Introduction. Cerebrovascular diseases are often associated with the development of epileptic seizures. It was suggested that in the implementation of epileptogenesis in patients with ischemic brain damage, a hemodynamic factor, namely the state of the perfusion reserve, may be important.Objective. The examination of the state of cerebrovascular reactivity of different cerebral vascular basins in patients with the development of epileptic seizures affected by cerebral ischemia.Materials and methods. 772 patients with acute and chronic cerebral ischemia (265 stroke patients with epileptic seizures and 174 patients with seizures on the background of chronic cerebral ischemia and 203 patients with stroke and 130 patients with chronic cerebral ischemia without seizures) was comprehensively examined.Results. In patients with cerebral ischemia, focal seizures prevail. Cortical localization of ischemic foci prevailed in patients with both acute and chronic cerebral ischemia. Stenosis of the main arteries were more often detected as in patients with ischemic stroke with the development of epileptic seizures – 218 (82.3%) compared with patients with stroke in the comparison group – 151 (74.4%) patients, р < 0.05), and in patients with CBI (chronic brain ischemia) with the development of epileptic seizures – 121 (69.5%) people, p < 0.05) compared with patients in the comparison group – 74 (56.9%) patients. The prevalence of stenosisof the main cerebral arteries was revealed in more than 70% in patients with pre-stroke epileptic seizures – 77 (33.5%) compared with patients without precursor seizures, who have been diagnosed with stenosis of more than 70% were found in only 4 (11.5%) patients (χ2 = 10.1; p = 0.03). In the comparison group of patients, there was no significant difference in CVR (cerebrovascular reactivity) changes in the carotid system and in the VBS (vertebrobasilar system) – 30 (36.6%) and 42 (47.7%) examined, respectively.Conclusion. The revealed decrease in cerebrovascular reactivity in the vertebrobasilar basin can be considered as one of the risk factors for the development of epilepsy in conditions of brain ischemia.
Epilepsy is one of the most actual social problems in modern neurology and psychiatry. According to the results of the domestic and foreign studies, the risk of developing epilepsy increases with age. The increased rate of nervous system vascular and degenerative diseases as well as brain tumors and head injuries in elderly patients is one of the reasons for it. The review is devoted to the development of epilepsy in adults having an active cerebrovascular disease. Epilepsy is the disease with multiple causative factors. Among the etiological factors of epilepsy development in adults, the predominant place belongs to vascular diseases. The article presents the epidemiological aspects of the problem, the questions of pathophysiology, the variability of epileptic syndromes developing as a result of ischemic brain disease. It describes the characteristics of epileptic process as a result of a vascular lesion. The role of the cerebrovascular reactivity in brain vascular diseases development is described. A place of different research methods (such as electroencephalography, transcranial and extracranial duplex ultrasonography scanning of the major brain vessels, different modes of magnetic resonance imaging, functional magnetic resonance imaging and magnetic resonance spectroscopy) in identifying risk factors for seizures in patients with cerebrovascular pathology is reported. Possible exogenous and endogenous precipitants (cerebral atherosclerotic vascular disease, hypertension, cerebrovascular deregulation, increased convulsive predisposition, the external epileptic triggers, etc.) are described.
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