Symptomatic epilepsy is a chronic neurological disease characterized by recurrent seizures caused by excessive electrical activity of a certain group of neurons (nerve cells) in the brain.. This activity is always associated with the presence of a particular cerebral pathology in the patient.. In the overall structure of the incidence of epilepsy, the symptomatic form accounts for 25% of cases, according to the online publication for girls and women from 14 to 35 years old Pannochka. net Symptomatic epilepsy develops as a symptom of the underlying diseaseCausesSymptomatic epilepsy (SE, episyndrome) always develops secondary, as a complication of any pathology. The main reasons leading to its occurrence are:.

metabolic disorders (phenylketonuria, hypoparathyroidism, hypoglycemia);

cerebrovascular disease (stroke, vascular malformation, vasculitis);

volumetric processes (tumors, hematomas, parasitic cysts, brain abscess);

congenital anomalies of the brain;

traumatic brain injury, including birth;

cerebral hypoxia (asphyxia of newborns, carbon monoxide poisoning, Adams-Stokes syndrome);

infections of the central nervous system (cerebral cysticercosis, 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).

ClassificationDepending on the characteristics of the clinical manifestations, seizures in epilepsy are divided into several types:.

Seizure type.

Description.

Simple partial (local, focal).

Consciousness preserved. The attack can proceed:.

with vegetative traits;

with sensory specific and somatosensory symptoms (hallucinosis);

with movement disorders;

with mental symptoms (affective, cognitive, dysmnesic, dysphasic).

In some cases, an attack in this form of the disease begins as a simple one, and then, a wave of pathological excitation begins to spread throughout the cortex of both hemispheres, that is, the process is generalized, which leads to the occurrence of classic tonic-clonic seizures (secondary generalized seizure).

Compound partials.

In most cases, the attack begins as a simple one, after which the patient has a violation of consciousness.. Sometimes there is only loss of consciousness.

Absences (small epileptic seizure, petit mal).

A seizure can occur:.

with a vegetative component;

With automatisms;

with tonic component;

with an atonic component;

with clonic component;

only with impaired consciousness.

Myoclonic.

Sudden twitching of individual muscle groups or muscles of the whole body.

Tonic-clonic (grand mal seizure).

Occurs suddenly. The patient lets out a loud cry and falls, losing consciousness. The clonic phase lasts 10–30 seconds, followed by clonic convulsions lasting 1–3 minutes.

Febrile.

Observed in children under the age of five against the background of a high rise in body temperature. At the same time, it is not possible to explain the development of generalized convulsions by the presence of any other causes..

Epileptic status.

This condition is one of the most severe forms of symptomatic epilepsy.. Attacks follow continuously one after another and in the intervals between them the consciousness of the patient is not restored..

Symptoms Consider the main clinical manifestations of various types of epileptic seizures:.

Seizure type.

Symptoms.

Absences.

The seizure occurs in the form of a short-term loss of consciousness with minimal motor activity.. Lasts 10-30 seconds. A person suddenly stops his activity and resumes it after the end of the attack.. Seizures usually occur during physical activity and almost never occur during rest..

tonic-clonic seizure.

The onset of a seizure is preceded by a brief aura. Following her, the patient screams, loses consciousness and falls.. He has respiratory arrest, cyanosis of the skin of the face. Tonic convulsions last 10-40 seconds and are replaced by clonic. There is a noisy breath, foam appears from the mouth, convulsions of all muscle groups are noted. Total seizure duration 2–5 minutes.

myoclonic seizure.

It is more often observed in encephalitis, degenerative diseases and metabolic disorders.. Characterized by sudden twitching of the muscles of the trunk or limbs.

Simple partial seizure.

Manifested by isolated clonic or tonic activity, transient sensory disturbances. There are no disturbances of consciousness.

Complex psychomotor (partial) seizure.

Its development is often preceded by an aura. The patient loses contact with others for 1-2 minutes. At this time, he makes useless automatic movements, does not understand the speech addressed to him, can make inarticulate sounds..

Febrile convulsions.

Occurs in children under five years of age with a fever. There are two types:.

benign - generalized, single short;

Complicated - arising during the day more than twice or focal, lasting more than 15 minutes.

Epileptic status.

Mental, sensory or motor seizures occur almost without interruption and last from several hours to several days. In the absence of timely medical care - a high probability of death.

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

over-sentimentality;

excessive pedantry;

vindictiveness;

suspicion;

cruelty;

revenge;

outbursts of anger.

Patients' speech becomes stereotypical, slow, detailed. They can hardly switch from one topic of conversation to another..

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

decline in intelligence;

selective memory impairment (only remember what is important to him well);

limiting the range of interests solely to one's own needs;

aggressiveness, cruelty;

disinhibition of instincts;

ridiculous behavior;

lack of criticism.

DiagnosisThe main diagnostic method for symptomatic epilepsy is electroencephalography (EEG). If necessary, the patient is recommended to conduct EEG monitoring (night, 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 visualization of possible focal lesions of the cerebral tissue;

general blood test - with a neuroinfectious process, an increase in the number of leukocytes is noted, a shift in the leukocyte formula to the left;

biochemical blood test, including determination of plasma concentration of electrolytes, glucose, urea;

toxicological examination of blood for the content of alcohol, drugs.

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

dementia;

schizophrenia (with epipsychosis);

trigeminal neuralgia;

simulated epileptic seizure;

fainting;

migraine;

narcolepsy.

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

In the treatment of epilepsy, they resort to therapy with anticonvulsants. Conservative therapy of the disease consists in long-term regular use of anticonvulsants (anticonvulsants). In case of ineffectiveness, 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 reduce body temperature.. The child is prescribed non-steroidal anti-inflammatory drugs, antispasmodics, physical cooling is carried out. With repeated febrile seizures, the prophylactic administration of diazepam is justified.. The drug is used during the entire period of fever and 24 hours after the temperature normalizes..

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 seizures..

The most serious complication is the development of status epilepticus.. Mortality with it reaches 18%. Prognosis worsens with long-term seizures. Thus, the probability of death with an attack duration of more than 12 hours is 80%..

If, against the background of anticonvulsant therapy, epileptic seizures are not recorded in a patient for two years, then drug treatment is gradually canceled.. However, a third of patients subsequently relapse.

Pregnancy and lactationAt the background of taking anticonvulsants by a pregnant woman, the risk of congenital anomalies in the fetus increases by 2 times. Therefore, pregnant women, especially in the first trimester, are advised to reduce the dosage of anticonvulsants..

But if they develop an epileptic seizure, then you should definitely return to the original dose..

In order to reduce the risk of fetal 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.

neboleem. net.