Epilepsy has never been a purely medical problem; its social significance is well known. It is a global issue that affects people of all ages, races, and social classes in different countries and occurs in both men and women. Drug-resistant epilepsy is a form of the disease in which seizures persist despite appropriate therapy with two antiepileptic drugs, either as monotherapy or in combination. However, surgical treatment of drug-resistant epilepsy is still underutilized. The purpose of the study is to compare the level of quality of life in patients with drug-resistant epilepsy under medical treatment and 1 year after surgery in order to evaluate the dynamics in the areas of quality of life. The study design was a prospective case-control observation. The study included neurosurgical patients with a confirmed diagnosis of drug-resistant epilepsy divided into two groups: group 1 - patients in the preoperative phase receiving drug therapy with antiepileptic drugs, and group 2 - patients 1 year after surgical treatment of drug-resistant epilepsy. Demographic and clinical parameters were analyzed, and the Quality of Life in Epilepsy Inventory-31 survey was carried out before and 1 year after surgery. The first group consisted of 56 patients (55%), and the second group comprised 46 patients (45%). The overall mean quality of life score in group 1 was 53.5, and in group 2 – 59.9, which was statistically significantly different from group 1 (p=0.05). Of the 7 quality of life indicators, a statistically significant improvement was found in 2: general quality of life (p=0.01) and social functioning (p=0.01). 5 indicators showed no statistical differences between the groups: seizure worry (p=0.06), emotional well-being (p=0.9), energy/fatigue (p=0.5), cognitive function (p=0.7), and medication side effects (p=0.6). A comparative analysis of the quality of life of patients with pharmacoresistant epilepsy showed positive dynamics of quality of life from the first year after surgery in contrast to uncontrolled epilepsy against the background of medical treatment with antiepileptic drugs.

Epilepsy is associated with comorbid diseases and cognitive impairment, which, even with successful compensation of seizures by medication and/or surgery, continue to have a negative impact on the quality of life of patients. The cognitive outcomes of surgery are variable: they may include positive changes or no changes, but there is also a risk of increasing cognitive dysfunction. Purpose of the study. To ascertain the impact of resective and destructive surgeries in pharmacoresistant epilepsy on cognitive functions, as assessed using the Montreal Cognitive Assessment (MoCA) screening scale. Materials and Methods. The article presents the results of an investigation into the impact of resective and destructive surgeries in pharmacoresistant epilepsy on cognitive functions, as assessed by the MoCA. The study comprised 50 patients with a verified diagnosis of focal pharmacoresistant epilepsy, divided into two groups: group 1 (25 patients) underwent resective surgery, while group 2 (25 patients) had destructive surgery. Cognitive function was evaluated using the Montreal Cognitive Assessment Scale (MoCA) prior to surgery and at intervals between six months and five years post-operatively. Results. The mean age of the subjects at the time of surgery was 33.2 ± 10.05 years, and the mean duration of epilepsy was 20.7 ± 10.98 years. In 50 % of patients, the epileptic focus was localized to the left side of the brain, while in 44 % of cases, it was localized to the right side. In 6 % of patients, the epileptic focus was bilateral. The majority of patients (70 %) exhibited temporal epilepsy, while 18 % demonstrated extratemporal epilepsy and 4 % showed both temporal and extratemporal epilepsy. At the preoperative stage, cognitive deficit was observed in the majority of patients (76 %), with an average score of 23.1 points. In the postoperative period, cognitive impairment was also observed in 76 % of patients, with no change in the mean MoCA score of 23.1. In group 1, 80 % of patients exhibited cognitive deficits prior to the operation, with an average score of 22.2. In the postoperative period, the score showed an increase, reaching 23.4. In group 2, cognitive deficit was also observed in the majority of patients (72 %) at the preoperative stage. The average score in group 2 was 21.7 points, which increased to 22.2 points after the operation. Conclusion. The practice of delaying surgical treatment for pharmacoresistant epilepsy persists, with cognitive functions preserved at the time of hospitalization in only a quarter of patients. The mean score on the Cognitive Function Assessment Screening Scale did not decline as a result of surgical intervention. However, a negative effect was observed in patients who did not show cognitive deficits prior to surgery. The findings will assist physicians in making informed decisions regarding the timing and approach to pharmacoresistant epilepsy treatment.

Morphometric MRI analysis improves neuroimaging of structural changes in epilepsy.OBJECTIVE:To investigate diagnostic potential of MR brain morphometry in neurosurgical epileptology.MATERIAL AND METHODS:An interdisciplinary working group reviewed the studies devoted to MR morphometry in epileptology as a part of state assignment No. 056-00119-22-00. Study subject was trials of MR-morphometry in epilepsy. Searching for literature data was conducted in international and national databases between 2017 and 2022 using certain keywords. Final analysis included 36 publications.RESULTS:Currently, MR brain morphometry allows measurement of cortical volume and thickness, surface area and depth of furrows, as well as analysis of cortical tortuosity and fractal changes. In neurosurgical epileptology, MR-morphometry has the greatest diagnostic value in MR-negative epilepsy. This method simplifies preoperative diagnosis and reduces costs.CONCLUSION:Morphometry in neurosurgical epileptology is an additional method for verifying the epileptogenic zone. Automated programs simplify application of this method.

Epilepsy is one of the oldest known nervous system disorders and imposes enormous physical, psychological, social and economic burden on individuals, families and countries due to misunderstanding and stigmatization. These problems are most relevant for developing countries, where up to 85 % of epilepsy patients live. Despite the fact that it is a treatable and preventable disorder, there is a lack of adequate public awareness and understanding of the problems of epilepsy. This article is devoted to the Intersectoral Global Action Plan on epilepsy and other neurological disorders (IGAP) 2022–2031, adopted on 27 May 2022 at the 150th session of WHO’s Executive Board. It provides data on the public and medical importance of epilepsy, the history of the joint initiatives of WHO, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) aimed at reducing the burden of epilepsy on society and improving public knowledge about neurological disorders. The key provisions of the Intersectoral Global Action Plan on epilepsy and other neurological disorders 2022–2031 are announced. The Epilepsy 90–80–70 cascade target, launched by ILAE and IBE, is presented to inspire decades of action and significantly improve care and treatment for all people living with epilepsy worldwide. The final section is devoted to the evolution of epileptology at Almazov National Medical Research Centre, its present and its prospects.

Carotid stenosis is a multidisciplinary problem that requires the involvement of a specialists’ team, including cardiovascular surgeons, neurosurgeons, endovascular surgeons, cardiologists, neurologists, and internists. In this consensus statement, a group of experts considered the main stages of diagnosing carotid stenosis, as well as discussed, the necessary prevention methods and features of choosing the optimal treatment approach. The aim was to provide concise and structured information on the management of patients with carotid stenosis. This document was developed based on the updated clinical guidelines of the European Society for Vascular Surgery and the American Association for Vascular Surgery, taking into account the consensus opinion of Russian experts.

Spontaneous pneumomediastinum is a rare complication of viral pneumonia. The prevalence of pneumomediastinum among coronavirus infection patients is unknown.Subjects and methods. Three cases of spontaneous pneumomediastinum among the COVID-19 pneumonia patients were analyzed. The researchers investigated and compared clinical, radiological and laboratory data.Results. According to the research results, no correlation was found between the development of pneumomediastinum and changes in values of blood laboratory tests. As well as there were no signs of correlation between drug treatment and pneumomediastinum frequency.Conclusion: The researchers suggest that the leading cause of spontaneous pneumomediastinum is viral pneumonia-associated severe alveolar damage.

The article discusses the possible causes of polycystic posthemorrhagic ventriculomegaly in infants, as well as predictors of this pathological process. When choosing a treatment method the doctor shall take into account not only the etiology of the disease, but also age parameters, concomitant pathology. An important aspect in the approach to the treatment of polycystic posthemorrhagic multilevel hydrocephalus includes the determination of the biomechanical properties of the craniospinal system, especially the compliance of the brain and resorption of cerebrospinal fluid. Particular attention is paid to the timely correction of complications, including the analysis of inflammatory changes markers in the craniospinal system, which serve as predictors of the outcome of cerebrospinal fluid resorption. The authors also noted that the violation of the cerebrospinal fluid outflow from the cranial cavity in children may depend on a large number of «extracerebral» factors. They consider the stages of neurosurgical care to patients in this group on a clinical example. This example and literature data demonstrate that children with age develop changes not only in the craniospinal segment, which is responsible for the transformation of free fluid, but also in the extracranial cavities. Thus, we are able to recommend an integrated approach for the management of newborns with intracranial hemorrhage, complicated by posthemorrhagic hyporesorbent and occlusive hydrocephalus, with the justification of the optimal neurosurgical tactics for managing drainage-dependent patients, the course of the disease in which is accompanied by a multicomponent inflammatory syndrome.

Objective : to evaluate the impact of surgical treatment for drug-resistant temporal lobe epilepsy in children on seizure frequency and quality of life. Patients and methods . Examinations were made in 80 children aged 2–17 years with drug-resistant temporal lobe epilepsy, who had undergone surgery in 2011–2016. To assess its outcomes, the investigators used the Quality of Life Childhood Epilepsy, QOLCE questionnaire for patientsu0027 parents and the Engel Epilepsy Surgery Outcomes Scale. Results and discussion . In the long-term period after surgical treatment, 54.5% of the children with drug-resistant temporal lobe epilepsy achieved a favorable outcome (Engel class I); there were significant (pu003c0.05) positive changes in quality of life subdomains, such as speech, physical limitations, energy levels/weakness, and overall quality of life. Comparison of quality of life before and after surgical treatment established its positive impact on subdomains, such as social contacts and activity, behavior, physical limitations, attentiveness, memory, and speech. In general, there was a neutral or beneficial effect of the treatment on most of the quality of life subdomains. Conclusion . To make recommendations based on high-level evidence, there is a need for further multicenter prospective studies of large patient populations with a detailed analysis of the relationship of factors influencing the outcome of surgery and indicators of psychosocial well-being of a child. The preoperative and postoperative changes in health and quality of life indicators cannot be more accurately assessed in patients without standardizing their preoperative examination algorithm and using equivalent psychometric tools.

Tuberculosis remains a serious global health issue. Tuberculosis of the central nervous system is the most frequent cause of chronic infection. Presented is a case of a 17 year-old patient with simple partial seizures with secondary generalization and increased intracranial pressure. MRI revealed a space occupying lesion of the right frontal lobe without edema. The lesion was thought to be a benign brain tumor. It was totally resected through an approach in the right frontal region. Histology identified tuberculoma.

Objective: to evaluate the impact of surgical treatment for drug-resistant temporal lobe epilepsy in children on seizure frequency and quality of life.Patients and methods. Examinations were made in 80 children aged 2–17 years with drug-resistant temporal lobe epilepsy, who had undergone surgery in 2011–2016. To assess its outcomes, the investigators used the Quality of Life Childhood Epilepsy, QOLCE questionnaire for patients' parents and the Engel Epilepsy Surgery Outcomes Scale.Results and discussion. In the long-term period after surgical treatment, 54.5% of the children with drug-resistant temporal lobe epilepsy achieved a favorable outcome (Engel class I); there were significant (p<0.05) positive changes in quality of life subdomains, such as speech, physical limitations, energy levels/weakness, and overall quality of life. Comparison of quality of life before and after surgical treatment established its positive impact on subdomains, such as social contacts and activity, behavior, physical limitations, attentiveness, memory, and speech. In general, there was a neutral or beneficial effect of the treatment on most of the quality of life subdomains.Conclusion. To make recommendations based on high-level evidence, there is a need for further multicenter prospective studies of large patient populations with a detailed analysis of the relationship of factors influencing the outcome of surgery and indicators of psychosocial well-being of a child. The preoperative and postoperative changes in health and quality of life indicators cannot be more accurately assessed in patients without standardizing their preoperative examination algorithm and using equivalent psychometric tools.