Epilepsy and paroxysmal conditions

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Vol 13, No 4 (2021)


318-324 809

Background. Over the two last years the novel coronavirus infection, COronaVIrus Disease 2019 (COVID-19), has become one of the urgent health and social problems. Reports on the SARS-CoV-2 neuroinvasiveness raise the question as to whether the infection could be related to an increased risk of seizure recurrence in patients with concomitant epilepsy and COVID-19.

Objective: to study the seizure dynamics in patients with epilepsy recovered after COVID-19 by analyzing clinical observations.

Material and methods. A single-center retrospective uncontrolled open-label observational study regarding an impact of COVID-19 on the course of epilepsy was performed. Patients with epilepsy recovered after COVID-19 were interviewed between January and February 2021 by using a questionnaire containing three sets of questions. The study included 13 patients suffering from COVID-19 along with epilepsy: 7 cases (54%) of genetic (idiopathic) generalised form, 6 cases (46%) of focal form. The mean age was 34.31±12.68 years.

Results. Seizure remission prior to COVID-19 was noted in 10 patients (77%), with no seizure control found in 3 cases (23%) of focal epilepsy at the time of COVID-19. No seizure frequency rise was observed in any case. No recurrent seizures were detected. Electroencephalographic follow-up showed no exacerbated seizures compared to the pre-infection parameters. Monotherapy with anti-epileptic drugs was used in 61% of cases. Levetiracetam monotherapy was administered to 50% of patients, and as a part of a polytherapy regimen – to 100%.

Conclusion. The research findings and literature data show that patients with epilepsy are not at greater risk than the general population. Young age, seizure remission, absence of somatic comorbidities, modern drug use with no interaction with antibiotics and antivirals for the coronavirus disease treatment can be considered as positive predictive value of the course of epilepsy with COVID-19. Further studies are required to be performed in a larger patient sample.

325-337 658

Background. Idiopathic generalized epilepsy (IGE) comprises 15–20% among all types of epilepsy. However, specifics of administration for lamotrigine in IGE in the Russian Federation remain poorly investigated, especially in female subjects.

Objective: to assess efficacy and potential adverse events (AEs) in girls and females with preserved childbearing potential and verified IGE upon initial treatment with lamotrigine, upon switching to lamotrigine from a first-antiepileptic drug (AED) that provided no full seizure control and/or was coupled to AEs, as well as while introducing lamotrigine as an adjunctive therapy in case a monotherapy achieved no therapeutic efficacy.

Material and methods. There were enrolled 54 female patients aged 4 to 40 years (mean age 19.3 years, median 11 years). After verifying IGE, patients received a monotherapy with lamotrigine. In case a patient received a first monotherapy course, but achieved no full seizure control and/or was coupled to AEs due to administered AED, lamotrigine was prescribed as a second AED followed by a potential for further switch to a second monotherapy.

Results. It was found that a first monotherapy resulted in the maximum remission rate in patients with isolated generalized tonic-clonic seizures. Lamotrigine efficiently suppressed EEG epiactivity, with observed EEG-remission in 8 out of 16 (50%) patients. While being administered as a second monotherapy, lamotrigine resulted in remission in 87.5% patients. A combination therapy with lamotrigine was required in 22 cases. Most commonly, it was combined with levetiracetam (15 patients). While administering a dual therapy with lamotrigine, remission was observed in 9 patients receiving basal therapy with this drug, as well as 3 and 1 patients receiving valproic acid and topiramate, respectively. Six more patients were observed to demonstrate more than 50% improvement (5 subjects in levetiracetam group and 1 in ethosuximide group).

Conclusions. The study demonstrated high efficacy of administered lamotrigine as a first monotherapy as well as a second monotherapy and a combination therapy in girls, adolescent girls and females with IGE. Lamotrigine resulted in no serious AEs that might lead to its cancellation.

339-348 341

Background. Neuronal and mixed neuronal-glial tumors are rare brain tumors that are most commonly observed in pediatric patients. The main clinical manifestations are presented by epilepsy substantially affecting child’s physical and neurocognitive development.

Objective: to assess short-term and long-term changes in seizure frequency and neurocognitive status in pediatric patients who underwent surgery for mixed neuronal-glial tumors.

Material and methods. Thirty-eight pediatric patients underwent surgery for mixed neuronal-glial tumors at the Almazov Research Medical Centre within the period from 2008 to 2018. All patients had comprehensive diagnostic examination including clinical neurological examination, neuroimaging tests, electroencephalography and electrocorticography before and after surgery. The postoperative changes in the seizures rate were assessed by using the 1993, 1996 Engel classification. Neurocognitive status was evaluated using The Child Behavior Checklist (a component of the Achenbach System of Empirically Based Assessment).

Results. During the postoperative period, 84% of patients were found to be seizure-free; 42.6% demonstrated no clinically relevant behavioral disturbances or social adaption issues after the surgery. However, 76% of children experienced poor concentration. In a long-term perspective, seizures reoccured in 25% of patients and were not associated with any magnetic resonance signs of tumor progression.

Conclusion. A gross total resection of the brain tumor was the main factor that affected changes over time in seizure rate. Assessment of long-term changes over time has shown that the patients tended to retain concentration difficulties, which should be taken into account while planning school education programs.

349-358 354

Background. The probability of seizures after endoscopic surgical treatment of hydrocephalus may comprise up to 9.5%, therefore accounting for a need to find solutions for alleviating the surgical trauma to the brain. One option to this problem might be based on using “seamless” neurosurgery, particularly endoscopes with a minimal outer sheath diameter (needle endoscopes, shunt endoscopes).

Objective: to evaluate major outcomes of surgically treated epilepsy, cerebral haemodynamics and electroencephalogram (EEG) in children with hydrocephalus and concomitant drug-resistant epilepsy before and after endoscopic ventriculocysternostomy of the third ventricular floor by using a semi-rigid needle endoscope.

Material and methods. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p<0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p<0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p<0.01), mean circulating blood volume by 22.4±5.27% (p<0.05) and decreased mean transit time by 12.8±2.5% (p<0.05).

Results. In the early and remote postoperative periods, no epileptic seizures were observed in 57.1% of subjects (Engel Class I). Mean seizure frequency decreased from 12.9±6.1 to 0.82±0.31 per month (p<0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p><0.01) were observed, as well as improvement of cerebral hemodynamics in the form of increased mean cerebral blood flow by 29.1±4.3% (p><0.01), mean circulating blood volume by ><0.01). A significant decline in slow-wave amplitude and the paroxysmal index from 19.1±2.5% to 6.9±1.7% (p<0.01), mean circulating blood volume by 22.4±5.27% (p<0.05) and decreased mean transit time by 12.8±2.5% (p><0.05).

359-366 437

Objective: to assess vitamin D deficiency and hyperhomocysteinemia along with psychoemotional status in patients with vestibular migraine.

Material and methods. The neurovestibular examination of 23 patients was performed. All patients were diagnosed with vestibular migraine in accordance with the international criteria. The levels of 25-hydroxyvitamin D and homocysteine were assessed by enzyme-linked immunosorbent assay (ELISA). The effect of dizziness on everyday life was assessed according to the Dizziness Handicap Inventory (DHI). Psychoemotional status was investigated for all patients by using the following scales: Beck depression scale, Spilber–Hanin Scale, Toronto Alexithymia Scale (TAS-26).

Results. The mean level of 25-hydroxyvitamin D was 23±15 ng/ml, homocysteine – 11±3.4 μmol/L. The mean levels of situational and personal anxiety were 48.8±9 and 50.4±10.8, respectively. A correlation analysis revealed a significant positive correlation for Beck's depression parameters and DHI score (Spearman's criterion value 0.64, p=0.0016).

Conclusion. The data obtained evidence about a rather frequent detection of 25-hydroxyvitamin D insufficiency and deficit among patients with vestibular migraine that requires further evaluation, including expanding patients sample and/or comparison with other groups of patients. Of significance was to find an elevated level of anxiety and a correlation between the severity of dizziness (according to DHI score) and the level of depression (based on the Beck Scale).


367-376 549

Background. Non-pharmacological methods of palliative therapy for structural focal epilepsy (SFE) have been extensively investigated. Development of self-care methods based on behavioral psychotherapy and reference bioadaptation is a promising and economically justified approach.

Objective: to present a clinical case of administering EpiTapp application based on the author-proposed wrist tapping method for palliative care in adult SFE.

Material and methods. The author-proposed method of wrist tapping (RF patent No. 2606489 of 01.10.2017) for a smartphone Android OS application was used. Wrist tapping was performed during the period of aura and/or focal seizures (FS) in patients with SFE. Patients used the smartphone application as an element of emergency palliative therapy for SFE outpatient settings.

Results. Patient L., 33 years old, suffering from SFE with frequent FS and bilateral seizures (BS), received duotherapy in the preoperative period. The woman used the EpiTapp application regularly that allowed to reduce FS rate by 65%, as well as prevent BS development without altering the antiepileptic therapy regimen.

Сonclusion. The experience of using the EpiTapp application based on the author-proposed method of wrist tapping has demonstrated that it holds promise for SFE palliative therapy. The proposed technique requires additional research to confirm its effectiveness.


377-392 591

According to 2019 statistics records, traumatic brain injuries (TBI) are the most common type of injuries and one of the main causes for disability in Russia. Every year 200 people per 10,000 subjects around the world suffer from serious brain injuries. Severe TBI can result in long-term disability. Posttraumatic epilepsy (PTE) is one of the most dramatic consequences of TBI with an estimated incidence rate ranging from 2% to 50% based on severity of injury. Conducting studies on PTE poses numerous challenges because epilepsy never develops in many patients with TBI or it may occur more than 10 years after TBI.

In this review, which includes data from studies conducted by Russian researchers, including us, and foreign colleagues over the last few years (mainly 2017–2022), we analyzed and generalized currently known risk factors, clinical and diagnostic features of PTE in order to increase the awareness about modern methods of laboratory and instrumental diagnostics related to this disease (including electroencephalography and routine/special neuroimaging techniques that allow to identify PTE biomarkers). We also aimed to promote development of preventive strategies for patient management. It has been proved that no clear algorithms for PTE diagnostics and treatment are currently available, which often leads to insufficient patient care.


393-398 428

On September 25, 2021, the Russian League Against Epilepsy (RLAE) Working Group Meeting was held regarding approaches to therapy of pediatric focal epilepsy. Considering the experience of the world medical community and Russian epileptologists, the participants discussed issues related to administering diverse anti-epilepsy agents in this patient cohort. It was noted that an ideal therapy might provide rapid and long-lasting seizure control, few side effects, low potential of drug interaction, good compliance and adherence to therapy, and no effects on course of comorbidities. The article presents the Resolution of the RLAE Working Group Meeting that was approved after discussion.


400-403 329

The letter raises the issue of myths existing among the general population about the harmfulness of synthetic medicines. The problems of drug provision, the lack of vital antiepileptic drugs on sale, frequent changes in the prescription forms are touched upon. The reasons for the low efficiency of domestic generics are indicated, an inconvenient form of their release is noted. The author emphasizes how important it is for a doctor to take into account the individual characteristics of a patient when choosing drug therapy.

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