[Effectiveness of Anvifen in the treatment of insomnia in elderly patients]. / Effektivnost' preparata Anvifen pri lechenii insomnii u pozhilykh patsientov.

OBJECTIVE: Purpose of the study to determine the effectiveness of Anvifen in the case of insomnia and meteosensitivity as comorbid stress-induced disorders. MATERIAL AND METHODS: 67 patients aged 60-70 years were examined, who were randomly divided into two groups: group 1 - 33 patients (20 men, 13 women), group 2 - 34 patients (19 men, 15 women). The average age of group 1 was 62.7 [61; 65] years, group 2 was 63.1 [60; 66] years (p=0.28). Research methods: questionnaire for scoring subjective characteristics of sleep, assessing the influence of meteosensitivity on daily activity using a numerical rank scale (NRS) for the previous three months. Patients in group 1 took Anvifen 250 mg (capsules) in the morning and afternoon, 500 mg (2 capsules) in the evening at 10 p.m., and upon awakening at night - an additional 250 mg of the drug per capsule. Patients in group 2 took Anvifen powder (extracting it from the capsule) 250 mg in the morning and afternoon, 500 mg in the evening at 10 p.m., and upon awakening at night - an additional 250 mg of the drug. The time from the nightly intake of Anvifen to the onset of sleep was also assessed on a three-degree scale: «fast¼, «long¼, «very long¼. The duration of treatment was 4 weeks. RESULTS: Baseline results of measured parameters did not differ significantly between groups. After completion of treatment, the total score of subjective sleep characteristics improved in 1st (p=0.00001) and 2nd (p=0.000001) groups. Significant differences from group 1 for the better in group 2 were in «quality of sleep¼ (p=0.00027) and «quality of awakening¼ (p=0.00001). Weather sensitivity decreased in 1st (p=0.00001) and 2nd (p=0.000001) groups. CONCLUSION: Anvifen showed good effectiveness in the treatment of two comorbid conditions of elderly people - insomnia and meteosensitivity. Using the drug in powder form allows you to get a faster and better effect without side-effects.

[Vasculitis as a cause of stroke]. / Vaskulity kak prichina insul'ta.

The review considers the clinical picture, key aspects of the diagnosis and treatment of vasculitis that are the causes of strokes (giant cell arteritis, polyarteritis nodosa, varicella zoster virus vasculopathy, cerebrovascular pathology caused by herpes simplex virus types 1 and 2, primary CNS angiitis, adenosine deaminase-2 deficiency).

[Neurological aspects of connective tissue dysplasia]. / Nevrologicheskie aspekty displazii soedinitel'noi tkani.

Disturbances in the formation of connective tissue lead to significant pathological changes in both individual organs and tissues, and at the organismal level. The complexity of diagnostics is also connected with the fact that there is no single terminology, a single view of the diagnostic criteria, a single approach among doctors of different specialties. The prevalence of external phenotypic signs of connective dysplasia is quite high, which can lead to overdiagnosis. On the other hand, insufficient attention to the manifestations of dysplasia can lead to delayed diagnosis, which can cause adverse complications. The most studied are clinical manifestations in dysplastic changes in the cardiovascular system, musculoskeletal system. This article provides an overview of current data on changes in the nervous system. Sufficient attention was paid to the pathology of the nervous system in differentiated forms (Marfan syndrome, Ehlers-Danlos, etc.). Currently, the role of various vascular anomalies, aneurysms associated with undifferentiated forms of connective tissue dysplasia is widely discussed. Much attention is also paid to clinical manifestations of the autonomic nervous system: sympathicotonic manifestations predominate in connective tissue dysplasia. There is evidence of an association of headaches, musculoskeletal pain, and connective tissue dysplasia in both children and adults.

[Efficacy of potassium N-acetylaminosuccinate (Cogitum) in the treatment of asthenic syndrome: results of double-blind placebo-controlled trial]. / Effektivnost' kaliya N-atsetilaminosuktsinata (Kogitum) pri lechenii astenicheskogo sindroma: rezul'taty dvoinogo slepogo platsebo-kontroliruemogo issledovaniya.

OBJECTIVE: Study of the effectiveness of monotherapy with potassium N-acetylaminosuccinate (Cogitum) for asthenic syndrome (fatigue) in individuals, uncharacteristic somatic, neurological diseases, anxiety disorders, depression and other diseases that may interfere with asthenia. MATERIAL AND METHODS: Patients with fatigue scores of 22 or more on the Fatigue Assessment Scale (FAS) were randomly divided into the main group (MG) - 37 people, mean age 22 years [21; 24] and the control group (CG) - 34 people, mean age 21 years [19; 23]. The Trail Making Test (TMT-A and TMT-B), the assessment of general well-being on a visual analogue scale (VAS), where 0 is the worst state of health, 10 is the state of absolute well-being, was assessed. MG patients received a solution of potassium N-acetylaminosuccinate (Cogitum) 750 mg per day in a sterile container, CG patients received sterile water with banana flavor in a sterile container. The duration of the study was 21 days. RESULTS: Prior to the start of the study, there were no statistically significant differences in FAS, TMT, and VAS between MG and CG. After 21 days, the FAS score in the MG decreased (p=0.00001), the time of TMT-A (p=0.000012) and TMT-B (p=0.000033) decreased, the VAS score increased (p=0.00024). There were no statistically significant changes in the CG. Placebo effect was noted in 10 patients of the CG (29.4%). CONCLUSION: Potassium aminosuccinate (Cogitum) at a daily dose of 750 mg and a duration of treatment of 21 days effectively eliminates the symptoms of asthenic syndrome (fatigue), while accompanied by an improvement in complex cognitive functions. The results of our study suggest that fatigue (asthenic syndrome) and cognitive impairment may have a common pathogenetic mechanism - a deficiency of systems in which mediators are N-acetylaspartate and N-acetylaspartylglutamate. Cogitum had no side effects and was well tolerated. Cogitum is superior to placebo in the treatment of fatigue (asthenic syndrome).

[The effectiveness of short and prolonged course treatment of anxiety with Anvifen]. / Effektivnost' korotkogo i prolongirovannogo kursovogo lecheniya trevozhnogo rasstroistva preparatom Anvifen.

OBJECTIVE: To determine the effectiveness of the treatment of anxiety disorder with Anvifen (aminophenylbutyric acid) in a short (21 days) and prolonged (60 days) course of treatment. MATERIAL AND METHODS: Patients were randomly divided into two groups: a short course (21 days) of treatment with Anvifen (group 1) and a prolonged course (60 days) of treatment with Avifen (group 2). In each group, patients were divided into age subgroups: 20-40 years old (1a - n=30, mean age 32 [21; 39], 2a - n=30, mean age 33 [23; 38] years) and 41-70 years (1b - n=30, mean age 62 [51; 67] years; 2b - n=30, mean age 60 [51; 68] years). Evaluated by: Hospital Anxiety and Depression Scale (HADS); fatigue according to the Russian version of the fatigue assessment scale (The Fatigue Assessment Scale - FAS); sleep assessment according to the questionnaire for scoring the subjective characteristics of sleep (sleep assessment - OS); mean frequency per month of attacks meeting the criteria for a panic attack (PA) in the previous 6 months; a comprehensive assessment of the severity of all subjective symptoms on a 10-point numerical rank scale (NRS), where «0¼ corresponded to the complete absence of any significant subjective symptoms, «10¼ - the maximum degree of bodily and mental discomfort presented by the patient. Anvifen patients took at a dose of 500 mg three times a day. The evaluation of the studied parameters was carried out at the point «1¼ (before the start of treatment), at point «2¼ at the end of the course of treatment (for group 1 - on the 21st day of treatment, for group 2 - on the 60th day of treatment), at point «3¼ (30 days after the end of treatment for patients in both groups). RESULTS: The indicators of subgroups 1a and 1b at point 2 had a significant positive trend (p<0.05) compared with the indicators at point 1, but at point 3 these indicators did not differ significantly (p>0.05). The indicators of subgroups 2a and 2b at point 2 had a significant positive trend (p<0.05) compared with the indicators at point 1, and these differences persisted at point 3 (p<0.05). CONCLUSION: Anvifen effectively eliminates anxiety symptoms, but the effect of a short course lasts less than 1 month, the effect of prolonged treatment lasts more than 1 month. The authors recommend prolonged treatment of anxiety with Anvifen for at least 2 months.

[Cerebral venous thrombosis associated with COVID-19]. / Tserebral'nye venoznye trombozy, assotsiirovannye s COVID-19.

The literature reports that cerebral venous thrombosis (CVT) develops in 1-1.5% of patients with COVID-19. Recently, a new syndrome named vaccine-induced immune thrombotic thrombocytopenia (VITT) has been described. VITT is a rare side-effect of COVID-19 vaccination that also causes CVT. The article presents an overview of the above problem and a clinical case of a patient with CVT that developed within a month after the first component of the Sputnik V vaccination and COVID-19.

[Anxiety in children and adolescents with primary headaches: diagnosis and treatment options]. / Trevozhnye rasstroistva u detei i podrostkov s pervichnymi golovnymi bolyami: diagnostika i vozmozhnosti terapii.

OBJECTIVE: To determine the comorbidity of primary headaches (PH) and anxiety in adolescents and the effectiveness of aminophenylbutyric acid (Anvifen) in the treatment of anxiety (750 mg per day for 21 days). MATERIAL AND METHODS: Group 1 - «episodic PH¼ (up to 15 days with headaches per month for 12 months) - 84 patients (mean age 15.5±1.3 years; 46.4% boys, 53.6% girls). Group 2 - «chronic PH¼ (15 days or more with headache per month for 12 months) - 55 patients (mean age 15.2±1.4 years; 44.3% boys, 55.7% girls). Group 3 - «teenagers without headache¼ (have not experienced pain in the last 6 months) - 67 people (mean age 15.7±1.4 years; 44.8% boys, 55.2% girls). Anxiety assessment using the Pediatric Anxiety Rating Scale (PARS): number of symptoms (patient); number of symptoms (expert); severity scale (expert); clinical examination (expert). RESULTS: Before/after treatment: group 1 number of symptoms (patient) = 24 [23; 26]/9 [8; 10], number of symptoms (expert) = 23 [22; 25]/12 [12; 13], severity scale (expert) = 21 [20; 25]/9 [8; 11], clinical examination (expert) = 14 [13; 14]/9 [8; 9]; group 2 number of symptoms (patient) = 47 [46; 48]/43 [45; 47], number of symptoms (expert) = 40 [38; 41]/39 [38; 40], severity scale (expert) =33 [31; 34]/32 [31; 34], clinical examination (expert) = 20 [20; 22]/19 [19; 21]. CONCLUSION: Anxiety is a comorbid symptom in adolescents with PH, it is more pronounced in chronic PH. Anvifen has high efficacy in the treatment of anxiety comorbid with episodic PH, moderate efficacy in chronic PH. Treatment of anxiety in adolescents should begin as early as possible to prevent chronicity of the disease.

[Effectiveness of the anxiolytic Anvifen in the treatment of post-COVID brain fog]. / Effektivnost' preparata Anvifen pri lechenii patsientov s sindromom postkovidnogo «tumana v golove¼.

OBJECTIVE: To determine the significance of anxiety disorder and comorbid disorders in patients with post-covid brain fog, to determine the effectiveness of the GABAergic nootropic drug with an anxiolytic effect - Anvifen. MATERIAL AND METHODS: 92 post-COVID-19 patients with no organic brain damage who complain of brain fog 12 weeks after the onset of COVID-19 symptoms. Group 1 (n=40; 43.4±4.5 years) were treated at home; group 2 (n=32; 44.9±5.5 years) were treated in a hospital without oxygen support; group 3 (n=20; 45.1±4.8 years) were treated in a hospital with oxygen support. Assessment scales: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment Scale (MoCA); Trail Making Test part B (TMT-B); a scoring questionnaire for the subjective characteristics of sleep; Fatigue Assessment Scale (FAS), 36-Item Short Form Survey (SF-36). According to the indicated scales, no statistically significant differences were found between the groups, therefore, the data of all patients were combined into one group, the indicators were compared before and after treatment (Anvifen 500 mg three times a day for 21 days). RESULTS: Results before/after treatment: HADS anxiety 10.5 [8.5;12]/7 [5;8] (p=0.000025); HADS depression 5 [4; 7] / 4 [4; 6] (p=0.00003); MoCA 22 [21; 22] / 25 [24; 26] (p=0.00001); TMT-B 281 [279; 290] sec / 231 [220; 236] sec (p=0.00001); FAS 27 [23; 31] / 20 [23; 31] (p=0.00001); questionnaire for scoring the subjective characteristics of sleep 15 [15; 16] / 25 [25; 26] (p=0.00001); SF-36 Physical Health 43.8 [42.3; 47.4] / 53.8 [52.3; 20] (p=0.00001); SF-36 Mental Health 34 [32.5; 35] / 47 [45.5; 48] (p=0.00001). CONCLUSION: The authors conclude that anxiety disorder and asthenia play an important role in the pathogenesis of post-COVID brain fog syndrome. Anvifen effectiveness is considered from the point of view of the participation of GABAergic structures in the pathogenesis of the phenomenon under study.

Neuroinflammation and Neuropathology.

This review addresses the current understanding of the role of autoimmune neuroinflammation in the pathogenesis of vascular, neurodegenerative, and other diseases of the nervous system. The mechanisms of responses of resident CNS cells (glial cells, astrocytes) and peripheral immune system cells are presented. The therapeutic potentials of phosphodiesterase inhibitors, which have antiaggregant properties and can suppress autoimmune inflammation, are discussed. The phosphodiesterase inhibitor dipyridamole is regarded as a potential drug for this purpose.

[Cerebral venous thrombosis]. / Tserebral'nye venoznye trombozy.

Cerebral venous thrombosis (CVT) is one of the rare causes of stroke. It can manifest itself in different symptoms, making its timely diagnostics greatly complicated. Early recognition of symptoms and correct treatment tactics improve the prognosis in these patients. The article is a review of modern data about pathogenesis, clinical picture, principles of diagnosis and treatment of cerebral venous and sinus thrombosis.

[Diabetic encephalopathy: current insights and potential therapeutic strategies]. / Diabeticheskaya entsefalopatiya: sovremennye predstavleniya i potentsial'nye terapevticheskie strategii.

OBJECTIVE: To study the effect of alpha-lipoic acid (ALA) on cognitive functions in patients with non-insulin dependent diabetes mellitus type 2 (DM-2) and thick fiber polyneuropathy. MATERIAL AND METHODS: The MoCA test was used to assess cognitive functions, and vibrometry («Somedic¼ vibrometer) was used to assess the function of thick fibers. Patients in group 1 (n=37) received alpha lipoic acid (ALA) in a dose of 600 mg per day for 16 weeks, patients in group 2 (n=41) started taking ALA 8 weeks after the start of the study. RESULTS: Comparison of both groups showed an increase in the indicators of the MoCA test in group 1 after 8 weeks (p=0.0025) with a further plateau and an improvement in vibration sensitivity after 16 weeks (p=0.023). The improvement in the MoCA test in group 2 also began after 8 weeks. CONCLUSION: The authors recommend ALA in polyneuropathy as a drug that also has a positive effect on cognitive functions in DM-2 and dipyridamole for the treatment of patients with diabetic encephalopathy and cerebral small vessels disease and stroke.

[Neuroinflammation and neuropathology]. / Neirovospalenie i nevropatologiya.

The review highlights the current understanding of the role of autoimmune neuroinflammation in the pathogenesis of vascular, neurodegenerative and other diseases of the nervous system. The mechanisms of the response of the resident cells of the central nervous system (microglia, astrocytes) and peripheral cells of the immune system are considered. Possible therapeutic potential of phosphodiesterase inhibitors, which have antiplatelet properties and the ability to suppress autoimmune inflammation, are outlined. The authors consider dipyridamole, an inhibitor of phosphodiesterase, as a promising drug.

[Failed back surgery syndrome: the role of central sensitization and treatment approaches]. / Sindrom neudachnoi operatsii na pozvonochnike: rol' tsentral'noi sensitizatsii i podkhody k lecheniyu.

OBJECTIVE: To study a role of central sensitization (CS) in patients with Failed Back Surgery Syndrome (FBSS) after decompression of the lumbar and/or sacral roots. MATERIAL AND METHODS: The study included three groups of patients: 1) early FBSS (e-FBSS, n=23), pain after surgery decreased, but continued to significantly bother the patient, or recurred in the first 6 months after surgery; 2) middle FBSS (m-FBSS, n=42), pain after surgery completely stopped, but recurred within 6-12 months; 3) late FBSS (l-FBSS, n=31), if pain relapse occurred more than 12 months later. Neurological status assessment, study of muscle trigger zones (MTZ), postoperative scar trigger zones (TZS), pain assessment according to the Visual Analogue Scale (VAS), CS assessment according to the Russian version of the Central Sensitization Inventory (CSI) were performed. Treatment included the following stages: stage 1 (non-steroidal anti-inflammatory drug (NSAID) meloxicam 15 mg 7 days); stage 2 (aminophenylbutyric acid hydrochloride (APAH) 250 mg 3 times a day 14 days); stage 3 (fluvoxamine 50 mg daily 8 weeks); stage 4 (MTZ and TZS treatment, fitness program). In addition to the previously described 96 patients, 15 patients (4 men and 11 women, aged 36-47 years) with FBSS and widespread pain, corresponding to the criteria for fibromyalgia ACTTION-APS Pain Taxonomy, who took only milnacipran 25-50 mg daily for two months (WSP-FBSS group), were studied. RESULTS: At baseline, CSI and VAS are as follows: CSI=72.2±6.5; VAS=58.5±8.8 in the e-FBSS group; CSI=49.2±9.0; VAS=39.5±5.3 in the m-FBSS group; CSI=18.1±5.9; VAS=18.1±5.4 in the l-FBSS group. All patients have active MTZ and TZS. The differences between MTZ and TZS subgroups were in the reproduction of pain - the appearance of pain characteristic of the patient during stimulation (pressure) of the MTZ or TZS. In the e-FBSS group, there is the low efficacy of NSAIDs, the moderate efficacy of APAH, the high efficacy of fluvoxamine. In the m-FBSS group, the moderate efficacy of NSAIDs and APAH and the high efficacy of fluvoxamine are observed. In the l-FBSS group, there is the high efficacy of NSAIDs. In the WSP-FBSS group, VAS and CSI are 58.8±9.2 mm and 75.1±8.04, respectively, before treatment, 15.51±5.1 mm (p=0.00032) and 25.6±8.2 (p=0.0002), respectively, after 2 months of treatment. CONCLUSIONS: In patients with FBSS, MTZ and TZS should be treated taking into account CS. The study shows the efficacy of APAH, fluvoxamine and milnacipran in the presence of CS.

[Psychometric validation of the Russian version of the Central Sensitization Inventory in adolescents (14-17 years old)]. / Psikhometricheskaya validatsiya russkoyazychnoi versii Oprosnika tsentral'noi sensitizatsii dlya podrostkov 14­17 let.

OBJECTIVE: To validate a Russian version of the Central Sensitization Inventory (CSI) in adolescents (14-17 years old). MATERIAL AND METHODS: The study included adolescents aged 14-17 years. Group 1 (n=69) - frequent episodic and chronic tension type headache; group 2 (n=63) - chronic myogenic neck pain; group 3 (n=61) - infrequent episodic tension type headache; group 4 (n=67) - adolescents without pain during the last 6 months. The first stage was linguistic validation of the statements (symptoms) in CSI (100 randomly selected adolescents). Psychometric validation was performed by comparing the indicators of CSI, Pediatric Anxiety Rating Scale (PARS), and M. Kovacs' Children's Depression Inventory. RESULTS: A strong correlation between CSI scores with the PARS indicators (number of symptoms, severity scale, clinical examination scale) and M.Kovacs' Children's Depression Inventory was shown. CONCLUSION: CSI can be used in adolescents from the age of 14, and it is an informative and useful clinical tool for identifying and assessing the severity of central sensitization in pediatrics.

[Genetics of epilepsy: successes, problems and development prospects]. / Genetika epilepsii: uspekhi, problemy i perspektivy razvitiya.

The authors present a detailed review of current advances in the field of genetics of epilepsy. Separately, new views on the etiology and pathogenesis of genetic epileptic encephalopathies, focal epilepsy and idiopathic generalized epilepsies are examined. The authors emphasize the importance of genetic discoveries for the clinical practice, including the prospects in the development of patients' personalized treatment. A comparative analysis of the value of various methods of genetic research in the diagnosis of epilepsy, methods of integrating molecular genetic analyses into everyday practical medicine is presented.

[Central Sensitization Inventory - a Russian version]. / Oprosnik tsentral'noi sensitizatsii ­ russkoyazychnaya versiya.

OBJECTIVE: To develop and validate a Russian version of The Central Sensitization Inventory (CSI-R). MATERIAL AND METHODS: The study included 3 stages: 1) direct and reverse translation, linguistic validation of the questionnaire; 2) assessment of internal consistency, reliability and sensitivity (n=50); 3) psychometric validation in the samples of patients with fibromyalgia syndrome (n=40), chronic widespread pain (n=40), regional chronic low back pain without other specific pain complaints (n=40), and in the control sample of informants with no pain complaints (n=40). RESULTS AND CONCLUSION: The Russian version of CSI-R is valid, reliable and can be used in clinical practice as a diagnostic tool for revealing central sensitization. The study of the sensitivity of the questionnaire in patients during drug therapy proved its effectiveness in assessing the dynamics of the disease and the effect of therapy.

[Stress-induced disorders]. / Stress-indutsirovannye rasstroistva.

The review analyses the diseases and conditions caused by acute and chronic stress. The authors describe the pathogenesis of stress-induced disorders from the perspective of imbalance between stress-realizing and stress-limiting systems (sympathetic and parasympathetic nervous systems). The effects of acute and chronic stress on the cardiovascular, respiratory, and immune systems, the contribution of stress to the pathogenesis of skin diseases, the gastrointestinal tract, post-stroke disorders, headaches, and dizziness are considered. The authors highlight the role of gamma-aminobutyric acid (GABA) as the main mediator of stress-limiting systems in protecting the nervous system and target organs from the damaging effects of acute and chronic stress. The authors recommend aminophenylbutyric acid hydrochloride, an analogue of GABA, as a drug with protective effect on organs and systems that are exposed to the negative effects of acute and chronic stress. Aminophenylbutyric acid hydrochloride (anvifen) is successfully used in both adults and children, has good tolerance, has no significant drug interactions and side-effects.

[Cerebral small vessel disease and silent cerebrovascular diseases: modern standards of diagnosis, prevention, treatment prospects]. / Bolezn' tserebral'nykh melkikh sosudov i bessimptomnye tserebrovaskuliarnye bolezni: sovremennoe standarty diagnostiki, profilaktiki, perspektivy lecheniia.

The review presents modern clinical and radiological criteria for cerebral small vessel disease and silent cerebrovascular diseases. The authors discuss the STRIVE criteria, ideas about the pathogenesis, morphological changes and proposed options for the prevention of disease progression. As a drug of choice, the authors recommend vinpocetine (cavinton), which has the ability to influence many parts of the pathogenesis of cerebral small vessel disease.

[Cerebral insulin resistance: current concepts of the pathogenesis and possible therapeutic strategies]. / Tserebral'naia insulinorezistentnost': sovremennye predstavleniia o patogeneze i vozmozhnye terapevticheskie strategii.

The review presents current concepts about the problem of cerebral insulin resistance (IR). It has now been established that cerebral IR plays a key role in the pathogenesis of degenerative and metabolic diseases of the brain. Based on literature data and own clinical experience, the authors recommend to use the standardized extract of ginkgo biloba EGb761 as a cellular protector, which increases insulin sensitivity of cells and reduces atherogenesis, in order to improve cognitive functions and quality of life in patients with diabetes mellitus.

[Modern achievements in genetic studies of idiopathic generalized epilepsies]. / Sovremennye dostizheniia v oblasti geneticheskikh issledovanii idiopaticheskikh generalizovannykh épilepsii.

The review presents modern data on the genetics of idiopathic generalized epilepsies. Identified genes encode different structures of neurons, including voltage-dependent channels, receptors of neurotransmitters, protein-associated ion channels and synaptic proteins. The authors describe already identified genes, which are a causative factor of idiopathic generalized epilepsies and discuss further prospects of using molecular genetic studies.