[Quantitative susceptibility mapping in assessment of inflammation and neurodegeneration in multiple sclerosis]. / Kolichestvennoe kartirovanie vospriimchivosti v otsenke vospalitel'nogo i neirodegenerativnogo protsessov pri rasseyannom skleroze.

Quantitative susceptibility mapping (QSM) is a relatively new MRI technique that may potentially help estimate iron concentrations in the brain. It plays a big role in diagnosis of many pathological processes, including multiple sclerosis (MS). Iron metabolism in the brain is a complex and not fully understood process. It is known that the content of iron in the brain increases with age; in addition, its accumulation is often observed in many neurodegenerative diseases, including MS foci, and its amount changes over time. In this regard, the values of magnetic susceptibility obtained using QSM can potentially become a convenient biomarker that reflects the latent activity and progression of MS, which, in turn, can influence the choice of therapy and the tactics of treating patients.

[Efficiency of erenumab in neurologist's real practice]. / Rezul'taty otsenki effektivnosti erenumaba v ambulatornoi praktike nevrologa.

OBJECTIVE: To assess the effectiveness and safety of erenumab in real-life study. MATERIAL AND METHODS: 33 patients with episodic and chronic migraine (30 females, mean age 39.2±9.2, 3 males, mean age - 49.3±7.6) received erenumab 70 mg for each 3 months. Patients achieved a 50% reduction in the number of days with headache, pain intensity, duration, the number of days of acute medication use, effect on daily activity (HIT-6), side effects, neuropsychological testing (Beck Depression scale, Spielberger-Khanin questionnaire, Hospital Depression and Anxiety Scale) were assessed. RESULTS: During the first month of therapy, a 50% decrease in headache days was observed in 48% of patients, during the second - in 53% of patients, during the third - in 51.5% of patients (p<0.001), a reduce in pain intensity, HIT-6 score, duration of migraine attack was observed (p<0.005). A decrease in situational anxiety was revealed (Spielberger-Khanin questionnaire, p=0.02), but not depression. There was a decrease in the consumption of triptans (p<0.0005) and other analgesics (p=0.0018). 1 patient noted transient constipation. CONCLUSION: The effectiveness and safety of erenumab in the outpatient practice is shown.

[Modern neuroprotection in the treatment of patients with cerebrovascular diseases]. / Sovremennaya neiroprotektsiya v kompleksnom lechenii patsientov s tserebrovaskulyarnymi zabolevaniyami.

Currently, both in Russia and in the world as a whole, the problem of acute and chronic cerebrovascular pathology does not lose its relevance, despite the organizational measures taken to prevent and treat this pathology. The search for highly effective methods of treating stroke patients continues, while preference is given to drugs with polymodal neuroprotective, neuroreparative effects. In this regard, the promising Russian drug cellex, obtained from the embryonic brain tissue of pigs, is of interest. The drug contains tissue-specific signaling proteins and polypeptides (growth factors, differentiation of nerve cells). The article presents the results of a number of experimental and clinical studies proving its primary and secondary neuroprotective effects. In multicenter Russian studies, including placebo-controlled studies, convincing data were obtained on the effectiveness and safety of the drug in the acute and recovery periods of ischemic and hemorrhagic stroke, as well as in chronic brain ischemia. Based on the analysis of the results obtained during the research, it is concluded that it is advisable to use drugs with a pleiotropic effect. The complex of measures that contribute to improving the effectiveness of rehabilitation measures both in the acute and in the recovery period of stroke, as well as in chronic cerebrovascular pathology, should include drugs that have neurotrophic and neuroprotective properties. They significantly contribute to the activation of neuroplasticity capabilities, thereby providing a powerful therapeutic effect. One of the drugs in this group is cellex, which has a decent evidence base of effectiveness and safety.

[Acupuncture in the prevention and treatment of stroke: a review of foreign studies]. / Akupunktura v profilaktike i lechenii insul'ta: obzor zarubezhnykh issledovanii.

Acupuncture has been recommended by the World Health Organization (WHO) as an alternative and complementary method for treating stroke and a way to increase the effectiveness of rehabilitation. The data available in the literature suggest that acupuncture has a beneficial effect on the status of patients with stroke. The mechanism of action of acupuncture for stroke includes the following components: 1) stimulation of neurogenesis and cell proliferation in the CNS; 2) regulation of cerebral blood flow; 3) antiapoptosis; 4) regulation of neurotransmitters; 5) improvement of the neuronal synaptic function, stimulation of long-term potentiation; 6) stimulation of neuroplasticity; and 7) decrease in blood-brain barrier permeability. Acupuncture has been proven to have a positive impact on the restoration of stroke-related dysfunctions, such as motor disorders, spasticity, cognitive impairment, and dysphagia. The most commonly used acupuncture points for the treatment of motor disorders are GV20, GB20, LI4, ST36, SP6, LI11, GB39, and motor scalp area; those for the treatment of cognitive dysfunction are GV20 and EX-HN-1, and those for the treatment of dysphagia are GV20, GV16, and CV23. A review of the literature indicates that studies of the clinical potential of acupuncture in the treatment of complications and the prevention of stroke are insufficient. It is assumed that the international community's recent interest in acupuncture methods used in the treatment of stroke will lead to the emergence of new studies and publications.

[Dose-dependent effects of cortexin in chronic cerebral ischemia (results of a multicenter randomized controlled study)]. / Dozozavisimoe deistvie korteksina pri khronicheskoi ishemii mozga (rezul'taty mnogotsentrovogo randomizirovannogo kontroliruemogo issledovaniia).

AIM: To study an effect of cortexin on neurological symptoms and oxidative stress as part of the ischemic cascade in chronic cerebral ischemia (CCI), I-II stages. MATERIAL AND METHODS: The multicenter randomized controlled study included 189 patients with CCI, 42 (22.2%) men and 147 (77.8%) women, mean age 64.3±0.5 years. Patients were randomized into three groups. Group 1 received intramuscular injection of 20 mg of cortexin, group 2 received 10 mg of cortexin; group 3 received basic treatment only. The duration of treatment was 10 days, the treatment course was repeated after 6 months. The patients were examined at baseline and during treatment (in total 5 times). Along with clinical and neurological examinations, some scales and tests ('Fedin Outpatient scale of chronic brain ischemia', MFI-20, Spiegel sleep scale, the Zung self-rating depression scale, Spielberger's inventory, the clock-drawing test, the 5-word test) were used. The severity of oxidation stress was assessed by the content of reduced SH-groups and total superoxide dismutase activity. RESULTS AND CONCLUSION: A dose-dependent effect of cortexin on the severity of neurological disorders, asthenia, sleep disturbance was shown. Antidepressant and anxiolytic effects were insignificant and were determined after repeated courses of the drug. The laboratory data confirmed the antioxidant effect regardless of the dose of cortexin. The safety and good tolerability of the drug were shown.

[Primary-progressive multiple sclerosis in Russia: a medical-sociological study involving patients and neurologists]. / Pervichno-progressiruiushchii rasseiannyi skleroz v Rossii: mediko-sotsiologicheskoe issledovanie s uchastiem patsientov i nevrologov.

The main results of a medical-sociological study aimed at the evaluation of the level of satisfaction with treatment in patients with primary progressive multiple sclerosis (PPMS) are presented. The survey was conducted in 19 regions of the Russian Federation and involved 437 patients with confirmed diagnosis of PPMS and 80 neurologists specialized in multiple sclerosis. The research was carried out by the All-Russian Public Organization of Disabled People with Multiple Sclerosis with the participation of the Russian Committee for Treatment and Research in Multiple Sclerosis. This is the first medical-sociological study in the Russian Federation involving patients with PPMS and neurologists. The study revealed typical medical and social problems patients with PPMS faced. A significant decrease in quality-of-life of PPMS patients was shown.

[Primary progressive multiple sclerosis: current issues of timely diagnosis]. / Pervichno-progressiruiushchii rasseiannyi skleroz: sovremennoe sostoianie problemy svoevremennoi postanovki diagnoza.

This article presents a review of international data on primary progressive multiple sclerosis (PPMS) and an analysis of factors influencing timely diagnosis of PPMS in a number of regions of the Russian Federation.

[Cognitive disorders in stroke patients: the possibilities of pharmacological correction].

OBJECTIVE: To determine the efficacy and safety of cellex in treatment of cognitive disorders in acute ischemic stroke (IS). MATERIAL AND METHODS: The study involved 246 patients with acute IS. Patients were randomly divided into two groups depending on the use of cellex or placebo along with basic treatment during 10 days. The dynamics of neuropsychological status was evaluated. RESULTS AND CONCLUSION: In IS patients, treatment with cellex have led to more rapid and marked reduction of mild and moderate cognitive disorders.

[Possibilities of the treatment of speech impairment in the acute stage of ischemic stroke using neuroprotective therapy]. / Vozmozhnosti korrektsii rechevykh rasstroĭstv v ostrom periode ishemicheskogo insul'ta s pomoshch'iu neĭroprotektivnoĭ terapii.

AIM: To estimate an effect of cellex on the dynamics and time of speech functions recovery in the acute stage of ischemic stroke. MATERIAL AND METHODS: A multicenter, randomized, double-blind, placebo controlled clinical study included 8 Russian clinical sites. Four hundred eighty patients were involved. During the standard base therapy, cellex (or placebo) was introduced subcutaneously in dose 0,1 mg once a day in the first 10 days from the beginning of hospitalization. RESULTS AND CONCLUSION: The rapid and complete regress of aphasia, especially in cases of severe and middle to severe clinical course, was observed.

[An analysis of treatment of the Russian group of patients in the international observational study «Factors influencing response to botulinum toxin type A in patients with idiopathic cervical dystonia¼].

AIM: The analysis of the results of treatment of the Russian patient population in the frame of international, multicenter, non-interventional study of CD, the primary purpose of which was to determine the response rate to therapy with BTA at the peak of the effect: after one course of injections in settings of routine practice, as well as the results of application of modern definition for "response" to treatment with BTA. MATERIAL AND METHODS: In Russia 60 patients with idiopathic CD were included. Patients were classified as «responders¼ according to the following 4 criteria: effect size (improvement by ≥ 25% assessed by TWSTRS); effect duration: ≥ 12 weeks interval between the BTA injection and the day when the patient reported a decrease of clinical effect, indicating the need for repeated treatment; good tolerability of treatment (no treatment-related serious adverse events (AEs) during the study period); patient-reported Clinical Global Improvement (CGI) score is +2 («significant improvement¼) or +3 («very significant improvement¼) at the visits 2 or 3. RESULTS AND CONCLUSION: In the Russian population, patients with a ≥ 25% improvement by TWSTRS scale at visit 2 (peak effect) accounted for 88.3%. Most of patients (81.6%) and physicians (81.7%) evaluated the efficacy of therapy as a «significant improvement¼ or «very significant improvement¼ by CGI. The criterion of the effect duration was achieved in 50% of cases. The BTA therapy was well tolerated (no severe AEs related to treatment) in 98.3% of patients. Overall, 40% of all patients met all the criteria for response to BTA treatment. According to the analysis of the general population, a high degree of response was observed for the effect size (73.6%), tolerability (97.5%) and patient-reported global clinical improvement (69.8%). Subjective assessment of the duration of the effect was achieved in 49.3% of patients, with 28.6% of patients considered as responders. Most patients met three of the four criteria. The proposed multifactorial definition of «response¼ may be of practical use for routine practice.

[Efficacy of the combination drug vasobral in chronic vascular encephalopathy].

OBJECTIVE: Despite the high prevalence of chronic vascular encephalopathy, its diagnosis and treatment remain understudied. This observational multicenter trial assessed the efficacy and safety of vasobral in patients with cerebral ischemia. MATERIAL AND METHODS: The open observational study was carried out in 37 centers in 11 Russian cities and included 300 patients with confirmed diagnosis of chronic vascular encephalopathy, stages 1 and 2, without dementia. The patients received 1 tablet (4 mg α-dihydroergocryptine and 40 mg caffeine) 2 times a day during 3 months. RESULTS AND CONCLUSION: There was an improvement of cognitive and affective status as well as quality of life and a decrease of subjective signs of chronic vascular encephalopathy. Vasobral did not cause significant fluctuations of arterial pressure and was safe for patients with chronic vascular encephalopathy and arterial hypertension.

[New possibilities of pharmacological treatment of adult epilepsy].

OBJECTIVE: To study an effect of cortexin on epilepsy course and electroencephalographic pattern in stopping the symptoms concomitant to epilepsy. MATERIAL AND METHODS: A study included 64 patients with epilepsy (22 men and 42 women, aged from 20 to 85 years). Along with standard treatment, the patients received cortexin (three 10-day courses during 12 months intramuscular in dose 10 mg daily). RESULTS AND CONCLUSION: There were the significant decrease in the frequency of seizures and the absence of failure of remission, the positive dynamics of electroencephalographic pattern as well as stopping of such symptoms as headache, non-systemic vertigo, asthenia, cognitive impairment, anxiety and depression, arterial hypertension.