Инфекция и иммунитет. 2021; 11: 433-446
Цитокины и нейроспецифические белки при вирусных энцефалитах и судорожном синдроме у детей. II. Судорожный синдром
https://doi.org/10.15789/2220-7619-CAN-1449Аннотация
Во второй части обзора приведены новые сведения о факторах патогенеза судорожного синдрома у детей, в том числе о значительной роли вирусной инфекции в развитии судорог и эпилепсии (ЭПЛ) у детей, о чем свидетельствуют данные клинических и экспериментальных исследований. Различные формы судорожного синдрома, ассоциированного с вирусной инфекцией, включают фебрильные судороги и фебрильный эпилептический статус, острые симптоматические судороги при энцефалитах и постэнцефалитическую эпилепсию. Причинным фактором фебрильных судорог и фебрильного эпилептического статуса чаще всего является герпесвирус человека 6 типа, который выделен и при височной эпилепсии. Фебрильные судороги, и особенно фебрильный эпилептический статус, ассоциированы с развитием в дальнейшем эпилепсии. Особого внимания заслуживает эпилептический синдром, связанный с фебрильными инфекциями (FIRES), поражающий чаще детей школьного возраста и отличающийся крайне тяжелым течением и неблагоприятным исходом. Судорожный синдром ассоциирован с системным воспалением и гиперпродукцией провоспалительных цитокинов, повышающих проницаемость гематоэнцефалического барьера и функциональную активность резидентных клеток мозга, которые участвуют в генерации судорог и поддерживают эпилептогенез. С учетом ведущей роли воспаления в генезе судорожного синдрома цитокины и хемокины в последние десятилетия широко изучаются в качестве возможных прогностических критериев эпилептогенеза. Нейроспецифические белки исследуются как маркеры поражения клеток мозга при разных воспалительных заболеваниях центральной нервной системы. В первой части обзора были изложены современные сведения о системном и локальном ответе цитокинов/хемокинов при вирусных энцефалитах. Здесь представлены клинические исследования в основном за последние 5—7 лет с определением цитокинов/хемокинов и нейроспецифических белков у детей с разными формами судорожного синдрома, в том числе эпилепсией. Обсуждаются ассоциации уровня биомаркеров с клиническими параметрами болезни и возможность их использования в диагностике и прогнозе ее дальнейшего течения.
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Russian Journal of Infection and Immunity. 2021; 11: 433-446
Cytokines and neuro-specific proteins in viral encephalitis and convulsive syndrome in children. II. Convulsive syndrome
https://doi.org/10.15789/2220-7619-CAN-1449Abstract
In this Section we provide new data on the pathogenetic factors in pediatric convulsive syndrome, including a prominent role of viral infection in developing seizures and epilepsy (EPL) in children, as evidenced by clinical and experimental studies. Various forms of convulsive syndrome associated with viral infection include febrile convulsions and febrile epileptic status, encephalitis-related acute symptomatic seizures, and postencephalitic epilepsy. The human herpesvirus-6 isolated in temporal lobe epilepsy is a frequent causative agent of febrile seizures and febrile epileptic status. Febrile seizures and, especially, febrile epileptic status are associated with further developing epilepsy. Of special note is the febrile infection-related epileptic syndrome (FIRES) more often affecting school-aged children and characterized by extremely severe course and unfavorable outcome. Convulsive syndrome is associated with systemic inflammation and overproduced pro-inflammatory cytokines that increase permeability of the blood-brain barrier and functional activity of brain-resident cells, which are involved in eliciting seizures and maintaining epileptogenesis. Taking into consideration the key role of inflammation underlying convulsive syndrome, in recent decades cytokines and chemokines have been widely studied as possible prognostic criteria for epileptogenesis. Neuron-specific proteins are examined as markers of brain cell damage in various inflammatory diseases of the central nervous system. The first Section of the review presented current understanding on systemic and local cytokine/chemokine response in viral encephalitis. Here we present clinical trials published within the last 5—7 years assessing cytokines/chemokines and neuron-specific proteins in children with various forms of convulsive syndrome, including epilepsy. Association between biomarker level and disease clinical parameters as well as potential for their use to diagnose and predict its further course are discussed.
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