The large number of antiepileptic drugs (AEDs) at the physician's disposal provides not only a broad therapeutic potential in the treatment of epilepsy (EP), but creates difficulties in the adequate choice of AED. The sufficient experience in the management of patients with epilepsy has been gained so far in the world, based on which the International League Against Epilepsy (ILAE), updated classification, adopted the basic definition of efficiency, remission, resistance, evidence of research on the effectiveness of AED therapy, and introduced the concept of "resolved" epilepsy. In this article, a group of Russian experts suggest recommendations on the main steps in the choice of therapy in epilepsy. Possible drug interactions between different AEDs and other drugs as well as main characteristics of mono- and polytherapy of epilepsy are described. Some features of the use of AEDs in the elderly, characteristics of the "female" epilepsy related to the reproductive function and basic requirements for the therapy of epilepsy in children are presented.
The newest antiepileptic drug (AED) brivaracetam (Briviac, UCB Pharma) (BRV) was approved in the Russian Federation in 2017 as an adjuvant therapy for the treatment of partial seizures with/without secondary generalization in adults and adolescents over 16 years old with epilepsy. This review contains the data of BRV preclinical studies, pharmacokinetic profile and the results of comparative study of BRV and LEV. The results of main studies of efficacy and tolerability with pooled analysis as well as data from meta-analysis are presented. The authors present conclusions of the Russian leading epileptologists on perspectives of using BRV in different populations of epileptic patients. The use of BRV is able to provide long-term efficacy in terms of seizure control, is well tolerated, keeps quality of life and social activity of people with epilepsy.
Brain-derived neurotrophic factor (BDNF) is principally involved in the phenomena of neuroplasticity of the brain and long-term synaptic potency (LTP) in the hippocampus. This article covers the role played by BDNF as a diagnostic marker of vascular cognitive disorders. The relationship between etiology and the degree of cognitive impairment with the level of BDNF is ambiguous. Especially if we take into account the fact that vascular pathology can be a trigger for molecular mechanisms of neurodegeneration. The lowest BDNF level can be found among patients with dementia in Alzheimer’s disease, and there is evidence that patients with neurodegenerative disease without cognitive impairment have a decreased BDNF level. Patients with vascular cognitive impairment have a less expressed decrease of BDNF level, although it can depend on severity of stroke. In case of vascular cognitive impairment, it is possible to improve cognitive state thanks to increased BDNF level in hippocampus after physical activity. That opens new opportunities in rehabilitation. Genetic polymorphism of BDNF leads to the problems with cognitive rehabilitation and increases the risk of post-stroke dementia and dementia in Alzheimer’s disease. Supposedly, changes in the structure of BDNF-propeptide, which is involved in the processes of long-term synaptic depression (LTD) of the hippocampus, are the main cause in this case.
Цель исследования-сравнительная оценка эффективности гидрохлорида γ-амино-β-фенилмасляной кислоты-ноофена с таковой классического ноотропного препарата-пирацетама у пациенток с клиническими проявлениями климактерического синдрома. Материал и методы. Проведена сравнительная оценка эффективности γ-амино-β-фенилмасляной кислоты гидрохлорида (ноофен) и пирацетама (ноотропил) у 62 женщин с проявлениями климактерического синдрома в пери-и постменопаузе. В 1-ю группу вошли 42 пациентки, которым назначался ноофен в дозе 250 мг 3 раза в день в течение 3 нед, во 2-ю-20 больных, которым в течение того же периода времени проводили лечение ноотропилом в дозе 400 мг 1 раз в сутки. Выбор препаратов определялся лечащим врачом, больные были информированы о проводимой терапии. У всех пациенток до лечения, через 3 нед терапии и через месяц после прекращения лечения проводились оценка динамики жалоб, тревожных и депрессивных расстройств по вопросникам, ЭКГ, контроль уровня эстрадиола, прогестерона, тестостерона, пролактина, лютеинизирующего, фолликулостимулирующего, тиреотропного гормонов, трийодтиронина и тироксина в сыворотке крови. Результаты. Анализ динамики жалоб, гормонального профиля, показателей вопросников HADS, тревоги Бека, депрессии Бека, шкалы астенического состояния показал, что ноофен достоверно устраняет тревожные и вегетативные проявления климактерического синдрома, не влияя на симптомы депрессии, в то время как ноотропил обладает малым спектром клинической эффективности у больных с патологическим течением климактерия: уменьшает головные боли, утомляемость и снижение работоспособности. Заключение. Бóльшая эффективность ноофена при патологическом течении климактерия обусловлена в большей степени его транквилизирующим и антиастеническим действием. Ноофен и ноотропил не влияют на гормональный профиль больных с климактерическим синдромом. Авторы информируют об отсутствии конфликта интересов.
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