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Section 7. Medical science
Section 7. Medical science
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-36-37
Abdullayeva Nargiza Nurmatovna, Samarkand Medical Institute, Neurology, neurosurgery, traumatology, and orthopedics department, senior lecturer
E-mail: [email protected]
Doplerographic values of cerebral hem dynamics in gerontologic patients with epilepsy
Abstract: Old people have notable increase of the values of linear systolic velocity of blood flow in the examined cerebral veins and development of compensatory mechanisms of venous flow out, testifying the presence of disorder of venous circulation, and noted mostly within the late stages of cerebral vascular pathology. Keywords: epilepsy, dopplerographic changes, geriatric patients.
Old people have notable increase of the values of linear systolic velocity of blood flow in the examined cerebral veins and development of compensatory mechanisms ofvenous flow out, testifying the presence of disorder of venous circulation, and noted mostly within the late stages of cerebral vascular pathology.
Topicality. Epilepsy is a widespread pathology, the morbidity rate ofwhich in various countries varies from 11/100000 to 190/100000 of population. The incidence of epilepsy among adults was about 15 cases per 100 thousands ofpopulation, and it grows starting approximately from 50 years old, reaching 50-75 cases per 100 thousands of population in the age 60-75 years old respectively [1, 6]. Several studies provide the data, that the risk of epilepsy in patients above 70 years old is higher, then within initial 10 years of life [7].
Epileptic seizures proceed with impairments in various parts of cerebral metabolism: oxidation stress, disorder of mediator amino acids' exchange, suppression of energetic exchange [5]. Alterations in cerebral hem dynamics in patients with epilepsy make the application of transcranial doplerography (TCD) useful, as that method provides achievement of reliable information about speed and spectral characteristics of the blood flow in cerebral vessels, and, respectively, about the status of cerebral hem dynamics [3]. Application of TCD using various functional loads of physical and chemical nature is considered to be more significant perspective [2, 4]. The advantage of TCD is its non-invasive character and, consequently, possibility of its application for a wider contingent of patients and multiple repetition. Within the period of compensatory mechanisms exhaustion, besides the statement of decompensation, it is possible to determine degree of its expression and to define the direction of the shift from optimum within the limits of homeostatic range [5].
The objective: to study peculiarities of cerebral hem dynamics in patients with epilepsy in gerontologic practice.
Materials and methods of the research: Patients were divided to basic and control groups. The basic group involved 89 patients with epilepsy (according to WHO classification above 60 years old) of elder (60-75 years old) and senile age (75-90 years old). The control group comprised 52 patients with epilepsy in the age from 25 to 60 years old.
Diagnosis of epilepsy was based on the complex of clinical, electroneurophysiological, and neuroradiological data. It was for-
mulated in compliance with the guidelines of International Anti-epileptic League (1989).
The technology of ultra sound checking of carotid arteries includes scanning in three planes: two longitudinal (frontal and dorsal) and one transversal. Application of 3 planes of scanning minimizes the risk of diagnostic mistakes. The studies were conducted with the help of linear sensor with 5-7MHz frequency.
The results of the research: In 58 (65.2%) elder patients with epilepsy we determined hem dynamic significant stenosis of cerebral arteries, which was singular in 17 (19.1%) patients and multiple in 41 (46.1%). Singular stenosis alterations in cerebral arteries were determined in 9 (75%) patients with the II stage of CCI, 4 (44.4%) patients with cranial trauma, 2 (50%) patients with neural infection, and 2 (40%) with chronic alcoholic intoxication, which was the etio-logic factor of epilepsy development. Multiple stenosis of cerebral arteries was diagnosed in 36 (87.8%) patients with the III stage of CCI, 2 (22.2%) patients with cranial trauma, 1 (25%) patient with neural infection, which was the etiologic factor of epilepsy development, and 2 (40%) patients with chronic alcoholic intoxication, which was also the etiologic factor of epilepsy. 13 (14.6%) elder patients had occlusion of cerebral arteries, which was singular in 4 (4.5%) and multiple in 9 (10.1%) of these patients. Singular occlusion of cerebral arteries was diagnosed in 4 (30.7%) patients with previous cerebral insult. Multiple occlusion of cerebral arteries was determined in 9 (69.2%) patients with recurrent cerebral insults.
In 3 (5.8%) young patients with symptomatic epilepsy developed as a result of cranial trauma we determined a stenosis of cerebral arteries. In 2 (3.8%) young patients with symptomatic epilepsy developed as a result of insult we determined singular occlusion of cerebral arteries.
Average linear velocity of blood flow (ALVBF) in common carotid artery of elder patients with rare seizures was 34.6 cm/sec, with moderate frequency of seizures 31.4 cm/sec, and in case of often seizures 27.2 cm/sec. ALVBF in the inner carotid artery in young patients with epilepsy was equal to 42.3 cm/sec. ALVBF in the inner carotid artery in elder patients with rare epileptic seizures was 30.3 cm/sec, with moderate frequency of seizures was 27.1 cm/sec, and with often seizures 24.8 cm/sec. ALVBF in anterior cerebral artery in young patients with epilepsy was 36.4 cm/sec.
Doplerographic values of cerebral hem dynamics in gerontologic patients with epilepsy
ALVBF in anterior cerebral artery in elder patients with rare epileptic seizures was 30.4 cm/sec, with moderate frequency of seizures was 26.9 cm/sec, and with often seizures 23.8 cm/sec. ALVBF in the interim cerebral artery in the elder patients with rare epileptic seizures was 27.8 cm/sec, with moderate frequency 25,8 cm/sec, and with often seizures 23.6 cm/sec. ALVBF in posterior cerebral artery in elder patients with rare epileptic seizures was 30.1 cm/sec, with moderate frequency of seizures 28.3 cm/sec, and with often seizures it was 23.4 cm/sec. ALVBF in spinal artery in elder patients with rare epileptic seizures was 27.1 cm/sec, with moderate frequency 24.7 cm/sec, and with often seizures 22.3 cm/sec.
Comparative analysis of ALVBF in elder patients with epilepsy in cerebral arteries of the left and right hemispheres of brain showed, that asymmetry of ALVBF was observed rarely and mostly in patients with previous stroke. Comparative analysis of the values of average linear velocity of blood flow in cerebral arteries in elder patients with epilepsy and young patients showed, that these values were reliably lower in elder patients (p>0.05), than in the patients of the control group.
Elder patients with epilepsy had notable dependence of ALVBF in cerebral arteries on the frequency of epileptic seizures: the greater was the frequency of epileptic seizures development, the lower the velocity ofblood flow was in cerebral arteries. It is possibly linked with the fact, that frequent epileptic seizures are registered within later stages of cerebral vascular pathology, accompanied by expressed structural alteration in magistral arteries ofhead, among which there is prevalence of multiple stenosis lesions in cer4ebral arteries.
Pulsation index, representing the ratio of the difference of maximal systolic and diastolic velocity to the average velocity of blood flow, is the most characteristic reflection of elastic-flexible properties of arteries, and indirectly indicates the status of intracranial pressure, by these means demonstrating the interrelation of cerebral blood flow with intracranial pressure.
Pulsation index in common carotid artery in young patients with epilepsy was equal to 1.04. Pulsation index in common carotid artery in elder patients with rare epileptic seizures was 1.12, while with moderate frequency of seizures it was 1.21, and with often seizures 1.37. Pulsation index in inner carotid artery in young patients with epilepsy was 1.05. Pulsation index in inner carotid in elder patients with rare seizures was 1.09, with moderate frequency of seizures 1.27, and with often seizures it was equal to 1.36. Pulsation index in the anterior cerebral artery in young patients was equal to 1.03. Pulsation index in the anterior cerebral artery of elder patients
with rare seizures was 1.13, with moderate frequency 1.32, and with often seizures 1.43. Pulsation index in the interim cerebral artery in young patients was 0.99. Pulsation index in the interim cerebral artery in elder patients with rare seizures was 1.03, with moderate frequency of seizures 1.25, and with often seizures it was 1.38. Pulsation index in the posterior cerebral artery in young patients with epilepsy was 1.03. Pulsation index in the posterior cerebral artery of elder patients with rare seizures was 1.09, with moderate frequency 1.17, and with often seizures 1.28. Pulsation index in spinal artery of young patients with epilepsy was 1.03. Pulsation index in spinal artery in elder patients with rare epileptic seizures was 1.08, with moderate frequency 1.26, and often seizures 1.38. the results of the performed study showed, that different from younger patients in elder patients with epilepsy the values ofpulsation index were higher. The greatest increase of pulsation index in elder patients was registered in anterior, interim, spinal, and common cerebral arteries. Lesser increase of pulsation index in elder patients with epilepsy was registered in posterior and inner carotid arteries. Alteration of the values of pulsation index in elder patients was interrelated with the frequency of epileptic seizures development: the greatest values of pulsation index were observed were observed in elder patients with frequent epileptic seizures.
Thus, compared with young patients the elder patients with epilepsy had notable increase of the velocity of cerebral blood flow in the examined veins.
Conclusions:
1. Characteristic alterations of pulsation index revealed in elder patients with epilepsy testify the decrease of elasticity and flexibility ofvascular system in the patients with frequent epileptic seizures, registered mostly within the later stages of cerebral vascular pathology.
2. Analysis of structural alterations in magistral arteries ofhead (MAH) demonstrated, that compared with young patients the elder patients with epilepsy had characteristic greater prevalence of structural alterations in MAH, represented mostly by multiple stenosis in cerebral arteries.
3. Elder patients with epilepsy had notable dependence of ALVBF in cerebral arteries on the frequency of epileptic seizures: the greater was the frequency of epileptic seizures development the lower the velocity of blood flow was in cerebral arteries.
4. Results of the performed study testify the presence of more expressed alterations of cerebral hem dynamics in elder patients with frequent epileptic seizures, noted mostly within the later stages of cerebral vascular pathology.
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