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Neurology, Neuropsychiatry, Psychosomatics

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Vol 8, No 1 (2016)
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https://doi.org/10.14412/2074-2711-2016-1

LECTURES

4-8 554
Abstract

Neck pain (cervicalgia) occupies one of the leading places among the reasons for outpatient visits, 75% of people have experienced neck pain at least once in their lives. In most cases, neck pain regresses; however, it recurs in almost one half of patients. The paper gives data on the risk factors, mechanisms, course, and prognosis of cervicalgia. It discusses the issues of differential diagnosis, examination, and approaches to treating this condition in these patients. Nonsteroidal anti-inflammatory drugs are most effective in treating patients with acute cervicalgia. Therapeutic exercises and manual therapy are indicated in patients with chronic cervicalgia. There is evidence on the efficacy and safety of meloxicam for the management of acute and chronic cervicalgia.

ORIGINAL INVESTIGATIONS

9-15 421
Abstract

The main purpose of examination of patients before thrombolytic therapy for ischemic stroke (IS) is to timely identify contraindications to the use of recombinant tissue plasminogen activator.

Objective: to estimate opportunities and benefits in applying multimodal magnetic resonance imaging (MRI) to improve clinical outcomes in acute stroke, among other processes, by enhancing the efficiency and safety of thrombolytic therapy.

Patients and methods. The clinical experience of the S.M. Kirov Military Medical Academy in using multimodal MRI of the brain since 2004 was analyzed in patients with stroke.

Results. Comprehensive assessment of the results of perfusion-weighted MRI of the brain and those of transcranial Doppler ultrasound identified five clinically significant variants of perfusion changes in IS: normal perfusion; postischemic hyperemia; persistent hypoperfusion; acute pathological hyperperfusion, and unrecovered perfusion. With an irreversible tissue damage volume of >60 cm3 on day 1 of stroke, as evidenced by diffusion-weighted MRI, the odd ratio for cerebral edema in the acutest period of the disease is 39.4% (95% CI 2.57–2436; p<0.05). The risk of hemorrhagic transformation increases with a measured diffusion coefficient in the area of the nucleus of developing nonlacunar infarct <35×10-5 mm2/sec within the first 24 hours after disease onset (p<0.005).

Conclusion. The data of local clinical practice and the results of international clinical trials show that multimodal MRI of the brain is a reliable tool for the detailed evaluation of the expected efficiency and safety of thrombolytic therapy for IS. When persistent hypoperfusion is detected, the determination of perfusion-diffusion mismatch is of no informative value in deciding on whether thrombolytic therapy can be performed. Estimating the volume of pathological changes on diffusion-weighted images and the measured diffusion coefficient in the area of the nucleus of developing nonlacunar infarct in the measured diffusion coefficient maps allows the risk of major intracranial complications due to IS to be identified.

16-21 366
Abstract

Objective: To explore the prevalence of hostility (Hs) and its relation to awareness of health, family and job stress, and other psychosocial factors in a Novosibirsk female population aged 25–64 years.

Patients and methods. A random representative sample of 870 women aged 25–64 years from one of the Novosibirsk districts was surveyed within the third screening of the WHO «MONICA-psychosocial» (MOPSY) program in 1994. The response rate was 72.5%. Hs was studied using the MOPSY test (the subscale «Hostility»). Awareness and attitude towards health and preventive measures were assessed using the awareness and attitude towards health test. Chi-square test (χ2) was used to assess the statistical significance of differences between the groups.

Results. The prevalence of high Hs was 43.9%. Women with high Hs rated negatively their health more frequently, complained of health complaints more often, and had poor awareness of preventive methods, much smoking, and inadequate physical activity. High Hs was associated with personal anxiety, major depression, high vital exhaustion, low social support, high family and job stresses.

Conclusion. The prevalence of obvious Hs in a female population aged 25–64 years is high and it is associated with poor self-rated health, insufficient health care, and a large number of negative psychosocial factors.

22-28 824
Abstract

Objective: to investigate the clinical features of depression within bipolar affective disorders types I and II (BADI and BADII).

Patients and methods. An examination was made in 100 depressive patients, including 25 with BADI, 37 with BADII, and 38 with recurrent depressive disorder (RDD) (a comparison group). The patients' status was evaluated in accordance with the ICD-10 and DSM-V affective disorder criteria, by using a specially developed questionnaire.

Results. BAD-related depression has features distinguishing it from RDD: sexual preference (men); an earlier age of disease onset; a shorter duration, but a higher frequency of exacerbations; a greater tendency for the continuum; a more marked decrease in social and family adaptation; development in people with predominantly hyperthymic premorbid; more frequently a family history of affective disorders, schizophrenia, and alcoholism; high comorbidity with metabolic diseases and psychoactive substance abuse; worse health more commonly in autumn and winter; a predominant anxious affect and an obviously decreasing interest in the structure of depression; a higher incidence of atypical sleep, appetite, and weight disorders; high suicidal activity; higher motor retardation (in BADI); relatively small involvement of somatic complaints in BAD I and frequent panic attacks in BADII.

Conclusion. Knowledge of the specific features of BAD-related depression will be able to make a more accurate differential diagnosis and to perform more effective treatment in these patients.

29-34 928
Abstract

Neck pain and migraine are common diseases. Neck pain seldom occurs in a patient with migraine. However, the relationship between migraine and neck pain has been inadequately investigated.

Objective: to analyze neck pain in patients with migraine to determine possible comorbidity mechanisms of these diseases.

Patients and methods. The investigation enrolled 63 patients with chronic migraine (CM) and 40 with episodic migraine (EM) diagnosed in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-3). Winking reflex (WR) and nociceptive flexion reflex (NFR) were examined to evaluate the function of antinociceptive systems.

Results. In the patients with CM, neck pain was more common than in those with EM (53.03% versus 14.02%); and panful tenderness, sensitivity, and tension of neck muscles were more marked. There was also a significant reduction in WR and NFR thresholds. Neck pain was noted to be an integral component of the pathogenesis of CM in a large number of patients with this condition. The authors proposed several pathophysiological mechanisms of a relationship between migraine and neck pain. Neck muscles and craniovertebral junction areas serve as a source for the arrival of nociceptive pain pulses in the central nervous system (peripheral sensitization), promoting pain chronization. Muscle dysfunction in this area may be, in turn, a reflection of central sensitization and impaired descending pain control.

35-38 291
Abstract

Objective: to determine the impact of SNAP-25 gene polymorphisms on the cognitive potential of patients with ischemic stroke (IS) and hemorrhagic stroke (HS).

Patients and methods. A total of 188 patients who had experienced IS (n=116) or HS (n=72) were examined. The SNAP-25 gene polymorphisms rs 363039 and rs 363050 were studied. Cognitive functions were evaluated from the results of the shortened Raven test.

Results. The genotypic distribution of the polymorphisms in question did not differ from the standard one in patients with the sequels of both IS and HS. In the patients who had experienced IS, the A alleles of the SNAP-25 polymorphism rs 363039 were found to have a positive impact on the efficiency of the Raven test. The average test scores were 83 and 67.5 in AA and GG genotype carriers, respectively (p<0.01). There was no impact of the genotypes on test scores in the patients who had experienced HS.

Conclusion. The polymorphism rs 363039 in the SNAP-25 gene may be used as a marker for predicting the cognitive resource in patients with IS sequels.

39-42 388
Abstract

Infantile cerebral palsy (ICP) occupies a leading position in its prevalence among childhood disabling neurological diseases.

Objective: to investigate the structure of spastic muscles in patients with ICP using ultrasonography (USG).

Patients and methods. A total of 196 patients with ICP (spastic diplegia) who received a cycle of sanatorium-and-spa treatment underwent clinical, neurological, electromyographic examinations and lower limb muscle USG.

Results. It was established that USG could reliably estimate the degree of structural changes in lower limb muscles. An average correlation was found between the level of development, by using the Gross Motor Function Classification System for Cerebral Palsy (GMFCS), and age at contracture formation (R=0.60; p=0.001). Analysis of USG and electromyographic findings in patients with ICP revealed a strong negative correlation with the amplitude and rates (R=-0.81; p=0.002; R=-0.77; p=0.001, respectively) and weak reciprocity-adequacy correlations (R=0.21; p=0.071; R=0.24; p=0.043, respectively).

Conclusion. Based on the findings, the authors formed rehabilitation approaches for motor disorders in children with ICP in relation to the magnitude of structural changes in the muscular system.

43-48 269
Abstract

Objective: to study relationships between the specific features of the social network of patients with vertebro-spinal cord injury sequels (VSIS), subjectively perceived and actual social support, and social skills assessment by the patients.

Patients and methods. In 2014–2015, a psychodiagnostic study was conducted in 41 VSIS patients (32 men and 9 women), including 18- to 20-year-olds (n=5), 21- to 30-year-olds (n=18), 31- to 40-year-olds (n=9), 41- to 50-year-olds (n=4), and patients over 50 years of age (n=5). Paraplegia (paraparesis) and tetraplegia (tetraparesis) were present in 30 and 11 patients, respectively. The duration of VSIS was 1 to 125 months. Correlations between different types of subjectively perceived and actual social support and the parameters of a social network of the patients were assessed.

Results. Correlation analysis has showed that there is a need for psychotherapeutic interventions related to social network extension for patients so that the latter should have sufficient and persistent interpersonal support.

49-55 705
Abstract

The clinical picture of dysmorphophobia (DMP) (dysmorphia, DM) has been inadequately investigated; its descriptions are contradictory.

Objective: to study the clinical structure of DMP (DM) on a sample of plastic or cosmetic surgery patients.

Patients and methods. An examination was made in of 103 patients, including 81 (78.6%) women (mean age, 35.8±4.9 years) and 22 (21.4%) men (mean age, 30.9±5.7 years), who had gone to a clinic of cosmetic or plastic surgery with complaints of objectively unverified appearance defects and DM signs and given consent to take part in the investigation. All the patients underwent clinical and psychopathological examination; in so doing the follow-up data in the past 1-3 tears were borne in mind. Their somatic condition was analyzed on the basis of the data available in the medical documents and the results of laboratory, clinical, and instrumental studies.

Results. The dysmorphic syndrome has been found to have overvalued, hypochondriacal, obsessive-compulsive, depressive, and delusional forms. It has been established that DM can manifest within schizophrenia, personality disorders, affective disorders, and organic mental diseases. Differential diagnostic criteria for different types of DM in heterogeneous psychopathological disorders are given.

CLINICAL OBSERVATIONS

56-60 474
Abstract

Vertigo is one of the most common reasons for visits to physicians of different specialties. Thorough collection of history data and neurovestibular examination by a set of simple clinical tests are of great importance for the diagnosis of diseases of the vestibular system. The paper gives an update on the principles of diagnosis of different forms of vertigo, diagnostic errors, and treatment of major diseases manifesting by vertigo. The authors present their own data concerning the diagnosis and treatment of the most common vestibular disorders, such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuronitis, and postural phobic instability. They also describe a clinical case of a female patient with vestibular neuronitis, in whom a specialized examination (neurovestibular examination, videonystagmography, and caloric testing) could identify right labyrinthine hypofunction that could not be detected prior to the examination in the clinic.

REVIEWS

61-70 351
Abstract

Hemorrhagic stroke (HS) is associated with high mortality and disability rates. Due to the introduction of the current guidelines for the prevention of systemic thromboembolic events in patients with atrial fibrillations and to an increase in the number of older patients, there has been a rise in the incidence of intracranial hemorrhage (ICH) associated with the use of oral anticoagulants. The paper discusses medical treatment in patients with HS during therapy with vitamin K antagonists (warfarin) and novel oral anticoagulants (dabigatran. rivaroxaban, apixaban), as well as an anticoagulant resumption policy after prior ICH in patients at high risk for thromboembolic events.

71-81 914
Abstract

The paper discusses whether antidepressant treatment is rational in schizophrenics. It analyzes the results from trials evaluating the efficiency of the therapy in patients with depressive, negative, or obsessive-phobic symptoms. The validity of results of these trials is assessed. The results of demonstrative trials of the efficiency of therapy with different representatives of antidepressants (selective serotonin reuptake inhibitors) in the above patient groups are given separately and compared with the data obtained in observational studies. Emphasis is placed on the criticism of shortages of procedures and results of demonstrative trials conducted in foreign countries. Prospects for further trials evaluating the efficiency of antidepressant therapy for schizophrenia are depicted.

82-85 892
Abstract

Multiple sclerosis (MS)-related fatigue is encountered in 75–92% of patients and it is one of the key symptoms that affect quality of life. Physicians and patients' relatives frequently underestimate MS-related fatigue; the latter may occur at any disease stage, its degree is inadequate to physical exercise and reduces after a short-term daytime rest. Fatigue due to MS is not directly related to the degree of paresis; however, it is more common in patients with pyramidal insufficiency. Overfatigue may be the first symptom of an MS exacerbation. The genesis of fatigue in MS is not known with certainty. The development of this symptom is associated with impairments in neuroimmune responses and biochemical processes and with the administration of some drugs. Special tests and scales are used to objectify the degree of fatigue. The most commonly used questionnaires are the Fatigue Severity Scores to rate physical and mental fatigue, as well as the Modified Fatigue Impact Scale in patients having MS. When a patient with MS complains about fatigue, it is necessary to rule out its other possible causes and to specify its relation to MS and the necessity of fatigue correction. Аmantadine is one of the drugs used for the symptomatic therapy of MS. This paper presents the data of randomized clinical trials evaluating the efficacy and safety of this drug for the symptomatic treatment of MS. Correction of MS-related fatigue requires a multidisciplinary approach that involves a combination of drug therapy, therapeutic exercises, active lifestyle, and relatives' understanding.

86-89 426
Abstract

The paper considers the synergy between the nootropic drug piracetam and the metabolic agent thiotriazoline that maintains energy metabolism and survival of neurons and other types of cells. Piracetam, a nootropic drug, a chemical pyrrolidone derivative, is used in neurological, psychiatric, and narcological practice. There is evidence on the positive effect of piracetam in elderly and senile patients with coronary heart disease. This drug is supposed to stimulate redox processes, to enhance glucose utilization, and to improve regional blood flow in the ischemic brain regions. Due to its action, the drug activates glycolytic processes and elevates ATP concentrations in brain tissue. Thiotriazoline is a compound that has antioxidant, anti-ischemic properties. The co-administration of piracetam and thiothriazoline is an innovation area in the treatment of stroke and other brain damages, especially in insulin resistance and high blood glucose levels. The paper considers the neurobiological properties of thiotriazoline and piracetam, which synergistically exert neuroprotective and neurotrophic effects.

90-95 299
Abstract

The paper gives the data available in the literature on the role of a level of elevated lipoprotein (a) (Lp (a)) in the development of ischemic stroke and other cardiovascular diseases. It shows the normal level of Lp (a) and the typical distribution of its concentration for people of European origin and representatives of other races. There is evidence on the genetic determination and variability of the Apo (a) gene. The paper presents the results of the recent large survey of 8000 patients with coronary heart disease and 8000 control persons, which has studied candidate genes for cardiovascular diseases. It indicates the role of Lp (a) as a risk factor for early atherosclerosis and describes main pathomorphological mechanisms. The propositions that it is necessary to screen Lp (a) in different risk groups, its target level, and possible methods for correcting the elevated Lp (a) level are given.



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