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Epilepsy and paroxysmal conditions

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Vol 7, No 2 (2015)

ORIGINAL ARTICLES

6-17 125
Abstract

The aim of our research was search of possible ways to optimize the diagnostic care for patients with symptomatic focal epilepsy with chronic parainfectious encephalitis associated with viruses of the family Herpes viridae. Materials and Methods. The study included 180 patients (107 women and 73 men) aged 18 to 50 years. Diagnostic methods include analysis of objective and subjective neurological symptoms, video-EEG monitoring, multimodal evoked potentials, brain MRI, laboratory methods (hemogram, immunogram, antibody titers of IgG and IgM to antigens of viruses HSV-1, HSV-2, CMV, VZV, HHV-6 and EBV, antibody avidity). Results. Relapsing course labial / facial herpes with subacute course was recorded in 93.1% of patients without epilepsy versus 95.7% patients with epilepsy (φ=0,764, p>0.05). Patients had a combined lesion of the central and peripheral nervous system involvement in the pathological process of II and VIII of the pairs (usually), V and VII pairs of cranial nerves (rarely), and the presence of chronic diseases of the paranasal sinuses in the form of chronic hyperplastic sinusitis. Patients with epilepsy, the total concentration of the major classes of immunoglobulins was smaller compared with uncomplicated encephalitis (IgA – 1,12 g/l vs. 1,5 g/l; IgG – 10,3 g/l vs. 13.8 g/l). This indicates a highly probable functional deficiency of B-lymphocytes and is manifested in the reduction antiteloproduktsii that promotes slow accumulation of specific antibodies, chronic process, an increase in viral load and associated complications. Reduced visual afferentation was 65.5% cases of encephalitis without epilepsy vs. 62.4% encephalitis with epilepsy. Reduced hearing afferentation observed less frequently (24.1% vs. 26.9%, respectively). Changes in cognitive evoked potentials identified in 28.7% cases of encephalitis without epilepsy vs. 53.8% encephalitis with epilepsy. Conclusions. Possible ways to optimize the diagnostic care for patients with symptomatic epilepsy parainfectious include a multidisciplinary approach (neurologist, neuroscientist, epileptologist, immunologist, otolaryngologist, ophthalmologist, psychotherapist), immune status, serum antibodies to herpesviruses, video-EEG monitoring, multimodal evoked potentials, neuropsychological testing, brain MRI with contrast, MR spectroscopy mediobasal (limbic) parts of brain. 

18-24 177
Abstract

Objective. To study the clinico-psychological personality features of patients with early-stage epilepsy.

 Materials and methods. 482 adult epileptic patients (52.3%-males; 47.7% – femails; aged up to 36 year) with different clinical manifestation of the disease were studied. Among the patients, 123 patients had early-stage epilepsy, its duration being up to 3 years; 120 patients, had seizure remission. To assess the cognitive, emotional and behavioural spheres, a psychological diagnostic assessment was carried out using 12 experimental psychological methods.

 Conclusion. A clinico-psychological epileptic patients with different clinical manifestations of the disease was carried out to diagnose latent or active symptoms of non-psychotic mental disorders and personality changes (disorders). The use of psychological methods has allowed revealing the heterogeneity of personality structure in patients with epilepsy. The progression and severity of mental disorders determine the role of the neurologist and the psychiatrist in the treatment-and-rehabilitation work with epileptic patients on the basis of the F06.822 and F07.02. A hypothesis on the mechanism of the development of mental disorders in patients with epilepsy is offered. 

25-40 122
Abstract

The review of scientific literature has shown that epilepsy is associated with a large number of social and psychological problems. We have analyzed the cinema feature films from different countries in which different aspects of epilepsy or incorporated in the basic idea of the picture, or disclosed in a short episode. Studied scientific publications devoted to the study of a number of problems epileptology, most of which occurs in the movies. Based on the analysis of the scientific literature produced scientific interpretation of films. Revealed that the film works reveal the numerous problems of epilepsy, the most important of which are: reducing the problem of compliance, alternative methods of treatment of epilepsy, the difficulties of social adaptation. Also in the movie are displayed features of social insurance patients with this diagnosis, addresses the issue of driving a vehicle. In addition, the film shows the prevailing in the society myths and legends associated with epilepsy. Concluded that the feature films, reflecting the most significant social aspects of the disease, providing physicians the opportunity to look at this through the eyes of the layman pathology. However, the cinema should correctly reflect the real problems of epilepsy, to show the progress made in its treatment of issues. Otherwise, the works of cinema will not have the benefit and will only exacerbate the situation, reducing the chances of de-stigmatization of patients with epilepsy. 

CLINICAL CASES

41-48 168
Abstract

Rationale: It is thought that temporal lobe epilepsy tends to show three types of seizures: simple partial seizures, complex partial seizures and secondary generalized motor (tonic ore tonic-clonic) seizures. Methods: Female 23-years-old patient on 12 week of pregnancy with multiple bilateral myoclonic seizures was investigated.

Results: At 4 years patient started presenting afebrile paroxysms of generalized tonic-clonic seizures from 2 to 5 times per month. For 2 years before our first meeting patient had been suffering from multiple bilateral myoclonic seizures that happened during wakefulness hundreds time per day. Patient had been treated with Carbamazepine, Phenobarbital, Fenitoin, Lamotrigine, Valproic acid in therapeutic doses without any result. On video-EEG monitoring focal epileptic activity was found in right and left temporal zones. Remission of epilepsy was reached on Clobazame 40 mg per day. The patient bore the healthy term infant through the maternal passages.

Conclusion: according to this case it becomes clear that temporal lobe epilepsy can manifest not only by focal seizures but by myoclonic seizures too. Benzodiazepines could be appropriate in treatment of such type of epilepsy. The continued epileptic seizures during pregnancy before the prescription of effective treatment aren’t the obligatory indication to cesarean section. 

49-58 135
Abstract

Hypoglycemia in congenital hyperinsulinism (WGI) in children increases the risk of brain damage, seizures and development delay. The aim of our study was to evaluate the clinical manifestations in children with CHI. Hypoglycemia is often manifests with seizures, which are sometimes in the future may lead to the development of epilepsy. Seizures in CHI do not always require a diagnosis of epilepsy and prescription of anticonvulsants. EEG changes in these children may be observed in the absence of epileptic seizures. Developmental delay was more common in children with neurological abnormalities and MRI changes. Children with ABCC8 gene mutations have more complicated for CHI and more prominent developmental delay. 

SCIENTIFIC SURVEYS

59-64 150
Abstract
The article presents a review of world literature on significance of various clinical lateralizing signs in temporal lobe epilepsy, such as dystonic posturing, limb automatisms, ictal and postictal aphasia, ictal nystagmus, head turning, periiktal headache, etc. The results of current research are compared with previously published reports. The ictal dystonic unilateral limb posturing (possibly isolated in a hand, foot, predominantly in distal parts of limbs) is still one of the most informative lateralizing signs and it is lateralized in contralateral hemisphere in 100% of cases. It is shown that the "early" and "late" head turning, and unilateral limb automatisms are the most important and convincing lateralizing signs, which must be considered in connection with the EEG data to determine the epileptogenic focus in patients with temporal lobe epilepsy.
65-75 142
Abstract

The aim of this article is analytical literature review on psychological factors contributing to the epileptic process. It was shown that emotional stress may trigger the onset of epilepsy and have a negative impact on the patients’ condition. Three types of seizure psychological triggers were identified: 1) stress (stress-induced seizures); 2) behavioral patterns (auto-induction, secondary gain); 3) conditioned-reflex mechanism (seizures are associated with specific simple and complex stimuli). Approaches to psychological intervention in a complex treatment of epilepsy are described. 

76-81 126
Abstract

Bioethics is examined through the context of the technological advancement of civilization. It has been shown that the most serious technological achievements are tied to the science of the brain. This science requires the use of bioethics, whose principles and norms are called to help medicine preserve the health, quality of life, and life of a human. For this to be possible, it is crucial for not only doctors, but also patients from different countries and of different nationalities and faiths to combine forces. The founders of ILAE understood this not long before the appearance of the field of bioethics in the beginning of the 20th century. This was not a coincidence: epilepsy is found to be a model for the study of the structural and functional organization of the brain. The tradition of ethics in Russian neurology was started by the father of Russian neuroscience, V.M. Bekhterev, who established RLAE only 4 months after the organization of ILAE. Today, RLAE and the All-Russian Society of Neurologists continue to develop this tradition. Only through combined forces is it possible to achieve a full implementation of the ethical mechanism of control in medicine. 



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