A method for the diagnosis of epilepsy in patients with preclinical stage of the disease

 

(57) Abstract:

The invention relates to medicine, namely to psychiatry and neurology, and can be used as a method of revealing hidden epileptogenesis, allowing to improve the diagnosis of epilepsy in its preclinical stage. Spend electroencephalographic monitoring and process the EEG. When detecting epileptic complexes of the type “peak-wave” or “sharp-slow wave synchronous with high-frequency discharges amplitude 6-150 µv range from 300 Hz to 1 kHz diagnosed epilepsy. The method improves the accuracy of diagnosis in the preclinical stage of the disease.

The invention relates to medicine, namely to psychiatry and neurology, and can be used as a method of revealing hidden epileptogenesis, giving an opportunity to assess the degree of compansionate or mobility, allowing to improve the diagnosis of epilepsy in its preclinical stage.

Basic neurophysiological method in the diagnosis of epilepsy is encephalographic study. Hypersynchronous electrical activity recorded at the same time, difficult to travlemate to the problem of the origin and formation of the total electrical phenomena of the brain data on the activity of individual neurons and neuronal groups. Considerable interest in this respect is the study of high-quality electrical activity of the brain associated clear positive correlation with the frequency of spike discharges of cortical neurons. (Ginevicius K., Milukas Century, Micki A. “the Extremes of electrocorticogram and neuronal activity.” - Neurophysiology, 1973, No. 51, S. 138-146).

High-quality components can be highly informativni indicator reflecting the functional restructuring of the activity of neural ensembles (dumenco Century. N. “High-quality components of the electrical activity of the neocortex dogs in the formation of motor food conditioned reflexes”, 1985, 35, 3, S. 849-858).

The closest in technical essence and the achieved result is a method for the diagnosis of epilepsy, including electroencephalographic monitoring and subsequent processing of electroencephalogram (EEG). (Zenkov L. R. Clinical electroencephalography with elements of epilepsy. - Taganrog, 1996, S. 287-295).

The disadvantages of this method is its low reliability of the diagnosis of epilepsy, especially in its preclinical stage.

The technical result of the invention is to improve At is achieved by that method for the diagnosis of preclinical stage of epilepsy, including electroencephalographic monitoring and post-processing of the EEG according to the invention, the diagnostic criteria are high-frequency components of the electrical activity of the brain, while the occurrence of epileptic complexes of the type peak wave” or “sharp-slow wave synchronous with high-frequency discharges amplitude 6-150 µv range from 300 Hz to 1 kHz diagnosed epilepsy.

A method for the diagnosis of epilepsy in patients with preclinical stage of the disease is as follows.

EEG studies of patients with epilepsy was made patch electrodes using a specially designed low-noise (1,5 µv) amp biopotentials parallel frequency division channels of amplification in two sub-bands of frequencies from 1 to 100 Hz 100 Hz to 1 kHz. Standard EEG and the envelope of high-frequency brain activity were recorded simultaneously on the recorder N-6P. Visual inspection of high-frequency discharges was carried out on the screen of the oscilloscope with memory C8-13. Registration of electric activity in patients provide typical epileptic complexes of the type peak wave” or “sharp-slow wave”.

Studies have shown that spontaneously recorded in the background recording epileptic complexes occur synchronously with the high-frequency discharges amplitude 6-15 mV in the frequency range from 300 Hz to 1 kHz. When this was observed directly proportional dependence between the values of the peak amplitudes of the complex peak-wave and high-frequency electrical oscillations. On the background of hyperventilation in patients were observed progressive increase in the amplitude of the RF discharge and the reduction of the intervals between the individual high-frequency packages.

Significant and non-problem of electroencephalography is the identification of different types of high-frequency activity with standard EEG (up to 30 Hz) and behavioral manifestations of epilepsy. A comprehensive study of this issue, carried out on white rats with experimental epilepsy, has also made it possible to look more closely at the stages of formation of paroxysmal activity. The development of convulsive seizure was modeled intraperitoneal introduction of gradually increasing doses of corazol. Bipolar electrodes were introduced into the region of nuclei of the amygdala complex. In predatorily period after the first injection to the Vesti, of which gradually formed a burst discharges with an amplitude of 60-100 mV and a fill rate up to 1 kHz. The duration of high-frequency discharges in the process of their formation was increased gradually from 5-10 MS to 50-75 MS, after which it remained stable during the whole observation period. In the subrange of frequencies from 1 to 100 Hz were registered single epileptiform complexes “peak-wave” that occurs synchronously with the high-frequency discharges. Detailed analysis showed that the complex peak wave” was recorded only when the amplitude of high-frequency discharge reached a value of not less than 60-100 mV and its duration was 50-75 MS. During this period, pronounced a single high-frequency discharges could be accompanied by myoclonic twitching of the head and body. Convulsive seizures developed after the introduction of additional corsola. Electrographically he was accompanied by hypersynchronous paroxysmal rhythm frequency of 3-5 Hz and the following synchronously with him wads of high-frequency activity.

In order to identify the shape and localization of the lesion seizure activity in acute experiments the animals were thoroughly electrode sensing area almond complte to identify the boundaries of the hearth by a sharp decrease in the amplitude of the recorded signal. Studies have shown that when Karasyova convulsions in rats in the field basolateral nucleus of the amygdala develops hearth epileptiform activity with a radius of about 800 μm. Thus there is a gradual formation of a high-frequency discharges by duration, amplitude and interval between them, which characterizes a progressive development of hypersynchronization in this brain structure.

Thus, high frequency components of the electrical activity of the brain can serve as a diagnostic criterion, indicating the development of processes hypersynchronization. Their appearance may precede the formation expressed epileptic complexes of the type “peak-wave” or “sharp-slow wave”.

Detection doprocessing stage of disorder of brain electrical activity may be important not only for diagnosis and treatment of epilepsy in its preclinical stage, but also to develop a gentle automatic device electroconvulsive therapy. This suggests the potential analysis of high-frequency components of the EEG as a diagnostic tool and the practicability of further experimental and clinical research in this Napravnik more local processes, taking place directly under the electrodes, which may contribute to more accurate topical diagnosis of the epileptic focus relatively standard EEG recording.

The proposed method for the diagnosis of preclinical stage of epilepsy was tested in St.-Petersburg research psychoneurological Institute. C. M. Bekhterev.

The resulting studies have shown that the proposed method can improve the accuracy of diagnosis of epilepsy in patients with preclinical stage of the disease.

A method for the diagnosis of epilepsy in patients with preclinical stage of the disease, including electroencephalographic monitoring and post-processing of the EEG, characterized in that the diagnostic criteria are high-frequency components of the electrical activity of the brain, while the occurrence of epileptic complexes of the type peak wave" or "sharp-slow wave synchronous with high-frequency discharges amplitude 6-150 µv range from 300 Hz to 1 kHz diagnosed epilepsy.

 

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FIELD: medicine, neurology, psychopathology, neurosurgery, neurophysiology, experimental neurobiology.

SUBSTANCE: one should simultaneously register electroencephalogram (EEG) to detect the level of constant potential (LCP). At LCP negativization and increased EEG power one should detect depolarizational activation of neurons and enhanced metabolism. At LCP negativization and decreased EEG power - depolarized inhibition of neurons and metabolism suppression. At LCP positivation and increased EEG power - either repolarized or hyperpolarized activation of neurons and enhanced metabolism. At LCP positivation and decreased EEG power - hyperpolarized suppression of neurons and decreased metabolism of nervous tissue. The method enables to correctly detect therapeutic tactics due to simultaneous LCP and EEG registration that enables to differentiate transition from one functional and metabolic state into another.

EFFECT: higher accuracy of diagnostics.

5 dwg, 1 ex, 1 tbl

FIELD: medicine, neurology.

SUBSTANCE: one should establish neurological status, bioelectric cerebral activity, availability of perinatal and ORL pathology in patients, establish their gradations and numerical values followed by calculation of prognostic coefficients F1 and F2 by the following formulas: F1=-31,42+1,49·a1-2,44·a2+0,2·а3+1,63·a4+0,62·а5+3,75·a6+1,8·а7-3,23·a8-0,8·а9-1,32·а10+3,26·а11+8,92·a12-2,0·a13+3,88·а14+1,79·a15+0,83·a16-2,78·a17; F2=-27,58+1,43·a1+3,31·а2+0,08·а3+3,05·а4-0,27·а5+2,69·а6+3,11·а7-6,47·a8-6,55·a9+1,99·а10+5,25·а11+7,07·a12-0,47·a13+0,13·a14+4,04·a15-1,0·a16-1,14·а17, correspondingly, where a1 - patient's age, a2 - studying either at the hospital or polyclinic, a3 - duration of stationary treatment (in days), a4 - unconscious period, a5 - terms of hospitalization since the moment of light close craniocerebral trauma, a6 - smoking, a7 - alcohol misuse, a8 - arterial hypertension, a9 - amnesia, a10 - close craniocerebral trauma in anamnesis, a11 - psychoemotional tension, a12 - meteolability, a13 - cervical osteochondrosis, a14 - ORL pathology, a15 - availability of perinatal trauma in anamnesis with pronounced hypertension-hydrocephalic syndrome, a16 - availability of paroxysmal activity, a17 - availability and manifestation value of dysfunction of diencephalic structures. At F1 ≥ F2 on should predict the development of remote aftereffects in young people due to evaluating premorbid background of a patients at the moment of trauma.

EFFECT: higher reliability of prediction.

2 ex, 1 tbl

FIELD: medicine; medical engineering.

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EFFECT: enhanced effectiveness of differential diagnosis-making.

11 cl, 6 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.

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15 cl, 10 dwg

FIELD: medicine, psychiatry.

SUBSTANCE: one should conduct EEG-testing to detect total value of the indices of spectral power or percentage spectral power of delta- and teta-rhythms due to spectrometric technique in frontal, parietal, central and temporal areas both before and during emotional-negative loading when visual emotionally negative stimuli are presented followed by their imaginary reproduction. In case of higher indices to visual stimuli being above 15% against the background one should diagnose epilepsy. The method enables to increase the number of diagnostic means, increase accuracy and objectivity in predicting epilepsy with polymorphic paroxysms at dissociation of clinical and EEG-values.

EFFECT: higher efficiency of diagnostics.

1 ex, 1 tbl

FIELD: medicine, neurophysiology.

SUBSTANCE: one should carry out EEG survey to detect spectrometrically the index of full range if alpha-rhythm both before and after therapy. Moreover, power index of full range of alpha-rhythm and the index of 9-10 Hz-strip's spectral power should be detected in occipital cerebral areas. One should calculate the value of the ratio of the index of 9-10 Hz-strip's spectral power to the index of full range of alpha-rhythm and at the increase of this value by 20% against the background it is possible to evaluate positive result of therapy. The method increases the number of diagnostic means applied in evaluating therapeutic efficiency in the field of neurophysiology.

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1 ex

FIELD: medicine, neurology.

SUBSTANCE: method involves carrying out the standard vascular and nootropic therapy. Diazepam is administrated under EEG control with the infusion rate that is calculated by the following formula: y = 0.0015x - 0.025 wherein y is the rate of diazepam administration, mg/h; x is an average EEG amplitude, mcV. Method provides enhancing the effectiveness of treatment of patients. Invention can be used for treatment of patients in critical severe period of ischemic insult.

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2 tbl, 1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: method involves selecting signals showing patient consciousness level and following evoked auditory potentials as responses to repeating acoustic stimuli, applying autoregression model with exogenous input signal and calculating AAI index showing anesthesia depth next to it.

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EFFECT: increased efficiency.

3 cl, 1 dwg, 1 tbl

FIELD: medicine, neurology, professional pathology.

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EFFECT: higher accuracy of diagnostics.

6 ex, 1 tbl

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