Abstract
Background . Pathomorphosis of epilepsy is a process of the disease picture transformation due to environmental factors. It can be a result of natural evolution associated, for example, with genetic mutations, which makes it stable. It can also be caused by some artificial factors, such as pharmacotherapy. The article describes the most typical changes in the clinical picture of focal epilepsy induced by the main «engines of pathomorphosis» and affecting all periods of the disease: seizures, post-seizure and intra-seizure periods. Objective : to increase the efficacy of treatment of focal epilepsy in adults taking into account specific features of the disease pathomorphosis. Materials and methods . We enrolled 70 patients with focal epilepsy (mostly drug-resistant), who sought special medical assistance. The sample included 31 males (44 %) and 39 females (56 %) aged between 18 and 78 years. Results . In 76 % of patients in the general group, new types of seizures appeared. Of these, in 85 % of cases a new types of seizure have been added to existing ones. In 15 % of cases, seizures of the same type were replaced by another type. In 87 % of patients, a change in the incidence of relapse in the history was detected. «Migration of the seizures» during the day was observed in 19 % of cases. Cognitive disorders of varying severity were observed in 48 % of patients. Anxiety-depressive disorders were detected in 42 % of cases. The remission period in history for 12 months with subsequent relapse was observed in 27 % of patients in the general group. Of these, in 88 % of cases, remission was the result of using antiepileptic drugs, and 53 % of relapses were caused by their unjustified cancellation. Aggravation of seizures was observed in 9 % of patients in the general group. During the study, 91 % of patients were drug-resistant, of whom 64 % had severe secondarily generalized seizures. Non-compliance was detected in 47 % of cases. Conclusions. The variant of epilepsy pathomorphosis is determined by the complex of environmental factors. Antiepileptic pharmacotherapy is the most significant factor that requires further study, as well as other factors.
Highlights
Цель исследования – повышение эффективности терапии фокальных форм эпилепсии у взрослых с учетом особенностей патоморфоза заболевания
Pathomorphosis of epilepsy is a process of the disease picture transformation due to environmental factors
The article describes the most typical changes in the clinical picture of focal epilepsy induced by the main «engines of pathomorphosis» and affecting all periods of the disease: seizures, post-seizure and intra-seizure periods
Summary
Патоморфоз эпилепсии – процесс трансформации картины заболевания под воздействием факторов среды. В исследовании приняли участие 70 пациентов общей группы с фокальными формами эпилепсии, преимущественно с резистентным течением, обратившиеся за специализированной помощью; среди них мужчин – 31 (44 %), женщин – 39 (56 %), в возрасте от 18 до 78 лет. У 76 % пациентов общей группы отмечалось появление новых типов приступов в анамнезе. Периоды ремиссии в анамнезе более 12 мес с последующим рецидивом отмечались у 27 % пациентов общей группы. Из них в 88 % случаев ремиссия была результатом применения антиэпилептических препаратов, а 53 % рецидивов были связаны с необоснованной их отменой. На момент осмотра у 91 % пациентов течение эпилепсии было резистентным, из них у 64 % отмечались тяжелые вторично-генерализованные судорожные приступы. Тот или иной вариант патоморфоза эпилепсии является результатом комплексного влияния факторов среды. Vladimirsky Moscow Regional Research Clinical Institute; 61/2 Shchepkina St., Moscow 129110, Russia
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