Vol 6, No 2 (2012)

The article prepared by a group of authors on the initiative of the Russian Headache Research Society (RHRS) is a result of the analysis of approaches to the diagnosis of headache used by neurologists and general practitioners in Russia and some post-Soviet countries. Common diagnostic mistakes and misinterpretation of instrumental investigations results, as well as the reasons for erroneous treatment strategies in patients with headache are discussed. Practical steps focused on the improvement of headache diagnosis and treatment, as well as specialized care for headache patients are proposed.

The study was aimed at evaluating effectiveness of the method of tempo-rhythmic correction (TRC) of gait in patients with Parkinson’s disease (PD) in terms of main motor symptoms of the disorder. The following methods were used: a step-speed performance assessment device, a method of TRC of gait elaborated by our group, and a questionnaire of quality of life for patients with PD (PDQ-39). It was shown that the TRC method could improve gait in PD patients, increase quality of their life and reduce the pharmaco-economic burden. We suggest the existence of a possible neuroprotective effect of the TRC method in view of increased intervals between consecutive stages of PD and later occurrence of new disease symptoms in patients undergoing respective courses of treatment.

In this article, universal guidelines and requirements to clinical trials of new drugs in multiple sclerosis are presented. Principles of patients’ informed consent, various ethical aspects and possible problems occurring in the course of clinical trials in these patients are discussed in detail. Presented are main current documents regulating clinical trials of new drugs in the Russian Federation.

Myotonic dystrophy, type 2 (DM2) is an autosomal dominant disorder caused by expansion of the CCTG repeats in the zinkfinger protein-9 gene (ZNF9). It has been clinically reported in the middle 1990th. DM2 is less frequent than “classic” DM1, yet is relatively common, mostly in Europeans. Like DM1, DM2 is a multisystem disorder, and main distinctions from DM1 are: relatively late onset, proximal character of myopathy, less severe myotonia, presence of myalgia, etc. Clinical features complicate the diagnosis, and a number of cases cannot be identifiedon time. In the Research Centre for Medical Genetics the DNA diagnostics of DM2 is now available, and several cases have been confirmed molecularly.

Presented is a detailed analysis of different modern neuroimaging technologies used for studying pathophysiological mechanisms and morpho-physiological substrate of primary focal dystonia. Main attention is paid to functional MRI and voxel-based morphometry. Various applications of these methods for the purposes of basic neurology and neurophysiology, as well as for control of the effects of ongoing treatment, are summarized and discussed.

Cerebrovascular diseases are the most important cause of morbidity and mortality from cardiovascular disease among adults. Generalized atherosclerosis is the most frequent basis for vascular lesions of the brain, leading to the development of acute and chronic disorders of cerebral circulation. Polymorphism of clinical symptoms caused not only by lesions of the brachio-cephalic arteries, but also by simultaneous involvement in the variable-degree atherosclerotic rocess of other vessels, is often responsible for diagnostic difficulties. In the paper, a number of case reports describing patients with advanced atherosclerotic lesions of different vascular systems and marked variability of clinical manifestations are presented. Discussed are questions of rational diagnosis and general approaches to treatment of atherosclerosis, as well as questions of asymptomatic brachio-cephalic stenosis, “silent” brain infarcts and risk factors for atherosclerosis.