According to statistics, up to 70% of all cases of epilepsy are cryptogenic. In recent years, this disease has undergone an objective clinical assessment, and there is hope that in the future the number of cases will gradually decrease.
Definition
What is cryptogenic epilepsy? This is a form of the disease, in addition to idiopathic and symptomatic, characterized by a syndrome of recurring epileptic seizures. At the same time, it is possible to identify a pathological focus, but not the cause of its occurrence.
Specialists distinguish three stages of the disease:
- initial, which is characterized by convulsive seizures;
- sluggish - mental disorders of an intermittent nature;
- destructive - there is a decrease in intellectual activity.
There are two types of epilepsy: temporal and multifocal. Attacks are accompanied by a violation of neural connections, as a result of which brain cells die, there is a slowdown in development and loss of professional skills.
Cryptogenic generalized epilepsy leads to a violation of the functionality of the speech apparatus, manifestations of personality degradation are possible. Often this diagnosis is made in view of the fact that the study continues to the final and objective conclusions of specialists.
Causes of the disease
There are several factors that influence the occurrence of abnormalities due to cryptogenic epilepsy. What is it - an independent ailment or a consequence of pathology - is determined by the types of observed manifestations.
Types of disease (code in the range G40.0-G40.9):
- Symptomatic (secondary). The reasons are cerebral hemorrhages, tumors, CNS infection, developmental disabilities, cysts, use of prohibited substances, alcoholism.
- Idiopathic - occurs due to a hereditary predisposition and manifests itself at an early age. At the same time, there is a high activity of neurons, but no brain damage.
- Cryptogenic - develops in the absence of obvious reasons, may remain undetected even after many examinations.
It is currently unknown how disruptions in the impulses of brain activity occur. Cryptogenic epilepsy (ICD-10 code G40) has been common since ancient times, both among children and adults.
Among boys, the most common age is from 2 to 12 years with a disease of the "Rolandic" type, which affects 60% of patients. In some cases, unspecified cryptogenic epilepsy is diagnosed (according to ICD-10 - this is G40.9).
Common symptoms
How is the disease symptomatically manifested, what is cryptogenic epilepsy? This is an ailment, the manifestations of which not all look the same. So, babies bend their heads or upper bodies during a seizure, muscle twitching occurs in adolescents, so-called automatons are observed in some patients, during which a person performs some actions, but then absolutely does not remember what he was doing.
Over time, patients develop epileptic personality traits. They are prone to frequent changes in moods, can be both condescending and irritable to others. Cryptogenic epilepsy in children is characterized by pedantry, but it is not easy for them to switch from one topic to another.
Often, a violation of mental, autonomic, sensitive, motor functions is combined with severe speech impairment and a decrease in muscle tone. Sometimes cryptogenic epilepsy in adults manifests itself as a feeling of intense fatigue, after which problems with attention and mental perception begin. Apathy, dizziness, loss of consciousness, affective disorder, neurological pathologies, psychoses - among other symptoms.
A prolonged attack is preceded by stages of sleep disturbance, migraine, tachycardia, hallucinations. Against the backdrop of these symptoms, increased physical activity of the patient is possible, as well as fear for their own life after the condition. Attacks can occur during night sleep.
Types of Attacks
Cryptogenic epilepsy is divided into two main groups (according to the source of the arising discharge). With partial or focal, the temporal or frontal parts of the brain are affected, sometimes the parietal and occipital, but consciousness remains.
If the limbic system is influenced by the action of neurons, a person loses the feeling of space, and the discharge spreads through the cortex of both hemispheres. This phenomenon is called a secondary generalized attack. Its signs are a neurological deficit: blindness, speech defects, Todd's paralysis.
Cryptogenic focal epilepsy in children and adults is divided into the following types:
- Simple. With them, seizures occur in the presence of consciousness and with the repetition of one type of reaction. Clinical manifestations - the appearance of seizures, autonomic, sensory and mental disorders.
- Complicated. Seizures are characterized by the fact that the patient is unconscious. They are manifested by various random actions, grimacing, etc.
- Secondary generalized are characterized by the rapid spread of the discharge. The patient is not always aware of the changes before starting the attack. Generalized seizures cover the entire cerebral cortex, so confused thinking is characteristic of a person, there are no forebodings of aggravation.
Attacks in turn are divided as follows:
- Tonic-clonic. They begin spontaneously, without precursors, but sometimes they are preceded by malaise and discomfort. The attack begins with tonic muscle tension and screaming, increased pressure, increased heart rate, biting the tongue. The patient falls, he has characteristic muscle cramps and excessive salivation. After the acute phase, as a rule, relaxation occurs, but the consciousness remains confused, the patient is put to sleep. Upon awakening, people cannot remember what happened.
- Absences. Characteristic exclusively for children and young adolescents. At the same time, the patient freezes with an absent gaze in one pose, sometimes throws back his head. These attacks do not last long, and often relatives do not even suspect a child’s illness, only difficulties with concentration in the learning process can indicate the presence of a problem. Abscesses are also manifested in Lennox-Gastaut syndrome.
- Myoclonic. Sudden and fleeting. In this case, an involuntary contraction of the flexor muscles occurs. The cause is a person’s fall, sometimes these symptoms accompany other conditions: ischemia, Creutzfeldt-Jakob disease, etc.
- Tonic, atonic. In the latter case, the patient falls due to the sudden disappearance of postural muscle tone. And with tonic, there is an increase in tone and regidity, which is why the patient falls back.
With cryptogenic temporal lobe epilepsy, paroxysms that are not suitable for any of the above descriptions can be observed. In medicine, they are called unclassified.
Outbreak attacks
Manifestations of cryptogenic epilepsy are classified by the source of occurrence:
- frontal part, front part - during the attack the patient has a frozen look, impaired consciousness, head deviates, eyes close;
- paraorbital focus - a change in smell is observed, involuntary urination, movements are automated;
- the frontal lobe, the middle part - the cessation of speech, complex gestures, aggression, screaming, facial expressions reflect horror;
- occipital part - automatic gestures and movements.
Cryptogenic epilepsy with generalized seizures has the most severe consequences. After connecting the deep foci of the brain, the rest are activated, there is a loss of awareness and convulsions. Over time, a person loses memory, personality degradation is observed.
Diagnosis of the disease
For the treatment of cryptogenic epilepsy, a step-by-step exclusion of pathologies with characteristic manifestations is performed.
In order to make a diagnosis, specialists collect the following data:
- An anamnesis in details and information about perinatal pathology, birth injuries, loss of consciousness in childhood.
- Electroencephalographic study, including registration of brain biorhythms in sleep and during exercise. Additionally, a study is carried out with sleep deprivation, which allows to identify the convulsive readiness of the nervous system.
- Imaging techniques (MRI in dynamics), in which not only focal pathology of brain tissue is detected, but also sclerotic changes.
- Angiography, the study of blood supply to the brain with ultrasound, and, if necessary, duplex scanning in combination with MRI in angiographic mode.
- Neuropsychological examination.
- Serological blood tests for viruses. This technique allows you to identify infectious pathology of the central nervous system.
- Laboratory tests, including general and biochemical blood tests (for immunoglobulins, glucose, amylase, lactic acid, coagulability, hemoglobin, hematocrit, white blood cell count, platelets), urinalysis and genetic testing.
Treatment of cryptogenic epilepsy
Conventional methods in the case of this type of epilepsy are ineffective. As a rule, monotherapy is recommended, due to which it is possible to reduce the development of side effects, which can adversely affect the condition. There are no other methods except classical ones.
Of the antiepileptic drugs, carbamazepine or valproates are used, and in the case of low effectiveness, they resort to a combination of these or other types. At the same time, other types of disorders stop. Since it is often not known what cryptogenic epilepsy is, these abnormalities are carefully examined by qualified specialists without disturbing the patient's usual lifestyle.
Do you always need medicine?
There is a list of cases when there is no need for anticonvulsants:
- a single attack in a child;
- pregnancy without complications;
- absence of risk factors, family history;
- seizure after prolonged sleep deprivation.
Situations in which anticonvulsants are required for cryptogenic focal epilepsy in children and adults:
- confirmation of history of epileptic seizures;
- the presence of neurological pathology;
- manifestations of idiopathic generalized epilepsy ;
- characteristic changes in the data of the encephalogram;
- birth trauma in a child;
- organic pathology of the central nervous system from early childhood;
- epileptic stigma;
- severe, life-threatening seizures;
- personality changes (most informative in adults);
- mental conditions equivalent to seizures;
- inadmissibility of a second seizure.
The choice of the drug is based on gender, age, the presence of concomitant conditions, a variety of seizure.
Disability
Disability in cryptogenic epilepsy is indicated if a threat to the health and life of the patient is confirmed. The specialist to be contacted is a neurologist.
The amount of the retirement pension is determined by the disability group. Complete loss of performance corresponds to the first or second group. The patient's condition requires hospitalization, an outpatient examination.
To get a referral for a special examination, it is necessary to have permanent deterioration with complications.
Disability groups, depending on the condition of the patient, are defined as follows:
- The third is the easiest, attacks are rare and without complications, a person remains operational.
- The second - it is characterized by frequent attacks and a change in the patient's personality.
- The first is the most difficult, a person is limited in servicing himself, is considered to be incapable of work, and has dementia. If the cause was a head injury - the brain has a high probability of degeneration. Convulsions, memory loss, mental disorders are observed.
The most common factors affecting disability: seizures, injuries, occupational diseases, physical disabilities from childhood or as a result of military service.
How to reduce the frequency of seizures
It is impossible to get rid of epilepsy having this disease, but you can do everything that affects the frequency of parocrisis:
- ensure a full sleep;
- avoid physical stress;
- exclude alcoholic beverages;
- reduce the number of meat dishes in the diet, eliminate salted and smoked foods, eat onions and spinach juice;
- during menstruation, women use natural diuretics (bearberry, cucumber grass, lingonberry leaf decoction);
- in the event of the development of epilepsy as a result of an injury or infection, it is recommended to carry products containing sugar in order to prevent its decrease in blood and an attack;
- protect your eyes from bright sunlight (wear dark glasses), avoid places with blinking lights;
- use funds to help delay an attack (lavender oil);
- take a day after a bath with valerian;
- work and have hobbies that distract and improve well-being.
Traditional medicine recommends the following remedy: boil 30 g of the root of a wolf's bast, insist, take a teaspoon three times a day.