Neurology, Neuropsychiatry, Psychosomatics

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Vol 14, No 4 (2022)
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4-11 201

Infective endocarditis is a serious diagnostic and therapeutic challenge for doctors of many specialties. In order to form a structured approach to patient management, the article discusses the key points regarding the neurological aspects of the disease, which are formulated in ten rules. They cover the clinical diagnosis of endocarditis in patients with stroke, features of reperfusion therapy, approaches to prescribing antithrombotic and antibiotic therapy, as well as issues of surgical treatment.


12-19 290

The use of high-frequency repetitive transcranial magnetic stimulation (rTMS) in patients with a drug-resistant depressive episode is associated with a high variability of its effect, which determines the relevance of the search for predictive biomarkers of the effect.

Objective: to search for neuroimaging biomarkers of the clinical effectiveness of navigational rTMS in patients with a drug-resistant depressive episode.

Patients and methods. The study included 30 patients with a drug resistant depressive episode who underwent 20 sessions of navigational highfrequency rTMS of the dorsolateral prefrontal cortex (DLPFC) of the left hemisphere. We performed an analysis of correlations between functional connectivity and gray matter volume (GMV) in given areas (before rTMS) with the degree of reduction in the Beck score for assessment of depression and the presence of a clinically significant response to therapy.

Results and discussion. A relationship was shown between the clinical effect and low values of functional connectivity between the subgenual cingulated cortex and DLPFC of the right hemisphere. A relationship was found between a decrease in the severity of symptoms of depression and the volume of GMV in the insula, inferior frontal gyrus, temporal pole, superior temporal gyrus, and median cingulate cortex of the left hemisphere, as well as a relationship between the presence of a significant response to therapy and the volume of GMV in the insula, inferior frontal gyrus, temporal pole and superior temporal gyrus on the left.

Conclusion. The obtained results may become a prerequisite for the development of individual predictive biomarkers of the effectiveness of rTMS in patients with a resistant depressive episode.

20-24 343

The use of neuroimaging diagnostics of Chiari malformation type 1 (CM1) allows us to expand our understanding of both the spectrum of clinical manifestations of the anomaly and its radiological characteristics. New approaches in the study of the CM1 symptom complex include cognitive dysfunction and the mechanisms of its formation. Of great research interest is the previously unexplored relationship of cognitive dysfunction in patients with CM1 with different degree of tonsils ectopia.
Objective: to identify the features of the cognitive status in patients with CM1 and to assess the relationship of CM1 with the degree of cerebellar tonsil ectopia.
Patients and methods. The study included 110 adult patients with CM1 aged 25.61±6.9 years. The control group consisted of 50 people aged 26.36±5.0 years without signs of CM1 and other organic brain pathology. The assessment of neuroimaging parameters was carried out on a magnetic resonance tomograph with a magnetic field induction of 1.5 T. Cognitive status was assessed using the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Trail Making Test (TMT; subtests A and B – TMTA, TMTB).
Results and discussion. When assessing the cognitive status of patients with СM1 and those of the control group, statistically significant differences were determined in the domains of executive functioning, visuospatial skills, attention, delayed recall, and speech. All patients, regardless of the degree of cerebellar tonsil ectopia, had lower cognitive performance compared to the control group. There was a trend towards an increase in cognitive deficit with an increase in the degree of ectopia of the cerebellar tonsils. The most pronounced cognitive deficit with a significant decrease in the domains of executive functioning, visuospatial skills, attention, delayed recall and speech was noted in a subgroup of patients with a high degree of tonsil ectopia.
Conclusion. The presence of a specific cognitive deficit in patients with СM1 was revealed, and a significant relationship between cognitive dysfunction and the degree of cerebellar tonsil ectopia was established.

25-32 170

The widespread use of statins for cardiovascular complications prevention makes it important to study their effects on the body. There is still no unambiguous opinion regarding the effect of statins on cognitive functions (CF).
Objective: to evaluate the effect of a 12-week course of statins on the parameters of oxidative stress and CF in patients with cerebral atherosclerosis (CA) and moderate cognitive impairment.
Patients and methods. 106 patients aged 45–75 years with CA and vascular risks were included, they received stable therapy for 12 weeks, including antihypertensive, nootropic drugs, antiplatelet agents and statins with stable dose and combination of drugs. At baseline and after 12 weeks of treatment, parameters of oxidative stress using Fe2+-induced chemiluminescence and cognitive phenotype, using the MoCA test, including MoCA indices, were assessed in two groups of patients: treated with statins (group 1; n=34) and those who did not receive statins (group 2; n=72).
Results and discussion. In patients of group 1, more pronounced manifestations of oxidative stress and lower initial values of CF indicators were revealed. The therapy made it possible to achieve an improvement in cognitive performance in all patients, but an improvement in oxidative performance was only in group 1. The positive effect of statins on CF was manifested as a significant increase in attention- (by 1.5 points versus 0.1 points; p<0.05) and memory- (by 0.9 points against 0.2 points; p<0.05) indicators; and on the oxidative status – an increase of the indicator of resistance of lipoproteins to lipid peroxidation (LPO) by 25.9 sec vs. 3.5 sec (p<0.05) and a decrease in the activity of LPO processes (-13.6 mV vs. 39.1 mV; p<0.05).
Conclusion. The 3 month therapeutic course of statins in patients with CA and vascular risks helps to reduce the manifestations of oxidative stress and improve attention and mnestic function.

33-37 204

Objective: to study the connection between smoking and sleep disorders in the open population of 45–64 year old in Novosibirsk.
Patients and methods. IV screening of the population was carried out in 2003–2005, 1650 persons were examined (576 men, mean age – 54.23±0.2 years, response – 61%; 1074 women, mean age – 54.27±0.2 years, response – 72%). Attitudes towards smoking were studied using the scale “Knowledge and attitude to one's health” of the WHO “MONICA-psychosocial” program. To study sleep disorders and sleep duration, a standard Jenkins questionnaire was used.
Results and discussion. In an open population of 45–64 years of age, 65.8% of men experienced sleep problems (satisfactory sleep – 53.6%, poor sleep – 12.2%) and 78.6% of women (satisfactory sleep – 58.9%, poor sleep – 19.7%; χ2 =38.553; df=2; p<0.001). 78.9% of men and 34.7% of women smoked (χ2 =313.175; df=5; p<0.001). Men who smoke more often rated sleep as “bad” (82.9%) than “good” (76.2%; χ2 =32.267; df=10; p<0.001). Women who tried to quit smoking were more likely to have “bad” sleep (4.7%) than “good” sleep (2.6%; χ2 =69.747; df=10; p<0.001). Among male smokers, the duration of sleep was 5–6 hours (76.9%) more often than 9–10 hours (67.6%; χ2 =3.696; df=2; p>0.05). Women who smoke were more likely to report 5–6 hours of sleep (30%) than 9–10 hours (18.2%).
Conclusion. It has been established that smoking men and women aged 45–64 are more likely to experience both sleep disorders and lack of sleep.

38-43 5046

A decrease in the quality of life (QoL) in cervical dystonia (CD) is often due to anxiety and depressive manifestations. However, the change in the emotional state of patients with CD after botulinum therapy has not been studied enough.
Objective: a comparative analysis of the severity of anxiety and depressive disorders in CD and their dynamics during the year with a decrease in movement disorders during botulinum therapy.
Patients and methods. 25 patients with CD (9 men and 16 women) and 25 healthy volunteers (11 men and 14 women) were examined. The severity of CD was assessed using the Tsui Rating Scale. To assess the level of anxiety, the GAD-7 scales were used, depression – PHQ-9. The EQ-5D questionnaire was used to assess the quality of life. The emotional state was assessed before and after 4, 8 and 12 months of the correction of movement disorders using botulinum therapy. The control group was examined at similar time intervals.
Results and discussion. Patients with CD have a significant increase in anxiety (13.5±3.6) and depression (7.72±5.2), as well as a decrease in QoL (66.6±11.0) compared with the control group (p<0.001). Anxiety symptoms show a significant dependence on the clinical severity of CD symptoms and regress against the background of successful botulinum therapy – from 13.50±3.6 at the time of the first visit to 8.20±2.9 (p<0.001) by the fourth visit. Depressive symptoms do not depend on the motor manifestations of CD and do not improve as a result of successful botulinum therapy, tending to increase from 7.72±5.2 to 10.12±5.8 (p<0.05).
Conclusion. The persistence of depression after successful botulinum therapy in CD indicates its role as an emotional manifestation of the disease independent of motor disorders.


44-50 162

Currently, there is no single algorithm for the treatment of acute tandem occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA). The article presents the clinical case of ischemic stroke, which developed 10 days after the first ischemic episode with hemorrhagic transformation. As reperfusion therapy, thrombectomy from the M1 segment of the left MCA and simultaneous stenting of the left ICA were performed. The use of dual antiplatelet therapy at a loading dose in this clinical case was justified by the risk of stent thrombosis, but this increased the risk of recurrent hemorrhagic transformation. Follow-up of the patient for 90 days after this vascular event showed a favorable clinical outcome without hemorrhagic complications. The presented clinical case is extremely rare and shows one of the possible approaches in the management of patients with tandem lesions of the brachiocephalic arteries with a history of intracranial hemorrhagic complications. To develop a unified algorithm for managing acute tandem occlusion in recurrent ischemic strokes, more observations are needed.

51-53 265

Apathy is one of the most common manifestations of neurodegenerative pathology, including Alzheimer's disease (AD). Despite such a significant role of apathy in the course of the disease, there are no unambiguous recommendations for the treatment and prevention of this symptom complex. Some classes of psychotropic drugs commonly prescribed for AD, such as antidepressants of the SSRI class, may themselves cause apathy. The authors present a series of clinical observations describing four cases of deterioration in the condition of patients with AD during SSRI therapy. The features of the clinical course of the disease are discussed, new strategies for drug therapy are proposed.

54-61 269

The management of patients with chronic pelvic pain (CPP) is a serious problem, the solution of which is in the complex interdisciplinary approach. The article describes the neurological aspects of the disease, including musculoskeletal and neurogenic causes of pain. Treatment of patients should be aimed at both the anatomical cause of pain and the correction of emotional disorders. Education and patient involvement in the treatment program are important. In the presence of a nociceptive source of pain in the form of myofascial or joint pain, treatment is carried out in accordance with general recommendations for the treatment of musculoskeletal pain and includes non-steroidal anti-inflammatory drugs and myorelaxants administration. We present our own clinical observation, which reflects a comprehensive approach to the treatment of a patient with CPP.

62-67 223

A clinical observation of a patient with subacute nonspecific lower back pain and comorbid panic disorder is presented; it illustrates a modern approach to the management of this type of patients. Subacute back pain is the transition from acute to chronic pain. Clinically, the pain becomes constant, exhausting the patient and reducing his quality of life, and pathophysiologically, the pain transforms from nociceptive to dysfunctional. Chronicity of musculoskeletal pain does not occur in conditions of mental and social well-being, the patient necessarily has the so-called “yellow flags” – factors that contribute to central sensitization and chronic pain. In the presented clinical case, the most common “yellow flags” were identified – anxiety, misunderstanding about the causes of back pain, pain catastrophizing, restrictive “pain” behavior. These factors are often found among patients with subacute back pain. It is important to identify “yellow flags” timely and treat patient taking into account their correction. For the treatment of this category of patients, the prescription of pain therapy alone is not enough, an interdisciplinary approach is needed, which will include rational pharmacotherapy, psychological methods and kinesiotherapy.
The patient underwent interdisciplinary treatment, including non-drug and drug therapies and in accordance with Russian and foreign clinical guidelines for the treatment of subacute nonspecific lower back pain and panic disorder. Non-drug treatment consisted of educational talks, recommendations for daily activities, cognitive behavioral therapy, and kinesiotherapy. These methods were aimed at forming the patient's correct ideas about his condition, at reducing the catastrophizing of pain and anxiety, and at increasing the patient's physical and social activity. It is known that many patients with pain syndromes have insufficient adherence to treatment and adherence to medical recommendations. Patient adherence to non-drug treatments was maintained through educational conversations and cognitive-behavioral therapy. Taking into account the previous multiple intake of non-steroidal anti-inflammatory drugs and in order to avoid the risk of side effects, drugs of this group were not included in the present pharmacotherapy plan. The patient was prescribed Alflutop as a pharmacotherapy. After 10 days of treatment, a marked relief of pain was observed, and after 3 weeks of treatment, back pain regressed, and anxiety significantly decreased. The patient has formed correct ideas about his condition, about his lifestyle. Follow-up of the patient for 12 months showed that there were no repeated episodes of back pain and panic attacks. The patient continued to regularly engage in kinesiotherapy and maintain an active lifestyle.


68-74 238

Oxidative stress is one of the main mechanisms for the development of Alzheimer's disease (AD); it is closely related to other key mechanisms of neurodegeneration such as mitochondrial dysfunction, inflammation, dysregulation of metal homeostasis, and protein misfolding. We have considered the role of beta-amyloid plaques and neurofibrillary tau-glomeruli in the development of AD. We analyzed the role of the products of oxidation of proteins, lipids and nucleic acids in the pathogenesis of the disease, which can be considered as markers of an early stage of AD. The main mechanisms of mitochondrial dysfunction, the damaging effect of accumulating metals under oxidative stress, as well as the role of brain hypoperfusion in its occurrence are considered.

75-81 147

Despite progress in the development of treatments and prevention for the new coronavirus infection COVID-19, there is still insufficient data on the impact of the global pandemic on people's mental health, in particular on the nature of mental disorders resulting from both the impact of SARS-CoV-2 on the central nervous system, and the impact of stress factors associated with the pandemic on the mental state, which indicates the relevance of the problem and the need for further research. The article presents data on mental disorders that occur for the first time in life under the influence of restrictive measures, quarantine and other factors caused by the epidemic in the general population. The specificity of the influence of these factors on persons diagnosed with mental illness is also shown. The papers that present the results of studies of mental disorders in patients in the acute period of infection and after recovery are analyzed. The possible consequences of COVID-19 for the mental health of people are considered.

82-86 153

The review article provides data on the prevalence and treatment problems of depression, highlights the issues of adherence to antidepressant therapy, investigation of the safety and efficacy of agomelatine in real clinical settings. The results of a prospective observational multicenter cohort study of agomelatine in clinical practice are analyzed in detail, taking into account the effect of treatment on the social functioning of patients. The results obtained in a sample representative for depression, including patients with comorbidities, confirm the long-term efficacy and good tolerability of agomelatine in daily practice, which is the basis for adherence to therapy and achievement of the goal of depression treatment

87-95 229

The article presents new views on the treatment of pain syndromes in musculoskeletal diseases, in particular in osteoarthritis (OA) of various localizations (gonarthrosis, coxarthrosis). New recommendations (2019–2020) of international societies for the study of symptomatic delayedacting drugs (SYSADOA) and their use in the treatment of OA are presented. We present the opinions of experts from different communities: the American College of Rheumatology (ACR, 2019), the European Alliance of Associations for Rheumatology (EULAR, 2019), the European Society for the Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO, 2020) – on the prescription of SYSADOA, which include chondroitin sulfate (CS), glucosamine sulfate (GS), avocado and soy unsaponifiable compounds, diacerein, hyaluronic acid for intraarticular administration. New domestic clinical guidelines (2020–2021) for the treatment of OA are presented. The changes that have taken place in the terminology of pain and in the classification of pain syndromes, reflected in the new International Classification of Diseases of the 11th revision (ICD-11), are analyzed. New approaches to the stratification of OA, taking into account endo- and phenotyping, as well as new aspects in pain therapy associated with the molecular genetic mechanisms of SYSADOA are shown. According to the EULAR recommendations, there is indisputable evidence of the efficacy and safety of pharmaceutical CS, which is reflected in a meta-analysis (2019), a randomized placebo-controlled trial (2019), approved by the Russian Ministry of Health, and confirmed in Chondroguard’s meta-analysis of clinical trials (2020). New approaches in the treatment of pain syndromes provide for parenteral administration of CS and GS according to an intermittent scheme. The search and development of new molecules comparable in efficacy to SYSADOA in the treatment of pain in OA and low back pain have led to the emergence in clinical practice of biologically active compositions, including undenatured type II collagen, the effectiveness of which is associated with a neuroimmune mechanism of action.

96-102 426

The pathogenesis of the development of cognitive impairment (CI) associated with the SARS-CoV-2 virus is complex and includes the direct neurotoxic effect of the virus, vascular, disimmune factors, artificial lung ventilation, and adverse psychological consequences of social isolation. The relationship between CI and SARS-CoV-2 infection appears to be two-way: patients with premorbid CI have a higher risk of infection, severe illness, and death; on the other hand, past infection with SARS-CoV-2 may stimulate the clinical onset and progression of CI, including Alzheimer's disease. For the treatment of severe CI after COVID-19, memantine (akatinol memantine) is recommended.

103-107 338

Mental and cognitive impairments are common non-motor symptoms of Parkinson's disease (PD), which affect more than half of patients at various stages of the disease. These symptoms significantly reduce the quality of life of patients and their relatives. The article reflects the features of the pathogenesis of mental and cognitive impairments in PD, as well as the role of the dopamine receptor agonist piribedil in their correction. Piribedil, having a good safety and tolerability profile, and also, presumably, having a positive effect on such non-motor symptoms of PD as increased daytime sleepiness, depression, apathy, anhedonia and cognitive functions, can significantly improve the quality of life of patients and their adherence to therapy.


108-113 221

On July 6, 2022, an interdisciplinary meeting of the Expert Council was held on the topic "Control of dyslipidemia in the prevention of acute and recurrent ischemic cerebrovascular accidents". The conclusion of the Expert Council was that after verification of a lipid metabolism abnormality, in patients with ischemic stroke (IS) and transient ischemic attack (TIA) it is recommended to start or continue statin therapy as early as possible. For secondary prevention of IS, it is necessary to achieve the target level of low-density lipoprotein cholesterol (LDL-C) set for each category of cardiovascular risk, with consistent administration of the maximum tolerated dose of statins with biochemical monitoring of the effectiveness and safety of therapy in the interval of 4–12 weeks. The insufficient effectiveness of statins requires the inclusion of ezetimibe therapy and the decision to increase the dose of statins; in case of intolerance to statins and / or contraindications to their administration, early administration of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors: evolocumab, alirocumab – or an PCSK9 synthesis inhibitor, inclisiran, should be considered. At a LDL-C level of >5.0 mmol/l in patients of the extreme or very high risk group who have had atherothrombotic IS / TIA, necessary administration of a combination including a statin, ezetimibe and an PCSK9 inhibitor (evolocumab, alirocumab) or a PCSK9 synthesis inhibitor (inclisiran) should be considered as early as possible.

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