[The system stress-limiting action of mexidol in chronic cerebral ischemia].

OBJECTIVE: To clarify the mechanisms of the action of anti-stress antioxidant agent (mexidol) in patients with chronic cerebral ischemia. MATERIAL AND METHODS: Sixty-seven patients with chronic cerebral ischemia (TE stage II),48 women and 19 men, mean age 48.2 years, were examined. To assess the stateof multilevel stress system, the level of anxiety and depression, degree of autonomic imbalance, adaptive reactions of the blood and functional properties of erythrocyte membranes, level of average weight molecules in the blood plasma were studied. Therapeutic complexes consisted of standard therapy (vinpocetine and piracetam) and mexidol (10 ml intravenous drip 200 ml of physiological solution once a day every day for 10 days with subsequent transition to the oral ingestion of the drug (1 tablet (125 mg) 3 times a day for three months). RESULTS AND CONCLUSION: In group 1 treated with additional antioxidant mexidol, the more pronounced and prolonged positive effect on the clinical symptoms of TE was observed. There were the persistent decrease in the level of anxiety and reduction of autonomic imbalancein the main group. The dynamics of adaptive reactions of blood indicated the activation of the adrenal cortex. There was a decrease in the content of average weight molecules and recovery of the sorption capacity of red blood cells. The results indicate the multi-component multi-level stress-limiting effect of mexidol in patients with chronic cerebral ischemia stage II.

[Genetic aspects of migraine].

Migraine is a common disease characterized by severe headache with nausea, vomiting and hypersensitivity to sounds, light, smell. Neurological symptoms during aura period develop in 25% of patients. Genes responsible for migraine development have been identified. The mutations in familial hemiplegic migraine are better investigated. The serotonin system plays a key role in the migraine pathogenesis. It was described the syndrome of migraine-like headache occurring due impaired serotonin metabolism in patients with celiac disease. Celiac disease is a chronic polysyndrome disease, enteropathy. Arteriopathies associated with migraine are cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (syndrome CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL), hereditary systemic angiopathy (HSA), mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS).

[Gluten migraine].

OBJECTIVE: to study the prevalence of migraine among patients with celiac disease (CD) and clinical features of «gluten migraine¼ syndrome and to assess the efficacy of gluten diet in its treatment. MATERIAL AND METHODS: Authors examined 200 CD patients (main group) and 100 patients with reflux esophagitis and without CD (control group). All patients fulfilled the headache diary during three months before the diagnosis of migraine was made and six months during gluten diet. RESULTS AND CONCLUSION: CD group had migraine syndrome four times more often than the control group (48.5%; p<0.001). In CD group migraine attacks were 2.5 times more frequent than in the control group (р=0.004), but the duration of the attacks was less long, 8 hours in average. The migraine attacks measured by the Visual Analog Scale were less intensive, 55% in average, and had a later onset. The attacks were more frequent in CD patients who were older than 50 years old (р<0.05). The attacks disappeared in 25% of patients with migraine syndrome who were on the gluten diet and the reduction in the intensity and/or frequency of attacks was observed in 38% of patients. We revealed the clear association between migraine syndrome and CD and the high efficacy of gluten diet in the treatment of migraine symptoms.

[Polyneuropathy of thin fibers].

Polyneuropathy of thin fibers (PTF) is a disorder with selective damage of Aδ- and C-fibers. Having a skin biopsy the SFN became visible. In the article there are data on the pathogenesis, clinics and diagnostics of the PTF. The skin biopsy, the quantitative sensory testing, the corneal confocal microscopy, nociceptive evoked potentials, the microneurography and the autonomic testing are described in detail. New diagnostic criteria ofthe PTF are given. Main directions in the management of the PTF are the treatment of systemic diseases and the neuropathic pain relief.

[Immunohistochemical examination of skin biopsy specimens with calculation of C fibers in the diagnosis of polyneuropathy].

The paper discusses the anatomy of innervation of the skin, the epidermis and dermis in particular, which are related to pain, the markers of skin nerves and cells. It gives data on the diagnosis of fine unmyelinated fibers, by immunohistochemically examining skin biopsy specimens. The paper also describes the morphometry of skin nerves: intraepidermal nerve fibers, dermal nerve fibers, and autonomic nerve fibers. It discusses whether a skin biopsy specimen may be used to diagnose polyneuropathies of different etiology: diabetic, immune, HIV-related, and hereditary ones.

[An effect of cytoprotective therapy on stress resistance and compensatory abilities of patients with chronic cerebral ischemia].

OBJECTIVE: To study an effect of nonspecific cytoprotective therapy on clinical manifestations, disease course and indicators of stress system in patients with different stages of chronic cerebral ischemia (CCI). MATERIAL AND METHODS: Authors examined 266 patients with CCI, aged from 35 to 55 years. The patients received basic and nonspecific cytoprotective therapy. The dynamics of subjective and objective symptoms of encephalopathy, clinical outcomes after a year of observation, and the state of stress system were analyzed. An effect of therapy on stress was assessed by the dynamics of blood pressure reactions to stress. RESULTS AND CONCLUSION: An open randomized comparative study has shown that the inclusion of the drug with nonspecific cytoprotective actions (cytoflavin) in the therapeutic complex improves the therapeutic effect on the clinical manifestations of CCI. The higher frequency of favorable outcomes over one year of follow-up is associated with the optimization of stress system activity under nonspecific cytoprotective therapy and the increase in stress resistance.

[Ophthalmic manifestations of Huntington's disease].

Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by a mutation in the huntingtin gene. The whole nervous system, including visual analyzer, is involved in the pathogenesis of the disease. Various ocular sings can be found in both preclinical and clinical stages of HD. Specific retinal damage, namely, abnormal proteins formation, photoreceptor degeneration and retinal remodeling, has been studied in animal models. Functional changes in occipital lobe activity and its atrophy as well as degeneration of visual pathways can already be present in the early stages of the disease. Oculomotor symptoms of HD include disturbed visual fixation, slower tracking eye movements and saccades, and suppressed vestibulo-ocular reflex. Visual perceptual disorders, such as visuospatial difficulties, problems of stimulus identification and motion perception, along with decreased contrast sensitivity, have also been described. The possibility of using certain ophthalmic parameters as biomarkers of HD is being discussed.

[The results of Russian multicenter open-label observational study of the efficacy and safety of мelaxen (melatonin) for the treatment of disordered sleep in patients with chronic cerebral ischemia].

The results of the multicenter open-label observational study of the efficacy and safety of the Melaxen (melatonin) for the treatment of disordered sleep in patients with chronic cerebral ischemia are presented. 2062 patients were studied with the use of subjective psychometric scales: subjective sleep characteristics scale, sleep apnea screening questionnaire, Epworth sleepiness scale, hospital anxiety and depression scale. Mean age of patients was 55.7±9.0 years, there were 74.1% females and 25.9% males. Melaxen was given in dosage of 3 mg. before sleep for 24 days. The use of Melaxen leads to the increase of subjective sleep quality by the subjective sleep characteristics scale from 19.7±3.1 points to и 22.7±3.4 points on day 14 and 22.7±3.4 on day 24 (differences are significant at p<0.0001). There was the decrease of the relative number of patients with frequent night awakenings, prolonged sleep latency, short night sleep, poor quality of morning awakening and multiple bothering dreams. Authors conclude that the use of Melaxen in dosage of 3 mg before sleep is effective and safe insomnia treatment in patients with chronic cerebral ischemia.

[Intensive glycemia control in the first day of the acute cerebral blood flow disturbance in patients with diabetes mellitus type 2].

Forty-seven patients with cerebral stroke and diabetes mellitus type 2 were included in the study. To maintain the target values of glycemia on the level 7.8-10.2 mmol/l, patients of the main group received the continuous intravenous infusion of insulin and patients of the control group received frequent (every 3h) subcutaneous injections of insulin during the first 24 h after the acute cerebral blood flow disturbance. The results obtained have shown that continuous intravenous insulin infusion reduces the risk of hypoglycemia, accelerates positive neurologic dynamics, reduces terms of hospitalization and decreases mortality in patients with diabetes mellitus type 2.

[Possibilities of preventive treatment of Alzheimer's disease: results of the 3-year open prospective comparative study on efficacy and safety of the course therapy with cerebrolysin and cavinton in elderly patients with the syndrome of mild cognitive impairment].

The study was conducted in 3 Russian centers (Moscow, St. Petersburg and Nizhniy Novgorod). The total sample included 110 patients whose mental state met the definition of <> (MCI). Patient's status was assessed with widely used scales (MMSE, GDS, CDR etc) and a battery of neuropsychological tests. Genotyping for the APOE polymorphism was performed as well. Patients were stratified into 2 comparable groups in compliance with the specifics of therapy: 55 patients were treated with cerebrolysin and 55 - with cavinton. The superiority of cerebrolysin over cavinton in slowing down of the cognitive deficit progression and delaying the time or transition of patients to the diagnostic category of Alzheimer's disease was demonstrated. Cerebrolysin was particularly effective in MCI patients with the ApoE(+) genotype, i.e. in those with higher risk for Alzheimer's disease. Adverse effects during the treatment were rare in both groups.

Effect of antioxidant therapy on glutathione system of erythrocytes in chronic brain ischemia.

We studied the effect of antioxidant therapy on the state of glutathione system in erythrocytes in patients with stage 1, 2, and 3 circulatory encephalopathy treated with antioxidant cytoflavin against the background of basic therapy (kavinton and pyracetam). It was demonstrated that the response of the erythrocyte glutathione system to antioxidant therapy was quantitatively and qualitatively different at different stages of cerebrovascular failure, which was related to changes in the glutathione system during the development of chronic cerebral ischemia. Endogenous reserve of the antioxidant defense system should be taken into account when prescribing antioxidant therapy; the glutathione system can be a marker of this reserve.

[Tanakan (EGb 761) in the therapy of mild cognitive impairment].

Mild Cognitive Impairment (MCI) means cognitive deterioration not yet causing disability or dementia. Aged patients with MCI constitute a group of high risk for Alzheimer disease and other types of dementia. Currently, there is no generally adopted approach to MCI management but medications with neuroprotective properties are presumed to be the most perspective. Presented are the results of a multicentral open-label clinical trial of vascular and neuroprotective drug tanakan (EGb 761). The study has shown the decrease of cognitive impairment, which was both clinically and statistically significant, in patients at early stages of vascular and neurodegenerative pathological process. Probable efficacy of long-term tanakan treatment in prevention of dementia is discussed.

[The influence of ceruloplasmin on the rat neocortical ultrastructure in circulatory hypoxia].

Diffuse cerebral ischemia and circulatory hypoxia were modeled by carotid arteries occlusion in 40 white Wistar male rats. The changes of microcirculation bed and neurons of the sensomotor cortical area in hypoxia, preventive and therapeutic regimes of ceruloplasmin injections were compared to the neocortex state of intact rats. The changes of the neocortical ultrastructure established by electron microscopy were characteristic of hypoxic lesions described earlier in the literature. As a result of prolonged administration of ceruloplasmin there was a significant decrease of sensomotor neocortical hypostasis and improvement of microcirculation that suggested its neuroprotective properties.

[Efficacy of combined kineso- and psychotherapy in the treatment of patients with migraine]. / Effektivnost' sochetannogo primeneniia kinezoterapii i psikhoterapii v lechenii bol'nykh migren'iu.

The study aimed at determining the efficacy of combined kineso- and psychotherapy in the treatment of patients with migraine in between-attacks periods. Forty-one patients with migraine (3 males, 38 females, mean age 38.2 +/- 1.5 years) were examined. The patients were randomly divided into 2 age-matched groups. No significant between-group differences in the intensity and duration of migraine attacks, autonomic and psychological status and level of tolerability to physical loading were found. The patients of group 1 (23) recurred individual kineso- and psychotherapy, and patients of group 2 (18) received a course of standard physical therapy and explanatory psychotherapy. After the treatment course, a significant decrease in intensity of headaches of tension, increased bicycle exercise tolerance, equalizing of the ratio between activities of ergo- and trophotropic systems, sympathic and parasympathic tones evaluated by mathematical analysis of heart rhythm variability, a decrease of the level of emotional tension measured by psycho diagnostic testing were observed in both groups. In the patients of group 1, global estimation of therapeutic effect (2.7 +/- 0.2) was significantly higher (p < 0.003), comparing to those of group 2 (1.8 +/- 0.2). Two months after treatment finishing, there was a reduction of migraine attacks frequency in both groups without significant between-group differences in regression extent of this index. The results obtained indicate efficacy of combined physical therapy and psychocorrection in the treatment of migraine patients. Moreover, individual approach to kineso- and psychotherapy improves the immediate results of the treatment.