Features of the manifestation of epilepsy in adolescents

Epilepsy in adolescence is most often a continuation of a disease that began in childhood. Epileptic seizures in adolescents can either increase or decrease. Puberty is associated with global changes in the body, preparation for growing up and puberty. Therefore, it is quite difficult to predict how epilepsy will manifest itself. To do this, the patient must be regularly monitored by a neurologist or epileptologist. The attending physician evaluates the results of the therapy, studies the dynamics of epileptic seizures, and changes in tests. Based on research data, the doctor makes recommendations to normalize the teenager’s condition. Epilepsy can also develop in adolescence as a result of a previous illness or brain injury. In this case, the child must undergo a comprehensive examination to make the correct diagnosis. Epilepsy brings significant discomfort to everyday life, which is especially difficult for adolescents due to emotional changes and social development. Therefore, the child must be shown to a qualified specialist as quickly as possible in order to prepare effective treatment.

The Yusupov Hospital provides diagnostics and high-quality treatment of various types of epilepsy. The highly qualified doctors, as well as the modern technical equipment of the hospital, make it possible to create the most optimal therapy that reduces the manifestations of epilepsy and allows you to completely eliminate the disease.

Prognosis and prevention

Adolescent epilepsy is considered a chronic disease.
Spontaneous remission is rare. In 90% of patients who interrupted treatment, epileptic attacks return, but in some cases a long period of remission is observed. When proper treatment is prescribed, in 80% of cases it is possible to completely rid the patient of seizures. The drugs are discontinued gradually over several years. This is done in order to completely eliminate relapse.

Juvenile epilepsy does not affect mental abilities in any way, so there is no need to worry about the child’s development.

Prevention consists of taking actions to prevent the occurrence of epileptic seizures.

This requires:

1. Timely diagnosis of chromosomal syndromes and various hereditary diseases.
2. Careful examination of pregnant women who are at high risk of giving birth to a child suffering from epilepsy. Most often this applies to women who take drugs and suffer from endocrine disorders.
3. Observation of children who were underweight at birth or had other deviations from the norm.
4. Conducting social events for patients with juvenile epilepsy.

Timely, competent diagnosis increases the chance that treatment will be effective. At the first suspicion of epilepsy, a child should be shown to a doctor.

He will develop an individual treatment plan. Its strict adherence guarantees a cure in most cases, so there is no need to despair.

About epilepsy in adolescents in this video:

Peculiarities of adolescent behavior

A child with epilepsy, especially if the symptoms are acute, may experience emotional and psychological problems. The disease greatly affects the well-being and comfort of the child. A syndrome of instability of personality formation is often observed: children violate the prohibitions of doctors and parents, begin to drink alcohol, only aggravating the situation, engage in dangerous sports, and ignore taking anticonvulsants.

In other cases, the opposite of rebellion, teenagers find themselves in forced social isolation, feeling abandoned and insecure. There is also unnecessary pressure from parents in the form of overprotection.

Causes of epilepsy

The causes of epilepsy in adolescents are associated with pathological functioning of neurons. Due to the spread of impulses across both hemispheres, seizures occur. Parocrises - convulsive seizures - occur between the ages of 11 and 17, and become more intense in adulthood.

In some cases, epilepsy goes away with age, especially in mild cases.

For reasons in adolescents, the disease is divided into 3 degrees:

• Idiopathic. Teenage epilepsy is passed on from parents.
• Secondary. Occurs as a symptom of complications after severe infections and injuries affecting the brain or nervous system. Sometimes it develops due to neoplasms.
• Cryptogenic. The diagnosis is made if no other obvious causes are found.

Cells begin to work incorrectly due to external factors and internal characteristics of adolescence. So, the impetus can be hormonal changes. And sometimes the cause is a failure that occurred during intensive development.

The psychological and emotional state of the child is no less important. The cause of epilepsy in adolescence can be severe stress caused by an unfavorable atmosphere in the family or excessive stress placed on the teenager. Sometimes the cause is teenage quarrels. Other reasons:

• trauma – mainly as a result of severe TBI, epilepsy attacks develop (including several years after the injury);
• organ diseases, including infantile paralysis, vascular pathologies in the brain;
• metabolic problems - in 10% of cases, adolescents have congenital or acquired pathologies (diabetes, lead poisoning, obesity due to abuse of unhealthy foods).

The disease can also be triggered by long-term exposure to toxic substances, including medications and drugs.

Features in teenagers

The disease occurs in childhood, and most cases occur in adolescence. In rare circumstances, hereditary epilepsy due to concomitant causes manifests itself at the age of 20 years. The first seizures begin at 11–16 years of age, but in rare cases they occur for the first time only at 17–19 years of age.

Epilepsy in adolescents is considered a chronic lesion of the central nervous system and brain. It differs from the adult form in the severity of its course.

Thus, children's “falling sickness” is often not accompanied by deep fainting or convulsions. The attacks go unnoticed, or are more like a nervous breakdown. Even at a young age - up to 11 years - parents are practically unable to notice this pathology. At school, the disease begins to make itself felt: it is difficult for the child to concentrate, and he begins to lag behind in his studies.

Symptoms of epilepsy

With epilepsy, all symptoms occur spontaneously, less often provoked by bright flashing lights, loud sounds or fever (increased body temperature above 38C, accompanied by chills, headache and general weakness).

1. Manifestations of a generalized seizure include generalized tonic-clonic seizures, although there may be only tonic or only clonic seizures. The patient falls during a seizure and often suffers significant injuries; very often he bites his tongue or loses urine. The seizure usually ends in epileptic coma, but there is also epileptic excitement, accompanied by twilight darkness of consciousness.
2. Partial seizures occur when a focus of excessive electrical excitability forms in a specific area of ​​the cerebral cortex. Manifestations of a partial attack depend on the location of such a focus - they can be motor, sensitive, vegetative and mental. 80% of all epileptic seizures in adults and 60% of seizures in children are partial.
3. Tonic-clonic seizures. These are generalized convulsive seizures that involve the cerebral cortex in the pathological process. The seizure begins with the patient freezing in place. Next, the respiratory muscles contract, the jaws tighten (the tongue may be bitten). Breathing may be cyanotic and hypervolemic. The patient loses the ability to control urination. The duration of the tonic phase is approximately 15-30 seconds, after which the clonic phase begins, during which rhythmic contraction of all muscles of the body occurs.
4. Absence seizures are attacks of sudden blackouts for a very short time. During a typical absence seizure, a person suddenly, for absolutely no apparent reason either for himself or for those around him, stops responding to external irritating factors and completely freezes. He does not speak, does not move his eyes, limbs or torso. Such an attack lasts a maximum of a few seconds, after which it also suddenly continues its actions as if nothing had happened. The seizure remains completely unnoticed by the patient himself.

In a mild form of the disease, seizures occur rarely and are of the same nature; in a severe form, they are daily, occur 4-10 times in a row (status epilepticus) and have a different character. Patients also experience personality changes: flattery and softness alternate with malice and pettiness. Many experience mental retardation.

Treatment of epilepsy

The goals of treatment are to stop epileptic seizures with minimal side effects and to manage the patient so that his life is as full and productive as possible.

The patient and his family should receive instructions about taking the drug and be informed both about the actually achievable results of treatment and about possible side effects.

Principles of treatment of epilepsy:

1. Compliance of the drug with the type of seizures and epilepsy (each drug has a certain selectivity in relation to one or another type of seizures and epilepsy);
2. If possible, use monotherapy (use of one antiepileptic drug).

Antiepileptic drugs are chosen depending on the form of epilepsy and the nature of the attacks. The drug is usually prescribed in a small initial dose with a gradual increase until the optimal clinical effect occurs. If the drug is ineffective, it is gradually discontinued and the next one is prescribed. Remember that under no circumstances should you change the dosage of the medicine or stop treatment on your own. A sudden change in dose can provoke a worsening of the condition and an increase in attacks.

Drug treatment is combined with diet, determination of work and rest schedules. For patients with epilepsy, a diet with a limited amount of coffee, hot spices, alcohol, salty and spicy foods is recommended.

Diagnostics

Myoclonic symptoms are included in the clinical picture of many diseases and epileptic syndromes. The diagnosis of “myoclonic epilepsy” is established only when myoclonic seizures predominate over other clinical manifestations. Diagnostics is aimed at verifying the nosological form of epilepsy, and when identifying the secondary nature of myoclonus, at searching for the underlying pathology. The main diagnostic steps are:

• Collection of anamnestic data. The age of onset, the nature of the onset, and the order of development of symptoms are of great importance.
• Neurological examination. Conducted by a neurologist, it is aimed at identifying myoclonic contractions, focal deficits, determining the level of mental development, the degree of cognitive impairment, and assessing mental status.
• Electroencephalography. In most patients, diffuse interictal symmetrical epileptogenic discharges and ictal high-amplitude spikes are recorded. In some cases, to detect epiactivity, daily EEG monitoring and provocative tests (EEG with flashes of light, hyperventilation, sharp sound signals) are required. The research results are assessed by a neurophysiologist and epileptologist.
• Neuroimaging. Before the fontanelles close, it is carried out using neurosonography, in children over one year old - using MRI of the brain. Adults can undergo MSCT. Morphological changes in cerebral tissues are characteristic of symptomatic ME.
• Laboratory research. Performed if metabolic disorders are suspected. Includes biochemical analysis of blood and urine, specific tests.
• Genetic consultation. Collecting a family history and drawing up a family tree makes it possible to determine the hereditary nature of epilepsy and establish the type of inheritance.

Differential diagnosis is carried out with non-epileptic myoclonus, the distinctive feature of which is the focal nature of myoclonus, lack of response to provocation, and a normal EEG pattern. Differentiation of ME is also necessary with convulsive syndrome of infectious etiology, febrile seizures, Lennox-Gastaut syndrome, cerebellar myoclonic dyssynergia of Hunt.

Preparing for diagnosis: what parents should remember

If epilepsy is suspected in a teenager, parents can prepare for the diagnosis so that it is more effective:

• you need to tell the neurologist when the seizures started;
• describe the seizures in detail: the position of the arms, legs, body and head, the condition of the pupils and skin color, duration;
• the specifics of the course of the attack - sharply or with an aura (preceding sensations);
• time of occurrence of the first seizures;
• what are the provoking factors: stress, temperature, menstrual cycle in girls, computer work;
• the child's behavior before the seizure.

After visiting a neurologist, they will prescribe electroencephalography of the brain, MRI and CT, as well as mandatory blood, stool and urine tests. Sometimes a cerebrospinal fluid test is needed to rule out other diseases.

Symptoms of epilepsy

The manifestations of epilepsy attacks may differ from patient to patient. First of all, the symptoms depend on those areas of the brain where the pathological discharge occurs and spreads. In this case, the symptoms will be directly related to the functions of the affected parts of the brain. Movement disorders, speech disorders, an increase or decrease in muscle tone, and dysfunction of mental processes can occur, both in isolation and in various combinations.

The severity and set of symptoms will also depend on the specific type of epilepsy.

Jacksonian attacks

Thus, during Jacksonian attacks, pathological irritation covers a certain area of ​​the brain without spreading to neighboring ones, and therefore the manifestations concern strictly defined muscle groups. Typically, psychomotor disorders are short-lived, the person is conscious, but it is characterized by confusion and loss of contact with others. The patient is not aware of the dysfunction and rejects attempts to help. After a few minutes the condition is completely normalized.

The twitching or numbness starts in the hand, foot, or leg, but can spread to the entire side of the body or develop into a grand mal seizure. In the latter case, they speak of a secondary generalized attack.

A grand mal seizure consists of successively alternating phases:

• Precursors - several hours before the onset of an attack, the patient is seized by an anxious state, characterized by an increase in nervous excitement. The focus of pathological activity in the brain gradually grows, covering more and more new sections;
• Tonic convulsions - all muscles tense sharply, the head is thrown back, the patient falls, hitting the floor, his body is arched and held in this position. Due to respiratory arrest, the face turns blue. The phase is short, about 30 seconds, rarely up to a minute;
• Clonic convulsions - all the muscles of the body contract rapidly rhythmically. Increased salivation, which looks like foam at the mouth. Duration – up to 5 minutes, after which breathing is gradually restored, the cyanosis disappears from the face;
• Stupor - in the focus of pathological electrical activity, strong inhibition begins, all the patient’s muscles relax, and involuntary passage of urine and feces is possible. The patient loses consciousness and there are no reflexes. The phase lasts up to 30 minutes;
• Dream.

After waking up, the patient may suffer from headaches, weakness, and movement disorders for another 2-3 days.

Minor attacks

Minor attacks are less pronounced. A series of twitching of facial muscles, a sharp drop in muscle tone (as a result of which a person falls) or, conversely, tension of all muscles when the patient freezes in a certain position may occur. Consciousness is preserved. There may be a temporary “absence” – absence. The patient freezes for a few seconds and may roll his eyes. After the attack, he does not remember what happened. Minor seizures often begin in preschool age.

Status epilepticus

Status epilepticus is a series of seizures following each other. During the intervals between them, the patient does not regain consciousness, has reduced muscle tone and lack of reflexes. His pupils may be dilated, constricted, or of different sizes, and his pulse may be rapid or difficult to feel. This condition requires immediate medical attention, as it is characterized by increasing brain hypoxia and swelling. Lack of timely medical intervention leads to irreversible consequences and death.

All epileptic seizures have a sudden onset and end spontaneously.

Symptoms of the disease

The main symptom of the pathology, by which epilepsy can be accurately identified, is a seizure. In adolescence, they differ in the following points:

• there is a feeling of a sharp blow in the area under the knee, which causes the need to sit down, in some cases the child falls to the ground;
• symmetrical convulsions appear, during which a person bends and straightens his arms and legs;
• sharp muscle contractions cause a person to drop or involuntarily throw objects.

Indirect signs of pathology can be identified, which are often detected at the age of 10-11 years. Many of the symptoms are related to sleep: sleepwalking, screaming during sleep, nightmares.

The child suffers from headaches that occur frequently and out of nowhere, often accompanied by bouts of vomiting. Speech is impaired in adolescents. Aggression gradually appears. After diagnosis, a person becomes withdrawn and tends to ignore medical and parental recommendations.

Localization of the focus of epilepsy: focal seizures

Focal seizures begin from a specific point and do not involve the entire cortex. Depending on the place where the pathology begins, the symptoms differ:

• Temporal lobe epilepsy

Develops in most cases of focal seizures. Affects the emotions, memory and feelings of a teenager. Symptoms such as sudden changes in mood and strange thoughts or emotions appear. The child becomes anxious and does not understand what is happening.

• Frontal epilepsy

Symptoms of seizures depend on the area of ​​the frontal lobe that is involved in the pathology. Sudden convulsions occur and pass quickly enough. There is marked weakness in the muscles, including those responsible for speech. Often attacks begin in a dream: the child rushes about uncontrollably, turns his head, moves his legs. Due to the large size of the frontal lobe, sometimes symptoms cannot be identified (they are believed to be hidden).

• Parietal epilepsy

Most of the symptoms affect human sensory receptors. In a teenager, epilepsy manifests itself as mixed sensations in different areas of the body: sudden warmth, tingling, an imaginary change in body size, partial numbness.

• Occipital

The least common form of adolescent epilepsy, which may cause changes in vision. The child experiences flashes of colors before the eyes, black dots, patterns, or images. Also with this form there is a flickering sensation, which causes a feeling of nausea.

Some children experience partial blindness at the time of the attack, uncontrolled eye movement, and painful sensations on the eyelids. When the attack lasts for a long time, severe headaches develop.

There is a second form of attacks, which are extensive and manifest with severe symptoms.

Generalized seizures

Generalized seizures are so called because in epilepsy all parts of the brain are affected by the improper action of neurons. In 100% of cases, the person loses consciousness or is in a semi-fainting state, cannot think soberly and cannot stand on his feet.

There are mild generalized seizures, in which a person is in this state for less than 5 seconds, which is why they can be missed.

Sometimes epileptic seizures begin as focal ones, but can develop into generalized ones. They can be identified by special beacons indicating loss of consciousness. To avoid injury, a person must sit comfortably. Types of seizures:

• Tonic-clonic. It begins with an acute phase, accompanied by a cry due to spasms of the vocal muscles responsible for contracting the gap. Air escapes from the larynx, and convulsions of the limbs occur. They run out in a few minutes. The person may experience severe drowsiness and confusion. Almost always, a teenager needs rest after an attack. If a seizure lasts longer than 5 minutes, emergency medical assistance is needed.

• Absence epilepsy . With this type of attack, a complete loss of consciousness occurs, but the teenager’s eyes remain open. Lasts no more than 10-15 seconds, in this state the person does not react in any way to external stimuli. Then there is a return to normal.

Sometimes people don't even notice such seizures. The complexity of the absence form is due to the fact that a person without a medical education cannot diagnose it or notice the first signs. This condition in adolescents with epilepsy is often confused with thoughtfulness. One of the signs can be considered a sudden interruption mid-sentence during a story.

• Myoclonic form . Epilepsy in adolescents of the myoclonic type often develops after sleep or before going to bed at night. Accompanied by a short-term loss of consciousness, but often goes unnoticed.
• Tonic seizures . They are less common than other forms, mainly in patients with Lennox-Gastaut syndrome. During such an attack, the muscles become very elastic from tension, there is a high risk of falling, and slight loss of consciousness.

• Atonic attacks . With this form of pathology, muscle tone is greatly reduced, as a result of which the teenager may fall to the ground. Loss of consciousness is short-lived. If a person is lying down or sitting, a seizure may be missed. At the age of 11-12 years, a child may experience a symptom such as a thrown back head.

Despite the fact that epilepsy in adolescence most often occurs in a mild form, many parents fear that the disease may affect the development of their child.

Types of attacks and accompanying symptoms

There are three types of myoclonus epilepsy attacks:

1. Myoclonic. Characterized by muscle twitching that cannot be controlled. They usually occur in the morning, but can also be triggered by fatigue, strong emotions, alcohol consumption, sound or light exposure. The presence of cramps can be observed both in an individual muscle or limb, and throughout the body.
2. Absence seizures. Consciousness turns off suddenly for a short period of time. It is caused by a lesion in the brain that affects its different parts. In this state, a person is in a stupor for several seconds, while his gaze also freezes, speech and movement stop. Despite their short duration, absence seizures lead to serious disturbances of consciousness.
3. Tonic-clonic. The whole body is subjected to a convulsive state. In addition, loss of consciousness is observed. Involuntary urination or defecation is possible. The duration of the attack is several minutes. They are observed in more than half of patients and usually occur during awakening.

Everything you need to know about sleep epilepsy

• Polina Yurievna Timofeeva
• March 26, 2021

Myoclonic epilepsy is classified into several forms:

1. Infants are benign in nature. This is a rare type of disease. Its development can last from several months to five years. However, it has not yet been possible to determine the root cause. The only thing is that in rare cases it can transform into an adolescent form, practically does not cause serious complications and quickly passes with correct and timely treatment. May be accompanied by twitching of the limbs or head, and sometimes the body. Myoclonus may also vary in intensity. During the period when a person falls asleep, they intensify, and during sleep they disappear. In this case, psychomotor development is not damaged in any way. The diagnosis is made based on the collection of anamnestic data.
2. Dravet syndrome is severe and occurs in 5 percent of infants. Until the symptoms begin to manifest themselves, the child develops normally. This type of attack often provokes severe psychoneurological disorders, sometimes even fatal.
3. Unferricht-Lundborg disease. It is considered the more common form. Observed during late childhood. The pathology begins to manifest itself with myoclonus, which is subsequently complicated by absence seizures and focal attacks. The disease develops slowly. Over the course of many years, the patient’s intellectual abilities remain unchanged, but afterward there is a decrease in memory and frequent depressive states. The disease has periods of remission and exacerbation, which leads to the fact that the patient is forced to spend all his time in bed. The diagnosis is based on the clinical picture. With timely treatment, there is a chance of slowing the development of pathology, which allows the patient to live to old age.
4. Myoclonic epilepsy with broken fibers. This form provokes the development of abnormal DNA. In most cases it is observed in childhood and adolescence, but it also occurs in adults. In addition to the fact that this form is accompanied by tonic convulsions and myoclonus, the patient’s coordination is impaired, deafness and myopathy progress. During diagnosis, torn fibers can be seen in the skeletal muscles, and the content of lactic acid in the blood increases significantly.

Conventionally, the course of the disease can be divided into three stages:

• Epileptic-titaniform - can last for several years. As the disease progresses, attacks become more frequent, accompanied by painful spasms and increased sweating. The patient is conscious. As a rule, at this stage there are no neurological disorders, but the patient may exhibit aggression, depression or withdrawal.
• Myoclonic-epileptic – often can last for many years. The number of seizures decreases, and attacks of myoclonus occur. At the beginning, muscle contractions occur only in part of the limb, gradually spreading to the entire body. The patient loses the ability to eat and write independently. While walking, there is a bending from side to side.
• Terminal – leads to serious changes at the mental level, which is expressed by memory and speech disorders.

It should be noted that the last stage can lead to dementia of the patient.

Disease prevention

Once diagnosed with juvenile myoclonic epilepsy, treatment with medications alone may not be enough. With this disease, it is necessary to follow a certain daily routine, especially with regard to sleep: you should not go to bed too late, you should get up every day at the same time. It is imperative to exclude factors of photostimulation in everyday life. As far as possible, you should avoid any alcoholic beverages and not drink them even in small quantities. Proper nutrition matters. If you follow a daily routine and avoid unfavorable factors, the disease will be much easier to bear.

Prevention of juvenile myoclonic epilepsy consists of actions that prevent the development of epileptic seizures in the patient.

To do this, it is recommended to carry out the following activities:

1. Timely diagnosis of hereditary diseases and chromosomal syndromes.
2. Identification during examination during pregnancy of women who have an increased risk of giving birth to a child with Janz syndrome. As a rule, these are women suffering from various endocrine diseases, drug addicts, and so on.
3. Monitoring children born with low body weight and other abnormalities, as well as developing a strategy for their treatment.
4. Performing social activities for patients with juvenile myoclonic epilepsy.

Janz syndrome is a fairly common phenomenon in medicine, it has been well studied, so specialists can help almost all patients who are faced with this problem to completely get rid of it. Most people with this diagnosis can lead quite active and fulfilling lives.

Myoclonic spasms in children

Mild myoclonic spasms in children, as in adults, often occur during sleep and when falling asleep. In these cases, the child may even wake up and get scared. In infancy, tight swaddling will help prevent this. As an adult, you can cover the child with a heavy blanket or tuck its edges under the mattress.

In some cases, myoclonic twitching in children is one of the signs of the development of epilepsy. It can be congenital, or hereditary, or acquired. Many factors can cause this pathology. Boys are more prone to its development.

There is an age-related benign form of idiopathic epilepsy called juvenile myoclonic epilepsy or Janz syndrome. This disease occurs in adolescents during puberty and goes away over time. Various factors can trigger an attack of convulsions: bright light, fear, severe stress, a loud sharp sound, etc.

Diagnostics

The initial clinical examination is indicative only. To make a correct diagnosis, additional laboratory and instrumental examinations are required.

Today, electroencephalography (EEG) is considered the “gold standard” for diagnosing this disease. It should be noted that every second child does not experience any changes in the electroencephalogram during the period of absence of an attack.

Identifying specific signs directly during a seizure attack allows you to accurately make a correct diagnosis. In complex clinical situations, when diagnosis is very difficult, several EEGs or daily monitoring of this indicator are required.

Such a study not only allows you to clarify the correct diagnosis, but also determine the prognosis and further treatment tactics. The studies included in neuroimaging include computed tomography and magnetic resonance imaging. MRI allows you to clarify local areas of pathological tissue, which trigger the appearance of unfavorable characteristic symptoms in the baby.

Children with epilepsy undergo multiple laboratory tests. These include general clinical blood and urine tests, biochemical blood tests, determination of specific autoantibodies and glucose and lactate levels, as well as serological tests.

In some cases, the examination plan also includes an ultrasound examination of the abdominal organs, Dopplerography of the vessels of the neck and brain, electrocardiography and other studies.

Epilepsy remission

What is complete remission of epilepsy?

Complete remission -

This is the complete suppression of all seizures and epiactivity on the EEG, in the absence of pronounced side effects from the treatment used, while maintaining a high quality of life.

What time period is sufficient to say that remission of epilepsy has occurred?

It is generally accepted that remission is the complete absence of attacks for 12 months.

How to achieve remission from epilepsy?

Use antiepileptic drugs for treatment.

We begin therapy immediately after diagnosis and clarification of the form of epilepsy according to the classification.

First, we use one antiepileptic drug in treatment, selecting the dose depending on the effectiveness and safety. If ineffective, we introduce a second drug. Further polytherapy is possible. The process of selecting therapy is complex and individual, but is based on clearly developed principles of therapy.

In a small number of people, surgical treatment may be used. An option for treating drug-resistant forms of epilepsy in addition to taking medications is a ketogenic diet or stimulation of the vagal nerve.

In cases where it is not possible to achieve complete electro-clinical remission, we achieve the maximum possible improvement in the patients' condition. This is how the terms are distinguished:

1. Incomplete remission
,
when the patient has no seizures, but epiactivity on the EEG remains and there are changes in intellectual-mnestic functions (the term
“remission of epileptic seizures”
).

2. P pseudoremission
-
those cases when, while taking anticonvulsants, the patient himself and those around him do not notice any seizures; but when carrying out the necessary diagnostics (most often, video EEG monitoring, when seizures and synchronous epiactivity are clearly recorded on the EEG).

What do we call recovery from epilepsy?

Complete electro-clinical remission for 5 years while taking AEDs and another 5 years without treatment, the absence of progressive changes in the mental sphere, can be called recovery

.
Epilepsy remission
Based on the materials of the conference on epilepsy in Krasnoyarsk, held in February 2014, where, together with major scientific figures in epileptology, such important concepts as “remission”, “pseudo-remission” and others were proposed. These and other terms should be generally accepted so that all doctors - neurologists, epileptologists, as well as doctors of other specialties and, of course, patients with epilepsy understand each other. These are important stages in the development of epileptology that determine the treatment tactics for each patient. How to treat epilepsy, how long to treat epilepsy, how often and for a long time to monitor the patient after the seizures have stopped? It is these questions that the adopted terminology answers. This is the first article on remission; further we will examine the terms “remission failure”, “pharmaco-resistance” and others.

Signs and symptoms

Myoclonic seizures indicate the occurrence of juvenile epilepsy.
They do not last long and are involuntary asynchronous muscle contractions. Most often, seizures occur in the morning, after waking up.

Muscle contractions usually involve only the arms and shoulder girdle, but in some cases they spread to the legs or even the entire body.

During an attack, patients may drop or throw away objects they were holding in their hands. If the lower extremities are involved in a seizure, adolescents fall.

Rarely, patients present with myoclonic status epilepticus. The patient does not lose consciousness. In 3-5% of cases, the disease occurs with only myoclonic seizures.

3 years after the first attack, in the vast majority of cases, tonic-clonic seizures develop.

They begin with increasing myoclonic twitching, which turns into clonic-tonic convulsions. 40% of such patients experience absence seizures. They lose consciousness for a short period.

Types and forms of the disease

Most often, patients experience the following forms of the disease:

1. Juvenile absence epilepsy - begins with generalized seizures and then progresses to simple absence seizures. 10% of patients experience febrile seizures (with an increase in temperature).
2. Juvenile myoclonic epilepsy , or Janz syndrome, most often begins in adolescence. Patients experience muscle twitching in the shoulder girdle and arms. They can be barely noticeable or very pronounced. After some time, generalized convulsions may appear. Attacks occur from once a day to once every few weeks. A seizure can be triggered by feelings of anxiety, forced awakening, insomnia, and drinking alcohol. Juvenile myoclonic epilepsy is characterized by a high relapse rate.
3. With generalized seizures - occurs in adolescence, seizures occur from 1 time per week to 1 time per year. Sometimes the addition of myoclonic seizures or absences is observed.
4. Catamenial epilepsy in girls. Characteristic only for girls. The appearance of epileptic seizures in teenage girls is associated with the phases of the menstrual cycle.

Causes and manifestations of pathology

It is not known exactly why nocturnal epilepsy occurs. But the main factor contributing to the occurrence of convulsive seizures is considered to be the lack of proper sleep.

Frequent lack of sleep leads to depletion of the energy reserves of the central nervous system, disruption of the processes of excitation and inhibition. As a result, epileptogenic foci are formed in the cerebral cortex. The longer a person neglects rest, the higher the likelihood of seizures occurring during sleep.

Possible causes of epilepsy at night also include:

• physical, mental stress;
• regular use of alcohol, drugs;
• frequent stress;
• suffered traumatic brain injuries;
• infectious diseases;
• congenital abnormalities of brain development;
• genetic predisposition;
• injuries during childbirth;
• neoplasms in the brain.

It is impossible to independently understand what triggered the occurrence of convulsive seizures during sleep. Only a doctor can determine the cause of the development of epilepsy and select the correct treatment after the patient has undergone an examination.

In the nocturnal form of epilepsy, seizures most often occur in the first half of the night, during the REM sleep phase (this is due to changes in brain activity). Their appearance can be triggered by a sudden awakening or a sudden phone call.

If the disease progresses, convulsive crises appear in any phase of sleep, regardless of the presence of provoking factors. Let's look at the main types of attacks (Table 1).

Table 1 - Types of nocturnal seizures

The symptoms of nocturnal epilepsy are practically no different from the clinical picture of the daytime form of the disease. Immediately before a seizure appears:

• intense headache;
• feeling of discomfort;
• nausea;
• spasm of the facial and laryngeal muscles;
• speech disorder;
• chills.

Differential diagnosis of seizures

After these symptoms appear, cramps occur in a specific muscle group. They then spread in a sequence corresponding to the location of the brain centers that control movement. The patient has difficulty breathing and increased salivation. Involuntary urination and defecation may occur.

Clinical manifestations of epilepsy at night in adults can be supplemented by symptoms that are characteristic of a sleep disorder:

• sleepwalking;
• nightmares;
• panic attacks;
• walking and talking while sleeping.

In general, an epileptic seizure lasts from 10 seconds to 5 minutes. After this time, the person falls asleep. After waking up, he does not remember the events that took place during the night. Epilepsy during sleep is not always accompanied by seizures. Non-convulsive seizures can be recognized by the following signs:

• dilated pupils;
• blank look;
• lack of response to the environment.

Features of epilepsy in childhood

4. Features of epilepsy in childhood

The main features of childhood epilepsy are as follows:

• there is a large number of treatment-resistant forms of epilepsy;
• characteristic is a large polymorphism of epileptic paroxysms;
• the frequency of masked manifestations of the disease is high: behind many unclear pain attacks, umbilical colic, fainting, acetonemic vomiting, epileptic paroxysms of an organic nature may be hidden;
• Various non-epileptic phenomena, such as sleepwalking, night terrors, enuresis, migraines, syncope, and hysterical (conversion) seizures, are often mistaken for manifestations of epilepsy. At the same time, there is a tendency to regard similar and some other symptoms as epileptic in blood relatives of patients, using the term “diseases of the epileptic circle” to designate them. It should be taken into account that with any multifactorial disease, which includes epilepsy, many paroxysmal disorders of a non-epileptic nature can be found in the patient himself and his blood relatives. Therefore, at present, the terms “pre-epilepsy” and “diseases of the epileptic circle” are considered obsolete;
• in childhood epilepsy, a malignant course is often observed with the development of psychopathological symptoms and mental retardation;
• at the same time, in childhood, absolutely benign forms of epilepsy occur, ending with complete recovery, restoration of all body functions and successful socialization;
• In children there are also delayed forms of epilepsy, when seizures begin during the neonatal period, then they stop and then resume years later.

As for epileptic seizures, they have some common features in children:

• high frequency of undeveloped, incomplete, rudimentary forms of epiparoxysms;
• the presence of forms of epilepsy and types of seizures that do not occur in adult patients;
• high proportion of all absence forms of paroxysms;
• transformation of seizures as one gets older;
• frequent development of post-ictal focal neurological symptoms.

4.1. Epileptic syndromes in neonatal and infancy:

• benign idiopathic neonatal seizures. Appear around the 5th day. Have a favorable prognosis;
• benign idiopathic neonatal familial seizures. Occurs on the 2nd–3rd day of life. Someone in the family sometimes experiences the same cramps. The prognosis is favorable;
• early (neonatal) myoclonic encephalopathy: massive partial or fragmented myoclonus and partial motor seizures, short-term tonic seizures, spike fast-wave and slow-wave activity on the EEG. These signs indicate severe brain damage. Early death is common;
• early epileptic encephalopathy with the EEG phenomenon “suppression - discharges” - Ohtahara syndrome. Onset in the 1st month of life. Seizures are in the form of tonic ones, often grouped in a series of spasms. The EEG records alternating short periods of flattening of the curve and generalized epileptic activity. The prognosis is severe, and early death often occurs.

4.2. Epileptic syndromes of early childhood. These include the following.

1) Febrile convulsions (see paragraph 2.6).

2) Benign myoclonic epilepsy of early childhood. The earliest form of idiopathic epilepsy. Onset in the 1st–2nd year of life in children with normal development. Seizures in the form of generalized myoclonus. EEG shows spike-wave activity during slow-wave sleep. The prognosis is good. The treatment of choice is valproate.

3) Severe myoclonic epilepsy. One of the most malignant forms, absolutely resistant to therapy. Onset in the 1st year of life in healthy children with a family history of epilepsy and febrile seizures. Characterized by febrile unilateral clonic seizures, myoclonus, and often partial seizures. Generalized spike waves and polyspike waves are recorded on the EEG. There is a pronounced delay in mental development and severe neurological symptoms.

4) Myoclonic epilepsy (myoclonic status) in combination with non-progressive encephalopathy. Encephalopathy is detected from the first months of life in the form of an atonic variant of cerebral palsy, dyskinetic syndrome and severe mental retardation. Myoclonus varies from rhythmic bilateral to asynchronous. Polysomnographic studies during slow-wave sleep show an EEG picture of status epilepticus. Encephalopathy does not progress. Over time, the condition stabilizes, although myoclonus persists and absence seizures occur.

4.3. Childhood and adolescent forms of epilepsy.

1) Childhood absence epilepsy, or Friedman's syndrome (1906), pycnolepsy, pycnoepilepsy (Greek pyknos - frequent; lepsis - attack, grasping). Usually begins in children aged 6–7 years (according to other sources, at 4–10 or 2–8 years). It is more common in girls and is characterized by a high degree of hereditary predisposition (penetrance of the epilepsy gene). The main symptom of the disease is the presence of typical absence seizures, which in most cases occur with a tonic component and are retropulsive (the head falls back, the eyes rise up). It is noted that retropulsive seizures are often accompanied by a mild clonic component - twitching of the muscles of the face and eyelids. The frequency of seizures can reach dozens per day, absence seizure status is also observed. Focal postictal neurological symptoms, mental retardation and neurodestructive changes in the brain are not detected. The disease responds well to therapy. The treatment of choice is valproate, if necessary in combination with succinimides.

2) Juvenile absence epilepsy is an age-dependent form of idiopathic epilepsy. Begins at puberty, there are no differences in sexual preference. It manifests itself as a combination of simple absence seizures and primarily generalized tonic-clonic seizures. Seizures appear much less frequently, and their duration is longer than with pycnolepsy. The EEG shows paroxysms of generalized, synchronous, symmetrical spike waves with a frequency of 3.5–4 Hz. Responds well to therapy. The treatment of choice is valproate.

3) Juvenile myoclonic epilepsy, or impulsive Janz epilepsy. Age-dependent form of idiopathic epilepsy. It begins in adolescents aged 12–16 years, and is more common in girls. A hereditary predisposition is noted, the disease gene is mapped to the 6p21.3 locus. It manifests itself as generalized myoclonic seizures, mainly after sleep, and occurs in the form of sudden symmetrical or asymmetrical twitching in the muscles of the shoulder girdle - flinching of one or both arms (“wing flapping”). At the same time, the arms involuntarily fall to the side, objects fall out of the hands, the head and torso turn sharply. Often, the muscles of the pelvic girdle and legs are involved in a myoclonic attack - the patient may squat at this time, fall on his knees or buttocks (myoclonic-astatic attack). Seizures occur in series or in bursts of 5–20 times in a row over several hours. On the EEG during an attack, in response to photostimulation, generalized spike and polyspike waves are recorded, often with gigantic amplitude, both episodic and spontaneous. The most important factor in provoking seizures is sleep deprivation. Consciousness is not impaired during seizures. Characterized by the absence of pronounced neurological symptoms and intellectual impairment. Treatment requires the elimination of provoking factors and the use of valproate, sometimes in combination with clonazepam.

4) Epilepsy with generalized tonic-clonic seizures on awakening. The main role in the development of the disease is attributed to genetic factors, but it is believed that there may also be symptomatic forms. It begins at the age of 10–20 years, sometimes earlier and later. Seizures occur within 2 hours of waking up from sleep, regardless of whether it is at night or during the day. Seizures are usually preceded by a series of bilateral myoclonus. There may also be a second peak of attacks before bedtime, especially with late onset of the disease. The EEG is characterized by an increased number of slow waves and generalized spike-wave and polyspike-wave activity at a frequency of 2.5–4 Hz. The prognosis is favorable. The main treatment is valproate and phenobarbital.

5) West syndrome (West), or infantile spasm. These are symptomatic and cryptogenic forms of epilepsy. One of the most common age-dependent epileptic syndromes. May begin in infancy, with peak incidence occurring between 2–4 and 7 months of age, sometimes later. More common in boys.

In typical cases, West syndrome is characterized by a triad of symptoms: a) generalized myoclonic or myoclonic-tonic seizures; b) delayed mental, speech and motor development and c) hypsarrhythmia.

Seizures manifest themselves as:

1. sudden sharp bending of the head (nodding);
2. sudden sharp bending of the head and shoulders (peck);
3. slow tonic bends with extension and abduction of the arms according to the type of eastern greeting (“Salaam convulsions”);
4. sudden propulsive movements with falling forward. Seizures are accompanied by a scream, an expression of fear on the face, a grimace of a violent smile. Injuries due to falls during an attack are common.

The duration of attacks ranges from fractions to several seconds. Seizures can be single or occur in series, numbering several hundred attacks per day. Most often, seizures appear before bedtime, when falling asleep, but especially often in the morning - during awakening or immediately after waking up from sleep. There are “good” and “bad” days – with fewer and more frequent attacks.

On the EEG, a special type of disturbance is recorded in patients - hypsarrhythmia: the absence of main activity and the presence of asynchronous slow activity, which alternates with sharp waves or spikes. The prognosis is poor: as people get older, myoclonic and myoclonic-tonic seizures transform into grand mal seizures.

Therapy: ACTH or glucocorticoids in combination with valproate and benzodiazepines, large doses of pyridoxine (up to 100 mg/kg/day), in resistant cases immunoglobulin G IV.

6) Lennox-Gastaut syndrome. This is an age-related encephalopathy syndrome of unknown origin. The onset of the disease occurs between the ages of 1 and 8 years (according to other sources, from 3 to 6 years). Often this syndrome is transformed from a previous infantile spasm. In typical cases the following are observed:

1. epileptic seizures mainly of the type of generalized tonic, atonic seizures and atypical absence seizures;
2. severe delay in mental, speech and motor development;
3. specific changes on the EEG.

Seizures most often occur in the morning, and there are “good” and “bad” days. Falls during seizures are often accompanied by injury. Tonic seizures are detected in 100% of patients. They last from 5 to 20 seconds and proceed according to the tonic-axial type (with rotation of the body around its axis). The EEG shows complexes of bilateral, synchronous spike waves of 1–2.5 Hz, irregular and unstable, transforming under the influence of sleep into rhythmic activity with a frequency of 10 Hz.

Subsequently, the seizures are replaced by generalized and complex partial seizures. In treatment, a combination of carbamazepine, valproate and benzodiazepines is used, in recent years - lamotrigine, vigabatrin, which are more effective in treating attacks of falling. The effectiveness of intravenous administration of immunoglobulin G has been established.

7) Duse syndrome, or myoclonic-astatic epilepsy. Symptomatic and cryptogenic form of the disease with age-dependent seizures. Begins in the 1st–2nd year of life with febrile and nonfebrile generalized tonic-clonic seizures. The main manifestation is myoclonic and astatic seizures. The EEG shows multifocal changes with generalized spike waves, spontaneous and in response to photostimulation. Spontaneous remissions are observed, but a malignant course is also possible. Treatment: Valproate is used, alone or in combination with ethosuximide, and sometimes with benzodiazepines. In the presence of generalized tonic-clonic seizures - ACTH, glucocorticoids. Carbamazepine is contraindicated.

Epilepsy with myoclonic absence seizures. Age-dependent form of symptomatic and cryptogenic epilepsy with onset at 6–8 years. It manifests itself as myoclonic absences lasting 10–60 seconds with massive bilateral rhythmic myoclonus. The EEG shows the rhythm of typical absence seizures with high photosensitivity. Most patients experience infrequent generalized tonic-clonic seizures. Subsequently, mental retardation is revealed. Treatment resistance is common. Therapy: use valproate, phenobarbital, clonazepam and other benzodiazepines.

In children, especially in prepubertal age, there are rare forms of epilepsy with myoclonus of the eyelids and “self-evoking epilepsy” with seizures sensitive to the closing and opening of the eyelids and light flickers.

9) Rolandic epilepsy, or benign epilepsy with centrotemporal adhesions. Hereditary complications play a major role in the etiology of the disease. Onset between ages 3 and 13 years. Convulsions or paresthesias during a seizure involve the face, lips, tongue, and pharynx. Possible speech arrest or anarthria. Drooling is common. Consciousness remains clear. Seizures can spread, becoming brachiofacial or even unilateral in nature. There may be, less frequently, attacks with throat sounds and loss of consciousness, with secondary generalization of seizures. EEG - biphasic high-voltage spikes, following at short intervals in the central and temporal regions, unilateral or bilateral with a predominance on one side. Adhesions sharply intensify in a state of drowsiness or sleep. Therapy: phenobarbital and carbamazepine. After the cessation of attacks and normalization of the EEG, even with short-term treatment (1–2 years), it can be stopped. For rare seizures, anticonvulsants may not be prescribed.

10) Benign partial epilepsy with affective symptoms. There is a high degree of hereditary burden. The onset of the disease is at the age of 2–10 years in children with normal development. Seizures are characterized by sudden fear (to the point of horror) in combination with chewing, swallowing, and vegetative symptoms (pallor, hyperhidrosis, abdominal pain, etc.). Consciousness is usually altered. On the EEG there are complexes of a sharp wave - a slow wave in the frontal or parietal region on one or both sides. Therapy: carbamazepine and phenytoin. The prognosis is favorable.

(Landau-Kleffner syndrome - see Chapter 2.)

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Complications, prognosis and prevention

The prognosis for treating the disease is moderately favorable if therapy is started in a timely manner. In such cases, it is possible to almost completely eliminate symptoms and seizures to the level of local nervous tics.

Formally, we can say that in this case epilepsy is cured, but if therapy is carried out late or the wrong drugs are prescribed, the average life expectancy of the patient is about 20 years (although some live to a ripe old age even with severe seizures).

In such cases, complications of epilepsy lead to death: pneumonia, cachexia and other associated pathologies.

Infant forms of pathology are fraught with mental disorders and retardation of children in intellectual development.

There are no special effective preventive recommendations that would allow one to avoid the development of the disease, but the risk of this can be reduced if, in childhood, one limits the consumption of caffeine-containing products and eats more fruits and vegetables that are rich in plant fiber.

Myoclonic seizures sometimes occur in healthy people. They are often observed during serious physical activity (this can often be seen in athletes), but if this happens in adults, there is generally no reason for concern.

But if signs such as twitching of the eyes, facial muscles and hands are observed in childhood and without obvious prerequisites, the child should be shown to a doctor.

Perhaps this will make it possible to recognize the disease in time and begin treatment, thanks to which pathological complications will be kept to a minimum.

About errors in the treatment of myoclonic epilepsy in this video:

Forecast

Treatment of epilepsy in adolescents and its causes comes down to complex therapy, which is calculated individually in each case. This necessarily includes taking anticonvulsants (usually one medicine).

Spontaneous remission after treatment occurs only in 10% of cases . In 90% of patients who interrupt therapy, the disease recurs. Periods of remission up to several years are possible. If therapy is prescribed correctly, then a teenager is relieved of seizures in 80% of cases. Mild and moderate epilepsy does not affect mental abilities in any way.

Timely detection of epilepsy helps in effective treatment. The longer the disease remains unattended, the higher the risk of increasing symptoms and deterioration of the child’s well-being.

Absence in children

Absence seizures in children first appear at the age of 2-4 years, when the formation of brain activity is completed. However, attacks may occur later. Absence seizures in children can be easily corrected with timely therapeutic intervention. Complete recovery in such cases is observed in 70-80% of patients.

In children, epilepsy attacks occur suddenly. Sometimes it is possible to identify an incipient seizure by the following phenomena that worry the child against the background of general health:

• headache;
• increased sweating;
• active heartbeat;
• panic mood;
• aggressive behavior;
• sound, taste, auditory hallucinations.

In children, the duration of epilepsy attacks is usually 2-30 seconds. Less common are myoclonic absence seizures, in which the muscles of the arms, legs, face, or entire body cramp. Movements can be unilateral or asymmetrical. A combination of eyelid myoclonus and absence seizures is very rare. Most attacks are caused by uncontrollable twitching of the muscles in the mouth area.

Features of the life of a teenager with a disease

A child with epilepsy, like an adult, can suffer from relapses and also go into long-term remissions. Sometimes there is a general deterioration in health. In some cases, epilepsy goes away on its own within a few months or years, and the child does not even need to take medications.

But there are severe forms, in which the number of attacks is constantly growing, from mild forms they flow into generalized seizures with acute symptoms. The prevalence of such seizures in children aged 12 to 19 years is up to 24 people per 100,000.

Forms of attacks

Conventionally, the forms of myoclonus have acquired the names benign and negative. Benign myoclonus does not require treatment. As a rule, they are observed at night or when a person falls asleep. The duration of the attacks is short - up to several minutes. In a conscious state, fear myoclonus occurs. Spasmodic conditions are provoked by a sharp cry, the fall of any object, or bright flashes of light. The condition is accompanied by tachycardia and sweating. As a result of an attack, hiccups sometimes occur. Involuntary hiccups also indicate chronic diseases of the gastrointestinal tract and intoxication of the body.

Paroxysmal numbness of the calf muscles and eye tics indicate physical overexertion. Such benign myoclonus is typical for children in the first months of life, observed during sleep, and during lactation. Myoclonus cannot be ruled out when the child falls asleep. It is possible to observe involuntary contractions of the neck muscles, limbs and back. As a rule, symptoms disappear within a year without special correction.

Negative myoclonus refers to epileptic seizures. A clear example of the mentioned attacks in children and adults is a slight tremor of the arms when in an extended position. An attack occurs in any type of muscle tissue, even the tongue.