Komorbiditāte un riska faktori epilepsijas un akūtu simptomātisku krampju lēkmju gadījumā

Epilepsy is one of the most common chronic neurological diseases, more than 65 million people worldwide suffer from it. The term epilepsy is used to define a disease of the brain characterized by an enduring predisposition to generate seizures, as well as neurobiological, cognitive, psychological and social consequences associated with this disease. Epilepsy is associated with a stigma against people suffering from the disease, and epilepsy patients are subject to risks unique to the disease, such as sudden unexpected (non-traumatic) death in epilepsy (SUDEP), a much higher rate of sudden cardiac death compared to the general population, and a higher incidence of virtually all comorbidities.
Pharmaceutical therapy has failed to solve the problem of drug-resistant epilepsy, 30–40% of patients cannot achieve seizure control, and epilepsy surgery of Latvia is in its initial stages. However, addressing of the risks associated with epileptic seizures and aspects thereof, like comorbidities, social and psychological aspects, is possible.
The work consists of four thematically related studies, which investigate aspects of disease and care in populations of patients with epilepsy, first-time seizures and alcohol withdrawal seizures.
Two studies on SUDEP found that, contrary to the practice in Western countries, physicians in Latvia do not inform patients about the negative aspects of epilepsy, which conflicts with the wishes of Latvian patients surveyed during the study. Ignorance of the risks reduces compliance with therapy. Non-compliance is one of the most common reasons for poor epilepsy control, and poor seizure control increases the risk of patient death.
In a study of signs of depression and alcohol abuse, it was found that two-thirds of epilepsy patients, who also suffer from alcohol withdrawal seizures, show signs of depression, which would justify considering alcohol use in the population of epilepsy patients as an indicator for depression screening.
The study of comorbidities and risk factors included 1,215 patients who were treated as inpatients from 2006 to 2014 after first-time seizure, epileptic seizure(s) or acute symptomatic seizures. The prognostic value of recurrent seizures, clinical and paraclinical parameters for the development of further seizures or delirium at the inpatient stage, as well as death in the late period after hospitalization were determined. Electrocardiographic parameters associated with death of epilepsy patients in the late period after discharge from hospital were determined.
Clarification of the above-mentioned factors allows the tailoring of medical care individually for patients with identified risks, for instance, to hospitalize patients with an increased risk of recurrent seizures, to intensify monitoring and therapy, to provide delirium preventive therapy for patients with a risk of delirium, to motivate patients with cardiac risk factors to consult a cardiologist. The results of the doctoral thesis allow us to understand how to improve the care for epilepsy patients beyond the concept of seizures.