Vol 21, No 2 (2019)


Multidisciplinary technology of rehabilitation aims definition in patients with stroke on the basis of International Classification of Functioning, Disability and Health

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


Aim. To create and test an algorithm for rehabilitation goal setting based on international classification of functioning, disability and health (ICF) for patients with acute cerebral stroke. Materials and methods. The study included 75 patients. Rehabilitation was carried out at the first stage for patients in the acute phase of a stroke involving a multidisciplinary team, which included: neurologist, PRM, speech therapist, occupational therapist, physical therapist, clinical psychologist and nurse. For all patients, a rehabilitation diagnosis was established in the categories of ICF. Results. An algorithm of rehabilitation goal setting is based on the ICF and patient’s rehabilitation potential. Conclusions. The main element in the algorithm for determining the rehabilitation goal for a patient with cerebral stroke in the acute period is the selection of one of the most complex activities formulated by the multidisciplinary rehabilitation team in the categories of ICF activity and participation, and available to the patient by the end of the rehabilitation course. The goal of rehabilitation is established on the basis of a rehabilitation diagnosis at the conclusion of each specialist multidisciplinary team of the patient's recovery potential, and its definition is one of the most important technological components of rehabilitation.
Consilium Medicum. 2019;21(2):9-17
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The role of neurotrophic factors in development of post-stroke depression

Bogolepova A.N.


Cerebrovascular disease is one of the most important causes of disability. Depression is reported to be the most widespread psychological disorder among stroke complications. Post-stroke depression is observed in about 1/3 of stroke survivors, the overall incidence rate is 55%. Depression that develops after stroke has a strong negative influence on the primary disease course, deteriorates functional improvement and quality of life and increases mortality rate. Depressive disorder in patients is a risk factor of additional cognitive disorders development, as much as to dementia. In recent years a lot of evidence on nerve growth factors involvement in pathogenesis of affective disorders development has been acquired. A decrease in brain-derived nerve factor (BDNF) levels was observed in patients with depressive disorders. Moreover, neurotrophic factors can be regarded as possible biomarkers not only of post-stroke depressive disorder itself but also of response to treatment with antidepressants. Acquired data show that BDNF has a key role in post-stroke depression pathophysiology. Use of medications with neurotrophic action such as cerebrolysin is an important aspect of post-stroke depression treatment. Preclinical studies showed that cerebrolysin influences levels of neurotrophic factor and demonstrated functional equivalence of cerebrolysin neuropeptides and neurotrophic factors. In clinical studies cerebrolysin effectiveness in post-stroke depression treatment was demonstrated. Positive results of cerebrolysin and antidepressants combined use were acquired.
Consilium Medicum. 2019;21(2):18-23
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Neurological disorders in patients with acute thallium poisoning

Zavaliy L.B., Petrikov S.S., Simonova A.Y., Pockhveriya M.M., Ostapenko Y.N., Gadzhieva M.G.


The largest study on neurological disorders in patients with laboratory-confirmed acute thallium poisoning was conducted in State Budgetary Healthcare Institution N.V.Sklifosovsky Research Institute of Emergency Medicine of Moscow Department of Health Care. For the first time affected patients were matched by route of poison exposure, time and severity of poisoning, and age. Neurological disorders as well as other symptoms typical for acute thallium poisoning are presented. Incidence of all symptoms and their severity depending on toxic agent concentration in biological liquids are presented. Thallium poisoning should be suspected if such symptoms as alopecia, myalgia of different localization (predominantly in chest and proximal leg muscles), peripheral paraparesis or tetraparesis, sensory polyneuropathy presenting with paresthesia accompanied by pain and/or hypesthesia transforming to mononeuropathy, coordination impairment presented by static or dynamic ataxia, and postural tremor coexist. Thallium determination in blood and urine is an informative diagnostic test. Pain, motor and coordination disturbances are first to regress, and tremor, sensory, cognitive and emotional disturbances preserve for a longer time. Polyneuropathies transform to mononeuropathies in time. Tremor can get worse despite thallium concentration in biological liquids decrease. Patents have cognitive and severe emotional impairment. Patients affected with thallium poisoning require long-term neurologist follow-up as well as rehabilitation.
Consilium Medicum. 2019;21(2):24-30
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Influence of proton pump inhibitors on cognitive function and dementia risk

Ostroumova O.D., Pereverzev A.P.


During the last half of the 20th century change of population age structure with constant increase of elderly and senior age population is observed all over the world. It determines the importance of prevention and treatment of great number of age-associated diseases including neurological ones. Proton pump inhibitors (PPI) use is one of possible risk factors for dementia and Alzheimer's disease development. The authors have performed research and data analysis on association of PPI use and dementia development. Acquired results are presented in the article. It has been shown that PPI use may influence b-amyloid production as they change b-secretase 1 and g-secretase activity - the enzymes responsible for b-amyloid precursor protein degradation, that results in increase of b-amyloid production. It was also demonstrated that cognitive impairment development in PPI use may be mediated by vitamin B12 deficit. Also the authors performed analysis of different PPI physical and chemical properties in order to develop suggestions on cognitive impairment risk decrease in patients with contributing risk factors. The performed analysis allowed to identify pantoprazole as one of the most appropriate medications for gastrointestinal disease treatment in patients with high risk of cognitive impairment and dementia development/progression.
Consilium Medicum. 2019;21(2):31-36
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Searching for diagnostic correlations in female patients after ischemic stroke

Vechorko V.I., Shapsigova O.A., Averkov O.V., Silaev B.V., Eliseev E.V., Kuchava G.R.


Aim. To perform a comparative analysis of clinical and laboratory parameters in groups of young women (pregnant or in early postpartum period) with stroke. Materials and methods. The study included 17 pregnant or in early postpartum period women (group 1) and 17 non-pregnant women (group 2) matched by disease severity with mean age 27.7±14.4 years in acute period of stroke in cerebral hemispheres of medium severity. Results. At the discharge improvement in NIH scale results was observed in women in both groups and there were no significant differences in outcomes. Not statistically significant differences of partial pressure of oxygen in venous blood (VB) from the median cubital vein (MCV) and the jugular vein (JV) in both groups at study period were acquired in comparative time interval. Differences in pH levels in VB from the MCV and the JV were observed during hospital stay. In patients from 2 groups pH levels were more acidic in the JV VB than in the MCV VB. Differences in lactate levels in blood from the MCV and the JV were observed. Lactate levels were lower in the MCV VB than in the JV VB during hospital stay in patients from both groups. In patients from both groups glycemia level in the JV VB was lower than in the MCV VB during the whole study period. At the discharge in patients from both groups a decrease in glucose level in arterial and venous blood from the MCV was observed. Arteriovenous oxygen difference (AVOD) in JV VB in 2 study groups was decreasing over time from admission to discharge. Differences in AVOD of VB from JV and MCV and AVOD in JV VB were higher in both study groups during the follow up period. Conclusion. In the conducted study of neurological status, brain and system metabolism charachteristics in patients with brain infarction in dynamics there were no differences found in 2 grops of women of fertile age. The reported changes suggest macroergic compounds deficit, and oxidative stress reactions products utilization disorders in brain tissue.
Consilium Medicum. 2019;21(2):37-42
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New opportunities of evaluation of ischemic stroke secondary prophylaxis effectiveness in therapeutic practice

Shishkova V.N.


Aim. Study of antibodies to NR2-subunit of NMDA receptor level dynamics in patients after first ischemic stroke (IS) after use of Mildronate® 1000 mg per day. Materials and methods. The study included 45 patients (25 male, 20 female) aged 45 to 83 years at the time of first IS development. The patients were randomized into 2 groups: group 1 patients (n=30) received Mildronate® in capsules 500 mg twice a day for 45 days combined with neurorehabilitation complex; group 2 patients (n=15) did not receive Mildronate®. Evaluation of antibodies to NR2 protein was performed twice (at the beginning of therapy and at the end of therapy) in all study patients with the use of Gold Dot Test (CIS Biotech, Inc., Atlanta, GA) blood test. Results. A significant decrease of concentration of central nervous system (CNS) ischemia marker - antibodies to NR2-subunit of NMDA receptor was observed in the group of patients who received Mildronate® 1000 mg per day for 45 days. Conclusions. According to acquired data it may be concluded that inclusion of Mildronate® 1000 mg per day for 45 days in neurorehabilitation period therapy results in significant decrease of CNS ischemia marker - antibodies to NR2-subunit of NMDA receptor concentration that may indicate decrease of ischemic CNS injury.
Consilium Medicum. 2019;21(2):43-47
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Study of associations of polymorphic variants of lipid metabolism genes and angiogenesis with first ischemic stroke

Shishkova V.N., Remennik A.Y., Valyaeva V.V., Adasheva T.V., Stakhovskaya L.V., Skipetrova L.A., Cheremin R.A., Shklovskii V.M.


Introduction. Ischemic stroke (IS) is a complex multifactorial disorder with heterogeneous congenital component. Polymorphic variants of genes of apolipoprotein В (APOB), apolipoprotein А-V (APOА-V), apolipoprotein С-IV (APOC-IV), apolipoprotein H (APOH), apolipoprotein D (APOD), angiopoietin-related protein 4 (ANGPT4) that regulate lipid metabolism and vascular regeneration, may be regarded as perspective ones. Although until recently they were not studied in complex, in a homogenous group from the perspective of possible association with first IS development. Aim. To study association between polymorphic variants of the following genes: АРОH, APOD, APOE, APOA5, APOC4, ANGPT4 and first IS development. Materials and methods. Frequencies of alleles and genotypes of single nucleotide polymorphic gene variants in 200 patients after first IS and in 115 people without stroke matched by sex, age and place of residence were studied. Blood was taken from all study participants in order to perform genotyping assay using protocol by J.Hixson and D.Vernier. Genomic deoxyribonucleic acid extraction from blood was performed using magnetic beads technology on an automated system for nucleic acid extraction Chemagen Prepito (ABBIS, Germany). For single nucleotide polymorphisms typing alleles identification analysis was performed using polymerase chain reaction with prepared TaqMan probes with Assey ID identification number (Applied Biosystems, USA). Amplification of polymorphic regions of the genes was performed with the use of 7500 Real-Time PCR System (Applied Biosystems, USA). Standard amplification conditions were used that were compatible with those defined by chemical agents supplier for each Assey ID. Genotypes nomenclature is given in accordance with international database db SNP (https://www.ncbi.nlm.nih.gov/SNP/). Results. Significant differences between groups in distribution of minor alleles and genotypes were acquired for АРОD (rs7659) and APOA5 (rs619054) polymorphisms. Conclusion. Significant association of single nucleotide АРОD (rs7659) and APOA-V (rs619054) genes polymorphisms with first IS development was found in study groups.
Consilium Medicum. 2019;21(2):48-52
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Comorbid patient in neurologist practice: possibilities of treatment

Chukanova A.S., Chukanova E.I.


From 4 to 8 comorbid diseases of various categories are commonly diagnosed in patients with chronic cerebrovascular insufficiency (CVI) that develops at the background of various risk factors. The importance of comorbidity problem in patients with chronic CVI is explained with worse disease prognosis and increase of treatment cost due to the use of many different medications. The most common risk factors of both cardiovascular disorders and chronic CVI development are arterial hypertension and diabetes mellitus. These are two correlated pathologies with synergic damaging effect on various organs and systems that result in early disability and mortality of these patients. Chronic CVI comorbid with arterial hypertension and diabetes mellitus is in most cases accompanied by diabetic polyneuropathy development. When selecting treatment for patients with comorbid pathology it is necessary to consider the existing pleiotropic effects of prescribed medications that may contribute to successful treatment and reduce the percent of polypharmacy. Such medications as dipiridamol and alpha-lipoic acid may be effective in treatment of comorbid patients with chronic cerebrovascular disease and diabetic polyneuropathy due to their multiple effects.
Consilium Medicum. 2019;21(2):53-58
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Pathophysiologic aspects of resorption of intervertebral disk hernia

Tkachev A.M., Epifanov A.V., Akarachkova E.S., Smirnova A.V., Iliushin A.V., Archakov D.S.


Spinal disc herniation is a pathological anatomical disorder that is associated with localized disk displacement beyond the intervertebral space. Although in most cases surgical intervention is not necessary for recovery, it still has an important role in this disorder treatment. In most patients a course of conservative treatment results in symptoms improvement and in some patients it allows to eliminate symptoms completely. Nevertheless the underlying mechanisms of this spontaneous improvement are still underexplored, though they may provide therapeutic potential that may speed up the recovery process and prevent development of long-term complications. The article considers in detail the origins of inflammatory response in spinal disc herniation development as well as interrelation between spinal disc herniation resorption and symptomatic improvement. Necessity for conduction of future research on the role of inflammatory response in spinal disc herniation formation and resorption is shown. It is important because understanding the reason why most of the patients recover without surgical intervention can speed up the recovery processes and allow many patients to avoid surgical treatment that will also result in improvement of quality of life in this group.
Consilium Medicum. 2019;21(2):59-63
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Intermittent catheterization of the bladder with tetraplegia due to spinal cord injury

Bushkov F.A., Salyukov R.V., Mashaneishvili S.G., Romanovskaya E.V.


Aim. Identify ways of urinary diversion and factors affecting the use of intermittent catheterization in patients with tetraplegia. Materials and methods. 31 patients participated in the examination with tetraplegia, under rehabilitation in Rehab center "Preodolenie" in 2017-2018, with neurological level corresponding to the C4-D1 segments of the spinal cord. All patients were assigned intermittent bladder catheterization, based on urodynamic examination data. Patients with an intact plucking of the fingers were engaged with the ergotherapist in mastering the skill of performing bladder catheterization on their own. 6 (12) months after discharge from the in-patient facility, patients were questioned by phone using the Neurogenic Bladder Symptom Score (NBSS). These data were compared with the conclusion of the ergotherapist and the results of a retrospective neurological examination (American Spinal Injury Association Neurological Standard - ASIA). Results. At the time of the survey, patients had urinary reflex urination with the prevailing methods of urine discharge - 39% (category D on the NBSS scale) and periodic catheterization (category C on the NBSS scale) - 32%. The only factor affecting the popularity of intermittent catheterization is the presence of the skill of its implementation directly by the patient (correlation coefficient R=0.86), which in turn depends only on the completeness of damage to the spinal cord (ASIA 1.20 vs 1.14; p=0.04); the quality of life of patients with neurogenic impaired urination was higher with an incomplete type of damage (C and D types according to ASIA; criterion F=3.1; p=0.04). Conclucion. Among the factors affecting the adherence of patients to the prescribed method of urine discharge, the skill of self-fulfillment and social reasons associated with the complexity of organizing the implementation of intermittent catheterization of the bladder at home is of paramount importance.
Consilium Medicum. 2019;21(2):64-68
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Study of different pharmaceutical forms and pathogenic therapy regimen effectiveness for back and joint pain treatment in comorbid patients with osteoarthritis

Vasil'eva L.V., Evstratova E.F., Nikitin A.V., Burdina N.S.


Aim. To compare the safety and efficacy of using various dosage forms of chondroitin sulfate (CS) and glucose amino sulfate (G) in combination with low-intensity laser radiation (LILR) in patients with back pain and joints with comorbid pathology. Materials and methods. 86 patients (60 women and 20 men) aged 62.6±4.6 years with OA knee, hip joints and spondylosarthrosis. 48 patients were treated injecting forms of CS and G in combination with LILR. 20 patients with the same diagnosis and the same age category have had parenteral introduction of CS and G. 18 similar in pathology of patients took oral forms CS and G. Results and discussion. The significant improvement of subjective and objective condition of patients treated with parenteral CS+G and LILR already on 10-12 day of treatment is shown. The pain in the knee joints, lumbar spine decreased to Visual analogue scale (mm) 32% and amounted to 24.8±0.49 mm, whereas before the treatment of its values were 74.4±0.26 mm (p<0.05). On 25-28 observation day and three months later Intensity of pain syndrome continued to decrease significantly and was 18.8±1.12 (p<0.05). In the group, received parenteral therapy, joint pain has significantly decreased already on 10-12, 25-28 day and after 3 months of observation, but less significant when compared with the group 1, p<0.05. In group 3, treated only with oral forms of CS+G, the positive dynamics of this indicator was noted only after three months (p<0.05) and was accompanied by the development of side effects from the digestive organs. Conclusions. The significant advantage of therapy with parenteral forms of CS and G, caused by faster onset of anti-inflammatory and analgesic effect, absence of complications on the part of gastrointestinal tract is demonstrated. Combination of local influence of LILR with introduction of parenteral forms of CS and G has potentially and accelerated all listed effects of subjects of preparations.
Consilium Medicum. 2019;21(2):69-73
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Challenges in musculoskeletal pain treatment: focus on nimesulide

Pogozheva E.I., Amirdzhanova V.N., Karateev A.E.


At present time effective pain relief is one of the most important problems of contemporary society. Overwhelming majority of the diseases is accompanied by pain and the prevalence rate of pain syndrome of different etiology is substantially increasing in elderly patients. The primary disorders accompanied by musculoskeletal pain (MSP) are nonspecific low-back pain, osteoarthritis, and rheumatologic disorders of periarticular soft tissue such as tenosynovitis, tendinitis, and bursitis of various localizations. Because inflammation is the main mechanism of acute and chronic pain development, non-steroidal anti-inflammatory drugs (NSAIDs) should be considered the first line therapy for MSP treatment. For effective treatment of patients with MSP a medication fr om NSAIDs group with significant therapeutic action, rapid effect development and good safety profile should be chosen. Nimesulide (Nimesil®) has all of these qualities. Nimesulide is presented on pharmaceutical market in 15 European countries and has been successfully used by both foreign and Russian medical professionals for more than 30 years. The article discusses results of Russian and foreign studies wh ere nimesulide (Nimesil®) was demonstrated to be effective as pain-relieving and anti-inflammatory agent in treatment of many disorders accompanied by MSP. Its undoubtful advantages include rapidity of the onset of action, short period of half-life that excludes accumulation and related adverse effects, and better safety in comparison with traditional non-selective NSAIDs in terms of gastrointestinal tract complications development, and also wide experience of use including long-term use.
Consilium Medicum. 2019;21(2):74-78
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Tension headache. Let us get a second look

Naprienko M.V., Filatova E.G., Smekalkina L.V., Makarov S.A.


Introduction. Tension headache (TH) is the most frequent type of headache. The overall amounts of patients’ disadaptation and social and economic damage caused by TH are more significant than ones caused by migraine. TH diagnostics and treatment are a challenge in outpatient conditions. Aim. To analyze in detail pathogenic mechanisms and chronification factors, and to generalize therapeutic approaches to TH treatment. Materials and methods. Materials from Russian and foreign publications for the last 20 years (PubMed, eLIBRARY and others) as well as clinical guidelines on TH diagnostics and treatment were systematized. Results. According to the results of a population study conducted in Russia in 2009-2011, TH prevalence rate was 30.8% over one year. TH is subdivided into infrequent, frequent and chronic headache. Apart from that, episodic and chronic TH with and without “tension” of pericranial muscles determined by palpation are distinguished. The studies conducted in recent years confirmed neurobiological genesis of TH. Peripheral as well as central mechanisms are involved in its genesis. The main risk factors of TH development include inability of psychological and muscular relaxation and insufficient nocturnal sleep. Emotional stress and pose strain are the most frequent predisposing factors. We thoroughly analyzed data of randomized controlled studies of rapid relief of TH symptoms and identified the most frequently used medications among which ketoprofen (Ketonal®) occupies an important place. Chronic or frequent episodic TH is indication for TH prevention therapy prescription. Antidepressants such as amitriptyline are considered the first choice medications for chronic TH treatment, mirtazapine and venlafaxine are of lower effectiveness. The third choice therapy includes other tricyclic and tetracyclic antidepressants, clomipramine, maprotiline, and mianserine. Effectiveness of muscle relaxant tizanidine use, dosage and duration of its use in TH treatment, possibilities of monotherapy and combination with antidepressants are discussed. Among non-pharmacological treatment methods biofeedback and cognitive behavior therapy are considered the most effective ones. Conclusion. Combination therapy, including non-pharmacological treatment methods along with pharmacotherapy, remains the most effective method of TH treatment.
Consilium Medicum. 2019;21(2):79-85
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The speech therapy for dysarthria in patient with amyotrophic lateral sclerosis (clinical case)

Poznyreva E.B., Yusov I.E.


Recently, the national speech therapy has increased interest in the problems of оral motor disorders. E.N.Vinarskaya, A.M.Pulatov’s fundamental monograph (1989) remains the only Russian-language research of semiotics of motor speech aspects disorders. These ones are described in point of view of neurology and linguistics. Subsequently, neurophonetic study of dysarthria was not continued, because the researchers chose aphasia as an object of analysis. There are very few studies on the rehabilitation education of adults with these disorders. The article is devoted to the analysis of speech therapist’s work with a patient suffering from the severe amyotrophic lateral sclerosis (ALS). She had virtually no speech. The importance of new tendency of Russian speech therapy is shown on the example of this clinical case. This is a management of patients with neurodegenerative disease, including palliative profile. The key points of speech therapy are described such as alternation of speech loads, selective application of massage techniques, breathing and articulation exercises, psychotherapeutic influence elements. The main results were improve pronunciation of some consonant groups, swallowing and phonation from the speech, and restoration of minimal communication capabilities from the social functioning.
Consilium Medicum. 2019;21(2):86-89
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Local use of non-steroid anti-inflammatory drugs in patients with dorsopathy

Kamchatnov P.R., Chugunov A.V., Shurygin S.N.


Dorsopathy (DP) is a frequent musculoskeletal pain syndrome. The main approach to treatment of patients with DP is the use of non-steroid anti-inflammatory drugs (NSAIDs) with account of their analgesic and anti-inflammatory effects. Considering that many patients with DP have a variety of comorbid conditions and need to use medications systematically, risk of adverse effects development and possible drug interactions should be considered in treatment tactics. The use of transdermal NSAIDs delivery systems, in particular Voltaren® Emulgel® 2% , contributes to maintaimance of the balance of treatment effectiveness and safety. Data from 31 scientific sources published in Russia and abroad during years 2008-2019 that present modern view on the use of such treatment, its advantages and disadvantages confirmed with the results of studies of medications bioavailability, effectiveness and safety are reviewed. The use of transdermal NSAIDs delivery systems (gel, cream, plaster) is considered much safer than the use of other drug delivery methods that makes reasonable to use them in patients with concurrent kidney or liver diseases, and in patients with high cardiovascular and gastrointestinal risks. Voltaren® Emulgel® 2% use in patients with DP allows to reduce treatment duration in patients with moderate pain syndrome and to reduce the need for additional NSAIDs and analgesics use.
Consilium Medicum. 2019;21(2):90-94
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Modern approach to intravenous valproate use in epileptic status treatment

Badalyan O.L., Savenkov A.A.


Commission on classification and terminology of International League Against Epilepsy defines epileptic status (ES) as a condition that implies a continuous seizure or a series of seizure lasting more than 30 minutes without full recovery of neurological functions in interictal period. It is considered one of the most dangerous life-threatening emergency conditions. ES etiology, timing and adequacy of therapeutic intervention are the main factors that define prognosis. The most frequent cause of ES development in a patient with previously diagnosed epilepsy is a decrease of antiepileptic medication concentration in serum associated with low compliance. ES pharmacotherapy is one of the most challenging issues in acute neurology. ES successful treatment includes the use of the most effective treatment regimen in as short a time as possible with minimal adverse effects. Along with traditionally used medications (benzodiazepines, hydantoins, barbiturates) for convulsive ES treatment injectable forms of valproate (Convulex®) can also be used that is supported by numerous foreign and Russian clinical studies. In a case of symptomatic ES after acute brain injury and coma, non-convulsive ES, and in cases associated with risk of cardiorespiratory function suppression, injectable forms of valproate are used.
Consilium Medicum. 2019;21(2):97-100
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Chronic cerebrovascular disorders: the possibilities of treatment

Kamchatnov P.R., Chugunov A.V., Osmaeva Z.K., Minaev D.P.


Chronic cerebrovascular disorders (CCVD) is a group of syndromes with heterogenic development mechanisms associated with a consistent deficit of brain tissue blood supply, consequences of acute cerebrovascular events and its combination. CCVD development is associated with involvement of vessels, primarily small vessels, in pathologic process and to a great extent with microcirculation and systemic hemodynamics disturbance. The key principles of patients with CCVD treatment include control of cardiovascular risk factors - the use of antiplatelet and antihypertensive therapy, statins and glycemic control in the case of appropriate indications. An important aspect in these patients treatment is the use of medications that improve cerebral blood flow. The most important effect of their use is not vasodilatation itself but the increase of vessel wall sensitivity to natural factors that regulate the inner diameter of the vessel. In this respect it appears to be appropriate to use the term “vasoactive medications”. One of these medications is Vasonit® (pentoxifylline) that is a derivative of methylxanthine. The article reviews its clinical effects, possible mechanisms of action and possibilities of use in patients with CCVD.
Consilium Medicum. 2019;21(2):102-107
pages 102-107 views

Application of the robotized mechanotherapy for patients with motive violations in the late recovery period

Mizieva Z.M., Shirshova E.V., Akarachkova E.S.


Abstract Aim. To study effectiveness of use of robotic devices with software support and patient-specific feedback Armeo and Amadeo in the late stroke recovery period. Materials and methods. The study included 65 patients (30 male, 35 female) aged from 18 to 86 years. The study participants were randomized into 2 groups: in group 1 (study group; n=33) neurorehabilitation course included robotic devices with software support and patient-specific feedback Armeo and Amadeo use for 18 days 2 times a day; in group 2 (n=32) a standard rehabilitation course was conducted. Results. Rehabilitation course with the use of robotic devices in late stroke recovery period in group 1 resulted in better improvement of upper extremity motor function in comparison with standard rehabilitation methods. Conclusion. The use of robotic devices with software support and patient-specific feedback Armeo and Amadeo in neurological function recovery in patients in the late stroke recovery period increases the effectiveness of rehabilitation course in comparison with standard rehabilitation methods.
Consilium Medicum. 2019;21(2):110-113
pages 110-113 views

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