Neurology, Neuropsychiatry, Psychosomatics

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Vol 4, No 1 (2012)


16-22 1319
Lewy body dementia (LBD) is a disease that was separated from a group of senile dementia in the 1990s. The paper details the pathogenesis, pathomorphology, and clinical manifestations of the disease, as well as a possible association of its symptoms with the specific features of the extent of the neurodegenerative process. It also fully describes mental disorders in LBD, their possible causes, an association of hallucinosis with lesion of nonspecific cerebral systems and mediator failure. The results of LBD treatment with basic symptomatic therapy are given. The results of the clinical trial of the activity of akatinol memantine in the patients with LBD are described in detail.
23-27 1174
Fibromyalgia is one of the most complex problems of clinical practice. Despite its high prevalence rates in the population and high medical visit rates, fibromyalgia is maldiagnosed. Its clinical symptom development, nosological independence, and the choice of priority treatments are debatable questions. By now the number of randomized trials dealing with the efficiency of treatment for fibromyalgia has substantially increased. This permits the identification of its treatment priorities.
27-35 832
The paper gives an account of approaches to treating patients with acute and chronic back pain in the context of evidence-based medicine and current clinical guidelines. In the vast majority, acute back pain is a benign self-limiting condition (nonspecific musculoskeletal pain) and most patients need additional instrumental examinations. An active approach to treatment is considered to be optimal. It is expedient to apply a more differential approach involving the refinement of mechanisms for development of the pain syndrome and the elaboration of treatment strategy in relation to the leading pathophysiological mechanism when examining the patients with chronic back pain.
36-42 555
The paper reviews the data available in the literature on the prevention of stroke in atrial fibrillation (AF). Until recently, mainly warfarin was noted to be used to prevent stroke in AF, which required regulatory laboratory (hematological) control. The authors give the results of the RE-LY trial that compared the efficacy of the new thrombin inhibitor dabigatran (pradax) in a dose of 150 or 110 mg twice daily and warfarin. The trial has indicated that the use of dabigatran in a dose of 150 mg twice daily results in a reduction in the rate of stroke and systemic embolism as compared to that with warfarin treatment. The administration of dabigatran in a dose of 150 or 110 mg twice daily decreases the rate of deaths from all cases, life-threatening hemorrhages, and hemorrhagic stroke as compared to that of warfarin. The prospects for using different doses of dabigatran in AF patients with prior ischemic stroke (IS) or transient ischemic attack (TIA) are discussed. In our country, most patients with prior IS or TIA in the presence of AF do not take warfarin due to the difficulty of regulatory laboratory control, the introduction of dabigatran into neurological care may increase the number of patients receiving effective anticoagulant therapy to prevent re-stroke.
43-48 625
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. Major approaches to therapy for insomnia, para-, and hypersomnia in these patients are discussed. Data on the efficacy of melatonin in sleep and awakening disorders are given.
48-51 652
Most patients with vertigo seek neurological advice. In spite of the availability of current examination techniques, a differential diagnosis of vertigo is not frequently made. The paper discusses the terminology and classification of vertigo and clinical methods for diagnosing central and peripheral vestibulopathies. It considers the common problems of management of patients with diseases of the central and peripheral vestibular systems, the use of piracetam and other drugs to stimulate rehabilitation.
52-57 1312
The differential diagnosis of cognitive impairments is of great importance in mental disorders detectable in general medical practice. Objective: to study whether Addenbrooke's Cognitive Examination — Revised (ACE-R) may be used in these patients. Patients and methods. The study was conducted in two steps at somatic hospitals and city polyclinics. It enrolled 130patients (36 men and 94 women) with anxiety-depression spectrum disorders (ADSD), mild cognitive disorders (MCD) and a concurrence of these conditions. The authors used the following psychometric scales: the hospital anxiety and depression scale; the mini-mental state examination; the frontal assessment battery; ACE-R; ten words learning test. The psychometric characteristics of ACE-R and the possibilities of its use were estimated to detect MCD. The differences in the spectrum of cognitive impairments were analyzed in patients with different types of ADSD. Results. ACE-R is shown to be an effective neuropsychological tool for the primary diagnosis, detection, and evaluation of MCD in the general medical network. The results of ACE-R use indicate that the spectrum of cognitive impairments has substantial differences in patients with different types of non-psychotic disorders.
57-63 664
Objective: to study the association of the DRD4, DAT genes with vital exhaustion in an open 25—64-old-year male population. A random representative sample of 657 men aged 25—64 years, living in one of the Novosibirsk districts was examined within the WHO MONICA project in 1994. The MONICA-MOPSY test was used to estimate the level of vital exhaustion. The examined DRD4, DAT gene Polymorphisms were genotypes in the Laboratory of Molecular Genetic Studies, Therapy Research Institute, Siberian Branch, Russian Academy of Medical Sciences (Novosibirsk). Results. The genotype containing allele 7 in the dopamine receptor subtype 4 (DRD4) gene, as well as genotype 9/9 in the dopamine-transporter protein (DAT) gene are significantly associated with the high level of vital exhaustion. Conclusion. The vital exhaustion is significantly associated with certain DRD4, DAT gene polymorphisms in the open 25—64-year-old male population of Novosibirsk.
63-67 721
The weather risk factors of stroke were studied in the Central Region of Russia. Case histories of patients admitted to Yaroslavl Clinical Hospital Eight with a diagnosis of stroke from October 2002 to December 2006 were analyzed. Among 3243 patients, there were 1607 men and 1636 women (mean age 62.45±12.19years. Ischemic and hemorrhagic strokes were identified in 61.1 and 19.0% of cases, respectively. The risk factors of stroke were found to be essential hypertension (70.4%), cerebral atherosclerosis (35.2%), and coronary heart disease (17.4%). A significant role is played in the occurrence of the disease by weather factors, such as wind speed (contribution factor, 32.1%), average daily air temperature (contribution factor, 17.9%), and atmospheric pressure (contribution factor, 17.1%).
67-71 2253
Objective: to study the efficacy of sulpiride in different types of non-psychotic types of endogenous depressive-hypochondriacal syndrome. Patients and methods. Forty-seven patients (36 women and 11 men) with a depressive episode (n = 15), recurrent depressive disorder (n = 14), and slowly progressive schizophrenia (SPS) (n = 18) were examined clinically and using the psychometric scales: the Clinical Global Impression Scale; Montgomery-Esberg Depression Rating Scale (MADRS), the Hamilton Anxiety Rating Scale (HARS), and Udvalg for Kliniske Undersшgelser Side Effect Rating Scale. Sulpiride was given in an initial dose of50—100 mg/day; the dose was, if required, increased up to 400—600 mg/day. Results. After 2 months of treatment in the patients with affective disorders, the MADRS and HARS scores showed reductions from 28.7+2.3 to 14.3+1.7 and from 14.8+2.1 to 7.4+2.7, respectively. The reductions in the symptoms of depression and anxiety were 50.2 and 50.0%, respectively. In SPS, the mean MADRS and HARS scores decreased from 21.4+3.7 to 13.7ё1.8 and from 10.2+1.5 to 6.4+3.2, respectively. There were generally 40 and 37.3% reductions in the symptoms of depression and anxiety, respectively. Conclusion. In patients with affective disorders, the efficacy of sulpiride is predominantly due to its antidepressant and anti-anxiety activities in depressive-hypochondriacal syndrome and to its antipsychotic and activating activities in SPS.
72-81 675
The concepts of generalized epilepsy have recently undergone considerable changes: the features of focality in generalized epilepsies and the typical features of idiopathic generalized epilepsies in focal epilepsies have been revealed. The closeness of these forms is also supported by genetic studies when one genetic abnormality shows diverse focal and generalized phenotypes in different members of one family. In this connection, the Commission on Classification and Terminology of the International League Against Epilepsy proposes to abandon the identification of the forms of epilepsy on the principle of focal and generalized seizures, by changing it for the notion Tneural network that involves different local and common brain mechanisms in each individual case. These neuropathophysiological concepts give an insight into why the pharmacotherapy based on a model of focal and generalized seizures is ineffective or occasionally even aggravates the disease. The current approach makes it preferential to choose a broad-spectrum drug that is effective in any types of seizures and forms of epilepsy, by taking into account its efficacy, dose titration rate, dosage form, side effects, and cost. Among broad-spectrum agents (valproate (VPA), levetiracetam, lamotrigine, topiramate), the original controlled release dosage forms of VPA (Depakine chrono and Depakine chromosphere) have a priority as first-line drugs for the initial treatment of generalized epilepsies. The paper considers the basic pharmacokinetic and pharmacodynamics properties of the drugs for the treatment of epilepsy and the algorithms of therapy for individual entities of generalized epilepsy.
82-87 1401
Cerebrovascular diseases are one of the most common risk factors of symptomatic epilepsy. The paper considers the epidemiology and pathogenesis of post-stroke seizures, the predictors of their development in patients with vascular lesions in the brain, as well as antiepileptic therapy.
88-91 614
The paper reviews the data available in the literature on higher psychic dysfunctions in adult patients with epilepsy. It considers the factors influencing the development of higher psychic dysfunctions, including the use of antiepileptic drugs. Possible correction options are given for higher psychic sphere impairments in patients with epilepsy.
92-96 607
Much progress has been made in the understanding of the pathophysiological mechanisms of motor control including a complex interaction of sensory, motor and cognitive functions. The identification and investigation of the functional role of the neurotransmitter systems that are involved in the regulation of motor functions offer new perspectives in interpreting the complex, inadequately clarified mechanisms of movement disorders and in developing approaches to their treatment. The organization of motor behavior, including the neurotransmitter anatomy of the so-called motor centers Р the cerebral structures involved in motor control, is extremely complex and requires further investigation.
96-101 553
The paper reviews the data available in the literature on the prevention of ischemic stroke by using antihypertensive therapy. It gives international guidelines and the results of randomized placebo-controlled trials of the use of different antihypertensive drugs in patients with prior stroke or transient ischemic attack. The possible neuroprotective effects of angiotensin II receptor blockers are discussed when analyzing the advantages of eprosartan over nitrendipine in the secondary prevention of stroke. The realities and optimization of secondary prevention of stroke in outpatient practice are analyzed.
101-105 1024
The paper considers the main causes of imbalance in elderly patients. It gives data on the specific features of the course of the most common vestibular diseases in the elderly, such as benign paroxysmal positional vertigo, Meniere’s disease, stroke, and transient ischemic attack. At the same time the vestibular system-aging mechanisms that are able to induce disequilibrium are considered. Multisensory disequilibrium is discussed as the most common cause of instability in the elderly. Basic treatments for vestibular diseases in the elderly, including drug therapy and vestibular rehabilitation, are analyzed.
105-111 654
The authors analyze the data available in the literature on sleep disorders and their correction in the population and in patients with mental disorders and give their experience in using zolpidem (sanval) to treat insomnia in different mental diseases. The clinical features of sleep disorders are characterized in neurotic and affective disorders, schizophrenia, and organic brain injuries. Indications for the use of sanval both alone and in combination with other psychotropic drugs (antidepressants and antipsychotics with a sedative effect) for the therapy of sleep disorders within the framework of mental disorders are discussed. Sanval is shown to be highly effective and well tolerated in 100psychiatric in- and outpatients. No dependence on this drug and withdrawal syndrome permit sanval to be used as long-term courses in patients with chronic permanent insomnia and at an old age.
112-116 670
Dopamine (DA) receptor agonists ensure stimulation of DA receptors in the brain, by compensating for dopaminergic deficiency in Parkinson’s disease (PD). Since 1996, pramipexole has been used to treat early and extensive PD stages; its clinical efficacy has been proven in many double-blind randomized placebo-controlled and open-labeled trials. Since 2009 the European countries and the USA has used extendedrelease pramipexole (ERP) that is given once daily. Its benefits are stabilized plasma drug concentrations, 24-hour action, which provides continuous dopaminergic stimulation ofpostsynaptic receptors for the prevention and therapy of already existing motor fluctuations and drug-induced dyskinesias. Once-daily dosing of ERP increases the adherence of a patient with PD to regular treatment. Two (extended- and immediate-release) formulations of pramipexole differ only in the release rate for the active ingredient from the contents of a tablet. Both formulations contain the same active ingredient, have the similar profile of interacting with DA receptors, and show pharmacotherapeutic efficacy.
116-120 682
The paper reviews the data available in the literature on the epidemiology of post-stroke depression (PSD), its pathogenetic mechanisms, and an association between stroke and depression. It gives the clinical types of PSD, the results of trials of the efficacy of antidepressants in these patients, and the use of escitalopram.
120-123 680
The paper discusses the clinical presentation and treatment of chronic forms of cerebrovascular diseases (CVD). The combined treatment of patients with chronic CVD comprises antiaggregants (in patients with atherosclerosis of the great arteries of the brain, essential hypertension), indirect anticoagulants (in patients with atrial fibrillation, in a number of patients with coagulation), antihypertensive drugs, statins. Based on the data available in the literature and their findings, the authors analyze whether it is expedient to prescribe cavinton for dyscirculatory encephalopathy.

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