[Experience of using eculizumab in refractory myasthenia gravis]. / Opyt primeneniya ekulizumaba pri refrakternoi miastenii.

Myasthenia gravis (MG) is a chronic autoimmune disease mediated by autoreactive T- and B-cells and manifested by progressive pathological muscle weakness and fatigue. Traditional immunomodulatory treatment does not always lead to the clinical picture significant improvement, despite adequate dosage and duration of use. Refractory myasthenia gravis requires new therapeutic approaches development and implementation. The range of target innovative agents in refractory MG includes monoclonal antibodies, which act directly on individual components of the complement system. Based on the results of randomized controlled trials, data on the effectiveness and safety of eculizumab, which inhibits the C5 component of the complement system, is presented. We present our own clinical experience of using eculizumab in a young woman with refractory generalized AChR-positive MG with a rapid decrease in the severity of symptoms to a minimum level and restoration of ability to work, and the absence of adverse events during therapy.

[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.

[Sinus node activity in Parkinson's disease].

Results of evaluation of cardiac rhythm variability (CRV) in Parkinson's disease (PD) are presented. High-resolution rhythmocardiography with a KAP-RK-01-Mikor diagnostic system was used to register CRY, peripheral and autonomous dysregulation of pacemaker activity of the synoatrial node. Reduced CRV was documented in 107 PD patients of whom 26% exhibited synoatrial dysfunction. The temporal statistical and spectral analysis of CRV, comparison of its results with clinical data suggest dissociation between cerebral and peripheral vegetative effects in PD, relatively well preserved suprasegmental ergotropic regulatory afferent impacts, and inadequate vegetative control at the post-ganglionic level.