[The possibilities of using chondroitin sulfate in patients with chronic back pain]. / Vozmozhnosti primeneniia khondroitina sul'fata u patsientov s khronicheskoi bol'iu v spine.

AIM: To study the efficacy and safety of chondroitin sulfate (mucosat) in the treatment of chronic lower back pain. MATERIAL AND METHODS: The medical documentation of 46 outpatients with chronic lumbosacral dorsalgia, who received 25 intramuscular injections of 2 ml mucosat, was studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the data of four visits (1-st, 10-th and 25-th day and 3 months after the end of treatment). Results of the clinical-neurological examination, pain intensity at rest and at movement according to the Visual Analogue Scale (VAS) and the severity of Lasegue and Wasserman signs and limitation of movements in the lumbar spine were taken into account. RESULTS: The use of mucosat at a dose of 2 ml intramuscularly 1 time in 2 days led to a significant decrease in the severity of pain syndrome and increased mobility in the lumbar spine (before treatment, the level of pain at rest according to the VAS was 4.22±1.28 scores, on the 25-th day 2.13±0.24, 3 month after treatment 2.37±0.31; the level of pain at movement: 5.78±1.15; 4.56±0.47; 4.78±0.22, respectively (p<0.01). There were a reduction of the dose of previously used non-steroidal anti-inflammatory drugs in the end of treatment and maintenance of the results of therapy for 3 months after the end of treatment. Good tolerability of the drug and the absence of significant side-effects were shown as well. CONCLUSION: This study showed the efficacy and safety of chondroitin sulfate (mucosat) in the treatment of outpatients with chronic lower back pain.

[The use of nimesulide in the treatment of acute low back pain].

The objective is to study the efficacy and safety of nimesulide (nemulex) in the treatment of acute low back pain (LBP). The medical documentation of 54 patients with primary syndrome of LBP, which were treated in a polyclinic with nemulex at a dose of 200 mg per day had been studied. The assessment of patients' condition and efficacy and safety of the treatment was conducted based on the information after three visits (1-st, 5-th and 10-th day). The analysis took into account the data of clinical-neurological examination and the assessment of pain intensity at rest and at movement according to the visual analogue scale (VAS) and the severity of Lasegue symptom and limitation of movements in the lumbar spine. Safety of the therapy was evaluated on the basis of accounting of undesirable side reactions and data analysis and physical examination and laboratory testing. Cardiovascular safety was assessed by blood pressure and blood lipid profile on day 10. The use of nemulex at a dose of 200 mg per day resulted in relief of pain and increase of mobility in the lumbar spine on the 5th day of treatment that indicates the effectiveness of anti-inflammatory therapy to restore the previous functional status of patients with LBP. The use of nemulex was accompanied not only by statistically significant analgesic effect (0,78±0,14 points alone; 1,12±0,18 points when moving by VAS on the 10th day of the treatment) and high security (only 1 of the 54 patients was recorded to have elevation of hepatic transaminases; and 2 patients with dyspepsia without endoscopic changes of gastrointestinal tract).

[Asthenia, emotional disorders and quality of life of patients with multiple sclerosis]. / Asteniia, émotsional'nye rasstroistva i kachestvo zhizni u patsientov s rasseiannym sklerozom.

Objective. The evaluation of the dynamics of asthenia, chronic fatigue syndrome, emotional disorders and quality of life of patients with multiple sclerosis (MS) and to explore the possibility of using idebenon (noben) in treatment of these impairments. Material and methods. We studied 35 patients, 18 men and 17 women, with MS (mean age 36.4±8.86 years, mean disease duration 10.33±6.07 years); 83% of patients had remitting type and others - secondary progressive type. Along with neurological examination, we used the Modified Fatigue Impact Scale (MFIS 21), the Hospital Anxiety and Depression Scale and a quality of life questionnaire (EQ5D). Patients had marked asthenia and chronic fatigue at baseline. The old age of the patients and duration of MS and its severity according to EDSS predicted the higher levels of asthenia, chronic fatigue and anxiety with depression and lower quality of life on EQ5D. All patients received noben in dosage 90 mg daily (30 mg 3 times a day) during 6 months. Results and conclusion. Idebenon (noben) reduced the severity of chronic fatigue syndrome, asthenia and depression in MS patients. The dose used in the study may be regarded as the optimal dose that provides best efficacy with minimal side-effects.

[Possibilities of medical correction of moderate cognitive impairment].

Thirty-four outpatients with moderate cognitive impairment were treated with one of standard extracts of Ginkgo Biloba - EGb761 (memoplant). Memoplant was used in high dosages (240 mg daily) twice a day during three months. Patients were assessed using the Montreal Cognitive Assessment (MoCA), the hospital depression scale and QoL questionnaire EQ5d as well as standard neurological and somatic examination. A statistical analysis of data revealed a significant improvement in most measures, mostly in attention, memory, orientation and visual-spatial/ executive functions as well as in anxiety and depression. The drug is well-tolerated and is recommended for practical use.

[Emotional disorders and quality of life in patients with post stroke asthenia].

An aim of the study was to assess the severity of asthenic syndrome, emotional disorders and quality of life indicators in post stroke patients treated with idebenone (noben). We studied 35 patients aged from 47 to 76 years, mean age 58,85±7,99 years, 21 men and 14 women. The time after stroke was 1-8 years (mean 2,63±1,51 years). The duration of follow-up was 6 months. Patients were examined at baseline and 3 and 6 months after treatment with noben in dose 90 mg daily (30 mg 3 times a day). Patients were examined clinically, the following scales were used as well: the Scandinavian stroke scale, the modified MFIS-21, the hospital anxiety and depression scale (HADS) and EQ5D including VAS. It has been shown that asthenic syndrome negatively influenced quality of life and emotional sphere thus impeding the recovery of daily activities. The follow-up study revealed that the treatment with idebenone in dose 90 mg daily decreased the severity of asthenia and emotional disorders and significantly improved quality of life.

Use of the new levodopa agent Stalevo (levodopa/carbidopa/entacapone) in the treatment of Parkinson's disease in out-patient clinical practice (the START-M open trial).

Despite the significant symptomatic effects of levodopa, stable 24-h treatment responses are in the vast majority of patients replaced 2-3 years from the start of treatment by oscillations in motor symptoms (fluctuation, dyskinesia), amelioration of which requires addition of constant (physiological) stimulation of postsynaptic dopamine receptors. To some extent this is provided by Stalevo, which contains levodopa and two enzyme inhibitors: the DDC inhibitor carbidopa and the COMT inhibitor entacapone. The results obtained in the present study demonstrated the advantages of Stalevo over traditional agents in patients with the "wearing off" and "on-off" phenomena.

[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.