INTRODUCTION: Early seizures are considered complications of stroke, and late seizures are a type of structural epilepsy. If they are separated as a new independent nosology unit, the problem in the diagnostic – treatment approach will be solved. PHYSIOLOGY: Cerebral blood flow is regulated by local factors such as carbon dioxide and oxygen content. Brain activity is also an important factor in the regulation of the volume speed of the blood – with locally increased neuronal activity, the local blood flow increases. Neurons in the CNS are subject to a variety of effects mediated by membrane receptors of two types – ionotropic and metabotropic. PATHOGENESIS: Early seizures are due to transient biochemical dysfunctions, while late seizures are due to gliosis changes affecting neuronal excitability. HISTOLOGY: The highlighted histopathological aspects confirm and support the results of clinical and radiological studies with dead nervous tissue, replaced by numerous newly formed capillaries, and surrounded by lipid-laden macrophages. CLINICAL PICTURE: This is represented by a complex combination of excitatory epileptic manifestations and residual focal symptoms depending on the localization of the lesion. LABORATORY DIAGNOSTICS: A very typical group of patients with post-stroke seizures have a high risk of recurrence when some of the studied biomarkers for this are available in the blood. In summary, the additional expanded package of studies of stroke patients should include screening diagnostics for the risk of epileptic seizures, namely: IL-6, IL-1β, TNF, Mg2+, Ca2+, CD40L, and Hsc70. IMAGING: Transient periodic MRI abnormalities have been demonstrated, possibly as a result of cerebral edema induced by seizure activity. Routine MRI in stroke patients is recommended. TREATMENT: It is possible that rt-PA may increase the risk of early seizures after stroke. Levetiracetam (LEV) as a neuroprotective agent in stroke has been proposed as the drug of first choice, based on safety and efficacy profiles. The usual practice is to treat recurrent early-onset seizures with short-term (3–6 months) treatment with antiepileptic drugs. CONCLUSIONS: Separation of stroke-epilepsy as a new independent nosology entity will solve the diagnostic-treatment problems in this area by changing the minimum package for laboratory tests, as well as routine MRI in patients with clinical evidence of stroke. LEV is the first-line agent for the treatment of these patients, in combination with correction of registered laboratory parameters.
The article discusses the use of transcranial pulse stimulation (TPS), a treatment method that uses ultrasound to penetrate the brain up to 8 cm. The article aims to review published studies on the effects of TPS on Alzheimer’s disease and to link the mechanism of the treatment with the pathophysiology of the disease. The discussion highlights the pathological triad of senile plaques, neurofibrillary tangles, and granular degeneration that causes Alzheimer’s disease. Patients with diabetes mellitus are predisposed to degenerative diseases, and the overlap between Alzheimer’s disease and obesity may be explained by the use of streptozotocin, which generates reactive oxygen species leading to DNA damage and cell death. The accumulation of beta-amyloid in the brain, mitochondrial malfunction, decreased production of ATP, and energy insufficiency is also discussed. The article concludes that TPS is a potential treatment for Alzheimer’s disease and that it can boost the expression of growth factors, enhance the flow of blood to the brain, trigger the creation of novel blood vessels, and promote the regeneration of nerves.
BACKGROUND: EEG is a way of graphically recording the electrical potentials of the brain. The main parameters of the EEG are related to the ratios between the individual frequency components, their amplitude and characteristic waveforms. AIM: The aim of the study was to develop and describe a consistent and detailed methodology for the technical conduct of an EEG study, as well as to find the reference values of some of the most frequently derived average values of parameters from the software analysis of modern EEG equipment. TOOLKIT: The EEG office of the Medical Faculty at Trakia University is equipped with a multifunctional 31-channel digital EEG/EP device with a sampling frequency of 1000 Hz. METHODOLOGY: Unification of the technical implementation is necessary so that the results can be compared with the maximum cleared probability of statistical error due to controllable factors. The outlined sequential steps can serve any technical contributor. RESULTS: Electroencephalographic study of 100 clinically sound participants and determination of the reference values of the indicators. We have created a table with the mean values of the EEG Software Analysis. CONCLUSION: The frequency composition of the EEG signal includes four types of waves or rhythms: delta/0.5−3.5Hz/, theta/4−7.5Hz/, alpha/8−12Hz/,and beta/13−30Hz/. The amplitude of the EEG under physiological conditions ranges from 15 microvolts/low-amplitude/to 150 microvolts/high-amplitude/. Average limits are between 30 and 80 microvolts.
INTRODUCTION: The connections between seizures and stroke, their characteristics and features are barely developed and also very important for the outcome. The diagnostic problem leads to ineffective treatment due to difficult selection of patients who are subject to prevention with antiepileptic drugs (AEDs) on one hand. On the other hand, is impossible to exam every stroke patient by EEG. We need an algorithm for screening indicated patients and conducting the EEG. After that we can include properly AED as a prevention. Their low frequency makes them time consuming to study. AIM: To conduct an epidemiological study of early epileptic seizures at the acute stroke phase and to derive principles for screening, diagnosis and behavior for prevention. CONTINGENT AND DESIGN: To achieve the goal we`ve researched retrospective patients, totally amounting to 656. RESULTS AND DISCUSSION: The factors identified so far in the genesis of seizures such as age, type and location of cerebrovascular accident and proximity to the cortex do not act alone, but in combination with undiscovered ones. CONCLUSIONS: There are no clear criteria to outline the rules for the AED prophylactic in patients with cerebrovascular disease (CVD). The most important indicator is the systematic assessment of the risk of seizures in the course of the disease. Patients at high risk of triggering seizures and developing epilepsy in CVDs are suitable for EEG examinations with a view to timely diagnosis and treatment.
AIM: Epilepsy is a socially significant neurological disease spread all over the world. Valproic acid (VPA) is one of the most used antiepileptic drug (AED) for treatment which has some side effects on hematology field. A nowadays update to the adult safety information is needed. The current aim is to conduct a cross-sectional study and to describe the hematology profile of adults with epilepsy treated by VPA. MATERIALS AND METHODS: Data collection was done retrospectively and includes characteristics of the subjects such as age, gender, electroencephalography (EEG) finding, duration of VPA treatment, type of treatment, and hematology profile. We report 50 subjects treated by VPA at least 1 year. RESULTS: The mean age is 46, 4 years, 50% male and 50% female. About 92% were generalized tonic-clonic seizure. Seven percent were partial complex epilepsy. Twenty-four EEG results were abnormal (48%). We found 4 cases (7%) of thrombocytopenia at therapeutic dose and 8 cases (16%) of mild anemia. DISCUSSION: Gender differences were eliminated by having the same number of participants of each gender. The EEG findings were almost equally normal and abnormal. Reported drug reactions due to VPA were thrombocytopenia and anemia. Thrombocytopenia requires discontinuation of VPA.
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