Эпилепсия – хроническое заболевание центральной нервной системы. Большинство исследований продемонстрировали, что пик заболеваемости приходится на детей младше 15 лет, и особенно на первый год жизни. Диагноз эпилепсии в отличие от других хронических заболеваний накладывает социокультурное и моральное бремя на пациентов и их родителей. Представлены данные по распространенности этого заболевания у детей по разным странам. Уровень смертности у детей, страдающих эпилепсией, в 2–4 раза выше, чем у остальной части населения. Продемонстрирована новая классификация эпилепсии 2017 г. по распределению в зависимости от этиологического фактора, что важно для выбора тактики течения. Более глубоко описаны эпилептические припадки у пациентов с инфекционными заболеваниями головного мозга, ишемическим или геморрагическим инсультом, после черепно-мозговой травмы, и представлены особенности острых приступов, а также поздних эпилептических приступов при этих заболеваниях. Освещены рекомендации об антиэпилептических препаратах в качестве исходной монотерапии у детей с очаговыми припадками и в зависимости от основного процесса, вызывающего развитие той или иной симптоматической (структурной) формы эпилепсии. Более детально рассмотрен препарат, широко применяемый в практической медицине, – вальпроевая кислота. Ключевые слова: структурная (симптоматическая) эпилепсия, инфекционные заболевания центральной нервной системы, острые нарушения головного мозга, черепно-мозговая травма, лечение.
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Epilepsy is a chronic neurological disorder. Most studies have shown that a peak of epilepsy incidence occurs in children less than 15 years of age, and especially in the first year of life. Epilepsy diagnosis, unlike that of other chronic diseases, places a sociocultural and moral burden on the patients and their parents. The article provides data on the prevalence of this disease in children in different countries. The mortality rate in children with epilepsy is 2–4 times higher than in the general population. The article presents a new classification of epilepsy of 2017 according to a distribution by the etiological factor, which is important for choosing the treatment tactics. It describes in details epileptic seizures in patients with infectious brain diseases, ischemic or hemorrhagic stroke, due to a brain injury as well as features of acute and late epileptic attacks at these diseases. Recommendations on antiepileptic drugs as initial monotherapy in children with focal seizures and depending on the basic process which causes the one or another symptomatic (structural) form of epilepsy are considered. Valproic acid, a drug, widely used in practical medicine, is discussed in details. Key words: structural (symptomatic) epilepsy, infectious neurological diseases, acute brain disorders, brain injury, treatment.
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1. Ngugi AK, Bottomley C, Kleinschmidt I et al. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. Lancet Neurol 2013; 12 (3): 253–63. DOI: 10.1016/S1474-4422 (13)70003-6
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Авторы
Н.В. Пизова*
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России, Ярославль, Россия
*pizova@yandex.ru
________________________________________________
Natalia V. Pizova*
Yaroslavl State Medical University, Yaroslavl, Russia
*pizova@yandex.ru