Mental disorders in epilepsy

At the same time, the negative component of process acquires prevailing importance, since the defeat of frontal lobes excludes the possibility of their valuable self-control and control from the side of the complex of cerebral systems in general, since the efferent pathologic incentive, which emanate from the struck frontal lobes, disrupt the normal functioning also of the underlying divisions of the brain.

The developing cerebral insufficiency, which correlates with the indications of EEG to the localization of epileptic focus in the frontal and temporal-frontal divisions, contributes to polymorphism and generalization of seizures, to appearance, and in the heaviest cases – to predominance of the psychoses of catatonic register. “Catatonic” (on K. Jaspers) can be noted, also, in the structure of developing paranoid epileptic dementia, when perseverance in achieving the desired is combined in patients with general unfocused querulant activity, when begins stereotypy of cognitive processes and when the surrounding reality is not almost fully taken into account by patients.

As far as syndromokinesis of psychopathological disorders is concerned, in the unfavorably elapsing cases most frequently on the motion of disease is noted the growth of polymorphism and an increase in the duration of the subsequent transitory and schubweise psychoses, shortening and reduction in the quality of their intermittent remissions. An increase in the clinical picture of the portion of catatonic manifestations is the typical feature of the dynamics of chronic psychosis.

Prognosis with epilepsy, which takes place with psychosis and dementia, is caused, therefore, by the relationship of the preservable personal resources and nature of processual manifestations. The earlier in the plan of ontogenesis and the more aggressively the epileptic process proceeds, the less the personal potential steady is.

This regularity in the inspected group of patients has completely “balanced” nature. It is possible to note three poles in premorbid status of patients, to the degree of progressive course of process, in the preferred defeat of the functional systems of the brain, in the predominance in clinical picture of one of the basic registers of productive psychopathological disorders and finally in the uniformity of the distribution of the enumerated gradations in population If we consider the fact of establishment in the course of the study of positive correlation of the type of the course of epileptic process with the defined exogenous etiological factors, then existence of the enumerated three poles in the studied pathology can estimate as the essential

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biological prerequisite of the possibility in principle radical improvement in the prognosis with epilepsy, since the successful combination of the preventive maintenance etiological of the factors indicated and the development of the methods of pathogenetic therapy with epilepsy, apparently, is the matter of the not so distant future.

At the same time it should be noted that in accordance with the applicable since 1989 The International Classification of epilepsy and epileptic syndromes ILAE at present depending on the etiology of disease it is accepted to separate three basic forms of epilepsy: symptomatic, cryptogenic and idiopathic. To symptomatic epilepsy carry those cases of the disease, when it is possible to determine the presence of the organic epileptogenic defeat of brain and its etiology (for example, post-traumatic epilepsy). With cryptogenic epilepsy it is possible to reveal the defeat of brain, but etiology remains unknown. To idiopathic epilepsy carry the cases, with which it is impossible to establish neither localization of epileptogenic focus nor reason for its appearance. Seizures usually bear primarily-generalized nature, and with EEG are recorded the synchronous and symmetrical generalized discharges. Frequently in this case occurs hereditary burdensomeness of epilepsy.

Taking into account our classification of epilepsy, which takes place with the mental disorders, based on the prognostic criteria – type and the stage of the course of disease, it is possible to establish that the enumerated etiological designations of epilepsy practically do not bear prognostic information.

According to our data, the light ancestral injuries, which take place without the phenomena of asphyxia, more frequently precede so that subsequently the signs of the specific localization of epileptic focus on EEG are absent and the distant favorable prognosis simultaneously corresponds to two basic forms of epilepsy – symptomatic and idiopathic.

To the same two basic types of epilepsies, but with its unfavorable flow, when general pathologic nature EEG occurs and the centers of pathologic activity are distributed predominantly in the frontotemporal divisions of the brain, correspond the most complex relationships between the assumed endogenous and exogenous etiological factors. To the first relate the presence of the epileptoid traits of nature in close relatives and deviation in the sphere of inclinations in parents, to the second – intracranial infections of early childhood.

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In connection with that presented, should be greeted the recent initiative of ILAE Commission on Classification and Terminology (2010) to highlight the following causes of disease: genetic (including revealed on the basis of molecular-genetic studies and study of families), structural, metabolic (including. as a result of the stroke, the injury, the infection, the tuberose sclerosis, the defects of cortical development and other) and the unknowns (consequence of the unrecognized disorders).

Obtained by us data indicates the need for an active search for the methods of the pathogenetic therapy of epileptic psychoses. In order to ensure prevention first of all is necessary to identify the immune mechanisms of the primary lesion or other functional systems of the brain. The combined drug therapy must be oriented not only to stop the primary or prevailing epileptic focus, but also to the complex action on the interested functional system.

With the existing practice of the use of the therapeutic and prophylactic measures, whose effectiveness frequently depends on relation to the treatment of the patients, in whom in proportion to the progression of disease are reduced critical functions up to the phenomena of anosognosia, it is expedient to be oriented, apparently, to some general clinico-social correlations chosen in the course of our study.

The greatest sharpness of process is characterized not only by its combination with the smaller manifestation of negative disorders, but also by the possibility of the more frequent appearance of the individual (premorbid) features of personal reaction, reanimation of the installations of personality to the use of customary habits of the working activity and in private life during ignoring of the limitations, caused by disease.

With the smaller sharpness of process, occurring during late remission, acquired in the course the diseases changes in the personality prove to be to a considerable extent soldered both with the productive, and with the negative psychopathological manifestations, due to the less expressed inadequacy of the claims of patients, which makes it possible to sufficiently effectively use their positive socialworking installations. Remission in the these cases should be understood, in accordance with the determination of S.A. Gromov (2010) as the complex compensating process, which is accompanied not only by the steadfast long-standing absence of all forms of seizures, by the disappearance of paroxysmal changes on EEG and by the re-

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gress of mental defect, but also by the restoration of the physiological mechanisms of protection.

In this respect, for the practical implementation of social rehabilitation are particularly important criteria for the foreseeable time prognosis established by the interplay between structure and dynamics of psychopathology with the presence and severity of personal changes.

At the first stage the development of psychopathological disorders, i. e. before the appearance of signs of dementia, the ability to work in the majority of patients remains with the transitory depressions with hypodynamia and sensitive delusion of relation, subdepressive schubs, chronic affective-delusional disorders with supervaluable delusion. Temporary disablement begins with an increase in the structure of the transitory psychoses of the portion of vegetative and delusional components, the appearance in the structure of the schubweise psychoses of the ideas of low value, hypochondriac reactions, the aggravations of the delusional experiences within the framework of chronic affective-delusional psychosis. Patients restrictedly are able-bodied (third group of disablement) or completely disabled (second group of disablement) with the protracted affectivedelusional schubs of psychosis, the loading of the clinical picture of disease due to the catatono-delusional, catatonic or polymorphous psychotic disorders.

At the second stage of the development of psychopathological disorders, characterized by predominance in the structure dementia of affective disturbances, the ability to work of patients with the schubweise psychoses of predominantly delusional structure stably is reduced (third group of disablement) as a result of significant reduction in the ability to adequately evaluate production situation, tendency toward the conflicts. Patients are disabled (second group of disablement) with the domination in the structure of the chronic psychosis of hallucinato- ry-delusional and сatatono-delusional disorders.

At the third stage of the development of psychopathological disorders, typical features are steadfast and expressed disturbances of thinking, bradyphrenia, there is a possibility of the working device of patients under the specially created conditions (second and third group of disablement) during the stabilization of the structure of polymorphous psychotic formations. Patients are disabled (second and first group of disablement) in the cases of the development of paranoid epileptic dementia.

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At the fourth and final stage of the development of the psychopathological disorders, when occurs the formation of the expressed mnestiсo-intellectual defect, with the decrease of the fraction of affective and delusional disorders the patients, acknowledged by invalids at the previous stages of disease, can be adapted to the labor in the therapeutic-production workshops or the special shop or, with (rare) possibility of the conversion into third group of disablement, under the conditions of usual production. With the predominance in the structure of the polymorphous protracted and chronic psychoses of sub-stuporous manifestations the patients are disabled (first and second groups of disablement).

It should be emphasized that preferred localization of epileptic process can indicate only the possibility of extended prognosis. The great significance for the expert practice have criteria of the visible in the time (from four-six months to one year – two years) prognosis. The special features of structure and the duration of psychosis and remission, the stage of the development of psychopathological disorders, social factors, special features of the personality of patients do not exclude that with all types of the course of epileptic process the undoubted value has a regularity and a continuity of the longstanding therapy by antiepileptic means.

The simultaneous calculation of the type, stage of the development of epileptic disease and special features of the personal reaction of patients is necessary for the substantiation of the criteria of the clinical and social prognosis visible in the time.

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