Polymorphism clinical manifestations of focal epilepsy in adults.

Polymorphism of clinical manifestations of focal epilepsy in adults. Multifocal epilepsy: mechanisms of formation in adults, semiology of seizures and prognosis.

Generalov V.O., Sadykov T.R, Kazakova Y.V., Yugay A.M.

There are 2 types of convulsive tonic-clonic seizures: generalized and secondary-generalized. GCS are common for idiopathic generalized forms of epilepsy (IGE), occur mainly in wakefulness (in sleep much less often), they are characterized by adherence to the period of awakening, mainly symmetrical nature of the kinematics of paroxysm, they usually occur unexpectedly. SGCS on the contrary are common for symptomatic forms of epilepsy, occur mainly during sleep, there is no connection with the period of awakening, the patient can anticipate the onset of an attack, and seizure is characterized by the presence of a focal component in the kinematics of paroxysm. In this case, there may be difficulties in the differential diagnosis of GCS and SGCS associated with the frequent presence of focal epileptic activity on EEG in IGE, structural changes in brain MRI, the presence in the kinematics of GCS of the focal component, the periodic occurrence of GCS during sleep. At the same time, not all patients feel the onset of an attack. In the analysis of SGCS, there are also problems associated with the fact that the patient can not feel the beginning of the attack, witnesses register the beginning of the attack on the occurrence of the convulsive component, the unconvulsive phase of the epileptic attack is asymptomatic and is detected only with VEG monitoring. There are various options of speed generalization of the attack. The harbingers of the attack, the paroxysm is preceded by up to a day (EEG-negative), aura (EEG-negative), partial beginning SGCS with slow clinical generalization (EEG positive), SGCS with fast clinical generalization. Clinical manifestations of the attack are due to the rate of distribution of ictal epileptic activity to neighboring regions – the rate of progressive increase in the critical mass of synchronized neurons involved in the attack. The kinematics of the attack is due to the topical relationship of the area of initiation of the attack (primary epileptogenic zone) and the symptomatogenic zone (zone of clinical manifestations of the attack). The area of initiation of the attack may correspond to the symptomatogenic or be distanced from it. In this case, different primary epileptogenic zones can initiate one symptomatogenic zone. And one primary primary epileptogenic zone in different patients can initiate different symptomatogenic zones. So the different location of the primary epileptogenic zone may be accompanied by similar clinical manifestations. A localization of the source of epileptic activity in clinical manifestations of the attack is impossible due to the presence of various topical relationships between the primary epileptogenic and symptomatogenic zone. It is important that SGCS in symptomatic focal epilepsy have 2 variants of clinical and encephalographic generalization: with slow clinical and encephalographic generalization and with rapid clinical and encephalographic generalization. Hippocampally epilepsy of various etiologies (lesional and non-lesional) has various clinical manifestations. In lesional epilepsy (MTS) SPS, CPS and SGCS with slow clinical-encephalographic generalization is common. In non-lesional epilepsy (alcocolic epilepsy, epilepsy due chronic brain ischemia) main form of seizures are SGCS with fast clinical and encephalographic generalization. This may be due to the difference in the speed of generalization and the involvement of different symptomatogenic zones. We can say that in the case of lesional temporal epilepsy, the morphological substrate determines, on the one hand, slow generalization and kinematic manifestations of epileptic seizure, on the other hand, resistance in treatment.With non-seasonal temporal epilepsy dominated by SGCS with rapid generalization, epilepsy has a good prognosis.