[The problem of pharmacoresistant tremor in Parkinson's disease and essential tremor]. / Farmakorezistentnyi tremor pri bolezni Parkinsona i essentsial'nom tremore.

MR-guided focused ultrasound (MRg-FUS) is a new noninvasive method for the treatment of contralateral disabling and pharmacoresistant tremor. Clinical studies have confirmed the high efficacy and safety of using MRg-FUS in patients with essential tremor and Parkinson's disease, in short and long-term studies. Advantages of this method in comparison with currently used invasive and noninvasive technics, potential brain target areas, the possibility of bilateral intervention, indications and contraindications are discussed.

[First experience of thalamotomy by focused ultrasound under MR-guided navigation in the treatment of tremor. Neuroimaging follow-up. Case report and literature review]. / Pervyi opyt talamotomii fokusirovannym ul'trazvukom s MRT-navigatsiei pri lechenii tremora. Neirovizualizatsiya v dinamike. Klinicheskoe nablyudenie i obzor literatury.

The authors describe dynamic MRI and clinical data after non-invasive treatment of tremor in the upper extremity. Thalamotomy by high-intensity focused ultrasound under MR-guided navigation was performed. A 57-year-old patient with Parkinson's disease underwent treatment with focused ultrasound. MRI of the brain was performed 1 and 48 hours, 47 days, 3 and 6 months later. Features of natural course of focal brain changes after treatment, data of MR tractography necessary for correction of target zone are described. The authors conclude that MR changes are characterized by presence of a focus in the area of focused exposure. Peak severity is observed on the second day after procedure with subsequent regression. MR-based analysis of predictors is promising to forecast treatment outcomes.

[Development of early diagnosis of Parkinson's disease based on the search for biomarkers such as premotor symptoms and changes in blood]. / Razrabotka rannei diagnostiki bolezni Parkinsona na osnove biomarkerov v vide premotornykh simptomov i izmenenii v krovi.

OBJECTIVE: To determine changes in the chemical composition of blood plasma in subjects at risk of Parkinson's disease (PD) at the prodromal stage compared with age control. MATERIAL AND METHODS: Subjects at risk were selected for the presence of characteristic premotor symptoms, including impairments of sleep, olfaction and constipation.The risk group included 12 people, the control group - 8 people. RESULTS: Among seven catecholamines and their metabolites detected in the blood, only the concentration of L-dioxiphenylalanine (L-DOPA) changed (decreased) in subjects at risk compared with the control. A decrease in the concentration of L-DOPA is considered as a manifestation (marker) of selective degeneration of central and peripheral catecholaminergic neurons in PD. In contrast to L-DOPA, the concentration of seven of the twelve detected sphingomyelins in the blood of the subjects at risk increased. Given that a change in the metabolism of sphingomyelins is associated with processes such as apoptosis, autophagy, and synucleinopathy, an increase in their concentration in the blood of patients at risk is considered as a manifestation of systemic general degeneration of central and peripheral neurons. Finally, in the blood of subjects at risk, we found a trend towards a decrease in the concentration of urates, which are endogenous neuroprotectors. CONCLUSION: The changes in the level of L-DOPA, sphingmyelins and urates in the blood of subjects at risk may serve as diagnostic markers of PD at the prodromal stage.

[Pantogam active in the complex treatment of dystonic hyperkineses].

Efficacy of pantogam active in the complex treatment of facial and cervical dystonic hyperkineses was studied in 37 patients (25 women, 12 men) with dystonic torticollis, blepharospasm, oromandibular dystonia with illness duration more than 6 months. In these patients, the previous treatment had no positive effect. Pantogam active was prescribed in dose 900-1800 mg/day during 12 weeks. Efficacy was assessed with the TWSTRS, the HADS and the CGI-I. Pantogam active as add-on to basic treatment led to the reduction of severity in dystonic hyperkineses on the average 2-2,5 months from baseline. The best effect was seen in patients with short disease duration. The prescription of this drug allowed to increase the dose of drugs traditionally used in treatment of dystonia (clonazepam, cyclodole, tiapridal, baclofen) due to the decrease of their side-effects.

Use of the new levodopa agent Stalevo (levodopa/carbidopa/entacapone) in the treatment of Parkinson's disease in out-patient clinical practice (the START-M open trial).

Despite the significant symptomatic effects of levodopa, stable 24-h treatment responses are in the vast majority of patients replaced 2-3 years from the start of treatment by oscillations in motor symptoms (fluctuation, dyskinesia), amelioration of which requires addition of constant (physiological) stimulation of postsynaptic dopamine receptors. To some extent this is provided by Stalevo, which contains levodopa and two enzyme inhibitors: the DDC inhibitor carbidopa and the COMT inhibitor entacapone. The results obtained in the present study demonstrated the advantages of Stalevo over traditional agents in patients with the "wearing off" and "on-off" phenomena.

[The study on the assessment of the new levodopa drug--stalevo (levodopa/carbidopa/entacapone), in treatment of Parkinson's disease in out-patient clinical practice (the results of the open START-M)].

Despite significant symptomatic effect of levodopa, in most patients the stable 24 hour's effect changed for alterations of movement symptoms (fluctuations, dyskinesia) after 2-3 years of the therapy. These complications may be reduced due to the constant (physiologic) stimulation of post-synaptic dopamine receptors that, to a certain degree, provides the drug stalevo, which contains levodopa and 2 enzyme inhibitors, dopa decarboxylase (carbidopa) and catechol-O-methyltransferase (entacapone). The results of the study demonstrated beneficial effects of stalevo as compared to traditional therapy in patients with "wearing off" and "on-off" phenomena.

[Antioxidants in complex treatment of Parkinson's disease].

Experimental and clinical study of mexidol efficacy in the complex therapy of Parkinson's disease has been carried out. It is shown that in a Parkinsonian animal model using oxotremorine, mexidol reduces Parkinsonian symptoms and decreases expression of neurophysiological changes caused by oxotremorine. Neurohistological study of substantia nigra neurons in a Parkinsonian model using MPTP revealed a neuroprotective effect of mexidol. An assignment of mexidol (4,0 ml intravenous in drops during 10 days) to patients with Parkinson's disease, receiving the basic therapy with antiparkinsonic drugs, reduced tremor, rigidity and bradykinesia. The most marked effect was observed in patients with prevalence of trembling symptoms at early stages of the disease. The results of clinical study have been confirmed by electromyographic and electroneuromyographic data.