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Неврология, нейропсихиатрия, психосоматика. 2018;10(2):20-26.Diffusion tensor magnetic resonance imaging in the diagnosis of white matter lesion in middle-aged patients with uncomplicated essential hypertension

Introduction. The MRI method has revolutionized the diagnosis of epilepsy. However, the widespread adoption of MRI in clinical practice is slowed by an insufficient number of high-field MRI scanners, a shortage of trained specialists, and the lack of standard examination protocols. The aim of this article is to present the Recommendations of the Russian League Against Epilepsy (RLAE) on the use of magnetic resonance imaging in the diagnosis of epilepsy.Materials and methods. As a structural element of the International League Against Epilepsy (ILAE), the RLAE considers it important to adapt the Protocol developed by ILAE for specialists in Russia and EAEU countries. The working group analyzed and generalized the clinical practice existing in the Russian Federation, the Republic of Kazakhstan, the Republic of Belarus and the Republic of Uzbekistan. These recommendations are intended for doctors in specialized centers of epilepsy surgery, and for doctors in general medical centers. The recommendations are applicable primarily to adult patients, but the general principles are relevant to children as well.Results. In all patients with convulsive seizures shortly after the first seizure, or patients diagnosed with epilepsy who have an unexplained increase in the frequency of seizures, rapid decrease in cognitive functions or the appearance / worsening of neuropsychiatric symptoms, the RLAE recommends using a unified MR protocol for the neuroimaging of structural sequences in epilepsy with three-dimensional pulse sequences T1 and T2 FLAIR with isotropic voxel 1 × 1 × 1 mm3 and two-dimensional T2- weighted pulse sequences with a pixel size of 1 × 1 mm2 or less. The MRI examination should be combined with EEG or EEG-video monitoring. Using this protocol allows one to set a unified standard for examining patients with epilepsy in order to detect (with high sensitivity) brain lesions playing a key role in the occurrence of seizures. Here, all 13 recommendations are presented.Conclusion. Implementation of these recommendations in clinical practice will improve the access to high-tech medical care and optimize health care costs.

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Прогрессирующие миоклонус-эпилепсии -клиниче-ски и этиологически гетерогенные генетические заболева-ния, характеризующиеся миоклонусом, генерализованны-ми тонико-клоническими приступами и прогрессирующи-ми церебральными расстройствами, главные из которых -атаксия и деменция. Преобладание миоклоний с прогресси-рующим течением объясняет объединение не менее 15 но-зологических форм, относимых к миоклонус-эпилепсии, в одну группу. Однако, по данным Марсельской группы со-гласования, абсолютное большинство составляют пять за-болеваний, а именно: болезнь Унферрихта-Лундборга (БУЛ), болезнь Лафора, синдром MERRF, нейрональный цероидный липофусциноз и сиалидоз [1]. Клонус (от греч. clonos) -это движение. Миоклонус -это аритмичные/рит-мичные, непроизвольные быстрые кратковременные мы-шечные сокращения, обусловленные вовлечением в пато-логический процесс центральной нервной системы (пози-тивный миоклонус). Наряду с этим различают негативный миоклонус, реализуемый кратковременным выключением мышечного тонуса. В основе заболевания лежат генетиче-ские факторы, в частности нарушения в митохондриальном геноме, либо наследственные болезни обмена [2].

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With the development of current neuroimaging techniques, their role in diagnosing epilepsy is becoming more significant and that is not only in identifying the disease that plays a key role in  epileptogenesis, but also in assisting a clinician in the subsequent  formulation of the diagnosis, in correcting drug therapy, and, in  some cases, in addressing the issue of surgical treatment in the  patient. The priority technique in this case is magnetic resonance  imaging (MRI) that has high sensitivity and specificity in defining the  location of minor and more major lesions of the brain structure  and that includes a set of current sequences that can obtain  important diagnostic information about the functional state of the  brain. This article highlights the International League Against  Epilepsy guidelines for MRI in patients with suspected epilepsy,  assesses the use of and briefly characterizes both structural and  functional pulse sequences that are most commonly included in the  epileptological protocol. It considers major pathological processes  and evaluates anatomical and functional changes in the brain  structure, which play an important role in epileptogenesis.

The article touches upon the issue of brain as an end-organ target of essential arterial hypertension (AH). The article gives current information about the possibilities and potential clinical application of diffusion-tensor magnetic resonance imaging for the earliest assessment of white matter damage in patients with essential AH. Dataare presented upon the reduction of fractional anisotropy in hypertensive patients and its correlation with blood pressure level.