Prognosis and treatment of idiopathic generalized epilepsy. Idiopathic generalized epilepsy (IGE): symptoms of the disease, treatment methods and prognosis for recovery Epilepsy with frequent generalized seizures

Epilepsy- a chronic progressive disease that occurs most often in childhood and adolescence, is characterized by brain damage, the presence of seizure disorders, personality changes, and leads to dementia over time. There are idiopathic (primary) and symptomatic (secondary) epilepsy. Idiopathic epilepsy is an epileptic disease in which there is no organic damage to the central nervous system and is hereditary.

Etiology and pathogenesis

Epilepsy is a disease with many causes. Heredity is of great importance; if there are people in the family with this disease, then the likelihood of developing epilepsy in the child is high. The process of pregnancy and childbirth in the mother, infectious diseases, and head injuries are affected.

It is widely believed that the cause is a pathology of the membranes of neurons in the central nervous system.

The pathogenesis of the idiopathic generalized form of epilepsy lies in the pathological excitability of the cerebral cortex, the cause of such excitability is associated with genetic factors. An abnormal impulse occurs that is not suppressed due to instability of the neuron membranes. It spreads along the nervous system and leads to symptoms of the disease.

In the local form of idiopathic epilepsy, an abnormal focus forms in the brain, which emits signals that cause paroxysms of epilepsy.

Types of seizures

To select a treatment method, it is determined which type of seizure predominates in an epileptic attack.

Focal (local) types of seizures:

Simple without impairment of consciousness. They are divided into: motor (motor); for seizures with sensory symptoms (illusions, hallucinations); with vegetative signs (abdominal pain, sweating).
Simple with impaired consciousness (damage to speech, thinking, perception, emotions).
Difficult with impaired consciousness.

Generalized:

absence seizures, typical and atypical;
myoclonic spasms;
clonic seizures;
tonic.

Generalized seizures

Generalized seizures are severe types of paroxysms, accompanied by a short-term loss of consciousness.

Absence seizures- common types of attacks of idiopathic generalized epilepsy. They manifest themselves as attacks with loss of consciousness, a small amount of motor activity, and freezing. Absence seizures are divided into simple And complex. Simple ones include freezing without physical activity. Complex ones include an attack with low rates of movement.

Absence seizures with IGE begin with freezing with tonic movements: throwing back the head, rolling the eyes. Then myoclonic (trembling of the eyelids, nose, shoulders) and atonic (head drooping) phenomena may join.

There is also a vegetative component of absence seizure: change in skin color, involuntary urination. The attacks last from 2 to 30 seconds.

Another type - seizures with generalized tonic-clonic manifestations and the presence of an aura. The aura begins before attacks. Manifested by vegetative changes: fever, change in complexion, nausea, vomiting. There are hallucinations, elevated mood, feelings of fear, and anxiety.

Seizures are associated with waking up and falling asleep. Cramps can be triggered by a decrease in sleep duration, falling asleep late and waking up at an unusual time. The attack lasts from 30 seconds to 10 minutes.

Tonic phenomena consist of a strong tone of all groups of skeletal muscles, clonic - in the contraction of individual muscles, unilateral or bilateral. After consciousness is restored, the muscles return to normal.

Forms of the disease in children

There are several forms of epilepsy in children.

Benign local epilepsy

Otherwise called Rolandic epilepsy, it is manifested by pharyngeal-oral and unilateral facial motor seizures that occur during falling asleep and waking up. This is a common type of paroxysm in children. The disease manifests itself in childhood from 2 to 14 years. Mostly boys are affected.

It is characterized by simple partial paroxysms that appear during falling asleep and waking up. It all starts with paresthesia, loss of sensitivity in the oropharynx, gums, and tongue.

Then the children make sounds like when gargling, a large amount of saliva is released. Twitching of the facial muscles appears: clonic, tonic and clonic-tonic convulsions of the muscles of the mouth, pharynx, and facial muscles. In some patients, the cramps spread to an arm or leg. Attacks can develop into generalized paroxysms.

Benign myoclonic epilepsy of newborns

These are generalized paroxysms in the form of myoclonic convulsions. It begins between the age of three months and the age of four years. It is manifested by nodding movements of the head and lifting of the torso and shoulders, movements of the elbows to the sides. Consciousness is preserved, attacks gradually become more frequent.
In such children, muscle tone is reduced, the psyche develops normally.

Doose syndrome

Doose syndrome - myoclonic-astatic paroxysms. It begins in children from one year of age to 5 years. Manifested by asynchronous contraction of the muscles of the limbs. The attacks are short-lived. Nodding movements with lifting of the body may appear. Consciousness is preserved.

Seizures occur frequently, sometimes several per minute, called status epilepticus.

In such children, coordination of movements is impaired, the central nervous system is affected, and they are lagging behind in mental development.

Childhood and juvenile absence seizure

Juvenile and childhood absence seizures are generalized seizures lasting several seconds, with absence, freezing, and a small number of motor contractions.

Rare forms of the disease

Panayiotopoulos syndrome- benign childhood idiopathic partial epilepsy with occipital seizures and early onset in the period from 1 year to 13 years. Attacks in this form are severe.

Characterized by autonomic disorders and a long absence of consciousness, they occur during sleep: first vomiting, then the head and eyes turn in one direction. Paroxysms become generalized. Attacks occur rarely, 1-2 times throughout the entire medical history.

Gastaut syndrome- benign epileptic syndrome with occipital seizures and late onset from the age of three to 15 years. The attacks are simple, lasting from several seconds to several minutes, during which visual hallucinations occur. After the attack, patients experience severe headache with nausea and vomiting.

Diagnostics

For treatment to be effective, it is necessary to detect the disease in the early stages of its development.

First, the cause of epilepsy is determined - whether it is hereditary or developed after suffering injuries or diseases. The doctor interviews the patient and his relatives, conducts a neurological and mental examination.

There are a number of methods for diagnosing epileptic seizures to clarify the diagnosis and select a treatment method:

EEG - electroencephalography. Allows you to determine convulsive readiness, epilepsy activity, and the location of pathological impulses.
EEG monitoring - recording an electroencephalogram for several days with video recording of the patient's behavior.
CT scan of the head (computed tomography). Conducted to diagnose formations in the brain and previous traumatic brain injuries.
Magnetic resonance examination. Superficial brain damage is detected.
Rheoencephalographic study (REG) is used to diagnose the condition of the vessels of the head and neck.

Treatment

Therapy is selected and carried out by a neurologist together with a psychiatrist. Treatment of idiopathic epilepsy takes place in the neurological department of a hospital or in a clinic on an outpatient basis.

Drug therapy should be long-term and continuous, i.e. about 5 years after the last attack, it should be carried out with appropriate medications.

Treatment begins with doses of anticolvulsants appropriate to the type of attack. If necessary, therapy is carried out with several types of drugs. Patients take complex vitamins, biostimulants, and follow a diet.

If conservative therapy is ineffective, surgical treatment is started. Highlight resective operations and functional.

Indications for resective types of operations for idiopathic epilepsy are a confirmed diagnosis of drug-resistant epilepsy and visualization of pathogenic foci in the brain.

Functional Operations- palliative. Indications for these types of operations are the impossibility of resective surgical interventions for intractable epilepsy and the high risk of complications after surgery.

Forecast

The prognosis for epileptic disease varies. A complete recovery, an outcome with changes in the brain, or death are possible. The risk of complications is higher in young children, since their nervous system is not perfect.

CT and MRI scans in patients with epilepsy reveal changes in the form of atrophy of the cerebral cortex.

Mortality is 18% for somatic epilepsy and 1% for idiopathic epilepsy.

Generalized epilepsy is considered a common disease, because a similar diagnosis is made to every third person suffering from epileptic seizures. The main feature of this disease is that the pathology is inherited by people. It does not appear only because a person has suffered an infectious disease or a brain injury has occurred.

The disease appears if at least one of the close relatives suffered from epileptic seizures. It is worth familiarizing yourself with the types of seizures, as well as the main symptoms of the pathology, so that you can identify it in a timely manner and begin professional treatment.

If a person has been diagnosed with generalized epilepsy, then he should become familiar with the characteristics of the disease. It is they that make it possible to distinguish the deviation from other diseases that also lead to epileptic seizures. As already mentioned, genetic predisposition plays an important role.

If a person suffers from generalized epilepsy, then there will be approximately a 50% chance that it will occur in close relatives. Of course, the presence of a disease in a parent does not guarantee that the child will have it. However, there is still a significant likelihood of encountering characteristic symptoms.

The first signs in most cases appear at an early age. As soon as parents notice them, they will be required to undergo an examination. It is necessary in order to accurately determine the disease and find out its type. Seizures mostly occur at the same time of day. They can also be provoked by the same factor, for example, a loud sound or a bright flash of light.

Many patients do not experience structural changes in the brain structures. This does not affect the neurological status and cognitive functions. When conducting electroencephalography, it is not always possible to see a change in rhythm.

The disease often has a favorable prognosis, so doctors urge people not to worry. With proper treatment, a person’s condition can be significantly improved and seizures can be eliminated. At the same time, there will still be a significant likelihood of relapse, so throughout your life, if possible, you should avoid those factors that provoke the appearance of generalized epilepsy.

Forms of the disease

In total, doctors distinguish two main types of epilepsy: primary and secondary. They differ depending on the cause that triggered the onset of the disease. Generalized idiopathic epilepsy is the primary type. That is, it is inherent in a person at the genetic level. Channelopathy occurs, that is, the membrane of the nerve cells is unstable, and this causes diffuse activity. Deviation occurs in approximately 30% of cases.

Symptomatic epilepsy is of the secondary type. In this case, the disease is directly related to other abnormalities, such as inflammation of the brain, encephalitis, and tumor. Consequently, epileptic seizures occur because the nerve cells of the brain are affected.

Also, in some cases, this type of deviation is a consequence of hypoxia during fetal development, various infections that occurred before birth, as well as birth trauma. Generalized paroxysms should be highlighted separately.

They are also called a grand mal seizure. This condition occurs in two stages. The beginning is abrupt, unexpected for the person and surrounding citizens. During the first phase, all muscles become very tense at once, which leads to a spasm. The person falls to the ground, straightens up, and throws his head back.

A fall may cause injury to the patient. During this period, the patient does not breathe, which leads to a blue tint of the facial skin. The person loses consciousness and does not understand what is happening to him. After this, the second stage begins, during which convulsive twitching begins. They gradually weaken and stop. They are followed by pathological sleep, after which the person feels weakness, severe headaches, and discomfort in the muscles.

This is a separate form of seizures in which a person loses consciousness. In this case, no visible spasms are observed on the body. This phenomenon is also called a minor seizure. Absence can be both typical and atypical. In the first case, the attack lasts several seconds, the person is unconscious, and sometimes repetitive movements may occur. This phenomenon can disturb people more than once throughout the day.

Myoclonic seizures

Separate and synchronous muscle contractions occur. In this case, not the entire area is affected, but only individual beams. In most cases, the person is conscious.

Initially, epileptic activity affects one area of the brain, such as the frontal lobe. After this, it spreads to all departments, which resembles tonic-clonic seizures. Before the attack, an aura occurs, during which tingling of the limbs, spots before the eyes, dizziness and slight numbness begin. From it you can understand that an epileptic seizure will soon occur.

Generalized epilepsy of any form is considered dangerous to health, and the greatest risk comes from falling. During it, you can get injuries that significantly worsen your health. It is for this reason that it is necessary to carry out treatment in order to improve well-being and reduce the number of attacks. Only a doctor can prescribe an exact treatment regimen after carefully examining the patient.

Symptoms

If a person has previously had to deal with an epileptic generalized seizure, then it will not be difficult to identify this condition. Of course, the symptoms vary, and they depend on what kind of attack occurred.

For example, absence seizures are characterized by the fact that the patient loses consciousness, becomes inhibited and significantly falls out of real life. There may be rapid and repetitive movements, such as a person clenching and unclenching a fist or moving a single finger.

As already mentioned, tonic-clonic seizures are characterized by the presence of two phases in the development of manifestations of the disease. At first, the person is immobilized, the torso is completely straightened, and breathing stops for a while. The person turns pale and may even turn blue. After this, cramps of all muscles begin, which gradually disappear.

Once they pass, the patient can breathe deeply again. Foaming at the mouth, often mixed with blood, may occur due to damage to the lips, cheeks and tongue. Muscle relaxation often occurs, which leads to uncontrolled urination and defecation. After this, the patient falls asleep, and then does not remember what exactly happened to him.

During myoclonic seizures, contractions of individual muscle bundles occur. Moreover, they are always symmetrical to each other. Uncontrolled movement of the limbs occurs. In most cases, a person falls to the ground, but remains conscious. As soon as the attack begins, the person goes into a state of apathy, becomes indifferent to the events taking place, and also loses attention.

Diagnostics

If generalized epilepsy occurs, a person should definitely undergo a medical diagnosis. You should contact a neurologist, because he is the one who evaluates this condition. There is also a more specialized specialist, such as. Such a doctor is not present in all hospitals, especially when it comes to small towns. In addition, a neurophysiologist is involved in diagnosing the disease.

First, you will need to undergo a general examination to assess the person’s condition and find out the causes of the disease. It is necessary to collect a complete medical history and ask people about the characteristics of the attack who may have observed it. It is also worth trying to remember what event preceded the seizure.

You will need to do an electroencephalogram to assess the state of electrical activity in the brain. As already mentioned, this examination does not always reveal generalized epilepsy, because its characteristic manifestations may be absent. In this case, the doctor is referred to this study so that the patient’s condition can be more accurately assessed.

Special electrodes will be placed on the head, which record potentials and then convert them into different vibrations. From them it will be possible to understand whether a person has any violations. Before the procedure, you will need to prepare approximately 12 hours before the process itself. You should not take medications (if your doctor temporarily prohibits them), you should not eat chocolate, drink coffee and energy drinks.

When undergoing a procedure, it is extremely important for a person not to be nervous, because such a state distorts the result. If a child is being examined, then it is important to explain to him what exactly awaits him. It is possible that parents will have to be present nearby to make the little patient feel more relaxed.

To identify hidden epilepsy, a specialist can use various tests. For example, bright light and noise are used. The person may be forced to breathe deeply or put to sleep. Diagnosis often includes. With these studies, it is possible to find the cause that caused the pathology and seizures. Naturally, we are talking about a situation where seizures are provoked by an internal disease.

If the doctor is convinced that the main reason for the onset of the disease is heredity, then he will need to contact a geneticist. It will also be necessary to separate epilepsy from other diseases that can also cause similar symptoms. After this, it will be possible to move on to therapy; the regimen for each patient is prescribed individually.

The sooner treatment is started, the easier it will be to improve a person’s well-being. At the same time, it is extremely important to follow all the doctor’s instructions so that you can maintain your health at a normal level.

Treatment options

Medical professionals often prescribe different medications to people that have a positive effect on their health. For example, valproic acid derivatives are prescribed: Ethosuximed, Carbamazepine and Felbamate. However, these products are often not recommended for pregnant women.

Often used, cloneepam is a benzodiazepine derivative. It is effective for all forms of epilepsy, but it cannot be used for a long time, because it becomes addictive and the effectiveness of treatment decreases.

It is extremely important to provide first aid to a person during an attack, because such a condition can be dangerous not only for health, but also for life. It will be necessary to remove all hard and sharp objects that could injure the patient. The person should be placed on the floor or the ground, and something soft, at least clothing, should be placed under him. This will avoid injury.

There is no need to try to hold the person or put anything in their mouth. If the seizure lasts more than 5 minutes, then you need to call an ambulance. When the attack passes, you will need to lay the person on his side, then clear his mouth of saliva and vomit. When symptoms of choking are observed, immediate medical attention will be required. Naturally, a person should not be left uncontrolled until the doctors arrive.

Treatment in childhood

Much will depend on what caused the attacks. In generalized epilepsy this is a hereditary factor. Specialists often use drug therapy as well as surgery at the same time. All drugs are selected individually depending on the person’s condition.

It is extremely important that medications do not cause delays in mental as well as physical development, because the child’s body must be fully formed. It is often necessary to use anticonvulsants, as well as vitamins to support the body.

It is important that the daily routine is strictly followed, and that the child gets plenty of sleep. In adolescents, it will be necessary to prevent nervous conditions; provoking factors should not be allowed. When you need to use drugs, then they will need to be used for a long time. Doses directly depend on the severity of the condition. Self-medication is not allowed, because it not only does not bring positive results, but can also significantly worsen your well-being.

The prognosis for the primary form is favorable. The disease is highly treatable, so a person can live a full life. Naturally, he will have to maintain the chosen treatment regimen, as well as change it on the doctor’s recommendation. In approximately 30% of cases, complete recovery is observed. If treatment does not produce results, then maintenance therapy will be required. It will be important to alleviate the symptoms of the disease and reduce the number of attacks. In this case, it will be possible to significantly improve the person’s condition. It should be understood that generalized epilepsy is a dangerous and serious disease, which is why at the first symptoms you need to go to the hospital.

Generalized epilepsy is one of the types of neurological disorder in which the patient temporarily loses consciousness during epileptic attacks. In most cases, this form of the disease is congenital (occurs when the brain is damaged in newborns). However, a symptomatic variant of the development of generalized epilepsy cannot be excluded.

The disease is characterized by multiple symptoms. Symptomatic epilepsy is treated mainly with medication.

Generalized epilepsy

If children in the first few years of life experience bilateral seizures (convulsions affecting the right and left limbs) and a short-term loss of consciousness is noted, this is idiopathic generalized epilepsy. This disease is chronic, but if diagnosed early, it can be easily corrected.

Epilepsy with generalized seizures is different in that, at the time of manifestation, the abnormal activity that causes seizures is recorded in both hemispheres of the brain.

Basically, this form of the disease is primary in nature, that is, it develops due to congenital pathologies. However, some researchers believe that generalized epilepsy cannot be symptomatic, developing as a result of organic brain damage.

Neurological disorder occurs under the influence of various factors. Idiopathic epilepsy develops against the background of a genetic predisposition. Moreover, the likelihood of such a pathology occurring in children whose parents suffer from generalized epilepsy is 10%.

The development of the disease after a person’s birth is due to the following factors:

traumatic brain injury;
infectious diseases affecting the brain (meningitis, encephalitis and others);
brain tumors of various types;
feverish state (more often provokes epileptic seizures);
some hereditary pathologies.

In children, secondary (symptomatic) generalized epilepsy occurs against the background of birth injuries, infection during intrauterine development, abnormal brain structure, and fetal hypoxia.

What types of generalized epilepsy is divided into?

Pathology is classified into three types: idiopathic, symptomatic and cryptogenic. What is idiopathic epilepsy? This form is caused by congenital developmental abnormalities. Often the onset of generalized pathology of the idiopathic type is observed in patients under the age of 21, so idiopathic epilepsy in children is not uncommon.

With this form, accompanying clinical symptoms are not diagnosed, with the exception of neurological seizures. Sometimes scattered phenomena occur. In rare cases, focal (localized) symptoms are disturbing. With generalized idiopathic epilepsy, the patient retains clarity of thought and other cognitive functions. However, it is possible that there are some intellectual disorders that disappear over time. On average, such disorders are observed in 3-10% of patients.

Secondary epilepsy (symptomatic) occurs at any age, which is explained by the cause of the disease. If the pathology is caused by congenital malformations, then the first attacks occur in childhood.

In symptomatic generalized epilepsy, seizures are part of a larger clinical picture.

The cryptogenic form is diagnosed in cases where it is impossible to establish the causes of the development of a neurological disorder.

Clinical picture of symptomatic epilepsy

There are two most common forms of symptomatic epilepsy, which can become generalized: partial and temporal lobe.

The first type of disease manifests itself in the form of simple seizures, during which twitching of the limbs is noted. In symptomatic partial epilepsy, convulsive movements are usually performed by the arms and legs. As the generalized pathology progresses, muscle twitching is observed in other parts of the body. In extreme cases, the disease causes loss of consciousness.

The following signs of symptomatic epilepsy of a generalized nature are less commonly diagnosed:

the patient sees surrounding objects in a curved projection;
presenting pictures that do not correspond to reality;
lack of speech while maintaining the integrity of the corresponding muscles;
illusions (incorrect perception of reality) and hallucinations (rare).

Temporal and parietal localization of the pathological focus is more typical for children. The manifestation of an epileptic seizure is often preceded by an aura, in which the patient experiences headaches and deterioration in general condition. Subsequently, attacks of generalized epilepsy occur with accompanying symptoms such as loss of consciousness, convulsions and other phenomena.

In the symptomatic form of the disease, signs of neurological symptoms in the interictal period are often absent. In the absence of seizures, clinical phenomena characteristic of concomitant pathologies that provoked epilepsy come to the fore.

Symptoms depending on the type of seizure

There are three types of epileptic seizures:

typical absence seizures;
tonic-clonic;
myoclonic.

Typical absence seizures most often appear in childhood. This form of attack is characterized by a temporary loss of consciousness. From the outside, absence seizure looks as if the patient has frozen and his gaze remains motionless. Also, during an attack of this type, the skin of the face often turns red or pale.

Complex absence seizures are characterized by muscle twitching, involuntary rolling of the eyes, and other actions that the patient does not control. During prolonged attacks, the patient loses orientation in space and is not aware of what is happening around. It is impossible to force the patient out of this state. The number of attacks during the day can reach 100.

There is such a thing as atypical absence seizure. This attack lasts longer, but the intensity of general symptoms (changes in muscle tone, duration of unconsciousness) is lower than with other forms of seizures. With atypical absence seizures, the patient retains some motor activity and the ability to respond to external stimuli.

During tonic-clonic seizures, all muscle groups first tense (tonic phase), after which convulsions occur (clonic phase). These phenomena occur against the background of complete loss of consciousness.

The tonic phase lasts about 30-40 seconds, the clonic phase – up to 5 minutes.

The onset of an epileptic attack following this scenario is indicated by the following signs:

complete loss of consciousness (the patient falls);
clenched teeth;
bitten lips or inner cheeks;
breathing is difficult or absent;
blue skin around the mouth.

At the end of the clonic phase, involuntary urination often occurs. As soon as the attack ends, patients usually fall asleep. After waking up, you may experience headaches and severe fatigue.

Myoclonic seizures involve involuntary and localized muscle twitching. Convulsions are observed both in individual areas and throughout the body. An important feature of myoclonic seizures is symmetrical muscle twitching. During the attack, the patient remains conscious, but some hearing loss (temporary deafness) is possible. Myoclonic seizures usually last no more than one second.

Pediatric generalized epilepsy

Generalized epilepsy in children is predominantly idiopathic in nature. At the same time, in this category of patients, various factors can provoke epileptic seizures, including:

allergic reactions;
helminthic infestations;
elevated body temperature and other childhood diseases.

Idiopathic epilepsy with generalized convulsive seizures in childhood occurs mainly in the form of absence seizures, which are characterized by temporary shutdown (but not loss) of consciousness. The presence of symptomatic epilepsy in children may be indicated by:

regular visits to everything;
sudden attacks of fear;
unexpected mood changes;
causeless pain in various parts of the body.

Symptomatic epilepsy with rare generalized seizures in children has a complicated history. The disease is difficult to correct due to the fact that it develops due to congenital anomalies.

In medical practice, it is customary to distinguish two syndromes characteristic of epilepsy in children:

West syndrome;
Lennox-Gastaut syndrome.

The first syndrome is more often detected in infants. It is characterized by muscle spasms that cause uncontrollable nodding. West syndrome mainly develops with organic brain damage. In this regard, the prognosis for the development of the disease is unfavorable.

Lennox-Gastaut syndrome first manifests itself after two years and is a complication of the previous one. The pathological deviation causes atypical absence seizures, which over time can cause a generalized attack of epilepsy. With Lennox-Gastaut syndrome, dementia develops very quickly and there is a lack of coordination of movements. The disease in this form is not amenable to drug treatment due to complications that arise, which lead to changes in the patient’s personality.

Diagnosis of generalized epileptic seizures

To establish what symptomatic epilepsy is, the doctor interviews, first of all, the patient’s close relatives in order to find out the presence of certain symptoms, the nature of the attacks and other information. Based on this, diagnostic measures are selected.

Generalized idiopathic epilepsy and accompanying syndromes (if we are talking about children) are diagnosed using an electroencephalogram. This method allows not only to determine the presence of the disease, but also to identify the localization of pathological foci in the brain.

Generalized epileptiform activity on the EEG is characterized by a change in the normal rhythm. The peculiarity of this form of the disease is the presence of several pathological foci, which are shown by an electroencephalogram.

To exclude other types of epilepsy, diagnose MRI and CT scan of the brain. Using these methods, it is possible to identify the localization of pathological foci. If generalized epilepsy of the idiopathic form is determined, consultation and examination with a geneticist will be required to detect congenital pathologies.

How to treat?

If symptomatic epilepsy is suspected, the doctor determines what it is and how to treat the disease. Self-diagnosis in this case will not lead to the desired results, since the pathology is characterized by symptoms characteristic of cardiac and pulmonary dysfunction, hypoglycemia, psychogenic paroxysms, and somnambulism.

The basis for the treatment of symptomatic epilepsy is valproic acid preparations:

"Lamorigine";
"Felbamat";
"Carbamazepine";
"Topiomat" and others.

Taking most valproic acid medications is contraindicated for pregnant women. Epilepsy of any type is well controlled with Clonezepam. However, this medicine becomes addictive relatively quickly, and therefore the effectiveness of drug therapy decreases over time. In children, Clonezepam provokes impairment of cognitive functions, which manifests itself in developmental delays.

As soon as generalized epilepsy begins, it is important to immediately remove hard and sharp objects from the patient and place the patient on something soft. If the duration of an epileptic attack exceeds 5 minutes, it is necessary to call a medical team. In other cases, the patient's condition returns to normal without outside intervention.

Generalized epilepsy in children is treated through a combination of surgery, which involves removing the lesion in the brain, and drug therapy.

Forecast

The prognosis for generalized epilepsy depends on the form of the disease. The idiopathic type, in the absence of adequate and timely treatment, provokes a delay in intellectual development. Generalized attacks in this form of pathology occur after reducing the dosage or discontinuing anticonvulsants.

After successful neurosurgical intervention, the likelihood of relapse according to the prognosis of idiopathic epilepsy is minimized.

The prognosis for the symptomatic form is determined by the characteristics of the concomitant pathology that caused disturbances in brain activity. For congenital malformations, treatment gives positive results in rare cases due to the body’s high resistance to medications. If therapy for concomitant pathologies is successful, then a favorable outcome cannot be ruled out.

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Idiopathic generalized epilepsy and its symptoms

Modern medicine includes more than 25 different forms of epilepsy. But the most common classification remains the causal division of species. There is an idiopathic form of epilepsy, which occurs against the background of intrauterine formation and development of the central nervous system, and a symptomatic form, which occurs as a result of damage or injury to the brain during an infectious disease, tumor, hypoxia or other damage.

Idiopathic generalized epilepsy is a form of the disease that differs from others in nonorganic brain damage. This pathology is characterized by a genetic predisposition, which is transmitted along the hereditary line and is in no way related to the provocation of the disease due to injury or past illnesses. A large number of cases of idiopathic epilepsy have a favorable prognosis and end with normalization of symptoms through control of epileptic seizures and seizures.

If the stage of the disease is advanced and for a long time the symptoms of the disease were simply ignored, diagnosis and symptomatic treatment were not carried out, a person’s life becomes significantly more difficult and becomes a real test. In childhood, the development of intellectual abilities is inhibited, absent-mindedness, restlessness, neurological disorders and the inability to adapt to society appear, which gives rise to complete apathy towards everything that happens, irritability, aggression and anger.

Due to the fact that the symptoms are pronounced, diagnosing this pathological process is not difficult; it is only important to go to the clinic in time for examination. Many of the manifestations arise in infancy, only taking on new forms and intensifying attacks over time.

Causes

Generalized idiopathic epilepsy and epileptic syndromes have the main cause of occurrence - genetic predisposition. Because the risk of transmitting the disease from a close relative suffering from seizures is very high. Also, the form of the disease can become complicated during childbirth due to the complexity of the process, viral infection during gestation and many other factors.

Provoking factors can also be alcohol abuse, smoking and other addictions, treatment with medications prohibited for pregnant women, bright light, too loud music or an unbalanced diet. In children, epilepsy can develop due to mental or physical stress.

Symptoms

Any manifestations have a fairly pronounced primary nature, so they can easily be used to diagnose ileus. Often the attack is accompanied by a lot of unpleasant signs of the disease:

severe cramps;
involuntary contraction of body muscles;
clouding of consciousness and loss of consciousness;
muscle tone decrease;
lack of response to external stimuli by light and sound;
nausea and vomiting;
poor visibility, decreased vision.

The duration of the seizure varies in each individual case, it can be a few seconds, or it can reach a couple of minutes or more. The severity of the manifestation and duration of the attack may indicate the severity of the case and help in the course of treatment.

Diagnostic methods

Diagnosis at the initial stage does not have any individual characteristics and consists of a hardware method - EEG. Ideally, it is necessary to correlate two results: during the rest period and during the attack. Sometimes this attack is caused deliberately with the help of medications, but this measure is forced and will help to quickly understand the causes of the disease. To confirm a presumptive diagnosis, MRI, CT and, if cancer is suspected, PET are used.

A generalized pathological process can be confirmed based on the following data:

clinical manifestation of symptoms (these may be video files recording symptoms);
survey of relatives and the presence of similar problems in the family;
listening to patient complaints;
results of hardware and laboratory research methods.

Some difficulties arise with the diagnosis of infants, but they are usually prescribed a standard treatment regimen followed by follow-up with a doctor.

Treatment

If you ignore the manifestations of epilepsy, you can create the following complications:

heart failure;
sudden and prolonged clouding of consciousness followed by loss of consciousness;
apnea;
coma and death.

Drug therapy is the main direction to relieve a generalized attack of epilepsy and remove negative manifestations. Any therapy begins only after at least two epileptic seizures, because a single manifestation can be provoked by another disease.

Modern pharmacology today includes a huge variety of different antiepileptic drugs, but experts recommend paying attention to the side effects of the drugs and using the most gentle of them, because the body in this state requires considerable care and caution. The dosage will differ in each individual case, and the attending physician decides what dose of the drug to take. In the future, this dosage may change depending on the result of treatment.

Usually they try to achieve remission with one remedy, so as not to seriously injure the patient’s already weakened body, but this is not always possible and a whole range of remedies is prescribed. The duration of treatment also varies individually. Every 3 months, all important indicators are re-analyzed to track the dynamics of platelet growth. An ultrasound of internal organs is performed once every six months.

In addition to pharmaceuticals, it is necessary to limit yourself in many things, lead a healthy lifestyle and not neglect the basic instructions of the doctor. It is important to establish a daily routine, get adequate sleep, and avoid stress and nervousness.

Diet is also an important component on the road to recovery. Overeating can trigger an attack just like drinking too much liquid. It is necessary to maintain a balance, exclude salted, smoked and fried foods. Fill your diet with legumes, which are rich in nitrogen.

What is prohibited

Patients with this pathology should not drive a vehicle. You should not overexert yourself, both physically and mentally. Stress, bad mood and being in uncomfortable conditions can also negatively affect the patient. You need to learn to relax, rest more, spend time outdoors and contact nature.

Favorite literature, hobbies, hobbies, games, and spending time with loved ones will help you get distracted, so you can’t be distracted by any negative aspects.

It is better to limit the time spent at the computer or TV, remove too bright light and sound.

We can speak of complete remission at the moment when the patient is not disturbed by a single attack of epilepsy for a year. But even in this case, constant monitoring by a doctor is not excluded. You need to take the necessary tests and undergo examinations.

The effectiveness of treatment depends on the severity of the disease and its form. There are cases when it is possible to only slightly reduce the frequency and severity of manifestations, without completely eliminating the symptoms and cause of the disease. And in some cases, remission is achieved quickly and unpleasant symptoms never bother the patient again.

The advice of traditional medicine must be used with great responsibility, because even natural herbs, herbs and ointments can not only fail to produce results, but also cause harm during the treatment process. Any actions you take must be coordinated with your doctor, who will give recommendations on traditional medicine as well. But these drugs do not provide a therapeutic effect; they can relax a person after an attack or simply overwork, and remove other side symptoms.

With idiopathic epilepsy with seizures, a person receives a disability that limits him in certain activities. Minimal stress can have consequences, some of which can be irreversible and even fatal. Moreover, the risk may be associated not only with the patient, but also with the people around him.

This unpleasant illness is growing with every generation, but at the same time medicine does not stand still, developing new methods and complexes of effective treatment until seizures are completely eliminated. You should not panic at the first manifestations of the disease, you need to pull yourself together and begin to counteract the disease as early as possible. Most cases end positively, so do not be afraid to visit a doctor and follow his recommendations. Then you will remain a healthy, healthy and full of life person.

The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

Epilepsy with generalized seizures

Idiopathic epilepsy with isolated generalized seizures (GSE) is a benign disease in which generalized tonic-clonic seizures play a major role in the clinical picture. The onset of the disease most often occurs in adolescence, 12–15 years. There is a genetic predisposition.

The attack begins spontaneously, without warning. The 1st phase of the attack is tonic, lasting seconds. The patient loses consciousness, falls, emits a loud cry due to spasm of the vocal cords, tonic tension of all muscle groups occurs, due to which the body bends back, arms and legs are extended. The eyes are open, the pupils are dilated, there is no breathing (apnea), facial cyanosis. Then comes the 2nd phase - clonic (on average 40–60 seconds, maximum up to 10 minutes). A deep breath occurs, small twitches of all muscles begin, which turn into rhythmic contractions. Breathing is hoarse, there is foam at the mouth, which may be stained with blood due to biting the tongue, and involuntary urination. After the attack, the patient is lethargic and falls asleep.

The frequency of attacks varies from 1-2 times a year to 1 time a month. An attack is provoked by disruption of the daily routine, lack of sleep (sleep deprivation), forced awakening, and alcohol intake. The second type of seizures in the clinical picture of the disease are simple absence seizures.

During a neurological examination of a patient with this type of epilepsy, no abnormalities are found. The diagnosis is made on the basis of complaints; eyewitness accounts of the attack play an important role, since the patient himself forgets it and cannot describe it. The patient undergoes an EEG, which reveals peak-wave and polypeak-wave activity without clear asymmetry, or no deviations from the norm are detected. There are no changes on CT and MRI.

Treatment begins after the second attack. Carbamazepine (finlepsin) 11 mg/kg is prescribed. If attacks recur a month after starting the full dose, the dose is increased to a maximum of 30 mg/kg. If finlepsin is ineffective or with generalized peak-wave activity on the EEG, when carbamazepine is contraindicated, valproate (Depakine) 20 mg/kg is prescribed, increasing the dose to 90 mg/kg if attacks recur. Topiramate is prescribed when first-line drugs are ineffective, 4–10 mg/kg.

The prognosis is favorable. If there are no attacks within 5 years, the drug is discontinued. Spontaneous remission is possible.

News

Are antiepileptic drugs safe to use during pregnancy?

New direction in the treatment of epilepsy

Scientists are developing new ways to protect the brain from seizures

Topiramate increases the likelihood of fetal malformations when used in pregnant women

The US Food and Drug Administration (FDA) has stated that taking topiramate during pregnancy increases the risk of fetal birth defects such as cleft lip and palate.

Drug interactions between antiretroviral and antiepileptic drugs

Scientists from the University of Michigan received a grant to study the interaction of antiviral drugs prescribed to HIV-positive people with certain anticonvulsant medications.

Frederic Chopin may have suffered from symptomatic epilepsy

This conclusion of Spanish scientists was published in Medical Humanities. It is known that the composer died at the age of 39 from chronic lung disease. The attacks of melancholy, which the musician also experienced, were associated with bipolar disorder or depression.

Most epilepsy drugs increase the risk of pathological fractures

Most antiepileptic drugs significantly increase the risk of pathological (occurring with minimal physical activity) bone fracture, says a retrospective study by a group of scientists published in the journal Archives of Neurology.

Publications

Child neurology: supporting the child, but not stopping him from going his own way

Some ailments that are easily curable in adults lead to serious consequences if they occur in children, and conversely, there are conditions that a child’s body can cope with without much difficulty, while in older people they are practically incurable.

First aid for seizures

Anyone can experience an epileptic attack, on the street, in transport or in the family. How to help a patient with seizures if you happen to be nearby at the time of the attack?

Nutrition for epilepsy

Fasting has always been used to treat a variety of diseases, including seizures. In the early 20s of the last century, after systematizing knowledge about epilepsy, a technique was developed that made it possible to cope with seizures quite effectively.

Epilepsy and sports

Conditions for which sports are traditionally contraindicated include epilepsy. There is an opinion that physical activity can provoke attacks and worsen the course of the disease.

Life after a stroke

A stroke rudely invades all aspects of a patient’s life, from everyday household tasks to strategic life goals.

Epilepsy: myths and reality

An epileptic seizure is scary to look at: the patient screams, falls, convulses, his breathing is hoarse, and there is foam at the mouth. People's idea of epilepsy is made up of many myths and prejudices, and often patients themselves are at the mercy of these myths, not quite clearly understanding what is actually happening to them.

Forms of idiopathic epilepsy and specific treatment

Idiopathic epilepsy differs from other forms in that there are no signs of organic brain damage and it is an independent disease. The most common cause is genetic predisposition. The generalized form differs from the localized form by a more favorable prognosis and is better treatable. Epilepsy is more common in developed countries; however, such statistics may also be associated with a higher level of medicine, as well as high-quality and timely diagnosis.

Etiology and pathogenesis

Idiopathic epilepsy is considered a primary disease, and its occurrence is associated with genetic predisposition. The pathogenesis of generalized and partial forms differs.

In the first form of idiopathic epilepsy, the functioning of brain structures that are responsible for suppressing “accidentally” occurring pathological impulses is disrupted. After all, normally an electrical signal is generated on the surface of nerve cells as a response to irritation that arrives along the ascending pathways. And pathological impulses arise independently, without corresponding irritation.

In the focal form of idiopathic epilepsy, a pathological focus of excitation with epileptic cells is formed in the cerebral cortex, which generate impulses leading to seizures.

Principles of classification

Idiopathic epilepsy is divided into groups according to the location of the focus: generalized and localization-related forms.

Types of seizures

When diagnosing generalized forms, it remains important to determine the type of attack that predominates in the clinical picture of the disease. This is necessary for the correct selection of drug treatment and determination of dynamics.

Absence seizures are most characteristic of the generalized form of idiopathic epilepsy. These are seizures with short-term depression of consciousness (up to thirty seconds), which is accompanied by “freezing”, a glassy look, interruption of any process in which the patient was busy. Autonomic disorders are also added: mydriasis, redness or paleness of the facial skin, tachycardia and others. The onset of the attack is sudden and is not preceded by an aura. Subsequently, the patient does not remember what happened.

A simple absence attack is formed without a motor component, but more often it is accompanied by a myoclonic, tonic or atonic component, or motor automatisms.

The attachment of the myoclonic component is characterized by rhythmic bilateral twitching of the muscles of the face and upper limbs. Such convulsions can be provoked by hyperventilation and light stimulation. Rhythmic stretching of the lips into a tube, uncontrolled sucking movements, and myoclonus of the eyelids are more often observed in childhood absence epilepsy. The same form is also characterized by attacks with a predominance of the tonic component: posterior deviation of the head and torso, tonic abduction of the eyes and asymmetric muscle tension.

The atonic component is manifested by a sudden relaxation of the muscles of both the whole body and its individual parts (a sharp “nod” of the head, objects falling out of the hands, etc.). This is inherent in Lennox-Gastaut syndrome.

Generalized seizures

But generalized attacks are always accompanied by an aura, loss of consciousness and, as a result, the patient falls.

An aura is a condition that precedes the onset of an attack and can be its harbinger. It can manifest itself as vegetative disorders (fever, redness/pallor of the face, discomfort in the epigastric area); in the form of hallucinations (auditory and visual), feelings of euphoria, feelings of fear, anxiety, “déjà vu” and many others. In some forms of epilepsy, an aura can be an independent attack.

In generalized tonic-clonic seizures, epileptic activity affects both hemispheres. Tonic spasms manifest themselves in the form of a sharp tension in the muscles of the entire body or individual groups. And clonic ones look like small twitches of symmetrical or asymmetrical muscle groups.

After a seizure, which can last from 1 to 5-6 minutes, consciousness begins to recover. This process directly depends on the duration of the attack: the longer it is, the longer the patient remains unconscious. In this case, complete relaxation of the muscles occurs, up to the involuntary act of defecation or urination.

Forms of the disease in children

Childhood absence epilepsy manifests itself as typical generalized absence seizures without loss of consciousness or convulsions. Girls are more often affected (2:1) with the onset of the disease before the age of 9 years.

Simple absences occur with a loss of consciousness, and complex ones with the addition of a minor motor phenomenon. Attacks are frequent, up to several times a day, with a sudden onset and end. At the same time, the child abruptly stops the activity in which he was engaged. His face is pale, his eyes are “glassy”; it is possible to attach automatisms. Hyperventilation, fatigue, emotional stress, and sleep deprivation can provoke attacks.

Juvenile absence epilepsy appears in adolescents against the background of complete well-being and unnoticed by him and his parents. Seizures occur rarely and are not as severe as in childhood absence epilepsy. Therefore, it happens that until the disease progresses and generalized seizures appear, epilepsy is not diagnosed. These convulsions are clonic-tonic in nature. The prognosis for treatment is favorable and remission with optimal drug therapy is more than 80%.

Generalized forms also include epilepsy with isolated generalized seizures. Clinically, it manifests itself as a sudden loss of consciousness; the attack is not preceded by an aura.

The attack itself consists of two phases:

Tonic phase - the patient loses consciousness and falls. Due to a tonic spasm of the laryngeal muscles, a groan or cry escapes from his mouth. The whole body is arched, arms and legs are tense and straightened. His eyes are open, there is no breathing, and his face is pale. The phase lasts no more than 30 seconds;
Clonic phase. The muscle spasm goes away, breathing returns (hoarse). The muscles begin to contract rhythmically, and the twitching becomes more and more widespread. During this phase, tongue biting and involuntary urination or defecation may occur. It lasts up to 10 minutes, and after that the patient falls asleep.

Most often, an attack is provoked by various sleep disorders, and the attack itself occurs immediately after waking up. In women, seizures may become more frequent during the premenstrual period.

Rare forms of the disease

Eyelid myoclonus with absence seizures or Jeavons syndrome refers to a photosensitivity form of idiopathic epilepsy. The onset of the disease occurs in early childhood. This disease begins as a simple absence seizure. But motor activity of the eyelids like fluttering is pathognomonic; This symptom is often more noticeable than the absence seizure itself. Moreover, myoclonus of the eyelids is mandatory and without it the diagnosis of “Jeevons syndrome” is incompetent. The duration of the attack is very short (up to five seconds), but the frequency is significant - several hundred times a day. A neurological examination registers a violation of mnestic functions, as well as a noticeable decrease in intelligence

Myoclonic-astatic seizures are the “core” of the syndrome. They manifest themselves in the form of very fast, short, asynchronous, finely sweeping twitches in the muscles of the arms and legs. There may also be myoclonic nodding, which is accompanied by pulling the shoulders towards the head and a slight tilt of the torso forward. When examined by a neurologist, multiple disturbances of motor and sensory activity, as well as intellectual functions, are noted.

Photosensitive epilepsy is an idiopathic form with reflex dependence. Seizures can be triggered by watching TV or sitting at a computer monitor for a long time, observing small, rhythmically moving objects, flashing headlights, color music in a club, and much more.

Patients may develop photosensitivity epilepsy with spontaneous seizures. They can be provoked, or they can arise against the background of complete well-being. On examination, patients experience photophobia, lacrimation, a feeling of pain in the eyes, frequent blinking and headache. In addition to the main anticonvulsant treatment, prevention (avoidance of provoking factors) has a good effect. This includes wearing sunglasses, avoiding watching programs with frequent picture changes, not visiting clubs with color music, and so on.

Diagnostics

Epilepsy is currently a global problem. Its diagnosis should be carried out in the early stages and be as accurate as possible.

First, you need to identify the cause of the attacks, if possible. In the case where the etiology is known, treatment is based on the principle of influencing the root cause. To do this, it is necessary to carefully interview the patient and his relatives for traumatic brain injuries, cancer, infectious meningitis, and also find out a possible genetic predisposition.

The key method in diagnosing idiopathic epilepsy is electroencephalography. It is built on the principle of determining the difference in electrical potential between two points. To do this, electrodes are placed above the brain to record electrical impulses.

Using this method, it is possible to determine the localization of the focus of excitation (if any), the characteristics of the waves (they are specific to different types of epileptic activity), as well as changes in the interictal period.

In addition, an examination by a neurologist is important. It checks the severity of reflexes, deviations in the intellectual and emotional spheres.

Additional research methods include MRI and CT, angiography of cerebral vessels, and echo-encephalogram.

Therapy

Idiopathic epilepsy requires long-term and thoughtful treatment. A course of anticonvulsant drugs can be prescribed only after a final diagnosis has been made. It is not so much the form of seizures that is important, but the form of epilepsy.

The prescription of anticonvulsant drugs occurs in accordance with the scheme. Adhere to the principles of monotherapy starting with small doses. This means that it is better to start treatment with one drug in a small dosage, gradually increasing it until the required therapeutic effect is obtained. If it is not achieved, then the drug is changed to another and started again with small dosages.

In cases of resistance to drug therapy, surgical treatment, vagus nerve stimulation and a ketogenic diet can be used.

Indications for surgical intervention must be strict: idiopathic partial epilepsy, suitable somatic condition.

The ketogenic diet aims to reduce the number of attacks. Doctors recommend starting it with fasting: ordinary drinking still water. ON the fourth day you can add food to your diet. It is necessary to reduce the amount of carbohydrates coming from food, and increase the amount of fat.

Once complete remission is achieved, patients should be seizure-free for one year. One should strive to normalize electroencephalogram parameters.

The prognosis depends on how the disease responds to therapy and whether the progression of epilepsy is recorded.

All information provided on this site is for reference only and does not constitute a call to action. If you notice any symptoms, you should immediately consult a doctor. Do not self-medicate or self-diagnose.

Generalized epilepsy

Generalized epilepsy is a clinical concept that unites all forms of epilepsy, the basis of which is primary generalized epileptic seizures: absence seizures, generalized myoclonic and tonic-clonic paroxysms.

In most cases it is idiopathic in nature. The basis of diagnosis is the analysis of clinical data and EEG results. Additionally, an MRI or CT scan of the brain is performed. Treatment of generalized epilepsy consists of monotherapy with anticonvulsants (volproate, topiramate, lamotrigine, etc.); in rare cases, combination therapy is required.

Generalized epilepsy

Generalized epilepsy (GE) is a type of epilepsy in which epileptic paroxysms are accompanied by clinical and electroencephalographic signs of primary diffuse involvement of cerebral tissues in the process of epileptiform excitation. The clinical picture of this form of epilepsy is based on generalized epileptic seizures: absence seizures, myoclonic and tonic-clonic paroxysms. Secondary generalized seizures do not belong to generalized epilepsy. However, since the beginning of the 21st century, some authors began to question the accuracy of the division into generalized and focal epilepsy. So, in 2005 Studies conducted by Russian epileptologists were published, which indicate the focal onset of atypical absence seizures, and in 2006. a detailed description of the so-called “pseudogeneralized paroxysms” appeared.

However, the concept of “generalized epilepsy” is still widely used in practical neurology. Depending on the etiology, idiopathic and symptomatic GE are distinguished. The first is hereditary in nature and accounts for about a third of all cases of epilepsy, the second is secondary, occurs against the background of organic brain damage, and is less common than idiopathic forms.

Causes of generalized epilepsy

Idiopathic generalized epilepsy (IGE) has no other causes other than genetic determination. Its main pathogenetic factor is usually channelopathy, which causes membrane instability of neurons, leading to diffuse epileptiform activity. The probability of having a child with epilepsy if one of the parents has the disease does not exceed 10%. About 3% are monogenic forms of IGE (frontal epilepsy inherited according to an autosomal dominant principle, benign familial convulsions of newborns, etc.), in which the disease is determined by a defect in one gene, and polygenic forms (for example, juvenile myoclonic epilepsy, childhood absence epilepsy), caused by mutations of several genes.

Etiofactors for the occurrence of symptomatic HE may include traumatic brain injury, neurointoxication, infectious diseases (encephalitis, meningitis), tumors (brain gliomas, lymphomas, multiple metastatic brain tumors), dysmetabolic conditions (hypoxia, hypoglycemia, lipidosis, phenylketonuria), fever, hereditary pathology (for example, tuberous sclerosis). Symptomatic generalized epilepsy in children can occur as a result of fetal hypoxia, intrauterine infection, birth trauma of the newborn, or abnormal brain development. Among symptomatic epilepsy, most cases are of the focal form; the generalized version is quite rare.

Generalized Epilepsy Clinic

Idiopathic generalized epilepsy manifests itself in childhood and adolescence (mainly before 21 years of age). It is not accompanied by other clinical symptoms, except for epileptic paroxysms of a primary generalized nature. In the neurological status, in some cases, diffuse symptoms are observed, and extremely rarely, focal symptoms. Cognitive functions are not impaired; in some cases, intellectual disorders may be transient, which sometimes affects the performance of schoolchildren. Recent studies have shown the presence of mild intellectual decline in 3-10% of patients with IGE, and the possibility of some affective and personal changes.

Symptomatic generalized epilepsy occurs at any age against the background of an underlying disease, with hereditary pathology and congenital defects - more often in early childhood. Generalized seizures make up only part of her clinical picture. Depending on the underlying disease, there are cerebral and focal manifestations. Intellectual decline often develops, and in children, mental retardation occurs.

Types of generalized paroxysms

Typical absence seizures are paroxysms of short-term loss of consciousness lasting up to 30 seconds. Clinically, the attack looks like the patient freezing with a blank gaze. A vegetative component in the form of hyperemia or pallor of the face, hypersalivation is possible. Absence may be accompanied by unconscious movements: twitching of individual facial muscles, licking of lips, rolling of eyes, etc. In the presence of such a motor component, absence is classified as complex; in its absence, it is classified as simple. Ictal (during an epileptic seizure) EEG records generalized peak-wave complexes with a frequency of 3 Hz. Typically, the frequency of peaks drops from the beginning of the attack (3-4 Hz) to its end (2-2.5 Hz). Atypical absence seizures have a slightly different EEG pattern: irregular peak waves, the frequency of which does not exceed 2.5 Hz. Despite diffuse EEG changes, the primary generalized nature of atypical absence seizures is currently being questioned.

Generalized tonic-clonic seizures are characterized by a change in tonic tension of all muscle groups (tonic phase) and intermittent muscle contractions (clonic phase) against the background of complete loss of consciousness. During a paroxysm, the patient falls, initially for a period of time. there is a tonic phase, then a clonic phase lasting up to 5 minutes. At the end of the attack, involuntary urination occurs, then complete muscle relaxation and the patient usually falls asleep. In some cases, isolated clonic or tonic paroxysms are observed.

Generalized myoclonic seizures are diffuse rapid asynchronous muscle twitches caused by involuntary contraction of individual muscle bundles. They may not affect all muscles of the body, but are always symmetrical in nature. Often, such contractions cause involuntary movements in the limbs; involvement of the leg muscles leads to a fall. Consciousness during the period of paroxysm is preserved, sometimes stupor is observed. Ictal EEG records symmetrical polypeak-wave complexes with a frequency of 3 to 6 Hz.

Diagnosis of generalized epilepsy

The diagnostic basis is the assessment of clinical and electroencephalographic data. For IGE, a normal basic EEG rhythm is typical, although it may be slightly slowed down. In symptomatic forms, the basic rhythm may be changed depending on the disease. In both cases, in the interictal interval, diffuse peak-wave activity is recorded on the EEG, the distinctive features of which are a primary generalized nature, symmetry and bilateral synchrony.

To exclude/identify the symptomatic nature of epilepsy, CT or MRI of the brain is used in diagnosis. With their help, it is possible to visualize organic brain damage. If a primary genetic disease is suspected, a consultation with a geneticist is indicated, genealogical research is carried out, and DNA diagnostics is possible. In cases where organic pathology is excluded and the presence of other diseases in which epilepsy is secondary, the neurologist makes a diagnosis of idiopathic epilepsy.

It is necessary to differentiate GE from focal and secondary generalized forms, drop attacks, somatogenic fainting (with severe arrhythmia, chronic lung pathology), hypoglycemic conditions, psychogenic paroxysms (with hysterical neurosis, schizophrenia), episodes of transient global amnesia, somnambulism.

Treatment and prognosis of generalized epilepsy

The choice of anticonvulsant therapy depends on the type of epilepsy. In most cases, the first-line drugs are valproate, topiramate, lamotrigine, ethosuximide, and levetiracetam. As a rule, idiopathic variants of generalized epilepsy respond well to therapy. In approximately 75% of patients, monotherapy is sufficient. In case of resistance, a combination of valproate and lamotrigine is used. Certain forms of IGE (for example, childhood absence epilepsy, IGE with isolated generalized convulsive seizures) are a contraindication for the use of carbamazepine, phenobarbital, oxcarbazepine, vigabatrin.

At the beginning of treatment, an individual selection of the anticonvulsant and its dose is carried out. After achieving complete remission (absence of epileptic attacks) while taking the drug, a gradual reduction in dosage is carried out only after 3 years of its constant use, provided that during this period there was not a single paroxysm. In case of symptomatic HE, in parallel with antiepileptic pharmaceuticals, if possible, treatment of the underlying disease is carried out.

The prognosis of GE largely depends on its form. Idiopathic generalized epilepsy is not accompanied by mental retardation and cognitive decline and has a relatively favorable prognosis. However, it often recurs when the dose is reduced or the anticonvulsant is completely discontinued. The outcome of symptomatic HE is closely related to the course of the underlying disease. In case of developmental anomalies and the impossibility of effective treatment of the underlying disease, epileptic attacks turn out to be resistant to the therapy. In other cases (with TBI, encephalitis), generalized epilepsy can act as a residual consequence of a cerebral lesion.

Among other diseases of the nervous system, generalized is one of the most common diagnoses. The disease is characterized by stereotypical seizures that recur periodically. The frequency of occurrence of epilepsy accounts for up to ten percent. An epileptic seizure is caused by the occurrence of pathological discharges in the brain; they manifest themselves as temporary disturbances in mental, autonomic, sensory and motor functions. Although many people believe that epilepsy cannot be cured, medicine considers this judgment to be erroneous. Using modern antiepileptic drugs, it is possible to completely eliminate seizures in approximately sixty-five percent of patients. In addition, in another twenty percent, the severity of attacks is significantly reduced.

Here, the basis of treatment is daily long-term therapy, and regular medical examinations and examinations are also required. The causes of the development of the disease are classified, as symptomatic epilepsy, idiopathic, and cryptogenic are distinguished. When symptomatic, a structural defect of the brain is detected, this can be a tumor, malformations, hemorrhage, cyst, etc. Idiopathic epilepsy implies a hereditary predisposition; there are no structural changes in the brain. With cryptogenic epilepsy, the cause remains unclear, but the doctor in any case prescribes treatment that provides the desired results, and the disease recedes. The main thing in the treatment of epilepsy is timeliness.

Epileptic seizures can range from generalized seizures to minor changes that are barely noticeable to others. Seizures are focal, caused by the appearance of a discharge of electricity in an area of the cerebral cortex. If both hemispheres are simultaneously involved in the discharge, then this is an example of generalized epilepsy. Focal attacks are characterized by peculiar sensations, convulsions, and numbness in certain parts of the body. This refers to arms, legs, face, or other parts of the body. At the same time, the manifestation of focal attacks is in short hallucinations, they are olfactory, gustatory, and auditory. During such attacks, the patient retains consciousness, and the person is able to describe what he feels.

Generalized epilepsy is divided into non-convulsive and convulsive. Generalized convulsive epilepsy usually seems especially frightening to others. In the tonic phase of the attack, muscle tension is observed, breathing stops briefly, and the patient often screams shrilly. In some cases, the tongue may be bitten during an attack. The clonic phase occurs after about fifteen seconds, alternating muscle tension and relaxation. In addition, clonic
Non-convulsive generalized epilepsy is accompanied by seizures called absence seizures. Basically, they are observed in children, and can occur in early adolescence. At the same time, the child suddenly freezes, his gaze is directed to one point, he seems absent. Sometimes this occurs when the eyes are closed, the head is slightly thrown back, and the eyelids tremble. The duration of such attacks is up to several seconds, and sometimes they are simply not noticed. The phase often ends with urinary incontinence. The cessation of seizures occurs voluntarily, followed by a post-attack period. It is characterized by drowsiness, confusion, then a headache occurs, then the patient falls asleep.

Currently, experts identify up to forty different types and forms of epilepsy, and in this regard, for each form, doctors prescribe a separate treatment regimen. Therefore, it is so important for the doctor to not only make a diagnosis, but also identify the exact form of epilepsy. Tomography, magnetic resonance or computer is currently used as the main diagnostic technique. In addition, an EEG recording is used, no more than fifteen minutes, which is common in mass research. Most experts note that EEG monitoring, which is a regular electroencephalogram recorded over a long period of time, is the most informative, in some cases up to twelve hours. The period of wakefulness and sleep is included in the study.

If a woman suffers, she is prescribed antiepileptic therapy, and the patient is planning a pregnancy, she must inform the doctor and undergo a number of additional studies to avoid complications. It is possible that a successful pregnancy will require a change in therapy. The doctor will select other drugs that will not harm the development of the fetus. Perhaps the medications will not be stopped, but the dose will be changed. If possible, you should consult a doctor who has experience in managing such pregnancies. In addition, even before pregnancy, the patient needs to attend a medical genetic consultation.

What should you do if you have discovered signs of this disease in yourself, or have your loved ones been diagnosed with generalized epilepsy? Treatment should be carried out by a neurologist. If the attack occurs for the first time, the patient has trouble breathing, or it lasts more than five minutes, call an ambulance. In addition, it is necessary to remove all solid objects, if there are any close to the patient. The person needs to be placed on his side, with a soft object placed under his head, but it must be flat. During an attack, epileptic patients should not try to restrain it. Pay attention to when the attack began, as it is necessary to establish its duration. The choice of antiepileptic drugs is made taking into account the form of the disease and the nature of the attacks. It should be remembered that self-treatment is not allowed; therapy must be prescribed by a doctor!