[Tardue scales in the diagnostic of spasticity]. / Shkala Tard'e v diagnostike spastichnosti.

Diagnosis, treatment and rehabilitation of patients with spasticity remain a challenge, in which standard methodological approaches have not yet been developed. One of the most promising solutions to this problem is the use of the Modified Tardieu scale (MTS). The article describes the method of working with MTS tested in the examination, treatment and rehabilitation of patients with acute cerebrovascular accident (n=112) and patients with multiple sclerosis (n=17). The original version of MTS has been translated into Russian. The use of MTS assessment system allows the diagnosis of the main elements of the clinical picture of the damage to the central nervous system, such as paresis, spasticity, violation of proprioception, as well as the qualitative and quantitative assessment of the dynamics of rehabilitation and treatment of spasticity with botulinum neurotoxin (BoNT).

[Manual differential diagnosis of migraine and cervicogenic headache]. / Manual'naia differentsial'naia diagnostika migreni i tservikogennoi golovnoi boli.

AIM: To study the informative nature of manual therapy for differential diagnosis of migraine and cervicogenic headache (CH). MATERIAL AND METHODS: The authors analyze two clinical cases of patients with a previously established diagnosis of migraine, with the duration of the disease of over ten years and neuroimaging signs of degenerative-dystrophic changes in the upper cervical spine. In both cases, there was no hereditary history and low efficacy of the previous drug therapy was noted. The informative value of the tests performed by methods of manual medicine followed by manipulation procedures of neck structures for the differential diagnosis of migraine and CH was assessed. RESULTS: Despite the absence of complaints, both patients demonstrated the limitation of the volume of neck movements during the tests performed by methods of manual medicine. After a course of manipulation procedures, headaches in both patients were completely stopped for a period of six to ten months. The analysis of literature suggests that manipulative effects on neck structures in cases of migraine can reduce the intensity and the duration of pain, and the frequency of attacks by no more than 20%. The therapeutic effectiveness of manual therapy for CH is much higher; this method provides an opportunity to reduce the severity of these pain characteristics by 30-80%. These results are the basis for changing the previously established diagnosis to CH. CONCLUSION: The complex of diagnostic and therapeutic techniques of manual therapy is an important tool for the differential diagnosis of migraine and CH.

[Combination of central and peripheral muscle relaxants in the treatment of post-stroke spasticity]. / Kombinatsiia miorelaksantov tsentral'nogo i perifericheskogo deistviia v lechenii postinsul'tnoi spastichnosti.

AIM: To study the electromiographic (EMG) parameters and to evaluate the therapeutic efficacy of a combination of central (baclofen, baclosan) and peripheral (incobotulotoxinA, xeomin) muscle relaxants in the treatment of post-stroke spasticity (PSS). MATERIAL AND METHODS: Ninety-six patients with PSS of upper and lower limbs were divided into 2 groups: the first group (n=56) was treated with xeomin and the second (n=40) received combined therapy of xeomin and baclofen. Xeomin was administered according to the pattern of spasticity. The total dosage reached 800 U. Baclofen was used orally in a dose of 10 mg 3 times a day. The scales of paresis and spasticity assessment (MRCS, MAS and Tardieu), activity and participation of patients in everyday life (Bartel, Rankin, Rivermead mobility Index, comfortable walking test, LASIS) were used. EMG and transcranial magnetic stimulation (TMS) were performed. M-response, H-reflex, F-wave, central conduction time were determined. The total duration of the study was 120 days. Patients were assessed at 4 points. RESULTS AND CONCLUSION: Potentiation of peripheral and central muscle relaxants and prolongation of the effect of xeomin was revealed (it was expressed in the reduction of the number of injection sessions from 7-8 to 5-6). The use of xeomin in a total dosage of up to 800 U has shown its efficacy and safety for the treatment of spasticity of the upper and lower limbs. The results of EMG and TMS shed a light on the mechanisms of the therapeutic effect of combined (xeomin+baclosan) and monotherapy (xeomin) spasticity.

[Spasticity: from pathophysiology to treatment]. / Spastichnost': ot patofiziologii k lecheniiu.

The article presents modern views on the pathophysiology of spasticity, which is a frequent disabling consequence to the upper motor neuron (UMN) damage. Morphological and functional system of motion organization and the changes after the UMN damage is considered. The authors analyze existing definitions of spasticity. Stages of spasticity development are described in the context of neuroplasticity as well as in the framework of pathogenesis and sanogenesis. Existing ideas of its pathogenesis are compared with the typical clinical symptoms. The occurring pathological processes in muscles, tendons and joints that can aggravate the development of spasticity and complicate the diagnosis are considered. In addition, the main pathological spasticity patterns are described and the current development of diagnostic techniques is estimated. A review of main methods of spasticity treatment is presented. Special attention is paid to the botulinum neurotoxin type A (BoNT) preparations and central action muscle relaxants. The pathophysiological basement for complex treatment of spasticity as a part of the general rehabilitation process is given, so that the BoNT can be considered as the obligatory element of standard rehabilitation programs.

[Scales and tests in the rehabilitation and treatment of patients with spasticity of the lower limbs]. / Shkaly i testy dlia otsenki éffektivnosti lechebno-reabilitatsionnykh meropriiatii u patsientov so spastichnost'iu nizhnei konechnosti.

The problem-oriented approach in the rehabilitation of patients with spasticity requires careful assessment of the situation in the concept of The International Classification of Functioning, Disability and Health (ICF): impairment of the structure, functions and limitation of activity in specific environmental factors. Standardized tools in the assessment of muscle tone allow to get objective data about motor function. The use of the Modified Ashworth scale (MAS) and the Tardieu Scale are discussed. The standardized assessment of independent mobility is an important issue in outcome measuring. The ultimate goal of intervention, including the use of botulinum toxin therapy in the case of spasticity, is to support patient's daily activities. The article presents scales and tests for assessment of mobility: The Hauser Test, the Rivermead Mobility Index and functional assessment walking tests. The authors describe a clinical case of lower limb spasticity treatment with abobotulinumtoxin A and its assessment with these scales.

[Efim Anatolyevich Dyskin - the hero of the Defence of Moscow (To the 75th anniversary of the Battle of Moscow 1941-1942)].

Efim Anatolyevich Dyskin - the hero of the Defence of Moscow (To the 75th anniversary of the Battle of Moscow 1941-1942). Efim Dyskin - one of the first artilleryman, who awarded the title of Hero of the Soviet Union for a feat accomplished in the Battle of Moscow. After the war he finished the Military Medical Academy and later became a prominent domestic scientist - anatomist and morphologist, head of the general anatomy department, teacher of high school, Major General of the Medical Service. He created a scientific morphological school that developed guidelines for the features of the morphology of the different species of a gunshot wound and the impact of extreme factors of the military working on the body brow-century. Under the leadership of E.A.Dyskin conducted research on. the status of collateral circulation, functional anatomy of the digestive system, craniology, histoty of military medicine and the Military Medical Academy.