According to the criteria for the International Anti-Epileptic League, the first seizure (attack) is one or several first-earned seizures that can be repeated within 24 hours, with a complete restoration of consciousness between them.

reference Information:

Conceptual definition of epileptic attack and epilepsy (Report ILAE, 2005) epileptic attack (seizure) transient clinical manifestations The pathological excess or synchronous neural activity of the brain epilepsy is a brain disorder, characterized by a resistant predisposition to epileptic attacks, as well as neurobiological, cognitive, psychological and social consequences of this state. This definition of epilepsy provides for the development of at least one epileptic attack (note: the attack associated with the effects of a transient factor on a normal brain that temporarily reduces the convulsive threshold is not related to epilepsy).

Practical clinical definition Epilepsy. Epilepsy - brain disease, corresponding to any of the following states: [ 1 ] At least two unwriting (or reflex) epileptic seizures with intervals\u003e 24 hours; [ 2 ] One unwatching (or reflex) epileptic attack and the likelihood of repeated seizures, corresponding to the general risk of relapse (\u003e 60%) after two unwitted epileptic seizures, over the next 10 years; [ 3 ] diagnosis of epileptic syndrome (for example, benign epilepsy With centerothamporal spikes, Landau syndrome - Kleffner).

Distinguish the first attack:

[1 ] Epileptic - the transient appearance of signs and / or symptoms as a result of the pathological or enhanced activity of brain neurons;
[2 ] acute symptomatic - attack developing with heavy damage brain or in a clear temporal dependence on documented acute brain damage;
[3 ] remote symptomatic - an attack that develops without an obvious provocation factor, but with the presence of a preceding the fit diagnosed serious damage to the brain, for example, severe injury or concomitant disease;
[4 ] progressive symptomatic - a convulsive attack, developing in the absence of a potentially responsible clinical condition or outside the time interval, for which acute symptomatic seizures are possible, and caused by a progressive disorder (for example, a tumor or degenerative disease);
[5 ] Psycho - transient behavioral disorders without any cause of organic nature (in the DSM-IV classification, such an attack is classified as a somatoform violation, while according to the classification of the ICD-10 [WHO, 1992], a similar attack is classified as dissociative convulsions and refers to a group Conversion disorders.

read also Article: Psychogenic non-epileptic attacks (to the website)

Acute symptomatic convulsive seizures are episodes arising in close temporary interconnection with acute CNS damage, which may have a metabolic, toxic, structural, infectious or inflammatory nature. The time period is usually defined as the first week after an acute pathological state, but it may be shorter or longer. Such convulsive seizures are also called reactive, provoked, induced or situationally caused convulsive attacks. To conduct epidemiological studies, a precise definition is required, so the International Anti-Epileptic League recommends using the term - sharp symptomatic convulsive seizures ( note: Acute symptomatic attack is a "provoked attack", therefore, even at a high risk of its relapse, the diagnosis of epilepsy is not exhibited [cm. "Reference information" is a practical clinical definition of epilepsy]).

Epileptic, distant symptomatic and progressive symptomatic attacks are "unprovoked attacks". Disposable seizures are a fit or a series of seizures developed within 24 hours in a patient under the age of 1 month in the absence of provoking factors. Disrupied seizures may be single or recurrent. Although all patients with single unwatching seizures have the likelihood of epilepsy, recurrence comes only in half cases. According to population studies, the risk of recruits of seizures for 1 year was 36 - 37%, within 2 years - 43 - 45%. After the 2nd unwriting seizure, the risk of development of the 3rd reaches 73%, and the 4th - 76% (Anne T. Berg, 2008).

Acute symptomatic seizures differ from epilepsy on a number of important signs. [ 1 ] First, in contrast to epilepsy, the immediate cause of these seizures is clearly determined. If there is an explicit temporal connection, there is a possibility that the reasons are the seizure of the steps such as uremia, head injury, hypoxia or stroke, which always precede the seizure or develop simultaneously with it. The causal relationship is also confirmed in cases where the acute impairment of the integrity of the brain or metabolic homeostasis is developing due to stroke. In many cases, heavier injury increases the likelihood of seizures. [ 2 ] Secondly, in contrast to epilepsy, sharp symptomatic seizures are not necessarily repeated in the relapses of the states that caused their cause. [ 3 ] Third, although acute symptomatic seizures are an undisputed factor of the risk of epilepsy, they cannot be included in the definition of epilepsy, for which there are 2 or more unprovoked seizures.

With the firstly developed convulsive fit, it is recommended to hold next examination :

[1 ] General somatic examination. [ 2 ] Neurological examination. Of the variety of symptoms, reliable indicators of the epileptic nature of a convulsive seizure are cyanosis and to a lesser extent - hypersion (associated symptoms), biting language and disorientation (symptoms appearing after the seplide). Closed during the tonic-clonic phase, the seven eyes testify in favor of a dissociative (psychogenic non-epileptic) seal with a sensitivity of 96% and specificity of 98%. [ 3 ] Blood biochemical studies: general analysis blood, glucose, urea, electrolytes (including calcium), creatinine, aspartate-aminotransferase, alanine aminotransferase, creatinery / prolactin; urine analysis Toxicological tests (if necessary).

With the exception of the children of the first 6 months of life, in which hyponatremia (<125 ммоль/л) в 70% случаев сопутствует эпилептическим припадкам, метаболические нарушения (гипер- и гипогликемия, электролитные нарушения и др.) редко обнаруживаются у детей и взрослых при биохимическом/гематологическом скрининге после припадка.

To differentiate epileptic seizures and psychogenic non-epileptic seizures, it is advisable to determine the level of serum prolactin (two-time excess of the basal level or\u003e 36 ng / ml suggests either generalized tonic-clonic, or complex partial seizures.

[4 ] Holding EEG. If the standard EEG recorded during wakefulness is non-informative, it is recommended to record EEG against sleep. The EEG recorded within 24 hours after the seizure helps to identify epileptiform activity with greater degree of probability than recorded in the following days. On the contrary, the slowdown in the basal EEG activity after 24-48 hours after the seizure may be transient and must be interpreted with caution.

read also Article: Video EEG-monitoring (to the website)

[5 ] Conducting computed tomography (CT) and magnetic resonance imaging (MRI) brain. Although pathological changes can be found in almost half of adults and 1/3 of children, the contribution of neurovalization research methods is limited in patients with existing epileptogenic brain injuries and / or partial seizures. There is no data that MRI is informative than CT in urgent states, at least in children. The value of the CT-study in the absence of pathological changes in neurological status was 5 - 10%. Despite the fact that up to 1/3 of children have pathological changes that are detected by neurovalization, most of these findings do not affect the further tactics of treatment and patient management, such as the need for hospitalization and appointment of further surveys.

[6 ] Indications for the study of the spinmboslement fluid (SMG). Due to high sensitivity and specificity, the study of the SMF is usually performed in febrile seizures, accompanied by meningeal symptoms, To eliminate the infection of the brain. In children under 6 months of age with a violation and incomplete recovery of consciousness in the SMF, pathological changes may be observed even in the absence of symptoms of irritation brain shells. On the contrary, the value of the study of the SMG in patients with the first oil maker has not yet been determined.

Treatment. In the presence of the first acute symptomatic secess (metabolic encephalopathy, the acute injury of the central nervous system in patients with a fixed underlying fideline) is recommended for the treatment of the disease that caused the cause of the seizure. Symptomatic (anti-epileptic) therapy of the first unworched seven is illegal, unless the seizure is epileptic status. The decision on the start of treatment with antiepileptic agents after the first seal largely depends on the risk of relapse (patients with acute symptomatic attacks and high risk of relapse should not be treated with anti-ebileptic drugs (PEP) on a long-term basis, although such treatment can be justified for the short term, while The acute state was not compensated; in the treatment of sharp symptomatic attacks, it is advisable to apply injection forms for intravenous administration PEP, such as convoilex, Vimpate, Keppra). Although this risk can differ significantly in different cases, it is the highest in patients with the presence of pathological EEG changes and confirmed (documented) brain injury. Such situations also include the only epileptic attack of at least one month after a stroke or the only fit in a child with structural pathology, or a distant symptomatic attack in the presence of epileptiform changes on the electroencephalogram (EEG). Another example is a specific epileptic syndrome with a resistant decrease in a convulsive threshold, identified after a single seplif. In general, the risk of recurrence is highest during the first 12 months and is reduced almost to 0 2 years after the seaside. Studies that correspond to the levels of evidence A, C, have shown that the treatment of the first unprovoked secess reduces the risk of relapse in the next 2 years, but does not affect the remote outcomes of both in children and in adults.

Since acute symptomatic seizures partially reflect the severity of the TSS defeat, it is clear that their appearance is associated with a poor treatment prediction. Nevertheless, the direct effect of sharp symptomatic seizures has not yet been proven to the forecast.

In order to assess the risk of recurrence, spend differential diagnosis and make a decision on the appointment of treatment, a council of a neurologist specializing in the problem of epilepsy is necessary. That is why all patients, with a developing convulsive, who developed a convulsive fit should be consulted in specialized centers or cabinets (epileptologist) within 1 - 2 weeks after the seaside.

The diagnosis of epilepsy after a single unprovoked convulsive attack even at a high risk of recurrence does not always lead to the appointment of therapy. The proposed practical definition of epilepsy (see above) supports the beginning of treatment in a patient with a high risk of recurrence after a single unprovoked secess. However, the decision to start treatment should be made individually taking into account the desire of the patient, the ratio of risk and benefits, as well as the available therapy options. The doctor must measure the possibility of preventing attacks with risk side Effects Preparations and patient's costs for treatment.

It should once again clarify that the diagnosis of epilepsy and the decision on treatment is two connected, but different aspects of the problem. Many epileptologists are treated for some time after an acute symptomatic attack (for example, under herpese encephalitis), which is not related to epilepsy. On the contrary, in patients with light attacks, long intervals between the seizures or when refusing treatment, therapy may not be carried out even with an undoubted diagnosis of epilepsy.

Convulsive syndrome - An unpleasant symptom, which can lead to irreversible consequences with a non-time-rendered assistance. According to the international classifier of diseases, such a state may have code R 56.0 or R 56.8. We are talking about not epileptic and epileptic cramps. If this symptom had to face for the first time, the exact diagnosis will put a doctor after a thorough examination.

Seizures at high temperature

In the fever, adults are quite rare, but still the convulsive syndrome (ICD R 56.0) is manifested. Hyperthermia can be a consequence of a dangerous viral, bacterial or fungal infection. The convulsive syndrome in adults, as a rule, is developing due to a meeting with a new dangerous microorganism, with which she had not had previously faced. Thus, under the usual flu, the probability of manifestation of such symptoms is reduced to a minimum. Often, when infected in someone else's country, convulsive syndrome is developing (ICD R 56.0).

Unpleasant symptoms Against the background of increasing body temperature manifests itself due to overheating of all organism systems, including brain. The risk of developing seizures increases when the indicators on the thermometer reach 39.5 ° C. Experts recommend not allowing it to accept the antipyretic agent before arrival emergency care.

It is necessary to cause a doctor if, against the background of a high temperature, a person has "marble" of the skin, apathy, dizziness. Significantly increases the risk of developing convulsive syndrome during fever for allergy.

Epileptic cramps

Pathological symptoms can develop due to congenital or acquired defects nervous system. In an adult person provoke the development of epileptic convulsive syndrome (R 56.8 μb) can:

• head injuries;
• alcoholic intoxication;
• strokes;
• benign and malignant brain neoplasms.

In 40% of cases, the exact causes of convulsion can not be found out. With age risk of development dangerous symptoms Increases. People suffering from alcohol and narcotic dependence fall into the risk group.

Healthy young people rarely develop convulsive syndrome. The reasons are most often concluded in epilepsy, which did not show itself before. This is a cerebral disease, which suffer over 40 million people around the world. In a third of people who collided with him, the first attack develops even before adulthood. However, many patients have a pathological process can manifest much and much later.

Causes of epilepsy

The convulsive syndrome (ICB R 56.8 or R 56.0) is the result of the synchronous excitation of all cells of a separate section of the cerebral cortex (epileptic focus). The disease is often transmitted by inheritance. Therefore, if relatives had to face such pathology, the child must be examined at an early age.

Epilepsy can also be acquired. A number of patients have convulsive syndrome begins to manifest after serious injuries transferred infectious diseases Brain (meningitis, encephalitis), poisoning. Every tenth alcoholic or drug addict suffers from epileptic seizures.

In case of epilepsy, convulsive syndrome can manifest itself in different ways. Sometimes there is only a short-term loss of communication with the outside world. The surroundings might think that the sick attended for a second. The syndrome takes place very quickly. But in many cases, convulsive attacks are accompanied by twisting all the muscles, swinging the eyes. In this case, it is important to provide the right assistance to the patient.

With convulsive syndrome

The convulsive fit in itself cannot lead to the patient's death, no matter how terrible did the clinical manifestations of the pathological process. Provice the development of complications may incorrect actions of people who are nearby. In no case cannot forcibly restrain convulsive movements. In execution artificial respiratory And the heart massage is also no need.

If the epileptic attack began, the patient must be put on a flat solid surface, you can put a roller from the clothes or a small pillow under the head. To prevent the blurred language, the patient's head should be rotated on the side. After graduation, the convulsion should be given to the patient to come to themselves, sleep. Usually cramps for epilepsy lasts not more than 30 seconds. When the fit is over, it is worth calling ambulance.

Diagnosis of the disease

If the epileptic fit happened for the first time, the patient will be sent for a full examination in the neurological department. Put an accurate diagnosis will allow encephalography. To determine the epileptic focus, such research can be carried out as CT or MRI.

Treatment of epilepsy

If urgent assistance in convulsive syndrome was rendered correctly, and the patient immediately appealed for qualified medical care, the likelihood of the development of hazardous complications is minimized. Modern medicines allow 70% to reduce the number of seizures in patients with chronic epilepsy.

It is not a reason for serious restrictions of convulsive syndrome. Clinical recommendations Only touch the patient's lifestyle adjustment. The patient will have to abandon emotional and strong physical overloads. However, it is quite possible to lead normal life, attend work or training institution. Such patients are not forbidden to drive a vehicle.

Epilepsy is complex and still not fully studied brain disease manifested by convulsive attacks. The article discusses the concept, symptoms and treatment of this disease, as well as the form of epilepsy on the ICD 10

Epilepsy (ICD 10 - G40), or paroxysmal epileptic disorder - chronic pathology The brain, characterized by repeated infrarable epileptic attacks.

It should be remembered that a single convulsion cannot be considered an epileptic attack.

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The main thing in the article

Often the causes of this disease are unknown, but some pathological conditions are able to provoke the so-called symptomatic epilepsy - they include, for example, um tumors, strokes and malformations of vessels.

Symptomatic epilepsy is a disease that develops as a symptom of already known pathologies. Attacks provoked by them are the name of symptomatic epileptic seizures. Often this phenomenon is observed in elderly patients and newborn babies.

Epileptic seizures should be distinguished from neepileptic attacks, as a rule caused by a transient disease or an irritant.

These include:

• metabolic disorders;
• infections of the nervous system;
• heart disease and vessels;
• toxic effects of certain medicines or their cancellation;
• psychogenetic disorders.

In children, before a certain age, convulsive attacks may be caused by hyperthermia - these are so-called febrile cramps.

Quality criteria specialized medical care Adults and children with epilepsy deploy consilium in System: Available only for doctors!

In addition, symptomatomy, similar to epilepsy (MKB 10 - G40), the pseudo acceptances of a psychogenic nature are distinguished - they are usually characteristic of people with psyche disorders.

The difference is that at this state does not record the pathological electrical activity of the brain.

Classification of epilepsy on the ICD

In accordance with International classification of disease 10 revisions allocate several etiological forms of epilepsy.

They are presented in the table below:

Idiopathic, symptomatic or cryptogenic epilepsy

The international classification of epilepsy, epileptic syndromes, adopted in 1989 by the international antiepileptic league, is based on 2 principles.

The first is to determine whether the epilepsy is focal or generalized.

According to the second principle, idiopathic, symptomatic or cryptogenic epilepsy is distinguished.

Localization (focal, local, partial) epilepsy:

• idiopathic;
• symptomatic (epilepsy frontal, temporal, dark, occipital lobe);
• cryptogenic.

Generalized epilepsy:

• idiopathic (including children's and juvenile absolute epilepsy);
• symptomatic;
• cryptogenic.

Epilepsy Code on ICD 10 in adults

The epiproter implies the pathological uncontrolled electrical activity in the cells of the gray matter of the crust of the GM. This leads to a temporary disorder of its functions.

Most often, the attack accompany such phenomena as a changed consciousness, sensory disorders, focal motor disorders or convulsions. A generalized convulsive seizure is developing, accompanied by an involuntary reduction in all muscle groups.

According to statistics, an attack of epilepsy (MKB-10 - G40)) At least once in life, approximately 2% of adults had to be survived. In 2/3 of them, he never repeated.

Epileptic seizures in human and older people are usually secondary, that is, they develop due to any serious illness or strong external influence. In these cases, the doctor must suspect symptomatic epilepsy or epileptic syndrome.

Clinical manifestations

One of the common symptoms is aura - simple partial seizures beginning with focal symptoms.

This condition may include motor activity, sensory, vegetative or mental sensations (for example, paresthesia, incomprehensible discomfort in the epigastric region, olfactory hallucinations, anxiety, fear, as well as the state of the deja vu (with Fr. - "already seen") or Jamyev ( With Fr. - "Never seen"). In essence, the last two phenomena are opposite to each other.

Most epileptic seizures last no more than 1-2 minutes and pass on their own. After a generalized attack, a secondary state may occur, manifested deep Snam, headaches, confusion of consciousness, pain in the muscles.

It lasts from a few minutes to several hours. Sometimes the so-called paralysis of Todd is revealed - transient neurological failure, manifested by weakness in the limb located opposite to the hearth of pathological brain activity.

In most of the patients with epilepsy (code on the ICD 10 - G40), there are no neurological symptoms between the attacks, despite the fact that the reception of high doses of anticonvulsive drugs inhibits the work of the central nervous system.

The progressive deterioration in mental functions is most often due to the main pathology, which caused the attack, but not with the attack itself as such. In very rare cases, the attacks are without stopping, one by one - in this case we are talking about the epileptic status of the patient.

How to organize a clinicalization in 90 minutes

Symptomatic epilepsy (Code of ICD 10 - G40.2)

Symptomatic epilepsy is manifested in different ways. Generalized attacks, as a rule, are characterized by loss of consciousness, loss of control over the actions, falling the patient who develops a pronounced convulsive syndrome.

According to the severity of epilepsy (MKB-10 - G40) is divided into light and heavy. The symptoms of the disease is diverse and depends on which section of the cerebral cortex is amazed. From this point of view, mental, sensual, vegetative and motor disorders are distinguished.

Under the attacks of a mild, the patient usually does not lose consciousness, but unusual fraudulent sensations may occur. Also may be lost control over some parts of the body.

A severe form of symptomatic epilepsy is characterized by a complete loss of communication with reality, a convulsive reduction in all muscle groups, loss of control over their own actions and movements.
Depending on which section of the cerebral cortex is amazed, the following symptoms of symptomatic epilepsy may be observed:

• the frontal share is a sudden beginning of the attack, its small duration (up to 1 minute), high frequency of attacks, motor disorders;
• temporal share - confusion of consciousness, visual and auditory hallucinations, facial and bruste automates;
• the parietal share is the development of muscle spasms, pain, libidism, impaired temperature perception;
• the occipital share - visual hallucinations, uncontrolled blinking, violation of the field of view, head twitching.

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Frebel convulsions It occurs in children under 3 years when increasing the body temperature above 38 ° C in the presence of genetic predisposition (121210, Â). Frequency - 2-5% of children. The prevailing floor is male.

Code of PO international Classification MKB-10 diseases:

• R56.0.

Options . Simple febrile cramps (85% of cases) - one attack of convulsion (usually generalized) during the day lasting from a few seconds, but not more than 15 minutes. Complex (15%) - several episodes during the day (as a rule, local seizures), which are ongoing more than 15 minutes.

Symptoms (signs)

Clinical picture. Fever. TonyClonic convulsions. Vomiting. General arousal.

Diagnostics

Laboratory research. The first episode: determining the level of calcium, glucose, magnesium, other blood serum electrolytes, urine analysis, blood sowing, residual nitrogen, creatinine. In severe cases - toxicological analysis. Lumbar puncture - with a suspicion of meningitis or the first episode of the child's cramps over 1 year old.

Special studies. EEG and CT of the brain in 2-4 weeks after the attack (carried out with repeated attacks, neurological diseases, sophisticated seizures in a family history or in the case of the first manifestation after 3 years).

Differential diagnosis. Febrile delirium. Africral cramps. Meningitis. Head injury. Epilepsy in women in combination with mental retardation (* 300088, à): febrile convulsions can be the first sign of the disease. Sudden termination of the arrival of anti-wurals. Intracranted hemorrhages. Vernoy sinus thrombosis. Asphyxia. Hypoglycemia. Acute glomerulonephritis.

Treatment

TREATMENT

Tactics of keeping. Physical cooling methods. Patient position - lying on side to ensure adequate oxygenation. Oxigenotherapy. If necessary, intubation.

Drug therapy. Preparations of choice - paracetamol 10-15 mg / kg rectally or inside, ibuprofen 10 mg / kg - during fever. Alternative preparations .. Phenobarbital 10-15 mg / kg V \u200b\u200b/ in slowly (breathing oppression and arterial hypotension are possible) .. Phenytoin 10-15 mg / kg in / in (cardiac arrhythmia and arterial hypotension).

Prevention . Paracetamol 10 mg / kg (inward or rectally) or ibuprofen 10 mg / kg orally (at a body temperature above 38 ° C - rectally). Diazepams - 5 mg under the age of 3 years, 7.5 mg - from 3 to 6 years or 0.5 mg / kg (up to 15 mg) rectally every 12 hours to 4 doses - at a body temperature above 38.5 ° C. Phenobarbital 3-5 mg / kg / day - for long-term prevention in children risk groups with burded history, multiple repeated attacks, neurological diseases.

The course and forecast. Febrile attack Does not lead to a delay in physical and mental development or to death. Risk of re-attack - 33%.

MKB-10. R56.0 cramps for fever

Code on the ICD-10 - G40.3

Idiopathic Generalized epilepsy (IHE)- This is a disease in which repeated convulsive seizures arise, causing excessive bioelectric activity (discharges) of neurons and accompanied by various clinical and paraclinic manifestations.

Its compulsory honors from acute symptomatic attacks is the absence of specific reasons for their causing (, encephalitis, etc.).

Types and classification

1.Idiopathic with age-dependent

· Benign family seizures of newborns (arise on the second or third day of life, it is also known about the presence of similar seizures in the family).
· Benign convulsions of newborns (appear for about the fifth day of the baby).
· A benign myoclonic epilepsy of early infancy (arises in the first and second year of the child's life; manifested by generalized myoclonies, the forecast is good).
· Children's absentee epilepsy, or picnolepping (small children of 2-8 years old, are characterized by simple abscans, prognosis is favorable).
· Youth Absanter epilepsy (appears during sexual maturation, GTKP and myoclonies are combined).
· Youth myoclonic epilepsy (after sleep synchronous bilateral myoclonies occur).
· Epilepsy with generalized convulsive wake-ups (a few hours after sleep bilateral myoclonies occur).
· Other forms of idiopathic generalized epilepsy.
· Epilepsy with seizures caused by specific methods (more often photosensitive epilepsy).

2. Cryptogenic

· West Syndrome, or Infantile Spasms (Appears in four to-seven months, the seizures arise between the series, with pauses, the head and torso are bend, and the hands are dismissed, the forecast is serious).
· Lennox-Gasto Syndrome (Debut in three or six years, mental development slows down, is characterized by an atypical character, atonic seizures and tonic seizures arising at night, this form has insensitivity to therapy).
· Epilepsy with myoclonically-astatic seizures (Arrives from the first years in the form of febrile GTCP, can be spontaneously move into remission).
· Epilepsy with myoclonic absans (Debuts in six to eight years with the addition of mental delay, insensitive to therapy).

3.Simptomatic

This is a narrow clinical specialist who is engaged in the diagnosis and treatment of sleep disorders. With these disorders, as well as in the epipridges, an important diagnostic value is the execution of video EEG - when electroencephalography is performed under the control of the chambers, with the translation of convulsions to the monitor screen. It helps to observe and defraenate convulsive syndrome from other pathological conditions not only according to the results of the EEG, but also visually.

Another variety of electroencephalography is daily EEG monitoring. This study is carried out in a somnunical laboratory, which is a room where bioelectric activity indicators are removed at night. Just at this time and may manifest night epilepsy. A person comes to a study in the evening and goes to bed, and during the sleep, the doctors you are interested in the test.

In addition to the appearance of characteristic changes that can be seen on the film of the encephalographer, you can observe and how these changes look from the side: how a person behaves at this time, how long the convulsive seizure continues and what is it character.