Å˙΄‡Ò͇ ç‚ÓÎÓ„ËflBulgarian Neurology

àÁ‰‡ÌË ̇ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„ËflOfficial Journal of the Bulgarian Society of Neurology

íéå 2 / Åêéâ4 ÑÖäÖåÇêà , 2002

VOLUME 2 / NUMBER 4 DECEMBER, 2002

ëöÑöêÜÄçàÖ

éÅáéêàç‚ÓÔ‡Ú˘̇ ·ÓÎ͇ Ë Gabapentinå. 䇇‰ÊÓ‚‡, è. òÓÚÂÍÓ‚ . . . . . . . . . . . . . . . .118

ç‚ÓÎӄ˘ÌË ÛÒÎÓÊÌÂÌËfl ÔË ·ÓÎÌË Ò ıÓÌ˘̇·˙·Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ Ì‡ ıÂÏӉˇÎËÁÌÓ Î˜ÂÌËÂÖ. Ç˙ÁÂÎÓ‚, è. ëÚ‡ÏÂÌÓ‚‡,ñ. ñ‡ÌÍÓ‚‡, ü. ïËÒÚÓ‚ . . . . . . . . . . . . . . . . . . .124

Levetiracetam ÌÓ‚Ë ÔÂÒÔÂÍÚË‚Ë ‚ ΘÂÌËÂÚÓ̇ ÂÔËÎÂÔÒËflÚ‡à. ê‡È˜Â‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

éêàÉàçÄãçà ëíÄíààEÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓËé. ÉË„ÓÓ‚‡, à. èÂÚÓ‚‡, ê. ä‡ÎÔ‡˜ÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

éÔÚËχÎÌÓ Î˜ÂÌË ̇ Ó·̉ӂ‡Ú‡ ÂÔËÎÂÔÒËfl:Ô‰ËÏÒÚ‚Ó Ì‡ valproate Ô‰ carbamazepineè. ÑËÏÓ‚‡, Ñ. чÒ͇ÎÓ‚, à. îËÎËÔÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . .134

Gabapentin (neurontin), ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl Ôˉˆ‡ Ò ÂÙ‡ÍÚÂÌË ÂÔËÎÂÔÚ˘ÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔËÄ. ç‡È‰ÂÌÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

ᇂËÒËÏÓÒÚË ÏÂÊ‰Û ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ë‡ÒËÏÂÚËËÚ ̇ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ ÔË ·ÓÎÌË Ò‡ÒËÏÔÚÓÏ̇ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚ, Ú‡ÌÁËÚÓÌËËÒıÂÏ˘ÌË ‡Ú‡ÍË Ë Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙaÍÚËà. ÇÂΘ‚‡, ë. ü̘‚‡, Ö. íËÚflÌÓ‚‡,Ç. èÂÚÛÌfl¯Â‚ . . . . . . . . . . . . . . . . . . . . . . . . . .141

CONTENTS

REVIEWSNeuropathic pain and GabapentinM. Karadjova, P. Shotekov . . . . . . . . . . . . . . . . . .118

Neurologic complications in patients with chronic renal failure on hemodialysisE. Vazelov, P. Stoimenova, Tz. Tzankova, J. Christov . . . . . . . . . . . . . . . . . . .124 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Levetiracetam - new perspectives in the treatment of epilepsyI. Raychev . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

ORIGINAL PAPERSEpileptic seizures in patients with brain tumorsO. Grigirova, I. Petrova, R. Kalpachki . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

Optimal treatment of the benign epilepsy - BECTS -ëarbamazepine vs Valproate P. Dimova, D. Daskalov, I. Filipova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134

Gabapentin (neurontin) as add-on therapy in children withrefractory partial seizuresA. Naydenov . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

Correlations between the hemorheological variables and theasymmetries of the cerebral blood flow in patients withasymptomatic cerebrovascular disease, transient ischemicattacks and unilateral cerebral infarctionsI. Velcheva, S. Yancheva, E. Titianova, V. Petruniashev . . . . . . . . . . . . . . . . . . . . . . . . . .141

ISSN 1311-8641

Å˙΄‡Ò͇ ç‚ÓÎÓ„ËflBulgarian Neurology

àÁ‰‡ÌË ̇ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„ËflOfficial Journal of The Bulgarian Society of Neurology

êÖÑÄäñàéççÄ äéãÖÉàü EDITORS

ÄÎÂÍÒË‚ Ä. ëÓÙËfl Alexiev A. Sofia

ŇÈÍۯ‚ ë. èÎÓ‚‰Ë‚ Baykushev S. Sofia

ÅÂÎÓÔËÚÓ‚‡ ã. ëÓÙËfl Belopitova L. Sofia

ÅÓÊËÌÓ‚ ëÚ. è΂ÂÌ Bojinov St. Pleven

LJÒË΂‡ í. èÎÓ‚‰Ë‚ Vassileva T. Plovdiv

ÇÂ΂‡ ëÚ. ëÓÙËfl Veleva St. Sofia

ɇÌ‚‡ É. ëÓÙËfl Ganeva G. Sofia

ÉÂÓ„Ë‚ Ñ. ëÓÙËfl Georgiev D. Sofia

ɇÒËÏÓ‚ Å. ëÓÙËfl Gerassimov B Sofia

ÉË„ÓÓ‚‡ é. ëÓÙËfl Grigorova O. Sofia

ÑÂ΂‡ ç. LJ̇ Deleva N. Varna

ÑÂÌÒÍË Ç Ç‡Ì‡ Drensky V. Varna

á‡ı‡Ë‚ á. èÎÓ‚‰Ë‚ Zahariev Z. Plovdiv

à‚‡ÌÓ‚‡ ã. ëÓÙËfl Ivanova L. Sofia

à¯ÔÂÍÓ‚‡ Å. ëÓÙËfl Ishpekova B. Sofia

âÓÚÓ‚‡ ê. ëÓÙËfl Iotova R. Sofia

äÓ΂ é. ëÓÙËfl Kolev O. Sofia

ä˛˜ÛÍÓ‚ å. ëÓÙËfl Kyuchukov M. Sofia

å‡Ì˜Â‚ à. ëÚ.ᇄӇ Manchev I. St. Zagora

åË·ÌÓ‚ à. ëÓÙËfl Milanov I. Sofia

åË̘‚ Ñ. LJ̇ Minchev D. Varna

çËÍÓ‚ÒÍË ç. ëÓÙËfl Nikoevsky N. Sofia

èÂÚÓ‚ à. ëÓÙËfl Petrov I. Sofia

èÓÔÓ‚‡ å. è΂ÂÌ Popova M. PlÂven

ꇯ‚‡ å. ëÓÙËfl Rasheva M. Sofia

ÂÁÓ‚‡ ã. LJ̇ Havezova L. Varna

ÊË‚ Ñ. ëÓÙËfl Hadjiev D. Sofia

ÊËÔÂÚÓ‚‡ Ö. èÎÓ‚‰Ë‚ Hadjipetrova E. Plovdiv

ñ‡ÌÍÓ‚‡ ñ. ëÓÙËfl Tzankova Tz. Sofia

ñ‚ÂÚ‡ÌÓ‚‡ Ö. ëÓÙËfl Tzvetanova E. Sofia

󇂉‡Ó‚ Ñ. ëÓÙËfl Chavdarov D. Sofia

ó‡ÎχÌÓ‚ Ç. ëÓÙËfl Chalmanov D. Sofia

ó‡Î˙ÍÓ‚‡ ç. èÎÓ‚‰Ë‚ Chalakova N. Plovdiv

òÓÚÂÍÓ‚ è. ëÓÙËfl Shotekov P. Sofia

ü̘‚‡ ë. ëÓÙËfl Yancheva S. Sofia

ÉãÄÇçà êÖÑÄäíéêà EDITORS IN CHIEF

Ñ.ó‡Í˙Ó‚, è. ëÚ‡ÏÂÌÓ‚‡, à. ÇÂΘ‚‡ D. Chakarov, P. Stamenova, I. Velcheva

ëÖäêÖíÄê SECRETARY

å. чÒ͇ÎÓ‚ M. Daskalov

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ᇄ·‚̇ڇ ÒÚ‡Ìˈ‡ Ò˙‰˙ʇ Ô˙ÎÌÓ Ë Ò˙͇ÚÂÌÓ Á‡„·‚ËÂ,

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‚flÚ Ò ÔÓ‰ÂÌ ÌÓÏ ÓÚ ÍÌË„ÓÔËÒ‡. чÌÌËÚ ‚ ÍÌË„ÓÔËÒ‡ Ò Ô‰Ò-

Ú‡‚flÚ ÔÓ ÒΉÌËfl ̇˜ËÌ:

ëÚ‡ÚËfl ÓÚ ÒÔËÒ‡ÌË : Ä‚ÚÓ /Ë/. ᇄ·‚Ë ̇ ÒÚ‡ÚËflÚ‡.

ᇄ·‚Ë ̇ ÒÔËÒ‡ÌËÂÚÓ / Ò˙͇ÚÂÌÓ ÔÓ Index medicus/, ÚÓÏ, „Ó‰Ë̇

̇ ËÁ‰‡‚‡ÌÂ, ÌÓÏ ̇ ÍÌËÊ͇ڇ, ÒÚ‡Ìˈ‡ / ÓÚ-‰Ó/. èËÏ :

Andersen, G., Vestergaard, K., Lauritzen, L. Effective treatment of post-

stroke depression with the selective serotonin reuptake inhibitor citalo-

pram. Stroke, 25, 1994, 6, 1099-1104.

äÌË„‡ : Ä‚ÚÓ /Ë/ . ᇄ·‚ËÂ. èÓ‰Á‡„·‚ÌË ‰‡ÌÌË. åÂÒÚÓËÁ‰‡-

‚‡ÌÂ, ËÁ‰‡ÚÂÒÚ‚Ó, „Ó‰Ë̇ ̇ ËÁ‰‡‚‡ÌÂ, ÒÚ‡Ìˈ‡ /ÓÚ-‰Ó/.èËÏ :

Calligaro,K., DeLaurentis, D., Baker, W. Management of Extracranial

Cerebrovascular Disease.Philadelphia-New York, Lippincott - Raven

Publishers, 1997, 217.

èÛ·ÎË͇ˆËË ÓÚ Ò·ÓÌËÍ : Ä‚ÚÓ /Ë/. ᇄ·‚ËÂ: - Ç: ᇄ·‚ËÂ

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ÒÚ‡Ìˈ‡ / ÓÚ-‰Ó/. èËÏ : Binnie, C. , Jeavsons , .M. Photosensitive

epilepsies. In : Epileptic syndromes in infancy, childhood and adoles-

cence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss, A.Perret ,

P.Wolf. London, John Libbey & Company, Ltd, 1992, 299-305.

Ä‚ÚÓËÚ ÔÓ‰ÔËÒ‚‡Ú ‰ÂÍ·‡ˆËfl, ˜Â Ô‰ÓÒÚ‡‚ÂÌËfl χÚÂ-

ˇΠÌ  Ô‰ÎÓÊÂÌ Á‡ Ô˜‡Ú ̇ ‰Û„Ó ÏflÒÚÓ.

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Úfl·‚‡ ‰‡ ÓÚ„Ó‚‡flÚ Ì‡ ÂÚ˘ÌËÚ Òڇ̉‡ÚË

èË Ò˙‡‚ÚÓÒÚ‚Ó ÛÚ‚˙‰Â̇ڇ Á‡ Ô˜‡Ú ÒÚ‡ÚËfl Úfl·‚‡ ‰‡

·˙‰Â ÔÓ‰ÔË҇̇ ÓÚ ‚Ò˘ÍË ‡‚ÚÓË.

ê˙ÍÓÔËÒËÚ ‚ ‰‚‡ ÂÍÁÂÏÔÎfl‡ (ËÎË Â‰ËÌ ÂÍÁÂÏÔÎfl Ë ‰ËÒÍÂÚ‡)

ËÁÔ‡˘‡ÈÚ ̇ ‡‰ÂÒ :

ëÓÙËfl 1504, ìÎ. 4 ÅflÎÓ ÏÓ " ‹ 8åÅÄã " ñ‡Ëˆ‡ âÓ‡Ì̇" - ÖÄÑ äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl èÓÙ. è.ëÚ‡ÏÂÌÓ‚‡

INSTRUCTION FOR AUTHORS

Bulgarian Neurology is the official journal of the Bulgarian Society of

Neurology. It will consider for publication papers in neurology and relat-

ed areas in the following categories:

-Editorials, consisting of up to 3 pages, when approved by the

Editorial Board

-Original papers - up to 8 pages, including tables, figures and ref-

erences. An abstract in Bulgarian and English up to 40 rows on a sep-

arate sheet is required. The abstract should contain title, authors,

objective, background, methods, results and conclusions plus up to 6

keywords.

The original papers include short introduction, material, methods

results, discussion and references.

The title page should carry the full title, the short running title,

the authors with their initials, academic degrees, institutional affilia-

tions, address for correspondence, with telephone, fax and e-mail

-Short communications and case reports up to 3 pages

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books, congresses and conferences, new drugs, future events in neurolo-

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papers, short case reports and discussion on current problems

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heading

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reproduction.

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authors should be indicated by the number from the reference list .

The reference should be presented as follows:

Journal paper : (1) author(s), (2)title, (3) journal name ( as abbre-

viated in Index Medicus ). (4) volume, (5) year of publication, (6) jour-

nal number , (7) inclusive pages. Example: Andersen, G., Vestergaard,

K., Lauritzen, L. Effective treatment of poststroke depression with the

selective serotonin reuptake inhibitor citalopram. Stroke, 25, 1994, 6,

1099-1104.

Book : (1) author(s), (2) title, (3) city of publication, (4) publisher,

(5) year of publication , (6) pages. Example : Calligaro,K., DeLaurentis,

D., Baker, W. Management of Extracranial Cerebrovascular

Disease.Philadelphia-New York, Lippincott - Raven Publishers, 1997,

217.

References to books : (1) authors(s), (2) chapter title, (3) title of

book, (4) editor(s), (5) city of publication, (6) publisher, (7) year of pub-

lication, (8) specific pages. Example : Binnie, C. , Jeavsons , .M.

Photosensitive epilepsies. In : Epileptic syndromes in infancy, child-

hood and adolescence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E.

Dreifuss, A.Perret , P.Wolf. London, John Libbey & Company, Ltd,

1992, 299-305.

The articles are considered for publication on the understanding

that the presented material has not been published or is being submitted

elsewhere before appearing in BULGARIAN NEUROLOGY.

Authors should indicate that ethical approval of the study was

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sent to the following address:

Sofia 1504, Bulgaria, 8, Bialo more str.Department of Neurology University Hospital ◊ Queene Jovanna“: Prof. P. Stamenova

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 115‰ÂÍÂÏ‚Ë, 2002

ëöÑöêÜÄçàÖ

éÅáéêàç‚ÓÔ‡Ú˘̇ ·ÓÎ͇ Ë Gabapentinå. 䇇‰ÊÓ‚‡, è. òÓÚÂÍÓ‚ . . . . . . . . . . . . . . . .118

ç‚ÓÎӄ˘ÌË ÛÒÎÓÊÌÂÌËfl ÔË ·ÓÎÌË Ò ıÓÌ˘̇·˙·Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ Ì‡ ıÂÏӉˇÎËÁÌÓ Î˜ÂÌËÂÖ. Ç˙ÁÂÎÓ‚, è. ëÚ‡ÏÂÌÓ‚‡,ñ. ñ‡ÌÍÓ‚‡, ü. ïËÒÚÓ‚ . . . . . . . . . . . . . . . . . . .124

Levetiracetam ÌÓ‚Ë ÔÂÒÔÂÍÚË‚Ë ‚ ΘÂÌËÂÚÓ̇ ÂÔËÎÂÔÒËflÚ‡à. ê‡È˜Â‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

éêàÉàçÄãçà ëíÄíààEÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓËé. ÉË„ÓÓ‚‡, à. èÂÚÓ‚‡, ê. ä‡ÎÔ‡˜ÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

éÔÚËχÎÌÓ Î˜ÂÌË ̇ Ó·̉ӂ‡Ú‡ ÂÔËÎÂÔÒËfl:Ô‰ËÏÒÚ‚Ó Ì‡ valproate Ô‰ carbamazepineè. ÑËÏÓ‚‡, Ñ. чÒ͇ÎÓ‚, à. îËÎËÔÓ‚‡ . . . . . . . . . . . . . . . . . . . . . . . . . . . .134

Gabapentin (neurontin), ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl Ôˉˆ‡ Ò ÂÙ‡ÍÚÂÌË ÂÔËÎÂÔÚ˘ÌË Ô‡ˆË‡ÎÌËÔËÒÚ˙ÔËÄ. ç‡È‰ÂÌÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

ᇂËÒËÏÓÒÚË ÏÂÊ‰Û ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ë‡ÒËÏÂÚËËÚ ̇ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ ÔË ·ÓÎÌË Ò‡ÒËÏÔÚÓÏ̇ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚ, Ú‡ÌÁËÚÓÌËËÒıÂÏ˘ÌË ‡Ú‡ÍË Ë Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙaÍÚËà. ÇÂΘ‚‡, ë. ü̘‚‡, Ö. íËÚflÌÓ‚‡,Ç. èÂÚÛÌfl¯Â‚ . . . . . . . . . . . . . . . . . . . . . . . . . .141

êÂÁÛÎÚ‡ÚË ÓÚ Ú‡ÌÒ͇ÌˇÎÌÓ ÑÓÔΠsÒÓÌÓ„‡ÙÒÍÓËÁÒΉ‚‡Ì ÔË 106 ·ÓÎÌË Ò˙Ò ÒÛ·‡‡ıÌÓˉÂÌÍ˙‚ÓËÁÎË‚å. äÎËÒÛÒÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . .145

ëÛ·‡ÍÛÚeÌ ÒÍÎÂÓÁˇ˘ Ô‡ÌÂ̈ÂÙ‡ÎËÚ- ˜ÂÒÚÓÚ‡ ̇Á‡·ÓÎfl‚‡ÌÂÚÓ, ÍÎËÌ˘̇ ı‡‡ÍÚÂËÒÚË͇ ˉˇ„ÌÓÒÚË͇ - ‡Ì‡ÎËÁ ̇ 25 „Ӊ˯ÂÌ ÔÂËÓ‰Ç. ÅÓÊËÌÓ‚‡, è. ÑËÏÓ‚‡, ã. ÅÂÎÓÔËÚÓ‚‡ . . . . . .150

äêÄíäà çÄìóçà ëöéÅôÖçàü臇ÏËÓÚÓÌËfl ÍÓÌ„ÂÌËÚ‡ - Ò˙‚ÂÏÂÌÌË ‡Á·Ë‡ÌËfl ËÔ‰ÒÚ‡‚flÌ ̇ ÒÎÛ˜‡Èê. ÅÓÊËÎÓ‚‡, Ç. É„ÂΘ‚‡, Ç. ÅÓÊËÌÓ‚‡ . . . . .155

CONTENTS

REVIEWSNeuropathic pain and GabapentinM. Karadjova, P. Shotekov . . . . . . . . . . . . . . . . . .118

Neurologic complications in patients with chronic renalfailure on hemodialysisE. Vazelov, P. Stoimenova, Tz. Tzankova, J. Christov . . . . . . . . . . . . . . . . . . .124

Levetiracetam - new perspectives in the treatment ofepilepsyI. Raychev . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126

ORIGINAL PAPERSEpileptic seizures in patients with brain tumorsO. Grigirova, I. Petrova, R. Kalpachki . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130

Optimal treatment of the benign epilepsy - BECTS -Valproate vs ëarbamazepine P. Dimova, D. Daskalov, I. Filipova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134

Gabapentin (neurontin) as add-on therapy in childrenwith refractory partial seizures

A. Naydenov . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138

Correlations between the hemorheological variables andthe asymmetries of the cerebral blood flow in patientswith asymptomatic cerebrovascular disease, transientischemic attacks and unilateral cerebral infarctionsI. Velcheva, S. Yancheva, E. Titianova, V. Petruniashev . . . . . . . . . . . . . . . . . . . . . . . . . .141

Results from transcranial Doppler examinations of 106patients with subarachnoid hemorrhage

M. Klissurski . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145

Subacute sclerosing panencephalitis- morbidity, clinicalcourse and diagnostics- analysis in 25 years period

V. Bojinova, P. Dimova, L. Belopitova . . . . . . . . .150

SHORT COMMUNICATIONS AND CASE REPORTSParamyotonia congenita - current understanding and acase reportR. Bojilova, V. Guerguelcheva, V. Bojinova . . . . .155

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 116‰ÂÍÂÏ‚Ë, 2002

ч„Ë ÍÓ΄Ë,ᇠÔ‰ÒÚÓfl˘ËÚ äÓΉÌË Ô‡ÁÌËˆË Ë çÓ‚‡Ú‡ 2003

„Ó‰Ë̇ ÇË ÔÓÊ·‚‡Ï Á‰‡‚Â, ÛÒÔÂıË Ë ‰Ó·Ó ̇ÒÚÓÂÌË !

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2003

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 117‰ÂÍÂÏ‚Ë, 2002

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SUMMARY

NEUROPATHIC PAIN AND GABAPENTIN

M. Karadjova, P. ShotekovAbstract: Neuropathic pain is caused by functional abnor-

malities or structural lesions in the peripheral or central ner-vous systems, and may occur even without peripheral noci-ceptor stimulation. It has been described in about 1% of thepopulation. The development of neuropathic pain follows acomplex series of events involving changes in both the periph-eral and central nervous systems. These excitotoxic events arepossibly mediated by excitotory amino acid activity at recep-tors that may leed to increased Ca2+ permeability. Treatmentof neuropathic pain may be targeted at interruption of any ofa variety of steps in this sequence. While several effectivepharmacologic treatments are available for nociceptive pain,no definitive pharmacologic treatment is currently availablefor neuropathic pain. Gabapentin is a structural analog ofGABA that has shown some promise as a non-opioid agentoffering both substantial pain relief and a good safety profile.Numerous small clinical studies and case reports in a varietyof neuropathic pain syndromes have been have been reportedwith gabapentin. The largest of these studies are performed inpatients with postherpetic neuralgia and painfull diabeticperipheral neuropathy.Key words: neuropathic pain, Gabapentin, postherpetic neu-ralgia, diabetic peripheral neuropathy.

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ç‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ Ò Ô‰ËÁ‚ËÍ‚‡ ÓÚ ÙÛÌ͈ËÓ-̇ÎÌË Ì‡Û¯ÂÌËfl ËÎË ÒÚÛÍÚÛÌË ÎÂÁËË Ì‡ ÔÂËÙÂ̇ڇËÎË ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ Ë ÏÓÊ ‰‡ Ò ÔÓfl‚Ë ·ÂÁÔÂËÙÂ̇ ÌӈˈÂÔÚ˂̇ ÒÚËÏÛ·ˆËfl. ífl Ò ÛÒÚ‡ÌÓ‚fl‚‡ÔË ÔÓ˜ÚË 1% ÓÚ ÔÓÔÛ·ˆËflÚ‡. ê‡Á‚ËÚËÂÚÓ È Â ÂÁÛÎ-Ú‡Ú ÓÚ ÔÓ‰ˈ‡ Ò˙·ËÚËfl, ‚Íβ˜‚‡˘Ë ÔÓÏÂÌË ‚ ÔÂË-ÙÂ̇ڇ Ë ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ ̇ ÙËÁËÓÎӄ˘-ÌÓ Ë ·ËÓıËÏ˘ÌÓ ÌË‚Ó. ã˜ÂÌËÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ·ÓÎ͇ ˆÂÎË ÔÂÍ˙Ò‚‡ÌÂÚÓ Ì‡ ‚Òfl͇ ÓÚ ÒÚ˙ÔÍËÚ ‚ Ú‡ÁËÔÓÒΉӂ‡ÚÂÎÌÓÒÚ ÓÚ ÔÓˆÂÒË. ÑÓ͇ÚÓ Á‡ ΘÂÌËÂÚÓ Ì‡ÌӈˈÂÔÚ˂̇ڇ ·ÓÎ͇  ÛÒÚ‡ÌÓ‚ÂÌÓ ÂÙÂÍÚË‚ÌÓ Ù‡Ï‡-ÍÓÎӄ˘ÌÓ Î˜ÂÌËÂ, Á‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ ‚ ÏÓÏÂÌÚ‡Ìflχ ÔÓ‰ıÓ‰fl˘Ó ‰ÂÙËÌËÚË‚ÌÓ Ù‡Ï‡ÍÓÎӄ˘ÌÓ Î˜ÂÌËÂ.Gabapentin ÔÓ͇Á‚‡ ӷ¢‡‚‡˘ ÔÓÙËΠ͇ÚÓ ÌÂ-ÓÔËÓˉÌÓÒ‰ÒÚ‚Ó Ò˙Ò Ò˙˘ÂÒÚ‚ÂÌ Ó·ÂÁ·ÓÎfl‚‡˘ ÂÙÂÍÚ Ë ‰Ó·‡ ÔÓ-ÌÓÒËÏÓÒÚ. íÓÈ Â ÒÚÛÍÚÛÂÌ ‡Ì‡ÎÓ„ ̇ γ-‡ÏËÌÓχÒÎÂ̇ÍËÒÂÎË̇ (ÉÄåä). Ç ÎËÚ‡ÚÛ‡Ú‡ Ò Ò¢‡Ú „ÓÎflÏ·ÓÈ Ï‡ÎÍË ÍÎËÌ˘ÌË ÔÓÛ˜‚‡ÌËfl, Ò˙Ó·˘ÂÌËfl Á‡ ËÁÔÓÎÁ‚‡-ÌÂÚÓ Ì‡ Gabapentin ÔË Ì‚ÓÔ‡Ú˘ÌË ·ÓÎÍÓ‚Ë ÒË̉ÓÏË.ç‡È-„ÓÎÂÏË Ò‡ ÔÓÛ˜‚‡ÌËflÚ‡, ̇ԇ‚ÂÌË ÔË Ô‡ˆËÂÌÚË ÒÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl Ë ÔË ‰Ë‡·ÂÚ̇ ÔÂËÙÂ̇Ì‚ÓÔ‡ÚËfl, ÍÓflÚÓ Ò ÔÓfl‚fl‚‡ Ò Ì‚ÓÔ‡Ú˘ÂÌ ·ÓÎÍÓ‚ÒË̉ÓÏ. í‡Í‡ Gabapentin  ̇ÏÂËÎ Ò‚ÓÂÚÓ ÏflÒÚÓ ÔËΘÂÌËÂÚÓ Ì‡ ÚÛ‰ÌÓ ÔÓ‚ÎËfl‚‡˘‡ Ò Ì‚ÓÔ‡Ú˘̇ ·ÓÎ-

͇.äβ˜Ó‚Ë ‰ÛÏË: Ì‚ÓÔ‡Ú˘̇ ·ÓÎ͇, Gabapentin, ÔÓÒÚ-ıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl, ‰Ë‡·ÂÚ̇ Ì‚ÓÔ‡ÚËfl

ë˙Á̇ÚÂÎ̇ڇ ÒÂÚ˂̇ ÔˆÂÔˆËfl  ‰ËÌ ÓÚ ÓÚ΢Ë-ÚÂÎÌËÚ ·ÂÎÂÁË Ì‡ ˜Ó‚¯͇ڇ ÏÓÁ˙˜Ì‡ ‡ÍÚË‚ÌÓÒÚ Ë ÏÓ-Ê ‰‡ ·˙‰Â ‡Á„ÎÂʉ‡Ì‡ ͇ÚÓ ‡ÙÂÂÌÚ̇ ‰˙„‡ ÓÚ ÍÓÏÔ-ÎÂÍÒ ÂÙÎÂÍÒË Ì‡ ÏÌÓ„Ó ÌË‚‡, ÎÂʇ˘Ë ‚ ÓÒÌÓ‚‡Ú‡ ̇ ÔÓ‚Â-‰ÂÌËÂÚÓ (15). ÅÓÎ͇ڇ, ͇ÚÓ ÌÓχÎÌÓ ÒÂÚË‚ÌÓ ÛÒ¢‡ÌÂÓÚ‡Áfl‚‡ ‡ÍÚ˂ˇÌÂÚÓ Ì‡ ÓÔ‰ÂÎÂÌË ˆÂÌÚÓ‚Â ÓÚ ÒÂ-ÚË‚ÌËÚ Ô‰ÒÚ‡‚ËÚÂÎÒÚ‚‡ ‚ ÏÓÁ˙͇, ‚Íβ˜‚‡˘Ë ÒÓχ-ÚÓÒÂÌÁÓ̇ڇ ÍÓ‡, ÔÂÙÓÌÚ‡ÎÌËÚÂ Ë ÎËϷ˘ÌËÚ ӷ-·ÒÚË, Ò‚˙Á‡ÌË Ò ˜Û‚ÒÚ‚‡Ú‡. ëÔÓ‰ åÂʉÛ̇Ӊ̇ڇ‡ÒӈˇˆËfl Á‡ ËÁÒΉ‚‡Ì ̇ ·ÓÎ͇ڇ (InternationalAssociation for the Study of Pain - IASP) ÌӈˈÂÔÚ˂̇ڇ·ÓÎ͇ Ò Ô‰ËÁ‚ËÍ‚‡ ÓÚ ‡ÍÚ˂ˇÌÂÚÓ Ì‡ ÔÂËÙÂÌËÚÂÌӈˈÂÔÚÓË (·ÓÎÍÓ‚Ë ÂˆÂÔÚÓË) Ë Ú‡Í‡ ÓÒË„Ûfl‚‡"‡Î‡Ï‡", ÔÓÚÂÍÚ˂̇ ÒËÒÚÂχ ÒÂ˘Û Û‚Âʉ‡˘ËÚÂÙ‡ÍÚÓË Ì‡ ‚˙̯̇ڇ Ë ‚˙Ú¯̇ڇ Ò‰‡.

ç‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ (çÅ) Ò ÔÓfl‚fl‚‡ ‚ ÂÁÛÎÚ‡Ú̇ Ô˙‚˘̇ ÎÂÁËfl ËÎË ‰ËÒÙÛÌ͈Ëfl ‚ Ì‚̇ڇ ÒËÒÚÂχ.ífl  ҇ÏÓ ÒËÏÔÚÓÏ Ì‡ Ì‚ÓÎӄ˘ÌÓ Ì‡Û¯ÂÌËÂ, ‡ Ì ̇·ÓÎÂÒÚ Ò‡Ï‡ ÔÓ Ò· ÒË (15). çÅ Ò Ô‰ËÁ‚ËÍ‚‡ ÓÚ ÙÛÌÍ-ˆËÓ̇ÎÌË Ì‡Û¯ÂÌËfl ËÎË ÒÚÛÍÚÛÌË ÎÂÁËË Ì‡ ÔÂËÙÂ-̇ڇ ËÎË ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ ÏÓÊ ‰‡ Ò ÔÓfl‚Ë·ÂÁ ÔÂËÙÂ̇ ÌӈˈÂÔÚ˂̇ ÒÚËÏÛ·ˆËfl. ífl Ò ̇·Î˛‰‡-‚‡ ÒΉ Ú‡‚χ ̇ ÔÂËÙÂÌË Ë ˜ÂÂÔÌÓ-ÏÓÁ˙˜ÌË ÌÂ‚Ë (‚ÂÁÛÎÚ‡Ú Ì‡ ÔËÚËÒ͇ÌÂ, ‡ÏÔÛÚ‡ˆËfl), ÔË ÚË„ÂÏË̇Î-̇ Ì‚‡Î„Ëfl, ËÌÙÂ͈ËË (ÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl,çIV-‡ÒÓˆËˇ̇ Ì‚‡Î„Ëfl), ÌÂÓÔ·ÒÚ˘̇ ÍÓÏÔÂÒËfl,ÏÂÚ‡·ÓÎËÚÌË Ì‡Û¯ÂÌËfl (‰Ë‡·ÂÚ̇ Ì‚ÓÔ‡ÚËfl); ÏÓÁ˙-˜ÂÌ ËÌÙ‡ÍÚ (ËÌÒÛÎÚ) ËÎË Ë‰ËÓÔ‡Ú˘ÌÓ (13). çÅ ‚Ë̇„ËÒ ËÁfl‚fl‚‡ Ò ‡ÁÌÓÓ·‡ÁË ÓÚ ‚˙Á·Û‰ÌË Ë ÓÚÔ‡‰ÌË ÒÂÚË‚-ÌË, ‰‚Ë„‡ÚÂÎÌË Ë ‚„ÂÚ‡ÚË‚ÌË ÒËÏÔÚÓÏË.

ç‚ÓÔ‡Ú˘ÌËÚ ·ÓÎÍË ËÏ‡Ú ÔӉӷ̇ ÍÎËÌ˘̇ ı‡-‡ÍÚÂËÒÚË͇, ÌÂÁ‡‚ËÒËÏÓ ÓÚ Úflı̇ڇ ÂÚËÓÎÓ„Ëfl. ÅÓÎ-͇ڇ  ÒÔÓÌÚ‡Ì̇, ÔÓ‰˙ÎÊËÚÂÎ̇, Ô‡ÓÍÒËÁχÎ̇(ÒÚÂÎ͇˘‡, ÂÊ¢‡), Ô‰ËÁ‚Ë͇̇ ÓÚ ‡Á΢ÌË ÏÂı‡-Ì˘ÌË, ÚÂÏÔ‡ÚÛÌË Ë ‰Û„Ë ÒÚËÏÛÎË (2). èË ÌÂfl ÒÂ̇·Î˛‰‡‚‡: 1.ïËÔ‡΄‡ÁËfl, ÍÓflÚÓ ÒÔÓ‰ IASP  ÛÒËÎÂÌÓÚ„Ó‚Ó Ì‡ ÒÚËÏÛÎ, ÍÓÈÚÓ ÌÓχÎÌÓ Â ·ÓÎÂÁÌÂÌ; 2. ÄÎÓ-‰ËÌËfl - ·ÓÎ͇, Ô‰ËÁ‚Ë͇̇ ÓÚ ÒÚËÏÛÎ, ÍÓÈÚÓ ÌÓχÎÌÓÌ Ô‰ËÁ‚ËÍ‚‡ ·ÓÎÍÓ‚Ó ÛÒ¢‡ÌÂ; 3. ÑËÁÂÒÚÂÁËfl - ÌÂÔËfl-ÚÌÓ, Ô‡ÚÓÎӄ˘ÌÓ ÛÒ¢‡ÌÂ, ÔË ÍÓÂÚÓ Â‰ËÌ ‚ˉ ÒÚËÏÛÎÒ ÛÒ¢‡ ͇ÚÓ ‰Û„ (15). çÅ Ó·ËÍÌÓ‚ÂÌÓ Â ÎÓ͇ÎËÁˇ̇ ‚ӷ·ÒÚË Ò anesthesia dolorosa ( ıËÔÂÒÚÂÁËfl ËÎË ‡ÌÂÒÚÂ-ÁËfl), ÍÓÂÚÓ ÔÓ͇Á‚‡, ˜Â Úfl Ì Á‡‚ËÒË Ò‡ÏÓ ÓÚ ÒÚËÏÛ· ̇ÌӈˈÂÔÚË‚ÌËÚ ˆÂÔÚÓË, ÌÓ Ë ÓÚ ‰Û„Ë ÏÂı‡ÌËÁÏË(2).

ë˙˘ÂÒÚ‚Û‚‡Ú ‰‚‡ ÔÂËÙÂÌË Ì‚ÓÔ‡Ú˘ÌË ·ÓÎÍÓ‚ËÒË̉Óχ - ͇ÛÁ‡Î„Ëfl /causalgia/ Ë ÂÙÎÂÍÒ̇ ÒËÏÔ‡ÚËÍÓ‚‡‰ËÒÚÓÙËfl, Ò˙Ò ÒıӉ̇ ÍÎËÌ˘̇ ËÁfl‚‡ Ë ÔÓ‰Ó·ÌË ÏÂı‡-ÌËÁÏË Ì‡ ‚˙ÁÌËÍ‚‡ÌÂ. ä‡ÛÁ‡Î„ËflÚ‡ ·Â¯Â ̇ÒÍÓÓ ÔÂ̇Ë-ÏÂÌÛ‚‡Ì‡ ‚ "ÍÓÏÔÎÂÍÒÂÌ Â„ËÓ̇ÎÂÌ ·ÓÎÍÓ‚ ÒË̉ÓÏ ÚËÔ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 118‰ÂÍÂÏ‚Ë, 2002

é·ÁÓ

çÖÇêéèÄíàóçÄ ÅéãäÄ à GABAPENTINå. 䇇‰ÊÓ‚‡, è. òÓÚÂÍÓ‚

ç‚ÓÎӄ˘̇ ÍÎËÌË͇, ìÌË‚ÂÒËÚÂÚÒ͇ ·ÓÎÌˈ‡ "ÄÎÂÍ҇̉ӂÒ͇",å‰ˈËÌÒÍË ÛÌË‚ÂÒËÚÂÚ -ëÓÙËfl

II" (CRPS II) Ë ÒÔÓ‰ IASP ‚Íβ˜‚‡ ËÁ„‡fl˘‡ ·ÓÎ͇, ‡ÎÓ-‰ËÌËfl ËÎË ıËÔÂÔ‡ÚËfl, Ó·ËÍÌÓ‚ÂÌÓ ‚ ˙͇ڇ ËÎË Í‡Í‡.燷≇‚‡ Ò ÒΉ ˜‡ÒÚ˘̇ ۂ‰‡ ̇ Ì‚ ËÎË Â‰ËÌ ÓÚ„ÓÎÂÏËÚ ÏÛ ÍÎÓÌÓ‚Â. êÂÙÎÂÍÒ̇ڇ ÒËÏÔ‡ÚËÍÓ‚‡‰ËÒÚÓÙËfl  ̇˜Â̇ "ÍÓÏÔÎÂÍÒÂÌ Â„ËÓ̇ÎÂÌ ÒË̉ÓÏÚËÔ I" (CRPS I). ëÔÓ‰ IASP ÚÓÈ Ì Ò ‡Á‚Ë‚‡ ‚ ÓÔ‰Â-ÎÂ̇ ÔÂËÙÂÌÓ-Ì‚̇ ÚÂËÚÓËflÚ‡, ‡ Ó·ı‚‡˘‡ ÔÓ-¯Ë-ÓÍË ÚÂËÚÓËË. ÅÓÎÍÓ‚ËflÚ ÒË̉ÓÏ Â ÔˉÛÊÂÌ ÓÚÓÚÓÍ, ÔÓÏÂÌË ‚ Í˙‚ÌËfl ÚÓÍ, ̇ۯÂÌË ‚˙‚ ‚‡ÁÓÏÓ-ÚÓ̇ڇ ‡ÍÚË‚ÌÓÒÚ ‚ ‡ÈÓ̇ ̇ ·ÓÎ͇ڇ, ‡ÎÓ‰ËÌËfl ËÎËıËÔ‡΄ÂÁËfl.

çÅ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÔË ÔÓ˜ÚË 1% ÓÚ ÔÓÔÛ·ˆËflÚ‡ (13).çÂÈÌÓÚÓ Î˜ÂÌË ÒÚÛ‚‡ ÒÍ˙ÔÓ - ͇ÍÚÓ Ì‡ Ô‡ˆËÂÌÚ‡, Ú‡-͇ Ë Ì‡ Ó·˘ÂÒÚ‚ÓÚÓ. èÓÏÂÌfl ÒÂ Ë Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË-‚ÓÚ Ì‡ Ô‡ˆËÂÌÚËÚÂ, ÍÓÂÚÓ Â Ò‚˙Á‡ÌÓ Ò˙Ò Ò˙Ô˙ÚÒÚ‚‡˘Ë-Ú ÂÏÓˆËÓ̇ÎÌË ÒÚ‡‰‡ÌËfl, ÙÛÌ͈ËÓ̇ÎÌË Ì‡Û¯ÂÌËfl ËÒӈˇÎÌË ÚÛ‰ÌÓÒÚË, ‚Íβ˜ËÚÂÎÌÓ ‡ÁÛ-¯‡‚‡Ì ̇ ÒÂ-ÏÂÈÒÚ‚ÓÚÓ, ÒӈˇÎ̇ ËÁÓ·ˆËfl Ë ÔÓÙÂÒËÓ̇Î̇ ÌÂÔ˙ÎÌÓ-ˆÂÌÌÓÒÚ (9).

èÂÁ ÔÓÒΉÌËÚ „Ó‰ËÌË Ò ̇·Î˛‰‡‚‡ „ÓÎflÏ Ì‡Ô‰˙Í‚ ÛÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ Ì‡ ÌflÍÓË ÓÚ ÏÂı‡ÌËÁÏËÚ ÓÚ Ô‡ÚÓ„Â-ÌÂÁ‡Ú‡ ̇ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇, ÍÓÂÚÓ ÓÒË„ÛË ÓÒÌÓ‚‡-Ú‡ Á‡ ÔÓ-‡ˆËÓ̇ÎÌÓ ËÁÔÓÎÁ‚‡Ì ̇ Ò˙˘ÂÒÚ‚Û‚‡˘ËÚ ÎÂ-͇ÒÚ‚‡ Ë Ò˙Á‰‡‚‡Ì ̇ ÌÓ‚Ë (3).

åÖïÄçàáåà çÄ ÇöáçàäÇÄçÖ çÄ çÖÇêéèÄíàóçÄíÄ ÅéãäÄ

èË ÌÓχÎÌË Ó·ÒÚÓflÚÂÎÒÚ‚‡ ·ÓÎÂÁÌÂÌËÚ ÒÚËÏÛÎËÔ‰ËÁ‚ËÍ‚‡Ú ÔÓÔ‡„‡ˆËfl ̇ ËÏÔÛÎÒËÚ ÔÓ ‰˙ÎÊË̇ڇ ̇‡ÙÂÂÌÚÌËÚ ÌӈˈÂÔÚË‚ÌË ‚·Í̇ (·˙ÁÓ ÔÓ‚Âʉ‡ÌÂÔÓ Ò··Ó ÏËÂÎËÌËÁˇÌË Äδ Ë ·‡‚ÌÓ - ÔÓ ÌÂÏËÂÎËÌËÁˇÌËë-‚·Í̇) Í˙Ï „˙·Ì‡˜ÌËfl ÏÓÁ˙Í. í Á‡‚˙¯‚‡Ú „·‚ÌÓ ‚laminae ¨ Ë ¨¨ ̇ Á‡‰ÌËÚ ӄ‡. èË Ì‚ÓÔ‡Ú˘̇ ·ÓÎ͇Äβ-‚·Í̇ڇ Ë„‡flÚ Ò˙˘ÂÒÚ‚Â̇ ÓÎfl ‚ Ú‡ÌÒÏËÒËflڇ̇ ·ÓÎÂÁÌÂÌËÚ ÒÚËÏÛÎË Ë ‚ ÔÓ‰‰˙ʇÌÂÚÓ Ì‡ ‡ÎÓ‰ËÌËfl-Ú‡.

èÖêàîÖêçà åÖïÄçàáåà çÄ ÇöáçàäÇÄçÖ çÄ çÖÇêéèÄíàóçÄíÄ ÅéãäÄ

ÅÓÎ͇ڇ Ò Ô˘ËÌfl‚‡ ÓÚ ÂÍÒˆÂÒË‚ÌÓ ‰‡ÁÌÂÌ ̇ ÌÓ-ˆËˆÂÔÚÓËÚ ÓÚ Â‰Ëˆ‡ ·ËÓıËÏ˘ÌË ‡Î„Ó„ÂÌÌË ÒÛ·ÒÚ‡Ì-ˆËË, ÍÓËÚÓ Ò ÓÚ‰ÂÎflÚ Ë ÒËÌÚÂÁË‡Ú ÔË ÏÂı‡Ì˘ÌË,ÚÂÏ˘ÌË ËÎË ‚˙ÁÔ‡ÎËÚÂÎÌË ‚˙Á‰ÂÈÒÚ‚Ëfl. íÓ‚‡ Ò‡ ÔÓÒ-Ú‡„·̉ËÌË Ë Î‚ÍÓÚËÂÌË, ÔÓ‰ÛÍÚË Ì‡ ˆËÍÎÓÓÍÒË„Â̇Á-ÌËfl Ë ÎËÔÓÓÍÒË„Â̇ÁÌËfl Ô˙Ú ÓÚ ÏÂÚ‡·ÓÎËÁχ ̇ ‡‡ıˉÓ-ÌÓ‚‡Ú‡ ÍËÒÂÎË̇, ˆËÚÓÍËÌË (ËÌÚÂ΂ÍËÌË, ÚÛÏÓ ÌÂÍ-ÓÚËÁˇ˘ Ù‡ÍÚÓ, Ì‚Ó̇ÎÂÌ ‡ÒÚÂÊÂÌ Ù‡ÍÚÓ(NGF)), ‡Á΢ÌË Ì‚ÓÔÂÔÚˉË, ÔÛËÌË (·‡‰ËÍËÌËÌ,ÒÛ·Òڇ̈Ëfl "ê", ÒÓχÚÓÒÚ‡ÚËÌ, ẨÓÙËÌË, ͇ΈËÚÓÌËÌ„ÂÌ-Ò‚˙Á‡Ì ÔÂÔÚˉ), Ì‚ÓωˇÚÓË (ÒÂÓÚÓÌËÌ, „ÎÛ-ڇχÚ), ‡ÁÓÚÂÌ ÓÍÒˉ Ë ÏÌÓ„Ó ‰Û„Ë. ä‡ÈÌËflÚ ÂÁÛÎ-Ú‡Ú Â Ôӂ˯Â̇ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Í˙Ï ıËÏ˘ÌËÚ هÍ-ÚÓË Ì‡ ‚ËÒÓÍÓÔ‡„Ó‚ËÚ ÌӈˈÂÔÚÓË, ÍÓÂÚÓ ‰Ó‚Âʉ‡‰Ó ÔÓ‚Âʉ‡Ì ̇ ·ÓÎÂÁÌÂÌË ÒÚËÏÛÎË ÔË ÌËÒ˙Í ËÌÚÂÌÁË-ÚÂÚ Ì‡ ‰‡ÁÌËÚÂÎfl (1). èÓÎÛ˜‡‚‡ Ò "ÔÂËÙÂ̇ ÒÂÌÒË·Ë-ÎËÁ‡ˆËfl", ÍÓflÚÓ Ò ı‡‡ÍÚÂËÁˇ Ò Ôӂ˯Â̇ ‡ÍÚË‚-ÌÓÒÚ Í˙Ï ıËÏ˘ÌË, ÚÂÏ˘ÌË Ë ‰Û„Ë ‰‡ÁÌËÚÂÎË ‚ Ó·-·ÒÚÚ‡ ̇ Á‡Òfl„‡Ì - ÁÓ̇ڇ ̇ Ú.Ì. "Ô˙‚˘̇ ıËÔ‡΄Â-ÁËfl" (13)

ìÒÚ‡ÌÓ‚ÂÌË Ò‡ ÔÓÌ ˜ÂÚËË ‡Á΢ÌË „·‚ÌË ÏÂı‡ÌËÁ-χ Á‡ ‚˙ÁÌËÍ‚‡ÌÂÚÓ Ì‡ Ô˙‚Ó̇˜‡Î̇ ‡·ÌÓÏ̇ ‡ÙÂÂÌÚ-̇ ‡ÍÚË‚ÌÓÒÚ ÒΉ ÔÂËÙÂÌÓ-Ì‚̇ ۂ‰‡.

1.Ä·ÌÓÏ̇ ÒÔÓÌÚ‡Ì̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ÂÍÚÓÔ˘ÌË ÏÂÒ-Ú‡. ëΉ ÏÂı‡Ì˘̇, ÚÂÏ˘ÌË ËÎË ‚˙ÁÔ‡ÎËÚÂÎ̇ ۂ‰‡Ì‡ ÔÂËÙÂÌËfl Ì‚ „ÂÌ¡˘ËÚ ͇ˢ‡ ̇ ۂ‰ÂÌË-Ú ‡ÍÒÓÌË (ÏËÂÎËÌËÁˇÌË Ë ÌÂÏËÂÎËÌËÁˇÌË ‚·Í̇)‡Á‚Ë‚‡Ú ÂÍÚÓÔ˘ÌË Ó„Ìˢ‡, ÍÓËÚÓ „ÂÌÂË‡Ú ‡·ÌÓÏÌË

ÒÔÓÌÚ‡ÌÌË ‡ÍˆËÓÌÌË ÔÓÚÂ̈ˇÎË Ë Ôӂ˯Â̇ ˜Û‚ÒÚ‚Ë-ÚÂÎÌÓÒÚ Í˙Ï ‡Á΢ÌË ‰‡ÁÌËÚÂÎË (13). íÂÁË ÂÍÚÓÔ˘Ìˇ·ÌÓÏÌË ‡Áfl‰Ë Ì ÔÓËÁÎËÁ‡Ú ÓÚ ÌӈˈÂÔÚÓËÚÂ.àÌÚËÏÌËÚ ÏÂı‡ÌËÁÏË Ì‡ ‚˙ÁÌËÍ‚‡Ì ̇ ÂÍÚÓÔ˘ÌËÚ‡Áfl‰Ë Ò‡ Ò‚˙Á‡ÌË Ò: 1. ÑËÒ„Û·ˆËfl ‚ ÒËÌÚÂÁ‡ Ë/ËÎËÙÛÌ͈ËÓÌˇÌÂÚÓ Ì‡ ÈÓÌÌËÚ ͇̇ÎË. ë˜ËÚ‡ ÒÂ, ˜Â Ò˙-˘ÂÒÚ‚Â̇ ÓÎfl Á‡ ‚˙ÁÌËÍ‚‡ÌÂÚÓ Ì‡ ÚÂÁË ËÏÔÛÎÒË Ë„‡Â̇ÚÛÔ‚‡ÌÂÚÓ Ì‡ ̇ÚËÂ‚Ë Í‡Ì‡ÎË. íÓ ÏÓÊ ‰‡ ÔÓÌËÊËÔ‡„‡ Á‡ „ÂÌÂˇÌ ̇ ‡ÍˆËÓÌÂÌ ÔÓÚÂÌˆË‡Î Ë Â ÛÒÚ‡ÌÓ‚Â-ÌÓ ‚ ‡ÍÒÓÌËÚ ̇ ˜Ó‚¯ÍËÚ ·ÓÎÂÁÌÂÌË Ì‚ÓÏË. 2. åÂÏ-·‡ÌÌË ÔÓÏÂÌË Ì‡ ۂ‰ÂÌËfl ÔÂËÙÂÂÌ Ì‚ÓÌ. 3. èÓ-Ïfl̇ ‚ ÒËÌÚÂÁ‡Ú‡ ̇ ÔÓÚÂËÌËÚÂ. 4. 삉‡ ̇ ‡ÍÒÓÔ·Á-χÚ˘ÌËfl Ú‡ÌÒÔÓÚ Ë ‰. (1). íÓ‚‡ Ó·flÒÌfl‚‡ Ë ˜Û‚ÒÚ‚Ë-ÚÂÎÌÓÒÚÚ‡ ̇ ÂÍÚÓÔ˘ÌËÚ ‡Áfl‰Ë Í˙Ï ÏÂÏ·‡ÌÓÒÚ‡-·ËÎËÁˇ˘Ë ‡„ÂÌÚË Ë ·ÎÓ͇ÚÓË Ì‡ ‚ÓÎÚ‡Ê-Á‡‚ËÒËÏËÚÂ̇ÚËÂ‚Ë Í‡Ì‡ÎË, ͇ÚÓ ‡ÌÚˇËÚÏ˘ÌË ÔÂÔ‡‡ÚË(Mexiletine), ÎÓ͇ÎÌË ‡ÌÂÒÚÂÚËˆË (Lidocain) Ë ‡ÌÚËÍÓÌ-‚ÛÎÒ‡ÌÚË (Carbamazepine, Phenytoin Ë ‰.).

2. è‡ÚÓÎӄ˘ÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl ̇ ‚·Í̇ڇ. èËÁ‰‡‚Ë ÌÂ‚Ë ‡ÙÂÂÌÚÌËÚ ‚·Í̇ ÔÓ‚Âʉ‡Ú ËÏÔÛÎÒË-Ú ÌÂÁ‡‚ËÒËÏÓ Â‰ÌÓ ÓÚ ‰Û„Ó. èË Ô‡ÚÓÎӄ˘ÌË Ò˙ÒÚÓfl-ÌËfl Ò ̇·Î˛‰‡‚‡Ú ‡·ÌÓÏÌÓ ÔÂı‚˙ÎflÌ ̇ ‚˙Á·Û‰‡Ú‡‚˙ıÛ Ò˙Ò‰ÌË Á‰‡‚Ë ‡ÙÂÂÌÚÌË Ì‚ÓÌË ËÎË Ì‚Ì˂·Í̇. éÔËÒ‡ÌË Ò‡ ‰‚‡ ‚ˉ‡ ‡·ÌÓÏÌË Ò‚˙Á‚‡ÌËfl ÏÂʉÛÔÂËÙÂÌËÚ ‚·Í̇: 1. ä˙ÒÚÓÒ‡ÌÓ ‚˙Á·Ûʉ‡ÌÂ, ̇˜Â-ÌÓ "crossed afterdischarges". íÓ Â Ì‡·Î˛‰‡‚‡ÌÓ Û ÊË‚ÓÚËÌ-ÒÍË ÏËÂÎËÌËÁˇÌË ‚·Í̇. èË ÌÂ„Ó Â‰ËÌ˘ÌËÚ ÒÚËÏÛ-ÎË Ì Ô‰ËÁ‚ËÍ‚‡Ú ‚˙Á·ÛʉÂÌËÂ, ÌÓ ÔÓ‚Ú‡fl˘‡ Ò ÒËÌı-ÓÌ̇ ‡ÍÚË‚ÌÓÒÚ ‚ Ô˙‚˘ÌËÚ ‡ÙÂÂÌÚÌË ‚·Í̇ Ë̉Û-ˆË‡ ÒÛÏˇÌ ̇ ‚˙Á·Û‰‡Ú‡ Ë Úfl Ò ÔÂı‚˙Îfl ̇ Ò˙Ò‰-ÌË ‡ÙÂÂÌÚÌË Ì‚ÌË ‚·Í̇. èÓ ÚÓÁË Ì‡˜ËÌ ·ÓÎ͇ڇ ÏÓ-Ê ‰‡ Ò ‡ÁÔÓÒÚ‡ÌË ÔÓÒÚ‡ÌÒÚ‚ÂÌÓ Ë ÔÓ ‚ÂÏÂ, Ë ‰‡ÔÂÒËÒÚˇ ‰˙΄Ó. ä˙ÒÚÓ҇̇ڇ ‚˙Á·Û‰‡ ÏÂÊ‰Û ÌËÒÍÓÔ-‡„Ó‚ËÚÂ Ä Ë ‚ËÒÓÍÓÔ‡„Ó‚ËÚ ë-‚·Í̇ Ó·flÒÌfl‚‡Ú ıË-Ô‡΄ÂÁËflÚ‡, ÔË ÍÓflÚÓ Ò··Ë ÒÂÚË‚ÌË ÒÚËÏÛÎË Ô‰ËÁ-‚ËÍ‚‡Ú ·ÓÎ͇ Ò ıËÔÂÔ‡Ú˘ÂÌ ı‡‡ÍÚÂ. ë ÚÂÁË ‚Á‡ËÏÓ-‰ÂÈÒÚ‚Ëfl Ò ӷflÒÌfl‚‡Ú ÓÒÚ‡Ú˙˜Ì‡Ú‡ ÒÔÓÌÚ‡Ì̇ ·ÓÎÍÓ-‚‡ ‡ÍÚË‚ÌÓÒÚ, ‡Á¯Ëfl‚‡Ì ̇ ˆÂÔÚÓÌÓÚÓ ÔÎÂ, ÓÚ‡-ÁÂ̇ڇ ·ÓÎ͇, ÍÓÊ̇ڇ ıËÔÂÂÒÚÂÁËfl ‚ ÁÓÌËÚ ̇ HeadÔË ÒÂÚË‚ÌË ËÏÔÛÎÒË ÓÚ ‚˙Ú¯ÌËÚ ӄ‡ÌË Ë ‚Íβ˜‚‡-Ì ̇ ÒËÏÔ‡ÚËÍÓ‚‡Ú Ì‚‚̇ ÒËÒÚÂχ Ë ‡Á‚ËÚË ̇ ÒË-χԇڇ΄ËË (1). ä˙ÒÚÓÒ‡ÌÓÚÓ ‚˙Á·Ûʉ‡Ì ÏÂÊ‰Û ‚·Í-̇ڇ  ̇·Î˛‰‡‚‡ÌÓ ‚ ÒÂÚË‚ÌËÚ „‡Ì„ÎËË Ì‡ Á‡‰ÌËÚ ÍÓ-Â̘ÂÚ‡, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ Û˜‡ÒÚ‚‡Ú ‚ ıËÔ‡΄ÂÁËflÚ‡ËÎË ‡ÎÓ‰ËÌËflÚ‡, ‡ÍÓ Ò Á‡‡Ì„‡ÊË‡Ú Â‰ÌÓ‚ÂÏÂÌÌÓ „ÓÎfl-χ ˜‡ÒÚ ÓÚ Ô˙‚˘ÌËÚ ‡ÙÂÂÌÚÌË ‚·Í̇. 2. ÑÛ„ËflÚÚËÔ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ë Ô‰ÒÚ‡‚Îfl‚‡Ú Ú.Ì. "ephapses".èË ÌÂ„Ó Â Ì‡Îˈ ÚflÒÌÓ ÔËÎÂÔ‚‡Ì ÏÂÊ‰Û Ò˙Ò‰ÌË ‡ÍÒÓ-ÌË ÔË ÎËÔÒ‡Ú‡ ̇ ÌÓχÎÌÓ „ΡÎÌÓ Ó·Í˙ÊÂÌËÂ, ÍÓÂÚÓÔÓÁ‚ÓÎfl‚‡ ‰ËÂÍÚÌÓ ‚˙Á·ÛʉÂÌË ̇ ‰ÌÓ ‚·ÍÌÓ ÓÚ Ò˙-Ò‰ÌËÚÂ. åÓÊ ·Ë ÚÓ‚‡ Ô‰ÒÚ‡‚Îfl‚‡ ÏÂı‡ÌËÁÏ˙Ú, ÔÓÍÓÈÚÓ ÌËÒÍÓÔ‡„Ó‚ËÚ ‡ÙÂÂÌÚË ÏÓ„‡Ú ‰‡ ‡ÍÚ˂ˇÚÌӈˈÂÔˆËflÚ‡ Ë ‰‡ Ë̉ۈËÚ ÔÓ ÚÓÁË Ì‡˜ËÌ ‡ÎÓ‰ËÌËfl.íÂÁË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl, Ó·‡˜Â Û ıÓ‡ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË Á‡Ò„‡Ò‡ÏÓ ÔË ÏÓÚÓÌËÚ Ì‚Ë.

3. èӂ˯Â̇ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Ì‡ ÌӈˈÂÔÚÓËÚÂ.ÍÚÂËÁˇ ÒÂ Ò ÔÓ‰˙ÎÊËÚÂÎÂÌ ‡Áfl‰ (Ó·ËÍÌÓ‚ÂÌÓÌӈˈÂÔÚÓËÚ ҇ ‚ ÔÓÍÓÈ ÔË ÎËÔÒ‡ ̇ ·ÓÎÍÓ‚ ÒÚË-ÏÛÎ), ÔÓÌËÊÂÌ Ô‡„ ̇ ‡ÍÚ˂ˇÌ Á‡ ÚÂÏ˘ÌË Ë ÏÂı‡-Ì˘ÌË ‰‡ÁÌËÚÂÎË, Ë ‡·ÌÓÏÌË ‡Áfl‰Ë ÔË Ì‡‰Ô‡„Ó‚‡ÒÚËÏÛ·ˆËfl.

4. ïËÔ˜ۂÒÚ‚ËÚÂÎÌÓÒÚ Í˙Ï Í‡ÚÂıÓ·ÏËÌË. èË ÙË-ÁËÓÎӄ˘ÌË Ò˙ÒÚÓflÌËfl ÔÂËÙÂÌËÚ Ì‚ÌË ÓÍÓ̘‡ÌËfl ÌÂÒ‡ ˜Û‚ÒÚ‚ËÚÂÎÌË Í˙Ï Í‡ÚÂıÓ·ÏËÌË Ë Ò‡ ÙÛÌ͈ËÓ̇ÎÌÓÓÚ‰ÂÎÂÌË ÓÚ ÒËÏÔ‡ÚËÍÓ‚ËÚ ÂÙÂÂÌÚË. ëΉ ÂÍÒÔÂË-ÏÂÌÚ‡Î̇ Ô‡ˆË‡Î̇ ËÎË ÚÓÚ‡Î̇ ÔÂËÙÂÌÓ-Ì‚̇ ÎÂ-ÁËfl, „ÂÌ¡˘ËÚ ͇ˢ‡ ̇ Ì‚ÓÌËÚ ‚ ÒÂÚË‚ÌËÚÂ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 119‰ÂÍÂÏ‚Ë, 2002

„‡Ì„ÎËË Ò‡ Ò Ôӂ˯ÂÌ ÓÚ„Ó‚Ó (ÔÓ‡‰Ë Ôӂ˯ÂÌË ÂÍÚÓ-Ô˘ÌË ‡Áfl‰Ë Ë ÌӈˈÂÔÚÓ̇ ÒÂÌÒË·ËÎËÁ‡ˆËfl) Í˙Ï ÌÓ-‡‰Â̇ÎËÌ ËÎË Í˙Ï ÂÎÂÍÚÓÒÚËÏÛ·ˆËfl ̇ Ì‚ÌËflÒÚ‚ÓÎ. íÓ‚‡ Ò ‰˙ÎÊË Ì‡ ‡·ÌÓÏ̇ ÂÍÒÔÂÒËfl ̇ ‡‰ÂÌÓÂ-ˆÂÔÚÓË. çflÍÓË ‡‚ÚÓË Ò‡ ÓÔËÒ‡ÎË ÂÚÓ„‡‰ÂÌ ‡ÒÚÂÊ̇ ÒËÏÔ‡ÚËÍÓ‚Ë ‚·Í̇, ÍÓËÚÓ ÌÓχÎÌÓ ËÌÂ‚Ë‡Ú Í˙-‚ÓÌÓÒÌËÚ Ò˙‰Ó‚ ‚ ÒÂÚË‚ÌËÚ „‡Ì„ÎËË, ÙÓÏˇÈÍË ÔÓ-‰Ó·ÌË Ì‡ ÍÓ¯˜Â ÒÚÛÍÚÛË ÓÍÓÎÓ Ô˙‚˘ÌËÚ ‡ÙÂÂÌÚ-ÌË Ì‚ÓÌË (·ÂÁ ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ÒË̇ÔÚ˘ÌË ‚˙ÁÍË ÒÚflı). íÓÁË ‡ÒÚÂÊ ÏÓÊ ‰‡  ÚË„ÂË‡Ì ÓÚ Ì‚ÓÚÓ-ÙËÌ, Ò˙˘Ëfl ͇ÚÓ Ì‚Ó̇ÎÂÌ ‡ÒÚÂÊÂÌ Ù‡ÍÚÓ (NGF).í‡Í‡ ÓÔËÒ‡ÌËÚ ÏÂı‡ÌËÁÏË Ò ҘËÚ‡, ˜Â Û˜‡ÒÚ‚‡Ú ÔËÍÓÏÔÎÂÍÒÌË Â„ËÓ̇ÎÌË ·ÓÎÍÓ‚Ë ÒË̉ÓÏË (CRPS) Ë Â ÛÒ-Ú‡ÌÓ‚ÂÌÓ, ˜Â Ò ÔÓ‚ÎËfl‚‡Ú ÓÚ ÌflÍÓË ÒËÏÔ‡ÚËÍÓÎËÚ˘ÌËÔӈ‰ÛË Ò ËÁÔÓÎÁ‚‡Ì ̇ guanetidin, „‡Ì„ÎËÓ̇ÌË ·ÎÓÍÓ-‚ ËÎË ËÌÚ‡‚ÂÌÓÁÌÓ ÔËÎÓÊÂÌË ̇ phentolamine. é·‡Ú-ÌÓ - ÒÚËÏÛ·ˆËflÚ‡ ̇ ÒËÏÔ‡ÚËÍÓ‚‡Ú‡ Ì‚̇ ÒËÒÚÂχÔË Ô‡ˆËÂÌÚË Ò Í‡ÛÁ‡Î„Ëfl ÏÓÊ ‰‡ Á‡ÒËÎË ·ÓÎ͇ڇ. é·‡˜ÂÍÓ̈ÂÔˆËflÚ‡ Á‡ ÒËÏÔ‡ÚËÍÓ-ÔÓ‰‰˙ʇ̇ڇ ·ÓÎ͇, Ó·ÓÒ-ÌÓ‚‡Ì‡ ËÁÍβ˜ËÚÂÎÌÓ ‚˙ıÛ ÔÓÎÓÊËÚÂÎÌËfl ÂÙÂÍÚ ÓÚÒËÏÔ‡ÚËÍÓÎËÚˈËÚ Ô‰ËÁ‚Ë͇ ‚‡ÊÌË ÒÔÓÓ‚Â. ëÍÓ-Ó¯ÌË ‡Ì‰ÓÏËÁˇÌË Ô·ˆÂ·Ó-ÍÓÌÚÓΡÌË ÔÓÛ˜‚‡ÌËflÔË Ô‡ˆËÂÌÚË Ò ÍÎËÌ˘̇ ͇ÚË̇ ̇ CRPS Ì ҇ ÔÓ͇Á‡-ÎË Ò˙˘ÂÒÚ‚ÂÌÓ ÔÓ‰Ó·ÂÌË ÓÚ ‡Á΢ÌË ÒËÏÔ‡ÚËÍÓÎË-Ú˘ÌË Ôӈ‰ÛË (2).

ëÔÓ‰ ÌflÍÓË ‡‚ÚÓË, ·ÓÎ͇ڇ ÔË Ì‚̇ڇ ۂ‰‡ÏÓÊ ‰‡  Ô‰ËÁ‚Ë͇̇ ‰ËÂÍÚÌÓ ÓÚ ‡ÍÚ˂ˇÌÂÚÓ Ì‡ÌӈˈÂÔÚÓËÚ ̇ nervi nervorum, ËÌ‚ˇ˘Ë Ò˙‰Ë-ÌËÚÂÎ̇ڇ Ú˙Í‡Ì Ì‡ Ì‚ËÚÂ. í‡Í‡‚‡ ·ÓÎ͇ Ò ÓÚ̇Òfl͇ÚÓ Ì‚ÌÓ-ÒÚ‚ÓÎÓ‚‡ ·ÓÎ͇ Ë ÏÓÊ ‰‡ Ò ÔÓfl‚Ë Í‡ÚÓ Â-ÁÛÎÚ‡Ú Ì‡ ‚˙ÁÔ‡ÎÂÌË ̇ Ì‚‡ ËÎË ËÒıÂÏËfl ÔË Ò˙ÒÚÓfl-ÌËfl ͇ÚÓ ÒË̉ÓÏ Ì‡ ÉËÎÂÌ-Ň ËÎË ÌÓ‰ÓÁÂÌ Ô‡Ì‡ÚÂ-ËÚ. èË ÌflÍÓË Ô‡ˆËÂÌÚË Ò ÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl‚˙ÁÔ‡ÎËÚÂÎÌËÚ ËÌÙËÎÚ‡ÚË Ò ̇·Î˛‰‡‚‡Ú ‚ ÒÂÚË‚ÌË-Ú „‡Ì„ÎËË. éÒ‚ÂÌ ÚÓ‚‡, ÔË ÔÓÛ˜‚‡ÌËfl ̇ ÛÎÚ‡ÒÚÛÍ-ÚÛ‡Ú‡ Ò‡ ÓÚÍËÚË ·ÂÎÂÁË Ì‡ χÍÓÙ‡„‡Î̇ ‡ÍÚË‚‡ˆËfl‚ Á‡Ò„̇ÚËÚ ÌÂ‚Ë Ë ÒÂÚË‚ÌËÚ „‡Ì„ÎËË ÒΉ ÒˆˇÌÂ̇ ÔÂËÙÂÂÌ Ì‚. ÄÍÚ˂ˇÌËÚ χÍÓÙ‡„Ë ÏÓ„‡Ú ÓÚÒ‚Ófl Òڇ̇ ‰‡ ÔÓ‰ÛˆË‡Ú ˆËÚÓÍËÌË Í‡ÚÓ ÔÓËÌÙ·-χÚÓÌËfl ÚÛÏÓÌÂÍÓÚËÁˇ˘ Ù‡ÍÚÓ ?, Á‡ ÍÓÈÚÓ Â̇·Î˛‰‡‚‡ÌÓ, ˜Â Ë̉ۈˇ ÂÍÚÓÔ˘ÌË ‡Áfl‰Ë ‚ ۂ‰Â-ÌËfl Ì‚. í‡Í‡ ÚÓÈ ÏÓÊ ‰‡ Ëχ ÓÚÌÓ¯ÂÌË Í˙Ï ‡Á‚Ë-ÚËÂÚÓ Ì‡ ‡ÎÓ‰ËÌËflÚ‡.

éÔËÒ‡ÌËÚ ÔÓ-„Ó ÔÂËÙÂÌË ÏÂı‡ÌËÁÏË Ì ÏÓ„‡Ú ‰‡Ó·flÒÌflÚ ÌflÍÓË ÍÎËÌ˘ÌË ÓÒÓ·ÂÌÓÒÚË Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ·ÓÎ͇, ͇ÚÓ Ë‡‰Ë‡ˆËflÚ‡ È, ÌÂÈ̇ڇ „ÓÎflχ ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚ (ÂÙÂÍÚ Ì‡ ÔÓÒΉÂÈÒÚ‚ËÂ) ÒΉ ÎÂÍË ‰‡ÁÌÂÌËfl,‚ÂÏ‚ÓÚÓ Ë ÚÂËÚÓˇÎÌÓ ÒÛÏˇÌ ̇ ·ÓÎ͇ڇ, Ë Ì‡-΢ËÂÚÓ Ì‡ anesthesia dolorosa. éÒ‚ÂÌ ÚÓ‚‡, ÌflÍÓË ÂÍÒÔÂ-ËÏÂÌÚ‡ÎÌË ËÁÒΉ‚‡ÌËfl ÒÓ˜‡Ú, ˜Â ÏÂı‡Ì˘̇ڇ ‰Ë̇-Ï˘̇ ‡ÎÓ‰ËÌËfl, ̇·Î˛‰‡‚‡Ì‡ ÔË ÌflÍÓË ÔÂËÙÂÌË Ì‚-ÓÔ‡ÚËË ÏÓÊ ‰‡ ·˙‰Â ÔÓ‚Âʉ‡Ì‡ ÔÓ „ÓÎÂÏËÚ (‰Â·ÂÎÓ-ÏËÂÎËÌËÁˇÌË) Äb-‚·Í̇. íÓ‚‡ Ô‰ÔÓ·„‡ Û˜‡ÒÚËÂÚÓ̇ ˆÂÌÚ‡Î̇ Ó·‡·ÓÚ͇ ̇ ÌÂÌӈˈÂÔÚ˂̇ڇ ËÌÙÓ-χˆËfl, ÌÓχÎÌÓ ÔÓ‚Âʉ‡Ì‡ ÔÓ ÚÂÁË ‚·Í̇. èË ÌÂfl ÔÂ-ËÙÂÌËÚ ÔÓÏÂÌË ÔÂÚ˙Ôfl‚‡Ú ˆÂÌÚ‡Î̇ ÍÓÏÔÂÌÒ‡-ˆËfl (8).

ñÖçíêÄãçà åÖïÄçàáåà çÄ îéêåàêÄçÖ çÄçÖÇêéèÄíàóçÄíÄ ÅéãäÄ

Ç ÂÁÛÎÚ‡Ú Ì‡ ÂÍÒÔÂËÏÂÌÚ‡ÎÌË ËÁÒΉ‚‡ÌËfl ÔË ÊË-‚ÓÚÌË Ò‡ Ô‰ÎÓÊÂÌË ÚË ‚˙ÁÏÓÊÌË „·‚ÌË ÏÂı‡ÌËÁχ,Û˜‡ÒÚ‚‡˘Ë ‚˙‚ ‚˙ÁÌËÍ‚‡ÌÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇.í ·Ëı‡ ÏÓ„ÎË ‰‡ Ô‰ËÁ‚ËÍ‡Ú Ô‡ÚÓÎӄ˘ÌÓ ‡ÍÚ˂ˇÌÂ̇ ˆÂÌÚ‡ÎÌËÚ ÌӈˈÂÔÚË‚ÌË Ì‚ÓÌË, ÓÚ„Ó‚ÓÌÓ Á‡: 1.èÓÏfl̇ ‚ ÏÓ‰ÛΡ˘Ëfl ÍÓÌÚÓΠ̇ Ô‰‡‚‡ÌÂÚÓ Ì‡ ÌÓ-ˆËˆÂÔÚ˂̇ڇ ËÌÙÓχˆËfl Ò Û˜‡ÒÚËÂÚÓ Ì‡ ÒÔË̇ÎÌË(Ò„ÏÂÌÚÌË) Ë ÒÛÔ‡ÒÔË̇ÎÌË ÒÚÛÍÚÛË (˜ÂÁ ‰ÂÒˆÂÌ-

‰ÂÌÚÂÌ ÍÓÌÚÓÎ); 2. Ä̇ÚÓÏ˘̇ ÂÓ„‡ÌËÁ‡ˆËfl (Ì‚ÓÔ-·ÒÚ˘ÌÓÒÚ) ̇ ˆÂÌÚ‡ÎÌËÚ ÌӈˈÂÔÚË‚ÌË Ì‚ÓÌË,ÓÚ„Ó‚ÓÌË Á‡ Ô‡ÚÓÎӄ˘̇ڇ ‡ÍÚË‚‡ˆËfl; 3. ñÂÌÚ‡Î̇ÒÂÌÒË·ËÎËÁ‡ˆËfl - ıËÔ‚˙Á·Û‰ËÏÓÒÚ Ì‡ ˆÂÌÚ‡ÎÌËÚ ÌÓ-ˆËˆÂÔÚË‚ÌË Ì‚ÓÌË.

ÑÓ͇ÚÓ Ô˙‚˘̇ڇ ıËÔ‡΄ÂÁËfl ‚˙ÁÌËÍ‚‡ ͇ÚÓ Â-ÁÛÎÚ‡Ú Ì‡ ÒÂÌÒË·ËÎËÁ‡ˆËfl ‚ ÌÂÔÓÒ‰ÒÚ‚Â̇ڇ ÁÓ̇ ̇Ú˙͇Ì̇ڇ ۂ‰‡, "‚ÚÓ˘̇ڇ ıËÔ‡΄ÂÁËfl" Ò fl‚fl‚‡‚ ÌÂۂ‰Â̇ڇ Ú˙Í‡Ì ÓÍÓÎÓ ÏflÒÚÓÚÓ Ì‡ Á‡Òfl„‡ÌÂÚÓ. ÇÚ‡ÁË ÁÓ̇ Ôӂ˯Â̇ڇ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ Í˙Ï ÎÂÍ ‰ÓÔË(ÏÂı‡Ì˘ÌË ÒÚËÏÛÎË) ÏÓÊ ‰‡ Ô‰ËÁ‚Ë͇ ·ÓÎ͇. è‰ÔÓ-·„‡ ÒÂ, ˜Â Ú‡ÁË ‚ÚÓ˘̇ ıËÔ‡΄ÂÁËfl Ò ‡Á‚Ë‚‡ ͇ÚÓÔÓÒΉˈ‡ ÓÚ ÔÓÏÂÌËÚÂ, ̇ÒÚ˙Ô‚‡˘Ë ‚ ÔÂËÙÂËflÚ‡,͇ÍÚÓ Ë ‚ ñçë - Ú.Ì. ˆÂÌÚ‡Î̇ ÒÂÌÒË·ËÎËÁ‡ˆËfl. èËÂχÒÂ, ˜Â ‚ÒΉÒÚ‚Ë ̇ ÔÂËÙÂ̇ڇ Ì‚̇ ۂ‰‡, ÂÍÒˆÂ-ÒË‚ÌË ÒÂÚË‚ÌË ÒÚËÏÛÎË Ò ÔÓ‚Âʉ‡Ú ‰Ó ñçë Ë Ì‡ÒÚ˙Ô-‚‡ Ì‚ÓÔ·ÒÚ˘̇ ÂÓ„‡ÌËÁ‡ˆËfl Ë ÒÂÌÒË·ËÎËÁ‡ˆËfl ÒÔÓÏÂÌË ‚ ˆÂÔÚË‚ÌËÚ ÔÓÎÂÚ‡ ̇ ÍÎÂÚÍËÚ ̇ Á‡‰ÌË-Ú ӄ‡. èÓÏÂÌËÚ ‚ ñçë ‚Íβ˜‚‡Ú ‡Á¯Ëfl‚‡Ì ‡Á-χ ̇ ˆÂÔÚË‚ÌËËÚ ÔÓÎÂÚ‡, ̇‡ÒÚ‚‡Ì ‚Â΢ËÌ‡Ú‡Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ ÓÚ„Ó‚ÓËÚ Í˙Ï ‰‡ÁÌËÚÂÎË-ÚÂ, Ë Ì‡Ï‡Îfl‚‡Ì ̇ Ô‡„‡ ̇ ·ÓÎÍÓ‚ËÚ ÛÒ¢‡ÌËfl. í‡Í‡ÌÓχÎÌÓ Ì·ÓÎÂÁÌÂÌËÚ ÏÂı‡Ì˘ÌË ÒÚËÏÛÎË ‡ÍÚ˂ˇÚÌ‚ÓÌËÚÂ, ÔÓ‚Âʉ‡¯Ë ÌӈˈÂÔÚ˂̇ ËÌÙÓχˆËfl Ë ÚÂÒ ‚˙ÁÔËÂÏ‡Ú Í‡ÚÓ ·ÓÎ͇. äÎÂÚÍËÚ ̇ Á‡‰ÌËÚ ӄ‡ ÌÂÒ‡ÏÓ Ò ‡ÍÚ˂ˇÚ, ÌÓ Ò ÔÓÏÂÌflÚ Ë Ò‚ÓÈÒÚ‚‡Ú‡ ̇ÓÚ„Ó‚Ó‡ ËÏ. 燷≇‚‡ Ò ÔÓ„ÂÒË‚ÌÓ Û‚Â΢‡‚‡Ì ̇‚˙Á·Û‰ËÏÓÒÚÚ‡ ̇ ÚÂÁË Ì‚ÓÌË Ë ‡Á¯Ëfl‚‡Ì ̇ ˆÂÔ-ÚÓÌËÚ ËÏ ÔÓÎÂÚ‡, ̇˜ÂÌÓ "wind-up" (ËÁ‰Ë„‡ÌÂ). íÓ‚‡Ô‡‚Ë Ì‚ÓÌËÚ ÔÓ-˜Û‚ÒÚ‚ËÚÂÎÌË Í˙Ï ‰Û„Ë ‰‡ÁÌËÚÂ-ÎË Ë Â Ò˙˘ÂÒÚ‚ÂÌ ÂÎÂÏÂÌÚ ÓÚ ˆÂÌÚ‡Î̇ڇ ÒÂÌÒË·ËÎËÁ‡-ˆËfl, ÓÒÌÓ‚ÂÌ ‚ ÔÓ‰‰˙ʇÌÂÚÓ Ì‡ Ôӂ˜ÂÚÓ ‚ˉӂ Ì‚Ó-Ô‡Ú˘̇ ·ÓÎ͇.

éÒ‚Ó·Óʉ‡‚‡ÌÂÚÓ Ì‡ Ì‚ÓÚ‡ÌÒÏËÚÂË Í‡ÚÓ ÒÛ·Ò-ڇ̈Ëfl ê, „ÎÛڇχÚ, ͇ΈËÚÓÌËÌ „ÂÌÌÓ-Ò‚˙Á‡Ì ÔÂÔÚˉ(CGRP), γ-‡ÏËÌÓχÒÎÂ̇ ÍËÒÂÎË̇ (ÉÄåä, GABA) Ë Ì‚-ÓÍËÌËÌ Ä Ò‡ Íβ˜Ó‚Ë Ù‡ÍÚÓË ‚ ‰ÂÁËÌı˷ˈËflÚ‡ Ë ËÌ-‰Û͈ËflÚ‡ ̇ ˆÂÌÚ‡Î̇ڇ ÒÂÌÒË·ËÎËÁ‡ˆËfl. åÌÓ„Ó Ì‚-ÓÚ‡ÌÒÏËÚÂË ‰ÂÈÒÚ‚‡Ú, ‡ÁÔÓÎÓÊÂÌË ÔÂ- Ë ÔÓÒÚÒË-̇ÔÚ˘ÌÓ ‚˙ıÛ ÓÍÓ̘‡ÌËflÚ‡ ̇ Ô˙‚˘ÌËÚ ‡ÙÂÂÌÚÌ˂·Í̇ ‚ Á‡‰ÌËÚ ӄ‡. ÖÍÒˆËÚ‡ÚÓÌËÚ Ì‚ÓÚ‡ÌÒÏË-ÚÂË, ͇ÚÓ ‡ÏËÌÓÍËÒÂÎË̇ڇ Glutamate, Ô‰ËÁ‚ËÍ‚‡ÚÛ‚Â΢ÂÌ Í‡ÎˆË‚ ÔÂχ·ËÎËÚÂÚ Ë ‡Á‚ËÚË ̇ ÂÍÒˆË-ÚÓÚÓÍÒ˘ÌÓÒÚ. ë˜ËÚ‡ ÒÂ, ˜Â ÚÂÏ˘̇ڇ Ë ÏÂı‡Ì˘̇-Ú‡ ıËÔ‡΄ÂÁËfl Ô‰ËÁ‚ËÍ‚‡Ú ‡ÍÚ˂ˇÌ ̇ ‡Á΢ÌËÂÍÒˆËÚ‡ÚÓÌË ‡ÏËÌÓÍËÒÂÎËÌÌË ÂˆÂÔÚÓË Ë ËÌÚ‡ˆÂÎÛ-·ÌË Í‡Ò͇‰Ë ‚ Á‡‰ÌËÚ ӄ‡ ̇ „˙·Ì‡˜ÌËfl ÏÓÁ˙Í. ìÒÚ‡-ÌÓ‚ÂÌÓ Â, ˜Â NMDA-ˆÂÔÚÓËÚ ˄‡flÚ ‚‡Ê̇ ÓÎfl ‚Ë̉Û͈ËflÚ‡ Ë ÔÓ‰‰˙ʇÌÂÚÓ Ì‡ ÚÂÏ˘̇ڇ ıËÔ‡΄Â-ÁËfl.

èÓ‰˙ÎÊËÚÂÎÌÓ ‡ÍÚ˂ˇÌ ̇ ˆÂÔÚÓË ÓÚ „ÎÛÚ‡-ÏËÌ„˘ÌËÚ ÔÓ‰ÚËÔӂ ̇ ÄåêÄ-(α-‡ÏËÌÓ-3-ıˉÓÍ-ÒË-5-ÏÂÚËÎ-4-ËÁÓÎÂÔÓÔËÓÌÓ‚‡ ÍËÒÂÎË̇) Ë Ì‚ÓÍËÌË̇ÍÚË‚Ë‡Ú NMDA-(N-ÏÂÚËÎ-D-‡ÒÔ‡Ú‡Ú) ˆÂÔÚÓ‡(îË„.1). í‡Í‡ ‡ÍÚË‚Ë‡Ì NMDA-ˆÂÔÚÓ˙Ú ‚Íβ˜‚‡ ‚‰ÂÈÒÚ‚Ë ÔÓ‰ˈ‡ ÓÚ Ò˙·ËÚËfl, ÍÓËÚÓ Ôӂ˯‡‚‡Ú ÓÚ-„Ó‚Ó‡ ̇ ÌӈˈÂÔÚ˂̇ڇ ÒËÒÚÂχ. èË ÌÓχÎÌËfl ÔÓ-ÚÂ̈ˇΠ̇ ÔÓÍÓÈ ÈÓÌÌËflÚ Í‡Ì‡Î Ì‡ NMDA-ˆÂÔÚÓ‡ ·ÎÓÍË‡Ì ÓÚ Ï‡„ÌÂÁË‚‡ ÈÓÌ̇ "Á‡ÔÛ¯‡Î͇". ÄÍÚ˂ˇ-ÌÂÚÓ Ì‡ ˆÂÔÚÓ‡ ‚Ó‰Ë ‰Ó ÓÚÒÚ‡‚Ìfl‚‡Ì ̇ Á‡ÔÛ¯‡Î-͇ڇ Ë Ì‡‚ÎËÁ‡Ì ̇ ͇ΈËÈ ‚˙Ú ‚ ÍÎÂÚ͇ڇ. íÓ‚‡ ÔÂ-‰ËÁ‚ËÍ‚‡ Ôӂ˯Â̇ ‚˙Á·Û‰ËÏÓÒÚ Ì‡ ÍÎÂÚ͇ڇ, ÓÌÍÓ„ÂÌ̇Ë̉Û͈Ëfl Ë ÔÓ‰Û͈Ëfl ̇ ‡ÁÓÚÂÌ ÓÍËÒ (NO). 燂ÎËÁ‡ÌÂÚÓ̇ ͇ΈËÈ Â ÏÌÓ„Ó ‚‡ÊÌÓ Á‡ ÔÓ‰‰˙ʇÌÂÚÓ Ì‡ ˆÂÌÚ‡Î̇-Ú‡ ÒÂÌÒË·ËÎËÁ‡ˆËfl. ä‡ÎˆË‚ËÚ ÈÓÌË ‰ÂÈÒÚ‚‡Ú ͇ÚÓ‚ÚÓ˘ÌË ÔÓÒ‰ÌËˆË Ë ‚Ó‰flÚ ‰Ó ‡ÍÚ˂ˇÌÂÚÓ Ì‡ ÔÓ-ÚÂËÌ ÍË̇Á‡ ë, ÙÓÒÙÓÎËÔ‡Á‡ ë, NO-ÒËÌÚÂÚ‡Á‡ Ë Ë̉ÛÍ-ˆËfl ̇ ‡Ì̇ „ÂÌ̇ ÂÍÒÔÂÒËfl. èÓÚÂËÌ ÍË̇Á‡ ë ÙÓÒÙÓ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 120‰ÂÍÂÏ‚Ë, 2002

ËΡ NMDA-ˆÂÔÚÓ‡, Ô‰ËÁ‚ËÍ‚‡ÈÍË ÔÓ‰˙ÎÊË-ÚÂÎÌÓ ÓÚÒÚ‡Ìfl‚‡Ì ̇ χ„ÌÂÁË‚‡Ú‡ ·ÎÓ͇‰‡ Ë Ú‡Í‡ÓÒÚ‡‚fl ˆÂÔÚÓÌËfl ͇̇ΠڇÈÌÓ ÓÚ‚ÓÂÌ. è‰ÔÓ·„‡ÒÂ, ˜Â ‡ÁÓÚÌËflÚ ÓÍËÒ ‰ËÙÛ̉ˇ Ó·‡ÚÌÓ ÔÂÁ ÔÂÒË̇Ô-Ú˘̇ڇ ÏÂÏ·‡Ì‡ Ë ÒÂÌÒË·ËÎËÁˇ ‰Û„ËÚ ˆÂÔÚÓË‚ ÔÓÎÂÚÓ. ÇÂÓflÚÌÓ ÚÓÈ Ëχ ÓÚÌÓ¯ÂÌË Í˙Ï ÍÎÂÚ˙˜Ì‡-Ú‡ ÒÏ˙Ú, ̇·Î˛‰‡‚‡Ì‡ ÒΉ ÔÓ‰˙ÎÊËÚÂÎ̇ ‡ÍÚË‚‡ˆËfl̇ ÌӈˈÂÔÚË‚ÌËÚ ‡ÙÂÂÌÚË. èӂ˯Â̇ڇ ÙÓÒÙÓÎËÔ‡-Á‡ ë ‚Ó‰Ë ‰Ó ÔÓ‰Û͈Ëfl ̇ ÔÓÒÚ‡„·̉ËÌË, ÍÓËÚÓ ÔÓ‚Ë-¯‡‚‡Ú ‚˙Á·Û‰ËÏÓÒÚÚ‡ ̇ Ò˙Ò‰ÌËÚ Ì‚ÓÌË Ë ‡Á¯Ëfl-‚‡Ú ‡Áχ ̇ ˆÂÔÚÓÌÓÚÓ ÔÓΠ(13). ÖÍÒÔÂÒˇ ÒÂÔÓÚÓÓÌÍÓ„ÂÌ G, ˜ËÈÚÓ ÔÓ‰ÛÍÚ ÎÂÒÌÓ Ì‡‚ÎËÁ‡ ‚ ÍÎÂÚ͇-Ú‡. íÓÈ Â Ô˙‚ËflÚ ÎË„‡Ì‰, ÍÓÈÚÓ ‚Á‡ËÏÓ‰ÂÈÒÚ‚‡ Ò α

2β-

Ò۷‰ËÌˈ‡Ú‡ ̇ ͇ΈË‚Ëfl ͇̇Î, ÏÓ‰ÛΡÈÍË ÔÓ ÚÓÁË̇˜ËÌ ÈÓÌÌËfl ÔÓÚÓÍ ÔÂÁ Ì„Ó. íÂÁË ÂÍÒˆËÚÓÚÓÍÒ˘ÌËÔÓˆÂÒË ‚ÂÓflÚÌÓ Ò‡ Ï‰ËˇÌË ÓÚ ÂÍÒˆËÚ‡ÚÓ̇ ‡ÏË-ÌÓÍËÒÂÎËÌ̇ ‡ÍÚË‚ÌÓÒÚ, ÍÓÂÚÓ ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó Û‚ÂÎË-˜ÂÌ Í‡ÎˆË‚ ÔÂχ·ËÎËÚÂÚ.

Ç˙‚ ÙÓÏˇÌÂÚÓ Ì‡ ‡ÎÓ‰ËÌËflÚ‡ Ò˙˘Ó Û˜‡ÒÚ‚‡Ú ˆÂÌ-Ú‡ÎÌË ÏÂı‡ÌËÁÏË. çÓχÎÌÓ ÒÚËÏÛ·ˆËflÚ‡ ̇ Äβ-β·Í̇ڇ, ÍÓËÚÓ ‰ÓÒÚË„‡Ú laminae III Ë IV ‚ „˙·Ì‡˜ÌËflÏÓÁ˙Í Ô‰ËÁ‚ËÍ‚‡ ÛÒ¢‡Ì Á‡ ‰ÓÔË. èË ÌflÍÓË Ì‚ÓÔ‡-Ú˘ÌË ·ÓÎÍÓ‚Ë ÒË̉ÓÏË (̇Ô. ÔÓÒÚıÂÔÂÚ˘̇ڇ Ì‚-‡Î„Ëfl) ÒÚËÏÛ·ˆËflÚ‡ ̇ ÚÂÁË ‚·Í̇ Ô‰ËÁ‚ËÍ‚‡ ·ÓÎÂÁ-ÌÂÌË ÛÒ¢‡ÌËfl (‡ÎÓ‰ËÌËfl). ëÔÓ‰ ‰̇ ÓÚ ıËÔÓÚÂÁËÚÂ,Ì‚ÌËÚ ‚·Í̇, ÍÓËÚÓ ÌÓχÎÌÓ Ì ÔÓ‚Âʉ‡Ú ·ÓÎÍÓ‚‡ËÌÙÓχˆËfl ÔÓ‡ÒÚ‚‡Ú ‚ ÔÓ-ÔÓ‚˙ıÌÓÒÚÌË Â„ËÓÌË Ì‡Á‡‰ÌËÚ ӄ‡, ÔÂÒ˘‡ÈÍË Î‡ÏËÌËÚÂ Ë Ú‡Í‡ Ò Á‡‡Ì„‡ÊË-‡Ú ‚ ·ÓÎÍÓ‚‡Ú‡ Ú‡ÌÒÏËÒËfl. Ç·Í̇ڇ, ÍÓËÚÓ ÌÓχÎ-ÌÓ Á‡‚˙¯‚‡Ú ‚ laminae III Ë IV ËÁÔ‡˘‡Ú ‡ÁÍÎÓÌÂÌËflÍ˙Ï lamina ¨¨. åÓ„‡Ú ‰‡ Ò ‡Á‚ËflÚ ÔÂÒË̇ÔÚ˘ÌË Ò‚˙-Á‚‡ÌËfl ÏÂÊ‰Û ë Ë Äβ-‚·Í̇ڇ, ڇ͇ ˜Â, ÒÚËÏÛ·ˆËflڇ̇ Äβ-‚·Í̇ڇ ‰‡ ‡ÍÚ˂ˇ ë-‚·Í̇ڇ, ‚Ó‰Â˘Ó ‰Ó ÛÒÂ-˘‡Ì Á‡ ·ÓÎ͇. íÂÁË Ò‚˙Á‚‡ÌËfl ÓÒË„Ûfl‚‡Ú ÌÓ‚ ‰ÓÒÚ˙Ô Á‡·ÓÎÍÓ‚ËÚ Ô˙Úˢ‡, Î˯ÂÌ ÓÚ ‚Òfl͇͂‡ ÔÂÒË̇ÔÚ˘̇ËÌı˷ˈËfl.

ëÔÓ‰ ÌflÍÓË ÌÓ‚Ë ËÁÒΉ‚‡ÌËfl Ë̉˂ˉۇÎÌËÚ ÓÒÓ-·ÂÌÓÒÚË ‚˙‚ ‚˙ÁÌËÍ‚‡ÌÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ËÏ‡Ú „ÂÌÂÚ˘̇ ÓÒÌÓ‚‡ - Ò˙˘ÂÒÚ‚Û‚‡ Ë „ÂÌÂÚ˘ÌÓ Ô‰-‡ÁÔÓÎÓÊÂÌË Í˙Ï Ì‚ÓÔ‡Ú˘̇ ·ÓÎ͇ (10).

ê‡Á‚ËÚËÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇  ÂÁÛÎÚ‡Ú ÓÚÔÓ‰ˈ‡ Ò˙·ËÚËfl, ‚Íβ˜‚‡˘Ë ÔÓÏÂÌË ‚ ÔÂËÙÂ̇ڇ ˈÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ ̇ ÙËÁËÓÎӄ˘ÌÓ Ë ·ËÓıË-Ï˘ÌÓ ÌË‚Ó. ã˜ÂÌËÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ ˆÂÎËÔÂÍ˙Ò‚‡ÌÂÚÓ Ì‡ ‚Òfl͇ ÓÚ ÒÚ˙ÔÍËÚ ‚ Ú‡ÁË ÔÓÒΉӂ‡-ÚÂÎÌÓÒÚ ÓÚ ÔÓˆÂÒË. àÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ÍÓÏ·Ë̇ˆËfl ÓÚ‡„ÂÌÚË ÏÓÊ ‰‡ ·˙‰Â ‡ÁÛÏÂÌ ÔÓ‰ıÓ‰ Í˙Ï ÔÓ‚ÎËfl‚‡ÌÂÚÓ̇ ͇Ò͇‰‡Ú‡ ̇ ÏÌÓ„Ó ÌË‚‡.

ãÖóÖçàÖ çÄ çÖÇêéèÄíàóçÄíÄ ÅéãäÄÑÓ͇ÚÓ Á‡ ΘÂÌËÂÚÓ Ì‡ ÌӈˈÂÔÚ˂̇ڇ ·ÓÎ͇ (ÓÚ

ÍÓʇڇ ËÎË ‰˙ηÓÍÓ ‡ÁÔÓÎÓÊÂÌË ·ÓÎÍÓ‚Ó-ÒÔˆËÙ˘ÌË Â-ˆÂÔÚÓË)  ÛÒÚ‡ÌÓ‚ÂÌÓ ÂÙÂÍÚË‚ÌÓ Ù‡Ï‡ÍÓÎӄ˘ÌÓ Î˜Â-ÌËÂ, Á‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ ‚ ÏÓÏÂÌÚ‡ Ìflχ ÔÓ‰ıÓ‰fl-˘Ó ‰ÂÙËÌËÚË‚ÌÓ Ù‡Ï‡ÍÓÎӄ˘ÌÓ Î˜ÂÌË (9).

íˈËÍ΢ÌË ‡ÌÚˉÂÔÂÒ‡ÌÚË. ç‡È-ËÁÔÓÎÁ‚‡ÌËÚ ÎÂ-͇ÒÚ‚‡ Á‡ ΘÂÌËÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ ͇ÚÓÏÓÌÓÚ‡ÔËfl ËÎË ‚ ÍÓÏ·Ë̇ˆËfl Ò‡ amitriptylline, doxepin,desipramine, clomipramine. ë˙˘ÂÒÚ‚Û‡Ú Â‰Ë̇‰ÂÒÂÚ ‡Ì-‰ÓÏËÁˇÌË ÍÓÌÚÓΡÌË ÔÓÒÔÂÍÚË‚ÌË ÍÎËÌ˘ÌË ÔÓÛ-˜‚‡ÌËfl, ËÁÒΉ‚‡˘Ë ÂÙË͇ÒÌÓÒÚÚ‡ ËÏ (̇ÔËÏ ÔË ÔÓÒ-ÚıÂÔÂÚ˘̇ Ì‚ÓÔ‡ÚËfl). èË Úflı Ò‡ÏÓ ÓÍÓÎÓ 50% ÓÚÔ‡ˆËÂÌÚËÚ ҇ Ò˙Ò Á‡‰Ó‚ÓÎËÚÂÎÌÓ Ó·ÎÂ͘‡‚‡Ì ̇ ·ÓÎ͇-Ú‡ ÔË ÔÓÌÓÒËÏË ÒÚ‡Ì˘ÌË ÂÙÂÍÚË (‡ËÚÏËË, ÔÓÒÚÛ-‡ÎÌË ıËÔÓÚÂÌÁËË, Ò‰‡ˆËfl, ÒÛıÓÚ‡ ‚ ÛÒÚ‡Ú‡, ÍÓÌÒÚËÔ‡-ˆËfl, Ó·˙͇ÌÓÒÚ Ë ÂÚÂ̈Ëfl ̇ ÛË̇ڇ), ÍÓÂÚÓ „Ë Ô‡-‚Ë ÌÂÔÓ‰ıÓ‰fl˘Ë Á‡ ËÁÔÓÎÁ‚‡Ì ÔË ÔÓ-‚˙Á‡ÒÚÌË Ô‡ˆËÂÌ-

ÚË Ë Ú‡ÍË‚‡ Ò˙Ò Ò˙‰Â˜ÌÓ-Ò˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl. ÄÌÚˉÂÔÂÒ‡ÌÚËÚ ÓÚ „ÛÔ‡Ú‡ ̇ ÒÔˆËÙ˘ÌËÚ ËÌ-

ıË·ËÚÓË Ì‡ Ó·‡ÚÌËfl Á‡ı‚‡Ú ̇ ÒÂÓÚÓÌË̇ (SSRIs) Ìfl-Ï‡Ú ‰Ó͇Á‡Ì ‡Ì‡Î„ÂÚ˘ÂÌ ÂÙÂÍÚ.

ãÓ͇ÎÌËÚ ‡ÌÂÒÚÂÚËˆË Ë ÌÂÒÚÂÓˉÌËÚ ÔÓÚË‚Ó‚˙Á-Ô‡ÎËÚÂÎÌË Ò‰ÒÚ‚‡ Ò‡ Ò Í‡ÚÍÓÚ‡ÂÌ ÂÙÂÍÚ Ë Á‡ ÚflıÎËÔÒ‚‡Ú ‰‡ÌÌË Á‡ ‰˙΄ÓÚ‡È̇ ÛÔÓÚ·‡.

éÔËÓˉÌËÚ ‡Ì‡Î„ÂÚˈËË ËÏ‡Ú ‰Ó·˙ Ô˙‚Ó̇˜‡ÎÂÌÂÙÂÍÚ, ÌÓ Ì  ÔÓ‰ÍÂÔÂÌÓ Ò˙Ò Á‡‰Ó‚ÓÎËÚÂÎÌË Ô·ˆÂ·Ó-ÍÓÌÚÓΡÌË ÔÓÛ˜‚‡ÌËfl, ÍÓËÚÓ ‰‡ ÔÓÍ‡Ê‡Ú ÂÙÂÍÚË‚-ÌÓÒÚÚ‡ ÔË ‰˙΄ÓÚ‡È̇ ÛÔÓÚ·‡. éÒ‚ÂÌ ÚÓ‚‡, Úfl Ì Âڇ͇ ‰Ó·‡ ÔË Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇, ͇ÍÚÓ ÔË ÌÓˆË-ˆÂÔÚ˂̇ڇ. (9).

Gabapentin (1-[‡ÏËÌÓÏÂÚËÎ]-ˆËÍÎÓıÂÍÒ‡ÌÓˆÂÚ̇ ÍËÒÂ-ÎË̇) Ó͇Á‚‡ ӷ¢‡‚‡˘ ÔÓÙËΠ͇ÚÓ ÌÂ-ÓÔËÓˉÌÓ Ò‰Ò-Ú‚Ó Ò˙Ò Ò˙˘ÂÒÚ‚ÂÌ Ó·ÂÁ·ÓÎfl‚‡˘ ÂÙÂÍÚ Ë ‰Ó·‡ ÔÓÌÓÒË-ÏÓÒÚ. íÓÈ Â ÎËÔÓÙËÎÂÌ Ï‰Ë͇ÏÂÌÚ Ë ÎÂÒÌÓ ÔÓÌËÍ‚‡ÔÂÁ Í˙‚ÌÓ-ÎËÍ‚Ó̇ڇ ·‡Ë‡. Ç˙‚‰ÂÌ Â ‚ ëÄô ÔÂÁ1994„. ͇ÚÓ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚ Á‡ ÔÓ‚ÎËfl‚‡Ì ˜ÂÒÚÓڇڇ̇ ÔËÒÚ˙ÔËÚ ͇ÚÓ ‰ÓÔ˙ÎÌËÚÂÎ̇ Ú‡ÔËfl (9).

Gabapentin  ÒÚÛÍÚÛÂÌ ‡Ì‡ÎÓ„ ̇ γ-‡ÏËÌÓχÒÎÂ̇ÍËÒÂÎË̇ (ÉÄåä), ÌÓ Ì Ò ҂˙Á‚‡ Ò ÉÄåä-ˆÂÔÚÓËÚÂ(13). íÓÈ Ëχ ÒΉÌËÚ ÂÙÂÍÚË:

1.ì‚Â΢‡‚‡ ÍÓ̈ÂÌÚ‡ˆËflÚ‡ Ë ‚ÂÓflÚÌÓ ÒËÌÚÂÁ‡ ̇ÉÄåä ‚ ÏÓÁ˙͇. ë˙˘ÂÒÚ‚Û‚‡Ú ‰Ó͇Á‡ÚÂÎÒÚ‚‡ in vitro,˜Â Gabapentin ÔÓÏÂÌfl ‡ÍÚË‚ÌÓÒÚÚ‡ ̇ ‰Â͇·ÓÍÒË·Á‡-Ú‡ ̇ „ÎÛÚ‡ÏËÌÓ‚‡Ú‡ ÍËÒÂÎË̇ ( „ÎÛÚ‡ÏË̇ˆË‰‰Â͇·ÓÍ-ÒË·Á‡). ä‡ÚÓ ÂÁÛÎÚ‡Ú Ò ̇χÎfl‚‡ ‡Á„‡Ê‰‡ÌÂÚÓ Ë ÒÂÛ‚Â΢‡‚‡ ÒËÌÚÂÁ‡ ̇ ÉÄåä-„ÎÛÚ‡Ï‡Ú ‚ Ì‚̇ڇ Ú˙-͇Ì, Ò ÍÓÂÚÓ Ò ‡ÍÚË‚Ë‡Ú ËÌıË·ËÚÓÌËÚ ÔÓˆÂÒË ‚Ì‚̇ڇ ÒËÒÚÂχ.

ìÒÚ‡ÌÓ‚ÂÌÓ Â, ˜Â ÉÄåä-ˆÂÔÚÓËڠωËË‡Ú ÔÂ-Ë ÔÓÒÚÒË̇ÔÚ˘ÌÓÚÓ ËÌıË·‡Ì ̇ ÒÂÚË‚ÌËÚ ‡ÙÂÂÌÚ-ÌË ‚·Í̇, ‡ ÉÄåä-‡„ÓÌËÒÚËÚ ËÏ‡Ú ÒËÎ̇ ‡ÍÚË‚ÌÓÒÚÔË ÔÓÎËfl‚‡Ì ‡ÎÓ‰ËÌËflÚ‡ ÔË ÊË‚ÓÚÌË. èÓ‡‰Ë ÚÓ‚‡ ÒÂÔ‰ÔÓ·„‡, ˜Â Gabapentin ÏÓÊ ‰‡ ·˙‰Â ÂÙÂÍÚË‚ÂÌ ‚ ‡Ì-Ú‡„ÓÌËÁˇÌÂÚÓ Ì‡ ÌflÍÓË ÓÚ ·ÓÎÍÓ‚ËÚ ÒË̉ÓÏË.

2. Gabapentin ÏÓ‰ÛΡ ÓÔ‰ÂÎÂÌ ‚ˉӂ ÓÚ Í‡ÎˆË‚Ë-Ú ÔÓÚÓˆË (13). è‰ÔÓ·„‡ ÒÂ, ˜Â ˜ÂÁ ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ë Òα

2β-Ò۷‰ËÌˈ‡Ú‡ ̇ ‚ÓÎÚ‡Ê-Á‡‚ËÒËÏËÚ ͇ΈË‚ËÚÂ

͇̇ÎË (‡ÁÔÓÎÓÊÂÌË ‚˙ıÛ Ô˙‚˘ÌËÚ ‡ÙÂÂÌÚÌË Ì‚-ÓÌË) ÚÓÈ ÏÓÊ ‰‡ ÔÓ‰ÚËÒÌ ÓÒ‚Ó·Óʉ‡‚‡ÌÂÚÓ Ì‡ ÂÍÒˆË-Ú‡ÚÓÌËÚ ‡ÏËÌÓÍËÒÂÎËÌË ÓÚ Ô˙‚˘ÌËfl ‡ÙÂÂÌÚÂÌÌ‚ÓÌ. ᇠ‡ÁÎË͇ ÓÚ ‰Û„ËÚ ‡ÌÚËÍÓ‚ÛÎÒ‡ÌÚË,Gabapentin Ì ÔÓ‚ÎËfl‚‡ ̇ÚË‚ËÚ ÈÓÌÌË ÔÓÚÓˆË.

3. ìÒÚ‡ÌÓ‚ÂÌÓ Â, ˜Â Gabapentin ÔÓ‰ÚËÒ͇ ÏÓÌÓ‡ÏËÌ-Ì‚ÓÚ‡ÌÒÏËÚÂÌÓÚÓ ÓÒ‚Ó·Óʉ‡‚‡Ì - ‚ÂÓflÚÌÓ ˜ÂÁ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂÚÓ ÏÛ Ò Í‡ÎˆË‚ËÚ ͇̇ÎË.

4. Gabapentin Ëχ ‚ÂÓflÚÌÓ Ë ˆÂÌÚ‡ÎÂÌ ÏÂı‡ÌËÁ˙Ï Ì‡‰ÂÈÒÚ‚ËÂ. íÓÈ Ëχ ÏÓ‰ÛΡ˘ ÂÙÂÍÚ ‚˙ıÛ ‡Á‚ËÚËÂÚÓ̇ ˆÂÌÚ‡Î̇ڇ ÒÂÌÒË·ËÎËÁ‡ˆËfl. ë˙˘ÂÒÚ‚Û‚‡Ú Ò˙˘Óڇ͇ ‰Ó͇Á‡ÚÂÎÒÚ‚‡, ˜Â ωË͇ÏÂÌÚ˙Ú Ëχ Ô‚‡ÌÚË-‚ÂÌ ÂÙÂÍÚ ÔÓ ÓÚÌÓ¯ÂÌË ̇ ıËÔ‡΄ÂÁËflÚ‡ - ‡ÌÚ‡„ÓÌË-Áˇ Í˙ÒÌÓÙ‡ÁÓ‚‡Ú‡ ÒÂÌÒË·ËÎËÁ‡ˆËfl.

5. Gabapentin Ëχ ‰ËÂÍÚÌÓ Ë Ë̉ËÂÍÚÌÓ ÏÓ‰ÛΡ-˘Ó ‰ÂÈÒÚ‚Ë ‚˙ıÛ ÙÛÌ͈ËËÚ ̇ Ì‚ÓÌËÚ ̇ Á‡‰ÌËÚÂÓ„‡.

äãàçàóçà èêéìóÇÄçàü ë GABAPENTIN èêàçÖÇêéèÄíàóçà ÅéãäéÇà ëàçÑêéåà

Ç ÎËÚ‡ÚÛ‡Ú‡ Ò Ò¢‡Ú „ÓÎflÏ ·ÓÈ Ï‡ÎÍË ÍÎËÌ˘-ÌË ÔÓÛ˜‚‡ÌËfl Ë Ò˙Ó·˘ÂÌËfl Á‡ ËÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡Gabapentin ÔË Ì‚ÓÔ‡Ú˘ÌË ·ÓÎÍÓ‚Ë ÒË̉ÓÏË. é·Ó·-˘ÂÌËÚ ‰‡ÌÌË ÔÓ͇Á‚‡Ú, ˜Â: 1. Gabapentin ÓÒË„Ûfl‚‡ ÔÓ-‰˙ÎÊËÚÂÎÌÓ Ó·ÎÂ͘‡‚‡Ì ÔË Ì‚ÓÔ‡Ú˘̇ ·ÓÎ͇, ÎÓ͇-ÎËÁˇ̇ ‚ ӷ·ÒÚÚ‡ ̇ ¯ËflÚ‡ Ë „·‚‡Ú‡, ÔË ÏÌÓÊÂÒÚ-‚Â̇ ÒÍÎÂÓÁ‡, ÒË̉ÓÏ Ì‡ ÉËÎÂÌ-ŇÂ, Ì‚ËÚ Ì‡ Îˈ‚Ëfl

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 121‰ÂÍÂÏ‚Ë, 2002

Ì‚, ÂÙÎÂÍÒ̇ ÒËÏÔ‡ÚËÍÓ‚‡ ‰ËÒÚÓÙËfl Ë ÚË„ÂÏË̇Î-̇ Ì‚‡Î„Ëfl (13). 2. Gabapentin  ËÁÔÓÎÁ‚‡Ì Ò ÛÒÔÂı ͇ÚÓ‰ÓÔ˙ÎÌËÚÂÎ̇ Ú‡ÔËfl Í˙Ï ÓÔËÓˉ̇ڇ ‡Ì‡Î„ÂÁËfl ÔËÌÂÓÔ·ÒÚ˘̇ Ì‚ÓÔ‡Ú˘̇ ·ÓÎ͇ (6). 3. èË ·ÓÎÌË ÒÏÛÎÚËÔÎÂ̇ ÒÍÎÂÓÁ‡  ËÁÔÓÎÁ‚‡Ì Á‡ Ó·ÎÂ͘‡‚‡Ì ̇ ·ÓÎÂÁ-ÌÂÌËÚ ÏÛÒÍÛÎÌË ÒÔ‡ÁÏË, ÌÂÔÓ‚ÎËfl‚‡˘Ë Ò ÓÚ ÏËÓ·Í-Ò‡ÌÚË (‰‚ÓÈÌÓ ÒÎflÔÓ, Ô·ˆÂ·Ó-ÍÓÌÚÓΡÌÓ ÔÓÛ˜‚‡ÌÂ)(11). 4. àχ Ò˙Ó·˘ÂÌËfl Á‡ ËÁÔÓÎÁ‚‡Ì ̇ Gabapentin ͇ÚÓÔ‚‡ÌÚ˂̇ Ú‡ÔËfl ÔË ÏË„ÂÌÓÁÌÓ „·‚Ó·ÓÎËÂ.

ç‡È-„ÓÎeÏË Ò‡ ÔÓÛ˜‚‡ÌËflÚ‡, ̇ԇ‚ÂÌË ÔË Ô‡ˆËÂÌÚËÒ ÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl Ë ÔË ‰Ë‡·ÂÚ̇ ÔÂËÙÂ̇Ì‚ÓÔ‡ÚËfl, ÍÓflÚÓ Ò ÔÓfl‚fl‚‡ Ò Ì‚ÓÔ‡Ú˘ÂÌ ·ÓÎÍÓ‚ÒË̉ÓÏ. í‡Í‡ Gabapentin  ̇ÏÂËÎ Ò‚ÓÂÚÓ ÏflÒÚÓ ÔËΘÂÌËÂÚÓ Ì‡ ÚÛ‰ÌÓ ÔÓ‚ÎËfl‚‡˘‡ Ò Ì‚ÓÔ‡Ú˘̇ ·ÓÎ-͇, ÔÓfl‚fl‚‡˘‡ Ò ͇ÚÓ ÛÒÎÓÊÌÂÌË ̇ ÓÒÚ‡Ú‡ ıÂÔÂÒ-ÁÓÒÚÂÓ‚‡ ËÌÙÂ͈Ëfl - ÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl (5).

Rowbotham Ë Ò˙ÚÛ‰ÌËˆË (1998) ÔÛ·ÎËÍÛ‚‡Ú ÂÁÛÎÚ‡-ÚËÚ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ PHN (postherpetic neuralgia)(14).íÓ ‚Íβ˜‚‡ 229 Ô‡ˆËÂÌÚ‡ ÓÚ 16 ÍÎËÌ˘ÌË ˆÂÌÚ˙‡, Û˜‡Ò-Ú‚‡˘Ë ‚ ‰‚ÓÈÌÓ ÒÎflÔÓ, ‡Ì‰ÓÏËÁˇÌÓ, Ô·ˆÂ·Ó-ÍÓÌÚÓ-ΡÌÓ, ÛÒÔÓ‰ÌÓ ÔÓÚ˘‡˘Ó Á‡ ÔÂËÓ‰ ÓÚ 8 Ò‰ÏˈË.èÓÛ˜‚‡ÌÂÚÓ Á‡ÔӘ̇ÎÓ Ò Â‰ÌÓÒ‰Ï˘ÂÌ ËÁıÓ‰ÂÌ ÔÂËÓ‰,ÔÓÒΉ‚‡Ì ÓÚ ˜ÂÚËËÒ‰Ï˘ÌÓ ÚËÚˇÌ ̇ ‰ÓÁËӂ͇-Ú‡ ‰Ó 3600 Ï„./‰ÂÌ Ë ˜ÂÚËËÒ‰Ï˘ÂÌ ÔÂËÓ‰ Ò˙Ò ÒÚ‡·ËÎ-̇ ÔÓ‰‰˙ʇ˘‡ ‰ÓÁËӂ͇. ë‰̇ڇ ‰Ì‚̇ ÓˆÂÌ͇ ̇·ÓÎ͇ڇ (ÓÚ˜Ëڇ̇ Ë Á‡ÔËÒ‚‡Ì‡ ‚ ‰Ì‚ÌËˆË ÔÓ 11-ÚÓ˜ÍÓ-‚‡Ú‡ Ò͇· ̇ Likert) ·Ë· Á̇˜ËÚÂÎÌÓ Â‰ÛˆË‡Ì‡ ‚ ͇fl̇ ÔÓÛ˜‚‡ÌÂÚÓ ÔË „ÛÔ‡Ú‡ Ô‡ˆËÂÌÚË, ÔËÂχ˘ËGabapentin ÒÔflÏÓ ÚÂÁË, ÚÂÚˇÌË Ò Ô·ˆÂ·Ó ( 33.3%ÒÂ˘Û 7.7% Ò˙ÓÚ‚ÂÚÌÓ). èÓ‰Ó·ÂÌË ·ËÎÓ ÓÚ˜ÂÚÂÌÓ ÔÓÓÚÌÓ¯ÂÌË ÚÓÚ‡Î̇ڇ ·ÓÎ͇, ͇ÍÚÓ Ë Á‡ ÒÂÌÁÓÌËfl ˇÙÂÍÚË‚ÌËfl È ÍÓÏÔÓÌÂÌÚ (ê<0.001 Á‡ ÚËÚÂ). 臈ËÂÌ-ÚËÚÂ, ÔËÂχÎË Gabapentin Ò˙Ó·˘ËÎË Ë Á‡ Á̇˜ËÏÓ ÔÓ-‰Ó·ÂÌË ̇ Ò˙Ìfl (ÓÚ˜ÂÚÂÌÓ ÔÓ ÓˆÂÌ˙˜ÌË Ò͇ÎË) ‚ Ò‡‚ÌÂ-ÌËÂ Ò „ÛÔ‡Ú‡, ÔËÂχ˘Ë Ô·ˆÂ·Ó (ê<0.001). Ç Í‡fl ̇ÔÓÛ˜‚‡ÌÂÚÓ 43.2% ÓÚ ÎÂÍÛ‚‡ÌËÚÂ Ò Gabapentin ͇Ú„Ó-ËÁˇÎË ·ÓÎ͇ڇ ͇ÚÓ "ÏÌÓ„Ó" Ë "ÛÏÂÂÌÓ" ̇χÎfl·ÒÂ˘Û 12.1% ÓÚ Ô·ˆÂ·Ó-ÚÂÚˇÌËÚÂ. ë͇ÎËÚ Á‡ÓˆÂÌ͇ ͇˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ‡ Ë ÔÓÙË· ̇ ÂÏÓˆËÓ̇Î-ÌÓÚÓ Ò˙ÒÚÓflÌË (̇ÒÚÓÂÌËÂÚÓ) ÔÓ͇Á‡ÎË Á̇˜ËÏÓ ÔÓ-‰Ó·ÂÌË ÔË Ô‡ˆËÂÌÚËÚÂ Ò Gabapentin (ê<0.01 Á‡ ‰‚ÂÚÂÒ͇ÎË).

燷≇‚‡ÌËÚ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË ·ËÎË ÒÓÏÌÓÎÂÌÚ-ÌÓÒÚ (27.4% ÒÂ˘Û 5.2%), Á‡Ï‡flÌÓÒÚ (23.9% ÒÂ˘Û 5.2%ÓÚ Ô·ˆÂ·Ó-ÔËÂχ˘ËÚÂ), ‡Ú‡ÍÒËfl (7.1% ÒÂ˘Û 0%), ÔÂ-ËÙÂÌË ÓÚÓˆË (9.7% ÒÂ˘Û 3.4%) Ë ËÌÙÂ͈ËË (8.0% ÒÂ-˘Û 2.6%). Ç ÍÎËÌ˘̇ڇ Ô‡ÍÚË͇ ÚÂÁË ÒÚ‡Ì˘ÌË ÂÙÂÍ-ÚË ·Ëı‡ ÏÓ„ÎË ‰‡ Ò ̇χÎflÚ ˜ÂÁ ·‡‚ÌÓ ÔÓÒÚÂÔÂÌÌÓ ÔÓ-͇˜‚‡Ì ̇ ‰ÓÁËӂ͇ڇ - ÚËÚˇÌÂ.

Gabapentin Ò ËÁÔÓÎÁ‚‡ Ë ÔË Î˜ÂÌËÂÚÓ Ì‡ ·ÓÎÂÁÌÂ̇‰Ë‡·ÂÚ̇ Ì‚ÓÔ‡ÚËfl (12). èÓÛ˜‚‡ÌÂÚÓ, ̇ԇ‚ÂÌÓ ÔËÔ‡ˆËÂÌÚË Ò ·ÓÎÂÁÌÂ̇ ‰Ë‡·ÂÚ̇ ÔÓÎËÌ‚ÓÔ‡ÚËfl ÓÚBackonja Ë Ò˙Ú.(1998) Ëχ ÔÓ‰Ó·ÂÌ ‰ËÁ‡ÈÌ Ì‡ ÔÓÛ˜‚‡ÌÂ-ÚÓ Ì‡ Rowbotham Ë Ò˙Ú. Ç ÔÓÛ˜‚‡ÌÂÚÓ Ò‡ ‚Íβ˜ÂÌË 165Ô‡ˆËÂÌÚ‡, ÓÚ ÍÓËÚÓ 84 ÔËÂχÎË Gabapentin Ë 81 - Ô·ˆÂ-·Ó Ë ÔÓ‰˙ÎÊËÎÓ ÓÒÂÏ Ò‰ÏËˆË (Ô‰¯ÂÒÚ‚‡ÌÓ ÓÚ 7-‰Ì‚̇ ÒÍËÌËÌ„Ó‚‡ Ù‡Á‡) (4). ìÒÚ‡ÌÓ‚ÂÌË Ò‡ ÒÚ‡ÚËÒÚË-˜ÂÒÍË Á̇˜ËÏË ‡ÁÎËÍË ‚ ÓˆÂÌ͇ڇ ̇ ·ÓÎ͇ڇ (Ò‰ÌˉÌ‚ÌË ÓˆÂÌÍË) ÏÂÊ‰Û ÔËÂχ˘ËÚ Gabapentin Ë Ô·ˆÂ-·Ó-„ÛÔ‡Ú‡ ̇ ‚ÚÓ‡Ú‡, ˜ÂÚ‚˙Ú‡Ú‡ Ë ÓÒχڇ Ò‰ÏˈË(ê<0.01). èË Ô‡ˆËÂÌÚËÚÂ Ò Gabapentin  ÓÚ·ÂÎflÁ‡ÌÓ Á̇-˜ËÏÓ ÔÓ‰Ó·ÂÌË ÔÓ ÓÚÌÓ¯ÂÌË ӷ˘‡Ú‡ ÓˆÂÌ͇, ÒÂÌÁÓ-ÌËfl Ë ‡ÙÂÍÚË‚ÌËfl ‡ÒÔÂÍÚË Ì‡ ·ÓÎ͇ڇ (ê<0.01), Ë ÔÓ‰Ó·-ÂÌË ̇ Ò˙Ìfl (ê<0.001). É·‚ÌËÚ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË ÔËÔ‡ˆËÂÌÚËÚ ·ËÎË Á‡Ï‡flÌÓÒÚ (23.8%) Ë ÒÓÏÌÓÎÂÌÚÌÓÒÚ(22.6%), ‡ ‚ ÏÌÓ„Ó ÔÓ-χÎ͇ ÒÚÂÔÂÌ - „·‚Ó·ÓÎËÂ Ë ‰Ë‡Ëfl(ÔË 10.7%); Ó·˙͇ÌÓÒÚ Ë „‡‰ÂÌ (ÔË 8.3%). êÂÁÛÎÚ‡ÚË-

Ú ÓÚ ÚÓ‚‡ ÔÓÛ˜‚‡Ì ‰Ó‚ÂÎË ‰Ó Á‡Íβ˜ÂÌËÂÚÓ, ˜ÂGabapentin  ӷ¢‡‚‡˘Ó ÌÓ‚Ó ÎÂ͇ÒÚ‚ÂÌÓ Ò‰ÒÚ‚Ó Ì‡ËÁ·Ó, ÍÓÂÚÓ ÏÓÊ ‰‡ Ò ËÁÔÓÎÁ‚‡ ÔË Ô‡ˆËÂÌÚË Ò Ì‚Ó-Ô‡Ú˘̇ ·ÓÎ͇.

Ö‰ÌÓ ÔÓ-ÌÓ‚Ó ÔËÎÓÚÌÓ ÓÚÍËÚÓ ÔÓÛ˜‚‡Ì ҇‚Ìfl‚‡ÂÙÂÍÚ‡ ÓÚ ‰ÂÈÒÚ‚ËÂÚÓ Ì‡ Amitriptylin Ë Gabapentin, Ò˙-˘Ó ÔË Ô‡ˆËÂÌÚË Ò ·ÓÎÂÁÌÂ̇ ‰Ë‡·ÂÚ̇ Ì‚ÓÔ‡ÚËfl (7).íÓ‚‡ ÔÓÛ˜‚‡Ì ÔÓ‰˙Îʇ‚‡ 12 Ò‰ÏËˆË Ë ‚ ÌÂ„Ó Û˜‡ÒÚ-‚‡Ú 25 ·ÓÎÌË Ò˙Ò Ò‰̇ ‚˙Á‡ÒÚ 71„., ÓÚ ÍÓËÚÓ 13 ÔËÂ-χÎË Gabapentin Ë 12 - Amitriptylin. éÚ˜ËÚ‡Ì ·ËÎ ÂÙÂÍ-Ú˙Ú Ì‡ ωË͇ÏÂÌÚËÚ ‚˙ıÛ ·ÓÎ͇ڇ Ë Ô‡ÂÒÚÂÁËflÚ‡,ÓˆÂÌfl‚‡ÌË ÔÓ 4-ÒÚÂÔÂÌÌË Ò͇ÎË. èÓÛ˜‚‡ÌÂÚÓ ÔÓ͇Á‚‡, ˜ÂË ‰‚ÂÚ ÎÂ͇ÒÚ‚‡ Ò‡ ÂÙÂÍÚË‚ÌË, ÌÓ ÂÙÂÍÚ˙Ú Ì‡Gabapentin ÔÓ ÓÚÌÓ¯ÂÌË ·ÓÎ͇ڇ Ë Ô‡ÂÒÚÂÁËflÚ‡ ÒÚ‡-ÚËÒÚ˘ÂÒÍË Ò  Ó͇Á‡Î ÔÓ-‰Ó·˙ ÓÚ ÚÓÁË Ì‡ Amitriptylin.éÒ‚ÂÌ ÚÓ‚‡ Amitriptylin  Ô‰ËÁ‚Ë͇ΠÔӂ˜ ÒÚ‡Ì˘ÌËÂÙÂÍÚË ÓÚ Gabapentin, ͇ÚÓ Ò˙ıÌÂÌ ̇ ÛÒÚ‡Ú‡, ÓÚÓÒ-Ú‡Ú˘̇ ıËÔÓÚÂÌÁËfl Ë ‰. èÓÚÂ̈ˇÎÌËÚ Ô‰ËÏÒÚ‚‡Ì‡ Gabapentin Ô‰ ÚˈËÍ΢ÌËÚ ‡ÌÚˉÂÔÂÒ‡ÌÚË ·Ë-ÎË Ó˜Â‚Ë‰ÌÓ ÔÓ-‰Ó·‡Ú‡ ÔÓÌÓÒËÏÓÒÚ, ÔÓÙËÎ˙Ú Ì‡ ÒË-„ÛÌÓÒÚ Ë ÎËÔÒ‡Ú‡ ̇ ÎÂ͇ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl. Gabapentin  ËÁÔÓÎÁ‚‡Ì ‚ ‰ÓÁËÓ‚ÍË ‰Ó 3600Ï„./‰ÂÌ ÔË‚˙Á‡ÒÚÌË Ô‡ˆËÂÌÚË (Ò‰̇ ‚˙Á‡ÒÚ 73 „Ó‰ËÌË ‚ ÔÓÛ˜-‚‡ÌÂÚÓ ÔË ÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl), ÔË ÍÓÂÚÓ Ì ҇Ì·β‰‡‚‡ÌË ÒÂËÓÁÌË ÒÚ‡Ì˘ÌË ÂÙÂÍÚË. ìÒÚ‡ÌÓ‚ÂÌÓ Â,˜Â Ë ÔÓ-χÎÍË ‰ÓÁËÓ‚ÍË (1200-1800 Ï„./‰ÂÌ) Ò˙˘Ó Ò‡ÂÙÂÍÚË‚ÌË.

áÄäãûóÖçàÖê‡Á‚ËÚËÂÚÓ Ì‡ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇ Ò ·‡Áˇ ̇

ÒÎÓÊ̇ ÔÓÒΉӂ‡ÚÂÎÌÓÒÚ ÓÚ ÔÓˆÂÒË ‚ ÔÂËÙÂ̇ڇ ˈÂÌÚ‡Î̇ Ì‚̇ ÒËÒÚÂχ, ÓÚ ÍÓËÚÓ Â¯‡‚‡˘Ë Ò‡ ÔÓ-ÏÂÌËÚ ‚ Á‡‰ÌËÚ ӄ‡ ̇ „˙·Ì‡˜ÌËfl ÏÓÁ˙Í. å‰Ë͇ÏÂÌÚÓÁÌÓÚÓ Î˜ÂÌË ̇ Ì‚ÓÔ‡Ú˘̇ڇ ·ÓÎ͇‚Ò Ӣ ÓÒÚ‡‚‡ ÓÚÍËÚ ÔÓ‡‰Ë ̉ÓÒÚ‡Ú˙˜ÌÓ Ú‡ÈÌÓ-ÚÓ ‰ÂÈÒÚ‚Ë ̇ ÚˈËÍ΢ÌËÚ ‡ÌÚˉÂÔÂÒ‡ÌÚË Ë ÓÔË-ÓˉËÚÂ Ë ÚÂıÌËÚ ÒÂËÓÁÌË ÒÚ‡Ì˘ÌË ÂÙÂÍÚË.Gabapentin  ÌÓ‚ ÒÚÛÍÚÛÂÌ ‡Ì‡ÎÓ„ ̇ ÉÄåä, ÍÓÈÚÓ ÔÓ-͇Á‚‡ ÔÓ-‰Ó·‡ ÂÙÂÍÚË‚ÌÓÒÚ ÔË Î˜ÂÌË ̇ Ì‚ÓÔ‡Ú˘-̇ ·ÓÎ͇ ÔË ÔÓÒÚıÂÔÂÚ˘̇ Ì‚‡Î„Ëfl Ë ‰Ë‡·ÂÚ̇ Ì‚-ÓÔ‡ÚËfl. å‰Ë͇ÏÂÌÚ˙Ú Â ‰Ó·Â ÔÓÌÓÒËÏ, Ò ÌÂÁ̇˜Ë-ÚÂÎÌË ÒÚ‡Ì˘ÌË ÂÙÂÍÚË Ë ÎËÔÒ‡ ̇ ÎÂ͇ÒÚ‚ÂÌË ‚Á‡Ë-ÏÓ‰ÂÈÒÚ‚Ëfl.

ëÔÓ‰ Ôӂ˜ÂÚÓ ‡‚ÚÓË, Gabapentin ÏÓÊ ‰‡ ·˙‰ÂÒ˜ËÚ‡Ì Á‡ ωË͇ÏÂÌÚ Ì‡ ËÁ·Ó ÔË Î˜ÂÌËÂÚÓ Ì‡ Ì‚Ó-Ô‡Ú˘ÌËÚ ·ÓÎÍÓ‚Ë ÒË̉ÓÏË (8, 12).

ãàíÖêÄíìêÄ

1. òÓÚÂÍÓ‚ è. Ä̇ÚÓÏ˘ÌË Ë Ô‡ÚÓÙËÁËÓÎӄ˘ÌË ÓÒÌÓ‚Ë Ì‡ ÚÂÂÔËflÚ‡ ̇·ÓÎ͇ڇ ‚ "ÅÓÎ͇ڇ - Ô‡ÚÓ„ÂÌÂÁ‡ Ë Ú‡ÔËfl" (‰. è.òÓÚÂÍÓ‚) ëÓÙËfl, åà"ãˉ ÔÂÒ", 1998: 27-46. 2. Attal N, Bouhassira D. Mechanism of pain in peripheral neuropathy.Acta Neurol.Scand. 1999; 173: 12-243. Attal N. Symposium highlights overview Symposium : rational treatment strate-gies for the successful management of neuropathic pain; September 24-26,2000.Cannes, France:4.4. Backonja M, Beydoun A, Edwards S et al. Gabapentin for the symptomatic treat-ment of painful neuropathy in diabetes mellitus. A randomized controlled trial.JAMA, December2, 1998 - Vol 280, No. 21:1831-18365. Bonezzi C, Demartini L. Treatment options in postherpetic neuralgia. ActaNeurol. Scand. 1999; Suppl.173: 25-356. Caraceni A, Zecca E, Martini C, De Conno F. Gabapentin as an adjuvant to opi-oid analgesia for neuropathic cancer pain. J.Pain Symptom Manage 1999; 17: 441-4457. Dallocchio C, Buffa C, Mazzarello P, Chiroli S. Gabapentin vs Amitriptyline inpainful diabetic neuropathy - an open-label pilot study. . J.Pain Symptom Manage2000;20: 280-2858. Dickenson A. A central perspective on neuropathic pain Symposium : rationaltreatment strategies for the successful management of neuropathic pain; September24-26,2000. Cannes, France: 10-169. Harden RN. Gabapentin : a new tool in the treatment of neuropathic pain. ActaNeurol. Scand. 1999; 173:43-4710. Mogil J. The genetic basis of individual differences in neropathic pain.Symposium : rational treatment strategies for the successful management of neuro-pathic pain; September 24-26,2000. Cannes, France: 5-9

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11. Mueller M, Gruenthal M, Olson W. Gabapentin for relief of upper motor neuronsymptoms in multiple sclerosis. Arch. Phys. Med. Rehabil. Vol 78,May 1997:521-52412. Nash T. Treatment options in painful diabetic neuropathy. Acta Neurol. Scand.1999; 173:36-4213. Nicholson B. Gabapentin use in neuropathic pain syndromes. Review article.Acta Neurol. Scand. 2000; 101:359-37114. Rowbotham M, Harden N, Stacey B. et al. Gabapentin for the treatment of pos-therpetic neuralgia. A randomized controlled study. Jama, - Vol 280, 1998, No.21:1837-184215. SERRA J. Overview of neuropathic pain syndromes. Acta Neurol. Scand. 1999;173:7-11.12. Kellermann, M., Fekete, I., Gesztelyi, R., Csiba, L., Kollar, J., Sikula, J.,Bereczki, D. Screening for depressive symptoms in the acute phase of stroke. Gen-Hosp-Psychiatry, 21, 1999, 2, 116-121. 13. Kotila, M., Humminen, H., Waltimo, O., Kaste, M. Depression after stroke.Results of the FINNSTROKE study. Stroke, 29, 1998, 368-372.14. Lawfor, B. Vascular depression - an important subtype of late-life depression.Neuropsychiatry, 1, 1998, 4, 12-13.15. MacHale, M.S., O'Rourke, S.J., Wardlaw, J.M., Dennis, M.S. Depression and itsrelation to lesion location after stroke. J. Neurol. Neursurg. Psychiatry, 64, 1998,371-374.16. Pohjasvaara, T., Leppavuori, A., Siira, I., Vataja, R., Kaste, M., Erkinjuntti, T.Frequency and clinical determinants of poststroke depression. Stroke, 29, 1998, 11,2311-2317.

17. Price, T.R. Affective disorders after stroke. Stroke, 21, 1990, (suppl II), 12-13.18. Robinson, R.G., Bolduc, P.L., Price, T.R. Two year longitudinal study ofpostrstoke mood disorders: diagnosis and outcome at one and two years. Stroke, 18,1987, 837-843.19. Robinson, R.G., Kubos, K.L., Starr, L.B., Rao, K., Price, T.R. Mood disordersin stroke patients: importance of location of lesion. Brain, 107, 1984, 81-93.20. Shima, S. The efficacy of antidepressants in post-stroke depression. Keio J.Med., 46, 1997, 1, 25-26. 21. Senyor, D., Jacques, P., Kaloupek, D.G., Becker, R., Goldenberg, M.,Coppersmith, H. Poststroke depression and lesion location: an attempted replication.Brain, 109, 1986, 537-546.22. Starkstein, S.E., Robinson, R.G., Price, T.R. Comparison of patients with andwithout poststroke major depression matched for size and location of lesion. Arch.Gen. Psychiatry, 45, 1988, 247-252.23. Tiller, J.W.G. Post-stroke depression. Psychopharmacology, 1992, 106 (suppl),130-133.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: èÓÙ. Ñ- è.òÓÚÂÍÓ‚, Ñåçç‚ÓÎӄ˘̇ ÍÎËÌË͇, ìÅ"ÄÎÂÍ҇̉ӂÒ͇"ìÎ. "É.ëÓÙËÈÒÍË"‹1, 1432 ëÓÙËfl

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 123‰ÂÍÂÏ‚Ë, 2002

îË„.1. åÂı‡ÌËÁ˙Ï Ì‡ ‡Á‚ËÚË ̇ ÒÔÓÌÚ‡Ì̇ڇ Ì‚Ó̇Î̇ ‡ÍÚË‚ÌÓÒÚ Ë ıËÔ‡΄ÂÁËfl

SUMMARY

NEUROLOGIC COMPLICATIONS IN PATIENTS WITHCHRONIC RENAL FAILURE ON HEMODIALYSIS

TREATMENTEvgueniy Vazelov, Paraskeva Stoimenova,

Tzenka Tzankova, Jantcho ChristovThe different forms of neuropathy affect up to 65% of the

patients, on the start of dialysis treatment. This fact explainsthe great importance of their understanding, which could pos-itively affect the treatment of this specific group of patients.The aim of this review is to present the main forms of uraemicneuropathy - peripheral polyneuropathy, autonomic nervoussystem dysfunction, "carpal tunnel" syndrome, dialysis dise-quilibrium syndrome, dialysis dementia and most often exhib-ited in this group of patients acute disturbances of brain cir-culation and infections of CNS.Key words: Chronic Renal Failure - Neuropathy -Hemodailysis

êÖáûåÖê‡Á΢ÌËÚ ÙÓÏË Ì‡ Ì‚ÓÔ‡ÚËfl Á‡Òfl„‡Ú ‰Ó 65% ÓÚ

Ô‡ˆËÂÌÚËÚ ÔË Á‡ÔÓ˜‚‡Ì ̇ ‰Ë‡ÎËÁ‡, ÍÓÂÚÓ Ó·ÛÒ·‚fl Ë„ÓÎflÏÓÚÓ Á̇˜ÂÌË ÓÚ ÔÓÁ̇‚‡ÌÂÚÓ ËÏ Á‡ ΘÂÌËÂÚÓ Ì‡ÚÓÁË ÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË. ñÂΠ̇ ̇ÒÚÓfl˘Ëfl Ó·ÁÓ Â ‰‡·˙‰‡Ún Ô‰ÒÚ‡‚ÂÌË ÓÒÌÓ‚ÌËÚ ÙÓÏË Ì‡ ÛÂÏ˘̇ڇÂ̈ÂÙ‡ÎÓÔ‡ÚËfl - ÔÂËÙÂ̇ ÔÓÎËÌ‚ÓÔ‡ÚËfl, ‰ËÒÙÛÌ͈Ëfl̇ ‡‚ÚÓÌÓÏ̇ڇ Ì‚̇ ÒËÒÚÂχ, "͇ԇΠÚÛÌÂÎ"ÒË̉ÓÏ, ‰Ë‡ÎËÁÂÌ ‰ËÒÂÍ‚ËÎË·ËÛÏ ÒË̉ÓÏ, ‰Ë‡ÎËÁ̇‰ÂÏÂ̈Ëfl, ͇ÍÚÓ Ë ˜ÂÒÚÓ Ò¢‡ÌËÚ ÔË ÚÓÁËÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË ÓÒÚË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓÍ˙‚ÓÓ·‡˘ÂÌËÂ Ë ËÌÙÂ͈ËË Ì‡ ñçë. äβ˜Ó‚Ë ‰ÛÏË: ïÓÌ˘̇ ·˙·Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ -ç‚ÓÔ‡ÚËfl - ïÂÏӉˇÎËÁ‡

ê‡Á‚ËÚËÂÚÓ Ì‡ ıÓÌ˘̇ڇ ·˙·Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜-ÌÓÒÚ (ïÅç)  ҂˙Á‡ÌÓ Ò ÔÓÏÂÌË ‚˙‚ ÙÛÌ͈ËËÚ ̇ ‚Ò˘-ÍË ÒËÒÚÂÏË Ì‡ ˜Ó‚¯ÍÓÚÓ ÚflÎÓ. ç‚̇ڇ ÒËÒÚÂχ, ÍÓ-flÚÓ ÍÓÓ‰ËÌˇ ͇ÍÚÓ ÌÓχÎÌÓÚÓ ÔÓÚ˘‡Ì ̇ ÏÂÊ-‰ÛÒËÒÚÂÏÌËÚ ‚˙ÁÍË ‚ Ó„‡ÌËÁχ, ڇ͇ Ë ‡‰‡ÔÚ‡ˆËflÚ‡Í˙Ï ÓÍÓÎ̇ڇ Ò‰‡, Ӣ ‚ ̇˜‡ÎÌËÚ ÒÚ‡‰ËË Ì‡ ïÅç ÂÁ‡Ò„̇ڇ ÓÚ Ô‡ÚÓÎӄ˘ÌËÚ ÔÓˆÂÒË. ÉÓÎflχ ˜‡ÒÚ ÓÚÒËÏÔÚÓÏËÚ ̇ ÛÂÏËflÚ‡ - ‡ÌÓÂÍÒËfl, ‡‰Ë̇ÏËfl, ‡Ô‡-ÚËfl, ÍÓ΢ÂÒÚ‚ÂÌË Ë Í‡˜ÂÒÚ‚ÂÌË ÔÓÏÂÌË ‚ Ò˙Á̇ÌËÂÚÓÒ‡ Ï‰ËˇÌË ÔÓÒ‰ÒÚ‚ÓÏ Ì‚̇ڇ ÒËÒÚÂχ.(4) Ç Ò˙Ó-Ú‚ÂÚÒÚ‚ËÂ Ò ÔÓÒΉÌËÚ Òı‚‡˘‡ÌËfl ̇ ÄÏÂË͇ÌÒ͇ڇÅ˙·Â˜Ì‡ îÓ̉‡ˆËfl /NKF/ (äÎËÌ˘ÌË Ô‡‚Ë· ÔË ıÓ-Ì˘ÌË ·˙·Â˜ÌË ·ÓÎÂÒÚË /KDOQI/, ÔÓfl‚ËÚ ̇ Ì‚ÓÔ‡-ÚËflÚ‡ Ò‡ Ò‚˙Á‡ÌË Ò ÌË‚ÓÚÓ Ì‡ ·˙·Â˜Ì‡Ú‡ ÙÛÌ͈Ëfl, ‡ ÌÂÒ ÚËÔ‡ ·˙·Â˜ÌÓ Á‡·ÓÎfl‚‡ÌÂ.(12) Ç Ì‡˜‡ÎÓÚÓ Ì‡ 60-Ú „Ó-‰ËÌË Ì‡ ÏË̇ÎËfl ‚ÂÍ, Ò Ì‡‚ÎËÁ‡Ì ̇ ‰Ë‡ÎËÁÌËÚ ÏÂÚÓ‰ËÁ‡ ΘÂÌË ̇ ıÓÌ˘̇ڇ ·˙·Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ Í˙ÏÍ·Ò˘ÂÒÍËÚ Ì‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË Ì‡ ÛÂÏËflÚ‡ ÒÂ

̇·Î˛‰‡‚‡Ú Ë Ú‡ÍË‚‡, Ò‚˙Á‡ÌË Ò˙Ò Ò‡ÏÓÚÓ Î˜ÂÌËÂ. èÓÚÓÁË Ì‡˜ËÌ Í˙Ï ‰‚ÂÚ ÓÒÌÓ‚ÌË „ÛÔË ÔÓÏÂÌË - ÛÂÏ˘̇Â̈ÂÙ‡ÎÓÔ‡ÚËfl Ë ÔÂËÙÂ̇ Ì‚ÓÔ‡ÚËfl Ò ÔË·‡‚flÚ Ë‰ËÒÙÛÌ͈Ëfl ̇ ‡‚ÚÓÌÓÏ̇ڇ Ì‚̇ ÒËÒÚÂχ, "͇ԇÎÚÛÌÂÎ" ÒË̉ÓÏ, ‰Ë‡ÎËÁÂÌ ‰ËÒÂÍ‚ËÎË·ËÛÏ ÒË̉ÓÏ, ‰Ë‡-ÎËÁ̇ ‰ÂÏÂ̈Ëfl, ͇ÍÚÓ Ë ˜ÂÒÚÓ Ò¢‡ÌËÚ ÔË ÚÓÁË ÍÓÌ-ÚËÌ„ÂÌÚ ·ÓÎÌË ÓÒÚË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·-‡˘ÂÌËÂ Ë ËÌÙÂ͈ËË Ì‡ ñçë. ëÔÓ‰ Burn Ë Ò˙Ú. ‡Á΢-ÌËÚ ÙÓÏË Ì‡ Ì‚ÓÔ‡ÚËfl Á‡Òfl„‡Ú ‰Ó 65% ÓÚ Ô‡ˆËÂÌ-ÚËÚ ÔË Á‡ÔÓ˜‚‡Ì ̇ ‰Ë‡ÎËÁ‡, ÍÓÂÚÓ Ó·ÛÒ·‚fl Ë „ÓÎflÏÓ-ÚÓ Á̇˜ÂÌË ÓÚ ÔÓÁ̇‚‡ÌÂÚÓ ËÏ Á‡ ΘÂÌËÂÚÓ Ì‡ ÚÓÁËÍÓÌÚËÌ„ÂÌÚ ·ÓÎÌË.(5)

ÍÚÂÌË ËÁfl‚Ë Ì‡ ÛÂÏ˘̇ڇ Â̈ÂÙ‡ÎÓÔ‡ÚËflÚ‡Ò‡ ÔÓÒÚÓflÌÌÓÚÓ „·‚Ó·ÓÎËÂ, Ó·˙͇ÌÓÒÚ, ÏËÓÍÎÓÌ˘ÌËÔÓÚÂÔ‚‡ÌËfl Ë „˙˜Ó‚Â, Á‡„Û·‡ ̇ ÍÓ̈ÂÌÚ‡ˆËfl ̇ ‚ÌË-χÌËÂÚÓ, Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl, ·ÂÁÒ˙ÌËÂ, ‡Á‰‡ÁÌËÚÂÎ-ÌÓÒÚ, ËÏÔÓÚÂ̈Ëfl, Ô‡‡ÌÓˉÌË Ì‡ÎÛ‰ÌÓÒÚË.(19) èÓfl‚Ë-ÚÂ Ë ÔË Ô‡ˆËÂÌÚË Ò ïÅç ‚‡Ë‡Ú ‚ ÏÌÓ„Ó ¯ËÓÍË „‡-ÌËˆË - ÓÚ ÎÂÍË Ì‡Û¯ÂÌËfl ̇ ÒÂÚË‚ÌÓÒÚÚ‡ ‰Ó ‰ÂÎË Ë ÍÓ-χ, ‡ ‡ÁÓÚ̇ڇ Á‡‰˙Ê͇  ҇ÏÓ Â‰Ì‡ ÓÚ ÏÌÓ„ÓÚÓ Ô˘Ë-ÌË. ä˙Ï ÌÂfl Ò ÔË·‡‚flÚ Ì‡Û¯ÂÌËflÚ‡ ‚˙‚ ‚Ó‰ÌÓ-ÂÎÂÍÚ-ÓÎËÚÌÓÚÓ Ë ‡Î͇ÎÌÓ-ÍËÒÂÎËÌÌÓÚÓ Ò˙ÒÚÓflÌËÂ, ËÌÚÓÍÒË-͇ˆËËÚ ‚ ÚÓ‚‡ ˜ËÒÎÓ Ï‰Ë͇ÏÂÌÚÓÁÌËÚ ÔÓ‡‰Ë ̇Û-¯ÂÌ ÏÂÚ‡·ÓÎËÁ˙Ï Ì‡ ÎÂ͇ÒÚ‚‡Ú‡ ÔË ïÅç, ËÌÙÂ͈ËËÚÂÔÓ‡‰Ë ̇ۯÂÌËfl ÓÚ ÛÂÏËflÚ‡ ËÏÛÌËÚÂÚ. éÚ ÓÒÓ·ÂÌÓ‚‡ÊÌÓ Á̇˜ÂÌË ҇ ẨÓÍËÌÌËÚ ÔÓÏÂÌË (Ì‚˙ÁÏÓÊ-ÌÓÒÚ Ì‡ ۂ‰ÂÌËfl ·˙·ÂÍ ‰‡ Û˜‡ÒÚ‚‡ ‚ ÒËÌÚÂÁ‡ Ë ‡Á„-‡Ê‰‡ÌÂÚÓ Ì‡ „ÓÎflÏ ·ÓÈ ıÓÏÓÌË), ͇ÍÚÓ Ë Ì‡Û¯ÂÌËfl-Ú‡ ‚ ÏÂÚ‡·ÓÎËÁχ ̇ ‡ÏËÌÓÍËÒÂÎËÌËÚ (Ää).(9, 22) èÓÒ-ΉÌËÚ ҇ Ò‚˙Á‡ÌË Ò ÌÓχÎÌÓÚÓ ÙÛÌ͈ËÓÌˇÌ ̇ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ (ñçë) ÔÓ‰ ÙÓχڇ ̇:Ì‚ÓÚ‡ÌÒÏËÚÂË („ÎˈËÌ, „ÎÛÚ‡ÏËÌ, „‡Ï‡-‡ÏËÌÓ Ï‡Ò-ÎÂ̇ ÍËÒÂÎË̇ /ÉÄåä/), ÏÓÌÓ‡ÏËÌË (5-ıˉÓÍÒËÚËÔÚ‡-ÏËÌ Ë ‰ÓÔ‡ÏËÌ) Ë Ì‚ÓÔÂÔÚˉË. éÒ‚ÂÌ Ää ‰ËÒ·‡Î‡ÌÒ Ò˙-˘ÂÒÚ‚Û‚‡Ú Ë ÚÂÓËË, ÔËÂχ˘Ë ̇΢ËÂÚÓ Ì‡ Ô‡ÚÓÎÓ-„˘ÌË "Ò‰ÌË ÏÓÎÂÍÛÎË" Á‡ ÓÒÌӂ̇ Ô˘Ë̇ Á‡ Á‡Òfl„‡ÌÂ-ÚÓ Ì‡ ñçë ÔË ÛÂÏËfl.(1, 19) í‡Í‡‚‡ ÒÛ·Òڇ̈Ëfl  ıÓ-ÏÓ̇ ̇ Ô‡‡˘ËÚӂˉÌËÚ ÊÎÂÁË - Ô‡‡ÚıÓÏÓÌ (èíï),˜ËÂÚÓ ÌÓχÎËÁˇÌ ÒΉ Ô‡‡ÚËÂÓˉÂÍÚÓÏËfl ‚Ó‰Ë ‰Ó̇χÎÂÌË ̇ ÔÓfl‚ËÚ ̇ ˆÂ·‡Î̇ڇ Â̈ÂÙ‡ÎÓÔ‡ÚËflÔË ÛÂÏˈË.(15) ëËÏÔÚÓχÚ˘̇ڇ ‡ÌÂÏËfl ÔË ıÓÌ˘-̇ ·˙·Â˜Ì‡ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ ÔÓ‚ÎËfl‚‡ Ì··„ÓÔËflÚÌÓÙÛÌ͈ËËÚ ̇ ñçë ˜ÂÁ ÓÒË„Ûfl‚‡Ì ̇ ̉ÓÒÚ‡Ú˙˜ÌÓÍÓ΢ÂÒÚ‚Ó ÍËÒÎÓÓ‰, ‡ Û‚Â΢ÂÌËfl ÍÓÏÔÂÌÒ‡ÚÓÌÓ Í˙-‚ÓÚÓÍ Ô‰ËÁ‚ËÍ‚‡ Ôӂ˯ÂÌÓ ‚˙Ú˜ÂÂÔÌÓ Ì‡Îfl„‡Ì ËÏÓÁ˙˜ÂÌ ÓÚÓÍ.

á‡ÔÓ˜‚‡ÌÂÚÓ Ì‡ Á‡ÏÂÒÚ‚‡˘‡ ·˙·Â˜Ì‡Ú‡ ÙÛÌ͈Ëfl ÚÂ-‡ÔËfl - ıÂÏӉˇÎËÁ‡ (ïÑ) ËÎË ÔÂËÚÓ̇Î̇ ‰Ë‡ÎËÁ‡(äÄèÑ) Ì ‚Ë̇„Ë Â Ò‚˙Á‡ÌÓ Ò Ó‚Î‡‰fl‚‡Ì ̇ ˆÂ·‡Î̇-Ú‡ Â̈ÂÙ‡ÎÓÔ‡ÚËfl. Ç ÌflÍÓË ÒÎÛ˜‡Ë Ò‡ÏÓÚÓ ‰Ë‡ÎËÁÌÓ ÎÂ-˜ÂÌË ‚Ó‰Ë ‰Ó ÓÒÚË ËÎË ıÓÌ˘ÌË ‡ÁÒÚÓÈÒÚ‚‡ ̇ ñçë- ‡ÌÓχÎËË ‚ ÂÎÂÍÚÓÎËÚÌËfl Ò˙ÒÚ‡‚ ̇ ÚÂÎÂÒÌËÚ Ú˜-ÌÓÒÚË, ‰Ë‡ÎËÁÂÌ ‰ËÒÂÍ‚ËÎË·ËÛÏ ÒË̉ÓÏ (ÑÑë), ıËÔÂ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 124‰ÂÍÂÏ‚Ë, 2002

é·ÁÓ

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Ö‚„ÂÌËÈ Ç˙ÁÂÎÓ‚, *臇ÒÍ‚‡ ëÚ‡ÏÂÌÓ‚‡, *ñÂÌ͇ ñ‡ÌÍÓ‚‡, *üÌ˜Ó ïËÒÚÓ‚

éÚ‰ÂÎÂÌË ÔÓ ıÂÏӉˇÎËÁ‡ Ë *äÎËÌË͇ ÔÓ ÒÔ¯̇ Ì‚ÓÎÓ„Ëfl, åÅÄã "ñ‡Ëˆ‡ âÓ‡Ì̇", ëÓÙËfl

ÚÓÌ˘̇ Â̈ÂÙ‡ÎÓÔ‡ÚËfl, ÒÛ·‰Û‡ÎÂÌ ıÂχÚÓÏ. á̇˜Ë-ÚÂÎÌÓÚÓ Ôˉ‚ËÊ‚‡Ì ̇ ‚Ó‰‡ Ë ÂÎÂÍÚÓÎËÚË ÏÂÊ‰Û ËÌ-Ú‡ Ë ÂÍÒÚ‡ˆÂÎÛ·ÌËÚ ÔÓÒÚ‡ÌÒÚ‚‡ ÔÓ ‚ÂÏ ̇ ïÑÒÚ‡‚‡ Ô˘Ë̇ Á‡ flÁÍË ÔÓÏÂÌË, ÍÓÂÚÓ ÏÓÊ ‰‡ ‰Ó‚Â‰Â‰Ó ‡Á΢ÌË ËÁfl‚Ë Ì‡ ˆÂ·‡Î̇ڇ Â̈ÂÙ‡ÎÓÔ‡ÚËfl.(1, 2)éÒÚ‡Ú‡ ıËÔÂ̇ÚËÂÏËfl Ò ı‡‡ÍÚÂËÁˇ Ò Ê‡Ê‰‡,ÎÂÒ̇ ‡Á‰‡ÁÌËÚÂÎÌÓÒÚ, ÏÛÒÍÛÎ̇ ˄ˉÌÓÒÚ, „˙˜Ó‚ ËÍÓχ, ‰Ó͇ÚÓ ÔË ıËÔÓ̇ÚËÂÏËfl (ÒÂÛÏÂÌ Na < 125ÏÏÓÎ/Î) ‚Ӊ¢‡Ú‡ ˆÂÌÚ‡ÎÌÓÏÓÁ˙˜Ì‡ ÒËÏÔÚÓχÚË͇ ÒÂËÁ‡Áfl‚‡ ‚ ÎÂÒ̇ ÛÏÓflÂÏÓÒÚ, Ò··ÓÒÚ, ÍÓχ Ë ÒÔˇÌ ̇‰Ë¯‡ÌÂÚÓ.

óÂÒÚÓÚ‡Ú‡ ̇ ÔÂËÙÂ̇ڇ Ì‚ÓÔ‡ÚËfl ‚‡Ë‡ ‚ ¯Ë-ÓÍË „‡ÌˈË, ͇ÚÓ ÔÓ˜ÚË ‚Ò˘ÍË ıÂÏӉˇÎËÁÌË Ô‡ˆËÂÌ-ÚË ËÏ‡Ú ÙÛÌ͈ËÓ̇ÎÌË Ì‡Û¯ÂÌËfl. èÓˆÂÌÚ˙Ú Ì‡ ËÁfl-‚ÂÌËÚ ÍÎËÌ˘ÌÓ ÙÓÏË Ì‡ ÔÓÎËÌ‚ÓÔ‡ÚËfl  ÓÍÓÎÓ 10%Ë Á‡Òfl„‡ Ô‰ËÏÌÓ Ï˙ÊÍËfl ÔÓÎ.(4) Ç Ì‡˜‡ÎÌËÚ ÒÚ‡‰ËË ÒÂ̇·Î˛‰‡‚‡ Á‡Òfl„‡Ì ̇ ‰‚Ë„‡ÚÂÎÌËÚ ÙÛÌ͈ËË Ì‡ ‰ÓÎÌË-Ú ͇ÈÌËˆË - ÒËÏÔÚÓÏ Ì‡ "ÌÂÒÔÓÍÓÈÌËÚ ͇͇" ͇ÍÚÓË Ì‡ Ô˙‚˘ÌËÚ ÒÂÚË‚ÌË Ì‚ÓÌË, ÍÓÂÚÓ Ì‡Û¯ÂÌË ÒÂχÌËÙÂÒÚˇ Ò ˜Û‚ÒÚ‚Ó Á‡ "χ‚͇ۘÌÂ" ‚ ‰ËÒÚ‡ÎÌËÚ˜‡ÒÚË Ì‡ ‰ÓÎÌËÚ ͇ÈÌˈË. (23) çÂÁ‡‚ËÒËÏÓ, ˜Â Ëχ ̇-Û¯ÂÌËfl ‚ ÒÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡ÌÂ Ë Ì‡ „ÓÌËÚ ͇È-ÌˈË, ÍÎËÌ˘ÌÓ ËÁfl‚ÂÌËÚ ÒÎÛ˜‡Ë Ò‡ χÎÍÓ. ÖÚËÓÎÓ„Ëflڇ̇ ÔÂËÙÂ̇ڇ ÔÓÎËÌ‚ÓÔ‡ÚËfl ÔË ‰Ë‡ÎËÁÌËÚ ԇˆËÂÌ-ÚË Ì  ̇Ô˙ÎÌÓ ËÁflÒÌÂ̇ - ÔÓ-‚‡ÊÌË ‰ÓÔË̇Òfl˘Ë Á‡ ‡Á-‚ËÚËÂÚÓ Ë Ù‡ÍÚÓË Ò‡: ‰ÂÙˈËÚ Ì‡ ‚Ó‰ÌÓ-‡ÁÚ‚ÓËÏË‚ËÚ‡ÏËÌË ÓÚ „ÛÔ‡Ú‡ Ç, ıÓÏÓ̇ÎÂÌ ‰ËÒ·‡Î‡ÌÒ, ̇ۯÂ-ÌË ÏÂÚ‡·ÓÎËÁχ ̇ ÌflÍÓË ÂÌÁËÏË Û˜‡ÒÚ‚‡˘Ë ‚ Ú‡ÌÒ-ÏÂÏ·‡ÌÌËfl Ú‡ÌÒÔÓÚ Ë Ì‡ÚÛÔ‚‡Ì ̇ ÛÂÏ˘ÌË ÚÓÍ-ÒËÌË.(8) è˙‚Ó̇˜‡ÎÌËÚ Òı‚‡˘‡ÌËfl, ˜Â Ôӂ˯ÂÌËÚ ÌË-‚‡ ̇ èíï Ë„‡flÚ ÓÎfl ‚ Á‡·‡‚flÌÂÚÓ Ì‡ Ì‚̇ڇ ÔÓ‚Ó-‰ËÏÓÒÚ, Ò ÓÚı‚˙ÎflÚ ‚ ÔÓÒΉÌËÚ „Ó‰ËÌË Í‡ÍÚÓ ÚÂÓ-ËÚ˘ÌÓ, ڇ͇ Ë ÔÓ‡‰Ë ÎËÔÒ‡ ̇ ÍÎËÌ˘ÂÌ ÂÙÂÍÚ ÓÚ Ô‡-‡ÚËÂÓˉÂÍÚÓÏËflÚ‡ Á‡ ΘÂÌË ̇ ÔÓÎËÌ‚ÓÔ‡ÚËfl-Ú‡.(23)

ÑËÒÙÛÌ͈ËflÚ‡ ̇ ‡‚ÚÓÌÓÏ̇ڇ Ì‚̇ ÒËÒÚÂχ ÔËÔ‡ˆËÂÌÚËÚ ̇ ıÂÏӉˇÎËÁ‡ ̇È-˜ÂÒÚÓ Ò ËÁ‡Áfl‚‡ ‚ ‡·-ÌÓÏÂÌ ·‡ÓˆÂÔÚÓÂÌ ÂÙÎÂÍÒ, ͇ÚÓ Ì Ò Ô‰ËÁ‚ËÍ‚‡ÔÓÏfl̇ ‚ Ò˙‰Â˜Ì‡Ú‡ ˜ÂÒÚÓÚ‡ ÔË ıËÔÓ‚ÓÎÂÏËfl, Ë ÏÓʉ‡ Á‡ÒÚ‡¯Ë ÊË‚ÓÚ‡ ̇ ·ÓÎÌËfl.(14) çflÍÓË ËÁÒΉ‚‡ÌËflÛÒÚ‡ÌÓ‚fl‚‡Ú Ë ‚˙Á͇ ÏÂÊ‰Û Ì‡Û¯ÂÌËfl ·‡ÓˆÂÔÚÓ-ÂÌ ÂÙÎÂÍÒ Ë ÂÔËÁÓ‰ËÚ ̇ ıËÔÓÚÓÌËfl ÔÓ ‚ÂÏ ̇ ‰Ë‡-ÎËÁ‡ (21), ‰Ó͇ÚÓ ‰Û„Ë ‡‚ÚÓË Ì ÔÓÚ‚˙ʉ‡‚‡Ú ÔÓ‰Ó·-ÌÓ Ì‡·Î˛‰ÂÌËÂ.(16) ÑÛ„Ë ÔÓfl‚Ë Ì‡ ‡‚ÚÓÌÓÏ̇ڇ Ì‚Ó-Ô‡ÚËfl Ò ÔÓ-χÎÍÓ ËÁ‡ÁÂÌÓ ÍÎËÌ˘ÌÓ Á̇˜ÂÌË ҇ Ô‡ÚÓÎÓ-„˘ÌËfl ÚÂÒÚ Ì‡ Valsalva Ë ÔÓÏÂÌË ‚ ÒÂ͈ËflÚ‡ ̇ ÔÓÚ-ÌËÚ ÊÎÂÁË.

"ä‡Ô‡Î-ÚÛÌÂÎ" ÒË̉ÓÏ˙Ú Ò Ô˘ËÌfl‚‡ ÓÚ ÔËÚËÒ-͇Ì ̇ n. medianus ‚ ˜‡ÒÚÚ‡, Í˙‰ÂÚÓ ÔÂÏË̇‚‡ ÔÂÁcanalis carpi, ÔÓ‡‰Ë ̇ÚÛÔ‚‡ÌÂ Ú‡Ï Ì‡ Ò‰ÌÓÏÓÎÂÍÛ-ÎflÌËfl ÔÓÚÂËÌ ·ÂÚ‡-2 ÏËÍÓ„ÎÓ·ÛÎËÌ.(7) Ç ÂÁÛÎÚ‡Ú Ì‡ÚÓ‚‡ Ò Á‡ÚÛ‰Ìfl‚‡ Ì‚ÌÓÚÓ ÔÓ‚Âʉ‡Ì Í˙Ï ‰ËÒÚ‡Î-ÌËÚ ÂÙÂÍÚÓÌË ÏÛÒÍÛÎË. ë˙Ò Á‡ÔÓ˜‚‡Ì ̇ ‰Ë‡ÎËÁÌÓÚÓΘÂÌËÂ, Ù‡ÍÚÓË, Ò‚˙Á‡ÌË Ò Ì‡Û¯Â̇ ·ËÓÒ˙‚ÏÂÒÚË-ÏÓÒÚ ‰ÓÔË̇ÒflÚ Á‡ Ӣ ÔÓ-‚ËÒÓÍËÚ ÏÛ Ô·ÁÏÂÌË ÌË‚‡,͇ÍÚÓ Ë Á‡ ÓÚ·„‡ÌÂÚÓ ÏÛ, ÍÓÂÚÓ Ô‰ËÁ‚ËÍ‚‡ ÚẨӂ‡-„ËÌËÚË, ‰ÂÒÚÛÍÚË‚ÌË ‡ÚÓÔ‡ÚËË, "ä‡Ô‡Î-ÚÛÌÂÎ ÒËÌ-‰ÓÏ".(4) éÒ‚ÂÌ Ì‚ÓÎӄ˘ÂÌ, ÚÓ‚‡ ÛÒÎÓÊÌÂÌË Ò Ô‚-˙˘‡ ‚ ‚χÚÓÎӄ˘ÂÌ, ‡ ÔÓ ÓÚÌÓ¯ÂÌË ̇ ΘÂÌËÂÚÓ Ë‚ ÓÚÓÔ‰˘ÂÌ ÔÓ·ÎÂÏ.

ÑˇÎËÁÌËfl ‰ËÒÂÍ‚ËÎË·ËÛÏ ÒË̉ÓÏ (ÑÑë) Ò ̇·Î˛-‰‡‚‡ ̇È-˜ÂÒÚÓ ÔÓ ‚ÂÏÂ, ͇ÍÚÓ Ë ‰Ó 24 ˜‡Ò‡ ÒΉ Ô˙‚Ë-Ú ÌflÍÓÎÍÓ ‰Ë‡ÎËÁÌË Ôӈ‰ÛË Ì‡ ÍÓÌÒ‚‡ÚË‚ÌÓ ÎÂÍÛ-‚‡ÌË ‰Ó ÚÓÁË ÏÓÏÂÌÚ ·ÓÎÌË Ò ıÓÌ˘̇ ·˙·Â˜Ì‡ ̉ÓÒ-Ú‡Ú˙˜ÌÓÒÚ. èÓ-˜ÂÒÚ‡ ̇ıӉ͇  ÔË Ï·‰Ë Ô‡ˆËÂÌÚË ËÒ ËÁ‡Áfl‚‡ ‚ Ì‚ÓÎӄ˘ÌË ÔÓfl‚Ë ÓÚ Ó‰‡ ̇ „·‚Ó·ÓÎËÂ,ÚÂÏÓ, ÏÛÒÍÛÎÌË Í‡ÏÔË, ̇ۯÂÌËfl ‚ ÁÂÌËÂÚÓ, Ó·˙-

͇ÌÓÒÚ, ‚ ‰ÍË ÒÎÛ˜‡Ë ÒÓÔÓ Ë ÍÓχ Ò Ù‡Ú‡ÎÂÌ ËÁıÓ‰.(3)è˙‚ËÚ ӷflÒÌÂÌËfl ̇ ‰Ë‡ÎËÁÌËfl ‰ËÒÂÍ‚ËÎË·ËÛÏ ÒË̉-ÓÏ Ò‡ ·ËÎË Ò‚˙Á‚‡ÌË Ò ‰ËÒ·‡Î‡ÌÒ ‚ Ó˜ËÒÚ‚‡ÌÂÚÓ Ì‡ ÛÂ-flÚ‡ ‚ Ô·Áχڇ Ë ÏÓÁ˙˜ÌÓÚÓ ‚¢ÂÒÚ‚Ó, ÔÓÒΉ‚‡ÌÓ ÓÚÒ˙Á‰‡‚‡Ì ̇ ÓÒÏÓÚ˘ÂÌ „‡‰ËÂÌÚ Ë Ôˉ‚ËÊ‚‡Ì ̇ ‚Ó-‰‡, ÍÓflÚÓ Ô˘ËÌfl‚‡ ÏÓÁ˙˜ÂÌ ÓÚÓÍ. (2) èÓ-Ò˙‚ÂÏÂÌÌËÚÂÚÂÓËË Ò‚˙Á‚‡Ú ÑÑë Ò Ì‡ÚÛÔ‚‡ÌÂÚÓ Ì‡ ÓÒÏÓÚ˘ÌÓ‡ÍÚË‚ÌË ‚¢ÂÒÚ‚‡, ÍÓËÚÓ Ì‡Ï‡Îfl‚‡Ú ç ͇ÍÚÓ Ì‡ ˆÂ-·ÓÒÔË̇Î̇ڇ Ú˜ÌÓÒÚ, ڇ͇ Ë Ì‡ ‚Ó‰ÌÓÚÓ Ò˙‰˙ʇ-ÌË ̇ ÏÓÁ˙˜ÌËÚ ÍÎÂÚÍË. S.M. Silver (1995) ÔÂÔÓ˙˜‚‡Ô·‚ÌÓ Ì‡Ï‡Îfl‚‡Ì ̇ Ôӂ˯Â̇ڇ Í˙‚̇ ÛÂfl, ͇ÍÚÓ Ë‰Ó·‡‚flÌ ̇ ÓÒÏÓÚ˘ÌÓ ‡ÍÚË‚ÌË ‚¢ÂÒÚ‚‡ („βÍÓÁ‡,ÙÛÍÚÓÁ‡, 10% ̇ÚË‚ ıÎÓˉ), ÍÓËÚÓ ‰‡ ·‡Î‡ÌÒˇÚ̇ÚÛÔ‚‡ÌÂÚÓ Ì‡ Ó„‡Ì˘ÌË ÍËÒÂÎËÌË ÔÓ ‚ÂÏ ̇ ıÂÏÓ-‰Ë‡ÎËÁ̇ڇ Ôӈ‰ۇ. (20)

ÑˇÎËÁ̇ڇ ‰ÂÏÂ̈Ëfl (ÑÑ)  ÒË̉ÓÏ, Ò‚˙Á‡Ì Ò ÛÒÍÓ-Â̇ ‡ÚÂÓÒÍÎÂÓÁ‡ (Á̇˜ËÚÂÎÌÓ ÔÓ-ËÁ‡ÁÂ̇ ÓÚ ÌÓχÎ-̇ڇ Á‡ ‰‡‰Â̇ڇ ·ËÓÎӄ˘̇ ‚˙Á‡ÒÚ), ‚ËÒÓÍË ıÓÏÓˆËÒ-ÚÂËÌÓ‚Ë ÌË‚‡ Ë ‚ÎÓ¯ÂÌ ı‡ÌËÚÂÎÂÌ ÒÚ‡ÚÛÒ ‰Ó ÒÚÂÔÂÌ Ì‡Ï‡ÎÌÛÚˈËfl. èÂÁ 1976 „Ó‰. A.C. Alfrey ‰Ó͇Á‚‡, ˜Â ‚ ÒË-‚ÓÚÓ ÏÓÁ˙˜ÌÓ ‚¢ÂÒÚ‚Ó Ì‡ Ô‡ˆËÂÌÚË Ì‡ ïÑ Ò ‰Ë‡ÎËÁ̇‰ÂÏÂ̈Ëfl Ëχ ÏÌÓ„Ó ÔÓ-‚ËÒÓÍÓ Ò˙‰˙ʇÌË ̇ ‡ÎÛÏËÌËÈÓÚÍÓÎÍÓÚÓ ÔË Ô‡ˆËÂÌÚË ·ÂÁ ÚÓ‚‡ ÛÒÎÓÊÌÂÌËÂ.(1) á̇˜Ë-ÚÂÎ̇ڇ ÛÔÓÚ·‡ ̇ ‡ÎÛÏËÌËÂ‚Ë ÔÂÔ‡‡ÚË Í‡ÚÓ ÙÓÒ-Ù‡ÚÒ‚˙Á‚‡˘Ë Ë ÎËÔÒ‡Ú‡ ̇ Ò˙Ó˙ÊÂÌËfl Ó˜ËÒÚ‚‡˘Ë ‚Ó-‰‡Ú‡ ÓÚ ‡ÎÛÏËÌËÈ (ÔË Â‰Ì‡ ‰Ë‡ÎËÁ‡ Ò ËÁ‡ÁıÓ‰‚‡Ú ÍÓÎË-˜ÂÒÚ‚‡ ÓÚ ÔÓfl‰˙͇ ̇ 120 Î. ‚Ó‰‡) Ò‡ Ò ҘËÚ‡ÎË Á‡ ÓÒ-ÌÓ‚ÌË Ù‡ÍÚÓË ÔË ‚˙ÁÌËÍ‚‡Ì ̇ ‰Ë‡ÎËÁ̇ڇ ‰ÂÏÂ̈Ëfl.(17) çÂËÁflÒÌÂÌ Â ÓÒڇ̇Π‚˙ÔÓÒ˙Ú Á‡˘Ó ÚÓ‚‡ ÛÒÎÓÊÌÂ-ÌË Ò ‡Á‚Ë‚‡ ÔË ÏÌÓ„Ó Ï‡Î͇ ˜‡ÒÚ ÓÚ Ô‡ˆËÂÌÚËÚÂ,ÒΉ ͇ÚÓ Ô‡ÍÚ˘ÂÒÍË ‚Ò˘ÍË Ò‡ ·ËÎË ËÁÎÓÊÂÌË Ì‡ ‚ËÒÓ-͇ ‡ÎÛÏËÌË‚‡ ÂÍÒÔÓÁˈËfl. R. Katzman (1986) ÛÒÚ‡ÌÓ‚fl‚‡Á̇˜ËÚÂÎÌÓ ÒıÓ‰ÒÚ‚Ó ÏÂÊ‰Û ÑÑ Ë ·ÓÎÂÒÚÚ‡ ̇Alzheimer. (11)

àÌڇ͇ÌˇÎÌËÚ Í˙‚ÓËÁÎË‚Ë Ò‡ ˜ÂÒÚÓ Ì‚ÓÎӄ˘-ÌÓ ÛÒÎÓÊÌÂÌË ÔË Ô‡ˆËÂÌÚËÚÂ Ò ıÓÌ˘̇ ·˙·Â˜Ì‡ ÌÂ-‰ÓÒÚ‡Ú˙˜ÌÓÒÚ. Ç˙ÁÌËÍ‚‡ÌÂÚÓ ËÏ Ò ҂˙Á‚‡ Ò ‰‚‡ ÓÒÌÓ‚-ÌË Ù‡ÍÚÓ‡ - ÌÂӂ·‰fl̇ڇ ÓÚ Ï‰Ë͇ÏÂÌÚÓÁÌÓÚÓ Ë ïÑΘÂÌË ‡Ú¡Î̇ ıËÔÂÚÓÌËfl, ͇ÍÚÓ Ë Â‰Ó‚Ì‡Ú‡ÛÔÓÚ·‡ ̇ ıÂÔ‡ËÌ ÔÓ ‚ÂÏ ‰Ë‡ÎËÁ‡, ‡ ‚ ÔÂËÓ‰‡ ÏÂÊ-‰Û Ôӈ‰ÛËÚ ‡ÌÚˇ„„‡ÌÚ̇ Ú‡ÔËfl.(6, 18) 燘‡Î-ÌËÚ ÒËÏÔÚÓÏË Ì‡ ÒÛ·‰Û‡ÎÌËfl ıÂχÚÓÏ - „·‚Ó·ÓÎËÂ,„‡‰ÂÌÂ, ÔÓ‚˙˘‡Ì Ì ҇ Ô‡ÚÓ„ÌÓÏÓÌ˘ÌË, ÌÓ ÔË ÔË·‡-‚flÌ ̇ fl‚ÎÂÌËfl ̇ Ôӂ˯ÂÌÓ ‚˙Ú˜ÂÂÔÌÓ Ì‡Îfl„‡Ì - Á‡-„Û·‡ ̇ Ò˙Á̇ÌËÂ, ÍÓÌ‚ÛÎÒËË Ë ÍÓχ, Úfl·‚‡ ‚ ‰Ë‡„ÌÓÒÚË-˜ÂÌ ÔÎ‡Ì ‰‡ Ò Ô‰ÔÓ·„‡ Ë ÚÓ‚‡ ÛÒÎÓÊÌÂÌËÂ. ëÎÛ˜‡ËÚ ÒÔÓ‰ÓÒÚÓ ËÎË ıÓÌ˘ÌÓ ÔÓÚ˘‡Ì ÏÓ„‡Ú ‰‡ Ò χÌËÙÂÒ-ÚË‡Ú Ò ÔÒ‚‰Ó‰ÂÏÂ̈Ëfl, Ó·˙͇ÌÓÒÚ ËÎË ÎÂ͇ ıÂÏËÔ‡-ÂÁ‡. ÖÔˉۇÎÌËÚ ıÂχÚÓÏË Ë ÒÛ·‡‡ıÌÓˉ‡ÎÌËÚ Í˙-‚ÓËÁÎË‚Ë Ò‡ ‚Ӊ¢‡ Ô˘Ë̇ ÔË ÓÚ˜Ëڇ̠̇ ÒÏ˙Ú-ÌÓÒÚÚ‡ ÓÚ Ì‚ÓÎӄ˘ÌË ÛÒÎÓÊÌÂÌËfl ÔË ·ÓÎÌËÚ ÎÂÍÛ-‚‡ÌË Ò ıÂÏӉˇÎËÁ‡.(5, 10) éÒ‚ÂÌ ‡ÌÚËÍÓ‡„Û·ÌÚ̇ڇ ÚÂ-‡ÔËfl, ͇ÚÓ ÓÒÌÓ‚ÂÌ Ù‡ÍÚÓ Á‡ ÒÛ·‡‡ıÌÓˉ‡ÎÌËÚ Í˙-‚ÓËÁÎË‚Ë Ò ӷÒ˙ʉ‡Ú Ë ‚Ó‰ÂÌËÚ ‰ÂÙÂÍÚË Ì‡ ËÌÚ‡Í-‡ÌˇÎÌËÚ ÏÓÁ˙˜ÌË Ò˙‰Ó‚Â, ̇È-˜ÂÒÚÓ ÔË ‡‚ÚÓÁÓÏÌÓ-‰ÓÏË̇ÌÚ̇ڇ ÙÓχ ̇ ·˙·Â˜Ì‡Ú‡ ÔÓÎËÍËÒÚÓÁ‡.

àÌÙÂ͈ËËÚ ̇ ñçë ÔË Ô‡ˆËÂÌÚË Ì‡ ‰Ë‡ÎËÁÌÓ Î˜Â-ÌË ̇È-˜ÂÒÚÓ Ò‡ Ô˘ËÌÂÌË ÓÚ ÒÂÔÚ˘ÌË ÛÒÎÓÊÌÂÌËfl ̇ڇÈÌËfl Ò˙‰Ó‚ ‰ÓÒÚ˙Ô (ÙËÒÚÛÎË Ë ÔÓÚÂÁË), ͇ÍÚÓ Ë ÔËÛÔÓÚ·‡ ̇ ‰‚ÓÈÌÓ ÎÛÏÂÌÌË Í‡ÚÂÚË. Kovalik Ë Ò˙Ú.ÛÒÚ‡ÌÓ‚fl‚‡Ú, ˜Â ÓÚ 10 Ô‡ˆËÂÌÚË Ì‡ ïÑ Ò ÂÔˉۇÎÂÌ ‡·-ÒˆÂÒ, 8 Ò‡ ·ËÎË Ò ‰‚ÓÈÌÓ ÎÛÏÂÌÌË Í‡ÚÂÚË, ͇ÚÓ ÔË 5 ÓÚÚflı Ò  ̇·„‡Î‡ ‡ÌÚË·ËÓÚ˘̇ Ú‡ÔËfl ÔÓ ÔÓ‚Ó‰ ÒÂÔ-Ú˘ÌË Ò˙ÒÚÓflÌËfl, Ò‚˙Á‡ÌË Ò Í‡ÚÂÚ‡. (13)

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 125‰ÂÍÂÏ‚Ë, 2002

ãàíÖêÄíìêÄ:

1. Alfrey AC. Dialysis encephalopathy. Kidney Int 1986; 18:S53-S572. Arieff AI, Massry SG, Barientos A, Kleeman CR. Brain water and electrol-lyte metabolism in uremia: effects of slow and rapid hemodialysis. Kidney Int1973; 4:177-823. Arrief Dialysis disequlibrium syndrome: current concepts on pathogenesisand prevention. Kidney Int 45(3):629-35, 19944. Blagg CR. Brain abnormalities. In: Textbook of Nephrology (Eds. MassrySG, Glassock RJ) 2-nd ed.; Williams & Wilkins, Baltimore 1983, 7.15-7.195. Burn DJ, Bates D. Neurology and the kidney. J Neurol NeurosurgeryPsychiatry 65:810-21, 19986. Campese VM. Neurogenic factors and hypertension in chronic renal failure. JNephrol 1997; 10:184-77. Chanard J, Bindi P, Lavaud S. Carpal tunnel syndrome and type of dialysismembrane. Br Med J 1989:867-88. Chazot C, Kopple JD. Vitamin metabolism and requirements in renal diseaseand renal failure. In: Nutritional Management of Renal Disease (Eds. Kopple JD,Massry SG) Williams & Wilkies, Baltimore, 1997:415-79. Divino Filho JC, P Barany, P Stehle. Free amino acids simultaneously col-lected in plasma, muscle and erythrocytes of uraemic patients. Nephrol DialTranspl 1997; 12:2339-4810. Kaplan N. Treatment of hypertension. In: Drug therapy in clinical hyperten-sion (Ed. Glassock R) 7-th ed.; Williams & Wilkins, Baltimore 1998, 181-26311. Katzman R. Alzheimer`s disease. N Engl J Med 1986; 314:964-512. KDOQI. Guideline 11. Association of level of GFR with nephropathy. Am JKid Disease 39; 2002; Suppl 2:S156-S16013. Kovalik EC, Raymond JR, Albers F. A clustering of epidural abscesses inchronic HD patients. J Am Soc Nephro 1996; 7:2264-714. Krivoshiev S, Vazelov E, Koteva A, Zlatarska S, Antonov S, Kirjakov Z.Does uraemic autonomic neuropathy increase risk of sudden death. . Nephrol DialTranspl 1989; 4:7515. Leunissen KML, Kooman JP, van der Sande FM. Acute dialysis complica-tions. In: Complications of dialysis (Eds. Lameire N, Mehta RL) Marcel Dekker

Inc, New York-Basel 2000:29-4016. Lichtenberg G, Blankenstjin PJ, Boomsma F, Koomans HA. No change inautonomic function tests during uncomplicated hemodialysis. Nephrol DialTransplant 1996; 11:651-617. Pascoe MD, Gregory MC. Dialysis encephalopathy: aluminium concentrationin dialysate and brain. Kidney Int 1979; 16:9018. Rump L, Amann K, Orth S, Ritz E. Sympathetic overactivity in renal dis-ease: a window to understand progression and cardiovascular complications ofuraemia? Nephrol Dial Transplant 2000; 15:1735-819. Said G. Neurological aspects of dialysis patients In: Replacement of RenalFunction by Dialysis (Eds. Jacobs C, Kjielstrand CM, Koch KM, Winchester JF)Kluwer Academic Publishers, Boston, 1996:1243-6020. Silver SM. Cerebral edema after rapid dialysis is not caused by an increase inbrain organic osmoles. J Am Soc Nephrol 1995; 6:1600-621. Stoicheva-Taneva O, Masin G, Polenakovitch M, Stojcev S, Stojkovski L.Autonomic nervous system dysfunction and volume nonresponsive hypotension inhemodialysis patients. Am J Nephrol 1991; 11:123-622. Vazelov E, Ribarova F, Shishkov S. Plasma levels of Tryptophan and LargeNeutral Amino Acids (LNAA} in patients on chroniohemodialysis. ComptesRendus de i`Academie Bulgare des Sciences 1999; 52: 1-2:133-623. Wetter TC, Stasuyk K, Kohnen R, Oertel WH, Trenkwalder C.Polysomnographic sleep measures in patients with uremic and idiopathic restlesslegs syndrome. Mov Disord 13; 1998:820-4

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LEVETIRACETAMçéÇà èÖêëèÖäíàÇà Ç ãÖóÖçàÖíé çÄ ÖèàãÖèëàüíÄ

à. ê‡È˜Â‚

å‰ˈËÌÒÍË ìÌË‚ÂÒËÚÂÚ - ëÓÙËfl, ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl

ìÌË‚ÂÒËÚÂÚÒ͇ ÒÔˆˇÎËÁˇ̇ ·ÓÎÌˈ‡ Á‡ ‡ÍÚË‚ÌÓ Î˜ÂÌË ÔÓ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl "ë‚ÂÚË ç‡ÛÏ"

SUMMARY

LEVETIRACETAM A NEW PERSPECTIVES IN THE TREATMENT OF EPILEPSY

I. Raychevíhe treatment of epilepsy has remained problematic

despite the many advances in the last decades. Approximately30% of patients require add-on therapy, but unfortunatelyaround 25% of all epileptic patients remain resistant to dualtherapy i.e., refractory.

Levetiracetam is a new chemical entity with a novel modeof antiepileptic action. It has a unique preclinical profileamong antiepileptic drugs, has demonstrated broad- spectrumpotential and wide margin of safety. It has a favorable near to"ideal" pharmacokinetic profile, fast absorbtion not affectedby dose and food, predictable linear kinetics, reaching steady- state concentration within two days, minimal protein bindingand metabolism.

Levetiracetam is licensed for use as adjunctive therapy forpartial seizures with or without secondary generalization. It isvery well tolerated and has a low potential for interactionswith other drugs.

Treatment with Levetiracetam can be directly initiated in atwice - daily regiment at a therapeutic dose of 1000 mg/d,reaching 1500 mg/b.i.d. if nesessary , depending on clinicaleffect and tolerability. An increase or decrease of daily dosecould be made by 500 mg/b.i.d. every 2 - 4 weeks.Key words: Levetiracetam, clinical trials, pharmacologicalprofile, therapeutic use.

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ã˜ÂÌËÂÚÓ Ì‡ ÂÔËÎÂÔÒËflÚ‡ ‚Ò Ӣ ÔÓÒÚ‡‚fl ‰ˈ‡ÔÓ·ÎÂÏË, ÌÂÁ‡‚ËÒËÏÓ ÓÚ „ÓÎÂÏËfl ̇Ô‰˙Í Ì‡ÔÓÁ̇ÌËflÚ‡ ÌË ‚ ÔÓÒΉÌËÚ ‰ÂÒÂÚËÎÂÚËfl.èË·ÎËÁËÚÂÎÌÓ 30% ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò ÂÔËÎÂÔÒËfl ÒÂÌÛʉ‡flÚ ÓÚ ‰Ó·‡‚˙˜Ì‡ ‡ÌÚËÍÓÌ‚ÛÎÒ˂̇ Ú‡ÔËfl, ‡ÓÍÓÎÓ 25% ÓÚ ‚Ò˘ÍË ÂÔËÎÂÔÚ˘ÌÓ ·ÓÎÌË Ò‡Ú‡Ô‚Ú˘ÌÓ ÂÁËÒÚÂÌÚÌË.

Levetiracetam  ÌÓ‚ ‡ÌÚËÂÔËÎÂÔÚ˘ÂÌ Ï‰Ë͇ÏÂÌÚ ÒÌÂÚ‡‰ËˆËÓÌÂÌ Ì‡˜ËÌ Ì‡ ‰ÂÈÒÚ‚ËÂ, ¯ËÓÍ Ú‡Ô‚Ú˘ÂÌÔÓÚÂÌˆË‡Î Ë ÏÌÓ„Ó ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ. LevetiracetamÔËÚÂʇ‚‡ هχÍÓÍËÌÂÚ˘ÂÌ ÔÓÙËÎ, ·ÎËÁ˙Í ‰Ó"ˉ‡ÎÌËfl",Ò ·˙Á‡ ‡·ÒÓ·ˆËfl, ÍÓflÚÓ Ì  ‰ÓÁÓÁ‡‚ËÒËχ ËÌ Ò ‚ÎËfl ÓÚ ı‡Ì‡, Ëχ ÎËÌÂÈ̇ ÍËÌÂÚË͇, ‰ÓÒÚË„‡steady - state Á‡ 2 ‰ÌË, Ò‚˙Á‚‡ Ò ÏËÌËχÎÌÓ Ò ·ÂÎÚ˙ˆËÚÂË Ëχ ÌÂÁ̇˜ËÚÂÎÂÌ ËÁ‚˙̘ÂÌÓ‰Ó·ÂÌ ÏÂÚ‡·ÓÎËÁ˙Ï.å‰Ë͇ÏÂÌÚ˙Ú Ò ËÁÔÓÎÁ‚‡ ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl ÔËÔ‡ˆË‡ÎÌË ÔËÒÚ˙ÔË ·ÂÁ Ë Ò ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl. íÓÈÒ ÔÓ̇Òfl ÏÌÓ„Ó ‰Ó·Â ÓÚ Ô‡ˆËÂÌÚËÚÂ Ë Ì‚Á‡ËÏÓ‰ÂÈÒÚ‚‡ Ò ‰Û„Ë ÎÂ͇ÒÚ‚‡.

ã˜ÂÌËÂÚÓ Ò Levetiracetam ÏÓÊ ‰‡ Á‡ÔӘ̠‰ËÂÍÚÌÓ,Ӣ ÓÚ Ô˙‚Ëfl ‰ÂÌ Ò Ú‡Ô‚Ú˘̇ ‰ÓÁ‡ ÓÚ 1000 mg/‰Ì.,‡Á‰ÂÎÂ̇ ‚ ‰‚‡ ÔËÂχ. Ç Á‡‚ËÒËÏÓÒÚ ÓÚ ÍÎËÌ˘ÌËflÓÚ„Ó‚Ó Ë ÔÓÌÓÒËÏÓÒÚ ‰ÓÁ‡Ú‡ ÏÓÊ ‰‡ Ò ۂÂÎË˜Ë ‰Ó1500 mg ‰‚‡ Ô˙ÚË ‰Ì‚ÌÓ. èÓÏfl̇ڇ ‚ ‰ÓÁ‡Ú‡, Ò‚˙Á‡Ì‡Ò Û‚Â΢‡‚‡Ì ËÎË Ì‡Ï‡Îfl‚‡ÌÂÚÓ È, ÏÓÊ ‰‡ Ò ËÁ‚˙¯‚‡Ì‡ ‚ÒÂÍË 2 - 4 Ò‰ÏËˆË Ò 1000 mg, ‡Á‰ÂÎÂÌË ‚ ‰‚‡ ÔËÂχ.äβ˜Ó‚Ë ‰ÛÏË: Levetiracetam, ÍÎËÌ˘ÌË ÔÓÛ˜‚‡ÌËfl,هχÍÓÎӄ˘ÂÌ ÔÓÙËÎ, Ú‡Ô‚Ú˘̇ ÂÙÂÍÚË‚ÌÓÒÚ.

éÒÌӂ̇ڇ Á‡‰‡˜‡ ÔË Î˜ÂÌËÂÚÓ Ì‡ eÔËÎÂÔÒËflÚ‡  ‰‡Ò ‰ÓÒÚË„Ì ÂÙÂÍÚË‚ÂÌ ÍÓÌÚÓΠ̇ ÔËÒÚ˙ÔËÚÂ Ë ‰Ó·Ó͇˜ÂÒÚ‚Ó Ì‡ ÊË‚ÓÚ Ì‡ Ô‡ˆËÂÌÚËÚÂ, ·ÂÁ ̇΢ˠ̇ Á̇˜Ë-ÏË Ë ÌÂÊ·ÌË ÒÚ‡Ì˘ÌË ÂÙÂÍÚË, Ò‚˙Á‡ÌË Ò ÛÔÓÚ·‡-Ú‡ ̇ ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌËڠωË͇ÏÂÌÚË. çÂÁ‡‚ËÒË-ÏÓ ÓÚ „ÓÎÂÏËflÚ Ì‡Ô‰˙Í ‚ ÔÓÁ̇ÌËflÚ‡ ÌË ÓÚÌÓÒÌÓ ËÌ-ÚËÏÌËÚ ÏÂı‡ÌËÁÏË Ì‡ ÂÔËÎÂÔÚÓ„ÂÌÂÁ‡Ú‡ Ë ÓÚ ‰ÓÒÚË-ÊÂÌËflÚ‡ ‚˙‚ هχÍÓÚ‡ÔËflÚ‡, ¯‡‚‡ÌÂÚÓ Ì‡ Ú‡ÁËÓÒÌӂ̇ Á‡‰‡˜‡ ‚Ò Ӣ  ÔÓ·ÎÂχÚ˘ÌÓ. èË·ÎËÁËÚÂÎ-ÌÓ 30% ÓÚ Ô‡ˆËÂÌÚËÚ ËÏ‡Ú ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË,ÍÓËÚÓ Ì ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ‰Ó·Â ÍÓÌÚÓΡÌË Ò ÏÓÌÓÚÂ-‡ÔËfl, ÌÂÁ‡‚ËÒËÏÓ ÓÚ Ô‡‚ËÎÌËfl ËÁ·Ó ̇ ωË͇ÏÂÌÚ ËÓÚ ÔË·„‡ÌÂÚÓ ÏÛ ‚ ÓÔÚËχÎ̇ ‰ÓÁ‡. éÍÓÎÓ 25% ÓÚ‚Ò˘ÍË ÂÔËÎÂÔÚ˘ÌÓ ·ÓÎÌË ÓÒÚ‡‚‡Ú ÂÁËÒÚÂÌÚÌË Ë Í˙ÏΘÂÌËÂ Ò ‰‚‡ ωË͇ÏÂÌÚ‡. èÓÎËÚ‡ÔËflÚ‡ Ó·‡˜Â ÔÓÒ-Ú‡‚fl ÔÓ·ÎÂÏË Í‡ÚÓ ˜ÂÒÚÓÚ‡ ̇ ÔËÂÏËÚÂ, ÒıÂÏË Ì‡ÚËÚˇÌÂ, ‡ÁÌÓÓ·‡ÁÌË ÎÂ͇ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl,‚ËÒÓ͇ ˆÂ̇, ÍÛÏÛÎˇÌ ̇ ÒÚ‡Ì˘ÌËÚ ÂÙÂÍÚË, ̉ӷ-Ó Ò˙‰ÂÈÒÚ‚Ë ÓÚ Òڇ̇ ̇ ·ÓÎÌËÚÂ. ÇÒ˘ÍÓ ÚÓ‚‡ ÎÓ-„˘ÌÓ Ôӂ˯‡‚‡ ËÁËÒÍ‚‡ÌËflÚ‡ Í˙Ï ÌÓ‚ËÚ ‡ÌÚËÂÔËÎÂÔ-Ú˘ÌË Ï‰Ë͇ÏÂÌÚË, ÍÓËÚÓ Úfl·‚‡ ‰‡ ÔËÚÂʇ‚‡Ú ·˙-Á‡ Ë Ô˙Î̇ ‡·ÒÓ·ˆËfl ÔË Ó‡ÎÌÓ ÔËÎÓÊÂÌËÂ, ‰˙Î˙„ Ô·Á-ÏÂÌ ÔÓÎÛ-ÊË‚ÓÚ, ÎËÌÂÈ̇ هχÍÓÍËÌÂÚË͇, Ò·· ÏÂÚ‡-·ÓÎËÁ˙Ï, ÎËÔÒ‡ ̇ ÎÂ͇ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl, ‚ËÒÓ͇ÍÎËÌ˘̇ ÂÙÂÍÚË‚ÌÓÒÚ, ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ, ÎÂÒÌÓ ÚËÚ-ˇÌÂ, ‚˙ÁÏÓÊÌÓÒÚ Á‡ Ò˙ı‡ÌÂÌË ̇ ÍÓ„ÌËÚË‚ÌËÚÂÙÛÌ͈ËË.

Levetiracetam  ÌÓ‚ ωË͇ÏÂÌÚ Ò ‡ÌÚËÂÔËÎÂÔÚ˘ÌÓ‰ÂÈÒÚ‚ËÂ, ÍÓÈÚÓ Ô‰ÒÚ‡‚Îfl‚‡ S- Â̇ÌÚËÓÏ ̇ ÔËÓ-ÎˉËÌÓ‚ ‰ÂË‚‡Ú Ò ıËÏ˘̇ ÙÓÏÛ· alpha- ethyl-2- oxo-1-pyrrolodin acetamid.

åÌÓ„Ó·ÓÈÌËÚ Ô‰ÍÎËÌ˘ÌË ÔÓÛ˜‚‡ÌËfl ‚˙ıÛ ÊË-‚ÓÚËÌÒÍË ÏÓ‰ÂÎË Ì‡ ıÓÌ˘̇ ÂÔËÎÂÔÒËfl Ò Ô‡ˆË‡ÎÂÌ Ë „Â-̇ÎËÁË‡Ì ı‡‡ÍÚ ҇ ‰Ó͇Á‡ÎË Û·Â‰ËÚÂÎÌÓ, ˜ÂLevetiracetam ÔËÚÂʇ‚‡ Á̇˜ËÚÂÎÂÌ ‡ÌÚËÂÔËÎÂÔÚ˘ÂÌÔÓÚÂ̈ˇÎ, Ò˙˜ÂÚ‡Ì Ò ‡ÌÚËÂÔËÎÂÔÚÓ„ÂÌ̇ ‡ÍÚË‚ÌÓÒÚ(11, 12,13, 14, 15, 16, 17). íÂÁË ‰‡ÌÌË Ó·ÛÒ·‚flÚ ‚˙ÁÏÓÊ-ÌÓÒÚÚ‡ ωË͇ÏÂÌÚ˙Ú ‰‡ ·˙‰Â ÔË·„‡Ì ͇ÍÚÓ Á‡ ΘÂ-ÌË ̇ ̇΢ÌË ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË, ڇ͇ Ë Á‡ Ô‚ÂÌ-ˆËfl ̇ Ó˜‡Í‚‡Ì‡ ÔÓfl‚‡ ̇ Ú‡ÍË‚‡ ÔËÒÚ˙ÔË Í‡ÚÓ ÛÒÎÓÊ-ÌÂÌË ÔË ‡Á΢ÌË ·ÓÎÂÒÚÌË Ò˙ÒÚÓflÌËfl (̇Ô. ÔË Ô‡ˆË-ÂÌÚË Ò ˜ÂÂÔÌÓ- ÏÓÁ˙˜Ì‡ Ú‡‚χ) (26).

ÑÂÈÒÚ‚ËÂÚÓ Ì‡ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚËÚ ÔË̈ËÔÌÓ ÒÂÓÒ˙˘ÂÒÚ‚fl‚‡ ÔÓ ˜ÂÚËË ÓÒÌÓ‚ÌË Ì‡˜Ë̇:● èÓÚÂ̈ˇÌ ̇ ËÌıË·ËÚÓÌËÚ ÏÂı‡ÌËÁÏË („·‚ÌÓ˜ÂÁ GABA ÒËÒÚÂχڇ).● àÌı˷ˇÌ ̇ ÂÍÒˆËÚ‡ÚÓÌËÚ ÏÂı‡ÌËÁÏË („·‚ÌÓ-„ÎÛڇχÚ̇ڇ ÒËÒÚÂχ).● àÌı˷ˇÌ ̇ ÂÍÒˆÂÒ˂̇ڇ Ì‚ÓÌ̇ ‚˙Á·Û‰ËÏÓÒÚ˜ÂÁ ÏÓ‰ÛÎˇÌ ̇ ‚ÓÎÚ‡ÊÌÓ- Á‡‚ËÒËÏËÚ ̇ÚË‚ËÈÓÌÌË Í‡Ì‡ÎË.● àÌı˷ˇÌ ̇ ÌËÒÍÓ- ‚ÓÎÚ‡ÊÌËÚ í- ͇ΈËÂ‚Ë ÈÓÌÌË͇̇ÎË.

Levetrracetam Ò ‡Á΢‡‚‡ ÔÓ Ò‚ÓËÚ ÏÂı‡ÌËÁÏË Ì‡‰ÂÈÒÚ‚Ë ÓÚ ÓÒڇ̇ÎËÚ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚË. íÂÁË ÏÂı‡-ÌËÁÏË Ì ҇ ‚ÒÂ Ó˘Â Ì‡Ô˙ÎÌÓ ËÁflÒÌÂÌË, ÌÓ Ò ҘËÚ‡ Á‡ ‰Ó-͇Á‡ÌÓ ( 14,16 ), ˜Â ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌËÚ ÏÛ ÂÙÂÍÚË ÒÂÓ·ÛÒ·‚flÚ ÓÚ :● àÌı˷ˇÌ ̇ ‚ËÒÓÍÓ-‚ÓÎÚ‡ÊÌËÚ N-͇ΈËÂ‚Ë ÈÓÌÌË͇̇ÎË, Ô‚Â̈Ëfl ̇ ËÌڇ̂ÓÌÌËfl ͇ΈË‚ ËÌÙÎÛÍÒ Ë‰Û͈Ëfl ̇ Ì‚ÓÌ̇ڇ ‡ÍÚË‚ÌÓÒÚ.● àÌı˷ˇÌ ̇ ‰ÂÔÓÎflËÁˇ˘ËÚ ÈÓÌÌË ÔÓÚÓˆË.● èÓÚËÒ͇Ì ̇ ËÌı˷ˇ˘ÓÚÓ ‰ÂÈÒÚ‚Ë ̇ ˆËÌ͇ Ë Ì‡beta- ͇·ÓÎËÌËÚÂ, ÍÓËÚÓ Ò‡ ‡ÎÓÒÚ¢ÌË ÏÓ‰Û·ÚÓË Ì‡GABA-A Ë Ì‡ „ÎˈËÌÓ‚ËÚ ˆÂÔÚÓË. èÓÚË‚Ó‰ÂÈÒÚ-‚ËÂÚÓ Ì‡ ‡ÎÓÒÚ¢ÌËÚ ÏÓ‰Û·ÚÓË ‚˙ÁÒÚ‡ÌÓ‚fl‚‡

ıÎÓÌËfl ÈÓÌÂÌ ËÌÙÎÛÍÒ ‚ Ì‚̇ڇ ÍÎÂÚ͇.● èÓÏfl̇ ‚ ÏÂÚ‡·ÓÎËÁχ ̇ GABA ÔÓÒ‰ÒÚ‚ÓÏ ÔÓÒÚ-ÒË̇ÔÚ˘ÌË ÂÙÂÍÚË.● ÑËÂÍÚÌÓ ‰ÓÔ‡ËÏ„˘ÌÓ ‡ÍÚ˂ˇÌÂ.● Ç˙Á‰ÂÈÒÚ‚Ë ‚˙ıÛ ÒÔˆËÙ˘ÌË ÂˆÂÔÚÓË Ì‡ ÒË̇Ô-Ú˘̇ڇ ÏÂÏ·‡Ì‡. í‡ÍÓ‚‡ ˆÂÔÚÓÌÓ Ò‚˙Á‚‡Ì ̇Levetiracetam  ÛÒÚ‡ÌÓ‚ÂÌÓ Ò‡ÏÓ ‚ ñçë (ıËÔÓ͇ÏÔ, ÍÓ-ÚÂÍÒ, ˆÂ·ÂÎÛÏ).● ëÂÎÂÍÚË‚ÌÓ ËÌı˷ˇÌ ̇ ÂÔËÎÂÔÚ˘̇ڇ ‡ÍÚË‚-ÌÓÒÚ ‚ ıËÔÓ͇ÏÔ‡ÎÌËÚ Ì‚ÓÌË, ·ÂÁ ‰‡ Ò ÏÓ‰ËÙˈˇÌÓχÎ̇ڇ Ì‚ÓÌ̇ ‚˙Á·Û‰ËÏÓÒÚ.

îÄêåÄäéäàçÖíàóçà éëéÅÖçéëíàèËÎÓÊÂÌ Ó‡ÎÌÓ ‚ ‰ÓÁË ÏÂÊ‰Û 250 mg Ë 5000 mg

Levetiracetam ÔÓ͇Á‚‡ ·˙Á‡ Ë ÔÓ˜ÚË Ô˙Î̇ ‡·ÒÓ·ˆËfl, ÍÓ-flÚÓ Ì Ò ‚ÎËfl Ò˙˘ÂÒÚ‚ÂÌÓ ÓÚ Ì‡Î˘ËÂÚÓ Ì‡ ı‡Ì‡ ‚ÒÚÓχı‡ (11,12). Ä·ÒÓβÚ̇ڇ ÏÛ Ó‡Î̇ ·ËÓ̇΢ÌÓÒÚ ÔÓ˜ÚË 100%. å‡ÍÒËχÎ̇ڇ Ô·ÁÏÂ̇ ÍÓ̈ÂÌÚ‡ˆËfl(C max) ӷ˘‡ÈÌÓ Ò ‰ÓÒÚË„‡ Á‡ 1,3 ˜‡Ò‡, ÔÓ͇Á‚‡ÈÍË ‰ÓÁÓ-Á‡‚ËÒËÏÓ Ì‡‡ÒÚ‚‡ÌÂ. èË ‰ÓÁË ÓÚ 500 mg ‰Ó 5000 mgsteady- state ̇ÒÚ˙Ô‚‡ ÒΉ 2 ‰ÌË. èÓ‡‰Ë ̇΢ËÂÚÓ Ì‡ÎËÌÂÈ̇ ÍËÌÂÚË͇ Ë ‡·ÒÓ·ˆËfl, Ô·ÁÏÂÌÓÚÓ ÌË‚Ó Ë ‰ÓÁ‡-Ú‡ ̇ Levetiracetam ÍÓÂÎË‡Ú ÏÌÓ„Ó ‰Ó·Â, ÍÓÂÚÓ ÌÂËÁËÒÍ‚‡ ÛÚËÌÌÓ ÔÓÒΉfl‚‡Ì ̇ Ô·ÁÏÂÌËÚ ÍÓ̈ÂÌÚ-‡ˆËË Ì‡ ωË͇ÏÂÌÚ‡ (11,12, 17, 21).

Levetiracetam ÔÂÏË̇‚‡ ÔÂÁ Í˙‚ÌÓ- ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë-‡, ‡ Ò‚˙Á‚‡ÌÂÚÓ ÏÛ Ò Ô·ÁÏÂÌËÚ ÔÓÚÂËÌË Â ÏËÌË-χÎÌÓ (ÔÓ‰ 10%). å‰Ë͇ÏÂÌÚ˙Ú Ò ÂÎËÏËÌˇ ÓÒÌÓ‚ÌÓ˜ÂÁ ·˙·ÂˆËÚÂ, ͇ÚÓ 2/3 ÓÚ ÔËÂÚÓÚÓ ÍÓ΢ÂÒÚ‚Ó ÒÂËÁÎ˙˜‚‡ ÌÂÔÓÏÂÌÂÌÓ, ‡ ÓÍÓÎÓ 25%- ÔÓ‰ ÙÓχڇ ̇ ̇Í-ÚË‚ÌË ÏÂÚ‡·ÓÎËÚË, ÓÒÌÓ‚ÌÓ ucb LO57. Levetiracetam ÔÂ-Ú˙Ôfl‚‡ ÏËÌËχÎÂÌ ËÁ‚˙̘ÂÌÓ‰Ó·ÂÌ ÏÂÚ‡·ÓÎËÁ˙Ï ÔÓÒ-‰ÒÚ‚ÓÏ ÂÌÁËÏ̇ ıˉÓÎËÁ‡ ‚ ‡Á΢ÌË Ú˙͇ÌË, ‚Íβ˜Ë-ÚÂÎÌÓ ‚ Í˙‚ÌËÚ ÍÎÂÚÍË, Ú.Â. ÚÓÈ Â ÌÂÁ‡‚ËÒËÏ ÓÚ ˜Â-ÌÓ‰Ó·ÌËÚ ˆËÚÓıÓÏ P450 (CYê) ËÁÓÂÌÁËÏË (11,12, 14,21).

è·ÁÏÂÌËflÚ ÔÓÎÛÊË‚ÓÚ Ì‡ Levetiracetam  6-8 ˜‡Ò‡ Ë ÂÌÂÁ‡‚ËÒËÏ ÓÚ ‰ÓÁ‡, ̇˜ËÌ Ì‡ ÔËÎÓÊÂÌË ËÎË ÏÌÓ„Ó͇Ú-ÌÓÒÚ Ì‡ ÔËÂχ. íÓÈ Ì‡‡ÒÚ‚‡ ‰Ó 10- 11 ˜‡Ò‡ ÔË ‚˙Á‡Ò-ÚÌË Ë Â ÒÍ˙ÒÂÌ ‰Ó 6 ˜‡Ò‡ ÔË ‰Âˆ‡ ÓÚ 6 „. ‰Ó 12 „. ‚˙Á‡ÒÚ.è·ÁÏÂÌËflÚ ÔÓÎÛ- ÊË‚ÓÚ Â Û‰˙ÎÊÂÌ Ë ÔË Ô‡ˆËÂÌÚË Ò Ì‡-Û¯ÂÌË ·˙·Â˜ÌË ÙÛÌ͈ËË Ë Â ‰ËÂÍÌÓ ÔÓÔÓˆËÓ̇ÎÂÌ Ì‡Í‡ÚËÌËÌÓ‚Ëfl ÍÎË˙ÌÒ. èË ·ÓÎÌË Ì‡ ıÂÏӉˇÎËÁ‡ ÚÓÈ̇‡ÒÚ‚‡ ‰Ó 25 ˜‡Ò‡ ‚ ËÌÚ‰ˇÎËÁÌËfl ÔÂËÓ‰ Ë Â 3,1 ˜‡-Ò‡ ÔÓ ‚ÂÏ ̇ ‰Ë‡ÎËÁ‡Ú‡.

ãÂÍÓ Ë ÛÏÂÂÌÓ Ì‡Û¯ÂÌËÚ ˜ÂÌÓ‰Ó·ÌË ÙÛÌ͈ËË ÌÂÔÓ‚ÎËfl‚‡Ú Ò˙˘ÂÒÚ‚ÂÌÓ Ù‡Ï‡ÍÓÍËÌÂÚË͇ڇ ̇Levetiracetam. ĉ‡ÔÚ‡ˆËfl ̇ ‰ÓÁ‡Ú‡ Ò ̇·„‡ Ò‡ÏÓ ÔË̇΢ˠ̇ ÒÂËÓÁÌË ˜ÂÌÓ‰Ó·ÌË Û‚Â‰Ë, Ò˙˜ÂÚ‡ÌË Ò ·˙·-˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

Ç ÎËÚ‡ÚÛ‡Ú‡ ÎËÔÒ‚‡Ú ‰‡ÌÌË Á‡ ̇΢ˠ̇ ÎÂ͇Ò-Ú‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl ÏÂÊ‰Û Levetiracetam Ë ‰Û„Ë ÏÂ-‰Ë͇ÏÂÌÚË (13). èË ÔË·„‡ÌÂÚÓ ÏÛ Í‡ÚÓ ‰Ó·‡‚˙˜Ì‡Ú‡ÔËfl ̇ Ô‡ˆËÂÌÚË Ò Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË ·ÂÁ Ë Ò ‚ÚÓ-˘̇ „Â̇ÎËÁ‡ˆËfl ‚ ‰ÓÁË ÏÂÊ‰Û 500 mg Ë 4000 mg/ 24˜. Á‡ ÔÂËÓ‰ ‰Ó 48 Ò‰ÏËˆË Ì ҇ ÛÒÚ‡ÌÓ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒ-Ú‚Ëfl Ò Î‡ÏÓÚËÊËÌ, ‚‡ÎÔÓ‚‡ ÍËÒÂÎË̇, ÂÚÓÒÛÍÒËÏˉ,͇·‡Ï‡ÁÂÔËÌ, ÙÂÌÓ·‡·ËÚ‡Î, ÙÂÌËÚÓËÌ, „‡·‡ÔÂÌÚËÌ,ÔËÏˉÓÌ (6,13, 24). éÒ‚ÂÌ ÚÓ‚‡ Levetiracetam Ì ‚Á‡ËÏÓ-‰ÂÈÒÚ‚‡ Ò Í‡‰ËÓÚÓÌˈË, Ë̉ËÂÍÚÌË ‡ÌÚËÍÓ‡„Û·ÌÚË ËÓ‡ÎÌË ÍÓÌÚ‡ˆÂÔÚË‚Ë (18).

P.N.Patsalos (18, 19) Ò˙Á‰‡‚‡ Ò͇· Á‡ ÍÓ΢ÂÒÚ‚Â̇ӈÂÌ͇ ̇ ÌflÍÓË ÓÒÌÓ‚ÌË Ù‡Ï‡ÍÓÍËÌÂÚ˘ÌË ı‡‡ÍÚÂËÒ-ÚËÍË Ì‡ ‡ÌÚËÂÔËÎÂÔÚ˘ÌËڠωË͇ÏÂÌÚË, Á‡ ‰‡ ·˙‰ÂËÁ„‡‰Â̇ Ô‰ÒÚ‡‚‡Ú‡ Á‡ ÎÂ͇ÒÚ‚ÓÚÓ Ò "ˉ‡ÎÂÌ" Ù‡-χÍÓÍËÌÂÚ˘ÂÌ ÔÓÙËÎ. í‡ÁË Ò͇· ‡Ì‡ÎËÁˇ Ë ÚÓ˜ÍÛ‚‡Ó‡Î̇ڇ ‡·ÒÓ·ˆËfl (‰Ó·‡, ÎÓ¯‡, ÔÓ‚ÎËfl‚‡˘‡ Ò ÓÚ ı‡-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 127‰ÂÍÂÏ‚Ë, 2002

̇); ÌÂÓ·ıÓ‰ËÏËfl ·ÓÈ ÎÂ͇ÒÚ‚ÂÌ ÔËÂÏ Á‡ 24 ˜. (‚‰Ì˙ÊËÎË ‰‚‡ Ô˙ÚË ‰Ì‚ÌÓ, ÚË Ô˙ÚË ‰Ì‚ÌÓ , Ôӂ˜ ÓÚ ÚËÔ˙ÚË ‰Ì‚ÌÓ); ÍËÌÂÚË͇ (ÎËÌÂÈ̇, ÌÂÎËÌÂÈ̇); ÏÂÚ‡·ÓÎË-Á˙Ï (ÎËÔÒ‚‡˘ ËÎË Ò··, ˜‡ÒÚ˘ÂÌ, ËÌÚÂÌÁË‚ÂÌ); ÎÂ͇ÒÚ-‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ò ‰Û„Ë ‡ÌÚËÂÔËÎÂÔÚ˘ÌË Ï‰Ë͇-ÏÂÌÚË.

àÁÔÓÎÁ‚‡ÈÍË Ú‡ÁË Ò͇· P.N.Patsalos ÓˆÂÌfl‚‡Levetiracetam ͇ÚÓ ÎÂ͇ÒÚ‚Ó Ò ÔÓ˜ÚË "ˉ‡Î̇" هχ-ÍÓÍËÌÂÚË͇, ÍÓÂÚÓ ‰ÓÒÚË„‡ 94% ÓÚ ÒÚÓÔÓˆÂÌÚÓ‚Ëfl"ˉ‡ÎÂÌ" ωË͇ÏÂÌÚ (18, 19).

äãàçàóçà èêéìóÇÄçàü燘‡ÎÓÚÓ Ì‡ ÔÓÛ˜‚‡ÌËflÚ‡, ÔÓÒ‚ÂÚÂÌË Ì‡ ÍÎËÌ˘̇ڇ

ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ Levetiracetam  ÔÓÒÚ‡‚ÂÌÓ ÔÂÁ 1996 „.ÓÚ M. Sharief Ë Ò˙Ú.(22), ÍÓËÚÓ ÔË·„‡Ú ωË͇ÏÂÌڇ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl ÔË 17 ·ÓÎÌË Ò ÂÁËÒÚÂÌÚ̇ÂÔËÎÂÔÒËfl ‚ ‰ÓÁË ÓÚ 500 mg ‰Ó 2000 mg/‰Ì. ‚ ÔÓ‰˙ÎÊÂ-ÌË ̇ 16 Ò‰ÏˈË. íÓ‚‡ Ô˙‚Ó, placebo- ÍÓÌÚÓΡÌÓ ËÁ-ÒΉ‚‡Ì ÔÓ͇Á‚‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜ËÏÓ Ì‡Ï‡Îfl‚‡Ì ̇ÔÓÒÚËÚÂ Ë ÍÓÏÔÎÂÍÒÌËÚ ԇˆË‡ÎÌË ÔËÒÚ˙ÔË ÔÓ ‚ÂÏÂ̇ ˆÂÎËfl Θ·ÂÌ ÔÂËÓ‰ Ò Levetiracetam ‚ ‰ÓÁË 500 mg -1500 mg.

ëΉ‚‡˘ÓÚÓ ÔËÎÓÚÌÓ ÔÓÛ˜‚‡ÌÂ, ‡ÎËÁˇÌÓ ÓÚ R.Grant Ë S. Shorvon (9) Ó·ı‚‡˘‡ 29 Ô‡ˆËÂÌÚË, ÎÂÍÛ‚‡ÌË ÒÔÓÒÚÂÔÂÌÌÓ ÔÓ͇˜‚‡˘Ë Ò ‰ÓÁË Levetiracetam ÓÚ 1000 mg‰Ó 4000 mg/‰Ì., ‰Ó·‡‚ÂÌË Í˙Ï Ô‰¯ÂÒÚ‚‡˘‡ Òڇ̉‡Ú-̇ ‡ÌÚËÍÓÌ‚ÛÎÒ˂̇ Ú‡ÔËfl. Ä‚ÚÓËÚ ÛÒÚ‡ÌÓ‚fl‚‡Ú̇‡ÒÚ‚‡˘ ·ÓÈ Ì‡ Ô‡ˆËÂÌÚËÚ ·ÂÁ ÔËÔ‡‰˙ˆË Á‡ ‚Ò˘ÍˉÓÁËÓ‚ÍË Ì‡ Levetiracetam Ë ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜ËÏÓ Ì‡-χÎfl‚‡Ì ̇ Ò‰̇ڇ ˜ÂÒÚÓÚ‡ ̇ ÔËÒÚ˙ÔËÚ Á‡ ‰ÓÁË-Ú 1000 mg Ë 4000 mg/‰Ì.

íÂÁË ‰‚ ÔËÎÓÚÌË ËÁÒΉ‚‡ÌËfl Ò‡ ÔÓÒΉ‚‡ÌË ÓÚ ˜ÂÚË-Ë ÏÛÎÚˈÂÌÚÓ‚Ë, ‡Ì‰ÓÏËÁˇÌË, ‰‚ÓÈÌÓ - ÒÎÂÔË, place-bo - ÍÓÌÚÓΡÌË ÔÓÛ˜‚‡ÌËfl, Ó·ı‚‡˘‡˘Ë Ó·˘Ó 1023·ÓÎÌË Ò ÂÁËÒÚÂÌÚÌË Ì‡ ΘÂÌË ԇˆË‡ÎÌË ÔËÒÚ˙ÔË.èË ‚Ò˘ÍË ·ÓÎÌË Levetiracetam  ‰Ó·‡‚flÌ Í˙Ï Ò˙˘ÂÒÚ‚Û-‚‡˘‡ ‰Ó ̇˜‡ÎÓÚÓ Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ ‡ÌÚËÍÓÌ‚ÛÎÒ˂̇ ÚÂ-‡ÔËfl. íË ÓÚ ÚÂÁË ˜ÂÚËË ÔÓÛ˜‚‡ÌËfl (‰‚ ‚ÓÔÂÈÒÍË Ë‰ÌÓ- ‚ USA) ËÏ‡Ú ÔË·ÎËÁËÚÂÎÌÓ Â‰Ì‡Í˙‚ ‰ËÁ‡ÈÌ, ÓˆÂÌfl-‚‡ÈÍË ÂÙÂÍÚ‡ ̇ Levetiracetam ‚˙ıÛ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÔËÒ-Ú˙ÔËÚÂ, ·Ófl ̇ Ô‡ˆËÂÌÚËÚÂ, ÓÚ„Ó‚‡fl˘Ë ̇ ΘÂÌËÂÚÓÒ Ì‡Ï‡ÎÂÌË ̇ ÔËÔ‡‰˙ˆËÚÂ Ò 50% Ë Ôӂ˜ (responders)Ë ÔÓˆÂÌÚ‡ ·ÓÎÌË Ò Ô˙ÎÌÓ ÔÂ͇Úfl‚‡Ì ̇ Ô‡ˆË‡ÎÌËÚÂÔËÒÚ˙ÔË (1,2,5,20, 23). å‰Ë͇ÏÂÌÚ˙Ú Â ÔË·„‡Ì ͇ÚÓ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl ‚ ‰ÓÁË ÓÚ 1000 mg, 2000 mg Ë 3000mg/‰Ì, ‡ÁÔ‰ÂÎÂÌË ‚ ‰‚‡ ÔËÂχ, ‚ ÔÓ‰˙ÎÊÂÌË ̇ 12 -14 Ò‰ÏˈË, ÔË ÒÚ‡ÚÓ‚‡ ‰ÓÁ‡ 1000 mg, Û‚Â΢‡‚‡˘‡ ÒÂÒ 500 mg ÔÂÁ 14 ‰ÌË.. óÂÚ‚˙ÚÓÚÓ ÔÓÛ˜‚‡Ì (3) Â Ò ÔÓ-‡Á΢ÂÌ ‰ËÁ‡ÈÌ; Ôӂ‰ÂÌÓ Â ‚ Ö‚ÓÔ‡ ÔË 119 Ô‡ˆËÂÌÚËÒ ‡Á΢ÌË ‚ˉӂ ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË, ͇ÚÓLevetiracetam  ‰Ó·‡‚flÌ Í˙Ï ÔÓ‚Âʉ‡ÌÓÚÓ ‰Ó ÏÓÏÂÌڇ̇ ÔÓÛ˜‚‡ÌÂÚÓ Î˜ÂÌËÂ Ò Â‰ËÌ, ‰‚‡ ËÎË ÚË Òڇ̉‡ÚÌËÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌË Ï‰Ë͇ÏÂÌÚ‡. àÁÒΉ‚‡ÌÂÚÓ Â ÒÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ 24 Ò‰ÏËˆË ‚ ÛÒÎÓ‚ËflÚ‡ ̇ ‰‚ÓÈÌÓ -ÒÎflÔ ÓÔËÚ, ÔÓÒΉ‚‡ÌÓ ÓÚ ÓÚÍËÚ‡ Ù‡Á‡ Á‡ ÔÂËÓ‰ Ò˙˘ÓÓÚ 24 Ò‰ÏˈË. ëÚ‡ÚÓ‚‡Ú‡ ‰ÓÁ‡ ̇ Levetiracetam  2000mg, ÔÓÒΉ‚‡Ì‡ ÓÚ 4000 mg/‰Ì. ·ÂÁ ÚËÚˇÌÂ, ‡ ÓÒÌÓ‚-̇ڇ Á‡‰‡˜‡ ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ‰‡ Ò ‡Ì‡ÎËÁˇ ÔÓÌÓÒË-ÏÓÒÚÚ‡ ̇ ωË͇ÏÂÌÚ‡.

é·Ó·˘ÂÌËÚ ÂÁÛÎÚ‡ÚË ÓÚ ÚÂÁË ÏÛÎÚˈÂÌÚÓ‚ËÔÓÛ˜‚‡ÌËfl ÔÓ͇Á‚‡Ú, ˜Â Ò‰̇ڇ ˜ÂÒÚÓÚ‡ ̇ ÂÔËÎÂÔ-Ú˘ÌËÚ ÔËÒÚ˙ÔË Ì‡Ï‡Îfl‚‡ Ò 16% - 20% ÔË ‰ÓÁ‡ ̇Levetiracetam 1000 mg/‰Ì.; Ò 18% - 21% - ÔË ‰ÓÁ‡ 2000mg/‰Ì. Ë Ò 28% - ÔË 3000 mg/‰Ì., ‡ÁÔ‰ÂÎÂÌË ‚ ‰‚‡ ÔË-Âχ. ê‰Û͈ËflÚ‡ ̇ Ô‡ˆË‡ÎÌËÚ ÔËÒÚ˙ÔË Ò 50% Ò ÛÒ-Ú‡ÌÓ‚fl‚‡ ÔË 40% ÓÚ Ô‡ˆËÂÌÚËÚÂ, ÎÂÍÛ‚‡ÌË Ò 3000mg/‰Ì., ‡ ÔË 28% - 30% Ú‡ÁË Â‰Û͈Ëfl  ̇‰ 75%. èË

ÔË·ÎËÁËÚÂÎÌÓ ‰‚‡‰ÂÒÂÚ ÔÓˆÂÌÚ‡ ÓÚ ‚Ò˘ÍË Ô‡ˆËÂÌÚËÒ ÓÚ˜ËÚ‡ Ô˙ÎÌÓ ÔÂ͇Úfl‚‡Ì ̇ Ô‡ˆË‡ÎÌËÚ ÔËÒÚ˙-ÔË, ͇ÚÓ ·ÓflÚ Ì‡ ÚÂÁË ·ÓÎÌË Â ÔÓ- ‚ËÒÓÍ ‚ „ÛÔ‡Ú‡, ÔÓ-ÎÛ˜‡‚‡Î‡ 3000 mg/‰Ì.

Ä̇ÎËÁ˙Ú, ÓÒ˙˘ÂÒÚ‚ÂÌ ÓÚ Ch. Elger (8) ‚˙ıÛ 505 ÓÚÔ‡ˆËÂÌÚËÚÂ, ÎÂÍÛ‚‡ÌË Ò Levetiracetam Ò‰ÌÓ Á‡ ÔÂËÓ‰ÓÚ 22 Ò‰ÏËˆË ÔÓ͇Á‚‡, ˜Â 43% ÓÚ Úflı ÓÚ„Ó‚‡flÚ Ì‡ ÎÂ-˜ÂÌËÂÚÓ Ò Ì‡Ï‡Îfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚÂ Ò >50% ; ÔË 32%‰Û͈ËflÚ‡ ̇ ÔËÒÚ˙ÔËÚ  Ôӂ˜ ÓÚ 75%, ‡ 20% ÓÚÔ‡ˆËÂÌÚËÚ ҇ ·ÂÁ ÔËÒÚ˙ÔË. ÇÎÓ¯‡‚‡Ì ̇ Ò˙˘ÂÒÚ‚Û-‚‡˘ËÚ ÔËÔ‡‰˙ˆË  ÛÒÚ‡ÌÓ‚ÂÌÓ Ò‡ÏÓ ÔË 14% ÓÚ ·ÓÎÌË-ÚÂ.

Levetiracetam Ëχ ÏÌÓ„Ó ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ, ͇ÚÓÒÚ‡Ì˘ÌËÚ fl‚ÎÂÌËfl („·‚ÌÓ- ÒÓÏÌÓÎÂÌÚÌÓÒÚ, ‡ÒÚÂÌËfl,ÌÂÔÓÒÚÓflÌÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ) Ò‡ Ò˙ËÁÏÂËÏË ÔÓ ÚÂÊÂÒÚ Ë˜ÂÒÚÓÚ‡ Ò ÚÂÁË, ̇·Î˛‰‡‚‡ÌË ÔË placebo, ÔÓ͇Á‚‡ÈÍËÒ˙‚ÒÂÏ Ò··‡ ËÎË ÔÓ˜ÚË ÎËÔÒ‚‡˘‡ Á‡‚ËÒËÏÓÒÚ ÓÚ ‰ÓÁ‡-Ú‡. çÂÊ·ÌËÚ ÂÙÂÍÚË ÓÚ ÔË·„‡ÌÂÚÓ Ì‡Levetiracetam Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÔË ÔÓ- χÎÍÓ ÓÚ 6% ÓÚ ËÁ-ÒΉ‚‡ÌËÚ 1023 Ô‡ˆËÂÌÚË. éÒ‚ÂÌ ÒÓÏÌÓÎÂÌÚÌÓÒÚ, ‡Ò-ÚÂÌËfl Ë Ò‚ÂÚÓ‚˙ÚÂÊ, ÏÌÓ„Ó fl‰ÍÓ ÏÓ„‡Ú ‰‡ Ò ‡Á‚ËflÚÔӂ‰Â̘ÂÒÍË ÓÚÍÎÓÌÂÌËfl ͇ÚÓ ÒÚ‡ı, ‡Ô‡ÚËfl, ‰ÂÔÂÒËflËÎË ‚˙Á·Û‰ÂÌÓÒÚ, ̇Ô„̇ÚÓÒÚ, „Ìfl‚ Ë ‡„ÂÒËfl (7).

ç  ÛÒÚ‡ÌÓ‚ÂÌÓ ‚ÎËflÌË ̇ Levetiracetam ‚˙ıÛ ÍÓ„ÌË-ÚË‚ÌËÚ ÙÛÌ͈ËË (7).

èÓ‡‰Ë ÎËÔÒ‚‡˘Ë ‰‡ÌÌË Á‡ ÔÓÚÂ̈ˇÎÌËfl ËÒÍ ÓÚ Û‚-‰‡ ̇ ÔÎÓ‰‡, Ì Ò ÔÂÔÓ˙˜‚‡ ÔË·„‡ÌÂÚÓ Ì‡Levetiracetam ÔÓ ‚ÂÏ ̇ ·ÂÏÂÌÌÓÒÚ Ë Í˙ÏÂÌ (14).

Levetiracetam Ì  „ËÒÚË‡Ì Á‡ ÏÓÌÓÚ‡ÔËfl, ÌÓ Ò˙-˘ÂÒÚ‚Û‚‡˘ËÚ ÎËÚ‡ÚÛÌË ‰‡ÌÌË ‚ ÚÓ‚‡ ÓÚÌÓ¯ÂÌËÂÒ‡ ӷ̇‰Âʉ‡‚‡˘Ë (1). Ä‚ÚÓËÚ ÔË·„‡Ú LevetiracetamÔË ÔÓ‰·‡ÌË ·ÓÎÌË ‚ ‰ÓÁ‡ ÓÚ 3000 mg/‰Ì. ͇ÚÓ ‰Ó·‡‚˙˜-ÌÓ Î˜ÂÌËÂ, Ò ÔÓÒΉ‚‡˘Ó ÔÓÒÚÂÔÂÌÌÓ ÒÔˇÌ ̇ ÒÚ‡Ì-‰‡ÚÌËfl ‡ÌÚËÂÔËÎÂÔÚ˘ÂÌ Ï‰Ë͇ÏÂÌÚ. 臈ËÂÌÚËÚÂ,ÔÓÎÛ˜‡‚‡ÎË Levetiracetam - ÏÓÌÓÚ‡ÔËfl, Ò‡ ÔÓ͇Á‡ÎË ÒÚ‡-ÚËÒÚ˘ÂÒÍË Á̇˜ËÏÓ ÒÌËÊÂÌË ̇ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÂÔËÎÂÔ-Ú˘ÌËÚ ÔËÒÚ˙ÔË, Ò‡‚ÌÂÌÓ Ò ÔÂËÓ‰‡ ̇ ΘÂÌË Ò˙ÒÒڇ̉‡ÚÌËfl ‡ÌÚËÂÔËÎÂÔÚ˘ÂÌ Ï‰Ë͇ÏÂÌÚ.

èÓÒÚÂÔÂÌÌÓÚÓ ‡Á¯Ëfl‚‡Ì ̇ Ë̉Ë͇ˆËËÚ Á‡ ÔË·-„‡Ì ̇ Levetiracetam ÔÓ͇Á‚‡Ú, ˜Â ÚÓÈ Â ÂÙÂÍÚË‚ÂÌ Ë ÔËÔ‡ˆËÂÌÚË Ò „Â̇ÎËÁˇÌË ÚÓÌ˘ÌÓ- ÍÎÓÌ˘ÌË ÔËÔ‡‰˙-ˆË, ‡·Ò‡ÌÒË, ÏËÓÍÎÓÌ˘ÌË ÔËÒÚ˙ÔË (3, 4). ëÔÓ‰ R.Coupez, J. Nicolas Ë T. Browne (6) Levetiracetam Ëχ ËÁÍβ-˜ËÚÂÎÌÓ ‰Ó·˙ ÂÙÂÍÚ ÔË ÙÓÚÓÒÂÌÁËÚË‚ÌË ÔËÒÚ˙ÔË, ‡K. Smith, T. Betts Ë L. Pritchett (25) ÓÚ˜ËÚ‡Ú ÔÓÚÂ̈ˇÎ-̇ ÔÓÎÁ‡ ÓÚ ÔË·„‡ÌÂÚÓ Ì‡ ωË͇ÏÂÌÚ‡ ÔË Ô‡ˆËÂÌÚËÒ ˛‚ÂÌËÎ̇ ÏËÓÍÎÓÌ˘̇ ÂÔËÎÂÔÒËfl.

Ç˙ÔÂÍË, ˜Â Levetiracetam Ӣ Ì  ËÌ‰ËˆË‡Ì Á‡ ÛÔÓÚ-·‡ ‚ ‰ÂÚÒ͇ ‚˙Á‡ÒÚ, T.A.Glauser Ë Ò˙Ú.(10) „Ó ÔË·-„‡Ú ͇ÚÓ ‰Ó·‡‚˙˜ÌÓ Î˜ÂÌË ̇ Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ôˉˆ‡ ÓÚ 6„. ‰Ó 12 „. ‚ ‰ÓÁ‡ 20 - 40 mg/Í„ Ú.Ú./24 ˜. ëÔÓ‰‡‚ÚÓËڠωË͇ÏÂÌÚ˙Ú Â ‰ÂÏÓÌÒÚˇΠÂÙÂÍÚË‚-ÌÓÒÚ, ·ÂÁÓÔ‡ÒÌÓÒÚ Ë ÏÌÓ„Ó ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ.

èÓ ‰‡ÌÌË Ì‡ UCB Sector Sales Tracking (14) ‰Ó Ï. ˛ÌË2002 „. Ó·˘Ó 140 674 Ô‡ˆËÂÌÚË ÔËÂÏ‡Ú Levetiracetam ͇-ÚÓ ‰Ó·‡‚˙˜ÌÓ Î˜ÂÌË ÔË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ò Ë ·ÂÁ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl.

é·Ó·˘ÂÌËflÚ ‡Ì‡ÎËÁ ̇ ÂÁÛÎÚ‡ÚËÚ ÓÚ Ôӂ‰ÂÌËÚÂÏÛÎÚˈÂÌÚÓ‚Ë, ‰‚ÓÈÌÓ- ÒÎÂÔË, placebo - ÍÓÌÚÓΡÌËÔÓÛ˜‚‡ÌËfl ‰‡‚‡Ú ÓÒÌÓ‚‡ÌË ‰‡ Ò ÔËÂÏÂ, ˜ÂLevetiracetam  ÌÓ‚ ‡ÌÚËÂÔËÎÂÔÚ˘ÂÌ Ï‰Ë͇ÏÂÌÚ Á‡ ‰Ó-·‡‚˙˜ÌÓ Î˜ÂÌËÂ, ˜ËÂÚÓ ÔË·„‡Ì ÒÚ‡Úˇ ‰ËÂÍÚÌÓ ÒÚ‡Ô‚Ú˘ÌÓ ÂÙÂÍÚ˂̇ ‰ÓÁ‡ 1000 mg/‰Ì., ‡ ÔË ÌÂÓ·ıÓ-‰ËÏÓÒÚ - Ë Ò Ì‡ÚÓ‚‡‚‡˘‡ ‰ÓÁ‡ ÓÚ 2000 mg/‰Ì.; ÚËÚË-‡ Ò ·˙ÁÓ Ë ÎÂÒÌÓ ‰Ó ‰ÓÁË 3000 mg - 4000 mg/‰Ì.; ‡ÁÔÂ-‰ÂÎfl Ò ‚ ‰‚‡ ÔËÂχ Á‡ 24 ˜‡Ò‡; ‰ÂÏÓÌÒÚˇ Ô˙Î̇ Ó‡Î-̇ ‡·ÒÓ·ˆËfl, ÔÓ˜ÚË 100% ·ËÓ̇΢ÌÓÒÚ, ÎËÔÒ‡ ̇ ÎÂ͇-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 128‰ÂÍÂÏ‚Ë, 2002

ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl, ÎËÌÂÈ̇ ÍËÌÂÚË͇, Ò˙˜ÂÚ‡ÌË ÒÏÌÓ„Ó ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ Ë ÔÓ˜ÚË Ô˙ÎÌÓ ÓÚÒ˙ÒÚ‚Ë ̇ÒÚ‡Ì˘ÌË ÌÂÊ·ÌË ÂÙÂÍÚË.íÂÁË Í‡˜ÂÒÚ‚‡ ̇Levetiracetam ÔÓÁ‚ÓÎfl‚‡Ú ÚÓÈ ‰‡ ·˙‰Â Í·ÒËÙËˆË‡Ì Í‡-ÚÓ Ï‰Ë͇ÏÂÌÚ Ò "ˉ‡ÎÂÌ" هχÍÓÍËÌÂÚ˘ÂÌ ÔÓÙËÎ,Ó˜ÂÚ‡‚‡˘ ÌÓ‚Ë ÔÂÒÔÂÍÚË‚Ë ‚ ΘÂÌËÂÚÓ Ì‡ ÂÔËÎÂÔÒËfl-Ú‡.

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1. Ben-Menachem, E.,Falter, U., for the European Levetiracetam Stury Group.Efficacy and tolerability of levetiracetam 3000 mg/d in patients with refractorypartial seizures: a multicenter, double - blind, responder- selected study evaluatingmonotherapy. Epilepsia, 2000, 41,10,1276 - 1283.2. Ben-Menachem, E. Sustained efficacy during long- term treatment withLevetiracetam. J.Neurol. Science, 2001, 187 (suppl. 1), P 0851.3. Betts, T.,Waegemans, T.,Crawford, P. A multicentre, double - blind, random-ized, parallel group study to evaluate the tolerability and efficacy of two oral dosesof levetiracetam, 2000 mg daily and 4000 mg daily, without titration in patientswith refractory epilepsy. Seizure, 2000, 9, 80 - 87.4. Betts, T. How does levetiracetam perform in real life clinic practice? 6thEFNS Congress. Satellite symposium: Levetiracetam 2000 - 2002: from expecta-tion to experience, Vienna, 27 Oct.,2002.5. Cereghino, J.J., Biton, V. et al. the United States Levetiracetam Study Group.Levetiracetam for partial seizures: results of double -blind, randomized clinicaltrial. Neurology, 2000, 55, 236 - 242.6. Coupez, R.,Nicolas J.M.,Browne, T.R. Levetiracetam, a new antiepilepticagent: lack of in vitro and in vivo pharmacocinetic interaction with valproic acid.Epilepsia, 2002,in press.7. Doodley, M., Plosker, G.L. Levetiracetam. A review of its adjunctive use inthe management of partial onset seizures. Drugs, 2000, 60, 4, 871 - 893.8. Elger, Ch.E. Siezures control with Levetiracetam : does clinical experiencecompare with trial results? 6th EFNS Congress. Satellite symposium :Levetiracetam 2000 - 2002 : from expectation to experience. Vienna, 27 Oct. 2002.9. Grant, R., Shorvon, S.D. Efficacy and tolerability of 1000 - 4000 mg per dayof Levetiracetam as add-on therapy in patients with refractory epilepsy. EpilepsyRes., 2000, 42, 89 -95.10. Glauser, T.A, Pellock, J.M.,Bebin, E.M. et al. Efficacy and safety of leve-tiracetam in children with partial seizures: an open- label trial. Epilepsia, 2002, 43,5, 518 - 524.11. Klitgaard, H, Matagne A., Gobert, J., Wulfert, E. Evidence for a unique pro-file of levetiracetam in rodent models of seizures and epilepsy. Eur.J.Pharmacol.,1998, 353, 191 - 206.12. Klitgaard, H. Levetiracetam he preclinical profile of a new class ofantiepileptic drugs? Epilepsia, 2001, 42 (suppl. 4), 13- 18.13. Ledent, E., Martin, A., Baltes, E. Assessment of pharmacokinetic drug - drug

interactions in levetiracetam phase III epilepsy studies (metaanalysis). UCBInternational Report: RXLE 98L 3001. 1999.14. Levetiracetam. Product Monograph, UCB SA, 2002.15. Loscher, W., Honack, D. Profile of ucb L059, a novel anticonvulsant drug, inmodels of partial and generalized epilepsy in mice and rats. Eur. J.Pharmacol.,1993, 232, 147 - 158.16. Margineanu, D.G. Preclinical profile and model(s) of action: what can weexpect? 6th EFNS Congress. Satellite symposium : Levetiracetam 2000 - 2002 :from expectation to experience. Vienna, 27 Oct.,2002.17. Mitchell, T.N., Sander, J.W. Levetiracetam : a new antiepileptic drug for theadjuctive therapy of chronic epilepsy. Drugs of Today, 2001, 37, 10, 665 - 873.18. Patsalos, P.N. Pharmacokinetic profile of levetiracetam : toward ideal charac-teristics. Pharmacol. Ther., 2000, 85, 2, 77 - 85.19. Patsalos, P.N. Pharmacological effects : how do these impact on everydayuse? 6th EFNS Congress. Satellite symposium : Levetiracetam 2000 - 2002 : fromexpectation to experience. Vienna, 27 Oct.,2002.20. Privitera, M. Efficacy of Levetiracetam : A review of the pivotal clinical tri-als. Epilepsia, 2001, 42 (suppl. 4),31 - 35.21. Radtke,R. Pharmacokinetics of Levetiracetam. Epilepsia, 2001, 42 (supll. 4),24 - 27.22. Sharief, M., Sigh, P., Sander, J.W. et al. Efficacy and tolerability study ofUCB L059 in patients with refractory epilepsy. J. Epilepsy, 1996,9, 106 - 112.23. Shorvon, S.D., Lowenthal, A. et al., for the European Levetiracetam StudyGroup. Multicenter double- blind, randomized, placebo - controlled trial of leve-tiracetam as add-on therapy in patients with refractory partial sezures. Epilepsia,2000, 41, 9, 1179 - 1186.24. Sisodiya, S.M., Sander, J.W., Patsalos, P.N. Carbamazepine toxicity duringcombination therapy with levetiracetam : a pharmacodinamic interaction. EpilepsyResearch, 2002, 48, 217 - 219.25. Smith, K., Betts, T., Pritchett, L. Levetiracetam. A promising option for thetreatment of juvenile myoclonic epilepsy. Epilepsia, 2000, 41 (suppl. 39). Abstract.26. Walker, M.C., Sander, J.W. Overtreatment with antiepileptic drugs. CNS Drugs, 1994, 2, 5, 335 - 340.*Keppra®  Á‡Ô‡ÁÂ̇ Ú˙„Ó‚Ò͇ χ͇ ̇ UCB Pharma

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- à‚Ó ê‡È˜Â‚ìëÅÄãçè "ë‚. ç‡ÛÏ",ç‚ÓÎӄ˘̇ ÍÎËÌË͇ÅÛÎ. ñ‡Ë„‡‰ÒÍÓ ¯ÓÒ - 4 ÍÏ1113 ëÓÙËflÚÂÎ. (02) 70 93 60e-mail: iraychev@doctor.bg

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 129‰ÂÍÂÏ‚Ë, 2002

SUMMARY

EPILEPTIC SEIZURES IN PATIENTS WITH BRAINTUMORS

O. Grigorova, I. Petrova, P. KalpachkiWe have investigated retrospectively 120 patients with

brain tumors , who have been treated at the university neuro-logical clinic in the last 7 years. Of them 25 are patients withepileptic seizures ( 20, 8%) , 18 men and 7 women, of agefrom 23 to 75 years old, 15 patients are of age below 50 yearsold ( 60 %). The patients were diagnosed via CT and MRI,and in 19 of the cases the diagnose was confirmed duringsurgery. The distribution of the patients with epileptic seizuresbased on the type of the tumor is as follows: 2 oligoden-droglioma, 2 ganglioglioma, 2 glioblastoma, 4 astrocytoma, 5mixed glioma, 5 meningeoma, 1 osteoma, 1 cysta arach-noidalis, 1 pseudocysta, 2 brain metastases from a lung can-cer.The distribution of the patients based on the type of theepileptic seizures is as follows: simple partial 5, simple partialwith secondarily generalized 5, complex partial with secon-darily generalized 5, generalized tonic- clonic 6, generalizedatonic- akinetic 3, as a drop attaks 1.The first clinical symp-toms of brain tumor were: epileptic seizures (13 patients),localized symptoms (4 patients), intracranial hypertension (2patients), mental disorders (2 patients), both epileptic seizuresand localized symptoms (2 patients). In 3 cases of patientsthat underwent surgery, the epileptic seizures were the firstsymptoms of the recurrence of brain tumor.While hospital-ized, 8 patients were with negative status and 17 were withlocalized symptoms; 13 patients with mono- or hemiparesis, 4with headache, 2 with intracranial hypertension, 2 with papil-loedema, 5 with apatiko-abulic syndrome. EEG was per-formed in 15 patients and were found out focal slow wavesactivity in 11 patients, focal sharp waves activity in 4 patientsand generalized activity in 8 patients. The following changeswere found in 22 patients using CT scan: hypodense zone in11 patients, hyperdense zone in 6 , heterodense zone in 3,periphocal edema in 9 and dislocation in 3. Centroparietalglioma and ganglioglioma of the ammonium horn were notclearly visualized with CT, but were found using MRI.Key words- brain tumor; epileptic seizures

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èÓÛ˜ÂÌË Ò‡ ÂÚÓÒÔÂÍÚË‚ÌÓ 120 ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛ-ÏÓË, ıÓÒÔËÚ‡ÎËÁˇÌË ‚ ÛÌË‚ÂÒËÚÂÚÒ͇ Ì‚ÓÎӄ˘̇ÍÎËÌË͇ Á‡ 7 „Ó‰. éÚ Úflı Ò ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Ò‡ 25·ÓÎÌË (20,8 %), 18 Ï˙ÊÂ Ë 7 ÊÂÌË, ̇ ‚˙Á‡ÒÚ ÓÚ 23 ‰Ó 75„Ó‰. èÓ‰ 50 „Ó‰. Ò‡ 15 ÓÚ ·ÓÎÌËÚ (60%). Ñˇ„ÌÓÁ‡Ú‡ ÂÔÓÒÚ‡‚Â̇ Ò äí, åêí Ë ‚ÂËÙˈˇ̇ ÓÔ‡ÚË‚ÌÓ ÔË 19·ÓÎÌË. ê‡ÁÔ‰ÂÎÂÌËÂÚÓ Ì‡ ·ÓÎÌËÚÂ Ò ÂÔËÎÂÔÚ˘ÌË ÔË-Ô‡‰˙ˆË ÒÔÓ‰ ‚ˉ‡ ̇ ÚÛÏÓ‡  ͇ÍÚÓ ÒΉ‚‡: 2 ÓÎË„Ó-‰ẨӄÎËÓÏ, 2 „‡Ì„ÎËÓ„ÎËÓÏ, 2 „ÎËӷ·ÒÚÓÏ, 4 ‡ÒÚÓˆË-ÚÓÏ, 5 „ÎËÓÏ, 5 ÏÂÌËÌ„ÂÓÏ, 1 ÓÒÚÂÓÏ, 1 ‡‡ıÌÓˉ̇ ÍËÒ-

Ú‡, 1 ÔÒ‚‰ÓÍËÒÚ‡, 2 ÏÂÚ‡ÒÚ‡ÁË ÓÚ ·ÂÎÓ‰Ó·ÂÌ Í‡ˆË-ÌÓÏ. ëÔÓ‰ ‚ˉ‡ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË ·ÓÎÌËÚÂÒ ‡ÁÔ‰ÂÎflÚ Ú‡Í‡: ÔÓÒÚË Ô‡ˆË‡ÎÌË 5, ÔÓÒÚË Ô‡-ˆË‡ÎÌË Ò ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl 5, ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡Î-ÌË Ò ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl 5, „Â̇ÎËÁˇÌË ÚÓÌ˘ÌÓ-ÍÎÓÌ˘ÌË 6, „Â̇ÎËÁˇÌË ‡ÚÓÌ˘ÌÓ-‡ÍËÌÂÚ˘ÌË 3, Ò ı‡-‡ÍÚ ̇ drop attacks -1. 燘‡ÎÌËÚ ÍÎËÌ˘ÌË ÔÓfl‚Ë Ì‡ÏÓÁ˙˜ÌËfl ÚÛÏÓ Ò‡: ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË 13 ·ÓÎÌË, Ó„-ÌˢÌË ÔÓfl‚Ë 4 ·ÓÎÌË, ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌÒËfl 2·ÓÎÌË, ÔÒËı˘ÌË ÔÓÏÂÌË 2 , ÛÒÔÓ‰ÌÓ ÂÔËÎÂÔÚ˘ÌË ÔË-Ô‡‰˙ˆË Ë Ó„ÌˢÌË ÔÓfl‚Ë 2 ·ÓÎÌË. èË 3 ÓÔ¡ÌË ·ÓÎÌËÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË Ò‡ Ô˙‚‡ ÔÓfl‚‡ ̇ ˆˉ˂‡Ì‡ ÏÓÁ˙˜ÌËfl ÚÛÏÓ. èË ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ 8 ÓÚ ·ÓÎÌË-Ú ҇ Ò Ì„‡ÚË‚ÂÌ ÒÚ‡ÚÛÒ, ‡ 17 Ò‡ Ò Ó„ÌˢÌË ÔÓfl‚Ë: 13·ÓÎÌË Ò ÏÓÌÓ- Ë/ËÎË ıÂÏËÔ‡ÂÁ‡, 5 ·ÓÎÌË Ò ‡Ô‡ÚËÍÓ-‡·ÛÎË-˜ÂÌ ÒË̉ÓÏ, 2 ·ÓÎÌË Ò ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌÒËfl, 4·ÓÎÌË Ò „·‚Ó·ÓÎËÂ, 2 ·ÓÎÌË Ò˙Ò Á‡ÒÚÓÈÌË Ô‡ÔËÎË. ë ÖÖÉÔË 15 ÓÚ ËÁÒΉ‚‡ÌËÚ ·ÓÎÌË Ò ‡ÁÍË‚‡ ÙÓ͇Î̇ ·‡‚ÌÓ-‚˙ÎÌÓ‚‡ ‡ÍÚË‚ÌÓÒÚ ÔË 11 ·ÓÎÌË Ë ÙÓ͇Î̇ ‡ÍÚË‚ÌÓÒÚÓÚ ÓÒÚË ‚˙ÎÌË ÔË 4 ·ÓÎÌË . ÉÂ̇ÎËÁË̇ Ô‡ÓÍÒËÁχÎ-̇ ‡ÍÚË‚ÌÓÒÚ Ò „ËÒÚˇ ÔË 8 ·ÓÎÌË. äí ÔË 22 ·ÓÎ-ÌË ‚ËÁÛ‡ÎËÁˇ ÒΉÌËÚ ÔÓÏÂÌË:ıËÔÓ‰ÂÌÁ̇ ÁÓ̇ ÔË 11·ÓÎÌË, ıËÔ‰ÂÌÁ̇ - ÔË 6 ·ÓÎÌË, ıÂÚÂÓ‰ÂÌÁ̇ - ÔË 3·ÓÎÌË, ÔÂËÙÓ͇ÎÂÌ Â‰ÂÏ ÔË 9 ·ÓÎÌË, ‰ËÒÎÓ͇ˆËfl ÔË 3·ÓÎÌË. ë åêí Ò ÓÚÍË‚‡ ˆÂÌÚÓÔ‡ËÂÚ‡ÎÂÌ „ÎËÓÏ Ë „‡Ì-„ÎËÓ„ÎËÓÏ Ì‡ ‡ÏÓÌË‚Ëfl Ó„, ÍÓËÚÓ Ì Ò ‚ËÁÛ‡ÎËÁˇډӷ ̇ äíäβ˜Ó‚Ë ‰ÛÏË- ÏÓÁ˙˜ÂÌ ÚÛÏÓ; ÂÔËÎÂÔÚ˘ÂÌ ÔËÔ‡‰˙Í

èÂ‰Ë ‚˙‚Âʉ‡ÌÂÚÓ Ì‡ ÏÓ‰ÂÌËÚ Ì‚ÓËÁÓ·‡Áfl‚‡˘ËÏÂÚÓ‰Ë (äí Ë åêí) Ôӂ˜ÂÚÓ ÓÚ ÏÓÁ˙˜ÌËÚ ÚÛÏÓË,Ô‰ËÁ‚ËÍ‚‡˘Ë ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË, Ò ‰Ë‡„ÌÓÒÚˈË-‡ı‡ ÌflÍÓÎÍÓ „Ó‰ËÌË ÒΉ ̇˜‡ÎÓÚÓ ËÏ (2,11,22). éÒÓ·ÂÌÓÚÛ‰ÌÓ Ë Í˙ÒÌÓ (‰ÓË ‰Ó 5 „Ó‰ËÌË) Ò ÓÚÍË‚‡ı‡ ·‡‚ÌÓ‡ÒÚfl˘ËÚ ÚÛÏÓË Ì‡ ÚÂÏÔÓ‡ÎÌËfl ‰flÎ (22).

óÂÒÚÓÚ‡Ú‡ ̇ ÏÓÁ˙˜ÌËÚ ÚÛÏÓË ÔË ·ÓÎÌË Ò ÂÔËÎÂÔ-Ú˘ÌË ÔËÔ‡‰˙ˆË  ·Ë· Ó·ÂÍÚ Ì‡ ÏÌÓ„Ó ÔÓÛ˜‚‡ÌËfl Ë ‚‡-ˇ ÓÚ 1 ‰Ó 15% ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÒÂÎÂ͈ËflÚ‡ ̇ Ô‡ˆË-ÂÌÚËÚÂ Ë ‚˙Á‡ÒÚÚ‡ ËÏ Ë ‰ÓÒÚË„‡ ‰Ó 20-36% ÔË Ï‰Ë-͇ÏÂÌÚÓÁÌÓ ÂÙ‡ÍÚÂ̇ ÂÔËÎÂÔÒËfl (3,5,6,19). í‡Í‡ Ôˉˆ‡ ‰Ó 15 „Ó‰ËÌË Ò ÂÔËÎÂÔÒËfl, ÚÛÏÓË Ò ÓÚÍË‚‡Ú ‚1,5%, ‡ ÔË ‚˙Á‡ÒÚÌË Ì‡ 35-64 „Ó‰ËÌË - ‚ 10,5% (6).ëÔÓ-‰ ‰Û„Ë ‡‚ÚÓË ˜ÂÒÚÓÚ‡Ú‡ ̇ ÏÓÁ˙˜ÌËÚ ÚÛÏÓË Ôˉˆ‡ Ò ÂÔËÎÂÔÒËfl ‚‡Ë‡ ÓÚ 0,2% ‰Ó 6% (20).

èÓfl‚‡Ú‡ ̇ ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Á‡ Ô˙‚ Ô˙Ú, ÓÒÓ-·ÂÌÓ Û ‚˙Á‡ÒÚÌË, ‚Ë̇„Ë Úfl·‚‡ ‰‡ ÔӇʉ‡ Ò˙ÏÌÂÌË Á‡ÏÓÁ˙˜ÂÌ ÚÛÏÓ. èÓÛ˜‚‡ÌËflÚ‡ ‚ ÒÔ¯ÌË ÓÚ‰ÂÎÂÌËfl ÔÓ-͇Á‚‡Ú 10% ˜ÂÒÚÓÚ‡ ̇ ÏÓÁ˙˜ÌË ÚÛÏÓË ÔË ‚˙Á‡ÒÚÌËÒ Â‰ËÌ „Â̇ÎËÁË‡Ì ÂÔËÎÂÔÚ˘ÂÌ ÔËÔ‡‰˙Í (18). ᇠ‰Û-„ËÚ ‚˙Á‡ÒÚÓ‚Ë „ÛÔË ‚ÂÓflÚÌÓÒÚÚ‡ ÔËÔ‡‰˙ˆËÚ ‰‡Ò ‰˙ÎÊ‡Ú Ì‡ ÏÓÁ˙˜ÂÌ ÚÛÏÓ Â Í‡ÍÚÓ ÒΉ‚‡: 2,4% ÔËÔ‡ˆËÂÌÚË Ì‡ 15 - 30 „Ó‰ËÌË, 8,3% ÔË Ô‡ˆÂÌÚË Ì‡ 30 - 60„Ó‰ËÌË Ë ÒÚË„‡ ‰Ó 18,2% ÔË Ô‡ˆËÂÌÚË Ì‡‰ 60 „Ó‰ËÌË (18).

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 130‰ÂÍÂÏ‚Ë, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË

EèàãÖèíàóçà èêàèÄÑöñà èêà Åéãçà ë åéáöóçàíìåéêà

é. ÉË„ÓÓ‚‡, à. èÂÚÓ‚‡, ê. ä‡ÎÔ‡˜ÍËå‰ˈËÌÒÍË ÛÌË‚ÂÒËÚÂÚ åÅÄã- ÄÎÂÍ҇̉ӂÒ͇ ç‚ÓÎӄ˘̇ ÍÎËÌË͇ „. ëÓÙËfl

èË ·ÓÎÌË Ò ‰Ó͇Á‡ÌË ÏÓÁ˙˜ÌË ÚÛÏÓË ˜ÂÒÚÓÚ‡Ú‡ ̇ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË ͇ÚÓ Ì‡˜‡ÎÂÌ ÒËÏÔÚÓÏ ‰ÓÒ-ÚË„‡ 30% ÔË ‚˙Á‡ÒÚÌË Ë 14% ÔË ‰Âˆ‡ (6), ‡ ÔË ‡Á„˙-̇ڇ ÍÎËÌ˘̇ ͇ÚË̇ ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Ò ̇·-≇‚‡Ú ‚ 20-90% ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ıËÒÚÓÎÓ„ËflÚ‡, ÎÓ͇-ÎËÁ‡ˆËflÚ‡, ‡ÁÏÂËÚÂ Ë Ò˙Ô˙ÚÒÚ‚Û‚‡˘ËflÚ Â‰ÂÏ Ë ‰ËÒ-ÎÓ͇ˆËfl (1,4,7,10,12,13,14,16,21,23). íÛÏÓËÚÂ, ÍÓËÚÓ̇È-˜ÂÒÚÓ Ô‰ËÁ‚ËÍ‚‡Ú ˆˉ˂ˇ˘Ë ÂÔËÎÂÔÚ˘ÌËÔËÔ‡‰˙ˆË Ë ˜ÂÒÚÓ Ú‡Ô‚Ú˘ÌÓ ÂÙ‡ÍÚÂ̇ ÂÔËÎÂÔ-ÒËfl Ò‡: ‡ÒÚÓˆËÚÓÏ, ÓÎË„Ó‰ẨӄÎËÓÏ, „‡Ì„ÎËÓ„ÎËÓÏ,‰ËÒÂÏ·ËÓÔ·ÒÚ˘ÌË Ì‚ÓÂÍÚÓ‰ÂχÎÌË ÚÛÏÓË(DNTs), ÔÎÂÈÓÏÓÙÂÌ ÍÒ‡ÌÚÓ‡ÒÚÓˆËÚÓÏ(1,4,7,10,12,13,14,16,21,22,23). è‰ÔÓ·„‡ ÒÂ, ˜Â ҇χڇÚÛÏÓ̇ Ú˙Í‡Ì - „ΡÎ̇, Ì‚Ó̇Î̇, Ò˙‰Ó‚‡ ËÎË ÒÏÂÒÂ-̇, Ìflχ ÂÔËÎÂÔÚ˘̇ ‡ÍÚË‚ÌÓÒÚ. ÖÔËÎÂÔÚÓ„ÂÌÌÓÚÓ Ó„-Ìˢ Ò ̇Ïˇ ‚ ÍÓÚÂÍÒ‡ ·ÎËÁÓ ‰Ó ÚÛÏÓ̇ڇ χ҇, ͇-ÚÓ ‚˙ÁÌËÍ‚‡Ú Ë ‰ËÒÚ‡ÌÚÌË ÒË̇ÔÚ˘ÌÓ Ò‚˙Á‡ÌË Ó„Ìˢ‡- Ú.̇. ‚ÚÓ˘̇ ÂÔËÎÂÔÚÓ„ÂÌÂÁ‡. é·Ò˙ʉ‡ ÒÂ Ë ÍÓ̈ÂÔ-ˆËflÚ‡ Á‡ Ú.̇."‰‚ÓÈ̇ Ô‡ÚÓÎÓ„Ëfl - dual pathology"- ̇-΢ˠ‰ÌÓ‚ÂÏÂÌÌÓ Ì‡ ÏÓÁ˙˜ÂÌ ÚÛÏÓ Ë ‡Á΢ÌË ÒÏÛ˘Â-ÌËfl ‚ ‡Á‚ËÚËÂÚÓ - ÍÓÚË͇Î̇ ‰ËÒÔ·ÁËfl, „ÎËÓ-Ì‚Ó-̇Î̇ ıÂÚÂÓÚÓÔËfl Ë ‰. (9,14,15,17).

ñÂÎÚ‡ ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ÂÚÓÒÔÂÍÚ˂̇ ÓˆÂÌ͇ ̇˜ÂÒÚÓÚ‡Ú‡ Ë ı‡‡ÍÚ‡ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆËÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË, ‡Ì‡ÎËÁ ̇ ÍÎËÌ˘ÌËÚ ÔÓ-fl‚Ë Ë Ì‡ ÔÓÏÂÌËÚ ‚ ··Ó‡ÚÓÌËÚÂ Ë ËÌÒÚÛÏÂÌÚ‡Î-ÌËÚ ËÁÒΉ‚‡ÌËfl.

äãàçàóÖç äéçíàçÉÖçíÇ ÔÓÛ˜‚‡ÌÂÚÓ Ò‡ ‚Íβ˜ÂÌË 120 ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛ-

ÏÓË, ıÓÒÔËÚ‡ÎËÁˇÌË ‚ ÛÌË‚ÂÒËÚÂÚÒ͇ Ì‚ÓÎӄ˘̇ÍÎËÌË͇ ÔÂÁ ÔÓÒΉÌËÚ 7 „Ó‰ËÌË. Ñˇ„ÌÓÁ‡Ú‡ "ÏÓÁ˙˜ÂÌÚÛÏÓ"  ÔÓÒÚ‡‚Â̇ ̇ ·‡Á‡Ú‡ ̇ ÍÎËÌ˘̇ڇ ͇ÚË̇,Ì‚ÓÎӄ˘ÌËfl ÒÚ‡ÚÛÒ, Ô‡‡ÍÎËÌ˘ÌËÚ ËÁÒΉ‚‡ÌËfl Ë ÂÔÓÚ‚˙‰Â̇ Ò Ì‚ÓËÁÓ·‡Áfl‚‡˘ËÚ ÏÂÚÓ‰Ë (äí Ë/ËÎËåêí) Ë ÓÔ‡ÚË‚ÌÓ ÔË 19 ·ÓÎÌË. Ä̇ÎËÁˇÌË Ò‡ ÔÓ‰Ó·-ÌÓ ËÒÚÓËflÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Á‡ ̇΢ˠ̇ ÂÔËÎÂÔÚ˘-ÌË ÔËÔ‡‰˙ˆË Ë ÚÂıÌËfl ı‡‡ÍÚÂ, ͇ÍÚÓ Ë ÓÒڇ̇ÎËÚÂÌ‚ÓÎӄ˘ÌË ÔÓfl‚Ë. ç‡Ô‡‚Â̇  Ò˙ÔÓÒÚ‡‚͇ ÏÂÊ‰Û ‚Ë-‰‡ Ë ÎÓ͇ÎËÁ‡ˆËflÚ‡ ̇ ÏÓÁ˙˜Ì‡Ú‡ ÌÂÓÔ·Áχ Ë ÂÔËÎÂÔ-Ú˘ÌËÚ ÔËÔ‡‰˙ˆË. Ä̇ÎËÁˇÌË Ò‡ Ò˙˘Ó Ë ÔÓÏÂÌËÚ ‚ËÌÒÚÛÏÂÌÚ‡ÎÌËÚÂ Ë Î‡·Ó‡ÚÓÌËÚ ËÁÒΉ‚‡ÌËfl.

êÖáìãíÄíàéÚ ÔÓÛ˜ÂÌËÚ 100 ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË ÂÔËÎÂÔ-

Ú˘ÌË ÔËÔ‡‰˙ˆË ËÏ‡Ú Ò‡ÏÓ 25 ·ÓÎÌË (25%). íÂÁË 25 ·ÓÎ-ÌË Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ Ë Ò˙Ò ÒËÏÔÚÓχÚ˘ÌË ÂÔËÎÂÔÚ˘ÌËÔËÔ‡‰˙ˆË ˘Â ·˙‰‡Ú Ó·ÂÍÚ Ì‡ ÔÓÛ˜‚‡ÌÂÚÓ. ÅÓÎÌËÚ ҇̇ ‚˙Á‡ÒÚ ÓÚ 23 ‰Ó 75 „Ó‰ËÌË, 18 Ï˙ÊÂ Ë 7 ÊÂÌË. èÓ‰ 50„Ó‰ËÌË Ò‡ 15 ÓÚ ·ÓÎÌËÚ (60%) - Ú‡·Î.1.

èӂ˜ÂÚÓ ·ÓÎÌË Ò ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Ò‡ Ò Ô˙‚˘-ÌË ÏÓÁ˙˜ÌË ÚÛÏÓË (23 ·ÓÎÌË - 92%) Ë Ò‡ÏÓ 2 ·ÓÎÌË (8%)

Ò‡ Ò ÏÂÚ‡ÒÚ‡ÁË ÓÚ ·ÂÎÓ‰Ó·ÂÌ Í‡ˆËÌÓÏ. ë‰ Ô˙‚˘ÌË-Ú ÏÓÁ˙˜ÌË ÚÛÏÓË ÔÂӷ·‰‡‚‡Ú „ÎËÓÏËÚ - 15 ·ÓÎÌË(60%): ÓÎË„Ó‰ẨӄÎËÓÏ 2 ·ÓÎÌË, ‡ÒÚÓˆËÚÓÏ 4 ·ÓÎÌË,„ÎËӷ·ÒÚÓÏ 2 ·ÓÎÌË, „‡Ì„ÎËÓ„ÎËÓÏ 2 ·ÓÎÌË, „ÎËÓÏ 5 ·ÓÎ-ÌË (Ú‡·Î.2). Ñ‚‡Ï‡ ÓÚ ·ÓÎÌËÚÂ Ò ÏÂÌËÌ„ÂÓÏ Ò‡ ÂÓÔÂË-‡ÌË Á‡ ˆˉ˂ ̇ ÚÛÏÓ‡ Ë ÔÓfl‚‡ ÓÚÌÓ‚Ó Ì‡ ÔËÔ‡‰˙ˆË.èÓ-„ÓÎflχ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚ (23 - 92%) Ò‡ Ò˙Ò ÒÛÔ‡ÚÂÌ-ÚÓˇÎÌË ÚÛÏÓË Ë Ò‡ÏÓ 2 Ò‡ Ò ËÌÙ‡ÚÂÌÚÓˇÎÌË ÚÛ-ÏÓË: 35 „Ӊ˯ÂÌ ·ÓÎÂÌ, ÓÔÂË‡Ì ÔÂ‰Ë 18 „Ó‰. Á‡ ‡ÒÚÓ-ˆËÚÓÏ Ì‡ χÎÍËfl ÏÓÁ˙Í Ë ÔÓÒÚ˙Ô‚‡˘ ÔÓ ÔÓ‚Ó‰ ̇ 2 „ÂÌÂ-‡ÎËÁˇÌË ÚÓÌ˘ÌÓ-ÍÎÓÌ˘ÌË ÔËÒÚ˙ÔË Ë ÌÂÍÓÎÍÓ͇Ú-ÌË ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ò ı‡‡ÍÚ ̇ deja vuË jamais vu Ë äí ‰‡ÌÌË Á‡ ͇ΈËÙË͇ÚË Ë ÚÛ·ÂÓÁ̇ ÒÍÎÂ-ÓÁ‡ Ë ·ÓÎÂÌ Ì‡ 23 „Ó‰. Ò „ÎËÓÏ Ì‡ ÏÂÁÂ̈ÂÙ‡ÎÓ̇ Ë ‡ÚÓ-Ì˘ÌÓ-‡ÒÚ‡Ú˘ÌË ÔËÒÚ˙ÔË. ë ÙÓÌÚ‡Î̇ Ë ÚÂÏÔÓ‡Î̇ÎÓ͇ÎËÁ‡ˆËfl ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ Ò‡ 10 ÓÚ ·ÓÎÌËÚÂ Ë Ò ‡Ì-„‡ÊˇÌ ̇ Ò˙Ò‰ÌËfl Ô‡ËÂÚ‡ÎÂÌ ‰flÎ - Ú.Â. ÙÓÌÚÓ-Ô‡-ËÂÚ‡Î̇ Ë ÚÂÏÔÓÓ-Ô‡ËÂÚ‡Î̇ ÎÓ͇ÎËÁ‡ˆËfl - 6 ·ÓÎÌË(Ú‡·Î.3). èË 12 ÓÚ ·ÓÎÌËÚ ‚ÍÎ. ‰‚‡Ï‡Ú‡ ·ÓÎÌË Ò ÏÂ-Ú‡ÒÚ‡ÁË ÚÛÏÓ˙Ú Â ÎÓ͇ÎËÁË‡Ì ‚ Îfl‚‡Ú‡ ıÂÏËÒÙ‡,ÔË 9 ·ÓÎÌË - ‚ ‰flÒ̇ڇ ıÂÏËÒÙ‡, ÔË 2 ·ÓÎÌË Ò ÏÂÌËÌ-„ÂÓÏ - ‰‚ÛÒÚ‡ÌÌÓ.

ч‚ÌÓÒÚÚ‡ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË ÓÚ ÔÓfl‚‡Ú‡ËÏ ‰Ó ÓÚÍË‚‡ÌÂÚÓ Ì‡ ÏÓÁ˙˜ÌËfl ÚÛÏÓ Â ‡Á΢̇ - 3 ‰ÌËÔË ·ÓÎÂÌ Ò ÏÓÁ˙˜ÌË ÏÂÚ‡ÒÚ‡ÁË Ë 40 „Ó‰ËÌË ÔË ·ÓÎ̇ ÒÔÒ‚‰ÓÍËÒÚ‡ ‚ ÚÂÏÔÓ‡Î̇ڇ ӷ·ÒÚ ‚ÂÓflÚÌÓ ÒΉ Ó-‰Ó‚‡ Ú‡‚χ. èË 14 ·ÓÎÌË (56%) ÏÓÁ˙˜ÌËflÚ ÚÛÏÓ ÂÓÚÍËÚ ‰Ó 6 ÏÂÒˆ‡ ÓÚ ÔÓfl‚‡Ú‡ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔË-Ô‡‰˙ˆË (Ú‡·Î.4). ÅÓflÚ Ì‡ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ‰ÓËÁflÒÌfl‚‡Ì ̇ Ô˘Ë̇ڇ Á‡ ÚflıÌÓÚÓ ‚˙ÁÌËÍ‚‡Ì  ‡ÁÎË-˜ÂÌ - ‰ËÌ ÔËÒÚ˙Ô ÔË 6 ·ÓÎÌË, 2 ÔËÒÚ˙Ô‡ - ÔË 4 ·ÓÎ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 131‰ÂÍÂÏ‚Ë, 2002

‚˙Á‡ÒÚ Ï˙Ê ÊÂÌË ‚Ò˘ÍÓ

20 - 29 3 0 3

30 - 39 7 2 9

40 - 49 1 2 3

50 - 59 5 1 6

60 - 69 1 3

70 - 79 0 1 1

18 7 25

퇷Î.1. ê‡ÁÔ‰ÂÎÂÌË ̇ ·ÓÎÌËÚÂ Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ ËÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË ÔÓ ÔÓÎ Ë ‚˙Á‡ÒÚ

‚˙Á‡ÒÚ Ï˙Ê ÊÂÌË ·ÓÈ

20-29 éÎË„Ó‰ẨӄÎËÓÏ ÙÓÌÚ‡ÎÌ 3

ÉÎËÓÏ ÚÂÏÔÓ‡ÎÌÓ

ÉÎËÓÏ Ì‡ ÏÂÁÂ̈ÂÙ‡ÎÓ̇

30-39 éÎË„Ó‰ẨӄÎËÓÏ ÚÂÏÔÓ‡ÎÌÓ åÂÌËÌ„ÂÓÏ Ô‡ËÂÚÓ- 9

ÄÒÚÓˆËÚÓÏ ÙÓÌÚÓ-ÚÂÏÔÓ‡ÎÌÓ Ó͈ËÔËÚ‡ÎÌÓ

ÄÒÚÓˆËÚÓÏ Ì‡ χÎÍËfl ÏÓÁ˙Í É‡Ì„ÎËÓ„ÎËÓÏ Ì‡ ‡ÏÓÌË‚Ëfl

ÉÎËÓÏ ÚÂÏÔÓÓ·‡Á‡ÎÌÓ Ó„

ÉÎËӷ·ÒÚÓÏ Ì‡ ıÂÏËÒÙ‡ڇ

åÂÌËÌ„ÂÓÏ ÙÓÌÚ‡ÎÌÓ - 2 ·ÓÎÌË

40-49 ÉÎËÓÏ ˆÂÌÚÓÔ‡ËÂÚ‡ÎÌÓ ÄÒÚÓˆËÚÓÏ ÙÓÌÚÓ- 3

Ô‡ËÂÚ‡ÎÌÓ

èÒ‚‰ÓÍËÒÚ‡ ÚÂÏÔÓ‡ÎÌÓ

50 - 59 ÄÒÚÓˆËÚÓÏ Ô‡ËÂÚ‡ÎÌÓ Ä‡ıÌÓˉ̇ ÍËÒÚ‡ Ô‡ËÂÚ‡ÎÌÓ 6

ÉÎËӷ·ÒÚÓÏ ÚÂÏÔÓ‡ÎÌÓ

åÛÎÚˈÂÌÚ˘ÂÌ „ÎËÓÏ

‚ ·‡Á‡ÎÌËÚÂfl‰‡ Ë ıÂÏËÒÙ‡ڇ

åÂÌËÌ„ÂÓÏ ÚÂÏÔÓÓ-Ô‡ËÂÚ‡ÎÌÓ

î‡ÎÍÒ-ÏÂÌËÌ„ÂÓÏË ÙÓÌÚÓ-

Ô‡ËÂÚ‡ÎÌÓ

60 - 69 åÂÚ‡ÒÚ‡Á‡ Ô‡ËÂÚ‡ÎÌÓ É‡Ì„ÎËÓ„ÎËÓÏ 3

ÙÓÌÚÓÓÔÂÍÛ·ÌÓ

70 - 79 éÒÚÂÓÏË (ÓÒËÙˈˇÌË 1

ÏÂÌËÌ„ÂÓÏË) ÙÓÌÚ‡ÎÌÓ Ë

ÚÂÏÔÓ‡ÎÌÓ

퇷Î.2. ê‡ÁÔ‰ÂÎÂÌË ̇ ·ÓÎÌËÚ ÒÔÓ‰ ‚ˉ‡ ËÎÓ͇ÎËÁ‡ˆËflÚ‡ ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ

ÌË, ÌflÍÓÎÍÓ - ÔË 6 ·ÓÎÌË Ë ˜ÂÒÚË ÔËÒÚ˙ÔË - ÔË 9 ·ÓÎÌË.

ÍÚÂ˙Ú Ì‡ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË  ÔÓ͇Á‡Ì ̇ڇ·Î. 5. èÓ-„ÓÎflχ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚ (19 ·ÓÎÌË - 76%) Ò‡Ò „Â̇ÎËÁˇÌË ÔËÒÚ˙ÔË, ÓÚ Úflı - 9 Ò Ô˙‚˘ÌÓ „ÂÌÂ-‡ÎËÁˇÌË Ë 10 Ò ‚ÚÓ˘ÌÓ „Â̇ÎËÁˇÌË ÔËÒÚ˙ÔË. ë

ÙÓ͇ÎÌÓ Ì‡˜‡ÎÓ Ì‡ ÔËÒÚ˙ÔËÚ ҇ 15 ·ÓÎÌË (62,5%).èË 13 (52%) ÓÚ ·ÓÎÌËÚ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË

Ò‡ Ô˙‚‡ ÔÓfl‚‡ ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ, ÔË 3 ·ÓÎÌË Ò˙˘Óڇ͇ Ò‡ Ô˙‚‡ ÔÓfl‚‡ ̇ ˆˉ˂‡ ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓÒΉ ÓÔ‡ˆËflÚ‡ Ë ÔË 2 ·ÓÎÌË Ò ÔÓfl‚fl‚‡Ú ÛÒÔÓ‰ÌÓ ÒÓ„ÌË˘Ì‡Ú‡ ÒËÏÔÚÓχÚË͇ - ڇ͇ ÔË 18 ·ÓÎÌË (72%)Ӣ ‚ ̇˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò‡ ̇Îˈ ÂÔËÎÂÔÚ˘ÌË

ÔËÔ‡‰˙ˆË. èË ÓÒڇ̇ÎËÚ 7 ·ÓÎÌË ÂÔËÎÂÔÚ˘ÌËÚ ÔË-Ô‡‰˙ˆË Ò Ô‰¯ÂÒÚ‚‡Ú ÓÚ Ó„ÌˢÌË ÒËÏÔÚÓÏË (4 ·ÓÎ-ÌË), ÔÒËı˘ÌË ÔÓfl‚Ë (2 ·ÓÎÌË) Ë Ò‡ÏÓ ÔË 1 ·ÓÎÂÌ Ò „ÎËÓ-·Î‡ÒÚÓÏ Ô˙‚Ë Ò‡ ÔÓfl‚ËÚ ̇ ËÌڇ͇ÌˇÎ̇ ıËÔÂ-ÚÂÌÒËfl (Ú‡·Î. 6).

èË ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ Ó„ÌË˘Ì‡ ÒËÏÔÚÓχÚË͇ Ò ÛÒ-Ú‡ÌÓ‚fl‚‡ ÔË 17 ·ÓÎÌË (68%), ‡ ÔË ÓÒڇ̇ÎËÚ 8 ·ÓÎÌË(32%) Ì‚ÓÎӄ˘ÌËflÚ ÒÚ‡ÚÛÒ Â Ì„‡ÚË‚ÂÌ (Ú‡·Î. 7).éÚÓ„ÌˢÌËÚ ÔÓfl‚Ë Ì‡È-˜ÂÒÚ‡  ÔÓ„ÂÒˇ˘‡Ú‡ ÏÓÌÓ-ËÎË ıÂÏËÔ‡ÂÁ‡. ë ÔÓfl‚Ë Ì‡ ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌ-ÒËfl Ò‡ Ò‡ÏÓ 2 ·ÓÎÌË: 51-„Ӊ˯ÂÌ ·ÓÎÂÌ Ò ÏÛÎÚˈÂÌÚ˘ÂÌ„ÎËÓÏ ‚ ·‡Á‡ÎÌËÚ fl‰‡ Ë Îfl‚‡Ú‡ ıÂÏËÒÙ‡ Ë 39-„Ó‰Ë-¯ÂÌ ·ÓÎÂÌ Ò „ÎËӷ·ÒÚÓÏ Ì‡ ‰flÒ̇ڇ ıÂÏËÒÙ‡ڇ. á‡

„·‚Ó·ÓÎË Ò˙Ó·˘‡‚‡Ú 4 ·ÓÎÌË („ÎËӷ·ÒÚÓÏ ÚÂÏÔÓ‡Î-ÌÓ, „‡Ì„ÎËÓ„ÎËÓÏ ÙÓÌÚÓÓÔÂÍÛ·ÌÓ, ÏÂÌËÌ„ÂÓÏ ÚÂÏÔÓ-Ó-Ô‡ËÂÚ‡ÎÌÓ Ë ÏÂÚ‡ÒÚ‡ÁË ÙÓÌÚÓ-Ô‡ËÂÚ‡ÎÌÓ). èËËÁÒΉ‚‡Ì ̇ Ó˜ÌËÚ ‰˙̇ ̇˜‡Î̇ Á‡ÒÚÓÈ̇ Ô‡ÔË· ÒÂÓÚÍË‚‡ Ò‡ÏÓ ÔË 2 ·ÓÎÌË (33 „Ӊ˯ÂÌ ·ÓÎÂÌ Ò Î‚ÓÒÚ‡-ÌÂÌ ÙÓÌÚ‡ÎÂÌ ÏÂÌËÌ„ÂÓÏ Ë ÌflÍÓÎÍÓ Éíäè ÓÚ 4 ÏÂÒˆ‡ Ë51 „Ӊ˯ÂÌ ·ÓÎÂÌ Ò ÏÛÎÚˈÂÌÚ˘ÂÌ „ÎËÓÏ Ì‡ ·‡Á‡ÎÌËÚ„‡Ì„ÎËË Ë Îfl‚‡Ú‡ ıÂÏËÒÙ‡ Ë Â‰ËÌ ÑʇÍÒ˙ÌÓ‚ ÏÓÚÓÂÌÔËÒÚ˙Ô Ò ÔÓÒΉ‚‡˘‡ Ò··ÓÒÚ ‚ ‰ÂÒÌËÚ ͇ÈÌËˆË Ì‡ÙÓ̇ ̇ ‡Ô‡ÚËÍÓ-‡·Û΢ÂÌ ÒË̉ÓÏ Ë ÏÓÚÓ̇ ‡Ù‡ÁËfl ÓÚ3 ÏÂÒˆ‡).

ÖÖÉ ÔË 15 ËÁÒΉ‚‡ÌË ·ÓÎÌË ‡ÁÍË‚‡ ÙÓ͇Î̇ ·ËÓ-ÂÎÂÍÚ˘̇ ‡ÍÚË‚ÌÓÒÚ ÓÚ ·‡‚ÌË ÚÂÚ‡ Ë/ËÎË ‰ÂÎÚ‡ ‚˙Î-ÌË ÔË 11 ·ÓÎÌË Ë ÓÚ ·˙ÁË ‚˙ÎÌË ÔË 4 ·ÓÎÌË. ÉÂ̇ÎË-Áˇ̇ Ô‡ÓÍÒËÁχÎ̇ ‡ÍÚË‚ÌÓÒÚ Ò „ËÒÚˇ ÔË 8·ÓÎÌË (Ú‡·Î. 8). îÓ͇ÎÌËÚ ÔÓÏÂÌË Ó·ı‚‡˘‡Ú Ò‡ÏÓ‰ËÌ ÏÓÁ˙˜ÂÌ ‰flÎ ÔË 7 ·ÓÎÌË Ë ‰‚‡ ‰fl· - ÔË 8 ·ÓÎÌË. é„-ÌË˘Ì‡Ú‡ ‡ÍÚË‚ÌÓÒÚ ÓÚ ·‡‚ÌË ËÎË ÓÒÚË ‚˙ÎÌË Ò ÓÚ-‚Âʉ‡ ̇È-˜ÂÒÚÓ ÓÚ ÚÂÏÔÓ‡ÎÌËfl ‰flÎ (10 ·ÓÎÌË) Ë ˜ÂÎ-ÌËfl ‰flÎ (7 ·ÓÎÌË) Ë ÔÓ-fl‰ÍÓ ÓÚ Ô‡ËÂÚ‡ÎÌËfl ‰flÎ (4 ·ÓÎ-ÌË) Ë ÚËÎÌËfl ‰flÎ (3 ·ÓÎÌË).

èË 22 ÓÚ ËÁÒΉ‚‡ÌËÚ ·ÓÎÌË äí ‚ËÁÛ‡ÎËÁˇ ÒΉÌË-Ú ÔÓÏÂÌË: ıËÔÓ‰ÂÌÁ̇ ÁÓ̇ 11 ·ÓÎÌË, ıËÔ‰ÂÌÁ̇ ÁÓ̇6 ·ÓÎÌË Ë ıÂÚÂÓ‰ÂÌÁ̇ ÁÓ̇ 3 ·ÓÎÌË. èÂËÙÓ͇ÎÂÌ ÏÓÁ˙-˜ÂÌ Â‰ÂÏ Ò ‚ËÁÛ‡ÎËÁˇ ÔË 9 ·ÓÎÌË, ‡ ‰ËÒÎÓ͇ˆËfl - Ò‡ÏÓÔË 3 ·ÓÎÌË (Ú‡·Î.9). èË Â‰ËÌ ·ÓÎÂÌ Ò ıËÒÚÓÎӄ˘̇ ‰Ë-‡„ÌÓÁ‡ „ÎËÓÏ Ì‡ gyrus cinguli äí (̇ÚË‚ÂÌ Ë Ò ÍÓÌÚ‡ÒÚ)Ì ÓÚÍË‚‡ ÏÓÁ˙˜Ì‡Ú‡ ÌÂÓÔ·Áχ, ÍÓflÚÓ Ò ‚ËÁÛ‡ÎËÁˇ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 132‰ÂÍÂÏ‚Ë, 2002

ÎÓ͇ÎËÁ‡ˆËfl ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ ·ÓÈ ·ÓÎÌË ÔÓˆÂÌÚîÓÌÚ‡Î̇ 3 12

îÓÌÚÓ-Ô‡ËÂÚ‡Î̇ 4 16

îÓÌÚÓ-ÚÂÏÔÓ‡Î̇ 2 8

íÂÏÔÓ‡Î̇ 5 20

íÂÏÔÓÓ-Ô‡ËÂÚ‡Î̇ 2 8

è‡ËÂÚ‡Î̇ 5 20

ïÂÏËÒÙ¡Î̇ 2 8

åÓÁ˙˜ÂÌ ÒÚ‚ÓÎ Ë Ï‡Î˙Í ÏÓÁ˙Í 2 8

퇷Î.3. ê‡ÁÔ‰ÂÎÂÌË ̇ ·ÓÎÌËÚ ÒÔÓ‰ ÎÓ͇ÎËÁ‡ˆËflڇ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ

‰‡‚ÌÓÒÚ Ì‡ ·ÓÈ ‚ˉ ̇ ÚÛÏÓ‡ÔËÔ‡‰˙ˆËÚ ·ÓÎÌË

0 - 1 ÏÂÒˆ 7 1 ÓÎË„Ó‰ẨӄÎËÓÏ, 1 ‡ÒÚÓˆËÚÓÏ,1 „ÎËÓÏ, 2

ÏÂÚ‡ÒÚ‡ÁË, 1 ÏÂÌËÌ„ÂÓÏ,1 ÓÒÚÂÓÏ

1 - 6 ÏÂÒˆ‡ 7 2 „ÎËӷ·ÒÚÓÏ, 1 ‡ÒÚÓˆËÚÓÏ, 1 „ÎËÓÏ,

3ÏÂÌËÌ„ÂÓÏ

6 ÏÂÒ. - 1 „Ó‰. 2 1 ‡ÒÚÓˆËÚÓÏ, 1 „‡Ì„ÎËÓ„ÎËÓÏ

1 - 5 „Ó‰. 4 1 ‡ÒÚÓˆËÚÓÏ, 2 „ÎËÓÏ, 1 ‡‡ıÌÓˉ̇ ÍËÒÚ‡

̇‰ 5 „Ó‰. 5 1 ÓÎË„Ó‰ẨӄÎËÓÏ, 1 „‡Ì„ÎËÓ„ÎËÓÏ, 1 „ÎËÓÏ, 1

ÏÂÌËÌ„ÂÓÏ, 1 ÔÒ‚‰ÓÍËÒÚ‡

퇷Î. 4. ê‡ÁÔ‰ÂÎÂÌË ̇ ·ÓÎÌËÚÂ Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓÒÔÓ‰ ‰‡‚ÌÓÒÚÚ‡ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË

‚ˉ ̇ ÔËÔ‡‰˙ˆËÚ ·ÓÈ ·ÓÎÌË ‚ˉ ̇ ÚÛÏÓ‡·ÓÎÌË

èÓÒÚË Ô‡ˆË‡ÎÌË - 5 2 ‡ÒÚÓˆËÚÓÏ, 2 „ÎËÓÏ,

ÏÓÚÓÌË, ÒÂÌÁÓÌË 1 „ÎËӷ·ÒÚÓÏ

èÓÒÚË Ô‡ˆË‡ÎÌË Ò 5 1 ÓÎË„Ó‰ẨӄÎËÓÏ, 1 „ÎËÓÏ,

‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl 2 ÏÂÌËÌ„ÂÓÏ, 1 ÏÂÚ‡ÒÚ‡Á‡

äÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË Ò 5 2 ‡ÒÚÓˆËÚÓÏ, 1 „ÎËÓÏ,

‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl 1 „‡Ì„ÎËÓ„ÎËÓÏ, 1 ÔÒ‚‰ÓÍËÒÚ‡

ÉÂ̇ÎËÁˇÌË ÚÓÌ˘ÌÓ- 6 1 ÓÎË„Ó‰ẨӄÎËÓÏ, 1 „‡Ì„ÎËÓ„ÎËÓÏ,

ÍÎÓÌ˘ÌË 2 ÏÂÌËÌ„ÂÓÏ, 1 ÏÂÚ‡ÒÚ‡Á‡, 1 ÓÒÚÂÓÏ

ÉÂ̇ÎËÁˇÌË 3 1 „ÎËӷ·ÒÚÓÏ, 1 ÏÂÌËÌ„ÂÓÏ,

‡ÚÓÌ˘ÌË/‡ÍËÌÂÚ˘ÌË 1 ‡‡ıÌÓˉ̇ ÍËÒÚ‡

Drop attacks 1 1 „ÎËÓÏ Ì‡ ÏÂÁÂ̈ÂÙ‡ÎÓ̇

퇷Î. 5. Çˉ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË ÔË ·ÓÎÌËÚÂÒ ÏÓÁ˙˜ÂÌ ÚÛÏÓ

äÎËÌË͇ ·ÓÈ ‚ˉ ̇ ÚÛÏÓ‡·ÓÎÌË

燘‡ÎÓ Ò ÂÔËÎÂÔÚ˘ÌË 13 2 ÓÎË„Ó‰ẨӄÎËÓÏ, 2 ‡ÒÚÓˆËÚÓÏ,

1 „‡Ì„ÎËÓ„ÎËÓÏ, 3 „ÎËÓÏ, 1 ÏÂÌËÌ„ÂÓÏ,

2 ÍËÒÚ‡, 1 ÓÒÚÂÓÏ, 1 ÏÂÚ‡ÒÚ‡Á‡

燘‡ÎÓ Ò Ó„ÌˢÌË 4 1 „ÎËÓÏ Ì‡ ÏÂÁÂ̈ÂÙ‡ÎÓ̇,

ÒËÏÔÚÓÏË 1 „ÎËӷ·ÒÚÓÏ, 1 ÏÂÌËÌ„ÂÓÏ,

1 ÏÂÚ‡ÒÚ‡Á‡

燘‡ÎÓ 1 1 „ÎËӷ·ÒÚÓÏ

Ò ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌÒËfl

燘‡ÎÓ Ò ÔÒËı˘ÌË ÔÓfl‚Ë 2 1 „‡Ì„ÎËÓ„ÎËÓÏ, 1 ÏÂÌËÌ„ÂÓÏ

燘‡ÎÓ Ò ÂÔËÎÂÔÚ˘ÌË 2 1 ‡ÒÚÓˆËÚÓÏ, 1 „ÎËӷ·ÒÚÓÏ

ÔËÔ‡‰˙ˆË Ë Ó„ÌˢÌË

ÒËÏÔÚÓÏË

èÓfl‚‡ ̇ ÂÔËÎÂÔÚ˘ÌË 3 2 ÏÂÌËÌ„ÂÓÏ, 1 ‡ÒÚÓˆËÚÓÏ

ÔËÔ‡‰˙ˆË ÒΉ ÓÔ‡ˆËflÚ‡ ̇ χÎÍËfl ÏÓÁ˙Í

Á‡ ÏÓÁ. ÚÛÏÓ

퇷Î.6. 燘‡ÎÌË ÔÓfl‚Ë ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË ËÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË

Ò‡ÏÓ Ì‡ åêí.

åêí  ÓÒ˙˘ÂÒÚ‚Â̇ Ò‡ÏÓ ÔË 7 ·ÓÎÌË. èË ‰‚‡Ï‡ ÓÚ·ÓÎÌËÚ (ıËÒÚÓÎӄ˘ÌÓ ÓÎË„Ó‰ẨӄÎËÓÏ Ë ‡ÒÚÓˆË-ÚÓÏ) ‰ÓÔ˙ÎÌËÚÂÎÌÓ Ò ‚ËÁÛ‡ÎËÁˇ ÍËÒÚÓÁ̇ ‰Â„Â̇-ˆËfl, ͇͂‡ÚÓ Ì Ò ‚Ëʉ‡ ̇ äí. èË Ô‡ˆËÂÌÚ͇ ̇ 39 „Ó-‰ËÌË Ò ˜ÂÒÚË äèè Ë Éíäè ÓÚ 18 „Ó‰ËÌË Ò äí (̇ÚË‚ÂÌ ËÒ ÍÓÌÚ‡ÒÚ) Ò ÓÚÍË‚‡ ıËÔ‰ÂÌÒ̇ ÁÓ̇ ‚‰flÒÌÓ ÚÂÏÔÓ-Ó·‡Á‡ÎÌÓ, Ò˙ÏÌËÚÂÎ̇ Á‡ ‡Ì‚ËÁχ. èÓÒΉ‚‡˘‡Ú‡ ÏÓ-Á˙˜Ì‡ ‡Ì„ËÓ„‡ÙËfl Ì ‡ÁÍË‚‡ ÏÓÁ˙˜Ì‡ ‡Ì‚ËÁχ ËÎË Ò˙-‰Ó‚‡ χÎÙÓχˆËfl, ‡ ÔË åêí Ò ‚ËÁÛ‡ÎËÁˇ ıËÔÂËÌ-ÚÂÌÁ̇ ‚ í2 ÎÂÁËfl ‚ ‰ÂÒÌËfl ‡ÏÓÌË‚ Ó„ Ò ËÁ‚ÂÒÚ̇ ÂÍÒ-Ô‡ÌÁËfl Ë ‰ËÒÍÂÚÂÌ Ï‡Ò-ÂÙÂÍÚ („‡Ì„ÎËÓ„ÎËÓÏ?). ë åêí

Ò ‚ËÁÛ‡ÎËÁˇ ÏÌÓ„Ó ‰Ó·Â Ë ÒÚ‚ÓÎÓ‚ „ÎËÓÏ ÔË 23-„Ó‰Ë-¯ÂÌ Ô‡ˆËÂÌÚ Ò dorsal midbrain syndrome Ë ˜ÂÒÚË ‡ÚÓÌ˘-ÌÓ-‡ÒÚ‡Ú˘ÌË ÔËÒÚ˙ÔË Ò ı‡‡ÍÚ ̇ drop attacks.

éÅëöÜÑÄçÖ à àáÇéÑàóÂÒÚÓÚ‡Ú‡ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ÔË ÔÓÛ˜Â-

ÌËfl ÍÓÌÚËÌ„ÂÌÚ ÓÚ 100 ·ÓÎÌË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË Â 25%,ÍÓÂÚÓ ÓÚ„Ó‚‡fl ̇ ÎËÚ‡ÚÛÌËÚ ‰‡ÌÌË (3,4,6). èÓ-„Ó-Îflχ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚ (60%) Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ Ë ÒËÏÔ-ÚÓÏÌË ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Ò‡ ÔÓ‰ 50 „Ó‰ËÌË. é˜Â-Ú‡‚‡ ÒÂ Ë ÔÓÎÓ‚‡ Ô‰ËÎÂ͈Ëfl - ÔÂӷ·‰‡‚‡Ú Ô‡ˆËÂÌÚË-Ú ÓÚ Ï˙ÊÍË ÔÓÎ (72%), ÍÓÂÚÓ ÏÓÊ ‰‡ Ò ҂˙ÊÂ Ò ÔÓ-„ÓÎflχڇ ˜ÂÒÚÓÚ‡ ̇ Ôӂ˜ÂÚÓ ÏÓÁ˙˜ÌË ÚÛÏÓË, ÓÒÓ·Â-ÌÓ „ÎËÓÏËÚ ÔË Ï˙ÊÂÚ (1,4,7). Ç ËÁÒΉ‚‡ÌËfl ÍÓÌÚËÌ-„ÂÌÚ ÔÂӷ·‰‡‚‡Ú ·ÓÎÌËÚÂ Ò „ÎËÓÏË (60%). èË 36% ÓÚ·ÓÎÌËÚ ÚÛÏÓËÚ ҇ ÎÓ͇ÎËÁˇÌË ‚ ‰flÒ̇ڇ ıÂÏËÒÙÂ-‡. àÁ‚ÂÒÚÌÓ Â, ˜Â ÚÛÏÓË Ò Ú‡Í‡‚‡ ÎÓ͇ÎËÁ‡ˆËfl, ÓÒÓ·Â-ÌÓ ‚ ÚÂÏÔÓ‡ÎÌËfl ‰flÎ, ÚÛ‰ÌÓ Ò ‰Ë‡„ÌÓÒÚËˆË‡Ú ÍÎË-Ì˘ÂÒÍË, ‡ÍÓ Ì Ò ÔËÎÓÊ‡Ú Ì‚ÓËÁÓ·‡Áfl‚‡˘ËÚ ÏÂ-ÚÓ‰Ë (2,11,22).

èË ÔÓÛ˜ÂÌËÚ ·ÓÎÌË Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ Ë ÒËÏÔÚÓÏ̇ÂÔËÎÂÔÒËfl ı‡‡ÍÚÂËÒÚË͇ڇ ̇ ÔËÒÚ˙ÔËÚ ÓÚ„Ó‚‡fl̇ ËÁ‚ÂÒÚÌËÚ ÓÚ ÎËÚ‡ÚÛ‡Ú‡ ‰‡ÌÌË (4,7,8). èË ÔÓ-„ÓÎflχ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚ (60%) ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙-ÔË Ò‡ Ò ÙÓ͇ÎÌÓ Ì‡˜‡ÎÓ. èÓÒÚË Ô‡ˆË‡ÎÌË ‰Ó ÏÓÏÂÌڇ̇ ıÓÒÔËÚ‡ÎËÁ‡ˆËflÚ‡ ÓÒÚ‡‚‡Ú ÔËÒÚ˙ÔËÚ ÔË 20%, ‡ÔË ÓÒڇ̇ÎËÚ 40% Ò‡ èè Ë äèè Ò ‚ÚÓ˘̇ „Â̇ÎË-Á‡ˆËfl. é·˘Ó ÔÓˆÂÌÚ˙Ú Ì‡ Ô˙‚˘ÌÓ Ë ‚ÚÓ˘ÌÓ „Â̇-ÎËÁˇÌËÚ ÔËÒÚ˙ÔË Â 76%.

Ñˇ„ÌÓÁ‡Ú‡ ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ Ò ÔÓÒÚ‡‚fl Ò äí Ë/ËÎËåêí Ӣ ÒΉ Ô˙‚Ëfl ÔËÒÚ˙Ô ÔË 24% ÓÚ ·ÓÎÌËÚÂ Ë Ò‡-ÏÓ ÒΉ ÌflÍÓÎÍÓ ÔËÒÚ˙Ô‡ - ‚ 40% ÓÚ ·ÓÎÌËÚÂ. í‡Í‡ ÔË64% ÓÚ ·ÓÎÌËÚ Ô˘Ë̇ڇ Á‡ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙-ˆË (ÏÓÁ˙˜ÌËflÚ ÚÛÏÓ) Ò ÓÚÍË‚‡ Ӣ ‚ Ô˙‚ËÚ ¯ÂÒÚÏÂÒˆ‡ ·Î‡„Ó‰‡ÂÌË ̇ Ò˙‚ÂÏÂÌÌËÚ Ì‚ÓËÁÓ·‡Áfl‚‡-˘Ë ÏÂÚÓ‰Ë.

èË ıÓÒÔËÚË·Á‡ˆËflÚ‡ ÔË 32% ÓÚ ·ÓÎÌËÚ ÎËÔÒ‚‡Ó„ÌË˘Ì‡ Ì‚ÓÎӄ˘̇ ÒËÏÔÚÓχÚË͇, ÔË 68% ÓÚ ·ÓÎ-ÌËÚ Ò ̇ÏË‡Ú ‡Á΢ÌË ÔÓÏÂÌË ‚ Ì‚ÓÎӄ˘ÌËfl ÒÚ‡-ÚÛÒ Ì‡È-˜ÂÒÚÓ ÔÓ„ÂÒˇ˘‡ ÏÓÌÓ- ËÎË ıÂÏËÔ‡ÂÁ‡(52%), ÔÓ-fl‰ÍÓ ‡Ô‡ÚËÍÓ-‡·Û΢ÂÌ ÒË̉ÓÏ (20%) Ë ÚÂÍÓÂÒÔÓÌ‰Ë‡Ú Ì‡ ÎÓ͇ÎËÁ‡ˆËflÚ‡ ̇ ÌÂÓÔ·Áχڇ. ë „Î‡-‚Ó·ÓÎË ҇ Ò‡ÏÓ 16% ÓÚ ·ÓÎÌËÚÂ Ë Ò‡ÏÓ 2 ·ÓÎÌË Ò‡ Ò ÍÎË-Ì˘ÌË ÔÓfl‚Ë Ì‡ ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌÒËfl Ë Ì‡˜‡ÎÌËÁ‡ÒÚÓÈÌË Ô‡ÔËÎË.

àáÇéÑàèË ÔÓÎÓ‚Ë̇ڇ ·ÓÎÌË ÂÔËÎÂÔÚ˘ÌËÚ ÔËÔ‡‰˙ˆË Ò‡

Ô˙‚‡ Ë Â‰ËÌÒÚ‚Â̇ ÔÓfl‚‡ ̇ ÏÓÁ˙˜ÌËfl ÚÛÏÓ, ÍÓÂÚÓÔÓÚ‚˙ʉ‡‚‡ ËÁ‚ÂÒÚÌÓÚÓ Ô‡‚ËÎÓ ‰‡ Ò Ú˙ÒË ÏÓÁ˙˜Ì‡ÌÂÓÔ·Áχ ÔË ÔÓfl‚‡Ú‡ ̇ ÔËÔ‡‰˙ˆË ‚ Ò‰̇ Ë Ì‡Ô‰̇-· ‚˙Á‡ÒÚ ‰ÓË ÔË ÎËÔÒ‡Ú‡ ̇ ‰Û„‡ ÍÎËÌ˘̇ ÒËÏÔÚÓ-χÚË͇.

ãàíÖêÄíìêÄ:

1. Berger M.S., Ghatan S., Haglund M.M. et al. Low grade glioma associated withintractable epilepsy. J. Neurosurg., 1993, 79, 62-692. Bergin P.S., Fish D.R., Sharvon S.D. et al. MRI in partial epilepsy: additionalabnormalities schown with FLAIR pulse sequence. J. Neurol. Neurosurg.Psychiatry, 1995, 58, 439-4433. Brust J.C.M. Seizures in the elderly. In: Epileptic seizures. H.O.Luders andS.Noachtar (Eds), 2000, Churchill Livingstone, New York, 529-5384. De Angelis L. Brain tumors. N Engl.J.Med., 2001, 344, 114-1235. Hauser W.A., Annegers J.F., Kurland L.T. Incidence of epilepsy and unpro-voked seizures in Rochester, Minnesota: 1935-1984. Epilepsia, 1993, 34, 453-4686. Hauser W.A. Seizures disorders: the changes with age. Epilepsia, 1992, 33,Suppl.4, S4-S147. Kawasaki M., Hernandes-Fustes O.J., Machado S. et al. Epilepsia y tumor cere-bral. Rev.Neurol., 1999, 28, 1047-10498. Kramer G. Epileptic seizures and epilepsy in the elderly. Ther.Umsch., 2001,58, 684-690

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 133‰ÂÍÂÏ‚Ë, 2002

äÎËÌ˘ÌË ÔÓfl‚Ë ·ÓÈ ·ÓÎÌË ÔÓˆÂÌÚ焇ÚË‚ÂÌ Ì‚ÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ 8 32%

ë Ó„ÌˢÌË Ì‚ÓÎӄ˘ÌË ÔÓfl‚Ë 17 68%

åÓÌÓ- Ë ıÂÏËÔ‡ÂÁ‡ 13 52%

ñÂÌÚ‡Î̇ Ô‡ÂÁ‡ ̇ VII Ë/ËÎË ïII óåç 7 28%

ïÂÏËıËÔÂÒÚÂÁËfl 4 16%

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åÓÚÓ̇ ‡Ù‡ÁËfl 4 16%

åÓÚÓ̇ ‡Ô‡ÍÒËfl 1 4%

ë ÔÓfl‚Ë Ì‡ ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌÒËfl 2 8%

ë „Î‡‚Ó·ÓÎË 4 16%

ë˙Ò Á‡ÒÚÓÈÌË Ô‡ÔËÎË 2 8%

퇷Î. 7. äÎËÌ˘ÌË ÔÓfl‚Ë ÔË ·ÓÎÌËÚÂ Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓË ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË

ÖÖÉ ·ÓÈ ·ÓÎÌË ÔÓˆÂÌÚîÓ͇Î̇ ·‡‚ÌÓ‚˙ÎÌÓ‚‡ ‡ÍÚË‚ÌÓÒÚ 11 73,3

îÓ͇Î̇ ‡ÍÚË‚ÌÓÒÚ ÓÚ ÓÒÚË ‚˙ÎÌË 4 26,6

ÉÂ̇ÎËÁˇ̇ Ô‡ÓÍÒËÁχÎ̇ ‡ÍÚË‚ÌÓÒÚ 8 53,3

퇷Î.8. èÓÏÂÌË ‚ ÖÖÉ ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ ËÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË

äí ÅÓÈ %·ÓÎÌË

ïËÔÓ‰ÂÌÁÂÌ ÚÛÏÓ 11 50,0 2 ÓÎË„Ó‰ẨӄÎËÓÏ,

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äËÒÚÓÁ̇ ‰Â„Â̇ˆËfl 2 9,1 2 „ÎËӷ·ÒÚÓÏ

èÓÒÚÓÔ‡Ú˂̇ ÍËÒÚ‡ 2 9,1 1 ‡ÒÚÓˆËÚÓÏ Ì‡ χÎÍËfl ÏÓÁ˙Í,

1 „ÎËÓÏ

퇷Î.9. äí ÔÓÏÂÌË ÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ ËÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË

9. Kroh H., Matyja E., Bidzinski J. Disorganisation of cortical structure and thebrain tumors. Folia Neuropathol., 1999, 37, 20-2610. Lugant A., Haldre S., Oun A. et al. Seizure disorders in patients with braintumors. Europ.Neurol, 2001, 45, 46-5111. Mohamed A., Luders H.O. MRI in temporal lobe epilepsy: usefulness for theethiological diagnosis of temporal lobe epilepsy. Neurol.Med.Chir., 2000, 40, 1-1512. Moots P.L., Maciunas D.R., Eisert D.R. et al. The course of seizures in par-tients with malignant gliomas. Arch.Neurol., 1995, 52, 717-72513. Moreno A., Felipe J., Garcia-Sola R. et al. Neuronal and mixed neuronal-glialtumors associated with epilepsy. A heterogenous and related group of tumors.Histol.-Histopathol. 2001,16, 613-62214. Oda M., Arai N., Maehara T. et al. Brain tumors in surgical neuropathology ofintractable epilepsies with special reference to cerebral dysplasias. Brain TumorPathol., 1998, 15, 41-4515. Prayson R.A., Estes M.L., Morris H.H. Coexistence of neoplasia and corticaldysplasia in patients presenting with seizures. Epilepsia, 1993, 34, 609-61516. Raymond A.A., Halpin S.F., Alsanjari N. et al. Dysembrioplastic neuroepithe-lial tumor. Features in 16 patients. Brain, 1994, 117, 461-47517. Sinclair D.B., Wheatley M., Aronyk K. et al. Pathology and neuroimaging inpediatric temporal lobeectomy for intractable epilepsy. Pediatr.Neurosurg., 2001,35, 239-24618. Tardy B., Lafond P., Convers P. et al. Adult first generalized seizure: etiology,

biological tests, EEG, CT scan in an ED. Am.J.Emerg.Med., 1995, 13, 1-519. Valenca M.M., Valenca L.P. Etiologia das crises epilepticas na cidads doRecife, Brasil: estudo de 249 patientes. Arq.Neuropsiquiatr.,2000, 58, 1064-107220. Williams B.A., Abbott K.J., Manson J.I. Cerebral tumors in children present-ing with epilepsy. J.Child Neurol.,1992,7, 291-29421. Wolf H.K., Muller M.B., Spanle M. et al. Ganglioglioma: a detailed histopato-logical and immunohistochemical analysis of 61 cases. Acta Neuropathol., 1994,88, 166-17322. Weinstock A., Cohen B.H. Seizures in patients with brain tumors and cancer.In: Epileptic seizures. H.O.Luders and S.Noachtar (Eds), 2000, ChurchillLivingstone, New York, 738-74623 . Zentmer J., Hufnagel A., Wolf H.K. et al. Surgical treatment of neoplasmsassociated with medically intractable epilepsy. Neurosurgery,1997, 41, 378-386

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈ËflÑÓˆ. é. ÉË„ÓÓ‚‡ 1431 ëÓÙËfl ÛÎ. É. ëÓÙËÈÒÍË 1å‰ˈËÌÒÍË ÛÌË‚ÂÒËÚÂÚ åÅÄã- ÄÎÂÍ҇̉ӂÒ͇ç‚ÓÎӄ˘̇ ÍÎËÌË͇ ÚÂÎ /02/ 9230-665

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 134‰ÂÍÂÏ‚Ë, 2002

SUMMARY

OPTIMAL TREATMENT OF THE BENIGN EPILEPSY- BECTS - VALPROATE VS ëARBAMAZEPINE

P. Dimova, D. Daskalov, I. FilipovaIt was the aim of this study to evaluate the treatment effects

of the anticonvulsants most often used in benign epilepsy withcentrotemporal spikes The medical charts and electroen-cephalographic (EEG) records of 66 children with the diagno-sis of BECTS were retrospectively analyzed. Out of thesepatients, 48 children were treated initially with ëarba-mazepine (CBZ), ‡nd 17 - with Valproate (VPA).). In general,CBZ and VPA had similar efficacy in seizure control andreduction, but differed in terms of lacking efficacy and seizureaggravation. Main differences between these drugs werefound in their effects on the ÖÖG abnormality. The epilepticpotentials disappeared or improved significantly more oftenunder VPA, and were unchanged or activated significantlymore often with CBZ. This EEG-response reflected on thebetter effects of VPA on the neuropsychological disturbancesin some patients. These results lead us to suggest that VPAcould be a drug of first choice in BECTS. Key words: Epilepsy, Childhood, Rolandic, EEG, Valproate,Carbamazepine.

êÖáûåÖñÂΠ̇ ̇ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡Ì  ‰‡ Ò ӈÂÌflÚ Ú‡-

Ô‚Ú˘ÌËÚ ÂÙÂÍÚË Ì‡ ̇È-˜ÂÒÚÓ ÔË·„‡ÌËÚ ‡ÌÚËÍÓÌ-‚ÛÎÒ‡ÌÚË ÔË êÓ·̉ӂ‡ ÂÔËÎÂÔÒËfl (ËÎË ‰Ó·Ó͇˜ÂÒÚ‚Â̇‰ÂÚÒ͇ ÂÔËÎÂÔÒËfl Ò ˆÂÌÚÓ-ÚÂÏÔÓ‡ÎÌË ÓÒÚËfl =BECTS). êÂÚÓÒÔÂÍÚË‚ÌÓ Â ‡Ì‡ÎËÁˇ̇ ωˈËÌÒ͇ڇ‰ÓÍÛÏÂÌÚ‡ˆËfl Ë ÂÎÂÍÚÓÂ̈ÂÙ‡ÎÓ„‡ÙÒÍËÚ ËÁÒΉ‚‡-

ÌËfl (ÖÖÉ) ̇ 66 ‰Âˆ‡ Ò ‰Ë‡„ÌÓÁ‡ BECTS. óÂÚËˉÂÒÂÚ ËÓÒÂÏ ÓÚ ÚÂÁË ‰Âˆ‡ Ò‡ ÎÂÍÛ‚‡ÌË Ì‡˜‡ÎÌÓ Ò ëarbamazepine(CBZ), ‡ 17 - Ò Valproate (VPA). é·˘Ó, CBZ Ë VPA Ò‡ ‰Ó-‚ÂÎË ‚ ÒıÓ‰ÂÌ ‰flÎ ÓÚ Ô‡ˆËÂÌÚËÚ ‰Ó Á̇˜Ëχ ‰Û͈ËflËÎË Ó‚Î‡‰fl‚‡Ì ̇ ÔËÒÚ˙ÔËÚÂ, ÌÓ Ò ‡Á΢‡‚‡Ú ÔÓ ÓÚ-ÌÓ¯ÂÌË ̇ ÔÓ͇Á‡ÚÂÎËÚ ÎËÔÒ‚‡˘ ÂÙÂÍÚ ËÎË ‚ÎÓ¯‡‚‡ÌÂ̇ ÂÔËÎÂÔÒËflÚ‡. éÒÌÓ‚ÌËÚ ‡Á΢Ëfl ÏÂÊ‰Û ‰‚‡Ú‡ ωË-͇ÏÂÌÚ‡ Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ÔÓ ÓÚÌÓ¯ÂÌË ̇ ÂÙÂÍÚËÚ ËÏ‚˙ıÛ ÖÖÉ-‡·ÌÓÏÌÓÒÚÚ‡. èË Î˜ÂÌËÂ Ò VPA ÖÖÉ Â ·Ë-· Á̇˜ËÏÓ ÔÓ-˜ÂÒÚÓ ÌÓχÎËÁˇ̇ ËÎË Ò ÔÓ‰Ó·ÂÌËÂ, ‰Ó-͇ÚÓ ÔË CBZ  ·Ë· ÔÓ-˜ÂÒÚÓ ·ÂÁ ÔÓÏfl̇ ËÎË ‰ÓË ‚ÎÓ-¯Â̇. íÓ‚‡ ÖÖÉ-ÔÓ‚ÎËfl‚‡Ì  ‰Ó‚ÂÎÓ Ë ‰Ó ÔÓ-‰Ó·ËflÂÙÂÍÚ Ì‡ VPA ‚˙ıÛ Ì‚ÌÓÔÒËıÓÎӄ˘ÌËÚ ̇ۯÂÌËfl ÛÌflÍÓË ‰Âˆ‡. èÓÒÓ˜ÂÌËÚ ÂÁÛÎÚ‡ÚË ÌË ‰‡‚‡Ú ÓÒÌÓ‚‡Ìˉ‡ ÔÂÔÓ˙˜‡Ï VPA ͇ÚÓ Ò‰ÒÚ‚Ó Ì‡ ËÁ·Ó ÔË Î˜ÂÌË-ÂÚÓ Ì‡ BECTS.Kβ˜Ó‚Ë ‰ÛÏË: ‰Âˆ‡, EEÉ, ÂÔËÎÂÔÒËfl, êÓ·̉ӂ‡,Carbamazepine, Valproate

ìÇéÑêÓ·̉ӂ‡Ú‡ ÂÔËÎÂÔÒËfl (ËÎË ‰Ó·Ó͇˜ÂÒÚ‚Â̇ ‰ÂÚÒ͇

ÂÔËÎÂÔÒËfl Ò ˆÂÌÚÓ-ÚÂÏÔÓ‡ÎÌË ÓÒÚËfl = BECTS)  ̇È-˜ÂÒÚ‡Ú‡ ‰ÂÚÒ͇ Ô‡ˆË‡Î̇ ÂÔËÎÂÔÒËfl / 6, 26 /. ë˜ËÚ‡ ÒÂ,˜Â ΘÂÌËÂÚÓ È Ì  Á‡‰˙ÎÊËÚÂÎÌÓ / 1, 6, 14, 18, 26 / ËÂÎÂÍÚÓÂ̈ÂÙ‡ÎÓ„‡ÙÒ͇ڇ (ÖÖÉ) ̇ıӉ͇ Ìflχ „ÓÎflχÓÎfl ‚ Ë̉Ë͇ˆËflÚ‡ ÏÛ, ÔÓ‡‰Ë ÎËÔÒ‡Ú‡ ̇ ÍÓ·ˆËflÏÂÊ‰Û ‡ÍÚË‚ÌÓÒÚÚ‡ ̇ ÂÔËÎÂÔÒËflÚ‡ Ë Ú‡ÁË Ì‡ Ô‡ÓÍÒËÁ-χÎ̇ڇ ÖÖÉ-‡·ÌÓÏÌÓÒÚ / 1, 14 /. Ç˙ÔÂÍË ˜Â ÓÒÌÓ‚ÌËÚÂ"‰Ó·Ó͇˜ÂÒÚ‚ÂÌË" ı‡‡ÍÚÂËÒÚËÍË Ì‡ BECTS Ò‡ ‰Ó·ÂËÁ‚ÂÒÚÌË / 6, 26 /, ‚Ò Ôӂ˜ ÔÓÛ˜‚‡ÌËfl Ò˙Ó·˘‡‚‡Ú Á‡‡ÚËÔ˘ÌË ·ÂÎÂÁË, ‚Íβ˜ËÚÂÎÌÓ Ì‡Û¯ÂÌËfl ‚ Ì‚ÓÔÒË-ı˘ÌÓÚÓ ‡Á‚ËÚË ÔÓ ‚ÂÏ ̇ ‡ÍÚ˂̇ڇ Ù‡Á‡ ̇ ·Ó-ÎÂÒÚÚ‡ / 4, 8, 15, 19, 20, 25, 27, 28, 29 /. íÂÁË ÔÓ‰Ó·ÌË ËÁ-

éË„Ë̇ÎÌË ÒÚ‡ÚËË éèíàåÄãçé ãÖóÖçàÖ çÄ êéãÄçÑéÇÄíÄ ÖèàãÖèëàü:

èêÖÑàåëíÇé çÄ VALPROATE èêÖÑ CARBAMAZEPINEè. ÑËÏÓ‚‡, Ñ. чÒ͇ÎÓ‚, à. îËÎËÔÓ‚‡ìëÅÄãçè "ë‚.ç‡ÛÏ" - IV ÍÏ., ëÓÙËfl

ÒΉ‚‡ÌËfl ‡ÁÍË‚‡Ú ÎÂÍË ÍÓÓ‰Ë̇ˆËÓÌÌË Ì‡Û¯ÂÌËfl,˜‚ ‰ÂÙˈËÚ Ò ‰ËÁ‡ÚËfl, ̇ۯÂÌËfl ̇ ‚ËÁÛÓ-ÏÓÚÓ-̇ڇ ÍÓÓ‰Ë̇ˆËfl, ÔÓ·ÎÂÏË Ò ÍÓ̈ÂÌÚ‡ˆËflÚ‡ Ë Ô‡-ÏÂÚÚ‡, ÓÚ‡Áfl‚‡˘Ë ‰Ó „ÓÎflχ ÒÚÂÔÂÌ ‡ÍÚË‚ÌÓÒÚÚ‡ ̇Ó·̉ӂÓÚÓ Ó„ÌË˘Â Ë ÓÒÓ·ÂÌÓ Ì„ӂ‡Ú‡ ÒÍÎÓÌÌÓÒÚ Í˙Ï‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl / 2, 4, 8, 15, 25 / èÓ‡‰Ë ÚÓ‚‡, ‚ÒÂÔÓ-¯ËÓÍÓ Ò ‡ÁÔÓÒÚ‡Ìfl‚‡ ÏÌÂÌËÂÚÓ, ˜Â Úfl·‚‡ ‰‡·˙‰‡Ú ÔÓÚËÒ̇ÚË Ì ҇ÏÓ ÔËÒÚ˙ÔËÚÂ, ÌÓ Ë ‡·ÌÓÏ̇ڇÖÖÉ-‡ÍÚË‚ÌÓÒÚ. í‡Í‡, "ÓÔÚËχÎÌÓ" ΘÂÌË ̇ BECTSÒΉ‚‡ ‰‡ ÓÁ̇˜‡‚‡ ÍÓÌÚÓΠ̇ ÔËÒÚ˙ÔËÚÂ, ÌÓχÎËÁË-‡Ì ̇ ÖÖÉ Ë Ó‚Î‡‰fl‚‡Ì ̇ ‚ÂÌÚÛ‡ÎÌË Ì‚ÓÔÒËıÓÎÓ-„˘ÌË ÓÚÍÎÓÌÂÌËfl.

Carbamazepine (CBZ)  ̇È-˜ÂÒÚÓ ËÁÔÓÎÁ‚‡ÌËflÚ Ï‰Ë-͇ÏÂÌÚ, ÌÓ ÚÓÈ ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó ‡„‡‚‡ˆËfl ̇ ÂÔËÎÂÔ-ÒËflÚ‡, ‚Íβ˜ËÚÂÎÌÓ ‡ÍÚË‚‡ˆËfl ̇ ÙÓ͇Î̇ڇ Ô‡ÓÍÒËÁ-χÎ̇ ‡ÍÚË‚ÌÓÒÚ, ‰ÓË ‰Ó ÔˆËÔËÚˇÌ ̇ ÂÔËÎÂÔÚË-˜ÂÌ ÒÚ‡ÚÛÒ ÔÓ ‚ÂÏ ̇ ·‡‚ÌÓ‚˙ÎÌÓ‚ Ò˙Ì Ò˙Ò Á̇˜ËÚÂÎÌËÍÓ„ÌËÚË‚ÌË ÔÓ·ÎÂÏË / 10, 11, 13, 21, 22 /. Ç˙ÔÂÍË ˜Â ÂÙË-͇ÒÌÓÒÚÚ‡ Ë ‰Ó·‡Ú‡ ÔÓÌÓÒËÏÓÒÚ Ì‡ Valproate (VPA) ÌÂÒ‡ÏÓ ÔË „Â̇ÎËÁˇÌË, ÌÓ Ë ÔË Ô‡ˆË‡ÎÌË ÂÔËÎÂÔÚ˘-ÌË ÙÓÏË Â ËÁ‚ÂÒÚ̇ ‚˜ ÓÚ ÏÌÓ„Ó „Ó‰ËÌË / 7, 9, 24 /, ÚÓÈÌ Ò ҘËÚ‡ Ò‰ÒÚ‚Ó Ì‡ Ô˙‚Ë ËÁ·Ó ÔË BECTS. ë ˆÂÎ ÛÒÚ‡ÌÓ‚fl‚‡ÌÂ Ë Ò‡‚Ìfl‚‡Ì ̇ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ̇CBZ Ë VPA ÔË "ÓÔÚËχÎÌÓÚÓ" ΘÂÌË ̇ BECTS ÌË ËÁ-‚˙¯ËıÏ ̇ÒÚÓfl˘ÓÚÓ ÔÓÛ˜‚‡ÌÂ.

äéçíàçÉÖçí à åÖíéÑàêÂÚÓÒÔÂÍÚË‚ÌÓ Â ‡Ì‡ÎËÁˇ̇ ωˈËÌÒ͇ڇ ‰ÓÍÛ-

ÏÂÌÚ‡ˆËfl (‚Íβ˜ËÚÂÎÌÓ EEÉ- ËÁÒΉ‚‡ÌËfl) ̇ ‰Âˆ‡Ú‡ ÒBECTS, ÎÂÍÛ‚‡ÌË ‚ ÍÎËÌË͇ڇ ÏÂÊ‰Û 1997 Ë 2001 „. 뇂-ÌÂÌËÂÚÓ ÏÂÊ‰Û „ÛÔËÚÂ, ÎÂÍÛ‚‡ÌË Ò CBZ Ë VPA,  ËÁ‚˙-¯ÂÌÓ ÔÓ ÓÚÌÓ¯ÂÌË ˜ÂÒÚÓÚ‡Ú‡ ̇ ÔËÒÚ˙ÔËÚÂ, ËÌÚÂÌ-ÁË‚ÌÓÒÚÚ‡ Ë ˜ÂÒÚÓÚ‡Ú‡ ̇ Ó·̉ӂËÚ ԇÓÍÒËÁÏË ‚ÖÖÉ, ÒÚ‡Ì˘ÌËÚ ÂÙÂÍÚË ÓÚ Î˜ÂÌËÂÚÓ Ë ÂÙÂÍÚ‡ ‚˙-ıÛ Â‚ÂÌÚÛ‡ÎÌË ÍÓ„ÌËÚË‚ÌË Ë Ôӂ‰Â̘ÂÒÍË ÓÚÍÎÓÌÂÌËfl.ÖÖÉ-ËÁÒΉ‚‡ÌËflÚ‡ Ò‡ ÔÓ‚Âʉ‡ÌË ÔÂ‰Ë Ë ÔÓ ‚ÂÏ ̇ΘÂÌËÂÚÓ, Ó·ËÍÌÓ‚ÂÌÓ ÔÂÁ 1- ‰Ó 3-ÏÂÒ˜ÌË ËÌÚ‚‡ÎË,͇ÚÓ Ò‡ ‡Ì‡ÎËÁˇÌË Ò‡ÏÓ ËÁÒΉ‚‡ÌËfl ‚ ·Û‰ÌÓ Ò˙ÒÚÓfl-ÌËÂ. èË ÔÒËıÓÎӄ˘ÌËÚ ËÁÒΉ‚‡ÌËfl ̇ ‚Ò˘ÍË ‰Âˆ‡ Ò‡ÔË·„‡ÌË ÚÂÒÚÓ‚ÂÚ ̇ Wechsler, Binet-Terman Ë Raven,͇ÍÚÓ Ë ‡Á΢ÌË Ô‡ÏÂÚÓ‚Ë ÚÂÒÚÓ‚Â. ëÚ‡ÚËÒÚ˘ÂÒ̇͡ÎËÁ  ËÁ‚˙¯ÂÌ ˜ÂÁ c2-ÚÂÒÚÓ‚Â, ͇ÚÓ Á‡ ÒÚ‡ÚËÒÚË-˜ÂÒÍË Á̇˜ËÏË Ò‡ ÔËÂχÌË ÒÚÓÈÌÓÒÚË Ì‡ <0.05.

êÖáìãíÄíàé·˘Ó 66 ‰Âˆ‡ Ò‡ ·ËÎË ‰Ë‡„ÌÓÒÚˈˇÌË Í‡ÚÓ BECTS-

ÒÎÛ˜‡Ë. Ç˙Á‡ÒÚÚ‡ ̇ ËÁfl‚‡  ·Ë· ÏÂÊ‰Û 2 Ë 12 „. (Ò‰-ÌÓ 6.3 „.). Ñ‚‡‰ÂÒÂÚ Ë ‰‚ ‰Âˆ‡ (33.3%) Ò‡ ËχÎË Ô‡ˆË‡Î-ÌË Ë „Â̇ÎËÁˇÌË ÚÓÌ˘ÌÓ-ÍÎÓÌ˘ÌË ÔËÒÚ˙ÔË(Éíäè), 26 (39.4%) - Ò‡ÏÓ ÔÓÒÚË Ô‡ˆË‡ÎÌË (ÓÓ-Ù‡ˆË‡-ÎÌË, Ù‡ˆËÓ-·‡ıˇÎÌË ËÎË ıÂÏËÍÓÌ‚ÛÎÒË‚ÌË), ‡ 18 (27.3%)- Ò‡ÏÓ Éíäè Ò fl‚̇ ‚˙Á͇ Ò˙Ò Ò˙Ìfl. óÂÒÚÓÚ‡Ú‡ ̇ ÔËÒ-Ú˙ÔËÚ  ·Ë· Ú‚˙‰Â ‡Á΢̇ - ÓÚ 3 ÔËÒÚ˙Ô‡ „Ӊ˯-ÌÓ ‰Ó 4 ÔËÒÚ˙Ô‡ Ò‰Ï˘ÌÓ.

èÂӷ·‰‡‚‡ÎË Ò‡ ÒÎÛ˜‡Ë Ò Í·Ò˘ÂÒ͇ڇ ˆÂÌÚÓ-ÚÂÏ-ÔÓ‡Î̇ (C-T) ÎÓ͇ÎËÁ‡ˆËfl ̇ ÙÓ͇Î̇ڇ ‡·ÌÓÏÌÓÒÚ(n=27, 41%). Ç 21 ÒÎÛ˜‡fl (32.8%)  ̇·Î˛‰‡‚‡Ì‡ ıÓÏÓ·-Ú‡Î̇, ‡ ÔË 13 Ô‡ˆËÂÌÚË (20.3%) ‰‚ÛÒÚ‡Ì̇ ÒËÌıÓ-ÌËÁ‡ˆËfl ̇ ÙÓ͇Î̇ڇ ‡ÍÚË‚ÌÓÒÚ

óÂÚËˉÂÒÂÚ Ë ÓÒÂÏ ‰Âˆ‡ (72.7%) Ò‡ ·ËÎË Ò Ì‡˜‡ÎÌÓΘÂÌË CBZ (‡Á΢ÌË Ú˙„Ó‚ÒÍË ÔÂÔ‡‡ÚË); 17 (25.8%)- Ò VPA (14 ‰Âˆ‡ ËÎË 77% ÓÚ „ÛÔ‡Ú‡ - Ò Depakinechrono‚); Ë 1 - Ò CZP. êÂÁÛÎÚ‡ÚËÚ ÓÚ Î˜ÂÌËÂÚÓ Ò CBZËVPA Ò‡Ó·Ó·˘ÂÌË ‚퇷ÎËˆË 1 Ë 2, Ë Ò‡‚ÌÂÌË ‚ 퇷Îˈ‡ 3. é·˘Ó, ÂÁÛÎÚ‡ÚËÚ ÓÚ Î˜ÂÌËÂÚÓ ‚ ‰‚ÂÚ „ÛÔË Ì Ò‡Á΢‡‚‡Ú Ò˙˘ÂÒÚ‚ÂÌÓ (c2=4.65, p=0.199, n.s.). ëÔˇÌÂË Á̇˜ËÚÂÎ̇ ‰Û͈Ëfl (̇‰ 50%) ̇ ÔËÒÚ˙ÔËÚ ҇ ÔÓÒ-

Ú˄̇ÚË ‚ ÒıÓ‰ÂÌ ‰flÎ ÓÚ Ô‡ˆËÂÌÚËÚ (c2 =4.59, p=0.101,n.s.). èÓ ÓÚÌÓ¯ÂÌË ÎËÔÒ‡Ú‡ ̇ ÂÙÂÍÚ ËÎË ‚ÎÓ¯‡‚‡ÌÂÚÓ̇ ÂÔËÎÂÔÒËflÚ‡, Ó·‡˜Â, CBZ Ëχ Á̇˜ËÏÓ ÔÓ-ËÁ‡ÁÂÌË ÓÚ-ˈ‡ÚÂÎÌË ÂÙÂÍÚË ‚ Ò‡‚ÌÂÌËÂ Ò VPA (c2 =22.28,p<0.001), ͇ÚÓ ÔË 2 ‰Âˆ‡ Ò CBZ  ̇·Î˛‰‡‚‡Ì Ô‡ˆË‡ÎÂÌÂÔËÎÂÔÚ˘ÂÌ ÒÚ‡ÚÛÒ.

ÖÙÂÍÚ˙Ú Ì‡ VPA  ‚˙ıÛ Ó·̉ӂËÚ ÖÖÉ-Ô‡ÓÍÒËÁ-ÏË ·ËÎ Á̇˜ËÏÓ ÔÓ-‰Ó·˙. îÓ͇Î̇ڇ Ô‡ÓÍÒËÁχÎ̇ ‡Í-ÚË‚ÌÓÒÚ ËÁ˜ÂÁ‚‡ ËÎË ËÁ‡ÁÂÌÓÒÚÚ‡ È Ì‡Ï‡Îfl‚‡ ÔÓ-˜ÂÒÚÓÔË Î˜ÂÌËÂ Ò VPA, ÓÚÍÓÎÍÓÚÓ Ò CBZ. ë˙˘Ó ڇ͇, ÎËÔ҇̇ ÂÙÂÍÚ ËÎË ‡ÍÚË‚‡ˆËfl Ò ÓÚ˜ËÚ‡Ú Á̇˜ËÏÓ ÔÓ-fl‰ÍÓÔË Î˜ÂÌËÂ Ò VPA, ÓÚÍÓÎÍÓÚÓ Ò CBZ (c2=17.48, p<0.001).é·˘Ó, VPA  ÔÓ͇Á‡Î Á̇˜ËÏÓ ÔÓ-‰Ó·˙ ÂÙÂÍÚ ‚ Ò‡‚ÌÂ-ÌËÂ Ò CBZ ‚˙ıÛ ÖÖÉ-‡·ÌÓÏÌÓÒÚËÚ (c2=33.99,p<0.001).

èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ ΘÂÌËÂÚÓ Ë Ì‡˜ËÌ˙Ú Ì‡ ÔË-ÎÓÊÂÌË ̇ CBZ Ë VPA (퇷Îˈ‡ 3) Ò ‡Á΢‡‚‡Ú Á̇˜Ë-ÏÓ (c2=40.05, p<0.001). VPA  ÔË·„‡Ì ͇ÚÓ ‚ÚÓË Ï‰Ë-͇ÏÂÌÚ ÔË ÔÂÒËÒÚˇ˘Ë ÔËÒÚ˙ÔË (n=17) Ë ÌÂÔÓÏÂ-ÌÂ̇ ËÎË ‚ÎÓ¯Â̇ EEÉ (n=29). é·˘Ó, 34 ‰Âˆ‡ (74%) Ò‡ ·Ë-ÎË Ì‡ ͇È̇ ÏÓÌÓÚ‡ÔËfl (18 Ò CBZ, 16 Ò VPA), ‡ ÓÒÚ‡-̇ÎËÚ ҇ ÔÓÎÛ˜‡‚‡ÎË ‡Á΢ÌË ‰‚ÓÈÌË ÍÓÏ·Ë̇ˆËË ÓÚ ‡Ì-ÚËÍÓÌ‚ÛÎÒ‡ÌÚË, ͇ÚÓ 12 ÓÚ Úflı - VPA Ë CBZ.

Ç ˆÂÎËfl ÍÓÌÚËÌ„ÂÌÚ Ì‚ÓÔÒËıÓÎӄ˘ÌË Ì‡Û¯ÂÌËfl Ò‡ÛÒÚ‡ÌÓ‚ÂÌË ÔË 20 ‰Âˆ‡ (30.3%). ç‡È-˜ÂÒÚË Ò‡ ·ËÎË ÔÓ‚Â-‰Â̘ÂÒÍËÚ ÓÚÍÎÓÌÂÌËfl, ÓÒÌÓ‚ÌÓ - ıËÔ‡ÍÚË‚ÌÓÒÚ(n=12, 18.2%), ÒΉ‚‡ÌË ÓÚ ‰ÂÙˈËÚ Ì‡ ‚ÌËχÌËÂÚÓ(n=10, 15.2%), ‰ËÒÎÂÍÒ˘ÌË ÔÓ·ÎÂÏË (n=7, 10.6%) Ë Â˜Â-‚Ë Ì‡Û¯ÂÌËfl Ò ÎÂ͇ ‰ËÁ‡ÚËfl (n=4, 6.1%). Ñ‚‡ ÓÚ ÔÓÒ-ΉÌËÚ ÒÎÛ˜‡Ë Ò‡ ·ËÎË Ò fl‚ÌÓ ‚ÎÓ¯‡‚‡Ì ÒΉ Á‡ÔÓ˜‚‡ÌÂ̇ ΘÂÌËÂ Ò CBZ, ÔË ËÁ‡ÁÂ̇ ‡ÍÚË‚‡ˆËfl ̇ ̇˜‡Î̇ ë-í ΂ÓÒÚ‡Ì̇ ÖÖÉ-‡·ÌÓÏÌÓÒÚ Ò ÏÌÓ„Ó ˜ÂÒÚ‡ ‰‚ÛÒÚ-‡Ì̇ ÒËÌıÓÌËÁ‡ˆËfl Ë ÔË ÌÂÁ̇˜ËÚÂÎ̇ ‰Û͈Ëfl ̇ÔËÒÚ˙ÔËÚÂ.

ë‡ÏÓ ÔË 3 ÓÚ 14 ‰Âˆ‡ Ò Ì‚ÓÔÒËıÓÎӄ˘ÌË ÔÓ·ÎÂÏË,ÎÂÍÛ‚‡ÌË Ò CBZ,  ̇·Î˛‰‡‚‡ÌÓ ÔÓ‰Ó·ÂÌË ÔÓ ‚ÂÏ ̇̇˜‡Î̇ڇ ÏÓÌÓÚ‡ÔËfl, ÍÓÂÚÓ Â ·ËÎÓ ÛÒÔÓ‰ÌÓ Ò ÌÓ-χÎËÁˇÌ ̇ ÖÖÉ. Ç˙ÔÂÍË ‰Ó·Ëfl ÂÙÂÍÚ ‚˙ıÛ ÔËÒ-Ú˙Ô̇ڇ ˜ÂÒÚÓÚ‡, ÔË ÓÒڇ̇ÎËÚ 11 ‰Âˆ‡ ÖÖÉ Â ·Ë· ÒÌÂÁ̇˜ËÚÂÎ̇ ÔÓÏfl̇ ËÎË ‰ÓË ‚ÎÓ¯‡‚‡ÌÂ, ÔÓ‡‰Ë ÍÓÂÚÓVPA  ·ËÎ ‰Ó·‡‚ÂÌ ËÎË Â Á‡ÏÂÌËÎ CBZ (Ò˙ÓÚ‚ÂÚÌÓ ‚ 7 ÒÎÛ-˜‡fl).

òÂÒÚ ‰Âˆ‡ Ò ËÁ‡ÁÂÌË Ì‚ÓÔÒËıÓÎӄ˘ÌË ÔÓ·ÎÂÏË Ò‡·ËÎË ÎÂÍÛ‚‡ÌË Ì‡˜‡ÎÌÓ Ò VPA, ͇ÚÓ ÔË 4 ÓÚ Úflı  ̇·-≇‚‡ÌÓ Ô˙ÎÌÓ Ó‚Î‡‰fl‚‡Ì ̇ ÔËÒÚ˙ÔËÚÂ, ÛÒÔÓ‰ÌÓÒ˙Ò Á̇˜ËÚÂÎÌÓ ÔÓ‰Ó·ÂÌË ËÎË ÌÓχÎËÁˇÌ ‚ ÖÖÉ,͇ÍÚÓ Ë Ò ÔÓ‰Ó·ÂÌÓ Ôӂ‰ÂÌËÂ Ë ÔÒËıÓÎӄ˘̇ ÓˆÂÌ͇ ÔÓ‚ÂÏ ̇ ̇·Î˛‰ÂÌËÂÚÓ Ë ÔÒËıÓÎӄ˘ÌÓÚÓ ÚÂÒÚÛ‚‡ÌÂ.èË ÓÒڇ̇ÎËÚ ‰‚ ‰Âˆ‡ ÔÓ‡‰Ë ÌÂÔ˙ÎÌËfl ÍÎËÌ˘ÂÌ ËÖÖÉ-ÂÙÂÍÚ Â ‰Ó·‡‚ÂÌ ã‡ÏÓÚËÊËÌ Ò ÓÚ΢ÂÌ ÂÁÛÎÚ‡Ú.

éÅëöÜÑÄçÖã˜ÂÌËÂÚÓ Ì‡ "‰Ó·Ó͇˜ÂÒÚ‚Â̇ڇ" êÓ·̉ӂ‡ ÂÔË-

ÎÂÔÒËfl Ô‰ÒÚ‡‚Îfl‚‡ ÍÓÏÔÎÂÍÒÂÌ ÔÓˆÂÒ Ò ÌflÍÓÎÍÓ ˆÂÎË,ÍÓÂÚÓ ÔÓÌflÍÓ„‡ „Ó Ô‡‚Ë ÚÛ‰ÌÓ. ë˜ËÚ‡ÏÂ, ˜Â ӷ˘‡ÈÌÓ-ÚÓ Ì‡˜‡ÎÌÓ Î˜ÂÌËÂ Ò CBZ Ì ÒΉ‚‡ ‰‡ Ò ÔËÂχ ͇ÚÓ Á‡-‰˙ÎÊËÚÂÎÌÓ ÛÒÔ¯ÌÓ. êÂÁÛÎÚ‡ÚËÚ ÓÚ Ì‡¯ÂÚÓ ÔÓÛ˜-‚‡Ì ÔÓ͇Á‚‡Ú, ˜Â VPA Ëχ Á̇˜ËÏÓ Ô‰ËÏÒÚ‚Ó Ô‰CBZ ‚ ÌflÍÓË ‡ÒÔÂÍÚË ÓÚ Î˜ÂÌËÂÚÓ Ì‡ BECTS. Ñ‚‡Ú‡Ï‰Ë͇ÏÂÌÚ‡ Ì Ò ‡Á΢‡‚‡Ú ÔË ÔÓÒÚË„‡ÌÂÚÓ Ì‡ Ô˙-ÎÂÌ ÍÓÌÚÓΠ̇ ÔËÒÚ˙ÔËÚÂ: 55% ÔË CBZ ͇ÚÓ Ì‡˜‡ÎÌÓΘÂÌË ÒÔflÏÓ 58.8% Ò VPA. Ç˙ÔÂÍË ˜Â Ò‡ ̇·Î˛‰‡‚‡ÌË‚ ÓÚÌÓÒËÚÂÎÌÓ Ï‡Î˙Í ·ÓÈ ÒÎÛ˜‡Ë, ÎËÔÒ‚‡˘ ÂÙÂÍÚ Ë ‡„-‡‚‡ˆËfl ̇ ÔËÒÚ˙ÔËÚÂ, Ó·‡˜Â, Ò ̇·Î˛‰‡‚‡Ú Á̇˜ËÏÓÔÓ-˜ÂÒÚÓ Ò CBZ, ÓÚÍÓÎÍÓÚÓ Ò VPA.

èÓ‚ÎËfl‚‡ÌÂÚÓ Ì‡ Ô‡ÓÍÒËÁχÎ̇ڇ Ó·̉ӂ‡ ÖÖÉ-‡Í-ÚË‚ÌÓÒÚ Ô‰ÒÚ‡‚Îfl‚‡ ̇È-۷‰ËÚÂÎÌÓÚÓ Ô‰ËÏÒÚ‚Ó

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 135‰ÂÍÂÏ‚Ë, 2002

̇ VPA ‚ ΘÂÌËÂÚÓ Ì‡ BECTS. íÓÈ Â Á̇˜ËÏÓ ÔÓ-ÂÙÂÍÚË-‚ÂÌ, ÓÚÍÓÎÍÓÚÓ CBZ. íÂÁË ÂÁÛÎÚ‡ÚË Ò ‡Á΢‡‚‡Ú ÓÚ‰‡ÌÌËÚ ̇ Mitsudome et al. / 16 /, ÍÓËÚÓ Ì‡·Î˛‰‡‚‡Ú ÔÓ-ÎÓÊËÚÂÎÂÌ ÖÖÉ-ÂÙÂÍÚ Ì‡ VPA Ò‡ÏÓ ‚ 10% ÒÎÛ˜‡ËÚÂ, ÌÓÔÓ‰ÍÂÔflÚ ÒÚ‡ÌӂˢÂÚÓ ËÏ Á‡ ̉ÓÒÚ‡Ú˙˜ÌËfl ÂÙÂÍÚ̇ CBZ ‚˙ıÛ Ó·̉ӂ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ.

ë˜ËÚ‡ÏÂ, ˜Â ÖÖÉ-ÂÙÂÍÚ˙Ú Ì‡ VPA ÒÚÓË ‚ ÓÒÌÓ‚‡Ú‡Ì‡ ÓÚ΢ÌÓÚÓ ÔÓ‚ÎËfl‚‡Ì ̇ Ì‚ÓÔÒËıÓÎӄ˘ÌËÚ ÔÓ·-ÎÂÏË, ̇΢ÌË ‚ ıÓ‰‡ ̇ BECTS. ìÒÚ‡ÌÓ‚Â̇ڇ Ì χÎ͇

˜ÂÒÚÓÚ‡ ̇ Ú‡ÍË‚‡ ̇ۯÂÌËfl ‚ ̇¯ÂÚÓ ÔÓÛ˜‚‡Ì (‚ÓÍÓÎÓ 1/3 ÓÚ ÍÓÌÚËÌ„ÂÌÚ‡)  ÒıӉ̇ Ò Ô‰ÒÚ‡‚Â̇ڇ(28%) ‚ ÒÍÓÓ¯ÌÓ ÔÓÛ˜‚‡Ì / 15 / ‚˙ıÛ ÍÓ·ˆËflÚ‡ ËÏÒ ËÌÚÂËÍÚ‡Î̇ڇ ÖÖÉ-̇ıӉ͇. çË ÛÒÚ‡ÌÓ‚fl‚‡Ï ‡„-‡‚‡ˆËfl ̇ Â˜Â‚Ë ÔÓ·ÎÂÏË ‚ 2 ÓÚ 4 ÒÎÛ˜‡fl ÔË Î˜ÂÌË ÒCBZ, ͇ÚÓ Î‚ÓÒÚ‡Ì̇ڇ ë-í-‡·ÌÓÏÌÓÒÚ Ò „ËÒÚ-ˇ ÔÓ˜ÚË ÌÂÔÂÍ˙Ò̇ÚÓ ‚ ÖÖÉ. íÓ‚‡ ̇·Î˛‰ÂÌË ÔÓ‰Í-ÂÔfl ıËÔÓÚÂÁ‡Ú‡ Á‡ ÔÓ‚ÎËfl‚‡ÌÂÚÓ Ì‡ ÙÛÌ͈ËËÚ ̇ ÍÓÓ-‚ËÚÂ Â˜Â‚Ë ÁÓÌË ÓÚ Ó·̉ӂËÚ ‡Áfl‰Ë ‚ Ú‡ÁË Ó·Î‡ÒÚ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 136‰ÂÍÂÏ‚Ë, 2002

/ 4, 8, 25 /. èÓ‡‰Ë ÚÓ‚‡ ÔËÂχÏÂ, ˜Â ‚ ÒÎÛ˜‡Ë Ò ËÁ‡ÁÂÌËÌ‚ÓÔÒËıÓÎӄ˘ÌË ÔÓ·ÎÂÏË Ë ÓÒÓ·ÂÌÓ Ò ‰ËÒÎÂÍÒ˘ÌË Ë‰ËÁ‡Ú˘ÌË Ì‡Û¯ÂÌËfl ÔÓÚËÒ͇ÌÂÚÓ Ì‡ ‡·ÌÓÏ̇ڇÖÖÉ-‡ÍÚË‚ÌÓÒÚ Úfl·‚‡ ‰‡ ·˙‰Â Á‡‰˙ÎÊËÚÂÎ̇ ˆÂΠ̇ ÎÂ-˜ÂÌËÂÚÓ. Ç ÚÂÁË ÒÎÛ˜‡Ë CBZ ÏÓÊ ‰‡ Ì  ̇È-Û‰‡˜ÌËflÚωË͇ÏÂÌÚ, ÍÓÂÚÓ Ò ÔÓÍÂÔfl ÓÚ Ì‡¯ËÚ ÂÁÛÎÚ‡ÚË Á‡ÔÓ‰Ó·ÂÌË ‚ Ì‚ÓÔÒËıÓÎӄ˘ÌËÚ ÙÛÌ͈ËË Ò‡ÏÓ ÔË 3ÓÚ 12 ÒÎÛ˜‡fl, flÒÌÓ Ò‚˙Á‡ÌÓ Ò ÌÓχÎËÁˇÌÂÚÓ ‚ ÖÖÉ.чÌÌËÚ Á‡ ÂÙÂÍÚËÚ ̇ CBZ ÔË BECTS, χ͇ Ë ÔÓ-ÚË‚Ó˜˂Ë, ̇ÒÓ˜‚‡Ú Í˙Ï ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ‚ÌËχ-ÚÂÎÌÓÚÓ ÏÛ ÔËÎÓÊÂÌË ÔË Ú‡ÁË ÂÔËÎÂÔÚ˘̇ ÙÓχ.Seidel Ë Mitchell / 23 / ÓÔËÒ‚‡Ú Á‡ÒË΂‡Ì ̇ Ôӂ‰Â̘ÂÒÍËË ÍÓ„ÌËÚË‚ÌË Ì‡Û¯ÂÌËfl ÓÚ Ï‰Ë͇ÏÂÌÚ‡, ‰Ó͇ÚÓCorda Ë Ò˙‡‚Ú. / 5 / ÓÔËÒ‚‡Ú ÂÎÂÍÚÓ-ÍÎËÌ˘̇ ‡„‡‚‡ˆËflÒ‡ÏÓ ÔË Â‰ËÌ ÓÚ 40 Ô‡ˆËÂÌÚË Ò BECTS. 燯ËÚ ÂÁÛÎ-Ú‡ÚË Á‡ ‡ÍÚË‚‡ˆËfl ̇ Ó·̉ӂËÚ ‡Áfl‰Ë ÔË 22 ‰Âˆ‡(45.8%) Ò CBZ Ë Ì‡·Î˛‰‡‚‡ÌËÚ 2 ÒÎÛ˜‡fl (4.2%) Ò Ô‡ˆË-‡ÎÂÌ ÂÔËÎÂÔÚ˘ÂÌ ÒÚ‡ÚÛÒ Ò‡ ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ÔÓÒÓ˜‚‡-ÌËÚ ÓÚ ÏÌÓ„Ó ‡‚ÚÓË ÂÙÂÍÚË Ì‡ CBZ, Ò‚˙Á‡ÌË Ò ‡„‡-‚‡ˆËfl ËÎË ÔˆËÔËÚ‡ˆËfl ̇ ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË / 3,10, 17 /, ÓÒÓ·ÂÌÓ ‚ ‡ÏÍËÚ ̇ BECTS / 21, 22 /.

èË Ô‡ˆËÂÌÚË Ò Ì‚ÓÔÒËıÓÎӄ˘ÌË ÓÚÍÎÓÌÂÌËfl, ÎÂÍÛ-‚‡ÌË Ò VPA, ‚ 4 ÓÚ 6 ÒÎÛ˜‡fl ÚÓÈ Ëχ ÔÓÎÓÊËÚÂÎÌË ÂÙÂÍ-ÚË: ̇χÎfl‚‡Ì ̇ ÔËÒÚ˙Ô̇ڇ ˜ÂÒÚÓÚ‡, ÔÓ‰Ó·fl‚‡Ì ‚ÖÖÉ-̇ıӉ͇ڇ Ë ‚ ÓˆÂÌ͇ڇ ÔË ÔÒËıÓÎӄ˘ÌÓÚÓ ÚÂÒ-ÚÛ‚‡ÌÂ. ä‡ÍÚÓ ÔÓÒÓ˜‚‡Ú Legarda Ë Ò˙‡‚Ú. / 12 /, ÎËÚ‡-ÚÛÌËÚ ‰‡ÌÌË Á‡ ÍÓ„ÌËÚË‚ÌËÚÂ Ë Ôӂ‰Â̘ÂÒÍË ÂÙÂÍÚË̇ VPA ÔË ‰Âˆ‡ Ò ÂÔËÎÂÔÒËfl Ò‡ ÓÒÍ˙‰ÌË Ë Ì ÔÓÁ‚ÓÎfl‚‡ÚÁ‡Íβ˜ÂÌËfl, ÔÓ‡‰Ë ÍÓÂÚÓ Ò‡ ÌÂÓ·ıÓ‰ËÏË ÔÓ-̇ڇÚ˙¯ÌËÔÓÛ˜‚‡ÌËfl Á‡ ÔˆËÁˇÌ ̇ Ì‚ÓÔÒËıÓÎӄ˘ÌËÚ ÏÛÂÙÂÍÚË.

ç‡ ÔÓÒΉÌÓ, ÌÓ Ì χÎÓ‚‡ÊÌÓ ÏflÒÚÓ ÔÓÒÚ‡‚flÏ ‰‡Ì-ÌËÚ Á‡ ÔÂÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ΘÂÌËÂÚÓ ÔÓ‡‰Ë ÒÚ‡Ì˘-ÌË ÔÓfl‚Ë, ‡Á΢ÌË ÓÚ ‚ÎÓ¯‡‚‡ÌÂÚÓ ‚ ıÓ‰‡ ̇ ÂÔËÎÂÔÒË-flÚ‡. èË 4 ÓÚ Ó·˘Ó 52 ‰Âˆ‡ Ò CBZ (7.7%)  ̇·Î˛‰‡‚‡ÌχÒË‚ÂÌ Ó·Ë‚ ÔÂÁ Ô˙‚ËÚ ‰‚ Ò‰ÏËˆË ÒΉ ̇˜‡ÎÓÚÓ̇ ΘÂÌËÂÚÓ Ë ÚÓ Â ÒÔflÌÓ. çËÍÓ ÓÚ ‰Âˆ‡Ú‡ Ò VPA Ì ·ËÎÓ Ò ‰ÓÒÚ‡Ú˙˜ÌÓ ÒÂËÓÁÌË ÒÚ‡Ì˘ÌË ÔÓfl‚Ë, Á‡ ‰‡ ·˙-‰Â Ô‰ÔËÂÚÓ ÔÂÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ΘÂÌËÂÚÓ. à ÔÓ ÚÓ-ÁË ÔÓ͇Á‡ÚÂÎ VPA Ëχ ÔÂËÏÛ˘ÂÒÚ‚Ó Ô‰ CBZ ‚ ̇¯ËflÍÓÌÚËÌ„ÂÌÚ. íÂÁË ÂÁÛÎÚ‡ÚË Ò ‡Á΢‡‚‡Ú ÓÚ ‰‡ÌÌËÚ‚ ÔÓ‰Ó·ÌÓ ÔÓÛ˜‚‡ÌÂ, ‚ ÍÓÂÚÓ ‰‚‡Ú‡ ωË͇ÏÂÌÚ‡ËÏ‡Ú Â‰Ì‡Í‚‡ ˜ÂÒÚÓÚ‡ (4%) ̇ ÌÂÔËÂÏÎË‚Ë ÒÚ‡Ì˘ÌËÂÙÂÍÚË / 7 /.

Ç˙ÔÂÍË ˜Â ÓÎflÚ‡ ̇ VPA-ÏÓÌÓÚ‡ÔËflÚ‡ ÔË Ô‡-ˆË‡ÎÌË ÂÔËÎÂÔÚ˘ÌË ÙÓÏË Â ÛÚ‚˙‰Â̇ ÓÚ 80-Ú „Ó‰Ë-ÌË, Ëχ Ò‡ÏÓ ÌflÍÓÎÍÓ ÔÛ·ÎË͇ˆËË Á‡ Ì„ӂÓÚÓ ÏflÒÚÓ ‚ΘÂÌËÂÚÓ Ì‡ ‰ÂÚÒÍËÚ ˉËÓÔ‡Ú˘ÌË Ô‡ˆË‡ÎÌË ÂÔËÎÂÔ-ÒËË / 9, 24 /. чΘ ÒÏ ÓÚ Ú‚˙‰ÂÌËÂÚÓ, ˜Â ̇¯ËÚ Â-ÁÛÎÚ‡ÚË ‡ÁÍË‚‡Ú ÌÓ‚Ë Ú‡Ô‚Ú˘ÌË ÂÙÂÍÚË Ì‡ VPAÔË BECTS. éÚ˜ËÚ‡ÈÍË Ì‰ÓÒÚ‡Ú˙ˆËÚ ̇ ÚÓ‚‡ ÂÚ-ÓÒÔÂÍÚË‚ÌÓ ÔÓÛ˜‚‡ÌÂ, ÔËÂχÏÂ, ˜Â ‰‡ÌÌËÚ ҇ ‚ ÔÓÎÁ‡Ì‡ ÔËÎÓÊÂÌËÂÚÓ Ì‡ VPA ÔË BECTS, ÍÓ„‡ÚÓ ÒÚÂÏÂ-Ê˙Ú Â Í˙Ï "ÓÔÚËχÎÌÓ" ΘÂÌËÂ. íÓ Â ÏÌÓ„Ó ÎÂÒÌÓ ÓÒ˙-˘ÂÒÚ‚ËÏÓ Ò ÂÚ‡‰ÌËÚ ÙÓÏË Ì‡ VPA (Û Ì‡Ò: Depakinechrono‚), Ú˙È Í‡ÚÓ ‰‚Û͇ÚÌËflÚ ÔËÂÏ Ëχ ÌflÍÓÎÍÓÔ‰ËÏÒÚ‚‡, ÒÔˆˇÎÌÓ ÔË BECTS: ÏÓÊ ‰‡ ·˙‰Â ÓÒË„Û-fl‚‡Ì Ò‡ÏÓ ÓÚ Ó‰ËÚÂÎËÚÂ Ë ‰‡ Ì ÔÂ˜Ë Ì‡ Ó·Û˜ÂÌËÂÚÓ̇ ‰Âˆ‡Ú‡ (‡ Ú‡ÁË ÂÔËÎÂÔÒËfl Ò ̇·Î˛‰‡‚‡ ÓÒÌÓ‚ÌÓ ‚ Û˜Â-Ì˘ÂÒ͇ ‚˙Á‡ÒÚ); ÒÚ‡·ËÎÌÓÚÓ Ô·ÁÏÂÌÓ ÌË‚Ó ÓÒË„Ûfl‚‡Á‡˘ËÚ‡ ÓÚ ÔËÒÚ˙ÔË ‚˙‚ ‚Ò˘ÍË ÔÂËÓ‰Ë ÓÚ ‰ÂÌÓÌÓ˘ËÂ-ÚÓ, ‚Íβ˜ËÚÂÎÌÓ ÓÍÓÎÓ Á‡ÒÔË‚‡ÌÂÚÓ ËÎË Ò˙·Ûʉ‡ÌÂÚÓ,ÍÓ„‡ÚÓ Ó·̉ӂËÚ ÔËÒÚ˙ÔË Ò‡ ̇È-˜ÂÒÚË; ÚÓ Ì ÔÂ-‰ËÁ‚ËÍ‚‡ Ì„‡ÚË‚ÌË Ì‚ÓÔÒËıÓÎӄ˘ÌË ÒÚ‡Ì˘ÌË ÔÓfl-‚Ë, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ Á‡‰˙ηӘ‡Ú Ò˙˘ÂÒÚ‚Û‚‡˘Ë ̇ۯÂ-ÌËfl ‚ Ú‡ÁË ÒÙ‡. Ç Á‡Íβ˜ÂÌËÂ, ÂÁ‰ÛÎÚ‡ÚËÚ ÓÚ ÚÓ‚‡

ÔÓÛ˜‚‡Ì ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Ô˘Ë̇ Ë Ì‡ÒÓ͇ Á‡ ÔÓÒÔÂÍ-ÚË‚ÌË ÔÓÛ˜‚‡ÌËfl ‚˙ıÛ ÂÙÂÍÚ‡ ̇ VPA ÔË ‰ÂÚÒÍË Ô‡-ˆË‡ÎÌË ÂÔËÎÂÔÒËË, Ë ‚ ˜‡ÒÚÌÓÒÚ - ÔË BECTS, Ò ˆÂÎ ‚ÂË-ÙˈˇÌ Ô‰ËÏÒÚ‚‡Ú‡ ̇ ÚÓÁË ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚ ‚ ÎÂ-˜ÂÌËÂÚÓ Ì‡ ̇È-˜ÂÒÚ‡Ú‡ ‰ÂÚÒ͇ ÂÔËÎÂÔÒËfl, Í˙‰ÂÚÓ ·ËÏÓ„˙Î ‰‡  Ò‰ÒÚ‚Ó Ì‡ Ô˙‚Ë ËÁ·Ó.

ãàíÖêÄíìêÄ1. Ambrosetto, G., Tassinari, C.A.: Antiepileptic drug treatment of benignchildhood epilepsy with rolandic spikes: is it necessary? Epilepsia, 31, 1990,802-805.2. Baglietto, M.G., Battaglia, F.M., Nobili, L., et al: Neuropsychological disor-ders related to interictal epileptic discharges during sleep in benign epilepsy ofchildhood with centrotemporal or Rolandic spikes. Dev. Med. Child. Neuro.l,43(6), 2001, 407-412.3. Bauer, J.: Seizure-inducing effects of antiepileptic drugs: a review. Acta.Neurol. Scand., 94, 1996, 367-377.4. Carlsson, G., Ingelbrink-Schulze, N., Neubauer, B.A., Stephani, U.:Neuropsychological long-term outcome of rolandic EEG traits. Epileptic Disord.,2(Suppl 1), 2000, S63-S66.5. Corda, D., Gelisse, P., Genton, P., et al: Incidence of drug-induced aggrava-tion in benign epilepsy with centrotemporal spikes. Epilepsia, 42(6), 2001, 754-759.6. Dalla Bernardina, B., Sgro, V., Fejerman, N.: Epilepsy with centro-temporalspikes and related syndromes. In: Epileptic syndromes in infancy, childhood andadolescence, 3rd ed., eds. Roger, J., Bureau, M., Genton, P., Tassinari, C.A. &Wolf, P. London, John Libbey & Company Ltd., 2002, 181-202.7. de Silva, M., MacArdle, B., McGowan, M., et al: Randomized comparativemonotherapy trial of phenobarbitone, phenytoin, carbamazepine, or sodium val-proate for newly diagnosed childhood epilepsy. Lancet, 347(9003), 1996, 709-713.8. Deonna, T.: Rolandic epilepsy: neuropsychology of the active epilepsy phase.Epileptic Disord., 2(Suppl 1), 2000, S59-S61.9. Dulac, O., Steru, D., Rey, E., et al: Sodium valproate monotherapy in child-hood epilepsy. Brain. Dev., 8(1), 1986, 47-52.10. Genton, P.: When antiepileptic drugs aggravate epilepsy. Brain Dev, 22(2),2000, 75-80.11. Hirsch, E., de Saint-Martin, A., Arzimanoglou, A.: New insights into theclinical management of partial epilepsies. Epilepsia, 41(Suppl 5), 2000, S13-S17.12. Legarda, S.B., Booth, M.P., Fennell, E.B., et al: Altered cognitive function-ing in children with idiopathic epilepsy receiving valproate monotherapy. J. Child.Neurol., 11(4), 1996, 321-330.13. Lerman, P.: Seizures induced or aggravated by anticonvulsants. Epilepsia, 27,1986, 706-710.14. Loiseau, P., Duche, B., Cordova, S., et al: Prognosis of benign childhoodepilepsy with centrotemporal spikes: a follow up study of 168 patients. Epilepsia,29, 1988, 229-235.15. Massa, R., de Saint-Martin, A., Carcangiu, R., et al: EEG criteria of compli-cated evolution in idiopathic rolandic epilepsy. Neurology, 57(6), 2001, 1071-1079.16. Mitsudome, A., Ohfu, M., Yasumoto, S., et al: The effectiveness of clon-azepam on the Rolandic discharges. Brain. Dev., 19(4), 1997, 274-278.17. Perucca, E., Gram, L., Avanzini, G., Dulac, O.: Antiepileptic drugs as a causeof worsening seizures. Epilepsia, 39(1), 1998, 5-17.18. Peters, J.M., Camfield, C.S., Camfield, P.R.: Population study of benignrolandic epilepsy: is treatment needed? Neurology, 57(3), 2001, 537-539.19. Piccirilli, M., D'Alessandro, P., Sciarma, T., et al: Attention problems inepilepsy: possible significance of the epileptogenic focus. Epilepsia, 35, 1994,1091-1096.20. Piccirilli, M., D'Alessandro, P., Tiacci, C., Ferroni, A.: Language lateraliza-tion in children with benign partial epilepsy. Epilepsia, 29, 1988, 19-25.21. Prasad, A.N., Stefanelli, M., Nagarajan, L.: Seizure exacerbation and devel-opmental regression with carbamazepine. Can. J. Neurol. Sci., 25(4), 1998, 287-294.22. Prats, J.M., Garaizar, C., Garcia-Nieto, M.L., Madoz, P.: Antiepileptic drugsand atypical evolution of idiopathic partial epilepsy. Pediatr. Neurol., 18(5), 1998,402-406.23. Seidel, W.T., Mitchell, W.G.: Cognitive and behavioral effects of carba-mazepine in children: data from benign rolandic epilepsy. J. Child. Neurol., 14(11),1999, 716-723.24. Spiel, G., Feucht, M.: [Valproic acid monotherapy in epilepsies in childhoodand adolescence]. Padiatr. Padol., 22(3), 1987, 267-278.25. Staden, U.E., Isaacs, E., Boyd, S.G., et al: Language dysfunction in childrenwith Rolandic epilepsy. Neuropediatrics, 29, 1998, 242-248.26. Stephani, U.: Typical semiology of benign childhood epilepsy with cen-trotemporal spikes (BCECTS). Epileptic Disord., 2(Suppl 1), 2000, S3-S4.27. Weglage, J., Demsky, A., Pietsch, M., Kurlemann, G.: Neuropsychological,intellectual, and behavioral findings in patients with centrotemporal spikes withand without seizures. Dev. Med. Child. Neurol., 39, 1997, 646-651.28. Wirrell, E.C., Camfield, P.R., Gordon, K.E., et al: Benign rolandic epilepsy:atypical features are very common. J. Child. Neurol., 10(6), 1995, 455-458.29. Yung, A.W., Park, Y.D., Cohen, M.J., Garrison, T.N.: Cognitive and behav-ioral problems in children with centrotemporal spikes. Pediatr. Neurol., 23(5),2000, 391-395.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: Ñ- èÂÚfl ëÚ. ÑËÏÓ‚‡, ‰ÏÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇, ìëÅÄãçè "ë‚. ç‡ÛÏ"ìÎ. "ã. êÛÒ‚"‹1, 1113 ëÓÙËflíÂÎ: 70-40-05e-mail: pdimova@omega.bg

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 137‰ÂÍÂÏ‚Ë, 2002

SUMMARY

GABAPENTIN (NEURONTIN) AS ADD-ON THERAPYIN CHILDREN WITH REFRACTORY

PARTIAL SEIZURESA. Naydenov

Gabapentin (Neurotin) is a novel antiepileptic dug (AED)approved in the United States in 1993 as add-on therapy foradult and children with refractory partial epilepsy. The anti-convulsant mechanism is not entirely known. The efficacyand safety of Gabapentin (Neurotin) as add-on therapy forrefractory partial seizures in 15 children, aged 3-16 years wereevaluated over a 6-month period. All patients had partialseizures with or without secondary generalization. Childrenreceived Gabapentin (Neurotin) at 30 to 60 mg(kg) day (meandose, 44 mg (kg) daily). Six children (40 %) had a greatherthan 50 % decrease in seizure frequency and five children(33,3 %) had a 25 % to 50 % decrease in seizure frequency.Of the 15 children who received the medication for 6 months,two children (13,3 %) were seizure free. Simple partialseizures showed > 50 reduction in seizure frequency of 50 %,complex partial seizures 33,3 %, and secondary generalizedtonic-clonic seizures 37,5 %. Most common side effeetsincluded somnolence (13,3 %), dizziness (6,7 %), irritability(6,7 %), headache (6,7 %). This 6-month study has demon-strared that Gabapentin (Neurotin) was well tolerated andappeared to show a efficacy in a large population of childrenwith refractory partial and secondary generalized tonic-clonicseizures. A specific advantage with using Gabapentin(Neurotin) would appear to be its lack of significant interac-tion with other AED particularly in children receiving poly-therapy.Key words: partial epilepsy, Gabapentin (Neurotin), treatment, side effects

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(Neurontin)  ÌÓ‚Ó ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌÓ Ò‰ÒÚ‚Ó(èÖë), Ó‰Ó·ÂÌÓ ‚ ëÄô ÔÂÁ 1993 „., ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ ÚÂ-‡ÔËfl ÔË ‚˙Á‡ÒÚÌË Ë ‰Âˆ‡ Ò ÂÙ‡ÍÚÂ̇ Ô‡ˆË‡Î̇ÂÔËÎÂÔÒËfl. åÂı‡ÌËÁÏ˙Ú Ì‡ ‰ÂÈÒÚ‚Ë Ì  ̇Ô˙ÎÌÓ ËÁflÒ-ÌÂÌ. éˆÂÌÂÌ Â Ú‡Ô‚Ú˘ÌËflÚ ÂÙÂÍÚ Ë ·ÂÁÓÔ‡ÒÚÌÓÒÚ̇ Gabapentin (Neurontin), ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl Á‡ 6-ÏÂÒ˜ÂÌ ÔÂËÓ‰ ÔË 15 ‰Âˆ‡ ̇ ‚˙Á‡ÒÚ ÓÚ 3 ‰Ó 16 „Ó‰ËÌËÒ ÂÙ‡ÍÚÂÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË. ÇÒ˘ÍË Ô‡ˆËÂÌÚË Ò‡Ò Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ò ËÎË ·ÂÁ ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl.ш‡Ú‡ Ò‡ ÎÂÍÛ‚‡ÌË Ò Gabapentin (Neurontin) ‚ ‰ÓÁ‡ ÓÚ 30‰Ó 60 Ï„/Í„ ‰Ì‚ÌÓ (Ò‰̇ ‰ÓÁ‡ 44 Ï„/Í„ ‰Ì‚ÌÓ). 6 ‰Âˆ‡(40 %) ËÏ‡Ú Ì‡‰ 50 % ‰Û͈Ëfl ̇ ÔËÒÚ˙Ô̇ڇ ˜ÂÒÚÓ-Ú‡, ‡ 5 ‰Âˆ‡ (33,3 %) - ‰Û͈Ëfl ÓÚ 25 % ‰Ó 50 %. èÂÁ̇·Î˛‰‡‚‡ÌËfl ÔÂËÓ‰ Ô˙ÎÌÓ Ó‚Î‡‰fl‚‡Ì ̇ ÂÔËÎÂÔÚ˘ÌË-Ú ÔËÒÚ˙ÔË Â Ì‡Îˈ ÔË 2 ‰Âˆ‡ (13,3 %). 臈ˇÎÌËÚÂÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË Ò‡ Ò Â‰Û͈Ëfl ̇‰ 50 % ÔË ÔÓÎÓ-‚Ë̇ڇ ÓÚ ÒÎÛ˜‡ËÚÂ, ÍÓÏÔÎÂÍÒÌËÚ ԇˆË‡ÎÌË ÔËÒÚ˙ÔË- ÔË 33,3 % Ë ÇÉíäè - ÔË 37,5 %. ç‡È-˜ÂÒÚËÚ ÒÚ‡-Ì˘ÌË Â‡ÍˆËË Ò‡ Ò˙ÌÎË‚ÓÒÚ (13,3 %), Á‡Ï‡flÌÓÒÚ (6,7 %),

‡Á‰‡ÁÌËÚÂÎÌÓÒÚ (6,7 %), „·‚Ó·ÓÎË (6,7 %). ç‡ÒÚÓfl-˘ÂÚÓ 6-ÏÂÒ˜ÌÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡, ˜Â Gabapentin(Neurontin) Â Ò ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ Ë ÂÙË͇ÒÌÓÒÚ ÔË ÔÓ‚Â-˜ÂÚÓ ‰Âˆ‡ Ò Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ë ÇÉíäè. è‰ËÏÒÚ‚‡-Ú‡ ÔË ÛÔÓÚ·‡Ú‡ ̇ Gabapentin (Neurontin) Ò‡ Ò‚˙Á‡ÌËÒ ÎËÔÒ‡Ú‡ ̇ ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËÂ Ò ‰Û„ËÚ èÖë, „·‚ÌÓ Ôˉˆ‡, ÎÂÍÛ‚‡ÌË ˜ÂÁ ÔÓÎËÚ‡ÔËfl. äβ˜Ó‚Ë ‰ÛÏË: Ô‡ˆË‡Î̇ ÂÔËÎÂÔÒËfl, ç‚ÓÚËÌ, ΘÂ-ÌËÂ, ÒÚ‡Ì˘ÌË Â‡ÍˆËË

èË·ÎËÁËÚÂÎÌÓ 1 % ÓÚ ‰Âˆ‡Ú‡ ËÏ‡Ú ÂÔËÎÂÔÒËfl, ͇ÚÓÂÔËÎÂÔÚ˘ÌËÚ ÒË̉ÓÏË Á‡ÔÓ˜‚‡Ú ̇È-‚˜ ‚ Í˙χ˜ÂÒ-͇ ‚˙Á‡ÒÚ. èӂ˜ÂÚÓ ÓÚ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ‚‰ÂÚÒ͇ ‚˙Á‡ÒÚ Ò ÍÛÔË‡Ú ˜ÂÁ ËÁÔÓÎÁ‚‡Ì ̇ ‰ÌÓ ÔÓ-ÚË‚ÓÂÔËÎÂÔÚ˘ÌÓ Ò‰ÒÚ‚Ó (èÖë). Ç˙ÔÂÍË ÚÓ‚‡, ̇‰ 25% ÓÚ ‰Âˆ‡Ú‡ ÔÓ‰˙Îʇ‚‡Ú ‰‡ ÔÓÎÛ˜‡‚‡Ú ÂÔËÎÂÔÚ˘ÌËÔËÒÚ˙ÔË, ÍÓËÚÓ Ì ҇ ‰Ó·Â ӂ·‰flÌË, ËÎË Ò‡ ÔˉÛÊÂ-ÌË ÓÚ Á̇˜ËÏË ÒÚ‡Ì˘ÌË Â‡ÍˆËË. çÓ‚ËÚ èÖë ͇ÚÓvigabatrin, lamotrigine, gabapentin, topiramate Ò‡ ÂÙÂÍÚË‚-ÌË ‚ ΘÂÌËÂÚÓ Ì‡ ÂÙ‡ÍÚÂÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË ÔË‚˙Á‡ÒÚÌË Ë ‰Âˆ‡ (1, 4, 7, 13, 14, 17). Gabapentin(Neurontin)  1-(‡ÏËÌÓÏÂÚËÎ/ ˆËÍÎÓıÂÍ҇̇ˆÂÚ‡Ú̇ ÍË-ÒÂÎË̇)  ÌÓ‚ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚ. èËÂÚ Á‡ ΘÂÌË ̇ Ô‡-ˆË‡Î̇ ÂÔËÎÂÔÒËfl Ò ËÎË ·ÂÁ „Â̇ÎËÁ‡ˆËfl ‚ ëÄô ÔÂÁ1993 „., Ò ÌÂ„Ó ÔÓ̇ÒÚÓfl˘ÂÏ Ò ÎÂÍÛ‚‡Ú ‰‚‡ ÏËÎËÓ̇ Ô‡-ˆËÂÌÚË.

Gabapentin (Neurontin) Á‡Âχ ‚‡ÊÌÓ ÏflÒÚÓ Ò‰ ÌÓ‚Ë-Ú èÖë ÔÓ‡‰Ë ˉ‡Î̇ڇ ÏÛ Ù‡Ï‡ÍÓÍËÌÂÚË͇: ·˙Á‡‡·ÒÓ·ˆËfl (2-3 ˜‡Ò‡), Ì Ò ҂˙Á‚‡ Ò Ô·ÁÏÂÌËÚ ÔÓÚÂË-ÌË, Ì Òe ÏÂÚ‡·ÓÎËÁˇ ‚ ˜ÂÌËfl ‰Ó·, ÓÚ‰ÂÎfl Ò ÌÂÔÓ-ÏÂÌÂÌ ˜ÂÁ ÛË̇ڇ, Ì ‚Á‡ËÏÓ‰ÂÈÒÚ‚Û‚‡ Ò ‰Û„ËÚ èÖë,ÓÚ΢‡‚‡ ÒÂ Ò Ú‡Ô‚Ú˘ÂÌ Ë̉ÂÍÒ Ì‡‰ 10 (2, 5, 9, 15,16). åÂı‡ÌËÁÏ˙Ú Ì‡ ‰ÂÈÒÚ‚Ë ̇ Gabapentin (Neurontin)Ì  ‰Ó·Â ËÁflÒÌÂÌ: ÔÓÚÂ̈ˇ ËÌı˷ˈËflÚ‡ ̇ „‡Ï‡-‡ÏË-ÌÓχÒÎÂ̇ڇ ÍËÒÂÎË̇ (ÉÄåä), ‰ۈˇ ÒËÌÚÂÁ‡ ̇ „ÎÛ-ڇχÚ; ‚˙Á‰ÂÈÒÚ‚Û‚‡ ‚˙ıÛ Ì‚ÓÚ‡ÌÒÏËÚÂËÚÂ.

ç‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡Ì Ëχ Á‡ ˆÂÎ ‰‡ ÔÓÒÎÂ‰Ë ÂÙÂÍ-Ú‡ ̇ Gabapentin (Neurontin) ÔË ‰Âˆ‡ Ò ÂÙ‡ÍÚÂÌË Ô‡-ˆË‡ÎÌË ÔËÒÚ˙ÔË ‚ ÔÓ‰˙ÎÊÂÌË ̇ 6 ÏÂÒˆ‡.

äãàçàóÖç äéçíàçÉÖçí à åÖíéÑàå‰Ë͇ÏÂÌÚ˙Ú Gabapentin (Neurontin)  ÔËÎÓÊÂÌ ÔË

15 ‰Âˆ‡ (9 ÏÓϘÂÚ‡ Ë 6 ÏÓÏ˘ÂÚ‡) ̇ ‚˙Á‡ÒÚ ÓÚ 3 ‰Ó 16„. (Ò‰̇ ‚˙Á‡ÒÚ 7,8) ((Ú‡·Î. 1). 7 ‰Âˆ‡ (46,7 %) Ò‡ ÒÔÓÒÚË ËÎË ÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË, ‡ 8 (53,3 %)ËÏ‡Ú ‚ÚÓ˘ÌÓ-„Â̇ÎËÁˇÌË ÚÓÌ˘ÌÓ-ÍÎÓÌ˘ÌË ÔË-Ô‡‰˙ˆË (ÇÉíäè). ÇÒ˘ÍË ‰Âˆ‡ ÔÓÎÛ˜‡‚‡Ú ÂÊÂÒ‰Ï˘ÌË ËÂÊÂÏÂÒ˜ÌË ÔËÒÚ˙ÔË. èË ‚Ò˘ÍË ‰Âˆ‡  ÔÓ‚Âʉ‡Ì‡ ÔÓ-ÎËÚ‡ÔËfl Ò ‰‚‡ ËÎË Ôӂ˜ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚË. 燘‡ÎÓÚÓ̇ ÂÔËÎÂÔÒËflÚ‡  ‰Ó 3 „. ÔË 9 ‰Âˆ‡ (60 %), ‡ ‰Ó 7 „. - ÔË4 ‰Âˆ‡ (26,7 %). èË ÓÒڇ̇ÎËÚ 2 ‰Âˆ‡ (13,3 %) ̇ÒÚ˙Ô-‚‡ ‚ ÔÓ-Í˙Ò̇ ‚˙Á‡ÒÚ (7-14 „.). èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ÂÔËÎÂÔÒËflÚ‡  ̇‰ 5 „Ó‰ËÌË ÔË 7 ‰Âˆ‡ (46,7 %), ̇‰ 7 „Ó-‰ËÌË - ÔË 6 ‰Âˆ‡ (40 %) Ë Ì‡‰ 10 „Ó‰ËÌË - ÔË 2 ‰Âˆ‡ (13,3%). ÖÔËÎÂÔÒËflÚ‡  ÒËÏÔÚÓχÚ˘̇ ÔË 11 ‰Âˆ‡ (73,3 %):Ò˙ÒÚÓflÌË ÒΉ ÔÂË̇ڇÎ̇ ‡ÒÙËÍÒËfl - 8 ‰Âˆ‡, 6 ÓÚ ÍÓ-ËÚÓ Ò ıËÔÓÍÒ˘ÌÓ-ËÒıÂÏ˘̇ Â̈ÂÙ·ÔÓÚËfl, Ò˙ÒÚÓflÌËÂ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 138‰ÂÍÂÏ‚Ë, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË GABAPENTIN (NEURONTIN), äÄíé ÑéÅÄÇöóçÄ íÖêÄèàü èêà

ÑÖñÄ ë êÖîêÄäíÖêçà ÖèàãÖèíàóçà èÄêñàÄãçàèêàëíöèà

Ä. ç‡È‰ÂÌÓ‚ÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇, ìëÅÄã ÔÓ ‰ÂÚÒÍË ·ÓÎÂÒÚË - ëÓÙËfl

ÒΉ ˜ÂÂÔÌÓ ÏÓÁ˙˜Ì‡ Ú‡‚χ - 2 ‰Âˆ‡, Ò˙ÒÚÓflÌË ÒΉÏÓÁ˙˜ÂÌ ËÌÒÛÎÚ - 1 ‰ÂÚÂ. äËÔÚÓ„ÂÌ̇ ÂÔËÎÂÔÒËfl  ÛÒÚ‡-ÌÓ‚Â̇ ÔË 4 ‰Âˆ‡ (26,7 %). èË Ì‚ÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡-ÌÂ Ò ÌÓχÎÂÌ Ì‚ÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ Ò‡ 9 ‰Âˆ‡ (60 %), ˆÂÌ-Ú‡Î̇ Í‚‡‰ËÔ‡ÂÁ‡ Ò ̇·Î˛‰‡‚‡ ÔË 4 ‰Âˆ‡ (26,7 %), ‡ˆÂÌÚ‡Î̇ ıÂÏËÔ‡ÂÁ‡ - ÔË 2 ‰Âˆ‡ (13,3 %). ÖÖÉ ËÁÒΉ-‚‡ÌËfl Ò‡ Ôӂ‰ÂÌË ÔÂ‰Ë Î˜ÂÌËÂÚÓ Ò Gabapentin(Neurontin) Ë ‚ ͇fl ̇ ‚ÚÓËfl ÏÂÒˆ. ë äÄí Ë Ï‡„ÌËÚÌÓ-ÂÁÓ̇ÌÒ̇ ÚÓÏÓ„‡ÙËfl (åêí) ̇ „·‚ÌËfl ÏÓÁ˙Í Ò‡ ËÁÒ-Ή‚‡ÌË ‚Ò˘ÍË 15 ‰Âˆ‡. è‡ÚÓÎӄ˘ÌË ÔÓÏÂÌË Ò‡ ÛÒÚ‡ÌÓ-‚ÂÌË ÔË 7 ‰Âˆ‡ (46,7 %), ÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl - ÔË 4 (26,7%), ÏÛÎÚËÍËÒÚ˘̇ Â̈ÂÙ‡ÎÓχ·ˆËfl - ÔË 1 ‰ÂÚ (6,7%), ͇ΈËÙË͇ÚË - ÔË 1 ‰ÂÚ (6,7 %), ËÒıÂÏËfl ‚ ͇ÔÒÛ·ËÌÚÂ̇ - ÔË 1 ‰ÂÚ (6,7 %).

ã˜ÂÌËÂÚÓ Ò Gabapentin (Neurontin)  Ôӂ‰ÂÌÓ Í‡ÚÓ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl Í˙Ï Ô‰¯ÂÒÚ‚‡˘ÓÚÓ Î˜ÂÌËÂ Ò èÖë(Ú‡·Î. 2). èÓ ‚ÂÏ ̇ Ú‡ÔËflÚ‡ Ò Gabapentin  ÒÔflÌÓΘÂÌËÂÚÓ Ò Clonazepam ÔË 5 ‰Âˆ‡, Ò Topamax - ÔË 2 ‰Â-ˆ‡, Ò Lamotrigine - ÔË 1 ‰ÂÚÂ, Ò Carbamarepin - ÔË 1 ‰Â-ÚÂ.

ã˜ÂÌËÂÚÓ Ò Gabapentin (Neurontin)  ÔËÎÓÊÂÌÓ ÔË 15‰Âˆ‡ Ò ÂÙ‡ÍÚÂÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË ‚ ‰ÓÁ‡ ÓÚ 30 ‰Ó60 Ï„/‰Ì‚ÌÓ (Ò‰̇ ‰ÓÁ‡ 44 Ï„). àÁÔÓÎÁ‚‡ÌÓ Â ÒÚ˙Ô‡ÎÓ-‚ˉÌÓ ÚËÚˇÌ ‰Ó ÔÓ‰‰˙ʇ˘‡ ‰ÓÁ‡ 30 Ï„/Í„: Ô˙‚ˉÂÌ - 10 Ï„/Í„, ‚ÚÓË ‰ÂÌ - 20 Ï„/Í„ Ë ÚÂÚË ‰ÂÌ - 30Ï„/Í„. èÓ-̇ڇÚ˙Í ‰ÓÁ‡Ú‡  ۂÂ΢Â̇ ‰Ó 60 Ï„/Í„ ‚ Á‡‚Ë-ÒËÏÓÒÚ ÓÚ ÔÓÌÓÒËÏÓÒÚÚ‡ ̇ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚ‡ Ë ÍÎË-Ì˘ÌËfl ÓÚ„Ó‚Ó Ì‡ ‚ÒÂÍË Ô‡ˆËÂÌÚ.

êÖáìãíÄíàÇ ÔÓÛ˜‚‡ÌÂÚÓ Â ÓÚ˜ÂÚÂÌ ÏÌÓ„Ó ‰Ó·˙ ÍÎËÌ˘ÂÌ

ÂÙÂÍÚ Ì‡ Gabapentin (Neurontin) ÔË 8 ‰Âˆ‡ (53,3 %) Ò ÔÂ-ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ ÔË 2 ‰Âˆ‡ (13,3 %) Ë Ò Â-‰Û͈Ëfl ̇‰ 50 % ÔË 6 ‰Âˆ‡ (40 %). ÖÔËÎÂÔÚ˘ÌËÚ ÔËÒ-Ú˙ÔË Ò‡ Ò Â‰Û͈Ëfl ÓÚ 25 % ‰Ó 50 % ÔË 5 ‰Âˆ‡ (33,3 %),

͇ÚÓ ÎËÔÒ‡ ̇ Ú‡Ô‚Ú˘ÂÌ ÂÙÂÍÚ Â ÓÚ˜ÂÚÂÌ ÔË 2 ‰Â-ˆ‡ (13,3 %). í‡Ô‚Ú˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ Â ‡Á΢̇ÔË Ô‡ˆË‡ÎÌËÚ ÔËÒÚ˙ÔË: ÔÓÒÚËÚ ԇˆË‡ÎÌË ÔËÒ-Ú˙ÔË ÔÂÛÒÚ‡ÌÓ‚fl‚‡Ú ÔË 1/4 (25 %) Ë ÒÂ Â‰ÛˆË‡Ú Ì‡‰50 % ÔË 2/4 (50 %), Ò Â‰Û͈Ëfl ̇‰ 50 % Ò‡ 2/4 (50 %); Ò‰Û͈Ëfl ÔÓ‰ 50 % Ò‡ 1/4 (25 %); ÍÓÏÔÎÂÍÒÌËÚ ԇˆË‡Î-ÌË ÔËÒÚ˙ÔË Ò‡ Ò Â‰Û͈Ëfl ̇‰ 50 % ÔË 1/3 (33,3 %), Ò Â-‰Û͈Ëfl ÔÓ‰ 50 % - 1/3 (33,3 %) Ë ÎËÔÒ‡ ̇ ÂÙÂÍÚ - ÔË 1/3(33,3 %). ÇÉíäè ÒÔË‡Ú ÔË 1/8 (12,5 %), Ò Â‰Û͈Ëfl ̇‰50 % Ò‡ 3/8 (37,5 %), Ò Â‰Û͈Ëfl ÔÓ‰ 50 % Ò‡ 3/8 (37,5 %)Ë ·ÂÁ ÂÙÂÍÚ Ò‡ 1/8 (12,5 %).

èË Î˜ÂÌËÂ Ò Gabapentin (Neurontin) ‚ ‰ÓÁ‡ 40-60 Ï„/Í„ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ÒÔË‡Ú ÔË 2 ÓÚ Ó·˘Ó 12 ‰Âˆ‡(16,7 %), Â‰ÛˆË‡Ú Ò ̇‰ 50 % ÔË 5 ÓÚ 12 ‰Âˆ‡ (41,7%). èË Î˜ÂÌËÂ Ò ‰ÓÁ‡ 30-39,9 Ï„/Í„ Ò Â‰Û͈Ëfl ̇‰ 50 %Ò‡ 1 ÓÚ Ó·˘Ó 3 ‰Âˆ‡ (33,3 %) Ë ·ÂÁ ÍÎËÌ˘ÂÌ ÂÙÂÍÚ Ò‡ 2ÓÚ Ó·˘Ó 3 ‰Âˆ‡ (66,7 %) (Ú‡·Î. 3).

éÚ‰ÂÎÌÓ Â ÔÓÒΉÂÌ ÍÎËÌ˘ÌËflÚ ÂÙÂÍÚ Ò ÔÓÏÂÌËÚ‚ ÖÖÉ. èÂ‰Ë Î˜ÂÌËÂÚÓ Ò Gabapentin (Neurontin) 11 ‰Âˆ‡(73,7 %) ËÏ‡Ú ÖÖÉ ‰‡ÌÌË Á‡ ÙÓ͇Î̇ ‡·ÌÓÏÌÓÒÚ, ͇ÚÓÔË 6 ‰Âˆ‡ Ò ÙÓÏË‡Ú ‚ÚÓ˘ÌÓ „Â̇ÎËÁˇÌË ÍÓÏÔ-ÎÂÍÒË. ë „Â̇ÎËÁˇ̇ Ô‡ÓÍÒËÁχÎ̇ ‡ÍÚË‚ÌÓÒÚ Ò‡ 4‰Âˆ‡ (26,7 %). ëΉ ΘÂÌËÂÚÓ - ‚ ͇fl ̇ ‚ÚÓËfl ÏÂÒˆ -ÙÓ͇Î̇ڇ ‡·ÌÓÏÌÓÒÚ Ò ÔÓ‚ÎËfl‚‡ ÔË 9 ‰Âˆ‡ (81,8 %),͇ÚÓ ÔË 4 (36,7 %) Úfl Ò ‰ۈˇ, ‡ ÔË 5 ‰Âˆ‡ (45,5 %)ËÁ˜ÂÁ‚‡. ë ÌÂÔÓÏÂÌÂ̇ ÙÓ͇Î̇ ‡·ÌÓÏÌÓÒÚ ÓÒÚ‡‚‡Ú 2‰Âˆ‡ (18,2 %). ÉÂ̇ÎËÁˇ̇ڇ Ô‡ÓÍÒËÁχÎ̇ ‡ÍÚË‚-ÌÓÒÚ Ò ÔÓ‚ÎËfl‚‡ ÔË 2 ÓÚ Ó·˘Ó 4 ‰Âˆ‡ (50 %), ͇ÚÓ ÔË1 ‰ÂÚ Ò ‰ۈˇ, ‡ ÔË ‰Û„Ó 1 ‰ÂÚ ËÁ˜ÂÁ‚‡. èË ÓÒ-ڇ̇ÎËÚ 2 ‰Âˆ‡ (50 %) ÎËÔÒ‚‡ ÔÓ‚ÎËfl‚‡Ì ̇ „Â̇ÁËÎË-Áˇ̇ڇ ÂÔËÎÂÔÚ˘̇ ‡·ÌÓÏÌÓÒÚ. Ç Í‡fl ̇ 2-Ëfl ÏÂÒˆÒΉ ΘÂÌËÂÚÓ Ò Gabapentin (Neurontin) 7 ‰Âˆ‡ Ò‡ Ò ‰ËÙÛÁ-ÌË ËËÚ‡ÚË‚ÌË ÔÓÏÂÌË, ‡ 4 ‰Âˆ‡ ËÏ‡Ú ÌÓχÎ̇ ÖÖÉ.

èË 5 ‰Âˆ‡ (33,3 %) Ò ̇·Î˛‰‡‚‡Ú ÒΉÌËÚ ÒÚ‡Ì˘-ÌË Â‡ÍˆËË: Ò˙ÌÎË‚ÓÒÚ - 2 ‰Âˆ‡ (13,3 %), Á‡Ï‡flÌÓÒÚ - 1 ‰Â-Ú (6,7 %), ‡Á‰‡ÁÌËÚÂÎÌÓÒÚ - 1 ‰ÂÚ (6,7 %), „·‚Ó·Ó-ÎË - 1 ‰ÂÚ (6,7 %).

éÅëöÜÑÄçÖç‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡ ÏÌÓ„Ó ‰Ó·˙ ÍÎËÌË-

˜ÂÌ ÂÙÂÍÚ Ì‡ Gabapentin (Neurontin) ÔË Î˜ÂÌË ̇ ‰Âˆ‡ ÒÚ‡Ô‚Ú˘ÌÓ ÂÁËÒÚÂÌÚÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË: Ô˙ÎÌÓӂ·‰fl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ Ò ÔÓÒÚË„‡ ‚ 13,3 %, ‡ ‰ÛÍ-ˆËfl ̇ ˜ÂÒÚÓÚ‡Ú‡ ̇‰ 50 % - ÔË 40 % ÓÚ ÒÎÛ˜‡ËÚÂ. èÂÁ6-ÏÂÒ˜ÌËfl ÔÂËÓ‰ ̇ ΘÂÌËÂÚÓ Ì Ò ÛÒÚ‡ÌÓ‚fl‚‡ Û‚ÂÎË-˜‡‚‡Ì ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ËÎË ÔÓfl‚‡ ̇ ÌÓ‚Ë.èÓ‰Ó·ÌË Ò‡ Ë ‰‡ÌÌËÚ ̇ ‰Û„Ë ‡‚ÚÓË (2, 5, 9, 16). èË24-Ò‰Ï˘ÌÓ ÏÛÎÚˈÂÌÚÓ‚Ó ÓÚ‚ÓÂÌÓ ÔÓÛ˜‚‡ÌÂ, ÔÓ-‚‰ÂÌÓ ÔË 273 ‰Âˆ‡ Ò ÂÙ‡ÍÚÂ̇ Ô‡ˆË‡Î̇ ÂÔËÎÂÔÒËfl,R. Appleton et al. (2) ÛÒÚ‡ÌÓ‚fl‚‡Ú ‰Û͈Ëfl ̇‰ 50 % ÔË34 % ÓÚ ÒÎÛ˜‡ËÚÂ. èÓ‰Ó·ÌË ÂÁÛÎÚ‡ÚË Ò˙Ó·˘‡‚‡Ú D.Khurana et al. (10) ÔË Î˜ÂÌË ̇ 32 ‰Âˆ‡ Ò ÂÙ‡ÍÚÂ̇ԇˆË‡Î̇ ÂÔËÎÂÔÒËfl Ò Gabapentin (Neurontin) ‚ ‰ÓÁ‡ ÓÚ10 ‰Ó 50 Ï„/Í„ ‰Ì‚ÌÓ. ÖÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ÔÂÛÒ-Ú‡ÌÓ‚fl‚‡Ú ‚ 6,3 %, ‡ ‰Û͈Ëfl ̇‰ 50 % Ò ̇·Î˛‰‡‚‡ ‚

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 139‰ÂÍÂÏ‚Ë, 2002

퇷Î. 1. äÎËÌ˘̇ ı‡‡ÍÚÂËÒÚË͇ ̇ ‰Âˆ‡Ú‡ ÒÔ‡ˆË‡Î̇ ÂÔËÎÂÔÒËfl

äÎËÌ˘̇ ı‡‡ÍÚÂËÒÚË͇ n=15èÓÎ, n %ÏÓϘÂÚ‡ 9 (60)ÏÓÏ˘ÂÚ‡ 6 (40)Ç˙Á‡ÒÚ („Ó‰.)Ò‰̇ 7,8‚‡Ë‡Ì 3 - 16Ç˙Á‡ÒÚ ÔË Ì‡˜‡ÎÓÚÓ Ì‡ ÂÔËÎÂÔÒËflÚ‡ („Ó‰.)Ò‰̇ 3,5‚‡Ë‡Ì < 1 - 10,3èÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ÂÔËÎÂÔÒËflÚ‡ („Ó‰.)Ò‰̇ 6,4‚‡Ë‡Ì < 1 - 15,9

퇷Î. 3. äÎËÌ˘ÂÌ ÂÙÂÍÚ Ì‡ Gabapentin (Neurontin) ‚Á‡‚ËÒËÏÓÒÚ ÓÚ ‰ÓÁ‡Ú‡

Gabapentin ëÔˇÌ ̇ ê‰Û͈Ëfl ê‰Û͈Ëfl ÅÂÁ ÂÙÂÍÚ ÇÒ˘ÍÓ‰ÓÁ‡ Ï„/Í„ ÔËÒÚ˙ÔËÚ ̇‰ 50 % 25%-50%

n % n % n % n %

30 - 39,9 - - 1/3 33,3% - - 2/3 66,7% 340 - 49,9 1/5 20% 3/5 60,0 % 1/5 20% - - 550 - 60 1/7 14,3% 2/7 28,6 % 4/7 57,1 % - - 7

퇷Î. 2. ÄÌÚËÍÓÌ‚ÛÎÒ˂̇ Ú‡ÔËfl ÔÂ‰Ë ‚Íβ˜‚‡Ì ̇Gabapentin (Neurontin)

nValproat 4Valproat + Clonazepam 2Carbamazepin + Clonazepam 3Carbamazepin + Valproat 2Lamotrigine + Valproat 2Topamax + Valproat 2

34,4 %. äÓÌÚÓÎÌË ÔÓÛ˜‚‡ÌËfl ÛÒÚ‡ÌÓ‚fl‚‡Ú ÂÙÂÍÚË‚-ÌÓÒÚÚ‡ ̇ Gabapentin, ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl Ë ÏÓÌÓ-Ú‡ÔËfl ÔË ‚˙Á‡ÒÚÌË Ò ÂÙ‡ÍÚÂÌË Ô‡ˆË‡ÎÌË ÔËÒ-Ú˙ÔË Ò ËÎË ·ÂÁ ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl (5, 11, 15, 17). Ñ‚ÂÓÚ‚ÓÂÌË ÏÛÎÚˈÂÌÚÓ‚Ë ÔÓÛ˜‚‡ÌËfl ÔÓ͇Á‚‡Ú ·ÂÁÓÔ‡Ò-ÚÌÓÒÚÚ‡, ÔÓÌÓÒËÏÓÒÚÚ‡ Ë ÂÙË͇ÒÌÓÒÚÚ‡ ̇ Gabapentin(Neurontin), ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl ÔË ‚˙Á‡ÒÚÌË ÒÂÙ‡ÍÚÂÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË. Ä‚ÚÓËÚ ÛÒÚ‡ÌÓ‚fl-‚‡Ú ‚ 46 % ÒÔˇÌ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË Ë Â‰ÛÍ-ˆËfl ̇‰ 50 % ÓÚ 71 % ÔË 76 % ÓÚ ÒÎÛ˜‡ËÚÂ.

í‡Ô‚Ú˘̇ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ Gabapentin (Neurontin),͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl  ÛÒÚ‡ÌÓ‚Â̇ Ë ÔË ‰Âˆ‡ Ò ÂÙ-‡ÍÚÂ̇ Ô‡ˆ‡Î̇ ÂÔËÎÂÔÒËfl (2, 9, 10, 16).

Gabapentin (Neurontin) ̇Ïˇ ÔËÎÓÊÂÌËÂ Ë ÔË Î˜Â-ÌË ̇ ‰Ó·Ó͇˜ÂÒÚ‚Â̇ ÂÔËÎÂÔÒËfl Ò ˆÂÌÚÓ-ÚÂÏÔÓ‡ÎÌËÓÒÚËfl. V. Trudeau et al. (19) ÔË Î˜ÂÌË ̇ 60 ‰Âˆ‡ Ò êÓ-·̉ӂ‡ ÂÔËÎÂÔÒËfl ÔÓÒÚË„‡Ú ÍÓÌÚÓÎ ‚ 93 % ̇ ÂÔËÎÂÔ-Ú˘ÌËÚ ÔËÒÚ˙ÔË.

ìÒÚ‡ÌÓ‚Â̇  ÏÌÓ„Ó ‰Ó·‡ Ú‡Ô‚Ú˘̇ ÂÙÂÍÚË‚-ÌÓÒÚ Ì‡ Gabapentin (Neurontin) ÔË Î˜ÂÌË ̇ ÂÁËÒÚÂÌ-ÚÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË, ‰˙Îʇ˘Ë Ò ̇ ÏÓÁ˙˜ÌË ÚÛÏÓ-Ë, ÍÓËÚÓ Ì Ò ӂ·‰fl‚‡Ú Ò èÖë. J. Perry et al. (17) ÔÓÒ-ÚË„‡Ú ‚ 57 % ÍÛÔˇÌ ̇ Ú‡ÍË‚‡ ÂÙ‡ÍÚÂÌË ÔËÒÚ˙-ÔË ÔË Ô‡ˆËÂÌÚË Ò ÏÓÁ˙˜ÌË ÚÛÏÓË.

Ç Ì‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡Ì  ÔÓÚ˙ÒÂ̇ ‚˙Á͇ ÏÂʉÛÍÎËÌ˘ÌËfl ÂÙÂÍÚ Ì‡ Gabapentin (Neurontin) Ë ‡Á΢ÌËÚ‚ˉӂ ԇˆË‡ÎÌË ÔËÒÚ˙ÔË. è˙ÎÌÓ Ó‚Î‡‰fl‚‡Ì  ÔÓÒÚË„-̇ÚÓ ‚ 25 % ÔË ‰Âˆ‡Ú‡ Ò ÔÓÒÚË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ë‚ 12,5 % ÔË ‰Âˆ‡Ú‡ Ò ÇÉíäè. 燉 50 % ‰Û͈Ëfl ̇ÔËÒÚ˙Ô̇ڇ ˜ÂÒÚÓÚ‡ Ò ̇·Î˛‰‡‚‡ ‚ 50 % ÔË ‰Âˆ‡Ú‡Ò ÔÓÒÚË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË, ‚ 33,3 % - ÔË ‰Âˆ‡Ú‡ ÒÍÓÏÔÎÂÍÒÌË Ô‡ˆË‡ÎÌË ÔËÒÚ˙ÔË Ë ‚ 37,5 % - ÔË ‰Âˆ‡Ú‡Ò ÇÉíäè. 燯ËÚ ‰‡ÌÌË Ò‡ ·ÎËÁÍË ‰Ó ÚÂÁË Ì‡ ‰Û„Ë ‡‚-ÚÓË (2, 5, 9, 11, 20, 21). R. Appleton et al. (21) ÛÒÚ‡ÌÓ‚fl-‚‡Ú ÔË Î˜ÂÌË ̇ 237 ‰Âˆ‡ Ò ÂÙ‡ÍÚÂ̇ ÂÔËÎÂÔÒËflÒ‰ÌÓ Â‰ÛˆË‡Ì ̇ ÔÓÒÚËÚ ԇˆË‡ÎÌË ÔËÒÚ˙ÔË Ò53 %, ̇ ÍÓÏÔÎÂÍÒÌËÚ - Ò 38 % Ë Ì‡ ÇÉíäè - Ò 35 %.Ç Ì‡¯ÂÚÓ ÔÓÛ˜‚‡Ì  ÔÓÚ˙ÒÂ̇ ‚˙Á͇ ÏÂÊ‰Û ‰ÓÁ‡Ú‡Ì‡ Gabapentin (Neurontin) Ë Ú‡Ô‚Ú˘ÌËfl ÂÙÂÍÚ. ç‡È-·Î‡„ÓÔËflÚÂÌ ÂÙÂÍÚ Â ÛÒÚ‡ÌÓ‚ÂÌ ÔË Î˜ÂÌË ÒGabapentin (Neurontin) ‚ ‰ÓÁ‡ ÓÚ 40 ‰Ó 60 Ï„/Í„ ‰Ì‚ÌÓ.ÖÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ÒÔË‡Ú ‚ 16,7 %, ‡ ̇‰ 50 %‰Û͈Ëfl ̇ ÔËÒÚ˙Ô̇ڇ ˜ÂÒÚÓÚ‡ Ò ̇·Î˛‰‡‚‡ ‚ 41,7%. í‡Ô‚Ú˘ÂÌ ÂÙÂÍÚ Ì Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‚ 66,7 % ÔËΘÂÌËÂ Ò ‰ÓÁ‡ ÓÚ 30 ‰Ó 39,9 Ï„/Í„ ‰Ì‚ÌÓ.

ê‡Á΢ÌË ÔÓÛ˜‚‡ÌËfl ÓÚÍË‚‡Ú ÍÓ·ˆËfl ÏÂÊ‰Û ‰Ó-Á‡Ú‡ ̇ Gabapentin (Neurontin) Ë Ú‡Ô‚Ú˘̇ڇ ÏÛÂÙÂÍÚË‚ÌÓÒÚ (1, 5, 11, 18, 21). éÔÚËχÎ̇ڇ ‰ÓÁ‡ ̇Gabapentin (Neurontin) ÔË ‰Âˆ‡ ‚‡Ë‡ ÓÚ 30 ‰Ó ̇‰ 90Ï„/Í„ ‰Ì‚ÌÓ, ͇ÚÓ Ï‰Ë͇ÏÂÌÚ˙Ú Â ÂÙÂÍÚË‚ÂÌ ÔË ÔÓ-‚ËÒÓÍÓ ‰ÓÁˇÌ (2, 3, 9, 16, 19).

äÎË˙ÌÒ˙Ú Ì‡ Gabapentin (Neurontin)  ÔÓ-‚ËÒÓÍ Ôˉˆ‡, ‚ Ò‡‚ÌÂÌËÂ Ò ‚˙Á‡ÒÚÌË, ÔÓ‡‰Ë ÔÓ-‚ËÒÓÍËfl ͇-ÚËÌËÌÓ‚ ÍÎË˙ÌÒ, ‡ ÚÓ‚‡ ̇·„‡ ËÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ÔÓ-‚ËÒÓ-ÍË ‰ÓÁË. å‡ÍÒËχÎ̇ڇ ‰Ì‚̇ ‰ÓÁ‡ ̇ Gabapentin(Neurontin) ‚ ‰ÂÚÒ͇ ‚˙Á‡ÒÚ Ì  ÛÒÚ‡ÌÓ‚Â̇. àÁÔÓÎÁ‚‡-ÌÂÚÓ Ì‡ ‚ËÒÓÍË ‰ÓÁË Gabapentin (Neurontin) Á‡ ΘÂÌË ̇ÂÔËÎÂÔÒËfl Ì  „‡‡ÌˆËfl Á‡ ÛÒÔÂı, ÌÓ Ì‡‰ÂÍ‚‡ÚÌÓÚÓ ‰Ó-ÁˇÌ ̇ ‰‡‰ÂÌ ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚ Ò fl‚fl‚‡ ̇È-˜ÂÒÚ‡Ú‡Ô˘Ë̇ Á‡ ÌÂÛÒÔÂı.

èÓ ÓÚÌÓ¯ÂÌË ̇ ÒÚ‡Ì˘ÌËÚ ‡͈ËË ÔÂÁ ̇·Î˛‰‡-‚‡ÌËfl ÔÂËÓ‰ ÓÚÍË‚‡Ï ÒıÓ‰ÌË ‰‡ÌÌË ‚ ÎËÚ‡ÚÛ‡Ú‡(1, 2, 9, 10). ëÚ‡Ì˘ÌËÚ ‡͈ËË Ò ÔÓfl‚fl‚‡Ú ‚ Ô˙‚Ë-Ú 10 ‰ÌË ÒΉ Á‡ÔÓ˜‚‡Ì ̇ Ú‡ÔËflÚ‡, ÔÓ‰˙Îʇ‚‡Ú 14‰ÌË Ë Ì ̇·„‡Ú ÔÂÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ΘÂÌËÂÚÓ. óÂÒÚÓ-Ú‡Ú‡ ̇ ÒÚ‡Ì˘ÌËÚ ‡͈ËË ‚ ̇ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡Ì ÔÓ-ÌËÒ͇ ÓÚ Ú‡ÁË ÔË ‚˙Á‡ÒÚÌË, ÎÂÍÛ‚‡ÌË Ò Gabapentin

(Neurontin) (1, 15, 16, 20, 21). 燯ËÚ ‰‡ÌÌË Ò‡ ‚ ÔÓÚË-‚Әˠ̇ ÚÂÁË ÓÚ ÛÔÓÚ·‡Ú‡ ̇ Topiramate, Í˙‰ÂÚÓÒÚ‡Ì˘ÌËÚ ‡͈ËË Ò Ò¢‡Ú ̇‰ 50 % ÓÚ 49 ‰Âˆ‡(14) Ë 47 % ÓÚ 51 ‰Âˆ‡ (13). Gabapentin (Neurontin) ÌflχˉËÓÒËÌ͇Ú˘ÌË ËÎË ‰ÓÁ‡-Á‡‚ËÒËÏË ÒÚ‡Ì˘ÌË Â‡ÍˆËË,ÍÓËÚÓ Ò ̇·Î˛‰‡‚‡Ú ÔË ‰Û„Ë ÌÓ‚Ë èÖë, ̇ÔËÏÂÒÚÂÒÌÂÌË ̇ ÁËÚÂÎÌËÚ ÔÓÎÂÚ‡ ÔË Î˜ÂÌË ÒVigabatrin ËÎË ÒË̉ÓÏ Ì‡ Stevens-Johnson ÔË Ú‡ÔËfl ÒLamotrigine (7, 8). ãËÚ‡ÚÛÌËÚ ‰‡ÌÌË ÒÓ˜‡Ú, ˜Â ̇È-˜ÂÒÚËÚ ÒÚ‡Ì˘ÌË Â‡ÍˆËË ÔË Î˜ÂÌËÂ Ò Gabapentin(Neurontin) Ò‡: Ò˙Ì΂ÓÒÚ, ‡Á‰‡ÁÌËÚÂÎÌÓÒÚ, Á‡Ï‡flÌÓÒÚ,Ôӂ˯‡‚‡Ì ̇ Ú„ÎÓÚÓ. ë¢‡Ú Ò Ò˙˘Ó ڇ͇ ‡Ú‡ÍÒËfl,ÌËÒÚ‡„˙Ï, ÚÂÏÓ, ÓÚÓÍ Ì‡ ͇ÈÌˈËÚ (2, 3, 5, 6, 12,18). èË ‰Âˆ‡ ÔÓ‰12-„Ӊ˯̇ ‚˙Á‡ÒÚ Ò‡ ̇·Î˛‰‡‚‡ÌË ‡„-ÂÒË‚ÌÓÒÚ Ë ıËÔ‡ÍÚË‚ÌÓÒÚ Ò ˜ÂÒÚÓÚ‡ ÔÓ‰ 10 %, „·‚-ÌÓ ÔË ‰Âˆ‡ Ò Ô‰¯ÂÒÚ‚‡‚‡˘‡ ÛÏÒÚ‚Â̇ ËÁÓÒڇ̇ÎÓÒÚ(10, 16).

áÄäãûóÖçàÖÇ Ì‡ÒÚÓfl˘ÂÚÓ ÔÓÛ˜‚‡Ì  ÛÒÚ‡ÌÓ‚ÂÌ ÏÌÓ„Ó ‰Ó·˙

ÍÎËÌ˘ÂÌ ÂÙÂÍÚ ÔË Î˜ÂÌËÂ Ò Gabapentin (Neurontin) ̇15 ‰Âˆ‡ Ò ÂÙ‡ÍÚÂ̇ Ô‡ˆË‡Î̇ ÂÔËÎÂÔÒËfl Ò ËÎË ·ÂÁ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl. ÖÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ÒÔË-‡Ú ‚ 13,3 % Ë ÒÂ Â‰ÛˆË‡Ú Ì‡‰ 50 % ÔË 40 % ÓÚ ÒÎÛ-˜‡ËÚÂ. ÑÓ·˙ ÍÓÌÚÓÎ Â ÔÓÒÚË„Ì‡Ú ÔË ÔÓÒÚË, ÍÓÏÔ-ÎÂÍÒÌË Ë ‚ÚÓ˘ÌÓ-„Â̇ÎËÁˇÌË ÔËÔ‡‰˙ˆË. ìÒÔÓ‰ÌÓÒ ‰Ó·Ëfl Ú‡Ô‚Ú˘ÂÌ ÂÙÂÍÚ Ò ÛÒÚ‡ÌÓ‚fl‚‡ Ë ÔÓ‰Ó·fl-‚‡Ì ̇ ÙÓ͇Î̇ڇ ‡·ÌÓÏÌÓÒÚ Ë „Â̇ÁËÎËÁ‡‡Ì‡Ú‡ Ô‡-ÓÍÒËÁχÎ̇ ‡ÍÚË‚ÌÓÒÚ ‚ ÖÖÉ. èÓÛ˜‚‡ÌÂÚÓ ÔÓ͇Á‚‡, ˜Â‰ÓÁËÚ ̇ Gabapentin (Neurontin) ‰Ó 60 Ï„/Í„ ‰Ì‚ÌÓ Ò‡ÂÙË͇ÒÌË Ò ‰Ó·‡ ÔÓÌÓÒËÏÓÒÚ. óÂÒÚÓÚ‡Ú‡ ̇ ÒÚ‡Ì˘-ÌËÚ ‡͈ËË ÔÂÁ ̇·Î˛‰‡‚‡ÌËfl ÔÂËÓ‰  ÔÓ-ÌËÒ͇ ÓÚÚ‡ÁË ÔË ‚˙Á‡ÒÚÌË, ÎÂÍÛ‚‡ÌË Ò Gabapentin (Neurontin).ëÚ‡Ì˘ÌËÚ ‡͈ËË Ò Ò¢‡Ú ‚ Ô˙‚ËÚ 10 ‰ÌË ÓÚÁ‡ÔÓ˜‚‡Ì ̇ Ú‡ÔËflÚ‡ Ë Ì ̇·„‡Ú ÒÔˇÌ ̇ ‡ÌÚË-ÍÓÌ‚ÛÎÒ‡ÌÚ‡. èÓ‡‰Ë ͇ÚÍÓÚÓ ‚ÂÏ ̇ ÚËÚˇÌ (3‰ÌË), ÎËÔÒ‡Ú‡ ̇ ÎÂ͇ÒÚ‚ÂÌË ‚Á‡ËÏÓ‰ÂÈÒÚ‚Ëfl Ë ‰Ó·‡-Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ, Gabapentin (Neurontin)  ÔÓ‰ıÓ‰fl˘ÓÒ‰ÒÚ‚Ó Ì‡ ËÁ·Ó ͇ÚÓ ‰Ó·‡‚˙˜Ì‡ Ú‡ÔËfl Á‡ ΘÂÌË ̇ÂÙ‡ÍÚÂ̇ Ô‡ˆË‡Î̇ ÂÔËÎÂÔÒËfl ‚ ‰ÂÚÒ͇ڇ ‚˙Á‡ÒÚ.

ãàíÖêÄíìêÄ1. Anhut, H., Ashman P. et al. Gabapentin (Neurontin) as add-on therapy inpatients with partial seizures: a double-blind, placebo-conrolled study. Epilepsia,35, 1994, 795-8O1.2. Appleton, R., Fichtner K., Lamoreaux L. et al. Gabapentin as add-on therapyin children with refractory partial seizures: a 24-week, multicentre open-labelstudy. Developmental Medicine and Child Neurology, 43, 2OO1, 269-273.3. Bydoun, A. I., Fakhoury, Nasreddin Wets. Conversation to high dosegabapenrin monotherapy in patients with medically refractory partial epilepsy.Epilepsia, 39, 1998, 188-193.4. Brodie, M.J. Monostars: an aid to chosing an antiepileptic drug as monother-apy. Epilepsia, 4O (suppl. 6), 1999, S17-22.5. Bruni, J. Gabapentin as Adjuctive therapy for partial seizures. Epilepsia, 4O(suppl. 6), 1999, S27-S28.6. De Toledo, J.C., Toledo C. et al. Changes in body weight with chronic, high-dose gabapentin therapy. Ther Drug Monit. 19, 1997, 394-396.7. Eke, T., Talbot J.F., Lawdn M.C. Severe persistent visual field constrictionassociated with vigabatrin. British Medical Journal, 314, 1997, 18O-181.8. Guberman, A.H., Besag F.M., Brodie M.J. et al. Lamotrigine-associattedrash: risk/benefit considerations in adults and children. Epilepsia, 4O, 1999, 985-991.9. Holmes, G.L. Gabapentin for treatment of epilepsy in children. Seminars inPediatic Neurology, 4 (3), 1997, 244-25O.10. Khurana, D.S., Riviello J., Helmers S. et al. Efficacy of gabapentin therapyin children with refractory partial seizures. J. Pediatr., 128, 1996, 829-833.11. Leidermann, D.B. Gabapentin as add-on therapy for refractory partial epilep-sy: results of five placebo-controlled studies. Epilepsia, 33 (suppl. 5), 1994, S74-S76.12. Martinez, O.A., Vega M., Philbrook B. et al. Acute, chronic, and dose relatedside effects with gabapentin. Epilepsia, 36 (suppl. 4), 1995, S71.13. Mohamed, K., Appleton R.E., Rosenbloom L. Efficacy and tolerability oftopiramate in childhood and adolescent epilepsy: a guideline. Seizure, 9, 2000,137-141.14. Moreland, E.C., Griesemer D.A., Holden K.R. Topiramate for intractablechildhood epilepsy. Seizure, 8, 1999, 18-40.15. Morrell, M. Dosing to efficacy with Neurontin. The steps trial. Epilepsia, 40(suppl. 6), 1999, S23-S26.16. Pellock, J., Appleton R. Use of new antiepileptic drugs in the treatment of

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childhood epilepsy. Epilepsia, 40 (suppl. 6), 1999, S29-S38.17. Perry, J.R., Sawka C. Add-on gabapentin for refractory seizures in patientswith brain tumours. Can. J. Neurol. Sci. 23, 1996, 128-131.18. Pina-Garza, J.E., Bukhari A.A. et al. Treatment of patients with refractorypartial epilepsies with gabapentin: a retrospective analysis. Epilepsia, 36 (suppl.4), 1995, S69.19. Trudeau, V.L., Kilgore M.B., Poulter C.J. et al. A multicenter open-labelextension study of Gabapentin (Neurontin) monotherapy in pediatric patients withBECTS. Epilepsia, 37 (suppl. 5), 1996, 84.20. UK Gabapentin. Study Group. Gabapentin in partial epilepsy. Lancet, 335,1990, 1114-1117.21. US Gabapentin Study Group No 5. Gabapentin as add-on therapy in refracto-ry partial epilepsy: a double-blind, placebo-controlled, parallel-group study.Neurology, 43, 1993, 2292-2298.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- Ä̇ÚÓÎËÈ ç‡È‰ÂÌÓ‚, ‰Ïç‚ÓÎӄ˘̇ ÍÎËÌË͇ìëÅÄã ÔÓ ÑÂÚÒÍË ·ÓÎÂÒÚË·ÛÎ. "à‚. ɯӂ" 11, ëÓÙËflÚÂÎ. 952-38-40 /‚.271/

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 141‰ÂÍÂÏ‚Ë, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË áÄÇàëàåéëíà åÖÜÑì ïÖåéêÖéãéÉàóçàíÖ

èéäÄáÄíÖãà à ÄëàåÖíêààíÖ çÄ åéáöóçàü äêöÇÖçíéä èêà Åéãçà ë ÄëàåèíéåçÄ åéáöóçéëöÑéÇÄ

ÅéãÖëí, íêÄçáàíéêçà åéáöóçà àëïÖåàóçà ÄíÄäàà ÖÑçéëíêÄççà åéáöóçà àçîÄêäíà

à. ÇÂΘ‚‡, ë. ü̘‚‡, Ö. íËÚflÌÓ‚‡, Ç. èÂÚÛÌfl¯Â‚ ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl ÔË åì - ëÓÙËfl,

ëÔˆˇÎËÁˇ̇ ·ÓÎÌˈ‡ Á‡ ‡ÍÚË‚ÌÓ Î˜ÂÌË ÔÓ Ì‚ÓÎÓ„Ëfl ËÔÒËıˇÚËfl "ë‚.ç‡ÛÏ" ÖÄÑ

SUMMARY

CORRELATIONS BETWEEN THE HEMORHEOLOGI-CAL VARIABLES AND THE ASYMMETRIES OF THE

CEREBRAL BLOOD FLOW IN PATIENTS WITHASYMPTOMATIC CEREBROVASCULAR DISEASE,

TRANSIENT ISCHEMIC ATTACKS AND UNILATERALCEREBRAL INFARCTIONS

I.Velcheva, S.Yancheva, E.Titianova, V.PetruniashevThe aim of the study was to search relationship between

the blood viscosity parameters and the presence of interhemi-spheric asymmetries of the mean hemispheric blood flow/mHBF/ and the regional cerebral blood flow /rCBF/ inpatients with ischemic disorders of the cerebral circulation.

The study was carried out in 145 patients with ischemiccerebrovascular disease /CVD/ , 70 women and 75 men atmean age of 55,25 + 8,58 years.According to the type of theCVD the patients were distributed as follows: 53 with asymp-tomatic cerebrovascular disease /ACVD/, 44 with transientischemic attacks /TIAs/ and 48 with unilateral cerebral infarc-tions /UCI/. Additional relative distribution was made accord-ing to the presence of pathological asymmetries of the rCBFin each of the investigated symmetrical cerebral zone with for-mation of two subgroups: with pathological asymmetries andwithout pathological asymmetries.

The hemorheological investigation revealed predominantincrease of fibrinogen /FIB/ and plasma viscosity /PV/ and itis marked in the group with UCI.

A tendency for increase of PV in the patients with TIAsand UCI and pathological asymmetries was found; this eleva-tion of PV was significant for the whole group with CVD /p <0,05/.

The effect of FIB and PV on the CBF in the patients withACVD, TIAs and UCI increased in the separate subgroupswith and without pathological asymmetries; the correlationskept their direction and became more pronounced . In the sub-group with UCI without pathological asymmetries of CBFsignificant positive correlations between HT and rCBF for awide range of cerebral zones was delineated.

Along with the preserved tendency for significant positivecorrelations in ACVD and significant negative correlations inTIAs for HT, FIB and rCBF , in the subgroup with pathologi-cal asymmetries of CBF a number of significant negative cor-relations of PV with mHBF and rCBF in the patients with UCIwas observed.

The important role of PV to control the CBF was delineat-ed.

Confirming the importance of the pathological interhemi-spheric asymmetries of the CBF in patients with differenttypes of CVD , our study showed that this importance wouldincrease when elucidating the role not only of the hemorheo-logical factors but also of other related to these asymmetriesfactors.Key words: cerebral blood flow asymmetries, cerebrovascu-lar diseases, hemorheological factors

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ä‡ÚÓ ÔÓÚ‚˙ʉ‡‚‡ Á̇˜ÂÌËÂÚÓ Ì‡ Ô‡ÚÓÎӄ˘ÌËÚ ËÌ-ÚÂıÂÏËÒÙÂÌË ‡ÒËÏÂÚËË Ì‡ åäí ÔË ·ÓÎÌË Ò ‡Á΢ÌËÙÓÏË Ì‡ åëṦ¯ÂÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡, ˜Â ÚÓ‚‡ Á̇˜Â-ÌË ˘Â ̇‡ÒÚÌ ÔË ËÁflÒÌfl‚‡Ì ÓÎflÚ‡ Ì ҇ÏÓ Ì‡ ıÂÏÓ-ÂÓÎӄ˘ÌËÚÂ, ÌÓ Ë Ì‡ ‰Û„Ë Ò‚˙Á‡ÌË Ò ÚÂÁË ‡ÒËÏÂÚËËÙ‡ÍÚÓË.

äβ˜Ó‚Ë ‰ÛÏË: ‡ÒËÏÂÚËË Ì‡ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ, ÏÓ-Á˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, ıÂÏÓÂÓÎӄ˘ÌË Ù‡ÍÚÓË

àÁ‚ÂÒÚÌÓ Â,˜Â ËÁÒΉ‚‡ÌÂÚÓ Ì‡ „ËÓ̇ÎÌËfl ÏÓÁ˙˜ÂÌÍ˙‚ÂÌ ÚÓÍ /åäí/ Ò Â‰ÌÓÙÓÚÓÌ̇ ÂÏËÒËÓÌ̇ ÍÓÏÔ˛-Ú˙̇ ÚÓÏÓ„‡ÙËfl /SPECT/ Ëχ ‰Ë‡„ÌÓÒÚ˘̇ Ë ÔÓ„-ÌÓÒÚ˘̇ ÒÚÓÈÌÓÒÚ ÔË ·ÓÎÌË Ò Ú‡ÌÁËÚÓÌË ËÒıÂÏ˘-ÌË ‡Ú‡ÍË /íàÄ/ Ë Ò ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË /4, 5, 6/. èÓÏÂÌË-Ú ‚ åäí ÏÓÊ ‰‡ Ò ÓÔ‰ÂÎflÚ Ò ËÁ˜ËÒÎfl‚‡Ì ̇ ËÌ-ÚÂıÂÏËÒÙÂÌËÚ ‡ÒËÏÂÚËË ‚ ÒËÏÂÚ˘ÌË ÁÓÌË Ì‡ ‰‚Â-Ú ıÂÏËÒÙÂË /16/. èÓ ÚÓÁË Ì‡˜ËÌ Ò ËÁÏ‚‡Ì ̇ åäí,̇ ÔÓˆÂÌÚ‡ ̇ ‡ÒËÏÂÚËË Ë Ì‡ ‰Ë·ڇÚÓÌËfl ÓÚ„Ó‚Ó̇ ‡ˆÂÚ‡ÁÓ·Ïˉ ÔË 98% ÓÚ ËÁÒΉ‚‡ÌËÚ Ò˙Ò SPECT·ÓÎÌË Ò Ô˙‚Ë ÂÔËÁÓ‰ ̇ ÓÒÚË ÔÂıÓ‰ÌË ËÒıÂÏ˘ÌË ‡Ú‡-ÍË Ò‡ ÛÒÚ‡ÌÓ‚ÂÌË ‡·ÌÓÏÌË ÔÓÏÂÌË /10/. èÓ͇Á‡ÌÓ Â, ˜ÂSPECT ÏÓÊ ‰‡ ˉÂÌÚËÙˈˇ ·ÓÎÌËÚÂ Ò Ì‡È-„ÓÎflÏ ËÒÍÓÚ ÔÓÒ‰‚‡˘ ËÌÙ‡ÍÚ ÔÂÁ Ô˙‚‡Ú‡ Ò‰Ïˈ‡ ÒΉ ÔÂ-ÊË‚fl̇ڇ íàÄ /6/. ë ÔÓÏÓ˘Ú‡ ̇ Ë̉ÂÍÒ‡ ̇ ‡ÒËÏÂÚËfl̇ åäí  ÓÔ‰ÂÎfl̇ ÔÓ„ÌÓÒÚ˘̇ڇ ÒÚÓÈÌÓÒÚ Ì‡SPECT ÔË ·ÓÎÌË Ò ÓÍÎÛÁËË Ì‡ Ò‰̇ڇ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ ËÒıÂÏËflÚ‡ /8/.Ñˇ„ÌÓÒÚ˘̇ Ë ÔÓ„ÌÓÒÚ˘̇ ÒÚÓÈÌÓÒÚ ËÏ‡Ú Ë ÔÓÏÂ-ÌËÚ ‚ ÒÍÓÓÒÚÚ‡ ̇ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ ‚ ·‡Á‡ÎÌËÚÂÏÓÁ˙˜ÌË ‡ÚÂËË, ÓÔ‰ÂÎfl̇ Ò Ú‡ÌÒ͇ÌˇÎ̇ ‰ÓÔÎÂÓ-‚‡ ÒÓÌÓ„ÓÙËfl Ë ÓÒÓ·ÂÌÓ Ì‡ Ë̉ÂÍÒËÚ ̇ ËÌÚÂıÂÏËÒ-ÙÂ̇ ‡ÒËÏÂÚËfl ̇ ÒÍÓÓÒÚÌËÚ Ì‚ÓÒÓÌÓ„‡ÙÌË ÔÓ-͇Á‡ÚÂÎË ÔË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË Û ÌÓ‚ÓÓ‰ÂÌË /11/ Ë ÔË‚˙Á‡ÒÚÌË /3/.

Ö‰ËÌ ÓÚ Ù‡ÍÚÓËÚÂ,ÍÓËÚÓ ÔÓ‚ÎËfl‚‡Ú åäí  Í˙‚ÌË-flÚ ‚ËÒÍÓÁËÚÂÚ Ò Ì„ӂËÚ ‰ÂÚÂÏË̇ÌÚË: ıÂχÚÓÍËÚ/ïí/, ÙË·ËÌÓ„ÂÌ /îàÅ/, Ô·ÁÏÂÌ ‚ËÒÍÓÁËÚÂÚ /èÇ/,ÂËÚÓˆËÚ̇ Ë Î‚ÍÓˆËÚ̇ ‡„„‡·ËÎÌÓÒÚ Ë ‰ÂÙÓÏËÛ-ÂÏÓÒÚ. ìÒÚ‡ÌÓ‚ÂÌÓ Â ‚ÎËflÌËÂÚÓ ÓÒÌÓ‚ÌÓ Ì‡ ïí Ë èÇ ‚˙-ıÛ åäí ̇ Òڇ̇ڇ ̇ ËÒıÂÏ˘̇ڇ ÎÂÁËfl ,͇ÍÚÓ Ë ‚˙-ıÛ ÍÓ·Ú‡ÎÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌË /1,9,13/. èÓ-Ò··ÓÔÓÛ˜ÂÌ Â ÂÙÂÍÚ˙Ú Ì‡ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË‚˙ıÛ ‡ÒËÏÂÚËËÚ ̇ åäí.

ñÂÎÚ‡ ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ‰‡ Ò ÔÓÚ˙ÒË Á‡‚ËÒËÏÓÒÚÏÂÊ‰Û ÔÓ͇Á‡ÚÂÎËÚ ̇ Í˙‚ÌËfl ‚ËÒÍÓÁËÚÂÚ Ë Ì‡Î˘ËÂ-

ÚÓ Ì‡ ıÂÏËÒÙÂÌË ‡ÒËÏÂÚËË Ì‡ Ò‰ÌËfl /Òïäí/ Ë Â„ËÓ-̇ÎÌËfl ÏÓÁ˙˜ÂÌ Í˙‚ÂÌ ÚÓÍ /åäí/ ÔË ·ÓÎÌË Ò ËÒıÂÏ˘-ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ.

äéçíàçÉÖçí à åÖíéÑàäàèÓÛ˜‚‡ÌÂÚÓ Â Ôӂ‰ÂÌÓ ÔË 145 ·ÓÎÌË Ò ËÒıÂÏ˘̇

ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚ /åëÅ/, 70 ÊÂÌË Ë 75 Ï˙Ê ̇ Ò‰-̇ ‚˙Á‡ÒÚ 55,25+8,58 „Ó‰ËÌË. Ç Á‡‚ËÒËÏÓÒÚ ÓÚ ‚ˉ‡ ̇åëÅ ·ÓÎÌËÚ ҇ ‡ÁÔ‰ÂÎÂÌË Í‡ÍÚÓ ÒΉ‚‡: 53 Ò ‡ÒËÏÔ-ÚÓÏ̇ åëÅ /ÄåëÅ/, 44 Ò Ú‡ÌÁËÚÓÌË ÏÓÁ˙˜ÌË ËÒıÂ-Ï˘ÌË ‡Ú‡ÍË /íàÄ/ Ë 48 Ò Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡Í-ÚË /Öåà/.

èË ‚Ò˘ÍË ·ÓÎÌË Â Ôӂ‰ÂÌÓ ÍÎËÌ˘ÌÓ ËÁÒΉ‚‡Ì Ò˙ÒÒÓχÚ˘ÂÌ Ë Ì‚ÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ, ËÁÒΉ‚‡Ì ̇ Í˙‚̇Á‡ı‡ Ë ÎËÔˉÂÌ ÔÓÙËÎ, ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl ̇ χ„ËÒ-Ú‡ÎÌËÚ ‡ÚÂËË Ì‡ „·‚‡Ú‡ Ë ·‡Á‡ÎÌËÚ ÏÓÁ˙˜ÌË ‡-ÚÂËË, ÍÓÏÔ˛Ú˙̇ ÚÓÏÓ„‡ÙËfl ̇ „·‚ÌËfl ÏÓÁ˙Í. ïÂÏÓÂÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡Ì ‚Íβ˜‚‡ ÓÔ‰ÂÎflÌ ̇ïí, ÔÓ ˆÂÌÚÓÙÛÊÂÌ ÏÂÚÓ‰, ̇ èÇ ‚ mPa.s Ò Í‡ÔËÎflÂÌ‚ËÒÍÓÁËÏÂÚ˙ Ë Ì‡ îàÅ ‚ g/l ÔÓ ÍÓ‡„Û·ˆËÓÌÂÌ ÏÂÚÓ‰ ̇Clauss. êÂÁÛÎÚ‡ÚËÚ ÓÚ ıÂÏÓÂÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡ÌÂÒ‡ Ò‡‚ÌÂÌË Ò ÍÓÌÚÓÎ̇ „ÛÔ‡ ÓÚ 80 Á‰‚Ë Îˈ‡ ̇ ‚˙Á-‡ÒÚ 51,4+6,3 „Ó‰ËÌË.

ê„ËÓ̇ÌËflÚ ÏÓÁ˙˜ÂÌ Í˙‚ÂÌ ÚÓÍ Â ËÁÏ‚‡Ì Ò˙ÒSPECT /Tomomatic 32,Medimatic -чÌËfl/ Ò ËÌı‡ÎˇÌ ̇133 Xenon. ç‡ ÌË‚Ó éå+5 ˜ÂÁ ÒËÏÂÚ˘ÂÌ ‡Â‡ÎÂÌ ‡Ì‡-ÎËÁ Ò‡ ËÁ˜ËÒÎfl‚‡ÌË Ò‰ÌËÚ ÒÚÓÈÌÓÒÚË Ë Òڇ̉‡ÚÌËÚÂÓÚÍÎÓÌÂÌËfl ̇ Òïäí Ë åäí ‚ ml/100g/min ‚¸‚ ÙÓÌÚ‡Î-ÌËÚ /î/,ÙÓÌÚÓ-ÚÂÏÔÓ‡ÎÌËÚ /î-í/, ÚÂÏÔÓ‡ÎÌË-ÚÂ/í/, ÚÂÏÔÓÓ-Ó͈ËÔËÚ‡ÎÌËÚ /í-é/ ӷ·ÒÚË Ë Ú‡Î‡-ÏÛÒËÚÂ/í‡Î/. àÁ˜ËÒÎfl‚‡ÌË Ò‡ Ô‡ÚÓÎӄ˘ÌËÚ ‡ÒËÏÂÚËË̇‰ 10% ̇ Òïäí Ë åäí /Vorstrup S.,A.Lassen,1985/.

чÌÌËÚ ÓÚ ÔÓÛ˜‚‡ÌÂÚÓ Ò‡ Ó·‡·ÓÚÂÌË ÒÚ‡ÚËÒÚË-˜ÂÒÍË Ò ‚‡Ë‡ˆËÓÌÂÌ Ë ÍÓ·ˆËÓÌÂÌ ‡Ì‡ÎËÁË.

êÖáìãíÄíàïÂÏÓÂÓÎӄ˘ÌÓÚÓ ËÁÒΉ‚‡Ì ‡ÁÍË‚‡ Á̇˜ËÏÓ ÔÓ‚Ë-

¯ÂÌË ̇ èÇ Ë îàÅ ÔË ‚Ò˘ÍË „ÛÔË ·ÓÎÌË Ò åëÅ ‚Ò‡‚ÌÂÌËÂ Ò ÍÓÌÚÓÎËÚÂ; Á‡ ïí Ôӂ˯ÂÌËÂÚÓ Â Á̇˜ËÏÓÒ‡ÏÓ ‚ „ÛÔËÚÂ Ò ÄåëÅ Ë Öåà /Ú‡·Îˈ‡ 1/.

Ç˙ÔÂÍË ˜Â Òïäí ‚ Îfl‚‡ Ë ‰flÒ̇ ıÂÏËÒÙ‡ ÓÒÚ‡‚‡ ‚ÌÓχÎÌË „‡ÌËˆË /Ú‡·Î.2/, ÔË ËÁÒΉ‚‡ÌËÚ ·ÓÎÌË ÒÄåëÅ Ë íàÄ Â Ì‡Û¯ÂÌÓ ÌÓχÎÌÓÚÓ ‡ÁÔ‰ÂÎÂÌË ̇åäí. Ç „ÛÔ‡Ú‡ Ò ÄåëÅ Ò ̇·Î˛‰‡‚‡ ÒÌËÊÂÌË ̇åäí, ÍÓÂÚÓ Â Ì‡È-ÔÓ‰˜ÂÚ‡ÌÓ ‚˙‚ î,î-í Ë í ÁÓÌË. èË·ÓÎÌËÚÂ Ò íàÄ ÒÌËÊÂÌËÂÚÓ Ì‡ åäí ÔÂӷ·‰‡‚‡ ‚ í Ëí-é ӷ·ÒÚË. á̇˜ËÏÓ ÔÓ-ÌËÒ˙Í /<0,01/  Òïäí ̇ ËÌ-Ù‡ÍÚ̇ڇ ıÂÏËÒÙ‡ ‚ Ò‡‚ÌÂÌËÂ Ò ÔÓÚË‚ÓÔÓÎÓÊ̇ڇÔË ·ÓÎÌËÚÂ Ò Öåà. ÑËÙÛÁÌÓ Â ÒÌËÊÂÌ åäí, ͇ÚÓ Â-‰Û͈ËflÚ‡ ıÓÏÓ·Ú‡ÎÌÓ Ì‡ ËÌÙ‡ÍÚ‡  Á̇˜Ëχ Á‡ ÚÂÏ-ÔÓ‡ÎÌËfl ‰flÎ /<0,01/, Á‡ î-í ÁÓ̇ Ë Á‡ ڇ·ÏÛÒËÚÂ/p<0,05/.

è‡ÚÓÎӄ˘ÌËÚ ‡ÒËÏÂÚËË Ì‡ åäí ÔÂӷ·‰‡‚‡Ú ‚í,î-í Ë í-é ÁÓÌË ÔË ·ÓÎÌËÚÂ Ò ÄåëÅ Ë Öåà Ë ‚˙‚ î-íË í ÁÓÌË ÔË íàÄ /Ú‡·Î.3/.

èË Ò‡‚Ìfl‚‡Ì ̇ Ò‰ÌËÚ ÒÚÓÈÌÓÒÚË Ì‡ ıÂÏÓÂÓÎÓ-„˘ÌËÚ ÔÓ͇Á‡ÚÂÎË ‚ ÔÓ‰„ÛÔËÚÂ Ò ËÎË ·ÂÁ Ô‡ÚÓÎӄ˘ÌˇÒËÏÂÚËË ÔË ·ÓÎÌËÚÂ Ò Ò ÄåëÅ, íàÄ Ë Öåà Ì Ò ÛÒ-Ú‡ÌÓ‚fl‚‡Ú Ò˙˘ÂÒÚ‚ÂÌË ‡ÁÎËÍË. é˜ÂÚ‡‚‡ Ò ӷ‡˜ÂÚẨÂ̈Ëfl Á‡ Ôӂ˯ÂÌË ̇ èÇ ÔË ·ÓÎÌËÚÂ Ò íàÄ Ë ÒÖåà,ÔË ÍÓËÚÓ Ëχ Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚËË.ᇠˆfl·ڇ„ÛÔ‡ ·ÓÎÌË Ò åëÅ èÇ Â Á̇˜ËÏÓ Ôӂ˯ÂÌ/p<0,05/ ÔË·ÓÎÌËÚÂ Ò Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚËË Ì‡ Òïäí.

èӂ‰ÂÌËflÚ ÍÓ·ˆËÓÌÂÌ ‡Ì‡ÎËÁ Ì ‡ÁÍË‚‡ Á̇˜Ë-ÏË Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ËÁÒΉ‚‡ÌËÚ ıÂÏÓÂÓÎӄ˘ÌËÔÓ͇Á‡ÚÂÎË Ë Òïäí Ë ‚ ÚËÚ „ÛÔË Ò åëÅ. ç‡ÏÂÂÌËÚÂÔÓÎÓÊËÚÂÎÌË ÍÓ·ˆËË ÏÂÊ‰Û ïí Ë åäí ÔË ·ÓÎÌËÚÂ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 142‰ÂÍÂÏ‚Ë, 2002

Ò ÄåëÅ Ò‡ Á̇˜ËÏË Á‡ î-í ӷ·ÒÚ Ë í‡Î ‚ ‰flÒÌÓ. á̇˜Ë-ÏË ÔÓÎÓÊËÚÂÎÌË Ò‡ Ë Á‡‚ËÒËÏÓÒÚËÚ ̇ îàÅ Ë åäí ‚Îfl‚Ó Ë ‰flÒÌÓ Ó͈ËÔËÚ‡ÎÌÓ /Ú‡·Î.4/.

èË ·ÓÎÌËÚÂ Ò íàÄ Ò ̇·Î˛‰‡‚‡ ÒÌËÊÂÌË ̇ åäíÔË Ôӂ˯ÂÌË ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË.ìÒÚ‡-ÌÓ‚fl‚‡Ú Ò ӷ‡ÚÌË Á‚ËÒËÏÓÒÚË ÏÂÊ‰Û îàÅ Ë åäí‚˙‚ î-í ӷ·ÒÚ Ë ‚ ‰ÂÒÌËfl ڇ·ÏÛÒ, ͇ÍÚÓ Ë ÏÂÊ‰Û èÇË åäí ‚ ΂Ëfl ڇ·ÏÛÒ/r=-0,31,p<0,05/.

ç‡Îˈ ҇ ÔÓÎÓÊËÚÂÎÌË ‚˙ÁıÓ‰fl˘Ë Á‡‚ËÒËÏÓÒÚË ÏÂÊ-‰Û ïí Ë åäí ‚ ÔÓÚË‚ÓÔÓÎÓÊ̇ڇ ̇ ÏÓÁ˙˜ÌËfl ËÌ-Ù‡ÍÚ ıÂÏËÒÙ‡ ÔË ·ÓÎÌËÚÂ Ò Öåà, ͇ÚÓ Â„ÂÒËÓÌ-ÌËÚ ÍÓÂÙˈËÂÌÚË Ò‡ Á̇˜ËÏË Á‡ î,î-í,í Ë í-é ӷ·ÒÚË/Ú‡·Î.4/.

èÓÒΉfl‚‡ÌÂÚÓ Ì‡ Á‡‚ËÒËÏÓÒÚËÚ ÏÂÊ‰Û ıÂÏÓÂÓ-Îӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË Ë ‡·ÒÓβÚÌËÚ ÒÚÓÈÌÓÒÚË Ì‡‡ÒËÏÂÚËËÚ ̇ Òïäí Ë åäí ÔÓ͇Á‚‡ ‡ÁÌÓÔÓÒÓ˜ÌË Â-ÁÛÎÚ‡ÚË.èӂ˯ÂÌËÂÚÓ Ì‡ ÒÚÓÈÌÓÒÚËÚ ̇ îàÅ Â Ò‚˙-Á‡ÌÓ Ò Ôӂ˯ÂÌË ̇ ‡ÒËÏÂÚËËÚ ̇Òïäí/r=0,31,p<0,05/ Ë ÒÌËÊÂÌË ̇ ‡ÒËÏÂÚËËÚ ̇åäí ‚ ڇ·ÏÛÒËÚÂ/r=-0,36,p<0,05/. Ç „ÛÔ‡Ú‡ Ò Öåà‰ËÌÒÚ‚‡ÌÂÚ‡ Á̇˜Ëχ ÍÓ·ˆËfl ÓÚ‡Áfl‚‡ ÔÓ-‚ËÒÓÍËÒÚÓÈÌÓÒÚË Ì‡ ‡ÒËÏÂÚËËÚ ̇ åäí ‚˙‚ î ӷ·ÒÚ ÔËÔӂ˯ÂÌË ̇ ïí/r=0,31,p<0,05/.

ÖÙÂÍÚ˙Ú Ì‡ îàÅ Ë èÇ ‚˙ıÛ åäí ̇‡ÒÚ‚‡ ‚ ÓÚ‰ÂÎ-ÌËÚ ÔÓ‰„ÛÔË Ò ËÎË ·ÂÁ Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚËË,͇ÚÓÁ‡‚ËÒËÏÓÒÚËÚ Á‡Ô‡Á‚‡Ú Ò‚Ófl ÁÌ‡Í Ë ÒÚ‡‚‡Ú ÔÓ-ÓÚ˜ÂÚ-ÎË‚Ë.

èË ·ÓÎÌËÚ ·ÂÁ Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚËË Ì‡ åäí ÔÂ-ÒËÒÚË‡Ú Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌË Á‡‚ËÒËÏÓÒÚË Ì‡ îàÅ Òåäí,ÍÓËÚÓ Á‡ ·ÓÎÌËÚÂ Ò ÄåëÅ Ò‡ Á̇˜ËÏË Ò åäí ‚˙‚î ӷ·ÒÚ Ë ‚ í‡Î ‚ Îfl‚Ó.èÓ‰Ó·ÌË Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌËÍÓ·ˆËË Ò ̇·Î˛‰‡‚‡Ú Ë Á‡ èÇ Ë åäí ‚ ‰‚ÂÚ é Ó·-·ÒÚË. ᇠ·ÓÎÌËÚÂ Ò íàÄ Á‡‚ËÒËÏÓÒÚËÚ ̇ îàÅ Ë èÇÒ‡ Á̇˜ËÏË ÓÚˈ‡ÚÂÎÌË. Ç ÔÓ‰„ÛÔ‡Ú‡ ·ÂÁ Ô‡ÚÓÎӄ˘ÌˇÒËÏÂÚËË Ì‡ åäí Ò ÓÚÍÓfl‚‡Ú Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌËÍÓ·ˆËË ÏÂÊ‰Û ïí Ë åäí Á‡ „ÓÎflÏ ‰Ë‡Ô‡ÁÓÌ ÏÓÁ˙˜ÌËÁÓÌË /Ú‡·Î.5/.

éÒ‚ÂÌ Á‡Ô‡ÁÂ̇ڇ ÚẨÂ̈Ëfl ̇ Á̇˜ËÏË ÔÓÎÓÊËÚÂÎÌËÔË ÄåëÅ Ë Á̇˜ËÏË ÓÚˈ‡ÚÂÎÌË ÔË íàÄ ÍÓ·ˆËË̇ ïí Ë îàÅ ‚ ÔÓ‰„ÛÔ‡Ú‡ Ò Ì‡Î˘Ë ̇ Ô‡ÚÓÎӄ˘ÌË ‡ÒË-ÏÂÚËË Ì‡ åäí Ò ̇·Î˛‰‡‚‡ ÔÓ‰ˈ‡ ÓÚ Á̇˜ËÏË ÖåàË ÓÚˈ‡ÚÂÎÌË ÍÓ·ˆËË Ì‡ èÇ Ò˙Ò Òïäí Ë åäí/Ú‡·Î. 6/.

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‚ÎËflÌËÂÚÓ Ì‡ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË ‚˙ıÛ ‡·-ÌÓÏÌËÚ ÔÓÏÂÌË Ì‡ åäí ÔË ·ÓÎÌË Ò ‡Á΢ÌË ÙÓÏË̇ åëÅ : ‡ÒËÏÔÚÓÏ̇, íàÄ, Öåà /1,7/. ç‡ÏÂÂÌËÚ Á̇-˜ËÏË Á‡‚ËÒËÏÓÒÚË ÏÂÊ‰Û ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎËË åäí Ò ÓÚ̇ÒflÚ Á‡ ÏÓÁ˙˜ÌËÚ ÁÓÌË Ò Ì‡È-„ÓÎflÏÓ ÒÌË-ÊÂÌË ̇ åäí Ë Ì‡È-„ÓÎflχ ˜ÂÒÚÓÚ‡ ̇ Ô‡ÚÓÎӄ˘ÌËÚ‡ÒËÏÂÚËË.èÓ‰Ó·ÌÓ Ì‡ ‰Û„Ë Ì‡¯Ë ÔÓÛ˜‚‡ÌËfl /1/ ‚ „Û-Ô‡Ú‡ Ò ÄåëÅ Ú ËÏ‡Ú ÔÓÎÓÊËÚÂÎÂÌ ÁÌ‡Í Ë ÓÚ‡Áfl‚‡ÚÍÓÏÔÂÌÒ‡ÚÓ̇ ‚‡ÁÓÏÓÚÓ̇ ̇„·҇ Í˙Ï ÔÓÏÂÌËÚ ̇ïí, îàÅ Ë èÇ Ò ÛÒÍÓfl‚‡Ì ̇ åäí ÔË Ôӂ˯ÂÌËÒÚÓÈÌÓÒÚË Ì‡ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ͇Á‡ÚÂÎË.èÓ‰Ó·ÌË Ò‡ÍÓ·ˆËËÚ ̇ ïí Ò åäí „ÛÔ‡ Ò Öåà Ë ÓÒÓ·ÂÌÓ ÔË·ÓÎÌËÚ ·ÂÁ Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚËË Ì‡ åäí. ë˙˘ËÚÂÁ‡‚ËÒËÏÓÒÚË Ò‡ ̇·Î˛‰‡‚‡ÌË ÔË ·ÓÎÌË Ò Öåà Ë Ò ÌÓ-χÎÌË ÒÚÓÈÌÓÒÚË Ì‡ ‡Ú¡ÎÌÓÚÓ Ì‡Îfl„‡Ì /2/.

ᇠ‡ÁÎË͇ ÓÚ ÄåëÅ ÔË ·ÓÎÌËÚÂ Ò íàÄ Ò ̇·Î˛‰‡-‚‡ ‰ËÂÍÚÂÌ ÓÚˈ‡ÚÂÎÂÌ ÂÙÂÍÚ Ì‡ ıÂÏÓÂÓÎӄ˘ÌËÚÂÔÓ͇Á‡ÚÂÎË ‚˙ıÛ åäí,ÍÓÈÚÓ Ì Á‡‚ËÒË ÓÚ Ì‡Î˘ËÂÚÓËÎË ÓÚÒ˙ÒÚ‚ËÂÚÓ Ì‡ Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚËË Ì‡ åäí.èË ÚÂÁË ·ÓÎÌË ‚ ÛÒÎÓ‚ËflÚ‡ ̇ ̇ۯÂ̇, ÌÓ ‚Ò Ӣ ÓÚ-ÌÓÒËÚÂÎÌÓ Á‡Ô‡ÁÂ̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ÏÓÁ˙˜ÌËÚ Ò˙‰Ó‚Â

Ò Á‡ÒË΂‡Ú ‚Á‡ËÏÓ‰ÂÈÒÚ‚ËflÚ‡ ÏÂÊ‰Û ıÂÏÓÂÓÎӄ˘ÌË-Ú ÔÓ͇Á‡ÚÂÎË Ë åäí /1, 7/. íÂÁË ‰‡ÌÌË ÔÓÚ‚˙ʉ‡‚‡ÚÁ̇˜ÂÌËÂÚÓ Ì‡ ïí Á‡ ÔÓ‚ÎËfl‚‡Ì ̇ ÍÓ·Ú‡ÎÌÓÚÓ Í˙-‚ÓÓ·‡˘ÂÌËÂ/3,13/.

éÒÓ·ÂÌÓ ‚ÌËχÌË Á‡ÒÎÛʇ‚‡Ú Á‡‚ËÒËÏÓÒÚËÚ ̇ èÇÒ åäí ÔË Öåà ‚ ÔÓ‰„ÛÔ‡Ú‡ Ò Ô‡ÚÓÎӄ˘ÌË ‡ÒËÏÂÚ-ËË, ÍÓËÚÓ ÔÓ͇Á‚‡Ú Á̇˜ËÏÓ ÒÌËÊÂÌË ̇ åäí ÔË ÔÓ-‚˯ÂÌË ÒÚÓÈÌÓÒÚË Ì‡ èÇ. ÑÛ„Ó Ì‡¯Â ÔÓÛ˜‚‡Ì ÔË Ò˙-˘ËÚ ·ÓÎÌË Â ÔÓ͇Á‡ÎÓ , ˜Â ÚÓÁË ÂÙÂÍÚ Ì‡ èÇ ‚˙ıÛ åäí ÌÂÁ‡‚ËÒËÏ ÓÚ ÔÓÏÂÌËÚ ̇ ‡Ú¡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ/2/. è·ÁÏÂÌËflÚ ‚ËÒÍÓÁËÚÂÚ Â Ò˙˘Ó ıÂÏÓÂÓÎӄ˘ÂÌ ÔÓ-͇Á‡ÚÂÎ Ò ÔÓ͇Á‡Ì ÂÙÂÍÚ ‚˙ıÛ Ë̉ÂÍÒ‡ ̇ ‚‡ÁÓÏÓÚÓ̇‡ÍÚË‚ÌÓÒÚ Ì‡ Ò‰ÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË /15/. LJÊ̇-Ú‡ ÓÎfl ̇ èÇ Á‡ ÍÓÌÚÓÎˇÌ ̇ åäí  ÔÓÚ‚˙‰Â̇ Ë ÒÂÍÒÔÂËÏÂÌÚ‡ÎÌË ÔÓÛ˜‚‡ÌËfl/14/. í‡ÁË ÓÎfl ·Ë Ïӄ· ‰‡Ò ҂˙ÊÂ Ò ‚ÎËflÌËÂÚÓ Ì‡ ̇ۯÂ̇ڇ ÔÓÚÂËÌÓ‚‡ ÒËÌ-ÚÂÁ‡, ̇ ÔÓËÌÙ·χÚÓÌËÚ ˆËÚÓÍËÌË Ë Ì‡ Í˙‚ÌÓ‚ËÒ-ÍÓÁËÚÂÚÌËÚ ‡‚ÚÓ„Û·ÚÓÌË ÏÂı‡ÌËÁÏË ÔË ÏÓÁ˙˜Ì‡ËÒıÂÏËfl /12/.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 143‰ÂÍÂÏ‚Ë, 2002

ä‡ÚÓ ÔÓÚ‚˙ʉ‡‚‡ Á̇˜ÂÌËÂÚÓ Ì‡ Ô‡ÚÓÎӄ˘ÌËÚ ËÌ-ÚÂıÂÏËÒÙÂÌË ‡ÒËÏÂÚËË Ì‡ åäí ÔË ·ÓÎÌË Ò ‡Á΢ÌËÙÓÏË Ì‡ åëṦ¯ÂÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡,˜Â ÚÓ‚‡ Á̇˜Â-ÌË ˘Â ̇‡ÒÚÌ ÔË ËÁflÒÌfl‚‡Ì ÓÎflÚ‡ Ì ҇ÏÓ Ì‡ ıÂÏÓ-ÂÓÎӄ˘ÌËÚ ,ÌÓ Ë Ì‡ ‰Û„Ë Ò‚˙Á‡ÌË Ò ÚÂÁË ‡ÒËÏÂÚËËÙ‡ÍÚÓË.

ãàíÖêÄíìêÄ1. ÇÂΘ‚‡,à., ÊË‚, Ñ. ,ü̘‚‡, ë., ÅÓ‚‡, Ñ., èÂÚÛÌfl¯Â‚, Ç. ïÂÏÓÂ-ÓÎӄ˘ÌË ÔÓÏÂÌË Ë ÏÓÁ˙˜ÂÌ Í˙‚ÂÌ ÚÓÍ ÔË ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜-ÌÓÚÓ Í˙‚ÓÓ·‡˘ÂÌËÂ.åÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl‚‡ÌËfl, 2, 1994, 1, 11 - 15.2. ÇÂΘ‚‡, à., ü̘‚‡, ë., íËÚflÌÓ‚‡, Ö. ÇÎËflÌË ̇ ıÂÏÓÂÓÎӄ˘ÌËÚ ÔÓ-͇Á‡ÚÂÎË Ë Ò‰ÌÓÚÓ ‡Ú¡ÎÌÓ Ì‡Îfl„‡Ì ‚˙ıÛ ÏÓÁ˙˜ÌËfl Í˙‚ÂÌ ÚÓÍ ÔË·ÓÎÌË Ò Ú‡ÌÁËÚÓÌË ËÒıÂÏ˘ÌË ‡Ú‡ÍË Ë Â‰ÌÓÒÚ‡ÌÌË ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË.Å˙΄‡Ò͇ Ì‚ÓÎÓ„Ëfl, 2, 2002, 2, 49 - 53.3. íËÚflÌÓ‚‡, Ö., ÇÂΘ‚‡, à. ç‚ÓÒÓÌÓ„‡Ù̇ ÓˆÂÌ͇ ̇ ‡ÒËÏÂÚËflÚ‡ ‚ÒÍÓÓÒÚÚ‡ ̇ Í˙‚ÌËfl ÚÓÍ ‚ χ„ËÒÚ‡ÎÌËÚÂ Ë ·‡Á‡ÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËËÔË ·ÓÎÌË Ò ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·ÓÎÂÒÚ. Ç: éÒÌÓ‚ÌË ÔÓ·ÎÂÏË ‚ Ì‚ÓÎÓ„Ëfl-Ú‡.‰. Ö.ÊËÔÂÚÓ‚‡, èÎÓ‚‰Ë‚, 1994, 57 - 59.4. ü̘‚‡, ë. Ñˇ„ÌÓÒÚ˘̇ ÒÚÓÈÌÓÒÚ Ì‡ ‰ÌÓÙÓÚÓÌ̇ڇ ÂÏËÒËÓÌ̇ ÍÓÏ-Ô˛Ú˙̇ ÚÓÏÓ„‡ÙËfl ÔË ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl ̇ ÏÓÁ˙˜ÌÓÚÓ Í˙‚ÓÓ·‡-˘ÂÌËÂ. ÑÓÍÚ. ÑËÒ., ë., 1989.5. ü̘‚‡, ë., ãÂıÌÂ, ï.,ÊË‚, Ñ. ç‚ÓËÁÓ·‡Áfl‚‡˘Ë ÏÂÚÓ‰Ë. Ç: ñÂ-·ӂ‡ÒÍÛ·ÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË. ê‰. Ñ. ÊË‚, ï. ãÂıÌÂ, ë., åà Ä-ÒÓ, 1998, 118 - 120.6. Culebras, A., Kase, C. S.,Masdeu, J.C., Fox, A.J., Bryan, R. N., Grossman,C. B., Lee, D.H., Adams, H.P., Thies, W. Practice Guidelines for the Use ofImaging in Transient Ischemic Attacks and Acute Stroke. A Report of the StrokeCouncil, American Heart Association. Stroke, 28, 1997, 7, 1480 - 1497.7. Grotta, J., Ackerman, R., Correia, J., Fallick, G., Chang, I. Whole blood vis-cosity parameters and cerebral blood flow . Stroke, 13, 1982, 296 - 301.8. Iseda, T., Nakano, S., Yano, T., Sizuki, Y., Wakisaka, S. Time - threshholdcurve determined by single photon emission CT in patients with acute middlecerebral artery occlusion. Am. J. Neuroradiol.,23, 2002, 4, 572 - 576.9. Lenz, C., Frietsch, T., Futterer, C., van Ackern, K., Kuschinski, W., Waschke,K., F. Influence of blood viscosity on blood flow in the forebrain but not in thehindbrain after carotid occlusion in rats. J. Cereb. Blood Flow Metab. , 20 , 2000,6, 947 - 955.10. Marti - Fabregas, J., A., Catafau, A., M., Mari, C., Mendoza, G., Sanahuja,J.,Lieo, A., Mari - Vilalta, J., L. Eur. J. Nucl. Med. 28, 2001, 12, 1828 - 1835.11. Nishimaki, S., Seki, K.,Yokota, S. Cerebral blood fow velocity in two

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ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:ÑÓˆ. ‰ - à. ÇÂΘ‚‡ëÅÄãçè "ë‚. ç‡ÛÏ" ÖÄÑ, ÛÎ."ã. êÛÒ‚" 11113 ëÓÙËflÚÂÎ.: 709 - 031e-mail: ivelcheva@yahoo.com

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 145‰ÂÍÂÏ‚Ë, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË êÖáìãíÄíà éí íêÄçëäêÄçàÄãçé ÑéèãÖê ëéçéÉêÄîëäé

àáëãÖÑÇÄçÖ èêà 106 Åéãçà ëöë ëìÅÄêÄïçéàÑÖçäêöÇéàáãàÇ

å. äÎËÒÛÒÍËä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl, åì - ëÓÙËfl

SUMMARY

RESULTS FROM TRANSCRANIAL DOPPLER EXAMINATIONS OF 106 PATIENTS WITH

SUBARACHNOID HEMORRHAGEM.Klissurski

Distinguishing pathological changes related to hemody-namic disturbances after subarachnoid hemorrhage (SAH) isoften based on additional information from transcranialDoppler (TCD) examinations. The purpose of the article is topresent summarized clinical, TCD and CT data of 106 patientswith SAH, and to determine the value of different TCD char-acteristics in defining DID as well as to discuss informationalrelevance of conventional monitoring of patients with SAH. Key words: transcranial Doppler ultrasonorgaphy, subarach-noid hemorrhage, blood flow velocities, cerebral vasospasm,delayed ischemic deficit, Hunt & Hess and Fisher scale

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‰Ë̇Ï˘̇ ÓˆÂÌ͇ Ë ÏÓÌËÚÓˇÌ ̇ ıÂÏÓ‰Ë̇Ï˘ÌËÚÂ̇ۯÂÌËfl ÔË ·ÓÎÌË Ò˙Ò ÒÛ·‡‡ıÌÓˉÂÌ Í˙‚ÓËÁÎË‚(ëÄä)/2,3,6,10,15,16/. àÌÙÓχˆËÓÌ̇ڇ Á̇˜ËÏÓÒÚ Ì‡íÑë ÔË ÚÂÁË ·ÓÎÌË ÏÓÊ ‰‡ ·˙‰Â ‡Á΢̇ ‚ Á‡‚ËÒËÏÓÒÚÓÚ ÍÓÌÍÂÚ̇ڇ Ô‡ÍÚË͇ Á‡ ‰Ë‡„ÌÓÁ‡ Ë Ú‡ÔËfl. Ç˙Ô-ÓÒ˙Ú Á‡ ÔÓ„ÌÓÒÚ˘̇ڇ Á̇˜ËÏÓÒÚ Ì‡ ÏÂÚÓ‰‡ (Ò ‚‡Ë-‡·ËÎ̇ ÒÚÓÈÌÓÒÚ ÏÂÊ‰Û 50-90%) Ë ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ÔÓÙË·ÍÚË͇ ̇ Í˙ÒÌËfl ËÒıÂÏ˘ÂÌ Ì‚ÓÎӄ˘ÂÌ ‰ÂÙË-ˆËÚ (äàçÑ) Ë ‰Û„Ë ‚˙ÁÌËÍ‚‡˘Ë ÛÒÎÓÊÌÂÌËfl  ‡ÍÚÛ‡ÎÂÌ‚ Ô‡ÍÚ˘ÂÒÍË ÔÎ‡Ì /7,12,15/. èÂÁ ÔÓÒΉÌËÚ „Ó‰ËÌË ÒÂ̇ÚÛÔ‡ı‡ ÏÌÓ„Ó ‰‡ÌÌË Á‡ ÓÎflÚ‡ ̇ ÏÂÚÓ‰‡, ˜ÂÒÚÓ Ò‰ËÒÍÛÚ‡·ËÎÂÌ ı‡‡ÍÚÂ, ̇ÔËÏ ÓÚÌÓÒÌÓ ÍÓ·ˆËflÚ‡ÏÂÊ‰Û íÑë, ÍÎËÌ˘ÌËfl ÒÚ‡ÚÛÒ Ë ‰Û„ËÚ ÏÂÚÓ‰Ë Á‡ ËÁ-ÒΉ‚‡Ì /4,5,8,9/. íÑë ÍËÚÂËË Á‡ Çë ·flı‡ ‰ÂÙËÌˇÌËÔË ‡Á΢ÌË ÔÓÛ˜‚‡ÌËfl /2,6,10,11/, ÌÓ ‚Ò Ӣ ÎËÔÒ‚‡Â‰ËÌÂÌ ÏÂʉÛ̇ӉÂÌ ÍÓÌÒÂÌÒÛÒ Á‡ íÑë ‰ÂÙËÌˈËfl ̇Çë. ᇠÚӘ̇ ‰Ë‡„ÌÓÁ‡ Ë ÓÔÚËχÎÌÓ Î˜ÂÌË  ÌÂÓ·ıÓ‰Ë-ÏÓ ‰‡ Ò ÓÔ‰ÂÎË ÍÓË ıÂÏÓ‰Ë̇Ï˘ÌË ÍËÚÂËË Ò‡ ̇È-ËÌÙÓχÚË‚ÌË, Ú˙È Í‡ÚÓ ÒË·ڇ ̇ ÏÂÚÓ‰‡  ̇È-„ÓÎfl-χ ÔË ÓÚ˜Ëڇ̠̇ ÍÓÏÔÎÂÍÒ ÓÚ Ô‡‡ÏÂÚË. ç‡ÔÓÒÎÂ-‰˙Í Â ‚‡ÊÌÓ ÓÔ‰ÂÎflÌÂÚÓ Ì ҇ÏÓ Ì‡ ÒÂÌÁËÚË‚ÌÓÒÚÚ‡ ËÒÔˆËÙ˘ÌÓÒÚÚ‡, ÌÓ Ì‡ ÔÓÁËÚ˂̇ڇ Ë Ì„‡Ú˂̇ Ô‰Ë-͇Ú˂̇ ÒÚÓÈÌÓÒÚ, ͇ÍÚÓ Ë Ì‡ ‚ÂÓflÚÌÓÒÚÌËÚ ÓÚÌÓ-¯ÂÌËfl, ÍÓËÚÓ Ì Á‡‚ËÒflÚ ÓÚ ˜ÂÒÚÓÚ‡Ú‡ ̇ äàçÑ, Ò‰ÍÓÌÍÂÚÌÓ ËÁÒΉ‚‡ÌËÚ ·ÓÎÌË /24/.

Ç˙‚ ‚˙Á͇ Ò ÌÂÓ·ıÓ‰ËÏÓÒÚÚ‡ Á‡ ÓÔ‰ÂÎflÌ ̇ ̇‰ÂÊ-‰ÌÓÒÚÚ‡ Ë ‚‡ÎˉÌÓÒÚÚ‡ ̇ íÑë ÔË Ì‡¯ËÚ ÛÒÎÓ‚Ëfl, ÒËÔÓÒÚ‡‚ËıÏ Á‡ ˆÂÎ ‰‡ ÔÓÛ˜ËÏ ‚˙ÁÏÓÊÌÓÒÚËÚ ̇ ÏÂÚÓ-‰‡ Á‡ ÔÓ„ÌÓÁˇÌ ̇ äàçÑ Ë Ô‡ÍÚ˘ÂÒ͇ڇ ÔÓÎÁ‡ ÓÚÏÓÌËÚÓˇÌÂÚÓ ÔË 106 ·ÓÎÌË Ò˙Ò ëÄä, ‚ ÓÒÚ‡Ú‡ Ù‡-Á‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ.

äãàçàóÖç äéçíàçÉÖçí à åÖíéÑà çÄ àáëãÖÑÇÄçÖ

åÂÊ‰Û 1995-2001 „. ÍÎËÌ˘ÌÓ Ò‡ ËÁÒΉ‚‡ÌË Ë ÔÓÒÎÂ-‰ÂÌË 106 ·ÓÎÌË (Ï˙Ê 42, ÊÂÌË 64) Ò ‰Ë‡„ÌÓÁ‡ ÒÔÓÌÚ‡ÌÂÌëÄä, ÔÓÒÚ˙ÔËÎË ‚ ÍÎËÌË͇ڇ ÔÓ Ì‚ÓÎÓ„Ëfl ÔË åÅÄã"ñ‡Ëˆ‡ âÓ‡Ì̇" ëÓÙËfl. 74 (69,8%) ÓÚ Úflı Ò‡ ·ËÎË Ì‡‚˙Á‡ÒÚ 41-60 „Ó‰ËÌË. ë‰̇ڇ ‚˙Á‡ÒÚ Ì‡ ·ÓÎÌËÚ ÒäàçÑ (n = 38)  ·Ë· 49,8 + 12,02 „., ̇ ÚÂÁË ·ÂÁ äàçÑ(n = 68) - 46,06 + 11,7. Ñˇ„ÌÓÁ‡Ú‡  ÔÓÚ‚˙‰Â̇ ˜ÂÁ äíË/ËÎË ÎËÍ‚ÓÌÓ ËÁÒΉ‚‡ÌÂ Ë ÛÚÓ˜ÌÂ̇ ˜ÂÁ ÏÓÁ˙˜Ì‡ Ô‡-̇̄ËÓ„‡ÙËfl (ÄÉ), ÔÓ áÂΉËÌ„Â. åÌÓ„Ó͇ÚÌÓ Ò‡ „ËÒ-ÚˇÌË: RR, ÔÛÎÒÓ‚‡Ú‡ ˜ÂÒÚÓÚ‡, ÚÂÏÔ‡ÚÛ‡Ú‡, ‰Ë-

ı‡ÚÂÎ̇ڇ ˜ÂÒÚÓÚ‡, Í˙‚ÌË ÔÓ͇Á‡ÚÂÎË. èË ·ÓÎÌËÚ ‚ÍÓχÚÓÁÌÓ Ò˙ÒÚÓflÌËÂ, ÔÓÒÚ‡‚ÂÌË Ì‡ àÅÇ,  ËÁÒΉ‚‡ÌÓË̉˂ˉۇÎÌÓ Ääê Ë ‡ëé2 ËÎË ëé2 ‚ ËÁ‰Ë¯‚‡ÌËfl ‚˙Á-‰Ûı. àÁÔÓÎÁ‚‡ÌË Ò‡ ÒΉÌËÚ ÏÂÚÓ‰Ë: 1.) íÑë Ò ‡Ô‡‡ÚSchiller SV-75: ˜ÂÁ 2-åHz ÒÓ̉‡  ÓÔ‰ÂÎfl̇ ̇È-‚ËÒÓ͇-Ú‡ Ò‰̇, ‰Ë‡ÒÚÓ΢̇ Ë ÒËÒÚÓ΢̇ ëäí ‰‚ÛÒÚ‡ÌÌÓ Á‡ëåÄ, èåÄ, áåÄ, ÇëÄ, ÇÄ Ë ÄÅ (ÔË ÒÚÂÏÂÊ Á‡ χÍ-ÒËχÎÌÓ ‰Ó·˙ Ò˄̇Î). ëÚÓÈÌÓÒÚËÚ ҇ ÓÒ‰ÌÂÌË ÒΉÔÓÌ 15 Ò˙‰Â˜ÌË ÔÛÎÒ‡ˆËË. àÁÒΉ‚‡ÌÓÚÓ Â ÏÌÓ„Ó͇ÚÌÓ(ÔÓÌ ÔÂÚ͇ÚÌÓ; ÔË ÔÓÒÚ˙Ô‚‡ÌÂÚÓ Ë ÔÓÒΉfl‚‡ÌË ıÂ-ÏÓ‰Ë̇Ï˘ÌÓ Ì‡ 3-fl, 7-fl, 10-fl, 14-fl 17-fl, 21-fl ‰ÂÌ Ë ÒΉ 1ÏÂÒˆ). ç‡ ÓÚ‰ÂÎÌË ·ÓÎÌË íÑë ·Â ËÁ‚˙¯‚‡Ì‡ ‚ÒÂÍË ‰ÂÌËÎË ÒΉ 21-fl, ‰Ó 30-fl ‰ÂÌ ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Ë̈ˉÂÌÚ‡.Ñ˙ηӘË̇ڇ ̇ ÎÓ͇ÎËÁ‡ˆËfl (˙ÍÓ‚Ó‰ÒÚ‚‡ - 1,2,3) Á‡ëåÄ Â 57,5 ÏÏ, Á‡ èåÄ - 65 ÏÏ, áåÄ- 65 ÏÏ, ÄÇ ÓÚ 65-80 ÏÏ, ‡ Á‡ ÄÅ ÓÚ 87,5 ÏÏ. 艂‡ËÚÂÎÌÓ Ò‡ ËÁÒΉ‚‡Ìˉ‚ÂÚ ÇëÄ Á‡ ̇΢ˠ̇ ÂÍÒڇ͇ÌˇÎ̇ Ò˙‰Ó‚‡ Ô‡ÚÓ-ÎÓ„Ëfl ˜ÂÁ 4 - åHz ÒÓ̉‡, ‡ Ë̉ÂÍÒ˙Ú Ì‡ Lindegaard (LI) ÂÓÔ‰ÂÎflÌ ˜ÂÁ 2-åHz ÒÓ̉‡, - Ò۷χ̉˷Û·ÌÓ, ̇ ‰˙Î-·Ó˜Ë̇ 40 ÏÏ. éÔ‰ÂÎflÌ ̇ Ë̉ÂÍÒËÚ LI Ë PI, RI; éÔ-‰ÂÎfl̇  χÍÒËχÎ̇ڇ ‰Ì‚̇ ‡ÍˆÂ·ˆËfl ̇ ëäí,‡ÒËÏÂÚËflÚ‡ Îfl‚Ó/‰fl‰ÒÌÓ Ë ‡Á‚ËÚËÂÚÓ Ì‡ ÒÍÓÓÒÚËÚ‚˙‚ ‚ÂÏÂÚÓ. 2.) äÎËÌ˘ÌË ÏÂÚÓ‰Ë - ÔÓ‰Ó·ÂÌ Ì‚ÓÎÓ„Ë-˜ÂÌ ÒÚ‡ÚÛÒ, ͇‰ËÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ; Ò͇· Á‡ ÓˆÂÌ͇ ̇·ÓÎÌËÚ ÒÔÓ‰ Ò͇·ڇ ̇ Hunt Ë Hess (ëïï); ÓˆÂÌ͇ ̇˜ÂÒÚÓÚ‡Ú‡, ÒÚÂÔÂÌÚ‡ Ë ı‡‡ÍÚ‡ ̇ Í˙ÒÌËfl ËÒıÂÏ˘ÂÌÌ‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ (äàçÑ); ÓˆÂÌ͇ ̇ ‚˙ÁÌËÍ‚‡ÌÂÚÓ̇ ÏÓÁ˙˜ÌË ËÌÙ‡ÍÚË, Ò‚˙Á‡ÌË Ò äàçÑ. 3.) ç‚ÓËÁÓ·-‡ÁËÚÂÎÌË ÏÂÚÓ‰Ë - ÍÓÏÔ˛Ú˙̇ ÚÓÏÓ„‡ÙËfl ̇ „·‚ÂÌÏÓÁ˙Í - Ò͇· Á‡ äí ÓˆÂÌ͇ ÔÓ Fisher (ëî); äÓÌ‚Â̈ËÓ̇Î-̇ ÏÓÁ˙˜Ì‡ Ô‡Ì-‡Ì„ËÓ„‡ÙËfl (ÄÉ). 4.) ㇷӇÚÓÌË ËÁÒ-Ή‚‡ÌËfl - èää, Ääê, ·ËÓıËÏËfl; ÎËÍ‚ÓÌÓ ËÁÒΉ‚‡ÌÂ. 5.)ëÚ‡ÚËÒÚ˘ÂÒÍË ÏÂÚÓ‰Ë: ‰ÂÏÓ„‡ÙÒÍË Ë ‚‡Ë‡ˆËÓÌÂ̇̇ÎËÁ, ÍÓ·ˆËÓÌÂÌ ‡Ì‡ÎËÁ, Ô‡‡ÏÂÚ˘ÌË ÚÂÒÚÓ‚Â Á‡Á‡‚ËÒËÏË Ë ÌÂÁ‡‚ËÒËÏË ËÁ‚‡‰ÍË (Student t-test) Ë ÌÂÔ‡‡-ÏÂÚ˘ÌË ÚÂÒÚÓ‚Â (XË-Í‚‡‰‡Ú), ÄNOVA. чÌÌËÚ ҇Ô‰ÒÚ‡‚ÂÌË Í‡ÚÓ Ò‰ÌË ÒÚÓÈÌÓÒÚË Ë SD ÔË ÏÂʉۄ-ÛÔÓ‚ËÚ ҇‚ÌÂÌËfl. èË ÓÔËÒ‡ÚÂÎ̇ڇ ı‡‡ÍÚÂËÒÚË-͇ ̇ ÍÓÌÚÓÎ̇ڇ „ÛÔ‡ Ò‡ Ô‰ÒÚ‡‚ÂÌË ‰ÓÔ˙ÎÌËÚÂÎÌÓÒڇ̉‡Ú̇ڇ „¯͇ ̇ Ò‰̇ڇ (SEM) Ë ÏËÌËχÎ̇-Ú‡ Ë Ï‡ÍÒËχÎ̇ ÒÚÓÈÌÓÒÚ. åËÌËχÎÌÓÚÓ ÌË‚Ó Ì‡ ÒË„-ÌËÙË͇ÌÚÌÓÒÚ Â p<0.05. éÔ‰ÂÎflÌÂÚÓ Ì‡ ÓÒÌÓ‚ÌËÚ ı‡-‡ÍÚÂËÒÚËÍË Ì‡ ÏÂÚÓ‰‡ (ÒÂÌÁËÚË‚ÌÓÒÚ Se = a/(a+c);ÒÔˆËÙ˘ÌÓÒÚ Sp = d/(b+d); ÔÓÁËÚ˂̇ Ô‰Ë͇Ú˂̇ÒÚÓÈÌÓÒÚ PPV= a/(a+b); Ì„‡Ú˂̇ Ô‰Ë͇Ú˂̇ ÒÚÓÈ-ÌÓÒÚ NPV = d/(c+d); ÔÓÁËÚË‚ÌÓ ‚ÂÓflÚÌÓÒÚÌÓ ÓÚÌÓ¯Â-ÌË LRP = Se/(1-Sp); Ì„‡ÚË‚ÌÓ ‚ÂÓflÚÌÓÒÚÌÓ ÓÚÌÓ¯Â-ÌË LRN = (1-Se)/Sp)  ËÁ‚˙¯ÂÌÓ Ò ÔÓÏÓ˘Ú‡ ̇ ËÁ‚ÂÒ̇-Ú‡ ‚ ÒÚ‡ÚËÒÚË͇ڇ ˜ÂÚËËÍÎÂÚ˙˜Ì‡ Ú‡·Îˈ‡, Í˙‰ÂÚÓ‡, ‚, Ò Ë d Ò‡ ÓÚ‰ÂÎÌËÚ ÂÎÂÏÂÌÚË Ì‡ Ú‡·Îˈ‡Ú‡ Ò ‰‡‰Â-̇ ÒÚÓÈÌÓÒÚ. éÚÌÓÒËÚÂÎÌËflÚ ËÒÍ RR = a/(a+b) /c/(c+d), Ë ‰Ó‚ÂËÚÂÎÌËflÚ ËÌÚ‚‡Î 95% CI =RRexp[±1,96vVar (lnRR)]) Á‡ ‰ÂÙËÌˇÌÂ Ë ÔÓ„ÌÓÁˇÌÂ̇ äàçÑ Ò‡ ÓÔ‰ÂÎflÌË Ì‡ ·‡Á‡Ú‡ ̇ Ó·˘ÓÔËÂÚËÚ ‰Â-ÙËÌˈËË Ì‡ ÍÎËÌ˘̇ڇ ÂÔˉÂÏËÓÎÓ„Ëfl Ë ·ËÓÒÚ‡ÚËÒÚË-͇ Á‡ ÚÓ‚‡.

èË·„‡Ì  Òڇ̉‡ÚÂÌ Ú‡Ô‚Ú˘ÂÌ ÔÓÚÓÍÓÎ, ‚˙Ô-ÂÍË ˜Â ÔË ‡Á΢ÌËÚ „ÛÔË ·ÓÎÌË, ‚ Á‡‚ËÒËÏÓÒÚ ÓÚÚÂÊÂÒÚÚ‡ ̇ ÔÓfl‚ËÚÂ Ë ÍÓÌÍÂÚÌËfl ÍÎËÌ˘ÂÌ ÒÚ‡ÚÛÒ,Ò‡ ËÁÔÓÎÁ‚‡ÌË ‡Á΢ÌË Ï‰Ë͇ÏÂÌÚË Ë ÔÓ‰ıÓ‰Ë. ëÚÂÏÂ-Ê˙Ú ÔË ‚ÒÂÍË ·ÓÎÂÌ,  RR ‰‡ Ò ÔÓ‰˙ʇ ÏÂÊ‰Û 160/80mm Hg, Ht - 40-30%, ‰‡ Ò ÓÒ˙˘ÂÒÚ‚fl‚‡ ‡‰ÂÍ‚‡Ú̇ ıˉ-‡Ú‡ˆËfl Ë Ò‰‡ˆËfl. ã˜ÂÌËÂÚÓ Ò nimodipine  ÔÓ‚Âʉ‡-ÌÓ I.V., Ó·ËÍÌÓ‚ÂÌÓ ÓÚ 4-fl ‰ÂÌ, ‚ ‰ÓÁ‡ 2-4 mg/h, ËÎË ÔËÔÓ-ÎÂÍËÚ ÒÎÛ˜‡Ë per os, ‚ ‰ÓÁ‡ 4 ı 60 mg, ËÎË ‡ÎÚÂ̇-ÚË‚ÌÓ Ò 2 ı 5 mg Flunarizine. 臈ËÂÌÚËÚ ҇ ÔÓÒΉfl‚‡-ÌË ÍÎËÌ˘ÌÓ Á‡ ‡Á‚ËÚË ̇ Çë Ë Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ

˜ÂÁ ëïï, ͇ÍÚÓ Ë ÏÓÌËÚÓˇÌË ˜ÂÁ íÑë Á‡ ÔÓÏfl̇ ‚ÒÍÓÓÒÚÌËÚ ÔÓ͇Á‡ÚÂÎË.

ᇠˆÂÎËÚ ̇ ̇¯ÂÚÓ ÔÓÛ˜‚‡Ì ҇ ËÁÔÓÎÁ‚‡ÌË íÑ뉇ÌÌË Ì‡ 125 Îˈ‡ (57 Ï˙ÊÂ Ë 68 ÊÂÌË), ÓÚ 20 ‰Ó 81 „Ó‰Ë-ÌË (Ò. 50,5 +18,7 SD), ·ÂÁ ‰‡ÌÌË Á‡ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚‡ ·Ó-ÎÂÒÚ, Ò˙ÓÚ‚ÂÚÌË ËÒÍÓ‚Ë Ù‡ÍÚÓË ËÎË ÍÎËÌ˘ÌÓ ËÁfl‚ÂÌÌ‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ, Á‡ ÍÓÌÚÓÎ̇ „ÛÔ‡.

êÖáìãíÄíà38 ·ÓÎÌË (35,9%) Ò‡ ‡Á‚ËÎË Ìfl͇͂‡ ÒÚÂÔÂÌ Ë ÙÓχ

̇ äàçÑ, ÔË Ò‰ÌÓ ‚ÂÏ ̇ ÔÓfl‚‡ 6,8 + 3,4 ‰ÂÌ Ë Ò‰-̇ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ ‰Ó 15,9 + 6,6 ‰ÌË ÒΉ ̇˜‡ÎÓÚÓëÄä. èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ äàçÑ ÔË 14 ·ÓÎÌË(14/38, 36,8%)  ·Ë· ÏÂÊ‰Û 24 ˜‡Ò‡ Ë 7 ‰ÌË, a Ôӂ˜ ÓÚÒ‰ÂÏ ‰ÂÌÓÌÓ˘Ëfl - ÔË 21 ·ÓÎÌË (21/38, 55,2%). èË 28·ÓÎÌË (26,4%) ‰ÂÙˈËÚ˙Ú Â ·ËÎ Ú‡ÂÌ Ë ÒΉ ËÁÔËÒ‚‡ÌÂ-ÚÓ Ë/ËÎË Ì‚ÓıËۄ˘̇ڇ ÓÔ‡ˆËfl. è˙‚ÓÚÓ íÑë ËÁ-ÒΉ‚‡Ì  ËÁ‚˙¯ÂÌÓ ÔË 86 ÓÚ ·ÓÎÌËÚ (81%) ‚ ‡ÏÍË-Ú ̇ Ô˙‚ËÚ ÚË ‰ÂÌÓÌÓ˘Ëfl. äÎËÌ˘̇ڇ ÓˆÂÌ͇ ÔËÔÓÒÚ˙Ô‚‡ÌÂÚÓ ÒÔÓ‰ ëïï Ë ÒÔÓ‰ äí - ëî  Ô‰ÒÚ‡-‚Â̇ ̇ ÙË„Û‡ 1. èË 57 (53,7%) ÓÚ ·ÓÎÌËÚ  Ôӂ‰Â-ÌÓ ÄÉ ËÁÒΉ‚‡ÌÂ, ͇ÚÓ ÔË 41 (38,7%) ÓÚ Úflı Ò‡ ‰Ó͇Á‡-ÌË ‡Ì‚ËÁÏË ËÎË ‰Û„Ë Ò˙‰Ó‚Ë Ï‡ÎÙÓχˆËË.

ᇠ‰‡ ÓÔ‰ÂÎËÏ ‚˙ÁÏÓÊÌÓÒÚËÚ ̇ íÑë Á‡ ÔÓ„ÌÓÁË-‡Ì ̇ äàçÑ Ë Ô‡ÍÚ˘ÂÒ͇ڇ ÔÓÎÁ‡ ÓÚ ÏÓÌËÚÓˇÌÂ-ÚÓ, ËÁÒΉ‚‡ıÏ ÒΉÌËÚ ÔÓ͇Á‡ÚÂÎË Ë ı‡‡ÍÚÂËÒÚË-ÍË:

1. ëÍÓÓÒÚÌË ÔÓ͇Á‡ÚÂÎË Á‡ ëåÄ: Ä·ÒÓβÚÌËÚÂχÍÒËχÎÌË Ò‰ÌË ëäí ‚ „ÛÔ‡Ú‡ Ò˙Ò Ë ·ÂÁ äàçÑ Â Ò˙-ÓÚ‚ÂÚÌÓ 127,6 +27,9 Ë 95,2 +22,3 ÒÏ/ÒÂÍ. ( <0,05, t-test).ë‰̇ڇ ÒÍÓÓÒÚ ÔË ÍÓÌÚÓÎ̇ڇ „ÛÔ‡  ·Ë·63+11,2 ÒÏ/ÒÂÍ.

ëÍÓÓÒÚË Ì‡ ëåÄ ÔË ·ÓÎÌË ·ÂÁ Ë Ò˙ÓÚ‚ÂÚÌÓ Ò ‡Á-΢̇ ÚÂÊÂÒÚ Ì‡ äàçÑ: ê„ËÒÚˇÌËÚ χÍÒËχÎÌËÒ‰ÌË ÒÍÓÓÒÚË Ì‡ ëåÄ ÔË ·ÓÎÌËÚ ·ÂÁ ‰ÂÙˈËÚ (95,2ÒÏ/ÒÂÍ) Ë ÔË ÚÂÁË Ò˙Ò ÎÂÍ (n=9), ÛÏÂÂÌ (n=19) Ë ÚÂÊ˙ÍäàçÑ (n=10) Ò‡ Ò˙ÓÚ‚ÂÚÌÓ 118, 122 Ë 142 ÒÏ/ÒÂÍ(<0,05). å‡ÍÒËχÎ̇ڇ ëäí ÔË ·ÓÎÌËÚÂ Ò ÚÂÊ˙Í ‰Â-ÙˈËÚ, ÂÒÔÂÍÚË‚ÌÓ Çë, ·Â 162 ÒÏ/ÒÂÍ, ‚ Ò‡‚ÌÂÌËÂ Ò Ú‡-ÁË ÔË ·ÓÎÌËÚÂ Ò ÎÂÍ ‰ÂÙˈËÚ - 103 ÒÏ/ÒÂÍ ( <0.001).åÂÊ‰Û Ï‡ÍÒËχÎÌËÚ ‰ÓÒÚ˄̇ÚË ëäí ÔË ·ÓÎÌËÚ ÒÎÂÍ ‰ÂÙˈËÚ Ë ÛÏÂÂÌ ‰ÂÙˈËÚ Ìflχ Á̇˜Ëχ ‡ÁÎË͇(>0,05), ͇ÍÚÓ Ë ÏÂÊ‰Û ·ÓÎÌËÚÂ Ò ÛÏÂÂÌ Ë Ò ÚÂÊ˙Í ‰Â-ÙˈËÚ (>0,05).

èË ÏÓÌËÚÓˇÌÂÚÓ, 30 ÓÚ 38 ·ÓÎÌË Ò äàçÑ Ò‡ Ëχ-ÎË Ï‡ÍÒËχÎÌË ëäí ̇‰ 120 ÒÏ/ÒÂÍ (ÒÂÌÁËÚË‚ÌÓÒÚ ÓÚ78,9%), ‡ 8 Ò‡ ÓÒڇ̇ÎË ÔÓ‰ Ú‡ÁË ÒÍÓÓÒÚ (Ú‡·Îˈ‡ 1 Ë 2).

ëÍÓÓÒÚÌË ÔÓ͇Á‡ÚÂÎË Ôe‰Ë ÔÓfl‚‡ ̇ äàçÑ. èË·ÓÎÌËÚÂ Ò äàçÑ, ̇È-‚ËÒÓÍËÚ ëäí Á‡ ëåÄ ÔÂ‰Ë ‰ÂÙË-ˆËÚ‡ Ò‡ ·ËÎË Ò‰ÌÓ ÔÓ-‚ËÒÓÍË ÓÚ Ì‡È-‚ËÒÓ͇ڇ ëäí Á‡ˆÂÎËfl ·ÓÎÌ˘ÂÌ ÔÂÒÚÓÈ Ë ÏÓÌËÚÓˇÌ ÔË ·ÓÎÌËÚ·ÂÁ ‰ÂÙˈËÚ (162 ÒÏ/ÒÂÍ ÒÂ˘Û 144 ÒÏ/ÒÂÍ, <0,01). ë‡-ÏÓ ÔË 8 (11,7%) ÓÚ 68 ·ÓÎÌË, ÓÚ „ÛÔ‡Ú‡ ·ÂÁ äàçÑ, ÒÏ„ËÒÚˇÎË ÒÍÓÓÒÚË, ÔÓ-„ÓÎÂÏË ÓÚ 120 ÒÏ/ÒÂÍ (p<0,001, X2-ÚÂÒÚ). í‡Í‡  ÓÔ‰ÂÎÂ̇ ‡Ì̇ڇ, Ó·Ó·˘Â̇ÒÔˆËÙ˘ÌÓÒÚ (88%) Ë ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚ(74%) Á‡ ÔÓ͇Á‡-ÚÂÎfl - ‡·ÒÓβÚ̇ ‰ÓÒÚ˄̇ڇ Ò‰̇ ëäí ̇ ëåÄ ÔÂ-‰Ë ‰ÂÌfl ̇ ÔÓfl‚‡ ̇ ‰ÂÙˈËÚ - ͇ÍÚÓ Ë ÔÓÁËÚ˂̇ڇ(78%) Ë Ì„‡Ú˂̇ Ô‰ËÍÚ˂̇ ÒÚÓÈÌÓÒÚ (86%), ÔÓÁË-ÚË‚ÌÓÚÓ (6,2) Ë Ì„‡ÚË‚ÌÓ ‚ÂÓflÚÌÓÒÚÌÓ ÓÚÌÓ¯ÂÌËÂ(0,3) Á‡ ÔÓ„ÌÓÁˇÌ ̇ äàçÑ (Ú‡·Îˈ‡ 2). àÁ˜ËÒÎÂÌËflÚÓÚÌÓÒËÚÂÎÂÌ ËÒÍ (RR) Á‡ ‡Á‚ËÚË ̇ äàçÑ ÔË Çë Â5,44 (95%CI 4,52-9,3). ê‡Á΢ÌËÚ íëÑ ÔÓ͇Á‡ÚÂÎË Á‡ëåÄ Ë ı‡‡ÍÚÂËÒÚËÍË Ì‡ ÏÂÚÓ‰‡ Á‡ ÔÓ„ÌÓÁˇÌÂäàçÑ Ò‡ Ô‰ÒÚ‡‚ÂÌË Ì‡ Ú‡·Îˈ‡ 1 Ë 2.

2. ê‡Á΢ÌËÚ íÑë ÒÍÓÓÒÚÌË Í‡Ú„ÓËË Á‡ ëåÄ ËÚÂÊÂÒÚÚ‡ ̇ ëÄä ÒÔÓ‰ äí Ò͇· ̇ Fisher Ë Ò͇·ڇ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 146‰ÂÍÂÏ‚Ë, 2002

̇ Hunt & Hess Ò‡ Ô‰ÒÚ‡‚ÂÌË Ì‡ ÙË„Û‡ 2. ÇËʉ‡ ÒÂ, ˜ÂÓÚ ¨-‚‡ ‰Ó ¨¨¨-Ú‡ ÒÚÂÔÂÌ ÔÓ ëî Ò ۂÂ΢‡‚‡ ·ÓflÚ Ì‡·ÓÎÌËÚÂ Ò äàçÑ, ˜ËËÚÓ ëäí ̇ ëåÄ Ò‡ ‚ ‰Ë‡Ô‡ÁÓ̇ 120- 160 ÒÏ/ÒÂÍ (<0,05), ͇ÍÚÓ Á‡ χÎÍÓÚÓ ·ÓÎÌË Ò˙Ò ÒÍÓ-ÓÒÚË Ì‡‰ 160 ÒÏ/ÒÂÍ. í‡Í‡‚‡ ÚẨÂ̈Ëfl Ì Ò ̇·Î˛‰‡‚‡ÏÂÊ‰Û ¨¨¨-Ú‡ Ë ¨V-Ú‡ „ÛÔ‡, ‡ ̇χÎÂÌË ̇ ·Ófl ̇ ·ÓÎ-ÌËÚÂ Ò ‚ËÒÓÍË ëäí Ë Û‚Â΢ÂÌË ̇ ÚÂÁË Ò ÌËÒÍË ÒÍÓÓÒ-ÚË. é·‡ÚÌÓ, ÔË ëäí ÔÓ‰ 120 ÒÏ/ÒÂÍ, Ò Ì‡‡ÒÚ‚‡Ì ̇ÚÂÊÂÒÚÚ‡ ̇ ëÄä ÓÚ ¨¨¨-Ú‡ Í˙Ï ¨V-Ú‡ ÒÚÂÔÂÌ, Ò ۂÂ-΢‡‚‡ ·ÓflÚ Ì‡ ·ÓÎÌËÚÂ Ò ÔÓ-ÌËÒÍË ÒÍÓÓÒÚË ‚ ëåÄ.åÂÊ‰Û ¨¨-‡ Ë ¨¨¨-Ú‡ „ÛÔ‡ Ìflχ ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜Ë-χ ‡ÁÎË͇ Á‡ ‡Á‚ËÚË ̇ äàçÑ, ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÚÂ-ÊÂÒÚÚ‡ ̇ ëÄä, ͇ÍÚÓ Ë ÏÂÊ‰Û ¨-‚‡ Ë ¨V-Ú‡. Ä̇Îӄ˘-̇  ÚẨÂ̈ËflÚ‡ (ÙË„Û‡ 2) Á‡ ̇‡ÒÚ‚‡Ì ̇ ·Ófl ̇·ÓÎÌËÚÂ Ò äàçÑ, Ò˙Ò ëäí ‚ ‰Ë‡Ô‡ÁÓ̇ 120-160 ÒÏ/ÒÂÍ, ËÚÂÊÂÒÚ Ì‡ ëÄä ÓÚ ¨-‚‡ ‰Ó ¨¨¨-Ú‡ ÒÚÂÔÂÌ ÒÔÓ‰ ëïï(<0,05). á̇˜Ëχ ÚẨÂ̈Ëfl Á‡ ̇‡ÒÚ‚‡Ì ·Ófl ̇ Ô‡ˆË-ÂÌÚËÚÂ Ò ëäí ̇‰ 120 ÒÏ/ÒÂÍ Ò ̇·Î˛‰‡‚‡ ÏÂÊ‰Û I-‚‡ ËIII-Ú‡ „ÛÔ‡, ÌÓ ÌÂ Ë ÔË ëäí ̇‰ 160 ËÎË ÔÓ‰ 120 ÒÏ/ÒÂÍÔË ·ÓÎÌËÚ ÓÚ IV-Ú‡ Ë V-Ú‡ ÒÚÂÔÂÌ ÔÓ ëïï. é·˘Ó78,9% ÓÚ ·ÓÎÌËÚÂ, Í·ÒËÙˈˇÌË ÔÓ ëî, Ò‡ ‰ÂÏÓÌÒÚË-‡ÎË íÑë ‰‡ÌÌË Á‡ Çë ÔË ÍËÚÂËË Ì‡‰ 120 ÒÏ/ÒÂÍ. ë˙Ó-Ú‚ÂÚÌÓ 73,6% ÓÚ ·ÓÎÌËÚÂ, Í·ÒËÙˈˇÌË ÔÓ ëïï, Ò‡‰ÂÏÓÌÒÚˇÎË Çë ÔË Ò˙˘ËÚ ÑÓÔÎÂÓ‚Ë ÍËÚÂËË(>0,05).

3. å‡ÍÒËχÎÌÓ ‰Ì‚ÌÓ ÛÒÍÓÂÌË ̇ ëäí. ë‰̇ڇÒÚÓÈÌÓÒÚ Ì‡ ̇‡ÒÚ‚‡Ì ̇ Ò‰̇ڇ ëäí ̇ ëåÄ Á‡ÚˉÌ‚ÌËfl ËÌÚ‚‡Î ̇ ̇·Î˛‰ÂÌË (0-3 ËÎË 3-7, ËÎË 7-10, ËÎË 10-14-ÚË ‰ÂÌ) ÔË 26 ËÁÒΉ‚‡ÌË ·ÓÎÌË Ò äàçÑ Â·Ë· 20,7 +6,41 cm/s Ë Ò˙ÓÚ‚ÂÚÌÓ 9,54 +3,88 ÒÏ/ÒÂÍ ÔË38 ·ÓÎÌË ·ÂÁ ‰ÂÙˈËÚ (p<0.001, unpaired t-test). èË Ô˙-‚‡Ú‡ „ÛÔ‡  ̇·Î˛‰‡‚‡ÌÓ Ï‡ÍÒËχÎÌÓ Ì‡‡ÒÚ‚‡Ì ÓÚ 96ÒÏ/ÒÂÍ Á‡ ÚˉÌ‚ÂÌ ËÌÚ‚‡Î, Á‡ ‡ÁÎË͇ ÓÚ 20,6 ÒÏ/ÒÂÍÔË ·ÓÎÌËÚ ·ÂÁ ‰ÂÙˈËÚ (<0.001). å‡ÍÒËχÎÌÓ ‰Ì‚ÌÓ̇‡ÒÚ‚‡Ì ÔÂ‰Ë ÔÓfl‚‡Ú‡ ̇ äàçÑ (>21 ÒÏ/ÒÂÍ)  Ëχ-ÎÓ ÔË 13 ÓÚ 26 ·ÓÎÌË Ò äàçÑ (ÒÂÌÁËÚË‚ÌÓÒÚ ÓÚ 50%) ËÒ‡ÏÓ ÔË 1 ÓÚ 38 (2,63%) ·ÂÁ äàçÑ, ͇ÍÚÓ Â ÔÓ͇Á‡ÌÓ Ì‡Ú‡·Îˈ‡ 2.

4. à̉ÂÍÒ Ì‡ ‚‡ÁÓÒÔ‡Á˙Ï Á‡ ëåÄ (ıÂÏËÒÙÂÂÌ Ë̉ÂÍÒ̇ Lindegaard - LI). ç‡È-‚ËÒÓÍ Ï‡ÍÒËχÎÂÌ, ͇ÍÚÓ Ë ÒÂ-‰ÂÌ LI ̇·Î˛‰‡‚‡ıÏ ÔË ·ÓÎÌËÚ ÓÚ „ÛÔ‡Ú‡ Ò äàçÑ.ë‰̇ڇ ÏÛ ÒÚÓÈÌÓÒÚ ÓÚ 3,56 +0,46 (n=29)  ÔÓ-‚ËÒÓ͇(<0.001, t-test) ÓÚ Ú‡ÁË - 2,73 +0,5 - ÔË ·ÓÎÌËÚ ·ÂÁäàçÑ (n=40) (ÙË„Û‡ 4). à̉ÂÍÒËÚ ÓÚ ‰‚ÂÚ „ÛÔË Ò‡ÔÓ-‚ËÒÓÍË (<0.01, t-test) ÓÚ Ò˙ÓÚ‚ÂÚÌËÚ ÔË ÍÓÌÚÓ-ÎËÚ ̇ Ò˙˘‡Ú‡ ‚˙Á‡ÒÚ - 1,78 +0,11 (n=45). å‡ÍÒËχÎ-̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ LI ÔË Ô˙‚‡Ú‡ „ÛÔ‡  5,29 Ò¢Û3,59 ÔË ‚ÚÓ‡Ú‡. ç‡ Ú‡·Îˈ‡ 1  Ô‰ÒÚ‡‚ÂÌÓ ‡ÁÔ‰Â-ÎÂÌËÂÚÓ Ì‡ ·ÓÎÌËÚ ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÍËÚÂËfl Á‡ ‰ÂÙË-ÌˇÌ ̇ Çë LI>3. èË 26 ÓÚ 29 ·ÓÎÌË (89,7%) ‚ „ÛÔ‡-Ú‡ Ò ‰ÂÙˈËÚ ÚÓÁË Ë̉ÂÍÒ Â Ì‡‰‚˯‡‚‡Î ÒÚÓÈÌÓÒÚÚ‡ÓÚ 3 Á‡ ÔÂËÓ‰‡ ̇ ÏÓÌËÚÓˇÌÂÚÓ. íËχ ·ÓÎÌË(10,3%) ÓÚ Ú‡ÁË „ÛÔ‡ Ò‡ ËχÎË LI < 3. è‡‚Ë ‚Ô˜‡ÚÎÂ-ÌËÂ, ˜Â 17 ÓÚ ÚÂÁË 29 ·ÓÎÌË (58,6%) Ò‡ ‰ÓÒÚ˄̇ÎË ÒÚÓÈ-ÌÓÒÚ, ÔÓ-„ÓÎflχ ÓÚ Ò‰̇ڇ Á‡ ˆfl·ڇ „ÛÔ‡ 3,56 - ÔÂ-‰Ë ÔÓfl‚‡Ú‡ ̇ äàçÑ (ï2, =0,018). Ç „ÛÔ‡Ú‡ ·ÂÁ äàçÑ26 ÓÚ 40 ·ÓÎÌË (65%) Ò‡ Á‡Ô‡ÁËÎË Ò˙ÓÚÌÓ¯ÂÌËÂÚÓ ÏÂʉÛëäí ëåÄ/ÇëÄ < 3, ͇ÚÓ Ò‡ÏÓ ÔË 11 (27,5%) ÚÓ Â ·ËÎÓ̇‰ 3, ‡ ÔË 3 (7,5%) ̇‰ 3,56.

èË ËÁ˜ËÒÎfl‚‡Ì ̇ LI Á‡ ËÌÚ‚‡Î‡ ÔÂ‰Ë ‰ÂÙˈËÚ‡Ò ÓÚÍË‚‡ χÎ͇, ÌÓ Á̇˜Ëχ ‡ÁÎË͇ ÔË 12 ÓÚ 29 ·ÓÎ-ÌË (41,3%) Ò äàçÑ (LIÒ. 3,18 +0,2), ‚ Ò‡‚ÌÂÌËÂ Ò 40 ·ÓÎ-ÌË ·ÂÁ ‰ÂÙˈËÚ (2,73 +0,5) (<0.01, t-test).

óÂÁ ÍËÚÂËfl Á‡ Çë LI > 3, ÌË ÓÔ‰ÂÎËıÏ ı‡‡ÍÚÂ-ËÒÚËÍËÚ ̇ ÏÂÚÓ‰‡ (26 ÓÚ 29 ·ÓÎÌË Ò äàçÑ, ÒÔflÏÓ11 ÓÚ 40 ·ÂÁ ‰ÂÙˈËÚ, Ú‡·Îˈ‡ 2). ÄÍÓ Ò ËÁÔÓÎÁ‚‡ ÍË-ÚÂËfl LI >3,56, Ú ҇ ÓÔ‰ÂÎÂÌË ÔË 17 ÓÚ 29 ·ÓÎÌË Ò

äàçÑ, ‚ Ò‡‚ÌÂÌËÂ Ò 3 ÓÚ 29 ·ÓÎÌË ·ÂÁ äàçÑ (p=0,003,ï2 ÚÂÒÚ).

5. ÄÒËÏÂÚËfl ‚ Ò‰̇ڇ ëäí ÏÂÊ‰Û ‰‚ÂÚ ëåÄ.ë‰̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ χÍÒËχÎ̇ڇ ‡ÒËÏÂÚËfl ‚ ëäí̇ ëåÄ ‚ „ÛÔ‡Ú‡ ·ÂÁ äàçÑ (n = 31)  29,6 +15,3, ‡ Ò˙Ó-Ú‚ÂÚÌÓ Á‡ „ÛÔ‡Ú‡ Ò äàçÑ (n = 31)  31,2 +16,8 ( = 0.35,unpaired t-test). 13 ÓÚ 31 (41,9%) ÓÚ 1-Ú‡ „ÛÔ‡ Ò‡ ·ËÎË Ò‡ÒËÏÂÚËfl ̇‰ 30 ÒÏ/ÒÂÍ, ͇ÚÓ 2 ·ÓÎÌË Ò‡ ÔÓ͇Á‡ÎË ÒÚÓÈ-ÌÓÒÚË Ì‡‰ 50 ÒÏ/ÒÂÍ. ë˙ÓÚ‚ÂÚÌÓ 15 ÓÚ 31 (48%) ·ÓÎÌËÓÚ „ÛÔ‡Ú‡ Ò äàçÑ Ò‡ ‰ÂÏÓÌÒÚˇÎË ‡ÁÎË͇ ̇‰ 31ÒÏ/ÒÂÍ, ‡ ‡ÁÎË͇ ̇‰ 50 ÒÏ/ÒÂÍ Â Ì‡·Î˛‰‡‚‡Ì‡ Ò‡ÏÓ ÔË 5ÓÚ ÚÂÁË ·ÓÎÌË (Ú‡·Îˈ‡ 2).

6. à̉ÂÍÒËÚ RI Ë PI. 뇂ÌËıÏ ‰‡ÌÌËÚ Á‡ RI Ë PI ̇47 ·ÓÎÌË Ò Ô‰ÔÓ·„‡ÂÏÓ ÌËÒÍÓ (·ÂÁ ÚÓ˜ÌÓ ËÁÏ‚‡ÌÂ)ËÌڇ͇ÌˇÎÌÓ Ì‡Îfl„‡Ì (àäç) ÔÓ ëïï ÓÚ 1-2-‡ ÒÚÂ-ÔÂÌ Ë ÔÓ ëî ÓÚ 1-2 ÒÚÂÔÂÌ, ·ÂÁ äàçÑ, Ë Ì‡ 27 ·ÓÎÌË ÓÚ„ÛÔ‡Ú‡ Ò ‚ËÒÓÍÓ àäç (4-5-‡ ÒÚÂÔÂÌ ÔÓ ëïï Ë Ò 3-4-Ú‡ÒÚÂÔÂÌ ÔÓ ëî, ÏÂÊ‰Û 1-10-fl ‰ÂÌ ÒΉ ëÄä, Ò˙Ò Ë ·ÂÁäàçÑ, 7 ÓÚ ÍÓËÚÓ ‚ ̇È-ÚÂÊÍÓ ÍÎËÌ˘ÌÓ Ò˙ÒÚÓflÌËÂ).èË ·ÓÎÌËÚ ÓÚ 1-Ú‡ „ÛÔ‡ Ò‰ÌËÚ RI (0,49 +0,1) Ë PI(0,73 +0,2) Ò‡ ÔÓ-ÌËÒÍË ÓÚÍÓÎÍÓÚÓ Ò˙ÓÚ‚ÂÚÌËÚ (RI 0,77+0,4 Ë PI 1,23 +0,5 p<0.001, t-test) Á‡ „ÛÔ‡Ú‡ Ò ËÌڇ͇-ÌˇÎ̇ ıËÔÂÚÂÌÁËfl (ÙË„Û‡ 5). à̉ÂÍÒËÚ ÔË ÍÓÌÚÓ-ÎËÚ (31-60 „.) Á‡ RI Ò‡ Ò˙ÓÚ‚ÂÚÌÓ 0,52 - 0,51 Ë Á‡ PI 0,85-0,73. åÂÊ‰Û ÍÓÌÚÓÎËÚÂ Ë ·ÓÎÌËÚ ÓÚ „ÛÔ‡ Ä ÌflχÒÚ‡ÚËÒÚ˘ÂÒ͇ ‡ÁÎË͇ Á‡ Ò‰ÌËfl Ë̉ÂÍÒ RI, ÌÓ Ò ̇·-≇‚‡ χÎ͇ ‡ÁÎË͇ Á‡ PI (p<0,03).

éÅëöÜÑÄçÖ1.ëäí, ÓÔ‰ÂÎÂÌË ˜ÂÁ íÑë, ̇‡ÒÚ‚‡Ú ÔÓÔÓˆËÓ-

̇ÎÌÓ Ì‡ ̇χÎÂÌËÂÚÓ Ì‡ Ò˙‰Ó‚Ëfl ‰Ë‡ÏÂÚ˙ /1,2/. ëäí̇‰ 120 ÒÏ/Ò, Ò˙ÓÚ‚ÂÚÒÚ‚‡˘Ë ̇ Ò˙‰Ó‚ ÒÔ‡Á˙Ï, „ËÒÚ-ˇıÏ ÔË 26 ÓÚ 38 ·ÓÎÌË Ò äàçÑ Ë ÔË 8 ·ÂÁ ‰ÂÙˈËÚ(Ó·˘Ó 34 ÓÚ 106 - 32%). ç‡È-‚ËÒÓ͇ڇ ëäí ÔË ·ÓÎÌËÚÂÒ äàçÑ ‚‡Ë‡¯Â ÓÚ 98 ‰Ó 168 ÒÏ/ÒÂÍ (Ò‰ÌÓ 127,6ÒÏ/ÒÂÍ), ‡ ÔË ·ÓÎÌËÚ ·ÂÁ ‰ÂÙˈËÚ - ÓÚ 86 ‰Ó 144 ÒÏ/ÒÂÍ(Ò‰ÌÓ 95 ÒÏ/ÒÂÍ). ë‡ÏÓ 4 ·ÓÎÌË Ò äàçÑ Ò‡ ·ËÎË Ò˙Ò ëäí̇‰ 160 ÒÏ/ÒÂÍ. íÓ‚‡ ÏÓÊÂÏ ‰‡ Ó·flÒÌËÏ Ò ÔÓ-χÎÍËfl ·ÓÈËÁÒΉ‚‡ÌË Ò ÚÂÊ˙Í ëÄä Ë ÎËÏËÚˇ˘ËÚ ‚˙ÁÏÓÊÌÓÒ-ÚË Ì‡ ËÁÔÓÎÁ‚‡Ì‡Ú‡ ÚÂıÌË͇. Ç˙ÔÂÍË ‡ÁÎË͇ڇ ‚ ÔÓÎÛ-˜Â̇ڇ χÍÒËχÎ̇ Ò‰̇ ëäí ÔË Ì‡¯ËÚ ·ÓÎÌË, ÒÚ‡-ÚËÒÚ˘ÂÒ͇ڇ Á̇˜ËÏÓÒÚ Ì  ÓÒÓ·ÂÌÓ „ÓÎflχ ( <0,05).ë‰̇ڇ ÒÍÓÓÒÚ Ì‡ ëåÄ ÔË ÍÓÌÚÓÎËÚ ÓÚ 63ÒÏ/ÒÂÍ Â ‡Á΢̇ ( <0,01) ‚ Ò‡‚ÌÂÌËÂ Ò „ÛÔ‡Ú‡ ·ÂÁ ËÒ˙Ò äàçÑ. íÓ‚‡ ÔÓÚ‚˙ʉ‡‚‡ ÒıÓ‰ÌË ÂÁÛÎÚ‡ÚË/2,5,6,8,19,20/. å‡ÍÒËχÎÌËÚ ëäí Ò‡ ‚‡ÊÌË Á‡ ÔÓ„ÌÓÁË-‡ÌÂÚÓ Ì‡ äàçÑ, χ͇ ‚˜ ‰‡ Ò ÒÏflÚ‡, ˜Â Ú Ìflχڇ·ÒÓβÚ̇ Á̇˜ËÏÓÒÚ /9,12,15,21/. óÂÒÚÓ Ú Ò „ËÒÚ-Ë‡Ú Ë ÒΉ ÔÓfl‚‡Ú‡ ̇ Çë, ͇ÚÓ ÔÓ-Ò˙˘ÂÒÚ‚ÂÌÓ Â ‰‡ ÒÂ̇·Î˛‰‡‚‡ Úflı̇ڇ ‰Ë̇ÏË͇ ‚ ‰ÌËÚ ÔÂ‰Ë Çë. ᇠԇ-ÚÓÎӄ˘ÌË ëäí, ‰ÂÙËÌˇ˘Ë Çë ‚ ëåÄ, Ôӂ˜ÂÚÓ ‡‚ÚÓ-Ë ÔËÂÏ‡Ú ÓÚÍÎÓÌÂÌËfl ̇‰ 120 cm/s, ÍÓÂÚÓ Ô˙‚Ó̇˜‡Î-ÌÓ Â ÓÔ‰ÂÎflÌÓ ˜ÂÁ Ò‡‚Ìfl‚‡ÌÂ Ë ÍÓ·ˆËfl Ò ‡Ì„ËÓ„‡Ù-ÒÍË ‰‡ÌÌË /2,3,5,8,9,15,21/. 34 ÓÚ Ì‡¯ËÚ ·ÓÎÌË (26 ÒäàçÑ, 68,4%) Ò‡ ÔÓÒÚ˄̇ÎË ëäí ̇‰ 120 ‰Ó 160 ÒÏ/ÒÂÍ,‡ Ò‡ÏÓ ÔË 4 (3,8%) „ËÒÚˇıÏ ÒÍÓÓÒÚË Ì‡‰ 160ÒÏ/ÒÂÍ. èË ÌËÚÓ Â‰ËÌ ·ÓÎÂÌ ·ÂÁ äàçÑ Ì ÒÏ ̇·Î˛‰‡-‚‡ÎË ëäí ̇‰ 160 ÒÏ/ÒÂÍ, ÍÓÂÚÓ ÔÓ͇Á‚‡, ˜Â Ú‡ÁË „‡Ìˈ‡Ì‡‰ÂʉÌÓ ÎËÏËÚˇ ÍÎËÌ˘ÌËfl ËÒÍ.

2.ë‰̇ڇ ÒÍÓÓÒÚ Ë SD, ËÁ˜ËÒÎÂÌË Á‡ ëåÄ ÔË ·ÓÎ-ÌËÚ ÓÚ ¨-‚‡ ‰Ó V-Ú‡ ÒÚÂÔÂÌ ÔÓ ëïï Ò‡ 108, 126, 132, 54,38 ÒÏ/ÒÂÍ. ëÚ‡ÚËÒÚ˘ÂÒ͇ ‡ÁÎË͇ (t-test) ̇·Î˛‰‡‚‡ıÏÂÔË ¨-‚‡ ÒÔflÏÓ ¨¨¨-Ú‡ „ÛÔ‡, Ë ¨¨-‡ Ë ¨¨¨-Ú‡ ÒÔflÏÓ ¨V-Ú‡. 燷≇‚‡ ÒÂ Ë ÎÂ͇ ÚẨÂ̈Ëfl Á‡ ̇‡ÒÚ‚‡Ì ̇Ò‰ÌËÚ ëäí ÔË ·ÓÎÌËÚ ÓÚ ¨-‚‡ ‰Ó ¨¨¨-Ú‡ ÒÚÂÔÂÌ ÔÓëïï Ë Á̇˜ËÚÂÎÌÓ Ì‡Ï‡ÎÂÌË ̇ Ò‰ÌËÚ ÔÓ͇Á‡ÚÂÎË Ì‡ëåÄ ÓÚ ¨V-Ú‡ Í˙Ï V-Ú‡ ÒÚÂÔÂÌ. çflχ ‡ÁÎË͇ ÏÂʉÛ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 147‰ÂÍÂÏ‚Ë, 2002

ëäí, ̇·Î˛‰‡‚‡ÌË ‚˙‚ ‚ÂÏÂÚÓ ÔË ·ÓÎÌËÚ ÓÚ ¨, ¨¨ ˨¨¨-Ú‡ „ÛÔ‡ ÔÓ ëïï. ç‰ÓÒÚ‡Ú˙Í Ì‡ ÚÓÁË ‚ˉ ‡Ì‡ÎËÁ Â,˜Â ·ÓflÚ Ì‡ ·ÓÎÌËÚÂ Ò ‰‡‰Â̇ ÒÚÂÔÂÌ ÔÓ ëïï Ò ÔÓÏÂ-Ìfl ÓÚ 1-fl ‰Ó 30-fl ‰ÂÌ Ì‡ ËÁÒΉ‚‡ÌÂÚÓ Ë ÚÂıÌËÚ ‰‡ÌÌËÚfl·‚‡ ‰‡ ·˙‰‡Ú ÌÂÍÓÎÍÓ͇ÚÌÓ ‚Íβ˜‚‡ÌË ‚ ‡Á΢ÌË-Ú „ÛÔË ÒÔÓ‰ ëïï. íÓ‚‡ ÒÚ‡Ìӂˢ  ‚ ÔÓ‰ÍÂÔ‡ ̇‰‡ÌÌËÚ /14/.

Ä̇Îӄ˘ÂÌ Â ‡Ì‡ÎËÁ˙Ú Ì‡ χÍÒËχÎÌËÚ Ò‰ÌË ëäíÁ‡ ëåÄ ÔË ·ÓÎÌËÚ ÓÚ ‡Á΢ÌËÚ „ÛÔË ÒÔÓ‰ ëî(ÙË„Û‡ 3). ë˙ÓÚ‚ÂÚÌËÚ Ò‰ÌË ëäí Ò‡ 89 (SD +19,1),110 (+10,8), 124 (+8,5), 73,1 (+33,7) ÒÏ/ÒÂÍ ÔË ·ÓÎÌËÚÂÓÚ ¨-‚‡ ‰Ó ¨V-Ú‡ ÒÚÂÔÂÌ. á̇˜Ëχ ‡ÁÎË͇ ÛÒÚ‡ÌÓ‚ËıÏÂÏÂÊ‰Û ¨-‚‡ Ë ¨¨-Ú‡ „ÛÔ‡ (p<0,001) Ë ¨¨-‡ Ë ¨¨¨-Ú‡(p=0,014), ͇ÍÚÓ ÏÂÊ‰Û ¨¨¨-Ú‡ ÒÔflÏÓ ¨V „ÛÔ‡(p<0,0001).

3.Ç ÎËÚ‡ÚÛ‡Ú‡ Ò ÔÓÒÓ˜‚‡, ˜Â Ì ҇ÏÓ ‡·ÒÓβÚ̇-Ú‡ χÍÒËχÎ̇ ëäí Ëχ ÔÓ„ÌÓÒÚ˘ÌÓ Á̇˜ÂÌËÂ, ÌÓ Ë‡ÁÏÂ˙Ú Ì‡ ‰Ì‚ÌÓÚÓ Ì‡‡ÒÚ‚‡Ì ̇ ëäí ÔË ·ÓÎÌËÚ ҂ËÒÓÍ ËÒÍ Á‡ äàçÑ /9,12,21/. í‡Í‡ ÔË ‰Ì‚ÌÓ Ì‡‡ÒÚ‚‡-Ì ̇ ëäí ‚ ëåÄ > 21 cm/sec, ÓÔ‰ÂÎËıÏÂ, ˜Â ÒÂÌÁËÚË‚-ÌÓÒÚÚ‡ ̇ ÏÂÚÓ‰‡ ÔË Ì‡¯ËÚ ·ÓÎÌË Â 50 %. íÓ‚‡  ÌÂ-‰ÓÒÚ‡Ú˙˜ÌÓ Á‡ ÍÎËÌ˘ÌÓ ÔÓ„ÌÓÁˇÌÂ. é·‡ÚÌÓ, ÒÔˆË-Ù˘ÌÓÒÚÚ‡ ÓÚ 97%  ÏÌÓ„Ó ‚ËÒÓ͇ Ë ÏÓÊ ‰‡ ÒÎÛÊË Á‡ÔÓ„ÌÓÁˇÌÂ, ˜Â ÔË ·ÓÎÌËÚ Ò˙Ò ëÄä Ìflχ ‰‡ Ò ‡Á‚ËÂäàçÑ, ËχÈÍË Ô‰ ‚ˉ Ò‡ÏÓ ÚÓÁË ÔÓ͇Á‡ÚÂÎ. àÁ˜ËÒÎÂ-ÌËflÚ ÓÚÌÓÒËÚÂÎÂÌ ËÒÍ (RR) Á‡ ‡Á‚ËÚË ̇ äàçÑ ÔÓÚÓÁË ÍËÚÂËÈ Â 3,78 (95%CI 3,57 - 11).

4.àÁÛ˜‡‚‡ÈÍË Ë̉ÂÍÒ‡ ̇ Lindegaard ͇ÚÓ ÍËÚÂËÈ Á‡Çë ÔË Ì‡¯Ëfl ÍÓÌÚËÌ„ÂÌÚ ÓÔ‰ÂÎËıÏÂ, ˜Â ÒÂÌÁËÚË‚-ÌÓÒÚÚ‡ ÓÚ 90% ̇χÎfl‚‡ ‰Ó 59 % ‡ÍÓ ‚Íβ˜ËÏ ‚ ‡Ì‡ÎË-Á‡ Ò‡ÏÓ ·ÓÎÌËÚÂ Ò LI > ÓÚ Ò‰̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ ÔÓ͇-Á‡ÚÂÎfl Á‡ „ÛÔ‡Ú‡ Ò äàçÑ. íÓ‚‡ Ì  ‰ÓÒÚ‡Ú˙˜ÌÓ Ì‡‰ÂÊ-‰ÌÓ Á‡ ÍÎËÌ˘ÌÓ ÔÓ„ÌÓÁˇÌÂ, ‰Ó͇ÚÓ ÒÔˆËÙ˘ÌÓÒÚÚ‡ÓÚ 90% ‰Ó 73% Ë Á‡ ‰‚ÂÚ ͇Ú„ÓËË Ì‡ LI  ÏÌÓ„Ó ‚ËÒÓ-͇, Ë Ò ÔÓ-„ÓÎflχ ‚ÂÓflÚÌÓÒÚ ÏÓÊ ‰‡ ÒÎÛÊË Á‡ ÓÚı‚˙-ÎflÌ ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ äàçÑ. éÚÌÓÒËÚÂÎÌËflÚ ËÒÍ(RR) Á‡ ‡Á‚ËÚË ̇ äàçÑ ‚ ÚÂËÚÓËflÚ‡ ̇ ëåÄ ÔËÍËÚÂËÈ LI >3, Ëχ ÒÚÓÈÌÓÒÚ 7,5 (CI 95% 4,71 - 9,18).èË ÍËÚÂËÈ LI > 3,56, ÚÓÁË ËÒÍ e 2,69 (95% CI 4,09-10,27). èÓÒΉÌËflÚ Ï‡Í‡ Ë Ò ÔÓ-χÎ͇ ÒÚÓÈÌÓÒÚ, ÔÓ‡-‰Ë ‡Á΢ÌËfl ·ÓÈ Ì‡ ·ÓÎÌËÚ (n = 17, ÒÂ˘Û 26), Ëχ Á̇-˜ÂÌË Á‡ ÍÎËÌ˘ÌÓÚÓ ËÌÚÂÔÂÚˇÌ ̇ ÂÁÛÎÚ‡ÚËÚÂÓÚ íÑë ËÁÒΉ‚‡ÌÂ Ë ÔÓ‰ÍÂÔfl ÔÓ‰Ó·ÌË ÂÁÛÎÚ‡ÚË/8,9,15,18,24/.

5.ᇠËÁÒΉ‚‡Ì ̇ Á‡‚ËÒËÏÓÒÚÚ‡ ÏÂÊ‰Û Ï‡ÍÒËχÎ̇-Ú‡ ‡ÒËÏÂÚËfl ‚ ëäí Ë ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ ‡Á‚ËÚË ̇äàçÑ ‚ ·‡ÒÂÈ̇ ̇ ëåÄ Ò ÔÓ-‚ËÒÓÍËÚ ÒÍÓÓÒÚË, ÌËÂÔÓÛ˜ËıÏ ‰‡ÌÌËÚ ̇ 62 ·ÓÎÌË. éÔ‰ÂÎÂ̇ ·Â Ò··‡ ÒÂÌ-ÁËÚË‚ÌÓÒÚ (48%), ÒÔˆËÙ˘ÌÓÒÚ (58%) Ë Ò˙ÓÚ‚ÂÚÌËÔ‰Ë͇ÚË‚ÌË ÒÚÓÈÌÓÒÚË. éÚÌÓÒËÚÂÌËflÚ ËÒÍ 1,14,χ͇ Ë Ò Ì„ÓÎflχ ÒÚÓÈÌÓÒÚ, ·Ë ÏÓ„˙Î ‰‡ Ëχ ËÁ‚ÂÒÚÌÓÍÎËÌ˘ÌÓ Á̇˜ÂÌË ÔË ·ÓÎÌË Ò˙Ò Á̇˜ËÚÂÎ̇ ·Ú‡ÎËÁ‡-ˆËfl ̇ Í˙‚Ú‡. éÚÌÓÒÌÓ ‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ ÔÓfl‚‡ ̇äàçÑ, ÔË ·ÓÎÌËÚ Ò˙Ò ëÄä,  Ò˙˘ÂÒÚ‚ÂÌÓ ‰‡ Ò ÓÔÂ-‰ÂÎË Í‡Í‚‡  ‡ÒËÏÂÚËflÚ‡ ‚ ëäí ÔË ÒÎÛ˜‡ËÚÂ Ò ‡ÒËÏÂÚ-˘ÌÓ ÍÓ΢ÂÒÚ‚Ó Í˙‚ (‚ ÒË΂Ë‚ËÚ ·‡Á‰Ë Ë ‰Û„Ë ÒË-ÏÂÚ˘ÌË ÒÛ·‡‡ıÌÓˉ‡ÎÌË ÔÓÒÚ‡ÌÒÚ‚‡), ÒÔÓ‰ äíÒ͇ÎË Á‡ ÚÂÊÂÒÚÚ‡ ̇ ëÄä /4,5,7,8,12,18,24,27/. Ç˙ÔÂÍËÎËÔÒ‚‡˘‡Ú‡ ÒÚ‡ÚËÒÚ˘ÂÒ͇ Á̇˜ËÏÓÒÚ ‚ Ò‰̇ڇ ‡ÒË-ÏÂÚËfl ÏÂÊ‰Û „ÛÔËÚÂ, ÔË Ì‡¯ËÚ ·ÓÎÌË Ò äàçÑ Ëχ-¯Â ÔÓ-‚ËÒÓÍË ëäí ÏÂÊ‰Û ‰‚ÂÚ ÒÚ‡ÌË ÓÚÍÓÎÍÓÚÓ ÔË·ÓÎÌËÚ ·ÂÁ ‰ÂÙˈËÚ, ˜ËËÚÓ ÒÍÓÓÒÚË ·flı‡ ÔÓ-ÌËÒÍË ÓÚÑÓÔÎÂÓ‚ËÚ ÍËÚÂËË Á‡ Çë.ëÔÓ‰ ̇¯ËÚ ‰‡ÌÌË, Á‡ÔÓ„ÌÓÁˇÌ ̇ äàçÑ ˜ÂÁ ËÁÔÓÎÁ‚‡Ì ̇ ÍËÚÂËfl ÒÍÓ-ÓÒÚ̇ڇ ‡ÒËÏÂÚËfl >20%, ÔÓ-‚‡Ê̇  ‡ÒËÏÂÚËflÚ‡ÔË ëäí, ‰‚ÛÒÚ‡ÌÌÓ Ì‡‰ Ô‡„‡ ÓÚ 120-127 ÒÏ/ÒÂÍ. 燷-≇‚‡ıÏ 23 ÓÚ 31 ·ÓÎÌË (74%) ÓÚ „ÛÔ‡Ú‡ Ò äàHÑ Ò

ڇ͇‚‡ ‡ÒËÏÂÚËfl Ë ëäí ̇ ëåÄ Ì‡‰ Ú‡ÁË „‡Ìˈ‡, ‰Ó-͇ÚÓ ÔË ·ÓÎÌËÚ ·ÂÁ ‰ÂÙˈËÚ Ú‡Í‡‚‡ ‡ÁÎË͇ Ò Ò¢‡-¯Â Ò‡ÏÓ ÔË 7 ÓÚ 31 ·ÓÎÌË (25,8%) (p<0.001, ï2).6. èË Á̇˜ËÚÂÎÌÓ Ôӂ˯ÂÌÓ ËÌڇ͇ÌˇÎÌÓ Ì‡Îfl„‡ÌÂ(àäç), ̇‡ÒÚ‚‡ÌÂÚÓ Ì‡ ëäí Ì ‚Ë̇„Ë ÍÓÂΡ ̇‰ÂÊ-‰ÌÓ Ò ÍÎËÌ˘ÌÓÚÓ ‡Á‚ËÚË ̇ Çë Ë äàçÑ /13/. ᇠÔÓ„-ÌÓÁˇÌ ̇ ËÒıÂÏ˘ÌËÚ ÛÒÎÓÊÌÂÌËfl ÔË ·ÓÎÌËÚ Ò˙ÒëÄä  ÌÂÓ·ıÓ‰ËÏÓ ‰‡ Ò ÓÔ‰ÂÎflÚ Ë̉ÂÍÒËÚ RI Ë PI͇ÍÚÓ Ë ÒÚÓÈÌÓÒÚËÚ ̇ àäç. PI Á‡‚ËÒË ÓÚ ‡Á΢ÌËÙ‡ÍÚÓË, ͇ÚÓ Á̇˜ËÏÓ ÌËÒÍËÚ ÏÛ ÒÚÓÈÌÓÒÚË Ò‡ Ò‚˙-Á‡ÌË Ò ÔÓÍÒËχÎÌÓ ıÂÏÓ‰Ë̇Ï˘ÌÓ Ì‡Û¯ÂÌË ËÎË ‰ËÒ-Ú‡Î̇ ‚‡ÁӉ˷ڇˆËfl. ÖÍÒÚÂÏÌÓÚÓ ÏÛ Ì‡‡ÒÚ‚‡Ì ÒÂ̇·Î˛‰‡‚‡ ÔË ÚÂÊ͇ ËÌڇ͇ÌˇÎ̇ ıËÔÂÚÂÌÁËfl/3,4,15,17/.

RI ÔË 16 ÓÚ 47 ·ÓÎÌË (34%) ÓÚ „ÛÔ‡ Ä ·ÂÁ èàäç e·ËΠ̇‰ 0,49. ë‡ÏÓ ÔË 6 ·ÓÎÌË ·ÂÁ äàçÑ Ë ëäí <120ÒÏ/ÒÂÍ Â Ì‡·Î˛‰‡‚‡ÌÓ Ò˙˜ÂÚ‡ÌËÂ Ò ‚ËÒÓÍ RI >0,6. íÂÁË 6·ÓÎÌË Ò‡ ·ËÎË ‚ ÚÂÊÍË ÍÓχÚÓÁÌË Ò˙ÒÚÓflÌËfl Ë Ò‡ ËÁÒΉ-‚‡ÌË ˜ÂÁ íÑë Á‡ ͇ÚÍÓ ‚ÂÏ ÓÚ 1 ‰Ó 4 ‰ÌË, ÔÓ‡‰Ë ÍÓ-ÂÚÓ Ì  ̇·Î˛‰‡‚‡Ì ‰ÂÙˈËÚ Ë Ì ҇ ‚Íβ˜ÂÌË ‚ „ÛÔ‡-Ú‡ Ò äàçÑ. í Ô‰ÒÚ‡‚Îfl‚‡Ú ÔÓÚÂ̈ˇÎÂÌ ËÒÍÓ‚ ÍÓÌ-ÚËÌ„ÂÌÚ Á‡ ‡Á‚ËÚË ̇ äàçÑ, ÔÓ‡‰Ë ÚÂÊÍËfl ëÄä, Ë‚ÂÓflÚÌÓ ÔÓ-Í˙ÒÌÓ ·Ëı‡ ËχÎË íÑë ‰‡ÌÌË Á‡ Çë, ‡ÍÓ Ì·flı‡ ÔÓ˜Ë̇ÎË ·˙ÁÓ ÓÚ ÚÂÊÍËfl ëÄä.

é·˘Ó 22 ÓÚ 27 (81,4%) ÓÚ „ÛÔ‡ Å Ò èàäç Ò‡ ·ËÎË ÒRI >0,6 ͇ÚÓ Ò‡ÏÓ 9 ÓÚ Úflı (33,3%) Ò‡ ËχÎË Ë̉ÂÍÒ Ì‡‰0,77. 17 ÓÚ 27 (62,9%) Ò‡ ·ËÎË Ò˙Ò ëäí ÔÓ-χÎÍË ÓÚ 80ÒÏ/ÒÂÍ. ë‡ÏÓ ÔË 7 ·ÓÎÌË (6 Ò 4-Ú‡ ÒÚÂÔÂÌ ÔÓ ëî Ë 1 Ò 5-Ú‡ ÔÓ ëïï)  ̇·Î˛‰‡‚‡ÌÓ ‡Á‚ËÚË ̇ äàçÑ ÔË ëäíÁ‡ ëåÄ, ÔÓ-χÎÍË ÓÚ 120 ÒÏ/ÒÂÍ, ͇ÚÓ ÚÂıÌËÚ RI Ò‡ ·Ë-ÎË > 0,6. 13 ·ÓÎÌË ÓÚ ‰‚ÂÚ „ÛÔË Ò ‚ËÒÓÍË RI Ë ÍÓχÚÓÁ-ÌË Ò˙ÒÚÓflÌËfl (6 ·ÂÁ ‰ÂÙˈËÚ Ë 7 Ò˙Ò äàçÑ) Ì ҇ ÔÓ͇-Á‡ÎË íÑë ‰‡ÌÌË Á‡ Çë, ÒÔÓ‰ Ô˙‚Ó̇˜‡ÎÌËfl ÍËÚÂËÈ(Vmax ̇ ëåÄ >120 ÒÏ/ÒÂÍ). ÑÛ„ËÚ 7 ·ÓÎÌË ÓÚ „ÛÔ‡Å, Ò Ôӂ˯ÂÌÓÚÓ àäç, ÔË ÍÓËÚÓ Ì‡·Î˛‰‡‚‡ıÏ äàçÑ,Ô‰ÒÚ‡‚Îfl‚‡Ú ËÁ‚‡‰Í‡ Ò Ù‡Î¯Ë‚Ó Ì„‡ÚË‚ÂÌ ÂÁÛÎÚ‡ÚÁ‡ Çë ÒÔÓ‰ ÍËÚÂËfl ÓÚ 120-160 ÒÏ/ÒÂÍ. ÄÍÓ „Ë ‰Ó·‡-‚ËÏ Í˙Ï 26-Ú ·ÓÎÌË Ò íÑë-Çë ÓÚ Ú‡·Îˈ‡ 1 Ë 2, ÏÓÊÂω‡ Ôӂ˯ËÏ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÚ‡ ̇ ÏÂÚÓ‰‡ Á‡ „ËÒÚË-‡Ì ̇ Çë ÓÚ 68% ̇ 86,8%, ÍÓÂÚÓ Â ‚ËÒÓÍ ÂÁÛÎÚ‡Ú.èË Ì‡¯ËÚ ·ÓÎÌË Ì ÒÏ Ò˙ÔÓÒÚ‡‚ËÎË íÑë ‰‡ÌÌË Ò ÍÓ-΢ÂÒÚ‚ÂÌÓÚÓ ÓÔ‰ÂÎflÌ ̇ àäç. ëÏflÚ‡ ÒÂ, ˜Â ÍÓ„‡ÚÓRI < 0,5 /13/, ÚÓ ËÁÏÂÂÌËÚ ëäí ˜ÂÁ íÑë ‡ÎÌÓ ÓÚ‡-Áfl‚‡Ú ÚÂÊÂÒÚÚ‡ ̇ Çë ÒΉ ëÄä. äÓ„‡ÚÓ ÚÓÁË Ë̉ÂÍÒ ÂÔÓ-„ÓÎflÏ ÓÚ 0,6, ÒÌËÊÂÌËÚ ëäí (>150 ÒÏ/ÒÂÍ) Ô‰Ò-Ú‡‚Îfl‚‡Ú Ù‡Î¯Ë‚Ó Ì„‡ÚË‚ÂÌ ÂÁÛÎÚ‡Ú Á‡ Çë ‚˙‚ ‚˙Á-͇ Ò˙Ò Á̇˜ËÏÓ Ôӂ˯ÂÌÓ àäç (̇‰ 20 mm Hg) ÔË ·ÓÎÌË-ÚÂ Ò ÚÂÊ˙Í ëÄä, ÍÓËÚÓ ‡Á‚Ë‚‡Ú äàçÑ. çË ÔÓ‰ÍÂÔfl-Ï ÚÂÁË ‰‡ÌÌË /13/, Ú˙È Í‡ÚÓ ÔË 81% ÓÚ Ì‡¯ËÚ ·ÓÎÌËÒ Ôӂ˯ÂÌÓ àäç ̇·Î˛‰‡‚‡ıÏ Ë̉ÂÍÒ RI >0,6. àÌÚÂÔ-ÂÚˇÌÂÚÓ Ì‡ ëäí Á‡ ̇΢ˠ̇ Çë ÔË Ú‡ÍË‚‡ Ô‡ˆËÂ-ÌÚË Úfl·‚‡ ‚Ë̇„Ë ‰‡ ÒÚ‡‚‡ ‚ Ò˙ÔÓÒÚ‡‚͇ Ò Ë̉ÂÍÒËÚÂ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 148‰ÂÍÂÏ‚Ë, 2002

îË„. 1

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Fisher (n=102)

RI Ë PI. Ç Á‡Íβ˜ÂÌËÂ, ıÂÏÓ‰Ë̇Ï˘ÌËÚ ÔÓ͇Á‡ÚÂÎË ÓÚ ÍÓÌ-

‚Â̈ËÓ̇Î̇ڇ íÑë ‰‡‚‡Ú ‡Á΢̇ ËÌÙÓχˆËfl, ÌÓ ÍÓÏ-ÔÎÂÍÒÌËflÚ ËÏ ‡Ì‡ÎËÁ ‚ Ò˙˜ÂÚ‡ÌËÂ Ò ÍÎËÌ˘ÌËÚÂ Ë Ì‚Ó-ËÁÓ·‡ÁËÚÂÎÌË ‰‡ÌÌË ÏÓ„‡Ú ‰‡ Û‚Â΢‡Ú ËÌÙÓÏˇ-ÌÓÒÚÚ‡ Ë ‚˙ÁÏÓÊÌÓÒÚËÚ ̇ ÍÎËÌˈËÒÚ‡ Á‡ ÔÓ„ÌÓÁˇ-ÌÂ Ë ÚÂÚˇÌ ̇ ·ÓÎÌËÚ Ò˙Ò ëÄä.

ãàíÖêÄíìêÄ1. òÓÚÂÍÓ‚ è.å. í‡ÌÒ͇ÌˇÎ̇ ‰ÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl. ËÁ‰. "ÇÂÌÂÎ", ëÓ-ÙËfl, 1993.2. Aaslid R, (ed): Transcranial Doppler Sonography. Vienna, Springer-Verlag,1986.3. Aaslid R. Haemodynamics of cerebrovascular spasm. Acta Neurochir [Suppl](Wien) 1995; 72: 47-57.4. Babikian VL, Wechsler LR, eds. Transcranial Doppler Ultrasonography. Mo:BC Decker-Mosby Year Books; St Louis 1993, pp 29-38.5. Boecher-Schwartz HG, G Fries, W Muller-Forell, G Kassel, A Perneczky.Cerebral Blood Flow Velocities after Subarachnoid Hemorrhage in Relation to theAmount of Blood Clots in the Initial Computed Tomography. Acta Neurochir(Wien). 140: 1998; 573-578.6. Compton JS, Redmond S, Symon L. Cerebral blood velocity in subarachnoidhemorrhage: a transcranial Doppler study. J Neurol Neurosurg Psychiatry. 1987;50:1499-1503.7. Davis SM et al. Correlation between cerebral arterial velocities, blood flowand delayed ischemia after subarachnoid hemorrhage. Stroke. 1992:23:492-497.8. Ekelund A, Saveland H, Romner B, Brandt L. Is transcranial Doppler sonog-raphy useful in detecting late cerebral ischaemia after aneurysmal subarachnoidhaemorrhage? Br J Neurosurg 1996;10(1):19-25.9. Grosset DG, J.Straiton, I.McDonald, M.Kockburn, R.Bullock. Use of tran-scranial Doppler sonography to predict development of a delayed ischemic deficitafter subarachoid hemorrhage. J Neurosurg 78:183-187,1993.10. Harders A. Neurological Applications of Transcranial Doppler Sonography.Wien/New York: Springer-Verlag, 1986.11. Harders AG, Gilsbach JM: Time course of blood velocity changes related tovasospasm in the circle of Willis measured by transcranial Doppler ultrasound. JNeurosurg 66: 718-728, 1987.12. Kirik T, Pamir MN, Ozek MM, Zirh T, Erzen C. A new, more dependablemethodology for the use of transcranial Doppler ultrasonography in the manage-ment of subarachnoid hemorrhage. Acta Neurochir (Wien) 1996; 138(9): 1070-78.13. Klingelhofer J., Sanders D., Holzgraffe M., Bischoff C, Conrand B. Cerebralvasospasm evaluated by transcranial Doppler ultrasonography at different intracra-nial pressures. J Neurosurg. 75:1991; 752-758.14. Laumer R, Steinmeir R, Vogtmann T: Value of transcranial Dopppler sonog-raphy in patients treated with nimodipine. Adv Neurosurg. 1992; 20: 202-20715. Lindegaard K.F. The role of Transcranial Doppler in management of patientswith subarachnoid hemorrhage - a Review. Acta Neurochir (Wien). 72: 1999[suppl], 59-71. 16. Manno EM, DR Gress, LH Schwamm, MN Diringer, CS Ogilvy. Effects ofInduced Hypertension on Transcranial Doppler Ultrasound Velocities in PatientsAfter Subarachnoid Hemorrhage. Stroke. 1998; 29: 422-428.17. Newell D.W., Aaslid R., (eds). Transcranial Doppler Sonography. New York,Raven Press Publishers, 1992.18. Romner B, Ljunggren B, Brandt L, Saveland H. Correlation of TC Dopplersonography findings with timing of aneurysm surgery. J Neurosurg 1990; 73: 72-76.19. Seiler RW, Grolimund P, Aaslid R, Huber P, Nornes H: Cerebral vasospasmevaluated by transcranial ultrasound correlated with clinical grade and CT-visual-ized subarachnoid hemorrhage. J Neurosurg 64:594-600, 1986.20. Sekhar LN, Wechsler LR, Yonas H, et al: Value of transcranial Doppler

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 149‰ÂÍÂÏ‚Ë, 2002

îË„. 4

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Áåç äåôèöèä

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LIñð 3,56+0,5

LIñð 2,73+0,5

Âèñîêî ÈÊÍ n=27

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îË„. 2

SUMMARY

SUBACUTE SCLEROSING PANENCEPHALITIS- MORBIDITY, CLINICAL COURSE, AND DIAGNOSTICS-

ANALYSIS IN 25 YEARS PERIODV.Bojinova, P.Dimova, L.Belopitova

Subacute sclerosing panencephalitis (SSPE) is a rare slowvirus infection with onset in childhood caused by persistentdefective measles virus in CNS. Higher risk for SSPE havechildren contacted with measles before 2 years of age. Themeasles vaccine decreased the world wide incidence of SSPE.The aim of the present study was to analyze: 1. The registeredmorbidity of SSPE in the Clinic of Child Neurology,University Hospital of Neurology and Psychiatry, Sofia for 25years period (1978-2002); 2. The clinical course and 3. Theearly diagnostic features in such patients. SSPE was diag-nosed in 40 children (29 boys and 11 girls, mean age 8,5years), 28 of whom in the period 1978-1984, and 12- between1995-2002. Thirty-nine of the children (97,5%) were no vac-cinated against measles. The tendency of a new increase ofthe morbidity after 10 years disease-free period related to themeasles epidemics before 10 years, and the incomplete immu-nization against measles. These results suggested the impor-tance of the early natural measles infection as a factor for per-sistent neuroinfection and of the vaccination against measlesfor the SSPE prophylaxis. The most often onset of SSPE wasbetween 8 and 11 years (52,2%), and the median latency peri-od between natural measles infection and SSPE was 7,0 years.

During the period 1995-2002 predominated children with anearlier onset of SSPE (mean age 8,4 years) in comparison withthe period 1978-1984 (mean age 11,2 years). The initial clini-cal manifestation included intellectual deterioration (35%),extrapyramidal hyperkinesias (29%), epileptic seizures(15%), hemiparesis (10%), visual agnosia (10%). Eighth chil-dren had asymmetric atypical onset, 2 of whom (5%) withstroke-like course. Fulminate course were discovered in 4children (10%), a chronic progressive course with pseudore-missions over 2 years - in 8 cases (20%). The early diagnosisof SSPE was based on the typical clinical course, the highantimeasles antibodies titters in CSF (100%), the increasedgamma globulin with oligoclonal banding (100%), the peri-odic high amplitude slow waves activity in EEG(Radermecker's complexes), as well as on the MRI showdlesions in the gray and in white matter- bilateral symmetric in45% (5/11), or asymmetric in other 37% (4/11), while CTrevealed latter brain atrophy.Key words: Subacute sclerosing panencephalitis, morbidity,atypical cases, MRI, CSF

êÖáûåÖ

ëÛ·‡ÍÛÚÌËflÚ ÒÍÎÂÓÁˇ˘ Ô‡ÌÂ̈ÂÙ‡ÎËÚ (SSPE) efl‰Í‡ ·‡‚ÌÓ‚ËÛÒ̇ ËÌÙÂ͈Ëfl Ò Ì‡˜‡ÎÓ ‚ ‰ÂÚÒ͇ ‚˙Á‡ÒÚ,Ô˘ËÌÂ̇ ÓÚ ÔÂÒËÒÚˇ˘ ‰ÂÙÂÍÚÂÌ ÏÓ·ËÎÓÁÂÌ ‚ËÛÒ‚ ñçë. èÓ-‚ËÒÓÍ ËÒÍ Á‡ SSPE ËÏ‡Ú ‰Âˆ‡Ú‡, ·ÓΉۂ‡ÎË-Ú ÓÚ ÏÓ·ËÎË ÔÂ‰Ë 2 „. èËÎÓÊÂÌËÂÚÓ Ì‡ ÔÓÚË‚ÓÏÓ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 150‰ÂÍÂÏ‚Ë, 2002

examination in the diagnosis of cerebral vasospasm after subarachnoid hemor-rhage. Neurosurgery 22:813-821, 1988.21. Sloan MA. Detection of vasospasm following subarachnoid hemorrhage. In:Babikian VL, Wechsler LR, eds. Transcranial Doppler Ultrasonography. St Louis,BC Decker-Mosby; 1993, pp 105-127.22. Sloan MA, Burch CM, Wozniac MA, Rothman MI, Rigamonti D, Permutt T,Numaguchi Y. Transcranial Doppler Detection of Vertebrobasilar VasospasmFollowing Subarachniod Hemorrhage. Stroke 1994; 25:2187-2197.23. Soulstiel JF, Bruk B, Shik B, Hadani M, Feinsod M. Transcranial Doppler inVertebrobasilar Vasospasm after Subarachniod Hemorrhage. Neurosurgery. 1998;43: 282-293.24. Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM. Role ofTranscranial Doppler monitoring in the diagnosis of cerebral vasospasm after sub-arachnoid hemorrhage. Neurosurgery. 44, 1999; 1237-1248.25. Wardlaw JM, Offin R, Teasdale GM, Teasdale EM. Is routine transcranialDoppler ultrasound monitoring useful in the management of subarachnoid hemor-rhage? J Neurosurg. 88, 1998; (2): 272-276.26. Wranze-Bielefeld E, Dauch WA, Bauer BL. Discrepancy between the resultsof transcranial Doppler and the clinical status of patients after subarachnoid haem-orrhage. Adv Neurosurg. 1990; 19:276-280.27. Zygmunt SC, TJ Delgado-Zygmunt. The haemodynamic effect of transcra-

nial Doppler-guided high dose Nimodipine treatment in established vasospasmafter subarachnoid haemorrhage. Acta Neurochigurgica (Wien). 1995; 135:179-185.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- å. äÎËÒÛÒÍË, „·‚ÂÌ ‡ÒËÒÚÂÌÚ, åÅÄã "ñ‡Ëˆ‡ âÓ‡Ì̇", äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl,ÛÎ." ÅflÎÓ ÏÓÂ" No 8, ëÓÙËfl 1527ÚÂÎ: (02) 43-44-559/597/516e-mail: mklissurski@yahoo.com

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·ËÎ̇ ‚‡ÍÒË̇ ÔÓÌËÊË Á̇˜ËÚÂÎÌÓ Á‡·Ó΂‡ÂÏÓÒÚÚ‡ ÓÚSSPE ‚ Ò‚ÂÚÓ‚ÂÌ Ï‡˘‡·. àÁÒΉ‚‡ÌÂÚÓ ˆÂÎË: 1.ìÒÚ‡ÌÓ-‚fl‚‡Ì ̇ „ËÒÚˇ̇ڇ Á‡·ÓÎflÂÏÓÒÚÚ‡ ÓÚ SSPE ̇·‡Á‡Ú‡ ̇ ÒÎÛ˜‡ËÚ ÓÚ ÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇,ìëÅÄãçè-åì, ëÓÙËfl Á‡ 25 „Ӊ˯ÂÌ ÔÂËÓ‰ (1978-2002„.); 2. Ä̇ÎËÁˇÌ ̇ ÍÎËÌ˘̇ڇ ı‡‡ÍÚÂËÒÚË͇ Ë 3.Ç˙ÁÏÓÊÌÓÒÚËÚ Á‡ ‡Ì̇ ‰Ë‡„ÌÓÒÚË͇. SSPE e ‰Ë‡„ÌÓÒ-ÚËˆË‡Ì ÔË 40 ‰Âˆ‡ (29 ÏÓϘÂÚ‡ Ë 11 ÏÓÏ˘ÂÚ‡ ̇Ò‰̇ ‚˙Á‡ÒÚ 8,5 „), 28 ÓÚ ÍÓËÚÓ ÓÚ 1978 ‰Ó1984 „. Ë 12- ÓÚ 1995 ‰Ó 2002 „. íẨÂ̈ËflÚ‡ Á‡ ÌÓ‚Ó Ôӂ˯‡‚‡Ì ̇˜ÂÒÚÓÚ‡Ú‡ ̇ SSPE (1995-2002 „) ÒΉ 10 „Ӊ˯ÂÌ ÔÂË-Ó‰ ·ÂÁ Á‡·ÓÎfl‚‡Ì (1985-1994 „.)  ҂˙Á‡Ì‡ Ò ÂÔˉÂÏËË ÓÚÏÓ·ËÎË ÔÂ‰Ë 10 „. Ë Ì‰ӂ̇ڇ ÔÓÚË‚ÓÏÓ·ËÎ̇ËÏÛÌËÁ‡ˆËfl. éÚ 40 ÒÎÛ˜‡fl 39 (97,5%) Ò‡ ÌÂËÏÛÌËÁˇÌË ËÒ‡ ·ÓΉۂ‡ÎË ‡ÌÓ ÓÚ ÏÓ·ËÎË (Ò‰̇ ‚˙Á‡ÒÚ- 11 ÏÂÒÂ-ˆ‡). íÂÁË ÂÁÛÎÚ‡ÚË ÔÓÚ‚˙ʉ‡‚‡Ú Á̇˜ÂÌËÂÚÓ Ì‡ ‡Ì-ÌÓÚÓ ·ÓΉۂ‡Ì ÓÚ ÏÓ·ËÎË Í‡ÚÓ Ù‡ÍÚÓ Á‡ ÔÂÒËÒÚË-‡˘‡ Ì‚ÓËÌÙÂ͈Ëfl Ë Ì‡ ÔÓÚË‚ÓÏÓ·ËÎ̇ڇ ‚‡ÍÒË̇ Á‡ÔÓÙË·ÍÚË͇ڇ ̇ SSPE. 燘‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ̇È-˜ÂÒÚÓ Â ÏÂÊ‰Û 8 Ë 11 „. (52,5%), Ò‰ÌÓ 7 ,0 „. ÒΉ ËÌ-ÙÂÍÚˇÌÂÚÓ. èÂÁ ÔÂËÓ‰‡ 1995-2002 „. ÔÂӷ·‰‡‚‡Ú‰Âˆ‡Ú‡ Ò ÔÓ-‡ÌÌÓ Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (Ò‰̇ ‚˙Á-‡ÒÚ 8,4 „.), ‚ Ò‡‚ÌÂÌËÂ Ò ÔÂËÓ‰‡ 1978-1984 „. (Ò‰̇‚˙Á‡ÒÚ 11,2 „.). 燘‡ÎÌË ÍÎËÌ˘ÌË ËÁfl‚Ë Ì‡ SSPE ‚Íβ˜-‚‡Ú ‰ÂÏÂ̈Ëfl (35%), ÂÍÒÚ‡ÔˇÏˉÌË ıËÔÂÍËÌÂÁË(29%), ÂÔËÎÂÔÚ˘ÂÌ ÒË̉ÓÏ (15%), ıÂÏËÔ‡ÂÁ‡ (10%),ÁËÚÂÎ̇ ‡„ÌÓÁËfl (10%), ‡Ù‡ÁËfl (3%). ë ‡ÒËÏÂÚ˘ÌÓ,‡ÚËÔ˘ÌÓ Ì‡˜‡ÎÓ Ì‡ ÒËÏÔÚÓχÚË͇ڇ Ò‡ 8 ‰Âˆ‡ (20%), 2ÓÚ ÍÓËÚÓ (5%) Ò ËÌÒÛÎÚÓ-ÔÓ‰Ó·ÌÓ ÔÓÚ˘‡ÌÂ. ë ÓÒÚÓÔÓÚ˘‡Ì ҇ 4 ‰Âˆ‡ (10%), Ò ıÓÌ˘ÂÌ ıÓ‰ Ò Ì‡‰ 2 „. ‚Ó-βˆËfl Ò‡ 8 ‰Âˆ‡ (20%). ê‡Ì̇ڇ ‰Ë‡„ÌÓÒÚË͇ Ò ÓÒÌÓ‚‡‚‡Ì‡ ı‡‡ÍÚÂ̇ڇ ÍÎËÌË͇ڇ, Ôӂ˯ÂÌËÚ ‡ÌÚËÏÓ·ËÎ-ÌËÚ ‡ÌÚËÚ· ‚ ÒÂÛÏ Ë ÎËÍ‚Ó (100%), ÎËÍ‚ÓÌË ÔÓ-ÏÂÌË Ò Îfl‚ ÚËÔ ÍÓÎÓˉ̇ ÍË‚‡ (100%), Ò۷ه͈ËÓÌˇ-ÌË „‡Ï‡ „ÎÓ·ÛÎËÌË (100%), ÖÖÉ Ò ê‡‰ÂÏÂÍÂÓ‚Ë ÍÓÏÔÎÂÍ-ÒË Ë ÏÓÁ˙˜Ì‡Ú‡ χ„ÌËÚÌÓ ÂÁÓ̇ÌÒ̇ ÚÓÏÓ„‡ÙËfl Ò ‰‚ÛÒ-Ú‡ÌÌË ÒËÏÂÚ˘ÌË (5/11ËÎË 45%) ËÎË ‡ÒËÏÂÚ˘ÌË ÎÂ-ÁËË ‚ ÔÓ‰ÍÓÓ‚ÓÚÓ ·flÎÓ ‚¢ÂÒÚ‚Ó (4/11 ËÎË 37%), ‰Ó͇-ÚÓ äí ÔÓ-Í˙ÒÌÓ ‚ËÁÛ‡ÎËÁˇ ÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl.äβ˜Ó‚Ë ‰ÛÏË: ëÛ·‡ÍÛÚÂÌ ÒÍÎÂÓÁˇ˘ Ô‡ÌÂ̈ÂÙ‡ÎËÚ(SSPE), Á‡·ÓÎflÂÏÓÒÚ, ‡ÚËÔ˘ÌË ÒÎÛ˜‡Ë, MRI, ÎËÍ‚ÓÌËÔÓÏÂÌË

ëÛ·‡ÍÛÚÌËflÚ ÒÍÎÂÓÁˇ˘ Ô‡ÌÂ̈ÂÙ‡ÎËÚ (SSPE),ÓÔËÒ‡Ì ÓÚ Dawson (1933), e ·‡‚ÌÓ‚ËÛÒ̇ ËÌÙÂ͈Ëfl Ò Ì‡-˜‡ÎÓ ‚ ‰ÂÚÒ͇ ‚˙Á‡ÒÚ, Ô˘ËÌÂ̇ ÓÚ ÔÂÒËÒÚˇ˘ ‚ËÛÒ̇ ÏÓ·ËÎË ËÎË Û·ÂÓ·. ÍÚÂËÁˇ ÒÂ Ò ÔÓ„ÂÒˇ˘ıÓ‰ ‚ ˜ÂÚËË ÒÚ‡‰Ëfl: ‰ÂÏÂ̈Ëfl Ë Ôӂ‰Â̘ÂÒÍË ÓÚÍÎÓÌÂ-ÌËfl; ÔË·‡‚flÌ ̇ ÂÍÒÚ‡ÔˇÏˉÌË ıËÔÂÍËÌÂÁË; ËÁ˜ÂÁ-‚‡Ì ̇ ıËÔÂÍËÌÂÁËÚ ̇ ÙÓ̇ ̇ ÒËÎÌÓ ËÁ‡ÁÂ̇ ÂÍÒÚ‡-ÔˇÏˉ̇ Ë ÔˇÏˉ̇ ÏÛÒÍÛÎ̇ ıËÔÂÚÓÌËfl; ÚÂÊÍË Ì‡-Û¯ÂÌËfl ̇ ÚÓÙË͇ڇ Ë Ì‡ ‡‚ÚÓÌÓÏÌËÚ ÙÛÌ͈ËË Ë ÎÂ-Ú‡ÎÂÌ ËÁıÓ‰ 1,6 ,26. ᇠÔÂÒËÒÚˇ˘‡Ú‡ Ì‚ÓËÌÙÂ͈ËflÓÒÌÓ‚ÌÓ Á̇˜ÂÌË ËÏ‡Ú ÏÌÓÊÂÒÚ‚Ó ÏÛÚ‡ˆËË Ì‡ ÏÓ·Ë-ÎÓÁÌËfl ‚ËÛÒ, Ó·ÛÒ·‚fl˘Ë ÔÓÌËÊÂÌÓ ‡ÁÔÓÁ̇‚‡Ì ÓÚËÏÛÌ̇ڇ ÒËÒÚÂχ, ‰ÂÙÂÍÚ ‚ ÂÔÎË͇ˆËflÚ‡ Ë ÓÒ‚Ó·ÓÊ-‰‡‚‡ÌÂÚÓ ÏÛ ÓÚ ËÌÙÂÍÚˇÌËÚ ÍÎÂÚÍË, ÔÓ‡‰Ë ̇Û-¯ÂÌ ÒËÌÚÂÁ ̇ å-ÔÓÚÂË̇ ̇ ‚˙̯̇ڇ ÏÛ Ó·‚˂͇.èË ‡ÌÓ Á‡·ÓÎÂÎËÚ ÓÚ ÏÓ·ËÎË ‰Âˆ‡ ËÌÙÂ͈ËflÚ‡ ıÓ-ÌËÙˈˇ Ë ÔÓ‡‰Ë ËÏÛÌ̇ڇ ÏÓ‰Û·ˆËfl ̇ ËÌÚ‡ÌÛÍ·-̇ڇ ÂÍÒÔÂÒËfl ̇ ‚ËÛÒ‡ ÓÚ ˆËÍÛΡ˘ËÚÂ, ÌÓ Ì‰ÓÒ-Ú‡Ú˙˜ÌË Ï‡È˜ËÌË ‡ÌÚËÚ· 6,10,19,26. éÚÍËÚËÂÚÓ,˜Â ÏÓ·ËÎÓÁÌËflÚ ‚ËÛÒ Â Ô˘ËÌËÚÂΠ̇ SSPE ÔÂÁ 1969„. Ë Ï‡ÒÓ‚ÓÚÓ ‚˙‚Âʉ‡Ì ̇ ÔÓÚË‚ÓÏÓ·ËÎ̇ڇ ‚‡ÍÒË-̇, ÔÓÌËÊËı‡ Á̇˜ËÚÂÎÌÓ Á‡·Ó΂‡ÂÏÓÒÚÚ‡ ÓÚ ÚÓÁËÔÓ„ÂÒˇ˘, Ù‡Ú‡ÎÂÌ Â̈ÂÙ‡ÎËÚ ‚ Ò‚ÂÚÓ‚ÂÌ Ï‡˘‡·10,16,19,20,26. ᇷÓ΂‡ÂÏÓÒÚÚ‡ ÓÚ SSPE ‚‡Ë‡ ÓÚ

1/106 ‚ ëÄô ‰Ó 20-100/106 ‚ Ò··Ó‡Á‚ËÚË ÒÚ‡ÌË Ò ÂÌ-‰ÂÏËË ÓÚ ÏÓ·ËÎË 6,17. ã‡ÚÂÌÚÌËflÚ ÔÂËÓ‰ ÓÚ ·ÓΉÛ-‚‡Ì ÓÚ ÏÓ·ËÎË ‰Ó ÍÎËÌ˘̇ڇ ÔÓfl‚‡ ̇ SSPE e Ò‰ÌÓ8 „.26, ͇ÁÛËÒÚËÍË Ò‡ ÒÎÛ˜‡ËÚ Ò˙Ò SSPE, ‡Á‚ËÎË Ò ÓÚ 3ÏÂÒˆ‡ ‰Ó 2 „. ÒΉ ÏÓ·ËÎË 13,15 , ͇ÍÚÓ Ë SSPE Û ‚˙Á-‡ÒÚÌË 7,14. éÒÌÓ‚ÂÌ Ù‡ÍÚÓ Á‡ ‚ËÛÒÌÓÚÓ ÔÂÒËÒÚˇ-ÌÂ Ë ‡Á‚ËÚË ̇ SSPE e ‡ÌÌÓÚÓ Á‡·ÓÎfl‚‡Ì ÓÚ ÏÓ·Ë-ÎË. èÓ ÂÔˉÂÏËÓÎӄ˘ÌË ‰‡ÌÌË Ì‡‰ 50% ÓÚ ·ÓÎÌËÚ Ò˙ÒSSPE Ò‡ ·ÓΉۂ‡ÎË ÓÚ ÏÓ·ËÎË ÔÂ‰Ë 2 „., ‡ 75%- Ô‰Ë4 „Ӊ˯̇ ‚˙Á‡ÒÚ 10. èË Á‡·ÓÎfl‚‡Ì ÔÓ‰ 1 „. Ëχ 16 Ô˙-ÚË ÔÓ-‚ËÒÓÍ ËÒÍ Á‡ SSPE, ÓÚÍÓÎÍÓÚÓ ÒΉ 6 „Ӊ˯̇‚˙Á‡ÒÚ, ‡ Ó·˘Ó ËÒÍ˙Ú Á‡ SSPE ÒΉ ·ÓΉۂ‡Ì ÓÚ ÏÓ-·ËÎË Â 28 Ô˙ÚË ÔÓ-‚ËÒÓÍ (4/100 000) ‚ Ò‡‚ÌÂÌËÂ Ò ËÒ͇Á‡ SSPE ÒΉ ‚‡ÍÒËÌˇÌ (0,14/100 000) 17. èÂÁ ÔÓÒΉ-ÌËÚ „Ó‰ËÌË ‚ Å˙΄‡Ëfl Á‡·Ó΂‡ÂÏÓÒÚÚ‡ ÓÚ SSPE Ò ÔÓ-‚˯‡‚‡ ‚˙‚ ‚˙Á͇ Ò ÂÔˉÂÏËË ÓÚ ÏÓ·ËÎË ÔÂ‰Ë 10 „. Ë̉ӂ̇ ÔÓÚË‚ÓÏÓ·ËÎ̇ ËÏÛÌËÁ‡ˆËfl, ͇ÚÓ Ò ̇·Î˛-‰‡‚‡Ú Ë ‡ÚËÔ˘ÌË ÙÓÏË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.

àÁÒΉ‚‡ÌÂÚÓ Ëχ Á‡ ˆÂÎ ‰‡ ÛÒÚ‡ÌÓ‚fl‚Ë ˜ÂÒÚÓڇڇ̇ „ËÒÚˇ̇ڇ Á‡·ÓÎflÂÏÓÒÚ, ÍÎËÌ˘ÌÓÚÓ ÔÓÚ˘‡-ÌÂ, ‰Ë‡„ÌÓÒÚË͇ڇ Ë Î˜ÂÌËÂÚÓ Ì‡ SSPE ‚˙Á ÓÒÌÓ‚‡ ̇‰‡ÌÌËÚ ̇ ÎÂÍÛ‚‡ÌËÚ ‰Âˆ‡ ‚ ÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎË-ÌË͇ Á‡ 25 „Ӊ˯ÂÌ ÔÂËÓ‰.

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SSPE e ‰Ë‡„ÌÓÒÚËˆË‡Ì ÔË 40 ‰Âˆ‡ ̇ Ò‰̇ ‚˙Á‡ÒÚ8,5 „ (29 ÏÓϘÂÚ‡ Ë 11 ÏÓÏ˘ÂÚ‡) ÔÂÁ ÔÂËÓ‰‡ 1978-2002 „. èË ‚Ò˘ÍË Ô‡ˆËÂÌÚË Â ÔÓÒΉÂ̇ ‰Ë̇ÏË͇ڇ ‚Ì‚ÓÎӄ˘ÌËfl ÒÚ‡ÚÛÒ, ÓÙÚ‡ÎÏÓÎӄ˘ÌËfl ÒÚ‡ÚÛÒ Ë ÖÖÉ.àÁ‚˙¯ÂÌÓ Â ÎËÍ‚ÓÌÓ ËÁÒΉ‚‡ÌÂ, ÒÂÓÎӄ˘ÌÓ ËÁÒΉ‚‡-Ì Á‡ ÏÓ·ËÎÓÁÂÌ ‚ËÛÒ ‚ ÒÂÛÏ Ë ÎËÍ‚Ó, ÍÓÏÔ˛Ú˙̇ÚÓÏÓ„‡ÙËfl (äí), ‡ ÔË 11 ‰Âˆ‡ - Ë Ï‡„ÌËÚÌÓ-ÂÁÓ̇ÌÒ̇ÚÓÏÓ„‡ÙËfl (åêí) ̇ „·‚ÂÌ ÏÓÁ˙Í. êÖáìãíÄíà

1. ᇷÓÎflÂÏÓÒÚ. чÌÌËÚ Á‡ Á‡·ÓÎflÂÏÓÒÚ ÓÚ SSPE,ÒÔÓ‰ Ó·˙˘‡ÂÏÓÒÚ Í˙Ï ÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇̇ ìëÅÄãçè "ë‚.ç‡ÛÏ", åì-ëÓÙËfl, Á‡ 25 „Ӊ˯ÂÌ ÔÂË-Ó‰ (1978-2002 „.) Ò‡ Ô‰ÒÚ‡‚ÂÌË Ì‡ îË„.1. ᇠÔÂËÓ‰‡1978-1984 „. Ò‡ ‰Ë‡„ÌÓÒÚˈˇÌË 28 ‰Âˆ‡ Ò˙Ò SSPE (Ò‰-ÌÓ 4 ÒÎÛ˜‡fl „Ӊ˯ÌÓ), Á‡ 10 „. (1985-1994 „.) Ì ҇ ̇·Î˛-‰‡‚‡ÌË ÒÎÛ˜‡Ë, ‡ ÔÂÁ ÔÓÒΉÌËÚ 7 „. (1995-2002 „) ËχÌÓ‚Ó Ôӂ˯‡‚‡Ì ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ ( 12 ÒÎÛ˜‡fl).

ë˙ÓÚÌÓ¯ÂÌË ÏÓϘÂÚ‡: ÏÓÏ˘ÂÚ‡  2,6:1. ᇷÓÎfl‚‡-ÌÂÚÓ Á‡ÔÓ˜‚‡ ÏÂÊ‰Û 3 Ë 16 „., ̇È-˜ÂÒÚÓ ÏÂÊ‰Û 8 Ë 11 „.(21 ‰Âˆ‡ ËÎË 52,5%). èÂÁ ÔÂËÓ‰‡ 1995-2002 „. ÔÂӷ·‰‡-‚‡Ú ‰Âˆ‡Ú‡ Ò ÔÓ-‡ÌÌÓ Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (Ò‰̇‚˙Á‡ÒÚ 8,4 „., ͇ÚÓ 4/12 ËÎË 33% Ò‡ ̇ ‚˙Á‡ÒÚ 4-5 „.), ‚Ò‡‚ÌÂÌËÂ Ò ÔÂËÓ‰‡ 1978-1984 „. (Ò‰̇ ‚˙Á‡ÒÚ 11,2 „.,͇ÚÓ 4/28 ËÎË 14,3% Ò‡ ÓÚ 3 ‰Ó 5 „.) (îË„Û‡ 2).

é·˘Ó ÓÚ 40-Ú ÒÎÛ˜‡fl 39 (97,5%) Ò‡ ÌÂËÏÛÌËÁˇÌË ËÒ‡ ·ÓΉۂ‡ÎË ‡ÌÓ ÓÚ ÏÓ·ËÎË (Ò‰̇ ‚˙Á‡ÒÚ- 11 ÏÂÒÂ-ˆ‡). ÇÒ˘ÍË 28 ‰Âˆ‡, Á‡·ÓÎÂÎË ÔÂÁ ÔÂËÓ‰‡ 1978-1984 „. Ò‡ÌÂËÏÛÌËÁˇÌË ( ‰ӂ̇ڇ ËÏÛÌËÁ‡ˆËfl Á‡ÔÓ˜‚‡ ÓÚ 1969„. Á‡ ̇‚˙¯ËÎËÚ 1 „). éÚ 12-Ú ·ÓÎÌË Ò˙Ò SSPE ÔÂÁ ÔÂ-ËÓ‰‡ 1995-2002 „. Ò‡ÏÓ Â‰ÌÓ ‰ÂÚ  ËÏÛÌËÁˇÌÓ, ‡ 11 Ò‡ÌÂËÏÛÌËÁˇÌË, 3 ÓÚ ÍÓËÚÓ Ò‡ ·ËÎË ÓÒ‚Ó·Ó‰ÂÌË ÔÓ Ï‰Ë-ˆËÌÒÍË ÔÓ͇Á‡ÌËfl. ë‰ÌËflÚ ÔÂËÓ‰ ÓÚ ·ÓΉۂ‡ÌÂÚÓ ÓÚÏÓ·ËÎË ‰Ó ËÁfl‚‡Ú‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Â 7,0 „. (ÓÚ 4 ‰Ó 14„.)

2. äÎËÌ˘̇ ı‡‡ÍÚÂËÒÚË͇ ̇ SSPE. 燘‡ÎÌËÚÂÍÎËÌ˘ÌË ËÁfl‚Ë Ì‡ SSPE ‚Íβ˜‚‡Ú ‰ÂÏÂ̈Ëfl (14 ‰Âˆ‡ ËÎË35%), ÂÍÒÚ‡ÔˇÏˉÌË ıËÔÂÍËÌÂÁË (11 ‰Âˆ‡ ËÎË 29%),ÂÔËÎÂÔÚ˘ÂÌ ÒË̉ÓÏ (6 ‰Âˆ‡ ËÎË 15%), ıÂÏËÔ‡ÂÁ‡ (4 ‰Â-ˆ‡ ËÎË 10%), ÁËÚÂÎ̇ ‡„ÌÓÁËfl (4 ‰Âˆ‡ ËÎË 10%), ıÓËÓÂ-ÚËÌËÚ, Ì‚ËÚ Ì‡ n.opticus Ë ‡Ù‡ÁËfl (ÔÓ Â‰ÌÓ ‰ÂÚ ËÎË3%) (îË„.3.). ÖÍÒÚ‡ÔˇÏˉÌËÚ ıËÔÂÍËÌÂÁË, ÛÒÚ‡ÌÓ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 151‰ÂÍÂÏ‚Ë, 2002

‚ÂÌË ÔË 11 ‰Âˆ‡, Ò‡ Ò ı‡‡ÍÚ ̇ ÏËÓÍÎÓÌËË (40%), ·‡-ÎËÁ˙Ï (30%), ıÂÏËÔ‡ÍËÌÒÓÌÓ‚ ÒË̉ÓÏ (20%), ÚÓÁËÓÌ-̇ ‰ËÒÚÓÌËfl (10%), ͇ÚÓ Ò ÍÓÏ·ËÌË‡Ú Ë ÔÓÏÂÌflÚ ÔÓÒÚÂÔÂÌ Ì‡ ËÁfl‚‡ ‚ ıÓ‰‡ ̇ ÔÓÒΉfl‚‡ÌÂÚÓ Ë ÔÓÒÚÂÔÂÌÌÓËÁ˜ÂÁ‚‡Ú ÔÂÁ ¨¨¨ ÒÚ‡‰ËÈ, ÍÓ„‡ÚÓ ‚Ӊ¢‡  ÚÂÊ͇ڇ ÂÍ-ÒÚ‡ÔˇÏˉ̇ ˄ˉÌÓÒÚ. ë ‡ÚËÔ˘ÌÓ, ‡ÒËÏÂÚ˘ÌÓ̇˜‡ÎÓ Ì‡ Ó„ÌË˘Ì‡Ú‡ Ì‚ÓÎӄ˘̇ ÒËÏÔÚÓχÚË͇ Ò‡ 8‰Âˆ‡ (20%), 2 ÓÚ ÍÓËÚÓ (5%) Ò ËÌÒÛÎÚÓ-ÔÓ‰Ó·ÌÓ ÔÓÚË-˜‡ÌÂ. èË Â‰ÌÓ ‰ÂÚ ÏËÓÍÎÓÌ˘ÌÓ-‡ÒÚ‡Ú˘ÌËÚ ÂÔËÎÂÔ-Ú˘ÌË ÔËÒÚ˙ÔË Ô‰¯ÂÒÚ‚‡Ú 7 ÏÂÒˆ‡ ‡Á‚ËÚËÂÚÓ Ì‡‰ÂÏÂ̈Ëfl. èË ‰Ë‡„ÌÓÒÚˈˇÌÂÚÓ ‚ ÍÎËÌ˘ÌË ÛÒÎÓ‚Ëfl·ÓÎÌËÚ ӷËÍÌÓ‚ÂÌÓ Ò‡ ‚˜ ‚˙‚ ¨¨ ÒÚ‡‰ËÈ Ë ÒËÏÔÚÓχ-ÚË͇ڇ ̇ SSPE  ‡Á„˙̇ڇ, Ò ËÁfl‚fl‚Â̇ ‰ÂÏÂ̈Ëfl (21‰Âˆ‡ ËÎË 53%), ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Ò ı‡‡ÍÚ ̇ ÏË-ÓÍÎÓÌ˘ÌÓ-‡ÒÚ‡Ú˘ÌË Ë ÔÓ-fl‰ÍÓ „Â̇ÎËÁˇÌË ÚÓÌ˘-ÌÓ-ÍÎÓÌ˘ÌË ÔËÒÚ˙ÔË (12 ‰Âˆ‡ ËÎË 29%), ÏËÓÍÎÓÌËË Ë‡Ô‡ÍÒËfl ( ÔÓ 8 ‰Âˆ‡ ËÎË 20%), ·‡ÎËÁ˙Ï, Ô‡ÍËÌÒÓÌÓ‚ ÒËÌ-‰ÓÏ, ‚Íβ˜ËÚÂÎÌÓ ÔÓ ıÂÏËÚËÔ, ÁËÚÂÎ̇ ‡„ÌÓÁËfl, „·-‚Ó·ÓÎË ( ‚ ÔÓ 5 ÒÎÛ˜‡fl ËÎË 12%), ‡Ù‡ÁËfl Ë ‡Ú‡ÍÒËfl (‚ ÔÓ4 ÒÎÛ˜‡fl ËÎË 9%). Ä‚ÚÓÌÓÏ̇ڇ ‰ËÒÙÛÌ͈Ëfl Ò ÔÓfl‚Ë Ì‡‰ËÁıˉÓÁ‡ Ë Ú‡ıË͇‰Ëfl  ˜ÂÒÚ ÒËÏÔÚÓÏ (10 ‰Âˆ‡ ËÎË24%), ͇ÚÓ ÔÂÁ ¨¨¨ Ë ¨V ÒÚ‡‰ËÈ ‚ 100% Ò‡ ̇Îˈ ͇ıÂÍ-ÒËfl, ÍËÁË ÓÚ ˆÂÌÚ‡Î̇ ıËÔÂÔËÂÍÒËfl, Ú‡ıË͇‰Ëfl, ‡-Ú¡Î̇ ıËÔÂÚÓÌËfl. (îË„.4.) ë ÓÒÚÓ ÔÓÚ˘‡Ì ҇ 4‰Âˆ‡ (10%), ıÓÌ˘ÌË ÙÓÏË Ò Ì‡‰ 2 „. ‚ÓβˆËfl Ò‡ ̇·Î˛-‰‡‚‡ÌË ÔË 8 (20%), ‰ÌÓ ÓÚ ÍÓËÚÓ Ëχ 5 „Ӊ˯ÂÌ ÔÒ‚-‰ÓÒÚ‡ˆËÓ̇ÂÌ ÔÂËÓ‰.

3. 臇ÍÎËÌ˘ÌË ËÁÒΉ‚‡ÌËfl ÔË ·ÓÎÌËÚ Ò˙Ò SSPE. èË ÎËÍ‚ÓÌËÚ ËÁÒΉ‚‡ÌËfl Ò ÛÒÚ‡ÌÓ‚fl‚‡ ı‡‡ÍÚÂÌË-Ú Á‡ SSPE ÔÓÏÂÌË: Îfl‚ ÚËÔ ÍÓÎÓˉ̇ ÍË‚‡ (100%), ÒÛ·-ه͈ËÓÌˇÌË „‡Ï‡ „ÎÓ·ÛÎËÌË (100%), Ôӂ˯ÂÌË IgG-‡Ì-ÚËÚ· (100%), ıËÔÂÔÓÚÂËÌÓ‡ıËfl (19/40 ËÎË 47,5%)̇΢ˠ̇ ‡ÌÚËÏÓ·ËÎÌËÚ IgG ‡ÌÚËÚ· ‚ ÚËÚË Ì‡‰1: 4 (100%).

Ç ÖÖÉ Ò „ËÒÚË‡Ú „Û·Ó ‰ÂÁÓ„‡ÌËÁˇ̇ ÓÒÌӂ̇‡ÍÚË‚ÌÓÒÚ Ë ÚËÔ˘ÌËÚ ꇉÂÏÂÍÂÓ‚Ë ÍÓÏÔÎÂÍÒË ÔÂÁ¨ Ë ¨¨ ÒÚ‡‰ËÈ ÔË ‚Ò˘ÍË ·ÓÎÌË, Ò ÔÓÒÚÂÔÂÌÌÓ ËÁ˜ÂÁ‚‡ÌÂ̇ ÔÂËӉ˘̇ڇ Ô‡ÓÍÒËÁχÎ̇ ‡ÍÚË‚ÌÓÒÚ ÔË Ì‡Ô‰-‚‡Ì ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ.

ç‚ÓËÁÓ·‡Áfl‚‡˘Ë ËÁÒΉ‚‡ÌËfl: äí ̇ „·‚ÂÌ ÏÓÁ˙Í ÂÌÓχÎ̇ ‚ ̇˜‡ÎÓÚÓ ÔË 38 ‰Âˆ‡, ÔË 1 Â Ò ‡ÒËÏÂÚ˘̇ÍÓÓ‚‡ ‡ÚÓÙËfl, ÔË 1- Ò Ó·¯ËÌË ‡ÒËÏÂÚ˘ÌË ıËÔÓ‰ÂÌ-ÁÌË ÁÓÌË ‚ ·flÎÓÚÓ ‚¢ÂÒÚ‚Ó ‰‚ÛÒÚ‡ÌÌÓ. èË ÔÓ-̇ڇ-Ú˙¯ÌÓ ÔÓÒΉfl‚‡Ì ÔË ‚Ò˘ÍË Ô‡ˆËÂÌÚË Ò ̇·Î˛‰‡‚‡ÍÓÓ‚‡ ‡ÚÓÙËfl Ë ‚˙Ú¯̇ ıˉӈÂÙ‡ÎËfl. åêí, ÓÒ˙-˘ÂÒÚ‚Â̇ ‚ ̇˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË 11 ÓÚ ‰Âˆ‡Ú‡ÔÂÁ ÔÂËÓ‰‡1996-2002 „., Â Ò Ô‡ÚÓÎӄ˘ÌË ÓÚÍÎÓÌÂÌËflÔË 9 ‰Âˆ‡ (82%), ‡ ÔË 2 ‰Âˆ‡  ·ÂÁ ÔÓÏÂÌË. ìÒÚ‡ÌÓ‚fl-‚‡Ú Ò ‰‚ÛÒÚ‡ÌÌË ıËÔÂËÌÚÂÌÁÌË ÔË í2 ËÁÏ‚‡Ì ÎÂ-ÁËË ‚ ÔÓ‰ÍÓÓ‚ÓÚÓ ·flÎÓ ‚¢ÂÒÚ‚Ó, ÒËÏÂÚ˘ÌË ÔË 5(45%) ËÎË ‡ÒËÏÂÚ˘ÌË ÔË 4 (37%) (îË„ÛË 5, 6, 7). ãÂ-˜ÂÌËÂ Ò Isoprinosine  Ôӂ‰ÂÌÓ ÔË 8 ·ÓÎÌË- 2 Ò ÓÒÚÓÔÓÚ˘‡ÌÂ, ÔË Â‰ÌÓ Ò ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂ-ÚÓ 7 ÏÂÒˆ‡, ÔË 5 Ò ıÓÌ˘ÌÓ ÔÓÚ˘‡Ì ̇‰ 2 „. (‰ÌÓ‰ÂÚÂ- 5 „.).

è‰ÒÚ‡‚flÏ 3 ̇·Î˛‰ÂÌËfl Ò ÓÚÌÓÒËÚÂÎÌÓ fl‰ÍÓ,‡ÚËÔ˘ÌÓ, ‡ÒËÏÂÚ˘ÌÓ Ì‡˜‡ÎÓ Ì‡ ÒËÏÔÚÓχÚË͇ڇ ËMPT ÎÂÁËËÚÂ Ë ÓÒÚÓ ËÎË ıÓÌ˘ÌÓ ÔÓÚ˘‡ÌÂ.

燷β‰ÂÌË 1. SSPE Ò ËÌÒÛÎÚÓÓ·‡ÁÌÓ Ì‡˜‡ÎÓ Ë ÓÒÚÓÔÓÚ˘‡Ì (Ä.Å.ä., 10 „. àá‹551/ 2001 „.). åÓϘ ̇ 10„., ·ÓΉۂ‡ÎÓ ÓÚ ÏÓ·ËÎË Ì‡ 1 „., Ò "ÑÂÚÒ͇ ˆÂ·‡Î̇ԇ‡ÎËÁ‡, ΂ÓÒÚ‡Ì̇ ˆÂÌÚ‡Î̇ ·ÚÂÌÚ̇ ıÂÏËÔ‡Â-Á‡", ÎÂÍÓÒÚÂÔÂÌÂÌ ËÌÚÂÎÂÍÚÛ‡ÎÂÌ ‰ÂÙˈËÚ Ë ÔÓÒÚÚ‡‚-ÏÂ̇ ‰‚ÛÒÚ‡Ì̇ ‡Ï·ÎËÓÔËfl ÔË ÂÍÒÚËÔˇÌË Ó˜ÌË ÎÂ-˘Ë, ÔË ÍÓÂÚÓ ‚ÌÂÁ‡ÔÌÓ ÒΉ Ò˙·Ûʉ‡Ì ÓÚ Ò˙Ì Ò ÍÓÌÒ-Ú‡Úˇ ΂ÓÒÚ‡Ì̇ ˆÂÌÚ‡Î̇ ıÂÏËÔ΄Ëfl, „·‚Ó·ÓÎËÂ.ç‚ÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ: ÄÏ·ÎËÓÔËfl, ΂ÓÒÚ‡Ì̇ ˆÂÌÚ-

‡Î̇ ÚÂÊ͇ ıÂÏËÔ‡ÂÁ‡, ÔÓ ËÁ‡ÁÂ̇ ‚ ˙͇ڇ ÔË Ôˇ-ÏˉÌË ÂÙÎÂÍÒÌË ÔÓÏÂÌË Ë ‚ ‰ÂÒÌË Í‡ÈÌˈË- ‰‚ÛÒÚ‡Ì-̇ ıËÔÂÂÙÎÂÍÒËfl sin>dex, ‡Á¯ËÂÌË ÂÙÎÂÍÒÓ„ÂÌÌË ÁÓ-ÌË, ÔÓÎÓÊËÚÂÎÌË ÂÙÎÂÍÒË ÓÚ „ÛÔ‡Ú‡ ̇ Ň·ËÌÒÍË ‰‚ÛÒ-Ú‡ÌÌÓ. äí ̇ „·‚ÂÌ ÏÓÁ˙Í Â ÌÓχÎ̇, åêí- Ò ıËÔÂËÌ-ÚÂÌÁÌË ÔË í2 ËÁÏ‚‡Ì ӷ¯Ë̇ ÁÓ̇ ‚ ·flÎÓÚÓ ÏÓÁ˙˜-ÌÓ ‚¢ÂÒÚ‚Ó ‚ ‰flÒÌÓ ÙÓÌÚÓ- Ô‡ËÂÚÓ-Ó͈ËÔËÚ‡ÎÌÓ ËχÎ͇ ÁÓ̇ ‚ ΂Ëfl centrum semiovale (îË„Û‡ 5). ãËÍ‚Ó-ÌÓ ËÁÒΉ‚‡ÌÂ- Îfl‚ ÚËÔ ÍÓÎÓˉ̇ ÍË‚‡, ·ÂÎÚ˙Í 0,41„/Î,Ò۷ه͈ËÓÌˇÌË „‡Ï‡ „ÎÓ·ÛÎËÌË Ò ÙÓÏˇÌ ̇ ÚË åÍÓÏÔÓÌÂÌÚ‡. èӂ˯ÂÌË ‡ÌÚËÏÓ·ËÎÌË IgG-‡ÌÚËÚ· ‚ÎËÍ‚Ó 1:16. äí ÒΉ 2 ÏÂÒˆ‡- Ó·˘‡ ÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl ˉ‚ÛÒÚ‡ÌÌË ÒËÏÂÚ˘ÌË Ó͈ËÔËÚ‡ÎÌË ÔÓ‰ÍÓÓ‚Ë ıËÔÓ-‰ÂÌÁÌË ÁÓÌË. Ç ıÓ‰‡ ̇ ÔÓÒΉfl‚‡ÌÂÚÓ ÒΉ Ô˂ˉ̇ "Â-ÏËÒËfl" ‚ ͇fl ̇ Ô˙‚Ëfl ÏÂÒˆ Ë Ò‡ÏÓÒÚÓflÚÂÎ̇ ÔÓıӉ͇ÚËÔ ÇÂÌËÍÂ-å‡Ì, ‡Á‚Ë‚‡ ‡Ô‡ÍÒËfl ̇ ÔÓıӉ͇ڇ, ÚÓÌÛ-ÒÓ‚Ë ÔÓÏÂÌË ÔÓ ÚËÔ‡ ̇ spasmus mobillis Ë ÔÓÒΉ‚‡˘ÓÁ̇˜ËÚÂÎÌÓ Ôӂ˯‡‚‡Ì ÏÛÒÍÛÎÌËfl ÚÓÌÛÒ ÔÓ Ë„Ë‰ÂÌ ÚËÔ‰‚ÛÒÚ‡ÌÌÓ; ÔÓfl‚fl‚‡Ú Ò ÏËÓÍÎÓÌ˘ÌÓ-‡ÒÚ‡Ú˘ÌË ÔËÒ-Ú˙ÔË, ‡‚ÚÓÌÓÏ̇ ‰ËÒÙÛÌ͈Ëfl Ò ıËÔÂıˉÓÁ‡, ‡Ú¡Î-̇ ıËÔÂÚÓÌËfl, Ú‡ıË͇‰Ëfl, ıËÔÂÚÂÏËfl. Exitus letaliṡÒÚ˙Ô‚‡ 3 ÏÂÒˆ‡ ÒΉ ̇˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.燷β‰ÂÌË 2. SSPE Ò ‡ÒËÏÂÚ˘ÌÓ Ì‡˜‡ÎÓ Ë ıÓÌ˘ÌÓÔÓÚ˘‡ÌÂ. (å.å.è., 11 „.àá ‹26 Ë 80/1997 „.) åÓÏ˘Â,ÌÂËÏÛÌËÁˇÌÓ ÔÓÚË‚ ÏÓ·ËÎË, Ô·ÓΉۂ‡ÎÓ ÓÚ ÏÓ-·ËÎË Ì‡ 1 „. Ë 10 ÏÂÒ. ç‡ 11 „. ÓÒÚÓ Ò ‡Á‚Ë‚‡ ‡ÍˆËÓÌÂÌÚÂÏÓ ‚ ‰flÒ̇ڇ ˙͇, ÔË·‡‚flÚ Ò ÔÓ„ÂÒˇ˘Ë „ÌÓÒ-Ú˘ÌË, Ô‡ÏÂÚÓ‚Ë Ì‡Û¯ÂÌËfl Ë ‡Ô‡ÍÒ˘ÌË ÔÓfl‚Ë Ò ÙÎÛÍ-ÚÛˇ˘ ıÓ‰ Á‡ 4 ÏÂÒˆ‡. ëΉ‚‡ ‚ÎÓ¯‡‚‡ÌÂ Ò ËÁfl‚‡ ̇ ˜Â-ÎÂÌ ÒË̉ÓÏ (ˉeÓÏÓÚÓ̇ ‡Ô‡ÍÒËfl, ÏÓÚÓ̇ ‡Ù‡ÁËfl,ÒÔ„̇ÚÓ ÓÚÍÎÓÌÂÌË ̇ „·‚‡Ú‡ Ë ÔӄΉ‡ ̇‰flÒÌÓ),ÔË·‡‚fl Ò ÂÍÒÚ‡ÔˇÏˉ̇ ÒËÏÔÚÓχÚË͇ Ò Ì‡˜‡ÎÂÌspasmus mobillis, ‚ÔÓÒΉÒÚ‚ËÂ Ò ÚÂÊ͇ ÏÛÒÍÛÎ̇ ˄ˉ-ÌÓÒÚ Ë ‰ËÒÚÓÌËfl, Ôӂ˜ ‚ ‰ÂÒÌËÚ ͇ÈÌˈË. 䂇‰ËÔË-‡Ïˉ̇ڇ ÒËÏÔÚÓχÚË͇  ‰ËÒÍÂÚ̇, ÔÓ-χÌËÙÂÒÚ̇‚ ‰flÒÌÓ. èÂÁ 5-ÚËfl ÏÂÒˆ Ò ÔË·‡‚flÚ ÏËÓÍÎÓÌËË, ·‡-ÎËÒÚ˘ÌË Ë ıÓÂÓ‡ÚÂÚÓÁÌË ıËÔÂÍËÌÂÁË ÔÓ ıÂÏËÚËÔ ‚‰ÂÒÌËÚ ͇ÈÌˈË. àÁfl‚fl‚‡Ú Ò ˆÂÌÚ‡ÎÌË ‚„ÂÚ‡ÚË‚ÌË̇ۯÂÌËfl, ÒÚ‚ÓÎÓ‚Ë ‰ËÒÙÛÌ͈ËË Ò ‰ËÒÙ‡„Ëfl Ë ËÌ‚ÂÒËfl̇ Ò˙Ìfl. Ñˇ„ÌÓÁ‡Ú‡ "SSPE" Ò ÔÓÒÚ‡‚Ë Ì‡ ·‡Á‡Ú‡ ̇ ÍÎË-Ì˘̇ڇ ͇ÚË̇ Ë ÎËÍ‚ÓÌËÚ ÔÓÏÂÌË: Îfl‚ ÚËÔ ÍÓÎÓË-‰Ì‡ ÍË‚‡, ÎÂ͇ ÔÓÚÂËÌÓ‡ıËfl (0.72 g/l), ÓÎË„ÓÍÎÓ̇ÎÌÓÙ‡„ÏÂÌÚˇÌË „‡Ï‡„ÎÓ·ÛÎËÌË Ë ‚ËÒÓÍË ÚËÚË Ì‡ ‡ÌÚË-ÏÓ·ËÎÌË IgG-‡ÌÚËÚ· ‚ ÎËÍ‚Ó (1:16, 1:32 ‚ ‰Ë̇ÏË͇)Ë ‚ ÒÂÛÏ (1:512), ÖÖÉ Ò ÚËÔ˘ÌËÚ Á‡ SSPE ꇉÂÏÂÍÂ-Ó‚Ë Ô‡ÓÍÒËÁÏË. èÂÁ 4-ÚËfl ÏÂÒˆ åêí ÔË T2W ËÁÏÂ-‚‡Ì ‡ÁÍË‚‡ Ó·¯Ë̇ ıËÔÂËÌÚÂÌÁ̇ ‰ÂÒÌÓÒڇ̇ÙÓÌÚ‡Î̇ ÎÂÁËfl ‚ ÒË‚ÓÚÓ Ë ·flÎÓ ‚¢ÂÒÚ‚Ó (îË„Û‡ 6),‰Ó͇ÚÓ äí  ÌÓχÎ̇; ÔÂÁ 6-ÚËfl ÏÂÒˆ ÔË äí Ò ÛÒÚ‡-ÌÓ‚fl‚‡ ËÁ‡ÁÂ̇ ÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl ‰‚ÛÒÚ‡ÌÌÓ, Ô‰ËÏÌÓ˜ÂÎÌÓ-Ô‡ËÂÚ‡ÎÌÓ. èÓ‚Âʉ‡ ҠΘÂÌËÂ Ò Isoprinosine,ÔÓÒΉÂ̇  5 „. Ë Â ‚ ÒÚ‡ˆËÓÌˇÌÓ "‚„ÂÚ‡ÚË‚ÌÓ Ò˙Ò-ÚÓflÌËÂ".

燷β‰ÂÌË 3. SSPE Ò ‡ÒËÏÂÚ˘ÌÓ Ì‡˜‡ÎÓ Ë Ô˂ˉÌË"ÂÏËÒËË" (É.å.ü., 5 „. àá ‹ 358/1997). åÓÏ˘ ̇ 6 „Ó-‰ËÌË, Ô·ÓΉۂ‡ÎÓ ÓÚ ÏÓ·ËÎË Ì‡ 6 ÏÂÒ˜̇ ‚˙Á‡ÒÚ,ÔË ÍÓÂÚÓ ‚ Ô˙ÎÌÓ Á‰‡‚ Ò ËÁfl‚fl‚‡Ú ‰ËÒÚÓÌÌË ÔÓfl‚Ë ‚ÎÂ‚Ë Í‡ÈÌˈË, ‡Á‚Ë‚‡ ΂ÓÒÚ‡ÌÂÌ ıÂÏËÔ‡ÍËÌÒÓÌËÁ˙Ï,ÁËÚÂÎ̇ ‡„ÌÓÁËfl, ‡Ô‡ÍÒËfl, ‰ÂÏÂ̈Ëfl Ò ÔÓfl‚Ë Ì‡ ÂıÓ·-ÎËfl Ë ÂıÓÔ‡ÍÒËfl, Ú‡ÁÓ‚Ó-ÂÁ‚Ӈ̇ ËÌÍÓÌÚËÌÂ̈Ëfl.Ñ‚‡ ÏÂÒˆ‡ ÔÓ-Í˙ÒÌÓ ‚ ‰ÂÒÌËÚ ͇ÈÌËˆË Ò p‡Á‚Ë‚‡ spas-mus mobillis, ÔÓfl‚fl‚‡Ú Ò ÏËÓÍÎÓÌËË Ë ‡ÚÓÌ˘ÌË ÙÂÌÓÏÂ-ÌË Ò ı‡‡ÍÚ ̇ "ÔÓÍÎÓÌË". 䂇‰ËÔˇÏˉ̇ڇ ÒËÏÔ-ÚÓχÚË͇  ‰ËÒÍÂÚ̇. ãËÍ‚ÓÌÓÚÓ ËÁÒΉ‚‡ÌÂ Â Ò ÚË-Ô˘̇ڇ Á‡ SSPE ÎÂÍÓÒÚÂÔÂÌ̇ ÔÓÚÂËÌÓ‡ıËfl (0.5 g/l),Ò۷ه͈ËÓÌˇÌË „‡Ï‡„ÎÓ·ÛÎËÌË Ò ‰‚‡ å-ÍÓÏÔÓÌÂÌÚ‡,Û‚Â΢ÂÌË IgG-‡ÌÚËÏÓ·ËÎÌË ‡ÌÚËÚ· ‚ ÎËÍ‚Ó (1:8 ‰Ó

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 152‰ÂÍÂÏ‚Ë, 2002

1:16) Ë ‚ ÒÂÛÏ (1:256). ÖÖÉ Â Ò „Û·Ó ‡·ÌÓÏ̇ ‚ËÒÓÍÓ‚ÓÎ-Ú‡Ê̇ ÓÒÌӂ̇ ‡ÍÚË‚ÌÓÒÚ Ë ‰‚ÛÒÚ‡ÌÌÓ ÒËÌıÓÌÌË Ô‡-ÓÍÒËÁÏË ÓÚ ÏÌÓÊÂÒÚ‚ÂÌË ÓÒÚËfl-·‡‚̇ ‚˙Î̇. äí ̇ÏÓÁ˙͇ ÔÓ͇Á‚‡ ‰ËÙÛÁÌÓ ÔÓÌËÊÂ̇ ÔÎ˙ÚÌÓÒÚ ‰‚ÛÒÚ‡ÌÌÓÔÂË‚ÂÌÚËÍÛ·ÌÓ, åêí Â Ò ‡ÒËÏÂÚ˘ÌË ÔÓ‰ÍÓÓ‚Ë ıË-ÔÂËÌÚÂÁÌË ÁÓÌË - Ó·¯Ë̇ ‚ ‰flÒÌÓ Ô‡ËÂÚÓ-ÚÂÏÔÓÓ-Ó͈ËÔËÚ‡ÎÌÓ Ë ÔÓ-χÎ͇ ‚ Îfl‚Ó Ó͈ËÔËÚÓ-ÚÂÏÔÓ‡ÎÌÓ;̉ÓÒÚ‡Ú˙˜Ì‡ ‰ËÙÂÂ̈ˇˆËfl ÏÂÊ‰Û ÒË‚ÓÚÓ Ë ·flÎÓ ‚Â-˘ÂÒÚ‚Ó (îË„Û‡ 7 ).

éÅëöÜÑÄçÖᇷÓ΂‡ÂÏÓÒÚÚ‡ ÓÚ SSPE e ÓÚ 1/106 ÔË Â‰Ó‚ÌË

ËÏÛÌËÁ‡ˆËË Á‡ ÏÓ·ËÎË ‰Ó 20/106 Ë ‰ÓË 100/106 ‚ Ò··Ó‡Á‚ËÚË ÒÚ‡ÌË, ẨÂÏ˘ÌË Á‡ ÏÓ·ËÎË6,17,20. Ñˇ„ÌÓÒ-ÚˈˇÌËÚ 28 ÒÎÛ˜‡fl ‚ ̇¯‡Ú‡ ÍÎËÌË͇ Á‡ ÔÂËÓ‰‡1978-1984 „. (Ò‰ÌÓ 4/„Ӊ˯ÌÓ), Ò‡ ÌÂËÏÛÌËÁˇÌË ‰Âˆ‡,ÌÂÓ·ı‚‡Ì‡ÚË ÓÚ Á‡‰˙ÎÊËÚÂÎ̇ڇ ËÏÛÌËÁ‡ˆËfl, ̇ Ò‰̇‚˙Á‡ÒÚ 11,2 „., ‡Á·ÓÎÂÎË Ò Ò‰ÌÓ 7 „. (ÓÚ 4 ‰Ó 14 „.)ÒΉ ËÌÙÂÍÚˇÌÂÚÓ Ò ÏÓ·ËÎË. ëΉ ‚˙‚Âʉ‡ÌÂÚÓ Ì‡ÔÓÚË‚ÓÏÓ·ËÎ̇ ËÏÛÌËÁ‡ˆËfl ‚ Å˙΄‡Ëfl ÓÚ 1969 „. Á‡‰Âˆ‡Ú‡ ̇ 1 „., Ò ̇·Î˛‰‡‚‡ Á̇˜ËÚÂÎÌÓ ÒÌËʇ‚‡Ì ̇ Á‡-·Ó΂‡ÂÏÓÒÚÚ‡ ÓÚ ÏÓ·ËÎË, ‡ ‚ÔÓÒΉÒÚ‚ËÂ Ë ÓÚ SSPE.Ç Ñçä ‚ ÔÓ‰˙ÎÊÂÌË ̇ 10 „.(1985-1994) Á‡·ÓÎfl‚‡ÌÂÚÓÌ  ̇·Î˛‰‡‚‡ÌÓ. íÂÁË ÂÁÛÎÚ‡ÚË Ò‡ Ó˜‡Í‚‡ÌË, Îӄ˘ÌË Ë‰Ó͇Á‚‡Ú ‚‡Ê̇ڇ ÓÎfl ̇ ÔÓÚË‚ÓÏÓ·ËÎ̇ڇ ËÏÛÌË-Á‡ˆËfl Á‡ ÔÓÙË·ÍÚË͇ ̇ ÏÓ·ËÎË Ë Ò˙ÓÚ‚ÂÚÌÓ Ì‡ ÔÂ-ÒËÒÚˇ˘‡Ú‡ Ì‚ÓËÌÙÂ͈Ëfl SSPE, ÔÓfl‚fl‚‡˘‡ Ò Ò‰-ÌÓ 8 „. ÒΉ ËÌÙÂÍÚˇÌÂÚÓ 5,25. çÓ‚ÓÚÓ Á‡˜ÂÒÚfl‚‡ÌÂÚÓ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ ÓÚ 1995 ‰Ó 2002 „. (12 ÒÎÛ˜‡fl Á‡ 7 „.) ÂÒ‚˙Á‡ÌÓ Ò ÂÔˉÂÏËË ÓÚ ÏÓ·ËÎË ÔÂÁ ÔÓÒΉÌËÚ 10 „. Ë̉ӂ̇ڇ ÔÓÚË‚ÓÏÓ·ËÎ̇ ËÏÛÌËÁ‡ˆËfl. ᇷÓÎÂÎËÚÂÔÂÁ ÚÓÁË ÔÂËÓ‰ ‰Âˆ‡ Ò‡ Ò ÔÓ-ÌËÒ͇ Ò‰̇ ‚˙Á‡ÒÚ (8,35„.), ÔÓ-˜ÂÒÚÓ Ò ÔÓ-͇Ú˙Í ËÌÍÛ·‡ˆËÓÌÂÌ ÔÂËÓ‰ (3-4 „. ÔË33%) Ë ‡ÌÌÓ Á‡·ÓÎfl‚‡Ì ÓÚ ÏÓ·ËÎË (ÏÂÊ‰Û 6 Ï. Ë 2 „).ᇘÂÒÚfl‚‡Ì ̇ SSPE Ò ̇·Î˛‰‡‚‡ Ë ÒΉ ÏÓ·ËÎÓÁÌËÂÔˉÂÏËË ‚ ëÄô 9.

äÎËÌ˘̇ڇ ı‡‡ÍÚÂËÒÚË͇ ̇ ̇·Î˛‰‡‚‡ÌËÚ ÓÚÌ‡Ò ÒÎÛ˜‡Ë  ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ÓÔË҇̇ڇ ‚ ÎËÚ‡ÚÛ‡-Ú‡. àÁ‚ÂÒÚ̇  ÔÓ-˜ÂÒÚ‡Ú‡ Á‡·Ó΂‡ÂÏÓÒÚ Ò‰ ÏÓϘÂ-Ú‡Ú‡ (2-4:1) 6, 12,26. ëÔÓ‰ ̇¯ËÚ ‰‡ÌÌË Ò˙ÓÚÌÓ¯Â-ÌËÂÚÓ ÏÓϘÂÚ‡:ÏÓÏ˘ÂÚ‡  2,6:1. ëΉ ‰˙Î˙„ ËÌÍÛ·‡ˆË-ÓÌÂÌ ÔÂËÓ‰ (Ò‰ÌÓ 8 „.) Ò ‡Á‚ËÚË‚‡ ÔÓ„ÂÒˇ˘‡ ‰Â-ÏÂ̈Ëfl (¨ ÒÚ‡‰ËÈ), ÔË·‡‚flÚ Ò ÂÍÒÚ‡ÔˇÏˉÌË ıËÔÂ-ÍËÌÂÁË (¨¨ ÒÚ‡‰ËÈ), ËÁ˜ÂÁ‚‡Ú ıËÔÂÍËÌÂÁËÚ ̇ ÙÓ̇ ̇ËÁ‡ÁÂ̇ ÂÍÒÚ‡ÔˇÏˉ̇ Ë ÔˇÏˉ̇ ÏÛÒÍÛÎ̇ ıËÔÂ-ÚÓÌËfl (¨¨¨ ÒÚ‡‰ËÈ) Ë ÚÂÏË̇Î̇ ÚÂÊ͇ ‡‚ÚÓÌÓÏ̇‰ËÒÙÛÌ͈ËË ÔË ‚„ÂÚ‡ÚË‚ÌÓ Ò˙ÒÚÓflÌË (¨V ÒÚ‡‰ËÈ)6,26. à ÔË Ì‡¯ËÚ ̇·Î˛‰ÂÌËfl ‚Ӊ¢ ‡ÌÂÌ ÒË̉ÓÏ Â‰ÂÏÂ̈ËflÚ‡ (35%), ÌÓ ÔË 15% Ò‡ ̇Îˈ ̇˜‡ÎÌË ÂÔËÎÂÔ-Ú˘ÌË ÔËÔ‡‰˙ˆË, ÔË 10%- ıÂÏËÔ‡ÂÚ˘ÂÌ ÒË̉ÓÏ (2‰Âˆ‡ Ò ÔÒ‚‰ÓËÌÒÛÎÚÌÓ, 2 ‰Âˆ‡ Ò ÔÒ‚‰ÓÚÛÏÓÌÓ ÔÓÚË-˜‡ÌÂ), ÔË ‰Û„Ë 10% Ò‡ ̇Îˈ ÁËÚÂÎ̇ ‡„ÌÓÁËfl, ıÓËÓ-ÂÚËÌËÚ Ë Ì‚ËÚ Ì‡ ÁËÚÂÎÌËfl Ì‚, ÚËÔ˘ÌË Á‡ ıÓ-Ì˘̇ڇ ÏÓ·ËÎÓÁ̇ ËÌÙÂ͈Ëfl 6,26. éÚ ÂÍÒÚ‡ÔˇÏˉ-̇ڇ ÒËÏÔÚÓχÚË͇, ËÁfl‚fl‚‡˘‡ Ò ÔÂÁ ¨¨ ÒÚ‡‰ËÈ, ̇È-˜ÂÒÚË Ò‡ ÏËÓÍÎÓÌ˘ÌËÚ ıËÔÂÍËÌÂÁË, ÌÓ ÔË 30% ËχıÂÏË·‡ÎËÁ˙Ï, ÔË 20%- ıÂÏËÔ‡ÍËÌÒÓÌÓ‚ ÒË̉ÓÏ. ä‡ÚÓËÁÍβ˜ÂÌË ԇÍËÌÒÓÌÓ‚ËflÚ ÒË̉ÓÏ ÏÓÊ ‰‡ ·˙‰‡ ̇-˜‡Î̇ ËÁfl‚‡ ̇ SSPE ÔË ‚ËÁÛ‡ÎËÁˇÌË ÎÂÁËË ‚ ·‡Á‡ÎÌËÚÂfl‰‡ 18,22,27. éÔËÒ‡ÌËÚ ÓÚ Ì‡Ò ‡ÚËÔ˘ÌË ÒÎÛ˜‡Ë Ò ‡ÒË-ÏÂÚ˘ÌÓ Ì‡˜‡ÎÓ Ì‡ ÒËÏÔÚÓχÚË͇ڇ Ë ‡ÒËÏÂÚ˘ÌË̇ıÓ‰ÍË ÔË åêí2,8 Ò‡ fl‰ÍÓÒÚ ‚ ÎËÚ‡ÚÛ‡Ú‡11,21.A.Kornberg Ë Ò˙‡‚Ú.13 Ô‰ÒÚ‡‚flÚ 2-„Ӊ˯ÌÓ ‰ÂÚ Ò˙ÒSSPE Ò Ì‡˜‡Î̇ ÔÓ„ÂÒˇ˘‡ ıÂÏËÔ‡ÂÁ‡ Ë ÙÓ͇ÎÂÌ ÂÔË-ÎÂÔÚ˘ÂÌ ÒË̉ÓÏ ÔË Â‰ÌÓÒÚ‡Ì̇ ıÂÏËÒÙ¡Î̇ ÍÓÓ-‚‡ ÎÂÁËfl. ÖÔËÎÂÔÚ˘ÌËflÚ ÒË̉ÓÏ Â Ô˙‚‡ ÔÓfl‚‡ ̇SSPE ÔË 15 % ÓÚ Ì‡¯ËÚ ·ÓÎÌË (6/40), ͇ÚÓ ÔË Â‰ÌÓ‰ÂÚ ÏËÓÍÎÓÌ˘ÌÓ-‡ÒÚ‡Ú˘ÌËÚ ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙-

ÔË Ô‰¯ÂÒÚ‚‡Ú 6 ÏÂÒˆ‡ ‡Á‚ËÚËÂÚÓ Ì‡ ‰ÂÏÂ̈ËflÚ‡ ËÔÓÒÚ‡‚flÌÂÚÓ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡ SSPE. ÄÚËÔ˘ÌËÚ ÒÎÛ˜‡Ë ÒËÁfl‚ÂÌ Ì‡˜‡ÎÂÌ ÂÔËÎÂÔÚ˘ÂÌ ÒË̉ÓÏ, ‚Íβ˜ËÚÂÎÌÓ Ò ‡·-Ò‡ÌÒÂÌ ÒÚ‡ÚÛÒ Ò‡ ÏÌÓ„Ó Â‰ÍË 23. A.Kornberg Ë Ò˙‡‚Ú. 13ÔÓ‰˜ÂÚ‡‚‡Ú, ˜Â ÔË Ï‡ÎÍË ‰Âˆ‡ Ò˙Ò SSPE ‚Ó‰Â˘Ë ÏÓ„‡Ú‰‡ ·˙‰‡Ú ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË Ë ÚÓ‚‡ Úfl·‚‡ ‰‡ ÒÂËχ Ô‰‚ˉ ‚ ‰ËÙÂÂ̈ˇÎÌÓ-‰Ë‡„ÌÓÒÚ˘ÂÌ ‡ÒÔÂÍÚ ÔËÚ‡Ô‚Ú˘ÌÓ ÂÁËÒÚÂÌÚÂÌ, ÓÒÓ·ÂÌÓ ÙÓ͇ÎÂÌ ÂÔËÎÂÔÚË-˜ÂÌ ÒË̉ÓÏ Ë ÔÓ„ÂÒˇ˘‡ ıÂÏËÔ‡ÂÁ‡. èË ÔÓÒÚ‡‚flÌÂ-ÚÓ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡ "SSPE" ÂÔËÎÂÔÚ˘ÂÌ ÒË̉ÓÏ Ò ÛÒÚ‡-ÌÓ‚fl‚‡ ÔË 29% ÓÚ Ì‡¯ËÚ ԇˆËÂÌÚË, ÛÒÔÓ‰ÌÓ Ò ‰Â-ÏÂ̈Ëfl, ‰ËÒÔ‡ÍÒËfl Ë ÂÍÒÚ‡ÔˇÏˉ̇ ÒËÏÔÚÓχÚË͇.É·‚Ó·ÓÎËÂ, Ò‚˙Á‡ÌÓ Ò ‡ÍÚË‚ÂÌ ‚˙ÁÔ‡ÎËÚÂÎÂÌ ÔÓˆÂÒ ÒÂ̇·Î˛‰‡‚‡ ÔÂÁ ¨ Ë ¨¨ ÒÚ‡‰ËÈ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË 12%ÓÚ Ì‡¯ËÚ ԇˆËÂÌÚË. Ä‚ÚÓÌÓÏÌËÚ ‰ËÒÙÛÌ͈ËË Ò‡ ÌÂ-fl‰ÍÓ Ì‡ÎËˆÂ Ó˘Â ÓÚ ¨¨ ÒÚ‡‰ËÈ (24%), ÌÓ Ò‡ χÍÒËχÎÌÓËÁ‡ÁÂÌË ‚ IIIË IV ÒÚ‡‰Ëfl ‚ 100% ÓÚ ÒÎÛ˜‡ËÚÂ.

ᇠÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„ÌÓÁ‡Ú‡ SSPE ¯‡‚‡˘‡  ÍÎËÌ˘-̇ڇ ͇ÚË̇, ̇΢ËÂÚÓ Ì‡ ı‡‡ÍÚÂÌËÚ Á‡ Á‡·ÓÎfl‚‡-ÌÂÚÓ ÎËÍ‚ÓÌË ÔÓÏÂÌË Ò Îfl‚ ÚËÔ ÍÓÎÓˉ̇ ÍË‚‡ (100%),Ò۷ه͈ËÓÌˇÌË „‡Ï‡-„ÎÓ·ÛÎËÌË (100%), ‡ÌÚËÏÓ·ËÎÌËIgG-‡ÌÚËÚ· ‚ ÚËÚË Ì‡‰ 1: 4 (100%), ÖÖÉ Ò ‡·ÌÓÏ̇ÓÒÌӂ̇ ‡ÍÚË‚ÌÓÒÚ Ë ê‡‰ÂÏÂÍÂÓ‚Ë ÍÓÏÔÎÂÍÒË, ͇ÍÚÓ Ëåêí Ò ‰‚ÛÒÚ‡ÌÌË ÒËÏÂÚ˘ÌË (45%) ËÎË ‡ÒËÏÂÚ˘ÌËÎÂÁËË ‚ ÒË‚ÓÚÓ ËÎË ÔÓ‰ÍÓÓ‚ÓÚÓ ·flÎÓ ‚¢ÂÒÚ‚Ó (37%).äí ‡ÁÍË‚‡ Ò‡‚ÌËÚÂÎÌÓ ÔÓ-Í˙ÒÌÓ ıËÔÓ‰ÂÌÁÌË ÎÂÁËË ËÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl. èÓ„ÂÒËflÚ‡ ̇ åêí-Ô‡ÚÓÎÓ„ËflÚ‡ÔË Ô‡ˆËÂÌÚËÚ Ò˙Ò SSPE Ëχ Á‡ÍÓÌÓÏÂÂÌ ıÓ‰: ‡Á¯Ë-fl‚‡Ì ̇ ıËÔÂËÌÚÂÌÁÌËÚ ÎÂÁËË ÔË í2W ËÁÏ‚‡ÌÂ,‚Íβ˜ËÚÂÎÌÓ Ò ÔÓfl‚‡Ú‡ ̇ ‰‚ÛÒÚ‡ÌÌË ÔÓÏÂÌË ÔË ÒÎÛ-˜‡ËÚÂ Ò Ì‡˜‡ÎÌË Â‰ÌÓÒÚ‡ÌÌË ÎÂÁËË, Ë ÔÓÒΉ‚‡˘‡ ÔÓÒÚ-‚˙ÁÔ‡ÎËÚÂÎ̇ ÏÓÁ˙˜Ì‡ ‡ÚÓÙËfl, ‚ËÁÛ‡ÎËÁˇ˘‡ Ò ÔË äí4,5,14,24. èÂËӉ˘ÌËÚÂ, ‰‚ÛÒÚ‡ÌÌÓ ÒËÌıÓÌÌË Ë ÒË-ÏÂÚ˘ÌË ÍÓÏÔÎÂÍÒË (ꇉÂÏÂÍÂÓ‚Ë ÍÓÏÔÎÂÍÒË) Ò‡ ËÌ-‰Ë͇ˆËfl Á‡ ÔÂÒËÒÚˇÌ ̇ ‚˙ÁÔ‡ÎËÚÂÎÌËfl ÔÓˆÂÒ 23. ᇄÂÌ¡ÌÂÚÓ ËÏ Ò‡ ÓÚ„Ó‚ÓÌË ÏÂÁÂ̈ÂÙ‡ÎÌËÚ ÒÚÛÍ-ÚÛË 28, ̇È-‡ÌÓ ‡Ì„‡ÊˇÌË ÓÚ ‚˙ÁÔ‡ÎËÚÂÎÌË ÔÓÏÂÌË.燉 60% ÓÚ Ô‡ˆËÂÌÚËÚ ËÏ‡Ú Ë ÏÛÎÚËÙÓ͇Î̇ ÂÔËÂÎÂÔ-ÚËÙÓÏÂ̇ ‡ÍÚË‚ÌÓÒÚ ‚˙‚ ‚ÒÂÍË ÒÚ‡‰ËÈ ÓÚ Á‡·ÓÎfl‚‡ÌÂ-ÚÓ, ̇È-˜ÂÒÚÓ ‚˙‚ ÙÓÌÚ‡Î̇ڇ, ˆÂÌÚ‡Î̇ ËÎË Ó͈ËÔË-Ú‡Î̇ ӷ·ÒÚ 12. å‡ÎÍËflÚ ·ÓÈ ·ÓÎÌË, ÔË ÍÓËÚÓ Â ÔË-ÎÓÊÂÌ Isoprinosine (8) Ì ÌË ‰‡‚‡ ÓÒÌÓ‚‡ÌË Á‡ ͇Ú„Ó˘-ÌË ËÁ‚Ó‰Ë, ÌÓ Ó·Ì‡‰Âʉ‡‚‡˘  هÍÚ˙Ú, ˜Â 5 ÓÚ Úflı Ò‡ ÒıÓÌËÙËˆË‡Ì ıÓ‰ Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓÏÂÊ‰Û 2 Ë 5 „. çflχÏ ÓÔËÚ ÓÚ Ò˙˜ÂÚ‡ÌË ̇ IsoprinosineÒ Interferon Ä ËÌÚ‡ÚÂ͇ÎÌÓ3, ËÎË Interferon Ä ÒRibavirine, Á‡ ÍÓËÚÓ Ëχ ‰‡ÌÌË Á‡ ÔÓ-„ÓÎflχ ÔÂÊË‚flÂ-ÏÓÒÚ 25.

àáÇéÑà1. ÑË̇ÏË͇ڇ ̇ Á‡·ÓÎflÂÏÓÒÚÚ‡ ÓÚ SSPE ‰Ó͇Á-

‚‡ ‚‡Ê̇ڇ ÓÎfl ̇ ‡ÌÌÓÚÓ Ë Ï‡ÒÓ‚Ó ÔËÎÓÊÂÌË ̇ÔÓÚË‚ÓÏÓ·ËÎ̇ڇ ‚‡ÍÒË̇ Á‡ ÔÓÙË·ÍÚË͇ڇ ̇ Á‡-·ÓÎfl‚‡ÌÂÚÓ.

2. éÔËÒ‡ÌËÚ ‡ÚËÔ˘ÌË ÙÓÏË Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò‡ÒËÏÂÚ˘ÌÓ Ì‡˜‡ÎÓ, ÔÒ‚‰ÓËÌÒÛÎÚÌÓ Ë ÔÒ‚‰ÓÚÛÏÓÌÓÔÓÚ˘‡ÌÂ Ë ‡ÒËÏÂÚ˘ÌË ÎÂÁËË ÔË åêí, ̇΢ËÂÚÓ Ì‡‡ÌÂÌ Ë Ú‡Ô‚Ú˘ÌÓ ÂÁËÒÚÂÌÚÂÌ ÂÔËÎÂÔÚ˘ÂÌ ÒË̉-ÓÏ Ì‡Î‡„‡Ú ¯ËÓ͇ ‰ËÙÂÂ̈ˇÎ̇ ‰Ë‡„ÌÓÁ‡ ‚ ‰ÂÚÒ͇ڇ‚˙Á‡ÒÚ.

3. ᇠ‡Ì̇ڇ ‰Ë‡„ÌÓÒÚË͇ ̇ SSPE  ‚‡ÊÌÓ Ò˙˜Â-Ú‡ÌËÂÚÓ Ì‡ ÍÎËÌ˘ÌËÚ ı‡‡ÍÚÂËÒÚËÍË Ò˙Ò ÒÔˆÂÙ˘-ÌËÚ ÎËÍ‚ÓÌË ÔÓÏÂÌË (Îfl‚ ÚËÔ ÍÓÎÓˉ̇ ÍË‚‡, Û‚ÂÎË-˜ÂÌË Ë Ò۷ه͈ËÓÌˇÌË „‡Ï‡-„ÎÓ·ÛÎËÌË, ̇΢ˠ̇ ÔÓ-‚˯ÂÌË ÚËÚË Ì‡ IgG-‡ÌÚËÏÓ·ËÎÌË ‡ÌÚËÚ·), Ó·˘Ó‰ÂÁÓ„‡ÌËÁˇ̇ ÖÖÉ ‡ÍÚË‚ÌÓÒÚ Ò ê‡‰ÂÏÂÍÂÓ‚Ë ÍÓÏÔ-ÎÂÍÒË, åêí ÎÂÁËË ‚ ÒË‚ÓÚÓ Ë ·flÎÓ ÏÓÁ˙˜ÌÓ ‚¢ÂÒÚ‚Ó.

4. èËÎÓÊÂÌËÂÚÓ Ì‡ Isoprinosine ‚Ó‰Ë ‰Ó Û‰˙Îʇ-‚‡Ì ̇ ÔÂÊË‚flÂÏÓÒÚÚ‡ ̇ ·ÓÎÌËÚÂ.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 153‰ÂÍÂÏ‚Ë, 2002

ãàíÖêÄíìêÄ1. ÅÓÊËÌÓ‚, ë., ÉÂÓ„Ë‚ à‚., çËÌÓ‚ ç. ïËÔÂÍËÌÂÚ˘ÂÌ ÔÓ„ÂÒˇ˘ Ô‡-ÌÂ̈ÂÙ‡ÎËÚ. Ç: ë˙‚ÂÏÂÌÌË Ì‚ÓËÌÙÂ͈ËË. è.. ë. ÅÓÊËÌÓ‚, ë., å‰ˈË̇ ËÙËÁÍÛÎÚÛ‡, 1983, 180-185.2. ÅÓÊËÌÓ‚‡, Ç., ÅÂÎÓÔËÚÓ‚‡ ã., ÑËÏÓ‚‡ è., É„ÂΘ‚‡ Ç. èÓ ‚˙ÔÓÒ‡ Á‡ÒÛ·‡ÍÛÚÌËfl ÒÍÎÂÓÁˇ˘ Ô‡ÌÂ̈ÂÙ‡ÎËÚ Ò ‡ÚËÔ˘ÌÓ Ì‡˜‡ÎÓ- ÍÎËÌËÍÓ-ÍÓÏÔ˛-Ú˙ÚÓÏÓ„‡ÙÒÍË Ë fl‰ÂÌÓχ„ÌËÚÌÓ-ÂÁÓ̇ÌÒÌÓ ÚÓÏÓ„‡ÙÒÍË ÍÓ·ˆËË.è‰ˇÚËfl, 1998;38 (1): 25-29.3. Anlar B., Yalatz K., Oktem F. et al. Long-term follow-up of patients withsubacute sclerosing panenceohalitis treated with intraventricular alpha interferon.Neurology 1997; 48: 526-528.4. Bohlega, S., Kavi M.Z. Subacute sclerosing panencephalitis. Imaging andclinical correlation. J. Neuroimaging, , 1994; 4 (2): 71-76.5. Brismar,J., Gascon G. G., von Steyern K. V. et al. Subacute sclerosing panen-cephalitis: evalution with CT and MRI. Am. J. Neuroradiol.1996;17 (4): 761-772.6. Britt W.J. Slow wiruses. In: Feigin RD, Cherry JD eds. Textbook of Pediatricinfectious Diseases. Philadelphia, WA Saunders Company; 1998: 1646-1665.7. David, P., Elia M., Mariotti P. et al. Adult onset of subacute sclerosingpanencephalitis: A case report. Riv. Neurol. 1990; 60 (2): 83-87.8. Dimova, P., Bojinova V. Subacute sclerosing panencephalitis with atypicalonset: clinical, computed tomographic and magnetic resonance imaging correla-tions. J.Child Neurol 2000; 15 (4): 258-261.9. Dlugos D.J., Brooks-Kayal A.R. A 4-year-old with pica, progressive incoor-dination and decreased responsiveness. Semin.Pediatr.Neurol.1999; 6(3): 164-167. 10. Dunn R.A. Subacute sclerosing panencephalitis. Pediatr.Infect.Dis.J. 1991;10:68-72.11. Geller, T.J., Vern B. A., Sarwar M. Focal MRI findings in early SSPE.Pediatr. Neurol. 1987; 3(5): 310-312.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 154‰ÂÍÂÏ‚Ë, 2002

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Ôèã.4.Ñèíäðîìè è ñèìïòîìè ïðè äèàãíîñòèöèðàíåòî íà SSPE (n=40)

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‚ ÒË‚ÓÚÓ Ë ·flÎÓ ‚¢ÂÒÚ‚Ó

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‰flÒÌÓ Ô‡ËÂÚÓ-ÚÂÏÔÓÓ-Ó͈ËÔËÚ‡ÎÌÓ Ë ÔÓ-χÎ͇ ‚Îfl‚Ó Ó͈ËÔËÚÓ-ÚÂÏÔÓ‡ÎÌÓ

SUMMARY

PARAMYOTONIA CONGENITA - CURRENT UNDER-STANDING AND A CASE REPORT

R. Bojilova, V. Guergueltcheva, V. BojinovaParamyotonia congenita is a hereditary sodium chan-

nelopathy and is clinically characterized by: 1/ paradoxicalmyotonia which appears during exercise and increases withcontinued exercise; 2/ severe worsening of the exercise-induced myotonia by cold; 3/ a predilection of the myotoniafor the face, neck, and distal upper extremity muscles; 4/weakness after prolonged exercise and exposure to cold inmost cases. In some families patients have spontaneousattacks of weakness like those occurring in hyperkalaemicperiodic paralysis. The condition is transmitted in a dominantfashion with complete penetrance. Mutations are detected inSCN4A gene on 17q23.

We present a case of a 12 years old girl with paramyotoniacongenita. The methods include: clinical assessment, para-clinical examination, electroneurography, electromyographyand molecular genetic analysis of the patient and her parents.History of the disease revealed: cold induced paradoxicalmyotonia from infancy, transient mild pareses of the handsinduced by exercise and cold, and rare myoplegic attacks inthe extremities with duration from hours to several days andstarting from the morning. Electromyography revealedmyotonic discharges and rare fibrillation-like potentials and

electroneurography - a positive cooling test. Serum potassiumlevels in and outside a paralytic attack were normal. CK lev-els were two times increased. Molecular genetic analysis inthe patient detected R1448P mutation in the SCN4A gene on17q23. Diagnosis, differential diagnosis, etiology and patho-physiology of the disease are discussed as well as the recom-mended therapy and anaesthesia-related events.Key words: paramyotonia congenita

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臇ÏËÓÚÓÌËfl ÍÓÌ„ÂÌËÚ‡  ̇ÒΉÒÚ‚Â̇ ̇ÚË‚‡Í‡Ì‡ÎÓÔ‡ÚËfl Ë ÍÎËÌ˘ÌÓ Ò ı‡‡ÍÚÂËÁˇ Ò: 1/ Ô‡‡‰ÓÍ-Ò‡Î̇ ÏËÓÚÓÌËfl, ÔÓfl‚fl‚‡˘‡ Ò ÔË ÏÛÒÍÛÎÌÓ Ì‡ÔÂÊÂÌËÂË ÛÒË΂‡˘‡ Ò ÔË ÔÓ‰‰˙ʇÌ ̇ ̇ÔÂÊÂÌËÂÚÓ; 2/ Á̇-˜ËÚÂÎÌÓ ‚ÎÓ¯‡‚‡Ì ̇ ÏËÓÚÓÌËflÚ‡ Ë̉ۈˇ̇ ÓÚ ÏÛÒ-ÍÛÎÌÓ Ì‡ÔÂÊÂÌË ÔË ÒÚÛ‰; 3/ Ô‰ËÎÂ͈Ëfl ̇ ÏËÓÚÓÌË-flÚ‡ Á‡ ÎˈÂÚÓ, ‚‡Ú‡ Ë ‰ËÒÚ‡ÎÌËÚ ÏÛÒÍÛÎË Ì‡ „ÓÌËÚÂ͇ÈÌˈË; 4/ ÔË Ôӂ˜ÂÚÓ ÒÎÛ˜‡Ë - Ò··ÓÒÚ ÒΉ ÔÓ‰˙Î-ÊËÚÂÎÌÓ ÏÛÒÍÛÎÌÓ Ì‡ÔÂÊÂÌËÂ Ë ËÁ·„‡Ì ̇ ÒÚÛ‰. èËÌflÍÓË Ù‡ÏËÎËË Ô‡ˆËÂÌÚËÚ ËÏ‡Ú ÒÔÓÌÚ‡ÌÌË ÂÔËÁÓ‰Ë Ì‡Ò··ÓÒÚ Í‡ÚÓ ÚÂÁË ÔË ıËÔÂ͇ÎËÂÏ˘̇ڇ ÔÂËӉ˘̇ԇ‡ÎËÁ‡. ᇷÓÎfl‚‡ÌÂÚÓ Ò Ô‰‡‚‡ ÔÓ ‡‚ÚÓÁÓÏÌÓ- ‰ÓÏË-̇ÌÚÂÌ Ô˙Ú Ò Ô˙Î̇ ÔÂÌÂÚ‡ÌÚÌÓÒÚ. ìÒÚ‡ÌÓ‚fl‚‡Ú ÒÂÏÛÚ‡ˆËË ‚ SCN4A „ÂÌ˙Ú ‚˙ıÛ 17q23.

è‰ÒÚ‡‚ÂÌ Â ÒÎÛ˜‡È ̇ 12 „Ӊ˯ÌÓ ÏÓÏË˜Â Ò Ô‡‡ÏË-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 155‰ÂÍÂÏ‚Ë, 2002

12. Gurses C., Ozturk A., Baykan B. et al. Correlation between clinical stagesand EEG findings of subacute sclerosing panencephalitis. ClinElectroencephalogr.2000; 31(4): 201-206.13. Kornberg, A.J., Harvey A. S., Shield L. K. Subacute sclerosing panencephali-tis presenting as simple partial seisures. J. Child Neurol.1991; 6 (2): 146-149.14. Kunika N.S., Yasaki S.,. Oshima J. et al. Serial changes of MRI and SPECTfindings in a case of adult- onset SSPE. Rinsho-Shinkeigaku, 35, 1995 (11), 1214-1220.15. Lackmann G.M., Hannen M., Madjlessi et al. Rapid progressie subacute scle-rosing panencephalitis in 2-year old child with congenital athyreosis.Clin.Ifect.Dis. 2000; 31(1): 196-199.16. The measles epidemic. The problems, barriers and reccomendations. TheNational Vaccine Advisory Committee, JAMA 1991; 266: 1547-1552. 17. Miller C., Farrington C.P., Harbert K. The epidemiology of subacute scleros-ing panencephalitis in England and Wales 1970-1989. Int.J.Epidemiol.1992;21:998-1006.18. Murata R., Matsuoka O., Nakajima S. Serial magnetic resonance imaging insubacute sclerosing panencephalitis. Jpn. J. Psychiatr. Neurol. 1987; 41(2): 277-282.19. Park Y.S., Kohl S. Subacute sclerosing panencephalitis in an indentical twin.Pediatrics 1999; 104(6): 1390-1394.20. Public-sector vaccination efforts in rsponce to resurgence of maesles amongpre-scool children - United States, 1989-1991. 21. Salvan A.M., Confort-Gouny S., Cozzone P.J. et al. In vivo cerebral protonMRS in a case of subacute sclerosing panencephalitis. J.Neurol.Neurosurg.Psychiatr.1999; 66:547-555.22. Sawaishi Y., Yano T., Watanabe Y., Takada G. Migratory basal gangliaLesions in subacute sclerosing panencephalitis& clinical manifestations of axonalspread. J.Neurol.Sci. 1999; 168(2): 137-140.

23. Sousa G., Ribero J.A., Guilmares M.L. Different clinical and electroen-cephalographic patterns of SSPE. Boll. Lega Ital Epilessia, 79-80, 1992, 123-124.24. Takahashi M., Abe K., Fujimura H. et al. A case of SSPE that showed water-shed infarction-like change on MRI initialy and progressive to whole brain atro-phy. Rinsho- Shinkeigaku, 31, 1991(5), 554-556.25. Tomoda A. Shiraishi S., Hosoya M. et al. Combinned treatment with interfer-on -alpha and ribavirin for subacute sclerosing panencephalitis. Pediatr.Neurol.2001; 24 (1): 54-59. 26. Weil M.L., Levine M. Infections of the Nervous system. Subacute sclerosingpanencephalitis. In: Textbook of child neurology. Ed. J.H.Menkes. Williams&Wilkins, Baltimore, 1995, p.451-454.27. Woodward K.G., Weinberg P.E., Lipton H.L.: Basal ganglia involvement insubacute sclerosing panencephalitis: CT and MRI demonstration. J. Comput.Assist. Tomogr.,12,1988 (3), 489-491.28. Yagi S. The origin of myoclonus and periodic synchronous discharges in sub-acute sclerosing panencephalitis. Acta Pediatr.Jpn. 1992; 34: 310-315.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:ÑÓˆ.Ç.ÅÓÊËÌÓ‚‡, ìëÅÄãçè "ë‚.ç‡ÛÏ" ÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇,ëÓÙËfl 1113, ÛÎ."ã.êÛÒ‚" 1,e-mail: tchamov@bulinfo.net

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̇ Ô‡‡ÎËÁ‡. ÇÚÓ˘ÌËÚ ÙÓÏË Ì‡ ÔÂËӉ˘ÌË Ô‡‡ÎËÁË

Ò ÔÓfl‚fl‚‡Ú ‚˙‚ ‚˙Á͇ Ò ıËÔÂÚËÂÓˉËÁ˙Ï ËÎË ÔË Á‡-

„Û·‡ ËÎË Á‡‰˙Ê͇ ̇ ͇ÎËÈ. å‡ÎË„ÌÂ̇ڇ ıËÔÂÚÂÏËfl ‚

ÚÂÒÂÌ ÒÏËÒ˙Π̇ ‰Ûχڇ Ì  ÏÛÒÍÛÎÌÓ Á‡·ÓÎfl‚‡ÌÂ, ‡

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̇ ÓÔ‰ÂÎÂÌË ‡ÌÂÒÚÂÚˈË. É·‚ÌËflÚ ÒËÏÔÚÓÏ Â Ó·˘‡

ıËÔÂÚÂÏËfl, ÍÓflÚÓ ‡ÍÓ Ì Ò ÎÂÍÛ‚‡ ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó

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/Ú‡·Î.1/.

åÛÚ‡ˆËË ‚ SCN4A „ÂÌ˙Ú ‚˙ıÛ 17q23, ÍӉˇ˘ a-ÒÛ-

·Â‰ËÌˈ‡Ú‡ ̇ ̇ÚË‚ËÚ ͇̇ÎË ‚ ÁÂÎËÚ ÒÍÂÎÂÚÌË

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Ò Ô‰ÔÓ˜ËÚ‡ Ú ‰‡ Ò ‡Á„ÎÂʉ‡Ú ÓÚ‰ÂÎÌÓ, Ú˙È Í‡ÚÓ

Ò˙˘ÂÒÚ‚Û‚‡Ú Ù‡ÏËÎËË Ò Ì‡Î˘Ë ҇ÏÓ Ì‡ ‰ËÌËfl ÚËÔ

ÒËÏÔÚÓÏË. é˘Â Ôӂ˜Â, ˜Â ÔÓ‡‰Ë ‚Ò Ӣ Ì ̇Ô˙ÎÌÓ

ËÁflÒÌÂÌË Ô˘ËÌË ÒËÏÔÚÓÏËÚ ̇ ÏÛÒÍÛÎ̇ Ò··ÓÒÚ /Ô‡-

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‡Á΢ÌË Ï‰Ë͇ÏÂÌÚË.

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ÚÓ ÔÂÁ Ô˙‚ËÚ 24 ˜‡Ò‡  ·Ë· ̇ é2

Ú‡ÔËfl ÔÓ ÌÂflÒ̇

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Á‡ÚÛ‰ÌÂÌÓ ÓÚ‚‡flÌ ̇ Ó˜ËÚÂ, ÔÓ-fl‰ÍÓ - ÔÂıÓ‰ÌË ÒÔ‡Á-

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ÌÓ ‚ÂÏÂ, ÌÓ ÔÂÒËÒÚË‡Ú Ë ÔÂÁ ÓÒڇ̇ÎÓÚÓ ‚ÂÏÂ, ͇-

ÚÓ ÏÓ„‡Ú ‰‡ Ò ÔÓ‚ÓÍË‡Ú ÓÚ ÔÓ‚Ú‡fl˘Ó Ò Á‡Ú‚‡flÌÂ

Ë ÒÚËÒ͇Ì ̇ Ó˜ËÚ /̇Ô. ÔË Ô·˜/. éÚ 1 „Ó‰. 6 ÏÂÒ.

‚˙Á‡ÒÚ ÓÍÓÎÓ 1 -2 Ô˙ÚË „Ӊ˯ÌÓ, Ó·ËÍÌÓ‚ÂÌÓ ÔË ËÌÚÂ-

ÍÛÂÌÚÌË ËÌÙÂ͈ËË Ëχ ÂÔËÁÓ‰Ë, ‚ ÍÓËÚÓ ÓÚ ÒÛÚËÌÚ‡

 Ò˙Ò Ò··ÓÒÚ ‚ 4 -Ú ͇ÈÌË͇, ÔÓ-ËÁ‡ÁÂ̇ Á‡ ‰ÓÎÌË

͇ÈÌËˆË Ë Ôӂ˜ ‰ËÒÚ‡ÎÌÓ, Ò Ì‚˙ÁÏÓÊ̇ Ò‡ÏÓÒÚÓfl-

ÚÂÎ̇ ÔÓıӉ͇. é·ËÍÌÓ‚ÂÌÓ ‰Ó ‚˜ÂÚ‡ ÏÛÒÍÛÎ̇ڇ ÒË·

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‰ÌË. éÚ ÌflÍÓÎÍÓ „Ó‰ËÌË Ò˙Ó·˘‡‚‡ Ë Á‡ ÂÔËÁÓ‰Ë Ì‡ Ò·-

·ÓÒÚ ‚ Ô˙ÒÚËÚ ̇ ˙ˆÂÚÂ, ·ÂÁ Ô‰ıÓʉ‡˘Ë ÒÔ‡ÁÏË,

ÔÓ‚Ó͡˘Ë Ò ÓÚ ÒÚÛ‰ ‚ ˜‡ÒÓ‚Â ÔÓ ÙËÁ˘ÂÒÍÓ ‚˙ÁÔËÚ‡-

ÌËÂ, Ò ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ ÓÍÓÎÓ 50 -60 ÏËÌ., ÔÂÏË̇‚‡˘Ë

Ó·ËÍÌÓ‚ÂÌÓ ÔË Á‡ÚÓÔÎflÌÂ. èË ÍÎËÌ˘ÌÓÚÓ ËÁÒΉ‚‡ÌÂ

‰ÂÚÂÚÓ Â Ò ‡ÚÎÂÚ˘ÂÌ ı‡·ËÚÛÒ, Ò ËÁ‚ÂÒÚ̇ ÒÚ„̇ÚÓÒÚ

̇ ÏÛÒÍÛ·ÚÛ‡Ú‡ ̇ ÔÓ‰·Â‰ËˆËÚÂ. àÁ‚˙Ì ÏËÓÔ΄˘ÂÌ

ÂÔËÁÓ‰ ‚ ÔÓÒΉÌËÚ „Ó‰ËÌË Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‰ËÒÍÂÚ̇

Ò··ÓÒÚ Ì‡ Ô¡ÍÒˇÎ̇ڇ ÏÛÒÍÛ·ÚÛ‡. ëÛıÓÊËÎÌÓ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 156‰ÂÍÂÏ‚Ë, 2002

̇‰ÍÓÒÚÌËÚ ÂÙÎÂÍÒË Ò‡ ÛÏÂÂÌÓ ÊË‚Ë. èÂÒËÒÚˇÚ

ÏËÓÚÓÌ˘ÌË ÔÓfl‚Ë ‚ ÏÏ. Ó·ËÍÛ·ËÒ ÓÍÛÎË, ÍÓËÚÓ ÒÂ

Á‡ÒË΂‡Ú ÔË ÌÂÍÓÎÍÓ͇ÚÌË ÏÛÒÍÛÎÌË ÍÓÌڇ͈ËË, ̇-

Îˈ ҇ ÏËÓÚÓÌ˘ÌË ÙÂÌÓÏÂÌË ÔË ÔÓ˜ÛÍ‚‡Ì ̇ ÂÁË͇ Ë

̇ ÚÂ̇‡. Ç ÏËÓÔ΄˘ÂÌ ÂÔËÁÓ‰ ‰ÂÚÂÚÓ Â Ò ‚fl· Í‚‡‰Ë-

Ô‡ÂÁ‡, ÔÓ- ËÁ‡ÁÂ̇ ‚ ‰ÓÎÌË Í‡ÈÌËˆË Ë Ôӂ˜ ‰ËÒÚ‡ÎÌÓ,

Ò˙Ò ÒÛıÓÊËÎÌÓ-̇‰ÍÓÒÚ̇ ıËÔÓ- ‰Ó ‡ÂÙÎÂÍÒËfl Ë ÏÛÒÍÛÎ-

̇ ıËÔÓÚÓÌËfl. ç  Ëχ· ‰Ëı‡ÚÂÎÌË ËÎË „˙ÎÚ‡ÚÂÎÌË Ì‡-

Û¯ÂÌËfl, ͇ÍÚÓ Ë ÔÓÏÂÌË ‚ Ò˙Á̇ÌËÂÚÓ. èÓ‰Ó·ÂÌËÂÚÓ

‚ ÏÛÒÍÛÎ̇ڇ ÒË· ̇ÒÚ˙Ô‚‡ Ó·ËÍÌÓ‚ÂÌÓ ‰Ó ‚˜ÂÚ‡, ‡

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Ú‡ÈÌÓ ÎÂÍÓ Ôӂ˯ÂÌË - ‰Ó 2 Ô˙ÚË. ÖåÉ ÔÓ͇Á‚‡ ÒÔÓÌ-

Ú‡ÌÌË ÏËÓÚÓÌ˘ÌË ‡Áfl‰Ë ÓÚ ‚Ò˘ÍË ËÁÒΉ‚‡ÌË ÏÛÒÍÛ-

ÎË /ÙË„.1/, ÓÚ Ï.Ú˷ˇÎËÒ ‡ÌÚÂËÓ Ò ÓÚ‚Â‰Â Ë ÒÔÓÌ-

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ÚÂ̈ˇÎË /ÙË„.2/. èË ÏËÓÔ΄˘ÂÌ ÂÔËÁÓ‰ ‡ÏÔÎËÚÛ‰ËÚÂ

̇ å-ÓÚ„Ó‚Ó‡ ̇ ËÁÒΉ‚‡ÌËÚ ÌÂ‚Ë Ì‡ ‰ÓÎÂÌ Ë „ÓÂÌ

͇ÈÌËÍ Ò‡ Ò˙Ò ÒÌËÊÂÌË ‡ÏÔÎËÚÛ‰Ë, ÑãÇ Ë ÒÍÓÓÒÚËÚÂ

̇ ÔÓ‚Âʉ‡Ì ҇ ‚ ÌÓχ. àÁ‚˙Ì ÂÔËÁÓ‰ ÂÎÂÍÚÓÌ‚ӄ-

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Ô˙Ú ÓÚ Eulenburg (1886), ‡ ÔÓ-Í˙ÒÌÓ ÔÓÚ‚˙‰ÂÌË ÓÚ

Becker (1970) Ò‡ ÒΉÌËÚ (4, 2): 1/ Ô‡‡‰ÓÍÒ‡Î̇ ÏËÓÚÓ-

ÌËfl, ÔÓfl‚fl‚‡˘‡ Ò ÔË ÏÛÒÍÛÎÌÓ Ì‡ÔÂÊÂÌËÂ Ë ÛÒË΂‡˘‡

Ò ÔË ÔÓ‰‰˙ʇÌ ̇ ̇ÔÂÊÂÌËÂÚÓ; 2/ Á̇˜ËÚÂÎÌÓ ‚ÎÓ-

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„‡Ú ‰‡ ·˙‰‡Ú ÓÚ‚ÓÂÌË ÌflÍÓÎÍÓ ÒÂÍÛ̉Ë. èË ‡·ÓÚ‡ ̇

ÒÚÛ‰ÂÌÓ, Ô˙ÒÚËÚ ̇ ˙ˆÂÚ Ò ÒÚfl„‡Ú Ë Ô‡ˆËÂÌÚ‡ ÌÂ

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ÌÂÚËÔ˘ÌË Á‡ Á‡·ÓÎfl‚‡ÌÂÚÓ. èË ÌflÍÓË Ù‡ÏËÎËË Ò èä Ò‡

ÓÔËÒ‡ÌË ÔÓ-‡Á΢ÌË ÒËÏÔÚÓÏË: ÏËÓÚÓÌ˘ÌË ÒÔ‡ÁÏË ÔË

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‡ÚÛ‡Ú‡ Ô‡‡ÎËÚ˘ÌË ‡Ú‡ÍË, ÔÓ‰Ó·ÌË Ì‡ ÚÂÁË ÔË ïË-

ÔÂèè, ‡Ú‡ÍËÚ ӷËÍÌÓ‚ÂÌÓ Á‡ÔÓ˜‚‡Ú ‡ÌÓ ÔÂÁ ‰ÂÌfl Ë

ÏÓ„‡Ú ‰‡ ÔÓ‰˙ÎÊ‡Ú ÌflÍÓÎÍÓ ˜‡Ò‡, Ó‡ÎÌËflÚ ÔËÂÏ Ì‡

͇ÎËÈ ÏÓÊ ‰‡ Ë̉ۈˇ Ú‡Í˙‚ ÏËÓÔ΄˘ÂÌ ÂÔËÁÓ‰ (15).

SCN4A „ÂÌ˙Ú, ÍӉˇ˘ a-Ò۷‰ËÌˈ‡Ú‡ ̇ ̇ÚË‚Ë-

Ú ͇̇ÎË ‚ ÁÂÎËÚ ÒÍÂÎÂÚÌË ÏÛÒÍÛÎË Â ÍÎÓÌË‡Ì ÔÂÁ

1990 „Ó‰. ë‚˙Á‚‡ÌÂÚÓ Ì‡ ïËÔÂèè Ò Ì„ӂËflÚ ÎÓÍÛÒ

‚˙ıÛ 17q23 (5)  Ô˙‚ÓÚÓ ‰Ó͇Á‡ÚÂÎÒÚ‚Ó Á‡ ̇΢ˠ̇

˜Ó‚¯͇ ̇ÚË‚‡ ͇̇ÎÓÔ‡ÚËfl. ëÍÓÓ ÒΉ ÚÓ‚‡, ÚË

ÌÂÁ‡‚ËÒËÏË ÍÓÎÂÍÚË‚‡ ÔÓ͇Á‚‡Ú, ˜Â èä  ҂˙Á‡Ì‡ Ò˙Ò Ò˙-

˘Ëfl ÎÓÍÛÒ (3, 7, 12). íÂÚÓÚÓ Á‡·ÓÎfl‚‡ÌÂ, ÛÒÚ‡ÌÓ‚ÂÌÓ, ˜Â

 ҂˙Á‡ÌÓ Ò˙Ò Ò˙˘Ëfl ÎÓÍÛÒ Â äáå. SCN4A „ÂÌÌËflÚ ÔÓ-

‰ÛÍÚ Â 260 -kDa „ÎËÍÓÔÓÚÂËÌ, Ò˙‰˙ʇ˘ ÓÍÓÎÓ 2000

‡ÏËÌÓÍËÒÂÎËÌË Ë Ò ‡Á΢‡‚‡˘Ë Ò 4 ‰ÓÏÂ̇ Ò ‚˙Ú¯̇

ıÓÏÓÎÓÊÌÓÒÚ, ‚ÒÂÍË Ò˙‰˙ʇ˘ 225-325 ‡ÏËÌÓÍËÒÂÎËÌË.

ÑÓÒ„‡ Ò‡ ËÁ‚ÂÒÚÌË 20 ÚÓ˜ÍÓ‚Ë ÏÛÚ‡ˆËË ‚ ‡Á΢ÌË ˜‡Ò-

ÚË Ì‡ SCN4A. ÑÂÒÂÚ ÓÚ Úflı ‚Ó‰flÚ ‰Ó èä. èӂ˜ÂÚÓ

ÓÚ Úflı Á‡Òfl„‡Ú S4 Ú‡ÌÒÏÂÏ·‡ÌÌËfl Ò„ÏÂÌÚ, ÍÓÈÚÓ ÒÂ

ÒÏflÚ‡, ˜Â ‰ÂÈÒÚ‚‡ ͇ÚÓ ‚ÓÎÚ‡ÊÂÌ ÒÂÌÁÓ Á‡ ͇̇Î̇ڇ

ÔÓÔÛÒÍÎË‚ÓÒÚ. R1448P ÏÛÚ‡ˆËflÚ‡  ÓÔË҇̇ Á‡ Ô˙‚Ë

Ô˙Ú ÓÚ Wang et al. ÔÂÁ 1995 „Ó‰.(16) Ë Ô‰ÒÚ‡‚Îfl‚‡

‡ÏËÌÓÍËÒÂÎËÌ̇ Á‡Ïfl̇ ̇ ‡„ËÌËÌ Ò ÔÓÎËÌ. Ä‚ÚÓËÚ fl

ÛÒÚ‡ÌÓ‚fl‚‡Ú ÔË 8 „Ӊ˯ÌÓ ÏÓÏË˜Â Ò èä Ë Ò‡‚Ìfl‚‡Ú

ÍÎËÌ˘̇ڇ È Í‡ÚË̇ Ò Ô‡ˆËÂÌÚË Ò ‰Û„Ë ‰‚ ÏÛÚ‡ˆËË ‚

Ò˙˘‡Ú‡ ÔÓÁˈËfl - Á‡Ïfl̇ ̇ ‡„ËÌËÌ Ò ˆËÒÚÂËÌ Ë ıËÒÚË-

‰ËÌ, ͇ÍÚÓ Ë ÔÓËÁÚ˘‡˘ËÚ ÓÚ ÚÓ‚‡ ÒÚÛÍÚÛÌË ÔÓ-

ÏÂÌË ‚ ͇̇·. á‡Ïfl̇ڇ Ò ÔÓÎËÌ ÔË ÏÓÏ˘ÂÚÓ Â ‰Ó‚Â-

· ‰Ó ̇È-ÚÂÊ͇ ÒÚÛÍÚÛ̇ ÔÓÏfl̇ Ë ÍÎËÌ˘̇ ͇ÚË-

̇, ÏÓÏ˘ÂÚÓ Â ·ËÎÓ Ò ËÁÍβ˜ËÚÂÎÌÓ ˜Û‚ÒÚ‚ËÚÂÎ̇ ̇

ÒÚÛ‰ ÏËÓÚÓÌËfl, Ò ÙËÍÒˇÌË ‰ÂÙÓÏËÚÂÚË Ì‡ „ÎÂÁÂÌËÚÂ

Ë ıÓ‰ÂÌ ̇ Ô˙ÒÚË, ÌÓ Ò ÔÓ-ÎÂÍË ÔÂËӉ˘ÌË Ô‡‡ÎËÁË.

èÂÁ 1996 „Ó‰. Lerche et al.(11) ÓÔËÒ‚‡Ú ÔÓ‰Ó·ÌÓ Ô‡ÚÓ-

ÙËÁËÓÎÓ„ËflÚ‡ ̇ Ú‡ÁË ÏÛÚ‡ˆËfl.

ê‡Á·Ë‡ÌËflÚ‡ Á‡ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ èä Ò ÓÒÌÓ‚‡‚‡Ú ̇

ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌË ËÁÒΉ‚‡ÌËfl ‚˙ıÛ ÂÍÒˆËÁˇÌË

ÏÛÒÍÛÎÌË ‚·Í̇. í ÔÓ͇Á‚‡Ú ÌÓχÎÌÓ ÔÓ‚Âʉ‡Ì ̇

ıÎÓÌËÚ ÈÓÌË. ìÒÚ‡ÌÓ‚ÂÌÓÚÓ ÒÔˆËÙ˘ÌÓ Ì‡Û¯ÂÌË Â

ÌÂ-Ë̇ÍÚ˂ˇ˘ ÍÓÏÔÓÌÂÌÚ Ì‡ ̇ÚË‚ËflÚ ÔÓÚÓÍ (9,

10). à ÏËÓÚÓÌËflÚ‡ Ë Ò··ÓÒÚÚ‡ Ò Ô˘ËÌfl‚‡Ú ÓÚ Â‰ËÌ

Ë Ò˙˘Ë ÏÂı‡ÌËÁ˙Ï - ‰˙΄ÓÚ‡È̇ ‰ÂÔÓÎflËÁ‡ˆËfl ̇ ÏÂÏ·-

‡ÌËÚ ̇ ÏÛÒÍÛÎÌËÚ ‚·Í̇. ãÂ͇ڇ ‰ÂÔÓÎflËÁ‡ˆËfl /5-

10 ÏV/ ÏÓÊ ‰‡ Ô‰‡ÁÔÓÎÓÊË ‚ÓÎÚ‡ÊÌÓ Á‡‚ËÒËÏËÚÂ

̇ÚËÂ‚Ë Í‡Ì‡ÎË ‰‡ Ò ÓÚ‚ÓflÚ ÓÚÌÓ‚Ó ÒÔÓÌÚ‡ÌÌÓ ÒΉ

‡ÍˆËÓÌÌËfl ÔÓÚÂ̈ˇÎ, ÍÓÂÚÓ Â ÓÒÌÓ‚‡Ú‡ Á‡ Ì‚Ó΂‡Ú‡

ÏÛÒÍÛÎ̇ ‡ÍÚË‚‡ˆËfl, ÛÒ¢‡Ì‡ ÓÚ Ô‡ˆËÂÌÚ‡ ͇ÚÓ ÏÛÒÍÛ-

ÎÂÌ ÒÔ‡Á˙Ï. èË ÒËÎ̇ ‰ÂÔÓÎflËÁ‡ˆËfl /20-30 ÏV/ ÌÓχÎ-

ÌÓ ÙÛÌ͈ËÓÌˇ˘ËÚ ̇ÚËÂ‚Ë Í‡Ì‡ÎË ÔËÂÏ‡Ú Ò˙ÒÚÓfl-

ÌË ̇ Ë̇ÍÚË‚‡ˆËfl, Ú.Â. ÏÛÒÍÛÎÌËÚ ÍÎÂÚÍË ÒÚ‡‚‡Ú ÌÂ-

‚˙Á·Û‰ËÏË, ÍÓÂÚÓ Â ‚ ÓÒÌÓ‚‡Ú‡ ̇ ÏÛÒÍÛÎ̇ڇ Ò··ÓÒÚ.

äÓ„‡ÚÓ ‚Ò˘ÍË ÏÛÒÍÛÎÌË ‚·Í̇ Ò‡ ‰ÂÔÓÎflËÁˇÌË Â Ì‡-

Îˈ Ô˙Î̇ Ô‡‡ÎËÁ‡ /Á‡ ˘‡ÒÚË Ò˙‰Â˜ÌËflÚ ÏÛÒÍÛÎ Ë ‰Ë-

‡Ù‡„χڇ ÓÒÚ‡‚‡Ú ÌÂÁ‡Ò„̇ÚË/.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 157‰ÂÍÂÏ‚Ë, 2002

Ñˇ„ÌÓÁ‡Ú‡ èä Ò ÔÓÒÚ‡‚fl ÔË Ì‡Î˘Ë ̇ „ÓÂÓÔËÒ‡-

̇ڇ ÍÎËÌ˘̇ ͇ÚË̇ Ë Ó·ÂÏÂÌÂ̇ Ù‡ÏËÎ̇ ‡Ì‡ÏÌÂÁ‡.

ÖåÉ ÔÓ͇Á‚‡ „Â̇ÎËÁˇ̇ ÒÔÓÌÚ‡Ì̇ ‡ÍÚË‚ÌÓÒÚ ÔÓ‰

ÙÓχڇ ̇ ÏËÓÚÓÌ˘ÌË ‡Áfl‰Ë Ë ÔÓ‰Ó·ÌË Ì‡ ÙË·Ë·-

ˆËË ÔÓÚÂ̈ˇÎË, ˜ÂÒÚÓ ‰ÓË Ë ÔË ÌÓχÎ̇ ÚÂÏÔ‡ÚÛ-

‡ ̇ ÏÛÒÍÛ·. ëÂÛÏ̇ڇ äîä ÏÓÊ ‰‡ ·˙‰Â Ôӂ˯Â̇

‰Ó 10 Ô˙ÚË Ì‡‰ ÌÓχڇ. Ñˇ„ÌÓÁ‡Ú‡ ÏÓÊ ‰‡ ·˙‰Â ÔÓ‰-

ÍÂÔÂ̇ ÓÚ ÒÚÛ‰Ó‚‡Ú‡ ÔÓ·‡ (6). ÑÛ„ ÔÓ-ÔˆËÁÂÌ ÚÂÒÚ

Á‡ ÏËÓÚÓÌËfl Ë Ò··ÓÒÚ Â ÓÔ‰ÂÎflÌ ̇ ËÁÓÏÂÚ˘̇ڇ

ÒË· Ë ‚ÂÏ Á‡ ·ÍÒ‡ˆËfl ̇ ‰˙΄ËÚ ÙÎÂÍÒÓË Ì‡ Ô˙Ò-

ÚËÚ ÔÂ‰Ë Ë ÒΉ ËÁÒÚÛ‰fl‚‡Ì (14).

ᇠÓÚ‰ËÙÂÂ̈ˇÌ ̇ èä ÓÚ ‰Û„ËÚ ‰‚ Á‡·ÓÎfl‚‡-

ÌËfl Ò˙Ò Ò˙˘Ëfl ÎÓÍÛÒ - ïËÔÂèè Ë äáå ÒÔÓχ„‡Ú ÌflÍÓË

ÍÎËÌ˘ÌË ‡Á΢Ëfl. ïËÔÂèè ÏÓÊ ‰‡ Ò ÔÓfl‚Ë ·ÂÁ ÏËÓ-

ÚÓÌËfl Ë Ò ÍÎËÌ˘̇ ËÎË ÂÎÂÍÚÓÏËÓ„‡ÙÒ͇ ÏËÓÚÓÌËfl.

ë˙˘ÂÒÚ‚Û‚‡ Ë ÙÓχ Ò Ô‡‡ÏËÓÚÓÌËfl. åËÓÚÓÌËflÚ‡ ÒÂ

ÔÓfl‚fl‚‡ ̇È-ÒËÎÌÓ ÔË ‚ÌÂÁ‡ÔÌÓ ÒËÎÌÓ ‰‚ËÊÂÌËÂ Ë Á‡ ‡Á-

ÎË͇ ÓÚ Ô‡‡ÏËÓÚÓÌËflÚ‡ ̇χÎfl‚‡ ÔË ÔÓ‚ÚÓÌË, ÔÓÒ-

Ήӂ‡ÚÂÎÌË ÍÓÌڇ͈ËË. èË Ì‡Î˘Ë ̇ ÏËÓÚÓÌËfl ÔË

ïËÔÂèè, Úfl  ÏÌÓ„Ó ÎÂ͇. èËÂÏ˙Ú Ì‡ ͇ÎËÈ ÌËÍÓ„‡ ÌÂ

‚Ó‰Ë ‰Ó ÏËÓÚÓÌËfl, ‡ ‚Ë̇„Ë ‰Ó Ò··ÓÒÚ. ë··ÓÒÚÚ‡  ÌÂ-

Á‡‚ËÒËχ ÓÚ ÌËÒÍË ÚÂÏÔ‡ÚÛË. äáå Ò ‰ËÙÂÂ̈ˇ

ÓÚ èä /‡ Ò˙˘Ó Ë ÓÚ ïËÔÂèè/ ˜ÂÁ Ù‡ÍÚ‡, ˜Â Ô‡ˆËÂÌÚË-

Ú ÌËÍÓ„‡ Ì ËÁÔËÚ‚‡Ú Ò··ÓÒÚ. ëÚÂÔÂÌÚ‡ ̇ ÏËÓÚÓÌË-

flÚ‡ ‚‡Ë‡ ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ‡Á΢ÌËÚ ÏÛÚ‡ˆËË Ë ÓÔ-

‰ÂÎfl ‰‚ÂÚ ÙÓÏË - fluctuans Ë permanens. èËÂÏ˙Ú Ì‡

͇ÎËÈ Á‡ÒË΂‡ ÏËÓÚÓÌËflÚ‡ Ë Ì Ô‰ËÁ‚ËÍ‚‡ Ò··ÓÒÚ.

ᇠΘÂÌË ̇ èä Ò ËÁÔÓÎÁ‚‡Ú ‡ÌÚˇËÚÏ˘ÌË Ï‰Ë-

͇ÏÂÌÚË Í‡ÚÓ mexiletine, ÍÓËÚÓ Ò ÒÏflÚ‡Ú ÂÙÂÍÚË‚ÌË

Á‡ Ô‰ÓÚ‚‡Úfl‚‡Ì ̇ ÏÛÒÍÛÎÌËÚ ÒÔ‡ÁÏË Ë Ò··ÓÒÚ,

Ë̉ۈˇÌË ÓÚ ÙËÁ˘ÂÒ͇ ‡ÍÚË‚ÌÓÒÚ ËÎË ÌËÒÍË ÚÂÏÔÂ-

‡ÚÛË. èӂ˜ÂÚÓ ÓÚ Ô‡ˆËÂÌÚËÚÂ Ò èä, Ó·‡˜Â, ÌflχÚ

ÌÛʉ‡ ÓÚ Î˜ÂÌËÂ Ë Á̇flÚ Ì‡È-‰Ó·Â Í‡Í ‰‡ Ò ÒÔ‡‚flÚ

Ò˙Ò ÒËÏÔÚÓÏËÚ ÒË. Ç ÚÂÊÍËÚ ÒÎÛ˜‡Ë Ò ÔÂÔÓ˙˜‚‡

360 Ï„ mexiletine (Mexitil Depot), ‰ËÌ ‰Ó ‰‚‡ Ô˙ÚË ‰Ì‚-

ÌÓ. èÂ‰Ë Ì‡˜‡ÎÓÚÓ Ì‡ ‡ÌÚËÏËÓÚÓÌ˘̇ڇ Ú‡ÔËfl Ò

mexiletine Ò ÔÂÔÓ˙˜‚‡ ËÁÒΉ‚‡Ì ̇ Ò˙‰Â˜ÌËfl ÒÚ‡ÚÛÒ

Ë ËÁÒΉ‚‡Ì ̇ ÒÂÛÏÌËÚ ÏÛ ÍÓ̈ÂÌÚ‡ˆËË ÔÓ‡‰Ë ÚÂÒ-

ÌËflÚ ÏÛ Ú‡Ô‚Ú˘ÂÌ ÒÔÂÍÚ˙. èË Ô‡‡ÏËÓÚÓÌ˘̇-

Ú‡ ïËÔÂèè ÍÓÏ·ËÌˇÌÓÚÓ ËÁÔÓÎÁ‚‡Ì ̇ mexiletine Ë

hydrochlorothiazide ÏÓÊ ‰‡ Ô‰ÓÚ‚‡ÚË ÒÔ‡ÁÏËÚ Ë

Ò··ÓÒÚÚ‡, Ë̉ۈˇÌË ÓÚ ÒÚÛ‰ Ë ÒÔÓÌÚ‡ÌÌËÚ ‡Ú‡ÍË

̇ ıËÔÂ͇ÎËÂÏ˘̇ ÔÂËӉ˘̇ Ô‡‡ÎËÁ‡ (13, 14).

é·˘‡Ú‡ ‡ÌÂÒÚÂÁËfl ÔË Ô‡ˆËÂÌÚË Ò ÌflÍÓË ÏÛÒÍÛÎÌË Á‡-

·ÓÎfl‚‡ÌËfl ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó ÛÒÎÓÊÌÂÌËfl, ÍÓËÚÓ Ì‡ÔÓ‰Ó-

·fl‚‡Ú χÎË„ÌÂ̇ ıËÔÂÚÂÏËfl. èË èä, ͇ÍÚÓ Ë ÔË

‰Û„Ëڠ̉ËÒÚÓÙ˘ÌË ÏËÓÚÓÌËË Ë ÔÂËӉ˘ÌËÚ ԇ-

‡ÎËÁË succinylcholine ͇ÚÓ ‰ÂÔÓÎflËÁˇ˘ ÏËÓ·Í-

Ò‡ÌÚ ÏÓÊ ‰‡ Ô‰ËÁ‚Ë͇ ÒËÎ̇ ÏËÓÚÓÌ˘̇ ‡͈Ëfl ‚

ÓÚ‰ÂÎÌË ÏÛÒÍÛÎË /̇Ô. Ï. χÒÂÚÂ, ÔÓ-fl‰ÍÓ ‰Ëı‡ÚÂÎÌË

Ë ‰Û„Ë ÒÍÂÎÂÚÌË ÏÛÒÍÛÎË/. åËÓÚÓÌËflÚ‡ ÏÓÊ ‰‡ Ò Á‡-

‰˙Î·Ó˜Ë Ë ÓÚ ÔË·„‡Ì ̇ ͇ÎËÈ Ë ‡ÌÚËıÓÎËÌÂÒÚ‡ÁÌË

ωË͇ÏÂÌÚË, ͇ÍÚÓ Ë ÔË ·ÂÏÂÌÌÓÒÚ Ë ıËÔÓÚËÓˉË-

Á˙Ï. ᇠΘÂÌË Ò ËÁÔÓÎÁ‚‡Ú ÏÂÍÒËÎÂÚËÌ, ÎˉÓ͇ËÌ Ë

ÚÂıÌË ÔÓËÁ‚Ó‰ÌË. èË ÔÓ„ÂÒˇ˘‡ ÍËÁ‡ ÓÚ Ï‡ÎË„ÌÂ-

̇ ıËÔÂÚÂÏËfl ËÎË ÔË ÚÂÊ͇ ÏËÓÚÓÌ˘̇ ‡͈Ëfl ÒÂ

ÔË·„‡ ‰‡ÌÚÓÎÂÌ (1).

èÂ‰Ò Ú‡‚ÂÌËflÚ ÓÚ Ì‡Ò ÒÎÛ˜‡È Ò˙‰˙ʇ ‰ÓÒÚ‡Ú˙˜ÌÓ

ÍÎËÌ˘ÌË ı‡‡ÍÚÂËÒÚËÍË, ̇ÒÓ˜‚‡˘Ë Í˙Ï èä, ÔÓ‰ÍÂ-

ÔÂÌË ÓÚ ÖçÉ Ë ÖåÉ ËÁÒΉ‚‡ÌËflÚ‡, ͇ÍÚÓ Ë ÓÚ Ôӂ‰Â-

ÌËfl ÏÓÎÂÍÛÎflÌÓ-„ÂÌÂÚ˘ÂÌ ‡Ì‡ÎËÁ. éÚÒ˙ÒÚ‚ËÂÚÓ Ì‡ ÏÛ-

Ú‡ˆËflÚ‡ ÔË ÌflÍÓÈ ÓÚ Ó‰ËÚÂÎËÚ ÏÓÊ ‰‡ Ò ‰˙ÎÊË Ì‡

ÒÔÓÌÚ‡ÌÌÓ ‚˙ÁÌËÍ̇· ÏÛÚ‡ˆËfl ÔË ‰ÂÚÂÚÓ ËÎË Ì‡ ÏÓÁ‡-

ˈËÁ˙Ï Ì‡ „ÂÏË̇Ú˂̇ڇ ÎËÌËfl. éÔ‰ÂÎflÌÂÚÓ Ì‡ ÒÔÂ-

ˆËÙ˘̇ڇ ÏÛÚ‡ˆËfl ÔË Ô‡ˆËÂÌÚ͇ڇ ÔÓÁ‚ÓÎfl‚‡ ÒΉ

‚ÂÏ ÔË Ê·ÌË ÓÚ ÌÂÈ̇ Òڇ̇ ‰‡ ·˙‰Â Ó·Ò˙‰Â̇

‚˙ÁÏÓÊÌÓÒÚÚ‡ Á‡ ÔÂ̇ڇÎ̇ ‰Ë‡„ÌÓÒÚË͇ ̇ ÌÂÈÌÓÚÓ

ÔÓÍÓÎÂÌËÂ. éÔËÒ‡ÌËÂÚÓ Ì‡ ÍÎËÌ˘̇ڇ ͇ÚË̇ ÔË

Ô‰ÒÚ‡‚ÂÌËfl ÒÎÛ˜‡È ‰ÓÔË̇Òfl Á‡ Ó·Ó„‡Úfl‚‡Ì ‡Á·Ë‡-

ÌÂÚÓ Ì‡ ÙÂÌÓÚËÔ̇ڇ ÂÍÒÔÂÒËfl ÔË ÚÓ‚‡ Á‡·ÓÎfl‚‡Ì Ë

ËÁflÒÌfl‚‡Ì ÒÚÂÔÂÌÚ‡ ̇ ÔËÔÓÍË‚‡ÌÂÚÓ ÏÛ Ò ïËÔÂèè.

ãàíÖêÄíìêÄ

1. Baur C.P, Jurkat-Rott K, Lehmann-Horn F. Anaesthesia-related events inneuromuscular disease. Acta Myologica, 2002; XXI, 3-11.2. Becker P.E. Paramyotonia Congenita (Eulenburg). Fortschritte derAllgemeinen und Klinischen Humangenetic. Georg Thieme, Stuttgart, 1970.3. Ebers G.C, George A.L.Jr, Barchi R.L. et al. Paramyotonia congenita andhyperkalemic periodic paralysis are linked to the adult muscle sodium channelgene. Ann. Neurol 1991, 30, 810-816.4. Eulenburg A. Uber eine familiare durch 6 Generationen verfolgbare Formcongenitaler Paramyotonie. Neurol. Zentralbl. 1886, 5, 265-272.5. Fontaine B, Khurana T.S., Hoffman E.P. et al. Hyperkalemic periodic paraly-sis and the adult muscle sodium channel alpha-subunit gene. Science, 1990, 250,1000-1003.6. Jackson C.E, Barohn R.J, Ptacek L.J. Paramyotonia congenital: abnormalshort exercise test, and improvement after mexiletine therapy. Muscle Nerve, 1994,17, 763-768.7. Koch M.C, Ricker K, Otto M. et al. Linkage data suggesting allelic hetero-geneity for paramyotonia congenital and hyperkalemic periodic paralysis on chro-mosome 17. Hum. Genet., 1991, 88, 71-74.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 158‰ÂÍÂÏ‚Ë, 2002

îË„. 1: åËÓÚÓÌ˘ÂÌ ‡Áfl‰ ÓÚ Ï. Ú˷ˇÎËÒ ‡ÌÚÂËÓ

îË„. 2: èÓ‰Ó·ÂÌ Ì‡ ÙË·Ë·ˆËfl ÔÓÚÂ̈ˇΠÓÚ Ï.Ú˷ˇÎËÒ ‡ÌÚÂËÓ

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ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- ê.ÅÓÊËÎÓ‚‡,Ñ- Ç.É„ÂΘ‚‡,ÑÓˆ. Ç.ÅÓÊËÌÓ‚‡ÑÂÚÒ͇ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇ìëÅÄãçè "ë‚. ç‡ÛÏ",4-ÚË ÍÏ,„. ëÓÙËfl 1113, ÚÂÎ. 70 40 05

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IN MEMORIAM

Ç èÄåÖí çÄ èêéîÖëéê êÄòé êÄòÖÇ( 08.02.1927 - 09.10.2002 )

삇ʇÂÏË ÍÓ΄Ë, ç‡ 09.10.2002 „. ÔÓ˜Ë̇ ËÁ‚ÂÒÚÌËflÚ ÎÂ͇-Ì‚ÓÎÓ„ ÔÓÙ. ê‡¯Ó ê‡¯Â‚.èÓÙ. ê. ꇯ‚  ӉÂÌ Ì‡ 08 ÙÂ‚Û‡Ë 1927 „. ‚ Ò. èÓÔˈ‡, LJ˜‡ÌÒÍÓ. ᇂ˙¯ËÎ Â „ËÏ̇ÁËfl‚ „. Åfl· ë·ÚË̇ ÔÂÁ 1946 „. Ë Ï‰ˈË̇ ‚˙‚ Çåà, ëÓÙËfl - ÔÂÁ 1952 „. ëΉ Á‡‚˙¯‚‡ÌÂ-ÚÓ Ì‡ ‚ËÒ¯ÂÚÓ ÒË Ï‰ˈËÌÒÍÓ Ó·‡ÁÓ‚‡ÌË  ‡·ÓÚËÎ ÔÓ ‡ÁÔ‰ÂÎÂÌË ͇ÚÓ ÎÂ͇ ‚ „. Åfl-· ë·ÚË̇. èÂÁ 1957 „. ÒΉ ÍÓÌÍÛÒ Â ËÁ·‡Ì Á‡ ‡ËÒÚÂÌÚ ‚ ä‡Ú‰‡Ú‡ ÔÓ Ì‚ÓÎÓ„Ëfl Í˙Ïàëìã. ëΉ ÚÓ‚‡ ÔÓÒΉӂ‡ÚÂÎÌÓ Â ËÁ·‡Ì Á‡ ‰ÓˆÂÌÚ ÔÓ Ì‚ÓÎÓ„Ëfl ÔÂÁ 1969 „. Ë Á‡ ÔÓÙÂ-ÒÓ - ÔÂÁ 1984 „. ä‡ÍÚÓ Í‡Ì‰Ë‰‡ÚÒ͇ڇ, ڇ͇ Ë ‰ÓÍÚÓÒ͇ڇ ÏÛ ‰ËÒÂÚ‡ˆËfl Ò‡ ÔÓÒ‚ÂÚÂ-ÌË Ì‡ ÏÓÁ˙˜ÌÓ-Ò˙‰Ó‚ËÚ Á‡·ÓÎfl‚‡ÌËfl, ͇ÚÓ ‚Íβ˜‚‡Ú ‚ Ò· ÒË Ë Â‰Ì‡ Á̇˜ËÚÂÎ̇ ÂÍÒÔÂË-ÏÂÌÚ‡Î̇ ˜‡ÒÚ. ç‡Â‰ Ò ÏÌÓ„Ó·ÓÈÌËÚ ÒË Ì‡Û˜ÌË ÔÛ·ÎË͇ˆËË, ÔÓÙ. ê. ꇯ‚ Ëχ Û˜‡ÒÚË‚ ÏÌÓ„Ó ˙ÍÓ‚Ó‰ÒÚ‚‡ Ë ÏÓÌÓ„‡ÙËË. éÒ‚ÂÌ ÚÓ‚‡, ÚÓÈ Ò ̇ÎÓÊË Í‡ÚÓ Ú‡Î‡ÌÚÎË‚ ÔÂÔÓ‰‡-‚‡ÚÂÎ Ë ÓÚ΢ÂÌ ÍÎËÌˈËÒÚ, ÔÓ‰„ÓÚ‚ËÎ ÒÚÓÚËˆË Ì‚ÓÎӄ˘ÌË Í‡‰Ë ‚ ˆfl·ڇ Òڇ̇. ÇÔÓ‰˙ÎÊÂÌË ̇ ÏÌÓ„Ó „Ó‰ËÌË ÔÓÙ. ê. ꇯ‚ ˜ÂÚ¯ ÎÂ͈ËË ÔÓ Ì‚ÓÔÒËıÓÎÓ„Ëfl ‚ ëÓÙËÈÒ-ÍËfl ÛÌË‚ÂÒËÚÂÚ. èÓ‰ Ì„ӂÓÚÓ Ì‡Û˜ÌÓ ˙ÍÓ‚Ó‰ÒÚ‚Ó Ò‡ Á‡˘ËÚÂÌË Â‰Ëˆ‡ ‰ËÔÎÓÏÌË ‡·Ó-ÚË Ë Í‡Ì‰Ë‰‡ÚÒÍË ‰ËÒÂÚ‡ˆËË. ìÒÔÓ‰ÌÓ Ò Ì‡Û˜ÌÓ-ÔÂÔÓ‰‡‚‡ÚÂÎÒ͇ڇ ‰ÂÈÌÓÒÚ, ÚÓÈ ‚Ë̇-„Ë Â Û˜‡ÒÚ‚‡Î ‡ÍÚË‚ÌÓ ‚ Ó·˘ÂÒÚ‚ÂÌËfl ÊË‚ÓÚ Ì‡ ä‡Ú‰‡Ú‡ ÔÓ Ì‚ÓÎÓ„Ëfl Ë Çåà - ëÓÙËfl.

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