Abstract. Levetiracetam (LEV) is one of the most commonly prescribed antiepileptic drugs (AED). However, there were no studies on its efficacy and safety in terms of the correlation with epileptiform activity index (EAI) performed among the Russian population.

Aim. To evaluate the efficacy and tolerability of LEV monotherapy in patients with newly-diagnosed epilepsy using epileptiform activity index (EAI) assessment.

Materials and methods. The study included 107 patients (46 (43.0%) male and 61 (57.0%) female) with focal epilepsy (FE) (39.3%; n=42) or idiopathic generalized epilepsy (IGE) (60.7%; n=65). At each visit, video-electroencephalographic (video-EEG) monitoring was performed (baseline and in 1, 3, 6, and 12 months of the therapy). Therapeutic drug monitoring was performed at dose titration in 1 month of the therapy or in case of therapy correction. Treatment efficacy was assessed using the criteria of seizure absence (medically induced remission), seizure rate decrease by >50% (responders), seizure rate decrease by <50% – insufficient efficacy, a composite index of efficacy/tolerability (retention on treatment), and seizure rate increase compared to baseline and/or development of a new type of seizures (aggravation). Adverse events (AE) were assessed using the scale for side effects in AED treatment (SIDAED).

Results. Total EAI at baseline was 5.2-fold higher in patients with IGE compared to FE patients (23.4±3.0 and 4.5±0.97, respectively). After 1 month of LEV therapy, EAI decreased to 3.4±1.1 and 1.9±0.4 in patients with IGE and FE, respectively (p<0.01). The decrease continued during the whole follow-up period. Retention on monotherapy was achieved in 82.2% (n=88/107) patients; in 87.6% (n=57/65) patients with IGE and in 73.8% (n=31/42) with FE. The rate of serious AEs during the follow-up period was 8.4% (n=9).

Conclusions. LEV is an effective drug of choice for the initial treatment of newly-diagnosed FE and IGE in monotherapy along with a significant decrease in EAI. EAI is an objective measure of LEV treatment efficacy.

Aim. To approve of diagnostic effectiveness of SWAN (SWI) images in revealing of calcium containing epileptogenic substrates in children with resistant focal epilepsy.

Materials and methods. The results of MRI in children with refractory focal epilepsy obtained in the Radiology Department of the Russian State Children Hospital in the period from 2018 to 2020 were observed retrospectively. High-resolution epileptological MR protocol used for investigation of 67 children. SWAN was applied in all cases for identification of calcium containing epileptogenic substrates, including cavernomas, DVA syndrome, cortical gangliogliomas, Sturge-Weber syndrome and tuberous sclerosis complex. All images were received by using MRI 3T 750 W Discovery GE.

Results. In 17 cases (25%) SWAN provided important diagnostic information about the nature of the of epileptogenic lesion, its prevalence and borders. Additional earlier invisible structural changes were revealed in 2 cases of SWS and 1 cases of FCD; and in 13 cases SWAN gave us possibility to avoid CT for approving calcium in epileptogenic focus.

Conclusion. We believe that adding SWAN in to the epileptological MR protocol is the necessary step for optimizing calcium and blood degradation products identification in the structure of potential epileptogenic focuses. Moreover, it would be very effective instrument for differential diagnosis of cerebral structural changes, specifying its etiology and, hence, would have influence on the therapeutic tactic and surgical strategy in children with focal epilepsy.

Aim. The study aimed to motivate doctors for ethical management of patients with epilepsy, to study the real picture of the application of values and principles of bioethics during the treatment of patients with epilepsy, and to develop an algorithm of ethical management of patients taking into account sex and age-related factors.

Materials and Methods. Content analysis of historical documents and publications in Russian neurological journals was performed. The sociological study included observation, a questionnaire survey of post-graduate students and junior and senior students of medical institutions, standardized and non-standardized interviewing of 211 neurologists, and 265 pediatric neurologists.

Results. In their clinical practice, 60% of the interviewed in 2017-2019 followed the principles of respect for the private autonomy of patients and their human dignity. 55% of responders followed partner and negotiation models of interaction with patients. More than 97% of respondents from these groups try to follow the principles of bioethics. However, more than 50% of them could not name classic and special principles of bioethics for their category of patients; 29% could not identify the type of model that they use in their work with patients; 75% of pediatric neurologists significantly lacked knowledge in the area of bioethics and practical skills in their application in patients’ management.

Conclusion. The study revealed controversy between the increased motivation of doctors to ethical management and an insignificant level of knowledge in the area of bioethics and its practical implementation. To reduce this controversy, it is necessary to develop a system of continuous ethical education.

In February 2020, in Moscow, Expert Forum was held on the issues of the application of perampanel in routine clinical practice. The main aim of the Forum was to discuss the tolerance and safety profile of perampanel in patients with epilepsy in different age and gender groups in the conditions of routine clinical practice. Leading experts in neurology and epileptology took part in the Forum, wherein the acute data on the efficiency and safety of perampanel and the management of potential risks were presented.