[B vitamins and brain dysfunction]. / Vitaminy gruppy B i mozgovaya disfunktsiya.

An unbalanced diet and some other factors are the reason for the extreme prevalence of hypovitaminosis among the population of both developing and developed countries. The metabolic relationships of B vitamins determine the more frequent occurrence of poly-, rather than monovitamin deficiency. Since B vitamins play an important role in the processes of energy production and in the functioning of neurotransmitter systems, the first symptoms of such polyhypovitaminosis are signs of brain dysfunction: asthenia, depression, anxiety, cognitive disorders. Correct diagnosis of polyhypovitaminosis based on the identification of risk groups of patients and the determination of their subclinical or early manifesting signs of brain dysfunction is the most important task of a practicing physician. Detection of insufficient intake and vitamin content, as well as verification of the onset of symptoms of brain dysfunction and the appointment of adequate therapy can significantly increase the effectiveness of treatment, as well as prevent asthenic, psycho-emotional and cognitive disorders in patients with polyhypovitaminosis.

[Functional impairments in large-scale brain projects in opioid addiction]. / Funktsional'nye narusheniya v krupnomasshtabnykh setyakh pokoya golovnogo mozga pri opioidnoi narkomanii.

OBJECTIVE: To assess the functional state of large-scale resting networks of the brain in patients with opioid intoxication. MATERIAL AND METHODS: Thirty-one male subjects, aged 27.4+5.1 years, were studied. Resting state functional MRI was performed in 12 patients with heroin intoxication aged 29.1+5.9 years. The control group consisted of 16 healthy volunteers without bad habits aged 26.2+4.2 years. RESULTS: In the group of opioids intoxication, there is a decrease in the functional activity of the salience network with the executive control network and the default mode network of the brain (p<0.05) compared to the control group. A positive correlation of functional connections is found between the anterior cingulate cortex and the medial prefrontal cortex (T=2.74; p=0.041), which is not recorded in the control group. The functional connections between the default mode network and executive control are more highly represented in opioid intoxication in comparison with the control group (medial prefrontal cortex - left posterior parietal cortex T=7.5; p=0.001; medial prefrontal cortex - right posterior parietal cortex T=3.71; p=0.014; posterior cingulate cortex - left posterior parietal cortex T=6.15; p=0.002; posterior cingulate cortex - right posterior parietal cortex T=3.25; p=0.023; posterior cingulate cortex - right dorsolateral prefrontal cortex T=2.83; p=0.037). CONCLUSION: The results indicate that functional connections in large-scale resting networks are disrupted during opioid intoxication, which indicates a disturbance of the normal functional architectonics of the brain.

[Low doses of quetiapine (Seroquel) as an impulsivity corrector in patients with bipolar affective disorder in remission]. / Nizkie dozy kvetiapina (Serokvelya) v kachestve korrektora impul'sivnosti u patsientov s bipolyarnym affektivnym rasstroistvom v remissii.

OBJECTIVE: To evaluate the effectiveness of low doses (25-75 mg/day) of quetiapine (Seroquel) in patients with bipolar affective disorders in a euthymic state with signs of impaired impulse control. MATERIAL AND METHODS: The main criteria for patients' selection were as follows: both sex, diagnoses of bipolar affective disorders, remission (euthymic state), adult age (from 18 to 60 years old), stable basic therapy. The duration of the study was 6 weeks, a dose of quetiapine (Seroquel) varied from 25 to 75 mg. The examinations were carried out with the Barratt scale, computerized Go-No-Go and Balloon tests. RESULTS: The study group included 32 patients (11 men and 21 women), mean age 31.2±9.7 years (minimum 18, maximum 60 years). The changes in Barratt total score (p=0.000014, Wilcoxon test, effect size 0.48) and Balloon total earnings (p=0.03, Wilcoxon test, effect size 0.22) were statistically significant and reflected clinically significant improvement. The changes of the indices of the Go-No-Go test were not significant. The data of fMRI showed an increase in the connectivity of the cortex of the central and parietal tegmentum of the left hemisphere with other areas of the brain, which correlated with the changes in psychometric and test parameters. CONCLUSION: The results of the study showed that add-on of the low doses of quetiapine (Seroquel) significantly decreases impaired impulse control in remitted patients with bipolar affective disorders both in self-evaluation and in risk-taking experimental test. The drop of high level of impulsivity can improve the quality and stability of remission and reduce behavioral risks due to impaired impulse control.

[Eye as an object of investigation of cognitive impairment in Parkinson's disease]. / Organ zreniia kak ob''ekt izucheniia narushenii kognitivnykh funktsii pri bolezni Parkinsona.

AIM: To study visual and spatial disorders in Parkinson's disease (PD). MATERIAL AND METHODS: One hundred and eighteen patients with PD and 30 healthy people (the control group) were studied. All participants underwent neurological and ophthalmological examinations. PD progression was assessed using The Hoehn and Yahr scale. MMSE, FAB and other psychological tests were administered. Optical coherence tomography (OCT) and MRI of the brain were performed. RESULTS AND CONCLUSION: The relationship of the variation in the thickness of various parts of the retina and brain cortex with cognitive deficit that manifests itself as visual-spatial disturbances is shown. The complex diagnostic technique, including neuropsychological and instrumental method (OCT of the retina, MRI of the brain with MRI-morphometry), should be used.

[MRI morphometry of neuroplastic changes in the brain after conservative treatment of traumatic brachial plexopathy]. / Magnitno-rezonansnaia morfometriia neiroplasticheskikh izmenenii golovnogo mozga pri konservativnoi terapii travmaticheskoi plechevoi pleksopatii.

AIM: To identify neuroplastic changes in the brain structures during treatment of traumatic axonotomy of the brachial plexus (the pathology of peripheral nervous system). MATERIAL AND METHODS: MRI morphometry of white and grey matter was studied in 62 patients with traumatic axonotomy of the brachial plexus. RESULTS: There were correlations between the thickness of sensorimotor cortex, morphometric parameters (volume, diffusion, fractional anisotropy) of subcortical formations (corticospinal tracts, the forceps minor), severity of neurological deficit and dynamics of clinical course depending on the therapeutic strategy. CONCLUSION: The results expand the current view on central mechanisms of posttraumatic axon regeneration on the model of traumatic brachial plexopathy and establish a neuromodulative effect of neuromidin and noofen. Some morphometric parameters may be used as the markers of reactive neuroplastic processes in the central nervous system.

[Early diagnosis of dementia with the help of MR-morphometry in patients with Parkinson's disease].

54 patients with idiopathic Parkinson's disease were examined. 1,5 Tesla MRI with T1 gradient-echo protocol and following calculating by FreeSurfer software was performed. Dementia was revealed in 23 patients. Significant changes of different zones of brain-cortex were revealed in patients with Parkinson's disease accompanied by dementia. Changes were revealed in the hemispheres, particularly in frontal, temporal and occipital lobes. Thickness of lingual medial occipitotemporal gyrus can be used as a criterion for dementia prognosis. Individual patient monitoring and cortex alteration evaluation allow prognosticating increasing risk of cognitive disorders development and prescribing proper therapy.

[Brain metabolism in multiple sclerosis: effects of neurotrophic therapy].

We studied 15 patients with relapsing-remitting multiple sclerosis (MS) in the state of remission (disease duration 1-5 years, EDSS scores 2.5-5.5) treated with сerebrolysin (Cere) to investigate the rate of brain metabolism changes. All patients continued to receive their disease modified treatment therapy (copaxon or interferons). Patients of the main group (n=10) received i.v. 20 ml of Cere (diluted in 200 ml NaCl 0.9%) for 10 days and vitamins B (pentovit) in tablets. Patients in the control group (n=5) were treated only with pentovit in tablets. All the patients underwent magnetic resonance spectroscopy (MRS) (Siemens Symphony 1.5T) prior to the beginning of treatment and 1-3 days after the end of therapy. Five patients of the main group who had best results according to the data obtained from the 2nd MRS underwent a third MRS investigation after 3 months. After 10 days of Cere treatment, the level of N-acetylaspartate in MS lesions had increased from 2.12 to 2.39 (p<0.001) and the level of lactate had decreased by 4 times (from 0.21 to 0.05; p<0.001). In perifocal lesion areas, the level of lactate had significantly decreased from 0.22 to 0.1 (p<0.05). We have also found the trend towards NAA increase in morphologically intact brain tissues. The positive metabolic changes after Cere therapy remained in some patients for 3 months. In the control group, there was the increase of creatine level in intact brain tissues from 1.16 to 1.30 (p<0.05) without significant changes in other areas. All the patients in the main group reported subjective improvement and one patient had the improvement in EDSS scores by 1.0 point.

[The use of succinates for the correction of metabolic disorders in the penumbra in patients with stroke].

The aim of the study was to determine the quantitative content and correlation between metabolites in the core ischemic zone, the ischemic penumbra and the intact tissue of the opposite hemisphere in the acute stage of ischemic stroke using MR-spectroscopy. We studied 72 patients, including 37 patients (the main group) treated with the antioxidant mexidol (2-ethyl-6-methyl-3-hydroxypiridine succinate) in addition to standard therapy and 35 patients who received standard therapy only. The severity of stroke was assessed using the NIHSS. The Barthel index and Rankin scale were used to evaluate functional outcome in the 30th day, hydrogen MR-spectroscopy was used twice: in the first 24 h from disease onset and in the 5th day. Mexidol used in dose 500 mg intravenously during 14 days reduced significantly the content of lactate (p=0.002) and inositol (p=0.005) in the cells compared to the control group that enhanced the restoration of the balance between aerobic and anaerobic mechanisms of oxidation and positively influenced on the rehabilitation of patients. Positive correlations between the content of lactate in the ischemic penumbra and NIHSS scores (r=0.5786; p=0.049) and the negative correlation between the content of lactate in the ischemic penumbra and the degree of functional restoration assessed by the Barthel index (r= -0.6305; p=0.028) were found. These findings support the evidence for the interaction between the disturbance of glucose metabolism in conditions of hypoxia and the degree of nervous tissue damage.

[New approach to gait disorders therapy in late stages of Parkinson's disease].

We conducted an open noncontrolled study of efficacy of repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) combined with acetylcholinesterase inhibitor (galantamine) therapy in 30 Parkinson's disease patients with cognitive impairment and higher level of gait disorders. Galantamine dose gradually increase to maximum of 16 mg/day (8 weeks) before rTMSand after that we start rTMS for 10 consecutive days. Cognitive, neuropsychiatric and motor symptoms were assessed clinically at baseline and at end of 10 weeks combined therapy using the Mini Mental State Examination (MMSE), Freezing Of Gait (FOG), Clinical Gait And Balance Scale (GABS), Tinetti scale, the clock drawing test, the Frontal Assessment Battery (FAB), PDQ-39 and Beck Depression Inventory (BDI). The metabolism in the frontal lobes, caudate nucleus, thalamus were assessed in 9 patients at baseline and end of rTMS by [18F]FDG-PET. Changes in total point scores on the scales at the ends of 10 weeks were compared with the baseline. Results were significant in the FOG (p = 0.00002), GABS (p = 0.000006), MMSE (p = 0.0001), FAB (0 = 0.003), PDQ-39 (p = 0.00009), BDI (p = 0.00004). Improvements in gait and decreases in freezing and falls were seen in the end of study period. Our study demonstrated the beneficial effect of rTMS of the DLPFC combined with acetylcholinesterase inhibitor treatment on metabolism in the frontal lobes, caudate nucleus, thalamus ([18F]FDG-PET), improving of gait and cognitive functions in PD patients.