Epilepsy is a chronic neuropsychiatric disease characterized by a tendency to recurrent sudden seizures. There are various types of seizures, but any of them is based on abnormal and very high electrical activity of nerve cells in the brain, as a result of which a discharge occurs.
In this case, three outcomes are possible: 1) the discharge can stop within the boundaries of its occurrence; 2) it can spread to neighboring parts of the brain and stop when it encounters resistance; 3) it can spread to the entire nervous system and only then stop. Seizures that occur in the first 2 cases are called partial, in the latter case they speak of a generalized seizure. In generalized seizures, consciousness is always impaired, while in partial seizures it is sometimes lost and sometimes saved. The terms “convulsions”, “attacks”, “episodes” are also not often used to refer to seizures.
Epilepsy has been known since ancient times. Epileptic seizures were noted in many prominent people, such as the apostle Paul and Buddha, Julius Caesar and Napoleon, Handel and Dante, Van Gogh and Nobel.
The true number of epilepsy cases is difficult to establish, since many patients do not know about their disease or hide it. In the United States, according to subsequent studies, at least 4 million people suffer from epilepsy, and its prevalence reaches 15–20 cases per 1,000 people. In addition, about 50 out of 1,000 babies have at least one seizure when the temperature rises. In other states, these figures are probably about the same, since the incidence does not depend on gender, race, socioeconomic status or place of residence. There is no radical treatment for epilepsy, but currently, with the help of medications, seizures can be stopped in 60-80% of cases. The disease does not often lead to death or a gross violation of the physical condition or mental abilities of the sick person.
Epilepsy is classified according to its origin and type of seizures. There are two main types based on their origin:
- idiopathic epilepsy, in which the cause cannot be identified;
- symptomatic epilepsy associated with certain organic brain damage.
Approximately 50–75% of cases have idiopathic epilepsy.
For diagnosis, an electroencephalogram (EEG) is very important, which makes it possible to identify pathological electrical activity of the brain, as well as to determine the localization of the focus of this activity (epileptic focus) and the degree of its spread. However, not all patients have EEG changes, so that its usual picture does not exclude epilepsy.
It is important to accurately determine the type of seizure, since treatment depends on this. Some patients develop seizures of different types, which requires a combination of drugs. Every person who has had a seizure should definitely see a doctor.
Although seizures can occur in many diseases and thus may be associated with them, the true underlying cause of epilepsy is unknown. Research shows that this disease occurs when a certain area of the brain is damaged but not completely destroyed. It is the cells that have suffered, but retained their viability, that serve as a source of pathological discharges, and, consequently, seizures. Sometimes during a seizure, new brain damage occurs, near or far from the previous one. This is how additional epileptic foci are formed.
It is still unknown why the same disease in one patient is accompanied by seizures, while in another it is not. Even more mysterious is the fact that some people who have had a seizure do not recur in the future, while others have frequent recurrent seizures. Genetic predisposition is probably important, but the mode of inheritance has not been clearly established. Apparently, epilepsy is caused by a combination of hereditary and environmental factors, including previous diseases.
Large (generalized) convulsive seizures. This type of seizure is traditionally referred to by the French term grand mal (which translates as a big seizure). It is characterized by severe convulsions. The seizure is traditionally preceded by a prodromal period (the period of precursors), lasting from several hours to several days. At this time, irritability, high excitability, decreased appetite or behavioral changes are detected. Just before a seizure, some sufferers develop an aura, a precursor condition that ranges from repeated nausea or muscle twitching to a feeling of unspeakable elation. At the onset of a seizure, a person may make screams or grunting sounds. He loses consciousness, falls to the floor, his body tense. Breathing slows down, the face becomes gray, cyanotic or pale.
Then there are twitches in the arms, legs or throughout the body. The pupils dilate, blood pressure rises, the face becomes flushed, the skin becomes covered with sweat, saliva comes out of the mouth. Involuntary excretion of urine and feces often occurs. Bite of the tongue or cheeks is possible. Then the muscles relax, breathing becomes deep, convulsions subside. Consciousness returns through slumber. Drowsiness and confusion sometimes persist throughout the day. Generalized seizures can manifest themselves in different ways: sometimes only one of the described phases is observed, sometimes another of them in succession.
There is no memory of a generalized seizure, sometimes the patient remembers only the aura. Headache, confusion, pain throughout the body, and other symptoms may be associated with a fall during a seizure, severe muscle spasm, or bruising due to involuntary movements. Seizures traditionally last from a few seconds to several minutes and resolve spontaneously.
Febrile seizures are traditionally a type of generalized seizure and occur in infants with a high fever, most often between the ages of 6 months and 4 years. Many of these babies have relatives who suffered from the same seizures in childhood. Since the majority of cases have one or two similar episodes that do not develop into true epilepsy, some experts do not classify febrile convulsions as epilepsy.
Focal (partial) seizures. Only one part of the body is involved in them; Seizures may be motor or sensory and present with convulsions, paralysis, or abnormal sensations. The term “Jacksonian epilepsy” refers to seizures that tend to move (“march”) from one part of the body to another; sometimes such a seizure is generalized and spreads to the whole body. After leg cramps, weakness (paresis) may remain in it for up to a day. The appearance of an aura, loss of consciousness and drowsiness after a seizure are not always noted. In this type of seizure, organic brain damage is often detected, especially in adults, so that patients should seek medical help as soon as possible.