[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.

[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.

[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.

[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.

[Upper crossed syndrome of muscle imbalance in adolescents with tension-type headache]. / Verkhnii perekrestnyi sindrom myshechnogo disbalansa u podrostkov s golovnoi bol'iu napriazheniia.

AIM: To assess the efficacy of elastic kinesiotaping in the treatment of upper crossed syndrome of muscle imbalance (UCSMI) in adolescents with tension type headache (TTH). MATERIAL AND METHODS: The authors examined 65 adolescents, aged 14-17 years, with TTH with trigger zones of the pericranial muscles (myogenic trigger zones - MTZ). UCSMI was identified in all patients. The method of elastic kinesiotaping was used for the treatment of UCSMI. A number of days with headache (HA), intensity of HA assessed by the Visual Analogue Scale (VAS), pain threshold and pain tolerance threshold were evaluated. In the second stage of the study, patients were randomized into group A (33 adolescents, mean age 14.73±1.29 years, the number of days with HA 10.6±6.2, the intensity of HA 39.98±18.4 according to VAS); 2) group B (32 adolescents, mean age 13.59±2.27 years, the number of days with HA 12.4±4.5, the intensity of HA 44.8±18.8). For the next 28 days, patients of group A underwent elastic kinesio-taping, and patients of group B were taped with a medical non-elastic hypoallergenic patch (placebo). The third stage of the study included one month training. RESULTS AND CONCLUSION: By the end of the study, a statically significant positive dynamics was noted (p<0.001) for all indicators in group A (number of days with HA 1.2±1.1, intensity of HA 9.42±2.7) compared to the results before treatment and to the results in group B after treatment (the number of days with HA 9.9±4.2, the intensity of HA 41.2±15.60).

[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.

[Persistent postural-perceptual dizziness]. / Persistiruiushchee postural'no-pertseptivnoe golovokruzhenie.

AIM: To study persistent postural perceptual dizziness (PPPD) in outpatients with benign paroxysmal positional vertigo (BPPV) and patients with presbiataxia (PAt). MATERIAL AND METHODS: Eighty-four patients with PPPD, including 14 with Meniere's disease (MD), 19 with BPPV, 17 with a history of ischemic stroke (IS) in the vertebrobasilar system and 34 with Pat, were examined. For the diagnosis of anxiety, the original 15-point questionnaire with the Likert Scale structure was used. Patients received anvifen (aminophenylbutyric acid hydrochloride) in dose of 250 mg 3 times a day for 6 weeks. Results and сonclusion. The most common trigger of PPPD was sleep deprivation. The highest level of anxiety was identified in the PAt group (19,5±2,89). There was a good effect of the drug: it reduced anxiety in all patients studied. The quality of sleep was improved as well. The authors recommend anvifen as the drug of choice in patients with PPPD during vestibular rehabilitation and cognitive-behavioral therapy.

[Tension type headache: GABA-ergic drug anvifen efficacy].

OBJECTIVE: To assess the efficacy of aminophenylbutyric acid (anvifen), a synthetic GABA-receptor agonist, in the treatment of adult patients with tension type headache (TTH). MATERIAL AND METHODS: Eighty-seven patients with episodic TTH (ETTH) and 30 patients with chronic TTH (CTTH) were examined. The area under the headache curve, sleep quality, the Hospital Anxiety and Depression Scale (HADS) scores and stress resistance measured by an original questionnaire were evaluated. RESULTS: Anvifen in dose of 250 mg TID during 3 weeks had a positive effect on all parameters studied, excluding the area under the headache curve in CTTH. Similar results were demonstrated after the subsequent course of treatment for 3 weeks. CONCLUSION: Anvifen was highly effective in ETTH but less effective in CTTH. A combination of anvifen with antidepressants can be recommended for patients with CTTH.

[Discirculatory encephalopathy and small vessel disease]. / Distsirkuliatornaia éntsefalopatiia i bolezn' melkikh sosudov.

The report examines the practicability of the term 'discirculatory encephalopathy' used in the Russian Federation to designate the chronic cerebral ischemia of different origin. The authors discuss the state of small vessel disease which manifests itself through slowly progressive cerebral changes. On the basis of their own research results and literature review the authors conclude that a standardized extract of Ginkgo biloba EGb761 (tanakan) can be effectively used in patients with small vessel disease.

[Tanakan as a multimodal cytoprotective factor in general medicine (part II)].

The second section of the review provides an update of the data on mechanisms of action of a standardized extract of Ginkgo biloba EGb761® (tanakan) and its efficacy in treatment of depression, pain, complications of diabetes, Parkinson disease, tinnitus and dizziness, reproductive dysfunction. Updated data enable to use EGb761® (tanakan) as a highly-effective cytoprotective agent in treatment of cardiovascular, degenerative and metabolic diseases of the nervous system, inner ear disturbances (tinnitus), dysfunction of reproductive system as well as in prevention and treatment of stress-induced disorders.

[Cognitive impairment in patients with diabetes mellitus type 2 and possibilities of its treatment].

OBJECTIVE: To identify the most frequently affected cognitive functions and to study the efficacy of Ginkgo biloba (EGb 761). MATERIAL AND METHODS: We examined 120 patients with diabetes mellitus type 2. To assess cognitive dysfunction, we used MMSE, MoCa test, TMT (Part A and B). RESULTS AND CONCLUSION: Cognitive impairment characterized by a decrease in attention, short-term memory, speed of thinking was identified in 85% of patients; 83% of them had a mild cognitive impairment. The study showed that the standardized extract of Ginkgo biloba (EGb 761) used in dose 240 mg per day during one month had a positive effect on cognitive function.