Professor Gagik N. Avakyan, a prominent Russian neurologist, epileptologist, public figure, and educator would have marked the 80 th anniversary of his birth on April 6, 2026. His name is inextricably linked with establishing contemporary Russian school of epileptology, developing the Russian League Against Epilepsy (RLAE) as well as implementing the highest standards of medical and social care for patients with epilepsy. Professor Avakyan passed away unexpectedly on November 12, 2019, leaving behind a colossal scientific, pedagogical, organizational, and, no less important, human legacy. In this publication, we have endeavored to cover his life thoroughly and accurately, so that new generations of physicians can fully appreciate the magnitude of his personality and the depth of his contribution to Russian neurology.
The journal “Epilepsy and Paroxysmal Conditions”, published since 2009, demonstrated steady positive dynamics in key scientometric indicators at year-end 2025. In May 2026, based on updated data, the journal moved to the third quartile (Q3) of the authoritative international scientometric database Scopus, thereby confirming its growing international recognition. At the same time, the journal achieved leading positions among peer-reviewed publications in the "Neurosciences" category in the Russian Science Citation Index (RSCI), evidencing its leading role in the national academic space. The key drivers of growth were the open-access model, the introduction of HTML versions of articles, as well as refinement of requirements for the methodological quality of manuscripts. An analysis of publication activity shows increased proportion of original research, a rise in the number of citations in high-ranking journals, as well as prominently expanded readership. The paper also examines new legal requirements for the publication of genetic data, which come into force in Russia in 2026, and outlines strategic prospects to further promote the journal in international scientometric databases. The journal continues to serve as a key communication platform for Russian and foreign researchers in the field of neurosciences, practicing physicians specializing in various areas of neurology, instrumental diagnostic methods, therapy, pediatrics, neonatology, physical and rehabilitation medicine, and related fields.
Background. Epilepsy remission rates in Russia lag behind global figures, which is partly attributable to the fragmentation of approaches to evaluating antiseizure medications (ASMs): the subjectivity of expert opinions, the limited scope of consumption data, and the failure of clinical guidelines to account for regional specificities. Objective: To develop and test a methodology for comprehensive evaluation of ASMs based on matrix expertise with multilevel verification across four independent data sources to optimize drug provision for epilepsy patients at the regional level. Material and methods. A structured survey of 32 expert epileptologists from 7 Russian regions was conducted to assess21 ASMs using a 10-point scale (therapeutic line and risk). Verification involved comparison with clinical guidelines, practice data, consumption metrics, and a pharmacokinetic safety rating. Concordance was assessed using Kendall's coefficient of concordance (W). Results. The developed methodology enabled, for the first time, a multi-level verification of expert preferences and the identification of systemic discrepancies in approaches to epilepsy therapy. A divergence was found between expert opinions and clinical guidelines in the treatment of generalized epilepsy, attributable to the challenges of implementing new classification criteria and the evolving nature of therapeutic approaches. The identified mismatch between the proven safety of modern ASMs and their actual positioning in treatment algorithms reflects the influence of economic and organizational barriers. Conclusion. The proposed methodology serves as an analytical tool for auditing the pharmaceutical supply system, enabling the formation of rational ASM formularies, the substantiation of “negative lists”, and the identification of targeted administrative and educational measures.
Objective: To summarize current evidence on the prevalence, phenomenology, and temporal characteristics of prodromal symptoms and early ictal manifestations (auras) in focal epilepsy, and to clarify their clinical relevance for patient counseling and management. Material and methods. A narrative review of the literature on prodromal symptoms and auras in focal epilepsy was conducted. Publications were identified through searches in PubMed/MEDLINE and by screening reference lists of key articles. Given the heterogeneity in definitions and time frames across studies, findings were analyzed qualitatively without meta-analysis, particularly emphasizing on practical aspects of clinical interviewing and safety recommendations. Results. Prodromal symptoms are reported in a substantial proportion of patients with focal epilepsy; reported prevalence varies depending on assessment methods and diagnostic criteria. Prodromes typically occur minutes to hours (less commonly a day or more) before seizure onset and may include affective, cognitive, and autonomic manifestations. According to the current classification by the International League Against Epilepsy, an aura is defined as a focal aware seizure and represents the ictal phase of the epileptic event. Clinically, auras are characterized by brief, stereotyped subjective experiences occurring seconds to minutes before potential seizure propagation. Patients’ responses to warning symptoms often include cessation of ongoing activities, seeking a safe environment, and alerting others, which may reduce the risk of injury. However, in some individuals, anticipatory anxiety and avoidance behaviors develop, negatively affecting quality of life. Conclusion. In patients with focal epilepsy, routine and systematic inquiry about prodromal symptoms and auras during clinical evaluation is advisable. Clinicians should carefully distinguish between prodromal and early ictal manifestations and help patients adopt proportionate safety measures without reinforcing hypervigilance or unnecessary restrictions in daily activities.
Currently, in clinical practice, electroencephalography (EEG) is used in several different types of studies, such as routine EEG examinations, video-EEG monitoring, EEG in intensive care units, etc. Each of these techniques requires appropriate preparation and organization of the room, specialized furniture, personnel training, and the availability of accessories and consumables. Here, some practical recommendations are provided for organizing a place for conducting routine EEG examinations, that may be useful while designing a new or reorganizing an existing EEG room.
Background. Generating a sensitive and selective method to quantitate valproic acid (VPA) for therapeutic drug monitoring, using as low as 50 µl of blood serum sample, is highly relevant for pediatric patients, for whom biomaterial collection can be challenging. Objective: To develop and validate a method to quantitate VPA level in blood serum using gas chromatography-mass spectrometry (GC-MS) without derivatization, added with phenylacetic acid as an internal standard (IS), for therapeutic drug monitoring, and to comparatively analyze results obtained using developed method and immunochemical approach. Material and methods. Extraction of VPA and IS was performed using liquid-liquid extraction with ethyl acetate, after preacidification of blood serum sample with 1 M hydrochloric acid. The lower limit of quantification was 5 µg/ml, with calibration range 5–200 µg/ml. The study employed a GC-MS system consisting of Agilent 5977B SQ single quadrupole MS-detector equipped with a high-efficiency source for electron impact ionization, and Agilent 7890 gas chromatograph (both – Agilent Technologies, USA). Analytes were quantitated by using electron impact ionization in selected ion monitoring mode. For VPA, the characteristic fragment ion with mass-to-charge ratio (m/z) 102 was used, and for IS – most intense characteristic fragment ion with m/z 91. Chromatographic separation was carried out on HP-5MS Ultra Inert column (30 m × 250 µm × 0.25 µm) (Agilent Technologies, USA). Results. A comparative analysis of the results obtained in determining VPA level in blood serum samples using GC-MS and immunochemical method demonstrated a high degree of correlation, thereby verifying feasibility of the developed method for therapeutic drug monitoring. Conclusion. The developed GC-MS method is characterized by high sensitivity and selectivity and can be recommended for introduction into clinical practice for therapeutic drug monitoring of VPA concentration as an alternative to immunochemical approach.
The article systematizes data on rare levetiracetam-related adverse events that go beyond the approved data provided in package insert. The key factor in selecting an antiepileptic drug is the risk-benefit ratio, which is largely determined by the knowledge of all potential adverse effects. This review aims to increase awareness of adverse reactions to levetiracetam in patients with epilepsy. Further research is needed to explore the pathogenetic mechanisms and identify risk factors of adverse effects for better understanding of the drug safety profile.
This literature review focuses on studying reflex epilepsy: a group of epileptic syndromes characterized by seizures triggered by specific external stimuli. Current scientific publications assessing the mechanisms underlying formation, clinical manifestations, and approaches to treat various subtypes of reflex epilepsy were analyzed. The domestic and foreign publications containing up-to-date information on reflex (stimulus-sensitive) epilepsy and its subtypes were investigated. The literature search was conducted in the PubMed/MEDLINE, Cochrane Library, eLibrary and CyberLeninka databases. The main types of reflex epilepsy, including photosensitive, praxis-induced, musicogenic, bathing epilepsy, etc, were detailed. Of special attention were clinical features and therapeutic approaches. Shedding light on reflex epilepsies is crucial for increasing effectiveness of medical care and improving patients’quality of life.
Background. Recently, patients with comorbid conditions such as epilepsy and dissociative (psychogenic non-epileptic) seizures have been increasingly identified in clinical practice. No generally accepted diagnostic algorithms for confirming such conditions are currently available. However, it is known that patients with epilepsy and comorbid pathology have certain personality characteristics, for identifying which an experimental psychological examination is conducted, which uses multidimensional personality questionnaires. Among them, the Minnesota Multiphasic Personality Inventory (MMPI) is most widespread, adapted by L.N. Sobchik (2007) as a standardized multifactorial personality study.Objective: To examine the personality pattern in patients with epilepsy and comorbid dissociative disorders.Material and methods. The study included 54 patients with epilepsy, 27 of them with comorbid dissociative disorders (ED group) in the form of psychogenic non-epileptic seizures, and 27 respondents with exclusively epileptic seizures (E group). All study participants underwent clinical and psychological examinations using MMPI.Results. Patients in ED vs. E group had a higher level of hypochondria score points (74.96 vs 65.23 points; p=0.012). According to the results of the assessment by the scale of anxiety and depression, the average score in ED group was lower than in E group (64.26 vs 75.77 points; p=0.001). According to the hysteria scale, patients in ED group had a higher average score compared with E group (73.26 vs 64.08 points; p=0.014).Conclusion. Patients with epilepsy and comorbid dissociative disorders have higher levels of hypochondria, hysteria, as well as low levels of anxiety and depression, compared with patients without conversion disorders. The results obtained correspond to the “conversion five” and characterize the personality pattern observed in such patients.
Background. Pharmacotherapy of secondary metabolic syndrome (MetS) induced by antiepileptic drugs (AEDs) remains unresolved issue in epileptology. The mechanisms of development and incidence of metabolic disorders (changes in eating behavior, weight gain, lipid and carbohydrate metabolism disturbances, etc.) in patients with epilepsy taking AEDs long-term remain poorly understood. AED-induced MetS (AED-MetS) impairs quality of life and reduces life expectancy in patients with epilepsy, increasing the risk of cardiovascular disease, type 2 diabetes mellitus, and abdominal obesity.Objective: To investigate incidence of metabolic disorders induced by long-term use of AEDs of various generations in monotherapy and polytherapy regimens in adult patients with epilepsy.Material and Methods. A pilot, single-center, open-label, observational, clinical, cross-sectional, comparative study was conducted in patients with epilepsy taking valproic acid (VPA), lamotrigine (LTG), and levetiracetam (LEV). The total sample consisted of 60 participants, including 45 patients with epilepsy (study group) and 15 clinically healthy volunteers (control group). Patients in main group were divided into subgroups based on the prescribed AED. The mean age of the participants was 37.5±12.6 years. The scope of the research included a clinical somatic and neurological examination, anthropometry (height, weight, waist and hip circumferencеs), a pharmacological history, as well as clinical and biochemical blood tests (serum biomarker analysis, AED-MetS).Results. It was found that AED-MetS anthropometric biomarkers peaked for body mass index (p=0.015), waist circumference (p=0.048), and hip circumference (p=0.024), which were significantly higher in the VPA subgroup compared to control group. In contrast, no such changes were observed in LTG and LEV subgroups when compared to control group (p>0.05). Abdominal fat distribution was significantly more common in VPA subgroup compared to newer-generation AEDs (LTG and LEV) and control group. C-reactive protein with significantly higher level in VPA subgroup (p=0.02) was most sensitive laboratory biomarker for AED-MetS, confirming the role for AED-induced systemic inflammation in developing metabolic disorders.Conclusion. The prevalence of the examined AED-induced metabolic disorders was higher in patients receiving VPA vs. LTG and LEV. However, AED-MetS laboratory (biochemical) biomarkers excepting C-reactive protein, had no clinical significance. Thus, it may account for a need to search for new specific and sensitive AED-MetS biomarkers to be introduced in real-world clinical practice.
Mesial temporal lobe epilepsy (MTLE) is a severe form of focal epilepsy, often therapy-resistant, resulting from a long-term epileptogenesis. This clinical lecture examines the key early provoking factors of MTLE development: prolonged febrile seizures in childhood, neuroinfections, perinatal hypoxia, and traumatic brain injuries. The universal pathophysiological mechanisms triggered by these factors are analyzed in detail: excitotoxicity, neuroinflammation, blood-brain barrier disruption, aberrant neurogenesis, synaptic reorganization, and the central role of mammalian target of rapamycin (mTOR) signaling pathway hyperactivation. MTLE pathogenesis is explained from the perspective of the “dual/multiple hit” model, according to which the cumulative impact of several injuries leads to the depletion of the hippocampal compensatory capabilities and the formation of hippocampal sclerosis. The importance of comprehensive diagnosis, including detailed history collection, magnetic resonance imaging according to epileptology protocol, and the search for biomarkers is emphasized. Treatment prospects are related to shifting focus towards predictive and preventive therapy targeting key molecular pathways (pro-inflammatory cytokines, mTOR signaling), paving the way for personalized disease management.
A substantial amount of progress has been made in the field of neurohumoral transmission, which has led to the disclosure of precise details regarding the communication mechanisms that occur within the neurological system. This review article gives an extensive analysis of neurohumoral transmission, focusing on the evolving concept of co-transmission and its implications for understanding psychiatric disorders in adolescents. It first provides details on classical neurotransmitters: acetylcholine, serotonin, dopamine, glutamate, and gamma-aminobutyric acid and their role in neuronal communication. Recent research findings have shown that many neurons have the ability to simultaneously release one or more than one neurotransmitter, a phenomenon termed as co-transmission and seem to add complexity to how signals are processed through the nervous system. This phenomenon raises important implications in adolescent psychiatric disorders such as depression, anxiety, schizophrenia, attention deficit hyperactivity disorder, and autism spectrum disorder, which inevitably worsen during this stage of critical development. Recent findings suggest that diminished neurotransmitter co-transmission in certain regions, such as the prefrontal cortex, might be associated with some of these impaired cognitive and emotional regulatory processes. Understanding these complex mechanisms might provide insights into the development of effective treatments targeting several neurotransmitter systems simultaneously-especially during adolescence, when the brain is particularly sensitive to chemical interactions. This review integrates recent findings into a discussion on their implications for treatment strategies, and it hints at new pharmacological interventions directed at modulating co-transmission pathways that can enhance mental health outcomes in adolescents.
Modern telecommunication solutions have been gradually penetrating the medical field. For example, in the field of electroencephalography (EEG), cloud-based databases remotely accessing to examination data have recently become widespread. Given the shortage of qualified specialists, especially in small Russian cities, the ability to remotely interpret EEG examinations opens up new opportunities for providing highly qualified medical care to the population. Telemedicine technologies are gradually moving beyond simple teleconsultations. Wearable medical devices for home use are emerging, taking many diagnostic methods, including video-EEG monitoring, to a new level, increasing the availability of diagnostic methods, and developing screening methods, thereby improving the overall accessibility and quality of medical care. This article provides an overview of modern capabilities for cloud storage and remote access to EEG examination data.
Background. Due to the high prevalence of autism spectrum disorders (ASD) and the dependence of prognosis on intervention time, the development of factor models for autistic symptoms in preschool childhood is an urgent area of research. Comparing autism symptoms multifactorial models obtained using structural equation modeling for preschoolers with autism of different age groups is valuable because it provides information that cannot be covered by studying a single age group.Objective: To compare the factor patterns for ASD symptoms in children aged 3–4 and 5–7 years to identify autism development trajectories.Material and methods. Since autism symptoms pattern changes as children develop, comparing factor models allows to identify age-related indicators and use more accurate diagnostic criteria adapted to each age group for improving sensitivity and specificity of early autism diagnosis and optimize corrective interventions. Within the years 2023–2024, 7-factor and 8-factor models for autism symptoms, respectively, were obtained in 3–4-year-old (n=294) and 5–6-year-old (n=374) ASD children. The data in both studies were collected by specialists who worked with the patients on a regular basis by filling out the online questionnaires.Results. When comparing two autism factor models, it was found that the identified factor pattern, which includes three groups of symptoms for young children, was dramatically changed in older children. With age, the relationship between specific symptoms and the underlying factors has significantly increased and become more complex. For younger children, the identified 7-factor pattern consists of three unrelated groups of symptoms: communication problems (including factors such as emotional dysregulation, speech understanding, echolalia, alienation), persistence on sameness with sensory disintegration and hyperactivity/disinhibition. For older children, the 8-factor pattern has developed into three other groups of relatively independent but related symptoms: the verbal group (including factors of speech understanding and empathy), praxis disorders (including factors such as hyperactivity, emotional dysregulation, motor disorders) and sensory disintegration (including factors such as persistence on sameness, sensory disintegration and echolalia).Conclusion. Speech and motor development are two lead symptoms that deserve special attention from specialists. By understanding how the pattern of ASD symptoms and factor load change throughout preschool age, researchers can improve existing diagnostic tools to increase their accuracy and effectiveness in detecting autism at different ages and develop targeted intervention strategies.
A full-content structured analysis of international and national guidelines was performed to determine the scope, coverage, and consensus on all seizure-related first-aid recommendations. The analysis identified more than 50 distinct recommendations related to seizure first aid. The coverage of recommendations was generally poor and inconsistent. The lack of consensus between the recognized and influential guideline documents raises concerns regarding the adequacy of current first aid education and practice and underscores the compelling need for establishing an international consensus on evidence-based seizures first aid.
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy. The mechanisms of epileptogenesis in TLE involve a wide range of neurobiological, biochemical, genomic, epigenetic, and transcriptomic changes. Together, these processes lead to morphofunctional reorganization of neural networks and the onset of spontaneous seizures. Neuroinflammation (involving glia activation and cytokine release), neural network remodeling, impaired signal transmission, and loss of inhibitory interneurons play a prominent role in epileptogenesis. Hippocampus transcriptomic studies have revealed a wide range of involved genes, highlighting the importance for interplay between genetic predisposition and acquired factors in developing this disease. The review presents current views on the neurobiological and molecular genetic basis of TLE-related epileptogenesis.
Background . Traditionally, the influence of maternal intake of antiepileptic drugs during breastfeeding has been studied in terms of their concentration in breast milk and infant serum, whereas their long-term consequences for child development have not been assessed. In this regard, no comparison has been made of the further mental development and adaptation of children who were breastfed and formula-fed, which is why the issue of breastfeeding safety while receiving antiepileptic therapy remains controversial to this day. Nor the development of children born to mothers with epilepsy, delivered naturally and by cesarean section, has been compared as well. Meanwhile, these two issues (the choice of delivery method and type of feeding) are of vital importance for such women. Objective : To study an influence of intranatal and neonatal factors on the mental development of children born to mothers with epilepsy. Material and methods . A study investigating the impact of intranatal (delivery routes) and neonatal (feeding type) factors on the mental development of children born to mothers with epilepsy was conducted by enrolling 176 participants: 88 children aged 3–9 years and paired mothers suffering from epilepsy. The following methods were used: forms for parents – Child Behavior Checklist (CBCL) by T. Achenbach, attention deficit hyperactivity disorder and other behavioral dysfunction questionnaire modified by N.N. Zavadenko, as well as Luria neuropsychological batteries by J.M. Glozman, and Wechsler Intelligence Scale for Children (WSIC). A detailed history of the mother’s illness and early child development was also collected. Statistical data processing was performed in the IBM SPSS using Pearson's χ2 coefficient, nonparametric U Mann–Whitney criterion, multivariate analysis of variance, correlation, regression analysis, and moderator analysis. Results . Children born by cesarean section subsequently exhibited more pronounced motor awkwardness, speech development delays, difficulties with voluntary attention concentration, and handling numerical material. Children who were breastfed subsequently had less severe emotional and volitional disorders, as well as better developed subject gnosis, reciprocal coordination, spontaneous speech, understanding of addressed speech and speech logic, as well as non-verbal intelligence. Regression analysis showed that artificial feeding in combination with prenatal risk factors (maternal epileptic seizures before and during pregnancy, anemia, valproic acid intake) has important prognostic significance in developing emotional and volitional disorders, delays in the development of praxis, gnosis, spontaneous speech, understanding of addressed speech, as well as functional underdevelopment of the left temporal lobe in children. Conclusion . Breastfeeding can be considered as a moderator that reduces the negative impact of anemia on further neurocognitive development of children born to mothers with epilepsy.
Objective : to analyze microelement composition profiles of ethylmethylhydroxypyridine succinate (EMHPS) preparations promising to use for increasing efficiency and safety of epilepsy pharmacotherapy. Material and methods . Inductively coupled plasma atomic emission spectrometry was used to analyze content of 72 elements from the D.I. Mendeleyev’s periodic table in eleven EMHPS preparations. Next, a series of analyses of the microelement composition in EMHPS samples was carried out based on modern data mining methods. Results . Specific preparations with varying degrees of microelement purity were identified, including those containing toxic and conditionally toxic microelements. Microelement impurities in EMHPS composition may result from water, sodium hydroxide and hydrochloric acid used in the manufacturing process. Conclusion . The data obtained suggest that the quality of preparation microelement standardization may be significantly improved, provided that hydrochloric acid solutions purified by sequential rectification are used to normalize pH-value.
Background . Stereoelectroencephalography (stereo-EEG) parameters may be predictors of surgical treatment outcomes in patients with focal drug-resistant epilepsy (fDRE). Objective : To assess a relationship between stereo-EEG parameters and surgical treatment for fDRE outcome. Material and methods . The stereo-EEG parameters were retrospectively evaluated in fDRE patients examined in 2016–2020. We reviewed the following parameters: patient’s gender, age at stereo-EEG examination, lesion presence and lateralization on magnetic resonance images, seizure onset zone localization and size, seizure pattern type, latency and propagation. These parameter-related effect on surgical treatment outcomes in fDRE patients were analyzed. Results . The outcome of surgical treatment was found to depend on the size of epileptic seizure onset zone (p=0.002). No other analyzed parameters appeared to have an impact on epilepsy surgery outcome. Conclusion . Size of seizure onset zone represent a sole stereo-EEG parameter affecting fDRE surgical treatment outcome.
Background . Most publications aimed at analyzing brain bioelectrical activity in post-anoxic conditions focus primarily on disturbances in the acute phase of post-anoxic encephalopathy (PAE). The dynamic changes in bioelectrogenesis mechanisms during subsequent disease progression are described in few publications reporting contradictory results. Motor phenomena recorded during PAE in children can be present simultaneously or alternate, creating difficulties in their interpretation and selection of pharmacotherapy. Therefore, a retrospective pilot study was needed to assess clinical significance of videoelectroencephalographic monitoring (VEEM) and the impact of its results on therapeutic strategy and prognosis for recovery in patients with chronic post-anoxic myoclonus (PAM). Objective : Тo assess extent of VEEM sufficient to determine the level of myoclonus generation in children with PAE. Material and methods . The retrospective study included 10 children with post-anoxic conditions of different genesis (freshwater drowning, mechanical asphyxia, cardiopulmonary resuscitation during septic shock) who underwent rehabilitation treatment at the Research Institute of Emergency Pediatric Surgery and Trauma – Dr. Roshal’s Clinic in the years 2020–2023. Nine of the examined subjects underwent VEEM according to a standardized protocol; 1 child received VEEM in another medical institution. Results . Chronic PAM was present in 2 children examined. In one case, there was a myoclonus of different levels of generation combined with epileptiform seizures and generalized dystonia, in the other case – myoclonus recorded along with generalized dystonia. In both cases, the use of clonazepam improved PAM clinical manifestations. Conclusion . Patients with history of PAM are required to receive an extended VEEM added with myographic channels for conducting differential diagnostics with motor phenomena, to clarify generation level for chronic postanoxic myoclonus, if any, and select pharmacotherapy strategy.
