[Pathophysiological aspects of the use of botulinum toxin dysport in the upper motor neuron lesion].

The most frequent causes of disability of patients with neurological diseases are motor disorders in the upper motor neuron lesion caused by the damage of the brain and/or the spinal cord that resulted in the formation of spastic paresis and paralysis. The correct understanding of the pathophysiological basis of clinical presentations of the upper motor neuron lesion will allow to chose the most adequate and prognostically successful methods of treatment. Currently, treatment with botulotoxin can be considered as such a method. This method in the combination with non-pharmacological rehabilitation decreases the activity of phasic and tonic stretching reflexes, associated contractions, synkinesia, spastic dystonia and spasticity that leads to the increase in muscle elasticity, mobility of extremities, reduction of pain, joint stiffness and soft tissue deformation that, in its turn, can increase the independence of the patient from any help.

[Spinal segmental myoclonus in multiple sclerosis (case report)]. / Spinal'naia segmentarnaia miokloniia pri rasseiannom skleroze (nabliudenie iz praktiki).

Multiple sclerosis (MS) is a disease with multicentric lesions of central nervous system. These numerous lesions can cause a lot of different symptoms. Sometimes these signs are atypical and make difficulties for MS diagnosing. Hyperkinesis is extremely rare manifestation of MS especially if it concerns spinal myoclonus. Spinal myoclonic jerks can be caused by various focal damages of neuraxis including demyelination lesions. This report describes the case of spinal segmental myoclonus as an unusual manifestation of MS. The patient was diagnosed definite MS according to the McDonald criteria (2010). The nature of movement disorders was defined by careful neurologic and neurophysiologic examination. These movement disorders were reliably caused by demyelinating type lesions in the cervical cord.

[Pain syndrome in patients with spastic torticollis before and after the treatment with dysport].

53 patients with the syndrome of spastic torticollis (ST) were examined to assess the nature and dynamics of pain syndrome during the treatment with dysport. The patient's condition assessment was examined before and 1 month after injection of dysport using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The TWSTRS scale includes 3 subscales (severity of torticollis, disability and pain), each of which consists of the attributes estimated for scores. Observations showed that 1 month after injection of dysport with doses ranging from 500 to 1000 units in the affected muscles of the neck pain intensity decreased by an average of 55%, which has averaged 6,2 points of the TWSTRS pain subscale (p<0,01). Observation confirmed that pain is one of the leading complaints in patients with ST. Pathogenetic basis of the pain formation in this disease and prospects of botulinum toxin therapy in pain syndrome correction were discussed.

[Topiramate in the treatment of essential tremor].

Therapeutic efficacy of topiramate in essential tremor (ET) was assessed in comparison with propranolol in two groups which included 24 and 20 patients, respectively, aged from 21 to 83 years (mean age 53 years). Along with clinical examination, a number of scales: Clinical rating scale for tremor, scale of functional disturbances and Visual-analogous scale have been administered. The efficacy of topiramate was comparable to that of propranolol in 83% and 75% cases, respectively. However topiramate has some therapeutic advantages compared to propranolol; it may be prescribed for all clinical forms regardless of sex (its efficacy is higher in women), age and illness duration, both in earlier and later onset, familial and sporadic variants of ET (propranolol is more effective in patients with family history of ET). Moreover, in contrast to propranolol, topiramate may be prescribed to patients with predisposition to arterial hypertension and bradicardia, bronchial spasms of diabetes mellitus and heart rhythm disturbances.