THE EFFECT OF THE TREATMENT AND THE COLLATERAL …biologie.uvt.ro/annals/fullaccess/vol_XI_57-68 .pdf · concerning the presence or the absence of the convulsions (Borundel, 2006)

Annals of West University of Timişoara, ser. Biology, vol. XI, pp 57-68

57

THE EFFECT OF THE TREATMENT AND THE COLLATERAL

FACTORS DURING THE EPILEPSY

Marioara Nicoleta FILIMON1, Smaranda Rodica GOŢIA2, Laura GOŢIA2, Ion George

DAN1

1West University of Timisoara, Faculty of Chemistry-Biology-Geography,

Department of Biology, Pestalozzi, 16, 300115, Romania 2 University of Medicine and Pharmacy “Victor Babes” Timisoara, Departament of

Phisiology, E. Murgu, 2, 300041, Timisoara, Romania

ABSTRACT The epilepsy is a chronic, paroxysmal clinical syndrome, with sudden beginning

and ending. In major crises, it is characterized by fainting, tonic and clonic

convulsions. When the epileptic crises are repeated, then we can talk about the

epilepsy as a disease. It is not a form of intellectual retardation or a physical

disease and it is not contagious. If the epilepsy shows up during childhood, it can

disappear during adolescence or at the beginning of the adult life. The reasons

are not clearly known, lots of people have a primary unidentified cause.

Sometimes the epilepsy is the result of: brain traumatism, brain tumor, brain

infections or brain vascular accidents. It is difficult to find a diagnosis for the

epilepsy. It is made by the neurologist, using electroencephalography. This study

present the dynamic evolution of a meal patient that was diagnosted whith

epilepsy at the age of 7 mounth until the aget of 21.

KEY WORDS: epilepsy, epileptic crises, electroencephalography

INTRODUCTION

Epilepsy, a disease with a great clinical variability, has a genetic

determinism, but it is also influenced by exogene factors, which can act even from

the first period of birth and then during the whole life of the individual. The

diagnosis is established based on the medical, on the description of the crisis

(especially by people who are closer). History of the pacient by the clinical exam,

by the electroencephalograph route in crisis and intercrisis.

Sometimes, it can be established by a computerized tomography or by the

nuclear magnetic resonance, for secondary causes. The convulsions can show up at

every age. Studies made in developed countries showed that 2-4 % from the

citizens have recurrent crises in a certain moment during their lifetime. In the

countries from the third world and in the urban areas, the incident is doubled. The

epileptic crisis can last from a few seconds until several minutes and their

presence is like the anatomical fix point of origin.

It can be the major paroxysmal crisis, which presents like an aura, the so–

called attack and the period after the crisis. The aura phenomenon, which precedes

the loss of conscience, is a sign–symptom, which warns the patient of the crisis.

The patient has a reduced tolerance, though the crisis doesn’t let him decide the

place where to faint. The aura can be: motivated (convulsions located in a certain

part of the body, which will generalize), vegetative (larynx contraction, gastric

FILIMON MARIOARA NICOLETA et al.: The effect of the treatment and the collateral factors during the

epilepsy

58

spasm, salivation, mastication, waves of heat, cold, pain, orgasm), sensorial and

auditory (noises, voices, sounds), sensorial and visual (bright spots, stars,

kaleidoscopic images, flames, explosions, imaginary people or animals, grotesque

visions), sensorial, olfactive and gustative (unpleasant impressions) or a

phenomenon called “already seen” or “never seen”; physical (delirious, obsessive

phenomenon), for instance “that they hear their own thoughts.”

The major paroxysmal (slowly or quickly) is automatically followed by

faint and convulsions. The convulsive phase lasts almost 60 seconds, meanwhile

the patient is not breathing. Then comes the phase with the profound, loud breath,

with hipersalivation, which can last a few seconds. Later, the patient wakes up,

after a period of physiological sleep. When he wakes up, the patient doesn’t

remember anything or is confused. After the crisis, the patient can suffer of: a

cephalic crisis, drowsiness or the previous neurological disturbance can persist,

especially those from the aura, lasting from minutes to days.

The differential diagnosis of the complex partial convulsions includes

especially absences like petit mall and psychotic estates. The petit mall absences

start and end suddenly, lasts only a few seconds, usually it is not followed by

anxiety, it doesn’t establish an aura or automatisms with a diagnosis value. The

complex partial crisis does not constitute an explanation for the violence or the

deliberate crimes.

Like it was mentioned above, lots of partial crisis can develop rapidly into

convulsions, before stopping the epileptic unload. Sometimes, the convulsions

appear before any kind of focal signs. In these cases, the studied systematic

electroencephalogram, the brain imagery or the limited paresis, may indicate the

epileptic fixed point and the injury which was caused. The primary generalized

epilepsies may have different forms, depending on the patient’s age in the

beginning, nature and extension of the structured brain lesion or the associated

metabolic.

Through convention, the primary generalized epilepsies can be divided

concerning the presence or the absence of the convulsions (Borundel, 2006).

Factors which may precipitate or accelerate the frequent epileptic crisis are

multiple. Some of these factors are: dismetabolic factors (progressive brain anoxia,

hypoglycemia, disturbance of the hydroelectrolytic metabolism, endocrine

affections, gastrointestinal affections, cardiac insufficiency, and renal

insufficiency), toxic factors (the use of alcohol), effort, physical trauma (Ion and

co. 1999).

At children, we have the following forms of crisis:

• absence (petit mall) - at children between 2 and 12 years old, almost every

time before the age of 20. Until now, there has been no identification of

structural abnormality or metabolic association, although genetic studies

showed an incidence of approximately 40% concerning the abnormality EEG,

at the first grade relatives. The intellect is not affected, nor is the neurological

factor.


59

• simple absence, which lasts only 1 or 2 seconds and is characterized by the

loss of consciousness. Usually, the patient is blinking rapidly, with a 3-4 Hz.

The head of the child falls, the eyelids and sometimes the arms are

rhythmically contracting, enuresis and short motor automatism can occur. At

children severely affected, these episodes appear ten or even a hundred times.

• complex absence, longer ones, can last from 15 to 30 minutes, rarely more

than a minute.

The crisis is characterized by a sudden, short, unconscious contraction of

the entire body or in a certain part of the body. The phenomenon takes place, as it

is normal, during the somnolence, before falling asleep. Slight, repetitive,

unconscious contractions affect more girls than boys, and it can occur more in the

arms then in the legs. This kind of epilepsy usually affects teenagers. A pain can

be felt in the shoulders and arms. Frequently, the route of the EEG has a bifrontal,

iritative activity with a 3,5-4 Hz. The slow activity is similar to the petit mall.

Pathologically and genetically, it is closer to the petit mall and it has a reduced risk

of tonic and clonic convulsions for the future (Andreoli and co. 1999).

The improvement of the studied subject is based on several collateral

factors, like: the willingness of the patient to talk freely about his disease, strictly

and efficiently respecting the treatment, respecting a balanced lifestyle (without

alcohol, smoking, disco - powerful noises, discontinuous lights), support from the

family, permanent and unconditional support from colleagues and friends, the

entourage, the created environment has a positive influence on the patients life

quality.

Tests of sensorimotor function were given to 60 ambulatory epileptic

patients, half with grand ma1 and half with temporal lobe seizures, none with

neurological abnormalities; and to 50 control persons, 30 of them healthy and 20

with medical illness. The tests involved tapping, pointing, flow of speech,

attention span, perception of "ambiguous figures" and adjustment to reversed

glasses. The patients were significantly different from normal control persons and

from patients with medical illness. The patients with grand ma1 and with temporal

lobe epilepsy were also clearly different from each other, in that temporal lobe

epileptics had more deficit in motor control, in flow of speech, attention span, and

adjustment to reversed glasses, whereas patients with grand ma1 epilepsy were

relatively intact. Since the deficits were related to the age at onset and duration of

the disease, the disease may have been causative. A questionnaire listing 55

attributes to be graded on a 5-point scale was filled out by 300 respondents to

obtain their opinion of patients with seizures. Unfavourable characteristics were

attributed to epileptics more often than favourable ones. The same questionnaire

was filled out by 53 ambulatory patients, who were much more apt to ascribe

favourable attributes to themselves than were the respondents (Remschmidt,

1973).

The majority of previous studies investigating the impact of epilepsy on

the QOL of adolescents have used proxy opinions from clinicians and/or parents.

This study highlights the need for research to investigate QOL from the direct


epilepsy

60

perspective of adolescents and consider issues in the context of a developmental

perspective. A focus group technique was used. Twenty-two adolescents aged

between 12 years 4 months and 18 years 0 months (6 males and 16 females) were

stratified by age (12–13, 14–15 and 16+ years) into six focus groups. Data were

transcribed and QSR NUD*IST 4.0 was used to help generate central themes.

Several procedures were undertaken to increase validity and reliability of findings.

Analysis identified two main themes comprising (a) issues related to adolescent

development (identity formation) and (b) epilepsy related variables, with five and

four main sub-themes, respectively (‘peer acceptance’, ‘development of

autonomy’, ‘school related issues’, ‘epilepsy as part of me’ and ‘future’, and

‘medication issues’, ‘seizures’, ‘knowledge of epilepsy’ and ‘sense of

uncertainty’). The main issues related to peer acceptance and development of

autonomy. In contrast to previous studies, academic difficulties were not

highlighted as an issue. No significant age-related differences in issues were

identified. A conceptual model representing these findings is presented and

clinical implications and suggestions for future research are reported.

The formation of a coherent sense of identity, separate from parents, is

recognised as one of the core developmental tasks of adolescence. Adolescence is

a time of significant transition in terms of biological changes, alteration in one’s

role and development of appropriate and healthy peer relationships. Successful

completion of these tasks is vital for healthy identity formation (i.e. the process by

which an individual develops a comfortable and coherent idea of who they are,

which relies heavily on positive evaluation by both themselves and other people).

Difficulties with identity formation directly impact on the adolescent’s quality of

life (QOL), i.e. “the individual’s evaluation of the quality of their lives as it relates

to their own personal expectations”. Problems can result in depersonalisation and

subsequently lead to low self-esteem, depression, loneliness, anxiety and

behavioural. Studies have consistently shown that epilepsy impacts on both peer

relationships and the development of independence and autonomy in children and

adolescents. Risk factors for poor QOL in teenagers have been identified as aged

between 14 and 17 years, ‘active’ epilepsy and greater seizure severity14, higher

numbers of medications, longer duration of illness and co-morbid learning

difficulties. Some studies have suggested that young people who are seizure free

do not demonstrate poorer QOL than age matched controls. However, comparison

of QOL in adolescents with epilepsy, diabetes and asthma, have found poorer

QOL in those (Mcewan and co., 2004).

Panayiotopoulos syndrome is a common idiopathic childhood-specific

seizure disorder formally recognized by the International League Against

Epilepsy. Panayiotopoulos syndrome probably affects 13% of children aged 3 to 6

years who have had 1 or more afebrile seizures and 6% of such children in the 1-

to 15-year age group. An expert consensus has defined Panayiotopoulos syndrome

as “a benign agerelated focal seizure disorder occurring in early and mid-

childhood. It is characterized by seizures, often prolonged, with predominantly


61

autonomic symptoms, and by an EEG [electroencephalogram] that shows shifting

and/or multiple foci, often with occipital predominance.” The purpose of this

review is to provide guidance for appropriate diagnosis and management of

Panayiotopoulos syndrome.

Autonomic epileptic seizures and autonomic status epilepticus are the

cardinal manifestations of Panayiotopoulos syndrome. Autonomic seizures in

Panayiotopoulos syndrome consist of episodes of disturbed autonomic function

with emesis as the predominant symptom. Other autonomic manifestations include

pallor (or, less often, flushing or cyanosis), mydriasis (or, less often, miosis),

cardiorespiratory and thermoregulatory alterations, incontinence of urine and/or

feces, hypersalivation, and modifications of intestinal motility. In approximately

one fifth of the seizures the child becomes unresponsive and flaccid (ictal

syncope) before or often without convulsions. Cardiorespiratory arrest is

exceptional. Moreconventional seizure symptoms often appear after the onset of

autonomic manifestations. The child, who was initially fully conscious, becomes

confused and unresponsive. Eyes turn to one side or gaze widely open. Only half

of the seizures end with brief hemiconvulsions or generalized convulsions.

Convulsive status epilepticus is extremely rare. Autonomic symptoms may be the

only features of the seizures. Half of the seizures in Panayiotopoulos syndrome

last for 30 minutes, thus constituting autonomic status epilepticus, which is the

more common nonconvulsive status epilepticus in normal children. Two thirds of

seizures occur during sleep (Covanis, 2006).

A big advance in epileptology has been the recognition of syndromes with

distinct aetiology, clinical and EEG features, treatment and prognosis. A prime

and common example of this is rolandic epilepsy that is well known by the general

paediatricians for over 50 years, thus allowing a precise diagnosis that predicts an

excellent prognosis.However, rolandic is not the only benign childhood epileptic

syndrome.Converging evidence from multiple and independent clinical, EEG

andmagnetoencephalographic studies has documented Panayiotopoulos syndrome

(PS) as a model of childhood autonomic epilepsy, which is also common and

benign. Despite high prevalence, lengthy and dramatic features, PS as well as

autonomic status epilepticus had eluded recognition because emetic and other ictal

autonomic manifestations were dismissed as non-epileptic events of other

diseases. Furthermore, PS because of frequent EEG occipital spikes has been

erroneously considered as occipital epilepsy and thus confused with the idiopathic

childhood occipital epilepsy of Gastaut (ICOE G), which is another age-related but

rarer and of unpredictable prognosis syndrome. Encephalitis is a

commonmisdiagnosis for PS and migraine with visual aura for ICOE-G.

Pathophysiologically, the symptomatogenic zone appears to correspond to the

epileptogenic zone in rolandic epilepsy (sensory-motor symptomatology of the

rolandic cortex) and the ICOE-G (occipital lobe symptomatology), while the

autonomic clinical manifestations of PS are likely to be generated by variable and

widely spread epileptogenic foci acting upon a temporarily hyperexcitable central

autonomic network. Rolandic epilepsy, PS, ICOE-G and other possible clinical


epilepsy

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phenotypes of benign childhood focal seizures are likely to be linked together by a

genetically determined, functional derangement of the systemic brain maturation

that is age related (benign childhood seizure susceptibility syndrome). This is

usually mild but exceptionally it may diverge to serious epileptic disorders such as

epileptic encephalopathy with continuous spike and wave during sleep. Links with

other benign and age-related seizures in early life such as febrile seizures, benign

focal neonatal and infantile seizures is possible.Overlap with idiopathic

generalized epilepsies is limited and of uncertain genetic significance.Taking all

these into account, benign childhood focal seizures and related epileptic

syndromes would need proper multi-disciplinary re-assessment in an

evidencebasedmanner (Panayiotopoulos et al, 2008).

MATERIALS AND METHODS

In the present work, we took into consideration the development of the

epilepsy in adolescence, by following the dynamic of the obtained

electroencephalography, from the day the diagnosis was known, from the first step

until the present day.

This study has in view the following aspects: to identify the beginning of

the disease and the possible causes; to observe of the treatments efficiency,

following in dynamic the EEG (at the age of 7 month) until the age of 6; to

identify the causes which brought back the epilepsy crises at the age of 16; to

observe of the treatments efficiency at the age of 16 until the present day; the

establishment of the factors precursory to the crisis, specific to the studied subject;

to identify the progress realized by the use of a balanced lifestyle, specific to

somebody who suffers from epilepsy.

The electroencephalogram is a preclinical exploration, which has a

bioelectrical brain activity. It is made with the help of an apparatus called

electroencephalograph. The bioelectric activity is depicted through some

electrodes, changed in a hydro saline solution, used on the scalp, at equal

distances, which collects the unloaded bioelectric, formally established in certain

parts of the world. The electrodes are connected to an apparatus which amplifies

the graph elements. Subsequently, these graph elements are registered on paper.

There two types of registration: unipolar and bipolar. The information is gathered

longitudinally or transversally (depending on the link between the electrodes).

At an electroencephalogram, we study: the morphology of the wave (form

and duration), amplitude (in volts), the wave’s frequency and their topography.

According to the group of electroencephalograms with a slow rhythm on a certain

derivation, the pathological process can be located, but nothing can be said on the

nature and pathology of the process (Mihalas et al, 2000).

The entire EEG registration contains the following: the reference route -

wakefulness, closed eyes, physical and psychic relaxation; the eyes-opened route;

the eyes - closed route and activation of the hyperpnoea; light stimulation

intermittent with 6Hz and 12Hz; and further activations. During the entire process


63

of registration, the patient and the EEG route are studied in parallel, in order to

observe the correlations between the changes of the route, certain motor display

and possible changes of the consciousness. Partial reactions are noted as well as

the objective ones - wince, miotonia, and sleep during the record. In case of

comitial crisis, first - aid must be given.

The EEG route must be recorded while at rest, in conditions of activation

(“cortical, electric activity”). By the aid of certain stimulus, the cortical activation

method has a single target: to give birth to the pathological, electric

manifestations, absent during the spontaneous EEG route. Usual activations are

made on every EEG route, no matter the clinical assignment, because it has a

simple technique and the patient goes under no risk.

The EEG diagnosis recommended in the following clinical domains:

neurology – epilepsy, meningo-encephalitis, degenerative processes, neuro-surgery

- brain trauma, neoplasic, expansive processes, benign tumors, vascular

malformations; psychiatry - physical disease, neurosis; intensive therapy - depth of

coma and the diagnosis of clinical death.

The epileptic equivalent is defined through the fact that the patient is in a

so - called crepuscular state, wandering around without a specific goal in mind, or

he is making gestures that he is not really aware of. It’s the same with the epileptic

illness, characterized by subentry crisis.

The differential diagnosis epilepsy must eliminate pretending, tetany and

hysterical crisis. The last disturbance is released by emotions and physical

conflicts. The crisis takes place in front of witnesses. Usually, the patient is

choosing the place to fall. During the crisis, the patient has to lie in bed, with

untied necktie, opened collar and seatbelt. Eventually, the patient has to be

immobilized, in order to avoid the hits, provoked by the convulsions.

The factors precursory to the crisis are generally represented by the loss of

balance, powerful headache, indecipherable talking, dim sight, hard breath, a

smell, a sound, intermittent light and continuous music. The epilepsy crisis can

last from a few seconds (rhythmical movement of a certain part of the body) to a

few minutes. The so - called grand mall crisis lasts at least 5 minutes. If it lasts

more than 5 minutes, then we are talking about a medical urgency.

The lifestyle of an epileptic patient consists of 8 hour sleep, without

drinking alcohol, any salt, sweets or excitants. Choosing this kind of profession is

the most important decision, because the nature of this disease is above every

profession on air, water, by car or by foot.

The medical treatment is based on phenobarbital in dozes of 1 cg per year,

day and age. For the adults, the dozes vary between 10 and 40 mg per day,

together with phenitoin or ethothoin (2-4 tablets a day), primidon or trepal.

Another medicine used for epilepsy is called Keppra, 500 mg (a medicine used for

treating the epileptic crisis). Keppra is recommended as a unique treatment during

the partial convulsive crisis, at 16 years old patients. Keppra is recommended to

patients who already use another medicine for epilepsy. In the last period, the


epilepsy

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medical treatment is combined with a natural treatment based on tea, juice, hot

bath or cold showers and massages (www.terapii_naturiste.com).

RESULTS AND DISCUSSIONS

The present work has in view to follow the general aspects of the nervous

system affection, namely the epilepsy. We studied somebody who has been

diagnosed with epilepsy and we followed the evolution of the disease from the

beginning of the disease until the present day. The followed aspects are: to identify

the beginning of the disease and the possible causes, to observe the efficiency of

the treatment until the age of 7 month and until the age of 6 to identify the causes

which brought back the disease, to follow the efficiency of the treatment

recommended at the age of 16 until the present day, to establish the precursory

factors of the crisis for this specific patient and to identified the progress of the

patient through a balanced lifestyle.

History of the disease

It started on April 26, at the day of his baptism, when the patient had a

very high temperature. The parents thought that the cause of the temperature was

that the child caught a cold and he was brought to the Municipal Hospital from

Orsova for a month. Although, the child was kept in the hospital and he received

proper treatment, the epileptic crisis continued the child was sent to the District

Hospital from Timisoara, there the medicine was changed to another, but the crisis

was rather frequent. For 1 year the child when on using the same treatment,

without any changes.

At the age of 1 year and 10 month, the child is brought to the Emilia Elsza

nursing - home from Bucharest, where he is diagnosed with grand – mall epilepsy.

Fenobarbital was recommended to him, which was considered a very dangerous

medicine in those times. Later, the patient was brought home, using the same

medicine. During 2 years, he was brought to Bucharest, every 3 month, for the

doctors to check his health condition. The fenobarbital significantly reduced the

convulsive crisis and the child’s health was beginning to improve.

By the age of 4, the visits to Bucharest were reduced from one to three

month, to six month. The doze of the medicine was also reduced. At the age of 6,

he had his last check – up.

But the nightmare was going to start all over again at the age of 16. On the

background of a serious psycho emotional estate, drinking alcohol and dancing at

the disco, where people smoked. There was a lot of noise and intermittent light.

The epileptic crises reappeared. At first, he was feeling tired. Then, he fainted and

was brought to the Municipal Hospital from Orsova, where after 8 hours of sleep,

it has been discovered that the disease reappeared. Two years different kind of

medicine was tried like depakina or carbamazepina, but the crisis was rather

frequent. At the age of 18, after a crisis, he was brought to the District Hospital

from Timisoara.


65

A new treatment is recommended to him, based on fenobarbital and

keppra. His treatment consisted of 3 tablets of keppra and 1 tablet of fenobarbital

per day, during 1 year. During the second year, he had 1 keppra and 1 fenobarbital

every morning, every night and half tablet in the evening. Later, he got 2 keppra

and 1 fenobarbital. Then, this was reduced to 1 Phenobarbital and half tablet of

keppra in the morning and at night. During the treatment, in 4 years, the crisis

disappeared completely. Nowadays, the patient still under this treatment, hoping

that one day he will end this treatment forever, that the crisis will disappear.

In the following, we will present some electroencephalograms and their

explanation, in order to analyze, in dynamic, the way the disease has developed

and the efficiency of the treatment. Trying to explain the electroencephalograms

recorded at the age of 2 and 3, we discovered the following: paroxysm of biphasic

sharp, sharp waves, sharp wave complexes in the temporal - frontal regions,

temporal - parietal and temporal - occipital; the activity of the θ and δ sinusoidal

waves, grouped in buffets, temporary located with extensions through the frontal,

parietal and occipital (fig. 1, 2).

Figure 1. Electroencephalogram at the age of 2

At the age of 5, the studied electroencephalogram is characterized by

isoelective routes, with an iritative, diffused aspect. At the age of 6, the studied

electroencephalogram is characterized by the following: isoelectric routes within

normal limits, instable α alpha rhythm intracortical in a slow rhythm at the level of

the posterior areas; diminished theta rhythm, predominant at the temporal areas. In

the hyperpnoea, we established a short - term, sharp wave discharge.


epilepsy

66


During 2003 and 2008, the developing disease has been followed through

electroencephalograms. The last electroencephalogram was made in 2004.

Respecting the medical treatment was very important in this period. The

electroencephalograms are characterized through: isoelectric routes with a normal

aspect; predominance of the α rhythm in the posterior occipital - temporal and

parietal regions; the presence of the β rhythm in the former areas, without

modifying them into bright stimulus (fig. 3). In the hyperpnoea, we established the

growing amplitude of the α waves.



67

At the age of 16, the crisis was detached again, due to on unbalanced

lifestyle (drinking alcohol, smoking, noises and intermittent light). There are more

factors which determined the crisis like: emotional stress and the daily intellectual

stress from school. By this time, the patient was in high school.

The studied patient who is stressed, becomes mad, looses his temper, he is

aggressive, he starts to shiver, then he feels sick and finally he has the crisis. The

factors precursory to the crisis were that the patient was loosing his balance, he

had a powerful headache, his sight was dim, and he was breathing hard (a strong

sigh), indescribable talk and finally the crisis itself.

Lotlley on improvement of the disease was observed. The factors which

may have caused this improvement are: the patient’s ability to talk freely about his

disease, respecting strictly and efficiently the treatment, having a balanced

lifestyle (without alcohol, no smoking, disco - powerful noises and intermittent

lights), the family’s support, the permanent and unconditioned support from

colleagues and friends. The environment, the created background had a positive

influence on this patient’s lifestyle.

CONCLUSIONS

The electroencephalogram is a very useful method for diagnosing the

epilepsy.

The dynamic follow of the EEG allows establishing an efficient treatment,

the changes of the wave rhythm and the improvement of the route EEG.

The patient has to respect a balanced lifestyle (without alcohol, no

smoking, disco - powerful noises, intermittent light, adequate treatment, and

affective support from the dear ones), which brings to the improvement of the

disease and eventually to the disappearance of the epileptic crisis at this case.

BIBLIOGRAPHY

• Andreoli, T.E., Carpenter, Ch.C.J., Bennett, J.C., Plum, F., 1999 – Cecil Essentials

of Medicine, Editura MAST, Ediţia a IV-a, Bucureşti.

• Borundel, C., 2006 – Medicină internă pentru cadre medii, Editura All, Bucureşti.

• Covanis, A., 2006 Panayiotopoulos Syndrome: A Benign Childhood Autonomic

Epilepsy Frequently Imitating Encephalitis, Syncope, Migraine, Sleep Disorder, or

Gastroenteritis, Pediatrics, 118, 1237-1243.

• Ion, V., Georgescu, Ş., Câmpeanu, A., Tufănoiu, E., Tudoran, C., Lupescu, I.,

1999 -Neurologie clinică, Editura All, Bucureşti.

• Mcewan, M. J., Espie, C. A., Metcalfe, J., Brodie, M. J., Wilson, M. T., 2004

Quality of life and psychosocial development in adolescents with epilepsy: a qualitative

investigation using focus group methods, Quality of Life Research, 13: 15–31.

• Mihalaş, G., Goţia, S.R., 2000, Lucrări practice de fiziologie – Explorarea funcţională

a aparatelor şi sistemelor, Editura UMFT, Timişoara.

• Panayiotopoulos, C. P., Michael, M., Sanders, S., Valeta, T., Koutroumanidis, M., 2008, Benign childhood focal epilepsies: assessment of established and newly

recognized syndromes, J Neurol Neurosurg Psychiatry, 131, 2264-2286.


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• Remschmidt, H., 1973, Psychological Studies of Patients with Epilepsy and Popular

Prejudice, Epilepsia (Amst.), 14: 347-356.

• http://www.terapii-naturiste.com/remedii_naturiste/epilepsie.htm

Documents

THE EFFECT OF THE TREATMENT AND THE COLLATERAL …biologie.uvt.ro/annals/fullaccess/vol_XI_57-68 .pdf · concerning the presence or the absence of the convulsions (Borundel, 2006)