Vol 6, No 1 (2012)

Original articles

Clinical and epidemiological study of the nervous system diseases according to screening of the open population

Varakin Y.Y., Gornostaeva G.V., Manvelov L.S., Konstantinov V.V., Suslina Z.A.

Abstract

Screening of the open population of men and women at the age of 35-64 years was performed. The random representative sample of the population of one of the Moscow’s districts was examined (726 people – 70.2% from the original sample). The unified criteria were used to diagnose the nervous system diseases (NSD). Not only the diseases but also the certain syndromes (headache, low-back pain etc.), which considerably influence the quality of life, were analyzed. Both mild (which do not require the medical assistance) and severe forms of disorders were taken into account. Not only recent cases of the NSD were revealed (which occurred within the last year), but also the ones which occurred in the past but were absent for the moment of screening. The prevalence of the NSD at the moment of examination was 75.8%, including peripheral nervous system diseases (56.7%), cerebrovascular diseases (45.4%), headaches (44.5%), craniocerebral injury consequences (5.9%), and paroxysmal impairment of consciousness (5.0%). The other NSD occurred more infrequently. The structure of certain classes and types of the NSD was assessed. It was shown that the found rates exceed several times the prevalence of the NSD according to official healthcare statistics. The article discusses probable reasons for that discrepancy.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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Five-year survival after stroke

Kulesh S.D., Likhachev S.A., Filina N.A., Struneusky A.V., Kostinevich T.M., Kliatskova L.A., Sauchanko M.E.

Abstract

Five-year survival of Grodno’s inhabitants who had a stroke in 2001 was investigated. Patients followed up prospectively up to 5 years from the beginning of the disease; complete data after 5 years were available for 853 of 875 patients (97.5%). The cumulative five-year death risk, 63.0%, was 2.9 times greater than for people of the same age and sex in Grodno’s general population. The relative death risk was the highest in patients younger than 45 years (55.0) and decreased to 1.1 in patients older than 84 years. The significant distinction in 5-year survival in patients with different types of stroke (subarachnoid hemorrhage – 0.68; cerebral infarction – 0.41; intracerebral hemorrhage – 0.17; undetermined stroke – 0.08) was mostly determined by the influence of acute stage rates and decreased to small non-significant values in a group of 28-day survivors. Stroke (including the recurrent episodes) was the prevalent cause of death during the first year in 28-day survivors (67.0%), where as other cardiovascular diseases were the main causes of death (62.0%) during the later period. The significant prognostic factors of the 5-year death risk after stroke were age (hazard ratio (HR) 1.04), stroke in anamnesis (HR 1.48), arterial hypertension (HR 0.76), and diabetes mellitus (1.26). In 28-day survivors the significant prognostic factors of the 5-year death risk were age (HR 1.05), stroke in anamnesis (HR 1.62), diabetes mellitus (HR 1.46), atrial fibrillation (HR 1.34), and myocardial infarction in anamnesis (HR 1.43). The obtained data shows strong necessity of secondary prevention, focused both on cerebral and heart vascular pools.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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New technologies in rehabilitation: plantar imitator of bearing load for patients with Guillain-Barre syndrome

Khoroshun A.A., Piradov M.A., Chernikova L.A.

Abstract

Guillain-Barre syndrome often requires administration in intensivecare unit but is associated with good prognosis. That usually means partial or full regress of motor impairment. However, we found that many reconvalescents after Guillain-Barre syndrome were suffering from different sensory disorders for a long period of time. The analysis of the sensory impairment in patients with severe forms of Guillain-Barre syndrome showed discordance between the results of clinical examination and neurophysiological tests. We also found that some kind of sensory loss was present in patients with “pure motor” form. In this article we review our experience of treatment with plantar imitator of bearing load which seems positive in correction of sensory disturbances in patients with severe forms of Guillain-Barre syndrome.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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Predictors of pharmacoresistance in adults with epilepsy

Kotov A.S.

Abstract

Six hundred ninety-six patients with epilepsy were examined. Clinical and neurological examinations, routine EEG and/or video-EEG monitoring, MRI and/or CT of the brain, and laboratory tests were performed. Antiepileptic pharmacotherapy was either prescribed for the first time or corrected if it was prescribed before. Factors associated with pharmacoresistance were analyzed, such as: onset in infancy or early childhood, high frequency of seizures, failures in the previous pharmacotherapy, diffuse epileptiform activity or abnormal background activity according to EEG, progressive brain lesion etc. According to the obtained data, only non-compliance (r=0.31; p<0.001) and high frequency of seizures (r=0.31; p<0.001) were significant predictors of pharmacoresistance. Routine EEG and MRI are not informative enough for prediction of pharmacoresistance of epilepsy. Accurate patient examination and identification of a certain epileptic syndrome are necessary for correct prognosis of pharmacoresistance.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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Locomotion supraspinal control assessment in healthy people and stroke patients with the use of passive motor fMRI paradigm

Kremneva E.I., Chernikova L.A., Konovalov R.N., Krotenkova M.V., Saenko I.V., Kozlovskaya I.B., Chervyakov A.V.

Abstract

Functional magnetic resonance imaging (fMRI) is widely applicable for sensorimotor cortex mapping in human. The most challenging fMRI task for researchers is the assessment of locomotion. The aim of our study was to design of a passive motor fMRI paradigm for assess supraspinal control of the skillof walking in normal subjects and in patients with motor neurologic deficit after ischemic stroke. We conducted fMRI in two groups of human subjects: first group – 19 healthy subjects (10 females and 9 males, mean age = 38 [31,5; 60] years), second group – 18 ischemic stroke patients in early recovery period (first 6 months) (6 females, 12 males, mean age = 55,5 [45,5; 64,5] years) with severe and moderate (mean Fugl- Meyer scale score = 22 [15; 28]).The protocol consisted of blocked-design paradigm: plantar stimulation by imitation of slow walking vs rest. Individual and group activation patterns were analyzed using statistical package SPM5. A significant activation (pcorrect<0.05 at cluster level) in first group was observed in the primary and secondary sensorimotor cortex, premotor and dorsolateral prefrontal cortex, in insula. Due to lesion localization second group was subdivided into corticalsubcotrical (CS) and subcortical (S) subgroups. In CS subgroup there was reduce of activation size, more prominent in the affected hemisphere, whereas in S subgroup the extension of activation regions in both hemispheres was revealed, comparing to group 1. It was demonstrated that our passive motor fMRI paradigm of walking imitation with the use of plantar load imitator Korvit can be used to localize the ensorimotor brain areas involved in locomotion in both healthy people and patients. Concerning stroke patients, such an approach can help in understanding the mechanisms of supraspinal control of the skill walking and optimal rehabilitation strategy.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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Prevention of venous thromboembolic complications and heparin-induced thrombocytopenia in patient with acute inflammatory polyneuropathy (Guillain-Barre syndrome)

Piradov M.A., Gorodetsky V.M., Ryabinkina Y.V., Galstyan G.M., Khoroshun A.A.

Abstract

The case of severe thrombocytopenia caused by direct anticoagulant therapy, immunologically confirmed in patient with Guillain-Barre syndrome, is presented. The clinical presentation was characterized by acute peripheral tetraparesis, accompanied by multiple embologenic thrombosis in deep venous system of shanks. As a result of direct anticoagulant treatment, improvement of ultrasonic image was demonstrated. At the same time the decay of the thrombocytes level and development of haemorrhagic syndrome were observed. The assay of coagulation factors didn’t demonstrate consumption coagulopathy. The results of the bone marrow examination excluded the oncological process in haematopoietic system. Considering that the thrombocytopenia developed exactly 10 days after the onset of the direct anticoagulant therapy, the analysis of the antibodies to the platelet factor 4/heparin complex was performed; the result was positive. Withdrawal of fraxiparine and implementation of plasmapheresis to eliminate the antibodies improved the patient’s condition. The presented case demonstrates the necessity of regular control of all parts of haemostasis, because treatment with remedies intended to correct the coagulation system may cause itself strong hemorheological disorders.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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Principles of diffusion tensor imaging and its application to neuroscience

Kitaev S.V., Popova T.A.

Abstract

This review article deals with technical issues of diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) and magnetic resonance tractography. We define such parameters of DWI like: apparent diffusion coefficient, b-factor, fractional anisotropy (FA) and diffusion tensor. We retell about main algorithms of MR-tractography pointing their specifics and drawbacks. We explore aspects of DTI in clinical neuroradiology and neuroscience for diagnosis and evaluation of axonal injury, demyelinization, tumors, peripheral nerves injuries, spinal cord diseases and brain development in late embryonic and neonatal period. We explain, how DTI allows to judge about micro-architecture of a brain going into details on technical issues, limiting an application of DTI only on small animals ex vivo.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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Creutzfeldt-Jakob disease: current issues (review)

Peresedova A.V., Zavalishin I.A.

Abstract

Creutzfeldt-Jakob disease and others human prion diseases are fatal neurodegenerative conditions. Etiologic classification includes sporadic, hereditary and acquired forms. Conformational change of the normal (cellular) form of prion protein (PrPc) to a pathological form (PrPSс) is considered central to formation of the infectious agent. In this article the molecular classification of sporadic CJD, the phenotypic variability and the major pathogenetic pathways in prion diseases have been analyzed. The unique resistance of prions to classic methods of decontamination, and evidence that prion diseases can be transmitted iatrogenically pose a serious control to decontamination procedures. Many therapeutic strategies have been tested as potential treatments for prion diseases in cell cultures and in animals. But only few trials of human prion disease have been published or ongoing.

 
Annals of Clinical and Experimental Neurology. 2012;6(1):
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