Neurology, Neuropsychiatry, Psychosomatics

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Vol 2, No 3 (2010)


6-11 871
The paper considers the specific features of the diagnosis and treatment of parkinsonism in young and middle-aged patients. It is stressed that early-onset Parkinson's disease (PD) shows a number of the specific features of the mechanism responsible for the development, clinical picture, and course, as well as a response to antiparkinsonian agents, and prognosis. Indications for the use of different groups of antiparkinsonian drugs and the basic principles of management in young and middle-aged patients are discussed. Emphasis is laid on the key role of non-ergoline dopamine receptor agonists in the treatment of patients with PD. Approaches to correcting the non-motor symptoms of PD and current indications for neurosurgical treatment are considered.
12-17 1772
The paper analyzes clinic symptomatology and an algorithm for diagnosis, preventive and syndromic treatment, and rehabilitation in patients with different forms of hypertensive dyscirculatory encephalopathy, such as subcortical arteriosclerotic encephalopathy and hypertensive multi-infarct encephalopathy.
17-21 1000
The paper describes the basic problems in the diagnosis and treatment of diseases accompanied by vertigo. In particular, it discusses the specific features of vertigo terminology, the overestimation of the value of cerebrovascular diseases and degenerative cervical spine changes in the development of vertigo and the underestimation of a role of peripheral vestibular diseases and psychogenic disorders in the genesis of different forms of vertigo. Emphasis is placed on the importance of vestibular exercises in the complex treatment of diseases manifesting themselves as vertigo. In addition, the possibilities of drug-induced stimulation of vestibular compensation are discussed.
22-29 1090
In most cases, spinal nerve root lesion is due to vertebral causes, such as disk herniation, degenerative changes in the intervertebral joints, and a narrow vertebral canal. The paper considers the pathogenetic mechanisms responsible for the development of discogenic radiculopathy and its associated pain syndrome and main approaches to its diagnosis and treatment. Some attention is given to therapy for neuropathic pain syndrome.
30-34 679
The paper considers the causes and risk factors of chronic lumbosacral pain. Particular emphasis is placed on the differential diagnosis of specific and nonspecific low back pain. It analyzes in detail the efficiency of various treatment modalities for chronic low back pain in the context of evidence-based medicine and the efficacy of nonsteroidal anti-inflammatory drugs.



47-52 928

Objective: to evaluate the efficacy and tolerability of sustained-release sodium valproate sodium as first-line monotherapy in patients with newly or recently diagnosed focal epilepsy.

Subjects and methods. This was an open-label, prospective, observational study performed in the real treatment setting. It covered 1580 patients (children older than 6 years and adults) with focal epilepsy. The patients received sustained-release sodium valproate in an average daily dose of 1268 mg for 6 months. Therapeutic effectiveness was evaluated from remission rates when the study was completed. Moreover, the proportion of patients who continued to take the drug following 6 months was estimated. The total efficiency of the therapy was evaluated by the Clinical Global Impression Scale (CGI).

Results. At 6 months of the study, 1478 (93.5%) patients continued to take the drug, 1167 (73.9%) of the 1580 patients achieved remission (they were seizure-free). The drug proved to be effective in all types of epileptic seizures of different etiology and different localization of an epileptic focus. In complex partial seizures and secondary generalized seizures, the efficiency of sustained-release sodium valproate was somewhat higher than that in simple partial seizures [71.1% (477/672), 74% (853/1153), and 68.4% (476/697), respectively]. During treatment, 67.9% (1072/1580) of the patients showed an evident and significant improvement without side effects. The drug was well tolerated. Drug-induced side effects were observed in 139 (8.8 %) of the 1580 patients; these were mild and moderate and led to drug discontinuation in only 10 (0.6%) of the 1580patients. The most adverse events were weight gain in 1.8% (29/1580) of the patients, alopecia in 1.8% (28/1580), and tremor in 1.5% (25/1580).

Conclusion. The study indicates that the use of sustained-release sodium valproate is an effective and well tolerable first-line drug for the treatment of focal epilepsy in children and adults.

52-57 949

Objective: to obtain additional Russian data on the efficacy of Depakine Chronosphere as first-line monotherapy in the treatment of epilepsy in children without epileptic encephalopathy.

Subjects and methods. This was a short-term open-label, prospective observational study performed in the real treatment setting. The observation of patients lasted at least 2 months. The study included 297 patients aged 2 months to 17 years with varying epilepsy other than epileptic encephalopathies. The patients received Depakine Chronosphere in an average daily dose of 26.9±8.2 mg/kg. The efficacy of the drug was objectively evaluated from the change in the number of attacks; in addition, a physician and a patient or his/her parents made a subjective assessment of therapeutic effectiveness. The safety of therapy was judged from the reports made by the patients ' parents on adverse events recorded during the observation period.

Results. More than 90% responded to Depakine Chronosphere well (epileptic seizures ceased or reduced in number). Epileptic seizures completely disappeared in 48.8% of the patients. The drug proved to be effective in different (both partial and generalized) forms of epilepsy. Depakine Chronosphere was well tolerated in this study. No adverse events were seen in 7.41% of the patients and permitted the drug to be discontinued in as low as 0.34%. The physicians and the patients' parents unanimously evaluated therapeutic efficiency as very good and good in more than 90% of cases.

57-63 1004

Criminal clozapine (azaleptin, leponex) intoxications are notified very frequently (as high as 99.7% of all criminal intoxications) and have virtually supplanted earlier predominant clofelin poisoning.

Objective: to identify the characteristic clinical features of acute clozapine intoxications to make their differential diagnosis with the similar acute states that are most frequently encountered at the prehospital stage.

Subjects and methods. A total of 4757 patients diagnosed as having criminal clozapine intoxication, followed at the Toxicology Unit, Prof. A.A. Ostroumov City Clinical Hospital Thirty-Three, in 2003 to 2009, were examined and their case histories were analyzed. There were 4474 (94.05%) men and 283 (5.95%) women. The patients aged less than 21 years were 10.6%; those of 21 to 60 and over 60 years of age were 88.7 and 0.7%, respectively. None of them had been followed by a psychiatrist and had systematically taken any psychotropic drugs. Most (54%) of the victims were the capital's guests. Clinical and laboratory studies were used to examine the patients. The pattern and situational features of the intoxication were revealed; the leading clinical syndrome and its degree were established. The group patients' conditions were rated on admission, by applying the integral APACHE-2 scale; the Glasgow coma scale was used to determine the degree of impaired consciousness. The patients' status was analyzed by clinico-anamnestic and clinicopsychopathological studies, as well as by a neuropsychological test after abolishing sopor and coma and then on days 3 and 5 of inpatient treatment.

Results. The interval between intoxication to the arrival of an emergency team (ET) was 30 min to 5 hrs (mean 1.43+0.68 hrs). During this period, the level of consciousness reduced with on-going agent absorption, changing from torpor to sopor or coma. ET sent 98.3% of the patients to hospital for the diagnoses of alcoholic intoxication, alcoholic surrogate, opiate, or clofelin poisoning, closed brain injury, or coma of unknown etiology. On admission, the patients' condition was rated as severe in 98.5% and moderate in 1.5%. Stage I intoxication was present in 17 (0.35%) patients; Stage IIA in 4579 (96.25%), IIB in 75 (1.57%), III in 1 (0.02%), and IV in 85 (1.86%). The patients were found to have peculiar mnestic disorders. Intensive care comprised complex detoxification, infusion therapy, and vitamin therapy; respiratory support was also made in the absence of respiratory disorders. Prominent in the therapy was the use of the antidote intravenous aminostigmine and galantamine bromide in a dose of 2-3 mg. During therapy, there was consciousness recovery for an average of 1.22+0.68 hours with psychomotor excitement developing within 40-90 min and giving way to the significant asthenic syndrome that preserved within 16-30 other hours. Three patients died; 2 of them were patients with Stage IIB with comorbidities.

Conclusion. Criminal clozapine intoxications are distinguished by the fact that they generally occur in the street (97.75%) or public area; the intoxication victims are socially preserved patients; moreover, their money and valuables practically always disappear. In addition, the intoxications are characterized by the rapid development of severe disorders of consciousness, a short-term toxicogenic phase, and a rarity of severe in-hospital complications (from 1.2% in Stage IIA to 3.5% in Stage IIB; no bronchopulmonary complications in Stages I and IV). Fatal outcomes in criminal intoxications are recorded in 00.11% of cases whereas those are in 10-18%. The specific features of the course of criminal clozapine intoxications seem to lie in the combined effects of clozapine and ethanol on the central nervous system and their synchronous metabolism.

64-70 628

Objective: to study personality characteristics, behavioral style, and modes of relations with their people in patients with somatized disorder.

Subjects and methods. Eighty-six patients diagnosed as having somatized disorder were examined using Leary's interpersonal diagnosis system.

Results. The author revealed the following personality characteristics and behavioral styles: a depressed need for authoritarianism, dominance, autonomy, aggressiveness, a display of qualities, such as superfriendliness, benevolence, submissiveness, dependency, and suspiciousness. These characteristics give an insight into the development of somatization in patients with somatized disorder.

67-70 1185
Citicoline (Ceraxon) is a neuroprotective agent used in acute ischemic stroke (IS) and chronic cerebrovascular diseases. The efficiency and safety of Ceraxon intravenously in a dose of2000 mg/day for 10 days, then orally for 35 days with evaluation of its effect on cognitive functions were studied in 24 patients (13 men, 11 women; mean age 68.2+9.3 years) with IS. During treatment, none of the patients died or developed recurrent stroke, myocardial infarction, or other vascular events. A gradual regression of neurological disorders and a lower degree of disability were observed in most patients (18/24). Ceraxon was found to have a positive effect on cognitive function and their improvement on day 45 after disease onset. The findings agree with the results of the multicenter studies showing the efficacy and safety of citicoline in IS.
72-75 512

Objective: to study baseline autonomic tone and autonomic responsiveness in patients with neuroreflectory syncopal states (NSS) during a passive orthotest in orthostatic and clinostatic phases.

Subjects and methods. A study group comprised 40 patients with NSS, a comparative group included 57 patients with panic attacks (PA); a control group consisted of 22 subjects without the above conditions. Cardiac rhythm variability was estimated applying a Neuron-spectrum device.

Results. During the orthotest, the patients with NSS showed inadequate activity of the sympathetic nervous system as compared with the patients with PA and the control group. At the same time, the clinostatic test revealed that the indicators restored to the normal values in patients with NSS, unlike in those with PA.


76-80 639
The epidemiology, symptomatology, pathogenesis, diagnosis of post-stroke spasticity, and its basic treatment principles based on the current methods of evidence-based medicine are described. Possibilities for post-stroke spasticity therapy with botulinum, in particular botulinum toxin type A (Xeomin) used in these patients, are discussed.
80-86 1258
Due to its high prevalence and diversity of its forms, chronic neocancer pain is noted to have become a serious medical problem. Chronic pain is regarded as an independent disease, not a symptom of any disease, which calls for special attention and complex etiopathogenetic treatment.
The paper gives the characteristics and causes of pain syndromes and an algorithm for the treatment of chronic pain. It is stated that treating patients with chronic neocancer pain requires that its clinical features be kept in mind; moreover, treatment should be itself safe and effective. Drugs must be used for a long period, by strictly following the schedule in individual doses.
87-90 1969
The paper describes the present view of the problem of insomnia and gives a classification of sleep disorders and basic methods for their drug and non-drug therapy. Emphasis is placed on the role of the objective sleep study - polysomnography. The use of the current hypnotics belonging to a three Zs group and the minimization of administration of benzodiazepines are most important in pharmacotherapy for insomnia. The results of a clinical polysomnographic study of the effect of Zolpidem (Sanval) in patients with insomnia are presented. The subjective evaluation of the beneficial effect of a 10-day course of Sanval is confirmed by the objective studies of the sleep pattern undergoing positive changes in the most important indicators, such as the process of falling asleep, the time of intrasleep awakenings, and the duration of Δ-sleep. The high safety and good tolerability of Sanval permit the latter to be assessed as an effective agent for the treatment of insomnia.

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