Atonic seizures are a rarer type of epileptic seizures (less than 1% of all seizures with epilepsy). They occur in some severe forms of epilepsy, with onset in early childhood, such as Lennox-gasto syndrome. Atonic attacks are manifested by a sudden loss of muscle tone, the patient " goes limp "and falls (slowly"settles"). Convulsive contractions are absent. Atonic seizures are often the result of severe brain damage.
The aura is unusual, but specific to the patient’s feelings, which is the initiation (beginning) focal seizure (e.g., visual illusions, a sense of unpleasant odor, fear, etc.). Aura-the result of a pathological discharge in a certain area of the cortex and depends on the function performed by this part of the cortex. If the epileptic discharge remains localized, the consciousness remains during the further development of the attack, since the epileptic activity does not affect other areas of the cortex, and they continue to function normally. With the further spread of the discharge to other areas, there is the addition of other symptoms, possibly a violation of consciousness. If the discharge extends to the cortex of both hemispheres of the brain, there is loss of consciousness and convulsions. Another sign pointing to the local nature of the attack is the occurrence of post-criminal neurological disorders (for example, transient weakness in the limbs on one half of the body, blindness or speech disorders). In many cases, EEG can play an important role in determining the location of the focus in partial epilepsy.
Aura is very important, as it indicates the local nature of the attack and suggests the localization of the epileptic focus in the cerebral cortex. Therefore, always inform the doctor about the presence of the patient’s aura and its manifestations. In addition, the aura performs a “protective” function, as it warns the patient that an attack will occur, due to the fact that the patient or close people can take precautions to reduce the likelihood of injury during the attack.
Pregnancy and epilepsy
In some cases, pregnancy does not change the frequency of seizures, and sometimes even improves the control of seizures, but in about 1/3 of cases there is a deterioration in the control of seizures during pregnancy. This may be due to a number of factors. High levels of estrogen/progesterone may play a role in the first trimester of pregnancy. In addition, there is a decrease in the level of some AEP in plasma due to physiological processes occurring during pregnancy. In 2 and 3 trimesters of pregnancy, the volume of blood plasma increases by about 1/3, thereby reducing the concentration of AEP when administered in the body of the previous dose. Changes in AEP concentrations are also explained by an increase in the rate of excretion of drugs from the body, a change in the binding ability of plasma proteins, and less often – a violation of drug absorption. Often women with epilepsy do not follow the doctor’s recommendations, fearing the teratogenic effect of drugs. This is extremely dangerous, as it can lead to a resumption and a sharp increase in seizures, even in women in remission. In some cases, the provoking factor in the development of attacks can serve as a limitation of sleep.
Thus, during pregnancy, regular visits to the doctor are necessary to monitor the effectiveness of treatment of epilepsy. When frequent attacks, it is recommended to determine the concentration of AEP in the blood. It may be necessary to adjust the dose of drugs, especially given the fact that attacks (especially generalized seizures) pose a threat to the mother and fetus. Although if the attacks do not become more frequent or the woman is in remission, there is no need for changes in therapy. If during pregnancy there is a need to change the dose of AEP, after birth, the patient will be able to return to the previous treatment regimen.
Pregnancy and epilepsy, peculiarities of treatment
Women with epilepsy need to prepare in advance for pregnancy. In order for the pregnancy to be successful for both the mother and the child, it may be necessary to change the treatment regimen, which will take some time. With polytherapy (ie, simultaneous administration of several AEP) significantly increases the risk of teratogenic effects of drugs (ie, the ability to cause anticonvulsant developmental disorders and malformations of the fetus). Therefore, be sure to inform your doctor about the planned pregnancy. The doctor will seek to change the treatment regimen so as to minimize the number of drugs taken, it is desirable to switch to monotherapy (treatment with one anticonvulsant). It is possible to switch to AEP that do not have a negative effect on the course of pregnancy and fetal development (since it is known that the teratogenic potential of different drugs varies).
In some cases, patients in stable remission or receiving preventive treatment, as well as, if there are doubts about the diagnosis, before the planned pregnancy can be a complete abolition of antiepileptic therapy, without the resumption of attacks. Patients, continuing treatment with antiepileptic drugs during pregnancy, it is recommended to conduct replacement therapy with folic acid (at a dose of 5 mg daily before pregnancy and in the first trimester of pregnancy), to minimize the risk of fetal malformations.