[Pharmacotherapy approaches to vascular mild cognitive impairment in patients of different age groups]

The article discusses the possibilities of pharmacotherapy of moderate vascular cognitive impairment in different age groups. The results of a double-blind randomized clinical trial «MEMO» using the antioxidant and antihypoxic drug Mexidol are presented. On the basis of cognitive scales, when using a sequential course of parenteral and oral administration of mexidol, its reliable effectiveness was shown in each of the three analyzed groups: 40-60 years old, 61-75 years old and 76-90 years old. Mexidol showed an optimal safety profile in all age groups.

[Arterial hypertension and cognitive impairment. Neurologist's view]

The article presents a review of the literature on the relationship of cognitive impairment (CI) with arterial hypertension (AH). The pathogenetic mechanisms AH are characterized by the development of cerebral microangiopathy. Antihypertensive therapy (AHT) should take into account violations of autoregulation of cerebral blood flow in cerebrovascular disease and critical stenoses of large cerebral arteries, especially in fragile patients older than 80 years. The importance of AHT focused on the level of cerebral perfusion blood pressure, the severity of CI and the physical functioning of patients is emphasized. Neurocytoprotective therapy is recommended for correction of CI.

[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.

Influence of psychosocial risk factors on the course and prognosis of cardiovascular diseases

It has now been established that psychosocial risk factors significantly worsen the course of cardiovascular diseases (CVDs) and reduce patients’ adherence to treatment. Patients with CVDs are characterized by a high prevalence of anxiety comorbidities, which can reach 50-60%. The presence of concomitant anxiety disorders seriously worsens the prognosis of CVDs. The results of studies showed that anxiety increases the risk of fatal myocardial infarction and sudden death by 1,9 times and 4,5 times, respectively. Therefore, the correction of psychosocial factors, in particular anxiety symptoms, should be an important component of the treatment of patients with CVDs. The conducted studies show that the use of fabomotizole in patients with CVD and concomitant anxiety disorders reduces the anxiety manifestations. In addition, a pronounced improvement of somatic status is recorded, which is important for improving the course and prognosis of CVDs. The accumulated experience of fabomotizole use makes it possible to recommend it for the treatment of patients with anxiety and CVDs.

[Results of an international multicenter, randomized, double-blind, placebo-controlled study assessing the efficacy and safety of sequential therapy with Mexidol and Mexidol FORTE 250 in patients with chronic brain ischemia (MEMO)]

OBJECTIVE

To assess the efficacy and safety of sequential therapy with Mexidol solution for intravenous and intramuscular administration, 50 mg/ml and Mexidol FORTE 250 film-coated tablets, 250 mg in patients with chronic brain ischemia (CBI).

MATERIAL AND METHODS

An international multicenter, randomized, double-blind, placebo-controlled trial, conducted in 15 clinical centers located in Russian Federation and Republic of Uzbekistan, included 318 patients with CBI aged 40 to 90 years. The patients were randomized into 2 groups, the patients of the 1-st group received Mexidol intravenously 500 mg once daily for 14 days, followed by Mexidol FORTE 250 - 250 mg 3 times a day orally for 60 days; patients of the 2-nd group received a placebo in a similar mode. The primary endpoint was the mean value of difference by MoCA scale at the point of completing the therapy comparing to initial value.

RESULTS

According to the results of the assessment of the primary endpoint, statistically significant changes in the MoCA scores at the stage of completion of study were revealed when comparing the dynamics between the 1-st and 2-nd groups (p<0.000001). The lower limit of the 95% confidence interval for the difference in the average of the main efficacy endpoint between the 1-st and 2-nd groups was 1.51, which allows to state a higher efficacy of the use of Mexidol. According to the estimates of secondary endpoints, a statistically significant advantage over placebo at the last visit achieved while evaluation by the following scales and tests: digit symbol substitution test, MFI-20 asthenia assessment scale, Beck anxiety scale, Vane questionnaire, Tinetti scale, SF-36 questionnaire (mental component of health), CGI scale. The comparable nature of the safety profile of Mexidol and Placebo was established.

CONCLUSION

The validity and expediency of the use of Mexidol and Mexidol FORTE 250 in the treatment of patients with CBI has been demonstrated.

[Oxidative stress in focal symptomatic and cryptogenic epilepsy in young patients]

OBJECTIVE

To study oxidative stress in young patients with focal symptomatic and cryptogenic epilepsy and after the new-onset epileptic seizures.

MATERIAL AND METHODS

Patients, aged from 19 to 44 years, were distributed into three groups, 30 patients in each: patients after a few (first) epileptic seizures, patients in the clinical remission that has lasted at least one year, and patients with treatment-resistant epileptic seizures. The control group included 20 healthy people. Parameters of the pro-oxidant status (TBA-reactive products) and the antioxidant defense (total superoxide-scavenging activity, catalase, total antioxidant activity, and reduced thiols (SH groups)) were measured in the blood plasma.

RESULTS

No significant differences in the concentrations of TBA-reactive products were identified in patients with epilepsy compared with healthy controls while concentrations of reduced SH groups, total superoxide-scavenging activity, catalase activity and the total antioxidant activity were significantly decreased in patients. In addition, some of the parameters displayed significant differences between different groups of patients.

CONCLUSION

In patients with epilepsy, the changes in the free-radical processes are seen already after the first seizures and persist in the treatment-resistant epilepsy and in clinical remission. Since the parameters of the activity of the antioxidant defense are significantly different in different groups of patients, one can assume that different elements of the oxidative stress are present after the first epileptic seizures and in different courses of the disease.

[Review of clinical guidelines for the treatment and prevention of ischemic stroke]

One of the leading causes of death, disability and severe maladaptation of patients is ischemic stroke, which accounts for about 80% of all types of acute cerebrovascular accidents. At the same time, approximately ²/₃ of the patients show residual effects of cerebral circulation disorders of varying severity. Currently, the problem of ischemic stroke attracts great attention and international and domestic recommendations developed for the prevention, treatment and rehabilitation of stroke patients are one of the aspects of work in this area. The article provides an overview of the latest clinical guidelines for the early management of patients with acute ischemic stroke of the American Heart Association and the American Stroke Association, as well as features of stroke therapy and prevention in Russia, Europe and USA.

[Pharmacoeconomic analysis of the neuroprotective medicines in the treatment of ischemic stroke]

AIM

To perform a pharmacoeconomic analysis of the most frequently prescribed neuroprotective medicines for treating patients with mild ischemic stroke in the acute and early rehabilitation periods in the Russian Federation.

MATERIAL AND METHODS

Three medical technologies were compared: ethylmethylhydroxypyridine succinate (mexidol), inosine + nicotinamide + riboflavin + succinic acid (cytoflavin) and a deproteinized hemoderivate of the blood of calves (actovegin). Cost minimization analysis, budget impact analysis and sensitivity analysis were performed based on the indirect comparison results.

RESULTS

Efficacy analysis shows that mentioned above medicines have the same efficacy: mean difference mexidol is 0,2 (CI min 0,25; max 0,65), cytoflavin - 0,61 (CI min 0,23; max 0,99), actovegin 0,2 (CI min 0,18; max 0,22). The cost minimization analysis for the Russian Federation shows that mexidol therapy is associated with the lowest costs, while savings are observed both in the evaluation of total costs and separate components: intravenous ampoules and tablet forms. The savings in comparison with cytoflavin and actovegin are 231 RUB and 12,872 RUB, respectively. These savings will be enough to treat five patients with ischemic stroke (IS) with mexidol. Moreover, oral mexidol therapy is cheaper than the same dosage forms of cytoflavin and actovegin by 481 RUB and 3,164 RUB, respectively. This is an advantage for the treatment of population at the outpatient stage. Budget impact analysis has shown that the budget for the medicines for treating IS at the current distribution between treatment regimens, is estimated at 1.99 BN RUB. The increase in the proportion of patients receiving mexidol by 10% reduces total costs to 1.75 BN RUB, which is 240 M RUB less than current costs. With these savings 85 thousand patients with IS could be treated. The sensitivity analysis reveals that the result of the cost minimization analysis and the budget impact analysis remain stable when both the amount of the population and the cost of 1 mg of mexidol vary from -10% to + 10%.

CONCLUSIONS

Mexidol has the same efficacy as alternatives. However mexidol is superior to cytoflavin and actovegin in terms of cost minimization analysis. The savings from one course of alternatives will cover costs of treatment of five patients with IS using mexidol. The increase in the proportion of patients receiving mexidol is associated with savings, which allows us to consider mexidol therapy of mild IS as budget-saving in the Russian Federation.

[Dose-dependent effects of cortexin in chronic cerebral ischemia (results of a multicenter randomized controlled study)]

AIM

To study an effect of cortexin on neurological symptoms and oxidative stress as part of the ischemic cascade in chronic cerebral ischemia (CCI), I-II stages.

MATERIAL AND METHODS

The multicenter randomized controlled study included 189 patients with CCI, 42 (22.2%) men and 147 (77.8%) women, mean age 64.3±0.5 years. Patients were randomized into three groups. Group 1 received intramuscular injection of 20 mg of cortexin, group 2 received 10 mg of cortexin; group 3 received basic treatment only. The duration of treatment was 10 days, the treatment course was repeated after 6 months. The patients were examined at baseline and during treatment (in total 5 times). Along with clinical and neurological examinations, some scales and tests ('Fedin Outpatient scale of chronic brain ischemia', MFI-20, Spiegel sleep scale, the Zung self-rating depression scale, Spielberger's inventory, the clock-drawing test, the 5-word test) were used. The severity of oxidation stress was assessed by the content of reduced SH-groups and total superoxide dismutase activity.

RESULTS AND CONCLUSION

A dose-dependent effect of cortexin on the severity of neurological disorders, asthenia, sleep disturbance was shown. Antidepressant and anxiolytic effects were insignificant and were determined after repeated courses of the drug. The laboratory data confirmed the antioxidant effect regardless of the dose of cortexin. The safety and good tolerability of the drug were shown.

[Oxidative stress in epilepsy]

This article contains an analysis of clinical and experimental studies in which oxidative stress is considered as a possible mechanism in the pathogenesis of epilepsy. Oxidative stress occurs as a result of brain damage after epileptic seizures and may later cause epileptogenesis. Patients with epilepsy showed a high level of lipid peroxidation markers, while the activity of antioxidant defense system was low. The level of oxidative stress was shown to be significantly higher in epileptics with associated mental disorders and in patients with refractory epilepsy. Further study of oxidative stress in epilepsy may play the key role in the treatment of this disease.

[Liposomal form of lipoic acid: preparation and determination of antiplatelet and antioxidant activity]

Optimal conditions for obtaining phosphatidylholine (PC) liposomes with lipoic acid (LA) are chosen that lead to the formation of nanoparticles with a size of 175¸284 nm with efficiency (extent) of inclusion of LA in liposomes equal 85% and characterized by a slow release of substance from the nanoparticles. The effect of "empty" liposomes and liposomal form of LA on platelet aggregation induced by arachidonic acid (AA) is established. It is found that liposomes with LА inhibit platelet aggregation, caused by AА, to 80%. In addition, it is shown that "empty" liposomes slightly (to 30%) suppress platelet aggregation, caused by AА. The amount of TBA-sensitive products in samples of platelet-rich plasma (PRP) incubated with liposomal LA is determined. It is shown that LA in the composition of liposomes retains its antioxidant properties, and the amount of products of lipid peroxidation in platelet-rich plasma decreases in a dose-dependent manner when arachidonic acid is used as an inductor of platelet aggregation. It is assumed that the antiplatelet action of the liposomal form of LА is induced by inhibition of the initiation of lipid peroxidation products caused by exogenous inducer AА. It is supposed that, after additional research, the liposomal form of LA can be considered as a new drug in complex treatment of cerebral ischemia.

[The use of L-lysine aescinat in the treatment of microcirculatory disturbances in patients young and middle age with violation of the intracranial venous outflow]

AIM

To study the efficacy of L-lysine aescinat in the treatment of vascular and microvascular disorders in patients with cerebral venous dystonia.

MATERIAL AND METHODS

Sixty-eight patients, 25 male and 43 female, aged from 25 to 56 years, with disturbances of venous cerebral blood circulation and venous outflow difficulties were examined. The examination included the assessment of cerebral hemodynamics using the algorithm of complex ultrasound examinations and functional status of the microcirculation by the laser Doppler flowmetry (LDF) at baseline and 10 days after treatment with L-lysine aescinat.

RESULTS AND CONCLUSION

L-lysine aescinat improves intracranial venous outflow, significantly improves the functioning of microcirculation, while not affecting the normal type of microcirculation or changing it in the direction of improvement of hemodynamic parameters, has a modulating effect on the autonomic response, and can be recommended in the complex treatment of young and middle aged patients with disturbances of cerebral venous blood circulation with the predominance of vagotonia as well as hypersympathicotonia.

[The efficacy of pharmacological preconditioning in carotid endarterectomy]

OBJECTIVE

To assess the efficacy of pharmacological preconditioning with actovegin in carotid endarterectomy.

MATERIAL AND METHODS

The study was based on the results of surgical treatment of 80 patients with hemodynamically significant uni- and bilateral lesions of carotid arteries. Half of the patients was operated immediately and others after pharmacological preconditioning with actovegin in dose of 1200 mg/daily during 1,5 months.

RESULTS

Pharmacological preconditioning with actovegin increased the cerebral perfusion determined with one-photon emission computed tomography that improved significantly results of the surgery. There were significant changes in patient's state 7 days and 6 months after surgery. The improvement was correlated with the less number of asymptotic post-surgery ischemic strokes in different brain areas.

CONCLUSION

A positive role of pharmacological preconditioning with actovegin in surgical treatment of carotid artery stenosis has been demonstrated.

[The effect of cholesterol on the electrokinetic properties of erythrocyte membranes in chronic cerebral ischemia]

AIM

To determine the effects of total plasma cholesterol on the electrokinetic properties of erythrocyte membranes of healthy volunteers and patients with chronic cerebral ischemia (CCI).

MATERIAL AND METHODS

Authors studied the erythrocytes from venous blood of 95 patients with CCI and 54 healthy people (controls). To perform an electrophoretic cell analysis of erythrocytes, we used the shorthand method of computer microelectrophoresis.

RESULTS AND CONCLUSION

Plasma cholesterol level increased with the age. In the control group, there were the increase in percentage of fixed red blood cells, decrease in the amplitude of oscillations and electrophoretic mobility of red blood cells. In CCI patients, a significant increase in the share of fixed red blood cells, decrease in the amplitude of oscillations and electrophoretic mobility were observed compared to the controls. An increase in percentage of fixed red blood cells as well as in the qualitative heterogeneity of red blood cells in the amplitude of the oscillations was identified both in patients and controls, regardless of sex and age, with higher levels of total cholesterol.

[Pharmacological preconditioning in carotid endarterectomy]

The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months. It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain. A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions.

[Treatment of asthenic syndrome in patients with chronic brain ischemia: results of the non-interventional observational program TRIUMPH]

OBJECTIVE

To assess the severity of asthenic syndrome (AS) in chronic brain ischemia (CBI) in primary health care settings.

MATERIAL AND METHODS

The study included 1170 patients with brain ischemia, aged 45-65 years, treated with phenotropil in dose 100 mg during 2 and 3 months. Clinical examination and MFI-20 subscales were administered. RESULTS AND СONCLUSION: The high incidence of asthenic syndrome was observed across all MFI-20 subscales. The decrease in asthenic syndrome severity was significant already in the end of the first month of treatment with phenotropil. Such dynamics maintained to the end of the second and third month of treatment. More than 2-fold decrease in the severity of asthenia symptoms was achieved in all subgroups 3 months after treatment. More rapid and apparent decrease in asthenic syndrome was observed in younger patients.

[Study of the influence of gold nanoparticles on activation of human blood neutrophils]

Activation of neutrophils in the presence of gold nanoparticles is accompanied by the formation of free radical peroxidation products recording the flash of chemiluminescence. The basis for the activation mechanism has its origins most likely in the influence of the gold particles on the surface membrane potential of neutrophils. Investigation of changes in the fluorescence intensity of the negatively charged ANS probe on the surface of model membranes by adding different concentrations of gold nanoparticles indicates the change in the membrane surface charge density that can cause cell activation.

[Pharmacotherapy of endothelial dysfunction in patients with atherosclerotic brain ischemia]

We studied the effect of deproteinized hemoderivative of calf blood, thioctic acid and vinpocetine with piracetam on the endothelial function in patients with chronic cerebral ischemia stage III. After pharmacological treatment, there was the improvement in the endothelium properties of both large and small blood vessels. The index of occlusion that characterized the function of small vessels reached normal values while the phase shift did not approach to the reference values. This notion indicates that in cerebral atherosclerosis small arteries initially are subject to alterations to a lesser extent compared to the arteries of large and medium caliber. The most effective medicines of those used for the correction of endothelial dysfunction are deproteinized hemoderivative of calf blood and thioctic acid.

[The association between oxidative stress markers and clinical course of chronic cerebral ischemia]

Authors studied 360 patients with different stages of chronic cerebral ischemia (CBI), including 180 patients followed-up for 12 months after the first examination, who were stratified into two groups with regard to disease course - favorable (stable) and unfavorable (progressive or with acute episodes of cerebral blood circulation disturbance). Oxidative stress markers were evaluated by the level of lipid- (malonic dialdehyde) and protein - (carbon products of protein oxidation, the level of plasma SH-groups, the accumulation of the products of deep oxidation of proteins) oxidation. Along with indicators of oxidative stress, we evaluated the binding capacity of albumin using fluorescent probe K-35. Initial level of these markers and their concentrations after the copper ion induced oxidation of the plasma were determined. The highest increase in oxidative stress indicators was seen in patients with acute episodes. Authors identified significant differences in these indicators in the groups of patients with different clinical variants of CBI course as well as qualitative and quantitative diagnostic criteria of unfavorable course and risk of stroke. Our findings suggest that the imbalance of oxidative-antioxidative system contributes to the course of CBI. Prediction of unfavorable course of CBI determines the timeliness of adequate treatment.

[L-carnitine treatment patients with chronic cerebral ischemia]

The purpose of this study is to investigate the effectiveness of L-carnitine treatment in patients with dodementia stage chronic cerebral ischemia. In parallel comparative clinical study included 60 patients (22 men and 38 women aged 42 to 74 years), the average age of the patients was 61.2±8.2 years. All patients received basic treatment, including antihypertensive and antiplatelet drugs. The first group consisted of 20 patients who received 1000 mg of L-carnitine per day (bilology supplement karniton). In the second group (20 patients), the drug was administered to 2000 mg per day. In the third (the control group) was carried out only basic therapy. The course of treatment was 60 days. After treatment significantly reduced the frequency of complaints of weakness, decreased performance, memory loss, headache, dizziness, unsteadiness of gait. Statistically significant differences after treatment revealed in the MMSE total score and subtests "focus" and "memory", compared to the baseline reduced the running time with all 5-tables in the test Schulte. According to questionnaire fatigue MFI-20 the main group level decreased overall, physical and mental asthenia, increased activity and the level of motivation. Revealed a dose-dependent effect of the drug.

[The complex energy correction of chronic brain ischemia]

Considerable disturbance of all quality of life domains that worsens social adaptation and daily living and results in an asthenic-neurotic syndrome, along with neurologic and mnestic-intellectual disturbances, was revealed in patients with chronic brain ischemia (stages I, II, III). Based on the results of the double blind placebo-controlled trial, the high clinical efficacy of cytoflavin in patients with chronic brain ischemia has been shown. The treatment with cytoflavin decreases the severity of subjective symptoms and complaints thus increasing the working ability of patients, improves balance and gait, decreases the severity of asthenic and neurotic syndromes, improves cognitive and memory functions (information storage, reasoning and attention), positively effects on quality of sleep and all aspects of quality of life, in particular, on physical activity, self-rating of health and viability as well as social activity, mental health and emotional lability.

[State of the brain blood flow autoregulation]

The brain blood flow autoregulation (BFA) has been studied in normalcy and different variants of atherosclerosis in 97 subjects. Group 1 included 32 patients with obliterating atherosclerosis of the arteries of the low extremities with different stages of chronic artery insufficiency without hemodynamic lesions of brachiocephalic arteries; group 2 consisted of 30 patients wit different forms of chronic brain ischemia with hemodynamically significant unilateral atherosclerotic stenosis of the inner carotid artery (from 70 to 95%). The control group included 35 healthy volunteers aged 20-25 years. BFA parameters were assessed using the original technique worked out by the authors. In the normalcy, the BFA mechanism is able to maintain the constancy of perfusion pressure in the brain due to two major components. In the first stage, it is the aggravation of arterial blood inflow lasting for 1,5 min after the removal of pneumatic cuffs with the following surpassing increase of the venous blood outflow from the scull that decreases the tissue pressure. The most distinct BFA changes were seen in patients with hemodynamically significant stenosis of the inner carotid artery while patients with peripheral atherosclerosis had less marked BFA disturbances.

[A search for new markers of oxidative stress in brain ischemia for the optimization of treatment approaches]

Data of literature on the role of inflammation factors in the pathogenesis of stroke are presented. The study of myeloperoxidase level in the early acute phase of ischemic stroke and dynamics of this parameter after the antioxidant treatment with the α-lipoic acid preparation berlition was carried out. It has been shown that the activation of systemic inflammation and related oxidative stress recorded in the early acute phase of brain infarction needs pharmacological treatment. Neuroprotective action of α-lipoic acid related to the prevention of damaging effect of free radicals on cell membranes and reduction of oxidative stress intensity is a pathogenetic explanation for using its preparations in ischemic brain lesions. The decrease in plasma myeloperoxidase content after the treatment with berlition may consider as a criterion of its efficacy.

[Relationship between clinical characteristics and primary and secondary products of lipid and protein peroxidation]

Recent studies showed that activation of free oxygen radicals and the resulting stress play a key role in the development of brain vascular lesions related to hypertensive disease and atherosclerosis leading to chronic cerebral ischemia. To recall, activation of oxidative stress precedes chronic cerebral ischemia and stroke. Therefore, detection of stress markers may be a step toward the development of a new method for the identification of groups at high risk of stroke among patients with the unfavourable course of cerebral ischemia. This study was focused on the relationship between lipid and protein peroxidation products and clinical manifestations of the disease.

[Effect of early correction of energy and free-radical homeostasis on the clinical-morphological presentation of cerebral infarction]

A randomized comparative prospective 35-day clinical-instrumental trial of 30 patients with an ischemic hemispheric stroke hospitalized on the first day of disease was carried out. In addition to basic therapy, 16 patients of the main group were treated with the antioxidant power-normalizing drug cytoflavin used in dosage 20 ml/day intravenous in drops from the 1st to 10th day and 2 tablets twice a day from the 11th to 35th day. Fourteen patients of the comparison group received basic therapy only. Patient's state was assessed at 0-24 h and 5, 11, 21, 35 days of stroke. Assessment of neurological status (the Glasgow Coma Scale, the NIH stroke scale, a short version of MMSE), brain MRI (brain lesion volume), a study of antioxidant stress markers, assessment of functional outcome (the Barthel index and the modified Rankin scale) were conducted. The early active correction of power and free radical homeostasis by cytoflavin improved the dynamics of brain morphological changes and free-radical changes that was correlated with the activation of consciousness and reduction of neurologic deficit that resulted in the decrease of disability.

[The role of homocysteine levels in the pathogenesis of cognitive disorders in patients with chronic cerebral ischemia]

One hundred and twenty-one patients (mean age 64.13 +/- 8.43 years) with the diagnosis of chronic cerebral ischemia were examined. Somatic and neurological examinations, biochemical blood test, plasma homocysteine measurement, CKT/MRI were carried out. Neuropsychological tests (the MMSE, a battery of frontal dysfunction tests (BFDT), the Clock drawing test, the test of speech activity, the five words test, semantic and categorical associations, the Tailor Manifest Anxiety Scale) were administered: Patients were stratified into 3 groups: group 1 included 34 patients with confirmed cognitive disorders and mild hyperhomocysteinemia (> 15 mcmol/l); group 2 consisted of 51 patients with cognitive disorders and normal levels of homocysteine (< 15 mcmol/l) and group 3 consisted of 36 controls without cognitive disorders and with normal levels of homocysteine. In group 1, the performance of neuropsychological tests was significantly lower and neurological deficit was the most severe. We found reverse correlations between homocysteine levels and severity of cognitive disorders, which were most strong for the results of BFDT, the clock drawing test and the test of speech activity. Hyperhomocysteinemia was positively correlated with the worse values of neurological status and severity of chronic cerebral ischemia.

[Correction of disordered cerebral blood flow autoregulation in atherosclerosis]

The work deals with studying the parameters of autoregulation of the cerebral blood flow in a total of 127 patients subdivided into four groups. Clinical Group I consisted of thirty 45-to-70-year-old male patients (mean age 55.13 +/- 6.44 years) presenting with no signs of systemic atherosclerosis (CAD, chronic arterial insufficiency of the lower extremities, cerebrovascular insufficiency) or any other chronic diseases (chronic cardiac, pulmonary or renal insufficiency, chronic hepatitis, etc.). Clinical Group II comprised 32 patients diagnosed as having varying-degree chronic arterial insufficiency on the background of atherosclerosis obliterans of the lower-limb arteries (average age 57.46 +/- 5.15 years). Clinical Group III was composed of 30 patients presenting with different degrees of chronic cerebral ischaemia and having haemodynamically significant unilateral atherosclerotic lesions of the internal carotid artery (mean age 55.39 +/- 6.25 years), with the Control Group enrolling thirty-five 20-to-25-year-old volunteers. The findings of the work showed that the patients with atherosclerosis had significant impairments of the cerebral blood flow autoregulation, whose type and degree appeared to depend upon localization of the lesion. In the patients with peripheral atherosclerosis, a 10-day therapeutic course of intravenous administration of alpha-lipoic acid (Berlithion) at a dose of 600 mg daily could be used to correct disordered autoregulation of the cerebral vessels and may be considered from the position of preoperative preparation of such patients for reconstructive vascular interventions on the aorta and lower-limb arteries. Efficacy of alpha-lipoic acid (Berlithion) on the alterations in the cerebral blood flow autoregulation in patients presenting with haemodynamic stenosis of the internal carotid artery is insignificant, in connection with which such patients require surgical restoration of the patency of the major cerebral arteries.

[Haemorheological problems in lower-limb chronic arterial insufficiency]

Chair of Neurology of the Advanced Medical Training Department of the Federal Educational Facility of the Higher Vocational Education Russian State Medical University under the Russian Public Health Ministry, Moscow, Russia. The article deals with the findings obtained in examining and treating a total of eighty-seven patients suffering from atherosclerosis obliterans of the lower-limb arteries with stage IIB and III chronic arterial insufficiency. Studied were impairments of the theological properties of the blood and plasma, erythrocytic deformability and the concentration of malonic dialdehyde in blood at admission to the hospital, upon completion of the course of conservative treatment, and after the reconstructive vascular intervention performed. It was determined that the leading mechanism disturbing oxygen utilization by tissues is a decrease in erythrocytic deformability, which promotes shunting of the arterial blood flow and persists after the surgical vascular reconstruction preformed.

[Present-day possibilities of correcting impaired autoregulation of the cerebral circulation]

Reviewed herein is the present-day literature data concerning the causes leading to the development of ischemic stroke. Special attention is drawn to the haemodynamic mechanism, of cerebral circulation impairment. Also discussed is the fed of the onset of such disorders in patients suffering from peripheral atherosclerosis during reconstructive surgical vascular interventions, in relation with a multifocal nature of the lesion. Presented are modern findings on diagnostic methods making it possible to assess autoregulatory disorders of cerebral circulation, the main causes of these impairments, as well as potential principles of correction thereof.

[Early motor rehabilitation with the help of a software/hardware complex "Vertical" in acute period of stroke]

The purpose of our study was the investigation of effectiveness of restoration of lost motor functions in acute period of stroke with the help of software/hardware complex "Vertical". This complex includes a functional bed-trainer for leg movements with phase-dependent functional electrical myostimulation (FES). Fifty-five subjects (mean age 64 +/-1.5 years) were assigned randomly to two groups receiving standard rehabilitation (a control group--27 subjects) and standard rehabilitation combined with the treatment by the "Vertical" complex (FES group--28 subjects). The treatment course was started on average 9 +/- 4 days after stroke and consisted of 30 min sessions 5 days per week during 2 weeks. Outcome was assessed by a battery of scales, everyday movement abilities and biomechanical parameters before and after treatment. No significant differences were found in baseline measurements. After the treatment, there was a positive dynamics in both groups with significant improvement in scores in the FES group. Most of patients of this group (67%) had hemiparesis of mild degree compared to the control group (7%, p < 0.05) to the end of treatment. Also 89% of subjects in the FES group were able to walk without assistance after treatment as compared to the control group (p < 0.05). There was a significant improvement in ankle flexors and extensors force of the paretic leg as well as in ankle joint movements of voluntary "walking" in the supine position in the FES group (p < 0.05).

[Clinical presentations of the secondary bilateral synchronization syndrome in adults with epilepsy]

One thousand eight hundreds and eighty patients with symptomatic and cryptogenic forms of focal epilepsy have been studied. Ninety patients (4.7%) had the secondary bilateral synchronization (SBS) syndrome in the EEG. Criteria of the syndrome are the presence of focal epileptiform activity in the EEG and SBS detected during the long-term video-EEG monitoring. In this group of patients, secondary generalized tonic-clonic, myoclonic and complex partial seizures were found. The clinical presentations of focal epilepsy were similar to the syndromes of idiopathic epilepsy in most cases. Long-term video-EEG monitoring is a method of choice in the instrumental diagnostics of these forms of epilepsy which are different in genesis and prognosis but similar in the kinematic characteristics.

[Efficacy and tolerability of the combined therapy with mesipol and baclosan in chronic recurrent vertebrogenic pain syndrome]

An article highlights the pathogenetic aspects of treatment of reflex pain syndromes in the degenerative-dystrophic spinal lesions. Attention is focused on a rational combination of medications that may shorten the duration of analgesic and anti-inflammatory therapy to prevent the development of side-effects caused by non-steroid anti-inflammatory medications. The results of own research of analgesic efficacy and tolerability of treatment in 50 patients with chronic skeletal-muscle pain syndromes in the state of exacerbation assigned to the combination of a non-steroid anti-inflammatory medication mesipol (meloxicam) with a central myorelaxant baclosan (baclofen) are discussed. It was found the positive effect of therapy not only on pain syndrome but on comorbid symptoms as well.

[The free-radical processes and antioxidant therapy in brain ischemia]

A role of the free-radical processes and disturbances of oxidative-restorative blood homeostasis and nervous tissue in the pathogenesis of brain ischemic pathology and other diseases are reviewed. Attention is focused on the search for optimal ways of pharmacological correction of oxidative stress in the schemes of complex treatment of chronic blood circulation insufficiency and on the necessity of combined application of several antioxidants with different mechanisms of action which reciprocally potentiate each other. Experimental and clinical suppositions of the use of a-lipoic acid as one of the most studied antioxidant in the treatment of brain ischemia as well as the results of own studies on the preparation berlition which contains a-lipoic acid used in the neuroprotective therapy of chronic brain ischemia for correction of free-radical processes are discussed.

[Correction of free-radical processes in patients with chronic brain ischemia with intravenous laser irradiation of blood]

We examined lipid peroxidation (LPO) in 130 patients with chronic brain ischemia (CBI). Primary and secondary LPO products, oxidative and antioxidative enzymes were studied in the course of therapy with antioxidant drug cytoflavin and intravenous laser radiation of blood (ILRB). The latter proved to have a normalizing action on LPO and antioxidant defense. With progression of CBI, effects of ILRB on enzymatic activity weakens due to depletion of endogenic antioxidants. This necessitates administration of exogenic antioxidants (cytoflavin) for complex correction of free radical processes. This conclusion allows recommending combined schemes of therapy for patients with CBI stage II and III.

[Computer-assisted EEG in epileptic patients treated with intermittent normobaric hypoxic therapy in combined treatment of epilepsy]

The article presents an analysis of bioelectrical brain activity in patients with epilepsy during adaptation to intermittent normobaric hypoxia. Before adaptation and after the 1st, 4th, 20th adaptation sessions, resting EEG and EEG during hyperventilation were registered. By the end of the hypoxic trainings, a significant increase of spectral power of the EEG bands was found in resting EEG. At comparing bioelectrical activity in the resting condition and during hyperventilation, the difference between these indices decreased towards the end of hypoxic therapy course. This evidence argues for brain functions normalization during hypoxic therapy.

[The use of normobaric hypoxia in the therapy of epilepsy]

The article concerns the usage of discrete normobaric hypoxic therapy as a way to enhance non-specific resistance in epilepsy treatment. The optimising effect of hypoxia on physiological functions of the patients with epilepsy consists in an increase of haemoglobin and erythrocytes in blood, less systole frequency, a systolic and diastolic pressure reduction, prolongation of a breathing hold during a Stange's test). As a result of these changes, the frequency of epileptic attacks decrease and normalization of behavioural responses was observed.

[Clinical course and diagnosis of the acute craniocervical injury]

Combined observation and treatment of 126 patients (80 men, 46 women) aged 15-67 years were carried out in the acute period of craniocerebral trauma of mild or moderate severity. Diagnostic methods including neurological examination, manual testing and X-ray investigation are discussed. The conclusion is made that craniocerebral trauma should be considered as craniocervical trauma as an indirect damage of the neck was revealed in each case in the form of myofascial syndrome pronounced in different degree; cervical syndrome of vertebral artery was also frequent. These data must be taken into consideration in pathogenetic treatment of patients with craniocerebral trauma.

[Cerebral blood flow in syndrome of vertebral artery]

The paper presents the results of clinical-neurologic study of the indices of cerebral hemodynamics (ultrasonic dopplerography of major arteries of the head, transcranial dopplerography) in 114 patients aged 15-36 years with vertebral artery (VA) syndrome. In the clinical status both subjective manifestations and typical vertebral symptomatology prevailed. There were tendencies to changes of blood flow in extracranial arteries of the carotid system that differed in compression-irritative and reflex-angiospastic forms of VA syndrome. The most significant changes (decrease of blood flow velocity, increase of the indices of the kinematics of blood flow) were observed in vertebral and posterior cerebral arteries (PCA), especially in compression-irritative form of VA syndrome. Homolateral decrease of blood flow in PCA was characteristic for unilateral decrease of blood flow in VA. The results show an important role of the changes of cerebral hemodynamics in pathogenesis of the syndrome of VA.