docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2022-21-8-31-38docru-38Research ArticleНЕВРОЛОГИЯNEUROLOGYПроблемы диагностики аутоиммунной эпилепсииProblems with Autoimmune Epilepsy Diagnosticshttps://orcid.org/0000-0002-1294-3116КантимироваЕ. А.KantimirovaE. A.

Кантимирова Елена Анатольевна — к. м. н., доцент кафедры медицинской генетики и клинической нейрофизиологии ИПО

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Partizan Zheleznyak Str., Krasnoyarsk, 660022

kantilea@mail.ruhttps://orcid.org/0000-0001-9946-2878ДоморацкаяЕ. А.DomoratskayaE. A.

Доморацкая Екатерина Алексеевна — младший научный сотрудник лаборатории медицинской генетики

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Partizan Zheleznyak Str., Krasnoyarsk, 660022

e.domorats@yandex.ruШилкинаО. С.ShilkinaO. S.

Шилкина Ольга Сергеевна — к. м. н., врач-невролог Университетской клиники

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Partizan Zheleznyak Str., Krasnoyarsk, 660022

olgabbn@mail.ruhttps://orcid.org/0000-0003-4639-6365ДмитренкоД. В.DmitrienkoD. V.

Дмитренко Диана Викторовна — д. м. н., доцент, заведующая кафедрой медицинской генетики и клинической нейрофизиологии ИПО

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Partizan Zheleznyak Str., Krasnoyarsk, 660022

mart2802@yandex.ruФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Министерства здравоохранения Российской ФедерацииРоссияProfessor V.F. Voyno-Yasenetsky Krasnoyarsk State Medical University (Federal Government-funded Educational Institution of Higher Education), Russian Federation Ministry of HealthRussian Federation202214022025218НЕВРОЛОГИЯ. ПСИХИАТРИЯ3138Copyright © Кантимирова Е.А., Доморацкая Е.А., Шилкина О.С., Дмитренко Д.В., 20252025Кантимирова Е.А., Доморацкая Е.А., Шилкина О.С., Дмитренко Д.В.Kantimirova E.A., Domoratskaya E.A., Shilkina O.S., Dmitrienko D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/38Цель обзора

Цель обзора: анализ и систематизация результатов научных работ по проблеме диагностики аутоиммунной эпилепсии.

Основная часть

Основная часть. Клинические фенотипы иммуноопосредованной эпилепсии определены в соответствии с различными типами антител. Однако аутоиммунную этиологию выявляют и у пациентов, наблюдаемых по поводу хронической рефрактерной эпилепсии неизвестной причины, особенно при впервые развившемся эпилептическом статусе и эпилепсии с поздним началом без структурных изменений по данным нейровизуализации. Изменения при нейровизуализации могут отсутствовать, особенно на ранних стадиях заболевания. Зачастую диагностической дилеммой при аутоиммунных эпилепсиях является отличие эпилептических приступов от поведенческих симптомов и изменения психики в связи с поражением лимбических структур мозга. Важную роль в обнаружении приступов и дифференциальной диагностике играет видео-ЭЭГ-мониторинг, который позволяет выявить истинное количество эпилептических приступов, межприступную эпилептиформную активность, изменения поведения, не связанные с пароксизмальной активностью корковых нейронов. До сих пор не обнаружено специфических признаков на ЭЭГ для различных типов аутоиммунной эпилепсии. Тем не менее ЭЭГ может представлять паттерны, уникальные для определенных форм аутоиммунного энцефалита.

Заключение

Заключение. Видео-ЭЭГ-мониторинг вносит весомый вклад в диагностику аутоиммунной эпилепсии, а некоторые изменения могут быть рассмотрены как биомаркер тяжести заболевания. Это имеет важное значение, особенно у пациентов с нарушением сознания, для которых сложно определить клинический статус и ответ на терапию.

Objective of the Review

Objective of the Review: To analyse and systematise knowledge in the problems with autoimmune epilepsy diagnostics.

Main part

Main part. Clinical phenotypes of immune-mediated epilepsy depend on various types of antibodies. However, autoimmune epilepsy is diagnosed also in patients who are followed up for chronic refractory unexplained epilepsy, especially in initial epileptic status and late onset epilepsy without structural changes on brain imaging. Brain imaging changes may not be observed, especially in early disease. Very often a diagnostic challenge in autoimmune epilepsy is the difference between epileptic seizures and behavioural symptoms and the mental changes caused by involvement of limbic brain structures. An important role in detection of seizures and differential diagnosis is played by video-EEG-monitoring, which allows identifying the true number of seizures, epileptiform activity between seizures, behavioural changes not related to paroxysmal activity of cortical neurons. Any specific EEG signs for differentiation between various types of autoimmune epilepsy have not been found yet. Still, EEG can provide patterns that are unique for certain forms of autoimmune encephalitis.

Conclusion

Conclusion. Video-EEG-monitoring significantly contributes to autoimmune epilepsy diagnostics, and some changes can be used as markers of disease severity. It is very important, especially in patients with impairment of consciousness, where identification of the clinical status and response to therapy is challenging.

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The authors declare that there are no conflicts of interest present.