**3. Conclusion**

*Epilepsy - Advances in Diagnosis and Therapy*

*2.1.7 Transcranial magnetic stimulation*

**2.2 Nonpharmacological invasive therapy**

*2.2.1 Percutaneous stimulation of trigeminal nerve*

noticed a 50% or more reduction in the number of seizures [54].

dependent ion channels [53].

*2.2.2 Vagus nerve neurostimulation*

who cannot get resection surgery.

*2.2.3 Deep brain stimulation*

motor rhythm [49].

temporal, and hippocampal beta-neuron schemes can be studied with auditory

in the cerebellum during the processing of sensorimotor information [52].

In other studies, it was concluded that the decrease in beta-rhythm in temporal areas is connected with rhythmic movements (in this case, rhythmic hand movements) [50]. It is also supposed that temporal areas play an important role in rhythm reproduction, correlating with frontal areas and basal ganglia, forming a link between auditory stimulus and motor response [51]. It is proven that the hippocampus is connected with the processing of rhythmic information. Moreover, EEG showed the beta-fluctuation

Low-frequency rhythmic transcranial magnetic stimulation (rTMS) leads to a decrease in the cerebral cortex neuronal excitability, while high-frequency rTMS increases their excitability [2]. The mechanisms of rTMS are related to its ability to cause long-term effects of postsynaptic inhibition in excitatory neurotransmitter systems and neuronal excitability reduction through inactivation of the voltage-

Percutaneous stimulation of trigeminal nerve is a minimally invasive method which is based on exposure of the first trigeminal nerve's branches to electricity. To implement this method in practice, a special system is used which consists of external electric impulse generator and electroconductive plasters. There are few studies which report the use of this method, but most of them consider this method to have a positive clinical effect. During preliminary clinical trials, 57% of patients

Vagus nerve neurostimulation (VNS) is one of the nondrug epileptic treatment methods. The principle of this method is in the chronic electrical stimulation of the left vagus nerve, using an implantable stimulator [55]. The primary candidates for the application of this method are patients with drug-refractory epilepsy (DRE),

The main contraindications for this method are pregnancy and lactation, cardiac arrhythmia, bronchial asthma, chronic obstructive pulmonary disease, acute peptic and duodenal ulcer, vasovagal syncope, and type 1 diabetes [56]. Against the background of VNS therapy during the period from 3 months to 3 years, a complete cessation of seizures was revealed in 4.8–17.6% of patients. The decrease in the number of seizures by 50% or more was detected in 27.3–47% of patients, while the decrease in the number of seizures by less than 50% was detected in 23.5% of patients [57–59].

Deep brain stimulation is an effective therapeutic method for DRE treatment, especially for temporal lobe epilepsy. Thus, according to a randomized study, assessing the effectiveness of hippocampal stimulation in patients with temporal lobe DRE, positive effect in the form of complete disappearance of seizures was found in 50% of patients [60]. According to other studies, it was shown that after

**138**

Based on the conducted literature review results, it can be stated that an adequate number of Russian and foreign studies of the analyzed period are dedicated to nonpharmacological epilepsy treatment. Both methods with proven clinical effectiveness and low-reliable treatment options were found in the studied literature.

Most of the authors emphasize a positive influence of physical activity on epileptic patients, including prevention of epileptic seizures. Besides, physical activity is reported to have a positive influence on patients' psychic function, preventing cognitive disorders. However, up until now, physical exercises as an additional therapy are not included in any treatment program for patients with epilepsy. The analysis of the literature showed that it is due to the current concern of neurologists and epileptologists over the occurrence of epileptic seizures in state of hyperventilation.

Those concerns are not unfounded, because hyperventilation can provoke epileptic seizures in a certain group of patients with epilepsy. As a result, it is reasonable not to ban physical activity for all epileptic patients but to limit its intensity for the group of patients, in whom hyperventilation can provoke epileptic seizures. Meanwhile, the fact is reported that during physical exercising the reduction of epileptiform activity occurs on the epileptic patients' EEG. There are also works that prove a positive effect of music therapy, but the issue is still underinvestigated.

All the options for nonpharmacological epilepsy treatment, represented in the present review, are based on the classical theory of Kryzhanovskii about creation and destruction of pathological systems [62]. The author noted that on early stages of the disease the elimination of pathological determinant leads to liquidation of pathological (and, as a result, epileptic) system.

On late stages the fixation of pathological system leads to chronization of pathological process and corresponding neural disorders. The battle with pathological systems, especially with those with complicated and matured forms, is hard and is not always effective. It requires a complex pathogenetic therapy, focused on elimination of pathological determinant (e.g., the elimination of epileptic focus) and normalization of other links of the pathological system. Activation of antiepileptic system, amplification of overall control, and other genetic mechanisms are important as well. It is also known that there is a constant countdown in living system, on which homeostasis is based [63].

According to the theory of Rudnev [14], the so-called internal time is a genetic core of any motor activity, having both populations' and individual characteristics. Internal time is expressed as an individual rhythm. A lot of studies explore individual rhythm, its "maturation" in late ontogenesis, as well as its breaking in different cases of neural disorders [64]. Individual rhythm is a reflection of harmony of brains' work, and its breaking is a sign of disintegration in brain's work. Since there is an established fact that in case of epilepsy a pathological activation of brains' neurons occurs, which is a stress for central neural system, it is possible that the epileptic system occurrence can change patients' individual rhythm.

In reproduction of tapping, there are different brain structures concerned, such as the cerebellum. Taking into account the fact that the cerebellum is an antiepileptic device, its activation during tapping can have a therapeutic effect on epileptic patients. Tempo-rhythm studies focused on epileptic patients could be used for the development of new rehabilitative methods. As a fundamental support of this theory, exploration of dominants involving the opportunity to work out a new dominant for this group of patients with tapping exercises makes these studies relevant. Consequently, research on individual rhythm changes in patients with symptomatic post-surgery epilepsy and comparison of these changes with healthy persons' individual rhythm indicators can help to create a new dominant in the absence of pathological focus and reset remaining epileptic system links, imposing the mode of operation closest to the physiological one and activate antiepileptic system. There is also a concept which states that "seizures lead to seizures." First proposed by doctor William Gowers (1881) and reflecting the concept of epilepsy as a progressing disease [65], this concept remains relevant.
