Epilepsy and paroxysmal conditions

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Vol 6, No 1 (2014)


27-33 443
Abstract: the efficacy and tolerability of adjunctive perampanel (PER) in refractory partial epilepsy in Russian adolescents has been investigated. It was the part of three international (global) randomized placebo-controlled prospective phase III trials with prolonged open follow–up phase. Materials and methods: 26 patients with refractory partial seizures (both secondarily generalized and without generalization) aged from 12 to 18 years were included. All of them were unsuccessfully pretreated with 1-3 antiepileptic drugs. They were randomizes either to placebo or to 2, 4, 8, 12 mg of PER daily respectively. After completing the double blind phase they were transferred to open extention phase with titration of daily dose of PER up to 12 mg. Results: PER in doses of 4, 8, and 12 mg/day provided reductions in the frequency of partial-onset seizures compared with placebo – 17.24%, 4.51%, и – 24.89% respectively. Efficaсy became more evident in open phase of the trial – at 78th week of the trial all patients – 23/23 (100%) responded to the treatment with PER (had reduction in seizure frequency 50% and more), proving that efficaсy outcomes may be maintained with long-term treatment. PER was effective in al types of partial seizures, especially in secondarily generalized ones. Adverse events (AEs) were seen in 8/26 (47.1%) of patients receiving PER versus 4/9 (44,4%). The incidence of AEs in open phase was 16/23 (69.6%). The most common AEs (≤ 11,8%) were dizziness, somnolence, aggression. The majority of them were mild or moderate in intensity. There were no clinically important changes in vital signs, ECG measures, or biochemical or hematologic parameters. Conclusion: in adolescents with refractory partial epilepsy PER appeared to be a promising new antiepileptic drug with a new mode of action and unique pharmacological profile.
6-14 431

Abstract: an article presented the data on application of autologous multipotent mesenchymal stem cells (MMSCs) from bone marrow for therapy of 10 patients suffering from drug-resistant symptomatic epilepsy. Intravenous injection of 40.0-101.0Ч106 (mean 68.2± 8,48Ч106) MMSCs endolumbal injection of 2.7-8.0Ч106 (mean 6.34±0.72Ч106) neuroinduced MMSCs did non induced in patients unfovarable reactions an complications. Moreover, during 3-11 months of monitoring 5 of 10 patients demonstrated decrease the frequency or disappearance of seizures, severity the incidence of seizures. 2 patients demonstrated increase of cognitive functions, 2 patients – decrease the level of anxiety. We concluded that application of MMSC-base cellular therapy id safe and enable to facilitate seizure status in patients with drug-resistant symptomatic epilepsy. 

34-43 683
Abstract: we present the experience of applying the methods of non-drug treatment drug-resistant epilepsy in children. These include surgery, ketogenic diet and chronic vagus nerve stimulation (VNS therapy). Methods. We observed 118 patients with refractory epilepsy. As a result of a comprehensive survey 46 patients became candidates for surgical treatment, VNS stimulator implanted in 17 patients, and the ketogenic diet recommended for 50 patients. Results. Surgical treatment showed the highest efficiency: the complete elimination of seizures (100%) was observed in 28 (61%) patients, reducing the number of seizures of >75% was observed in 1 (2%), >50% in 5 (11%) and <50 % in 12 (26%) patients. Efficiency of a ketogenic diet conceded to surgery: 100 % reduction of seizures observed in 9 (18%) patients, >75% in 10 (20%), >50 % in 4 (8%) and <50% in 27 (54%) patients. VNS stimulation, as well as the ketogenic diet was less effective compared with surgical treatment: 100% effect was observed in 3 (17.5%) patients, reducing the seizures of >75% in 2 (12%), >50 % in 17 (15%) and <50 % in 43 (38%) patients. Conclusions. The most effective and radical treatment of refractory epilepsy is surgery in comparing with the ketogenic diet and VNS stimulation. The overall efficiency of these treatments (seizure reducing more than 50%) was observed in 70 patients, representing 62% of the total. Thus, an integrated approach in the treatment of refractory epilepsy allows to achieve a positive effect in significant number of cases.
15-18 398
Abstract: the characteristics of some immunological Features were studied in 52 patients with epilepsy. The group of control included 10 healthy subjects of the comparable age.There were studied such immunological aspects in this group of patients as level of neurotropic autoantibodies to NF-200, GPAP, S100, common protein of myelin, Voltage-dependent Ca canals, glutamate receptors, GAMK-, Dofamine, Serotonin and N-choline-receptors.Neuroimmune reorganizing in epilepsy is accompanied by increase in autoantibodies to receptors of GAML, dofamine and borderline deviations to protein B2 glycoprotein. However, more reliableparameters in relation to indicators of control group there were noted in the contents of autoantibodies to such neurospecific proteins as: NF-200, S100 and to two-spiral DNA. This indicated about degenerative disorders of axonal type in the brain of the patients with epilepsy.
44-48 433
Abstract: idiopathic occipital epilepsy , not uncommon in practice, pediatric neurologist . According to Panayiotopoulos , they are found in 30% of cases of idiopathic epilepsy (25 % – Panayiotopoulosao syndrome, 4% – Gastaut type ). Particular difficulty is the abundance of autonomous symptoms, the presence of transitional forms of epilepsy, the combination of migraine , which has age-appropriate. In addition, the child s brain is different excitability and registration abnormalities in the EEG is not casuistry . We have provided supervision for children with occipital epilepsy and EEG changes in the occipital region, clinical and medical history characteristics of this group and outcome monitoring for 5-7 years.
19-26 425

Abstract: the data of analysis of probable anticonvulsive mechanisms of repetitive transcranial magnetic stimulation (rTMS) are presented on the article. The analysis bases on review of scientific publications and proper researches. Clinical, neurophysiological and neurovisualization predictors of complex therapy with rTMS course effectivity are interpreted what permit to prognoses the outcomes of new technology using and lead stimulation with reliable result of effectivity. 

49-56 388
Abstract: Purpose of the study is аssessment of changes in the peripheral blood parameters and immune status of patients with chronic herpes infection without and with symptomatic (parainfection) focal epilepsy. Materials and Metods. the study included 128 adults. Group 1 – control (40 pers.; median age – 31 ye.o., 2 group – patients with chronic herpes virus infection without symptomatic focal epilepsy (43 pers.; median age – 35 ye.o.). 3 group – patients with chronic herpes virus infection complicated by symptomatic focal epilepsy (45 pers.; median age – 32 ye.o.). Volume of research: history of the disease, epidemiological history, neurological examination, video-EEG monitoring, MRI, MR-spectroscopy, immune status, serology, immunologist consultation. Results. The analysis of immune status of the patients with chronic herpes infection has shown significant differences between the studied parameters compared with the control group, as well as comparisons between groups. We were shown lymphocytosis, imbalance of immunoregulatory subpopulations, reducing the immunoregulatory index. Serological studies in patients 2 and 3 groups of 100% of the cases were shown specific G class antibodies to HSV, a high titer of antibodies found in patients 2 groups accession symptomatic focal epilepsy, p <0.01. Also, the study was shown a reduce of Ig A level in groups 2 and 3 compared with the control. Statistically significantly more frequently in patients two groups met chronic recurrent herpesvirus mixed infection. Conclusions. The patients with chronic herpes infection with symptomatic focal epilepsy revealed more serious violations in the humoral and cellular immunity, adversely affecting the formation of specific antiviral response. This testifies to the prolonged course of infection , which is a predictor of high risk of forming refractory symptomatic (parainfection ) focal epilepsy.
57-63 1411
Abstract: the article present the literature data on clinical, EEG characteristics of benign occipital epilepsy of childhood with early debut – Panayiotopoulos syndrome, and the results of own research group of patients with this form of idiopathic epilepsy. The article contains the case report of a 5 years-old girl with combination Panayiotopoulos syndrome and a structural pathology of the brain by neuroimaging data. In conclusion the authors provide recommendations for diagnosis and treatment of Panayiotopoulos syndrome that may be useful for pediatric neurologist in everyday practice.


64-69 1089
Abstract: this article represents review of literature devoted to a new antiepileptic drug Zonegran (zonisamide, ZNS). History of successful clinical use of ZNS in world practice lasts for 25 years. Zonisamide is on the Russian market from 2014 and is approved for monotherapy and adjunctive therapy of partial seizures with or without secondary generalization. This review is based on principles of evidence based medicine. Data of ZNS mechanism of action and pharmacokinetics are considered. Results of the most significant studies of ZNS efficacy and tolerability in drug-resistant focal epilepsy in adults and children in adjunctive and monotherapy regimes are presented. Possibilities of clinical use of ZNS in treatment of concomitant diseases are considered.
70-84 664
Abstract: altered permeability of the blood-brain  barrier (BBB) plays a key role in the pathogenesis of epilepsy as well as vascular, demyelinating, neurodegenerative central neural system (CNS) diseases, head injury, hypoxic-ischemic CNS damage in obstetric practice, and other common disorders.  The understanding  of functions, transport  mechanisms and mechanisms of damage  of the BBB in pathologic  settings  would allow determining  promising  ways to improve the efficacy of current diagnostics  and treatment  options.  The review article describes  brain-to-blood  and blood-to-brain  transport  and presents four main mechanisms of transcellular  transport  of bioactive substances via the BBB: simple diffusion, carrier-mediated diffusion, carrier-mediated  transport  (liquid endocytosis,  receptor-mediated  endocytosis,  absorption-mediated  transport) and efflux transport.  Our knowledge of mechanisms of BBB damage  are limited to three main types (dehiscence  of 'tight junctions' between endothelial cells, toxic damage of the membrane structures of astrocytes  and endotelial cells, and physical destruction  of the BBB). Detailed descriptions  are provided of specific features of the BBB damage associated with various pathologies – hypoxic-ischemic CNS damage, inflammation, pain, toxic exposure, tumor growth, etc. This allows to rationalize the need for objective assessment of the BBB and neural tissue condition by detecting neurospecific proteins in blood serum to choose adequate approach to treatment and rehabilitation.
85-90 873
Abstract: the article presents a review of world literature on significance of various clinical lateralizing signs in temporal lobe epilepsy, such as dystonic posturing, limb automatisms, ictal and postictal aphasia, ictal nystagmus, head turning, periiktal headache, etc. The results of current research are compared with previously published reports. The ictal dystonic unilateral limb posturing (possibly isolated in a hand, foot, predominantly in distal parts of limbs) is still one of the most informative lateralizing signs and it is lateralized in contralateral hemisphere in 100% of cases. It is shown that the “early” and “late” head turning, and unilateral limb automatisms are the most important and convincing lateralizing signs, which must be considered in connection with the EEG data to determine the epileptogenic focus in patients with temporal lobe epilepsy.

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