Aleksey Kotov: “Most forms of epilepsy respond well to therapy”
MD, head of the children’s neurological department GBUZ MO MONICA them. M. F. Vladimirsky of section “Science”, Professor of the Department of Neurology of Postgraduate Medical Faculty GBUZ MO MONICA them. M. F. Vladimirsky, neurologist of higher category Alex S. Kotov told about the peculiarities of the current, diagnosis and treatment of childhood epilepsy.
– Please tell us about the frequency of the disease and its prevalence in Russia. In what is the characteristics of this disease, its causes?
– Epileptic seizures are one of the most common medical problems in children. Moreover, the younger the children are, the more often this problem occurs. It is important to understand that epilepsy is not a single disease. This is a whole complex of different syndromes, each of which has its own course, its own treatment efficiency and its own prognosis. And these syndromes begin at different times: some appear from the first days of life, and some, for example, only in adolescence. Therefore, there is no universal opening time .
– How to recognize epilepsy and epileptic seizures?
– There are many options for seizures, they depend on the age of the patient. In particular, a newborn does not have the seizures that an adult does . An epileptic seizure is an abnormal electrical discharge in the cells of the brain. In some cases, seizures in children can be triggered by stress, deep, rapid breathing, flickering light, temperature, and certain medications. But in most cases, seizures occur completely unexpectedly – and that is the insidious disease. Moreover, many parents believe, for example, that epileptic seizures are exclusively cramps of the whole body, foam at the mouth, bite of the tongue. In reality, this is not entirely true. The attack may be subtle and pass without cramps, bites, or foaming at the mouth. Parents do not consider this type of seizure to be epileptic, because from a common point of view it does not resemble the classic symptoms of seizures. They may resemble some kind of shuddering, freezing, tics, falls, involuntary movements. It is very difficult to list all the signs, since there are really many of them. The most important advice: if you see something strange in a child’s behavior, in his movements, behavior, reactions, then try to film it and consult a neurologist.
– With what diseases is often confused epilepsy?
– There are many diseases in which episodic movement disorders, breathing or swallowing disorders, fainting are observed. Distinguishing them from epilepsy is not easy even for a specialist. Therefore, we and encourage parents to remove all deviations from the normal behavior of your child in the video. It is much easier for doctors to see than hear a parent’s description of a seizure .
– If a child has a classic epileptic seizure, what should be the action? Call an ambulance, or are there first aid procedures?
– During the seizure itself, it is necessary to put the child where he cannot fall, for example, on the floor or on a wide bed. Then turn it on its side so that the head is not thrown back and nothing gets into the respiratory tract. If possible, then timed the attack and record the attack on a video, which in the future show to the attending physician. You should not call an ambulance, because most of the attacks are short-lived. It is also not recommended to try to forcefully open the jaw or pull out the tongue: this way you can only injure the patient.
– Does the child understand what is happening to him and does a psychologist need to work with him so that he is not afraid of a recurrence of the attack?
– Awareness and fear of seizures depends on the child’s age, level of mental development, the type of seizures and the environment, such as the reaction of others. The best cure for seizure fear is to prescribe therapy to prevent seizures from recurring. Psychological assistance is of additional importance here. – How critical is it to know the cause of epilepsy for further treatment?
– Of course, if you know the cause of the disease, it is easier to treat it. This is especially true for ongoing inflammation or brain tumors, some of the underlying genetic syndromes of epilepsy. However, in many cases, even after the most complete examination, the cause of epilepsy remains unknown.
– What methods of therapy exist today?
– As I and mentioned earlier, epilepsy – this is not one disease, it’s dozens of different syndromes, which appear attacks. Some of them respond very well to therapy, and some even go away on their own. To select the correct therapy, it is necessary to conduct a detailed clinical examination, EEG, and tomography. In some cases, if there are suspicions of genetic diseases, genetic tests and biochemical studies are needed. The survey algorithm is set individually. Therapy for epilepsy is currently symptomatic, drugs do not cure the disease, but prevent the development of seizures. Moreover, treatment can last for many years and sometimes even for life. In some forms of epilepsy, seizures resolve on their own and without treatment. If medications do not work , there are alternative treatments, such as a ketogenic diet (a diet rich in fat), which alters the body’s metabolism and thus prevents seizures ^; electrical stimulation of the vagus nerve ^; various types of operations on the brain, electrical stimulation of the deep structures of the brain. However, such methods are used very rarely.
– Most often, for epilepsy, prolonged-release drugs are prescribed. Why is this form of therapy needed and how does it differ from conventional therapy ?
– All modern drugs for the treatment of epilepsy are designed to be taken twice a day (morning and evening). The so-called prolonged-release forms are needed in order to ensure a stable concentration of the drug. Special prolonged-release forms have also been created for drugs that were developed many decades ago. In any case, these drugs are prescribed by a doctor if the patient has already been diagnosed with epilepsy.
– It turns out that epilepsy is not a sentence today ? It can be cured?
– It all depends on the form of the disease. By Unfortunately, there are forms of epilepsy with poor prognosis. However, most forms of the disease respond well to therapy, and the child can grow up to be an absolutely normal and full-fledged person. On the date a large number of our young patients are socialized to live a full life, and does not differ from healthy children.