[The use of P300 event-related potentials in the evaluation of the effectiveness of therapy of episodic exertional headaches].

Fifteen healthy individuals and 17 patients with episodic exertional headaches were examined before and after treatment with citalopram using P300 event-related potentials. Unlike healthy controls, patients with headaches before treatment displayed an increase in P300 amplitude and the loss of its habituation, which correlated with a decrease in cognitive functions. The treatment lowered the degree of pain and vegetative syndromes, normalized P300 parameters, and improved cognitive functions. The use of P300 method may be an additional criterion of the effectiveness of therapy in patients with exertional headaches.

[An electrophysiological study of the rehabilitation of cognitive functions during the treatment of patients with panic disorders].

To investigate psychophysiological features of panic disorder (PD) before and after treatment with citalopram, P300 auditory event-related potentials (ERPs) were recorded in 31 patients who met the DSM-IV criteria of PD and 24 age- and sex-matched normal controls. The ERPs were recorded during a standard two-tone discrimination task (oddball task). The treatment was conducted as a monotherapy during 6 weeks, with citalopram dosage of 20 mg/day. Compared to controls, patients differed significantly by the reduced P300 amplitude and the alteration of its habituation. These patients also demonstrated more pronounced anxiety, depression, autonomic dysfunction, alexithymia and attention insufficiency. High efficacy of the medication was detected in 80,7% of patients. The data obtained demonstrate disturbances of cognitive function in PD patients as well as qualitative psychoneurophysiologic differences of patients before and after the treatment which were most striking for the wave amplitude and for the alteration of its habituation. It is concluded that P300 evaluation may be used as a diagnostic tool and should be taken into account in the choice of effective therapy for PD patients.

The contributions of the right and left hemispheres of the brain to the polymorphism and heterogeneity of pyramidal syndrome.

This study was conducted to address the clinical and neurophysiological features of pyramidal syndrome in patients with lateralized hemispheric lesions. A total of 52 patients were studied, all with hemiparesis following acute cerebrovascular accidents of the ischemic type in the right (24 patients) or left (28 patients) hemispheres of the brain. Clinical neurological analysis was performed, along with transcranial magnetic stimulation, evoked abdominal reflexes, movement-associated motor potentials, and somatosensory evoked potentials. Lesions of the right hemisphere resulted in significant weakening of activatory influences at both the hemisphere level and on descending motor structures, with marked impairment of the afferent flow from both sides of the body and excessive disorganization of activity in the left, "presumptively healthy," side. Left-sided pathology impaired efferent control not only of the contralateral, but also of the ipsilateral side of the body. These data identify different neuroanatomical and neurophysiological features of the cerebral hemispheres not only in healthy people, but also in pathological conditions, this probably accounting for the polymorphism and heterogeneity of pyramidal syndrome in patients with lateralized cerebral lesions.

[A course of coronary heart disease and quality of life in patients with varying depressive states]. / Osobennosti techeniia ischemicheskoi bolezni i kachestvo zhizni bol'nykh s depressivnymi rasstroistvami razlichnogo urovnia.

AIM: To study a course of coronary heart disease (CHD) in patients with depressive disorders. MATERIAL AND METHODS: The trial included 77 CHD patients aged 39 to 68 years (mean age 54.9 +/- 0.9 years), 40 (51.9%) of them had myocardial infarction. All the examinees had effort angina of functional class II-IV by criteria of the Canadian Cardiology Association. All the patients have undergone standard clinical examination, stress tests, coronaroangiography (n = 30), assessment of the degree of vegetative dystonia and quality of life. The patients were divided into two groups depending on the depression degree. RESULTS: CHD patients with manifest depression vs those with subclinical depression had a higher level of personality and reactive anxiety. They had neurotic and psychopathological personality alterations associated with more pronounced vegetative disorders. These patients suffered from more severe coronary atherosclerosis, more hospitalizations for the previous year, more myocardial infarctions, lower physical activity and quality of life. CONCLUSION: CHD patients with manifest depression have lower physical performance and quality of life though this is not confirmed at exercise tests.

[A psychoneurophysiological evaluation of non-specific cerebral systems in patients with permanent autonomic disorders of psychogenic etiology during therapy]. / Psikhoneirofiziologicheskaia otsenka sostoianiia nespetsificheskikh sistem mozga u bol'nykh s permanentnymi vegetativnymi rasstroistvami psikhogennogo kharaktera v protsesse lecheniia.

Fifteen patients with permanent vegetative disorders combined with a pronounced anxiety were examined before and after treatment by the Nott drug. The clinical-and-neurological technique, psychometric evaluation of cognitive functions and the neurophysiological method of acoustic cognitive induced potentials P300 were made use of. Before treatment, pronounced vegetative anxiety-related and cognitive disorders were observed in patients. A reliably decreased amplitude of the P300 peak was noted in patients versus healthy subjects while registering the cognitive induced potentials. After treatment, there was a reliably decreased severity of vegetative, anxious and cognitive disorders in patients; the P300 amplitude went up reliably. Supposedly, the changed P300 amplitude, as observed in patients with permanent vegetative disorders; denotes the malfunction in non-specific limbic-reticular brain structures. A growing P300-peak amplitude combined with the arrest of psychovegetative and anxious disorders and with an improvement of cognitive functions in patients due to therapy are indicative of a lower degree of the functional disintegration in the non-specific limbic-reticular brain structures. Finally, the method of endogenous induced P300 potentials can be used as a diagnostic tool in the objective evaluation of a condition of non-specific brain systems in patients with the psychovegetative syndrome; it can also be an objective criterion in the efficiency assessment of a conducted therapy.

[Contribution of right and left brain hemispheres to pyramidal syndrome polymorphism and heterogeneity]. / Vklad pravogo i levogo polusharii golovnogo mozga v polimorfizm i geterogennost' piramidnogo sindroma.

The study aimed at investigation of clinical and neurophysiologic peculiarities of pyramidal syndrome in lateralized hemispheric lesion. Fifty-two patients with hemi-paresis caused by acute ischemic attack in the right (24 patients) and left (28 patients) brain hemispheres have been studied, using clinico-neurological analysis, transcranial magnetic stimulation, evoked abdominal reflexes, movement-related method of motor potential and somatosensory evoked potentials. In right hemispheric lesion, significant reduction of activating influences both on hemispheric and descending movement structures, pronounced damage of afferent flow from both body sides and excessive disorganizing activity in the left "relatively healthy" hemisphere were observed. Left hemispheric pathological process disturbs efferent control not only in the counter lateral body side, but in the ipsilateral one as well. The results obtained allow to discuss different neuroanatomical and neurophysiologic peculiarities of brain hemispheres, both in normal and pathological cases, as a factor, possibly determining polymorphism and heterogeneity of pyramidal syndrome in lateralized cerebral lesion.

[Characteristics of psycho-autonomic correlations and clinical course of ischemic heart disease in men and women]. / Osobennosti psikhovegetativnykh sootnoshenii i klinicheskogo techeniia ishemicheskoi bolezni serdtsa u zhenshchin i muzhchin.

AIM: To study psychovegetative correlations and clinical course of ischemic heart disease (IHD) in men and women. MATERIAL AND METHODS: Personality characteristics (MMPI test), reactive and personal anxiety (Spilberger's questionnaire), severity of depression (Back's questionnaire), vegetative status (vegetative disorders questionnaire), variability of cardiac rhythm (cardiovascular tests) were studied in 60 females and 62 males with IHD. RESULTS: IHD females vs males were characterized by higher neurotization, personal accentuation, more serious anxiety, depression and vegetative disturbances, lower variability of heart rate. IHD in females is more frequent in postmenopause, is characterized by less severe hemodynamically significant coronary stenoses. CONCLUSION: Emotional disorders make a great contribution to a course of ischemic heart disease.

[Psychophysiologic disorders in patients with functional disorders of upper sections of the gastrointestinal tract and with gastroesophageal reflux disease]. / Psikhovegetativnye narusheniia u bol'nykh s funktsional'nymi rasstroistvami verkhnikh otdelov zheludochno-kishechnogo trakta i gastroézofageal'noi refliuksnoi bolezn'iu.

The features of the psychovegetative status in patients with functional disorders of the esophagus and stomach (FD) and gastroesophageal reflux disease (GERD) are investigated. The methods included clinical, instrumental and psychometric examination. The patients of both groups had similar vegetative abnormalities and a tendency towards the growth of depression and anxiety parameters, did not differ in psychosocial factors, and had a wide range of psychovegetative abnormalities (PA). Lump in the throat, heartburn, epigastralgia (p < 0.01), depression, actual anxiety, alexitymia and vegetative disorders decreased in both groups (p < 0.05) after treatment with citalopram (20 mg per day) during 2 months. So PA are revealed in patients with FD and GERD, and citalopram reduces psychovegetative and GIT disorders.

[Use of enerion in psychovegetative syndrome with pronounced asthenia]. / Primenenie éneriona pri psikhovegetativnom sindrome v sochetanii s vyrazhennoi asteniei.

Enerion was used in the treatment of 40 patients with psychovegetative syndrome and asthenia. Before treatment, the patients have pronounced asthenia appearances, anxiety disorders, relevant autonomic disorders, mild depression and decrease of working capacity, attention concentration and memory. The treatment was conducted as monotherapy during 28 days with enerion dosage 400 mg/day. After treatment, expression of autonomic and asthenic disorders was reduced significantly, along with improvement of psychometric and neurophysiological indices. High efficacy of the medication was detected in 75% of the patients and moderate one--in 25%. The drug was well-tolerated.

[Clinico-neurophysiological features of migraine with and without aura]. / Kliniko-neirofiziologicheskie osobennosti migreni s auroi i bez aury.

Clinical phenomenon of migraine aura and comparison of main types of migraine were studied, using a method of visual evoked potentials (VEP) in 46 patients with migraine with aura, in 30--without aura and in 10 healthy controls. Common features as well as differences were revealed. Patients with migraine with aura were distinguished by significantly higher mean amplitudes of P300 component and by more frequents unstable VEP registration as compared to those without aura. Qualitative changes of amplitude and configuration and reduction of latent P300 period concomitant with headache side had the same frequency in both groups. In intra-group clinico-neurophysiological analysis, in regard to visual aura phenomena, the attacks with simple phenomena were the most severe in frequency, combinations with other aura symptoms, clinical and neurophysiological signs of visual system hyperexcitability.

[Clinical and neurophysiological aspects of cognitive disturbances in patients with panic disorders]. / Klinicheskie i neirofiziologicheskie osobennosti narushenii v kognitivnoi sfere bol'nykh s panicheskimi atakami.

Auditory event-related potentials P300 were studied in 44 patients with panic disorders (PD) and 23 normal controls. Compared to the controls, the patients differed significantly by the reduced P300 wave amplitude and alteration of its habituation. PD patients also demonstrated more pronounced anxiety, depression, autonomic dysfunction, hyperventilation and attention insufficiency. The patients with atypical PD differed from those with typical PD by reduced P300 wave amplitude, higher depression and lower personality anxiety levels. The data obtained demonstrate that cognitive function disturbances in PD patients as well as qualitative psychoneurophysiologic differences between patients with typical and atypical PD which were most striking for P300 wave amplitude and alteration of its habituation. Therefore, event-related potentials P300 method may be used as a diagnostic tool and should be taken into account in deciding on therapy.

[Motor, cognitive and affective disorders in Parkinson's disease]. / Dvigatel'nye, kognitivnye i affektivnye rasstroistva pri bolezni Parkinsona.

The study aimed at investigating the ratio of movement disorders to cognitive and affective ones. The group of patients with Parkinson's disease (PD, n = 42) compared with those with brain tumors (n = 14), neurotic depression (n = 15) and normals (n = 20). Clinical, psychological and neurophysiologic (motor evoked potentials--MP) methods were used. Location of the pathological process, lesion side, severity of movement deficit and presence of cognitive and affective disorders (depression) were shown to influence an organization of movement act. Location of the pathological process determines a disturbance of preparing and realizing the targeted movements. The more pronounced MP changes were detected in right-side parkinsonism and frontal lobes brain tumors. Affective disorders have the least influence on MP. In PD, a clear association between motor disorders and changes of cognitive and affective functions was found.

[The case of prominent EEG sleeping activity in thalamic stroke patients]. / Sluchai vyrazhennoi asimmetrii élektroéhtsefalograficheskoi aktivnosti vo vremia sna pri insul'te talamicheskoi lokalizatsii.

Presented here is a clinical case of thalamic stroke which affected mainly non-specific thalamic regions. In acute disease stage, the patient exhibited a prominent psychopathological features, slight hemihypoaesthesia and sleep disturbances. Polysomnography confirmed the disturbances of sleep structure: the increase of sleep onset latency, number of awakenings, waking time and stage 1 duration, decrease of both deep sleep stages (3 and 4) and REM sleep. Visual analysis revealed EEG spindle asymmetry in stage 2 of the first sleep cycle, with sleep spindles predominating in the undamaged hemisphere. Spectral EEG analysis confirmed the presence of power asymmetry not only in the sigma-band but also in the other band ranges. This clinical case allows discussing the role of the thalamus in generation of quiet sleep EEG phenomena.

[Specific features of the structure of sleep and personality under the conditions of chronic emotional stress and methods of improving the adaptive abilities of man]. / Osobennosti struktury sna i lichnosti v usloviiakh khronicheskogo émotsional'nogo stressa i metody povysheniia adaptivnykh vozmozhnostei cheloveka.

The results of a complex psychophysiological study of human sleep in the chronic stress condition are described. 20 patients with complaints of night sleep disturbances in the chronic stress condition and 10 healthy controls were examined by polysomnography. Profound changes of the quantitative and qualitative sleep parameters, mainly, related with the slow sleep phase, sleep delta characteristics and adaptive wakefulness mechanisms. The study demonstrated the effectiveness of improving the human adaptive parameters in the chronic stress conditions by using the drug and drugless therapy methods.

[Gender differences in migraine and wake-sleep migraine attacks]. / Polovye osobennosti migreni i migren' bodrstvovaniia i sna.

A follow-up clinical study was made of 320 patients examined in Autonomic Pathology and Headache Center, Nervous disease clinic, Sechenov Moscow Medical Academy, since 1989 to 1999. The peculiarities of migraine attack course and remission period, psychological characteristics, concomitant diseases and quality of life in men and women were described. In women, migraine attacks were more typical, prolonged and severe, being often stipulated by provoking factors, especially by emotional ones, as well as accompanied by autonomic disturbances, anxiety and depression. Despite a more favorable migraine course, men proved to score lower on quality of life, revealing more maladaptation. Patients with sleep migraine attacks were distinguished by more severe migraine course, multiple disturbances in remission period, higher depression and anxiety levels, as well as lower quality of life. Common serotoninergic mechanisms were suggested to underlie sleep migraine and depression. The leading role of depression in the origin of night migraine attacks is discussed.