[Long-term postoperative outcomes in patients with drug-resistant epilepsy]. / Otdalennye rezul'taty khirurgicheskogo lecheniya patsientov s farmakorezistentnymi formami epilepsii.

Epilepsy surgery is effective in 30-82% of patients with drug-resistant epilepsy. However, risk factors of unfavorable outcomes after epilepsy surgery require further study. OBJECTIVE: To evaluate risk factors of favorable and unfavorable long-term postoperative outcomes in patients with drug-resistant epilepsy. MATERIAL AND METHODS: Postoperative outcomes in a large cohort of patients with epilepsy are reported for the first time in the Russian Federation. There were 271 patients with drug-resistant scheduled for surgery. Preoperative examination and surgical treatment were carried out between January 1, 2014 and December 12, 2019 at the Evdokimov Moscow State University of Medicine and Dentistry and Sklifosovsky Research Institute for Emergency Care. We used Engel grading system to assess postoperative outcomes after 12, 24, 48 and 60 months. We distinguished favorable (Engel I-II) and unfavorable (Engel III-IV) outcomes and analyzed the factors influencing postoperative results in these patients. RESULTS: There were 319 surgical procedures in 271 patients (217 primary resections, implantation of vagus nerve stimulator in 31 patients, 9 redo resections and 8 radiosurgical procedures). Focal cortical dysplasia (FCD) was found in 162 (60%) patients, «dual pathology¼ - in 118 (44%) cases. In 12 months after surgery, favorable outcomes (Engel l-II) were observed in 69% of patients (n=148), after 24 months - in 71% (n=127) of patients. Postoperative complications occurred in 6 (1.9%) patients. There was no mortality. The earlier onset of epilepsy (p=0.01), multifocal (p=0.002) and bilateral lesions (p=0.0038) were the most significant risk factors of unfavorable postoperative outcomes. CONCLUSION: Surgical resection is effective approach for drug-resistant epilepsy.

[New Technologies in the Diagnostics and Treatment of Brain Deseases: from Neurosciences to the Multidisciplinary Clinical Practice and Maintaining of Mental Health].

Over the past years, the prevalence of brain diseases and, consequently, their social significance and economic burden for society has been steadily increasing throughout the world. Brain diseases are a heterogeneous group of diseases that unite a number of disorders that are within the competence of both neurology and psychiatry, often concurrent or comorbid with each other. Z. P. Soloviev Research and Clinical Center for Neuropsychiatry is a leading medical organization in Moscow, which performs a full treatment cycle, studies the data and has postgraduate training programs in this field of medicine. It is conducting a number of relevant research programs; some in collaboration with international clinics. This study deals with the following programs: fundamental aspects of depression and stress-reactivity, suicidal and self-damaging behavior, usage of biofeedback and gravity therapy in rehabilitation and training programs for medical workers in successful communication.

[Paresthesias of the upper respiratory tract in the patients of the elder age group]. / Parestezii verkhnikh dykhatel'nykh putei u patsientov starshei vozrastnoi gruppy.

The present study was designed to carry out the comprehensive clinical examination of 120 patients presenting with paresthesia of the upper respiratory tract (42 men (35%) and 78 women (65%P) aged 56 to 90 years). The most frequent complaints included cough (72%), globus sensation (46%), itching (43%), dry throat (38%), and difficulty of swallowing (28%). The duration of the clinical symptoms ranged from 1 month to 3 years (m±M: 1+to 1.46). The etiological factors behind paresthesias in the patients of the older age groups in comparison with the patients below 55 years of age included gastroenterological and cardiovascular diseases, pathology of the broncho-pulmonary system, and neurological pathology. ENT pathology was diagnosed equally often in the patients of both groups. Endocrine pathology and stress-associated conditions occurred more frequently in the patients below the age of 55 years. The intolerance of drugs was more commonly encountered in the patients of the older age group (amounting up to 35%). It is concluded that the ultimate etiological factor of paresthesia of the upper respiratory tract can be deduced based on the detection of a particular disease and the analysis of the dynamics of the patients' complaints after the completion of the adequate treatment.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts]. / Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ékspertov.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

[Possible applications of rac-hopantenic acid in the treatment of anxiety and depressive disorders in patients with chronic cerebral ischemia]. / Vozmozhnosti primeneniya rats-gopantenovoi kisloty v kompleksnom lechenii trevozhno-depressivnykh rasstroistv u bol'nykh s khronicheskoi ishemiei golovnogo mozga.

AIM: To evaluate the efficacy and tolerability of rac-hopantenic acid (pantogam activ) in patients with mixed anxiety-depressive disorder and anxiety-depressive disorder with chronic cerebral ischemia. MATERIAL AND METHODS: A total of 50 patients were examined (30 patients in the main group, 20 patients in the control one). All patients received standard therapy with SSRI antidepressants. Rac-hopantenic acid at a daily dose of 1200 mg was included in the complex therapy of patients of the main group. Duration of the therapy with rac-hopantenic acid was 21 days. Psychopathological, psychometric and detailed somatic examinations were performed. RESULTS: In the main group, the combination of pantogam activ and antidepressants promoted distinct balanced nootropic, antidepressant and anxiolytic effects, as well as the improvement of health outcomes. The reduced total number of adverse events (less frequent drowsiness and headaches) was noted as well. CONCLUSION: The rapid and reliable reduction of anxiety, depression and cognitive impairment during concomitant therapy with antidepressants and pantogam activ was identified.

[A feedback method in clinical practice].

The authors reviewed a history of development of a feedback method, its physiological basis, essence, methodological aspects of its practical application and factors related to its effectiveness. This method may be used in studies of basic functional disorders, syndromes and diseases. Perspectives of its using in restorative and preventive health care are considered.

[Apathy in the structure of mental and neurological disorders of the old age].

The studies on apathy, a common phenomenon in psychiatry, are summarized. The definitions of this term suggested by different authors are presented. The difference between apathy as a symptom and apathy as a syndrome is described. Main pathogenetic mechanisms of the development and epidemiology of this disorder, the results on the differential diagnosis of apathy and depression in patients with neurological and mental diseases as well as methods of treatment are presented.

[Possibilities of using intravenous forms of antiepileptic drugs in epileptic seizures]. / Vozmozhnosti primeneniia vnutrivennykh form protivoépilepticheskikh preparatov pri épilepticheskikh pristupakh.

The literature data on using intravenous forms of AEDs that expand treatment possibilities for patients with epilepsy are presented. AEDs can be used in different situations, when patients are not able to take AEDs in per os. These situations can include seizure emergencies (recurrent seizures, clusters, status epilepticus), caused by disease decompensation; acute symptomatic seizures; perioperative preparation in the case of surgery; dysphagia; gastrointestinal problems; psychiatric disorders, and others. This article is based on a review of International and Russian expert consensus practice guidelines for management of clinical situations mentioned above. The authors present data on available Russian parenteral forms of drugs used today (valproats, levetiracetam, lacosamide, diazepam, midazolam, propofol, thiopental potassium). It has been concluded that an ideal intravenous AED should be highly effective, acts fast, has no severe adverse effects, has low drug-drug interactions, does not require frequent plasma concentration monitoring, and should be easily switched to a per os form without any additional titration. The importance of separate treatment approaches on different stages of medical help is emphasized. The choice of drug used can be influenced by a particular clinical situation, indications/contraindications, the recommended infusion speed, side effects, possible drug-drug interactions with other AEDs and other drugs used for the treatment of concomitant diseases, availability of a particular drug at the moment and the level of a physician's knowledge of usage of intravenous forms of AEDs.

[Influence of cytoflavin on symptoms of asthenia, emotional disorders and autonomic regulation in patients with organic asthenic disorder].

The present observational study addressed effects of cytoflavine on symptoms of asthenia and emotional and autonomic regulation in patients with organic emotional-labile (asthenic) disorder (F06.6). Fifty one females and 49 males (mean age 36.8±11.0 years) were included into the study during their in-patient treatment in Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department. All patients received standard antidepressant and vascular therapy, were consulted by psychologists or psychotherapists, visited physiotherapeutic procedures, massage and medical physical training. In addition, 50 patients received cytoflavin two tablets twice per day. At the psychiatric re-assessment before discharge both cytoflavin and control groups showed similar significant reduction of asthenia symptoms. At the same time, patients with cognitive deficits showed significantly larger improvement of cognitive functions after cytoflavin treatment in comparison with cognitively deficient patients after only standard therapy. Improvement of depressive symptoms was significantly larger in cytoflavin group in comparison with controls as well. These data are consistent with previous studies which showed cytoflavin to be effective as a treatment for patients with cognitive deficits and organic depression.

[The role of neurobioregulation in the combined treatment of subjective tympanophonia and dizziness].

The objective of the present study was to evaluate the effectiveness of the biological control technologies applied in the framework of the combined treatment of the patients complaining of subjective tympanophonia and dizziness with concomitant changes in the psychoemotional status. It was shown that the disturbances in the psychoemotional sphere associated with complaints of subjective tympanophonia and dizziness took place in 81.4% of the patients included in the study although 17.2% of them had no signs of organic pathology in the central and peripheral regions of the auditory and vestibular apparatuses. It is concluded that the proposed therapeutic strategy can be recommended in the case of poor effectiveness of the medicamnetal treatment in the patients presenting with subjective tympanophonia and dizziness with concomitant changes in the psychoemotional status because it permits to eliminate clinical manifestations of the disease or reduce their severity.

[Paresthesias of the upper respiratory tract].

This review concerns the modern views of etiology, diagnostics, and treatment of the patients presenting with paresthesias of the upper respiratory tract. Various concepts of etiology of this pathology are described along with the relevant diagnostic and therapeutic approaches. Special attention is given to the debatable aspects of diagnostics and treatment of the patients complaining of the feeling of a lump in the throat ("globus sensation"). The opinions of the domestic and foreign authors concerning this problem are considered. The necessity of the search for the new additional therapeutic procedures for the treatment of paresthesias of the upper respiratory tract, including the non-medicamental modalities, is substantiated. It is concluded that the development of the new adequate diagnostic and therapeutic algorithm is indispensable for the enhancement of the effectiveness of the management of the patients with paresthesias of the upper respiratory tract and complaints of "globus sensation".

[Molecular and cellular mechanisms of depression. Role of glucocorticoids, cytokines, neurotransmitters, and trophic factors in genesis of depressive disorders].

Here we review modern data on appearance and maintenance of depression at different levels of the body. We discuss a role of impairments of emotional and motivation mechanisms of adaptive behavior in genesis of depression. We demonstate an interaction of stress response and neuroinflammatory processes in pathogenesis of depression and analyze the effects of these molecular cascades on neurotrophic support of the central mechanisms of memory and neurogenesis.

[Modern approaches to the encephalographic diagnosis of non-convulsive status epilepticus].

The article presents modern conceptions on instrumental diagnosis, using electroencephalography, of non-convulsive status epilepticus (NCSE) based on a traditional classification and recommendations of the American Clinical Neurophysiology Society (2012). The descriptive diagnostic parameters for the recognition of different changes in the brain electrical activity in NCSE and their correlations in the structure of traditional and new classifications are presented.

[Investigation of the effects of cytoflavin on symptoms of depression and autonomic dysfunction in patients with organic depressive disorder].

The present observational study addressed effects of cytoflavin as an adjunctive nootropic therapy in patients with organic depressive disorder (F06.36). 54 female and 46 male in-patients were included into the study. All patients received standard antidepressant therapy (controls) and 48 patients additionally received 2 pills of cytoflavin twice per day. Age, gender distribution, education and severity of depression were equal in cytoflavin and control groups. The follow-up assessment at discharge showed a significantly more pronounced decline in the severity of depression symptoms in patients receiving cytoflavin in comparison with the controls. Importantly, the effect of cytoflavin on the depression symptoms was prominent only in females. Moreover, women receiving cytoflavin demonstrated the more pronounced normalization of autonomic regulation in comparison with control women. The present results allow to recommend cytoflavin in dose 4 pills daily as an adjunctive therapy in female patients with organic depressive disorder.

[Age aspects of quality of life research in patients with epilepsy].

In spite of the fact that patients of advanced age are the fastest growing population of patients with epilepsy, there is no sufficient data on quality of life (QOL) questionnaires sensitivity in the elderly patients. The aim of this study was to evaluate correlations between QOLIE-31 and QOLIE-10 scores in the elderly and young patients with epilepsy before and after antiepileptic therapy optimization. Twenty-seven elderly (average age 65.36±3.88 years) and 30 young (average age 25.05±3.06 years) patients completed questionnaires QOLIE-31 and QOLIE-10 The analysis of QOL indicators was conducted at the following control points: 1) before the beginning or correction of antiepileptic therapy; 2) 6 months after the beginning of therapy or its optimization. In young patients after the beginning or optimization of therapy, the statistically significant negative correlation between the majority QOLIE-31 subscales and a total QOLIE-10 score, with the exception of the "Emotional well-being", was revealed. In the elderly patients, the positive correlations with the "Energy/fatigue" (r=0.46) and the "Medications effect" (r=0.20) subscales were noted. Considering the score estimation in QOLIE-31 and QOLIE-10 questionnaires, the revealed positive correlations could testify smaller sensitivity of questions in the brief version (QOLIE-10) in the elderly patients with epilepsy in comparison with young patients. According to the data received, the validity of QOLIE-10 appeared to be insufficient in the elderly patients, with the QOLIE-31 questionnaire being preferred. In young patients, the QOLIE-10 can be recommended as a screening QOL tool at the beginning of antiepileptic therapy, and later for estimation of AEDs efficiency.

[Valproate (depakine chrono) in adult patients with partial epilepsy: results of a multicentral prospective non-comparative study].

We present results of an open multicentral prospective non-comparative clinical study on the efficacy and tolerability of depakine-chrono in patients with newly or recently diagnosed partial epilepsy (VIPe-1) that has been carried out in the Russian Federation. The study included 299 patients. It's duration was 6 months. Efficacy and tolerability of the drug used in mean dose 1479.0±448.7 mg/day were evaluated. After 6 month of treatment, 65.9% (95% CI 60.2 -71.2%) of patients were seizure-free. There was no significant difference in seizure-free rate in patients with different types of focal seizures. The improvement assessed with the Clinical Global Impression Scale (CGI) was seen in 73.3% of patients. Adverse events (mild or moderate) were recorded in 8% of patients. The most common adverse events were weight gain in (1.7%), hair loss (1.7%) and gastrointestinal disorders (1.3%). A serious adverse event (thrombocytopenia) occurred only in one case (0.3%). The results confirmed the high efficacy and good tolerability of depakine-chrono as first line monotherapy in adult patients with partial epilepsy.

[Clinical significance of humoral compensatory reactions in the acute period of ischemic stroke].

To determine the clinical significance of humoral nonspecific reactions in the acute period of ischemic hemispheric stroke (IS), some biochemical and biophysical parameters have been studied in 30 patients (mean age 67±10 years). Platelet monoaminooxidase (MAO) activity, levels of middle-sized molecules (MM), malonic dialdehyde (MDA) and parameters of the functional state of serum albumin (the effective concentration and binding reserve of albumin) have been measured. Severity of neurological deficit and functional recovery of patients with IS was assessed with the NIHSS and the Barthel index. The control group included 17 age- and sex-matched healthy people (p<0,1). The significant changes in all biochemical and biophysical parameters were seen in patients compared to the control group (p<0,01). The increase in MAO activity in patients was associated with the enhancement of free-radical reactions MDA/MAO: rs=+0,62, p=0,0001. The elevation of acceptor capacity of albumin related to the enhancement of its detoxicating function was found in patients with the regression of neurological deficit. It has been assumed that some nonspecific humoral reactions play a pathogenetic role in the acute period of ischemic stroke.