Epilepsy is a process associated with metabolic disorders in the brain, which causes seizures. They are divided into convulsive and focal or generalized and partial, which involve both hemispheres or one, respectively. During a seizure, pathological excitations occur in the tissues, which provoke a change in impulses emanating from neurons. Focality is expressed in the localization of the lesion, based on which the treatment is based. To most accurately determine the focus, special techniques and trained specialists with extensive experience are required. The Yusupov Hospital has a specialized neurological clinic that provides high-quality diagnostics and effective treatment for patients with this disease.
What is partial epilepsy
A change in the structure of the cerebral cortex in a specific area is called partial epilepsy. This phenomenon is accompanied by chaotic nerve impulses emitted by neurons. Signals are sent to all cells associated with the affected area. The clinical picture reflects a seizure.
The main parameter adopted for classification is the localization of the functional disorder, which determines the observed picture during a seizure. The following types of localization are distinguished: temporal, frontal, occipital, parietal.
Expert opinion
Author: Daria Olegovna Gromova
Neurologist
Epilepsy has been considered one of the most dangerous and common neurological pathologies for many years. According to WHO statistics, in Russia, patients suffering from seizures account for about 2.5% of cases. The variety of forms of epileptic seizures can make diagnosis difficult. Partial epilepsy most often occurs in childhood. Until now, doctors have not been able to establish the exact causes of the disease. Great importance is attached to intrauterine development disorders and complicated childbirth.
At the Yusupov Hospital, experienced neurologists and epileptologists diagnose partial epilepsy using modern medical equipment: CT, MRI, EEG. Thanks to this, it is possible to quickly determine the location of the pathological focus. Therapy is selected individually for each patient. The drugs used meet European quality and safety standards. Patients at the Yusupov Hospital are provided with recommendations to reduce the risk of developing recurrent attacks. It has been proven that if medical prescriptions and preventive measures are followed, 60-70% of patients enter a state of long-term remission.
Diagnostics
New localized seizures may indicate severe damage to the central nervous system. The diagnostic program includes not only confirmation of the presence and determination of the type of epilepsy, but also a detailed examination to identify the provoking pathology. During the conversation, the doctor establishes the characteristics, frequency of occurrence and duration of paroxysms.
During a neurological examination, in the symptomatic form, changes are determined that indicate the localization of the pathological focus. To make a final diagnosis, the following methods are used:
Electroencephalography. Epi-activity is often recorded not only during seizures, but also in the interictal period. If the indicators are normal, provocative tests are performed. To establish the exact localization of the lesion, subdural corticography is performed.- MRI. Recommended for clarifying the underlying pathology. To increase reliability, the minimum slice thickness is selected. Confirms the presence of focal dysplastic or atrophic areas.
- Other methods. Positron emission tomography sometimes visualizes an area of hypometabolism. SPECT in the same area at the time of paroxysm reveals increased blood supply, the rest of the time - deterioration of blood circulation.
Types of partial seizures
As described earlier, several options for the development of this type of disease are possible. Let's take a closer look at each of them:
- The temporal one occupies the position of the most common type, accounting for 50-60% of all cases associated with distortion of neural connections.
- Frontal is the second most common manifestation; in approximately 25% of cases the disease is associated with this pathology.
- Occipital appears quite rarely, in no more than 10% of patients.
- Parietal almost never occurs and has a probability of occurrence of less than 1%.
The localization of the lesion is determined using an EEG (electroencephalogram). Most often, diagnosis is carried out while the patient is at rest, but the most accurate results can be obtained only during an attack. To create such a situation, with the consent of the patient, special means are used.
In addition to classification according to local criteria, there is also a system of differences based on severity. The following forms are distinguished:
- Simple - not accompanied by a distortion of consciousness, manifestations are variable and determined by the region.
- Complex - simple seizures with simultaneous impairment of consciousness.
- Secondary generalized (convulsive) - develops from simple and complex seizures, accompanied by convulsions.
Causes of partial epilepsy
This disease is most common in children and develops due to problems during pregnancy or childbirth. For example, from undermining the development of the fetus inside the womb or from a prolonged lack of oxygen during the birth of a child.
It is possible that the disease may develop in an adult. The disease may occur as a result of injury or other brain disease and will be symptomatic. The following factors may influence its development:
- malignant and benign growths;
- circulatory dysfunction;
- hematomas;
- cyst;
- aneurysms;
- malformations;
- infectious diseases;
- stroke attacks;
- abscess;
- weak intercellular metabolism;
- congenital pathologies;
- traumatic brain injuries.
The above disorders sharply increase the risk of developing a defect due to the formation of pathological signals of altered intensity from neurons, so it is necessary to seek treatment in a timely manner.
Symptoms of partial epilepsy
When determining the area of brain damage, the first thing to pay attention to is the symptoms that the patient exhibits. They are the main signals for establishing the type of disorder and prescribing the necessary therapy.
When the temporal part is damaged, memory and sound perception are affected. The victim may think that he hears some sounds or music, although in fact there are none. He is attacked by a feeling of déjà vu, and various memories from the long past emerge. The patient is also subjected to emotional attacks, which are expressed in anxiety, anger or feelings of joy and happiness.
Manifestations of damage can be simple, complex, convulsive and combined. The most common are complex ones with automatisms and confusion. Before an attack, there is a sensation of olfactory, visual, gustatory, auditory, mental, somatosensory or vegetative-visceral aura.
The frontal lobe is responsible for motor functions, so damage in this part can be determined by chaotic uncontrolled twitching of the limbs, hands and fingers, the play of facial muscles, and eyes darting from side to side. The patient may make repeated movements of the lips and tongue, as well as stomp in one place.
Based on their form, they can distinguish simple, complex, convulsive and combined seizures. Duration is up to 1 minute, repetitions are observed. Most often occur at night. The aura is not felt.
Peculiarities:
- high duration;
- minimal impact on consciousness;
- rapid occurrence of secondary attacks;
- frequent manifestation of motor dysfunctions;
- there are automatisms before a seizure;
- the victim falls.
The occipital part of the brain is focused on the functioning of the visual organs, so damage to it will affect a person’s vision. During an attack, spots, flashing and colored lights appear in the eyes, or loss of visual fields occurs, followed by severe pain in the head, similar to a migraine.
Damage to the parietal lobe leads to sensory dysfunction. There is a localized feeling of tingling, warmth or cold at a constant ambient temperature, as well as a feeling of enlargement or shrinkage of different parts of the body.
In symptomatic partial epilepsy, there is a secondary generalization - the so-called transition from focal to generalized. In this case, the patient experiences seizures, loss of muscle tone, and paralysis.
Symptoms
The main manifestation is repeated focal seizures with or without loss of consciousness. Simple paroxysms are sensitive, motor, somatosensory, and autonomic. Sometimes hallucinations (perception of non-existent sounds, tastes, smells, visual phenomena) and pathopsychological symptoms are observed.
With complex partial epilepsy, the onset is the same as with simple epileptic seizures. Automatisms and loss of consciousness are possible. After the episode ends, there is a feeling of confusion. Secondarily generalized seizures begin as simple or complex. Then the excitation covers other parts of the brain with the occurrence of tonic-clonic seizures.
Paroxysms are supplemented by symptoms caused by the main lesion of the central nervous system. Secondary seizures are combined with mental retardation, decreased intelligence, and cognitive decline. The idiopathic form is benign. There are no mental, intellectual or neurological disorders. The clinical picture is determined by the localization of the lesion:
- Temporal. Duration - up to 1 minute. Preceded by an aura. Motor and sensory components are pronounced. Possible loss of consciousness. Oral automatisms are more common in childhood, and automatic gestures are more common in adults. In half of the cases, secondary generalization is detected. When the dominant hemisphere is involved after a complex attack, short-term disorders of speech activity are observed.
- Frontal. There is usually no aura. Short-term serial stereotypies are determined. Complex gestures, leg movements reminiscent of riding a bicycle, agitation, screaming, and aggression are possible. Often partial seizures of epilepsy develop during sleep.
- Occipital. Lasts up to 13 minutes. The most typical are illusions, a decrease in the field of vision, and temporary blindness.
- Parietal. Rarely seen. Characterized by somatosensory seizures followed by transient aphasia. Sometimes only sensitivity disorders are observed.
Diagnosis of partial epilepsy
A correctly selected treatment program mainly depends on the timeliness and accuracy of diagnosing the disease. Incorrectly prescribed medications can aggravate the situation and intensify partial seizures of epilepsy. To diagnose dysfunction, magnetic resonance imaging and electroencephalogram are used as research methods, with the help of which it is possible to determine the cause and source of the disease.
The final diagnosis can only be made by a specialist in the field of neurology or epileptology. After examining the patient, questioning him about complaints and information about symptoms, the doctor identifies the most likely causes of the disorders that have arisen, which are confirmed as a result of methodological studies.
Causes
Partial seizures of epilepsy occur under the influence of the following factors:
- abnormalities of limited areas of the brain: cysts, arteriovenous malformations, areas of dysplasia in the cortex;
- cerebral infections: cysticercosis, abscesses, encephalitis of various origins, neurosyphilis;
- vascular pathologies: hemorrhages in the medulla;
- TBI;
- neoplasms;
- dysmetabolic encephalopathies.
During development in children, intrauterine infections and complications during pregnancy and childbirth play a significant role: fetal hypoxia, asphyxia during passage through the birth canal. Sometimes symptoms are provoked by disturbances in the maturation of cortical structures and disappear as they grow older.
Treatment of partial epilepsy
A high rate of successful outcome of therapy for idiopathic partial epilepsy is available at the Yusupov Hospital. In the neurology clinic, equipped in accordance with modern standards, specially trained doctors with extensive experience treat various types of pathologies associated with brain damage.
The main method of healing involves the use of medications. Drugs are selected individually based on the patient’s clinical picture, which includes symptoms, affected areas and other indicators. Correctly selected therapy will reduce the number and intensity of partial epileptic seizures. Highly qualified and extensive experience of specialists will allow you to achieve remission and return to a full life.
If conservative methods do not give a positive result, and the frequency of seizures is too high, then neurosurgery is resorted to. In the process, craniotomy is performed in the required area and further excision of everything that has a physical effect on the cerebral cortex. Such actions are called meningoencephalolysis. Less commonly, an operation is performed using the method of the English neurosurgeon Horsley, in which the affected areas are scooped out.
In case of scar damage to the membrane of the central organ, surgical intervention will not bring positive results. This is due to the fact that scars are renewed in large volumes.
The consequences of Horsley's operation may be paralysis of the limb, but the seizures will disappear. Paralysis eventually turns into monoparesis. Weakness in the limb remains for life, and attacks will return in the future.
In medical practice, the most preferable method is a conservative method of achieving a healing effect in a patient.
