With the aim to optimize the diagnosis of epileptic seizures in patients with acute and chronic cerebrovascular diseases by elaboration of prognostic criteria for epilepsy connected with them, a clinical cross-section randomized cohort comparative study was performed with retrospective and prospective stages including 136 patients (men and women) on the base of the Department of Vascular Brain Pathology of the Kharkiv Clinical H
Acute cerebrovascular disease was represented by ischemic stroke, chronic – with slow-progressing disorders of cerebral circulation, dyscirculatory encephalopathy (chronic cerebral ischemia). Standardized criteria for inclusion and non-inclusion of participants in the study were applied. The total research database included 178 basic studied variables, in particular: a block of clinical indicators aimed at assessing the peculiarities of the development and course of epileptic seizures in different periods of ischemic stroke and chronic cerebral ischemia; a block of clinical and anamnestic parameters aimed at establishing the role of comorbid and premorbid pathology in the development of epilepsy and epileptic seizures in the examined patients; a block of indicators of magnetic resonance imaging, which allowed to assess the nature and role of structural disorders of the brain in the development of epileptic seizures in acute and chronic disorders of cerebral circulation; block of neurophysiological (electroencephalographic) parameters to specify the significant characteristics of changes in the bioelectrical activity of the brain in patients with cerebrovascular diseases; block of ultrasound Doppler data, which allowed to study changes in cerebral hemodynamics and assess their importance in the development of paroxysmal disorders in patients with acute and chronic cerebrovascular diseases; a powerful logical-statistical analysis of data with theoretical substantiation and development of differential-diagnostic and prognostic criteria for the development and course of epileptic seizures in patients with acute and chronic cerebrovascular diseases was applied.
The research was conducted in accordance with the actual legislation in Ukraine and the world and sectoral regulatory documents on ethics and bioethics.
Clinical features of the development and course of epileptic seizures in ischemic stroke and chronic cerebral ischemia are: mostly single lesions of the middle cerebral artery; the frequency structure of the brain localization of the lesion is characterized by the location in the right hemisphere (66.7±38.5 %), left hemisphere (56.7±37.3 %), cerebellum (3.3±3.3 %), the inherent simultaneous lesion of the left and the right hemisphere; there is a tendency to a higher proportion of cardioembolic subtype of ischemic stroke (60.0±37.9 %); the structure of the number of previous strokes is dominated by individuals with one case of stroke in the anamnesis (66.7±38.5 %); persons with plegia predominate (36.7±29.2 %); higher frequency of generalized, tonic-clonic single variants of seizures in patients over 60 years of age (maximum for 61–70 years, descending – 71–80 years, over 80 years). In most cases, the onset of epilepsy (76 % in men and 71 % in women) is observed in patients with chronic cerebrovascular disorders aged 40–60 years.
Structural disorders of the brain according to magnetic resonance imaging of the brain are characterized by the following frequency of localization of organic brain damage in patients with epileptic seizures after ischemic stroke: dilation of the subarachnoid space (93.3±24.1 %), dilation of the ventricles (83,3±34,0 %), ischemic subcortical ganglia (76.7±37.0 %), right hemisphere or temporal lobe (60.0±37.9 %), ischemic subcortical affection (56.7±37.3 %), ischemic frontal lobe affection (50.0±35.4 %), left hemisphere or diffuse atrophic changes in the cortical departments (43.3±32.6 %), isolated affection of temporal lobe (20.0±17.9 %), occipital lobe (16.7±15.2 %). Such a frequency distribution of affections may testify their role in the development of epileptic seizures this categoty of patients.
