[A differentiated approach to Parkinson's disease treatment in early stage of the disease]. / Differentsirovannyi podkhod k lecheniiu patsientov s bolezn'iu Parkinsona v rannem periode.

A conception of the approach to Parkinson's disease treatment at early stage, which could be realized in practice is suggested. The conception is based on the results of dopaminergic drugs treatment of 149 patients, aged 33-87 years. The patient's state was assessed by neurological examination and clinical scales with regard to different disease types, tremor and rigid, and levodopa doses--from moderate (up to 500 mg) to high (above 500 mg). A general treatment policy, including therapy directed to activation of regulatory and compensatory influences and differentiated usage of levodopa and combined therapy with levodopa and dopamine agonists, is presented.

[Clinical features of an early stage of Parkinson's disease]. / Klinicheskie osobennosti techeniia bolezni Parkinsona v rannem periode.

One hundred and forty-nine patients with Parkinson's disease (PD), mean age 66.3 years, have been examined. It was found that the early stage of the disease might include isolated depression, minimal movement disorders and functional compensation, the latter being observed during L-Dopa treatment. In general, the peculiarities of this stage comprise polymorphism of clinical symptoms, predominance of movement disorders over high mental dysfunctions and slow progression of pathological disorders with patient's adaptation to developing defect and reversibility of some dysfunctions under the treatment. The early stage was distinguished also by independence of high mental functions damage on movement disorders severity. More pronounced disturbances were detected in akinetic PD type in the presence of depression in the older patients. Depression may be a prodrome of movement disorders manifestation. The above peculiarities of the early stage are important for early PD diagnosis.

[Catecholamine metabolism in Parkinson's disease with depression]. / Obmen katekhomaminov pri bolezni Parkinsona s depressiei.

Daily urinary catecholamine excretion (DOPA, DA, DOPAC, NA, A) was studied in 66 patients with Parkinson's disease, 38 of them with differently expressed depression. Depression severity correlated with rigid form of disorders (p < 0.001). Biochemical profile of the depressive patients was characterized by noradrenaline (NA) to adrenaline (A) ratio reduction (p < 0.01) and dopamine to NA (p < 0.01) ratio increase on the background of total catecholamines deficit. Changes of NA/A and DOPA and correlation between DOPA and depression severity imply a role of dopamine neuromediator deficit in depression development.

[Catecholamine metabolism in different forms of Parkinson's disease]. / Obmen katekholaminov pri raznykh formakh bolezni Parkinsona.

Catecholamine metabolism was evaluated by daily urine excretion in patients with Parkinson's disease of tremor (18 patients) and rigid (14 patients) types. The group included 16 untreated patients. According to urine analysis, most informative peripheral markers for dopamine metabolism proved to be DOPA excretion, 3,4-dioxyphenylacidic acid (DOPAA) level and DOPA/DOPAA ratio. In the initial disease stage, a marked decrease of free dopamine and noradrenaline as well as dopamine metabolism intensification with corresponding DOPA/DOPAA ratio decrease were found. Significantly lower DOPAA and DOPA excretion was detected in patients with predominance of akinesia and rigidity types compared to tremor ones. In contrast to untreated patients, those treated with drugs containing dopamine revealed correlations between daily urine DOPA excretion as well as DOPA/DOPAA ratio with neurological symptoms severity.

Impaired production of plasma interleukin-6 in patients with Parkinson's disease.

The contents of interleukin-6 in the plasma from patients with Parkinson's disease and endogenous depression were compared by enzyme immunoassay. Interleukin-6 content in the plasma increased in the early stage of idiopathic parkinsonism complicated by depressive syndrome. A correlation was found between interleukin-6 content and changes in higher mental activity estimated by neuropsychological tests.

Clinical-neurophysiological features of motor lesions in patients with post-stroke epilepsy.

Twenty-two patients with post-stroke epilepsy (group 1) were studied, along with 30 stroke patients without epilepsy (group 2). Bilateral (on both the paralyzed and intact sides) decreases in the central conduction time (CCT) along the pyramidal tract were found in group 1, which were not seen in group 2, who had similarly severe motor lesions (p < 0.01). The tendency to decreased CCT was also seen 5-6 days after ischemic stroke in patients without epileptic manifestations, though CCT in this group increased by day 10-14; low values persisted in group 1 for prolonged periods. The facilitation differentiation (deltaF, the difference in CCT between resting and effort conditions) was also found to increase. In patients with post-stroke epilepsy, motor lesions were characterized by higher levels of muscle tone than in other stroke patients, though the levels of paralysis were similar.

[Disorders of muscle tonus and their treatment with sirdalud in patients in the early recovery period of ischemic stroke]. / Narusheniia myshechnogo tonusa i ikh lechenie sirdaludom u bol'nykh v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

The paper presents the results of clinical and neurophysiologic study of muscular tonus in 94 patients aged 42-70 years in early recovery after ischemic stroke. Selective role of spasticity was estimated in clinical pattern of motor disorders in groups of the patients with different disorders of muscular tonus with the same degree of paresis. Efficiency of antispastic preparation sirdalud was analyzed in 28 patients from this group. Sirdalud in daily dose of 6-12 mg in patients with prevalence of a spasticity in a clinical picture of the paresis and with either moderate or manifested degree of paresis of the extremities has significant antispastic effect without any decrease of muscular strength, which, in turn, increases the degree of restoration of motor functions.

[Clinical neuropsychological aspects of motor disorders in patients with post-CVA epilepsy]. / Kliniko-neirofiziologicheskie osobennosti dvigatel'nykh narushenii u bol'nykh s postinsul'tnoi épilepsiei.

The study included 22 patients with poststroke epilepsy (group 1) and 30 patients with stroke without epilepsy (group 2). A bilateral decrease of the time of central conduction (TCC) through pyramidal path (both on the paretic and intact side) was revealed in group 1. This was not observed in patients of group 2 with similar gravity of motor disorders (p < 0.01). Tendency to TCC decrease was also observed in patients without epileptic disorders by day 5-6 after ischemic stroke. However, TCC values were increased in such patients by day 10-14. Low indices persisted for a long time in patients with poststroke. There was also an increase of delta index of facilitation (the difference between TCC in rest and in muscle effort). It was also found that motor disorders in the group of patients with poststroke epilepsy were characterised by higher muscular tone than in poststroke patients with the same degree of the paresis.

[Epilepsy in patients with ischemic brain disease]. / Epilepsiia u bol'nykh s ishemicheskoi bolezn'iu golovnogo mozga.

The paper presents the results of follow-up study of 610 patients with ischemic stroke. In 52 patients (8.6%) there was observed symptomatic epilepsy conditioned by local causes (2 and more epileptic fits in anamnesis). The age of the onset of epileptic seizures was in the range 50-69 years, and men prevailed. From all 52 patients with episyndrome 36 had only one stroke, 16 patients-two and more strokes. 14 patients had fits before the stroke development. Meanwhile in 10 patients the fits were the first stroke symptoms (early) and in 28 individuals the fits arose 7 days after the stroke development (late). Significantly more severe disorders of dynamic praxis were revealed in psychologic examination of the patients with secondary generalized fits than of ones with partial seizures. Pathogenetic and clinical aspects of vascular epilepsy, interactions between transitory ischemic attacks and the fits which developed before the stroke are considered.

[The metabolic therapy of ischemic stroke: the use of nootropil]. / Metabolicheskaia terapiia ishemicheskogo insul'ta: primenenie nootropila.

54 patients were treated by notropil (pyracetam). The results of therapy were evaluated statistically according to a number of clinical scales and neurophysiologic indices (EEG and evoked potentials with mapping of bioelectric activity). The results were compared with the data about 56 patients of the control group which were treated by traditional method without application of notropil. Notropil was applied by two ways: small doses (4-12 g daily) during 5 days or high doses (10-12 g daily) during 30 days from the moment when the patient admitted to the hospital. Intravenous injections of the drug were used in all cases as well as its internal administration. It was showed either efficiency of the drug, especially in high doses, in early beginning of the treatment and its duration for at least 30 days or good tolerance of the drug. Authors supposed that application of pyracetam is not adequate in strokes with severe disorders of consciousness and cerebral edema.

[An analysis of the data from the neurophysiological examination of patients with bronchial asthma and hyperventilation]. / Analiz dannykh neirofiziologicheskogo obsledovaniia bol'nykh bronkhial'noi astmoi s giperventiliatsiei.

Bronchial asthma (BA) patients with hyperventilation (HV) were examined by means of evoked cutaneous sympathetic potential (ECSP) and short-latency evoked stem potentials to acoustic stimulation (SLESP to AS). Measurements of these parameters allowed quantitation and differentiation of hyperventilation disorders in BA patients. The latter were divided into 4 groups: BA patients with HV syndrome (HVS), BA patients with functional HV (FHV), BA patients with spontaneous HV (SHV) and BA patients without HV. BA patients with HVS exhibited a significant increase of latent ECSP period and latent periods III and V SLESP to AS peaks. This evidences for vegetative neuropathy and dysfunction of the pons and mesencephalic brain compartments. In BA patients with FHV there was a longer latent period II of SLESP to AS peak indicating dysfunction of caudal brain stem. BA patients with SHV and without HV had no significant shifts.

[The clinico-neurophysiological study of the effect of cerebrolysin on brain function in the acute and early recovery periods of hemispheric ischemic stroke]. / Kliniko-neirofiziologicheskoe issledovanie vliianiia tserebrolizina na funktsional'noe sostoianie golovnogo mozga v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta.

Thirty patients with acute ischemic stroke and at early terms of postapoplectic recovery received cerebrolysin in daily doses 10, 20 and 30 ml for 5 days or 10 ml, i. v. for 10 days, respectively. The patients were examined for neurological status and cerebral function. In acute stroke the highest effect occurred in the affection of moderate severity. In severe stroke the drug stimulated recovery of impaired functions which tended to restore more quickly than in control subjects. In early convalescents cerebrolysin improved motor functions. Details of the results of the combined neurophysiological examination in the course of the treatment are discussed.

[The complex clinico-electrophysiological assessment of the motor disorders in patients in the early period of recovery from an ischemic stroke]. / Kompleksnaia élektrofiziologicheskaia otsenka dvigatel'nykh narushenii u bol'nykh v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

A neurophysiological analysis of motor affections has been made in post-apoplectic patients during early convalescence. Altogether 26 patients aged 45-68 were examined on week 3-4 since ischemic hemispheric apoplexy. Magnetic stimulation of cerebral cortex motor zones, measurements of M-response and evoked skin sympathetic potential. Mild or moderate motor dysfunctions were characterized by reduced amplitude of the M-response and prolonged central pyramid conduction on the affected side. Severe paresis is associated with no M-response to magnetic stimulation of the cortex on the affected side. Pathogenetic mechanisms of the above disorders and their implications for treatment and rehabilitation are discussed.