Vol 9, No 2 (2014)

The paper deals with the study of a group of patients with focal automotor seizures, by taking into consideration their nosological, anamnestic, clinical, electroencephalographic, and neuroimaging features.

Physicians frequently consider that epilepsy is a disease in children and young adults; however, its incidence in elderly patients is not lower and commonly higher than those among children and young people. Among the causes of epilepsy in elderly patients, there is a predominance of acute and chronic cerebral circulatory disorders (50 % of all cases). Other causes of epilepsy (neurodegenerative processes, tumors, etc.) are rarely encountered in the elderly. However, there is actually no real pattern of incidence of epilepsy in the elderly since the diversity and features of its clinical manifestations in these patients, as well as difficulties in describing their status make the diagnosis of the disease very hard in this category of patients. Seizures without loss of consciousness, which are especially associated with the development of transient muscle tone disorders and autonomic dysfunction, are commonly regarded as benign vertigo, autonomic or mental disorders. This study has indicated that the development of epilepsy in the elderly, which results from cerebrovascular and neurodegenerative pathology, is not a rare, but relatively common neurological disorder. By taking into account the aging tendency in economically developed countries, the increasing number of elderly patients with epilepsy is an important medical and economic problem that calls for in-depth investigation, timely diagnosis,
and treatment.

The paper gives a brief literature review coming to the attention of practitioners to the problem of aggravation in epilepsy. Despite the fact that the purpose of use of antiepileptic drugs is to stop seizures and to suppress epileptic activity on electroencephalogram; in some cases their administration may worsen epilepsy, namely may make seizures more frequent and severer (may cause aggravation). Status epilepticus is the severest manifestation of aggravation. The drugs differ in the risk of aggravation, which also depends on the type of seizures and patient age.

Despite a considerable advance made in epileptology, resistant epilepsies are about 30 % among all epilepsy types. The paper reviews the current literature dealing with the efficacy and safety of the new antiepileptic drug zonisamide (Zonegran) in the treatment of epilepsy. It describes the mechanism of action, pharmacokinetics, efficacy, and tolerability of zonisamide in resistant epilepsy. The authors focus their attention on recent trials of zonisamide used in monotherapy.

The authors consider the historical description, nosological entity, clinical and electroencephalographic manifestations of gelastic seizures, a rare type of epileptic seizures manifesting as sudden attacks of spasmodic laughter. They describe their case of gelastic seizures in a child with tuberous sclerosis.