Articles
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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