Neurology, Neuropsychiatry, Psychosomatics

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Vol 5, No 2 (2013)


18-22 1435
Generalized anxiety disorder (GAD) is poorly diagnosed and inadequately treated by general practitioners. The paper considers the major diagnostic signs of GAD, its differential diagnosis, prevalence, etiology, and pathogenesis. Antidepressants from a group of selective serotonin reuptake inhibitors in combination with psychotherapy are the drugs of first choice.
23-29 583
The paper provides the results of neuropsychological examinations in 10 patients with Parkinson’s disease who underwent deep electrical stimulation of pallidar complex structures. The general neuropsychological test battery that had been developed by A.R. Luria and allowed the qualitative classification of the cognitive impairment symptoms detectable on examination to be made was used to study cognitive functions. The patients were examined before and just after surgery and in the late period (following 1—2 years). The examinations have shown that the syndromes indicative of dysfunctions in the deep, parietal, and occipital and prefrontal regions of the left hemisphere and in the parietooccipital regions of the right hemisphere are stable components that determine the pattern of cognitive disorders and are preserved throughout all examinations.
29-34 548
The paper presents the specific features of the clinical presentation and pathophysiology of sleep and awakening disorders in patients with Parkinson's disease (PD). It covers the current views of the role of chronobiological mechanisms in the regulation of sleep and awakening in PD. The results of a follow-up of 20 patients (aged 58.56+8.24 years) diagnosed with PD without dementia with subjective nocturnal sleep disorders (disease history was 4.44+3.46 years; PD stage, 2.5+0.47) are given. In addition to antiparkinsonian drugs, melatonin was given in a dose of 3 mg/day. The efficiency of the therapy was evaluated by clinical assessment procedures before and 4—8 weeks after administration of the drug. The therapy outcome was better sleep characteristics in 17 (85%) patients, as evidenced by specialized questionnaires. The positive therapeutic effect as judged by the changes in Parkinson's disease sleep scale scores was shown by improvement of subjective sleep quality, reductions in awakening difficulties, in the total number of nocturnal awakening, in the degree of restlessness in bed, which mimics akathisia, and in the frequency of awakenings that were associated by the patients with urges to urinate (p<0.05).
35-38 448
Background. To choose tactics for patients with a single unprovoked generalized convulsive seizure (SUGCS) is a quite a challenge due to the lack of common approaches to interpreting this episode. Objective: to study the clinical, electroencephalographic (EEG), neuroimaging (magnetic resonance imaging (MRI) — positron emission tomography (PET)) and morphocytochemical features of peripheral blood cells (PBC) in patients with SUGCS. Patients and methods. Group 1 included 47 patients with SUGCS. A comparison group comprised 50 patients with different forms of locally induced symptomatic and/or cryptogenic epilepsy (LIE). All the patients underwent complex clinical examination including EEG, MRI, and PBC morphocytochemical study, which could reveal predictors for a high risk of recurrent convulsive seizure. In addition, PET was performed in 34 (72%) patients with SUGCS and 41 (82%) patients with LIE. Results and conclusion. The paper shows the possibilities of complex diagnosis using highly informative studies (PET, PBC cytomorpholog-ical examination) that allows identification of predictors of a high risk for a recurrent convulsive seizure. The findings may be useful in defining the treatment policy in patients with SUGCS and in timely using antiepileptic therapy.
38-42 2125
The differential diagnosis of dyscirculatory encephalopathy is one of the topical problems in Russian neurology. Forty-seven patients diagnosed with dyscirculatory encephalopathy and followed up in the polyclinic were examined. Only in 9 (19.2%) of them, the diagnosis was confirmed. Most patients were established to have other diseases, among which there were primary depressive and/or anxiety disorders (34%), primary headache (23.4), benign paroxysmal positional vertigo (BPPV) (8.5%), and Alzheimer’s disease (10.6%). The paper describes patients with migraine and BPPV, in whom the detection and treatment of these diseases have yielded a positive effect. The examination of patients diagnosed with dyscirculatory encephalopathy with investigations of their cognitive and emotional functions, otoneurological examination, and psychiatric consultation (if indicated) makes it possible to identify other diseases presenting with the symptoms similar to dyscirculatory encephalopathy and to prescribe effective treatments.
42-45 601
Objective: to study the efficacy of metaprot in the treatment of neurasthenia. Patients and methods. Thirty patients aged 18 to 45 years with neurasthenia (F48.0) were followed up. The patients were examined using a subjective asthenia rating scale (Multidimensional Fatigue Inventory (MFI-20)), a 10-point anesthesia visual analog scale, Spielberger’s self-report scale modified by Yu.L. Khanin, and a computed Test of Variables of Attention (TOVA). Metaprot was given in a dose of 0.25 g b.i.d. after morning and evening meals as two administrations for 10 days (5 days at a 2-day interval). The results of therapy were assessed on day 30 after its course. Results. There was clinical improvement in 21 (70.0%) patients after metaprot therapy. Evaluation of the patient’s status using the MFI-20 showed a significant improvement in the items of general asthenia, physical asthenia, psychic asthenia, and decreased activity. Psychophysiological examination using the TOVA revealed a significant reduction in response times, as compared to the scores obtained before the treatment, and a decrease in the number of errors in the second half of the test, which allows us to state that there is a reduction in the degree of mental exhaustion and an increase in work capacity after the treatment. Psychological tests showed no significant reduction in anxiety scores. There were no adverse reactions or complications. It has been concluded that it is promising to use metaprot to treat neurasthenia.
46-51 592
The paper discusses whether the irritable bowel syndrome is an independent nosological entity. It presents data on the association of this functional disease with mental disorders with emphasis on comorbidity with depression, as well as on the efficiency of psychopharmacotherapy options. Particular attention is given to the possibility of using antidepressants. An observation of the efficacy of paroxetine is outlined.
51-58 622
The paper gives data available in the literature on the variants of unconsciousness, bases of their development, and modes of correction. The authors analyze their observation of consciousness recovery after protracted unconsciousness (for about 6 months) during neuromodulation therapy and repetitive transcranial magnetic stimulation (rTMS) in a patient with severe traumatic and, probably, concominant hypoxic brain injury. Over time (within 2 years), they traced neurological and psychic changes, evaluated structural damages by Tl-, T2-weighted, FLAIR, and DTI magnetic resonance imaging, by constructing corticospinal tracts, and cerebral blood flow (computed tomography perfusion), and plasma catecholamines (epinephrine, norepinephrine, and dopamine). The case in question is clinical, instrumental, and laboratory evidence for the efficiency of use of not only direct stimulants of dopaminergic transmission, but also drugs with indirect dopaminergic activity, as well as rTMS for emergence from protracted akinetic mutism in the presence of akinetic-rigid syndrome.
58-63 593
The paper describes the clinical picture of Parkinson’s disease (PD), by indicating its stages in accordance with the classifications by different authors. It gives clinical diagnostic criteria for PD and indicates difficulties in making its correct diagnosis. Clinical examples were used to demonstrate misdiagnosed cases confirming a variety of the clinical symptoms at PD onset, which suggest that there is the need for a thorough patient examination and history data collection.
64-69 511
The paper considers the main therapeutic and preventive areas of management of patients with stroke, which are relied on evidence-based medicine data. To treat stroke patients is a multistep and multidisciplinary problem that starts with the emergence of the first neurological symptoms and extends over the entire life. Each period, including factors, such as the pattern of prehospital first medical aid; the rate of patient delivery to hospital; further actions of medical staff; measures for the prevention of recurrent cerebral ischemic events, cardiac complications, and cognitive disorders, is of importance in itself and serves a common aim. All efforts must aim eventually to reduce death rates in acute stroke, patient functional dependence, and recurrent brain damage rates, to prevent and timely treat cognitive impairments, to strictly adhere to the principles of secondary treatment of cardiovascular events in order to increase life expectancy and quality.
69-77 572
The review of novel oral anticoagulants (dabigatran, rivaroxaban and apixaban) in stroke prevention and also own data of administration of dabigatran in primary and secondary prevention of ischemic stroke in 45 patients with cerebrovascular diseases are presented. Most patients received dabigatran 14 days after the first stroke associated with nonvalvular atrial fibrillation. In other cases dabigatran was used for primary prevention of stroke in patients with chronic forms of cerebrovascular diseases and nonvalvular atrial fibrillation. Dabigatran shows good tolerability and efficacy. Recurrent strokes were diagnosed in 2 patients. The reasons for these events were arterial hypertension in one case and symptomatic atherosclerotic plaque in the other case.
78-83 721
The paper characterizes an association of cognitive and affective disorders in epilepsy, which may be a cause of worse quality of life, social dysadaptation, and disability. In this connection, it is imperative to choose correct antiepileptic drugs (AEDs). Groups of AEDs with different modes of action are considered, among which, lamotrigine that is noted for its unique profile of not only antiepileptic, but also psychotropic properties is given much attention.
84-88 547
The paper gives information on the state-of-the-art of pharmacoresistant neuropathic pain (PNP). It presents the definitions of PNP, which make it possible to accurately identify such patients and to plan tactics for their treatment. Similarities and differences in scales and questionnaires for the valid identification of a neuropathic pain component are discussed. General information is given on international guidelines for the treatment of neuropathic pain, the use of stepwise therapy, and indications for neurostimulation.
88-92 509
Topical glucocorticoid (GC) therapy for locomotor diseases is an extremely important component of a comprehensive program to treat inflammatory and, to a lesser extent, degenerative diseases. It reduces the time of hospitalization by 5—10 days in this category of patients, has a prompt and potent anti-inflammatory effect, and shows predictable efficiency. This therapy shows good tolerability and high safety and prevents serious adverse reactions to GC treatment.
92-96 634
According to the WHO data from the Global Burden of Disease Study 2010, migraine is recognized to be third (14.4%) in its worldwide prevalence among men and women. In the Russian Federation, a population-based study has revealed migraine in 20.8% of cases. Questionnaires, disability scales, and headache diaries, the use of which helps a patient and a physician understand the nature, intensity, and frequency of headache attacks, to identify predisposing factors, and to assess treatment results, play a large role in the diagnosis of migraine. The stratified approach where which first-line therapy is determined depending on the intensity of migraine symptoms (the magnitude of headache and concomitant symptoms, including diminished working capacity) is applied to obtain better results in relieving migraine attacks. A migraine attack relieved with eletriptan 40 mg has proved to be highly effective in not only reducing the intensity of headache and concomitant symptoms within an hour after the intake of the drug, but also in promptly restoring the working capacity.
97-105 3908
Diabetes mellitus (DM) is a global epidemic followed by late complications as diabetic polyneuropathy (DPN) and diabetic foot syndrome, leading to appreciable social and economic consequences. Virtually all patients with DM develop DPN in different periods. There is a clear correlation between the presence and magnitude of painful DPN and the duration of DM and the level of glycosylated hemoglobin and the severity of DPN. In spite of the abundance of theories of the development of DPN, its main identified pathogenetic factor is hyperglycemia. The literature gives no universal classification due to the variability of clinical symptoms. The main goals of treatment are to affect the pathogenesis of the disease and to prescribe symptomatic medications. The pathogenetic treatment of DPN includes compensation for carbohydrate metabolism and use of neurometabolic drugs. Pain from DPN may be controlled with antidepressants, anticonvulsants, local anesthetics and opioid analgesics. Although much evidence for the pathogenesis of peripheral nervous system injury has been recently accumulated, a universal standard for the effective therapy of DPN and the follow-up of these patients has not yet been developed.
105-108 677
Post-stroke cognitive impairments are common effects of stroke. Vascular cognitive impairments are characterized by the heterogeneity of the neuropsychological profile in relation to the site and pattern of stroke. Their common trait is the presence of dysregulation secondary to frontal dysfunction. The treatment of vascular cognitive impairments should be multimodality and aimed at stimulating neuroplasticity processes, restoring neurotransmitter imbalance, and preventing recurrent vascular episodes.

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