medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-175medsovet-9046Research ArticleНЕВРОЛОГИЯ, ПСИХИАТРИЯNEUROLOGY AND PSYCHIATRYВисочная эпилепсия и коморбидные тревожные расстройстваTemporal lobe epilepsy and comorbid anxiety disordershttps://orcid.org/0000-0002-7682-6672МаксимоваМ. Ю.MaximovaM. Yu.

Максимова Марина Юрьевна, д.м.н., профессор, руководитель 2-го неврологического отделения Института клинической и профилактической неврологии

125367, Москва, Волоколамское шоссе, д. 80

Marina Yu. Maximova, Dr. Sci. (Med.), Professor, Head of the 2nd Neurological Department, Institute of Clinical and Preventive Neurology

80, Volokolamskoe Shosse, Moscow, 125367

ncnmaximova@mail.ruhttps://orcid.org/0000-0003-0787-6251ШитоваА. Д.ShitovaA. D.

Шитова Анна Денисовна, аспирант 2-го неврологического отделения Института клинической и профилактической неврологии

125367, Москва, Волоколамское шоссе, д. 80

Anna D. Shitova, Postgraduate Student, 2nd Neurological Department, Institute of Clinical and Preventive Neurology

80, Volokolamskoe Shosse, Moscow, 125367

Научный центр неврологииРоссияResearch Center of NeurologyRussian Federation202504052025053040Copyright © Максимова М.Ю., Шитова А.Д., 20252025Максимова М.Ю., Шитова А.Д.Maximova M.Y., Shitova A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9046

Частота тревожных расстройств у больных фокальной височной эпилепсией (ФВЭ) превышает соответствующий показатель в общей популяции. Исследований, посвященных диагностике и коррекции тревожных расстройств у больных височной эпилепсией, не столь много, и их результаты несколько противоречивы. Препарат для коррекции тревожных расстройств, назначаемый больным эпилепсией, должен обладать высокой эффективностью, благоприятным профилем переносимости и минимальными побочными эффектами. Во многих исследованиях показано, что гамма-аминомасляная кислота (ГАМК) играет ключевую роль в регуляции возбудимости нейронов. Снижение ингибирующей ГАМК-ергической передачи в центральной нервной системе имеет решающее значение для развития тревоги. Усиление тормозного действия ГАМК приводит к снижению гиперактивности нейронов, позволяя уменьшить симптомы тревоги. Бензодиазепины являются одними из наиболее эффективных препаратов для лечения тревожных расстройств. Усиление тормозного действия ГАМК приводит к седативному, анксиолитическому и миорелаксирующему эффектам. При длительном использовании бензодиазепинов может развиваться толерантность, требующая коррекции дозы, повышается риск потенциальной зависимости, наблюдаются выраженная седация и когнитивные нарушения. В связи с этим актуальным представляется применение препаратов, точкой приложения которых является рецептор ГАМК, однако с меньшим спектром нежелательных эффектов. Этифоксин – небензодиазепиновый препарат семейства бензоксазинов – обладает анксиолитическим действием за счет двойного механизма действия на ГАМКА-рецепторы, благодаря чему улучшается ГАМК-ергическая передача импульса. Приводится два клинических наблюдения мезиального височного склероза (склероза гиппокампа) с развитием тревожных расстройств. Больным, помимо противоэпилептической терапии, был назначен этифоксин 50 мг по 1 капсуле 3 раза в день. При повторном обследовании через 21 день общее самочувствие больных улучшилось, отмечен регресс эмоционального напряжения и тревожных расстройств. Учитывая высокую эффективность этифоксина в коррекции тревожных расстройств и благоприятный профиль переносимости, а также такие дополнительные эффекты, как противосудорожный, нейропластический, нейротрофический и нейропротективный, его применение необходимо рекомендовать в комплексном лечении больных височной эпилепсией.

The incidence of anxiety disorders in patients with temporal lobe epilepsy (TLE) is higher than in the general population. Studies on anxiety disorders and their correction in patients with temporal lobe epilepsy are not so numerous, and their results are somewhat contradictory. A drug for the correction of anxiety disorders prescribed to patients with epilepsy should have a high efficiency, favourable tolerability profile and minimal side effects. Many studies have shown that gamma-aminobutyric acid (GABA) plays a key role in the regulation of neuronal excitability. Decreased inhibitory GABAergic transmission in the central nervous system is crucial for the development of anxiety. Enhancement of the inhibitory action of GABA leads to a decrease in neuronal hyperactivity, allowing the symptoms of anxiety to be reduced. Benzodiazepines are among the most effective drugs for the treatment of anxiety disorders. Enhancement of the inhibitory action of GABA leads to sedative, anxiolytic and myorelaxant effects. Long-term use of benzodiazepines may lead to tolerance requiring dose adjustment, increases the risk of potential dependence, marked sedation and cognitive impairment are observed. In this regard, it seems relevant to use drugs that target the GABA receptor, but with a smaller spectrum of undesirable effects. Etifoxin, a non-benzodiazepine drug of the benzoxazine family, has anxiolytic action due to a dual mechanism of action on GABA-receptors, so that GABA-ergic transmission is improved. Two clinical observations of mesial temporal sclerosis (hippocampal sclerosis) with the development of anxiety disorders are presented. In addition to antiepileptic therapy, the patients were prescribed etifoxine (Strezam) 50 mg 1 capsule 3 times a day. At the repeated examination after 21 days the general well-being of the patients improved, regression of emotional tension and anxiety disorders was noted. Given the high efficiency of etifoxin in the correction of anxiety disorders and its favorable tolerability profile, as well as additional effects such as anticonvulsant, neuroplastic, neurotrophic and neuroprotective effects, its use should be recommended in the complex treatment of patients with temporal lobe epilepsy.

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The authors declare that there are no conflicts of interest present.