Epilepsy and epileptic syndrome

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In complex absences, loss of consciousness is manifested in combination with various tonic and vegetative components. Complex absences are a bit more complicated than normal absences, loss of consciousness lasts longer (20-30 seconds), and falls are more common. Such attacks, which appear without any aura, cause the patient many injuries. Also, complex abscesses are manifested by various automatisms, i.e. the patient says something to himself, makes some gestures with his facial muscles, performs various unconditional movements with his limbs. During automatics, the patient loses consciousness, does not know what he is doing, and does not remember.

Febrile attacks. Attacks that occur when the body temperature rises are called febrile seizures. Febrile seizures occur in children aged 6 months to 5 years. The most common period of the disease is 1-2 years. Elevated body temperature is often associated with upper respiratory tract infections. Seizures if medications are taken to lower body temperature; attacks will also stop. Febrile seizures are primary-prevalent epileptic seizures characterized by tonic attacks. Febrile attacks are always accompanied by loss of consciousness. However, they are among the mildest epileptic seizures. Because the prognosis in this disease is almost always good. Focal attacks are not unique to him. The earlier the febrile seizures start, the sooner they disappear. The number of febrile seizures decreases as the child gets older. Usually, febrile seizures stop before the child is 6 years old. Sometimes epileptic status develops and the child's life is in danger. There is no consensus that febrile seizures may progress to other epileptic seizures. If a child with febrile seizures has structural changes in the brain and neurological disorders, especially in the offspring with epileptic seizures, if seizures are repeated, other types of epilepsy are more likely to develop later. Such patients are often diagnosed with sclerosis. In them, febrile seizures can progress to Lennox-Gasto syndrome.

Diagnosis. Not all doctors experience the first epileptic attacks in a patient. That's why diagnosing epilepsy almost always starts with a thorough medical anamnesis.

A doctor who has not seen the attacks observed in a patient with his own eyes will certainly come to an opinion after a thorough examination of the anamnesis of the disease. Here, the information of the doctor who has treated the patient before and seen the attacks once or twice, especially the neurologist, is very important. Therefore, the chronology of epileptic seizures should be detailed in the medical record or biography. Accurate and detailed information provided by the doctor who treated the patient first is very important for the doctors who will treat the patient later.

Subjective data and anamnesis. When diagnosing epilepsy, the doctor faces the following 2 questions.

1. Has the patient had an epileptic attacks or other condition?

2. What is the type of epileptic attacks and what is the cause?

To clarify these questions, the patient and his relatives are asked a series of questions, and in parallel, a medical history is collected.

Questions for diagnosing epileptic attacks:

• Did the patient lose consciousness?

• Was he wheezing?

• Has he stopped breathing?

• Did he shout during the attack?

• Were aura messengers observed?

• Is there a bloody foam in the mouth?

• Did he lose his eyesight, shake his head, or turn to the back or sides?

• Were there any tremors in the limbs?

• When did the attacks occur: at bedtime, early in the morning, during the day or at night?

• Approximately how long did the attacks last?

• Did the patient fall into a deep sleep when he regained consciousness?

• Has this happened before?

Questions to identify absences:

• Does he stare at a point?

• What is the condition of the eyes during an attack?

• Head, body and limbs?

• How long does the sensitivity last?

• What is the patient's condition after the attack?

• Does he feel aggressive?

• How many times a day (week or month) do the attacks recur?

Here we have raised questions about the most common types of epileptic seizures, including the identification of abscesses. The length of the answers to these questions will help clarify the question of whether an epileptic seizure has been observed in a patient. After answering these questions, the doctor moves on to the next stage of diagnosis, which is to determine the type and cause of epileptic seizures. This should be based on subjective symptoms, anamnestic data, somatic and neurological status, laboratory tests, EEG, CT and MRI data.

Anamnestic data:

• Do any family members have epilepsy?

• Were there any febrile seizures in early childhood?

• What complications were observed during fasting?

• Have you had any brain diseases (brain injuries, meningitis, encephalitis)?

• Do you currently have tuberculosis sclerosis, brain abnormalities?

• Have you had any brain surgery?

• No endocrine diseases and various metabolic disorders?

• When and after what was the first attack?

• Are you not taking medications that aggravate epileptic seizures?

The physician reviewing the anamnestic data is listed above

ask questions to the patient and his relatives and thoroughly study the information on the medical record. The absence or presence of a history of disease does not rule out a diagnosis of epilepsy. Because if epileptic seizures are observed but the cause is not identified, a cryptogenic epilepsy is diagnosed.

Electroencephalography. EEG is of great importance in diagnosing epilepsy. It is important to distinguish between physiological (normal) and pathological waves when performing these tests. Acute waves, spikes, and peak-wave complexes that appear on the EEG are the main epileptic waves. No additional screening methods are important at the EEG level in the diagnosis of epilepsy. EEG can not only differentiate epilepsy from other paroxysmal conditions, but also determine the type, severity, treatment outcome, and prognosis of epileptic seizures. EEG video monitoring data increase the diagnostic value of this method.

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