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GENERALIZED TONIC-CLONIC SEIZURES : CLASSIFICATION, ELECTRO-CLINICAL CHARACTERISTICS, AND EFFICACY OF ANTIEPILEPTIC THERAPY

https://doi.org/10.17749/2077-8333.2017.9.3.006-017

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Abstract

Objective: to study patients with generalized tonic-clonic seizures (GTCS) with emphasis on their nosological, anamnestic, clinical, EEG, and neuroimaging characteristics, as well as their response to antiepileptic therapy.

Materials and methods. A total of 1261 patients with various forms of epilepsy and the onset of seizures from the first day of life to 18 years of age were examined. Among those, a group of patients with confirmed GTCS was subjected to further analysis.

Results. We identified 190 patients with GTCS, which comprised 15.1% of all epilepsy cases (1261). There was a slight predominance of male patients in the GTCS group: 99 (52.1%) versus 91 (47.9%) females. It is known that GTCS can be part of 13 different epileptic syndromes. Among the patients in the present study, the following syndromes prevailed: epilepsy with isolated generalized seizures (26.2%), juvenile absence epilepsy (23.7%), and juvenile myoclonic epilepsy (23.2%). Symptomatic / cryptogenic focal epilepsy (SFE / CFE) was diagnosed in 11.6% of patients. In these patients with GTCS, the debut of epilepsy varied from the first month of life to 18 years of age. The average age of the debut was 10.4±5.35 years. The highest incidence of epilepsy in these pediatric patients was observed between 13 and 15 years of age – 27.4% of all cases. Along with that, the onset of epilepsy with generalized seizures reached its maximum at the interval between 10 and 18 years of age (60.4% of all cases). GTCS as the only type of seizures for the entire period of the disease was observed in 27.4% of cases. In the remaining patients, GTCS were observed together with other types of seizures. Of those, myoclonic seizures (34.2% of cases) and typical absences (31.6%) were mostly common. It is shown that in most patients (75.8%), antiepileptic medications brought about a complete remission. In 18.9% of patients, this treatment resulted in a more than two-fold decrease in the occurrence of seizures. In 5.3% of cases, the antiepileptic therapy had no effect. In 35 patients (18.4% of cases) in remission, recurrent seizure attacks were observed.

Conclusion. The variety of GTCS- associated syndromes, and the significant differences in the prognosis and the therapeutic approaches, necessitate using the full range of diagnostic measures.

About the Authors

M. B. Mironov
Institute for Advanced Studies of the Federal Medical Biological Agency
Russian Federation

PhD, Associate Professor, the Department of clinical physiology and functional diagnostics, the Institute for Training of the Federal Medical and Biological Agency. Address: Volokolamskoe shosse, 91, Moscow, Russia, 125371



N. V. Chebanenko
The Scientific and Practical Center for Child Psychoneurology of the Moscow City Health Department
Russian Federation

MD, PhD, neurologist & expert in medical rehabilitation, the Center for pediatric psychoneurology. Address: Michurinsky Prospect, 74, Moscow, 119602, Russia. Tel.: +7(495) 430-80-81



S. G. Burd
Russian National Research Medical University named after N. I. Pirogov, Health Ministry of Russian Federation
Russian Federation

MD, Professor, the Department of neurology, neurosurgery and medical genetics, Faculty of Medicine, the Russian National Medical University named after N. I. Pirogov. Address: ul. Ostrovityanova, 1, Moscow, Russia, 117997



T. M. Krasilshikova
Russian National Research Medical University named after N. I. Pirogov, Health Ministry of Russian Federation
Russian Federation

Assistant Professor, the Department of neurology, neurosurgery and medical genetics, Faculty of Pediatrics, the Russian National Medical University named after N. I. Pirogov. Address: ul. Ostrovityanova, 1, Moscow, Russia, 117997



M. N. Sarzhina
The Scientific and Practical Center for Child Psychoneurology of the Moscow City Health Department
Russian Federation

Head, the Department of medical rehabilitation, the Center for pediatric psychoneurology. Address: Michurinsky Prospect, 74, Moscow, 119602, Russia. Tel.: +7(495) 430-80-81



M. M. Gunchenko
The Scientific and Practical Center for Child Psychoneurology of the Moscow City Health Department
Russian Federation

Deputy director (in charge of the outpatient clinic), the Center for pediatric psychoneurology. Address: Michurinsky Prospect, 74, Moscow, 119602, Russia. Tel.: +7(495) 430-80-81



G. G. Avakyan
Russian National Research Medical University named after N. I. Pirogov, Health Ministry of Russian Federation
Russian Federation

PhD, Associate Professor at the Department of Neurology, Neurosurgery and Medical Genetics, the Russian National Medical University named after N. I. Pirogov. Address: ul. Ostrovityanova, 1, Moscow, 117997, Russia. Tel.: +7(495)5316941



Yu. V. Rubleva
Russian National Research Medical University named after N. I. Pirogov, Health Ministry of Russian Federation
Russian Federation

with the Department of neurology, neurosurgery and medical genetics, Faculty of Medicine, the Russian National Medical University named after N. I. Pirogov. Address: ul. Ostrovityanova, 1, Moscow, Russia, 117997



T. T. Batysheva
The Scientific and Practical Center for Child Psychoneurology of the Moscow City Health Department
Russian Federation

MD, Professor, Director of the Center for pediatric psychoneurology, Honored Doctor of the Russian Federation. Address: Michurinsky Prospect, 74, Moscow, 119602, Russia. Tel.: +7(495) 430-80-81



G. N. Avakyan
Russian National Research Medical University named after N. I. Pirogov, Health Ministry of Russian Federation
Russian Federation

MD, Honored Scientist of the Russian Federation, Professor at the Department of Neurology, Neurosurgery and Medical Genetics, the Russian National Medical University named after N. I. Pirogov. Address: ul. Ostrovityanova, 1, Moscow, Russia, 117997



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For citation:


Mironov M.B., Chebanenko N.V., Burd S.G., Krasilshikova T.M., Sarzhina M.N., Gunchenko M.M., Avakyan G.G., Rubleva Y.V., Batysheva T.T., Avakyan G.N. GENERALIZED TONIC-CLONIC SEIZURES : CLASSIFICATION, ELECTRO-CLINICAL CHARACTERISTICS, AND EFFICACY OF ANTIEPILEPTIC THERAPY. Epilepsy and paroxysmal conditions. 2017;9(3):6-17. (In Russ.) https://doi.org/10.17749/2077-8333.2017.9.3.006-017

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ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)