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Neurology, Neuropsychiatry, Psychosomatics

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Vol 8, No 3 (2016)
View or download the full issue PDF (Russian)
https://doi.org/10.14412/2074-2711-2016-3

LECTURES

4-9 409
Abstract

Chronic cerebrovascular disease (CCVD) is one of the most common  iagnoses in Russian neurology, by which is meant vascular cognitive impairment (VCI) in modern foreign literature. There are data available in the literature on the diagnosis and treatment of CCVD (VCI). Theresults of the author’s studies show that CCVD often masks other diseases (anxiety and depressive disorders, primary headache, peripheral vestibulopathy, and Alzheimer's disease) that are unfortunately poorly diagnosed in our country, so patients do not receive effective treatment. To modify risk factors for stroke (smoking and alcohol cessation, sufficient exercise), to normalize blood pressure (the use of antihypertensivemedications), to reduce blood cholesterol levels (statins), to perform antithrombotic therapy (antiplatelet agents and anticoagulants), and to use cognitive enhancers are of key importance when treating patients with CCVD (VCI). There are data on the use of pentoxifylline in patients with CCVD, vascular dementia.

ORIGINAL INVESTIGATIONS

10-16 185
Abstract

Objective: to study the prevalence of vital exhaustion (VI) and sleep disorders, the pattern of the latter in 45–69-year-old Novosibirsk dwellers (Siberia) with different levels of VI.

Patients and methods. A random representative sample of 45–69-year-old women (n=2401) from two Novosibirsk districts were examined within the 2003–2005 HAPIEE (Health, Alcohol and Psychosocial Factors In Eastern Europe) prospective cohort study. Another random representative sample of 45–69 men (n=1770) from two Novosibirsk districts were examined within a subsequent screening study. The entire sample consisted of 4171 residents: men and women were 42.4% and 57.6%, respectively. The mean age of the men was 56.5±7.01 and that of the women was 56.3±7.07. The response rate was as high as 61%. Testing was carried out using the short 14-item version of the Maastricht Questionnaire (MQ) to evaluate VE and the 4-item Jenkins Sleep Questionnaire (JSQ) to investigate sleep quality and duration.

Results. The leading determinants of VE were the incidence of fatigue, interrupted sleep, lethargy, the degree of irritability, and a feeling of exhaustion and tiredness. The population examined was found to have a high prevalence of VE and sleep disorders. There was a close correlation between high VE and impaired sleep quality and duration.

Conclusion. The high rate of impaired sleep quality and duration in the Novosibirsk population, which is sometimes twice greater than that in other populations, is associated with the high prevalence of depression, anxiety, VE, and hostility among the population. This is due to the high prevalence of cardiovascular diseases. A sleep disorder may cause VE. It is important to promptly establish a psychotherapeutic diagnosis of these conditions, followed by their subsequent correction.

17-25 197
Abstract

Objective: to determine the behavioral manifestations and electroencephalographic correlates of modality-nonspecific attention using a clinical model of severe brain injury (SBI).

Patients and methods. 35 patients with SBI in the dynamics of post-coma recovery of mental activity (a study group) and 23 healthy subjects (a control group) were examined. The behavioral manifestations of NSA from coma to clear consciousness were analyzed in the patients. Changes in the pattern of EEG and in the indices of its coherence in the presence and activation of different forms of attention (an orienting response to the sound and eye opening; involuntary and voluntary visual forms), by applying specially developed computerized techniques, were investigated. The features of associated with attention changes in interhemispheric EEG coherence (IHC) with the data of 3T diffusion tensor tractography of the corpus callosum (CC) were compared.

Results. Attention disorders were shown to be essential and an «axial disorder» in patients with SBI. There were statistically confirmed qualitative and quantitative differences attention-associated changes in the EEG pattern and IHC in reversible and chronic unconsciousness. The important favorable prognostic sign proved to be reactive changes in interhemispheric EEG relations, including frontal ones characterized by the absence of clear external manifestations of consciousness in the very earliest stages. There was a significant correlation between the preservation of CC tracts (primarily, the rostrum, anterior portion, and splenium) and attention-related reactivity of IHC, which reflects the specific, though nonrigid, structural determinacy of the latter.

26-30 227
Abstract

The focal form of mixed tick-borne encephalitis-Borrelia infection (MTBEBI) is characterized by a nervous system lesion with the development of permanent neurological disorders and a possible fatal outcome. Uniform approaches to treating MTBEBI have not been currently elaborated. Obviously, adequate treatment of the mixed infection requires a comprehensive approach and simultaneous action on tick-borne encephalitis and tick-borne borreliosis. Its promising treatment is immunocorrection with normal human immunoglobulin that contains a wide spectrum of antibodies and exerts an immunomodulatory effect.

Objective: to evaluate the efficiency of combination (etiotropic and pathogenetic) therapy with normal human immunoglobulin for the focal form of MTBEBI.

Patients and methods. The results of the treatment were analyzed in 57 patients with MTBEBI with a nervous system lesion, who had been notified in the Kemerovo Region in 2000 to 2014.

Results and discussion. It was shown that the use of normal human immunoglobulin in a treatment regimen for the focal form of MTBEBI could considerably reduce the incidence of residual neurological deficit. The administration of normal human immunoglobulin was assumed to improve the efficiency of treatment for the focal form of MTBEBI. The paper also describes a clinical case of a patient with MTBEBI, which demonstrates the efficiency of combination therapy for this disease.

31-33 287
Abstract

Objective: to study the clinical and epidemiological features of multiple sclerosis (MS) in the Bryansk Region.

Patients and methods. Information about 180 (31.0%) of 590 MS patients registered in the Bryansk Region with a valid diagnosis of MS according to the 2005 McDonald criteria was analyzed. All the patients are followed up at the Demyelinating Disease Office, Neurology Department, Bryansk Regional Hospital One. The Expanded Disability Status Scale (EDSS) was used to evaluate the severity of the disease and the degree of disability. The rate of MS progression was calculated from the ratio of EDSS scores at the time of examination to disease duration.

Results. The Bryansk Region is shown to belong to a moderate MS risk area: the prevalence of the disease is 48.1 cases per 100,000; its incidence in the individual districts of the region is 5.0 to 211.4 cases per 100,000. There has been an approximately 1.2-fold increase in the prevalence of MS in the past 7 years. The mean age of MS patients in the Bryansk Region is 39.9±10.1 years; about 70% of the patients are in the age range of 29–49 years. The mean age at the onset of MS is 28.0±9.1 years. Early-onset MS before the age of 18 years is recorded in 20 (11.1%) patients; late-onset MS (after the age of 45 years) is in 7 (3.9%). There is a preponderance of its multifocal onset. Sensitive and motor disorders and optic neuritis more frequently occur as the first symptom at monofocal onset. The duration of MS averages 11.0±5.5 years (1 to 32 years). The mean duration of the first remission is as long as 33.1±26.1 (0–144) months and that of the second one is 19.2±17.7 (0–132) months. The mean EDSS score was 3.3±2.4 (0–9.0). The rate of MS progression in the region averages 0.38±0.28 per year. About 60% of the patients have Groups I, II, and III disability. Remitting MS is more common (69.4% of cases), its secondary and primary progressive course is noted in 28.9% and in nearly 2% of the patients, respectively.

Conclusion. The findings may be useful in planning sociomedical care for patients with MS in some areas of the Bryansk Region.

34-38 330
Abstract

Electroencephalogram (EEG) is an important tool to study brain function. EEG can evaluate the current functional state of the brain with high temporal resolution and identify metabolic and ion disorders that cannot be detected by magnetic resonance imaging.

Objective: to analyze the relationship between some neurophysiological and biochemical parameters with a Neuro-KM hardware-software complex for the topographic mapping of brain electrical activity.

Patients and methods. 75 patients with depression, 101 with anxiety disorders (AD), and 86 control individuals were examined. EEG spectrum and coherence changes were estimated in the depression and AD groups versus the control group. Correlation analysis of EEG indices and blood serotonin concentrations was carried out.

Results and discussion. The patients with depression and those with AD as compared to the controls were observed to have similar EEG spectral changes in the beta band. Coherence analysis in the beta-band showed that both disease groups versus the control group had oppositely directed changes: a reduction in intra- and interhemispheric coherence for depression and its increase for AD (p < 0.001). That in the theta and alpha bands revealed that both disease groups had unidirectional interhemispheric coherence changes: a decrease in integration in the alpha band and its increase in the theta and delta bands in the depression and AD groups (p < 0.05) and multidirectional changes in intrahemispheric coherence: its reduction in the depression group and an increase in the AD group (p < 0.05). Correlation analysis of EEG parameters and platelet serotonin concentrations showed opposite correlations of serotonin concentrations and EEG percentage power in the theta and beta bands. When there were higher serotonin concentrations in the patients with depression, EEG demonstrated a preponderance of a synchronization pattern; when these were in the patients with AD, there was a predominance of a desynchronization pattern.

Conclusion. The specific features of EEG in the depression and AD groups may indicate serotonin metabolic disorders and the efficiency of therapy with selective serotonin reuptake inhibitors.

39-42 147
Abstract

Cardiovascular autonomic symptoms significantly impart quality of life in patients with multiple sclerosis (MR) and, in some cases, pose a threat to their life.

Objective: to study cardiovascular autonomic dysfunction by cardiointervalography in MS patients.

Patients and methods. Cardiovascular tests (CVT) were carried out in 47 patients with MS (a study group) and in 22 healthy individuals (a control group).

Results. Comparative analysis revealed a significant reduction in the values of basic CVTs (Cresp, C30:15, and CVals) in MS patients (p<0.05). The isometric contraction test showed a statistically significant decrease in diastolic blood pressure; a severe lesion of the segmental area of the autonomic nervous system was detected in 45% of cases.

Conclusion. A significant decrease in vagal and sympathetic activities was recorded in patients with MS.

43-47 161
Abstract

Objective: to identify the indicators of bioelectrical activity of the cerebral cortex, which are associated with cognitive impairments in patients with coronary artery disease (CAD).

Patients and methods. The study included 122 male patients aged 45 to 69 years with CAD. Sixty of them were found to have mild cognitive impairments (MCI), their average Mini-Mental State Examination (MMSE) score was 26.2±0.90; the other 62 patients had no cognitive impairment; their MMSE score was 28.5±0.86. All the patients underwent clinical and instrumental examinations and computer-based multichannel electroencephalography (EEG). Eyes-closed and eyes-open resting EEG monopolarly recorded in 62 standard leads of the 10-20 system. A binary logistic regression analysis was used to identify EEG predictors of MCI in patients with CAD.

Results. The high power values of theta1-rhythm biopotentials with closed eyes in the frontal and occipital areas of the left hemisphere and those of alpha2-rhythm ones with open eyes in the frontal areas of the right hemisphere, and the high theta/alpha EEG power ratio are associated with an increased risk of MCI in CAD patients. The most important clinical and anamnestic factors associated with a decreased risk of MCI were higher education level, the lack of type 2 diabetes, and milder coronary bed lesions according to the SYNTAX scale. There was an association of the power values of the biopotentials and theta/alpha EEG power ratio and the development of MCI in CAD patients.

48-52 337
Abstract

Objective: to evaluate cognitive functions in patients with type 2 diabetes mellitus (DM2) and hypertension and the efficacy of Ginkgo biloba extract Egb 761®.

Patients and methods. 120 patients with DM2 and 50 hypertensive patients with no complications or a history of stroke and/or myocardial infarction, without active complaints of hypomnesia and other cognitive functions were examined. The exclusion criteria were prior stroke and/or myocardial infarction; clinically significant diseases of the peripheral arteries and major arteries of the head; DM2 decompensation; glomerular filtration rate <60 ml/min; proliferative retinopathy; and other endocrine diseases. The investigators used the following methods for the evaluation of cognitive functions: the Mini-Mental State Examination, the Montreal Cognitive Assessment, and the hand- eye coordination test (Parts A and B).

Results and discussion. 85% of the patients with DM2 were found to have cognitive impairments (CI): disorders of attention, short-term memory, and thinking speed. Out of them, 82.5% had moderate CI and 2.5% had dementia. 30% of the hypertensive patients were diagnosed as having moderate CIs and 10% had dementia. At the same time, the degree of CI was higher in the patients with MD2 than in those with hypertension. The use of Egb 761® 240 mg/day for 3 months had a statistically significant positive impact on cognitive functions (improvements in short-term memory, concentration, and thinking speed) and everyday activity.

Conclusion. The authors consider that CIs are the first sign of encephalopathy in DM2. It is also noted that DM2 has a more pronounced impact on cognitive functions than hypertension. Egb 761® can be used as an effective drug to treat CI in these diseases.

53-60 270
Abstract

Ethylmethylhydroxypyridine succinate (EMHPS) is used in the therapy of ischemic stroke. A more complete understanding of the conditions that can affect the clinical efficacy of EMHPS needs the most complete information about its molecular mechanisms of action.

Objective: to comparatively analyze the properties of EMHPS using the newest area of postgenomic pharmacology – chemoreactome simulation. Succinic acid and citicoline were used as the molecules of comparison (control molecules).

Material and methods. Chemoreactome analysis was employed to assess the biological activity of a test molecule (simulation of the affinity profile of the examined molecular structure for various proteome proteins). A new mathematical method based on the combinatorial theory of solvability was devised for chemoinformational analysis.

Results and discussion. Chemoreactome simulation has shown that EMHPS may be an agonist of acetylcholine and GABA receptors, as well as that of cannabinoid receptor type 2. The anti-inflammatory effect of an EMHPS molecule may be due to the inhibition of synthesis of proinflammatory prostaglandins. Its higher safety (a weaker effect on serotonin and opioid receptors and lower interaction with Erg channels and the enzymes monoamine oxidase and cytochrome CYP1A1) distinguish EMHPS from the molecules of comparison (citicolne and succinic acid). The predicted properties of the molecule of EMHPS make a substantial contribution to its neuroprotective effect.

Conclusion. The results of chemoreactome analysis could reveal not only quite unexpected mechanisms of action of EMHPS, but also its mechanisms of synergic action with pyridoxine and magnesium. Owing to a combination of EMHPS with pyridoxine and magnesium, there is an increase in the antioxidant, anticonvulsant, stress- and neuroprotective, nootropic, and anxiolytic effects of EMHPS via activation of pyridoxine-dependent and magnesium-dependent proteins. The combination of EMHPS with pyridoxine and magnesium also contributes to the potentiation of hemodynamic, antiplatelet, antiaggregant, and anticoagulant actions, activates homocysteine neutralization and anti-inflammatory protection, and decreases the risk of proarrhythmic effects.

CLINICAL OBSERVATIONS

61-65 204
Abstract

The paper describes an atypical case of amyotrophic lateral sclerosis (ALS) concurrent with extension of the central canal – hydromyelia.Diagnostic difficulty is due to the presence of symptoms which are atypical for ALS, such as early age of onset, slow progression with long-term involvement of one leg, as well as extension of the central canal of the spinal cord at the level of TIII-IX bodies, as evidenced by magnetic resonance imaging (MRI). The paper presents a clinical case, a review of current literature on the clinical and MRI signs of ALS and on the differential diagnosis of motor neuron disease.

66-70 216
Abstract

The paper presents a brief review of an update of the etiology and pathogenesis of Niemann–Pick disease type C (NPC), a rare neurovisceral lysosomal storage disease. It highlights the main clinical manifestations and classification of the disease. There is information about developed pathogenic miglustat substrate reduction therapy for NPC. The authors describe their clinical case of adult-onset NPC in a 32-year-old female patient. The clinical syndrome and the results of laboratory and instrumental studies that could establish an accurate diagnosis and determine indications for pathogenetic therapy are given in detail.

71-75 201
Abstract

The differential diagnosis of transverse myelitis (TM) is a challenging clinical problem due to a wide range of diseases, the pattern of which may include TM. Comorbidity is also a highly relevant problem in the development of inflammatory myelopathies. The described clinical case demonstrates difficulties in the nosological diagnosis in case of monophasic TM concurrent with its several probable causes. An examination of a female patient with longitudinally extensive TM and a history of two cerebral ischemic strokes also revealed the reduced levels of vitamin B12 in serum and oligoclonal IgG in cerebrospinal fluid. A CNS lesion is regarded as a possible interaction of two typical pathological processes: inflammation and thrombogenesis. In this case vitamin B12 deficiency could predispose to the initiation and maintenance of the above mechanisms. The specific features of formulation of a diagnosis in patients with such multifactorial conditions are considered.

REVIEWS

76-81 187
Abstract

Medication-induced headache (MIH) is a variety of chronic daily headache (HA). MIH belongs to secondary (symptomatic) HA, develops as a complication of pre-existing primary cephalgia, and is caused by the overuse of drugs to relieve HA. The role of drug dependence syndrome and behavioral and emotional disorders in the development of MIH, which may be associated with dysfunction of certain brain systems that control these functions, has been recently discussed. The paper reviews the literature dealing with studies of the role of behavioral and emotional disorders and orbitofrontal cortical dysfunction in the development of drug dependence syndrome in patients with MIH. The importance of analyzing these aspects of MIH is determined by the prospects for applying alternative approaches to managing these patients.

82-87 195
Abstract

The article discusses the factors that influence the efficacy and safety of generic drugs, including regular generics, biosimilars, and generic nonbiological complex drugs. It emphasizes the importance of adequate regulatory requirements to provide a comparable therapeutic efficacy and a comparable cost-effectiveness ratio for generics versus brand-name drugs.

88-94 361
Abstract

The paper deals with the role of a discogenic factor in the development of lumbar pain. It gives the updated CTF classification (2014) that describes disc pathological changes and the MSU classification of disc herniation. The pathogenesis and clinical manifestations of two most common manifestations of lumbar discogenic abnormalities (axial discogenic pain and disc radicle conflict), and additional methods for their diagnosis and differential (medical and surgical) treatment are discussed. Emphasis is laid on the role of inflammation in the development and maintenance of discogenic pain and in the regression of disc herniation. The paper provides the materials of the first evidence-based guideline developed by the Expert Group of the North American Spine Society (NASS) (2012) for the diagnosis and treatment of disc herniation with symptoms of radiculopathy.

95-100 406
Abstract

Increased life expectancy and related demographic changes, as well as lifestyle modification in the population enhance a steady rise in the incidence of disorders in middle and later life. It increases the burden of diseases and overloads healthcare systems. Therefore prevention strategies are currently on the cutting edge and becoming more and more essential. The article discusses approaches to preventing the most common mental and neurological disorders in middle and old age. It also describes cerebrovascular disease, dementia, cognitive impairment, and stroke and outlines some state-of-the-art prevention strategies.

101-105 1148
Abstract

Postoperative cognitive dysfunction (POCD) is a cognitive impairment syndrome of multifactorial etiology after general anesthesia and surgery. The urgency of the problem associated with the prevention and correction of POCD is due to its high frequency particularly in elderly patients and to the long-term sequels that impair quality of life. To date, the possibilities of preventing POC remain controversial; there is no generally accepted effective strategy for reducing its incidence. A number of proposed techniques aimed at reducing the risk of cognitive impairments lead, among other things, to improvements in surgical and anesthetic techniques with transition to minimally invasive interventions and to the use of short-acting general anesthetics. However, by taking into account the multifactorial genesis of POCD and the involvement of mechanisms, such as neuroinflammation and apoptosis, in its development, the additional use of neuroprotective agents seems justified. Further investigations are needed to develop effective therapeutic strategies for treating POCD. This review gives the data currently available in the literature on the clinical phenomenology, pathogenesis, treatment, and pharmacological prevention of POCD.

106-112 179
Abstract

The paper presents a systematic analysis of experimental and clinical studies of etifoxine. The anxiolytic effect of etifoxine is due, firstly, to the modulation of GABA receptor activity and, secondly, to that of metabolism of neurosteroids that are themselves characterized by anxiolytic and neuroprotective properties. The results of clinical trials of etifoxine are also analyzed. In addition to its anxiolytic effect that partially persists even after treatment discontinuation, etifoxine is ascertained to be characterized by analgesic, neurotrophic and neuroprotective properties.



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