[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

[Early predictive biomarkers of posttraumatic epilepsy]. / Rannie prediktivnye biomarkery posttravmaticheskoi epilepsii.

Traumatic brain injury (TBI) affects about 50 million people in the world every year. Posttraumatic epilepsy (PTE) is a significant complication of TBI of any severity. PTE occurs in 20% of patients with TBI. Treatment of patients with PTE is particularly difficult due to obvious tendency towards drug resistance. Currently, there are no validated predictive biomarkers for PTE. Development of a system of validated predictive markers would improve PTE prediction quality and therapeutic approach for these patients. This review is devoted to the current data on the most perspective predictive biomarkers of PTE for clinical practice.

[Features of ictal and interictal electrical activity in assessment of the epileptogenic zone in children with focal cortical dysplasias]. / Osobennosti iktal'noi i interiktal'noi élektricheskoi aktivnosti v otsenke épileptogennoi zony u detei s fokal'nymi kortikal'nymi displaziiami.

Currently, there is no single standard defining what rhythmic activity should be considered as the area of ictal pattern onset. Differences in electroencephalographic patterns associated with different types of focal cortical dysplasias (FCDs) have not been defined. Aim - we aimed to identify features of the ictal onset pattern on a scalp EEG, depending on the histology, location, and extension of epileptogenic zone, as well as to elucidate the relationship between concordance of the interictal and ictal activity localization and ictal onset pattern types. MATERIAL AND METHODS: We studied scalp video-EEG monitoring data of 38 FCD patients who underwent surgical treatment for intractable epilepsy in the period between 2010 and 2016. We analyzed the data on interictal and ictal activity localization and compared them with the data on FCD types and lesion location. RESULTS: Two types of the ictal onset pattern on EEG, local and generalized, were identified. The local and generalized types included two and four variants of the ictal onset pattern, respectively. Therefore, 6 combinations of rhythmic activity were identified, which manifested within the first 10 s after the onset of electrographic changes on EEG simultaneously with initial clinical manifestations of seizure. Co-localization of the interictal and ictal activity zones occurred in 42% of cases; of these, 88% of patients had the ictal onset pattern. In the remaining cases (58%), no co-localization of the interictal and ictal activity zones was detected; of these, 76% of patients were assigned to the group with the generalized ictal onset pattern. The local ictal onset pattern was more common in patients with type II FCD, while the generalized ictal onset pattern was more common in patients with type I and type III FCD. No correlation between the ictal onset pattern type and the lesion localization was found. CONCLUSION: We describe two ictal onset pattern types, local and generalized, on EEG in children with FCD. The co-localization of ictal and interictal activity zones prevails in the local ictal onset pattern group. The local ictal onset pattern is often associated with type II FCD. In the case of type I and type III FCD, the generalized ictal onset pattern predominates. There is no clear relationship between the ictal onset pattern type and the lesion location.

[In search of an effective algorithm for rhythmic transcranial magnetic stimulation in neurorehabilitation after severe traumatic brain injury]. / V poiskakh éffektivnogo algoritma ritmicheskoi transkranial'noi magnitnoi stimuliatsii v neiroreabilitatsii posle tiazheloi cherepno-mozgovoi travmy.

Rehabilitation of patients with severe traumatic brain injury (sTBI) is a topical medical and social issue because this pathology is one of the main causes of mortality and disability in the young working age population [1]. The most common sTBI consequences include motor and cognitive impairment as well as depression of consciousness [2, 3]. Despite significant progress in treatment of the consequences of severe traumatic brain injury, there are no treatment and rehabilitation standards for these patients, and the used rehabilitation measures are not always effective. These circumstances substantiate the need for the development of additional methods of neurotherapy. Over the past decade, transcranial electrical and magnetic stimulation (TMS) has been increasingly used as neuromodulatory treatment in clinical practice [4-12]. The accumulated experience has shown that transcranial neurostimulation methods require a more individualized approach in terms of both careful selection of patients and choice of exposure parameters. This review is based on an analysis of the most significant publications and recommendations recognized in the scientific community, as well as on reports of domestic and foreign authors presented at dedicated congresses in comparison with experience of our own research on transcranial stimulation. The paper discusses the main problems of using this method in medical practice of sTMI and their possible solutions.

[Results of motor cortex stimulation in the treatment of chronic pain syndromes].

AIM: The article is aimed to demonstrate our experience in motor cortex stimulation (MCS) in patients with chronic neuropathic pain syndromes, assess the clinical efficacy of the technique in short-term and long-term follow-up, and analyze potential predictors of the MCS efficacy. MATERIAL AND METHODS: Twenty patients were implanted with MCS electrodes at the Burdenko Neurosurgical Institute in the period between 2004 and 2014. The mean age of patients was 52 years (26 to 74 years). The patients suffered from neuropathic pain syndromes of different genesis (post-stroke, multiple sclerosis, atypical facial pain, phantom limb pain, brachial plexus injury, spinal cord injury, complex regional pain syndrome I). All patients underwent neurological examination with verification of neuropathic pain (DN4, Pain Detect, LANSS). The pain intensity and its effect on quality of life were assessed before operation and during follow-up according to 10-point visual-analog scales (modified Brief Pain Inventory). Before surgery, all patients underwent several repetitive transcranial magnetic stimulation (rTMS) sessions. After implantation of epidural electrodes, test MCS was performed. RESULTS: Test stimulation was positive in 19 (95%) patients. All these patients were implanted with a chronic MCS system. The mean follow-up was 49.3 months (from 3 to 96 months). In short-term follow-up (fist 6 months), a positive result of MCS was observed in 17 patients, and a reduction in the pain intensity ranged from 37.5% to 90%. In long-term follow up (from 12 to 96 months), 14 patients had positive MCS RESULTS: and a reduction in the pain intensity amounted to 25% to 60%. All patients with positive MCS results received significantly decreased doses of opioids and tramadol. Two patients developed infectious complications, but there was no neurological deficit. Analysis of the factors affecting the efficacy of motor cortex stimulation did not reveal a statistically significant effect of rTMS and the presence and intensity of motor deficit. CONCLUSION: Chronic epidural MCS is an effective and safety method for the treatment of some chronic neurogenic medically-refractory pain syndromes. Further research is necessary to specify the patient selection criteria and the MCS efficacy predictors.

[EEG and fMRI reactions of a healthy brain at active and passive movements by a leading hand].

Bioelectrical (EEG) and hemodynamic (fMRI) responses of cerebral reactions to active and passive movements by the right hand were analyzed in 17 right-handed healthy persons. Individual and averaged fMRI and EEG data was analyzed. The main cortex fMRI responses (sensorimotor cortex of the contralateral, left hemisphere) were topographically similar during both active and passive movements. This fact allows us to recommend the usage of the passive movement paradigm for the mapping of the motor areas in patients with movement disorders. Including in reactive process of cerebellum and subcortical structures at passive movements was more variability than active ones. FMRI-reactions at passive movements were characterized more individual variability than during active ones at the expense of diversity of cerebellum and subcortical structures answers. The EEG analysis revealed that at both passive and active movements there is a coherence increase in the high-frequency alpha-ban in left central-frontal area of the left, activated hemisphere. The power-frequency changes of the EEG parameters during active and passive movements were primarily shown in a frequency increase and the desynchronization of the beta-band. Consistency with the topography of the fMRI response was not found.

[Preliminary results of treatment for spastic forms of infantile cerebral paralysis by chronic epidural neurostimulation of lumbar enlargement].

Six patients with infantile cerebral paralysis following drug-resistant spastic syndrome were operated on. Four children suffered from lower spastic paraparesis; 2 had spastic tetraparesis. All the children were observed to have leg chiasm and myogenic equinus talipes. Electrodes were implanted under X-ray guidance into the posterior epidural cavity of the spinal cord at the level of Th10-Th12 vertebrae and the MATTRIX system. In the postoperative period, all the children had a steady-state decrease in leg and arm muscle tone during 1-2 daily high-frequency electrostimulation sessions. Within the early week, there was a regression of equinus talipes and leg chiasm. A follow-up indicated a steady-state clinical effect in all the patients. Stimulation myography revealed that the H reflex was suppressed and the H/M ratio decreased to the normal level (60-80%) in all the patients. An average of one daily electrostimulation session was sufficient to maintain muscle tone at the near-normal level.

[Visual evoked potentials and the P300 component in different courses of the posttraumatic vegetative state]. / Zritel'nye vyzvannye potentsialy i komponent P300 pri raznom techenii posttravmaticheskogo vegetativnogo sostoianiia.

The late latency components of visual evoked potentials (VEP) and the component P300 AEP were analyzed to evaluate their informative value in the process of mental function restoration in patient after long-term traumatic coma. VEP components with latencies of 70 to 320 msec were studied in 24 patients. Topographical mapping of the power of the study VEP components and components P300 was made by the peak amplitude. Long-term VEP components and component P300 were examined by the method of three-dimensional localization of equivalent dipole sources. In 16 patients with positive tendencies in the condition there was a stable localization of the maximum VEP power in the parietal, sagittal, and occipital regions, component P300 showed its maximum amplitude in the central and parietal regions in the left hemisphere. Eight patients with negative tendencies in the status had the maximum VEP and component P300 in the frontal and temporal regions, predominantly in the right hemisphere. The paper shows it important to evaluate not only time-amplitude parameters and analyzes the tomographic features of its formation in dynamics.

[The genesis of movement-related human brain potentials in different forms of motor pathology]. / Genez sviazannykh s dvizheniem potentsialov mozga cheloveka pri raznykh formakh dvigatel'noi patologii.

To study the role of subcortical structures and cerebellum nuclei in the genesis of the human brain potentials connected with motion patients were examined with parkinsonism and hyperkinetic form of children cerebral paralysis. In one group of patients the motor responses were recorded by means of long-term electrodes implanted with the medical purpose into the ventro-oral group of thalamus nuclei, subcortical nuclei and dentate cerebellum nuclei. In patients of the second group potentials, connected with motion were led from the scalp before and after one-moment destruction in the zone of the same structures. In ventro-oral and reticular thalamus nuclei lateral and medial segments of the pale globe and in the cerebellum dentate nucleus post-motor components were recorded which were considered as electrographic expression of motion realization and completion processes (P2 and N3) and also as slow negative oscillation (component N1), that pointed to participation of the studied structures not only in regulation of voluntary movement but also in the process of movement preparation. Absence of N2 component at recording motor responses from deep electrodes and its sufficient stability at scalp leads gave the reason to suggest that its genesis was connected with the cortex activity.

[Movement-related brain potentials during the treatment of parkinsonism]. / Sviazannye s dvizheniem potentsialy mozga v protsesse lecheniia parkinsonizma.

The authors studied motor associated brain potentials (MABP) in patients with disturbed motor function (hypertonia, tremor) due to affection of the basal ganglia (parkinsonism) and studied the changes of these potentials after stereotaxic operations conducted for the correction of the motor pathology. It was found that in a favourable effect of operative treatment manifested by decrease of the tonus and inhibition of tremor in patients with parkinsonism, there was a tendency towards normalization of MABP. Restoration of some of the components of the motor response and in certain cases of the MABP on the whole occurred on the 14-16th postoperative day. No clearly defined changes of motor associated potentials characteristic of different forms of parkinsonism were discovered.

Characteristics of motor potentials on impairment of the function of subcortical human brain motor structures.

We have investigated the characteristics of motor potentials (MPs) in patients with impaired function of subcortical motor structures of the brain, causing symptoms of parkinsonism. We have isolated the MP components that precede movement, such as "the readiness potential" (N1), "the motor potential" (N2), and MP components which are electrophysiological correlates of processes of execution (P2 component) and of completion (N3 component) of movement. We established that in parkinsonism patients the MPs are changed compared to the normal; the most significant changes were observed in components N1, P2, and N3 as shown by a prolongation and certain decrease in the amplitude of these components. Component N2, regarded to be an electrophysiological correlate, reflecting the triggering of movement, has amplitude-time related parameters that are the most similar to the normal. We believe that this component is of cortical origin.

[Characteristics of the motor potentials in disorders of the subcortical motor structures of the human brain]. / Osobennosti motornykh potentsialov pri narushenii funktsii podkorkovykh dvigatel'nykh struktur mozga cheloveka.

Properties of motor potentials (MPs) were studied in patients with disturbance of function of subcortical motor structures--disturbance causing parkinsonism manifestations. MPs components are singled out preceding movement--"readiness potential" (N1), "motor potential" (N2) and MP components which are electrophysiological correlates of realization processes (component P2) and movement completion (component N3). It is revealed that MPs in patients with parkinsonism are changed in comparison with the norm; the most significant differences are observed in components N1, P2, N3, what is expressed in prolongation and a certain amplitude decrease of these components. Amplitude-temporal parameters most similar to the norm belong to the component N2, which is considered as an electrophysiological correlate of movement triggering. A hypothesis is suggested on its cortical origin.