Результаты фармакоэпидемиологического исследования эпилепсии в Белоруссии

the lack of proper information on the epidemiological characteristics of epilepsy results in significant shortcomings in available health care. This pharmacoepidemiological study was undertaken to improve the situation. Objective: to assess the prevalence profile and management of patients with epilepsy in Minsk based on out-patient visit data obtained in health centres subordinate to the Ministry of Health of the Republic of Belarus. Materials and methods: the epidemiological study was conducted in accordance with the ILAE ‘Guidelines for epidemiologic studies on epilepsy’. Results: epilepsy incidence and prevalence were evaluated across Minsk gender- and age-based population groups. Aetiological and social aspects of epilepsy were reviewed. Out-patient visit data collected for the period from 2008 to 2012 revealed 705 patients with epilepsy. The overall epilepsy prevalence rate of the district varied from 165.2 per 100,000 population in 2008 to 275.5 per 100,000 population in 2012, while the incidence rate ranged from 36.9 per 100,000 population (in 2008) to 25.0 per 100,000 population (in 2012). The most frequently administered anti-epileptics included carbamazepine (52.9 % of patients) and valproates (31.0 % of subjects). The most commonly administered second-generation anti-epileptics were topiramate (7.1 % of patients) and lamotrigine (2.9 % of subjects). No anti-epileptics were used by 9.5 % of study subjects. Conclusions: the prevalence of epilepsy corresponds to the European Union prevalence rate. Proposals have been made concerning optimization of health care for patients with epilepsy. There is a need for large-scale pharmacoepidemiological and pharmacoeconomic studies.отсутствие должной информации об эпидемиологических характеристиках эпилепсии обусловливает существенные недостатки организации медицинской помощи. Для устранения этих факторов предпринято данное фармакоэпидемиологическое исследование. Цель: исследование профиля заболеваемости и ведения пациентов с эпилепсией в г. Минске по данным обращаемости за медицинской помощью в учреждения системы Минздрава Республики Беларусь. Материалы и методы: исследование эпидемиологии проводилось в соответствии с руководством по проведению эпидемиологических исследований эпилепсии (Guidelines for epidemiologic studies on epilepsy) ILAE. Результаты: изучена заболеваемость эпилепсией и распространенность в гендерновозрастных группах населения г. Минска. Рассмотрены этиологические и социальные аспекты эпилепсии. По данным обращаемости в амбулаторно-поликлинические учреждения за период 2008-2012 гг., выявлено 705 пациентов с эпилепсией. Общая заболеваемость эпилепсией в районе составляла от 165,2 на 100 тыс. населения в 2008 г., до 275,5 – на 100 тыс. населения в 2012 г., первичная – от 36,9 на 100 тыс. населения (в 2008 г.), до 25,0 на 100 тыс. населения (в 2012 г.). Среди назначаемых противоэпилептических препаратов наиболее часто применялись карбамазепин (52,9% пациентов) и вальпроаты (31,0% пациентов). Из противоэпилептических препаратов II поколения назначались топирамат – 7,1% пациентов, и ламотриджин – 2,9% пациентов. При этом 9,5% пациентов не принимали противоэпилептических препаратов. Выводы: распространенность эпилепсии соответствует уровню распространенности в Евросоюзе. Предложены пути оптимизации оказания противоэпилептической помощи. Существует потребность в проведении масштабных фармакоэпидемиологических и фармакоэкономических исследований

EPIDEMIOLOGIC RESEARCH ON EPILEPSY IN MINSK

the lack of proper information on the epidemiological characteristics of epilepsy results in significant shortcomings in available health care. This pharmacoepidemiological study was undertaken to improve the situation. Objective: to assess the prevalence profile and management of patients with epilepsy in Minsk based on out-patient visit data obtained in health centres subordinate to the Ministry of Health of the Republic of Belarus. Materials and methods: the epidemiological study was conducted in accordance with the ILAE ‘Guidelines for epidemiologic studies on epilepsy’. Results: epilepsy incidence and prevalence were evaluated across Minsk gender- and age-based population groups. Aetiological and social aspects of epilepsy were reviewed. Out-patient visit data collected for the period from 2008 to 2012 revealed 705 patients with epilepsy. The overall epilepsy prevalence rate of the district varied from 165.2 per 100,000 population in 2008 to 275.5 per 100,000 population in 2012, while the incidence rate ranged from 36.9 per 100,000 population (in 2008) to 25.0 per 100,000 population (in 2012). The most frequently administered anti-epileptics included carbamazepine (52.9 % of patients) and valproates (31.0 % of subjects). The most commonly administered second-generation anti-epileptics were topiramate (7.1 % of patients) and lamotrigine (2.9 % of subjects). No anti-epileptics were used by 9.5 % of study subjects. Conclusions: the prevalence of epilepsy corresponds to the European Union prevalence rate. Proposals have been made concerning optimization of health care for patients with epilepsy. There is a need for large-scale pharmacoepidemiological and pharmacoeconomic studies

STUDY OF THE INCIDENCE AND PREVALENCE OF EPILEPSY IN MINSK

Abstract: epidemiological study of epilepsywas carried out in Minsk. Aim: study of the incidence and prevalence of epilepsy in the gender-age population groups in Minsk. Materials and Methods: A retrospective study was carried out by assessing the medical data of the outpatient case report forms of patients with epilepsy who were seeking medical aid during the period 2008-2012. Results: Overall incidence of epilepsy ranged from 165.2 per 100,000 population in 2008 to 275.5 per 100,000 population in 2012; incidence of primary epilepsy ranged from 36.9 per 100,000 population in 2008 to 25.0 per 100,000 population in 2012. The prevalence of epilepsy was 6.06 per 1000 population. Etiological factors that increase the risk of developing epilepsy were head injuries (28.6%), neuroinfection (13.3%), chronic alcoholism (10.0%), vascular diseases of the brain (6.7%), perinatal pathology (5 , 2%), brain tumor (2.9%). In 33.3% of patients the cause of the disease has not been established. Conclusions: the prevalence of epilepsy in Minsk is comparable with the prevalence level in the European developed countries. It seems appropriate to create a unified electronic database of patients with epilepsy and continue studies targeted on finding ways for solving medical and social problems in the Republic of Belarus

CELL THERAPY OF EPILEPSIA. CLINICAL AND IMMUNOLOGICAL ASPECTS

The aim is to develop and implement a method for the treatment of drug-resistant epilepsy using autologous mesenchymal stem cells and the neuroimaging, immunological and neurophysiological predictors of the brain function.Material and Methods. Twenty patients (12 males and 8 females) with symptomatic drug-resistant epilepsy participated in the study. The patient age varied from 23 to 46 years; and the duration of epilepsy was 7-29 years. Autologous mesenchymal stem cells of the bone marrow were characterized using cultural, morphological, immunological, molecular-genetic, clinical-functional, laboratory, pathopsychological, and neurophysiological methods. The standard parametric and nonparametric statistical tests were used to evaluate the results.Results. The study resulted in producing of cultured autologous mesenchymal stem cells of the bone marrow (AMSCBM) sufficient to conduct 20 courses of cell therapy. In total, 40 transplantation procedures using AMSCBM were performed (20 intravenous and 20 endolumbar injections). Cellularity index in the intravenous inoculate ranged from 39.5 to 110.0 million and that for the endolumbar injection – from 5.1 to 10.0 million with viability not less than 95%. The distribution of AMSCBM by key surface markers (CD105+, CD90+, CD45-, CD34-) matched the criteria of the International Association for cell therapy (ISCT). The cell injections were well tolerated and did not cause any severe adverse effects. To monitor the process of neurogenic differentiation, the expression of the surface markers was determined. In most samples with confirmed neural differentiation, a significant increase in the expression of neuron-specific enolase, nestin and MAR-2 was detected. In patients with symptomatic epilepsy, the most significant deviations from normal values were found for the numbers of cytotoxic and activated cells, natural killer (NK) cells, and T-cells with the NK activity. After a course of cell therapy, a significant decrease in CD4+CD8+, CD3+CD8+, CD3+CD95+, and CD8+CD25+ cells was noted. Also decreased were the numbers of NK cells and T-cells with the NK activity, however, their levels remained relatively high as compared with the control group. Following the treatment, we continued to monitor the patients for 3, 6, and 12 months after the cell administration as well as the patients from the group of comparison.Conclusion. For the first time in the Republic of Belarus, cell therapy in patients with epilepsy was conducted. An intravenous injection of AMSCBM and endolumbar administration of neuro-induced AMSCBM can serve an effective additional therapy of choice in patients with drug-resistant epilepsy