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Neurology, Neuropsychiatry, Psychosomatics

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Scientific and practical reviewed journal

Since 2009 the “Nevrologiya, Neiropsikhiatriya, Psikhosomatika" (Neurology, Neuropsychiatry, Psychosomatics) journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of neurology. The Journal is aimed to provide a forum to discuss etiology and pathogenesis, clinical features, modern diagnostic and treatment approaches to neurology, psychiatrics and its complications, as well as associated conditions.

The journal is intended for a wide range of neurologists, psychiatrists, neuropsychologists, and specialists of related occupations.

Articles from all specialized medical institutions of the Russian Federation and neighboring countries and materials prepared by Western partners are submitted to the journal.

Among editorial board members of the journal there are 24 Russian and foreign doctors of medical sciences and 3 candidates of medical sciences.

Federal Supervision Agency for Information Technologies and Communications registration ПИ № ФС77-35419 from 20.02.2009.

 

 

Current issue

Vol 14, No 3 (2022)
View or download the full issue PDF (Russian)

LECTURES 

4-11 233
Abstract

Currently, patients who attribute their complaints and disorders to the past COVID-19 are turning to a neurologist for a consultation. One should consider dangerous complications of COVID-19 such as stroke, including cerebral venous thrombosis, autoimmune encephalitis and myelitis, posterior reversible encephalopathy syndrome, Guillain–Barre’ syndrome. Disorders of consciousness, disorders of smell and taste, headache and dizziness are significantly more often present in the acute period of COVID-19. Long-term persistence of complaints and disorders after COVID-19 is regarded as post-COVID syndrome (PCS). Neurological complaints and disorders in a patient who has had COVID-19 are often caused by the development or exacerbation of a comorbid disease, including primary headache, musculoskeletal pain in the neck and back, various vestibular disorders, Alzheimer's disease, anxiety and depressive disorders. Unfortunately, in real clinical practice, these diseases are often not diagnosed, patients are observed with a diagnosis of PCS, and it is not taken into account that the basis for diagnosing PCS is the exclusion of other diseases that can explain complaints and disorders in a patient who has suffered from COVID-19.

ORIGINAL INVESTIGATIONS 

12-18 185
Abstract

Objective: to study the anamnestic, clinical and laboratory features of the acute period of ischemic stroke (IS) and to determine the risk factors for its development in young patients.

Patients and methods. Clinical and statistical processing of data of 256 patients aged 18 to 44 years included, who had IS, confirmed by computed and/or magnetic resonance imaging of the brain in the acute period, was carried out. Furthermore, in 154 patients and in 117 healthy participants, who made up the control group, eight polymorphisms of the thrombophilic spectrum genes were determined – FGB: -455G>A, F2: 20210G>A, F5: 1691G>A, F7: 10976G>A, F13: 103 G>T, ITGA2: 807C>T, ITGB3: 1565 T>C, PAI-1: -675 5G>4G.

Results and discussion. 154 (60.15%) patients demonstrated good recovery (achievement of a level of ≤2 points on the Rankin scale by the patient). None of the patients died during their hospitalization. In the evaluated group of patients, we identified allelic variants of the thrombophilic spectrum genes and gene-gene combinations, the carriage of which increased the likelihood of IS development at the young age by 1.74 and 2.19 times, respectively. Taking into consideration additional examination methods, the pathogenetic variant of IS according to the TOAST classification was verified in 226 (88%) patients.

Conclusion. In IS at a young age a detailed assessment of risk factors is required, including an analysis of carrier variants and combinations of procoagulant and prothrombotic spectrum gene polymorphisms.

19-25 59
Abstract

Cervical dystonia (CD) has a wide range of non-motor (neuropsychiatric, sensory, dyssomnic) disorders. Relationships between dystonia, nonmotor manifestations of the disease and patients quality of life (QoL) require clarification.

Objective: to clarify the impact of dystonia, sensory, affective, behavioral disorders, quality of sleep and wakefulness on the quality of life of patients with CD.

Patients and methods. We examined 61 patients with CD (mean age – 48.03±11.49 years, mean duration of CD – 4.89±4.05 years). We used Toronto Western Hospital Spasmodic Torticollis Rating Scale (TWSTRS), Cervical Dystonia Quality of Life Questionnaire (CDQ-24, with five subscales: «stigma», «emotional wellbeing», «pain», «activities of daily living», «social/family life»), Spielberger–Khanin Inventory (STAI),Beck Depression Inventory (BDI), Barratt Behavioral Impulsivity (BIS-11), Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Montreal Cognitive Assessment Scale (MoCA), Stroop Test (VST), 12 Word Memory Test, Pittsburgh Sleep Quality Assessment Scale (PSQI), Epworth Sleepiness Scale (ESS).

Results and discussion. There was a deterioration in all characteristics of QoL in patients with CD, largely in emotional well-being, stigmatization, pain syndrome (50% change from the maximum CDQ-24 score). A statistically significant moderate correlation was established between the total assessment of QoL and the severity of dystonia (r=0.35; p<0.01), a statistically significant strong correlation between the total assessment of QoL and depression index (r=0.73; p<0.001 ), moderate strength correlation – with indicators of anxiety (r=0.65; p<0.01), obsessivecompulsive disorders (r=0.61; p<0.01), sleep quality (r=0.52; p<0.001), impulsiveness in behavior (r=0.31; p<0.01), weak relationship with the assessment of executive cognitive functions (according to the Stroop test interference index; r=0.24; p<0.01). A statistically significant moderate correlation was found between the assessments of activity in everyday, social/family life and impulsiveness in behavior (r=0.33; p<0.001); between stigma, emotional well-being and an indicator of executive cognitive functions (r=0.3; p<0.05). There were no statistically significant relationships between indicators of affective, cognitive functions, behavioral disorders and the severity of dystonia. There was a moderate correlation between pain score and dystonia severity (r=0.35; p<0.01).

Conclusion. The decrease in QoL in patients with CD is largely due to affective, sensory, and behavioral disorders. Diagnosis and appropriate therapy of the non-motor aspects of the disease are required for adequately improvement of QoL of patients.

26-31 92
Abstract

Fibromyalgia (FM) often occurs under the mask of non-specific low back pain (NLBP).

Objective: to compare the combined disorders and treatment efficacy in FM and chronic NLBP (chNLBP).

Patients and methods. We examined 33 patients with chNLBP (27 women and 6 men, mean age 51.5±16.7 years) and 53 patients with FM (47 women and 6 men, mean age 46.8±14.6 years). Pain intensity was assessed using a numerical rating scale (NRS), using the Hospital Anxiety and Depression Scale (HADS), the Screening for Somatoform Symptoms-2 (SOMS-2), the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), updated Fibromyalgia Impact Questionnaire (FIQR; disability in patients with FM), Oswestry Index (IO; disability in patients with chNLBP). Comprehensive treatment of patients included educational conversations, cognitive behavioral therapy, kinesitherapy, among drugs antidepressants, and in patients with FM anticonvulsants.

Results and discussion. Previously, the diagnosis of FM was established only in 15% of patients, the diagnosis of chNLBP – in 82% of patients. The intensity of pain in FM was 7.1±1.9 points according to the NRS and was higher than in chNLBP (5.6±2.4 points; p=0.002). In the group of patients with FM compared to patients with chNLBP, significantly higher values of anxiety according to HADS (10.9±4.5 and 6.9±4.0 points; p<0.001), sleepiness according to ESS (8.2±4.6 and 6.2±4.6 points; p=0.014), somatization according to SOMS-2 (28.0 and 20.0 points; p<0.001) were detected. Possible anatomical causes of pain have been identified in all patients with chNLBP and only in 13% of patients with FM. 6 months after thestart of treatment in the FM group, pain intensity significantly (p<0.001) decreased to 3.7±2.6 points according to the NRS, anxiety to 6.7±3.5 points according to HADS, depression to 4.7±2 .6 points according to HADS, disability from 54.9±18.4 to 34.0±20.2 points according to FIQR; in chNLBP group pain intensity significantly (p<0.05) decreased to 2.6±2.1 points according to the NRS, anxiety decreased to 4.2±2.5 points according to HADS, depression to 6.5±3.3 points according to HADS, disability from 37.8±17.4 to 14.5±14.2 points according to IO.

Conclusion. FM is less frequently diagnosed in comparison with chNLBP, accompanied by a higher pain intensity, anxiety, sleepiness and somatization. Complex therapy leads to a stable positive effect both in chNLBP and in FM.

32-37 76
Abstract

Alcohol dependence (AD) and mood disorders are not only a serious medical and socio-economic problem for modern society, but also the cause of social adaptation disorders that form even in the early stages of each of these disorders, as well as in case of their comorbidity.

Objective: to determine the relationship between the level of subjective assessment of social adaptation and the main clinical, dynamic and psychological characteristics in patients with affective disorders (AFD) with comorbid AD.

Patients and methods. The study included 126 patients treated for AFD in the departments of affective or addictive conditions of the clinic of the Research Institute of Mental Health of the Tomsk National Research Medical Center (F31 – F34.1 according to ICD-10; n=83) or AFD comorbid with AD (F10. 2; n=43). The study used clinical-dynamic, psychometric, pathopsychological and statistical methods.

Results and discussion. Patients with AFD without comorbidity at admission were characterized by a greater severity of subjective impairment of social adaptation and anhedonia; hypochondriacal, depressive, psychasthenic and schizoid traits predominated in the structure of their personality. At the same time, the condition of patients with AFD and AD comorbidity was objectively assessed as more severe. An inverse correlation was found between the level of subjective assessment of social adaptation and anhedonia in the group of patients with «pure» AFD, and in the group with AFD and AD comorbidity, with the severity of depressive symptoms (due to typical depressive symptoms), as well as with depressive and anxious personality traits of patients.

Conclusion. Self-assessment of social adaptation of patients with “pure” AFD depends on the intensity of anhedonia manifestations, and in patients with AFD and AD comorbidity, on depressive symptoms (due to typical depressive symptoms) and on the severity of such psychological characteristics as depression and psychasthenia.

38-43 65
Abstract

Peripheral nervous system involvement in patients with type 2 diabetes mellitus is a severe complication associated with a decrease in the quality of life, the development of disability and lethal outcomes. The most negative in terms of prognosis is autonomic diabetic polyneuropathy (DPN).

Objective: to study the effectiveness of the drug ipidacrine (Ipigrix) in patients with DPN.

Patients and methods. 49 patients with DPN were observed, they were divided into three groups. Patients of the 1st group (n=16) received ipidacrine 20 mg orally 3 times a day for 60 days, patients of the 2nd group (n=17) received ipidacrine 15 mg 1 time per day intramuscularly for 15 days, then – 20 mg 3 times a day orally up to 2 months; patients of the 3rd group (n=16) received only basic therapy. The clinical condition, severity of pain syndrome according to the Neurological Symptoms Score (NSS), vegetative tests, and treatment tolerance were assessed.

Results and discussion. The therapy was effective in terms of reducing the severity of neuropathic pain syndrome, as well as normalizing the results of vegetative tests. In patients of the 1st group, the total scores on the NSS scale decreased by 37% (p<0.05) by the 60th day of treatment. In patients of the 2nd group, the total scores on the NSS scale decreased by 22% by the 30th day (p<0.05) and by 35% (p<0.05) by the 60th day of treatment. A pronounced positive effect in terms of vegetative tests was noted on the 60th day of treatment in the 1st and 2nd groups of patients. No adverse events were observed during the treatment period in any of patients of the 1st and the 2nd groups. In the comparison group, there were no significant changes in scores on the NSS scale and indicators of vegetative samples.

Conclusion. The effectiveness of the drug ipidacrine (Ipigrix) in patients with pain and vegetative manifestations of DPN was noted.

44-53 109
Abstract

Cognitive dysfunction is one of the most common disorders in the elderly and senile age. There are currently 57 million people with dementia worldwide.

Objective: to assess cognitive functions, to understand the prevalence of cognitive impairment (CI) and to analyze their associations with socioeconomic, demographic and anthropometric factors and geriatric syndromes in people aged ≥65 years.

Patients and methods. Subjects living in 11 regions of the Russian Federation took part in the EVKALIPT epidemiological study. The inclusion criterion was age ≥65 years. Participants were divided into three age groups (65–74 years, 75–84 years, and ≥85 years) according to the protocol. All patients underwent a comprehensive geriatric assessment, comprising a specially designed questionnaire and physical examination. Cognitive functions were assessed using the mini-Cog test. The study included 3545 patients (of which 30% were males) aged 65 to 107 years.

Results and discussion. According to the data obtained in our study, CI was detected in 60.8% of the subjects, and severe disorders – in 19.9% (0 or 1 point according to the mini-Cog). Patients with CI had a lower socioeconomic status. One-way regression analysis showed that the risk of CI increased by 10% with increasing age for every 1 year but did not depend on the sex of the subjects. Associated with increased CI risk also were: living alone (by 28%), living in a nursing home (by 90%), widowhood (by 2.2 times) or absence of a partner (by 2.2 times), underweight (by 2.9 times) and normal body weight (by 1.6 times), disability (by 54%), primary (by 4.8 times) and secondary (by 75%) education, bad economic conditions (by 95%). On the contrary, the presence of overweight and obesity reduced the risk of CI by 14 and 24% respectively, living in a family – by 24%, having a spouse – by 55%, divorce – by 29%, having a job – by 73%, higher education and a scientific degree – by 55 and 59%, medium and good economic conditions – by 38 and 52%, respectively. In patients with CI, the incidence of all geriatric syndromes was higher.

Conclusion. The frequency of CI among elderly patients was higher compared with data from other studies. The EVKALIPT study was the first to obtain national data on the prevalence and characteristics of CI in persons aged ≥65 years in the general population.

CLINICAL OBSERVATIONS 

54-61 80
Abstract

Behavioral and neuropsychiatric symptoms occur in 80% of patients with Alzheimer's disease (AD) and represent one of the most common reasons for early hospitalization and increased treatment costs. It is believed that the development of mental disorders (MD) is a marker of a number of additional adverse outcomes in patients with AD. The disease is accompanied by the development of other behavioral disorders, the most unpleasant of which are agitation (excitation) and aggression. The article discusses the causes and factors that can provoke the development of MD in AD. Traditionally used pharmacotherapeutic methods for the treatment of MD in AD in this age group have limited efficacy and are characterized by high toxicity. Antipsychotics are often associated with serious side effects and increased mortality in patients with dementia. A clinical case of AD with the development of neuropsychiatric disorders is presented. We discuss the issue of nonpharmacological strategies that have been shown to be more effective than pharmacological treatment and have fewer side effects than antipsychotic pharmacotherapy. On the example of the given clinical case, modern approaches to the correction of such complications and the management of this group of patients are shown. It seems appropriate to use memantine (akatinol memantine) in patients with neuropsychiatric symptoms of AD. In clinical studies, memantine has shown a positive effect in terms of reducing the rate of deterioration of general, cognitive, functional and behavioral parameters compared with treatment with antipsychotics. The drug is characterized by a minimum number of side effects and a limited range of contraindications.

62-67 64
Abstract

Objective: to study the possibilities and effectiveness of treatment of patients with hemimasticatory spasm (HMS) with injections of botulinum neuroprotein type A (BNPA). The authors present a clinical case of long-term HMS: a 50-year-old patient, who suffered from the age of 20 from frequent involuntary muscle contractions that occurred in the temporal and masticatory muscles of the left half of the face. The patient was observed by neurologists for a long time, while the prescribed therapy did not have a satisfactory result. In the process of a comprehensive examination of the patient, in addition to intense involuntary contraction and pronounced hypertrophy of the affected muscles, secondary compensatory changes in other masticatory muscles were revealed, both on the side of the lesion and on the opposite side. BNPA treatment led to a robust improvement in the patient's condition.

For patients with a long course of HMS and hypertrophy of the muscles involved in the pathological process, the use of bilateral injections of BNPA is the method of choice, since it not only effectively reduces the number of episodes, but also restores muscle balance, and also restores the motor function of the entire masticatory muscle group.

REVIEWS 

68-73 96
Abstract

The management of patients with chronic musculoskeletal pain is an important biomedical problem due to the prevalence of this pathology and its resistance to therapeutic interventions. Psychosocial factors play a significant role in the formation and maintenance of chronic pain. In this regard, psychotherapeutic assistance is very important in the management of patients with chronic pain within the framework of multidisciplinary treatment. This review discusses the main psychotherapeutic approaches that have been used for chronic musculoskeletal pain: cognitive behavioral therapy, mindfulness therapy, psychoanalysis, hypnosis. General information about the essence of the discussed methods and the evidence base for their use in chronic pain are presented. A significant effectiveness of cognitive-behavioral therapy and techniques based on mindfulness therapy has been demonstrated.

74-80 76
Abstract

Alzheimer's disease (AD) is the most common cause of cognitive impairment and dementia. A non-systematic review of literature is presented, which discusses the clinical features and current criteria for diagnosis of this disease. The review presents classifications of cognitive impairments, including severity, as well as diagnostic criteria for various stages of dementia. The main approaches to the management of patients with dementia in AD as the disease progresses are highlighted. Modern publications dedicated to the problem of combined therapy of dementia in AD with donepezil and memantine are considered. The fixed combination of these drugs in a single tablet once daily regimen has been shown to provide significant benefits over acetylcholinesterase inhibitor monotherapy, especially in patients with dysphagia, poor adherence to treatment and limited interaction with caregivers.

81-86 98
Abstract

Most patients survive their first non-cardioembolic ischemic stroke (IS), but a significant proportion of them experience a second stroke within the first year. The main directions for the prevention of recurrent IS are antihypertensive and lipid-lowering therapy, control of glucose levels in patients with diabetes mellitus, and smoking cessation. Clinical guidelines recommend the use of antiplatelet therapy in patients with noncardioembolic IS or transient ischemic attack (TIA). The administration of antiplatelet agents to patients who have had a TIA or stroke reduces their risk of recurrent stroke by 23% and the overall risk of vascular events (myocardial infarction, stroke, and death from cardiovascular disease) by 17% (Antithrombotic Trialists' Collaboration, 2009). Acetylsalicylic acid (ASA), the combined use of clopidogrel and ASA, and the combination of ASA with sustained release dipyridamole have been shown to be effective for secondary prevention of non-cardioembolic IS. Intensive antiplatelet therapy reduces the risk of recurrent stroke, but increases the frequency of bleeding.

87-93 39
Abstract

The article presents current data on the prevalence of anxiety, depressive disorders and cognitive impairment in patients with chronic heart failure (CHF). Data on the main pathogenetic mechanisms of the relationship in the development of emotional and cognitive impairments in patients with CHF are summarized. Recommendations for screening for cognitive and emotional disorders in this patient are given. The prospects for the correction of these disorders in patients with CHF are discussed, including within the framework of interdisciplinary cooperation.

94-100 73
Abstract

Atrial fibrillation (AF) is the main cause of cardioembolic ischemic stroke (IS), it occurs in 25–35% of patients with IS, and its presence increases the risk of recurrent stroke compared with patients with sinus rhythm. The main method of preventing recurrent IS in AF is the administration of oral anticoagulants (OACs); in non-valvular AF, direct OACs (DOACs) have an advantage. Meta-analysis of randomized clinical trials showed a 19% greater reduction of stroke and systemic embolism risk in the DOACs group compared to warfarin (p<0.0001), including a 51% greater hemorrhagic stroke (HS) risk reduction (p<0.0001). In an additional sub-analysis of the ARISTOTLE trial, patients with AF and a history of stroke/transient ischemic attack showed a significant reduction in the risk of all types of strokes and HS. Although no randomized trial explored the direct comparisons of drugs from the DOACs group, data from observational studies indicate the potential advantage of apixaban in terms of reducing the risk of IS. Russian 2020 clinical guidelines for AF treatment suggest that the resumption/initiation (1–3–12 days) of anticoagulant therapy after an IS should be determined by the decision of a multidis ciplinary team (neurologist, cardiologist, neuroimaging specialist) based on recurrent IS and bleeding risk assessment. According to the 2020 guidelines of the Ministry of Health, the resumption of OACs therapy after an intracranial hemorrhage in patients with AF may be recommended 4–8 weeks after the event, and the decision to reinitiate therapy, as well as after IS, should be made by a multidisciplinary team.

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