[Conservative and surgical treatment of patients with resistant epilepsy].

AIM: To optimize drug treatment in early (6 months) and late (up to 3 years) stages of postoperative period and to study its efficacy. MATERIAL AND METHODS: There were selected 72 patients with resistant epilepsy and epileptic encephalopathy symptoms from 467 patients operated for epilepsy. RESULTS: By the end of a 3-year follow-up observation, we found the reduction in seizure frequency and seizure control in 66.3% of patients; regression of EEG paroxysmal activity in 56.8% and reduction in mental disorder symptoms (anxiety and depression) in 12.7%. CONCLUSION: The data obtained substantiate the necessity to optimize antiepileptic and pathogenetic drug treatment of patients with resistant epilepsy and encephalopathy symptoms during the 3-year postoperative period.

[Modern aspects of the rehabilitation of patients with epilepsy].

A conception of rehabilitation of epileptic patients, which corresponds to the realities of their life, has been elaborated on the basis of clinical data on 4348 epileptic patients with long-time follow-up period. An algorithm of treatment and rehabilitation programs based on medical-biopsychosocial approaches and studying of QOL was proposed and scientifically substantiated. The system of rehabilitation was tested in practice and its high efficacy was shown.

[The use of the antiepileptic drug trileptal in the clinical practice].

The data on therapeutical efficacy of the new antiepileptic drug trileptal (oxcarbazepine) and results of the own observations of 38 patients with partial epilepsy who received trileptal as mono- or polytherapy are presented. The high efficacy and good tolerability of the drug has been shown. The seizure control has been obtained in 84% of patients.

[The use of generic valparin xr in the treatment of epilepsy.].

Therapeutic efficacy of valparin xr, a new form of valproic acid (VPA) generic drugs, manufactured by "Torrent Pharmaceuticals Ltd", India, has been studied in 25 patients with epilepsy of different types and frequency of seizures. The therapeutic efficacy similar to that of an original VPA was determined in monotherapy strategy, being lower in polytherapy, but more effective than other antiepileptic treatment. As for original drugs, the best results were obtained for controlling myoclonic and polyclonic seizures. The percentage of side-effects did not exceed the same index for brand drugs. The substantial advantage of valparin xr is a lower price as compared to the original VPA.

[Topamax in the treatment of epilepsy].

To specify efficacy of topamax in different types of epileptic seizures and its influence on patient's quality of life (QL), the drug was assigned to 38 patients, aged 18-69 years, as mono- and polytherapy (in combination with other anticonvulsive medications). Topamax dosages ranged from 25-50 mg at a base-line to 600 mg. Treatment duration was 6-18 months. Positive effect of different extent was achieved in 95.7% patients. A seizures frequency decreased by 25% in 17.4% patients; by 50%--in 8.7%; by 75%--in 43.5%; a complete disappearance of seizures was detected in 30.4%. The results confirmed the earlier data received by the authors that topamax was most effective in generalized convulsive, partial and secondary generalized seizures. It exerts a less pronounced effect in myoclonic seizures and absences. After topamax treatment, a total QL index measured by WHO questionnaire increased by 5.2%. The drug is well tolerated and does not affect cognitive functions of the patients. It is concluded that currently topamax is one of the most effective antiepileptic medications.

[The use of valproates-generics in the treatment of epileptic patients].

Therapeutic efficacy, adverse effects, cost efficacy of Encorate chrono (generics of Depakine chrono) as well as impact on quality of life have been studied in 36 patients with symptomatic and idiopathic epilepsy and different types of seizures. For all parameters, Encorate-chrono was as effective as the original drug. It may be recommended for patients with epilepsy with generalized and partial seizures as an equal analogue of Depakine in case of its absence.

[Neuroimmunopathological mechanisms of preclinical epileptogenesis and their correction by cycloferon]. / Neiroimmunopatologicheskie mekhanizmy doklinicheskogo épileptogeneza i ikh korrektsiia tsikloferonom.

The peculiarities of immunologic processes and immunocorrecting potential of Cyclopheron were studied in 62 patients with preclinical epileptogenesis. Using clinical, EEG and biochemical examination, expression of epileptogenesis was estimated as regressed, compensated, increasing, decompensated. Preclinical stage of epilepsy was accompanied by disturbance of immunological brain reactivity the expression of which was correlated with a level of compensative epileptogenesis manifestation. The decrease of the latter is followed by intensive disintegration of neuroimmune interactions characterized by immunodeficiency of mixed type with significant presentation of neuroimmune disturbances. Therefore, a use of Cyclopheron, as a medication with multilevel immuno-correcting action, is expedient at initial stage of epilepsy.

[Convulex and its place in epilepsy treatment with original valproates]. / Konvuleks i ego mesto v terapii épilepsii original'nymi val'proatami.

Therapeutic efficacy of three original valproates (convulex, depakine enteric and convulsofine) as well as direct cost of drugs for epilepsy treatment have been studied in 249 patients with long-term epilepsy with different types of epileptic seizures. The convulex efficacy was found to be lower than that of the other two drugs. Also, convulex reduces the frequency of seizures by 50-100% in 75% of the patients. During the convulex treatment of some types of seizures, remission was achieved in 81-90% of the patients. At the same time, the cost of treatment with convulex is 1.5 times lower comparing to that with depakine and is equal to that for convulsofine. The authors concluded the cost benefit of convulex treatment appeared to stimulate regional health departments and individual patients for wholesale and retail drug purchases.

[Medico-social aspects of risk factors impairing quality of life in patients with epilepsy]. / Mediko-sotsial'nye aspekty riska razvitiia oslozhnenii zhizni bol'nykh épilepsiei.

The results of 2-year multicenter project "Epilepsy, risk factors and insurance" organized by Epilepsy European Commission, on risk factors deteriorating quality of life of epileptic patients in 9 European countries (Italy, Germany, Spain, Netherlands, England, Portugal, Estonia, Russia and Slovenia), have been used in the study. The "patient-control" pairs were matched for various features characterizing social aspects of epileptic patient's life (educational level, professional level and employment, marital status, driving abilities, sports, medical insurance) as well as medical events (concomitant diseases, medical complications, seizures, frequency of accidents, hospitalization, disablement indices, etc). Patients at low and high risk for quality of life impairment were defined. In Russia, the rate of these risk factors in epileptic patients corresponds in general to that in other European countries.

[Quality of life and rehabilitation of epileptic patients]. / Kachestvo zhizni i reabilitatsiia bol'nykh épilepsiei.

The quality of life (QL) study has been conducted using the WHOQOL-100 questionnaire in 146 patients with epilepsy in the process of their rehabilitation. Before treatment and restorative interventions, the majority of the patients evaluated their QL as moderate and low depending on the type, frequency and severity of seizures as well as on the age of the disease onset. During restorative therapy, the QL scores increased in physical, psychological and social relationship domains and some indices correlated with the results of restorative treatment.

[The optimization of epilepsy therapy with finlepsin]. / Optimizatsiia terapii épilepsii finlepsinom.

A clinical pharmacological study (270 patients) was made to optimize therapy of epilepsy with carbamazepines (finlepsin and its retard form). It was established that insufficient (standard) doses of finlepsin are often used, serum levels of the drug are not estimated, drug pharmacokinetics is not taken into account, maximum permissible doses of the drug are not reached. Estimation of the efficiency of both preparations in the treatment of various types of the seizures was carried out. The advantages of finlepsin-retard were demonstrated.

The presence of autoantibodies to N-terminus domain of GluR1 subunit of AMPA receptor in the blood serum of patients with epilepsy.

We have analyzed the serum from patients with refractory epilepsy for the presence of autoreactive antibodies to AMPA glutamate receptor subunits. The presence and the level of autoantibodies were assessed using immunoblot and ELISA with synthetic peptides specific for subregions of AMPA glutamate receptor subunits. Patients with refractory epilepsy exhibited strong immunoreactivity to GluR1 subunit compared to healthy donors and patients with Parkinson's disease and Alzheimer's disease. Weak immunoreactivity to other AMPA glutamate receptor subunits was also detected and the signal was diminished in the raw GluR4>GluR3>GluR2. The occurrence of autoantibodies to specific neurotransmitter subunits in the sera of patients with refractory epilepsy suggest that autoimmune process may underlie this disorder.

[Clinico-biochemical study in epilepsy]. / Kliniko-biokhimicheskoe issledovanie pri épilepsii.

Diagnostic opportunities of the test of paroxysmal activity (TPA) were examined in 253 epileptic patients of different age and duration of disease. It was established that the changes of autoantibodies (aAB) titers in the control group were about 64-110% (mean value 85%). Meanwhile in epileptic patients there was elevation of the same indices 2.1 times (182%). The correlation was observed between the levels of aAB titers and duration of the disease, frequency and character of paroxysmal disorders. The conclusion was made that TPA may be used quite successfully in diagnosis of epilepsy, especially in difficult cases. The level of accumulation of aABs in blood of patients with the fits may be used as new immunological index which may facilitate essentially objective of diagnosis of epilepsy.

[Optimisation of epilepsy monotherapy (clinico-pharmacological study)]. / Optimizatsiia monoterapii épilepsii (kliniko-farmakologicheskoe issledovanie).

The effect of four preparations (benzonal, phenobarbital, diphenyn, finlepsin), were examined in 214 epileptic patients with different forms of the fits. The advantages of monotherapy of epilepsy were grounded and therapeutic possibilities of the drugs were considered by means of clinico-pharmacological study. Standard and intensive methods of treatment of different forms of the fits were considered. It is demonstrated that maximal usage of therapeutic possibilities of the drugs resulted in the increase of the efficiency of treatment 2.5-fold. Daily doses and blood levels of the preparations were elevated, respectively. The term of "pseudotherapy" is grounded.

[A clinico-pharmacological basis for optimizing the treatment of therapy-resistant forms of epilepsy]. / Kliniko-farmakologicheskoe obosnovanie optimizatsii lecheniia rezistentnykh k terapii form épilepsii.

On 44 epileptic patients antiepileptic phenobarbital, finlepsin, diphenine, hexamidine were studied. The alterations in the level of free and bound fractions under the drug application in maximal tolerance daily doses, depending on changes in the administration frequency during the day, were recorded. It was established that level fluctuations of the total preparation occur mainly owing to level alterations in the fraction not bound to serum proteins. An increase in the drug administration frequency under the constant daily dose leads to a distinct reduction in the free fraction level fluctuations between doses, to a decrease in the intensity or removal of side effects, and makes it possible to further build up the daily dose to obtain the required effect.

[The current aspects of the social and biological adaptation of epilepsy patients in Russia]. / Sovremennye aspekty sotsial'noi i biologicheskoi adaptatsii bol'nykh épilepsiei v Rossii.

The influence of social alterations on the treatment effectivity and social adaptation of 1350 epileptic patients was followed up in 1981-1993. It is shown that during the period of social stability clinical observation of such patients was quite satisfactory. Therapeutic response reached 98.2% at invalidity rate 0.2% in 1989. On the contrary, during period of social instability 10.8% of patients did not resolve any treatment, the effectiveness of the treatment lowered to 76.6%, remission failure occurred in 6%, and the percent of the invalids increased to 5.6% of patients. The recommendations are given concerning adaptation of epileptics to new social conditions.