Epilepsy in diseases of the thyroid gland. The influence of endocrine glands on the development of epilepsy

Influence of the glands internal secretion on the epileptic process seems undoubted already because such important factors from the point of view of this process as metabolism, blood circulation, water and mineral balance, blood pressure, etc., are regulated by hormones. In addition, among patients with epilepsy we find many suffering endocrine disorders. However, due to the complex interaction between individual endocrine glands, on the one hand, and constantly changing autonomic reactivity, on the other, it is not possible in each case to establish any unambiguous connection between increased or reduced function glands and convulsive readiness.

The anterior lobe of the pituitary gland, which, together with the diencephalon, regulates all endocrine and autonomic functions, affects seizure readiness differently depending on the nature of the triple hormones produced. This readiness increases under the influence of two hormones of the posterior lobe of the pituitary gland: adiuretin, which, by increasing the excretion of NaCl in the urine, inhibits the excretion of water and vasopressin, the effect of which leads to a reduction in peripheral vessels and increase blood pressure. With adiposis-genital dystrophy, seizures.

Coming after removal pair thyroid gland epilepsy indicates that epithelial cells regulating calcium metabolism, increase the seizure threshold; says the same thing beneficial influence to seizures of implantation of these glands. They regulate the metabolic balance between compounds of potassium, phosphates and bicarbonates that increase excitability and calcium, magnesium and hydrogen ions that reduce it.

Insulin, produced by the beta cells of the islets of Langerhans in the pancreas and converting glucose into glycogen, promotes water retention in tissues, decreased O2 utilization, alkalosis and increased specific gravity blood due to a decrease in its water content. When excess insulin enters the bloodstream, it causes hypoglycemic attacks, which can be stopped by administering glucose. When the blood sugar level is from 65 to 80 mg%, minor seizures occur, at 50-70 mg% - medium ones, and at levels below 50 mg% - major ones; complete loss of consciousness occurs in most cases only when the blood sugar level drops below 35 mg%.

Sex hormones reduce convulsive readiness. Menopause and castration can provoke seizures or intensify those that have already occurred; many patients with epilepsy experience dysfunction, and often even underdevelopment of the gonads. It is impossible to indicate an unambiguous causal relationship between menstruation and a seizure. However, the appearance of the first menstruation often coincides with the first seizure, and in a considerable number of women with epilepsy there is a known connection between the seizures and the days of menstruation or the days immediately preceding or following them. The menstrual cycle, which is an additional burden of increased autonomic lability in epilepsy, from the point of view of blood chemistry (acidosis-alkalosis) is the opposite of a convulsive seizure (alkalosis-acidosis). One of our patients status epilepticus, often occurring in direct connection with menstruation, ceased with the onset of menopause.

Out of 25 healthy women In 7 patients, during menstruation, the electroencephalogram showed increased dysrhythmia close to the pathological picture of brain biocurrents in patients with epilepsy, while after menstruation, even after hyperventilation, no deviations from the norm were detected. During pregnancy, seizures may stop, but due to water retention in the body, lack of CO2 and a hypoglycemic tendency, they may intensify, especially during the first half of pregnancy, which occurs with mild alkalosis.

The thyroid hormone - thyroxine, which acts slowly but persistently, accelerates combustion processes, increases cardiac activity and diuresis, and increases blood sugar levels. Hypofunction of this gland may be accompanied by a decrease in the seizure threshold. But since in order for a seizure to begin, the action of ergotropic factors is necessary, then with the removal of the thyroid gland, convulsive readiness also decreases. After the administration of thyroid drugs, specialists observed in some patients within the next 10-15 minutes a normalization of dysrhythmia on the electroencephalogram and in others an activation with pathological potentials such as psychomotor seizures.

Formed in medulla adrenal glands adrenaline, the effect of which appears very quickly, but for a short time, irritates sympathetic nerve, leads to increased O2 consumption, blood sugar levels, blood pressure and pulse rate, constriction of skin blood vessels and internal organs and to the expansion of brain and coronary vessels. Adrenaline injected into the cerebral cortex lowers the seizure threshold. After removal of the adrenal glands, convulsive readiness decreases.

A variety of hormones of the adrenal cortex, of which the most important are those that regulate carbohydrate and protein balance and counteract inflammation glucocorticoids (cortisone), regulating salt and water balance mineralocorticoids and those affecting genital area And protein metabolism androgens (testosterone) may be derivatives of cholesterol. In a number of children who suffered from grand mal seizures, Cambaro found signs of adrenal insufficiency, growth retardation, gastrointestinal disorders, pallor, fatigue, etc. and came to the conclusion that convulsive seizures in these patients were caused, in addition to a certain cerebral predisposition, by insufficiency of the adrenal cortex, leading to dysfunction of ganglion cells. Electric shock, irritating the hypothalamus, causes activation of the adrenal cortex by releasing ACTH.

Women's magazine www.

What kind of lifestyle should you follow after removal of the thyroid gland?

— Is it necessary to take hormones after removal of the thyroid gland?

- Yes. After surgery, a persistent deficiency of thyroid hormones occurs. This condition is called hypothyroidism. However, this is not a complication of the operation, but its consequence. No mandatory replacement treatment Thyroid hormones are indispensable. They are needed to maintain normal metabolism.

Most often, L-thyroxine or eutirox tablets are used for this. If their dose is selected correctly, then the symptoms of insufficient thyroid function disappear. The levels of hormones T3, T4 and TSH are normalized in the blood. You can and should live, work, and relax with hypothyroidism like everyone else normal people. The only thing that can reduce the quality of life is the need for daily intake drug.

— Will I really need to take L-thyroxine for the rest of my life? Does he have any side effects?

— If the amount of the drug received corresponds to the body’s needs, no undesirable changes should occur. All side effects associated with either an excess or lack of hormones in the blood. Monitoring the correct dose selection is carried out using periodic blood tests for the hormones T4 and TSH.

— How to determine that the dose of medication is too high?

— In case of an overdose, a woman becomes irritable, whiny, restless, and gets tired quickly. Despite a good appetite, she's losing weight. There may also be heart palpitations, interruptions in heart function, increased sweating, trembling in the hands or throughout the body. In many cases there is a tendency to diarrhea. If there are similar symptoms, you need to see a doctor.

— Will my weight increase while taking this medicine?

- Weight gain may occur with insufficient dosage of this drug. But if normal level hormones are laboratory confirmed, then the cause of weight change is not related to their intake.

— Can taking any other medications affect the level of thyroid hormones?

- Yes. Absorption of L-thyroxine may be reduced when taking certain stomach medications. These include antacids containing aluminum hydroxide, such as Maalox, Almagel, and Venter. Therefore, you should take the drug no earlier than two hours after taking antacids and Venter. It is advisable not to take other medications at the same time as hormonal pills. A two-hour interval is universal; during this time the medicine has time to enter the blood.

The female sex hormones estrogens can also reduce the effectiveness of thyroid hormones. They are found in birth control pills.

— Is it possible to become pregnant and give birth after surgery on the thyroid gland?

- If you get enough L-thyroxine every day, then there are no restrictions. When planning a pregnancy, you must inform your doctor about this. Every three months you will need to donate blood to test your blood levels. TSH hormones and free T. Remember that the need for L-thyroxine increases during pregnancy.

— It’s difficult to answer this question unambiguously. Age, weight and, of course, matter concomitant diseases. The diet must be selected individually. But there are also general recommendations.

The most important rule: all products must be fresh, and dishes must be freshly prepared. It is equally important to store food correctly. For example, vegetable oil It is poorly preserved in plastic and metal containers and does not tolerate contact with air and light. Therefore, it is better to keep it in a dark glass bottle. You need to follow a diet. It’s better to forget about snacking on sandwiches and pies.

— Which products should be preferred and which should be removed from the diet?

— Fats should be consumed no more than 90 g. Of this, a third should be fats plant origin. But they are not recommended for frying, because heat treatment are formed in oil toxic substances. The remaining two thirds should come from butter, cottage cheese, sour cream and meat.

About 80-100 g of protein per day is required. Beef, lean pork and cottage cheese, sea ​​fish, eggs are reliable sources of protein.

But the amount of regular sugar should be kept to a minimum - up to 30-40 g per day. If you are not allergic to bee products, it is better to replace it with honey. Complex carbohydrates, contained in cereals, bread, vegetables and fruits, the body needs about 350 g per day. But it is very important to do right choice: Among the cereals you should prefer buckwheat and oatmeal. It is very useful to eat bread with bran. And, of course, the diet should include vegetables and fruits. Firstly, they are rich in fiber, which stimulates intestinal function. Secondly, they contain natural antioxidants - vitamin C and beta-carotene. Thirdly, red and yellow vegetables and fruits contain bioflavonoids, which help proper metabolism in cells.

— Fatty fish varieties are very healthy. They contain substances that “restor” cell membranes. We can also recommend dried apricots and raisins: they contain a lot of potassium, which strengthens the heart muscle. Good to include on the menu seaweed: she is a record holder for the content of microelements. Kiwi, persimmon, pomegranates, feijoa, as well as black grape varieties, currants, and chokeberry are very useful.

— Are there any foods that should be tabooed?

— It is advisable to replace fried foods for boiled, steamed, stewed. Substances contained in cabbage inhibit the action of thyroid hormones. Therefore, you need to give up cabbage. When eating soy, you may need to increase the dose of L-thyroxine, since its proteins reduce the absorption of the hormone. It is better to replace pickled foods with pickled ones. A spicy foods- smoked meat, fish, herring - it is advisable to exclude them altogether.

- Indeed, some women may experience a decrease in appetite after surgery. But smoked meats can be successfully replaced by a sour apple or glass tomato juice 40 minutes before meals.

— Do I need to take any dietary supplements?

— Needs for biological active additives after the operation no. You should especially avoid taking “miracle remedies” under the influence of advertising.

— Is it possible to exercise after surgery? therapeutic fasting?

- No. Fasting is one of the factors that disrupts normal exchange thyroid hormones. Particular care should be taken when considering various low-calorie diets.

— Is it possible to do fitness and aerobics after surgery?

- If there are no symptoms or laboratory indicators of thyroxine overdose, then you can perform any physical exercise, not related to increased load on the heart. Calm swimming and playing table tennis are good options. Walking in the fresh air is very beneficial.

— Is it possible for women to travel to the south after thyroid surgery?

— Of course, you can go to the south. However, lying on the beach or in a solarium in order to change skin color is dangerous. Influenced ultraviolet rays Unfavorable fluctuations in hormone levels may occur.

— Is it possible to take a steam bath after surgery?

— You can go to the bathhouse and sauna, but the time spent in the steam room should be minimal. Sudden changes in temperature are not recommended, so after steaming, there is no need to jump into ice-cold water.

- Are they capable of influencing one’s well-being? electromagnetic radiation, for example, from a computer?

— You can work on a computer. However, the monitor must be modern and meet current safety requirements.

— Do removal of the thyroid gland and hypothyroidism affect the duration of subsequent life?

— No, if a woman receives adequate treatment, then life expectancy does not suffer. This has been proven through long-term scientific research. Those who have undergone surgery and are receiving hormones are recommended to be under the supervision of an endocrinologist and have their TSH level and do an ultrasound of the thyroid gland.

Estrogens contained in birth control pills can reduce the effectiveness of thyroid hormones.

Lyudmila ROMASHKINA

An enlarged thyroid gland (called a goiter) is quite common. There are many reasons for this. In some cases, the thyroid gland is enlarged due to a lack of iodine in food (compensatory enlargement), in others, an enlargement of the gland is a symptom of a disease of this organ. Women are most often affected. Enlargement of the thyroid gland in men is several times less common. Treatment for an enlarged thyroid gland depends on both the causes and manifestations of this reaction of the body.

The fact is that an increase in this organ may not lead to disruption of its functions (hormones are normal - euthyroidism), but may be accompanied by an increase (hyperthyroidism) or decrease (hypothyroidism) in the function of the gland. Depending on the diagnosis and results clinical tests and treatment for an enlarged thyroid gland is prescribed.

Degrees of enlargement of the thyroid gland

An important factor in treatment is determining the degree of organ enlargement. Thyroid consists of two lobes and an isthmus; most often, an increase in the lobe of the thyroid gland occurs on one side.

It is customary to distinguish the following degrees:

• Enlargement of the thyroid gland of the 1st degree is characterized by the fact that it is possible to palpate its isthmus, sometimes slightly enlarged lobes. Visually no changes are detected.
• Enlargement of the thyroid gland of the 2nd degree is clearly determined by palpation; during swallowing movements it becomes noticeable.
• A grade 3 enlargement of the thyroid gland is already clearly visible at a quick glance at the patient.
• With grades 4 and 5, the configuration of the neck changes, it becomes deformed, and the goiter interferes normal process swallowing and breathing.

Of course, with the last two degrees, as a rule, it is shown surgical intervention. However, the fourth and fifth degrees are rare today because modern medicine identifies the problem earlier. Quite often, an enlarged thyroid gland is discovered during routine examinations or when visiting a doctor for another reason.

Forms of thyroid diseases

Depending on the condition of the gland tissue, it can be:

• Diffuse enlargement - the gland is uniformly enlarged,
• Nodular enlargement - one or more nodules form in the tissues of the gland. They can be tiny, then they are simply kept under control. If the nodes increase more than 1 cm in diameter or there are several of them, a biopsy is prescribed, as there is a threat of their degeneration into malignant neoplasms.
• Mixed form. It starts with diffuse increase with subsequent formation of nodes.

For the reasons for the development of diseases:

• Endemic goiter (lack of iodine in water and food),
• Sporadic goiter (occurs under the influence of unfavorable factors),
• Thyroiditis (inflammatory processes),
• Congenital goiter.

Choice of treatment tactics

Very important comprehensive examination, which reveals the cause of the enlargement of the gland and the degree of impairment of its functions. Treatment of an enlarged thyroid gland is aimed primarily at normalizing hormonal levels. If the hormones are normal, then the patient is simply observed, periodically monitoring the level of thyroid hormone production.

Extreme cases of gland enlargement are surgery, after which you most often have to take medications containing thyroid hormones for the rest of your life.

Except surgical treatment apply:

• Hormone replacement therapy (for hypothyroidism),
• Therapy that inhibits the production of hormones by the gland,
• Treatment radioactive iodine.

Substitute hormone therapy It is usually carried out using the drug L-thyroxine. The dosage is selected individually. Treatment is started with small doses, gradually increasing them towards the middle of the course of treatment, after which the dose is gradually reduced until the drug is completely discontinued. Treatment can take from a month to one and a half to two years. Treatment hormonal drugs, normalizing the function of the gland, leads to a decrease in its size. In the absence of nodes, restoration of normal dimensions is quite possible.

This treatment is prescribed to children and adolescents who, during a period of rapid development, may suffer from reduced thyroid function. Today our children in schools and kindergartens regularly undergo preventive examinations. If a child has an enlarged thyroid gland, this is detected on early stages and is treatable. An enlarged thyroid gland in children is especially dangerous because it entails problems in the intellectual and behavioral spheres, impaired growth and sexual development.

For hyperthyroidism, drugs are prescribed that inhibit the production of hormones (propylthiouracil, mercazolil, methizol, thiamazole, tyrosol). If the effect is insufficient, surgery or, alternatively, radioactive iodine is indicated.

Treatment with radioactive iodine is a single (less often double) dose of the drug. In this case, the function of the thyroid gland is suppressed due to its destruction. The difficulty lies in correct selection doses. The attitude towards this method is ambiguous, since in 25% of cases, in addition to normalizing the size of the gland, symptoms of hypothyroidism are observed, which remain for life and require hormonal adjustments.

Abstract of the dissertationin medicine on the topic The effect of anticonvulsant therapy on thyroid function in epilepsy

P 4 4 "I Z5

MINISTRY OF HEALTH OF THE RUSSIA

RUSSIAN STATE MEDICAL UNIVERSITY NAMED AFTER N.I.PIROGSZA

As a manuscript

SHUTNZHOZA 15riga Vladiafsaga

UDC 616.953:616-008.9

INFLUENCE OF CONVILITY THERAPY ON CYTONVILITY 2ELESIS IN EPILEPSY

14.00.13 - nervous tears 14.00.03 - endocrinology

dissertation for the candidate's scientific degree medical sciences

Moscow 1992

The work was carried out at the Russian State medical university them. N.I. Pirogova.

Scientific supervisors:

laureate of the State Prize. Academician of the Russian Academy of Sciences and Russian Academy of Education, Professor L.O. Badalyan,

Doctor of Medical Sciences, Professor A.S. Gnetov

Official subscribers:

Doctor of Medical Sciences, Professor N.R. Starkova, Doctor of Medical Sciences, Professor Yakunin

Leading institution of the KII Pediatrics RAS

The defense of the dissertation will take place "...."......... 1932

at "...." o'clock - at a meeting of the specialized council (D.064-14.03) at the Russian State Medical University km. N.I. Pirogova SIoskva, st. Ostrovityanova, 1)

The dissertation can be found in the institute's library. Abstract sent out ".,..."......1932

Academic Secretary of the Spyaraipzfozannogo soya hundred dsetsr yadvdknskih sciences,

Grofessor P.H.yeeeshch

OssiG»sklya I-g^-b.-.

ABOUT ITTERPSHA WORKS,

Relevance of work. Epilepsy is one of the most common diseases nervous system. The incidence of epilepsy in the population varies from 0.352 to 5.32 (Loisen et al. 193? Osuntokun et al. 1537). The incidence of epilepsy and seizure disorders in children is higher than in adults (Jallon et al. 1987). Currently, significant progress has been made in the drug correction of convulsive paroxysms. Along with heat, long-term antisulsant therapy causes side effects, often having a significant impact on the ontogenetic development of the child. The most important aspects of the problem of epilepsy on modern stage is timely assessment of effectiveness drug therapy, detection and prevention of<дах проявлений антиконвульсантов (Л.О.Бадалян, 1970. В.ft.Карлов. 1S84, Т.И.Геладзе, 1997. О.Вайнтруй. 1389, Flcardl et al., 1983, Dasmr, Davie, 1987, Herranz et all., 1988). Значительное влияние в работах последних лет уделяется изучении влияния антиконвульсантов на нейроэндокриннув систему (П.Й.Теим, 1988, FIchsel H., st al. 1978, Kruse,1982, Bonuceile. et al., 1985, Joffe, et al..1986, Isojarvl et al., 1988). Одкиа из частых побочных эффектов является развитие у больных эпилепсией при длительном применении антиконвульсантов субклинического гипотериоза. Данный факт является очевидным и доказан болыгинствсм авторов во многих исследованиях (Llevendahl R., et al., 1978, Bensen, et al.. 1983, Larkin. et al., 1989). Вместе с тем, до настоящего времени недостаточно ясный остается вопрос о мехакизазх, детеркинирипдах развитие суйклгасетесксго гипоткриоза у больных эпилепсией на фоне антиконвульсантной терапии, характера влияния различных антиконвульсантов на функциональное состояние щитовидной железы на различных сроках применения, взаимосвязи изменений тиресид-ного статуса с особенностям нейропсихологического развита детей. Следует такгэ отметить, что оценка функционального состояния цитозидной аелезы проводится исключительно на основании исследования сывороточной концентрации тиреодных гормонов. Отсутствие дополнительных коиглексинх исследований, 9 частности 53И ситовидной келезы, не позволяет з полной мэре судить о возможных повреждениях щитовидной сзлвзн.

Tsvli and research objectives. Study of the differentiated effect of various anticovulsants (carbamazepine, diphenin, convulex, papitherapy) on the structural and functional state of the thyroid gland. Clarification of the mechanisms that determine development and the relationship of possible changes with the characteristics of neuropsychological development.

In accordance with the goal, the specific objectives of the study included:

1) study of the comparative effect of various anticonvulsants (carbamazepine, Darenia, Convulex, Polygeralia) on the fuctral state of the chitoid veleza in children suffering from epilepsy;

2) determination of the possible relationship between changes in thyroid status and epilepsy patients taking anticonvulsant drugs for a long time with the pathogenesis and characteristics of the course of epilepsy;

3) study of the possible correlation between changes in the functional state of the thyroid gland and the characteristics of the neuropsychological development of children suffering from epilepsy who have been taking anticonvulsant therapy for a long time; and so with the dose of various anticonvulsant drugs and the duration of treatment;

4) clarification of the nature of structural changes in the thyroid gland of children with epilepsy and long-term exposure to angioconsulsants according to ultrasound scanning data.

Scientific novelty. For the first time, a comprehensive study of the functional state of the thyroid gland was carried out on a sick group of children (123 patients) with epilepsy, including determination of the level of thyroid hormones in the blood (T4, ST4, T3, ST3, TTL and ultrasound examination of the thyroid gland).

The results of the study clarify and complement modern ideas about the effect of anticonvulsants on structural and functional changes in the thyroid gland in epilepsy in adolescent children. It has been noted that anticovulsant therapy causes, in a high percentage of cases, an increase in the size of the thyroid gland and a decrease in the chogenicity of the parenchyma against the background of subclinical hypothyroidism.

A correlation was revealed between the decrease in serum concentration of thyroid hormones and an increase in thyroid gland.

It has been shown that, regardless of the type of anticonvulsant therapy, there is a change in the neuropsychological development of a child suffering from epilepsy - a decrease in subtest indicators 5, 8 when studied using the Bexler method, which indicates a decrease in the ability to identify objects or concepts by their essential characteristics or classify them into a certain category, a decrease logical thinking abilities.

A correlation between changes in the structure of the intellect of patients with epilepsy and low serum concentrations of thyroxine was revealed, which indicates that the relative insufficiency of thyroxine plays a role in the development of changes in the intellect of patients with epilepsy.

Practical value. As a result of studies of patients with epilepsy who have been receiving anticonvulsants for a long time, the diagnostic value of a comprehensive study of the structural and functional characteristics of the thyroid gland has been revealed. When studying the serum concentration of thyroid hormones, the most informative test for identifying subclinical hypothyroidism is determining the level of CT4. It is recommended to conduct an ulcerative ultrasound of the thyroid gland in children suffering from epilepsy and receiving anticonvulsants, in order to identify the nature of structural changes and decide on the advisability of further endocrinological examination.

The presence of disorders of neuropsychological functions in children with epilepsy on anticonvulsant treatment indicates the advisability of including in the complex of therapy drugs that improve metabolic processes in the brain (vascular, macroenergetic compounds).

Approbation of work. The dissertation was completed in accordance with the scientific research plan of the Russian School named after. N.I. Pirogova. The materials of the work were published and discussed at a joint conference of the Department of Nervous Diseases of the Pediatric Faculty of the Russian State University of Medicine named after. N.I. Pirogova, department ZVD01FIN0L0GII TSOLIYV C20.0s.92).

Structure and scope of the dissertation. The dissertation is presented on pages of written text (excluding figures, tables and bibliography). Consists of an introduction, a literature review, 2 chapters with an exposition of the own research results, discussion, conclusion, and conclusions. The work is illustrated with tables and drawings. Bibliography incl.

no sources, of which - domestic and foreign

The author expresses deep gratitude to the scientific supervisor - the head of the department of nervous diseases of the pediatric faculty of the Russian State Medical University named after. N.I. Pirogov, laureate of the State Debate, academician of RA1GN, Professor L.Ts. Badalyan, head of the Department of Endocrinology TsOLINV, Professor Y.S.Ymetov for providing the topic of scientific co-investigation and supervising the work. The author also thanks the staff of the Department of Nervous Drakes of the Pediatric Faculty of the Russian State Medical University named after. N.I. Pirogov and the Department of Endocrinology TsOLIUB for advisory and methodological assistance.

CONTENTS OF WPSH

Sample characteristics of the examined group.

For the period from 1933 to 1932. We examined 123 patients aged from? up to 15 years of age (65 boys, 58 girls) suffering from discernible forms of epilepsy. The examination was carried out in herd-based conditions on the basis of the Department of Nervous Diseases of the Pediatric Faculty of the Russian State Medical University named after. N.I. Pirogova (head of departments - laureate of the State Debate, academician of the Russian Academy of Sciences and RyO, professor L.O. Badalyan), in the neurological departments of the DIB N1 of Uoskva (chief physician - Honored Doctor of the Russian Federation, Candidate of Sciences K. J. Kornshin), in the 6th department of the Moscow Children's Hospital (chief physician V.V. Konevnikova) and outpatient at the consultative neurological specialist in Moscow (head of the department E.B. Nessel).

According to the nature of the attacks, patients were divided in accordance with the classification of epileptic conditions developed by the International League against Epilepsy in 1381. Patients with impaired thyroid, liver or kidney function were not included in the study group. Distribute the patients according to age and gender as shown in Table K 1.

Table No. 1.

Distribution of patients depending on age and gender, type of anticonvulsant therapy used.

Age groups Gender

boys girls

years years years

ORN A 13 6 12 13

sag 10 16 5 15 18

them. 5 12 7 13 11

Polytherapy 12 22 9 25 18

Total 33 63 27 65 58

As follows from the table, the main contingent of observed patients were children aged 10 - 12 years - 51.22 patients. The number of patients aged 7-10 years is 26.8% of the total number of those examined; at the age of 13 - 15 years - 21,952. The majority of patients have primary and secondary generalized convulsive paroxysms. The frequency of paroxysms among the examined patients varied (Table No. 2).

Table No. 2

The distribution of patients depends on the frequency of paroxysms and the type of anticonvulsant used.

Anticonvulsant Frequency of paroxysms

Partial (once a month or more) Rare (less than once a month) No paroxysms C1 year and more)

ORN 1 1 23 svg 6 4 21 im. 1 2 21 Polytherapy 13 22 2

To clarify the question of the effect of the type of anticonvulsant and the duration of therapy, the patients were divided into groups (Table 3). The largest number of patients was observed during combination therapy, which included the simultaneous use of several anticonvulsants: carbamazepine, diphenin, phenobarbital, benzonal. In order to obtain objective information about the possible differentiated effect of various anticonvulsants on the functional state of thyroid kelosis in children with epilepsy, groups were identified depending on the dose of the drug used. The effect of monotherapy in the treatment of patients suffering from epilepsy was analyzed in three groups: carbaiazepine was used in 31 patients; diphenin - in 25 patients; convclex - in 24 patients with epilepsy. The daily dose of the drug varied within the permissible physiological doses. In order to identify the dynamics of changes in the function of thyroid kelosis, the study was carried out at various stages of treatment. For this purpose, the patients were divided into three groups: with a treatment duration of up to 6 months; up to 1 year; over 1 year. The distribution of patients with epilepsy depending on the duration of therapy used is presented in Table. 3.

Table No. 3

Distribution of patients with epilepsy depending on the duration of epithelial therapy

Anticonvulsant Duration of therapy

up to 6 carried up to 1 year above 1 year total

SRN 0 9 15 25

svg 6 5 20 31

Polytherapy 35 4 4 43

It should be noted that among the patients who were observed in the early stages of therapy, patients were examined with different periods of treatment - from 1 week to 0 months. The periods of late therapy varied, some patients took anticonulsants for up to 5 years. Some patients were examined repeatedly, over time, using complex examination methods.

thyroid cancer /n=30/ and a study of neuropsychological status was carried out in patients whose serum thyroid hormone concentration differed significantly from the normative values.

Safe! identifying the differentiated effect of anticonvulsants on neuropsychological development and possible relationship with functional!! condition of the thyroid gland, 29 children aged 8 to 15 years old suffering from epilepsy and receiving various anticonsulsants in monotherapy were examined. To identify a possible relationship with the type of antixnulsant, patients were divided into three groups depending on the drug used (CBZ n^u); DPH n=10; UflL n=8/. All patients suffered from generalized seizures.

The control group consisted of 20 healthy children, aged from 7 to 13 years,

Research methods. In the work, a special examination card was filled out for each patient, in which the passport part, a detailed clinical diagnosis, anacnestic data (pregnancy, childbirth, condition during birth and in the period of early adaptation, previous psychomotor development, previous diseases, family history, medical history) were noted. neurological status, disease dynamics; Therefore, the diagnosis was established on the basis of instrumental examination data: EchoEG, EEG, skull radiography, fundus examination, and according to indications, a computed tomography scan of the brain and an ultrasound scan of the thyroid gland were performed. To assess neuropsychological development, the Wechsler unified score (HISC) was used; patients were consulted by a psychologist.

To study the hormonal profile of the pituitary-hypothalamus-thyroid system, serum concentrations of T4, ST4, T3, ST4, and TSH were determined. Blood was drawn from the ulnar vein, on an empty stomach, from 8 to 10 am. All patients were free of paroxysms for at least 2 weeks. Quantitative determination of serum concentration of hormones for the purpose of differential diagnosis of thyroid disease was carried out with a test kit from the company Emerlight, which uses a competitive immunometric method based on enhanced lininescence /Whitehead T.R., et al., 983/.

Palpation and determination of the degree of enlargement of the thyroid gland were carried out in accordance with the generally accepted in the USSR, modified “Swiss classification of five degrees of enlargement of the thyroid gland / K.A. Vakovsky. 1982/. The possibility of clinical manifestations of thyroid kelesis dysfunction was assessed.

Echolocation of the thyroid kelosis was performed on a Bismetica AI 420 ultrasound scanner in real time. A sensor with a frequency of 10 MHz, with a water bag and a 0.5 cm diameter was used.

Statistical processing of the research materials was carried out on a personal computer 1VM-AT using the statistical data analysis package 51a1vgar11. The data was processed by calculating the arithmetic mean indicators /M/ for groups and subgroups of the surveyed and standard deviations from the arithmetic mean indicators, median, mode, standard deviation, dispersion, slope coefficient. Considering that the distribution of the majority of indicators across groups did not obey the laws of normal distribution, to assess the reliability of differences in the levels of the corresponding indicators in different groups, non-parametric criteria for assessing the reliability of differences were used - the “CI-squared” goodness-of-fit test and the Brokson test. analysis of variance. An analysis of the mutual dependence of the characteristics was carried out with the calculation of the Brivais-Pearson matrix correlation; in addition, the cumulative correlation coefficient was calculated, which takes into account the joint influence of several factors on the studied trait.

The result of research and discussion

The results of generalized studies of the serum concentration of thyroid hormones in patients with epilepsy on anticonvulsant therapy are presented in Table No. 4. It follows from the table that with all types of therapy used, a significant decrease in the average values ​​of T4 and CT4 was observed. There were no statistically significant differences between separate groups of patients taking different anticonvulsants. Similar results on changes in blood levels of T4 and CT4 in children were obtained by P1sb5e1 N., e1 a1, /1978/. When examining adult patients, the authors mostly showed a decrease in the levels of T4 and CT4.

Table K 4

Svrotochtaa concentration of treoadih gsr*llgas Yogyshz zgaiopsia during long-term treatment with ant: “koshtslj carrais”

ÍETüKSS"btat: P ¡H:Í/I CU !!C!b/l I nsn"i CT3 sian/i PG BÏÏ/tl

íspíaiaaeasj J: L 11.7" 5.5" MS.I-ÍS.D I2.M.J"" (3.87-13.1) U!(í.5i 5.11+1.64 (1.13-IU) ( i,51-1,75) 1.7"3,!" (i,35-3,37)

¡!(Ш1 1: 23 (SÍ.l-lJ.17) (l, "-7¡,3) 1.5.8.3 (8.35-2.2) Ш.) (5.33-7, 53) (1.51-7.3)

ItïïICJtIC Il: >1 33.2(3.7" (5i.i-iJ.l7) 17.Jil.ti (IM-Is.l! !.5"U 5.J+U (4.35-2 .25) (1.12-3.03) (1.53-3.27)

JîilIfMniJ j , 1! 73*lS,3t" 11.5*2.4*"<42.7 -131,7) (3,7-11,3) 2,37)3,3« 5.3»U (i,27-!,571 (i,11-7,15) t.lií.í (i,31-2,¡51

(WSHJ: 21 U5»l5,i (11.3-127.1) 15.4+2.7 Ill,l-l3.3) W (1.1-5.37) S.ÍUI.l ( 1.3-7.23) 1.¡3"3.S (l.37-i.43)

i - jitmepssm times ""! et:?ashpv with îîstjsîm, ; (I,i!” - ;< I,(il

3 comparison with the change in T4 levels, the serum concentration of T3 when taking RPR, "JAL did not change significantly and varied within the control hams, although there was a tendency to lower the level of T3; treatment with C3Z, the level of TZ moderately decreased, and with polytherapy it moderately increased. The level in blood STZ when taking all treatment options varied within the control values. Literature data on studying the level of TZ and STZ in antixnulsant therapy are contradictory. However, most researchers note their decrease. The level of TSH in the blood when using CBZ, OP"rl, UAL moderately increased, with taking polytherapy varied within the limits of nersha. It should be noted that despite the statistically significant change in the values ​​of serum concentrations of thyroid hormones in the blood / Fi chsel H. et al., 1975, 1978; Lievendahl K. et al., 1973, I960; Aanderud et al.,1981; Bentsen et al., 1983; Ericsson et al., Lar.kln et al., 1963; ïsojarui et al..1989/ TIT levels varied within normal values, although there was

a persistent tendency towards the previously noted changes. Exploring Changes

serum concentration of thyroid hormones depending on

duration of anticonvulsant therapy used in the ear in early

treatment period (up to 6 months) revealed a decrease in the level of T4, St4.

Comparison of groups of patients suffering from epilepsy with duration

anticonvulsant therapy for up to 6 months, up to a year, over a year did not reveal

there are no statistically significant differences between them. This indicates

that changes in serum concentrations of thyroid hormones,

more likely to occur in the early stages of anticonvulsant therapy and subsequently with

Knowing the duration of anticonvulsant therapy progresses. However, despite the pronounced changes in the serum concentration of thyroid hormones, none of the Solnys had clinical manifestations of hypothyroidism. These changes are 1ark)n K. eb a1., 19B9, IetepyaY K. e1 a1. ,1380/ is considered as subklishmesky or “biochemical” hypothyroidism.

The study of correlations between the age of patients, the age of onset of epilepsy, the age of initiation of regular therapy, the frequency of paroxysms, the duration of seizures and the daily dose of the anticonvulsant and serum concentrations of thyroid hormones was carried out with the calculation of the partial and cumulative correlation coefficient. An inverse correlation was found between the level of CT4 in the blood and: the age of the flow of the disease /r - - 0.58/; frequency of paroxysms /g = - 0.74/ duration of ERI use /g - -0.51/. High correlation coefficients are demonstrated by the close relationship between the serum content of ST- and: with the age of the onset of regular terrorist attacks /r - 0.53/; daily dose VRN /g - 0.72/; age of the patient "g - 0.47/. A correlation relationship was revealed between the concentration of serum CT4 and the combined effect of the listed factors /K - 0.56/, a correlation relationship was revealed between the concentration in the blood of SGZ and: age of disease flow /g - 0 .49/; frequency of paroxysms /g - 0.63/; and timing of 0RK use /g - 0.57/. An inverse correlation with a high coefficient was found by kendu STZ and; age at the start of regular therapy /g = - 0.74/: daily dose of SRP /g = - 0.73/, age." patients /t - - 0.44/. High cumulative

the correlation coefficient separates the connection between the joint dgLstsi^n of the listed (actors and the level of STZ in the blood /I = 0.57/. In addition, a clear correlation relationship was found between the listed F"ctors.^ /taking into account their simultaneous action/ and the content of TSH in the serum / ?. - 0.69/; TZ/K = 0.66/; 14 /k = 0.47/.

A moderate correlation was revealed between the age of the debit of the disease, the severity of paroxysms, the age of onset of regular therapy, duration of CB2 use, daily dose and blood level 74 /P = 0.417/; TZ /P = 0.437/; ST4 /th = 0.423/. A moderate correlation was revealed due to the blood content and the combined effect of the above factors /R - 0.466/. The correlation between serum TSH concentration and exposure to factors is characterized as moderate /K = 0.4/.

The correlation coefficient demonstrates the close relationship between the duration of use of L1 and the content of T4 in the blood /g = -0.45/ and T3/g = 0.54/. Consequently, there is an inverse relationship of average severity between the duration of use and the serum concentration of T4, i.e., with an increase in the duration of treatment, the content of T4 in the blood decreases. The level of T3 compensatory increases or is within the range. At that time, there is a direct connection between the average degree of pregnancy and the age of onset of the disease, the frequency of paroxysms, the age of the start of regular therapy. daily dose , duration!? treatment I"11 and blood content 74 /I - 0/56/; as well as the combined effect of the listed factors and the serum content of T3/?. - 0.273."": ST4 /I g 0.4/; STZ /G; ; 0.52/. Not sG"pzru::eko corrvlatsga; with sodeuzak^ek in the cut of TTG.

Using the Eilcoxep reliability criterion, the X1 agreement criterion and the correlation analysis allows us to state that CT4 is the most: with;-ngizn:a skrllkng-trst pa hypothyrgoidism in the population with epilepsy, Na:ti dan!y."e is consistent with Cr.tsger ii. fi., L a1. 1987. Dispersive analysis of gasvol"m to compare the effect of anticonsulsant Inactivity on the content of ST4 in the blood. The deviation of the median from the average half demonstrates that the distribution function is asymmetric. The asymmetry of the cogettes is influenced by a slight decrease in the serum content of CT4; the degree of deviation is indicated by the corresponding slope coefficient. In a group of patients with epilepsy

long term DPH was 1.56; for polyterashes - 1.67; on C3Z therapy - 1.16; on UfiL - 0.81. Consequently, the effect of polytherapy, DPH, CBZ, when used for a long time for the purpose of relieving seizures, on the functional state of gastric hypertension is more significant than the effect of UñL. Despite the low serum concentrations of thyroid hormones, it is noteworthy that patients treated with anticonvulsants remain clinically hypothyroid. The TSH level increased in the group of patients with epilepsy on therapy with DPK, CBZ, UfiL; but at the same time remained within euthyroid limits. Consequently, the use of basal serum TSH as a screening test for anticovulsant treatment of epilepsy is not sufficiently informative. A more effective screening test for hypothyroidism in this group of patients may use serum CT4 levels,

An ultrasound scan of the thyroid kelosis showed /Table 5/ that ionotherapy, regardless of the type of anti-cavulsact, when used for a long time (more than 6 months), causes an increase in the size of the thyroid gland. It is noteworthy that a more pronounced increase (II degree) was noted when taking CBZ and DPH. Taking UfiL caused an increase in the size of thyroid kelesis, mainly grade I.

Table K 5

U31 results! ErtoeidnoI shelzzy in patients with severe pain ka therapy achtihoshulsyntosh!

1зшзш]pizt S-zv 1»з?agl 1и?gi Cjmau tsazg (ншшст Zipchshe rzzirn tüíissae<шш (пин jííara ишшдосша amnujn- мигцн.-г lemu iiiirta-(«j.l tr) tir/£ä!l iuiiGt тгра- - шн sa-

In bis! I! ;;su¿í

(r) crasas tme¡a pistij-asä cis-28

5?! 19 1st 1.3 - 11 555 - 1755 0.5-8 2ÜZ Sil ¡!2

ig 19 8-15 9.23- 15 Ш - (39 1-3 23Z HZ Ш

iE 19 8-13 1.23- I 252 - ESZ 9.25 - 2.5 Sai! 5S2 5

A characteristic feature baked nani in the treatment of SI. and DPH. I am aware of the diffuse decrease in the echogenicity of the parenchis and is going on. During CB7 therapy, a decrease in echogenicity was established in 402 patients; during the treatment of DPH in 2CX, while the actual UflL therapy did not cause a decrease in echogenicity. It should be answered that the majority of the patients examined were in prepubertal and pubertal age, when as a result of relative physiological insufficiency! cribriform velosis, fluctuations in sex hormones and other factors create a predisposition to an increase in the size of the thyroid kelosis. In epilepsy, changes according to ultrasound data were quite significant, but they were not accompanied by signs of the pathology of thyroid kelosis. It is possible that the influence of DPH, CBZ, UAL is different in intensity on echogenicity indirectly reflects the degree of influence of anticonvulsants on the structure of the threadlike gland.

Summarizing the above data, it should be noted that anticonvulsant therapy, regardless of the type, dose, duration of use, causes changes in the content of thyroid hormones /Larkin K., et al., 1937; Ericsson et al., 1984; Dentsen et al., 1981; Lieuendahl K.. et al., 1978/, contributing to the rise of a pathologically stable state with relative thyroid insufficiency. Changes in the content of free and total T4 are not accompanied by a significant increase in the level of TSH in the blood, as could theoretically be due to a feedback mechanism. There were no clinical signs of hypophrosis, even with long-term use of anticonvulsants. However, according to the results of ultrasound, the size of the cetoid was significantly increased, in 202 patients there was a decrease in echogenicity, which gave grounds to classify this group of patients as a “risk group” for hypothyroidism. The absence of clinical hypothyroidism in most patients indicates that in the process of long-term anticonvulsant therapy, which contributes to a persistent decrease in the level of thyroid hormone, an adaptive restructuring of metabolic processes occurs; which creates the possibility of “protecting” the patient from a possible sharp depletion of the sieve gland reserves and the development of clinical hypothyroidism. The discovery of these mechanisms should be the subject of special research.

Changes in the reactivity of the thyroid gland and its sensitivity to the action of TSH play a major role in the development of goiter /Barthier S..

Leoarchaud-Bezand T., 1978/. It is not clear that in epilepsy, when metabolic processes as a result of the disease and long-term anticonvulsant therapy are significantly altered, the sensitivity of the thyroid gland to the action of TSH also changes. The change in the sensitivity of the thyroid gland to the action of TSH is based on a change in the concentration of iodine in the gland. In search of the mechanisms that determine the increase in the size of the thyroid gland in epilepsy during puberty, it is necessary to study the effects of anticonvulsants on sex hormones. Estrogens significantly influence the metabolism of the thyroid gland; Single studies carried out in epilepsy show that anticonvulsants, affecting the activity of oxisomal liver enzymes, significantly change the level of steroid sex hormones. However, no special studies have been conducted on the effect of anticonsulsantosis on the level of sex hormones during puberty.

Assessment of the neuropsychological state according to the Wechsler test did not reveal significant deviations from the average values ​​for 0I1, NIP, BIL / table. 6/. Although, when individually analyzing each test indicator, there is a tendency towards wheat in the subtest 5.8. It was established that, regardless of the type of anticonvulsant therapy, changes in individual parameters of the Wechsler scale were observed, which indicates that patients had impairments in logical thinking and the ability to identify objects and concepts according to their essential characteristics, and classify them into a certain category. Correlation analysis revealed the relationship of changes in the Wechsler scale with serum T4 levels, in addition, it is assumed that CBZ and DPH affect the hypothalamus-pituitary system /Theodoropoulos S., et al, 1380; Reggu Z.S., 1979; Purks ML. et al. 1983; Isojarvi 3.T., et al. 1989/.

Table No. 6

The results of the neuropsychiatric study (H1SC) of patients with epilepsy on achticonvulsant therapy

£m 1-i r?s- Sa g-t t£ST ls:)