Rare Clinical Case of Cryopyrin-Associated Periodic Syndrome Presented with Ankylosing Spondylitis: A Case Report

BACKGROUND

Cryopyrin-Associated Periodic Syndrome (CAPS) is a variety of clinical variants of autoinflammatory diseases. The pathology is based on a mutation in the NLRP3 gene encoding the cryopyrin protein, which leads to the uncontrolled production of interleukin-1β. Particular attention should be paid to the rarity of this disease and the lack of clinical knowledge about it in therapeutic and rheumatological practice, which leads to an erroneous diagnosis and the appointment of ineffective treatment for a long time, leading to the progression of the disease and disability of the patient.

CASE PRESENTATION

This article describes a clinical case of this disease. The first manifestations of the disease in a woman appeared from the age of 2 years, in the form of a rash and fever. Since school age, there have been signs of arthritis. By the age of 24, sensorineural hearing loss and pain in the spine were evident. The disease occurred under the clinical manifestations of spondyloarthritis. Its treatment with anti-inflammatory therapy did not give a stable result.

CONCLUSION

From the analysis, we can conclude that patient M. from early childhood suffers from a severe Neonatal-onset Multisystem Inflammatory Disease of a genetic nature. For a long time, the patient was diagnosed with ankylosing spondylitis, and appropriate treatment was carried out without significant success. The correct diagnosis of CAPS was made only in 2018. This patient has conditions of both CAPS and AS together, which is a very rare association in rheumatological practice. The only treatment method that could stop the manifestations of the disease and prevent life-threatening kidney damage (amyloidosis) is the use of genetically engineered biological drugs, i.e., IL-1β inhibitors. The only drug of this group registered in Russia is canakinumab (Ilaris ®). From the moment of diagnosis to the present day, the patient is treated with the genetically engineered drug canakinumab (Ilaris ®) at a dose of 150 mg once every 8 weeks. 6 months after taking the drug, the patient went into complete clinical and laboratory remission.

[Comparison of premorbid personality and psychopathological structure of some anxiety-affective disorders]

OBJECTIVE

To compare premorbid personality and structure of psychopathological status of organic anxiety-depressive disorder in comparison with endogenous depression and anxiety neurotic disorders.

MATERIAL AND METHODS

One hundred and twelve patients, including 57 with organic anxiety-depressive disorder (OADD), 41 with endogenous depression (ED) and 14 with anxiety neurotic disorder (AND) were studied. have been included into the study. The Munich personality test (MPT) and Toronto alexithymia scale (TAS) were used for the evaluation of premorbid personality. Psychopathological structure was assessed with SCL-90. The correlation between premorbid personality and current structure of psychopathological states was studied.

RESULTS

OADD patients were characterized by higher scores of frustration tolerance, rigidity and isolation tendency and less expression of neuroticism, esoteric tendencies and motivation compared with ED. In the AND patients, the values of neuroticism and motivation predominated compared with OADD, while the value of frustration tolerance was higher in OADD. A correlation analysis revealed the strong positive relationships of alexithymia, neuroticism and isolation tendency with depression, anxiety, somatization, obsessions and sensitivity in AND group.

CONCLUSION

The comparison of correlations between OADD and ED revealed no significant differences. It implies the similarity in the pathogenesis of OADD and ED.

[Aged changes of dynamic component of the vertical stability in women 60-74 years old.]

The article presents characteristics of the dynamic component of postural balance and its features in elderly women with postural deficit. The assessment of the dynamic component of postural balance was performed on a computer stabilometric complex «Balance Manager» in women aged 60-74 with and without a history of falls. The most significant changes are manifested by an increase in the time of implementation and a decrease in the effectiveness of performing complex motor acts. In the factor structure of indicators of the dynamic component of postural balance in postural deficit, the leading factor is the factor that characterizes speed and power indicators in the implementation of complex motor acts. The study of the dynamic component of postural balance is recommended to be included in the comprehensive diagnosis of walking disorders in the elderly and in evaluating the effectiveness of treatment and rehabilitation measures.

[The changes in cognitive impairment in patients with epilepsy during the disease course (on example of executive functions)]

AIM

To identify the relationship between executive functions (EF), personality traits and clinical characteristics of disease course.

MATERIAL AND METHODS

One hundred and five patients with partial epilepsy, including temporal lobe epilepsy (61%), lobe epilepsy (33%) and other forms (6%), were examined. Mean age of the patients was 30.24±8,67 years. EF were studied using the the Wisconsin Card Sorting Test (WCST) in 25 out of 105 patients of the main group. The patients were followed-up after 5.5 years.

RESULTS

Correlations between the EF decline and the age, illness duration and disability was found. Seizure remission and its duration have a positive effect on EF indices. There were no correlations with the age at seizure onset, severity of seizures, amount of medications used, psychopathological symptoms and left-handedness. The WCST scores were worse in patients with temporal lobe epilepsy and patients with alexithymia. A follow-up examination showed the relationship between the further EF decline and the left-sided localization of the epileptic focus as well as the absence of seizure remission. No relationship between the EF deficit and antiepileptic treatment was found.

CONCLUSION

The EF deficit was observed in all forms of epilepsy, it was correlated with disability of patients, may be aggravated by personality and neurobiological characteristics and increased with the persistence of seizures. Based on the results of the study, the achievement of remission is needed in treatment tactics for epilepsy to preserve cognitive functioning and social well-being of patients.

[Features of invariant recognition of visual objects in preschool children with typical and atypical development]

We studied the ability of invariant recognition of the form of visual images concerning color, size and location of the image in 5-6 year-old children with typical and atypical patterns of development. It was found that the children of this age with typical development are able to identify the invariant form of a visual object regardless of any changes in its color, size or location. Children with neurodevelopmental disorders have difficulties with identifying the form of a visual object when its location is changed among a large number of figures. In children with early infantile autism, we observed different degrees of visual perception deficit. Children with milder forms of autistic disorders have difficulties only with recognizing the forms of an image when its location is changed; children with more severe forms of disorders, we observed serious disability of invariant recognition regardless of the color, size and location of images.

[Spatio-Temporal Bioelectrical Brain Activity Organization during Reading Syntagmatic and Paradigmatic Collocations by Students with Different Foreign Language Proficiency]

Texts or words/pseudowords are often used as stimuli for human verbal activity research. Our study pays attention to decoding processes of grammatical constructions consisted of two-three words--collocations. Russian and English collocation sets without any narrative were presented to Russian-speaking students with different English language skill. Stimulus material had two types of collocations: paradigmatic and syntagmatic. 30 students (average age--20.4 ± 0.22) took part in the study, they were divided into two equal groups depending on their English language skill (linguists/nonlinguists). During reading brain bioelectrical activity of cortex has been registered from 12 electrodes in alfa-, beta-, theta-bands. Coherent function reflecting cooperation of different cortical areas during reading collocations has been analyzed. Increase of interhemispheric and diagonal connections while reading collocations in different languages in the group of students with low knowledge of foreign language testifies of importance of functional cooperation between the hemispheres. It has been found out that brain bioelectrical activity of students with good foreign language knowledge during reading of all collocation types in Russian and English is characterized by economization of nervous substrate resources compared to nonlinguists. Selective activation of certain cortical areas has also been observed (depending on the grammatical construction type) in nonlinguists group that is probably related to special decoding system which processes presented stimuli. Reading Russian paradigmatic constructions by nonlinguists entailed increase between left cortical areas, reading of English syntagmatic collocations--between right ones.

[Features of memory and intellectual activity among the elderly with different reading productivity]

The aim of this work was the study of indicators of memory and intellectual activity among the elderly with different reading productivity. The results of the study showed that the elderly were distinguished by a greater number of errors when performing tasks on oral-aural, visual memory and visual-spatial activities. The mistakes made by subjects with low reading productivity may indicate dysfunction of tone and wakefulness, of receiving, processing and storing information, as well as weakening of hemispheric interaction.

[Features of detection of the general direction of movement of visual objects at children of preschool age with typical and atypical development]

It is investigated the specificity of functioning of the two pathways for visual processing--magno- and parvocellular, in solving the problem of recognition of moving objects preschool children in the norm and in case of violation of development normal and impaired development. It is shown that in children with disorder autistic spectrum, complicated by mental retardation and learning disabilities, there is a lack of functioning of the higher levels of magno- and parvocellular pathways of visual processing, related to the violation of the direction of the evaluation mechanisms for the temporal and spatial characteristics of objects. Thus the severity of the deficiency is correlated with both severity of neurological disorders, as the speech level and child development.

[Bioelectrical brain activity during visual perception of verbalized and non-verbalized stimuli in 7-8 year-old schoolchildren]

Neurophysiological mechanisms of visual perception of verbalized and non-verbalized stimuli have been studied in girls (n = 89) and boys (n = 109) aged 7-8 years. It has been shown that in children of this age neurophysiological mechanisms of the visual perception system during choosing verbalized and non-verbalized stimuli have a similar organization of functional rearrangements and are characterized by generalized involvement of cortical areas and by the lack of clear specialization of the cerebral hemispheres. However, the choice of non-verbalized visual stimuli is characterized by a more pronounced generalization of the functional interaction between cortical areas and by an increased spectral power of EEG high-frequency components in anterior associative areas. The increased spatial synchronization in EEG theta and beta bands in the frontal areas emphasizes the contribution of these structures to the analysis and processing of visual stimuli at this stage of development. Differences in neurophysiological mechanisms of visual perception in boys and girls have been detected. Spatial and temporal organization of BEA of the brain in girls performing visual tasks is characterized by a stronger and more varied ipsi- and contralateral statistical relationships in the fronto-occipital direction and displacement of interaction centers into the left hemisphere. In boys perceiving verbalized and non-verbalized visual stimuli a greater contribution of postcentral cortical areas has been observed. The detected differences are regarded as reflecting a greater maturity of identification mechanisms in girls aged 7-8 years as compared to boys.

[Personality and neurobiological factors as predictors of treatment efficacy in patients with partial epilepsy]

In the present study, we attempted to find predictors of the response to antiepileptic treatment with the adjustment for individual constitutional characteristics of patients including the profile of hemispheric asymmetry (right- and left handedness), premorbid personality, predisposition to affective and other mental disorders. We administered a large battery of tests (MMSE, HAM-A, HAM-D, TAS-26 and others). Treatment efficacy was assessed by the degree of seizure frequency reduction and remission duration. Two groups of patients, with 100% reduction of seizures after 12 months of treatment with antiepileptic drugs and with the absence of reduction of seizures, were singled out. It has been shown that left-handedness, cognitive impairment in right-handers, alexithymia and affective disorders in left-handers predict poor treatment efficacy.

Functional maturity of brain structures in children aged 7-8 with differing levels of speech development

First graders (aged 7-8) in a public elementary school served as subjects for this study. The structural components of their speech were analyzed to determine speech maturity level; total EEG activity was analyzed to assess the functional maturity of brain structures. Results showed that children with levels of speech below the age norm exhibited abnormal EEG patterns suggesting immaturity of the cerebral cortex and fronto-thalamic regulatory system, as well as impairments in the functioning of the mesodiencephalic structures and nonspecific activation systems. Abnormalities in the functioning of brain regulatory systems and the presence of local abnormalities in EEG activity of deep origin are important factors in determining the severity of functional speech impairments.

[Anticonvulsant and psychotropic effects of topamax capsules]

Anticonvulsant and psychotropic effects of "Topamax capsules"(TC) were compared to a traditional form of topiramate (TFT) and some other anticonvulsant drugs (ACD). Thirty-six patients (12 men and 24 women) with partial temporary epilepsy were examined. Sixteen patients received TFT in tablets and 20 patients received ACD before the beginning of the study. Drug effect was assessed by frequency of seizures and some neuropsychiatric parameters. The results revealed that TC was comparable to TFT and ACD in the reduction of seizures of any semiotics. After 3 months of therapy, total MMSE scores increased from 27 to 28. There were less perseverant errors and more right responses in the WCST. Verbal fluency and memory measured with Sunderland test improved as well. TC led to decreased latencies of negative responses in the WCST and increased verbal fluency compared to TFT. Patients who received TFT prior to TC did fewer errors in the WCST than patients who received ACD prior to TC. Verbal fluency improved compared to patients who received other ACD. At the same time, a somewhat increase of paranoid signs on the scale SCL-90 was noted in the group treated with topiramate only. It has been concluded that TC has an activating effect on frontal brain areas.

[Psychotropic and cognitive effects of topiramate in the treatment of epileptic patients]

To study a character of topiramate (TPM) effect on psychopathological and neurocognitive processes in patients with temporal partial epilepsy, 83 patients (33 men and 50 women, mean age 29.1 +/- 10.6 years) were examined. Fifty-three patients were diagnosed with temporal cryptogenic epilepsy and 20 with temporal symptomatic epilepsy. Thirty-three patients received TPM (124 +/- 35.6 mg daily), 26--carbamazepine (819 +/- 274.2 mg daily), 15--phenobarbital (154.6 +/- 95.1 mg daily) and 11 patients received no therapy. The statistically significant difference between the groups treated with TPM and phenobarbital were found only for cognitive traits (total MMT scores, total scores on the executive functions scale, latencies of positive and negative answers in WCST, verbal fluency). TPM was more effective than phenobarbital for all traits, with the exception of verbal fluency. The comparison of patients by some parameters before and during the treatment with TPM revealed the favorable effect of the drug in the reduction of obsessive symptoms, aggressiveness and social isolation on the SCL-90 as well as higher scores on the executive functions scale and the lower latency of positive answer in WCST. The monotherapy with TPM leads to the improvement of executive functions, reduction of aggressive and obsessive symptoms that may be explained by the improvement of prefrontal brain function in epilepsy.

[Monotherapy of epilepsy in women: psychiatric and neuroendocrine aspects]

An aim of the study was a comparative evaluation of efficacy and safety of traditional and modern antiepileptic drugs in women of reproductive age. A main group of patients consisted of 65 women, including 48 patients with partial epilepsy and 17 - with idiopathic generalized epilepsy. Some issues are solved in the study of a larger group comprising 110 patients (65 female and 45 male). The following drugs have been studied: topamax, valproates, carbamazepines and barbiturates. All of them were used as a monotherapy. Patient's state was assessed using clinical, neuropsychological and hormonal parameters. A general conclusion is that topamax is most beneficial, comparing with other drugs studied, in the treatment of women with epilepsy.

[Comparison of efficacy of trileptal (oxcarbazepine) and carbamazepine in the treatment of temporal epilepsy]

An aim of the study was to compare the spectrum of effects of oxcarbazepine and carbamazepine in patients with partial temporal epilepsy. Seventy-two patients (24 men and 48 women) diagnosed with cryptogenic partial epilepsy have been examined. Fifty-one patients received carbamazepine as a monotherapy in dosage 300-1200 mg/day, 21 patients were treated with oxcarbazepine in dosage 600-1500 mg daily. The results revealed the similar effects of two drugs. However some differences were also found: the effect of oxcarbazepine on complex partial seizures was more pronounced comparing to carbamazepine. These differences became evident after the first month of therapy and were related only with part of the reduction of complex partial seizures after 1, 2, and 3 month of therapy. The highest levels of significance for these differences for the complete reduction of complex partial seizures (a control over seizures) were observed after 2 and 3 months of therapy. During the therapy, oxcarbazepine was more effective than carbamazepine in the reduction of refractory complex partial seizures. In conclusion, oxcarbazepine can be considered as a drug of choice in the treatment of complex partial seizures in patients with partial epilepsy.

[A use of Magne-B6 in the treatment of anxiety-depressive states in patients with epilepsy]

Magne-B6 was used, together with anticonvulsive therapy, in the treatment of 25 patients with different forms of epilepsy. In all cases, psychiatric status of patients featured by depression, anxiety and some psychotic sighs. The drug was prescribed in the mean therapeutic dose during 28 days. Along with psychopathologic examination, a psychometric method, using self-rating scales for Zung anxiety and depression scale, SCL-90 and Global clinical impression (CGI) scale, was administered. Magne-B6 exerted a positive non-specific influence on patient's mental state, especially with regard to affective disorders. The positive effect of the drug emerged on 14th day of the treatment and achieved a statistically significant level to 28th day. The medication was more effective in asthenic and subdepressive syndromes, in encephalopathic syndrome the efficacy was lower. The drug was well tolerated and did not cause any side effects.

[Topamax monotherapy of partial epilepsy]

Thirty patients diagnosed with partial epilepsy (PE): 17 cases with cryptogenic PE, 11--with symptomatic PE and 2--with symptomatic generalized PE, have been switched to topamax monotherapy, in dosage 50-200 mg daily, for 3 months. A type of seizures--simple partial, complex partial and secondary generalized, was taken into account, when considering topamax efficacy. A complete elimination of seizures was achieved after 3 months treatment in 80% of the cases, the mostly pronounced effect being demonstrated for secondary generalized seizures. A decrease of seizures frequency was shown for all types, but in simple partial and secondary generalized seizures the effect emerged earlier (after 1 month of the treatment) comparing to complex partial seizures. Good tolerability of topamax was observed.

[From physiological theory to psychological facts (on the centenary of I. P. Pavlov's speech in Madrid)]

Pavlovian theory of conditioned reflexes and Ukhtomsky's theory of dominanta are considered as the most important biological concepts of the XX century. They have laid the foundation of the modern views of the adaptive and active character of the nervous activity underlying the integral behavior in the environment. Approach to a burning problem of neurophysiological mechanisms of goaldirected behavior is impossible without a comprehensive study of works of both these schools. They have formed not only the methodological basis of modern investigations but opened a new avenue of attack.

[Topamax in the treatment resistance partial epilepsy]

Twenty-five epileptic patients, mean age 25.7 years, have been studied. Twenty-two of them were diagnosed with symptomatic partial epilepsy, 1--with criptogenic partial epilepsy and 2--with idiopathic partial epilepsy. Illness duration was estimated as follows: above 5 years--5 patients, above 10 years--10, above 20 years--4 and less than 5 years--6. Polymorphic seizures were detected in 56% of the cases and monomorphic ones, resistant to the previous traditional anticonvulsant therapy,--in 44%. Topamax was used as an add-on therapy to the previously prescribed anticonvulsants in initial dose of 25 mg daily, with a following continuous dose increase. The mean therapeutic dosage was 100 mg daily. Therapeutic efficacy was assessed during 3 months. Since 1 month of topamax adjunction to a treatment schedule, a mean frequency of all types of seizures was reduced. The best effect was found in the case of combination of simple partial and secondary generalized seizures. The medication was effective in 60-80% of the patients with strong resistance to traditional anticonvulsants. Topamax is concluded to be a highly effective antiepileptic medication, which gives new possibilities for a treatment of patients with partial epilepsy resistant to traditional drugs.

[Cerebral mechanisms of behavior and higher mental functions]

The paper is dedicated to the 50th anniversary of the Department of Higher Nervous Activity and Psychophysiology at St.-Petersburg State University.

[A. A. Ukhtomskiĭ and I. P. Pavlov: a controversy or a dialogue?]

Pavlov's concept of conditioned reflexes and Ukhtomskii theory of dominanta fall within the biological line in physiology. They unravel the integral adaptive and active nature of the organism behavior in the environment. It is impossible to develop modern concepts about the determinants of goal-directed behavior of animals and voluntary activity of humans without in-depth study of the achievements of these Russian physiological schools which not only formed the methodological basis for the current studies but also directed the way for their further development.

[Depakine syrup in the treatment of therapy-resistant epilepsy]

Depakin syrup was given for several weeks in initial dose 300 mg/day with graded increase of the dose to 1200 mg/day to 11 patients aged 15-39 suffering from epilepsy and residual-organic affection of CNS with epileptic syndrome. A complete or partial discontinuation of the fits was achieved in 82% of the patients, primarily in those with partial and primary-generalized fits, partial fits with secondary generalization. It is concluded that depakin syrup treatment is justified in management of epilepsy, especially in the treatment-resistant cases.

[Use of bronchovaxom in the treatment of patients with chronic obstructive bronchitis and bronchial asthma]

Polyvalent vaccine bronchovaxom (BV) was studied for efficacy against chronic obstructive bronchitis and bronchial asthma exacerbation. Good results were reported: reduction of disability duration, number of recurrences, cough intensity, discharged sputum. Laboratory tests discovered that BV brought about IgE decrease, IgA, T3, T4/T8 increase in bronchoalveolar lavage.

Microbiological 1,2-dehydration of microcrystalline epihydrocortisone and its 21-acetate

A method is described for obtaining epiprednisolone and its 21-acetate by means of microbiological 1,2-dehydration by a culture of Mycobacterium globiforme 193. The substrate, epihydrocortisone or its 21-acetate, is added in the form of a microcrystalline suspension at a concentration of 25-100 g/liter medium.

[Proliferative activity of Shvetz tumor following single and repeated irradiation]

Autoradiographic study of an experimentally-induced tumour following local irradiation in a dose of 600 rad showed no retardation of the cell cycle 6 to 12 hours after the irradiation. Marked reduction of the mitotic index (MI) and of the labeled nuclei index (LNI) was noted to the 96th hour after the irradiation. In repeated irradiation in a dose of 1200 rad at an interval of 18 hours there was revealed a marked reduction of the MI and of the LNI as a result of the block of the passage of cells from the G1-period into S. However, restoration of the cell proliferation uas noted by the 24th-48th hours. A high MI revealed at all the periods of investigation after repeated tumour irradiation at an interval of 24 hours was possibly caused by an increase in the time of mitosis proper, this also being confirmed by a significant accumulation of the number of late mitotic phases.