The annual conference "Actual problems of Epileptology" in Samara.

Objective. To define therapeutic drug monitoring (TDM) role when using drugs of valproic acid and a levetiraсetam as options of medication with a nonlinear and linear pharmakokinetics.

Materials and  methods. Analysed are the results of the therapeutic drug monitoring (TDM) among 80 patients who were using valproic acid during the monotherapy  and levetiracetam during monotherapy  or the combination  of any other antiepileptic drugs (AEDs). We determine  plasma concentration C min (before use next dose  AED).

Results.  Аmong  the  group consisting  of 57 patients and taking valproic acid with the individual daily dosages  in the range of 7.5 mg/kg  to 30.7 mg/kg,  C min of valproic acid equaled to the range of 44 to 111 mcg/ml  (therapeutic range is 50-100 mcg/ml).  The  research determined the presence  of significant individual pharmacokinetic features of valproic acid that play a role in achieving clinical effects and appearance of undesired results. 23 patients were taking the daily dosage of levetiracetam starting from 500 to 3000 mg  twice or thrice which equal from 7.5 mg/kg/day  to 36.9 mg/kg/day  individually. TDM confirmed  the linear pharmacokinetics  of levetiracetam, furthermore determining that the method  of determining the daily dosage by the body mass being more effective among the adults. 30 mg/kg can be considered the average effective daily dose of levetiracetam.

Conclusion. TDM proved to be a reasonable AEDs treatment not only for patients with the nonlinear pharmacokinetics  but also for those with the linear pharmacokinetics.

Goal. To assess the state of epileptic system using mathematical modeling to monitor the effectiveness of the therapy of epilepsy  in  various  age  group. 

Materialy and  methods.  It  conducts   research  on  visual  evoked  potentials  facing checkerboard  pattern in patients  with various forms  of epilepsy  in the young  and the elderly. We used  the original method  of  mathematical  analysis  of  the  results. 

Results.  A study  of  evoked  potentials  to  evaluate the  stability of neurodynamic  system in terms  of the risk of an epileptic seizure.  Obtained significant differences  in the calculated indicators of a group of young patients with cerebral morphofunctional immaturity and a group of elderly patients with involutional changes. Normal values should be regarded as the ratio of positive and negative component (Sp / Sn) from 0.5 to 3.0. More than 3.0 determined  a high risk of seizures  in patients with brain immaturity, below 0.5 – the risk of seizures  in patients  with severe  cerebral involutional changes.  Conclusion.Using the algorithm described  in clinical practice as a supplementary  budget method with the routine EEG and video-EEG monitoring for epilepsy will predict an individual patient and change pharmacotherapy due time for the rapid achievement  of remission  counter. The process of generating an epileptic fit in each age group can be described with the use of the theory of unstable systems.

Cognitive problems in epilepsy have a multifactorial origin with etiology, seizures, and the «central» side-effects of drug treatment being involved. Cognitive side effects  of antiepileptic drugs (AEDs) have been demonstrated to be one of the most important tolerability problems in chronic AED treatment, especially in children with epilepsy. Memory impairments, mental slowing, and attentional deficits are the most frequently reported ones. Neuropsychological profiles of AEDs are important considerations  for treatment selection, particularly in children and adolescents.  In evaluating studies  of the cognitive effects  of AEDs we must  follow an evidence-based approach, but in the majority of cases,  specific data on cognitive functions  in children and adolescents  with epilepsy are not yet available. A randomized double blind trial on cognitive effects of adjunctive perampanel for partial-onset seizures is cited (Meador K. F. et al, 2015) and discussed. In this trial adjunctive perampanel did not have any significant overall negative cognitive effect and was improving episodic memory in adolescent patients with inadequately controlled partial-onset seizures.

The current possibilities of treatment of depression in epilepsy were represented. Depression is one of the most frequent psychiatric comorbidities  in epilepsy. The prevalence of depression  ranges from 10 to 80%, and most  often found in patients with focal epilepsy resistant to antiepileptic therapy. Depression in patients with epilepsy are not often diagnosed and therefore not treated. A number of common epilepsy and depression  pathogenetic mechanisms, such as impaired metabolism  of certain neurotransmitters  in the central nervous system, especially serotonin was descripted. Based on this, the most  promising  drugs in the treatment  of depression  in epilepsy  are now the selective  serotonin  reuptake inhibitor (SSRI), such  as escitalopram.  Objective. The primary objectives  were to evaluate the efficacy and safety  of escitalopram in treating depressive symptoms. Materials and  methods. The study involved 68 patients aged 19-69 years with cryptogenic and focal epilepsy and different disease duration (from 5 to 21 years), different types of seizures and suffering depression  interictal (between  2 and 5.5 years). Depression Rating Scale of Montgomery-Asberg (MADRS) was used.  To assess the severity of the patient ’s condition at the time of the survey, a global assessment of disease severity (CGI-S) and the global assessment of the mental state (CGI-I) were used. While taking escitalopram (10-20 mg per day.), all patients received basic anticonvulsant therapy. Results.  During follow-up the patients with epilepsy who took  escitalopram,  proconvulsant  effect  were not  denoted.  In assessing depressive  symptoms improved  markedly. Against the background of escitalopram no deterioration was marked, no sedation, addiction to the drug was observed, minimum drug interactions with anticonvulsants was registered. Conclusion. The results described observation program suggests a safe and effective treatment of escitalopram epilepsy patients with depression,  it is well tolerated, low drugdrug interactions, as well as improve the quality of life of patients.

The aim of this study was to investigate the electrophysiological and neurochemical mechanisms of the anticonvulsant effect of a new original compound  GIZH-298 and to define the leading structure as the target for influence compound. Materials and  Methods. The partial (focal) and secondary generalized seizures were modeled by methods of creation a chronic epileptic focus  that was caused  by cobalt applique on the brain of rats. The liquid chromatography  (HPLC) analysis used for neurochemical study of the effect GIZH-298. There was studied the effect on metabolism  and quantity of biogenic amines in the brain structures of rats. Results. It was found that GIZH-298 at a dose of 60 mg / kg (i.p.) has a pronounced effect on the primary and especially secondary generalized epileptic foci in various brain structures with a primary influence on the cortex. GIZH-298 at a dose  of 60 mg / kg caused  a statistically significant increase in the content of serotonin and dopamine in the frontal cortex after 30 minutes after the administration and reduced the rate of metabolism  of dopamine  in the  dorsal striatum.  Conclusion.  The anticonvulsant  effect  GIZH-298  is enhanced  with increased of epileptic system, may be due to increased synthesis of serotonin and dopamine in the cortex, and decreased metabolism  of the latter in the striatum.

Objective.   The analysis of the frequency of occurrence of clinical phenotypes of JME among residents  of the Siberian Federal District (Russia).

Materials  and  Methods.  80 patients with JME underwent preliminary anamnestic  and clinical selection  using  stratified randomization.  After verification of  their diagnosis,  patients  were  grouped  based  on  the phenotype  classification proposed  by Martínez-Juárez  et al (2006).  Gender was also noted  for subsequent  genderrelated analysis.

Results.   The incidence of JME among males was lower than among females.  In general, the average JME onset age was characteristic for this clinical form of idiopathic generalized epilepsy. Furthermore, JME onset age in males  was higher than in females.  In general, the most  frequent phenotype  was the classical Type I phenotype.  The frequency  of Type I  occurrence  in males  was  significantly higher than that in females.  Type II,  the  least  favorable phenotype  in terms  of stable pharmacological remission,  occurred 3.5 times  less  frequently  in  males  compared  to females.  Types III and IV did not reveal significant gender-related differences. 

Conclusions. The results allow to revise the initial diagnosis of JME in burdened families: we recommend video-EEG monitoring in adolescent female patients at a younger age, with mandatory testing of levels of consciousness during induced stress. Higher frequency of Type II JME in females  suggests imminent  need for dynamic and lengthy video-EEG monitoring to exclude the chance of pseudo remission, before a decision can be made about reduction or termination of AEDs.

The prevalence of depression (D) in patients with epilepsy (PE) is quite high and 12-37% due to common neurobiological structural and morphological  and neurotransmitter  mechanisms underlying  these  diseases.  Depression  negatively affects the quality of life and control of seizures  in PE is associated  with a high risk of suicidality in PE, the disease is poorly diagnosed  the PE shall be appointed and rarely antidepressants  (AD) for the treatment  D in PE.

Materials  and Methods. The aim of our prospective observational study with an active control was to evaluate the clinical efficacy and safety  of AD the second  generation – of escitalopram in the treatment  of depressive  disorders in 30 PE with D. The control group consisted  of 30 PE not receiving AD. Evaluation of the effectiveness of treatment in PE with D was carried out at three points (baseline, after 3 and 6 months  of treatment  AD) by depression  rating score using psychometric scales and scales assessing the overall clinical impression  of the gravity of the violations.

Results.  In the PED group, treated with AD significantly decreased the values of D, there was a decrease in the severity and frequency of seizures, improvement  in the overall clinical impression,  while distinct trends in these indicators in the comparative group were note.

Conclusion. Our findings confirm the need for early detection  of D in PE and destination AD with a harmonious profile of efficacy and safety.

Objective: to evaluate and compare the clinical efficacy of topiramate and levetiracetam in the treatment of tic disorders.

Materials and  methods. We assessed the effectiveness of 1-2 mg/kg topiramate and up to 30 mg/kg levetiracetam in 17 tic patients aged 10 to 17 years old. Clinical evaluation of hyperkinesia severity and surface electromyography (EMG) were recorded before receiving the drug and later after 6 weeks of treatment. The clinical severity was assessed by Yale Global Tic Severity Scale (YGTSS, 1989). The control group consisted  of 15 healthy children of comparable sex and age.

Results.  Topiramate and levetiracetam  significantly reduced  the  hyperkinesia,  tics  severity  according to  Yale Scale (p<0.05), and the prevalence of firing activity on EMG when registering hyperkinesia from different muscle groups. The maximum  effect was obtained in the topiramate treatment group (p<0.05).

Conclusion. The study has shown the clinical efficacy of anticonvulsants in the treatment of tics in children.

Epileptic eyelid myoclonia with or without absences  – epileptic seizures  presented  with closing of eyes  and frequent (3-6 times  per second)  rhythmic  myoclonias  of eyelids («eyelid fluttering»). They can be accompanied  by absences seizures  of short duration or they are not accompanied  by loss of consciousness. We analyzed the forms of epilepsy, seizure types and compulsive  movements of eyes associated with epileptic eyelid myoclonia. We present an algorithm of video-EEG monitoring to diagnostic this epileptic syndrome.  Epileptic eyelid myocloniais a seldom type of seizures. It observed with generalized and focal epilepsies. Epileptic eyelid myoclonia can be combined with It can be combined with obsessive eye movementsб what is need differential diagnosis with tics and other obsessions. Using of prolong EEG monitoring is necessary  in order to avoid the deterioration of the state of imaginary or perceived improvement. AEP efficiency depends  on the epileptic syndrome  associated with of еpileptic eyelid myoclonia.