[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]. / Klinicheskie rezul'taty i perspektivy primeneniya fenozanovoi kisloty u vzroslykh patsientov s fokal'noi epilepsiei.

OBJECTIVE: To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)). RESULTS: Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients. CONCLUSION: The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[Results of treatment with intravenous amantadine sulfate (PK-Merz) patients with chronic disorders of consciousness]. / Rezul'taty primeneniya amantadina sul'fata (PK-Merts) u patsientov s khronicheskim narusheniem soznaniya.

The article presents literature review of the recent publications devoted to the drugs with dopaminergic, antiglutamatergic and GABA-ergic effects in the treatment of patients with vegetative state/areactive wakefulness syndrome (VS/AWS). The authors analyzed their own results of the effects of intravenous form of amantadine sulfate (PK Merz) in 142 VS/AWS patients caused by different etiological factors. Depending on the dominant neurological symptoms, patients were divided into three main groups: areactive type of course (group 1 - 61 patients), predominance of primitive limbic reactions (group 2 - 35 patients) and predominance of extrapyramidal symptoms (group 3 - 46 patients). Therapy results were evaluated one month later by CRS-R scale, which showed that the most distinct positive dynamics was observed in group 3.

[Magnetic resonance spectroscopy data in the prognosis of consciousness recovery in patients with vegetative state]. / Prognozirovanie vosstanovleniia soznaniia u patsientov v vegetativnom sostoianii s primeneniem metoda vodorodnoi magnitno-rezonansnoi spektroskopii.

AIM: To study the prognostic value of magnetic resonance spectroscopy (MRS) in patients with vegetative state/unresponsive wakefulness syndrome (VS/UWS). MATERIAL AND METHODS: Thirty-four patients with VS/UWS underwent multi-voxel MRS (thalamus, globus pallidus, putamen, internal capsules, fornix, brainstem, temporal and frontal cortex). Subjects were grouped according to etiology: 22 patients with traumatic brain injury (TBI) (group 1) and 12 patients with a hypoxia (group 2). The groups were matched by age and duration of UWS (mean 2, 3 months). The CRS-R was used to identify the first signs of consciousness during hospitalization and 6-12 months later. Outcomes of the patients with TBI were as follows: chronic VS/UWS (n=6), minimally conscious state (MCS) plus (n=9), emergence from MCS (EMCS) (n=7). Outcomes of the patients with hypoxia were: chronic vegetative state (n=10), minimally conscious state (MCS) (n=2). RESULTS: The decrease in the NAA/Cr ratio in thalamus, capsula interna, temporal cortex are correlated with poor outcome in both groups. Higher rates of NAA/Cr in these structures are correlated with further recovery of consciousness. The decrease in the ratio of NAA Cr and NAA/NAA+Cho+Cr in the midbrain is correlated with poor outcome only in UWS with hypoxia. CONCLUSION: The results suggest that the MRS allows to more accurately predicting the outcome in VS/UWS patients with hypoxic brain damage, as well as in UWS patients with TBI, who have recovered consciousness to the level of EMCS.

[MUSCLE WEAKNESS WITH NO SIGNS OF POLYNEUROPATHY IN PATIENTS WITH PROLONGED DISTURBANCE OF CONSCIOUSNESS. CASE REPORT].

Paper present several clinical examples of prolonged tetraplegia, which could be outcome not only of polyneuromyopathy of critical states, but also of disturbances in hierarchical relationship in CNS.

[Extrapontine myelinolysis developed after aneurysmal subarachnoid hemorrhage (a case report and literature review)]. / Ekstrapontinnyi mielinoliz, razvivshiisya posle anevrizmaticheskogo subarakhnoidal'nogo krovoizliyaniya (sluchai iz praktiki i obzor literatury).

TOPICALITY: Central pontine and extrapontine myelinolysis is a rare and dangerous form of the demyelinating process of undefined origin, the development of which is associated with a very low sodium level in the blood (hypernatremia). OBJECTIVE: To describe a rare case of extrapontine myelinolysis as a complication occurring in the hemorrhagic period of anterior communicating artery aneurysm rupture as well as to demonstrate that this condition can be diagnosed intravitally. CONCLUSION: Clinical vigilance of extrapontine myelinolysis may promote the timely diagnosis and treatment of this disease, which is a potential cause of death. Pulse-therapy with glucocorticoids provides the opportunity to achieve regression of neurological symptoms and to stabilize the patient's condition.

[INFLUENCED ARBEPOETINALFA TO REDUCE THE NUMBER OF BLOOD TRANSFUSION IN CHILDREN WITH NON-SYNDROMIC CRANIOSYNOSTOSIS.]

BACKGROUND: According to the literature, the prevalence of non-syndromic forms of craniosynostosis in children is very high. Given that the treatment of this pathology and surgery performed only at an early age of the child, the need for transfusion arise very often. THE AIM: To study the efficacy ofpreoperative use of darbepoetin alfa in combination with intraoperative normovolemic hemodilution to reduce the number of blood transfusions during surgery and in the early postoperative period. MATERIALS AND METHODS: The study included 70 children between the ages of 6 months up to 12 months, divided into two groups: a control group (n=34) without stimulation of erythropoiesis and the study group (n =36) using apre-stimulation oferythropoiesis darbepoetin alfa. RESULTS: In the control group, blood transfusion was performed in 79% of cases, compared with the test group-22% of cases. Also, the patients ofthe study group determined a statistically significant (p<0. 05) increase the level of red blood cells, hemoglobin and reticulocytes. CONCLUSION: In children up to a year with various forms ofnon-syndromic craniosynostosis preoperative stimulation of erythropoiesis in conjunction with normovolemic hemodilution reduces the number of blood transfusions 3 times, or to opt out of its holding.

[Vegetative State: Difficulty in Identifying Consciousness and Predicting Outcome].

Article consists of literature review, authors experience of the application of neurovisualization and neurophysiological research methods to predict the recovery of consciousness in patients in vegetative state (VS). According to the literature data PET with FDG has higher sensitivity in the detection of signs of consciousness, then functional MRI (fMRI). The method fMRI allows assessing the functional activity of the brain in a state of rest and in response to stimulation with different modalities ­ visual, auditory, etc (with the application of active and passive paradigm). A higher specificity in the detection of signs of consciousness have the methodology of fMRI with the active paradigm, at the same time, the absence of signs of consciousness according to the fMRI can not be charged as a basis for the conclusion of a poor prognosis in a particular patient. Neurophysiological tests (EEG, TMS, EP, etc) are more readily available and quite effective. Based on the literature analysis, the authors comes to the conclusion that neurovisualization and neurophysiological tests used in the prediction of the outcome of VS reflects the residual functional activity of different brain areas, in a context of diffuse brain damage, and the recovery of consciousness is usually combined with the restoring of the functional activity off the thalamocortical tracts, which activity, indirectly, is evaluated using these methods. In the authors' opinions, the main disadvantage in the interpretation of the is the lack of a common pathophysiological concept of the organization of brain functions in VS patients. The authors offer for the discussion their concept of stable pathological states of the brain, which is based on the works of Russian pathophysiologists.

[Conservative and surgical treatment of patients with resistant epilepsy].

AIM: To optimize drug treatment in early (6 months) and late (up to 3 years) stages of postoperative period and to study its efficacy. MATERIAL AND METHODS: There were selected 72 patients with resistant epilepsy and epileptic encephalopathy symptoms from 467 patients operated for epilepsy. RESULTS: By the end of a 3-year follow-up observation, we found the reduction in seizure frequency and seizure control in 66.3% of patients; regression of EEG paroxysmal activity in 56.8% and reduction in mental disorder symptoms (anxiety and depression) in 12.7%. CONCLUSION: The data obtained substantiate the necessity to optimize antiepileptic and pathogenetic drug treatment of patients with resistant epilepsy and encephalopathy symptoms during the 3-year postoperative period.

[The clinical picture of nonsyndromic craniosynostosis in children].

OBJECTIVE: to study clinical presentations of nonsyndromic craniosynostosis (NCS) in children. MATERIAL AND METHODS: Authors analyzed 56 cases of different forms of NCS. To verify the diagnosis, all children underwent computed tomography with 3D cranial reconstruction. RESULTS AND CONCLUSION: The distribution of diagnoses was as follows: scaphocephaly - 28 (50%) patients, trigonocephaly - 21 (38%), different forms of plagiocephaly - 7 (12%). On admission to the hospital, 25 (43%) patients were diagnosed with perinatal CNS damage, 10 (18%) were born premature, 33 (59%) had neurological deviations. The clinical picture of NCS was polymorphic that might explain an increase in the number of children with late-diagnosed craniosynostosis. The early diagnosis of NCS which is the basis for using less invasive surgical methods is particularly important for prognosis.

[Disturbances of blood lipid content after acute disorders of brain blood flow].

The parameters of blood lipid spectrum have been analyzed in 421 patients who survived cerebral stroke and transitory ischemic attacks in 2004-2008. The study included people of Khanty-Mansiysk and Khanty-Mansi autonomous okrug and watchmen. The statistical analysis did not reveal differences between mean concentrations of total cholesterol, high and low density lipoproteins and triglycerides in the settled population and in watchmen. Mean values of all parameters, with the exception of high-density lipoprotein, were higher compared to normative values. The highest frequency of deviations was found for low-density lipoproteins (63.5% of cases). The highest concentrations of total cholesterol and low-density proteins were seen in patients after transitory ischemic attacks regardless of their sex. The comparison of blood lipid spectrum parameters in different age groups revealed significant differences only for total cholesterol.

[Modern aspects of treatment of chronic brain ischemia in atherosclerotic lesions of precerebral arteries].

Epidemiologic, etiologic and pathogenetic aspects of chronic brain ischemia are reviewed. Based on the modern conception of neuroplasticity, neuroprotection and neurogenesis, the authors substantiate the lines of pharmacotherapy. The results of the clinical study of photochromotherapy in the restorative treatment of chronic brain ischemia are presented.

[The use of simvastatin in patients with hypertensive intracerebral hemorrhages].

Twenty-three patients with hypertensive intracerebral hemorrhage, aged from 41 to 72 years, have been examined. The mean volume of hemotoma was 18,8+/-3,1 cm3. Patients of the control group (n=12) received standard treatment. The index group of patients (n=11) received additionally 20 mg of simvastatin daily for 30 days. Levels of cholesterol, low-density lipoprotein, number of venous circulating endothelial cells were measured in the peripheral blood. Outcomes were assessed using the modified Rankin scale. Patients with hypertensive intracerebral hemorrhage had disturbances of lipid metabolism and signs of endothelial dysfunction which manifested itself in the reduction of endothelium-dependent vasolidation and increase of circulating endothelial cell number. The study showed that the use of simvastatin normalized the lipid blood spectrum, improved the endothelial function and decreased unfavorable outcomes by 22%.

[Minimally invasive surgery of patients with hypertensive intracerebral bleedings].

An analysis of results of surgical treatment of 79 patients aged from 41 to 72 years with hypertensive intracerebral hematomas of supratentorial localization has shown that results of surgical treatment depended on the severity of the patients' state, the degree of impairment of consciousness, volume and localization of hematoma, ventricular hemorrhage and in less degree on the terms of operation and the degree of displacement of the median structures of the brain. The endoscopic techniques proved to be preferential in hematomas of the lateral and mixed localizations with the volume not more than 60 cm3. The developed method using a cannula allowed abandon open operations in most patients with the lateral and mixed hematomas. The postoperative lethality became less by 9.9%.

[Changes of hemo- and liquor-dynamics during intravascular interventions on venous-arterial malformations of the brain].

Changes in the arterial and venous blood flow and liquor-dynamics during intravascular venous-arterial interventions were studied in 30 patients with venous-arterial malformations of the brain. It was found that against the background of reduced venous-arterial shunting no expected drop of pressure in the jugular veins occured. Data were obtained on possible active autoregulation of pressure by the jugular veins. The investigation of pressure in the sinus system of the brain has shown that it correlates with intracerebral and systemic arterial pressure. The results obtained can be used in vascular neurosurgery, anesthesiology and neurology.

[The experience in non-relative allogenic transplantation of stem hemopoietic cells in the Clinic of Bone Marrow Transplantation at I.P. Pavlov St-Petersburg Medical Academy].

AIM: To evaluate efficacy of allogenic transplantation of hemopoietic stem cells (allo-THSC) from non-relative donor in patients with hematological diseases in the Clinic of Bone Marrow Transplantation at L.P. Pavlov St-Petersburg Medical Academy for the period 2000-2006. MATERIAL AND METHODS: A total of 84 allo-THSC from non-relative donor to patients aged from 10 months to 65 years (median 18 months, 44 years) was carried out. RESULTS: Six-year overall survival (OS) in all the patients was 51.4%, in remission of AML--66.7%, ALL--33%, depending on the presence or absence of acute reaction graft versus host reaction (GVHR)--54 and 50.9%, chronic FVHR--75.6 and 58.2%, blood group compatibility or incompatibility in donor/recipient pairs--58.4 and 47.9%, by gender--61.4 and 40.6%, in use of HSC of the bone marrow--58.3%, peripheral blood--26.7%. OS in the dose of transplanted CD 34+ cells per 1 kg body mass < 5.0 x 10(6)/kg--173%, in the dose 5.0--8.0 x 10(6)/kg--38.8%, > 8.0 x 10(6)/kg--35.5%. Acute GVHR developed in 56% patients, chronic--in 20%, hemorrhagic cystitis--in 27.7%, bacterial, cytomegalovirus and fungal infection--in 10, 70 and 30%, respectively. The causes of death were acute GVHR (20%), infection 99%), polyorganic failure (4%), transplant rejection (5.3%), recurrence (18.7%). CONCLUSION: Bone marrow transplantation clinics in the Russian Federation must develop all kinds of allo-THSC--relative, non-relative and haploidentical using bone marrow, peripheral blood, umbilical blood as the source of HSC. It is necessary to create a national register of non-relative donors.