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Epilepsia and paroxysmal conditions

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Vol 6, No 4 (2014)

DISTINCTIVE ARTICLES

6-14 107
Abstract
Abstract: this paper presents the results of therapeutic drug monitoring (TDM) of anticonvulsants – valproats and carbamazepins. Analysis include 800 patients with epilepsy in clinical practices, who received monotherapy and drug combinations. We determine plasma concentrations in two points: Cmin – before use next dose and Cmax – after next dose; concentration range for valproats – 50-150 mg/l, for carbamazepin – 4-12 mg/l. Plasma concentrations of valproats was statistically low in combination with carbamazepins than in monotherapy: Cmin 44,1±1,4 versus 62.1±2.0 (р<0,001) и Cmax 57.6±1.9 versus 76.5±2.4, without differences in daily doses. The frequency of achievement the therapeutic concentrations of valproats on valproat/carbamazepin combination was 34% versus 67% in monotherapy as result of inducing metabolism valproate acid by carbamazepin. For carbamazepin there was tendency for high frequency of achievement the therapeutic concentrations on combination treatment than on monotherapy – 86% versus 75.9%, but the doses of carbamazepin were also higher in combination therapy. However, plasma concentrations of carbamazepin were statistically higher only in combinations with other anticonvulsants exclude valproats: Cmin 8.0±0.2 versus 6.1±0.16 и Cmax 9.4±0.2 versus 7.3±0.18 (р<0,001) in monotherapy. The frequency of achievement the therapeutic concentrations for valproats and carbamazepin simultaneously in combination therapy was only 28.5%. This demonstrate the level of drug interactions in combination therapy of epilepcy especially with valproats and carbamazepin.
16-22 103
Abstract
Abstract: the aim of our research was assessment of the cumulative risk of disorders of metabolism of folic acid in the development of the congenital defect fetus (CDF) in women with epilepsy and receiving antiepileptic drugs (AEDs). Materials and Methods: the study included 124 cases of pregnancy. Results: 54.7% of the daily doses of AEDs exceeded teratogenic levels; at 4.9% - registered the CDF. In 57.1% cases - the CDF associated with hereditary metabolic disorders of folic acid. Conclusions. Women which receive AEDs and have hereditary metabolic disorders of metabolism of folic acid are at increased risk group of developing congenital malformations.

CLINICAL CASES

23-28 122
Abstract
Abstract: prescription of Levetinol in regimen of integrated adjunctive therapy in 30 patients with symptomatic and cryptogenic focal forms of epilepsy with poorly controlled seizures, receiving the reference probe of antiepileptic drugs, was accompanied by the attainment of a higher therapeutic effect. Remission with an average effective dose of the drug 1437.5 mg/day was observed in 6, reduction of attacks by 75% – in 8 patients. Levetinol significantly affect the indicators of anxiety and depression in the reduction of symptoms of affective disorders.

FORUM MATERIALS

31-36 75
Abstract
Abstract: this article discusses the unique features of the structural-functional organization of the visual distance perception which in contrast to other distant sensory systems has not only afferent but also efferent part – the frontal visual field and, smooth and stripy muscles of the eye which accordingly service of the visual function. The article shows the increasing importance of the efferent part of the visual system in the present conditions of real and virtual movements of visual objects. The case of photosensitivity in epilepsy proves the fact that the efferent part of the visual system can react in a protective way to the rhythmic photo-stimulation.
37-45 110
Abstract
Abstract: ambulatory or Holter EEG (AMEEG) are the prolonged record EEG and number of polygraphist indices under the natural conditions of the behavior of man during the active, wakefulness and the sleep. Its role in the clinical practice is thus far insufficiently studied. Purpose of the work to generalize the experience of the application of long-term monitoring EEG in the neurologic practice and to show his possibility and limitations. In the work shown its value for the clinical practice on the basis of the generalization of the experience of conducting AMEEG in the Research Center of neurology. We generalized the experience of the examiner of 354 patients with the aid of AMEEG with a duration of inspection of from 3 to 24 h. Of 354 patients in 231 was conducted ambulatory monitoring, in 58 – ward monitoring EEG, in 65 reanimation monitoring EEG and polygraphist indices in resuscitation or ward of intensive care. The inspection of patients was carried out with the aid of the compact EEG- recording “Ensefalan-EEGR-19/26” of Medicom-MTD firm (Taganrog). It is shown in the concrete examples, that the ambulatory monitoring EEG considerably enlarges the possibilities of inspection EEG and poligraphic indices and it makes it possible to obtain new information about the state of the brain. In diagnostics of epilepsy, with differential diagnostics of the epileptic and non epileptic forms of paroxysm, and prolonged monitoring makes it possible to improve diagnostics. Under resuscitation conditions the monitoring EEG makes it possible to more fully reveal changes in patients, who be in a reactive (critical) state; during the ward monitoring of – to answer the number of the questions, connected with the differential-diagnostic tasks, which appear in the neurologic practice. With the aid of AMEEG it is sufficiently easy to carry out polisomnografic research, without resorting to the bulky systems (they are not necessary special ward, the expensive equipment).
46-49 134
Abstract
Abstract: the primary tasks of the current stage in the therapy of epilepsies and epileptic syndromes are: the widespread introduction of new antiepileptic drugs with innovative mechanisms of action on the "target" pathological epileptic systems; the use of new AEDs, not only as additional therapy of drug-resistant epilepsies, but possibly more rapid transition to new forms of drugs at the early stages of ineffective treatment baseline probes.
50-54 105
Abstract
Abstract: were investigated 79 children with consequences of secondary encephalitis, 41 of them with symptomatic epilepsy and 38 without seizures. Was revealed most significant risk factors of symptomatic epilepsy, where importance ones was unfavorable perinatal background and hereditary fatality of children by epileptic conditions and psychological diseases.
55-61 83
Abstract
Abstract: the selection principles for antiepileptic drugs choice for the initial treatment of partial seizures in epileptic patients with newly diagnosed or untreated epilepsy are discussed; evidence-based criteria and opportunities of the personalized therapy of AED therapy are argued in the review.
62-66 81
Abstract
Abstract: the article presents a discussion of the problem of rational polytherapy (RPT). RPT has become one of the main strategies of modern epilepsy treatment. Early using of the RPT is a tactic of choice for patients with high risk for pharmacoresistant epilepsy (EDF) and for patients with risk of problems that can occur while switching to alternative monotherapy. For early RPT a seizure control can be achieved more quick. That reduces the risks associated with seizures for patients with severe epilepsy. AEDs choice for the RPT should be based on the prevention of the pharmacodynamic and pharmacokinetic side effects. But efficacy data of AEDs in clinical practice should be taking into account.
67-71 88
Abstract
Abstract: there were significant increase in the values of the evening melatonin excretion in the spring of the year compared to the autumn. In patients with epilepsy, nocturnal seizures, nocturnal melatonin excretion two times lower than in patients with daytime seizures. In the spring, the evening excretion increased COMT 6; concentration morning urinary 6-COMT higher with anticonvulsant therapy with valproic acid compared with carbamazepine.
72-76 81
Abstract
Abstract: symptomatic epilepsy remains a difficult problem for the diagnosis and effective treatment. The main epidemiological indicators of symptomatic epilepsies, methods of diagnosis and semiotics attacks, aspects of the therapy probe and combined treatment with primenenie months were studied.
79-82 78
Abstract
Abstract: this article reveals the variants of epilepsy drug-resistance formation in children. Particular attention is paid to perinatal brain pathology, which is often a consequence of focal and global ischemia. Neonatal seizures considered by the authors as predominantly symptomatic, leading eventually to the intractable epilepsy.


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