Volume 02 Issue 04-2022
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International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
02
I
SSUE
04
Pages:
40-45
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I
MPACT
FACTOR
(2022:
5.
705
)
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1121105677
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–
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ABSTRACT
The autonomic nervous system plays an important role in the functioning of the human div. It regulates the work
of internal organs, ensures the maintenance of homeostasis, adaptive reactions, motor and mental activity, affects
immunity and emotions. In turn, the imbalance of the functional state of the patient's brain leads to disruption of
the activity of nonspecific systems and is manifested by characteristic disorders in the cognitive, mental and
vegetative status of the patient. The mechanism of chronic pathological adaptation is based on an automatic
metabolism, genetically predetermined with the participation of the regulatory role of the nervous and endocrine
systems.
KEYWORDS
Hypothalamic-pituitary system, autonomic nervous system, epilepsy, cognitive impairment.
Research Article
CLINICAL AND NEUROLOGICAL FEATURES OF PATIENTS WITH
ENDOCRINE PATHOLOGY
Submission Date:
April 20, 2022,
Accepted Date:
April 25, 2022,
Published Date:
April 30, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue04-07
Shomurodova Dilnoza Salimovna
Department Of Neurology, Samarkand State Medical Institute, Uzbekistan
Jurabekova Aziza Tahirovna
Department Of Neurology, Samarkand State Medical Institute, Uzbekistan
Jalolitdinova Shaxnoza Akbarjon Kizi
Student Of Group 517 Of Pediatric Faculty, Samarkand State Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.c
om/index.php/ijll
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 02 Issue 04-2022
41
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
02
I
SSUE
04
Pages:
40-45
SJIF
I
MPACT
FACTOR
(2022:
5.
705
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
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INTRODUCTION
Violation of the functional state of the patient's brain
leads to an imbalance in the activity of specific
systems
and
is
manifested
not
only
by
electroencephalographic features but also by
characteristic disorders in the patient's cognitive,
mental and vegetative status [1, 5, 9].
In this regard, the study of the functional status of the
hypothalamic-pituitary system (HPS) in epilepsy will
contribute to the expansion and in-depth study of
pathogenetic mechanisms that will contribute to the
optimization of modern diagnostic methods, which in
turn will give a more complete picture of the clinical
manifestation of this disease and optimize treatment
methods [2, 7, 8, 10].
The hypothalamus is an important link in the
system of regulation of cerebral functions and
regulates many additional pituitary processes on the
one hand and on the other hand controls the state of
the adeno-pituitary gland constitutes a single
hypothalamic-pituitary
system,
hormones
are
modulators of epileptic activity, which is are
prerequisites for optimizing the principles of
treatment of these diseases [3, 4, 6].
Most of the available research concerns the
studies of hormonal disorders, which were studied
during or immediately after a seizure, when urgent
mechanisms for regulating hormonal homeostasis are
realized. Whereas the interictal period and the
formation of a chronic pathological process, provided
by slow-acting mechanisms of adaptation, are
practically not studied. The mechanism of chronic
pathological adaptation is based on automatic
metabolism, genetically predetermined with the
participation of the regulatory role of the nervous and
endocrine systems [5, 8].
Separate pathogenetic mechanisms of epilepsy,
neurohormonal relationships and their influence on
the course and prognosis of epilepsy have not been
studied.
The
neurological
manifestations
of
dysfunction of the hypothalamic-pituitary system in
patients with epilepsy, as well as the role of the
hypothalamic-pituitary system in the formation of the
clinical manifestations of this pathology, have not
been sufficiently studied.
Purpose of the study: to investigate the features
of clinical and neurological manifestations of
imbalance and disadaptation of the hypothalamic-
pituitary system in patients with epilepsy.
Materials and methods of research
Patients with epilepsy who were hospitalized in the
neurology department of the 1-Clinic of SamMI for the
period 2020–2022 were subject to examination,
patients registered in the endocrinological dispensary
of Samarkand.
The total number of patients examined was 85,
including 40 patients with epilepsy (group 1), 45
patients with epilepsy and signs of hypothalamic-
pituitary syndrome (HPS; group 2).
To determine hormones in blood plasma, a
radioimmunoassay method was used. All patients
were determined the level of triiodothyronine (T3),
thyroxine
(T4),
thyrotropin
(THG),
adrenocorticotropic hormone (ACGH) and cortisol
(using standard commercial kits).
Assessment of the functioning of the autonomic
nervous system is carried out according to the
method for determining the autonomic index (VI)
Kerdo. In accordance with the state of the autonomic
Volume 02 Issue 04-2022
42
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
02
I
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04
Pages:
40-45
SJIF
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MPACT
FACTOR
(2022:
5.
705
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
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Servi
nervous (ANS) system, 5 tones are distinguished:
severe parasympathicotonia - the predominance of
parasympathetic tone, the index value > (-31);
parasympathicotonia - an intermediate state between
the norm and parasympathetic tone, values from (-16
to -30); norm - balance of sympathetic and
parasympathetic influences, values from (-15 to +15);
sympathicotonia - an intermediate state between the
norm and sympathetic tone - from +16 to +30;
pronounced sympathicotonia - the predominance of
sympathetic tone, the index value > (+31).
All patients underwent EEG studies in dynamics.
The structure of the brain was mainly studied by
magnetic resonance computed tomography (MRI).
RESEARCH RESULTS
During the examination of patients , attention is
drawn to the specificity of the external data of
patients of group 2, in particular, overweight in 16
patients ( χ2=10.656; p=0.453), while in group 1 it is 2
times less. Striae are clearly visible in the area of the
abdominal wall. Young women aged 18–28 years (9)
complained (considering the main problem of
epileptic seizures) of headache and occasional
dizziness.
The duration of the disease in the groups was
identical (10.5±2.3 years and 10.9±1.9 years,
respectively, in groups), despite these indicators,
epileptic seizures in group 2 were severe, seizures
were longer and more frequent.
When evaluating the data of VI Kerdo, a moderate
fluctuation in the initial autonomic tone was
established with a slight predominance of both
sympathetic and parasympathetic shifts.
As can be seen from the presented data, in
patients with epilepsy, sympathicotonia is noted in
most cases; moreover, in patients with HHS burden,
sympathicotonia was observed in 52.1% of cases, while
in patients of group 1—in 36.8% of cases;
Parasympathy was noted in 29.8% of patients with
epilepsy along with HHS, while in patients with
epilepsy it was in 34.7%. The balance of sympathetic
and parasympathetic influences was observed 2.6
times more often in patients of the 1st group.
Expressed vegetative symptoms, vegetative
lability, unstable arterial hypertension, often against
the background of headaches. The most reliable was
the absence of the menstrual cycle (aminorrhea),
which confirms the hypothalamic-pituitary syndrome
in these patients.
Conducting a clinical study contributed to the
establishing of the functional state of HGS in patients
with epilepsy, which showed a pronounced
polymorphism of pathological syndromes and
symptoms caused by epilepsy, which regulates
vegetative-trophic and endocrinological functions.
The severity of symptoms depended on the presence
of a pathological imbalance in the HGS function, i.e., in
patients of group 2.
Disorders of the HGS function are most often
manifested by the presence of neurotrophic
syndrome ( χ2=2.877; p =0.233), sleep and
wakefulness disorders (χ2=2.523; p=0.219) and the
development of emotional and psychological
disorders (χ2=6.044; p=0.333). A comparative analysis
of the data obtained allows us to conclude that there
is more pronounced pathology in patients with
epilepsy and HHS.
Neurological
examination
revealed
diffuse
symptoms in most patients, however, in patients with
epilepsy not aggravated by HHS, disturbances were
observed mainly at the cortical-subcortical level, and
Volume 02 Issue 04-2022
43
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
04
Pages:
40-45
SJIF
I
MPACT
FACTOR
(2022:
5.
705
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
in patients with HHS in this disease, the stem level of
the vestibular system was involved in the pathological
process.
Changes in bioelectrical activity in epilepsy,
observed by us in the interictal period, are similar to
those described in the literature, however, computer
processing of the electroencephalogram revealed
differences between the data of studies of patients of
the 1st and 2nd groups. Patients with epilepsy
aggravated by HHS were characterized by a shift in
the average effective frequency of the spectrum
towards pathological slow-wave activity, as well as
the presence of signs of dysfunction of the mid-deep
structures of the brain and a change in the correlative
relationships between the main EEG rhythms.
In the study of the hormonal status in patients
with epilepsy, data were obtained indicating
significant changes in the hormonal function of the
hypothalamic-pituitary system, which is manifested by
an imbalance of the hypothalamic-pituitary-adrenal
and hypothalamic-pituitary- thyroid axis.
In the study of the content of ACTH in patients
with epilepsy in the interictal period, no significant
changes in its concentration were found. An increase
in the level of ACTH, according to the literature,
during seizures and its normal content in the
interparoxysmal period suggests that ACTH is a factor
in the div's adaptation to stress.
A significant increase in cortisol levels varied
depending on the duration of the disease and was
maximum in patients ill for more than 5 years (mean
values 7.4±0.09 years).
Since glucocorticoids increase the synthesis of
serotonin, reduce the level of GABA in the brain,
increase the permeability of neuronal membranes for
Na + and Ca +, and reduce the synthesis of proteins in
the brain, an increase in the level of cortisol can
decrease the convulsive threshold and a characteristic
sign of an epileptic seizure. An increase in cortisol
levels at normal ACTH values is a manifestation of
dysregulation in the hypothalamus-pituitary-adrenal
system.
A decrease in the content of T3 in the blood
plasma of patients with epilepsy and significant
variability in the level of T4 and TSH in all examined
patients were established. Moreover, the severity of
changes in thyroid status correlates with the severity
of epilepsy, clinical signs of hypothalamic pathology,
as well as with the duration of the disease, the
frequency and type of seizure.
Under stress (of any nature), a synergistic increase
in the activity of the suprarenal and thyroid complex
at the hypothalamic, pituitary, and peripheral levels
occurs only in the initial phase. But further activation
of the adrenal complex inhibits the function of the
thyroid gland at the hypothalamic-pituitary and
peripheral levels. These mechanisms explain the
presence of subclinical hypothyroidism in the patients
examined during the interparoxysmal period.
Thus, the hypothyroid state disrupts bioelectrical
processes in organs with a high level of metabolism,
including the brain, where the activity of glycolytic
and oxidative enzymes decreases. In addition to
energy
metabolism,
the
exchange
of
mucopolysaccharides in the vascular wall is disturbed,
the tone of the cerebral vessels decreases.
Recurrent epileptic seizures of various origins are
accompanied by persistent disorders of energy
metabolism, in particular, a decrease in the rate and
coefficient
of
phosphorylation.
With
this,
anticonvulsants decrease the respiratory activity of
Volume 02 Issue 04-2022
44
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
04
Pages:
40-45
SJIF
I
MPACT
FACTOR
(2022:
5.
705
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
brain tissue, uncoupling of respiration from
phosphorylation, and this aggravates disturbances in
the bioenergetics of patients with epilepsy caused
using the epileptic process.
T3 deficiency leads not only to a distortion of the
hormonal status of the div, but also, to the variety
of influences of thyroid hormones, to the
development of pathological energy and metabolic
state, which aggravates the course of the disease and
creates a pathological basis for its progression.
Thus, the functional restructuring of the state of
the brain in patients with epilepsy significantly
changes the activity of the hypothalamic-pituitary
system. This is confirmed by the identified vegetative
disorders, changes in the bioelectrical activity of the
brain, disorders in the hypothalamus-pituitary-thyroid
gland and hypothalamus-pituitary-adrenal glands, and
a violation of the integrated connections between
these systems.
CONCLUSION
Clinical and neurological picture of disadaptation The
hypothalamic- pituitary system is characterized by
disorders of the autonomic nervous system with a
predominance of sympathetic orientation.
The hypothalamic-pituitary system affects the
functional restructuring of the brain in patients with
epilepsy and is manifested by polymorphic symptoms,
on the one hand, HGS dysfunction increases
excitation through biologically active substances, on
the other hand, reduces the level of excitation
through the synthesis of certain neurotransmitters
and disorders of the autonomic nervous system.
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