[Cholinergic profile as a target of rational therapy of central nervous system diseases and injuries]. / Kholinergicheskii profil' kak mishen' ratsional'noi terapii zabolevanii i travm tsentral'noi nervnoi sistemy.

AIM: A comparative analysis of the clinical efficacy of cholinergic drugs and acetylcholinesterase inhibitors (IHE), as well as their combination, in the treatment of cerebrovascular disease and consequences of intracranial injury according to clinical, instrumental and laboratory dynamic observations. MATERIAL AND METHODS: Ninety patients with cerebrovascular pathology, including 45 with chronic brain ischemia stage 2 (ICD-10 I67) and 45 with sequelae of intracranial injury (ICD-10 T90.5), were enrolled in the study. Complex treatment of patients included basic and specific therapy. The groups were divided into 3 subgroups of 15 people: the neuromidin group, the gliatilin group and the neuromidin + gliatilin group. The duration of treatment was 2 months. All patients underwent a comprehensive clinical, neurophysiological and laboratory examination prior to therapy, after 1 month and 2 month from the beginning of therapy: a study of cholinesterase activity in the blood, testing on MMSE and Hamilton scales, transcranial magnetic stimulation with determination of Central motor conduction time and somatosensory evoked potentials with calculation of Central afferent conduction time. RESULTS: Prior to treatment, a significant positive strong correlation was found between the age of patients and the level of CE activity in serum (Rs=0.77; p=0.0001). The treatment resulted in a significant (p<0.05) improvement of all parameters (except for MMSE that showed a trend towards improvement) in the neuromidin and the neuromidin + gliatilin subgroups of each group compared to those in the gliatilin subgroups. In addition, after 2 months from the beginning of treatment, there was a significant decrease in the activity of CE in serum in the neuromidin and the neuromidin + gliatilin subgroups. CONCLUSION: The study of deviations of the 'cholinergic profile' (the level of CE activity in the blood) in patients with cerebral pathology and the strategy using cholinergic drugs, IHE and their combination for the treatment of neuropsychiatric disorders, is one of the important directions in the optimization of combined therapy of patients of this profile.

[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.

[Contemporary paradigm of rational stroke treatment]. / Sovremennaia paradigma ratsional'noi terapii insul'tov.

Stroke was and remains one of the world's leading medical and social problems. Nowadays we are watching permanent sometimes cardinal changes in view about etiology, pathogenetic mechanisms and therapy of patients with stroke. In this work there have been elucidated contemporary theoretical and practical aspects of stroke treatment and prophylaxis 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 is showed that application of neuroprotective drugs is of great importance, among which antihypoxants with pleiotropic action play a crucial role (mexidol).