[The role of the phenosanic acid in the combined treatment of patients with epilepsy]. / Rol' fenozanovoi kisloty v lechenii patsientov s epilepsiei.

Epilepsy is one of the most studied chronic neurological disorders in the world. Despite significant progress in epilepsy research, some patients continue to experience recurrent seizures. It has been proven that oxidative stress plays an important role in epilepsy. Targeting oxidative stress may provide a novel therapeutic intervention to attenuate epileptogenesis as well as cognitive and psychiatric impairment in patients with epilepsy. One of the promising directions in the search for new strategies for the treatment of epilepsy is the combined use of antiepileptic drugs with antioxidants that affect the pathogenetic links of this disease. The new Russian antiepileptic drug fenosanoic acid (Dibufelon) has an anticonvulsant effect due to the inhibition of lipid peroxidation of brain cells and the reconstruction of cell membranes. This mechanism of action also paves the way for an increase in the effectiveness of co-administered drugs with phenosanoic acid. The effect of the drug on the cognitive and mental functions of patients, the regression of asthenia phenomena is also observed. The clinical efficacy and safety of the combination of this drug with other antiepileptic drugs in epilepsy has been demonstrated in experimental and clinical studies.

[Lacosamide (vimpat). Prospects for clinical application]. / Lakosamid (vimpat). Perspektivy klinicheskogo primeneniia.

This article presents the review of the most significant studies of the efficacy and tolerability of lacosamide (LCM) in treatment of patients with focal epilepsy. The review includes the results of the main studies which preceded the official approval of LCM use in mono- and polytherapy. Results on the efficacy of LCM in long-term use and treatment retention in clinical practice, most effective LCM combinations, tolerability, an influence on cognitive and mental functions, advantages in treatment of elderly patients are presented. Characteristics of LCM in comparison with other sodium channel-blocking antiepileptic drugs and selection priorities are shown. The authors assess perspectives of further use of LCM in clinical practice.

[Focal features of idiopathic generalized epilepsy].

Idiopathic generalized epilepsies (IGE), in some cases, have focal features in the kinematic of seizures and in the EEG. The aim of the paper was to study these clinical phenomena using video-EEG monitoring. We studied 180 patients (80 men and 100 women) with different forms of IGE with epileptic seizures recorded with this method. The effect of the "superposition" of focal electro-clinical features on the kinematic matrix and EEG pattern of the generalized myo- (clonic)-tonic-clonic seizures was noted. The authors suggest to discuss the definition of the "phenomenon of secondary focalization". This is the clinical/electroencephalographic phenomenon developed in IGE and presented by the appearance of secondary focal features (clinical and electroencephalographic) in the structure of the generalized epileptic seizure. The evidence for the secondary generalization of the seizure with the presence of the regional cortical ictogenic source as well as the diagnosis of focal epilepsy are the exclusion criteria for the phenomenon of secondary focalization.

[Focal characteristics in the clinical examination and EEG in children with idiopathic generalized epilepsy].

The aim of the study was to determine the prevalence of focal characteristics in the clinical symptoms of seizures and in EEG in children with different clinical variants of generalized idiopathic epilepsy. We studied 71 patients, 29 boys and 42 girls, aged from 2 to 18 years. Video-EEG-monitoring and MRI were performed in all cases. The results provided further evidence fort the continuum between focal and generalized epilepsy supported by the presence of focal characteristics in the semiology of seizures and in EEG as well.

[Lacosamide in the treatment of epilepsy].

The new antiepileptic drug (AED) lacosamide (vimpat, "UCB Pharma") with a new mechanism of action was registered in Russia in 2010. The drug should be used as add-on treatment in patients over 16 years and older with non-controlled focal seizures with- or without secondary localization. The authors review the data of literature and the results of trials on efficacy and safety of lacosamide for peroral and intravenous introduction. Randomized clinical trials of the peroral form of this drug provide evidence that lacosamide is a prospective preparation for complex treatment of drug-resistant epilepsy in the view of its safety and tolerability. The availability of the infusion form is advantageous compared to other AED making it possible to continue treatment in cases when the peroral intake of AED is temporary impossible.

[Side-effects of antiepileptic treatment: the current state of the problem].

The current treatment of epilepsy is directed not only at the control of seizures and comorbid states but at the improvement of quality of life and destigmatization that is the key strategic direction. The basis of treatment of epilepsy is a long-term regular taking of antiepileptic drugs (AED). However, it has been shown that quality of life of patients depends not only on clinical presentations of the disease, including seizures and higher mental functions, but on the tolerability of AED. The safety of these drugs becomes the most important component of the treatment even compared to the control of seizures. Therefore, tolerability and compliance (a patient's adherence to a recommended course of treatment, common understanding between a doctor and a patient as well as his/her relatives) receive special attention. The timed detection and correction of side-effects is an integral component of treatment of epilepsy. In some cases, the presence of rare seizures with minimal clinical presentations and even more frequent seizures that are not danger for a patient seems to be more appropriate than the increase in the number and doses of AED reducing quality of life. The balance between therapeutic and toxic effects of AED is a key issue of treatment of epilepsy.

[Transitory cognitive dysfunction in rolandic epilepsy].

Forty-four patients with rolandic epilepsy (32 boys, 12 girls), aged from 5 to 14 years, were examined in the prospective study during 5 years. Before the antiepileptic treatment, most of patients had transitory cognitive disturbances. There were the impairment of verbal functions, especially verbal intellect, while non-verbal intellect remained intact; dyspraxia, impairment of auditory-speech memory, disturbances of arbitrary regulation and optical-motor coordination. The cognitive impairment was not severe and did not impact on learning of school program. No significant correlations were found between the lateralization of regional EEG changes and the character of cognitive dysfunction though the age-related lateralization of the focal epileptiform activity was shown: the right-side localization of central-temporal EEG spikes predominated in children at the age of 6.29 +/- 0.9 years, the left-side localization - in children at the age of 8.4 +/- 1.4 years. The clinical remission was achieved 4-5 years earlier than the recovery of cognitive functions. Valproates used as monotherapy or in the combination with ethosuximidum and levetiracetam were drugs of choice.

[Idiopathic focal epilepsies of infancy and childhood].

We studied 1036 children with epileptic seizures, aged from 1 to 18 years, during 2004-2008. One hundred and six patients were diagnosed with idiopathic focal epilepsy (IFE). The following forms of IFE were singled out: benign seizures of infancy (familial and non-familial) - Watanabe--Vigevano syndrome - 5,7%, occipital epilepsy of childhood with early manifestation (Panayiotopoulos syndrome) -26,4%, occipital epilepsy of childhood with late manifestation (Gastaut syndrome) - 12,3%, benign epilepsy of childhood with central-temporal spikes (rolandic epilepsy) - 51%, benign focal epilepsy with affective symptoms - 4,7%. The efficacy of the first monotherapy was significantly worse in rolandic epilepsy compared to the other IFE forms. Prescription of valproate or the combination of valproate, ethosuximidum and levetiracetam, in case of resistant course, as a starting therapy was found optimal.

[Modern principles of epilepsy therapy].

Long regular use of antiepileptic drugs (AED) aimed at reducing frequency of seizures or stopping them completely without any significant side-effects is a main principle of epilepsy treatment. The main attention is drawn to the issues of tolerability of antiepileptic therapy and compliancy, mutual understanding between a physician and a patient as well as relatives and other significant persons. The timely detection and correction of side-effects is integral part of epilepsy treatment. Currently, the attention is focused on quality of life of patients with epilepsy including physical and mental health, education, social and psychological functioning. In some cases, the occurrence of rare seizures with minimal clinical presentation or even more frequent seizures which are not dangerous to a patient is less harmful than decreasing of quality of life due to the effect of larger AED number or dose. The balance between AED therapeutic and toxic effects is a main question in epilepsy therapy. Pharmacotherapy of epilepsy requires deep knowledge of AED: spectrum of therapeutic efficacy and extent of drug effect; safety, tolerability and side-effects, in particular severe and life-threatening ones, specifics of pharmacokinetics, pharmacodynamics, between-drug interactions and mechanisms of action; titration rate, necessity in laboratory tests during treatment, peculiarities of application of pharmacoeconomics. The present review addresses modern aspects of epilepsy therapy.

Use of Noben (idebenone) in the treatment of dementia and memory impairments without dementia.

Noben (idebenone) at a dose of 120 mg per day for six months was used in the treatment of 35 patients aged 60-86 years with Alzheimer's-type dementia, mixed dementia, and memory impairments not reaching the stage of dementia. Patients were assessed on the basis of data from somatic, neurological, and psychiatric investigations, as well as neuropsychological testing and a series of psychometric and other scales and tests, before and after treatment. Significant improvements in patients' conditions on the MMSE were seen in patients with mild and moderate dementia. Improvements in daily activities were obtained in 27% of patients. Neuropsychological investigations demonstrated improvements in short-term and long-term memory and attention, with improvements in speech functions, performance of kinesthetic, spatial, and dynamic praxis tests, and in visuospatial gnosis, thought, and writing. On the CGI scale, positive treatment effects were obtained in 37% of patients, while 48% of patients remained in a stable state.

[Noben (idebenone) in the treatment of dementia and memory impairment without dementia].

Noben (idebenone) was administered in dosage 120 mg during 6 months to 35 patients, aged from 60 to 86 years, with dementia, Alzheimer's type and mixed type, and with memory disturbances which did not reach the level of dementia. The assessment of patient's state before and after treatment was based on the results of somatic, neurological and psychiatric examination as well as neuropsychological testing and using of psychometrical and other scales. The significant improvement on the MMSE scale was found in patients with mild and moderate dementia. The improvement of daily activity was observed in 27% of patients. The neuropsychological study revealed the improvement of short-term and delayed memory and attention, speech functions, the performance on kinesthetic, spatial and dynamic praxis tests, visual-spatial gnosis, reasoning and writing. The positive therapeutic effect assessed by the CGI scale was observed in 37% of patients, the stable state--in 48%.

[West syndrome: clinico-electro-anatomical characteristics and a differential therapeutical approach].

One hundred and thirty children with West syndrome, aged 1.5 months-2 years, were studied. The symptomatic form of West syndrome was diagnosed in 95.4% of cases. The prenatal etiological factors were observed in 57% of patients. Different variants of hypsarrhythmia at EEG were revealed in 87%. The percentage of cases with typical and modified hypsarrhythmia was 13.3% and 86.7%, respectively. The choice of treatment was based on the revealed disturbances on EEG and MRI that was useful for increasing the effectiveness of treatment of West syndrome resulting not only in the reduction of seizures and improvement of EEG but also in the stabilization of intellectual disintegration and recovery of functions. The basic drugs in the treatment were valproates used both as mono- and polytherapy.

[Clinical polymorphism of malignant epilepsy of infancy with migrating multifocal seizures (8 cases)].

Malignant migrating partial seizures in infancy are rare epilepsy syndrome that begins in the first 6 months of life and characterized by multiple continuous electroencephalographic and electroclinical focal ictal patterns which involved different independent areas of both hemispheres with arrest of psychomotor development. The present detailed review is based on the personal observation of 8 patients newly diagnosed at the Russian Children Clinical hospital, Moscow, Russia. At least three ictal patterns recorded from different independent areas of both hemispheres were fixed by video-EEG-monitoring in all patients. The high polymorphism and very frequent seizures (not less than five types at every child) were observed. The cases were pharmacoresistant, with the absence of reaction to antiepileptic therapy and progressive deterioration in 4 (50%) patients. Decreasing of seizure frequency by 50% was achieved in 3 (37.5%) patients treated with the combination of valproates, benzodiazepines and barbiturates and by 75% in 1 (12.5%) patient case treated with valproates, benzodiazepines and levetyracetam (keppra). The authors proposed a definition of this epileptic syndrome as: "malignant epilepsy of infancy with migrating multifocal seizures".

Efficacy of topiramate (Topamax) in epileptic patients of different ages.

The aim of the present work was to assess the efficacy and tolerance of topiramate (Topamax) in patients of different ages with different types of epilepsy. This agent was used as monotherapy and combined therapy in 114 patients (53 male, 61 female) of the following age groups: early childhood (16), preschool and school age (20), pubertal (16), young (23), adult (38), and elderly (1). Treatment produced complete clinical remission in 48% of patients and decreases in fit frequency by more than 50% in 44% of patients. In terms of remission, Topamax was more effective in adolescents, youths and adults than in younger children, and this pattern was also seen in the treatment of symptomatic epilepsy. Tolerance was good in patients of all groups, and cases of side effects (weight loss, irritability, allergic skin reactions, paresthesia) were occasional.

[Efficacy of topiramate (topamax) in epileptic patients of different age].

The aim of the study was to evaluate efficacy and tolerability of topamax in patients of different age with various types of epilepsy. The drug was prescribed as monotherapy and combined therapy to 114 patients (53 men, 61 women) who were divided into age groups as follows: early age children--16 patients, preschool and school children--20, pubertal children--16, adolescent--23, middle-age patients--38, elderly--1. During topamax treatment, a complete remission was achieved in 48% patients, reduction of seizures frequency (more than by 50%)--in 44% patients. Topamax was more effective by remission index in the pubertal children, adolescent and adults as compared to early age children. The same peculiarity was characteristic of topamax in the treatment of symptomatic epilepsy. This drug was well-tolerable in all the groups studied, with isolated cases of moderate side-effects (body mass reduction, irritability, allergic skin reactions, paresthesias).

[Use of reminyl (galantamine) in the treatment of dementia].

Clinical efficacy and safety of reminyl monotherapy has been studied in patients with dementia of Alzheimer's and mixed vascular-degenerative types. The reminyl treatment has been conducted in dosage of 16 mg/kg daily during 6 months in 30 patients (20 female, 10 male) aged from 59 to 86 years. The results of the study revealed high efficacy of reminyl in the treatment of patients with mild and moderate dementia and good tolerability of the medication.