[Assessment of the safety and clinical efficacy of the Brainmax in therapy of non-demented patients with a mild cognitive impairment]. / Otsenka klinicheskoi effektivnosti i bezopasnosti preparata Breinmaks v terapii patsientov s nedementnymi kognitivnymi narusheniyami.

OBJECTIVE: The assessment of the clinical efficiency and safety of the drug Brainmax and its influence on the degree of functional recovery in the treatment of patients with non-dementia cognitive disorders with this drug. MATERIAL AND METHODS: An open multicenter randomized study included 60 patients of 18-55 years with light and moderate CI, having complaints of the cognitive spectrum. They used a clinical and neurological study using generally accepted scales and tests (MoCA, MMSE, MFI-20 tests, Schulta, DSST tests and an assessment of the quality of life of SF-36). Patients were randomized in two groups comparable by age and gender. Group 1 was treated with Brainmax per os twice every day for 14 days. After 10-days rest they received same medication for another 14 days. Group 2 was treated with Brainmax per os twice every day for 14 days, without the continuation. The total duration of the study was 40 days, the assessment of their condition was carried out on the 1st day (visit 1), after 15 days (visit 2) and after 40 days (visit 3) using the indicators of the above scales and tests in comparison with the background data. Safety assessment was carried out by the presence and structure of undesirable phenomena. RESULTS: The use of Brainmax led to a significant improvement in cognitive performance according to all generally accepted scales and tests (concentration and maintaining of attention, working memory, visual-constructive skills, volume and speed of attention speed, information processing and executive functions), as well as to the decrease severity of asthenia and improvement of the quality of life. CONCLUSION: Brainmax has shown a good safety profile, tolerability and clinical efficacy in the treatment of young and middle-aged patients with non-demented cognitive impairment. Significant improvement was observed both with single and double course administration of the drug, but a significantly better effect was noted after its repeated course, which reflects, among other things, the cumulative effect of the active substances of this drug and makes longer use of the drug Brainmax justified and appropriate in these categories of patients. The data obtained allow us to recommend the wider use of the drug Brainmax in clinical practice for the treatment of CI in patients of different ages, which will optimize therapy and improve the course and outcome of the disease.

[FIRES Syndrome in a Preschool Child]. / Sindrom FIRES u doshkol'nika.

Severe epileptic syndromes of childhood are an urgent problem for pediatric neurologists and neuroresuscitators. The article presents a clinical observation of FIRES syndrome in a pediatric patient, which is a form of severe drug-resistant epilepsy in children of preschool and school age, the development of which is caused by hyperthermia, probably associated with herpesvirus (human herpesvirus type 6) infection. The features of the progressive course and the difficulties of diagnostic search are reflected. An empirical approach to etiotropic therapy is described, since the disease manifested itself with respiratory manifestations and fever. The tactic of pathogenetic treatment is described, in which drugs of polyfunctional action, such as Cytoflavin, have a priority, many years of experience in the use of which allows the authors to recommend it as a starting intensive therapy.

[The effectiveness of cytoflavin in complex therapy of patients with the coronavirus infection COVID-19]. / Effektivnost' primeneniya Tsitoflavina v kompleksnoi terapii patsientov s COVID-19.

OBJECTIVE: To study therapy, including a sequential course of the drug Cytoflavin, on the dynamics of neurological and general status in patients with new coronavirus infection COVID-19. MATERIAL AND METHODS: 47 patients with a new coronavirus infection COVID-19, admitted to the hospital and having a state of moderate severity, according to the criteria of the Interim Guidelines of the Ministry of Health of the Russia for the prevention, diagnosis and treatment of a new coronavirus infection (COVID-19, version 9 of 10.26.2020). Clinical and neurological research, laboratory and instrumental examination methods were used before and after the course of therapy. RESULTS: When a sequential Cytoflavin regimen is used in patients with COVID-19 infection, along with standard therapy, a significant improvement in neurological and general status is observed, as well as a significant positive dynamics in the results of laboratory and instrumental research methods (markers of a systemic inflammatory response, hemostasis and oxygenation disorders), which indicates on the influence of the significant effect of Cytoflavin on the processes of inflammation and hypercoagulability in COVID-19 infection. CONCLUSION: The use of the drug Cytoflavin in the complex therapy of patients with COVID-19 infection is pathogenetically justified and expedient. The data obtained make it possible to recommend the inclusion of Cytoflavin in the treatment protocols for patients with COVID-19 coronavirus infection to optimize therapy and improve the course and outcome of the disease, as well as a longer use of Cytoflavin and repeated courses of its use in patients with COVID-19 infection.

[Problems of differential diagnosis of acute symptomatic infectious seizures and epilepsy in children]. / Problemy differentsial'noi diagnostiki simptomaticheskikh pristupov pri ostroi infektsii i epilepsii u detei.

Viral encephalitis, its complications and the newly diagnosed epilepsy in children require a complex approach to the differential diagnosis using laboratory and instrumental examinations. Possibilities of MRI in the differential diagnosis of seizures in children and in detection of ischemic-hypoxic and metabolic disorders in the suspected epileptic focus are demonstrated in the clinical observation.

[Neuroimaging for the diagnosis of dementia.]

Development of laboratory diagnosis and neuroimaging revealed some biomarkers for in vivo diagnosis of the most common forms of dementia (Alzheimer's disease, Lewy body dementia and vascular dementia) for their differential diagnosis. Structural changes found using magnetic resonance imaging (MRI) are significant for the prognosis of the cognitive decline. Cerebral microbleeds are an available adjuvant diagnostic marker, which increases the diagnostic value of leukoaraiosis that suggests the development of cerebral amyloid angiopathy or hypertensive microangiopathy, especially in cases of mixed causes of dementia and severe cognitive deficits. We describe our own clinical case and the results of digital voxel hippocampometry as an example of effective usage of neuroimaging for the differential diagnosis of dementia.

[Age dynamic of the motor evoked potential from the tongue in healthy persons.]

Our aim was to determine parameters of motor evoked potential (MEP), elicited by the transcranial magnetic stimulation (TMS) from the tongue in healthy persons of different age. 62 neurologically healthy individuals without any speech problems (age range from 2 years old to 75 years, 34 females & 28 males) were enrolled. All underwent diagnostic TMS, single-pulse protocol, 90-sm round coil, Neiro-MS-D device. Coil was placed on Fz point, registration was performed by the surface electrode on the middle line of the tongue. Results. MEPs were of different appearance, but were registered in all cases, its average latency was 7,14±0,63 ms, average amplitude - 1,79±1,09 mV. There were no gender differences. Significant age difference (p<0,001) was registered between children (age 2-17 years) and two older groups (18-55 and 56-75 years) both on latency and on amplitude. MEPs latency was in three age groups, respectively, 6,21±0,45; 7,05±0,76, and 7,27±0,64 ms. MEPs amplitudes were 0,81±0,61; 1,88±1,01 and 1,69±0,92 mV, respectively. In healthy people aged 2-75 years MEP from the tongue may be registered in 100% of the cases; its average latency is 7,14±0,63 ms, average amplitude - 1,79±1,09 mV; there are no significant gender differences, but significant age differences. TMS of the tongue according to this protocol is relatively simple, not time-and efforts-consuming & may be widely implemented in clinical neurophysiology. There are significant differences on MEPs latencies and amplitudes in healthy persons, which may reflect age-related changes - lengthening of the cortico-lingual pathways and tongue muscle maturing in the childhood and then fibrous tissue development and other changes in nervous tissue and tongue muscle, developing with age.

[Transcranial magnetic stimulation in the diagnostic and treatment of pain syndromes in children and adults]. / Transkranial'naia magnitnaia stimuliatsiia v diagnostike i terapii bolevykh sindromov u detei i vzroslykh.

The authors review the literature and own data concerning therapeutic use of transcranial magnetic stimulation (TMS) in children and adult patients with pain syndromes of different origins. TMS may act as a tool to excite or inhibit neuroplasticity in the central nervous system, which depends of the therapeutic regime used. TMS induces neurogenesis and synaptogenesis, rhythmic TMS may cause long-lasting after-effects, including pain inhibitory effect. A decrease in the threshold and an increase in the amplitude of motor evoked potentials in TMS are the most frequent changes in pain syndromes in the diagnostic modality. The efficacy of different regimes in the treatment of pain syndromes remains understudied. Despite vast knowledge on clinical use of TMS in pain syndromes in adults, in pediatrics its use is limited to migraine treatment. TMS is a valuable diagnostic and therapeutic tool that should be more often implemented in neurorehabilitation and treatment of neurological diseases in adults and children with pain syndromes.

[Age-related changes of peripheral nerve system and muscles of the limbs in healthy persons].

Our aim was to present and analyze age-related changes of peripheral nerves and muscles of limbs on a huge population of healthy persons of different ages. Persons aged from 2 months to 87 years were studied by conduction studies (EMG) during the period 2009-2016 years in Scientific Research Institute of Children's Infection. Data of those 1 121confirmed healthy was included in our study. Conduction along n. Medianus, n. Ulnaris, n. Musculocutaneus, n. Axillaris, n. Facialis, n. Tibialis, n. Peroneus et n. Femoralis was registered, with latency and amplitude of compound muscle action potential (CMAP) being analyzed. There were significant differences on latencies and amplitudes of CMAPs between different age groups. Significant lengthening of CMAP latency was registered in older age groups. We marked CMAP amplitude increase from the early childhood until adolescence and later it dropped in persons aged 55 years old and older. These changes may reflect, concerning latency, the lengthening of the peripheral nerves in the age 0-25 years, and later on age-related slowing of conduction starting from 55 years. Amplitude of CMAP may rise with the growing of muscles and drop in later life with age-related muscle atrophy and fibrous changes.

[Age-related changes of sensory peripheral nerve system in healthy subjects.]

Our aim was to present and evaluate age-related changes of peripheral nerves of limbs on a huge population of healthy subjects of different ages. In 2009-2016 subjects aged from 1months to 90 years were studied by nerve conduction velocity studies (NCV). Data of those confirmed healthy was included in our study. In total there were 372 healthy subjects. NCV for nn. Medianus et Ulnaris was registered, with NCV and amplitude of compound sensory action potential (CSAP) being analyzed. There were significant differences on both these parameters between different age groups. Since the childhood the improvement of conduction (which was reflected in rising of CSAP amplitudes and NCV quickening) was registered; from 40-50 years steady decline of both these parameters were observed in both nerves. Conduction studies of peripheral nerves may be implemented in gerontology for early detection of neurophysiology patterns reflecting physiological aging. Also our results may be implemented for accelerated aging detection.

[Neurosonography of the facial nerve in children with idiopathic neuropathy of facial nerve]. / Neirosonografiia litsevogo nerva u detei s idiopaticheskoi neiropatiei.

AIM: To find the correlation between neurophysiological and neurosonographic (NSG) parameters of the facial nerve of children with idiopathic neuropathy of the facial nerve (NLN) in the acute period with good and poor prognosis of recovery of facial nerve function. MATERIAL AND METHODS: Sixty-five children with NLN (mean age 11.5±4.9 years) and 57 children of control group (mean age 12.5±5.2 years) were examined. All children with NLN were studied using NSG with the measurement of the diameter of the facial nerve in the area of processus stylomastoideus and in the parotid gland. Stimulation electroneuromyography of the facial nerve with the registration of the M-response from the m. orbicularis oculi and evaluation of the degree of paresis of facial muscles using the 6-point House-Brackmann scale on the 10-15 day were performed. On the 30th day after manifestation of paresis, children with NLN were divided into two groups: the good recovery group 1 (n=54) and the poor prognosis recovery group (n=11). Correlation between NSG and electroneuromyography indicators with good and poor prognosis of recovery of facial nerve function was analyzed. RESULTS AND CONCLUSION: Based on the results obtained, 85% sensitivity and 77% specificity of measuring the diameter of the facial nerve using NSG in predicting poor prognosis of recovery of facial nerve function was shown. Normative and thresholds NSG parameters of the facial nerve in children were obtained.

[The role of the neurophysiological methods in the assessment of the effectiveness of the rehabilitation of sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level].

AIM: The objective of the present study was the evaluation and comparison of the effectiveness of the differential approaches to the neurorehabilitation of the somatosensory disturbances in the patients presenting with the spinal cord lesions. MATERIALS AND METHODS: A total of 68 patients with spinal cord lesions were enrolled in the study, including 38 suffering from vascular myelopathy, 18 with the consequences of extramedullar meningioma surgery, 12 with the sequelae of acute transverse myelitis. The control groups was comprised of were 55 subjects. All the participants of the study underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, kinesiotherapy, physical therapy, ergotherapy, massage, etc. Transcranial magnetic stimulation (TMS) and evaluation of somatosensory evoked potentials (SSEP) were carried out before and after the therapy. RESULTS: In those patients who received personalized therapy, significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Moreover, the patients who had undergone personalized therapy exhibited better clinical results than in the absence of such treatment. CONCLUSION: The results of the study gave evidence that neurorehabilitation had produced the more pronounced beneficial influence as regards the correction of motor disturbances even though the disturbances of the somatosensory functions proved to be more resistant to therapy. The data obtained suggest that taking into consideration the afferent deficit has to be mandatory for the purpose of planning the neurorehabilitative treatment of the patients suffering from sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level. TMS and SSEP have to be utilized as the tools for the objective evaluation of the effectiveness of the neurorehabilitation process in such patients.

[Ultrasonography in evaluating the character of lesions of the median nerve in carpal tunnel syndrome]. / Ul'trazvukovoe issledovanie kharaktera porazheniya sredinnogo nerva pri sindrome zapyastnogo kanala.

AIM: To correlate the cross-sectional area of the median nerve proximal and distal to carpal tunnel and the character of nerve lesion - axonotmesis and neurapraxiain in carpal tunnel syndrome. MATERIAL AND METHODS: Twenty-six hands with carpal tunnel syndrome and 30 hands of controls were examined. In all cases, median nerve cross-sectional areas were measured using ultrasonography and electromyography. The diagnosis and categorization of carpal tunnel syndrome were based on electrophysiological criteria. In all patients with confirmed carpal tunnel syndrome, needle electromyography of m. abductor pollicis brevis was used. Patients with carpal tunnel syndrome were divided into two groups according to the type of lesion of the median nerve - axonotmesis or neurapraxia. Correlation of ultrasound parameters with the character of the nerve lesion was evaluated. RESULTS AND CONCLUSION: Sensitivity and specificity of measurements of cross-sectional area of the median nerve after tunnel in the diagnosis of carpal tunnel nerve lesion by axonotmesis type were estimated as 89% and 85%, respectively. Thresholds of cross-sectional area with respect to the character of lesions of the median nerve were established.

Diagnostic transcranial magnetic stimulation as a prognostic tool in children with acute transverse myelitis.

STUDY DESIGN: We performed transcranial magnetic stimulation (TMS) in children with sequelae of acute transverse myelitis. Single-pulse TMS protocol was implemented. Twenty controls and 24 patients with myelitis were enrolled. TMS was performed on 12-24 day after the onset of the first symptoms, average on 16th day. OBJECTIVES: The objective of our study was to evaluate motor pathways in children with viral myelitis using the TMS technique. SETTING: All investigations were performed in Scientific Research Institute for Children's Infections, Russia. RESULTS: There were statistically significant differences between the groups on central motor conduction time and motor evoked potential (MEPs) amplitudes. MEP thresholds were elevated, and MEP shape was abnormal in 96% of patients with myelitis (n=23). Three neurophysiologic patterns were observed: the presence of both cortical and spinal MEP, the absence of cortical MEP with the spinal MEP present and the total absence of both cortical and spinal MEP. Last finding was associated with paraplegia, resistant to any sort of treatment. CONCLUSION: Thus, myelitis in 96% of the cases causes neurophysiologic changes, which may be detected by TMS; the method may be used as a predicting tool.

Diagnostic transcranial magnetic stimulation as a method of objective evaluation of motor pathways in patients with neoplastic and infectious brain damage.

The aim of our study was to evaluate validity of transcranial magnetic stimulation as evaluation tool of motor pathways condition dynamics in patients with gliomas and meningitis. There were included 91 patients: 40 children with aseptic meningitis, 26 matching age controls, 10 adults with gliomas and 16 matching controls. All patients underwent transcranial magnetic stimulation (TMS) before and after the treatment. TMS showed good tolerability in all groups. Significant improvement of central motor pathways conductivity (MEPs amplitudes) was seen in both groups. In meningitis group significant rising of functional state of motoneurons was seen as well. We propose that TMS proved to be effective evaluation tool of motor pathways condition dynamic in patients with gliomas and meningitis.

[Ischemic resistance of motor axons in children with viral meningitis and Guillain-Barré syndrome].

The effect of temporal local ischemia at the forearm on ulnar motor nerve conduction velocity in the control (n = 26 children), group of patients with acute period viral meningitis (VM) (n = 16 children), 14 days after the clinical manifestation of VM (n = 11 children) and children with Guillain-Barre syndrome (GBS) in catamnesis (n = 11 children) was evaluated. Less pronounced reactivity of neural conduction on ischemia for 10 minutes (by 50%, p < 0.00001), was seen in children with GBS in catamnesis, comparing to the controls. In the acute period VM also less pronounced reactivity of neural conduction by 29%, than in the controls, was registered. We propose, that ischemic resistance in immune-mediated neuropathy and in the acute period of infection may happen due to cytokine-mediated channelopathy.

[Diseases of "operating hand" in hypermarket checkout counter workers].

The authors evaluated peripheral neuropathy in 34 female workers of hypermarket checkout counter, via neurologic examination and electric neuromyography. Average length of service in checkout counter was 4 years, maximal one--8 years. All the examinees demonstrated slower peripheral nerve impulse conductivity. 22% of the examinees presented significantly lower nerve impulse conductivity. Right median neuropathy was diagnosed in 47% of the examinees, left one--in 38% of the cases, and ulnar neuropathy--in 24% of the cases. Possibility is that work conditions at major hypermarket checkout counters require improvement.

[Objective evaluation of rehabilitation efficiency in patients with upper limbs occupational vegetosensory polyneuropathy].

Clinical and neurophysiologic study covered efficiency of rehabilitation in 40 patients with upper limbs occupational vegetative-sensory polyneuropathy. Each patient underwent infrared thermography and electroneuromyography of hands before and after the treatment. Findings are that post-treatment nerve impulse velocity in right median nerve has improved considerably, thermovisual pictures of both upper limbs also have reliably improved. Electroneuromyography and infrared thermography for evaluation of rehabilitation efficiency are justified. Applied rehabilitation protocol was clinically effective, reliable improvement in the patients state was registered.

[Infrared thermography and electroneuromyography in occupational polyneuropathy diagnosis].

We have evaluated diagnostic value of the combination of infrared thermography and electromyography in professional polyneuropathy diagnosis. 20 patients with working-hand syndrome and 5 controls were enrolled. In 18 cases (90%) both methods were sensitive: on EMG CNV slowing and amplitudes drop were seen, as well as M-response shape changes, and thermography have detected focal hypothermia in hands in some cases and appearance of obscure hypothermia in others. Thus, both methods demonstrated good sensitivity. We recommend using thermography as a screening test and EMG as a following investigation.

[Preliminary experience with assessing the motor pathways and central inhibition in patients with malignant cerebral gliomas in preparation for conformal radiotherapy].

We investigated central motor pathways and central inhibition in patients with brain gliomas by transcranial magnetic stimulation (TMS). 10 glioma patients and 16 matching controls were enrolled. Central motor conduction time, MEP latencies and amplitudes and silent period were evaluated. In 90% glioma patients TMS parameters were abnormal, mostly MEP shapes and thresholds were affected. In 40% of the cases central inhibition in glioma affected hemisphere was abnormally high. We propose that TMS is safe and informative tool in glioma patients; central inhibition seems to be affected in some cases by the glioma presence in the hemisphere. One of the possible causes of that may be GABA system activation.