Vol 19, No 2 (2017)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.