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Neurology, Neuropsychiatry, Psychosomatics

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Vol 10, No 1 (2018)
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https://doi.org/10.14412/2074-2711-2018-1

LECTURES

4-11 583
Abstract

The paper analyzes the concepts of personality profiles and demonstrates the possibility of applying this approach to comparatively assessing the psychological characteristics of patients with essential arterial hypertension (EAH).

It sets forth the fundamentals of the concepts by F. Alexander, H.F. Dunbar, M. Friedman, and R. Rosenman, which emphasize the importance of emotional, personal, and behavioral factors for the etiology and pathogenesis of EAH and analyzes in detail the psychological study of the characteristics of the so-called type D (distressed) personality that is characterized by a combination of the predominance of negative emotions, social isolation, and inability to regulate these factors.

The authors present the results of their own empirical study of personal characteristics (through the Cattel's 16 personality factors questionnaire) in patients with office hypertension (OH) versus those with classical EAH and healthy individuals. OH patients are shown to be significantly less sociable, less emotionally stable, more overwrought and shy, and more prone to self-control and feelings of guilt. The experimental psychological study (by simulating of emotional stress and by using the modified variant of the procedure developed by S. Rosenzweig to examine frustration reactions) has revealed that the patients with OH tend to experience the most intense negative sthenic emotions and they significantly more frequently resort to repression of these emotions.

The findings prove that the EAH group is e heterogeneous and confirm the assumption that OH patients show negative affectivity and lower social activity.

12-16 2464
Abstract
Vascular myelopathy is a rare severe disease caused by a broad spectrum of causes, among which pathology of the aorta and its branches, aortic surgery, spinal diseases, and spinal trauma occupy the main place. The processes of neuroinflammation and glutamate neurotoxicity play a leading role in the pathogenesis of myeloischemia. The clinical picture of the disease is nonspecific and depends on the location and volume of an ischemic focus. Magnetic resonance imaging is a gold standard for diagnosis. However, this method remains insensitive in the acute period and fails to detect spinal cord ischemia at preclinical stages. The investigation and introduction of specific biochemical markers (glutamate receptors and their antibodies) for neurotoxicity, which can identify ischemia in the advanced stage and predetermine its development, are promising. The treatment of vascular myelopathy has not currently been standardized and it is mainly pathogenetic and symptomatic.

ORIGINAL INVESTIGATIONS

17-23 254
Abstract

Arterial spin labeling (ASL) is a promising non-invasive method to assess cerebral perfusion, which identifies a decrease in cerebral blood flow (CBF).

Objective: to assess cerebral perfusion in middle-aged untreated patients with uncomplicated grade 1–2 hypertension compared to same-age healthy controls.

Patients and methods. 33 patients with essential hypertension and 40 healthy individuals (a control group) at the age of 40–59 years were examined. 24-hour blood pressure (BP) monitoring and brain magnetic resonance imaging were performed in different modes (T1 MPRAGE, T2 TSE, T2 FLAIR, DTI, and ASL).

Results. White matter hyperintensive changes were found in 7.5% of the healthy individuals and in 51.5% of the hypertensive patients (p = 0.0002). In hypertensive patients, CBF in the cortical plate of anterior frontal regions was significantly (p < 0.001) lower than that in the controls: right CBF, 39.1±5.6 and 45.8±3.2 ml/100 g/min, respectively; left CBF, 39.2±6.2 and 45.2±3.6 ml/100 g/min, respectively. In hypertensive patients with white matter hyperintensive changes, CBF was significantly lower than that in the controls: right CBF, 38.5±5.9 ml/100 g/min (p = 0.0001); left CBF, 39.2±6.7 ml/100 g/min (p = 0.002), and in those without these changes, right CBF was 39.5±5.1 ml/100 g/min (p = 0.0002); left CBF was 38.9±4.3 ml/100 g/min (p = 0.00002). Correlation analysis revealed significant inverse correlations of CBF with BP and systolic BP variability.

Conclusion. Lower cerebral perfusion occurs in middle-aged untreated patients with uncomplicated grade 1–2 hypertension even in the absence of white matter hyperintensity foci. 

24-31 168
Abstract

Cerebral small vessel disease (CSVD) is the most common neurological pathological process and contributes to the process of aging and to the development of dementia and stroke. At the same time, the role of CSVD as a factor influencing the course of acute ischemic stroke (IS) has been little studied. There is no generally accepted magnetic resonance imaging (MRI) scale for the integrated assessment of CSVD markers.

Objective: to carry out an integrated assessment of the MRI manifestations of CSVD in acute ischemic stroke and to analyze a correlation of both individual markers and the final indicator with the clinical and functional status of patients.

Patients and methods. 100 patients with acute IS were examined. All patients underwent standard clinical, laboratory and instrumental examinations, as well as brain MRI estimating the number of lacunae, visible perivascular spaces (PVSs) and leukoaraiosis. The number of cerebral microbleeds (CMBs) was additionally calculated in 57 patients. Integral scale scores were calculated by gradation and summation of four MRI markers of CSVD.

Results. The patients with acute IS showed the high representativeness of individual markers for CSVD. The values of MRI markers for CSVD correlated with age, education level, and cardiovascular parameters in patients. An integrated CSVD severity assessment scale was developed. The overall manifestations of CSVD, which were assessed using this scale, were associated with the severity of a stenotic process in the brachycephalic arteries, with BP levels at admission, ejection fraction, hyperglycemia, and atherogenic index of blood lipids. The high CSVD score was also correlated with low mobility and more severe disability in patients being discharged from hospital. The high severity of CSVD was associated with lower neurological deficit regression during inpatient treatment. Subgroup analysis showed the greatest negative impact of CSVD on the severity of stroke in female patients, young and middle-aged ones, diabetics, as well as in patients with noncardioembolic stroke, a smallsized focus, and intima-media thickening.

Conclusion. The overall manifestations of CSVD calculated using the original scale based on the analysis of the degree of lacunae, PVSs, leukoaraiosis, and CMBs are associated with premorbid cardiovascular parameters in a patient and are important indicators for the neurological, cognitive, and functional outcomes of acute IS.

32-36 229
Abstract

Cognitive impairment (CI) is a basis for the clinical presentation of chronic cerebral ischemia (CCI). However, the role of the mechanisms of inflammation and angiogenesis in the origin of CI is unclear, as is its relationship to the number and localization of foci during a neuroimaging examination.

Objective: to investigate the relationship between the presence of CI, focal brain tissue changes, and the plasma and serum levels of vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein-1 (MCP-1) in patients with CCI.

Patients and methods. Examinations were made in 59 patients with CCI and in 20 apparently healthy individuals. The investigators evaluated the cognitive status using the Mini-Mental State Examination (MMSE) and the clock drawing test), performed brain magnetic resonance imaging (MRI), duplex scanning of cerebral vessels, and determined laboratory indicators: the serum levels of MCP-1 and C-reactive protein, and the serum and plasma concentrations of VEGF.

Results. The patients with CI were found to have higher values of inflammatory markers, lower serum and plasma concentrations of angiogenic factors, and a greater number of focal changes on MRI than those without CI (5.06±0.23 and 2.36±0.3 scores, respectively; p<0.05). Imbalance of angiogenic and antiangiogenic factors can cause disease progression and moderate vascular CI in patients with CCI. 

37-42 292
Abstract

Prior stroke plays an important role in the development of cognitive impairment (CI), the prevention of which requires detailed study.

Patients and methods. A total of 350 patients (mean age, 65±17.7 years; 49% men) who had experienced a stroke with a small degree of neurological deficit were followed up. Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE), Mattis dementia rating scale, the clock drawing test, the test on memorizing 12 words, and the Schulte table. During 5 years of follow-up, 61 (17.4%) patients died, including 45 (12.8%) from recurrent stroke; 89 recurrent strokes developed.

Results. The first examination did not reveal CI in 59 (17%) patients; 73 (21%) were found to have marked CI (mild or moderate dementia). After 1, 3, and 5years of follow-up, the proportion of patients with marked CI increased up to 23.2, 29.5, and 34.5%, respectively. Within 5 years, there was an average decline of 2 MMSE scores. The maximum decrease in cognitive functions was seen in patients who had experienced a recurrent stroke, but this also occurred in the absence of a stroke. Cognitive functions were substantially better in a group of patients with blood pressure (BP) normalization.

Conclusion. The 5-year follow-up has shown that post-stroke CI gradually progresses, which is associated with the progression of both vascular disease and a concomitant neurodegenerative process. BP normalization during antihypertensive therapy contributes to the prevention of progressive post-stroke CI. 

43-46 164
Abstract

Objective: to investigate the association of G308A tumor necrosis factor-α (TNF-α) (rs1800629) gene polymorphism with depression in an open male population aged 25–64 years in Novosibirsk.

Patients and methods. The investigation was conducted within the framework of the WHO MONICA-psychosocial (Multinational Monitoring of Trends and Determinants of Cardiovascular Disease) program using the material of Screening III of a representative sample of 25–64-yearold men (n=657; mean age, 44.3±0.4 years; response rate, 82.1%) from an open Novosibirsk population in 1994. The depression scale (Mopsy Test) form was used to assess depression. Depression was assessed as none, moderate (MD), or severe (SD).

Results. The prevalence of depression in the 25–64-year-old male population was 29% (MD, 25.9%; SD, 3.1%). There were TNF-α G/G, G/A, and A/A genotypes in 79.1, 19, and 1.9% of cases, respectively. The G allele was present in 88.6% of the men and the A allele was only in 11.4%. Comparative analysis showed that the G/A genotype was more common in men with MD (28.8%) than in those without depression (14.8%): χ2 =6.486; df=1; p=0.011; odds ratio (OR), 2.316; 95% confidence interval (CI), 1.202–4.463. The G/A genotype was also more frequently observed in individuals with depression (MD and SD, 26,5%) than in men without depression (14.8%): χ2 =5.256; df=1; p=0.022; OR, 2.072; 95% CI, 1.103–3.892 compared with G/G genotype carriers. Carriage of the A allele was more often noted in individuals with MD (17.4%) than in those without depression (8%) (χ2 =9.67; df=1; p=0.002; OR=2.43; 95% CI, 1.371–4.307; similarly, A allele carriers were more common among the individuals with MD and SD (163.6%) than among the examinees without depression (8%) (χ2 =9.122; df=1; p=0.003; OR=2.296; 95% CI, 1.325–3.98).

Discussion. Analysis of the association of G308A TNF-α gene polymorphism with depression showed that although the G/G genotype proved to be most frequently found in the G308A TNF-α gene polymorphism, the heterozygous G/A genotype and the homozygous A/A genotype, the A allele were more often detected in depression. Subsequent comparative analysis confirmed that the OR for the development of MD and depression (MD and SD) in individuals with the G/A genotype was increased by 2.3 and 2 times, respectively.

Conclusion. A significant association was found between depression and G308A TNF-α gene polymorphism. 

47-54 320
Abstract

Cyclooxygenase-2 (COX-2) is the main targeted protein of non-steroidal anti-inflammatory drugs (NSAID); nevertheless, the latter substantially differ in pharmacological properties.

Objective: to establish the spectrum of pharmacological actions of dexketoprofen, ketoprofen, and diclofenac, by using a chemoreactome analysis.

Material and methods. A chemoinformation analysis was used to determine a list of the chemical structures closest to dexketoprofen. For each molecule, the investigators extracted the results of experimental measurements of the rheological properties of this molecule from databases and a chemoreactome analysis was carried out. The comparative chemoreactome analysis of the molecule of dexketoprofen and control molecules (ketoprofen, diclofenac) could assess the biological activity of the studied molecule.

Results and discussion. Unlike the molecules of comparison, dexketoprofen was found to be able to accumulate mainly in muscles, adipose tissue, and adrenal glands. The anti-inflammatory and analgesic effect of dexketoprofen can be carried out via modulation not only of the metabolism of prostaglandins, but also that of leukotrienes and encephalins, as well as via inhibition of metalloproteinases and glutamate receptors. In addition, the analysis showed a considerable difference in the interaction profiles of dexketoprofen, ketoprofen, and diclofenac with cytochrome P450 enzymes. Dexketoprofen can enhance the efficacy of anti-arrhythmic and antiadrenergic agents, whereas ketoprofen and diclofenac are able to negatively affect the metabolism of omega-3 polyunsaturated fatty acids and vitamin D.

Conclusion. The chemoreactome analysis could identify the promising vasodilatory, antiplatelet, antidiabetic, and antitumor effects of dexketoprofen in addition to its main action. 

55-59 1829
Abstract

Dizziness can be caused by different problems in elderly patients; the possibilities of drug therapy are limited; betahistine dihydrochloride is most commonly used.

Objective: to investigate the efficiency and safety of combination therapy with mexidol and betahistine in patients with vertigo according to the global assessment scale for treatment efficiency.

Patients and methods. The investigation enrolled 89 elderly patients (mean age, 73.7 years) with chronic cerebrovascular disease and complaints of dizziness. Neurological, otoneurological (the orthostatic test, the forced hyperventilation test, the Dix–Hallpike test, the Tinetti test, and the visual vertigo analogue scale), somatic, cognitive and emotional statuses were evaluated in all the patients. The patients were randomized into two groups. A study group included patients who took betahistine 48 mg/day, intravenous Mexidol® 5.0 ml for 10 days, then 375 mg tablets daily for 50 days; a comparison group consisted of patients who used only betahistine 48 mg/day for 60 days. The efficiency of treatment in both groups was evaluated using the global scale on day 60 of therapy, by taking into account the opinion of a physician and a patient.

Results. In the elderly patients, vertigo was caused by several problems in the majority (75%) of cases. The combined (betahistine + mexidol) treatment group showed a more significant (more than double) reduction in the symptoms of vertigo than the comparison group.

Conclusion. In elderly patients with chronic cerebrovascular disease and vertigo, combined therapy with betahistine and mexidol, which has neuroprotective properties, improves the results of treatment. 

CLINICAL OBSERVATIONS

60-64 209
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) is an inflammatory demyelinating disease of the central nervous system with a selective injury of the optic nerves and spinal cord. The formation of neuromyelitis optica ((NMO)-IgG autoantibodies against the cell membrane water channel protein aquaporin 4 (AQP4) underlies the pathogenesis of the disease. The article describes the clinical presentation of the disease in pediatric patients followed up by the authors. It presents the criteria for diagnosing NMOSDs and their therapy regimens.
65-69 482
Abstract
The paper describes a clinical case of dissociative amnesia in a 22-year-old patient. A marked hysterical radical was observed in premorbid. As a result of the psychotraumatic situation, the patient twice lost memories of the events of his life, could not remember his name, place of residence. At the same time, his ability to memorize new information, training knowledge, and some dance skills were preserved. Instrumental examinations detected no organic pathology. Memory in both cases was fully restored within a few months. Patients with similar symptoms were increasingly encountered in psychiatric practice. At the same time, there are different viewpoints on the occurrence of such symptoms. It is obvious that the problem of dissociative amnesia is relevant and requires further investigation.

REVIEWS

70-73 320
Abstract
The review presents the data characterizing the mechanism of action of anti-B-cell therapy for multiple sclerosis (MS) and the results of clinical trials of ocrelizumab, the first drug of this group, which has been approved for use in MS. Multicenter randomized controlled studies have shown that this drug is effective in treating both MS with exacerbations and primary progressive MS. Currently ocrelizumab is the only drug that can be used as a pathogenetic treatment for this MS course type.
74-77 315
Abstract
Alzheimer’s disease (AD), one of the leading causes of dementia worldwide, is commonly accompanied by behavioral and psychopathological disorders. The earliest observed symptoms of AD include sleep disorders, the incidence of which varies from 25 to 60%. Sleep problems and sleep disorders can develop as one of the symptoms accompanying cognitive impairment, but can also be associated with an increased risk of cognitive decline and with a higher risk of dementia. Anti-dementia therapy is of great importance in preventing and treating sleep disorders in patients with AD. Akatinol memantine is one of the drugs with proven efficacy in such patients.
78-82 407
Abstract
Anxiety disorders are an important biomedical problem due to the high prevalence and significant negative impact on the quality of life and the course of concomitant somatic and neurological diseases. Cognitive impairment (CI) is one of the most intensively studied aspects of pathological anxiety. Impairments in attention, executive functions, memory, cognitive deficit, as well as abnormal cognitions and metacognitions are identified in anxiety disorders. Moreover, the treatment of the latter with the most frequently used drugs (antidepressants, atypical antipsychotics, anticonvulsants, tranquilizers) does not lead to a significant improvement in cognitive functions, and often contributes to their worsening. In this connection, in addition to psychotherapy, cognitive function-improving agents play a large role in treating anxiety diseases associated with cognitive dysfunction. Ginkgo Biloba extract (EGb 761, Tanakan®) that positively affects cognitive functions, especially in the domains of memory, concentration and attention deserves special attention.
83-89 216
Abstract
The paper gives data on the incidence of cerebrovascular diseases (CVD) and the pathogenetic mechanisms of their development in various common somatic diseases, such as hypertension, atherosclerotic lesions in the great arteries of the head, and diabetes mellitus. It considers data on the occurrence of CVD in more rare diseases, such as hereditary diseases, hyperhomocysteinemia, and migraine. It is noted that the currently available data suggest that that the pathogenetic mechanisms of CVD are heterogeneous and that there are diverse types of cerebral ischemic lesions and their clinical manifestations. Therefore, therapeutic strategies for CVD should take into account not only the clinical features of the disease, but also the mechanisms of its development. The main areas of therapy are highlighted. The use of vasobral to treat CVD is discussed.
90-95 347
Abstract
Cranial dystonia is a common disease of the extrapyramidal nervous system. The clinical manifestations of dystonia are extremely variable; many of its forms are often undiagnosed. Dystonia is a sensorimotor disorder of the nervous system. Damage affects not only one structure, but also a network of the nodes interacting with each other in the somatosensory cortex and associative sensory and motor fields, which play a role in the integration of various sensory modalities coming from both outside the body and from the receptors within it. Botulinum toxin preparations show the highest efficacy in treating cranial dystonia. If their administration cannot achieve a positive result, oral drugs and surgical treatments should be used.
96-101 223
Abstract
Many physicians have difficulty managing patients with vertigo. Incorrect routine diagnoses are frequently made in patients with peripheral vestibulopathy, which makes therapy fail. Most cases of vestibular vertigo are caused by peripheral vestibular disorders (otolithiasis, hydrops, neuronitis). Rehabilitation maneuvers are effective in the treatment of benign paroxysmal positional dizziness; salt-free diet, diuretics, and betahistine dihydrochloride are for MОniПre’s disease (syndrome); vestibular rehabilitation is for vestibular neuronitis. Betahistine dihydrochloride is most effective among all the medicines used in different causes of vestibular vertigo, including that of unclear origin. The paper gives the positive experience with betahistine made in Russia for vestibular vertigo.
102-106 1309
Abstract

Chronic cerebral ischemia (CCI) is one of the most common diagnoses in middle-aged and elderly patients in the practice of an outpatient neurologist. Unfortunately, the diagnosis of CCI in these patients is often established only on the basis of complaints of headache, dizziness, instability during walking, and lower mood. At the same time, other diseases that cause these symptoms are not diagnosed, patients do not receive treatment, which considerably worsens quality of life and leads to anxiety and depression.

A variety of diseases, such as headache, peripheral vestibular vertigo, depression, Alzheimer's disease, and Parkinson's syndrome, are frequently hidden under the diagnosis of CCI. The leading neurological syndrome in CCI is cognitive impairment that can be both moderate and reach the level of dementia. Approximately 40% of patients with chronic cerebrovascular disease complain of headache that is usually caused by mixed primary headache. The management tactics for a CCI patient suffering from headache is aimed at treating primary headache, modifying vascular risk factors, and managing cognitive impairment. The paper discusses the use of choline alphoscerate in patients diagnosed with CCI. 



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