Neurology, Neuropsychiatry, Psychosomatics

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Vol 4, No 1S (2012): Special issue "Epilepsy"


4-9 625

Epileptic aura (EA) is a short focal epileptic seizure accompanied by a patient's subjective feelings in the presence of preserved consciousness. The study covered 88 patients who were found to have different types of epileptic auras. It analyzed the clinical, electroencephalographic, and neuroimaging features of epileptic auras and their prevalence in patients with focal forms of epilepsy. A scenario is given for video-assisted electroencephalographic monitoring for suspected EA.

10-14 993

Objective: to study the clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy.
Patients and methods. The manifestations of the dВjЕ vu phenomenon were compared in 154 examinees in two groups: 1) 139 healthy individuals and 2) 25 patients with epilepsy (mean age 25.17±9.19 years; women, 63.2%) The characteristics of the phenomenon were determined, by questioning the examinees; 12—16-hour ambulatory electroencephalogram (EEG) monitoring was made.
Results. The deja vu phenomenon occurred with cryptogenic and symptomatic focal epilepsy with equal frequency; however, the phenomenon was also seen in the idiopathic generalized form of the latter and could be concurrent virtually with any types of seizures and observed as an individual seizure and in the structure of a partial and secondarily generalized seizure. In epileptic patients, the main clinical characteristics of the deja vu vu phenomenon are its frequency, fear before its onset, and emotional coloring. The most important criterion is a change in the characteristics of deja vu vu: prolongation, more frequencies, and the emergence of negative emotions. On EEG, the phenomenon was characterized by the onset of polyspike activity in the right temporal leads and, in some cases, ended with slow-wave, theta-delta activity in the right hemisphere.

15-19 575

The paper gives the data that reflect a change in a physician’s notion of the menacing symptom of brain damage, such as neonatal seizures (NS). Based on the data available in the literature and the results of their studies, the authors analyze the types of NS and its complications in children of different age groups. The paper describes current therapeutic approaches and the possibilities of preventing the development of NS.

20-24 604

The problem of stigmatization of a patient with epilepsy is frequently essential in restricting the capacities of his social performance. Society is often unready to recognize an epileptic patient as its equal member. The authors consider the main sources of social support (SS) to patients with epilepsy: the patient’s family takes first place; friends and other important persons also play a major role. The perception of SS has been found to be related to the number of used antiepileptic drugs and the hemispheric lateralization of a leading epileptic focus.

24-28 573

The epidemiological survey among the adult population of Sterlitamak identified 587 epileptic patients. This yielded prevalence and incidence rates for epilepsy in Sterlitamak (2.74 per 1000 population and 13.08 per 100.000 population, respectively), which were the same as those in other regions of Russia and relatively low compared to those shown by foreign investigators. Examining the prevalence of epilepsy by sex revealed a slight male preponderance (3.42 per 1000). The greatest proportion of new cases among the men and women was in the age range of 11—20 years. Among the examinees, 51.7% had been epileptic for more than 10 years. Patients with frontal focal lobe epilepsy were prevalent among the adult population. Rational therapy can substantially enhance the control over epileptic seizures.

28-34 896

Objective: to optimize pharmacotherapy in patients with epilepsy and to evaluate the clinical and cost-effectiveness of its therapy with the new antiepileptic drugs (AED): levetiracetam, lamotrigine, topiramate, and oxcarbazepine.

Patients and methods. The study enrolled 134 patients (women, 69.03%; men, 30.97%) with different types of seizures, who had previously received antiepileptic therapy. The patients visited their physician at least twice; after correcting therapy by an epileptologist, the mono- or polytherapy regimen included new AEDs. The patients' mean age was 29.8±8.7 years; disease duration was 13.01±6.7 years; mean age at onset was 16.8±8.5 years. In the groups of working and nonworking patients with different types of seizures, the authors calculated the cost of epilepsy therapy, by taking into account the use of new AEDs and the pharmacoeconomic index "cost-benefit" before and after therapy optimization.

Results. When the new AEDs were incorporated into the therapy, the low incidence rate of seizures following a year averaged 75 to 92%. The index cost-effectiveness was decreased by 2—3 times in all types of seizures when the new AEDs were used despite the increased direct cost of treatment. Also, there was a significant reduction in the cost of epilepsy treatment in practically all the groups under study. The findings suggest that the index cost-efficacy directly depends on the rational choice of an AED in an adequate dose. Rational therapy with the new AEDs makes it possible to reduce not only the total cost of epilepsy treatment, but also to lower the index cost-efficacy.

34-38 633

Hormonal function of the ovary was analyzed in 95 childbearing-age (18—30-year-old) epileptic patients receiving monotherapy with antiepileptic drugs (AEDs) for at least a year. Of them, 40, 40, and 15 patients had monotherapy with valproic acid, carbamazepine, or lamotrigine, respectively. Fifty-two (54.7%) patients with epilepsy were observed to have ovarian hormonal dysfunctions characterized by lower progesterone levels and higher luteinizing hormone and testosterone concentrations in both the follicular and luteinic phase of a menstrual cycle. The magnitude of hormonal changes depended on the specific features of epilepsy: duration, form, site of an epileptogenic focus. The use of various AEDs had an insignificant impact on the rate and pattern of hormonal abnormalities.

39-42 600

Epilepsy continues to occupy one of the leading places in the structure of neurological diseases. The stability of epilepsy remission is one of the topical problems. The course and prognosis of epilepsy and therapy choice have their features in adolescents and elderly persons. Investigation of evoked brain potentials permits judgment of remission stability and promotes the simulation of the pathogenesis of epilepsy.

43-47 711

The paper analyzes the efficiency of 3-year monotherapy with levetiracetam (LTC) (keppra) in 143 patients aged 16—73 years with partial epilepsy. LTC was used as first-line monotherapy in 71 patients (Group 1); second- or third-line monotherapy in 72 patients (Group 2) when the first-line therapy with antiepileptic drugs was insufficiently effective or poorly tolerated.

The percentage of treatment retention is an integral index of the cumulative efficiency of therapy (remission + a >50% reduction in seizure frequency) minus the percent of drug discontinuation for various reasons over a given period of time. In Group 1, the retention rate was 90.1, 87.3, and 83.1 in the first, second, and third year and in Group 2, that was 75.0, 70.8, and 69.4%, respectively.

LTC was found to be well tolerated. Its discontinuation because of its adverse reactions at one-year follow-up was noted in less than 5.6% (Group 1) and 8.2% (Group) of the patients. The findings suggest that the long-term use of keppra is promising in therapy for partial epilepsy.

48-53 1129

Malignant migrating partial seizures in infancy (MMPSI) are a rare epileptic syndrome that occurs in the first 6 months of life and is characterized by multiple continuous electroencephalographic and electroclinical focal ictal patterns with involvement of different independent areas of both hemispheres and with arrested psychomotor development. Is proposed the definition of this epileptic syndrome as: «malignant epilepsy of infancy with migrating multifocal seizures» or «Coppola-Dulac syndrome». The paper describes an observation of 19 MMPSI patients examined and treated at Departament of Psychoneurology №2, Russian Children Clinical Hospital. Video-EEG monitoring showed that all the patients had very frequent and polymorphous seizures — at least 5 types in every child with ictal patterns originating from different areas of both hemispheres. The infants with MMPSI were found to have 4 subtypes of the syndrome: (1) a classic
form with drug-resistant migrating status epilepticus (SE) of migrating multifocal seizures and with absolutely poor prognosis (n = 7); (2) a severe mixed form (MMPSI + early myoclonic encephalopathy (EME) with a combination of electroclinical characteristics of MMPSI with migrating multifocal SE and EME with chaotic erratic myoclonus and a suppression-burst pattern with diffuse polyspikewaves on EEG (n = 5); (3) a moderate type with reverse evolution to monofocal or multifocal epilepsy with a decrease in seizure frequency and better prognosis of life and psychomotor development (n = 5); (4) a subtle form manifesting itself as slightly identified minimal motor and inhibitory seizures, subclinical migrating multifocal SE pattern on EEG, multiple partial awakenings during sleep due to ictal patterns, and as severely delayed psychomotor development (n = 2). MMPSI is a severe form of SE in infancy with high drug resistance. At the same time, only the injection form of valproate (convulex) could stabilize progressive worsening and reduce seizure frequency in 3 cases of benzo-diazepine-resistant SE in MMPSI. Intravenous convulex is a rational alternative to benzodiazepines in SE in infancy, especially in cases of bulbar innervation disturbances and at high risk for depressed respiratory and cardiac functions.

53-59 850

Objective: to evaluate the efficacy of injectable valproate (convulex) in patients with serial epileptic seizures and status epilepticus (SE) at the prehospital stage.

Patients and methods. Thirty-two adult patients, including 17 (53%) men and 15 (47%) women, were examined. Most patients were aged over 40 years (mean age 54.7±9.4 years). To define the required dose of the drug, the authors estimated the patient's weight that averaged 76.8±1.9 kg, i.e. there was a preponderance of patients who needed convulex, more than 500 mg, to achieve a therapeutic effect.

Results. It was impossible to reliably and validly evaluate the type of a seizure as the medical emergency team (MET) generally observed the patient with a just evolving seizure and the medical history data were not always valid therefore the type of convulsions and the type of a seizure were evaluated. In most cases, solitary convulsive attacks (tonic and/or clonic convulsions) and/or serial seizures were observed in 12 (37.5%) and 14 (43.7%) patients, respectively; SE was recorded in 6 (8.8%) patients. Generalized seizures (without a clear focal onset) were prevalent in 24 (75%) patients while 8 (25%) patients were found to have partial seizures (seizure onset lateralization, a focal onset). According to the pattern of convulsions, seizures may be classified into three types: tonic-clonic, clonic, and tonic in 22 (68.8%), 7 (21.9%), and 3 (9.3%) patients, respectively. Analysis of the efficacy of intravenously injectable valproate (convulex) in the group of patients with SE and epileptic seizures indicated that complete cessation of seizures could be achieved in 68.8%, their rate decreased in other 9.4% of the patients. Seizures were preserved in 7 (21.8%) cases, which required additional administration of drugs.
Conclusion. Injectable valproic acid (convulex) has a high efficacy and may be preclinically used as the drug of choice to arrest SE and serial seizures caused by both epilepsy and other diseases of the brain. Convulex is easy-to-use (a ready-to-use solution), particularly in the work of MET. The ready-to-use formulation allows for its bolus administration within minutes, the drug does not affect hemodynamic parameters, which is particularly important for elderly patients and children. The administration of convulex makes it possible to prevent respiratory depression and fails to affect the level of patient consciousness.

60-63 578

The authors analyze the efficacy of intravenous lacosamide (LCSM) in combined therapy for partial epilepsy. The data available in the literature and their 2 observations suggest that intravenous LCSM is promising when its oral use is impossible, including in therapy for status epilepticus/series of partial seizures.

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)