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Epilepsia and paroxyzmal conditions

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Vol 9, No 3 (2017)
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DISTINCTIVE ARTICLES

6-17 184
Abstract

Objective: to study patients with generalized tonic-clonic seizures (GTCS) with emphasis on their nosological, anamnestic, clinical, EEG, and neuroimaging characteristics, as well as their response to antiepileptic therapy.

Materials and methods. A total of 1261 patients with various forms of epilepsy and the onset of seizures from the first day of life to 18 years of age were examined. Among those, a group of patients with confirmed GTCS was subjected to further analysis.

Results. We identified 190 patients with GTCS, which comprised 15.1% of all epilepsy cases (1261). There was a slight predominance of male patients in the GTCS group: 99 (52.1%) versus 91 (47.9%) females. It is known that GTCS can be part of 13 different epileptic syndromes. Among the patients in the present study, the following syndromes prevailed: epilepsy with isolated generalized seizures (26.2%), juvenile absence epilepsy (23.7%), and juvenile myoclonic epilepsy (23.2%). Symptomatic / cryptogenic focal epilepsy (SFE / CFE) was diagnosed in 11.6% of patients. In these patients with GTCS, the debut of epilepsy varied from the first month of life to 18 years of age. The average age of the debut was 10.4±5.35 years. The highest incidence of epilepsy in these pediatric patients was observed between 13 and 15 years of age – 27.4% of all cases. Along with that, the onset of epilepsy with generalized seizures reached its maximum at the interval between 10 and 18 years of age (60.4% of all cases). GTCS as the only type of seizures for the entire period of the disease was observed in 27.4% of cases. In the remaining patients, GTCS were observed together with other types of seizures. Of those, myoclonic seizures (34.2% of cases) and typical absences (31.6%) were mostly common. It is shown that in most patients (75.8%), antiepileptic medications brought about a complete remission. In 18.9% of patients, this treatment resulted in a more than two-fold decrease in the occurrence of seizures. In 5.3% of cases, the antiepileptic therapy had no effect. In 35 patients (18.4% of cases) in remission, recurrent seizure attacks were observed.

Conclusion. The variety of GTCS- associated syndromes, and the significant differences in the prognosis and the therapeutic approaches, necessitate using the full range of diagnostic measures.

18-21 196
Abstract

Objective. The study aimed to investigate the significance of MRI and video electro-encephalography (EEG) monitoring in diagnosis of occipital lobe epilepsy.

Materials and methods. The study involved 103 patients aged 2-17 years old who were diagnosed with occipital lobe epilepsy. All patients underwent brain MRI scans using a CT scanner 1.5 TL in the T1 and T2 modes in the axial, sagittal and frontal planes. For video electro-encephalography monitoring the EEG-recorder Encephalan 9 was used.

Results. For the analysis of MRI studies in patients with occipital epilepsy, we grouped the patients as follows: with signs of perinatal brain lesions – 39 patients (38%), with congenital abnormalities of brain development – 26 patients (25%), and those with no pathological findings in the brain structures – 38 (37%). The EEG monitoring results revealed no deviations from the normal background rhythm in 27 patients (26%). Fifty patients (49%) demonstrated abnormalities of the alpha rhythm. In 26 patients (25%) a slowdown of the background rhythm was detected. The results demonstrated that a slowdown and abnormalities of the background rhythm occurred more often in children with symptomatic occipital lobe epilepsy, while these EEG changes occurred the least in patients with Lennox-Gastaut Syndrome. All patients showed the epileptiform activities manifested by the “peak – slow wave” complexes similar to the benign epileptiform rhythm patterns.

Conclusion. The results obtained from the brain MRI studies in patients with occipital lobe epilepsy indicate that the perinatal brain damage has a role in the pathogenesis of the disease. The EEG results show that the EEG patterns in Panayiotopoulos Syndrome are more variable as compared to Lennox-Gastaut Syndrome and symptomatic occipital lobe epilepsy.

22-31 136
Abstract

Objective: to evaluate the use of valproic acid in treatment of epilepsy during pregnancy.

Material and Methods. The maternal and obstetric outcomes of 601 pregnancies in women with epilepsy in the Samara region were reviewed. The incidence rates of fetal major congenital malformations (MCM) in women with epilepsy were analyzed; the data were obtained from the Samara regional MCM registry and from EURAP – the European epilepsy and pregnancy registry (report dated November, 2016). The development of intelligence (IQ) in 23 children born to women with epilepsy and 10 children of healthy women was assessed.

Results. Among the 601 pregnant women with epilepsy, 219 (36.4±2.0%) received no antiepileptic drugs (AED), 290 patients (48.3±2.0%) received AED monotherapy, and 92 patients (15.3±1.5%) – AED polytherapy. Fetal MCM were diagnosed in 19 of 601 women with epilepsy (3.2±0.7%); of those five MCM cases were attributed to monogenic and chromosomal abnormalities. The reported incidence of MCM in the population of the Samara region is 2.7%. However, within the present study we found deviations from the standard protocol of MCM registration; therefore, we assume that the real MCM incidence rate in the regional population is higher. The rate of fetal MCM in women exposed to AED monotherapy was 3.1±1.0%, with polytherapy – 4.3±2.1%, and in the untreated women – 0.5±0.5%. The rate of MCM was relatively higher after exposure to valproic acid monotherapy (4.7±1.7%) than that for carbamazepine monotherapy (3.1±2.2%); these figures were still considered to be within the limits of low genetic risk. Notably, the present rates of MCM incidence for the Samara region were lower than those reported in EURAP. Among the children born to the women with epilepsy, the general, verbal and non-verbal IQ averaged at 128.8; 116.5 и 133.3 points (respectively), which did not significantly differ from the IQ values in children born to the women without epilepsy. Likewise, no significant differences were found between the IQs of children exposed in their fetal period to valproate or carbamazepine and those who were not exposed to antiepileptic drugs.

Conclusion. If good seizure control is reached with valproic acid, this drug can be used during pregnancy at the lowest effective dose.

32-38 143
Abstract

The incidence of epilepsy is highest in children and in elderly people (over 60 years of age). In about 75% of cases, the first seizures occur before the age of 16 with the maximal occurrence observed before the age of 10 [1]. The problems of diagnosis and treatment of epilepsy in patients of the “transitional” age – adolescents, as well as elderly people – need more attention because these two groups go through the most vulnerable periods of their lives, both psychologically and physiologically. These problems should be approached in the way specific for each age group. For example, there are difficulties in diagnosing a particular form of epilepsy in adolescents; therefore the diagnoses of “unspecified epilepsies” are made. In these cases, the use of wide spectrum antiepileptic agents is recommended. In elderly patients, we often see symptomatic forms of epilepsy in combination with a number of concomitant disorders. Given the age-related changes in pharmacokinetics of antiepileptic drugs, the treatment options for the elderly are quite limited. Here, the medical records of 420 patients (from 3 to 79 years old) diagnosed with various forms of epilepsy were studied. We were interested in patients with “unspecified” forms of epilepsy and the treatments they received. In 17% of cases, the form of epilepsy could not be identified. Levetiracetam and valproate were used most often; as a result of the therapeutic optimization, the volume of carbamazepine-based therapy declined. Among other agents, topiramate, zonisamide, lamotrigine and lacosamide were also in use. In 75% of the studied cases, the treatment with broad-spectrum drugs allowed to control seizures in patients with “unspecified” forms of epilepsy, which indicated the correct choice of therapy.

EXPERIMENTAL EPILEPTOLOGY

39-46 131
Abstract

Objective: to study the anticonvulsant and psychotropic effects of novel benzothienopyrimidine derivatives and rationalize their use for medical practice.

Materials and methods. The anticonvulsant effects were studied by using the models of murine seizure induced with corazole, camphor, thiosemicarbazide, picrotoxin, or strychnine as well as the maximal electroshock. The psychotropic properties of the compounds were studied using the “open field”, “elevated crossshaped maze”, “forced swimming”, “electroshock retrograde amnesia”, or “rotating rod” models in mice and rats.

Results. The benzothienopyrimidine derivatives showed high anticonvulsant activities, especially against the corazoleinduced seizures.

Conclusion. The tested compounds surpass the well-known clinically used anticonvulsants 3-(p-Isopropoxyphenyl)succinimide and ethosuximide. One of the tested compounds is selected and recommended for further development as an anticonvulsant with psychotropic properties.

LITERATURE SURVEY

47-53 135
Abstract

The paper reviews the current data on the risk factors, pathogenesis, psychopathological symptoms and therapy of depression in patients with epilepsy. Depression predominantly occurs in patients with temporal epilepsy. The lateralization of the focus cannot be readily interpreted, although the literature indicates that depression occurs more often with left-sided foci. In their external manifestations, the episodes of depression in epilepsy can be fully the same as in any affective disorder. Treatment of depression is carried out without canceling therapy with antiepileptic drugs; the latter may have different impacts on the course of depression. In this respect, valproate, carbamazepine, oxcarbazepine, and lamotrigine do not exacerbate depression. All of them, despite the differences in their mechanisms of action, have a common component – an increase in the serotonin level in the central nervous system. Among the drugs listed above, valproate is especially beneficial.

54-63 162
Abstract

The role of epilepsy in developing autism spectrum disorders (ASD) is not well understood. According to some reports, epilepsy of early childhood is often found in patients with autism of early childhood. In such children, epilepsy can progress at later periods, while the presence of both disorders in one child has a specific clinical pattern and requires specific treatment. The question whether suppression of epileptic discharges on the EEG could lead to cognitive improvement in children with ASD remains open. Likewise, the etiology of autism and its possible links to epilepsy and other pediatric disorders need more research. Here we present an overview of recent clinical studies on the proposed connection between epilepsy and ASD.

CLINICAL CASES

64-72 127
Abstract

Among the various types of epileptic syndromes, gelastic seizures are considered the rarest one. The condition is characterized by forced laughter and the finding of hypothalamic hamartoma. Gelastic seizures may be associated with temporal or frontal foci of epilepsy, tumors, tuberous sclerosis, hemangiomas, and infectious lesions, including hypothalamic hamartoma. The tissue of a hypothalamic hamartoma is, by its nature, an epileptogenic zone. In the presence of a hypothalamic hamartoma, the expression of neuropeptides is often disturbed, which can contribute to the development of a seizure attack. Episodes of forced laughter in patients with hypothalamic hamartomas can be combined with various vegetative manifestations, motoric and mental symptoms. The report presents a clinical case of gelastic seizures in an adult male with hypothalamic hamartoma; the report includes the stepwise diagnosis and the treatment with transcranial magnetic stimulation (TMS). After a course of restorative therapy, control of epileptic seizures has been improved.

RESOLUTIONS



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