[Diagnosis and treatment of low back pain in old patients]. / Diagnostika i lechenie boli v spine u pozhilykh.

The back pain is one of the most common and socially significant neurological syndromes, leading to limited mobility and household independence of elderly patients. Specific «serious¼ causes of back pain account for 1-2% of all cases of back pain, approximately 10% of cases of pain correspond to radiculopathy, while the rest of the most common variants is related to nonspecific axial back pain. In the most cases of back pain, a clear connection between degenerative-dystrophic changes in the spine and the clinical manifestations and intensity of back pain is absent. On the other hand, dystrophic changes in the spine, which under certain conditions can be a source of chronic pain, cannot be completely ignored. Therefore, «osteochondrosis¼ is currently considered as a heterogeneous cascade process with the different course variations. In practice, it is not always possible to draw a line between nociceptive, neuropathic, nociplastic and psychogenic pain, more often in this case we can talk about a mixed nature of pain. Unreasonable neuroimaging with the identification of «accidental¼ findings can complicate the interpretation of the causes of pain, however, it is absolutely indicated to exclude serious specific diseases, spinal stenosis, when determining the indications for surgery. The presence of comorbid affective disorders, certain personality characteristics of patients contributes to the persistent nature of low back pain, therefore it is important to take these factors into account when diagnosing the causes and treatment of pain. Along with conventional anti-inflammatory drugs and other analgesics with a proven effect in the complex treatment of patients with degenerative-dystrophic changes in the spine with radicular and non-root pain syndromes, Symptomatic Slow-Acting Drugs in Osteoarthritis can be recommended.

[Case-report of neuroacanthocytosis associated with a compound mutation in the VPS13A gene]. / Sluchai neiroakantotsitoza, svyazannyi s mutatsiei VPS13A.

Neuroacanthocytosis is a group of neurodegenerative diseases manifested by a combition of neurological symptoms (most often choreic hyperkinesis) and the presence of an increased number of acanthocytes (erythrocytes with horns) in the peripheral blood. This group includes chorea-acanthocytosis, MacLeod's syndrome, pantothenate kinase-associated neurodegeneration, Huntington-like disease type 2, and some other very rare diseases. This article presents a genetically confirmed clinical case of chorea-acanthocytosis associated with a compound mutation in the VPS13A gene, discusses in detail the stages of a diagnostic search, presents an algorithm for examining patients with chorea.

[Unusual failure of swimming skills in patients with Parkinson's disease]. / Neozhidannaya utrata navykov plavaniya u patsientov s bolezn'yu Parkinsona.

The results of individual observations and several studies confirm the frequent complaints of patients with Parkinson's disease (PD) about difficulty or inability to swim. Difficulties moving the limbs, coordination and maintaining the horizontal position during swimming appear to be the main problems that prevent normal swimming. Further studies are needed to assess the frequency of swimming disorders in PD and the mechanisms of their development. Patients with PD must be educated about the potential risk of drowning and the need to evaluate and carefully monitor their swimming skills before going into deep water.

[Parkinsonism-associated speech disorders]. / Rechevye narusheniya pri parkinsonizme.

OBJECTIVE: To study clinical and neurophysiological features of speech disorders in PD, multisystem atrophy (MSA) and progressive supranuclear palsy (PNP). MATERIAL AND METHODS: Thirty-one patients with PD and 14 patients with MSA and PSP were examined. The Unified rating scale for Parkinson's disease of the International movement disorders society (MDS-UPDRS) and a neurophysiological analysis of speech disorders using acoustic spectral analysis of voice and speech according to the method of Jan Rusz et al (2004) were used. RESULTS: Patients with PD showed a parallel increase in the severity of axial motor disorders (hypomimia, walking disorders, postural disorders) and speech disorders. Patients with MSA and PSP differ not only from the PD patients but also among themselves by clinical presentations (motor, autonomic, cognitive) and speech disorders. CONCLUSION: The clinical and neurophysiological features of speech disorders in patients with various variants of parkinsonism will be useful in the differential diagnosis of these diseases and can be used in developing approaches to patient rehabilitation.

[Speech disorders in Parkinson's disease]. / Rechevye narusheniia pri bolezni Parkinsona.

Speech disorders are widely spread in patients with Parkinson's disease, and these symptoms are only getting worse as the disease progresses. Nevertheless, only a few percent of the population have an access to an adequate and qualified care. This review describes the pathophysiology of parkinsonian speech disorders, methods of diagnostics and monitoring and treatment modalities, which include pharmacotherapy, speech therapy and surgical approaches. The authors believe that treatment of parkinsonism-related speech disorder is an integral part of a multidisciplinary patient care.

[The use of transcranial magnetic stimulation in treatment of affective disorders in Parkinson's disease]. / Primenenie transkranial'noi magnitnoi stimuliatsii v korrektsii affektivnykh narushenii pri bolezni Parkinsona.

In this literature review, the authors summarize the data on affective disorders in Parkinson's disease (frequency, clinical presentations, treatment), the results on using transcranial magnetic stimulation, its safety in Parkinson's disease.

[Gait disorders in Parkinson's disease]. / Narusheniia khod'by pri bolezni Parkinsona.

Gait and posture disorders are frequent signs of Parkinson's disease. Authors reviewed clinical and pathophysiological results reported for these disorders as well as the methods of investigation and treatment approaches including rehabilitation measures.

[Freezing of gait in patients with Parkinson's disease]. / Zastyvaniia pri khod'be u patsientov s bolezn'iu Parkinsona.

Objective. Freezing of gait (FOG) are the brief episodes of voluntary movement blocks in Parkinson`s disease and other variants of parkinsonism, which limit patient's mobility and decrease quality of life. Pathogenesis of FOG is still unclear. Authors studied characteristics of FOG in different stages of PD. Material and methods. Seventy patients were examined using different scales for assessment of clinical features. We measured the length, speed and cadence of gait and carried out a kinematic analysis of movements and stabilometry. Results and conclusion. FOG were found in 34.3% patients with PD, most of them were in advanced and late stages. FOG in off-periods were observed in 2/3 patients treated with levodopa, 1/3 of patients did not relate FOG with the periods of levodopa action. Turn and start FOG were noted more often. In patients with FOG, there were more expressed Parkinson's signs, especially axial symptoms, and more frequent urination disorders. The reduced speed of gait and asymmetry of gait were found as well. The kinematic analysis of gait revealed a correlation between the frequency of FOG and periods of support (and double support).

[Influence of levodopa, stalevo on dyskinesia in Parkinson's disease: STRIDE-PD study].

The results of the large-scale study STRIDE-PD of patients with Parkinson's disease (PD) are presented. The aim of the study was to verify whether a combination of levodopa with DOPA decarboxylase and catechol-O-methyltransferase inhibitors (stalevo) could delay the development of dyskinesia compared to the standard two-component drug due to the more stable concentration levodopa in the blood that provided the persistent stimulation of dopamine receptors in the striatum. The results of the study allowed to discuss the issues related to PD treatment, in particular, the dose of levodopa that should not be exceeded to reduce the low risk of fluctuations and dyskinesia, and the necessity of maintaining equivalent doses of levodopa in the combination of antiparkinsonian drugs.