[Clinical epidemiology of multiple sclerosis in Moscow. Сlinical demo-graphic characteristics in population of one region of Moscow]. / Klinicheskaia épidemiologiia rasseiannogo skleroza v Moskve. Sovremennye kliniko-demograficheskie osobennosti na primere populiatsii odnogo iz okrugov goroda.

The changes in clinical features of multiple sclerosis (MS) are noted worldwide which can be explained by diagnosis improvement and DMT implementation. Epidemiological studies of 2008-2012 in the North-West Administrative District of Moscow noted the higher proportion of women among patients of MS (M:F=1:2.61), longer duration of the disease (mean 14.3±10.6 years, maximum - 53 years) and life expectancy of patients (44.3±12.7 years, the maximum age - 77 years). The percentage of patients with secondary progressive course of MS increased (35%). In addition, MS onset before 16 years old was diagnosed more often (5.66% of cases) and late onset MS was identified in 4.04% of the cases. Up to 45.9% of MS patients have moderate and expressed disability (group 1 and 2 disability).

[Clinical epidemiology of multiple sclerosis in Moscow. Descriptive epidemiology in population of one region of Moscow].

The epidemiological study of multiple sclerosis (MS) has been done in the population (927 400 people) of the North-Western Administrative District (SZAO) of Moscow for the period of 2008-2012. In average for the 5 years the prevalence of MS was amounted to 53.38 cases per 100 000 population, incidence was 2.16 cases per 100 000 population and the mortality rate was 0.23 cases per 100 000 population. Thus, the population of SZAO belongs to high-incidence area. An increase in the prevalence of MS as well as a reduction of incidence and mortality were observed during a comparative analysis with the epidemiological indicators of MS in Moscow in the period of 1991-1996. Such dynamics of epidemiological indicators is due to the accumulation of patients in population that, in the first place, is related with the quality improvement of diagnostic and therapeutic-rehabilitative measures which increased the frequency of early diagnosis and patient's life expectancy together with the implementation of disease-modifying therapy (DMT) and modern methods of symptomatic treatment.

[The use of cerepro (choline alfoscerate) in the treatment of outpatients with chronic progressive cerebrovascular disease].

The main aim of the study was the evaluation of the efficacy and drug safety of cerepro (choline alfoscerate) used for treating outpatients with cerebrovascular disease. Ninety patients with cerebrovascular disease, who had motor, coordination, emotional and cognitive disturbances were enrolled in the study. Sixty patients of the group 1 had stroke, 30 patients (group 2) had chronic ischemic brain disease. All patients received basic therapy (antihypertensive, antiaggregant or anticoagulant, cholesterol-lowering drugs). Cerepro was administrated in combined therapy according to the scheme: 1000 mg cerepro (in 200 ml of the 0.9% NaCl solution) once a day intravenously in drops during 10 days; then 1200 mg daily per os during 6 weeks. We assessed the dynamic of neurological symptoms and restoration of lost functions (MMSE, Feeling-activity-mood test, HDRS, GCI). The results indicate the efficacy of cerepro in outpatients with chronic cerebrovascular disease and stroke. It was demonstrated that cerepro led to improvement of coordination neurological symptoms, cognitive and emotional functions, activity and mood in patients of both groups. Clinical effect was higher in patients after stroke. Cerepro was well tolerated.

[Effect of dopamine agonist pramipexole (mirapex) on tremor, affective disorders and quality of life in patients with Parkinson's disease].

The open 6-month study (the MIRAG study) on the effect of D2/D3 dopamine agonist pramipexole (mirapex) on tremor, affective disorders and quality of life in patients with Parkinson's disease (PD) was carried out. Ninety-eight patients, aged from 42 to 75 years (mean age 63.2+/-10.2 years) were included in the study. Scores on the Hoehn and Yahr scale varied from 1 to 4 (mean 2,5+/-0,8). Seventy percent of patients received levodopa in average dose 351.2+/-279.4 mg; 62% of patients had motor fluctuations and 43% had dyskinesias. Pramipexole was titrated to the effective dose (maximum 3 mg/d, mean 2.1 mg/d). In the end of the study, resting tremor was reduced by 54%, postural and kinetic tremor, as assessed with UPDRS and spirography, by 50% and 15%, respectively. The severity of depressive symptoms measured with the Montgomery-Asberg Scale and a modified version of the Geriatric-Depression Scale (GDS-15) was reduced by 56%. Motor fluctuations and dyskinesias were significantly reduced while cognitive functions were not changed. The clinically significant effect reflected in the reduction of motor and non-motor symptoms was observed in 83% of patients, regardless of disease duration, severity of motor deficit, affective and cognitive disorders,. The drug was well tolerated in all patients, including those older than 70 years. Pramipexole improved quality of life in PD patients due to the attenuation of cardinal motor parkinsonian symptoms as well as symptoms, which were relatively resistant to levadopa, e.g. postural and kinetic tremor, and depression. The therapeutic effect remained for at least 6 months.

[Influence of dopamine agonist pramipexole (mirapex) on tremor, cognitive and affective impairment in patients with Parkinson's disease].

The open 3-month study of influence of D2/D3 dopamine agonist pramipexole on of Parkinson's disease (PD) features, which are relatively resistant to traditional dopaminergic therapy: tremor, affective and cognitive impairment, has been conducted. Ninety-eight patients with PD, aged from 42 to 75 years (mean age 63,2+/-10,2 years), have been included in the study. Twenty percents of patients included were older than 70 years. The Hoehn and Yahr stage varied from 1 to 4 (men stage 2,5+/-0,8). Seventy percents of patients received levodopa (mean dosage 351,2+/-279,4 mg); 62% had motor fluctuations and 43% - dyskinesias. Pramipexole was titrated to effective dose (maximum 3 mg/d, mean 2,1 mg/d). The decrease of resting tremor by 50% and postural and kinetic tremor (assessed with the UPDRS and spiralography) by 37% was noticed to the end of 3 month. The severity of depressive symptoms measured with the Montgomery-Asberg scale and a modified version of the Geriatric Depression scale was reduced by one third. The statistically significant decrease of motor fluctuations and dyskinesias, increase of verbal fluency (but not other cognitive functions) were also found. The clinically significant effect of reducing of motor and non-motor symptoms was seen in 86% patients regardless of their age, illness duration, severity of motor deficit and affective and cognitive disturbances. The fair tolerability of the drug was shown including patients older than 70 years.

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.

[The use of the drug ginos in the treatment of out-patients with chronic progressive brain disorders].

Ginos, a derivative of extract Ginkgo Biloba, was administered to 100 patients, aged from 45 to 80 years, mean age 62,3+/-0,7), in dosage 120 mg 3 times daily during 3 months in addition to somatic therapy. A patient's state was assessed before, during and after the treatment using clinical methods and a battery of psychometric scales and neuropsychological tests. A significant improvement of neurological and mental status was found in 90 (90%) of patients that was most distinctly observed in the dynamics of their global state and neurocognitive performance on the MMSE and other tests. The effect of the drug was less pronounced for affective disorders - depression and anxiety. The drug was well-tolerated by patients.

[Phezam efficacy in patients with chronic cerebral ischemic disease].

The efficacy of combined medication which comprised compounds with nootropic (piracetam) and vasoactive (cinnarisin) effects, was studied in patients with cerebral blood flow insufficiency. The main inclusion criterion was a diagnosis of chronic brain ischemia (CI). The study consisted of two stages: (1) a randomized comparative trial in neurological clinic (60 patients) and (2) estimation of the drug efficacy in routine practice (60 patients). The clinical examination was accompanied by neuropsychological tasks, kinetic tests and ultrasound investigation of brain vessels. At the first stage, a positive neurological and neuropsychological dynamics was found after 8 weeks of phezam treatment. Also a statistically significant positive dynamics was observed for a number of blood flow velocity parameters in the middle brain artery. In routine medical practice, a positive effect of phezam was seen after 2 months of the treatment for all but CI main symptoms and confirmed by the data of kinetic investigation. The patients reported good tolerability and convenience of the drug intake (one capsule instead of two tablets of nootropic and vasoactive drugs).

[Use of tremonorm in treatment of Parkinson's disease: outpatient experience of Moscow Municipal Health Care Service]. / Primenenie tremonorma pri bolezni Parkinsona: opyt ambulatornoi nevrologicheskoi sluzhby Moskovskogo gorodskogo zdravookhraneniia.

The efficacy of domestic drug tremonorm (levadopa-carbidopa) for Parkinson's disease (PD) treatment was studied. The treatment was conducted in neurological outpatient departments in several Moscow administrative regions and was administered to 142 PD patients, 15 being assigned to this drug for the first time and 127 being previously treated with other medications containing levadopa/carbidopa. A minimal effective dose (up to 500 mg) was selected for each patient and was not changed during 2 months. For patients previously switched to levadopa, the change for tremonorm has been done during 1 day if the dose of levadopa did not exceed 500 mg, and during 2 months in case a patient received over 500 mg per day. Modified Hoehn&Yahr scale, UPDRS, MMSE, PDQ-39 and other scales were used in complex evaluation of the disease stage. Positive effect of tremonorm was detected for 94 patients (66.2%), all of them continued tremonorm therapy after the end of the study. The most frequent side-effects proved to be dyspeptic symptoms. Tremonorm caused statistically significant positive changes in patient's movement scaled by UPDRS and the QL indexes in all PDQ-39 subscales. Positive changes in movement activity were accompanied by decrease of bradykinesia, tremor, better walking, writing and every day activity of PD patients. A change of nacom for tremonorm did not result in significant alteration of symptoms and Quality of Life indexes that suggest similar influence of these drugs on PD symptomatology. At the same time, a substantially lower price of tremonorm allows reducing of treatment costs.

[Dopamine receptor agonists in treatment of outpatient patients with Parkinson's disease]. / Opyt ispol'zovaniia agonistov dofaminovykh retseptorov v ambulatornom lechenii bolezni Parkinsona.

The paper summarized an experience of pronoran (piribedil) treatment of 516 patients with Parkinson's disease (primary parkinsonism) conducted in the district outpatient clinics of 7 Moscow administrative areas. In 84 cases, the medication was used as a monotherapy and in 432--in combination with levodopa-contained drug madopar. An improvement of patient's state, with reducing of bradikinesia, tremor and rigidity, was achieved in 73.0 +/- 20.4% of the patients. Combined therapy allowed decreasing of madopar dosage in 58.5 +/- 16.7% of the patients. Pronoran (piribedil) is well tolerated. The authors recommend it for the treatment of outpatients with Parkinson's disease.