Epilepsy and paroxysmal conditions

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Vol 12, No 4 (2020)


197-204 751

Introduction. Cerebral palsy is often combined with epilepsy and epileptiform electroencephalographic (EEG) activity. Currently, the question of how rehabilitation with cerebral palsy is dangerous in relation to the provocation of epileptic seizures is relevant.
Objective: to study the effect of cerebral palsy rehabilitation on epilepsy in a standard rehabilitation center.
Material and methods. We examined 80 children with various forms of cerebral palsy and epileptiform EEG activity. The patients were divided into two groups: children of Group 1 never had epileptic seizures, children of Group 2 had a history of epileptic seizures of more than 6 months ago. The follow-up was 12 months during which children underwent EEG before and after rehabilitation courses. Depending on the risks associated with provoking epileptic seizures, patients were prescribed rehabilitation procedures of various intensities: Vojta kinesiotherapy, massage, physiotherapeutic treatment in the form of transcranial micropolarization and paraffin therapy.
Results. During the study, epileptic seizures developed in 5 patients (12.5%) from Group 1 and in 7 children (17.5%) from Group 2. In all cases, rare focal seizures were recorded (1–2 times a year). All patients with seizures during our study had a history of seizures under the age of 1 year. The onset of seizures was quickly stopped by the basic antiepileptic drugs in monotherapy. Epileptic seizures developed in children with moderate to severe cerebral palsy on GMFCS (Gross Motor Function Classification System) and a history of neonatal seizures. We attributed both of these to risk factors. In children with cerebral palsy and epilepsy in remission of 6 months or more, massage and Vojta therapy did not provoke epileptic seizures. The effect of epileptiform activity on the severity of motor status and on cognitive functions in cerebral palsy has not been established in our study.
Conclusion. According to our data, rehabilitation measures do not have a significant impact on the risk of developing epilepsy.

205-215 564

Introduction. Epilepsy is a common feature of mitochondrial disorders, including those associated with mutations in the POLG gene. Nevertheless, brain electrical activity features of POLG-related disorders in adult patients have not been adequately studied.
Objective. To study the features and characteristics of the electroencephalography (EEG) pattern in adult patients with POLG-related disorders.
Material and methods. Eight patients were examined: 7 with SANDO (Sensory Ataxic Neuropathy, Dysarthria, Ophthalmoparesis) syndrome, and 1 with MEMSA (Myoclonic Epilepsy Myopathy Sensory Ataxia) syndrome; median age was 32.5 years. All patients underwent routine EEG monitoring using a 19-channel electroencephalograph according to the generally accepted method.
Results. Epileptic seizures were found in 3 patients, for 2 of them – as the first manifestation of the disease. In 6 patients, theta waves predominated in the occipital regions. Of those 6 patients, in 5 bilateral synchronous bursts of theta and delta wave groups were identified being more prominent in the frontocentral regions; 4 patients had transient non-lateralized delta activity in the occipital and parieto-occipital brain regions. In all patients, opening eyes led to the depression of rhythms and burst suppression. After photostimulation, in 2 cases bilateral synchronous bursts of delta and theta wave groups were recorded predominantly in frontal lobes. In 3 patients during hyperventilation an increase in delta activity in the occipital lobes and bilateral synchronous bursts of delta wave groups were observed. Epileptiform activity was recorded in 2 cases.
Conclusion. In adult patients with POLG-related disorders, regardless of the clinical manifestation, typical EEG features include generalized background slowing, theta and delta bursts in occipital lobes with their suppression by opening eyes.

216-225 441

Objective: to determine the factors influencing quality of life (QoL) in patients with drug-resistant focal epilepsy (DRFE).
Material and methods. 111 adult patients with DRFE were included in the study. Quality of life was measured using the Quality Of Life In Patients with Epilepsy – 31 questionnaire (QOLIE-31). The severity of the disease (frequency and subjective assessment of the severity of seizures), the effect of pharmacotherapy (drug load and composition of the treatment regimen), the social status of patients, comorbid conditions (anxiety and depressive disorders, pathological fatigue) were assessed.
Results. In the studied sample, a pronounced decrease in QoL was shown, the median of the final QOLIE-31 score was 65.4 points (interquartile range 53.0–72.6 points). A statistically significant decrease in QoL was found in subgroups of patients with seizures during the previous three months; taking carbamazepine or benzobarbital; with anxiety and depressive disorders; with pathological fatigue; and in unemployed patients. A multiple linear regression model (R2=0.66) was developed, which included the following determinants: Fatigue Severity Scale, Liverpool Seizure Severity Scale, and the risk of depression according to the NDDI-E questionnaire.
Conclusion. In patients with drug-resistant focal epilepsy, there is a pronounced decrease in the quality of life due to combination of factors associated with the characteristics of the disease, treatment, comorbidities, and social status. The key QoL determinants in patients with DRFE are pathological fatigue, anxiety and depression, and subjective severity of epileptic seizures; employment is a positive factor. The role of epileptic seizures frequency in QoL formation in these patients requires further research.

226-236 824

Background. Over the past decades many Russian and foreign authors have devoted their studies to psychiatric comorbidity and suicidal behaviour in people with epilepsy. It is particularly important to find risk factors to develop suicidal ideation in this group of patients. According to the World Health Organisation, suicide is the second cause of death among patients with epilepsy, especially those under 29 years. Social maladaptation and deviant reactions to isolation within the framework of personality disorder and frustrating elements necessitate strategy development to prevent suicide intentions in this group of patients.
Objective: to find risk factors contributing to suicidal behaviour in patients with epilepsy.
Material and methods. We examined 102 patients diagnosed with epilepsy and divided them into two groups consistent with the available relevant suicide ideators: Group 1 (reference group) – without suicide ideators (n=73), Group 2 (study group) – with suicide ideators at the time of the study (n=29). We conducted a pathopsychological study using scales and questionnaires.
Results. Patients with epilepsy and suicidal ideation are more vulnerable to a wide range of mental health disorders. Behavioural and mood disorders predominate. Risk factors for suicide in this patient cohort relate to a darker outlook on the future and emotional instability. All limits of the antisuicidal behaviour pattern reduced uniformly, except for the Family responsibility. Amidst the severe course of the underlying medical conditions, disharmony is formed in attitude towards the disease.
Conclusion. Assessment of the risk factors for the development of suicidal ideation in patients with epilepsy is a challenging multidisciplinary task. Even with relative mental well-being, it is worth focusing on all aspects of quality of life.


237-247 633

General practitioners, therapists, and cardiologists do not have formal education (training) regarding cerebrocardial syndrome, primarily heart rhythm and conduction disorders in epilepsy and sudden unexpected death in epilepsy (SUDEP), as well as the potential arrhythmogenic effect of antiepileptic drugs. This lecture presents important elements of knowledge about the genetic predictors of cerebrocardial syndrome and SUDEP in juvenile myoclonic epilepsy, which is the most common form of genetic generalized epilepsy.


248-261 347

In June 2020, an online forum of experts on the use of perampanel in adolescents with epilepsy in everyday clinical practice was held. The main goal was to discuss the features of juvenile epilepsy, its diagnosis, the possibilities of using perampanel in this category of patients, and the effectiveness of using the drug in everyday clinical practice. The forum was attended by leading experts in neurology and epileptology. Current data on the epidemiology of epilepsy in the child and juvenile population were presented; the issues of difficulties and diagnostic errors were considered, as well as features of managing adolescents with epilepsy, adverse events of antiepileptic therapy, results of studies on the effectiveness of perampanel, and many social aspects of the life of patients in this category.


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