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Neurology, Neuropsychiatry, Psychosomatics

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Vol 9, No 1 (2017)
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https://doi.org/10.14412/2074-2711-2017-1

LECTURES

4-10 731
Abstract

Periarthritis of the shoulder joint is the most common cause of humeroscapular pain. The term “scapulohumeral periarthritis” encompasses injuries of both the muscles and the joint capsule proper. It is more justified to differentiate periarticular lesions from rotator cuff pathology and injury of the capsule proper (frozen shoulder) in daily clinical practice. The diagnosis is generally based on clinical data. Medical therapy is effective in the vast majority of cases; surgery is performed as specially indicated. The best results are yielded by combination treatment for scapulohumeral periarthrosis, which encompasses pharmacotherapy (nonsteroidal anti-inflammatory drugs, periarticular injection of glucocorticoids and local anesthetics) and non-pharmacological therapies (manual therapy with high-amplitude joint mobilization, post-isometric relaxation, and active exercises).

ORIGINAL INVESTIGATIONS

11-19 416
Abstract

Selective serotonergic antidepressants with a miltimodal mechanism of action are a new group of antidepressants, which includes trazodone and vortioxetine. Data on the efficacy of trazodone and vortioxetine in treating endogenous depression (major depressive disorder) appear to be rather uncertain now. There have been no direct comparative trials of the efficiency of therapy with trazodone and vortioxetine.

Objective: to compare the efficiency of therapy with trazodone and vortioxetine in treating patients with endogenous depression on the basis of statistical generalization of the results of studies of the efficacy of each antidepressant alone.

Material and methods. On the basis of the selection criteria, 7 double-blind, randomized, placebo-controlled trials of the efficiency of therapy with trazodone or vortioxetine in patients with endogenous depression were chosen from the PubMed database. The trials were divided into 2 groups according to the comparability of original samples of patients, methods for evaluating their state, and duration of follow-up. The efficiency of therapy with trazodone and that of vortioxetine were compared by determining the statistical significance of differences in the ratio of responders/nonresponders or remitters/nonremitters in Groups 1 and 2 separately.

Results. 1) Comparison of the values of 8-week therapy efficiency in Group 1: a) therapy with trazodone at an average dose of about 300 mg/day significantly more frequently results in the alleviation of depressive symptoms to the level of classifying patients into the category of responders than that with vortioxetine at an average dose of about 9 mg/day; b) therapy with trazodone at an average dose of about 300 mg/day significantly more often relieves depressive symptoms to the level of classifying patients into a category of remitters than that with vortioxetine at average dose of about 9 mg/day; c) therapy with trazodone at an average dose of about 300 mg/day and that with vortioxetine at an average dose of about 18.5 mg/day lead to the comparable reduction of depressive symptoms to the level of referring patients to a category of responders or remitters. 2) Comparison of the values of of 6-week treatment efficacy in Group 2: therapy with trazodone at an average dose of about 300 mg/day is statistically significantly less frequently accompanied by the attenuation of depressive symptoms to the level of assigning patients to a category of responders than that with vortioxetine at average dose of about 7.5 mg/day. The validity of the results of comparing the efficiency of therapy in Group 2 is constrained by incomplete comparability of the clinical and demographic characteristics of initial patient samples.

Conclusion. The findings suggest the higher efficacy of trazodone 300 mg/day versus vortioxetine 5–10 mg/day and the comparable efficacy of trazodone 300 mg/day and vortioxetine 15–20 mg/day in treating patients with endogenous depression.

20-26 138
Abstract

The rehabilitation potential in ischemic stroke depends both on the localization and size of cerebral infarction and on many other factors ensuring the restoration of neuron function in the ischemic penumbra. Sleep-disordered breathing (SDB) appears as intermittent episodes of apnea and hypopnea, which are accompanied by hypoxemia and tissue hypoxia, and may slow early functional recovery in patients.

Objective: to evaluate the impact of SDB on early neurological recovery in patients with ischemic stroke and to identify predictors of unfavorable functional outcome.

Patients and methods. A total of 56 patients (24 men, 32 women; mean age 62±15 years) with ischemic stroke were examined. All the patients underwent brain magnetic resonance imaging. Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) on admission and at 3 weeks. To identify SDB, cardiorespiratory monitoring was performed on 2–5 days after the onset of the disease. The total number of episodes of SDB, apnea, hypopnea, apnea-hypopnea index (AHI), hypoxemia index, and the total time with arterial oxygen saturation < 90% (desaturation time < 90%) were recorded.

 

Results and discussion. At baseline, the median NIHSS score was 6 (range 4–10) and the median mRS score was 3 (range 2–5). After 3 weeks, the median NIHSS score was 3 (range 1.5–5) and the median mRS score was 1 (range 0–3). According to the degree of achieved functional independence, the patients were divided into 2 groups: 1) 40 functionally independent patients (a mRS score of ≤2; 2) 16 patients in need of assistance/care (a mRS score of ≥3). The groups were matched for age, sex, localization of cerebral infarction, degree of cerebral atherosclerosis, and incidence of cardiac pathology. At the same time, at baseline Group 2 had a more severity of neurological deficit (p=0.001) and respiratory disorders (p<0.04) and more frequently large and medium-sized foci (p=0.01). Discriminant analysis with a model including the characteristics of patients who had a difference in the two groups was carried out to confirm the role of the factors considered as predictors for poor functional prognosis and to identify their specific contribution to outcome. The investigation showed the predictive value of the studied model as a whole with relation to early functional recovery in the patients. As this took place, the number of apnea episodes demonstrated the proper importance as a predictor of poor prognosis.

Conclusion. It is established that the number of nocturnal apnea episodes >123 is associated with the worst functional recovery. The results of the comparative analysis can be taken as the threshold value associated with unfavorable functional recovery in the early stages (AHI≥25/hr-1). It is precisely these patients that can be considered as candidates for early CPAP therapy (Continuous Positive Airway Pressure) in order to improve early functional recovery.

27-33 235
Abstract

Objective: to analyze the characteristics of the functional neuroanatomy of movements in severe traumatic brain injury (STBI) patients with varying severity of motor defect versus that in healthy individuals for the study of brain neuroplasticity as a basis of compensation.

Patients and methods. Functional magnetic resonance imaging (fMRI, 3T) was used to analyze cerebral hemodynamic changes in 28 patients with STBI during an active right-hand finger tapping task. A control group consisted of 17 healthy individuals. The percentage of representation of individual brain structures involved in movements and volume activation (Vox) was determined in fMRI responses.

Results. The patient group showed a tendency for an increased fMRI response diffusion with the emergence of activation zones (the left frontal and parietal regions, as well as the occiptal and temporal regions of the cerebral hemispheres) that are atypical for healthy individuals during motor exercises. This trend is more evident in patients with right-sided hemiparesis.

Conclusion. The results of the study clarify the existing ideas about the neurophysiological mechanisms of motor impairment and compensation in traumatic brain injury, which is important for the development and improvement of neurorehabilitation techniques. There is evidence for the hypothesis that the extrapyramidal system may be actively involved in the compensation for post-traumatic musculoskeletal defect, which was earlier proposed by E.V. Sharova et al. (2014).

34-38 133
Abstract

Objective: to comparatively analyze the patterns of functional hemispheric specialization in patients with local brain tumor lesions and in healthy participants.

Patients and methods. 40 patients (20 men and 20 women) with local unilateral brain tumor lesions (astrocytomas, gliomas, metastases) aged 19–60 years (mean age, 33±9.2 years) were examined for functional hemispheric specialization for verbal and visual perceptual functions when performing cognitive tasks by functional transcranial Doppler ultrasonography. The findings were compared with those in 57 healthy individuals (mean age, 28±5.1 years). All the participants were right-handed.

Results. There was a more pronounced increase in blood flow velocity (BFV) while performing verbal cognitive tasks in the vessels of the left hemisphere (LH) and a more marked rise in that when fulfilling non-verbal cognitive tasks in the vessels of the right hemisphere (RH). The trends in the ratio of LH/RH BFV amplification when performing cognitive tasks were observed to be the same as previously observed in the healthy participants.

39-41 83
Abstract

Objective: to study the opinion of dwellers in the Republic of Tyva on the formation of a healthy lifestyle in order to prevent stroke.

Patients and methods. A survey was conducted among 302 patients (125 men and 177 women; mean age, 56.68±2.85 years) admitted to the Department of Neurology, Republican Hospital One, with a diagnosis of acute cerebrovascular accident, encephalopathy, consequences of acute cerebrovascular accident, or vegetative vascular dystonia.

Results. The survey showed that 17.55% of the patients found it difficult to answer the question of what constituted a healthy lifestyle. None of the respondents constantly went to sports sections constantly, 11.26% did rarely. 47.35% were smokers; 14.62% were alcohol abusers. 7.95% of the respondents were regularly engaged in physical exercises. Only 8.61% consumed vegetables and fruits every day. The majority of respondents ate not more than once every two months. Only 8.61% of the respondents walked a distance of more than 5 km every distance; 17.88% were engaged in daily physical activity.

Conclusion. To introduce the principles of a healthy lifestyle in the Republic of Tyva, it is necessary to implement targeted preventive measures.

42-49 242
Abstract

Objective: to evaluate the triple effect of ethylmethylhydroxypyridine succinate (EMHPS), organic magnesium salt (magnesium lactate), and vitamin B6 (pyridoxine).

Material and methods. A systematic analysis of the molecular mechanisms of the triple synergic action of EMHPS, magnesium, and vitamin B6 was carried out. For chemoinformational analysis, the investigators developed a new mathematical method based on the combinatorial theory of solvability, which allows one to obtain quantitative estimates of the affinity constants of proteome proteins.

Results. The pharmacological effects of the EMHPS molecule characterized by nootropic and antioxidant properties are shown to work in synergy with magnesium and vitamin B6. A systematic analysis of synergy interactions indicated 46 biological roles, in which the synergy of EMHPS, magnesium, and pyridoxine could be manifested. The main goals of this synergy are to protect neurons from damage, by combating excitotoxicity in the cells and to neutralize excess homocysteine (to reduce the risk of ischemic and thrombotic stroke, myocardial infarction, and coronary heart disease); to improve cognitive functions and neuromuscular transmission, to reduce anxiety, by activating acetylcholine, GABA, and dopamine receptors; to normalize lipid and glucose metabolism, by lowering hyperglycemia and improving the processing of fats.

50-54 130
Abstract

Objective: to conduct clinical laboratory studies of spinal muscular atrophy (SMA) for the clarification of the pathogenetic features and role of neurotrophic factors in the formation of polymorphism of this disease

Patients and methods. Thirty-five patients aged 9 months to 53 years (mean age, 14.5 years) with different inherited forms of SMA were examined. Clinical, genealogical, and laboratory tests were carried out. A control group consisted of 40 healthy individuals aged 7–45 years (mean age, 16.5 years). The levels of neurotrophins, such as brain-derived growth factor (BDGF), nerve growth factor (NGF), and ciliary neurotrophic factor (CNTF) in serum samples were determined by enzyme immunoassay.

Results. Changes in the expression of the neurotrophic factors were found in patients with SMA. The enzyme immunoassay data suggest that the serum concentrations of BDGF, NGF, and CNTF in patients with SMA were significantly higher than those in healthy controls. The group of SMA patients aged under 18 years showed a statistically significant (p<0.001) increase in NGF concentrations (3680±936 ng/ml) versus the control group of the same age (625±444 pg/ml).

Conclusion. In our opinion, the clinical polymorphism of SMA can be explained by the polymorphism of various pathogenic factors: genetic, morphofunctional, and biochemical ones. Overexpression of neurotrophins was first noticed to play a role in the development of more severe clinical types of SMA (proximal SMA), which may be related to both the ontogenetic features of children's age and disease duration. The study results can be further used to choose pathogenetic personalized therapy for SMA.

55-60 283
Abstract

Objective: to analyze the regional register of patients with multiple sclerosis (MS) in the Kursk Region in terms of gender- and age- related characteristics of patients, the degree of their disability and a range of prescribed disease-modifying drugs (DMDs) used to treat MS.

Patients and methods. Data on 877 patients included in the regional MS register in 2014–2016 were analyzed. The diagnosis of MS was substantiated by the McDonald criteria edited by C.H. Polman and evidenced by brain magnetic resonance imaging. A total of 793 (91.4%) patients, of whom 529 (66.7%) received DMDs for MS, were actively followed up.

Results and discussion. The Kursk Region was established to be a high-risk area for MS; territories with its maximum and minimum prevalence were determined. MS cases were 2.5 times more common among women. The risk factors for MS in the region were as follows: female gender (except for the age of 26–30 years) and urban residence; the role of genetic characteristics and exposure to pesticides and industrial allergens was also possible. The relationship of the symptomatic onset of MS to age in males and females has its own characteristics in the region. The pattern of disability was studied in patients. Glatiramer acetate and interferons were most frequently prescribed as DMDs for MS in the region.

Conclusion. The findings may be used to plan drug supply for patients with MS and the work of sociomedical examination service and to enhance the efficiency of organizing the treatment with and use of DMD for MS in the region.

61-66 88
Abstract

Objective: to investigate the anticonvulsant and neuroprotective effects of magnesium orotate in a rat thiosemicarbazide model of seizures in rats.

Material and methods. The investigation was conducted in 112 male albino rats weighing 200 g, in which severe clonic-tonic seizures weresimulated by the convulsant thiosemicarbazide. The anticonvulsant effects against of thiosemicarbazide-induced seizures were evaluated in the following drugs: gabapentin; a combination of gabapentin + magnesium orotate; sodium valproate; a combination of sodium valproate + magnesium orotate; and magnesium orotate. The neurological status, characteristics of seizures, survival rates, body weight, and plasma and red blood cell magnesium concentrations were compared. After completing the animal experiment, the animals were euthanized and the histological characteristics of their brains and nerves were analyzed.

Results. Magnesium orotate was ascertained to reduce the severity and duration of thiosemicarbazide-induced seizures, to increase animal survival rates, and to potentiate the anticonvulsant action of gabapentin and sodium valproate. The neurohistological findings showed that the used model of seizures led to ischemic brain damage.

Conclusion. It has been concluded that magnesium orotate minimized the level of ischemic damage to nerve cells and contributed to restoration of the morphology of brain tissues after thiosemicarbazide administration.

67-70 137
Abstract

Objective: to evaluate the efficacy of long-acting melatonin in EMERCOM employees with sleep disorders (insomnia) associated with desynchronosis.

Patients and methods. 30 patients (EMERCOM employees) having manifestations of desynchronosis-associated insomnia were examined using the following tests and questionnaires: the short-term verbal memory test (five words test); the modified point subjective sleep characteristics scale; the Hospital Anxiety and Depression Scale; the Screening Dysfunctional Beliefs and Attitudes Scale; the symbolic-digital coding test; individual sleep diaries.

Results. According to the tests and questionnaires, the treatment resulted in a statistically significant improvement in sleep quality and indicators of short-term memory and cognitive functions (attention concentration) and a reduction in anxiety and depression.

Conclusion. Long-acting melatonin has a good safety profile and can be recommended as a first-line drug to treat desynchronosis-associated sleep disorders.

71-77 229
Abstract

Objective: to evaluate the safety and efficacy of the first Russian botulinum toxin-A relatox versus botox in treating arm and hand spasticity after ischemic stroke.

Patients and methods. A multicenter randomized clinical trial was conducted in 6 centers of the Russian Federation, which covered 160 patients with prior ischemic stroke and upper limb spasticity (an Ashworth scale score of at least 2). Not earlier than 3 months after stroke, a single injection of relatox or botox was made, followed by the evaluation of changes in muscle tone and the presence and severity of adverse events (local and systemic reactions).

Results. After relatox injection, all the patients had significantly decreased upper limb muscle tone according to the Ashworth scale (p<0.05), which was recorded at all visits as compared to that at the baseline visit. The greatest muscle tone reduction was observed at 1 and 2 months after injection, and that in the pattern of fingers was seen at 3 months. The effect persisted within 3 months following the injection, which was confirmed by the Ashworth scale scores during the last visit as compared to the baseline one (p<0.05). No significant differences were found in muscle tone reductions between the relatox and botox groups (p>0.05). Relatox showed the good tolerability and safety that was comparable to those of the comparison drug. The number of registered local and systemic reactions was low and was not significantly different in both groups (p>0.05). There were no considerable differences in laboratory parameters and electrocardiographic findings in both patient groups (p>0.05). Serious adverse events were not detected during the study either.

Conclusion. The findings suggest that relatox is safe and efficient in decreasing upper limb muscle tone in patients after ischemic stroke, which is an important component in the structure of rehabilitation (first of all, functional recovery) of patients with spastic paresis of the upper limb.

78-83 104
Abstract

Preparations based on organic lithium salts are promising neuroprotective agents that are effective just in the micromolar concentration range and, at the same time, have high safety (Toxicity Class V).

Objective: to elucidate more detailed mechanisms responsible for the biological and pharmacological effects of lithium citrate, by analyzing the possible interactions of lithium ion with human proteome proteins that are also represented in the rat proteome.

Material and methods. The targets of lithium are two proteins, such as glycogen synthase-3β (GSK-3β) and inositol monophosphatase 1 (IMPA1), were experimentally validated using lithium citrate.

Results. The cycle use of oral lithium citrate was shown to decrease the activity of these proteins in the rat brain hydrolysates. The effects of lithium were analyzed in the human and rat proteomes. 47 proteins were ascertained to be present in the human and rat proteomes, the activity of which depended on lithium ions. There were 4 groups of lithium-dependent proteins: 1) the proteins regulated by GSK3β kinase; 2) those modulating the level of inositol phosphates; 3) those modulating the metabolism of neurotransmitters; 4) those working via other mechanisms.

CLINICAL OBSERVATIONS

84-89 216
Abstract

The paper deals with the problem of cognitive and emotional impairments (CI and EI) in patients with arterial hypertension (AH). It stresses the importance of their correction to improve adherence to treatment. The mechanisms of action and clinical efficacy of standardized Ginkgo biloba extract (Egb 761®) and the results of its trials are discussed. The paper describes a clinical case illustrating the efficacy and safety of the drug in a female patient with AH, CI, and EI.

REVIEWS

90-95 157
Abstract

The paper sets forth the data available in the literature on the prevalence, pathogenesis, and clinical features of cognitive impairment (CI) in diabetes mellitus (DM). It presents the results of the authors' own studies of cognitive functions in patients with type 2 DM in relation to the presence or absence of a clinically significant vascular disease. It was established that CIs were mild and moderate, equally marked in both patient groups, which allows consideration of DM as an independent risk factor for cognitive dysfunction. Inadequate regulation of voluntary activity was a leading neuropsychological mechanism of CI in DM. The pathogenesis of CI in DM is largely due to the development of vascular complications. Methods for the prevention and treatment of CI in DM are proposed.

96-100 191
Abstract

Parkinson's disease (PD) is a multifactorial disease that develops in the presence of both genetic and environmental factors. In recent years, there has been sufficient information on the role of genetic predisposition in the development of not only familial cases, but also sporadic ones. A hereditary burden in PD may not be traced in cases of recessive inheritance with a low gene penetrance, as well as in a patient's death before the onset of the disease. Active introduction of molecular genetic methods, including next generation sequencing, can annually identify new gene mutations that underlie sporadic PD cases. This paper provides an overview of the current literature on the genetic aspects of PD with emphasis on the ethnic characteristics of the disease.

101-105 272
Abstract

The review presents the data of recent studies dealing with cognitive impairments (CI) in patients with Parkinson's disease (PD) and gives their characteristics and epidemiology, the specific features of the pathogenesis and clinical manifestations, as well as current methods for their diagnosis and treatment. Moderate CIs (MCIs) occur in 18.9–55% of patients with PD; the prevalence of dementia during a cross-sectional study approaches 30%. The 2007 Movement Disorder Society criteria and algorithm for the diagnosis of dementia in PD and the 2012 criteria and the algorithm for the diagnosis of MCIs allow one to maximally accurately identify these disorders. Only rivastigmine is now recognized as effective in treating CI in PD and recommended for use. Overall, therapies for CI in PD have been inadequately investigated, making it necessary to conduct further large-scale studies.

106-110 552
Abstract

The choice of effective treatments for vestibular vertigo is one of the important problems, by taking into account the high prevalence of peripheral vestibular diseases. Different drugs, such as vestibular suppressants for the relief of acute vertigo attacks and vestibular compensation stimulants for rehabilitation treatment, are used to treat vestibular vertigo. Drug therapy in combination with vestibular exercises is effective in patients with vestibular neuronitis, Meniere's disease, so is that with therapeutic maneuvers in patients with benign paroxysmal positional vertigo. The high therapeutic efficacy and safety of betahistines permit their extensive use for the treatment of various vestibular disorders.



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