Introduction . In 2022, new clinical guidelines ‘Epilepsy and status epilepticus in adults and children’ were released, according to which it is recommended for adult patients with epilepsy to include behavioral methods in the form of self-management programs in addition to standard antiepileptic therapy as rehabilitation measures in comprehensive care for patients with epilepsy in order to improve the quality of life, cognitive functions and adherence to treatment. Considering the urgency of this problem and the opportunities offered by new clinical guidelines, there has been interest in a more detailed study of the EpiTapp® technique as an element of a self-management program in addition to standard antiepileptic therapy as a comprehensive care, using the example of a patient with structural focal epilepsy (SFE). Objective . To present a clinical case of using the EpiTapp® application as part of a self-management program in addition to standard antiepileptic therapy as a comprehensive care for an adult patient with SFE. Materials and methods . The study used the author's technique of brush tapping (RF patent No. 2606489 dated 10.01.2017). Patient A. used the EpiTapp® application in addition to the antiepileptic therapy she received, as a part of rehabilitation program for self-management of epileptic seizures, on an outpatient basis. Results . The analysis of the diary of observation of epileptic seizures showed that in 93 % of cases, patient A. managed to stop the incipient motor focal seizure (FS) and prevent its transformation into a bilateral tonic-clonic seizure. Thus, against the background of regular use of the EpiTapp® method, the patient's frequency of FS decreased by 55.8 % by visit 4 compared to visit 2. Patient A. rated the effectiveness and safety of the EpiTapp® application by 95 %. Conclusions . Thus, the use of the EpiTapp® application allowed a woman with difficult-to-treat SFE to gain control over epileptic seizures without changing the regimen and dose of antiepileptic therapy.

Target. To investigate the effect of the EpiTapp® application on alpha rhythm synchronization in patients with genetic generalized epilepsy. Materials and methods. The total sample size was 81 people, including: patients suffering from juvenile myoclonic epilepsy (main group, mean age — 2 7 [23; 38] years) — 30 people; healthy volunteers (control group, mean age — 39 [21; 56] years) — 51 people. Results. The present study showed that wrist tapping using the EpiTapp® application statistically significantly reduced the degree of alpha synchronization in juvenile myoclonic epilepsy. At the same time, a decrease in the synchronization of the alpha rhythm is achieved in 66.7 % of cases. Conclusion. Our results of changes in the bioelectrical activity of the brain after a session of wrist tapping indicate the possibility of using the EpiTapp® application as a non-drug rehabilitation method related to seizure relief programs in patients with juvenile myoclonic epilepsy .

Aim: To present a clinical case of the use of the wrist tapping method in a 30-year-old patient with structural focal epilepsy (SFE). Key points. During 4 visits, we examined patient N., 30 years old, suffering from SFE, which developed against the background of a gunshot wound to the skull, with frequent focal seizures (FS) and bilateral tonic-clonic seizures (BTCS). After 6 months from the start of wrist tapping sessions (4th visit), using the application, the patient noted a 55% increase in quality of life due to the ability to stop AF and prevent the development of BTK. In 87.5% of cases, he was able to stop incipient motor hemifacial FS and prevent its transformation into BTCS. With regular use of the application by the patient, the incidence of FS decreased by 65.4% on the 4th visit compared to that on the 2nd visit. The patient highly rated the effectiveness and safety of the wrist tapping method (97.6%). Conclusion. The use of the application allowed a young man with treatment-resistant post-traumatic SFE, without changing the dosage regimen and dose of the antiepileptic drug, to reduce the frequency of FS by 65.4% from baseline and significantly reduce the number of BTCS, significantly improving the quality of life. Keywords: structural focal epilepsy, wrist tapping.

Background. One of the main goals of rehabilitation programs is to improve the quality of life (QoL) of patients with various chronic diseases, including epilepsy. However, the issues of rehabilitation of adult patients with drug-resistant epilepsy remain not fully resolved. Objective: to evaluate an impact of the author-proposed EpiTapp ® method on QoL of patients with drug-resistant structural focal epilepsy (SFE). Material and methods. The study involved 60 patients with drug-resistant SFE: main group – 30 patients (median age 33.5 years) with drug-resistant SFE who along with antiepileptic therapy regularly used the wrist tapping EpiTapp ® method as an element of emergency self-help upon appearance of the first signs of arising epileptic seizure; control group – 30 patients (median age 39.5 years) with drug-resistant SFE who used no EpiTapp ® method, but continued to receive previously selected antiepileptic therapy. QoL was assessed by the questionnaire approach using author-translated Quality of Life in Epilepsy Inventory (QOLIE-31). Results. While comparing QoL of two patient groups over a 6-month follow-up period, a significant (p<0.05) positive parameter dynamics was demonstrated only in main group but not in control group. Conclusion. The author-based EpiTapp ® technique improves QoL of patients with drug-resistant SFE and can be used as an additional method of rehabilitation.

Background. Non-pharmacological methods of palliative therapy for structural focal epilepsy (SFE) have been extensively investigated. Development of self-care methods based on behavioral psychotherapy and reference bioadaptation is a promising and economically justified approach.Objective: to present a clinical case of administering EpiTapp application based on the author-proposed wrist tapping method for palliative care in adult SFE.Material and methods. The author-proposed method of wrist tapping (RF patent No. 2606489 of 01.10.2017) for a smartphone Android OS application was used. Wrist tapping was performed during the period of aura and/or focal seizures (FS) in patients with SFE. Patients used the smartphone application as an element of emergency palliative therapy for SFE outpatient settings.Results. Patient L., 33 years old, suffering from SFE with frequent FS and bilateral seizures (BS), received duotherapy in the preoperative period. The woman used the EpiTapp application regularly that allowed to reduce FS rate by 65%, as well as prevent BS development without altering the antiepileptic therapy regimen.Сonclusion. The experience of using the EpiTapp application based on the author-proposed method of wrist tapping has demonstrated that it holds promise for SFE palliative therapy. The proposed technique requires additional research to confirm its effectiveness.

Currently, a search for a solution to the problem of drug-resistant epilepsy is being actively pursued. Along with personalized (including targeted) drug methods, personalized nondrug methods of treating drug-resistant epilepsy are being actively developed. Our previous studies have shown that the developed author's technique with an individual selection of the wrist tapping (WT) leads to an increase in the activity of the frontotemporal cortex, mainly of the right hemisphere, involved in emotional control, and a decrease in the fear of recurrence of focal epileptic seizures (FS) or transformation of FS into bilateral tonic-clonic seizures (BTCS). In addition, WT leads to a decrease in intrahemispheric coherence in the frontotemporal regions of the left hemisphere, which is a biomarker for reducing the risk of generalized epileptic activity.

Objective of the Review: To describe brain lateralization of emotional regulation. Key Points: The authors analyze a number of studies that focused on brain lateralization of emotional regulation and discuss prospects for making use of this phenomenon in clinical neurology. The analysis includes articles identified in a literature search in Russian (E-Library) and foreign (PubMed, Press, and Collection) databases. Analysis of the available data suggests that the left hemisphere is more resistant to mood changes than the right hemisphere, while the latter may play an important role in immediate (more rapid) positive or negative emotional responses in patients with neurological disorders. Conclusion: Despite great interest in this subject from Russian and foreign researchers, the available data are limited and fragmented. This is because the theoretical and methodological aspects of this subject need comprehensive research. Studies of the role of interhemispheric and intrahemispheric connections in the brain, including electroencephalogram markers such as interhemispheric and intrahemispheric coherence, are promising in that the results of these studies may be used in the clinical management of patients with anxiety disorders.

Aim. To study the characteristics of carpal tapping in the normal condition and the effect of subclinical anxiety on its parameters with post-stroke epilepsy in adults.Material and methods. We examined 140 people aged from 22 to 55 years. The total sample was divided into 3 observation groups: the first (I) group included healthy volunteers; the second (II) group included the patients with post-stroke frontal lobe epilepsy; the third (III) group included the patients with post-stroke temporal lobe epilepsy. Each group was divided into two subgroups: subgroup Ia (33 people) included healthy volunteers who did not show reliably expressed symptoms of anxiety; subgroup Ib (27 people) included healthy volunteers with subclinical anxiety; subgroup IIa (20 people) included patients with post-stroke frontal lobe epilepsy who did not show reliably expressed symptoms of anxiety; subgroup IIb (20 people) included patients with post-stroke frontal lobe epilepsy with subclinical anxiety; subgroup IIIa (19 people) included patients with post-stroke temporal lobe epilepsy who did not show reliably expressed symptoms of anxiety; subgroup IIIb (21 people) included patients with post-stroke temporal lobe epilepsy with subclinical anxiety. The parameters of carpal tapping were investigated using the modified author’s program “Method of influencing an individual human rhythm through exogenous rhythmic stimulation”.Results. An acceleration of the individual rhythm was found in the presence of subclinically expressed anxiety both in healthy volunteers (from 1.13 Hz to 1.53 Hz) and in patients with post-stroke frontal lobe and temporal lobe epilepsy (from 2.07 Hz to 3, 45 Hz and from 1.83 Hz to 2.82 Hz, respectively). The rate of acceleration of the individual rhythm in patients with post-stroke frontal lobe and temporal lobe epilepsies was higher than in healthy volunteers (1.66 and 1.54 versus 1.35, respectively).Conclusion. The effect of anxiety on the parameters of carpal tapping was greater in patients with post-stroke epilepsy compared with healthy volunteers.

This review examines the epidemiology of drug resistant epilepsy in adults in Russia and abroad. References were taken from Russian and foreign databases for the period from 2010–2017. Only full-text publications (66) were included in this review. We concluded that the despite the achievements of clinical pharmacology and the development of new antiepileptic drugs, the problem of drug resistant epilepsy remains not fully resolved today. The worldwide high prevalence rate of patients with drug resistant epilepsy substantiates the problem. Thus, the average incidence of this disease varies from 30% to 70%, depending on the type of epilepsy and background pathology, which is the cause of symptomatic epilepsy. However, we have faced the problem of the absence both in Russia and abroad of large multicenter studies on the epidemiology of drug resistant epilepsy in the analyzed period of time. We have also revealed the lack of a unified definition of the disease, which is probably one of the reasons for the insufficient number of epidemiological studies of drug resistant epilepsy in different countries of the world.

Практическая медицина© НАРОДОВА В. В., НАРОДОВ А

The article is devoted to working out a method to identify internal speech by recording the language microarticulation electromagnetic sensor. It was investigated the individual rhythm with the carpal tapping.

We analyzed the internal speech in patients with motor aphasia in the acute phase of ischemic stroke by specially invented sensor of micro movements of the tongue. Applicability of the method and estimation of internal speech during motor aphasia treatment were determined.

We analyzed different clinical variants of central venous thrombosis. Role of prothrombotic conditions and brain venous system maldevelopment in manifestation of the disease are shown.

Progression of plasma membrane blebbing in peripheral blood lymphocytes obtained from patients with essential hypertension complicated by stroke was studied with phase-contrast microscopy. Intensity of plasma membrane blebbing was found to correlate some changes in blood coagulation and reactive response of an organism.