[Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts (June 8, 2023)]

Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts.

[Treatment of cognitive, behavioral and mental disorders in patients with vascular dementia: results of a multicenter, randomized, double-blind, placebo-controlled clinical trial]

OBJECTIVE

Evaluation of the efficacy and safety of Prospect in the treatment of cognitive, behavioral and mental disorders in patients with vascular dementia (VSD).

MATERIAL AND METHODS

In a double-blind, placebo-controlled, parallel-group randomised clinical trial, 406 patients aged 60-85 years old with a diagnosis of mild/moderate vascular dementia (10-24 on the Mini-Mental State Examination (MMSE)) and without signs of depression (Cornell Scale for Depression in Dementia (CSDD) scores ≤10) were included. At Visit 1, complaints and medical history were collected, vital signs were recorded, cognitive impairment was assessed using MMSE and MoCA, NPI-C and CSDD were completed, and an MRI brain scan was performed. Patients were randomised into two groups: patients in group 1 received Prospekta in a dosage of 2 tablets two times a day for 24 weeks, and patients in group 2 received Placebo according to the study drug regimen.

RESULTS

Patients in both groups had no differences in demographic and baseline clinical characteristics. Administration of Prospekta for 24 weeks reduced cognitive impairment in patients with vascular dementia compared to the placebo group. The mean MoCA score increased from 17.0±3.6 [17.1±3.6] to 20.5±4.7 [20.4±4.7] in patients treated with Prospekta, whereas it increased from 17.3±3.7 [17.3±3.8] to 19.2±4.9 [19.2±5.0] in the Placebo group. Treatment with the medication also reduced the severity of neuropsychiatric symptoms as measured by the NPI-C scale. The mean score on this scale decreased from 57.0±26.7 [56.7±25.4] to 39.8±23.6 [39.8±23.5] in the Prospekta group and from 55.5±25.5 [55.3±24.4] to 42.8±27.6 [42.3±25.3] in the Placebo group. The difference in mean MoCA and NPI-C scores between the Prospekta and Placebo groups was statistically significant.

CONCLUSION

Prospekta is an effective and safe drug for treating cognitive, behavioural and mental disturbances in patients with vascular dementia.

Application of a new biological pathogenetic therapy of migraine in clinical practice: expert consensus of the Russian Headache Research Society

This consensus reviewed the main current issues of clinical application and integration into everyday practice of a new targeted preventive therapy for migraine using monoclonal antibodies (mAbs) to the calcitonin gene related peptide (CGRP) ligand or receptor. These recommendations are based on current scientific and clinical studies and an analysis of the results of several years of clinical use. The main purpose of the consensus is to assist practitioners in prescribing effective prophylactic treatment of migraine using anti-CGRP mAbs and to improve care for patients with various forms of the disease. 

Diagnosis and treatment of migraine: Russian experts' recommendations

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

[Migraine burden and clinical inertia: what can we do?]

AIM

To study the compliance of neurologists and headache specialists to chronic headache and chronic migraine (CM) diagnosis and treatment guidelines.

MATERIAL AND METHODS

The survey included 634 neurologists from all regions of the Russian Federation. Mean age of respondents was 40.7±8.5 years, mean years of experience 14.2±7.8 years.

RESULTS

Most doctors work in outpatient or hospital settings (49% and 24%, respectively), 7% were headache specialists. Tension-type headache (TTH) was diagnosed in 30% and CM in 17% of patients while 44% of patients were presumed to have a mixed headache disorder (TTH+CM). Only 10% of physicians do not use instrumental diagnostic methods in chronic headache. This study has shown sufficient attention to comorbid conditions and frequent prescription of headache preventative treatment. Botox prescription data is equivocal: 35% of physicians recommend such treatment, 27% do not, while other doctors prescribe it for off-label indications.

CONCLUSION

To overcome clinical inertia, further education in chronic headaches and their optimal treatment is warranted.

['Point of no return' in diabetic neuropathies: a dangerous delusion]

Polyneuropathy in patients with diabetes mellitus is manifested by a lesion of peripheral sensory, motor and autonomic nervous system. Different severity of damage of sensory, motor and autonomic fibers in typical and atypical forms of diabetic polyneuropathy, requires a differentiated approach to therapy, but not the rejection of its implementation. In an interdisciplinary consensus, consultations are held with physicians from different regions of the Russian Federation, and modern methods of diagnosing and assessing the severity of diabetic polyneuropathies, which determine the algorithm for treating patients, are discussed.

[Efficiency of post-stroke rehabilitation measures at hospital: quantitative analysis of motor function recovery]

BACKGROUND

Mobility recovery is one of the main purposes of physical rehabilitation after acute stroke and in a number of other neurological diseases.

AIM

To quantify the efficiency of rehabilitation measures in patients after stroke and to compare the effectiveness of motor function restoration in patients in the acute phase of stroke and in the early recovery period.

METHODS

Examinations were made in 116 patients aged 27 to 88 years who had experienced a stroke (75% of ischemic stroke cases) and been admitted to the Department of Medical Rehabilitation. A control group consisted of 111 sex- and age-matched patients who had suffered a stroke (86% of ischemic stroke cases) and been admitted to the Department of Neurology for patients with acute cerebrovascular accident. The methods of working with patients included a clinical interview and an evaluation of complaints and history data, as well as a classic neurological examination using quantitative scales to assess symptoms, degree of disability and mobility.

RESULTS

The cycle of rehabilitation measures provided the following quantitative recovery indicators: the strength scale showed recovery indicators (from 0 to 5 scores) by an average of 1 score in both groups; Ashworth's scale scores for spasticity improved by an average of 1 in the Department of Rehabilitation; the average Rankin scale demonstrated 1 score better in both groups; and the Rivermead mobility index improved by an average of 3 scores in the Department of Rehabilitation and by an average of 8 scores in the Department of Neurology for patients with acute cerebrovascular accident.

CONCLUSION

The investigation demonstrated the quantitatively best indicators in patients with acute stroke, in those with more severe motor deficits, and in younger individuals.

[An impact of affective and cognitive impairment on the quality of life in patients with lymphoproliferative diseases]

AIM

To assess the neurological and cognitive status, identify the frequency of anxiety and depression in patients with lymphoproliferative diseases, and analyze their impact on the quality of life of patients.

MATERIAL AND METHODS

Fifty-eight patients, including 35 (60.34%) men and 23 (39.66%) women aged from 42 to 86 years, with a diagnosis of chronic lymphocytic leukemia (CLL) or multiple myeloma (MM) were examined. Clinical and anamnestic methods, the Montreal scale of cognitive function assessment, the Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Cancer Therapy-General (FACT-G) were administered.

RESULTS

Cognitive impairment was observed in 44 (75.86%) patients. Thirty-two (56.14%) patients had no symptoms of depression, clinically diagnosed depression was observed only in 8 (14.04%). In 37 (64.91%) patients, there were no symptoms of anxiety, clinically diagnosed anxiety was revealed in 6 (10.53%). The average score on the FACT-G scale for quality of life was 62.72±23.29 with a maximum score of 108.

CONCLUSION

Cognitive impairment was observed in a large number of patients. Symptoms of depression were found in less than half of the patients, and manifestations of anxiety were found in one third. The presence of affective disorders, such as anxiety and depression, reduced quality of life evaluated in all its modules.

[Depression and depression-related disorders after a subarachnoid hemorrhage]

Psychiatric disorders often develop after subarachnoid hemorrhage (SAH); the most frequent of them are depression and depression-related disorders (anxiety, apathy, pathological fatigue, posttraumatic stress disorder, etc.). Both biological and psychological mechanisms may underlie the development of these disorders. Depression and depression-related disorders decrease patients' quality of life and prevent the full recovery after SAH. Identification and correction of these disorders should take a prominent place in the rehabilitation of post-SAH patients. More research is needed in this area.

[Pathological fatigue and fatigability after stroke]

AIM

To compare the phenomena of pathological fatigue and fatigability in patients after stroke.

MATERIAL AND METHODS

Forty-two patients were examined 6-24 months after stroke onset. Fatigue and fatigability were assessed by Russian versions of the Fatigue Assessment Scale and the Dutch Exertional Fatigue Scale, respectively.

RESULTS AND CONCLUSION

The severity of both fatigue and fatigability was related to the levels of anxiety and depression. The degree of fatigability, but not fatigue, depended on the severity of cognitive and physical deficits. Thus, fatigue and fatigability after stroke represent different phenomena.

[The early post-stroke mobilization]

Early mobilization is an important prerequisite for the successful recovery after stroke. However, it is unclear at present how early mobilization should be started after stroke. Three randomized controlled trials were devoted to the comparison of the effectiveness and safety of very early (within the first day after stroke) and early (within two days after stroke) mobilization. The meta-analysis of the results of these studies did not reveal any advantages of very early mobilization over early mobilization. One randomized control study was designed to compare the consequences of mobilization within 3 and 7 days after stroke. It has demonstrated that earlier mobilization is associated with fewer complications and does not exert negative effect on cerebral haemodynamics. A number of observational studies confirmed the positive effect of early mobilization on the outcome of stroke. It is concluded that it may be justified to start mobilization on the second day after stroke provided there are no contraindications to such modality. The practicability of very early mobilization remains to be elucidated.

[Impairment of attention in post-stroke fatigue and depression]

OBJECTIVE

To study the relationship between impairment of attention and development of pathological fatigue and depression after non-disabling stroke.

MATERIAL AND METHODS

Thirty patients were examined. Attention was assessed by the Attention Network Test (ANT). Pathological fatigue and depression were assessed by the Fatigue assessment scale and depression subscale of the Hospital Anxiety and Depression Scale, respectively.

RESULTS AND CONCLUSION

The association between the severity of depression and fatigue after stroke and reduction of mean reaction time in ANT was found. A decrease in the reaction time may be one of the factors reducing working ability in patients with post-stroke fatigue and depression even in the absence of severe neurological deficit. This has to be taken into account when planning rehabilitation.

[Delirium in the clinical practice of a therapist]

Delirium is a neuropsychiatric condition that may complicate any visceral disease. Its rate is especially high among patients with inflammatory diseases or metabolic disturbances and in the elderly. Brain injury concurrent with an abnormal stress response underlies the development of delirium. The clinical picture of delirium is characterized by clouding of consciousness accompanied by global cognitive and behavioral changes. According to the nature of changes in motor behavior, delirium is divided into hyperactive, hypoactive, and mixed subtypes. Special scales, such as Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), are used to identify delirium. Management of delirium includes specific therapy for the underlying disease and adequate care. Low-dose neuroleptics, haloperidol in particular, are recommended to correct behavioral changes.

[Confusion assessment method for intensive care unit (CAM-ICU)]

Delirium is a serious complication of disorders of nervous system and requires early detection for successful treatment. Confusion assessment method for intensive care unit (CAM-ICU) is a fast and reliable tool for detection of delirium. We performed screening for delirium among patients of neurological ward using CAM-ICU. Our experience showed that CAM-ICU could be used for the identification of delirium in neurological patients excluding those who suffer from severe aphasia.

[Posttraumatic stress disorder in patients after stroke]

Objective. To assess the frequency of main symptoms of posttraumatic stress disorder (PTSD) in post stroke patients. Material and methods. Forty-eight patients took part in the study. We used the Impact of Events Scale (IES) and other scales to assess the severity of posttraumatic stress. Results and conclusion. Thirty three percent of patients experienced posttraumatic stress, 12.5% suffered from PTSD. We found an association between the severity of posttraumatic stress after stroke and the level of anxiety, sleep disturbances and decrease of quality of life. Symptoms of posttraumatic stress are often observed after stroke, this needs to be taken into account during planning of rehabilitation programs.

[Delirium in the acute phase of stroke: frequency and predisposing factors]

Delirium is a common complication of stroke worsening its prognosis. In this work we have analyzed the frequency of delirium and factors, predisposing to its development in the population of Russian patients in hyperacute phase of stroke. Twenty two of 96 (around 23%) recruited patients revealed symptoms of delirium according to DSM-IV criteria. Patients of older age, those with severe stroke, with prominent chronic cerebral changes on brain CAT scan, with fever, those with urine catheter and with positive snout reflex were more likely to develop delirium. Severity of posterior leucoareosis was the only independent predictor of delirium according to multivariate analysis.

[Randomized blind placebo-controlled study of the effectiveness of transcutaneous adaptive electrostimulation in the treatment of nonspecific low back pain]

The effectiveness of dynamic transcutaneous electrostimulation was compared to its imitation in patients with low back pain. Patients were randomized into two groups: 21 patients were treated with transcutaneous electrostimulation and 21 patients received placebo. Patients had one session of electrostimulation (20 minutes) daily during 7-10 days. Pain was assessed by the Visual Analogous scale (VAS) daily. The Oswestry Low Back Pain Scale, the Beck Depression scale and the Spilberger-Khanin Anxiety test were used as well before and after the treatment. The significant improvement on the VAS (p=0,048) and the Oswestry scale (p=0,047) was found in the main group compared to the placebo one. No side-effects of transcutaneous electrostimulation were observed.

[Quality of life of patients with primary headaches, strokes and myotonic dystrophy]

Results of the first comparative study using a Russian validated version of the Medical Outcomes Study Short Form-36 (MOS SF-36) are presented. Two hundreds and seventy-four patients with several neurological disorders - primary cephalgias (124 patients), strokes (120) and myotonic dystrophy (30) were examined. A remarkable decrease of quality of life (QOL) in all groups as well as between-group differences on QOL domains (physical, psychological, social and others) were observed. These data might serve as a basis of support programs for patients.

Free Radical Oxidation in Rat Brain during Chronic Stress and Pharmacological Regulation of This Process

We studied free radical oxidation in the brain and blood serum from experimental animals exposed to chronic stress and receiving psychotropic drugs (phenazepam, Atarax, Fluanxol, and valerian). Chronic stress was accompanied by activation of free radical oxidation, which could be modulated by psychotropic drugs.

[Glycosaminoglycans and their fractions in patients with hereditary neuromuscular disorders]

Hereditary neuromuscular disorders (HNMD), with population incidence 1:3000, are characterized in most cases by progressive course and treatment resistance and patient's disabling. To study the involvement of the tissue-connecting structures in the pathogenesis, glycosaminoglycans and their fractions were determined in blood serum. The test group involved 40 patients with hereditary myotonia, myodystrophy, neuropathy and spinal muscular atrophy and control one consisted of 27 healthy age- and sex-matched subjects. The study was conducted using anion exchange chromatography on DEAE-cellulose. Comparing to controls, significant increase of total glycosaminoglycans and decrease of gilauronic acid fraction (p < 0.05) were found in HNMD patients, with no differences being detected between nosologic entities. Reverse correlation (r = -0.46) was revealed between patient's age and glycosaminoglycans concentration in blood serum. We concluded on intracellular and intercellular matrix heteropolyglycans metabolism dysregulation in the patients and suggested a part of HNMD pathogenesis scheme.

[Analysis of expansion of the triplet repeat (CTG)n in myotonic dystrophy patients from Bashkir]

A method was elaborated for simple and rapid diagnosis of myotonic dystrophy (MD). The method consists in estimating expansion of the CTG repeat in the myotonin protein kinase gene by means of PCR amplification of a gene fragment from genomic DNA and Southern hybridization of the amplified fragments with probe (CTG)9. Bashkir patients with Rossolimo-Steinert-Batten-Kurshmann MD were examined with this method.