Vol 16, No 4 (2022)

Cover Page

Full Issue

Original articles

Evaluation of the outcome in ischemic stroke acute period

Novikova L.B., Akopyan A.P., Latypova R.F.


Introduction. As a major cause of both temporary and permanent disability, ischemic stroke is the most common type of cerebrovascular accident (CVA).

Objective. To assess fatal outcome probability in the acute period of ischemic stroke.

Materials and methods. We performed post-hoc analysis of the fatal outcome probability in the patients with acute ischemic stroke at the Neurology Department of the Ufa Emergency Hospital, the Republic of Bashkortostan, Russian Federation. The analysis included data from the randomly selected medical records of 31 patients with fatal outcomes and 55 patients discharged with favorable outcomes.

Results. The patients with fatal outcomes were significantly (p < 0.001) older, with more severe strokes and a higher prevalence of disorders of consciousness, medical co-morbidities, and recurrent strokes as compared to the group of patients with favorable outcomes. Regression coefficients showed that brain herniation, kidney and liver disease, post-infarction cardiosclerosis, diabetes mellitus, and atrial fibrillation were associated with a higher probability of the fatal outcome. Increased severity of disorders of consciousness, NIHSS and mRS scores, specific blood tests values, age, and heart rate were associated with a more probable fatal outcome, while elevated hemoglobin, total protein, red blood cells, and lymphocytes, a higher GCS score, and a history of hypotensive drug therapy were associated with a less probable fatal outcome.

Multivariate analysis showed that the stroke fatal outcome was related with the age, a NIHSS score, and elevated creatinine and total bilirubin levels.

Conclusion. The detected predictors of the stroke fatal outcome can be used as reference points to choose management strategy for patients in the acute period of ischemic stroke.

Annals of Clinical and Experimental Neurology. 2022;16(4):5-11
pages 5-11 views

Spectroscopic analysis of metabolic profile in patients with relapsed multiple sclerosis

Shkilnyuk G.G., Bogdan A.A., Kryukova E.V., Petrov A.M., Trofimova T.N., Stolyarov I.D.


Introduction. Managing patients with relapsing-remitting multiple sclerosis (RMS) remains a pressing issue.

Objective. To detect the reversible metabolic changes of the brain matter in patients with clinically exacerbated RMS and to follow them up after intravenous glucocorticoid (IVGC) treatment.

Materials and methods. Neurological examination and neuroimaging in the RMS patients included expanded disability status scale (EDSS) scoring, conventional brain magnetic resonance imaging (MRI), and proton nuclear magnetic resonance spectroscopy (1H-NMR spectroscopy) before and after IVGC treatment. Multivoxel 1H-NMR spectroscopy was used to assess metabolism in the centra semiovale and cingulate gyri.

Results. Based on the multivoxel 1H-NMR spectroscopy, relative metabolite concentrations in the grey and white matter statistically differed within the study cohort before and after the IVGC treatment. The N-acetylaspartate/choline ratio significantly recovered and the choline/creatine ratio decreased in the anterior cingulate gyri in 27% of patients. The brainstem function score significantly improved in the metabolic response group as compared to the non-metabolic response group.

Conclusion. We should study the potential predictors of RMS activity and the IVGC response to select the RMS relapses when pulse-therapy with IVGCs is definitely indicated. Spectroscopy may reveal RMS pathogenesis variability earlier than conventional MRI.

Annals of Clinical and Experimental Neurology. 2022;16(4):12-17
pages 12-17 views

Survival, cognitive functions, and brain MRI in patients with cSVD: 5-year observation

Dobrynina L.A., Gadzhieva Z.S., Kremneva E.I., Shamtieva K.V., Tsypushtanova M.M., Makarova A.G., Trubitsyna V.V., Bitsieva E.T., Filatov A.S., Byrochkina A.A., Krotenkova M.V.


Introduction. Contributing to high disability and mortality, cerebral small vessel disease (cSVD) is a common condition in senior and elderly individuals.

Objective: to assess the 5-year survival as well as cognitive and MRI changes in patients with cSVD and cognitive impairment (CI).

Materials and methods. A prospective 5-year study included 54 patients (of them 37 women; mean age: 60.51 ± 6.76 years) with cSVD, CIs, and white matter hyperintensities (WMHs; Fazekas 2–3). Twenty-two subjects were followed up to assess cognitive functions and a type of CI, cSVD MRI features, WMH, white and grey matter, and cerebrospinal fluid (CSF) volume as well as microstructural brain changes and correlate cognitive and MRI parameters at 5 years timepoint after the baseline.

Results. Dementia developed in 14% of the subjects and 14% of the subjects died over a 5-year period. The subjects assessed twice had controlled hypertension (HTN). CIs worsened in the domain of executive functions and memory with mixed-type CI worsening. The follow-up showed that the WMH and CSF volume increased while the white matter volume decreased and axial diffusivity increased in the corpus callosum. The CSF volume correlated with the Stroop Test results and delayed memory (r = 0.803 and r = –0.701, respectively) and with white matter atrophy (r = –0.256) while the latter correlated with the axial diffusivity increased in the corpus callosum (r = –0.560).

Conclusion. cSVD with advanced WMHs is associated with high mortality and dementia progression. General cognition assessment and MRI scan are not enough sensitive to assess disorder progression over a 5-year period. Stroop Test and Delayed 10-Word Recall Test results and transition to mixed-type CI indicate CI worsening and, therefore, can be used for the follow-up assessment. Cognitive decline in extensive cSVD is mediated by the brain matter atrophy and altered CSF circulation.

Annals of Clinical and Experimental Neurology. 2022;16(4):18-28
pages 18-28 views

Surgical outcomes in patients with drug-resistant bilateral temporal lobe epilepsy confirmed via magnetic resonance imaging

Krylov V.V., Gekht A.B., Lebedeva A.V., Rider F.K., Trifonov I.S., Kaimovsky I.L., Sinkin M.V., Kordonskaya O.O., Yakovlev A.A., Komoltsev I.G., Magomedsultanov A.I., Navruzov R.A.


Introduction. In patients with drug-resistant temporal lobe epilepsy (TLE), surgical treatment is aimed to resect an epileptogenic zone (EZ) followed by seizure control. Despite complicated EZ location, surgical resection should be considered as a treatment of choice in bilateral TLE.

Objective: to evaluate surgical outcomes and factors contributing to outcomes in patients with drug-resistant bilateral TLE confirmed via magnetic resonance imaging.

Materials and methods. The study included patients with unilateral (n = 50) and bilateral (n = 50) temporal lobe involvement. The results of surgical treatment were evaluated according to the classification of J. Engel (1993).

Results. Favorable outcomes of surgical treatment (Engel I and Engel II) in the group with unilateral temporal lobe involvement were found in 98% of patients after 12 months, in 88% after 24 months, and in 100% after 48 and 60 months after surgery. In the group with bilateral temporal lobe involvement outcomes of surgical treatment were favorable in 41% of patients after 12 months, in 50% after 24 months, in 39% after 48 months, and in 50% of patients after 60 months post-surgery.

Conclusion. Early onset, burdened perinatal history, and MRI-confirmed left temporal lobe involvement contribute to the poor outcome (Engel III and Engel IV) in the bilateral TLE group. Engel I outcomes were more common in the patients with unilateral TLE while Engel II–IV outcomes were more common in the patients with bilateral TLE.

Annals of Clinical and Experimental Neurology. 2022;16(4):29-37
pages 29-37 views

Identification of RNA markers associated with Parkinson's disease using multiplex gene expression analysis

Ardashirova N.S., Abramycheva N.Y., Fedotova E.Y., Sukhorukov V.S., Voronkova A.S., Mudzhiri N.M., Illarioshkin S.N.


Introduction. Parkinson's disease (PD) is a neurodegenerative disorder, and the development of biomarkers is essential due to complicated PD diagnosis and progression assessment.

Objective. To identify PD RNA markers by multiplex expression profiling of 760 genes associated with the main neuropathological processes.

Materials and methods. We studied the expression of 760 genes associated with the main neuropathological processes using Nanostring nCounter® Human Neuropathology Panel in 29 blood samples obtained from PD patients, including 13 samples from those in the early stage and 16 samples from those in the advanced stage, and in 16 control blood samples.

Results. The comparison of gene expression in the patients with early PD and in the controls demonstrated differential expression of genes CDKN1A and CPT1B. The comparison of gene expression in the patients with advanced PD and in the controls showed LRP1 upregulation in the advanced PD group. We also revealed СPT1B upregulation in advanced disease, with a positive correlation between СPT1B expression and PD duration.

Discussion. The variably expressed genes may be relevant as PD biomarkers for diagnosis and progression assessment.

Annals of Clinical and Experimental Neurology. 2022;16(4):38-43
pages 38-43 views


The structural patterns of the potentiation and the blockade of inhibitory cys-loop receptors through the transmembrane domain

Rossokhin A.V.


Anion-conducting cys-loop receptors activated by γ-aminobutyric acid (GABAАRs) and glycine (GlyRs) have inhibitory activity in the brain and spinal cord. GABAАRs and GlyRs are targets for various substances that potentiate or inhibit the receptor functions. Many of these substances are clinically significant agents to treat neurological and psychiatric conditions.

The review covers both our results and literature data on electrophysiology, mutations, and biochemistry of non-competitive antagonists, general anesthetics, barbiturates, and fenamates modulating GABAАRs and GlyRs. We focused on our own molecular modeling to determine the sites and the characteristics of binding of these substances to the GABAАR and GlyR transmembrane domain. With the structural patterns of the binding, we have identified possible molecular mechanisms of action for these substances.

Annals of Clinical and Experimental Neurology. 2022;16(4):44-53
pages 44-53 views

Multiple system atrophy: diagnostic methods and biomarkers

Andreev M.N., Fedotova E.Y.


Multiple system atrophy (MSA) is a neurodegenerative disease belonging to a group of synucleinopathies and characterized by significant autonomic failure, parkinsonian syndrome, and cerebellar signs. Diagnostic criteria used currently were updated in 2022. While the clinical method and neuroimaging are typically diagnostic in MSA, new modalities are currently emerging. Novel candidate biomarkers are being intensively and thoroughly studied.

The review analyzes the clinical picture and diagnostic criteria of the disease, describes imaging methods for diagnosing synucleinopathies, as well as known laboratory markers of multiple system atrophy.

Annals of Clinical and Experimental Neurology. 2022;16(4):54-61
pages 54-61 views

Insomnia and its management in patients with panic disorder

Korabelnikova E.A., Yakovleva E.V.


Sleep disorder, especially insomnia, is one of the most common panic disorder (PanD) comorbidities, with PanD and insomnia being closely related. PanD severity is definitely associated with sleep disorder while sleep disorder is caused by abnormal anxiety. Insomnia management in PanD patients is based on a multidisciplinary approach to achieve emotional balance and includes both medicinal treatment and a wide range of psychotherapy methods. Successful insomnia management contributes to the effectiveness of PanD therapy, reduces relapse probability, and improves susceptibility to many anxiolytics.

Annals of Clinical and Experimental Neurology. 2022;16(4):62-70
pages 62-70 views


Theta-gamma phase-amplitude coupling: physiological basics, analysis methods, and perspectives of translation into clinical practice

Poydasheva A.G., Bakulin I.S., Sinitsyn D.O., Zabirova A.H., Lagoda D.Y., Suponeva N.A., Piradov M.A.


Studying rhythmic neural synchronization (cross-frequency coupling in various ranges) is an emerging topic in present-day neurophysiology. One of the best-studied cross-frequency couplings is theta-gamma phase-amplitude coupling that contributes to the cognitive function and may vary in patients with several conditions associated with cognitive impairment. Changes in theta-gamma coupling can be registered in a wide range of diseases associated with cognitive decline.

The review covers the physiological basics of theta-gamma coupling, its registration and calculation, correlation with cognitive test results in healthy volunteers, and changes in patients. We have discussed the results of the preliminary studies of frequency-dependent non-invasive brain stimulation based on theta-gamma coupling.

Annals of Clinical and Experimental Neurology. 2022;16(4):71-79
pages 71-79 views

Clinical analysis

Postvaccination acute disseminated encephalomyelitis with area postrema syndrome and quasi benign paroxysmal positional vertigo: a case report

Bogdanov E.I., Kazantsev A.Y., Ahunova A.G.


Area postrema syndrome (APS) develops in patients with lesions found in the floor of the fourth ventricle and manifests with nausea, intractable vomiting, and hiccup. APS is most commonly associated with neuromyelitis optica spectrum disorders although it may develop in some other conditions as well.

We have presented a case study of APS with positional vertigo developed in a 41-year-old woman caused by acute disseminated encephalomyelitis after COVID-19 vaccination. Quasi benign paroxysmal positional vertigo acutely manifested with nausea, vomiting, and vertigo that dramatically worsened with head movement. Physical examination revealed patchy hypesthesia on the left side of the face and decreased convergence of the left eye. MRI scan showed a lesion adjacent to the floor of the fourth ventricle (area postrema). The manifestations totally regressed on glucocorticoids without any relapse during 1-year follow-up.

Annals of Clinical and Experimental Neurology. 2022;16(4):80-84
pages 80-84 views

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