An algorithm of diagnostics of pharmacoresistent epilepsy in children of different age groups

Abstract

WHO estimates that seizures persist in 30% of patients with epilepsy, despite treatment with antiepileptic drugs. In this regard, one of the main tasks is to find the reasons for the formation of pharmacoresistance, leading to neurological deficit and cognitive impairment. To create a diagnostic algorithm for pharmacoresistant epilepsy, we examined 256 children aged 1 day to 18 years who had uncontrollable seizures. All patients were divided into 3 groups: the first group - children of neonatal age - up to 1 month of life, the second group - children of early age from 1 month to 5 years, the third group - children over 5 years. All patients underwent anamnestic, clinical, neurophysiological (EEG, EEGvideo monitoring), neurovisualization (NSG, high-field MRI in the “Epilepsy” mode), laboratory research methods. It has been shown that in the neonatal period, metabolic parameters, acid-base blood balance, bacteriological and virological studies, including cerebrospinal fluid, are of significant importance. In young children, when there is a high risk of the formation of epileptic encephalopathy, increased attention is directed to a medical genetic examination with a molecular genetic study. In non-removable epileptic seizures in older children, a significant place is given to etiological factors, in case of structural epilepsy to localization and size of the focus and complex somatic examination with an assessment of the cytochrome P450 system and immunological status. The revealed patterns of the formation of pharmacological resistance influence the choice of treatment tactics.