Idiopathic epilepsy with generalized tonic clonic attacks. Generalized epilepsy

Epiopathic generalized epilepsy is one of the most common diseases in the field of children's neurology. The disease actively manifests itself in preschool age. This leads to a deterioration. further development Child, decrease in school performance.

Epilepsy development mechanism

Epilepsy is chronic disease with a tendency to gradually deteriorate symptoms. It develops due to an equilibrium impairment in the brain between exciting and braking systems. In the cortex of the brain, foci of increased epileptic readiness are formed (so they are called neurologists). They are activated under the influence of any external factors: Strong light, flashing items, after stress or nervous voltage.

The most frequent manifestation of epilepsy is a convulsive attack. But there are also form of epilepsy, clinical manifestations of which do not include convulsions.

The presence of only one convulsive attack is not yet a reason for diagnosis. Only dynamic seizures can be epilepsy. A single attack in children is a symptom of different pathologies. Often found febrile convulsions (with high temperatures).

Attacks can be short (30 seconds) and long (up to 10 minutes). Usually the attack is united, the repetition is not typical. Most often, the seizures arise in the first two hours after the awakening, suddenly, without the "Auras" preceding them. This beginning is especially dangerous for the patient, as it cares for him. This can lead to a serious fall and injury.

They are often provoked by excessive intake of alcoholic beverages, insomnia, menstrual period in women.

It is inappropriate comparing idiopathic and generalized epilepsy, since the generalized form is one of the varieties of idiopathic.

Diagnosis of the disease

The diagnosis of idiopathic generalized epilepsy should be carried out as early as possible. Early diagnosis provides timely start of treatment. And timely therapy improves the forecast of idiopathic generalized epilepsy for recovery.

Most effective method Diagnosis - electroencephalography (EEG). With it, it is possible not only to diagnose "epilepsy", but also to set the localization of the lesion focus.

The essence of this method is to record the electrical activity of the brain with the help of electrodes that are attached to the head. Next, this entry is displayed on the computer monitor. It has the form of waves of different shapes and amplitude.

To form a diagnosis of idiopathic epilepsy must be observed the following criteria Electricencephalography:

• normal EEG background;
• normal recording during sleep;
• between the attacks there are activity on EEG with peak waves with a frequency of at least three complexes per second;
• activity occurs in two hemispheres at the same time and is generalized;
• in the phase of slow sleep, an increase in epileptic activity is characterized;
• when injecting benzodiazepines, epileptic activity stops.

The advantages of the method is that it is absolutely safe and painless. When carrying out the electroencephalogram, a video monitoring is applied. The camera recording allows you to match the presence of an attack with changes on the computer monitor.

For greatest efficiency, stimulation is possible. Flashing of light or a series of deep breaths and exhalations can activate epileptic foci in the brain. This will cause the appropriate changes to the EEG.

Treatment of the disease

In the overwhelming majority, treatment of idiopathic generalized epilepsy is life. It depends on the form of epilepsy, as well as the severity of the course of the disease.

One of the most effective medicines for therapy of all forms of idiopathic epilepsy is "Sodium Valproat". The effectiveness of treatment is only one of this drug, without any combinations, is 75%. It is effective in absunas, myoclonic and generalized attacks. But a large number adverse Reactions Limit the use of this drug.

"Clonazepam" also has high efficiency, but has wide spectrum Side Effects. In addition, the patient quickly develops addictive to the drug, which requires an increase in dose, and after and replacing it to another medicine.

Lookinzhin is used only for absaxing therapy and generalized attacks. His effect for the treatment of myoclonium is not fully found.

In the treatment of children, it is recommended to receive "Etosuximide". But it cannot be used to treat youthless absissues. With youthful form, there is a high risk of developing generalized attacks, and Etosuximide is not effective for their treatment.

Here is a list of basic preparations for the treatment of different forms of attacks in idiopathic generalized epilepsy.

Thank you

The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

Violation of the functions of organs and systems

Sigger - This is a kind of paroxysm. Seating or paroxysm is a sharply emerging transient violation of organs or organ systems ( for example, renal colic, attacks of chest pain, etc.). The fit is implemented by cerebral mechanisms, and arises against the background of visible health or with a sharp deterioration in the pathological condition in the chronic stage.

Share such types of seizures:

• Epileptic.
• Psychogenic.
• Febrile.
• Narcoleptic.
• Cataleptic.
• Anoxic.
• Toxic.
• Metabolic.
• Tetanic.
• Tonic.
• ATONIC.
• Clonic.
• Absans.
• Unclassified.

The catalysis of convulsive attacks is an increased excitability of neurons in the brain. As a rule, brain neurons in a certain section of the brain form a hearth. You can detect such a focus using the EEG technique ( electroencephalography), and for some clinical signs ( the character of coming cramps).

Epileptic

It often makes an opinion that the epileptic seizure is synonymous with a convulsive attack. Really not all convulsive attacks are epileptic, and epileptic seizures are often dismissed ( most often in children).

Most of these attacks are included in the structure of epileptoid disorders.

Small generalized epileptic seizures are dismissed. They are called absans.

Absanance manifestations: Consciousness is absent, all actions are interrupted, the look of empty, pupils are expanded, hyperemia or pallor skin. A simple abscix can last no more than a few seconds, even the patient himself can not know about it.

Complex attacks are often characterized by more severe clinical manifestations and in all cases are accompanied by changes in consciousness. Patients are not always aware of what is happening; They may include complex hallucinations of an auditory or visual nature, accompanied by the phenomena of the dramatization or depersonalization.

The depositance phenomenon is characterized by the unusual perception of the sensations of his body. The patient even makes it difficult to describe them. Derealization is manifested by the feeling of immobileness, the dullness of the world. The fact that before the attack was well known - it seems unfamiliar, and vice versa. The patient may seem to seem that everything that happens to him is a dream.

Another characteristic manifestation of complex partial attacks are automatic stereotypical actions, which are formally appropriate, but in this situation they are inappropriate - the patient mirkets, gesticulates, looking for something hands. As a rule, the patient does not remember the automatic actions completed, or remembers them fragmentary. In more complex cases, the patient may perform quite complex behavioral activities: for example, come on public transport from home to work. What is interesting: he may not remember this event.

Complex vegetative and visceral seizures are characterized by unusual and strange sensations in the chest or in the stomach, which are accompanied by vomiting or nausea, as well as mental phenomena ( racing thoughts, fear, violent memories). Such an attack may be like an absax, but during the EEG there are no changes typical for the absanse. Therefore, in clinical practice, such seizures are sometimes called pseudoabsans.

Mental paroxysmal phenomena arising from epilepsy are components of partial seizures, or their only manifestation.

Epileptic status

With the epileptic status of the seizures are followed as often that the patient does not have time to fully return to consciousness after the previous attack. He can still have changed hemodynamics, changed breathing, twilight consciousness.

Facial attacks in epileptic status are accompanied by the development of comporaous and comatose states, which creates a significant threat to life.
patient. Thus, during the tonic phase, respiratory muscles are spying and apnea appears with characteristic features described above. To cope with hypoxy, the body begins to breathe hard and superficially ( phenomenon hyperventilation), as a result, there is hinders. This condition enhances epileptic activity and increases the duration of the attack.

With a comatose state, pharyingeal respiratory paralysis develops, which lies in the fallout of the pharyngeal reflex and as a result of this - accumulation of salivary secretion in the upper respiratory tractThat worsens breathing up to the appearance of a cyanosis. Hemodynamics varies: the number of heart impacts reaches 180 per minute, the pressure increases sharply, the myocardium ischemia arises. Metabolic acidosis occurs due to the violation of metabolic processes, intracellular breathing is disturbed.

Medical tactics for epilepsy

The main therapeutic principles: early start of treatment, continuity, complexity, continuity, individual approach.

This disease is a serious stress for the patient's family and for him. A person begins to live in fear, waiting for every new attack, and flows into depression. Some activities are impossible to carry out people, sick epilepsy. The quality of the patient's life is limited: he cannot break the mode of sleep, drink alcohol, drive the car.

The doctor must establish productive contact with the patient, convince him of the need for long-term systematic treatment, to clarify that even a one-time skipping of anti-epileptic drugs can lead to a strong decrease in the effectiveness of therapy. After extracting from the hospital, the patient is obliged to accept the prescribed drugs for three years after the last seizure.

At the same time, it is known that anti-epileptic drugs with long-term admission negatively affect cognitive functions: attention decreases, the memory and the rate of thinking deteriorate.

The choice of anti-epileptic drugs affects clinical form Diseases and presented type of seizures. The mechanism of the effects of such drugs is to normalize internal cell balances and polarization in cell membranes of epileptic neurons ( dEPENDING OF VTOK IN NA + Cage or exit from it to +).

In absissues, effective is the purpose zarotin and suxilepamaybe in combination with valproatami.

With cryptogenic or symptomatic epilepsy, in which complex and simple partial seizures occur, are effective phenytoin, phenobarbital, depakin, lookifin, carbamazepine.

At the same time, phenobarbital has a pronounced depressing effect ( in adults), and in children, on the contrary, very often causes the state of hyperactivity. Phenytoin has a narrow therapeutic latitude and nonlinear pharmacokinetics, is toxic. Therefore, most doctors consider choices carbamazepine and valproat. The latter is also effective in idiopathic epilepsy with generalized seizures.

Toxic seizures require intravenous administration of magnesium sulfate to restore intracellular balance. With any attacks as an additional preparation shown diakarian. This drug has high antiepileptic activity and manifests dehydration properties.

With epileptic status ( the most severe condition of epilepsy) Apply benzodiazepine derivatives: sibazon, nitrazempam, relaignation, clonazepam, sadocent. Such drugs as gabapentin and vigabatrin Do not exposed metabolization in the liver, in connection with which they can be assigned in diseases of the liver. Vigabatrin showed excellent effectiveness in the treatment of severe form of the disease: lennox-Gasto Syndrome .

Some antiepileptic drugs have the properties of slow release, which allows to provide a stable concentration of medicinal substances in the blood in a single or twofold reception. That is, it gives the best effect, and reduces the toxicity of the drug. To the means include depakin-Chrono. and tehretol.

New drugs used in anti-epileptic therapy are okskarbazepine (manifest better efficiency compared to carbamazepine); hlobazam.

Lookifin It is a means of choosing during atypical absans and atonic seizures in children. Recently, its effectiveness has been proved with primary generalized convulsive attacks.

It is very difficult to choose an effective and least toxic therapy for those patients who suffer from liver diseases.

Seizures of non-epileptic character

Neepileptic attack may be accompanied by the occurrence of clonic or tonic seizures. It develops under the influence of born factors and is also running quickly, as arising.

The attack catalyst may be:

• Increase body temperature.
• Viral infections.
• Polyimopathy.
• Hypoglycemia.
• Rahit in children.
• Inflammatory diseases of the nervous system.
• Polyneuropathy.
• A sharp increase in intracranial pressure.
• Sharp weakness.
• Vestibular symptoms.
• Medical medication poisoning.
• Strong dehydration with vomiting, diarrhea.

Febrile convulsive

Neepileptic convulsive seizures are characteristic, mainly for children to age up to four years, which contributes to the immaturity of their nervous system, and due to genetic factors is low threshold convulsive readiness.

In children at this age, temperature is often found ( febryls) cramps. A sharp occurrence of seizures is associated with a rapid increase in temperature. They pass without leaving the trace. Long-term treatment is not required, only symptomatic.

If such convulsions are repeated and occur during subfebrile, not high temperatures, then you need to find out their cause. The same applies to those convulsive seizures that are recalled without increasing body temperature.

Neepileptic psychogenic

Psycho seizures were previously called hysterical. Modern medicine It practically does not use this term due to the fact that psychogenic seizures are found not only for hysteria, but also during other neuroses, as well as some accentuated persons as a way of responding to a stressful situation. Sometimes for differentiation from epileptic seizures they are called pseudoids, but this term is not correct.

Accentuations - These are excessively pronounced traits that are enhanced during stress. Accentuations are located on the border between the norm and pathology.

Psychogenic manifestations can take such an extent to epileptic, which is very difficult to differentiate them from each other. And this, in turn, makes it difficult to choose effective treatment.

Classic hysterical seizures developing due to the occurrence of peculiar psycho-emotional reactions ( sick people meow or nail, tear their hair, etc.), it is rare enough. When diagnosing the state of the doctors are guided by the set clinical signswhich, however, have 100% reliability:

• Screams, moans, bite of lips, swinging heads in different directions.
• Neo-Ordinated, asynchrony, rawness of limb movements.
• Resistance when inspection, when trying to break up the eyelids - clogging eyes.
• Development of attack in front of several people ( demonstration).
• Too long attack ( more than 15 minutes).

Help in differentiation of psychogenic phenomena can laboratory diagnostic methods: for example, the increase in the level of prolactin indicates the epileptic nature of the seizure. Although this method is also 100% accurate.

The latest data obtained during psychophysiological studies, suggests that the problems of psychogenic seizures are much more confusing, since the epipridges arising from the appearance of the focus in the pole-mediobasal part of the frontal share, and psychogenic attacks are completely repeated.

Narcoleptic

The narcoleptic seizures are manifested by an irresistible sudden attack of drowsiness. Dream short, although very deep; Patients often fall asleep in uncomfortable poses and in an inappropriate place ( comes to falling asleep while eating or walking). After waking up, they do not just restore normal mental activity, but also a tide of strength and vigor appears.

The frequency of the appearances of a narcoleptic attack is several times a day. In addition to drowsiness, the blockade of muscles is accompanied. Character is chronic. The nature of this state is the encephalitis, brain tumors, cranial injury. This ailment suffer more young people than people of old years. The narcolepsy syndrome was described for a long time - in 1880. Although at that time only the external manifestations of the attack were described, and about its causes could only guess.

Cataleptic

Cataleptic seizure is short-term ( duration up to three minutes). The loss of the muscular tone is manifested, which causes the patient's drop, falling down his head, the lethargy of the hands and legs. The patient can not move the limbs and head. On the face are visible signs of hyperemia; When listening to the heart, bradycardia is observed; Skin and tendon reflexes are reduced.

Such an attack may occur in schizophrenia, narcolepsy, organic lesions of the brain, emotional experiences.

Anoxic

Anxic attack occurs due to the lack of oxygen in organs and tissues ( that is, with anoxia). Anoxia is much less common than hypoxia. There is oxygen in hypoxia, but it lacks it for the full functioning of the organs. With the ischemic forms of the anoxia, a person often falls into fainting. Diagnostic differentiation with some varieties of epileptic seizures is difficult due to the similarity of clinical manifestations.

In people suffering from vegetative-vascular dystonia, fainting of a neurogenic character often arise. They are provoked by different stress factors: a stuff, in the influx of people in close room, blood view. The diagnostic distinction of epileptic seizures of vegetative-visceral nature with neurogenic fainting is a challenge.

Toxic

The attacks of toxic genesis may occur under the influence of a tetanus toxin, for example. Tennic attacks differ from epileptic because the patient remains in full consciousness. Another difference is that the toxic fit is manifested by tonic convulsions, and during epilepsy they are rare. During the attack of a tetanical spasm, the voltage of the mimic and chewing muscles occurs, which causes a "sardonic smile."

For strikhnin poisoning, toxic seizures with a clinical picture in the form of cramps and trembling limbs, tug excit and pain in them are characteristic.

Metabolic

The seizures of metabolic origin are seriously differentiated with hypoglycemic attacks and some kinds of epipridges.

Hypoglycemic states are characterized not only by the fact that sugar in the blood falls, but also how quickly it happens. Such states arise in the strokes of the pancreas, as well as with functional hyperinsulism.

Metabolic cramps, which are the symptom of the same attacks, arise as a result of various states or diseases ( dehydration, fever, less often cerebral pathology, etc.). More often there are hypocalcemic and hypoglycemic convulsions.

Metabolic disorders are more often accompanied by tonic-clonic, as well as multifocal convulsions.

Metabolic disorders need immediate correction and in establishing the root causes of this state. Acidosis, renal failure or other disorders can affect the occurrence of metabolic seizures. That this is precisely metabolic convulsive syndrome, indicate such signs as an early appearance, the ineffectiveness of anticonvulsants, and the constant progress of the disease.

Tetanic

Tetania is a disease of an acute or chronic nature, manifested by convulsive seizures affecting the muscles of the limbs, as well as the muscles of the larynx and face. Such violations are caused by changes in the functioning of the parathyroid glands.

The main symptom of an acutely occurring disease is a thetaic attack. During the seizure, the nervous system is exposed to strong excitation and due to this muscle cramps arise. Localization of seizures is different under different forms of Tetania. Children occur more often laryngospasis - the cramps of the muscles of the larynx. Adults meet darous form The Tetanic attack at which the convulsions of the coronary arteries and the heart muscle occur. Such convulsions can lead to death due to a heart stop.

Sometimes convulsions of muscles of bronchi or stomach happen. During the seizure of the stomach, an indomitable vomiting arises. With convulsive spasms of the urinary bubble sphincter, a violation of the urinary. Causes are painful. Their duration varies within an hour.

Tonic

These states are characteristic of children's age, in adults they are almost never found. Tonic attacks in children during the manifestation of Lena-Gasto syndrome are often combined with an atypical absanus.

Three varieties of tonic seizures:
1. Involving the muscles of the face, torso; Causes of respiratory muscles.
2. Engine hands and leg muscles.
3. Engine and torch muscles, and muscles of limbs.

You can visually distinguish tonic convulsions on the "protective" position of the hands, which, as it were, cover the face with compressed fists from the blow.

Such types of convulsive manifestations may be accompanied by clouding of consciousness. Pupils cease to respond to light, tachycardia appears, blood pressure is increased, eyeballs rolled upstairs.

Tonic and tonic-clonic seizures carry a threat to injury for a patient or even death ( due to the associated vegetative violations; due to acute adrenal insufficiency; Due to the stop of breathing).

ATONIC

Atonic states occur dramatically and last for a few seconds. This short time is disturbed by consciousness. Externally, this can manifest itself to a nodder or head hanging. If the attack lasts longer, then a person can fall. A sharp drop can lead to an acceleracy injury.

Atonic seizures are characteristic of a number of epileptic syndromes.

Clonic

A typical manifestation of clonic attacks is observed more often in infants. Along with vegetative disorders and loss of consciousness, bilateral rhythmic seizures arise throughout the body. In the intervals between the clonic twitching of muscles, its hypotension is observed.

If the attack lasts a couple of minutes, then consciousness is rapidly restored. But often it lasts longer, and in this case, it is not an elimination of clouding consciousness, but the onset of the comatose state.

Absans

For an abscanance, a typical shutdown of consciousness. Externally, this is manifested by stopping the movement, "petition", immobility of the view. Reactions to external stimuli does not occur, I do not respond to questions and octications. After leaving the state, the patient remembers nothing. His movements are resumed from the moment of stopping.

It is characteristic that such attacks can repeat dozens of times a day, and the sick person may not even know about it.

Upon the occurrence of a complex Abnsan, the clinical picture is complemented by elementary short-term automatism ( reliefing with hands, rolling eyes, twitching age). With an atonic abscanance, the lack of muscle tone leads to a drop of body. Reducing cheerfulness and fatigue, lack of sleep - all this affects the appearance of an absanance. Therefore, the absans often arise in the evening after a whole day of wakefulness, in the morning immediately after sleep; Or after the absorption of food, when the blood drops from the brain and sticks to the digestive organs.

Unclassified

Doctors are called nonclassifiable seizures that cannot be described on the basis of diagnostic criteriaused to differentiate other types of paroxysmal states. These include attacks of newborns with concomitant chewing movements and rhythmic twitching eye applesas well as hemiconvulsive attacks.

Night paroxy

These states were described in the writings of Aristotle and Hippocratic. Modern medicine revealed and described an even greater number of syndromes that are accompanied by paroxysmal sleep disorders.

In clinical practice, the problem of accurate differential diagnosis of syndromes of non-epileptic sleeping and epileptic genesis syndromes has not yet been solved. And without such differentiation it is extremely difficult to choose adequate treatment tactics.

Paroxysmal disorders of different genesis occur in the phase of slow sleep. Sensors attached to the patient to read the activity of nerve pulses show specific patterns that are characteristic of this condition.

Separate paroxins are similar among themselves in polysomnographic characteristics, as well as clinical manifestations. Consciousness when finding in these states can be impaired or saved. It is observed that the paroxysms of non-epileptic nature bring more suffering to patients than epileptic attacks.

Epileptic attacks with convulsive manifestations in a dream are often found in children. They arise in connection with the violation of intrauterine development and with the action of harmful factors that influenced the development of the baby in the first months of life. In children, the children have a functionally immature nervous system and a brain, which is why they have the rapid excitability of the central nervous system and the inclination to extensive convulsive reactions.

Children is an increased permeability of vascular walls, and this leads to the fact that toxic or infectious factors quickly cause brain edema and a convulsive reaction.

Neepileptic attacks can go to epileptic. There may be many reasons for this and not all of them are led by studying. The diagnosis of epilepsy to children put only five years, subject to unanimous heredity, good health of parents, the normal development of pregnancy among mother, normal uncomplicated birth.

Neepileptic convulsive seizures arising during sleep may have the following etiology: asphyxia of newborn, congenital development defects, hemolytic diseases of newborn, vascular pathologies, congenital heart defects, brain tumors.

As for adult patients, the method of polysomnography is used for the diagnostic differentiation of paroxysmal disorders in combination with the video monitoring during sleep. Due to polysomnography, changes are recorded on EEG during and after an attack.
Other Methods: Mobile Long EEG ( telemetry), a combination of long-term EEG monitoring and short-term EEG registration.

In some cases, for distinguishing paroxysmal disorders of different genesis, a test anti-wuel treatment is applied. Study of the patient's response ( lack of changes or binding), makes it possible to judge the nature of paroxysmal disorder in the patient.

Before use, you must consult with a specialist.

The most famous and dramatic view epileptic attacks are generalized convulsive seizures. A convulsive epileptic attack can be primary or secondary-generalized. The development of a generalized convulsive attack may be preceded by certain symptoms that are called the name of Odrma, or the harbinger. It may be a common discomfort, anxiety, aggression, headache, irritability, etc. The forerunners arise in a few hours or days before the development of a generalized convulsive attack, but they may be absent.

The second-general-generalized convulsive attack is preceded by the offensive of the Aura (the feeling of the unreality of what is happening, discomfort in the area of \u200b\u200bthe stomach, visual or auditory sensations, the sensations of non-existent odors, more often unpleasant, etc.). Aura is part of the attack preceding the loss of consciousness that the patient remembers after the end of the seal. Aura is usually short-term, lasts only a few seconds, but for the patient the value of the aura is very large, some sick manage to protect themselves - call for help, sit on the floor, stop the car. Stereotype (repeatability) Aura from the attack to the rose allows epileptologist's doctor In some cases, decide on the localization (location) of the epileptic focus.

With primary-generalized convulsive attacks, Aura does not happen, these attacks are dangerous with their suddenness. Most often, these krops develop in the structure of idiopathic generalized epilepsy, more often in the morning after awakening, seizures often occur in a dream. The attack, as a rule, begins with a loud cry, there is a voltage of the muscles of the whole body, the teeth are sprinkled, the lips are tightly compressed, the bite of the tongue is possible. There is a short-term respiratory stop with the subsequent appearance of a cyanosis (skin sinusiness). Then develop rhythmic twitching of the muscles of the body and limbs. The attack is usually stopped spontaneously after 1-5 minutes. It is very important to be able to provide adequate help. As a rule, this form of epilepsy is well amenable to treatment with anticonvulsants who appoint epileptologistAgainst the background of adequate treatment, it is possible to achieve complete remission of seizures. To appoint adequate treatment of this form of epilepsy, the information obtained during EEG monitoring sleep. In all cases, but, especially, with suspected idiopathic generalized epilepsy, the recording continues within 10 minutes after the patient's awakening, it is precisely in this period that epileptiform activity.

Problems associated with the diagnosis and treatment of idiopathic generalized epilepsy (IGE) in adults were investigated in 114 patients adult age. IHE amounted to 9.5% of all forms of adult epilepsy. The IHE structure included the following forms of epilepsy: Youthful myoclonic epilepsy (YUME) - 42% (n \u003d 48), Youth Absanter epilepsy - 12% (n \u003d 14), Children's Absanle epilepsy (DEE) - 8% (n \u003d 9), IHE With an unknown phenotype - 38% (n \u003d 43). Late diagnosis of IHE (maximum 68 years) is marked in 1/3 (n \u003d 32) patients. The main reasons for the late diagnosis of IHE were ignoring of absans and myoclonic seizures (n \u003d 21), erroneous diagnosis of focal epilepsy (n \u003d 16).
Most patients under study prepared carbamazepine treatment. This was the main reason for the ineffective treatment and severe IHE treatment. Pharmacoresistan-tight epilepsy is diagnosed in 10% of patients. 75% of patients were in remission of epilepsy lasting 5-13 years, but continued to take anti-epileptic therapy. Cancellation of treatment is undertaken in 46 patients. The best results were obtained in patients with DEE (relapse of attacks from one of 6 patients). The least favorable results were obtained in patients with IGA with an unspecified phenotype (recurrence of attacks - 60%). Satisfactory results of treatment in adult patients IGE (achieving clinical remission) were obtained in 70% of cases, but the cessation of treatment in these patients remains a serious problem.

Keywords: idiopathic generalized epilepsy, adults, diagnosis, treatment.

The Study of IDIOPathic Generalized Epilepsies (IGE) include 114 Adult Patients. The Share of Igé Cases Was 9.5% of All Forms of Adult Epilepsy. The Structure of IgE WAS AS Follows: Juvenile Myoclonic Epilepsy (JMM) - 42% (n \u003d 48), Juvenile Absence Epilepsy (JAE) - 12 (n \u003d 14), Childhood Absence Epilepsy (SAE) - 8% (n \u003d 9 ), IgE with Indefinite Phenotype -38% (n \u003d 43). Late Diagnosis IgE (TAX - 68 YEARS OLD) WAS Identified For 1/3 (n \u003d 32) of patients. The Main Causes of Late Diagnosis Ige Were and Failure to Recognize Absence and Myoclonic Seizures (n \u003d 21) or missed Diagnosis of FOSAL Epilepsy (n \u003d 16).
The Main Cause of Noneffective Therapy or Severe Seizures Was Therapy Bow Carbamazepine. Pharma-CoreSistant Epilepsy Was Diagnosed in 10% of patients. Remission of 5 to 13 Years Was Detected in 75% of Patients, Though Those Patients Had Still Bade Taking Drugs (AED). Therapy Was Discontinued for 46 Patients and Best Results Were Achieved in Patients Were (Seizures Relapse Appeared In 1 of 6 Patients). The Worst Results Were Observed in Patients with Ige Indefinite Phenotype (Seizures Relapse in 60% of Cases). In General, SatisFactory Results of Aed Therapy (Seizure Remission) Were Achieved in 70% Adult Patients. HOWEVER, Discontinuation of Aed Therapy for Those Patients with Ige Remains and Problem.

Keu Words: IDiopathic Generalized Epilepsy, Adults, Diagnostics, Treatment.

As the age increases in the population of patients with epilepsy, the proportion of patients with idiopathic generalized epileps (ISE) decreases, the absolute majority of which is characterized by the age-dependent debut; At the same time, the proportion of persons suffering from partial SIM-Ptomatic and cryptogenic forms of epilepsy increases. Most of the ISG shapes are distinguished by a beneficial prognosis and high efficiency of valproic acid preparations. That is why the ratio of IHE / PTE, which constitutes the 20/60 patients in the children's population, in the adult population changes in favor of the latter, making up for various data 10-20 / 80-90, which may be explained by the greater re-distribution of partial attacks to treatment, i.e. Less probability of remission. One to a certain circle of problems associated with IHE, an hour that was not solved in a timely manner, remains for many years, sometimes for life.

In accordance with the data obtained in the process of operation of the epileptological office of KLO Monica, the share of patients with IGA on the total number of patients with epi-leops for the Moscow region adult population is 9.5%: only 114 people (48 women and 66 men) aged 18 Up to 68 years old with durability of 1.5 to 60 years (on average -16). Active epilepsy is observed in 30% (O \u003d 38) of them, the remaining patients have a medicated remission of different duration. The ratio of the shapes of IHE looks as follows: UME is 42% (O \u003d 48), DEE - 8 (O \u003d 9), Youth Absanter epilepsy - 12 (O \u003d 14), IGE with an unidentified (variable) Feno-type - 38% ( O \u003d 43).
The most common problems in this patient cohort: an unusually late debut of IGE, non-adequate diagnosis of the form of epilepsy in childhood, long-term inadequate therapy, pharmaco-resistance of attacks, recurrence of the disease after canceling therapy, differential diagnostics with non-epileptic states.

Unusually late diagnosis of children's and juvenile forms of epilepsy after 20 and even 30 or more years have been marked more than 30% of patients observed. Part of them had in essence relapse of an undiagnosed previously diseased disease after a long spon of Tanne remission, which lasted over 5 years (n \u003d 11).

Clinical Primep.

Patient A., 30 years old. Complaints for repeating one year with a frequency of 1-2 times a month attacks in the form of loss of consciousness and seizures arising in the morning after waking up; Racing cramp usually precedes shuddering hands. In the history of short rare episodes of shuddering hands aged 19-20 during the service in the army, which spontaneously stopped without treatment. When conducting video-EEG monitoring sleep monitoring, typical changes, characteristic of UME, while falling asleep and awakening, in the background, generalized high-amplitude outbreaks of peak and polypics-wave complexes with a predominance of the left duration of 1.5 to 3 s are occurring. The prescribed therapy of the Depakin chrono in a dose of 25 mg / kg led to a mustache electric clinical remission observed within 1 year.
Perhaps, in this and similar observations, the length of the clinical remission was not true, Pos-Kolch a long period of life was not observation of the patient, including EEG was not registered. According to Panayiotopolus et al. (1991), despite the well-developed UME criteria, the percentage of diagnostic errors remains high due to insufficient attention from major and doctors to myoclonies and variability of EEG-Pat-terns of this disease. Non-specificity of EEG changes in UME in many cases and the characteristic youth of focal changes are emphasized by many researchers.

Another part of patients with late diagnosed IHE (O \u003d 32) are those cases when active epilepsy proceeded for many years and even decades under the mask of another form of the disease. In particular, often typical generalized attacks (absans and MiOk-latonic paroxysms) were regarded and treated as partial. The main reason for this was the absence in the history of the disease of patients, long-suffering IHEs, differentiation on the form of epilepsy and types of priests, dominance of the formulations of "epilepsy" or "episindrome", "attacks by the type of absansuses". The most ignored both sick and doctors with the type of stupes were myoclonic acids: myoclonies of hands (n \u003d 16) and century myoclonies (N \u003d 5) within the framework of UME and Sind-Roma Dzhivons. Almost all the history of the disease contained the defects of recording and interpretation of the EEG, or the EEG study was not carried out at all, or the EEG records were lost. In most patients of this group, treatment was carried out by carbama-dye drugs in monotherapy or polyterapetes, which is not only not justified, but can provoke attacks at IGA. All this explains the unjustified post-day diagnosis of IGE, the absence of a differentiated approach to anti-epileptic therapy, its inadequate and, as a result, long-term persistence and formation of difficult attacks.

Clinical Primep.

Patient P., 31 years old. Debit epilepsy in the age of 13 years from a generalized convulsive attack (GSP), which has developed suddenly, after awakening. When applying to the doctor, the epilepsy was immediately established and therapy was prescribed therapy, which was held constantly until 31 years with a periodic dose correction (the maximum dose of 600 mg per day).
Stereotypical GSPs were repeated exclusively at the time of awakening with a gradual increase in time: from 1 time per month in the debut of the disease to dozen per month, and periodically - to daily attacks by 29 years, when the patient appealed to Monica.
In case of inspection of violations in mental, somatic and neurological status, it is not marked. The EEG presented is several short routine records (no more than 5 minutes) - typical patterns of epileptiform activity did not contain. The painting of the MRI brain corresponded to the norm.
When performing video EEG monitoring during night sleep, a normal background activity was recorded in a combination with single short gene-rally high-amplitude discharges of peak, dubble- and polypics-slow wave, in the morning hours forming into more regular and long-term flashes up to 1, 5 with a frequency of 3 Hz. On the 1st and 2nd min. hyperventilation synchronously with flashes registered 2 episodes of the establishment of eyeballs with secondary blink (a typical absanse pattern with a MiOk-laton component) (Fig. 1) On the 20th minute after waking, a generalized convulsive attack of GSPs was developed synchronously with the EEG pattern Gsp.

Fig. 1. EEG patient P., 29 years old. On an unchanged background, periodically arising outbreaks of the general-dimensional bilateral-synchronous activity of a peak-slow wave with a frequency of 3-3.5 Hz, an amplitude of 250-300 μV and a duration of 3-5 C - a typical absanse pattern are recorded.

Thus, the clinical picture and the character-ristal EEG corresponded to the diagnosis of YAE, which manifested by GSP and typical absans; The presence of the last patient did not know. For 16 years, Finlepsin therapy was carried out, which led to the formation of severe, difficult epilepsy. Against the background of therapy held for two years (Necha-la Depakin Chrono in a dose of up to 3000 mg / day in mono-therapy mode, then Depair Chrono 3000 mg / day in combination with a Topiramom of 300 mg / day) Sustainable remission succeeded. Against the background of the last combination of AEP (Depakin Chrono, rare GSPs are preserved in a combination with topiramat).

To the category of difficult or drug-resistant os, we include 13 (10%) observations (YAEE - 2, YUME - 3, IHE with an unidentified phenotype - 8). As is known, the feature of the IHE is the high sensitivity of the attacks at all without exception of the forms of epilepsy to the drugs of val-acic acid, in the treatment of which remission is up to-stink at 70-75% and a significant improvement in 20% of cases in patients of children's and adolescence.
For the treatment of difficult epilepsy epilepsy with a non-sufficient clinical efficacy of valproic acid preparations used in the maximum dose, we used combined therapy, including platforms and topiramate (at a dose of 200-400 mg / day in 8 patients), hollows and levethiracets (in a dose ~ 3000 mg / day in 5 patients). The first combination Pose-was effectively monitoring resistant Mio-clonic and gerallized convulsive seizures, the second is all three types of attacks. It should be noted that the achievement of clinical remission in 7 patients of both groups has not correlated with an electric remission, which, with most shapes, IHE is often associated with an unfavorable forecast and a high probability of recurrence of attacks after the abolition of anti-epileptic therapy. In three patients, there was a significant impetuation of the attacks, but it was not possible to achieve complete remission.
Most patients with IHE (N \u003d 75), turning to the epileptologist, had a long clinical medical remission (more than 5 years, maximum 13 years), continuing to constantly accept the appointed therapy. An attempt to cancel treatment was the case of most of them. Reducing the dose of hollows was carried out no faster 250-300 mg once a month under the control of the routine EEG record. Unfortunately, not in all cases it was possible to conduct video-EEG-Mo-Nutoring before canceling therapy. With this we associate the recurrence of seizures in part of patients, apparently unfinished electro-clinical remission. Reliable dependence on the resistance of clinical remission after the cancellation of therapy and the duration of medicine-tousine remission various forms Igé celebrated, but not. The best indicators are stated in patients with DEE. The recurrence of GSPs appeared at one of the 6 patients with a decrease in the dose of hollows by 50% of the is-running. Of 8 patients with YUA, two attacks have become new in the first 6 months, one - after 14 months. After canceling treatment. The rest of the patients with a mounted diagnosis of UME and IGE with an indefinite phenotiff in 60% of cases of complete cancellation of the AEP could not be achieved due to the resumption of attacks or the appearance of epileptiform activity on the EEG, registered during the cancellation of treatment or in the first months after it Completion. On average, the best results were achieved in patients who have the presence of electric clinical remission was confirmed with many hours of EEG monitoring. Our experience is under-talking that the abolition of anti-epileptic therapy in adult patients with IGA requires a more thorough control of EEG with the phased EEG of the monitoring of monitoring both in the process of selecting therapy and when adhere to the discontinuation of therapy and with gradual abolition of drugs.
Sometimes there was a need for a differential diagnosis of IHE with somatic diseases.

Clinical Primep.

Patient with., 68 years old. Diagnosis: Children's Absanter Epilepsy. The status of absissues. From the anamnesis it is known that at the age of 8-9 years, gene-rolled convulsive attacks, which in the distance dominated in the distance clinical picture Disease-Vania throughout life. Indications for the presence of absansons in the history was not (perhaps the patient did not remember about them). The frequency of attacks in adulthood waters was high - up to 7 or more attacks per month. For many years, the patient was treated with diphenin (300 mg / day) and phenobarbital (300 mg / day). After 60 years have appeared side effects (According to the patient), an-tiepileptic therapy in the form of violations from the stroke of the gastrointestinal tract, and therefore the dose of the received AEP was reduced twice and carbamazepine was added to the treatment at a dose of 300 mg / day. The frequency of GSPs with age gradually decreased to 1-2 per year (WHO, attacks occur more often, but since the pain lived alone, they could remain unnoticed). However, the states appeared, during which the Pear Entka for several days (from 3 to 7) became sluggish, inhibited, practically did not get out of bed, did not take food, the contact with it was difficult. Conducts were regarded as manifestations of discirculatory-like encephalopathy. The appointed vascular therapy turned out to be ineffective. The states were interrupted outside, as developed. After the patient's appeal to the epileptologist, KLO Monica was carried out by an electro-trochephalographic study, in which almost continuous generalized bilateral-synchronous high-amplitude peak was detected - wave activity with a frequency of 3 Hz - pattern of typical absissues status (Fig. 2) . The absax remission was achieved against the background of the therapy of the Depaakin chrono at a dose of 20 mg / kg / day.

Fig.2. EEG patient S., 68 years old. Throughout the era of the recording, frequent and practically continuous (after 3-5 seconds) of the outbreaks of generalized bilateral-synchronous activity of the peak-slow wave are registered with 3-3.5 Hz - the pattern of the status of typical absansines.

In general, therapy of IHE in adult patients, despite the transient complexity and shortcomings of preceding treatment, can be assessed as highly efficient. Satisfactory control of the attacks is achieved in 70% of cases, but the forecast for the abolition of therapy in most cases remains pretty-but serious.

Bibliography

1. Mukhin K.Yu., Petrukhin A.S. Idiopathic generalized epilepsy: systematics, diagnosis, therapy. - M.: Art Business Center, 2000. - from 285-318.
2. Mukhin K.Yu., Petrukhin AS, Glukhova L.Yu. Epilepsy. Atlas of electro-clinical diagnostics - M.: Al-Vares Publishing, 2004. - C.202-240.
3. Petrukhin A.S. Epileptology of children's age: guide for doctors. - M.: Medicine, 2000. - P. 44-62.
4. Janc D. Juvenile Myoclonic Epilepsy // In: DaM M., Gram L. (EDS). Complensive Epileptology - New York: Raven Press, 1991. - P.171-185.
5. Loiseau R. Childhood Absence Epilepsy // In: Roger J. ET AT (EDS) Epileptic Syndromes in Infancy, Childhood and Adolescence - London: Libbey, 1992. - R. 135 -150.
6. Panayiotopolus S.R., Tahan R., Obeid T. Juvenile Myoclonic Epilepsy: Factors of Error Involved in The Diagnosis and Treatment // Epilepsia - 1991. - Vol. 32. - R. 672-676.
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Among other diseases of the nervous system, generalized is among the most common diagnoses. The disease is characterized by stereotypical seizures that are periodically repeated. In the frequency of occurrence, epilepsy accounts for up to ten percent. Epileptic seizure due to the occurrence of pathological discharges in the brain, they manifest themselves as temporary disorders of thought, vegetative, sensitive and motor functions. Although many people are confident that epilepsy is impossible to cure, such a judgment of medicine considers erroneous. Applying modern anti-epileptic drugs, it is possible to completely eliminate the attacks of approximately sixty-five percent of patients. In addition, twenty percent of the seizures of the attacks are significantly reduced.

Here the basis of treatment is daily long therapy, moreover, regular medical research and inspections are required. The reasons for the development of the disease are classified, since it is allocated symptomatic epilepsy, idiopathic, and cryptogenic. With symptomatic, the structural brain defect is detected, it may be a tumor, malformations, hemorrhage, cyst, and so on. Epiopathic epilepsy implies a hereditary predisposition, there are no structural changes in the brain. With cryptogenic epilepsy, the reason remains unexplained, but the doctor in any case assigns treatment that ensures the desired results, and the disease retreats. The main thing in the treatment of epilepsy is timeliness.

Epileptic seizures can vary from generalized seizures and to minor changes that are barely noticeable for others. The attacks are focal, due to the appearance of the discharge of electricity in the cerebral cortex. If both hemispheres are simultaneously involved in the category, this is an example of a generalized epilepsy. Focal attacks are characteristic of peculiar sensations, cramps, numbness in certain parts of the body. This refers to the hands, legs, face, or other parts of the body. At the same time, the manifestation of focal seizures in short hallucinations, they are olfactory, taste, auditory. With such attacks, the patient has consciousness preserved, and a person can describe what it feels.

Generalized epilepsy is divided into dismissed and convulsive. Usually the surrounding especially frightening seems generalized convulsive epilepsy. In the tonic phase of the attack, muscle tension is observed, breathing shortly stops, often the patient shrirly shouts. In some cases, during an attack, a language may be born. The clonic phase is observed about fifteen seconds, there is an alternate tension and muscle relaxation. In addition, clonic
Clevless generalized epilepsy is accompanied by attacks called absans. Basically, they are observed in children, may be in early youth. At the same time, the child suddenly freezes, the look is directed at one point, it seems missing. Sometimes at the same time takes off the eye, a slight throwing of the head, the eyelid trembling. The duration of such attacks to a few seconds, and sometimes they simply do not notice. Fabd is often completed by incontinence of urine. Termination of seizures occurs arbitrarily, then there is a post pricier period. It is characterized by drowsiness, confusion of consciousness, then a headache arises, then the patient falls asleep.

Currently, specialists are excreted to forty different types and forms of epilepsy, and in connection with this, for each form, doctors are prescribed a separate therapeutic scheme. Therefore, the doctor is so important that not only the diagnosis was made, but also detected exactly the form of epilepsy. As the main diagnostic methodology, tomography is currently applied, magnetic resonance or computer. In addition, the EEG record is applied, no more than fifteen minutes are distributed in conducting mass studies. Most specialists note that EEG is distinguished by maximum informative, which is a conventional electroencephalogram recorded for a long timeIn some cases up to twelve hours. The time of wakefulness and sleep is included in the study.

If a woman suffers, antiepileptic therapy is appointed to her, and at the same time the patient plans pregnancy, she must provide a doctor, pass a number of additional research to avoid complications. It is possible that the beneficial course of pregnancy will require the change of therapy,. The doctor will select other drugs that will not harm the development of the fetus. Maybe drugs will not be canceled, and the dose will be changed. If possible, you should contact the doctor, having experience doing such pregnancies. In addition, before the occurrence of pregnancy, the patient must be in the medical and genetic consultation.

How to do if you found signs of this disease, or generalized epilepsy diagnosed from your loved ones? Neurologist should be engaged in treatment. If the attack arose for the first time, the patient has a breath, or its duration for more than five minutes, call an ambulance. In addition, it is necessary to delete all solid items if there are close to the patient. A person needs to put on the side, under the head put a soft object, but it should be flat. During the attack of epileptic patients should not be attempted to hold. Note when the attack began, as it is necessary to set its duration. The choice of antiepileptic drugs is made taking into account the form of the disease, the nature of the attacks. It should be remembered that independent treatment is not allowed, the therapy must be appointed by a doctor!