[Experience in using xeomin in the treatment of arm and hand spasticity in the early rehabilitation phase of stroke].

To reduce arm and hand spasticity, 28 patients in the early rehabilitation phase of ischemic hemisphere stroke received injections of the botulinum toxin A preparation xeomin in the content of complex rehabilitation programs. The following muscles: m. biceps brachii, m. flexor digitorum profundus, m. flexor digitorum superficialis, m. flexor carpi ulnaris, m. flexor carpi radialis were injected according to standard scheme. The total dose of drug was 200U in moderate (2-3 scores on the Ashworth scale) and 300U in marked (3-4 scores on the Ashworth scale) spasticity. Efficacy and safety of treatment was assessed at baseline and 2, 4, 8, 12, 16 weeks after injections. Xeomin significantly (p<0.05) reduced muscle tonus in patients with post-stroke spasticity of different severity. Clinical effect was seen 2 weeks after injection, it reached maximum at week 4 and then slowly decreased to week 16. The improved functional activity of the paretic arm (due to patient's and caregiver's reports) remained for to 12 weeks. The treatment was most effective in the group of patients with moderate spasticity. The correlation analysis confirmed that the severity of spasticity increased with the disease duration that reduced rehabilitation efficiency. The treatment with xeomin was safe, no serious side-effects were found.

[The use of cerepro (choline alfoscerate) in the treatment of outpatients with chronic progressive cerebrovascular disease].

The main aim of the study was the evaluation of the efficacy and drug safety of cerepro (choline alfoscerate) used for treating outpatients with cerebrovascular disease. Ninety patients with cerebrovascular disease, who had motor, coordination, emotional and cognitive disturbances were enrolled in the study. Sixty patients of the group 1 had stroke, 30 patients (group 2) had chronic ischemic brain disease. All patients received basic therapy (antihypertensive, antiaggregant or anticoagulant, cholesterol-lowering drugs). Cerepro was administrated in combined therapy according to the scheme: 1000 mg cerepro (in 200 ml of the 0.9% NaCl solution) once a day intravenously in drops during 10 days; then 1200 mg daily per os during 6 weeks. We assessed the dynamic of neurological symptoms and restoration of lost functions (MMSE, Feeling-activity-mood test, HDRS, GCI). The results indicate the efficacy of cerepro in outpatients with chronic cerebrovascular disease and stroke. It was demonstrated that cerepro led to improvement of coordination neurological symptoms, cognitive and emotional functions, activity and mood in patients of both groups. Clinical effect was higher in patients after stroke. Cerepro was well tolerated.

[Treatment of vestibular vertigo and Ménière syndrome in outpatient clinics].

An aim of this study was to assess clinical efficacy and tolerability of tagista in the symptomatic treatment of vestibular vertigo and Ménière syndrome. Thirty-two patients, 16 women and 16 men, aged from 25 to 67 years, were examined. Vertigo was caused by chronic brain ischemia in 17 cases and by the disturbance of blood circulation in the vertebral-basilar system in 14 patients with osteochondrosis of cervical spine. One patient was diagnosed with Ménière syndrome. Tagista was used in dose 24 mg twice a day during 4 weeks in the combination with standard treatment, exercise therapy and stability training. The results revealed a statistically significant effect of the drug on main symptoms (frequency, duration and intensity of vertigo attacks etc) and its good tolerability that allowed to recommend the drug in neurological practice.

[Effect of dopamine agonist pramipexole (mirapex) on tremor, affective disorders and quality of life in patients with Parkinson's disease].

The open 6-month study (the MIRAG study) on the effect of D2/D3 dopamine agonist pramipexole (mirapex) on tremor, affective disorders and quality of life in patients with Parkinson's disease (PD) was carried out. Ninety-eight patients, aged from 42 to 75 years (mean age 63.2+/-10.2 years) were included in the study. Scores on the Hoehn and Yahr scale varied from 1 to 4 (mean 2,5+/-0,8). Seventy percent of patients received levodopa in average dose 351.2+/-279.4 mg; 62% of patients had motor fluctuations and 43% had dyskinesias. Pramipexole was titrated to the effective dose (maximum 3 mg/d, mean 2.1 mg/d). In the end of the study, resting tremor was reduced by 54%, postural and kinetic tremor, as assessed with UPDRS and spirography, by 50% and 15%, respectively. The severity of depressive symptoms measured with the Montgomery-Asberg Scale and a modified version of the Geriatric-Depression Scale (GDS-15) was reduced by 56%. Motor fluctuations and dyskinesias were significantly reduced while cognitive functions were not changed. The clinically significant effect reflected in the reduction of motor and non-motor symptoms was observed in 83% of patients, regardless of disease duration, severity of motor deficit, affective and cognitive disorders,. The drug was well tolerated in all patients, including those older than 70 years. Pramipexole improved quality of life in PD patients due to the attenuation of cardinal motor parkinsonian symptoms as well as symptoms, which were relatively resistant to levadopa, e.g. postural and kinetic tremor, and depression. The therapeutic effect remained for at least 6 months.

[Osteogenic factor in pathogenesis of vertebrogenic cardialgia].

A total of 136 patients with clinical symptoms of thoracic osteochondrosis and reflex vertebrocardiac disorders were examined. 100 of them presented with vertebrogenic cardialgia and CHD, 36 had no CHD. 56 patients with clinical symptoms of thoracic osteochondrosis and CHD received traditional therapy and a course of intraosseous blockade (IOB). 56 patients with clinical symptoms of thoracic osteochondrosis and CHD received traditional therapy and a course of paravertebral blockade (PVB). 36 patients with clinical symptoms of thoracic osteochondrosis without CHD received a course of IOB. Efficiency of therapy was assessed from dynamics of pain syndrome parameters, data of the visual analog scale, McGill and body diagram questionnaires, changes of cardiac function and heart rhythm recorded by 24-hr Holter monitoring. Therapeutic efficiency of IOB in patients with vertebrogenic cardialgia with and without CHD was higher than that of PVB in patients with clinical symptoms of thoracic osteochondrosis and CHD. It is concluded that osteogenic factor plays a key role in the mechanism of development of vertebrogenic cardialgia.

[The use of the drug ginos in the treatment of out-patients with chronic progressive brain disorders].

Ginos, a derivative of extract Ginkgo Biloba, was administered to 100 patients, aged from 45 to 80 years, mean age 62,3+/-0,7), in dosage 120 mg 3 times daily during 3 months in addition to somatic therapy. A patient's state was assessed before, during and after the treatment using clinical methods and a battery of psychometric scales and neuropsychological tests. A significant improvement of neurological and mental status was found in 90 (90%) of patients that was most distinctly observed in the dynamics of their global state and neurocognitive performance on the MMSE and other tests. The effect of the drug was less pronounced for affective disorders - depression and anxiety. The drug was well-tolerated by patients.

[The efficacy of paravertebral blockades in the complex treatment of patients with the combination of neurological symptoms of cervical-thoracic osteochondrosis and ischemic disease].

Sixty-seven patients with clinical symptoms of cervical-thoracic osteochondrosis and ischemic disease have been studied. In the main group included 43 patients, paravertebral blockades (PVB) were applied and in the control group (24 patients) - antianginal and metabolic therapy was used. Treatment efficacy was assessed by the dynamics of pain syndrome parameters as measured with the visual analogue scale and by changes of heart rhythm variability, ischemic disturbances and arrhythmia measured by Holter monitoring. The higher therapeutic efficacy of PVB in the complex treatment of these patients comparing to traditional treatment of ischemic disease was found.

[The use of katadolon in patients with spondylogenic dorsalgia].

The open non-comparative study of the efficacy of katadolon (100 mg 3 times daily during 2 weeks) in 90 out-patients with spondylogenic dorsalgia has been carried out. A good effect, i.e. the complete relief of the pain syndrome, rehabilitation of the ability to self-service and regress of neurological symptoms, was observed in 59 (65.6%) patients, a satisfactory effect, i.e. the complete relief of the pain syndrome with elements of restricted daily activity and symptoms of radiculopathy-- in 24 (26.7%) patients and a moderate effect, i.e. the presence of the residual pain syndrome, restricted daily activity and symptoms of radiculopathy,--in 7 (7.8%) patients. After the therapy, the intensity of the pain syndrome decreased by 4 times, from 69.7 +/- 4.3 to 17.6 +/- 0.11 according to the numerical scale of pain (p < 0.01), and by 2.5 times, from 2.51 +/- 0.27 to 1.04 +/- 0.09 (p < 0.0001), according to the verbal scale of pain. At the same time, the ability to self-service increased by 3 times on the daily living scale (2.6 +/- 0.28; p < 0.0001). At the end of the treatment, the intensity of the pain syndrome was associated with illness duration (r = 0.538; p < 0.01) and the presence of the root pain syndrome (r = 0.266; p < 0.03). The drug was well-tolerable and caused minimal side-effects.

[Phezam efficacy in patients with chronic cerebral ischemic disease].

The efficacy of combined medication which comprised compounds with nootropic (piracetam) and vasoactive (cinnarisin) effects, was studied in patients with cerebral blood flow insufficiency. The main inclusion criterion was a diagnosis of chronic brain ischemia (CI). The study consisted of two stages: (1) a randomized comparative trial in neurological clinic (60 patients) and (2) estimation of the drug efficacy in routine practice (60 patients). The clinical examination was accompanied by neuropsychological tasks, kinetic tests and ultrasound investigation of brain vessels. At the first stage, a positive neurological and neuropsychological dynamics was found after 8 weeks of phezam treatment. Also a statistically significant positive dynamics was observed for a number of blood flow velocity parameters in the middle brain artery. In routine medical practice, a positive effect of phezam was seen after 2 months of the treatment for all but CI main symptoms and confirmed by the data of kinetic investigation. The patients reported good tolerability and convenience of the drug intake (one capsule instead of two tablets of nootropic and vasoactive drugs).

[Use of tremonorm in treatment of Parkinson's disease: outpatient experience of Moscow Municipal Health Care Service]. / Primenenie tremonorma pri bolezni Parkinsona: opyt ambulatornoi nevrologicheskoi sluzhby Moskovskogo gorodskogo zdravookhraneniia.

The efficacy of domestic drug tremonorm (levadopa-carbidopa) for Parkinson's disease (PD) treatment was studied. The treatment was conducted in neurological outpatient departments in several Moscow administrative regions and was administered to 142 PD patients, 15 being assigned to this drug for the first time and 127 being previously treated with other medications containing levadopa/carbidopa. A minimal effective dose (up to 500 mg) was selected for each patient and was not changed during 2 months. For patients previously switched to levadopa, the change for tremonorm has been done during 1 day if the dose of levadopa did not exceed 500 mg, and during 2 months in case a patient received over 500 mg per day. Modified Hoehn&Yahr scale, UPDRS, MMSE, PDQ-39 and other scales were used in complex evaluation of the disease stage. Positive effect of tremonorm was detected for 94 patients (66.2%), all of them continued tremonorm therapy after the end of the study. The most frequent side-effects proved to be dyspeptic symptoms. Tremonorm caused statistically significant positive changes in patient's movement scaled by UPDRS and the QL indexes in all PDQ-39 subscales. Positive changes in movement activity were accompanied by decrease of bradykinesia, tremor, better walking, writing and every day activity of PD patients. A change of nacom for tremonorm did not result in significant alteration of symptoms and Quality of Life indexes that suggest similar influence of these drugs on PD symptomatology. At the same time, a substantially lower price of tremonorm allows reducing of treatment costs.