[Mismatch negativity and its hemodynamic equivalent (based on fMRI) in research of speech perception in healthy and in speech disorders].

The review is devoted to the use of electrophysiological index of auditory discrimination, known as "mismatch negativity" (MMN), and its hemodynamic equivalent obtained by functional magnetic resonamce imaging (fMRI) to study speech perception in normal and pathological conditions. Most attention is paid to works with using MMN as a neurophysiological index of the phonemic hearing impairment in patients with sensory aphasia. The MMN applicability for examination of speech compensation degree is substantiated. Also the perspectives of simultaneous EEG-fMRI registration in exploring speech pathologe are considered.

[The role of risk subcortical brain regions in the formation alalie].

Complex children examination with alalia was based the analysis by the role of subcortical brain structures for the formation of speech was investigated. Alalia is systemic speech underdevelopment in children, which violated all the components of speech. Evaluation of the functional state of brain structures on the EEG has allowed to distinguish the two groups, which depend on the nature of changes in bioelectric activity (BEA). The first group is one with the changes of alpha rhythm and/or local changes in BEA predominantly in the left hemisphere, the second group with violations ofbrainstem origin, mainly generalized EEG changes. A comprehensive analysis of clinical data has allowed to suggest the basis of the formation alalia lies subcortical structures lesion of the left hemisphere of the brain and stem departments of one. The analysis of perinatal risk factors has allowed to hypothesize about the connection of subcortical structures lesion with antenatal complications in the first half of pregnancy.

[Role of semicarbazide-sensitive amine oxidase in disturbances of endogenic detoxication in ischemic stroke patients].

Oxidative stress is a pathogenetic factor of ischemic stroke. Enhancement in the activity of one of xenobiotic transformation enzymes and biogenic amines (serum semicarbazide-sensitive amine oxidase (SSAO)) leads to the higher production of secondary toxins stimulating oxidative stress. We studied 38 patients (mean age 69,5 +/- 7,2 years) in the early restoration period of ischemic stroke. A control group included 17 age- and sex-matched healthy people. Severity of neurological and functional deficits was assessed with the NIHSS and the Barthel index, respectively. A number of biochemical parameters: serum SSAO activity, concentration of middle-sized molecules (MSM) and malonic dialdehyde (MDA) were measured. The higher concentration of MSM (0,80 +/- 0,22 and 0,5 +/- 0,1 g/l) and MDA (4,5 +/- 1,25 and 3,66 +/- 0,15 mmol/ml), respectively, was found in patients compared to the controls (p < 0,001). The correlative increase in MSM and MDA suggest the formation of chronic oxidative stress in the 4-5 months of disease. The changes in SSAO activity in patients with ischemic stroke that differed from controls were seen in 84% of cases while the increase in SSAO activity was found in 31% of patients. The pathogenetic link between the increase in SSAO activity and severity of neurological deficit was shown. This increase might be one of the pathogenetic links in the disturbance of neuroplasticity.

[Endogenous intoxication and compensatory reactions in the restoration period of ischemic stroke].

An aim of the study was to assess the severity of the syndrome of nonspecific metabolic endogenous intoxication (EI) and characteristics of compensatory reaction of serum albumin (SA) in patients in the early restoration period (4-5 months) of ischemic stroke (II). We measured levels of middle-sized molecules (MSM) and malonic dialdehyde (MDA) and determined parameters of functional activity of SA in 30 patients (mean age 69 +/- 8 years) after the first II and in 17 age- and sex-matched healthy people. Neurological deficit and functional restoration of patients were assessed with the NIHSS and Barthel index. The increase of MSM and MDA concentrations was found in 98% and 88% patients, respectively, as compared to healthy people (p<0,01). These metabolic disturbances were associated with the formation of EI and caused functional-structural changes of SA molecules. The correlation between changes of effective concentrations of SA and MDA was characteristic of the group of patients with II. The increase of total SA concentration was found in 87% of cases compared to controls (p<0,01) that indicated the manifestation of compensatory reaction of SA in response to EI. The decrease of all SA parameters, including the total concentration, was noted in 13% of patients and was associated with the decompensatory reaction to SA. The rehabilitation of CNS dysfunctions was associated with the undamaged SA compensatory reaction. The functional-structural changes of SA molecules in patients in the restoration period of II may lead to the changes in drug disposition, i.e. pharmacokinetics and pharmacodynamics, thus reducing possibilities of rehabilitation therapy.

[The use of akatinol memantine in the residual phase of stroke].

Fifty patients who had had left-hemisphere stroke 1-12 months before the inclusion in the study were examined. All patients underwent the 90-day course of neurorehabilitation. Forty patients of the main group received akatinol memantine as an add-on drug during 90 days in the initial dosage 5-10 mg/day with the gradual increase to 20 mg/day (10 mg twice a day); the control group included 10 patients. Comparative efficacy of neurorehabilitation was assessed 1,5 and 3 months after treatment with clinical scales NIHSS and Barthel, testing of higher mental functions with 10-score original digital scale (V.M. Shklovsky et al), neurophysiological study (electroencephalography and constant brain potentials). The distinct effect of akatinol memantine on the restoration of higher mental functions and, to a less extent, on the movement deficit was seen. The dynamic neurophysiological study revealed that the addition of akatinol memantine to the neurorehabilitation course activates reserve possibilities of the left hemisphere in small or moderate poststroke lesions. The trend toward the association between the efficacy and the time since stroke onset and the intensity of rehabilitation measures was found.

[Some aspects of metabolic dysregulation in patients with ischemic stroke].

To study the mechanisms of formation of an endogenous intoxication syndrome in patients after ischemic stroke, the activity of platelet monoaminooxidase (MAO) and serum aminooxidase, concentration of middle-size molecules and parameters of functional albumin activity have been determined in 27 patients with illness duration 4-5 months and 16 healthy age- and sex-matched controls. The significant dysregulation of biogenic amine metabolism and total homeostasis was observed in patients compared to controls. There were a significant increase of MAO and concentration of middle-size molecules and a decrease of aminooxidase and functional albumin activity (p < 0.01). Such metabolic disturbances suggest a presence of endogenous intoxication. A possible mechanism of formation of an endogenous intoxication syndrome in ischemic stroke is discussed.

[Conception of neurorehabilitation in post-stroke patients]. / Kontseptsiia neiroreabilitatsii bol'nykh s posledstviiami insul'ta.

Based on the long research and practical experience of specialized neurorehabilitation service study in different Moscow and Russian regions, the article presents the conception of post-stroke patient's neurorehabilitation. Heading by the Federal Scientific Speech Pathology and Neurorehabilitation Center, Health Care Ministry RF and Moscow Institute of Psychiatry, 108 clinico-rehabilitation settings (emergency clinics for neurosurgery and cerebrovascular pathology, to home care, and rehabilitation daily in-patient clinics and specialized units of municipal out-patients clinics) provide a specialized care in Moscow. The methodological approaches to rehabilitation of patients with the consequences of focal brain lesions have been specified. The particular attention was focused on a neurorehabilitation of the patients with dominant hemisphere lesion with higher mental and movement functions disturbances. The significance of mental and social factors in the pathogenesis of these disorders was highlighted. A system of patient's neurorehabilitation and principles of service organization in different disease stages are presented.

[Pathogenetic mechanisms of stuttering]. / Patogeneticheskie mekhanizmy zaikaniia.

A complex study including neurologic, psychologic, neurophysiologic and EEG investigation of 33 stutter patients was performed to determine pathogenetic mechanisms of stutter. All clinical data obtained were presented by means of structural schemes based on topical diagnosis. All the symptoms were divided into blocks containing information about functional state of separate CNS structures and systems, character and degree of observed deviation. The analysis of obtained results permits to consider dysfunction of hypothalamus-hypophysis-adrenal system under emotional stress as a cause of stutter. Peculiarities of the neurohumoral regulatory system development determine both age and sex specificity of the considered syndrome.

[Prognostic criteria of speech rehabilitation in patients with sequelae after ischemic stroke]. / Prognosticheskie kriterii vosstanovleniia rechi u bol'nykh s posledstviiami ishemicheskogo insul'ta.

Structural analysis concerning a complex of both neuropsychologic and clinical data of the patients with sequelae of ischemic stroke was performed. It was revealed, that a character of the local alterations of electric activity (EA) on EEG, testifying a functional state of cerebral structures, was an important prognostic criterion of the efficiency of neurorehabilitation. The local EA changes in form of groups of theta-waves and sharp waves of alpha- and theta-activities were prognostically favourable signs; meanwhile polymorphic slow-wave was unfavourable background for performing a restorative education. An analysis of the speech disorders revealed that both semantic and dynamic aphasias occur more frequently after ischemic stroke. A semantic aphasia was always accompanied by the dynamic one and each form may be both leading and secondary. It may be dependent on location of a focus (according to EEG) as well as on the character and manifestation of the accompanying neuropsychologic symptomatology.

The effects of lesions to subcortical conducting pathways on the electrical activity of the human cerebral cortex.

Simultaneous assessment, during the neurorehabilitation process, of electroencephalographic and neurological data, along with computerized tomography and computerized emission tomography data from patients suffering from sequelae due to ischemic insult allowed the organic origin of a number of EEG phenomena to be identified. These studies showed that lesions to the conducting pathways between the cortex and subcortical structures due to circulatory pathology in the territory of the middle cerebral artery were accompanied by local changes in the electrical activity of the cortex, mainly in the form of polymorphic waves in the theta and delta frequency ranges, along with groups of theta oscillations. The nature of slow-wave oscillations depended on the extent of the lesions and the severity of the blood supply loss in the affected area. Reductions in the size of the lesion focus and improvements in blood supply during rehabilitation were accompanied by changes in the nature of local abnormalities in cortical electrical activity: polymorphic slow-wave activity was replaced by sharp waves in the alpha and theta frequency ranges. Localization of changes in the caudal part of the cortex was an unfavorable prognostic factor for patients with ischemic insult, in terms of recovery of motor function.

[The effect of afferent subcortical conduction pathways on speech function status]. / Vliianie afferentnykh podkorkovykh provodiashchikh putei na sostoianie rechevykh funktsii.

The combined analysis of neuropsychologic, electroencephalographic, and neurologic data as well as of the results of computerized and emission-computerized tomography in patients with ischemic stroke during the neurorehabilitation period made it possible to ascertain the correlation between the lesions of subcortical pathways and speech disorders. Besides the intracortical, the cortico-subcortical connections of the left associative cortex were demonstrated. The semantic aphasia was shown to be always associated with the dynamic aphasia; and each of these forms could be either primary or secondary depending on the lesion localization (from the EEG and neurophysiologic data). The incidence of local polymorphous delta and theta waves in the EEG is an unfavorable predictive sign for patients after ischemic stroke.

[EEG diagnostic potential in the estimation of the severity and sequelae of ischemic stroke]. / Vozmozhnosti EEG-diagnostiki dlia otsenki vyrazhennosti i posledstvii ishemicheskogo insul'ta.

Simultaneous consideration of both electroencephalographic and neurologic data as well as the results of both computer and emission computer tomography in patients with consequences of ischemic stroke during a process of neurorehabilitation gave chance for more accurate definition of organic origin of some EEG phenomena. It was found that a damage of the conductive pathways between the cortex and subcortical structures associated with disorders of blood circulation in the area of the middle cerebral artery was accompanied by local disorders in electric activity of the cortex mainly in form of polymorphic waves of theta- and delta-ranges and groups of theta-waves. Besides, a character of the slow waves depended on the size of the damage and on the degree of a decrease of blood circulation in the area of the damage. A decrease of the damage focus and improvement of circulation during restoration process was accompanied by changes in local deviations in cortical electric activity: polymorphic slow waves activity was replaced by sharp waves of alpha- and theta-ranges. Location of the changes of electric activity in caudal regions of the cortex is an unfavourable prognostic sign for restoration of motor activity in patients with ischemic stroke.

[Structural approach to presentation and analysis of neuropsychological information]. / Strukturnyi podkhod k predstavleniiu i analizu neiropsikhologicheskoi informatsii.

The paper outlines a universal scheme for presenting neuropsychological information for diagnosing, predicting, and classifying higher psychic dysfunctions by using the structural organization method involving the determination of key issues whose awareness is sufficient to make decisions. The proposed scheme has a number of benefits: neuropsychological syndromes which constitute a diagnosis form on automatic scheme completion; the scheme itself, including data and reasoning for evaluation of functions, is a base of knowledge for the expert system and may be useful in training young specialists; the specific features of information presentation allow one to successfully compare neuropsychological data with the evidence of other clinical studies.

[The effect of a lesion of the subcortical conducting pathways on the electrical activity of the human cerebral cortex]. / Vliianie porazheniia podkorkovykh provodiashchikh putei na élektricheskuiu aktivnost' kory golovnogo mozga cheloveka.

Simultaneous consideration of EEG, neurological, and imaging data obtained with sequelae of ischemic stroke during rehabilitation allowed us to verify the organic nature of some EEG phenomena. It was shown that stroke-induced impaired circulation in the area of the middle brain artery gave rise to deviant local cortical electrical activity (EA) in the form of polymorphic theta and delta waves or groups of theta waves. The character of such activity depended on the lesion size and extent of blood supply deficit in the damaged area. Decrease in the lesion size and restoration of blood supply during rehabilitation were accompanied by changes in the local deviant EA: the polymorphic slow-wave activity was replaced by single alpha and theta sharp waves. The restoration of motor functions was less successful in cases with the local deviant EA localized in the caudal part of the cortex.