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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 12, No 6 (2020)
View or download the full issue PDF (Russian)

LECTURES

4-10 195
Abstract

Under the conditions of the COVID-19 pandemic, a rapid change in the epidemiological situation, and introduced quarantine measures, there are conditions for a sharp deterioration in the mental health of a wide range of people. There are specific stressors that negatively affect mental health; there are population groups that are more vulnerable to psychological stress and the development of pathological psychological defense reactions; there is a sharp rise in the number of cases of heterogeneous mental disorders (depression, anxiety, post-traumatic stress disorders, etc.) among the population and healthcare workers in the foci of infection. The manifestation or exacerbation of mental illness in turn contributes to the spread of viral infection and is associated with a more frequent development of somatic complications and a poor prognosis. The practical problem is to choose effective psychopharmacological agents for the relief and treatment of mental disorders, by taking into account the need to combine the agents with antiviral drugs in somatically weakened COVID-19 patients.

ORIGINAL INVESTIGATIONS

11-18 123
Abstract

Antipsychotics are a first-line treatment for psychotic disorders. The cytochrome P450 isoenzymes CYP3A4/5 and CYP2D6 metabolize most antipsychotics. The activity of these isoenzymes in children changes with maturation, so it is different from that in adults. Objective: to study the associations of CYP3A and CYP2D6 isoenzyme activity parameters with the efficacy and safety of antipsychotics in adolescents with an acute psychotic episode. Patients and methods. The investigation enrolled 53 adolescents with an acute psychotic episode who took antipsychotics. The observation period lasted 14 days. The CGAS, PANSS, UKU SERS, SAS, and BARS scales were used to evaluate the efficiency and safety of the therapy on day 14. The activity of CYP3A and CYP2D6 isoenzymes was measured by determining the metabolic ratios of the concentrations of endogenous substrates of the isoenzymes and their metabolites in a morning urine sample on days 1 and 14 of the study. The activity of CYP3A was assessed by the 6-beta hydroxycortisol/cortisol ratio; that of CYP2D6 was measured by the 6-hydroxy-1,2,3,4-tetrahydro-beta-carboline/pinoline ratio. The influence of carriage of polymorphic variants CYP2D6*4,*9,*10, CYP3A4*22, CYP3A5*3 on the activity of isoenzymes was excluded by removing their carriers from the analysis. Results and discussion. The investigators revealed an association of certain antipsychotic-induced undesirable symptoms with CYP3A and CYP2D6 activity parameters. On day 1, a lower CYP2D6 activity was initially observed in patients with tremor (0.54 [0.34; 1.34] vs 1.25 [0.91; 1.75]; p=0.023). Also, patients with any documented adverse reaction (ARs) to therapy had initially a decreased CYP3A activity (1.2 [0.85; 2.29] vs 2.55 [1.44; 4.83]; p=0.047) and an enhanced CYP3A activity during therapy (the activity difference between day 14 and day 1 was 0.28 [-0.28; 2.32] vs -1.3 [-3.47; 0.66]; p=0.042). Conclusion. The initially reduced activity of CYP2D6 and CYP3A isoenzymes is a significant predictor of antipsychotic-induced ARs in adolescents with an acute psychotic episode. The predictive role of CYP2D6 and CYP3A activity levels in the efficacy of antipsychotics has not been confirmed.

19-25 90
Abstract

Patients with migraine and signs of leukoencephalopathy are frequently found to have cognitive impairment (CI), the pathogenesis of which is not entirely clear. The dynamics of CI in these patients during preventive therapy has been little studied.

Patients and methods. A six-month follow-up study was conducted in 50 patients (8 men and 42 women; mean age, 41.9±11.9 years) with migraine (mainly chronic one) and signs of cerebral leukoencephalopathy according to magnetic resonance imaging (MRI). A control group consisted of 40 healthy individuals (13 males and 27 females) aged 20 to 64 years (mean age, 42.6±12.0 years). Neuropsychological examinations (the 12-word recall test; the test of literal and categorical associations; the Benton visual retention test, the Munsterberg test; the Montreal Cognitive Assessment (MoCA), the trail making test; the forward and backward digit recall test; the digit-symbol coding test; and the Stroop color test) and studies of emotional disorders (the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D); the Hospital Anxiety and Depression Scale (HADS), and the Spielberger-Khanin Scale) were performed at baseline, and at 3 and 6 months of preventive therapy for migraine.

Results and discussion. The patients with migraine versus the control group were observed to have lower scores of the MoCA (p=0.004), the 12- word recall test (p=0.0003), and the tests of literal (p=0.001) and categorical (p=0.0002) associations. No significant relationship was found between the volume of MRI cerebral white matter lesions and the severity of CI. There was a moderate inverse correlation (correlation coefficient R=-0.41) between the number of headache (HA) days per month and the MoCA score (p<0.05). The patients with migraine were found to have the signs of depression on the Hospital Depression Scale (p=0.04), the BDI (p=0.003), and the CES-D Scale (p=0.0001) and increased anxiety on the HADS (p=0. 0001) and the Spielberger–Khanin Scale (p=0.0001). There was a significant association between the degree of depression and the MoCA score (p=0.007). During 6-month preventive therapy, there was a decline in the incidence of HA from 19.4±2.9 to 12.6±4.4 days per month (p<0.05), a significant reduction in the severity of emotional disorders, and an improvement in cognitive functions by most neuropsychological tests (the MoCA, the 12-word recall test, the Munsterberg test, and the trail making test Part B) compared to the baseline data.

Conclusion. During preventive treatment for migraine, there was a reduction in the frequency of HA attacks and in the severity of emotional and cognitive impairment. The preventive treatment of migraine and related emotional disorders seems to be the most effective way to improve cognitive functions.

26-32 125
Abstract

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.

Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.

Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).

Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.

Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

33-41 126
Abstract

Studies of the biomarkers of atrial cardiopathy seem to be promising for identifying patients with cryptogenic stroke (CS), in which an intensive search for atrial fibrillation is indicated. Nevertheless, the diagnostic value of these markers and their threshold values require clarification.

Objective: to present the characteristics of echocardiographic markers for atrial cardiopathy and the serum concentration of N-terminal pro-Btype natriuretic peptide (NT-proBNP) in embolic CS versus cardioembolic stroke (CES) and non-cardioembolic stroke (non-CES) to determine the threshold values of parameters with the highest sensitivity and specificity in differentiating CES and non-CES.

Patients and methods. A total of 259 patients with ischemic stroke were examined. The standard examination additionally involved calculation of the parameters that reflected left atrial LA) function (LAF): LA emptying fraction (LAEF), and LA functional index (LAFI). The serum NT-proBNP concentration was also determined in 75 patients.

Results and discussion. The patients with CES versus those with CS and non-CES were characterized by a considerable increase in LA diameter (4.3 [3.5; 4.5] cm vs 3.7 [3.4; 4.0] cm vs 3.7 [3.4; 3.9] cm; p=0.005 and p=0.009, respectively), LAVI (35.7 [30.5; 39.9] ml/m2 vs 28.5 [25.6; 34.6] ml/m2 vs 27.1 [24.5; 31.2] ml/m2 ; p< 0.001) and NT-proBNP level (559 [409; 1144] pg/ml vs 164 [65; 308] pg/ml vs 191 [63; 446] pg/ml; p=0.002 and p=0.019, respectively), as well as by a lower LAEF value [50.3 [48.5; 51.1]% vs 54.7 [51.6; 56.6]% vs 54.9 [52.5; 56.8]%; p< 0.001). The only parameter that showed significant differences between all the three groups (CES, CS, and nonCES) was LAFI (0.24 [0.2; 0.32] units vs 0.37 [0.3; 0.47] units vs 0.40 [0.34; 0.47] units; p<0.00 1), while maintaining the differences in the values for the two groups (CS and non-CES) (p=0.004). The following threshold values of biomarkers were obtained for CES and nonCES; these were a LA diameter of 41.5 mm (p< 0.001), a LAVI of 36.3 ml/m2 (p< 0.001), a LAEF of 51.8% (p< 0.001), a LAFI of 0.28 units (p< 0.001), and an NT-proBNP of 316 pg/ml (p< 0.001). Analysis of the ROC curves and the area under the curve (AUC) revealed that the most informative criteria for sensitivity and specificity were LAEF (79 and 88%, AUC 0.89), NT-proBNP (67 and 91%, AUC 0.89) and LAFI (93 and 72%, AUC 0.81).

Conclusion. The CS group and non-CES one are comparable in the echocardiographic manifestations of atrial cardiopathy and in serum NTproBNP values. LAEF and NT-proBNP concentrations are promising biomarkers to classify CS patients into potential arterio- and cardioembolic types.

42-48 76
Abstract

Parkinson’s disease (PD) is a disease characterized by marked phenotypic heterogeneity. The akinetic-rigid (AR) and tremor-dominant (TD) types of PD differ not only in motor manifestations, but also in the severity of non-motor symptoms, including cognitive impairment (CI). It is the PD heterogeneity study that can achieve the task of creating a modern personalized therapy for this disease.

Objective: to study the characteristics of cerebral glucose metabolism in CI in patients with AR and TD PD.

Patients and methods. Examinations were made in 69 patients with PD (the TD and AR subtypes were in 23 and 46 patients, respectively). Their cognitive status was assessed using the Mini-mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Clock Drawing Test. 18F-fluorodeoxyglucose positron emission tomography was performed according to the standard procedure; glucose metabolism rate (GMR) was determined in different Brodmann areas (BA).

Results and discussion. GMR in the frontal areas (right BA 6, 8, 9, 46 and left BA 46) was lower in the AR group that in the TD one (p< 0.05). The severity of CI in the AR group correlated with GMR in the parietal and posterior cingulate cortex (BA 7, 23, 26, 29, 30, and 31). The TD group showed correlations of the values of cognitive tests mainly with GMR in the frontal and anterior cingulate cortex (BA 6, 8–11, 24), and in the parietal (BA 7) and temporal cortices (BA 22). The only area, in which GMR correlated with cognitive performance in both groups, was BA 7.

Conclusion. Two distinct patterns of GMR were identified in AR and TD within the general pattern of decreased cerebral glucose metabolism, which was specific for CI in PD. The findings may suggest that there are two different CI pathogenetic mechanisms associated with the clinical subtypes of PD.

49-53 92
Abstract

Perampanel (PER) is an antiepileptic drug (AED), the effects of which on sleep have not been studied in Russia.

Objective: to assess changes in the quality of sleep, the level of daytime sleepiness, and the polysomnographic (PSG) characteristics of nocturnal sleep in patients with drug-resistant focal epilepsy when PER is incorporated into the therapy regimen as an additional AED.

Patients and methods. The investigation enrolled 12 patients (4 men and 8 women) aged 21 to 49 years with drug-resistant epilepsy treated with several AEDs, who had initiated therapy with PER as an additional AED. PSG study and questioning survey were done before and 1 month after initiation of PER therapy.

Results and discussion. After one month of PER therapy, there was an increase in the quality of night sleep in 5 cases and a reduction in daytime sleepiness in 6 cases. The PSG pattern was stable in 3 patients, worsened in 1, and improved in 8.

Conclusion. The preliminary results suggest that PER therapy improves night sleep quality and reduces daytime sleepiness in about half of the cases, as evidenced by the improved PSG pattern in 67% of patients.

54-60 73
Abstract

Personalized medicine means the selection of therapy for patients, taking into account the assessment of genetic risk factors for side effects. A number of studies show that folate metabolism disorders, including single nucleotide polymorphisms (SNPs) in the genes of folate-metabolizing enzymes, are more frequently detected in schizophrenic patients than in the general population. The role of SNPs of the key folate cycle enzymes in developing the extrapyramidal side effects of antipsychotics has not yet been studied, although there is evidence of their association with other movement disorders.

Objective: to analyze the association between the carriage of SNP alleles of MTHFR 677C>T, MTR 2756A>G, and MTRR 66A>G and the severity of extrapyramidal side effects of antipsychotics in patients with schizophrenia.

Patients and methods. The investigation included 61 patients with schizophrenia (according to the criteria for ICD-10 Code F20). All the patients took antipsychotics for at least 7 hospital days were examined using real-time polymerase chain reaction (PCR) with allele-specific primers, followed by detection for the carriage of SNP alleles of MTHFR 677C>T, MTR 2756A>G, and MTRR 66A>G. The standardized Simpson–Angus scale (SAS) was used to evaluate the severity of extrapyramidal symptoms; the PCR test results were unknown during their examination.

Results and discussion. In the patients carrying a low-functional 677 T allele in the gene of the key folate cycle enzyme MTHFR, the severity of extrapyramidal side effects of antipsychotics was statistically significantly higher than in the carriers of the wild-type genotype: 13.27±5.10 versus 9.84±6.03 SAS scores, respectively (t=-2.40; p=0.020). In addition, the carriage of the wild allele A of SNP in the MTRR 66A>G gene (F=3.83; p=0.0283; pcorr.=0.043) is associated with the severity of extrapyramidal symptoms. There was a direct moderate correlation of the number of risk alleles at two loci with the total SAS score (r=0.51; p=0.00017).

Conclusion. The polymorphic allele of MTHFR 677T and the wild allele of MTRR 66A can be regarded as risk alleles for the development of extrapyramidal side effects of antipsychotics.

61-70 59
Abstract

Spasticity treatment remains an urgent problem of modern neurorehabilitation. The targeted injection of botulinum neurotoxin (BoNT) into the muscle motor points (MPs) is gaining more and more popularity. But there are insufficient data on the position of MPs, while a MP search methodology has not been worked out yet. Most information about MPs has been obtained on cadaveric material using anatomical dissection or Sihler’s staining technique. Clinical data on the targeted injection of BoNT into the MPs are contradictory, which may be due to the inaccurate determination of their position.

Objective: to verify upper and lower limb muscle MPs through electromyography (EMG).

Patients and methods. Forty healthy volunteers were examined and underwent anthropometric assessment. Upper and lower limb muscle projections were completely scanned using EMG and ultrasound.

Results and discussion. The anatomical localization of MPs in the upper and lower limb muscles involved in spasticity patterns was determined. The position of MPs was found to populationally identical, to have a slight deviation associated with the limb length, and to be unrelated to gender, age, and limb dominance. Original tables and maps for limb MP localization were created.

Conclusion. The findings can enhance the efficiency of BoNT administration and improve the quality of rehabilitation measures, since the use of reliable information on the position of MPs will allow targeted BoNT injection in the immediate vicinity of the site of biological action. In clinical practice, this opens a window of opportunity for the early initiation of rehabilitation measures aimed at restoring movement.

71-76 89
Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are used orally or intramuscularly (IM) to treat lumbar ischialgia caused by musculoskeletal disorders or radiculopathy. A comparative study has been conducted to investigate the efficacy and safety of the NSAID meloxicam (Amelotex®) injected intramuscularly and into the trigger points in combination with tolperisone and B-group vitamins for lumbar ischialgia.

Patients and methods. The investigation enrolled 62 patients aged 30–60 years with lumbar ischialgia, who were randomized into three equal groups. Group 1 patients were injected with meloxicam 1.5 ml (15 mg of its active ingredient) into the trigger points daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 2 received IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days; Group 3 had IM meloxicam 15 mg daily for 3 days, followed by one 15-mg tablet daily for 14 days in combination with tolperisone (Calmirex®) as tablets: 150 mg (Day 1 of therapy), 300 mg (Day 2), and 450 mg daily (Day 3 until the end of therapy). All the patients received IM Vitamin B complex (Compligam B®) 2 ml for 5 days. The treatment efficiency was evaluated using the pain visual analogue scale (VAS), the Oswestry disability questionnaire, and the McGill pain questionnaire, the range of motion, and the severity of neurodystrophic syndrome.

Results and discussion. All the patient groups showed a rapid and substantial pain reduction on the VAS and a functional activity improvement according to the Oswestry scale, which made it possible to complete the treatment within an average of 9.6 days. Groups 3 and 1 exhibited a faster improvement and, as a result, a shorter therapy duration on 8.6±1.2 and 9.2±0.9 days than did Group 2 (8.6±1.2 days). On day 2 of treatment, there was a more considerable pain reduction on the VAS in Group 1 that received meloxicam injections into the trigger zones. The administration of meloxicam intramuscularly and into the trigger zones in combination with tolperisone and vitamin B complex was noted to be safe and well tolerated.

Conclusion. The injection of Amelotex into the trigger zones is highly effective and safe in treating lumbar ischialgia. An NSAID (meloxicam) in combination with a muscle relaxant (tolperisone) speeds up recovery and shortens the duration of NSAID intake.

77-82 92
Abstract

Epilepsy is a common neurological disease that negatively affects all areas of life, with a need to take antiepileptic drugs (AEDs) for a long time and with a high incidence of side effects.

Objective: to determine the main directions of studies dealing with the problem of pregnancy in epilepsy, by analyzing their results.

Material and methods. Over past 10-year publications on pregnancy in epilepsy, their prospects for and prognostic significance for solving scientific and practical problems underwent an analytical review.

Results and discussion. It was found that the risk for higher frequency of seizures was 15 times lower if the latter were controlled within 9–12 months before pregnancy. AED therapy noncompliance during pregnancy is the cause of relapses, increased seizure frequency, and status epilepticus. Changes in the blood concentrations of AED during pregnancy require therapeutic drug monitoring and correction of daily dosages of these drugs. The indication for caesarean section in epilepsy is a high perinatal and maternal risk. Breastfeeding in maternal epilepsy is indicated applying a personalized approach. Studying the predictors of changes in the frequency of seizures and improving pregravid preparation are promising areas for optimizing pregnancy outcomes in epilepsy.

REVIEWS

83-89 92
Abstract

Myofascial pain syndrome (MFPS) is a regional pain syndrome that can be diagnosed in any age group and is characterized by the presence of a trigger point in the muscle involved in the pathological process. Clarifying the molecular mechanisms of trigger point formation and dysregulation of specific skeletal muscle proteins is important to understand the causes of abnormal sarcomere contraction observed in myofascial pain. Wide variability in using the diagnostic criteria in some cases leads to the impossibility of performing a meta-analysis of the data; in this connection, the search for the gold standard for MFPS diagnosis is actively underway. At the moment, a special clinical examination is of paramount diagnostic value. The paper considers various treatment options for myofascial pain and discusses the priority importance of using nonsteroidal anti-inflammatory drugs and muscle relaxants, as well as non-drug therapies.

90-95 80
Abstract

Chronic pain (CP) is still one of the urgent problems of modern medicine. The paper provides a review of the main pharmacotherapeutic approaches from the standpoint of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) guidelines. When preparing this material, the authors have analyzed the publications available in the resources: PubMed, EMBASE, Cochrane, and еLIBRARY. The paper presents the main pathogenetic mechanisms of pain syndrome development in osteoarthritis (OA), including synovial inflammation and associated immune disorders. It considers the types of development of pain syndrome and the main prognostic outcomes according the mechanism of pain, providing a rationale for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or chondroprotectors (CPs). In accordance with the ESCEO guidelines, it is noted that when starting OA therapy, CPs should be considered as the first step (in their long-term prescription and pharmaceutical quality), then NSAIDs should be added (topically), then (if ineffective) orally, by excluding patients with hip OA. It is known that the intramuscular administration of CPs (chondroitin sulfate (CS) in particular) can increase their bioavailability. The use of glucosamine sulfate (GS) is recommended for patients over 60 years of age. According to the recommendations of the 2019 ESCEO experts, CS and GS should be used as a disease-modifying OA drug from the first step and at all subsequent stages.

96-103 78
Abstract

Diabetes mellitus (DM) and chronic alcoholism (CA) are diseases that damage many organs and systems of the body and, in particular, lead to peripheral neuropathies. The pathogenesis of peripheral neuropathies caused by diabetes mellitus (DM) and CA is complex and diverse. Different types of peripheral neuropathies develop according to the leading pathogenetic mechanism. The most common type of peripheral neuropathy in DM is diabetic distal symmetric polyneuropathy (DSPN) and that in CA is alcoholic polyneuropathy (APN). The principles of diagnosis and treatment of DSPN and APN are considered. Treatment of DSPN and APN is complex, which is aimed at treating the underlying disease and includes non-drug and drug treatments. The mainstay of DSPN treatment is achievement of the optimal blood glucose level, maintenance of a healthy lifestyle (diet, daily activity), and correction of cardiovascular comorbidities (if any) with symptomatic pharmacotherapy for neuropathic pain (if any) with antidepressants or anticonvulsants. Antioxidants, such as B group vitamins (B1, B6 and B12) and alpha-lipoic acid (ALA), are widely used to treat DSPN in clinical practice. APN treatment involves cessation of alcohol consumption, physical and mental rehabilitation, and intake of B group vitamins (B1, B2, B6 and B12). The use of ALA in DSPN and APN is discussed.

CLINICAL OBSERVATIONS

104-109 72
Abstract

Idiopathic normal pressure hydrocephalus (NPH) is cerebral ventriculomegaly characterized by a wide range of controversial issues related to the prevalence of the disease, the mechanisms of its development, and nosological independence. Developing in old age, NTH is often concurrent with other neurodegenerative or cerebrovascular diseases, posing certain diagnostic difficulties. The paper describes a clinical case of a patient initially diagnosed with NTH, followed by amyloid angiopathy signs detected during magnetic resonance imaging after bypass surgery. It discusses the diagnostic features of NTH and amyloid angiopathy and the possible common mechanisms of these diseases.

110-116 108
Abstract

Stroke is the leading cause of disability in adults. Depression after a stroke is detected in one third of patients, complicating physical rehabilitation, worsening functional outcome, increasing mortality rates. The question of the use of antidepressants in the treatment of post-stroke depression is currently not completely resolved, there is no consensus on the most optimal drug. The drugs of choice are selective serotonin reuptake inhibitors, the use of tricyclic antidepressants is possible. A number of clinical studies indicate the effectiveness of selective serotonin reuptake inhibitors in the treatment of post-stroke depression, including through mechanisms including increased neuroplasticity and stimulation of neurogenesis, while others disprove their effectiveness. The article presents a clinical case of the use of vortiroxetin in the patient’s neurorehabilitation in the early recovery period of a stroke, its safety and positive effect are shown.

117-123 47
Abstract

Langerhans cell histiocytosis (LCH) is a rare disease with hitherto unknown etiology and pathogenesis. It is extremely rare for clinicians to encounter histiocytic lesions of the central nervous system (CNS); the proportion of cases of which is only 1–4% of all polysystemic and multifocal bone lesions. The paper describes a clinical case of fixation amnesia in a female patient with focal brain lesions in LCH. It depicts the most characteristic clinical features and presents an algorithm for the diagnosis of histiocytic brain lesion. The results of the experimental psychological examination of the patient are considered in detail and the clinical presentations of fixation amnesia are described. There are neuroimaging data showing the lesions in the hypothalamic-pituitary region and temporal bone, which involve the auditory structures. The clinical findings have led to the conclusion that both the clinical and neuroimaging patterns of histiocytic lesions in the CNS are non-specific, which complicates the diagnostic search in LCH. For correct diagnosis and timely treatment, it is necessary to perform a biopsy of the pathological focus, followed by histological and immunohistochemical examination of the material.

124-130 82
Abstract

Approaches to treating cognitive-amnestic disorders of various origins, including Korsakoff's syndrome (KS), are currently being actively elaborated. KS is manifested by severe memory impairment, leading to disability. It is quite common in alcohol abusers. There is still no proven effective treatment for KS. In view of the fact that studies on the treatment of KS have been very few, there are no clear recommendations for its most effective treatment. There has been evidence that in addition to thiamine deficiency, the toxic effect of glutamate that is actively released through binding to NMDA receptors during the ethanol withdrawal period is the basis for KS development. Memantine, a noncompetitive NMDA receptor antagonist, has recently been used successfully to treat KS. The paper describes a clinical case of a 55-year-old patient with KS treated with akatinol memantine, in which the latter has demonstrated its high efficacy and good tolerance. Analysis of the data available in the literature and the presented clinical case suggest that it is advisable to prescribe memantine for patients with alcohol-related memory impairment.

131-136 54
Abstract

The paper describes a clinical case of applying a set of computer-based stimulation programs for cognitive impairment arising from severe open traumatic brain injury (TBI). It demonstrates the rehabilitation capabilities of a set of «Neurotechnology+» stimulation programs for correction of cognitive deficits in patients with dysregulated moderate cognitive impairment resulting from experienced severe open TBI. It is noted that the use of a set of the programs contributed to the improvement of impaired regulatory and neurodynamic functions, the expansion of phonemic and semantic speech activity, and the improvement of memory processes. The described case suggests that computer-based cognitive training has a positive impact on cognitive recovery after post-traumatic brain injury.

137-143 76
Abstract

The COVID-19 coronavirus pandemic has added additional difficulties to the differential diagnostic evaluation of the status of patients with disorders of affective and neurotic registers. In such conditions, the works describing and analyzing specific clinical cases are of considerable interest. The paper describes three clinical cases of somatization mental disorders manifesting themselves during the COVID-19 pandemic, with an account of their history, somatic and mental status, psychopathological classification of the condition, and a rationale for the therapy regimen. Itching, dysuria, and hyperventilation without a somatic basis come to the fore in the clinical picture. These somatic symptoms developing in the pattern of mental disorders of the affective and neurotic registers substantially make the diagnosis, specialized care provision, and medical routing of patients difficult. An integrated psychosomatic approach to clinically evaluating psychopathological disorders that are partially realized in dermatological, urological, and pulmonological spheres, contributes to their adequate diagnosis and effective therapy.

144-150 155
Abstract

Atypical depression (AtD) is contrasted with classical endogenous melancholic depression and is characterized by the presence of its uncharacteristic abnormalities, but the list of the latter varies from individual symptoms (increased appetite, weight gain, drowsiness, weakness, and anxiety) and their concurrence to syndromes accompanying depression (anxiety-phobic, obsessive-compulsive, panic attacks, derealization-depersonalization, hypochondriacal syndrome). In accordance with the DSM-5 diagnostic criteria, AtD is a symptom complex that includes mood reactivity and at least two of the following symptoms: hyperphagia, hypersomnia, lead-palsy, and personality sensitivity. AtD has been described within a variety of disorders: recurrent depressive disorder, bipolar affective disorder, dysthymia, cyclothymia, and psychogenic depression. The paper describes a clinical case of atypical depressive syndrome within the framework of type 2 bipolar disorder in a 51-year-old patient. AtD was concurrent with dermatitis herpetiformis (Dühring's disease) in some depressive episodes; it was accompanied by various somatic complaints in other cases. The latest episode of AtD occurred during the COVID-19 pandemic and included obvious reactive anxiety-phobic disorders. A detailed clinical and psychopathological analysis of history data, mental state, and ongoing therapy was carried out, which clearly reflects difficulties in the differential diagnosis of AtD and the use of adequate treatment.

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