Showing papers in "Zhurnal Nevrologii I Psikhiatrii Imeni S S Korsakova in 2017"

[Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA)].

Abstract: Aim To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS). Material and methods A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients' participation in trial ranged from 67 to 71 days. Results By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups. Conclusion It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.

Ischemic stroke in young adults

Abstract: The authors have analyzed the causes of ischemic stroke (IS) in more than 600 young patients examined in the cerebrovascular department of the Neurological Research Center (Moscow) during the period 2003-2016 years. It has been suggested that a wider use of high-resolution MRI and T1 weighted db-fs images as well as intracranial CTA will help to verify more often intracranial dissection and primary cerebral vasculitis that will result in a decrease of cryptogenic IS frequency.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts].

Abstract: These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

[Meta-analytic assessment of parenteral cytoflavin effectiveness in different neurologic disorders].

Abstract: AIM To carry out an integral quantitative assessment of the clinical efficacy of parenteral use of cytoflavin in treatment of patients with CNS disorders based on the systemic selection of published controlled clinical trials and their meta-analysis. MATERIAL AND METHODS Twenty-one high evidence-based studies on the efficacy of parenteral use of cytoflavin in different CNS disorders (4314 patients) have been analyzed. Comparisons with basic treatment groups were undertaken to clarify the drug clinical effects adjusted for heterogeneity and variability of response parameters. RESULTS AND CONCLUSION An analysis of formalized efficacy indicators (increase in the absolute and relative value, odds ratio (OR) etc.) has demonstrated the advantages of cytoflavin. Group combination has increased the statistical power of the meta-analysis. Two models with fixed (Mantel-Haenszel amendment) and random effects were used. All the estimation protocols in different clinical groups of patients with neurologic diseases provided similar results and confirmed the stability of calculated values irrespective of heterogeneity of data arrays. OR of positive outcomes in neuropathologies treated with cytoflavin was 3,02 with χ2 heterogeneity 427,3 and p = 0,000…, I2= 85,7% (82%; 88%).

Modern principles of integrated diagnostics and rehabilitation of perinatal lesions of the nervous system and their consequences

Abstract: The article is devoted to the comprehensive diagnosis and treatment of perinatal lesions of the nervous system and their consequences in children. Reflects modern approaches to data classification conditions, taking into account ideas on the etiology and pathogenesis of the disease, the clinical manifestations of the main syndromes (excitation and depression, hypertensive, convulsive, movement disorders) as the neonatal period, and in the formation of long-term effects (motor and mental delay and speech development, hyperkinetic syndrome, cerebral palsy and others). Considerable attention is paid to the modern principles of diagnosis (clinical, psychometric, instrumental) and comprehensive rehabilitation (medical, social and psycho-pedagogical) the effects of perinatal lesions of the nervous system. The results of the review of research on the use of the polypeptide and nootropic neurometabolic stimulator - cortexin - in the complex rehabilitation of perinatal lesions of the nervous system and their consequences in children. It is shown that the use of cortexin in treatment of critical conditions in newborns reduced the duration of intensive care and the length of stay of patients in a intensive care unit, the average period of hospital treatment and the stage of the primary neurological rehabilitation 2.5-3 times, but also reduces the frequency of detection of syndromes movement disorders in 2 times, hypertension-hydrocephalic disorders 3 times, vegetative-visceral dysfunctions 5 times. Application cortexin in the rehabilitation of children of the first years of life with the consequences of perinatal CNS indicates a significant improvement in their motor and cognitive functions, as well as predrechevogo and speech development. Application cortexin significantly improved the forecast recovery of motor, cognitive, and neurological status in general, with full compensation by the end of 1 year of life in 90% of patients, and was accompanied by a decline in disability in extremely premature newborns from 13.6% to 4.6% compared to the standard therapy, as well as reduced length of stay in hospital for 14.7 days of hospital stay. Revealed the cumulative effect of the drug: maintained for 6 to 18 months with repeated courses of therapy, his positive influence. High efficiency of cortexin due to a combination of nootropic, neurotrophic, neuroprotective, anticonvulsant and reparative effects, as well as antioxidant, metabolic and anti-stress action, which determines the need for wide application in complex regenerative treatment of perinatal lesions of the nervous system and their consequences.

Endothelium as a target for new therapeutic strategies in cerebral vascular diseases

Abstract: The author evaluates a role of endothelium in the pathogenesis of cerebral vascular diseases (CVD) and considers the concept about endothelium as prevention and treatment of pathological processes leading to or triggering CVD. There are two medical strategies for correction of endothelium dysfunction in CVD: tactic (using of antioxidants) and strategic (statins, hypotensive drugs, antiaggregants).

Modern trends in epidemiology of dementia and management of patients with cognitive impairment

Abstract: Dementia is an important medical problem with the prevalence and significance growing year after year. Improvement of diagnostic methods facilitates early diagnosis and treatment. This year marks the 20th anniversary of memantine, one of the basic anti-dementia drugs, registration in Russia. It provided conditions for more efficient care of patients with dementia and development of memory clinics in Moscow and major regions of Russia used modern investigation technology and neuropsychological testing. Many multi-central studies involving 1250 patients with cognitive impairment were conducted A great number of educational activities, social projects that helped to increase awareness of dementia issues in medical community as well as society in general were implemented. Total screening programs for identification of cognitive impairment are being introduced, psychological support programs for caregivers of dementia patients are being implemented.

Multicenter observational program for evaluation of the effectiveness of the recognan (citicoline) in the correction of cognitive impairment in patients with chronic cerebrovascular pathology

Abstract: AIM To study the efficacy and safety of recognan (citicoline) in the treatment of cognitive and depressive disorders in chronic cerebrovascular pathology (chronic brain ischemia) developed in patients with arterial hypertension and/or atherosclerosis. MATERIAL AND METHODS Seven hundred and thirty-six patients with cerebrovascular pathology, cognitive impairment and mild dementia were examined. The sample included 279 (37.9%) men and 457 (62.1%) women aged from 35 to 80 years (mean age 64.5±8.7 years). The drug recognan ('Gerofarm', Russia) was administered in the dose of 1000 mg daily during 30 days. Recovery of cognitive functions was assessed with MSSE, correction of visual/spatial coordination with CDT, depression severity with MGDS. RESULTS The improvement of cognitive function, memory and visual/spatial coordination, decrease in depression severity were observed during the treatment. CONCLUSION Recognan reduced cognitive dysfunction and disturbances of visual/spatial coordinationas well as had a positive effect on the emotional sphere decreasing the level of depression.

Restoring of the speech functions in patients with aphasia in the early rehabilitation period of ischemic stroke

Abstract: AIM To study the efficacy of combined therapy including daily sessions and two 10-day injections of the drug cellex in patients with aphasia in the early rehabilitation period of ischemic stroke (II). MATERIAL AND METHODS Forty patients in the early rehabilitation period of II in the basin of the left middle cerebral artery with moderate to severe aphasia were studied. Twenty patients received combined therapy, including daily sessions with a speech therapist-aphasiologist within 10 days using the improved method, then a self-study using educational materials and two 10-day injections of cellex. Other 20 patients received only speech therapy. To assess the efficacy of therapy, the automated "Program of examination of patients with aphasia", Goodglass-Kaplan scale, modified Rankin scale were used. RESULTS There was a significant improvement of speech functions, communicative abilities and functional recovery (p<0.01) in patients of both groups. However, a significantly greater level of rehabilitation (p<0.05) was noted in patients treated with combined therapy included two courses of cellex. CONCLUSION The results allow to recommend the inclusion of cellex in the complex rehabilitation of patients with post-stroke speech disorders.

Gut human microbiota and multiple sclerosis

Abstract: Recently the relationship between gut microbiota changes and the development of immune-mediated diseases of the central nervous system (CNS) has been reported. This review presents literature data on the effect of gut microbiota on the function of the immune and nervous systems. The authors discuss possible mechanisms of the relationship between gut microbiota changes and CNS diseases on the model of multiple sclerosis (MS).

[Nitric oxide: from the mechanism of action to pharmacological effects in cerebrovascular diseases].

Abstract: The article presents the data of studies of nitric oxide (NO) in the pathogenesis of cerebrovascular diseases. It is emphasized that endothelial dysfunction contributes to the formation of cerebrovascular diseases. Generalized data on preparations with endothelioprotective effect, as well as own data on the use of the preparation 'Divaza' in patients of middle and advanced age with chronic cerebrovascular disease are given.

Pharmacological effects and clinical application of pantogam and pantogam active

Abstract: Clinical studies and experience in the use of pantogam (hopanthenic acid) and pantogam active (rac-gopantenic/D-, L-gopantenic acid) showed their efficacy and safety in patients with various pathologies. Pantogam has a unique spectrum of pharmacological effects (nootropic, anticonvulsant, mild activating) in the absence of addiction, hyperstimulation or withdrawal syndrome. Pantogam active, having also an additional anxiolytic effect, is characterized by bimodal activity, improves not only cognitive functions, but also emotional state in patients in psychiatric, neurological and cardiological practice with such diseases and conditions as anxiety/anxiety-depressive disorders, chronic brain ischemia, ischemic heart disease, chronic heart failure, arterial hypertension, epilepsy, craniocerebral trauma, schizophrenia as well as cognitive impairment in the structure of neurological and psychogenic deficiencies.

A comparative study of the effects of mexidolum and mildronatum on the physical performance of experimental animals

Abstract: AIM To evaluate the effects of mexidolum on physical performance using acute and subchronic administration in experimental animals MATERIAL AND METHODS The investigation was carried out using 123 male white outbred mice The forced swim test was used to assess the effects of the drugs on the physical performance of mice RESULTS AND CONCLUSION A single intraperitoneal administration of 50 and 100 mg/kg mexidolum and subchronic intraperitoneal administration of 100 mg/kg mexidolum significantly enhances the physical performance of animals in the forced swim test Subchronic intraperitoneal administration of 100 mg/kg of the comparison drug mildronatum enhances the physical performance of animals, while intraperitoneal administration at a lower dose (50 mg/kg) has no effect The effect of mexidolum at a dose of 50 and 100 mg/kg is comparable with the effect of mildronatum in a dose of 100 mg/kg

A comparative chemoreactome analysis of mexidol

Abstract: Aim To compare mexidol with control molecules (choline alfoscerate, piracetam, glycine, semax) using chemoreactome analysis. Material and methods The chemical structure of mexidol was compared to molecule metabolites extracted from the Human Metabolome Database (HMDB) and a drug database. More than 40 000 of metabolites from HMDB were used as a model of human metabolome. Results and conclusion The chemoreactome analysis showed that mexidol may be (1) an agonist of acetylcholine and GABA-A receptors; (2) an anti-inflammatory agent, the effects of which are carried out by inhibiting the synthesis of pro-inflammatory prostaglandins; (3) a neurotrophic agent with neuroprotective properties; (4) a coagulation inhibitor; (5) a diabetes medication and (6) a hypolipidemic agent. Compared to 'control' molecules, mexidol has a more pronounced safety profile (a lower impact on serotonin, dopamine and adrenergic receptors, a lesser degree of interaction with the potassium channels of the heart, MAO and P450 cytochromes). The results of modeling allow to specify the mechanisms of action of mexidol at the molecular level.

Postoperative cerebral dysfunction

Abstract: AIM To study the structure, risk factors and methods of prevention of postoperative brain dysfunction on the example of coronary artery bypass surgery with cardiopulmonary bypass. MATERIAL AND METHODS The study included 77 patients who undergone elective coronary artery bypass surgery at the beating heart (22 patients) or with cardiopulmonary bypass (55 patients, including 24 patients, who received cerebroprotective treatment with cytoflavin in the preoperative period). All patients underwent dynamic (pre- and postoperative) neurological, neuropsychological, instrumental examinations. RESULTS The postoperative cerebral dysfunction was diagnosed in 34 (44,2%) patients. The frequency of the clinical types of postoperative cerebral dysfunction significantly differed: perioperative stroke - 3 (3,9%) cases, symptomatic delirium of the early postoperative period - 11 (14,3%) cases, delayed cognitive impairment - 28 (36,4%) cases. The risk factors of postoperative cerebral dysfunction after the coronary artery bypass surgery with cardiopulmonary bypass were identified. Preventive preoperative use of the neuroprotective drug cytoflavin reduces the severity of delayed cognitive impairment after the coronary artery bypass surgery with cardiopulmonary bypass and has a good safety profile. CONCLUSION An analysis of the literature data and the results of our own studies show that postoperative cerebral dysfunction is the nosological entity with various etiological factors, pathogenetic mechanisms and the characteristic clinical types, which has an effect on the outcome of surgical treatment.

Modern conception of the pathogenesis of neurodegenerative diseases and therapeutic strategy

Abstract: Here we discuss the pathogenesis of the inflammatory and degenerative nervous system disorders on the example of Parkinson's disease, Alzheimer's disease, multiple sclerosis. Common mechanisms of neurodegeneration in these diseases are reviewed. The role of neurodegeneration as the main process leading to the resistant disability of patients with multiple sclerosis is discussed. The authors consider a contribution of inflammatory process and chronic infection to the manifestation and progressing of a neurodegenerative disease and discuss the use of treatment not usually indicated including interferon, anti-inflammatory drugs, statin, vitamin D, monoclonal antibodies, correction of the intestinal microbiota in Parkinson's disease and Alzheimer's disease.

Results of a randomized double blind parallel study on the efficacy and safety of tolpersione in patients with acute nonspecific low back pain

Abstract: Aim To evaluate the efficacy and safety of tolpersione injection and oral formulations combined with NSAID over NSAID monotherapy in acute non-specific low back pain. Material and methods In this randomized double blind study 239 patients were included in the per protocol analysis. The first 5 days of treatment, patients received tolpersione or placebo injection which was followed by per os administration of tolpersione/placebo tablet up to 14 days. NSAID diclofenac tablet was used in both groups through the study. Functionality assessed by the Roland Morris Disability Questionnaire (RMDQ) at day 5 was the primary endpoint. Secondary endpoints were RMDQ at other time points, pain level change at rest and on movement assessed by the Visual Analogue Scale (VAS), the Clinical Global Impression of Improvement/Patient Global Impression of Improvement (CGI-I and PGI-I), change in the range of motion assessed by the distance from the fingertips to the floor, period of disability days, relative (%) changes in the daily dose of diclofenac from the 7th to the 14th day of therapy. Results and conclusion The primary and secondary endpoints clearly demonstrated the significant superiority of tolpersione added to NSAID monotherapy over NSAID monotherapy. The safety assessment revealed no statistically significant differences between the two groups. Based on the results, tolpersione injection and per os formulations can be considered an effective and safe drugs in the combined therapy for patients with acute nonspecific back pain.

The efficacy of the exoskeleton ExoAtlet to restore walking in patients with multiple sclerosis

Abstract: AIM To investigate the efficacy and safety of the exoskeleton ExoAtlet in complex therapy of patients with multiple sclerosis (MS). MATERIAL AND METHODS A pilot study within the prospective open controlled program was conducted. Eighteen patients with relapsing-remitting MS (RRMS) in remission and secondary progressive MS (SPMS) with the level of neurological deficit on the EDSS from 3 to 7 points have completed the study. EDSS, MSFC, HADS, MoCA scales were administered and the force measuring insoles F-Scan Tekscan (USA) were used to study the biomechanics of walking. RESULTS AND CONCLUSION Good tolerability of workload within 30-40 min. was observed. The improvement in the EDSS was detected in 9 patients, in whole, a significant positive trend (p<0.01) was shown. The study of the biomechanics of the walk showed its significant impairment compared to healthy individuals: reduction of parameters of rate, speed and step length, significant instability, pronounced asymmetry, the decrease in support and shock lower limb function, high coefficient of variability of the parameters, the phenomenon of recurrence of the vertical component of support reactions. After a course of exercise of walking in the exoskeleton, the walking speed and stability increased, oscillation of the body decreased, support function increased, the phenomenon of cyclical changes of the vertical component of support reactions reduced. The results of the pilot study showed promising future research opportunities for robotic-assisted walking and maintenance of the vertical posture with the help of the exoskeleton ExoAtlet to restore the abilities of movement in MS patients with locomotor disorders.

Evolution of the schizophrenic deficit concept

Abstract: The relevance of this study is the high prevalence and clinical heterogeneity of deficit states in chronic schizophrenia and schizophrenia spectrum disorders. The study aimed at analyzing negative symptoms in schizophrenia and schizophrenia spectrum disorders from historical and modern perspectives. An analysis of available literature, along with own observations, has been performed. It was found that negative symptoms comprise 3 clinical types: 1) 'pseudopsychopathic' type (overlapping personality dimensions and premorbid/initial negative symptoms), 2) pseudoorganic/asthenic/pseudobradiphrenic type (pseudoorganic states), developing at different stages of schizophrenia), 3) 'new'-life pseudopsychopathic type (not associated with premorbid personality traits), developing at late stages in schizophrenia. The trajectory heterogeneity of negative symptoms in their relation to positive symptoms has been defined: simultaneous-continuous course (synchronous course of positive and negative symptoms), polar course (alternative development of predominantly positive or negative symptoms), simultaneous-phasic course (pseudopsychopathic negative symptoms, attracting depressive symptoms, or depression that exacerbates latent deficit). The authors discuss some aspects of psychopharmacological treatment of negative symptoms. Negative symptoms in schizophrenia and schizophrenia spectrum disorders differ clinically, have heterogeneous trajectory course, and require differentiated approach with regard to psychopathological qualification, prognosis and treatment.

Modern approaches to neuroprotective treatment of ischemic stroke

Abstract: The authors present the results of domestic clinical trials on the efficacy and safety of mexidol in patients with cerebrovascular disorders including ischemic stroke (IS). The use of mexidol is associated with complete and rapid regression of the focal neurological deficit. Mexidol is well tolerated with no significant side-effects. The drug is recommended for enteral and parenteral administration in patients with IS.

Dynamics of indicators of the functional state of the central nervous system in Navy operators treated with cytoflavin after a long working cycle

Abstract: AIM To evaluate the efficacy of cytoflavin in the correction of functional state and working ability of Navy operators after a long working cycle. MATERIAL AND METHODS Results of the examination of 25 Navy operators, aged from 27 to 42 years, were analyzed at baseline and after treatment with cytoflavin. The Rusalov questionnaire for Individuality Formal Dynamic Properties and EEG were used to evaluate the state of participants. RESULTS AND CONCLUSION The results demonstrate the ability of cytoflavin to exert the positive effect on the energetic component of the functional state of Navy operators after a long working cycle, increasing the psychomotor activity and optimizing the spontaneous electrical activity of the brain. The activation of energetic potential, physical activity and emotional reactions by cytoflavin is correlated with the growth of the central nervous system reserves in Navy operators treated after a long working cycle.

[Anxiolytic and antidepressant effects of emoxipine, reamberin and mexidol in experimental diabetes mellitus].

Abstract: Aim To perform a comparative study of anxiolytic and antidepressant effects of derivatives of 3-oxypyridine and succinic acid (emoxipine, reamberin and mexidol) in experimental diabetes mellitus. Material and methods An effect of emoxipine, reamberin and mexidol on manifestations of anxiety in 'elevated plus maze' (EPM) and duration of 'desperate behavior' (DB) in Porsolt test in rats with alloxan diabetes during medication course was studied. Alpha-lipoic (thioctic) acid (α-LA) was used as a reference drug. In additional experimental series, an effect of emoxipine, reamberin, mexidol and α-LA on the intensity of hyperglycemia in experimental DM was investigated. Results and conclusion All studied medications used in doses equivalent to therapeutic range in humans and administered for 14 days significantly reduced manifestations of anxiety and depression in rats with alloxan diabetes. The most pronounced anxiolytic potential was demonstrated for emoxipine that emerged as the only medication in the study that reduced manifestations of anxiety not only in comparison with 'alloxan diabetes-control' groups but also in comparison to 'intact control'. The intensity of tranquilizing activity of derivatives of 3-oxypyridine and succinic acid was similar to that of α-LA while the thymoanaleptic activity, when the drugs were administered in maximal doses to rats with experimental DM, was higher. Both emoxipine and mexidol as well as α-LA in all studied doses significantly decreased hyperglycemia in alloxan diabetes. Reamberin demonstrated only insignificant tendencies of the same trend.

Current algorithms of diagnosis and treatment of multiple sclerosis based on the individual assessment of the patient

Abstract: This review presents the current knowledge on diagnosis, therapy of relapses of multiple Sclerosis (MS) and disease-modifying therapy (DMT) in MS. Algorithms of diagnosis and therapy of MS are presented. Special attention is paid to the analysis of efficacy, tolerability and safety of DMT in MS.

Dendritic cells in multiple sclerosis

Abstract: Main functions, structure and stages of development of dendritic cells (DCs) are reviewed A role of DCs in the development of immune tolerance and autoimmune diseases as well as involvement of DCs in the immunopathogenesis of multiple sclerosis (MS and their therapeutic potential in the treatment of MS are discussed

[Population models of mental health in the Russian population: assessment of an impact of living conditions and psychiatric care resources]

Abstract: ОBJECTIVE: The development and use of population models of mental health in the Russian population to analyze the relationship between indicators of mental disorders, psychiatric care resources taking into account medical/demographic and socio-economic factors in the period of 1992-2015. Material and methods The sources of information were: 1) the data of the Russian medical statistics on the main indicators of mental health of the Russian population and psychiatric care resources; 2) government statistics on the demographic and socio-economic situation of the population of Russia during this period. The study used system data analysis, correlation and regression analyses. Results and conclusion Linear and nonlinear models with a high level of significance were obtained to assess the impact of socio-economic, health and demographic (population, life expectancy, migration, mortality) factors and resources of the service (primarily, manpower) on the dynamics of the main indicators (prevalence, incidence) of mental health of the population. In recent years, a decline in the prevalence and incidence of the Russian population is a consequence of the scarcity of mental health services, in particular, personnel resources.

Staging of neuroplasticity alterations during epileptogenesis (temporal lobe epileply as an example)

Abstract: Using temporal lobe epilepsy as an example, staging of long term plasticity in the hippocampus is considered. Major stages demonstrating opposite alterations in neuroplasticity are active epileptogenesis and the period of established temporal lobe epilepsy. During the epileptogenesis, multiple events resulting in forming of epileptic neuronal nets occur: changes in glutamatergic and GABAergic neurons, increase of aberrant neurogenesis, axonal sprouting and dendrite remodeling, particularly, supported by an excessive enhancement of the BDNF system in specific hippocampal regions. As epileptogenesis progresses, this stage of an aberrant superplasticity is changing for opposite events accompanying formation of the epileptogenic focus and limiting plasticity: axonal damage, neuronal cell death, hippocampal sclerosis, suppression of neurogenesis. At this neurodegenerative stage of temporal epilepsy, the inclusion of neuroprotectants with neurotrophic properties (e.g. drugs containing cerebral peptide hydrolizates) into the treatment protocol appears promising. Potential use of such neuroprotectants during the active epileptogenesis period is discussed.

[Epileptic syndromes in childhood associated with secondary generalized tonic-clonic seizures].

Abstract: AIM To study a group of patients with secondary generalized tonic-clonic seizures (SGTCS) in view of nosology, medical history, clinical, electroencephalographic and neuroimaging features. MATERIAL AND METHODS The study included 471 patients, 244 (51.8%) men and 227 (48.2%) women. RESULTS SGTCS were observed in many epileptic syndromes. The most frequent were symptomatic focal epilepsy (33.8%), cryptogenic focal epilepsy (23.8%), rolandic epilepsy (12.6%), FEBL-BEDC syndrome (12.3%). Other forms of epilepsy were less frequent. The onset of epilepsy ranged over a wide age range from the first month of life to 18 years. The average age of onset was 5.7±4.96 years. SGTCS as the only type of paroxysms were observed in 28.3% of cases. Two or more types of seizures were observed in 71.7% of patients, three or more types in 39.3%. Epileptiform activity on EEG during long VEM was detected in 91.3% of patients with SGTCS. In 37.2% of patients, benign epileptiform discharges of childhood were recorded. Treatment with antiepileptic drugs (AEP) led to complete remission in 57.1% of cases of epilepsy associated with SGTCS. A reduction of the frequency of seizures by 50% or more was found in 33.6% of patients treated with AEP. No effect was observed in 9.3% of patients. CONCLUSION Significant differences in the prognosis and therapeutic approaches to specific epileptic syndromes associated with SGTCS necessitate the use of the entire spectrum of diagnostic measures, which should include careful history taking, clinical examination, video-EEG monitoring with the inclusion of sleep dynamics, MRI / CT brain, genetic testing.

The optimization of management of chronic daily headache patients

Abstract: Aim To optimize the management of chronic daily headache (CDH) using cognitive-behavioral therapy (CBT). Material and methods The study included 90 patients (76 women and 14 men), aged from 23 to 78 years (mean age 46.71±11.99) with primary forms of CDH. The patients were followed-up by the neurologist during 12 months, psychological characteristics were studied together with the psychiatrist. Patients received combined treatment, including optimized pharmacotherapy, educational program, relaxation training, CBT and exercise therapy. Results The diagnosis of CDH has not been previously established in 86.7% of the patients. All patients received unnecessary additional diagnostic examinations, ineffective treatment (86.7%) that resulted in the formation of wrong conceptions about their state (90%). Three months after combined treatment, a significant positive effect has been achieved in 62.2% of the patients and after 12 months in 72.2%. Conclusion The combined treatment program that included CBT can relatively rapidly help patients with CDH and exerts a stable positive effect during 12 months of the follow-up.

[Perspectives of the diagnosis of Alzheimer's disease using optic coherent tomography].

Abstract: There is a constant search for new possibilities of the diagnosis of neurodegenerative diseases that cause dementia. The problem is important because of the growing prevalence of dementia, 60-80% of which are caused by Alzheimer's disease (AD). Over the last years, changes in the retina are thought to be a marker neurodegeneration. Assessment of these changes is performed using a method of optical coherent tomography (OCT) that allows taking cross-sectional imaging of a tissue. OCT is considered a potential biomarker of the early stage of AD. Identification of the relationship of the changes in retina and the optic nerve with cognitive impairment open new possibilities for the diagnosis of AD.

[Pathological redundancy of the motor act: modern concepts of the pathogenesis and approaches to the pharmacological treatment].

Abstract: The authors present characteristics of pathogenetic mechanisms of pathological motor redundancy in children with neurological and psychoneurological pathologies examined in accordance with the original author's concept. Pathological mechanisms of the development of motor redundancy, including obsessive movements, hyperkinesia, compulsions, motor and sensory stereotypes, taking into account a certain unity of mechanisms of their origin at the anatomical level, are described. The article demonstrates the differences in the formation of these pathological motor acts associated with changes in their function, i.e. neuromediation and neuromodulation, in certain structures of the central nervous system.