[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.

[Electroencephalography in acute stroke]. / Elektroentsefalografiya v ostrom periode insul'ta.

OBJECTIVE: To determine the incidence of non-convulsive status epilepticus, epileptiform activity, rhythmic and periodic patterns in patients with acute stroke. MATERIAL AND METHOD: An analysis of electroencephalography (EEG) in 86 stroke patients in the neurointensive care unit of the tertiary medical center was performed. Criteria for starting EEG recording were epileptic seizures or clinical suspicion of uncontrolled epileptic status. The ictal-interictal continuum biomarkers and the diagnostic value of EEG for prediction of survival and recovery were assessed. RESULTS: Pathological changes on EEG were recorded in 84% of patients. These patients showed the absence of the dominant occipital rhythm (66%) and hemispheric slowing (42%). Diffuse slowing below the theta range was observed in 41% of patients. EEG reactivity was absent in 20%. Sporadic epileptiform discharges were recorded in 36% of patients and rhythmic and periodic patterns in 26%. Reliable predictors of the unfavorable outcome were the absence of dominant occipital rhythm, lack of reactivity, and low amplitude of the background EEG. No association between the recording of epileptiform activity and the probability of death was shown. CONCLUSION: The most useful EEG biomarkers for predicting survival are amplitude, dominant frequency of background EEG activity and reactivity to external stimulus. Sporadic epileptiform discharges, rhythmic, and periodic patterns are not mandatory associated with a negative prognosis in stroke patients.

[Pharmacoeconomic aspects of monotherapy of focal epilepsy]. / Farmakoékonomicheskie aspekty monoterapii fokal'noi épilepsii.

AIM: To perform a clinical/economic comparison of monotherapy with antiepileptic drugs (AED) in patients with newly diagnosed focal epilepsy (FE) based on the results of previous studies. MATERIAL AND METHODS: The most common AEDs (carbamazepine (CBZ), oxcarbazepine (OXZ), lamotrigine (LTG), lacosamide (LCM)) were compared in patients, aged 16 years and over, with illness duration of five years. RESULTS AND CONCLUSION: CBZ, OXZ and LCM can be used as monotherapy in patients with newly diagnosed FE. Monotherapy with LCM is associated with lowest costs for stopping focal seizures and the highest percentage of seizure-free patients. CBZ remains the most economical AED: the cost-effectiveness is minimal compared to all other AEDs used in the study. However, monotherapy with LCM is advisable if it is necessary to minimize side-effects in patients with newly diagnosed FE.

[Posttraumatic seizures: a prospective cohort study]. / Posttravmaticheskie pristupy: prospektivnoe kogortnoe issledovanie.

AIM: To evaluate the incidence and risk factors for posttraumatic seizures (PTS). MATERIAL AND METHODS: The authors conducted a prospective study of 237 patients with TBI of varying severity. The patients were hospitalized and examined in Moscow neurosurgery departments. Then they participated in the follow-up observation for 2 years. PTS were classified as early (occurred from 1 to 7 days after TBI) and late (occurred later than 7 days). RESULTS AND CONCLUSION: Forty-three people (18.1%) experienced early seizures, 15 patients (6.3%) had late seizures. The early seizures were the significant predictor of the late seizures. In the group of patients with early seizures, the proportion of severe TBI was significantly higher. Subdural hematoma, depressed skull fracture, alcohol abuse were reliable predictors of early and late PTS. Thus, these factors increased the risk of posttraumatic epilepsy (PTE).

[Outcomes of surgical treatment of patients with pharmacoresistant epilepsy]. / Iskhody khirurgicheskogo lecheniya patsientov s farmakorezistentnymi formami epilepsii.

AIM: To evaluate the results of surgical treatment of patients with pharmacoresistant epilepsy. MATERIAL AND METHODS: Examination and surgical treatment of 61 patients with pharmacoresistant forms of symptomatic epilepsy were performed from 01.01.14 to 01.05.16. RESULTS AND CONCLUSION: The results confirmed the safety and efficacy of the surgical treatment of pharmacoresistant epilepsy. After 12 months, seizures were controlled in 69% of operated patients. The necessity of complex examination of all patients with pharmacoresistant epilepsy to make a decision about possible surgery is shown.