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Epilepsy and paroxysmal conditions

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Vol 13, No 1 (2021)

EDITOR-IN-CHIEF MESSAGE 

ORIGINAL ARTICLES 

6-20 173
Abstract

Objective: to assess the status of the epileptological service in Russia by conducting a questionnaire survey of epileptologists working in different regions of the Russian Federation.
Material and methods. To assess the structure and mechanisms of the antiepileptic service in the Russian Federation, The Russian League Against Epilepsy (RLAE) offered a questionnaire to 63 epileptologists, among which answers were provided by 37 subjects from 28 regions of the country. The questionnaire data are presented as diagrams and expressed as a percentage.
Results. The analysis of data obtained allows to assess differences in the structure of the epileptological service in diverse regions of Russia, the level of care transition and interaction between outpatient and inpatient specialists, specialists in various fields as well as those involved in the scientific and practical fields of healthcare. Besides, it has also started to shape insight into further development of epileptological service in Russia envisioned by practicing epileptologists.
Conclusion. A feedback from geographic regions is an ultimate goal posed by the Russian League Against Epilepsy. It is necessary to continue involve medical specialists in diverse regions to cooperate and develop new types of collaboration.

21-32 205
Abstract

Introduction. Video-electroencephalography (EEG) monitoring (VEEGM) is an indispensable functional method in epileptology. However, virtually no trials on assessing efficacy of antiepileptic drugs (AED) by using VEEGM are available.
Objective: to improve efficacy of EEG-diagnostics and evaluate the epileptiform activity index (EAI) in newly-diagnosed idiopathic generalized epilepsy in adult patients receiving  alproic acid and levetiracetam.
Material and methods. T here w ere e nrolled 130 p atients: 6 0 (46.2%) m ales a nd 7 0 (53.8%) f emales w ith n ewlydiagnosed
idiopathic generalized epilepsy (IGE), aged 22.51±8.9 years. All patients underwent VEEGM with quantitative EAI analysis at baseline visit and 1 3, 6 and 12 months later after treatment. Each seizure episode developed during the VEEGM study were assessed for type, time of seizure onset, relation to wake-sleep cycle, duration, ictal EEG pattern followed by diagnosing epileptic syndrome. Valproic acid and levetiracetam were used for initial therapy in groups per 65 patients in each. Treatment efficacy was assessed using parameters such as retention on therapy, absence of seizures, decrease of seizure frequency by >50%, decrease of seizure frequency by <50% – insufficient efficacy.
Results. It was found that seizures during baseline VEEGM were recorded in 43.1% (n=56) patients, who were assigned to group 1, whereas remaining 74 (56.9%) patients were assigned to group 2. EAI was significantly higher in patients with seizures recoded at baseline VEEGM, compared to those lacking seizure episodes during initial VEEGM (p<0,001), mean EAI was also higher in group I at second (p<0.001) and third (p<0.001) visits. EAI magnitude at 6 and 12 months of study became virtually comparable in all groups and did not depend on AED prescribed. Treatment efficacy was higher in patients with IGE, with no  eizures recorded during the initial VEEGM.

Conclusion. Long-term VEEGM allows unbiased assessment of treatment dynamics based on EAI analysis. The first 6 months of initial treatment titration in represent most crucial period for patients with newly-diagnosed IGE.

CLINICAL CASES 

33-43 162
Abstract

Focal cortical dysplasia (FCD) is one of the most common causes in developing pharmacoresistant epilepsy. We present the clinical case of the patient with generalized seizures. Routine electroencephalography (EEG) data registered diffuse epileptiform activity that allowed to diagnose genetic  eneralized epilepsy and pharmacoresistant course of seizures.
After performing magnetic resonance imaging using the epileptological program and video-EEG-monitoring, the diagnosis was revised: structural focal epilepsy with seizures with  focal onset with oroalimentary, gesture automatisms in the right hand, bilateral tonic-clonic, uncompensated by levetiracetam monotherapy (1500 mg/day). Background disease: congenital  malformation of the brain: FCD in the basal parts of the left temporal lobe. Lacosamide was added to the therapy in the drug dose 300 mg/day, and the frequency of epileptic seizures decreased. Differential diagnosis between genetic generalized  epilepsy and structural epilepsy with FCD usually poses no  obstacles. However, in some cases, structural epilepsy occurs  under the “mask” of generalized epilepsy. Hence, this clinical  case demonstrates the importance of diagnostic measures in the  differential diagnostics of various forms of epilepsy to determine  further tactics of patient management. 

44-50 111
Abstract

We present the clinical case of patient with epilepsy, developmental retardation and hearing loss. The whole exome sequencing allowed to reveal compound heterozygous variants  of the nucleotide sequence in SPATA5 gene (c.1714+1G>A, c.1678G>A). Mutations in the SPATA5 gene have been described  in patients with epilepsy, hearing loss and mental retardation  syndrome (MIM 616577). Paired parents were carriers of one  heterozygous gene variant. Such mutations lead to the  development of epileptic disorders in 3% of cases, and should be  considered in patients not only as a possible cause of  neurodegenerative diseases, but also leading to pathology with  clinical manifestations mimicking mitochondrial disease. 

SCIENTIFIC SURVEYS 

51-64 315
Abstract

Patients with epilepsy may require a neurorehabilitation aid particularly due to developing motor alterations related to stroke, sequelae of traumatic brain injury, multiple sclerosis and  other brain damage. Modern neurorehabilitation approaches  directly or indirectly affect neuroplastic processes altering cerebral cortex excitability, stimulate the afferentation systems,  and result in fatigue and may act as factors provoking seizures or  aggravated epilepsy. In addition, developing seizures may  temporarily coincide but unrelated to the neurorehabilitation  activities: e.g., while omitting antiepileptic drug administration,  sleep deprivation or long-term stress occurring to patient etc. Here we present a review on recent studies aimed at  investigating epilepsy triggers by aligning them with the factors  of interventions used in motor rehabilitation. We also emphasize  the safety data for routine use of the main neurorehabilitation methods as well as propose actions to reduce the risk of developing epileptic seizure.

65-82 139
Abstract

Acute symptomatic epileptic seizures are one of the complications of hematopoietic stem cell transplantation. The etiological factors leading to the development of this complication differ from those in the general population, while the significance of each of them is different depending on the time after transplantation. We analyze the literature data on the role of drugs, metabolic disorders and infectious complications, as well as the structural pathology of the brain substance in the development of acute symptomatic seizures in patients with oncohematological pathology. We also consider the clinical features of symptomatic epileptic seizures and the possible prognostic significance of their development in patients who underwent hematopoietic stem cell transplantation.

DISCUSSION 

83-84 104
Abstract

In order of discussion, the Editor-in-Chief of the journal Epilepsy and Paroxysmal Conditions expresses his opinion on the article,  published in No. 4, 2020.

ANNIVERSARY 



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