Pathophysiological mechanisms of development of epilepsy and special features of epileptogenesis in the immature brain

Abstract

The article is devoted to the urgent problem of neonatology and pediatric neurology — seizures in newborns and young children. The work analyzes the scientific literature on the pathogenetic mechanisms of the development of the epileptic process, which is based on the anatomical and physiological mechanisms of the functioning of brain cells, in particular, in newborns and young children. New pathophysiological data on the increased excitability of the developing brain are described. It has been shown that the implementation of the mechanism of increased excitability of the fetal brain may be due to the peculiarities of the functioning of NMDA, AMPA, kainate receptors, and the peculiarities of the localization of ion channels in different brain structures. The paradoxical (exciting, depolarizing) role of gamma-aminobutyric acid, which is due to the peculiarities of the activation of chlorine co-transporters, is emphasized. The features of the epileptic process in newborns and young children have been determined. The reasons for the development of seizures in newborns are emphasized. The classification and clinical phenotypes of neonatal seizures are considered. It is emphasized that the convulsions in newborns rarely have a deployed clinical picture and are often represented by abortive or focal seizures, which is associated with the ontogenetic features of the fetal brain, namely: incomplete by the time of the birth of a cortical-neural organization, synaptogenesis and myelination of its structures, insufficiency of the development of commulectral intermetrous bonds , uneven representation in the cortex of ion channels with a relatively well-formed limbico-reticular system and its bond with a brain barrel. It was noted that despite various clinical manifestations, the newborn has four main types of seizures: subtitle (erased, abortive, fragmentary), tonic, clonic and myocloniс. No conflict of interest was declared by the authors. Key words: newborn, brain, pathophysiology, seizures, epilepsy, review.