Vol 5, No 4 (2011)

Original articles

Carotid artery stenting: early and long-term results

Chechetkin A.O., Kunzevich G.I., Skrylev S.I., Koshcheev A.Y., Prozky S.V., Lagoda O.V., Krasnikov A.V., Suslina Z.A.


We studied 147 patients who underwent 171 interventions of transluminal balloon angioplasty with carotid artery stenting (CAS). Mean degree of stenosis measured by angiography before the intervention was 74±10%. Technical success (residual stenosis <30%) was achieved in 97% cases. Acute stroke during the intervention and in the early postoperative period was registered in 17 (11.6%) subjects: 11 (7.5%) patients had TIAs, 3 (2.05%) had “minor” stroke and 3 (2.05%) had “major” stroke. No events of myocardial infarction or death were observed. One hundred thirty-three patients (90%) were followed-up in the long-term perspective (21 [13; 38] months). Ipsilateral stroke was diagnosed in one patient (0.8%). No events of restenosis (≥50%) were observed in 155 cases of CAS. Asymptomatic stent occlusion was recorded 11 months after intervention in one patient (0.6%) who had subtotal stenosis of ipsilateral intracranial internal carotid artery. Thus, acute neurological deterioration develops mainly in the perioperative period, but the rate of stroke is low (4.1%). CAS is an effective method to prevent stroke in the long-term perspective in patients with extracranial carotid stenosis.

Annals of Clinical and Experimental Neurology. 2011;5(4):4-10
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Differential diagnosis of disorders manifesting with tremor on the basis of their clinical and neurophysiological characteristics

Kunitsyna A.N., Turbina L.G., Bogdanov R.R., Evina E.I., Litvinova A.S., Ratmanova P.O., Napalkov D.A.


To search for additional methods of differential diagnosis of essential tremor (ET) and early-stage Parkinson’s disease (PD), a clinical, psychometric, tremorometric, stabilometric and electrooculografic study was carried out in PD, ET and age-matched controls. Patients with ET had bilateral distribution of predominantly postural-kinetic tremor with slight prevalence in one hand, and limb tremor often combined with head tremor. PD was characterized by asymmetric debut of clinical manifestations, as well as by rest and postural tremor with slight hypokinesia and rigidity. The frequency of rest and postural tremor was significantly higher than in the PD group. Stabilometry revealed improvement of postural stability in “Target-test” in patients with PD. In the dynamic “Evolventatest” patients with PD showed smaller statokinetic curve length and lower center-of-motion velocity compared to healthy subjects. No stabilometric changes were found in ET patients. In contrast to ET, patients with PD were characterized by significant increase in latencies of saccadic eye movements and fraction of multi-step saccades; eye movements lateralization was revealed on stage I of PD. Discussed is significance of the obtained data for clinical practice.

Annals of Clinical and Experimental Neurology. 2011;5(4):11-16
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Complex approach to the therapy of rare forms of dystonia

Likhachev S.A., Charnukha T.N., Navosha S.A., Melnic V.F., Borisenko A.V., Zabrodzetc G.V., Charnenka N.I., Zobnina G.V.


Neurological manifestations of the disease in patients with rare forms of dystonia residing in Belarus are analyzed. Clinical variants of these dystonias and possible methods of their complex treatment are discussed. According to extensive long-term experience of the authors, optimal treatment of writer’s cramp, oromandibular dystonia, camptocormia, and segmentary and multifocal forms of dystonia should include different medications, injections of botulotoxin and physiotherapy.

Annals of Clinical and Experimental Neurology. 2011;5(4):17-20
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Changes in the electrical activity of the brain in patients with multiple sclerosis depending on the presence of central pain syndrome

Krupina N.A., Churyukanov M.V., Kukushkin M.L., Alexeev V.V., Yakhno N.N.


The electrical activity of the brain depending on the presence of central pain syndrome in patients with multiple sclerosis was analyzed. In patients with multiple sclerosis and central pain syndrome, the increase of power spectrum of electrical activity in the theta- and beta1- frequency ranges in the temporal lobes of the right hemisphere and the increase of spectral power of 2-band in the occipital, parietal and temporal lobes of both hemispheres were revealed. Data obtained and results of previous studies in patients with pathological conditions associated with nervous dys-regulation suggest that the increase in the high EEG spectrum may be a universal indicator of changes in the CNS activity in different pathologies, including the development of central pain syndrome.

Annals of Clinical and Experimental Neurology. 2011;5(4):21-28
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Recurrent facial nerve neuropathies: clinical, electrophysiological and molecular analysis

Savitskaya N.G., Nikitin S.S., Illarioshkin S.N., Klushnikov S.A., Ivanova-Smolenskaya I.A., Ostaphyichuk A.V.


We present results of clinical and electrophysological analysis of 34 patients with recurrent facial neuropathy (rFN). Its frequency (10.9%) among all forms of facial neuropathies was determined, and clinical and EMG characteristics, as well as possible risk factors, were described. A separate group of familial rFN was identified, and these patients exhibited high percentage of subclinical peripheral nerve involvement. Positive family history, presence of relapses and electroneurographic features allowed to suspect hereditary neuropathy with liability to pressure palsy in these patients. However, molecular analysis of the РМР22 gene failed to reveal a typical gene deletion. These results leave open the question about etiology and pathophysiologic mechanisms of rFN and warrant further studies of genetic defect underlying a familial form of rFN.

Annals of Clinical and Experimental Neurology. 2011;5(4):29-32
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Antiparkinsonian effect of dicholine succinate on the model of MPTP-induced parkinsonism

Sariev A.K., Rychikhin V.M., Pomytkin I.A., Voronina T.A.


Antiparkinsonian effects of dicholine succinate (intranasal application of 0.2–5.0 mg/kg) was studied in the C57Bl/6 mice model of parkinsonism caused by a single i.p. injection of 25 mg/kg 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Dicholine succinate was found to be characterized by significant antiparkinsonian effects, as indicated by reduction of akinesia in the “open field” test horizontal locomotor activity (0.2, 1.0 and 5.0 mg/kg) and reduction of muscle rigidity assessed through the step length (1.0 and 5.0 mg/kg). However, dicholine succinate did not exhibit any effect on such major MPTP-induced parkinsonian symptoms as tremor, piloerection, latero- and retropulsion.

Annals of Clinical and Experimental Neurology. 2011;5(4):33-36
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Induced pluripotent stem cells: new possibilities in neurobiology and neurotransplantaion

Lebedeva O.S., Lagarkova M.A., Illarioshkin S.N., Khaspekov L.G., Grivennikov I.A.


The discovery of embryonic stem cells (ES) and methods of ES handling belong to most significant achievements of science in the 20th century. As mammalian ES represent an essentially unlimited source of non-differentiated cells with normal diploid caryotype, they will remain to be an important object in basic research, including neurobiology, although their use for the purposes of practical neurology meets a number of medical and ethical difficulties. Results of last studies open completely new possibilities in the field of cell therapy of severe human disorders. We are talking about reprogramming of somatic cells in mammalians, including humans, into pluripotent stem cells (so called induced pluripotent stem cells, iPS), with their further differentiation to cells of different types. The practical capability of patients’ iPS to be transformed into dopaminergic and other specific neurons of the CNS is shown, that gives to doctors a fundamentally new technology of getting adequate and genetically identical cell material for neurotransplantation in Parkinson’s disease, Huntington’s disease and other severe neurodegenerative disorders.

Annals of Clinical and Experimental Neurology. 2011;5(4):37-45
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Alpha-synuclein as a biomarker of Parkinson’s disease

Pchelina S.N.


Parkinson’s disease (PD) is a common neurodegenerative disorder. Toxic aggregation of a small presynaptic protein alpha-synuclein is considered to be the main step in the pathogenesis of PD. Today there are no suitable diagnostic tests based on biochemical investigation of such readily accessible tissues as blood and cerebrospinal fluid (CSF). A search for PD biomarkers aimed at diagnosis and monitoring of the disease remains very actual. As suggested in several studies, the use of the peripheral alphasynuclein level might be a prognostic marker for PD, but until now this question remains open. Evaluation of blood and CSF alpha-synuclein levels in patients with PD compared with agematched controls provided conflicting results. Specific detection and quantification of oligomeric forms of alpha-synuclein in combination with the improvement of imaging techniques may be considered as most perspective direction.

Annals of Clinical and Experimental Neurology. 2011;5(4):46-51
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Sporadic Creutzfeldt-Jakob disease: clinical observation

Peresedova A.V., Stoida N.I., Gnezdizky V.V., Konоvаlоv R.N., Kоrеpina O.S., Zavalishin I.A.


Creutzfeldt-Jakob disease (CJD) is a form of human prion diseases, fatal neurodegenerative conditions. They can be etiologically divided into sporadic, hereditary and acquired forms. Conformational change of the normal (cellular) form of prion protein (PrPc) to a pathological form (PrPSс) is a central event in the formation of an infectious agent. In this article, diagnostic criteria for sporadic CJD are summarized. Case report of probable sporadic CJD is presented. Many therapeutic strategies (based on cell cultures or animals) have been tested as potential treatments for prion diseases. However, only few clinical trials are in progress now or have been completed.

Annals of Clinical and Experimental Neurology. 2011;5(4):52-56
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