Резюме В статье представлены результаты клинического применения метода трансплантации аутологичных мезенхимальных стволовых клеток костного мозга (АМСК КМ) в лечении пациентки с фармакорезистентной эпилепсией, показана эффективность комбинированной терапии, включающей противоэпилептические лекарственные средства и аутологичные мезенхимальные стволовые клетки костного мозга, проведена оценка выполнимости, переносимости этого вида локального воздействия. Получены обнадеживающие результаты эффективности предложенного метода лечения фармакорезистентной эпилепсии на клиническом случае одной пациентки, что требует дальнейшего изучения клинического применения метода трансплантации АМСК КМ на более значимом количестве клинических случаев в рамках масштабных клинических исследований. Ключевые слова Фармакорезистентная эпилепсия, комбинированная терапия, противоэпилептические лекарственные средства, аутологичные мезенхимальные стволовые клетки костного мозга.
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The results of successful treatment of schizophrenic psychosis with persistent catatonic symptoms, refusal to eat in a patient with epilepsy are presented. In view of the progressive course of the disease, the lack of dynamics from the ongoing drug treatment, the method of electroconvulsive therapy was applied. Epileptic seizures and visual signs of brain epileptization were absent with the development of psychosis. As a result of the course of electroconvulsive therapy (9 procedures), the patient's clinical condition improved significantly. This observation illustrates the possibility of using electroconvulsive therapy in combination with antipsychotics and antiepileptic drugs as an alternative method for treating drug-resistant epilepsy.
BACKGROUND
Existing anti-epileptic drugs (AED) have limited efficiency in many patients, necessitating the search for alternative approaches such as stereotactic radiosurgery (SRS) and followed by stem cell therapy to improve results of previous treatment.
MATERIAL AND METHODS
From 2016 to 2017, a prospective study included 6 patients with a combined pathology, a median of 56 years of age, in the past TBI - 3 patients, a solitary metastatic focus in the brain (GM) - 2 patients. The indications for stereotactic intervention were both the presence of a metastatic lesion of the GM, and the bitemporal epilepsy with generalized convulsive, complex and simple partial attacks, regardless of the presence of an organic focus on CT or MRI GM. SRS was undertaken in patients undergoing a course of anticonvulsant drug therapy in combination with other types of symptomatic therapy in the absence of therapeutic effect. The frequency of generalized convulsive seizures ranged from 2–3 to 7–10 per month, complex partial from daily to 2–3 per month. SRS was performed on a stereotactic irradiation system with conical “BrainLab” collimators mounted on a linear CLINAC accelerator and allowing the session of SRS arc arches. Total dose was 12–30 Gy in isocenter, 1 fraction. After 2–3 monthes from SRS the patients received AED supplemented with single intravenous administration of undifferentiated autologous MSC (target dose of 1 × 106 cells/kg), followed by a single intrathecal injection of neurally induced autologous MSC (target dose of 0.1 × 106 cells/kg).
RESULTS
duration of epilepsy at the time of surgery ranged from 3 to 42 years. Cessation of attacks after 2–3 months after SRS with followed MSC therapy in 2 out of 6 patients was achieved remission (no seizures for one year and more), and 3 patients became responders to AEDs additionally, reduction of the pathological EEG pattern (disappearance of beta focusing, reduction of theta2-index to 23.6). Persistent clinical onco- and neurological remission 18 months. Reduction of the dose of enkorata-chrono - 3 patients, complete abolition of anticonvulsant therapy - 2 patients. MSC injections were well tolerated and did not cause any severe adverse effects.
CONCLUSION
MSC possess unique immunomodulatory properties and are a safe and promising candidate for cell therapy in AED resistant epilepsy patients in the frame of combined treatment.
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