EPILEPSY

EPILEPSIA is a chronic disease caused by CNS damage; Manifested seizures and specific personality changes. Convulsive seizures are divided into large and small. A large (generalized) convulsive fit is an acutely occurring attack with tonic and clonic convulsions and a comatose obscuration of consciousness. The development of a seizure is often preceded by an aura - a brief (a few seconds) obscuration of consciousness that occurs immediately before a large convulsive seizure, which can be accompanied by various deceptions (visual, olfactory, etc. hallucinations) and autonomic paroxysms. As a rule, feelings experienced during the aura are stored in memory. In the tonic phase of a large fit, the patient loses consciousness, with a cry (due to a convulsive contraction of the muscles of the larynx), the body and limbs are cramped. The tongue is bitten, the breath stops, the face pales, then becomes cyanotic, the pupils do not respond to light, consciousness is completely lost (coma). After a few seconds the clonic phase of the seizure begins: convulsive twitching of the muscles of the limbs, neck, the release of foam from the mouth, often involuntary urination. Breathing is restored only after cramping. Exit from the coma passes through the stage of stunning, when the twilight frustration of consciousness can develop, after which deep sleep occurs. The help to the patient during a seizure is reduced to that as much as possible to protect it from a trauma and aspiration of a gastric contents. The patient is placed on a bed or floor, if possible on his side, remove all surrounding sharp objects. You should not try to prevent a bite of the tongue by placing an object between the teeth, as the result of this activity is more often the broken teeth. The introduction of diazepam (10 mg intravenously) is usually required when the duration of the generalized tonic-clonic seizure exceeds 5 minutes.

A small epileptic fit is a short-term loss of consciousness, which can be accompanied by clonic seizures of individual muscles; Patients usually do not fall, but their face turns pale, the look stops. After a seizure, which can last from a few seconds to a minute, amnesia also develops.

There may be other forms of seizures that mimic various somatic symptoms: visceral seizures suddenly show short-term sharp pains in the abdomen, sometimes with nausea, flatulence, drooling, etc. To correctly diagnose epileptic seizures, the following symptoms should be considered: paroxysmal nature, sudden onset and short-term course (no longer than 1-2 min), their recurrence with the same symptoms, accompanying specific personality changes or epilepsy-related mental disorders. Myoclonus-epilepsy is manifested by brief convulsive twitching of the muscles without losing consciousness.

The frequency of seizures is supposed to be indicated in the diagnosis of the patient with epilepsy; The criteria are as follows: 1 fit per year - rare, once a month - medium, once a week - frequent.

With a long course of the disease, the patient develops certain psychological traits, which are specific changes in the personality ("epileptic character"): the circle of interests is narrowing, the patients become selfish, picky, petty; Coldness to others is masked by ostentatious courtesy and sugacity; Easily transitions from flattery of obsession to malice and aggressiveness, violent rage; At the same time, they are characterized by inertia, rancor, vindictiveness; Thinking becomes "viscous", with a tendency to detail. With prolonged and unfavorable course of the disease, epileptic dementia develops .

Specific somatoneurological disorders, characteristic only for patients with epilepsy, do not exist. Among them, more common people with dysplastic physique; On the body of the majority of long-suffering people, traces of various injuries or burns, obtained during convulsive seizures, scars in the language from multiple bites, etc., are usually found.

Prognostically unfavorable signs are: the early onset of the disease, the presence of small seizures, the tendency to serial large seizures and the emergence of epileptic status, impaired consciousness in the post-fatal period, the frequency and severity of twilight disorders of consciousness.

Prophylactic recommendations: prevention of craniocerebral injuries, infections, intoxications; Ensuring the normal course of pregnancy and childbirth; Prevention of marriage in the case when both spouses suffer from epilepsy.

Treatment of epilepsy should begin as early as possible, be complex and individual, long and continuous. It is based on the use of anticonvulsants, which lead to a reduction or complete cessation of seizures, to the relief of their manifestations. In epilepsy, which occurs with large seizures, first of all, use: phenobarbital , diphenin , chloracon, didepyl, hexamidine, benzonale. In recent years, mixtures are used, the basis of which is phenobarbital : a mixture of Sereisky, gluferal and paglyuferal. In case of insufficient effect additionally (in various, individually selected combinations and doses), preparations of other chemical groups, for example, finlepsin (tegretol) are prescribed. For small seizures, trimethine, picnolep- sine, sulex, and seduxen are used. The effectiveness of the same drugs in different patients may not be the same. The question of discontinuing drug antiepileptic treatment is considered only 2 to 3 years after the last convulsive treatment and 1.5 to 2 years after the last small seizure. An important criterion in this case is the normalization of the EEG. The withdrawal of drugs is done gradually by slowing down the doses. Patients are recommended a diet with a limited amount of liquid, table salt, spices, coffee, cocoa and especially alcohol, the reception of which, as a rule, always causes more seizures.

Epileptic status is a condition characterized by the continuous following of convulsive seizures one by one without restoring clarity of consciousness. The epileptic status threatens the patient's life and is an absolute indication for the onset of emergency therapy and subsequent hospitalization with low effectiveness of the treatment being performed in the intensive care unit.

Emergency care on the spot (at home, in the street) should prevent or eliminate mechanical asphyxia due to tongue twisting or aspiration of vomit, to support cardiac activity and, if possible, to block seizures . To this end, it is necessary to release the oral cavity from foreign bodies, vomit, the introduction of an airway, intramuscular injections of cordiamine or caffeine, as well as stimulants of respiration - cititon or lobeline (camphor is contraindicated!). The complexity of treatment lies in the fact that not all measures can be successfully implemented, since convulsive seizures proceed one after another and interstitial intervals can be very short.

The drug of the first stage of choice for epileptic status is seduxen (sibazon, Relanium), which is injected slowly (intravenously (slowly!) From 2 to 4 ml of 0.5% solution to 20 ml of isotonic sodium chloride solution or 40% glucose solution. Approximately the same efficacy is possessed by rohypnol, which is administered via an ampoule (0.002 g of dry substance diluted with a special solvent) slowly intravenously. After 1 -2 h the dose can be repeated. To reduce hypoxia of the brain, 10-20 ml of a 20% solution of sodium oxybutyrate is injected intravenously.

Treatment in the ambulance car has the following objectives: further improvement of respiratory and cardiac activity; Temporary or persistent elimination of convulsive syndrome. Through the duct with the electric pump remove the contents of the upper respiratory tract. If necessary, intubation is performed, which allows for the complete drainage of the trachea. If injections of seduxen were ineffective or convulsions resumed, 2 ml of a 2.5% solution of aminazine and a lytic mixture consisting of 2 ml of 25% analgin, 2 ml of 0.5% novocaine, and 2 ml of 1% dimedrol are additionally injected intramuscularly.

In the intensive care unit, the next stage of treatment of the status epilepticus is already taking into account the nature of convulsive seizures - intensive therapy for the final elimination of convulsive syndrome, respiratory and circulatory disorders, normalization of the main parameters of homeostasis, withdrawal from coma.

The duties of the average medical staff in relation to patients with epilepsy are due to both current manifestations of the disease, and specific changes in the personality, "epileptic character." Work and communication with patients with epilepsy makes the highest demands on the professional and humane qualities of medical workers, demanding from them, among other things, extraordinary patience and equanimity.