Проблемы диагностики аутоиммунной эпилепсии

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

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. 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.

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