Vol 19, No 9 (2017)

The purpose of this review is to study existing literature on the epidemiology, pathophysiology and treatment of sleep disordered breathing following stroke. Unrecognized and untreated sleep disordered breathing may influence rehabilitation efforts and functional outcomes following stroke and increase risk for stroke recurrence. Improving screening and treatment for sleep disordered breathing is paramount in the secondary prevention of stroke and in improving stroke outcomes.

This publication is devoted to the issues of effective rehabilitation of patients with vascular accident. The principles of carrying out, advantages and risks of early rehabilitation, rules of postural correction are considered. Also, the basic rules of physical, neuropsychological and drug rehabilitation are analyzed. In addition, this article presents the results of a study of the efficacy of antiplatelet therapy in the rehabilitation of patients after cerebrovascular catastrophe. The analysis was applied to the results of rehabilitation of 750 patients who were divided into 2 groups: the Curantil® N group (main group) and a group of other antiplatelet agents (control group). After 6 months from the onset of the disease, the degree of recovery of functions was determined using the Barthel, Lindmark and Scandinavian scales, the level of household adaptation - the Merton and Sutton scales, the quality of life - the Sickness Impact Profile. According to the results of the study, the use of Curantil® N in statistically significant degree raises the effectiveness of rehabilitation, which is manifested in increasing the recovery of neurological functions and the level of social adaptation of patients, and in improving the quality of their lives.

The aim of the study was to study the effectiveness of the use of the drug Phenazepam® in patients with sleep disorders. Materials and methods. In an open approbative comparative study, 30 patients with sleep disorders aged 18 to 65 years were selected. Phenazepam® is administered once a day, out of communication with food intake, in the evening at 21.00 (2 hours before bedtime) for 28 days. Some patients received a dose of Phenazepam® 0.5 mg per night, part of the patients - 1 mg per night. Also, the examined patients were divided into 2 subgroups, based on the indices of the evaluation of autonomic disorders. The first subgroup included persons with minor disorders in the autonomic nervous system, the second included patients with severe autonomic disorders. The survey methods included a clinical questionnaire and a questionnaire. The patients' condition was assessed according to questionnaires: Epworth Sleepiness Scale, Hospital Alarm and Depression Scale, Subjective Sleep Characteristics Scale (Ya.I.Levin), questionnaire for evaluating vegetative disorders (A.M.Veyn), scoring subjective sleep characteristics. Results and conclusion. The administration of Phenazepam® significantly reduced anxiety in patients. Decreased the time of falling asleep, the duration of sleep increased, the number of awakenings decreased, the overall assessment of the quality of sleep, the morning feeling improved. Dosage of Phenazepam® 1 mg was more effective both for all subjective characteristics of sleep, and for depressiveness, anxiety and vegetative manifestations. Dosage of Phenazepam® 0.5 mg had a positive effect on sleep quality. Phenazepam® significantly reduced the

Craniomandibular dysfunction is not independent-term nosology, but rather reflects the different etiology and pathophysiology of the disorder primarily neurological, neurostomatologic, neuroorthopedic, rheumatologic, otorhinolaryngological, ophthalmological and other violations.

Relevance. According to modern recommendations, migraine treatment should last at least 12 months. In this regard, adherence to patient therapy is the main condition for its success. Nevertheless, among patients receiving p-adrenoblockers, anticonvulsants, antidepressants, 40% of patients refuse therapy within 1 month, 24-25% remain on treatment after 6 months, 13-16% take drugs for up to 12 months. The main reason for refusing therapy, especially in the first weeks, is the poor tolerance of these drugs (psychotropic effects, sedation, bradycardia). The aim of the study lies in examining the efficacy and safety of the appointment of candesartan (Ordiss) to patients with chronic migraine (according to the criteria of the International Classification of Headache III, 2013) and arterial hypertension (increase in systolic blood pressure - BP of above 140, diastolic - 90 mm Hg). Materials and methods. Treatment was conducted in 72 patients with chronic migraine and hypertension (9 men, 63 women, mean age 46.4±9.7 years). Evaluation of the effectiveness was carried out by analyzing the data of the diary of a headache (indicators of the number of days with a headache, days with migraine). At each of the visits BP was recorded. Evaluation was carried out before the start of treatment, after 1,3 and 6 months. Results. There was a statistically significant decrease in days with headache: from 22.3±6.0 days to 10.4±3.5 days after 1 month, 8.8±3.1 days after 3 months and 6.2±2.7 day after 6 months of therapy (everywhere p<0.01). A statistically significant decrease was also observed in the dynamics of the indicator of days with migraine: from 16.9±5.4 days before treatment to 7.3±2.9 days after 1 month, 6.5±2.7 days -after 3 months, 4.9±1.8 days - after 6 months. Treatment with candesartan (Ordiss) also led to the normalization of BP in 92.8% of patients. 2 patients interrupted treatment due to the development of general weakness and increased fatigue. 5 (6.9%) patients also had general weakness and increased fatigue, but these phenomena were transient. Conclusions. Candesartan (Ordiss) can be recommended for the treatment of patients with chronic migraine and hypertension.

The syndrome of a rigid person is a rare autoimmune disease characterized by progressive muscular rigidity, walking disorders and painful spasms in axial muscles and limbs provoked by external stimuli. The syndrome has a different clinical phenomenology, it can be manifested by myoclonus, vegetative and emotional disorders, combined with epilepsy and dystonia, and neuro-ophthalmologic manifestations. The pathogenesis of the syndrome is associated with a violation of GABAergic transmission as a result of the interaction of specific antibodies with glutamate decarboxylase (glutamate decarboxylase), an enzyme involved in the synthesis of y-aminobutyric acid. Taking into account the pathogenesis in the treatment of this disease, GABAergic drugs (diazepam in high doses, etc.) and immunosuppressive therapy are used. We give our own observation of a patient with an atypically occurring syndrome of a rigid person.

Neurophysiological examination is used to assess the topic and severity of nerve conduction disorders in patients with myelopathy, but its use for rehabilitation prognosis is complicated by the absence of a direct correlation between clinical and neurophysiological data. Earlier, we hypothesized that the "myelinopathic" changes in segmental conduct according to electroneuromyography are correlated with the presence of functional dynamics in myelopathy. We give a description of the clinical case that illustrates this hypothesis.

The data on patients with amyotrophic lateral sclerosis - ALS (n=25) were analyzed in comparison to the control groups of patients with chronic ischemia (n=45) and similar demographic indicators. In the blood plasma of ALS patients, as compared to the control group, lower levels of lithium (-1.7 mcg/kg, p=2×10-12) and selenium (at -37 mcg/kg, p=0.005) were found. With the help of the data mining techniques, we performed the analysis of the interactions between the trace elements in the plasma and the clinical state of the ALS patients. The results of this study indicated the necessity of the use of the lithium and selenium preparations in patients with ALS

The differential diagnostics of acute vestibular syndrome is discussed in the following article. Features of collection of complaints and anamnesis, basic clinical and instrumental methods of research are presented as well. The main approaches to the therapy of such diseases, manifested by acute dizziness, such as vestibular neuronitis, benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine, etc. are presented.

Vitamin D plays an important role in the management of calcium metabolism and maintenance of calcium-phosphorus homeostasis. Deficiency of vitamin D due to "extra-skeletal effects" can influence the development of various somatic diseases. This relationship is confirmed by epidemiological studies. However, pathophysiological mechanisms continue to be investigated. One of the mechanisms that bind vitamin D deficiency and obesity, metabolic syndrome, diabetes, chronic obstructive pulmonary disease, cardiovascular disease is systemic inflammation. Calcitriol regulates calcium metabolism and has immunomodulatory properties, which gives a protective effects in systemic inflammation. Alfacalcidol is an activity metabolism of vitamin D, used to prevent and treat D-deficiency conditions.

In the article in the form of clinical lecture, disorders of purine metabolism, their clinical forms, pathogenesis, peculiarities of laboratory diagnostics and medicamentous correction with inhibitors of xanthine oxidase (allopurinolum, febuxostat) are considered. From the position of the urologist, the specifics of citrate litholytic therapy and metaphylactics of urate nephrolithiasis with regard to hyperuricemia, the administration of inhibitors of xanthine oxidase, citrates, and diet therapy are specified. An attempt was made to generalize the role of disorders of purine metabolism from the positions of not only the urologist, but also of internal medicine as a whole.