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Psychogenic nonepileptic seizures: to the issue of diagnosis and patient management (with a case report) 心因性非癫痫性发作:诊断与患者处理问题(附1例报告)
Q4 Medicine Pub Date : 2021-07-20 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.056
N. Shova, D. Alekseeva, V. Mikhailov
Establishing misdiagnosis “epilepsy” is a common event comprising 25% total cases of “pharmacoresistant” forms. Eventually, the majority of cases resulted in diagnosing psychogenic nonepileptic seizures, or functional seizures, conversion seizures, and dissociative seizures. Here we review publications assessing psychogenic non-epileptic seizures. The scientific resources for analysis were selected in Russian (eLibrary) and international (Pubmed/MEDLINE, Google Scholar) databases, as well as in open access resources. We also present a clinical case of a patient diagnosed with epilepsy. In particular, the patient was admitted to the hospital with complains of paroxysmal conditions starting as headache, nausea proceeding with speech arrest and decreased mindfulness of what happens in personal life. He also informed about at least two episodes of disorientation described as “missed public transport stop” and “finding himself in unfamiliar place”. The patient underwent examination (electroencephalography, brain magnetic resonance imaging) and dynamic follow-up to verify origin of such conditions. As a result, he was diagnosed with psychogenic non-epileptic seizures. Administering proper therapy allowed to achieve stabilized condition and arrest seizures. The criteria provided in the review as well as clinical case report may help clinical practitioners to timely conduct differential diagnostics and deliver specialized medical aid.
误诊“癫痫”是一种常见事件,占“耐药”形式总病例的25%。最终,大多数病例诊断为心因性非癫痫性发作,或功能性发作、转换性发作和解离性发作。在这里,我们回顾了评估心因性非癫痫发作的出版物。分析的科学资源选择在俄罗斯(library)和国际(Pubmed/MEDLINE,谷歌Scholar)数据库以及开放获取资源中。我们也提出了一个临床病例的病人诊断为癫痫。特别是,该患者入院时,主诉为阵发性症状,开始时头痛,恶心,继而言语停止,对个人生活的专注力下降。他还说自己至少有两次迷失方向的经历,被描述为“错过公共交通站”和“发现自己在一个陌生的地方”。患者接受了脑电图、脑磁共振成像检查和动态随访,以验证这些疾病的起源。结果,他被诊断为心因性非癫痫性发作。给予适当的治疗可使病情稳定并使癫痫发作停止。审查中提供的标准以及临床病例报告可以帮助临床医生及时进行鉴别诊断和提供专业医疗援助。
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引用次数: 1
Efficacy and safety of using vagus nerve stimulation in patients with pharmacoresistant epilepsy in the Russian Federation: a multi-center retrospective observational program 迷走神经刺激对俄罗斯联邦耐药癫痫患者的疗效和安全性:一项多中心回顾性观察项目
Q4 Medicine Pub Date : 2021-07-19 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.089
K. Voronkova, M. N. Klochkov, N. Koroleva, S. Ivanov, A. Dmitriev, E. S. Bolshakova, E. F. Fatykhova, A. A. Usoltseva, D. Dmitrenko, A. A. Feygina, Y. Koshelyaevskaya
Objective: to assess efficacy and safety of vagus nerve stimulation (VNS) in patients with pharmacoresistant epilepsy.Material and methods. A multi-center retrospective observational program was applied in patients with pharmacoresistant epilepsy by using vagus nerve stimulation for at least 2 years. There were enrolled 151 subjects, patient age on stimulator implantation varied from 5 to 65 years (24.4±13.1 years). Among them, subjects under 18 or at least 18 years of age comprised 58 (38.4%) and 93 (61.6%), respectively. Changes in rate and severity of major group epileptic seizures (highly disabling type) 24 months after VNS-therapy vs. baseline state as well as during 3-, 6-, 9-, 12-month follow-up were compared. There were assessed stimulator-related effects on VNS-therapy as well as patient quality of life 2 years after therapy. The dynamics of the frequency of all types of epileptic seizures was evaluated according to McHugh Outcome scale.Results. Mean epilepsy duration on stimulator implantation was 170.9±126.8 months, with maximum up to 666 months (55 years). Number of patients with dominant (disabling) seizures on implantation procedure comprised 136 (90.1%). Decline in dominant epileptic seizure rate by 50–99% was recorded in 91 patients (66.9%) 24 months after VNStherapy. Among such subjects were 41 patients (30.15%) featured with disabling seizures including 24 fully seizure free subjects (17.65%). Decreased rate of all group epileptic seizures by more than 50% (responders) was found in 52.9% cases, including subjects under 18 and adults in 63.9% and as few as 46.3% (p<0.05), respectively. While assessing dynamic rate for all groups of epileptic seizures applied with VNS-therapy by using McHugh Outcome scale it was found that class I (lowered seizure rate by 80–100%) was observed in 44 cases (29.1%), including 18 patients under 18 (31%) and 26 subjects above 18 (28%) (insignificant difference). Mean dominant group epileptic seizure rate was also significantly decreased in both age groups from 20 down to 5.7 per month. Severity of epileptic seizures and postseizure condition upon VNS-therapy was decreased in 38.6% and 43.9% patients 24 months after therapy and on final follow-up visit, respectively (more than 24 months after implantation). No serious adverse events as well as adverse effects resulting in therapy cancel were noted. Conclusion. Vagus nerve stimulation is an effective and safe auxiliary treatment method for therapy of pharmacoresistant epilepsy both in children and adults.><0.05) , respectively. While assessing dynamic rate for all groups of epileptic seizures applied with VNS-therapy by using McHugh Outcome scale it was found that class I (lowered seizure rate by 80–100%) was observed in 44 cases (29.1%), including 18 patients under 18 (31%) and 26 subjects above 18 (28%) (insignificant difference). Mean dominant group epileptic seizure rate was also significantly decreased in both age groups from 20 down to 5.7 per mon
目的:评价迷走神经刺激(VNS)治疗耐药癫痫的疗效和安全性。材料和方法。本研究采用多中心回顾性观察方案,通过迷走神经刺激治疗耐药癫痫患者至少2年。共入组151例,患者年龄5 ~ 65岁(24.4±13.1岁)。其中18岁以下58人(38.4%),18岁以上93人(61.6%)。比较vns治疗后24个月与基线状态以及3、6、9、12个月随访期间主要组癫痫发作(高度致残型)的发生率和严重程度的变化。评估了刺激器对vns治疗的相关影响以及治疗后2年患者的生活质量。根据McHugh结局量表评估所有类型癫痫发作频率的动态变化。刺激器植入后的平均癫痫持续时间为170.9±126.8个月,最长可达666个月(55年)。植入过程中出现显性(致残)癫痫发作的患者占136例(90.1%)。91例患者(66.9%)在接受vns24个月后,优势癫痫发作率下降50-99%。其中41例(30.15%)为致残性癫痫发作,24例(17.65%)为完全无癫痫发作。52.9%的患者组癫痫发作率降低50%以上(反应者),其中18岁以下患者组降低63.9%,成人组降低46.3% (p<0.05)。采用McHugh结局量表评估vns治疗的各组癫痫发作动态率,发现I级(癫痫发作率降低80-100%)44例(29.1%),其中18岁以下18例(31%),18岁以上26例(28%)(差异无统计学意义)。两个年龄组的平均优势组癫痫发作率也显著下降,从每月20次降至每月5.7次。vns治疗后24个月(植入24个月以上)和最后一次随访时,分别有38.6%和43.9%的患者癫痫发作的严重程度和癫痫发作后的状况有所下降。未见严重不良事件及导致治疗取消的不良反应。迷走神经刺激是治疗儿童和成人耐药癫痫的一种有效、安全的辅助治疗方法。
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引用次数: 1
Periodic discharges with triphasic morphology: a differential diagnosis and therapeutic approaches 周期性放电与三相形态:鉴别诊断和治疗方法
Q4 Medicine Pub Date : 2021-07-19 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.052
D. S. Kan’shina, I. V. Okuneva, A. V. Vakhlyaev, O. Bronov
The article presents two clinical cases of intensive care unit (ICU) patients with periodic discharges. Examination according to the American Clinical Neurophysiology Society (ACNS) protocol with the use of electroencephalography and functional probes allows differential diagnosis of periodic discharges, which makes it possible to conduct early pathophysiological treatment, to assess its effectiveness in dynamics and to avoid unjustified prescription of antiepileptic drugs. At the same time, the prognosis of the disease and the effectiveness of treatment are largely determined by the etiology of the disease. Evaluation of periodic discharges of three-phase morphology in ICU, considering its nosological nonspecificity, is rational to carry out according to the ACNS recommendations, indicating the ictal genesis, background activity, response to antiepileptic drugs.
本文报道两例重症监护病房(ICU)患者周期性出院的临床病例。根据美国临床神经生理学会(ACNS)协议,使用脑电图和功能探针进行检查,可以对周期性放电进行鉴别诊断,从而可以进行早期病理生理治疗,以评估其动态有效性,并避免不合理的抗癫痫药物处方。同时,该病的预后和治疗效果在很大程度上取决于该病的病因。考虑到ICU患者的病分学非特异性,根据ACNS推荐进行三相形态周期性出院评估是合理的,可以显示患者的发病原因、背景活动、对抗癫痫药物的反应。
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引用次数: 0
Early infantile epileptic encephalopathy type 54: clinical and neurophysiological aspects 早期婴儿癫痫性脑病54型:临床及神经生理方面
Q4 Medicine Pub Date : 2021-07-19 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.053
D. I, V. A. Aysina
A clinical case of a boy aged 20 months old with early infantile epileptic encephalopathy (EIEE) type 54 due to mutated HNRNPU gene presumably suffering from genetic generalized epilepsy and impaired psychomotor development is described. Exome-wide sequencing was carried out by using NextSeq 500 (Illumina, USA). Video electroencephalographic (VEEG) monitoring was conducted by using NeuroScope NS425 (Biola, Russia). The patient was noted to suffer from neonatal delayed motor development and muscular hypotonia with atypical petit mal epilepsy with regional onset at the occipital-parietal-posterior temporal areas based on VEEG data developed at age of eight months as well as progressive psychoemotional disorders. Ethosuximide and valproic acid administered together were efficient in alleviating EIEE seizures that requires to be further followed up. The data obtained allow to identify a precise etiology of epilepsy and apply a differential approach to administer anti-epileptic agents.
本文报道1例20月龄男孩,因HNRNPU基因突变而出现早期婴儿癫痫性脑病(EIEE) 54型,可能患有遗传性全身性癫痫和精神运动发育障碍。使用NextSeq 500 (Illumina, USA)进行全外显子组测序。视频脑电图(VEEG)监测采用NeuroScope NS425 (Biola, Russia)。根据8个月大的VEEG数据,该患者患有新生儿运动发育迟缓和肌肉张力低下,并伴有非典型小癫痫,区域性发病于枕-顶叶-后颞区,并伴有进行性精神情绪障碍。乙索酰亚胺和丙戊酸联合用药对缓解eee发作有效,需进一步随访。获得的数据允许确定癫痫的精确病因和应用不同的方法来管理抗癫痫药物。
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引用次数: 0
Assessing efficacy and safety of buccally inoculated midazolam and intravenously administered diazepam for relieving pediatric primary generalized epileptic seizures 评估口腔接种咪达唑仑和静脉注射地西泮缓解小儿原发性全面性癫痫发作的有效性和安全性
Q4 Medicine Pub Date : 2021-07-19 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.088
A. G. Prityko, K. V. Osipova, P. L. Sokolov, E. A. Ezhova, I. G. Kotel’nikova, E. Lukyanova, G. A. Osipova
Objective: to confirm a therapeutic equivalence and similar safety profile of “Midazolam, oromucosal (buccal) solution” and “Sibazon, solution for intravenous and intramuscular administration” used in children aged from 1 year to 18 years suffering from primary generalized and bilateral tonic, clonic and tonic-clonic seizures.Material and methods. An open-label, randomized clinical trial on efficacy and safety was conducted with 25 patients having primary generalized and bilateral tonic, clonic and tonic-clonic seizures due to epilepsy or epileptic syndrome. The study used age-appropriate doses of Midazolam with a single buccal administration as well as diazepam (Sibazon) for single intramuscular administration. Midazolam dosing was as follows: 5 mg for children of the younger age group (1 tube-dropper 5 mg/ml), 7.5 mg for children of the middle age group (1 tube-dropper 5 mg/ml and 1 tube-dropper 2.5 mg/ml), 10 mg for older children (2 tube-droppers 5 mg/ml). The drug effectiveness was assessed by primary and secondary criteria. The number of cases of drug administration in each group was used as the primary criteria, in which the convulsions ended up within 10 minutes after using the drug and did not resume within 60 minutes after drug administration. The following criteria were used as secondary: no repeated convulsive seizures within 24 hours after drug administration, no repeated convulsive seizure within 48 hours after drug administration, time before repeated convulsive seizure within 48 hours after drug administration. Clinical assessment was carried out according to clinical data, electroneurophysiologic (electroencephalographic) studies, electrocardiography, clinical blood and urine tests, aswell as biochemical blood tests by measuring glucose, total protein, albumin, total bilirubin, cholesterol, aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, alkaline phosphatase, creatinine, urea, and creatinine clearance level.Results. Compliance with the first efficacy criterion after using Midazolam and Sibazon was observed in 11 (84.6%) and 9 (75%) patients in Group 1 and Group 2, respectively, showing insignificant differences (Fisher's exact test (FET): p=0.645). The number of no cases of repeated convulsive seizure within 24 hours after drug administration differed significantly and was 12 (92.3%) and 6 (50%), respectively (FET: p=0.030). The number of cases with no second seizures within 48 hours after drug administration in Group 1 and Group 2 was 12 (92.3%) and 5 (41.7%), respectively, showing insignificant differences (FET: p=0.0112). No serious adverse events were reported during the study. No patients cancelled participation in the study due to developed adverse event.Conclusion. The data obtained evidence about compatibility of therapeutic efficacy profile and similar safety profile for “Midazolam, oromucosal (buccal) solution” and “Sibazon, solution for intravenous and intramuscular administration” that ag
目的:确认“咪达唑仑口腔粘膜(颊)溶液”和“西巴松静脉及肌内给药溶液”用于1 - 18岁原发性全身性和双侧强直、阵挛和强直-阵挛性癫痫患儿的治疗等效性和相似的安全性。材料和方法。对25例因癫痫或癫痫综合征发生原发性全身性和双侧强直性、阵挛性和强直-阵挛性发作的患者进行了一项开放性、随机化的疗效和安全性临床试验。该研究使用适合年龄剂量的咪达唑仑单次口腔给药,以及地西泮单次肌肉给药。咪达唑仑的剂量为:低龄儿童5mg(1支管滴5mg /ml),中年儿童7.5 mg(1支管滴5mg /ml和1支管滴2.5 mg/ml),大龄儿童10mg(2支管滴5mg /ml)。采用一级和二级标准评价药物疗效。以各组给药例数为主要标准,惊厥在给药后10分钟内结束,在给药后60分钟内未恢复。继发性标准为:给药后24小时内无反复惊厥发作,给药后48小时内无反复惊厥发作,给药后48小时内反复惊厥发作前时间。根据临床资料、神经电生理(脑电图)检查、心电图、临床血、尿检查,以及血液生化检查(葡萄糖、总蛋白、白蛋白、总胆红素、胆固醇、天冬氨酸转氨酶、丙氨酸转氨酶、肌酸磷酸激酶、碱性磷酸酶、肌酐、尿素、肌酐清除率)进行临床评价。使用咪达唑仑和西巴松后,1组11例(84.6%)患者符合第一疗效标准,2组9例(75%)患者符合第一疗效标准,差异无统计学意义(Fisher精确检验(FET): p=0.645)。给药后24小时内无反复惊厥发作的例数差异有统计学意义,分别为12例(92.3%)和6例(50%)(FET: p=0.030)。1组和2组给药后48 h内无第二次癫痫发作的例数分别为12例(92.3%)和5例(41.7%),差异无统计学意义(FET: p=0.0112)。研究期间未见严重不良事件的报道。没有患者因不良事件而取消参加研究。该数据获得了“咪达唑仑口腔粘膜(口腔)溶液”和“西巴松静脉及肌内给药溶液”的治疗效果和类似安全性的相容性证据,这与早期研究的多项数据一致。
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引用次数: 0
Evaluation of the effectiveness of electroconvulsive therapy in the treatment of psychosis in a patient with epilepsy. Clinical case 电休克治疗癫痫患者精神病的疗效评价。临床病例
Q4 Medicine Pub Date : 2021-07-13 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.084
T. Dokukina, F. Khlebokazov, I. I. Khvostova, N. Misyuk, K. A. Bondar, P. Korolevich, E. Slobina, I. S. Glavinskiy
The results of successful treatment of schizophrenic psychosis with persistent catatonic symptoms, refusal to eat in a patient with epilepsy are presented. In view of the progressive course of the disease, the lack of dynamics from the ongoing drug treatment, the method of electroconvulsive therapy was applied. Epileptic seizures and visual signs of brain epileptization were absent with the development of psychosis. As a result of the course of electroconvulsive therapy (9 procedures), the patient's clinical condition improved significantly. This observation illustrates the possibility of using electroconvulsive therapy in combination with antipsychotics and antiepileptic drugs as an alternative method for treating drug-resistant epilepsy.
结果成功治疗精神分裂症精神病与持续紧张性症状,拒绝进食的癫痫患者提出。鉴于病情进展,持续药物治疗缺乏动力,采用电休克治疗方法。随着精神病的发展,没有癫痫发作和脑癫痫的视觉迹象。经过9次电休克治疗,患者临床状况明显改善。这一观察结果说明了使用电痉挛疗法联合抗精神病药物和抗癫痫药物作为治疗耐药癫痫的替代方法的可能性。
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引用次数: 1
I stood on the shoulders of giants 我站在巨人的肩膀上
Q4 Medicine Pub Date : 2021-07-13 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.072
V. Karlov
The author dedicated the article to the outstanding scientific achievements of his mentors, who represented the Moscow Neurological School founded by Dr. E.K. Sepp and Dr. M.B. Zucker, and accompanied his story with invaluable personal memories about their everyday scientific and clinical practice and personal human qualities. It also demonstrated how the fundamental concepts put forward by Dr. E.K. Sepp were developed and expanded by his students by using modern research methods.
作者将这篇文章献给了他的导师们杰出的科学成就,他们代表了由E.K. Sepp博士和M.B. Zucker博士创立的莫斯科神经学学院,并伴随着他的故事讲述了关于他们日常科学和临床实践以及个人人性品质的宝贵个人记忆。它还展示了E.K.塞普博士提出的基本概念是如何被他的学生利用现代研究方法发展和扩展的。
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引用次数: 0
Epilepsy: take care of the women’s beauty from childhood 癫痫病:从小呵护女性美丽
Q4 Medicine Pub Date : 2021-07-13 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.081
I. Zhidkova
The report considers an important issues of the course and treatment of epilepsy in women. Specific aspects of the problem are noted, the basic principles and features of the treatment of female epilepsy are shown, the problems of pregnancy planning are discussed.
该报告审议了妇女癫痫病程和治疗的一个重要问题。指出了问题的具体方面,显示了治疗女性癫痫的基本原则和特点,讨论了计划生育的问题。
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引用次数: 0
Clinical evolution of perinatal pathology. Dialogues with the Teacher 围产期病理的临床进展。与老师的对话
Q4 Medicine Pub Date : 2021-07-13 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.079
E. Morozova
Here are reported the data of investigating clinical evolution of perinatal brain pathology performed under the auspices of Professor V.A. Karlov. Analysis of the data obtained revealed an importance for detecting ante- and intranatal predictors for most relevant neurological disorders in childhood: neonatal seizures, some epilepsy forms, headache and attention deficit / hyperactivity disorders. The speaker argues for the necessity to conduct topical diagnostics of the nervous system disturbances in neonates and justifies a relationship between early and delayed neurological disorders in diverse pediatric periods.
这里报告了在V.A.卡尔洛夫教授主持下调查围产期脑病理临床演变的数据。对所获得数据的分析显示,对于检测大多数相关儿童神经系统疾病(新生儿癫痫发作、某些癫痫形式、头痛和注意缺陷/多动障碍)的产前和产后预测因素具有重要意义。演讲者认为有必要对新生儿的神经系统紊乱进行局部诊断,并证明了不同儿科时期早期和延迟神经系统疾病之间的关系。
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引用次数: 0
Russian League Against Epilepcy: the answer to the present challenge 俄罗斯抗癫痫联盟:当前挑战的答案
Q4 Medicine Pub Date : 2021-07-13 DOI: 10.17749/2077-8333/EPI.PAR.CON.2021.085
V. Karlov
Closing the conference, Professor V.A. Karlov, President of the Russian League Against Epilepsy (RLAE), shows how to use it’s potential to solve the most important tasks set for the present domestic medicine. He touches upon the problems of health care financing, treatment of epilepsy “through life”, interdisciplinary interaction of epileptologists with obstetricians and gynecologists, neurologists, psychiatrists, neurosurgeons, as well as the state of the epileptological service in the Russian Federation as a whole.
俄罗斯抗癫痫联盟(RLAE)主席V.A. Karlov教授在会议结束时展示了如何利用它的潜力来解决当前国内医学面临的最重要任务。他谈到了保健筹资、癫痫"终生"治疗、癫痫医生与妇产科医生、神经科医生、精神科医生、神经外科医生的跨学科互动以及整个俄罗斯联邦的癫痫服务状况等问题。
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引用次数: 3
期刊
Epilepsy and Paroxysmal Conditions
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