobazam", "Lacosamid", " Lamotrigine ", "Phenobarbital", preparations of valproic acid, etc. Drugs are selected individually and in the absence of a good effect are replaced by others. The goal of such treatment is to significantly reduce the number of seizures and alleviate symptoms.

If focal epilepsy is provoked by other diseases, then in addition to relief of epicas, one must treat the underlying disease, otherwise the result will be inadequate.

Among the symptomatic types of epilepsy, the occipital and parietal forms are well suited for drug treatment. But with temporal localization of the epileptic focus, after a couple of years, resistance to the action of antiepileptic drugs can develop. In this case, surgical treatment is recommended.

Indications for surgical treatment may be deterioration of the patient's condition, increase in the number and duration of seizures, decreased intellectual abilities, and so on. The neurosurgeons perform surgery on the mozzo, removing either the epileptogenic focus itself or neoplasms (tumors, cysts, etc.) that provoke the pathological excitability of neurons (focal or extended resection with the removal of adjoining tissues where epiaktivity spreads). Such operations are possible only in the case , if the localization of the epiotic is clearly defined as a result of diagnostic studies (corticography).

For the successful treatment of epilepsy, the surrounding environment plays an important role. In no case should the patient feel defective and experience condemnation or pity from other people. Attacks occur periodically and rarely affect a person's ability to communicate and learn. The child and the adult should lead a full life. They are not prohibited physical activity (there may be only some restrictions that prevent the occurrence of seizures).

The only thing that is recommended is to protect the patient from strong emotional shocks and heavy physical exertion.

Medicines for focal epilepsy

Since the treatment of focal epileptic seizures is impossible without the use of anticonvulsants, we will now talk about them.

"Karmazepin" - a popular anticonvulsant drug, which is used to treat epilepsy, ideopathic neuralgia, acute manic conditions, affective disorders, alcohol withdrawal, diabetic neuropathies, etc. The drug is named for the active substance, which is a derivative of dibenzazepine and has a normotonic, antimanic and antidiuretic effect. In the treatment of epilepsy, the anticonvulsant effect of a drug, which is available in the form of tablets and syrup, that can be used in the treatment of children, is valued.

In the case of monotherapy for children up to the age of 4, the dose is calculated from the formula 20-60 mg per kilogram of weight per day, depending on the severity of the symptoms. Every two days, the dose should be increased by 20-60 mg. The initial daily dose for babies over 4 years is 100 mg. Subsequently, every week it will have to be increased by 100 ml.

Children 4-5 years of age are prescribed 200-400 mg per day if you take a pill), children from 5 to 10 years should take 400-600 mg per day. Adolescents are prescribed from 600 mg to 1 g of the drug. The daily dose should be divided into 2-3 doses.

Adults prescribe the drug in a dosage of 100-200 mg once or twice a day. Gradually, the norm is increased to 1.2 g per day (maximum 2 g). The optimal dosage is established by the attending physician.

The drug is not prescribed for hypersensitivity to its components, disorders of bone hemopoiesis, acute porphyry, revealed during the study of anamnesis. It is dangerous to prescribe medication for AV blockade of the heart and parallel administration of MAO inhibitors.

Caution should be observed when prescribing a drug for patients with heart failure, hyponatrimony, impaired liver and kidney function, dysplastic processes in the prostate gland, increased intraocular pressure. It is also possible to include elderly people and those who suffer from alcoholism.

The drug may cause dizziness, drowsiness, ataxia, asthenic conditions, headaches, accommodation disorders, allergic reactions. Less common are hallucinations, anxiety and decreased appetite.

"Phenobarbital" - a drug with a hypnotic effect, also used in anticonvulsant therapy for epilepsy for the relief of generalized and focal seizures in patients of different ages.

Doses of the drug are set individually for the control of blood tests. Assign a minimally effective dosage.

Children prescribed a medicine at the rate of 3-4 mg of active ingredient per kilogram of weight, taking into account the increased metabolic rate in children and adolescents. For adults, the dosage is adjusted - 1-3 mg per kg of body weight, but not more than 500 mg per day. Take the medicine 1 to 3 times a day.

Dosage may be lower if you have to treat older people or patients with impaired renal function.

The drug is not prescribed for hypersensitivity to its components, porphyria, respiratory depression, severe liver and kidney pathologies, acute poisoning, including intoxication with alcohol, during pregnancy and lactation. Assign to patients older than 6 years.

Taking medication can be accompanied by dizziness, impaired coordination of movements, headaches, trembling in the hands, nausea, stool and vision disorders, lowering of blood pressure, allergic and other reactions.

"Konvuleks" is a drug based on valproic acid, which belongs to the category of antiepileptic drugs, since it has an anticonvulsant effect in various forms and forms of epilepsy, as well as in febrile seizures in children not associated with the disease. Produced in the form of syrup, tablets, drops for oral administration and solution for injection.

The dosage of the drug is determined depending on the age and body weight of the patient (from 150 to 2500 mg per day) with dose adjustment in elderly patients and having renal pathologies.

The drug can not be prescribed for hypersensitivity to its components, hepatitis, liver and pancreatic function disorders, porphyria, hemorrhagic diathesis, obvious thrombocytopenia, urea metabolism disorders, breastfeeding. Do not apply simultaneously with mefloquine, lamotrigine and preparations of St. John's Wort.

Caution should be observed when treating several drugs, during pregnancy, with organic brain lesions, before the age of 3 years. It is advisable to abstain from pregnancy, since there is a possibility of the birth of children with CNS pathologies.

Like previous preparations, "Convoolex" is well tolerated by patients. But such side effects are also possible: nausea, abdominal pain, appetite and stool disorders, dizziness, hand tremors, ataxia, visual disturbances, changes in blood composition, changes in body weight, allergic manifestations. Typically, such symptoms are observed if the level of active substance in the blood plasma exceeds 100 mg per liter or the therapy is carried out simultaneously by several drugs.

"Klobazam" - a tranquilizer with sedative and anticonvulsant action, appointed as part of a complex therapy for epilepsy. It is used to treat patients older than 3 years of age.

For adults, the drug in the form of tablets is prescribed in a daily dosage of 20 to 60 mg. The medicine can be taken alone (at night) or twice a day. Older patients require dose adjustment (not more than 20 mg per day). The pediatric dose is 2 times less than the adult dose and is set by the doctor depending on the condition of the patient and the drugs taken.

The drug is not prescribed for hypersensitivity to the drug, respiratory disorders (respiratory center depression), serious liver diseases, acute poisoning, in the first trimester of pregnancy, with drug dependence (revealed in the study of anamnesis). Do not appoint children under 6 months.

Caution should be observed with myasthenia gravis, ataxia, bronchial asthma, liver and kidney pathologies.

At the time of taking the drug, patients can feel tired, drowsy, dizzy, trembling fingers, nausea, and constipation. Sometimes there are allergic reactions. There is a possibility of bronchospasm. Severe reversible disorders of the functions of different organs are possible with prolonged administration of large doses of the drug.

In parallel with anticonvulsant drugs, you can take vitamins, phytonutrients, antioxidants - drugs that improve brain function and contribute to increasing the effectiveness of special treatment. Reduce the number of seizures and omega-3 fatty acids. But any medicine epileptic can take only after consulting a doctor.

Alternative treatment

It must be said that alternative medicine also succeeds in the treatment of focal epilepsy, considered an easier form of the disease. Alternative treatment not only does not interfere with medical therapy, but even enhances its effect and reduces the number of epicas. At the same time, recipes from various gifts of nature and herbal treatment can be used together.

For example, for the treatment of epilepsy in children, you can use apricot stones. It is necessary to choose not bitter specimens, to clean and give to the child in an amount corresponding to the number of full years of the child's life. Use bones recommended in the morning before eating. Treatment continues for a month, after which it is necessary to take a break of the same duration, observing whether seizures are repeated. If necessary, repeat the treatment.

If a patient suffers from night seizures, one can buy myrrh (myrrh) in the church and fumigate her premise before bedtime for at least one and a half months. This helps the patient to calm down and relax.

Also, you can take thrice a day, an infusion of valerian root, which must be grinded beforehand. 1 tbsp. Plant raw materials are poured 200-250 ml of cool water and aged for 8 hours. Adults are recommended to take 1 tablespoon. Infusion, for children - 1 tsp.

Epileptics are recommended herbal baths. To fill them, you can prepare an infusion of forest hay or a composition of pine buds, branches of aspen and willow, roots of ayr (chopped raw materials are poured with boiling water and insist). The bath should be taken no more than 20 minutes. The water temperature should not exceed 40 degrees.

With any kind of epilepsy, it is useful to add in the filling for pillows such dry herbs as mint, thyme, hops (cones), sweet clover, lovage, marigolds (flowers). The patient should sleep on such a pillow every night.

With alcoholic epilepsy, it is useful to take thrice daily the angelica powder (0.5 grams) purchased at the pharmacy and drink coffee made from peeled grains of rye, barley, oats, acorns with the addition of dandelion roots and chicory. All components are poured with boiling water and insist.

For the treatment of symptomatic focal epilepsy, in addition to the main treatment, you can try to stop seizures, applying the following recipe: take 3 tablespoons. Good black tea, dried camomile flowers and dried wormwood, brew 1 liter of boiling water and insist for at least 4 hours. Cooked infusion after percolation need to drink during the day. 3 monthly courses are necessary with an interval between them in 1 month.

Helps in the treatment of the disease and stone oil, containing a huge amount of substances beneficial to the human body. A stone oil in the amount of 3 g is recommended to dilute in 2 liters of water and take this medicine for a month three times a day before meals. Single dose - 1 glass. Carry out treatment regularly at least once a year.

Suitable for the treatment of epilepsy and alcohol tincture of the petals of the maria root. For 0.5 liters of good vodka you need to take three sols of vegetable spoons. The drug is administered for 3-4 weeks. Take it three times a day for 1 tsp.

Applying various alternative drugs should not be forgotten and about drug treatment. On the Internet, there are reports that the use of Doman's oxygen mask helped many people stop using drugs. This treatment option can also be considered, but if it does not bring the desired improvement, it is better to return to traditional treatment, backed up by alternative recipes.

[34], [35], [36], [37], [38], [39], [40], [41]

Homeopathy

Probably, adherents of alternative treatment will have to easier than fans of homeopathy. The fact is that in our country few of the homeopaths undertake to treat patients with diagnoses of generalized or focal epilepsy. Yes, and drugs that help with this pathology is not so much.

To improve the condition and work of the brain, you can take a homeopathic preparation Cerebrum compositum. But such treatment alone will not help get rid of the attacks of the disease.

Epileptic seizures at night and during menstruation, as well as seizures that increase in heat, are in the pathogenesis of the homeopathic drug Bufa wound, made from the poison of the toad.

For the treatment of nocturnal convulsive attacks, one can use Nux vomica. A beneficial effect on the nervous system is also provided by Kuprum, so it is also used to treat epilepsy, accompanied by convulsive attacks with a previous cry.

Applying homeopathic preparations (and they should be prescribed by a homeopathic physician) for the treatment of epilepsy, one must understand the principle of their action. Taking drugs first worsens the condition of patients. BUT this is a temporary situation, followed by a decrease in the number of seizures and a decrease in their intensity.

Prevention

As for the prevention of the disease, it all depends on the form of the disease. Prevent the symptomatic form of the disease will help timely treatment of the underlying disease, causing seizures, adequate nutrition, healthy and active lifestyle.

To prevent the appearance of an idiopathic form of the disease in a child, a future mother should stop smoking, drinking and drugs during pregnancy and on the eve of conception. This does not give an absolute guarantee that the child will not have such a deviation, but will reduce the likelihood of such an outcome. It is also recommended to provide the baby with adequate nutrition and rest, protect the head from overheating and injuries, contact the pediatrician in time when any unusual symptoms appear and do not panic if a seizure occurs that does not even always indicate a disease.

[42], [43], [44], [45]

Forecast

The prognosis of such a disease, as focal epilepsy entirely depends on the localization of the affected area and the etiology of the disease. Idiopathic forms of the disease are easily amenable to medical correction and do not cause difficulties in treatment. Intellectual and behavioral disorders in this case is not observed. In adolescence, seizures may simply disappear.

With appropriate treatment in half of patients, seizures gradually reduce to zero and another 35% note that the number of paroxysms has decreased markedly. Serious mental disorders are observed in only 10% of patients, while 70% of patients do not have intellectual disabilities. Surgical treatment guarantees almost one hundred percent relief from seizures in the near future or in a remote period.

With symptomatic epilepsy, the prognosis depends on the pathology that causes the appearance of epicasis. The easiest way to treat is frontal epilepsy, which has a softer course. The prognosis of treatment for alcoholic epilepsy has a strong dependence on whether a person can refuse to drink alcohol.

In general, the treatment of any form of epilepsy involves the rejection of beverages that excite the nervous system (alcohol and caffeine-containing fluids), the consumption of large amounts of pure water and foods rich in protein: nuts, chicken, fish, vitamin products and foods high in polyunsaturated fatty acids. It is not desirable for epileptics to work in the night shift.

The established diagnosis of focal or generalized epilepsy grants the patient the right to receive a disability. Any epileptic with episodes of moderate intensity can claim to receive the 3 group of disability, which does not limit his ability to work. If a person develops simple and complex seizures with loss of consciousness (with pathology with secondary generalization) and a decrease in mental ability, he can be given even 2 groups, because the employment opportunities in this case are limited.

Focal epilepsy is a disease that proceeds more easily than the generalized form of the disease, and nevertheless, epicas can somewhat reduce the patient's quality of life. The need to take medicines, seizures that present a danger of injury, possible complications and suspicious views (and sometimes stupid, tactless questions) of others who have witnessed an attack can affect the patient's attitude to himself and life in general. Therefore, much depends on relatives and friends of the epileptic, which can raise a person's confidence in their abilities and stimulate him to fight the disease. A person should not perceive the disease as a sentence. It is more a feature of a person and a test of his will and desire to live a healthy, fulfilling life.

[46], [47], [48], [49], [50], [51]