[Clinical results and prospects for the use of phenosanic acid in patients with focal epilepsy]. / Klinicheskie rezul'taty i perspektivy primeneniya fenozanovoi kisloty u vzroslykh patsientov s fokal'noi epilepsiei.

OBJECTIVE: To study the efficacy and safety of using a new original synthetic antioxidant - phenosanic acid as an adjunct therapy in patients with focal epilepsy. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled, parallel-group study evaluated the efficacy and safety of phenosanic acid as an adjunct therapy to basic antiepileptic drugs in 120 patients with focal epilepsy. Primary purpose: to study the dynamic of seizure frequency. Secondary purposes: to study the dynamic of seizure-free days, the dynamics of bilateral tonic-clonic seizures, the results of questionnaires and scales (General Dynamics Assessment, Visual Analogue Scale (VAS), Quality of Life in Epilepsy (QOLIE-31-P), European Quality of Life Questionnaire (EQ-5D), Hospital Anxiety and Depression Scale (HADS), Frontal Asstssment Battery (FAB), Mini-Mental State Examination (MMSE)). RESULTS: Phenosanic acid (Dibufelon) showed statistically significant benefit over placebo in the primary indicator of efficacy (reduction in the frequency of epileptic seizures by at least 50%) and in the secondary indicators. The drug was safe and well tolerated by the patients. CONCLUSION: The addition of phenosanic acid (Dibufelon) to base antiepileptic drugs seems to be perspective because of its positive effect on reducing the number of epileptic seizures, as well as on comorbid disorders in the emotional and cognitive spheres.

[Mechanisms of formation and a diagnostic algorithm of postural disorders in stroke].

Three hundreds and twenty-nine patients with stroke were examined. In the acute stage of stroke, disorders of postural balance dynamic disturbances were detected in 85% of patients, in a half of patients disorders of static balance were found either. Four variants of postural balance disorders were singled out: I -- afferent, with a prevalence of sensory deficiency, II -- efferent, with a prevalence of pyramidal and cerebellar symptoms, III -- integrative, with a domination of cognitive impairments, IV -- psychogenic with affective disorders. It was found that different variants of balance disorders differed not only in the structure of disturbances, but also by the degree of severity of individual clinical syndromes. These variants differed in the frequency of cerebral focal and atrophic changes of certain localization. Moreover, the severity of the disorders of postural balance was also depended on the location of affected areas of the brain. Based on the analysis of clinical and neuroimaging studies of patients, we suggest the concept of deafferentation and disintegration of blocks of the motor act. The algorithm for the clinical diagnosis of the variants of postural balance disorders was developed.

[Post-stroke somatic pathology in patients with a history of alcohol abuse].

AIM: to study concomitant somatic pathology in brain stroke patients abusing alcohol before cerebral catastrophe. SUBJECTS AND METHODS: Two groups were identified according to the results of examining 255 poststroke patients. A study group included 57 (22.4%) pre-stroke alcohol abusers; a control group consisted of 198 (77.6%) alcohol non-abusers. RESULTS: Among the study group patients, lacunar and hemodynamic pathogenetic subtypes of ischemic stroke were encountered 3 times more and 2 times less frequently, respectively, than in the control groups. After cerebral stroke, the study group patients had a clinical picture with a preponderance of diminished cognitive functions, as well as motor disorders mainly as hemiparetic syndrome. Assessment of the pattern of somatic pathology in both group patients revealed a predominance of myocardial infarction by almost 2-fold, hepatobiliary diseases by 4.7-fold, duodenal ulcer disease by 1.6-fold, and bronchopulmonary pathology by 2-fold among the study group patients. Arthrosis deformans and obesity were observed by 6.4 and 3.5 times more frequently, respectively. The incidence of cardiac disease and hypertension in the acute period did not differ greatly in the compared groups. No thyroid pathology was recorded in the study group. In this group, the poststroke period was generally severer or ran as a galloping type in one third of cases. CONCLUSION: Somatic pathology aggravates the poststroke period, on the one hand, and it is decompensated in the presence of inadequate cerebral blood supply, on the other. Measures to compensate for neuropsychological disorders should be efficiently combined with rehabilitative actions on somatic pathology in poststroke patients with a history of burdened alcohol abuse.

[Specific features with of intramedullary osteosynthesis with blocking in fractures of the shin bones at different levels].

The results of closed intramedullary osteosynthesis with blocking were analyzed in 180 patients with open (in 22) and closed (in 158 patients) fractures of shin bones fulfilled within the period from 3 days to 3.5 months after trauma. In 16 patients the intramedullary canal was drilled out. The exact reposition of the shin-bone in closed intramedullary osteosynthesis was obtained in 142 patients: the terms of consolidation in this case were (6.4+/-1.3) months. The examination of all the patients in the period from 6 months to 2 years after operation has shown consolidation of the shin-bone fracture in 176 (97.7%) of them.

[Arteriovenous malformation of septum pellucidum in combination with persistent trigeminal neuralgia].

A 16-year-old boy with arteriovenous malformation (AVM) of septum pellucidum in combination with left side persistent trigeminal artery (PTA) is described. Presentation of AVM included severe intracranial hemorrhage and the lesion was removed surgically. The case deserves interest for two reasons. 1) The observation demonstrates the possibility of increased pressure in the afferent arteries of AVM. It was illustrated by distinctive displacement of the zones of the hemodynamical balance around the circle of Willis. The raised pressure in conditions of shunting can be explained using principles of the constant shear stress in the vascular system. 2) The observation of the features of venous system that may be causative for PTA. These features included presence of the large anastomotic vein between petrosal and cavernous sinuses, enlargement of petrosal sinuses and shrinking of transverse sinus ipsilateral to PTA.

[The use of lucetam for improvement of cognitive functions in chronic cerebrovascular insufficiency (clinical and encephalographic study)].

One hundred and ninety-three patients, aged 35-60 years, with chronic cerebrovascular insufficiency of I and II stage have been studied. It has been shown that memory and attention disturbances at stage I are of pseudomnemonic character. At stage II, the syndrome of mild cognitive impairment is formed first with the following formation of the moderate one. After the treatment with lucetam, the overall improvement as measured by neurophysiological testing was observed in 64% of patients, the memory improvement - in 18%, the attention improvement - in 10% and no positive effect was found in 8%. The significant improvement of cognitive functioning was correlated with positive changes of brain neurodynamics in the EEG study.

[Nervous-mental health of children who had perinatal damage of the nervous system]. / Nervno-psikhicheskoe zdorov'e detei, perenesshikh perinatal'noe porazhenie nervnoi sistemy.

The paper presents the results of somatic, neurologic and neurophysiologic examination of 614 children which had hypoxic-ischemic encephalopathy of a moderate degree during the period from the birth till 3 years old. A period of gestation was characterised by some signs of fetoplacental insufficiency in 44.3% of children. Disorders in labor activity were revealed in 83.7% of mothers. Delay in nervous-mental development (77.3%), deviations in forming rhythmic EEG activity (75%), signs of morphologic immaturity of brain (38.8%) testified to inhibition of postnatal neuroontogenesis. All that together with high frequency of motor disorders (73.3%) and disorders in cerebral blood flow (43.8%) during the 1-st year of life were found to underlie development of psychoneurologic diseases in children of early age and necessitates early rehabilitation of these children.

[On the etiology of epileptic seizures in children of the first year of life]. / O prichinakh épilepticheskikh pripadkov u detei pervogo goda zhizni.

The paper presents the analysis of unfavourable ante- and intranatal factors as well as the data of neurosonography of 109 children with the fits during the first year of life and of 58 children with hypoxic-ischemic encephalopathy without convulsions. The high degree of the correlation was found between complications of the first half of pregnancy and the disturbances of growth and development of a child. Frequency of a trauma in the course of a delivery correlated with frequency of asphyxia. A persistence of a germinative matrix and signs of functional immaturity of the brain suggested the important role of both focal and multifocal cerebral dysplasias in the genesis of epileptic fits at the early stages of ontogenesis. In children with nonmalignant neonatal and idiopathic fits there were some nonvisualized cortical disorders that became pronounced under hypoxic-dysmetabolic conditions in the first case and during a period of the following maturation of axon-dendritic bounds and of the increase of neuronal activity in the second case.

[Neuro-ontogenic factors in the pathogenesis of febrile seizures in children during the first year of life]. / Neiroontogeneticheskii faktor v patogeneze febril'nykh pripadkov u detei pervogo goda zhizni.

Sensomotor development, periods of febrile attacks (FA), spectral EEG characteristics in narrow range of frequency were examined in 12 healthy children and 34 children with FA. There was a correlation between FA debute, relapse and physiologic formation and change of sensomotor rhythm on months 4-5, 7-8, 11-12 of life. The correlation was also established between a decrease of sensomotor reactivity of child, neocortical activation with repeated FA as well as transformation of the attacks' structure. It is suggested that clinical spectrographic regularities observed indicate both activity of pace-maker neurons of pre- and postcentral cortical areas and the disorders of some intercentral relations.

[Correlation between clinical findings and indices of stimulation electromyography in the acute stage of strokes]. / Korreliatsiia klinicheskikh dannykh i pokazatelei stimuliatsionnoi élektromiografii v ostroi stadii mozgovogo insul'ta.

In 33 patients with the acute stage of a cerebral stroke the function of the spinal centres was examined by the stimulation electromyography method. The H-reflex of the sural muscle and the late responses of the hand and foot muscles were determined in patients with truncal and hemispheric lesions on the 1st-2nd, 3d-12th, and 13th-18th days of the disease. In the patients with hemispheric lesions an increased excitability of mononeurons was on the 1st-2nd days only on the contralateral side, while in the patients with truncal lesions this symptom was bilateral: this correlated with the bilateral motor disturbances. Beginning from the 3d-5th day, as muscular hypotonicity developed the mononeuron excitability in the patients with the hemispheric lesions increased on the homolateral, and decreased on the contralateral side, while in the patients with the truncal lesions the depression of the excitability of the spinal centres was bilateral. On the 14th-18th days of the disease the excitability of the spinal centres returned to normal in the patients with the hemispheric lesions, while in those with the brain trunk involvement it still remained increased.

[Functional state of spinal centers in patients with cerebral circulatory disorders according to the results of stimulation electromyography]. / Funktsional'noe sostoianie spinal'nykh tsentrov u bol'nykh s narusheniiami mozgovogo krovoobrashcheniia po dannym stimuliatsionnoi élektromiografii.

In 53 patients in different periods of brain strokes the authors studied the functional state of spinal centers by means of registration of H-reflex and F-wave of the skeleton muscles. In spite of the stroke character a marked increase of excitation of the spinal centers was observed, it being especially significant in the subacute period of the disease. The increase of H-reflex amplitude was maximal in extremities, contralateral to the focus of the lesion, but it was observed on the lesion side as well. The patients with cerebral coma in the acute stage of the stroke demonstrated a descrease of relation between central and motor responses up to 12--13%, it gradually increased as the coma ceased. The latent period of F-wave on the both extremities was reliably lower than the control indices along the whole period of the study. The authors show the significance of registration in the dynamics of the muscle evoked potentials for topical diagnosis of the cerebral vessel process and for effective control of the administered therapy.