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T.I. Korablyova, psychoneurologist



More or less persistant mental disturbances typical of epilepsy (3) account, alongside paroxysmal conditions, for a large share in the clinical picture of epilepsy. In terms of their quantity and quality, psychic dysfunctions are as diverse as paroxysmal manifestations are.

As was demonstrated in previous studies (1, 2), conventional anticonvulsants contribute, as a rule, to slowing down and inertia of psychic processes and chronic inhibition in the cortex of the large hemispheres, which in childhood may result in psychospeech and psychomotor retardation, learning difficulties and behavioral problems.

The purpose of the present studies was to reveal the effect of amino acid compounds designed to correct mental behavior on indices of the epileptic condition of patients with cerebral pathology.


The existing classification of psychopathologic disorders in epilepsy (2) defines four groups of mental disturbances:

Asthenic conditions;

Psychic retardation and mental subnormality;

Deviant behavior;

Affective disorders.

The four enumerated mental types of disorders most often combine with each other, but the prevailing type of disorder can always be isolated in the clinic picture. Besides, the background against which psychopathologic symptoms typically develop are asthenic conditions resulting from organic brain lesions.

A total of 20 patients aged 3-19 of either sex diagnosed as epileptics or having an epileptiform syndrome was administered amino acid compounds.

The main type of mental disorders in patients was found to be psychic retardation and mental subnormality and, to a lesser degree, asthenic conditions in their pure form. Out of all the patients admitted for treatment, only one patient had a predominant type of psychic disorders - deviant behaviour - and was not accounted for in the studies.

During treatment, the patients continued to receive the basic anticonvulsant therapy (phenolbarbital, finlepsin, clonazepam, succilep, depakin, etc.) without changing the dosage of medications.


The studies have established that, as was assumed theoretically, a number of amino acid compounds produces a specific effect on the convulsive potential of the brain. In this connection, some drugs produce a gradual decrease of the brain convulsive potential (Aminovil, Primavit) while others cause its short-time increase with a subsequent sharp decrease. Similar drugs are, in our view, especially recommended for treating patients with generalized epilepsy.

Let us conditionally call "AAC stimulators" those amino acid compounds that are administered for correcting psychic retardation and that produce a short-time increase of the brain convulsive potential.

The investigations have revealed 3 types of AAC stimulators:

mild (Glucaprim);

moderate (Neoprim);

potent (Vitamixt).

According to objective studies (EEG, ECHO-EG), the nature of the activity of the AAC stimulators is as follows.

In generalized epilepsy, there is no manifest focus of pathological activity in the brain, the disease is developing in a "latent" (subacute) form.

AAC stimulators, while acting mildly temporarily and producing an increased epileptic activity, "localize" the epileptic focus associated with an organic brain lesion. But already several days later, the nature of seizures changes from generalized to focal that is easily cured with both amino acid compounds and conventional preparations.The effect of AAC stimulators on the brain convulsive potential versus time of treatment.


The qualitative dependence of the activity of AAC stimulators on the brain convulsive potential on the treatment time is shown in Fig. 1. The brain convulsive potential is understood to be a relative increase in pathologic signs on EEG (sharp waves, spikes, paroxysmal discharges of the spike-wave type, changes in the theta- and delta-waves) as compared with the background activity (4).

As can be inferred from the figure, the effect of AAC stimulators is characterized by a certain time delay. The maximum effect is typically manifested 5-7 days after commencement of preparation intake.

The indicated property of compounds differs with different medications. Fig. 2 shows graphs illustrating the degree of manifestation of the therapeutic effect depending on the time of drug intake for Glucaprim (curve 1) and Aminovil (curve 2).

As can be seen from the graph, the maximum effect of Aminovil is revealed 2-3 days later than that of Glucaprim. Accordingly, if the intake of both drugs begins at the same time, then there is a time period from the 3rd to the 6th day when the Glucaprim activity remains prevalent.

This is why, to avoid the undesirable Glucaprim effect as reflected by increased brain convulsive potential, Glucaprim should be administered one week later than Aminovil (curve 3).

Therapeutic effect versus time of drug administration.


In connection with what has been stated, the following schedule of treatment of epileptic patients with psychic retardation, mental subnormality and asthenic conditions is suggested.

1st week. Preparation stage. Aminovil is prescribed as the basic antiepileptic daytime drug and Avit is administered for the nighttime (in nocturnal attacks). An EEG of the patient is made.

2nd week. Stage of correction of mental disorders. Treatment is conducted within the context of Aminovil administration Aminovil being a GABA-ergic defense drug.

Depending on the convulsive potential, the following preparations are prescribed:

Glucaprim: in high convulsive potential and in the event of regular seizures;

Neoprim: in low convulsive potential and the absence of attacks during several months before admission;

Vitamixt: in the absence of convulsive potential, but in the presence of attacks in the patient's remote anamnesis. Aminovil and AAC stimulators are administered every other day.

3rd week. If Glucaprim has been administered in the 2nd session, but no change has occurred in the epileptic condition, Neoprim is prescribed. In another case, Glucaprim is repeated.

4th week. Glucaprim and Aminovil are prescribed. To correct the general condition (in hyperagitation, behavioral disturbances), Cerebron may be administered. A follow-up EEG of the patient is made.

5th week. Glucaprim and Aminovil are administered. In case of diminished convulsive potential in mental retardation they may be substituted by Oldarin.

6th week. Glucaprim and Aminovil are given.

This treatment scheme allows to properly prepare the patient for the AAC stimulator activity. In addition, stimulations conducted within the framework of the basic therapy make it possible to alleviate the post-seizure period, reduce the severity and duration of the seizures. An EEG made twice provides an objective assessment of the patient's condition.

Furthermore, the investigations have shown that the results of the treatment of the right and left hemispheric types of focal epilepsy forms are different.

The studies have revealed that the left hemispheric forms are treatable more easily which may be attributable to an additional load on the left hemisphere produced by writing-connected exercises. The majority of patients who recorded considerable improvement are continuously subjected to such a load by compiling synopses at colleges or actively learning at school.

The studies have also shown that the great majority of patients admitted for treatment had the illness focus that was localized in the left temporal region. Such correlation of different localization types of psychopathologic disorders in the patients admitted to the Center may be associated with different functions of the right and left hemisphere.

As is known, the left hemisphere controls concrete thinking, counting, speech, minor movements and positive emotions. The right hemisphere contains the representation of abstract thinking, imagination, reading, static movements and negative emotions.

If one of the hemispheres is damaged, its functions are partially taken over by the other hemisphere which results in hypertrophies of the mental functions assigned to it (hyperfunction of the hemisphere).

Thus, in case of a right hemisphere lesion, minor movements may improve (drawing, writing, counting, etc.) which, in conjunction with elevated spirits, leads to an inadequate assessment by the patient of his or her condition. In this case, the patient can consult our Center only in the presence of clear-cut epileptic signs, feeble mindedness, but in this state he is, as a rule, already in an inpatient department.

Thus, correlation of various types of psychopathologic disorders in epilepsy and epileptiform syndromes in patients admitted to our Center is fairly stable and distributed along the following lines:

1/2 - 2/3: psychic retardation and mental subnormality against the background of asthenic conditions;

1/3 - 1/4: asthenic conditions in pure form;

isolated cases of deviant behavior and affective disorders.

Considering that psychic manifestations of psychopathologic disturbances are relatively hard to reveal and their clinic changes are especially hard to record in dynamics, two types of additional sheets were drawn up that are attached to the case reports: these sheets record dynamics observations of the mental condition and pathology.

The sheet concerned with a dynamic supervision of the mental state is an original development, whereas the sheet concerned with dynamic observations of manifestations of mental pathology was drawn up on the basis of a quantified assessment of the clinic-pharmacological effect of psychopharmacological drugs of the Pharmacology Research Institute of the Russian Academy of Medical Sciences and of the V.P. Serbsky Research Institute of General and Forensic Psychiatry.

These sheets will help not only analyze the psychopathologic condition of the patients but also get a better insight into the dynamics of the positive effect of the treatment with amino acid compounds.


Thus, the use of amino acid compounds designed to correct mental conditions exerts a positive effect on indices of the epileptic condition of patients with cerebral pathology.

The presented two-stage treatment scheme allows to more adequately prepare the patient for the activity of such medications, whereas stimulation concomitant with the basic treatment with Aminovil being a GABA-ergic defense preparation allows to alter illness progression. The repeated EEG provides for an objective assessment of the dynamics of the patient's state.

In forthcoming studies it would be advisable to continuee the monitoring of the treatment processes on the right and left hemispheric forms of epilepsy and develop special methodologies for patient rehabilitation with a selective load both on the right and left brain hemispheres.

REFERENCES (in Russian)

Oudshoorn, D.N. Infantile and adolescent psychiatry. Supplement to the Journal "Social and Clinical Psychiatry". M., 1993, p. 320.

Boldyrev, A.I. Epilepsy in children and adolescents. M., Meditsina, 1990, p. 320.

Sukhareva, G.Ye. Selected lectures on psychiatry. M., Meditsina, 1974, p. 288.

Blagosklonova, N.K. Electroencephalography in the diagnosis of epilepsy in children and adolescents. Manual. M., TSOLIUV, 1986, p. 40.

Khokhlov, A.P., et al. Myelopathies and demyelinating diseases. M., Meditsina, 1990.

Gromov, S.A. Rehabilitation of epilepsy patients. L., Meditsina, 1987, p. 176.