For personality change in epilepsy is characteristic. Psychic personality changes in epilepsy. Gradually increasing dementia

The features of the behavior of a group of patients with epilepsy, the formation of certain character traits that are different from others - mentally healthy people are described.

epilepsy character

Character traits in some people with temporal lobe epilepsy : obsession, viscosity, thoroughness, excessive concretization, a dull sense of humor, emotionality, suspicion, fixation on the problems of religion and mysticism, a decrease in sexual instinct.

Personality traits in some people with frontal lobe epilepsy : foolishness, a tendency to flat jokes, apathy, lack of will, hyposexuality, aggressiveness, excitability, disinhibition.

Character traits in some people with juvenile myoclonic epilepsy : irresponsibility, distraction, lack of sense of proportion, irritability, irascibility.

Most often, mental disorders are denied by the patients themselves, but can be clearly articulated by their attendants.

Contribute to the formation of "epileptic personality" factors:

Isolation of people with epilepsy (due to seizures, prejudices of others against epilepsy, defects in parenting - overprotection).
Organic brain damage.

At the appointment of an epileptologist, patients with epilepsy make up to 90% of all those who applied. Among them, about 20% of children have severe behavioral and learning disabilities.

Parents of patients with epilepsy also differ to some extent in mental disorder in comparison with parents of patients without pronounced abnormalities who applied for preventive examination.

Due to hereditary predisposition to mental disorders or under the influence of living conditions, circumstances, feelings for their children, or a combination of these factors, psychopathological personality formation occurs in varying degrees in the parents of patients with epilepsy.

Character Traits of Some Parents Whose Children Have Epilepsy: aggressiveness, denial of the obvious, search for the guilty in the environment, anxiety, obsession with minor details, irresponsibility or overprotection, fears, depression, distrust, negative,

Most parents of patients with epilepsy

mentally safe;

inclined to rational actions aimed at preserving and restoring the health of children;

informed about the disease from the Internet, information from doctors, personal experience and the experience of acquaintances;

are ready to spend their efforts, emotions, material values for recovery;

if possible, they rely on social assistance from the state, municipal medical institutions, preferential provision.

To conduct an appointment with these patients and accompanying relatives costs doctors a lot of emotional stress.

The task of an epileptologist is to understand the interweaving of facts about the disease, draw the right conclusions, make the correct diagnosis, select effective therapy, give written (printed) recommendations, tell patients and parents at the appointment about the disease and its treatment methods within the allotted short time frame. It is necessary to take into account the difficulty in understanding information about epilepsy, the different intellectual level of those present, the psychological characteristics of patients.

How does it manifest itself in patients with epileptic character at the reception:

patients with epilepsy may want to hug the doctor, be negative, ignore, or make contact selectively. Such emotions can replace each other in one child for a short time. For various reasons, sometimes intentionally, patients can give false or misinterpreted information about the disease, from which they need to cut off the excess.

Patients or relatives may want to be diagnosed with Epilepsy but not have the condition. They can aggravate (increase painful symptoms) to confirm the diagnosis.

The doctor tries to be friendly, attentive, adequate, moderately strict, correct, informed, responsible.

So, in this article we talked about personality change in epilepsy , what " epileptic personality ", which personality in epilepsy , what kind available in different forms epilepsy personality changes , mentality of their parents. The doctor often treats epilepsy as a mental illness.

Mental health is one of the most important values of every person.

Watching the video from channel 1: Currently, there is a general increase in mental disorders.

In fact, this problem is quite relevant in psychiatry, neurosurgery and neurology around the world. Epilepsy leads to a change in a person's life, reduces the quality of his life and worsens his relationship with family and friends. This disease will not allow the patient to drive a car ever again in his life, he will never be able to attend a concert of his favorite band and go scuba diving.

History of epilepsy

Previously, the disease was called 2 epilepsy, divine, possession by the devil, Hercules disease. Many great people of this world suffered from its manifestations. Among the loudest and most popular names are Julius Caesar, Van Gogh, Aristotle, Napoleon I, Dostoevsky, Joan of Arc.
The history of epilepsy is shrouded in many mysteries and mysteries even to this day. Many people believe that epilepsy is an incurable disease.

What is epilepsy?

Epilepsy is considered a chronic neuropsychiatric disease with multiple causes. The symptoms of epilepsy are diverse, but there are certain specific clinical signs of it:

repeated, which are not provoked by anything;
fickle, transient human;
changes in personality and intelligence that are practically irreversible. Sometimes these symptoms turn into.

Causes and features of the spread of epilepsy

In order to accurately determine the epidemiological moments of the spread of epilepsy, it is necessary to carry out several procedures:

brain mapping;
determine the plasticity of the brain;
explore the molecular basis of the excitability of nerve cells.

This was done by scientists W. Penfield and H. Jasper, who performed operations on patients with epilepsy. They, to a greater extent, created maps of the brain. Under the influence of current, individual parts of the brain react differently, which is interesting not only from a scientific point of view, but also from a neurosurgical point of view. It becomes possible to determine which parts of the brain can be painlessly removed.

Causes of epilepsy

It is not always possible to identify the cause of epilepsy. In this case, it is called idiopathic.
Recently, scientists have discovered that one of the causes of epilepsy is a mutation of certain genes that are responsible for the excitability of nerve cells of neurons.

Some statistics data

The incidence of epilepsy varies from 1 to 2%, regardless of nationality and ethnicity. In Russia, the incidence ranges from 1.5 to 3 million people. Despite this, individual convulsive conditions that are not epilepsy occur several times more often. Almost 5% of the population has experienced at least 1 seizure in their lifetime. Such attacks usually arise from exposure to some provoking factors. Of these 5% of people, a fifth will definitely develop epilepsy in the future. Almost all people with epilepsy have their first seizure in the first 20 years of life.
In Europe, the incidence is 6 million people, 2 million of which are children. On the planet at the moment there are about 50 million people suffering from this terrible disease.

Predisposing and provoking factors for epilepsy

Seizures in epilepsy occur without any provoking moments, which indicates their unpredictability. However, there are forms of the disease that can be provoked:

flickering light and;
and taking certain medications
strong emotions of anger or fear;
alcohol intake and frequent deep breathing.

In women, menstruation can be a provoking factor due to changes in hormonal levels. In addition, during physiotherapy, acupuncture, active massage, activation of certain parts of the cerebral cortex and, as a result, the development of a convulsive attack can be provoked. Taking psychoactive substances, one of which is caffeine, sometimes causes an attack.

What mental disorders can occur in epilepsy?

In the classification of human mental disorders in epilepsy, there are four points:

mental disorders that portend a seizure;
mental disorders that are a component of an attack;
mental disorder after the completion of the attack;
mental disturbances between attacks.

Mental changes in epilepsy also distinguish between paroxysmal and permanent. Let us first consider paroxysmal mental disorders.
The first are mental attacks that are harbingers of convulsions. Such attacks last from 1-2 seconds. up to 10 minutes.

Transient paroxysmal mental disorders in humans

Such disorders last for several hours or days. Of these, we can distinguish:

epileptic mood disorders;
twilight disturbances of consciousness;
epileptic psychoses.

Epileptic mood disorders

Of these, dysphoric conditions are considered the most common. The patient is constantly yearning, embittered at others, constantly afraid of everything for no reason. From the predominance of the above described symptoms, melancholic, anxious, explosive dysphoria occurs.
Rarely, there may be an increase in mood. At the same time, a sick person shows excessive inadequate enthusiasm, foolishness, clowning around.

Twilight clouding of consciousness

The criteria for this state were formulated as early as 1911:

the patient is disoriented in place, time and space;
there is detachment from the outside world;
inconsistency in thinking, fragmentation in thinking;
the patient does not remember himself in a state of twilight consciousness.

Symptoms of twilight consciousness

The pathological condition begins suddenly without precursors, and the condition itself is unstable and short-lived. Its duration is about several hours. The patient's consciousness is seized with fear, rage, anger, longing. The patient is disoriented, cannot understand where he is, who he is, what year it is. The instinct of self-preservation is significantly muted. During this state, vivid hallucinations, delusions, inconsistency of thoughts and judgments appear. After the attack is over, a post-attack sleep occurs, after which the patient does not remember anything.

Epileptic psychoses

Mental disorders of a person with epilepsy can be chronic. Acute are with clouding and without clouding of consciousness.
There are the following acute twilight psychoses with elements of clouding of consciousness:

Protracted twilight states. They develop mainly after extended convulsive seizures. Twilight lasts up to several days and is accompanied by delirium, aggression, hallucinations, motor excitement, emotional tension;
Epileptic oneiroid. Its onset is usually sudden. This distinguishes him from the schizophrenic. With the development of epileptic oneiroid, delight and ecstasy arise, as well as often anger, horror and fear. Consciousness is changing. The patient is in a fantastic illusory world, which is complemented by visual and auditory hallucinations. Patients feel like characters from cartoons, legends, fairy tales.

Of the acute psychoses without clouding of consciousness, it is worth highlighting:

Acute paranoid. With paranoia, the patient is delusional and perceives the environment in the form of illusory images, that is, images that are not really there. All this is accompanied by hallucinations. At the same time, the patient is excited and aggressive, since all hallucinations are threatening.
Acute affective psychoses. Such patients have a depressive dreary-angry mood with aggression towards others. They accuse themselves of all mortal sins.

Chronic epileptic psychoses

There are several described forms:

Paranoid. They are always accompanied by delusions of damage, poisoning, attitudes, religious content. Epilepsy is characterized by an anxious and malicious nature of mental disorders or ecstatic.
Hallucinatory-paronoid. Patients express broken, unsystematized thoughts, they are sensual, undeveloped, there are a lot of specific details in their words. The mood of such patients is reduced, dreary, they experience fear, often there is a clouding of consciousness.
Paraphrenic. With this form, verbal hallucinations occur, the statement of delusional ideas appears.

Permanent mental disorders of a person

Among them are:

epileptic personality change;
epileptic dementia (dementia);

Epileptic personality changes

This concept includes several states:

Formal thinking disorder, when a person cannot think clearly and think quickly. The patients themselves are verbose, thorough in conversation, but they cannot express the most important thing to the interlocutor, they cannot separate the main thing from something secondary. The lexicon of such people is reduced, what has already been said is often repeated, template turns of speech are used, words are inserted into speech in diminutive forms.
Emotional disturbances. The thinking of these patients does not differ from those with a formal thought disorder. They are irritable, picky and vindictive, prone to outbursts of rage and anger, often rush into quarrels, in which they often show aggression not only verbally, but also physically. In parallel with these qualities, excessive courtesy, flattery, timidity, vulnerability, religiosity are manifested. By the way, religiosity was previously considered a specific sign of epilepsy, according to which this disease could be diagnosed.
Change of character. With epilepsy, special character traits are acquired, such as pedantry, hypersociality in the form of solidity, conscientiousness, excessive diligence, infantilism (immaturity in judgments), the desire for truth and justice, a tendency to preach (banal edifications). Such people are extremely valuable to relatives, they are very attached to them. They believe that they can be completely cured. The most important thing for them is their own personality, their own ego. In addition, these people are very vindictive.

epileptic dementia

This symptom occurs if the course of the disease is unfavorable. The reasons for it are not yet clear. The development of dementia occurs mainly after the expiration of 10 years of illness or after 200 convulsive attacks.
The progression of dementia is accelerated in patients with low intellectual development.
Dementia is manifested by a slowdown in mental processes, stiffness in thinking.

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With a long course of epilepsy, a change in the personality of the patient occurs, so epilepsy brings not only medical problems, but also social ones. Patients suffering from epilepsy are observed by both a neurologist and a psychiatrist. Slowly, the painful process forms the core of a new personality that supplants the old one. Mental problems appear.

Personality changes can be aggravated in the presence of alcoholism, cerebral atherosclerosis, and traumatic brain injuries.

Epilepsy and psychiatry

Short-term single seizures do not have negative consequences, but prolonged convulsions, frequent seizures lead to inevitable changes in brain cells. Seizures that occur in front of people around, classmates, work colleagues, friends affect the human psyche, contribute to a secluded lifestyle, loss of interest in life, the emergence of a sense of inferiority.

Possible asthenia, vegetative disorders, personality changes. At the beginning of the disease, the majority of patients are impressionable, subtle natures, very sociable. At first, it is noticeable how a “split” personality occurs: stubbornness and increased suggestibility, obsequiousness and outbursts of rudeness, arrogance and vulnerability.

Personality changes in long-term epilepsy

But some scientists argue that such traits as increased accuracy, obsequiousness, touchiness are an innate personality trait.

Changes in conversation in epilepsy

In the conversation, attention is drawn to the detail and detailed description of what is happening. Thinking becomes viscous, combinatorial abilities decrease, a person can repeat one phrase, the same movements, monotony and fragmentation of speech develop. Memory is decreasing. The patient cannot distinguish the main from the secondary, is exaggeratedly attentive to trifles. Difficulty expressing his thoughts. In conversation, florid artsy phrases are often found.

emotional changes

Due to the lack of mobility of the patient, the emotions of an epileptic sufferer are dull and monotonous. He does not seem to have time to respond to the changes that are taking place. The mood is subject to fluctuations - from gloomy and irritable to excited and deliberately joyful.

Personality change and intelligence

People with epilepsy are characterized by a wide range of intellectual abilities. A mental retardation is possible, and at the same time, some patients may have a high level of intelligence (Socrates, Napoleon, Flaubert, Nobel, etc.). It is noted that the degree of dementia with age depends on the number of convulsive generalized seizures.

what are the complications of epilepsy

A terrible complication in epilepsy is status epilepticus, during which the attack lasts more than 30 minutes or the attack continues one after another, and the patient cannot regain consciousness. The cause of epistatus may be the abrupt cessation of antiepileptic drugs. In extreme cases, status epilepticus can be fatal due to cardiac arrest or aspiration of vomit.

One of the manifestations of epilepsy is the occurrence of epileptic encephalopathy, during which the mood deteriorates, the level of attention decreases, memory deteriorates. Children begin to write sloppily, forget reading skills, and have difficulty counting. There are also complications such as autism, migraine, hyperactivity.

During an attack, injuries, bruises, and injuries occur. Sudden loss of consciousness can lead to accidents

Mental disorders in epilepsy in the interictal period

Epilepsy brings not only medical problems, but also social ones. Patients suffering from epilepsy are observed by both a neurologist and a psychiatrist. Slowly, the painful process forms the core of a new personality that supplants the old one. Mental problems appear. Short-term single seizures do not have negative consequences, but prolonged convulsions, frequent seizures lead to inevitable changes in brain cells. Seizures that occur in front of people around, classmates, work colleagues, friends affect the human psyche, contribute to a secluded lifestyle, loss of interest in life, the emergence of a sense of inferiority. Possible asthenia, vegetative disorders, personality changes. At the beginning of the disease, the majority of patients are impressionable, subtle natures, very sociable. At first, it is noticeable how a “split” personality occurs: stubbornness and increased suggestibility, obsequiousness and outbursts of rudeness, arrogance and vulnerability.

With a long course of the disease, such traits appear in the character of the patient as vindictiveness, vindictiveness, pedantry, egocentrism, infantilism. Epileptic psychoses appear. The patient becomes touchy and aggressive, irritability increases. But some scientists argue that such traits as increased accuracy, obsequiousness, touchiness are an innate personality trait. In a conversation, attention is drawn to the detailing and detailed description of what is happening, thinking becomes viscous, combinatorial abilities decrease, a person can repeat one phrase, the same movements, monotony and fragmentation of speech develop. Memory is decreasing.

People with epilepsy are characterized by a wide range of intellectual abilities. A mental retardation is possible, and at the same time, some patients may have a high level of intelligence (Socrates, Napoleon, Nobel, etc.). It is noted that the degree of dementia with age depends on the number of convulsive generalized seizures.

Doctor of Medical Sciences, Professor,
doctor of the highest category, psychiatrist

Introduction

Epidemiological studies show that epilepsy is one of the most common neurological diseases with certain mental disorders. As you know, in epidemiology there are two cardinal indicators: incidence and morbidity (prevalence). Under the incidence is usually understood as the number of newly ill patients with a particular disease during the year. The incidence of epilepsy in European countries and the USA is about 40-70 cases per 100,000 population (May, Pfäfflin, 2000), while the incidence is much higher in developing countries (Sander and Shorvon, 1996, Wolf, 2003). Interestingly, the incidence of epilepsy in men, especially in the elderly and late age, is higher than that in women (Wolf, 2003). It is important that the incidence of epilepsy shows a clear dependence on age.

So, in the first four years of life, the incidence of epilepsy in the 30-40s of the 20th century in one of the foreign Western studies was about 100 cases per 100,000, then in the range from 15 to 40 years, a decrease in the incidence was observed to 30 per 100,000, and after 50 years - increase in incidence (Hauser et al., 1993).
The prevalence (morbidity) of epilepsy is 0.5-1% of the general population (M.Ya. Kissin, 2003). Some foreign epidemiological studies found that the index of the so-called cumulative prevalence of epilepsy is 3.1% by the age of 80 years. In other words, if the entire population lived to age 80, epilepsy could develop in 31 out of every 1,000 people in their lifetime (Leppik, 2001). If we take into account not epilepsy, but convulsive seizures, then the cumulative prevalence rate for them is already 11%, i.e. epileptic seizures can occur in 110 people out of a thousand of the population throughout their lives. In the CIS countries, about 2.5 million people suffer from epilepsy. In Europe, the prevalence of epilepsy is 1.5% and in absolute terms 6 million people suffer from it (M.Ya. Kissin, 2003). All of the above shows the relevance of studying and timely detection and, most importantly, treatment of patients with epilepsy.

In our country, as, indeed, in most other countries of the world, doctors of two specialties were engaged in the diagnosis and treatment of epilepsy - neuropathologists and psychiatrists. There is no clear demarcation line in the field of tasks for managing patients with epilepsy between neurologists and psychiatrists. Nevertheless, in accordance with the traditions characteristic of national health care, psychiatrists take the “main blow” in terms of diagnosis, therapy and socio-rehabilitation work with patients with epilepsy. This is due to mental problems that occur in patients with epilepsy. They include changes in the personality of patients, specific for epilepsy, associated with a mnestic-intellectual defect, affective disorders and, in fact, the so-called epileptic psychoses (V.V. Kalinin, 2003). Along with this, one should also point out a variety of psychopathological phenomena that occur within the framework of simple partial seizures in temporal lobe epilepsy, which are also more likely to be of greater interest to psychiatrists. Based on this, it becomes clear how important a task for psychiatrists is the timely diagnosis of mental disorders and their adequate treatment in patients with epilepsy.

Indications and contraindications for the use of the method.
Indications:
1. All forms of epilepsy, according to the International Classification of Epilepsy and Epileptic Syndromes.
2. Mental disorders of the borderline spectrum in patients with epilepsy in accordance with the diagnostic criteria of the ICD-10.
3. Mental disorders of the psychotic level in patients with epilepsy in accordance with the diagnostic criteria of the ICD-10.

Contraindications for the application of the method:
Mental disorders of non-epileptic origin

Logistics of the method:
To apply the method, the following anticonvulsants and psychotropic drugs should be used:

Name of the drug	Medicines. the form		Registration number
Depakine-chrono			P No. 013004/01-2001
Depakine enteric			P-8-242 No. 007244
Tegretol			P No. 012130/01-2000
Tegretol CR			P No. 012082/01-2000
Topamax			№ 011415/01-1999
Lamictal			No. 002568/27.07.92 PPR
Clonazepam			№2702/12.07.94

Suxilep			№007331/30.09.96
Phenobarbital
			P-8-242 No. 008799
			P No. 011301/01-1999
fluoxetine
Sertraline

Citalopram
Rispolept
Zuclopenthixol		2 mg, 10 mg, 25 mg, 50 mg,
Quetiapine		25 mg, 100 mg,

Description of the method

Personal characteristics of patients with epilepsy.

It is known that there is a close relationship between personality change and dementia in epilepsy. At the same time, the more pronounced the personality changes according to the type of energeticity, in the understanding of Mauz, the more pronounced the degree of dementia can be legitimately expected. Characterological changes in general are of fundamental importance for the development of intellectual decline. At the same time, the pathological personality change in epilepsy at first does not affect the core of the character at all, and the epileptic process at first only changes the formal course of mental processes, experiences and aspirations, ways of expression, reactions and behavior towards their slowdown, tendency to get stuck and perseveration. In this regard, it is believed that in patients with epilepsy there is the same variety and richness of variants of premorbid personality as in healthy individuals. It can be assumed that personality changes owe their appearance to seizures. At the same time, this is contradicted by the observations of the old French psychiatrists about the possibility of the existence of such personality changes in individuals who never had seizures at all. For such conditions, the term “epilepsia larvata” was introduced, i.e. latent epilepsy. Such a contradiction can be explained by the fact that the so-called personality changes in epilepsy are not the prerogative of this disease, but can also occur in other pathological conditions and processes of organic genesis.

The slowdown of all mental processes and the tendency to torpidity and viscosity in patients with epilepsy cause difficulties in the accumulation of new experience, a decrease in combinatorial abilities and a deterioration in the reproduction of previously acquired information. On the other hand, one should point out a tendency to brutal and aggressive actions, which was previously associated with an increase in irritability. Such personality traits, which were described in the psychiatric literature of past years under the name of “enechetic constitution”, “glischroidia”, “ixoid character” (V.V. Kalinin, 2004), lead to a decrease in productivity, and as the disease progresses, to persistent fallout higher mental functions, i.e. to the development of dementia. As Schorsch (1960) pointed out, epileptic dementia consists in a progressive weakening of cognitive abilities and memorization, in an increasing narrowness of judgments. It is also characterized by the inability to distinguish the essential from the non-essential, the inability to make synthetic generalizations and the inability to understand the salt of jokes. At the final stages of the disease, the monotony of the speech melody and the discontinuity of speech develop.

Attempts to study the characteristics of personality typology depending on the form of epilepsy were made already in the middle of the 20th century. So, after Janz, it is customary to contrast the types of personality changes in primary generalized and temporal lobe epilepsy. At the same time, the so-called “epilepsy of awakening” (Auchwachepilepsie) is referred to the first one, which is characterized by personality changes in the form of low sociability, stubbornness, deprivation of purpose, carelessness, indifference, loss of self-control, violations of doctor’s prescriptions, anosognosia, desire to drink alcohol and a tendency to deviant behavior. and delinquent behavior. These same patients are distinguished by pronounced impressionability, a fairly lively mind, mild emotional irascibility, lack of self-confidence with low self-esteem. Tellenbach's designation "adult child" is appropriate for this type of personality change.

It is essential that the noted personality traits coincide with those in patients with the so-called juvenile myoclonic epilepsy. These observations are not shared by all authors, since the patterns obtained can be explained not so much by the nature of the epileptic process as by the influence of adolescence.

However, in personal terms, this type of patients is the opposite of patients with sleep epilepsy. The latter is a type of temporal lobe epilepsy (TE). It is characterized by personality changes in the form of egocentrism, arrogance, hypochondria, pettiness against the background of viscosity and stiffness of thinking and affects, thoroughness and pedantry.
This syndrome is the opposite picture of the condition that occurs in the Kluver-Bucy syndrome (KBS), obtained in the experiment with the removal of the temporal lobes of the brain in animals. CHD is characterized by persistent exploratory behavior, increased sexual desire, and reduced aggressiveness.

In Anglo-American epileptology, following Waxman S. and Geschwind N., it is customary to single out a group of signs of altered, but not pathological, behavior that is associated with TE. This group of phenomena includes an increase in emotions, thoroughness, increased religiosity, decreased sexual activity, and hypergraphia. These personality traits are called "interictal behavioral syndrome". Subsequently, this syndrome was named Gastaut-Geshwind syndrome in the psychiatric literature (Kalinin V.V. 2004).

It is essential that, depending on the side of the focus of epileptic activity in the temporal lobes, there will be certain differences in the personal characteristics of patients. So, in patients with a right-sided temporal focus, there are more emotional personality traits and a desire to present deviations in a favorable light (to polish their image). On the contrary, in patients with a left-sided temporal focus, ideational (mental) characteristics are more pronounced, while at the same time striving to depersonalize the image of their behavior compared to the assessments of outside observers. Along with this, it is also important that with a right-sided focus, spatial left-sided agnosia occurs, and with a left-sided focus, depressive symptoms are more common. At the same time, left-sided spatial agnosia corresponds to the desire to polish, and depression - the tendency to depersonalize the image of one's behavior.

Mnestic-intellectual defect.
Patients with epilepsy are characterized by a wide range of intellectual abilities - from mental retardation to a high level of intelligence. Therefore, the measurement of IQ rather gives the most general idea of intelligence, the level of which can be influenced by a number of factors, such as the type and frequency of seizures, the age of onset of epilepsy, the severity of epilepsy, the depth of brain damage, heredity, antiepileptic drugs (AEDs) and educational level.

It should also be taken into account that IQ indicators in patients with epilepsy do not remain at a constant level, but are subject to fluctuations over time.

Of particular interest is the issue of differences in the performance of the verbal and performance subtype of IQ in connection with the lateralization of brain functions. In this context, it can be assumed that in patients with epilepsy with a left-sided focus or damage, a decrease in the verbal IQ should be expected, while in patients with a right-sided focus, a decrease in the performance IQ. For this purpose, Wechsler tests were widely used to assess both verbal and executive functions in patients with temporal lobe epilepsy. The results obtained, however, are not consistent.

Brain injuries caused by falls during generalized seizures can reduce intelligence. In this regard, the observations of Stauder (1938), which have become classic, deserve attention. According to them, the number of seizures suffered decisively determines the degree of dementia. This becomes apparent about 10 years after the onset of the disease. It is significant that in patients who have had more than 100 advanced convulsive seizures, dementia can be observed in 94% of cases, while in patients with fewer seizures in history, dementia is formed only in 17.6% of individuals (Stauder, 1938).

This is consistent with more recent data. At the same time, the number of seizures before the start of therapy, the number of seizures over a lifetime, or the number of years with seizures are the main factors influencing the formation of an intellectual defect and dementia. In general, it can be considered that the severity of mnestic-intellectual decline correlates with the number of years of having seizures. So, for secondary generalized seizures, a statistically significant relationship with the depth of the intellectual defect was established. In this case, the defect develops in the presence of at least 100 tonic-clonic seizures during life, which confirms the above observations of Stauder (1938).

It has been established that in patients who managed to completely suppress seizures with drugs and achieve remission, there is an increase in the level of IQ. On the other hand, in forms of epilepsy resistant to AEDs, lower IQs are observed. This leads to the conclusion about the need for persistent and prolonged antiepileptic therapy.

It has been established that the level of intelligence can decrease by at least 15% compared with healthy individuals in the presence of a history of status epilepticus, which is in full agreement with the above data.

On the other hand, no such pattern has been established for complex partial seizures in temporal lobe epilepsy. In relation to them, it was shown that for the occurrence of a defect and dementia, it is not their total number that matters, but the so-called “time window” indicator, during which one can count on the restoration of cognitive processes. On the contrary, when this indicator is exceeded, irreversible intellectual and mnestic changes develop. So, in some studies, irreversible changes were found after 5 years of continuous occurrence of complex partial seizures, although in most other studies this figure is at least 20 years (Kalinin V.V., 2004).

However, there are other observations as well. So, there is an example of the formation of severe dementia after a single series of seizures, as well as cases of the formation of dementia as a result of a few and abortive seizures. This is believed to be especially true of the child's brain, which is especially sensitive to hypoxia and edema resulting from seizures. This is related to another problem associated with the development of severe dementia in childhood due to encephalopathy in the Lennox-Gastaut syndrome.

Comparison of the level of intelligence in genuine and symptomatic epilepsy shows that among children with a symptomatic form of epilepsy, there are much more mentally retarded (about 3-4 times) than in idiopathic epilepsy. All of the above emphasizes the importance of long-term anticonvulsant therapy.

Antiepileptic drugs and mnestic-intellectual defect.
The effect of AED on the severity of the mnestic-intellectual defect is a large independent problem that cannot be fully considered in this manual. When studying traditional AEDs, it was found that phenobarbital leads more often to severe cognitive impairment than other drugs. At the same time, psychomotor retardation occurs, the ability to concentrate attention, assimilate new material decreases, memory is disturbed and the IQ index decreases.
Phenytoin (diphenin), carbamazepine and valproate also cause similar side effects, although they are much less pronounced than in the case of phenobarbital. Data on the behavioral toxicity of these drugs are generally not consistent. This allows them to be considered more preferable than barbiturates, although it is not clear which of the three drugs listed is the most harmless.

Relatively little is known about the behavioral toxicity of new AEDs, in particular felbamate, lamotrigine, gabapentin, tiagabine, vigabatrin, and topiramate. It has been established that AED of a new generation, in general, do not have a negative impact on the course of cognitive processes.

In our opinion, the cognitive impairments noted in a small number of studies in patients in the case of topiramate use cannot be explained solely by the influence of this drug, since it was used in the regimen of an additional agent to the main AEDs. Obviously, in such cases, it is necessary to take into account the pharmacokinetic interaction between all AEDs, which undoubtedly complicates the problem of studying cognitive impairment depending on the types of AEDs used.
Our own experience of long-term therapy with Topamax for various forms of epilepsy with varying degrees of mnestic-intellectual decline shows that mnestic processes are normalized in patients with long-term use of Topamax. This applies, first of all, to patients with temporal lobe epilepsy (mediotemporal variant), which is characterized by severe autobiographical memory impairments.

Here we should also point out the possibility of some slowing down of associative processes (decrease in speech fluency) at the very beginning of the use of topiramate in the mode of unreasonably rapid increase in doses. It is important that these violations leveled out with further use of the drug.

Before turning to the issue of mental disorders proper in epilepsy, it should be emphasized that modern epileptology has a tradition of considering all these disorders (depressions, psychoses) depending on the time of their onset in relation to seizures (Barry et al., 2001; Blumer , 2002; Schmitz, 2002; Kanemoto, 2002; Kanner, 2004). In accordance with this rule, periictal (pre- and postictal), ictal and interictal disorders are distinguished.

Preictal mental disorders occur immediately before the seizure and actually pass into it.
Postictal disorders, on the contrary, follow after seizures. They usually occur 12-120 hours after the last seizure and are characterized by a high affective charge and a duration not exceeding a few hours to 3-4 weeks.

Ictal mental disorders should be considered as the mental equivalent of paroxysms, while interictal mental disorders occur against the background of clear consciousness long after the seizures and do not depend on them. Consider separately affective and psychotic disorders in accordance with the proposed scheme.

affective disorders.
Affective disorders are almost the main significance among the whole variety of mental pathology in patients with epilepsy. They include depression, anxiety, panic disorders, phobic disorders, and obsessive-compulsive experiences. This is due to their high frequency in the population of patients with epilepsy. In particular, it has been found that the proportion of depressive states among patients with epilepsy is at least 25-50% (Baumgartner, 2001; Barry et al., 2001; Wolf, 2003). Comparison of the frequency of occurrence of depressive disorders proper in patients with epilepsy and in the general population shows that they occur approximately 10 times more often in the former (Barry et al., 2001).

Among the main causes of the development of affective disorders, both reactive and neurobiological factors are distinguished. Earlier in epileptology, the point of view about the predominant importance of reactive mechanisms in the genesis of depressive symptoms prevailed (A.I. Boldyrev, 1999). This approach has not lost its significance today. In this regard, the importance of psychosocial characteristics in the life of patients with epilepsy is considered (Kapitany et al., 2001; Wolf, 2003). Among them, first of all, there are factors of stigmatization and social discrimination, which often lead to the loss of work and family in patients. Along with this, in the origin of affective symptoms, they also attach importance to the mechanisms of “learned helplessness”, which is based on the fear of losing a family or job due to illness. This leads to a decrease in social activity, labor maladjustment and, ultimately, depression (Kapitany et al., 2001; Wolf, 2003).

In the last 10-15 years, it is believed that the main role in the origin of affective symptoms is played not so much by psychoreactive as by neurobiological mechanisms. In this regard, it has been convincingly shown that certain types of seizures (complex partial seizures), a certain localization of the focus of epileptic activity (mainly in the medial parts of the temporal lobes of the brain), lateralization of the focus (mainly on the left), a high frequency of seizures, and the duration of the course of the disease are important for the occurrence of depressive symptoms. and early age of onset (Kapitany et al., 2001; Schmitz, 2002).
In favor of the predominant importance of biological factors for the occurrence of affective symptoms in epilepsy is also the fact that depressive disorders occur much less frequently in other severe neurological diseases than in epilepsy (Mendez et. al., 1986; Kapitany et al., 2001).

Finally, one cannot ignore the significance of the nature of the drugs used for long-term anticonvulsant therapy. In this regard, it has been established that long-term treatment with barbiturates and phenytoin (diphenin) leads to the development of depressive states (Kapitany et al., 2001; Schmitz, 2002).

Ictal affective disorders are characterized predominantly by the affect of anxiety, fear, or panic, less often by depression and mania. These phenomena should be considered as a clinical manifestation of simple partial seizures (aura), or as the initial stage of complex partial seizures. Ictal affective disorders occur, as a rule, with mediotemporal (temporal paleocortical) epilepsy. It is important that psychopathological symptoms account for at least 25% of all auras (simple partial seizures), among which 60% are symptoms of the affect of fear and panic and 20% are symptoms of depression (Williams, 1956; Kanner, Kusniecky, 2001; Kanner, 2004 ).

Accurate diagnosis of epilepsy, occurring in the form of simple partial seizures with a picture of panic disorder, presents diagnostic difficulties. In practical terms, an accurate diagnosis of epilepsy can easily be established after the onset of generalized tonic-clonic seizures. However, an analysis of the duration of ictal panic in temporal lobe epilepsy shows that the duration of the panic period almost never exceeds 30 seconds, while in panic disorder it can be up to half an hour. Panic is characterized by a stereotyped picture and occurs without any connection with previous events. Along with this, one should point out the possibility of the presence of phenomena of confusion of varying duration and automatism, the severity of which varies from low intensity to a significant degree. The intensity of panic experiences rarely reaches the high intensity seen in panic disorder (Kanner, 2004).

On the contrary, the duration of interictal panic attacks is at least 15-20 minutes and can reach up to several hours. In terms of their phenomenological manifestations, panic interictal attacks differ little from panic disorder that occurs in patients without epilepsy. In this case, the feeling of fear or panic can reach an extremely high intensity, and is associated with an abundance of autonomic symptoms (tachycardia, severe sweating, tremor, respiratory failure). At the same time, however, consciousness is preserved, and there are no phenomena of confusion, as happens with complex partial seizures.

Misdiagnosis of panic disorder in epileptic patients with ictal panic may be partly due to the absence of epilepsy-specific EEG changes during simple partial seizures in patients with mediotemporal epilepsy (Kanner, 2004).

It should be remembered that in patients with ictal panic, interictal panic attacks can also occur, which are observed in 25% of patients with epilepsy (Pariente et al., 1991; Kanner, 2004). Moreover, the presence of the ictal affect of fear and panic is a predictor of the development of panic attacks in the interictal period as well (Hermann et al., 1982; Kanner, 2004).

Quite often, interictal symptoms of anxiety are combined with the affect of melancholy. In this regard, we can talk about at least two varieties of affective pathology in patients with epilepsy: a disorder similar to dysthymia and depression reaching the depth of a major depressive episode.

In a disorder like dysthymia, symptoms of chronic irritability, frustration intolerance, and affective lability come to the fore. Some authors in this context prefer to speak of “interictal dysphoric disorder” (Blumer, Altschuler, 1998), although the symptomatology of dysphoria, from our point of view, is much more complex and cannot be reduced only to irritability and frustration intolerance.

The authors refer to the observations of Kraepelin (1923). According to these observations, dysphoric episodes include the actual depressive affect, irritability, anxiety, headache, insomnia, less often episodes of euphoria. Dysphorias are characterized by rapid onset and disappearance, a clear tendency to recurrence, and a similar psychopathological picture. It is essential that consciousness is preserved in dysphoria. The duration of episodes of dysphoria varies from several hours to several months, but most often does not exceed 2 days (Blumer, 2002).

From our point of view, dysphoria should not be equated with a depressive episode of even a deep degree in patients with epilepsy, since there are pronounced phenomenological differences between these two states, which actually allows us to oppose dysphoria to depressive affect.
So, in the structure of simple depression, the affect of vital melancholy with a pronounced intrapunitive orientation (ideas of self-accusation and self-abasement) and the holotimic delirium that follows from them predominates. On the contrary, dysphorias have a much more complex structure. The main feature of dysphoric affect is the elements of discontent, annoyance, gloom, irritability, grief, anger (for the whole world around) and bitterness (against everyone). Dysphoria is characterized by an extrapunitive orientation of the patient's experiences (Scharfetter, 2002).
In addition to dysphoria in patients with epilepsy in the interictal period, usually many years after the cessation of seizures, affective disorders develop, which, in their phenomenological features, practically do not differ from the picture of endogenous depression. In this case, the diagnosis of an organic affective disorder arising from epilepsy is legitimate (ICD-10: F 06.3) (Wolf, 2003).
The origin of such phenomena is usually associated with the development of inhibitory processes in the brain in patients with epilepsy in remission. It is believed that such inhibitory processes are a natural consequence of previous long-term processes of excitation and result from the good effect of antiepileptic therapy (Wolf, 2003).
The problem of organic depressions of the endoform structure (not only in connection with epilepsy) has generally received much attention over the past decade.
(Kapitany et al., 2001; Lishman, 2003; Marneros, 2004; Pohlman-Eden, 2000; Wetterling 2002). In this regard, it is emphasized that organic affective disorder (OAR) should be understood not as a depressive reaction or a depressive assessment of a severe somatic illness, as well as not their consequences. RAD should not be understood as nonspecific disorders in the affective sphere and drives. On the contrary, it is a disorder that has arisen in the setting of a verified organic (somatic) disease and is phenomenologically indistinguishable from an endogenous (non-organic) affective disorder. In this connection, some authors generally speak of “psycho-organic melancholia” or “psycho-organic mania” (Marneros, 2004).
The picture of organic affective disorder (depression) in patients with epilepsy is not much different from classical endogenous depression. In these cases, a rather noticeable dreary affect with a vital component and daily fluctuations comes to the fore. Against the background of depressive affect, there are ideas of self-accusation and self-abasement, characteristic of depressive states, with a clear intrapunitive orientation. It is fundamental that in about half of the patients the fact of the presence of epilepsy does not receive any proper sounding and interpretation in the structure of experiences. Patients agree with the diagnosis of epilepsy, but they have little connection with this depressive episode. On the contrary, the main thing that they emphasize in a conversation with a doctor is the presence of a real depressive state. From our point of view, this once again indicates that it would not be legitimate to associate the development of such severe depressions exclusively with psychogenic experiences. Obviously, they are based on some other neurobiological patterns.
Within the framework of the multifaceted problem of organic depressions in epilepsy, it is impossible not to single out a more particular problem - suicidal behavior in patients with epilepsy.
It should be emphasized here that the frequency of suicide attempts among patients with epilepsy is approximately 4-5 times higher than in the general population. If only patients with temporal lobe epilepsy are taken into account, then in these cases the frequency of suicides will already be 25-30 times higher than that in the general population (Harris & Barraclough, 1987; Blumer, 2002; Schmitz, 2002).
A targeted analysis of the relationship between the severity of organic affective disorder and suicidal readiness showed a correlation between these parameters. At the same time, it turned out that this relationship is more characteristic of women with epilepsy than men (Kalinin V.V., Polyansky D.A. 2002; Polyansky, 2003). In this plan, it was found that the risk of committing a suicide attempt in women with epilepsy in the presence of concomitant organic depression is approximately 5 times higher than in women with epilepsy without depressive symptoms. On the other hand, the risk of developing suicidal behavior in men with depression is only twice as high as in men with epilepsy, but without depression. This suggests that a similar style of behavior in patients with epilepsy, associated with a suicide attempt due to concomitant depression, is a rather archaic way of solving problems. The law of V.A. speaks in favor of this. Geodakyan (1993) about the tropism of evolutionarily old traits for the female sex and young ones for the male.
Treatment of depressive conditions within the framework of organic affective disorder in epilepsy should be carried out with the help of antidepressants. In this case, the following rules must be observed (Barry et al., 2001):
1. Therapy for depression should be carried out without canceling AED;
2. Antidepressants that do not lower the seizure threshold should be prescribed;
3. Preference should be given to selective serotonin reuptake inhibitors;
4. Among AEDs, phenobarbital, primidone (hexamidine), vigabatrin, valproates, tiagabine and gabapentin should be avoided;
5. Topiramate and lamotrigine are recommended among AEDs

6. Pharmacokinetic interactions of AEDs and antidepressants should be taken into account.
When choosing a specific antidepressant, it is necessary to take into account, firstly, how the drug affects the threshold for convulsive readiness and, secondly, how it interacts with AED.
Tricyclic antidepressants (imipramine, clomipramine, maprotiline) have the greatest convulsive readiness (proconvulsive effect). All of these drugs cause seizures in 0.3-15% of patients. On the other hand, antidepressants from the group of serotonin reuptake inhibitors (SSRIs) are much less likely to lead to such side effects (with the exception of citalopram, for which there are conflicting data).
Regarding pharmacokinetic interactions, the following recommendations should be taken into account. (Barry et al., 2001):
1. Pharmacokinetic interactions between AEDs and antidepressants are carried out in the system of hepatic enzymes СР-450.
2. Phenobarbital, phenytoitn (difenin) and carbamazepine lead to a decrease in the concentration of ATC and SSRIs due to the induction of the 2D6 isoenzyme.
3. SSRIs, on the contrary, lead to an increase in the concentration of AEP.
4. Fluoxetine most often increases the concentration of carbamazepine and phenytoin (diphenin).
5. Fluoxetine AEDs should be avoided.
6. The 1st choice among SSRIs are paroxetine, sertraline, fevarin and citalopram.
At the same time, one must be aware of the proconvulsant effect of citalopram, which makes it used with caution. In general, for the treatment of depression, paroxetine 20-40 mg/day, sertraline 50-100 mg, fevarin 50-100 mg, clomipramine 100-150 mg can be recommended. Our own clinical data show that the presence of obsessive-phobic experiences in the structure of a depressive state in epilepsy is an indicator of a generally favorable effect of SSRIs.
epileptic psychoses.
The problem of epileptic psychoses, or, more precisely, psychoses that occur in patients with epilepsy, has not received a definitive solution despite numerous studies on this problem conducted over many decades.
This is due both to the lack of common ideas about the pathogenesis of these conditions, and the lack of a unified classification of these psychoses. Without delving into such a complex problem, it should be emphasized that by now it is customary to consider all epileptic psychoses depending on the time of their appearance in relation to seizures. This allows us to speak separately about ictal, periictal and interictal psychoses.
The so-called ictal psychoses are considered by most authors as a clinical rarity. In relation to them, there are no verified clinical observations, more precisely, they are fragmentary and isolated, which does not allow them to be extrapolated to the entire population of patients with epilepsy. However, it is generally accepted that the picture of such psychoses is characterized by a paranoid structure with hallucinatory phenomena (both visual and auditory). The development of such psychoses is believed to be associated with primary generalized seizures in the form of absences that occurred at a relatively late age, or with the status of complex partial seizures (Markland, et al., 1978; Trimble, 1982). The latter provision seems to be more legitimate.
Postictal and chronic postictal psychoses are much more important, since when they appear in patients with epilepsy, various diagnostic doubts arise. This is primarily due to the fact that the picture of such psychoses has a pronounced schizoform or schizophrenic-like structure. From our point of view, in the absence of indications of a history of seizures in this category of patients, the diagnosis of schizophrenia would be justified. In this regard, it is appropriate to refer to the position of G. Huber (2004), according to which there is not a single symptom or syndrome of schizophrenia that could not occur in patients with epilepsy. The main thing is that this rule does not work in the opposite direction. In other words, there are a large number of psychopathological features that are pathognomonic only for epilepsy, and not for schizophrenia.
The structure of postictal and interictal epileptic psychoses includes all the variety of endoform symptoms. On the contrary, phenomena characteristic of the exogenous type of reactions in these cases were not noted in the literature.
In relatively recent studies, it was found that in the case of postictal psychoses, the phenomena of acute sensory delusions, reaching the stage of staging with signs of illusory-fantastic derealization and depersonalization with the phenomena of twins, come to the fore (Kanemoto, 2002). All these experiences develop quickly (literally in a matter of hours) after the seizure stops and the patient regains consciousness against the background of an altered affect. The modality of affect, from our point of view, does not matter, and psychosis can develop both against the background of severe depression with confusion, and against the background of manic affect. Accordingly, the content of delusional experiences will be determined by the nature of the dominant affect. In the case of the prevalence of depression, ideas of self-accusation come to the fore, which are quickly joined by ideas of attitude, threat to the life of the patient, persecution and influence. At the same time, the ideas of persecution and influence are not of a stable, complete character, but are fleeting and fragmentary. As acute postictal psychosis develops, delusional false recognition syndromes (Fregoli syndrome, intermetamorphosis syndrome), illusory-fantastic derealization and depersonalization, imperceptibly turning into oneiroid syndrome, become increasingly important. In other words, the movement of psychosis in these cases almost completely coincides with that in schizoaffective and cycloid psychoses (K. Leonhard, 1999), for which K. Schneider used the term “Zwischenanfalle” (intermediate cases). Attempts to delimit epileptic psychosis at the height of symptom development from phenomenologically similar endogenous psychoses, as a rule, do not lead to a tangible result.
When making a diagnosis in this regard, the fact of epilepsy in history and the nature of personality changes after the end of psychosis are of decisive importance. Our own few observations show that such conditions can occur during intensive anticonvulsant therapy in patients with epilepsy, when high doses of drugs with a pronounced GABAergic mechanism of action (valproates, barbiturates, gabapentin, vigabatrin) are used as the main anticonvulsants.
Such occurrence of psychosis is traditionally associated with the development of the so-called “forced normalization”, which is understood as the normalization of the EEG pattern (disappearance of epileptic signs, paroxysms and, conversely, the appearance of signs of desynchronization in the EEG) (Landolt, 1962). The term “alternative psychoses” (Tellenbach, 1965) was proposed to refer to these conditions, which implies an alternating nature of the relationship between seizures and psychoses.
So-called interictal psychoses occur without any connection with seizures in patients with epilepsy. These psychoses develop months or years after the seizures stop. The clinical picture of these psychoses has certain differences from the structure of postictal psychoses (Kanemoto, 2002). In the structure of interictal psychoses, experiences come to the fore, which in modern Western psychiatry are usually called symptoms of the 1st rank K Schneider (1992) for schizophrenia. In other words, these psychoses are characterized by the phenomena of influence and openness of thoughts, auditory (verbal) hallucinations, ideas of persecution and influence, as well as signs of delusional perception, which makes it possible to diagnose the paranoid form of schizophrenia in the absence of seizures.
Unlike postictal psychoses, interictal psychoses can take a protracted and even almost chronic course.
The idea that dominated in psychiatry for many years that epileptic psychoses are distinguished from psychoses in schizophrenia by a greater proportion of religious experiences (religious delusions, complex panoramic hallucinatory phenomena of religious content) with a slight severity of symptoms of the 1st rank has been revised in the last 15-20 years. (Helmchen, 1975; Diehl, 1978, 1989). In this regard, it is emphasized that delusions of religious content have ceased to be the prerogative of patients with epilepsy, but reflect the general trends in the society (environment) of the patient.
On the other hand, the frequency of visual hallucinations in epileptic psychoses is not much higher than that in endogenous psychoses. Auditory verbal hallucinations occur at about the same frequency as in schizophrenia. Moreover, they have almost all the features characteristic of schizophrenia, up to the phenomena of "made" and blurring of the boundaries of one's own "I" and the absence of criticism of psychosis after its termination (Kröber, 1980; Diehl, 1989). All this indicates the difficulties of differential diagnosis of psychosis in patients with epilepsy and schizophrenia. The nature of personality change is of primary importance in making a final judgment about diagnostic affiliation.
Treatment of postictal and interictal psychoses is carried out with antipsychotics. In this regard, new (atypical) antipsychotics (risperidone, amisulpride) or traditional classical antipsychotics with good tolerance and not causing a decrease in the seizure threshold and extrapyramidal effects (zuclopenthixol) have advantages. Acute post-ictal psychosis usually does not require high doses of antipsychotics to “break off”. In these cases, 2-4 mg of rispolept, 300-400 mg of quetiapine, or 20-30 mg of zuclopenthixol per day are sufficient. In this case, AEP should not be canceled.
For the treatment of interictal psychoses, it is also advisable to use these antipsychotics in slightly higher doses and for a longer time.

Efficiency from using the method
The characteristics of the most common mental disorders in epilepsy given in this manual will allow practitioners to better navigate in cases of providing assistance to this category of patients. The greatest difficulties in qualifying the diagnosis are, as a rule, psychotic disorders, which, according to the clinical picture, differ little from endogenous psychoses. In this regard, the presented definitions of epileptic psychoses can be fundamental in the differential diagnosis of schizophrenia and epilepsy.
The above methods of treatment of psychosis in epilepsy, with the preferred choice of certain antipsychotics, will allow the most safe, with the lowest risk of side effects, to stop acute symptoms.
A certain emphasis on the treatment of depressive disorders, as one of the most common mental pathologies in epilepsy, makes it possible to single out priority antidepressants in the treatment of epilepsy.
In order to prevent cognitive impairment and, ultimately, mnestic-intellectual defect in patients with epilepsy, recommendations are given for the use of antiepileptic drugs that have the least effect on mental functions.
Thus, this differentiated approach to the treatment of mental disorders in epilepsy will significantly increase the effectiveness of the proposed method, which in turn will ensure the stability of remissions and improve the quality of life and the level of social functioning in patients with epilepsy.

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PERSONALITY CHANGES IN EPILEPSY

The severity of personality traits in patients with epilepsy, according to most researchers, depends on the duration of the disease and the severity of its manifestations. The main features of the psyche of such patients is the slowness of all mental processes, primarily thinking and affects. Torpidity, viscosity of thinking, a tendency to be thorough and stuck on small, minor details are well known to every practical psychiatrist and epileptologist. With a long course of the disease, such features of thinking deepen more and more, the patient loses the ability to separate the main from the secondary, gets stuck on small, unnecessary details. The conversation with such patients drags on for an indefinitely long time, the doctor's attempt to switch attention to the main topic does not lead to results, the patients stubbornly state what they consider necessary, adding more and more new details. Thinking is becoming more and more concrete and descriptive, stereotyped with the use of standard expressions, it is unproductive; according to some researchers, it can be described as "labyrinth thinking".

A significant role in the structure of personality changes is played by the polarity of affect in the form of a combination of affective viscosity, especially negative affective experiences, on the one hand, and explosiveness and explosiveness, brutality, on the other. This determines such personality traits of patients with epilepsy as vindictiveness, vindictiveness, malice, egocentrism. Exaggerated sanctimonious sweetness, emphasized obsequiousness, tenderness in handling and a combination of increased sensitivity, vulnerability with brutality, spitefulness, malevolence, sadistic inclusions, anger, aggressiveness are also quite often observed. Even in the old days, religiosity was considered almost a pathognomonic property of the character of an epileptic. Now this is explained not so much by the disease itself, but by the fanatical mood of the patients, adherence to the system of views and the environment in which they were brought up, which is generally characteristic of infantile people. Patients with epilepsy are often characterized by extreme pedantry in relation to both their clothes and the special order in their home, workplace. They make sure that everywhere there is perfect cleanliness, objects stand in their places.

Patients with epilepsy also have hysterical and asthenic personality traits. These can be hysterical discharges with throwing, breaking dishes, loud cries of abuse, which is accompanied by angry facial reactions, “shaking of the muscles of the whole body”, a piercing screech, or hyperesthesia characteristic of asthenia, which is observed in about a third of patients (A. I. Boldyrev, 1971 ).

E. K. Krasnushkin (1960) ranked the typical manifestations of an epileptic character, determining that slowness (90.3%) is in the first place, then viscosity of thinking (88.5%), heaviness (75%), irascibility (69 .5%), selfishness (61.5%), vindictiveness (51.9%), thoroughness (51.9%), hypochondria (32.6%), vexatiousness and quarrelsomeness (26.5%), accuracy and pedantry (21.1%). The appearance of patients with epilepsy is also quite characteristic. They are slow, restrained in gestures, laconic, their face is inactive and inexpressive, mimic reactions are poor, a special, cold, “steel” gleam of eyes (a symptom of Chizh) is often striking.

A very close connection can be traced between the characteristics of the personality of patients with epilepsy and the formation of final epileptic states (S. S. Korsakov, 1901, E. Krepelin, 1881). The most successful definition of epileptic dementia as viscous-apathetic (VM Morozov, 1967). Along with the pronounced stiffness of mental processes in patients with epileptic dementia, lethargy, passivity, indifference to the environment, spontaneity, stupid reconciliation with the disease are noted. The unproductiveness of viscous thinking, memory loss, vocabulary is impoverished, oligophasia develops. The affect of tension, malice is lost, but traits of obsequiousness, flattery, hypocrisy can be preserved. In the initial states, the patients lie, indifferent to everything, their feelings “dry up” (W. Griesinger, 1868). Own health, petty interests, egocentrism - this is what comes to the fore in the final stage of the disease.