[The changes in cognitive impairment in patients with epilepsy during the disease course (on example of executive functions)]. / Dinamika kognitivnogo snizheniya u bol'nykh epilepsiei na protyazhenii bolezni (na primere ispolnitel'skikh funktsii).

AIM: To identify the relationship between executive functions (EF), personality traits and clinical characteristics of disease course. MATERIAL AND METHODS: One hundred and five patients with partial epilepsy, including temporal lobe epilepsy (61%), lobe epilepsy (33%) and other forms (6%), were examined. Mean age of the patients was 30.24±8,67 years. EF were studied using the the Wisconsin Card Sorting Test (WCST) in 25 out of 105 patients of the main group. The patients were followed-up after 5.5 years. RESULTS: Correlations between the EF decline and the age, illness duration and disability was found. Seizure remission and its duration have a positive effect on EF indices. There were no correlations with the age at seizure onset, severity of seizures, amount of medications used, psychopathological symptoms and left-handedness. The WCST scores were worse in patients with temporal lobe epilepsy and patients with alexithymia. A follow-up examination showed the relationship between the further EF decline and the left-sided localization of the epileptic focus as well as the absence of seizure remission. No relationship between the EF deficit and antiepileptic treatment was found. CONCLUSION: The EF deficit was observed in all forms of epilepsy, it was correlated with disability of patients, may be aggravated by personality and neurobiological characteristics and increased with the persistence of seizures. Based on the results of the study, the achievement of remission is needed in treatment tactics for epilepsy to preserve cognitive functioning and social well-being of patients.

[About the comorbidity of affective and conversion disorders in epilepsy]. / O komorbidnosti affektivnykh i konversionnykh rasstroistv pri épilepsii.

In this literature review, special attention is drawn to the pathogenesis of conversion disorders in patients with epilepsy, in particular, with psychogenic non-epileptic seizures. Diagnostic issues and pharmacotherapy of affective and conversion disorders in patients with epilepsy is discussed.

[Personality and neurobiological factors as predictors of treatment efficacy in patients with partial epilepsy].

In the present study, we attempted to find predictors of the response to antiepileptic treatment with the adjustment for individual constitutional characteristics of patients including the profile of hemispheric asymmetry (right- and left handedness), premorbid personality, predisposition to affective and other mental disorders. We administered a large battery of tests (MMSE, HAM-A, HAM-D, TAS-26 and others). Treatment efficacy was assessed by the degree of seizure frequency reduction and remission duration. Two groups of patients, with 100% reduction of seizures after 12 months of treatment with antiepileptic drugs and with the absence of reduction of seizures, were singled out. It has been shown that left-handedness, cognitive impairment in right-handers, alexithymia and affective disorders in left-handers predict poor treatment efficacy.

[The role of sex hormones in the development of affective disorders in women with epilepsy].

The objective of this study was the comprehensive assessment of the association between the level of hormones, reproductive disorders, symptoms of epilepsy and psychopathological symptoms in female patients with epilepsy and affective disorders. We studied 101 women using clinical and psychopathological examination, hormone measurement and statistical analysis. The data analysis showed correlations between scores on the scales measuring the mental health status and the level of hormones in the blood of patients. It has been concluded that the effect of female sex hormones on affective symptoms depends on characteristics of depressive affect.

Monotherapy of epilepsy in women: psychiatric and neuroendocrine aspects.

The aim of the present work was to perform a comparative assessment of the efficacy and safety of traditional and contemporary antiepileptic agents in women of reproductive age. The experimental group consisted of 65 patients, of whom 48 had partial epilepsy and 17 had idiopathic generalized epilepsy. A number of issues were addressed in studies of a larger group of patients (110), including both women (65) and men (45). The following agents were studied: Topamax, valproates, carbamazepine, and barbiturates, all used as monotherapy. Patients' status was evaluated using clinical (neurological, psychiatric), psychometric, neuropsychological, and hormonal parameters. The data led to the general conclusion that Topamax had advantages over the other study agents in the treatment of women with epilepsy.

[Anticonvulsant and psychotropic effects of topamax capsules].

Anticonvulsant and psychotropic effects of "Topamax capsules"(TC) were compared to a traditional form of topiramate (TFT) and some other anticonvulsant drugs (ACD). Thirty-six patients (12 men and 24 women) with partial temporary epilepsy were examined. Sixteen patients received TFT in tablets and 20 patients received ACD before the beginning of the study. Drug effect was assessed by frequency of seizures and some neuropsychiatric parameters. The results revealed that TC was comparable to TFT and ACD in the reduction of seizures of any semiotics. After 3 months of therapy, total MMSE scores increased from 27 to 28. There were less perseverant errors and more right responses in the WCST. Verbal fluency and memory measured with Sunderland test improved as well. TC led to decreased latencies of negative responses in the WCST and increased verbal fluency compared to TFT. Patients who received TFT prior to TC did fewer errors in the WCST than patients who received ACD prior to TC. Verbal fluency improved compared to patients who received other ACD. At the same time, a somewhat increase of paranoid signs on the scale SCL-90 was noted in the group treated with topiramate only. It has been concluded that TC has an activating effect on frontal brain areas.

[Monotherapy of epilepsy in women: psychiatric and neuroendocrine aspects].

An aim of the study was a comparative evaluation of efficacy and safety of traditional and modern antiepileptic drugs in women of reproductive age. A main group of patients consisted of 65 women, including 48 patients with partial epilepsy and 17 - with idiopathic generalized epilepsy. Some issues are solved in the study of a larger group comprising 110 patients (65 female and 45 male). The following drugs have been studied: topamax, valproates, carbamazepines and barbiturates. All of them were used as a monotherapy. Patient's state was assessed using clinical, neuropsychological and hormonal parameters. A general conclusion is that topamax is most beneficial, comparing with other drugs studied, in the treatment of women with epilepsy.

[Psychotropic and cognitive effects of topiramate in the treatment of epileptic patients].

To study a character of topiramate (TPM) effect on psychopathological and neurocognitive processes in patients with temporal partial epilepsy, 83 patients (33 men and 50 women, mean age 29.1 +/- 10.6 years) were examined. Fifty-three patients were diagnosed with temporal cryptogenic epilepsy and 20 with temporal symptomatic epilepsy. Thirty-three patients received TPM (124 +/- 35.6 mg daily), 26--carbamazepine (819 +/- 274.2 mg daily), 15--phenobarbital (154.6 +/- 95.1 mg daily) and 11 patients received no therapy. The statistically significant difference between the groups treated with TPM and phenobarbital were found only for cognitive traits (total MMT scores, total scores on the executive functions scale, latencies of positive and negative answers in WCST, verbal fluency). TPM was more effective than phenobarbital for all traits, with the exception of verbal fluency. The comparison of patients by some parameters before and during the treatment with TPM revealed the favorable effect of the drug in the reduction of obsessive symptoms, aggressiveness and social isolation on the SCL-90 as well as higher scores on the executive functions scale and the lower latency of positive answer in WCST. The monotherapy with TPM leads to the improvement of executive functions, reduction of aggressive and obsessive symptoms that may be explained by the improvement of prefrontal brain function in epilepsy.

[Comparison of efficacy of trileptal (oxcarbazepine) and carbamazepine in the treatment of temporal epilepsy].

An aim of the study was to compare the spectrum of effects of oxcarbazepine and carbamazepine in patients with partial temporal epilepsy. Seventy-two patients (24 men and 48 women) diagnosed with cryptogenic partial epilepsy have been examined. Fifty-one patients received carbamazepine as a monotherapy in dosage 300-1200 mg/day, 21 patients were treated with oxcarbazepine in dosage 600-1500 mg daily. The results revealed the similar effects of two drugs. However some differences were also found: the effect of oxcarbazepine on complex partial seizures was more pronounced comparing to carbamazepine. These differences became evident after the first month of therapy and were related only with part of the reduction of complex partial seizures after 1, 2, and 3 month of therapy. The highest levels of significance for these differences for the complete reduction of complex partial seizures (a control over seizures) were observed after 2 and 3 months of therapy. During the therapy, oxcarbazepine was more effective than carbamazepine in the reduction of refractory complex partial seizures. In conclusion, oxcarbazepine can be considered as a drug of choice in the treatment of complex partial seizures in patients with partial epilepsy.

[A use of Magne-B6 in the treatment of anxiety-depressive states in patients with epilepsy]. / Primenenie preparata Magne-B6 dlia lecheniia trevozhno-depressivnykh sostoianii u bol'nykh épilepsiei.

Magne-B6 was used, together with anticonvulsive therapy, in the treatment of 25 patients with different forms of epilepsy. In all cases, psychiatric status of patients featured by depression, anxiety and some psychotic sighs. The drug was prescribed in the mean therapeutic dose during 28 days. Along with psychopathologic examination, a psychometric method, using self-rating scales for Zung anxiety and depression scale, SCL-90 and Global clinical impression (CGI) scale, was administered. Magne-B6 exerted a positive non-specific influence on patient's mental state, especially with regard to affective disorders. The positive effect of the drug emerged on 14th day of the treatment and achieved a statistically significant level to 28th day. The medication was more effective in asthenic and subdepressive syndromes, in encephalopathic syndrome the efficacy was lower. The drug was well tolerated and did not cause any side effects.

[Topamax monotherapy of partial epilepsy]. / Monoterapiia partsial'nykh form épilepsii topamaksom.

Thirty patients diagnosed with partial epilepsy (PE): 17 cases with cryptogenic PE, 11--with symptomatic PE and 2--with symptomatic generalized PE, have been switched to topamax monotherapy, in dosage 50-200 mg daily, for 3 months. A type of seizures--simple partial, complex partial and secondary generalized, was taken into account, when considering topamax efficacy. A complete elimination of seizures was achieved after 3 months treatment in 80% of the cases, the mostly pronounced effect being demonstrated for secondary generalized seizures. A decrease of seizures frequency was shown for all types, but in simple partial and secondary generalized seizures the effect emerged earlier (after 1 month of the treatment) comparing to complex partial seizures. Good tolerability of topamax was observed.

[Topamax in the treatment resistance partial epilepsy]. / Primenenie topamaksa pri lechenii rezistentnoi partsial'noi épilepsii.

Twenty-five epileptic patients, mean age 25.7 years, have been studied. Twenty-two of them were diagnosed with symptomatic partial epilepsy, 1--with criptogenic partial epilepsy and 2--with idiopathic partial epilepsy. Illness duration was estimated as follows: above 5 years--5 patients, above 10 years--10, above 20 years--4 and less than 5 years--6. Polymorphic seizures were detected in 56% of the cases and monomorphic ones, resistant to the previous traditional anticonvulsant therapy,--in 44%. Topamax was used as an add-on therapy to the previously prescribed anticonvulsants in initial dose of 25 mg daily, with a following continuous dose increase. The mean therapeutic dosage was 100 mg daily. Therapeutic efficacy was assessed during 3 months. Since 1 month of topamax adjunction to a treatment schedule, a mean frequency of all types of seizures was reduced. The best effect was found in the case of combination of simple partial and secondary generalized seizures. The medication was effective in 60-80% of the patients with strong resistance to traditional anticonvulsants. Topamax is concluded to be a highly effective antiepileptic medication, which gives new possibilities for a treatment of patients with partial epilepsy resistant to traditional drugs.

[Depakine syrup in the treatment of therapy-resistant epilepsy]. / Depakin-sirup pri lechenii rezistentnoi k terapii épilepsii.

Depakin syrup was given for several weeks in initial dose 300 mg/day with graded increase of the dose to 1200 mg/day to 11 patients aged 15-39 suffering from epilepsy and residual-organic affection of CNS with epileptic syndrome. A complete or partial discontinuation of the fits was achieved in 82% of the patients, primarily in those with partial and primary-generalized fits, partial fits with secondary generalization. It is concluded that depakin syrup treatment is justified in management of epilepsy, especially in the treatment-resistant cases.

[Determination of phenobarbital by solid-phase immunoenzyme analysis. Choice of optimal strategy]. / Opredelenie fenobarbitala metodami tverdofaznogo immunofermentnogo analiza. Vybor optimal'noi strategii.

Two variants (direct and indirect) of enzyme linked immunosorbent assay (ELISA) of phenobarbital are compared. Both techniques were developed on the basis of the same monoclonal antibodies, and horse radish peroxidase was used as the label in both cases. When microtitration plates are used as the solid phase, indirect ELISA, in which phenobarbital of the sample competes with phenobarbital sorbed on plates in the form of a conjugate with protein for the binding with peroxidase-labeled antiphenobarbital antibodies, is preferable. In indirect ELISA, the sample volume was 5 microliters, the time of assay was 40 min, the variability coefficient was < 8%.

[The pharmacokinetic characteristics of fenazepam in epileptics]. / Farmakokineticheskie kharakteristiki fenazepama u bol'nykh épilepsiei.

Testing the injectable dosage form of phenazepam showed no substantial pharmacokinetic differences in epileptic patients receiving a single intravenous and intramuscular doses of 2 mg. The bioavailability of the drug was 0.82. The individual and mean experimental stationary phenazepam concentration (157.3 ng/ml) in the patients' blood during course intramuscular therapy was found to be close to the theoretical stationary one (150.6 ng/ml). The pharmacokinetic findings allow one to optimize phenazepam therapy for epileptic patients.