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1.
Artigo em Russo | MEDLINE | ID: mdl-38884434

RESUMO

OBJECTIVE: To evaluate the diagnostic capabilities of modifying the standard MRI protocol as part of an interdisciplinary presurgical examination of patients with epileptogenic substrates of unknown etiology. MATERIAL AND METHODS: The results of dynamic MRI of 8 patients with a referral diagnosis of focal cortical dysplasia (FCD) were analyzed. In 7 patients, epilepsy was the reason for a standard MRI of the brain; in another patient with myasthenia, MRI was performed as part of a comprehensive examination. All patients, in addition to standard MRI, underwent a modification of the real-time scanning protocol to include contrast, tractography (DTI), and perfusion techniques (ASL/DSC). In 1 case, with questionable results, the results of a modification of the standard MRI protocol, high-resolution MRI (HR MRI) and hybrid positron emission CT with 11C-methionine (PET/CT with 11C-MET) were combined. RESULTS: Seven patients underwent epileptic surgery and 1 patient was operated on for a tumor. In 4 out of 8 patients, based on the results of a modification of the standard MRI protocol, radiological signs of a neoplastic process were identified, which suggested a low-grade tumor. One of them needed PET/CT to confirm the assumption. The results of pathomorphological examination correlated with the direct diagnosis for surgical treatment. One of the 4 patients was suspected to have dysembryoplastic neuroepithelial tumor (DNET) based on the results of the protocol modification, which was also confirmed by pathological examination. In another 4 patients in whom it was possible to narrow the differential between FCD type II and DNET based on the results of the modification, FCD IIb was pathomorphologically verified. CONCLUSION: The proposed modification of the standard MRI protocol can significantly facilitate the differential diagnosis between the neoplastic and dysplastic origin of an epileptogenic substrate of unknown etiology, which in turn affects the patient's management tactics.


Assuntos
Epilepsia , Imageamento por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética/métodos , Feminino , Masculino , Diagnóstico Diferencial , Adulto , Epilepsia/diagnóstico por imagem , Epilepsia/diagnóstico , Epilepsia/etiologia , Malformações do Desenvolvimento Cortical/diagnóstico por imagem , Adolescente , Adulto Jovem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Encefálicas/diagnóstico por imagem , Criança
2.
Artigo em Russo | MEDLINE | ID: mdl-38465811

RESUMO

OBJECTIVE: Analysis of demographic, clinical, laboratory, electrophysiological and neuroimaging data and pathogenetic therapy of pediatric patients with chronic inflammatory demyelinating polyneuropathy (CIDP). MATERIAL AND METHODS: Patients (n=30) were observed in a separate structural unit of the Russian Children's Clinical Hospital of the Russian National Research Medical University named after. N.I. Pirogova Ministry of Health of the Russian Federation in the period from 2006 to 2023. The examination was carried out in accordance with the recommendations of the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society on the Management of CIDP (2021). All patients received immunotherapy, including intravenous immunoglobulin (IVIG) (n=1), IVIG and glucocorticosteroids (GCS) (n=17, 56.7%), IVIG+GCS+plasmapheresis (n=12, 40.0%). Alternative therapy included cyclophosphamide (n=1), cyclophosphamide followed by mycophenolate mofetil (n=1), rituximab (n=2, 6.6%), azathioprine (n=3), mycophenolate mofetil (n=2, 6.6%). RESULTS: In all patients, there was a significant difference between scores on the MRCss and INCAT functional scales before and after treatment. At the moment, 11/30 (36.6%) patients are in clinical remission and are not receiving pathogenetic therapy. The median duration of remission is 48 months (30-84). The longest remission (84 months) was observed in a patient with the onset of CIDP at the age of 1 year 7 months. CONCLUSION: Early diagnosis of CIDP is important, since the disease is potentially curable; early administration of pathogenetic therapy provides a long-term favorable prognosis.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Humanos , Criança , Lactente , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Imunoglobulinas Intravenosas/uso terapêutico , Imunoglobulinas Intravenosas/efeitos adversos , Ácido Micofenólico/uso terapêutico , Nervos Periféricos , Ciclofosfamida/uso terapêutico
3.
Artigo em Russo | MEDLINE | ID: mdl-38529872

RESUMO

N-Hexane is a solvent widely used in manufacturing as a cleaner, degreaser and component of rubber cement. Chronic exposure to n-hexane either through contact with unprotected skin or inhalation can lead to the development of clinical symptoms and electrophysiological changes similar to those of inflammatory demyelinating polyneuropathy which requires careful differential diagnosis. This article presents three cases of severe predominantly motor polyneuropathy with demyelinating features in 15- and 16-year-old adolescents. The results of laboratory tests were within normal limits; electroneuromyography revealed symmetrical involvement of sensory and motor fibers of the nerves of the legs and arms with a decrease in the speed of propagation of excitation and conduction blocks. Sural nerve biopsy revealed intraneural and perineural swelling without any signs of inflammation or fibrosis confirming the genesis of the neuropathy. Despite a relatively favorable prognosis there is no specific therapy for hexane poisoning and the recovery period can last up to several years.


Assuntos
Hexanos , Doenças do Sistema Nervoso Periférico , Adolescente , Humanos , Eletromiografia , Condução Nervosa
4.
Artigo em Russo | MEDLINE | ID: mdl-38261280

RESUMO

High-resolution MRI is an important tool in the diagnosis of structural epilepsy |in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we have tried to demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The second part of the article is devoted to the spectrum of epileptogenic cerebral disorders, in addition to cortical malformations.


Assuntos
Encefalopatias , Criança , Humanos , Convulsões , Cognição , Complicações Pós-Operatórias
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 123(9. Vyp. 2): 20-32, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37942969

RESUMO

Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS is characterized by progressive symmetrical, ascending muscle weakness. Patients with GBS require meticulous monitoring due to the risk of bulbar syndrome, respiratory failure and autonomic dysfunction, which can be life-threatening. Early diagnosis and timely prescription of pathogenetic therapy for GBS are particularly important, especially in young children. Meanwhile, the spectrum of disorders covered by GBS has expanded significantly; its eponym is now designate any variant of acute dysimmune polyneuropathy, and its atypical forms pose a serious diagnostic problem for clinicians. This review article provides an analysis of the data available in the medical literature on GBS in children and discusses the tactics for diagnosing and managing patients with GBS, taking into account the Russian and European clinical recommendations.


Assuntos
Doenças do Sistema Nervoso Autônomo , Síndrome de Guillain-Barré , Adulto , Humanos , Criança , Pré-Escolar , Síndrome de Guillain-Barré/diagnóstico , Debilidade Muscular , Paresia , Federação Russa
6.
Zh Nevrol Psikhiatr Im S S Korsakova ; 123(9. Vyp. 2): 43-50, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37942971

RESUMO

Mexidol (ethylmethylhydroxypyridine succinate) is a modern neurometabolic medication increasingly being used in neuropediatrics. The results of recent studies confirming the positive effects of Mexidol pharmacotherapy in children with attention deficit hyperactivity disorder (ADHD), perinatal damages of the central nervous system (hypoxic-ischemic encephalopathy) and their consequences, neurological disorders and neurodevelopmental delay after surgery for congenital heart defects, neuroinfections (meningitis, encephalitis), posttraumatic epilepsy. Taking into account the unique multimodal action of Mexidol, it seems promising to expand the range of indications for its application in neuropediatrics, based on the results of new clinical trials organized in accordance with modern principles of evidence-based medicine.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Hipóxia-Isquemia Encefálica , Gravidez , Feminino , Criança , Humanos , Picolinas/uso terapêutico , Hipóxia-Isquemia Encefálica/tratamento farmacológico , Sistema Nervoso Central , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico
7.
Artigo em Russo | MEDLINE | ID: mdl-37084359

RESUMO

High-resolution MRI is an important tool in the diagnosis of structural epilepsy in determining the seizure initiation zones, identification of the mechanisms of epileptogenesis in predicting outcomes and preventing postoperative complications in patients. In this article we demonstrate the neuroradiological and pathohistological characteristics of the main epileptogenic substrates in children using modern classification. The first part of the article is devoted to cortical malformations as the most common epileptogenic cerebral disorders.


Assuntos
Encefalopatias , Epilepsia , Humanos , Criança , Epilepsia/diagnóstico por imagem , Epilepsia/etiologia , Convulsões/complicações , Encefalopatias/complicações , Imageamento por Ressonância Magnética , Cognição , Estudos Retrospectivos , Resultado do Tratamento , Eletroencefalografia/efeitos adversos
8.
Artigo em Russo | MEDLINE | ID: mdl-36440779

RESUMO

OBJECTIVE: Evaluation of the efficacy and safety of the new drug Prospekta in the treatment of attention deficit hyperactivity disorder (ADHD) in patients aged 7-12 years. MATERIAL AND METHODS: A multicenter (35 clinical centres) double-blind, placebo-controlled, randomized, parallel-group clinical trial enrolled 363 patients. The mean age was 9.3±1.7 years. Children of both sexes aged between 7 and 12 years with a diagnosis of ADHD confirmed by DSM-V diagnostic criteria were included in the study. Patients with a total score of 22 or more on the Attention Deficit Hyperactivity Disorder-Rating Scale-V (ADHD-RS-V) were included in the study. After randomisation, patients in group 1 received Prospekta, 1 tablet twice daily; patients in group 2 received placebo according to the study drug regimen. The primary efficacy criterion was the proportion of patients with a 25% or greater reduction in the overall ADHD-RS-V scale score after 8 weeks of treatment. As additional criteria for efficacy assessment were assessed: change of ADHD-RS-V total score from baseline after 8 weeks of treatment; Clinical Global Impression Efficacy Index (CGI-EI) score after 8 weeks of treatment; side effects. RESULTS: The proportion of patients with a 25% or more reduction in the ADHD-RS-V scale score after 8 weeks of treatment was 55.9% in the Prospekta group, and 43.3% in the placebo group (p=0.0199). There was a reduction of ADHD symptoms in the Prospekta group as a mean ADHD-RS-V score decreased by 10.2±7.7 (in the placebo group by 8.1±7.9); the difference between the mean ADHD-RS-V score reduction during Prospekta and placebo treatment was 2.09±7.81 (p=0.0096). Mean CGI-EI scores calculated on the basis of physician scores were different in the Prospekta group compared to the placebo group at 6.9±3.2 versus 8.0±3.1 (p=0.0012), indicating greater clinical efficacy of the study drug. The frequency of adverse events (AEs) did not differ significantly between the groups. There were a total of 66 AEs in 46 patients, including 31 AEs in 23 (13.2%) Prospekta group participants and 35 AEs in 23 (12.2%) placebo group participants (p=0.87). No cases of serious AEs were reported during the study. Prospekta is compatible with drugs used in pediatric practice. Prospekta did not cause an exciting effect and did not adversely affect the sleep of patients. CONCLUSION: The drug Prospekta is an effective and safe treatment for ADHD in patients 7-12 years old.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Masculino , Feminino , Humanos , Criança , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Método Duplo-Cego , Resultado do Tratamento , Comprimidos/uso terapêutico
9.
Zh Nevrol Psikhiatr Im S S Korsakova ; 122(9. Vyp. 2): 27-31, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36170095

RESUMO

Deficiency of the pyruvate dehydrogenase complex E1-alpha subunit is a rare genetic disease with X-linked dominant inheritance. The clinical spectrum of the disease is extremely wide: from lethal forms in children of the first year of life with lactic acidosis to chronic neurological manifestations with structural changes in the central nervous system without increasing the level of lactate in the blood. The authors report a case of this disease in a preschool child and present the results of laboratory and instrumental studies. The importance of early diagnosis of the disease is emphasized.


Assuntos
Epilepsia , Transtornos dos Movimentos , Doença da Deficiência do Complexo de Piruvato Desidrogenase , Pré-Escolar , Epilepsia/complicações , Epilepsia/diagnóstico , Epilepsia/genética , Humanos , Lactatos , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/genética , Mutação , Piruvato Desidrogenase (Lipoamida)/genética , Doença da Deficiência do Complexo de Piruvato Desidrogenase/complicações , Doença da Deficiência do Complexo de Piruvato Desidrogenase/diagnóstico , Doença da Deficiência do Complexo de Piruvato Desidrogenase/genética
10.
Artigo em Russo | MEDLINE | ID: mdl-36036398

RESUMO

Comprehensive multimodal examination of patients with focal refractory epilepsies is currently a prerequisite for high-quality pre-surgical diagnostics, which aims not only to expand the indications for radical treatment of epilepsy, but also to avoid the appearance of severe postoperative deficits. High-resolution MRI plays a key role in preoperative assessment. In this review, we illustrate the modern aspects of a pre-surgical diagnostical complex in examinations of patients with focal drug-resistant epilepsy, including the possibilities of neuroimaging.


Assuntos
Epilepsia Resistente a Medicamentos , Epilepsias Parciais , Epilepsia , Eletroencefalografia , Humanos , Imageamento por Ressonância Magnética , Neuroimagem
11.
Artigo em Russo | MEDLINE | ID: mdl-35485068

RESUMO

OBJECTIVES: To evaluate the efficacy and safety of two dosing regimens of Mexidol film-coated tablets, 125 mg («RPC «PHARMASOFT¼ LLC Russia), compared with placebo in children with attention deficit hyperactivity disorder (ADHD) aged 6 to 12 years. MATERIAL AND METHODS: A multicenter randomized, double-blind, placebo-controlled study in 3 parallel groups was conducted in 14 clinical centres of the Russian Federation to assess efficacy and safety of Mexidol film-coated tablets, 125 mg («RPC «PHARMASOFT¼ LLC Russia) in the treatment of attention deficit hyperactivity disorder (ADHD) in children 6-12 years old with different dosing regimens. The study involved 333 boys and girls aged 6 to 12 years with a confirmed diagnosis of ADHD established in accordance with ICD-10 and DSM-5 criteria. After screening (up to 14 days) the patients were randomised into 3 treatment groups in a 1:1:1: Mexidol 125 mg 2 times daily, Mexidol 125 mg daily+placebo and the placebo group. The duration of treatment in all groups was 42 days. 332 children completed the study. ADHD and comorbid disorders assessment scales were used. RESULTS: There were statistically significant changes in the sum of the total scores on the SNAP-IV inattention and hyperactivity/impulsivity subscales after 6 weeks of therapy in all three study groups (p<0.05). There were statistically significant differences between the Mexidol 125 mg and placebo groups and between the Mexidol 125 mg 2 times daily and placebo groups (for the PP population: p=0.000308 and p=0.000024, respectively; for the FAS population: p=0.000198 and p=0.000024, respectively), indicating that Mexidol therapy is superior to placebo. Statistically significant differences (p<0.05) were also obtained for most of the secondary efficacy criteria (average change in SNAP-IV inattention subscale score, average change in SNAP-IV hyperactivity/impulsivity subscale score, average change in SNAP-IV subscale score - Conners index, average change in ADHD-RS-IV score, change in CGI-ADHD-S scores, change in CGI-I score - the Clinical Global Impressions Scale - Improvement) when comparing Mexidol therapy with placebo. The results of statistical analysis of the incidence of adverse events, laboratory values, physical examination show no significant differences between the compared groups in the main safety parameters. CONCLUSIONS: The regimen of Mexidol, 125 mg film-coated tablets twice daily has been shown to be superior to the regimen of Mexidol, 125 mg film-coated tablets once daily and placebo. The safety profiles of the studied dosing regimens of Mexidol and placebo were comparable.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Feminino , Humanos , Masculino , Picolinas/efeitos adversos , Comprimidos/uso terapêutico
12.
Artigo em Russo | MEDLINE | ID: mdl-34693689

RESUMO

OBJECTIVE: The aim of the observational program was to study the effect of the use of the drug recognan (citicoline) on the state of higher mental functions (memory, attention, visual-motor coordination, dynamic praxis,verbal thinking and imagination) in patients with mild cognitive impairment. MATERIAL AND METHODS: A survey of 54 subjects (16 of them male and 38 female) aged 18-50 years (average age 28.5±10.5 years) was conducted with a diagnosis of «Mild cognitive impairment¼ («F06.7¼). The group was randomized into 2 subgroups: the main subgroup (26 people) received oral therapy with the drug Recognan, for 30 days, with the daily dosage of the drug being 500 mg. In the control group (28 people), nootropic drug therapy was not performed. Standard psychometric techniques were used to study higher mental functions. All subjects were examined three times (initially, in the middle of the study - on day 15, at the end of the study - on day 30). RESULTS AND CONCLUSION: After 2 weeks of treatment with recognan, there was an improvement in concentration in 81.9%, memory in 50% (p=0.008), verbal imagination productivity in 68.2% (p=0.015), counting functions in 60% (p=0.015), visual-motor coordination and dynamic praxis - in 86.4% (p=0.003), increased speed and efficiency of mental work (p=0.001). After a 30-day course of treatment with recognan, there was an improvement in memory in 58.3% of patients (p=0.007), an increase in concentration in 64%, an improvement in counting functions in 64.3% (p=0.011), verbal imagination productivity in 63.3%, visual-motor coordination and dynamic praxis in 86.4% (p=0.007), speed and efficiency of mental work (p=0.006), which indicates a complex positive effect of recognan on higher mental functions in patients with mild cognitive impairment cognitive impairment.


Assuntos
Disfunção Cognitiva , Nootrópicos , Preparações Farmacêuticas , Adolescente , Adulto , Cognição , Disfunção Cognitiva/tratamento farmacológico , Citidina Difosfato Colina/uso terapêutico , Feminino , Humanos , Masculino , Nootrópicos/uso terapêutico , Adulto Jovem
13.
Artigo em Russo | MEDLINE | ID: mdl-34481451

RESUMO

On June 25-26, 2021, a round table was held in Kazan with the participation of leading neurologists of Russia, where the issues of treatment of patients with cognitive impairment due to cerebrovascular diseases were discussed. Cognitive disorders of vascular genesis (VCD) are widespread in the population, are a common cause of a decrease in the quality of life and restriction of daily activity. The cause of VCD is both acute and chronic cerebrovascular diseases. An effective way to prevent VCD is to control cardiovascular risk factors, ensure a sufficient level of cognitive and physical activity throughout life. The role of drug therapy, aimed, among other things, at normalizing metabolic processes in the brain, is extremely important. The data on the mechanisms of action of the new domestic drug prospecta, the results of its clinical trials in patients with VCD are presented.


Assuntos
Transtornos Cerebrovasculares , Transtornos Cognitivos , Disfunção Cognitiva , Encéfalo , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/tratamento farmacológico , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Humanos , Qualidade de Vida
14.
Artigo em Russo | MEDLINE | ID: mdl-34283526

RESUMO

On the example of the diagnosis of the structural basis of focal epilepsy in an adult patient, the possibilities of a multimodal and interdisciplinary approach to diagnosis, combining the latest methods of neuroimaging with the results of neurophysiological examinations, are considered. The interaction and high qualification of specialists in epileptology, neuroradiology and pathomorphology provide a high probability to determine the cause of the focal forms of epilepsy. Along with the introduction of super-inductive MR systems, it is important to use their capabilities correctly and optimize the scanning protocol for the individual characteristics of the patient. With a long-term pharmacoresistant course of focal epilepsy, accompanied by low quality of life, the progression of neurological deficits and the aggravation of cognitive and personality problems in patients, it becomes obvious that these patients, even with negative results of standard MRI, are candidates for a more in-depth comprehensive examination to identify the structural basis of epileptogenesis and subsequent epileptic surgery. However, the problem of epilepsy pseudoresistance should be considered, when a patient with uncontrolled seizures takes antiepileptic drugs for a long time in inadequate dosages. Modern comprehensive diagnostics offers new rational approaches to antiepileptic therapy indication on the part of the doctor, as well as to improve the patient's compliance to the treatment.


Assuntos
Epilepsias Parciais , Epilepsia , Adulto , Anticonvulsivantes/uso terapêutico , Epilepsias Parciais/diagnóstico , Epilepsias Parciais/tratamento farmacológico , Epilepsia/diagnóstico por imagem , Epilepsia/tratamento farmacológico , Humanos , Qualidade de Vida , Convulsões/tratamento farmacológico
15.
Artigo em Russo | MEDLINE | ID: mdl-33580760

RESUMO

OBJECTIVE: The aim of the study was to study the effect of the drug recognan (citicoline) on the neurodynamic characteristics of mental activity in patients with mild cognitive impairment. MATERIAL AND METHODS: A survey of 58 subjects (17 of them male and 41 female) aged 18-45 years (average age 27.2±12.5 years) was conducted. Clinical diagnosis according to ICD-10 «Mild cognitive impairment¼ (F06.7). The main subgroup included29 people received oral recognan therapy (in solution, 100 mg in 1 ml) for 30 days, with a daily dosage of 500 mg (5 ml of solution). In the control group (29 people) drug therapy was not performed. Tests were used: «Graphic sample¼, the sample on the reciprocal coordination of the hands (Ozeretsky test), test for the compression of fingers, the test «number series¼. The follow-up period was 30 days. All subjects were examined three times (initially, in the middle of the study - on day 15, at the end of the study - on day 30). RESULTS AND CONCLUSION: The results obtained showed that the use of the drug recognan (citicoline) has a positive effect on the indicators of visual-motor coordination and spatial representations, neurodynamic characteristics of movement, and cognitive functions. After a 2-week treatment with recognan improved graphical sample, 84% of patients, with reliable improvement according to the Wilcoxon (p=0.0002), the sample in the compression of the fingers 60%, as well as coordination 60%, the accounting functions in 44%. After a month (30 day) treatment course recomanem there was an increase in indices of samples for the compression of fingers in 71.4% of patients, with significant improvement (p=0.0499) and run the graphical samples of 71.4%, coordination at 46.4%, counting functions - 48% patients.


Assuntos
Disfunção Cognitiva , Nootrópicos , Preparações Farmacêuticas , Adolescente , Adulto , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/tratamento farmacológico , Citidina Difosfato Colina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nootrópicos/uso terapêutico , Adulto Jovem
16.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(11. Vyp. 2): 38-45, 2021.
Artigo em Russo | MEDLINE | ID: mdl-35038845

RESUMO

Neurodevelopmental disorders (NDD) are characterized by disturbances of the formation of cognitive functions, communication skills, behavior characteristics and/or motor skills, which are caused by abnormalities in the course of the processes of neuroontogenesis. In the clinical practice of a pediatric neurologist and pediatrician, a significant part consists of patients with NDD without a general decrease in intelligence, primarily with speech development disorders, attention deficit hyperactivity disorder (ADHD), specific learning disorders (dyslexia, dysgraphia, dyscalculia). NDD represent a heterogeneous group of diseases, having multifactorial origin and a neurobiological nature, which are caused by genetic mechanisms and early (perinatal) brain damage. Among children with NDD, there is a higher occurrence of anxiety disorders compared to their peers. With NDD, early intervention is indicated, and its positive effect is possible during the period when the brain is most plastic and capable of changes. The published results of multicenter, double-blind, placebo-controlled, randomized clinical trials of pharmacotherapy with the medication "Tenoten for children" for ADHD, specific learning disorders, anxiety disorders and the consequences of perinatal damage to the central nervous system are reviewed.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos do Neurodesenvolvimento , Transtornos de Ansiedade , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Criança , Deficiências do Desenvolvimento/tratamento farmacológico , Humanos , Destreza Motora , Estudos Multicêntricos como Assunto , Transtornos do Neurodesenvolvimento/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Artigo em Russo | MEDLINE | ID: mdl-33340303

RESUMO

OBJECTIVE: To analyze the images obtained during pre-surgical neuroimaging in patients with gangliomas for the presence of specific signs and verification of the neoplastic process. MATERIAL AND METHODS: The results of presurgical MRI (3.0, 1.5 Tesla) of 20 patients with gangliomas were analyzed to identify specific signs of a neuronal-glial tumor and verify the neoplastic process based on the results obtained and a review of the literature. In addition to high-resolution MRI (HR MRI), various protocol modifications were applied to patients with epileptogenic pathological substrates of unclear etiology, including tractography (DTI) and contrast-free MR perfusion (ASL). In 5 cases, a multi-modal study was performed that combined the results of CT, routine MRI, HR MRI, functional MRI (fMRI) in various combinations and PET CT. RESULTS AND CONCLUSION: In 17 cases, patients underwent epileptic surgery. Three patients without epilepsy were operated on for a tumor diagnosed by radiological examination. In all 20 cases, gangliogliomas were verified, including 1 anaplastic, 1 infantile desmoplastic, and another patient had histological samples showing signs of a composite tumor. Combination with FCD IIIb was observed in 3 cases. Two patients had a double pathology (cases of tumors combination with lissencephaly and neuronal heterotopia) and another had a composite neuronal-glial tumor. In 15 cases, gangliogliomas showed neuroradiological features typical for dysembryoplastic neuroepithelial tumor (DNT) such as multicystic, nodular, and diffuse (dysplastic) described in the literature. In addition, in 9 cases, they had significant signs of neoplastic process such as contrast enhancement, continued growth and remodeling of the underlying bone. Verification of the neoplastic process based on the results of neuroradiological studies was difficult in 6 cases. In 2 cases, it was not possible to confirm the presence of neoplasm by radiological methods, and in 1 patient, the verification of the tumor during differential diagnosis took more than 8 years. The most common differential diagnosis was performed with DNT and FCD type IIb, which have a number of similar neuroradiological features.


Assuntos
Neoplasias Encefálicas , Epilepsia , Ganglioglioma , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Ganglioglioma/diagnóstico por imagem , Ganglioglioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Neuroimagem
18.
Artigo em Russo | MEDLINE | ID: mdl-33244956

RESUMO

OBJECTIVE: To study the therapeutic efficacy of two treatment modes of peptidergic nootropic medication cortexin in children with developmental dysphasia aged 3-4 years. MATERIAL AND METHODS: Ninety-four children with developmental dysphasia were divided into three groups. In group 1 (27 patients), cortexin was administered once a day intramuscularly for 10 days. After this course, the children were not prescribed drug therapy, a second examination was carried out 2 months after the start of treatment. In group 2 (40 patients), two courses of cortexin were administered at 1-month intervals, and the children were also followed up for two months. Control group 3 (27 patients) did not receive medication, but was also followed up for two months. All the parents were provided with recommendations for the stimulation of speech development in children. Before the study and two months later, speech development was assessed with special scales and questionnaires for parents. RESULTS: The increase ratio of the active vocabulary volume by 2 times or more was observed in group 2 (two courses of cortexin treatment) in 80.0% of patients (significant differences with groups 1 and 3, p<0.001), in 44.4% of group 1 (one course of cortexin), in 22.2% of the control group. Over a two-month period, the increase ratio in the active vocabulary and the number of uttered phrases in group 2 was 2.8 and 4.2 times, in group 1 2.3 and 3.6 times, respectively, in the control group it was only 1.4 and 1.5 times. Furthermore, the volume of active vocabulary in group 2 (42.4±3.6) became significantly larger (p=0.01) than in group 1 (31.7±5.6), although its initial values in group 1 (13.7±1.8) and group 2 (14.9±1.7) were similar. CONCLUSION: The results of the study confirm the higher effectiveness of two courses of the peptidergic nootropic medication cortexin in the pharmacotherapy of developmental dysphasia in children, aged 3-4 years, conducted over two months, compared with the indication of one treatment course.


Assuntos
Afasia , Nootrópicos , Afasia/tratamento farmacológico , Criança , Pré-Escolar , Humanos , Injeções Intramusculares , Nootrópicos/uso terapêutico , Pais , Inquéritos e Questionários
19.
Artigo em Russo | MEDLINE | ID: mdl-33081444

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of tenoten for children in the treatment of specific developmental disorders of academic skills in children of 1-3 grades. MATERIAL AND METHODS: Two hundred and forty children, aged 7-9 years, (Total set, Safety population) with verified specific reading disorder (F81.0), specific spelling disorder (F81.1), specific disorder of arithmetical skills (F81.2), mixed disorder of scholastic skills (F81.3; F81.2+F81.0, or F81.2+F81.1, or F81.2+F81.0+F81.1), diagnosed with the use of logopedic or psychological testing (15-35 scores in Fotekova T.A. and Akhutina T.V. reading and writing tests; 5-15 scores in arithmetical subscale of the Wechsler Intelligence Scale for Children) were enrolled in the study. CT was conducted in 10 clinical centers in Russian Federation in 2015- 2019. Patients were randomized into two groups. The first one (n=122) received tenoten for children in a dose of 1 tablet 3 times a day, the second one (n=118) was administered placebo in the same dosage regimen. The clinical data on 237 children (121 of the tenoten group and 116 of the placebo group) were used for Intention-to-treat efficacy analysis. Data on 220 children (115 of the tenoten group and 105 of the placebo group) were included in Per-protocol analysis. The duration of study was 12 weeks. The mean total academic skills (reading, spelling, and counting) score in groups after 12 weeks of treatment was set as the primary efficacy endpoint. RESULTS: The mean total academic skills score increased by 18.55±15.87 points. The significant total difference between the median changes in the total score in the tenoten and placebo groups was 5 points. There was a trend towards positive changes in reading and spelling mean scores in tests that didn't reach statistical significance due to lack of normal distribution of points in samples. There were 73 adverse events (AEs) in 42 patients of the tenoten group and 95 AEs in 31 children of the placebo group. No serious or severe AEs were registered in the tenoten group. No AEs definitely related to the study treatment were registered. No negative drug interactions were observed in the tenoten group. CONCLUSIONS: Tenoten for children is an effective and safe treatment for specific developmental disorders of academic skills in primary school children. Tenoten for children is well tolerated. The treatment is characterized by a high level of adherence of children and their parents to therapy.


Assuntos
Anticorpos , Dislexia , Criança , Método Duplo-Cego , Dislexia/tratamento farmacológico , Humanos , Federação Russa
20.
Artigo em Russo | MEDLINE | ID: mdl-33081456

RESUMO

The number of COVID-19 patients is increasing worldwide and the number of patients with neurological manifestations of a new coronavirus infection is increasing as well. Pathognomonic for COVID-19 is the presence of cephalgic syndrome, infectious-toxic encephalopathy, hypo- and anosmia and ageusia. Inducing of pathological autoimmune response contributes to the development of Miller Fischer and Guillain-Barré syndrome. Hyperergic reaction with the generation of the so-called «cytokine storm¼ provokes multisystem hemorrhagic complications such as Kawasaki disease and acute necrotizing hemorrhagic encephalopathy. There is also a special form of COVID-19-associated stroke. Almost all post-COVID-19 patients complain of severe fatigue, emotional lability, and sometimes have features of asthenic-neurotic, anxiety-phobic disorders and apato-abulic syndromes, which require rehabilitation measures, as well as courses of restorative neurotrophic and nootropic therapy.


Assuntos
Infecções por Coronavirus , Síndrome de Guillain-Barré , Doenças do Sistema Nervoso , Pandemias , Pneumonia Viral , Adulto , Betacoronavirus , COVID-19 , Criança , Humanos , Doenças do Sistema Nervoso/virologia , SARS-CoV-2
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