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21.09.2005:
   21.09.2005

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USE OF AMINO ACID COMPOUNDS IN TREATING EPILEPSY PATIENTS.

S.A. Nikolayeva, Cand. Sc. (Med.), neuropathologist
1997

INTRODUCTION

Although a series of new antidepressants has appeared lately, clinicians still cannot be satisfied with the effectiveness of drug therapy of epileptics since these agents fail to produce a positive clinical effect in a great number of patients. New possibilities in epilepsy treatment emerged in connection with a more accurate definition of pathogenic mechanisms of the disease concerned. It was proved that cerebral seizures can be associated with innate or acquired metabolism disturbance of transmitters, in particular, of the g -Aminobutyric acid (GABA) level (V.M. Gabashvili, 1987) and that of glutamate.

The purpose of this study was to examine the possibility of using amino acid compounds (AC) in order to enhance the effectiveness of anticonvulsive therapy in epilepsy.

MATERIAL AND STUDY METHODS

ACs were administered perorally in capsules at individual therapeutic doses 4 times daily during a 6-7 week course. Treatment efficiency was assessed by a reduction of seizure frequency in patients during a period of not less than 3 months. The effect of drugs on the nature of epileptic seizures, characteristics of the after-seizure period were studied as well as the electroencephalogram (EEG) data were investigated. A psychophysiological study was conducted before and after the treatment course in order to assess cognitive disturbances (those of memory and attention) as well as the state of social adaptation. The commonly accepted A.R. Luria methods (1968) as well as psychologic tests characterizing intellectual performance (correction test, Shulte test) and peculiarities of personal responses to a given situation (modified Rosenzweig test) were applied. Computer tomography (CT) of the brain was made in all patients.

37 patients aged 7 to 42 years of either sex suffering from different forms of epilepsy were observed. Among etiological factors of this disease exogenous factors prevailed (56.8%); hereditary predisposition to epilepsy was found in 29.7% of cases, and in the remaining 13.5% of cases etiology of the disorder was uncertain. The duration of illness by the moment of admission was 1-3 years. In the majority of patients (72.9%) frequent paroxysms (1 time a month or more often) were recorded. Generalized convulsions occurred in 54.1% of patients; absence attacks were registered in 5.4% of cases; in 18.9% there were partial seizures with elementary and in21.6% with complex sympathy. In some cases (8.1%) epileptic fits occurred serially. And in 16.2% of patients convulsive conditions set in in sleep. Not infrequently (27.0%) tonic-clonic seizures were preceded by a sensory aura. The onset of initial epileptic paroxysms in the majority of patients was observed at the age of several months to

During neurologic examinations unpronounced manifestations of residual cerebral organic insufficiency were revealed in 35.1% of patients. In 48.6% of cases there were mixed vegetative-vascular dystony symptoms. Asthenic conditions in the form of annoying weakness, mood changes, increased fatiguability, and sleep disturbances were noted in 89.2% of patients. 78.4% of patients had squeezing and pressing headaches that increased by physical effort, in weather changes and psychogenic states. Mental disorders were recorded in 81.1% of patients. In 33.3% of cases intellectual-mnemic disturbances and in 36.7% emotional-volitional disturbances were prevalent; in 24.3% periodic prolonged dysphorias were observed. Pathologic character traits of epileptic nature as revealed in the form of explosivity, affect viscosity and pedantry were noted in 51.2% of patients.

Analyzing EEG recordings, epileptic activity was found in 62.2% of patients; in 34.8% it was combined with foci. In 52.2% of patients epileptic activity on the EEG appeared spontaneously and in 47.8% it emerged after hyperventilation tests or rhythmic light irritation. In 10.8% of patients changes in EEG pointed to the involvement of the medullar structures and reduced functional cortex abilities. In 21.6% of cases EEG changes were of diffuse nature and were manifested by dysrhythmia, smoothed regional differences, presence of high-amplitude slow and isolated sharp waves. An asymmetry of biopotentials (24.3%) on account of amplitude differences, especially in the temporal areas, was recorded. In 5.4% of cases in the event of grand mal seizures and absence no pathology on the EEG was recorded, which apparently was due to prolonged administration of antiepileptic agents.

The CT showed pathologic changes in 32.4% of patients. A distention of the brain ventricular system was found in 18.9% of cases. In 10.8% of patients there were local changes of the brain substance in the form of decreased density areas and calcifications.

STUDY RESULTS

The use of amino acid compounds proved effective with respect to paroxysmal and psychopathologic symptoms. This beneficial therapeutical effect of amino acid compounds in epilepsy was produced 7-10 days after the treatment and lasted 2-6 months after drug withdrawal. Deterioration of the condition or side effects were not recorded.

It was proved that the nature of seizures changed in 47.5% of patients under the influence of amino acid drugs. Transformation of generalized convulsive attacks into partial fits and of complex partial seizures into simple fits was noted. In some instances the therapy resulted only in minor twitching of the face or arm muscles without drops to the floor or loss of consciousness. Complete cessation of seizures was observed in 45.9% of patients: in 9 out of 20 (45.0%) with generalized attacks and in 8 out of 15 (53.3%) with partial attacks. A good therapeutic effect (reduction of seizure frequency by 75%) was recorded in 35.1% of patients, and a satisfactory effect (reduction in seizure frequency by 50.0%) was recorded in 18.6% of patients.

It should be emphasized that amino acid compounds altered the condition of patients in the post-attack period. In 64.8% of patients severity and duration of the post-attack period subsided considerably. Headaches, flabbiness, somnolence and flaccidness vanished.

Improved mental condition is an important aspect of the AC effect. In patients observed a decrease in manifest effect was noted, dysphoria diminished, asthenic manifestations became less pronounced, physical and intellectual activity increased, attention became more concentrated and its shifting to an another kind of activity improved.

The positive clinical effect resulting from AC therapy was combined with favorable changes on EEG. In the majority of patients (86.5%) there was a quantitative and qualitative decrease in paroxysms of epileptic complexes on EEG and a reduction in the response of the cerebral cortex to functional loads.

Psychological investigation of 94.6% of patients treated with amino acid compounds revealed a greater ability to perform tests due mainly to an increased amount of memorized material and more active attention.

CONCLUSION

Thus, the completed study demonstrates the advisability of the use of amino acid compounds as additional therapy in the treatment of various forms of epilepsy with unfavorable progression.

REFERENCES (in Russian)

Boldyrev, A.I. Epilepsy in adults. M., 1984.

Gabashvili, V.M. Some perspectives of a systemic approach to epilepsy study. Neuropathology and Psychiatry. 1987, N. 6, pp. 1783-1788.

Karlov, V.A. Epilepsy. M., 1990.

Nikolayeva, S.A. The epileptiform syndrome in cerebrovascular diseases. Proceedings of the Plenary Session of the Russian Society of Neurologists. Irkutsk, 1992, pp. 37-39.

Khokhlov, A.P., Khailova, M.M., Nenasheva, T.I.. Pediatrics. 1989, N. 10, pp. 46-48.


 
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