The dissertation presents a theoretical generalization and a new solution to the urgent problem of childhood neurology: determination of clinical and diagnostic criteria for the effectiveness of treatment of epilepsy and epileptic syndromes in children of different age groups, pathogenetic features of the disease course with assessment of its modifying markers and creating a prognosis of the disease. A comprehensive longitudinal population epidemiological, clinical and social study of children with epilepsy in the Kharkiv region was conducted. Based on the received epidemiological data, a prediction of the prevalence, morbidity and disability among the pediatric population has been created and its reliability confirmed. A register was created to monitor the condition of children with paroxysmal states of epileptic and other genesis. On the example of a large region, the peculiarities of the nosological and semiological structure of epilepsy in children of different age groups were studied in depth. The idiopathic form of epilepsy has been found to be more common in age groups up to 1 year and after 7 years. The most common is a symptomatic form with a gradual decrease in the proportion from early to adolescence, which is likely to be associated with a gradual decrease in the value of pre-, perinatal factors and an increase in the influence of genetic and exogenous factors. The prevailing type of attacks in children of different age groups is specified. It has been found that infants are dominated by frequent generalized seizures with a predisposition to polymorphism and seriality, and older infants are dominated by single focal or secondary generalized seizures, indicating immaturity of the excitation - inhibition system and predominance of excitations. to the cerebral cortex in infants. A systematic approach to a complex clinical-anamnestic, somatic, neurological, electroencephalographic study with the use of qualitative and quantitative assessment (spectral power and coherence), neuroimaging (with morphological and multiparametric indicators) examination of children of different age groups of patients the impact of these indicators on the course of epilepsy. The rank estimation of risk factors of formation of pharmacoresistant course of the disease is carried out and Pearson contingency coefficients are determined. It has been proved that the greatest correlation with the effectiveness of treatment have: nosological form, etiology, semiology of seizures, pregnancy, delivery period, Apgar score at 1 minute of life, pathological changes in neurological status, delayed psychomotor development, changes in EEG in the form focal epileptiform activity and impaired background activity, coherence rates, changes in MRI with focal disorders (especially temporal localization) and changes in cerebrospinal spaces, apparent diffusion coefficient, availability lactate during spectroscopy. The pharmacoeconomic evaluation of treatment with anti-epileptic drugs (АEP) of children with epilepsy in the Kharkiv region was conducted. Direct costs of anti-epileptic therapy have been found to depend on the age of the patient and the course of the disease. Cost-effectiveness is the best in the 4-6 year age group. Patients with epilepsy with uncontrolled frequent and severe seizures (with predominance of polymorphic seizures) are more likely to receive treatment with several AEP, the cost of costs in uncontrolled seizures is greater by 36.4%, % than in controlled ones. The cost of AEP in polytherapy significantly exceeds that of monotherapy, the cost index - the effectiveness of polytherapy is more 7.01 times than that of monotherapy. Rational approaches to improving the diagnosis and treatment of patients with epilepsy are scientifically substantiated: an advanced algorithm for the diagnosis of pharmacoresistant epilepsy in children of different age groups is proposed and implemented. Two models of prognosis of development and effectiveness of treatment of epilepsy in children have been created. Their high specificity (94.88% and 94.49% respectively), sensitivity (83.92% and 92.16% respectively) and excellent quality (and respectively) of multidimensional mathematical models for predicting the course of epilepsy in children at different stages have been scientifically proven providing medical care that can suspend the development of epileptogenesis and control seizures before the development of irreversible changes in the CNS.
