Иктальные, постиктальные и интериктальные вегетативные нарушения у пациентов с фокальной эпилепсией

Фокальная эпилепсия ассоциирована с выраженными вегетативными нарушениями, возникающими в иктальном, постиктальном и интериктальном периодах. Дифференциальная диагностика таких нарушений имеет значение для повышения эффективности противоэпилептической терапии и снижения риска развития внезапной необъяснимой смерти при эпилепсии (англ. sudden unexpected death in epilepsy, SUDEP). В обзоре систематизированы современные представления о патофизиологических механизмах, клинической семиотике и диагностической значимости вегетативных проявлений у пациентов с фокальной эпилепсией. В иктальном периоде наиболее часто регистрируются изменения сердечного ритма (тахикардия, реже – брадикардия), дыхательные нарушения (апноэ, гипервентиляция), гастроинтестинальные симптомы (эпигастральная аура), а также пиломоторные реакции. Постиктальные вегетативные расстройства включают артериальную гипотензию, гиперсаливацию, аспирационные явления и постприступную аритмию, которые коррелируют с риском развития SUDEP. Интериктальные нарушения проявляются снижением вариабельности сердечного ритма, артериальной гипертензией, нейрогенной дисфункцией мочевого пузыря и терморегуляторными расстройствами, что отражает подавление активности автономной нервной системы. Вегетативные нарушения, возникающие при фокальной эпилепсии, представляют собой значимые клинические феномены, которые, тем не менее, зачастую не получают адекватной оценки в рутинной клинической практике. Детальный анализ указанных нарушений способствует уточнению локализации эпилептогенной зоны, совершенствованию стратификации риска развития жизнеугрожающих состояний, а также персонализации терапевтической стратегии.

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