Signs of symptomatic epilepsy and methods of its treatment

It is a chronic disease in which a rapid increase in electrical excitability is observed in the cerebral cortex. The pathology is characterized by spontaneous attacks and is divided into several types, one of which is symptomatic epilepsy, also called cryptogenic.

It is worth noting that cryptogenic epilepsy is one of the most common forms of the disease, which is diagnosed in 70-75% of cases.

Causes

Symptomatic epilepsy (SE, episyndrome) always develops secondarily, as a complication of some pathology. The main reasons leading to its occurrence are:

• metabolic disorders (phenylketonuria, hypoparathyroidism, hypoglycemia);
• cerebrovascular diseases (stroke, vascular malformation, vasculitis);
• volumetric processes (tumors, hematomas, parasitic cysts, brain abscess);
• congenital brain abnormalities;
• traumatic brain injuries, including birth injuries;
• cerebral hypoxia (newborn asphyxia, carbon monoxide poisoning, Adams-Stokes syndrome);
• infections of the central nervous system (cystecircosis of the brain, toxoplasmosis, malignant malaria, HIV infection, tetanus, rabies, neurosyphilis, encephalitis, meningitis);
• poisoning with toxic agents and drugs (cocaine, alcohol, lead, picrotoxin, strychnine, corazole, camphor);
• anaphylactic reactions;
• cerebral edema (eclampsia, hypertensive encephalopathy);
• withdrawal syndrome after prolonged use of alcohol, tranquilizers, anticonvulsants;
• hyperpyrexia (heat stroke, acute infections).

Symptomatic epilepsy: what is it?

Symptomatic epilepsy is a polyetiological, partly progressive nervous system psychiatric disease in its final stage, which manifests itself in varieties of convulsive and often non-convulsive seizures and similar conditions, which is predominantly paroxysmal in nature. Leads to specific changes in the person and in particular her personality, epileptic psychoses, specific non-classical stupidity. Epilepsy is a form of disruption of the brain, its functioning, and is a very common pathology. Regardless of any ethnic characteristics related to the location of the country, epilepsy occurs in one percent of people. Approximately 6% of individuals have at least once had a seizure, which is similar in etiology to epileptic seizures. A characteristic feature of epilepsy is the onset in childhood or adolescence, but symptomatic epilepsy begins after a clear cause that has a precise onset in time.

To rationally understand the terminology in the context of epileptic disease, it is important to understand some conditions. The epileptic reaction has the characteristics of a convulsive or non-convulsive seizure that occurs as a general biological response to an external stimulus. There is a widespread use of the diagnostic syndrome complex epileptic syndrome - these are paroxysms that can have not only convulsive components, but also symptoms that are part of the structure of diseases that have a connection with the organics in the brain along with other neurologically determined and psychopathological symptom complexes of the underlying disease.

Variants of symptomatic epilepsy : epilepsy based on past pathologies of organic origin of lesions of the brain, completed before the disease with symptomatic epilepsy; epileptic syndrome of actively occurring progressive conditions and cerebral processes. In this case, epilepsy is established as a concomitant.

Epilepsy is a massive disease that has a lot of subtypes and is characterized by a clear localization, thanks to which it is possible to even determine the location of the epileptic focus. Generalized or general seizures occur with loss of clarity of consciousness. These include major and minor seizures. Small ones have many subspecies, depending on their manifestations. Such a threatening condition as status epilepticus is also classified as generalized.

Focal or patchy seizures are also very common, are not always distinguishable and have their own clear classification. All of them pass without loss or lack of awareness. Motor petit mal seizures are as follows: Jacksonian, adversive, masticatory, muscular postural and myoclonic. Sensory attacks: somatosensory, visual, olfactory, auditory, gustatory. Mental seizures: short-term psychoses, twilight of consciousness, special states in the form of dysphoria, as special types of anger; epileptic psychoses. Automatisms, like short obscurations: trance, fugue. Vegetative-visceral seizures. Speaking seizures: attack of loss of articulation, aphotic. Reflex seizures are a separate type with special symptom complexes.

Symptoms

Let's consider the main clinical manifestations of various types of epileptic seizures:

With a long course of symptomatic epilepsy, patients gradually develop chronic personality disorders, including the following symptoms:

• excessive sentimentality;
• excessive pedantry;
• rancor;
• suspicion;
• cruelty;
• vindictiveness;
• outbursts of anger.

The speech of patients becomes stereotypical, slow, and detailed. They have difficulty switching from one topic of conversation to another.

With a malignant course of the disease, dementia develops. The patient experiences the following changes:

• decreased intelligence;
• selective memory impairment (they remember well only what is important to him);
• limiting your range of interests solely to your needs;
• aggressiveness, cruelty;
• disinhibition of instincts;
• ridiculous behavior;
• lack of criticism.

Briefly about classification

1. Depending on the course and clinical manifestations, mild and severe forms are distinguished.
2. Depending on the location of the affected area, there are generalized (specific and nonspecific syndromes) and localized (temporal, frontal, parietal, occipital).

A separate group includes such varieties of focal (local) form as Kozhevnikov syndrome (found mainly in children), specific syndromes (audiogenic, photogenic, startle epilepsy, etc.).

Diagnostics

The main diagnostic method for symptomatic epilepsy is electroencephalography (EEG). If necessary, the patient is recommended to conduct EEG monitoring (nightly, daily).

In order to establish the root cause of the disease, a laboratory and instrumental examination of the patient is indicated, which, according to indications, may include the following methods:

• CT and MRI of the brain - allow you to visualize possible focal lesions of cerebral tissue;
• general blood test - during a neuroinfectious process, there is an increase in the number of leukocytes, a shift in the leukocyte formula to the left;
• biochemical blood test, including determination of plasma concentrations of electrolytes, glucose, urea;
• Toxicological blood test for alcohol and drug content.

Differential diagnosis is carried out with a number of diseases and pathological conditions:

• dementia;
• schizophrenia (with epipsychosis);
• trigeminal neuralgia;
• simulation of an epileptic seizure;
• fainting;
• migraine;
• narcolepsy.

Clinical manifestations

A striking symptom (as a rule, such an episode is quite enough for the initial diagnosis) is an epileptic attack, which is characterized by a sharp, unusual change in behavior, emotions, motor skills or sensory functions. Seizures happen:

• partial: simple without impairment of consciousness, complex or developing into generalized (secondary generalized epilepsy);
• generalized: absences, myoclonic, tonic, tonic-clonic, etc.

Generalized attacks are sometimes preceded by a difficult to describe state of general discomfort. This may be a headache, drowsiness, sudden mood swings, irritability. But often the seizure begins suddenly, or the warning signs are so short-lived that neither the patient nor those around him have time to pay attention to them.

A generalized epileptic seizure does not last long, its duration, as a rule, does not exceed 2 minutes. More often than others, tonic-clonic seizures with convulsive syndrome develop. After this, the epileptic falls into a state resembling a coma, followed by a slow awakening, but consciousness often remains confused.

Absence seizures are characterized by a completely different clinical picture. Consciousness is disrupted abruptly, for a few seconds, after which it is just as suddenly restored. The eyes are open, and small convulsive twitching of the facial muscles is possible.

Treatment

Treatment of symptomatic epilepsy is carried out on an outpatient basis. Patients with status epilepticus are subject to emergency hospitalization in the intensive care unit.

Anticonvulsant drugs are used to treat epilepsy.

Conservative treatment of the disease consists of long-term regular use of anticonvulsants (anticonvulsants). If ineffective, the possibility of surgical treatment is considered (dissection of the corpus callosum, excision of the epileptic cortical focus, resection of the temporal lobe).

The main treatment for febrile seizures is to lower body temperature. The child is prescribed nonsteroidal anti-inflammatory drugs, antispasmodics, and physical cooling is performed. For repeated febrile seizures, prophylactic administration of diazepam is justified. The drug is used throughout the entire period of fever and 24 hours after the temperature normalizes.

General recommendations

Doctors advise a patient with epilepsy to sleep for a sufficient amount of time without disturbing the sleep rhythm. Limitation of night rest provokes attacks.

Physical and mental overload have a negative impact, so it is important to properly alternate work and rest.

Compliance with a diet improves the condition of an epileptic.

Simple safety measures can save the lives of patients whose attacks are accompanied by loss of consciousness.

Recommendations are individual in nature, taking into account the form of the disease and the characteristics of the manifestation of attacks.

Course and prognosis

Symptomatic epilepsy is more difficult to treat than idiopathic epilepsy. Patients often develop mental disorders, and the frequency of their occurrence does not depend on the frequency of attacks.

The most serious complication is the development of status epilepticus. Its mortality rate reaches 18%. The prognosis worsens with long-lasting seizures. Thus, the probability of death when an attack lasts more than 12 hours is 80%.

If, against the background of anticonvulsant therapy, the patient does not experience epileptic seizures for two years, then drug treatment is gradually discontinued. However, a third of patients subsequently experience a relapse of the disease.

Characteristic signs

The symptoms of the disease depend on the form of its manifestation. If we are talking about a generalized form, then the attacks are accompanied by loss of consciousness and control over actions. Convulsions are pronounced and prolonged.

The symptomatic focal form of epilepsy is manifested by a number of symptoms that depend on the location of the source of excitation:

Pregnancy and lactation

When a pregnant woman takes anticonvulsants, the risk of congenital anomalies in the fetus doubles. Therefore, pregnant women, especially in the first trimester, are recommended to reduce the dosage of anticonvulsants. But if they develop an epileptic seizure, they should definitely return to the original dose.

In order to reduce the risk of fetal developmental abnormalities, folic acid intake is indicated throughout the entire period of pregnancy (it is advisable to start at the planning stage).

If the mother is taking anticonvulsants, breastfeeding is not contraindicated, but the concentration of drugs in breast milk should be checked regularly.