[Compression of nerves and senses: ipidacrine as the light at the end of the tunnel]. / Kompressiya nervov i chuvstv: ipidakrin kak svet v kontse tunnelya.

OBJECTIVE: To evaluate the efficacy of the AChE inhibitor ipidacrine when added to traditional therapy in outpatients with tunnel syndromes (TS) based on clinical, neurophysiological and psycho-emotional indicators. MATERIAL AND METHODS: Ninety-two patients with a verified diagnosis of TS were randomized into a main group (MG), in which ipidacrine was added to the therapy (n=50), and a control group (CG), which received conventional therapy (n=42). Clinical neurological examination, provocative (Tinel, Falen, Goldberg finger compression, elevator and tourniquet) tests, pain questionnaires (VAS, DN4, PainDetect, Pain Disability Index), Beck's depression scale, the Spielberger Trait and State Anxiety Inventory, electroneuromyography (ENMG) were used. RESULTS: Most of the examined subjects were patients with mild TS without muscle weakness or amyotrophy (80%). In the main group, there was a significant decrease in hypoesthesia, normalization of provocative tests, the increase of SNAP amplitudes, as well as nerve conduction velocities over motor and sensory fibers of the studied nerves (p<0.05). Besides, the regression of neuropathic pain syndrome was objectified according to VAS, DN4 and PainDetect scales, which indexes decreased significantly (p<0.01) in the course of therapy combined with ipidacrine. The positive dynamics, in its turn, contributed to the reduction of depression according to Beck's depression scale, comorbid chronic pain syndrome and improvement of patients' quality of life according to Pain Disability Index (p<0.05). There was no significant improvement of clinical and neurophysiological parameters in the CG (p>0.05). There were no significant differences in the assessment of pain, depression and quality of life (p>0.05), except for a decrease in VAS scores (p=0.03). CONCLUSION: In patients treated with traditional therapy in combination with ipidacrine, the follow-up study after 4 weeks showed the reliable positive dynamics of clinical, neurophysiological and psycho-emotional indicators without application of psychoactive drugs.

[Optimizing the diagnosis and treatment of dorsalgia in real-world clinical practice: the primary endpoint of the DORISS multicenter observational study]. / Optimizatsiya diagnostiki i lecheniya dorsalgii v usloviyakh real'noi klinicheskoi praktiki: pervichnaya konechnaya tochka mnogotsentrovogo nablyudatel'nogo issledovaniya DORISS.

OBJECTIVE: To evaluate the impact of treatment with Ipigrix on the dynamics of clinical symptoms, neurological status, and quality of life in patients with dorsalgia of the lumbosacral spine based on the DORISS non-interventional multicenter observational study. MATERIAL AND METHODS: A total of 3563 patients with verified diagnoses of low back pain in 200 clinical centers across the Russian Federation who received comparable baseline therapy according to nosological standards were examined, some of whom additionally received oral or staged administration of Ipigrix. The primary endpoint of the study was the description of clinical and sociodemographic parameters, the consumption of medical resources, and the search for optimization of dorsalgia diagnosis in contemporary Russian outpatient neurological practice. RESULTS: The population of patients included in the study represents a homogeneous group of educated, overweight people of working age with average severity of low back pain and related dysfunction. In 91.6% of cases nonspecific mechanisms of pain syndrome development with a moderate neuropathic component prevail in the genesis of back pain, being a reason for seeking medical advice once every 2 months on average. The overdiagnosis of lumbar radiculopathies is discussed, which most probably is of combined nature due to overuse and straightforward interpretation of neuroimaging results, nonsyndromological diagnosis, and classification defects. CONCLUSION: Improving the methods of diagnosis and treatment of patients with PB will reduce the incidence and the number of relapses of pain syndrome.

[Disturbances of Autonomic Regulation of Cardiovascular System at Different Working Regimes with Night Shifts].

Aim        To study temporal and spectral characteristics of heart rhythm variability (HRV) in night shift workers.Materials and methods       Along with traditional risk factors, conditions of labor contribute to development of cardiovascular morbidity, including night shift work, which can be associated with disorders of the autonomic regulation detected by analysis of HRV. This study included 100 healthy men. 74 of them were engaged in shift work, including 53 men with rotating shift work, 21 men with fixed night shifts, and 26 men with day-time work. HRV was analyzed by data of 5-min electrocardiogram recording (background recording and orthostatic test).Results   Night-shift workers had decreases in total power of regulation (ТР, SDNN) and in the parasympathetic branch (HF, pNN50). Rotating night-shift workers displayed significant decreases in SDNN and pNN50 and pronounced changes in the VLF / LF / HF ratio in the orthostatic test.Conclusion            In work with night shifts, the type of autonomic regulation differs from the "standard" functioning of the autonomic nervous system (ANS). This study showed different effects of night work regimens on HRV indexes. With the rotating shift work, the ANS dysregulation was more profound and was evident by a significant decrease in the ANS total tone and parasympathetic activity (SDNN, pNN50) compared to night shifts with fixed working hours. The excessive weakening of the parasympathetic component in the passive orthostatic test can be considered as an early marker for ANS maladaptation.

[An outpatient with hand numbness: old prejudices, new strategies of differential diagnosis and treatment]. / Patsient s onemeniem v rukakh na ambulatornom prieme nevrologa: starye predrassudki, novye strategii differentsial'noi diagnostiki i lecheniia.

AIM: To search for 'diagnostic masks' of tunnel syndrome (TS) of the upper limbs and evaluate the efficacy of the antiacetylcholinesterase agent ipidakrine in the treatment of TS in a polyclinic. MATERIAL AND METHODS: An analysis of outpatient cards showed that 597 people had complaints of numbness in their hands (23.9% of all neurological pathology). After exclusion of patients with vascular, demyelinating pathology, somatoform disorders, 92 people, who previously had the diagnosis of osteochondrosis, were first-time diagnosed with TS of upper limbs with mild to moderate severity. Kruskal-Wallis' nonparametric analysis of variance revealed homogeneity of clinical and instrumental manifestations in all patients. Patients were divided into 2 comparable groups: the control group (n=42), which received traditional therapy and the main group (n=50), which additionally received ipidacrine. The follow-up clinical-neurophysiological examination was carried out 4 weeks after treatment. RESULTS: A significant improvement was revealed during the use of ipidacrine in addition to the traditional therapy, despite the short period of drug administration. Positive dynamics was also observed in the group receiving traditional therapy, but no significant differences were recorded between baseline and after treatment. CONCLUSION: The key 'diagnostic masks' of TS are various syndromes caused by spinal osteochondrosis. The high efficacy of ipidacrine in the complex treatment of patients with mild to moderate TS is confirmed.

[A clinical efficacy of electrode pharmaphoresis in treatment of railway workers with low-back pain].

OBJECTIVE: To evaluate clinical efficacy and tolerability of electrode pharmaphoresis using preparations xefocam and mydocalm-richter in railway workers with low-back pain. MATERIAL AND METHODS: Authors carried out an open prospective noncomparative study of 16 patients, aged 21-82 years, with spinal osteochondrosis with root syndrome and radiculopathia of the lumbar/sacral spine with pain syndrome regardless of its duration. Treatment efficacy was assessed by the dynamics of pain syndrome severity based on the scores of a self-rated scale completed by the patient and the McGill Pain Questionnaire. Quality-of-life was assessed with the Oswestry Disability Index before and in the end of treatment. Clinical outcome was evaluated with the modified Nurick scale. Electrode pharmaphoresis (the "Farma T.E.B. Trans Epidermal Barrier Physio" apparatus) was administered to all patients using xefocam (solution for injections 8 mg, 2 ml per procedure) and mydocalm-richter (solution for injections 100 mg, 2 ml per injection) in the lumbar/sacral spine. RESULTS AND CONCLUSION: The high clinical efficacy of electrode pharmaphoresis using xefocam and mydocalm-richter was shown. The complex restoration study resulted in the reduction of pain syndrome in all patients. Pain severity was reduced to mild grade in 68.8% to the middle of treatment and in 93.8% patients in the end of treatment. As a consequence of pain reduction, the functional activity (quality of self-service, daily activities) increased significantly in 68.8% of patients. Positive treatment effect was noted in 100% of patients, good tolerability of this medication in 87.5%.

[Piascledin in the treatment of chronic dorsalgia].

Piascledine is a plant drug which positively influences the metabolism of cartilage and bone tissues. The authors studied the therapeutic effect of the drug in outpatients with chronic nonspecific dorsalgia. Piascledine was administered in dose 300 mg daily during two months. In the first month, it was used in the combination with artrosilene (320 mg daily). A comparison group included patients receiving monotherapy with NSAIDs (artrosilene). The study confirmed the high analgesic efficacy of piascledine in the treatment of patients with chronic nonspecific dorsalgia with controlled using of NSAIDs. The positive effect of piascledine was demonstrated after one month of treatment. The authors suggest that further clinical trials and placebo-control studies are needed to confirm these results.

The role of axonopathy in the mechanisms of development of demyelination processes in the central and peripheral nervous system.

The role of axonopathy in the development of demyelinating processes in the CNS and peripheral nervous system was addressed in studies of 43 patients with multiple sclerosis (MS) and 144 patients with chronic inflammatory demyelinating polyneuropathy (CIDPN). Patients with MS were found to have foci of reduced MRI intensity in the T1 regime ("black holes," present in 28%) and regional atrophy of the cerebral cortex (in 46%), which showed a significant association with the degree of invalidity on the EDSS (Kendall tau = 0.38 and 0.43; p = 0.038 and 0.021, respectively). The mean fatigue score on the FSS was 4.9 (3.6; 5.4). A significant increase in the central conduction time on the background of fatigue (p = 0.016), along with an absence of signs of impaired reliability of neuromuscular transmission and an absence of past-activation phenomena, suggested that central mechanisms were predominant in the formation of fatigue phenomena in MS. In addition, 34.9% of patients with MS showed signs of peripheral nervous system involvement, while the clinical-electrophysiological pattern in 12.5% of patients with CIDPN showed signs of CNS involvement. These data widen existing concepts of the mechanisms of formation of axonopathy in the CNS, based on evidence for the development of axon-demyelinating processes in CIDPN, which is the most accessible model of demyelination for study using contemporary neurophysiological methods.