What are the types of attacks?
The manifestation of an attack depends on in which area of the brain the discharge originates and how widely it spreads. Hence the huge variety of forms.
- A generalized tonic-clonic seizure is what it usually is: loss of consciousness, tension of the whole body, then rhythmic convulsions, often biting the tongue and involuntary urination
- Absence seizures are a short “switching off” for 5–20 seconds with a frozen gaze, without falling; in children they are often mistaken for inattention
- Focal seizures with preserved consciousness - twitching in one hand, numbness, unusual smell or taste, feeling of “already seen”
- Focal attacks with impaired consciousness - the person looks detached, makes automatic movements: smacks his lips, fiddles with clothes, walks in a circle
- Myoclonic seizures - sudden short jerks, often in the morning
- Atonic - sudden loss of muscle tone with a fall
What to do during an attack
- Засеките время начала приступа — это важно и для помощи, и для врача.
- Уберите вокруг твёрдые и острые предметы, подложите что-то мягкое под голову.
- Поверните человека на бок, чтобы слюна и рвотные массы не попали в дыхательные пути.
- Расстегните воротник, ослабьте пояс, обеспечьте доступ воздуха.
- Оставайтесь рядом до полного восстановления сознания и спокойно объясните, что произошло.
- Вызовите скорую, если приступ длится дольше 5 минут, повторяется, произошёл впервые, был в воде или сопровождался травмой.
It is strictly forbidden to: unclench your jaws and insert anything into your mouth - this leads to injuries to the teeth and jaw; hold a person by force; give water or medicine until consciousness is completely clear; perform artificial respiration during convulsions.
Causes and provoking factors
In approximately half of the patients, a specific cause cannot be found - they speak of an idiopathic form, where genetic predisposition plays a leading role. In other cases there is a structural or metabolic cause.
- Previous traumatic brain injuries
- Stroke and other vascular lesions of the brain are a common cause in the elderly
- Past neuroinfections: meningitis, encephalitis
- Tumors and malformations of the brain, consequences of birth trauma
- Hereditary predisposition
Separately, there are provocateurs that do not cause the disease, but trigger an attack in a person with epilepsy: lack of sleep, skipping a drug dose, alcohol, high temperature, and in some patients - flickering light.
Diagnostics
- Подробный расспрос пациента и обязательно очевидцев приступа — описание со стороны часто информативнее всех исследований. Видеозапись приступа на телефон очень помогает.
- Электроэнцефалография (ЭЭГ) — регистрация электрической активности мозга; при необходимости с депривацией сна или длительный видео-ЭЭГ-мониторинг.
- МРТ головного мозга — поиск структурной причины: рубца, опухоли, порока развития.
- Анализы крови для исключения обменных причин: глюкоза, электролиты, кальций.
- ЭКГ — некоторые нарушения ритма сердца имитируют приступы с потерей сознания.
Treatment
The basis of treatment is antiepileptic drugs. They are selected according to the type of attack, age, gender and concomitant diseases, starting with one drug in the minimum effective dose. The goal is complete absence of attacks with a minimum of side effects.
- Take strictly daily, at the same time - missing a dose is one of the main reasons for failure of remission
- You cannot cancel or change the dose yourself: abrupt withdrawal can provoke status epilepticus
- Evaluating the effect takes time; the drug is changed gradually, with overlap
- If two correctly selected drugs are ineffective, surgical treatment or other methods are discussed
- For women planning a pregnancy, the regimen is reviewed in advance - not after pregnancy
The regimen is part of the treatment: proper sleep, abstinence from alcohol, caution with activities where an attack is dangerous (altitude, water, driving). The issue of driving is decided individually and according to the timing of remission.
Myths that interfere with treatment
- “Epilepsy is a mental illness” - no, it is a neurological disease; intelligence is not affected in most patients
- “The attack must include convulsions and foam” - many forms occur without convulsions and falls
- “Epilepsy is contagious” - not transmitted in any way
- “Since there are no attacks, you can quit the pills” - the absence of attacks is the result of treatment; Cancellation is possible only gradually and according to the doctor’s decision
- “You need to unclench your teeth with a spoon” is a dangerous action that leads to injury