[Nootropics and antioxidants in the complex therapy of symptomatic posttraumatic epilepsy].

To study the possibility of application of nootropics and antioxidants in the complex antiepileptic therapy, we examined 75 patients with symptomatic focal posttraumatic epilepsy. A statistically significant reduction in the number of epileptic seizures, improvement of cognitive function and quality of life of the patients as well as a decrease in the severity of depression and epileptic changes in the EEG were identified. The potentiation of antiepileptic activity of basic drugs, normalization of brain's electrical activity and reduction in EEG epileptiform activity, in particular coherent indicators of slow-wave activity, were noted after treatment with the antioxidant mexidol. A trend towards the improvement of neuropsychological performance and quality of life was observed. There was a lack of seizure aggravation typical of many nootropic drugs. Thus, phenotropil and mexidol can be recommended for complex treatment of symptomatic posttraumatic epilepsy.

[Season fluctuations of carbamazepine and valproate concentration in patients with epilepsy].

We studied 107 patients with epilepsy who received monotherapy with valproic acid drugs (58) and carbamazepine (49). The seasonal distribution of number and severity of seizures assessed with the NHS3 scale in dependence of Cmin and Cmax content of antiepileptic drugs carbamazepine and valproates in the serum of patients was estimated. There was a significant increase in the number of seizures and their severity in the cycle spring>autumn>summer>winter. The serum content of carbamazepine and valproates was significantly lower in spring compared to autumn.

[The dynamics of the morbidity rate of stroke in the Dagestan Republic].

Results of the first epidemiologic survey of cerebral stroke in the Dagestan Republic (DR) carried out in 2009--2010 are presented. Using a population register, we evaluated the dynamics of the morbidity rate of stroke and effectiveness of primary and secondary prevention of stroke. There were 7533 cases of stroke, including 4116 in 2009 and 3413 in 2010. The morbidity rate per 1000 people was 2.76 in 2009 and 2.29 in 2010. The diagnoses were distributed as follows: ischemic stroke 3029 (73.6%) in 2009 and 2457 (72%) in 2010; hemorrhagic stroke -- 760 (18.5%) in 2009 and 692 (20.3%) in 2010; undifferentiated -- 327 (7.9%) in 2009 and 264 (7.7%) in 2010. Mean age at disease onset was 65.41±11.4 in 2009 and 66.43+12.6 in 2010. The measures for primary and secondary prevention of stroke performed in DR led to the reduction of stroke cases by 17% in 2010 compared to 2009.

[Concentrations of urine 6-sulfatoxymelatonin during the treatment of patients with epilepsy: a pilot clinical trial].

The effect of the epiphysis hormone melatonin on the brain bioelectrical activity is understudied: the data of experimental and clinical studies of melatonin effects are inconclusive and related mostly to exogenous administration. We studied 43 patients with focal epilepsy, 25 patients with cryptogenic epilepsy and 18 with symptomatic epilepsy. Carbamazepine and valproate were used as anticonvulsive drugs. Morning and evening urine concentrations of 6-sulfatoxymelatonin (6-COM), the main melatonin metabolite, were determined twice using immunoassay method: in autumn at the inclusion in the study and beginning of the anticonvulsant treatment and after 6 months, in spring, when anticonvulsant doses had been adjusted. The presence of epileptic seizures was associated with the reduction of melatonin concentration in the body that was supported by the decrease of urine 6-COM, in particular in the morning, in non-treated patients. Prescription of anticonvulsant treatment resulted in the increase of 6-COM. The concentration of the morning urine 6-COM was higher in patients with focal epilepsy receiving anticonvulsant treatment with valproate compared to those receiving carbamazepine: 49.28±6.71 and 37.09±5.43 ng/ml versus 20.00±3.6 and 13.11±2.08 ng/ml in patients treated with valproate and carbamazepine, respectively, before and after the adjustment.

[The methodology on the study of blink reflex and its normative parameters].

The study of blink reflex is a modern and high informative method of electroneurophysiological diagnosis. The data of clinical studies are controversial that confirm the actuality of the problem and indicate the necessity of universal approaches to methodology and interpretation of obtained results. We studied peculiarities of reflex electromyographic (EMG) components of blink reflex of the circular eye muscle during the electric stimulation of the supraorbital nerve in 31 healthy people. The latency of R1 and R2 components, amplitude of R1-component, square of general power spectrum of EMG-discharge, making up the R2 component, duration of R2-component and latency of R3-component, in case of its presence, have been estimated.

[The analysis of risk factors for acute stroke in Dagestan].

Results of the first epidemiologic survey of cerebral stroke in Dagestan carried out in 2009 using a method of population register are presented. Arterial hypertension was on the first place (98.5%) among risk factors. Other risk factors were determined as follows: cardiac diseases (24.2%), cardiac fibrillation (14.5%), lipid profile dysfunction (10.6%), smoking (8.7%), diabetes mellitus (8.6%), stress (7.5%), history of myocardial infarction (3.6%).

[Autochronometry in patients with focal epilepsy].

A study included 163 patients with focal cryptogenic and symptomatic forms of epilepsy and 47 sex- and age-matched controls. Disturbances of autochronometry in epileptic patients were studied with regard to character, duration, severity, seasonality of seizures and localization of pathological activity in EEG. The elongation of internal count of chronominutes and the ratio of individual chronominute to duration of daylight hours suggest either the approach of a seizure or the early post seizure period, the effect of the completed seizure. The right hemisphere lesion mostly impacts on the patient's perception of time making it longer.

[Therapeutic blockades and reflexotherapy in the complex treatment of tension headache].

The analysis of treatment effectiveness was carried out in 138 patients with tension headache. Patients of group 1 received fluoxetine in dose 20-40 mg/day during not less than 3 months and tizanidini in dose 4-8 mg/day during not less than 2 weeks. Patients of group 2 were assigned to therapeutic blockades of the occipital nerve and trigger points of cervico-cranial area using local anesthetics (2.5 ml of 0.5% marcain solution and 0.5-1 ml dexazone, for 1-5 blockades course) and needle reflexotherapy. The further treatment was based on the decision of the necessity of using analogous drugs in dose regime. Effectiveness was assessed on the basis of clinical neuroorthopedical examination, scores on the Visual Analogous Scale and questionnaires of McGill and A.M. Vein. The inclusion of therapeutic blockades of the cervical zone and reflexotherapy increased the effectiveness of the treatment and minimized the use of drugs. In group 2, the amount of analgesics was decreased by more than 60%, central myorelaxants were prescribed in 34.8% of cases and antidepressants - in 19.1%. The decrease of daily and course doses of the drugs allowed to completely avoid the side-effects.

[Autonomous component in cervicocranial pains and grounds for its pathogenetic treatment].

An analysis of an autonomous component of the pain syndrome has been performed in 484 patients with neck and head pain syndromes. The frequency of autonomous disorders in this cohort reaches 84,7%. Autonomous dysregulation in different nosological groups as assessed with the A.M. Vein questionnaire was seen in all types of pain syndromes but was most distinct in cases of migraine, cervicogenic headache, headache of tension and trigeminal neuropathy. The data obtained suggest the deficiency of brain regulatory mechanism functions responsible for adaptation of the organism to external and internal changes and explain, in large, signs of maladaptation in patients with cervicocranial pain syndromes. The use of vegetotropic drugs in the complex therapy of neck and head pain is pathogenetically substantiated.

[Association study of the SCN1 gene polymorphism and effective dose of lamotrigine].

An association between a polymorphism of the SCN1 gene, a therapeutical target of lamotrigine, and an effective dose (a blood plasma concentration) of the drug in patients with epilepsy has been studied. Fifty patients with different forms of epilepsy have been genotyped for the SCN1 IVS5N+5 G>A polymorphism using polymerase chain reaction. The distribution of allelic variants was as follows: 23 patients had the mutant homozygous genotype (V/V), 20 - the heterozygous genotype Wt/V and 7 were homozygous for the wild allele (Wt/Wt). Mean lamotrigine doses were 85,7+/-7,4 mg/day for carriers of the Wt/Wt genotype, 113,75+/-7,13 mg/day for the Wt/V genotype and 142,4+/-15,43 mg/day for the V/V genotype. Peak plasma concentrations corresponded to effective doses were 0,6+/-0,065 mg/ml for Wt/Wt, 0,96+/-0,1 mg/ml for V/V and 0,72+/-0,1 mg/ml for Wt/V. The hypothesis on the association between the SCN1 IVS5N+5 G>A polymorphism and the effective dose (concentration) of lamotrigine was confirmed. The significantly higher frequency of the SCN1A mutation in the group of patients with epilepsy compared to the control group of Caucasians (45,5 and 21,3%, respectively) implies that this polymorphism may contribute to the pathogenesis of epilepsy.

[The possibilities of using himantane in the treatment of Parkinson's disease].

The domestic drug himantane has been used as a monotherapy in dosage 25 mg daily during 12 weeks in patients with Parkinson's disease. Patient's state has been assessed using clinical, electromyographic, electroneuromyographic, EEG and psychometric (UPDRS and other scales) methods. The preparation used is well tolerated, induces the significant decrease of movement disorders, i.e. tremor, and exerts a positive effect on emotional and personality disturbances. The clinical changes have been confirmed by electroneuromyographic data and EEG.