Evaluation of the results of complex (operative and conservative) treatment of patients with drug-resistant epilepsy

At the current stage of epileptology development there are positive changes concerning the solution of the problem of drug-resistant epilepsy. Modern capabilities of neurosurgery make it possible to successfully solve the problems of treating this disease, however, the issues of postoperative management of patients remain insufficiently developed, and relapses of seizures during the first year after surgery require further development of conservative treatment. Purpose of the study: optimization and study of the effectiveness of medication-assisted antiepileptic and pathogenetic treatment at early (6 months) and late (up to 3 years) stages of the postoperative period. Materials and methods. The analysis of the work is based on the material of 70 patients with drug-resistant epilepsy accompanied by symptoms of epileptic encephalopathy. These patients received optimized antiepileptic therapy and pathogenetic treatment for 3 years, as well as a thorough follow-up examination according to specially developed algorithms for the immediate and long-term postoperative periods. Results. It was established that after 3 years, a different degree of seizure reduction and regression of convulsive activity according to electroencephalographic data were observed in 17 (56.7 %) patients, restoration of higher mental functions occurred in 19 (63.3 %) patients, a decrease in the indicator of mental disorders (anxiety, depression) — in 29 (73.1 %). A significant (p < 0.05) increase in the proportion of favorable outcomes and a significant improvement in the quality of life were registered in 41 (58.6 %) patients as a result of the analysis of data obtained in the immediate and longterm postoperative periods. Conclusion. The data we obtained and presented in the proposed article confirm the validity of optimization of drug antiepileptic and pathogenetic therapy in patients with drug-resistant epilepsy, accompanied by encephalopathic symptoms, in the immediate and distant postoperative periods for a total period of not less than 3 years.

1. Карлов В. А. Патофизиология эпилепсии. В кн.: Эпилепсия. Под ред. Н. Г. Незнанова. СПб.: 2010; 64–105.

2. Громов С.А. Контролируемая эпилепсия. Клиника, диагностика. Лечение. СПб.: НИЦ Балтика; 2004.

3. Асатрян Э.А., Абрамов К. Б., Тадевосян А. Р. и др. Современные проблемы хирургии эпилепсии. Вестник неврологии, психиатрии и нейрохирургии. 2017;(3):36–48.

4. Blümcke I, Sarnat HB, Coras R. Surgical neuropathology of focal epilepsies: textbook and atlas. Paris: John Libbey Eurotext; 2015: 158. https://doi.org/10.1111/nan.12343

5. Гузева В.И., Гузева О.В., Гузева В.В. и др. Характеристики эпилептических приступов у взрослых больных с посттравматической эпилепсией. Вестник Российской военно-медицинской академии. 2019; S3:198.

6. Гузева В.И., Гузева О.В., Гузева В.В. и др. Результаты исследования неврологического статуса больных с посттравматической эпилепсией. Вестник Российской военно-медицинской академии. 2019; S3:197–198.

7. Гузева В.И., Касумов В.Р., Виноградов А.Ю. и др. Особенности течения симптоматической эпилепсии у пациентов с опухолями лобной доли. Нейрохирургия и неврология детского возраста. 2019;(1):79–84.

8. Chen Z, Brodie MJ, Liew D, Kwan P. Treatment Outcomes in Patients with Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurol. 2018;75(3):279–286. https://doi.org/10.1001/jamaneurol.2017.3949

9. Phuong TH, Houot M, Méré M, et al. Cognitive impairment in temporal lobe epilepsy: contributions of lesion, localization and lateralization. J Neurol. 2021;268(4):1443–1452. https://doi.org/10.1007/s00415‑020‑10307‑6

10. Helmstaedter C, Elger CE, Vogt VL. Cognitive outcomes more than 5 years after temporal lobe epilepsy surgery: remarkable functional recovery when seizures are controlled. Seizure. 2018;62:116–123. https://doi.org/10.1016/j.seizure.2018.09.023

11. Alexandratou I, Patrikelis P, Messinis L, et al. Long-term neuropsychological outcomes following temporal lobe epilepsy surgery: an update of the literature. Healthcare (Basel). 2021;9(9):1156. https://doi.org/10.3390/healthcare9091156

12. Engel J Jr. А proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE task force on classification and terminology. Epilepsia. 2001;42(6):796–803. https://doi.org/10.1046/j.1528–1157.2001.10401.x

13. Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2018;91(2):82–90. https://doi.org/10.1212/WNL.0000000000005756

14. Barzegar M, Afghan M, Tarmahi V, et al. Ketogenic diet: overview, types, and possible anti-seizure mechanisms. Nutr Neurosci. 2021;24(4):307–316. https://doi.org/10.1080/1028415X.2019.1627769

15. Mathon B, Bielle F, Samson S, et al. Predictive factors of long-term outcomes of surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Epilepsia. 2017;58(8):1473–1485. https://doi.org/10.1111/epi.13831