Epilepsy: is it possible to die from a sudden attack?

Epilepsy is a chronic brain disease that manifests itself as uncontrollable seizures. They arise as a result of a pathologically enhanced impulse in the cerebral cortex. The disease is characterized by a wave-like course - after an attack there comes a period of remission. Clinical manifestations of the disease depend on the location of the lesion, the severity and type of seizures. At the Yusupov Hospital, neurologists diagnose epilepsy using the latest methods. For complex therapy, modern medications are used that are effective and have a minimal range of side effects.

Causes

One of the main causes of epilepsy is considered to be a hereditary predisposition: if parents have a history of seizure symptoms, then the child is more likely to develop them. Epilepsy also develops under the influence of the following reasons:

• Traumatic brain injury;
• Cerebrovascular accidents;
• Cerebral vascular dysplasia;
• Volumetric formations in the cerebral cortex;
• Neurosurgical intervention;
• Infectious diseases of the central nervous system;
• Previous ischemic or hemorrhagic stroke.

The occurrence of epileptic attacks is caused by the presence in the cerebral cortex of a stable focus with epileptic activity. Convulsive activity from the primary focus can spread through commissural fibers, cortical neuronal complexes, and the centrencephalic system of the brain. In the presence of increased convulsive activity over a long period of time, secondary lesions arise. They can, under the influence of certain factors, become independent and independent. As a result, the attack in the primary focus fades, but not in the secondary. This picture is observed in patients after two years of illness. Over the course of some time, tertiary foci of seizure activity may develop in the cerebral cortex.

Epilepsy can develop under the influence of the following provoking factors:

• Hormonal imbalances;
• Alcoholism and drug addiction;
• Chronic stress;
• Excessive emotional stress;
• Chronic fatigue.

Secondary attacks of epilepsy occur in patients suffering from brain tumors, cerebral vascular pathology, after hemorrhage in the head, due to poisoning with toxic substances.

It is very important to identify the disease early to reduce the likelihood of complications. Which doctor treats epilepsy? For quality therapy, it is necessary to be observed by a neurologist, epileptologist, or psychotherapist. As clinical symptoms progress, assistance from a physiotherapist or pharmacologist may be required.

How to reduce risk

Although many risks are beyond your control, there are several things you can do to reduce your chance of death.

In particular, the most important thing to prevent SUDEP is to be sure to take prescribed seizure medications. Other ways to avoid SUDEP include:

• avoid known seizure triggers, such as flashing lights
• refusal to drink alcohol
• getting enough sleep
• understanding how to control seizures when they happen

To prevent injury or death from all attacks, consider making adjustments to make your space safer.

Precautions may include:

• smoothing sharp corners on desks and tables
• use of non-slip carpets
• installation of barriers in front of fireplaces and stoves
• providing fall protection to your home by avoiding glass tables

Following water safety rules is an important way to protect yourself from death by drowning. You can drown in just a few inches of water.

To stay safe in the water:

• When swimming, make sure a lifeguard or someone trained in lifesaving is nearby
• swim with a partner
• wear a life jacket
• take a shower instead of a bath
• use a shower chair.

Frequency of epileptic seizures

The frequency of attacks can vary from once every 2-3 months to single or multiple daily. A seizure can be triggered by sleep disturbances, stress, excessive alcohol consumption, long stays in a stuffy room, sudden flashes of light, etc. At the moment, the specific factor influencing the increase in the frequency of seizures is not yet known.

Expert opinion

Author: Daria Olegovna Gromova

Neurologist

Epilepsy has been considered one of the most dangerous and common diseases for many years. According to WHO statistics, 4-10 people per 1000 population suffer from seizures. Doctors note an annual increase in cases of onset of epilepsy. Thanks to numerous clinical studies, it has been proven that the disease is registered 2-3 times more often in countries with low and medium levels of development. This is due to the presence of a greater number of provoking factors, such as infections and a high level of injuries. According to statistics, 80% of patients with epilepsy live in such conditions.

The exact causes of seizures are still unknown. Doctors distinguish several types of seizures, as well as the factors that cause them. When selecting therapy, neurologists and epileptologists at the Yusupov Hospital take into account all the data. If you follow the rules of prevention and take anticonvulsants, about 70% of patients can live for a long time without seizures. An individual epilepsy treatment plan is developed for each patient at the Yusupov Hospital. The drugs used meet European quality and safety standards. In addition, patients are provided with personalized preventive recommendations that minimize the risk of epilepsy relapse.

Precursors of epileptic seizures

The first harbinger of epileptic seizures is an aura. It is individual for each patient. Thanks to the constant warning signs, patients can warn others about the onset of an attack or independently move to a safe place.

There are the following types of aura that precede the onset of an epileptic attack:

• Hallucinations;
• Sharp contraction of the muscles of the upper or lower extremities;
• Repeating the same movements;
• Burning, crawling or tingling sensation in various parts of the body;
• Sharp deterioration in mood.

The duration of the aura is several seconds. During this time, patients do not lose consciousness.

Minor paroxysmal disorders

Unlike generalized seizures, petit mal seizures are characterized by short-term changes in muscle tone.

• Absence seizures . Characterized by a sudden loss of consciousness for several seconds. The person becomes silent and freezes, looking at one point, then, as if nothing had happened, continues the conversation or the interrupted action.
• Propulsive paroxysms are accompanied by sharp forward movements of the head or torso.
• Unexpanded rudimentary retropulsive seizures , manifested by protrusion of the eyeballs, small twitching of the eyelids, facial muscles.

Types of seizures in epilepsy

Depending on the cause of occurrence, the following types of epileptic seizures are distinguished:

• Idiopathic – occurring in the presence of epilepsy in close relatives;
• Symptomatic – occur after a traumatic brain injury, infectious or tumor lesion of the brain substance;
• Cryptogenic – the causes of occurrence cannot be determined.

The external manifestations of a convulsive syndrome are determined by its type. If the pathological focus is localized in one hemisphere of the brain, simple or complex seizures occur.

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Simple partial seizures

Against the background of simple convulsions, the patient does not always lose consciousness. Clinical symptoms depend on the location of the pathological focus in the cerebral cortex. The average duration of simple partial seizures is two minutes.

Neurologists identify the following main signs of the disease:

• Emotional lability;
• Hallucinations of various types;
• Twitching in various parts of the body;
• Cardiopalmus;
• Feeling of nausea;
• Frequent feelings of deja vu;
• Difficulty understanding and reproducing words.

Complex partial seizures

The duration of complex partial seizures is one or two minutes. An aura appears before the attack begins. There is uncontrollable crying and screaming, repetition of words, and performance of certain movements. At the end of the seizure, patients are not oriented in space and time. A simple partial seizure of epilepsy can develop into a complex seizure.

Generalized seizures

Generalized seizures occur against the background of total brain damage. They are as follows:

• Tonic;
• Clonic;
• Tonic-clonic;
• Atonic;
• Myoclonic.

With tonic spasms, unconscious muscle contractions occur. Patients are bothered by severe pain in the muscles of the back, upper and lower extremities. Tonic convulsions rarely lead to fainting. The attack lasts no more than twenty seconds. Tonic seizures can occur during sleep.

Patients with epilepsy are less likely to experience clonic seizures. They manifest themselves as uncontrolled paroxysmal muscle contractions. During convulsions, foam is released from the patient's mouth. He loses consciousness. Paralysis may develop. Clonic seizures occur due to severe stress, traumatic brain injury, cerebrovascular accident, or brain tumor. During an attack, short-term muscle tension is replaced by relaxation. The attacks quickly follow each other.

The most typical and characteristic of an epileptic attack are tonic-clonic convulsions. Their duration varies from 1 to 3 minutes. If tonic-clonic seizures persist for a longer period of time, calling an ambulance is recommended. Neurologists distinguish tonic and convulsive phases in the course of an attack. In the tonic phase, the patient loses balance and consciousness, in the convulsive phase, involuntary muscle contractions occur. After the attack is over, patients do not remember what happened.

Tonic-clonic seizures may also be accompanied by the following symptoms:

• Increased salivation;
• Sweating;
• Involuntary tongue biting;
• Injury as a result of uncontrolled actions;
• Involuntary urination or defecation;
• Blueness of the skin.

Atonic seizures occur after a traumatic brain injury, stroke, infectious inflammatory processes, or in the presence of a brain tumor. During an attack, the patient loses consciousness for a while and falls. In some cases, convulsions can be expressed by twitching of the head. The attack lasts about 15 seconds. At the end of it, the patient does not remember what happened.

Myoclonic seizures are characterized by rapid jerking of various parts of the body. The attack resembles jumping inside the body. Most often, muscle contractions occur in the upper half of the body, the area of ​​the upper and lower extremities. Myoclonic spasms can occur when falling asleep or waking up. A symptom of an attack may be hiccups. The duration of the attack is several seconds. During myoclonic seizures, patients do not lose consciousness.

First signs

Epilepsy has three clinical periods of seizure disorders:

• ictal - period of attack;
• postictal - the seizure itself, in which neurological abnormalities are present or absent;
• interictal - the period between attacks.

In the picture of the disease, it is customary to distinguish the main types of auras that precede complex partial deviations, namely: autonomic, motor, mental, speech and sensory. First signs:

• severe nausea;
• weakness;
• dizziness;
• darkening of the eyes;
• noise in ears;
• numbness of the tongue, part of the face, lips;
• feeling of a lump in the throat or squeezing of the sternum.

The causes of this deviation in adults are associated with the localization of the epileptic focus in the cerebral cortex.

With complex partial defects, automated movements are observed, which from the outside can be attributed to inappropriate behavior. In this case, it is almost impossible to establish contact with the patient.

Often a disease is diagnosed that was caused by the influence of alcoholic beverages on the human nervous system. This is alcoholic epilepsy, its symptoms: loss of consciousness, pale face, hallucinations, foam at the mouth and vomiting may appear. Consciousness returns to a person slowly, and this state ends in deep sleep.

Classification

Psychoneurological diseases are usually divided according to the type of attack, taking into account the etiological factor.

1. Local paroxysms, this includes focal, localized and partial forms. They are idiopathic (rolandic), symptomatic and cryptogenic.
2. Generalized, this group includes: idiopathic forms (infantile absence) and symptomatic (myoclonic type, Wanst and Lennox-Gastaut syndrome).
3. Epilepsy of indeterminate type (convulsive conditions in newborns, Landau-Kleffner syndrome). This group contains both local and generalized pathologies.

If, after a comprehensive examination in the clinic, the specific cause of paroxysms has not been identified, then the disease is of the idiopathic type and is hereditary. The symptomatic variety is recorded when there are structural changes in the brain area.

Nocturnal epilepsy

In one third of patients, epilepsy attacks occur at night. Pathological signs may appear when falling asleep, during sleep, or during awakening. Nocturnal epilepsy occurs under the influence of the following factors:

• Hereditary predisposition;
• Suffered traumatic brain injury;
• Excessive consumption of alcoholic beverages;
• Sleep disorders;
• Prolonged psycho-emotional stress.

The duration of a nocturnal epilepsy attack varies from a few seconds to five minutes. Most patients do not remember the seizures that occurred. Some people clearly describe the sensations they experience. An epileptic attack that occurs during a dream is accompanied by the following manifestations:

• A sharp, causeless awakening;
• Feeling of nausea, which may result in vomiting;
• Severe headache;
• Tremor;
• Pronunciation of unusual sounds;
• Speech impairment.

During a nocturnal epilepsy attack, patients may perform rash actions. They get down on all fours or pretend to ride a bicycle. You can suspect the presence of a nocturnal attack based on the following indirect attacks:

• Tongue bite:
• Traces of blood on the pillow after waking up;
• Bruises and abrasions on the body;
• Painful muscle syndrome;
• Wet bed due to loss of urinary control;
• Uncontrolled urination;
• Waking up in an unusual place (on the carpet, on the floor).

These symptoms are individual for each patient. They appear with one degree or another. Therefore, neurologists believe that nocturnal epilepsy attacks are very difficult to diagnose.

Rolandic epilepsy

Epilepsy of this type is focal and genetically determined. It manifests itself in rare attacks at night, they affect one half of the face with the tongue and pharynx. The Rolandic type is characterized by partial epileptic seizures without loss of consciousness.

The first sign of onset is tingling or numbness on one side of the face, lips, gums, or tongue. Afterwards motor paroxysms develop.

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Alcoholic epilepsy

This type of epilepsy develops in patients who abuse alcohol. Seizures occur due to irreversible pathological processes in the cerebral cortex. Epilepsy attacks caused by alcohol intoxication most often occur in patients suffering from the following concomitant diseases:

• Atherosclerosis;
• Consequences of traumatic brain injury;
• Brain tumors;
• Residual effects of previously suffered infectious and inflammatory diseases of the brain.

The cause of the disease may be aggravated heredity. The symptoms of alcoholic epilepsy have some peculiarities. The disease does not necessarily begin with a convulsive syndrome. Initially, the following pathological signs appear:

• Increased salivation;
• Marked weakness throughout the body;
• Paleness of the skin;
• Blueness of lips;
• Dizziness;
• Strong headache;
• Loss of consciousness;
• Nausea, vomiting;
• Uncontrolled urination;
• A spasm of the vocal cords that causes a person to emit a high-pitched scream.

An attack of alcoholic epilepsy can result in respiratory arrest and death.

Nonconvulsive paroxysms

In mild cases of epilepsy, such seizures occur in the form of ambulatory automatisms—repetitive actions performed by the patient in complete detachment from the environment. Highlight:

• oral automatisms: chewing, smacking, swallowing, etc.;
• rotatory: trampling, swaying or spinning in one place.

Non-convulsive mild attacks of epilepsy are characterized by the absence of delusional themes, uncontrolled psychomotor agitation with aggression and rage, and hallucinations.

Epilepsy of newborns

Up to one year, a baby may experience the following types of epilepsy seizures: small, large and nocturnal. During a minor attack, the child throws back his head and freezes in one position. His gaze is directed to one point. The baby does not respond to stroking and sound and rolls his eyes. His body temperature may rise.

A major seizure of epilepsy is manifested by the fact that the child stretches out, bends his legs and assumes a fetal position. Convulsions, loss of consciousness and respiratory arrest occur.

During a night attack, the baby suddenly awakens and screams. His face changes. After an attack, the child cannot fall asleep for a long time. Children suffering from epilepsy may lag behind their peers in development, their memory is impaired, and mental health problems occur.

Pediatric epilepsy

Epilepsy in children is manifested by the following symptoms:

• Tonic-clonic seizures;
• Absences (minor seizures);
• Myoclonic convulsions with and without disturbance of consciousness.

This condition occurs due to the immaturity of the child’s brain, when processes of excitation, burdened heredity or organic brain damage predominate. Initially, warning signs of a seizure occur: headache, irritability, and a feeling of fear. In the generalized form of the disease, the child groans, screams and loses consciousness. All his muscles tense, his jaw clenches, breathing stops, his pupils dilate, his face becomes cyanotic.

The child's legs stretch and his arms bend at the elbows. After the completion of the tonic phase of the seizure, clonic convulsions occur. The child's breathing becomes noisy and foam comes out of the mouth. He bites his tongue. Involuntary urination and defecation occur. Minor seizures do not last long.

Absence epilepsy

This is idiopathic generalized epilepsy that occurs in preschool children. Characteristic symptoms: short-term loss of consciousness during the daytime, less often at night. This does not affect neurological status or intelligence in any way.

The attack begins suddenly, the child seems to freeze and does not react to any stimuli, his gaze is directed to the side. This condition lasts no longer than 15 seconds and is rare in isolated form. More often it is supplemented by throwing the head back, rolling the eyes, and possibly repeating some actions: stroking hands, licking lips, repeating words or sounds. The child does not remember what he did.

If severe fatigue, drowsiness are added to the symptoms, and the attack lasts for a long time, then this indicates an unfavorable course of the disease.

Other types of epilepsy

Temporal lobe epilepsy

It is characterized by the localization of the focus of epileptic activity in the temporal lobe of the brain. It manifests itself in simple and complex partial epileptic seizures. As the disease progresses, secondary generalization occurs. The patient experiences mental health disorders.

Structural focal epilepsy

The onset of the disease occurs in individuals of various age groups. The lesion is located in the temporal zone of the brain. The patient feels time speeding up or slowing down. He perceives a familiar environment as new, and a new incident as something that has been experienced for a long time.

An epileptic seizure is manifested by the following symptoms:

• Preserved consciousness;
• Turning the eyes and head towards the localization of the focus of increased activity;
• The appearance of gustatory and olfactory paroxysms;
• The presence of auditory and visual hallucinations;
• Systemic dizziness.

The patient complains of pain in the heart, stomach, nausea, heartburn, and suffocation. There is a disturbance in the rhythm of cardiac activity, an increased feeling of fear, chills, and pale skin. As temporal lobe epilepsy progresses, a secondary generalized form of the disease develops. The attack is manifested by tonic convulsions in all muscle groups, loss of consciousness.

Post-traumatic epilepsy

Develops as a result of meningitis, encephalitis, traumatic brain injury, asphyxia. The disease is more often diagnosed in children. The attack is not accompanied by loss of consciousness or occurs with impaired consciousness. If the patient loses consciousness, they may experience a secondary generalized seizure. The muscles of the foot and upper limbs are involved in the convulsive process.

Why is an epileptic seizure dangerous?

During a tonic-clonic seizure, breathing stops, and in all other seizures with convulsions, additional trauma is possible due to hitting the head on a hard surface. Falls from one's own height and loss of consciousness are also dangerous. Each seizure that occurs damages the neurons of the brain, which subsequently leads to a decrease in cognitive and mental abilities, and changes in the psyche.

This does not prevent patients with epilepsy from leading an active life. However, some aspects are limited - it is prohibited to drive a car and work in production in workshops, with open fire or at height, as well as in work that requires frequent switching of attention. Properly selected therapy can increase the interictal period by months or even years.

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Novikova Larisa Vaganovna

Neuropathologist, Candidate of Medical Sciences, doctor of the highest category

Experience 39 years

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Pankov Alexander Rostislavovich

Neurologist

40 years of experience

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Diagnostics

Diagnosis of the disease occurs by taking an anamnesis. The specialist listens to complaints, on the basis of which a preliminary diagnosis can be made.

After this, the patient is sent for laboratory and hardware examinations, which makes it possible to differentiate epileptic seizures from other pathologies, allows one to find out the cause, the nature of the changes, determine the form and prescribe treatment.

The diagnosis is made by neurologists and epileptologists who determine the causes of epilepsy in adults using indications obtained from a comprehensive comprehensive examination.

Instrumental diagnostic methods

The safest hardware diagnostics is an EEG. It has no contraindications; it can be used to detect areas of paroxysmal activity. These can be sharp waves, spikes, slow waves. Modern EEG makes it possible to identify the exact localization of the pathological focus.

The most informative neuroimaging method is brain MRI. The study allows us to identify the initial cause of the deviation and determine the location of the lesion in the central nervous system.

Laboratory diagnostic methods

Epilepsy occurs under the influence of various reasons; in order to identify the presence of infection, inflammation, hormonal imbalances, genetic defects, the patient needs to take a general blood test, biochemical, molecular genetic, and check the tumor marker.

First aid for seizures

Proper care for an epileptic seizure reduces the risk of complications and injuries. The person who happens to be next to the patient should catch him and prevent him from falling. You also need to do the following:

• Place a blanket, pillow or cushion of clothing under your head;
• Free your neck and chest from constricting objects and clothing (tie, shirt, scarf);
• Carefully turn the patient's head to the side to minimize the risk of inhalation or passive reflux of vomit or own saliva;
• Open your mouth and put a cloth or handkerchief in it to prevent the patient from biting his tongue;
• Do not forcefully open your mouth;
• If breathing stops for a long time, perform artificial ventilation from the mouth to the nose or mouth.

During an attack, the patient may experience involuntary urination or bowel movements. This manifestation of epilepsy should not cause fear in others. After an attack, patients usually experience drowsiness and severe weakness.

Personality changes

Over time, even with unexpressed epileptoid symptoms, certain changes occur in the patient’s behavior and his attitude towards others. Characteristic :

• emphasized pedantry, accuracy;
• manic desire for cleanliness and order in the house;
• rigidity of thinking;
• slowness;
• rancor;
• inexpressiveness of facial expressions and gestures;
• indifference, apathy to what is happening around, including one’s own illness, and at the same time they often note emphasized, demonstrative care for loved ones.

Without proper treatment, the ability to separate the important from the unimportant is gradually lost; in communication, the patient “gets bogged down” in trifles. Memory deteriorates, speech becomes monosyllabic, without figurative expressions, comparisons, proverbs, quotes from books or films.

Treatment

Neurologists at the Yusupov Hospital provide complex treatment for epilepsy. It is aimed at reducing the frequency of epileptic seizures and stopping medications during remission. According to statistics, in 70% of cases, adequately selected treatment helps to almost completely relieve paroxysmal activity in patients.

To achieve optimal results in treatment, patients are prescribed drugs for epilepsy of the following properties:

• anticonvulsants – help relax muscles, they are prescribed to both adults and children;
• tranquilizers - allow you to remove or reduce the excitability of nerve fibers; the drugs have shown a high degree of effectiveness in the fight against minor attacks;
• sedatives – help relieve nervous tension and prevent the development of severe depressive disorders;
• injections - used for twilight states and affective disorders.

Idiopathic focal epilepsy is benign. It requires symptomatic treatment. In focal forms with seizures that appear in series 2-3 times a month and are accompanied by an increase in mental disorders, neurosurgeons perform surgery.

Is epilepsy curable?

Before starting treatment, a diagnosis should be determined, because loss of consciousness and various convulsions can occur due to a sharp drop in blood sugar, anemia, poisoning, high fever, cerebrovascular accident, calcium deficiency and other conditions. Antiepileptic drugs cannot be prescribed to such patients immediately. The diagnosis of epilepsy is made only when epileptic seizures recur.

With adequate treatment, according to generalized statistics, a good therapeutic effect is achieved in 80-85 percent of patients, and in 60-70 percent of patients seizures can be eliminated completely. And this is a very good reason to stop antiepileptic drugs.

The percentage of patients with epileptic seizures could be significantly lower if patients took medications regularly and did not stop treatment on their own. The decision to discontinue medications can only be made by a doctor, and not earlier than after 5 years of treatment, if during this time the patient has not had epileptic seizures. At the Yusupov Hospital, an epileptologist always monitors how the patient’s illness develops.

Conclusion

Death from attacks is rare.

Although there is little a person can do to prevent SUDEP other than continuing to take medications, there are ways to reduce the risk of accidentally dying during an attack.

Keeping your space as safe as possible and making behavioral adjustments can help prevent death from drowning, falling, or suffocation during an attack.

Living with someone or using a buddy system when participating in water sports is another way to reduce the risk of living with seizures.

Forecast

The prognosis for epilepsy if you follow medical recommendations and take medications in a timely manner is favorable.
To do this, it is important for a person to maintain a careful attitude towards his health: maintain a daily routine, have adequate sleep, avoid overexertion, and completely give up bad habits such as cigarettes and alcohol. Loss of ability to work depends on the frequency of attacks: if they are episodic and occur at night, then there are no contraindications to performing work functions. Daytime attacks with loss of consciousness cause limited choice of work.

In most clinics, patients with epilepsy are seen by neurologists or psychotherapists, who sometimes find it difficult to understand the details of diagnosis and the intricacies of treatment of this disease. Just one EEG requires enormous experience and skills of a professional. Therefore, the Yusupov Hospital employs highly specialized epileptologists who can answer all your questions. You can make an appointment with them by calling the Yusupov Hospital.

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