Clinical picture and personality transformation
The course of epilepsy is accompanied not only by the development of convulsive or non-convulsive episodes, but also by characteristic changes in the patient's mental state. The most important characteristic of any seizures that occur is their stereotyped nature. In clinical practice, a wide variety of paroxysm types may be encountered, with certain types of seizures classified as partial seizures.
A significant age period during which disease onset or active progression most frequently occurs spans from 1 to 19 years. A specific statistical indicator (prevalence or probability of detecting certain signs) reaches 25%.
In addition to the seizures themselves, epilepsy can be suspected when a patient experiences stereotypically recurring short periods of hallucinations. Over time, patients develop specific personality changes:
- Pedantry: becomes a typical feature that dictates the patient's behavior in everyday life and society.
- Speech characteristics: in conversation, patients begin to excessively use words with diminutive suffixes.
- The long-term outcome of the disease gradually produces a specific irreversible cognitive deficit known as concentric dementia.
Etiology, pathogenesis, and diagnostic markers
A leading role in the mechanisms of epileptic seizure development is played by the neurotransmitter imbalance of GABA (gamma-aminobutyric acid) and glutamate. It is this disruption of excitatory and inhibitory processes in the cerebral cortex that creates the conditions for pathological neuronal activity.
When evaluating the prognosis of the disease, it was found that forms of epilepsy with a familial pattern are considered more favorable for the further course.
It is important to differentiate true pathology from reactive states. Epileptic seizures do not always indicate the presence of true epilepsy in a patient. They can be symptomatic in nature and occur against the background of acute intoxication or psychoactive substance withdrawal—for example, in alcohol withdrawal syndrome.
In instrumental diagnostics, electroencephalography plays a leading role. However, specific spike-wave complexes on the EEG, which are traditionally associated with epileptiform activity, can also be sporadically observed in completely healthy individuals, and therefore they are not a 100% pathognomonic sign exclusively for patients.
Principles of pharmacotherapy and patient regimen
The treatment of epilepsy requires strict compliance on the part of the patient and careful selection of medications by the physician. Antiepileptic drugs (anticonvulsants) must be taken continuously for many years.
Basic rules of drug control:
- Monotherapy: currently, the ideal approach in the treatment of epilepsy (specifically with tonic-clonic seizures) is considered to be the use of a single broad-spectrum agent. This reduces the risk of side effects and drug-drug interactions.
- Dose titration: when selecting anticonvulsant dosages, an immutable rule applies: one should start with the lowest dose and extremely slowly increase it until a therapeutic effect is achieved.
- Lifestyle restrictions: patients with epilepsy should strictly and lifelong abstain from alcohol consumption, as it can provoke seizures and disrupt the metabolism of anticonvulsants.
Briefly: answers to topical questions
Which drugs are first-line agents for terminating status epilepticus in the pre-hospital setting?
First-line drugs for terminating status epilepticus are benzodiazepines: diazepam, lorazepam, clonazepam.
- Diazepam — slow intravenous injection of 10–20 mg mixed with 10 ml of 40% glucose solution; if no effect is observed after 30 minutes, repeat administration is possible.
- If intravenous administration is not feasible, alternative routes are permitted: rectal administration of the drugs specified in the source or administration via a nasogastric tube of valproates, barbiturates, and benzodiazepine tranquilizers.
- Intramuscular injections of diazepam are ineffective.
What actions are strictly prohibited when providing first aid during a convulsive seizure?
- Intramuscular injections of diazepam are ineffective.
- Abruptly discontinuing antiepileptic drugs is dangerous: it can lead to increased seizure frequency and the development of status epilepticus.
- Patients with epilepsy should strictly abstain from alcohol consumption.
What time criteria are used to diagnose status epilepticus?
Status epilepticus (status epilepticus) is diagnosed when seizures recur for more than 30 minutes without recovery of consciousness in the intervals between them.
- Convulsive status — seizures recur for more than 30 minutes, the patient does not regain consciousness between attacks
- Initiation of emergency therapy for bilateral tonic-clonic seizures — after 5 minutes
- Initiation of emergency therapy for focal seizures — no later than 10 minutes
- Repeat administration of diazepam — possible within 20 minutes, without exceeding the total dose of 10 mg
Against the background of what conditions can symptomatic epileptic seizures occur?
Symptomatic epileptic seizures occur against the background of various exogenous and organic factors not related to true epileptic disease.
- Alcohol withdrawal syndrome (AWS) — isolated seizures against the background of alcohol, barbiturate, or benzodiazepine dependence
- Febrile seizures in children
- Eclampsia and electrical injury
- Industrial intoxications — lead, organic solvents, organophosphates
- Drug intake — camphor, bromocamphor, corazole, bemegride, ketamine, neostigmine
- Intracranial tumors and space-occupying processes — metastases, cysts, hematomas, cysticercosis, hormonally active tumors (insulinoma)
- Late stages of diseases — cerebral syphilis, general paresis of the insane, cerebral atherosclerosis, Alzheimer's disease
Class and exam questions
Does a convulsive seizure always indicate epilepsy?
No, epileptic seizures do not always indicate true epilepsy; they can be symptomatic, for example, occurring during alcohol withdrawal syndrome.
What rule applies when selecting an anticonvulsant dose?
When selecting dosages of antiepileptic drugs, it is necessary to start with the lowest dose and slowly increase it.
Are spike-wave complexes on an EEG absolute proof of the disease?
No, specific spike-wave complexes on the electroencephalogram may also be sporadically observed in healthy individuals.
What else to study on this topic
- Mechanisms of GABA and glutamate neurotransmitter imbalance
- Specific personality changes: pedantry and concentric dementia
- Differential diagnosis of true epilepsy and alcohol withdrawal syndrome
- Advantages of monotherapy with broad-spectrum agents
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Other topics in "Chapter 20. Epilepsy"
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