[Decompressive craniotomy in the complex intensive treatment of malignant forms of massive ischemic stroke].

A group of patients with benign course of massive ischemic stroke (MII) without development of the dislocation syndrome and a group of patients with malignant course with development of the hemispheric brain edema with the following transtentorial herniation were singled out. Risk factors for the development of malignant form of MII and its fatal outcomes were specified as lateral dislocation (>7 mm), more than 70% of ischemia size in frontal and parietal lobes and more than 80% - in temporal lobes, the disturbance of wakefulness up to moderate coma or more. Based on these results, it was selected patients for decompressive craniotomy in the affected hemisphere that allowed to reduce the fatality rate by more than twice compared to patients treated without surgery.

[Efficacy of cereton in acute ischemic stroke: results of the trial SOLNTSE].

We studied 95 patients with acute (no later than 24h after onset) carotid ischemic stroke. Patients of the main group (50 patients) received cereton in dose 4 ml (1000 mg) intravenously during 10 days in the combination with traditional treatment; 45 patients of the control group received only traditional treatment. Neurological deficit on NIHSS and vigilance on The Glasgow Coma Scale were assessed at baseline and in 5th, 7th and 19-21th days. The Barthel index was used to measure functional independence of the patient at the discharge from a hospital (21th day). The "cost-effectiveness" ratio, the cost of one score on the NIHSS and Barthel scales were calculated. The reduction in neurological deficit (p<0.05) and higher extent of functional independence were seen in the main group compared to the controls. Based on the "cost-effectiveness" analysis, the use of cereton was shown to be more effective for treatment of patients with acute ischemic stroke: the cost of the achievement of positive effect in patients of the control group receiving only traditional treatment was significantly higher (p<0.05).

[Pathogenetic treatment of multiple sclerosis: the present and the future].

Treatment of multiple sclerosis (MS) remains one of the most serious problems of modern medicine though a significant progress in understanding of disease pathogenesis has been achieved over the last years. Currently there are the ways of modifying the disease course that improve the remote prognosis. In this review, we present results of studies of drugs modifying the MS course which have been approved for MS treatment and those that are in the stage of clinical trials and expected to enlarge possibilities of MS treatment.

[Natalizumab: a new way for MS treatment].

Because multiple sclerosis (MS) mostly affects young working-age adults, the search for new effective disease-modifying drugs is extremely important. All the first line MS therapies approved in Russia are injectable medications for continuous subcutaneous or intramuscular self-administration once weekly or once daily. This fact is often a reason for a patient to refuse the treatment. Also it can result in specific side-effects. Natalizumab (Tysabri) is the first of a new class of drugs, alpha4-integrin antagonists, approved in the USA and EU for the treatment of active RRMS. It has shown a significant influence on clinical and MRI-activity of the disease. Natalizumab monotherapy leads to significant decrease in annualized relapse rate, disability progression risk and lesion load. This article reviews recent publications on the mechanism of action, effectiveness and safety of natalizumab, a new promising drug for MS therapy.

[The impact of microcirculation dysfunction on the clinical presentations of multiple sclerosis in patients above 45 years and the possible ways of correction of the vascular pathology].

The study was based on the hypothesis that the age-specific vascular disturbances, along with autoimmune processes, might play a role in the development of neurodegenerative changes in multiple sclerosis (MS) in patients above 45 years. Vascular disturbances were assessed using single photon emission computer tomography. Also magnetic resonance imaging, ultrasound dopplerography of the brain and evaluation of patient's neurological and mental state with the MMSE were used. The main group consisted of 10 patients with MS aged above 45 years with the history of vascular disturbances was studied before and after the treatment with fezam, a preparation contained piracetam and cinnarizine. It has been shown that in the presence of the vascular risk factors the neurological deficit can increase in this group of patients not only due to inflammation and demyelinization but to vascular disturbances as well. In these cases, the administration of fezam used in treatment of brain vascular disorders proved to be effective. The drug exerted a positive effect on the patient's mental state including cognitive dysfunction.