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- Epilepsy is a chronic neurological disease caused by impaired brain function due to excessive electrical activity of neurons and accompanied by recurring seizures.
According to the World Health Organization (WHO), today in the world of epilepsy more than 50 million people are sick, which is about 0.5-1% of the world's population. Usually, hearing or reading the term "epilepsy" people present a fit with loss of consciousness, seizures and foam at the mouth. Such a stereotyped picture arose from the fact that so epilepsy is usually depicted in movies and serials. This frightening image does not reflect all the variety and complexity of the disease, which is discussed in this section. The disease has many more manifestations than this form, replicated by mass culture.
How diverse are the clinical manifestations of epilepsy, and its causes are also numerous. Epileptic seizures can occur as a result of a brain injury and a previous infection of the brain. In addition to these causes, epilepsy can cause tumors or stroke. If convulsive attacks appear after the impact on the human body of a specific factor, then this epilepsy is called symptomatic. The list of causes of epilepsy is not exhausted, but there are seizures that can not find a specific cause. The disease appears as if by itself, and in its development an important role is played by genetic factors. This type of epilepsy is called idiopathic epilepsy. Another form of epilepsy, which is allocated by specialists, is reflex epilepsy. With her attack of the disease is provoked by an external stimulus. Most often they are visual impact: for example, flashes of light from the TV screen or light in the disco. In more rare cases, an attack can trigger intense thinking, listening to music or eating. One of the important principles of treating such seizures is the avoidance of factors provoking seizures.
The basis for the development of convulsive seizures with epilepsy is a violation of the balance of the two brain systems - exciting and inhibitory. Normally, these systems work simultaneously, creating an optimal level of activity of neurons. With epilepsy, there is an increase in excitatory activity with a lack of inhibitory. As a result, this leads to the fact that whole groups of nerve cells begin to synchronously produce electrical discharges of high power. These discharges can spread to other parts of the nervous system, which leads to an attack6. Antiepileptic drugs can significantly reduce the excessive activity of neurons or completely suppress it. The convulsive seizure itself is only the tip of the iceberg, a noticeable, but not an exhaustive part of the disease. With the help of a fit, the brain "dumps" excess tension; convulsive attack becomes a way to reduce the pathological activity of nerve cells.
As already mentioned, some epilepsy cases are associated with genetic disorders that affect the functioning of nerve cells. The electrical signal of a neuron is formed due to the variable opening and closing of ion channels on the cell surface, and mutations affect the work of the genes responsible for these channels. Problems with genes can be transmitted from generation to generation, so there are family, that is, inherited, epilepsy. Very often the presence of epilepsy in one of the family members raises questions about whether the disease can be transmitted to its offspring. If one of the parents suffers from epilepsy, the risk of developing the disease in his child is 3 times higher than the average.
The manifestations of epilepsy are very diverse. This is directly related to the fact that the occurrence of convulsive attacks can be triggered by various factors. A seizure attack can occur only once, but in other cases it will be repeated with a certain periodicity. The nature of convulsive seizures is able to change with the course of the disease: their duration and appearance in some patients do not remain stable throughout life.
- Despite these difficulties, doctors identified several permanent features of convulsive seizures.
First, epileptic seizures always have a sudden onset. A person suffering from epilepsy can not accurately predict when he will have a seizure. This feature of epilepsy can be considered one of the factors that have a negative impact on a person's psychological state. A patient with epilepsy lives in tension, constantly expecting that he will have an attack. At the same time, a number of patients before the appearance of seizures may have an aura - specific, repeated from time to time sensation. Aura can be presented in the form of smells, emotional experiences or have a different appearance.
Secondly, the epileptic attack has a short duration - from fractions of a second to several minutes. Depending on the type of epilepsy, a person for this time can freeze and not notice an attack, experience some unusual sensations or fall down, unconscious. In some cases, seizures may follow one after another, but a normal, one-time attack does not last long.
Thirdly, a seizure with epilepsy is capable of stopping by itself. The development of an attack of the disease does not require the mandatory use of medication to interrupt it. Special medication interventions are used only if there is an ongoing series of seizures (status epilepticus) or when the factor at work is the cause of the attack. Such situations include seizures in children at high temperature.
Fourthly, seizures with epilepsy are stereotyped. If the patient has an attack of one type, then in the future he will repeat in the same form. Sometimes with the course of the disease, the appearance of seizures may change, but for a short period of time, the seizures will look very similar, actually copying each other.
If we talk about how the appearance looks like, then we must say that the nature of the attack depends on the area of the brain, where there is excessive electrical activity of neurons. Also, the course of an attack depends on whether the excess excitation is transferred to other parts of the brain. For example, if the focus of pathological excitation is in the temporal lobe, then the attack can take the form of olfactory, taste or auditory sensations (more often music). When the frontal lobe is affected, seizures can be expressed as speech disorders, violent head and eye rotation, and other movements that the patient can not control.
Other manifestations of convulsive activity in epilepsy can be:
Given the complexity and variety of clinical manifestations of epilepsy, a neurologist and not other physicians should determine the diagnosis and prescribe the treatment of the disease.
Epilepsy manifests itself not only in the form of convulsive seizures and other specific phenomena of perception. With the long course of the disease, the personality of a person can also change: it acquires some features that are well known to doctors. Typically, the personality traits of patients suffering from epilepsy are traditionally referred to as slowness of thinking, which is externally manifested in the leisurely actions of a person. The patient can acquire pedantry, thoroughness in matters and words, as well as excessive craving for accuracy. Separately describe the changes in the emotional life of patients. The mood of a person acquires a dysphoric tone: anxiety is combined with anger, a constant willingness to respond to a threat or direct aggression. Other patients on the contrary become very polite, prudent and caring. In some people with epilepsy, the features described above exist even before the onset of epileptic seizures, which can be explained by genetic causes. In general, changes in the personality of a patient with a disease are a complex topic that neuroscientists and psychiatrists have been discussing for decades. It is important to understand that none of the above features is mandatory for epilepsy.
Another sign of epilepsy, which is now rare, is a marked decrease in memory and intelligence against the background of the disease. Currently, this consequence of the disease is rare. This was due to the fact that patients are diagnosed on time, and they receive modern and adequate drug therapy.
The attitude of society to epilepsy throughout the history of mankind can not be called unambiguous. Our ancestors saw epilepsy as a mystical phenomenon. The change in the state of consciousness of a person before the attack and during it brought together epilepsy in the eyes of people with trance or religious experiences. The attack was perceived by ordinary people as a person's contact with higher powers. It's not for nothing that the Senate of Ancient Rome interrupted its meetings, if someone from those present had an epileptic attack. As the Romans believed, in such a special way the gods claimed their dissatisfaction with what was happening among the politicians.
In general, epilepsy was perceived as a punishment from the gods, the infusion of evil spirits into the human body. From this impression of the disease, a negative attitude towards people suffering from epileptic seizures has grown. In the Middle Ages, they had to live apart from the rest of the people, like a leper. Healthy people avoided eating and drinking from one dish with suffering epilepsy and even touching such a person. As then believed, through the touch of a person prone to epileptic seizures, and his breathing, a healthy person could become exposed to the demon, the evil spirit. Even beautiful and poetic names of epilepsy - a sacred illness, a lunar illness - appeared in a row with designations that did not leave any chance for merciful treatment of patients. The curse of Christ, black infirmity, grievous suffering - all these "pleasant" words called the same disease - epilepsy. Even Hippocrates at one time spoke on the "sacredness" of epilepsy and pointed out the role of the brain in its emergence: "It seems to me that the first who recognized this disease as sacred were such people that now are magicians, purifiers, charlatans and deceivers ... but the reason this disease, like other great diseases, has a brain".
Over time, the mystical attitude towards epilepsy was replaced by her perception only as a neurological disease. Such a change could not save people suffering from epilepsy from prejudiced negative attitudes towards them. This phenomenon is called stigmatization: a patient suffering from epilepsy is perceived as dangerous or unpleasant only because of the very presence of the disease. The disease becomes a "black mark", and other people avoid contact with a person, begin to treat it worse than they could. About patients with epilepsy may think that they do not control themselves and are dangerous to others. This negative attitude on the part of other people can cause a deterioration in the mental state of a patient with epilepsy or lead to problems with taking antiepileptic drugs. Given the latter fact, we can say that a bad attitude to the disease prevents her from normal treatment. One must understand that stigma is reflected not only in the patient with epilepsy, but also in his relatives. Some parents may be ashamed that they have a child with such a disease that their life differs from that of parents with "normal" children. Such problems in the patient's environment can also negatively affect his treatment. Families of patients need special educational programs and psychological support to avoid such difficulties in their daily lives. If a competent information on epilepsy is available to the public, the impact of stigma on the lives of patients and their loved ones will be minimal.
The World Health Organization believes that with adequately selected treatment, about 70% of patients can achieve remission. The absence of seizures for more than 12 months is called remission3. If the disappearance of seizures occurs against the background of taking antiepileptic drugs, then this is called drug or drug remission. Of course, it is more pleasant for the patient to completely get rid of the attacks of the disease and not to drink medicines, but this does not always happen. In such cases, the constant reception of maintenance therapy and regular observation by the doctor allows the patient to feel better and to avoid the resumption of seizures. Approximately half of the patients have the disappearance of epileptic seizures already with the first prescribed drug.
The success of treatment depends not only on the drug used, but also on other factors. In medical science, there are studies in which the patient is being monitored for several years. Such studies are called longitudinal studies. Several such studies have revealed signs that indicate an increased likelihood of a positive outcome in the treatment of epilepsy. Such favorable signs were attributed to the absence of brain injuries in childhood and adolescence and the absence of extensive changes in the work of the brain in electroencephalography. It is also known that genetically conditioned forms of epilepsy are better amenable to treatment, which are caused by external causes. Cases of the disease with a higher frequency of seizures within 6 months after the first convulsive episode are less treatable.
In another study, it was estimated how many patients would be able to completely stop taking antiepileptic therapy. It turned out that if antiepileptic drugs are taken in accordance with the recommendations, and their cancellation occurs gradually, under the control of doctors, then about 30% of patients do not return to taking medication on the background of normal health.
The ultimate goal of treatment for epilepsy is to get rid of bouts of the disease. This can dramatically improve the patient's condition, regain control of his life. Significant advances in therapy have been achieved in the last few decades, when doctors have a whole arsenal of medicines for the treatment of epilepsy. The appearance of the first drugs of this group allowed to save many patients from suffering. Unfortunately, not all patients responded to treatment, and the search for new drugs began. In parallel with medicinal methods, non-drug therapies were also developed. For the treatment of epilepsy, neurosurgical interventions, vagus nerve stimulation, ketogenic diet and some others are currently used.
- More information about these methods of treatment you can read in the relevant sections of our website.
In addition to methods of treatment, methods of diagnosing the disease have improved. If earlier doctors only had access to the method of patient observation and neurological examination, now modern and accurate methods are used in diagnostics. Electroencephalography (EEG) allows evaluating the electrical activity of different parts of the brain. To study the work of the brain at night, video EEG monitoring can be used, which gives even more information for the doctor. Magnetic resonance imaging of the brain allows you to determine whether there are any changes in the patient's brain that cause convulsive seizures. Genetic studies can shed light on the origin of epilepsy, and measuring the concentration of the drug in the blood helps control the effectiveness of treatment and monitor the intake of therapy.
Among the variety of methods of diagnosis and treatment, the doctor must make a choice that will help the patient to gain control over the seizures and to adapt to society as best as possible. Only a specialist can recommend ways of treating epilepsy, taking into account the individual characteristics of the patient and the specificity of the disease.