Neurology, Neuropsychiatry, Psychosomatics

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Vol 2, No 2 (2010)


5-10 473
Moderate cognitive disorders (MCD) are the acquired diminution of one or a few cognitive functions, which is outside the normal age values, but does not achieve the degree of dementia. Alzheimer's disease or cerebrovascular insufficiency is the most common causes of MCD. In most cases, MCD is a progressive condition and transforms into dementia with time. Therefore it is expedient to diagnose MCD and initiate its therapy as soon as possible. The management of patients with MDC should be individualized by taking into account the polyetiological nature of this pathological condition. It is mandatory to make a screening of systemic dysmetabolic disorders and neuroimaging, to detect and compensate for existing cardiovascular diseases, and to correct the patient's emotional status. It is also advisable to affect cerebral microcirculation and neurometabolic processes.
11-19 663
Based on a review of the literature, the authors consider the pathogenesis, diagnosis, epidemiology, and clinical features of catamenial migraine. The view that catamenial migraine attacks are severest receives more and more support. The criteria that may be used to predict a severer course of catamenial migraine attacks in a specific patient are to be further defined.
19-26 671
Cervicogenic headache (CH) is a common form of cephalgias. Despite the progress in understanding the mechanisms of CH, the clinical diagnosis and effective therapy of this condition present considerable difficulties. The prevalence of CH in the population is as high as 20%. Pathological changes in the upper cervical spinal segments form the basis of the neuroanatomy of CH. Its diagnosis is based on the diagnostic criteria of the Cervicogenic Headache International Study Group and on the criteria of the International Classification of Headache Disorders, 2nd Edition (2004). Effective therapy for CGP is possible when a comprehensive approach and combined use of drug and nondrug treatments, including local anesthetic blocks, are employed.
26-32 520
Based on his many year's studies and the data available in the literature, the author considers the neuropathophysiological mechanisms responsible for the damaging action of epileptic discharges on basic brain functions and provides evidence for the views of prolonged non-paroxysmal psychoneurological epileptic disorders and epileptic encephalopathies. He shows the consistency of clinical manifestations of the site of cerebral epileptic discharges on the basis of an update on their functional localization and functional neuroimaging. Computerized three-dimensional electroencephalography (EEG) data mapping is shown to play a crucial role in the understanding of the mechanisms, diagnosis, and treatment of non-paroxysmal epileptic disorders. Based on the concepts that epileptiform activity plays a neuropathological role in the genesis of non-paroxysmal epileptic disorders, the author substantiates the use of agents that are effective in suppressing EEG epileptiform activity (valproate, levetiracetam, and lamotrigine) as a first-choice drug and caution when giving the antiepileptics that can aggravate epileptiform activity and clinical manifestations.
33-39 529
The paper presents current methods for the diagnosis and treatment of cerebrovascular diseases. It shows that an approach to evaluating some clinical manifestations has been changed due to the introduction of new diagnostic techniques into practice. The surgical and therapeutic aspects of elimination of causes of vertebrobasilar circulatory disorders are given.


40-45 407
The efficacy of the acetylcholine esterase inhibitor reminil was studied in vascular dementia (VD). Eighty-four (54 men and 30 women) patients aged 60-85 years with the verified diagnosis of VD were followed up. Their mean age was 65±4,3 years; the mean duration of VD after its diagnosis was 2,3 years (that after firstly detected VD was less than 4 years). Primary examination before therapy showed that all the patients had cognitive disorders characteristic of VD concurrent with varying motor disorders. Reminil showed a significant effect against the symptoms of VS within 1,5-2 months after initiation of its administration and when the therapeutic effect of the drug was achieved. Improved cognitive functions were preserved during a 12-month follow-up. Owing to its double mechanism of action, reminil is active against cognitive and behavioral disorders in a wide circle of patients with dementia, well tolerated, and causes no serious adverse reactions.
46-49 441
To develop the clinical and electroencephalographic criteria for the efficiency of rispolept in children with Tourette's syndrome, the authors analyze the results of treatment in 15 patients aged 8-15 years who took rispolept in a dose of 2-3 mg/day. The clinical and electroencephalographic assessment of the therapy for tick hyperkinesis revealed a significant reduction in the frequency of ticks, a decrease in the number of hyperkinesis tests, and normalization of bioelectrical rhythms in the brain sensomotor regions. The use of rispolept caused positive changes on treatment day 15; its adverse reactions were noted rarely and required no drug discontinuance.
49-54 986
Vertigo is a common complaint that leads patients to visit physicians of various specialties. Diseases resulting in vestibular vertigo are very diverse and may be caused by lesion of both the central parts of the vestibular system and the peripheral vestibular apparatus. In many cases, its diagnosis can be made from complaints and a history of disease and special bedside tests requiring no sophisticated equipment. Management of vestibular vertigo should aim at treating the underlying disease; vestibular dilators as symptomatic therapy can be effective for several days. Vestibular exercises the efficiency of which can be enhanced by betahistine and other drugs accelerating vestibular compensation should be further needed. Data on the efficacy of betaver (betahistine) in patients with vestibular vertigo are given.
55-58 2288
The paper deals with the study of reasons for urgent neurological hospitalization for vestibular vertigo and a role of cervical osteochondrosis in the development of vestibular disorders. A subgroup of 109 patients (84 women and 25 men) who had isolated vestibular vertigo (without other symptoms of nervous system lesion) was identified among 230 patients with acute systemic dizziness, nausea, vomiting with the referral diagnosis of «cervical osteochondrosis, vertebral artery syndrome», or «acute vertebrobasilar circulatory attack». The patients underwent a standard neurological examination, brain magnetic resonance imaging, an otorhinolaryngologist's advice with otoscopy, cervical spine X-ray in two interperpendicular (frontal and lateral) projections, and functional spondylography (flexion, extension). Meticulous manual examination was made in all the patients to verify reflex muscle and myofascial pain syndromes as a cause of vertebral artery irritation during an exacerbation of cervical osteochondrosis. The «cerebral» level of vestibular disorders could be excluded in most (82.3%) patients. The latter had acute peripheral vestibular pathology that required cerebral stroke or hemorrhage to be ruled out according to clinical data in most cases. Intermittent, recurrent, short-term vestibular crisis in the examined group of patients is temporarily or clinically unrelated to an exacerbation of cervical osteochondrosis.
58-62 408
An open-labeled study of the efficiency and tolerance of complex injection therapy with Amelotex in a dose of 15 mg/day for 6 days and CompligamV in a dose of one ampoule for 15 days was conduced in 30 patients (24 women and 6 men) aged 45 to 71 years with chronic cervicogenic headache (CGH) (its duration of 2 months to 10 years). The Numerical Rating Scale (NRS), the Visual Analog Scale (VAS), the McGill Pain Questionnaire (MPQ), and the Brief Pain Inventory (BPI) developed by C.S. Cleeland were used to rate different characteristics of pain and to evaluate the efficiency of treatment. Laboratory redetermination of the levels of von Willebrand factor, factor VIII, antithrombin III, D-dimer, and homocysteine was made in 10 patients to study hemostatic parameters. Combined injection therapy with Amelotex and CompligamV in patients with CGH reduced the intensity of acute and chronic pain, by affecting both the sensory-discriminative and affective-motivational pain components. The therapy did not worsen endothelial dysfunction, a marker of activated blood coagulation; there was a rise in the content of antithrombin III (within the normal range). Combined injection therapy with Amelotex and CompligamV was observed to be well tolerated and to cause no adverse reactions.
62-64 534
Cerebrovascular diseases, such as ischemic stroke and dyscirculatory encephalopathy, rank second in the structure of circulatory mortality and in total mortality. The prevention of the first or repeat stroke, which is based on the normalization of blood pressure and the use of antiplatelet agents or warfarin, statins, and, in some patients, surgical treatments, plays a dominant role in the treatment of patients with cerebrovascular pathology. Choline alfoscerate (Cereton) manufactured by the Sotex pharmaceutical company is widely used to improve cognitive functions in patients with ischemic stroke and dyscirculatory encephalopathy. The aim of this study was to evaluate the efficacy and safety of Cereton used in patients with acute ischemic stroke and in those with dyscirculatory encephalopathy appearing as moderate cognitive disorders. After therapy, there was a two-fold neurologic improvement in patients with ischemic stroke. All the patients reported a good tolerance of the drug. During treatment, all patients with dyscirculatory encephalopathy showed positive neurological changes and cognitive improvement. The studies have demonstrated the efficacy and safety of Cereton used in patients with acute ischemic stroke and in those with dyscirculatory encephalopathy.


66-70 416
The investigation evaluated the clinicoeconomic benefits of epilepsy therapy performed by a district neurologist versus an epileptologist in the outpatient setting. The index «cost-benefit» was calculated for different types of epileptic seizures in employed and unemployed patients before and after therapy optimization. Even if there was a considerable increase in direct costs after correction of antiepileptic therapy, the cost of patient management was shown to decrease by 2-3 times on average irrespective of the type of a seizure.


71-76 453
The paper outlines indications for the use of acetylsalicylic acid (ASC) to prevent and treat ischemic stroke. A study of the effect of this agent in the primary prevention of stroke has demonstrated the obligatory identification of a category of individuals at higher risk for ischemic cerebral complications. The early initiation of ASC therapy in the acutest phase of ischemic stroke results in a significant reduction in mortality, risk for restroke, and neurological improvement. When used in the secondary prevention of noncardioembolic stroke, ASC belongs to the most studied antiplatelet agents that additionally reduce the rate of restroke or death.
77-82 493
Based on the data available in the literature, the author gives information on the prevalence of ankylosing spondyloarthritis. The clinical picture and pathogenesis of this disease and the principles of its diagnosis and treatment are described. Particular emphasis is placed on the use of etoricoxib, a nonsteroidal anti-inflammatory drug, in ankylosing spondyloarthritis. The available data strongly prove that etoricoxib is an alternative in the treatment of inflammatory diseases of the joints and vertebral column, ankylosing spondyloarthritis in particular.
83-88 451
Based on the data available in the literature, the authors consider the prevention of ischemic stroke and other cardiovascular diseases in high-risk group patients. Timely identification and assessment of risk factors in a specific patient allow one to elaborate individual and the most optimal management tactics and to define rational drug therapy. Antiplatelet therapy the efficiency of which has been confirmed during randomized clinical trials is pathogenetically warranted. The paper considers the preventive and therapeutic efficacy of different groups of anriaggregants, such as aspirin, thienopyridines, and dipyridamole. It also gives data on the use of surgical and X-ray techniques to prevent cerebral circulatory disorders.
88-91 418
The review considers the treatment of anxiety disorders (generalized anxiety and the anxious variant of adaptation disorders) with Tanakan® that is a standardized gingko biloba extract. The successful use of the drug in moderate anxiety states in elderly patients having cognitive disorders of cerebrovascular nature is now beyond question. However, the pronounced stimulating effect of Tanakan® requires that caution should be exercised when giving it in anxiety syndrome.

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