The policy of conducting patiens with febrile convultions

То substantiate the policy of conducting patients with febrile convultions in different phases of rendering aid catamnesis study of one hundred and sixty three children with febrile convulsions in anamnesis were conducted. The duration of catamnesis varied from eight to twelve years. The clinical data as well as the results of additional methods of study (EEG and MRT) of the head brain were analised. Comparison of two groups of children with clinical outcome of febrile convultions into epilepsy (n=24) and benignant outcome (n=139) were conducted. The results of the study testify to the fact that patients with simple febrile convulsions do not need EEG and MRT of the head brain, but children with complex ( atypical) febile convulsions do need conducting these tests. Medical diagnostic and organisation measures in different phases of rendering medical aid to children with febrile convulsions (in the outpatient and hospital setting) recording the phase and stage of the disease have been worked out.Для обоснования ташки ведения больных с фебрильными судорогами на различных этапах оказания им медицинской помощи были проведены катамнестические исследования 163 детей с фебрильными судорогами в анамнезе. Длительность катамнеза варьировала от 8 до 12 лет. Анализировались клинические данные, а также результаты дополнительных методов исследования (ЭЭГ и МРТ головного мозга). Проведены сравнения двух групп - детей с исходом фебрильных судорог в эпилепсию (n=24) и доброкачественным исходом (n=139). Полученные результаты свидетельствуют о том, что пациенты с простыми фебрильными судорогами не нуждаются в проведении ЭЭГ и МРТ головного мозга, а детям со сложными (атипичными) фебрильными судорогами необходимо проведение этих исследований. Разработаны лечебно-диагностические и организационные мероприятия на различных этапах оказания медицинской помощи детям с фебрильными судорогами (амбулаторный и госпитальный) с учетом фазы и стадии заболевания

The prognosis for children's epilepsy with febrile seisures

In search of significant diagnostic criterion to prognosticate epilepsy there has been analysed the role of perinatal pathology, the hereditary load in febrile seisures and epilepsy, the clinical data and results of additional methods of research ( EEG, MRT of the head brain) of children with febrile seisures (FS) in the anamnesis. There has been carried out catamnesis research of 163 children having febrile seisures in their anamnesis. The duration of catamnesis varied from 8 to 12 years old. There has been carried out the comparison of 2 groups - children having febrile seisures with the outcome to epilepsy (n=24) and benign outcome (n=139). In accordance with the research there have been taken the indices in which the groups under tests varied statistically significant- heredity, anamnestic record for epilepsy, focal character of the febrile seisures, abnormalities in neurological status, changes in EEG and MRT of the head brain. They have been used to maintain models for prediction of epilepsy development. The results showed that it is possible to prognose the development of epilepsy on the basis of the results of the EEG and heredity load. The most important diagnostic rate for the development of epilepsy is the epileptiform activity on EEG.Для поиска достоверных диагностических критериев прогнозирования эпилепсии была проанализирована роль перинатальной патологии, наследственной отягощенности по фебрильным судорогам и эпилепсии, клинических данных и результатов дополнительных методов исследования (ЭЭГ и МРТ головного мозга) у детей, имеющих фебрильные судороги (ФС) в анамнезе. Проведены катамнестические исследования 163 детей с фебрильными судорогами в анамнезе. Длительность катамнеза варьировала от 8 до 12 лет. Проведены сравнения двух групп - детей с исходом фебрильных судорог в эпилепсию (п=24) и доброкачественным исходом (п=139). По результатам исследования были взяты показатели, по которым исследуемые группы пациентов различались статистически значимо - это наследственная отягощенность по эпилепсии, фокальный характер фебрильного приступа, нарушения в неврологическом статусе, изменения на ЭЭГ и МРТ головного мозга. Они были использованы для построения моделей прогнозирования развития эпилепсии. Расчеты показали, что прогнозировать развитие эпилепсии возможно на основании данных о наследственной отягощённости по эпилепсии и результатах ЭЭГ. Наиболее важным диагностическим показателем развития эпилепсии является эпилептиформная активность на ЭЭГ

Febrile children's convulsions and risk of emergence

There has been studies of clinical peculiarities of febrile children's convulsions and the estimation of the additional research data and the factors of the emergence. There has been examined and observed 109 children aged from three months to five having febrile convulsions. Age, sex, genetic predisposition to febrile attacks and epilepsy were analysed along with perinatal anamnesis, the temperature at which the attacks appear, the background diseases, the character of the attacks, the neurological status, the additional methods of research of the head brain (EEG, MRI). The comparison group included the children of the same age suffering epilepsy. Statistically important factor of the risk of the beginning of febrile attacks is the burden of the family anamnesis in febrile convulsions and the marker of the higher probability of the beginning is perinatal pathology (chronic hypoxia of the baby). Additional factors of the risk are frequent acute respiratory diseases.Изучались клинические особенности фебрильных приступов у детей с оценкой данных дополнительных методов исследования, а также факторы их возникновения. Проведен анализ наблюдения 109 детей с фебрильными судорогами в возрасте от 3 месяцев до 5 лет. Анализировались - возраст, пол, генетическая предрасположенность по фебрильным судорогам и эпилепсии, перинатальный анамнез, температура возникновения фебрильных приступов, фоновые заболевания, характер приступов, неврологический статус, данные дополнительных методов исследования (ЭЭГ, МРТ головного мозга). В группу сравнения вошли дети с эпилепсией того же возраста. Статистически значимым фактором риска возникновения фебрильных судорог у детей является отягощенный семейный анамнез по фебрильным приступам, а маркером повышенной вероятности их возникновения - перинатальная патология (хроническая гипоксия плода). В качестве дополнительного фактора риска можно рассматривать частые острые респираторные заболевания у детей

THE RISK FACTORS IN RELAPSE OF FEBRILE CONVULSIONS

The factors of risk in relapse of febrile convulsions have been studied: age, sex, perinatal anamnesis, heredity on febrile attacks, epilepsies, neurological status, the results in analysis (EEG, MRI of the head brain), the temperature, the type of the illness, frequency of the illness, the character of febrile paroxysm. 109 children have been investigated aged from three months to five years suffering from febrile attacks. There has been held the comparison of the groups of children with different quantity of episodes of febrile bouts (with one, two, three and more). The results of the observations testify to high degree of credibility the influence of relapsing course of febrile attacks of the following factors: hereditary burden on febrile attacks, the presence of perinatal pathology, frequent acute respiratory diseases

Risk factors for transition of febrile convulsions to epilepsy

Object: to assess a relationship between febrile convulsions (FC) and epilepsy. Patients and methods. The role of perinatal hereditary diseases, a family history of FC and epilepsy, as well as clinical findings and the results of supplementary studies (electroencephalography and brain magnetic resonance imaging) were analyzed in children with a history of FC. One hundred and sixty-three children with a history of FC were followed up for 8 to 12 years. Two groups of children with transition of febrile convulsions to epilepsy (n=24) and with a good outcome (n=139) were compared. Results and discussion. The findings suggest that factors, such as a family history of epilepsy, the focal pattern of FC, and neurologic changes, highly significantly affect the transformation of FC to epilepsy. Changes in epileptiform EEG activity and abnormal structural neuroimaging are markers for the high probability of transition of febrile convulsions to epilepsy

HEMICONVULSION-HEMIPLEGIA-EPILEPSY SYNDROME (HHE SYNDROME) (A LECTURE)

Hemiconvulsion-hemiplegia-epilepsy syndrome (HHE syndrome) — polyetiologic disease, with onset in childhood, characterized by the triad of symptoms: 1) prolonged convulsive seizures (usually on background of fever), involving one half of the body (hemiconvulsions); 2) acute hemiparesis occurring immediately after seizures (on the side of convul­sions); 3) symptomatic focal epilepsy, occurring in the sequel. The authors discuss in detail different aspects of the disease, including etiology, pathogenesis, diagnostic approaches, differential diagnosis, and approaches to treatment (including prevention and therapy of the disease) and outcome

CLINICAL AND ELECTROENCEPHALOGRAPHIC SEMIOLOGY OF MYOCLONIC-ATONIC SEIZURES

Abstract: myoclonic-atonic seizures (MAS) – short epileptic generalized seizures in the form of sudden falling spells (or drop attacks). Inour study were vealed MAS in 1.3% of all cases of epilepsy with onset of seizures before 18 years old (n=1261). Predominance of man among the patients was revealed (76.5% men versus 23.5% woman). The most often in the patients with MAS myoclonic-astatic epilepsy (MAE) was diagnosed – 41,2% of cases. Symptomatic and cryptogenic forms of focal epilepsy were diagnosed in 35.2% of the patients. Lennox-Gastaut syndrome was revealed in 23.6% of cases. Onset of epilepsy with MAS varied widely – from 9 month to 6 year soflife; middle age of onset was 3.4 years±1.28 years. In all the cases MAS occurred in combination with other types of seizures: there can be any of 9 differenttypes of seizures. The most often myoclonic seizures (70.6% of cases), generalized convulsive seizures (47.1%) and absences (47.1%) were registered. Remission was achieved in 64.7% cases of epilepsy, associated with MAS. Reduction of seizure frequency ≥50% on antiepileptic treatment was achieved in 29.4% of the patients. Only in one patient (5.9%) the therapy was not effective. Our study demonstrated different efficacyof antiepileptic drugs in the treatment of different epileptic syndromes, associated with MAS

ELECTROENCEPHALOGRAPHIC CHANGES WITH DRAVET SYNDROME

Dravet syndrome (DS, severe myoclonic epilepsy of early infancy) is epileptic encephalopathy with onset in the first year of life, manifested with febrile and afebrile generalized and focal seizures, with the presence of myoclonic paroxysms in typical cases, mental retardation, and resistance to antiepileptic therapy. The disease was for the first time described by Ch. Dravet in 1978 in France, then, in details, by Сh. Dravet et al. in 1982. In the classification of 1989, DS held a particular place being attributed to the forms of epilepsy that have both generalized and focal clinical manifestations. According to Proposed diagnostic scheme for people with epileptic seizures and with epilepsy (2001), this disease is attributed to epileptic encephalopathies of early infancy. The main reason of DS development is a mutation in the SCN1A gene revealed with most (but not all) patients. It is assumed that there are certain other mutations that determine DS development, in particular, the GABRG2 mutation. Polymorphism of epileptic seizures is typical of the DS: febrile seizures, focal motor (including hemiclonic and secondarily generalized), generalized tonic and clonic, alternating hemiconvulsions, myoclonic, atypical absences, focal dialeptic seizures, as well as epileptic status. The prognosis of the disease is severe. In most cases, seizures continue to occur in adult life but with lower frequency than in childhood. The authors review the issues of etiology and pathogenesis in details, as well as clinical manifestations, diagnostics, and treatment of the DS. A particular emphasis is given to pathological changes on electroencephalogram (EEG) of patients with DS. Distinct slowing of background activity, prevalence of multiregional epileptiform activity, regional slowing, and severe photosensitivity (pattern sensitivity) are the most prognostically unfavorable EEG patterns of the DS