[Pharmacotherapy of epilepsy in elderly patients].
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Biomedical subjects
Publications and source records attributed to A V Lebedeva.
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The paper presents the results of follow-up study of 610 patients with ischemic stroke. In 52 patients (8.6%) there was observed symptomatic epilepsy conditioned by local causes (2 and more epileptic fits in anamnesis). The age of the onset of epileptic seizures was in the range 50-69 years, and men prevailed. From all 52 patients with episyndrome 36 had only one stroke, 16 patients-two and more strokes. 14 patients had fits before the stroke development. Meanwhile in 10 patients the fits were the first stroke symptoms (early) and in 28 individuals the fits arose 7 days after the stroke development (late). Significantly more severe disorders of dynamic praxis were revealed in psychologic examination of the patients with secondary generalized fits than of ones with partial seizures. Pathogenetic and clinical aspects of vascular epilepsy, interactions between transitory ischemic attacks and the fits which developed before the stroke are considered.
The study included 22 patients with poststroke epilepsy (group 1) and 30 patients with stroke without epilepsy (group 2). A bilateral decrease of the time of central conduction (TCC) through pyramidal path (both on the paretic and intact side) was revealed in group 1. This was not observed in patients of group 2 with similar gravity of motor disorders (p < 0.01). Tendency to TCC decrease was also observed in patients without epileptic disorders by day 5-6 after ischemic stroke. However, TCC values were increased in such patients by day 10-14. Low indices persisted for a long time in patients with poststroke. There was also an increase of delta index of facilitation (the difference between TCC in rest and in muscle effort). It was also found that motor disorders in the group of patients with poststroke epilepsy were characterised by higher muscular tone than in poststroke patients with the same degree of the paresis.
The observational study included 79 rheumatic patients aged 14-49 years. The diagnosis of acute rheumatic fever (ARF) was made in 29 patients (13-first attack, 16-recurrence), 50 patients had rheumatic heart disease (RHD) without signs of activity, 40 healthy donors served control. Antibodies to cardiolipin (a-CL) in the blood were determined by enzyme immunoassay, hemostasis was assessed by the level of antithrombin III, platelet aggregation, readings of electrocoagulograms. ARF patients were examined throughout the year, RHD patients--only once. Compared to the controls, both ARF and RHD patients demonstrated higher occurrence of a-CL, enhanced platelet aggregation, low antithrombin III level, hypercoagulation on electrocoagulogram, a-CL in ARF patients were detectable from the first month of the attack. By month 7-12 their count decreased, hemostasis normalized. In the onset and progression of RHD in the presence of ARF a-CL occurred more frequently. A direct relationship was found between the time of a-CL detection in the blood and severity, duration of rheumatic carditis. The data obtained validate feasibility of using a-CL for diagnosis of rheumatic carditis severity and prognosis of RHD development.
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Application of 17-oxyprogesterone-capronate as a component of complex treatment of 188 patients with stage I-III carcinoma of corpus uteri improved the long-term results at all stages of the process. Hormonotherapy should be recommended as a method of choice in the postoperative treatment of patients suffering from stage I-II endometrial carcinoma with superficial infiltration of the muscular layer or as an independent method of treatment in elderly patients in case of contraindications for surgery and radiation procedures. The method offers good advantages in young patients at the initial stages only.
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Twenty-two patients with post-stroke epilepsy (group 1) were studied, along with 30 stroke patients without epilepsy (group 2). Bilateral (on both the paralyzed and intact sides) decreases in the central conduction time (CCT) along the pyramidal tract were found in group 1, which were not seen in group 2, who had similarly severe motor lesions (p < 0.01). The tendency to decreased CCT was also seen 5-6 days after ischemic stroke in patients without epileptic manifestations, though CCT in this group increased by day 10-14; low values persisted in group 1 for prolonged periods. The facilitation differentiation (deltaF, the difference in CCT between resting and effort conditions) was also found to increase. In patients with post-stroke epilepsy, motor lesions were characterized by higher levels of muscle tone than in other stroke patients, though the levels of paralysis were similar.
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