Neurology, Neuropsychiatry, Psychosomatics

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Vol 5, No 3 (2013)


13-17 531

The indicators of pain and psychological status, the concentrations of serum serotonin and blood platelets, and the levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor were studied in 82 patients with diabetic peripheral neuropathy (DPN). Along with conventional treatment aimed to normalize carbohydrate metabolism, 30 patients with DPN received actovegin in an intravenous, jetwise dose of 10.0 ml for 10 days. Prior to treatment, their pain intensity was 5.94±1.2 and 29.6±6.24 scores according to a visual analogue scale (VAS) and PainDETECT, respectively. The subclinical level of anxiety and depression was noted. The amount of serotonin in the serum (90.39±55.43 ng/ml) and blood platelets (298.13±80.33 ng/ml) was lower than that in the control. The content of serum BDNF in DPN was also substantially lower (419.27±132.7 pg/ml; p<0.04) than that in the control. After treatment, the actovegin group showed a more significant reduction in pain syndrome according to the VAS (3.5±0.6 cm; p=0.005) and PainDETECT (19.4±4.1 scores, p=0.005), a decrease in the degree of anxiety and depression according to the Beck inventory (11.4±1.4 scores; p=0.001), and an increase in BDNF levels up to 979.71±289.9 pg/ml. Serum serotonin and blood platelets increased up to 206.13±78.3 and 477.06±114.45 ng/ml, respectively; which is indicative of the correct choice of the treatment for DPN.

18-23 486

Objective. To study the efficacy and tolerance of tanakan in the treatment of mild cognitive impairment in young patients.
Patients and methods. The study enrolled 30 patients whose mean age was 33.5±7.5 years. It used clinical neurological examination; a test for rating general condition, activity, and mood; studies to evaluate aural short-term and verbal short-term memories and to estimate the level of attention using Schulte's tables, and questionnaires for the rating of autonomic disorders and nocturnal sleep quality, those for the patient subjective assessment of treatment efficiency and for the recording of adverse reactions.
Results. Tanakan therapy led to the normalized emotional status in the patients, improved nocturnal sleep, and reduced autonomic disorders. There was a tendency towards improvement of all characteristics of attention. Aural and verbal memories became better. Conclusion. Tanakan is an effective and safe drug to treat cognitive impairment at any age.

24-27 391

The paper presents the results of an investigation of 569 patients with macrosocial disadjustments. The latter were diagnosed in 71.1% of the examinees from a sample of 800 people from different socially disadapted population groups (unemployed miners, police officers on 6-month business to Chechnya, and migrants). The epidemiological and syndrome characteristics and the results of examining some aspects of the internal picture of disease, such as protective mechanisms, coping strategies, and aggravational and dissimulative tendencies, are given.

28-31 813

Patients and methods. The results of clinical and psychodiagnostic examination using the Minnesota Multiphasic Personality Inventory (MMPI) were analyzed in 210 therapeutic inpatients from 4 groups of psychosomatic diseases (coronary heart disease, hypertensive disease, duodenal ulcer disease, asthma, and bronchitis with an asthmatic component) and 3 groups of diseases in whose genesis the psychosomatic mechanisms (pneumonia, gastritis, renal diseases) played a lesser role. Healthy individuals (n=38) served as a control group. The correlation coefficients between the first scale reflecting the number of somatic complaints and the magnitude of their hypochondriacal fixation and the second one characterizing the degree of anxiety and depressive disorders were calculated within each disease group. Results. In psychosomatic diseases, the correlation coefficients between the first and second MMPI scales proved to be insignificant and substantially lower than those in the healthy individuals. This suggests that in such patients, a larger number of somatic complaints and their enhanced hypochondriacal fixation alleviate anxiety and depressive disorders, which may be regarded as an indication that there is psychosomatic defense that lessens anxiety due to a somatic disease. In somatic diseases that are not referring to as psychosomatic ones, the correlation coefficient between the first and second scales is highly significant and considerably higher than that in the healthy individuals and particularly higher than in the group of psychosomatic diseases. In the patients of these groups, an increase in anxiety and depression aggravates autonomic dysregulation reflecting in the larger number of hypochondriacal complaints. This direct relationship between autonomic functions and the level of anxiety and depression may be a risk factor for developing these disorders.

32-35 482

he paper shows the urgency of enhancing the efficiency of systemic thrombolytic therapy (TLT).
Objective: to study the impact of age, gender, smoking, atrial fibrillation, glucose levels at admission and the time of initiation of TLT after ischemic stroke onset on its early efficiency.
Patients and methods. The efficiency of TLT was analyzed in 44 patients with ischemic stroke. Their mean age was 59.5 (range 53.0–70.0) years; 43.2% were smokers; persistent and paroxysmal atrial fibrillation was seen in 27 and 7% of the patients, respectively. The interval between the onset of the disease onset and thrombolysis averaged 187.5 (range 152.5–217.5) min. The criterion for the early efficiency of TLT was a ≥4 score reduction in the severity of neurological deficit according to the National Institute of Health Stroke Scale (NIHSS) on day 7. The mean NIHSS score at admission was 11.5 (range 9–16.5%). Neurological deficit at hospital admission was higher in patients with cardioembolic stroke – 14.0 (range 12.0–18.0) scores.
Results. Improvement was observed in 66% of the patients on day 7. The mean NIHSS score on day 7 was 6.0 (range 4–12). There was a significant correlation between the high early efficiency of TLT, time to start thrombolysis, and baseline blood glucose level. The influence of other factors calls for further investigations in a larger patient sample.

36-40 521

Most patients with prior ischemic stroke are observed to have depressive disorders and as a consequence the loss of usual lifestyle, interests,belief in recovery.
Objective: to study emotional disorders within the first 7 days after ischemic stroke and their association with the severity of the disease and the lateralization of an ischemic focus in 72 patients. 
Results and discussion. Patients with severe stroke were found to have maximum blood cortisol and insulin levels. There was a direct relationship of emotional-volutional disorders to the levels of cortisol and neurospecific enolase

41-46 1665

Wilson–Konovalov disease (hepatolenticular degeneration) is a monogenic autosomal recessive genetic disorder. For its pathogenesis, there is the underlying genetic disorder of copper metabolism in which copper accumulates in excessive amounts in target organs, primarily in the liver and cerebral basal ganglia. The disease more commonly manifests at a young age and, when untreated, progresses rapidly to death. At the same time, hepatolenticular degeneration is one of a few of hereditary diseases for which an effective pathogenetic therapy with copper-eliminating medications has been developed to reduce the amount of dietary copper and to remove its excess from the body. The paper describes two patients with the rigid-arrhythmic-hyperkinetic and trembling-rigid forms of Wilson–Konovalov disease.

47-48 993

Miller–Fisher syndrome is a rare variant of acute inflammatory demyelinating polyneuropathy. The paper describes a case of Miller–Fisher syndrome developing as ophthalmoplegia, ataxia, and areflexia one week after acute respiratory viral infection. Within 3 weeks, neurological disorders completely regressed due to a plasmapheresis session and intravenous immunoglobulin injection.

49-54 480

The prevention of venous thromboembolic events (VTEEs) combining leg vein thrombosis and pulmonary thromboembolism is one of the effective areas in the management of patients with ischemic stroke. Methods for prevention of VTEEs and their risk factors in this disease are analyzed. The prevention of VTEEs involves maximally early activation of a patient with stroke, adequate fluid administration into the body, and therapeutic gymnastics. The use of unfractionated heparin (UFH) and low-molecular-weight heparins (LMWH) is effective as medications. The results of trials comparing the efficacy of UFH and LMWH in ischemic stroke are presented. Enoxaparin is noted to be superior to UFH in preventing VTEEs. The economic calculations show that the use of LMWH instead of UFH may lead to a reduction in the total cost of treatment for ischemic stroke due to the lower expenditures on therapy for VTEEs.

55-59 543

Systemic intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is a proven effective treatment in a certain category of patients with ischemic stroke during the first 4.5 hours after onset of this disease. Thrombolytic therapy (TLT) promotes the achievement of reperfusion in the cerebral ischemic portion, thus improving the patient's functional state. The results of international trials of TLP are presented and therapeutic strategies considered.

60-63 546

Rotigotine is a new, non-ergot dopamine receptor agonist (DRA) formulated as a transdermal drug delivery system. This article reviews the clinical efficacy and tolerability of Rotigotine transdermal patch in Parkinson's disease (PD) and discusses the results of clinical trials of Rotigotine in early- and late-stage PD. The Rotigotine transdermal patch is efficacious in the treatment of PD. Drug-related adverse events (AEs) include side effects typical for DRA, which are generally mild or moderate in intensity. The most common AEs are local reactions that are mild or moderate. Once-daily administration of the rotigotine transdermal patch is effective in the treatment of patients with early-stage PD as monotherapy and in combination with levodopa in late-stage PD and in inadequate morning motor control despite antiparkinsonian treatment.

64-70 895

The literature review deals with the evaluation of the efficacy and safety of tiapride used in the treatment of addictions of alcohol and psychoactive substances, such as opiate and heroin, vascular dementia with the signs of acute psychic confusion and Tourette's syndrome. The spectrum of neurochemical activity and mechanism of action of tiapride and the possibility of its combination with other drugs to enhance the therapeutic efficacy in the above disorders are described.

78-85 814

About 15% (12–30%) of the population experience pain in the lower back – LBP (lumbosacral region). Back pain is nonspecific in most cases (90–95%). In the past decade, the number of patients with back pain has remained virtually unchanged while the cost of medical care for this category of patients has risen manifold, which constitutes one of the most important problems in health care today. The paper considers main approaches to drug and nondrug therapies for nonspecific acute LBP in the context of current evidence-based medicine data, as well as new possibilities of effective and safe relief of pain syndrome in this group of patients.

4-12 804

The paper presents the literature review of chronic pain syndromes concurrent with depression. Chronic pain and depression have a mutual impact on clinical manifestation, course and treatment effectiveness in these patients. When there is a multitude of neurological, somatic, and autonomic disorders characteristic for the concurrence of pain and depression, understanding the nature of this comorbidity, as well as its diagnosis and treatment priorities assumes an importance. The complexity of detecting the affective symptoms proper in these patients determines less favorable outcomes, chronic persistent pain, the development of therapeutic resistance, and the risk of disease recurrence. The epidemiology and clinical manifestations of chronic pain and depression in the most common neurological diseases are discussed. The current concepts of the pathogenesis of comorbidity of chronic pain and depression and the problems of psychopharmacology are considered.

71-77 628

The types and mechanisms of acute cerebral circulatory impairments (ACCIs) are variable in different stages of pregnancy, which complicates problems in reducing the risk of their development and performing medical therapy. In recent years, the incidence of ACCIs during pregnancy has tended to increase. So an analysis of their risk factors and a review of current treatment algorithms enhance the validity and efficiency of therapeutic, diagnostic, and preventive measures.

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