Features of visual changes in children with epilepsy

Аннотация

The incidence of epilepsy is 50-70 people per 100,000 population, the prevalence is 5-10 people per 1000 (Kwan P., Brodi M., 2000; Hauser W.A., 2015). In 70% of patients, it is possible to achieve remission or a decrease in the frequency of attacks (Gusev E.I., 2000; Brodi M., 2004). Keywords: monozygotic twins, epileptogenesis, sciascopy, visometry, microdysgenesis The modern hypothesis of the etiopathogenesis of epilepsy assumes the multifactorial and polygenic nature of this disease, as well as the complex nature of the interaction of genetic predisposition to seizure activity with environmental factors [1,2,3,10,14]. The most interesting from a genetic point of view are idiopathic forms of epilepsy, which are an independent disease not associated with organic brain damage or other diseases. They are traditionally considered as cases with a high hereditary predisposition, as evidenced by the hereditary burden and high degree of concordance among monozygotic twins (65%) compared to heterozygous twins (12%) [Kjeldsen MJ. et al., 2003]. Numerous works devoted to epilepsy have noted that the development of an epileptic seizure is based on a paroxysmal dysfunction of a certain pool of neurons in the brain, and the mechanism of this condition is a violation of the electrogenesis of neurons, which consists in their spontaneous and synchronized charging and discharging [4,5,6, 12,13,15]. The morphological and biochemical disturbances that lead to explosive, synchronized neuronal activity have been the subject of study for many decades. There are also concepts of different levels of events occurring, referred to as “epileptogenesis”: cellular (including disturbances on the surface of cell membranes), the level of neural networks (transmitter or synaptic) and glial, i.e. cells surrounding neurons (including vascular cells) [6,7,9,10,11]. In Uzbekistan, problems of epileptology are more often dealt with by neurologists (children and adults) and psychiatrists, despite the fact that this is a multidisciplinary problem that also requires the attention of neurophysiologists, geneticists, biochemists, immunologists, and a wide range of doctors. When analyzing the literature data, we did not find any works concerning the study of the function of the visual organs in epilepsy. However, this issue is relevant in ophthalmology, because epilepsy is a common disease [5,6,12,13]. Purpose of the study: to study the clinical and functional features of visual impairment in children with certain forms of epilepsy. Materials and methods of research. The clinical study was conducted in the Department of Ophthalmology, TashPMI Clinic. The study is based on the results of examination and treatment of 151 patients (302 eyes) with epilepsy. The age of the observed patients varied from 4 months. up to 14 years (average age 6.8±1.2 years). All patients had a carefully collected history of life and illness. To assess concomitant somatic pathology, all children were examined by a pediatrician, neurologist, otolaryngologist and other specialists as necessary. Clinical, laboratory and instrumental research methods were carried out. The entire process of examining sick children 163 SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 3 ISSUE 5 MAY 2024 ISSN: 2181-3337 | SCIENTISTS.UZ with epilepsy can be divided into the following r e s e arch methods: visometry, determination of refraction by skiascopy in conditions of drug-induced cycloplegia, determination of the angle of strabismus according to Hirschberg, study of binocular vision, examination of the fundus (ophthalmoscopy), and also all patients with strabismus were carried out special research methods. Research results. The criterion for including children in the study was the presence of epilepsy of various origins. The children were divided into two groups. Patients with epilepsy with pathology of the visual organ made up the main group of 103 (68.2%) and the control group consisted of 48 children with epilepsy without pathology of the visual organ (31.7%). In 42 patients, a hypoxic factor of brain damage was identified, the vast majority in patients with epilepsy and visual impairment. Of the established etiological factors of the disease, the main role was played by: hypoxic-ischemic encephalopathy (n=41, 45.5%), abnormalities of brain development (n=17, 18.8%). According to an analysis of case histories in children of the neonatal period and early age suffering from epilepsy, perinatal pathology was identified in 66% of cases. Among the identified risk factors, hypoxic-ischemic encephalopathy predominated in 62.7% of cases. In the etiology of “non-idiopathic” focal epilepsies in young children, malformations of the brain (focal cortical dysplasia, microcephaly, heterotopia of gray matter) stood out in the first place. In our study, in patients with cryptogenic epilepsy and hypoxic factor in the perinatal period, the presence of microdysgenesis, which were not detected on