Epilepsy went away. Which doctors should you contact if you have Epilepsy?
Epilepsy
What is Epilepsy -
Epilepsy- chronic illness, manifested by repeated convulsive or other seizures, loss of consciousness and accompanied by personality changes.
The disease has been known for a very long time. Its descriptions are found among Egyptian priests (about 5000 BC), doctors Tibetan medicine, Arabic-language medicine, etc. Epilepsy in Russia is called epilepsy, or simply epilepsy. The disease is common: 3-5 cases per 1000 population.
What provokes / Causes of Epilepsy:
Despite the long period of study, the etiology and mechanisms of the disease have not been sufficiently studied.
In newborns and infants, the most common reasons seizures are severe hypoxia, genetic defects metabolism, as well as perinatal lesions. IN childhood seizures in many cases are caused by infectious diseases nervous system. There is a fairly clearly defined syndrome in which seizures develop only as a consequence of fever - febrile seizures. 5% of children have experienced seizures at least once in their lives when their body temperature rises, and in about half of them repeated seizures should be expected.
At a young age, the main cause of epileptic disorders is traumatic brain injury, and one should remember the possibility of developing seizures both in acute and more severe cases. late period. In persons over 20 years of age, especially if there is no history of epileptic seizures, possible reason epilepsy is a brain tumor.
In patients over 50 years of age among etiological factors epilepsy should first of all indicate vascular and degenerative diseases brain. Epileptic syndrome develops in 6-10% of patients who have suffered an ischemic stroke, most often outside acute period diseases.
It is important to emphasize that in 2/5 patients the cause of the disease cannot be established with sufficient evidence. In these cases, epilepsy is regarded as idiopathic. Genetic predisposition plays a role in some types of epilepsy. Patients with a family history of epilepsy have more high risk seizure development than in the general population. Currently, the localization of genes responsible for some forms of myoclonic epilepsy has been established in the human genome.
Pathogenesis (what happens?) during Epilepsy:
In the pathogenesis of epilepsy, the leading role is played by changes in the neuronal activity of the brain, which, due to pathological factors becomes excessive and periodic. Characteristic is a sudden pronounced depolarization of neurons in the brain, which is either local and occurs in the form of partial seizures, or becomes generalized. Significant disturbances in the processes of thalamocortical interaction and an increase in the sensitivity of cortical neurons have been established. The biochemical basis of seizures is the excessive release of excitatory neurotransmitters - aspartate and glutamate - and a lack of inhibitory neurotransmitters, primarily GABA.
Pathomorphology. In the brains of deceased patients with epilepsy, dystrophic changes ganglion cells, karyocytolysis, shadow cells, neuronophagia, glial hyperplasia, disorders in the synaptic apparatus, swelling of neurofibrils, formation of “windows” of desolation in nerve processes, “swelling” of dendrites. These changes are more noticeable in the motor zone of the cerebral cortex big brain, sensitive zone, hippocampal gyrus, amygdala, nuclei of the reticular formation. Residual changes in the brain associated with past infections, injuries, developmental defects. These changes are not specific.
Symptoms of Epilepsy:
IN clinical picture epilepsy is distinguished by a period of seizure, or attack, and interictal period. It should be emphasized that in the interictal period, neurological symptoms may be absent or determined by the disease causing epilepsy (traumatic brain injury, stroke, etc.). Most characteristic feature epilepsy is grand mal seizure . Usually it begins suddenly, and its onset is not associated with any external factors. Less commonly, distant warning signs of a seizure can be identified. In these cases, 1-2 days before it is noted bad feeling, headache, sleep disturbance, appetite, increased irritability. In most patients, a seizure begins with the appearance of an aura, which in the same patient is of a stereotypical nature. Depending on the irritation of the area of the brain from which the epileptic discharge begins, several main types of aura are distinguished: vegetative, motor, mental, speech and sensory. After the aura, which lasts several seconds, the patient loses consciousness and falls as if knocked down. The fall is accompanied by a kind of loud cry caused by a spasm of the glottis and convulsive muscle contraction chest. Convulsions immediately appear, initially tonic: the torso and limbs are stretched out in a state of tension, the head is thrown back and sometimes turned to the side, breathing is held, the veins in the neck swell, the face becomes deathly pale, with gradually increasing cyanosis, the jaws are convulsively clenched Tonic the seizure phase lasts 15-20 s. Then clonic convulsions appear in the form of jerky contractions of the muscles of the limbs, neck, and torso. During the clonic phase of a seizure lasting up to 2-3 minutes, breathing is often hoarse and noisy due to the accumulation of saliva and retraction of the tongue, cyanosis slowly disappears, foam is released from the mouth, often stained with blood due to biting the tongue or cheek. The frequency of clonic convulsions gradually decreases, and at the end of them a general muscle relaxation. During this period, the patient does not react even to the strongest irritants, the pupils are dilated, there is no reaction to light, tendon and defensive reflexes are not caused, often noted involuntary urination. Consciousness remains soporous and only after a few minutes it gradually clears up. Often, leaving soporous state, the patient plunges into deep dream. After the attack ends, they complain more about weakness, lethargy, and drowsiness, but they don’t remember anything about the attack itself.
The nature of epileptic seizures can be different. According to International classification epileptic seizures are divided into partial (focal, local) and generalized seizures. Partial seizures are further divided into simple, complex, occurring with impaired consciousness, and secondary generalized.
Symptoms of partial seizures are determined by the syndrome of irritation of any zone of the diseased brain cortex. Among simple partial seizures, the following can be distinguished: with motor signs; with somatosensory or specific sensory symptoms(sounds, flashes of light or lightning); With vegetative symptoms or signs (peculiar sensations in the epigastrium, pallor, sweating, redness of the skin, piloerection, mydriasis); with mental symptoms.
Complex seizures are characterized by varying degrees of impairment of consciousness. In this case, consciousness may not be completely lost; the patient partially understands what is happening around him. Often complex partial seizures are caused by a focus in the temporal or frontal lobe and begin with an aura.
The sensory aura includes various violations perception. Visual aura, which occurs when the occipital lobe is damaged, is usually manifested by the vision of bright sparks, shiny balls, ribbons, bright red coloring of surrounding objects (simple visual hallucinations) or in the form of images of some faces, individual parts of the body, figures (complex visual hallucinations) . The size of objects changes (macro- or micropsia). Sometimes visual fields fall out (hemianopsia), and complete loss of vision (amaurosis) is possible. With olfactory aura (temporal lobe epilepsy), patients are haunted by a “bad” smell, often combined with taste hallucinations (taste of blood, bitterness of metal, etc.). The auditory aura is characterized by the appearance of various sounds: noise, crackling, rustling, music, screams. For the psychic aura (with damage to the parieto-temporal region), experiences of fear, horror or bliss, joy, and a peculiar perception of “what has already been seen” are typical. The vegetative aura is manifested by changes functional state internal organs: palpitations, chest pain, enhanced peristalsis intestines, the urge to urinate and defecate, epigastric pain, nausea, salivation, a feeling of suffocation, chills, paleness or redness of the face, etc. Motor aura (if the sensorimotor area is affected) is expressed in various kinds motor automatisms: throwing back or turning the head and eyes to the side, automated movements of the limbs, which have a natural distribution pattern (leg - torso - arm - face), while sucking and chewing movements appear. A speech aura is accompanied by the utterance of individual words, phrases, meaningless exclamations, etc. With a sensitive aura, patients experience paresthesia (a feeling of cold, crawling, numbness, etc.) in certain parts of the body. In some cases, with partial seizures, simple or complex, pathological bioelectrical activity, initially focal, spreads throughout the brain - and a secondary generalized seizure develops.
With primary generalized seizures in pathological process initially both hemispheres of the cerebrum are involved. The following types of generalized seizures are distinguished:
- absence seizures and atypical absence seizures;
- myoclonic;
- clonic;
- tonic;
- tonic-clonic;
- atonic.
Children with epilepsy often experience absence seizures, which are characterized by a sudden and very short-term cessation of activity (play, conversation), freezing, and lack of response to calls. The child does not fall and after a few seconds (no more than 10) continues the interrupted activity. On the EEG of patients during absence seizure, characteristic peak-wave activity with a frequency of 3 Hz is usually recorded. The patient is unaware and does not remember the seizure. The frequency of absence seizures sometimes reaches several dozen per day.
The international classification of epilepsy and epileptic syndromes should be distinguished from the classification of epileptic seizures, since in a number of cases the same patient, especially with severe epilepsy, has different seizures.
The classification of epilepsy is based on two principles. The first is whether the epilepsy is focal or generalized; the second is whether any pathology is determined in the patient’s brain (according to MRI, CT studies, etc.); Accordingly, symptomatic or idiopathic epilepsy is distinguished.
Sometimes seizures occur so frequently that it develops life-threatening condition - status epilepticus.
Status epilepticus - a condition in which the patient does not regain consciousness between seizures or the seizure lasts more than 30 minutes. The most common and severe is tonic-clonic status epilepticus.
Diagnosis of Epilepsy:
In the presence of seizures with loss of consciousness, regardless of whether they were accompanied by convulsions or not, all patients should undergo an electroencephalographic examination.
One of the main methods for diagnosing epilepsy is electroencephalography. The most typical types of epileptic activity are the following: sharp waves, peaks (spikes), peak-slow wave complexes, sharp wave-slow wave. Often the focus of epileptic activity corresponds clinical features partial seizures; application modern methods Computerized EEG analysis allows, as a rule, to clarify the localization of the source of pathological bioelectrical activity.
There was no clear relationship between EEG pattern and seizure type; at the same time, generalized high-amplitude peak-wave complexes with a frequency of 3 Hz are often recorded during absence seizures. Epileptic activity is usually noted on encephalograms recorded during a seizure. Quite often it is determined on the so-called interictal EEG, especially when conducting functional tests(hyperventilation, photostimulation). It should be emphasized that the absence of epileptic activity on the EEG does not exclude the diagnosis of epilepsy. IN last years so-called multi-hour EEG monitoring and parallel video and EEG monitoring began to be used.
When examining patients with epilepsy, it is necessary to carry out computed tomography, preferably MRI examination; It is advisable to examine the fundus, biochemical research blood, electrocardiography, especially in the elderly.
In recent years, the method of recording evoked visual potentials for checkerboard pattern reversal has begun to be used as an additional method to study the state of visual afferentation pathways in patients with epilepsy. Specific shape changes were identified visual potential and sensory after-discharge in the form of their transformation into a phenomenon similar in form to the “spike-wave” complex.
Treatment of Epilepsy:
The purpose of treatment are the cessation of epileptic seizures with minimal side effects and the management of the patient in such a way that his life is as full and productive as possible. Before prescribing antiepileptic drugs, the doctor must conduct a detailed examination of the patient - clinical and electroencephalographic, supplemented by analysis of ECG, kidney and liver function, blood, urine, and CT or MRI data. The patient and his family should receive instructions about taking the drug and be informed both about the actually achievable results of treatment and about possible side effects.
Modern tactics Treatment of patients with epilepsy includes the following:
- identifying those causes of seizures that are treatable (tumor, aneurysm, etc.);
- eliminating factors that provoke seizures (lack of sleep, physical and
- mental stress, hyperthermia);
- correct diagnosis of the type of epileptic seizures and epilepsy;
- appointment of adequate drug therapy(inpatient or outpatient);
- attention to education, employment, recreation of patients, social problems patient with epilepsy.
Principles of treatment of epilepsy:
- compliance of the drug with the type of seizures and epilepsy (each drug has a certain selectivity in relation to one or another type of seizures and epilepsy);
- if possible, use monotherapy (use of one antiepileptic drug).
Conservative treatment. Treatment should begin with a small dose of an antiepileptic drug recommended for this type of seizure and form of epilepsy.
The dose is increased if there are no side effects and seizures persist overall. For partial seizures, carbamazepine (Tegretol, Finlepsin, Karbasan, Timonil), valproates (Depakine, Convulex), phenytoin (Difenin), phenobarbital (Luminal) are effective. The first line drugs are carbamazepine and valproate. Average therapeutic dose carbamazepine is 600-1200 mg per day, valproate - 1000-2500 mg per day. Daily dose divided into 2-3 doses. The so-called retard drugs, or long-acting drugs, are very convenient for patients. They are prescribed 1-2 times a day (Depakine-Chrono, Finlepsin-Petard, Tegretol-CR). Side effects phenobarbital and phenytoin determine their use only as second-line drugs.
For generalized seizures, the patterns of drug prescription are as follows. For generalized tonic-clonic seizures, valproate and carbamazepine are effective. For absence seizures, ethosuximide and valproate are prescribed. Valproate is considered the drug of choice for patients with idiopathic generalized epilepsy, especially myoclonic seizures and absence seizures. Carbamazepine and phenytoin are not indicated for absence seizures and myoclonic seizures.
In recent years, many new antiepileptic drugs have appeared (lamotrigine, tiagabine, etc.), differing more high efficiency and better tolerability.
Treatment of epilepsy is a long process. The question of gradual cessation of taking antiepileptic drugs can be raised no earlier than 2-5 years after the last seizure (depending on the age of the patient, the form of epilepsy, etc.).
At status epilepticus Sibazon (diazepam, seduxen) is used: 2 ml of a solution containing 10 mg of the drug (administered intravenously slowly with 20 ml of a 40% glucose solution). Re-introduction permissible no earlier than 10-15 minutes If there is no effect from sibazon, administer phenytoin, hexenal or sodium thiopental. 1 g of the drug is dissolved in an isotonic solution of sodium chloride and administered very slowly intravenously as a 1-5% solution. In this case, there is a danger of respiratory and hemodynamic depression, so the drugs should be administered with minute pauses after infusion of every 5-10 ml of solution. In cases where seizures continue and their frequency is high, use inhalation anesthesia nitrous oxide mixed with oxygen (2:1). Anesthesia is contraindicated in deep comatose, severe breathing disorders, collapse.
Surgery. In case of focal epilepsy, the indications for surgery are determined primarily by the nature of the disease that caused the epileptic seizures (tumor, abscess, aneurysm, etc.).
More often in these cases, the need for surgery is determined not by the presence of epileptic syndrome in the patient, but by the danger to his health and life of the disease itself that led to the occurrence of seizures. This applies primarily to brain tumors, abscesses and some other volumetric formations brain
It is more difficult to determine the indications in cases where the epileptic syndrome is caused by the consequences of an injury, inflammatory process or obvious reason epilepsy is absent, difficult to detect, with the help special methods. In these cases, the main treatment method is medication. Only a relatively small number of patients with seizures that are not amenable to drug correction and with progressive personality degradation require brain surgery.
Due to the complexity and responsibility of deciding on the feasibility surgical intervention, examination of patients and the operation itself should be carried out in specialized centers.
Of particular importance in clarifying the nature of epilepsy is the study of brain metabolism using positron emission or single-photon tomography (for now, such studies are only possible in certain specialized centers).
A special place in the examination of patients suffering from epilepsy is monitoring their condition, behavior and targeted research of the bioelectrical activity of the brain.
If surgical treatment is contemplated, there is often a need to use electrodes implanted in the deep structures of the brain for long-term recording of the electrical activity of these structures. For the same purpose, multiple cortical electrodes can be used, the installation of which requires craniotomy.
If using the above methods it is possible to detect a focus of pathological electrical activity (epileptic focus), indications may arise for its removal.
In certain cases, such operations are performed under local anesthesia in order to be able to control the patient’s condition and not cause damage to functionally significant areas of the brain (motor, speech areas).
In case of focal epilepsy that occurs after a traumatic brain injury, the meningeal adhesions are separated, cysts and glial scars are removed from the brain tissue, according to the location of the epileptogenic focus, and subpial removal of the cortex is performed.
One of the special forms of focal epilepsy that is subject to surgical treatment is temporal lobe epilepsy, the origin of which is often birth injury with the formation of foci of gliosis in the hippocampus and medial sections temporal lobe.
The basis temporal lobe epilepsy constitute psychomotor seizures, the appearance of which is often preceded by a characteristic aura: patients may experience a feeling unreasonable fear, discomfort V epigastric region, feel unusual, often unpleasant odors, the experience of “already seen.” Seizures may be of a nature motor restlessness, uncontrolled movements, licking, forced swallowing. The patient becomes aggressive. Over time, personality degradation occurs
For temporal lobe epilepsy long time Resection of the temporal lobe was used with some success. IN Lately a more gentle operation is used - selective removal of the hippocampus and amygdala. The cessation or weakening of seizures can be achieved in 70-90% of cases.
In children with congenital underdevelopment of one of the hemispheres, hemiplegia and epilepsy that cannot be corrected with medication, in some cases there are indications for removal of the entire affected hemisphere (hemispherectomy).
In case of primary generalized epilepsy, when it is not possible to identify an epileptogenic focus, intersection of the corpus callosum (callesotomy) is indicated. During this operation, interhemispheric connections are broken and generalization does not occur. epileptic seizure. In some cases, stereotactic destruction of deep brain structures (amygdala complex, cingulate gyrus), which are parts of the “epileptic system,” is used.
Prevention of Epilepsy:
It is recommended to avoid drinking alcohol, smoking, strong coffee and tea, overeating, hypothermia and overheating, staying at high altitude, as well as other adverse effects. external environment. A dairy-vegetable diet, prolonged exposure to air, and lungs are indicated. physical exercise, compliance with the work and rest regime.
Work ability. Often depends on the frequency and timing of seizures. In case of rare seizures that occur at night, the ability to work is maintained, but business trips and night work are prohibited. Seizures with loss of consciousness during the daytime limit the ability to work. It is prohibited to work at heights, near fire, in hot shops, on water, near moving mechanisms, on all types of transport, in contact with industrial poisons, at a fast pace, neuropsychic stress and frequent switching of attention.
Which doctors should you contact if you have Epilepsy:
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Other diseases from the group Diseases of the nervous system:
| Absence epilepsy Kalpa |
| Brain abscess |
| Australian encephalitis |
| Angioneuroses |
| Arachnoiditis |
| Arterial aneurysms |
| Arteriovenous aneurysms |
| Arteriosinus anastomosis |
| Bacterial meningitis |
| Amyotrophic lateral sclerosis |
| Meniere's disease |
| Parkinson's disease |
| Friedreich's disease |
| Venezuelan equine encephalitis |
| Vibration disease |
| Viral meningitis |
| Exposure to ultra-high frequency electromagnetic fields |
| Effects of noise on the nervous system |
| Eastern equine encephalomyelitis |
| Congenital myotonia |
| Secondary purulent meningitis |
| Hemorrhagic stroke |
| Generalized idiopathic epilepsy and epileptic syndromes |
| Hepatocerebral dystrophy |
| Herpes zoster |
| Herpetic encephalitis |
| Hydrocephalus |
| Hyperkalemic form of paroxysmal myoplegia |
| Hypokalemic form of paroxysmal myoplegia |
| Hypothalamic syndrome |
| Fungal meningitis |
| Influenza encephalitis |
| Decompression sickness |
| Childhood epilepsy with paroxysmal activity on EEG in the occipital region |
| Cerebral palsy |
| Diabetic polyneuropathy |
| Dystrophic myotonia Rossolimo–Steinert–Kurshman |
| Benign childhood epilepsy with EEG peaks in the central temporal region |
| Benign familial idiopathic neonatal seizures |
| Benign recurrent serous meningitis of Mollare |
| Closed injuries of the spine and spinal cord |
| Western equine encephalomyelitis (encephalitis) |
| Infectious exanthema (Boston exanthema) |
| Hysterical neurosis |
| Ischemic stroke |
| California encephalitis |
| Candidal meningitis |
| Oxygen starvation |
| Tick-borne encephalitis |
| Coma |
| Mosquito viral encephalitis |
| Measles encephalitis |
| Cryptococcal meningitis |
| Lymphocytic choriomeningitis |
| Meningitis caused by Pseudomonas aeruginosa (pseudomonas meningitis) |
| Meningitis |
| Meningococcal meningitis |
| Myasthenia gravis |
| Migraine |
| Myelitis |
| Multifocal neuropathy |
| Disorders of the venous circulation of the brain |
| Spinal circulatory disorders |
| Hereditary distal spinal amyotrophy |
| Trigeminal neuralgia |
| Neurasthenia |
| Obsessive-compulsive disorder |
| Neuroses |
| Femoral nerve neuropathy |
| Neuropathy of the tibial and peroneal nerves |
| Facial nerve neuropathy |
| Ulnar nerve neuropathy |
| Radial nerve neuropathy |
| Median nerve neuropathy |
| Nonfusion of vertebral arches and spina bifida |
| Neuroborreliosis |
| Neurobrucellosis |
| neuroAIDS |
| Normokalemic paralysis |
| General cooling |
| Burn disease |
| Opportunistic diseases of the nervous system in HIV infection |
| Skull bone tumors |
| Tumors of the cerebral hemispheres |
| Acute lymphocytic choriomeningitis |
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 of the 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 thyroid gland at different periods of use, the relationship between changes in thyroid status and the characteristics of the neuropsychological development of children. It should also be noted that the assessment of the functional state of cytosidic aelosis is carried out solely on the basis of a study of the serum concentration of thyroid hormones. The lack of additional studies of thyroid cancer, in particular 53I cribriform kelosis, does not allow us to fully judge possible damage to the thyroid gland.
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 neuropsychological dysfunctions 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: --
Paraclinical methods included: EEG - dynamic study, MRI of the brain, hormonal examination, with determination of the level of sex hormones (luteinizing, follicle-stimulating, prolactin, progesterone, estradiol, testosterone) on fixed days of the menstrual cycle (7 and 21) and thyroid hormones ( TSH, T3, T4), All patients underwent ultrasound examination of the thyroid gland and pelvic organs. All women were examined by a gynecologist and an endocrinologist.
The obtained research results were subjected to statistical processing methods using multivariate analysis of variance (MANOVA), Student's t test, criterion 2 (SPSS version 11).
Psychopathological qualification of mental disorders in the epilepsy clinic for women was carried out according to the diagnostic criteria of ICD-10, on the basis of which patients were selected for the study in accordance with section F.06 “Mental disorders due to brain damage or dysfunction.”
When determining the form of the disease and the structure of the leading paroxysmal syndrome, the modern classification of epilepsy (New Daily, 1989) and epileptic seizures (Kyoto, Japan, 1981) was used.
In the present study, two subtypes of epilepsy were studied: catamenial and non-catamenial, with an assessment of the characteristics of their course depending on the presence of concomitant psychopathological disorders and endocrine-gynecological disorders.
Research results
It was found that catamenial epilepsy in the entire studied sample was no more than 19%, while non-catamenial epilepsy, respectively, accounted for 81%, i.e. Non-catamenial epilepsy occurs 4 times more often than catamenial epilepsy.
Moreover, among patients with the catamenial pattern, women with the perimenstrual subtype of the onset of seizures predominated (20 people, 87%) over patients with the follicular subtype of the onset of seizures.
A comparison of patients with catamenial and non-catamenial onset of seizures revealed some differences, indicating a longer duration of endocrine pathology in the group of catamenial patients. Along with this, there was also a tendency towards an earlier onset of both epilepsy and endocrine pathology compared to patients with non-catamenial epilepsy (see Table 1).
Table 1. Clinical and anamnestic age characteristics of patients with catamenial and non-catamenial epilepsy
| Age-related clinical and anamnestic characteristics | Catamenial epilepsy (n=27) | Non-catamenial epilepsy (n=114) | Differences |
| Age | 26+-7,4 | 25,4+-7,4 | n.z. |
| Age of onset of epilepsy | 12,6+-4,9 | 15,4+-7,7 | n.z. |
| 16,9+-4,1 | 19,4+-6,8 | n.z. | |
| Duration of epilepsy | 13,5+-8,6 | 10,3+-8,0 | n.z. |
| 9,3+-7,0 | 5,8+-3,8 | p=0.0013 | |
| - diseases | 4,3+-5,3 | 3,9+-7,8 | n.z. |
Table 2. Correlation between menstrual dysfunction and thyroid pathology
| Endocrine and gynecological pathology | Pathology of the thyroid gland | Absence of thyroid pathology | Total |
| Menstrual dysfunction | 7 | 83 | 90 |
| Normal menstrual cycle | 24 | 27 | 51 |
| Total | 31 | 110 | 141 |
| Significance | 2 =29,29 | = 0,45 | p= 0,000 |
Moreover, it turned out that thyroid pathology and menstrual dysfunction are largely mutually exclusive ( 2 =29.29; p=0.0000). Moreover, in the entire sample of patients, the simultaneous presence of thyroid pathology and menstrual dysfunction was found in only 5% of patients. On the contrary, a combination of thyroid gland pathology and normal menstrual function – in 17% of women; whereas normal thyroid condition and menstrual dysfunction were found in 59%, and normal thyroid condition and menstrual dysfunction were found in 19% of women.
Thus, the pathology of the endocrine system in the studied cohort of women with epilepsy predominantly goes in one direction. In this case, either the hypothalamic-pituitary-gonadal axis is predominantly affected (59%), or thyroid pathology occurs (17%). About a fifth of women do not have any neuroendocrine pathology.
A comparative analysis of the age-related characteristics of neuroendocrine disorders and epilepsy revealed some dependencies (see Table 3).
Table 3. Age characteristics of epilepsy and endocrine pathology depending on the nature of the comorbid endocrine disorder
| Index | Reproductive disorders (n=73) | Thyroid disorders (n=26) | Significance |
| Age of patients | 25+-0,93 | 26+-1,5 | n.z. |
| Age of onset of epilepsy | 14,7+-0,92 | 15,2+-1,4 | n.z. |
| Duration of epilepsy | 10,7+-1,06 | 11,5+-1,5 | n.z. |
| Age of onset of endocrine pathology | 17,9+-0,77 | 22,1+-1,2 | p=0.005 |
| Duration of endocrine pathology | 6,7+-0,61 | 4,9+-0,60 | n.z. |
| Interval between the onset of epilepsy and endocrine pathology | 3,2+-0,97 | 6,9+-1,20 | p=0.04 |
It follows from the table that the entire group of reproductive disorders in female epilepsy debuts earlier than thyroid pathology on average by about 4 years (p = 0.005). This also corresponds to a shorter interval between the onset of epilepsy and the appearance of reproductive disorders compared to the interval between the onset of epilepsy and thyroid pathology (p = 0.04).
Thus, we can assume that the group of reproductive disorders in epilepsy in women occurs at an earlier time than pathology of the thyroid gland. It is likely that the dissociation of the appearance of these disorders over time largely determines their mutual exclusion in the majority of patients. Epilepsy initially affects the hypothalamic-pituitary-gonadal axis and only after about 4 years the hypothalamic-pituitary-thyroid axis.
Taking into account the high incidence of menstrual dysfunction and thyroid pathology in epilepsy in women, it seemed appropriate to analyze the possible connections between this pathology and the catameniality/non-catameniality factor. Basic data for this section are presented in Table 4.
When analyzing the connection between the pathology of the gynecological sphere and the thyroid gland with indicators of catameniality and non-catameniality, a tendency towards a connection was revealed between catamenial epilepsy with concomitant pathology in the form of menstrual irregularities (p = 0.056), while in non-catamenial epilepsy - with pathology of the thyroid gland (p = 0.076) .
Table 4.
Correlation of menstrual dysfunction and thyroid pathology with the catamenial factor in women with epilepsy
| Pathology | Catamenial epilepsy | Non-catamenial epilepsy | Total |
| Menstrual dysfunction | 21 | 66 | 87 |
| Normal menstrual function | 6 | 48 | 54 |
| Total | 27 | 114 | 141 |
| Significance | 2 =3,65 | = 0,17 | p= 0.056 (n.s.) p=0.04, (T.m.F). |
| Thyroid pathology | 2 | 29 | 31 |
| Absence of thyroid pathology | 25 | 85 | 110 |
| Total | 27 | 114 | 141 |
| Significance | 2=3, 15 | = 0,17 | p=0.076 (n.s.) p=0.03 (T.m.F.) |
