Neurology, Neuropsychiatry, Psychosomatics

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Vol 4, No 3 (2012)


15-19 418
It is known that non-rheumatic atrial fibrillation (AF) is one of the most common types of cardiac arrhythmia and a common cause of cardiogenic cerebral embolism. Oral anticoagulant therapy is a leader in the prevention of thromboembolic events in AF. More than 60 years, only warfarin and other vitamin K antagonists (VKA) were used as oral therapy due to their extraordinary efficacy in preventing stroke and other thromboembolic events after myocardial infarction in AF and prosthetic heart valves. In addition, there are numerous problems associated with treatment with VKA, which significantly limits their widespread use. New anticoagulants, such as the oral direct thrombin inhibitor (dabigatrana etexilate) and the direct factor Xa antagonists rivaroxaban, apixaban, edoxaban, have been recently designed, clinically tested, and put into practice. The initiation of clinical use of these agents has opened up a new page of oral anticoagulant therapy in the prevention of thromboembolic events in AF.
20-24 1066
The paper discusses the issues associated with the definition of the concept «transient ischemic attack» (TIA) and with the prognosis of cerebrovascular disease after prior TIA. It is stated that following TIA, there is a high risk for ischemic stroke and a risk for evolving and progressive cognitive impairments. Approaches to organizing a therapeutic and diagnostic process in patients with TIA are covered.
24-28 547
The paper discusses the issues of differential diagnosis of cervicocranialgia with tension headache and migraine with concomitant cervical myofascial syndrome. It considers the basic mechanisms of the pathogenesis of these nosological entities and common approaches to their treatment. The mechanisms of pathogenetic action of myorelaxants are shown in cervicocranialgia and myofascial pain syndromes. Methods for mini-invasive therapy for cervicogenic headache and other musculoskeletal disorders are presented.
29-34 654
The paper shows the efficiency and safety of increasing the therapeutic window for systemic thrombolysis in verified ischemic stroke in the vertebrobasilar system (VBS), as well as the possibility of effective reperfusion in patients with stenotic occlusive lesions of the basilar artery and clinical signs of severe truncal stroke. Thrombolytic therapy (TLT) over 4.5 hours and in a neurological deficit of >25 scores according to the National Institute of Health (NIHSS) Scale should be performed only within the framework of clinical trials. TLT for stroke in the VBS may substantially alter the approach to rendering care in this pathology and contribute to an increase in the number of patients with a good functional outcome.
35-40 429
The paper presents the results of examining 101 patients (68 men and 33 women) aged 48 to 89 years with seizures in the first 7 days of stroke. A control group comprised 97 patients who had experienced ischemic stroke without seizures. Early seizures more frequently occurred in the cardioembolic subtype of stroke as simple partial seizures. The neuroimaging features of ischemic foci were revealed and the cerebrovascular responsiveness was evaluated in different vascular basins in these patients.
41-44 624
The paper analyzes the cost of treating 52 patients after carotid stenting (CS) and 50 after carotid endarterectomy (CE). It assesses their quality of life one year after treatment. The economic effectiveness of CS and CE as techniques for preventing stroke is shown. The cost of CS and CE is noted to become virtually equal when medical care is rationally organized. Whether surgical care for patients at high risk for stroke may be improved is analyzed.
45-47 518
Objective: to evaluate cognitive functions and drug correction of identified impairments in heroin users. Patients and methods. Thirty-two patients (7 women and 25 men) aged 18 to 45 years who had used heroin for 1—3 years were examined using the mini-mental state examination (MMSE), the techniques of «memorizing words» and «excluding words», the tests of «information-memory-concentration», quantitative assessment of clock drawing, and the frontal assessment battery. The detected cognitive impairments were corrected with the standardized Ginkgo Biloba extract (EGb 761 ®, Tanakan ®). Results. Cognitive impairments were found in all the patients: moderate cognitive disorders in 68.8% and mild dementia in 31.2%; thinking disorders were most noticeable; decreased attention, frontal lobe dysfunction, and visual spatial impairments were detectable. After a course of therapy with tanakan (120—240 g/day according to the degree of cognitive impairments for 3 months), there was a significant improvement in MMSE scores, thought, concentration, memory; however, they failed to achieve the scores in the control group consisting of 10 apparently healthy individuals of the same age and sex.
48-53 615
The efficacy of valdoxan (agomelatine) used to prevent and treat post-stroke depression was analyzed. The study enrolled 49 patients (21 men and 28 women; mean age 61+5.5years) in the acute period of ischemic stroke in different vascular basins (a study group). A control group included 50 patients (24 men and 26 women; mean age 64+4.8 years) who were comparable with the study group of patients and who did not receive valdoxan. The duration of a follow-up was 6 months. During valdoxan therapy, there were better changes in recovery with a rapider regression of neurological disorders in patients with moderate stroke as compared with the control group (according to the National Institute of Health Stroke Scale (NIHSS). The administration of valdoxan prevents depression, sleep disorders, pain syndromes, and cognitive impairments in the acute and early rehabilitation period of stroke.
54-59 643
Psychopathological disorders in patients with cardiovascular diseases (CVD) are treated with the methods of psychopharmacotherapy and psychotherapy used in psychiatry. The paper describes the experience in using psychopharmacotherapy in combination with and without psychotherapy in 121 patients with CVD (arterial hypertension, atrial fibrillation, coronary heart disease). The positive effect of psychopharmacotherapy is noted in 68.2% of cases and that of the latter in combination with psychotherapy is in 75.6%. There is evidence for the efficacy and tolerability of a number of psychotropic drugs. The administration of psychotropic drugs and psychotherapy are shown to result in a reduction in the incidence of exacerbations of CVD and in the number of visits to a cardiologist. Optimization of psychopharmacotherapy and psychotherapy in patients with CVD is discussed.
60-62 402
The efficacy of dopamine receptor agonists (DRAs) is determined by a number of advantages. DRAs are recommended as the drugs of choice as monotherapy and in combination with levodopa to enhance the efficiency of therapy for extensive-stage Parkinson’s disease (PD) and to correct motor fluctuations and drug-induced dyskinesias. Controlled-release DRAs are of particular interest. The results of using requip modutab in PD are presented. Its efficacy in treating dyskinesias and fluctuations and the magnitude of side effects are evaluated.
63-65 437
Two hundred and ninety-two schoolchildren (41.1% boys and 58.9% girls) aged 6—17 years were examined by psychometric methods. Back pain was diagnosed in 29.1% of cases. The findings permitted the detection of certain characteriological personality traits in schoolchildren with back pain.
65-68 496
Objective: to evaluate the effect of L-lysine aescinate, an injectable modifier of tissue edema, including brain swelling, on the course of edema syndromes in patients with acute cerebral circulatory disorders and lower limb varices. Patients and methods. The study included 20 patients (8 women and 12 men) aged 48 to 65 years with ischemic stroke who had been admitted to the clinic within the first 24 hours of the disease. The baseline severity of neurological symptoms was 10.2±2.12 scores according to the National Institute of Health Stroke Scale (NIHSS). All the patients were treated in accordance with the medicoeconomic standards for stroke management in Moscow; in addition, 10 patients were intravenously given L-lysine aescinate in a daily dose of10 ml in a slow dropwise manner during the first 3 days. Results. The NIHSS scores indicated more pronounced positive neurological changes in patients with acutest cerebral stroke, who were given L-lysine aescinate solution, 10 ml/day for 3 days as part of hospital combination therapy in a neurological intensive care unit, than in those who received only basic therapy. Conclusion. L-lysine aescinate may be used in the combination therapy of patients with cerebral stroke if they tend to develop brain edema.
69-71 440
The authors presents his experience in managing 1430 patients (858 men and 572 women) aged 22 to 65 years, mean age 61.3 years) with back pain who used Arthra as a chondroprotector in addition to standard therapy (nonsteroidal anti-inflammatory drugs, myorelaxants, manual therapy, reflex therapy, therapeutic exercises). A comparison group consisted of 118 patients with back pain who received only standard therapy. It is noted that the incorporation of the chondroprotector Arthra into combination therapy can improve quality of life in patients with back pain.
72-76 1085
A therapist somewhat more rarely encounters back pain in his practice than does a neurologist. However, the concept “osteochondrosis” that has existed for almost a century is commonly the only interpretation of this condition. At the same time, its differential range is wide. This paper will deal with one of the disease that may be masked by osteochondrosis.
77-84 696
The paper reviews the literature on the use of benzamide neuroleptics (by the example of sulpiride) to treat mental disorders and psychosomatic diseases. It characterizes medications, such as benzamide derivatives. The mechanism of action of sulpiride and its differences from other neuroleptics are discussed. The efficacy of sulpiride (as monotherapy or combined therapy) in the treatment of different mental disorders, psychosomatic diseases, alcohol and drug additions, etc. is critically analyzed. By taking into account the currently adopted multidisciplinary approach to managing patients with the above conditions, the presented data are certain to provoke interest among physicians of different specialties.
85-91 466
20% of world population suffers from dizziness. The low sensitivity of the most common vestibular tests makes their results questionable. Diagnostic methods for dizziness are compared. Four vestibular projections (cortical, motor, autonomic, and limbic) are considered. The cortical projection is assessed by evoked potentials (the sensitivity and specificity of the method are 90.57 and 98.57%, respectively). Examination of vestibular motor reactions is based on the tests of Romberg, Fukuda, and Uemura. Posturography and recording the movements of the center of mass at rest in the Romberg position (their sensitivity is 35 to 54%) are popular. In the same patients, the sensitivity of the tests of Fukuda and Uemura is as high as 98.15%. The caloric test is the gold standard for vestibular diagnosis; its sensitivity is 70% and its specificity is 90%. These of rotation tests are 33.5 and 92.5%, respectively. Methods for study of vestibular autonomic and limbic reactions are under development. Tests having a sensitivity of > 90% are proposed to be introduced into clinical practice.
92-95 552
There has recently been significant progress in the treatment of different diseases accompanied by dizziness. First and foremost, this is due to the development of highly effective medical positioning maneuvers for benign paroxysmal positional vertigo and to their introduction into practice. At the same time, drug treatments for vertigo are being continued under development. The paper considers the current methods of symptomatic and pathogenetic treatment for different diseases of the vestibular system. It gives data on current medicinal approaches to the treatment of vestibular neuronitis, Mеniеre's disease, migraine-associated vertigo, and central vestibulopathies. Furthermore, prospects for the use of drugs together with vestibular exercises to stimulate central vestibular compensation are discussed.
96-99 536
Cholinergic deficiency associated mainly with the degeneration of neurons in the nucleus basalis of Meynert is one of the key factors of the development of cognitive impairments in Alzheimer’s disease (AD). Cholinesterase inhibitors are used to treat mild and moderate dementia in AD. However, the wide use of this group of agents is limited by the high incidence of some side effects. The application of a novel rivastigmine transdermal (patch) formulation substantially reduces the risk of adverse reactions chiefly associated with a negative effect on the gastrointestinal tract and increases treatment adherence. Thus, there is a rise in the number of patients who may be given the drug in the optimal therapeutic dose for a long time.

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)