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There are automatisms with the continuation of the action started before the attack, and arising de novo, as well as automatisms with interaction with objects or people, without interaction and directed at oneself. Mimic automatisms are manifested by various grimaces, facial expressions of fear, surprise, confusion, as well as a smile, laughter, frown.Get sildenafil 100mg for men
Gesture automatism is manifested by rapid, stereotypical one- or two-way movements, such as rolling pills, clapping, rubbing hands, stroking, patting, or scratching one's body, sorting through clothes or bedding, shaking, shifting, or feeling objects, washing movements with hands, and etc. In addition to manual automatisms, there are often movements of sildenafil pills and torso. Characterized by looking around, marking time, rotation around its axis (rotary paroxysms), squatting or standing up (from a prone position).
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Speech automatisms are manifested by various speech disorders. Characterized by indistinct muttering, pronunciation of individual words, sounds, sobbing or crying, hissing, etc. Sexual automatisms are manifested by paroxysms of exhibitionism, transvestism, onanism and hypersexuality. During an attack, patients can completely undress, change into clothing of the opposite sex, expose and demonstrate their genitals, masturbate, and hug, kiss, feel the genitals of Viagra strangers. After leaving the attack, finding themselves naked, patients experience a pronounced sense of shame (this type of automatism can also be observed in the framework of frontal (cingular) epilepsy).
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Automatisms with stereotypical hypermotor movements (more typical for orbitofrontal frontal epilepsy) are manifested by typical intense stereotypical movements in the proximal parts of the lower (pedaling) or upper (boxing) limbs, which often occur during sleep. Cardiac attacks are manifested by sudden specific sensations in the region of the heart such as compression, compression, bursting. Perhaps the occurrence of heart rhythm disturbances, fluctuations in blood pressure, vegetative disorders (hyperhidrosis, pallor of the skin, chill-like hyperkinesis), a feeling of fear is expressed.
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Respiratory attacks are manifested by sudden suffocation, a violation of the rhythm of breathing with periods of apnea, a feeling of constriction in the neck with tonic tension in the muscles of the neck. Sexual paroxysms are manifested by a pleasant sensation of warmth in the lower abdomen with an increase in sexual arousal, often turning into orgasm (orgasmic attacks). Objectively appear vaginal hypersecretion, contraction of the muscles of the vagina, perineum, thighs. Perhaps local perception of orgasm, as well as orgasm with painful sensations.
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Auditory hallucinations (most typical in lateral temporal lobe epilepsy) are manifested by elementary (noise) and complex long-term (voices, music) phenomena. Often an attack, starting with auditory hallucinations, then turns into a complex partial one with a stop in the gaze and various automatisms. Seizures with impaired speech when the focus is localized in the superior temporal gyrus of the dominant hemisphere (Wernicke's speech center) are manifested by sensory aphasia. Paroxysmal sensory aphasia manifests itself in the form of the impossibility of the patient's perception of oral speech. Perhaps a combination with amuseia.
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Treatment of temporal lobe epilepsy is a complex task, which includes reducing the frequency of seizures andreducing remission, providing patients with social, labor and family adaptation (i.e. improving their quality of life). Carbamazepine, phenytoin, valproates and barbiturates are recognized as the basic drugs in the treatment of temporal lobe epilepsy, and lamotrigine and benzodiazepines are recognized as reserve sildenafil drugs.
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If there is no effect, you should stop using carbamazepines, instead prescribing hydantoins (difenin) or valproates (depakine). Doses of difenin in the treatment of temporal lobe epilepsy are 8-15 mg/kg per day. With the predominance of secondary generalized convulsive seizures, monotherapy with valproate - depakine at a dose of 50-100 mg / kg per day is possible. According to a number of authors, in partial seizures with secondary generalization, the effectiveness of valproates is higher than that of difenin, and depakine is the drug of the second (after carbamazepine) choice. In addition, diphenin is much more toxic than depakine, especially in relation to cognitive functions.
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Indications for surgical intervention are seizure resistance to various antiepileptic drugs at the maximum tolerated doses, frequent severe seizures leading to social disadaptation of patients, and the presence of a clearly localized epileptogenic focus. Surgical treatment is not recommended in severe somatic status of the patient and the presence of severe mental and intellectual-mnestic disorders.
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In the absence of the effect of monotherapy, it is possible to use polytherapy using any combination of basic and reserve antiepileptic drugs. With absolute resistance of seizures to antiepileptic drugs, neurosurgical intervention is performed. This requires a strict selection of viagra and a thorough preoperative examination.
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The most effective combinations are Finlepsin + Depakine and Finlepsin + Lamictal. A decrease in the frequency of seizures can be achieved by combining phenobarbital with diphenine, however, this combination causes a significant decrease in cognitive functions and is used in pediatric practice in extremely rare cases. In addition to basic anticonvulsant therapy, sex hormones can be used, which are especially effective in menstrual epilepsy, in particular oxyprogesterone capronate (12.5% solution) - 1-2 ml intramuscularly once on the 20-22nd day of the menstrual cycle, 5-8 injections per well.
