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The experience of applying vagus nerve stimulation in treatment of pharmacoresistant epilepsy 应用迷走神经刺激治疗药物耐药性癫痫的经验
Q4 Medicine Pub Date : 2023-12-22 DOI: 10.17749/2077-8333/epi.par.con.2023.160
A. A. Shatokhin, S. M. Karpov, E. V. Kushnareva, I. A. Peshkova, A. V. Shatokhin, I. Vyshlova
The article presents a clinical case of adult patient with pharmacoresistant epilepsy lacking focal cerebral morphological changes, who was surgically implanted with a vagus nerve stimulation (VNS) system. The results of 6 months-long treatment were analyzed. In addition, available publications were reviewed to evaluate effectiveness of the VNS system in different patient groups. Current clinical case was featured with significant positive dynamics revealed by regression of epileptic seizures and no recorded epileptiform activity based on electroencephalography during VNS stimulation. In the absence of morphological cerebral focal changes in adult patients, installation of the VNS system is an effective and safe method to control pharmacoresistant epilepsy.
文章介绍了一例通过手术植入迷走神经刺激(VNS)系统的临床病例,该患者患有药物耐受性癫痫,但没有局灶性大脑形态学改变。文章分析了长达 6 个月的治疗结果。此外,还查阅了现有文献,以评估迷走神经刺激系统在不同患者群体中的疗效。目前的临床病例具有显著的积极动态特征,表现为癫痫发作的消退,以及在 VNS 刺激期间脑电图没有记录到癫痫样活动。如果成年患者没有形态学上的脑局灶改变,安装 VNS 系统是控制药物耐药性癫痫的一种有效而安全的方法。
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引用次数: 0
Epilepsy and MELAS syndrome: literature review and clinical observation 癫痫与 MELAS 综合征:文献综述与临床观察
Q4 Medicine Pub Date : 2023-12-22 DOI: 10.17749/2077-8333/epi.par.con.2023.172
А. М. Teplysheva, М. А. Glazova, R. N. Konovalov
MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) belongs to the group of mitochondrial diseases. Most MELAS syndrome cases are associated with the A3243G mutation in the MTTL1 gene. A common clinical manifestation of the syndrome is presented by epileptic seizures (ES) characterized by phenotypic polymorphism and resistance to antiepileptic therapy. Diagnosis and treatment of epilepsy in patients with MELAS syndrome often poses difficulties. We present a clinical case of adult patient with MELAS syndrome with identified A3243G mutation and epilepsy. The disease course developed to severe cognitive impairment. The first focal ES occurred during stroke-like episode. Further seizures were observed spontaneously, with high frequency, often manifested as a series. Focal ES often had blurred polymorphic manifestations. The choice of drug therapy took into account the side effects of antiepileptic drugs (AEDs) including potentially mitochondria-related negative effects. While diagnosing EP in MELAS syndrome, it should be considered that seizures often occur during stroke-like episodes and may have blurred polymorphic clinical manifestations. Cognitive impairment in patients complicates ES detection. First-line drugs should be presented by AEDs with low mitochondrial toxicity.
MELAS 综合征(线粒体脑肌病、乳酸酸中毒和中风样发作)属于线粒体疾病。大多数 MELAS 综合征病例与 MTTL1 基因中的 A3243G 突变有关。该综合征的常见临床表现为癫痫发作(ES),其特点是表型多态性和对抗癫痫治疗的耐受性。MELAS 综合征患者癫痫的诊断和治疗往往存在困难。我们在临床上发现了一例MELAS综合征成年患者,其A3243G基因突变并伴有癫痫。患者的病程发展为严重的认知障碍。第一次局灶性 ES 发生在中风样发作期间。以后的癫痫发作是自发的,频率很高,通常表现为一系列发作。局灶性 ES 常有模糊的多形性表现。药物治疗的选择考虑了抗癫痫药物(AEDs)的副作用,包括可能与线粒体有关的负面影响。在诊断MELAS综合征的EP时,应考虑到癫痫发作常常发生在中风样发作期间,并可能有模糊的多态临床表现。患者的认知障碍会使 ES 的检测复杂化。一线药物应以线粒体毒性低的 AEDs 为主。
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引用次数: 0
Assessing neurotropic effects of new antiepileptic nitrogen-containing drugs 评估新型抗癫痫含氮药物对神经的影响
Q4 Medicine Pub Date : 2023-12-20 DOI: 10.17749/2077-8333/epi.par.con.2023.174
R. Paronikyan, G. G. Avakyan, V. N. Avakyan, E. Paronikyan
Objective: to evaluate an effectiveness of new nitrogen-containing compounds for alleviating epileptiform conditions in animal experimental study, and conduct molecular modeling of a new neurotropic drug.Material and methods. The anticonvulsant and psychotropic effects of six new heterocyclic compounds synthesized at the Institute of Fine Organic Chemistry were analyzed: № 1 (tetrahydrobenzothienopyrimidine), № 2 (pyridopyrimidine), № 3 (pyranotriazolopyridine), № 4 (thioalkylpyranotriazolopyridine), № 5 (pyrazolyltetrahydrothienoisoquinoline), and № 6 (thioxopyranopyridine). Experiments were carried out with 300 white outbred male mice weighing 18–24 g and 48 male rats weighing 120–150 g. The anticonvulsant spectrum of action was assessed in mice using the following tests: maximum electric shock, corazole-induced seizure. The psychotropic compound-related properties were analyzed using the following tests: elevated plus maze, open field, conflict situation. The neurotoxic compound-related effects were evaluated by incoordination of movements in rotating rod test. Comparison was performed with pufemide (3-(p-isopropoxyphenyl)succinimide), ethosuximide and diazepam.Results. The new nitrogen-containing drugs were revealed to exhibit high anticonvulsant activity, especially observed in corazoleinduced seizure test. All select compounds have anticonvulsant, anxiolytic, psychosedative or behavior-activating effects. Compound № 1 (N3212) is the most effective (median effective dose is 16 mg/kg) in antagonism to corazole action and is significantly superior to ethosuximide and pufemide exceeding by 10- and 5-fold, respectively. The compound shows least toxic (median lethal dose is 2300 mg/kg) and low neurotoxic (median toxic dose is 660 mg/kg) effects. Therapeutic and protective indices for Compound No. 1 exceeds that of ethosuximide by 17- and 13-fold, and of pufemide by 6- and 8-fold, respectively.Conclusion. The select compounds are superior to the approved drugs used in medical practice, pufemide and ethosuximide. A Compound N3212 selected among them may find application as an anticonvulsant drug with psychotropic effects.
目的:在动物实验研究中评估新型含氮化合物缓解癫痫症状的效果,并对一种新的神经刺激药物进行分子建模。分析了精细有机化学研究所合成的六种新杂环化合物的抗惊厥和精神作用:这些化合物是:№1(四氢苯并噻吩嘧啶)、№2(吡啶嘧啶)、№3(吡喃三唑吡啶)、№4(硫烷基吡喃三唑吡啶)、№5(吡唑基四氢噻吩异喹啉)和№6(硫氧吡喃吡啶)。实验对象是 300 只体重为 18-24 克的白色近交系雄性小鼠和 48 只体重为 120-150 克的雄性大鼠。对小鼠的抗惊厥作用谱进行了评估,测试方法如下:最大电击、科拉唑诱发癫痫发作。通过以下测试分析了精神药物的相关特性:高架加迷宫、开放场、冲突情境。神经毒性化合物相关效应通过旋转棒试验中的动作不协调进行评估。与普菲米特(3-(对异丙氧基苯基)琥珀酰亚胺)、乙琥胺和地西泮进行了比较。结果表明,新的含氮药物具有很强的抗惊厥活性,尤其是在科拉唑诱导的癫痫发作试验中。所有化合物都具有抗惊厥、抗焦虑、精神或行为激活作用。化合物№1(N3212)在拮抗 corazole 作用方面最为有效(中位数有效剂量为 16 毫克/千克),明显优于乙琥胺和普非米特,分别超出 10 倍和 5 倍。该化合物的毒性最低(中位数致死剂量为 2300 毫克/千克),神经毒性较低(中位数毒性剂量为 660 毫克/千克)。1 号化合物的治疗和保护指数分别是乙琥胺和普非米特的 17 倍和 13 倍,以及普非米特的 6 倍和 8 倍。所选化合物优于已获批准的医疗用药普非米特和乙琥胺。从中筛选出的化合物 N3212 有可能被用作具有精神作用的抗惊厥药物。
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引用次数: 0
DEPDC5-related familial focal epilepsy DEPDC5相关家族性局灶性癫痫
Q4 Medicine Pub Date : 2023-12-20 DOI: 10.17749/2077-8333/epi.par.con.2023.159
T. Kozhanova, S. S. Zhilina, L. M. Sushko, E. Lukyanova, K. V. Osipova, A. I. Krapivkin, N. N. Zavadenko
Focal epilepsy is the most common type of epilepsy accounting for 60–70% of all cases of this pathology. We present two familial cases of focal epilepsy associated with a nucleotide sequence variant in DEPDC5 gene. Clinical and ancestry examination was performed by using instrumental (magnetic resonance imaging, video-electroencephalography) and genetic testing methods. The nucleotide sequence variants in DEPDC5 gene were found in two probands and paired fathers with epilepsy. Focal cortical dysplasia was detected only in the father of Proband 1 as well as Proband 2 with resistant epilepsy and severe cognitive deficit. Hence, such clinical cases confirm that pathogenic variants in DEPDC5 gene are related with familial focal epilepsy, which clinical manifestation may depend on the type of identified mutation. The study of genotype-phenotype correlations is necessary to apply proper therapy. Before surgical treatment of epilepsy, the genetic testing by whole exome or whole genome sequencing should be performed.
局灶性癫痫是最常见的癫痫类型,占所有病例的 60-70%。我们报告了两例与 DEPDC5 基因核苷酸序列变异有关的局灶性癫痫家族病例。通过仪器(磁共振成像、视频脑电图)和基因检测方法进行了临床和遗传学检查。在两名患有癫痫的原发性癫痫患者和配对父亲中发现了DEPDC5基因的核苷酸序列变异。只有在 Proband 1 和 Proband 2 的父亲身上发现了局灶性皮质发育不良,他们患有抗药性癫痫和严重的认知障碍。因此,这些临床病例证实,DEPDC5 基因的致病变异与家族性局灶性癫痫有关,其临床表现可能取决于所确定的突变类型。研究基因型与表型的相关性对于采用适当的治疗方法十分必要。在对癫痫进行手术治疗之前,应进行全外显子组或全基因组测序的基因检测。
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引用次数: 0
A new approach to spatial localization of EEG-based electrical activity 基于脑电图的电活动空间定位新方法
Q4 Medicine Pub Date : 2023-12-05 DOI: 10.17749/2077-8333/epi.par.con.2023.177
А. V. Vartanov
Background. Accuracy and reliability of methods for spatial localization of brain activity based on electroencephalography (EEG) data do not lose relevance. Existing localization methods are coupled to specific difficulties due to ambiguity of the resulting solution.Ojective: verification of a new method for localizing brain activity using EEG data “Virtually Implanted Electrode” and demonstratoin of its capabilities.Material and methods. The new method was verified using deep brain stimulation (DBS) data. There were used the data from scalp electrical activity induced solely by potentials from two electrodes implanted into deep areas of human brain. It was achieved by filtering EEG signals at the stimulation frequency and excluding signals from other brain areas. A clinical case of applying the new method for EEG analysis of patient paroxysmal activity is presented as well.Results. Based on the verification data for the new “Virtually Implanted Electrode” method, it was shown that it allowed to quite accurately determine the localization of DBS current sources. The effectiveness of using the method for analyzing the mechanisms of paroxysmal activity was demonstrated: based on change in potentials calculated in 33 sites of the brain (brain areas), three groups of areas were identified specifically contributing to development of paroxysmal activity. For comparison, the same artificial DBS sources were localized using other verified methods: the BrainLoc (Russia) and sLORETA (Switzerland) software providing substantially worse data.Conclusion. Identifying spatial localization of electrical potentials recorded on the scalp surface by using the new approach with the “Virtually Implanted Electrode” method shows high efficiency and reliability, demonstrating a clear advantage over other known localization methods.
背景。基于脑电图(EEG)数据的脑活动空间定位方法的准确性和可靠性并没有失去相关性。现有的定位方法由于结果解的模糊性而遇到特定的困难。目的:验证一种利用脑电数据“虚拟植入电极”定位脑活动的新方法,并展示其功能。材料和方法。用深部脑刺激(DBS)数据验证了新方法。他们使用的是由植入人脑深部的两个电极的电位所引起的头皮电活动数据。它是通过过滤刺激频率的脑电图信号,并排除来自其他大脑区域的信号来实现的。本文还介绍了应用新方法分析患者发作性脑电图的一个临床病例。基于“虚拟植入电极”新方法的验证数据表明,该方法可以相当准确地确定DBS电流源的定位。使用该方法分析发作性活动机制的有效性得到了证明:基于大脑33个部位(脑区)的电位变化,确定了三组特定的区域对发作性活动的发展有贡献。为了比较,使用其他经过验证的方法对相同的人工DBS源进行了定位:BrainLoc(俄罗斯)和sLORETA(瑞士)软件提供的数据要差得多。利用“虚拟植入电极”方法对记录在头皮表面的电位进行空间定位,显示出高效率和可靠性,与其他已知的定位方法相比具有明显的优势。
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引用次数: 0
Post-stroke epileptic seizures: risk factors, clinical presentation, principles of diagnosis and treatment 脑卒中后癫痫发作:危险因素、临床表现、诊治原则
Q4 Medicine Pub Date : 2023-07-09 DOI: 10.17749/2077-8333/epi.par.con.2023.135
O. A. Al-Sahli, L. M. Tibekina, O. Subbotina, V. Flud
Post-stroke developing epileptic seizures represent a severe complication aggravating post-stroke condition. Epilepsy can exacerbate cognitive, psychopathological, somatic disorders resulting from cerebrovascular and comorbid diseases. Despite that post-stroke epilepsy (PSE) is a rather common type of acquired structural epilepsy, the issues related to diagnosis and management often raise difficulties for clinicians. Patients with severe strokes affecting brain, cortex, acute symptomatic seizures and intracerebral hemorrhage are at greater risk of developing PSE. Timely neurophysiological, neuroradiological research methods, assessed blood biomarkers as well as prognostic models provide information that complements PSE clinical risk factors. The management of post-stroke acute and long-term (late) symptomatic seizures differs markedly. At the same time, the choice of an optimal anticonvulsant drug should be based not only on its effectiveness, but also on related side effects, pharmacodynamics as well as an impact on concomitant diseases. Drug interactions, especially between anticonvulsants and anticoagulants or antiplatelet agents also affect a choice of treatment, which should be taken into consideration for management of PSE patients.
脑卒中后癫痫发作是一种严重的并发症,会加重脑卒中后的病情。癫痫可加重认知、精神病理、由脑血管和合并症引起的躯体疾病。尽管卒中后癫痫(PSE)是一种相当常见的获得性结构性癫痫类型,但与诊断和管理相关的问题往往给临床医生带来困难。影响大脑、皮质的严重中风、急性症状性癫痫发作和脑出血患者发生PSE的风险更大。及时的神经生理学、神经放射学研究方法、评估的血液生物标志物以及预后模型提供了补充PSE临床危险因素的信息。脑卒中后急性和长期(晚期)症状性癫痫发作的处理明显不同。同时,最佳抗惊厥药物的选择不仅要考虑其有效性,还要考虑相关的副作用、药效学以及对伴随疾病的影响。药物相互作用,特别是抗惊厥药与抗凝血药或抗血小板药之间的相互作用也会影响治疗的选择,在治疗PSE患者时应考虑到这一点。
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引用次数: 0
Awareness of doctors and epilepsy patients about preferential drug provision 医生和癫痫患者对优先用药的认识
Q4 Medicine Pub Date : 2023-07-09 DOI: 10.17749/2077-8333/epi.par.con.2023.143
A. S. Romanov, E. F. Sharakhova, N. Shova, V. Mikhailov
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引用次数: 0
Inclusion of epilepsy in life skills education of primary school learners: the perceptions of life skills advisors in Mpumalanga and Limpopo Provinces (South Africa) 将癫痫纳入小学学习者的生活技能教育:南非姆普马兰加省和林波波省生活技能顾问的看法
Q4 Medicine Pub Date : 2023-07-09 DOI: 10.17749/2077-8333/epi.par.con.2023.146
T. G. Makhado, R. T. Lebese, M. Maputle
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引用次数: 1
Overview of mathematical EEG analysis. Quantitative EEG 数学脑电图分析概述。定量脑电图
Q4 Medicine Pub Date : 2023-07-09 DOI: 10.17749/2077-8333/epi.par.con.2023.154
А. А. Ivanov
The purpose of this article is to familiarize medical specialists involved in registration and analysis of electroencephalographic (EEG) studies using methods of mathematical processing and analysis for recorded EEG data. Understanding the principles of how quantitative EEG analysis tools work should help medical personnel to properly use their capabilities and ultimately improve quality of medical care. Here, we discuss basic and innovative mathematical tools for EEG processing and analysis.
本文的目的是让参与脑电图(EEG)研究登记和分析的医学专家熟悉使用记录脑电图数据的数学处理和分析方法。了解定量脑电图分析工具的工作原理,有助于医务人员正确运用自己的能力,最终提高医疗质量。在这里,我们讨论了脑电图处理和分析的基本和创新的数学工具。
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引用次数: 1
First aid for generalized seizures: modern approaches and opportunities for improvement 全身性癫痫发作的急救:现代方法和改进的机会
Q4 Medicine Pub Date : 2023-07-09 DOI: 10.17749/2077-8333/epi.par.con.2023.142
А. А. Birkun, L. I. Dezhurny
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引用次数: 0
期刊
Epilepsy and Paroxysmal Conditions
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