ABSTRACT
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.
Subject(s)
Algorithms , Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Aged , Child , Drug Interactions , Drug Therapy, Combination , Female , Humans , Physicians , RussiaABSTRACT
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.
Subject(s)
Algorithms , Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Aged , Child , Drug Interactions , Drug Therapy, Combination , Female , Humans , Physicians , RussiaABSTRACT
Cryptogenic epilepsy (epilepsy with no obvious cause) is the most common form of the disease in adults. The author discuss clinical- electroencephalographic, neuroimaging (magnetic resonance tomography, positron emission tomography, proton magnetic resonance spectroscopy, diffusion tensor magnetic resonance tomography) and treatment aspects of 70 patients with cryptogenic epilepsy. A dynamic study of patients using neuroimaging methods allowed to single out two groups of patients differed by the course, outcome and treatment. The author suggests hypotheses on the explanation of processes underlying epilepsy with no obvious cause.
Subject(s)
Anticonvulsants/therapeutic use , Diagnostic Imaging/methods , Epilepsy/diagnosis , Adolescent , Adult , Brain/diagnostic imaging , Brain/pathology , Diagnosis, Differential , Electroencephalography/methods , Epilepsy/therapy , Female , Humans , Magnetic Resonance Imaging/methods , Male , Positron-Emission Tomography/methods , Prognosis , Severity of Illness Index , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Young AdultABSTRACT
A role of the white matter pathology in the pathogenesis of epilepsy is discussed. Results of the neurohistological study of the removed material of patients who were operated for pharmacoresistant temporal epilepsy are presented. The experimental study of animals that allowed to follow-up morphological changes in the cortex and underlying white matter during the formation of an epileptic focus has been conducted. The attempt has been made to evaluate in-vivo noninvasively the white matter in patients with local cryptogenic epilepsy using different functional neuroimaging methods.
Subject(s)
Epilepsy, Temporal Lobe/etiology , Epilepsy, Temporal Lobe/pathology , Leukoencephalopathies/complications , Leukoencephalopathies/pathology , Animals , Axons/ultrastructure , Epilepsy, Temporal Lobe/physiopathology , Functional Neuroimaging , Humans , Male , Myelin Sheath/ultrastructure , RabbitsABSTRACT
The results of the dynamic study of patients with epileptic seizures in chronic and acute cerebral vascular pathology are presented. Various methods of structural and functional neurovisualization--magnetic resonance tomography using perfusion- and diffusion-weighted imaging, proton magnetic resonance spectroscopy, positron emission tomography, single photon emission computed tomography were used. Based on the results obtained in the study, the authors discuss etiopathogenetic variants of the development of these seizures and new possible approaches to the complex treatment besides the administration of antiepileptic medications.
Subject(s)
Cerebrovascular Disorders/complications , Magnetic Resonance Imaging/methods , Seizures/diagnosis , Aged , Cerebrovascular Disorders/diagnosis , Diagnosis, Differential , Humans , Male , Seizures/etiologyABSTRACT
The authors present an analysis of scientific conceptions of epilepsy by the outstanding scientist and physician Herman Boerhaavey. All aspects of the disease, including etiology, pathogenesis, clinical presentations, rehabilitation, treatment, were described in the manuscripts devoted to neurology from the archive of H. Boerhaave in the Military Medical Academy.
