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Diagnosis and treatment of early forms of cognitive impairment: possibilities of influencing neuronal energy metabolism. Resolution of the Council of Experts.

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Cerebrovascular diseases are one of the main causes of death and permanent disability. Effective and timely neuroprotective therapy can reduce the burden of cerebrovascular disease. The possibilities of neuroprotection as a method of prevention and medical rehabilitation of acute and chronic cerebrovascular diseases are addressed.

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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.

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AIM: To study clinical, diagnostic and epidemiological aspects of the 'transitional form' of Parkinson's disease (PD) in the Yaroslavl region. MATERIAL AND METHODS: The study included the main group of patients (n=11) with a 'transitional' form of PD, comparison groups (15 patients with essential tremor (ET), 15 patients with PD) and healthy individuals (n=15). Diagnostic criteria of MDS ET were used. PD was diagnosed by criteria of The Parkinson's UK Brain Bank. The following scales were administered: UPDRS, HOEHN and YAHR, MMSE), PDQ-39, EUROQOL part 2, STAI, HDRS. RESULTS AND CONCLUSION: The period of 15.7±5.8 years, characterized by bilateral postural-kinetic tremor, preceded the appearance of signs of parkinsonism in the 'transitional' form of PD. This form of PD was characterized by slow progression, lack of cognitive and depressive disorders and less severity of anxiety disorders. In most cases, there was a head tremor (63.6%), a positive family history of ET in two generations (100%), the onset of parkinsonism from the left extremities (81.8%). The frequency of hyposmia was comparable to patients with PD. Quality of life indicators were significantly higher compared to PD patients. A genetic predisposition, which subsequently affects the development of parkinsonism, probably, underlies a rare phenotype associated with the transformation of ET into PDis.

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AIM: To evaluate the efficacy and safety of tolpersione injection and oral formulations combined with NSAID over NSAID monotherapy in acute non-specific low back pain. MATERIAL AND METHODS: In this randomized double blind study 239 patients were included in the per protocol analysis. The first 5 days of treatment, patients received tolpersione or placebo injection which was followed by per os administration of tolpersione/placebo tablet up to 14 days. NSAID diclofenac tablet was used in both groups through the study. Functionality assessed by the Roland Morris Disability Questionnaire (RMDQ) at day 5 was the primary endpoint. Secondary endpoints were RMDQ at other time points, pain level change at rest and on movement assessed by the Visual Analogue Scale (VAS), the Clinical Global Impression of Improvement/Patient Global Impression of Improvement (CGI-I and PGI-I), change in the range of motion assessed by the distance from the fingertips to the floor, period of disability days, relative (%) changes in the daily dose of diclofenac from the 7th to the 14th day of therapy. RESULTS AND CONCLUSION: The primary and secondary endpoints clearly demonstrated the significant superiority of tolpersione added to NSAID monotherapy over NSAID monotherapy. The safety assessment revealed no statistically significant differences between the two groups. Based on the results, tolpersione injection and per os formulations can be considered an effective and safe drugs in the combined therapy for patients with acute nonspecific back pain.

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It is shown that in the development of stroke observed sex differences, which manifest themselves both clinically and by laboratory parameters. While men have a higher incidence of stroke for most of his life, a woman in a more advanced age have a higher risk for stroke. Sex differences in the development of stroke depend on several factors, including genetic and hormonal changes throughout life. Studies sex differences in the risk of stroke is only in the initial stage, but the first results show that there are differences in neuronal cell death in males and females after experimental ischemic stroke. A better understanding of the mechanisms underlying the development of stroke in men and women will lead to more appropriate treatment strategies for patients of both sexes.

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OBJECTIVE: To evaluate efficacy and tolerability of cellex in the treatment of patients with acute disturbance of cerebral blood circulation (ADCBC) used in the clinical practice in the Russian Federation. MATERIAL AND METHODS: A trial included 178 patients with ADCBC from 6 Russian clinical centers, 146 (82%) patients were diagnosed with ischemic stroke and 32 (18%) with hemorrhagic stroke in the age of 35-80 years. RESULTS: One hundred and sixty-six patients have completed the trial. The better outcome with the decrease of motor, visual, speech and sensory disorders was found after 4-week treatment. CONCLUSION: Cellex may be recommended for treatment in acute and early rehabilitation stages of ADCBC.

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Systemic rheumatic disorders affect multiple organ systems. Seizures are among the most common neurological manifestation and occasionally can be the presenting symptom. This article reviews the literature on the mechanisms underlying seizures in systemic rheumatic disorders and predisposing factors, including vascular disease (e.g., prothrombotic state, anticardiolipin antibody, emboli, vasculitis), antineuronal antibodies, immune complexes, cytokines, metabolic disorders, infection, and therapy. Diagnostic and therapeutic strategies must be individualized for both the disorder and the patient.

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OBJECTIVE: To study the efficacy and safety of cereton in the treatment of patients with chronic brain ischemia and moderate cognitive impairment. MATERIAL AND METHODS: The study included 25 patients, 16 women and 9 men, mean age 53,8 ± 1,3 years. Moderate cognitive impairment measured with MMSE and HADS was found in all patients. Quality of life was assessed with SF-36. Somatic and neurological studies as well as brain MRI were carried out. Inpatients received cereton in dose 1000 mg in 200 ml of physiological solution during 15 days, after the discharge from the hospital patients received 1 capsule three times a day during 3 months. RESULTS AND СONCLUSION: Cereton had a significant positive effect on patient's condition including cognitive function. Subjective effect was recorded after 5-6 days of treatment, more evident and stable effect was seen from the 15th day. In the end of treatment, clinicians recorded "moderate" effect in 11 patients and "marked" effect in 8 patients (according to patients' reports, those effects were noted in 9 and 12 cases, respectively). The drug was well-tolerated and had a positive effect on quality of life of the patients.

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Multiple sclerosis (MS) is very similar to the Sjögren's syndrome (SS) by its clinical presentations. Features found in common between the two disorders include symptoms of lesions of the brain, spinal cord and optic tract, the detection of autoantibodies, such as antinuclear, anti-Ro, anti-La and the prevalence of MRI abnormalities such as periventricular and subcortical lesions. Almost all symptoms found in patients with the CNS-SS involvement described above could be attributed to the concomitant presence of MS. Therefore, the differential diagnosis of these diseases is difficult. The paper addresses clinical and biological presentations of similarity of and differences between MS and SS in the diagnostic aspect.

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Multiple sclerosis (MS), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjogren's syndrome (SS) and Behcet disease (BD) are chronic, immune-mediated disorders affecting young adults, the pathogenesis of which is still largely unknown. MS and other demyelinating processes are sometimes difficult to differentiate from the CNS involvement in systemic rheumatic diseases (SRD). An acute isolated neurological syndrome presents the greatest diagnostic problem, since it is common not only in MS, but can also be the only feature or first manifestation in SLE, APS, SS, and BD. Neurological manifestations and magnetic resonance imaging (MRI) can be indistinguishable and no specific diagnostic tools are available.

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The author presents the results on the efficacy and tolerability of valdoxan (agomelatine) in the treatment of mild and moderate depression in patients with cerebrovascular diseases (CVD) in the neurological practice. The study included 8 Russian clinical centers. Eighty-eight patients with CVD (18 men and 70 women, mean age 55,4±6,5 years) were studied. Depression symptoms were arrested in 81,20% patients after 6 weeks of treatment. The regression of clinically significant fatigability, increase in the efficiency of work, normalization of the coefficient of mental health and improvement in sleep were noted at the end of treatment.

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During the 2003-2006 period, the relationship of mortality from ischemic stroke (IS) and the environmental pollution in Yaroslavl, a Russian industrial center, was studied in 1983 patients with first ischemic stroke. A sample consisted of 978 men and 1005 women, the average age was 60.9±8.9 and 65.9±8.9 years, respectively. Additionally, the interactions between pollution, age, gender, and some of the major risk factors in these patients were analyzed.

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One hundred young patients (aged 17-45 years) with acute cerebral blood circulation disorders (ACBCD) have been studied. Phenotypic signs of non-differential dysplasia of the connective tissue (NDDCT) have been found in 50 patients (the main group) and other 50 patients had no clinical signs of NDDCT (the comparison group). Patients underwent a complex clinico-neurological, instrumental and laboratory study. In young patients with NDDCT, transient ischemic attacks were observed in 14%, ischemic strokes in 66%, hemorrhagic strokes in 20%. Risk factors characteristic of young patients with ACBCD have been singled out. The higher content of free oxyproline, the distinct positive dynamics (the reduction of clinical symptoms severity during the acute phase of stroke) and the significantly better restoration of lost functions were observed in patients with NDDCT compared to patients without NDDCT.

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