[Main directions of differential diagnosis optimization and rational treatment of an acute vertigo attack]. / Osnovnye napravleniia optimizatsii differentsial'noi diagnostiki i ratsional'noi terapii ostrogo pristupa golovokruzheniia.

AIM: To develop and assess the validity of the clinical algorithm VERTIGO for the differential diagnosis of central and peripheral vertigo and optimization of treatment of patients with vertigo. MATERIAL AND METHODS: Sixty-five patients with an acute attack of vertigo, aged from 18 to 75 years (53±6.7 years), were studied. All patients underwent standard neurological examination. In case of signs of central vertigo, patients underwent neuroimaging. Diagnostic accuracy, sensitivity and specificity of the VERTIGO algorithm as well as its positive and negative prognostic values were calculated. RESULTS: The sensitivity of VERTIGO for the diagnosis of central vertigo was 100% (95% CI: 78.2-100%), specificity 94.0% (95% CI: 83.5-98.8%), positive prognostic value 83.3% (95% CI: 58.6-96.4%); negative prognostic value 100% (95% CI: 92.5-100%). Cohen's kappa estimated by the results of final diagnosis was 0.88. CONCLUSION: Differential treatment of patients with acute vertigo should be performed according to the current recommendations and include multimodal pharmacological medications, e.g. cavinton forte, to restore the vestibular control by the stimulation of neuroplasticity. The VERTIGO algorithm allows the increase of the efficacy of clinical differential diagnosis of central and peripheral vertigo.

[Significance of sleep deprivation in the development of local epilepsy from neuroplasticity opinion]. / Znachenie deprivatsii sna v razvitii lokal'no obuslovlennoi epilepsii s pozitsii kontseptsii neiroplastichnosti.

AIM: Learning cycle «sleep-wake¼ is of great theoretical and practical importance because it allows to understand the general patterns of adaptive mechanisms of human interaction with the environment (neuroplasticity), violations of which are the basis of many diseases of the CNS, including epilepsy. MATERIAL AND METHODS: Complex clinical and electroencephalographic (video-EEG monitoring with mandatory recording of sleep) study was carried out before and after prolonged sleep deprivation (for at least 1 day) of 178 patients with locally due to epilepsy (LEi). 45 healthy volunteers were examined in the control group as well as the patients with epilepsy. The work was carried out to compare the results of clinical and neurological and electrophysiological studies during sleep deprivation (SD) in patients with LEi and in healthy individuals with neurohistological and electron microscopic patterns of changes in the brain of rats in an experiment with 48-hour SD. RESULTS AND CONCLUSION: Discovered in the CNS of rats after SD morphological changes such as pleyokoniya of mitochondria, damage in the blood-brain barrier, signs of exhaustion astrocytes, glial cells and the change of the nuclei of gliocytes and some neurons of the type of apoptosis and karyorrhexis and destruction of synapses reveal a violation of the fundamental mechanisms of neuroplasticity. The results allow us to consider the SD patients as a damaging factor for the central nervous system, provoking the development of epileptic seizures and epilepsy, and the SD in laboratory animals can be used as a model for further study of the mechanisms of neuroplasticity. In addition the findings greatly complement current understanding of the mechanisms of neuroplasticity and pathogenesis of epilepsy, and justify the need for the study of therapeutic efficacy of modulators of neuroplasticity (transcranial magnetic stimulation, ipidacrin etc.) in the complexe treatment of patients with the this specified profile.

[Theoretical and practical aspects of treatment and prevention of acute cerebral blood cerculation disorders]. / Teoreticheskie i prakticheskie aspekty terapii i profilaktiki ostrykh narushenii mozgovogo krovoobrashcheniia.

Stroke is an important medical and social problem. Views about etiology, pathogenetic mechanisms and therapy of patients with stroke have undergone significant changes. In this work, we elucidate contemporary theoretical and practical aspects of stroke treatment and prevention based on the results of multicenter clinical trials and experience of leading foreign and native specialists. Much attention is devoted to the pharmacotherapy of patients with stroke. It has been shown that neuroprotective drugs, in particular, antihypoxants with pleiotropic action (mexidol), play an important role in treatment of ischemic stroke.

[Metabolic therapy in neurology].

We studied the efficacy of rheosorbilact, an original infusion drug based on polyalcohols, in the complex therapy of patients with brain ischemia and diabetic neuropathy. Reosorbilact was used intravenously indrops 200-400 ml in day - 20 days. The primary endpoint of the study was the improvement of quality of life assessed with the SF-36 scale after 1 month of treatment. Patients with brain ischemia underwent neuropsychological tests and ultrasound duplex scanning of the carotid and vertebral arteries. In the group of patients with diabetic neuropathy, we evaluated the intensity of pain syndrome with the NRS, blood glucose level and electroneuromyography parameters of low extremities nerves. Some characteristics of acid-base balance were studied in patients of both groups. The results obtained in the study indicate the significant clinical effect of reosorbilact in patients with brain ischemia and diabetic neuropathy.

[Omaron in the treatment of vertebrobasilar insufficiency].

The study aimed at evaluation of tolerability, safety and clinical efficacy of omaron in the treatment of vertebrobasilar insufficiency (VBI). Forty patients with different stages of VBI have been examined. A diagnosis of VBI was based on the results of neurological study, ultrasonic dopplerography, electroencephalography, electrocardiography, brain MRI and CT examination. Neurological scales were used for assessment of neurological status and further data processing. The treatment with omaron resulted in significant clinical improvement and stabilization of the pathological process. The drug is well-tolerated by patients including those of older age groups.