Epilepsy

The relevance of this problem

Epilepsy is a common disease of the nervous system, as the International Classification of Diseases X revision (ICD-10) sets forth in class VI “Diseases of the nervous system”, section “Episodic and proxysmal disorders” (codes G40-G47). The complexity of the problem in helping patients with epilepsy is that many patients have mental disorders, and psychiatrists conduct treatment of patients with neurological diseases in these cases. When studying the epidemiology of non-infectious diseases, the incidence reflects the number of new cases of the disease per year per 100,000 people. The incidence rates of epilepsy in different countries range from 11 to 134/100000. The incidence of epilepsy in our country is high and in dynamics over 5 years increased by 38.3%. The incidence of epilepsy in various regions of Russia in 2013. This year, the average incidence in Russia was 95/10000. The incidence of epilepsy for all years of monitoring the disease of REC in Russia prevails in men compared with women. This is apparently due to the predominance of traumatic and toxic epilepsy in men. Indicators of the incidence of epilepsy in various age groups (the study did not include patients of childhood and adolescence). The highest incidence was observed in the group of 18-20 years old, then it decreases in the following age groups and begins to increase in old age over 60 years. The highest incidence is determined at the age of over 70 years. This is due to the growth of vascular and degenerative diseases of the brain in older age groups.

Various specialists are involved in the treatment of epilepsy in our country, who provide primary medical care for exacerbation of the disease, intensive care for complicating the disease with repeated epileptic seizures, their series and status epilepticus, as well as outpatient examination and treatment for chronic epileptic process. The provision of medical care for epilepsy has its own national characteristics in our country. With the development of an epileptic seizure to the patient, as a rule, an intensive care team is called up at the ambulance station, whose doctor (in some cities the paramedic) carries out drug therapy to stop the seizure. In large cities, specialized neurological teams function that are sent to patients with a series of epileptic seizures and status epilepticus. Hospitalization of patients is carried out during the first epileptic seizure, a series of seizures and status epilepticus. In the latter cases, the patient is assisted in the intensive care unit or intensive care wards of the neurological department of a multidisciplinary hospital or similar departments of a psychiatric hospital. Patients with epileptic psychoses are placed in these same hospitals.

An urgent problem is the development of neurosurgical care for patients with resistant epilepsy, which is carried out in a limited number of cities. In our country, the practice has developed that the majority of patients with epilepsy in adulthood at the outpatient stage are registered in a neuropsychiatric dispensary. This leads to certain social negative consequences, since patients without mental disorders often refuse to visit a psychiatric institution and treatment. In the future, this leads to a chronic process, epilepticization of the brain and resistant epilepsy.

Definition of epilepsy

Epilepsy is a chronic brain disease characterized by repeated seizures that result from excessive neural activity and are accompanied by various clinical and paraclinical manifestations (WHO definition).

The basis of epilepsy is increased neural activity with high-voltage hypersynchronous discharges (epileptic focus). When the discharge spreads to the whole brain, a generalized attack occurs; if the discharge remains local, the attack has a partial character.

In children, various convulsive conditions occur 5-10 times more often than in adults, which is obviously associated with structural features and functions of the brain, with tension and imperfect regulation of metabolism, lability and a tendency to irradiation of excitation, with increased vascular permeability, hydrophilicity brain, etc. In the origin of epilepsy, the interaction of hereditary predisposition and brain damage is of primary importance. In most forms of epilepsy, polygenic inheritance is noted, and in some cases it has a greater, in others - less importance. When analyzing heredity, it is necessary to take into account, first of all, the obvious signs of the disease, attaching a certain significance to its manifestations such as migraine, fainting, stuttering, and take into account the characterological characteristics of the person (conflict, viciousness, pedantry, importunity). Predisposing factors include organic cerebral defects of a perinatal or acquired (after neuroinfections or traumatic brain injury) nature. Risk factors may include various paroxysmal conditions and seizures of a non-epileptic nature. These include convulsive syndrome in the structure of perinatal encephalopathy, febrile convulsions and other forms of encephalic reactions, convulsions in metabolic disorders (hypoglycemic, hypomagnesial, pyridoxin-dependent), spasmophilia and other hypocalcemic conditions, affective and respiratory epileptic paroxysms.

The pathogenesis of epilepsy includes a number of mechanisms. This is primarily focal, which is characteristic not only for partial epilepsy, but also for primarily generalized seizures. Most often, generalized seizures occur with focal lesions of the mediobasal temporal and orbitofrontal localization. As the disease progresses, an epileptic system forms and the process spreads to the entire brain.

The biochemical mechanisms of epilepsy are associated with a disorder of ionic, mediator and energy processes. Thus, ionic shifts lead to an increase in membrane permeability and, as a result, depolarization of neurons and their over-excitability. Decreased glucose stores and the accumulation of lactic acid in brain tissue during an attack are the cause of acidotic changes; aggravating hypoxia and lowering the level of phosphate compounds. Before an attack, metabolic alkalosis is often detected. Inhibition of GABA - and dopaminergic systems and an increase in the activity of acetylcholine and aspartic mediators also contribute to the epileptic discharge. Also important are immunological reactions with the formation of anti-brain antibodies during repeated attacks, circulatory disorders and other factors that expand the affected area. Specific pathological changes in epilepsy are not found. However, the epileptic process can cause severe dystrophic changes and a decrease in the number of ganglion cells, progressive gliosis, especially in the temporal lobes. Significant changes are noted in the cerebral hemispheres, the hippocampus, the sub-tubercle region, and the reticular formation of the brain stem.

The clinical picture of epilepsy in children has some characteristic features. These include polymorphism and age-related transformation of seizures, a high proportion of absences, the frequency of abortive forms, the presence of syndromes not encountered in adults (West, Lennox-Gastaut syndromes), the frequent development of post-attack symptoms of focal brain damage, the rapid development of mental retardation with frequent attacks .

Frequency and age of onset of epilepsy

Regardless of ethnic or geographical features, epilepsy occurs in 1-2% of people. This means that in Russia this figure is 1.5-3 million. However, convulsive conditions are much more common. Approximately 5% of people have at least one epileptic seizure in their life. These conditions occur as a result of provoking causes, for example, febrile seizures at high temperature, convulsive withdrawal symptoms with prolonged chronic alcoholism, or convulsions caused by drug deficiency in chronic addiction. From this we conclude that only 20% of all people who have had at least one seizure in their life fall ill with epilepsy. Obtaining accurate numbers of the spread of epilepsy is very difficult due to the lack of uniform accounting, the use of different options by the classification of epilepsy by specialists, and also because this diagnosis is often not specially or erroneously established and passes under the guise of other diagnoses (episindrome, convulsive syndrome, various paroxysmal conditions, convulsive readiness, some types of febrile seizures, etc.) that are not taken into account by the general statistics of epilepsy.

In about 75% of people with epilepsy, seizures appeared in the first 20 years of life:

During the first two years of life - 17%
preschool age - 13%
early school age - 34%
adolescence - 13%
after 20 years of life - 16%
middle and older age - 2-5%

Causes of Epilepsy

“The cause of this disease, like other great diseases, is the brain.” (Hippocrates)

“It is unlikely that there is such a brain lesion that would not have the property under certain conditions to cause epilepsy.” (D. Collier)

With sufficiently strong influences, epileptic activity, as one of the methods for the reaction of brain cells, can occur in any person. However, in “healthy” people this requires a fairly strong effect - for example, alcohol withdrawal or severe traumatic brain injury. In young children, the ability of brain cells to respond by excessive stimulation to an irritating factor is more pronounced than in adults, so they can develop an epileptic seizure at high temperature. In about 1-2% of people, the activity of brain cells is so great that epileptic seizures occur on their own (spontaneously), for no apparent reason. The reasons for the development of epileptic activity in the brain, unfortunately, are not yet clear enough, but presumably related to the structure of the cell membrane the brain, as well as the chemical characteristics of these cells. The complex range of causes of epileptic seizures cannot be reduced to any one factor. In about 70% of cases, the cause of the attacks remains unknown, despite a special neurological examination (EEG, CT, NMR), since there are no obvious or suspected signs of a underlying brain disease. Then they talk about spontaneous epilepsy. With this type of epilepsy, we are apparently dealing with chemical changes in the brain that have not yet been investigated.

In other cases, epilepsy occurs with obvious or suspected underlying brain disease. Depending on the age at which the seizures appeared, one or another reason should be suggested. If they appeared before the age of 20, then the cause most likely may be brain damage during pregnancy and childbirth, than for example - a brain tumor. If epilepsy occurred after 25 years, then the most common cause, as a rule, are brain tumors, and in older people - circulatory disorders of the brain (strokes). It has been established that the cause of focal seizures is much more often the primary dysfunction of one or more parts of the brain than with generalized ones. However, with any seizures, a thorough examination must be carried out and the cause of their cause should be established.

Possible causes of epilepsy

Transnatal complications

Perinatal complications are the main cause of seizures in children. Injuries, both generic and prenatal, cause brain hypoxia (oxygen starvation of the brain). In fact, most congenital disorders of the brain are associated with its oxygen starvation. Fortunately, as a result of improving obstetric technology, the risk of such complications is reduced. However, some experts believe that 20% of cases of epilepsy fall into this category.

Head injury

Head injuries are the cause of another 5-10% of cases of epilepsy. Post-traumatic epilepsy can follow a brain injury as a result of a severe injury, a traffic accident, child abuse, a gunshot wound, etc. Post-traumatic cramps sometimes develop immediately after an injury, and sometimes appear after a few years. Experts believe that everyone who has suffered a brain injury leading to prolonged loss of consciousness has an increased likelihood of developing epilepsy.

Epilepsy very rarely occurs after minor head injuries. All parents know that falls and bruises are as much an integral part of growth as childhood illnesses, so there is no need to live in constant fear that a child may stumble. In addition, it must be understood that not every epileptic seizure is caused by a fall. However, it should be borne in mind that children are very vulnerable. Even severe motion sickness of a child, especially an infant, can harm his mental and physical health and lead to epileptic seizures or mental retardation. If your child has cramps immediately or several hours after a head injury, you can be reassured by the fact that such attacks are rarely repeated. However, seizures that develop several months or years after brain damage are repeated much more often. Post-traumatic seizures develop most slowly in children. They can appear even 25 years after a head injury.

Somatic and infectious diseases

Repeated epileptic seizures are observed in many diseases, including cerebral palsy. In this case, often the same brain injury provokes convulsions and a concomitant disease. Cancer that affects the brain, infections of the central nervous system such as meningitis and encephalitis can also cause repeated attacks.

Vascular diseases are also a common cause of epilepsy in epileptic seizures. Sometimes convulsions are the first sign of systemic lupus erythematosus (observed in approximately 15% of patients).

Tumors and brain abnormalities

About 35% of brain tumors provoke repeated attacks. However, brain tumors themselves cause less than 15% of all seizures. Most people with epilepsy have no visible brain abnormalities.

Arteriovenous dysplasia of cerebral vessels is a congenital defect, usually leading to repeated convulsions. Unfortunately, surgery in this case can provoke epileptic seizures.

Metabolic disease

Epilepsy can cause both hereditary metabolic disorders, and acquired, for example, lead poisoning. These are the causes of 10% of cases of epilepsy.

Eating foods rich in calories (carbohydrates, fats) can affect metabolism and provoke convulsive attacks in almost everyone. And people with diabetes and without diabetes with a significant increase in blood sugar sometimes have epileptic seizures. They can also accompany kidney and liver diseases. An individual seizure threshold is affected by genetic factors. If seizures recur due to a metabolic disorder, epilepsy can be diagnosed, although such manifestations often disappear with successful treatment of the underlying disease.

Stroke

With a stroke, cerebral circulation is disturbed, as a result of which short-term or long-term disorders of speech, thinking and movement occur (depending on which parts of the brain are affected). Perhaps due to an increase in the number of older people in this age group, epilepsy has become more common. Typically, strokes do not cause epileptic seizures - only 4-5% of patients develop chronic seizures. Seizures resulting from a stroke usually respond well to antiepileptic drugs.

Exposure to Drugs and Insecticides

Attacks can be caused by the action of insecticides, drugs, for example, cocaine (as well as “breaking”) and stopping the use of barbiturates, benzodiazepines (Valium, Librium, Dalman), alcohol and even anticonvulsants. Skipping a dose of an antiepileptic drug prescribed for you (AED) can also trigger an attack.

It should be borne in mind that convulsive seizures occur not only with drug abuse. In individuals with a low threshold, strong antipsychotics (for example, chlorpromazine, tricyclic antidepressants (such as amitriptyline) and monamine oxidase inhibitors (nialamide, etc.), amidopyrine, penicillin drugs can cause them. Sometimes, the interaction of antiepileptic drugs with other drugs also provokes an attack.

Spontaneous (genuinic) epilepsy

This refers to the case when there is no reason to suggest a primary brain disease. In addition to generalized seizures, this group includes myoclonic seizures of puberty, generalized nightly convulsive seizures, as well as some forms of epilepsy with myoclonic-astatic focal seizures. Another name for spontaneous epilepsy is idiopathic.

Epilepsy and heredity

If one of the parents has epilepsy, then the probability of its occurrence in their child is about 6%, i.e. 3-6 times more than for most people. At the same time, this suggests that 94% of children will not have epilepsy. If both parents have epilepsy, then the risk for the child increases to 10 - 12%. Most often, epilepsy occurs in a child if, in parents, epileptic seizures were not focal, but generalized.

This information is generalized and in each case can be supplemented during a consultation with an epileptologist or geneticist. It should be borne in mind that features of the brain activity, processes of excitation and inhibition, increased readiness for paroxysmal forms of the brain's response to changes in internal and external factors, and not epilepsy itself, are inherited. In most cases, epilepsy in children manifests itself much earlier than in parents. For example, if a mother has epileptic seizures from the age of 15, then her child may have them, for example, at 5 years old.

Provocation of an epileptic seizure

Discontinuation or dose reduction

In the absence of attacks for a long time, some people consider it possible to stop treatment on their own or reduce the dose of drugs in order to avoid their side effects. In these cases, there is often a resumption of seizures in a more severe form, and often the development of an epileptic status. A sharp cessation of taking phenobarbital and benzodiazepine drugs is especially dangerous.

Sleep disturbance

Sometimes, if a person with epilepsy falls asleep 2-3 hours later, he may have an attack. If he decides to make up for this watch with a later awakening, then this will not only not help, but may harm. The fact is that it is not the duration of sleep that is important, but its regularity (the same time falling asleep and waking up). If a person with epilepsy has not slept, an attack can occur during later awakening or sudden awakening with the intervention of someone close.

Alcohol consumption

Severe intoxication leads to sleep disturbances, metabolic changes and a decrease in the compensatory capabilities of the brain. More often, seizures appear the day after intoxication. A special form of epilepsy is described - alcoholic epilepsy.

Stress and strong emotions

Positive or negative stresses rarely lead to seizures. however, in each case, attention should be paid to whether there is a connection between strong excitement and an attack. Be sure to note this in the seizure calendar and tell your doctor in detail. If the cause of the stress of arousal, or a person’s own attitude towards it, can be changed, the number of seizures can decrease. Knowing the causes of the attacks can be important information for psychotherapy.

Shine

Often epileptic seizures occur directly from specific stimuli from the external environment. Most often, the causes of the attacks can be very contrasting light-type light stimuli, which appear, for example: when driving along an alley, if the sun is shining from the side, or past a fence through which the sun is shining from the side, onto the leaves of a tree moving in the wind, glowing in the sun the waves of the lake, lie looking at the rotating blades of a helicopter, the blinking of light at a disco, a faulty TV. When using a TV, people with a photosensitive form of seizures (photosensitive epilepsy) should consider the following: if the image is skipping, you should never come close to it, but adjust it with a remote device (or someone else). A color television is preferable, since there are fewer black and white contrasts that cause seizures. When approaching the TV, to turn it on or off, you need to close one eye with your hand. It’s good that when the TV is on, a dim general light is on - this reduces the contrast between the luminous screen and the room. With photosensitivity, glasses with tinted protective glasses can help. Much less often, the cause of attacks can be bright multi-colored objects or brightly lit text, or a picture.

Reading

Reading is a very rare cause of seizures. However, with prolonged reading (overwork), when the head begins to hurt and spots appear in front of the eyes, you should stop this activity, as this can cause a convulsive attack.

Sound

Even the simplest sounds: motor, bells, frogs croaking or the end of a long sound cause attacks, but, of course, these are very rare cases.

Self-control attacks

Attacks arising from external stimuli, for example, from contrasting light, images or touch, can be caused by the patient himself. Most often this applies to children with mental retardation, less often children and adults with normal development. A certain role here can be played by an internal need similar to “mania”, cause an attack and, rarely, pleasant sensations during an entrepreneurial state. Sometimes people with epilepsy self-provoke them to relieve rather severe internal discomfort that appears before the attack, and after the attack they may experience a state of emotional recovery and mental comfort.

Pregnancy

If the pregnant woman continues to take medication, and increases the dose during an attack, then there is no increased risk of worsening the condition. Pregnancy itself does not worsen the course of epilepsy. During pregnancy, seizures may intensify if this woman does not take the full dose of the drug recommended by the doctor, because of fear of harming the unborn baby or as a result of sleep disturbance.

Climate

It is noted that epilepsy is more common in countries with hot and humid climates, and also that when people with epilepsy move to regions with cooler and drier climates, the frequency of seizures may decrease.

Moon phases and solar activity

Some studies show an increase in doctor calls for seizures during the full and new moon. There are observations of increased seizures during periods of increased solar activity. This is associated with a change in the level of the functional state of the brain and the deterioration of its compensatory capabilities, as well as metabolic disorders in the body, leading to a decrease in the effect of antiepileptic drugs.

Diet

The specific effect of food on the provocation of attacks has not been confirmed. However, there are observations indicating the need to limit the intake of pure carbohydrates (especially sugar), salt, some spices, and legumes. It is necessary that the last meal was no later than two hours before bedtime. Overeating and excessive fluid intake should be avoided. In order to prevent constipation, which lead to self-poisoning of the body and provocation of attacks, it is necessary to use foods rich in fiber. In persistent cases of constipation, clisterotherapy is performed.

Fever and vaccination

Some doctors believe that vaccines (for diphtheria, tetanus and pertussis), which are usually given to newborns and young children, can cause convulsions. Evidence for this, however, is inconclusive, and cramps following vaccinations are rare. It is known that high fever - a common side effect of vaccination - can cause seizures in some children. Therefore, before vaccination, parents should discuss their concerns with the pediatrician, especially if the medical history is a bad reaction to vaccinations.

Sexual activity

Sometimes there is a fear that as a result of puberty and sexual activity, the condition of a person with epilepsy worsens not only in terms of their own health, but also socially. The opinion that as a result of any sexual activity - masturbation (masturbation) or sex life, seizures become more frequent and health is worsening, as fake as old. We can say with confidence that sexual activity is absolutely not harmful. Concern that mentally disabled young people, as a result of sexual activity, may find themselves in an unsafe situation, is not without meaning. Therefore, you should pay attention to the fact that sexual life took place, if possible, with a regular partner. Stress caused by unwanted pregnancy should be avoided. It is necessary to strictly observe the regimen of sleep and taking anticonvulsant drugs. It is necessary to find a compromise between the restriction that narrows the life of a person with epilepsy in society, and the opportunity to gain their own experience in the field of sex.

Other reasons

Quite rarely, an attack can occur when touching a part of the body, or while taking a bath. Even a thought in a dream about a known cause of the attack can cause this attack. The cause of the attack can be fright, for example, an unexpected sharp sound, a sudden unexpected movement. Despite the examples described, there is no evidence that epileptic seizures can occur as a result of a fright. Generally, you need to know what special causes can cause an attack and carefully avoid them. The treatment of epilepsy can only be effective if you can avoid all causes of an attack

Spontaneous cessation of epileptic seizures

It is possible. Not all people with epileptic seizures see a doctor and remain under his supervision. This usually happens when the seizures stop, either as a result of treatment, or spontaneously, without treatment. Since contact with such people is lost, information on the number of cases of self-healing is not accurate enough. After a series of studies in which patients who did not see a doctor were also covered, it should be recognized that in a significant part of these people, about half, after initial treatment or without it, the attacks stop, even without further treatment. This applies to most forms of epileptic seizures. However, it should be borne in mind that the causes of seizures are different, and therefore you should not rely on the fact that they will pass without treatment.

Learn the opinion of your doctor, study the available information on epilepsy, contact the mutual assistance group - this will help you make the right choice of tactics of behavior. Almost all people with epileptic seizures have passed the period of confidence in the possibility of spontaneous cessation of seizures and have their own judgment on her account. They can help you not make the wrong choice.

Some believe that epileptic seizures that begin at school age can themselves end with the end of the puberty period. Indeed it is. But the reason is not that the end of puberty somehow affects the seizures, just the percentage of people who have cured falls for the most part at this age. In no case can you rely on the fact that with the achievement of this period, epilepsy will pass without treatment.

International Classification of Epilepsy and Epileptic Syndromes

Epilepsy and syndromes with localized seizures

Idiopathic forms (the onset of seizures is related to age):

Benign epilepsy of children with central temporal (rolandic) peaks on the EEG;
Epilepsy of children with occipital paroxysms on the EEG;
Primary reading epilepsy.

Symptomatic forms:

Chronic progressive partial epilepsy of children (Kozhevnikov's syndrome);
Syndromes with specific causes of provocation of attacks (reflex epilepsy);
Frontal, temporal, parietal, occipital lobar epilepsy.

Cryptogenic forms (indefinite forms)

Epilepsy and generalized seizure syndromes

Idiopathic (the onset of seizures is related to age):

Benign family cramps of newborns;
Benign cramps of newborns;
Benign infant myoclonic epilepsy;
Epilepsy with pycnoleptic absences (pycnolepsy, abscess epilepsy of children);
Teenage abscess epilepsy;
Epilepsy with impulsive small seizures (teenage myoclonic epilepsy);
Epilepsy with generalized tonic-clonic seizures on waking;
Other forms of generalized idiopathic epilepsy;

Epilepsy with specific triggering factors (reflex and start-epilepsy)

Cryptogenic or symptomatic forms (associated with the age of the onset of seizures):

West syndrome;
Lennox-Gastaut syndrome;
Epilepsy with myoclonic-astatic seizures;
Epilepsy with myoclonic absences.

Symptomatic forms:

Early myoclonic encephalopathy;
Infantile epileptic encephalopathy with patches of isoelectric EEG;
Other symptomatic generalized forms of epilepsy;
Symptomatic generalized forms of epilepsy of a specific etiology.

Epilepsy and syndromes, with uncertainty as focal or generalized attacks

Together, generalized and focal seizures:

Attacks of newborns;
Severe myoclonic epilepsy of early childhood;
Epilepsy with long peak waves on the EEG during the slow phase of sleep;
Syndrome of aphasia-epilepsy (Landau-Kleffner);
Other vague forms of epilepsy.

Without certain generalized and focal signs (many cases of generalized tonic-clonic seizures, which according to the clinic and EEG cannot be attributed to other forms of epilepsy of this classification, as well as many cases of large convulsive attacks during sleep).

Special Syndromes

Situational (random) attacks:

febrile seizures;
Isolated seizures or isolated epileptic status;
Attacks associated exclusively with acute exposure to metabolic or toxic factors, as well as deprivation (deprivation) of sleep, alcohol, drugs, eclampsia, etc.

Problems of the personality of the patient with epilepsy

It has now been proven that epileptic seizures can occur in people of any age, from all social backgrounds and at any intellectual level, and that epilepsy is often not a disease, much less a mental illness in the usual sense of the word.

Epileptic seizures in the vast majority of cases can be controlled with drugs, and sometimes they go away on their own.

People with epilepsy are practically no different from people without seizures. In an atmosphere of emotional support by other people, they live a normal full life. And, despite this, a person with epileptic seizures and his family may have problems.

Personality problems:

decrease in self-esteem;
depression;
difficulties in finding their place in society;
the need to reconcile with a diagnosis of epilepsy;
the possibility of side effects of drug treatment and complications of seizures.

Family problems:

rejection by members of the family of the diagnosis of epilepsy;
the need for long-term emotional and material support for a person with seizures;
the need to try not to think constantly about the illness of a loved one;
the need to observe reasonable precautions and avoid hyper-custody;
the need for genetic counseling;
the need to help a person with epilepsy live a full life outside the family;
the need to take into account age-related characteristics of the human psyche with seizures;
the opportunity to have your own family and child;
the presence of side effects of drug therapy during pregnancy (risk of fetal hypoxia);
the danger of the effects of attacks on the mother on the normal formation of the fetus.

Problems between man and society:

restriction on certain types of labor activity;
Discrimination in training and employment;
restriction of certain forms of leisure and sports;
the need for self-control when taking alcohol;
prohibition of driving a car (you can drive a car if there are no attacks for more than two years);
the need to overcome prejudices in society in relation to epilepsy and, especially, the idea of epilepsy as a mental illness. People with epilepsy and their family members should have time to talk to each other about epilepsy, their problems, feelings and interests.

Epilepsy is not a mental illness! Sometimes epilepsy is called a mental illness. This concept in relation to epilepsy should be avoided, as it is erroneous and causes prejudice in people.

Epilepsy is not a mental illness

Mental illnesses include depression, psychoses with hallucinations and mania, as well as diseases accompanied by a decrease in intelligence and personality changes. Some patients with epilepsy are periodically subject to psychosis, however, it should be considered as a temporary complication. A decrease in intelligence may also occur, but the cause is often not in epilepsy, but in the main disease of the brain.

People with epilepsy without additional reasons, for example, without brain atrophy, have mental problems no more often than other people. This applies to both children and adults. First of all, these problems include mental retardation and behavioral disorders. Such people should be aware that they may be different from others, that they are somewhat different.

Unfortunately, sometimes from the side of their environment these people see alienation, mockery, which exacerbates their condition. If the pathology of the brain is not the basis of the disease of epilepsy, patients have normal intelligence. If epilepsy is a consequence of a severe brain pathology (trauma, atrophy, etc.), then it is a brain disease, and not epilepsy itself, that reduces the patient's intelligence. It is proved that the attacks themselves with sufficient treatment do not lead to a decrease in intelligence. Problems of the risk of mental changes in a person with epilepsy are another argument for earlier treatment of seizures in order to reduce subsequent social difficulties if possible.

Personality disorder

Usually, certain traits of character are attributed to patients with epilepsy. There is an opinion that these patients are slow, inactive, petty, distrustful and not flexible. Others argue that they are very frivolous, fickle, distracted, and irresponsible. These opinions arose from individual observations of patients with epilepsy and contain unacceptable generalizations. There is no evidence that the character traits described above are observed only in people with epileptic seizures. Therefore, there are no distinctive character traits in such people. However, one should not forget that long-term treatment with anticonvulsants (barbiturates, benzodiazepines) could certainly have changed the character to a slower one with impaired concentration and memory, the appearance of irritability and fussiness.

It is possible that repeated attacks with falls and head injuries can lead to organic brain changes and a certain inhibition and slowness. It follows that the treatment of seizures should begin as early as possible, as this gives a chance to stop them at an early stage of the disease. In addition, therapy should be carried out with the optimal number of drugs, it is best to use one drug and in minimum effective doses.

Personality disorders are the most common symptom of mental disorders found in people with epilepsy, and they appear most often in people with an epileptic focus in the temporal lobe.

In general, these violations include:

age-related disorders of attraction;
changes in sexual behavior;
a feature that is commonly called "viscosity";
increased religiosity and emotional sensitivity.

Personality disorders in their entirety are rarely pronounced even in those people who suffer from complex partial attacks due to damage to the temporal lobe. Most people with epilepsy do not suffer from personality disorders, but some of them have disorders that are very different from the personality changes described below.

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It is possible that of the indicated personality characteristics, it is most difficult to describe viscosity, rigidity. This personality trait turns out to be so typical that it is most noticeable in the conversation, which is usually slow, serious, boring, pedantic, oversaturated details due to irrelevant details and circumstances. The listener begins to get bored, is afraid that the speaker will never get to the right question, wants to get away from this conversation, but the talking person does not allow him to carefully and successfully get out. Hence the term "viscosity". The same feature is found in a person with epilepsy when writing and drawing, and hypergraphy is considered by some as a cardinal manifestation of this syndrome. The tendency to verbosity, circumstance, and excessiveness, evident in the conversation, is also reflected in the writing of these people. Some people with epilepsy can improve their communication style if a sympathetic listener indicates their lack. However, many lack criticism of their violations, or they do not perceive them as violations. The religiosity of people with epilepsy is often surprising and can be manifested not only in external religious activity, but also in an extraordinary preoccupation with moral and ethical problems, reflections on what is good and what is bad, and in an increased interest in global and philosophical problems.

Change in sexual obsession

Changes in sexual behavior can be expressed in the form of hypersexuality, violation of sexual relations, for example, fetishism, transvestism and hypexuality. Quite rare in epilepsy are increased sexual need - hypersexuality and violation of sexual relations. Cases of changes in sexual orientation — homosexuality — are more often noted.

Hypexuality is much more common and manifests itself both in a general decrease in interest in sexual issues and in a decrease in sexual activity. People who have had complex partial seizures before the puberty may not reach the normal level of sexuality. Hypexuality can lead to intense emotional distress and family education difficulties. Unilateral temporal lobectomy, sometimes successfully relieving seizures, can have a surprisingly strong positive effect on increasing libido. This operation, however, is rarely used. In addition, in the presence of hypexuality, it should be borne in mind that one of the main reasons for it may be anticonvulsants (barbiturates, benzodiazepines, etc.), taken for a long time. However, in people with epilepsy, as in other people, the cause of sexual disorders should be sought primarily in conflict situations with a partner.

Limited autonomy

Whether a person with epilepsy will achieve independence or lose it depends not only on the form of epilepsy and its treatment, but mainly on its self-adaptation. With frequent attacks, loved ones out of fear of injuries will limit this person’s mobility and avoid additional risk factors, such as cycling or swimming. The fear is based on the fact that without supervision and guardianship there will be an attack, and there will be nobody to help him. From here, of course, from the best of intentions, the often exaggerated desire for the constant presence of an attendant is born. These concerns need to be contrasted with the fact that most people with epilepsy are not exposed to injuries. It should also be weighed whether permanent custody actually reduces the risk of worsening a person with epilepsy, or if she herself does more harm. It is doubtful that a witness to an attack can prevent an accident. Often there is not enough strength to catch or keep a person in an attack. It is important that society, as far as possible, be as informed as possible about the existence of people with epileptic seizures. This will help people become more merciful and skilled in providing first aid for attacks.

The flip side of constant guardianship is a weakening sense of responsibility of a person for himself. The consciousness of constant supervision, the presence of another person reduces the person with epilepsy a sense of responsibility for their actions, independence in decision-making and their correct assessment. Own experience, even erroneous, strengthens the feeling of self-confidence.

Therefore, it is necessary to come to a compromise between fear for a state and a certain freedom. It is impossible to find a rule for all occasions. Therefore, in each case, it would be necessary in a conversation with a doctor to determine the restrictions characteristic of a person with epilepsy.

Dementia (intellectual disability)

Epileptic dementia is characterized by a combination of intellectual insufficiency (a decrease in the level of generalization, a lack of understanding of figurative and hidden meaning, etc.) with peculiar personality changes in the form of extreme egocentrism, pronounced inertia, stiffness of mental processes, affective viscosity, i.e. a tendency to long-term fixation on emotionally colored, especially negative experiences, a combination of vindictiveness, revenge and cruelty towards peers and younger children with exaggerated pleasures willowiness, flattering, servility to adults, especially doctors, medical personnel, teachers. Intellectual insufficiency and low productivity in mental work are greatly enhanced by bradyphrenia, the difficulty of inclusion in any new activity, switching from one activity to another, excessive thorough thinking with “getting stuck” on trifles, which even in the case of a shallow defect of abstract thinking give the impression of an inability to single out the main ones, essential signs of objects and phenomena, as a rule, mechanical memory suffers, but remember events that affect the personal interests of the patient ayutsya better. Children with epileptic dementia often have a sullen background of mood, a tendency to bursts of passion and aggression when dissatisfied with something. In children of preschool and primary school age in behavior, motor disinhibition, combined with the "heaviness" and the angularity of individual movements, often comes to the fore. Relatively often, including among preschool children, there is a gross disinhibition of sexual desire, manifested in persistent and undisguised masturbation, the desire to cling to someone’s naked body, hug, squeeze children. Perhaps a sadistic distortion of sexual desire, in which children enjoy, causing pain, bite, pinch, scratch, etc.) to others. When a malignant current epileptic process occurs at an early age, the structure of dementia usually has a pronounced oligophrenic component, and the depth of the dementia itself may correspond to imbecility and even idiocy. The distinction between such an oligophrenic variant of epileptic dementia from oligophrenic dementia is possible only by analyzing the entire clinical picture (including epileptic paroxysms) and the course of the disease. More or less typical epileptic dementia described above is present at the onset of the disease in children older than 3-5 years.

Psychoses

A psychotic state is more common in the interictal period, but personality disorders are even more common in the interictal state. Psychoses that resemble schizophrenia are described, and there is evidence that psychoses are more often observed in individuals with temporal lobe epilepsy than with epilepsy without a local focus or with a focus located outside the temporal lobe. These chronic schizophrenia-like psychoses can manifest acutely, sub-scale, or have a gradual onset. They usually occur only in patients suffering for many years with complex partial seizures, the source of which are violations in the temporal lobe. Thus, the duration of epilepsy becomes an important causative factor in causing psychosis. The appearance of psychosis is often preceded by personality changes. The most common symptoms of such psychoses are paranoid delusions and hallucinations (especially auditory hallucinations) with a clear consciousness. Emotional flattening may occur, but often patients retain emotional warmth and adequate affective experiences. Although schizophrenic psychoses are typically characterized by impaired thinking, the organic type of impaired thinking is dominated by impairment such as insufficient generalizations or details. The nature of the relationship of such psychoses with seizures is often unclear; in some patients, exacerbation of psychosis occurs when the seizures are successfully stopped, but such a perverted nature of the relationship between these phenomena is optional. Reactions to antipsychotic treatment are unpredictable. In most patients, these psychoses differ from classical schizophrenic psychoses in several important respects. Affect is less pronounced, and the person suffers less than with chronic schizophrenia. Some data indicate the great importance of organic factors in the occurrence of such psychoses. They occur, as a rule, only in those patients who suffer from epilepsy for many years, and are much more common in epilepsy with a dominant focus in the temporal lobe, especially if the epileptic focus includes deep temporal structures of the dominant (usually left) hemisphere. Over time, these people begin to look much more like patients with organic brain damage than patients with chronic schizophrenia, that is, their cognitive impairment prevails over impaired thinking. Affective psychoses or mood disorders, such as depression or a manic-depressive state, are not observed as often as schizophrenic-like psychoses. In contrast to them, however, affective psychoses occur sporadically and are more common when the epileptic focus is located in the temporal lobe of the non-dominant cerebral hemisphere. The important role of mood disorders in epilepsy can be judged on the basis of a large number of suicidal attempts in individuals with epilepsy.

Depression

May occur in people with epileptic seizures due to:

excessive concern about their unusual condition;
hypochondria;
excessive sensitivity.

It is necessary to distinguish between simple (reactive) depression and depression as an independent disease: reactive depression is a reaction to circumstances; Depression as a disease is depression associated with individual characteristics, endogenous depression.

Causes of depression in people with epileptic seizures:

diagnosis of epilepsy;
social, family, emotional problems associated with epilepsy;
prodromal phenomena of a depressive nature before an attack (aura in the form of depression);
depression accompanying the attack;
depression after an attack;
constant depression for a long period after an attack.

Aggression

Aggressive behavior usually occurs with the same frequency in people with epilepsy and in the population. Patients with epilepsy are capable of violence in exactly the same degree as others. Sometimes these patients are credited with increased irritability. Although quite often you can meet people without epilepsy, but quite cocky. And for people with epilepsy with their difficult life situations, with scanty social contacts, loneliness, restrictions, and also deeply offended by others, with their prejudice and ignorance it is explained that sometimes they can be irritable and angry with the whole world.

In addition, a person with epileptic seizures may have additional reasons to become aggressive:

if you take violence to him or keep him during an attack; as a result of a negative attitude towards this person on the part of society;
in the pre-crime or post-crime period;
during an attack of outpatient automatism or during the aura;
in case of a malfunction of the brain after severe attacks leading to personality changes, or to mental illness; when he is negative about treatment.

Pseudo-attacks

These conditions are deliberately caused by a person and look like seizures. They may appear in order to attract additional attention to themselves or to avoid any activity. It is often difficult to distinguish a true epileptic seizure from a pseudo-attack.

Pseudo-occurrences are found:

more often in women than in men;
people whose family has relatives with mental illness;
with some forms of hysteria; in families where there are difficulties in relationships;
in women with sexual problems;
in people with a burdened neurological history.

Clinical manifestations of pseudo-attacks:

The behavior during the attack is simple and stereotypical;
the movements are asymmetric;
excessive grimacing;
trembling instead of convulsions;
sometimes there may be intermittent breathing;
emotional explosion, a state of panic;
sometimes a scream; complaints of headache, nausea, abdominal pain, redness of the face.

But unlike epileptic seizures with pseudo-attacks, there is no characteristic post-attack phase, a very quick return to a normal state, a person often smiles, rarely there are body injuries, irritability is rarely, there is rarely more than one attack in a short period of time. Electroencephalography (EEG) is the main method of examination, allowing to identify pseudo-attacks.

Statistics

In 2012, patients with epilepsy without psychotic disorders accounted for 51.97% of the total number of patients with epilepsy. Only 547 patients (14.44%) of this number were registered in the clinics of Prokopyevsk, out of this number of patients, 3331 (85.56%) of them actually did not stay in psychiatric institutions because they did not need psychiatric help. Patients with epilepsy without psychotic disorders make up a significant part (66.41%) of the structure of patients with epilepsy in neuropsychiatric dispensaries. In this regard, the transfer of patients with epilepsy without psychotic disorders for outpatient treatment to municipal clinics under the supervision of neurologists is relevant for our country. Since 2000, Russia began to implement a program for organizing specialized classrooms of neurologists of epileptologists in clinics of administrative districts with a population of more than 1 million. Currently, 10 such classrooms have been organized, for which neurologists have specialized in neurology at the Department of Neurology of the Department of Neurology of the Russian State Medical University and REC. Over the past years, 132 doctors from 18 regions of the country underwent specialization in epileptology at the department and the center. In 1996, the Ministry of Health of the Russian Federation created the first Russian epileptological center. In recent years, regional epileptological centers have been established in 17 regions of the country. Such centers have been created in Moscow, Leningrad, Voronezh, Ufa, Krasnoyarsk and other Russian cities. Unfortunately, there are no epileptological centers on the territory of the Kemerovo region, but in Kemerovo there are about 22 specialists in epileptologists based on GB No. 13, City Clinical Hospital No. 2, State Hospital No. 1 named after Gorbunov, the Central Clinical Hospital of the Kemerovo Region and other medical institutions.

Conclusion

In accordance with the goals, a general description of the epileptic syndrome and epilepsy as a disease from different points of view - medical and psychological, was considered. This made it possible to expand and deepen the everyday idea of this disease, limited only by knowledge of the presence of convulsive seizures, i.e. allowed us to take the understanding of epilepsy beyond just somatic disease. From the point of view of neuropsychology and pathopsychology, various types of dysfunctions of patients with epilepsy were considered, which often helps to distinguish the location of the epileptic focus, as well as to understand the motivation of the actions of patients with epilepsy.

Epilepsy is a complex and controversial phenomenon. It can either be congenital or acquired as a result of trauma. Moreover, the causes of the occurrence of genuin (epileptic disease proper) epilepsy are still unknown. However, epilepsy is not only in seizures, but it changes the whole personality of the patient, giving him an epileptoid character.

By: Dr. Robert C Abrams