ABSTRACT
Polyneuropathy in patients with diabetes mellitus is manifested by a lesion of peripheral sensory, motor and autonomic nervous system. Different severity of damage of sensory, motor and autonomic fibers in typical and atypical forms of diabetic polyneuropathy, requires a differentiated approach to therapy, but not the rejection of its implementation. In an interdisciplinary consensus, consultations are held with physicians from different regions of the Russian Federation, and modern methods of diagnosing and assessing the severity of diabetic polyneuropathies, which determine the algorithm for treating patients, are discussed.
Subject(s)
Diabetic Neuropathies , Polyneuropathies , Diabetic Neuropathies/diagnosis , Humans , Polyneuropathies/diagnosis , Russia , Severity of Illness IndexABSTRACT
Diabetic polyneuropathy is the most often complication of diabetes mellitus. However, patients with diabetes may have other neuropathies, which need to be recognized and treated. Chronic nnflammatory demyelinating polyneuropathy is the most common non-diabetic polyneuropathy in patients with diabetes. The article discusses the classification, clinical features of diabetic and nondiabetic polyneuropathies, modern methods of diagnosis and approaches to treatment.
Subject(s)
Diabetic Neuropathies , Polyneuropathies , HumansABSTRACT
AIM: The study aimed at showing actual information about vestibular migraine and presenting different features of vestibular migraine for prevention of diagnostic mistakes and choosing an effective treatment. MATERIAL AND METHODS: Fifty patients with vestibular migraine were diagnosed according to the International Classification of Headache Disorders 3rd edition and examined in a neurological department. RESULTS: Problems with outpatient diagnosis and treatment were found. Many patients were not diagnosed correctly and, therefore, did not receive effective management of vestibular migraine. All clinical features, information of disease history and different objective signs were important for differential diagnosis with other types of dizziness. Management according to guidelines for migraine treatment and recent research of vestibular migraine showed its efficiency for patients. CONCLUSION: Spreading of actual information about vestibular migraine is important due to its underdiagnosis. Knowledge of clinical features is helpful for diagnosis and differential diagnosis. Treatment approaches according to guidelines and last research should be used.
Subject(s)
Headache/diagnosis , Migraine Disorders/diagnosis , Vertigo/diagnosis , Adult , Aged , Diagnosis, Differential , Diagnostic Errors , Female , Headache/drug therapy , Humans , Male , Middle Aged , Migraine Disorders/drug therapy , Outpatients , Treatment Outcome , Vertigo/drug therapyABSTRACT
Diagnosis and treatment of facial pain is a problem for physicians of different specialties (neurologists, dentists, surgeons, oculists, otolaryngologists and psychiatrists). A classification of this pathology is far from ideal and an interdisciplinary comprehensive approach is needed. Current approaches to etiotropic, symptomatic and pathogenetic treatment of patients with most frequent variants of orofacial pain are presented.
Subject(s)
Facial Pain/diagnosis , Facial Pain/drug therapy , Facial Pain/classification , HumansABSTRACT
In this article, the authors consider the characteristics of pathogenesis and clinical picture of peripheral nervous system lesions in elderly patients. Current approaches to pathogenetic and symptomatic treatment of polyneuropathy in elderly patients are analyzed. The authors suggest complex treatment approaches using antiepileptic drugs, group B vitamins, alpha-lipoic acid.
Subject(s)
Polyneuropathies , Aged , Anticonvulsants/therapeutic use , Humans , Middle Aged , Polyneuropathies/diagnosis , Polyneuropathies/drug therapy , Polyneuropathies/physiopathology , Thioctic Acid/therapeutic use , Vitamin B Complex/therapeutic useABSTRACT
The changes in the somatosensory system in aging and peripheral neuropathies are similar. Higher pain sensitivity thresholds in the presence of axonopathy are accompanied by paradoxically decreased pain tolerance associated with neuroplastic changes in the spinal cord and brain. The symptomatic treatment of neuropathic pain syndrome with antidepressants, anticonvulsants, and opioids is related to the lower quality of life in elderly patients and to the high risk of severe side effects. The pathogenetic treatment of polyneuropathies frequently increases the intensity of neuropathic pain at its beginning; however, it can recover the function of an axon and reduce the degree of deficiency states. The paper discusses methods for increasing the safety of treatment for neuropathic pain in elderly patients, a relationship between the pathogenesis of nervous system aging and distal diabetic polyneuropathy, and ways of their correction.
Subject(s)
Aging , Neuralgia , Polyneuropathies , Aged , Aging/pathology , Aging/physiology , Humans , Neuralgia/diagnosis , Neuralgia/physiopathology , Neuralgia/therapy , Polyneuropathies/diagnosis , Polyneuropathies/physiopathology , Polyneuropathies/therapyABSTRACT
AIM: To estimate the late duration of the effect of 3-week intravenous alpha-lipoic acid (alpha-LA) administration. SUBJECTS AND METHODS: The study included patients with symptoms of myodiabetic polyneuropathy. The authors studied trends in neuropathic symptoms by the TSS scale and neuropathic deficit by the NIS-LL scale after 3-week intravenous alpha-LA (600 mg/day) administration. Control follow-up visits were made at weeks 8 and 30 of the study. RESULTS: In alpha-LA-treated patients, the mean TSS score dropped from 9.46 +/- 1.01 to 3.29 +/- 1.49 after intravenous alpha-LA administration and continued to decrease to 260 +/- 1.18 and 4.39 +/- 201 scores at follow-up weeks 8 and 30, respectively. In the placebo group, these were 9.78 +/- 1.23, 6.16 +/- 1.95, 6.52 +/- 1.61, and 736 +/- 1.31 scores at weeks 3, 8, and 30, respectively; p < 0.05). In the alpha-LA group, NIS-LL scores fell from 8.65 +/- 3.46 to 6.01 +/- 3.12 at therapy week 3, to 6.11 +/- 3.36, at week 8, and to 7.68 +/- 3.68 at week 30 and in the placebo group, these decreased from 8.35 +/- 3.84 to 7.81 +/- 3.51, 7.89 +/- 3.72, and 8.32 +/- 3.49 scores at weeks 3, and 8, respectively; p < 0.05). CONCLUSION: . Alleviated neuropathic symptoms persisted within 6 months after 3-week intravenous alpha-LA injection. Reduced neuropathic deficit did within 8 weeks after initiation of alpha-LA therapy.
Subject(s)
Antioxidants/administration & dosage , Diabetic Neuropathies/drug therapy , Thioctic Acid/administration & dosage , Double-Blind Method , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Injections, Intravenous , Male , Middle Aged , Time Factors , Treatment OutcomeABSTRACT
Chronic pain syndromes comprise a heterogeneous group of very common clinical conditions having important medical and social implications. The author briefly reviews evolution of the concepts of mechanisms and characteristics of neuropathic, nociceptic, and psychogenic pain and current approaches to the diagnosis and treatment of neuropathic pain syndromes and musculo-skeletal pains. The recommended therapeutic modalities for patients with chronic pains are based on the results of original studies conducted in the Department of Neural Diseases, I. M Sechenov Moscow Medical Academy, during the last years and recent data obtained in foreign clinics.
