Vol 24, No 2 (2022)

In this article the concept of "net clinical benefit" (NCB) is considered in the context of stroke, the role of direct oral anticoagulants in secondary prevention of cardioembolic stroke and NCB from their prescription. Practical aspects of NCB evaluation from the neurologist's point of view are presented, taking into account such factors as stroke duration and severity, features of neurological deficit (severity of residual limitations, dysphagia, motor disorders and risk of falls), neuroimaging characteristics of stroke (focal size and hemorrhagic transformation) and concomitant neurological diseases (epilepsy and dementia). In all these situations, the use of oral anticoagulants has a significant clinical benefit, which justifies the inadmissibility of refusal to prescribe them.

Aim. To illustrate capabilities of the computational brain мagnetic resonance imaging (MRI) analyses on a small vessel disease (SVD) sample.

Materials and methods. Thirty-one patients underwent brain MRI in standard sequences. We used Lesion Segmentation Tool to assess white matter hyperintensities (WMH) volume and Computational Anatomy Toolbox to calculate cortical thickness. Both software plug-ins work within the Statistical Parametric Mapping 12 software for MATLAB. We also performed cognitive testing with the Montreal Cognitive Assessment test and tests to detect hippocampal and executive domain dysfunction.

Results. Sixteen patients had mild vascular cognitive impairment. The Median Fazekas scale score was 2 and 2 points. The median intracranial volume fraction occupied by the WMH was 0.07%. It correlated with the executive domain performance but not with cortical thickness. Cortical thickness within several clusters of the prefrontal complex and temporal lobe correlated with performance in cognitive tests. Among the computed MRI markers of the SVD, the occipital lobe cortical thickness had an area under the curve of 70%, and among the cognitive tests, the cued recall measure had an area under the curve of 73.8% to detect mild cognitive impairment.

Conclusion. The abovementioned metrics is a valuable tool to objectively estimate white and grey matter state in patients with small vessel disease. Performing those analyses helped to assess SVD properties in the sample further and register new correlations between MRI and cognitive markers.

The diagnosis of chronic migraine (CM) is made when there are 15 or more days of headache per month in a patient with migraine. Approximately 2.5% of patients with episodic migraine develop chronic migraine, which is more difficult to treat and often leads to drug-induced headache (LIH). Such patients are rarely included in clinical trials.

Aim. To analyze in clinical practice the effectiveness of the CGRP monoclonal antibody erenumab after 6 months of therapy in patients with CM with and without LIHD, and to evaluate possible predictors of the effectiveness of prophylactic therapy.

Materials and methods. The study included 47 patients with CM taking erenumab at a dose of 70 mg monthly for at least 3 months. Patients completed a headache diary throughout the study. The 12-item Allodynia Symptom Checklist (ACS-12) was used to assess the presence of allodynia. After 6 months of therapy, the efficacy and safety of treatment, the presence of LAH and possible predictors of efficacy were evaluated.

Results. After 6 months of therapy, 22 (78.6%) patients no longer met the criteria for LIHD. The factors that positively influenced the outcome of therapy were the absence of allodynia (p<0.05), the presence of photo- and phonophobia, and the one-sidedness of pain (p>0.05). The age and number of days with headache in patients with HM before treatment did not have a statistically significant effect on the effect of therapy. The presence of LIHD did not statistically significantly affect the outcome of therapy.

Conclusion. CGRP monoclonal antibodies are reasonable in patients with LIHD. The presence of LIHD does not affect the efficacy of erenumab prophylactic therapy, the presence of allodynia may be a predictor of failure, and the unilaterality of pain and irritability to light and sound indicate likely efficacy. Real-world studies with a large cohort of patients and longer durations of therapy are required to confirm these results.

Aim. To assess the extent to which cognitive and emotional disorders in patients undergoing spinal cord surgery affect the quality of rehabilitation and, based on the data obtained, to suggest optimization of rehabilitation measures.

Materials and methods. The study included 60 patients (30 men and 30 women) whose condition required spinal cord surgery. All patients underwent assessment of somatic and neurological status, as well as quantitative neuropsychological testing. The influence of cognitive and emotional disorders before and after surgery on the severity of pain syndrome and movement disorders was assessed. When included in the study, patients were randomized into the main (30 people) and control (30 people) group. The patients of the main group received cognitive-motor training, which was carried out using the methodological manual “Cognitive Training for Patients with Moderate Cognitive Impairment”, developed by the staff of the Department of Nervous Diseases and Neurosurgery of the Sechenov First Moscow State Medical University (Sechenov University). Cognitive, emotional, motor disorders, severity of pain syndrome, as well as the quality of life and adherence of patients to cognitive-motor training were assessed 3 and 6 months after the surgical intervention.The severity of cognitive and emotional disorders in patients of the main and control groups did not differ before the operation.

Results. After the operation, the severity of cognitive impairments was significantly higher in patients of the control group (p=0.03). Patients in the control group were significantly worse than patients in the main group in performing memory tasks (p=0.00), they also had a significantly lower rate of mental processes (p=0.00). These differences persisted 3 months after surgery (p=0.00). A week after the surgical intervention, the severity of anxiety and depression was significantly higher in patients in the control group (p=0.01). The positive effect of the operation in the form of pain reduction was achieved in all patients, but in the control group there was an increase in the severity of the pain syndrome after six months of observation compared with that after three months. An increase in the severity of the pain syndrome was associated with an increase in depression, anxiety, and cognitive impairment. The analysis showed that patients of the main group with high adherence to cognitive training showed significantly greater positive dynamics both in terms of cognitive functions and in terms of anxiety and depression (p<0.05). A survey of patients after inclusion in the study with the provision of prospective recommendations for clinical care showed the following: 58 patients (96.7% of patients) noted that the proposed recommendations for clinical care, from their point of view, would significantly improve their postoperative prognosis. Important points that should be reflected in the clinical guidelines for the management of patients with spinal cord surgery, from the point of view of patients, were: discussion with the doctor of the picture of their illness, duration of hospitalization, expected outcome, prognosis (60 patients, 100%), medical education rehabilitation skills (51 patients, 85% of patients), communicating with patients who have already undergone a similar operation earlier in this surgical department (49 patients, 81.7%), ensuring continuity and discussing the entire rehabilitation route before surgery (60 patients, 100%).

Conclusion. Cognitive and emotionally disorders determine the quality of life and rehabilitation of patients who have undergone surgery on the spinal cord. Our results allow us to recommend the inclusion of cognitive-motor training in the rehabilitation program for patients after spinal neurosurgical operations.

Diabetic polyneuropathy (DPN) is a common neurological complication of diabetes mellitus. The most common DPN type is distal symmetric, predominantly sensory, polyneuropathy (DSPN), often accompanied by pain syndrome. This article is aimed to evaluate of ipidacrine (Ipigrix) efficacy in complex DSPN therapy. The dynamics of clinical and neurophysiological manifestations of DPN in the form of the appearance of previously absent tendon reflexes, a decrease in the area and severity of sensory disturbances, the intensity of neuropathic pain, an increase in the amplitude of motor and sensory responses in response to stimulation of peripheral nerves indicates the activation of reinnervation processes against the background of therapy using ipidacrine. Assessing the positive effect on the restoration of the structure and function of peripheral nerves, good tolerability and safety of ipidacrine (Ipigrix), it is possible to recommend the drug in patients with DSPN.

Antibodies to myelin-oligodendrocyte glycoprotein (anti-MOG-IgG) is a specific biomarker that has been detected in peripheral blood from children with acute multiple encephalomyelitis (ADEM) as well as in adults with aquaporin-4 (AQP4), associated with seronegative opticoneuromyelitis spectrum disease (NMOSD), brainstem encephalitis, longitudinally disseminated transverse myelitis, and optic neuritis. Most experts now consider MOG-IgG-associated disorder (MOG-AD) an independent disease immunopathogenetically distinct from classical multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive optomyelitis. Isolated, bilateral, and less frequently unilateral OH, with simultaneous or sequential involvement of the eyes, is the most frequent clinical manifestation of MOG-AD. Because of the significant overlap in the clinical and radiological picture, MOG-AD is often misdiagnosed as MS. Timely diagnosis is critical to ensure appropriate treatment. This article describes a clinical case of anti-MOG-IgG encephalomyelitis with late-onset ON initially diagnosed as MS.

Diabetic polyneuropathy (DPN) is a common neurological complication of diabetes mellitus. The most common DPN type is distal symmetric, predominantly sensory, polyneuropathy (DSPN). This article is aimed to evaluate of ipidacrine (Ipigrix) efficacy in complex DSPN therapy. The dynamics of clinical and neurophysiological manifestations of DPN in the form of the appearance of previously absent tendon reflexes, a decrease in the area and severity of sensory disturbances, an increase in the amplitude of motor and sensory responses in response to stimulation of peripheral nerves indicates the activation of reinnervation processes against the background of therapy using ipidacrine. Assessing the positive effect on the restoration of the structure and function of peripheral nerves, good tolerability and safety of ipidacrine (Ipigrix), it is possible to recommend the drug in patients with DSPN.