Двигательная нейрореабилитация у пациентов с эпилептическими приступами: ограничения методов, имеющих доказанную эффективность при инсульте

Пациенты с эпилепсией по ряду причин могут нуждаться в реабилитационной помощи, в частности в связи с развитием двигательных нарушений вследствие инсульта, последствий черепно-мозговой травмы, рассеянного склероза и других повреждений головного мозга. Современные подходы нейрореабилитации, прямо или косвенно влияя на нейропластические процессы, изменяют возбудимость коры головного мозга, стимулируют системы афферентации, приводят к утомлению и могут выступать факторами провокации приступа или ухудшения течения эпилепсии. Кроме того, развитие приступа может совпасть по времени, но быть не связанным с реабилитационными мероприятиями: например, на фоне пропуска приема противоэпилептического препарата, депривации сна или длительно испытываемого пациентом стресса. В статье приведены результаты обзора исследований, направленных на изучение триггеров эпилепсии, проведено их сопоставление с факторами вмешательств, применяемых в двигательной реабилитации, рассмотрены данные по безопасности использования основных методов и предложены меры по снижению риска развития эпилептического приступа в процессе нейрореабилитации.

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