Vol 19, No 2 (2017)

Cover Page

Full Issue


System psychoneurology: current understanding of the structural and functional organization of the brain

Damulin I.V.


The article deals with modern aspects of structural and functional activity of the central nervous system. Connectome is important due to its concept, the construction of which is based on the results of functional magnetic resonance imaging and involves the separation of certain cerebral regions (oblasts), evaluating the links between these regions and the detailed analysis of these network connections. Connectome is characterized by dynamic and functional heterogeneity (exciting, inhibiting, modulating area). Operations of connectome are determined by energy metabolism in brain tissue. "Hidden" (or "internal") is not linked to external influences energy is spent on the process of evaluating and developing responses/reactions to the stimuli coming from the outside, as well as, probably, in the anticipation/prediction of events that may occur. This is important not only to the level of energy metabolism, but also fluctuations "stored energy". The brain operates with system-energy point of view in the direction of minimizing their own energy consumption. The article concludes that created in the current model (connectome) is more informative for the understanding of the processes occurring in the brain than the simple sum of the parts belonging to it. This model is the key to a new direction of development of neuroscience - system psychoneurology.
Consilium Medicum. 2017;19(2):8-13
pages 8-13 views

Post-stroke cognitive decline: the main features and risk factors

Kovalenko E.A., Bogolepova A.N.


In the following review article discusses modern ideas about the main features and risk factors of post-stroke cognitive decline. The most common effects of stroke are cognitive disorders which significantly contribute to the disability of patients. The occurrence of post-stroke cognitive impairment caused by many factors. Therefore, it is necessary to examine all patients after stroke and reveal potential predictors of decline in cognitive function. Early detection and adequate correction of modifiable risk factors can prevent the onset and progression of post-stroke cognitive decline that will significantly improve the quality of life of patients and their relatives.
Consilium Medicum. 2017;19(2):14-18
pages 14-18 views

Evaluation of circadence to predict the outcome of a vegetative state

Belkin A.A., Alekseeva E.V., Alasheev A.M., Davydova N.S., Leyderman I.N., Nikov P.N., Pinchuk E.A., Safonova T.Y., Semyannikova M.P., Fedorov E.G., Belkin V.A.


Coma in a true sense of dreamlike state lasts no more than 3 weeks, after which it enters the vegetative stage of recovery of consciousness, except in those patients who died or regained conscious wakefulness. The number of registered cases of vegetative state reaches 100 per 1 million population (S.Ashwal et al., 1996). This category of patients remains terra incognita even for an interdisciplinary analysis of neurologists and emergency physicians. Meanwhile, the emotional and financial costs of care for this category of patients is the most significant. In search of prognostic criteria for selection of a vegetative state the authors applied to the analysis of one of the earliest in the phylogeny of the autonomic functions - sleep. Based on the hypothesis: no sleep recovery - there can be recovery of cognitive status, on the basis of the rehabilitation clinic of the Clinical Brain Institute in the period from 2008 to 2014 conducted polysomnographic study of 64 patients in a vegetative state, and 10 patients evaluated the dynamics of the concentration of melatonin in the blood during treatment. Preliminary results indicate a direct relationship between these modalities circadian status and outcome of a vegetative state.
Consilium Medicum. 2017;19(2):19-23
pages 19-23 views

Technical note Computer aphasia screening test

Shcherbakova M.M., Kotov S.V.


The procedure may be used by group of different professionals, working in vascular units of neurological clinics, in trauma units, in post-stroke rehabilitation centers and other departments, for planning correct types and forms of rehabilitation of patients, who are required a particular treatment. Detection the relation between specificity of altered higher mental functions, including speech, and etiology, and also, correct and timely diagnosis of these diseases, should improve the quality of rehabilitation in selected group of patients.
Consilium Medicum. 2017;19(2):24-26
pages 24-26 views

The analysis of the clinical case of a patient with neurogenic dysphagia (subacute stage)

Gershun E.V., Rudometova Y.Y., Moskaleva V.V.


Dysphagia is a disorder of the swallowing act, which, if not eliminated in the early period, can lead to severe complications, up to a lethal outcome. In our article we reflect in detail the phased approach and methods of logopedic work (specialized diet and dishes for safe food intake, work on the vocaSTIM apparatus, postural techniques) that helped reduce the risk of penetration and aspiration, restore the actual swallowing function, and prevent the occurrence and fixation of Patient fear of eating.
Consilium Medicum. 2017;19(2):27-29
pages 27-29 views

Cardiac arrhythmias and stroke

Petrova E.A., Koltsova E.A.


In this paper we discussed the role of cardiac arrhythmias in the development of different types of ischemic stroke. In the pathogenesis of cardioembolic stroke the main role plays paroxysmal atrial fibrillation. Haemodynamic stroke can be caused by transient bradyarrhythmia due to the atrioventricular block and sick sinus syndrome, as well as the transient myocardial ischemiawith the deterioration of left ventricular contractility. It has been shown, that bradyarrhythmia and ventricular extrasystolesare associated with high risk of development of life-threatening acute coronarysyndrome, and may not correlate with the severity of the neurological deficit. In patients with cardioembolic stroke in 40% of cases cardiac arrhythmiasand episodes of myocardial ischemiawith pathogenetic significance have asymptomatic clinical course and are usually diagnosed only after the development of neurological symptoms. Thus, time lyregistration of hidden heart problems is crucial for optimization of treatment strategy.
Consilium Medicum. 2017;19(2):30-34
pages 30-34 views

The key element of the rehabilitation program: a clinical case - rehabilitation of a patient with a stroke

Maltseva M.N., Shmonin A.A., Melnikova E.V.


The article describes a clinical case of a multidisciplinary approach to a patient with a stroke in the first stage of rehabilitation. The rehabilitation diagnosis and the rehabilitation plan based on it are given. A special feature of this case was the timely appointment of an anti-inflammatory and an anesthetic drug Nimesil. This case showed how an anesthetic drug can help prevent developing disorders due to the underlying disease, and also prevent a decrease in motivation and development of negativity. The authors emphasize that very often one problem can be the key to the rehabilitation of the patient as a whole, and the technology of its solution by rehabilitation can be very simple if it is revealed as a result of the work of a multidisciplinary rehabilitation team.
Consilium Medicum. 2017;19(2):36-39
pages 36-39 views

The role of early skeletal plastics of a skull defect in the rehabilitation of patients who underwent decompressive trepanation of the skull for nontraumatic intracranial hemorrhage

Chipizubov V.A., Petrov S.I.


Decompressive trepanation of the skull in the complex treatment of non-traumatic intracranial hemorrhages certainly plays an important role. In different clinics it is performed in 30-40% of cases of increased intracranial pressure for various cerebrovascular pathologies. Being inherently urgent intervention aimed at saving lives, it entails a number of negative consequences, reduces the rehabilitation potential of the patient. The floor plastic of the defect of the bones of the skull is more often delayed, after a few months. For 2013-2015 years. Decompressive trepanation of the skull due to an uncontrolled increase in intracranial pressure, we performed 137 patients, 71 of them (study group) - early skeletal deformity of the skull defect in terms of 6 to 17 days, the rest of the plastic was not performed (control group). Patients from both groups were evaluated according to a number of criteria, the greatest difference was noted in the rate of recovery of the level of consciousness, regress of aphasic disorders after the plastic surgery. This is confirmed statistically by means of regression analysis functions. At the same time, the trends in patient recovery, regardless of nosology, were similar, as noted in the standard scales (Rankin, NIIHS, Rivermeade Barthel's index).
Consilium Medicum. 2017;19(2):40-43
pages 40-43 views

The diagnostic value of the study of the cytochemical activity of enzymes in hereditary mitochondrial diseases

Kazantseva I.A., Kotov S.V., Borodataya E.V., Sidorova O.P., Kotov A.S.


Examined in 8 patients with hereditary neurological mitochondrial disease. Through cytochemical analysis of lymphocytes in the peripheral blood, assessed the activity of 4 enzymes of mitochondria, involved in carbohydrate metabolism (lactate), metabolism of amino acids (glutaraldehydes), metabolism of fatty acids (α-glycerophosphorylcholine) and complex II of the respiratory chain of mitochondria (succinate dehydrogenase). Investigated the lactate in the blood before meals and after exercise carbohydrates. In 3 patients with optic atrophy of Leber three patients with optic atrophy of Leber, the activity rate of succinate dehydrogenase and α-glycerophosphorylcholine was changed. The level of lactate in the blood before meals were elevated after exercise with carbohydrates - in the normal range. The patient with the SANDO syndrome was changed, the activity rate of succinate dehydrogenase, α-glycerophosphate dehydrogenase and glutamate decarboxylase. The level of lactate in the blood were elevated after a meal significantly more. The syndrome MERRF cytochemical activity of mitochondrial enzymes have been totally reduced. Lactate was elevated before and after eating. The syndrome PEOA3 all cytochemical activity of mitochondrial enzymes was changed. Lactate in the blood before the food has been upgraded. The syndrome MELAS lactate in the blood was increased. Altered activity of mitochondrial enzymes except lactate dehydrogenase. The syndrome of Alpers-Huttenlocher was changed: the indexes of glutamate decarboxylase and α-glycerophosphate dehydrogenase. Lactate was elevated. Thus, the used method of investigation of the cytochemical activity of mitochondrial enzymes is effective for the evaluation of its violations.
Consilium Medicum. 2017;19(2):46-50
pages 46-50 views

Alcaptonuria patient with vertebrobasilar insufficiency: case report and literature review

Serdiuk A.V., Kovrazhkina E.A., Kulkova A.O.


Alcaptonuria is a rare hereditary disease, which manifests itself in violation homogentisic acid metabolism, deposition of its metabolites in tissues and lesions of various organs and systems. In this disease it is obligate symptoms, allowing error-free diagnosis, but often the diagnosis is late. Here is your own observation of 75-year-old patient.
Consilium Medicum. 2017;19(2):51-55
pages 51-55 views

Dynamics of vascular reactivity in patients with mixed encephalopathy

Akarachkova E.S., Dulaeva M.S., Kadyrova L.R., Kerimova K.S., Kotova O.V., Lebedeva D.I., Radchenko I.A., Travnikova E.V.


On the model of cerebral energy deficit - encephalopathy of mixed origin - the dynamics of vascular reactivity (VA) and brain metabolism in different functional states is demonstrated. The results showed that VA preserved level is a good predictor of the higher VA patients with encephalopathy, the less brain tissue hypoperfusion and thus better prognosis after standard nootropic vascular therapy. Acetazolamide helps to change the VA and effectiveness of the therapy against this background.
Consilium Medicum. 2017;19(2):56-59
pages 56-59 views

The differential diagnosis of "non-systemic vertigo" in patients with cerebral stroke

Kotov S.V., Isakova E.V., Romanova M.V.


Diagnosis of stroke by identifying symptoms of vertigo - a common situation in a typical practice. The aim of the study was to investigate the main reasons for non-systemic vertigo (imbalance and sustainability) in patients with stroke admitted to angioneurological hospitals of Moscow Region health care institutions (MR HCI). The study included 144 patients, who complained of dizziness non-system character. Based on the received careful clinical and instrumental examination data showing that nearly 90% of the cases the diagnosis was correct. At 1/10 of the surveyed patients with a diagnosis of "cerebral stroke," in MR HCI complaining of dizziness as a non-systemic basic, other causes of irregularities were detected, such as affective and neurotic disorders, somatic pathology.
Consilium Medicum. 2017;19(2):60-63
pages 60-63 views

Vestibular neuritis

Palchun V.T., Guseva A.L., Baybakova E.V., Makoyeva A.A.


Vestibular neuritis is an acute unilateral peripheral vestibular disorder, manifestating with vertigo, nausea, vomiting and balance disorders. The epidemiology, diagnostic features, differential diagnosis, and treatment of vestibular neuritis are reviewed. The main clinical criteria are peripheral nystagmus and positive head thrust test, absence of neurological signs and hearing disorders.The treatment includes vestibular suppressants, corticosteroids and individual physical vestibular rehabilitation.
Consilium Medicum. 2017;19(2):64-70
pages 64-70 views

Patient comorbidity in clinical practice

Putilina M.V.


The first place on the prevalence of certain forms of cerebral circulatory disorders is taken by a chronic ischemia of the brain (CIB). CIB is a special type of vascular cerebral pathology, caused by a slowly progressive diffuse violation of cerebral blood flow with gradually increasing variety of defects in its functioning. Clinical and epidemiological studies have shown that older patients per patient on average from 2 to 4 diseases, each of which may be the cause of self-sufficient CIB reason or be comorbid backdrop for others. Very often, this age group is difficult to identify a risk factor for cerebrovascular diseases are more common combination of the two, and sometimes three factors. Drug therapy in comorbid patients should be graded to prevent polypharmacy and at the same time complex. Use of a combination of drugs that act on the main pathogenetic mechanisms of pathological processes (power shortage, disturbance of cell membrane integrity, neurotransmitter imbalances), allows us to solve these problems and keep neyrobiohimicheskoe balance: on the one hand to work on all parts of the ischemic cascade, on the other hand to adjust the energy and trophic capabilities of the organism as a whole.
Consilium Medicum. 2017;19(2):71-79
pages 71-79 views

Features of tactics of conducting children with comorbidity Tourette's syndrome and sleep apnea syndrome: clinical case

Sidorenko D.R., Shnayder N.A., Terskova N.V., Alekseeva O.V.


Presentation of the rare cases of comorbid conditions (OSA - Tourette's syndrome) in a child with adenotonsillar hypertrophy of 3d degree against the background of edematous catarrhal chronic adenoiditis with subacute, recurrent course. This case demonstrates that the presence of adenotonsillar pathology complicated by obstructive sleep apnea/hypopnea syndrome (OSAHS) , in school children during the concomitant aggravates of neurological disease, which requires special attention to be given to an interdisciplinary approach to the management of this group of children.
Consilium Medicum. 2017;19(2):80-83
pages 80-83 views

Algorithm for diagnosis and therapy of cerebrovascular diseases in the practice of an outpatient physician

Isakova E.V.


The article is devoted to the problem of diagnosis and treatment of chronic cerebral ischemia from the position of analysis of pathogenetic mechanisms, leading risk factors. The features of clinical manifestations depending on the stage of the process are presented. Modern approaches to diagnostics, including neuroimaging methods, neuropsychological examination are considered.
Consilium Medicum. 2017;19(2):84-89
pages 84-89 views

The prevalence of tobacco smoking as the most important socially significant modifiable risk factor among patients with stroke

Koziaikin V.V., Kotov S.V., Isakova E.V.


The article presents an overview of current data on the prevalence of the modifiable stroke risk factor-adherence to tobacco smoking, its effect on the frequency of development, the severity of the course and the outcome of acute cerebrovascular accident. The data of the study included the results of treatment of 129 patients admitted to the hospital in the acute period of cerebral stroke. It was shown that the stroke in patients committed to smoking developed statistically significantly at a younger age than non-smokers. A distinct effect of smoking on the severity of the progression of cerebral stroke on the scale of the National Institutes of Health (NIHSS) and recovery of patients was not obtained. At the same time, the functional state of nonsmokers with Rankin's stroke in the debut was statistically significantly heavier than those committed to smoking, which was due to older age, more somatic diseases.
Consilium Medicum. 2017;19(2):90-95
pages 90-95 views

Interventional technology in the prevention of the stroke in the vertebrobasilar system

Sermagambetova Z.N., Maksimova M.Y., Skrylev S.I., Fedin P.A., Koshcheev A.Y., Shchipakin V.L., Sinitsyn I.A.


In a relatively short period of existence, interventional technology has become an integral component of angioneurology. Transluminal balloon angioplasty with stenting of vertebral arteries (VA) is an effective endovascular technique for improving cerebral blood flow with a low complication rate and good long-term results. Quality of life assessment is an independent objective multiple-factor indicator of surgical treatment efficiency. The present article is devoted to study of life quality of 50 patients after transluminal balloon angioplasty with stenting of vertebral arteries. In a cohort of the patients included in research low indicators of life quality were observed before stenting of vertebral arteries. In 6 months after stenting of vertebral arteries indicators of life quality are raised in physical and psychological spheres. Monitoring of brainstem auditory evoked potentials (BAEP) is an additional method of an objective assessment of neurophysiological processes in brainstem. Patients with hemodynamically significant of extracranial VA stenosis had brainstem auditory evoked potentials abnormalities including elongation of interpeak intervals I-V and V peak latency, reducing I peak amplitude. After transluminal balloon angioplasty with stenting of VA revealed a shortening V peak the latency (compared to preoperative period), reflecting the improved of the brainstem conductive functions. Atherostenosis of vertebral arteries is characterized by signs of disfunction of brainstem, predominantly at pontomesencephal level. After transluminal balloon angioplasty with stenting of VA revealed the improved of the brainstem conductive functions.
Consilium Medicum. 2017;19(2):96-103
pages 96-103 views

Chronic vascular diseases of the brain: an algorithm for diagnosis and treatment

Shakhparonova N.V., Kadykov A.S.


Chronic cerebrovascular diseases of the brain (CCVDB) along with stroke occupy a leading place among the causes of disability of the population. Correct and timely diagnosis of CCVDB taking into account their clinical form, etiology, pathogenesis, risk factors, allows us to prescribe adequate therapy that can improve the quality of life and slow the progression of the disease.
Consilium Medicum. 2017;19(2):104-109
pages 104-109 views

Mechanisms of chronic pain development. Approaches to prevention and treatment

Kukushkin M.L.


Presents data on the role of neurobiological, psychological and social factors in the pathogenesis of chronic pain. Chronic pain is considered not as a symptom of tissue damage, and as an independent disease arising from dysfunction of systems involved in the regulation of pain sensitivity. The complex pathophysiological basis of chronic pain syndrome requires a comprehensive approach in its treatment with the use of individualized programs of specialized pain centers.
Consilium Medicum. 2017;19(2):110-117
pages 110-117 views

Pain in Parkinson's disease

Pilipovich A.A.


Parkinson's disease (PD) is a widespread neurodegenerative disease characterized by motor symptoms and a number of non-motor manifestations, one of the most frequent and maladaptive of them is pain. Pain affects about 40-70% of patients with BP, which exceeds the frequency in the general population. Pain syndrome has a great negative impact on the general condition of the patient, his quality of life, and requires a separate approach to diagnosis and therapy. The article describes the etiological and pathogenetic aspects of pain in PD, its classification and the principles of therapy.
Consilium Medicum. 2017;19(2):118-122
pages 118-122 views

The effect of symptomatic delayed-action drugs on the progression of osteoarthritis of the knee joints (a 5-year prospective study)

Kashevarova N.G., Alekseeva L.I., Taskina E.A., Smirnov A.V.


Treatment of osteoarthritis is aimed both at the symptoms of the disease (reducing pain, inflammation, improving the functional state), and slowing the progression and improving the quality of life of patients. Symptomatic effects are achieved by a combination of non-pharmacological and pharmacological treatments set out in numerous recommendations. At present, sufficient evidence has been obtained that symptomatic delayed-acting drugs have anti-inflammatory, analgesic and structural-modifying effects.
Consilium Medicum. 2017;19(2):123-128
pages 123-128 views

Musculoskeletal pain: actual aspects of treatment at the stage of primary medical care

Trukhan D.I.


A wide range of therapeutic and diagnostic manipulations and expansion of medical care, including musculoskeletal pain, provided by doctors at the stage of primary health care, involves the inclusion in the arsenal of analgesics used various forms of the release of the nonsteroidal anti-inflammatory drug lornoxicam.
Consilium Medicum. 2017;19(2):129-135
pages 129-135 views

The use of Carnicetine in patients with diabetic polyneuropathy

Kamchatnov P.R., Kabanov A.A., Khanmurzaeva S.B., Chugunov A.V., Khanmurzaeva N.B.


Polyneuropathy is a frequent complication of diabetes mellitus, associated with severe disability, a decrease in the quality of life of patients, an increased risk of death. Treatment of patients with diabetic polyneuropathy (DPNP) includes correction of carbohydrate metabolism, restoration of the structure and functions of nerve fibers, elimination of the most significant symptoms of the disease. At present, information on the efficacy of acetyl-L-carnitine (Carnitine) in such patients is accumulated. Information on its role in metabolism in normal and pathological conditions is considered. The results of randomized clinical trials and meta-analyzes on this issue are presented, which testify to the effectiveness of the drug in patients with DPNP.
Consilium Medicum. 2017;19(2):136-140
pages 136-140 views

Modern approaches to the treatment of gout

Myasoedova S.E.


The article summarizes information on modern tactics for treating gout on the basis of the latest guidelines of the Association of Rheumatologists of Russia, the European League Against Rheumatism, the American College of Rheumatology. Algorithms for the treatment of acute gouty arthritis and urat-lowering therapy are presented. Particular attention is paid to the selective inhibitor of xanthine oxidase - febuxostat, which is superior to allopurinol in terms of efficacy and safety.
Consilium Medicum. 2017;19(2):141-144
pages 141-144 views

Maintenance of efficiency and safety of medical process of patients with a lumbar pain

Kamchatnov P.R., Khanmurzaeva S.B., Chugunov A.V., Khanmurzaeva N.B.


Low back pain (LBP) is the most common type of musculoskeletal pain syndrome. Regardless of the reasons for its occurrence, the LBP is associated with long periods of temporary disability, a decrease in the quality of life of patients, significant material costs of treatment and rehabilitation measures. Treatment of patients with LBP can lead to the development of undesirable side effects, the occurrence of which is associated with a number of reasons, important among which are the selection and use of inadequate drug combinations, the excess of daily and course dosages of drugs, a violation of the recommended medication regimen. A reduction in the risk of side effects can be facilitated by a correct assessment of the clinical situation and an adequate choice of the drug, strict adherence to the instructions for its use. The possibility of using the preparation Nolodatak (flupirtine), which has analgesic, myorelaxing and neuroprotective effects, in the treatment of patients with LBP is considered. The indications and limitations to its purpose, possible risks of the therapy are analyzed.
Consilium Medicum. 2017;19(2):146-150
pages 146-150 views

Slow acting symptomatic agents in the therapy of osteoarthritis

Pogozheva E.Y., Amirdzhanova V.N.


The article presents the definition of osteoarthritis (OA), the main manifestations of the disease, the problems of OA therapy, the algorithm for managing patients with OA, the importance of educational programs, the combination of pharmacological and non-pharmacological methods of treatment, and the approach to prescribing analgesic therapy. The use of slow-acting symptomatic agents with high safety, symptom-modifying and potential structural-modifying action is discussed. Data on the features of the mechanism of action, clinical efficacy and safety of chondroitin sulfate, glucosamine and their combination are presented. The data of clinical trials of the preparation Arthra® is presented, its effectiveness in relation to pain syndrome and joint function improvement in patients with OA is shown, the safety and tolerability of the drug are noted, as well as its ability to preserve the effect after the end of therapy.
Consilium Medicum. 2017;19(2):152-156
pages 152-156 views

The efficacy of Traumeel® S in terms of evidence-based medicine

Pilipovich A.A.


The article describes the principles of therapy of pain syndrome in diseases of the musculoskeletal system; the role of Traumeel® S is considered, the mechanism of its action is analyzed, the data of clinical studies of the efficacy and safety of the use of various forms of Traumeel® S preparation are summarized.
Consilium Medicum. 2017;19(2):157-162
pages 157-162 views

Alfacalcidol is the optimal vitamin D preparation for the treatment of osteoporosis in patients older than 45 years

Dydykina I.S., Kovalenko P.S., Kovalenko A.A.


The article presents information on the physiological role of vitamin D, the main causes of deficient conditions and the peculiarities of the metabolism of native and active forms of vitamin D, including after 45 years. The emphasis is that alfacalcidol, due to the absence of renal metabolism, demonstrates greater clinical effectiveness than native vitamin D in the treatment of various types of osteoporosis with a similar safety profile. Alfacalcidol in the form of monotherapy is included in the clinical recommendations for the treatment of osteoporosis - in contrast to native vitamin D - because it showed a more pronounced effect on the increase of bone mineral density, reducing the risk of falls, reducing fractures and a significant reduction in the pain syndrome. The wide choice of individual doses of Alfa D3-Teva® (alfacalcidol) allows to minimize the risk of side effects, which together with the prevention of new fractures, elimination of pain syndrome and improvement of motor activity contributes to improving the quality of life of patients of all ages.
Consilium Medicum. 2017;19(2):163-166
pages 163-166 views

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