[Epilepsy syndromes associated with hearing loss]

Patients with epilepsy who have also hearing loss represent a distinct group of patients, often with aggravated medical history, comorbidities and high potential for disability. The etiopathogenetic factors of epilepsy and hearing loss may be common to these conditions (neuroinfections, craniocerebral injuries, cerebral circulatory disorders, perinatal pathology, etc.). In addition, these two syndromes may occur as part of hereditary diseases, so their timely recognition and genetic diagnosis are important for determining further medical and genetic prognosis. This article provides an overview of orphan genetic diseases associated with epilepsy and hearing loss - MERRF syndrome, MELAS syndrome, EAST syndrome, Ayme-Grippsyndrome, epilepsy, hearing loss and mental retardation syndromes, associated with mutations in SPATA5 gene, DOOR syndrome, Gustavson syndrome.

Biochemical factors in the blood serum of neuroendocrine tumor patients with carcinoid syndrome

Introduction. Carcinoid syndrome is the most common functional syndrome in patients with neuroendocrine tumors. More than 40 biochemical factors are responsible for the manifestation of carcinoid syndrome, among which serotonin is the most important. The study of biochemical markers of carcinoid syndrome and associated carcinoid heart disease is an important aim of laboratory examination in neuroendocrine tumors patients.Aim. Analysis of levels and diagnostic efficiency evaluation of chromogranin A (CgA), serotonin, pro-brain natriuretic peptide (proBNP) and platelet-derived growth factor (PDGF-BB) in the blood serum of neuroendocrine tumors patients with various clinical manifestations, including carcinoid syndrome and carcinoid heart disease.Materials and methods. 66 patients with neuroendocrine tumors of various localizations were examined (pancreas – 24 cases, small intestine – 21, large intestine – 6, lungs – 10, unkown primary focus – 5). 38 patients had liver metastases. In 43 patients, a clinic of carcinoid syndrome was observed, 16 had signs of carcinoid heart disease. The control group consisted of 30 practically healthy people. Serum levels of CgA, serotonin, and PDGF-BB were determined by enzyme immunoassay in microplate format: Chromogranin A NEOLISA (Eurodiagnostica, Sweden), Serotonin ELISA (IBL, German), and PDGF-BB ELISA Kit (Invitrogen, USA). The proBNP analysis was performed on a Cobas e601 automated analyzer (Roche, Switzerland).Results. In carcinoid syndrome, the medians of CgA, serotonin, and proBNP were the highest, differing statistically significantly from the control group. In patients with G3 tumors, the median PDGF-BB was statistically significantly higher than in controls, in contrast to G1 and G2. The highest diagnostic sensitivity in the general neuroendocrine tumors group was in CgA – 63.6 %, with a specificity of 100 %. In patients with carcinoid syndrome, the highest diagnostic sensitivity was characteristic of serotonin and chromogranin A (79 %), while in patients with CAD clinic, proBNP had the highest sensitivity – 93.8 %.Conclusion. The study revealed the high efficiency of СgA, with the highest sensitivity in common forms and tumors with high biological activity. Serotonin can be used in the diagnosis of carcinoid syndrome, associated with cardiofibrosis development. Pro-brain natriuretic peptide is a highly sensitive and specific marker of carcinoid heart disease. The highest levels of PDGF-BB are associated with a high grade of neuroendocrine tumors malignancy.

Chromogranin B in blood serum of patients with neuroendocrine tumors

Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms from cells of the diffuse neuroendocrine system. Chromogranin B (CgB) is an acidic protein of the granin family, which can be used to detect the tumours of neuroendocrine nature. Analysis of levels and evaluation of the diagnostic efficiency of CgB in the blood serum of patients with NETs of various localizations. Patients with NETs (n=121) without specific treatment were examined. In the study were presented next localizations: 74 - pancreas, 20 - stomach, 12 - large intestine, 15 - other localizations (lungs, mammary gland, prostate gland, NETs with unidentified primary). 54 practically healthy donors were examined as control group. The determination of CgB in blood serum was performed with ELISA method on BEP 2000 analyzer using a standardized test system Human Chromogranin B (USCN, China). CgB levels in common NET group (median 18.9 ng/mL) were statistically significantly higher than in the control group (8.8 ng/mL). The highest median was obtained in group of intestinal NETs (21.2 ng/ml), which exceeded the median of the control group by more than 2.4 times. According to ROC analysis in the common NET group relative to the control group, the area under the curve AUC was 0.88 (95% CI 0.83-0.929). According to cut-off level of CgB - 15.8 ng/ml, the diagnostic sensitivity was 69.4%, with a specificity of 96.3%. The highest diagnostic sensitivity was in the group of the intestinal NETs (75.0%) and pancreas (71.2%). The study showed the significance of CgB as a potential biochemical marker of NETs with various localizations, alternative to CgA.

[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]

OBJECTIVE

To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy.

MATERIAL AND METHODS

A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)).

RESULTS

Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients.

CONCLUSION

The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[Long-term postoperative outcomes in patients with drug-resistant epilepsy]

Epilepsy surgery is effective in 30-82% of patients with drug-resistant epilepsy. However, risk factors of unfavorable outcomes after epilepsy surgery require further study.

OBJECTIVE

To evaluate risk factors of favorable and unfavorable long-term postoperative outcomes in patients with drug-resistant epilepsy.

MATERIAL AND METHODS

Postoperative outcomes in a large cohort of patients with epilepsy are reported for the first time in the Russian Federation. There were 271 patients with drug-resistant scheduled for surgery. Preoperative examination and surgical treatment were carried out between January 1, 2014 and December 12, 2019 at the Evdokimov Moscow State University of Medicine and Dentistry and Sklifosovsky Research Institute for Emergency Care. We used Engel grading system to assess postoperative outcomes after 12, 24, 48 and 60 months. We distinguished favorable (Engel I-II) and unfavorable (Engel III-IV) outcomes and analyzed the factors influencing postoperative results in these patients.

RESULTS

There were 319 surgical procedures in 271 patients (217 primary resections, implantation of vagus nerve stimulator in 31 patients, 9 redo resections and 8 radiosurgical procedures). Focal cortical dysplasia (FCD) was found in 162 (60%) patients, «dual pathology» - in 118 (44%) cases. In 12 months after surgery, favorable outcomes (Engel l-II) were observed in 69% of patients (n=148), after 24 months - in 71% (n=127) of patients. Postoperative complications occurred in 6 (1.9%) patients. There was no mortality. The earlier onset of epilepsy (p=0.01), multifocal (p=0.002) and bilateral lesions (p=0.0038) were the most significant risk factors of unfavorable postoperative outcomes.

CONCLUSION

Surgical resection is effective approach for drug-resistant epilepsy.

Experience with citicoline in patients with post-stroke cognitive impairment

Objective: to investigate the efficacy and safety of citicoline (Ceresil® Canon) in patients with post-stroke cognitive impairment.

Patients and methods. Examinations were made in 33 patients aged 45 years and older who had experienced primary ischemic hemispheric stroke with complaints of a decline in memory or other cognitive functions. The cognitive status was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The presence of anxiety-depressive spectrum disorders was determined on the Hospital Anxiety and Depression Scale. All the patients received citicoline (Ceresil® Canon) oral solution at a dose of 1000 mg/day for 3 months.

Results and discussion. Citicoline administration showed a statistically significant reduction in the severity of cognitive impairment (p<0.001). The time course of positive changes in the cognitive status of patients was reflected by an increase in the median score on the MMSE from 26 [25; 27.5] to 28 [26.5; 29] and on MoCA from 23 [21; 25] to 25 [22; 26]. There was a decline in the number of patients with anxiety-depressive disorders. No adverse events or side effects were found in the patients.

Conclusion. The findings suggest that citicoline (Ceresil® Canon) produced as an oral solution is well tolerated and improves cognitive functions and affective sphere in patients in the recovery period of ischemic stroke.

Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy

Introduction. The MRI method has revolutionized the diagnosis of epilepsy. However, the widespread adoption of MRI in clinical practice is slowed by an insufficient number of high-field MRI scanners, a shortage of trained specialists, and the lack of standard examination protocols. The aim of this article is to present the Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy.

Materials and methods. As a structural element of the International League Against Epilepsy (ILAE), the RLAE considers it important to adapt the Protocol developed by ILAE for specialists in Russia and EAEU countries. The working group analyzed and generalized the clinical practice existing in the Russian Federation, the Republic of Kazakhstan, the Republic of Belarus and the Republic of Uzbekistan. These recommendations are intended for doctors in specialized centers of epilepsy surgery, and for doctors in general medical centers. The recommendations are applicable primarily to adult patients, but the general principles are relevant to children as well.

Results. In all patients with convulsive seizures shortly after the first seizure, or patients diagnosed with epilepsy who have an unexplained increase in the frequency of seizures, rapid decrease in cognitive functions or the appearance / worsening of neuropsychiatric symptoms, the RLAE recommends using a unified MR protocol for the neuroimaging of structural sequences in epilepsy with three-dimensional pulse sequences T1 and T2 FLAIR with isotropic voxel 1 × 1 × 1 mm3 and two-dimensional T2- weighted pulse sequences with a pixel size of 1 × 1 mm2 or less. The MRI examination should be combined with EEG or EEG-video monitoring. Using this protocol allows one to set a unified standard for examining patients with epilepsy in order to detect (with high sensitivity) brain lesions playing a key role in the occurrence of seizures. Here, all 13 recommendations are presented.

Conclusion. Implementation of these recommendations in clinical practice will improve the access to high-tech medical care and optimize health care costs. 

[Brivaracetam in the treatment of patients with epilepsy]

The newest antiepileptic drug (AED) brivaracetam (Briviac, UCB Pharma) (BRV) was approved in the Russian Federation in 2017 as an adjuvant therapy for the treatment of partial seizures with/without secondary generalization in adults and adolescents over 16 years old with epilepsy. This review contains the data of BRV preclinical studies, pharmacokinetic profile and the results of comparative study of BRV and LEV. The results of main studies of efficacy and tolerability with pooled analysis as well as data from meta-analysis are presented. The authors present conclusions of the Russian leading epileptologists on perspectives of using BRV in different populations of epileptic patients. The use of BRV is able to provide long-term efficacy in terms of seizure control, is well tolerated, keeps quality of life and social activity of people with epilepsy.

[Assessment of quality of life and treatment adherence in patients with dizziness treated with vasobral]

AIM

To study indicators of quality of life and adherence to treatment with vazobral in patients with dizziness of vascular genesis.

MATERIAL AND METHODS

Vazobral was administered to 330 patients with vertigo due to cerebrovascular disease for 3 months during a non-inferiority, open-label study. Quality of life (measured using VAS and the second part of the EQ-5D questionnaire), severity and frequency of dizziness attacks (using VAS), the overall effectiveness of treatment on the basis of objective (according to the doctor) and subjective (using CGI) assessments, treatment adherence were evaluated.

RESULTS AND CONCLUSION

The positive effect of vazobral was reported by 320 patients (97.0%), 223 of them (67.6%) indicated a decrease in the frequency of episodes of dizziness by at least 50%, and 95 patients (28.8%) had complete relief of dizziness. Two hundred and sixty-two (79.4%) patients took the drug in full accordance with recommendations. Patients living alone missed drug intake more often. Improvement of quality of life was noted in 326 (98.8%) patients, scores for all domains of the questionnaire EQ-5D at baseline and in the end of the study were 50.8±18.1 and 78.8±14.7%, respectively (p<0.001). The tolerability of treatment was characterized by good tolerability.

[Anxiety disorders in epilepsy]

This review is devoted to the place of anxiety disorders in the spectrum of psychiatric comorbidity in patients with epilepsy. The authors present general characteristics of anxiety manifestations and current views on the classification and qualification of anxiety disorders in such patients. Recent data show the relationship of anxiety with different forms of epilepsy, demographic and gender characteristics, localization of epileptic focus. The problem of bidirectional relationship of anxiety and epilepsy as well as the temporal relationship between anxiety and epileptic states are considered.

[Prognosis for surgical treatment of pharmacoresistant epilepsy: the role of mental and cognitive disorders]

This review focuses on the role of mental and cognitive disorders in the prognosis for surgical treatment of pharmacoresistant epilepsy. The authors analyze historical aspects of the surgical treatment of epilepsy and present current data on the prognosis of operative intervention with respect to seizure control, cognitive functioning, and psychiatric disorders. The psychiatrist's role in the structure of preoperative and postoperative management of patients is considered.

[Surgical treatment patients with drug-resistant unilateral MRI-positive temporal forms of epilepsy]

AIM

To evaluate the results of surgical treatment of patients with unilateral MRI-positive temporal forms of drug-resistant epilepsy.

MATERIAL AND METHODS

A prospective analysis of 50 patients with unilateral MRI-positive temporal forms of drug-resistant epilepsy, who had undergone resective surgery in the Scientific Research Institute of Emergency Medicine of N.V. Sklifosovsky (Moscow) and in University Clinic of Moscow State University of Medicine and Dentistry between 01.01.14 and 12.12.17, has been performed. MRI-positive temporal symptomatic epilepsy was identified in 79 (55%) patients. MRI results showed unilateral temporal epileptogenic lesions in 50 (67%) patients. These patients were assigned to medial frontal lobectomy.

RESULTS

82% patients become 'seizure free' 12 and 24 months after surgical treatment. In other cases, seizures become less frequent and severe.

CONCLUSION

The results confirm the efficacy and safety of surgical treatment of drug-resistant MRI-positive temporal forms of epilepsy.

[Post-stroke rehabilitation training with a brain-computer interface: a clinical and neuropsychological study]

AIM

To evaluate the efficacy of cytoflavin in the treatment of patients with chronic cerebral ischemia and mild cognitive impairment predominantly of vascular origin.

MATERIAL AND METHODS

Treatment results of 140 patients, aged 60-74, with chronic cerebral ischemia were analyzed. The main group included 77 patients (35 men and 42 women of average age 66.38±4.64 years) who received cytoflavin throughout the observation period: 2 tablets twice a day 30 minutes before meals. The comparison group included 63 patients (26 men and 37 women of average age 67.48±5.22 years) who during the whole period of observation received ethyl methyl hydroxypyridine succinate: 2 tablets (250 mg) twice a day, according to the same scheme as in the main group. Treatment efficacy was assessed by neuropsychological testing and P300 evoked potentials.

RESULTS AND CONCLUSION

During treatment, there was an improvement in neurophysiological parameters in both groups, which was more pronounced in patients treated with cytoflavin: their P300 amplitude increased by1.3 times in the left hemisphere (from 9.21 (8.36, 10.11) to 12.41 (10.23, 13.37 μV) and 1,7 times in the right hemisphere (from 6.48 (5.26, 7.35) to 11.04 (9.29, 12.18) μV). Our study confirms the advisability of using drugs that have complex cytoprotective and energy-correcting mechanism in patients with cognitive impairment. Cytoflavin has shown the high efficacy and safety and can be recommended as part of complex therapy for cognitive disorders. Using simple and inexpensive instrumental methods (assessment of cognitive P300 evoked potential) along with diagnostic scales in patients with cognitive impairment can significantly objectify the assessment of treatment dynamics.

[Indication of antiepileptic drugs to patients with epilepsy: results of the survey of neurologists]

AIM

To study knowledge and opinions of neurologists about priorities in using antiepileptic drugs (AEP).

MATERIAL AND METHODS

Eighty-one neurologists from Moscow and surrounding regions were surveyed to identify the factors that influenced the choice of AEP.

RESULTS AND CONCLUSION

Valproic acid was the most frequently used drug followed by levetiracetam and carbamazepine, which reflected the overall picture of PEP indication in patients with epilepsy in the Russian population. Levetiracetam occupies a leading position as the starting drug for treatment of epilepsy; most often prescribed to women, patients with generalized seizures and idiopathic epilepsy. It is the drug of choice as adjuvant remedies for Duo therapy.

[Subcortical laminar heterotopia 'double cortex syndrome']

This article presents a clinical case of a 29-year-old patient with 'Double cortex syndrome' with epilepsy, intellectual and mental disorders. Subcortical band heterotopia is a rare disorder of neuronal migration. Such patients typically present with epilepsy and variable degrees of mental retardation and behavioral and intellectual disturbances. The main diagnostic method is magnetic resonance imaging (MRI).

[Outcomes of surgical treatment of patients with pharmacoresistant epilepsy]

AIM

To evaluate the results of surgical treatment of patients with pharmacoresistant epilepsy.

MATERIAL AND METHODS

Examination and surgical treatment of 61 patients with pharmacoresistant forms of symptomatic epilepsy were performed from 01.01.14 to 01.05.16.

RESULTS AND CONCLUSION

The results confirmed the safety and efficacy of the surgical treatment of pharmacoresistant epilepsy. After 12 months, seizures were controlled in 69% of operated patients. The necessity of complex examination of all patients with pharmacoresistant epilepsy to make a decision about possible surgery is shown.

[Depression and epilepsy: comorbidities, pathogenesis, principles of therapy]

Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.

[Russian experience of lacosamide (vimpat) usage in treatment of uncontrolled focal epilepsy]

Many patients with epilepsy receive treatment in polytherapy. Selection of antiepileptic drugs (AEDs) for the combination should be carried out in accordance with the principles of rational polytherapy, taking into account the mechanism of action, pharmacokinetic (PK) and pharmacodynamic (PD) properties of drugs. Along with levetiracetam, gabapentin, vigabatrin and pregabalin, lacosamide (LCM) shows superior PK profile in rating of all AED and can be combined with any of them. The goal of this study was to evaluate efficacy and tolerability of LCM in patients with uncontrolled partial onset seizures (POS) in routine clinical practice.

METHODS

181 patient's charts from 14 sites in Russia have been analyzed in retrospective manner. Patients 16 years old and older with POS with or without secondary generalization were included. Documented observation period of up to 12 months after initiation or until discontinuation of LCM therapy. Primary effectiveness variables was retention at Observational Point 3 (approximately 12 months). Other variables were: percentage change from historical baseline in seizure frequency, 50% and 75% treatment response and seizure-free status at the Observational Points 1, 2 and 3 (approximately 3, 6 and 12 months) and incidence and reason of treatment discontinuation.

RESULTS

retention rate was high with 89.5% after 12-month observation. The development of seizure frequency showed a continuous decrease in terms of 50%, 75% treatment respond rates and seizure free status. A total of 5 adverse drug reactions leading to discontinuation of LCM therapy were recorded in 5 of 181 patients (2.8%) during the observation period. The high retention rate observed in this retrospective chart review is assumed to indicate a good tolerability and effectiveness of an adjunctive LCM treatment in patients with uncontrolled partial epilepsy in Russia.

[Algorithms of mono- and polytherapy in clinical epileptology]

The large number of antiepileptic drugs (AEDs) at the physician's disposal provides not only a broad therapeutic potential in the treatment of epilepsy (EP), but creates difficulties in the adequate choice of AED. The sufficient experience in the management of patients with epilepsy has been gained so far in the world, based on which the International League Against Epilepsy (ILAE), updated classification, adopted the basic definition of efficiency, remission, resistance, evidence of research on the effectiveness of AED therapy, and introduced the concept of "resolved" epilepsy. In this article, a group of Russian experts suggest recommendations on the main steps in the choice of therapy in epilepsy. Possible drug interactions between different AEDs and other drugs as well as main characteristics of mono- and polytherapy of epilepsy are described. Some features of the use of AEDs in the elderly, characteristics of the "female" epilepsy related to the reproductive function and basic requirements for the therapy of epilepsy in children are presented.

[Algorithms of mono- and polytherapy in clinical epileptology. Part 1. General principles of drug choice]

The large number of antiepileptic drugs (AEDs) at the physician's disposal provides not only a broad therapeutic potential in the treatment of epilepsy (EP), but creates difficulties in the adequate choice of AED. The sufficient experience in the management of patients with epilepsy has been gained so far in the world, based on which the International League Against Epilepsy (ILAE), updated classification, adopted the basic definition of efficiency, remission, resistance, evidence of research on the effectiveness of AED therapy, and introduced the concept of "resolved" epilepsy. In this article, a group of Russian experts suggest recommendations on the main steps in the choice of therapy in epilepsy. Possible drug interactions between different AEDs and other drugs as well as main characteristics of mono- and polytherapy of epilepsy are described. Some features of the use of AEDs in the elderly, characteristics of the "female" epilepsy related to the reproductive function and basic requirements for the therapy of epilepsy in children are presented.

[Dopamine receptor agonists: new forms and new possibilities in the treatment of Parkinson's disease]

Main mechanisms of action of dopamine receptor agonists, efficacy of their use according to the results of earlier clinical trials and possible side-effects are discussed. The authors present their experience of prescription of rotigotine transdermal system in an open study of 30 patients with Parkinson's disease. The duration of the study was 8 weeks. There was a significant improvement of both motor and nonmotor (pain sensations, sleep, mood). The effective dose for treatment of initial stages was 4-6 mg daily and for the full-blown stage - 6-8 mg daily. The tolerability was good.

[IMPACT OF THE CHEMICAL OCCUPATIONAL FACTORS ON THE DEVELOPMENT OF ALLERGIC DISEASES IN HEALTHCARE PRACTITIONERS]

There was performed the assessment of the degree of the impact of the chemical occupational factors on the development of allergic diseases in healthcare practitioners of the Sverdlovsk Region. According to results of the certification of 145 workplaces in medical institutions of the Sverdlovsk Region's it was revealed that the health care professionals mostly contact with the chemical substances which were the strong allergens with potent nfavorable impact on the health. In the formation of allergic diseases in healthcare practitioners the leading role is belonged to antibiotics, vitamins and other medicines, as well as formaldehyde; there is less detected sensitization to cotton dust and synthetic detergents.

[The results of the multicenter pharmaco-epidemiological observational project on the use of mydocalm in the treatment of pain syndromes with the muscle spasm]

The prospective multicenter open noncomparative pharmaco-epidemiological observational project on the use of mydocalm in real clinical practice has been completed in 2013. The project has been performed in 2090 clinical/rehabilitation settings in 284 cities of 13 countries using the results of 35,383 patients. The project aimed to assess the safety of treatment (percentage of patients with adverse-effects) and pain relieving efficacy as well as patient's satisfaction with the treatment. In total, 6603 (19%) adverse-effects were recorded. Their severity was evaluated as mild in 84,48%, no serious adverse-effects were noted. The high efficacy of mydocalm in the treatment of pain syndromes with the muscle spasm has been demonstrated. The high level of tolerability and absence of the clinically significant increase of adverse effects in the combination with nonsteroidal anti-inflammatory drugs have been confirmed.

[Possibilities of using intravenous forms of antiepileptic drugs in epileptic seizures]

The literature data on using intravenous forms of AEDs that expand treatment possibilities for patients with epilepsy are presented. AEDs can be used in different situations, when patients are not able to take AEDs in per os. These situations can include seizure emergencies (recurrent seizures, clusters, status epilepticus), caused by disease decompensation; acute symptomatic seizures; perioperative preparation in the case of surgery; dysphagia; gastrointestinal problems; psychiatric disorders, and others. This article is based on a review of International and Russian expert consensus practice guidelines for management of clinical situations mentioned above. The authors present data on available Russian parenteral forms of drugs used today (valproats, levetiracetam, lacosamide, diazepam, midazolam, propofol, thiopental potassium). It has been concluded that an ideal intravenous AED should be highly effective, acts fast, has no severe adverse effects, has low drug-drug interactions, does not require frequent plasma concentration monitoring, and should be easily switched to a per os form without any additional titration. The importance of separate treatment approaches on different stages of medical help is emphasized. The choice of drug used can be influenced by a particular clinical situation, indications/contraindications, the recommended infusion speed, side effects, possible drug-drug interactions with other AEDs and other drugs used for the treatment of concomitant diseases, availability of a particular drug at the moment and the level of a physician's knowledge of usage of intravenous forms of AEDs.

[Asthenia, emotional disorders and quality of life of patients with multiple sclerosis]

Objective. The evaluation of the dynamics of asthenia, chronic fatigue syndrome, emotional disorders and quality of life of patients with multiple sclerosis (MS) and to explore the possibility of using idebenon (noben) in treatment of these impairments. Material and methods. We studied 35 patients, 18 men and 17 women, with MS (mean age 36.4±8.86 years, mean disease duration 10.33±6.07 years); 83% of patients had remitting type and others - secondary progressive type. Along with neurological examination, we used the Modified Fatigue Impact Scale (MFIS 21), the Hospital Anxiety and Depression Scale and a quality of life questionnaire (EQ5D). Patients had marked asthenia and chronic fatigue at baseline. The old age of the patients and duration of MS and its severity according to EDSS predicted the higher levels of asthenia, chronic fatigue and anxiety with depression and lower quality of life on EQ5D. All patients received noben in dosage 90 mg daily (30 mg 3 times a day) during 6 months. Results and conclusion. Idebenon (noben) reduced the severity of chronic fatigue syndrome, asthenia and depression in MS patients. The dose used in the study may be regarded as the optimal dose that provides best efficacy with minimal side-effects.

Local epileptic activity, histological and neuroimaging findings in symptomatic epilepsy

OBJECTIVE

This study is aimed at revealing the relationship between local interictal epileptic activity, cytoarchitectural disturbances and magnetic resonance imaging (MRI) findings.

MATERIAL AND METHODS

We prospectively investigated a series of 25 patients with symptomatic epilepsy due to isolated forms of focal cortical dysplasia (FCD) or hippocampal sclerosis and low-grade tumours associated with FCD, all of whom underwent tailored surgical procedures under intraoperative electrocorticography; we conducted neuropathological examinations of 92 biopsies taken from different places. We examined the relationship between dysplastic changes in the cortex and the absence or presence of seizure patterns (SPs), including regular spikes/sharp waves, recruiting discharges, paroxysmal fast activity and rhythmic delta-theta activity. Comparisons with MRI findings were also performed.

RESULTS

Complete removal of the SPs zone was associated with better results of surgical treatment. Areas with isolated architectural abnormalities were associated with SPs significantly more often than those where the cortex contains immature or giant neurons; these areas were associated with SPs more than areas containing dysmorphic neurons. The extent of MRI signs appearance in the neocortex correlated neither with the presence of SPs nor with the types of histological changes.

CONCLUSIONS

We suppose an inverse relationship between the morphological changes in neurons and their ability to generate epileptic activity. Electrocorticography may be used for the identification of the MRI-negative epileptogenic lesions.

[Possibilities of medical correction of moderate cognitive impairment]

Thirty-four outpatients with moderate cognitive impairment were treated with one of standard extracts of Ginkgo Biloba - EGb761 (memoplant). Memoplant was used in high dosages (240 mg daily) twice a day during three months. Patients were assessed using the Montreal Cognitive Assessment (MoCA), the hospital depression scale and QoL questionnaire EQ5d as well as standard neurological and somatic examination. A statistical analysis of data revealed a significant improvement in most measures, mostly in attention, memory, orientation and visual-spatial/ executive functions as well as in anxiety and depression. The drug is well-tolerated and is recommended for practical use.

[Emotional disorders and quality of life in patients with post stroke asthenia]

An aim of the study was to assess the severity of asthenic syndrome, emotional disorders and quality of life indicators in post stroke patients treated with idebenone (noben). We studied 35 patients aged from 47 to 76 years, mean age 58,85±7,99 years, 21 men and 14 women. The time after stroke was 1-8 years (mean 2,63±1,51 years). The duration of follow-up was 6 months. Patients were examined at baseline and 3 and 6 months after treatment with noben in dose 90 mg daily (30 mg 3 times a day). Patients were examined clinically, the following scales were used as well: the Scandinavian stroke scale, the modified MFIS-21, the hospital anxiety and depression scale (HADS) and EQ5D including VAS. It has been shown that asthenic syndrome negatively influenced quality of life and emotional sphere thus impeding the recovery of daily activities. The follow-up study revealed that the treatment with idebenone in dose 90 mg daily decreased the severity of asthenia and emotional disorders and significantly improved quality of life.

[Modern approaches to the encephalographic diagnosis of non-convulsive status epilepticus]

The article presents modern conceptions on instrumental diagnosis, using electroencephalography, of non-convulsive status epilepticus (NCSE) based on a traditional classification and recommendations of the American Clinical Neurophysiology Society (2012). The descriptive diagnostic parameters for the recognition of different changes in the brain electrical activity in NCSE and their correlations in the structure of traditional and new classifications are presented.

[Treatment of vestibular vertigo and Ménière syndrome in outpatient clinics]

An aim of this study was to assess clinical efficacy and tolerability of tagista in the symptomatic treatment of vestibular vertigo and Ménière syndrome. Thirty-two patients, 16 women and 16 men, aged from 25 to 67 years, were examined. Vertigo was caused by chronic brain ischemia in 17 cases and by the disturbance of blood circulation in the vertebral-basilar system in 14 patients with osteochondrosis of cervical spine. One patient was diagnosed with Ménière syndrome. Tagista was used in dose 24 mg twice a day during 4 weeks in the combination with standard treatment, exercise therapy and stability training. The results revealed a statistically significant effect of the drug on main symptoms (frequency, duration and intensity of vertigo attacks etc) and its good tolerability that allowed to recommend the drug in neurological practice.

[Age aspects of quality of life research in patients with epilepsy]

In spite of the fact that patients of advanced age are the fastest growing population of patients with epilepsy, there is no sufficient data on quality of life (QOL) questionnaires sensitivity in the elderly patients. The aim of this study was to evaluate correlations between QOLIE-31 and QOLIE-10 scores in the elderly and young patients with epilepsy before and after antiepileptic therapy optimization. Twenty-seven elderly (average age 65.36±3.88 years) and 30 young (average age 25.05±3.06 years) patients completed questionnaires QOLIE-31 and QOLIE-10 The analysis of QOL indicators was conducted at the following control points: 1) before the beginning or correction of antiepileptic therapy; 2) 6 months after the beginning of therapy or its optimization. In young patients after the beginning or optimization of therapy, the statistically significant negative correlation between the majority QOLIE-31 subscales and a total QOLIE-10 score, with the exception of the "Emotional well-being", was revealed. In the elderly patients, the positive correlations with the "Energy/fatigue" (r=0.46) and the "Medications effect" (r=0.20) subscales were noted. Considering the score estimation in QOLIE-31 and QOLIE-10 questionnaires, the revealed positive correlations could testify smaller sensitivity of questions in the brief version (QOLIE-10) in the elderly patients with epilepsy in comparison with young patients. According to the data received, the validity of QOLIE-10 appeared to be insufficient in the elderly patients, with the QOLIE-31 questionnaire being preferred. In young patients, the QOLIE-10 can be recommended as a screening QOL tool at the beginning of antiepileptic therapy, and later for estimation of AEDs efficiency.

[Characteristics of morphofunctional state of the pancreas in children with metabolic syndrome]

The paper presents the results of a study of the morphofunctional state of the pancreas in children with metabolic syndrome. It is shown that in the absolute majority of children identified various changes in the structure of the pancreas. Decrease Postprandial response and uneven increase in gland due to a head in the postprandial period, indicating a decrease in body adaptation abilities and a high risk of pancreatitis in children with MS. The interrelation between total size and size of the head of the pancreas on an empty stomach with disorders of carbohydrate metabolism. Obtained data indicate the need for in-depth examination of children with metabolic syndrome in order to timely diagnosis of chronic pancreatitis.

[Stigmatization and social adaptation of patients with epilepsy]

The results of previous studies carried out in different countries on the problem of stigmatization of epileptic patients indicate the deficit of knowledge about epilepsy, negative attitude in the society towards the possible mutual activity with epileptic patients, difficulty in choosing an occupation and possibilities of finding a job. These issues remain understudied. The extension of knowledge that demands additional research is needed to get a more full conception of acceptance of the disease by society and non-medical population.

[Magnetic-resonance tomography in the diagnosis of hystogically verified epileptogenic lesions]

The aim of the study was to reveal MRI features of focal cortical dysplasia and sclerosis of the hippocampus in patients with symptomatic epilepsy. Twenty-four patients who underwent the surgery with symptomatic epilepsy were studied. The results of pre-surgical MRI and histological studies of the removed cortex were compared. The signs of focal cortical dysplasia in the lesion area were found in patients with oncologic and non-oncologic lesions. In patients with sclerosis of the hippocampus, such specific sign as the T2-signal elevation was not seen in all cases. Though MRI is a highly sensitive method for detecting cortical dysplasia, it does not allow to differentiate significantly different types of this pathology. Even in the presence of typical signs of focal cortical dysplasia, its real boundaries may spread beyond the clearly visualized lesion. In the absence of typical signs of focal cortical dysplasia, one should take into account non-specific signs in the comparison with clinical and neurophysiologic data. In sclerosis of the hippocampus, the changes in the signal intensity were not constantly seen and the decrease in the volume of the structure was a main diagnostic sign. In the cases of so-called "medial temporal epilepsy", any changes in hippocampus volume may be diagnostically important.

[Dynamics of clinical and laboratory parameters in patients with severe ischemic stroke of hemispheric localization and different variants of nutrition support]

We studied an effect of different nutrition algorithms on the outcome of neurological symptoms and laboratory data in patients with ischemic stroke. The active nutrition support included in the basic therapy from the beginning of the disease has a positive effect on the patient's state. The mixed artificial nutrition (enteral + intravenous) was more effective compared to the intravenous or enteral nutrition alone in improving the clinical state, shortening the duration of staying in intensive care wards and complete compensation of disturbances of protein and energy metabolism during the first day of disease.