Russian Military Medical Academy ReportsRussian Military Medical Academy ReportsИзвестия Российской Военно-медицинской академии2713-23152713-2323Eco-Vector63687010.17816/rmmar636870Original articlesОригинальные исследованияResearch ArticleEpileptic seizures after the combat traumatic brain injury. The role and place of antiepileptic therapyЭпилептические приступы после огнестрельной черепно-мозговой травмы. Роль и место противоэпилептической терапии火器性颅脑损伤后癫痫发作：抗癫痫治疗的作用和地位https://orcid.org/0000-0002-4248-93216505963201J-1416-20169785-0471BazilevichSergey N.БазилевичСергей НиколаевичBazilevichSergey N.
Russian Federation

MD, Cand. Sci. (Medicine), Associate Professor

канд. мед. наук, доцент

MD, Cand. Sci. (Medicine), Associate Professor

basilevich@inbox.ruhttps://orcid.org/0000-0001-8988-301135734354000F-9120-20136112-2792LitvinenkoIgor’ V.ЛитвиненкоИгорь ВячеславовичLitvinenkoIgor’ V.
Russian Federation

MD, Dr. Sci. (Medicine), Professor

докт. мед. наук, профессор

MD, Dr. Sci. (Medicine), Professor

vmeda-na@mil.ruhttps://orcid.org/0000-0002-7314-77117003327776I-6024-20161155-9732OdinakMiroslav M.ОдинакМирослав МихайловичOdinakMiroslav M.
Russian Federation

Corresponding Member of the Russian Academy of Sciences, MD, Dr. Sci. (Medicine), Professor

член-корреспондент РАН, докт. мед. наук, профессор

Corresponding Member of the Russian Academy of Sciences, MD, Dr. Sci. (Medicine), Professor

odinak@rambler.ruhttps://orcid.org/0000-0002-5881-224237066611200H-9132-20161006-2845TsyganNikolay V.ЦыганНиколай ВасильевичTsyganNikolay V.
Russian Federation

MD, Dr. Sci. (Medicine), Professor

докт. мед. наук, профессор

MD, Dr. Sci. (Medicine), Professor

vmeda-na@mil.ruMilitary Medical AcademyВоенно-медицинская академияMilitary Medical AcademyMilitary Medical AcademyВоенно-медицинская академияMilitary Medical Academy081220244343773920910202425102024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/RMMArep/article/view/636870

BACKGROUND: Taking into account the increasing number of armed conflicts, the number of combat head traumatic injuries and their consequences, which are faced not only by military doctors, but also by civilian healthcare, is thereof increasing.

AIM: The purpose of this article is to focus the attention of practicing neurologists and neurosurgeons to the modern principles of diagnostic and treatment of post-traumatic epileptic seizures after high-energy combat traumatic brain injury of various severity.

MATERIALS AND METHODS: The article presents the discussion of the clinical application of a number of theoretical concepts, definitions and recommendations used in cases to epileptic seizures after trauma and post-traumatic epilepsy. A prospective analysis of 224 patients with severe combat traumatic brain injury is presented. To evaluate different approaches to preventive therapy of epileptic seizures, the entire cohort of patients was divided into two groups: the first group (n = 122, 54.5% of patients) — without prophylactic use of antiepileptic drugs; the second group (n = 102, 45.5% of patients) — with prophylactic use of antiepileptic drugs. All patients underwent EEG, CT of the brain, and MRI of the brain in the absence of metal fragments in the body. The follow-up period was 12–18 months. Data from 79 patients with concussion in the structure of mine-blast injury were analyzed separately.

RESULTS: The analysis of the incidence of early and late acute post-traumatic seizures is carried out, various approaches to their treatment are discussed, depending on the clinical and diagnostic findings. The historical aspect of comparing the incidence of post-traumatic epilepsy in major wars of the twentieth century and current armed conflicts is touched upon, taking into account the contemporary approaches — the availability of specialized medical care, the possibility of current methods of examination and therapy.

CONCLUSION: The results obtained in the work provide grounds for revising the strategy of prophylactic administration of antiepileptic drugs to patients with severe head injury in modern conditions of providing specialized care.

Актуальность. С учетом возросшего количества вооруженных конфликтов закономерно увеличивается число боевой травмы головы и ее последствий, с которыми сталкиваются не только военные врачи, но и гражданское здравоохранение.

Цель: обратить внимание практикующих неврологов и нейрохирургов на современные принципы диагностики и лечения посттравматических эпилептических приступов после высокоэнергетической боевой травмы головы различной степени тяжести.

Материалы и методы. В статье обсуждаются вопросы клинического применения ряда теоретических понятий, определений и рекомендаций, используемых по отношению к эпилептическим приступам после травмы и посттравматической эпилепсии. Представлен проспективный анализ 224 пациентов с боевой тяжелой черепно-мозговой травмой. Для оценки разных подходов к профилактической терапии эпилептических приступов вся когорта исследуемых пациентов была разделена на две группы: первая группа (n = 122, 54,5 % пациентов) — без профилактического применения антиэпилептических препаратов; вторая группа (n = 102, 45,5 % пациентов) — с профилактическим применением антиэпилептических препаратов. Всем пациентам выполняли электроэнцефалографию, компьютерную томографию головного мозга, при отсутствии осколков в теле магнитно-резонансную томографию головного мозга. Катамнез составил 12–18 мес. Отдельно проанализированы данные 79 пациентов с сотрясением головного мозга в структуре минно-взрывной травмы.

Результаты. Проведен анализ частоты ранних и поздних острых посттравматических приступов, обсуждаются различные подходы к их лечению в зависимости от клинической картины и диагностических находок. Затрагивается исторический аспект сравнения частоты возникновения посттравматической эпилепсии в крупных войнах ХХ в. и нынешних вооруженных конфликтах с учетом изменившихся подходов — доступности специализированной медицинской помощи, возможностями современных методов обследования и терапии.

Заключение. Полученные в работе результаты дают основания пересмотреть стратегию профилактического назначения антиэпилептических препаратов пациентам с тяжелой травмой головы в современных условиях оказания специализированной помощи.

Ключевые слова: антиэпилептический препарат; военная травма; огнестрельная травма мозга; острые симптоматические эпилептические приступы; посттравматическая эпилепсия; посттравматические приступы; проникающее ранение головы; профилактика эпилепсии; профилактика эпилептических приступов; черепно-мозговая травма.

背景。随着武装冲突的增加，战斗性头部创伤及其后果的发生率也在上升，这不仅是军事医生所面临的问题，也涉及民用医疗系统。

研究目的。引起临床神经科医生和神经外科医生对不同程度高能战斗性头部创伤后创伤性癫痫发作的现代诊断和治疗原则的关注。

材料和方法。本文讨论了与创伤性癫痫发作和创伤后癫痫相关的一些理论概念、定义和建议的临床应用。文章对224例重度战斗性颅脑创伤患者进行了前瞻性分析。为评估不同癫痫发作预防治疗方法，将所有患者分为两组：第一组（n = 122，占54.5%）未进行预防性抗癫痫药物治疗；第二组（n = 102，占45.5%）接受了预防性抗癫痫药物治疗。所有患者均进行了脑电图和头部CT检查，在无异物的情况下还进行了头部MRI检查。随访期为12~18个月。还单独分析了79例因爆炸伤导致脑震荡患者的数据。

结果。分析了早期和晚期急性创伤后癫痫发作的频率，并讨论了基于临床表现和诊断发现的不同治疗方法。通过对比二十世纪的大型战争和当前武装冲突中的创伤后癫痫发生率，考虑了专科医疗的可及性以及现代检查和治疗方法的进展。

结论。研究结果为在现代专科医疗条件下重度头部创伤患者的抗癫痫药物预防策略的重新审视提供了依据。

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