Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova最新文献

Objective: The application of the individual rehabilitating approach by hypokinesia and lack of physical activity in severe Parkinson's disease patient.

Material and methods: In the study were 43 patients with Parkinson's disease (17 men and 26 women; at the age 68.39±7.18 years) with 3-4 stage Hoehn and Yahr included. The physical state was previously defined. 10 individual complex lessons with the power exercises, the transfer training with external cueing, flexibility, balance-therapy, preparation of somatoreception to walking and the walking were in patient's stage with walking speed evaluation after the therapy conducted.

Results: Before the treatment 25 (58%) persons could not the test «6 minutes walking» perform, the time of the test «Up and Go» was lengthened and the grip strength was decreased, moreover in women the grip strength was less critical level. After the treatment the all patients participated in the test «6 minutes walking». Walking distance increased by 32.17 meter; p<0.01.

The conclusion: The individual complex rehabilitation in patient stage's approach in severe Parkinson's disease patient let improve the walking.

Objective: To evaluate the efficacy of Ipigrix in the complex treatment of patients with dorsalgia (DA) of the lumbosacral spine based on the results of the DORISS observational non-interventional multicenter study.

Material and methods: Overall 3563 patients with verified diagnoses of DA at 200 clinical centers within the Russian Federation who received comparable baseline therapy according to nosological standards were examined, some of them additionally received oral or staggered treatment with Ipigrix. Baseline therapy for DA was given to 376 patients (treatment group 1), combination of baseline with oral Ipigrix was given to 1026 patients (group 2), and combination with staggered prescription of ipidacrine - to 2161 (group 3). Secondary endpoint of the study included analysis of the improvement of clinical symptoms, values of pain NRS and DN4 scales together with Roland-Morris questionnaire during the period of observation depending on the therapy with an assessment of its safety.

Results: The results of the analysis of covariance allowed to exclude the influence of confounders (age and initial indicators of the utilized scales) on DA outcomes and demonstrated the greatest pain reduction in patients who additionally received Ipigrix via the staggered scheme. The inter-group comparison aligned by pseudorandomization showed statistically significant benefits of combined therapy regardless of the type of Ipigrix administration concerning main vertebral syndrome manifestations, sensory and motor disturbances, relief of pain, as well as neuropathic symptoms, improvement of neurophysiological parameters and restoration of life functioning without serious drug related adverse events.

Conclusion: Ipigrix (ipidacrine) can be considered an effective and safe adjuvant analgesic in the treatment of DA.

About 40% of cases of cognitive impairment (CI) are associated with modifiable risk factors, such as inactivity, hypertension, diabetes and obesity. Recently, sleep disorders, including obstructive sleep apnea syndrome (OSA), have been considered among these factors. OSA is one of the most widespread conditions among patients with CI. The pathogenesis of cerebral lesions in OSA is complex. Timely diagnosis and complex therapy of patients with OSA can reduce the risk, reduce the severity of CI and slow their progression. Along with non-drug methods of treatment, the use of the drug Cortexin with a multimodal mechanism of action can minimize the negative impact of OSA on the cognitive health of patients. Early detection and treatment of OSA can reduce the severity of CI and slow their progression.

Objective: To detect negative symptoms in adolescent depression, to determine their psychopathological structure and predictive significance.

Material and methods: Seventy-one young in-patients (average age 19.5±2.4 years) (main group) and 52 in-patients (average age 19.8±2.7 years) (comparison group) with the diagnosis «Depressive episode» according to ICD-10 F32.1, F32.2 were examined. Inclusion criterion in the main group was attenuated negative symptoms (ANS) in adolescent depression. Clinical-psychopathological and psychometric examination was carried out using HDRS, SOPS, SANS. The statistical analysis was done by Statistica 12.

Results: Adolescent depression with ANS was more persistent than depression in the comparison group (27.5±17.2 month versus 7.0±6.3, p<0.001), there was higher level of positive symptoms and disorganization symptoms on the respective SOPS sub-scales (7 [5; 9] and 4.5 [3; 8.75], p=0.002; 8 [6; 10] and 5.5 [3.25; 7], p<0.001, respectively). According to the psychopathological structure of the negative symptoms, patients in the main group were divided into a subgroup (n=38, 53.5%) with the predominance of emotional spectrum disorders and a subgroup (n=33, 46.5%) with the predominant involvement of the volition spectrum. ANS in the negative SOPS sub-scale were significantly higher (p=0.045) in patients of the subgroup with volitional disorders. Also, a total HDRS score, reflecting the severity of depressive symptoms, was significantly higher compared to a subgroup with the predominance of emotional spectrum disorders (p=0.038).

Conclusion: The results show that it is possible to clinically verify negative symptoms in the adolescent depression, which makes it possible to assign such patients to the risk group of manifestation of schizophrenia, and to assign depression with ANS to the model of the initial stage of schizophrenic process.

Objective: To study cognitive functions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and in the long-term after pulmonary thromboendarterectomy and to study factors that negatively affect cognitive status.

Material and methods: One hundred and twenty-four patients with CTEPH were examined before and 6 months after surgery with an assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Multivariate regression analysis was used to identify factors affecting the MMSE indicators before and in the long-term postoperative periods.

Results: Initially, patients with CTEPH had a total MMSE score 23.8±1.1. Six months after surgery, the score was 26.1±1.9 (p<0.001). A history of stroke, disability, stress (loss of spouse), and a high Charleson comorbidity index were independent factors affecting MMSE score before surgery. After surgery, the total MMSE score was influenced by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period.

Conclusion: Cognitive impairment in the form of mild dementia was observed in patients with CTEPH before surgery. Six months after the operation, an improvement in cognitive status was revealed, which corresponded to moderate cognitive impairment. At the same time, no complete recovery of cognitive functions was recorded. Patients with CTEPH still experienced the greatest difficulties in the following areas: concentration and counting, memory. A history of stroke, disability, stress (loss of spouse), and a high comorbidity index are associated with a decrease in MMSE scores before surgery. Six months after surgery, MMSE score was affected by a history of stroke, stress (loss of spouse), residual pulmonary hypertension and atrial fibrillation in the early postoperative period.

Disturbances in the formation of connective tissue lead to significant pathological changes in both individual organs and tissues, and at the organismal level. The complexity of diagnostics is also connected with the fact that there is no single terminology, a single view of the diagnostic criteria, a single approach among doctors of different specialties. The prevalence of external phenotypic signs of connective dysplasia is quite high, which can lead to overdiagnosis. On the other hand, insufficient attention to the manifestations of dysplasia can lead to delayed diagnosis, which can cause adverse complications. The most studied are clinical manifestations in dysplastic changes in the cardiovascular system, musculoskeletal system. This article provides an overview of current data on changes in the nervous system. Sufficient attention was paid to the pathology of the nervous system in differentiated forms (Marfan syndrome, Ehlers-Danlos, etc.). Currently, the role of various vascular anomalies, aneurysms associated with undifferentiated forms of connective tissue dysplasia is widely discussed. Much attention is also paid to clinical manifestations of the autonomic nervous system: sympathicotonic manifestations predominate in connective tissue dysplasia. There is evidence of an association of headaches, musculoskeletal pain, and connective tissue dysplasia in both children and adults.

Calcium (Ca²⁺) and Ca²⁺-regulated enzymes calpain and calcineurin are the key molecules of signaling mechanisms in neurons and ensure the normal course of intracellular neurochemical and neurophysiological processes. The imbalance and increase in the intracellular level of Ca²⁺ correlates with the activation of calpain and calcineurin. Inactivation of endogenous inhibitors and/or absence of exogenous pharmacological inhibitors of these enzymes may induce a cascade of intracellular mechanisms that are detrimental to the structural integrity and functional activity of neurons. The interrelated processes of Ca²⁺ imbalance, dysregulation of calpain and calcineurin are directly related to the development of intracellular pathophysiological reactions leading to the degeneration and death of selective neuronal populations in neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. The review briefly presents the characteristics of calpain and calcineurin, their interrelated role in the neurodegeneration processes. Data on the efficiency of the exogenous inhibitors (in vivo, in vitro) point out the potential role of pharmacological regulation of calpain and calcineurin for neuroprotection.

The review article enlightens contemporary concept about a role of sleep in cellular energy metabolism, neuroplasticity and glymphatic clearance of waste products. Many researches have demonstrated that prolonged wakefulness is an energetic and a neurophysiologic issue for the brain. The article provides description of biochemical processes that are responsive for energy restoration in sleep, particularly the role of ATP, adenosine and glycogen. Energy metabolism substrates depletion leads to endoplasmic reticulum stress and unfolded protein response. At the same time the conductance of synapses increases that worsens energetic problems. Level of the glymphatic clearance during wakefulness is substantially lower in comparison with sleep, and waste products are not removed fast enough.

Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst's encephalitis, is a rare demyelinating disease of the central nervous system characterized by rapid progression and acute inflammation of the white matter of the brain and spinal cord. AHLE is currently considered as a rare, most severe variant of acute disseminated encephalomyelitis. Clinically AHLE is characterized by a fulminant course with a rapid development of encephalopathy and multifocal neurological symptoms. AHLE is associated with high mortality rate that requires immediate and aggressive treatment initiation. This article describes a case of AHLE with an atypical course, a subacute form, which is extremely rarely described in the literature, with the progressive symptoms' development over several months. Due to delayed treatment initiation, unfortunately, a fatal outcome has been observed. Subsequent histological examination of the autopsy material confirmed the presence of a subacute form of AHLE in the patient.

Despite the proven importance of neurosteroids in many physiological processes, their role in the pathogenesis of the most of psychiatric disorders remains relatively understudied. This article reviews the current clinical evidence on the effects of neurosteroids on the formation and treatment of anxiety disorder, depression, bipolar disorder, and schizophrenia. In particular, the article points out the ambivalent nature of the effects of neurosteroids on GABA_A- and other receptors. We are especially interested in the anxiolytic and anxiogenic effects of some neurosteroids, the antidepressant effect of allopregnanolone in treating postpartum and other forms of depression, and the nature of short- and long-term mechanisms of antidepressant effects of neurosteroids of different types. The currently unproven hypothesis about the effect of changes in the level of neurosteroids on the course of bipolar disorder is also discussed, with an analysis of the scientific evidence on the development of schizophrenic symptomatology in relation to changing neurosteroid levels in the context of positive and cognitive symptoms.