Symptomatic epilepsy with polymorphic seizures. Epilepsy in a child: signs, diagnosis, treatment

Many parents have to be aware of such a diagnosis as epilepsy. This is a very serious diagnosis.

At the mention of epilepsy, almost every person has an association with seizures. Quite right, epilepsy is most often manifested by convulsions.

Epilepsy is a chronic disease nervous system, which is characterized by erratic electrical activity of either individual parts or the entire brain, resulting in seizures and loss of consciousness, both in adults and in children.

The human brain contains a huge number of nerve cells capable of generating and transmitting excitation to each other. A healthy person has healthy electrical activity in the brain, but in epilepsy there is an increase in electrical discharge and the appearance of a strong, so-called epileptic activity. A wave of excitation is instantly transmitted to neighboring areas of the brain, and convulsions occur.

If to speak about the causes of epilepsy in children , then first of all it is worth highlighting intrauterine hypoxia or lack of oxygen to brain cells during pregnancy, as well as traumatic brain injuries, encephalitis, the causes of which are infection, as well as heredity. It must be borne in mind that epilepsy is a poorly understood disease, so any causes can only contribute to the development of epilepsy, but it cannot be said that any cause directly causes the disease.

Is it only epilepsy that can cause seizures?

No. If your child has a seizure, don't panic. Children often have convulsions due to high fever, the so-called febrile convulsions. In order to avoid convulsions against the background of high temperature, it must be knocked down in time. Above 38 degrees should not be ignored, but immediately reduced with rectal paracetamol suppositories or a lytic mixture.

Not only high fever, but also a lack of calcium, magnesium, vitamin B6, a decrease in glucose levels, as well as a traumatic brain injury, can be caused by convulsions in children.

If your child is having a seizure for the first time, you should definitely call ambulance for hospitalization for the purpose of examination and treatment of the child.

What should you do if your child has a seizure?

• First, lay on the bed or on the floor away from sharp objects so that the child does not get hurt
• Secondly, lay on its side so that the child does not suffocate
• Third, do not put anything in the baby's mouth, do not hold the tongue

If it is an epileptic seizure, it can last up to 2-3 minutes.

After an attack, check your breathing, if there is no breathing, start breathing "mouth to mouth". Artificial respiration can be performed only after an attack.

You must definitely be with the child, and do not give him any drink or medicine until he comes to his senses.

If your child has a fever, be sure to give him a rectal suppository for the heat.

What are epileptic seizures?

big bouts begin with convulsions of the whole body, the so-called convulsions, accompanied by loss of consciousness, strong tension of the muscles of the whole body, flexion / extension of the arms and legs, contraction of the mimic muscles of the face, rolling of the eyes. A large attack may result in involuntary urination and defecation. After an attack, the child has a post-epileptic sleep.

In addition to large seizures, there may be so-called small seizures.

To small attacks include absence seizures, atonic seizures, and infantile spasm. Absences are fading, or short-term loss of consciousness. Atonic seizures are similar to fainting, the child falls, and his muscles during the attack are extremely flaccid or atonic. Baby spasm happens in the morning, the child brings his hands to his chest, nods his head and straightens his legs. As we can see, the manifestations of epilepsy are quite multifaceted, and if there is even the slightest suspicion of epilepsy, then it is necessary immediately do an EEG - an electroencephalogram.

Epilepsy may be true and symptomatic, that is, to be a symptom of a brain tumor. This needs to be dealt with immediately after a diagnosis of epilepsy is made.

The diagnosis itself is made after an electroencephalogram, on which, in the case of epilepsy, epileptic activity will be observed.

An hourly EEG is also performed for a more detailed examination.

To exclude a brain tumor, the child undergoes magnetic resonance imaging of the brain.

Epilepsy can be suspected if the child has fading, or absences, short-term loss of consciousness, in which the child seems to turn off for a few seconds. At the same time, there is precisely absence epilepsy, which proceeds without seizures. Sometimes an absence precedes an attack. In any case, it is necessary to send the child to the EEG.

Treatment of epilepsy in a child

If the child has had at least two seizures, then he needs to take drugs such as valproate (convulex), phenobarbital or carbamazepine, as well as topomax and keppra.

Taking these drugs for a long time, regularity is very important, if regularity is not observed, attacks may recur.

Most often, one drug is enough to prevent seizures. Antiepileptic drugs cause a decrease in attention, drowsiness, lower school performance, but in no case can you cancel or skip them, because canceling immediately can cause an attack. Each attack pushes the development of the child back.

The drug Konvuleks is used under the control of valproic acid in the blood. If valproic acid in the blood is more than 100 μg / ml, then it is impossible to increase the dosage of the drug, if it is less than 50 μg / ml, then the therapeutic dosage has not been reached, and the dose must be increased.

If the child had at least one attack, then for a month he is strictly prohibited from any massage, drugs that stimulate the central nervous system, as well as classes with a speech therapist.

With symptomatic epilepsy, the tumor is removed, after which the seizures completely stop.

Also appeared new method in the treatment of epilepsy - stimulation vagus nerve. To do this, the patient is implanted with a special electrical device. Vagus nerve stimulation improves the patient's emotional state.

Factors provoking seizures of epilepsy

Lack of sleep or interrupted sleep. The body seems to be trying to catch up on lost REM sleep, as a result of which the electrical activity of the brain changes and an attack may begin.

Stress and anxiety can contribute to seizures.

Drugs that stimulate the central nervous system (Ceraxon, Cerebrolysin) can cause an epileptic attack, as well as an increase in the dose of insulin due to hypoglycemia.

Any severe illness, such as pneumonia, can contribute to an attack.

Also, an attack can be facilitated by the flickering of bright light, for example, when watching animated series. There is a so-called television epilepsy - this is a special state of photosensitivity, which is based on the movement of the spots that make up the picture. Susceptible children may react to watching TV with a seizure.

If your child has epiactivity on the EEG, but there are no seizures, then you need to keep in mind that with any stress factors, be it illness or hormonal changes, they may appear. And when you enter a stable remission, you need to be ready.

Is epilepsy curable?

Fortunately, epilepsy in children can go away. But, if your child has had at least one major seizure, then he must receive antiepileptic treatment for three years. During these three years, the child must be hospitalized every three months for examination and observation. In the absence of seizures, the diagnosis is removed. However, the child is under the supervision of a neurologist for another five years.

This article is useful to all parents, because any seizures are a cause for concern, and it is necessary to know how to help the child. Even if your child has been diagnosed with such a serious diagnosis as epilepsy, do not despair and panic. It is necessary to strictly follow the appointments of a neurologist, perhaps to undergo a consultation with an epileptologist, and be sure to hope that your baby will get better - outgrow, so to speak. Believe me, a lot depends on your mood.

The climate in the family also means a lot. It is necessary to surround the child with attention and a friendly attitude. Epilepsy should not be overemphasized so that psychologically the child feels calmer and does not try to use his illness by manipulating you.

The main goal of the rehabilitation of children with epilepsy is to stop or minimize the number of seizures. It is also very important to socialize the child, introduce him to the children's team, and prepare him for school as much as possible without overloading his psyche. To do this, speech therapists and psychologists should work with the child. He may need an individualized education program at school.

The main thing in treatment is a properly selected drug regimen that will prevent the onset of seizures. The absence of seizures is very important, because each seizure not only slows down the development of the child, but also pushes him back.

Prevention of epilepsy

Prevention this disease It consists primarily in preventing hypoxia both intrauterine and after birth, preventing injuries and infections of the brain, as well as stressful situations in a child. You should try to avoid excessive TV viewing, and put the child to bed on time.

Therapist E. A. Kuznetsova

Generalized epilepsy is considered a common disease, because such a diagnosis is made to every third person suffering from epileptic seizures. The main feature of this disease is that the pathology is transmitted to people by inheritance. It does not appear only because a person has suffered an infectious disease or a brain injury has occurred.

The disease appears if at least one of the close relatives suffered from epileptic seizures. It is worth familiarizing yourself with the types of seizures, as well as the main symptoms of the pathology, so that you can identify it in a timely manner and begin professional treatment.

If a person has been diagnosed with generalized epilepsy, then he should familiarize himself with the characteristic features of the disease. It is they who make it possible to distinguish the deviation against the background of other diseases, which also lead to epileptic seizures. As already mentioned, genetic predisposition plays an important role.

If a person suffers from generalized epilepsy, then there is about a 50% chance that close relatives will have it. Of course, the presence of a disease in a parent does not guarantee that it will be in a child. In this case, there is still a significant likelihood of encountering characteristic symptoms.

The first symptoms usually appear in early age. As soon as parents notice them, it will be necessary to undergo an examination without fail. It is necessary in order to accurately determine the disease and find out its type. Seizures mostly occur at the same time of day. They can also be provoked by the same factor, for example, a loud sound or a bright flash of light.

Many patients do not show structural changes in brain structures. This does not affect neurological status and cognitive functions. When conducting electroencephalography, it is far from always possible to see a change in rhythm.

The disease often has a favorable prognosis, so doctors urge people not to worry. With proper treatment, you can significantly improve a person's condition and eliminate seizures. At the same time, a significant likelihood of relapse will still remain, therefore, throughout life, if possible, those factors that provoke the appearance of generalized epilepsy should be avoided.

Forms of the disease

In total, doctors pour two main types of epilepsy: primary and secondary. They differ depending on the cause that provoked the onset of the disease. Generalized idiopathic epilepsy is primary view. That is, it is inherent in a person at the genetic level. Channelopathy occurs, that is, the nerve cell membrane is unstable, and this causes diffuse activity. Deviation occurs in about 30% of cases.

Symptomatic epilepsy is of the secondary type. In this case, the disease is directly related to other abnormalities, such as inflammation of the brain, encephalitis, and also a tumor. Therefore, epileptic seizures appear for the reason that they are affected nerve cells brain.

Also in some cases this species deviation is a consequence of hypoxia during fetal development, various infections that occurred before birth, as well as birth trauma. Separately, generalized paroxysms should be singled out.

They are also called a grand mal seizure. This state proceeds in two stages. The beginning is abrupt, unexpected for the person and surrounding citizens. During the first phase, all the muscles at once are very tense, which leads to a spasm. The person falls to the ground, straightens up, while the head is thrown back.

Falling may cause injury to the patient. During this period, the patient does not breathe, which leads to a blue tint of the skin of the face. A person loses consciousness and does not understand what is happening to him. After this, the second stage begins, during which convulsive twitches begin. They gradually weaken and stop. They are followed by a pathological sleep, after which a person feels weakness, severe headaches, and also discomfort in the muscles.

This is a separate form of seizures in which a person loses consciousness. At the same time, there are no visible convulsions on the body. This phenomenon is also called a small seizure. Absence is both typical and atypical. In the first case, the attack lasts a few seconds, the person is unconscious, sometimes repetitive movements may occur. A similar phenomenon can disturb people more than once during the day.

Myoclonic seizures

Separate and synchronous muscle contractions occur. In this case, not the entire area is affected, but only individual beams. The person is conscious in most cases.

At first, epileptic activity affects one area of ​​the brain, for example, the frontal lobe. After that, it spreads to all departments, which is reminiscent of tonic-clonic seizures. Before the seizure, an aura occurs, during which tingling of the limbs, spots before the eyes, dizziness and slight numbness begin. It can be understood from it that an epileptic seizure will soon occur.

Generalized epilepsy of any form is considered dangerous to health, with the greatest risk being the fall of a person. During it, you can get injuries that significantly worsen your health. It is for this reason that it is imperative to carry out treatment in order to improve well-being and reduce the number of seizures. The exact treatment regimen can only be prescribed by a doctor, after carefully examining the patient.

Symptoms

If a person has already had to deal with an epileptic generalized seizure, then it will not be difficult to determine this condition. Of course, the symptoms are different, and they depend on what kind of attack occurred.

For example, it is typical for absences that the patient loses consciousness, becomes lethargic and falls out of real life significantly. Rapid and repetitive movements may occur, such as clenching and unclenching a fist or moving one finger.

As already mentioned, for tonic-clonic seizures, the presence of two phases of the development of manifestations of the disease is characteristic. At first, the person is immobilized, the body is completely straightened, and breathing stops for a while. The person turns pale, maybe even blue. After that, spasms of all muscles begin, which gradually disappear.

As soon as they pass, the patient can breathe deeply again. There may be foam at the mouth, often with an admixture of blood due to damage to the lips, cheeks and tongue. Muscle relaxation often occurs, leading to uncontrolled urination and defecation. After that, the patient falls into a dream, and then does not remember what exactly happened to him.

During myoclonic seizures, contractions of individual muscle bundles occur. However, they are always symmetrical to each other. There is uncontrolled movement of the limbs. A person in most cases falls to the ground, but at the same time remains conscious. As soon as an attack begins, a person goes into a state of apathy, becomes indifferent to ongoing events, and also loses attention.

Diagnostics

If generalized epilepsy occurs, a person should definitely undergo a medical diagnosis. You should contact a neurologist, because he is the one who evaluates this condition. There is also a narrower specialist, such as. Such a doctor is not present in all hospitals, especially when it comes to small towns. In addition, a neurophysiologist is involved in the diagnosis of the disease.

Initially, you will need to undergo a general examination to assess the person's condition and find out the causes of the disease. It is necessary to collect a complete anamnesis, ask people about the features of the attack, which could observe it. It is also worth trying to remember what event preceded the seizure.

You will need to do an electroencephalogram to assess the state of the electrical activity of the brain. As already mentioned, this examination does not always reveal generalized epilepsy, because there may be no manifestations characteristic of it. At the same time, the doctor is sent to this study so that the patient's condition can be more accurately assessed.

Special electrodes will be placed on the head, which register potentials and then convert them into different vibrations. From them it will be possible to understand whether a person has any violations. Before the procedure, you will need to prepare approximately 12 hours before the process itself. You should not use drugs (if the doctor forbids them for a while), you do not need to eat chocolate, drink coffee and energy drinks.

When the procedure is underway, it is extremely important for a person not to be nervous, because such a state distorts the result. If a child is examined, then it is important for him to explain what exactly awaits him. It is possible that parents will have to be present nearby so that the little patient feels more relaxed.

To identify latent epilepsy, a specialist can use various tests. For example, bright light, noise is used. A person can be forced to breathe deeply or put to sleep. Diagnostics often includes and. With these studies, you can find the cause that caused the pathology and convulsions. Naturally, we are talking about the situation when seizures provoke an internal disease.

If the doctor is convinced that the main reason for the appearance of the disease is heredity, then you will need to turn to genetics. It will also be necessary to separate epilepsy from other diseases that can also cause similar symptoms. After that, it will be possible to proceed to therapy, the scheme for each patient is assigned individually.

The sooner treatment is started, the easier it will be to improve the person's well-being. At the same time, it is extremely important to follow all the prescriptions of the doctor so that you can maintain your health at a normal level.

Methods of treatment

Medical professionals often prescribe people different drugs that have a positive effect on health. For example, derivatives of valproic acid are prescribed: Ethosuximed, Carbamazepine and Felbamate. However, these funds are often not recommended for pregnant women.

Cloneepam is often used and is a benzodiazepine derivative. It is effective in all forms of epilepsy, while it cannot be used for a long time, because addiction appears, and the effectiveness of treatment decreases.

It is extremely important to provide first aid to a person during an attack, because such a condition can be dangerous not only for health, but also for life. It will be necessary to remove all hard and sharp objects that may injure the patient. A person should be put on the floor or on the ground, while it is worth placing something soft under him, at least clothes. This will avoid injury.

No need to try to hold a person, and also put something in his mouth. If the seizure lasts more than 5 minutes, then you need to call an ambulance. When the attack passes, you will need to lay the person on their side, then clean the mouth of saliva and vomit. When symptoms of choking are observed, urgent medical attention will be required. Naturally, before the arrival of doctors, one cannot leave a person without control.

Treatment in childhood

Much will depend on the cause that led to the onset of seizures. In generalized epilepsy, this is a hereditary factor. Specialists often simultaneously use drug therapy, as well as surgery. All drugs are selected individually depending on the condition of the person.

It is extremely important that drugs do not cause mental and physical developmental delays, because the child's body must be fully formed. It is often required to use anticonvulsants, as well as vitamins to support the body.

It is important that the daily routine is strictly observed, and also the child should sleep fully. Adolescents will need to carry out the prevention of nervous conditions, you should not allow provoking factors. When you need to use drugs, then you need to use them for a long time. Doses directly depend on the severity of the condition. Self-medication is not allowed, because it not only does not bring positive results, but it can also significantly worsen well-being.

The prognosis for the primary form is favorable. The disease responds well to treatment, so a person can live a full life. Naturally, he will have to maintain the chosen treatment regimen, as well as change it on the recommendation of a doctor. In about 30% of cases, there is a complete recovery. If treatment fails, then supportive care is needed. It will be important to alleviate the symptoms of the disease and reduce the number of attacks. In this case, it will be possible to significantly improve the condition of a person. It should be understood that generalized epilepsy is a dangerous and serious disease, which is why at the first symptoms you need to go to the hospital.

Symptomatic or secondary epilepsy is one of the forms chronic disease nervous system, characterized by various kinds epileptic seizures.

It can develop:

• against or after damage to brain structures (trauma, stroke, congenital anomalies, tumors);
• with significant metabolic disorders in nerve cells (with hereditary metabolic disorders, long-term use of certain drugs).

In most cases, symptomatic epilepsy in children is considered a symptom of an organic lesion of a certain part of the brain or its deep structures, therefore it is difficult to treat.

Most often, the onset of epilepsy, including symptomatic, develops in children.

It's connected with anatomical features and physiological immaturity of brain structures, as well as the predominance of excitation processes and insufficient mechanisms for inhibiting brain activity.

The development of one of the forms of symptomatic epilepsy is associated with damage and / or death of neurons as a result of exposure to one or more pathological agents and the formation of a focus of epileptic activity in the affected area, the cells of which generate an excess electrical charge.

At the same time, the neurons of healthy areas form a “protective shaft” around the focus of pathological activity and restrain the spread of excessive charge, but at a certain moment, the accumulated epileptic discharges break through the boundaries of the antiepileptic shaft and manifest themselves in the form of an attack of convulsions or another type of epileptiform activity.

The type of attack (generalized or partial) depends on:

• patient's age;
• from the location and size of the focus;
• from causative factor;
• the presence of comorbidities.

The causes of attacks of symptomatic epilepsy include various diseases and pathological conditions:

• infectious and inflammatory diseases of the brain (abscess, encephalitis, meningitis):
• congenital anomalies of the brain, dysgenesis, atriovenous malformations;
• consequences of intrauterine hypoxia or birth trauma;
• traumatic brain injury;
• rheumatism of the nervous system;
• hereditary metabolic diseases;
• intoxication, including severe childhood infections (scarlet fever, chickenpox, mumps, measles, rubella, infectious mononucleosis);
• neoplasms (benign or malignant) of the brain;
• pathology of the liver, kidneys;
• diabetes;
• acute circulatory disorders of the brain, the consequences of a stroke;
• multiple sclerosis.

Symptomatic epilepsy can develop due to pathological effects on nerve cells of a number of factors and is a heterogeneous group of diseases.

The formation of foci of pathological activity in the brain of a child occurs under the following pathological conditions.

With an unfavorable course of pregnancy and the intrauterine period:

• with severe toxicosis;
• with fetoplacental insufficiency and severe fetal hypoxia;
• with intrauterine infections;
• with severe somatic and / or gynecological diseases in a pregnant woman;
• when taking medication;
• when exposed to occupational physical or chemical hazards of radiation, chemical carcinogens.

With brain damage in newborns as a result of birth trauma or severe asphyxia.

When neurons are damaged in the early neonatal period:

• when prescribing various medications to a child at an early age;
• with persistent and prolonged jaundice;
• with childhood infections (whooping cough, parapertussis, scarlet fever).

In the event of various diseases of the central nervous system and neoplasms of the brain against the background of:

• stress;
• inflammatory and infectious processes;
• intoxications;
• injuries;
• metabolic disorders.

The hallmarks of secondary forms of epilepsy are:

• the disease can manifest itself at any age;
• the presence in the child of focal neurological symptoms in the interictal period, in contrast to true epilepsy (the child has no changes in the neurological status in the interictal period);
• lack of hereditary burden;
• in parallel, a baby often has a lag in psycho-emotional development, mental retardation, decreased memory and intelligence;
• the presence of a causative factor and local brain disorders are determined, which are determined various methods neuroimaging and EEG.

There are two main forms of symptomatic epilepsy:

• generalized secondary epilepsy;
• focal form or localization-related symptomatic epilepsy.

Symptomatic generalized epilepsy manifested by complex convulsive seizures that occur with extensive brain damage:

• severe birth trauma;
• complex intrauterine infections with damage to the deep structures of the brain (toxoplasmosis, cytomegalovirus infection rubella, viral hepatitis);
• the formation of congenital anomalies of the brain under the influence of various damaging factors;
• hereditary diseases of the brain;
• severe and progressive brain infections (herpetic encephalitis, meningococcal meningoencephalitis, influenza encephalitis).

In addition to complex generalized seizures, patients often experience:

• movement disorders (ataxia, hemiplegia);
• delayed psychomotor development, mental retardation;
• vegetative paroxysms (apnea attacks, cyanosis, tear - and salivation, tachycardia, cyanosis);
• signs of cerebral palsy.

Focal forms of symptomatic epilepsy are distinguished depending on the location of the focus.

Diagnosis of symptomatic epilepsy should be carried out as early as possible - immediately after the onset of the first manifestations of the disease in a child.

First, a specialist neurologist or epileptologist conducts:

• collection of complaints;
• analysis of the anamnesis of life and disease;
• examination of the patient with the definition of focal neurological symptoms.

The criteria for diagnosis are specified:

• age of first manifestations;
• typical symptoms, especially in symptomatic focal epilepsy;
• neurological and mental status of the baby;
• possible provoking factors (sleep deprivation, photosensitivity).

Surveys by narrow specialists:

• ophthalmologist;
• endocrinologist;
• neurosurgeon;
• geneticist.

Spend instrumental methods diagnostics that will allow visualization of a focus or a pathological change in structures (tumor, hematoma, vascular malformation, congenital anomaly, focus of inflammation, abscess):

• MRI - or CT - of the brain, PET (positron emission tomography);
• EEG and video monitoring (for fixing an attack and localizing the focus of epileptic activity);
• survey and contrast radiography;
• angiography of the vessels of the brain and neck;
• examination of the cerebrospinal fluid;
• eye examination.

The main goal of therapy for any form of epilepsy is complete control of the disease with the achievement of long-term remission.

The main indicator is considered to be a reduction in the number of seizures with a significant decrease or complete absence of significant side effects.

Treatment of the symptomatic form of epilepsy is carried out in the form of long-term, sometimes lifelong therapy with anticonvulsants.

To date, therapies medicines, the possibility of radical surgical interventions and the prognosis for life depend on:

• from a form of symptomatic epilepsy;
• reasons for its development;
• the location and size of the epileptic focus and the possibility of its removal (neurosurgical operations are considered the most successful with small foci, with precisely established localization and the absence of contraindications to surgical intervention);
• determination and removal of volumetric formations of the brain (cysts, tumors, hematomas, adhesions, abscesses), which are the main cause of the formation of secondary epilepsy.

The main principles of treatment of symptomatic epilepsy are:

• therapy for a disease or pathological condition, which caused its development and long-term use of anticonvulsant drugs, even after successful neurosurgical intervention in focal or localized forms, the duration of anticonvulsant therapy is at least 5 years, and its earlier cancellation can provoke a relapse of the disease;
• treatment of all background somatic, neurological and mental diseases;
• elimination of factors contributing to the onset of an attack (stress, malnutrition, hormonal disruptions, external stimuli in the form of loud music, light stimuli, prolonged visual stress, sleep disturbances and overwork).

At present, great advances have been made in epileptology:

• creation modern classification illness;
• introduction of new diagnostic methods (EEG - video monitoring, high-resolution MRI devices using special programs, PEG) and improvement of the main methods for establishing and clarifying the diagnosis (EEG using various samples and tests, a complete and comprehensive examination of patients to identify the cause of symptomatic epilepsy) ;
• appearance a large number modern and more effective antiepileptic drugs.

pediatrician Sazonova Olga Ivanovna

Symptomatic epilepsy- this is a pathology that structurally has a symptom complex of epilepsy, like all its subspecies. But its occurrence is not genetic or congenital, but acquired. Symptomatic epilepsy is slightly less common than cryptogenic epilepsy, but still quite inconvenient and no less well known.

Symptomatic epilepsy itself is not very different from idiopathic epilepsy clinically. Its difference is the cause, and all varieties of symptoms do not differ. Epilepsy is a rather extensive pathology and has many manifestations. The person herself does not foresee the presence of epilepsy, because many of its subspecies manifest themselves as symptoms that are not entirely characteristic.

Symptomatic epilepsy is a polyetiological, partly progressive nervous system psychiatric disease in its final stage, which is manifested by varieties of convulsive, and often non-convulsive seizures and similar conditions, which is predominantly paroxysmal in nature. Leads to specific changes in the person and in particular her personality, epileptic psychosis, specific non-classical bewilderment. Epilepsy is a form of brain dysfunction, its functioning and is a very common pathology. Regardless of any ethnic, location-related features, epilepsy occurs in one percent of people. Approximately 6% of individuals have had at least one seizure, which is similar in etiology to epileptic seizures. characteristic feature epilepsy has onset in childhood or adolescence, but symptomatic epilepsy begins after a clear cause that has a precise time onset.

For a rational understanding of the terminology in the context of epileptic disease, it is important to understand some conditions. The epileptic reaction has the characteristics of a convulsive or non-convulsive seizure that occurs as a general biological response to an external stimulus. There is a widespread use of the diagnostic syndrome complex epileptic syndrome - these are paroxysms that can have not only convulsive components, but also symptoms that are part of the disease structure, which are associated with organic matter in the GM, along with other neurologically conditioned and psychopathological symptom complexes of the underlying disease.

Variants of symptomatic epilepsy: epilepsy based on the transferred pathologies of the organic genesis of lesions of the GM, completed before the moment of illness with symptomatic epilepsy; epileptic syndrome of actively flowing progressive states and cerebral processes. In this case, epilepsy is established as concomitant.

Epilepsy is a massive disease that has a lot of subspecies and is characterized by a clear localization due to which it is even possible to determine the location of the epileptic focus. Generalized or generalized seizures disappear with the loss of clarity of consciousness. These include large convulsive seizures and small ones. Small ones have many subspecies, depending on the manifestations. Generalized also include such a threatening condition as status epilepticus.

Focal or focal seizures are also very common, not always distinguishable and have their own clear classification. All of them pass without loss or lack of awareness. Motor small seizures are as follows: Jackson, adversive, masticatory, muscle postural and myoclonic. Sensory seizures: somatosensory, visual, scent, auditory, gustatory. Mental seizures: short-term psychoses, twilight of consciousness, special states in the form of dysphoria, as special types anger; epileptic psychoses. Automatisms, according to the type of brief obscurations: trance, fugue. Vegeto-visceral seizures. Conversational seizures: attack of loss of articulation, aphotic. Reflex seizures are a separate species with special symptom complexes.

Many diseases play a leading role in the development of symptomatic epilepsy.

Secondary symptomatic epilepsy comes from the fact that there is primarily a certain disease, which provokes the focus. Neoplasms, especially in the GM, are often capable of provoking epileptogenic foci. Any infections, especially those with access to GM: brain abscess of streptococcal, staphylococcal, meningococcal. Meningitis with cerebral symptoms, as well as encephalitis with focal symptoms, can also lead to such unfortunate consequences, the etiology of these pathologies is different from viral, herpes virus, cytomegalovirus, tick-borne encephalitis, etc. TBI and birth trauma can also give similar symptoms, like a stroke or any acute condition. Separate anomalies that arose congenitally, malformations, in the form of softening of brain particles, and sometimes blood vessels. Often a variety of dysgenesis, bookmark violations can also lead to a similar problem. Many rheumatological pathologies can give such consequences or as side effect individual medicines. Multiple sclerosis, as well as intrauterine or antenatal hypoxia can lead to symptomatic epilepsy, if not more lethal effects. Many metabolic pathologies, especially of hereditary origin.

Symptomatic epilepsy from alcohol is not uncommon for anyone, but not only ethanol can lead to this outcome, but many other toxins, substances and drugs, especially methamphetamine, cocaine and ephedrine. Many drugs also have the side effect of symptomatic epilepsy, many neuroleptics, certain antidepressants and bronchodilators. Antiphospholipid syndrome, like other metabolic syndromes, can lead to such consequences. Toxins and poisons can also give similar attacks, poisoning with poisons, heavy metals, especially lead and mercury, gasoline, barbituric drugs. Infections that have a general somatic effect can also produce individual convulsive seizures, especially with hyperthermia: tuberculosis, malaria, typhoid, chickenpox, measles, etc. Many organ disorders, especially the liver, kidneys and pancreas.

In addition to the triggers themselves that cause this pathology, there are risk factors. Secondary symptomatic epilepsy is provoked by exposure to certain factors that affect nerve cells. Influence have: impaired conduction of neurons, increased tendency to edema, problems during pregnancy, medication, hypoxic inclusions; malnutrition, as well as a violation of the concentration of any metabolites in the body. Stress, as well as incorrect difficult working conditions, can also become a kind of provocateurs for the development of this type of epilepsy.

Diagnosis of symptomatic epilepsy has clear criteria, according to ICD 10. Organics leading to lesions of the brain, for example, due to TBI, neuroinfections. To make a diagnosis, it is important to find the cause. Seizures have a characteristic recurrence, the mechanism of development is hypersynchronous neural impulses and discharges in certain areas of the brain. The presence of twilight and similar psychoses. affective disorders associated with mood, by type of dysphoria. The presence of permanent disorders of mental manifestations, specific personality modifications, the formation of dementia. The course is progredient, that is, some seizures change others, changes in the person are formed in the form of a specific personality, dementia, dynamics lead to the appearance of epileptic psychoses. On the EEG, foci that increase in size and change as the epileptic focus develops.

Symptomatic partial epilepsy manifested by simple seizures of the same name. These are separate twitches. Symptomatic partial epilepsy with motor seizures looks like a twitch in the arm or leg, sometimes the spasm moves from the distal part of the limb, involving more of the body, and may even go as far as loss of consciousness. Symptomatic partial epilepsy can also be manifested by psychosensory seizures that appear in different analyzers. It seems to the person that her body has changed, that the objects around are twisted and twisted. Sometimes there may even be paroxysms of the fiction of the surrounding or one's own self. There are also seizures with psycho-emotional disorders. Aphatic with a complete lack of speech, difficulty pronouncing words with complete muscle integrity. Dysmnestic with the presence of characteristic psychosensory disorders, of the type already seen before or never seen. There is also an attack with mental infidelities, when the only complaint is a change in the flow of thoughts, sometimes aggravated to illusory and hallucinatory disorders with the same name.

Symptomatic temporal lobe epilepsy is formed when the ammonium horn is damaged and is characterized by a polymorphic picture with various deviations. Symptomatic temporal lobe epilepsy has its focus in the temporal lobe, and it is he who provokes epileptoid activity with the onset of symptoms. Symptomatic temporal lobe epilepsy is provoked by damage and sclerosis of the median structures. Most often, it begins imperceptibly, at first an aura, like an unpleasant feeling or headache. But with days and time, complex massive manifestations can occur with seizures and a change in persona. Symptomatic temporal lobe epilepsy progresses, eventually leading to convulsions with loss of awareness and absences.

In the children's age category, there are some difficulties in pathologies of different systems, as well as epilepsy. Diagnosis is difficult, especially in young age, as well as the difference between the causes of seizures. Children in general have convulsive readiness, so worms, fever, allergies, and other diseases can provoke convulsions.

Epilepsy at a young age does not begin with massive seizures. More often, these are absences - turning off awareness for a few moments without losing muscle tone. Children are characterized by sleepwalking, which may be the first bell to suspect epilepsy. Sudden mood disorders, as well as bouts of pain in various organs and in unreasonable cases, even rumbling in the stomach can indicate epilepsy. Sudden fears, often unreasonable and inappropriate situations, are also the first symptom.

For children, there are special syndromes that indicate an unfavorable prognosis. In general, symptomatic epilepsy from childhood is unfavorable prognostically.

West syndrome consists of a triad: baby spasms with nods and pecks. Psychomotor development is aggravated and inhibited, the EEG shows key changes. There may be rapid extensions. It is typical for infants, more often boys. The prognosis of symptomatic epilepsy in children who are managed with West syndrome is unfavorable. It is characteristic in the presence of organic matter.

Lennox-Gastaut syndrome manifests later than two years and mostly flows from the previous one. The occurrence is provoked by encephalopathy. It includes atypical absences, nodding seizures, falls due to a violation of statics, tonic convulsions. Often they can acquire a serial course up to epistatus. Dementia grows very quickly, coordination suffers. Therapies are almost non-existent. The prognosis of symptomatic epilepsy is also unfavorable in this syndrome, because there is a high resistance to stopping therapy and rapid progression, which shows personality changes.

Children have a burdened history for the development of symptomatic epilepsy. To start seizures in such childhood must be perinatal pathology, that is, in utero and during childbirth, there could be the presence of adverse and dangerous factors that can provoke seizures. Birth trauma is also an impressive factor, because hypoxia and similar conditions can lead to irreparable consequences. The baby must certainly be protected, because infections and injuries in the first year of life can also lead to epileptic seizures.

Symptomatic epilepsy in children is not much different from classical epilepsy, just the realization that it could have been avoided if you had been more attentive to the pregnant woman is very upsetting. Therefore, prenatal diagnosis and calm pregnancy are important. All this in the future will deprive of many problems.

With symptomatic epilepsy, there is always a burdened history, that is, by asking the person carefully, it is possible to find many clues for yourself. There is always some kind of trauma, illness, operation, addiction or something similar in the past of such individuals. You can find clear signs of this, such as scars, traces of needles. In the children's age category, the presence of nuances during childbirth or in the postpartum period. It is important to distinguish this disease from others with the presence of convulsive seizures. Epilepsy has a sudden onset of the seizure, but may have an aura at first, which serves as something of a precursor. External causes the onset of a seizure cannot be detected. But some triggers can provoke it, for example, stopping anticonvulsant medication, sleep deprivation, drinking alcohol. Also less massive, but more frequent due to their spread, can be temperature, allergens, sharp irritants, sound, aromatic, stress, arousal, excessive intake of liquid or sugar substances.

Before the occurrence of the most symptomatic epilepsy, pathologies of its series may appear: migraines, night terrors, apnea, enuresis. Also, typical signs of an epileptic seizure include an aura, a fall, regardless of location, if it is a large seizure. The face changes color during convulsions, first turns pale, then becomes cyanotic. The pupils do not react to light during an attack, patients very often bite their tongue. During the examination, they even ask to show the tongue, because the presence of scars confirms the presence of epilepsy. Very often there may be bowel movements against the will of the person. The seizures are photographically similar, that is, one is similar to the previous one. The seizure has a clear sequence, first loss of consciousness, then a fall, tonic, then clonic convulsions, coma, stupor, stunning. Characterized by acute episodic oligophasia, an absolute loss of awareness during an attack. Amnesia after an attack is complete. The duration of the seizure is from half a minute to two minutes. Pyramid symptoms may occur.

A complete psycho-emotional and medical examination includes the collection of information, an anamnesis of the patient's life, an anamnesis of the disease. With epilepsy, it is very important to describe seizures, because this entitles a person to have a disability group. General somatic and neurological examinations, demonstrative EEG are mandatory. Typical for the EEG will be a sharp peak of the wave, slow waves. In some neurological examinations, an MRI is also performed to identify foci. The purpose of the survey is to identify the causes. You also need to find mental disorders that often accompany. To do this, we use a conversation, as well as psychiatric questionnaires: Moko, MMCE, scales and the definition of intelligence.

The treatment of epilepsy is a complex matter. A dehydration diet with low intake of fluids and sweets is important. The drugs that are indicated are anticonvulsants. The base ones in this case are valproates: Depakin, Depakin enteric and chrono, which is also a normotimic, Konvuleks, Konvulsovin, Enkorat. Carbamazepines are older and cheaper drugs are now moving to the second line: Tigretol, Finlepsin., Carbamazepine. Lamotroigin, Lamictal have a broad effect, taking 70 mg. Topiramate is a modern antiepileptic that is well used in resistant epilepsy. This group includes Topamax, Oscarbazepine, Leviteracetam. It is very important to select a dose with regular use, which will prevent such negative manifestations. After all, with each seizure, part of the neurons dies.

With epistatus, massive therapy and dehydration are used - Manit, Thiogama, Cytoflavin, Lasix with glucose, Magnesium sulfate, Prednisolone, Essentiale. With the addition of psychotic phenomena, Trifluoperazine, Zuclopenthixol, Clopixol, Triftazin, Fluanxol, Diazepam, Clozapine, Paliperidone, Ziprasidone, Amisulpride are added.

With the inclusion of depressive symptoms, you can apply: Fluoxetine, Paroxetine, Lamotrigine. If there is an aggravation of psychotic symptoms, then we add Quetiapine, Sertraline. The duration of the stabilization period is up to six months. For cognitive moments, we use Nimodipine, Gliatilin, Donepezil, Pyritinol.

Signs of epilepsy in children, noticed for the first time, seriously scare parents. Violent convulsive seizures, which suddenly seize a healthy-looking baby, give the impression of a bolt from the blue.

The first thing moms and dads need to do is pull themselves together and examine the baby. Then you need to learn the maximum about epilepsy in children and master the techniques of effective assistance to the patient. It is important to understand: the disease is severe, insidious, but can be controlled and treated when adequate conditions are created for this.

What is epilepsy in children? Medical studies have shown that this pathology has a neurological chronic character and is caused by abnormal activity of the brain. It affects every one of the hundred inhabitants of our planet. Children with epilepsy are detected several times more often than adults. The main target of "falling" disease is babies up to a year old.

The mechanism of development of epileptic seizures is associated with an increase in the bioelectrical activity of its functional structures - neurons in a certain area of ​​the brain. These cells form a focus of congestive pathological excitation, the so-called epileptic focus. When, under the influence of certain causes, the bioelectric impulse is discharged, activating the cells of the entire brain, an epileptic attack occurs.

The child falls unconscious, his body shaking in convulsions. After a few minutes, the tension is replaced by muscle weakness. This is a manifestation of the fact that the electrical activity of neurons fades, goes into a "sleep" mode. With the return of consciousness, the patient does not remember what happened.

To choose the right strategy for correcting the disease, you need to find out its etiology. Doctors distinguish several causes of epilepsy in children:

1. Heredity. Scientists have identified a substance - dopamine - which is responsible for the inhibition of overexcited neurons. Its volume is programmed in the genes: if parents have epileptic seizures, then there is a chance that their offspring will inherit them.
2. Malformations of the fetal brain. Everything affects the health of a future person in the womb: at what age she conceived (middle-aged first-born women are included in the risk group), what she was ill with, how she was treated, whether she abused drugs, alcohol. Poisoning the fetus with toxic substances - main reason brain pathologies.
3. Birth trauma. The causes of epilepsy often lie in the excesses that accompany the birth process. The baby's brain can be damaged by midwife's forceps, prolonged labor, squeezing the newborn's neck with the umbilical cord.
4. Inflammatory diseases of the brain and its membranes: encephalitis, meningitis, arachnoiditis.
5. Febrile convulsions with colds can detect epilepsy in children with aggravated heredity.
6. Craniocerebral injuries. The application of mechanical blows to the head often leads to the appearance of epileptogenic foci in the brain.
7. Volumetric neoplasms. Tumors that press on the brain can cause seizures in children.
8. Disorders of metabolic processes, manifested by hyponatremia, hypocalcemia, hypoglycemia.
9. Cerebral blood flow disorders.
10. Teen addiction to ephedrine, amphetamines and other drugs.

Important: inflammatory disease"meningitis" can be fatal! It is very important to be able to recognize it in time. How? Read the answer in this article.

Depending on the pathogenesis, epilepsy in childhood is differentiated by specialists into three groups:

• idiopathic: it is stated if the symptoms of the disease appear as a result of a genetic factor, but without significant pathologies in the brain;
• symptomatic: it is considered a consequence of brain defects due to developmental anomalies, injuries, neoplasms;
• cryptogenic: fixed by physicians in cases where the disease appeared due to unidentified causes.

Symptomatic epilepsy in children differs in the area of ​​localization of the pathogenic focus.

And depending on the localization thereof, it manifests itself in several types:

• frontal;
• parietal;
• temporal;
• occipital;
• chronic progressive.

The listed types of epilepsy declare themselves in different ways. For example, the frontal comes only at night; the temporal is characterized by blackouts of consciousness without a pronounced convulsive symptom.

Finding out the causes of the disease and its type helps to choose an adequate line of struggle with it. However, this is not enough for successful healing: it is important to recognize the first signs of epilepsy in a child in a timely manner.

Symptoms of epilepsy in children are sometimes mistaken by unlucky adults for excessive motor activity. This is the main reason for the late detection of a dangerous disease. Another common mistake is to think that an epileptic seizure can only be manifested by convulsions and foaming at the mouth.

In order not to miss precious time, parents of babies need to have a detailed understanding of clinical picture which is used to recognize childhood epilepsy.

Its features are quite diverse:

1. Generalized seizures. They begin with an alarming harbinger - the aura. At this stage, the patient feels something like a breath running through the body or other unusual sensations. Then comes the stage of sharp muscle tension and breath holding - the child falls screaming. The turn of convulsions comes, the eyes roll back, foam comes out of the mouth, spontaneous urination and bowel movements can be observed. Convulsive twitching can cover the entire body or muscle group. The attack lasts a maximum of 20 minutes. When the convulsions stop, the patient comes to his senses for a few moments and immediately falls asleep in exhaustion.
2. Non-convulsive (small) seizures. These not always noticeable attacks of epilepsy in children are called absence seizures. It all starts with the fact that the baby with an absent look suddenly freezes. It happens that the patient's eyes are closed, the head is thrown back. For 15-20 seconds he does not perceive anything. Coming out of a painful stupor, he returns to interrupted cases. From the outside, such pauses may seem thoughtful or distracted.
3. Atonic seizures. The manifestation of attacks of this kind is a sudden loss of consciousness and muscle relaxation. Often they are mistaken for fainting. The periodicity of such states should alert.
4. Child spasm. Epilepsy in a baby can be manifested by a sharp raising of the arms to the chest, an involuntary tilt forward of the head and body when the legs are straightened. This happens most often with children 2-4 years old when they wake up in the morning. The seizure lasts for several seconds. By the age of 5, the alarming manifestations of the disease either disappear or take another form.
5. Speech disorder for several minutes while maintaining consciousness and the ability to move.
6. Frequent nightmares that cause the baby to wake up screaming and crying.
7. Sleepwalking.
8. Regular headaches, sometimes causing nausea and vomiting.
9. Sensory hallucinations: visual, olfactory, auditory, gustatory.

The last four signs do not necessarily indicate an epilepsy disease. If such phenomena began and began to be repeated repeatedly, parents should conduct a neuropsychiatric examination of the child.

The question of how to recognize epilepsy in a child under one year old is extremely important. In infancy, the disease often passes atypically. Parents need to be extremely attentive to the condition and behavior of the newborn.

For the initial stage of epilepsy in children under one year, the following symptoms are characteristic:

• sharp fading;
• cessation of swallowing movements;
• tilting the head;
• trembling of the eyelids;
• empty, seeing nothing;
• complete non-contact.

This is followed by loss of consciousness and convulsions, not always accompanied by spontaneous defecation and urination. It should be noted that epilepsy in children under one year old has a kind of prelude and completion. Harbingers of an attack are increased tearfulness, excessive excitability, febrile temperature. After the end of the seizure, the baby does not always sleep.

Diagnosis of epilepsy in children involves a phased examination of a small patient:

1. History taking: clarification of the moment of occurrence of the first attacks, symptoms accompanying an attack, conditions of intrauterine development and childbirth, the presence of neurological diseases and bad habits of parents.
2. The main instrumental technique: an electroencephalographic study with video recording, which provides complete information about the bioelectrical activity of the brain and the occurrence of defects in its structure.
3. Additional methods carried out to clarify the diagnosis and establish the cause of the disease: MRI and CT of the brain, blood tests to determine the metabolic and immune status, lumbar puncture.
4. Research in the framework of differential diagnosis: ophthalmoscopy, ultrasound of cardio-vascular system and other examinations prescribed by the attending physician.

Such an extensive diagnostic complex allows you to confidently confirm or exclude the presence of epilepsy.

To the question of whether epilepsy is treated in children, today's medicine gives a positive answer. The success of therapy depends both on the professionalism of physicians and on the mood of the parents.

The latter should be prepared for the fact that it will take a long time to treat epilepsy in a son or daughter, without interrupting the course for a day.

What is required from parents:

• provide the baby with a diet with fluid and salt restriction;
• organize a rational regimen of the day with leisure breaks;
• eliminate stressful situations;
• limit the child's access to the TV and computer;
• make it a habit to walk in the fresh air, but not allow prolonged exposure to the sun, self-bathing in a pond or bath;
• encourage the child to engage in safe sports: badminton, tennis, cross-country skiing, etc.

During a seizure, you need to put the baby on his side in a safe place. You can not restrain convulsions, open your jaws, give medicine or water. The main task of the parents of an epileptic is to prevent him from harming himself.

Drug treatment of epilepsy in children is determined taking into account age characteristics and the patient's condition. The main role is given to anticonvulsants.

With a symptomatic form of pathology caused by a tumor in the brain, the patient can be cured surgically. Before the operation, a consultation of a neurosurgeon, a neurologist and a psychotherapist gathers, the risks of invasive intervention and the opinion of the parents are taken into account.

If the danger of the operation is too high, the question “how to treat the patient?” decided in favor of drug therapy.

In 80% of cases persistent and long-term treatment epilepsy in children leads to getting rid of a serious illness. The immediate environment of small epileptics should help them develop normally and find their place in society. Patience, wisdom and love of parents play a colossal role in this.

Epilepsy in children is one of the most common chronic neurological pathologies. In most cases (80%), it begins to appear already in childhood. Timely detection makes it possible to carry out more effective treatment, which will allow the patient to lead a full life in the future.

Epilepsy - serious disease which requires serious medical treatment

Epilepsy is a neurological disease that is chronic. It is characterized by the sudden onset of epileptic seizures associated with a disorder of brain activity.

During a paroxysmal attack, the patient cannot control himself, the motor, mental and sensitive functions are turned off. It is almost impossible to predict its appearance, since the disease is among the little-studied and is mainly transmitted at the genetic level.

Epilepsy is more commonly diagnosed in children. If we consider at what specific age it can manifest itself, then there is no definite answer. Basically, the disease is detected, starting from the age of 5 and up to 18 years.

The child's brain is endowed with bioelectrical activity, which is why certain electrical discharges occur with a clear periodicity. If the baby is healthy and there are no deviations in the functioning of the brain, then these processes do not provoke abnormal changes in the state.

Epileptic seizures occur when electrical discharges are of varying intensity and frequency. Depending on in which part of the cerebral cortex pathological discharges are formed, the course of the disease differs.

The causes of epilepsy include:

• defects in the structure of the brain;
• pathological processes during labor;
• Down's disease;
• conjugative jaundice in infants;
• anomalies in the formation of the brain;
• concussions, craniocerebral injuries;
• heredity;
• diseases of the central nervous system, accompanied by a severe course (convulsions, heat, chills, fever);
• infectious / viral diseases brain structures.

Since the concept of "epilepsy" includes about 60 varieties of the disease, it is difficult to determine it by individual signs. Many parents believe that this pathology manifests itself only in the form of epileptic seizures, so they do not attach importance to some alarming signals. For each age, children have the main distinguishing symptoms that you can independently recognize.

Symptoms of the disease in infants are not always recognized on time, which is why special supervision is required for children in the first years of life.

Pathology in newborns and children up to a year manifests itself in the same way. Parents should seek immediate medical attention if any of the following signs are observed:

• blue lip triangle during feeding;
• involuntary twitching of the limbs;
• focusing the gaze at one point;
• the baby does not respond to sounds for several minutes, starts to cry, spontaneous defecation is possible;
• the muscles on the face become numb, then contract rapidly.

Schoolchildren and adolescents often have worse behavior, because of their illness they become irritable and aggressive, their mood changes dramatically. Such children definitely need the help of a psychologist, otherwise it will affect the mental and physical health of the child. Parents should provide their child with support and care so that relationships with peers, study and free time do not cause negative outbursts.

The frequency of seizures may increase. It is necessary to control the intake of tablets, as children often deliberately neglect this.

Types and forms of epilepsy

More than 40 types of epilepsy are distinguished. The classification of the disease depends on several factors - the characteristic symptoms, the localization of the pathological site, the dynamics of the course of the pathology and the age when the first epileptic signs were detected. The main types of the disease are symptomatic epilepsy in children, rolandic, nocturnal, etc.

The absence form of the disease manifests itself at 5-8 years of age.

The disease is classified not only by type, there are several of its forms. Depending on the area of ​​the affected area, the course of attacks will differ. There are 4 forms of epilepsy:

Seizures are often accompanied by involuntary urination

There are such forms:

• Children's spasm - manifestations begin by 2 - 6 years. The attack appears immediately after sleep, is expressed in shaking (nodding) of the head, while the hands are brought to the chest. Continues for several seconds.
• Atonic seizures - look like a normal faint.
• Convulsive seizures - last from 30 seconds to 25 minutes. Initially, muscle cramps appear, breathing is almost absent. Convulsions may be accompanied by enuresis.
• Non-convulsive seizures (absences) - are observed from the age of 5. The kid throws his head back for 20-30 seconds, his eyelids are closed and tremble a little.

If parents notice signs of epilepsy in their child, then you should contact a neurologist to go through a series of diagnostic procedures. Not always deviations in the behavior of children indicate the presence of the disease.

This can be both a variant of the norm (for example, in infants it is very easy to confuse increased motor activity with signs of epilepsy), and a symptom of other neurological pathologies. Diagnostic methods used in modern medicine:

• encephalography;
• deprivation, photostimulation, sleep hyperventilation;
• EEG video monitoring and EEG of nocturnal sleep.

If a child is suspected of having a disease, a CT or MRI of the brain is performed

In some cases, the doctor prescribes a second examination, because. epileptiform activity in a child is possible without the presence of this disease. Diagnosis will help confirm / refute the diagnosis, prescribe effective treatment and track the dynamics of the pathology.

When the diagnosis is made, the doctor prescribes an effective treatment to eliminate the cause that provokes unpleasant symptoms and paroxysms caused by incorrect activation of neurons. In modern medicine, several medical methods(mono/polytherapy, non-drug treatment and surgery).

Therapy for each patient is selected individually, the specialist takes into account the severity of symptoms, the frequency and severity of seizures. The course is from 2 to 4 years, sometimes lifelong treatment is required. Regardless of the doctor's prescription, the patient should additionally observe the following recommendations:

• correct daily routine;
• special (ketogenic) diet;
• if necessary, visit a psychologist.

It is impossible to predict the occurrence of an attack, so parents need to know the rules that you should definitely follow during it. Knowing and applying the recommendations will help to provide the child with first aid without causing harm to health.

Action algorithm:

• put the baby on a flat, not overpriced surface;
• you can turn the head and torso on its side so that the vomit does not enter the respiratory tract;
• if there is no natural influx of fresh air, open the window;
• do not try to stop the seizure or insert a solid object into the mouth;
• if the attack lasts more than 5 minutes, call an ambulance.

Drug treatment is prescribed by a course that varies from several months to several years. Its main task is to reduce the frequency of seizures and gain control over them. Usually this method is enough for the patient to get better, in 30% of all cases it is possible to achieve a complete recovery.

The doctor prescribes anticonvulsants. Reception begins with a small dose, the dosage is gradually increased. To date, use such medicines as:

• diazepam;
• Luminali;
• Tegretol;
• Convulex;
• Fenlepsin;
• Depakine;
• Levetiracetam;
• Oxcarbazepine;
• Lamotrigine;
• Difenin.

The main method of non-drug therapy is the ketogenic diet. The foods consumed should have the correct ratio of carbohydrates, proteins and fats (4 grams of fat per 1 gram of proteins and carbohydrates). The following methods are also used to help treat the disease: biofeedback therapy, immunotherapy, psychotherapy and hormones.

Surgery is done only as a last resort. It is effective in the treatment of symptomatic epilepsy, which is provoked by the appearance of neoplasms (frontal, temporal form). Use the following methods of surgical intervention:

• extratemporal resection;
• hemispherectomy;
• anterior temporal lobectomy;
• installation of implants to stimulate the vagus nerve;
• limited temporal resection.

In children under one year old, the treatment is most successful, it is possible to achieve a complete recovery, especially if the cause of epilepsy is heredity. Such children are no different from their peers and develop according to age.

Taking anticonvulsant drugs during adolescence in 75% of cases allows you to stop all the symptoms, eliminate the occurrence of seizures and completely cure the patient. If the recommendations are followed, the forecast for the future is favorable.

For prevention purposes, parents should monitor the well-being of their child and periodically visit a neurologist. After recovery and elimination of seizures, you can continue to follow a diet, as well as maintain a normal psycho-emotional state.

Focal epilepsy is diagnosed in % of all cases. Patients with this diagnosis receive III group disabilities, but can still lead relatively normal lives.

This disease is included in the group of heterogeneous. The development of symptomatic focal epilepsy is based on:

• violations of the metabolic process in certain areas of the brain;
• violations of the process of blood supply.

Despite the fact that, as a rule, the disease manifests itself in early childhood It can develop in a person at any age. Here are some reasons why a person may get sick:

• traumatic brain injury, such as a concussion;
• infectious and viral diseases carried on the legs;
• various diseases of internal organs;
• inflammatory process in the brain;
• trauma during childbirth in newborns;
• dysgenesis of nervous tissue;
• arterial hypertension;
• dysplasia of the vessels of the neck;
• osteochondrosis cervical spine;
• serious violations cerebral circulation.

At the same time, focal epilepsy can make itself felt even several years after the illness or injury.

Classification of epileptic lesions

It is customary to distinguish the following types of symptomatic epilepsy depending on the affected area:

1. Temporal. It is characterized by a violation of those parts of the brain that are responsible for logical thinking, hearing, and behavioral characteristics of the individual. There are hippocampal, lateral, neocortical and other varieties temporal lobe epilepsy. In childhood, the amygdala form is common.
2. Frontal. It is characterized by speech impairment, deep cognitive disorders.
3. Parietal. It is characterized by a violation of motor functions, may be accompanied by convulsions, paresis.
4. Occipital. It is characterized by impaired vision, coordination of movements, and is also accompanied by rapid fatigue of the patient.

Each of these types of epilepsy is accompanied by characteristic symptoms.

Clinical picture in symptomatic focal epilepsy

Symptoms depend on which area of ​​the brain is affected. In this regard, the classification of seizures that accompany focal epilepsy is accepted in medicine. Such attacks are observed both in children and in adult patients:

1. Partial simple seizure. It is characterized by the absence of significant deviations in cognitive consciousness. After an attack, the patient's consciousness may be somewhat confused, the brain functions, vegetative, sensory and motor functions.
2. Partial complex, complex attack. Psychomotor attack, which often develops against the background of a simple attack. It is characterized by the fact that after it the consciousness is disturbed, obsessive thoughts and ideas, hallucinations appear. In addition, certain systems of the body are violated, which depends on the affected area. For some time after the attack, the patient has confused consciousness.
3. Secondarily generalized. It occurs on the background of a partial seizure. It is characterized by complete loss of consciousness. May be accompanied by convulsions (but not always), autonomic symptoms. In babies, an attack is accompanied by severe and frequent vomiting, tearfulness, and increased sweating.

In addition, a partial, or focal, attack is distinguished. In this case, convulsions are also observed, but they are partial, because only a certain part of the brain is damaged. So, the patient can “convulse” one hand with a cramp, only fingers can twitch, the whites of the eyes begin to rotate spontaneously, etc.

Diagnosis of the disease

Modern medicine has such diagnostic methods that allow you to identify the disease at the very beginning of its development. This means that it is possible to prevent the further development of the disease even at the stage of its inception. Diagnostic research has several goals:

• exclude symptoms characteristic of epilepsy;
• determine the form of the attack that occurred with the patient;
• determine the most correct and effective treatment regimen for a particular patient.

The neurologist makes the diagnosis and prescribes treatment. When a child is brought in for a consultation with a doctor with suspected epilepsy, the neurologist first collects an anamnesis. This involves studying the life of the patient and the history of the disease. The doctor collects information about the state of health of the parents in order to identify the factor of heredity, listens to the complaints of the parents, etc. Special attention the doctor pays attention to the health of the mother, since in children the symptoms of focal epilepsy very often pass from her.

Besides, great importance has the age of the patient. Children are much more likely than adults to develop complications.

At the consultation, parents (if they bring a child to the doctor) or an adult patient should be prepared for the fact that a neurologist may ask:

• average duration of an attack;
• the frequency of seizures;
• the age at which the seizures began;
• sensations experienced by the patient during an attack;
• factors, situations that precede an attack;
• measures that help alleviate the condition, and their effectiveness.

It may be necessary to evaluate not only the parents, but also the patient's friends, eyewitnesses of the attack, because the patient cannot objectively evaluate himself during the attack. After a conversation with relatives and the patient, the neurologist sends the patient for hardware diagnostics. For diagnosis use:

• magnetic resonance imaging, or MRI;
• electroencephalogram, or EEG.

These are the main methods that allow you to measure brain parameters, record and visualize them. In addition, using the EEG, it is possible to detect violations of the transmission of electrical impulses, which is extremely important, because these violations are the basis of epilepsy.

It is important to study the tone of the muscles, the work of the organs. Particular attention is paid to controllable damaged areas of the brain.

Additional research is being carried out, namely:

1. Laboratory research. Examine the level of glucose in the blood, indicators of electrolytes, the presence of infections, etc.
2. Magnetic resonance spectroscopy.
3. Positron emission computed tomography, or SPECT.

Only after the diagnostic procedures have been carried out, the doctor makes the final diagnosis and prescribes the appropriate treatment.

Epilepsy Treatment Methods

Treatment is aimed at freeing the patient from seizures.

The disease is treated with medication. Prescribe antiepileptic drugs (AEP) depending on the nature of the seizures. In this case, the patient is trying to prescribe the minimum dose of the drug, as far as possible. This is necessary to achieve the desired effect, but without adverse reactions.

So, for simple and complex seizures, Clobazam, Lacosamide, Phenytoin, Topiramate, Valproate, Zonisamide, etc. are prescribed. For generalized seizures, Carbamazepine, Levetiracetam, Pregabalin can be prescribed , "Tiagabin", etc.

At the same time, if the patient was diagnosed recently, monotherapy is always carried out, that is, treatment with one drug, in other cases, polytherapy with two or three (but not more) medications may be necessary.

Socialization of patients with epilepsy

When a child is diagnosed, a lot depends on the parents. It is very important that parents treat their child as healthy person and brought up in him the same attitude towards himself. Doctors give such recommendations:

• encourage the child to communicate with peers;
• choose to study at school, in the classroom, and not at home;
• organize leisure activities for the child, which will include communication with other children, learning something new.

As a rule, seizures of focal epilepsy in children are episodic and do not affect their mental abilities in any way. Children can study according to the regular school curriculum. The same applies to sports and physical education, with a restriction on exercises where falls and head injuries are inevitable. Most of the children subsequently go to universities and learn professions.

It is necessary to educate in the child an attitude towards himself as a full-fledged personality, significant and necessary in the family. If a child from childhood feels significant and needed by his relatives, with age he will also feel needed by society. It is important to discuss this issue with teachers at school so that they treat the child as a healthy person and do not do him any favors.

If an adult is already sick, a lot depends on the patient himself, and not just on his relatives. And here doctors also give similar recommendations:

• strive to communicate with other people;
• do not lock yourself in;
• load the brain, learn something new.

Highly important point- psychological setting. If a person wants to live a full life, he must drive away thoughts about his own inferiority, insolvency, etc. Such a “psychology of the disabled person” will not lead to anything good. On the contrary, an optimistic life position, social activity, a positive attitude are the right path to recovery.

It is very important that a person is not only socially, but also physically active, leads healthy lifestyle life.

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Focal symptomatic epilepsy in children prognosis

There are 3-6 times more children with epilepsy than adults. And the prognosis for young patients is generally favorable.

With careful treatment modern medicines and compliance with the rules of a healthy lifestyle in 75% of cases, they completely get rid of this disease with age.

The tendency to epilepsy and the beginning of its development are expressed in the characteristics of the child's behavior, which parents should pay attention to: the earlier the diagnosis is made, the more successful the treatment is then.

signs

A distinctive feature of the disease is that the symptoms of epilepsy in children are significantly different from the manifestations of the same disease in adults. Convulsive seizures are far from the only sign of "falling" (as this disease was called in the old days). Parents need to know the variety of clinical manifestations of epilepsy in order to identify the disease by the first signs and start treatment in a timely manner.

At the beginning of an epileptic seizure, the muscles tighten sharply, breathing is held for a short time. Then convulsions begin, convulsions lasting from 10 seconds to 20 minutes. Often, the child spontaneously empties the bladder. The convulsions stop on their own, and the tired, exhausted patient falls asleep.

Children with epilepsy may also be subject to non-convulsive seizures (in medicine they are called absences), which are not so noticeable. Suddenly the child freezes, his gaze becomes absent, empty, the eyelids tremble. During an attack, the patient may tilt his head back or close his eyes. He does not react to others, at this moment it is futile to attract his attention. After an attack, the baby calmly returns to the business that he was busy with before the attack. All this lasts no more than 20 seconds. Parents, not knowing about non-convulsive seizures, may not notice them, pay no attention, take them for the usual absent-mindedness of their child.

Attacks of this kind are characterized in children by a sharp loss of consciousness with relaxation of all muscles. Many perceive it as an ordinary faint. If the child periodically loses consciousness, this is a signal to undergo an examination and identify the real causes of such conditions.

Often, epilepsy is manifested by involuntary bringing the arms to the chest, tilting the entire body, head forward, and sharp straightening of the legs. Such attacks occur most often in the morning after waking up and last a few seconds. These are the first signs of childhood epilepsy, very young children of two years old suffer from them, by the age of five, seizures can go away completely or go into another form of the disease.

First symptoms

The symptoms of epilepsy in children of different ages depend, first of all, on the form of the disease, the severity, especially since in different forms has its own main characteristics. The standard signs of epilepsy in children include respiratory arrest, loss of consciousness, severe muscle tension in the body, which is accompanied by straightening the legs and bending the arms at the elbows, involuntary urination and defecation, as well as rhythmic muscle contractions throughout the body in the form of convulsions. In addition, the main sign of an attack of the disease is the rolling of the child's eyes, twitching of the legs and arms, and a change in the shape of the lips.

Often the first signs appear as early as kindergarten or at school when caregivers or teachers point out a child's odd behavior. Such behavior can include anger, convulsions, aggression, sleep disturbance, or temporary cessation of breathing. As a rule, epileptic seizures in children last no more than two minutes, however, if any of the symptoms are detected, it is urgent to call medical care. You should also see a doctor if:

signs of epilepsy in a child are observed for the first time or last more than five minutes;

after the attack ends, the child cannot breathe evenly and calmly;

convulsions during an attack are relatively short, but are repeated very often.

Causes

Epilepsy can be symptomatic, arising against the background of the existing pathology of the brain tissue. Then the reasons can be identified modern methods research.

Typically, brain tissue can be damaged as a result of exposure to the brain:

birth trauma, hemorrhage,

intrauterine infections of the nervous system and brain,

acquired brain infections,

traumatic brain injury with damage to the substance of the brain,

malformations in the development of the brain (cysts, underdevelopment),

chromosomal pathology, chromosomal diseases,

metabolic diseases and disorders.

All these causes lead to the development of the so-called "symptomatic" forms of epilepsy.

But, many of the existing forms of epilepsy in children are not based on apparent reason, they are genetically determined, and many are defined as a whole complex of features of genetic and prenatal and postnatal causes. In this case, a pathological epileptic focus of activity is formed, but at the same time, even a very deep and targeted examination of the brain does not reveal any structural lesions in the region of the brain tissue. Thus, this epilepsy is considered idiopathic - for no apparent reason.

Focal

Childhood epilepsy is a fairly common phenomenon, most often at such a young age, benign focal diseases can be found. According to statistics, a quarter of children suffer from afebrile seizures. These attacks occur infrequently, most likely at night.

If convulsions have begun, then they can stop in a year or three, it all depends on the degree of damage to the baby. Many patients with this disease only once in their entire lives were subject to a short or long attack. Sometimes there may be isolated attacks, vegetative.

As we have already found out, benign focal epilepsy is manifested by rare seizures, but despite this, the EEG shows that the child's body suffers from quite pronounced disorders in the form of high-amplitude spikes. In very rare cases, a normal EEG can be recorded, so it is best for patients to be examined at night during sleep.

Note that the same syndrome can evolve and change over time. Most often it depends on the age of the patient: the faster the children get older, the more one form of epilepsy is replaced by another.

ketogenic diet

The ketogenic diet is most commonly used in pediatric patients. The child is placed on inpatient treatment and fasting is prescribed for two to three days, after which they begin to diet. A child should follow a ketogenic diet for 2-3 days, and after that, as a rule, he is transferred to a regular diet.

Such a diet is considered especially effective in childhood from 1 year to 12 years. Often, doctors prescribe it when antiepileptic drugs do not show the expected effectiveness, or provoke the development of unwanted side effects.

Treatment of children with a diet must necessarily take place under the supervision of a specialist in baby food and a neurologist. In the early days, when the baby is starving, he is allowed to drink only water and tea without sugar. About a day later, a quick test for the content of ketone substances in the urinary fluid is used: if there are enough ketones, then you can start introducing high-fat foods into the diet.

It is important that the doctor carefully monitors what the child eats, since even a small increase in the caloric content of the diet can adversely affect the effectiveness of dietary treatment.

Usually, a sick child is discharged after about a week, while there is a decrease in the frequency of convulsive seizures over the next 3 months. If this dietary treatment in a particular patient is recognized as successful, then it is periodically repeated for 3-4 years.

Side effects of the ketogenic diet sometimes include nausea, difficulty defecation, and hypovitaminosis.

symptomatic

At given state organism in one of the hemispheres of the brain at the cellular level, a pathologically active focus of excitation of neurons is formed. This focus is surrounded by a "protective shaft" with the direct participation of antiepileptic structures, which for some time restrain an excess electrical charge. But there comes a moment when the charge, having accumulated, becomes redundant, and the "protective shaft" breaks through. As a result of this - the rapid spread of excitation to both hemispheres and ... an epileptic seizure. In childhood, the excitability of brain structures is significantly increased, which explains the high incidence among children before the onset of puberty: more than 80% of the first seizures occur in the first few years of life.

To make a diagnosis of symptomatic epilepsy, the following tests should be performed.

Magnetic resonance imaging of the brain. This study allows you to determine the area of ​​\u200b\u200bthe brain in which these changes occurred, as well as the degree of these changes.

Video-electroencephalographic monitoring, which can capture local epileptic activity. The most successful option is the registration of epileptic seizures that begin partially.

If the seizures themselves cannot be fixed, then the affected area can be determined by the symptoms of seizures. However, such a characterization may not be accurate, since sometimes there are cases when an attack originates in the temporal region and continues already in the frontal region.

Also, the main methods for diagnosing symptomatic epilepsy include: computed tomography, craniography, echoelectroencephalography, angiography, pneumoencephalography, examination of the fundus and cerebrospinal fluid.

Causes of symptomatic epilepsy in children

There are several reasons that provoke the development of symptomatic epilepsy in children.

The greatest number of diseases are the result of hypoxia, both intrauterine and asphyxia during childbirth and congenital malformation of the brain. According to statistics, over 75% of children suffering from cerebral dysplasia have epileptic seizures in the clinic that occur before the age of 5 when the body temperature rises above 38⁰С. Transferred infectious and specific meningitis, encephalitis, as well as traumatic brain injuries - concussions and bruises of the brain, can provoke the development of symptomatic epilepsy. Often, severe infections and intoxications, as well as brain tumors and various diseases, lead to epilepsy. genetic diseases such as neurofibromatosis, Sturge-Weber disease, hepatolenticular degeneration (Wilson-Konovalov disease), tuberous sclerosis. Among the causes of epilepsy, doctors also distinguish cerebrovascular accidents and leukoencephalitis.

Night

Some forms of epilepsy may also appear at night in the form of seizures. At the same time, cramps at night are no more dangerous than daytime ones, and most children do not have any problems later. The child may be injured during a night attack. To avoid this, take some precautions: for example, make sure that there are no sharp or potentially dangerous objects near the bed. Some parents sleep with their children to be close to the child during an attack, but doctors do not consider this the best solution. There are other options: - Use a baby monitor. - Attach a noisy device such as a bell to the bed. - Place the baby's bed next to the wall of your room. In the morning, you can often see signs that the child has had an attack - unusual fatigue or bedwetting.

Nocturnal epilepsy in children is not considered a separate form of the disease, because. nighttime attacks can disturb the child when different types illness. However, approximately 15-20% of children have epileptic seizures during sleep, so doctors use this terminology for more exact definition symptoms of epilepsy. If seizures bother the baby at night, it is important to determine the sleep phase, because. this information indicates the focus of the brain lesion, which helps to choose the optimal treatment. Despite the physiological and psychological complexity of epilepsy, in children this disease is almost always successfully treatable. The most important thing is that parents notice the symptoms of the disease in time and immediately consult a doctor.

absence

It occurs more often in girls aged 2 to 8 years and is considered a benign form of the disease. At timely diagnosis and the constant use of anticonvulsants, the duration of the disease averages 6 years with a favorable prognosis and in most cases ends with a complete cure or long-term remission up to 18–20 years (70–80% of cases).

Parents need to know the symptoms of manifestation in order to contact a specialist in a timely manner and start treating the baby.

Absences have characteristic features.

1. Sudden onset against the background of full health. As a rule, harbingers of seizures are very rare, but sometimes they can be manifested by headache, nausea, sweating or palpitations, behavior uncharacteristic for a child (panic, aggression) or various sound, taste and auditory hallucinations.

2. The attack itself is manifested by freezing symptoms:

the child suddenly completely interrupts or slows down his activity - the baby becomes motionless (freezes in one position) with an absent face and fixed at one point or an empty look;

fails to attract the attention of the child;

after the end of the attack, the children do not remember anything and continue the movements or conversation they have begun (a “hang-up” symptom).

These attacks are characterized by a deep disturbance of consciousness with its instant recovery at the same time. average duration attack is from 2-3 to 30 seconds.

It is important to remember that very short absences are not felt by the patient, and for a long time they are not noticed by parents or teachers.

It is important for teachers and parents to know - with a decrease in academic performance (for no apparent reason) - absent-mindedness in the classroom, deterioration of calligraphy, text omissions in notebooks - it is necessary to be alarmed and examine the child. Such symptoms should not be ignored, let alone scolded children. Without proper treatment, the signs will progress, and "small" forms of epilepsy may be complicated by typical convulsive seizures.

idiopathic

If we are talking about the idiopathic form, then it manifests itself in the following signs:

Tonic cramps, when the legs are straightened, certain muscles remain motionless.

Convulsions are clonic, when there is a contraction of various muscles.

The transition of one convulsions to others.

Often the child completely loses consciousness, during which there is a short-term cessation of breathing. Against this background, there is an involuntary devastation Bladder and profuse salivation. Foam coming out of the mouth may turn red. This happens as a result of the fact that during the attack the tongue was bitten. When the seizure ends and the child regains consciousness, he remembers absolutely nothing.

Cryptogenic

Cryptogenic epilepsy, like any other, is treated with anticonvulsants. The doctor determines the dosage, type and duration of use after careful diagnosis and dynamic monitoring of the patient. Medical therapy can last from three to five years and does not always bring the expected results.

The drugs of choice are derivatives of barbituric and valproic acid, carbamazepine, various tranquilizers. The advantage is given to monotherapy, but with its insufficient effectiveness medicines combine. Patients are shown the correct daily regimen, a healthy lifestyle and the prevention of nervous shocks.

focal epilepsy

Focal epilepsy is a type of epilepsy in which epileptic seizures are caused by a limited and clearly localized area of ​​increased paroxysmal brain activity. It is often secondary. It is manifested by partial complex and simple epiparoxysms, the clinic of which depends on the location of the epileptogenic focus. Focal epilepsy is diagnosed according to clinical data, EEG results and MRI of the brain. Antiepileptic therapy and treatment of causative pathology are carried out. According to the indications, it is possible to surgically remove the zone of epileptic activity.

focal epilepsy

The concept of focal epilepsy (FE) unites all forms of epileptic paroxysms, the occurrence of which is associated with the presence of a local focus of increased epi-activity in the cerebral structures. Starting focally, epileptic activity can spread from the focus of excitation to the surrounding brain tissue, causing a secondary generalization of the epileptic seizure. Such paroxysms of FE should be distinguished from attacks of generalized epilepsy with a primary diffuse character of excitation. In addition, there is a multifocal form of epilepsy, in which there are several local epileptogenic zones in the brain.

Focal epilepsy accounts for about 82% of all epileptic syndromes. In 75% of cases, it makes its debut in childhood. Most often, it occurs against the background of brain development disorders, traumatic, ischemic or infectious lesions. Such secondary focal epilepsy is detected in 71% of all patients with epilepsy.

Causes and pathogenesis of focal epilepsy

The etiological factors of FE are: malformations of the brain affecting its limited area (focal cortical dysplasia, arteriovenous malformations of the brain, congenital cerebral cysts, etc.), traumatic brain injury, infections (encephalitis, brain abscess, cysticercosis, neurosyphilis ), vascular disorders (past hemorrhagic stroke), metabolic encephalopathy, brain tumors. The cause of focal epilepsy may be acquired or genetically determined disorders in the metabolism of neurons in a certain area of ​​the cerebral cortex, not accompanied by any morphological changes.

Among the etiofactors of focal epilepsy in children, there is a high proportion of perinatal CNS lesions: fetal hypoxia, intracranial birth trauma, neonatal asphyxia, intrauterine infections. The emergence of a focal epileptogenic focus in childhood is associated with a violation of the maturation of the cortex. In such cases, epilepsy is temporary age-dependent.

The pathophysiological substrate of FE is the epileptogenic focus, in which several zones are distinguished. The zone of epileptogenic damage corresponds to the area of ​​morphological changes in the cerebral tissue, which in most cases are visualized using MRI. The primary zone is the area of ​​the cerebral cortex that generates epi-discharges. The area of ​​the cortex, during the excitation of which an epileptic seizure occurs, is called the symptomatogenic zone. There is also an irritative zone - an area that is a source of epi-activity recorded on the EEG in the interictal period, and a functional deficit zone - an area responsible for neurological disorders associated with epileptic seizures.

Classification of focal epilepsy

It is customary for neurologists to distinguish between symptomatic, idiopathic, and cryptogenic forms of focal epilepsy. With a symptomatic form, it is always possible to establish the cause of its occurrence and identify morphological changes, which in most cases are visualized during tomographic studies. Cryptogenic focal epilepsy is also called probably symptomatic, which implies its secondary nature. However, with this form, no morphological changes in modern ways neuroimaging is not detected.

Idiopathic focal epilepsy occurs in the absence of any changes in the central nervous system that could lead to the development of epilepsy. It may be based on genetically determined canal and membranopathies, disorders of the maturation of the cerebral cortex. Idiopathic FE wears benign character. It includes benign rolandic epilepsy, Panagiotopoulos syndrome, Gastaut's childhood occipital epilepsy, benign infantile episyndromes.

Symptoms of focal epilepsy

The leading symptom complex of PE is recurrent partial (focal) epileptic paroxysms. They can be simple (without loss of consciousness) and complex (accompanied by loss of consciousness). Simple partial seizures by their nature are: motor (motor), sensitive (sensory), vegetative, somatosensory, with a hallucinatory (auditory, visual, olfactory or gustatory) component, with mental disorders. Complex partial epileptic seizures sometimes begin as simple ones, and then there is a violation of consciousness. May be accompanied by automatisms. In the period after the attack, there is some confusion.

Secondary generalization of partial seizures is possible. In such cases, the epileptic seizure begins as a simple or complex focal, as it develops, excitation diffusely spreads to other parts of the cerebral cortex and the paroxysm takes on a generalized (clonic-tonic) character. A single patient with PE may have different types of partial paroxysms.

Symptomatic focal epilepsy, along with epileptic seizures, is accompanied by other symptoms corresponding to the main brain lesion. Symptomatic epilepsy leads to cognitive impairment and decreased intelligence, to mental retardation in children. Idiapathic focal epilepsy is distinguished by its benign nature, is not accompanied by neurological deficit and disorders of the mental and intellectual spheres.

Features of the clinic depending on the localization of the epileptogenic focus

Temporal focal epilepsy. The most common form with localization of the epileptogenic focus in the temporal lobe. For temporal epilepsy, sensorimotor seizures with loss of consciousness, the presence of an aura and automatisms are most characteristic. The average duration of an attack. In children, oral automatisms predominate, in adults - automatisms by the type of gestures. In half of the cases, paroxysms of temporal FE have a secondary generalization. With a lesion in the temporal lobe of the dominant hemisphere, post-attack aphasia is noted.

Frontal focal epilepsy. The epicenter located in the frontal lobe usually causes stereotypical short-term paroxysms with a tendency to seriality. Aura is not typical. Often there is a turn of the eyes and head, unusual motor phenomena (complex automatic gestures, foot pedaling, etc.), emotional symptoms (aggression, screaming, excitement). With a focus in the precentral gyrus, motor paroxysms of Jacksonian epilepsy occur. Many patients experience epileptic seizures during sleep.

Occipital focal epilepsy. When the focus is localized in the occipital lobe, epileptic seizures often occur with visual impairment: transient amaurosis, narrowing of visual fields, visual illusions, ictal blinking, etc. frequent view paroxysms - visual hallucinations lasting up to 13 minutes.

Parietal focal epilepsy. The parietal lobe is the rarest localization of the epicenter. It is mainly affected by tumors and cortical dysplasia. As a rule, simple somatosensory paroxysms are noted. After an attack, short-term aphasia or Todd's paralysis is possible. When the zone of epiactivity is located in the postcentral gyrus, sensory Jacksonian seizures are observed.

Diagnosis of focal epilepsy

For the first time, a partial paroxysm is a reason for a thorough examination, since it may be the first clinical manifestation serious cerebral pathology (tumors, vascular malformations, cortical dysplasia, etc.). During the survey, the neurologist finds out the nature, frequency, duration, sequence of development of the epileptic seizure. The abnormalities revealed during the neurological examination indicate the symptomatic nature of FE and help to establish the approximate localization of the lesion.

Diagnosis of epileptic brain activity is carried out using electroencephalography (EEG). Often, focal epilepsy is accompanied by epi-activity recorded on the EEG even in the interictal period. If the usual EEG turns out to be uninformative, then an EEG is performed with provocative tests and an EEG at the time of the attack. The exact location of the epicenter is established during subdural corticography - EEG with the installation of electrodes under the dura mater.

Identification of the morphological substrate underlying focal epilepsy is performed by MRI. To detect the slightest structural changes, the study should be carried out with a small thickness of sections (1-2 mm). With symptomatic epilepsy, MRI of the brain makes it possible to diagnose the underlying disease: focal lesion, atrophic and dysplastic changes. If abnormalities were not detected on MRI, then the diagnosis is idiopathic or cryptogenic focal epilepsy. Additionally, PET of the brain can be performed, which reveals an area of ​​cerebral tissue hypometabolism corresponding to an epileptogenic focus. SPECT in the same area determines the zone of hyperperfusion during an attack and hypoperfusion - in the period between paroxysms.

Treatment of focal epilepsy

Therapy for focal epilepsy is carried out by an epileptologist or neurologist. It includes the selection and constant use of anticonvulsants. The drugs of choice are carbamazepine, valproic derivatives, topiramate, levetiracetam, phenobarbital, etc. In symptomatic focal epilepsy, the main point is the treatment of the underlying disease. Usually, pharmacotherapy is quite effective in occipital and parietal epilepsy. With temporal lobe epilepsy, often after 1-2 years of treatment, resistance to ongoing anticonvulsant therapy is noted. The lack of effect of conservative therapy is an indication for surgical treatment.

Operations are performed by neurosurgeons and can be aimed at both removal of a focal formation (cysts, tumors, malformations) and resection of an epileptogenic area. Surgical treatment epilepsy is advisable with a well-localized focus of epi-activity. In such cases, focal resection is performed. If individual cells adjacent to the epileptogenic zone are also a source of epiactivity, extended resection is indicated. Surgical treatment is carried out taking into account the individual structure of the functional areas of the cortex, established using corticography.

Prognosis of focal epilepsy

In many respects, the prognosis of PE depends on its type. Idiopathic focal epilepsy is characterized by a benign course without the development of cognitive impairment. Its outcome is often the spontaneous cessation of paroxysms when the child reaches adolescence. The prognosis of symptomatic epilepsy is determined by the underlying cerebral pathology. It is most unfavorable for tumors and severe malformations of the brain. Such epilepsy in children is accompanied by mental retardation, which is especially pronounced in the early onset of epilepsy.

Among the patients who underwent surgery, 60-70% had no or significant decrease in epiparoxysms after surgery. The final disappearance of epilepsy in the long-term period was observed in 30%.

Signs of epilepsy in children, noticed for the first time, seriously scare parents. Violent convulsive seizures, which suddenly seize a healthy-looking baby, give the impression of a bolt from the blue.

The first thing moms and dads need to do is pull themselves together and examine the baby. Then you need to learn the maximum about epilepsy in children and master the techniques of effective assistance to the patient. It is important to understand: the disease is severe, insidious, but can be controlled and treated when adequate conditions are created for this.

What is epilepsy in children? Medical studies have shown that this pathology has a neurological chronic character and is caused by abnormal activity of the brain. It affects every one of the hundred inhabitants of our planet. Children with epilepsy are detected several times more often than adults. The main target of epilepsy is children up to a year old.

The mechanism of development of epileptic seizures is associated with an increase in the bioelectrical activity of its functional structures, neurons, in a certain area of ​​the brain. These cells form a focus of congestive pathological excitation, the so-called epileptic focus. When, under the influence of certain causes, the bioelectric impulse is discharged, activating the cells of the entire brain, an epileptic attack occurs.

The child falls unconscious, his body shaking in convulsions. After a few minutes, the tension is replaced by muscle weakness. This is a manifestation of the fact that the electrical activity of neurons fades, goes into a "sleep" mode. With the return of consciousness, the patient does not remember what happened.

Causes of the disease

To choose the right strategy for correcting the disease, you need to find out its etiology. Doctors distinguish several causes of epilepsy in children:

1. Heredity. Scientists were able to identify the substance - dopamine - which is responsible for the inhibition of overexcited neurons. Its volume is programmed in the genes: if parents have epileptic seizures, then there is a chance that their offspring will inherit them.
2. Malformations of the fetal brain. Everything affects the health of a future person in the womb: at what age she conceived (middle-aged first-born women are included in the risk group), what she was ill with, how she was treated, whether she abused drugs, alcohol. Poisoning the fetus with toxic substances is the main cause of brain pathologies.
3. Birth trauma. The causes of epilepsy often lie in the excesses that accompany the birth process. The baby's brain can be damaged by midwife's forceps, prolonged labor, squeezing the newborn's neck with the umbilical cord.
4. Inflammatory diseases of the brain and its membranes: encephalitis, meningitis, arachnoiditis.
5. Febrile convulsions with colds can reveal epilepsy in children with aggravated heredity.
6. Craniocerebral injuries. The application of mechanical blows to the head often leads to the appearance of epileptogenic foci in the brain.
7. Volumetric neoplasms. Tumors that press on the brain can cause seizures in children.
8. Disorders of metabolic processes, manifested by hyponatremia, hypocalcemia, hypoglycemia.
9. Cerebral blood flow disorders.
10. Teen addiction to ephedrine, amphetamines and other drugs.

Important: the inflammatory disease "meningitis" can be fatal! It is very important to be able to recognize it in time. How? Read the answer.

Varieties of the disease

Depending on the pathogenesis, epilepsy in childhood is differentiated by specialists into three groups:

• idiopathic: it is stated if the symptoms of the disease appear as a result of a genetic factor, but without significant pathologies in the brain;
• symptomatic: it is considered a consequence of brain defects due to developmental anomalies, injuries, neoplasms;
• cryptogenic: fixed by physicians in cases where the disease appeared due to unidentified causes.

Symptomatic epilepsy in children differs in the area of ​​localization of the pathogenic focus.

And depending on the localization thereof, it manifests itself in several types:

• frontal;
• parietal;
• temporal;
• occipital;
• chronic progressive.

The listed types of epilepsy declare themselves in different ways. For example, the frontal comes only at night; the temporal is characterized by blackouts of consciousness without a pronounced convulsive symptom.

Finding out the causes of the disease and its type helps to choose an adequate line of struggle with it. However, this is not enough for successful healing: it is important to recognize the first signs of epilepsy in a child in a timely manner.

The main signs of the disease

Symptoms of epilepsy in children are sometimes mistaken by unlucky adults for excessive motor activity. This is the main reason for the late detection of a dangerous disease. Another common mistake is to think that an epileptic seizure can only be manifested by convulsions and foaming at the mouth.

In order not to miss precious time, parents of babies need to have a detailed understanding of the clinical picture by which childhood epilepsy is recognized.

Its features are quite diverse:

1. Generalized seizures. They begin with an alarming harbinger - the aura. At this stage, the patient feels something like a breath running through the body or other unusual sensations. Then comes the stage of sharp muscle tension and breath holding - the child falls screaming. The turn of convulsions comes, the eyes roll back, foam comes out of the mouth, spontaneous urination and bowel movements can be observed. Convulsive twitching can cover the entire body or muscle group. The attack lasts a maximum of 20 minutes. When the convulsions stop, the patient comes to his senses for a few moments and immediately falls asleep in exhaustion.
2. Non-convulsive (small) seizures. These not always noticeable attacks of epilepsy in children are called absence seizures. It all starts with the fact that the baby with an absent look suddenly freezes. It happens that the patient's eyes are closed, the head is thrown back. For 15-20 seconds he does not perceive anything. Coming out of a painful stupor, he returns to interrupted cases. From the outside, such pauses may seem thoughtful or distracted.
3. Atonic seizures. The manifestation of attacks of this kind is a sudden loss of consciousness and muscle relaxation. Often they are mistaken for fainting. The periodicity of such states should alert.
4. Child spasm. Epilepsy in a baby can be manifested by a sharp raising of the arms to the chest, an involuntary tilt forward of the head and body when the legs are straightened. This happens most often with children 2-4 years old when they wake up in the morning. The seizure lasts for several seconds. By the age of 5, the alarming manifestations of the disease either disappear or take another form.
5. Speech disorder for several minutes while maintaining consciousness and the ability to move.
6. Frequent nightmares that cause the baby to wake up screaming and crying.
7. Sleepwalking.
8. Regular headaches, sometimes causing nausea and vomiting.
9. Sensory hallucinations: visual, olfactory, auditory, gustatory.

The last four signs do not necessarily indicate an epilepsy disease. If such phenomena began and began to be repeated repeatedly, parents should conduct a neuropsychiatric examination of the child.

The question of how to recognize epilepsy in a child under one year old is extremely important. In infancy, the disease often passes atypically. Parents need to be extremely attentive to the condition and behavior of the newborn.

For the initial stage of epilepsy in children under one year, the following symptoms are characteristic:

• sharp fading;
• cessation of swallowing movements;
• tilting the head;
• trembling of the eyelids;
• empty, seeing nothing;
• complete non-contact.

This is followed by loss of consciousness and convulsions, not always accompanied by spontaneous defecation and urination. It should be noted that epilepsy in children under one year old has a kind of prelude and completion. Harbingers of an attack are increased tearfulness, excessive excitability, febrile temperature. After the end of the seizure, the baby does not always sleep.

Diagnostic methods

Diagnosis of epilepsy in children involves a phased examination of a small patient:

1. History taking: clarification of the moment of onset of the first seizures, accompanying symptoms of an attack, conditions of intrauterine development and childbirth, the presence of neurological diseases and addictions in parents.
2. The main instrumental technique: an electroencephalographic study with video recording, which provides complete information about the bioelectrical activity of the brain and the occurrence of defects in its structure.
3. Additional methods carried out to clarify the diagnosis and establish the cause of the disease: MRI and CT of the brain, blood tests to determine the metabolic and immune status, lumbar puncture.
4. Studies within the framework of differential diagnosis: ophthalmoscopy, ultrasound of the cardiovascular system and other examinations prescribed by the attending physician.

Such an extensive diagnostic complex allows you to confidently confirm or exclude the presence of epilepsy.

On the way to healing

To the question of whether epilepsy is treated in children, today's medicine gives a positive answer. The success of therapy depends both on the professionalism of physicians and on the mood of the parents.

The latter should be prepared for the fact that it will take a long time to treat epilepsy in a son or daughter, without interrupting the course for a day.

What is required from parents:

• provide the baby with a diet with fluid and salt restriction;
• organize a rational regimen of the day with leisure breaks;
• eliminate stressful situations;
• limit the child's access to the TV and computer;
• make it a habit to walk in the fresh air, but not allow prolonged exposure to the sun, self-bathing in a pond or bath;
• encourage the child to engage in safe sports: badminton, tennis, cross-country skiing, etc.

During a seizure, you need to put the baby on his side in a safe place. You can not restrain convulsions, open your jaws, give medicine or water. The main task of the parents of an epileptic is to prevent him from harming himself.

Drug treatment of epilepsy in children is determined taking into account age characteristics and the patient's condition. The main role is given to anticonvulsants.

With a symptomatic form of pathology caused by a tumor in the brain, the patient can be cured surgically. Before the operation, a consultation of a neurosurgeon, a neurologist and a psychotherapist gathers, the risks of invasive intervention and the opinion of the parents are taken into account.

If the danger of the operation is too high, the question “how to treat the patient?” decided in favor of drug therapy.

Disease prognosis

In 80% of cases, persistent and long-term treatment of epilepsy in children leads to getting rid of a serious illness. The immediate environment of small epileptics should help them develop normally and find their place in society. Patience, wisdom and love of parents play a colossal role in this.