Epilepsy and paroxysmal conditions

Advanced search
Vol 11, No 3 (2019)



208-232 3702

Introduction. The MRI method has revolutionized the diagnosis of epilepsy. However, the widespread adoption of MRI in clinical practice is slowed by an insufficient number of high-field MRI scanners, a shortage of trained specialists, and the lack of standard examination protocols. The aim of this article is to present the Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy.

Materials and methods. As a structural element of the International League Against Epilepsy (ILAE), the RLAE considers it important to adapt the Protocol developed by ILAE for specialists in Russia and EAEU countries. The working group analyzed and generalized the clinical practice existing in the Russian Federation, the Republic of Kazakhstan, the Republic of Belarus and the Republic of Uzbekistan. These recommendations are intended for doctors in specialized centers of epilepsy surgery, and for doctors in general medical centers. The recommendations are applicable primarily to adult patients, but the general principles are relevant to children as well.

Results. In all patients with convulsive seizures shortly after the first seizure, or patients diagnosed with epilepsy who have an unexplained increase in the frequency of seizures, rapid decrease in cognitive functions or the appearance / worsening of neuropsychiatric symptoms, the RLAE recommends using a unified MR protocol for the neuroimaging of structural sequences in epilepsy with three-dimensional pulse sequences T1 and T2 FLAIR with isotropic voxel 1 × 1 × 1 mm3 and two-dimensional T2- weighted pulse sequences with a pixel size of 1 × 1 mm2 or less. The MRI examination should be combined with EEG or EEG-video monitoring. Using this protocol allows one to set a unified standard for examining patients with epilepsy in order to detect (with high sensitivity) brain lesions playing a key role in the occurrence of seizures. Here, all 13 recommendations are presented.

Conclusion. Implementation of these recommendations in clinical practice will improve the access to high-tech medical care and optimize health care costs. 


233-243 372

The aim is to assess the impact of resistant focal epilepsy on the quality of patients' life.

Materials and methods. Prospective, comparative, observational study conducted under conditions of real clinical practice. Inclusion criteria: age over 18 years; the presence of two or more epileptic seizures in history; a long history of treatment-resistant focal epileptic seizures; current AED therapy. Exclusion criteria: history of non-epileptic seizures of any etiology; inability to perform an MRI and/or EEG. The design included two patient visits, the second 3-12 months after the first ("primary" and "repeated" examinations). The examination included the medical history, analysis of seizure diary, clinical and neurological examination, routine EEG and/or EEG video monitoring, brain MRI, and laboratory tests. During the initial and repeated visits, the patients were asked to answer the QOLIE-31, NHS3, HADS questionnaires. The patients were also asked to give their own subjective assessment of their physical and psychological state, treatment results, side effects, social situation, and the quality of life. All patients had a follow-up history of at least one year.

Results. In total, 120 patients with current or past treatment-resistant epileptic seizures were examined (53 men and 67 women aged 18 to 77 years). At the time of the re-examination (under continuing AED therapy), seizures stopped in 50.8% of them. The number of seizure types decreased in 65.9% of people. The effect of resistant focal epilepsy on the patient's quality of life was determined.

Conclusion. The use of commonly accepted tests (QOLIE-31, HADS, etc.) in the "expertise" mode is incorrect, probably because these tests had been originally created for the "client" situation. A discrepancy was found between an objective improvement in the clinical picture as a result of successful treatment and a subjective "insignificant" improvement in the quality of life as per patients' assessments.

244-254 390

Aim: to study the anticonvulsant and psychotropic activities and side effects of pufemid, pyrathidine and compound N3012 developed at the Institute of Fine Organic Chemistry of the National Academy of Sciences.

Materials and methods. Anticonvulsant activities were tested using the following models of experimental seizures: maximum electric shock, corazol, camphor, thiosemicarbazide, picrotoxin, strychnine, amigdala-kindling convulsions. The psychotropic activities of the tested compounds were investigated using the “elevated plus maze”, “electroshock retrograde amnesia”, and the “open field” models. The neurotoxicity of the compounds was assessed by the level of impaired motor coordination in the “rotating rod” test and in the “grid climbing” test.

Results. Pufemid, pyrathidine, and compound N3212 demonstrated high anticonvulsant activity that was superior to the reference antiepileptic drugs; in addition, the tested compounds had low toxicity and high indicators of therapeutic and protective effects. Pufemid, pyrathidine and compound N3212 showed psychotropic activities: e. g., compound N3212 had anxiolytic and nootropic effects.

Conclusion. The tested compounds – pufemid, pyrathidine and compound N3212 – are highly efficient and low-toxic substances and are, therefore, promising for further preclinical and clinical studies as anti-epileptic drugs with psychotropic activities. 

255-262 504

Aim: to study the relationship between sexuality and temperament in patients with epilepsy.

Materials and methods. The study included 102 participants: 52 patients with epilepsy and 50 healthy individuals aged from 19 to 45 years. The psychological examination was based on the I-structural test of Ammon (ISTA), the Structure of temperament questionnaire (STQ) of Rusalov, and a clinical interview.

Results. Using the correlation analysis we were able to reveal 9 correlations between the types of sexuality and the temperament characteristics in patients with epilepsy; in subjects of the control group – 4 correlations were found. Thus, in patients with epilepsy, constructive sexuality positively correlated with plasticity, social erginess, and pace, whereas in healthy subjects – with social erginess. In patients with epilepsy, destructive sexuality positively correlated with plasticity, social erginess, and social plasticity; in healthy subjects, destructive sexuality negatively correlated with social erginess. In patients with epilepsy, deficient sexuality negatively correlated with pace, plasticity, and social erginess, whereas in healthy subjects – with plasticity and social plasticity.

Conclusion. The study shows that the sexuality in patients with epilepsy is more deterministic than that in the comparison group. In addition, all types of sexuality in these patients correlate with plasticity and social erginess, which suggests that patients with epilepsy can be satisfied with sexual relations, show flexibility and strive for diversity while being flexible and socially active. These correlations can be read vice versa, i.e., striving for diversity and social activity in patients with epilepsy is accompanied by satisfaction with their sexual relations and inclination to experiment. 

263-269 274

Objective – to conduct a retrospective study on the prevalence of epilepsy and the use of antiepileptic drugs (AED) in the adult population of the Republic of Bashkortostan (RB) in 2013-2017.

Materials and methods. The study was carried out by analyzing the data of annual reports by the neurology services of outpatient and inpatient medical institutions in cities and regions of the Republic of Bashkortostan. In addition, we used the results of clinical examinations of patients with confirmed epilepsy and the data from the Medical Information and Analytical Center (MIAC).

Results. The prevalence of epilepsy in the RB in 2013-2017 was 291.7-325.8 cases per 100 000 population; the incidence of epilepsy was higher in the central and eastern regions of the Republic. The average age of these patients ranged from 30.5±1.3 years to 41.8±0.2 years. The men/ women ratio was 1.1/1.0. The incidence rate of symptomatic epilepsy ranged from 82.6% to 46.5%. Of AED, carbamazepine was used most often (47.4% of patients) followed by valproic acid (up to 32.9%). AED of the new generation (perampanel) were rarely used (2.4%).

Discussion. According to the data for 2016, the prevalence of epilepsy (per 100 000 population) in the RB exceeded the average figure for Russia as a whole: 323.4 in the Republic of Bashkortostan and 255.4 in the Russian Federation. Patients of young age (up to 40 years old) prevailed; among those, men took some lead. According to the literature, the gender difference in the prevalence of epilepsy remains minimal. As for the etiology, symptomatic epilepsy was the predominant form, with an increased presence of cryptogenic and idiopathic epilepsy in 2016-17. The “basic” AED were largely used for the treatment. Conclusion. Studying the clinical and epidemiological characteristics of epilepsy is important for the systemic organization of specialized medical care and the improvement of life quality in patients with epilepsy. 


270-277 557
GLUT 1 transporter deficiency syndrome (De Vivo syndrome, GLUT 1 deficiency syndrome, De Vivo Disease) is a rare genetic disease associated with a deficiency of the glucose transporter GLUT 1. Due to this deficiency, diffusion of glucose through the blood-brain barrier is limited or completely blocked. As a result, a clinical symptom complex of neurological disorders – epileptic seizures, cognitive deficit, and motor disorders – develops. The article provides a review of the literature on the variety of epilepsy manifestations in this syndrome, including idiopathic generalized epilepsy with absences, myoclonic-astatic epilepsy, and focal epilepsy. The inability of the basic antiepileptic therapy to stop the seizures is noted. The main treatment method is the ketogenic diet. A clinical observation made by these authors is also presented.


278-284 270

Objective: to study the effect of valproic acid on epileptic seizures developing during radiation therapy (RT) following glioma surgery in patients taking antiepileptic drugs (AED).

Materials and methods. This prospective observational study involved 879 patients aged 18-78 with glioblastomas (GM) who were receiving RT. The patients underwent clinical and neurological examination, electroencephalography (EEG), and neuroimaging tests. After the examination and surgical treatment, patients were prescribed RT. During an RT procedure, the patient has to stay in a steady non-moving position for 30 min. To prevent the patient from developing sporadic or serial seizures during RT, we used valproic acid administered via the intravenous route. The efficacy and safety of valproic acid were evaluated together with the outcomes of RT.

Results. Of 879 participants, symptomatic epilepsy was detected in 147 patients (16.7%). An increase in epileptic seizures (even under basic AED therapy) after surgery for GM was noted on days14-21 after the start of RT (i.e. between the 7 and 11th RT session) in 65 of 147 patients (44.2%). The iv administration of valproic acid allowed all 65 patients to complete the course of RT. No adverse events associated with the use of valproic acid were reported.

Conclusion. This observation from our clinical practice allows us to recommend valproic acid for the treatment of epileptic seizures (focal and generalized) developing during radiotherapy after surgery for GM. The treatment should be accompanied by clinical, neurological and EEG monitoring. 

286-292 404
The existing approaches to treating epilepsy can be classified as therapeutic and/or surgical. In most cases, a patient with epilepsy is examined by a neurologist (or psychiatrist) and receives antiepileptic drugs (AEDs) in order to control seizures. And it is the neurologist who decides on referring the patient to the surgeon for further treatment if the medications have no effect. Undoubtedly, there are situations when, during the initial examination, the doctor reveals life-threatening lesions or brain abnormalities, which unequivocally indicate the necessity of surgical treatment. The present article addresses the issues of professional caution required from the neurologist in less-obvious clinical cases, when the doctor has to rely on his/her own clinical judgement in order to identify the “surgical” situations and refer the patient to a neurosurgeon for an adequate treatment.


293-297 365
The aim of the article is to review domestic and international reports on the causes of nosogenic mental disorders in patients with epilepsy. Classification of nosogenic mental disorders according to the type of patient’s reaction to the disease is presented. The main causes of nosogenic mental disorders in epilepsy are identified; those are social maladaptation associated with the diagnosis, stigmatization and self-stigmatization as well as the presence of epileptic seizures.



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