RU2254052C1 - Method for predicting epilepsy with polymorphic paroxysms - Google Patents

Abstract

FIELD: medicine, psychiatry.

SUBSTANCE: one should conduct EEG-testing to detect total value of the indices of spectral power or percentage spectral power of delta- and teta-rhythms due to spectrometric technique in frontal, parietal, central and temporal areas both before and during emotional-negative loading when visual emotionally negative stimuli are presented followed by their imaginary reproduction. In case of higher indices to visual stimuli being above 15% against the background one should diagnose epilepsy. The method enables to increase the number of diagnostic means, increase accuracy and objectivity in predicting epilepsy with polymorphic paroxysms at dissociation of clinical and EEG-values.

EFFECT: higher efficiency of diagnostics.

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Description

The invention relates to medicine, namely to psychiatry.

A known method for the diagnosis of epilepsy in the dissociation of clinical and electroencephalographic (EEG) indicators by conducting an EEG study against hyperventilation followed by analysis of the frequency ranges of EEG, including delta and theta rhythms (Guide for doctors "Research Methods in Neurology and Neurosurgery" edited by Gusev E.I. et al., Nolidzh Publishing House, 2000, p. 12).

The disadvantage of this method is the low accuracy of the evaluation of the test due to the fact that a change in the EEG parameters often enhances synchronization in the alpha range and does not always lead to the generation of pathological delta and theta activity characteristic of epilepsy.

The technical result of the proposed solution is to expand the diagnostic arsenal, increase the accuracy and objectivity of the diagnosis of epilepsy with polymorphic paroxysms during the dissociation of clinical and EEG indicators, which is of particular importance when conducting medical, labor and forensic psychiatric examination, as well as for choosing therapeutic tactics.

This result is achieved by the fact that the EEG study is carried out with the determination of the total index of the spectral power indices (SM) or the percentage spectral power (% CM) of the delta and theta rhythms by the spectrometric method in the frontal, parietal, central and temporal regions before and during carrying out an emotionally negative load - presenting visual emotionally negative stimuli with their subsequent mental reproduction) and with its increase of more than 15%, epilepsy is diagnosed compared to the background.

It does not follow from a known level that the increase in the total index of the SM or% SM SM of the delta and theta rhythms in the anterior cortical zones (frontal, parietal, central and temporal) under the influence of an emotionally negative load of more than 15% compared to the background can serve as an objective diagnostic criterion for epilepsy with polymorphic paroxysms, contributing to the manifestation of pathological epileptiform EEG indicators.

The method is as follows.

Patients suffering from epilepsy with polymorphic paroxysms and not having the corresponding epileptiform signs on the EEG are subjected to a background EEG study using a standard technique with spectrometric measurement of the indices of delta and theta waves in the frontal, parietal-central and temporal regions of the brain. The total index of the SM or% -CM delta and theta rhythms is determined. Then, patients undergo an emotionally negative load with visual stimuli presenting fear and fear for life, for example, images of a patient in a state of epileptic seizure with subsequent mental reproduction of this condition. During this load, a repeated EEG study is performed. Comparison of the total indicator of CM or% -CM during exercise with the background and with its increase of more than 15% diagnose epilepsy.

Example. Patient B., born in 1978, is under the supervision of the Epilepsy Clinic of the Moscow Research Institute of Psychiatry since 1998, outpatient card No. 963/98. Diagnosis: Idiopathic epilepsy with generalized convulsive and non-convulsive seizures. The disease debuted at age 15 (1993) with generalized seizures. Subsequently, absences joined, which became more frequent up to 1-3 per week due to inadequate therapy. At the same time, she complains of increased anxiety, sensitivity, decreased mood, sleep disturbances. On the EEG, carried out according to the standard method of pathological discharge activity characteristic of epilepsy, was not detected.

The patient conducted a background recording according to the standard method and spectrometric analysis of the EEG. Background indicators SM and% -SM) are presented in table 1.

Before the load, the total indicator of the delta and theta rhythms of SM: 210.8 + 78.6 = 289.4 μV ² ,% SM: 413.7 + 154.1 = 567.8%.

The patient was presented with a visual stimulus with the image of a patient in a state of an epileptic seizure, and then instructions were given: to mentally reproduce the emotionally negative situation - the approach of an epileptic seizure. During the mental presentation, the EEG was re-recorded with spectrometric analysis. The results are shown in table 1.

After loading, the total indicator of delta and theta rhythms of SM: 259.9 + 81.2 = 341.1 μV ² ,% SM: 506.6 + 160.6 = 667.2%.

Comparison of total indicators before and during the emotionally negative load of SM: 289.4 = 100%, 341.1 = X%, X = 117.86 μV ² ,% -CM: 567.8 = 100%, 667.2 = X% X = 117.51%, therefore the SM is 17.86% and the% -MS is 17.51% higher than the background index.

Thus, an increase in the total index of SM and% SM delta and theta rhythms during an emotionally negative test of more than 15% compared with the background in this patient corresponded to a diagnosis of epilepsy, which corresponded to clinical manifestations.

The specified method was used to study 37 patients with epilepsy with polymorphic paroxysms and the absence of discharge epileptiform activity on the EEG. The coincidence of the results of clinical and EEG studies took place in 32 patients - 86.5% of cases (p <0.01). In the control group of healthy subjects (10 people), no similar changes were found.

The proposed method has advantages over the known, consisting in expanding the arsenal of methods for objective diagnosis, increasing their accuracy in patients with epilepsy with polymorphic paroxysms during the dissociation of clinical and EEG indicators, which is of particular importance when conducting medical and labor and forensic psychiatric examination, as well as the choice of therapeutic tactics.

Table 1
Indicators CM (in microvolts) and% -CM (in%) before (A) and during (B) the emotional negative load Delta rhythm Theta rhythm CM %-CM CM %-CM A B A B A B A B F3 24.0 36,4 43.7 59.6 7.8 7.1 14.2 11.6 F4 27,2 35.0 48,2 56.9 8.6 8.2 15,2 13,4 C3 17,2 20.1 34.0 42.0 8.8 9.7 17.5 20,4 C4 21.0 25,2 37.7 45.5 10.3 10.5 18.6 18.9 P3 15.9 19,4 32.9 42.6 7.5 8.4 15.6 18,4 P4 21.9 26.6 39.7 49.9 8.7 8.9 15.7 16.7 T3 16.5 17.9 41.9 48,2 5.5 6.2 13.8 16.6 T4 28.3 28.5 48.9 51.6 8.0 8.6 13.9 15.6 F7 20.5 23,2 47.2 58.1 5,6 5,6 12.8 13.9 F8 18.3 27.6 39.5 52,2 7.8 8.0 16.8 15.1 Total indicators 210.8 259.9 413.7 506.6 78.6 81.2 154.1 160.6

Claims (1)

A method for diagnosing epilepsy by conducting a clinical electroencephalographic study with measuring indices of delta and theta waves in the frontal, parietal-central and temporal regions of the brain, characterized in that they determine the total index of the spectral power indices or percentage (%) spectral power of the delta and of theta rhythms by spectrometric method before and during the emotional negative load and with its increase of more than 15% compared with the background, epilepsy is diagnosed.