Method for diagnosis of remission of epilepsy
The invention relates to medicine, namely to neurology and psychiatry. Record the bioelectrical activity of the cerebral cortex and determine the dynamics of paroxysmal activity. Additionally, the period of absence seizures conduct a psychological examination of a patient, including a study of the characteristics of cognitive functions, self-esteem, emotional response, a system of relations. Determine the content of endogenous kynurenine in the blood plasma. By reducing the index of paroxysmal activity to almost zero, positive dynamics and stability of psychological symptoms, and decrease the concentration of kynurenine to 87,65,7 ug% diagnose persistent remission of epilepsy. The method improves the accuracy of diagnosis. 5 table.
The invention relates to medicine, namely to neurology and psychiatry, and can be used as a method of identifying compensation for illness - epilepsy, occurring in the process of adequate treatment with gaining control of seizures (remission).
Currently in the literature there is no clear concepts and definitions of remission of epilepsy that causes the in clinico-electroencephalographic and psychological studies of patients in stable remission of seizures suggests, what diagnostic process for this category of the ball much harder than it seems at first glance. Normalization of the electroencephalogram (EEG) and psychological performance significantly lags behind the normalization of the clinical manifestations of the disease, therefore the remission of seizures cannot be considered as remission of epileptic process as a whole, i.e. as remission of epilepsy.
The basis of diagnostic remission of epilepsy should be based on a set of data: 1) clinic; 2) EEG; 3) psychological, and (4) biochemical studies.
1. In formulating the concept of proof (full) remission of epilepsy, it is necessary to say that under it we understand this condition is a painful process and its compensation, when fully cropped any clinical seizures and their precursors, there are no characteristic of epilepsy EEG changes, no changes in personality and completed drug treatment.
All other types of remission should be considered as incomplete or partial.
The study of the level of functioning compensatory systems in the dynamics at various stages of stand (full) remission of epilepsy is of great importance for the development of questions zavershali closest to the technical essence and the achieved result of the proposed method is a method for the diagnosis of remission of epilepsy by EEG monitoring and subsequent processing of the EEG including monitoring of paroxysmal activity (“Restorative therapy of patients with epilepsy”. Rationale, methods of treatment /edited by C. A. Gromov. - SPb, NIPI them. C. M. Bekhterev, 1993, pages 80-99). . The disadvantage of this method is the limited diagnostic capabilities remission of epilepsy.
The technical result, which directed the present invention is to improve the accuracy of diagnosis of stable remission of the disease.
This technical result is achieved in that in the method for the diagnosis of remission of epilepsy by EEG monitoring and subsequent processing of the EEG, including monitoring of paroxysmal activity, according to the invention optionally in the absence of seizures conduct a psychological examination of a patient, including a study of the characteristics of cognitive functions, self-esteem, emotional responses, attitudes, and biochemical research, including the determination of endogenous convulsant - kynurenine, while the decrease of the index of paroxysmal activity to almost zero, positive psychological dynamics and indicators of the concentration of kynurenine in the patient's blood to 87.6±5,7 ug% diagnose persistent remission of epilepsy.
To assess changes in the EEG used quantitative method of assessing paroxysmal changes in EEG is a method of calculating the index paroxizmalnoe" (PI), which implies the ratio of the aggregate value of all seizures to a specific time segment on the EEG curve, expressed as a percentage. For comparative evaluation of paroxysmal changes when re-EEG studies have calculated the dynamics of paroxysmal activity (PDPA), i.e. the difference between the values of PI original EEG and PI EEG recorded during treatment.
EEG studies were conducted on 15-channel ink-writing the electroencephalograph firm “Allevard-Electronics” (France), and 16-channel electroencephalograph “EEGO 16-0,2” (Russia) and “Orion EAT” (Hungary). Check bioelectric activity of the cerebral cortex was performed with the symmetric parts of the frontal, Central, regnecentralen, parietal, ninatamani, peredvishnych and occipital regions. For quantitative evaluation of paroxysmal changes in EEG method was used to calculate the index paroxizmalnoe” (PI). For comparative evaluation of paroxysmal changes when re-EEG studies the initial EEG and FE following EEG. .
Analyzing the data of EEG studies, obtained by observation during long term treatment of patients, we concluded that the remission of the disease is characterized by compensatory reorganization EEG.
In table. 1 presents the dynamics of EEG indices (in %) for epilepsy patients during remission of seizures.
The results of the study indicate that in the process of becoming remission (remission 2-3 years) and subsequent increase in its terms of up to 4-5 years (persistent long-term remission of seizures) observed statistically significant normalization of EEG parameters, the most important criterion for the stability of remission is the lower value of index paroxizmalnoe close to zero (0,8±0,4).
Normalization of entrepreneurs in the process of remission of seizures that objectify is the main criterion in the formulation and solution of the important question of therapeutic tactics - feasibility complete support antiepileptic therapy.
3. In addition to EEG monitoring in patients in the absence of seizures had a psychological examination, including the study of special features of the psychological parameters, in turn, indicates the recovery of compensatory and protective mechanisms of the brain.
Clinical experimental-psychological examination of patients with epilepsy should begin with the study of the characteristics of cognitive functions (memory, attention, mental health), i.e., those functions to weaken most often they complain. In addition, we study the integral characteristics of intelligence, characteristics of emotional responses, attitudes and self-esteem.
The results of psychological testing are numeric expression and are probabilistic-statistical in nature, their generalization applies mathematical methods: level, correlation, factor and other types of analysis performed by the computer.
Was conducted psycho.
Studies have shown that remission of seizures accompanied by positive developments in the area of self-assessment of his condition, attitude towards their disease and treatment.
If during the period expressed paroxysmally manifestations of patients report such qualities as self-doubt, indecision, lack of independence, nalichevovalley themselves as people, confident in their abilities and capabilities. They have acquired more autonomy, determination, the ability to more productive communication with others.
In table. 2 presents the results of the study of memory, attention, pace mental health patients to cessation of seizures in a period of remission.
The table shows that the indicators of mental activity in patients with remission of seizures significantly better than in the initial period, and approach the performance of healthy persons. So patients with remission of seizures almost do not differ from healthy individuals in the rate of mental health, as measured by the run-time correction of the sample (632,4±63,6 seconds in remission and 604,5±52,8 seconds in healthy individuals). In patients with remission of seizures and healthy individuals not received significant differences on the level of stability of the active attention, measured by the number of mistakes made in correcting the sample, but there is a significant improvement compared to patients without remission of seizures.
Amount of short-term oral-aural and visual memory in patients in the period of remission of seizures was significantly lower than in healthy individuals (p=0.01), but not nearly Otley is th “memorize 10 words”. That is expressed improve memory in patients in the period of remission is not revealed.
Patients in stable remission of seizures psychological research was carried out in dynamics with an interval of 1/2-2 years with increasing duration of remission. In table. 3 presents the results of the study of memory, attention and mental performance in patients with epilepsy in the dynamics with increasing remission.
With increased periods of remission gradual improvement of such characteristics of mental activity, as the rate of mental health, estimated run time correction samples, hand-eye coordination and visual memory, analyzed using a test of visual retention.
The results obtained using a personality questionnaire in the dynamics with increasing duration of remission, as can be seen from the table. 4, demonstrate sufficient stability of the mental manifestations in the sphere of intellectual-mental activity and emotional response.
The results of the repeated psychological studies have shown that patients in the process of becoming resistant remiss the improvement of psychological indicators correlate with improvement in clinical condition of the patient and the positive dynamics in the EEG reducing the number of slow and will increase the alpha rhythm, along with a decrease in indices of paroxysmal activity. Thus, when remission of seizures is improved or stable mental state.
Repeated psychological research in the period of remission is carried out with an interval of1/2up to 2 years.
4. An important stage of diagnosis remission of epilepsy is a biochemical study of the content of endogenous convulsant kynurenine.
In the human body has a system that includes endogenous convulsant (kynurenine, quinolinic acid HC) and endogenous anticonvulsants (serotonin). The imbalance of this system can lead to an increase in the number of endogenous convulsion and cause a pathological condition, which leads first to the increased convulsive readiness, and then to the occurrence of seizures.
For epilepsy patients reduced the content of anticonvulsant - C. In the last decade identified convulsive effect of kynurenine - K. However, the role in the pathogenesis of epilepsy and in the formation of remission studied insufficient.
The increase of the content in blood plasma of patients with epilepsy. priyatnogo course of the disease. When confirming this fact may be one of the criteria (along with clinical, electroencephalographic and psychological) against which you can judge the regression of the epileptic process at the level of the neurochemical mechanisms.
The results of the study of the content of kynurenine in the blood plasma of patients with epilepsy in different periods of the disease and the control group are given in table. 5.
In patients with persistent remission of seizures content kynurenine in plasma was 88,9±6,4 mcg%.
Thus, our results indicate that the level in the blood may be a prognostic indicator of the effectiveness of therapy of epilepsy and one of the tests for the diagnosis of persistent remission of the disease, which can indirectly judge the degree of convulsive readiness of the brain and the regression of the epileptic process at the level of the neurochemical mechanisms.
Normalization of the content To the remission of epilepsy may serve as an additional criterion for the stability of the compensatory mechanisms of the brain and can be used along with clinical, electroencephalographic and psychological criteria when deciding on practical vyzdorovlenie the situations of the systems dynamics at various stages of remission of epilepsy is of great importance for the development of questions of maintenance therapy.
However, since the completion of maintenance therapy is an extremely critical step in the treatment of epilepsy, only continuous EEG monitoring is not enough, we need more extensive clinical, neurophysiological and biochemical examination, the combination of which give grounds for cancellation of antiepileptic therapy in patients during remission of the disease (5-6 years).
In patients with persistent remission EEG data can be used not only as one of the criteria of the degree of compensation of the epileptic process, but also to address the question of the extension of socio-labour recommendations. The study of the level of functioning compensatory systems in the dynamics at different stages of remission of epilepsy is of great importance for the development of questions of maintenance therapy and its subsequent cancellation (remission was 5.9±0.6 years).
The basis for cancellation of antiepileptic therapy is a decrease in paroxizmalnoe (PI) to almost zero.
The implementation of the method for the diagnosis of remission of epilepsy is illustrated by example.
Patient I. (25 years) suffering from epilepsy with rare seizures. On the original EEG bioelectric what about the amplitude (25-50 µv) alpha-rhythm frequency 10,5-11,0 Hz (index 79.3 percent). Alpha rhythm punctuated by irregular slow theta (index 10.1 percent) and Delta waves (index 27%) of moderate amplitude. All leads are recorded numerous sharp waves with a certain predominance of them in the region of the left hemisphere. There are evident paroxysmal changes in the electrical activity of the brain in the form of frequent generalized bilaterally synchronous outbreaks sharp and slow waves, isolated complexes sharp - slow wave. IE background EEG 55,6%. Hyperventilation significantly increases the severity of paroxysmal changes: FE during the second minute is 80%. Paroxysmal changes in the slow theta waves in combination with the isolated complexes peak of the slow wave. Therefore, there are marked changes in the electrical activity of the brain, characterized by a dysrhythmia slow type, symptoms of irritation of the cortex, paroxysmal EEG changes.
Examination of medical psychologist
When the primary psychological study of patients were found the following features of the cognitive and emotional areas: decrease in short-term oral-aural memory (5 presentation of a number of 10 words correctly reproduces 32 words), when otnositelno sketches 7); moderate dilation of mental health, as measured by the execution time of the digital correction of the sample (736 seconds); the reduction of background mood (scale score scale 2 of the questionnaire MMPI - 79); a decrease in the level of skills and strengthening social introversion (the indicator on the same scale MMPI - 63).
The content of kynurenine in the blood plasma of the patient And. at this stage of the study consisted of 127 ág %.
The patient was optimal dose of anticonvulsants and the seizures stopped. Held in this period repeated EEG examination found that the background activity is characterized by a regular, somewhat acuminate, unstable amplitude (25-55 µv) alpha-rhythm frequency of 10 Hz (index 77,5%), slow theta (index 8.3%) and Delta waves (index 8,7%), a large number of sharp potentials. Paroxysmal changes in background EEG is characterized by rare generalized hypersynchronous bilateral sporadic outbreaks sharp slow waves, alpha-emission with a variable emphasis on the area of the left hemisphere. IE background EEG is 2.8%. When hyperventilation in all the leads you receive a significant number of polymorphic slow waves recorded generaliz - antenna wave, IE during the second minute of 43.3% compared to the first EEG there is a positive trend, although paroxysmal activity is preserved.
The content of kynurenine in plasma - 116 ug%.
After 8 months. After cessation of seizures the patient made a control EEG, which shows positive dynamics compared with the previous, paroxysmal changes in background activity represented by a single generalized discharges sharp waves, alpha emissions slightly increased relative to the background amplitude without distinct regional dominance. IE background EEG is 2.2%. IE when hyperventilation during the second minute to 21.1%.
The advice of a medical psychologist
If you re a psychological study on the background of cessation of seizures detected change of some psychological parameters. So, there is some acceleration of the speed of mental health (run time digital correction of the sample is reduced and is 685 seconds), increases the background mood and improve communication capabilities (drop the indices “2” and “0” of the personality questionnaire MMPI respectively to scale estimates of 65 and 58).
Sterno be regarded as a variant of norm. Paroxysmal activity no.
The advice of a medical psychologist
With long-term observation of the patient is detected stabilization psychological indices on the background of stable remission of seizures.
The content of kynurenine in plasma amounted to 89 ug%, which corresponds to the variation norm.
Thus, psychological diagnostics at different stages of epileptogenesis and remission of seizures allows a deeper understanding of the mechanisms of formation and regression of the personality changes in patients with epilepsy.
On the basis of clinical established (stable remission of seizures 3.5 years), normalization of EEG and content of kynurenine in the blood plasma, the decision about the appropriateness of the gradual completion support antiepileptic therapy, the reduction of the daily dose of anticonvulsants on 1/3.
The present invention improves the accuracy of diagnosis of stable remission of the disease.
Our proposed method was tested in psychoneurological research Institute. C. M. Bekhterev at the Department of epilepsy.
Method for diagnosis of remission of epilepsy, including registration of bioelectric activity of the cerebral cortex and the definition of the display is about conduct a psychological examination, includes the study of cognitive functions, self-esteem, emotional response and system relations, and define the content of kynurenine in plasma and by reducing the index of paroxysmal activity to almost zero, positive dynamics and stability of psychic manifestations, reducing the concentration of kynurenine to (87,65,7) ug% diagnose persistent remission of epilepsy.