Epilepsy and paroxysmal conditions

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Vol 8, No 1 (2016)
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8-11 727

The purpose of epilepsy treatment is complete termination of seizures or maximum reduction of their number with minimal side effects from treatment. One of the reasons of treatment failure is low patient compliance. The objective of our study was the analysis of compliance of patients with epilepsy in the Smolensk region, depending on patient’s age.

Objective: the analysis of compliance of patients with epilepsy in the Smolensk region, depending on the age of the patient.

Materials and methods: a selected group of patients, where there is used or counting the remaining pills, questioning patients and their relatives, check diaries episodes and the diary of taking AEDs.

Results: the patient groups with the highest and lowest compliance.

Conclusion: the failure of drug-free remission, when clicking on some analogues caused the violation of the therapeutic interaction doctor — patient in all age groups.

66-74 875

Myoclonic absences (MA) are generalised epileptic seizures, classificated as absences with special features. MA characterized by changes in the level of consciousness combined with severe bilaterally synchronous rhythmic myoclonic jerks.

Objective. To study the clinical and electroencephalographic characteristics of MA.

Materials and Methods. The study included 8 patients 5 to 13 years (5 female, 3 — male), in whom MA were registered during of video-EEG monitoring with the inclusion of sleep.

Results. MA in wakefulness followed by stopping activity, hypomimia, the appearance of rhythmic bilateral myoclonic jerks in the muscles of the upper body and in some cases the tonic component (elevation of the arms) later joined. In 3 cases, unilateral myoclonus observed. Change in level of consciousness was able to identify if the seizure lasted for more than 5 seconds. EEG during MA in wakefulness has registered generalized bilaterally synchronous rhythmic discharges of sharp-slow wave or double / poly spike wave activity with amplitude predominance of discharges
in the anterior areas. Rhythmic myoclonus coincided with a sharp wave, double-spikes, poly-spikes, complex “sharp-slow wave.” In 5 patients low amplitude fast activity (LAFA) was marked on EEG immediately before bilaterally synchronous complexes “sharp-slow wave.” In 7 cases during the sleep registered seizures with clinical and electroencephalographic characteristics of MA. It is impossible to adequately assess the level of consciousness during sleep.

Conclusion. Nevertheless diagnosis absence during sleep is competent on the basis of two co-signs: changes in motor activity of the patient at the time of the EEG pattern of absences.

12-21 1093

Objective. We assessed the changes in EEG and event-related potential (P300) in elderly patients with poststroke aphasia and epilepsy.

Materials and Methods. We examined 57 patients with poststroke aphasia (age 55-79 years). Cortical aphasia was revealed in 47 cases, and 10 patients had subcortical aphasia. Control group consisted patients with chronic brain chronic brain ischemia and healthy persons.

Results. Local slow activity in the left hemisphere in EEG were revealed in 78% of patients with cortical aphasia, and in 20% of cases with subcortical aphasia. Local epileptic activity along with slow activity was spike-and-slow-wave complexes and sharp waves; temporal intermittent delta activity (TIRDA); both spike-and-wave complexes and TIRDA. In two cases epileptic activity was revealed as periodic lateralizing epileptiform discharges (PLEDs) besides local slow waves, and may deteriorate the aphasia. According to P300 data patients with poststroke aphasia hadn’t severe cognitive impairment, and the worst changes were noted in the group with chronic brain ischemia. In some patients with heavy aphasia it was possible to recorded P300 in passive perception of stimuli.

Conclusion. In cases with PLEDs and persistent epileptic activity antiepileptic treatment probably reduces the aphasia. P300 is important in diagnostic of cognitive decline in patients with poststroke aphasia, especially when aphasia is heavy and neuropsychological tests can’t be done.

75-82 1925

The purpose of this study was to examine in experiment anticonvulsant and antihypoxic action of 2-ethyl-6-methyl-3-hydroxypyridine succinate medications — Astroks in injectable form (vial of 100 mg in 2 ml) compared with Mexidol injectable form (vial of 100 mg in 2 ml) and the substance 2-ethyl-6- methyl-3-hydroxypyridine succinate (EMHPS).

Materials and methods. Simulation of primary generalized eizures was performed using the maximal electroshock (MES) and pentylenetetrazole injection. Antihypoxic effects of drugs was studied on the model of normobaric hypoxia with hypercapnia.

Results: it was found that astroks injection at a dose of 200 mg/kg has a similar antihypoxic and anticonvulsant efficacy with EMHPS substance. Compared to injectable form of Meksidol astroks has similar efficacy in the test of antagonism with MES. Astroks exceeds the effect of Mexidol in the test of antagonism with pentylenetetrazole and has more severe antihypoxic action.

Conclusion. Аstroks injectable has pronounced antihypoxic and anticonvulsant action in the experiment which have some advantages over injectable Meksidol.

22-28 2339

Treatment of drug-resistant epilepsy is an extremely difficult task. Unfortunately, in Russia there are no regulations containing the algorithm of actions to help the practical neurologist in management of drug-resistant patients. It is obvious that there is an urgent need to establish a network of specialized epilepsy centers of level 4 (classification of the National Association of Epilepsy Centers, USA) in the territory of the Russian Federation, united by a common ideology and methodology.

Objective: to increase the quality of care for patients with refractory forms of epilepsy, by combined use of non-drug treatments such as surgery, ketogenic diet and chronic vagus nerve stimulation (VNS Therapy).

Material and methods. We observed 168 patients aged 1 to 18 years with refractory epilepsy.

Results. Surgical treatment was performed in 63 patients, ketogenic diet — 73, VNS therapy — 32 patients. Analysis of the combined effectiveness showed the following results: complete seizure control was observed in 59 (35.1%) patients; reducing the number of seizures of more than 75% — in 19 (11.3%), 50% — and 53 (31.5%), no effect, — 37 (22%). Thus, the significant improvement was observed on the whole in 131 (78%) patients of 168. Conclusions. An integrated approach, involving a differentiated choice of a non-drug treatment allows to achieve significant positive results, despite the resistance of epilepsy to drug therapy.

29-36 1346

In the past decades, an increasing incidence and prevalence of epilepsy in older age groups. Neurophysiological constants of the usual analysis of the EEG in this age group of patients is quite contradictory and inconclusive.

Objective: to determine the most specific EEG-patterns, according to the spectral analysis of coherence and capacity in patients with epilepsy elderly, to identify correlations and neurophysiological data of emotional-affective disorders.

Materials and methods: we Studied 182 patients older, and of these, 142 respectively with the effects of organic lesions of the brain, in 101 patients the disease was complicated by symptomatic epilepsy local. All patients underwent EEG with subsequent processing by the method of coherent analysis. 142 patients with organic and vascular pathology clinical and psychological testing with the use of scales and questionnaires (SF-36,QOLIE-31, SCL-90-R, BDI, HRDS, STAI).

Results: In patients with epilepsy elderly according to the spatial temporal analysis formed persistent «pathological», coherent communication in the Delta and theta bands of the EEG nterhemispheric formation of contacts (T6-P3, T4-T3, P4-O1),
the increase in the number of these links in the rear temporal region, the anterior frontal right, parietal left (T6,T5, F8,P3).
Neurophysiological value analysis confirm the presence of depressive and anxiety disorders in this group of patients (depression in 56,3% of patients with epilepsy, anxiety disorder in 8.7% of MCI — 11.7%. Values of indicators of depression on the BDI scale in amounted 34.81±2.73 points, HRDS — of 21.84±1.50).

Conclusion: the materials obtained during the study allow to make a conclusion about some features of spatial-temporal organization of brain biopotentials in patients with epilepsy elderly in comparison with groups of elderly patients without this pathology, and their mutual relation with the severity of psychopathological symptoms.

37-42 718

Objective. We describe our experience of using the ketogenic diet (KD) for the treatment of drug-resistant epilepsy. Refractory epilepsy causing irreparable damage to the health of patients giving an epileptic encephalopathy with regression of cognitive and motor functions especially in childhood.

Materials and methods. We observed 95 patients, the children from 1 year to 14 years old with refractory epilepsy with frequent seizures.

Results. For 20% of children with drug-resistant epilepsy using KD with or without anticonvulsant therapy resulted to treating and prevention of all types of seizures. The improvement of the quality of life for them we estimated by Hague and QLS scales. Using the KD we have achieved the reliable positive changes in the psychomotor development of patients tested by Griffits 1, Griffits 2, and GMFM scales.

Conclusions. KD is an effective treatment for refractory epilepsy. The overall efficiency (seizure reducing more than 50%) was observed in 48 patients, representing 48% of the total. The use of the KD will improve the quality of life of patients.

43-49 760

Was carried out the analysis of basic somatic and reproductive disorders at adults’ epilepsy, as well as the role of valproates in the epilepsy therapy at the modern stage. The individual therapy of adults’ epilepsy along with forms of epilepsy/types of epileptic attacks, should mandatory take into account such things as somatic pathology, sexual function and the condition of the emotional-volitional sphere. The valproic acis remains the substance, referred to the first choice group in the treatment of idiopathic (generalized/focal) cryptogenic/symptomatic focal and non-differentiated epilepsies at patients from different age groups with broad spectrum of the accompanying somatic pathology and at men. The valporate is the selection choice at renal failures, kidney transplantation, heart diseases, pulmonary pathologies, brain tumors, different psychic disorders. The substance is not recommended in case of liver diseases with its decompensation, of the bone marrow and liver transplantation, porphyria, adiposity and during pregnancy. For women the valproic acid is applied with reserve in case of the inefficiency of other AED with mandatory information of the patient on possible consequences of the substance application.

50-54 949

Neurodevelopmental disorders, including intellectual disability, autistic-spectrum disorders, speech and language disorders, attention deficit hyperactivity disorder (ADHD), learning disabilities, are more prevalent in children with epilepsy compared with their peers. Marked developmental delay and regression of acquired skills are typical for epileptic encephalopathies. On the other hand, neurodevelopmental disorders associated with epileptiform activity on the EEG without any clinical manifestations of epileptic fits, represent a serious problem. The causes of neurodevelopmental disorders in children with epilepsy are discussed, as well as clinical features of some epilepsies, associated with neurodevelopmental disorders.

62-65 738

Complex of acquired disturbances of cognitive functions in children associated with continuous epileptiform activity on the EEG is a serious problem. Quite often the EEG patterns in epileptic encephalopathies of childhood such as Landau-Kleffner, pseudo-Lennox syndromes, autistic epileptiform regression etc. are represented by the so-called «benign focal epileptiform discharges of childhood» (BEDOC, BFEDC, BEDC). Epileptiform discharges are characterized by high index and diffuse spreading nature, especially during slow-wave sleep, forming the pattern of ESES. In the treatment of epileptic encephalopathies the following AEDs are applied in monotherapy or rational combined therapy: valproates, ethosuximide, levetiracetam, sultiame and benzodiazepines.

55-61 842

Epilepsy is a frequent and sometimes leading symptom in inborn errors of metabolism, especially in neonatal or infantile ones. Early myoclonic encephalopathy and myoclonus as a seizure type are the prototypes of epilepsy in inherited metabolic diseases. But clinical presentation also includes refractory neonatal seizures, Ohtahara syndrome, infantile spasms and progressive myoclonic epilepsy. Clinical manifestations seems to be similar in different etiology and in majority of cases look like unspecific epileptic encephalopathy. Selected treatable inborn errors of metabolism are discussed alongside with diagnostic approach to inherited metabolic epilepsies. Probably it’s better to avoid the treatment with valproic acid in clinical situations when etiology is unclear. Alternative use of levetiracetam is recommended. Besides the antiepileptic drugs we can also make pyridoxine, pyridoxal-5-phosphate and folinic acid consequent trials for 3-5 days before our diagnostic quest succeed.



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