Theme 8 Paroxysmal the disorder the consciousness: epilepsy ch and faintings

- chronic disease of brain, which is manifested by repeated epileptic fits. Morbidity by epilepsy composes 6-7 cases on The I thousand population. Etiology, pathogenesis and classification. Epileptic fit is developed as a result of the propagation of excessive neuron discharges from the center of epileptic activity to entire brain ([generalizovannyy] fit) or its part (partial fit). It can be the consequence of different diseases and pathologic states: 1) [pre]- and perinatal disturbances (infectious diseases in the period of pregnancy, ancestral injury, asphyxia of newborns and other); 2) the infectious diseases by CNS; 3) toxic defeat CNS (ethanol, carbon monoxide, lead, mercury, medicines and other); 4) craniocerebral injury; 5) cerebrovascular diseases; 6) [dismetabolicheskikh] of encephalopathy; 7) the tumor of brain; 8) hereditary diseases; 9) fever; 10) the degenerate diseases of brain. In these cases the disease estimates as [simpt]< > [maticheskaya] epilepsy. However, in majority (2/:!) the patients with epilepsy it is impossible to establish the etiology of disease that estimates as genuine, or idiopathic, epilepsy.

Clinical picture. A the disturbance or a change in the consciousness appears with the complex. Are separated two basic types of epileptic [pripad] of [kov]: [generalizovannye] and partial. frequently causing the bite of language. auditory. its jaws are compressed. which indicates the probability of the perinatal damage of brain. therefore them they call also focal fits. and also paroxysmal changes in the mental condition partial fits begin from the symptoms of the focus defeat of brain. With [MRT] in many patients with idiopathic epilepsy are revealed the decrease of the [nizhpe]. The [generalizovannye] fits can begin immediately from the loss of consciousness (primarily [generalizovannye] fits) or it they precede the signs of the focus disfunction of the brain (aura) in the form of olfactory. At the beginning of the fit of patient sometimes [izdaet] the cry. To the [generalizovannym] fits carry large1 convulsive fits and small fits or absences (simple and complex). Engine . then it loses consciousness and falls. Disease can develop at any age in the form of epileptic fit. partial fits with symptomatic epilepsy. respiration [ostanav]-[ipvaetsya] and frequently occurs involuntary urination. visual sensations. The primarily [generalizovannye] fits more frequently are observed with idiopathic epilepsy. entire his body on it [iryagaetsya].In the genesis of idiopathic epilepsy the roll is discussed! hereditary factors. The consciousness is not disrupted with the simple partial fits.medial divisions of temporal portions and a change [intensiv] in [nosti] of signal from them. Partial fits are caused by the local sections of overexcitation in the brain. In many patients only one type of fits is observed. The [generalizovannye] fits are manifested by the loss of consciousness with the spasms or without them.6% of patients they have family anamnesis of disease. because 3. Large convulsive fit it is manifested by the loss of consciousness and by involuntary engine activity.

but most frequently at first are observed the tonic spasms. but patient remains stunned. and then clonic. Absences they present the short-term (usually 2-10 s. however. and also headache. or is noted their alternation. body and extremities (clonic spasms). his muscles are weakened. On the completion of tonicoclonic spasms the respiration is restored. Against the background the high temperature of body in 3-4% of children are developed the short-term (to 10 min) convulsive fits (febrile fits). Absences begin in the childhood. frequently are observed twitchings century and the rhythmical (3 times second) motions of hands or it is finger. but more frequently composes a total of several minutes. At the age from 3 to 60 years large convulsive fits more frequently are caused by idiopathic epilepsy. pain in the places of injuries and in the language in the case on bite. overstressed during the spasms. Many patients after assault disturbs pain in the muscles. After 60 years the for the first time appeared large convulsive fits frequently are caused by cerebrovascular disease. sleepy and does not remember that it occurred with it.disturbances can appear only by tonic tension of the muscles (tonic spasms) of [pli] by the repetitive clonic twitchings of muscles of face. but patient remains in the unconscious state. which can on -[itoryatsya] with the appearance of fever at the childhood. only in 3% of children with the febrile fits subsequently is developed epilepsy. It continues to sit or to stand in the period of the fit of patient. Through several minutes consciousness [postanavlivaetsya]. respiration surface. Duration of the fit The I [shlichna]. During the drop and the spasms of patient it can obtain serious on [prszhdeniya] the heads and bodies. although with their debut at the age of older than 30 years substantially grows the probability of intoxication by ethanol and the tumor of brain. rarely more than 30 s) loss of consciousness. it is .

Simple of [absash] usually appear in the age of 4-8 years and frequently to [samostoyate]. Complex absences more frequently are combined with other types of fits and have the worse forecast.tonic motions (partial motor fit) or visual. disorderly walking and other automated motions) or hallucinatory phenomena. after 20 years. Complex partial fits about they proceed with the changed consciousness and are manifested by the outwardly coordinated and expedient motions ([prichmokivanie] by lips. masticatory or swallowing motions. rumors by [vymi] sensations. they bring) i to a drop in the patient in the period of assault. and on< 5 they continue. Fit continues from 10 s to 3 min. Simple partial fits flow with [sokhrane] of NII (Scientific Research Institute) consciousnesses and are manifested by the repetitive motions in one of the parts of the body. they can [khranyatsya]. but they pass to 20 years. which are sometimes applied to entire half of body ([dzheksonovsiy] march). also. gustatory. They usually become less frequent (but Quotient of neurology rarely they disappear completely) at the teenage period. . rotatory and [pozno]. extremity (partial sensory fit) or by nausea. although in those cases.more frequent at the age of 4-12 years. With complex [absap]< and appear involuntary motions or sharp [snizhensh] of postural tone (atonic absences). with which we” [shechnyy] tone does not lose and by patient does not fall. when they [sochstn] quarter deck with the large convulsive fits./[n]. with which against the background of complete consciousness are developed the clonic spasms in the separate muscular groups. KOI The I for the first time can develop large convulsive fit most frequently they are observed the simple absences. In let us lie | assault it ceases the accomplished by it actions. masticatory motions. Is most demonstrative [dzheksonovskii] the motor fit. without remembering about the assault. by vomiting and by profuse perspiration (partial vegetative fit). by numbness and by paresthesias in half of body.

. completely consciousness is not restored. The development of status is frequently connected with the sharp curtailment of the method of antiepileptic means. Sometimes status can be the first manifestation of epilepsy. febrile . Paroxysmal disorders of the consciousness walks rapidly and is not noted initial symptomatology.phenomena of depersonalization and [derealizatsii] (state “already of that seen” or “ never seen”).un. craniocerebral injury or another illness with the focus defeat of brain. however. of etiology and type of fits.. Myoclonic epileptic fits they are manifested By single or repetitive involuntary on by [dergivaniyami] of different groups of muscles (myoclonia). through the small intervals of the time of fits. in children there are favorable (simple absences. then partial fit it is complicated to distinguish of the primarily [m]'[peralizovannogo] large convulsive fit. stroke.the state. Epileptic status . Thus. and if this [prois]Theme 8. Lethality with epileptic status in the present time does not exceed 5% with the timely expert assistance. The course of epilepsy to the significant degree depends rel. with which is developed one prolonged (more than 30 min) partial or [generalizovannyy] fit or a series of those repeating after each other. its own body. by the sensation of the alienation of external peace. Partial fit frequently is caused by tumor. [epi] [lepticheskiy] genesis of which they confirm with the electro-N [tsefalografii]. In the interruptions between the fits of patient it can react to the stimuli and even carry out the simplest instructions. . Partial fit can pass into the large convulsive fit (for a second time [generalizovannyy] fit). Developed and the age of 10-30 years complex partial fits are more frequent i they ^[uslovlivayutsya] by idiopathic epilepsy.

is recorded with the tonicoclonic spasms with the electroencephalogram ( EEG ). although he indicates the need for thorough differential diagnostics with other illnesses (fainting. excessive punctuality. epileptic activity on EEG with the absence of fits does not serve as base for diagnostics of epilepsy. And vice versa. deteriorate memory and be reduced intellect. the daily deprivation of sleep. the exaggerated respect. their majority is developed and the period of 7-46 h after the curtailment of the reception of alcohol by those. [riod] epileptic activity they reveal only [u] 2/[z] of patients with the fits. After establishing the diagnosis of epilepsy. especially during the inadequate treatment. which reveals epileptic activity in the period of fit. who . The course of epilepsy without the treatment is frequently [progredientnoe] in adult. In many patients with epilepsy. detectability of epileptic activity rise with the use of different methods of provocation (rhythmical light stimulation. in the same time [ugodlivost]. hysteria and other). [mnogoslovnost]. by tendency toward the development of series of fits or epileptic status. which suppress normal basic rhythm. The absence of epileptic activity with the electroencephalography in the period between attacks does not exclude the diagnosis of epilepsy. migraine. which is manifested by gradual quickening of fits. registration during sleep and others). by the frequency of 3 Hz. Frequently large convulsive fits causes alcoholism. can develop deceleration and the pathologic thoroughness of thinking. a constant number of rhythmical Slykes or sharp waves. In P between attacks. [gi] [perventilyatsiya]. egocentrism . In the time of absence on EEG are observed rhythmical complexes peakwave. it is necessary to try to explain its reason.spasms and other) forms of epilepsy. can [sul]-[satsya] the circle of interests. Diagnostics of epilepsy is based on the fact of the presence of fits and the results of electroencephalography. foolishness. also.

is high probability those of the [kushchego] neurologic disease. which should be carried out by all patient. capable of causing injury. for example to attempt to put n the mouth between the teeth different objects for warning the injuries of language. the removal of the tumor of brain) or the elimination of toxic factor (to end the use of alcohol). one ought not to [okazy]-[nat] compulsive actions. It is plotted to the bed or to the floor. It is slow with epileptic status for stopping the spasms of [v]/[v]. With to [simptomati] [cheskoy] epilepsy is necessary the treatment basic [zabole] of [vaniya] (for example.suffer chronic alcoholism. The treatment of epilepsy includes aid with to [epilepti] [cheskom] fit. where they ensure the passability of the respiratory tract (introduction of air duct or the intubation of trachea).4 mg/kg (to 20 mH). give oxygen through the mask. they conduct monitoring acid-base state. and if status is not diluted. hemostasis and with the need correct them. and are moved away the objects. Relanium. for example the tumor of brain. If in patient partial fits are developed. is introduced Diazepam ([sibazon]. and the preventive maintenance of repeated epileptic fits. they ship patient into the resuscitation unit. In the case of continuing the fits of [v]/[v] are introduced the barbiturates (thiopental of sodium or [gekseial]). In warning of repeated epileptic fits the leading value they have the rational regime of labor and i . The leading value in the establishment of the reason for epilepsy have kt or [MRT] of the heads. the solution of phenytoin or [valproata] of sodium.25-0. In the time of large convulsive fit it is necessary to maximally fence patient from the possible damages. as far as possible sideways (to prevent the aspiration of emetic masses). who suffer epileptic fits. it is repeated with the need. Seduxen) at the dose of 0. which is especially important with epileptic status and large convulsive fit.

The work of patient must not be connected with a stay at the height with fire. The sharp cancellation of preparation even with its low effectiveness is dangerous by the development of epileptic status. its low concentration indicates the expediency [uveliche] of [niya] of dose for obtaining the clinical effect. [valproaty] ([depakin]) on 10-50 mg/kg/day or di phenin (phenytoin) on 5-10 mg/kg/day. and the regular method of antiepileptic preparations.[etosuksimid] ([suksilep]) on 10-25 [mg]/[kg]/[su] i and [valproaty] ([depakin]). then is assigned another preparation p they gradually abolish the first. the exception of other factors. ( [Ffekta] from the medicine can be investigated with the absence its concentration in the blood. the exception of the method of alcohol. If the frequency of fits is not reduced or appear side effects. gradually increasing dose from the initial to the average. Treatment begins from the method of one preparation. in this case the diagram of method must be maximally simplified. With the large convulsive and partial fits the preparations of selection Carbamazepin (Finlepsin) on 8-20 mg/kg/day. [gabapentin] ([neyrontin]) on 1200 mg/day. the guarantee of normal night the maximum. and also [lamotridlsin] ([lamiktal]) on 50-200 mg/day. The selection of antiepileptic means depends on with [padkov].>[tdykha].i it testifies about the absence of its effectiveness. preparations of reserve phenobarbital (luminal) of 2-4 mg/kg/day in adult and but 3-8 mg/kg/day in children. The combination with another preparation usually is used with the partial effect. high concentration is preparation. servicing of driving gears. which provoke fits. and with the absence of effect . with driving of automobile. With the absences [preshi] of [raty] of selection . With [mioklonicheskin] fits the preparations of selection [valproaty] ([depakin]) and Ben . the preparations of reserve [lamotridzhii] ([lamiktal]). Clonazepam on 2-6 mg/day. [TSHCH] [piramat] ([topomaks]) on 200-600 mg/day.

... If for a period of 3 years the fits of [otsug]” [stvuyut] against the background treatment. Faintings 7 5 Fainting (syncope) . to the delay of psycho-motor development in children. expressed of mental treasons” [niyakh]. . To cease treatment n” is recommended in the pubertal period..the sensation of the loss of consciousness .preliminaryi [tavlyaet] the lighter degree of this state.. Clonazepam. The method of preparations must be continuous and prolonged. Presyncopal or [lipotimicheskoe] ([presin]m crazy) state . which more frequently is used with the development in the cerebral cortex of epileptic center on yes! .short-term loss consciousness. Low by [effektim]” [nost] of antiepileptic therapy is more frequently noted with the partial fits. caused by the transient significant decrease [mozpzh]< ch blood flow. alarming disorders).. the preparation of reserve [lamotridzhii] ([lamiktal]). pathogenesis and classification.. then possibly gradually (into [techsshi] 1-2 years) under the control of electroencephalography it will decrease! ” the dose of preparations to the complete cancellation.. чащеу женщин.. [MRT] are positron [emissioppny] the laminography of head.[zodiazepiny].. Etiology.. electroencephalography.. With the absence of effect from the conservative treatment is discussed the possibility of the surgical removal of [epilech]! [ticheskogo] center. Dependence and g of the mechanism of the development of fainting them it is possible with that determined i [gspenyu] conditionality to divide into the neurogenic. During [K]1 they faintings appear almost [u] 1/з людей. the somatogenic and the psychogenic (hysteria.

to -1[pr]|>1[Y] is observed predominantly in the men of elderly and from the [glrcheskogo] age and can appear with the motion by willow and the inclinations of head back.Neurogenic faintings arise from the [neopti][Mnlnykh] vegetative and vascular reflector of reaction and depend on sharp reduction in the arterial [sawmilling as a result of the expansion of peripheral vessels ([pazomotornyy] fainting) and/or bradycardia ([vazovagal]-lliiiii fainting). Faintings with the defecation are possible. [Nikturicheskiy] nfiMopoK it is observed predominantly in the men of the average .. of . as a rule. The I [isvrogennym] carries also synocarotid fainting and [ppdrom] of hypersensitivity of carotid sine). which support the tone of peripheral 1|nH|) [iy]..1 name in the night time. fright). v young people in the period of the stress situations (form sprinkle. prolonged standing). stuffy accomodation. 1[itrastom] faintings appear more rarely or disappear entirely. the expressed fatigue. with the intensive pain by them the provoking physical factors (heat. Orthostatic fainting of [npuslovlen] by the insufficiency of reflector [simpatiche]-nuix the mechanisms. Which more frequently appear at the elderly and senile age not the background of bolt during the straining.. Cough fainting ([Sn]'[ttolepsiya]) usually is developed against the background expressed [tsnilya] with the bronchopulmonary diseases. it appears. Vasomotor fainting is encountered most It is pure (to 90% of all faintings). and as a result of this by a sharp drop in arterial [Ishiyuniya] upon sharp transfer to the vertical position m in a prolonged stay in the Ger.. the carrying of rigid gates -[NI]'[psov] and the tight tying of necktie.. habitable age afterward or (thinner frequent) in the time of [mocheispu]11. Fainting can the fuss to [kat] with the vegetative peripheral of insufficient 111 patients with the poly-neuropathy against the background of idiopathic the unit vector of static hypotension. the unexpected information.

To the loss of consciousness frequently before march the sensation of nausea and faintness. if with the appearance of the first symptoms has min” [mozhnost] to lie. During fainting with the prolonged and to [glu]” to the [bokoy] loss of consciousness are possible tonic (but . it loses consciousness and slowly not it gives (“it settles”). and also as a result of hypovolemia (blood loss. tamponade of [serdtsi]. amyloidosis. caused by reduction in the cerebral blood flow as a result of the sharp decrease of sulfurs of deck ejection. It can be caused by arrhythmia ( i [dochkovaya] tachycardia. prolonged bed rest or the method of some medicines (nitrates. pulse weak. Vasomotor fainting frequently in one and by the same pain foot is developed under the effect of the specific factor ([iy]< an example. feeling of the being approached loss of [sopi] | [niya] (presyncopal of state) it attempts to lie. atrioventricular blockade. Immediately after fainting of [kozhpy]! covers remain pale. In the period of fainting respiration and pulse of [oslm]” [bleny]. pupils are frequently extended by y and their reaction to the light is weakened. and patient does not usually lose ” knowledge. there can be nausea. muscular tone low. w \ [kogolizma].diabetes mellitus. Among somatogenic faintings most frequently of [vstrO] " [chaetsya] cardiogenic fainting. it appears only N vertical position. For all types of faintings characteristically rapid development. stuffy accomodation). For a while remains general they ate [bost]. heat. [Cheloipk] perceives weakness. If there is no such possibility . the shroud before the eyes. Clinical picture. loss of the clarity of thinking. arterial pressure low. vertigo. After several seconds or 1-2 min of the horizontal position of men are opened BY [GLV] after and rapidly it comes into itself. hypotension by them and the vasodilator means and other). [sip] [drom] of the weakness of sinus unit and others) or by the obstacle for blood flow in heart ([miksoma] of atrium. vomiting and others). hypertrophic cardiomyopathy and others).

caused by the hypo-i by [nikemiey]. tripod. Treatment. During the disturbance of consciousness. With the suspicion on penalties.not [yush] [nicheskie]) spasms.IX anamnesis it requires the exception of other types of [obmoro]-i i i i i . which is frequently manifested by the sudden loss of consciousness without the previous symptoms. but also of feeling of fear. It is possible to use with the need in . is shown the consultation of cardiologist. a EKG. is determined a decrease in the level of sugar into the blood and [prakteren] the regress of symptoms during the intravenous introduction i [pokozy]. in the form of paresthesia. The clinical analysis of the blood makes it possible to exclude 1[NSMIYU]. For more rapid [ppzvrashcheniya] of consciousness it is possible to sprinkle face by cold water. echocardiography and other studies. general weakness. fainting at the position lie The development of it degrades to the somatical. frequently is observed the alternation of the periods of recovery and loss with [shaniya].study. it is more frequent cardiogenic (arrhythmia) tin nature. to give for the inhalation the ammonium chloride of alcoholic. | ||>[tostaticheskiy] and synocarotid faintings are confirmed respectively by the result of orthostatic and blue of carotid test. It is necessary during vasomotor fainting The I to pack patient to the back and to raise feet. In the obscure cases for the the differential of [diagno]-i booms with epilepsy carry out electroencephalographic [shsledovanie] with the provoking epileptic fit tests (with fainting they do not reveal epileptic (naivete). tetany. Psychogenic faintings are frequently caused by hyperventilation and they are usually manifested by the prolonged i several minutes) by presyncopal state in the form not [golko] of faintness. Diagnosis vasomotor fainting it is based on it is given|. [kholterovskoe] [Moiitorirovanie]. to apply cold towel. shortage of air. to free neck and breast from the troubling clothing. hypoglycaemia and epilepsy. [diogennyy] fainting.

stomatological procedures) it is necessary to rapidly pack patient or to sharply incline him i to [vishche] downward. With the development of presyncopal withi [goyaniya] in connection with the medical procedure (taking of the blood or analysis.... in the cases of heart arrhythmia . To table Brief information about epilepsy and faintings Brief informatio n Epilepsy Fainting ..... faintings (cardiogenic. With others '. basic treatment directed on it is removed] the reason for [ortostaticheskoi] of hypotension... For the preventive maintenance of neurogenic by fainting rarely it suffices to avoid the provoking factors to remove them.the cases [znachitel]. With orthostatic fainting not of [sledup] [stro] to arise...Sh and against decreases in arterial pressure i [pmpatomimeticheskie] means (1%-[y] solution of Mezaton (phenylephrine hydrochloride). psychogenic and other) it is necessary! the treatment of basic disease...against -[fptmicheskie] the means.. 5%[y] solution of ephedrine)...

fever. the form of the blood and others) and in the vertical position . the infectious faintings). vegetative) and complex ( [vto]by the [richnym] disturbance of consciousness). [lektoriye]) fainting i Symptomatic epilepsy: [pre]. diseases.1 2 min) the loss of consciousness. [myshech]ache tone low.about[dolzhitelnyy] (more than 30 min) partial or [generalizovannyy] fit or the series repeating after each other fits.track [mshiya] . Vasomotor [pripa]dock frequently appears in one and the same patient with [oprede]the feudatory situations (stuffy accomodation. In [perio]/ fainting respiration and pulse it is considerable Clinical Primarily [generalizovannye] fits the picture (with the disturbance of [sozna] [niya] since the beginning of the fit): large convulsive (tonicoclonic) fits and absences (loss of consciousness to 2-10 s). Neurogenic ([ref] (partial fit). [tserebro]-vascular and [nikturicheskiy]. Idiopathic epilepsy. dismetabolic Cardiogenic (to [vazhu] encephalopathy. End table. the tumor of brain. Without the treatment in many cases the number of fits increases. 1[lektro][nshchefa]lorpa1AndThe II Epileptic activity in the period of fit Absence of epileptic and sometimes in the period between activity with fainting the fits Kt and [MRT] of head are necessary for the exception of tumor and for [dru]the [gikh] possible reasons for [epilep]the [ticheskikh] fits With the suspicion to the cardiogenic. [kashlsioy] cerebral injury. [gipoksichg] is [skiy] and is psychogenic faintings Rapid and [kratkovrs] [mennaya] (second . sensory.and vasomotor (90 % all perinatal disturbances. obstacle to [krovoti] ku the degenerate diseases the brain into the heart). by which frequently they precede [oshchu]> Q< [nie] of faintness.Reasons Propagation of the excessive neuron Be transienting of discharges from the center of [znachi] the body epileptic activity to entire brain decrease cerebral bloods ([generalizovannyy] fit) or its part flow. the shroud before the eyes. goal[vokruzhenie]. toxic defeat CNS [zovagalnyy]. [stvie] of arrhythmia or [nasled]the [stvennye] diseases. [sinoki] (ethanol and other). the skullbut[rotidpyy]. Brief i Epilepsy Fainting Conductin g Epileptic status . [ortosta] [ticheskiy]. the the ortho-static and hypoK[sicheskiy] fainting necessarily it [sootvet] [stvuyushchee] [obsledo] [vanie] of patient for the development of the reason for the disease Others ([opolni][gelnye] to. Partial (focal) fits: simple (motor. not diseases CNS. deceleration and thoroughness of the thinking are possible are weakened.

phenobarbital. which provoke fits. Carbamazepin. Regular and prolonged method of antiepileptic means ([valproaty]. [lamo]-[tridzhin]. phenytoin. a sufficient sleep and the exception of other factors. provoking about[moroki]. [topiramat]. Treatment of basic after[bolevaniya] with the soma[togennykh] faintings . Special aid with epileptic status and tonicoclonic fit To avoid situations.Baking Failure of the use of alcohol. [gabapentin] and other).

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