[Clinical-neurophysiological study of efficacy of adaptol in discirculatory encephalopathy].

Sixty-eight patients, aged from 40 to 70 years, with discirculatory encephalopathy, I and II stages, have been examined. Thirty-five patients of the main group received non-benzodiazepine tranquilizer adaptol in dose 500 mg 2 times daily in addition to regular vasoactive treatment and 33 patients of the control group received only regular treatment. The following characteristics were assessed at baseline and after 1 month of treatment: complaints and neurological status, anxiety level (the Spielberger-Khanin scale), quality of life (SF-36) and parameters of P300 cognitive evoked potentials. To the end of treatment, there were the significant decrease of state and trait anxiety, improvement of quality of life, decrease of P300 latencies and increase of P300 amplitudes. No significant side-effects were seen, only 2 (5.7%) patients had transitory dyspepsia. In conclusion, adaptol in dose 1000 mg daily is effective and safe for the complex treatment of discirculatory encephalopathy of I and II stages.

[Efficacy of neuromidin in alcoholic encephalopathy].

40 patients with alcoholic encephalopathy, aged from 30 to 60 years, were enrolled in the study. Patients were divided into two groups: 20 patients in the treatment group received vasoactive, antioxidant treatment and neyromidin in dose 15 mg in solution during 10 days and then in tabs in dose 20 mg three times a day during 2 months. The comparison group included 20 patients receiving only vasoactive and antioxidant treatment. To the end of treatment, the positive changes in the state of patients reflected in the decrease in the number of complaints and neurological symptoms were seen in the treatment group. The significant improvement of MMSE scores, positive changes in P300 latency and amplitude, the increase in scores on physical activity scales, emotional functioning, mental health scales of SF-36 questionnaire were found as well. There were no serious treatment-emergent adverse events.

[Approaches to the therapy of neurological presentations in diabetes mellitus].

A study included patients, aged from 30 to 70 years, with a verified diagnosis of compensated diabetes mellitus type 1 or type 2, diabetic polyneuropathy (DPN) or the syndrome of moderate cognitive disorders (MCD). Patients with DPN were stratified into two groups: 30 patients of the main group received the antioxidant drug tiolepta in tablets (600 mg) once a day during 60 days; 30 patients of the control group received only basic (sugar-reducing) therapy. Twenty patients with MCD were treated with the combined nootropic and vasoactive drug vinpotropil in dose 2 capsules, 3 times a day during 2 months in addition to the basic therapy (sugar-reducing, antihypertensive, antiaggregate drugs). To the end of treatment, the severity of DPN was lower in the main group treated with tiolepta that reflected in the normalization of NDS scores in 50% of patients compared to 30% in the controls and in the disappearance of neurological symptoms on the TSS in 30% of patients while these symptoms were present in the control group. The electroneuromyographic study showed the statistically non-significant trend (p>0,05) to the higher velocity of impulse conduction along the sensory and motor nerves as well as higher amplitudes of motor and sensory responses in the main group. To the end of the treatment, positive dynamics in the number of complaints and neurological status was found in patients with MCD. The neuropsychological study revealed the significant (p< or =0,05) improvement on the MMSE scale and in the delayed recall of words (the ten words test). Adverse effects that led to discontinuation of treatment were not found for both drugs.

[Long-term results of microvascular decompression in treatment of hemifacial spasm].

BACKGROUND: Aim of the study was to assess results of treatment and quality of life of patients with hemifacial spasm (HFS) after microvascular decompression and to analyze intraoperative data in surgical revision of intracranial portion of facial nerve. MATERIALS AND METHODS: The study included 30 patients with HFS who underwent microvascular decompression. Duration of symptoms varied between 1 and 30 years (mean--6.7 years). Typical manifestation of spasm was observed in 28 cases, atypical--in 22. Severity of HS and its influence on everyday activity were assessed using 5-grade scale (by E. Tan), and surgical results--according to degree of clinical improvement combined with evaluation of quality of life using scale HFS-7. RESULTS. Most frequent type of conflict observed in the series was contact between facial nerve and AICA (64.4%). Compression of facial nerve root entry zone was revealed in vast majority of cases (93.3%), and in 2 patients (6.7%) site of compression was distal to the root entry zone. In a female patient with secondary HFS due to the tumor relations of neurovascular structures were altered and their displacement produced conflict between AICA loop and facial nerve. In our series hearing depression of different severity was observed in 16.7% of patients. This disorder is persistent and does not regress in the follow-up period. All other symptoms of cranial nerve dysfunction are amenable to resolve within 1-2 months. CONCLUSION: Microvascular decompression of facial nerve is pathogenetically feasible and effective method of treatment of HFS. It allows achievement of consistent regression of symptoms and improvement of quality of life of patients with HFS.

[Lower motor neuron diseases with predominantly upper limbs affection: are they independent forms or atypical variants of amyotrophic lateral sclerosis?].

We carried out an analysis of 5 sporadic cases of lower motor neuron disease with predominant affection of the proximal parts of arms in 2 patients and distal parts in 3 patients. From clinical point of view, our own observations, along with similar cases reported in the literature with predominantly affected upper limbs, different progression of the disease and denervation changes during needle EMG, can argue for clinical heterogeneity of lower motor neuron disease. There were some difficulties in establishment of a differential diagnosis between atypical variants of amyotrophic lateral sclerosis ("flail arm" syndrome) and primary muscular atrophy of adults at the early stages of the disease. We suppose that atypical variants of amyotrophic lateral sclerosis resultant from affection of lower motor neuron only ("flail arm" syndrome and distal amyotrophy), could be distinguished from amyotrophic lateral sclerosis and considered as an independent entity.

[Predictors of alpha-lipoic acid treatment efficacy in diabetic polyneuropathy of the lower limbs].

AIM: To study efficacy of sensory deficiency treatment with alpha-lipoic acid (ALA). MATERIAL AND METHODS: Twenty seven patients with diabetes mellitus (DM) type 1 and diabetic polyneuropathy of the lower limbs received ALA treatment (600 mg, i.v., drip, for 15 days followed by 600 mg, per os, for 2 months). Mean age 40.9 +/- 6.9 years, DM history 17.6 +/- 5.1 years, HbA1c--9.44 +/- 1.94% (standard 4.0-6.2%). Tactile, vibration, pain sensitivity was assessed, electroneurography (n. suralis, n. tibialis) was made. The severity of sensory deficiency was determined by 10-score Young scale. RESULTS: There were positive changes in objective and electrophysiological parameters. The severity of sensory deficiency and treatment effect depend on DM duration and initial sensory deficiency (predictory value of the regression model was 92%, p = 0.001), initial neuropathy severity was responsible for up to 66% of the effect. The highest positive response of polyneuropathy was achieved in initial threshold of vibration sensitivity under 16 V or in total score of neuropathy severity under 6. CONCLUSION: ALA treatment of sensory deficiency was most effective in patients with a short history of DM and mild initial neurological disorders (neuropathy severity by M. Young scale under 6 scores, threshold of vibration sensitivity under 16 V).

[The role of somatosensory evoked potentials in evaluating the treatment of patients with degenerative-dystrophic diseases of the lumbosacral spine]. / Rol' somatosensornykh vyzvannykh potentsialov v otsenke lecheniia bol'nykh s degenerativno-distroficheskimi zabolevaniiami poiasnichno-kresttsovogo otdela pozvonochnika.

Somatosensory evoked potentials (SSEP) were dynamically studied through bilateral stimulation of n. tibialis at the cortical and spinal level in 160 patients with degenerative and dystrophic lumbosacral diseases. The study revealed significant changes in the peaks Pf, N21 and in the intervals Pf-N21 in 38 (23.75%) patients. The patients had generally vascular disorders as ascending arterial, venous or concomitant myeloradicopathies (the syndromes of venous or arterial ischemia of the epiconus or conus). There were SSEP no significant changes in the paralyzing ischiasis syndrome. Early decompressing operations on the vertebral column (within 1 to 3 months) led to reversal of neurological disorders in most patients. Thus, SSEP in combination with needle and stimulant electromyography may quantitatively assess the time course of changes in the spinal cord conductors at and beneath the lumbar enlargement of the spinal cord in the treatment of degenerative and dystrophic lumbosacral diseases.

[The assessment of the dynamics of somatosensory evoked potentials in the surgical and conservative treatment of patients following spinal and spinal cord trauma]. / Otsenka dinamiki somatosensornykh vyzvannykh potentsialov pri khirurgicheskom i konservativnom lechenii bol'nykh posle travmy pozvonochnika i spinnogo mozga.

Somatosensory evoked potentials at the cortical and spinal levels were dynamically studied in patients with vertebral column and spinal cord injuries before and after radical reparative surgery. The study showed that quantitative determination of the time course of changes occurring was highly effective in neurological disorders. Most significant were changes in the latent periods and amplitude of the peaks N11, N13, N20, P23 in the activation of n. medianus and N21, N28, P37, N45 in the bilateral stimulation of n. tibialis posterior. There was a correlation of neurophysiological and clinical manifestations in 50-60% of cases. Thus, the neurophysiological studies quantitatively verify the efficiency of surgical treatment for vertebral column and spinal cord injuries.