[Cerebrolysin as an early add-on to reperfusion therapy: heterogeneous treatment effect analysis in ischemic stroke patients with varying risk of hemorrhagic transformation]. / Effektivnost' rannego primeneniya Tserebrolizina pri reperfuzionnoi terapii: analiz geterogennykh effektov vozdeistviya u bol'nykh s ishemicheskim insul'tom pri razlichnom riske gemorragicheskoi transformatsii.

OBJECTIVE: The study goal was the assessment of heterogeneous treatment effects of Cerebrolysin as an early add-on to reperfusion therapy in stroke patients with varying risk of hemorrhagic transformation (HT). MATERIAL AND METHODS: It was post hoc analysis of the CEREHETIS trial (ISRCTN87656744). Patients with middle cerebral artery infarction (n=238) were stratified by HT risk with the HTI score. The study outcomes were symptomatic and any HT, and functional outcome measured with the modified Rankin Scale (mRS) on day 90. Favorable outcome was defined as an mRS score of ≤2. Heterogeneous treatment effect analysis was performed using techniques of meta-analysis and the matching-smoothing method. RESULTS: Heterogeneity of Cerebrolysin treatment effects was moderate (I2=36.98-69.3%, H2=1.59-3.26) and mild (I2=18.33-32.39%, H2=1.22-1.48) for symptomatic and any HT, respectively. A positive impact of the Cerebrolysin treatment on HT and functional outcome was observed in patients with moderate (HTI=1) and high (HTI≥2) HT risk. However, the effect was neutral in those with low risk (HTI=0). In high HT risk patients, there was a steady decline in the rate of symptomatic (HTI=0 vs. HTI≥2: by 3.8%, p=0.120 vs. 14.3%, p<0.001) and any HT (HTI=0 vs. HTI≥2: by 0.6%, p=0.864 vs. 19.5%, p<0.001). Likewise, Cerebrolysin treatment resulted in an overall decrease in the mRS scores (HTI=0 vs. HTI≥2: by 2.1%, p=0.893 vs. 63%, p<0.001) with a reciprocal increase of the fraction with favorable outcome (HTI=0 vs. HTI≥2: by 2% p=0.634 vs. 19.2%, p<0.001). CONCLUSION: Clinically meaningful heterogeneity of Cerebrolysin treatment effects on HT and functional outcome was established in stroke patients. The Cerebrolysin positive impact was significant in those whose estimated on-admission HT risk was either moderate or high.

[Effects of simultaneous use of Cerebrolysin and alteplase on hemorrhagic transformation of brain infarction and functional outcome in stroke patients: CEREHETIS, a randomized, multicenter pilot trial]. / Effekty sovmestnogo primeneniya Tserebrolizina i alteplazy na gemorragicheskuyu transformatsiyu infarkta mozga i funktsional'nyi iskhod u bol'nykh ishemicheskim insul'tom: pilotnoe randomizirovannoe mnogotsentrovoe klinicheskoe issledovanie CEREHETIS.

OBJECTIVE: The study aimed to assess effects of the simultaneous use of Cerebrolysin and intravenous thrombolysis (Alteplase) on hemorrhagic transformation (HT) and functional outcome as well as to analyze the treatment safety in acute stroke patients. MATERIAL AND METHODS: It was a prospective, randomized, open-label, multicenter, parallel-group, active-controlled pilot study (Trial Registration Number: ISRCTN87656744, https://doi.org/10.1186/ISRCTN87656744, Trial registration date: 16/02/2021). The intervention group (n=126) was treated with Cerebrolysin infusion (30 mL) started simultaneously with Alteplase (0.9 mg/kg) via a separate IV line. The Cerebrolysin treatment continued for 14 consecutive days with the baseline therapy along. The control group (n=215) received only Alteplase and the baseline therapy. The primary endpoints were the rate of any and symptomatic hemorrhagic transformation (HT) from admission to day 14. Secondary endpoints were treatment safety and functional outcome measured with the National Institutes of Health stroke scale (NIHSS) in 24 h and on day 14, and with the modified Rankin scale (mRS) on day 90. RESULTS: Treatment with Cerebrolysin resulted in a significant reduction of the symptomatic HT rate with an odds ratio of 0.248 (95% CI: 0.072-0.851; p=0.019). No serious adverse events related to Cerebrolysin were observed. On day 14, the intervention group showed a significant reduction in the NIHSS score (p=0.045). However, no difference in the mRS score was observed on day 90, but there was a trend towards its improvement. CONCLUSION: The combination of Cerebrolysin and Alteplase was safe and significantly reduced the rate of symptomatic HT and improved early neurological deficit. However, no difference in functional outcome was found on day 90, but there was a trend towards favorable functional outcome.

[Multicenter experience of using Fortelyzin during staged reperfusion therapy of acute ischemic stroke in anterior circulation]. / Opyt mnogotsentrovogo primeneniya preparata Fortelizin pri provedenii etapnoi reperfuzionnoi terapii ostrogo ishemicheskogo insul'ta v karotidnoi sisteme.

OBJECTIVE: To evaluate the safety and efficacy of Fortelyzin in the performance of staged reperfusion therapy for acute ischemic stroke (intravenous thrombolytic therapy plus mechanical thrombectomy) in anterior circulation within the FORTA RF multicenter pilot study. MATERIAL AND METHODS: The study included 72 patients with acute ischemic stroke in anterior circulation, who underwent staged reperfusion therapy in four vascular centers of the Russian Federation from December 2019 to January 2023. RESULTS: The mean time from illness onset to hospitalization was 94.5 minutes in the Fortelyzin group and 97.2 min in the Actilyse group (p=0.78). The time from the moment of hospitalization to the admission of the patient to the X-ray operating room was significantly lower in the Fortelyzin group (p=0.002). The incidence of symptomatic hemorrhagic transformations in the Fortelyzin group was 6%, in the Actilyse group - 8% (p=0.75). A favorable functional outcome in the first group was observed in 47% of patients, in the control group in 42% (p=0.66). Mortality in both groups did not differ significantly and amounted to 22% and 25%, respectively. CONCLUSION: The first results of the FORTA RF multicenter study demonstrate the safety and efficacy of Fortelyzin in staged reperfusion therapy compared to Actilyse.

[Current approaches in the treatment and rehabilitation of patients with neurological diseases after COVID-19. Resolution of the International Experts Forum]. / Lechenie i reabilitatsiya bol'nykh s nevrologicheskimi narusheniyami posle perenesennogo COVID-19. Rezolyutsiya Mezhdunarodnogo foruma ekspertov.

Despite the significant shift in global attention away from the pandemic, the problem of a new coronavirus infection remains important in the medical community. Almost 3 years after the start of the COVID-19 pandemic the issues of rehabilitation and management of delayed manifestations and sequelae of the disease are especially important. According to numerous available data, the new coronavirus infection is characterized by multiorgan lesions. Respiratory dysfunction, clotting disorders, myocardial dysfunction and various arrhythmias, acute coronary syndrome, acute renal failure, GI disorders, hepatocellular damage, hyperglycemia and ketosis, dermatological complications, ophthalmological symptoms and neurological disorders may be found. Significant prevalence of the latter in the post-coronavirus period necessitated this International Expert Forum to develop unified approaches to the management of patients with neurological complications and sequelae of new coronavirus infection based on practical experience and considering the scientific information available on COVID-19. The expert council developed a resolution formulating the tactics for the management of patients with neurological manifestations of COVID-19.

[COMPASS study results as a foundation for new treatment approach for neurological patients. Opinion of the expert council of december 18, 2021]. / Znachenie rezul'tatov issledovaniya COMPASS v izmenenii podkhodov k lecheniyu patsientov nevrologicheskogo profilya. Zaklyuchenie soveta ekspertov ot 18 dekabrya 2021 g.

The resolution of the Council of Experts devoted to the discussion of the effectiveness of the use of a combination of rivaroxaban 2.5 mg 2 times a day and acetylsalicylic acid 100 mg per day to prevent recurrent non-coronary ischemic stroke results of the COMPASS study is presented. The advantages of this combination and the safety of its use are considered. Recommendations for the implementation of the results of the study in clinical practice are given.

[Impact of integrated upper limb spasticity management including repeat botulinum toxin type A (BoNT-A) injections on patient-centred goal attainment in real-life practice: results from the prospective, observational Upper Limb International Spasticity cohort study (ULIS-III) in a Russian subpopulation]. / Vliyanie kompleksnogo lecheniya spastichnosti verkhnei konechnosti, vklyuchayushchego povtornye in"ektsii botulinicheskogo toksina tipa A, na dostizhenie tselei, orientirovannykh na nuzhdy patsienta, v real'noi klinicheskoi praktike: rezul'taty mezhdunarodnogo prospektivnogo, nablyudatel'nogo issledovaniya spastichnosti verkhnei konechnosti ULIS-III v rossiiskoi podgruppe patsientov.

OBJECTIVE: To assess the longitudinal attainment of patient-centred and function related goals after integrated spasticity management including repeated cycles of botulinum toxin A type A (BoNT-A) injections in real life settings over a period of 2 years. The article presents analysis of the results within the subpopulation of patients from Russia. MATERIAL AND METHODS: This international, multicentre, observational, prospective, longitudinal cohort study (registered at clinicaltrials.gov as NCT02454803) included patients ≥18 years old with upper-limb spasticity of any aetiology in whom a decision had already been made to inject any BoNT-A formulation commercially available in the Russi. The treatment outcomes were evaluated using the Upper Limb Spasticity Index, which combines the patient-centred Goal Attainment Scaling (GAS) with a set of targeted standardised measures to assess the neurological impairment. The extent of functional impairment was assessed using the DAS. RESULTS: 168 Russian patients from 7 sites with a mean age of 49.8 years participated in the study. The Russian subpopulation had some differences from the overall study population in baseline characteristics of patients and injection practices of BoNT-A treatment. During the study period, the majority of Russian patients received AboBoNT-A (Dysport) injections - 142 (85%) patients at cycle 1, while OnaBoNT-A (Botox) was used in 14 (8%) patients, and IncoBoNT-A (Xeomin) - in 12 (7%) patients. Higher doses of AboBoNT-A were observed compared to the overall population, mean doses of AboBoNT-A between cycles 1 and 4 were 909-934 U in the Russian patients and 814-859 U in the overall population. In general, patients of the Russian subpopulation successfully achieved their treatment goals. The mean cumulated GAS T-score over the study was 51.1±3.0, marginally exceeding the same parameter in the overall population (49.5±5.9). Across the 6 goal domains, cumulated GAS T-scores in Russian subpopulation were highest for the goals related to passive function and pain relief, with mean scores of 51.8±4.2 and 51.6±4.8, respectively. In the overall population cumulated GAS T-scores were highest for involuntary movements (mean 50.5±5.6) and pain relief (mean 50.4±6.2). The lowest GAS T-scores were for the treatment goals related to active function in both Russian subpopulation and overall population, the mean scores were 48.3±5.5 and 46.6±7.4 respectively. The study results also showed significant improvement in in terms of reduction of muscle tone according to MAS (Modified Ashworth Scale) and the extent of functional impairment according to DAS (Disability Assessment Scale). CONCLUSIONS: The results of this subgroup analysis on patients from Russia showed high effectiveness of repeated cycles of BoNT-A injections as part of the integrated upper limb spasticity management conducted in real life settings, both in terms of reduction of muscle tone and correction of functional impairment, which contributes to the successful achievement of the treatment goals. The right choice of individual patient-centred treatment goals and methods for assessing their achievement are important components of the treatment and rehabilitation process for patients with spastic paresis of the upper limb.

[Current issues of treatment and rehabilitation of patients with neurological disorders and the consequences of COVID-19. Resolution of Advisory Board]. / Osnovnye napravleniya lecheniya i reabilitatsii nevrologicheskikh proyavlenii COVID-19. Rezolyutsiya soveta ekspertov.

Last year the global medical community faced the pandemic of the new coronavirus infection caused by SARS-CoV-2. To date, there is considerable expert experience, which indicates that the brain, along with the corresponding respiratory system, is a target organ for a new coronavirus infection. Moreover, a number of symptoms from the central and peripheral nervous system can persist for several weeks, months, and even tens of months. To designate such protracted clinical conditions, a new definition was introduced: «Post-COVID-19 Condition¼. Advisory Board of Neurologists and Rehabilitation Therapists met to, discuss of practical experience and taking into account scientific information about COVID-19, which was available at the time of the meeting, to develop unified approaches for the management of patients with neurological complications and the consequences of a new coronavirus infection. The Advisory Board worked out a resolution in which formulated the tactics of managing patients with neurological manifestations of COVID-19. The substantiation of the importance and expediency of the development and implementation of a special program of clinical examination of patients who have undergone COVID-19, which would include a clinical examination with a detailed assessment of cognitive functions to early identification and diagnosis of neurodegeneration and subsequent therapy, is given.

[The efficacy of the anti-acidemic agent dimephosphone at the first rehabilitation stage in patients in the acute period of carotid-related ischemic stroke]. / Effektivnost' primeneniya antiatsidemicheskogo sredstva Dimefosfon na pervom etape reabilitatsii u patsientov v ostrom periode ishemicheskogo insul'ta v karotidnoi sisteme.

OBJECTIVE: To evaluate the efficacy of the intravenous form of dimephosphon at the first stage of rehabilitation in patients with ischemic stroke in the carotid system. MATERIAL AND METHODS: The article presents the results of examination of 60 patients in the acute period of ischemic stroke in the carotid system (30 patients were treated with dimephosphon and 30 patients were in the comparison group). The dynamics of the clinical picture (according to the NIHSS), functional dependence in self-service (according to the modified Rankin scale), state of autonomic response using spectral analysis of heart rate variability, cerebrovascular reactivity using functional tests were assessed during the treatment. RESULTS: A significant decrease in NIHSS points was recorded (on average by 60% from the initial level) in the main group, relative to the comparison group (on average by 33% from the initial points). On the 10th day of therapy, there was a significantly more improvement in cerebrovascular reactivity to hypercapnic and hypocapnic loads, the index of vasomotor reactivity, as well as the state of cerebral blood flow autoregulation in the main group compared with the comparison group. In addition, by the 10th day of therapy relative to the initial values in the main group, a statistically significant increase (by 30%) was revealed in the number of patients with adaptive sympathicotonic type of autonomic regulation with a decrease in the number of patients with hypersympathetic and asymptomatic types of autonomic regulation after orthostatic test (by 10% and 20%, respectively). By the 10th day of hospitalization, there were more patients with no or mild signs of disability (0-2 points according to the modified Rankin scale) in the main group (83%) compared with the comparison group (60%). CONCLUSION: The use of the multimodal drug dimephosphon in complex therapy in patients in the acute period of ischemic stroke in the carotid system contributes to the normalization of the regulatory mechanisms of cerebral circulation and autonomic regulation. This helps to improve functional recovery and enhance the rehabilitation potential of patients.

[Current issues in the rehabilitation of stroke patients against the background of a new coronavirus infection (COVID-19). Resolution of the Council of Experts]. / Aktual'nye voprosy reabilitatsii patsientov s insul'tom na fone novoi koronavirusnoi infektsii (COVID-19). Rezolyutsiya Soveta ekspertov.

The pandemic of the new coronavirus infection caused by SARS-CoV-2 has forced to reconsider the methods of rehabilitation of patients with emergency conditions, including neurology. The Council of Experts of Neurologists and Rehabilitation Therapists gathered to develop unified approaches to manage stroke patients based on a discussion of practical experience and, taking into account the scientific information on COVID-19 that was available by the time of the meeting. Stroke is a serious disabling condition that requires maximum rehabilitation efforts at all stages of medical care. In the context of the SARS-CoV-2 coronavirus epidemic, the process of medical rehabilitation and the routing of patients with stroke is undergoing major changes. Combining COVID-19 and stroke requires new approaches to rehabilitation and patient management. During the meeting, a resolution was developed in which the experts formulated the tactics of medical rehabilitation of patients with stroke and COVID-19 at the first and second stages. The arguments of the importance and practicability of carrying out measures of medical rehabilitation at the third stage is given and the need to continue consultations on the indicated topic is revealed.

[Clinical effectiveness of «thresholdless¼ low-frequency transcranial magnetic stimulation in patients with ischemic stroke]. / Klinicheskaya effektivnost' «besporogovoi¼ nizkochastotnoi transkranial'noi magnitnoi stimulyatsii u patsientov s ishemicheskim insul'tom.

PROBLEM RELEVANCE: As you know, complete successful recovery in stroke patients occurs only in 8% of cases, 20% need constant care. The use of innovative rehabilitation technologies, namely «thresholdless¼ low-frequency transcranial magnetic stimulation, will speed up the process of restoring impaired functions, increase independence in everyday life and, accordingly, the quality of life. AIM OF STUDY: To evaluate the effectiveness of use of low-frequency «thresholdless¼ transcranial magnetic stimulation in the treatment of patients in acute period of ischemic stroke. MATERIALS AND METHODS: The study included 93 patients aged from 49 to 68 years on second-third days of ischemic stroke. The 1st (main) group (n=48) received low-frequency «thresholdless¼ transcranial magnetic stimulation from the «Diamag¼ apparatus (AlMag-03) daily for 20 minutes, course - 8-10 procedures, with the background of drug treatment, and in addition to classes with an exercise therapy instructor and an occupational therapist. In the 2nd (control) group (n=45), standard therapy was carried out in accordance with the Procedure for rendering medical care to patients with stroke, only with the exception of physiotherapy. Assessment methods: clinical and neurological examination, indicators of duplex scanning of brachiocephalic vessels, Rivermead mobility index, modified Rankin scale, FIM scale (Functional Independence Measure), Hospital anxiety and depression scale (HADS). RESULTS AND DISCUSSION: In patients of the 1st (main) group, an increase in the linear velocity of blood flow in the internal carotid artery on the side of lesion was revealed by 18.1% when compared with the 2nd (control) group (p=0.042); mobility increased by 42.1%, functional independence in everyday life - by 38.1%, muscle strength - by 50%, compared with the 2nd (control) group (p=0.0005). According to the HADS scale, in 29 (60.8%) patients of the main group, psychoemotional disorders were not detected, neither a single case of significantly expressed symptoms of depression (p<0.0001). CONCLUSION: The inclusion of low-frequency transcranial electromagnetic stimulation in complex rehabilitation leads to the regression of movement disorders, reduces the level of anxiety and depression, improves daily activity and, as a consequence, the quality of life.

[A comprehensive assessment of brain perfusion data in patients with acute ischemic stroke for prediction of hemorrhagic transformation]. / Kompleksnaia otsenka perfuzionnykh dannykh golovnogo mozga u bol'nykh s ostrym ishemicheskim insul'tom dlia prediktsii gemorragicheskoi transformatsii.

A comprehensive assessment of brain perfusion data in connection with the Hemorrhagic Transformation Index (HTI) score to predict hemorrhagic transformation (HT) in acute ischemic stroke (AIS) patients. MATERIAL AND METHODS: Based on propensity score matching, the authors selected retrospectively 21 case-control pairs from 71 consecutive patients with AIS in the middle cerebral artery territory. Brain computed tomography (CT) perfusion data with blood-brain barrier permeability assessment were obtained in all patients within 12 h after the onset. The infarct core (IC) and penumbra were evaluated with mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF), and permeability surface-area product (PS). The outcome was any HT on a follow-up brain CT scan within 2 weeks after the onset. RESULTS: The Firth logistic regression analysis showed that PS was an independent HT predictor in the IC (odds ratio, 8; 95% confidence interval (CI), 1.32-48.4; p=0.023). The cut-off value was 2.88 mL/100 g/min (95% normal-based CI (NB-CI): 2.41-3,34) with sensitivity 0,95 (95% NB-CI: 0.87-1.0), specificity 1 (95% NB-CI: 0.95-1.0), and area under ROC-curve 0.98 (95% NB-CI: 0.94-1.0). However, no independent HT predictor was found in the penumbra. The generalized linear model analysis revealed that the HTI score was a predictor of CBV, CBF, and PS in the IC and penumbra. As the HT risk grew simultaneously with the HTI score increment, the CBV and CBF became low with a substantial PS rise in the IC; the IC size tended to increase as well. In the penumbra, there was a progressive CBF reduction with a significant CBV and PS climb. At the same time, the MTT-CBV mismatch shrank. CONCLUSION: The IC is more likely to be the site of HT. The PS is an independent HT predictor in the IC. The HTI score can predict the HT probability as well as the brain perfusion data. As the HT risk increases, the perfusion disorders become worse in the IC and penumbra.

[Results of a randomized double blind multicenter placebo-controlled, in parallel groups trial of the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (EPICA)]. / Rezul'taty randomizirovannogo dvoinogo slepogo mul'titsentrovogo platsebo-kontroliruemogo v parallel'nykh gruppakh issledovaniia éffektivnosti i bezopasnosti meksidola pri dlitel'noi posledovatel'noi terapii u patsientov v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta (ÉPIKA).

AIM: To evaluate the efficacy and safety of prolonged sequential therapy with mexidol in the acute and early recovery stages of hemispheric ischemic stroke (IS). MATERIAL AND METHODS: A randomized double blind multicenter placebo-controlled, in parallel groups trial included 151 patients (62 men and 89 women) with hemispheric IS. Using a method of simple randomization, 150 patients (62 men and 88 women), aged 40-79 years, were randomized into two groups. Patients of Group I were treated with mexidol: 500 mg/day IV infusion for 10 days, followed by 125 mg tid (375 mg/day) PO for 8 weeks. Patients of Group II received the placebo according to the same scheme. The total duration of patients' participation in trial ranged from 67 to 71 days. RESULTS: By the end of treatment, the mean score on the modified Rankin scale (mRS) was lower in Group I compared to Group II (p=0.04). In Group I, the decrease in mRS mean score (Visit 1-5) was more prominent (p=0.023), percentage of patients with 0-2 scores by mRS scale (Visit 5) was higher (p=0.039), mean NIHSS score lower (p=0.035) in Visit 5 compared to group II. By the end of treatment, the decrease in mean NIHSS score in patients with diabetes mellitus was more prominent in Group I in comparison with Group II (p=0.038). In Group I, the dynamic of improvement of quality of life was more prominent and started from Visit 2 in general population and subpopulation of patients with diabetes mellitus. The share of patients with no problems with movement in space was higher in Group I (p=0.022). There were no statistically significant differences in frequency of side effects in patients of both groups. CONCLUSION: It is recommended to include mexidol in therapy of patients with IS in the acute and early rehabilitation stages.

[The features of botulinum therapy for different patterns of poststroke spasticity]. / Osobennosti botulinoterapii pri razlichnykh patternakh postinsul'tnoi spastichnosti.

AIM: To assess the efficacy of botulinum toxin therapy for different patterns of poststroke spasticity. MATERIAL AND METHODS: Thirty-nine patients with poststroke spasticity were examined. Rehabilitation included 4 treatment courses of inpatient rehabilitation during 9 month usinga multidisciplinary team approach. Botulinum toxin therapy was included in the program. The individual program was developed taking into account the dynamics of a pathological spastic pattern. RESULTS AND CONCLUSION: The transformation of the pathological movement pattern was observed during the rehabilitation using botulinum toxin. The best positive changes, including an improvement of the upper extremity function, walk and a decrease in the degree of paresis, was identified when botulinum toxin therapy was used in early stages of neurorehabilitation (1-3 month after stroke).

[Contraction (retraction) of blood clots in patients with ischemic stroke]. / Kontraktsiya (retraktsiya) sgustkov krovi u bol'nykh s ostrym ishemicheskim insul'tom.

AIM: To study a possible pathogenetic role of the blood clot contraction and its disturbances in the acute stage of ischemic stroke (IS). MATERIAL AND METHODS: Using a new instrumental technique to study the dynamics of clot contraction in vitro, the authors have determined quantitative parameters of clot contraction (the extent and rate of contraction, duration of the lag-period) in the blood of 85 patients with acute IS. RESULTS AND CONCLUSION: The contractile activity of blood clots was substantially reduced compared to the blood of healthy subjects. Correlations between hemostatic and contractile parameters suggest that the reduced clot contraction in stroke is due to the lower platelet count and impaired platelet functionality, higher levels of fibrinogen and antithrombin III as well as higher hematocrit and hemoglobin contents, leukocytosis, and changes in the biochemical blood composition. The results show that the reduced ability of clots may be a novel pathogenic mechanism that aggravates the course and outcomes of IS.

[An analysis of treatment of the Russian group of patients in the international observational study «Factors influencing response to botulinum toxin type A in patients with idiopathic cervical dystonia¼].

AIM: The analysis of the results of treatment of the Russian patient population in the frame of international, multicenter, non-interventional study of CD, the primary purpose of which was to determine the response rate to therapy with BTA at the peak of the effect: after one course of injections in settings of routine practice, as well as the results of application of modern definition for "response" to treatment with BTA. MATERIAL AND METHODS: In Russia 60 patients with idiopathic CD were included. Patients were classified as «responders¼ according to the following 4 criteria: effect size (improvement by ≥ 25% assessed by TWSTRS); effect duration: ≥ 12 weeks interval between the BTA injection and the day when the patient reported a decrease of clinical effect, indicating the need for repeated treatment; good tolerability of treatment (no treatment-related serious adverse events (AEs) during the study period); patient-reported Clinical Global Improvement (CGI) score is +2 («significant improvement¼) or +3 («very significant improvement¼) at the visits 2 or 3. RESULTS AND CONCLUSION: In the Russian population, patients with a ≥ 25% improvement by TWSTRS scale at visit 2 (peak effect) accounted for 88.3%. Most of patients (81.6%) and physicians (81.7%) evaluated the efficacy of therapy as a «significant improvement¼ or «very significant improvement¼ by CGI. The criterion of the effect duration was achieved in 50% of cases. The BTA therapy was well tolerated (no severe AEs related to treatment) in 98.3% of patients. Overall, 40% of all patients met all the criteria for response to BTA treatment. According to the analysis of the general population, a high degree of response was observed for the effect size (73.6%), tolerability (97.5%) and patient-reported global clinical improvement (69.8%). Subjective assessment of the duration of the effect was achieved in 49.3% of patients, with 28.6% of patients considered as responders. Most patients met three of the four criteria. The proposed multifactorial definition of «response¼ may be of practical use for routine practice.

[The study of the efficacy of Botulinum toxin type A in patients with poststroke upper-limb spasticity ULIS-II: an analysis of Russian patients].

AIM: To assess the efficacy of Botulinum toxin type A (BoNT-A) injections in routine practice. MATERIAL AND METHODS: An international, post-marketing, multi-center, observational, prospective, longitudinal study included patients ≥18 years with poststroke upper-limb spasticity in whom a decision to inject BoNT-A had already been made, and who had no previous treatment with BoNT-A or BoNT-B within the last 12 weeks. The responder rate was assessed by the patient-centered goal attainment scaling (GAS). RESULTS AND CONCLUSION: The study included 7 Russian research centers (41 patients). Sixteen patients (39%) received BoNT-A injections prior to entering the study. During the treatment, 29 patients (70.7%) received dysport injections; 2 (4.9%) botox injections, 8 (19.5%) xeomin injections and 2 (4.9%) other BoNT-A agents. The primary treatment goals were successfully attained in 87.8%, secondary treatment goals in 88.3%. An improvement in passive function as primary goal and as secondary goal were achieved in 100%, in the range of movement in 94.9%, pain reduction in 82.4%, improvement in active function of the upper limb in 76.5%, reduction in involuntary movements (associated reactions) in 83.3% of cases. Investigators' global assessment of benefits revealed that 97.6% of patients showed positive effects from BoNT-A injections. Pateitnts' assessment of global benefits was slightly lower - 90,2% of patients reported positive treatment effects When assessed by patients, the rate of global benefits was 90.2%. Botulinum-toxin therapy is an effective treatment option. In the vast majority of patients, it allows both for reduction in muscle tone and functional benefits that could improve quality of life of the patients.

[Neurovisualisation predictors of malignant cerebral infarction and hemorrhagic transformation]. / Neirovizualizatsionnye prediktory zlokachestvennogo techeniia i gemorragicheskoi transformatsii ishemicheskogo insul'ta.

Neuroimaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of malignant middle cerebral artery infarction and hemorrhagic transformation in light of the aforementioned four Ps.

[Modern multimodal protocols of acute stroke visualisation]. / Sovremennye mul'timodal'nye protokoly vizualizatsii ostrogo insul'ta.

Brain imaging plays a central role in the assessment of patients with acute ischemic stroke. Modern multimodal imaging protocols can provide comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed the modern multimodal acute stroke imaging protocols in the light of the aforementioned four Ps.

[The introduction of the multilevel system of medical care for stroke patients in the Tatarstan Republic]. / Opyt vnedreniia mnogourovnevoi sistemy okazaniia meditsinskoi pomoshchi bol'nym s insul'tom v Respublike Tatarstan.

The analysis of introduction of multilevel system of medical care by the patient with a stroke in the Tatarstan Republic for 2008-2013 is carried out, results of efficiency of these changes are given.

[Multimodal imaging protocols and their predictive role in acute stroke functional outcome]. / Mul'timodal'nye protokoly vizualizatsii i ikh rol' v prognozirovanii funktsional'nogo iskhoda ostrogo insul'ta.

Brain imaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of stroke functional outcome in the light of the aforementioned four Ps.