Dynamics of epileptic activity patterns in patients receiving_anticonvulsant therapy with various forms of epilepsy

Dynamics of epileptic activity patterns in patients receiving anticonvulsant therapy with various forms of epilepsy. Protocol extension EEG. Practical application of the pharmacological testing of epileptic electroencephalogram.

Generalov V.O., Sadykov T.R Kazakova Y. Yugay A.M.

EEG is the most reliable indicator of quality of antiepileptic therapy: drug therapy, surgical treatment, non-drug therapy. In case of frequent epileptic seizures, EEG is an additional criterion for the effectiveness of treatment (the main criterion – the frequency of seizures). In case of rare epileptic seizures, EEG is the only indicator of the action of anticonvulsant therapy on the epileptic system of the brain. Indications of positive EEG dynamics are reduction of paroxysmal index of epileptic activity patterns, decrease in the number of sources of epileptic activity reduction of the amplitude of epileptic activity patterns, transformation of the serial patterns of epileptic activity in a single, transformation of diffuse patterns into bifrontal or focal patterns. Indications of negative EEG dynamics are increase of paroxysmal index of epileptic activity patterns, increase in the amplitude of epileptic activity patterns, increase in the number of sources of epileptic activity, emergence of serial patterns of epileptic activity instead of single, transformation of frontal patterns of epileptic activity into diffuse patterns, appearance of the secondary bilateral synchronization pattern. In IGE indications of positive EEG dynamics are disappearance of epileptic activity, increase of resistance to functional tests, reduction of the index of epileptic activity and duration of series of patterns of epileptic activity during wakefulness, during sleep, upon awakening, replacement of diffuse patterns of epileptic activity by bifrontal or focal patterns. The dynamics of the photoparoxysmal response in its presence is evaluated separately. A control algorithm for efficiency therapy of photosensitive epilepsy: starting night VEM (statement of photosensitivity), prescription of the therapy, control EEG (short recording with photic tests) after 1 week, if necessary – correction of the therapy, short EEG after 1 week, after relief of photoparoxysmal reaction providing of the night VEM. Recordings are made on the same equipment under standard conditions at the same frequencies. In focal epilepsy indications of positive EEG dynamics are normalization of EEG, decrease in the number of sources of epileptic activity, reduction of paroxysmal index of epileptic activity (each source of epileptic activity is evaluated separately), reducing the duration of a series of patterns of epileptic activity. Negative EEG dynamics is manifested in the increasing of the index of paroxysmal epileptic activity, increasing the number of sources of epileptic activity, the transformation of focal patterns in diffuse.
Benzodiazepine test can be used to assess the sensitivity to antiepileptic therapy. The aim of the study was to assess the prognostic value of the benzodiazepine test as part of the EEG Protocol of the study. 22 patients were analyzed with the presence of the EEG epileptic activity with a high quantity. The age of the patients was 4.4±1.5 years. Among them 10 patients with multifocal epileptic activity, 8 patients with pattern of continuous epileptic activity during slow sleep (CSWS), 4 patients with continuous regional epileptic activity. All patients during the video-EEG monitoring were administered 1 ml of 1% solution of Diazepam per os (dose 10 mg).
After 30 minutes, the index of paroxysmal epileptic activity was evaluated. All patients with a positive electroencephalographic effect, recorded on Diazepam, in the treatment regimen was included Clobazam in doses from 10 mg to 30 mg (1.2-1.3 mg/kg body weight). Among patients with multifocal epileptic activity in 8 (80%) patients on EEG after receiving Diazepam was recorded pronounced positive effect. Among patients with CSWS in 6 (75%) patients on EEGafter receiving Diazepam was recorded pronounced positive effect. Among patients with prolonged regional epileptic activity in 3 (75%) patients on EEG after receiving Diazepam was recorded a pronounced positive effect. Among patients with positive effects of receiving Diazepam in 76.5% of patients there was a significant (reduction of seizures by 50% or more) clinical effect with daily intake of Clobazam. So the results of the benzodiazepine test conducted during the EEG allow to objectively assess the possibility of the effect of the introduction of benzodiazepine into the treatment regimen.
 

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