International Medical Journal, Vol. 24., Iss. 2, 2018, P. 57−60.
ANALYSIS OF CAUSES OF EPILEPSY PHARMACORESISTANCE FORMATION IN CHILDREN AND WAYS OF OVERCOMING IT
Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Peculiarities of the developing brain determine clinical specificity of epilepsy in children which often takes a pharmacoresistant course and leads to developmental disorders. The number of therapeutically resistant epilepsy cases varies, according to different authors, from 20 to 60 % of all childhood epilepsies. The purpose of this study was to analyze the factors of formation of pharmacoresistance of epilepsy in children. "Relative" resistance associated with subjective causes from both the patient (asthenogenic) and the doctor (iatrogenic) deserves the greatest attention. Among the asthenogenic factors of the conditional pharmacoresistance formation, the following were noted in our study: irregular antiepileptic medication, unauthorized withdrawal from treatment, violation of regimen, psychosocial problems, unauthorized dose reduction, spontaneous switching from one drug to another, comorbid psychiatric and somatic disorders, consumption of alcohol and energy drinks. When analyzing the factors of forming iatrogenic conditional pharmacoresistance the most typical therapeutic errors that lead to ineffective treatment were identified: incorrect assessment of the type of seizures and the form of epilepsy; the discrepancy between the medication selected and the type of seizures and the form of epilepsy, combination of several drugs before the optimally dosed monotherapy is used, beginning of treatment with second−line drugs; interpretation of instrumental research methods without taking into account clinical data; prolonged monotherapy, maintaining a high daily dose of antiepileptic drugs in the absence of clinical effect; treatment with low doses of antiepileptic drugs; low concentration of antiepileptic drugs in the patients' blood despite the appointment of adequate dosages; use of drugs that activate epileptogenesis; unreasonably fast cancellation of antiepileptic drugs after remission; non−epileptic seizures. Thus, pharmacoresistant epilepsy in children is a serious complex, multidisciplinary medical and social problem. The use of adequate diagnostic and therapeutic tactics can only partially overcome drug resistance.
Key words: children, epilepsy, pharmacoresistance.