The influence of endocrine glands on the development of epilepsy. Epilepsy with neuroendocrine and mental disorders in women (clinic, therapy)

Epilepsy is neurological disorder with a unique set of symptoms. Distinctive features illnesses - seizures. This article will discuss the causes of epilepsy.

Epileptic seizures explained pathological change bioelectrical activity of the brain and are caused by the simultaneous discharge of a huge population of nerve cells (hypersynchronous discharge).

In the head, like a lightning strike, there are electric charges with frequency and strength uncharacteristic normal operation brain They can be generated in specific areas of the cortex (focal seizure), or take over the entire brain (generalized).

Clinical manifestations of epilepsy

The main symptom of epilepsy is epileptic seizures, or seizures. As a rule, they are short-lived (15 seconds - 5 minutes) and begin suddenly. Possible types manifestations:

• Grand mal seizure: a person loses consciousness, falls, the muscles of the whole body involuntarily contract, mouth goes foam.
• Small epileptic seizure(absence): the patient loses consciousness for a few seconds. The face twitches convulsively. A person performs illogical actions.

What types of epilepsy are there?

When does epilepsy appear?

Epileptic seizures occur in people:

• up to 20 years in 75% of cases;
• after 20 years in 16%;
• in older age - about 2-5%.

Why does epilepsy occur?

In 6 out of 10 cases of morbidity, the cause of epilepsy is unknown and doctors consider genetic features– idiopathic and cryptogenic form. Therefore, when talking about the causes of epilepsy, we consider the secondary or symptomatic form of the disease.

Epileptic seizures occur against the background of increased epileptic activity of brain cells, the cause of which is not clear. Presumably this is based on chemical features brain neurons and specific properties of the cell membrane.

It is known that in patients with epilepsy, brain tissue is highly sensitive to chemical changes as a result of exposure to various stimuli. The same signals received by the patient’s brain and healthy person, lead to an attack in the first case, and go unnoticed in the second.

Depending on the age when the symptoms of the disease appeared, one or another reason for the occurrence of epilepsy attacks should be assumed.

Epilepsy is inherited

Epilepsy cannot be attributed to hereditary diseases. However, 40% of patients with epilepsy have relatives who suffer from epileptic seizures. The child may inherit specific abilities of brain activity, inhibition and excitation processes, increased degree readiness for a paroxysmal response of the brain to fluctuations in external and internal factors.

When one of the parents has epilepsy, the probability of the child inheriting the disease is 3-6%, if both - 10-12%. The tendency to the disease is inherited more often if the attacks are generalized rather than focal.

Epileptic seizures appear earlier in children than in parents.

Main causes of the disease

Doctors have not yet clearly established what provokes epilepsy. In 70% of cases, idiopathic and cryptogenic epilepsy is diagnosed, the causes of which remain unknown.

Possible reasons:

• Brain damage during the prenatal or perinatal period
• Traumatic brain injuries
• Birth defects and genetic changes
• Infectious diseases (meningitis, encephalitis, neurocysticercosis)
• Brain tumors and abscesses

The provoking factors of epilepsy are considered:

• psycho-emotional stress, stress
• climate change
• overwork
• bright light
• lack of sleep, and vice versa, excess sleep

Epilepsy in children

Children suffer from epilepsy three times more often than adults. The nerve cells of a child's brain are easily excitable. Even a strong increase in temperature can cause an epileptic attack. In early childhood or adolescence(0-18 years) idiopathic epilepsy most often manifests itself.

The main cause of seizures in young children (20% of cases) is perinatal complications caused by prenatal or birth traumatic brain injuries. Hypoxia ( oxygen starvation) brain causes disruption nervous system.

Diagnosed in early age epilepsy, caused in children under two years of age is birth defects brain development and intrauterine infections- cytomegaly, rubella, toxoplasmosis, herpes (see,), treated symptomatically with medication.

Head injuries

Post-traumatic epilepsy - a consequence severe bruise head - diagnosed in 5-10% of cases. A traffic accident or child abuse can cause an epileptic seizure. Epilepsy immediately after injury or several years later. According to doctors, people after a serious head injury with loss of consciousness have increased likelihood occurrence of epilepsy. Post-traumatic seizures in children develop very slowly and can appear even after 25 years.

Infectious diseases

When various foreign agents enter the soft membranes of the brain, an infectious-toxic shock may develop, caused by massive decay of microorganisms. Released toxins provoke disruption of brain microcirculation, provoke intravascular coagulation, disrupt metabolic processes. Possible cerebral edema and increased intracranial pressure. This has a negative impact on blood vessels, causes atrophy - destruction of neurons and their connections, gradual death, which provokes seizures.

Poor blood circulation in the head

In 4-5% of older people acute disorder blood supply to the brain leads to chronic attacks of epilepsy.

At ischemic stroke Vascular spasm or blockage by a blood clot occurs. Blood stops flowing normally to certain areas or parts of the brain, and oxygen starvation of tissues follows (see,).

Hemorrhagic stroke– a consequence of hypertension and atherosclerosis. Unable to withstand the influence high pressure, the wall of the head vessel ruptures and hemorrhage occurs. After which swelling and death of the affected area of ​​the brain is observed.

Metabolic disorders

Hereditary and acquired metabolic disorders (toxic metal poisoning) are the cause of 10% of cases of recurrent epileptic seizures.

Excessive use fatty foods, disruption of the functioning of the pancreas (see) provokes changes in metabolic processes, causing cerebral infarction and hemorrhage.

Brain tumors and abnormalities

Epileptic seizures in 58% of cases - the first sign of a brain tumor different localization. Neoplasms provoke in 19-47.4% epileptic seizures. It has been noted that fast-growing tumors cause epilepsy more often than slow-growing ones. Atypical cells of formation violate normal functioning brain Damaged areas no longer correctly perceive and transmit signals received from the analyzers. When the formation is eliminated, epileptic seizures disappear.

Arteriovenous vascular dysplasia – congenital anomaly, often leading to repeated epileptic seizures.

Harm from drugs and insecticides

Drugs, alcohol, uncontrolled consumption medications(barbiturates, benzodiazepines) or their withdrawal is a common cause of epilepsy in adults. Violation of the schedule for taking antiepileptic drugs, change therapeutic dose Without a doctor's prescription, it provokes epileptic attacks. Eliminating the irritant helps prevent recurrence of attacks.

Micronutrient deficiency and the risk of developing epilepsy

In 1973, the American Society of Neurological Sciences, based on research results, established a connection between the deficiency of certain minerals and development seizures. It is important to control the level of zinc and magnesium in the body. The risk of seizures increases with decreasing concentrations. Magnesium is quickly depleted under stress, elevated temperatures and loads. Even a short-term shortage has a negative impact on contractility muscles and blood vessels.

New research into epilepsy

To this day, studies of epilepsy attacks and the causes of the disease are being carried out. According to latest research Ruhr University Bochum epilepsy, with its characteristic uncontrolled muscle contractions, is caused by changes in the neurons of the cerebellum, which is directly responsible for coordinating movements in the body. While these abnormalities cannot be detected after birth.

The disease is provoked by P/Q abnormalities calcium channels, which are responsible for the flow of calcium ions into neurons. They are present in almost all brain tissues, and in case of their mutation nerve cells incorrectly process and transmit signals generated in the cerebellum. This is how uncontrolled epileptic seizures are born.

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 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 among the 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, nonparametric 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!

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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 the presence of impairments in logical thinking and the ability of patients 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

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