Neurology, Neuropsychiatry, Psychosomatics

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Vol 14, No 6 (2022)
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4-11 226

The epidemiology of vestibular migraine (VM), which is the most common cause of episodic dizziness, is discussed. The pathogenesis schematic is discussed, the key feature of which is the disturbance of the interaction of trigemino-vascular system, nociceptive centers of the brain stem, thalamocortical networks and the vestibular system. The clinical picture of the disease is presented in the form of spontaneous, positional, visually induced and head movement-induced dizziness, cochlear and other symptoms. The relation of vestibular symptoms and headache was analyzed. The data of neurological and vestibular examination are reflected, the features of positional nystagmus are considered in detail. The diagnostic criteria of the disease are presented. Approaches to VM attacks relief and prevention are considered.


12-19 176

Improving the function of the upper limb in children with cerebral palsy (CP) is one of the main tasks of rehabilitation treatment and socialization of the patient.
Objective: to determine the dynamics of the concentration of neurotrophic factors (NTFs) in the peripheral blood of children with CP during rehabilitation treatment using the non-invasive interface “brain – computer – exoskeleton of the hand” (“NIMK – exoskeleton of the hand”).
Patients and methods. 151 patients aged 12 to 18 years with spastic forms of CP were examined. The complex of rehabilitation treatment included training on the hardware and software complex “NIMK – Exokist-2”. The dynamics of the spasticity level, muscle strength in the paretic limbs, the level of household skills, the concentration of NTFs (brain growth factor – BDNF; neurotrophins 3 and 4/5 – NT-3, NT-4/5; fibroblast growth factors – FGF-1 and FGF-2) in peripheral blood were determined.
Results and discussion. A positive result was obtained from the use of the combined technique “NIMK – exoskeleton of the hand” in the rehabilitation of children with CP due to an increase in the upper limbs muscle strength, an increase in working capacity, an improvement in everyday skills and stability of attention. At the same time, a significant decrease in the concentration of a number of NTFs was noted: BDNF, NT-3 and NT4/5, FGF-1 and FGF-2 – on the 10th day after the completion of rehabilitation treatment.
Conclusion. The results of clinical and laboratory studies show that during the use of the “NIMK – exoskeleton of the hand” technique the improvement in the upper limbs motor functions in children with spastic forms of CP is associated with a decrease in the concentration of NTFs in the peripheral blood, which may indicate their active involvement in this process.

20-24 156

Objective: to establish the clinical structure of mental disorders in patients with verified diagnosis of cervical dystonia (CD), as well as their impact on the severity of a neurological disease and quality of life.
Patients and methods. 43 patients (35 women, 8 men, mean age 40.67±10.4 years) with primary CD were examined using clinical and psychopathological methods, i.e. anamnestic data and psychometric methods (CDQ24, HADS, PSQI, TAS, SF-36).
Results and discussion. Four groups of patients were distinguished: 1) without mental pathology, 2) with conversion and dissociative symptoms, 3) with social phobia, and 4) with a history of psychotic episodes. It was shown that the severity of CD increased in the row of the described groups, however, psychopathological symptoms determined the severity of CD only in patients with social phobia and psychotic episodes. The only predictor of a decrease in the mental component of quality of life was a high level of anxiety.
Conclusion. Some patients with CD have comorbid mental disorders that require psychotherapeutic and psychopharmacological assistance.

25-32 139

In-hospital ischemic stroke (IHIS) is one of the most critical competing diseases that can develop in patients during inpatient treatment. Causes associated with diagnostic and therapeutic measures may play an additional role in the pathogenesis of IHIS, in addition to traditional risk factors.
Objective: to study the pathogenesis features and assess risk factors for IHIS.
Patients and methods. The comorbidity, main and additional risk factors of IHIS in patients of therapeutic (n=112; 44.3%), surgical (n=125; 49.4%) and neurological (n=16; 6.3%) profiles were studied.
Results and discussion. The proportion of perioperative stroke in the study was 37.2%. The frequency of atherothrombotic, cardioembolic, and lacunar subtypes of IHIS did not differ in groups of patients of different profiles. In the group of surgical patients, the proportion of strokes of another established etiology was 24.8% and was higher than in therapeutic (9.8%; p<0.05) and neurological (6.25%; p<0.005) patients. The proportion of strokes of unknown etiology in the group of surgical patients, on the contrary, was lower (15.2%) than in patients with therapeutic (35.7%; p<0.05) and neurological (50.0%; p<0.05) profile. An additional risk factor for IHIS for non-surgical patients was insufficient antithrombotic prophylaxis, for surgical patients – surgery.
Conclusion. Compared with out-of-hospital ischemic stroke, the causes of in-hospital ischemic stroke are more diverse and cannot always be explained solely by the higher comorbidity of hospitalized patients. The TOAST classification of ischemic stroke subtypes does not fully reflect the pathogenesis of IHIS, as it does not take into account the possibility of external influences, especially in cases where it is not possible to establish the exact cause of stroke, and the most likely trigger is medical intervention.

33-39 136

Objective: to study the causes and predictors of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness.
Patients and methods. We examined 100 patients who turned to a psychiatrist due to a deterioration in their mental state during the pandemic, 50 patients were newly diagnosed (Group 1) and 50 with previously diagnosed mental disorders (Group 2). The study was carried out by a clinical method using a specially designed map, followed by statistical processing of the obtained data.
Results and discussion. Mental disorders caused by the COVID-19 pandemic more often occurred at a young age, in patients with higher and secondary specialized education, and in single patients. In the 1st group, as a result of exposure to psychogenic factors (the influence of the media, quarantine, economic changes), anxiety (36.8%) and depressive (21.1%) disorders occurred more often, and after the coronavirus infection, depressive disorders were in the first place (54.2%). The 2nd group mostly included patients with endogenous disorders (bipolar affective disorder – 24%, recurrent depressive disorder – 20%, schizophrenia – 20%), which were exacerbated more often as a result of COVID-19, to a lesser extent – psychogenic (experiences associated with a change in material status and illness of relatives). Obsessive-compulsive disorder, generalized anxiety disorder, somatoform disorders have been associated with epidemic factors.
Conclusion. The results obtained indicate that there are differences between the mental disorders that first appeared during the pandemic and the exacerbations of the condition in mentally ill patients, which relate to the predictors, causes and clinical manifestations of these disorders.

40-48 95

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19.
Objective: to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate.
Patients and methods. A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire.
Results and discussion. Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5±5.62 years versus 5.12±3.24 years) and had a more pronounced (III–IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake.
Conclusion. The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.

49-54 111

The novel coronavirus SARS-CoV-2 is associated with a significant incidence of neuropsychiatric disorders, which tend to have a long course in the post-COVID period.
Objective: to study post-COVID mental disorders in clinical psychiatric practice.
Patients and methods. 30 patients aged 37.75±14.07 years with anamnesis of SARS-CoV-2 infection were examined. Clinical scale assessment was carried out using the Hamilton Depression and Anxiety Scale. The Symptom-Checklist (SCL-90-R) was used to assess the psychopathological status of the patient. Patients' cognitive functioning was assessed using the Mini-Cog Cognitive Assessment Questionnaire. Patients' sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI).
Results and discussion. Mental disorders associated with a previous coronavirus infection are observed in a wide time range from less than 1 month to a year after the previous disease, and in no case did the coronavirus infection have a severe course. Sleep disorders, anxiety and depressive disorders, which did not exceed a moderate degree of severity, and asthenia dominated in the structure of the post-COVID syndrome. The level of mental distress in patients with post-COVID syndrome increased 2 times. Post-COVID mental disorders are interrelated with female gender, age, and psychotraumatic factors associated with the pandemic. Cognitive impairment mediated by mental disorders was observed in approximately 60% of patients and did not reach the degree of dementia.
Conclusion. The clinical picture of the post-COVID syndrome is represented by a wide range of mental disorders, the development of which involves not only biological, but also psychosocial factors associated with the COVID-19 pandemic, which determines the specifics of diagnostic approaches and the feasibility of complex treatment of the post-COVID syndrome.

55-62 120

Objective: to evaluate the impact of various forms of atrial fibrillation (AF) on the development of mild cognitive impairment (MCI) and cerebral small vessel disease.
Patients and methods. The study included 31 patients with AF (paroxysmal form – 22 patients, permanent form – 9 patients). Arterial hypertension was diagnosed in 26 patients and diabetes mellitus in 6 patients. All patients were taking direct oral anticoagulants (DOACs). Patients underwent cognitive testing, screening ultrasound examination of the main arteries of the head and neck, MRI on a Siemens Skyra 3 T tomograph according to a protocol including diffusion tensor imaging and perfusion determination. To create a control group of healthy elderly individuals, the open database of clinical and MR data OASIS 3 was used that retrospectively evaluated more than 1000 people over a period of 30 years. Participants whose cognitive status was assessed clinically as "normal cognitive function" were selected.
Results and discussion. The frequency of MCI and indicators of cognitive tests did not differ in groups of patients with permanent and paroxysmal forms of AF. The distribution of foci of hyperintense white matter, the thickness of the cerebral cortex also did not differ in patients with different forms of AF. The neuroimaging pattern of cerebral small vessel disease in AF patients without stroke was consistent with population controls.
Conclusion. Prescribing DOACs to patients reduces the risk of cognitive impairment of vascular origin development due to the clear and predictable effect of this class of drugs that prevent the development of cerebral embolism.


63-66 248

The article presents a description of the family case of rare hereditary prion disease – Gerstmann–Sträussler–Scheinker syndrome with a verified p.P102L mutation in the PRNP gene. The clinical picture was represented by progressive cerebellar ataxia, pyramidal signs, bulbar syndrome, and neuropathy, which made it possible to establish a preliminary diagnosis of autosomal dominant spinocerebellar ataxia. Subsequently, the final diagnosis was verified using the massive parallel sequencing technology. The features of this observation are the variable age of onset within the family, with the unusually early age of the disease onset in the proband (age of 25 years), the absence of cognitive impairment, as well as the absence of pathological changes in the electroencephalography and brain MRI study. The possible modifying role of polymorphism in codon 129 of the PRNP gene (129Val) in the disease phenotype formation, as well as the clinical findings and diagnostic methods of this syndrome are discussed.

67-72 96

Hereditary transthyretin amyloidosis belongs to a group of diseases with an autosomal dominant type of transmission and a heterogeneous clinical picture, which depends on the type of transthyretin gene mutation. The leptomeningeal form is a rare phenotypic variant of amyloidosis with a predominant involvement of brain and spinal cord meninges, as well as cortical meningeal vessels. The main manifestations of this phenotype include cephalalgic syndrome, episodes of acute cerebrovascular accident, hearing impairment, epileptic seizures, progressive cognitive impairment reaching the degree of dementia, impaired consciousness, etc. The article describes a clinical case of revealing of amyloidogenic mutation Ala45Thr with a hereditary family history and typical manifestations of leptomeningeal amyloidosis at the onset of the disease, as well as impaired renal function. Neuroimaging with contrast enhancement revealed a characteristic thickening of the meninges of the spinal cord due to the deposition of amyloid masses.


73-79 343

White matter commissural fibers are a special type of fibers that connect similar areas of the cortex of opposite hemispheres. Telencephalic commissures have a direct impact on cognitive function. Diencephalic commissures connect the structures of the midbrain, diencephalon, and forebrain. The pathways they form are involved in the proliferation of white matter diseases. The review provides updated information on the morphology, functions, impairments of development and blood supply of brain commissures and their functional relationship with neurological diseases such as Alzheimer's disease, Parino's syndrome, agenesis of the corpus callosum, and autism spectrum disorders.

80-88 111

Intracranial hemorrhage (ICH) is characterized by a high level of disability and mortality. One of the most important reasons that lead to an increased risk and an increase in the ICH prevalence are antithrombotic drugs: anticoagulant, antiplatelet and thrombolytic. The main risk factors for ICH are advanced age, arterial hypertension, and the use of antithrombotic drugs of different groups. Treatment of ICH while taking drugs affecting hemostasis, is an extremely difficult task and there is not enough sufficiently convincing recommendations and evidence. The decision to resume therapy with the drug, that led to the development of ICH, and the timing of this resumption, is also not a completely clear problem that requires a balance between ischemic and hemorrhagic complications. The most important aspect of prevention is strict adherence to current recommendations regarding combinations of antithrombotic drugs and protocols for thrombolytic therapy, which will minimize the risks of ICH.

89-97 343

In elderly patients with COVID-19 cognitive functions decline; it has been suggested that SARS-CoV-2 infection may lead to the development of Alzheimer's disease (AD) and other long-term neurological consequences. We review several parallels between AD and COVID-19 in terms of pathogenetic mechanisms and risk factors. Possible mechanisms through which COVID-19 can initiate AD are discussed. These include systemic inflammation, hyperactivation of the renin-angiotensin system, innate immune activation, oxidative stress, and direct viral damage. It has been shown that increased expression of angiotensin-renin receptors (ACE2) may be a risk factor for COVID-19 in patients with AD. When entering the central nervous system, the SARS-CoV-2 virus can directly activate glial cell-mediated immune responses, which in turn can lead to the accumulation of beta-amyloid and the subsequent onset or progression of current AD. The involvement of inflammatory biomarkers, including interleukins (IL): IL6, IL1, as well as galectin-3, as a link between COVID-19 and AD is discussed. The rationale for the use of memantine (akatinol memantine) in patients with COVID-19 in order to prevent the development of cognitive deficits is discussed. Memantine has been shown to have a positive effect on neuroinflammatory processes in the onset or exacerbation of cognitive deficits, in reducing cerebral vasospasm and endothelial dysfunction in viral infections. Memantine therapy may improve everyday activity and reduce the risk of severe SARS-CoV-2 infection.

98-102 122

Acute musculoskeletal (non-specific) back pain is one of the most common causes of medical visits and temporary disability. A patient with acute non-specific back pain should be informed about the benign nature of the disease, a favorable prognosis, the expediency of maintaining physical activity, and receive a recommendation to avoid bed rest. Non-steroidal anti-inflammatory drugs and muscle relaxants are most commonly used to relieve the pain. The use of group B vitamins as additional analgesics in acute non-specific back pain is discussed, data from placebo-controlled studies and a meta-analysis of studies on the use of group B vitamins as additional analgesics are analyzed. Data on the positive role of neurotropic group B vitamins in the prevention of relapses in patients with back pain are presented. The possibilities of therapeutic exercises in the prevention of repeated episodes of back pain are discussed.

103-109 166

Currently, eight natural serotypes of botulinum neurotoxin (BNT-A-G, -X) are known. The mechanism of action of all BNT serotypes is presynaptic blockade of SNARE transport proteins (Soluble N-ethylmaleimide-sensitive factor [NSF] Attachment Protein Receptor), as a result of which the release of acetylcholine into the synaptic cleft is disrupted and neuromuscular transmission is blocked.
Each botulinum toxin serotype selectively binds to its own presynaptic membrane receptor and causes cleavage of its own SNARE protein. These differences determine the neuronal specificity and activity of botulinum toxins, which leads to their unique pharmacological properties, such as activity, duration of action, and time to onset of action.
In the international clinical practice, only two BNT serotypes (A and B) are allowed to be used, however, in recent years, a large number of studies on the efficacy and safety of other BNT serotypes (E, C, F) have been carried out, and technologies for changing their natural properties have been developed.
One of the indications for the use of botulinum therapy in neurology is the correction of post-stroke spasticity. Currently, BNT-A is used for this purpose, clinical improvement after its injection occurs after 2 weeks, the therapeutic effect persists for 3 months, and then the symptoms of spasticity increase again, which worsens the patient's quality of life and reduces the possibility of medical rehabilitation. The use of fast-acting recombinant botulinum toxins for this purpose could help overcome this disadvantage of BNT-A therapy.
Currently the LANTIMA study, supported by IPSEN company, is going on to evaluate the safety profile and level of efficacy of modified recombinant botulinum toxin type AB in the treatment of upper limb spasticity in adults.

110-114 130

The development of dementia is preceded by mild cognitive impairment (MCI), the treatment of which can slow down the transformation of MCI into dementia. The article discusses drug and non-drug therapies for MCI. Multiple pharmacological effects of citicoline on cognitive functions of patient’s with MCI and mild vascular dementia or Alzheimer's disease are analyzed. The need for long-term therapy with citicoline is actualized, increasing adherence to therapy by prescribing a convenient form of the drug Noocil (240 ml bottle, liquid form of citicoline for oral administration).

115-121 88

The article discusses the clinical features of cardioembolic stroke (CES). Approaches to the examination of a patient with clinical suspicion of CES are discussed within the framework of the concept of atrial cardiopathy and its main markers. The principles for choosing the timing of oral anticoagulant administration for the purpose of secondary prevention are presented. The article discusses the special aspects of direct oral anticoagulants prescription in difficult clinical situations, in particular, in elderly and senile patients, after reperfusion therapy, with the development of hemorrhagic transformation, in the presence of combined atherosclerosis, cerebral microangiopathy, anamnesis of intracerebral hemorrhage, as well as severe cognitive impairment. Approaches to the choice of oral anticoagulant in terms of purely clinical benefit are presented.

122-130 198

Backpain and pain in the limbs are often associate with the destruction of the cartilage and bone tissue of the joint, which affects the nerve terminals and leads to an exacerbation of pain symptoms (as happens, for example, in osteoarthritis). As a result, pain relief without protection and reconstruction of cartilage (chondroprotection), will be symptomatic. The chondroprotective effects of glucosamine sulfate (GS), chondroitin sulfate (CS) and undenatured type II collagen (UC-II) have different molecular mechanisms. Therefore, with the combined use of CS, GS and UC-II per os, different mechanisms of action of individual components will complement each other, increasing the effectiveness of pain pharmacotherapy.


131-138 132

Vascular cognitive impairment (VCI) is a very diverse group of conditions that differ in etiopathogenesis, severity, clinical picture, dynamics and severity of functional disorders. This heterogeneity significantly complicates the development of uniform standardized recommendations for the diagnosis and treatment of VCI. The development of criteria for each clinical and pathogenetic variant for permanent practical application is a difficult task. In this article, based on the analysis of previously proposed approaches to the diagnosis of various clinical and pathogenetic variants, common diagnostic criteria and classification of VCI are presented.


139-148 151

Neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory diseases of the central nervous system characterized by episodes of immune-mediated astrocytopathy, inflammatory demyelination and axonal damage, predominantly affecting the optic nerves and spinal cord. Currently, there are several unresolved issues that make it difficult to provide medical care to patients with NMOSD. The objective of this publication is to present the results of the work of the Russian experts panel, held in September 2022. The consensus council of experts adopted the main definitions and terms for NMOSD, proposed a therapeutic algorithm to prevent exacerbations in patients with NMOSD with serum IgG antibodies to aquaporin-4 (AQP4-IgG).
The experts formulated profiles of patients with NMOSD to whom eculizumab may be recommended, and proposed a risk management plan during the treatment with this drug. The experts worked out the next steps, which are necessary for the improvement of medical care for these patients: development of unified electronic register of patients with NMOSD in the Russian Federation, development and approval of clinical guidelines.

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