Neurology

Тазовая боль в аспекте междисциплинарного подхода в лечении пациентов (обзор литературы) / Л. В. Чичановская [и др.] // Вестник неврологии, психиатрии и нейрохирургии. – 2024. – Т. 17, № 9. – С. 1132–1144. (Pelvic pain in terms of an interdisciplinary approach in patient treatment (literature review))

Pelvic pain is one of the most significant problems in clinical practice. The issues of diagnosis and classification of disorders associated with pain in the pelvic girdle remain controversial, despite numerous studies in this area. Most disorders associated with chronic pelvic pain (CPP) do not have a specific pathological basis, which remains a blank spot in clinical practice. After analyzing modern literary sources, it can be considered that chronic pelvic pain syndrome (CPPS) has a multifactorial nature, since it occurs under the influence of the psychological aspect together with disorders occurring in the endocrine, nervous, and immune systems of the human body. When a patient seeks help for constant pelvic pain, a correct and thorough anamnesis plays a decisive role. Success in diagnosis and treatment depends 90 % on the quality of information collected about the patient’s condition. To determine the cause of chronic pelvic pain, it is necessary to exclude or confirm the influence of many factors, especially urological, gynecological, gastrointestinal, and neurological ones. CPPS can occur for various reasons. Of these, 40 % of cases are due to varicose veins of the pelvic veins; in 25 % of cases, endometriosis is detected; chronic inflammatory diseases of the small organs account for no more than 15 % of cases. Much less common are benign tumors of the uterus and appendages and adhesions in the small pelvis, accounting for up to 12 % and up to 6 % of cases, respectively. No less important are causes unrelated to the reproductive organs, such as interstitial cystitis, spastic colitis, and hypertonicity of the pelvic floor muscles (2 % of cases). After a detailed study and differentiation of the causes of chronic pelvic pain, there is no doubt that the optimal approach to understanding the pathogenesis of pelvic pain is an integrated approach that includes somatic and mental components, and diagnosis and treatment of pain syndromes should be carried out by a team of specialists, since in this case only an interdisciplinary approach is effective.

Терещенко, А. С. Мигрень и эндоваскулярное закрытие открытого овального окна, как метод ее лечения: обзор литературы / А. С. Терещенко, Е. В. Меркулов // Кардиоваскулярная терапия и профилактика. – 2024. – Т. 23, № 2. – С. 86–92. (Migraine and endovascular closure of patent foramen ovale as a method of its treatment: a literature review)

The literature review is devoted to the pathophysiology and clinical picture of migraine, targets of therapy and drugs used, and the connection between the pathogenesis of migraine with aura and patent foramen ovale is discussed. The results of clinical studies show a positive effect of endovascular patent foramen ovale closure on the course of migraine in the form of a decrease in the intensity, frequency of attacks and the number of headache-free days, as well as in some cases complete relief of the disease. Further study of the topic is promising, but requires careful study design and long-term follow-up of patients.

Проблемы вертеброневрологии: история вопроса и современный этап развития (обзор литературы) / К. А. Садоха [и др.] // Неврология и нейрохирургия. Восточная Европа. – 2024. – Т. 14, № 3. – С. 421–436. (Problems of vertebral neurology: history and current stage of development (literature review))

The article reviews the literature on such a problem as back pain (dorsalgia). Sources of dorsalgia, relevance of the problem, background, terminology, some aspects of pathogenesis, International Classification of Diseases 10th revision, three types of Modic changes of vertebral bodies on magnetic resonance imaging in patients with disc herniation are presented, causes of spontaneous regression of disc herniation, diagnosis of diseases with back pain, criteria of non-specific (musculoskeletal) pain, criteria of muscle-tonic and myofascial pain syndromes, radiculopathies, danger signals and basic principles of therapy. The authors present a modern classification of diseases – sources of back pain syndrome and their differential diagnostic criteria.

Забродец, Г. В. Селектиная дорзальная ризотомия в лечении спастического синдрома у взрослых (обзор литературы). Часть 1: общие принципы, показания / Г. В. Забродец, Ю. Н. Рушкевич, Э. Н. Василевич // Неврология и нейрохирургия. Восточная Европа. – 2024. – Т. 14, № 3. – С. 401–408. (Selective Dorsal Rhizotomy for Spasticity Treatment in Adults (a Literature Review). Part 1: General Principles and Indications)

Purpose. To highlight the general principles of selective dorsal rhizotomy (SDR), as well as approaches to determining indications and evaluating the efficacy of various surgical techniques based on current scientific data to inform a wide range of specialists dealing with the problem of spasticity. Results. The main indications and contraindications to surgical treatment of spasticity by SDR method are outlined on the basis of literature review. Differences in approaches among the adult population are shown. The main published results of spasticity treatment in adults with different pathologies are analyzed. Prospects for the development of this direction in medicine are outlined. Conclusion. SDR has proven favorable outcomes in adults with extended indications compared to pediatric population. To obtain more reliable data on SDR outcomes unified approaches to pre- and postoperative assessment of functional impairment and enrollment of a larger number of patients of the same etiology and similar age groups are required.

Горина, Я. В. Роль окситоцина и вазопрессина в эмоциональной памяти и «чтении мыслей по лицу»: нейробиологический подход и клинические аспекты / Я. В. Горина, О. Л. Лопатина, Л. В. Марарица // Анналы клинической и экспериментальной неврологии. – 2024. – Т. 18, № 3. – С. 58–71. (Oxytocin and Vasopressin in Emotional Memory and “Face Reading”: a Neurobiological Approach and Clinical Aspects)

The ability to adequately perceive and recognize emotions is a key and universal tool in interpersonal communication, which allows people to understand feelings, intentions, and emotional reactions of themselves and others. Throughout their life, people have to make inferences about mental state of others by interpreting subtle social signals, such as facial expressions, to understand or predict others’ behavior, which is crucial in constructive social interactions. Therefore, emotional memory associated with the ability to identify emotions based on one’s life experience is the cornerstone of social cognition and interpersonal relationships. Oxytocin and vasopressin are neurohypophysial peptides that have attracted scientific attention due to their role in the emotional and social aspects of behavior. Variable and contrasting effects of oxytocin and vasopressin may be related to the sites of the brain where they exert their activity. Aim. This review aimed to evaluate neural mechanisms underlying oxytocin-mediated and vasopressin-mediated modulation of emotional memory; to assess how cerebral oxytocin-signal and vasopressin-signal transduction mediates emotional and social behavior; to discuss the role of the two neuropeptides in non-verbal interpersonal communication; and to present their cerebral effects in relation to an ability for “face reading” in patients with mental disorders.

Немоторные симптомы болезни Паркинсона: обзор / Сайед Зохайр Хусейн Ризви [и др.] // Анналы клинической и экспериментальной неврологии. – 2024. – Т. 18, № 3. – С. 72–80. (Spectrum of Non-Motor Symptoms in Parkinson’s Disease — a Review)

Motor and non-motor symptoms of Parkinson’s disease (PD) and their management have been evaluated in numerous studies. Four classical symptoms, including bradykinesia, tremor, rigidity, and postural abnormalities, are used to establish a clinical diagnosis of PD. However, this research is aimed at exploring the range of non-motor symptoms with an emphasis upon their ability to affect the patients with PD and their quality of life. With a slow onset of the known symptoms like tremor or rhythmic shaking of limbs called “pill-rolling tremor”, slowed movement (bradykinesia), muscle rigidity, stooped and altered posture, loss of the ability to blink or smile, and various speech and writing changes; the disease takes a leap into the non-motor symptoms like dementia, drooling, swallowing issues, difficulty urinating, and constipation. The dopaminergic pathophysiology of PD explains the anxiety, slowness of thought, fatigue, and dysphoria. Knowing the non-motor symptoms is crucial to help the clinician to make early diagnosis and to better understand the prognosis of the spectrum of this disease.

Проблема дисфагии в неврологии / С. А. Зайцевская [и др.] // Анналы клинической и экспериментальной неврологии. – 2024. – Т. 18, № 2. – С. 52–61. (Dysphagia in Neurological Disorders)

Neurogenic dysphagia is a disorder with impaired swallowing, which is caused by various disorders of the central and peripheral nervous systems, neuromuscular transmission, or muscles. Dysphagia is one of the most common and at the same time the most dangerous symptoms of many neurological disorders. Patients with dysphagia often have severe disability, a higher risk of aspiration pneumonia, and signifi cantly increased mortality rate. Despite the availability of many diagnostic screening methods, clinical scales, questionnaires, and instrumental diagnostic methods, the issue of neurogenic dysphagia is underestimated, especially in the early stages. As a result, patients do not receive timely treatment and prevention of dysphagia and associated complications. Validation of available diagnostic scales, development of international protocols and standards for the diagnosis, treatment, and prevention of dysphagia and associated complications are important to establish a unifi ed and evidencebased approach for patients with dysphagia.

Нарушения поведения в REM-фазе сна: современная концепция и взаимосвязь с болезнью Паркинсона / Д. М. Хасанова [и др.] // Анналы клинической и экспериментальной неврологии. 2024. – Т. 18, № 2. – С. 62–69. (Rapid Eye Movement Sleep Behavior Disorder: Modern Concept and Parkinson’s Disease Correlation)

This review describes the association between rapid eye movement (REM) and synucleinopathies, primarily Parkinson’s disease. This article reviews the diagnostic criteria, the epidemiology of REMs, their pathogenesis, and their association with early non-motor symptoms. The data are presented to assess the risk of phenoconversion of REMs to Parkinson’s disease or other synucleinopathies such as Lewy body dementia and multiple system atrophy. A prodromal period of RBDs may precede synucleinopathies years or decades before potential manifestation of motor, cognitive, or autonomic disorders, and this may be important for initiating the neuroprotective therapy. Other causes of REMs are also reviewed.

Будипутра, Н.  Применение моноклональных антител в качестве анальгетиков при хроническом болевом синдроме в нижней части спины: систематический обзор и метаанализ эффективности и безопасности / Н. Будипутра, Х. Л. Будипутри, М. П. Мулджоно // Анналы клинической и экспериментальной неврологии. 2024. – Т. 18, № 2. – С. 70–83. (Monoclonal Antibodies as Analgesia of Chronic Low Back Pain: a Systematic Review and Meta-analysis of Efficacy and Safety)

Introduction. Monoclonal antibodies (mAb) emerged as a possible option in addressing the partial response to current treatment modalities in chronic low back pain (CLBP). Objective: to evaluate the efficacy and safety of mAb for CLBP.Materials and Methods. Randomized controlled trials on adult patients with CLBP who received mAb-therapy compared to those who did not as a control group. The result was the changes in Low Back Pain Intensity (LBPI) Numeric Rating Score and Roland–Morris Disability Questionnaire (RMDQ) indicating improved pain, disability, and the risk of adverse events. Meta-analysis, risk of bias, and confidence in the evidence for each analysis were assessed. We aimed at reviewing current treatment methods for degenerative lumbosacral spinal stenosis with an emphasis on sur-gical treatment methods.Results. Six studies were included, with a total of 3851 participants. mAb significantly reduce LBPI and RMDQ score (weighted mean difference –1.48; 95% CI –2.63 to –0.33; p = 0.01). Tanezumab and fasinumab were significantly reduced both LBPI (weighted mean difference of –4.11; 95% CI –6.27 to –1.95; p = 0.0002 and weighted mean difference –0.24; 95% CI –0.47 to –0.02; p = 0.04 respectively) and RMDQ scores (weighted mean difference –3.72; 95% –5.48 to –1.97 and weighted mean difference –0.50; 95% –0.73 to –0.26 respectively, both p < 0.0001). The mAb have significantly greater odds of any adverse events (OR 1.23; 95% 1.06 to 1.43; p = 0.007) but no greater odds regarding serious adverse events(OR 1.00; 95% 0.69 to 1.46; p = 0.98).Conclusion. Depending on the types of drugs used, mAb had a favorable outcome and were relatively safe in reducing LBPI and RMDQ scores.

Ахремчук, А. И. Методы интраоперационной диагностики кровотока и контроля микрохирургического клипирования аневризм сосудов головного мозга: обзор литературы / А. И. Ахремчук, Р. Р. Сидорович, О. Л. Змачинская // Неврология и нейрохирургия. Восточная Европа. – 2024. – Т. 14, № 2. С. 228–235. (Intra-Operative Diagnostic Methods of Blood Flow and Control of Microsurgical Clipping of Cerebral Aneurysms: A Literature Review)

Interventions on cerebral vessels belong to one of the most technically complex sections of modern neurosurgery. Complications arising during clipping of cerebral aneurysms, which include incomplete disconnection of the aneurysm from the blood flow, compression of afferent, efferent and perforating arteries by clips, are an urgent problem in the surgery of cerebral arterial aneurysms. To prevent complications arising during clipping of aneurysms, the following methods of intraoperative blood flow assessment and clipping control are widely used: contact ultrasound Dopplerography, intraoperative fluorescent videoangiography, ultrasound flowmetry and neuroendoscopy. Ultrasound contact Doppler ultrasonography is a highly informative method of ultrasound diagnosis of vascular pathology based on the Doppler effect. Intraoperative fluorescence video angiography – a method based on the use of fluorescent dye indocyanine green. Ultrasound flowmetry – a method of measuring the volumetric velocity of cerebral blood flow. Neuroendoscopy is an effective method in the prevention of complications arising during aneurysm clipping, using a video endoscopy stand, a set of endoscopes with different angles of view. This review presents these methods with a description of their capabilities, advantages and limitations, and also describes the priorities of using one or another method depending on the localization of cerebral aneurysms.

Марьенко, И. П. Вестибулярная мигрень: текущее понимание проблемы и будущие направления исследований / И. П. Марьенко, Е. В. Ануфриева // Неврология и нейрохирургия. Восточная Европа. 2024. –Т. 14, № 2. – С. 236–245. (Vestibular Migraine: Current Understanding of the Problem and Future Directions for Research)

Vestibular migraine may occur in up to 2.7% of the population. Vestibular migraine is characterized by recurrent vestibular symptoms, a characteristic history of the disease, confirming the association of vertigo with migraine symptoms when other causes of vestibular symptoms are excluded. This article presents diagnostic criteria for vestibular migraine, formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (HIS), 2018, and the features of vestibular migraine and probable vestibular migraine are presented. The differential diagnosis of vestibular migraine with other diseases with similar clinical manifestations is analyses in the article. The issues of neurofunctional testing in the diagnosis of vestibular migraine are considered.

Масько, М. В. Нехирургическое лечение хронической первичной боли в нижней части спины у взрослых в учреждениях первичной медико-санитарной помощи (согласно руководству Всемирной организации здравоохранения) / М. В. Масько // Неврология и нейрохирургия. Восточная Европа. – 2024. – Т. 14, № 2. – С. 246–269. (Non-Surgical Treatment of Chronic Primary Low Back Pain in Adults in Primary Health Care Settings (According to the World Health Organization))

Low back pain is one of the most pressing health problems, due to its extreme prevalence and impact on working capacity, as well as related socio-economic aspects. However, it is only now the World Health Organization has developed a guideline that examines the treatment of chronic low back pain in adults from a global public health perspective, taking into account universal health coverage and different levels of economic development in different countries. The guide covers 37 interventions in five different classes: education, physical interventions, psychological interventions, medications, and multicomponent intervention. As a result, 24 recommendations and one statement of good practice were made. No recommendations were given for 12 interventions. This article discusses the main sections of the guideline, provides recommendations and comments on them, and compares them with documents regulating the provision of medical care in the Republic of Belarus

Усова, Н. Н. Постинсультный болевой синдром: проблема, которую не замечают / Н. Н. Усова // Неврология и нейрохирургия. Восточная Европа. – 2024. – Т. 14, № 2. – С. 270–281. (Post-Stroke Pain Syndrome: An Overlooked Problem)

Purpose. To analyze the available information on the problem of post-stroke pain syndrome, its prevalence, pathogenetic mechanisms, classification and diagnostic criteria, treatment options. Materials and methods. A review of domestic and foreign publications from the eLIBRARY, PubMed, Cochrane Library, CyberLeninka databases containing information on post-stroke pain syndrome was conducted. Results. An analysis of modern publications on post-stroke pain syndrome was carried out. Its epidemiology, mechanisms of pathogenesis, types, possibilities of drug, non-drug and interventional treatment have been clarified. Conclusion. Post-stroke pain syndrome is a pathogenetically complex multimodal process that significantly affects the quality of life and recovery of the patient after a stroke. Treatment of post-stroke pain is a complex task for a neurologist and rehabilitation physician and requires a multidisciplinary approach. Timely identification and correction of post-stroke pain will solve the problem of pharmacoresistance and improve the quality of life and prognosis for patients who have suffered acute cerebrovascular accident.

Пономарева, Е. В. Алгоритм дифференциальной диагностики когнитивных нарушений церебрально-сосудистого и альцгеймеровского генеза у пациентов пожилого возраста / Е. В. Пономарева // Клиническая геронтология. – 2024. – Т. 30, № 3–4. – С. 47–51.– 2024. – Т. 16, № 3. – C. 378–384. (Algorithm of Differential Diagnosis of Cognitive Disorders of Cerebral Vascular and Alzheimer’s Genesis in Elderly Patients)

The aim of the study was to analyze the literature data on the role of vascular and neurodegenerative mechanisms of cognitive disorders in the elderly, as well as to develop an algorithm for their differential diagnosis. Material and method: the article analyzes the literature on the involvement of neurodegenerative and vascular mechanisms in the development of cognitive disorders. The features of their etiopathogenetic mechanisms and data on the possible relationship between these processes were studied. The article analyzes modern approaches to the drug correction of these disorders, describes the spectra of biochemical activity and the mechanisms of action of the main directions of dementia therapy. Conclusion: the analysis of the literature data indicates the commonality of risk factors, the presence of overlapping etiopathogenetic processes and the possible additive and synergistic interaction of atrophic and vascular processes of the brain.

О возможности применения опросников и шкал боли в клинической практике (обзор литературы) / А. М. Морозов [и др.] // Вестник неврологии, психиатрии и нейрохирургии. – 2024. – Т. 17, № 6. – С. 697–709. (On possibility of using pain questionnaires and scales in clinical practice (a literature review)).

Pain is one of the main, and sometimes the only, reason for visiting a doctor, therefore, in order to establish a diagnosis and provide effective treatment, it is important to correctly and objectively assess this condition of the patient, but the perception of pain is a very subjective phenomenon, so it is necessary to develop ways of qualitative and quantitative assessment of pain sensations. The World Health Organization has defined pain as «an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage». Pain sensations have both physical and psychological aspects that need to be considered when assessing and treating pain. Objectification of pain is a challenging yet important task for the clinician. Pain perception is a versatile field of study at present, as each person evaluates pain sensations completely differently. Currently, various methods of assessing pain sensation have been described, among which a separate place is allocated to scales and questionnaires. The disadvantages of all scales and questionnaires are their limitations; only one scale cannot be used to obtain a detailed picture of the patient’s condition, and the use of only one type of questionnaire does not cover all aspects of the pain syndrome and does not take into account the individual characteristics of the patient. There are modern technical methods of pain intensity assessment, but their high cost and insufficient distribution in clinical practice limit their use. After a detailed study of the problem of pain syndrome assessment, we can conclude that this topic is in demand in modern medicine and still remains open for innovations.

Немедикаментозная терапия при первичной дисменорее – взгляд невролога (обзор литературы) / Т. В. Сороковикова [и др.] // Вестник неврологии, психиатрии и нейрохирургии. – 2023. – Т. 16, № 11. – С. 900–911.. (Non-medication therapy for primary dysmenorrhea: a neurologist’s perspective (literature review))

Primary dysmenorrhea is the most urgent and socially significant problem at present. Every year the number of girls and women of reproductive age who suffer from this disease is steadily increasing. This is primarily due to the fact that women do not visit specialized doctors when a vivid clinical picture of this pathology appears. This study presents the information from the most relevant literature sources in order to demonstrate the common risk factors for this disease, the main pathophysiological mechanisms of its occurrence, as well as possible ways of non-medication therapy for primary dysmenorrhea, due to the fact that this disease should be approached comprehensively, involving other specialists, such as neurologists, physiotherapists, and specialists in therapeutic exercise, in addition to gynecologists. In this regard, the review presents the most relevant methods available at the moment that can alleviate the clinical manifestations of primary dysmenorrhea. These methods include moxibustion together with acupuncture, percutaneous electrical neurostimulation, kinesio taping, auricular acupressure, aromatherapy, and specially selected physical exercises. These techniques are considered non-invasive, non-pharmacological, easy to use, and most importantly, safe and effective in the treatment of menstrual pain.

Глеб, О. В. Возможности применения транскраниальной магнитной стимуляции при мигрени / О. В. Глеб, Т. Н. Чернуха, С. А. Лихачев // Неврология и нейрохирургия. Восточная Европа. – 2023. – Т. 13, № 4. – С. 474–482. (Possibilities of application of transcranial magnetic stimulation in migraine)

Some studies have shown that transcranial magnetic stimulation (TMS) can reduce the number of migraine days per month, reduce the intensity and duration of migraine attacks within a few days of TMS use, rapidly relieve a migraine attack, and improve quality of life. In addition, TMS is safe and well tolerated, compatible with the administration of pharmacological prophylactic therapy for chronic migraine. However, the lack of homogeneity of results and long-term real-world efficacy data means that the results do not provide conclusive evidence for the efficacy of TMS in the treatment of migraine. In order to optimally apply TMS in clinical practice for the treatment of migraine, further research is needed to clarify the mechanisms of the effects of this procedure on the brain. An important problem hindering the widespread clinical application of TMS in migraine is the incomplete knowledge of the mechanisms of action of TMS in migraine, concerning both prophylactic treatment and treatment of the acute phase. Consequently, further randomised placebo-controlled trials are needed to elucidate the pathophysiology of migraine and to analyse the safety of long-term and frequent use of TMS. It is also necessary to study the potential interaction between TMS and new available drugs for the treatment and prevention of migraine attacks. The development of optimal parameters of rhythmic TMS, number of sessions, and indications for referral to this type of treatment is relevant.

Потехина, Н. Н. Роль физических упражнений в коррекции когнитивных нарушений в зрелом и пожилом возрасте. Обзор литературы / Н. Н. Потехина, М. М. Скугаревская // Психиатрия, психотерапия и клиническая психология. – 2023. – Т. 14, № 4. – С. 443–451. (The Role of Exercise in the Correction of Cognitive Impairment in Older Adults. Literature Review)

Age-related cognitive decline is a major problem for health and social service systems. One of the ways to prevent cognitive disorders is physical activity and exercise. A review of the literature on the possibility of correcting age-related cognitive impairment using a set of physical exercises was carried out. Modern data on the mechanisms of infl uence, the role of aerobic, strength, multimodal exercises, the possibilities of application in normal aging and already developed cognitive disorders are presented.

Роль молекулярных биомаркеров в прогнозировании неврологических исходов после внезапной остановки кровообращения / Д. О. Старостин [и др.] // Анестезиология и реаниматология. – 2023. – № 6. – С. 99–107. (Molecular biomarkers in prediction of neurological outcomes after sudden cardiac arrest)

Many tools were developed to predict neurological outcomes after sudden circulatory arrest. However, none has absolute predictive value. Neuron-specific enolase (NSE) and S100 protein are of practical importance. Objective. To analyze the most perspective biomarkers used in predicting neurological outcomes after sudden circulatory arrest, their advantages and disadvantages, sensitivity and specificity. Material and methods. We reviewed the eLibrary, PubMed and Scopus databases for the period 2010—2022 and selected 57 articles. Results. S100B protein is useful for earlier prediction of the outcome after circulatory arrest compared to NSE. As for unfavorable neurological outcome, NSE ≤17 µg/l excludes adverse outcomes with negative predictive value of 92%. Serum S100 concentration within 3.56—16.6 ng/l is an indicator of unfavorable neurological outcomes. Serum GFAP concentration of 0.08 μg/l in 36—60 hours after restoration of spontaneous circulation can be considered as a predictor of adverse neurological outcomes. Conclusion. Modern biomarkers are in demand and promising in intensive care. Glial (glial fibrillar acidic protein, neurofilament light chain protein) and neuronal (serum tau protein, neutrophil gelatinase-associated lipocalin and others) markers are being studied. Algorithms for predicting the neurological outcomes after sudden circulatory arrest based on qualitative and quantitative analysis of markers of ischemic neuronal damage are being actively developed. Despite long-term history of research of certain markers (S100 protein and NSE), the list of potential biomarkers is updated every year.

Мансуров, Д. М. Головная боль у пациентов с дисплазией соединительной ткани / Д. М. Мансуров, Д. Х. Ханбуллнна // Практическая медицина. – 2023. – Т. 21, № 4. – С. 41–46. (Headache in patients with connective tissue dysplasia)

Headache in patients with connective tissue dysplasia (CTD) is an urgent problem of modern medicine. The article discusses different types of headache in patients with connective tissue dysplasia. The most well studied are differentiated forms of connective tissue dysplasia (Ehlers — Danlos syndrome, Marfan syndrome, etc.) and, accordingly, variants of cephalgia in them are described. A significant problem is the dissection of the carotid and vertebral arteries, which are variants of acute cerebrovascular accident. The interrelation of primary and secondary headaches with CTD syndrome is shown. The variety of clinical manifestations of headaches and connective tissue dysplasia in the same patient makes it difficult to diagnose, which can contribute to the chronicity of cephalalgia, the appointment of inadequate therapy and the development of complications. Further study of headache options in patients with CTD will improve the provision of medical care to this category of patients.

Применение искусственного интеллекта в диагностике нейродегенеративных заболеваний (литературный обзор) / Е. В. Петрова [и др.] // Вестник неврологии, психиатрии и нейрохирургии. – 2024. – Т. 17, № 4. – С. 502–510. (Artificial intelligence in diagnosis of neurodegenerative disorders (literature review))

Currently, there are virtually no objective diagnostic signs (markers) to diagnose neurodegenerative diseases, that is why it may take months of constant monitoring of symptoms to establish a reliable diagnosis. Now there is an increasing number of reports that artificial intelligence can provide a more accurate diagnosis of neurodegenerative diseases by identifying specific diagnostic features from electroencephalography data, neuroimaging, and wearable devices and smartphones. This study reviews the application of artificial intelligence to the diagnosis of neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, and Huntington’s disease. Using the international databases Scopus and PubMed, as well as the Russian Science Citation Index, we analysed studies that used artificial intelligence methods to detect, monitor, or control the progression of neurodegenerative diseases. The primary focus is on analysing electroencephalography data, neuroimaging data, and data from wearable devices and smartphones. The use of the latter may allow screening, diagnosis, and monitoring of the disease at home with a minimum economic cost. Artificial intelligence can be a useful tool for early, accurate, and non-invasive diagnosis of neurodegenerative diseases, as well as for assessing the effectiveness of treatment and predicting the course of the disease. However, for the widespread implementation of artificial intelligence in clinical practice, several issues related to the quality, availability, and standardization of data, validation and interpretation of results, ethical and legal aspects need to be resolved. The use of artificial intelligence requires both specialists from the IT industry with a deep understanding of the types and kinds of neural networks and physicians with fundamental knowledge of neurology, psychiatry, molecular biology, and biophysics.

Роль генетических факторов в развитии дегенеративно-дистрофического поражения межпозвонковых дисков / В. А. Чехонацкий [и др.] // Журнал Вопросы нейрохирургии им. Н. Н. Бурденко. – 2024. – Т. 88, № 2. – С. 112–118. (Genetic factors in degenerative disc disease)

To analyze available literature data on the role of genetic factors in degenerative disc disease. Methodology. We reviewed the PubMed, MEDLINE, Cohrane Library, e-Library databases using the following keywords: degenerative spine lesions, intervertebral disc herniation, pathogenesis, genetic regulation. Results. Searching depth was 2002—2022. We reviewed 84 references. Exclusion criteria: duplicate publications, reviews without detailed description of results, opinions. Finally, we included 43 the most significant studies. Conclusion. There are literature data on proinflammatory cytokines, growth factors and osteodestructive processes in pathogenesis of degenerative disc disease. However, there is only fragmentary information about the role of genetic regulation of these processes. Some factors, such as microRNA, TGF-b, VEGF, MMP are still poorly understood.

Восстановительный потенциал традиционной китайской медицины при аутоиммунных заболеваниях нервной системы: обзор литературы / Ю. О. Новиков [и др.] // Вопросы курортологии, физиотерапии и лечебной физической культуры. – 2024. – Т. 101, № 2. – С. 64–70. (Restorative capability of traditional Chinese medicine in autoimmune diseases of nervous system: a literature review)

Autoimmune diseases of the nervous system are characterized by the formation of pronounced neurological deficiency and often lead to disability. Complementary medicine as an adjuvant or preventive therapy of various diseases, including autoimmune ones, is increasingly attracting the attention of doctors and researchers. Traditional Chinese medicine (TCM) has a complex of treatment methods, including acupuncture, phytotherapy, nutrition, physical exercises and other methods that are often used in common with the recognized approaches of the official medical science. The article describes the TCM methods application in autoimmune diseases of nervous system, presents the practical experience of using acupuncture, phytotherapy, diet, physical exercises. It was concluded that TCM is important and frequently underestimated health care resource, especially in prevention and treatment of autoimmune diseases of nervous system.

Кащенко, С. А. Глимфатическая дисфункция и нарушения сна: опосредованное влияние на болезнь Альцгеймера / С. А. Кащенко, А. А. Еранова, Е. В. Чугуй // Журнал неврологии и психиатрии имени С. С. Корсакова. – 2024. – Т. 124, № 4. – С. 7–12. (Glymphatic dysfunction and sleep disorders: indirect effects on Alzheimer’s disease)

Modern research raises the question of the potentially significant role of glymphatic dysfunction in the development of neurodegeneration and pathological aging. The exact molecular mechanisms are not yet fully understood, but there is ample evidence of a link between sleep deprivation and decreased clearance of β-amyloid and other neurotoxin proteins that are associated with the development of neurodegenerative diseases, particularly Alzheimer’s disease. The review analyzes current scientific information in this area of research, describes the latest scientific discoveries of the features of the glymphatic system, and also illustrates studies of markers that presumably indicate a deterioration in the glymphatic system. The relationship between sleep deprivation and pathophysiological mechanisms associated with neurodegenerative diseases is considered, and potential targets that can be used to treat or delay the development of these disorders are noted.

Дороженок, И. Ю. Атипичные антипсихотики при терапии депрессий в рамках аффективных расстройств и шизофрении (на модели арипипразола) / И. Ю. Дороженок, А. В. Струкова // Журнал неврологии и психиатрии имени С. С. Корсакова. – 2024. – Т. 124, № 4. – С. 36–42. (Atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia (using the aripiprazole model))

The review discusses aspects of the use of atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia using the model of aripiprazole, a partial agonist of dopamine receptors. According to numerous studies, aripiprazole is the drug of choice for augmentative therapy of major depressive disorder, as well as for relieving and long-term maintenance monotherapy and combination therapy of various affective episodes of bipolar affective disorder and depression in schizophrenia.

Агрессивные опухоли и карциномы гипофиза: современная классификация, достижения и перспективы в лечении / Л. И. Астафьева [и др.] // Журнал Вопросы нейрохирургии им. Н. Н. Бурденко. – 2024. – Т. 88, № 3. – С. 103–110. (Aggressive tumours and carcinomas of the pituitary gland: current classification, advances and perspectives in treatment)

Despite the slow growth of most pituitary tumours, high rates of their radical removal and/or the effectiveness of medical treatment methods, in 10% of cases pituitary tumours exhibit ‘aggressive behaviour’ with high growth rate, frequent recurrences and resistance to standard treatment methods. In modern classifications of tumours of the central nervous system and endocrine and neuroendocrine tumours of the World Health Organization, the term ‘pituitary neuroendocrine tumour’ is proposed to be used instead of the previously used term ‘pituitary adenoma’, and ‘metastasizing pituitary neuroendocrine tumour’ instead of the term ‘pituitary carcinoma’. Currently, there are no reliable prognostic markers of aggressive behaviour of tumours, which makes their early diagnosis difficult. We propose to apply a five-stage prognostic classification based on the assessment of proliferation (including mitotic count, Ki-67 labelling index and p53 immunoexpression), combined with morphometric markers of invasiveness, of all removed pituitary neoplasms for earlier detection of aggressive tumours and pituitary carcinomas. Compression of the optic tract, III ventricle, brain stem due to rapid growth of aggressive tumours in most cases requires repeated surgeries followed by radiation treatment, in case of hormonally active tumours – therapy with somatostatin analogues, dopamine agonists in maximum tolerable doses. If standard methods of treatment are ineffective, chemotherapy is recommended, the first line of which is temozolomide. Alternative treatment options include peptide receptor radionuclide therapy, molecular targeted therapy (bevacizumab, tyrosine kinase inhibitors, everolimus and cyclin-dependent kinase inhibitors), and immunotherapy (immune response checkpoint inhibitors). Given the need for combined treatment, these cases should always be discussed by a multidiciplinary team of experts (neurosurgeon, endocrinologist, radiotherapist, oncologist, pathomorphologist) qualified and experienced in treating patients with this pathology. The treatment of aggressive tumours and pituitary carcinomas is becoming an active and rapidly developing field of neurosurgery, endocrinology and oncology.

Шевченко, О. И. Современные представления о состоянии нейрофункциональной активности головного мозга при профессиональном воздействии физических и химических факторов / О. И. Шевченко // Медицина труда и промышленная экология. – 2024. – № 3. – С. 172–181. (Modern ideas about the state of neurofunctional activity of the brain under the professional influence of physical and chemical factors)

The article provides an overview of modern scientific approaches to assessing the state of neurofunctional activity of the brain under the professional influence of physical and chemical factors is presented, carried out using bibliographic databases Scopus, MedLine, Web of Science, PubMed, The Cochrane Library, RSCI, Cyberleninka, Google Academy, Index Copernicus, SJR, Science Direct, Arxiv.Org. The work reflects the results of research by domestic and foreign scientists stating the fact of violations of neurobioelectric activity, cerebral hemodynamics, afferent conductive structures, cytokine and neuropsychological status in patients with vibration disease, sensorineural hearing loss, chronic mercury intoxication. There are prospects for using neuroenergic mapping with registration of the level of constant potential. The effects of biofeedback training (biofeedback method) on the reference reaction in order to stabilize and activate the neurofunctional activity of the brain in the treatment of neurological patients are reflected. The analysis of literary sources allowed us to substantiate the need to use artificial intelligence technologies to automate processes as a highly sensitive and specific method of detecting occupational pathology. The presented data indicate the relevance of the problem of studying disorders of neurofunctional activity, the relationship between the nervous and immune systems under the influence of vibration, noise, metallic mercury to improve the criteria for diagnosing lesions of the central nervous system.