Neurology, Neuropsychiatry, Psychosomatics

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Vol 3, No 3 (2011)




24-29 612
Parkinson's disease (PD) is a multisystemic neurodegenerative disease with a broad spectrum of not only movement, but also neuropsychiatry disorders (NPD). The efficiency of dopamine therapy in correcting NPD needs to be clarified.
Objective: to evaluate the impact of therapy with the MAO-B inhibitor rasagiline (Azilect®) on NPD in patients with extended stages of PD.
Subjects and methods. Twenty PD (disease duration 10.2+5.08 years; stage 2.4+0.5) patients with the wearing-of phenomenon were given rasagiline ' mg/day in addition to antiparkinsonian drugs. Following 6 and 24 weeks of therapy, its efficiency was evaluated using the unified PD rating scale, the motor fluctuation rating scale, the Beck depression inventory, the PD fatigue scale, the PD sleep scale, the Epworth sleeping scale, and the PD quality of life scale (PDQ-39).
Results. There were reductions in the severity of nocturnal and morning hypokinesia, daytime off periods, depression, insomnia, overfatigue and improved quality of life. The positive effect of therapy was stable within further 6 follow-up months.
30-34 455
Fifty-three patients followed up for back pain and operated on are analyzed. The failed back surgery syndrome was observed in 47% of cases. Surgical results did not depend on the duration of the last exacerbation, the frequency of admissions, the presence of radicular syndrome, the size of intervertebral hernias, and the type of intervention (discectomy or microdiscectomy). Magnetic resonance imaging showed postoperative recurrent hernia in 50% of patients with good surgical results and in 89% of those with its poor results, which suggested that the surgical outcome could be only partially determined by a recurrence. Surgical treatment failures were correlated with the presence of neuropathic pain, anxiety, and depression. The detection of the neuropathic and psychogenic components of pain syndrome and the use of combination therapy with antidepressants and anticonvulsants for back pain will reduce the number of surgical interventions and improve their results.
34-38 519
A trend in EEG interhemispheric asymmetry was studied in patients with endogenous depressions in morning and evening hours. In the morning, the spectral power of alpha rhythm particularly in the occipital cortical regions, proved to be higher than that in the evening. In the morning, the interhemispheric differences in the power of occipital alpha rhythm were leveled off while in the evening there was normalization of interhemispheric balance with the higher power of alpha rhythm in the right occipital region. Analysis of the mean coherence (mean Coh) of alpha rhythm in individual cortical regions revealed that the patients with endogenous depression had higher readings mainly in the parietal and central regions of both hemispheres and in the right temporal regions in the morning than in the evening. The occipital and posttemporal regions showed an inverse trend in the mean Coh - it was lower in the morning than in the evening.
38-46 405
Objective: to study changes in cognitive function (CF) in patients after reconstructive operations on the carotid arteries and their association with the development of postoperative asymptomatic focal cerebral ischemic changes.
Subjects and methods. Eighty-four patients (6' males and 23 females; mean age 62±8 years) with carotid artery occlusion were examined before and different periods (3, 6, and 9 months) after reconstructive operations on the carotid arteries. Various neuropsychological tests were used; cognitive evoked potentials (P300) were examined. Diffusion-weighed magnetic resonance imaging revealed postoperative cerebral ischemic changes in 27 (32%) patients on days 1-2.
Results and discussion. As compared to the baseline data, there was an increase in the total MMSE score at 6-9 months. Tests estimating different memory modalities and attention revealed differently directed changes: improved direct reproduction and slightly deteriorated thinking, as shown by a test of directed (categorical) associations. No substantial CF changes occurred in the majority of patients. There were no significant differences in neuropsychological testing results between patients in accordance with the development of asymptomatic postoperative cerebral ischemic foci; however, when the latter were absent, there was a reduction in P300 latency at 3 and 6 months, which was associated with improved MMSE scores.
Conclusion. In late periods after reconstructive operations on the carotid arteries for their occlusive lesion, estimates may vary with used neuropsychological procedures. The development of postoperative asymptomatic cerebral ischemic foci is unassociated with additional CF impairment.
46-52 820
Among nonsteroidal anti-inflammatory drugs, meloxicam has a slight effect on blood pressure (BP).
Objective: to study the efficacy and safety of amelotex in acute musculoskeletal pain in the lumbosacral region and essential hypertension (EH).
Subjects and methods. An open-label comparative trial of the safety and efficacy of amelotex (meloxicam injectable dosage form) in an intramuscular dose of 15 mg/day and diclofenac sodium in an intramuscular dose of 75 mg/day was conducted in 120 patients with acute muscu- loskeletal pain in the lumbosacral region and grade 1 EH.
Results. Amelotex was as effective as diclofenac sodium in reducing the intensity of pain and the degree of vertebral syndrome and decreasing the restricted daily activity of patients with acute lumbalgia and concomitant grade 1 EH. Ten-day use of amelotex in the above dose caused no significant BL elevation.
Conclusion. Amelotex was observed to be highly effective and well tolerated in patients with grade 1 EH who were treated for acute muscu- loskeletal pain in the back.
52-56 519
The data of the CIRCADIAN-I trial suggest that depressions are unsatisfactorily diagnosed in psychiatric practice. Thus, some of the ICD-10 diagnoses used to denote depressive states (dysthymia, cyclothymia) are made extremely rarely. Only comparatively short-term and reversible vital depressions are considered to be preferred for the categories of affective disorders (F.30-F.33). Any clinical deviations from this clinical presentation (sensitive, anxiety symptoms, a prolonged course, and no well-defined seasonal and circadian rhythms of mood worsening) are regarded as a guide for ruling out the diagnosis of affective disorder. At the same time depressive states are classified as schizophrenia, adjustment disorders, etc.
56-60 524
Objective: to evaluate the effect of citicoline (ceraxon) on recovery of cognitive functions in patients after ischemic stroke.
Subjects and methods. Thirty-three patients (13 males and 20 women) aged 46-82 years (mean age 66.5±6.75 years) after ischemic stroke were examined 3 months to 1 year after its development. Neuropsychological examination showed that all the patients had mild or moderate cognitive impairments as disorders of memory, attention, and thinking.
Results and discussion. Ten-day treatment with citicoline (ceraxon) in a dose of 500 or 1000 mg/day caused positive changes in the neurody-namic characteristics of cognitive functions, and improvements in memory, thinking, and health in the patients. Cognitive improvement was more significant when ceraxon was used in a dose of 1000 mg/day.
60-64 608
The paper presents the results of clinical and electromyographic studies in 182 patients with idiopathic facial neuropathy (BellXs palsy). The most commonly studied parameters of electroneuromyography (ENMG) were compared to determine a good or poor prognosis for recovery. The most sensitive parameters were shown to be nerve excitability threshold in the acutest period (up to 5 days), M-response amplitude fall ratio on the affected and intact sides and reversibility of impaired irritability in the acute period (on days 10 to 14), and muscle denervation changes starting on day 21. The most sensitive ENMG parameters for the evaluation of the efficiency of performed therapy were changes in M-response amplitude and latency. Thus, ENMG can estimate disease prognosis and monitor treatment efficiency.


65-70 589
The paper gives the data available in the literature on the treatment of spasticity in poststroke patients. Therapeutic exercises that should be started just on the first days of stroke are noted to play a leading role in the treatment of poststroke spasticity. The local administration of botulinum toxin preparations (botox, dysport, xeomin) may be effective for managing local spasticity that deteriorates motor functions. Baclofen (baklosan), tizanidine (sirdalud), and tolperisone hydrochloride (mydocalm) may be used as oral medications. The paper also presents the results of a placebo-controlled trial that has indicated that mydocalm given in a dose of 300 to 900 mg/day may be effective in treating poststroke spasticity.
70-75 590
The author analyzes the data available in the literature on and his clinical experience in diagnosing and treating back pain. It is shown that none of the surgical, pharmacological, physical, or psychological treatments singly used for chronic pain can effectively equal a multidisciplinary approach employed in specialized pain clinics when all the above approaches mutually intensify each other. At the same time the risk of adverse reactions is substantially lowered by the smaller doses of drugs and the shorter course of their use.
75-80 453
The concept of cervicogenic headache (CGH) comprises the types of headaches having different origins, which are associated with pathology in the cervical spine and its other structural areas. CGH is induced by diverse pathogenetic mechanisms and has different clinical manifestations so it is referred to different classification categories. The anatomic and pathophysiological causes of CGH, its clinical picture, and therapeutic principles are discussed. In clinical practice, more and more preference has been recently given to combined analgesics, ketorolac and nimesulide in particular.
80-86 724
The paper considers the expediency and efficiency of neurocytoprotection in poststroke rehabilitation, a system of measures to overcome existing disorders; a patient's adjustment to self-service and work activities under new disease-induced conditions. It analyzes the data available in the literature on studies deals with the mechanisms of action and clinical efficacy of vinpocetine (cavinton). The authors' study could positively appreciate the possibilities of adequate poststroke rehabilitation and showed the need for its long performance for many months and even many years to achieve the maximum clinical effect.

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