Epilepsy is one of the most common chronic neurological diseases in humans, manifested in the body’s predisposition to the sudden onset of seizures. These seizures occur as brief, involuntary seizures in one part of the body (partial seizures) or throughout the body (generalized seizures) and are sometimes accompanied by loss of consciousness and loss of bowel or bladder control. The diagnosis is made if seizures recur and are accompanied by other symptoms characteristic of epilepsy. In most cases, epilepsy affects children and the elderly, but can also occur in young and old adults.
Key facts:
- One single seizure does not indicate epilepsy (worldwide, up to 10% of people have had one seizure during their lifetime). The definition of epilepsy applies to 2 or more unprovoked seizures.
- Worldwide, approximately 50 million people suffer from epilepsy, one of the most common neurological diseases globally.
- Almost 80% of people with epilepsy live in low- and middle-income countries.
- Epilepsy is treatable in approximately 70% of cases.
- However, three quarters of people suffering from the disease in developing countries do not receive the treatment they need.
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Epilepsy is a chronic disease. During epilepsy, there are non-convulsive periods and the actual epileptic seizure - they alternate. With proper therapy, the duration of remission can be significantly increased. The disease develops due to a disturbance in the electrical activity of the brain. Epilepsy has many varieties with different courses.
Epilepsy is such a complex and complex disease that a special field has even emerged in neurology - epileptology. Epileptologists study the patterns of occurrence, the clinical course of the disease, and look for new approaches to treatment and prevention. For treatment, you can contact a neurologist or a highly specialized epileptologist.
Seizures
There are dozens of types of attacks. Therefore, here we describe only the most typical varieties. The most common type is a generalized tonic-clonic seizure. This is what they call convulsions with loss of consciousness. The attack is accompanied by twitching of the limbs and muscle tension. This is a rather severe course of the attack, which is how epilepsy is usually presented.
There are myoclonic seizures. They are distinguished by clear consciousness and manifest themselves in twitching of any limb or part of the body, less often of the whole body. If at the time of an attack the patient is holding something in his hands, then he may drop this object. If the twitching affects the lower limbs, the patient loses balance.
Tonic seizures are seizures involving prolonged tension in a specific part of the body. Externally manifested by trembling of this part of the body. At the same time, speech is normal, consciousness is clear.
There are attacks that occur mainly in children - they look like short tremors. They may be accompanied by unnatural spreading of the arms or legs to the sides. Sometimes the child, on the contrary, seems to shrink into a ball. In this case, periods of tension alternate with muscle relaxation throughout the attack.
Another type of childhood epileptic seizures is absence seizures. This is what they call freezing in any position with a lack of reaction to addressing the child. The main signs are trembling of any limb with asymmetric muscle tension. If asymmetrical tremors are noticeable during an attack, the doctor should suspect damage to a specific area of the brain.
Who is an epileptologist?
An epileptologist is a doctor who has received a specialty as a neurologist (less often a psychiatrist) and additional education with in-depth study:
- Electrophysiology;
- Methods for visualizing the structure, biochemical parameters and functioning of the brain;
- Paroxysmal disorders;
- Human genetic characteristics;
- Methods and means of social rehabilitation of patients with epilepsy;
- Pharmacology of drugs used for the treatment of epilepsy, etc.
Such versatile training of specialists is necessary so that the doctor has the opportunity to work with patients with severe and rare forms of epilepsy.
In addition, there are pediatric epilepsy specialists with an even narrower specialization. The fact is that the treatment of this disease in childhood differs from the treatment of epilepsy in adults. This applies, first of all, to the selection of medications.
An epileptologist’s goal in his work is to rid the patient of seizures forever, or to reduce the number of their occurrence to a minimum. In this case, it is necessary to competently select the drug and determine its dosage. This may take several months.
Epileptologist specialists can practice in specialized hospitals, clinics, and epileptology centers. Specialists receive seriously ill patients in large scientific centers, where departments equipped to treat such patients are located. It is also possible to perform surgical intervention there, if necessary. However, most often patients need long-term outpatient treatment under the supervision of a competent specialist.
If there is no epileptologist in the locality, then patients should be observed by a neurologist.
Read more: Epilepsy in adults - causes, signs and symptoms of epilepsy, consequences
Seizures and epilepsy
Contrary to popular belief, seizures do not always accompany epilepsy. Seizures are a separate symptom characteristic of many diseases. They occur when the temperature rises, and are especially often observed in children of the first years of life - febrile. Convulsions accompany various infectious and non-infectious diseases; they are observed in cases of poisoning, dehydration, head injuries, and acute cerebral circulatory disorders.
Based on external signs, it is sometimes difficult to distinguish seizures from other movement disorders, from loss of consciousness, from a migraine aura, from manifestations of psychiatric diseases. The main difference between an epileptic attack and a paroxysm characteristic of any other disease is spontaneity. With epilepsy, an attack can be triggered by almost anything: from bright lights and flashing lights to deep breathing.
Epilepsy: what kind of disease is this, what is an epileptic seizure?
Epilepsy has many names: “black disease”, “moon disease”, “sacred disease”. This disease has been known for a very long time; even the doctor Hippocrates described this disease. Even then, the great scientist suggested that the disease was the result of a malfunction of the brain.
Epilepsy has always been feared. For example, in ancient Rome they stopped conducting a meeting if an epileptic attack occurred. And in the Middle Ages, people with epilepsy had to live in exile, to be hermits. Society avoided such people; everyone was afraid of getting infected from a patient with epilepsy. And, of course, they considered epilepsy a curse.
Currently, quite a lot is known about epilepsy. And, fortunately, advances in medicine allow us to learn more and more about this disease.
In epilepsy, the excitatory system dominates over the inhibitory system. As a result, groups of nerve cells produce powerful electrical discharges. An epileptic attack occurs. Normally, the inhibitory and excitatory systems work synchronously.
Epilepsy can occur at any age. But most often the disease manifests itself in childhood.
Epilepsy disease
Behavior during an attack
Most attacks end safely on their own, without causing harm to the patient. The average seizure lasts from a few seconds to several minutes. The very first thing you can do to help the patient (no matter how bad it looks) is to call an ambulance, ensure free breathing and protect yourself from injury. It makes sense to call an ambulance for strangers. It is important to remember all the details of the seizures; if possible, it is worth recording the symptoms on video. This will make it very easy for the doctor to make a specific diagnosis and diagnose the form of epilepsy. If an attack occurs in a friend who knows about his illness and does not consider it necessary to call a doctor, then there is no need to call the emergency room.
If possible, the patient should be moved or taken away from sharp, piercing objects, unstable or dangerous structures. Ideally, the patient sits or lies on a flat, safe horizontal surface. The patient cannot be restrained by force. To ensure normal breathing, it must be placed on its side and ensure free access of air.
The most popular advice given by ordinary people is to unclench your jaw. In fact, doctors warn that you should never try to do this, especially with a hard object. The risk of injury is extremely high.
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After the attack ends, the patient often experiences drowsiness, fatigue, and a desire to rest. It is important to make sure that the person is clear-headed, understands what happened and can get home independently. It is recommended to check speech and limb movements. To assess the patient’s condition, it is enough to ask him simple questions, ask him to give his name, age, address. Along the way, you need to evaluate the clarity of movements. If there are any signs of impaired consciousness or motor impairment, the patient should not be allowed to drink, eat, or go home on their own.
Some seizures, such as absence seizures, do not require emergency treatment. It is enough to wait until the attack is over.
What does an employer need to know?
People with epilepsy often face discrimination when hiring. Even if the profession is not on the list of “prohibited”, the employer may refuse. Unfortunately, many managers are poorly informed about epilepsy and are biased towards such people; they do not want to “take another risk.” Such “reinsurance” does not lead to anything good. Having been refused in one place, the next time a person will begin to hide his illness, and it is unknown what consequences this will lead to.
It is important for employers to know about some points:
- In most cases, proper treatment can keep the disease under control.
- Modern antiepileptic drugs have virtually no effect on a person’s ability to cope with work. Minor treatment restrictions arise only in isolated cases.
- Epilepsy does not affect the skill level in any way. Many patients have high intelligence and can perform complex work and occupy leadership positions.
- According to statistics, with proper treatment and regular monitoring by a doctor, people with epilepsy get sick and miss work no more often than healthy people.
- Such people most often do not need any special conditions or special support. They can work just like everyone else. Naturally, with the right choice of profession.
It must be remembered that both the employer and employees are responsible for safety in the workplace. Violation of the law may result in accidents and serious claims from government agencies. Therefore, before hiring, it is important to undergo a preliminary medical examination and provide reliable information about your disease. Routine medical examinations will help monitor the health of workers, identify new diseases and the worsening of existing ones at an early stage. This will help the employer make the right decision in a timely manner and find compromises with an employee who, due to health reasons, can no longer hold his previous position.
You can use the services of doctors and undergo a medical examination at the ProfMedLab clinic. Contact us: +7 (495) 308-39-92
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Diagnosis of epilepsy
First of all, the diagnosis is assumed based on the clinical picture during examination by a neurologist. The main diagnostic tool is electroencephalography (EEG). An EEG records the electrical activity of the brain. This examination allows not only to determine the presence of epilepsy, but also to diagnose a specific form.
In addition to EEG, MRI is often prescribed, which can detect organic damage to the brain. Also, in the case of epilepsy, computed tomography () has diagnostic value.
Determination of drug concentrations in the blood.
Modern approaches to treatment involve not only adequate selection of the dose of the drug, but also monitoring the achievement of the correct concentration of the drug in the blood. This study is necessary in cases where the doctor has reason to assume that the dose received is insufficient (increased metabolism of the drug in the liver, or increased excretion in the urine). The characteristics of enzyme systems in different people can differ significantly, so the doctor must have criteria for individual selection of the dose of the drug.
If the patient receives drugs from the group of valproic acid (Depakine, Konvulex, etc.), carbamazepine (Tegretol, Finlepsin, etc.), phenobarbital, phenytoin - before seeing an epileptologist, it is necessary to determine the concentration of the drug in the blood (in the morning, before taking the drug).
IDNE specialists recommend conducting these studies at clinical sites:
- Determination of the concentration of AEDs (including new AEDs!) can be carried out in our EndoMedLab laboratory.
- Laboratory Invitro invitro.ru
- Laboratory Gemotest https://www.gemotest.ru/
Genetic research
In some cases, epilepsy and developmental delay may be caused by abnormalities of genes or chromosomes. If a hereditary pathology is suspected, the doctor refers the patient to genetic studies, including TMS (tandem mass spectrometry - inborn metabolic disorders), karyotype study, including the method of comparative genomic hybridization (chromosomal abnormalities); exclusion of individual genetic diseases or study of gene panels (“Hereditary epilepsies”, “Autistic”, “Neurological”). Studying a panel of genes responsible for a spectrum of disorders (epilepsy, autistic-like behavior, etc.) is more likely to identify the cause of the disease.
Genetic studies are carried out to establish the cause of the disease and determine the prognosis; In addition, some hereditary diseases have specific treatment, and the prognosis in this case depends on how quickly the correct diagnosis was made.
IDNE specialists recommend conducting these studies at clinical sites:
- In IDVNE named after St. LukeYou can undergo a number of genetic tests, including the most important for epilepsy, the extended genetic panel “Hereditary epilepsies and related conditions”, whole exome sequencing and chromosomal microarray analysis.
Is it possible to cure epilepsy in a child?
- The main question that worries parents is whether it is possible to completely cure epilepsy in a child. No doctor can promise you to cure your child of epilepsy forever. We can only talk about saving the child from painful attacks for a long time (stable remission) or complete relief from pathological symptoms. After 2-5 years, provided there are no attacks, the child can stop taking medications without relapse in the future.
- Regarding the prognosis of epilepsy surgery, the overall success rate will depend on the cause of the seizure, the type of epilepsy and the area of resection. With mesial temporal lobe epilepsy, a positive result is achieved in 90-95% of cases. If the pathology is limited to one hemisphere and the risk of spreading the pathological process is prevented, the success rate is close to 100%. The chance of complete freedom from seizures in patients with cortical dysplasia is 50-67%.
Exercise for epilepsy
Sport is very important for the human body. Periodic physical activity is good for health. They also help improve intellectual activity. But a patient with epilepsy must first discuss this issue with a doctor, and also make a decision based on his condition during such stress. Your doctor may not fully know how you will feel if you do heavy exercise. After all, their influence on your condition depends not so much on the number, time and severity of attacks, but on your body’s readiness for sports.
If you've never run, swam, or done push-ups or pull-ups, it can really affect your emotional state at first. Because at first it is difficult to do, and sport primarily comes through one’s willpower, through overcoming laziness. If you experience negative emotions when you are forced to do something, should you start exercising?
If you have frequent attacks, your epileptologist will advise you not to ride a horse, not to engage in diving, diving, boxing, mountaineering, gymnastics, wrestling and others.
If the attacks are not so serious and begin only during sleep or upon awakening, then sports such as football, table tennis, badminton and the like will be safer for you.
What happens at an appointment with an epileptologist?
It is better for the patient and the person who has witnessed the manifestation of epilepsy to attend the appointment. Usually these are relatives or close friends. They will tell you how the patient’s behavior looked from the outside and what was in his condition. After the examination, an accompanying relative or friend will be able to emotionally support him so that epileptic seizures do not occur again due to possible stress.
It is important to tell the exact time of the onset of the attacks, their duration, and circumstances. This information will help the doctor choose the direction of research for the disease in order to give an accurate diagnosis and choose the right treatment method.
The consultation with an epileptologist after this survey goes like this. Once the examination data becomes clear to the epileptologist, the next question will be whether other illnesses or concussions were suffered before these seizures. The doctor will ask about lifestyle, work, and what circumstances may cause stress in the patient. There will also be a question about hereditary predisposition to certain diseases.
After the interviews, an inspection is carried out. If it is difficult to give the results, the patient is again sent for examination. Indeed, in epilepsy it is very important to choose the right treatment method so that it becomes the most effective. If an epileptologist makes comments to you about your lifestyle, then it is better to follow them.
Epilepsy is not the end. Do not neglect treatment and take exactly the dose of medication that was prescribed. Do not be discouraged by the period during which you will have to be examined and take medications. The success of your treatment depends on this.
As a result of proper treatment, the number and complexity of seizures are reduced, which subsequently no longer bother the patient.
