SEROTONIN AND AMYOTROPHIC LATERAL SCLEROSIS.

Selective degeneration of motoneurons is the pathological hallmark of amyotrophic lateral sclerosis (ALS). Does serotonin (5-HT) play a role in progression or development of disease is under the research. The topic of the present paper is pressing as there is no data available regarding the spread of amyotrophic lateral sclerosis. It is also noteworthy that previous studies have indicated that the pathogenesis of ALS is closely linked to 5-hydroxytryptamine (5-HT). The clinical research was conducted in Georgia. During the last five years, 60 patients from different parts of Georgia have been studied, searched, and examined by us. Including from Samegrolo, Kartli, Adjara, Abkhazia, Guria, Kakheti regions. The Georgian Neurologists Corps participated and helped us in finding patients. Brain MRI and electromyography were also performed. 60 patients with different forms of ALS participated in the study, including 34 (56.66%) men and 26 (43.33%) women. Their age ranges from 30 to 81 years. The study was conducted after obtaining the written consent of the patients, taking into account the ethical requirements for the study. We also compared the results of the serotonin level of patients with amyotrophic lateral sclerosis with a control group of 20 people (aged 18 to 50 years) who had no neurological disease in past medical history. Patients of the first group, with LMN damage, are observed with decreased amount of serotonin (61.3) %, compared to other pairs, followed by patients of the upper neuron and bulbar syndrome groups, the level of serotonin in the control group is quite high. Thus, the level of serotonin in the group of patients with bulbar events is higher than in the other groups. Low serotonin requires further investigation. According to our research, the longer the anamnesis of amyotrophic lateral sclerosis patients is, the lower the level of serotonin is observed. It should also be taken into account that a low level of serotonin may be due to the presence of depression, which requires additional research. We speculate that 5-HT could therefore be a potential therapeutic target for amyotrophic lateral sclerosis.

RISK FACTORS OF AMYOTROPHIC LATERAL SCLEROSIS IN GEORGIA.

Objective - to identify risk factors in patients diagnosed with Amyotrophic Lateral Sclerosis in Georgia directed to The First University Clinic of TSMU and P. Sarajishvili Institute of Neurology. Totally 53 patients, aged 24 to 82 years, were investigated with Amyotrophic Lateral Sclerosis (ALS), defined by "Gold Coast " criteria. We have used the Questionnaire for Environmental Exposures, Toxins, and Neurological diseases developed by Dartmouth-Hitchcock Medical center to identify risk factors, and categorized patients according to the place of settlement and environmental hazards. The control consisted of age and sex matched 50 healthy individuals. The brain was visualized by MRI (1.5T), and Electromyography (EMG) was performed on all patients. ALS risk was higher among those ever holding a job in mechanics, painting, or construction (p<0.05), head trauma or concussion that caused a "blackout" or loss of consciousness was associated with a higher risk of ALS (p<0.01). Demographically more ALS cases were found in Tbilisi and Imereti, compared to other regions (p<0.05). According to our research on Georgian ALS cases, several occupational jobs, Head trauma is associated with developing ALS in Georgia, Research is needed to identify environmental risk factors attributing to higher rates of ALS in Tbilisi and Imereti.

CLINICAL CHARACTERISTICS OF ALS IN GEORGIAN PATIENTS.

Amyotrophic Lateral sclerosis (ALS ) is a fatal progressive neurodegenerative disease that affects the upper and lower motoneurons. .The disease is characterized by a plethora of neurological symptoms. There is a lot of information in the medical literature about ALS phenotypes, but the clinical diversity of ALS has not been studied in the Caucasus region and a unified clinical picture has not been conclusively established. In this regard, it is very important to study the symptoms among patients with ALS in Georgia. From 2018 to 2021, we examined 47 patients with ALS living in Georgia from different parts of the country, 23 - female, 24 - male, diagnosed based on clinical picture, electromyographic studies (AWAJI) and who met the EL ESCORIAL -Revised criteria. Also clinical symptom studies were conducted using the Mayo Clinic Laboratory Neurological Questionnaire. Cognitive changes were assessed using Addenbrooke's Cognitive Examination scale (ACE III) and the Frontal Behavioral Questionnaire, the patient's quality of life was assessed by ALSFRS-R. Patients were 26 to 84 years old, the age of onset of the disease was 58-60 years in men, 55-57 years in women. The bulbar type was observed in 21.3%, the upper limb type in 38.3% and the lower limb type in 40.4%. Frontotemporal dementia (FTD), diagnosed in 6 patients (12.7%). No reliable correlation was found between the forms of ALS and FTD. The results of the study showed that ALS is a multisystem disease and is not limited to damage to motoneurons. It is safe to say that ALS has characteristics of polysystemic degeneration, with the predominance of motorneuron damage. Therefore, we consider it advisable to screen all patients with ALS for additional symptoms with a focus on the examination of cognitive function, which ensures the proper management of the disease in the future.

[Anxiety, depression, panic disorder and bronchial asthma].

The Research purpose was studying anxiety and depression, and also the disturbing attacks in bronchial asthma (BA) patients. Research problems included: specification of prevalence of anxiety, depression, and also panic frustration of BA patients; an establishment of psychosomatic parities between anxiety, depression, panic frustration and BA. The study included the analysis of a mental condition, subjective and objective anamnestic information and medical documentation. 50 patients with BA are examined - 32 women, 18 men (average age of the patients was 38,7 ± 2,1). In 40% of cases the anxiety and depression is revealed. Subclinical expressed anxiety and depression is observed in 15 (39%) cases. Clinically expressed anxiety and depression is observed in 25 (50%) patients. During emotional and physical activities the phenomena of hypersthenic weaknesses is revealed in 45% of patients, short-term disturbance of falling asleep in 53%, propensity to revealing of polymorphic pathological corporal sensations (cephalgia, cardialgia, abdominalgia) is found out in 85% of cases. In all observation the beginning of mental frustration concerns to the second decade of life. In intervals between panic attacks are registered anxiety of expectation (fear of development of repeated panic attacks) and nosophobia (fear of development of myocardial heart attack, a stroke etc.). In all observation the beginning of mental frustration was revealed at the second decade of life. Symptoms of type "behavioral apnea (wind)" (breath dissatisfaction, feeling short of breath, arrhythmias and respiratory regularity of cycles) developed long before the manifestation of asthma (BA) and persist in its remission. The clinical manifestation of BA is extended by signs of panic attacks. Symptoms of anxiety and recurrent panic attacks worsen duration and outcome of BA. Hence, psychological and psychopharmacological therapy for anxiety disorders in addition to standard anti-asthma therapy could be suggested as one of the affective methods for treatment of BA patients with symptoms of anxiety and depression.

Depression as a risk factor for arterial hypertension.

The aim of the subject is to represents the connection of the Arterial Hypertension and thrombocyte number in blood and to find prevention ways. A clinical case of depression symptoms as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is a disorder with both physical and mental characteristics that negatively disrupts an individual's ability to function day to day in social and work environments. According to the DSM, real depression is a condition of this nature that lasts for more than two weeks. The subject is actual because Arterial Hypertension according to WHO's data's is one the 1stplace, while Depression - one the 2nd.According to Georgian Disease Controlling and Medical Statistic National Centre data's, depression is characterized from 15% to 25% of people. We've searched for the clinical methods in Batumi Republic Hospital departments. 30 patient is studied by us - 15 women and 15 men. Among them, 20 patients was fallen ill with Arterial Hypertension, 5 with Ischemic insult and 5 - with Discirculating Encephalopathy. We've the question are of Beck. According to which we were able to ascertain the depression quality. The question are consists of 21 questions; by them it was possible to ascertain depression qualities light, medium and complex. The depression quality was defined as follows: the absence of depression in 13%; mild depression in 17%; medium - 30% and severe in 60%. Thus, Depression quality is very high in people with Arterial Hypertension. The number of thrombocyte is high also. Thrombocytes depression causes significant changes in the function, Thrombocytes Activation, Thrombosis increases the risk. So, it's necessary to treat this patient with Antithrombotic medicines and Antidepressants. That will contribute to solving the problem.

[Psychological aspects of psychosomatic pathology of large intestine].

One of the most widespread aspects of psychosomatic pathology of gastrointestinal tract is irritable bowel syndrome (IBS). Over 70% of functional pathology of large intestine falls at IBS. The aim of the investigation was the assessment of depression rate in patients with IBS. Taking into consideration the age of individuals, 100 patients 50 men and 50 women aged 21 to 75 years were examined by using clinical, psychological and statistic (correlation) analysis to determine whether there were relations between clinical manifestations of the irritable bowel syndrome and personality. Diarrhea variant of IBS syndrome was detected in 17 (34%) men and in 21 (42%) females. Diarrhea and pain variant of IBS syndrome was detected in 12 (24%) men and 17 (34%) female. Pain variant of IBS syndrome was detected in 5 (10%) men and 12 (24%) females. Constipation variant was detected in 16 (32%) men and 3 (6%) female. In 84% of patients with IBS was found dysphoria; weight loss and bed appetite - in 44%, insomnia - in 40%, general lethargy and adynamia - in 80%; loss of interest - in 38%; asthenia - in 70%, devoured by guilt - 43%, uncertainty - 80%. Depression in patients with IBS was treated with serotonin selective antidepressants. Investigation revealed that the best result is achieved with serotonin-selective antidepressant therapy.

[Serotonin and suicide].

Suicide has been actual medico-social problem in the majority of countries. The impact of the socioeconomic variables on suicide is great. It was determined the decrease of the frequency of suicide in the post-Soviet countries in the period of "Perestroyka" (1984-1986), and permanent increase in late 80s and in the beginning of 90s. The aim of the research is to study depression, suicide thoughts and blood serotonin in 30 healthy people (15 females and 15 males from 20 to 70 years old) by means of BECK questionnaire. The following was determined: no depression in 40 % of healthy people; moderate depression of 40% of healthy people; light depression in 20 % of healthy people. Suicide thoughts were displayed in 30% of healthy people; no suicide readiness was determined. Blood serotonin was decreased in 85% of the able people; average level of blood serotonin was in 12%, and very high in 3% of healthy people. It is concluded that introduction of blood serotonin investigation in clinical laboratories is very important for monitoring of many diseases.

[Relationship between serum blood serotonin and tension--type headache].

Tension - type headache is one of the widely spread types of idiopathic headaches. The pathogenesis of the disease includes depression and change in brain serotonin level. The aim of the research is to study the characteristics of ache and the level of serotonin in blood serum in tension-type headache. The intensity of ache, complex psychometric parameters and the level of serotonin in blood serum were investigated in 100 patients (75% females and 25% males from 17 to 55 years old) with tension-type headache. The average period of the illness was 6-5 years. The diagnosis has been determined according to MKGB (2003) criteria. According to the duration of anamnesis of ache the patients were divided into 3 groups: the first - 66 patients, the second - 24 patients, the third - 10 patients with tension-type headache and migraine. Ache status and its impact on different spheres of activity were assessed according to international 150 millimeters visual analogous scale. The research showed that all patients with tension-type headache had moderate ache syndrome, depression and anxiety of the middle or high rate which were in inverse dependence on serotonin rate in the blood. Intensity of episodic tension-type headache (n=24) was 52 mm according to visual analogous scale, the high rate of anxiety (51,08+/-4,2 scores), moderate rate of depression (12,9 scores according to Bek scale) and tendency of serotonin decreasing in blood (205,72+/-6,74 ng ml) was noted. The research of 76 patients with chronic tension-type headache with cephalgy intensity according to VASH 62 mm the high indicators of reactive (46,81+/-2,68 scores) and personal anxiety, the rate of depression (22,4+/-1,64 according to Bek scale) were associated with the displayed decreasing of serotonin amount in blood (119,38+/-9,42 ng/ml). It was concluded that, tension-type headache and moderate ache syndrome leads to depression decreased self-control of pain and life quality. The quality of serotonin in blood decreases in patients with tension-type headache. The relationship between the intensity of pain syndrome, decrease of work capacity, life quality, and quantity of serotonin in patients with ageing was revealed. It is concluded that serotonin level in blood serum may be considered as pain intensity, degree of depression and index of efficacy of depression treatment. Serotonin is an extremely important neurohormone and its metabolism further study will show new characteristic features of its activity in cerebral neurochemical processes. Scientists thought, that the increased activity caused the psychological disorder, changes in the mood and depression. But the results of the last studies show that the person with the abnormal activity of serotonin does not realize the sense of danger and accordingly the main instinct of self-preservation is broken.

[Anxiety state in patients during postinsult period with old cerebral infarction].

According to ICD-10 International Statistical Classification of Diseases anxiety state is different combination of somatic and mental symptoms of anxiety of absence of real menace that is onset attack-like or permanently. Anxious disorder is observed in 5-10% of the population, twice more often at woman than at men. The lengthening of the postinsult period is observed more often in the structure of the patient with old cerebral infarction that is complicated with anxious disorder. Diagnostics, treatment and prevention of anxious disorder in the postinsult period require elaboration of new approaches by the doctors. It is announced that anxious disorder in the postinsult period at such patient may reach 60-70%. Researches have been held on the basis of the clinic "Medina" in Batumi. The main group consisted of 30 out-patients (14 women and 16 men) between 41 and 73 years old who experienced cerebral infarction of 3-18 months prescription. Patients with pancreatic diabetes and unstable accompanying somatic diseases were excluded. Computer or magnetic - resonant tomography of the brain was performed to all patients during insult in order to verify the diagnosis; the clinical-and-psychological and neurological check up was also performed using neurological scale NIH NINDS in order to identify severity of insult as well as using the scale "Renkin" to assess the degree of impairment of vital functions. Depression was assessed with the help of HDRS (Hamilton depression ration scale). The level and presence of anxiety were determined by the scale that assesses the level of reactive and personal - anxiety. The following initial data were received as a result of research from the patients of the comparing groups before treatment: an average age of patients was 55,1+/-1,9 years; prescription of cerebral infarction was 6,35+/-1,0 months; severity of cerebral infarction on scale NIH NINDS was 2,7+/-0,25 points; invalidation degree on "Renkin" scale was 1,95+/-0,25 points. Personal anxiety was 85,4+/-7,27 points according to self assessment scale, reactive anxiety equaled 86,3+/-7,1 points. Depression evidence in comparing groups turned out to be initially high and equaled 14,5+/-2,1 points. The study revealed cognitive functions according to MMSE at 4 men. Therefore, a long effecting social stress leads to development of depression. Unemployed people working under constant pressure, living in overpopulated areas are the most subject to stress as well as those whose mutual relation with associates are broken and who more often gets in disputed situations. The first condition in treatment of the anxious disorders is detailed knowledge of the patient and his understanding the essence of illness. The necessary information and the elementary receptions of treatment for overcoming anxiety and panic attacks are given by the doctor. Frequently, the relief comes only that the patient realizes that it not illness that is unknown and dangerous to a life, but curable anxious disorder. Whenever possible the doctor will advise a relevant method of psychotherapy which will help to cope with the problems caused by prolonged panic disorder.

[Insomnia, serotonin and depression].

It was the aim of the research to investigate insomnia in healthy volunteers. One hundred healthy volunteers from sixteen to seventy five years old (50 females and 50 males) were investigated. Biochemical aspects of insomnia were determined. Because depression and insomnia are closely linked, correlation between insomnia and depression was studied. The degree of depression was evaluated and means of its prevention was determined. The index of serotonin in blood plasma platelets was determined because the serotoninergic system is involved in the regulation of sleep and wakefulness. Low Serotonin levels are believed to be linked with depression, insomnia; when levels of serotonin are brought up to normal, sleep falls into place. Sleep disturbances was revealed in 85% persons, of which 32%, had difficulties to fall asleep; moderate insomnia was found in 16% persons; severe depression was found in 30% persons. Serotonin index in blood plasma platelets was low in 25% persons, moderate--in 10% persons and high in 65% persons. It is concluded that depression is a main factor of insomnia; treatment includes drug therapy and psychoreabilitation.