Epilepsy and paroxysmal conditions

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Vol 9, No 1 (2017)



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6-25 28474

The International League Against Epilepsy (ILAE) has developed and approved the Operational classification of seizure types 2017 and the Classification of the Epilepsies 2017 . According to the ILAE 2017 Operational classification of seizure types,   seizures  can be initially divided into focal or generalized; and the seizure onset  is of crucial importance in this case. Focal seizures are optionally subdivided into focal aware seizures and focal impaired awareness seizures. Several new types  of generalized-onset  seizures  were implemented. Specific motor and non-motor  classifiers may be added. Unknown onset seizures are placed separately.  Three levels of diagnostics are specified in the 2017 ILAE Classification of the Epilepsies: seizure type (defined in accordance with the 2017 ILAE Operational classification of seizure types), epilepsy  type  (focal, generalized,  combined  generalized  and focal, unknown),  and epilepsy  syndrome.  An etiologic diagnosis should be considered  at each step along the diagnostic pathway. A patient ’s epilepsy may be classified into more than one etiological category. The term “benign” is replaced by the terms “self-limited” and “pharmacoresponsive” to be used where appropriate. The term “developmental and epileptic encephalopathy” can be applied in whole or in part where appropriate. The 2017 Operational classification of seizure types and the 2017 ILAE Classification of the Epilepsies can be helpful both in routine clinical practice and scientific research that will assist  in improving epilepsy care and quality of life of patients with epilepsies.


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Objective. To study concentration of valproats in children with epilepsy, newborns  and infants with episyndrome  using therapeutic drug monitoring (TDM) in routine clinical practice.

Materials and  methods. 75 children aged 1-18 years and 59 preterm newborns aged 0-90 days receiving valproic acid drugs were included in the study. Valproic acid concentration was measured using high performance liquid chromatography (HРLC).

Results. Therapeutic concentration was achieved in 77.3%  of  children  aged  1-18  years  with  an  average  daily dose  of  25.94  mg/kg  (1021.4  mg);  overtherapeutic concentrations  were registered  in 9.3%  of the cases.  Concentration of valproic acid tended  to decrease  along with children’s age. Among children aged 1-18, a direct correlation between the daily dose (in mg/kg) and concentrations  of  valproates was observed: r=0.42 for Cmin and r=0.50 for Cmax. There was no correlation between age and concentration. In newborns,  therapeutic concentration  was achieved only in 33.9% of the cases  with an average daily dose  of 43.4 mg/kg  (82.6  mg); overtherapeutic  concentrations  were registered  in 11.9%  of the  cases.  Significant  differences  in average daily doses  and concentrations of valproic acid were found in newborns under 1 month of age; overtherapeutic concentrations  in the group of preterm newborns  under 1 month were observed  in 23.5% of the cases versus 9.5% in the group of newborns  of 2-3 months  of age (p=0.07).  Weak inverse  correlation between  age and concentration  of valproic acid was seen in newborns: r=-0.25 for Cmin and r=-0.24 for Cmax. There was no correlation between the dose and concentration of valproic acid, this explains unpredictability of the dose response  in the group of preterm newborns and low rates of achieving therapeutic concentrations. 

Conclusion. Specific features of valproic acid pharmacokinetics  in newborns  and children are associated  with specific TDM parameters identified within the study; these  findings show high value of TDM.

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Objective: to estimate the role of MR – tomography in epilepsy diagnostics. We have analyzed the main protocol used for examination of patients with epileptic seizures in anamnesis, as well as a number of modern techniques,  which help to get additional information about both structural and functional changes in the brain. We have described several types of pathological changes detected by us during examination of the patients from this group.

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Objective. To investigate the main features of sleep disorders in patients with three main forms of epilepsy and its impact on the quality of life.

Materials and  methods. One hundred and fifty patients with different forms of epilepsy (including idiopathic, cryptogenic, and symptomatic) aged 17-64 years were enrolled. The following parameters were evaluated: presence  of sleep  disorders  (estimated  using  special questionnaires  developed  by the  Somnological  Center of the Ministry of Health of the Russian Federation), presence  of daytime sleepiness according to the Epworth scale, level of anxiety and depression according to the hospital scale (HADS), quality of life (analyzed using the QOLIE-89 questionnaire).

Results.  Patients in all three groups experienced  daytime sleepiness, difficulty falling asleep and maintaining sleep at night, problems with final awakening. We found a reliable correlation between the daytime sleepiness at rest or during activities with the subjective sleep characteristics, difficulty falling asleep and maintaining sleep, level of anxiety, and the values from QOLIE-89 questionnaire (quality of life).

Conclusion. Our findings demonstrate  the obligatory nature of the circadian rhythm  sleep  disorders  in all three  groups  of  epileptic  patients.  The differences  in the  subjective  sleep characteristics between the groups (depending on the form of epilepsy: symptomatic/cryptogenic and idiopathic) can be compared with the psychological characteristics of the patients with these forms of epilepsy.
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Childhood absence  epilepsy  (CAE) is an idiopathic generalized epilepsy,  which could be attributed to genetic  forms according to the latest proposals  of the Commission  on Classification and Terminology of the International  League Against  Epilepsy  (2016).  CAE has  specific  clinical and  encephalographic  characteristics.  Data regarding cognitive impairment  in children with CAE is still controversial. There are some  attempts  to introduce more  strict diagnostic criteria to be able to define the disease course and prognosis of this form of epilepsy. These are the criteria proposed by Panayiotopoulos C. P.  in  2005. 

Objective.  To  asses   specific  features  of  CAE taking  into  account  the  criteria of Panayiotopoulos C. P. (2005).

Materials  and  methods. We have retrospectively  analyzed 186 cases  of CAE in children; study participants were divided into groups according to Panayiotopoulos’s criteria (2005).

Results.  Children from the group allocated in accordance with Panayiotopoulos’s criteria had neither generalized tonic-clonic seizures (GTCS) nor myoclonic  seizures; control of absence  seizures  was achieved in 94.3% of the cases; almost  90% of children in this group received monotherapy with mean treatment duration of 2.8 years.

Conclusions. The use of more precise diagnostic criteria for CAE will help to predict clinical course of this form of epilepsy and its outcome.
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Objective. To identify predictive factors of favourable outcomes in children with drug resistant epilepsy (DRE) associated with structural brain changes,  who received surgical treatment. 

Methods. We performed  a retrospective  analysis of surgical treatment in 239 children with drug resistant epilepsy treated at the Pediatric Neurosurgery Department of the A. L. Polenov Russian Neurosurgical Institute from 2004 to 2014. The age of the patients varied between  2 and 18 years. The follow-up time ranged from 1 year to 10 years (on average 4.3 years).

Results. According to magnetic resonance imaging (MRI), 223 (93.3%) patients had different structural brain changes. Among the patients, 47 (21.1%) had cerebral cicatrix, gliosis, cysts  and atrophic changes, 33 (14.8%) had malformations of the cortical development, 43 (19.3%) had benign brain tumors,  47 (21.1%)  had vascular malformations,  21 (9.4%)  had arachnoid cysts,  12 (5.4%)  had hippocampal sclerosis,  11  (4.9%)  had  phacomatosis, 5  (2.2%)  had  Rasmussen’s encephalitis,  and  4  (1.8%)  had  hypothalamic hamartoma.  Positron  emission  tomography  revealed the  areas of gray matter  hypometabolism in the  brain, which correspond to the areas of a metabolic deficiency around the epileptic focus. Favorable long-term outcomes of epilepsy surgery (class I according to Engel scale) were registered in 67.6% of the cases.  The most  favorable results (class I according to Engel scale) were achieved after lesionectomy (81.9%), temporal resections (78.4%), and hemispherectomy (72.7%).

Conclusions. The most important predictive factors of favorable outcomes after epilepsy surgery are as follows: detection of epileptogenic morphological changes of the brain, completeness of resection of an epileptic and epileptogenic areas, and absense  of seizures in the early postoperative period.

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Pharmacotherapy of epilepsy requires deep knowledge  of anti-epileptic drugs (AEDs), including the following issues: spectrum of therapeutic efficacy and therapeutic strength, adverse effects (especially severe and life-threatening adverse reactions); specific features of pharmacokinetics,  pharmacodynamics, and drug interactions; titration rate, the need for laboratory tests  during treatment,  pharmacoeconomic components.  The main properties  of antiepileptic drugs  are defined by their mechanisms of action. Today, particular attention is paid to the drugs with broad spectrum  activity, which give an ability to use them in patients with so-called undifferentiated epilepsies. In this article, the authors describe their own experience in optimization of antiepileptic therapy in a group of 141 patients with various forms of epilepsy. This new optimized  strategy implies inclusion of modern  broad spectrum  AEDs in treatment  schemes along with the reduction  in use  of narrow spectrum  drugs.  Moreover, polytherapy  was  used  in most  of the cases  after treatment regimen correction. All the measures  allowed to achieve remission  in about half of the patients with epilepsy earlier considered as incurable.


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Antiepileptic drugs are frequently associated with a risk of adverse effects,  which have an impact on the tolerability and success of treatment. Patients who develop intolerable adverse effects have to discontinue treatment early after initiation or to switch to another antiepileptic drug. A long-term management  strategy for the patients with such a long-lasting chronic disease  as epilepsy should include both effective  seizure control and early detection  of adverse drug events, ensuring prognosis, prevention and minimizing side effects,  which is quite important. All these measures  are expected to improve adherence to treatment, quality of patients’ life and control of epilepsy.

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