[Type 2 diabetes and cognitive functions in patients with chronic cerebrovascular diseases].

BACKGROUND: Type 2 diabetes (Т2DM) both directly and indirectly impacts the development of morphological and functional changes of the central nervous system. AIM: The study was to determine clinical and neurophysiological patterns of cognitive impairment (CI) in patients with chronic cerebrovascular diseases (CCD) and Т2DM. MATERIALS AND METHODS: We examined 132 patients with CCD. First group included 58 patients without Т2DM aged 64.5 [58; 72], second group 74 patients with CCD and Т2DM 63 [57; 70]. Clinical, neurological, neuropsychological, neurophysiological (cognitive evoked potentials (EP) and neurovisualisation (brain MRI) examination was carried out to all patients. RESULTS: Somatic and neurological characteristics of the patients were similar in both groups with the exception of more distinct metabolic changes in Т2DM patients. Neurovisualisation study of the brain MRI in Т2DM patients revealed more distinct changes in the form of white matter hyperintensity and subarachnoidal spaces enlargement. Neuropsychological examination in patients revealed the reduction of intellectual flexibility, constructive praxis disruption, optical spatial dysfunction and deteoration of delayed word recall. Significant disorders in the way of overall cognitive impairment, lobar dysfunction and impaired verbal associative productivity, proved by statistically lower amplitude and higher latency of P300 EP peak were noted in Т2DM patients. Correlation links were detected: for P300 amplitude and direct and inverse number listing test (r=0.366 and r=0.520; p=0.006 and p0.001 respectively); P300 latency and HbA1c (r=0.32; р0.05) in group 2 and glucose levels in both groups (r=0.30; p0.05); inverse relationship of latency with control functions evaluation (r=-0.34; p=0.008). CONCLUSION: CCD especially with Т2DM manifests with neurocognitive imbalance, including control functions disruption and are accompanied by neurophysiological and neurovisualistion changes.

[Chronic cerebrovascular diseases and neuroprotection: the clinical efficacy of meldonium (Mildronat)]. / Khronicheskie formy narushenii mozgovogo krovoobrashcheniya i neiroprotektsiya: klinicheskaya effektivnost' primeneniya mel'doniya (Mildronat).

OBJECTIVE: To evaluate the efficacy of meldonium (mildronat) in patients with chronic cerebral vascular disease (CVD). MATERIAL AND METHODS: An open comparative study of the clinical efficacy of meldonium (mildronat) in patients with chronic CVD caused by arterial hypertension and atherosclerosis was conducted. The main group included 30 (60%) patients who were prescribed meldonium (mildronat) at a dose of 1000 mg per day in addition to routine basic therapy. The control group was consisted of 20 (40%) patients who received routine basic therapy only. The duration of the study was 60 days. To evaluate the clinical efficacy of the meldonium (mildronat), the main subjective clinical symptoms, neurological, psychoemotional and cognitive status, quality of life were assessed when patients were included in the study (before treatment), on the 11th and 60th days from the start of treatment. To assess the meldonium (mildronat) effect on the endothelium vascular wall, asymmetric dimethylarginine (ADMA), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and endothelin-1 were determined in the blood when patients were included in the study, on the 11th and 60th days from the start of treatment. RESULTS: Meldonium (mildronat) has a positive therapeutic effect on the main clinical symptoms and cognitive functions which appears in increasing the quickness of mental activity, improving short-term and operative memory, increasing the resistance of mental processes and memory traces to interfering influences, and improving cognitive evoked potentials P300 results. Meldonium (mildronat) therapy leads to the decrease in the level of state and trait anxiety. The quality of life of patients treated with meldonium (mildronat) increases due to the physical and mental components. The effect of meldonium (mildronat) on the decrease in endothelin-1 and PAI-1 levels, which indicates the antitrombogenic effect of the drug, has been identified. CONCLUSION: Nootropic, anxiolytic and antitrombogenic effects of meldonium (mildronat) in patients with chronic CVD are demonstrated that makes it possible to recommend this drug for widespread use by specialists in clinical practice.

[The study of diagnostic capabilities of somatosensory evoked potentials in patients with neurogenic urinary retention]. / Diagnosticheskie vozmozhnosti issledovaniia somatosensornykh vyzvannykh potentsialov u bol'nykh s neirogennoi zaderzhkoi mochi.

OBJECTIVE: To study diagnostic capabilities of somatosensory evoked potentials (SSEP) in clarifying the mechanisms of formation of urinary disorders. MATERIAL AND METHODS: The authors studied the characteristics of nerve impulses during stimulation of the pudendal and tibial nerves in patients with neurogenic urinary retention and cerebral ischemic stroke in the parietal lobes (4 patients), spinal ischemic stroke (10 patients), myelitis at the level of thoracic segments (7 patients), spinal cord cauda equina tumors (3 patients). RESULTS AND CONCLUSION: The study of SSEPs made it possible to determine the localization and nature of damage to the structures of the central nervous system and to establish the neurogenic cause of urinary disorders.

[A pathogeneteic approach to the treatment of vestibular disorders in angioneurology]. / Patogeneticheskii podkhod k lecheniiu vestibuliarnykh rasstroistv v angionevrologii.

AIM: To study the efficacy of vinpocetine (cavinton comfort) in the treatment of vestibular disorders in patients with chronic cerebral ischemia. MATERIAL AND METHODS: A prospective study included 82 patients (43 men and 39 women, aged 61-75 years, mean age 63,8±5,4 years, with chronic cerebrovascular disease (1-2 stages) with vestibular disorders. Patients were divided into two groups. Patients of the main group were treated with cavinton comfort (10 mg three times per day during 60 days), while patients of the control group did not receive the drug. Subjective and objective symptoms of chronic cerebral ischemia were assessed on a 5-point scale. The results of objective otoneurological examination and auditory evoked potentials were also taken into account in assessing the effectiveness of therapy. RESULTS: The main clinical symptoms comprised vestibular disorders, cephalgia and asthenic syndrome. The reduction in subjective symptoms was noted in 71% of patients in the main group and 34% in the control group and improvement of objective manifestations in 74% and 37%, respectively. The efficacy of cavinton comfort was confirmed by the results of auditory evoked potentials. There was a decrease in the latency of the main peaks and increase in their amplitude (bilaterally). CONCLUSION: Cavinton comfort is an effective treatment of vestibular disorders, associated with central lesions of the vestibular system.

[Neurophysiological assessment of persistent idiopathic facial pain]. / Neirofiziologicheskaia otsenka persistiruiushchei idiopaticheskoi litsevoi boli.

AIM: To study neurophysiological characteristics of persistent idiopathic facial pain (PIFP) in comparison to trigeminal neuralgia. MATERIAL AND METHODS: Forty-five patients with PIFP at the age from 25 to 74 years (42 women and 3 men), 25 patients with trigeminal neuralgia at the age from 25 to 84 (15 women and 10 men) and 20 healthy volunteers were examined. Multimodal evoked potentials (EP): brainstem auditory (BAEPs), trigeminal (TEPs) and sympathetic skin responses (SSRs) evoked potentials were recorded. EEG with functional tests (hyperventilation, rhythmical photic stimulation and test with eye opening) was recorded as well. RESULTS: The neurophysiological pattern of PIFP includes: 1) shortening of the latent period (LP) and an increase in peak amplitudes of short-latent components of the BAEPs on both sides in combination with signs of brainstem structure dysfunction (fusion of II-III or III-IV peaks, bifurcation of peaks and lengthening of inter-peaks intervals); 2) normal parameters of the TEPs; 3) an increase in the amplitude of autonomic components (sympathetic and parasympathetic without signs of predominance of the tone of this or that system), intensification of the autonomic reaction; 4) disorganization and acuity of the alpha rhythm, smoothing of zonal differences, presence of bilateral tapering alpha-, theta- or alpha-theta waves on the EEG. CONCLUSION: Patients with PIFP have significant changes in EP and EEG connected with brainstem structure dysfunction and irritation of subcortical structures and autonomic disorders.

[The clinical significance of the lamotrigine pharmacokinetic variability]. / Klinicheskoe znachenie farmakokineticheskoi variabel'nosti lamotridzhina.

AIM: To estimate pharmacokinetic variability of lamotrigine (LTG) and its clinical significance. MATERIAL AND METHODS: One hundred patients, including 74 women, aged from 18 to 77 years (38.23±14.37 years), with focal epilepsy were examined. Monotherapy with LTG was administered to 54 patients, duotherapy to 46 patients (LTG and valproic acid combination to 27 patients, LTG and liver enzymes inducers to 19 patients). Patients underwent procedures of therapeutic drug monitoring (TDM). Minimal (Cssmin) and maximal (Cssmax) steady-state LTG plasma concentrations, and concentration-to-weight ratio (CDR) were calculated. RESULTS AND CONCLUSION: In patients who used LTG in monotherapy, LTG Cssmin was 5.6±4.65 mg/l, Cssmax 7.59±5.54 mg/l. In the group that received LTG in combination with valproate, LTG Сssmin was 7.8 [5.4; 11.8] mg / l and Cssmax 11.4 [7.3; 15.3] mg/l. In the group that received LTG in combination with drug-inducers of glucuronidation, Cssmin was 2.5 [1.99; 4.32] mg/l, Cssmax 4.73 [2.91; 6.70] mg/l. Statistically significant differences in CDR parameter between groups with LTG monotherapy and duotherapy, both with inducer and with inhibitors, as well as between groups of duotherapy with inductors and with inhibitors were obtained. The results of the study indicate a pronounced pharmacokinetic variability of the LTG. Conducting TDM allows the establishment of individual therapeutic concentrations of LTG in blood plasma and setting a correction vector for antiepileptic therapy.

[Brainstem auditory evoked potentials in neurophysiological assessment of brain stem dysfunction in patients with atherostenosis of vertebral arteries]. / Akusticheskie stvolovye vyzvannye potentsialy v neirofiziologicheskoi otsenke disfunktsii stvola mozga u patsientov s aterostenozom pozvonochnykh arterii.

AIM: To assess brain stem dysfunction in patients with hemodynamically significant stenosis of vertebral arteries (VA) using short latency brainstem auditory evoked potentials (BAEP). MATERIAL AND METHODS: The study group included 50 patients (mean age 64±6 years) with hemodynamically significant extracranial VA stenosis. RESULTS: Patients with hemodynamically significant extracranial VA stenosis had BAEP abnormalities including the elongation of interpeak intervals I-V and peak V latency as well as the reduction of peak I amplitude. After transluminal balloon angioplasty with stenting of VA stenoses, there was a shortening of peak V latency compared to the preoperative period that reflected the improvement of brain stem conductive functions. CONCLUSION: Atherostenosis of vertebral arteries is characterized by the signs of brain stem dysfunction, predominantly in the pontomesencephal brain stem. After transluminal balloon angioplasty with stenting of VA, the improvement of brain stem conductive functions was observed.

[Identification of people at the latent stage of Parkinson's disease (the PARKINLAR study): first results and an optimization of the algorithm].

AIM: To work out an optimal algorithm to identify people at the latent stage of neurodegenerative process of «parkinsonian¼ type in the Russian population. MATERIAL AND METHODS: Authors launched a two-step study aimed at identifying people at the latent stage of Parkinson's disease (PD) in the Russian population - the PARKINLAR (PARKINsonism, LAtent stage, Russia). As the first step, we formed a group of «primary risk¼ by the identification in neurologically healthy people of at least one of the following confirmed PD risk factors: a) the substantia nigra hyperechogenicity (ultrasound screening was performed in 193 people); b) mutations in «parkinsonian¼ genes (genetic screening was performed in 29 relatives of PD patients from families with LRRK2, PARK2 and GBA mutations). Thereby, 37 people comprised the «primary risk¼ group, of whom 23 agreed to continue further examination (44±10.2 years). A matched group of people without the aforementioned primary biomarkers of PD served as control. As the second step, we undertook in the prescreened groups a complex of investigations assessing the presence of secondary («minor¼) biomarkers of PD: Sniffin' Sticks olfactory testing; color visual evoked potentials; analysis of goal-directed eye-head-hand movements with the use of a special neuro-cybernetic system; assessment of motor and non-motor symptoms with the use of UPDRS and NMSS scales. RESULTS: When comparing the «primary risk¼ group with controls, maximal differences in the occurrence of symptoms were seen for goal-directed eye movements (43.5% vs. 20.0%) and color vision (39.1% vs. 26.7%). Among these individuals, we found two people with 4 secondary biomarkers and one with 3, and no such observations in controls. People with the combination of a primary biomarker with several secondary biomarkers of PD comprised a group of «high risk¼ in our study. CONCLUSION: Optimization of this algorithm of population screening of people predisposed to the development of PD may be done by expanding the spectrum of biomarkers and assessing their validity in a long-term prospective observational study.

[The modern methods of the electrical stimulation for the management of neurogenic disturbances of urination].

The results of the present study provide materials for the characteristic and the comparative analysis of the methods for electrical stimulation applied for the treatment of neurogenic disorders of urination and illustrate the up-to-date requirements to this therapy taking into consideration the neuroanatomical and neurophysiological features of micturition. One of the most advanced non-pharmacological methods is electrical stimulation and neuromodulation of the urinary bladder function and pelvic floor muscles. The objective of this three-step research was to elucidate the mechanisms of action of electrical stimulation and to compare the effects of tibial and pudendal neuromodulation in 22 patients presenting with ischemic lesions in the brain. The first step included the comprehensive clinical and neuroimaging investigations designed to determine the role of functional asymmetry of cortical and subcortical micturition regulatory centers during the recovery process following the ischemic lesions. At the second stage, afferent and central regulation of micturition was investigated by the method of tibial and pudendal somatosensory evoked potentials in the patients presenting with overactive bladder and acute or chronic cerebral ischemia. At the final step, the optimal parameters of neuromodulation were chosen depending on the form of the urination disorder. It is concluded that the study gave evidence of the high therapeutic effectiveness of tibial and pudendal neuromodulation for the treatment of overactive bladder associated with neurological disorders (including ischemic lesions in the brain).

[The role of the otoneurological method in early diagnosis of multiple sclerosis].

Complete vestibulometric, audiological and otoneurological examinations were made in 48 patients with multiple sclerosis (MS). Central cochlear-vestibular syndrome was diagnosed in all the examinees. The otoneurological examination and comparison of changes in the acoustic and vestibular functions revealed specific symptoms characteristic for demyelinating disease of the central parts of the cochleovestibular analyzer. MR-tomography visualization of the demyelination foci in the brain confirmed affection of the cochleovestibular analyzer.

[The analysis of brainstem acoustic evoked potentials in diphtheritic polyneuropathy].

The possibility of central and peripheral impairment of the acoustic analyser was studied in 18 patients with severe diphtheritic polyneuropathy (DP) using brainstem acoustic evoked potentials (BAEPs). The acoustic nerve impairment was found in 27.8%, the central abnormalities--in 44.4%. All the patients with CNS impairment suffered from chronic alcoholism. The data obtained have been compared to those of 26 patients with chronic alcoholism. In this group, peripheral polyneuropathy was confirmed in 76.9% cases; BAEPs revealed isolated involvement of the peripheral part of the acoustic nerve in 7.7% and CNS impairment was found in 84.6% patients. The results of the study suggest that diphtheritic toxin is not implicated in CNS lesions. Central changes found in the BAEPs analysis were related to chronic alcohol intake and did not aggravate diphtheria course.

[Epidemiology, clinical features and betaserc therapy of vertigo in initial and reversible cerebrovascular pathology].

The study comprised two sections: epidemiologic and clinical. The aim of the epidemiologic investigation was to determine prevalence of vertigo, including its mild cases, in patients with initial and reversible forms of cerebrovascular pathology. While screening an open population, 726 men and women aged 35-60 years have been examined using uniform program. Vertigo was detected in 30%, frequent and long-lasting one in 14.6% cases (8.1% men and 21.9% women, p < 0.001). A clinical section included a profound examination of 40 patients. Along with duplex scanning of major brain arteries, neurologic and otoneurologic examination of the patients, aucoustic stem evoked potentials have been registered. Marked dysfunctions of autonomic nervous system and changes in functioning of different vestibular analyzer regions were revealed. High efficacy of betaserk used during 2 months in dosage 16 mg three times a day was demonstrated by improvement of the patient's state in 97% cases.

[Acoustic brain stem and cognitive evoked potentials (P300) in patients with hepatolenticular degeneration]. / Akusticheskie stvolovye i kognitivnye vyzvannye potentsialy (P300) u bol'nykh gepatolentikuliarnoi degeneratsiei.

18 patients with hepatolenticular degeneration (Wilson's disease, WD) aged 15-38 years were subjected to an overall clinical and neurophysiologic examinations. As a result, the data obtained enable to evaluate functional reserves of CNS of the WD patients in correlation with the illness duration and severity of neurologic symptoms. Correlation between an increase of interpeak I-V and the degree of neurological deficit and, also, level of ceruloplasmin was established (r = -0.45; p < 0.05). Correlation between an increase of latency P300 and the degree of manifestation of neurologic symptoms was identified as well (r = 0.63; p < 0.05). Positive dynamics of evoked potentials was followed in 4 WD patients during copper-eliminative drugs treatment.

[Prognostic significance of neurophysiological parameters in nontraumatic apallic syndrome]. / Prognosticheskoe znachenie neirofiziologicheskikh pokazatelei pri netravmaticheskom apallicheskom sindrome.

The time course of neurophysiological parameters (EEG, evoked potentials of various modalities, including P300, and polysomnography) was followed up in 10 patients with apallic syndrome (AS) of nontraumatic origin (heart arrest, stroke, neuroinfection, etc.) during the formation of the syndrome and the condition of various severity: incomplete formation of AS eventuating in gross psychoneurological defects and complete formation of AS (a stable vegetative state). A dynamic follow-up of not only EEG of awaken and sleeping patients, but of their evoked potentials, specifically somatosensory and P300, were shown to be significant for assessment of the course of AS and prediction of its outcome.

[Brain stem auditory evoked potentials in spinocerebellar degeneration]. / Stvolovye akusticheskie vyzvannye potentsialy pri spinotserebral'nykh degeneratsiiakh.

A study was made of brainstem auditory evoked potentials (BAEP) in 66 patients from 56 families with different forms of spinocerebellar degenerations (SCD). 27 patients with olivopontocerebellar degeneration (OPCD), 13 patients suffering from Friedreich's disease (FD), 10 patients with Pierre Marie's familial ataxia (PMFA), 6 patients with late onset cerebellar atrophy (LOCA), and 10 patients with other forms of SCD were examined. The changes in BAEP turned out extremely diverse which can be regarded as a manifestation of marked phenotypic pleomorphism common to SCD. The most considerable changes in BAEP were discovered in FD and OPCD, whereas the least marked ones in PMFA and LOCA. The character and degree of BAEP disorders reflect the spreading and gravity of degenerative alterations in the brain stem in different forms of SCD. The authors discuss the possibility of the use of BAEP for objective estimation of the gravity and spreading of the pathological process as well as of the electrophysiological control over its course in SCD patients.