JACKSONIAN EPILEPSY

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JACKSONIAN EPILEPSY ( J. H. Jackson , English neuropathologist, 1835 — 1911; synonym Bravais — Jackson epilepsy) — the epilepsy which is characterized by the convulsive categories beginning with muscles of any part of a body on one party. The first wedge, description of this form epilepsies (see) the detailed description of attacks with the corresponding cortical somatotopichesky localization of neural categories in the field of the central furrow of hemicerebrums — J. Jackson in 1870 == the Aetiology == is given by the fr. doctor L. Bravais in 1927, and to Prichina D. e. organic lesion of a brain owing to injuries, meningoentsefalit, tumors, vascular anomalies of a brain etc., and also perinatal pathology is. At morfol, a research the pathology characteristic of a basic disease is noted; regarding cases it is possible to find microscopically small sites of an atrophy of bark about the central furrow.

e. — this most accurate manifestation of focal (partial) epileptic paroxysms with a tendency to generalization.

Clinical picture

D. e. it is characterized by emergence against the background of clear consciousness of convulsive paroxysms in muscles of any segment or in narrow group of muscles of an extremity (hands are more often) or in face muscles with the subsequent spread of spasms on an extremity of the party of the same name or a face muscle («a jacksonian march»). Such distributional pattern of spasms is defined by order of a projection of parts of a body in a front central crinkle: on the verkhnelateralny surface of bark of a great brain the greatest place at the person is taken by motoriums of a hand, and also person, language while the leg and especially a trunk take rather limited place.

Spasms usually have Clonic character (see. Clonus ), often following a short tonic phase. Sometimes spasms are limited to one extremity or pass to other extremity of the party of the same name, without extending to the person. The so-called heyrooralny type of an attack which is arising in the field of a nasolabial fold of the person on the one hand and quickly passing to fingers of a hand of the same party is quite often observed. Much less often spasms arise in a proximal segment of an extremity or in muscles of a prelum abdominale. In certain cases spasms can be limited to muscles of egg or any segment of an extremity, trunk. In other cases the attack can generalizovatsya — spasms extend to other side of a body, there can come the loss of consciousness (a secondary and generalized attack). At each patient of a spasm begin with the same segment of an extremity or face muscles. In some cases at the same patient the spasm can be limited once to any extremity or face muscles, at times to accept the developed character. Sometimes patients manage to stop the attack which began in a hand, having strong clasped it with other hand. So-called inhibitory focal attacks in the form of suddenly coming short-term decubital paralysis are very seldom observed (amyotonia). The alalia of aphotic character is even less often observed that indicates defeat of a dominant hemisphere. Combinations of an amiotonichesky attack in one extremity with clonic spasms of the person or other extremity of the party of the same name are sometimes observed. The epileptic status which is limited to one extremity, the person or with constantly repeating «jacksonian march» can be observed. The bilateral alternating D.'s attacks e are described. (on one, on other party). Sometimes somatomotor attack of D. e. begins with paresthesias in that segment, in Krom then there are spasms. The somatosensory attack (paroxysmal disorders of sensitivity) proceeding as «a jacksonian march» is even less often observed. The termination of spasms happens suddenly or more in a slowed-up way as it should be, the return to development of an attack. Postepileptic short-term paresis or even a decubital paralysis is characteristic, about a cut the attack began. The progressing increase of intensity and duration of a postepileptic decubital paralysis patognomonichno for tumoral process in a motor zone of bark.

The diagnosis

the Diagnosis is made on the basis of the nature of an attack and existence of permanent organic disturbances: paresis, paralyzes, disorders of sensitivity.

At electroencephalography (see) at a part of patients it is possible to observe strictly focal cortical categories of epileptic activity corresponding to the epileptic center. EEG is characterized by the peaks or edges passing in final stages of an attack into multiple acute waves. In other cases of change have diffusion character or are absent that and G. explain Jasper (1958) to Gasto (H. Gastaut, 1954) with very small amount of focal defeat of a cerebral cortex and a deep arrangement of the center.

On EMG (see. Electromyography ) D.'s attack e. it is characterized by a high-voltage, high-frequency interferential curve at a tonic spasm and group high-amplitude categories of muscular potentials at a clonic spasm. Patognomonichna the single and group muscular potentials registered in the interepileptic period arising at stimulation of electric activity it is selective in those segments about which the attack usually begins.

D.'s attacks e. it is necessary to distinguish from the so-called myoclonic attacks proceeding with disturbance of consciousness (see. Myoclonia ). In some cases D.'s attacks e. it is necessary to differentiate with hysteria (see) and genuinical epilepsy (see). It is important to establish the nature of the disease which caused D. e.

Treatment

Treatment — the basic process which caused focal attacks. At the same time, within not less than one year, vigorous continuous treatment by anticonvulsant drugs (phenobarbital, benzonal, etc.) and dehydrational means is necessary. In case of lack of lasting effect it is necessary to resort to neurosurgical intervention (see. Epilepsy, surgical treatment ).

The forecast

the Forecast is defined by the disease which caused D. e., and efficiency of the carried-out therapy.


Bibliography: Kukuyev of L, A. Sindr Dzheksona and jacksonian epilepsy, Zhurn, neuropath, and psikhiat., t. 72, No. 5, page 743, 1972, bibliogr.; M and r to about in D. A. and Gelman T. M. Epilepsies and their treatment, Minsk, 1954, bibliogr.; Penfild U. and Of Jasper. Epilepsy and functional anatomy of a brain of the person, the lane with English, M., 1958, bibliogr.; With and r and d and sh in and l and P. M. and of l about N of t and T. I. Epilepsiya, in book: Sovr, condition of the main sections neuropath., under the editorship of N. V. Konovalov, etc., page 147, M., 1961, bibliogr.; Ajmone-Marsan C. a. R and 1 s t about n B. L. The epileptic seizure, Springfield, 1957, bibliogr.; G a s-t an u t H. The epilepsies, Springfield, 1954; Jackson J. H. A study of convulsions, Trans. Andrews med. Grad. Ass., v. 3, p. 162, 1869.

P. M. Saradzhishvili.

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