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Possibilities of therapy for neuromyelitis optica spectrum disorders 视谱障碍神经脊髓炎治疗的可能性
Pub Date : 2022-01-31 DOI: 10.17650/2073-8803-2021-16-4-49-58
E. S. Novikova
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引用次数: 0
Symptomatic non-convulsive status epilepticus in a patient with acute lymphoblastic leukemia (case report) 急性淋巴细胞白血病患者有症状的非惊厥性癫痫持续状态1例(附1例报告)
Pub Date : 2022-01-31 DOI: 10.17650/2073-8803-2021-16-4-81-88
A. Y. Zakharova, M. Bobylova
Симптоматический эпилептический статус (ЭС) развивается у пациентов реанимационного отделения на фоне основного заболевания (травма, инсульт, интоксикации и др.) без эпилепсии в анамнезе. ЭС диагностируется в ходе проведения видеоэлектроэнцефалографического мониторинга. Электроэнцефалографические паттерны эпилептического статуса неспецифичны. Обязательным признаком ЭС является эпилептиформная активность. По мере пролонгации ЭС эпилептиформная активность на электроэнцефалограмме видоизменяется по частоте, морфологии и локализации, и возникают ритмические неэпилептиформные паттерны. На характер электроэнцефалограммы влияют острая церебральная недостаточность, срыв механизмов генерации биоэлектрической активности и интенсивная терапия. В качестве иллюстрации симптоматического ЭС приводим историю болезни пациентки с развитием бессудорожного ЭС на фоне острого лимфобластного лейкоза, его осложнений и специфического лечения. Клинический случай демонстрирует происхождение и течение симптоматического ЭС по данным электроэнцефалографии. Своевременная диагностика и купирование ЭС снижают риск развития эпилепсии и неврологического дефицита у онкологических пациентов после выхода из ургентного состояния.
症状性癫痫状态(s)发生在重症监护室的病人在没有癫痫史的情况下(创伤、中风、中毒等)。s在视频脑电图监测过程中被诊断出来。癫痫状态的脑电图模式是非特异性的。癫痫活动是s的必然特征。随着s的延长,脑电图上的癫痫活动随频率、形态和局部变化,出现了非癫痫模式的节奏变化。脑电图的性质受到急性脑衰竭、生物电活动产生机制的崩溃和强化治疗的影响。作为症状s的例子,在急性淋巴细胞白血病、并发症和特殊治疗的背景下,引入无癫痫患者的病史。根据脑电图的数据,临床病例显示了症状s的起源和流程。及时诊断和购买“s”降低了癌症患者从urgen状态中恢复后出现癫痫和神经缺陷的风险。
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引用次数: 0
CADASIL syndrome and demyelination: dual pathology? (a case report) CADASIL综合征和脱髓鞘:双重病理?(个案报告)
Pub Date : 2022-01-31 DOI: 10.17650/2073-8803-2021-16-4-77-80
I. O. Shtang, A. Kotov
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引用次数: 0
The hypothesis of the functional disintegration of the brain due to the persistence of benign epileptiform patterns on the electroencephalogram 由于脑电图上持续存在良性癫痫样模式而导致脑功能解体的假说
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-34-45
I. A. Sadekov, A. V. Polyakov, I. V. Sadekova, E. A. Tupikina, V. Y. Kochmar, T. V. Termenzhi
In this work, we have analyzed the results of observation of 200 children aged from 3 to 15 years old, who had various neuropsychiatric disorders in combination with benign childhood epileptiform patterns on the electroencephalogram. A hypothesis has been put forward about functional disorders of the developing nervous system with prolonged persistence of benign focal epileptiform discharge of childhood on electroencephalogram, mainly in slow-wave sleep. The possibilities of therapeutic correction of these disorders are discussed.
在这项工作中,我们分析了200名3至15岁的儿童的观察结果,这些儿童患有各种神经精神疾病,并在脑电图上有良性的儿童癫痫样模式。提出了一种假设,认为儿童脑电图上良性局灶性癫痫样放电持续时间长,主要发生在慢波睡眠中,可能是发育中的神经系统功能障碍。讨论了对这些疾病进行治疗性矫正的可能性。
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引用次数: 0
Pericallosal lipoma in an infant with fetal alcohol syndrome: a case report 胎儿酒精综合征婴儿胼胝体周围脂肪瘤1例报告
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-75-78
G. Golosnaya, M. Novikov, N. Knyazeva, D. Volodina, A. A. Skobeltsyn, V. Perepelov, A. V. Ogurtsov, T. Larionova, L. V. Ledyaykina, K. A. Seleznev
In this article we report a case of pericallosal lipoma in a newborn with fetal alcohol syndrome, brain malformation (agenesis of the corpus callosum), and intrauterine infection (meningitis) diagnosed in a perinatal center.
在这篇文章中,我们报告一例鞘周脂肪瘤的新生儿胎儿酒精综合征,脑畸形(胼胝体发育不全),并在围产期中心诊断宫内感染(脑膜炎)。
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引用次数: 0
Neuropsychological mechanisms underlying reading and writing disorders in primary school children 小学生阅读和写作障碍的神经心理学机制
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-55-62
A. S. Sableva
Background. There has been an increasing interest to the diagnostics of learning difficulties in primary school children, which is associated with scientific advances in the interdisciplinary paradigm and high prevalence of difficulties with writing among children. Long-term observations demonstrate the presence of neuropsychological disorders in children with reading and writing disorders, which, in our opinion, necessitates further investigation in the interdisciplinary clinical and pedagogical aspect.Objective: to perform factor analysis of the mechanism underlying initial development of the disorder and its dynamics, to identify its types considering the development factor in the context of mastering the educational material.Materials and methods. This study included 10 children of 2nd-5th forms who visited specialists for the first due to learning difficulties.Results. We have identified several neuropsychological factors that caused problems with writing, including kinetic factor; factor of deliberate regulation of mental activity; modal-specific factors; kinesthetic factor; spatial factor; neurodynamic factor; simultaneous and successive factors; factor of interhemispheric interaction. The most common were the neurodynamic factor and the factor of interhemispheric interaction. We also observed signs of disorders in the deep parts of the brain, subcortical structures in the form of diffuse stem symptoms (in 2 cases, electroencephalography showed diffuse changes in the bioelectric activity of the brain with signs of irritation of the subcortical-diencephalic structures, in particular, synchronization of the main rhythm). We have identified a number of symptoms (primarily originating from the subcortex), such as general decrease in pace, problems with starting to work, rapid fatigue, decreasing productivity, an increase in the number of kinetic and auditory-speech difficulties, and spatial deficits.Conclusion. The lack of specially organized management in children with neuropsychological syndrome reinforces reading and writing disorders and leads to aggravation and alteration of symptoms during learning. Understanding of neuropsychological mechanisms underlying reading and writing disorders and their course is crucial for differential diagnosis, therapy, and comprehensive correction.
背景。人们对小学生学习困难的诊断越来越感兴趣,这与跨学科范式的科学进步和儿童写作困难的普遍存在有关。长期观察表明,阅读和写作障碍儿童存在神经心理障碍,我们认为,这需要在跨学科临床和教学方面进行进一步的研究。目的:在掌握教材的背景下,结合发展因素,对障碍的初始发展机制及其动态进行因子分析,识别其类型。材料和方法。本研究包括10名二至五年级的儿童,他们第一次因为学习困难而去看专家。我们已经确定了几个导致写作问题的神经心理因素,包括动力因素;有意调节心理活动的因素;modal-specific因素;动觉因素;空间因素;神经动力的因素;同时的和连续的因素;大脑半球相互作用的因素。最常见的是神经动力学因素和半球间相互作用因素。我们还观察到大脑深部、皮层下结构紊乱的迹象,表现为弥漫性干症状(在2例中,脑电图显示大脑生物电活动的弥漫性变化,伴有皮层下-间脑结构的刺激迹象,特别是主节律的同步)。我们已经确定了一些症状(主要源于皮层下),如步伐普遍减慢,开始工作困难,快速疲劳,生产力下降,运动和听觉语言困难的数量增加,以及空间缺陷。神经心理综合症儿童缺乏专门组织的治疗,会加剧阅读和写作障碍,并导致学习过程中症状的加重和改变。了解阅读和写作障碍的神经心理学机制及其过程对鉴别诊断、治疗和全面纠正至关重要。
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引用次数: 0
Mowat-Wilson syndrome: literature review and case series 莫沃特-威尔逊综合征:文献回顾和病例系列
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-10-20
M. Bobylova, V. S. Kakaulina, M. O. Abramov, K. Mukhin
Mowat-Wilson syndrome (MWS) is a rare genetic disorder characterized by a combination of the following signs: 1) facial dysmorphism (wide nose, broad medial eyebrows, pronounced chin, and open mouth); 2) mental retardation; 3) abnormalities of internal organs (congenital heart defects, Hirschsprung's disease, hypospadias/cryptorchidism). The disease is associated with a heterozygous pathogenic mutation in the ZEB2 gene. More than 80 % of MWS patients are diagnosed with epilepsy, the onset of which is usually observed in infancy. Patents have focal motor seizures, atypical absence seizures, generalized convulsive seizures. Epileptic seizures are often triggered by fever; some children are resistant to therapy. MWS patients have a specific phenotype (blue eyes, fair hair, wide-based gait, frequent laughter, limited or absent expressive language) that requires differential diagnosis with Angelman syndrome (caused by a mutation in the UBE3A gene). MWS was described in 1998, but there have been no case reports in the Russian literature yet. We report 4 cases of MWS in children aged 2 to 13 years treated in the Svt. Luka's Institute of Neurology and Epilepsy. In all of these patients, we identified a heterozygous de novo deletion in the ZEB2 gene. Epilepsy was observed in all patients. Mean age at onset was 13 months. All children had focal motor seizures and atypical absence seizures. None of them had tonic-clonic seizures or status epilepticus. The analysis of electroencephalograms showed that patients with a lower index of epileptiform activity tend to have better development and vice versa: children with a high index of epileptiform activity during sleep had more severe developmental delay.
莫沃特-威尔逊综合征(MWS)是一种罕见的遗传性疾病,其特征是以下症状的组合:1)面部畸形(宽鼻子,宽内侧眉毛,突出的下巴和张开的嘴);2)智力迟钝;3)内脏器官异常(先天性心脏缺陷、先天性巨结肠病、尿道下裂/隐睾)。该疾病与ZEB2基因的杂合致病性突变有关。超过80%的MWS患者被诊断为癫痫,通常在婴儿期发病。患者有局灶性运动发作,非典型失神发作,全身性惊厥发作。癫痫发作通常由发烧引起;有些孩子对治疗有抵抗力。MWS患者具有特定的表型(蓝眼睛,金发,宽基步态,频繁笑,有限或缺乏表达性语言),需要与Angelman综合征(由UBE3A基因突变引起)进行鉴别诊断。MWS于1998年被描述,但在俄罗斯文献中尚未有病例报告。我们报告了4例在Svt治疗的2至13岁儿童MWS。卢卡神经病学和癫痫研究所。在所有这些患者中,我们发现了ZEB2基因的杂合从头缺失。所有患者均出现癫痫。平均发病年龄13个月。所有患儿均有局灶性运动发作和非典型失神发作。他们都没有强直阵挛发作或癫痫持续状态。脑电图分析显示,睡眠时癫痫样活动指数低的患儿往往发育较好,反之亦然,睡眠时癫痫样活动指数高的患儿发育迟缓较严重。
{"title":"Mowat-Wilson syndrome: literature review and case series","authors":"M. Bobylova, V. S. Kakaulina, M. O. Abramov, K. Mukhin","doi":"10.17650/2073-8803-2021-16-3-10-20","DOIUrl":"https://doi.org/10.17650/2073-8803-2021-16-3-10-20","url":null,"abstract":"Mowat-Wilson syndrome (MWS) is a rare genetic disorder characterized by a combination of the following signs: 1) facial dysmorphism (wide nose, broad medial eyebrows, pronounced chin, and open mouth); 2) mental retardation; 3) abnormalities of internal organs (congenital heart defects, Hirschsprung's disease, hypospadias/cryptorchidism). The disease is associated with a heterozygous pathogenic mutation in the ZEB2 gene. More than 80 % of MWS patients are diagnosed with epilepsy, the onset of which is usually observed in infancy. Patents have focal motor seizures, atypical absence seizures, generalized convulsive seizures. Epileptic seizures are often triggered by fever; some children are resistant to therapy. MWS patients have a specific phenotype (blue eyes, fair hair, wide-based gait, frequent laughter, limited or absent expressive language) that requires differential diagnosis with Angelman syndrome (caused by a mutation in the UBE3A gene). MWS was described in 1998, but there have been no case reports in the Russian literature yet. We report 4 cases of MWS in children aged 2 to 13 years treated in the Svt. Luka's Institute of Neurology and Epilepsy. In all of these patients, we identified a heterozygous de novo deletion in the ZEB2 gene. Epilepsy was observed in all patients. Mean age at onset was 13 months. All children had focal motor seizures and atypical absence seizures. None of them had tonic-clonic seizures or status epilepticus. The analysis of electroencephalograms showed that patients with a lower index of epileptiform activity tend to have better development and vice versa: children with a high index of epileptiform activity during sleep had more severe developmental delay.","PeriodicalId":196950,"journal":{"name":"Russian Journal of Child Neurology","volume":"59 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116592104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Experience with the use of a ketogenic diet with type 1 glucose transporter deficiency (De Vivo disease) 生酮饮食治疗1型葡萄糖转运蛋白缺乏(体内疾病)的经验
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-63-68
N. Lyukshina
De Vivo disease is characterized by early epileptic encephalopathy, delayed psychomotor development, spasticity, the formation of microcephaly, ataxia, dysarthria, alternating hemiplegia, and a decrease in glucose and lactate levels in the cerebrospinal fluid. Epilepsy is pharmacoresistant and the therapy for this syndrome is the ketogenic diet (until the time when will development of genetic targeted therapy). In GLUT1 deficiency syndrome, mutations are found in the SLC2A1 gene that lead to a decrease in glucose transport across the cell membrane.  The “classic” ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician and carefully monitored by a dietitian. It is usually used in children with seizures that do not respond to medications. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. Foods are weighed and measured. Normal dietary fats, which are used predominantly in the classical ketogenic diet, consist of a mixture of mainly long chain triglyceride (LCT) fats with a small amount of short and medium chain triglyceride (MCT) fats. The MCT ketogenic diet uses a fat supplement that consists only of MCT fats (MCT oil).
体内疾病的特征是早期癫痫性脑病、精神运动发育迟缓、痉挛、小头畸形的形成、共济失调、音障碍、交替性偏瘫以及脑脊液中葡萄糖和乳酸水平的降低。癫痫具有药物耐药性,治疗这种综合征的方法是生酮饮食(直到基因靶向治疗的发展)。在GLUT1缺乏综合征中,发现SLC2A1基因突变导致葡萄糖跨细胞膜运输减少。“经典”生酮饮食是一种特殊的高脂肪、低碳水化合物饮食,有助于控制一些癫痫患者的癫痫发作。它由医生开处方,并由营养师仔细监测。它通常用于对药物无反应的癫痫发作儿童。它比改良的阿特金斯饮食法更严格,需要仔细测量卡路里、液体和蛋白质。食物是称重和测量的。传统生酮饮食中主要使用的正常膳食脂肪,主要由长链甘油三酯(LCT)脂肪与少量短链和中链甘油三酯(MCT)脂肪的混合物组成。MCT生酮饮食使用仅由MCT脂肪(MCT油)组成的脂肪补充。
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引用次数: 0
Features of the diagnosis and treatment of patients with AQP-4-positive neuromyelitis optica and MOG antibody disease aqp -4阳性视神经脊髓炎伴MOG抗体病的诊治特点
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-21-33
V. E. Avdeeva, A. Kotov
Background. As the amount of knowledge about multiple sclerosis increases, there is an interest in other forms of demyelinating diseases, among which neuromyelitis optica spectrum disorder and MOG (myelin oligodendrocyte glycoprotein) antibody disease can be distinguished.Objective: to improve the efficiency of diagnosis and treatment, to assess the long-term outcome in patients with AQP-4-positive neuromyelitis optica and MOG antibody disease.Materials and methods. The study included 14 patients: children, adolescents, adults, and elderly (9 - female, 5 -male). The duration of catamnesis ranged from 1 year to 6 years.Results and discussion. Antibodies to AQP-4 were found in 5 patients, antibodies to MOG were found in 9 patients. 89 % of patients with MOG antibody disease had the number of antibodies to MOG less than 50 pg/ml, determined by the Sandwich-type ELISA method; therefore, multiple sclerosis cannot be excluded (considering the oligoclonal IgG type 2 in three patients). To clarify the diagnosis, antibodies to MOG must be tested by more specific method of live cell-based assay in these patients.Based on this group of patients, it can be assumed that the younger the patient was, the earlier the diagnosis was made and treatment started, the better was prognosis. The prognosis was more favorable in patients with AQP-4-positive neuromyelitis in whom the disease debuted with optic neuritis. Patients with MOG antibody disease had a more favorable prognosis if the disease debuted with a supratentorial brain lesion; less favorable - when oligoclonal IgG type 2 was detected. Gender had no influence on the outcome of the disease.Conclusion. Differential diagnosis of this diseases based on clinical data is practically impossible. The study was carried out in a small group, so it is difficult to translate the results to the population of patients with neuromyelitis optica spectrum disorders. During treatment, almost all patients show positive dynamics when using glucocorticosteroids, human immunoglobulin preparations. Plasmapheresis was ineffective in patients with AQP-4-positive neuromyelitis optica, in some patients with MOG antibody disease the positive effect was observed. Cytostatic therapy was effective in patients with AQP-4-positive neuromyelitis optica. B cell depletion therapy with rituximab was effective in patients with MOG antibody disease. Interferon preparations did not give a positive effect.
背景。随着对多发性硬化知识的增加,人们对其他形式的脱髓鞘疾病产生了兴趣,其中可以区分神经脊髓炎视谱障碍和MOG(髓鞘少突胶质细胞糖蛋白)抗体疾病。目的:提高aqp -4阳性视神经脊髓炎合并MOG抗体疾病的诊治效率,评价其远期疗效。材料和方法。该研究包括14例患者:儿童、青少年、成人和老年人(女性9例,男性5例)。灾变持续时间1 ~ 6年。结果和讨论。5例检测到AQP-4抗体,9例检测到MOG抗体。采用夹心型ELISA法检测MOG抗体数小于50 pg/ml的MOG抗体病患者占89%;因此,不能排除多发性硬化症(考虑到3例患者的寡克隆IgG 2型)。为了明确诊断,必须在这些患者中采用更具体的活细胞检测方法检测MOG抗体。根据这组患者,可以认为患者年龄越小,诊断越早,治疗越早,预后越好。aqp -4阳性神经脊髓炎以视神经炎首发的患者预后较好。MOG抗体疾病患者如果首发时伴有幕上脑病变,预后较好;当检测到2型寡克隆IgG时,不太有利。性别对疾病的转归无影响。根据临床资料对这种疾病进行鉴别诊断实际上是不可能的。该研究是在一个小群体中进行的,因此很难将结果转化为患有视神经脊髓炎的患者群体。在治疗过程中,几乎所有患者在使用糖皮质激素、人免疫球蛋白制剂时都表现出积极的动态。血浆置换术对aqp -4阳性视神经脊髓炎无效,对部分MOG抗体疾病患者有阳性效果。细胞抑制剂治疗对aqp -4阳性视神经脊髓炎有效。利妥昔单抗对MOG抗体疾病患者的B细胞消耗治疗有效。干扰素制剂没有产生积极作用。
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引用次数: 0
Leukoencephalopathy with vanishing white matter caused by EIF2B5 gene mutations: a case report EIF2B5基因突变致白质消失的脑白质病1例
Pub Date : 2021-11-04 DOI: 10.17650/2073-8803-2021-16-3-69-74
E. Saifullina, E. Gaysina, R. Magzhanov, A. A. Yalaev, I. Nagornov
Leukoencephalopathy with vanishing white matter (VWM disease) is a progressive neurodegenerative disease with a specific magnetic resonance pattern characterized by diffuse lesions to the white matter and cystic degeneration. In this article, we report a case VWM disease in a boy with white matter lesions, in whom early onset and neurological symptoms suggested infantile form of the disease. The diagnosis was confirmed by the detection of biallelic mutations c.1688G>A (p.Arg563Gln) and c.1309G>A (p.Val437Met) in the EIF2B5 gene. The c.1309G>A mutation (p.Val437Met) was detected for the first time; it caused the development of severe disease.
白质消失性脑病(VWM病)是一种进行性神经退行性疾病,具有特定的磁共振特征,以白质弥漫性病变和囊性变性为特征。在这篇文章中,我们报告了一例VWM病在一个男孩与白质病变,在他的早期发病和神经系统症状提示婴儿形式的疾病。检测到EIF2B5基因c.1688G>A (p.a g563gln)和c.1309G>A (p.a l437met)双等位基因突变,证实诊断。首次检出c.1309G>A突变(p.Val437Met);它导致了严重疾病的发展。
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引用次数: 0
期刊
Russian Journal of Child Neurology
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