[Structural brain changes in patients with temporal lobe epilepsy and comorbid depression]. / Strukturnye izmeneniya golovnogo mozga u patsientov s visochnoi epilepsiei i komorbidnoi depressiei.

OBJECTIVE: To assess the morphological features of the brain structures in patients with temporal lobe epilepsy and comorbid depression. MATERIAL AND METHODS: From 1 January 2017 to 31 December 2020, we studied 80 patients with temporal lobe epilepsy (aged 18-60 years, 38 of whom had comorbid depression) and 48 healthy subjects of comparable age. Magnetic resonance imaging (MRI) of the brain was performed using the epilepsy protocol in a scanner with a magnetic field strength of 1.5 T. Focal temporal lobe epilepsy was diagnosed by neurologists (epileptologists) specialising in epilepsy according to the International League Against Epilepsy (ILAE) classification of epilepsy. Psychiatrists assessed the presence and severity of depressive disorders by clinical interview and by participants' scores on the Beck Depression Inventory (BDI-II). MRI data were processed using FreeSurfer 6.0 software to determine volumes of subcortical structures and thicknesses of cortical structures. At the group level, analysis of covariance with Holm-Bonferroni correction was used as the statistical method. RESULTS: Morphometric analysis revealed a significant decrease in the volume of the thalamus bilaterally and the brain stem and an increase in the volume of the choroid plexus in the left hemisphere, as well as a significant decrease in the thickness of the entorhinal cortex, temporal pole and isthmus of the cingulate gyrus in the left hemisphere and middle temporal gyrus and inferior temporal gyrus in the right hemisphere in patients with epilepsy compared to healthy controls. No association was found between the presence of depression and significant structural changes on MRI. CONCLUSION: The data obtained suggest an effect of temporal lobe epilepsy, but not comorbid depression, on the morphology of brain structures.

[Psychogenic non-epileptic seizures in autistic spectrum disorder]. / Psikhogennye neepilepticheskie pristupy pri rasstroistve autisticheskogo spektra.

Psychogenic non-epileptic seizures (PNES) are paroxysmal conditions that resemble epileptic seizures, but are not accompanied by epileptiform activity on the electroencephalogram and are not associated with other neurological or somatic disorders. Unrecognized PNES places a heavy burden on the patient and family, and on the health care system. Among many possible combinations of PNES with psychiatric disorders, autistic spectrum disorders are the least studied. This article presents a case of a 19-year-old female patient with autistic spectrum disorder and paroxysmal events and the presence of potentially epileptogenic changes in the brain. A multidisciplinary approach made it possible to diagnose PNEP in the patient.

[Comorbidity of psychogenic non-epileptic seizures with mental disorders]. / Komorbidnost' psikhogennykh neepilepticheskikh pristupov s psikhicheskimi rasstroistvami.

The present review discusses the comorbidity of psychogenic non-epileptic seizures (PNES) with other mental disorders. Data on the prevalence of mood, anxiety, psychotic and personality disorders are presented. The role of traumatic experience in the development of PNES is described. Special attention is given to PNES as an independent nosological entity and its place in the modern classifications of mental disorders.

Epilepsy and COVID-19: Management of Patients and Optimization of Antiepileptic Treatment in the Pandemic.

There are as yet no data pointing to any increase in the incidence of the novel coronavirus infection (COVID-19) or a more severe course of illness in patients with epilepsy. However, considering the high prevalence of epilepsy in patients over 60 years of age, the high comorbidity of epilepsy and a whole series of somatic diseases, and the need to maintain the opportunity for constant access to antiepileptic medications and follow-up of epilepsy patients, we can expect a whole set of difficulties in the management of these patients in the conditions imposed by the COVID-19 pandemic. This article addresses the main principles of the management of epilepsy patients in the conditions of the COVID-19 pandemic: the need to follow regimes; preservation of regular and continuous taking of antiepileptic drugs, including consideration of interdrug interactions; and switching patients to i.v. forms of antiepileptic drugs where necessary.

[Long-term postoperative outcomes in patients with drug-resistant epilepsy]. / Otdalennye rezul'taty khirurgicheskogo lecheniya patsientov s farmakorezistentnymi formami epilepsii.

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 pathology¼ - 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.

[Psychogenic non-epileptic seizures]. / Psikhogennye neepilepticheskie pristupy.

The review provides epidemiological data and discuss the associated burden of non-epileptic seizures (PNES). Data on the prevalence, socio-demographic and clinical risk factors for the development of PNES are presented. The hypotheses of the PNES origin, including the contribution of psychological trauma, are considered. We also describe contemporary methods for differential diagnosis of epileptic seizures and PNES, including biomarkers and the use of diagnostic questionnaires. Special attention is given to the issues of the psychiatric comorbidity of PNES.

[Epilepsy and COVID-19: patient management and optimization of antiepileptic therapy during pandemic]. / Epilepsiya i COVID-19: vedenie bol'nykh i optimizatsiya protivoepilepticheskoi terapii v usloviyakh pandemii.

There is currently no data on the increased incidence of new coronavirus infection (COVID-19) or on the more severe course of the disease in patients with epilepsy. However, given the high prevalence of epilepsy among patients after age 60, an increased burden of somatic comorbidities among people with epilepsy, as well as the need of continuous access to antiepileptic drugs (AED) and care for patients with epilepsy, there are a number of important concerns in time of regarding the management of epilepsy during COVID-19 pandemic. The article discusses the main principles of epilepsy management during the COVID-19 pandemic: the need to comply with the regime; the importance of AED adherence, taking into account drug-drug interactions; switching patients to intravenous AED forms if necessary.

[Patterns of brain functional connectivity in frontal and temporal lobe epilepsies]. / Patterny funktsional'noi konnektivnosti mozga pri visochnoi i lobnoi épilepsii.

AIM: To examine alterations of functional connectivity (FC) of the brain in patients with frontal and temporal lobe epilepsies. MATERIAL AND METHODS: Forty-three patients, aged 18-55 years, including 32 with temporal lobe epilepsy (TLE) and 11 with frontal lobe epilepsy (FLE), and 32 age/gender-matched healthy controls (HC) underwent structural and functional MRI on 1,5 T scanner. Imaging data were further analysed for functional connectivity characteristics by seed-based and ICA analyses. RESULTS: Most prominent in the TLE group, was a decrease in FC of insula and peri-insular cortical regions compared to HC. These alterations of FC in left-side TLE were significant on the left. An increase of FC between dorsal part of attention resting network and regions of temporal and parietal cortices characterized right-side TLE. In addition, TLE group had decreased FC between anterior cingulate and basal ganglia. All the significant alterations of FC in FLE related to increased FC in patients compared to HC. FC of temporal regions was altered to a greater extent. CONCLUSION: Localization and lateralization of seizure focus determines the alterations of brain FC in patients with focal epilepsy.

[Psychometric properties of the Stigma Scale of Epilepsy]. / Psikhometricheskie svoistva shkaly stigmy pri épilepsii.

AIM: To assess the psychometric properties of the Stigma Scale of Epilepsy, a short simple to complete questionnaire to quickly and reliably determine the presence and the level of perceived stigma in a particular patient, as well as to assess the prevalence, socio-demographic, clinical and socio-psychological factors associated with this phenomenon. MATERIAL AND METHODS: The study included 398 patients with epilepsy. Exploratory (EFA) and confirmatory factor analysis (CFA) were used to assess the psychometric characteristics of the scale. RESULTS AND CONCLUSION: The EFA showed a two-factor scale structure explaining 57.25% of the variance. Values of GFI 0.948, CFI 0.927 and RMSEA 0.057 after the data correction show a good conformity of the model to the empirical data. Cronbach's alpha coefficient was 0.862 for the scale, 0.815 for factor 1, 0.809 for factor 2, which indicates a high consistency of both the entire scale and its subscales. The Russian-language variant of the Stigma Scale of Epilepsy is a short, economical to use tool with good psychometric properties for assessing perceived stigma in patients with epilepsy.

[Epilepsy as a social problem]. / Épilepsiia kak sotsial'naia problema.

The article considers the problem of social restrictions caused by epilepsy. Information on historical aspects and discrimination of patients with epilepsy is presented. The authors consider factors influencing marital status of patients in different countries and present information on the differences in medical restrictions to driving in different countries and in the Russian Federation. Employment status of patients with epilepsy, restrictions related to objective reasons and attitudes of patients and others toward epilepsy are elucidated.

[Prognosis for surgical treatment of pharmacoresistant epilepsy: the role of mental and cognitive disorders]. / Prognoz khirurgicheskogo lecheniia farmakorezistentnoi épilepsii: rol' psikhicheskikh i kognitivnykh rasstroistv.

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.

[Suicidality in epilepsy: epidemiology and clinical risk factors]. / Suitsidal'nost' pri épilepsii: épidemiologicheskie aspekty i faktory riska.

The results of studies on the prevalence of suicidal behavior in patients with epilepsy are discussed in the article. The reasons for the high incidence of suicides among patients with epilepsy are given, with special attention paid to social, demographic, clinical and pathopsychological risk factors. Existing gaps in our knowledge about suicidal behavior in patients with epilepsy are analyzed.

[Neuronet restructuring in focal and generalized epilepsy according to resting state fMRI]. / Neirosetevye perestroiki pri fokal'noi i generalizovannoi épilepsii po dannym fMRT pokoia.

AIM: To compare neuronet restructuring in focal and generalized epilepsy. MATERIAL AND METHODS: Seventy-seven patients, aged from 18 to 65 years, with the diagnosis of epilepsy, including 63 patients with focal epilepsy and 14 with generalized epilepsy, were examined. A control group included 23 healthy people. Neuronet restructuring was studied using fMRI. RESULTS AND CONCLUSION: According to resting state fMRI, there were between-group differences in spatial organization (activity map) of the brain structures as well as in the results of cross-correlation analysis of interaction maps of resting-state networks. It has been concluded that functional restructuring in connectomes in focal and generalized epilepsy have the opposite patterns of disorganization (toward increase or decrease) in most structures studied though there are structures with the same direction of connectivity changes.

[Perampanel in the treatment of patients with epilepsy]. / Mesto perampanela v terapii patsientov s épilepsiei.

Development of new antiepileptic drugs (AED) does not stop due to the fact that the number of patients with pharmacoresistant epilepsy remains at about 30%. One of the newest AEDs is perampanel (PER), a selective, non-competitive AMPA receptor antagonist to target post-synaptic glutamate transmission. PER is approved in the Russian Federation as adjunctive treatment for focal seizures with or without secondarily generalized seizures and for primary generalized tonic-clonic (PGTC) seizures in idiopathic generalized epilepsy (IGE) in patients with epilepsy aged ≥12 years. The drug is effective and well-tolerated in the dose of 4-8 mg/day, and most side effects are dose-dependent. The high efficacy of PER combined with the good tolerability, absence of life-threatening adverse reactions and convenient intake allow us to recommend PER as the first choice additional drug in treatment of patients with epilepsy.

[Depression and epilepsy: comorbidities, pathogenesis, principles of therapy]. / Depressiya i epilepsiya: komorbidnost', patogeneticheskoe skhodstvo, printsipy terapii.

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.

Changes in the levels of inhibitory and excitatory amino acids in the brain structures of female rats with cobalt epileptogenic focus during different phases of the estrous cycle.

We studied changes in the levels of inhibitory and excitatory neurotransmitters in female rat brain structures during different phases of the estrous cycle in health and after creation of a cobalt epileptogenic focus at stage I of epileptogenic system development. The most pronounced shifts were found in the contralateral cortex, where the levels of GABA and glycine decreased significantly during the diestrus-2 phase (corresponding to menstruation), which attests to a convulsive threshold decrease during this period.

[Association study of the SCN1 gene polymorphism and effective dose of lamotrigine].

An association between a polymorphism of the SCN1 gene, a therapeutical target of lamotrigine, and an effective dose (a blood plasma concentration) of the drug in patients with epilepsy has been studied. Fifty patients with different forms of epilepsy have been genotyped for the SCN1 IVS5N+5 G>A polymorphism using polymerase chain reaction. The distribution of allelic variants was as follows: 23 patients had the mutant homozygous genotype (V/V), 20 - the heterozygous genotype Wt/V and 7 were homozygous for the wild allele (Wt/Wt). Mean lamotrigine doses were 85,7+/-7,4 mg/day for carriers of the Wt/Wt genotype, 113,75+/-7,13 mg/day for the Wt/V genotype and 142,4+/-15,43 mg/day for the V/V genotype. Peak plasma concentrations corresponded to effective doses were 0,6+/-0,065 mg/ml for Wt/Wt, 0,96+/-0,1 mg/ml for V/V and 0,72+/-0,1 mg/ml for Wt/V. The hypothesis on the association between the SCN1 IVS5N+5 G>A polymorphism and the effective dose (concentration) of lamotrigine was confirmed. The significantly higher frequency of the SCN1A mutation in the group of patients with epilepsy compared to the control group of Caucasians (45,5 and 21,3%, respectively) implies that this polymorphism may contribute to the pathogenesis of epilepsy.