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Epilepsy and paroxysmal conditions

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Vol 14, No 1 (2022)

EDITOR-IN-CHIEF MESSAGES 

ORIGINAL ARTICLES 

8-14 248
Abstract

Objective: to compare the  methods of electroencephalography (EEG) and  amplitude-integrated electroencephalography (aEEG), related technical features, their clinical application in newborns  at the intensive care unit, as well as a correlation between aEEG and other diagnostic methods (neurological status, neurosonography).

Material and methods. Fifty-two newborns were examined who mainly born at full-term or had an initial degree of prematurity. In 29 infants, seizures were recorded, which were noted 1–5 times. An EEG was performed  within 107.7±32.7 minutes followed by further software aEEG processing.

Results. While analyzing aEEG, significant differences were found among the indices of delta 2 activity denoted as a percentage in premature vs. full-term infants relative to other rhythms. It was shown that prevalence of high-amplitude delta 2 activity throughout entire recording presented as percentage was higher in infants with vs. without seizures.

Conclusion. It was demonstrated that aEEG clarifies and supplements the data obtained with routine EEG, and can be used not only for conducting continuous monitoring of neonatal brain functions, but also as an additional program to a standard EEG study. The method has a great potential for specifying diagnosis and further neonatal neurological support at intensive care units.

15-27 507
Abstract

Objective: to study the effect of perampanel on the dynamics of epileptic seizures and anxiety in patients with brain metastases and epileptic seizures during chemotherapy (CT), radiotherapy (RT), and radiochemotherapy  (RCT).

Material and methods. The prospective clinical study included 48 patients with lung cancer and 39 women with breast cancer who underwent removal of primary focus.  After CT, RT or RCT epileptic seizures  were registered.  Brain metastases were revealed at brain magnetic  resonance imaging data. All patients underwent general and neurological examination as well as electroencephalography. The level of anxiety was assessed by the Beck Anxiety Inventory. Рatients were prescribed perampanel by the concilium decision.

Results. It was shown that administered perampanel was effective in any primary tumor location. The quantity of repeated epileptic seizures in all patients with lung and breast metastatic cancer was significantly decreased on Day 6–7 after adding perampanel to either earlier received antiepileptic drugs or as a monotherapy (p=0.0431).  In the follow-up period with the median survival rate of 8–13 months, the frequency of epileptic seizures was decreased and then remained stable. Perampanel as mono- or multitherapy positively influenced on controlling anxiety disorders in 25–75% patients with brain metastases.The level of anxiety was decreased due to lowered epileptic activity.

Conclusion. Based on the study results, we could recommend administration of perampanel for the treatment of metastatic brain cancers in patients with diverse primary tumors as well as both partial and generalized epileptic seizures while applying CT, RT, RCT or palliative care.

CLINICAL CASES 

28-36 704
Abstract

Myoclonic epilepsy with ragged  red fibers (MERRF) is a maternally inherited disease characterized by myoclonic epilepsy, cerebellar ataxia and progressive muscle weakness. Development of the disease is associated with the most common  (90% of cases)  point mutation at position 8344 in the mitochondrial lysine transport RNA gene – MTTLys. The disease diagnostics causes  certain difficulties due to the insufficient awareness of this pathology and polymorphism of clinical manifestations. The article presents a brief review of the literature data on current views on the disease pathogenesis, diagnostic methods and opportunities for drug treatment, and describes a clinical observation of a 7-year-old child with MERRF syndrome caused by a point  mutation  at position 8344  in the MTTLys gene.  The girl was under dynamic  supervision  at the neuropsychiatric department.  A comprehensive clinical, laboratory and instrumental examination was carried out that also included molecular genetic testing. The progredient progression and multiple symptoms of the disease, slightly increased lactate acidosis in the absence of typical neuroimaging and electromyographic changes are of interest in the observation, thereby confirming they might not necessarily be observed in MERRF. Intrafamily clinical diversity was noted in the absence of signs of the disease in paired mother.  A highly informative  method of MERRF diagnostics is provided by molecular genetic testing. Establishing a genetic diagnosis underlies a need for conducting medical and genetic counseling for family planning to prevent the re-birth of other sick siblings inheriting this pathology.

37-47 1814
Abstract

The article presents a case  report, and a literature review on benign epileptiform  discharges of childhood (BEDC) as well as effect of this type of epileptiform activity on speech, behavior and communication skills are analyzed. The incidence of BEDC comprises 5% in pediatric population.  Examining children with autistic spectrum disorder, BEDC is revealed  in 20% cases, whereas  in those with attention deficit and hyperactivity disorder  (ADHD) or speech  disorder  – in 25% and 18% cases, respectively.  Many studies  considering BEDC as  a  genetic marker of  brain immaturity highlighted by  different level of expressiveness and penetrance are discussed. It is highly probable that cognitive and speech disorders as well as ADHD in children with BEDC may be genetically determined. However, pediatric BEDC may be asymptomatic or become  manifested by diverse psychoneurological symptoms accounted for by developed epileptic encephalopathy and continuous spike and waves during slow wave sleep (CSWS)  requiring specialized long-term treatment. Markedly elevated  CSWS with morphological BEDC affects interneuron connections, which, in turn, alters memory consolidation in mesial temporal regions. The literature analysis  revealed  that children  with BEDC-like epileptic activity require obligatory periodic sleep electroencephalographic control  and dynamic  neuropsychological  evaluation due to  high incidence  of speech, mnestic  and behavioral disorders. Seizure-free BEDC-like epileptic activity should be corrected pharmaceutically only in case  of established  causative link with progressive cognitive impairments.

48-53 281
Abstract

The insight into the Norrie disease viewed from neurology perspective and clinical case of refractory epilepsy relevant to the disease are considered. Epilepsy rarely accompanies Norrie disease. The dynamics of changes  in electroencephalograms (EEG) and types of epileptic seizures during the disease progression as well as depending on the therapy received in the clinical case is analyzed. It is relevant for patients with Norrie disease to regularly undergo video-EEG monitoring to detect epileptiform activity, ictal patterns for timely diagnostics of epilepsy followed by prescribing  proper therapy to improve quality of life.

SCIENTIFIC SURVEYS 

54-64 1146
Abstract

Hysterectomy currently occupies one of the leading places among obstetric and gynecological surgeries and is one of the highly effective and sometimes the only method of treating various diseases of the female genital organs.  Quite often, however, hysterectomy results not only in the elimination of the cause of disease, but also in the development of complications that reduce the quality of life of patients. More and more attention is being paid to neurological complications, which is obviously due to improved diagnostic capabilities, as well as the results of recent research on the pathogenesis and treatment of neurological disorders. Only recently the scientists have begun to think about the true causes  of one of the most important neurologic complications of hysterectomy, namely chronic postoperative pain.

The review describes in detail the main neurological disorders that develop after hysterectomy: chronic postoperative pain, traumatic neuroma, residual ovarian syndrome  as possible causes of chronic pain, mononeuropathies, sexual and sleep disorders, decreased cognitive and motor functions, lower  urinary tract and bowel dysfunction.  Considerable  attention is given to the mechanisms of neurological complications and the relationship between the surgery and emotional disturbances in women.

65-73 286
Abstract

Objective: to demonstrate  the mutual influence  of  the quality of  patients’s life  during  epilepsy, adherence  to received anticonvulsant therapy and retention on therapy.

Material and methods. We conducted an analytical review of studies published by foreign authors in recent years (published within 2016–2021  were considered of top priority), devoted to the influence of various factors on adherence to therapy in patients with epilepsy. A search for relevant publications was conducted in English-language databases (PubMed/MEDLINE, ClinicalKey) by using key words and phrases: “epilepsy AND quality of life AND adherence  to therapy”, “epilepsy AND quality of life AND retention on  therapy”,  “epilepsy AND adherence   to therapy”, “compliance AND epilepsy  AND quality of  life”, “adherence to therapy AND retention on therapy AND epilepsy”, “nonadherence to therapy AND epilepsy  AND quality of life”. After the selection procedure, 22 scientific publications were included in the review.

Results. Factors that have a negative impact on adherence  to therapy have been identified (comorbid cognitive impairment, the combination of lack of control over seizures and the presence of adverse events after drug administration, depression and anxiety, the need to change the lifestyle for taking the drug, concern about the potential negative consequences of taking the drug, recent uncontrolled seizures, lack of professional implementation, high frequency of taking the drug, problems with doctor-patient relationship, insufficient social support), and factors that have a positive impact (emotional support from the doctor, establishing doctor-patient partnership).

Conclusion. There is a relationship between the patient's quality of life and adherence  to therapy. Patient adherence to therapy is important for the effectiveness of epilepsy treatment and, along with the severity of epilepsy, is a significant factor affecting the quality of patients’ life during epilepsy. An opportunity for long-term retention on anticonvulsant therapy also has a cross-correlation with quality of life.

74-90 641
Abstract

Investigation of autoimmune epilepsy (AIE) has been attracting increasingly more attention due to discovery of neuronal antibodies and improved understanding of the mechanisms related to such immune-mediated syndromes. The review is aimed at autoimmune epilepsy taking into account up-to-date advances  in exploring its pathophysiology. Definitions related to this issue are outlined, and pathogenetic mechanisms, features of antineuronal antibodies as well as AIE clinical picture based on type of autoantibodies, are considered. The necessity of regular monitoring patients with AIE is indicated, preferably by an epileptologist  together  with a neuroimmunologist.  With prolonged  follow-up,  chronic  pharmacoresistant  epilepsy persists in some  patients, despite aggressive immunotherapy and antiepileptic drugs. With a deeper understanding of the mechanisms of antibody-mediated and autoantigen-specific T-cell-mediated AIE syndromes, the use of antiepileptic drugs and immunotherapy can be further optimized.

DISCUSSION 

91-95 341
Abstract

According to the new classification of the epilepsies proposed in 2017 by The International League Against Epilepsy, idiopathic epilepsies  are recommended to refer  to genetic epilepsy,  suggesting to consider  the term “idiopathic” as outdated. In connection with this, a tendency arose to refer forms of epilepsy previously called “idiopathic” as genetic epilepsy. However, idiopathic  epilepsy  constitutes  just a part among  genetic epilepsies. The other  groups resulting from  this etiology are monogenic  epilepsies  (e.g., Dravet syndrome)  as  well as  symptomatic  epilepsies  due to  other  genetically  determined syndromes (e.g., biotinidase deficiency or neuronal ceroid lipofuscinosis). The distinction between the three groups comprising genetic epilepsy is important not only due to difference in related etiology and course, but also because specific treatment in some monogenic forms might be possible. Here, the major  criteria for distinguishing between such epilepsy groups are presented.



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