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Neurology, Neuropsychiatry, Psychosomatics

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Vol 14, No 2 (2022)
View or download the full issue PDF (Russian)
https://doi.org/10.14412/2074-2711-2022-2

LECTURES 

4-10 161
Abstract

Drug-induced tremor (DIT) is a term used to describe tremors that develop or increase in severity due to various medications administration. As multiple drugs are associated with DIT it is quite common in clinical practice and medication dose is frequently associated with tremor severity. DIT is associated with commonly prescribed drugs such as amiodarone, antidepressants, β-agonists, cyclosporine, lithium, tacrolimus and valproic acid. DIT mechanisms include dopamine receptors block, gamma-aminobutyric acid depletion, cholinergic deficiency. DIT risk factors include older age, female sex, longer administration of drugs associated with tremor or/and their administration in higher doses, history of tremor in the patient and/or relatives, excessive caffeine intake. It is necessary to establish a causal relationship between the use of a potential inducer drug and the development/intensification of tremor to diagnose DIT. If DIT is detected, the inducer drug should be discontinued or its dose reduced. To decrease DIT risk, it is recommended to avoid prescribing drugs which are most commonly associated with DIT.

ORIGINAL INVESTIGATIONS 

11-17 137
Abstract

Timely evaluation of cardioembolic stroke (CES) caused by atrial fibrillation is critical from the point of view of the possibility of prescribing effective secondary prevention with oral anticoagulants. Insular lesion is considered as a promising neuroimaging marker of CES.

Objective: to analyze the role of insular cortex lesions using magnetic resonance imaging (MRI) of the brain as a potential neuroimaging marker of the pathogenetic subtype of ischemic stroke (IS).

Patients and methods. 225 patients in the acute period of IS were examined. Depending on the stroke etiology, patients were divided into three groups: cryptogenic stroke (CS; n=99), CES (n=45), and non-CES (n=81). All patients underwent an MRI of the brain to analyze the insular cortex lesions. In 57 patients, foci of cerebral infarction were additionally marked manually on axial slices of diffusion-weighted MRI using the Anatomist software. The calculated MRI characteristics of foci for CES and non-CES groups were used to construct a decision tree in the WEKA 3.6 package. Echocardiographic markers of atrial cardiopathy were assessed in all patients – the left atrium (LA) emptying fraction and LA function index; in 68 patients, the concentration of serum NT-proBNP was also assessed.

Results and discussion. The insula was affected in 12% of patients: most often in CES (33%), significantly less often in CS and non-CES (6 and 7.4%, respectively), without significant differences between the latter groups. The presence of insula lesion in relation to CES has a sensitivity of 33% and a specificity of 93% (p=0.002); odds ratio 6.25; 95% confidence interval 2.22–17.63. In most patients, the posterior insular cortex was involved in the pathological process. Isolated insular infarction occurred in only one patient with CES, while the involvement of the insula and adjacent zone, and the combination of insular infarction with territorial infarction, were observed more often. The group of patients with insular lesions was distinguished by the predominance of women, greater severity of stroke at admission, less deficit at discharge, larger LA diameter, lower LA emptying fraction, and functional index. CES was four times more common in the insular lesion group, while CS was two times more common in those without insular lesions. Insula involvement identifies three out of five CES patients according to the decision tree. Further analysis of the total lesion volume can locate almost all remaining patients with CES: they are characterized by the indicator >12 sm3.

Conclusion. Insular lesions allow reliable differentiation of patients with CES and non-CES and can be considered a potential marker of the cardioembolic subtype of IS, which requires further investigation.

18-25 99
Abstract

Antipsychotics (AP) administration in schizophrenia patients is associated with several side effects (SE), in particular, with extrapyramidal (EP). Data suggests that oxidative damage to dopaminergic neurons in the EP system may be related to tardive dyskinesia and Parkinson's disease (PD) development, although data on the role of oxidative stress in the development of early EPSE of AP is lacking. Another poorly studied hypothesis of the EP-symptoms pathogenesis considers disorders of folate (pterin) metabolism.

Objective: to evaluate the relationship between redox imbalance and pterin metabolism with the severity of early EPSE caused by AP used in the schizophrenia treatment.

Patients and methods. The study included 50 patients with the first episode of schizophrenia. EP symptoms were evaluated using the UKU Side-Effect Rating Scale (“UKU-SERS-Clin” version). The levels of reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), aldehyde-2,4-dinitrophenylhydrazone, ketone-2,4-dinitrophenylhydrazone were assessed in blood plasma; levels of BH4, folate, cobalamin (vitamin B12), and homocysteine – in blood serum; superoxide dismutase (SOD) and catalase activity – in erythrocytes.

Results and discussion. EPSE severity was inversely proportional inversely proportional to the GSH level and directly proportional to the SOD activity. EPSE severity was also associated with AP selectivity, but not with their dosages. However, AP selectivity was not associated with studied biochemical parameters. MDA level in patients prescribed with amantadine was lower than in other participants.

Conclusion. Early AP-induced EPSE were associated with redox imbalance, which indicates the necessity for further research aiming at prevention of secondary neurodegenerative diseases in patients with schizophrenia receiving AP.

26-34 65
Abstract

Objective: to establish associations of cognitive functions (CFs) and professional level in an open population of Novosibirsk aged 25–44 years.

Patients and methods. The subject of the study was a random representative sample of one of the Novosibirsk districts population aged 25–44 years (463 men, mean age 35.94±5.957 years, and 546 women, mean age 36.17±5.997 years) in 2013–2016. CFs were screened using: A.R. Luria 10 words learning task – immediate and delayed recall after the interfering task; Bourdon Test (BT); exclusion of “the fifth extra” test; verbal fluency test (naming animals in 1 min). Education level and professional status were assessed according to the criteria of the WHO international program MONICA protocol.

Results and discussion. The analysis showed that the management and engineering and technical staff (ETS) coped significantly better with cognitive tests than manual labor workers. The analysis of memory using the A.R. Luria test showed that the differences in the first recall of 10 words between manual labor workers and managers reached 0.849 words, in the mean number of correctly remembered words it reached 0.735 words, and in delayed recall – 1.096 words (p<0.05). Attention assessment using BT revealed that the number of letters crossed out in 1 min was higher among the management staff compared to the manual labor workers, reaching 4.978 characters (p<0.05). ETS scores in this test were close to the management staff scores (p<0,0001). Also, a tendency to a smaller number of mistakes made by managers and ETS compared to workers was revealed in the BT. In the analysis of semantic associations in the verbal fluency test the differences in the number of animals named per 1 min reached 3.007 animals between manual labor workers and managers. Similar differences were observed between manual labor workers and ETS (p<0.05). Abstract reasoning evaluation using the “the fifth extra” test showed that managers and ETS excluded a greater number of words that did not correspond to the logical series (i.e., they showed the best result in this test) than manual labor workers (p<0.05). ETS and management staff showed best performance in cognitive tests compared to manual labor workers of the same educational level.

Conclusion. A quantitative association has been established between a low professional level, level of education and a decrease in cognitive functions among people aged 25–44 years.

35-42 97
Abstract

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. The aim of the work was

Objective: to determine the relationship between laboratory biomarkers in blood plasma and cerebrospinal fluid (CSF) in patients with AD and indicators of neuropsychological testing.

Patients and methods. 52 patients with AD were examined, in which the concentration of 90 potential biomarkers were measured in blood plasma and CSF. Neuropsychological assessment included the Mini-Mental State Exam (MMSE), Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA), and etc.

Results and discussion. Correlations of different strength between the values of biomarkers in blood plasma and CSF and the results of neuropsychological assessment were revealed. A correlation was found between the soluble cell adhesion molecule (sICAM-1) in blood plasma and the largest number of neuropsychological tests sensitive to dementia stages (MoCA, MMSE, FAB) in patients with AD at the dementia stage. A correlation was found between the concentration of growth/differentiation factor 15 and interferon γ in blood plasma and FAB scores in patients with AD. The levels of granulocyte colony-stimulating factor (G-CSF) in CSF were associated with the dementia stage in AD, and the interleukin-1 receptor antagonist (IL-1RA) levels, on the contrary, with stages preceding the development of dementia in AD.

Conclusion. sICAM-1 level in blood plasma, which is a marker of endothelial dysfunction, may be an indicator of the severity of the vascular neurodegenerative process in AD at the dementia stage. G-CSF in the CSF is associated with the dementia stage in AD, and IL-1RA – with the pre-dementia stage of AD, which determines the prospect of their further study as diagnostic markers.

43-48 75
Abstract

There is a growing body of evidence linking hypovitaminosis D with the prevalence and severity of various pain conditions. The effect of vitamin D levels on chronic tension type headache (CTTH) is almost unexplored.

Objective: to investigate the effect of serum vitamin D levels on the clinical characteristics of CTTH.

Patients and methods. The study enrolled women with CTTH (n=161). Headache frequency (HF), headache duration (HD), headache intensity (HI), presence of chronic widespread pain (WP) and the number of its zones, severity of anxiety and depression, and sleep quality index were evaluated. The vitamin D level was assessed by the concentration of 25-hydroxyvitamin D [25(OH)D].

Results and discussion. Low 25(ОН)D-level was associated with an increase in HF, HD and the prevalence of WP. For each of the listed parameters, the values in vitamin D deficiency were higher than in its insufficiency or normal ranges (p<0,001). 25(OH)D-level was inversely correlated with HF (rS=-0,49), HD (rS=-0,51; p<0,05). Vitamin D-deficiency increased the risk of WP: compared to its insufficiency relative risk (RR) was 2.12 (95% CI 1.39–3.21), to the normal ranges – 3.67 (95% CI 1.71–7.88). In case of insufficiency and normal level of vitamin D, the values for the listed parameters did not differ. Other characteristics did not depend on 25(OH)D-level.

Conclusion. In women with CTTH hypovitaminosis D contributes to the greater disease severity. Vitamin D deficiency, which is strongly associated with an increase in pain characteristics, has great clinical significance.

49-55 101
Abstract

Objective: to study the clinical efficacy and tolerability of omberacetam in comparison with piracetam/cinnarizine and aminophenylbutyric acid in non-demented patients with vascular cognitive impairment (VCI).

Patients and methods. The study included 150 patients with VCI that does not meet dementia, randomized into three groups of 50 patients. In addition to the basis therapy, patients of the 1st group recieved omberacetam 10 mg 2 times per day, the 2nd group – piracetam/cinnarizine 400/25 mg (1 tablet) 3 times per day, the 3rd group – aminophenylbutyric acid 250 mg 3 times per day. The duration of the treatment course was 45 days. In 50 patients of the 1st group and another 50 patients with VCI from other groups, the duration of the nootropic effect of omberacetam was evaluated 3.5 months after the end of follow-up. Cognitive functions and emotional state of patients were assessed using: 1) Montreal Cognitive Assessment (MoCA); 2) Hamilton Anxiety Rating Scale (HAM-A); 3) Subjective assessment of asthenia scale; 4) Modified subjective sleep characteristics scale. Evaluation of treatment effectiveness and tolerability was carried out.

Results and discussion. During omberacetam treatment a significant improvement in well-being and regression of patient complaints were observed. After 45 days of therapy an increase in the mean MoCA score from 19.8 to 23.3 points (p≥0.001) was observed in the omberacetam group. In other groups, an increase in the mean MoCA score was also noted, but it was less significant. A decrease in asthenic symptoms, anxiety, and dissomnic disorders was present in all studied groups. Anxiety level, assessed by the HAM-A, decreased by 16.9; 19.9 and 20.0 points (p≥0.001) in groups 1, 2 and 3, respectively. Sleep characteristics, assessed by the subjective sleep characteristics scale, improved by 4.6; 5.0 and 5.3 points (p≥0.001), respectively. 4.5 months after the completion of the omberacetam treatment course, the mean MoCA score was 0.8 points higher compared to baseline (p=0.061).

Conclusion. The results showed high efficacy and safety of omberacetam in patients with VCI. A long-term positive effect of omberacetam was observed.

56-63 85
Abstract

Objective: to perform a comparative study of the clinical features of atypical depression (AtD) in affective disorders of various origins: in bipolar affective disorder (BAD), recurrent depressive disorder (RDR) and psychogenic depression (PD).

Patients and methods. A sample of 250 depressed patients aged 18 to 65 years were examined, of which 77 participants (50 women and 27 men) with symptoms of AtD were included to the study. Group 1 included 35 patients with BAD, group 2 – 18 patients with RDR, and group 3 – 24 patients with diagnoses including PD. The patients' condition was assessed using the diagnostic criteria for affective disorders according to ICD-10 and DSM-5 with a Montgomery-Asberg Depression Rating Scale (MADRS).

Results and discussion. AtD detection rate was 30.8%, including 45.4% in BAD, 23.4% – in RDR, and 31.2% – in PD. AtD manifested at the age of about 20 years, and was more common in women. AtD in BAD occurred more often in individuals with cycloid, hyperthymic, and hysterical features. Affective fluctuations before the disease onset, a significantly greater number of depressive episodes in history were characteristic. The most frequent typical depressive symptoms included: daily and seasonal mood fluctuations, morning deterioration of well-being, decreased appetite. High comorbidity with metabolic endocrine diseases was observed. AtD in RDR often began spontaneously in individuals with emotionally labile, psychasthenic, and hysterical features. The most common typical depressive symptoms included melancholy, derealization, weakness, ideas of self-accusation, suicidal thoughts and attempts. A high comorbidity with cardiovascular diseases was found. AtD in PD occurred more often in psychasthenic individuals. The most characteristic symptoms included: increased appetite, anxiety, asthenia, superficial night sleep, hypochondriacal inclusions. Comorbidity with skin and gastrointestinal diseases was observed.

Conclusion. The identified features of the clinical picture and course of AtD in BAD, RDR, and PD can be used for earlier and more accurate evaluation of affective disorders and the adequate treatment administration.

64-70 83
Abstract

The role of miRNAs – small, regulatory, noncoding RNAs – in the multiple sclerosis (MS) development is being intensively investigated. Previously, we the first who observed a significant increase in the expression of 26 microRNA genes localized in the DLK1-DIO3 locus in men with relapsing-remitting MS (RRMS) in peripheral blood mononuclear cells (PBMCs), using RNA sequencing.

Objective: to evaluate the possible involvement of miRNAs in the regulation of the activity of the pathological process in RRMS by comparing the miRNA genes expression levels from this locus in patients in remission, relapse, and healthy individuals, separately for men and women.

Patients and methods. Analysis of miR-431-5p, miR-127-3p, miR-379, miR-376c, miR-381, miR-410 and miR-656-3p microRNA expression was performed by reverse transcription and subsequent real-time polymerase chain reaction in PBMCs of 16 patients in the relapse stage, 20 patients in remission who did not receive immunomodulatory drugs, and 20 healthy individuals.

Results and discussion. The expression levels of all studied miRNAs did not differ in patients in remission and relapse stages, in men and women. At the same time, men (in remission and relapse) showed a significant increase in the levels of all miRNAs compared with healthy men; in women, no changes in expression were observed. A high level of correlation of miRNA expression from the DLK1-DIO3 locus was shown in both patients and healthy individuals from the control group, regardless of gender. Coexpression was observed not only for miRNA genes from the same cluster (14q32.2 or 14q32.31), but also for genes from different clusters.

Conclusion. The miRNAs genes from the DLK1-DIO3 locus are involved in the pathophysiology of RMS onset, but not in the processes associated with the transition from remission to relapses. The high consistency of miRNA expression, regardless of the localization of their genes within this region, suggests the presense of a common mechanism that regulates their transcription.

71-77 64
Abstract

A serious complication of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) is a dysfunction of the autonomic nervous system, which requires early evaluation for the effective treatment. The possibilities of pulse oximetry, which allows to assess heart rate variability in screening of autonomic nervous system dysfunction in patients with T2DM and MetS, have not yet been studied sufficiently.

Objective: to evaluate the pulse oximetry effectiveness by comparing its results with the data of quantitative autonomic testing (QAT) to detect cardiac autonomic neuropathy (CAN) and clarify its degree in patients with T2DM and MetS.

Patients and methods. The study included 30 patients with T2DM (mean age 63±7.9 years), 30 patients with MetS (mean age 61.5±9.1 years), 30 subjects from the control group (mean age 49.7±9.3 years). Patients underwent pulse oximetry, basic cardiovascular reflex tests, assessment of subjective sensations according to the NSC questionnaire, the severity of neurological deficit in the legs according to the NIS-LL scale and neuropathic pain syndrome according to the NTSS-9 scale.

Results and discussion. In the group of patients with T2DM, severe CAN was detected in 13.3% of patients, moderate – in 40%. In the group of patients with MetS, severe CAN was detected in 10% of patients, moderate – also in 10%. In the control group, signs of moderate CAN were detected only in 3.3% of patients. The results of pulse oximetry tests with deep breathing were comparable to the QAT results (p<0.001). Conclusion. Pulse oximetry can be used to diagnose CAN.

78-83 42
Abstract

Currently, a significant proportion of children have dental anomalies (DA) and require orthodontic treatment. The effectiveness of treatment is reduced due to the age-related characteristics of the child's psyche, which lengthens the time and affects the quality of the appointment.

Objective: to assess the emotional state of children with DA aged 6–12 years.

Patients and methods. To study the characteristics of the psychological state of children, 122 patients aged 6–12 years (44 boys and 78 girls, mean age 9 [7; 11] years) were examined and orthodontically treated. Children's complaints, the presence of tics and obsessive habits were assessed. The psychological state of the patients was assessed using the G.P. Lavrentieva and T.M. Titarenko anxiety level in children questionnaire. Causes and factors that increase anxiety at the reception were assessed using a questionnaire developed by the authors.

Results and discussion. Aesthetic defect and speech disorders were the most frequent complaints among children aged 6–12 years with DA (58 and 23%, respectively), especially among older girls (r=0.72). 91.2% of children had obsessive habits, 48% had motor tics. Three groups were distinguished: with low (59.0%), medium (19.7%) and high (21.3%) levels of anxiety. No significant associations were found between the anxiety level and gender, age, presence of tics and obsessive habits. Factors that increased anxiety in children during an orthodontist's appointment were: past personal negative experience at a dental appointment (in 27.0%); office environment (23.8%); negative experience of parents or peers (16.4%); frequent visits to medical institutions in the past (21.3%); family relations (11.5%). The most common anxiety causes were pain expectation and inexplicable fear, a little less often - unpleasant manipulations in the oral cavity and comments from the parent. The rarest cause of anxiety was a disapproving remark from an orthodontist.

Conclusion. Children with DA aged 6–12 years have an increased anxiety level, independent of gender and age. These children require a special approach from the orthodontist and, possibly, a consultation with a psychotherapist.

REVIEWS 

84-90 68
Abstract

The clinical and etiological diversity of depressive, anxiety, dysmorphic and psychotic disorders of the generative cycle in women necessitates an integrated approach to evaluation and treatment methods.

During an individual approach to treatment administration, it is necessary to take into account the risk factors (heredity, comorbid disorders, gender, age, etc.) of adverse events, the spectrum of endocrine side effects characteristic of each drug, the balance of drug efficacy and safety.

The effectiveness of hormone replacement therapy, including in combination with “fortifying” drugs, vitamins, dietary supplements, physiotherapy, in mental disorders has not been proven.

Psychopharmacotherapy should include modern antidepressants, anxiolytics, antipsychotics with an emphasis on good tolerance, a minimum of adverse events, compatibility with hormonal therapy, and ease of dosing.

Psychotherapy, psychological support and psycho-correction can reduce the severity of anxiety and depressive symptoms and significantly increase the treatment effectiveness.

91-97 136
Abstract

The novel coronavirus infection is commonly referred to as COVID-19, sometimes by the name of the causative agent of a respiratory viral infection, as SARS-CoV-2. Frequently, the course of COVID-19 is divided into three main periods: acute COVID-19 (up to 4 weeks), post-acute COVID-19 (from 4 to 12 weeks), post-COVID (post-COVID; from 12 weeks to 6 months). If a more protracted course of COVID (over 6 months) is discussed, the term “long-COVID” is used. All observations demonstrated a high incidence of pain syndromes of various localization in the post-COVID period and long-COVID. According to survey data, 92.3% of patients with COVID-19 reported musculoskeletal problems at the time of admission. Pain syndrome is observed in 56.3% of cases 1 month after hospitalization. Three months after COVID-19, myalgia was observed in 40.55% of cases, joint pain in 39.18%, back pain in 31.62%, and lower back pain in 24.74%. After 6 months, joint pain continues to be observed in 18.59% of patients, myalgia – in 15.09%, back pain – in 14.39%, lower back pain – in 11.23%. In 50.8% of cases, patients reported new-onset pain, of which 38.5% had pain of moderate severity (≥3 points on the visual analog scale). Patients with new-onset pain during COVID had worse quality of life indicators and a negative correlation with the pain syndrome severity, which significantly hampered recovery. Data from a meta-analysis that included 47,910 patients with long-COVID and with a protracted course of COVID indicate that 19% of them had pain in the joints of various localization. The direct cytopathic effect of SARS-CoV-2 and the systemic immune inflammation that occurs in response to infection cause damage to the joint tissue. According to the Guidelines for the Treatment of Patients with the Consequences of COVID-19, it is recommended to use slow acting structure-modifying drugs – SYSADOA – in the pharmacological treatment regimen for patients with osteoarthritis, among which parenteral forms of pharmaceutically standardized drugs – chondroitin sulfate (CS) and glucosamine sulfate (GS) are preferred. GS and CS are inhibitors of the signaling cascade of the nuclear factor NF-κB, which is involved in the realization of biological effects of a pro-inflammatory cytokine (tumor necrosis factor α), the excessive activity of which is associated with the cytokine storm in COVID-19.

98-104 77
Abstract

The importance of the muscular factor, which is traditionally considered in myofascial pain syndrome (MFPS), in the development and maintenance of musculoskeletal pain (MSP) is actively discussed. The hypothesis of the leading role of myofascial trigger points (MTPs) in muscle pain remains debatable. Probably, muscle pain is secondary to the underlying disease. The MTP phenomenon is considered as an area of secondary hyperalgesia resulting from neurogenic inflammation in muscles that were not initially structurally and physiologically damaged. According to these ideas, MFPS is a complex form of neuromuscular dysfunction, which is represented by soft tissue damage with the development of peripheral and central sensitization as a result of neurogenic inflammation, changes in the functioning of limbic system structures. MFPS is a clinical diagnosis, based on the presence of painful spasmodic muscles, painful muscle indurations, active trigger points with zones of reflected pain. The sensitivity and specificity of clinical tests for MFPS have not been determined. Currently, there are no proven universally accepted criteria (such as biomarkers, electrophysiological evaluation, imaging, diagnostic blocks, etc.) for objectifying or quantifying MTPs. Nonpharmacological interventions with the most proven effectiveness include therapeutic exercises and psychotherapeutic techniques, other methods are of secondary importance. The effectiveness of aceclofenac (Aertal®) and the muscle relaxant tolperisone (Mydocalm®) in the of MSP treatment is discussed. It is noted that a new form of tolperisone – Mydocalm®-Long 450 mg - can reduce the frequency of drug administration, provide a proven and predictable therapeutic effect, and increase treatment adherence.

CLINICAL OBSERVATIONS 

105-109 90
Abstract

The article focuses on a rare form of primary headache – migraine with brainstem aura (previous term – basilar migraine). The place of this form in the International Classification of Headache Disorders is indicated, diagnostic criteria and clinical features are given. Clinical case of migraine with brainstem aura in a young man is presented. The effectiveness of the acute treatment and preventive therapy are discussed; features of the above case are analyzed.

110-116 148
Abstract

Alzheimer's disease (AD) is the most common cause of cognitive impairment in adults. There are two main forms of AD: early-onset (onset before 65 years) and late-onset (onset after 65 years). Early-onset AD accounts for at least 5% of all disease cases. The risk of early-onset AD increases in the presence of a family burden and a history of traumatic brain injury. However, it is less associated with cerebrovascular disease, diabetes mellitus, and obesity compared to late-onset AD. The article provides a review of current publications on the diagnostic and treatment problems in early forms of AD. Clinical, neuropsychological and neuroimaging differences between AD with early and late onset are presented.

On the example of a clinical observation of a patient with AD with an onset at the age of 38 years, stabilization of the cognitive defect for 6 months and a decrease in the severity of emotional and behavioral disorders after Akatinol Memantine administration are shown. The main problems of management of young patients with AD are considered.

CLINICAL GUIDELINES 

117-125 71
Abstract

Botulinum therapy for cerebral palsy (CP) is considered not only as one of the effective approaches for the treatment of increased muscle tone and spasticity, but also as a method of excessive salivation correction. The article presents an overview of the results of Russian and foreign studies on the efficacy and safety of incobotulinumtoxinA for the treatment of spasticity of the lower and upper limbs, as well as sialorrhea in patients with CP. The article also provides a consensus opinion of Russian specialists working with patients with CP and using Xeomin (incobotulinumtoxinA) in their practice for the treatment of spasticity and sialorrhea. This consensus was based on the results of a Russian retrospective multicenter study on the use of incobotulinumtoxinA for the treatment of spasticity and sialorrhea in CP, data from recently published international clinical trials, and our own clinical experience. We present detailed practical recommendations on the calculation of the total dose of incobotulinumtoxinA per procedure for the treatment of spasticity in CP, on the calculation of incobotulinumtoxinA dose for the most common target muscles (lower and upper limbs) for spasticity treatment in CP, on incobotulinumtoxinA dilution and dose calculation for sialorrhea treatment in children, on incobotulinumtoxinA dilution and dose calculation for simultaneous treatment of spasticity and sialorrhea in CP. We justify incobotulinumtoxinA use, when simultaneous treatment of spasticity and sialorrhea is necessary, which allows reducing the intervals between repeated injection cycles. IncobotulinumtoxinA use in children with CP demonstrates a favorable safety profile, including long-term use.



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