Kozhevnikovsky epilepsy

Description:

Kozhevnikovsky epilepsy is the form of focal symptomatic epilepsy which is shown in the form of constant kloniko-tonic or clonic spasms in certain groups  of muscles along with generalized convulsive attacks. This form is described by A. Ya. Kozhevnikov in 1894 as special type of cortical epilepsy.

Reasons of kozhevnikovsky epilepsy:

Most often the disease develops after the postponed encephalitic or poliomelitichesky form of a tick-borne encephalitis at children and teenagers. Kozhevnikovsky epilepsy is more rare is manifestation of a primary and chronic form of a tick-borne encephalitis. The pathogeny is not found out. Presumably, owing to defeat of motive area of bark, subcrustal educations and peripheral motor neurons the epileptogenic system forms.

Symptoms of kozhevnikovsky epilepsy:

The symptom complex consists of polyfocal neurologic signs, continuous local kloniko-tonic, clonic twitchings of groups of muscles, and also, periodic big convulsive paroxysms.

Kozhevnikovsky epilepsy through 1-6mesyats after disposal of a tick-borne encephalitis is shown, is more rare — during the acute period of a disease.

The beginning is most often characteristic emergence of local convulsive reductions of muscles against the background of paresis of extremities, most often, of brushes, but quite often there is a combination to myotonia of the person. Cases when twitchings of muscles were multifocal, for example, a brush, the person, foot are registered. Spasms differ in not synchronism, arrhythmy, in too time, in stereotype. Emergence of other hyperkinesias is not excluded at the same time (otetoidny, choreiform, etc.). Often the patient tries to lower a hyperkinesia, constraining a sore hand healthy, pressing a hand to a trunk, etc.

Generalized epileptic seizures arise seldom. After an attack the hyperkinesia can temporarily decrease, and paresis to amplify. Seldom in addition to big convulsive attacks there are also other epileptic paroxysms — psychosensorial, psychomotor and so forth.

Except a hyperkinesia, also other polyfocal neurologic picture is observed: asymmetry of reflexes of sinews, spastiko-atrophic paresis, incoordination, etc.

In the emotional sphere of change come to light at most of patients in the form of alarm, depressions, phobias, melancholy, aggression. Decrease in intelligence is often observed. Psychopathic or shizofrenopodobny symptoms are possible.

Diagnosis:

At diagnosis the characteristic clinical picture is important. Besides, it is necessary to consider the epidemiological anamnesis — the postponed tick-borne encephalitis, accommodation of the patient in the area, endemic on a tick-borne encephalitis.

Treatment of kozhevnikovsky epilepsy:

Anticonvulsant drugs select for the standard schemes for treatment of epilepsy. But it is necessary to consider that patients are much more sensitive to side effects of drugs as the disease developed against the background of organic lesion of a nervous system. If Kozhevnikovsky epilepsy, developed against the background of a chronic, progreduated form of a tick-borne encephalitis, treatment of encephalitis is in parallel carried out. Seldom at strongly expressed hyperkinesias, make neurosurgical operations — a talamotomiya, destruction of cortical fields.