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

Objective: To study the predictors of the efficacy of non-drug multimodal therapy in the treatment of mild vascular cognitive impairment.

Material and methods: Thirty patients with mild vascular cognitive impairment, under the supervision of their physician, received a 1-month non-drug treatment program including cognitive training, detailed recommendations for physical activity, and dietary planning.

Results: After the end of the course of treatment, improvements in the MoCa test were achieved by 22 patients (73%), which made up Group 1. In the remaining 8 patients, the treatment had no effect (Group 2). In Group 1, the dynamics of the MoCa test averaged 1.7±0.9, in the Group 2 it was (-0.4)±0.5. Patients of Group 1 had a significantly lower level of education (10.9±2.3) compared with Group 2 (14.9±2.0), a higher initial MoCa score, and a less pronounced white matter lesion on the Fazekas scale. After the regression analysis, the level of education (B -0.999, p<0.05) and white matter damage (B -2.761, p<0.01) were significant predictors.

Conclusion: When using non-drug multimodal therapy in the treatment of mild vascular cognitive impairment, lower levels of education and a lower degree of white matter vascular damage are reliable predictors of treatment efficacy.

Objective: To describe the features of the clinical presentation and evaluate the incidence of HIV-associated cerebellar degeneration in patients with progressive cerebellar ataxia.

Material and methods: Three hundred and seventy-seven patients with progressive cerebellar ataxia were studied. Brain MRI study, assessment by the Scale for the Assessment and Rating of Ataxia (SARA), screening for cognitive impairment by the Montreal Cognitive Assessment Scale (MoCA) were performed. In patients with HIV infection, autoimmune, deficient and other causes of ataxia, as well as opportunistic infections, multiple system atrophy and frequent forms of hereditary spinocerebellar ataxias were excluded.

Results: Five patients (1.3%) were identified with a combination of cerebellar ataxia and HIV infection (2 men, 3 women, aged 31 to 52 years). The median duration of HIV infection was 5 years, the duration of ataxia was 1 year. In the clinical findings, in addition to progressive ataxia, pyramidal signs, dysphagia, less often ophthalmoparesis, dystonia, postural hand tremor, affective and mild cognitive impairment were observed. In three patients, brain MRI revealed signs of olivopontocerebellar atrophy, two patients had isolated cerebellar degeneration (mainly of the vermis). All patients received combination of antiretroviral therapy in various regimens, but despite this, ataxia was progressive.

Conclusion: HIV infection is a rare cause of cerebellar degeneration. This diagnosis remains a diagnosis of exclusion to this day. Cerebellar degeneration can occur and progress even after achieving a stable remission of HIV infection while taking highly active antiretroviral therapy.

The review addresses the combined use of tractography and neuronavigation. Fundamentals of diffusion tensor imaging are given, technical aspects of fiber tracking in general and in depicting separate subcortical tracts are described. Main advantages of the method and possible causes of errors are highlighted. Precision assessment of this technology is given by comparing with results of subcortical neurostimulation. Surgical tactics is described depending on distance between the tumor and subcortical pathways.

Objective: To analyze the frequency of various sleep disorders in patients with epilepsy receiving antiepileptic therapy.

Material and methods: Sixty-four women were selected from the register of patients with epilepsy and other paroxysmal conditions. The group consisted of young and middle-aged women (36.9±13.5 years), all patients received antiepileptic therapy. To diagnose sleep disorders, we used a sequential algorithm for clinical examination supplemented by instrumental methods according to indications (polysomnography, respiratory monitoring).

Results: The duration of epilepsy was 15.7±7.6 years, the disease was represented by three forms: structural (n=15, 23.4%), genetic (n=32, 50%) and unspecified (n=17, 26.6%). Sleep disorders were common among female patients with epilepsy (43.7%), they are most frequently combined with genetic epilepsy (18.7%), and represented by: insomnia (43%) mild to moderately severe breathing disorders (32%) and sleep movement disorders (25%). Sleep disorders were combined with symptoms of depression in the majority of patients (71%). A 6-month follow-up evaluation of nighttime sleep parameters after treatment showed a decrease in the frequency of sleep disorders to 25%; scores on the Epworth Sleepiness Scale significantly decreased to 6.7±3.6. A change in antiepileptic therapy in patients with sleep breathing disorders resulted in a marked regression of the Apnea-Hypopnea Index (9.2±2.5 points; p=0.003). However, there were no significant changes in the severity of sleep movement disorders.

Conclusion: Sleep disorders are common in patients with epilepsy, in most cases they are associated with mood disorders, and may regress after optimization of antiepileptic therapy.

Objective: To determine the prognostic aspects of the development of pneumonia in patients with ischemic stroke of various pathogenetic subtypes.

Material and methods: The study enrolled 110 patients (64 men and 46 women), aged 44-95 years, with dysphagia during the acute period of ischemic stroke (IS). The TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding from the severity of dysphagia, a non-linear regression method was used using the least squares method.

Results: In patients with swallowing disorders in the acute period of IS, pneumonia often developed after 5 days from the onset of clinical manifestations of stroke. In the cardioembolic subtype of IS, the probability of pneumonia in groups with dysphagia severity from 90 to 120 points on the MASA was higher than in the atherothrombotic subtype of IS (p<0.05).

Conclusion: Patients with cardioembolic stroke subtype are characterized by a worse prognosis for the developing pneumonia compared to patients with atherothrombotic stroke subtype.

High and very high risk atherothrombotic ischemic stroke (ATIS) includes patients with severe extracranial atherosclerosis, any intracranial atherosclerosis, and aortic arch atheromatosis. The article discusses the most effective approaches to medical short- and long-term secondary prevention of ATIS, major vascular events and death, based on the results of modern research and current clinical guidelines. Clinical studies of recent years have proven the possibility of individualization and intensification of secondary prevention of ATIS. In the treatment of high-risk patients, it is advisable to use more widely short-term dual antiplatelet therapy (combination of ASA with clopidogrel or ticagrelor), long-term dual antithrombotic therapy (combination of ASA and rivaroxaban at a dose of 2.5 mg twice a day not earlier than 30 days from the development of stroke or TIA) to reduce the risk of recurrent stroke and death, as well as intensive lipid-lowering therapy (including the use of a combination of statins and ezetimibe or PCSK9 inhibitors).

The article is devoted to an urgent problem - primary and secondary prevention of atherosclerotic cardiovascular diseases. Modern approaches to management tactics depending on age and the appointment of antiplatelet therapy with acetylsalicylic acid in low doses from 75 to 150 mg/day are presented. At the same time, the relatively high effectiveness of the use of ASA for primary prevention in men 40-69 years old without an increased risk of bleeding from the gastrointestinal tract is shown. Low doses of ASA provide little benefit in reducing the risk of CVD in people 40 years and older, when there is no history of CVD, but at the same time they are at increased risk of CVD.

Objective: To study the attitude of patients with multiple sclerosis (MS) to vaccination as a method of preventing infectious diseases, in particular, COVID-19.

Material and methods: The data of a survey of 408 patients with MS in the Sverdlovsk region in relation to vaccination against COVID-19, conducted using the original questionnaire, were analyzed.

Results: According to the survey data, 266 (65.2%) patients with MS are positive about vaccination. 222 (54.4%) patients with MS refused vaccination. The most common reasons for refusal were - fear that the vaccine could worsen the state of health - 44.1%, coronavirus infection in the last 6 months - 14.85%, «I was always told that I should not be vaccinated» - 14.4%, a combination of the above answers - 16.65%. The accumulated world experience and our observations demonstrate the important role of vaccination of patients with MS from COVID-19.

Conclusions: It is necessary to rise the awareness of vaccination among patients with MS, since until recently this has been given insufficient attention.

An unbalanced diet and some other factors are the reason for the extreme prevalence of hypovitaminosis among the population of both developing and developed countries. The metabolic relationships of B vitamins determine the more frequent occurrence of poly-, rather than monovitamin deficiency. Since B vitamins play an important role in the processes of energy production and in the functioning of neurotransmitter systems, the first symptoms of such polyhypovitaminosis are signs of brain dysfunction: asthenia, depression, anxiety, cognitive disorders. Correct diagnosis of polyhypovitaminosis based on the identification of risk groups of patients and the determination of their subclinical or early manifesting signs of brain dysfunction is the most important task of a practicing physician. Detection of insufficient intake and vitamin content, as well as verification of the onset of symptoms of brain dysfunction and the appointment of adequate therapy can significantly increase the effectiveness of treatment, as well as prevent asthenic, psycho-emotional and cognitive disorders in patients with polyhypovitaminosis.