[Early differential diagnosis and restorative treatment of cerebral palsy]

The article is devoted to an urgent problem of modern neurology - early diagnosis and complex restorative treatment of cerebral palsy (cerebral palsy). Etiological factors and pathogenetic aspects of the formation of various forms of cerebral palsy are considered in detail, as well as modern possibilities of differential diagnosis in children of the first years of life of cerebral palsy and a wide range of pathological conditions (somatic, endocrine, hereditary-conditioned, including hereditary-metabolic and neuromuscular diseases). The leading directions of complex rehabilitation of cerebral palsy are widely presented, taking into account modern standards and clinical recommendations. The high efficacy of the drug Cortexin has been shown, due to its positive multimodal action (stimulation of the processes of neuropreparation, neuroprotection, neuroplasticity) in the treatment of motor, cognitive and autonomic disorders in children with perinatal lesions of the central nervous system and cerebral palsy.

[Post-COVID syndrome in the neurological practice]

Postcovid syndrome (PCS) is a complex multifactorial clinical condition that is a frequent complication of COVID-19. The development of PCS does not depend on the severity of the initial infectious disease, it has a pronounced effect on the quality of life and is characterized by a tendency to a protracted course. In the context of the ongoing COVID-19 pandemic, the emergence of new variants of the SARS-CoV-2 virus, it is important to develop common approaches to the diagnosis and management of patients suffering from this medical condition. The review presents current data on the epidemiology, pathogenesis, clinical presentation, and diagnosis of the PCS. The approaches to therapy of PCS are discussed, as well as the role of Cortexin, taking into account both theoretical and accumulated clinical data.

[Developmental outcomes of very preterm and extremely preterm infants at the 12 months corrected age]

OBJECTIVE

To establish effect of Cortexin for development outcomes of preterm neonates born with low and extremely low body weight, with perinatal pyramidal tract (PT) damage.

MATERIAL AND METHODS

127 children born with very low body weight and extremely low body weight were examined. I group - 22 infant with damage to the PT, treating non-drug rehabilitation during the first year. II group - 59 infant with damage to the PT, treating non-drug rehabilitation and Cortexin during the first year. III control group - 46 infant without structural changes according DTI MRI. Neurodevelopmental outcomes was evaluated by using the INFANIB scale at the 12 months corrected age.

RESULTS

Significant differences were found between groups. The results showed that at the correct age of 12 months normal neurodevelopment occurred more often in two times in second group (1 group - 18.2%, 2 group - 40.7%, p<0.05). Almost of children from control group had normal psychomotor development (3 group - 93.5%). Cerebral palsy was noted significantly more often in the first group (1 group - 36.4%, 3 group - 13.6%, p<0.05).

CONCLUSIONS

DTI MRI has high prognostic value for very preterm and extremely preterm infants. In the same time, we can observe better development outcomes with damage to the PT in the group of children treating non-drug rehabilitation and Cortexin during the first year.

[Results of a multicenter observational program to evaluate the effectiveness of complex therapy of patients with chronic cerebrovascular pathology with cognitive impairment with Cortexin and Neuromexol (CORNELia study)]

OBJECTIVE

To evaluate the effectiveness of complex therapy with Cortexin and Neuromexol in patients with chronic cerebral ischemia (CCI) and cognitive impairment (CI).

MATERIAL AND METHODS

We examined 801 patients with CCI on the background of arterial hypertension and atherosclerosis with confirmed CI: 329 (41.1%) men and 472 (58.9%) women aged 30 to 80 years (mean age 64±10 years), who were examined. Cortexin and Neuromexol. Examination - Mini-Mental State Examination (MMSE) scale, hour-long drawing test (HDT) and severity of depressive states (Brief Geriatric Depression Scale, Mini Geriatric Depression Scal, MGDS). In 30 patients receiving Cortexin and Neuromexol (main group, MG) and 30 patients in the comparison group (CG), biomarkers of ischemic brain damage (NSE, antibodies to NR2, VEGFA) were determined. The examination was carried out before the start of treatment and after 30 days.

RESULTS

During therapy with Cortexin and Neuromexol, characteristic signs of a decrease in the severity of CI were noted (p<0.05). A positive correlation was revealed between the performance indicators of the MMSE and TFC tests, both before and after treatment (r=0.5 and r=0.6, respectively; p<0.05). A positive effect of therapy on the emotional background of patients was noted, in particular, a decrease in the severity of depressive symptoms on the MGDS scale. During therapy, a 2-fold decrease in the NSE level (p<0.05) was detected in the MG, which indicates a decrease in the structural and functional parameters of biomembrane neurons in the brain. The concentration of antibodies to NR2 decreased compared to the baseline level in both groups (p<0.05), and VEGFA decreased only in the MG (p<0.05).

CONCLUSION

The results of the study allow us to recommend the complex prescription of Cortexin 10 mg/day for 10 days and Neuromexol tablets 125 mg (375-750 mg/day) for 30 days for chronic CVD. Complex therapy with Cortexin and Neuromexol is effective and safe in patients with CCI and CI.

[Obstructive sleep apnea - underestimated cognitive impairments risk factor]

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.

[Treatment of diseases with consequences of traumatic brain injury]

Traumatic brain injury (TBI) is one of the leading causes of neurological morbidity, disability and mortality in all age groups of the population. As a result of the general increase in the number of cases of brain injuries, there is a significant increase in the consequences of TBI, the dominant part of which is asthenic, vegetative, cognitive, emotional and liquorodynamic disorders. Therapeutic measures in the long-term period of TBI should be carried out intensively as in the first 12 months. after TBI, and in the future, considering the ongoing processes of morphofunctional maturation of the CNS and high brain plasticity, especially in childhood. Syndromic treatment should be differentiated and pathogenetically substantiated. The article covers in detail the modern methods of drug therapy in patients with remote residual effects of brain injury. The high efficiency of the use of the neuroprotective drug Cortexin in the correction of the consequences of TBI was shown.

[The glymphatic system in the brain - neurobiology and clinical pathology]

Given new information about the neurobiology of the processes of removal of waste products of the brain, consisting of the lymphatic vessels into the dura and the glial-lymphatic (glymphatic) system. The role of astrocytes and water-conducting channels located on them in cell membranes formed by the protein aquaporin-4 is emphasized. The connection between the functioning of the glymphatic system and the slow phase of sleep is discussed. Possible mechanisms for the development of cognitive impairments in violation of the function of the glymphatic system and a delay in the elimination of β-amyloid are shown. Directions of pathogenetic therapy are given.

Neurological Aspects of the Sequelae of COVID-19 in Children

It has now been established that neurological and neuropsychiatric disorders persist for prolonged periods in a significant proportion of adult patients who have had COVID-19, though there is much less information about the manifestations of post-COVID syndrome (PCS) in children and adolescents. This review presents data on the features of the course of PCS in young patients, and considers the options for treating these patients. The results of studies on the use of Cortexin for correcting cognitive and emotional disorders are analyzed.

[Of neurological disorders in extreme conditions and emergency situations]

The review examines the features of neurological disorders that develop in a contingent of people staying in war zones, extreme conditions and emergency situations. The structure of combat injuries is currently dominated by shrapnel and mine-explosive head injuries, craniocerebral trauma, compression and concussion of the brain. Traumatic wounds and features of military service in conditions of high risk and extreme physical exertion are accompanied by asthenia, cognitive disorders and mental disorders of varying severity. Substantiated is the use of Cortexin in craniocerebral and combined combat injuries received by military personnel and civilians in the centers of hostilities; with asthenic and anxiety-depressive disorders, cognitive impairment, sleep disorders, as well as to increase the body's resistance to adverse and extreme effects.

Drug Synergism as the Basis of Rational Neuroprotection

Optimization of the choice of neuroprotective therapy regimens in patients with cerebrovascular diseases (CVD), taking into account the synergism of drug interactions, is a basic approach in clinical practice. Unfortunately, modern pharmacology has no unified way of establishing synergistic spectra of drug actions, which would allow systematic investigation of the effects of combinations of drugs. An approach based on studying detailed mechanisms of action suggested combinations of drugs with the greatest possible synergism (by summation and potentiation of effects) for various directions in the treatment of neurological diseases. Examples of rational neuroprotection are considered, using Cortexin, citicoline, and antioxidants.

[Development of speech disorders in children]

The function of the formation of speech skills is decisive in the development of a child in communication and assimilation of information. Early pediatric diagnosis should become a routine practice of monitoring children from infancy to school age for the timely correction of speech disorders and associated dysgraphia and dyslexia. According to the ICD-10 classification, speech developmental disorders are divided into the following options: articulation impairment, delay in expressive and impressive speech. Articulation disorders, stuttering, impaired expressive speech are the most common and most favorable prognosis for speech therapy interventions. The data on the effectiveness of disorders of the receptive (impressive) language are ambiguous, since there is a high likelihood of a combination with neurogenetic diseases and autism. The development of speech therapy programs will make it possible to broader coverage of those in need of treatment, including complex course therapy with neuropeptides (cortexin).

[Antioxidant effect of cortexin, cerebrolysin and actovegin in rats with chronic cerebrovascular insufficiency]

OBJECTIVE

To compare the antioxidant effects of cortexin, cerebrolysin and actovegin in rats with chronic brain ischemia.

MATERIAL AND METHODS

Chronic brain ischemia was modeled in male rats by 50% stenosis of the common carotid arteries. Forty days after surgery, the animals received 2 ten-day courses of therapy, separated by a break of 10 days. Placebo, cortexin (0.3, 1 and 3 mg/kg), cerebrolysin (0.8, 2.5 and 7.5 ml/kg) and actovegin (5 ml/kg) were administered to animals as treatment. The concentration of malondialdehyde (MDA) in the homogenates was determined by the reaction with thiobarbituric acid, the concentration of reduced glutathione was determined by the reduction reaction of 5.5-dithiobis- (2-nitrobenzoic acid); determination of catalase activity, as well as the content of lactate and pyruvate, by commercially available reagent kits. The activity of superoxide dismutase (SOD) was determined by the photometric method based on an assessment of the degree of inhibition of the epinephrine oxidation reaction. All reactions were carried out in triplicates.

RESULTS

Modeling of chronic brain ischemia led to the statistically significant decrease in the content of lactate and pyruvate (p<0.001, when compared with the control group), which was not accompanied by a significant decrease in their ratio (p>0.05), as well as to the decrease in SOD, catalase activity, restored glutathione and increase in MDA concentrations. Compared with the control group, in the groups that received cortexin at a dose of 3 mg/kg/day, cerebrolysin at a dose of 7.5 ml/kg/day and actovegin at a dose of 5 ml/kg/day, there were an increase in the content of lactate and pyruvate (without a significant change in their ratio), restoration of glutathione levels and the activity of SOD and, to a lesser extent, catalase, combined with a decrease in the concentration of MDA.

CONCLUSION

Course administration of cortexin (3 mg/kg), cerebrolysin (7.5 ml/kg) and, to a lesser extent, actovegin (5 ml/kg) has a positive effect on the state of the antioxidant system of the brain in rats with chronic brain ischemia.

[Potential of peptidergic nootropic therapy in developmental dysphasia in children]

AIM

To study the therapeutic efficacy of peptidergic nootropic medication Cortexin during two-month follow-up in children with developmental dysphasia aged 3-4 years.

MATERIAL AND METHODS

Fifty-four children with developmental dysphasia were randomized into two equal groups. The cortexin group received the drug once daily intramuscularly during 10 days. After this course, children did not receive any pharmacotherapy and were examined two months after the beginning of treatment. The control group did not receive pharmacotherapy and was examined twice in two months interval. All the parents were provided with recommendations for the stimulation of speech development in dysphasic children. Before treatment and two months later, speech development was assessed by special scales and questionnaires for parents.

RESULTS AND CONCLUSION

After treatment with Cortexin, a significant improvement was achieved not only on the 'expressive language' scale but also on the 'attention to speech' and 'impressive language' scales. The volume of active vocabulary was increased by 2.3 times, the number of articulated phrases by 3.6 times. The evaluation of parents' questionnaires demonstrated the decrease of cerebrasthenic, psychosomatic problems, motor clumsiness, hyperactivity, attention deficit and problems with emotional control in children. The therapy contributed to the reduction of difficulties in communication and social adaptation. The positive effect of Cortexin was observed after the completion of treatment (the protracted effect).

Prospective, double blinded, comparative assessment of the pharmacological activity of Cerebrolysin and distinct peptide preparations for the treatment of embolic stroke

BACKGROUND

Our previous work in acute ischemic stroke and TBI models focused on efficacy and pharmacological parameters of Cerebrolysin®. In this prospective, randomized, blinded, placebo-controlled study we compared efficacy of neuropeptide preparations with putative neurotrophic potential to the reference product Cerebrolysin® by assessing functional outcome and lesion volumes after embolic stroke in a rodent model.

METHODS

Male Wistar rats were subjected to embolic right middle cerebral artery occlusion and were treated with: 1) Cognistar® (Cerebroprotein Hydrolysate) 2.5 ml/kg, 2) Cerebrolysat® 2.5 ml/kg, 3) Cortexin® 1.7 mg/kg, 4) Cerebrolysin® 2.5 ml/kg, or 5) 1 ml of saline according to a pre-generated randomization plan. Dosages were defined according to the packet leaflet of the corresponding preparation and were adapted to the animal model as previously described. All enrolled rats received intraperitoneal injections once daily for 10 consecutive days, starting 4 h after occlusion. Functional outcome was assessed once weekly over four weeks by using a battery of behavioral tests. Infarct volume was measured four weeks after occlusion. Generalized Estimation Equations (GEE) was performed to study the treatment effect on overall functional recovery at day 28 (primary outcome), compared to saline controls.

RESULTS

Similar functional outcome was observed for saline control, Cognistar®, Cerebrolysat® and Cortexin®; in contrast, a significantly improved neurological outcome was observed with Cerebrolysin® treatment in comparison to saline as well as to the comparator drug treatment (p < .002). However, there was no significant difference in lesion volumes between rats treated with either Cortexin® (33.5 ± 1.9%), Cerebrolysat® (28.5 ± 2.4%), Cognistar® (34.7 ± 2.0%), or Cerebrolysin® (26.5 ± 2.3%) compared to saline-treated rats (30.8 ± 2.1%).

CONCLUSION

Among all tested neuropeptide preparations, Cerebrolysin® was the only agent that was associated with a significant improvement of neurological outcome after stroke.

[Pinealon and Cortexin influence on behavior and neurochemical processes in 18-month aged rats within hypoxia and hypothermia]

The research of Cortexin and Pinealon within two models of stress, acute hypobaric hypoxia and mild hypothermia, within 18-month aged rats has been held. The peculiarities of peptide preparations' influence on behavior and neurochemical indeces have been identified. Cortexin shows a more pronounced effect on free radical processes and caspase 3 activity in brain than Pinealon. Both preparations forward an accumulation of adrenergic mediator within rats' brains in the model of acute hypobaric hypoxia, as well as serotonin within cerebrum cortex in the model of mild hypothermia, which may underlie their geroprotective effects.