Vol 20, No 2 (2018)
Articles
Fibronectin concentration in the prediction of survival and symptomatic transformation in patients with ischemic stroke treated by thrombolysis
Abstract
Background. Thrombolytic therapy (TLT) for ischemic stroke has a high proven efficacy, but is often accompanied by symptomatic hemorrhagic transformation (sHT) of the lesion, which can lead to lethal outcome (LO). The thrombolysis products in elimination from the bloodstream are opsonized by proteins, in particular fibronectin. Fibronectin is also involved in the blood clotting, which is activated in stroke. The aim of this study was to assess dynamics and interactions of fibronectin plasma concentration with the development of survival and symptomatic HT in patients with ischemic stroke treated TLT. Materials and methods. The study included 66 patients in the acute period of ischemic stroke. The stratification criteria were: the lack of sHT and LO, sHT without LO, LO without sHT, LO and sHT. Plasma fibronectin concentration was determined by ELISA at admission of patients to the hospital, after 0-4 hours after TLT, at 1th, 2th, 3-5th, and 7th days. Statistical processing of data was made using the software SPSS 8.0 and Microsoft Excel 2013. Results. Patients before TLT had fibronectin concentration within the reference limits, upper values of the dispersion measure are negligible and statistically insignificant higher then reference limits. In the 1th day after TLT we observed a statistically significant increase in fibronectin concentration with subsequent normalization. Surviving patients with sHT had statistically significantly higher level of fibronectin before TLT and in the first 4 hours after TLT than patients without sHT. Threshold value was 150 mg/ml. The probability of no symptomatic HT in surviving patients with a concentration of fibronectin ≤150 mg/ml was 7.5 times higher than with concentrations more than 150 mg/ml. Conclusion. Higher fibronectin concentrations in patients with sHT, probably due to opsonized functions of this protein that removes low molecular weight products of thrombolysis and degradation products of the cellular protein matrix from the bloodstream. Probably compensatory increase of fibronectin can be considered as a marker of high concentration of the near-wall proteolysis products. They can cause vascular wall damage and hemorrhagic infiltration of the lesion.
Consilium Medicum. 2018;20(2):8-13
8-13
Antiplatelet drugs in cerebral ischemia prevention: dipiridamol
Abstract
The article is concerned with one of the most common diseases of the circulatory system - ischemic stroke. Aspects of antiplatelet therapy use and cerebral ischemia prevention are reviewed. Issues of antiplatelet therapy complications prevention are discussed.
Consilium Medicum. 2018;20(2):14-17
14-17
Application of telemedicine for management patients with acute cerebral failure in Sverdlovsk region
Abstract
Health care in Sverdlovsk region shows wide opportunities of telemedicine application for management patients with acute cerebral failure. Due to telemedicine it is possible to support indefinitely big number of infinitely far patients to provide expert telepresence for difficult cases, to transfer patients to the next level hospitals at the right time, to increase availability of the specialized health care to the population in the remote areas, to lower unreasonable transfers of patients, and to reduce costs of bedside consultations of highly specialized experts. The article presents regulations of telemedicine in Sverdlovsk region, options of telemedicine application for management patients with acute cerebral failure (teleconsulting, telethrombolysis, telerouting, telemeetings, and teleconferences), and source of their funding. Future directions of telemedicine application and barriers of telemedicine distribution are presented.
Consilium Medicum. 2018;20(2):18-23
18-23
Aging as a degenerative process. Safe strategies for dementia treatment in elderly patients
Abstract
The relation of neurodegeneration and cell proliferation disruption in neurogenesis that determines the effectiveness of memory formation is thoroughly studied nowadays. Physiological age-related changes in cognitive function occur in patients aged 40 to 65 years. An aging brain becomes vulnerable to ischemic processes so the presence of comorbid diseases requires caution in diagnostics and treatment strategies choice. In elderly patients it is recommended to use optimal dosage of medicine and combination therapy adapted to metabolic processes, with polymodal mode of action and targeting neurodegeneration procecces to prevent adverse outcomes.
Consilium Medicum. 2018;20(2):24-29
24-29
Specificity of cognitive impairment in neurological patients. Rehabilitation programs
Abstract
For 12 years the author conducted a study of patients with cognitive impairments of various etiologies. As a result of this directional observation, it was found that, despite the no specificity of cognitive deficits, most patients with cognitive impairment clearly differentiate into two clinical groups: 1st - patients with a violation of the general tone of the cortex and a decrease in mental activity in general; 2nd - patients with primary oppression of the control frontal function.
Consilium Medicum. 2018;20(2):30-40
30-40
The use of citicoline in patients with impaired motor function after a stroke
Abstract
The review is devoted to the use of the drug citicoline in a complex of therapeutic and rehabilitation measures in patients with acute ischemic stroke. The results of numerous experimental and clinical studies of the effect of citicoline on ischemia and brain hypoxia are also presented. The main pharmacological properties of citicoline, which has a complex neuroprotective effect, are described, just as the data on the newest multicenter placebo-controlled trials of the drug in acute stroke, that is also presented. The basic principles of successful neurorehabilitation after a stroke - early onset, continuity, continuity, multidisciplinary organizational approach, combination of rehabilitation measures and drug support of neuroplasticity are discussed as well.
Consilium Medicum. 2018;20(2):41-44
41-44
Vascular wall properties of the vertebral arteries in patients with ischemic stroke in posterior circulation
Abstract
The aim was to assess the vascular properties of the vertebral arteries (VA) in healthy persons and to detect their possible impairments in patients with ischemic stroke in posterior circulation (PCIS) and patients with vertebrobasilar insufficiency (VBI). 39 patients with PCIS, 29 patients with VBI and 65 healthy voluntaries were included into the study. Wall thickness, systolic and diastolic diameters of the VA and the common carotid arteries were measured using ultrasonography and indexes characterizing elastic properties of vascular walls (compliance, distensibility, beta stiffness index) were calculated. As appose to the common carotid arteries wall thickness, vessel diameter and stiffness of the VA were not significantly correlated with age. This finding might be linked with the difference in the age-related remodeling processes in these arteries. Stiffness of the VA was significantly higher in patients with PSIC and VBI in comparison with healthy voluntaries, and this stiffness increase could be a risk factor for PCIS.
Consilium Medicum. 2018;20(2):45-49
45-49
Treatment of patients with chronic cerebral ischemia: pentoxifylline in focus
Abstract
Chronic cerebral ischemia (CCI) is a common cause of cognitive impairment and decrease in self-sufficiency. CCI development is associated with small and large vessels damage, microcirculation disorders and systemic hemodynamic disturbances. A sufficient level of cerebral blood flow support may slow down the disease progression. The article considers the possibilities of Vasonit (pentoxifylline) use in patients with CCI treatment.
Consilium Medicum. 2018;20(2):50-58
50-58
A case of severe generalized myasthenia with late onset and predominant lesion of bulbar muscles: the case report and review
Abstract
Myasthenia gravis according to modern concepts is a heterogeneous group of autoimmune pathology with a postsynaptic neuromuscular transmission defectsts and can be classified by the prevalence of the lesion, the detection of specific antibodies, the age at onset of the disease, the presence of thymus pathology. Such a clinico-pathogenetic heterogencity creates difficulties in the diagnostics and treatment of the disease. With late (over 50 years) myasthenia gravis debilily, the disease often has flow characteristics: a predominat lesion of bulbar musculature, a severe progressive course, a lack of proper effect from the therapy. If in patients with myastenia gravis of older age there is vascular load, then it is often mistakenly diagnosed with cerebral stroke. Presented case severe generalized myasthenia gravis with bulbar syndrome in a patient of 60 years old, shows the features of the cours of this disease with late debute.
Consilium Medicum. 2018;20(2):59-62
59-62
Sensorimotor integration in health and after stroke
Abstract
In the article a modern view on structural and functional somatosensory system organization is discussed. It is outlined that not only a feedback mechanism based on sensory impulsation is an essential condition for fine motor movements, but also sensorimotor integration is involved. The processes of sensorimotor integration are based on lookahead/forestalling phenomena of the movement results. Whereas an existing movement program of lookahead/forestalling modulates the sensory system, afferent activity of which influences movement accuracy. The neurological deficit associated with stroke is determined by the involved area and adjacent conduction tracts and also by neural networks damage outside the ischemic area. Acute ischemic stroke not only results in functional and effective connections of connectome damage, but also changes dynamical characteristics (amplitude and frequency) of cortical oscillations that results in desynchronization. Cerebral perfusion normalization, activation of tracts close to the ischemic area and distant from it, and cortical excitability change are the basis for recovery after stroke. Stroke recovery is considerably determined by central nervous system multimodal integration and is not limited only by sensorimotor integration. Understanding of structural and functional basis for sensorimotor integration and its dynamic properties opens up new possibilities of interventions that will result in better recovery after stroke.
Consilium Medicum. 2018;20(2):63-68
63-68
Actualization of effective stratified therapy in patients with mild traumatic brain injury (clinical trial)
Abstract
Synapse damage that develops due to linear and impact acceleration is the basis for clinical signs of mild traumatic brain injury (MTBI) development. The prognosis for functional recovery (in 1-2 weeks) is favorable in most patients, though in some of them more prolonged deficit can occur that is referred to post-concussion syndrome (PCS). The aim of this open-label observational study was to estimate the effectiveness of ipidacrine (Ipigrix®) use for PCS prophylaxis in patients with MTBI. Materials and methods. Patients with MTBI (n=108) were divided in two groups. The therapy in treatment group (n=60) included basic treatment program (rest, dehydration therapy as well as some medications required such as non-steroid anti-inflammatory drugs, antiemetic drugs, and anxiolytics) combined with anticholinesterase medication ipidacrine (Ipigrix®). The patients of control group (n=48) received only basic treatment program. The patients were followed up for 30 days. The treatment effectiveness was estimated using Post-Concussion Symptom Scale (PCSS) results analysis and overall number of patients diagnosed with PCS. Results. After 1 month of follow-up and treatment the PCSS score (mean ± s) was 6.5±3.5 in treatment group and 11.2±5.2 in control group (p<0.05). PCS was diagnosed in 7 (15.9%) patients of control group that is significantly more compared with treatment group where this diagnosis was established in 2 (3.6%) patients. It was found that female patients (adjusted odds ratio - OR 2.92, 95% confidence interval - CI 1.26-8.22), patients with a history of MTBI (adjusted OR 2.52, 95% CI 1.66-5.32), and patients who did not receive ipidacrine treatment (adjusted OR 1.50, 95% CI 0.96-2.30) have significantly higher risk of PCS development. Conclusions. Ipidacrine usage results in significant positive effect on frequency and risk of PCS development in patients with MTBI. Still, to confirm acquired data and develop clinical guidelines on rational management of these patients further research is needed.
Consilium Medicum. 2018;20(2):69-77
69-77
Idiopathic neuralgic amyotrophy: Parsonage-Turner syndrome
Abstract
The Parsonage-Turner syndrome, relatively rare disease of uncertain etiology, which has a characteristic clinical picture: severe pain syndrome in the onset of the disease, further regression of pain symptoms, and subsequent development of weakness in the musculature of the scapula. This clinical picture is the key to diagnosing this disease. The advantage of setting the right diagnosis determines the optimal treatment tactics, it allows to avoid the appointment of additional survey methods. The article describes two clinical cases of idiopathic neural amyotrophy (Parsonage-Turner syndrome). Questions of the clinical picture, differential diagnosis and course of the disease are discussed.
Consilium Medicum. 2018;20(2):78-83
78-83
Under-reported posterior reversible encephalopathy syndrome that requires emergency management
Abstract
The article presents a literature review on posterior reversible encephalopathy syndrome (PRES). Risk factors that promote the syndrome development, clinical manifestations, radiological signs, formation mechanisms, treatment, disease course and outcome prognosis of this encephalopathy are discussed. It is noted that clinical and radiological changes in PRES are determined by vasogenic cerebral oedema provoked by various pathological conditions, medications and treatment procedures. It is outlined that early diagnosis and adequate treatment result in clinical and radiological changes reduction. Аlso the emergency management includes analysis and elimination of causes that resulted in syndrome development. PRES symptoms management includes antihypertensive and antiepileptic therapy use.
Consilium Medicum. 2018;20(2):84-89
84-89
Efficacy and safety of patients with low back pain treatment
Abstract
Low back pain (LBP) is one of the most common reasons for visits to outpatient clinics and temporary disability. Wide LBP occurrence in population, frequent pain syndrome development in patients with comorbid diseases, and necessity of analgetics use are associated with high risk of adverse side effects development. Besides pain management and early return to habitual lifestyle, safety of LBP treatment is an important task. The article considers applicability of combined vitamin B complex drug Neuromultivit in patients with LBP treatment.
Consilium Medicum. 2018;20(2):90-95
90-95
Author's methods of kinesitherapy in neurorehabilitation (lecture)
Abstract
The material contains information on several effective methods of rehabilitation of motor neurological disorders, defined as "author's", characterized by originality of approaches and specificity for specific nosological conditions. Among them: the methods of Kenny, Cabot, Brunnstrom, Taub, Perfetti, as well as the method of mirror therapy.
Consilium Medicum. 2018;20(2):96-100
96-100
Aneurysms of the supraclinoid section of the internal carotid artery in neurological practice (clinical cases)
Abstract
Cerebral aneurysms (CA) are the main cause of non-traumatic subarachnoid hemorrhage, which often lead to death. The most common localization of the CA is the supraclinoid compartment of the internal carotid artery, aneurysms at this location can manifest oculomotor disorders. In this article, on the example of two own observations, the identified opportunities for differential diagnosis in acute or subacute oculomotor disorders, not only with stroke, volume formations, endocrine disorders and demyelinating diseases, but also aneurysms of the intracerebral arteries. Recognition of the neurological status of patients with CA in the early stages is necessary for timely surgical treatment.
Consilium Medicum. 2018;20(2):101-104
101-104
Recurrent facetalgy syndrome: clinical case analysis
Abstract
Back pain is often regarded as “non-specific” pain that is explained by complicated identification of the primary pain source in everyday clinical practice. In the article approaches to facet syndrome diagnostics are discussed through the clinical case analysis. The presented clinical case demonstrates the capabilities of effective complex conservative treatment (using disease-modifying drug Nimesil) of recurrent facetalgy syndrome in primary health-care facilities.
Consilium Medicum. 2018;20(2):106-111
106-111
Hopantenic acid: perspectives for its use in psychiatry
Abstract
Hopantenic acid is a substance that combines the neurochemical and pharmacological properties of both GABA and pantothenic acid. It acts as a precursor and analogue of both of them. But in contrast to both GABA and pantothenic acid, hopantenic acid readily crosses the blood-brain barrier. Due to that, it affects both the GABAergic systems of the brain and the systems that depend on the participation of pantothenate and its derivatives (coenzyme A and acetyl-CoA). Through its action on coenzyme A and acetyl-CoA system, it influences all the main neurotransmitter systems (dopaminergic, noradrenergic, serotonergic, cholinergic, glutamatergic), the metabolism of cholesterol and phospholipids, antioxidant systems and alike. Hopantenic acid has a wide spectrum of therapeutic activity. It has neuroprotective, neurotrophic, neurometabolic, nootropic (procognitive), antidepressant, anxiolytic, moderate antipsychotic, antinegative and analgesic effects, and also has the ability to reduce the extrapyramidal side effects of antipsychotics. In this article, we consider in detail the evidence base for the use of hopantenic acid in various mental illnesses, both in adults and in children and adolescents and in geriatric psychiatry. In adult psychiatric practice drugs hopantenic acid have been successfully used under such conditions as asthenic disorders, cognitive disorders, anxiety and depressive disorders, schizophrenia, correction of side effects of pharmacotherapy. In child psychiatric practice hopantenic acid drugs used in attention deficit disorder with and without hyperactivity, autism spectrum disorders, delay of mental development. One of the most commonly used in the practice of drugs hopantenic acid is Pantocalcin production of Valenta Pharm.
Consilium Medicum. 2018;20(2):112-123
112-123
Injectable valproate in the treatment of status epilepticus. Review of literature, clinical observation
Abstract
The article presents a literature review of the use of the injectable forms of valproate in the treatment of epileptic status. A clinical case of benign occipital epilepsy with a statistic course of attacks, stopped with valproic acid derivatives intravenously, is shown. Our data and the results of other authors' studies showed high efficacy and tolerability of valproic acid preparations in the injectable form in the treatment of epileptic status.
Consilium Medicum. 2018;20(2):124-127
124-127
Migraine in the clinical practice of a neurologist: a thorny path to rational therapy of patients
Abstract
Migraine is characterized by high disadaptation and a significant decrease in the quality of life of patients due to the frequency, duration and severity of attacks of headache. Despite the wide prevalence of the disease, the path from diagnosis, selection of effective therapy and significant improvement in the quality of life of patients with migraine sometimes takes many years. This variant of primary headache is distinguished by a significant polymorphism of attacks of cephalalgia, and it is not at all easy to choose the optimal means for relief of pain. The most effective selective agonists of 5HT1B/1D receptors of serotonin (triptans) are not often used even in patients with severe and prolonged attacks, not all patients are aware of their existence or are not satisfied with their effect, which is often associated with improper use of drugs during a migraine attack. In this connection, the study of funds from the group of triptans, which are the most effective, pathogenetically substantiated drugs for the therapy of migraine attacks, continues to be the subject of active research. Analysis of the clinical use of the domestic drug Migrepam® (zolmitriptan) for arresting migraine attacks without an aura demonstrated its high efficacy, good tolerability and safety, and also the high adherence of patients to Migrepam® therapy in the future.
Consilium Medicum. 2018;20(2):128-135
128-135
Differentiation therapy with vitamin D: modern treatment approach to comorbid pathology management
Abstract
The article provides a contemporary view on calcium and vitamin D role in bone tissue metabolic processes in health and pathology. Current data on vitamin D metabolism, its numerous extraskeletal effects and significance in comorbid pathology are considered. The principles of osteoporosis treatment in terms of differentiated application of native form and active vitamin D metabolites, in particular the most common and studied form - alfacalcidol (Alpha D3-Teva®), are presented.
Consilium Medicum. 2018;20(2):136-140
136-140
Lamotrigine in the practice of an adult epileptologist
Abstract
The article presents the data obtained by epileptologist on outpatient admission. Out of the 198 patients with epilepsy: idiopathic epilepsy was diagnosed in 14 (7.1%), focal epilepsy of unknown etiology in 97 (48.9%), structural focal epilepsy in 87 (44%). Antiepileptic therapy can be effective and safe provided an optimized approach to the treatment of epilepsy. Economic factors directly influence the solution of the problem of treatment effectiveness. The complex mechanism of action causes a wide range of activity lamotrigine, which makes it possible to use it in all forms of epilepsy in patients of different ages and women, fertility age.
Consilium Medicum. 2018;20(2):142-144
142-144
To the question of the use of alimamazine (Teraligen®) in patients with atopic dermatitis in combination with anxiety-depressive disorder
Abstract
The purpose of this trial was to study the effectiveness and safety of the preparation Teraligen® (alimemazine) solution for intramuscular injection (ampoules 5.0 mg of alimemazine tartrate in 1 ml, 5 ml) in adults with moderate atopic dermatitis combined with anxiety-depressive disorder. The study involved 69 patients (42% women and 58% men, the average age was 31.3 years with a diagnosis of moderate atopic dermatitis (on the SCORAD index of itching), combined with anxiety (according to the Hospital Anxiety and Depression Scale - HADS), as well as with the negative impact of the disease on the quality of life of the patient (based on the Dermatology life Quality Index). Patients received a course of treatment with Teraligen® by intramuscular injection of 25 mg (5 ml) 2 times in day. The duration of alimemazine treatment was 10 days (starting with the first dose of the drug) with a further observation period of 28±1 days. All patients treated with Teraligen® (alimemazine) noted a gradual improvement in the condition, expressed by a decrease in the severity of the underlying symptoms of atopic dermatitis. The mean value of the absolute values of the SCORAD index of pruritus by the 11th day decreased by 18.7 times (p<0.0001), the average value of the itching index (according to the SCORAD scale), by the 11th day of therapy decreased by 4.95 times (p<0.0001). The proportion of patients who reached the level of SCORAD index of 29 points or less by day 11 reached 100%. The proportion of patients with disappearance or decrease in the manifestation of the symptom "skin pruritus" (2 points or less) by day 11 was 98.4% of patients. The proportion of patients with complete disappearance of skin pruritus by the 11th day was 71.9% (p<0.0001). Therapy with Teraligen® marked a significant increase in the proportion of patients who have reached the target level of 10 points or less in terms of anxiety and depression (HADS); p<0.0001; attained at the end of the treatment, the low level of anxiety and depression remained virtually unchanged throughout the observation period (38±1 days). Patients noted a significant decrease in the negative impact of the disease on social and functional activity. In addition, a high safety profile of the study drug was established, only one adverse event was identified - drowsiness of a mild degree 3.1% (in 2 patients). Thus, Teraligen® (alimemazine) is useful for complex therapy of atopic dermatitis, accompanied by anxiety-depressive and other psychoneurological disorders.
Consilium Medicum. 2018;20(2):145-150
145-150
Vertigo after traumatic brain injury: diagnostics and treatment
Abstract
The article considers vertigo after traumatic brain injury etiology and pathogenesis. A typical clinical performance, diagnostics and treatment aspects in such conditions causing post traumatic vertigo as benign paroxysmal positional vertigo, perilymphatic fistula, superior semicircular canal dehiscence, labyrinth fracture post traumatic vestibular migraine, postconcussional syndrome, and other reasons are described.
Consilium Medicum. 2018;20(2):151-155
151-155
Clinical study of the effectiveness of reflexotherapy in the treatment of post-stroke cognitive disturbances in the acute period of the cerebral stroke
Abstract
The causes of disability after a stroke are not only motor, sensory, speech disorders, but also cognitive impairments that reach the severity of dementia. The purpose of this study was to evaluate the clinical efficacy of reflexotherapy inclusion in the scheme of rehabilitation of patients with acute ischemic stroke for the correction of post-stroke cognitive impairment and to increase the level of motivation of patients. Materials and methods. A survey and a course of early rehabilitation of fifty patients in the acute period of ischemic stroke were carried out. Cognitive impairment in patients was confirmed by the results obtained during testing on the MMSE scales and the MoCA test. The motivation of the patients was investigated using the Questionnaire Test "Motivation for Success and Motivation for Fear of Failure". The clinical study was supplemented by an assessment on the scale of assessing the severity of stroke NIHSS. In the main group (30 patients) the basic unified complex of rehabilitation measures was optimized by the inclusion of various methods of reflexotherapy. Patients in the control group (20 patients) received traditional treatment without reflexotherapy. Results. In the main group, on the fifteenth day from the beginning of reflexotherapy, cognitive functioning indices on both scales revealed significant positive dynamics (by 3.1 points by MMSE and 3.2 points by the MoCA test, p<0.001) and a significant increase in the level of motivation (on average 2.1 points, p<0.001). In the second group, cognitive improvements were less noticeable (p>0.05), there was no significant change in the level of motivation (p>0.05). The NIHSS scores in the main group significantly improved compared to baseline (mean 3.88 points, p<0.001), whereas in the second group the regression of the neurological deficit was less marked (on average by 1.85 points, p<0.05). Conclusion. Thus, the inclusion of reflexotherapy in the early rehabilitation of post-stroke patients is accompanied by reliable positive dynamics of cognitive functions, and also has a beneficial effect on increasing the level of motivation of patients, which is especially important for rehabilitation activities, promoting more rapid regression of focal neurological symptoms.
Consilium Medicum. 2018;20(2):156-159
156-159