Epilepsy and paroxysmal conditions

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Vol 12, No 3 (2020)


137-146 749

Introduction. Oxcarbazepine (OXC) is approved for initial and adjunctive therapy of focal epilepsy (FE), being also a drug of choice in case of pediatric FE. Despite that OXC has been used in the Russian Federation (RF) since 2007, studies assessing its efficacy and tolerability are scarce.

Aim. To evaluate efficacy and tolerability of OXC therapy in patients with newly-diagnosed epilepsy.

Patients and methods. There were enrolled 103 patients (56 (54.4%) into the study: males and 47 (45.6%) females with FE, aged 44.32±19.71 years. Depending on the OXC daily dose, all patients were divided into 3 subgroups: <1200 mg/ day (n=20; 19.4%); 1200 mg/day (n=67; 65.1%), and > 1200 mg/day (n=16; 15.5%). Video-electroencephalographic (video-EEG) monitoring was performed at each visit (at baseline, 1, 3, 6 and 12 months after then onset of therapy). Treatment efficacy was assessed by using the criteria of retention on treatment, seizure absence, seizure rate decrease by >50%, seizure rate decrease by <50% (insufficient efficacy). Adverse effects (AEs) were assessed in accordance to the Side Effects of Anti-Epileptic Drugs (SIDAED) treatment scale and emerging pharmacodynamics aggravation (increased seizure rate compared to baseline/emergence of new seizure type).

Results. It was found that retention on OXC monotherapy during the 12-month follow-up period was achieved in 69.0% (n=71) patients, among which 15.5% (n=16) received less than OXC at dose of 1200 mg/day, 44.7% (n=46) - 1200 mg/ day, and 8.8% (n=9) - more than 1200 mg/day, respectively. Total rate of intolerable AEs during the follow-up period was 13.6% (n=14). Comparing initial vs. 12-month timepoint EAI magnitude after the onset of OXC therapy revealed that it was significantly decreased by 6.9-fold (p<0.05).

Conclusions. OXC is an effective drug for the initial treatment of FE in adolescents and adults highlighted with favorable tolerability profile. 12-month follow-up monitoring demonstrated that EAI was reduced almost by 7-fold allowing to consider it as an objective quantitative marker for assessing treatment efficacy.

147-157 554

Objective. To analyze the long-term results after surgical treatment of multifocal cortical epilepsy in children and determine prognostic factors. The use of multilobar resections in the surgical treatment of pediatric multi-focal epilepsy remains an pressing problem of current neurology and neurosurgery.

Materials and methods. A retrospective analysis of the multifocal resections data in 47 children with drug-resistant single-hemispheric multifocal epilepsy was performed by monitoring patients between age of 8 months up to 17 years old, who were operated from 1994 to 2014, additionally examined for prognostic factors affecting short- and long-term treatment outcomes after surgery.

Results. According to the MRI data, structural changes in the brain were found in 63.8% subjects, whereas in 36.2% cases no pathology was detected. The following types of surgical interventions were performed: fronto-temporal resection - 44.68% cases; temporal resection combined with subpial removal of the frontal and parietal cortex in 21.28% patients; resection of the temporal lobe and cortical foci of the parietal lobe - 19.15%; removal of the temporal, parietal and occipital lobes - 2 cases; resection of the temporal and occipital - 2 cases; resection of the temporal lobe in combination with multifocal resection of the cortical epileptic foci of the frontal, parietal and occipital lobes - 1 cases; fronto-central-parietal combined with multiple subpial transection of the cortex - 1 case, fronto-parieto-occipital - 1 case. Immediately in postoperative period and up to 12 months post-surgery, seizures disappeared in 42.9% cases, whereas in long-term period results remained stable with Engel I outcome in 41.7% after 3 years, 41.2% - after 5 years and 40.6% - after 10 years post-surgery.

Conclusion: Multilobar resections performed in multifocal epilepsy allow to provide a favorable result in the short-term and long-term period with fully abrogated seizures in 48% and 41% cases, respectively. Positive prognostic factors were found to be duration of epilepsy less than 7 years, onset of the disease at school age, lack of generalized seizures and epileptic status in history, as well as the vastness of surgery.


158-168 487

Aim. To demonstrate clinical cases of rare stroke type - cerebral venous thrombosis with paroxysmal conditions.

Materials and methods. There were retrospectively analyzed medical histories of the three male patients at age of 19, 22 and 47 years old, respectively, diagnosed with venous stroke, and admitted at different time points to the Neurology Department managing acute cerebrovascular accidents.

Results. Patients with subacute and acute venous stroke suffered from headache and general discomfort. Depression of consciousness and paroxysmal events were observed during acute stage of the disease. No elevated arterial blood pressure was found. Focal neurological symptoms were observed in one out of three patients manifested as aphasic disorders. Neuro-ophthalmological examination revealed signs of swelling in the optic nerve (papilledema) and retinal artery spasm. Risk factors predisposing to such pathology were revealed in each clinical case.

Conclusions. Here we provided with most high-priority risk factors as well as initial clinical manifestations for developing cerebral venous thrombosis as a rather rare pathological condition. However, various issues related to it still remain and require further investigations.

169-176 1062

Here we provide a literature-based definition as well as etiological factors, clinical picture, prognosis, diagnostic algorithm, and treatment for the New-Onset Refractory Status Epilepticus (NORSE syndrome). In addition, we also present our personal experience by describing a female patient with refractory focal epilepsy associated with the cryptogenic new-onset refractory status epilepticus.


177-181 1061

Vestibular migraine is one of the most common causes of rotational vertigo, which, however, remains hard to diagnose a nosological entity. There will be discussed pathophysiological mechanisms and current therapeutic approaches along with epidemiology and diagnostic principles for vestibular migraine, which will be of value for hospital and out-patient neurologists as well as general practitioners.

182-191 475

The latest data on the eslicarbazepine (ESL) efficacy, tolerability and safety in treatment of focal epilepsy are presented based on the results of the European study in clinical practice Euro-Esli that enrolled 2058 patients from 14 European centers, a detailed subgroup analysis, as well as our own data on the follow-up of 65 patients with focal epilepsy receiving ESL in monotherapy or combination therapy.

According to the Euro-Esli study, a 12-months follow-up allowed to conclude that therapy retention comprised 73.4%; percentage of responders was 75.6%, whereas proportion of patients with complete seizure cessation was 41.3 %. Regarding ESL efficacy it may be concluded that our personal data were comparable to those obtained during the international study Euro-Esli so that retention was 80%; percentage of responders was 75.4%, whereas seizure-free rate was 58.5%. As for the ESL safety profile our study demonstrated that adverse events (AEs) were registered at lower rate in as few as 21.5% of patients compared to 34% found in the Euro-Esli study. No unexpected serious AEs during the long-term follow-up period were documented in the both studies, which evidence about favorable ESL safety profile elderly patients, patients with comorbid intellectual and mental disorders as well as patients with post-stroke epilepsy.

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