How does cryptogenic epilepsy manifest and how is it treated?

Epilepsy is one of the most common neurological diseases, which is expressed in the sudden onset of seizures.

It occurs due to “errors” in the functioning of brain neurons. Sudden electrical discharges occur in them. It can be generalized and focal.

Generalized epilepsy is characterized by the fact that disturbances in the functioning of brain cells spread to both hemispheres of the brain. Focal, in contrast, has a clear focus of damage.

Pathogenesis

 The pathophysiological substrate of FE is the epileptogenic focus, in which several zones are distinguished. The zone of epileptogenic damage corresponds to the area of ​​morphological changes in cerebral tissue, in most cases visualized using MRI. The primary zone is the area of ​​the cerebral cortex that generates epi discharges. The area of ​​the cortex, upon stimulation of which an epileptic seizure occurs, is called the symptomatogenic zone. There is also an irritative zone - an area that is the source of epi-activity recorded on the EEG in the interictal interval, and a zone of functional deficit - an area responsible for neurological disorders accompanying epileptic seizures.

Basic medical services according to treatment standards Select treatment using artificial intelligence

Doctor consultations

Neurologist consultation

Analyzes

Blood fibrinogen

Syphilis RPR test

General urine analysis

General blood analysis

INR

Blood type and Rh factor Codes without services: A09.05.035 Study of drug levels in the blood

Diagnostics

Electroencephalography (EEG)

Electrocardiography (ECG)

X-ray of the lungs

PCR diagnosis of one infection

MRI of the brain

Codes without services: A06.30.002.001 Description and interpretation of computed tomograms

A06.30.002.002 Description and interpretation of magnetic resonance imaging

What are the types of attacks?

The following types of seizures occur with CE:

1. Tonic. Cramps develop against a background of pain. The patient's arms are bent, and the legs, on the contrary, are straightened. The body is curved in the shape of an arc. Loss of consciousness usually does not occur.
2. Generalized tonic-clonic. The seizure begins with tonic muscle contractions, then convulsions begin, and the patient loses consciousness. After an attack, a person does not remember what happened to him.
3. Atonic. Manifested by a sudden loss of muscle tone without convulsive contractions. A person may suddenly lower his head and fall. A short-term loss of consciousness occurs, then the patient comes to his senses on his own.
4. Myoclonic. They are expressed in convulsive twitching of the muscles of the arms and shoulders, which lasts from 5 to 30 seconds.
5. Visceral and vegetative. The patient experiences discomfort in the upper part of the body (“lump in the throat,” lack of air). Vegetative manifestations: increased temperature, nausea, increased or decreased blood pressure, involuntary facial expressions.
6. Epileptic absence seizures. They are not as pronounced; sometimes others do not notice that the patient is having an attack. It’s just that a person suddenly freezes, looks at one point, and does not react to external stimuli. After 5-10 seconds he comes to his senses.

Causes and pathogenesis

Most often, the causes of the pathological condition lie in various malformations of the child. Complications during pregnancy and childbirth create conditions for brain damage. The presence of foci with increased epileptiform activity is more often observed against the background of such disorders as:

• arteriovenous malformation;
• focal cortical dysplasia;
• cerebral cysts;
• fetal hypoxia;
• traumatic brain injuries;
• encephalitis;
• cysticercosis;
• brain abscess;
• neurosyphilis.

It is believed that severe epileptic seizures in childhood may be the result of impaired maturation of the cerebral cortex. As the child grows, epiactivity may disappear completely. Neuroinfections can cause the development of epilepsy in adults.

An increase in electrical activity in the affected area of ​​the brain can be caused by vascular disorders, including hemorrhagic stroke. Metabolic encephalopathy also increases the risk of this pathology: brain tumors.

It is believed that acquired and genetically determined disorders in the metabolism occurring in the neurons of certain parts of the brain increase the risk of developing epilepsy. Epilepsy is often observed in people suffering from Alzheimer's disease.

The pathogenesis of the development of the pathological condition is complex. In most cases, after damage to a separate area of ​​the brain, compensatory mechanisms are triggered. As functional cells die, they are replaced by glial tissue, which helps restore nerve conduction and metabolism in damaged areas. Against the background of this process, pathological electrical activity often occurs, which leads to the appearance of severe seizures.

Lifestyle, do's and don'ts, what's prohibited

Children with this diagnosis require special treatment . They need psychological support more than others and experience difficulties adapting to children's groups.

Parents should protect their children from stress and ensure a comfortable environment in the family.

Lifestyle involves the introduction of some restrictions:

1. Refusal from traumatic sports.
2. Avoiding prolonged exposure to the sun.
3. Avoiding hypothermia.
4. Take medications strictly according to schedule, without omissions.
5. Maintaining a sleep and rest schedule.
6. Following a low carbohydrate diet.

G40.9 Epilepsy, unspecified

Health disorders belonging to the group of episodic and paroxysmal disorders

6,821,110 people diagnosed with Epilepsy, unspecified

107,199 died with a diagnosis of Epilepsy, unspecified

1.57% mortality in the disease Epilepsy, unspecified

3 959 921

Men are diagnosed with Epilepsy, unspecified. For 73,296 of them, this diagnosis is fatal.

mortality in men with the disease Epilepsy, unspecified

2 861 189

women are diagnosed with Epilepsy, unspecified. For 33,903 of them, this diagnosis is fatal.

mortality in women with the disease Epilepsy, unspecified

The disease most often occurs in men aged 5-9

In men, the disease is least common at age

In women, the disease is least common at age

The disease most often occurs in women aged 15-19

Features of the disease Epilepsy, unspecified

Absence or low individual and social danger

* — Medical statistics for the entire group of diseases G40 Epilepsy

Clinical picture

Conventionally, all diseases of the nervous system that manifest themselves in the form of attacks (paroxysms) can be classified as paroxysmal disorders - these are migraine attacks (paroxysmal painful headaches starting in one half of the head), and fainting that occurs with various other diseases, and suddenly developing dizziness with disease or Meniere's syndrome, etc. diencephalic crises or panic attacks (vegetative attacks accompanied by increased blood pressure, increased heart rate, fear, and severe anxiety), and epileptic attacks themselves, which can occur with or without convulsions, with or without loss of consciousness.

Diagnostics

There is no standard for diagnosing the disease Epilepsy, unspecified.

Diagnosis Unspecified epilepsy is in 11th place in terms of frequency of diseases in the heading EPISODICA AND PAROXYSMAL DISORDERS

The most common:

The disease Epilepsy, unspecified, ranks 13th in terms of the danger of diseases in the heading EPISODIC AND PAROXYSMAL DISORDERS

The diagnosis is made based on the patient’s complaints and a combination of clinical symptoms. Laboratory diagnostic methods are also used. Paroxysms are often similar to each other. In order to help the patient, first of all, it is necessary to know exactly what type of attacks his conditions belong to.

Clinical manifestations

The symptom complex goes through three successive stages:

• suddenly appearing convulsive seizures;
• mental breakdowns, unstable nature;
• destruction of the intellect and destruction of the patient’s personality.

The epileptic attack itself has the following symptoms.

1. Motor. Unpleasant sensations in the body, uncontrolled running and shouting are possible.
2. Autonomic, sensitive and mental disorders. Unjustified fear, visual flashes, and hallucinations appear.
3. Neurological symptoms. Muscle tone decreases, problems with speech appear (delay and underdevelopment in children, degradation in adults), confusion and drowsiness.

In addition to everything, during an epileptic seizure there is complete apathy, often loss of consciousness, states of passion, accompanied by neurological breakdowns. The attack is often preceded by insomnia, tachycardia, the so-called aura state and hallucinations. After the attack, the pressure drops, the pulse and breathing return to normal. This is followed by complete relaxation of the body and deep sleep. After waking up, a person may experience a headache, fatigue and impaired eye contact.

Causes

Etiology, pathogenesis . In the origin of epilepsy, a combination of predisposition and organic brain damage plays a role (impaired intrauterine development, birth asphyxia, mechanical damage during childbirth, infections, traumatic brain injury, etc.). In this regard, it is inappropriate to divide epilepsy into “genuine” (hereditarily determined) and “symptomatic” (the result of organic brain damage). An epileptic seizure is caused by the spread of excessive neural discharges from the focus of epileptic activity to the entire brain (generalized seizure) or part of it (partial seizure). An epileptic focus can occur for a short time in acute brain diseases, for example, in cerebrovascular accidents, meningitis, which is accompanied by so-called random epileptic seizures. In case of chronic brain diseases (tumors, parasitic diseases, etc.), the epileptic focus is more persistent, which leads to the appearance of repeated seizures (epileptic syndrome). With epilepsy as a disease, repeated seizures are usually the result of the action of a persistent epileptic focus in the form of a sclerotic-atrophic focus. An important link in the pathogenesis is the weakening of the functional activity of structures that have an antiepileptic effect (reticular nucleus of the pons, caudate nucleus, cerebellum, etc.), which leads to a periodic “breakthrough” of epileptic excitation, i.e., epileptic seizures. Epileptogenic lesions especially often occur in the medial-basal parts of the temporal lobe (temporal lobe epilepsy).

Symptoms, course . Generalized seizures are accompanied by loss of consciousness, vegetative symptoms (mydriasis, redness or paleness of the face, tachycardia, etc.), and in some cases, convulsions. A convulsive generalized seizure is manifested by general tonic-clonic seizures (grand mal seizure), although there may be only clonic or only tonic seizures. During a seizure, patients fall and often receive significant injuries, often bite their tongues and leak urine. The seizure usually ends in the so-called epileptic coma, but epileptic agitation with twilight stupefaction can also be observed. A nonconvulsive generalized seizure (petit mal, or absence seizure) is characterized by loss of consciousness and autonomic symptoms (simple absence seizure) or a combination of these symptoms with mild involuntary movements (complex absence seizure). Patients interrupt the actions they are performing for a short time, and then continue them after the seizure, while there is no memory of the seizure. Less commonly, during a seizure, loss of postural tone occurs and the patient falls (atonic absence). With partial epileptic seizures, the symptoms can be elementary, for example, focal clonic convulsions - Jacksonian seizure, turning the head and eyes to the side - adversive seizure, etc., or complex - paroxysmal memory disorders, attacks of obsessive thoughts, psychomotor seizures - automatisms, psychosensory seizures - complex perceptual disorders. In the latter cases, there are hallucinatory phenomena, phenomena of depersonalization and derealization - states of “already seen”, “never seen”, a feeling of alienation from the outside world, one’s own body, etc. Any partial seizure can turn into a generalized (secondary generalized seizure). Secondary generalized seizures also include seizures that are preceded by an aura (precursor) - motor, sensory, vegetative or mental phenomena with which the seizure begins and of which the patient retains the memory. The course of epilepsy largely depends on its form. Thus, in children there are absolutely favorable (rolandic epilepsy, pycnoepilepsy) and unfavorable (infantile spasms, Lennox-Gastaut syndrome) forms of epilepsy. In adults, the course of epilepsy without treatment in most cases is progressive, which is manifested by a gradual increase in seizures, the occurrence of other types of paroxysms (polymorphism), the addition of nocturnal seizures to daytime ones, a tendency to develop a series of seizures or status epilepticus, the occurrence of characteristic personality changes in the form of stereotypy and pathological circumstance thinking, a combination of affective viscosity with explosiveness, importunity, obsequiousness, egocentrism up to the final states defined as epileptic dementia. Among additional research methods, EEG is of greatest importance, in which spikes, peaks, sharp waves, isolated or in combination with a subsequent slow wave (the so-called peak-wave complexes) are detected. These changes can be caused by special methods of provocation - hyperventilation, rhythmic light stimulation, administration of corazol, etc. The most complete provoking effect on epileptic activity is exerted by sleep or, conversely, 24-hour sleep deprivation, which makes it possible to identify epileptic signs in 85 - 100% of cases . EEG studies also help clarify the localization of the epileptic focus and the nature of epileptic seizures.

General characteristics of the pathology

As already mentioned, the diagnosis of cryptogenic epilepsy is established when it is impossible to identify the causes of this chronic neuropsychiatric disease. During the acute period, the disease is accompanied by epileptic seizures (convulsions, muscle cramps), during which short-term loss of consciousness, as well as mental and autonomic disorders, are possible. As the disease progresses, the patient's personality may change.

But to better understand the essence of the disease, it is necessary to consider the mechanism of its development. Epilepsy seizures occur due to increased activity of the brain in certain areas. Against the background of sudden impulses emanating from the source of pathology, the excitability of the nervous system increases, which is why convulsive muscle contractions begin and failure occurs in other processes of the body.

After an attack, complete amnesia sets in: the patient does not remember the events that occurred during the attack. It is also worth noting that a distinctive feature of cryptogenic epilepsy is that when examining a patient, it is impossible to identify the exact location of the pathology in the brain.

Causes of symptomatic epilepsy

Symptomatic epilepsy is understood as epilepsy, in which convulsive seizures regularly occur against the background of existing somatic pathologies. This disease is acquired in nature and occurs against the background of concomitant pathological processes, in contrast to the congenital form, when the disease manifests itself due to disorders of brain development.

Possible reasons include:

• Previous traumatic brain injuries (especially bruises and concussions)
• Infections affecting the membranes of the brain
• Chronic intoxication
• Ionizing radiation
• Use of certain types of medicines
• Pathological neoplasms
• Previous strokes, hemorrhages
• High intracranial pressure

There are many reasons why diseases develop. One of the most important tasks when making a diagnosis comes down to determining the mechanism of development, since the effectiveness of therapeutic procedures depends on this in the future.

Clinical picture

Cryptogenic epilepsy is characterized by the same symptoms as classical epilepsy. Epileptic seizures can be caused by it

classified in the same way as ordinary ones. Several features of the disease can be identified:

• the attack is somewhat more severe than with the classic version;
• it is difficult to choose the appropriate treatment, since the disease responds poorly to the main groups of drugs used;
• personality regression occurs several times faster;
• the results of the examination, especially neuroimaging methods, turn out to be different each time.

However, there are several special focal forms that are attributed specifically to this variant of the disease.

West syndrome

West syndrome is the earliest manifesting variant of cryptogenic epilepsy and is usually diagnosed in children between the ages of two and

four months.

Its symptoms are sudden attacks of convulsions, which just as suddenly stop.

They lead to delayed mental development of the child.

Once the child reaches one year of age, the syndrome may cease on its own or transform into another variant of the disease.

Lenox-Gastaut syndrome

Lenox Gastaut syndrome is also a childhood form of the disease, but at a later age - from two to eight years. This syndrome can appear independently or develop from West syndrome.

The condition manifests itself as sudden episodes of loss of balance in the child or short-term states of deafness. In this case, no loss of consciousness is observed.

Frequent occurrence of attacks leads to traumatization of the child and impaired mental development.

Myoclonic-astatic variant

This type of cryptogenic epilepsy is typical for children aged five months to ten years. It manifests itself before the age of one year with the occurrence of attacks of generalized convulsions (grand seizure).

Once children begin to walk, they experience bouts of sudden loss of balance.

The remaining variants of cryptogenic epilepsy, manifesting both in childhood and in adults, are clinically similar to the classic course of the disease. All attacks can be divided into two large groups - partial and generalized. Each group contains several subspecies.

Partial seizures

1. Motor seizure. During this seizure, a contraction of the muscles of a particular part of the body is observed. These can be the muscles of the limbs, back, abdomen, facial muscles. The attack occurs suddenly and goes away the same way. There is no loss of consciousness.
2. Sensory attack. This option is characterized by the sudden appearance of any sensations. This can be paresthesia - a feeling of heat or cold, crawling, tingling, burning, cottoniness in the extremities, as well as sensory organ disorders - visual, auditory, gustatory and olfactory hallucinations. There is no loss of consciousness as such during sensory seizures, but there is a certain aura in the form of deafness or tinnitus.
3. Vegetative attack. This attack is characterized by the appearance of various autonomic disorders without loss of consciousness. There may be redness in certain areas of the skin, increased sweating, and fluctuations in heart rate and blood pressure.
4. Mental attack. Characterized by a sudden disruption of mental functions - speech, thinking, cognition. Various hallucinations, disturbances in balance and coordination of movements may appear.

Automatisms

This is a more complex version of an epileptic attack, characterized by the occurrence of movements that are often repeated by a person. and he does them unconsciously. The movements are varied in nature:

• facial expressions;
• gestural;
• twitching of limbs;
• gait disturbance.

Secondary generalized attack

The onset of such an attack can take place according to any of the above options, but it always ends with the formation of generalized convulsions, sometimes with loss of consciousness.

Absence is already a generalized disorder and is characterized by a sudden loss of consciousness lasting no more than five minutes. It may be accompanied by the appearance of any of the partial seizures, most often these are automatisms.

Generalized seizures

Cryptogenic generalized epilepsy is the most severe type of disease. Some time before the development of the actual seizures, a period of aura is observed - headache, vegetative disorders. panic states.

After this, tonic and clonic convulsions develop, lasting an average of ten minutes. Such an attack ends with involuntary emptying of the intestines and bladder.

In the post-attack period, amnesia is observed.

Classification and symptoms

Idiopathic

This form of the disease occurs when the nerve cells in the brain begin to function in a more active mode than in their normal state.
As a result, an epileptic focus appears, however, what is important, the patient does not have structural damage to the brain.

At the earliest stage of pathology, the body seems to create a kind of “protective wall” around the outbreak. Seizures begin when electrical signals break through this defense.

Typically, this form occurs due to damage in genes, therefore, it can be hereditary. Therefore, its first signs often appear in children.

If you contact a competent specialist in time, idiopathic epilepsy can be completely cured. Without treatment, on the contrary, it leads to very serious consequences, including mental retardation.

This type of pathology is classified according to the location of the outbreak, and it happens:

Temporal

The diagnosis of focal temporal lobe epilepsy is made if overactive neurons are localized in the temporal lobe of the brain. Epileptic seizures usually pass without loss of consciousness, and there may be no warning signs.

The patient may have hallucinations: auditory, visual, gustatory, nausea, abdominal pain, suffocation, discomfort in the heart, fear, altered sense of the passage of time, arrhythmia, chills.

The causes of temporal lobe epilepsy are:

1. In children:

• birth and perinatal trauma;
• hypoxemia - lack of oxygen in the blood;
• gliosis of the brain - that is, the formation of adhesions or scars, usually due to injury.

• In adults:
• circulatory disorders in the vessels of the brain;
• stroke;
• brain injuries.

Occipital

It is considered benign, just like temporal lobe epilepsy. Usually occurs in children 3-6 years old (76% of cases), but also occurs in adults.

Attacks can be different: both short, about ten minutes, and long, which can last for several hours. Also, their symptoms are often very different from each other. So,

• 10% of patients suffer only from vegetative symptoms: nausea, headache, sweating, pallor or redness of the face, cough, heart problems, urinary incontinence, fever;
• 80% of patients have incorrect eye position;
• 26% of patients suffer from random muscle twitching, i.e. hemiclonia;
• in 90% of cases there is loss of consciousness.

In rare cases, Jacksonian march (convulsions starting from the fingers and “marching” to the shoulders), blindness, and hallucinations are observed.

Primary reading

Primary reading epilepsy is the rarest type of idiopathic epilepsy, occurring twice as often in boys as in girls.

Seizures begin while reading, especially if the child is reading aloud. They are expressed in trembling of the chin, spasms of the muscles of the lower jaw, and, less often, difficulty breathing.

Typically, this child’s condition is not taken seriously, either by parents or teachers. However, without treatment, the disease will progress.

Symptomatic


This type of epilepsy is characterized by structural changes in the cerebral cortex.

Moreover, their reasons have been identified. It can be:

• traumatic brain injuries;
• viral or infectious pathologies;
• abnormal development (dysplasia) of neck vessels;
• hypertension;
• osteochondrosis;
• dysfunction of the nervous system;
• asphyxia;
• defects of internal organs;
• birth injuries.

The danger of the symptomatic form of the pathology is that it can manifest itself even years after the injury.
Classification of structural focal epilepsy:

1. Temporal . Characterized by hearing and logical thinking impairments. Accordingly, the patient's behavior has changed.
2. Parietal . This pathology is characterized by cognitive deviations from age norms. These are disorders of memory, intelligence, and speech.
3. Occipital . Symptoms: decreased vision, lethargy, fatigue, problems with coordination of movements.
4. Frontal . Convulsions, paresis (decreased strength of the limbs), impaired movement.
5. Kozhevnikov syndrome . This is a complex syndrome that consists of focal epileptic seizures that occur against the background of simple seizures.

Types of seizures in symptomatic epilepsy:

1. Simple - pass without loss of consciousness, are characterized by slight vegetative deviations, disturbances in the functioning of the sensory organs and the musculoskeletal system.
2. Complex – disruption of consciousness, problems with internal organs.
3. Secondarily generalized - a person loses consciousness, autonomic disorders and convulsive seizures occur.

Cryptogenic

Literally - “hidden origin.” That is, the cause of epilepsy cannot be identified.

Cryptogenic epilepsy is usually observed in adolescents and adults over 16 years of age.

Treatment is complicated by both the unclear causes of the pathology and the varied clinical picture.

Seizures can be of varying duration, with or without loss of consciousness, with or without autonomic disorders, convulsions may or may not occur.

Classification by localization:

• in the right hemisphere;
• in the left hemisphere;
• in the depths of the brain;
• focal frontal lobe epilepsy.

Multifocal

This type of epilepsy has several epileptic foci simultaneously. That is, the frontal, temporal, occipital and parietal lobes can be involved simultaneously.

Diagnostic procedures:

Sources

• https://yusupovs.com/articles/neurology/simptomaticheskaya-epilepsiya-kod-po-mkb-10-g40-2-prichiny-razvitiya-simptomy-i-lechenie/
• https://kiberis.ru/?p=34275
• https://autumnstardance.ru/simptomaticheskaya-epilepsiya/simptomaticheskaya-generalizovannaya-epilepsiya-kod-po-mkb
• https://psyholic.ru/psihiatriya/kriptogennaya-epilepsiya.html
• https://mozgi-doc.ru/simptomy/epilepsiya-kod-po-mkb-10-simptomaticheskaya-kriptogennaya-posttravmaticheskaya.html
• https://umozg.ru/zabolevanie/epilepsiya-mkb-10.html
• https://kiberis.ru/?p=21024

Drug treatment

The basis for correct treatment of epilepsy is determining the type of seizures. Both the prescription of antiepileptic drugs and the determination of the duration of treatment depend on this.

Treatment principles:

1. The goal is to achieve freedom of the patient from attacks or, in the worst case, a maximum reduction in their number in the absence of side effects.
2. Antiepileptic drugs (hereinafter referred to as AEDs) of first choice (Carbamazepine, Valproate, Phenytoin) are the most effective, the likelihood of side effects is the lowest.
3. The correct dosage of AEDs is minimal.
4. The principle of aggravation - AEDs that are effective for some types of attacks can cause worsening in patients with other types of attacks.
5. Titration (dose determination depending on the patient's weight and individual tolerance) increases the effectiveness of therapy.
6. If the dosage exceeds the patient's upper limit of tolerance, the overall effect of the treatment is impaired.

What determines the choice of medication:

1. Specificity of action - that is, effectiveness for specific types of epileptic seizures.
2. The power of healing.
3. The spectrum of effectiveness is a determination of how specific a given drug is.
4. Safety for the body: drugs with minimal side effects have an advantage.
5. Individual tolerance.
6. Side effects.
7. Furmacokinetics and pharmacodynamics: principles of action of drugs.
8. Drug interactions with other drugs.
9. Speed ​​of determining the most correct therapeutic dose.
10. The need for tests during treatment.
11. Reception frequency.
12. Price.

As a last resort, if medications do not help and conservative therapy has exhausted itself, focal epilepsy can be cured surgically.

Treatment

Relatives of patients with TBE should know how to properly provide first aid during an epileptic attack.

The algorithm is as follows:

1. Place the patient on a horizontal surface, away from sharp corners.
2. Place something soft under your head to prevent injury.
3. Turn your head to the side so that the person does not choke on vomit and the tongue does not sink.
4. Loosen the collar, remove the scarf, unbutton your outerwear.
5. You cannot unclench your teeth, hold an epileptic, or straighten your arms.
6. If the attack lasts too long, you should call an ambulance.
7. After the seizure ends, the patient should be put to sleep.

There is no exclusive treatment regimen suitable only for this type.

The patient is prescribed anticonvulsants (Carbamazepine, Ethosuxemide).

They reduce the duration and frequency of seizures. GABA receptor antagonists (Picamilon, Aminalon) are also used. Additionally, diuretics are used to reduce swelling of the brain.

It is important to eat a high-fat diet. In this case, carbohydrates should be kept to a minimum. The patient must stop smoking and drinking alcohol.

As a last resort, they resort to surgical intervention, which involves influencing the excitation center.

Therapy for cryptogenic focal epilepsy in children is no different, only in the dosages of drugs; some drugs are prohibited for use in childhood.

Surgery is also not used. The duration of treatment depends on the severity of the disease. In some cases, you will have to take the drugs for life.

Definition and code according to ICD-10

In the ICD-10 catalog, symptomatic epilepsy is designated by code G40. This is a chronic neurological disorder, which is considered secondary, as it occurs as a result of the progression of other diseases (including infectious ones) or occurs as a result of head injuries.

Seizures with this pathology can be convulsive or non-convulsive, and as the disease progresses, the patient’s personality changes.

Unlike other forms of epilepsy, which can manifest themselves under the influence of various external and internal factors after an indefinite period of time, the symptomatic form has a precise onset in time, and this is directly related to the cause that caused this condition.

Causes

Regardless of age, the causes of the development of symptomatic epilepsy can be:

• rheumatological diseases;
• infectious diseases that affect the brain and provoke the development of meningitis, encephalitis, herpes;
• head injuries of varying severity (including birth injuries);
• strokes;
• development of neoplasms and tumors in the neck and brain;
• malformation in the vascular system of the brain (pathological fusion of capillaries and veins);
• drug or alcohol intoxication.

The younger the patient, the higher the risk of developing epilepsy when exposed to external or internal factors.

Diagnostics

 The first occurrence of partial paroxysm is a reason for a thorough examination, since it may be the first clinical manifestation of serious cerebral pathology (tumor, vascular malformation, cortical dysplasia, etc.). During the survey, the neurologist finds out the nature, frequency, duration, and sequence of development of the epileptic attack. Deviations revealed during a neurological examination indicate the symptomatic nature of FE and help establish the approximate localization of the lesion. Diagnosis of epileptic brain activity is carried out using electroencephalography (EEG). Often, focal epilepsy is accompanied by epi-activity, recorded on the EEG even during the interictal period. If a regular EEG turns out to be uninformative, then an EEG with provocative tests and an EEG at the time of the attack are performed. The exact location of the epi-focus is determined by performing subdural corticography - EEG with the installation of electrodes under the dura mater. Identification of the morphological substrate underlying focal epilepsy is carried out using MRI. To identify the slightest structural changes, the study should be carried out with thin sections (1-2 mm). In symptomatic epilepsy, MRI of the brain makes it possible to diagnose the underlying disease: focal lesions, atrophic and dysplastic changes. If abnormalities were not detected on MRI, then a diagnosis of idiopathic or cryptogenic focal epilepsy is made. Additionally, a PET scan of the brain can be performed, which reveals the area of ​​hypometabolism of the cerebral tissue corresponding to the epileptogenic focus. SPECT in the same area determines the zone of hyperperfusion during an attack and hypoperfusion in the period between paroxysms.

Diagnosis of the disease

Diagnosing a patient with “epileptic syndrome” is only an intermediate stage of diagnosis. Next, you should identify the root cause of the development of this condition. At the moment, the following methods are used to search for the underlying disease:

1. MRI. The effectiveness of the procedure is based on the creation of a strong magnetic field. The technology allows us to identify pathologies of bone and muscle structures.
2. CT. Involves the use of x-rays. The technique differs from traditional radiography in higher quality images.
3. Electroencephalogram. The technique allows you to record seizures and determine their location.

Focal epilepsy: forms, causes, treatment. Where is epilepsy treated in Russia?

Previously, epilepsy was called a divine disease or epilepsy, and people who exhibited it were stigmatized, that is, they were given a psychological stigma in society, and in most cases negative. Even in our space age, in some countries, people diagnosed with generalized or focal epilepsy are not allowed to work in many professions, drive a car, or engage in certain leisure activities, such as diving.

There is a popular belief that an epileptic seizure necessarily looks like this: the patient falls to the ground, begins to convulse, and foam appears at the mouth. If the person is covered with a dark cloth at this moment, the attack passes and the patient falls asleep. In fact, epilepsy can manifest itself in different ways, and it is treated in specialized medical institutions. One of the best in Russia is the Bekhterev clinic, where modern diagnostic and treatment methods are used. Regarding focal epilepsy, patients and their relatives have many questions: where does it come from, is it inherited, is it contagious, why do small children suffer from epilepsy, can it be cured completely, what is it fraught with, how life-threatening it is, and many others. In this article we will try to provide complete information about this disease.

Cryptogenic epilepsy: symptoms

The symptom complex occurs in three successively changing stages:

1. Unexpectedly occurring convulsive seizures;

2. Mental breakdowns of an unstable nature;

3. Destruction of the personal properties of the individual and his intellectual abilities.

Signs of a cryptogenic seizure:

- Motor. Sometimes unpleasant sensations are present and provoke physical activity: running, shouting certain phrases and phrases.

— Sensitive, vegetative and mental disorders. Often there is unmotivated fear with hallucinations and visual flashes.

— Neurological symptoms: loss of muscle tone, lack of speech (delay and underdevelopment in children, degradation in adults), drowsiness or confusion.

— During an epileptic attack, complete apathy occurs, often loss of consciousness, affective disorders with neurological breakdowns.

— A prolonged attack begins after such precursors as: tachycardia, debilitating insomnia, precursor auras, hallucinatory visions.

Sequence of symptom complex of epileptic attacks:

- a person loses consciousness and falls sharply to the ground, the body relaxes greatly;

- screaming or the patient shouts out inarticulate sounds, all this is due to contraction of the muscles of the larynx, spasm of the glottis;

- clonic convulsions with rhythmic bending of arms and legs, throwing back of the head, tension of the torso;

- blood pressure increases, tachycardia;

- the head nods to the beat of muscle contraction;

- an epileptic seizure is felt sensory: the touch of the wind, stroking the skin;

- as the epileptic attack progresses, rotation of the eyeballs and nystagmus begin;

- hoarse breathing, possibly with bouts of stopping - apnea;

- skin with a marbled tint;

- muscle tremors;

- tongue retraction, foam and blood from the mouth;

- the epileptic attack ends with a smooth decrease in pressure, normalization and stabilization of respiratory functions and pulse characteristics occurs. Complete relaxation of the body, deep sleep, after which the patient develops a migraine headache, excessive fatigue and “weakness,” and visual disturbances.

First aid for an attack

Most often, attacks of symptomatic epilepsy pass without seizures, but if this happens, the person must first provide first aid and then call a doctor.

First of all, people nearby must protect the person in a seizure from causing injury to himself.

To do this, you need to lay him on a soft surface and try to fix or hold his arms and legs, and also limit the movement of his head (for this person it is better to lay him on his side).

It is important to ensure that the released foam and saliva flow out and do not enter the respiratory tract.

Contrary to the typical idea of ​​such seizures in feature films, you should not forcefully unclench a person’s jaws in order to insert any object between them: if the jaws are cramped, there is no such danger, but if the jaws are relaxed, such a technique would be appropriate.

You should definitely record the time of the onset of the seizure: if it lasts within one and a half minutes, you don’t have to call an ambulance. Longer seizures require specialist intervention.

Forecast

Focal epilepsy is a disease that has a much more positive prognosis than the generalized form.
If you take medications correctly and follow the therapy prescribed by your doctor, it can be cured. As a last resort, there is a surgical method, that is, removal of the affected area of ​​the brain.

Epilepsy is the most common neurological disease.

This means that no one is immune from developing this pathology.

It can easily appear after an injury - even if several years have passed.

Therefore, it is necessary to carefully monitor your condition and be sure to consult a doctor without waiting for the pathology to develop into a disease that cannot be controlled with medications.

Prevention methods

There are no specific methods of prevention. To reduce the risk of developing the disease, factors that provoke it should be eliminated. It is recommended to prevent head injuries, promptly treat infectious diseases, and give up bad habits. It is also advised to monitor the condition of blood vessels and combat high blood pressure.

Epilepsy is considered a difficult to treat neurological disease. The disease manifests itself in the form of periodic attacks that go away on their own or are controlled with medication. Modern methods of pharmacological therapy can reduce the frequency of seizures. If left untreated, the disease can cause irreversible consequences in the brain, leading to disability or death.

Cryptogenic epilepsy: treatment

Timely diagnosis of cryptogenic epilepsy helps to prescribe an adequate treatment program and prevent the development of serious side effects from the use of antiepileptic drugs. Treatment can take place in two options: on an outpatient basis or in a hospital inpatient setting.

Therapy for cryptogenic epilepsy is carried out according to protocols and standards for the treatment of patients with epilepsy. Treatment is recommended only after the diagnosis has been determined, and therapeutic measures themselves begin after the end of the patient’s second epileptic attack.

Stages before treatment:

— Differential diagnosis of epilepsy.

— Relief of epistatus.

— Providing first aid and selecting a treatment regimen.

The purpose of therapeutic procedures is the following subparagraphs:

- analgesia of epileptic attacks, leveling when taking anticonvulsant or painkillers, nutritional correction (food containing calcium and magnesium or taking vitamin complexes);

- prevention of new epileptic attacks, resorting to surgery or a conservative method - oral medication;

- reduce the frequency of epileptic attacks and shorten their duration as much as possible;

- ideally achieve complete abolition of drug use;

— minimization of side effects from the medications used.

The following groups of drugs are used to treat cryptogenic epilepsy:

- Anticonvulsants (reduce the frequency and duration of epileptic seizures), these are Carbamazepine, Levetiracetam, Ethosuximide.

— Neurotropes (inhibit or stimulate the process of occurrence as a nerve impulse in the brain).

— Psychotropics (change a person’s psychostatus and functioning in the nervous sphere of the individual).

— Psychoactive nootropics.

Non-drug methods: surgical interventions - neurosurgery, Voight method, special diet.

Until today, a single method of complete cure has not been developed, but antiepileptic treatment measures help in 60-80% of epi cases.

Treatment of episyndrome

If a person has an attack, then he needs help both at the time of the attack and in the future. Therefore, it is very important to know about the features of first aid and professional treatment of the syndrome.

First aid for an attack

If you have an attack, you should immediately call an ambulance

In the event of a seizure, the patient does not always need an ambulance. If the person is conscious, then he should be asked to sit down. If there is no deterioration in the condition, and the attack itself is short-lived, then you should not call a doctor.

If a person is unconscious, then he definitely needs help:

1. You need to call an ambulance.
2. The patient is placed on his back, his head is slightly raised. Folded clothing should be placed under the back of the head to prevent the person from hitting himself during convulsions.
3. To prevent tongue biting, a folded handkerchief is placed in the patient's mouth. If a person's teeth are clenched tightly, it is better not to try to open them.
4. If salivation is strong enough, then the patient's head is placed on the side so that he does not choke.
5. Do not panic if breathing suddenly stops - it will resume after a few seconds.

Important! No attempt should be made to bring the person to consciousness.

The average duration of an attack is about three minutes. The main task of first aid is to prevent swallowing of saliva and tongue, and to prevent injury. If a couple of minutes after the attack a person feels better and wants to get up, you should persuade him to sit for 10 minutes and rest.

You should definitely call an ambulance if:

• a seizure occurred in a pregnant woman;
• the patient remains unconscious for 10 minutes;
• the attack lasts more than three minutes;
• the patient is a child or an elderly person.

Treatment options

If you have episyndrome, fried and smoked foods are contraindicated

Therapy is prescribed to the patient individually. This takes into account factors such as age and the degree of development of the underlying disease.

Treatment options for children and adults differ. Adults are usually prescribed:

1. Anticonvulsants, which help reduce the frequency and intensity of seizures.
2. Tranquilizers that help relax muscle fibers.
3. Herbal medicine. Traditional medicine is an excellent addition to medications. They help relax muscles and improve the condition of the patient’s nervous system. The most commonly used decoctions are violet, linden, wild rosemary, celandine and oregano.
4. Proper nutrition. Patients are advised to avoid smoked, fried and salty foods. You should also drink less fluid.
5. In some cases, the patient is scheduled for surgery, which is performed by a neurosurgeon.

If an attack occurs in a child, treatment involves the following nuances:

1. In case of high temperature, antipyretic drugs are prescribed.
2. A diet that is low in protein and high in fat.
3. Normalization of calcium-potassium balance.
4. Phytotherapy.

It should be understood that attacks can be completely eliminated only by treating the root cause of their occurrence. Symptomatic therapy in this case is ineffective.

How does the disease manifest itself?

The main symptom of the disease is repeated epileptic seizures. They come in two types: partial (focal) and generalized. Frequent attacks can provoke irreversible changes in the brain, in which case some symptoms of the disease will persist even outside of attacks.

Cryptogenic focal epilepsy

In the cryptogenic form of the disease, partial seizures are more common. They are characterized by the appearance of a focus of excitation in a small area of ​​the brain. The symptoms that arise directly depend on the location of the source of excitation (temporal, frontal, parietal, occipital lobe).

The patient usually anticipates an exacerbation due to a characteristic aura - mild symptoms that appear before the onset of the attack.

There are three types of partial seizures:

• simple - without loss of consciousness;
• complex – with loss of consciousness;
• with secondary generalization - a partial seizure turns into a generalized one.

The clinical picture of partial seizures is varied and may include motor, sensory, autonomic and mental components. All variants of partial seizures have one common property - paroxysmal character.

Cryptogenic generalized epilepsy

Generalized attacks in the cryptogenic form of the disease are much less common. They are characterized by bilateral involvement of the brain; focal symptoms are absent. In most cases, generalized seizures manifest themselves in the form of a convulsive syndrome and are accompanied by loss of consciousness. There are tonic-clonic, myoclonic seizures and absence seizures.

Classification of attacks

Epileptic seizures can have different manifestations depending on the etiology, localization of the lesion, and EEG characteristics of the level of maturity of the nervous system at the time of the attack. Numerous classifications are based on these and other characteristics. However, from a practical point of view, it makes sense to distinguish two categories:

Primary generalized seizures

Primary generalized seizures are bilaterally symmetrical, without focal manifestations at the time of occurrence. These include two types:

• tonic-clonic seizures (grand mal)
• absence seizures (petit mal) are short periods of loss of consciousness.

Partial seizures

Partial or focal seizures are the most common manifestation of epilepsy. They arise when nerve cells are damaged in a specific area of ​​one of the brain hemispheres and are divided into simple partial, complex partial and secondary generalized.

• simple - during such attacks there is no impairment of consciousness
• complex - attacks with a disturbance or change in consciousness, caused by areas of overexcitation of various localizations and often become generalized.
• secondary generalized seizures - typically begin in the form of a convulsive or non-convulsive partial seizure or absence seizure, followed by a bilateral spread of convulsive motor activity to all muscle groups.