epilefsia

# 25
epilefsia
Temas uZRvebian:
eqimi-nevropaTologi, profesori gia natriaSvili
eqimi nevropaTologi, med. mecn. kand. sofio natriaSvili

epilefsia
2
ra aris epilefsia?
epilefsia aris qronikuli, progresulad
mimdinare, mravali sxvadasxva
mizeziT pirobadebuli Tavis tvinis
daavadeba, romelsac axasiaTebs tvinis
ujredTa jgufis zemZlavri bioeleqtruli
gantvirTva da amis safuZvelze
aRmocenebuli gulyrebi, emociuri,
Tu fsiqikuri darRvevebi.
ganmartebisaTvis - epilefsia Tavis
tvinis daavadebaa, amitom yvela is
mizezi, romelic iwvevs epilefsias,
SeiZleba iwvevdes tvinis iseTi funqciebis
moSlas, rogorebicaa inteleqti,
mexsiereba, metyveleba, emociebi,
qceva, gamiznuli moqmedeba da sxva.
ase rom, gulyra bavSvs SeiZleba ganuviTardes
fsiqoemociuri sferos ukve
arsebuli darRvevebis fonze (magali-
Tad, bavSvTa cerebruli damblis, sam-
Sobiaro travmis, asfiqsiis Sedegad),
an progresulad matulobdes fsiqoemociuri
da nevrologiuri mzardi darRvevebis
paralelurad (magaliTad,
genetikurad pirobadebuli nivTierebaTa
cvlis darRvevebi-fenilketonuria,
amavrozuli idiotia);
emociuri da fsiqikuri darRvevebi
SeiZleba gaCndes epilefsiis msvlelobaSic
- saqme imaSia, rom Tu gulyra
xSirad meordeba, tvinSi TandaTan warmoiSveba
axal-axali, e.w. `sarkisebri”
epilefsiuri kerebi, am kerebis normaluri
funqcionireba darRveulia.
rac metia aseTi kera, miT ufro xSiri,
mZime da mravalsaxovania gulyra, miT
ufro icvleba avadmyofis qceva da
inteleqti. saboloo jamSi, yalibdeba
e.w. `epilefsiuri tvini” myari fsiqoemociuri
darRvevebiT.
xSiri gulyrebis SeCerebis Semdeg
avadmyof bavSvTa fsiqikuri moqmedeba
mkveTrad umjobesdeba. mniSvnelovania,
rom epilefsiuri daavadeba yalibdeba
TandaTanobiT, sawyis darRvevaTa
progresirebis paralelurad. bavSvTa
asakSi umravles SemTxvevaSi epilefsia
Tavidan Camoyalibebuli ar aris, e.i.
darRvevebi atarebs Seqcevad xasiaTs!
am asakSi drouli CareviT SeiZleba
epilefsiisgan gankurneba!
raSi gamoixateba emociuri
da fsiqikuri darRvevebi?
epilefsiiT daavadebuli bavSvi
gulyrebis gameorebis SemTxvevaSi TandaTan
CamorCeba Tavisi gonebrivi ganviTarebiT
Tanatolebs; is veRar iTvisebs
srulfasovnad winasaskolo an
adreul saskolo masalas, ar uyalibdeba
yofacxovrebiTi Cvevebi. mcire
asakis bavSvebs uferxdeba metyvelebis
ganviTareba. gonebrivad CamorCenili
bavSvi veRar akontrolebs saTanadod
Tavis qcevas - viTardeba agzneba, avadmyofi
ver Cerdeba erT adgilze, umiznod
waepotineba xan erT, xan meore
sagans da maSinve kargavs misdami interess,
aqvs midrekileba gafuWebisadmi
- magaliTad, saTamaSos amtvrevs, wigns
xevs. aseTi bavSvebi agresiulebi xdebian
irgvliv myofTa mimarT, maTTan
sxva Tanatolebis gaCereba saxifaToa.
yvelaze meti muSti, nakawri, nakbeni
mainc mSoblebis wilad modis. aseTi
avadmyofebi asocialurni arian, skolaSi
maTi gaCereba SeuZlebelia gonebrivi
CamorCenilobis, agznebisa da
qcevis darRvevis gamo.
Tu epilefsia viTardeba SedarebiT
mogvianebiT asakSi, rodesac ZiriTadi
inteleqtualuri funqciebis da qceviTi
stereotipebis Camoyalibeba ukve

damTavrebulia, mozardebs aRwerili
darRvevebi, cxadia, aRar uviTardeba.
rig SemTxvevebSi epilefsiiT daavadebuli
pirebi maRal inteleqtsac
ki floben - gaixseneT, Tundac, napoleoni,
dostoevski, iulius keisari!
aseT dros, uxSiresad yalibdeba
metad Taviseburi xasiaTi, romelsac
epilefsiuri xasiaTi ewodeba: es aris
saocar zomebs miRweuli egoizmi da
pedanturoba. avadmyofma zustad icis
yoveli Tavisi sagnis adgili, icavs
tansacmlis tarebis niuansebs, punqtualuria
wamebSi da araadekvaturad
Zlier reaqciebs avlens, Tu stereotipi
daerRva. aseve pedanturia igi
kontaqtebSi, ramdenjerme iZleva
erTi da imave SekiTxvas, Zneli mosacilebelia
e.i. aReniSneba fsiqikis stereotipuloba
da inertuloba (Znelad
gadarTvadoba). misTvis damaxasiaTebelia
disforia - xasiaTis umizezod
gafuWeba da aseT dros SesaZlebelia
agresiac gamoavlinos.
ra gansxvavebaa gulyrasa
da krunCxvas Soris, da
romelia maT Soris ufro
msubuqi?
gulyra aris swored is Seteva, romelic
zemZlavri gantvirTvis dros
viTardeba. amitom gulyris sinonimad
xSirad `gantvirTvas” xmaroben. gulyra
SeiZleba mimdinareobdes krunCxvebiT
da krunCxvebis gareSe, e.i. krunCxva
warmoadgens gulyris erT-erT saxes.
gulyris dros SesaZlebelia cnobierebis
sruli daxSoba (gonebis dakargva),
cnobierebis Secvla (dabinduli
cnobiereba) da cnobierebis sruli
SenarCuneba. ukanasknel SemTxvevaSi
avadmyofi gulyris dros pasuxobs
3
SekiTxvebze, momxdari axsovs. xolo
dabinduli cnobierebis dros adamiani
imaxsovrebs momxdars nawilobrivad,
fragmentulad - rogorc sizmars.
mosaxleobisTvis `klasikurs” warmoadgens
e.w. didi gulyra, romlis
mimdinareobaSi avadmyofi uecrad
kargavs gonebas, mowyvetiT ecema da
viTardeba krunCxvebi kidurebisa da
sxeulis kunTTa daWimviT (tonuri
krunCxva) an kankaliT da xmauriani
sunTqviT (klonuri krunCxva). xSirad
ki erTi gulyra moicavs am ori saxis
krunCxvis Tanmimdevrobas. kriWa Sekrulia,
Tvalebi gaxelili da ukan an
gverdze gadaweuli, guga sinaTleze
ar reagirebs. ufrosi asakis bavSvebs
aReniSnebaT duJis gamosvla, romelic
zogjer sisxliTaa SeRebili, Tu
kriWaSi enaa moyolili. xSiria uneblie
Sardva (es movlenebi mcire asakis bavSvebs
TiTqmis ar aReniSneba).
didi gulyris dros goneba sruliad
daxSulia, avadmyofi umweoa da Sei-
Zleba moigudos duJiT, baliSiT (Tu
TavdaRmaa sawolSi), xolo Tu gulyra
ganviTarda wyalSi, daixrCos. gulyris
Semdeg bavSvi gabruebuli da moTen-
Tilia, darRveuli aqvs orientacia,
gadadis Rrma ZilSi. aseTi gulyra er-
Tianad xuT wuTamde grZeldeba.
zogjer did gulyras aqvs winamorbedi
aura (berZnulad - niavis Seberva)
- es uSualod gulyris wina wamieri SegrZnebaa
usiamovno sunis, TvalebSi naperwklebis,
saxesTan siTbos miwolis,
yurebis daxSobis an xmauris saxiT.
avadmyofma sakuTari gamocdilebiT
icis, rac moyveba auras, magram xSirad
Tavis Svelas var aswrebs...
krunCxvis gareSe mimdinare gulyra
ufro xanmokle da msubuqia, magram
epilefsia

epilefsia
4
xSirad ufro avTvisebianic. misi klasikuri
magaliTia e.w. mcire gulyra,
anu absansi (frangulad - `aryofna”).
absansi grZeldeba ara umetes 1-3 wamis
ganmavlobaSi da SeiZleba didi xani
darCes mSoblebis yuradRebis miRma.
aseT dros bavSvi uecrad Sewyvets im
moqmedebas, romelsac awarmoebda (mag.
laparaks, Wamas, TamaSs, siaruls), Tvalebs
umoZraod `miaSterebs” erT wertils
da araferze ar reagirebs. swrafadve
SekrTeba, TiTqos Cafiqrebuli
mdgomareobidan gamodis da ganagrZobs
moqmedebas. gaTiSvis periodi mexsierebaSi
ar rCeba. zogjer absansis dros
bavSvi avtomaturad agrZelebs dawyebul
moqmedebas, magram arasworad (mag.
siarulis dros icvlis swor mimarTulebas,
Wamis dros kovzi miaqvs piris
acdeniT da sxv.) es e.w. martivi absansia.
arsebobs rTuli absansis saxeebic,
romelTa dros wamieri gaTiSvis
garda viTardeba Tavis swrafi erTjeradi
Caqindvra, aRmosavluri salmis
tipis moZraoba, Tavis win moxriT da
xelebis gulze swrafi dakrefiT; win,
ukan an gverdze biZgisebri gadavardniT,
sxeulis an quTuToebis kankaliT,
sxeulis kunTebis erTbaSad modunebiT
(atoniuri gulyra). rTuli absansis
dros, martivisagan gansxvavebiT, avadmyofi
SeiZleba erTbaSad daeces.
romeli gulyra
mimdinareobs gonebis
dakargvis gareSe?
es aris e.w. parcialuri (nawilobrivi)
gulyra, rodesac krunCxva vi-
Tardeba saxis, erT-erTi kiduris an
sxeulis naxevris kunTebSi upiratesad
klonuri (kankala) xasiaTis. am dros
cnobiereba sruliad SenarCunebulia
(Tu krunCxva ar gavrcelda sxeulis
meore naxevarzec). SesaZlebelia krun-
Cxvas win uZRodes imave kiduris dabuJeba,
wvis an daWimulobis SegrZneba,
xolo gulyris CamTavrebis Semdeg
krunCxvaSi monawile kunTebSi droebiT
gamovlindes Zalis daqveiTeba. am
saxis gulyra, gansakuTrebiT Tu igi
ganviTarda saskolo asakSi, SeiZleba
miuTiTebdes saskolo asakSi Tavis
tvinSi mimdinare procesis arsebobaze
da saWiroebs dauyovnebliv srul nevrologiur
gamokvlevas.
parcialuri gulyris saxeobaa e.w.
visceraluri an vegeto-visceraluri
gulyra. am dros avadmyofs SeiZleba
SeteviTad ganuviTardes Zlieri tkivili
muclis areSi, RebinebiT, sifermkrTaliT,
civi ofliT, majis aCqarebiT;
SesaZlebelia gulyris msvlelobaSi
aRiniSnos woviTi, ylapviTi da
ReWviTi moZraobebi. Seteva grZeldeba
1-3 wuTs da, rogorc wesi, mTavrdeba
Rebinebis Semdeg. avadmyofi gonebas
ar kargavs, Seteva axsovs, xolo mis Semdeg
aqvs moTenTiloba, Zilianoba. Tu
aseTi gulyra atarebs seriul xasiaTs,
e.i. ramdenjerme zedized meordeba -
es xdeba rig SemTxvevaSi `mowamvlis”
araswori diagnozis da gaumarTlebeli
Sesabamisi `mkurnalobis” (kuWis
amorecxva, gadasxmebi) mizezi.
Zilis fsiqomotoruli gulyra epilefsiuri
gulyris erT-erTi saxeobaa.
igi imaSi gamoixateba, rom Zilis dros
bavSvi uecrad iwyebs tirils, yvirils,
miiwevs sadRac, an mZinare wamojdeba
sawolSi farTod gaxelili TvalebiT,
awarmoebs xelebiT gaugebar mo-
Zraobebs, Tan laparakobs. aseT dros
bavSvi kontaqtisTvis miuwvdomelia,
mSoblebs ver scnobs, maT SekiTxvebze

ar pasuxobs, an iZleva gaugebar, araadekvatur
pasuxebs. ramdenime xanSi
iZinebs, xolo meore diliT Setevis
Sesaxeb araferi axsovs.
aris Tu ara epilefsia
memkvidreobiTi daavadeba?
epilefsiuri daavadeba ar gadadis
memkvidreobiT, zogierTi Zalze iSviaTi
SemTxvevebis garda (rodesac
orive mSobeli daavadebulia epilefsiis
genetikuri formiT). memkvidreobiT
gadadis organizmis mzadyofna
(ganwyoba) epilefsiis mimarT, ramac
Sesabamisi gareSe mavne faqtorebis
daxmarebiT SesaZlebelia gamoiwvios
epilefsiis ganviTareba.
ra gamokvleva tardeba
epilefsiis dros?
avadmyofis sruli nevrologiuri
gamokvleva gulisxmobs pirvel rigSi
mSoblis gamokiTxvas (anamnezi) ojaxis
biologiuri da socialuri garemos,
naTesavebSi arsebuli daavadebebis Sesaxeb:
amiT SesaZlebeli xdeba rig SemTxvevebSi
epilefsiisadmi genetikuri
ganwyobis dadgena. didi mniSvneloba
aqvs dedis orsulobisa da mSobiarobis
periodSi nayofze SesaZlo mavne
moqmed faqtorebis gamovlenas, axal-
Sobilobis periodis mdgomareobis Sefasebas,
bavSvis zrdisa da ganviTarebis
Taviseburebebis dadgenas.
gansakuTrebiT sinatifiT, dawvrilebiT
gamovkiTxavT mSoblebs gulyris
aRmocenebis pirobebis Sesaxeb (travma,
SeSineba, maRali temperatura, infeqcia,
mzeze gadaxureba, televizorTan
jdoma - an am faqtorTa ararseboba).
maT gulyris xelSemwyobi anu maprovocirebeli
faqtorebi ewodeba. Za-
5
lian didi mniSvneloba diagnostikisa
da swori mkurnalobisTvis eniWeba
gulyris formulas. e.i. ra tipiT, ra
TavmimdevrobiT viTardeba gulyra,
yovelTvis erTtipiuria, Tu sxvadasxvanairi
(polimorfuli).
gulyris formulis analizi xSirad
warmodgenas gviqmnis Tavis tvinSi
epilefsiuri keris lokalizaciis Sesaxeb.
anamnezis Segrovebis Semdeg modis
avadmyofis gasinjva eqimis mier da
instrumentuli gamokvleva
ZiriTadi standartuli gamokvlevebi
epilefsiis dros ar aris Zviri.
esaa eqoencefaloskopia-ultrabgeriTi
gamokvleva, romlis mixedviT SesaZlebeli
xdeba qalas Sida wnevis registracia,
agreTve Tavis tvinis centraluri
warmonaqmnebis centridan gadanacvlebis
dadgena. es mniSvnelovania Tavis
tvinSi simsivnis gamosaricxad, rodesac
gulyra avadmyofs aqvs ara epilefsiis,
aramed simsivnis tvinze zewolis
gamo (e.w. simptomaturi epilefsia).
amave miznebs emsaxureba Tvalis fskeris
gamokvleva. mcire asakis (2wlamde)
bavSvebSi xSirad saWiro xdeba sisxlSi
kalciumis Semcvelobis gamokvleva, vinaidan
misi nakleboba am asakSi xSirad
xdeba krunCxvis ganviTarebis mizezi
(e.w. hipokalcemiuri krunCxva). sanam
bavSvs Ria aqvs yiflibandi, Zalian informatiulia
neirosonografiac - esec
ultrabgeriTi arasaziano gamokvlevaa,
romlis meSveobiTac ekranze mosCans
Tavis tvinis sxvadasxva nawili, Rruebi,
sisxlZarRvTa wnulebi. am gamokvlevebiT
xdeba tvinis ganviTarebis darRvevebis,
sxvadasxva defeqtis, agreTve sam-
Sobiaro travmis Sedegad Tavis tvinSi
sisxlCaqcevis diagnozi.
epilefsia

epilefsia
6
eleqtroencefalograma (eeg) Tavis
tvinis biologiuri eleqtrobis Canaweria.
igi gvaZlevs informacias Tavis
tvinis normaluri da paTologiuri
bioeleqtruli aqtivobis Sesaxeb
da aqedan gamomdinare - epilefsiuri
procesis gamoxatulebis xarisxis Sesaxeb.
eeg-s saSualebiT rig SemTxvevaSi
xdeba agreTve epilefsiuri keris
registracia. amitom epilefsiis
dros eeg-gamokvleva unda warmoebdes
6 TveSi erTxel mainc. regularuli
eeg-gamokvleva iZleva saSualebas gavakontroloT
warmoebuli mkurnalobis
efeqturoba. eeg gvexmareba agre-
Tve mkurnalobis vadebis dadgenaSic.
magram ar unda dagvaviwydes, rom SemTxvevaTa
daaxloebiT 25%-Si eeg da
avadmyofis gamovlinebebi ar emTxveva
erTmaneTs. swored amitom eeg ar aris
erTaderTi gadamwyveti kriteriumi
epilefsiis dros.
Tavis tvinis kompiuteruli tomografia
da e.w. birTvul-magnituri
rezonansi rTuli da ZviradRirebuli
gamokvlevebia. isini mxolod gansaku-
Trebul SemTxvevaSi iniSneba maSin, rodesac
warmoebuli mkurnaloba araefeqturia,
ufro ki rodesac mkurnalobis
fonze gvaqvs gulyraTa gaxSireba,
gulyris formulis Secvla.
aris Tu ara yvela gulyra
epilefsia?
ra Tqma unda ara! aris mTeli rigi
gulyrebisa, romlebic epilefsias ar
warmoadgens. esaa, pirvel rigSi, maRali
temperaturis fonze ganviTarebuli
gulyraTa (e.w.febriluri gulyra)
didi nawili, organizmSi kalciumis
da B6 vitaminis ukmarisobiT pirobadebuli
gulyrebi 2 wlamde bavSvebSi,
afeqtur-respiraciuli gulyra (Cab-
Jireba, Casusteba) 4-5 wlamde asakSi,
sinkopaluri gulyra (gulis wasvla)
ufro mozard bavSvebSi da sxv. meore
ambavia, rom am saxis gulyris diagnozi
kvlavac specialistma unda moaxdinos
da kvlavac mxolod mizandasaxuli gamokvlevis
Semdeg. isic unda iTqvas,
rom aseTi araepilefsiuri saxis
gulyra swori mkurnalobis gareSe
rig SemTxvevaSi SeiZleba gadaizardos
epilefsiurSi. xolo sapirispiro SemTxvevaSi,
e.i. bavSvTa asakSi krunCxvis
swori da xangrZlivi mkurnalobisas,
SesaZlebelia bevr SemTxvevaSi pacientis
sruli gankurneba.
rogor vumkurnaloT
epilefsias?
epilefsiuri gulyris saxeobebi
imdenad bevria da samkurnalwamlo
saSualebebi imdenad mravalferovania,
rom epilefsiis swori mkurnaloba
eqimis did gamocdilebas moiTxovs. medikamenti,
an maTi kompleqsi, SeirCeva
yovel konkretul SemTxvevaSi avadmyofis
individualuri Taviseburebebis
da natifi nevrologiuri gamokvlevis
safuZvelze.
ra unda icodes mSobelma?
• gulyris ganviTarebisTanave mimarTeT
eqims, nu daelodebiT
momdevno gulyraTa ganviTarebas,
rac did umravlesobaSi xdeba.
• ar mimarToT e.w. Sinauri saSualebebiT
mkurnalobas.
• CaatareT bavSvis regularuli Semowmeba
eqimTan 2-3 TveSi erTxel,
xolo laboratoriuli gamokvleva
5-6 TveSi erTxel.
• epilefsia saWiroebs xangrZliv da

ganuwyvetliv mkurnalobas.
• araviTar SemTxvevaSi ar moxsnaT
da ar SecvaloT wamali Tqveni
eqimis gareSe. aman SeiZleba gamoiwvios
gulyris ganaxleba ufro
mZime formiT, vidre manamde iyo.
• mkurnalobis uecrad, erTbaSad
Sewyvetam SeiZleba gamoiwvios xangrZlivi
ganuwyveteli gulyriTi
mdgomareobis ganviTareba (e.w.
epilefsiuri statusi).
• epilefsiuri statusis dros
sikvdilianoba stacionarSi aRwevs
20%-s, xolo misi Semdgomi invalidoba
30%-s.
pirvel rigSi daimaxsovreT, ar gamoketoT
bavSvi saxlSi, ar SezRudoT
TanatolebTan kontaqtebSi, raTa mas
SemdgomSi mTeli sicocxlis ganmavlobaSi
ar dayves arasrulfasovnebis
kompleqsi.
SeumuSaveT mas racionaluri, magram
srulfasovani dRis reJimi: iaros sabavSvo
baRSi, an skolaSi, iswavlos da
iTamaSos, mxolod gadauWarbeblad,
gadaRlis gareSe. aucilebelia Zili
sakmarisi periodis ganmavlobaSi, dasveneba
dRisiT 1-2 saaTi.
uyureT gadacemas
`Tqveni eqimi”, kviras 13:15 imedis arxze
7
udidesi mniSvneloba aqvs medikamentebis
regularul saaTobriv miRebas.
nu SeayovnebT pacients mzeze da televizorTan,
vinaidan radiacia da sinaTlis
cimcimi xels uwyobs gulyris
ganviTarebas. amave mizeziT, sazafxulo
dasasvenebeli adgilis SerCevisas
nu SeCerdebiT zRvis kurortebze, mieciT
upiratesoba saSualo simaRlis
mTis kurortebs (mag. surami-borjomis
monakveTi).
epilefsiiT daavadebuli bavSvis kvebis
racionidan amoRebuli unda iyos
cxvris da Roris xorci. Warbi cximi,
Sokoladi, kakao, yava, magari Cai, Sebolili
produqtebi da konservi, mware,
mJave da mariliani sakvebi. nu daalevinebT
dilidan (II kvebaze) rZes, gansaku-
TrebiT auduRars. rig SemTxvevebSi
saWiro xdeba didi raodenobiT cximebis
micema. aseT dros eqimi mogawvdiT
instruqciebs.
gaxsovdeT, rom gulyra, Tundac epilefsiuri
xasiaTis, bavSvTa asakSi jer
kidev ar niSnavs epilefsias. epilefsia
viTardeba mxolod gulyraTa ganmeorebis
Sedegad, xSirad umkurnalo, an
cudad namkurnaleb SemTxvevebSi.
dausviT SekiTxva “Tqvens eqims”
telefonis nomerze: 46 30 10
eleqtronul misamarTze: n.korsantia@ho.gpc.ge
an “wiTeli A”-s afTiaqebSi moiTxoveT da
SeavseT specialuri kiTxvarebi
epilefsia