TREATMENT OF EPILEPSY IN INFANTS BORN PRETERM WITH EXTREMELY LOW BODY WEIGHT

Makedonska I. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

It is difficult to treat young child with epilepsy. Even greater difficulties arise if a child suffering from epilepsy is born premature with extremely low birth weight. Development of technologies of nursing severely preterm infants has led not only to a decrease in mortality and improved survival of premature infants with extremely low birth weight, but also to the development of a number of diseases which significantly worsen the child’s condition not only during the acute phase but also in the long-term period. Treatment of epilepsy in preterm infants remains a challenge. The main purpose of the antiepileptic drug therapy is to achieve the absence of seizures in patients. In 40-50% of patients the seizure control can be achieved already when using the first anticonvulsant. However, about a third of patients have drug-resistant forms of epilepsy. The largest number of drug-resistant forms are found in childhood which is primarily due to the faster maturation of the excitatory glutamatergic system and belated formation of the brake GABAergic system. So it is in early childhood that the maximum number of epileptic encephalopathies with resistance to the ongoing anticonvulsant therapy and symptomatic forms of epilepsy resulting from perinatal pathology (symptoms of hypoxic-ischemic lesion of the central nervous system, congenital infections, malformations of brain development) are found. This leads to the emergence of many serious complications, including delayed psycho and motor development of a child, high frequency of attacks, their sequence, a combination of several types of seizures, the occurrence of status epilepticus, disruption of the drug remission, as well as the increased risk of death of the patient. Therefore, a timely and adequate anti-epileptic treatment, especially in the early stages of the disease, can stop this process and improve the condition of patients. Also, the initial occurrence of epilepsy in children deserves special attention because the boundary for convulsive readiness in children is higher than in adults. The lower the age, the lower is the seizure threshold. One of the features of the childhood period is the continuous development process of the structures and functions of the whole body, including the central nervous system which is responsible for the child’s adaptation to the environmental impact. The evolution of epilepsy and transformation of seizures in children are in most cases affected by the formation of the nervous system, perinatal brain injury, genetic factors and hormonal changes. One of the priority directions in the study of epilepsy in children is to find new opportunities for projecting the disease course and its complications which are determined by the degree of involvement of brain structures in the pathological process. The dynamics of the patients’ condition in the course of treatment may be a clinical criterion for evaluating its effectiveness. In connection with the presented problem, a great importance for the clinical management is placed on the determination of the methodological approaches, selection and justification of adequate diagnostic and treatment methods. The development of seizures in the child at an early age leads to her disability, even when seizures are capable of being treated. However, treatment of seizures is one of many aspects of the problem of epilepsy therapy in children born premature with extremely low birth weight. As a result of neonatal diseases, as well as intensive (intensive care, infusion), massive antibiotic therapy, such children can suffer from continuously maintained dysfunction of the gastrointestinal tract, liver and urinary excretory system. Prolonged mechanical ventilation can cause eye damage, as well as malfunctions of the respiratory and cardiovascular system. Therefore, the study of somatic condition (comorbid background) for delicate use of anticonvulsants will help to preserve the quality of life of these children. Elimination of seizures in children with epilepsy, who were born premature with extremely low birth weight, may not be the purpose of the treatment. Principles of treatment should be based on tailoring the adequacy of anticonvulsant therapy to the needs of the patient in each case, as well as the development of an integrated approach to the treatment strategies for children born prematurely with epilepsy. In an attempt to eliminate the clinical manifestations of epilepsy, it is very important to clearly identify the extent to which other organs and systems of the patient are able to tolerate anticonvulsant therapy.

epilepsy, preterm infants, extreme weight, anticonvulsant therapy

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«Bulletin of problems biology and medicine» Issue 1 part 2 (127), 2016 year, 91-95 pages, index UDK 616.853-063.32:616-009.6-08