Research methods in patients with epilepsy
Application of neuropsychological and psychodiagnostic research methods in the assessment of cognitive functions and emotional-personal sphere in patients with epilepsy.
Epilepsy in children is characterized by a high frequency of occurrence (up to 1% among the child population) and leads to significant mental disorders in terms of severity. This disease poses a serious threat during the period of development and education of children, when organic dementia and epileptic personality changes characteristic of epilepsy occur, requiring accurate diagnosis and rehabilitation.
In determining the focus of epileptic activity in the early stages of epilepsy in children, the clinician is faced with great difficulties. By the clinical picture of an attack, it is far from always possible to judge the location of the pathological process. The immaturity of the child’s brain, the polymorphism of convulsive states inherent in children, mask focal symptoms. In this case, great opportunities are opened by the neuropsychological method of research, which is more “sensitive” to the pathological state of various structures of the brain than technical means. Neuropsychological symptoms reflect subtle functional changes in brain tissue.
In modern psychiatry and neurology, neurocognitive studies based on the neuropsychological method have recently entered the scientific and research practice of medical specialists and psychologists and are relevant for clinical psychology (primarily neuropsychology) and medicine (primarily epileptology and neurology) … And the development of a comprehensive psychological assessment of cognitive disorders and methods of their correction in children with epilepsy is carried out on the basis of studying the structural and functional foundations of intellectual processes in children with different forms of epilepsy and is due to the individual characteristics of the cerebral organization of speech, mnestic and other HMF, manifested in non-standard relations of the hemispheres , blocks and levels of the brain.
The multidisciplinary nature of an in-depth neuropsychological study of speech, mnestic, emotional processes required the involvement of the cardinal provisions of a wide range of scientific disciplines. In addition to the well-known data of classical neurology, psychiatry, as well as the currently priority neuropsychological concept of A.R. Luria, the research compiled data from psychology, psycholinguistics, and neurophysiology.
For a long period of time, the author studied more than 2000 patients with various forms of epilepsy and convulsive syndrome caused by metabolic disorders, who were in neurological, epileptological and genetic departments: Moscow Research Institute of Pediatrics and Pediatric Surgery, Ministry of Health of Russia; scientific and practical center of medical care for children with malformations of the craniofacial region and congenital diseases of the nervous system under the government of Moscow.
The following research methods were used in the work: clinical and experimental (including neuropsychological testing), neurological, pathopsychological (“mental development profile”) for children with mental disabilities. Patients were also examined using electroencephalography, CT, NMR, single-photon emission computed tomography.
All patients underwent courses of complex medical, psychological and pedagogical influence, and rehabilitation training for patients with various forms of epilepsy was carried out.
At the first stage of the study, a complete neuropsychological examination was carried out in the educated discrete groups for children with normal mental development, and for children with mental retardation using a ” mental development profile “. Based on the results of the examination, a syndromic analysis of the identified mental disorders was given, taking into account the localization of the focus of epiactivity.
The types of neuropsychological syndromes identified in patients with epilepsy associated with the localization of the focus of epiactivity varied depending on the severity of the disease, the child’s mental development and the degree of involvement of the cortical and subcortical structures of the brain in the pathological process.
Verification of the localization of the focus of epiactivity by different methods showed certain correspondences between the results of neuropsychological, clinical and neurophysiological diagnostics.