Cryptogenic epilepsy
The content of the article:
- What it is
-
How does the disease manifest
- Cryptogenic focal epilepsy
- Cryptogenic generalized epilepsy
- Symptoms in the interictal period
- Diagnostic methods
- How to treat pathology
- Forecast and consequences
- Video
Cryptogenic epilepsy is the most common form of the disease, affecting about one in two patients. A characteristic feature of the cryptogenic form is that it is impossible to establish the cause of the development of the disease. Unidentified etiology creates certain difficulties in the selection of treatment; anticonvulsants form the basis of therapy for such patients.
When the cause of the seizure cannot be identified, it is referred to as cryptogenic epilepsy.
What it is
Epilepsy is a chronic neurological disease characterized by an increased susceptibility of the body to epileptic seizures. Epilepsy is one of the most common pathologies of the central nervous system; among adults and children, the prevalence of the disease is approximately 50-100 cases per 100 thousand population.
Depending on the etiology, 3 forms of pathology are distinguished:
- symptomatic;
- idiopathic;
- cryptogenic.
Cryptogenic epilepsy is a disease with an unknown etiology, that is, the cause of the development of the disease is not clear, not identified. The diagnosis is established only after excluding other forms.
For some reason, there is a predisposition of the brain cells to the formation of an excessive paroxysmal discharge. Such a discharge disrupts the normal functioning of neurons, which leads to the clinical manifestations of epilepsy - loss of consciousness, convulsions, sensory and autonomic disorders.
With the cryptogenic form of the disease, focal changes are more often detected. The focus of excessive activity can be localized in the frontal, temporal, parietal or occipital lobes. Less commonly, the discharge extends to both hemispheres of the brain.
How does the disease manifest
The main symptom of the disease is recurrent epileptic seizures. They are of 2 types - partial (focal) and generalized. Frequent seizures can provoke irreversible changes in the brain, in which case some of the symptoms of the disease will persist even outside the seizures.
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 symptomatology that occurs in this case directly depends on the localization of the focus of excitation (temporal, frontal, parietal, occipital lobe).
The patient usually has a premonition of an exacerbation due to the characteristic aura - mild symptoms that appear before the onset of the attack.
Partial seizures are of three types:
- simple - without loss of consciousness;
- difficult - with loss of consciousness;
- with secondary generalization - a partial seizure becomes generalized.
The clinical picture of partial seizures is varied and can include motor, sensory, autonomic and mental components. All variants of partial seizures have one common property - paroxysmal character.
| Partial seizure type | How does it manifest |
| Motor (motor) | A partial motor seizure is manifested in the form of rapid and rhythmic contractions of certain muscle groups. Most often, cramps are localized in the muscles of the face, left or right arm, leg. |
| Sensitive |
A partial seizure with sensory disturbances most often manifests itself in the form of unusual sensations in the body (burning, numbness, crawling creeps). Less common are olfactory, visual, auditory illusions and hallucinations. |
| Vegetative |
Seizures with a vegetative component are manifested by the following symptoms: • sharp blanching or redness of the skin; Excessive sweating; A feeling of a lump in the throat; Dizziness, ringing in the ears. |
| Mental | The mental component manifests itself in the form of unusual thoughts, derealization, depersonalization, aggressive or strange behavior, fears. |
Cryptogenic generalized epilepsy
Generalized seizures 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 as a convulsive syndrome and are accompanied by loss of consciousness. There are tonic-clonic, myoclonic seizures and absences.
| The presence of seizures | Type of generalized seizures | Characteristic |
|
Convulsive |
Tonic-clonic | The most common form of an attack. The patient does not anticipate its appearance, but suddenly loses consciousness. A tonic-clonic seizure consists of two phases - tonic and clonic. In the first phase, there is a strong muscle tension, the body bends, the muscles become as if stone. The patient falls down, may bite his tongue, his breathing stops. Then comes the second phase - fast and rhythmic twitching of all muscle groups. Twitching gradually ceases, at the end of the second phase, involuntary urination may occur. On average, an attack lasts from 30 seconds to 3 minutes. |
| Myoclonic | Occurs rarely, is characterized by short-term irregular twitching of muscle groups. | |
| Non-convulsive | Absance | Absance often occurs in childhood and is a non-convulsive form of generalized seizure. With the development of a typical absence, the person seems to freeze, but at the same time can make automatic movements. Consciousness during absence does not turn off, but is disturbed. The attacks last for a few seconds. |
Symptoms in the interictal period
Outside the attacks, nonspecific symptoms may persist that are not directly related to the seizure activity of the brain:
- depressed mood;
- anger, resentment;
- impairment of memory and other cognitive functions.
Such symptoms usually appear with prolonged and frequent generalized attacks, which lead to temporary cerebral hypoxia.
Diagnostic methods
Epilepsy is indicated by the appearance of two or more epileptic seizures, but the clinical picture alone is not enough to make a final diagnosis.
For a final diagnosis, additional studies are required. The main method for diagnosing the disease is electroencephalography (EEG); neuroimaging methods (MRI or CT of the brain) are prescribed to exclude the symptomatic form of the disease.
| Research method | results |
| EEG |
EEG is a technique that records electrical impulses in the brain. With the help of EEG, it is possible to reveal a high convulsive readiness of the entire brain, epileptic foci and their localization. To obtain more reliable results, an EEG is additionally performed with stimulation by sound, light. For the cryptogenic form of epilepsy, the focus of the pathological process is more characteristic. |
| MRI of the brain | The cryptogenic form of epilepsy is characterized by the absence of gross changes on MRI. |
How to treat pathology
Treatment for epilepsy should be selected by a physician after the final diagnosis is made. The difficulty in treating the cryptogenic form is that the cause of the development of the disease could not be identified, respectively, etiotropic methods are not used. The basis of therapy is the intake of antiepileptic drugs.
The choice of medication, first of all, depends on the type of seizure, the patient's age and the presence of concomitant diseases are also taken into account.
The main antiepileptic drugs are the derivatives of valproic acid (valproate) and carbamazepine. Valproate is a universal remedy, it can be used to treat any seizure, carbamazepine - for partial.
Valproic acid derivatives are among the main antiepileptic drugs.
Modern antiepileptic drugs include lamotrigine, topiramate, levetiracetam, clonazepam, etc.
| Seizure type | What drugs are prescribed |
| Generalized tonic-clonic, tonic, clonic | The drugs of choice for generalized epilepsy are valproate and lamotrigine. If ineffective, topiramate, pregabalin may be prescribed. |
| Generalized myoclonic | Valproate, topiramate, levetiracetam are used to treat myoclonic seizures. |
| Absances | The main drug for the treatment of absences is valproic acid. Less commonly, lamotrigine, clonazepam, levetiracetam are prescribed. |
| Partial | For the treatment of partial seizures, valproate, carbamazepine, as well as modern drugs - topiramate, levetiracetam, lamotrigine can be used. |
Treatment begins with taking one drug, if ineffective or side effects appear, it is changed. Only a doctor can prescribe or change antiepileptic therapy; direct treatment is carried out at home (with the exception of severe generalized seizures, development of status epilepticus).
Forecast and consequences
The prognosis for the cryptogenic form of the disease depends on many factors - the treatment being carried out, the type of seizures, their frequency and duration. With adequate therapy, the prognosis is favorable.
Frequent and prolonged seizures can lead to the development of epileptic encephalopathy. In severe cases, an attack can result in a head injury during a fall, asphyxiation. To prevent dangerous consequences, you need to take the prescribed treatment, avoid the effects of trigger factors (alcohol intake, lack of sleep, overwork, stress).
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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