Serum Level of Brain-Derived Neurotrophic Factor and Thrombotic Type Are Predictive of Cognitive Impairment in the Acute Period of Ischemic Strokes Patients.

40-70% of patients after a stroke, including a mild one, may experience cognitive impairment. Brain-derived neurotrophic factor (BDNF) plays a significant role in the pathogenesis and rehabilitation of ischemic stroke and also affects the patients' recovery prognosis. An association between cognitive impairment in the poststroke period and lower peripheral BDNF levels is known, but the prognostic significance of serum BDNF levels and clinical characteristics for the risk of developing cognitive impairment in the acute period remains uncertain. We conducted a prospective cohort study of patients in the acute phase of ischemic stroke. Clinical examination, assessment of neurological status, neuropsychological testing, and laboratory analyzes were performed on patients at 1 and 14 days after ischemic stroke. The state of cognitive functions was assessed by the Mini-Mental State Examination scale. Quantification of BDNF in blood serum was performed by solid-phaseenzyme-linked immunosorbent assay (ELISA). We found that within 14 days after an acute ischemic stroke, we found a decrease in the clinical severity of patients compared to 1 day of the onset of the disease before the start of treatment and a significant decrease in the level of BDNF in the blood serum of patients with ischemic stroke both on the first and on the 14th day. However, during the 2 weeks of the acute period, no significant changes were detected, despite the general improvement of the clinical condition. In our study, cognitive impairment was found in almost half of the patients on the first day of ischemic stroke, and there was no significant reduction in this prevalence over 2 weeks. We found that a low level of BDNF and a thrombotic subtype of ischemic stroke can be risk factors for cognitive impairment in the acute period, which can be useful in planning treatment and rehabilitation measures.

THE ROLE OF CIRCADIAN REGULATION OF GHRELIN LEVELS IN PARKINSON'S DISEASE (LITERATURE REVIEW).

The paper is aimed at the analysis of the role of the circadian regulation of ghrelin levels in patients with Parkinson's disease. Based on the literature data, patients with Parkinson's disease have clinical fluctuations in the symptoms of the disease, manifested by the diurnal changes in motor activity, autonomic functions, sleep-wake cycle, visual function, and the efficacy of dopaminergic therapy. Biological rhythms are controlled by central and peripheral oscillators which links with dopaminergic neurotransmission - core of the pathogenesis of Parkinson`s disease. Circadian system is altered in Parkinson`s disease due to that ghrelin fluctuations may be changed. Ghrelin is potential food-entrainable oscillator because it is linked with clock genes expression. In Parkinson`s disease this hormone may induce eating behavior changing and as a result metabolic disorder. The "hunger hormone" ghrelin can be a biomarker of the Parkinson's disease, and the study of its role in the pathogenesis, as well as its dependence on the period of the day, intake of levodopa medications to improve the effectiveness of treatment is promising.

PROSPECTIVE PILOT STUDY TO ASSESS MOTOR ACTIVITY AND THE STATE OF THE HEMOSTASIS SYSTEM IN THE ACUTE PERIOD OF ISCHEMIC STROKE DURING SYSTEMIC THROMBOLYTIC THERAPY.

OBJECTIVE: The aim: To investigate changes in motor activity and indicators of the state of the hemostasis system in the acute period of ischemic stroke during systemic thrombolytic therapy and without its use. PATIENTS AND METHODS: Materials and methods: We examined 26 male and female patients with a clinical diagnosis of ischemic stroke, who were hospitalized on the first day of the disease to the neurological departments. Patients were divided into 2 groups: group 1-patients who underwent systemic thrombolytic therapy (sTLT) (n=11), group 2-patients who did not receive sTLT (n=15). To compare the coagulogram parameters, 12 healthy patients were examined (control group). Examination of patients was performed on the 1st and 14th day of the disease (clinical examination, assessment of motor activity, coagulation test). Stroke severity was determined by the overall score of the National Institutes of Health Stroke Scale. RESULTS: Results: The average age of patients in group 1 - 60.1±8.2 years old, in group 2 -61.3±5.5 years old. The number of points on the NIHSS scale in group 1 was 8.8±1.13 on 1st day and 3.7±0.79 on 14th day (p<0.05), in group 2 -5.7±0,94 on the 1st day and 3.1±0.93 on the 14th day(p<0.05). The results of the study of the coagulogram indicate a significantly higher level of soluble fibrin-monomer complexes on the 1st day on the 14th day of the ischemic stroke. CONCLUSION: Conclusions: In the acute period of ischemic stroke changes in the hemostasis system reflected the direction of the selected therapy. The use of systematic thrombolytic therapy in ischemic stroke led to a more severe decrease in stroke severity on the NIHSS scale, a significant increase in Barthel index.

THE EFFECT OF α-LIPOIC ACID ON THE FUNCTIONAL STATE OF PERIPHERAL NERVE FIBERS IN POLYNEUROPATHY OF THE LOWER EXTREMITIES IN PATIENTS WITH CHRONIC HEMOBLASTOSIS.

OBJECTIVE: The aim: To evaluate the effectiveness of the appointment of α- lipoic acid for correcting electroneuromyographyс indicators polyneuropathy of the lower extremities in patients with hemoblastosis. PATIENTS AND METHODS: Materials and methods: The study included 77 patients from hematology department of Poltava Regional Hospital, who were divided into 3 groups according to the underlying disease: Group 1 - patients with chronic myeloid leukemia (CML) (n = 26 ) groups and 2 - patients with chronic lymphocytic leukemia (CLL) (n = 27 ), group 3 - patients with multiple myeloma (MM) ( n = 24 ). For the examined patients were taken electroneuromyographyc researches of distal lower extremities by measuring the following parameters: the amplitude of the M-response from short extensors nerves of the fingers ( MEDB) and abductor of the big toe ( MAH) and the rate of excitation the spread of short extensors nerve of the fingers ( VEDB), thumb abductor ( VAH), superficial shallow ( VSF) and calf ( VC) nerves on both sides (sin/dex ) before and after administration of α- lipoic acid. RESULTS: Results: ENMG examination of the peripheral nerves of the lower extremities in patients with CML and CLL revealed a slight decrease in M-responses at normal values of the rate of conduction of excitation through sensory and motor fibers. In patients with MM, multiple lesions of peripheral nerve fibers of the lower extremities were detected, which is represented by a decrease in the M-response and the rate of excitation through sensory fibers and indicates deeper lesions, namely the axial cylinder, which requires longer treatment. The difference in the dynamics of the studied indicators indicates a different degree of PNP. Administration of α-lipoic acid increased the M-response rate and the rate of excitation of motor fibers in all groups of patients. The rate of excitation through sensory fibers was improved in patients with CLL and MM. Following the use of α-lipoic acid in the complex treatment of patients with MM ENMG, the signs of peripheral nerve fiber damage in the lower extremities were worse due to the severe initial condition, but reached a medium level. The positive effect of α-lipoic acid can be caused by a decrease in oxidative stress and endothelial dysfunction in nerve vessels, and, as a consequence, an improvement in the trophism and functional state of nerve fibers. CONCLUSION: Conclusions: ENMG signs of defeat of PNP of the lower extremities are more expressed at MM. The appointment of α-lipoic acid in the complex treatment of PNP in patients with chronic hemoblastosis improves the functional state of the peripheral nerve fibers of the lower extremities and may be a component of pathogenetic therapy.

[Multisemic atrophy: a description of the clinical case of olivopontocerebellar atrophy against the background of stenosing atherosclerotic vascular lesions].

Features of the onset, the course of the disease causes difficulties in the early diagnosis and formulation of the correct diagnosis. Olivopontocerebellar atrophy is characterized by a broad polymorphism of clinical manifestations. There is a need to develop new methods of symptomatic and neuroprotective treatment, as well as the optimization of non-drug therapy.

Post-stroke fatigue and its dimensions over the second half year after stroke.

OBJECTIVE: Introduction: Post-stroke fatigue (PSF) is a common and often debilitating sequel of both ischemic and hemorrhagic strokes. The aim: Assess the rates and intensities of PSF over the second half year after stroke. PATIENTS AND METHODS: Materials and methods: There were examined 128 patients at 6, 9 and 12 months after ischemic or hemorrhagic stroke onset. PSF was measured by fatigue assessment scale (FAS), multidimensional fatigue inventory-20 (MFI-20) and fatigue severity scale (FSS). Distributions of continuous variables were checked by Shapiro-Wilk test. Parametric variables were represented as mean±standard deviation, non-parametric - as mediana (Me) and interquartile (25%-75%) range (Q1-Q3). Categorical data were represented by number (n) and percentage. The difference between the patients' proportions with PSF at definite time points after stroke onset was assessed using Cochran's Q-test. The Friedman F-test for repeated measurements was performed to analyze multiple non-parametric variables. When the Friedman F-test yielded a significant effect (p<0,05), it was followed by Dunnett's test for determination the differences between initial and subsequent measurements. A p-value <0,05 was considered statistically significant. RESULTS: Results: According to FAS and MFI-20 "global fatigue" sub-scale, PSF rates over the second half year after stroke were statistically stable and were present, respectively, in 28,1% and 34,0% at 6 months, in 26,2% and 32,4% at 9 months, in and 32,0% and 30,5% cases at 12 months after stroke. Physical, mental, activity-related and motivational PSF domains, due to MFI-20 sub-scales, had roughly similar percentage without any significant dynamics over the studied period. According to FSS value ranks, proportions of patients with different levels of PSF impact on daily life were statistically stable over the studied post-stroke period. However, it has been revealed significant reduction of PSF intensities in physical and activity-related domains whereas severities of mental and motivational PSF aspects have been statistically increased. CONCLUSION: Conclusions: Rates of PSF were stable over the second half year after stroke occurrence, however intensities of mental and motivational PSF domains have been statistically increased, whereas severities of physical and activity-related PSF domains have been significantly decreased.

Post-stroke fatigue and its dimensions within first 3 months after stroke.

INTRODUCTION: Post-stroke fatigue (PSF) is a common stroke complication with long-term negative consequences. AIM: Assess the qualitative and quantitative PSF characteristics during 3 month post-stroke period. MATERIALS AND METHODS: There were examined 141 patients with acute ischemic or hemorrhagic strokes at hospital stay, in 1, 2 and 3 months after stroke. PSF was measured by fatigue assessment scale (FAS), multidimensional fatigue inventory-20 (MFI-20) and fatigue severity scale (FSS). RESULTS: 116 (82.3%) patients had ischemic strokes, 25 (17.7%) had hemorrhagic strokes. According to FAS and MFI-20 "global fatigue" sub-scale, PSF was present, respectively, in 22.0% and 25.5% cases at hospital stay, in 38.3% and 35.5% cases in 3 month after stroke. The growing prevalence of PSF was based on significantly increasing the rates of PSD physical domain (from 28.4% to 41.1%) and the rates of PSF mental domain (from 19.1% to 31.9%). On the other hand, the rates of PSF activity-related component had been significantly reduced from 36.2% to 17.0% within observation period. Moreover, according to MFI-20, it had been revealed significant increasing of PSF intensities in global, physical and mental domains during first 3 post-stroke months. According to FSS value ranks, proportions of patients with "no PSF" had been decreased in 1.5 times due to simultaneously rising rates of "moderate" as well as "severe" PSF impacts on daily life. CONCLUSION: The PSF spreading is significantly increased during the first 3 post-stroke months due to increasing of rates and intensities of physical and mental PSF domains.