[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.

[Results of a study of velaxin (venlafaxine) efficacy in patients with subacute and chronic spondylogenic dorsalgia].

An open comparative study of efficacy and tolerability of velaxin (venlafaxine with prolonged action), which has been prescribed in a single dosage of 75 mg daily during 8 weeks, included 47 patients with subacute and chronic spondylogenic dorsopathy (SD). Degree of pain chronisation and its intensity (The Visual Analogous Scale - VAS and the Verbal Pain Scale - VPS) and levels of daily activity restriction (the modified Pain Disability Questionnaire - PDQ), anxiety and depression were measured. The comparison group consisted of 32 patients with SD matched for clinical characteristics with the main group, who did not receive antidepressants and antiepileptics in the complex treatment of pain syndrome. Scores of VAS, VPS and PDQ in the main group were 69+/-2.9; 2.8+/-0.1 and 44.2+/-3.2 respectively, at baseline; 38.8+/-3.3 (p<0.01); 1.6+/-0.2 (p<0.01) and 26.2+/-2.5 (p<0.01) after 4 weeks and 15.8+/-2.5 (p<0.05); 0.6+/-0.1 (p<0.05) and 11.2+/-1.6 (p<0.01) to the end of treatment. To the 8th week, scores on VAS, VPS and PDQ were significantly low in the main group compared to the controls (p<0.5) and the intensity of pain was reduced by 50% in 40 (85%) patients. No serious side-effects were observed.

[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.

[The use of katadolon in patients with spondylogenic dorsalgia].

The open non-comparative study of the efficacy of katadolon (100 mg 3 times daily during 2 weeks) in 90 out-patients with spondylogenic dorsalgia has been carried out. A good effect, i.e. the complete relief of the pain syndrome, rehabilitation of the ability to self-service and regress of neurological symptoms, was observed in 59 (65.6%) patients, a satisfactory effect, i.e. the complete relief of the pain syndrome with elements of restricted daily activity and symptoms of radiculopathy-- in 24 (26.7%) patients and a moderate effect, i.e. the presence of the residual pain syndrome, restricted daily activity and symptoms of radiculopathy,--in 7 (7.8%) patients. After the therapy, the intensity of the pain syndrome decreased by 4 times, from 69.7 +/- 4.3 to 17.6 +/- 0.11 according to the numerical scale of pain (p < 0.01), and by 2.5 times, from 2.51 +/- 0.27 to 1.04 +/- 0.09 (p < 0.0001), according to the verbal scale of pain. At the same time, the ability to self-service increased by 3 times on the daily living scale (2.6 +/- 0.28; p < 0.0001). At the end of the treatment, the intensity of the pain syndrome was associated with illness duration (r = 0.538; p < 0.01) and the presence of the root pain syndrome (r = 0.266; p < 0.03). The drug was well-tolerable and caused minimal side-effects.

[The influence of hormones of stress-promoting system on the course of acute ischemic stroke]. / Vliianie gormonov stressrealizuiushchei sistemy na techenie ostrogo perioda ishemicheskogo insul'ta.

Experimental and clinical studies have proved an important role of the reaction of a stress-realizing endocrine system for both a course and an outcome of acute somatic diseases. That is why plasma concentrations of thyroxine (T4), triiodo-thyronine (T3), thyrotropic (TTH) and adrenocorticotropic (ACTH) hormones as well as of renin were measured during the 1-st week of acute ischemic stroke (AIS) in relevant patients for determination of their prognostic significance. 16 patients with hemispheric AIS were examined. A complex clinical biochemical investigation performed in patients with acute disorders of cerebral circulation revealed the presence of the "low T3 syndrome" accompanied by an increase of blood plasma levels of T4 by the 7-th day of the disease as well as an increase of the concentrations of TTH, ACTH and renin on the 2-nd day of the stroke. That reflected the severity of cerebral ischemia. Close correlation observed between the degree of normalization of hormonal concentrations and manifestations of neurologic disorders' regression by the 7-th and the 21-st days gave a good ground to consider these indices as a prognostic criterion for determination of an outcome of the acute period of ischemic stroke.

[Investigation of mechanisms of neuro-protective effect of semax in acute period of ischemic stroke]. / Izuchenie mekhanizmov neiroprotektivnogo deistviia semaksa v ostrom periode ishemicheskogo insul'ta.

Semax is the first domestic nootropic drug of an unexhausted type from the group of neuropeptides. In experimental studies it showed angioprotective, antihypoxic and neurotrophic activity in the doses 100-150 micrograms/kg. A combined clinical-electrophysiologic study revealed its high efficiency in acute ischemic stroke. A clinical trial was performed of immunobiochemical mechanisms of neuroprotective properties of Semax in acute period of ischemic stroke. A retrospective comparative clinicoimmunobiochemical analysis provided objective data on the molecular level on activating influence of Semax on antiinflammatory postischemic reactions in the brain. Shifting neuromediatory balance toward a prevalence of the antiinflammatory agents (interleukin-10, tumor necrosis factor-alpha) over the factors maintaining the inflammation (interleukin-8, C-reactive protein).

[Clinico-immunobiochemical monitoring of factors of focal inflammation in the acute period of hemispheric ischemic stroke]. / Kliniko-immunobiokhimicheskii monitoring faktorov lokal'nogo vospaleniia v ostrom periode polusharnogo ishemicheskogo insul'ta.

The changes of cytokinis status and C-reactive protein were evaluated in cerebrospinal fluid of 50 patients in the acute period of ischemic hemispheric stroke with consideration of influence of the remote consequences of the ischemia, established experimentally, on the mechanisms of cerebral infarction development as well as on the progression of both atherogenesis and vascular encephalopathy in the period after the stroke. Significance both of a surplus releasing of the proinflammatory cytokines and deficiency of the protective antiinflammatory and trophotropic factors in the development of an inflammatory response was established. Immunobiochemical criteria were proposed for grading of process for stroke course prediction and for recovery of the altered neurologic functions. More favourable prognosis was anticipated in the patients in which a the treatment started within of the "therapeutic window".

[Effectiveness of semax in acute period of hemispheric ischemic stroke (a clinical and electrophysiological study)]. / Effektivnost' semaksa v ostrom periode polusharnogo ishemicheskogo insul'ta (klinicheskoe i élektrofiziologicheskoe issledovanie).

Efficiency of Semax (synthetic derivative of ACTH-4-10) was studied in 30 patients in acute period of hemispherical ischemic stroke. Control group consisted of 80 patients with the strokes analogous in severity and location of the damages and which were treated by conventional therapy. Different clinical rating scales were used for both objectivization of the severity of the patients' state and estimation of the degree of neurological defect. The control of Semax influence on the functional state of the brain included monitoring of EEG with mapping, repeated analysis of somatosensory evoked potentials and their mapping. It was established that including of Semax in combined intensive therapy of acute ischemic stroke had some influence on the rate of restoration of the damaged neurological functions in terms of increasing the regress of general cerebral and focal, especially motor disorders. The most effective daily doses were 12 mg for patients with strokes of moderate severity and 18 mg for patients with severe strokes (treatment course--5 and 10 days).