Psychomotor epilepsy

Description:

Psychomotor epilepsy (temporal epilepsy) - lokalizatsionno caused is more often a symptomatic form of epilepsy at which the epileptogenic center is localized in a temporal share. It is necessary to consider that the category coming from other departments of a brain (is more often from occipital bark), can irradiate in a temporal share, causing emergence of clinical symptoms of temporal epilepsy. Psychomotor epilepsy - one of the most common forms of epilepsy to which share about 1/4 all cases fall, and among symptomatic partial epilepsies - to 60%.

Symptoms of Psychomotor epilepsy:

Clinical displays of psychomotor (temporal) epilepsy extremely of a polimorfna are also various. This form of epilepsy is shown by simple, difficult partial and secondary and generalized (VGSP) convulsive attacks or their combination (50% of patients). In 75% of cases at temporal epilepsy attacks begin with aura. It is necessary to define accurately a concept of aura and to delimit it from harbingers of an epileptic attack. It is necessary to understand the clinical phenomena arising separately or preceding emergence of VGSP, psychomotor attacks and caused by the local epileptic category coming from certain departments of a cerebral cortex as aura (Greek "whiff of a breeze"). In fact the aura is a simple partial attack, and the name remains only historically. Harbingers appear in many minutes, hours and even several days to an epileptic attack, are shown by usually mental or vegetative symptoms which are not followed by local cortical categories. The nature of aura has extremely important topical value as often points to area of bark where the epileptogenic center is localized and from where the epileptic category begins. According to the classification offered H.O. Luders mark out the following auras: somatosensory, visual, olfactory, flavoring, acoustical, mental, vegetative, belly (abdominal). For convenience of systematization of partial paroxysms of Luders suggests to describe an attack, consistently reflecting the clinical phenomena arising at it, for example: 1) flavoring aura - a psychomotor attack - a left-side adversivny attack - a secondary and generalized toniko-clonic attack; 2) abdominal aura - a psychomotor attack; 3) left-side visual aura - left-side clonic spasms of a hand - a secondary and generalized toniko-clonic attack, etc. This classification gives clear idea of a developmental character of attacks and possible localization of the center while traditional definition of such attacks as simple, difficult partial or VGSP bear considerably smaller information for the doctor.
Modern classification allocates depending on localization of the epileptogenic center and according to clinical manifestations 4 types of psychomotor epilepsy: hippocampal, amigdalyarny, lateral zadnevisochny, operkulyarny (insulyarny). Traditionally for convenience of clinical physicians temporal epilepsy is subdivided into two big groups: amigdalogippokampalny and lateral.
Amigdalogippokampalny psychomotor  (temporal) epilepsy  (mediobazalny, paleokortikalny) is considered a separate nosological form within psychomotor epilepsy. Debuts with the broad age range, a thicket at early school age. In 30-60% of cases the disease is preceded by atypical FS. The difficult partial (psychomotor) attacks proceeding with disorder of consciousness in combination with the safe, but automated physical activity are most characteristic.
At lateral psychomotor epilepsy the peculiar attacks described in English-speaking literature as "temporal syncopes", and in Russian-speaking - as "an obmorokopodobny form of epilepsy" (L. G. Yerokhin) can meet. Attacks begin with aura (more often dizziness) or arise separately. Rather slow switching off of consciousness with subsequent "obmyakaniye" and falling is characteristic (falling unsharp!). Perhaps easy tonic muscle tension of extremities, facial muscles, emergence of oroalimentarny or sign avtomatizm. According to A. Gambardella and соавт., "temporal syncopes" develop at unilateral temporal epilepsy more often and emergence them testifies to spread of activation on a reticular formation of the bridge, but not to involvement of other temporal share as was considered earlier. These attacks should be differentiated with usual syncopes at which provocative factors (long motionless vertical position, stay in the stuffy room and so forth) and the lipotimiya ("faintness") preceding attacks come to light. It should be noted that at many patients clinical differentiation of amigdalogippokampalny and lateral VE can be very complicated in view of broad irradiation of excitement and complexity of identification of primary center. For example, some authors consider that the epigastric aura is often observed both at paleo-, and at neocortical temporal epilepsy.
Provocative factors. Provocative attacks factors come to light rather seldom. However to 1/3 women having psychomotor epilepsy note increase of attacks in the perimenstrualny period.

Reasons of Psychomotor epilepsy:

The reasons determining development of psychomotor epilepsy are diverse and can be presented by two main groups: perinatal and post-natal. Perinatal defeat of TsNS in the anamnesis is stated at 36% of the patients having psychomotor epilepsy  (pre-natal infections, a hypoxia, focal cortical a dysplasia, a birth trauma and so forth). The birth trauma as one of the main reasons for development of temporal (psychomotor) epilepsy is called by many authors. Death of neurons at a birth trauma is caused by a combination of three mechanisms: hypoxias, ischemia and the damaging operation of some neurotransmitters, in particular a glutamate. Among post-natal factors it should be noted neuroinfection (encephalitis, postvaccinal encephalomyelitis), a craniocereberal injury, tumors of temporal shares of a brain, a brain heart attack, vascular malformation, a tuberous sclerosis, etc. Before implementation in clinic of methods of neurovisualization it was possible to establish an etiology of psychomotor epilepsy only in 28% of cases. By means of MRT structural disturbances in a temporal share are verified on average at 62% of patients with temporal epilepsy, and when carrying out PET and intravital biopsy of a brain this indicator approaches 100%.

Treatment of Psychomotor epilepsy:

Treatment of psychomotor epilepsy represents a complex challenge. Reduction of frequency of attacks and achievement of remission - important, but not its only task. It is also necessary to provide to patients social, labor and family adaptation, i.e. to increase quality of their life. In the beginning monotherapy is carried out. In treatment of temporal epilepsy (at mono - or polytherapies) carbamazepine, Phenytoinum, Valproatums and barbiturates, reserve - ламотриджин and benzodiazepines are recognized as basic drugs. In case of lack of effect of monotherapy use of polytherapy with use of any combinations of basic and reserve anti-epileptic drugs is possible. At absolute resistance of attacks to anti-epileptic drugs neurosurgical intervention is carried out. At the same time strict selection of patients and careful preoperative inspection is necessary. Indications to an operative measure are resistance of attacks to various antiepileptic drugs in the most tolerable doses, the frequent heavy attacks leading to social disadaptation of patients, existence of accurately localized epileptogenic center. Operational treatment is not recommended at the heavy somatic status of the patient and existence expressed mental and intellectual мнестических frustration. The operation purpose - removal of the epileptogenic center and prevention of further "epileptization" of a brain. The temporal lobectomy is applied many decades and usually includes removal of front and mediobazalny departments of a temporal share, unkus, basolateral amygdala. Also the selection is applied amigdalo-and a gippokampotomiya. The stereotaxic bilateral amigdalotomiya gives a certain effect.