Epilepsy

Epilepsy (synonym epilepsy disease) is a chronic mental illness, manifested in various pripotocni States (paroxysmal), psychosis, and distinctive personality changes.
Epilepsy is one of the most common mental disorders. The beginning of epilepsy often in childhood and adolescence. In relatively rare cases, epilepsy occurs in adulthood and old age - the so-called late epilepsy. There are two forms of epilepsy - Hesse, or epileptic disease, and epilepsy symptomatic arising from various organic diseases of the brain - tumors, trauma, vascular diseases and syphilis of the brain, chronic alcoholism, etc. Distinguish between these two forms of the disease is not so much the nature of epileptic disorder, but in the features emerging in the course of the disease personality changes, and the presence or absence of organic disease.

Epilepsy (from the Greek. epilepsia - fit, epileptic fit; synonym: morbus sacer, morbus divinus, morbus comitialis, "epilepsy disease") is a disease, which is mainly manifested periodic Grand Mal seizures with loss of consciousness (grand mal, morbus major) or very short time (seconds) depositions (disorder) of consciousness (petit mal, morbus minor, absence - an absence or attacks outpatient automatism (psychomotor seizures with unmotivated and actions amnesia, "the psychological equivalent"), Electroencephalographically with different forms of epilepsy mostly registered pathological potentials. In some cases, epilepsy, there is a decrease of intelligence, can gradually evolve changes (epileptic nature), and mental disorders. Epilepsy is polietiologic disease.
Brava (L. F. from Bravais, 1827) was described by local cramps (localized form of epilepsy); Jackson (J. N. Jackson, 1870) believed that unilateral epileptic seizures associated with irritation of certain curves in the opposite hemisphere of the brain (hence epilepsy Brava - Jackson). It was also proposed to name these seizures "epilepsy Gagarin - Jackson", although the observed Gagarin (1827) cramps nothing to do with Jacksonian attacks have not. In 1894, A. Y. Kozhevnikov has described a new form of epilepsy, partial and permanent (epilepsia corticalis, sive partialis continua)named after him (see Kozhevnikovsky epilepsy).
Epilepsy is a common illness; occurs in all countries and among all peoples. The number of patients with epilepsy in nerve branches of somatic hospitals averaged 5%To 15 years of age falls ill, according to different data, from 47 to 68% of the total number of patients.

The etiology and pathogenesis

The etiology and pathogenesis of epilepsy in many ways not yet understood. Currently epilepsy study aimed either at clarifying the nature of organic lesions of the brain, causing a stroke, and various provoking moments of disease, or boils down to a thorough study of the metabolism (the phenomena of autointoxication), features innate disposition, associated with increased excitability mainly of the cerebral cortex, and precipitating factors.
Some authors believe that the basis of epilepsy are mainly humoral changes, other attribute its pathogenesis mainly with local changes in the brain. S. N. Davydenkov, E. K. Sepp, V. A. Giljarovsky, the Imperial family says and consider other chronic epilepsy as a special "epileptic disease" (this does not apply to symptomatic forms of epilepsy in tumors, meningoencephalitis, and so on). A number of authors [Roger, Cornell, Marchand, Ajuriaguerra (N. Roger, L. Cornil, L. Marchand, J. Ajuriaguerra), M. B. Kroll, D. A. Markov] sticks to a different concept, considering all forms of symptomatic epilepsy (syndromic).
Kreindler (A. Kreindler) believes that epilepsy is a peculiar syndrome, the response of the brain to a number of brain and namozgoh factors. The same opinion was shared by H. p. Minor.
At present, practically there are three forms of epilepsy: 1) clearly symptomatic; 2) probably symptomatic (a history of CNS, brain injury, birth complications, and so on); 3) idiopathic (Hesse), in which you cannot identify the factors listed above (Kreindler).
Hereditary predisposition. By S. N. Davydenkova, transfer of epilepsy from parents to children found 4.9%, according to Lennox (W. G. Lennox) - 2.5%. Penfield (W. Penfield) notes that pathological heredity is particularly evident in cases of Hesse (cryptogenic) epilepsy with presence centrencephalic seizures (epileptic discharges, bilateral synchronous with almost equal amplitude in the electroencephalogram).
When electroencephalographic studies "epileptic" families [Lennox, E. Gibbs, F. Gibbs (E. Z. Gibbs, F. A. Gibbs), Vigouroux, Gastaut (R. Vigouroux, N. Gastaut)] among healthy members of these families in 50-60% of cases were discovered characteristic electroencephalographic changes among the population in General are found only 10-12% of cases. Yet the assumption of some predostavlennogo and predisposition to epilepsy, "convulsive readiness" is devoid of concrete contents. Abadi (A. Abadie) denied the role of genetic predisposition in the origin of epilepsy. Kreindler believes that it is more correct to speak about the seizure of reactivity than convulsive predisposition.
Humoral changes in epilepsy. In patients with epilepsy, there is more flexibility in the exchange functions [Frisch (F. Frisch)]. C. K. Khoroshko indicated that only fat metabolism in epilepsy remains persistent. Known pathogenic importance shifts in the direction of alkalosis. Epilepsy discovered violations of water exchange, for the degree of hydration, apparently, is in some connection with the occurrence of an attack. Known value was ascribed to anoxia. However, it is hardly possible the complexity of epileptic manifestations attributed to a simple scheme of infringement of a metabolism of a particular type. The Imperial family says with TCS. believes that the basis of humoral disorders in epilepsy is a difficult coordinated system lesions of internal organs: liver, pancreas, thyroid and parathyroid, adrenal glands and stomach. M. I. Serijski allocated even endocrine-toxic form of epilepsy, Kreindler, E. K. Sepp, D. A. Markov believe that a significant portion of metabolic disorders in patients with epilepsy is among secondary. Thus, metabolism disorders in epilepsy should be given importance, especially if associated with a predisposition to an epileptic fit, i.e., with a reduction of the threshold of cortical excitability due to toxicity. In all circumstances, it seems that the status of the cell membranes in the direction of increase in permeability increases the tendency to epileptic seizure (A. M. Greenstein, M. B. Kroll, E. K. Sepp).
Exogenous factors in the pathogenesis of epilepsy. Epilepsy often occurs as a consequence of infectious lesions of the brain, especially in children. By D. S. the Footer, intrauterine infection with epilepsy meet at 8-12% of cases. Has a value of alcoholism among parents. With long-term alcohol use can occur alcohol epilepsy. Of particular importance in the origin of epilepsy is given to brain trauma (traumatic epilepsy and birth trauma in particular.
According to T. W. Geladze, 68.5 per cent of observations over 255 ambulatory patients with epilepsy in history was noted various perinatal pathology: forceps, caesarean section and asphyxia, heavy long-term and preterm birth, bleeding from the umbilical cord, cerebral haemorrhage, severe toxicity, infection, injury, uterine bleeding, rapid birth asphyxia, and so on, followed by severe postnatal infection (15.5%) and traumatic brain injury (7,05%).
I. Stoimenov believes that the very birth trauma often overlooked due to the presence of a large amount of time between it and the first signs of epilepsy. May be a birth trauma and without obvious external signs, but its effects may become evident later in the form of so-called temporal lobe epilepsy in children (2 to 10 years) and later. Earl, A. Baldwin (K. M. Earl, M. Baldwin), Penfield argue that in such cases during childbirth is the scheduling of the temporal lobe in incizura cerebellar nameta. These data provide a new way to consider the common pathological changes in patients Hesse epilepsy in the so-called nomerovska sector of the hippocampus (amonova horns). In old age the emergence of epileptic seizures may be related to atherosclerotic changes in the brain, and at Mature age - various toxic effects (alcohol, carbon monoxide, and so on), less often with syphilis, sometimes with cysticercosis brain, and so on, With traumatic epilepsy seizures can sometimes be atypical (single phase), often while vegetative (especially vasomotor) and vestibular symptoms, fatigue (sharp egocentrism and malice may be missing).
Especially clearly reflex mechanism provocation attack is when the so-called zvonkovoy (akusticheskoi) epilepsy white rats.
The pathogenesis of epilepsy. Epileptic seizure occurs in the result of the interaction of many factors, of which you can specify the following: (a) a kind of change in the proportion between excitation and inhibition (availability, for example, congestive centers of initiation, i.e. pathological foci capable of explosive reactions); sudorozhny predisposition, convulsive reactivity, according to some authors; b) epileptogenic stimuli associated with different organic (much less functional) changes in the brain; C) various reflex (extero - and interoceptive) impacts, including the conditioned-reflex (triggers - provoking points); d) trace phenomena previously transferred seizures; e) various features epileptic voltage megprobalja period, which can be seen largely as a compensatory complex.
Facial and pantomimic manifestations in various forms epileptic seizures, sometimes accompanied rapid vegetative phenomena, becomes more clear if we take into account that convulsive irritate can capture not only the motor, tonic and vegetative-humoral devices brain and spinal cord, but emotionally-facial mechanisms limbic system, morfofiziologicheskie associated with vegetative-humoral devices hypothalamic region.
Medpreparaty period. Epilepsy is a "seizure disease of the whole body", when the epileptic capture not only skills, but also extend to the receptor apparatus, metabolic and autonomic functions, mentality, etc., These small and often hidden paroxysms ("internal seizures") are deployed in various systems and organs of the patient with epilepsy (vasomotor seizures, biochemical crises, paroxysmal disorders of thermoregulation, electroencephalographic disritmia, hronicheskie perturbations, explosive nature of the psyche of a patient with epilepsy, and so on) and often long precede great convulsive seizures or interspersed with them (D. A. Markov). Experimental models of chronic epilepsy, which would be like epileptic disorder in humans (cryptogenic epilepsy), still have not been able to obtain. Therefore, the experiment are limited to the study of the pathophysiology of individual seizures or a series of them. I believe that provokes a separate attack external irritation, and the attack itself always reflex. The last mechanism is especially evident while "zvonkovoy" epilepsy.



Pathologic anatomy

Epilepsy are non-permanent and non-specific changes in the Central nervous system of primary and secondary (repeated seizures) - arachnoiditis, residual effects of meningoencephalitis, fusion between the shells, the dropsy, dysplastic violations of the architectonics of the cerebral cortex, etc.
In chronic epilepsy histopathological usually found gradually progressive development of gliomatosis (gliosis gray and white matter of the brain - Century K. Bielecki) spilled localization (especially in the temporal lobes), accompanied by a significant fibrotic changes of the vascular wall.

Clinic

The forecast. When properly administered treatment is always possible to achieve partial and even complete disappearance of seizures.
Treatment. Epilepsy patients need long lasting many years of continuous treatment. Sudden discontinuation of treatment entails a sharp deterioration of the disease. The task of the middle medical workers is to observe a systematic patients receiving a variety of anticonvulsants (see). The patient, who addressed for the first time about seizures, should be sent to a neurologist or psychiatrist. When Troubleshooting epileptic status of the patient should be immediately transported in any nearest hospital. During the great seizure cannot deviate from the patient, but do not want to keep him. Need to undo the collar of the shirt and belt. If the patient fell on the floor to keep his head on his hands, then put a pillow under his head. To monitor the movements, so that the patient does not hurt his hands and feet.
To protect the language from biting you should invest in your mouth between your teeth side when the patient open her teeth, cork, scarf or a metal spoon, spatula, wrapped in a soft cloth. You must ensure that the patient is not fuse language, which may cause asphyxia. After the seizure, if it is a dream, to put the patient on the bed. If the dream does not occur, you need to carefully monitor patients, because it may be short-term or long state of altered consciousness.
Epilepsy patients with disorders of consciousness or with epilepsy psychoses require immediate admission to a psychiatric hospital. Require hospitalization, and patients with long DISTREE. All of these patients can be assigned psychotropic drugs (see). During transportation of patients required a tireless supervision because of the tendency to suddenly arising States sharp excitation and extremely dangerous action.