Vol 7, No 1 (2013)

Original articles

Pathogenetic and prognostic role of autoantibodies to gangliosides of the peripheral nerves in Guillain-Barre syndrome

Suponeva N.A., Piradov M.A., Nikitin S.S., Timchenko O.L., Gracheva L.A., Bykova L.P., Lapin S.V., Fedkina J.A., Kostyreva M.V., Shabalina A.A., Grishina D.A.

Abstract

Testing for IgG+IgM autoantibodies to gangliosides of peripheral nerves (asialo-GM1, GM1, GM2, GD1a, GD1a, GD1b, GQ1b) was performed in 95 patients with Guillain–Barré syndrome (GBS) in Moscow. In 70 patients (74%) acute inflammatory demyelinating polyneuropathy (AIDP) was diagnosed, and in 25 patients (26%) – either acute motor axonal neuropathy (AMAN) or acute motorsensory neuropathy (AMSAN). The role of antibodies to gangliosides for prognosis of the disease course and response to pathogenic treatment was assessed. Antibodies to gangliosides were found in 55 patients (57.9%) – more often in patients with AMAN/AMSAN (p<0.05). The whole range of antibodies was found both in patients with AIDP and AMAN/AMSAN. Anti-GM1 were found in both subtypes of GBS. Anti-GD1b were associated with AMAN/AMSAN (p<0.05). There was a correlation between anti-GM1 and diarrhea (p<0.05), anti-asialo-GM1 and campylobacteriosis (p<0.05). There wasn’t found significant correlation between anti-GD1 and axonal subtypes, diarrhea in anamnesis, and campylobacteriosis. Association of severe GBS and elderly age, camplylobacteriosis and axonal subtypes was confirmed. AMAN/AMSAN subtypes, severity of the disease, necessity in mechanical ventilation were characterized by insufficient efficacy of pathogenic therapy. The same factors and elderly age were associated with unfavorable prognosis in terms of absence of unassisted walking in 6 and 12months. Anti-GD1a were associated with sever course of the disease, including necessity in mechanical ventilation. Immunologic factors are not sufficient in prognosis of the treatment efficacy. Antibodies to GM1 were associated with unfavorable prognosis with absence of unassisted walking in 6 months. Clinical and neurophysiological data is crucial for making diagnosis and prognosis of the GBS course. Testing for autoantibodies to gangliosides could be helpful in diagnostics of GBS. It is possible to use that test for revealing axonal type of the disease (anti-GD1b), prognostication of severe course of GBS (anti-GD1a) and unfavorable rehabilitation of unassisted walking.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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Critical illness polyneuromyopathy

Alasheev A.M., Belkin A.A., Zislin B.D.

Abstract

Critical illness polyneuromyopathy is acquired neuromuscular abnormalities (polyneuropathy and/or myopathy) as a result of critical illness with prolonged immobilization, clinically manifesting with muscle weakness and difficult weaning from mechanical ventilation. In review present up-to-date information about history, epidemiology, etiology, pathogenesis, clinical picture, diagnostics, differential diagnosis, disease course, prevention and treatment of critical illness polyneuromyopathy.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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Ultrasound of nerves of the lumbal plexus

Likhachev S.A., Charnenka N.I.

Abstract

Ultrasound examination of femoral, saphenous and lateral cutaneous femoral nerves was performed in 25 healthy volunteers (50 extremities) with normal body weight, at mean age 37±4.3 years. Examination procedure and topography of the investigated nerves are described. The nerves’ identification is possible due to anatomical landmarks. Femoral and lateral femoral cutaneous nerves were visualized in all cases. Cutaneous nerves are available for proper visualization in subjects with normally developed subcutaneous fat. Structural features of nerves didn’t show statistically significant sexual and bilateral distinctions. Sonography is an accessible method for examination of certain lumbar plexus nerves.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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Organization of language network in healthy subjects and its reorganization in patients with poststroke aphasia

Belopasova A.V., Kadykov A.S., Konovalov R.N., Kremneva E.I.

Abstract

It’s a traditional belief among neuroscientists that the speech function is located in some strictly definite areas of the left hemisphere: Broca’s area in the rear part of the lower frontal gyrus (Brodmann area 44, or BA44), and Wernicke’s area in the rear part of the upper temporal gyrus (BA22). However, data collected with the contemporary neurovisual research methods, in particular, with functional magnetic resonance imaging (fMRI), disprove the localizationist theory of speech. With the specially designed speech task (paradigm) consisted of sentence reading and sentence continuation tests, we researched distribution of speech neuron network in healthy people and its reorganization in patients with different types of aphasia. After processing of control sample data, we noticed activation of classic speech areas (Broca’s and Wernicke’s) and their right hemisphere homologies. However, the amount of activations was predominant in the left hemisphere. We also noticed bilateral activity in lower parts of pre-central (BA4) and post-central (BA1) gyri, in cerebellum hemispheres and in visual cortex (BA17–18). In stroke patients activation in Broca’s and Wernicke’s areas depended on a lesion location. Activation wasn’t registered in case of damage of corresponding region, but it was migrated on perilesional area. We revealed new regions of activity at patients with aphasia, including upper parietal gyrus (BA7), angular and over-marginal gyri (BA39–40). Aforementioned activations were disclosed both in left and right hemispheres. The research shows that the speech paradigm used demonstrates functioning of speech system in the optimal way. The received data will increase understanding of brain structures involved in process of speech and their importance for recovery of damaged speech functions.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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Thecaloscopy – newest less invasive method of diagnosis and surgical treatment in spine surgery

Kashcheev A.A., Arestov S.O., Goushcha A.O.

Abstract

Thecaloscopy is less invasive exploration of spinal subarachnoid space with ultra-thin flexible endoscope and endoscopic fenestratio of scars and adhesions. Thecaloscopy was used in Russian neurosurgery at the first time. Since 2009 we operated 32 patients with following diagnosis: 17 – spinal adhesive arachnoiditis (8 – local forms, 9 – diffuse forms), 12 –spinal arachnoid cysts (7 – posstraumatic cysts, 5 – idiopathic cysts), 3 – extramedullary tumors (thecaloscopic videoassistance and biopsy). In all cases we realized exploration of subarachnoid space and pathologic lesion with endoscopic perforation of cyst or dissection of adhesions using special instrumentation. Mean follow-up in our group was 11.4 months. Neurological improvement (mean 1.4 by modified Frankel scale, 1.8 by Ashworth spasticity scale) was seen in 87% of patients operated for spinal arachnopathies. Temporary neurological deterioration (mild disturbances of deep sensitivity) was seen in 9% of patients and managed successfully with conservative treatment. 1 patient (3.1%) was operated 3 times because of relapse of adhesions. There were no serious intraoperative complications (e.g., serious bleeding, dura perforation etc). Postoperative complications included 1 CSF leakage and 1 postoperative neuralgic pain. Mean term of hospitalization was 7.6 days. According to our data, we suppose that thecaloscopy is efficient and safe method, and should be widely used for spinal arachnopaties, adhesive arachnoiditis and arachnoid cysts. Taking into account that adhesive spinal arachnoiditis is systemic process and spinal arachnoid cysts can be extended as well, thecaloscopy may be regarded as the most radical and less-invasive way of surgical treatment existing currently in neurosurgery

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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Paraneoplastic coagulopathy as the cause of acute repeated stroke (clinical-morphological case)

Maximova M.Y., Smirnova I.N., Loskutnikov M.A., Seliverstov Y.A., Chajkovskaja R.P.

Abstract

A case of paraneoplastic coagulopathy with acute repeated stroke is described in the paper. In autopsy prostate cancer was found. The overview of etiology, pathogenesis, clinical data, MRI, morphology is presented.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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About astroglia in the brain and pathology

Goryaynov S.A., Protsky S.V., Okhotin V.E., Pavlova G.V., Revischin A.V., Potapov A.A.

Abstract

More than 140 years astrocytes were described as passive cellular elements of the brain, and their function was limited participation in providing trophic potential of neurons. It was described as doctrine of “neuronism” which supported such famous scientists as H.W. von Waldeyer and S. Ramun y Cajal, who is the author of phrases “each nerve cell – a fully autonomous physiological canton”. During last time we can see a revision of views on the role of astrocytes in the brain. Astrocyte is equal partner of the neuron in such fundamental functions of the brain, as modulation of synaptic transmission, gliotransmission and regulation of microcirculation. Discovery of a new element of glia – NG2 cells, identification of the relationship between neuronal networks and astrocyte syncytium have changed the doctrine of neuronism. New paradigm revises the role of astroglia in the brain in health and disease.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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Mechanisms of neuroplastisity and rehabilitation in hyperacute period of stroke

Sidyakina I.V., Schapovalenko T.V., Lyadov K.V.

Abstract

Main mechanisms of neuroplastisity obtained in hyperacute period of stroke are described in this review. Neurons regeneration process condition are discussed. Necessity of early rehabilitation and revision of stroke patients management asserted according to novel experimental and clinical data.

 
Annals of Clinical and Experimental Neurology. 2013;7(1):
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