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19MEDICAL SCIENCES
CHANGES IN CEREBRAL HEMODYNAMICS AND BIOELECTRIC ACTIVITY AS A PREDICTOR
OF EPILEPTIC SEIZURES
Mushehian M.
Postgraduate (PhD) student, the Department of neurology and child neurology, Kharkiv Medical Academy
of Post-Graduate Education, Kharkiv, Ukraine
Litovchenko T.
Doctor of medical sciences, professor, the Department of neurology and child neurology, Kharkiv Medical
Academy of Post-Graduate Education, Kharkiv, Ukraine
Abstract
With the aim to improve the diagnosis of epilepsy due to cerebrovascular disease by establishing the features of the hemodynamics and bioelectrical activity of brain in the patients with ischemic stroke and the subsequent development of epileptic seizures, a cross-sectional randomized cohort comparative study with retrospective and prospective stages was performed in 60 patients (men and women) with ischemic stroke aged 65 [57.0; 74.0] years, in 30 of which epileptic seizures were detected. Vascular deformities in patients with acute cerebrovascular disease are observed in at least a one-third of cases (S-shaped tortuosity of the left spinal artery in 36.7±29.2 %), reaching a maximum regarding pathological tortuosity of the left common carotid artery (63.3±38.4 %) and do not have the characteristics of the frequency response in the presence of epileptic seizures after ischemic stroke. The severity of stenosis of the right and left internal and common carotid arteries in patients with ischemic stroke is not specific with the development of epileptic seizures. Studies of cerebral hemodynamics in patients with epileptic seizures on the background of ischemic stroke can improve the diagnosis of epilepsy on the in combination with cerebro-vascular diseases. For patients with epileptic seizures after ischemic stroke the electroencephalogram is characterized by a tendency to increase the amplitude of delta waves (20.1 [15.8; 23.1] ^V), alpha waves (23.3 [20.3; 27.0] ^V). The median frequency on the electroencephalogram among patients with epileptic seizures after ischemic stroke has the following parameters: generalized - 8.7 [7.4; 9.8] Hz; in the leads from the left hemisphere - 8.6 [7.4; 10.3] Hz, in the leads from the right hemisphere - 8.9 [7.5; 9.4] Hz, which is significantly (p<0.01) lower than among patients with ischemic stroke without epileptic seizures. Patients with epileptic seizures after ischemic stroke have a significantly higher chance of focal changes (70.0±38.3 %; 9=3.2; p<0.01), paroxysmal activity on the encephalogram than in patients without epilepsy (26,7±22.8 %; 9=4.2; p<0.01), dysfunction of the median structures (63.3±38.4 %; 9=2.6; p<0.01). The established features of the bioelectrical activity of the brain in patients with ischemic stroke and the subsequent development of epileptic seizures allow to improve the diagnosis of epilepsy on the background of cerebrovascular diseases. The prospect of further research is to study the association of cerebral hemodynamics with the development of epileptic seizures in patients with ischemic stroke.
Keywords: epilepsy, ischemic stroke, electroencephalography, ultrasound, sonography, doppler, diagnosis.
Background. According to the guidelines of the International League Against Epilepsy (ILAE), one of the important diagnostic criteria for epilepsy is imaging methods of brain examination in addition to clinical symptoms, history, evaluation of electroencephalog-raphy, etc. [1].
Late seizures are the most common cause of post-stroke epilepsy - a chronic disease that impairs the quality of life of patients and has no other objective causes than a history of acute disturbance of cerebrovascular circulation [2, 3, 4]. Depending on the underlying cerebrovascular pathology, post-stroke epilepsy may develop in 2-4 % of patients [4, 5, 6, 7].
In addition to epileptic seizures, elderly patients may experience acute symptomatic (reactive, provoked) seizures that occur within a week after a registered metabolic, toxic, structural, infectious, or inflammatory brain injury [8].
Cerebrovascular diseases, including stroke, are considered to be the leading cause of epilepsy in the elderly population, 30-50 % of diagnosed new cases of epilepsy in this age group [9].
The degree of correlation of symptoms, EEG data and CT and MRI data depends on the time of onset of seizures. Thus, most often the clinical picture of seizures corresponds to the side of the zone of ischemia in the acute period of stroke, and the more time passes from the onset of acute brain circulation disorder to the first seizures, the greater dissociation occurs, which probably indicates the formation of areas of epilepto-genesis not associated with primary necrosis.
However, despite numerous studies of epidemio-logical, clinical history and other aspects of epilepsy, the specifics of the bioelectrical activity of the brain in patients with ischemic stroke and the subsequent development of epileptic seizures specific data in the scientific literature is still insufficiently covered.
Aim: to improve the diagnosis of epilepsy due to cerebrovascular diseases by establishing the features of cerebral hemodynamics and bioelectrical activity of the brain in patients with ischemic stroke with prediction of an epileptic seizure subsequent development.
Material and methods. The cross-sectional randomized cohort comparative study with retrospective
and prospective stages was performed in 60 patients (men and women) with ishemic stroke aged 65 [57.0; 74.0] years, in 30 of which epileptic seizures were detected.
The total number of study participants - 60 people of both sexes aged 65.0 [57.0; 74.0] years, who were examined and treated in the Department of Vascular Pathology of the Brain of the Kharkiv Railway Clinical Hospital #1 of Branch "Health Center" of Joint Stock Company "Ukrainian Railway" in 2008-2019, of which: 30 people aged 70.5 [62.0; 78.0] years with is-chemic stroke in combination with epilepsy as the main group (group 1a); 30 patients aged 69.5 [57.0; 76.0] years with ischemic stroke without epileptic seizures as a comparison group (group 1b).
Standardized criteria for inclusion and non-inclusion of participants in the study were applied.
Doppler echoencephalography was performed on the ultrasound system Sigmairis 880 CE CD (France) according to standard methods in order to assess the condition of cerebral vessels and cerebral blood flow. In the main vessels (right and left common carotid arteries, right and left internal carotid arteries) following indicators were recorded: thickness of the intima-media complex (mm), maximum blood flow velocity (cm/s), minimum blood flow velocity (cm/s), average velocity blood flow (cm/s), resistive index, pulsatility index. In addition, S-shaped tortuosity and hypoplasia were assessed to characterize the condition of the right and left vertebral arteries; pathological tortuosity, severity of stenosis (% of normal) - to assess the condition of the right and left internal and common carotid arteries.
The study was performed according to standard methods of electroencephalography with identification of neurophysiological semiotics and differentiation of EEG types. The following indicators were subject to registration. Wave amplitudes (^V): doubled average; bands: delta (1.5-4.0 Hz), theta (4-8 Hz), alpha (813 Hz), beta1 (14-20 Hz), beta2 (20-30 Hz). Zonal differences. Interhemispheric asymmetry in amplitude (%). The median frequency of the spectrum general, in the left hemisphere leads, in the right hemisphere leads. Sharp waves. Spike waves. Generalized characteristics of EEG: diffuse, focal changes, paroxysmal activity, dysfunction of a deep structures.
Following types of EEG have been distinguished.
Type I - organized ("normal" EEG) -alpha rhythm dominates as the main EEG component, it is regular in frequency, clearly modulated in the spindles, with a medium and high index, well-expressed zonal differences. The shape of the waves is usually smooth. Beta activity of high and medium frequency, small amplitude. Slow waves are almost not expressed. Less ordered structural and spatial organization of alpha activity and the presence of irregular slow activity, mainly
in the anterior parts of the brain, usually with a smaller amplitude than in alpha activity, are possible.
Type II - hypersynchronous. The main thing in the structure of this type is a high index of regular fluctuations of biopotentials with loss of their zonal differences. There are various options for such an increase in activity synchronization: with the preservation and even increase of oscillations of the alpha range, with the disappearance of alpha activity and its replacement by low-frequency beta activity or theta activity.
Type III - desynchronous ("flat" EEG) - is characterized by the absence or sharp decrease in the number of alpha waves with a relative increase in the number of beta and theta oscillations of not high, low or very low amplitude without zonal differences.
Type IV - disorganized, with a predominance of alpha activity. On the EEG, the main one is an alpha activity, but it is not regular enough or completely irregular in frequency. Such a rather disorganized alpha rhythm is not high enough in amplitude and may even dominate in all parts of the brain. Beta activity is also often enhanced, often represented by low-frequency oscillations of increased amplitude. In addition, on the EEG theta and delta waves of a fairly high amplitude may be present.
Type V - disorganized, with a predominance of theta and delta activity. The structure of this type of EEG is characterized by a weak representation of alpha activity. Fluctuations in the biopotentials of the alpha, beta, theta and delta bands are recorded without any clear sequence. This non-dominant type of curve can have both medium and high amplitude levels. Types of EEG were distinguished according to the classification of Zhirmunska A. A. (1984, 1991).
Logical and statistical analysis was performed by nonparametric methods. Thus, the central regularity of the studied traits in the assessment of the group of subjects was expressed using the median (Me), and the variability - the lower, 25 percent, quartile (LQ) and upper, 75 percent quartile (UQ), for brevity, expressing the description in : Me [LQ; UQ]. Qualitative, binary, ordinal indicators were described in frequency values - absolute and relative (percentage) with SD guidance. The groups were compared in pairs using Fisher's angular transformation, the value of the empirical angle and the corresponding p-level were given; more than two groups — with construction of conjugacy tables and application of the method of maximum likelihood of Pearson's chi-square criterion. In all types of statistical analysis, trends at the p-level less than 0.05 were considered statistically significant.
Results.
The frequency characterization of vascular deformities in patients with acute cerebrovascular disease was performed (Table 1).
Table 1
Frequency characteristics of vascular deformities in patients with acute cerebrovascular disease
Vascular deformities Group 1а, n=30 Group 1b, n=30
Abs. % SD Abs. % SD
S-shaped tortuosity of the right vertebral artery 14 46.7 34.1 13 43.3 32.6
S-shaped tortuosity of the left vertebral artery 11 36.7 29.2 12 40.0 31.0
Hypoplasia of the right vertebral artery 13 43.3 32.6 14 46.7 34.1
Pathological tortuosity of the left internal carotid artery 16 53.3 36.4 16 53.3 36.4
Pathological tortuosity of the right internal carotid artery 18 60.0 37.9 15 50.0 35.4
Pathological tortuosity of the right common carotid artery 13 43.3 32.6 16 53.3 36.4
Pathological tortuosity of the left common carotid artery 19 63.3 38.4 12 40.0 31.0
Note. * - the difference in comparison with group 1b is significant at p <0.05.
Vascular deformities in patients with acute cerebrovascular disease were observed in at least a third of cases (S-shaped tortuosity of the left vertebral artery in 36.7±29.2 %), reaching a maximum in the pathological tortuosity of the left common carotid artery (63.3±38.4 %) and there is no peculiarities of the
frequency characteristics in the presence of epileptic seizures after ischemic stroke.
The severity of stenosis in the right and left internal and common carotid arteries was assessed (Table 2).
Table 2
Stenosis severity of the right and left internal and common carotid arteries in patients with acute cerebrovascular disease
Артерп, виразшсть стенозу Group 1а, n=30 Group 1b, n=30
Me LQ UQ Me LQ UQ
Right common carotid artery,% 48.0 38.0 55.0 42.0 38.0 48.0
Left common carotid artery,% 42.5 38.0 50.0 45.5 36.0 53.0
Right internal carotid artery,% 46.0 40.0 54.0 46.5 40.0 55.0
Left internal carotid artery,% 44.0 40.0 50.0 48.0 38.0 55.0
Note. * - the difference in comparison with group 1b is significant at p <0.05.
The severity of stenosis of the right and left internal and common carotid arteries in patients with is-chemic stroke was not specific in case of epileptic seizures development.
Thus, taking into account the peculiarities of cerebral hemodynamics in patients with epileptic seizures
on the background of ischemic stroke can improve the diagnosis of epilepsy on the background of cerebrovas-cular diseases.
The amplitude characteristic of EEG waves has been evaluated (Table 3).
Table 3
Amplitude characteristics of electroencephalographic waves in patients with acute cerebrovascular disease
Amplitude Group 1а, n=30 Group 1b, n=30
Me LQ UQ Me LQ UQ
- average doubled, ^V 11.0 9.0 15.4 10.4 7.6 16.3
- delta waves, ^V 20.1* 15.8 23.1 15.0 10.8 18.2
- theta waves, ^V 26.1 21.4 31.7 22.5 20.2 27.2
- alpha waves, ^V 23.3* 20.3 27.0 30.8 26.1 38.6
- beta1-waves, ^V 15.5 13.7 17.2 16.5 14.7 18.6
- beta2-waves, ^V 13.1 10.1 16.8 13.4 8.9 16.2
Note. * - the difference in comparison with group 1b is significant at p <0.05.
Patients in group 1a had a significantly higher amplitude of delta waves (p<0.01), alpha waves (p<0.01).
The median frequency of an EEG spectrum among patients of group 1a is significantly lower than in group
1b by the following parameters: generalized (p<0.01), in the leads from the left (p<0.01) and right (p<0.01) hemispheres (Table 4).
Table 4
Median frequency of electroencephalographic wave spectrum in patients with acute cerebrovascular disease
Median frequency Group 1a, n=30 Group 1b, n=30
Me LQ UQ Me LQ UQ
- generalized, Hz 8.7* 7.4 9.8 10.1 8.8 10.7
- in leads from the left hemisphere, Hz - in leads from the right hemisphere, Hz 8.6* 8.9* 7.4 7.5 10.3 9.4 10.3 10.1 9.0 9.0 10.9 10.5
Note. * - the difference in comparison with group 1b is significant at p <0.05.
The frequency characteristic of qualitative indicators of EEG is carried out (Table 5).
Table 5
Frequency characteristics of electroencephalography in patients with acute cerebrovascular disease
Parameters Group 1a, n=30 Group 1b, n=30
Abs. % SD Abs. % SD
Sharp waves 9 30.0 25.1 15 50.0 35.4
Peak waves 5 16.7 15.2 4 13.3 12.4
Diffuse changes 30 100.0 0.0 30 100.0 0.0
Focal changes 21 70.0* 38.3 9 30.0 25.1
Paroxysmal activity 8 26.7* 22.8 0 0.0 0.0
Dysfunction of the deep structures 19 63.3* 38.4 9 30.0 25.1
Note. * - the difference in comparison with group 1b is significant at p <0.05.
The group of patients with epileptic seizures after ischemic stroke had a higher frequency of focal changes (9=3.2; p<0.01), paroxysmal activity (9=4.2; p<0.01), dysfunction of the deep brain structures (9=2.6; p<0.01).
The frequency response of EEG types showed the predominance of IV and V EEG types (Table 6).
Table 6
Frequency characteristics of EEG types in patients with acute cerebrovascular disease
Type of electroencephalogram Group 1a, n=30 Group 1b, n=30
Abs. % SD Abs. % SD
Type I 0 0.0 0.0 1 3.3 3.3
Type II 4 13.3 12.4 6 20.0 17.9
Type III 3 10.0 9.5 3 10.0 9.5
Type IV 13 43.3 32.6 12 40.0 31.0
Type V 10 33.3 27.2 8 26.7 22.8
Note. * - the difference in comparison with group 1b is significant at p <0.05.
Thus, the established features of the bioelectrical activity of the brain in patients with ischemic stroke and the subsequent development of epileptic seizures allow to improve the diagnosis of epilepsy on the background of cerebrovascular diseases.
The consideration of the basic criteria for assessing the clinical course in patients with acute and chronic cerebrovascular diseases is not completely perfect and leaves the possibility of insufficient effectiveness of this approach.
Discriminant analysis was used in the training sample in order to classify the prognostic solution by measuring various parameters (results) of the examination of patients.
Carrying out a canonical discriminant analysis of the results of examination of patients by the standard method allowed to develop mathematical models based on the task of increasing the informativeness of predicting the development and progression of epileptic seizures in patients with acute and chronic cerebrovascu-lar diseases.
The first issue to be addressed by discriminant analysis was the prediction of seizures in patients with acute cerebrovascular disease.
Source variables (age; history of hypertension; scores on the scales HAM-D, MoCA, NIHSS, Rankin, Barthel, NHS3; 10 EEG parameters; score by the Faze-kas scale) were selected, the number of which in the
process of step-by-step discriminant analysis (back- result the following formulas of canonical discriminant ward stepwise) is reduced to the optimal 10 and as a functions were developed:
ni(Ep1DevAcuiRUB)=(1.675xX1)-(0.234xX2)+(8.415xX3)+(10.963xX4)+ +(2.118xX5)+(29.745xX6)+(2.167xX7)+(L823xX8)+(6.506xX9)+
(12.222xX10)-355.400; ni(EpiDevAcuFALSE)=(1.793xX1)-(0.260xX2)+(11.164xX3)+(12.314xX4)+ +(2.090xX5)+(32.512xX6)+(2.345xX7)+(2.022xX8)+(7.571xX9)+ (13.823xX10)-446.278,
where PI is the value of the prognostic index (UI), which assesses the probability of developing an epileptic seizure in patients with cerebrovascular disorders (PI(EpiDevAcuTRUE) - the probability of development is greater than or equal to 95%, PI(EpiDevAcuFALSE) - the probability of developing less than 5%) ; X1 - age, years; X2 - history of hypertension, years; X3 - score on the HAM-D scale; X4 - score on the MoCA scale; X5 - score on the NIHSS scale; X6 - score on the Rankin scale; X7 - score on the Barthel scale; X8 - score on the NHS3 scale; X9 - median asymmetry in alpha rhythm; X10 - Fazekas score.
If PI(EpiDevAcuFALSE) < PI(EpiDevAcuTRUE), a high
(>95%) probability of developing an epileptic seizure in patients with acute cerebrovascular accident is established.
If PI(EpiDevAcuFALSE) > PI(EpiDevAcuTRUE) - a low
(<5%) probability of developing an epileptic seizure in patients with acute cerebrovascular accident is established.
Discussion
The vascular component of epileptogenesis which we have detected in the study corresponds to what other authors have revealed. Thus, as well as in our study, the significance of brain circulation state in the condition of neurovascular unit has been shown [25], an essential role of vascular integrity has been determined [26].
Transcranial and extracranial duplex ultrasound scanning is an inexpensive and non-invasive method of examination that allows to determine the features of cerebral blood flow and identify sites of occlusion in large vessels of a brain [10, 11]. Khasanova D. R. et al. (2010) found changes in cerebrovascular reactivity in patients with ischemic stroke and epileptic seizures. Emphasis was placed on the predominance of perfusion reserve disorders in the vertebrobasilar circulation (90.2 %), compared with carotid, which correlated with EEG-registered foci of pathological activity (79.3 %). This may partly explain the increased convulsive activity, as it develops insufficiency of the antiepileptic system, most of which (in particular, the cerebellum, reticular formation, caudate nucleus) are supplied with blood by the vessels of the vertebrobasilar circulation [12].
The results of visualization and electroneurophys-iological studies allow to establish etiopathogenetic features, type of epilepsy, characteristics of seizures in patients with cerebrovascular diseases. The basic and most common electroneurophysiological method, elec-troencephalography, is not included in the standard examination of patients with acute stroke, but this simple inexpensive non-invasive method can provide information about changes in the cerebral cortex as a result of its damage. According to our experience and the data
of other authors, electroencephalography is the best technique for detecting brain epileptic activity, especially in patients with nonconvulsive post-stroke seizures [13, 14, 15]. Thus, Claassen J. et al. (2004) found convulsive activity of brain in 19% of patients after stroke using continuous EEG monitoring, most of whom (92 %) had no motor manifestations [16]. In our study we have revealed higher amplitude of delta- and alpha waves, focal changes, paroxysmal activity, dysfunction of the deep brain structures.
Electroencephalography is of great importance in the early diagnosis of seizures and post-stroke epilepsy, and also allows you to monitor the course of the disease, helps to choose a method of treatment and predict its results [14, 17, 18]. Apart of this, EEG is also used to differentiate true seizures from non-convulsive conditions that can mimic them. The recording of a standard (routine) EEG takes 20-45 minutes, but there are also extended techniques such as extended EEG (recording for 1-2 hours) and continuous EEG monitoring, which can take up to 24 hours or more. Continuous EEG allows to fix ictal (during seizure) and interictal patterns better than standard EEG, especially in cases of non-convulsive seizures or non-convulsive status ep-ilepticus [15, 17, 19]. Thus, in the study Bentes S. (2017) the interictal epileptiform discharges on the first EEG were registered in 17.9 % of visitors, while daily serial EEG monitoring during the week after stroke revealed the majority of people with paroxysmal activity [20].
In general, abnormalities registered on the EEG in patients with stroke can be divided into three groups [13] (including which have been detected in our study):
1) nonspecific patterns (diffuse or focal polymorphic slowing of delta rhythm, ipsilateral attenuation or lack of alpha and beta activity);
2) interictal epileptiform patterns that develop due to irritation of the cerebral cortex and indicate an increased risk of seizures (sharp waves and spikes, lat-eralized periodic discharges, bilateral independent periodic discharges, generalized periodic discharges, temporal intermittent delta-activity);
3) ictal epileptic patterns (rhythmic theta, delta or alpha activity, rhythmic spikes or spike waves).
According to the meta-analysis of 8 studies examining EEG changes in patients with seizures after stroke (n=739), the most common finding was diffuse or focal slowing (49.3 %), followed by epileptiform discharges (35 %) and only 11.9 % had a normal EEG picture [21]. In the study of 69 patients with post-stroke EEG seizures, normal activity was maintained in only 8 % (compared to 54 % in patients without stroke), and most of them had the following EEG abnormalities: intermittent rhythmic delta activity (n=17), diffuse slowing
(n=15) and lateralized periodic discharges (n=4) [22]. Carrera E. et al. (2006) studied 100 patients with acute stroke by continuous EEG recording. They showed paroxysmal epileptic activity in 11.7 % of cases, and epi-leptiform disorders in 17 % of patients (3 % of lateral-ized periodic discharges and 14 % of other types of epileptiform discharges) [18].
Conducting an EEG in the acute period of stroke may be useful in predicting early and late seizures. Koren J. et al. (2015) in a small sample study found that the appearance of epileptiform discharges on a standard EEG within 30 minutes of the onset of stroke was associated with the registration of epileptic seizure patterns on subsequent continuous EEG monitoring and the appearance of acute symptomatic seizures in 23 % of patients [17]. Mecarelli O. et al. (2011) prospectively performed EEG on 232 patients with stroke within 24 hours after admission and found focal or diffuse slowing in 84 % of cases, but within one week of follow-up, no seizures occurred in any of them. Also, 6 % of patients showed lateralized periodic discharges on the EEG, and 10 % - other focal epileptiform disorders. Acute symptomatic seizures developed in 85.7 % of patients with lateralized periodic discharges (71 % of them progressed into status epilepticus) and in 13 % of patients with other focal epileptiform disorders [23]. A recent prospective study of 151 stroke patients showed that background activity disorders as well as the appearance of interictal epileptiform patterns on the EEG were not associated with the development of acute symptomatic seizures in patients, but these changes were independent precursors of late seizures in the first year after a stroke [24].
Thus, evaluation of cerebral hemodynamics and EEG in addition to basic examination end use of the developed discriminant prediction model improve the diagnosis of epilepsy due to cerebrovascular diseases in patients with ischemic stroke with prognosis of an epileptic seizure subsequent development.
Conclusion
1. Vascular deformities in patients with acute cer-ebrovascular disease are observed in at least a one-third of cases (S-shaped tortuosity of the left spinal artery in 36.7±29.2 %), reaching a maximum regarding pathological tortuosity of the left common carotid artery (63.3±38.4 %) and do not have the characteristics of the frequency response in the presence of epileptic seizures after ischemic stroke.
2. For patients with epileptic seizures after is-chemic stroke the electroencephalogram is characterized by a tendency to increase the amplitude of delta waves (20.1 [15.8; 23.1] p,V), alpha waves (23.3 [20.3; 27.0] p,V). The median frequency on the electroencephalogram among patients with epileptic seizures after ischemic stroke has the following parameters: generalized - 8.7 [7.4; 9.8] Hz; in the leads from the left hemisphere - 8.6 [7.4; 10.3] Hz, in the leads from the right hemisphere - 8.9 [7.5; 9.4] Hz, which is significantly (p<0.01) lower than among patients with ischemic stroke without epileptic seizures.
3. Patients with epileptic seizures after ischemic stroke have a significantly higher chance of focal
changes (70.0±38.3 %; 9=3.2; p<0.01), paroxysmal activity on the encephalogram than in patients without epilepsy (26,7±22.8 %; 9=4.2; p<0.01), dysfunction of the median structures (63.3±38.4 %; 9=2.6; p<0.01).
The prospect of further research is to study the clinical value of the predictive model in patients with ischemic stroke and epileptic seizures.
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A LOOK AT INSURANCE MEDICINE
Berdysh D.
medical faculty, spec. "medical business"
Ishchenko O.
Associate Professor AT night INKMI Krasnodar
ВЗГЛЯД НА СТРАХОВУЮ МЕДИЦИНУ
Бердыш Д.С.
лечебный факультет, спец. «лечебное дело»
Ищенко О.Ю.
доцент,
НОЧУ ВО КМИг. Краснодар
Abstract
Insurance has become an integral part of our life, and health insurance is a vital necessity. Today, every person in the Russian Federation has health insurance, but is it as reliable as we used to think? This article discusses current views on the insurance system in healthcare, the options for choosing an insurance system, and the pitfalls in each of them.
Аннотация
Страхование стало неотъемлемой частью нашей жизни, а страхование здоровья жизненной необходимостью. На сегодняшний день каждый человек на территории Российской Федерации имеет медицинское страхование, но так ли оно надежно, как мы привыкли считать? В этой статье рассматриваются современные взгляды на страховую систему в здравоохранении, варианты выбора страховой системы и подводные камни в каждой из них.
Keywords: insurance, protection, financing, private, public.
Ключевые слова: страхование, защита, финансирование, частное, государственное.
Долгое время в России существовала система государственной медицины, которая предполагала прямое финансирование медицинских организаций из средств бюджета и тем самым обеспечивала
население бесплатной медицинской помощью. Основным недостатком такой системы было то, что бюджетный метод финансирования учитывал лишь возможности бюджета, а не расходы, необходимые для обеспечения социальной защиты населения. В
