Диагностическая значимость субклинической эпилептиформной активности у пациентов с болезнью Альцгеймера

Введение. Высокая распространенность и значительная инвалидизация пациентов с болезнью Альцгеймера (БА) требуют поиска новых маркеров прогрессирования этого заболевания, а также новых подходов к его лечению. В последнее время накапливается все больше сведений о значимости применения электроэнцефалографии у пациентов с БА с целью выявления эпилептиформной активности у данной категории.

Цель. Определение частоты встречаемости эпилептиформной активности у пациентов с БА и оценка ее клинической и диагностической значимости.

Обсуждение. Установлено, что проведение ЭЭГ, особенно продолженной, с включением сна, позволяет выявить субклиническую эпилептиформную активность, которая ассоциирована с более выраженными когнитивными нарушениями и способствует прогрессированию заболевания. В обзоре рассмотрены данные исследований по распространенности и клинической значимости субклинической эпилептиформной активности у пациентов с БА без диагноза «эпилепсия». Также освещены основные патофизиологические механизмы взаимосвязи эпилептиформной активности и прогрессирования когнитивных нарушений в рамках БА. Кроме того, рассматривается вопрос о целесообразности назначения специфической противоэпилептической терапии при выявлении субклинической эпилептиформной активности.

Выводы. Показана высокая клиническая значимость проведения электроэнцефалографии и выявления эпилептиформной активности у пациентов с болезнью Альцгеймера вследствие ее потенциального негативного влияния на прогрессирование когнитивных нарушений и повышения рисков развития эпилептических приступов.

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