Biomedical subjects
Publications and source records attributed to V A Karlov.
Based on his own experience and literature on epilepsy study, the latest proposals of International League Antiepileptique, the authors reviews definitions related to epilepsy, such as cryptogenic epilepsy, idiopathic epilepsy, epileptic status, epileptic syndrome, epileptic encephalopathy and epileptic disease; proposes his own definitions of the above conditions resting on clinical and neurophysiological data.
Efficacy of topiramate usage in combined therapy of 35 patients (25 adults and 10 children) with therapy resistant epilepsy was analyzed. In 11.4% of the cases, medication remission for a period of up to 3 months has been achieved. Therapeutic efficacy, with reducing the number of fits by half was achieved in 40% of the cases. In children topiramate therapy was less beneficial. The authors emphasize a good tolerability of topiramate, along with a first ever described side-effect, emerging as a spot pigmentation. The results obtained reveal effectiveness of topiramate using in epileptology, in particular, in drug-resistant epilepsy.
Dynamics of carbamazepine and valproic acid concentrations in the middle of follicular and lutein menstrual cycle phases has been studied in women with epilepsy, aged 21-30 years. Nineteen patients were treated with valproic acid (Depakine 900-2000 mg/day), 35--with carbamazepine (500-1200 mg/day). All the patients have been treated during at least 6 months, the remission being observed during the last 3 months. Control group consists of 17 healthy age-matched women with no positive familial history of nervous and endocrine diseases. Carbamazepine and valproic acid concentrations were measured in blood serum using high-performance liquid chromatography. Blood for analysis was donated on an empty stomach in the morning before the next dose (i.e. at the lowest concentration) and two hours after the drug taking. Mean carbamazepine concentrations (4-12 mcg/ml) in the women with epilepsy were adequate when the day dose was more than 10 mg/kg. Carbamazepine concentrations during lutein phase were significantly lower (p < 0.03), comparing to those in the follicular phase. However, in the lutein phase, progesterone, which concentration was ten times higher is follicular one, has an additional effect, acting as anticonvulsive agent. Valproic acid concentrations do not significantly differ in the lutein and follicular phases that allows Depakine using in catamenial epilepsy. Practitioners are not recommended to overestimate the anti-epileptic drug (AED) concentration monitoring because the usage of the lower AED individual therapeutic dose, not achieving even the mean therapeutic drug concentrations, is acceptable. This seems to be of extremely importance for women with potential maternal role function.
Depersonalization states, expressed in interictal period, were analyzed in 23 patients. Depersonalization state occurs only in patients with partial complex seizures with epileptic focus in the temporal areas of the right hemisphere and in the mediobasal frontal areas of the left hemisphere. Also, compared to healthy subjects, schizoid personality features by MMPI and Rorshach psychological tests were found in these patients. The depersonalization states studied were defined as neurotic ones, because they manifested after psychotraumatic situation and did not recur after psychotherapy.
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Taking into account the drug monitoring data, twenty-six patients with partial epilepsy were treated with finlepsin (carbamazepin) and finlepsin-retard. According to the therapy, the patients were grouped as following: 11 patients were taking finlepsin, 10--finlepsin-retard and 5 were first treated with finlepsin and then, because of the lack of the effect, assigned to finlepsin-retard. The seizures severity was assessed using special seizures severity scale. Better clinical results (remission and reduction of seizures severity) were found in patients treated with finlepsin-retard as compared to those from other groups. Due to monitoring, a remission was reached using the lower finlepsin dosage. The authors confirm individuality of pharmacokinetic parameters, a need in precise individual treatment strategy and a necessity for controlling drug levels in plasma after replacing one form for another.
The unusual high frequency of adolescence onset epilepsy (100 cases of 334 patients) has been revealed. The finding is explained by prevalence of patients with drug resistant epilepsy in the sample investigated. Therefore, adolescence onset epilepsy appears to have poor outcome. Significant difference (p < 0.05) was found between girls and boys. The latter experience febrile convulsions, parasomnia more frequently with prevailing assynchronic attacks and alcohol abuse and sleep deprivation as precipitating factors. The dynamics and prognosis of age-dependent epilepsy types are presented.
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27 patients aged 47-64 years with left hemispheric ischemic stroke with similar cognitive and educational levels were examined. Pharmacotherapy of the stroke directed to improvement of both memory and thinking was taken into consideration. To evaluate both different kinds of memory and a degree of the cognitive functions' impairments in the patients with a local ischemic stroke in anterior, posterior and middle parts of the left hemisphere the following tests were used: evaluation of both the immediate memory of the digits and the short-term audio-verbal memory; short-term trials of the pathological action of interference; Benton test, Meily test; evaluation of the declarative, procedure, semantic, strategic, mediated, long-term kinds of memory. It is shown that remembering of the new information concerning verbal names, digits, was worse in mediobasal, frontal and temporal location of the stroke in the left hemisphere and depended on clinical manifestations of the disorders. The working semantic and strategic kinds of the memory were also damaged, while long-term memory (autobiographic, professional) was impaired in less degree.
The aim of modern antiepileptic therapy is not only to decrease frequency of the seizures and to prevent their rise, but to decrease negative consequences of the treatment too. It is, first of all, to decrease the influence of the antiepileptic preparations on the cognitive functions and, therefore, on quality of the patients' life. During therapy of 40 patients (8-57 year-olds) with partial epilepsy the severity of the seizures as well as emotional and cognitive functions of the patients were evaluated. A significant decrease of the severity of the seizures was observed during therapy with finlepsin-retard (p < 0.002). These changes correlated both with a decrease of anxiety according to MMPI questionnaire (p < 0.0001) and with an increase of the volume of the short-term imaginary memory. Finlepsin-retard is effective therapy for epilepsy.
Dynamics of steroid hormone (extradiol-17 beta, progesterone, total testosterone and cortisol) concentrations in the middle of follicular and lutein menstrual cycle phases has been studied in women with epilepsy aged 21-30 years. Nineteen patients were treated with valproic acid (depakine--900-2000 mg/day), 35--with carbamazepine (500-1200 mg/day). All the patients have been treated during at least 6 months, paroxysms being not registered during the last 3 months before blood analysis. Control group consisted of 17 healthy age-matched women with no positive familial history of nervous and endocrine diseases. Comparing to the control, the affected groups revealed a significantly lower estradiol level (p < 0.003) during the follicular phase and higher cortisol concentrations during both the follicular and the lutein phases (p < 0.05). Regardless of menstrual cycle phases, the differences in progesterone and total testosterone concentrations have not been found between subgroups treated by carbamazepine and depakine. The same hormonal deviations detected after using both carbamazepine and Depakine in the homogenous subgroups of the patients imply, to a certain extent, a common character of pathogenetic mechanisms for steroid hormone pattern development in women with epilepsy. Carbamazepine and depakine treatment during at least 6 months does not predispose to ovary polycystosis syndrome. The results support a multifactor character of hormonal deviations in epilepsy and do not show the medication factor as a major one.
On the basis of both own investigations and publications the next basic aspects of epilepsy were discussed: a) a clinical one--definition of epilepsy, seizures' classification, children's and women's epilepsy, status epilepticus; b) a neurophysiological aspect--epileptic and antiepileptic mechanisms, the significance of slow EEG activity, interhemispheric interactions, influence of the seizures on brain homeostasis.
An influence of geomagnetic field (GMF) on bioelectric activity of the brain was studied in 20 epileptic patients by the use of "hat", which attenuated GMF. A short-term attenuated GMF increased a EEG synchronisation by alpha-rhythm, generalized slow-waves discharges. Some similarities and differences were found in attenuated GMF effects and in the results of hyperventilation trial. The main role in perception of attenuated GMF belongs to the parietal area of the right hemisphere.
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The results of administration of Depakin 300 and Depakin-chrono during 4-year period were analysed in 137 patients aged 14-36 years with idiopathic generalized, cryptogenic, symptomatic partial and nonclassified epilepsy. Depakin was prescribed as basic medicine in idiopathic generalized epilepsy, while in partial and nonclassified epilepsy this drug was more frequently administered in combination with some other anticonvulsants. Early administration of Depakin was highly effective: a remission was observed in 91.2% of the patients during a year. During 3 years a remission was observed in 75.4%, frequency of the fits decreased more than by 50%--in 14.1% of the cases, no response was found in 10.5% of the patients (in cases of gross structural changes of the brain, inefficiency of the preceding therapy during 5 years). Frequency of side-effects was 1.7-12.3%. Indications to treatment are discussed: in addition to generally accepted recommendations (absence, myoclonic primary generalized, tonic-clonic forms of epilepsy, of reading, photosensitive epilepsy), application of Depakin is also recommended in nonclassified epilepsy with generalized epileptic EEG-patterns as well as a drug of choice in all cases of nonclassified fits. Depakin is also quite efficient as an additional drug in cases of partial epilepsy resistant to treatment.
Renin activity (RA), concentration of aldosterone and hydrocortisone in plasma were measured by radioimmunoassay in 78 males with arterial hypertension living in the Far North. RA and aldosterone concentrations were high in patients with borderline arterial hypertension irrespectively of hemodynamic type of the disease. Hydrocortisone levels in them were normal. In hypertension stage I and II RA and hydrocortisone concentrations were normal, while aldosterone levels have risen. Renin-aldosterone index showed high RA in all hemodynamic types of hypertension.
It is shown that antidromic stimulation of peripheral nociceptors induced by radicular compression is the initial pathogenetic factor of pain in patients with so-called paralytic sciatica and trigeminal neuralgia. Subsequently, segmental and suprasegmental mechanisms of pain retention are involved. The prevalence of one or another pain mechanisms at different stages of trigeminal neuralgia may determine the choice of adequate therapy.