Lennox-Gasto syndrome

The Lennox-Gastaut syndrome is one of the forms of epilepsy. Let's consider features of a pathology, methods of diagnostics and treatment, and also the forecast on convalescence.

The generalized form of epilepsy arises from the CNS lesions during intrauterine development and the negative factors that arise during the birth process and after it. Neurological disorder is most often diagnosed in children from 1-5 years, as a rule, in boys. Very often it is the result of the transformation of childhood encephalopathy and Vest syndrome. Therefore, it refers to age-dependent and resistant to therapy forms of neuralgia.

For the disease is characterized by a combination of atonic and tonic seizures, delayed mental development and atypical absence. As the patient grows up, the nature of seizures also changes, secondary generalized and partial seizures appear. In most cases, the disorder has a poor prognosis, since it practically does not lend itself to complete cure.

Causes of the lennox-Gasto syndrome

What provokes the development of serious neurological disorders is still unknown. The causes of Lennox-gasto syndrome are associated with epileptic activity in the brain, the structure of the membrane of brain cells and their chemical characteristics. Due to extensive clinical manifestations, the disorder is difficult to reduce to one factor. So in 70% of cases the cause remains unset, despite a comprehensive neurological examination.

There are a number of factors that can provoke a generalized form of epilepsy:

• Anomalies in the development of the brain.
• Congenital pathological diseases of the central nervous system and brain.
• Premature birth and asphyxia during the birth process.
• CNS trauma in the perinatal period.
• Postponed severe infectious diseases (rubella, meningitis, encephalitis).
• Craniocerebral injuries and blood circulation disorders caused by them.
• Tumors and abscesses of the brain.
• Frequent psycho-emotional overstrain.
• Overwork and stress.
• Change in climatic conditions.

Depending on the age of the patient, the doctor may presume certain causes of LH syndrome. If the disease appeared before the age of 20, the cause is most likely related to brain damage during pregnancy or childbirth. If the seizures occurred after 25 years, they may be associated with brain tumors or impaired blood circulation. Consider the possible causes of the syndrome by age category:

Age	Cause
0-2 years	Hypoxia and ischemia in the perinatal period Birth injuries Metabolic and genetic disorders Idiopathic disorders Acute infection
2-12 years old	Craniocerebral trauma Infections
12-18 years old	Idiopathic disorders Various injuries Arteriovenous malformations The withdrawal syndrome with alcohol or strong drugs
18-35 years old	Injuries Tumors of the brain Alcoholism and drug addiction
> 35 years old	Tumors and vascular lesions of the brain Alcoholism Metabolic disorders Injuries

According to medical research, focal seizures are based on lesions of one or more areas of the brain, in contrast to generalized ones. But both types of violations require a thorough diagnostic examination.

[1], [2]

Pathogenesis

The determining factor in the development of the syndrome is diffuse encephalopathy in the brain. Pathogenesis is a clear mechanism of pathophysiological processes. The appearance of seizures is associated with the functioning of the frontal lobes of the brain, where a lot of biochemical reactions take place. The frequency and nature of epileptic seizures depends on their condition. Another factor is the age of the child, when it is reached, frontal lobes form and mature. This explains the coincidence of the period of the onset of the disease and the maturation of the frontal lobes.

According to the symptomatology and clinical course, the defect refers to the epileptic nature of encephalopathy. That is, this disease is considered a transitional form between epilepsy and complete epileptic status. In 30% of cases, the symptoms are not related to the existing pathologies of the brain, which may indicate an idiopathic nature of the disease. This requires differential diagnosis, as it can indicate serious damage to the central nervous system and brain. In other cases, these are symptomatic attacks caused by severe brain damage. Infringements can be caused by infectious diseases, traumas or heavy sorts.

At the beginning of the development of the syndrome, the patient is registered with focal signals in the brain, which indicate the involvement of subcortical structures in the pathological process. Significant importance is the brain's wave activity, as it negatively affects its functioning and causes cognitive impairment, which manifests itself as epileptic seizures.

[3], [4]

Symptoms of the lennox-Gasto syndrome

Neurological disorder most often develops in patients between the ages of 2-8 years of the male sex. Symptoms of Lennox-gasto syndrome are characterized by a sudden onset of seizures for no apparent reason.

The main signs of the disease:

• Slowed psychomotor development or lack of it
• Violations of intellectual development
• Behavioral disorders (hyperactivity, aggression)
• Previously, puberty and hypersexity
• Autism and antisocial traits
• Chronic psychosis

But in most cases, the disorder does not have pronounced neurological signs. The symptomatology depends on the localization and extent of the pathology. Most often, patients face motor symptoms, that is, spasms of different muscle groups. Attacks are short-lived and depend on the participating muscle tissue. Let's consider them in more detail:

• Tonic - the musculature of the trunk, neck and limbs are involved in the pathological process. This manifests itself as sharp torso, nodding, pushing the legs or stretching the arms. Seizures last from a few seconds to a minute, most often occur during sleep or waking.
• Atypical absences - are not accompanied by cramps, but they are characterized by loss of consciousness, half-open mouth, twitching of facial muscles, lips and eyelids. Appear very often, as a rule, during the waking period, that is, during the day. They last less than five seconds, so they are invisible to others.
• Epileptic seizures of falls - jerking, sharp lifting of the shoulders and throwing out hands, squats, torso of the trunk, falling forward. Attacks are fleeting, without disturbance of consciousness.

In addition to the above described seizures may occur: myoclonic (muscle and limb spasms) and generalized tonic-clonic. Polymorphism of symptoms is a distinctive feature of the Lennox-gasto syndrome. Each type of seizure has its own diagnostic picture.

[5]

First signs

The main symptom of the generalized form of epilepsy is cramps of a different nature. The first signs are manifested as short-term spasms of different parts of the body. For patients characterized by mental retardation, they later begin to write, read and speak. At an older age, mental retardation may be delayed. The state of stupor is characterized by a smooth transition to epilepsy, personality and cognitive disorders.

Attacks appear as involuntary jerks in the whole body or in the extremities, a sharp strain on the muscles of the trunk, arms or legs and their contraction. Particular danger is represented by falls caused by temporary loss of muscle tone. Most often, seizures occur at night. Most patients experience impulsivity, a lack of self-preservation instinct, and attention to themselves.

[6], [7]

Lennox-Gastaut syndrome in children

The first symptoms of Lennox-gasto syndrome in children appear in 1-2 years. The main clinical manifestation is cerebellar ataxia, disruption of coordination of movements and speech, intentional tremor. By the age of 10, patients lose the ability to move independently. Violation of the consistency of movements can be combined with diffuse muscular hypotension, eye movement disorders, and decreased tendon reflexes. At later stages, there is a violation of mental and intellectual development.

In children with a generalized form of epilepsy, seizures (atonic, absences and tonic) are different in frequency and appearance. The cause of the disease can be congenital anomalies in the development of the brain and CNS, trauma in the process of childbirth, brain tumors and other pathologies. Depending on the cause, these forms of the Lennox-Gastaut syndrome are distinguished:

• Secondary (classical) - occurs against the background of brain damage (birth trauma), diseases, tumors.
• Primary (idiopathic) - has no clearly established cause.

In the majority of patients of children's age, there are violations of intelligence and delay of psychomotor development. This is manifested as impaired behavior, impulsiveness, lack of self-preservation, autism, the need for increased attention. Because of the delay in development, the probability of normal intelligence is extremely small. The main problem is related to the lack of formation of skills and the complete or partial cessation of the assimilation of information. According to medical statistics, half of the patients do not have self-service skills, and a quarter of those who survive to adolescence face emotional and social problems.

Autism, hyperactivity, attention deficit, frequent mood changes, a tendency to aggression, problems with adaptation in a society can also arise. There is a definite relationship between the age of the child and the appearance of seizures. The earlier the syndrome began to manifest itself, the greater the decline in intelligence.

The disease is diagnosed based on an analysis of generalized seizures. The doctor's task is to correct and tonic seizures and identify atypical absences. The prognosis for children is heavy, but variable. Thus, complete relief of the disorder with the help of drug therapy occurs in 10-20% of cases. Myoclinic seizures without severe CNS and brain pathologies are amenable to therapy, in contrast to tonic seizures with a strong decrease in intelligence.

Lennox-Gastaut syndrome in adults

Involuntary flinches, loss of consciousness and periodic loss of muscle tone are symptoms indicative of Lennox-gasto syndrome. In adults, it can be caused by craniocerebral trauma, acute disorders of cerebral circulation or hemorrhages, various tumors, cysts, flocks and brain aneurysms. Meningitis, encephalitis and toxic brain damage due to drugs or alcohol can also provoke frustration.

In most cases, generalized epipriples are accompanied by a disturbance of consciousness, that is, the patient does not remember what happened to him. Attacks in adults are divided into several groups, depending on the symptomatology accompanying them:

• Absenses - a sudden loss of consciousness for 5-15 seconds. If other symptoms join the fainting (rolls the eye, supports the eyelids and the nose, lick lips, palpitations and breathing), then this is a complicated absence.
• Myoclonic - pronounced muscular contractions, twitchings, tilting of the head, falling to the knees.
• Tonic-clonic - tonic convulsions cause a fall, a convulsive contraction of the muscles of the larynx and masticatory muscles, an arching of the trunk. The seizure lasts from 15 seconds to 1-2 minutes.
• Tonic - muscular spasms from 5 to 30 seconds (extension of the neck, extremities and trunk).
• Astatic - sudden loss of muscle tone in any part of the body. This can manifest as a jaw drop, a drop in the head or a complete fall of the body, fading in one position for a couple of seconds.
• Clonic - occur extremely rarely, similar to tonic-clonic seizures, only flow without the first phase.

On this basis, the signs of Lennox-gasto syndrome in adults do not always appear as convulsions or loss of consciousness. If the seizures last longer than 30 minutes or seizures occur one after another, then this indicates a severe status epilepticus, which is life-threatening. The main danger of the disease is that neurons die during seizures. This can lead to an epileptic change in personality. Patients become aggressive, rude, pedantic, tactless, gloomy, emotional. In this case, there is a slowdown in thinking.

Neurological disorder in adults is incurable. But with the correct type of seizures and diagnosis, the pathology can be treated with medication. Regular use of antiepileptic drugs minimizes epileptic attacks, allowing you to return to normal life.

Complications and consequences

Lennox-gasto syndrome is a complex disease, a complete cure of which is impossible. The effects of pathology make themselves felt throughout life, even under the condition of drug-induced relief of seizures. Most often, patients face such problems:

• Mental Inferiority
• Violation of labor and social adaptation
• Intellectual and behavioral disorders
• Changes in the psyche
• Frequent injuries and accidents due to seizures
• Psychological problems

In most cases, the consequences are of a social nature. If a sick child in school has had an attack, then he can become an outcast among peers. Despite the fact that the disorder is not contagious, not all people respond normally to its manifestations. Under the restriction of physical activity. Exhausting physical activity can provoke an attack, causing trauma or more dangerous irreparable consequences.

Particular attention is paid to women with the syndrome who are planning a pregnancy. The gynecologist should know the diagnosis of the future mother at the stage of the child's planning in order to create all the conditions for the preservation of the fetus. Medical genetics consultation is mandatory. The consequences of a neurological disorder cause a number of difficulties in daily life, but with the observance of medical recommendations and drug therapy it is possible to improve the patient's condition.

[8], [9]

Complications

If the disease was detected in childhood, then as the child grows up, the symptoms of the syndrome not only persist, but without the right treatment begin to progress. Complications are associated with a persistent decline in intelligence, periodic seizures and loss of ability to self-service.

Consider the main complications of the generalized form of epilepsy:

• Epileptic status - between seizures is short time, there are many different violations in the work of internal organs. Most complications affect the cardiovascular and respiratory system, which can cause death.
• Injuries - during an attack the muscles involuntarily strain or relax, which leads to falls and traumatization. A sharp fall is the risk of fracture of the limbs or compression fracture of the spine. Because of seizures, lesions are found on the tongue and cheeks, as during the fit the patient is able to bite them.
• Mental disorders - patients often live in a state of depression, asocial and in isolation from society.
• Neurogenic pulmonary edema - the pathological functioning of the nervous system causes an increase in blood pressure. Edema develops due to increased pressure in the left atrium and oxygen starvation.
• Sudden death - death can occur during an attack accompanied by extensive seizures.
• The syndrome is especially dangerous for pregnant women, since his attacks can lead to premature birth or miscarriage. In addition, the use of anticonvulsants during the period of gestation threatens the development of congenital malformations in the child.

In addition to the above complications, problems can occur with the use of antiepileptic drugs. This is encountered by 7-25% of patients of different ages. Most often these are toxic complications (constipation, low body temperature and muscle tone), allergic reactions (shortness of breath, urticaria, fatigue, dermatitis) and metabolic complications (sleep disorders, irritability and nervousness, apathy).

The main goal of a doctor-appointed treatment is to improve the patient's quality of life and minimize the occurrence of seizures. Refusal of treatment or independent change of the appointed or nominated scheme or plan of therapy leads to that the syndrome lennoksa-gasto it is transformed in more serious form of an epilepsy.

[10], [11]

Diagnostics of the lennox-Gasto syndrome

If the various neurological symptoms make themselves felt for a long period of time, then it is worthwhile to see a doctor, as this may indicate signs of serious pathology. Diagnosis of Lennox-gasto syndrome is based on clinical manifestations of the disease and the collection of anamnesis. It consists of:

1. Collection of anamnesis and analysis of complaints:

• When the symptoms of the syndrome first appeared.
• How the delivery took place, whether they were difficult, prolonged or traumatic.
• Is there a hereditary predisposition.
• Correspondence of the level to the development of age.

2. Neurological examination:

• Presence of CNS pathologies outside the attack.
• Questioning to determine the level of mental development.

3. Instrumental and laboratory diagnostics

• Analyzes
• Electroencephalography.
• CT scan.
• Magnetic resonance imaging.

The consultation with the epileptologist is mandatory. The doctor pays attention to the presence of generalized seizures, identifies tonic seizures and atypical absences. The examination is carried out during waking and sleeping. This allows us to identify cognitive impairments in the functioning of the brain.

[12]

Analyzes

If you suspect a neurological disorder, you need to undergo a series of diagnostic procedures. Analyzes are included in this complex and are:

• Biochemical and general blood test
• Study of blood sugar level
• Spinal puncture
• Analyzes for infectious diseases
• Functional tests of the liver and kidneys

Using a standard blood test, it is possible to determine whether seizures are associated with hypoglycemia, hyper / hypocalcemia, or hyper / hyponatremia. If biochemical disorders are detected, their correction will be assigned. Analyzes allow us to establish less common causes of the disease, for example: thyrotoxicosis, intoxication with lead or arsenic, intermittent porphyria.

Symptoms of Lennox-gasto syndrome in elderly patients may indicate an acute impairment of cerebral circulation or act as a consequence of a heart attack. Therefore, laboratory diagnostics will be aimed at confirming these assumptions. If generalized tonic-clonic seizures occur in patients without deviations from the CNS, this may indicate sleep deprivation. This is found in students, people working in the night shift, the military. If the analyzes did not reveal any deviations after a single seizure, further treatment is not required.

If there are no pathologies after the whole complex of tests, then most likely the seizures are idiopathic. A similar diagnosis is made with multiple attacks, which can be associated with severe CNS lesions or tumors in the brain.

[13], [14], [15], [16], [17]

Instrumental diagnostics

The examination with suspicion of a generalized form of epilepsy consists of a set of different procedures. Instrumental diagnosis is necessary to confirm the results of analyzes and other types of research. It is represented by such methods:

1. Electroencephalography is the recording of brain activity, that is, the measurement of brain waves. It is carried out in a state of sleep and wakefulness in order to track the frequency of occurrence of seizures. In the Lennox-gasto syndrome, diffuse slow acute waves are observed.
   • Interictal EEG - reveals convulsive activity. This manifests itself as a slowing of the background activity, complexes of spike waves with a frequency of <2.5 Hz, and paroxysms of fast rhythms.
   • Ectal EEG - depends on the type of seizures. Tonic manifestation as paroxysms of fast activity> 2 Hz, atypical absences - slow spike waves with a frequency <2.5 Hz, myoclonic - polyspikes, and atonic - fast action paroxysms, adhesions (slow, waves).
2. Videoelectroencephalography - is performed in a hospital environment, as the patient must be under constant video surveillance by a doctor. It is prescribed for both primary diagnosis and after ineffective therapy.
3. Computer tomography - brain scan refers to the methods of visualization. Determines the presence of pathological changes, makes it possible to examine the condition of soft tissues and bone structures in real time.
4. Magnetic resonance imaging - this method is prescribed to patients with uncaused seizures, significant mental or motor problems. Using MRI, you can determine the need for surgical treatment.

In addition to the above-described instrumental methods, positron emission tomography can be used in the diagnostics process. It detects scars and lesions in the brain in areas where seizures occur. Single-photon emission computed tomography is performed when surgical intervention is necessary. With her help, the doctor determines which part of the brain is to be removed. Both methods are done together with MRI.

Differential diagnosis

Any neurological disorder requires a comprehensive diagnostic approach. This is because many pathologies have similar symptoms. Differential diagnosis of Lennox-gasto syndrome is carried out with:

• Non-epileptic events.
• Epileptic encephalopathy.
• Epilepsy with myoclonic-astatic seizures.
• Recklinghausen's disease.
• Neurofibromatosis.
• The Louis-Bar syndrome.
• Tuberous sclerosis.

The task of doctors to exclude any conditions that cause generalized epileptic attacks, and this can be:

• Migraine - severe headaches with increased anxiety and cramps by mistake can be confused with neurology.
• Fainting is a short-term loss of consciousness, during which the flow of blood to the brain decreases. Very often, it is incorrectly diagnosed and taken for an attack of epilepsy, despite the fact that patients do not have rhythmic contractions and muscle relaxation.
• Panic state - partial seizures in some cases may resemble panic disorder. His symptoms include: rapid heartbeat, excessive sweating, choking, chest pains, chills, trembling, fear of death.
• Sleep disorders - narcolepsy is accompanied by a sudden loss of muscle tone and increased daytime sleepiness, so it can be mistaken for symptoms of the syndrome.

Based on the results of diagnostic activities, the doctor chooses the most effective and safe method of treatment.

Treatment of the lennox-Gasto syndrome

The main problem faced by doctors in the treatment of Lennox-gasto syndrome is its resistance to any kind of therapy. Therefore, even with timely diagnostics and properly designed scheme, the forecast remains serious. But thanks to a comprehensive approach, the patient's condition can be improved. To do this, use the following methods:

• Surgery - surgery is aimed at removing a tumor or tuberous sclerosis, that is, an organic substrate of pathology. In some cases, a corpus callosum is used and vagal nerve stimulation is used.
• Drug therapy - the patient is prescribed a series of anticonvulsants with a wide spectrum of action. At first, monotherapy with a gradual connection of other drugs is effective. If there are improvements, then drugs that are effective against certain types of seizures are added to stop the pathological symptoms. It is mandatory to take funds to improve metabolic processes in the brain.
• Physiotherapy is massages, physiotherapy exercises, acupuncture and other procedures that are aimed at preventing the onset of the syndrome and minimizing their pathological effects on the body. To correct development delays, regular sessions are held with a psychologist, teachers and speech therapist.

But even the application of the complex described above does not guarantee an improvement in the patient's condition, which is observed in 14% of cases. According to medical statistics, about 10% of children die within the first 10 years of life. In 100% of cases, a different degree of impairment of behavior and intelligence is diagnosed.

In addition to the above methods, there are a number of experimental methods for treating the generalized form of epilepsy:

• Deep stimulation of the brain - the generation of impulses is directed to the part of the brain that produces epileptic seizures. The results of the method showed a positive outcome.
• Neuroimplantation - the brain is implanted with stimulating devices that detect seizures through electric stimulation of the brain and stop them. According to this technique, stimulation of trigeminal nerves involved in the suppression of convulsive seizures has been developed.
• Stereotactic radiosurgery - with the help of focused radiation beams, lesions are removed in the depth of the brain. This method allows you to abandon open surgery, minimizing the trauma of the patient.

Particular attention is paid to the relief of seizures, which are accompanied by falls. Because this aggravates the degree of epileptic encephalopathy. As the patient grows up, the main directions of treatment remain unchanged, only the need to use drugs that reduce the side effects of the syndrome increases. In this case, complete control of seizures is unlikely.

Medicinal treatment

Treatment of Lennox-gasto syndrome requires mandatory medication for patients of all ages. Medicines are selected by a doctor based on the results of the diagnosis. When choosing medicines take into account the type of seizures, their duration and other features of the disease. The basic drugs are derivatives of valproic acid. In addition, they may be prescribed: benzodiazepines, succinimides and other agents. If there is absolute resistance to the above drugs, then hormonal therapy is carried out in combination with anticonvulsants.

Consider the popular antiepileptic drugs:

1. Valproate sodium

Anticonvulsant in the form of tablets 300/500 mg. The active substance is sodium valproate, auxiliary: hypromellose, copolyvidone, magnesium stearate, titanium dioxide, opadrai and others. The mechanism of action is associated with an increase in the concentration of the inhibitory neurotransmitter GABA in the central nervous system. Active components affect the potassium and sodium channels of neuronal membranes.

After oral administration, it is quickly and completely absorbed in the small intestine. About 95% of sodium valproate binds to blood proteins and is distributed throughout the body. Metabolized in the liver, excreted in the form of metabolites with urine. Half-life of 12-16 hours.

• Indications for use: generalized epileptic seizures, absences, tonic-clonic seizures, atonic and myoclonic seizures. Tablets can be used as an auxiliary therapy for focal and partial attacks.
• The method of administration and dose depend on the clinical response to the drug and the symptoms of the syndrome. At the initial stage of therapy, a minimum dosage is indicated to control seizures. Adults appoint 600 mg per day with a gradual increase in dose every 5-7 days until the complete cessation of seizures. The maintenance dose is 1000-2000 mg per day, the maximum daily dose is 2500 mg. The dose for children and elderly patients is calculated by the doctor for each patient individually.
• Adverse reactions are temporary and dose-dependent. Most often, patients complain of headaches and dizziness, nausea, gastrointestinal irritations, metabolic disorders. Possible reactions from the hematopoietic and cardiovascular system, for their elimination, you need to see a doctor.
• The drug is contraindicated for the individual intolerance of sodium valproate and other components. It is not used for chronic and acute hepatitis, severe renal and pancreatic dysfunction, with porphyria and a tendency to bleeding.
• When an overdose appears such symptoms: nausea, vomiting, respiratory depression, headaches and dizziness. There may be bouts of drowsiness, tachycardia, increased intracranial pressure and convulsions. There is no specific antidote, therefore symptomatic therapy is indicated.

2. Depakin

An anticonvulsant drug acting on the central nervous system. Produced in the form of tablets with the active substance valproic acid. Effective in the treatment of various forms of epilepsy, including Lennox-gasto syndrome. Has sedative and miorelaksiruyuschimi properties, increases the level of gamma-aminobutyric acid in the central nervous system. This leads to a decrease in excitability and convulsive activity of motor sites of the cerebral cortex. Tablets improve mood and have antiarrhythmic action.

• Indications for use: generalized and small epipriplets, focal partial seizures with simple and complex symptoms. Convulsive syndrome with organic brain diseases and behavioral disorders, teak, fibrillation convulsions. It can be used for manic-depressive psychosis, bipolar disorder and Vest syndrome.
• Tablets are taken orally, 2-3 times a day, washed down with water. Dosage is selected by the doctor for each patient individually, with the body weight of the patient should be more than 25 kg. For adults and adolescents appoint 20-30 mg / kg, with a gradual increase to 200 mg per day with a break of 3-4 days.
• Side effects: nausea, vomiting, aching epigastric pain, upset stomach and pancreas, allergic reactions, headaches, limb tremor, visual disturbances. To eliminate the above reactions it is recommended to reduce the dosage of the drug and consult a doctor.
• Contraindicated to use with increased sensitivity to the components of the drug, acute / chronic hepatitis, violations of the pancreas, liver failure. It is not prescribed for patients with hemorrhagic diathesis, thrombocytopenia, in the first trimester of pregnancy and during lactation, and also for children under three years of age. With special care is used in leukopenia, anemia, mental retardation, thrombocytopenia and organic lesions of the central nervous system. Depakin is prohibited during pregnancy, as in 2% of cases it can provoke congenital malformations in the fetus (developmental disorders of the neural tube, spina bifida).
• In case of an overdose, it is possible to have a coma, a sharp decrease in blood pressure, a violation of respiratory functions. To eliminate these symptoms, gastric lavage and osmotic diuresis are performed. You also need to monitor your blood pressure, heart rate and breathing. If necessary, hemodialysis is performed.

3. Carbamazepine

Antiepileptic, normotime and antidepressant. Produced in the form of tablets of 200 mg of 30 and 100 pieces per package.

• Indications for use: psychomotor epilepsy, severe seizures, posttraumatic and postencephalitic attacks, neuralgia of the trigeminal nerve. It is contraindicated to use in liver lesions and cardiac conduction disorders.
• Tablets are taken orally at the dosage prescribed by a doctor. For adult patients, as a rule, appoint 100 mg 2-3 times a day with a gradual increase in dosage to 800-1200 mg per day. The daily dose for children is calculated at 20 mg / kg, that is, from 100 to 600 mg per day, depending on the age.
• Side effects are rare, as the drug is well tolerated. In rare cases, there are bouts of nausea, vomiting, loss of appetite, headaches, impaired coordination of movements and drowsiness. To reduce unwanted reactions, it is necessary to reduce the dosage of the drug.

4. Phenobarbital

An antiepileptic drug. Very often it is used as a sleeping pill, since in small doses it has a calming effect. Produced in the form of tablets and powder, suitable for the treatment of children and adults.

• Indications for use: generalized tonic-clonic seizures, pathologies of the nervous system with motor excitations and uncoordinated movements, convulsive reactions, spastic paralysis. In combination with vasodilator and antispasmodic drugs can be used as a sedative or hypnotic in neurovegetative disorders.
• Treatment of Lennox-gasto syndrome is long, the drug is taken with a minimum dosage of 50 mg 2 times a day and gradually increased to 500 mg per day. Dosage for children is calculated according to the age of the patient. The withdrawal of the drug should occur gradually, since a sudden withdrawal can cause a number of epileptic seizures.
• Side effects: lowering blood pressure, skin allergic reactions, CNS depression, shifts in the blood formula.
• Contraindicated to use in severe kidney and liver damage, alcohol and drug dependence, muscle weakness. It is not prescribed for treatment in the first trimester of pregnancy and during lactation.

5. Oxcarbazepine

Antiepileptic drug, whose action is based on the stabilization of membranes of overexcited neurons. Inhibits serial discharges of neurons, reducing synaptic impulses.

• Indications for use: monotherapy and combined treatment of generalized epileptic seizures with loss or loss of consciousness, secondary generalization, tonic-clonic seizures.
• Dosage and duration of use depend on the symptomatology of the neurological disorder and medical indications. With monotherapy, the drug is taken 2 times a day, gradually increasing the dosage. The withdrawal of the medicine should be gradual in order to prevent the occurrence of adverse reactions. Adults appoint 600 mg per day for 2 divided doses, for children 3-5 mg / kg. As part of the combined treatment, the initial dose of 300 mg 2 times a day.
• Contraindicated to use in hypersensitivity to active ingredients, during pregnancy and lactation, for the treatment of children younger than two years.
• Side effects are manifested by such symptoms: drowsiness, headaches, dizziness, nausea, increased fatigue, vomiting, nausea, decreased appetite, tremor. In case of an overdose, the same symptoms appear. Symptomatic and maintenance therapy is indicated for its elimination. There is no specific antidote.

Most antiepileptic drugs used in the Lennox-gasto syndrome are prescribed simultaneously with other drugs of antispasmodic or soothing effect. If the patient responds well to medications and there are improvements in his condition, then they can be completely abandoned after 5-10 years, provided that the seizures do not make themselves felt during the last two years.

Vitamins

With any neurological disease, the body experiences severe stress and deficiency of nutrients. Vitamins in Lennox-gasto syndrome and other forms of epilepsy are necessary to maintain and strengthen the immune system. Vitamins and minerals are substances necessary for normal vital activity. They need to be taken only under medical supervision, since instead of the expected benefit, one can aggravate the course of the disease.

The need for vitamins is due to the fact that some pathologies transmitted by inheritance can provoke epi-seizures. For example, with a deficiency and a violation of the metabolism of vitamin B6, seizures may occur in early childhood. In addition, the continued use of various antiepileptic medicines affects the level of vitamin B, C, D and E in the blood, as well as folic acid, beta-carotene. The lack of these substances can provoke behavioral disorders.

Consider what vitamins should be used in the treatment of generalized form of epilepsy:

• B1 (thiamine)

Once ingested, it is transformed into an enzyme called thiamine pyrophosphate, which is necessary for the normal functioning of the nervous system. Provides the brain and the entire nervous system with nutrients, regulates the water-salt balance and is responsible for the hormonal regulation of nerve tissues. The main feature of this enzyme is that it utilizes lactic and pyruvic acid. If the process of utilization is insufficient, the nervous system does not receive a hormone, acetylcholine, which, together with norepinephrine, regulates the work of nerve cells throughout the body.

It is found in such products: beans, green vegetables, bread, cereals, nuts, berries, fruits, algae, spicy herbs, root vegetables, meat, dairy products. That is, to make a diet in which B1 is not very difficult. Because it is quickly consumed it must be constantly replenished. In addition, it is necessary to improve the absorption of vitamin B5.

• B2 (riboflavin, lactoflavin)

Water-soluble vitamin, is necessary for the formation of antibodies and erythrocytes, regulation of growth and normal functioning of reproductive functions. Responsible for the health of nails, hair and skin. Deficiency of this substance is negatively reflected on the state of tissues rich in blood vessels and capillaries, for example, brain tissue. Can provoke cerebral insufficiency of varying severity, general weakness, dizziness, increased tendon and muscle reflexes.

B2 is found in such products: by-products (liver, kidneys), egg white, fish, cheese, ceps, cottage cheese, buckwheat, milk, meat, legumes, leafy greens and vegetables. The body does not store this substance in reserve, so its excess is excreted in the urine. Regular consumption of the foods described above will help normalize the level of B2 in the body.

• B5 (pantothenic acid)

Responsible for the exchange of fats, amino acids and carbohydrates, synthesizes vital fatty acids. Getting into the body is transformed into pantetine, which is part of coenzyme A, which is responsible for acetylation and oxidation. B5 is required for the absorption and metabolism of vitamin B9. The lack of this substance is manifested by such symptoms: irritability, sleep disorder, fatigue, head and muscle pains, numbness of the extremities, dyspepsia.

The need for an organism in this vitamin is completely satisfied with normal nutrition, since B5 is found in products of plant and animal origin: buckwheat, oatmeal, peas, garlic, egg yolk, greens, bread with bran, cauliflower, carrots. In addition, it is synthesized by intestinal flora.

• B6 (pyridoxine, pyridoxal, pyridoxamine, pyridoxal phosphate)

Takes part in the formation of red blood cells and the process of assimilation of glucose by nerve cells. Participates in protein metabolism of amino acids. Deficiency of B6 causes seizures, irritability, increased anxiety, dermatitis and other skin reactions, a depressive condition. Many patients experience decreased appetite, frequent attacks of nausea and vomiting, polyneuritis.

High content of B6 is found in unrefined grains of cereals, leafy greens, yeast, wheat, rice and buckwheat groats, in legumes, carrots, bananas, fish, cod liver and cattle and other by-products. And also in egg yolks, cabbage and walnuts.

• B7 (biotin, vitamin H, coenzyme R)

It improves the functioning of the nervous system, participates in the decomposition of fatty acids and fat burning. Lack of vitamin causes such symptoms: nervousness, various skin rashes, drowsiness, lethargy, irritability, increased sugar and cholesterol in the blood. The substance is contained in yeast, tomato, soy, egg yolk, milk, cauliflower and mushrooms.

• C (ascorbic acid)

It is necessary to strengthen the body with prolonged use of antiepileptic drugs, which are metabolized in the liver. Contained in citrus fruits and vegetables. Vitamin is rich in wild rose, red pepper, kiwi, black currant, tomatoes, onions.

• E (tocopherol)

Reduces the frequency of epileptic seizures in patients of all ages. Rejuvenates the body, activates the processes of tissue respiration, reduces blood clotting, improves microcirculation and prevents blood congestion. It makes the walls of the blood vessels smooth, protecting them from the deposition of cholesterol plaques. Contained in vegetable oils, sprouted grains of wheat and corn, beans, pearl barley, oatmeal, buckwheat, eggs, seafood and fish.

Uncontrolled use of vitamins in Lennox-gasto syndrome is also dangerous, as is their deficiency. Any vitamin complexes are taken under strict medical supervision. This is due to the fact that some vitamins can reduce the effectiveness of antiepileptic drugs.

Physiotherapeutic treatment

To prevent and prevent neurological disorders, physiotherapy is indicated. Its essence lies in the impact on the body of various physical factors: electromagnetic fields, water, temperature, ultrasound, etc. Physiotherapy is rightfully considered to be the oldest direction of medicine, which is constantly being improved and developing. The advantage of this method is that it has a minimum of contraindications, it is safe and rarely causes side reactions.

Physiotherapy is used as an additional method of treatment. Independently it can be used at the initial stages of the disease, but in most cases it is carried out in combination with medicinal methods and means.

In the Lennox-gasto syndrome, such physiotherapy is carried out:

• Acupuncture
• Hydrotherapy (massage shower, hydrogen sulphide, carbon dioxide and radon baths)
• Electrophoresis with medicinal products
• Hyperbaric oxygenation (oxygen under high pressure)
• Ultrahigh-frequency therapy
• Inductothermy
• Regional Barotherapy

The main principle is a course treatment, as single procedures do not have a lasting effect. Physiotherapy is performed daily or after 2-3 days, the course of treatment takes from 6 to 20 days. This provides a comprehensive approach to the disease, since many of the body systems that require support and stimulation are involved in the pathological process.

Despite the positive effect of physiotherapy, the method has contraindications: malignant neoplasms, stage 3 hypertension, cerebral arteriosclerosis, diseases of the hematopoietic system, severe depletion of the body, fever, psychoses, epilepsy with frequent seizures. The effectiveness of physiotherapy treatment is much higher if before this was the course of drug therapy, which stopped the attacks.

Alternative treatment

The generalized epipriplets accompanying the Lennox-gasto syndrome appeared in humans even before the development of modern medicine and the description of this pathology. To eliminate them, various methods were used, but a special advantage was given to alternative treatment.

Consider effective recipes for alternative medicine:

• An excellent prevention of seizures of any severity is the juice of onions. Eating a day ½ of a bulb can ease attacks, make it so that they are repeated less often.
• Spinach juice has a similar effect. A bunch of fresh leaves thoroughly rinse and grind in a blender. During the day, you need to drink 100 ml of juice before each before eating. The juice must be freshly prepared.
• 100 g of sleep-grass roots (meadow chamber), pour 500 ml of alcohol and let it brew in a dark cool place for 10 days. After this, strain and take ½ cup (diluted with water) 3 times a day for an hour before meals. This recipe is contraindicated in chronic kidney disease. Also, it is not recommended to change the proportions of the ingredients, since the plant is poisonous and can cause side reactions.
• Antiepileptic properties have juice from the roots and leaves of a dandelion. Rinse fresh leaves and roots of the plant under cold water, cut into small pieces and boil with boiling water. Raw materials must be ground in a blender or through a meat grinder. The resulting plant liquid should be filtered through gauze, diluted 1: 1 with water and boiled for 3-5 minutes on low heat. Take the medicine for 1-3 tablespoons 2-3 times a day for 20 minutes before meals. The drug can be stored in the refrigerator, but no longer than three days.
• 30 g of ground peony roots, pour 750 ml of boiling water and let it brew in a sealed container for 1-1.5 hours. After this, the infusion should be filtered and taken 50 ml before meals 2-3 times a day.

Use any recipes of alternative treatment without medical permission is contraindicated. In addition, it is worth paying attention to the fact that vegetable decoctions and infusions can increase the acidity of gastric juice and lower the pressure. Therefore, during their use, you need to carefully plan your diet.

[18], [19], [20]

Herbal Treatment

Many drugs contain plant components, since they have a minimum of contraindications and side effects, effectively fight with various diseases. Herbal treatment refers to methods of alternative medicine and allows the full use of the value of plants.

Recipes of herbal therapy in the syndrome of generalized epipriplets:

• 30 g grass ruta fill with 250 ml of boiling water and let it brew for 1-2 hours, strain. Take 30 ml 2-3 times a day.
• 100 g of dried herb wormwood pour 350 ml of boiling water and let it sit for 3-4 hours in a sealed container, strain. Take 150 ml 2 times a day before meals.
• To reduce the frequency of seizures, strengthen and tonify the body, an infusion of 100 g of juice of green tops of sowing oats will suit. The medicine is taken 2-3 times a day before meals.
• Take in equal proportions cones of hop, peppermint, lemon balm, sweet clover grass, fragrant ashberry and root elecampane. Collection should be well mixed, for 30 g of collection use 250 ml of boiling water and insist until cooled. Take 2 times a day, regardless of food intake.
• Take in equal proportions the flowers of calendula and chamomile, valerian root, rose hips and mountain ash. 50 g of the mixture, pour 250 ml of boiling water and cook over low heat for 5 minutes. The medicine should be infused for 20-30 minutes, after which it is filtered and taken for ½ cup 3-4 times a day.

The above recipes can only be used after the permission of the attending physician. Their independent use can cause a number of uncontrolled adverse reactions.

Homeopathy

Many different methods are used to treat neurological disorders. Homeopathy belongs to the category of alternative therapies, since not all doctors agree with its effectiveness and safety of use. But, nevertheless, there are a number of drugs that can help with the pathology of Lennox-gasto.

Most often for the relief of epipriplets, such substances are used:

• Arnica 3x
• Argentum metalcum and nitrikum 6
• Hyoscyamus 3
• Kalium bro-matum b
• Kuprum Metallicum 6
• Sili-tsea 6
• Sulfur 6
• Platinum 6
• Nux vomica 6

They are taken on 8 peas 4-5 times a day throughout the year. The above complex helps to relieve seizures and reduce the frequency of their appearance. In addition, there are more effective collections, for example, a complex developed by the homeopath Voronsky:

First day

• In the morning before meals: argentum nitrikum 12, viper 12 for 8-10 peas.
• Ignacy 30, kuprum metallukum 30, nayya 12, kuprum atseti-kum 6 for 8-10 peas.
• Veratrum album 3, cicuta virosa 3, artemisia 3, cactus Zx for 8-10 peas 2-3 times a day.
• Viper 12 for 5-8 peas before bedtime.

Second day

• Before breakfast: argentum nitrikum 12, magnesium phosphoricum 3 to 8-10 granules.
• Belladonna 6, agaricus 6, ignation 3 (30), colocyntitis Zx - 8-10 peas.
• Hyoscyamus 3x, arnica 2, absinthium feta 3x, valerian feta 2x - 8-10 granules.
• Before going to bed - magnesium phosphoricum 3 for 7-8 peas.

The third day

• In the morning before meals: argentum nitrikum 12, zincum metalcum 3 - 8-10 grains
• Arsenicum 30, phosphorus 30, aurum bromatum 30, zincum cyanatum 30 - 8-10 grains.
• Calcium phosphoricum 6, curare 6, potassium phosphoricum 6, piperite menta 3x - 8-10 granules.
• In the evening before going to bed: zincum metalcum 3 for 7-8 peas.

The duration of the course is determined by the doctor, individually for each patient. But, as a rule, to permanently eliminate seizures make 3-4 cycles with a 1-2 day break.

Operative treatment

Surgical treatment of the generalized form of epilepsy is possible in the case when the results of the diagnosis show that seizures appear on small, clearly defined areas of the brain. In this case, the affected areas do not violate vital functions, that is, they do not affect speech, hearing, vision and other. Operative treatment is performed in 20% of patients with different forms of epilepsy. Its main goal is to improve the quality of life and minimize the number of seizures.

Indication for the operation:

• Attacks of an atonic character, sudden falls without seizures.
• Partial seizures with secondary generalization and loss of consciousness.
• Partial seizures with conserved consciousness.
• Progressive sclerosis of the hippocampus of the temporal lobe.

The process of pre-operational planning and the surgical methods themselves are improved every day. The operation becomes as safe as possible thanks to the methods of visualization and monitoring of the entire process. Before treatment, the patient is subjected to a series of diagnostic studies to determine whether surgery is necessary. The main ones are:

• MRI - identifies the pathological areas of the brain tissue on which seizures occur.
• Video EEG monitoring - monitoring a patient in a hospital with a permanent fixation of brain activity.
• Monitoring of outpatient EEG - studying the state of the brain and the central nervous system in the daily life of the patient.

These tests can accurately determine the affected tissue. If, according to their results, it is revealed that pathological activity seizes several sites, then more invasive methods of monitoring are used.

Types of operations:

• Resection of the temporal lobe - during the procedure the epileptogenic focus is excised or removed. Most often it is in the front or ophthalmic department. If you want to remove the brain tissue behind the temporal lobe, then an extra-temporal resection is performed.
• Lesionectomy - this method is aimed at eliminating isolated lesions, that is, traumatized areas or areas with pathologies. These can be tumors or malformations of blood vessels.
• Callosotomy of the corpus callosum is a partial or complete removal of neural connections between the hemispheres to prevent the spread of tumors that cause the syndrome. The operation is performed on patients with severe, uncontrolled forms of epilepsy, which are accompanied by atonic attacks.
• Functional hemisferectomy is the complete removal of one hemisphere of the brain. Most often it is carried out for children under 13 years old, in which one of the hemispheres has abnormal functioning.
• Stimulation of the vagus nerve - under the skin implant an electronic device that stimulates the vagus nerve, which is responsible for the connection between the brain and internal organs. After such an operation, convulsive activity is significantly reduced.
• Multiple subpial dissections - removal of pathological foci, which can not be removed without significant neurological risk. The doctor makes many transections in the tissues to prevent the spread of epileptic impulses. This method allows you to maintain the normal functioning of the brain.
• Implantation of the neurostimulator (RNS) - under the skin in the area of the skull implant neurostimulator. The device is connected to a pair of electrodes located on brain tissues that respond to attacks. The neurostimulator tracks pathological activity and stimulates the brain, normalizing its functioning and preventing an attack.

Depending on the type of operation chosen, its effectiveness is estimated at 50-80%. Attacks completely disappear in some patients; in others, they become less pronounced and less frequent. But regardless of the results of surgery, the patient still needs to take prescribed medications, but with reduced dosage.

Like any operation, surgical treatment of Lennox-gasto syndrome is associated with certain risks. First of all, these are postoperative infections, bleeding or reactions to the drugs used, anesthesia. There is a risk of neurological disorders, that is, loss of vision, memory, motor activity. Do not forget that even a carefully planned and successfully performed operation can not guarantee recovery.

Prevention

The principles of prevention of Lennox-gasto syndrome have not been developed, since pathology has unpredictable causes (traumas, tumors, meningitis) that cause it. Prevention is aimed at alleviating the patient's condition and improving the quality of his life.

Preventive actions:

• A full night's rest - a bad or fragmentary sleep can cause seizures. It is very important to regulate sleep and wakefulness.
• Nutrition - various food allergies cause not only seizures, but also headaches, discomfort in the digestive tract, migraines. Carefully follow the diet and carefully choose foods rich in vitamins and minerals.
• Harmful habits - alcohol, smoking and drug addiction are contraindicated for people with epileptic attacks of any severity, since they can provoke them.
• Relaxation and physical health - meditation and deep breathing reduce seizures and relieve anxiety. Regular exercise increases the tone and improves overall well-being.
• Emotional and psychological background - many patients and their relatives need professional psychological support. This will normalize relations, learn to take the disease and fight its manifestations.

In addition to the above recommendations, it is necessary to strictly follow the medication prescribed by the doctor, since the course of the illness depends on it. Categorically it is contraindicated to adjust the dosage yourself or take any medications. It is also recommended to wear a special medical bracelet. This will help doctors and others to orient themselves, if medical care is required. The patient must be attached to active social life. Since uncontrolled cramps affect life, causing bouts of apathy and depression.

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Forecast

The disease has a poor prognosis and almost does not lend itself to drug therapy. About 10% of cases result in death of patients during the first ten years of life. In 80-90% of seizures continue and at an older age. Unfavorable in terms of prognosis criteria, such factors are: high frequency of paroxysms, convulsive syndrome against the background of mental retardation, detection of pathology in early childhood.

Lennox-gasto syndrome is a serious diagnosis, the high lethality of which is associated with traumatization during seizures with falls. At the same time, 95% of patients have serious mental and neurological abnormalities, various degrees of mental retardation, 40% lack the ability to self-service.

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