When treating a patient with a first seizure (seizure, paroxysm), it is first necessary to decide whether the seizure is an epileptic or non-epileptic one. Then you should find out if the seizure was spontaneous or provoked. In the presence of a provocation factor (high body temperature, sleep deprivation, alcoholization, long-term viewing of television broadcasts, etc.), they choose a wait-and-see tactic when excluding provoking agents. If the first epileptic unprovoked seizure is diagnosed, the algorithm of further actions includes a number of diagnostic steps:
- Carefully collected history (to clarify the etiology):
- information on the incidence of epilepsy in relatives;
- chronic maternal diseases;
- maternal diseases during pregnancy (rubella, cytomegaly, toxoplasmosis, etc.); – taking the mother during pregnancy drugs;
- features of the course of pregnancy and childbirth; – features of early development of the child;
- age of onset of the disease.
- Detailed description of the first attack:
- the behavior of the patient before the attack;
- the onset of the attack (sudden, gradual);
- Presence of precursors (auras);
- the activity of the patient at the time preceding the attack (sleep, wakefulness);
- the course of an attack (the position of the head, eyes, limbs, changes in muscle tone,
discoloration of the face, skin, pupil size).
- The nature of the attacks (generalized, simple or complex partial, partial with
secondary generalization). - The frequency of attacks.
- The time of occurrence of attacks: sleep, the first hours after waking up, wakefulness. 6. Detailed neurological examination.
- The nature of the changes in the EEG.
- CT scan or MRI of the brain.
- If necessary, daily monitoring of ECG, EEG, biochemical
analyzes.
Neuroimaging techniques can detect brain dysgenesis, tumors, vascular
malformations, often associated with convulsive syndrome.
Indications for CT or MRI studies are:
- focal nature of epileptic paroxysms;
- the presence of focal neurological symptoms;
- the presence of focal EEG changes;
- the occurrence of epileptic paroxysms in the neonatal TM period or after 30 years.
A necessary diagnostic stage is the differentiation of attacks into partial and
generalized in accordance with the International Classification of Epilepsy and Epileptic Syndromes (1989).
Partial epileptic paroxysms, in turn, are divided into simple, complex and secondary-generalized. Among generalized epileptic seizures, there are absences, myoclonic, clonic, tonic, tonic-clonic and atonic seizures.