Classification of epilepsy
Classification of epilepsy is based on the form of seizures, changes in brain activity on the EEG, the localization of the epileptic focus in the brain, the presence of any triggering or causative factor in the development of seizures, as well as the age of the patient.
Forms of epileptic seizures
Epileptic seizures are divided into generalized and partial.
Generalized seizures
In this case, there is a spread of epileptic activity from the focus to the entire brain. There are following types of generalized seizures:
• Tonic-clonic seizure (large seizure) - accompanied by loss of consciousness. In this case, the patient at first freezes in any position, then there are convulsions of the whole body. There may be involuntary urination or defecation;
• Anon-convulsive generalized seizure (minor seizure) - accompanied by a sudden loss of consciousness, usually for only a few seconds, which may go unnoticed.
More characteristic of children, and it may seem that the child is just thinking;
• Atonic seizures - usually found in children; accompanied by a sudden fall;
• epileptic status - seizures occur continuously without periods of recovery of consciousness; possible fatal outcome.
Partial seizures
With partial seizures, only a part of the brain is involved in the pathological process. Usually they are a consequence of organic pathology. Partial seizures can pass into generalized seizures. Can be:
• simple seizures - the patient experiences a change in perception without losing consciousness;
• complex seizures - with loss of consciousness.
Diagnostics
One of the methods for diagnosing epilepsy is electroencephalography (EEG). Electrodes placed on the scalp of the patient record electrical impulses generated by the cortex of the brain. These impulses reflect the functional state and activity of nerve cells. Anomalies of the brain function usually arise when the coordinated work of cells is disturbed. This EEG demonstrates the electrical activity of the brain of a healthy person. EEG of a patient with epilepsy can detect abnormal electrical waves. Usually, the EEG procedure lasts about 15 minutes, but in some cases it does not reveal the changes in brain activity characteristic of epilepsy. Therefore, to obtain a diagnostic result, several EEG studies may be required.
Anamnesis of the disease
It is necessary to study a detailed history of the patient, including a description of the nature and frequency of seizures. Clarification of the nature of seizures can help in determining the form of epilepsy and localization of the focus of pathological electrical activity. Some types of seizures are preceded by a so-called aura, and after an attack the patient can complain of confusion, headache and pain in the muscles. An accurate description of the seizure by witnesses is also important for diagnosis.
Further examination
A more detailed examination may be needed to clarify that the seizure is really associated with epilepsy, ascertaining its nature and cause. The following studies may be required:
• Epilepsy manifestations range from headaches to seizures. Observation of symptoms by relatives or friends can help in the diagnosis of the disease.
- a blood test to detect changes in the level of various chemicals;
• Magnetic resonance imaging (MRI) - to detect the organic pathology of the brain.
After the diagnosis of epilepsy, the patient is prescribed anticonvulsant therapy. Currently, there are many available anticonvulsants, including carbamazepine and sodium valproate, but none of them is universal for the treatment of all forms of epilepsy. The choice of anticonvulsant depends on the form of epilepsy, the age of the patient and the presence of contraindications, such as pregnancy. Initially, the patient is assigned a low dose of the drug, which then rises until complete control over the seizures. When the dose is exceeded, it is possible to develop side effects, from drowsiness to excess hair. Sometimes a re-examination is necessary, helping to choose the right dosage, since the same dose of the drug may cause a different effect in different patients.
Surgery
Surgical treatment is used today in very rare cases - when drug therapy is ineffective, and the epileptic focus in the brain is precisely known.
• If a person has lost consciousness during an attack, but is able to breathe independently, it is necessary to give him a reclining position. This will prevent the breathing stops.
First aid
The first aid for a tonic-clonic epileptic fit is as follows:
• The space around the patient is released for safety reasons both for the patient and for the caregiver;
• Close clothing is removed;
• Under the patient's head, put something soft;
• If the patient does not breathe, artificial respiration is given.
As soon as convulsions in the extremities cease, the patient must be placed on a firm surface. You can not put anything in his mouth. In any case, you need to call an ambulance, especially if this is the first fit, it lasted more than three minutes or the patient received any damage. Most patients who have undergone one seizure experience a second occurrence within the next two years. This usually occurs within a few weeks after the first attack. The decision to choose treatment after a second fit will depend on the potential impact of the disease on the patient's performance and quality of life.
Drug therapy
Medical treatment provides complete control over seizures and significantly reduces their frequency in a third of patients. About two-thirds of patients with epilepsy after attaining seizure control may stop treatment. However, drugs should be withdrawn gradually, since seizures may resume with a decrease in the level of drug substance in the body.
Social aspects
Epilepsy, unfortunately, is still perceived by many as a kind of stigma. Therefore, patients often do not report their illness to friends, colleagues and employers, fearing a negative attitude towards themselves.
Restrictions
Patients suffering from epilepsy, among other limitations, are deprived of the opportunity to obtain a driving license and engage in certain activities. Children with epilepsy should not bathe or ride a bicycle without adult supervision. With the correct diagnosis, the right therapy and general precautions, most patients can monitor the course of their illness. The prognosis for children with epilepsy is generally favorable. As a precaution, a child should always play or swim under the supervision of adults.