Цель — представить опыт диагностики и лечения 43 больных с неврологическими проявлениями первичного антифосфолипидного синдрома (АФС), в том числе одного случая катастрофического АФС, за 10-летний период наблюдения.
Материалы и методы. С 2001 по 2011 год в неврологическом и акушерско-гинекологическом отделениях 5-й больницы г. Минска наблюдали 43 пациента (25 женщин, 18 мужчин, средний возраст — (38,7 ± 8,5) года) с неврологическими нарушениями, обусловленными первичным АФС. Диагноз подтвержден лабораторными исследованиями, проведенными в Республиканском научно-практическом центре гематологии и трансфузиологии (Минск). Определяли: 1) волчаночный антикоагулянт стандартными методами; 2) антикардиолипиновые антитела класса IgG методом твердофазного иммуноферментного анализа; 3) антитела к b2-гликопротеину I класса IgG методом твердофазного иммуноферментного анализа.
Результаты. Установлено, что наиболее частыми проявлениями АФС являются инфаркты мозга (62,7 %) и транзиторные ишемические атаки (13,9 %). Выявлены их отличительные особенности. К более редким неишемическим проявлениям АФС относились мигрень (9,3 %), эпилепсия (4,7 %), паркинсонизм (2,3 %), хорея (2,3 %), полиневропатия (2,3 %) и миодистрофия (2,3 %). Представлен случай катастрофического АФС, проявляющийся множественными тромбозами (головной мозг, легкие, почки). Полученные результаты согласуются с мнением большинства исследователей о том, что нарушения мозгового кровообращения — это наиболее частые неврологические проявления первичного АФС, доля которых в структуре симптомов заболевания может достигать 60—90 %. Механизм развития тромбозов при АФС связан со способностью антифосфолипидных антител вмешиваться в различные звенья коагуляционного каскада. Общепринятым является мнение, что основа терапии АФС — длительный прием непрямых антикоагулянтов под контролем международного нормализованного отношения. В серии наших наблюдений применяли варфарин в дозе 5,0—7,5 мг/сут в течение 5—6 мес, а при повторных нарушениях — пожизненно. В острый период инфаркта мозга считаем оправданным инфузионное введение гепарина либо фраксипарина. При высокой иммунологической активности АФС в комплекс лечения включали глюкокортикостероиды.
Выводы. Несмотря на то, что диагноз АФС возможно заподозрить клинически, неврологические нарушения не могут служить достаточным основанием для постановки этого диагноза. Окончательное заключение может быть сделано только после получения результатов лабораторного исследования о наличии в титре хотя бы одного из типичных для АФС антител, предусмотренных современными классификационными критериями.

Keywords: антифосфолипидный синдром, диагностика, лечение.

Stroke is an age-related disease, therefore it usually occurs on the ground of preexisting somatic pathology that is capable of influencing the course of stroke, level of neurological functions’ recovery, effectiveness and rate of rehabilitation, and it leads to increase of direct an indirect costs of treatment of patients after stroke. The current review covers the results of recent studies concerning associations of comorbidity with the risk and consequences of acute cerebral blood flow disturbances, their clinical and pathophysiological rationale is presented.

Keywords: somatic pathology, cerebral stroke, risk, course, consequences.

Инсульт является возраст-зависимым заболеванием, поэтому, как правило, возникает на фоне существующей соматической патологии, которая может влиять на его течение, степень восстановления неврологических функций, эффективность и скорость реабилитации, что обусловливает увеличение прямых и непрямых расходов на лечение пациентов, перенесших инсульт. В статье рассмотрены результаты исследований последних лет относительно связи коморбидности с риском и последствиями острых нарушений мозгового кровообращения, приведено их клиническое и патофизиологическое обоснование.

Keywords: соматическая патология, мозговой инсульт, риск, течение, последствия.

Parkinson's disease (PD) is an age-dependent neurodegenerative disorder, affecting 1–2 % persons aged over 60 years. Geometrical progressive increase of disease incidence due to population ageing is expected in future decades. The review of current data of PD treatment with dopamine receptor agonists has been performed. The whole spectrum of approved medications of the class, comparative meta-analyses data with different medication role in different PD stages is presented. Adverse events for whole group and its comparison for specific medication is also presented.

Keywords: Parkinson's disease, treatment, dopamine receptor agonists.

Parkinson's disease (PD) is an age-dependent neurodegenerative disorder, affecting 1–2 % persons aged over 60 years. Geometrical progressive increase of disease incidence due to population ageing is expected in future decades. The review of current data of PD treatment with dopamine receptor agonists has been performed. The whole spectrum of approved medications of the class, comparative meta-analyses data with different medication role in different PD stages is presented. Adverse events for whole group and its comparison for specific medication is also presented.

Keywords: Parkinson's disease, treatment, dopamine receptor agonists.

Болезнь Паркинсона (БП) является возраст-зависимым нейродегенеративным заболеванием, поражающим 1—2 % лиц в возрасте старше 60 лет. Из-за старения популяции в ближайшие десятилетия ожидают прогрессивное увеличение заболеваемости БП. В статье приведены современные данные, касающиеся лечения БП с применением агонистов допаминовых рецепторов, спектр препаратов, разрешенных для клинического использования в настоящее время, данные сравнительных метаанализов с характеристикой роли отдельных препаратов и возможностей их терапевтического влияния на разных этапах развития БП, информация о групповых и индивидуальных побочных явлениях данных препаратов в сравнительном аспекте.

Keywords: болезнь Паркинсона, лечение, агонисты допаминовых рецепторов.

The article deals with the headache types – migraine which affects 12–15 % of the world population. Epidemiology, pathogenesis, main clinical forms and modern management trends are presented in the article.

Keywords: migraine, migraine forms, migraine crisis phases, modern management trends.

Оbjective – to improve the spinal cord conductivity disorders diagnosis in patients with cervical spondylotic myelopathy (CSM) by means of transcranial magnetic stimulation (TMS).
Methods and subjects. Clinical and neurophysiologic (NPh) studies have been conducted in 160 patients with CSM, 60 % men and 40 % of women, with lesions mainly at the level of C4–C5, C5–C6 and C6–C7 segments. NPh studies have been conducted by means of electroneuromyography (ENMG) and TMS methods. 40 patients with CSM received surgical treatment, 120 patients underwent a course of pharmacotherapy and physiotherapy. The control group in the study consisted of 30 healthy men aged 22–55.
Results. In order to determine the level of partial spinal cord compression the data of NPh and MRI were compared. Patients with CSM have been found to demonstrate: prolonged cortical motor evoked potential (MEP) latency in 134 patients (83.7 %), elevated CMCT in 96 (60 %) compared with the control group. The level of MEP indicators change was significantly higher in the group of patients who had undergone surgical treatment (p < 0.05). The transcranial magnetic stimulation data in patient with TMS had diagnostic sensitivity 73–96 %, specificity – 50–74 %, diagnostic efficacy – 82.3 %, 82.4 % had latent period of cortical MEP from the upper extremities muscles. Statistical data assessment allows to recommend the applying of TMS data as with high informative value.
Conclusions. The application of TMS significantly increases the efficiency of diagnosis of motor disorders in patients with CSM; MEP has high sensitivity (96.1 %) and specificity (73.8 %). This medication also can be used for neuro monitoring of spinal functions.

Keywords: cervical spondylotic myelopathy, diagnosis, motor evoked potential, transcranial magnetic stimulation, central motor conduction time.

Objective – to study the changes of spontaneous and evoked brain’s bioelectrical activity among patients with type 2 diabetes mellitus.
Methods and subjects. The electroencephalography (EEG) and visual evoked potentials (VEP) were performed to 112 patients with type 2 diabetes mellitus (aged from 35 to 65 years old, mean – 55.2 ± 4.8 years). Control group included 40 people without diabetes mellitus. Types of EEG (after Zhirmunskaya) were determined. Latent periods and amplitude of VEP were assessed.
Results. Pathological EEG types – desynchronous, disorganized, strongly disorganized dominate among patients with diabetes mellitus. The severe gain of slow-wave activity was determined. Prolongation of latent periods of VEP late compounds and amplitude decline of all VEP compounds were established.
Conclusions. Significant neurodynamic disturbances are present among patients suffering from type 2 diabetes mellitus. They could indicate the cortico-subcortical connections disturbances.

Keywords: diabetes mellitus, electroencephalography, visual evoked potentials, neurodynamic disturbances.

Оbjectives – an estimation of development frequency of a sleep apnea syndrome and cardiorespiratory interrelations in patients with а diabetic encephalopathy (DE).
Methods and subjects. 106 patients suffering from diabetes mellitus (DM) have been examined: 26 patients with an autonomic dystonia syndrome; 42 – with DE I stage; 38 – with DE II stage. All patients were carried out clinical investigations, daily monitoring and registration of electrocardiogram and pneumograms parameters, investigation of the heart rhythm variability (HRV), condition of the cardiorespiratory synchronization, and pattern of acoustic brainstem evoked potentials (ABEV). Interrelation of these parameters was investigated.
Results. Correlation of HRV parameters and ABEV parameters, frequency and duration of sleep apnea&hypopnea and a body mass index, duration of sleep apnea/hypopnea and HRV parameters, ABEV parameters in patients with DE were revealed.
Conclusions. The sleep apnea&hypopnea syndrome was observed in 23.8 % patients with DE I stage and 39.5 % patients with DE II stage. One of the factors influencing the sleep breath impairments in patients with DE was disturbance of the central regulation respiration, which considered as one of early signs of the cerebrovascular disturbances. Correlations of sleep apnea/hypopnea duration and metabolic impairments due to DM were revealed.

Keywords: diabetes mellitus, diabetic encephalopathy, sleep apnea syndrome.

Objective – to study the metabolic syndrome (MS) influence on appearing and course of acute cerebral circulation disorders (ACCD).
Methods and subjects. 102 patients aged form 40 till 68 years with acute stroke have been examined, they were treated in the neurological department of Kyiv hospital #9. The main group comprised 88 patients with ACCD and MS, control group – 14 patients with ACCD (cardioеmbolic and atherothrombotic strokes) without overweight, diabetes and glucose tolerance disorders. Clinical and neurologic examinations were performed. The degree of neurologic disorders was estimated by means of NIHSS scale. MRI of brain was used to determine ischemic focus size, cysts number, lateral ventricle and convexus groove size.
Results. Principal neurological syndromes have been found out in patients with metabolic syndrome. Pyramidal, vestibular–ataxic and psychopathological syndromes prevailed. Cognitive impairments had mild and moderate degree of manifestation. On MRI there were leucoareosis and lacunar infarctions, which often are evidences of asymptomatic course of discirculatory encephalopathy patients with metabolic disorders. Such asymptomatic course during 7–10 years was a stroke predictor comparing with patients without metabolic disorders. Stroke in patients with metabolic disorders often is combined with kidney and heart affection and accompanied by quicker progressing of neurological disorders evolution of cognitive impairments.
Conclusions. The achieved data evidence that MS can be a stroke predictor at patients with MS and atherosclerosis manifestations comparing with patients presented with stroke consequences but without MS. Cerebral changes can not be found for a long time under the usual examination. But we can state that this period is much shorter comparing with patients after stroke without MS, normal pressure, less deviation of glucose level in blood, of lipidogram data, of rheological blood property and of body mass.

Keywords: stroke, metabolic syndrome, encephalopathy.

Objective – optimization of efficiency and safety of medication influence on a condition of central and cerebral hemodynamic at an ischemic stroke.
Methods and subjects. 76 patients in an acute period of an ischemic stroke with an arterial hypertension were examined, 37 of them received blocker calcium channels of the prolonged action Тiazak. On 1–2 and 18–19 days of a stroke transcranial dopplerography (Multigon 500 M) and definition of neurologic deficit degree was performed. On the basis of the achieved data the efficiency of influence blocker calcium channels on central and cerebral hemodynamic was estimated.
Results. Application of prolonged action diltiazem does not complicate a cardiac pathology at patients with an ischemic stroke and arterial hypertension. After the treatment target level of arterial pressure (below 140/90 mm Hg) was reached at 91.7 % of patients. Indicators of linear speed and circulator resistance mainly went down.
Conclusions. Application of prolonged action diltiazem leads to decrease of systolic and diastolic arterial pressure and allows to reach target level of pressure at more than 90 % of patients. Under the influence of treatment indicators of cerebral hemodynamic come nearer to levels of healthy people, the maximum effect of a preparation is revealed at people with initially high indicators of liner systolic blood flow speed.

Keywords: ischemic stroke, hypertension, cerebral hemodynamic, calcium channel blockers.

Objective – to determine and study the neuropsychological syndromes’ and psycho-vegetative disorders of brain correlation under interhemispheric cerebral functional asymmetry.
Methods and subjects. Higher psychological function were studied at 78 patients. 57 patients presented with cerebral stroke of hemispheric localization, 21 patients had hypertension without brain disorder manifestations. Among 57 patients 39 ones had right hemispheric stroke, 18 patients had left hemispheric stroke. Neuropsychological tests to study different types of praxis, healthy and hearing gnosis, memory, language functions and opticospatial activity were carried out by means of neuropsychological methods of O. Luria’s syndrome analysis.
Results. 18 (31.6 %) patients with left hemispheric stroke demonstrated anxiety, tensity, mobilizing, stress, diffusive memory decline, loss of interests, asthenization. 39 (68.4 %) patients with right hemispheric stroke also had neuropsychological disorders: passivity, mobilization absence, sensognostic phenomena. The correlation of neuropsychological disorders and anosognosia was revealed. Features of psycho-vegetative disorders are anxiety and vegetative sympathicotonia prevalence at 16 (28.1 %)patients with left hemispheric stroke and depression prevalence with elements of confabulation was observed at 36 (63.2 %) patients with right hemispheric stroke.
Conclusions. The following disorders were revealed in: dynamic, constructive and ideomotor praxis, healthy and hearing gnosis, memory, language functions and sensor integration which were non-systemic in nature. Investigation results evidence the correlation of neuropsychological syndromes and psycho-vegetative disorders under the interhemispheric cerebral functional asymmetry.

Keywords: neuropsychology, cognitive functions.

Objective – to improve the treatment results of patients with juvenile angiofibromas, based on the development of new approaches to treatment, using modern endovascular techniques.
Methods and subjects. The analysis of juvenile angiofibromas therapeutic embolization results was carried out. 24 patients aged 10–19 years (average age – 14 years) with juvenile angiofibromas were endovascular embolizated throughout 2002–2011. Male patients comprised 23 (95.8 %). The main investigation method for endovascular embolization administration was a selective angiography by Seldinger. Embolization was performed against the background of systemic heparinization. After the procedure all patients were sent to otorhinolaryngologist for the further observation.
Results. 25 surgeries were carried out in 24 patients. In one patient an effective embolization was achieved by re-surgery. The results of endovascular embolization were as follows: 20 (83.3 %) patients demonstrated total devascularization of tumor, subtotal – in 4 (16.7 %). The main indication for pre surgical embolization was blood loss reduction while surgery.
Conclusions. Selective angiography confirms the diagnosis of juvenile angiofibroma and it is the main diagnostic methods of this tumor detection. CT and MRI help to determine the type and size of a tumor. The therapeutic embolization is necessary for juvenile angiofibroma treatment.

Keywords: juvenile angiofibroma, endovascular intervention, therapeutic embolization.

Оbjective – the study of a clinical course, therapeutic modalities, surgical technique and results the current study were undertaken.
Methods and subjects. The dynamics of disease development was studied in 449 operated patients and 52 patients after the conservative treatment. Retrospective analysis of treatment results was performed in two groups: 36 patients with cavernous malformations who underwent surgery, 52 patients were treated with conservative therapy. Eighty-eight cases of symptomatic cavernous malformations affecting the spine and spinal cord were retrospectively reviewed. The methods of treatment, histological similarities and differences between cavernous malformations of each location are reviewed.
Results. The cases display a spectrum of pathological findings involving the vertebral body, vertebral body with epidural extension, epidural space without bony involvement, intradural extramedullar space, and intramedullar lesions. Lesions of all locations are identical in histology. Cavernous malformations of vertebral bodies are asymptomatic and an occasional godsend. Spread or initial malformations localization is determined by radicular and medullar compression.
Conclusions. Clinical management is determined by the presence and intensity of spinal compression syndrome. If there is no such syndrome or there are its initial manifestations the radiation treatment is indicated. We conclude that cavernous malformations represent a single entity regardless of location. In the cavernous malformations (hemangioma) of the vertebral bodies with a diameter exceeding 8 mm or even smaller sizes, but with significant radicular pain character, radiculopathy, the vertebroplasty is recommended. Surgery is administered in case of radicular and medullar compression elimination. Under intradural extramedullar space, and intramedullar cavernous malformations it is necessary of perform open surgical ablation of malformation.

Keywords: cavernous malformations, spinal cord, spine, diagnostic, treatment.

Оbjective – to study the efficacy and safety of two weaning methods from the respirator after prolonged mechanical ventilation in patients with severe traumatic brain injury.
Methods and subjects. A comparative analysis of the weaning duration, complications, use of sedatives, muscle relaxants and narcotic analgesics in patients with translaryngeal intubation and traheostomed patients was carried out. The study, which took place from September 2009 to May 2011, included 69 patients with severe traumatic brain injury who were on prolonged mechanical ventilation (more than 120 hours) and met the criteria for inclusion in the study. Prolonged translyaringeal intubation group included 33 patients, group of traheostomed patients – 36.
Results. The results of this study showed an advantage of weaning from the respirator in patients with traheostomy (TST) vs. with prolonged translyaringeal intubation after prolonged mechanical ventilation which was carried out by means of high-frequency additional respiratory ventilation (HFV). Duration of weaning patients of TST was 58.6 ± 21.3 hours vs. orotracheal intubation group – 103.5 ± 49.6 hours (p = 0.037), duration of analgosedation of group TST was almost twice as short as compared with orotracheal intubation group and was 3.7 and 6.2 days, respectively (p = 0.032).
Conclusions. In patients with severe traumatic brain injury, which is projected holding long-term mechanical ventilation, tracheostomy and methods of weaning with HFV is safer and more effective compared with prolonged orotracheal intubation and using the method of weaning with adaptive support ventilation.

Keywords: severe brain trauma, long-term mechanical ventilation, tracheostomy, weaning, adaptive support ventilation, high frequency support ventilation, orotracheal intubation.

Objective – to study the Noofen® impact on brain functional state in elderly patients after ischemic stroke taking into account hemispheric focal localization.
Methods and subjects. 30 patients after the stroke in the carotid basin were examined. The examination was carried out before and after the Noofen® therapy. The examination included: clinical and neurological examination, psychoemotional state assessment, ECG, MRI and ultrasound duplex scanning of the head and neck vessels.
Results. According to the complex analysis of Noofen® course impact on brain functional state of patients there was observed the main hemispheric medication’s impact on psychoemotional state, bioelectrical brain activity and cerebral hemodynamic. In patients with left hemispheric stroke Noofen® increased intensity of alfa-rhythm in both hemispheres and beta-rhythm in injured one, improved the short termed memory and cerebral hemodynamic in vessels of intact hemisphere – internal carotid, posterior cerebral artery and both spinal cord arteries. In patients with right hemispheric stroke there was decreasing of beta-rhythm and increasing of beta-rhythm in injured hemisphere, elevation of the depression level, improving of general state, increasing of linear systolic blood circulation speed in the right internal carotid, posterior cerebral artery, both spinal cord arteries and basilar artery. These results evidence the positive impact of the medication on hemodynamic in vertebral and basilar basin.
Conclusions. Positive Noofen® impact on psychoemotional state, bioelectrical brain activity structure and cerebral hemodynamic makes it possible to recommend this medication to apply in the system of ischemic stroke patients’ rehabilitation.

Keywords: ischemic stroke, bioelectrical brain activity, elderly, Noofen®.

Цель — изучить изменения спонтанной и вызванной биоэлектрической активности головного мозга у больных сахарным диабетом (СД) 2 типа.
Материалы и методы. У 112 больных СД 2 типа (возраст — от 35 до 65 лет, средний возраст — (55,2 ± 4,8) года) выполнена электроэнцефалография и изучены зрительные вызванные потенциалы (ЗВП). Группу контроля составили 40 лиц без СД. Проведено определение типа электроэнцефалограммы по Жирмунской, оценку латентных периодов и амплитуды ЗВП.
Результаты. У больных СД доминируют патологические типы электроэнцефалограммы — десинхронный, дезорганизованный, грубо дезорганизованный. Отмечено значительное усиление медленно-волновой активности, удлинение латентных периодов поздних компонентов ЗВП, а также уменьшение амплитуды всех компонентов.
Выводы. У больных СД развиваются значительные нейродинамические расстройства. Это может свидетельствовать о нарушении связей корково-подкоркового характера.

Keywords: сахарный диабет, электроэнцефалография, зрительные вызванные потенциалы, нейродинамические нарушения.

Цель — исследовать эффективность и безопасность использования двух методик отлучения от респиратора после проведения длительной искусственной вентиляции легких (ИВЛ) у пациентов с тяжелой черепно-мозговой травмой (ЧМТ).
Материалы и методы. Проведена сравнительная оценка продолжительности отлучения, осложнений, использования седативных препаратов, мышечных релаксантов и наркотических анальгетиков у пациентов с оротрахеальной интубацией и трахеостомированных больных. В исследование, проведенное в период с сентября 2009 по май 2011 г., вошло 69 пациентов с тяжелой ЧМТ, находившихся на длительной ИВЛ (более 120 ч) и отвечавших критериям включения в исследование. Группу длительной трансларингеальной интубации составили 33 пациента, группу трахеостомированных пациентов — 36 лиц.
Результаты. Установлено преимущество при отлучении от респиратора у трахеостомированных пациентов, у которых использовали методику высокочастотной вспомогательной вентиляции легких (ВЧ ВВЛ), по сравнению с больными с трансларингеальной интубацией и применением режима адаптивной поддерживающей вентиляции после длительной респираторной поддержки у пациентов с тяжелой ЧМТ. Продолжительность отлучения у пациентов группы трахеостомии (ТСТ) составила (58,6 ± 21,3) ч, группы оротрахеальной интубации (ОТИ) — (103,5 ± 49,6) ч (р = 0,037), продолжительность проведения аналгоседации в группе ТСТ была почти вдвое короче, чем в группе ОТИ, и составила 3,7 и 6,2 суток соответственно (р = 0,032).
Выводы. У пациентов с тяжелой ЧМТ, которым планируют проведение длительной ИВЛ, выполнение трахеостомии и применение методики отлучения с помощью ВЧ ВВЛ является более безопасным и эффективным методом по сравнению с длительной ОТИ и методикой отлучения с адаптивной поддерживающей вентиляцией легких.

Keywords: тяжелая черепно-мозговая травма, длительная искусственная вентиляция легких, трахеостомия, отлучение от респиратора, адаптивная поддерживающая вентиляция легких, высокочастотная вспомогательная вентиляция легких, оротрахеальная интубация.

Оbjective – to improve the spinal cord conductivity disorders diagnosis in patients with cervical spondylotic myelopathy (CSM) by means of transcranial magnetic stimulation (TMS).
Methods and subjects. Clinical and neurophysiologic (NPh) studies have been conducted in 160 patients with CSM, 60 % men and 40 % of women, with lesions mainly at the level of C4–C5, C5–C6 and C6–C7 segments. NPh studies have been conducted by means of electroneuromyography (ENMG) and TMS methods. 40 patients with CSM received surgical treatment, 120 patients underwent a course of pharmacotherapy and physiotherapy. The control group in the study consisted of 30 healthy men aged 22–55.
Results. In order to determine the level of partial spinal cord compression the data of NPh and MRI were compared. Patients with CSM have been found to demonstrate: prolonged cortical motor evoked potential (MEP) latency in 134 patients (83.7 %), elevated CMCT in 96 (60 %) compared with the control group. The level of MEP indicators change was significantly higher in the group of patients who had undergone surgical treatment (p < 0.05). The transcranial magnetic stimulation data in patient with TMS had diagnostic sensitivity 73–96 %, specificity – 50–74 %, diagnostic efficacy – 82.3 %, 82.4 % had latent period of cortical MEP from the upper extremities muscles. Statistical data assessment allows to recommend the applying of TMS data as with high informative value.
Conclusions. The application of TMS significantly increases the efficiency of diagnosis of motor disorders in patients with CSM; MEP has high sensitivity (96.1 %) and specificity (73.8 %). This medication also can be used for neuro monitoring of spinal functions.

Keywords: cervical spondylotic myelopathy, diagnosis, motor evoked potential, transcranial magnetic stimulation, central motor conduction time.

Цель — усовершенствовать диагностику двигательных нарушений у больных со спондилогенной шейной миелопатией (СШМ) с помощью метода транскраниальной магнитной стимуляции (ТМС).
Материалы и методы. У 160 пациентов с СШМ c преимущественным поражением на уровнях сегментов С4—С5, C5—C6, C6—C7 проведены нейрофизиологические (НФ) исследования функции сегментарных и проводниковых структур спинного мозга с помощью электронейромиографии (ЭНМГ) и ТМС. 40 пациентов получили хирургическое лечение; 120 — медикаментозное и физиотерапевтическое. Возраст больных — от 31 года до 76 лет. Контрольную группу составили 30 здоровых лиц в возрасте от 22 до 55 лет.
Результаты. Уровень частичной компресии спинного мозга определяли, сопоставляя данные исследования неврологического статуса и магнитно-резонансной томографии (МРТ) шейного отдела. У больных с СШМ выявлены достоверные изменения НФ-показателей: удлинение латентности корковых вызванных моторных потенциалов (ВМП) — у 134 (83,7 %) пациентов; увеличение времени центрального моторного проведення (ВЦМП) — у 96 (60 %). Наибольшие изменения НФ-показателей установлены в группе оперированных больных (p < 0,05). Показатели ТМС при СШМ имели диагностическую чувствительность в пределах 73—96 % (относительно данных МРТ и неврологического статуса); специфичность — 50—74 %; диагностическую эффективность — 82,3 % ВЦМП, 82,4 % латентный период корковых ВМП с мышц верхних конечностей. Статистическая оценка параметров ТМС при СШМ (р < 0,005) позволяет рекомендовать использование показателей ТМС как высокоинформативных относительно объективизации степени двигательных проводниковых нарушений у больных с СШМ.
Выводы. Применение ТМС существенно повышает эффективность диагностики двигательных проводниковых нарушений у больных с СШМ. Этот метод имеет высокую чувствительность и специфичность относительно выявления нарушений проведения по корково-спинальным путям и может быть использован для нейромониторинга спинальных функций на этапах лечения СШМ.

Keywords: спондилогенная шейная миелопатия, диагностика, вызванные моторные потенциалы, транскраниальная магнитная стимуляция, время центрального моторного проведения.