Classification of epilepsy and types of seizures: simple about the complex

Epilepsy is a severe chronic disease characterized by recurrent, spontaneous seizures. The disease can be of a traumatic nature (occurs as a result of injury) or diencephalic (appears as a result of damage to the diencephalic structure of the brain).

In modern neurology, there are a large number of qualifications for epilepsy, which are based on the clinical and electroencephalographic manifestations of epileptic seizures. To record them, EEG and video monitoring are used.

The Yusupov Hospital offers a comprehensive diagnosis of epilepsy using these and other studies. By accurately identifying the type of disease, epileptologists select an individual treatment regimen that is most effective for a particular form of epilepsy. Modern medical equipment, innovative therapeutic techniques and an individual approach provide high treatment results – patients’ health status significantly improves, and the development of new epileptic seizures is prevented.

Classification of the disease

Epilepsy can be congenital (idiopathic) or acquired (symptomatic).
Symptoms of congenital epilepsy appear already in childhood or adolescence. The disease is characterized by a benign course and a favorable prognosis. The right approach to therapy can ensure complete elimination of the need to take medications. This form of pathology is not accompanied by damage to the brain matter. The excitability of the brain is explained by an increase in the electrical activity of neurons. Seizures of congenital epilepsy can lead to complete loss of consciousness.

Congenital epilepsy develops due to genetic defects in brain structures. As a result, the brain is constantly in convulsive readiness, since an attack can happen suddenly at any moment. The development of congenital epilepsy can be triggered by the following factors:

• birth injuries;
• hypoxia, fetal asphyxia;
• intrauterine infections during pregnancy.

Acquired epilepsy is a more complex and severe illness that can occur in people of any age and is difficult to treat. The disease occurs as a result of pathological changes in the brain caused by exposure to certain external factors. During an epileptic seizure, the patient does not lose consciousness, but cannot control a certain part of the body that was affected by the attack.

Acquired epilepsy occurs as a result of the influence of unfavorable factors on the brain, which in turn leads to the formation of an epileptic focus that generates an excess electrical impulse.

Monitoring the dynamics of the disease, adjusting therapy, prognosis

All of these tasks are closely related to each other and their solution is important at all stages of managing a patient in whom problems associated with epilepsy arise. In any case, the appearance of clinical epileptic seizures is preceded by the development in the brain of hypersynchronous neuronal activity, involving several subsystems of the brain, and, consequently, accompanied by the appearance of epileptiform activity. In this regard, the question of its clinical assessment before the onset of epileptic seizures arises. In this regard, there are discrepancies in the management tactics of such patients with a passion for preventive long-term therapy with phenobarbital in groups “at risk of epilepsy,” which include children with febrile seizures, people who have undergone brain surgery, traumatic brain injuries, circulatory disorders, encephalitis and meningitis etc. Recently, taking into account the experience of the almost inevitable effect of any anticonvulsant drugs on neurological and higher mental functions, the possibility of irreversible organic disorders in the central nervous system under their influence, the development of hepatopathy and other somatic disorders, there has been a tendency to abandon their use not only in preventive purposes, but also in the presence of known epileptic seizures, when they are rare, do not cause significant discomfort to the patient and do not pose a vital danger. The occurrence of epilepsy is associated with many factors, and only their total assessment can accurately determine the management tactics for each individual patient. Such a statistically verified and scientifically and practically substantiated risk assessment can be obtained by taking into account the totality of risk indicators in the Epidaurus system we presented above. The use of epileptic indices makes it possible to individually decide in each specific case the need for prescribing and duration of anticonvulsant therapy. The general principle is that if the risk is zero or one, as measured by quantitative EEG and clinical signs, even in the presence of one or more traditional “risk factors,” prophylactic anticonvulsant therapy is not indicated. In the second degree of risk, anticonvulsant therapy is temporary and symptomatic. Its prescription is determined only by the presence of behavioral, vegetative or mental abnormalities in the patient that require pharmacological correction. If these deviations are paroxysmal in nature, then drugs of the valproate or carbamazepine group, which are effective psychotropic drugs, are simultaneously and prophylactically useful in preventing epilepsy. The duration of therapy in these cases is determined by the dynamics of the clinical picture, the extent and rate of disappearance of epileptiform activity from the EEG. A formal criterion for stopping the administration of anticonvulsants may be the patient's transition to the first or zero risk group. Finally, the third degree of risk is equivalent to the manifestation of epilepsy, and it requires long-term (at least 2 years) regular anticonvulsant therapy.

After deciding to start treatment, the selection of a therapeutic dose of the drug should be carried out under EEG monitoring. If, after a sufficient increase in the dose of the drug, it is not possible to achieve complete cessation of attacks, a repeat study is recommended. The absence of a significant decrease in the severity of epileptiform activity and a decrease in the electroencephalographic risk index of epilepsy may indicate an insufficient dose of the drug or its ineffectiveness in this form of the disease. If, after an additional increase in the dose for more than a week, there is no noticeable decrease in the number, severity of seizures and improvement in the EEG, the question arises of changing the drug. In these cases, it is necessary to reliably monitor the correctness of administration and examine the content of the drug in the patient’s blood plasma, and only if its level in the body is sufficiently high, the question of replacement should be raised. There are differences between the two main anticonvulsants: valproate and carbamazepine. Regarding the first, there is a very good correlation between clinical effectiveness and a decrease in the severity of epileptiform activity, as well as a decrease in spectral power in the EEG. Therefore, when treating with valproate, the dose should be adjusted within the therapeutic range, achieving, if possible, the complete disappearance of pathological activity in the EEG.

When treating with carbamazepine, such a correlation is not observed and situations are possible when, when seizures stop, epileptiform and (or) slow activity in the EEG remains, and sometimes intensifies, taking on a generalized character. In this situation, you should be careful, as this may indicate that carbamazepine is ineffective in this patient. On the other hand, with effective suppression of seizures, one should not necessarily achieve complete normalization of the EEG, remembering the rule of treating the patient, not the EEG.

EEG of a 27-year-old patient with resistant complex partial seizures with automatisms with an epileptogenic focus in the left temporal lobe

At a dose of 12 mg/kg of carbamazepine, the focus of constant sharp wave-slow wave complexes with an amplitude of up to 270 μV is recorded in the left temporal region with a projection between the T3 and T5 electrodes. Note the phase distortion in leads F7-T3 and T5-O1.

Patient's EEG from Fig. 70 after increasing the dose of carbamazepine to 20 mg/kg without a decrease in previous seizures, but with the addition of short “atypical absences” and atonic seizures

The EEG shows generalized discharges of sharp wave-slow wave complexes, sharp and slow waves with an amplitude of up to 350 μV, bilaterally synchronous, alternately asymmetrical, but with a predominance on the left, lasting up to 20-30 seconds. The EEG pattern indicates that carbamazepine is contraindicated for this patient.

The only but categorical exception to this rule is Landau-Kleffner epileptic aphasia syndrome. Since these patients may not have seizures, the only clinical criterion is recovery of speech, which, if achieved, may be significantly delayed. Since this recovery directly depends on the suppression of epileptic activity in the brain, the only direct criterion for the effectiveness of treatment in its most critical stage is the dynamics of the EEG. Considering that normalization of the functioning of the brain mechanisms of speech formation should be achieved as quickly as possible, before the development of irreversible communication disorders, EEG studies should be carried out at the shortest possible intervals to assess the success of therapeutic measures. The goal is to achieve complete normalization of the EEG, which is a condition for the restoration and further formation of speech (Fig. 65).

When the attacks are completely suppressed, there is no need for repeated EEG studies. The exception is relatively benign forms of epilepsy, which tend to spontaneously stop seizures if they occur in a mild form. With these forms, treatment can sometimes be stopped at earlier stages. This is possible with pycnolepsy (epilepsy of childhood and adolescence with typical absence seizures) and childhood epilepsy with centrotemporal spikes without grand mal seizures. In these forms of epilepsy, the EEG closely correlates with the number and severity of seizures. Considering that mild short attacks can occur unnoticed by the patient, his environment and the doctor, an EEG study is an accurate and direct criterion for the dynamics of the disease. Dynamic EEG studies at intervals of no more than 6 months are indicated in cases of the same forms of epilepsy, when, according to clinical indications for rare and mild forms of seizures, a decision has been made to refrain from prescribing anticonvulsants from the very beginning. In these cases, persistence, persistence, and especially increasing severity of epileptiform activity may be an indication for the prescription of anticonvulsants (for example, after the acute period has passed after liver disease, which was a contraindication to pharmacotherapy). In deciding whether to withhold treatment for minor seizures, a clinical assessment of the degree of consciousness impairment in the patient is crucial. In these cases, an effective technique is to record the patient's reaction by pressing a button in response to a signal (an audio click or a short photodiode flash) given by the examiner at the moment the epileptic discharge pattern appears on the EEG. The marking of irritation and reaction is made by antiphase rectangular emissions on the service channel of the electroencephalograph. Regular responses to all presented stimuli are a more reliable criterion for the preservation of consciousness and attention of the patient in a subclinical pattern of absence than a test with the presentation of words for subsequent recall, which may be normal in clinical absence, during which the patient did not respond to stimuli by pressing a button10.

EEG data are of decisive importance when the question arises about stopping anticonvulsant therapy after long-term remission. According to existing standards, this question can be raised at least 2 years after the last attack. In this case, an attempt to discontinue the drug is usually made if the EEG does not reveal pathological changes in the background and during tests with photostimulation and hyperventilation. Recently, in connection with the revision of a number of criteria for “normality” in the EEG11, it is considered possible to raise the question of cancellation when typical epileptiform phenomena disappear in the EEG, even with the preservation of nonspecific non-gross abnormalities. In this regard, the already repeatedly mentioned system for quantitative assessment of clinical-electroencephalographic data according to the degree of risk of epilepsy (“Epidaurus”) provides a more reliable criterion. Since most of the risk factors that make up the indices are dynamic in nature, the system allows you to flexibly monitor the dynamics of the epileptic process even in the absence of seizures. According to experience, the question of discontinuing therapy can be raised in cases where during treatment there was a decrease in the degree of risk, and the degree of risk at the time the question was raised is no more than the first. A gradual reduction in the dosage of the drug should be accompanied by EEG recordings, usually at least a week after the next dose reduction, then 1 and 3 months after its final discontinuation. The appearance and intensification of the severity of abnormal fluctuations in the EEG, and especially epileptiform activity, is a direct indication for increasing the dose of the drug to a level that returns the EEG to its original normalization, and abandoning attempts to cancel anticonvulsant therapy until better times. A similar decision should be made when the risk of epilepsy increases, calculated together with repeated EEG assessments.

The issues of prognosis, risk assessment and diagnosis of epilepsy are related to the tasks of medical examination in professional, insurance and forensic medicine. It should immediately be noted that the electroencephalographer does not have the right or obligation to make final expert judgments, and his data are only a partial contribution to the overall picture of the clinical condition of the subject. It is impossible to give a single system of recommendations suitable for each individual case, taking into account the complex combination of medical, psychological, professional, economic, legal and, not least, ethical factors.

When addressing issues of professional suitability, the detection of obvious epileptiform phenomena in the EEG, such as an epileptic seizure pattern or discharges of epileptiform activity, is a sufficient basis for screening in professions related to driving, tracking, requiring constant attention and quick response to sudden situations and stimuli in high-risk conditions. If there are signs in the EEG of a decrease in the threshold of convulsive readiness in the form of irregular, low-amplitude acute phenomena, high-amplitude pointed α- and β-rhythms, bursts of high-amplitude slow waves, the patient needs a more in-depth psychiatric and neurological examination to make a decision. Of particular importance here is the assessment of the risk of epilepsy using the Epidaurus system. Detection of the 2nd or higher risk level of epilepsy serves as sufficient grounds for professional screening. The professional status of the person being studied is also of certain importance. If we are talking about an initial examination when applying for a job or training, the decision to drop out is made more strictly. In the case of an already working professional, when there are no complaints and obvious clinical manifestations of pathology, more in-depth EEG studies are required, including recording with sleep deprivation against the background of daily fasting, recording night sleep with at least eight leads of the EEG itself. If bursts of slow activity are detected during wakefulness, a study is required by presenting audible clicks during the bursts and recording the patient’s reaction according to the method described above in the application to the differentiation of clinical and subclinical absence seizures. Detection of attention deficit during this test is a reason for screening, but if the test is performed correctly in all cases, the subject can continue to work in this professional field, remaining under supervision.

If we are talking about non-epileptiform manifestations, then the interpretation depends on the degree of their severity. Severe and moderate changes and persistent local changes in the EEG of any severity are a manifestation of pathology, and the patient needs a full neurological examination and appropriate treatment. Mild diffuse changes do not necessarily indicate the presence of actual organic disorders and in themselves cannot be a reason for professional screening, as well as normal variants, such as low-amplitude EEG and fast a-variant.

When addressing questions about disability arising in connection with professional activity (head injury, known harmful factors), one should take into account the already mentioned pattern that changes in the EEG are mainly a manifestation of the actual developing pathological process and in residual conditions, even with severe organic deficiency, can practically absent. In this regard, it should be firmly remembered that the absence of pathological changes in the EEG is not evidence of the intactness of the central nervous system. On the other hand, even mild EEG changes or recordings bordering between normal and pathological, in the context of the clinical picture, including subjective complaints of patients, can be evidence of the presence of cerebral pathology, if the causative factor in the occurrence of the disabling condition is known. Thus, after a traumatic brain injury in the absence of clear “organic” neurological symptoms, syndromes of a “functional” nature often arise, manifested by headaches, asthenia, emotional disorders, vestibular disorders, drowsiness during the day and insomnia at night. This whole complex of symptoms indicates dysfunction of nonspecific midline structures of the brain, therefore, manifestations of dysfunction of these same structures in the EEG, such as low-amplitude activity, diffuse theta waves up to 50-60 μV in amplitude, groups or bursts of bilaterally synchronous waves during hyperventilation, which can occur and normal, in this context confirm the diagnosis of post-traumatic disorders, which the electroencephalographer should note in the conclusion. As you can see, those mild dysfunctional manifestations in the EEG, which, when resolving issues of professional suitability with the subject’s motivation for this work and the absence of clinical symptoms, cannot serve as a reason for professional withdrawal, in this situation have the opposite meaning, motivated by the whole complex of factors influencing the outcome examination.

In forensic medical examination, issues of diagnosing epilepsy arise in assessing the motives for the committed act or the presence of consciousness at the time of the accident in the person responsible for the occurrence of the corresponding situation. The examination tactics here coincide with those described in the annex to professional selection. A full examination is necessary to identify known epileptiform activity such as an epileptic seizure pattern and epileptic discharge, an assessment of reactivity during these patterns and bursts of slow activity in the EEG. It is advisable to carry out this test in the absence of pathological changes in the EEG, and in the presence of outbreaks of abnormal activity, present stimuli outside and during these outbreaks with equal probability. Omission of reactions against the background of a normal EEG will be suspicious of its intentionality, on the other hand, normal reactions in normal areas of the EEG and omissions during bursts of even non-epileptiform activity will be strong evidence of pathological disorders of tracking and consciousness, since the subject, naturally, cannot know that what character the EEG has at the moment of stimulus presentation. Differentiation of simulated or psychogenic seizures from epileptic ones, if they are reportedly frequent and easily caused, can be done by the already described test with intravenous administration of saline under the guise of a convulsant, and then from another syringe - supposedly an anticonvulsant drug with simultaneous EEG recording.

In any case, assessing the risk of epilepsy using epilepsy indices is indicated. Let us recall that due to the 100% specificity of the Epidaurus system 3, the risk level according to this assessment is equivalent to a reliable diagnosis of epilepsy. It should be borne in mind that a number of signs in this system depend on the information provided to the subject, which, naturally, does not exclude certain deviations of the indices depending on the motivation of the subject. During professional selection, the subject suppresses or dissimulates factors (for example, heredity, early history, assessment of well-being); during forensic medical research, the opposite trends may be observed. Accordingly, in the first case, the clinical risk index turns out to be underestimated, and therefore the reason for screening may be 2 or even 1 degree of risk of epilepsy, if it is determined by a positive electroencephalographic risk index. In the second case, it is possible to obtain a falsely high clinical risk index, but in the absence of sufficiently pronounced EEG changes, the system will not give a positive diagnosis of epilepsy, which excludes false diagnosis due to simulation. And finally, it must be firmly remembered that due to the imperfect sensitivity of the system, failure to achieve the third degree of risk does not necessarily exclude epilepsy, although it makes it less likely.

Footnotes

1. Karlov V.A. Epilepsy. – M.: MIA, 2002.
2. Karlov V.A. Epilepsy in children and adult women and men. – M.: Medicine, 2010. – 720 p.
3. Gusev E.I., Avakyan G.N., Nikiforov A.S. Epilepsy and its treatment. Management. – 2nd edition corrected and expanded. – M.: GEOTAR-Media, 2021. – 310 p.
4. Okudzhava V.M. Basic neurophysiological mechanisms of epileptic activity. – Tbilisi: Science, 1969. – 302 p.
5. Bekhtereva N.P., Kambarova D.K., Pozdeev V.K. Stable pathological condition in brain diseases. – L., 1978. – 240 p.
6. Kryzhanovsky G.N. Determinant structures in the pathology of the nervous system: Generator mechanisms of neuropathological syndromes. – M.: Medicine, 1980. – 359 p.
7. Calcagnotto M.E., Paredes M.E., Tihan T, Barbara NM, Baraban CS Dysfunction of Synaptic Inhibition in Epilepsy Associated with Focal Cortical Dysplasia//J. Neu-rosci. 2005.25(42): 9649-9657.
8. Wasser St., Kasper JM Die BedeutungdesEEGfurdieverschidenen Klassifika-tionen der Epilepsien: Ergebnisse bei 856 kindlichen Epileptikern / Zbl. Neurochir., 1984, Bd. 45, s. 318-325.
9. Avakyan G.N., Blinov D.V., Lebedeva A.V., Burd S.G., Avakyan G.G. International League Against Epilepsy Classification of Epilepsy: 2021 Revision and Update. Epilepsy and paroxysmal conditions. 2017; 9 (1): 6-25.
10. Noachtar S. Der Klicker-Test: eine einfache Metode zur Prufung und Dokumen-tation der Bewustseinlage im EEG / EEG-Lab., 1993, Bd. 15, s. 41-46.
11. Eeg-Olofsson O. The development of the electroencephalogram in normal children and adolescents from the age of 1 through 21 years / Acta, pediat. scand. Suppl. 1970, v. 208, p. 1-47.

Local epilepsy

When diagnosing epilepsy, it is important for specialists to understand whether the seizure affects one of the brain hemispheres or the entire brain, thus identifying the type of seizure - partial or generalized.
Local (focal, partial) epilepsy can be simple or complex. With complex seizures, patients' consciousness is impaired, but with simple ones this does not happen. Simple seizures in local epilepsy are characterized by a variety of manifestations, which depend on the localization of epileptic activity in a particular area of ​​the cerebral cortex. Simple focal seizures are characterized by the occurrence of clinical convulsions in a certain part of the body and their further spread to neighboring areas.

Simple partial seizures can be:

• tonic – they are characterized by the patient adopting a forced posture and muscle tension. After a seizure, the muscles involved are temporarily weakened;
• sensory – patients experience illusions, hallucinations, any part of the body may become numb or tingling;
• vegetative - during attacks, piloerection, sweating, rapid heartbeat, and a feeling of a lump in the throat appear. With such seizures, patients experience a variety of mental disorders.

During complex seizures, patients' consciousness is impaired and they do not respond to external stimuli.
The duration of such an attack is usually from 30 to 90 seconds, after which drowsiness and fatigue appear. Complex seizures of local epilepsy must be distinguished from absence seizures. In the first case, the source is a focus of pathological activity, and the other is a primarily generalized seizure. The duration of focal seizures is often longer and they are characterized by confusion. Absence seizures are not accompanied by a similar phenomenon. The development of local epilepsy seizures is caused by focal damage to the cerebral cortex; they require different treatment than absence seizures.

Diagnosis of epilepsy

In epilepsy, an electroencephalographic study is of particular diagnostic importance. The specificity of the disease, manifested by periodic attacks, often occurring against the background of general well-being and the absence of clinical symptoms, the inability for the doctor in most cases, especially in outpatients and first-time patients, to directly see an epileptic seizure, amnesia accompanying the seizure, makes it very difficult, and in some cases make clinical diagnosis impossible without the help of electroencephalography. The role of additional objective research methods increases all the more because, for certain social reasons, this particular disease often becomes the subject of simulation or dissimulation. In addition, in a number of cases, serious differential diagnostic problems arise in distinguishing between epilepsy and hysterical or syncope attacks, as well as disorders of consciousness and behavior associated with other diseases.

In this regard, when diagnosing epilepsy in the process of analyzing the EEG, the following main questions arise: 1) diagnosis of epilepsy itself and its differentiation from other paroxysmal diseases of the nervous system; 2) determining the type of epileptic seizures or the form of epileptic disease; 3) monitoring the course of the disease, adjusting treatment, prognosis.

➥ For more details, read the article: EEG changes in epilepsy

Generalized epileptic seizure

In a generalized epileptic seizure, both hemispheres of the brain are involved, so there are no precursors to its development. Generalized epileptic seizures are divided into the following types:

• typical absence seizures - they are characterized by short attacks of impaired consciousness, during which the patient’s gaze freezes or stops. At the end of the seizure, there is no confusion. Lack of treatment threatens multiple repetitions of absence seizures. As a rule, they begin to appear in childhood and continue into adulthood;
• atypical absence seizures - attacks are characterized by a pronounced beginning and end, long duration, mental retardation and motor impairment;
• clonic seizures – myoclonic jerks occur;
• myoclonic seizures – patients develop short, sudden convulsive twitches. The attack typically involves the head, neck, upper and lower extremities. Such attacks can be isolated or combined with other seizures;
• tonic seizures – bilateral short attacks of muscle tension develop in the limbs and torso;
• atonic seizures – the patient’s muscles suddenly and briefly lose their tone. There is a sudden drooping of the head or a fall of the patient. Despite the fact that consciousness is restored quite quickly, such seizures threaten to cause injury;
• generalized epileptic seizures - patients completely lose consciousness, their tonic tension in the muscles of the trunk, arms and legs disappears. Most often, the seizure is preceded by a piercing scream, the appearance of which is associated with the expulsion of air through the closed vocal cords. The muscles tense, after which a convulsive attack begins, which is characterized by severe muscle tension, which can be accompanied by fractures and dislocations. After an attack, a person has a headache and drowsiness.

Report of the ILAE Commission (2001) on the classification of epileptic seizures

Self-limited seizures

Generalized: .

• tonic-clonic (including options for starting with the clonic or myoclonic phase);
• clonic (with or without a slight tonic component);
• typical absence seizures,
• atypical absence seizures,
• myoclonic absence seizures,
• tonic,
• epileptic spasms;
• epileptic myoclonus;
• eyelid myoclonus (with or without absence seizures),
• myocloic-atonic (myatonic); atonic;
• negative myoclonus (sudden paralysis of part of the muscles with loss of muscle tone);
• reflex generalized.

Focal:

• focal sensory (with simple symptoms associated with irritation of the occipital/parietal/temporo-parieto-occipital cortex)
• focal motor: clonic, asymmetric tonic (associated with irritation of the additional motor area), with typical, with hyperkinetic automatisms, with focal negative myoclonus, inhibitory;
• gelastic (violent attacks of laughter);
• hemiclonic;
• secondary generalized;
• reflex (stimulus-sensitive) focal.

Ongoing attacks

Generalized status epilepticus.

• generalized tonic-clonic seizures,
• clonic seizures;
• absence seizures;
• tonic attacks;
• myoclonic seizures.

Focal status epilepticus:

• Kozhevnikov epilepsy;
• continued aura;
• limbic seizure status;
• hemiconvulsive status with hemiparesis.

Types of epilepsy. Seizure symptoms

The classic manifestation of epilepsy is the presence of seizures.
They arise unexpectedly and do not always depend on environmental factors. In certain cases, it is possible to predict the occurrence of an attack based on the patient’s complaints of general malaise. He may be tormented by headaches, poor sleep, lack of appetite, and irritability. During an attack, convulsions occur, during which the head is thrown back, the limbs and torso are stretched, breathing is held, and the veins of the neck swell. Such convulsions are called tonic, their duration is about 20 seconds. They are followed by clonic convulsions, which manifest themselves in jerking movements. This phase lasts up to 3 minutes. The patient may experience foaming at the mouth mixed with blood, this is due to the accumulation of saliva in the mouth and possible biting of the cheek or tongue.

Modern medicine knows many types of epilepsy. There are main types of epilepsy:

• absence epilepsy. Characterized by a lack of reaction to events happening around;
• Rolandic epilepsy. It is characterized by numbness of the skin, spasms of certain parts of the body, and excessive salivation. Mostly boys aged 8-10 years are affected;
• myoclonic epilepsy. Characterized by the presence of epileptic seizures, myoclonus (muscle contractions), sometimes mental disorders are noticeable;
• post-traumatic epilepsy. Characterized by the presence of seizures as a result of traumatic brain injury;
• alcoholic epilepsy. Typical for people suffering from alcohol addiction. Manifested by convulsions and loss of consciousness. After the seizure ends, the patient may fall asleep for several hours;
• epilepsy of newborns;
• temporal lobe epilepsy. It is chronic in nature with gradual progression;
• epilepsy in children. Seizures may not be related to epilepsy. Careful diagnosis is necessary;
• non-convulsive epilepsy. Characterized by the absence of symptoms expressed by convulsions. It manifests itself as a lack of reaction to external stimuli, a blank look, and loss of consciousness.

Epilepsy, regardless of type, requires careful treatment.
Diagnosis and treatment of epilepsy is carried out by epileptologists at the Yusupov Hospital. Make an appointment

Newborn disease

Epilepsy in newborns is also called intermittent.
The seizures are general in nature, with spasms moving from one limb to another and from one side of the body to the other. Symptoms such as foaming at the mouth, tongue biting, and post-attack sleep are not observed. Manifestations may develop against the background of high body temperature. After consciousness returns, there may be weakness in one side of the body, and this can sometimes last for several days.

Symptoms that are warning signs of an attack include:

• irritability;
• lack of appetite;
• headache.

Status epilepticus

Status epilepticus is said to occur when seizures are repeated multiple times, so often that consciousness does not have time to recover between them.
Patients experience impaired hemodynamics and respiratory function, and twilight consciousness appears. Convulsive attacks are accompanied by soporous and comatose states, seriously threatening the life of the epileptic. In the tonic phase, a spasm of the respiratory muscles occurs, and apnea appears with the characteristic symptoms listed above. There is an appearance of increased and shallow breathing associated with hypoxia, which is accompanied by hypocapnia. With this condition, epileptic activity increases and the duration of the seizure increases.

Patients who have fallen into a coma suffer from pharyngeal respiratory paralysis with loss of the pharyngeal reflex. In the respiratory tract, salivary secretion accumulates, as a result of which breathing worsens and cyanosis occurs. Hemodynamics change, heart rate increases, blood pressure increases, myocardial ischemia develops, metabolism is disrupted, resulting in metabolic acidosis, and intracellular respiration is disrupted.

Myoclonic form of the disease

Myoclonic epilepsy affects both sexes. One of the most common types. The disease debuts between the ages of 10 and 20 years. Symptoms include epileptic seizures.

Over time, myoclonus occurs - involuntary muscle contractions. Mental changes occur very often.

The frequency of attacks can be completely different. They can happen every day, several times a month or even less often. Along with seizures, disturbances of consciousness may occur. However, this form of the disease is the easiest to treat.

Diagnostics

If you have epilepsy attacks, you should immediately seek help from a neurologist.
The Yusupov Hospital has an epileptologist who specializes in this disease. The doctor will conduct diagnostics using modern equipment. At the Yusupov Hospital, the following examination methods are used for this: encephalography, neurosonography, MRI, CT, Dopplerography of cerebral vessels, ultrasound if necessary. The doctor will determine the exact form and cause of the disease and prescribe appropriate treatment.

It is important to follow the exact recommendations of your doctor to achieve the maximum effect of treatment. According to statistics, with the correct course of treatment, attacks will soon decrease and soon disappear altogether.

Post-traumatic epilepsy

This form of epilepsy develops as a result of brain damage from head injuries. Symptoms include seizures. This type of epilepsy occurs in approximately 10% of victims who have suffered such an injury.

The likelihood of pathology occurring increases to 40% with penetrating brain injury. Characteristic signs of the disease can appear not only in the near future after the injury, but also several years after the injury. They will depend on the site of pathological activity.

Treatment

Epilepsy is a serious stress that is experienced by both the patient’s loved ones and himself.
A person experiences constant fear, waiting for each new attack, and as a result he develops depression. Therefore, neurologists at the Yusupov Hospital make every effort to help patients suffering from epilepsy, selecting treatment with the most modern antiepileptic drugs that can prevent the development of new seizures. In the fight against the disease, epileptologists at the Yusupov Hospital adhere to the following therapeutic principles:

• early start of treatment;
• continuity;
• complexity;
• continuity;
• individual approach.

Treatment of patients with epilepsy in the neurology clinic of the Yusupov Hospital is aimed at achieving the following goals:

• preventing the development of new epileptic seizures;
• relief of pain during attacks;
• reducing the frequency of epilepsy attacks;
• stopping medications or reducing side effects from their use;
• training relatives of an epileptic in the correct handling of the patient;
• conducting socio-neurological rehabilitation to improve the patient’s quality of life;
• the use of complex therapy for patients suffering from epilepsy and related diseases.

The Neurology Clinic of the Yusupov Hospital provides comprehensive, regular and long-term treatment for epileptic seizures.
It consists of dehydration, anticonvulsant, restorative and resorption procedures. Before starting treatment, a team of neurologists and diagnosticians at the clinic determine the type of epileptic seizures and the etiology of epilepsy. For drug therapy, the most optimal drug is selected, the dosage of which is constantly increased until the attacks completely stop. If taking the drug does not achieve the desired result, additional medications are prescribed.

The effectiveness of therapy largely depends on the actions of the patient himself - his compliance with all the recommendations of the attending physician. Interruption of the drug may result in status epilepticus.

In the neurology clinic of the Yusupov Hospital, during the treatment of epilepsy, doctors with extensive experience in treating all types of diseases use the latest technologies and the latest generation antiepileptic drugs. To conduct diagnostics and consult a neurologist or epileptologist at the Yusupov Hospital, you must make an appointment by phone or on the clinic’s website.

Report of the ILAE Commission (2001) on the classification of epilepsy and epileptic syndromes

Idiopathic focal epilepsies of infancy and childhood:

• benign infantile seizures (non-familial);
• benign childhood epilepsy with central temporal spikes (rolandic);
• benign occipital epilepsy of childhood with early onset (Panayotopoulos type);
• benign occipital epilepsy of childhood with late onset (Gastaut type).

Familial (autosomal dominant) focal epilepsies:

• benign familial seizures of newborns;
• benign familial attacks of infancy;
• autosomal dominant nocturnal frontal lobe epilepsy;
• familial temporal lobe epilepsy;
• familial focal epilepsy with variable focus.

Symptomatic focal epilepsies:

• mesial temporal lobe epilepsy with hippocampal sclerosis; other forms of specific localization and etiology;
• mesial temporal lobe epilepsy due to a specific etiology;
• Rasmussen's syndrome;
• hemiconvulsive-hemiplegic syndrome;
• migrating partial seizures of early infancy;
• other forms of specific localization and etiology.

Idiopathic generalized epilepsies:

• benign myoclonic epilepsy of infancy;
• epilepsy with myoclonic-astatic seizures;
• childhood absence epilepsy (CAE);
• epilepsy with myoclonic absence seizures;
• juvenile absence epilepsy (JAE);
• juvenile myoclonic epilepsy (JME);
• epilepsy with isolated generalized tonic-clonic seizures;
• generalized epilepsy with febrile seizures + progressive myoclonus epilepsy;
• specific diseases (such as Lafora, Unferricht-Lundborg diseases, neuronal ceroid lipofuscinosis).

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Reflex epilepsy:

• idiopathic photosensitivity occipital epilepsy,
• other forms of epilepsy with seizures resulting from visual stimulation;
• primary reading epilepsy;
• startle epilepsy.

Seizures with an optional definition of “epilepsy”. Epileptic encephalopathies:

• early myoclonic encephalopathy;
• Ohtahara syndrome;
• West syndrome;
• Dravet syndrome;
• Lennox-Gastaut syndrome;
• Landau-Kleffner syndrome; myoclonic status.
• epilepsy with continued peak-wave activity during slow-wave sleep;

The draft new classification will take into account 5 positions instead of the anatomical-electro-clinical approach:

1. description of the paroxysmal event;
2. attack classification;
3. diagnosis of a form of epilepsy;
4. establishing the etiology of epilepsy;
5. diagnosis of concomitant diseases and determination of the degree of disability.

An epileptic seizure is a short, usually unprovoked, stereotypical disturbance of behavior, emotions, motor or sensory functions, which, even based on clinical symptoms, can be associated with a neuronal discharge in the cerebral cortex.

Classification of epilepsy by areas of brain damage

There are the following types of disease in this classification.

Frontal form of epilepsy

Frontal epilepsy is characterized by the location of pathological foci in the frontal lobes of the brain. Can appear at any age.

The attacks occur very often, do not have regular intervals, and their duration does not exceed a minute. Start and end suddenly. Symptoms:

• feeling of heat;
• disordered speech;
• senseless movements.

A special variant of this form is nocturnal epilepsy. It is considered the most favorable variant of the disease. In this case, the convulsive activity of neurons in the pathological focus increases at night. Since excitement is not transmitted to neighboring areas, attacks proceed more mildly. Nocturnal epilepsy is accompanied by such conditions as:

• somnambulism - performing any active activity during sleep;
• parasomnias - uncontrollable shaking of the limbs when waking up or going to sleep;
• enuresis - involuntary urination.

Lesion in the temporal lobe

Temporal lobe epilepsy develops due to the influence of many factors, it can be a birth injury, damage to the temporal lobe during a head injury, or inflammatory processes in the brain. Characterized by the following short-term symptoms:

• nausea;
• stomach ache;
• cramps in the intestines;
• rapid heartbeat and heart pain;
• labored breathing;
• profuse sweating.

There are also changes in consciousness, such as loss of motivation and performing meaningless actions. In the future, the pathology can lead to social maladjustment and severe autonomic disorders. The disease is chronic and progresses over time.

Occipital epilepsy

It occurs in small children aged 2 to 4 years, has a benign nature and a favorable prognosis. The causes can be various neuroinfections, tumors, and congenital brain defects. Symptoms:

• visual disturbances - lightning, spots appear before the eyes;
• hallucinations;
• head tremor;
• rotation of the eyeballs.

Nonconvulsive epilepsy

This form is a common variant of the development of the disease. Symptoms are expressed in personality changes. It can last from several minutes to several days. It disappears as suddenly as it begins.

In this case, an attack is understood as a narrowing of consciousness, while the patient’s perception of the surrounding reality is focused only on phenomena that are emotionally significant for him.

The main symptom of this form of epilepsy is hallucinations that have a frightening overtone, as well as the manifestation of emotions to the extreme degree of their expression. This type of disease accompanies mental disorders. After attacks, a person does not remember what happened to him, only sometimes residual memories of events may arise.