[The impact of antiepileptic therapy on sleep disorders in women with epilepsy]. / Vliyanie protivoepilepticheskoi terapii na narusheniya sna u zhenshchin s epilepsiei.

OBJECTIVE: To analyze the frequency of various sleep disorders in patients with epilepsy receiving antiepileptic therapy. MATERIAL AND METHODS: Sixty-four women were selected from the register of patients with epilepsy and other paroxysmal conditions. The group consisted of young and middle-aged women (36.9±13.5 years), all patients received antiepileptic therapy. To diagnose sleep disorders, we used a sequential algorithm for clinical examination supplemented by instrumental methods according to indications (polysomnography, respiratory monitoring). RESULTS: The duration of epilepsy was 15.7±7.6 years, the disease was represented by three forms: structural (n=15, 23.4%), genetic (n=32, 50%) and unspecified (n=17, 26.6%). Sleep disorders were common among female patients with epilepsy (43.7%), they are most frequently combined with genetic epilepsy (18.7%), and represented by: insomnia (43%) mild to moderately severe breathing disorders (32%) and sleep movement disorders (25%). Sleep disorders were combined with symptoms of depression in the majority of patients (71%). A 6-month follow-up evaluation of nighttime sleep parameters after treatment showed a decrease in the frequency of sleep disorders to 25%; scores on the Epworth Sleepiness Scale significantly decreased to 6.7±3.6. A change in antiepileptic therapy in patients with sleep breathing disorders resulted in a marked regression of the Apnea-Hypopnea Index (9.2±2.5 points; p=0.003). However, there were no significant changes in the severity of sleep movement disorders. CONCLUSION: Sleep disorders are common in patients with epilepsy, in most cases they are associated with mood disorders, and may regress after optimization of antiepileptic therapy.

[Trigeminal autonomic cephalgias: features of diagnosis and treatment]. / Trigeminal'nye avtonomnye tsefalgii: osobennosti diagnostiki i lecheniya.

Trigeminal autonomic cephalgias is a group of primary headaches, including cluster headache, paroxysmal hemicrania and hemicrania continua, as well as two forms of short- lasting unilateral neuralgiform headache attacks, the complexity of diagnosis of which is determined by the low prevalence and some similarity of clinical manifestations both among themselves and with other diseases in particular with migraine and trigeminal neuralgia. Despite the rather short duration of headache attacks, the intensity of the pain syndrome reaches a severe and very severe degree, and the high frequency of paroxysms per day significantly complicates abortion treatment and leads to a pronounced professional and social maladjustment. At the same time, the possibility of using effective specific prophylactic therapy determines the importance of accurate diagnosis and, therefore, the knowledge of neurologists on this issue.

[Virtual reality in upper extremity dysfunction: specific features of usage in acute stroke]. / Virtual'naia real'nost' pri narushenii funktsii ruki: osobennosti primeneniia v ostrom periode insul'ta.

BACKGROUND: Stroke is a leading cause of permanent disability. Being a new technology for neurorehabilitation, virtual reality (VR) allows for intensive trainings with a larger number of repetitions focused on mastering specific skills in patients with upper limb dysfunction. To date, there are insufficient studies evaluating the use of VR in the acute period of a stroke. AIM: To investigate the effectiveness and safety of adding VR trainings to standard therapy for improving upper limb function and for enhancing activities in daily life in patients with acute stroke. SUBJECTS AND METHOD: The investigation enrolled 78 patients with acute stroke (the median time from stroke onset, 3.7 days; median age, 63 (43; 79.3) years), who were randomized into 2 groups: a study group (standard therapy + VR) and a control one (standard therapy only). The patients of the study group underwent a VR training cycle lasting 15 minutes twice daily for 10 days. Before and after the training cycle, the British Medical Research Council scale for muscle strength, the upper extremity motor function sections of the Fugl-Meyer assessment (FMA) scale, hand dynamometry, and the nine hole peg test (NHPT) were used to evaluate upper extremity function in the participants; Sections 6 and 7 of the motor function assessment scale (MAS), the modified Rankin scale (MRS), and the total motor function scores of the functional independence measure (FIM) utilizing a 7-point ordinal scale were employed to assess everyday activity limitations. RESULTS: On completion of rehabilitation measures, the participants in the study and control groups showed a statistically significant improvement in upper extremity function and activities of daily living. According to the ratings of the FMA subscales 'hand' (p=0.034), 'hand (speed)' (p<0,001), and the total score of this scale (p=0.035) and according to those of the FIM scale (p=0.045), the patients of the study group demonstrated a statistically significant improvement compared with those in the control group. Assessments using the MRC scale, FMA subscales 'upper extremity' and 'wrist', NHPT, MAS, the Barthel index (BI), and MRS revealed no differences between the groups. No serious adverse events were recorded in the participants of the study group during the study period. DISCUSSION: The vast majority of studies evaluating the effect of VR in upper extremity dysfunction are conducted in patients with stroke lasting longer than 3 months. Despite the validity of using VR in the acute period of cerebral lesion, the investigations of this design are not numerous. At the same time, these studies often have limitations, such as a small number of participants (usually less than 10); a small number of training VR sessions; lack of 'blinding'; different types of software and hardware systems that implement VR technology; heterogeneity of participants according to the degree of upper extremity dysfunction; insufficient detailing of the content and scope of conventional therapy; comparison of VR with basic methods of motor rehabilitation, and sometimes the absence of a control group. CONCLUSION: Thus, the use of VR in addition to standard rehabilitation measures in the acute period of stroke favors improvements in upper extremity function and a reduction in daily limitations and is safe.

[Migraine in women: clinical and therapeutical aspects]. / Migren' u zhenshchin: klinicheskie i terapevticheskie aspekty.

Migraine is one of the most common neurological disorders, affecting women. Physiological changes in the hormonal status can modulate the functional status of pain and analgesic systems of the brain and, by involving different pathophysiological mechanisms, change the course of migraine. In addition to an analysis of epidemiological data, the review provides current views on the clinical features of the disease in women population at different periods of life, particular attention was focused on menstrual migraine. It has certain features, such as acute and long attacks and treatment difficulties. One of main issues is the use of oral contraceptives in women with migraine according to the ratio of potential benefit to cardiovascular risk. The problems of treatment headaches in pregnant and breastfeeding women are also considered. An influence of migraine on the course and outcome of pregnancy was shown. The authors analysed the results of the studies on the course of migraine during perimenopause and postmenopause and recommendations for women with migraine attacks and climacteric syndrome. The data presented in the review are useful for clinicians, because this information represents new views on pathogenetic mechanisms, clinical features and treatment of migraine in women.

[Cognitive impairment and compliance in chronic heart failure]. / Kognitivnye narusheniia i priverzhennost' lecheniiu u patsientov s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To determine the factors of cognitive impairment and non-compliance in patients with chronic heart failure (CHF). MATERIAL AND METHODS: One hundred and fifty-seven patients with CHF and 32 patients without chronic heart failure (controls) were examined. Neuropsychological assessment using a 30-minutes protocol recommended by NINDS-Canadian Stroke Standards (NINDS CSS), magnetic resonance imaging, cognitive ERP and a test of compliance were used. RESULTS AND CONCLUSION: Approximately 62% of patients did not perform medical prescriptions. Non-compliance was associated with an increase in the severity of subcortical and perivenricular leukoaraiosis, a slowdown in decision-making processes (an increase in the P300 latency), worse performance on speech activity tests, optical/spatial and frontal dysfunctions and memory. Patients with non-compliance had frontal cognitive impairment (58%), memory impairment (40%) and mixed forms (21%). Cognitive impairment in patients with chronic heart failure was associated with the lower left ventricular ejection fraction and deterioration in indices of diastolic function.

[Abdominal pain in migraine patients]. / Abdominal'naia bol' u bol'nykh c migren'iu.

AIM: To study the frequency of comorbid abdominal pain in migraine patients and the influence of that symptom on the formation of disease phenotype. MATERIAL AND METHODS: Clinical features of migraine were studied in 66 patients with episodic migraine and 40 patients with chronic migraine. Presence of pain, intensity, duration of seizure-associated abdominal pain and interictal abdominal pain were assessed. RESULTS AND CONCLUSION: The frequency of abdominal pain in the painful phase of migraine was >11% and did not depend on the type of migraine. Pain in the abdomen were reported by 88% of patients, with the increase in the frequency in patients with chronic migraine. The intensity and frequency of abdominal pain did not depend on organic pathology of the digestive system. Correlations between the intensity and duration of abdominal pain during the migraine attack phase (k=0.59), between the intensity of associated pain and maladjustment severity (k=0.59), and also between the abdominal pain intensity during the painful phase and in the interictal period were identified. Allodynia developed more frequently in patients with abdominal pain between migraine attacks (РF=0.005). Also relationships between the level of intensity of interictal abdominal pain and the rates of alexithymia (k=0.24), anxiety (k=0.29) and depression (k=0.25) were revealed. The association of abdominal pain with disease severity and allodynia suggests similar development of these symptoms.

[Clinical significance of nausea in migraine]. / Klinicheskoe znachenie toshnoty pri migreni.

AIM: To study the prevalence and intensity of nausea in pain, prodromal and postdromal phases of migraine paroxysm, and in between the paroxysms in migraine patients, depending on the type of migraine paroxysm and frequency of pain days, and to evaluate an effect of nausea on the course of migraine. MATERIAL AND METHODS: One hundred and four patients with migraine, aged from 18 to 60 years, were examined. The intensity of nausea was evaluated by a 5-point verbal analogue scale, and its intensity in between the paroxysms by the Gastrointestinal Symptom Rating Scale. All of the patients underwent a complex examination of the gastrointestinal tract. RESULTS AND CONCLUSION: Paroxysms with accompanying nausea were found in 90% patients. Acute nausea was associated with older age, earlier onset and longer experience of migraine. In a group of patients with acute nausea, the frequency and intensity of migraine paroxysms, probability of reoccuring pain in the first day and the severity of social disability were higher. Development of nausea in between the paroxysms and its intensity was significantly higher in patients with high intensity of nausea in migraine paroxysms. Nausea in the prodrome was significantly associated with migraine without aura and chronicity of the disorder. Patients with nausea in the prodrome also had a longer painful phase and more severe social disability. No relationship between organic diseases of the digestive tract and nausea was found. Nausea can have its own pathological mechanisms not related to concomitant diseases of the digestive tract that should be taken into account in therapeutic interventions aimed at improving quality of life of the patients.

[Cognitive functions in patients with chronic heart failure].

OBJECTIVE: To evaluate cognitive functions in patients with different stages of chronic heart failure (CHF) and different degrees of stenosis of precerebral arteries. MATERIAL AND METHODS: Authors examined 148 patients with CHF and 21 patients without CHF (controls). Neuropsychological assessment (NINDS-Canadian Stroke Standards - 30 minutes protocol), ultrasound scanning of the main cranial arteries and transcranial dopplerography and echocardiogram were made. RESULTS AND CONCLUSION: Patients with CHF more frequently had combined (multifocal) cognitive impairment. Patients with systolic heart failure performed significantly worse on neuropsychological tests, in particular, functional domains within the frontal lobes and "executive" dysfunction, than those with diastolic heart failure. Cognitive impairment in patients with CHF was associated with the lower left ventricular ejection fraction and deterioration in indices of diastolic function but not with carotid artery stenosis.

[Spread and features of chronic and recurrent infectious diseases in patients with primary headache].

AIM: Study of spread and clinical-immunologic features of chronic and recurrent infectious diseases in patients with primary headache. MATERIALS AND METHODS: 158 patients with migraine and 79 patients with tension headache were examined. Diagnostics of chronic and recurrent infectious diseases were carried out by the appropriate specialists according to the current standards. Immunologic studies included evaluation of cellular, humoral, innate immunity, cytokine status parameters. RESULTS: Spread of chronic and recurrent infectious diseases, that were considered as clinical manifestations of secondary immunodeficiency, in patients with primary headache exceeded the spread in the population of the region. In the patients with a combination of cephalgia and infectious pathology a tendency of leucopenia, lymphocyte subpopulation composition disorders, neutrophil functional activity, IgG level decrease, cytokine system imbalance were characteristic. In chronic primary headache course rate of occurrence of infectious diseases and intensity of immune status disorders were higher than in episodic course of these cephalgias. CONCLUSION: Results of these studies suggest a connection between chronic and recurrent infectious diseases within secondary immunodeficiency with primary headache.