Current antiepileptic strategies aim to normalize the interaction
of the excitatory and inhibitory systems, which is ineffective in
treating patients with drug-resistant epilepsy. Neuroinflammatory processes
in the epileptic focus and its perifocal area can trigger apoptosis
and also contribute to the development of drug resistance. The level
of pro- and anti-apoptotic proteins (p-NF-kB, TNF-α, p53, FAS, caspase-3,
caspase-9) was analyzed in intraoperative biopsies of the temporal
lobe gray and white matter in the brain of patients with drug-resistant
epilepsy. An increased level of pro-apoptotic proteins was revealed
in the cortex and perifocal area’s white matter against the background
of an imbalance of protective anti-apoptotic proteins. It appears
that the activation of the extrinsic pathway of apoptosis occurs
in the perifocal area, while in the epileptic focus, there are proteins
responsible for the activation of the anti-apoptotic survival pathways.
Active neuroinflammation in the epileptic focus and perifocal area
of the temporal lobe may contribute to the development of the resistance
to antiepileptic drugs and the progression of neurodegeneration in
such patients.
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OBJECTIVE. The aim of this research was to improve results of gloss total resections of glial tumors of the brain. MATERIAL AND METHODS. Fluorescence-guided resection was performed in 31 patients with glial tumors of different degree of malignancy. «Photoditazin» was applied during operation. The authors assessed the efficacy, sensitivity and specificity of the method and degree of radical nature of resection in relation to surgery of gliomas. RESULTS. Sensitivity of the method numbered 68,3 % and specificity was 60,1 % in cases of gliomas of grade I-II. It was 85,4 % and 76,2 %, respectively in cases of gliomas of grade III-IV. The degree of achievement of gloss total resection (GTR) was 79,3 % (gliomas of grade III-IV) and 95,6 % (gliomas of grade III-IV). CONCLUSIONS. Intraoperative fluorescent diagnostics using «Photoditazin» was highly effective, sensitive and very specific method in surgery of glial tumors of different degree of malignancy. The method allowed doctors to develop the radical nature of surgery in cases of glial tumors removal.
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