Saratov JOURNAL of Medical and Scientific Research

№1, 2019, volume 15

Clinical case of the manifestation of Parkinson's disease in a patient with neuro-leptic-induced parkinsonism

Year: 2019, volume 15 Issue: №1 Pages: 199-202
Heading: Neurology Article type: Case report
Authors: Yudina V.V., Makarov N.S., Yudina G.K.
Organization: Saratov State Medical University

The article presents data on the mechanisms of development of drug-induced parkinsonism in patients taking neu-roleptic drugs, as well as on specifics of the development of Parkinson's disease in these patients. A clinical case of Parkinson's disease development in a patient with drug-induced parkinsonism who has been taken antipsychotics for a long time is described.

Keywords: drugs for Parkinson's disease treatment, neurolepticinduced parkinsonism, neuroleptics, Parkinson disease

Carotid arteries ultrasound screening in asymptomatic patients

Year: 2019, volume 15 Issue: №1 Pages: 190-199
Heading: Neurology Article type: Original article
Authors: Shchanitsyn I.N., Shvarts E.Yu., Ishmukhametova R.A., Vozdeeva A.S.
Organization: Saratov State Medical University

Objective: to reveal the most important predictors of carotid artery stenosis in ambulatory patients of Saratov and Saratov Region with the help of multivariate analysis and to define an ideal patient for ultrasound screening. Material and Methods. In 2014-2018 off-site consultations and ultrasound screening were performed for asymptomatic patients with suspected carotid artery disease in outpatient clinics of Saratov and Saratov Region. Those patients were referred for screening by neurologists and general practitioners. The study used 470 medical charts. The multivariate regression analysis was performed to identify independent predictors of carotid artery stenosis (>50%). Results. The >30% carotid artery stenosis was detected in 24.5% (115/470) of participants, >50% stenosis — in 10.2% (48/470) of participants, >70% stenosis — in 2.9% (14/470) of participants. The multivariate analysis revealed that the odds of finding >50% stenosis in patients chosen by neurologists and general physicians for screening was significantly higher in the presence of following factors: age older then 72, male sex, acute cerebrovascular event more than 6 months ago, atherosclerosis in arteries of lower extremities, episodes of speech disorder. The point scale for risk assessment has been created. In the absence of prognostic factors the absolute risk of >50% stenosis was only 3%. In the presence of 1 point it was 16% and more than 50% in the presence of 4 points. Conclusion. The analysis we conducted allowed to specify major predictors of atherosclerosis in patients followed in outpatient clinics of Saratov and Saratov Region and to create the patient model which allows to optimize selection for ultrasound screening.

Keywords: asymptomatic stenosis, carotid stenosis

Specific features of rehabilitation potential in adult patients with cerebral palsy

Year: 2019, volume 15 Issue: №1 Pages: 187-190
Heading: Neurology Article type: Original article
Authors: Shulyndin A.V., Antipenko Е.А.
Organization: Privolzhskiy Research Medical University

Objective: to determine the specific features of rehabilitation potential in adult patients with cerebral palsy (CP). Material and Methods. Fifty patients with a confirmed diagnosis of cerebral palsy established in childhood were studied. Level of development of gross motor skills according to GMFCS classification was evaluated in all patients; functions were assessed using the International Classification of Functioning (ICF, version 2.1a, clinical form). Results: In patients with level 2 GMFCS, dysfunctions of muscle tone, muscle strength, implementation and capacity for raising and transferring objects of moderate and severe degree (p<0.05) were more common. The frequency of restricted implementation of precise manual movements is comparable in patients with GMFCS levels 1 and 2 Restricted non- assisted walking was significantly more common in patients with 2nd functional level. The moderately significant positive impact of personal mobility assistive products is more common among level 2 patients, while the importance of communication tools was greater for level 1 GMFCS patients. Conclusion. In adult patients with cerebral palsy it is necessary to assess the rehabilitation potential using ICF. Indicators of activity and participation are of key importance to the rehabilitation potential of adult cerebral palsy patients and should be considered in terms of the possibility of full or partial recovery to a level at which the performance of a certain task will meet the needs of the patient.

Keywords: adults, cerebral palsy, International Classification of Functioning, rehabilitation

Idiopathic syringomyelia with involvement of all segments of spinal cord

Year: 2019, volume 15 Issue: №1 Pages: 180-182
Heading: Neurology Article type: Case report
Authors: Sergeeva А.А., Serebrennikov N.A.
Organization: First City Clinical Hospital n.a. E.E. Volosevich of Arkhangelsk, Northern State Medical University

Syringomyelia is a chronic disease with multiple etiologies characterized by a progressive development of longitudinal cavities within spinal cord, which are filled with cerebrospinal fluid or a liquid of similar composition. Etiologically syringomyelia is most often associated with type 2 Chiari malformation. One of the least common variants is an idiopathic syringomyelia. The article describes a rare clinical case of idiopathic syringomyelia with involvement of all spinal cord segments and the outcomes of its surgical treatment using syringo-subarachnoid shunting techinque.

Keywords: shunt, spinal cord, syringomyelia, syrinx

Types of cephalalgia syndrome observed in medical students of Saratov State Medical University

Year: 2019, volume 15 Issue: №1 Pages: 177-179
Heading: Neurology Article type: Original article
Authors: Salina Е.А., Parsamyan R.R., Kuznetsova Е.В., Sholomov I.I., Uzhakhov A.M., Shichanina E.K.
Organization: Saratov State Medical University

Purpose: to study the prevalence and clinical features of headache among medical students. Material and Methods. 160 students from the medical faculty on their 3rd and 6th years of education were surveyed. The type of headache was determined according to the International Classification of Headache (version 3, 2018). Neuropsychological status of students with tension headaches was studied with use of Schulte test, digital character substitution test, hospital anxiety and depression scale (HADS), test for determining sleepiness and sleep quality, tests for semantic and phonetic activity and memory. Statistical analysis was performed using MS Excel 2010 Results. The most common type of headache among medical students was primary headache, namely tension headache (78.2%). Migraine without aura (20.5%) and cluster headache (1.3%) were less common. Changes in the neuropsychological status were revealed in students suffering from tension headache. Conclusion. A study conducted among medical students showed a high prevalence of primary headache with a predominance of tension headache combined with anxiety and sleep disorders.

Keywords: primary headache, tension headache

Preliminary results of study on efficacy of a virtual reality technique for restoration of lower extremity motor function in patients in acute stage of stroke

Year: 2019, volume 15 Issue: №1 Pages: 172-176
Heading: Neurology Article type: Original article
Authors: Poverennova I.E., Zakharov A.V., Khivintseva E.M., Pyatin V.F., Kolsanov A.V., Chaplygin S.S., Osminina E.A., Lahov A.S.
Organization: Samara State Medical University

Objective: to study efficacy of using immersive virtual reality with proprioceptive sensory effects in the rehabilitation of static locomotor function in patients in acute stage of ischemic stroke. Material and Methods. The study included 33 patients in the acute stage of ischemic stroke in the carotid system. Patients were randomized into two groups, the main group additionally took exercises in immersive virtual reality with sensory stimulation. The course includes 10 sessions 15 minutes each. The comparison group received standard rehabilitation assistance. Results. According to Berg balance scale an improvement in static locomotor function was noted in the main group on the 6th day of exercises (p=0.03). The differences between both groups on the last day of rehabilitation course showed an

Keywords: immersive virtual reality, lower extremities, rehabilitation, stroke

Autonomic dysfunction in patients with chronic cerebral ischemia

Year: 2019, volume 15 Issue: №1 Pages: 167-172
Heading: Neurology Article type: Original article
Authors: Poverennova I.E., Khivintseva E.V., Zakharov A.V., Vasemazova E.N., Ananyeva S.A.
Organization: Samara State Medical University

Various autonomic nervous system (ANS) disorders exist in 25-80% of the general population. Seniors affected by chronic cerebral ischemia (CCI) are subject to the development of autonomic disorders. Purpose: to carry out the analysis of autonomic dysfunction in subjects with CCI. Material and Methods. Autonomic status was evaluated using autonomic function tests. All patients underwent cardiointervalography. Heart rhythm variability was estimated by mode, amplitude, variation range, power of waves of various frequency, coefficient of vagosympathetic balance etc. as measured by "Rhythm-MET" system. One hundred fifty one patients aged 48-93 years were examined and distributed to three groups depending on the degree of severity of CCI. Results were statistically processed using Statistica 6 software. Results. Patients with CCI had differences in autonomic function parameters which had multidirectional character and were dependent on sympathetic-parasympathetic balance and CCI stage. The obtained data demonstrate that prevalence of sympathetic influence was observed in 52.8% patients with I grade CCI, in 64.8% patients with II grade CCI and prevalence of parasympathetic

Keywords: autonomic dysfunction, autonomic nervous system, cardiointervalography, chronic cerebral ischemia

Issues of epidemiology of epilepsy in the Republic of Bashkortostan

Year: 2019, volume 15 Issue: №1 Pages: 163-166
Heading: Neurology Article type: Original article
Authors: Novikova L.B., Akopyan А.Р., Sharapova K.M.
Organization: Bashkir State Medical University of the Russian Health Care

Objective: to analyze the prevalence of epilepsy among adult population and the use of antiepileptic drugs (AED) in the Republic of Bashkortostan (RB) in 2013-2017. Material and Methods. Analysis of prevalence of etiological forms of epilepsy and used AEDs was carried out by analyzing data from annual reports of the neurological service of outpatient and inpatient medical institutions in cities and regions of the Republic of Bashkortostan, data of clinical examination of patients with a reliable diagnosis of epilepsy, as well as data from the Medical Information and Analytical Center (MIAC). Results. The prevalence of epilepsy in the Republic of Bashkortostan for the study period was 291.7- 325.8 case per 100 thousand population, which were most often recorded in central and eastern regions of the republic. The average age of patients ranged from 30.5±1.3to 41.8±0.2year. The ratio of men to women was approximately similar: 1.1:1.0. Cases of symptomatic epilepsy ranged from 82.6 to 46.5%. Among AEDs, carbamazepine was mainly used with a frequency of up to 47.4% and valproic acid with a frequency up to 32.9%. New generation drugs (parampanel) were rarely used (2.4%). Conclusion. The study of clinical and epidemiological characteristics of epilepsy is important for systemic organization of specific therapeutic and diagnostic measures and the creation of a specialized service to improve the quality of life of patients with epilepsy.

Keywords: age, antiepileptic drugs, epilepsy

Vegetative dystonia syndrome as a somatoform disorder

Year: 2019, volume 15 Issue: №1 Pages: 159-162
Heading: Neurology Article type: Author's opinion
Authors: Kukhtevich I.I., Aleshina N.I.
Organization: Penza Institute for Further Training of Physicians — Branch Campus of the Russian Medical Academy of Continuous Professional Education

Despite the fact that there is still no consensus on concept and use of vegetative vascular dystonia as a diagnostic term in Russian literature, this diagnosis has become firmly established in clinical practice. In this article we have tried to reconcile two competing concepts — psychovegetative syndrome and vascular dystonia — primarily on the basis that both concepts reflect functional disorders of suprasegmental apparatus of the autonomic nervous system (limbic-reticular complex, reticular formation of the brain stem) and have more similarities than differences, which allows us to include them in a general group of somatoform disorders.

Keywords: functional vegetative disorders, psycho-vegetative syndrome, somatoform disorders, vegetative vascular dystonia

Migraine and epilepsy: comorbidity and problems in diagnostics

Year: 2019, volume 15 Issue: №1 Pages: 154-158
Heading: Neurology Article type: Review
Authors: Kalinin V.A., Poverennova I.E., Yakunina A.V., Myakinina A.E.
Organization: Samara State Medical University

The purpose of this review is to carry out the analysis of published data on comorbidity of migraine and epilepsy. The review is based on results of epidemiological and genetic studies. Clinical manifestations of two diseases are in many respects similar, which sometimes leads to considerable difficulties in diagnostics. Differential diagnosis is based on careful analysis of clinical manifestations, electroencephalography and neuroimaging data. Genetic forms of epilepsy are often accompanied by migrainous headaches. The unity of some pathophysiological mechanisms of epilepsy and migraine predefines comorbidity and directions of diagnostics and treatment for both diseases. Nevertheless, there is a number of questions which demand more precise answers to improve diagnostics and treatment.

Keywords: comorbidity, diagnostics, epilepsy, migraine