Неврофизиологични методи за диагноза и мониториране лечението на епилепсията при възрастни
| dc.contributor.author | Бецинска, Диана Василева // Betsinska, Diana Vasileva | |
| dc.contributor.author | Betsinska, Diana Vasileva | |
| dc.date.accessioned | 2022-02-02T07:37:27Z | |
| dc.date.available | 2022-02-02T07:37:27Z | |
| dc.date.issued | 2021 | |
| dc.description.abstract | ЦЕЛИ И ЗАДАЧИ НА ИЗСЛЕДВАНЕТО Цел на настоящото изследване: да се установи значението на неврофизиологичните методи за диагностика, мониториране на лечението, и особеностите на клиничните характеристики при пациенти с Е в напреднала възраст. Задачи: 1. Да се определи връзката между резултатите от електрофизиологичните (ЕЕГ и видеоЕЕГ), невропсихологичните и невроизобразяващи изследвания с клиничните характеристики на пациентите (етиология, давност на заболяването, вид и честота на ЕП). 2. Да се изясни зависимостта между резултатите от проведените електрофизиологични изследвания и вида (класически и нови) и броя на приеманите АЕМ. 3. Да се изследва влиянието на проведената в миналото антиепилептична терапия върху клиничния ход на заболяването и резултатите от неврофизиологичните изследвания. 4. Да се оцени влиянието на най-честите придружаващи заболявания върху резултатите от неврофизиологичните изследвания и честотата на ЕП. 5. Установяване наличието на когнитивни нарушения, както и връзката им със заболяването, клиничните характеристики и приеманите АЕМ. // SUMMARY. Introduction: Through the last decades, life expectancy worldwide is steadily increasing. The elderly population has the highest incidence of epilepsy and it is the third most frequent neurological disorder after the cerebrovascular diseases and dementias. Purpose: The purpose of the research is to study the mеаning of neurophysiological methods for diagnostics and treatment monitoring, and the specifics in clinical characteristics in elderly with epilepsy. Materil and methods: This study covers patients hospitalized at the Multiprofile Hospital for Active Treatment in Neurology and Psychiatry St. Naum, Sofia. In the study were included 297 patients with specified diagnosis of epilepsy over 65 years of age and 193 patients in the same age without epilepsy. The mean duration of the disease: men- 10,83±12,07 years, women- 13,31±13,99 years. MMSE is used as screening method: patients with severe dementia (MMSE<19 points) are excluded. To identify the causes for the seizures in all patients were performed different investigation: clinical methods – anamnesis, somatic and neurological exam; CT/MRI, routine EEG, EEG, video- EEG, documentary analysis. Results: For the purpose of the study, we divide patients into groups as per certain clinical characteristics and compare the mean values or the rankings of the results, which patients in the different groups get on the tests. Patients are grouped according to age, onset and duration of the disease, type and frequency of seizures, mono- and polytherapy, classic and new AEM. The largest share have the patients with structural/ metabolic epilepsy, followed by those with genetic epilepsy and those with epilepsy with unknown cause. Elderly with focal seizures with impairment of consciousness and evolving to a bilateral convulsive seizure predominate; the frequency of seizures is up to 2-3 per month and increases with the duration of the disease. Patients with E<10 years have statistically significantly better results in EEG and neuropsuhological tests compare to those with E≥10 years. Patients with normal EEG or EEG with mild changes have lower frequency of seizures and take fewer AEMs. In our patients, the results of all tests were statistically significantly better in those with wellcontrolled epileptic seizures. In the treatment of elderly patients, monotherapy with new AEMs predominates, with the most commonly used anticonvulsant being LEV followed by OxCBZ, LTG and PGB. Conclusion: Treating epilepsy in elderly carries higher risk than in younger patients. The etiology of new onset seizures in the elderly is associated with more frequent cerebral structural disorders, brain tumors, metabolic abnormalities, neuroinfections. Clinical features in the elderly are often challenging because of the subtle and unspecific manifestations of seizures compare to younger patients. The choice of antiepileptic treatment requires consideration of factors unique to the elderly including lower dosing, pharmacokinetic changes, treatment response, co-morbidities and interactions with other medications. | en_US |
| dc.identifier.uri | http://hdl.handle.net/10861/1936 | |
| dc.language.iso | other | en_US |
| dc.publisher | Медицински университет - София // Medical University - Sofia | en_US |
| dc.subject | неврология; нервна система – болести; епилепсия – диагностика; епилепсия – терапия; неврофизиология // | en_US |
| dc.subject | neurology; nervous system diseases; epilepsy – diagnosis; epilepsy – therapy; neurophysiology | en_US |
| dc.title | Неврофизиологични методи за диагноза и мониториране лечението на епилепсията при възрастни | en_US |
| dc.title.alternative | en_US | |
| dc.type | Thesis | en_US |
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