The current review is concentrated on the modern pathogenetic data and analysis of age factor complex causing the progress of sarcopenia. Described the measuring methods of muscular weight of a body. Examined the molecular and cellular mechanisms of regeneration of muscular fibres and also the importance of power loading at the advanced age for maintenance of anabolic hormonal status. Represented data about reducing of different risk factors of death at level increase of general trainings.

Keywords: sarcopenia, anorexia, cytokines, satellite cells, markers of sarcopenia.

The aim – to improve the system for evaluation of a rehabilitation potential and recovery of the motor function in post-stroke patients.

Methods and subjects. 50 patients (mean age 58.7 ± 3.79 years) with newly emerged hemispheric ischemic stroke in the acute and early recovery period with a mild neurological deficit were examined. The main requirement for inclusion in the study was the presence of motor evoked potentials under magnetic stimulation of the motor cortex on the affected hemisphere. The research program included the neuroimaging study of ischemic focus (ACT or MRI). Transcranial magnetic stimulation (TMS) was applied for diagnostic purposes, as well as a component of the rehabilitation program by the developed technology. Parameters obtained from the examination of 15 persons of the same age without neurological abnormalities served as control.

Results. Based on literature data and results of original research, the possibilities of TMS for an objective assessment of motor disorders, and neuromuscular training during realization of rehabilitation programs were analyzed. Author’s technology of TMS in conjunction with electromyostimulation was also described.

Conclusions. TMS is an informative method in the rehabilitation diagnostics for determining the recovery potential of post-stroke patients and their selection for active physical interventions. Inclusion of TMS accompanied with electromyostimulation into a rehabilitation program enhances the effectiveness of medical rehabilitation for patients with hemispheric ischemic stroke. Data obtained give reason to recommend the developed technology for practical use.

Keywords: transcranial magnetic stimulation, medical rehabilitation, cerebral stroke.

The aim – to estimate the prognostic value of ultrasonographic indices of patients with constrictive stenotic arteriopathy (CSA) in determination of cerebral ischemia risk and the choice of differential treatment in the acute period of subarachnoid heamorrhage.

Methods and subjects. Clinical and instrumental comparisons with the help of cerebral angiography, neurovisualizing studies (spiral CT), ultrasonographic (duplex scanning,of head and neck blood vessels, transcranial dopplerography) and statistical methods have been performed in 260 patients in the acute period of subarachnoid haemorrhage as a result of cerebral arterial aneurysm rupture.

Results. It has been established that CSA in the acute period of subarachnoid haemorrhage has a progressive type of development; its occurrence increases from 31.4 % cases on the first 3 days to 90.8 % in 1–2 weeks since the moment of vascular catastrophe. The diagnosis and dynamic observation of CSA on the stages of surgical treatment may be conducted with the help of ultrasonography whose sensitivity for carotid system is 82 % on the moderate stage of CSA, specificity – 85 %; on the pronounced stage – 91 %, specificity – 98 %. The occurrence of CSA clinical signs in the form of delayed cerebral ischemia has been proved to increase along with its severity according to ultrasonography data, from moderate (17.3 %) to significant (36.7 %) and critical (73.6 %). According to statistical analysis, the following risk factors of delayed cerebral ischemia have been determined: pathological increase of systolic flow velocities і 250 cm/s (p < 0.05), hemisphere index і 5 (p < 0.01), decrease of total volumetric blood flow in two internal carotidarteries and two vertebral arteries < 300 ml/min (p < 0.05), decrease of blood flow autoregulation index Ј 1.1 (p < 0.05), apoplectiform type of CSA development (p < 0.05), the generalized character of the spasm with spreading to the vertebrobasilar system circulation segments (p < 0.05). The pathological changes of the blood flow found in the brainstem arteries called for the correction of treatment tactics as well as justification of indications for pharmacological endovascular angioplasty.

Conclusions. It has been proved that ultrasonographic examination on the stages of surgical treatment provides reliable diagnosis of CSA in patients with rupture of cerebral arterial aneurysm. Ultrasonographic indices, which give reliable evidence of delayed cerebral ischemia risk, are indicative of the necessity of the therapeutic approach correction, and may be included in the complex of indications for endovascular treatment of CSA.

Keywords: subarachnoid haemorrhage, cerebral arterial aneurysm, constrictive stenotic arteriopathy (cerebral vasospasm), delayed cerebral ischemia, ultrasonography.

The aim – to investigate the role of stroke risk factors in the development of post stroke cognitive impairment (PSCI) among Uzhgorog population.

Methods and subjects. 105 patients with stroke hospitalized in Stroke Department in the year 2006 were examined. We investigated cognitive functions and analyzed vascular risk factors and their role in the development of PSCI. The inclusive criteria were: intact consciousness, verified ischemic stroke, preserved functionality of the used hand, absent aphasia.

Results. We found positive correlation between PSCI and neurological status according to the Scandinavian Stroke Scale SSS (r = 0.64), fibrinogen level (r = 0.34), hematocrit (r = 0.33). We found that in the development of PSCI the following data evidenced high prognostic value: arterial hypertension (HA) – 91.1 %, ischemic heart disease (IHD) – 70.6 %, cardiac arrhythmias (CA) – 38.2 % and the history of stroke (HS) – 23.5 %

Conclusions. The probability of the development of PSCI is higher in patients with such risk factors as HA, IHD, CA and HS. We have to consider the risk of fast development of cognitive deficit in this group of patients. In the early stages of rehabilitation after stroke neurological status improvement might be used as indicator of the cognitive functions recovery.Key words: stroke, risk factors, cognitive deficit.

The aim – to investigate the role of stroke risk factors in the development of post stroke cognitive impairment (PSCI) among Uzhgorog population.

Methods and subjects. 105 patients with stroke hospitalized in Stroke Department in the year 2006 were examined. We investigated cognitive functions and analyzed vascular risk factors and their role in the development of PSCI. The inclusive criteria were: intact consciousness, verified ischemic stroke, preserved functionality of the used hand, absent aphasia.

Results. We found positive correlation between PSCI and neurological status according to the Scandinavian Stroke Scale SSS (r = 0.64), fibrinogen level (r = 0.34), hematocrit (r = 0.33). We found that in the development of PSCI the following data evidenced high prognostic value: arterial hypertension (HA) – 91.1 %, ischemic heart disease (IHD) – 70.6 %, cardiac arrhythmias (CA) – 38.2 % and the history of stroke (HS) – 23.5 %

Conclusions. The probability of the development of PSCI is higher in patients with such risk factors as HA, IHD, CA and HS. We have to consider the risk of fast development of cognitive deficit in this group of patients. In the early stages of rehabilitation after stroke neurological status improvement might be used as indicator of the cognitive functions recovery.Key words: stroke, risk factors, cognitive deficit.

The aim – to investigate the role of stroke risk factors in the development of post stroke cognitive impairment (PSCI) among Uzhgorog population.

Methods and subjects. 105 patients with stroke hospitalized in Stroke Department in the year 2006 were examined. We investigated cognitive functions and analyzed vascular risk factors and their role in the development of PSCI. The inclusive criteria were: intact consciousness, verified ischemic stroke, preserved functionality of the used hand, absent aphasia.

Results. We found positive correlation between PSCI and neurological status according to the Scandinavian Stroke Scale SSS (r = 0.64), fibrinogen level (r = 0.34), hematocrit (r = 0.33). We found that in the development of PSCI the following data evidenced high prognostic value: arterial hypertension (HA) – 91.1 %, ischemic heart disease (IHD) – 70.6 %, cardiac arrhythmias (CA) – 38.2 % and the history of stroke (HS) – 23.5 %

Conclusions. The probability of the development of PSCI is higher in patients with such risk factors as HA, IHD, CA and HS. We have to consider the risk of fast development of cognitive deficit in this group of patients. In the early stages of rehabilitation after stroke neurological status improvement might be used as indicator of the cognitive functions recovery.Key words: stroke, risk factors, cognitive deficit.

The aim – to investigate the role of stroke risk factors in the development of post stroke cognitive impairment (PSCI) among Uzhgorog population.

Methods and subjects. 105 patients with stroke hospitalized in Stroke Department in the year 2006 were examined. We investigated cognitive functions and analyzed vascular risk factors and their role in the development of PSCI. The inclusive criteria were: intact consciousness, verified ischemic stroke, preserved functionality of the used hand, absent aphasia.

Results. We found positive correlation between PSCI and neurological status according to the Scandinavian Stroke Scale SSS (r = 0.64), fibrinogen level (r = 0.34), hematocrit (r = 0.33). We found that in the development of PSCI the following data evidenced high prognostic value: arterial hypertension (HA) – 91.1 %, ischemic heart disease (IHD) – 70.6 %, cardiac arrhythmias (CA) – 38.2 % and the history of stroke (HS) – 23.5 %

Conclusions. The probability of the development of PSCI is higher in patients with such risk factors as HA, IHD, CA and HS. We have to consider the risk of fast development of cognitive deficit in this group of patients. In the early stages of rehabilitation after stroke neurological status improvement might be used as indicator of the cognitive functions recovery.Key words: stroke, risk factors, cognitive deficit.

The aim – to present the selective nosotropic directed medicinal treatment, directed on deceleration of pathological process, on the basis of pattern of electroneuromyographic selection of demyelinating and axonal denervation on the different stages of hereditary motosensory neuropathies (HMNP).

Methods and subjects. 58 children, aged 5–16 years, were examined with HMNP: 25 children with HMNP1, 12 children with HMNP2, 21 child with HMNP X-type. The clinical state of children was estimated on the basis of the adapted and modernized scale of neurological violations on NIS LL (1996) with the estimation of musculare force (0–4 bulk-tankers), tendon reflexes (0–2 bulk-tankers); sensory violations (estimation of superficial sensitiveness, to the oscillation sensitiveness are 0–5 bulk-tankers), volume of active motions in talocrural joints (0–5 bulk-tankers), function of walking (0–4 bulk-tankers). To all children with HMNP, being in the register of database of the Donetsk Regional Child Clinical Center of Neuroreabilitation clinical ENMG and EMG-monitoring (1 time per 3–6 months) was conducted during 8–10 years.

Results. Comparative analysis of estimation of the clinical state on the adapted and modernized scale of neurological violations on NIS LL (1996) and exposed ENMG indexes allowed to set links of the stage of clinical displays with weight of neuropathies from data of ENMG. Considering the authentication of involved of myelin or аxon of nervous fiber, on the different stages of illness at HMNP, the method of treatment is selected according to data of EMG and EMG-monitoring. The chosen method should be directed on deceleration of pathological process.

Conclusions. Findings testify that standardization of early diagnostics and selection of demyelinating and axonal denervation for the children of HMNP from data of clinical ENMG and EMG-monitoring, taking into account the estimation of the clinical state on the adapted and modernized scale of neurological violations on NIS LL (1996), is the basis for development of new standards of early presemeiotic diagnostics of HMNP and standardizations of the nosotropic directed treatment with the use of modern medicinal facilities.

Keywords: hereditary motosensory polyneuropathies, clinical and electroneuromyographic diagnostics, treatment.

The aim – to analyze neurologic status and MRI signs of demyelinating lesions of the brain and spinal cord in patients with acute transverse myelitis (ATM) and to evaluate its risk of transformation to multiple sclerosis (MS).

Methods and subjects. 12 patients with lesions in the spinal cord were examined (5 male and 7 female), aged 20–41. These patients were under the examination within 3 years. Patients underwent: brain and/or spinal cord MRI with Gd enhancement, total clinical examination. To evaluate the level of disability EDSS scale was used. For ATM diagnosis we used Transverse Myelitis Consortium Working Group criteria.

Results. During our study of 8 patients, 5 of them had lesions in brain also as in spinal cord, and 3 demonstrated the size of lesions in spinal cord larger than 2 segments with Gd enhancement detected lesions. These 8 patients have developed multiple sclerosis according to the McDonald criteria 2005.

Conclusions. Risk factors for ATM transformation to MS are: lesions larger than 2 segments, Gd+ lesions and presence of lesions in brain.

Keywords: multiple sclerosis, clinically isolated syndrome, acute transverse myelitis.

The aim – to elucidate possible influence of leptin on the appearance of vascular cognitive impairments in patients with metabolic syndrome (MetS) and chronic cerebrovascular insufficiency (CCI).

Methods and subjects. 30 patients with CCI and Mets aged from 50 till 74 years (mean age – 63.4 ± 7.6 years) were enrolled into the study. Diagnostic evaluation included clinical examination with determination of the blood pressure and body mass index (BMI). All patients underwent general laboratory tests (blood and urine count, biochemical blood count, lipidogramm)and instrumental tests (magnetic resonance imaging of the brain, liptin level was determined in blood. Cognitive assessment consisted of Mini-Mental State Examination / MMSE (general cognition) and other neuropsychological tests: verbal learning test, Paired Associates Learning Test /PALT (immediate and delayed memory for verbal stimuli), Shulte tables (information processing speed).

Results. According to our results the level of leptin in patients was significantly associated with their BMI and, so, with level of obesity. In our opinion the level of leptin can be recommended for practical use as diagnostic criteria in patients with Mets. We found correlation between the level of leptin and the severity of cognitive impairment, so it was considered to be one of the potential risk factors of cognitive impairment in patients with Mets. At the same time we did not find significant difference in the level of leptin in patients with different severity of cognitive impairments.

Conclusions. To elucidate the role of leptin as prognostic risk factor of cognitive impairment in patients with Mets further investigations should be conducted.

Keywords: cognitive impairment, leptin, metabolic syndrome.

The aim – to evaluate the mental and psychosomatic symptoms, affective disorders, stress-related disorders andqualityoflifeamong patients with metabolic and psychoendocrine syndromes.

Methods and subjects. A total of 142 patients took part in the study. Patients were recruited from psychoneurology, endocrinology, cardiology and gynecology departments in Railway Clinical Hospital N 1 and N 2, station Kiev. Patients distributed into 2 groups. The first group consists of 74 patients with endocrine pathology (cerebro-hypophyseal and hypothalamohypophysial pathology with pathogenesis of brain injury or endocrine system disorder). These condgroup consists of 68 patients with metabolic syndrome with outendocrinepathology. Socio-demographic data, biochemical parameters of blood, height, weight, body mass index were evaluated. Individuals were assessed with BDI, quality of life questionnaire, PSM-25.

Results. 12.2 % of patients with psychoendocrine syndrome and 26.5 % patients with metabolic syndrome had symptoms of depression (p = 0.05). 9.5 % of patients with psychoendocrine syndrome and 26.5 % patients with metabolic syndrome had stress disorder (p = 0.015). The total score of quality of life among patients with psychoendocrine syndrome (mean 81.42 ± 15.26) and patients with metabolic syndrome (mean 79.00 ± 14.14) did not differ (p = 0.388).

Conclusions. The results evidence a higher likelihood of depression and poor adaptation to stress among patients with metabolic syndrome, compared to individuals with psychoendocrine syndrome. It was shown the redistribution of quality of life among individuals with the metabolic syndrome and psychoendocrine syndrome. There were significant differences by two scales: somatic and psychological.

Keywords: metabolic syndrome, psychoendocrine syndrome, depression, stress, quality of life.

The aim – to study peculiarities of psychoorganic syndrome pathogenesis in the remote period of craniocerebral trauma on the basis of analysis clinical and neurological evaluation of patients with posttraumatic brain disorder and investigation of homeostasis of nucleic acids, nucleases, middle mass molecules and nitric oxide metabolism.

Methods and subjects. Data of clinical and paraclinical examination of 20 patients in the remote period of craniocerebral trauma with dominant psycho-organic syndrome were under the study.

Results. Clinical signs of the disease are accompanied with disturbances of homeostasis of nucleic acids and nucleases, endogenous intoxication and absence of changes in the nitric oxide metabolism.

Conclusions. In the clinical picture of psycho-organic syndrome, along with clinical signs of disease, disturbances in homeostasis of nucleic acids and nucleases, endogenous intoxication and absence of changes in the nitric oxide metabolism were revealed. The nitric oxide metabolism disorders were not evidenced.

Keywords: remote period of craniocerebral trauma, psychoorganic syndrome, nucleic acids, nucleases, lipid peroxidation, middle mass molecules, nitric oxide.

The aim – to study ultrasonic research self-descriptiveness of muscles for the characteristic of structural changes at patients with congenital anomalies of spinal cord development.

Methods and subjects. Complex clinical-neurologic examination of 17 sick children with the lower languid paraparesis, due to lumbosacral intumescence, and 40 healthy children was carried out. The data of clinical examination has been added with: ultrasonography, and electromyography of muscles.

Results. In group of patients the rough structurally functional changes of muscles were revealed. The received indicators by means of the developed method of a computer estimation of weight of regeneration of muscles authentically differeed from similar indicators in group of healthy children.

Conclusions. Thus, introduction in practice of the given method of research will allow to expand considerably medical – diagnostic possibilities of doctors taking up the problems of rehabilitation.

Keywords: myelodysplasia, ultrasonography, electromyography, structure of muscles.

The aim – to test the therapeutic potential of isoform e2 of apolipoprotein E (ароE2 designates gene; apoE2designates protein) which synthesis in brain tissue was induced by means of gene therapy and to substantiate itsmechanism of action according to current literature data.

Methods and subjects. To determine the structural and functional changes associated with severe diffuse traumatic brain injury, adult male Wistar rats were subjected to weight drop impact acceleration injury and sacrificed byday 10 after trauma. The mixture of DOTAP liposomes and 25 μg of recombinant plasmid pCMV-ароE3 cDNA wasinfused intraventicularly immediately after traumatic brain injury using ALZET osmotic pump. The posttraumatic structural changes were analyzed by histological investigation. Neurologic outcomes were assessed by means of motordysfunction scale, and cognitive consequences were tested in Morris water maze.

Results. The research data have shown that cationic liposome-mediated ароE2 gene transfer protects thebrain parenchyma and vascular system, prevents the evolution of secondary injuries after traumatic brain injury in ratsand effectively prevents the development of posttraumatic functional sequelae.

Conclusions. According to the data of literature the possible mechanisms of apoE therapeutic action are normalization of neural cellular lipid component, role in regulation of reactive gliosis and inflammatory response of CNS toinjury, antioxidant effects of apolipoprotein E, regulation of cell death mechanisms, influence of apolipoprotein E ondifferential gene expression and regulation of genomic response of CNS cells to injury

Keywords: brain injury, gene therapy, apolipoprotein E, action mechanism.

The aim – to test the therapeutic potential of isoform e2 of apolipoprotein E (ароE2 designates gene; apoE2designates protein) which synthesis in brain tissue was induced by means of gene therapy and to substantiate itsmechanism of action according to current literature data.

Methods and subjects. To determine the structural and functional changes associated with severe diffuse traumatic brain injury, adult male Wistar rats were subjected to weight drop impact acceleration injury and sacrificed byday 10 after trauma. The mixture of DOTAP liposomes and 25 μg of recombinant plasmid pCMV-ароE3 cDNA wasinfused intraventicularly immediately after traumatic brain injury using ALZET osmotic pump. The posttraumatic structural changes were analyzed by histological investigation. Neurologic outcomes were assessed by means of motordysfunction scale, and cognitive consequences were tested in Morris water maze.

Results. The research data have shown that cationic liposome-mediated ароE2 gene transfer protects thebrain parenchyma and vascular system, prevents the evolution of secondary injuries after traumatic brain injury in ratsand effectively prevents the development of posttraumatic functional sequelae.

Conclusions. According to the data of literature the possible mechanisms of apoE therapeutic action are normalization of neural cellular lipid component, role in regulation of reactive gliosis and inflammatory response of CNS toinjury, antioxidant effects of apolipoprotein E, regulation of cell death mechanisms, influence of apolipoprotein E ondifferential gene expression and regulation of genomic response of CNS cells to injury

Keywords: brain injury, gene therapy, apolipoprotein E, action mechanism.

The aim – to test the therapeutic potential of isoform e2 of apolipoprotein E (ароE2 designates gene; apoE2designates protein) which synthesis in brain tissue was induced by means of gene therapy and to substantiate itsmechanism of action according to current literature data.

Methods and subjects. To determine the structural and functional changes associated with severe diffuse traumatic brain injury, adult male Wistar rats were subjected to weight drop impact acceleration injury and sacrificed byday 10 after trauma. The mixture of DOTAP liposomes and 25 μg of recombinant plasmid pCMV-ароE3 cDNA wasinfused intraventicularly immediately after traumatic brain injury using ALZET osmotic pump. The posttraumatic structural changes were analyzed by histological investigation. Neurologic outcomes were assessed by means of motordysfunction scale, and cognitive consequences were tested in Morris water maze.

Results. The research data have shown that cationic liposome-mediated ароE2 gene transfer protects thebrain parenchyma and vascular system, prevents the evolution of secondary injuries after traumatic brain injury in ratsand effectively prevents the development of posttraumatic functional sequelae.

Conclusions. According to the data of literature the possible mechanisms of apoE therapeutic action are normalization of neural cellular lipid component, role in regulation of reactive gliosis and inflammatory response of CNS toinjury, antioxidant effects of apolipoprotein E, regulation of cell death mechanisms, influence of apolipoprotein E ondifferential gene expression and regulation of genomic response of CNS cells to injury

Keywords: brain injury, gene therapy, apolipoprotein E, action mechanism.

The aim – to study the effect of transplantation of fetal neural tissue [cerebellum] (TFNT) obtained from 18-day embryos (E-18) rats, and tissue transplantation of the olfactory bulb (TTOB) obtained from adult rats, on the process of regeneration after traumatic central nervous system damage to the cerebellar hemispheres.

Methods and subjects. After performing craniotomy in the posterior cranial fossa in female rats aged 5.5 months, simulated trauma damage to the surface of the cerebellar hemispheres by local hard mechanic damage was performed. TFNT and TTOB were produced by day 7 after injury in the cleaned from necrotic tissue masses of the bed of the cerebellum. There were three groups of comparison – simulation of cerebellar injury, trauma simulation of the cerebellum with the purification lodge injury by day 7, the simulation of cerebellar injury with the purification of the bed by day 7 of injury and transplantation of fetal kidney tissue (E-18). The results were evaluated with beam-walking test (BWT), every three days to 60 days inclusive.

Results. TFNT favors the maximum positive influence among the investigated groups on the regeneration process. The restoration of stato-coordination sphere function is evident in the form of equal growth indicator during the first and second months under the TTOB application and in the case of TFNT performance – on 3 and 4 weeks. Within 1 week after TTOB more intense increase in the indicator of functions is evident than in the case of TFNT.

Conclusions. TFNT intensifies, but does not change the qualitative characteristics of the recovery process stato-coordination sphere; TTOB causes the appearance of unusually early phase of post-transplant TFNT positive effect. TTOB, unlike TFNT may be regarded as a method of choice for restorative treatment of experimental damage to the cerebellum only at early stages of the traumatic process.

Keywords: experimental cerebellar trauma, reconstructive neurosurgery, neurogenic cells, fetal neural tissue, olfactory bulb, neurotransplantation.

The aim – to evaluate L-lysine aescinat efficacy in acute spinal cord injury on liquorologic and liquorodynamic indicators.

Methods and subjects. 75 patients (59 (78.6 %) – male, 16 (21.3 %) – female) aged 15–69 years with spinal injury were treated. The terms of hospitalization from the injury moment were from 8–48 hours. All patients demonstrated mild neurological impairments: paresis, sensitivity decreasing lower the injury lever, pelvic organs function partial impairments. According to Frankel scale they were in D group. The patients were divided into 2 groups. Study group, 38 patients used the drug L-lysine aescinat on the proposed scheme, the control group patients, 37 patients used traditional treatment with diuretics and corticosteroids.

Results. The data obtained showed that in 63.1 % cases in study group patients had positive results, whereas the figures in the control group did not exceed 32.4 %. Due to L-lysine aescinat anti-edematous action the liquor sanitization was achieved on 4–5 days early in the study group than in the control one.

Conclusions. The authors concluded, that reducing the severity of spinal cord edema, improving patency of subarachnoid space, improving circulation and liquor circulation in the injured spinal cord areas associated with a marked endotelium-protective, venotonic and anti-edematous effects of L-lysine aescinat. The obtained data evidence the efficacy of the drug application in acute spinal cord injury which causes the reduction of hospital treatment and disability level.

Keywords: spinal cord injury, acute period, liquor, liquorodynamic indicators, L-lysine aescinat.

The place of aceclofenac in a group of nonsteroidal anti-inflammatory drugs and its efficacy in osteoarthrosis are discussed.

Keywords: osteoarthrosis, aceclofenac.

The article deals with the choline alphoscerate Gliatilin action at 67 patients with Parkinson's disease of different age groups and a disease onset. All these patients underwent clinical, neurological and neuropsychological examination. An estimation of specific therapy efficiency has been carried out. Results of work allow to recommend Gliatilin to patients with the given problem as a medication possessing neuroprotection properties in a context of complex pharmacotherapy.

Keywords: Parkinson

Изучено действие холина альфосцерата (Глиатилин) у 67 пациентов с болезнью Паркинсона разных возрастных групп и с разным дебютом заболевания. Всем пациентам провели клинико-неврологическое и нейропсихологическое обследование, оценку эффективности специфической терапии. Полученные результаты позволяют рекомендовать использование Глиатилина как препарата, обладающего нейропротекторными свойствами, в комплексной фармакотерапии пациентов с болезнью Паркинсона.

Keywords: болезнь Паркинсона, шкала UPDRS, холина альфосцерат, Глиатилин.

The neurotransmitter mechanisms of the sleep phases regulation and clinical and electrophysiological characteristics of different sleep stages are presented in the article. The sleep disorders in patients with stroke were characterized with accent on patients with obstructive sleep apnea as a risk factor for stroke. The hemispheric features of sleep pattern failure in patients with stroke were also discussed. The interrelationship of sleep patterns in acute stroke to prognosis and rehabilitation efficiency were emphasized.

Keywords: sleep, polysomnography, sleep apnea syndrome, stroke, hemispheric asymmetry.

The aim – to improve the system for evaluation of a rehabilitation potential and recovery of the motor function in post-stroke patients.

Methods and subjects. 50 patients (mean age 58.7 ± 3.79 years) with newly emerged hemispheric ischemic stroke in the acute and early recovery period with a mild neurological deficit were examined. The main requirement for inclusion in the study was the presence of motor evoked potentials under magnetic stimulation of the motor cortex on the affected hemisphere. The research program included the neuroimaging study of ischemic focus (ACT or MRI). Transcranial magnetic stimulation (TMS) was applied for diagnostic purposes, as well as a component of the rehabilitation program by the developed technology. Parameters obtained from the examination of 15 persons of the same age without neurological abnormalities served as control.

Results. Based on literature data and results of original research, the possibilities of TMS for an objective assessment of motor disorders, and neuromuscular training during realization of rehabilitation programs were analyzed. Author’s technology of TMS in conjunction with electromyostimulation was also described.

Conclusions. TMS is an informative method in the rehabilitation diagnostics for determining the recovery potential of post-stroke patients and their selection for active physical interventions. Inclusion of TMS accompanied with electromyostimulation into a rehabilitation program enhances the effectiveness of medical rehabilitation for patients with hemispheric ischemic stroke. Data obtained give reason to recommend the developed technology for practical use.

Keywords: transcranial magnetic stimulation, medical rehabilitation, cerebral stroke.

The current review is concentrated on the modern pathogenetic data and analysis of age factor complex causing the progress of sarcopenia. Described the measuring methods of muscular weight of a body. Examined the molecular and cellular mechanisms of regeneration of muscular fibres and also the importance of power loading at the advanced age for maintenance of anabolic hormonal status. Represented data about reducing of different risk factors of death at level increase of general trainings.

Keywords: sarcopenia, anorexia, cytokines, satellite cells, markers of sarcopenia.

The aim – to test the therapeutic potential of isoform e2 of apolipoprotein E (ароE2 designates gene; apoE2designates protein) which synthesis in brain tissue was induced by means of gene therapy and to substantiate itsmechanism of action according to current literature data.

Methods and subjects. To determine the structural and functional changes associated with severe diffuse traumatic brain injury, adult male Wistar rats were subjected to weight drop impact acceleration injury and sacrificed byday 10 after trauma. The mixture of DOTAP liposomes and 25 μg of recombinant plasmid pCMV-ароE3 cDNA wasinfused intraventicularly immediately after traumatic brain injury using ALZET osmotic pump. The posttraumatic structural changes were analyzed by histological investigation. Neurologic outcomes were assessed by means of motordysfunction scale, and cognitive consequences were tested in Morris water maze.

Results. The research data have shown that cationic liposome-mediated ароE2 gene transfer protects thebrain parenchyma and vascular system, prevents the evolution of secondary injuries after traumatic brain injury in ratsand effectively prevents the development of posttraumatic functional sequelae.

Conclusions. According to the data of literature the possible mechanisms of apoE therapeutic action are normalization of neural cellular lipid component, role in regulation of reactive gliosis and inflammatory response of CNS toinjury, antioxidant effects of apolipoprotein E, regulation of cell death mechanisms, influence of apolipoprotein E ondifferential gene expression and regulation of genomic response of CNS cells to injury

Keywords: brain injury, gene therapy, apolipoprotein E, action mechanism.

The neurotransmitter mechanisms of the sleep phases regulation and clinical and electrophysiological characteristics of different sleep stages are presented in the article. The sleep disorders in patients with stroke were characterized with accent on patients with obstructive sleep apnea as a risk factor for stroke. The hemispheric features of sleep pattern failure in patients with stroke were also discussed. The interrelationship of sleep patterns in acute stroke to prognosis and rehabilitation efficiency were emphasized.

Keywords: sleep, polysomnography, sleep apnea syndrome, stroke, hemispheric asymmetry.

The current review is concentrated on the modern pathogenetic data and analysis of age factor complex causing the progress of sarcopenia. Described the measuring methods of muscular weight of a body. Examined the molecular and cellular mechanisms of regeneration of muscular fibres and also the importance of power loading at the advanced age for maintenance of anabolic hormonal status. Represented data about reducing of different risk factors of death at level increase of general trainings.

Keywords: sarcopenia, anorexia, cytokines, satellite cells, markers of sarcopenia.

The aim – to improve the system for evaluation of a rehabilitation potential and recovery of the motor function in post-stroke patients.

Methods and subjects. 50 patients (mean age 58.7 ± 3.79 years) with newly emerged hemispheric ischemic stroke in the acute and early recovery period with a mild neurological deficit were examined. The main requirement for inclusion in the study was the presence of motor evoked potentials under magnetic stimulation of the motor cortex on the affected hemisphere. The research program included the neuroimaging study of ischemic focus (ACT or MRI). Transcranial magnetic stimulation (TMS) was applied for diagnostic purposes, as well as a component of the rehabilitation program by the developed technology. Parameters obtained from the examination of 15 persons of the same age without neurological abnormalities served as control.

Results. Based on literature data and results of original research, the possibilities of TMS for an objective assessment of motor disorders, and neuromuscular training during realization of rehabilitation programs were analyzed. Author’s technology of TMS in conjunction with electromyostimulation was also described.

Conclusions. TMS is an informative method in the rehabilitation diagnostics for determining the recovery potential of post-stroke patients and their selection for active physical interventions. Inclusion of TMS accompanied with electromyostimulation into a rehabilitation program enhances the effectiveness of medical rehabilitation for patients with hemispheric ischemic stroke. Data obtained give reason to recommend the developed technology for practical use.

Keywords: transcranial magnetic stimulation, medical rehabilitation, cerebral stroke.

The aim – to estimate the prognostic value of ultrasonographic indices of patients with constrictive stenotic arteriopathy (CSA) in determination of cerebral ischemia risk and the choice of differential treatment in the acute period of subarachnoid heamorrhage.

Methods and subjects. Clinical and instrumental comparisons with the help of cerebral angiography, neurovisualizing studies (spiral CT), ultrasonographic (duplex scanning,of head and neck blood vessels, transcranial dopplerography) and statistical methods have been performed in 260 patients in the acute period of subarachnoid haemorrhage as a result of cerebral arterial aneurysm rupture.

Results. It has been established that CSA in the acute period of subarachnoid haemorrhage has a progressive type of development; its occurrence increases from 31.4 % cases on the first 3 days to 90.8 % in 1–2 weeks since the moment of vascular catastrophe. The diagnosis and dynamic observation of CSA on the stages of surgical treatment may be conducted with the help of ultrasonography whose sensitivity for carotid system is 82 % on the moderate stage of CSA, specificity – 85 %; on the pronounced stage – 91 %, specificity – 98 %. The occurrence of CSA clinical signs in the form of delayed cerebral ischemia has been proved to increase along with its severity according to ultrasonography data, from moderate (17.3 %) to significant (36.7 %) and critical (73.6 %). According to statistical analysis, the following risk factors of delayed cerebral ischemia have been determined: pathological increase of systolic flow velocities і 250 cm/s (p < 0.05), hemisphere index і 5 (p < 0.01), decrease of total volumetric blood flow in two internal carotidarteries and two vertebral arteries < 300 ml/min (p < 0.05), decrease of blood flow autoregulation index Ј 1.1 (p < 0.05), apoplectiform type of CSA development (p < 0.05), the generalized character of the spasm with spreading to the vertebrobasilar system circulation segments (p < 0.05). The pathological changes of the blood flow found in the brainstem arteries called for the correction of treatment tactics as well as justification of indications for pharmacological endovascular angioplasty.

Conclusions. It has been proved that ultrasonographic examination on the stages of surgical treatment provides reliable diagnosis of CSA in patients with rupture of cerebral arterial aneurysm. Ultrasonographic indices, which give reliable evidence of delayed cerebral ischemia risk, are indicative of the necessity of the therapeutic approach correction, and may be included in the complex of indications for endovascular treatment of CSA.

Keywords: subarachnoid haemorrhage, cerebral arterial aneurysm, constrictive stenotic arteriopathy (cerebral vasospasm), delayed cerebral ischemia, ultrasonography.

Цель — исследовать влияние отдельных факторов риска возникновения мозгового инсульта (МИ) на развитие постинсультной когнитивной несостоятельности (ПКН) у жителей Ужгорода.

Материалы и методы. У 105 больных, которые перенесли МИ и находились на лечении в отделении сосудистой неврологии Ужгородской центральной городской клинической больницы на протяжении 2006 г., проведено исследование когнитивных функций, а также анализ факторов риска возникновения МИ и их роли в развитии ПКН. Критериями включения в исследование были: сохраненное сознание, верифицированный МИ, сохраненная функция письма и отсутствие выраженных афатических расстройств.

Результаты. Выявлена позитивная корреляционная связь между ПКН и выраженностью неврологического дефицита согласно Скандинавской шкале инсульта (r  =  0,64), уровнем фибриногена (r  =  0,34) и гематокритом (r  =  0,33). У больных с ПКН артериальную гипертензию (АГ) регистрируют в 91,1 % случаев, ишемическую болезнь сердца (ИБС) — в 70,6 %, нарушение сердечного ритма — в 38,2 %, МИ в анамнезе — в 23,5 %.

Выводы. Вероятность развития ПКН высока у больных с такими факторами риска, как АГ, ИБС, нарушение сердечного ритма и МИ в анамнезе. Лечебная тактика у больных после перенесенного МИ должна учитывать вероятность быстрого развития ПКН у данной категории больных.

Keywords: мозговой инсульт, факторы риска, когнитивный дефицит.

The aim – to present the selective nosotropic directed medicinal treatment, directed on deceleration of pathological process, on the basis of pattern of electroneuromyographic selection of demyelinating and axonal denervation on the different stages of hereditary motosensory neuropathies (HMNP).

Methods and subjects. 58 children, aged 5–16 years, were examined with HMNP: 25 children with HMNP1, 12 children with HMNP2, 21 child with HMNP X-type. The clinical state of children was estimated on the basis of the adapted and modernized scale of neurological violations on NIS LL (1996) with the estimation of musculare force (0–4 bulk-tankers), tendon reflexes (0–2 bulk-tankers); sensory violations (estimation of superficial sensitiveness, to the oscillation sensitiveness are 0–5 bulk-tankers), volume of active motions in talocrural joints (0–5 bulk-tankers), function of walking (0–4 bulk-tankers). To all children with HMNP, being in the register of database of the Donetsk Regional Child Clinical Center of Neuroreabilitation clinical ENMG and EMG-monitoring (1 time per 3–6 months) was conducted during 8–10 years.

Results. Comparative analysis of estimation of the clinical state on the adapted and modernized scale of neurological violations on NIS LL (1996) and exposed ENMG indexes allowed to set links of the stage of clinical displays with weight of neuropathies from data of ENMG. Considering the authentication of involved of myelin or аxon of nervous fiber, on the different stages of illness at HMNP, the method of treatment is selected according to data of EMG and EMG-monitoring. The chosen method should be directed on deceleration of pathological process.

Conclusions. Findings testify that standardization of early diagnostics and selection of demyelinating and axonal denervation for the children of HMNP from data of clinical ENMG and EMG-monitoring, taking into account the estimation of the clinical state on the adapted and modernized scale of neurological violations on NIS LL (1996), is the basis for development of new standards of early presemeiotic diagnostics of HMNP and standardizations of the nosotropic directed treatment with the use of modern medicinal facilities.

Keywords: hereditary motosensory polyneuropathies, clinical and electroneuromyographic diagnostics, treatment.

The aim – to analyze neurologic status and MRI signs of demyelinating lesions of the brain and spinal cord in patients with acute transverse myelitis (ATM) and to evaluate its risk of transformation to multiple sclerosis (MS).

Methods and subjects. 12 patients with lesions in the spinal cord were examined (5 male and 7 female), aged 20–41. These patients were under the examination within 3 years. Patients underwent: brain and/or spinal cord MRI with Gd enhancement, total clinical examination. To evaluate the level of disability EDSS scale was used. For ATM diagnosis we used Transverse Myelitis Consortium Working Group criteria.

Results. During our study of 8 patients, 5 of them had lesions in brain also as in spinal cord, and 3 demonstrated the size of lesions in spinal cord larger than 2 segments with Gd enhancement detected lesions. These 8 patients have developed multiple sclerosis according to the McDonald criteria 2005.

Conclusions. Risk factors for ATM transformation to MS are: lesions larger than 2 segments, Gd+ lesions and presence of lesions in brain.

Keywords: multiple sclerosis, clinically isolated syndrome, acute transverse myelitis.

Цель — провести анализ клинико-неврологического статуса и магниторезонансно-томографических признаков очагов демиелинизации в головном и спинном мозге у больных с острым поперечным миелитом (ОПМ) и оценить вероятность его трансформации в рассеянный склероз (РС).

Материалы и методы. Обследовано 12 больных (5 мужчин и 7 женщин) в возрасте от 20 до 41 года с клиническими проявлениями ОПМ. Эти пациенты находились на динамическом наблюдении в течение 3 лет. Больным проведено: общеклиническое обследование, магнитно-резонансную томографию (МРТ) головного и/или спинного мозга с внутривенным введением гадолиния. Для оценки степени инвалидизации применяли шкалу ЕDSS, а для постановки диагноза острого поперечного миелита — критерии Transverse Myelitis Consortium Working Group (2002).

Результаты. В процессе динамического наблюдения у 5 пациентов обнаружены очаги как в спинном, так и в головном мозге. У 3 (25 %) больных размер очагов в спинном мозге превышал 2 сегмента. У этих 8 пациентов верифицирован клинически достоверный РС по критериям McDonald (2005).

Выводы. Факторами риска развития РС у больных с ОПМ являются: очаги размером, превышающим 2 сегмента на МРТ спинного мозга, контрастнакапливающие очаги, а также наличие очагов демиелинизации в головном мозге.

Keywords: рассеянный склероз, клинически изолированный синдром, острый поперечный миелит.

The aim – to elucidate possible influence of leptin on the appearance of vascular cognitive impairments in patients with metabolic syndrome (MetS) and chronic cerebrovascular insufficiency (CCI).

Methods and subjects. 30 patients with CCI and Mets aged from 50 till 74 years (mean age – 63.4 ± 7.6 years) were enrolled into the study. Diagnostic evaluation included clinical examination with determination of the blood pressure and body mass index (BMI). All patients underwent general laboratory tests (blood and urine count, biochemical blood count, lipidogramm)and instrumental tests (magnetic resonance imaging of the brain, liptin level was determined in blood. Cognitive assessment consisted of Mini-Mental State Examination / MMSE (general cognition) and other neuropsychological tests: verbal learning test, Paired Associates Learning Test /PALT (immediate and delayed memory for verbal stimuli), Shulte tables (information processing speed).

Results. According to our results the level of leptin in patients was significantly associated with their BMI and, so, with level of obesity. In our opinion the level of leptin can be recommended for practical use as diagnostic criteria in patients with Mets. We found correlation between the level of leptin and the severity of cognitive impairment, so it was considered to be one of the potential risk factors of cognitive impairment in patients with Mets. At the same time we did not find significant difference in the level of leptin in patients with different severity of cognitive impairments.

Conclusions. To elucidate the role of leptin as prognostic risk factor of cognitive impairment in patients with Mets further investigations should be conducted.

Keywords: cognitive impairment, leptin, metabolic syndrome.

The aim – to evaluate the mental and psychosomatic symptoms, affective disorders, stress-related disorders andqualityoflifeamong patients with metabolic and psychoendocrine syndromes.

Methods and subjects. A total of 142 patients took part in the study. Patients were recruited from psychoneurology, endocrinology, cardiology and gynecology departments in Railway Clinical Hospital N 1 and N 2, station Kiev. Patients distributed into 2 groups. The first group consists of 74 patients with endocrine pathology (cerebro-hypophyseal and hypothalamohypophysial pathology with pathogenesis of brain injury or endocrine system disorder). These condgroup consists of 68 patients with metabolic syndrome with outendocrinepathology. Socio-demographic data, biochemical parameters of blood, height, weight, body mass index were evaluated. Individuals were assessed with BDI, quality of life questionnaire, PSM-25.

Results. 12.2 % of patients with psychoendocrine syndrome and 26.5 % patients with metabolic syndrome had symptoms of depression (p = 0.05). 9.5 % of patients with psychoendocrine syndrome and 26.5 % patients with metabolic syndrome had stress disorder (p = 0.015). The total score of quality of life among patients with psychoendocrine syndrome (mean 81.42 ± 15.26) and patients with metabolic syndrome (mean 79.00 ± 14.14) did not differ (p = 0.388).

Conclusions. The results evidence a higher likelihood of depression and poor adaptation to stress among patients with metabolic syndrome, compared to individuals with psychoendocrine syndrome. It was shown the redistribution of quality of life among individuals with the metabolic syndrome and psychoendocrine syndrome. There were significant differences by two scales: somatic and psychological.

Keywords: metabolic syndrome, psychoendocrine syndrome, depression, stress, quality of life.

Цель — изучить психические и психосоматические признаки, аффективную сферу, особенности стрессовых расстройств и уровень качества жизни при метаболическом и психоэндокринном синдроме.

Материалы и методы. Проведено обследование 142 больных, которые находились на лечении в психоневрологическом, эндокринном, кардиологическом и гинекологическом отделениях дорожных клинических больниц № 1 и № 2 ст. Киев. Сформировано две сопоставимые группы: первая (n = 74) — пациенты с эндокринными органическими нарушениями (церебрально-гипофизарные или гипоталамо-гипофизарные заболевания, в патогенезе которых ведущим звеном является поражение мозга или заболевания периферических эндокринных желез), вторая (n = 68) — с метаболическим синдромом без эндокринной патологии за исключением сахарного диабета 2 типа. В работе использованы общие социодемографические показатели. Исследованы биохимические показатели крови: уровень холестерина липопротеинов высокой и низкой плотности, триглицеридов, глюкозы натощак. Измеряли рост и массу тела, для каждого пациента рассчитывали индекс массы тела. Для оценки психологического состояния применяли шкалу депрессии Бека, опросник качества жизни, шкалу психологического стресса PSM-25.

Результаты. Установлено, что частота психопатологических феноменов депрессии при психоэндокринном синдроме составляла 12,2 %, а при метаболическом — 26,5 % (p = 0,05), стрессовых расстройств — соответственно 9,5 и 26,5 % (p = 0,015). Группы психоэндокринного и метаболического синдромов не отличались по общему баллу качества жизни (среднее значение соответственно (81,42 ± 15,26) и (79,00 ± 14,14) балла; p = 0,388).

Выводы. При метаболическом синдроме по сравнению с психоэндокринным вероятность депрессии выше, а адаптация к стрессу — ниже. Выявлены достоверно значимые различия по двум субшкалам: соматической и психологической.

Keywords: метаболический синдром, психоэндокринный синдром, депрессия, стресс, качество жизни.

The aim – to study peculiarities of psychoorganic syndrome pathogenesis in the remote period of craniocerebral trauma on the basis of analysis clinical and neurological evaluation of patients with posttraumatic brain disorder and investigation of homeostasis of nucleic acids, nucleases, middle mass molecules and nitric oxide metabolism.

Methods and subjects. Data of clinical and paraclinical examination of 20 patients in the remote period of craniocerebral trauma with dominant psycho-organic syndrome were under the study.

Results. Clinical signs of the disease are accompanied with disturbances of homeostasis of nucleic acids and nucleases, endogenous intoxication and absence of changes in the nitric oxide metabolism.

Conclusions. In the clinical picture of psycho-organic syndrome, along with clinical signs of disease, disturbances in homeostasis of nucleic acids and nucleases, endogenous intoxication and absence of changes in the nitric oxide metabolism were revealed. The nitric oxide metabolism disorders were not evidenced.

Keywords: remote period of craniocerebral trauma, psychoorganic syndrome, nucleic acids, nucleases, lipid peroxidation, middle mass molecules, nitric oxide.

The aim – to study ultrasonic research self-descriptiveness of muscles for the characteristic of structural changes at patients with congenital anomalies of spinal cord development.

Methods and subjects. Complex clinical-neurologic examination of 17 sick children with the lower languid paraparesis, due to lumbosacral intumescence, and 40 healthy children was carried out. The data of clinical examination has been added with: ultrasonography, and electromyography of muscles.

Results. In group of patients the rough structurally functional changes of muscles were revealed. The received indicators by means of the developed method of a computer estimation of weight of regeneration of muscles authentically differeed from similar indicators in group of healthy children.

Conclusions. Thus, introduction in practice of the given method of research will allow to expand considerably medical – diagnostic possibilities of doctors taking up the problems of rehabilitation.

Keywords: myelodysplasia, ultrasonography, electromyography, structure of muscles.

The aim – to test the therapeutic potential of isoform e2 of apolipoprotein E (ароE2 designates gene; apoE2designates protein) which synthesis in brain tissue was induced by means of gene therapy and to substantiate itsmechanism of action according to current literature data.

Methods and subjects. To determine the structural and functional changes associated with severe diffuse traumatic brain injury, adult male Wistar rats were subjected to weight drop impact acceleration injury and sacrificed byday 10 after trauma. The mixture of DOTAP liposomes and 25 μg of recombinant plasmid pCMV-ароE3 cDNA wasinfused intraventicularly immediately after traumatic brain injury using ALZET osmotic pump. The posttraumatic structural changes were analyzed by histological investigation. Neurologic outcomes were assessed by means of motordysfunction scale, and cognitive consequences were tested in Morris water maze.

Results. The research data have shown that cationic liposome-mediated ароE2 gene transfer protects thebrain parenchyma and vascular system, prevents the evolution of secondary injuries after traumatic brain injury in ratsand effectively prevents the development of posttraumatic functional sequelae.

Conclusions. According to the data of literature the possible mechanisms of apoE therapeutic action are normalization of neural cellular lipid component, role in regulation of reactive gliosis and inflammatory response of CNS toinjury, antioxidant effects of apolipoprotein E, regulation of cell death mechanisms, influence of apolipoprotein E ondifferential gene expression and regulation of genomic response of CNS cells to injury

Keywords: brain injury, gene therapy, apolipoprotein E, action mechanism.

The aim – to study the effect of transplantation of fetal neural tissue [cerebellum] (TFNT) obtained from 18-day embryos (E-18) rats, and tissue transplantation of the olfactory bulb (TTOB) obtained from adult rats, on the process of regeneration after traumatic central nervous system damage to the cerebellar hemispheres.

Methods and subjects. After performing craniotomy in the posterior cranial fossa in female rats aged 5.5 months, simulated trauma damage to the surface of the cerebellar hemispheres by local hard mechanic damage was performed. TFNT and TTOB were produced by day 7 after injury in the cleaned from necrotic tissue masses of the bed of the cerebellum. There were three groups of comparison – simulation of cerebellar injury, trauma simulation of the cerebellum with the purification lodge injury by day 7, the simulation of cerebellar injury with the purification of the bed by day 7 of injury and transplantation of fetal kidney tissue (E-18). The results were evaluated with beam-walking test (BWT), every three days to 60 days inclusive.

Results. TFNT favors the maximum positive influence among the investigated groups on the regeneration process. The restoration of stato-coordination sphere function is evident in the form of equal growth indicator during the first and second months under the TTOB application and in the case of TFNT performance – on 3 and 4 weeks. Within 1 week after TTOB more intense increase in the indicator of functions is evident than in the case of TFNT.

Conclusions. TFNT intensifies, but does not change the qualitative characteristics of the recovery process stato-coordination sphere; TTOB causes the appearance of unusually early phase of post-transplant TFNT positive effect. TTOB, unlike TFNT may be regarded as a method of choice for restorative treatment of experimental damage to the cerebellum only at early stages of the traumatic process.

Keywords: experimental cerebellar trauma, reconstructive neurosurgery, neurogenic cells, fetal neural tissue, olfactory bulb, neurotransplantation.

Цель — изучить влияние трансплантации эмбриональной нервной ткани (мозжечка) (ТЭНТ), полученной от 18-дневных зародышей (Е-18) крыс, и ткани обонятельной луковицы (ТТОЛ), полученной от половозрелых крыс, на течение процесса регенерации ЦНС после травматического повреждения полушария мозжечка в эксперименте.

Материалы и методы. Травму моделировали путем локального твердомеханического повреждения поверхности полушария мозжечка крыс-самок в возрасте 5,5 мес после выполнения трепанации в области задней черепной ямки. ТЭНТ и ТТОЛ производили на 7-е сутки после моделирования травмы в очищенное от некротических масс ложе ткани мозжечка. Сформировали 3 группы сравнения: моделирование травмы мозжечка, моделирование травмы мозжечка с очищением ложа ушиба на 7-е сутки, моделирование травмы мозжечка с очищением ложа ушиба на 7-е сутки и трансплантацией ткани эмбриональной почки (Е-18). Результаты оценивали путем теста «ходьбы по бруску» (beam walking test — BWT) каждые три дня до 60-х суток включительно.

Результаты. ТЭНТ способствует максимальному среди исследуемых групп положительному влиянию на регенерационный процесс. Восстановление функции стато-координаторной сферы в случае выполнения ТТОЛ проявляется равновеликим ее приростом в течение первого и второго месяцев эксперимента, в случае выполнения ТЭНТ — в течение третьей и четвертой недели. В течение первой недели после ТТОЛ наблюдают более интенсивный прирост показателя функции, чем в случае ТЭНТ.

Выводы. ТЭНТ усиливает интенсивность, однако не приводит к изменению качественных характеристик процесса восстановления стато-координаторной сферы. ТТОЛ вызывает появление нехарактерной для ТЭНТ ранней фазы посттрансплантационного положительного эффекта. ТТОЛ, в отличие от ТЭНТ, может рассматриваться как метод выбора для восстановительного лечения экспериментального повреждения мозжечка лишь на ранних этапах травматического процесса.

Keywords: экспериментальная травма мозжечка, восстановительная нейрохирургия, нейрогенные клетки, эмбриональная нервная ткань, обонятельная луковица, нейротрансплантация.

The aim – to evaluate L-lysine aescinat efficacy in acute spinal cord injury on liquorologic and liquorodynamic indicators.

Methods and subjects. 75 patients (59 (78.6 %) – male, 16 (21.3 %) – female) aged 15–69 years with spinal injury were treated. The terms of hospitalization from the injury moment were from 8–48 hours. All patients demonstrated mild neurological impairments: paresis, sensitivity decreasing lower the injury lever, pelvic organs function partial impairments. According to Frankel scale they were in D group. The patients were divided into 2 groups. Study group, 38 patients used the drug L-lysine aescinat on the proposed scheme, the control group patients, 37 patients used traditional treatment with diuretics and corticosteroids.

Results. The data obtained showed that in 63.1 % cases in study group patients had positive results, whereas the figures in the control group did not exceed 32.4 %. Due to L-lysine aescinat anti-edematous action the liquor sanitization was achieved on 4–5 days early in the study group than in the control one.

Conclusions. The authors concluded, that reducing the severity of spinal cord edema, improving patency of subarachnoid space, improving circulation and liquor circulation in the injured spinal cord areas associated with a marked endotelium-protective, venotonic and anti-edematous effects of L-lysine aescinat. The obtained data evidence the efficacy of the drug application in acute spinal cord injury which causes the reduction of hospital treatment and disability level.

Keywords: spinal cord injury, acute period, liquor, liquorodynamic indicators, L-lysine aescinat.

Цель — оценить эффективность использования L-лизина эсцината в лечении острой позвоночно-спинномозговой травмы по ликворологическим и ликвородинамическим показателям.

Материалы и методы. Проведено лечение 75 больных в возрасте от 15 до 69 лет с позвоночно-спинномозговой травмой. Мужчин было 59 (78,6 %), женщин — 16 (21,3 %). Сроки госпитализации больных от момента получения травмы составили от 8 до 48 ч. Все больные при поступлении имели умеренные неврологические нарушения в виде пареза, снижение чувствительности ниже уровня повреждения и частичное нарушение функции тазовых органов. По шкале Frankel они относились к группе D. Пациентов распределили на две группы: в основной группе (n = 38) использовали препарат L-лизина эсцинат по предложенной схеме, в контрольной (n = 37) — традиционное лечение с применением мочегонных и кортикостероидных препаратов.

Результаты. У 63,1 % больных основной группы отмечено неврологическое улучшение, тогда как в контрольной группе — только у 32,4 %. Вследствие противоотечного эффекта L-лизина эсцината санация ликвора в основной группе достигнута на 4—5 сут раньше, чем в контрольной.

Выводы. Включение 0,1 % раствора L-лизина эсцината в комплексную интенсивную терапию в острый период позвоночно-спинномозговой травмы значительно уменьшает выраженность отека спинного мозга, улучшает проходимость субарахноидального пространства, кровообращение и ликвороциркуляцию в травмированном участке спинного мозга. Полученные результаты свидетельствуют о целесообразности применения препарата в острый период позвоночно-спинномозговой травмы для уменьшения отека спинного мозга, что способствует уменьшению продолжительности стационарного лечения и уровня инвалидности.

Keywords: позвоночно-спинномозговая травма, острый период, ликвор, ликвородинамические показатели, L-лизина эсцинат.

The place of aceclofenac in a group of nonsteroidal anti-inflammatory drugs and its efficacy in osteoarthrosis are discussed.

Keywords: osteoarthrosis, aceclofenac.

The article deals with the choline alphoscerate Gliatilin action at 67 patients with Parkinson's disease of different age groups and a disease onset. All these patients underwent clinical, neurological and neuropsychological examination. An estimation of specific therapy efficiency has been carried out. Results of work allow to recommend Gliatilin to patients with the given problem as a medication possessing neuroprotection properties in a context of complex pharmacotherapy.

Keywords: Parkinson

Представлена клинико-электрофизиологическая характеристика различных стадий сна и механизмы нейромедиаторной регуляции фаз сна. Рассмотрена система цикла сон-бодрствование. Дана характеристика нарушений сна у больных с инсультом. Акцент сделан на синдроме обструктивного апноэ сна как на факторе риска развития инсульта. Обсуждаются полушарные особенности нарушения структуры сна у больных с инсультом. Подчеркивается взаимосвязь нарушений структуры сна в острый период инсульта с прогнозом и эффективностью реабилитации.

Keywords: сон, полисомнография, синдром обструктивного апноэ сна, инсульт, полушарная асимметрия.

The current review is concentrated on the modern pathogenetic data and analysis of age factor complex causing the progress of sarcopenia. Described the measuring methods of muscular weight of a body. Examined the molecular and cellular mechanisms of regeneration of muscular fibres and also the importance of power loading at the advanced age for maintenance of anabolic hormonal status. Represented data about reducing of different risk factors of death at level increase of general trainings.

Keywords: sarcopenia, anorexia, cytokines, satellite cells, markers of sarcopenia.

Представлены современные патогенетические данные и результаты анализа комплекса возрастных факторов, приводящих к развитию саркопении. Описаны методы измерения мышечной массы тела. Рассмотрены молекулярные и клеточные механизмы регенерации мышечных волокон и значение силовых нагрузок в пожилом возрасте для поддержания анаболического гормонального статуса. Представлены данные о снижении факторов риска смерти при повышении уровня общей тренированности.

Keywords: саркопения, анорексия, цитокины, сателлитные клетки, саркопенический индекс.

Цель — усовершенствовать систему оценки реабилитационного потенциала и восстановления двигательных функций у постинсультных больных.

Материалы и методы. В исследование включено 50 больных (средний возраст — (58,7 ± 3,79) года) с впервые возникшим полушарным ишемическим инсультом и умеренным неврологическим дефицитом в острый и ранний восстановительный период. Основным критерием включения в исследование было наличие моторных вызванных потенциалов при магнитной стимуляции моторной коры пораженного полушария. В программу обследования входила также нейровизуализация ишемического очага (аксиальная компьютерная или магнитно-резонансная томография). Транскраниальную магнитную стимуляцию (ТМС) применяли с диагностической целью, а также как компонент разработанной реабилитационной программы. Контролем служили показатели, полученные при обследовании 15 лиц такого же возраста без неврологической патологии.

Результаты. С учетом данных литературы и результатов собственных исследований проанализированы возможности ТМС как для объективной оценки нарушений моторики, так и для нервно-мышечной тренировки в период реабилитации. Описана авторская методика сочетанного использования ТМС и электромиостимуляции.

Выводы. ТМС является информативным методом реабилитационной диагностики для определения реабилитационного потенциала и отбора постинсультных больных для активных физических воздействий. Включение в реабилитационную программу ТМС в сочетании с электромиостимуляцией способствует повышению результативности медицинской реабилитации больных с полушарным ишемическим инсультом, что позволяет рекомендовать разработанную методику для практического применения.

Keywords: транскраниальная магнитная стимуляция, медицинская реабилитация, мозговой инсульт.

Цель — оценить прогностическую значимость ультрасонографических (УС) показателей констриктивно-стенотической артериопатии (КСА) для определения риска церебральной ишемии и выбора дифференцированного лечения в острый период субарахноидального кровоизлияния.

Материалы и методы. У 260 больных в острый период субарахноидального кровоизлияния вследствие разрыва артериальной аневризмы головного мозга проведены сопоставления результатов церебральной ангиографии, нейровизуализирующих исследований (спиральной компьютерной томографии), УС (дуплексного сканирования сосудов головы и шеи, транскраниальной допплерографии) и статистических методов.

Результаты. Установлено, что КСА в острый период субарахноидального кровоизлияния имеет прогрессирующий характер развития, частота ее выявления возрастает с 31,4 % в 1-е—3-и сутки до 90,8 % на 7—14-е сутки от момента сосудистой катастрофы. Диагностику и динамическое наблюдение КСА на этапах хирургического лечения можно проводить с помощью УС-метода, чувствительность которого для каротидного бассейна составляет: при умеренной степени КСА — 82 %, специфичность — 85 %, при выраженной степени — соответственно 91 и 98 %. Частота клинических проявлений КСА в виде отсроченной ишемии мозга достоверно увеличивается с нарастанием степени ее тяжести по данным ультрасонографии от умеренной (17,3 %) до выраженной (36,7 %) и критической (73,6 %). По результатам статистического анализа определены факторы риска отсроченной ишемии мозга: патологическое повышение систолической линейной скорости кровотока і 250 см/с (p < 0,05), полушарного индекса і 5 (p < 0,01), снижение суммарного объемного кровотока по двум внутренним сонным артериям и двум позвоночным артериям < 300 мл/мин (p < 0,05), уменьшение величины коэффициента ауторегуляции кровотока Ј 1,1 (p < 0,05), апоплектиформный тип развития КСА (p < 0,05), тотальный характер спазма с распространением на сегменты вертебрально-базилярного бассейна (p < 0,05). Выявленные патологические изменения кровотока в артериях основы мозга потребовали коррекции лечебной тактики, а также обоснования показаний к фармакологической эндоваскулярной ангиопластике.

Выводы. Установлено, что УС-исследование на этапах хирургического лечения обеспечивает достоверную диагностику КСА у больных с разрывом артериальной аневризмы головного мозга. Определенные УС-показатели, достоверно отображающие риск отсроченной ишемии мозга, свидетельствуют о необходимости изменения лечебной тактики и могут быть включены в комплекс показаний к применению эндоваскулярных методов лечения КСА.

Keywords: субарахноидальное кровоизлияние, артериальная аневризма головного мозга, констриктивно-стенотическая артериопатия (церебральный вазоспазм), отсроченная ишемия мозга, ультрасонография.

The aim – to present the selective nosotropic directed medicinal treatment, directed on deceleration of pathological process, on the basis of pattern of electroneuromyographic selection of demyelinating and axonal denervation on the different stages of hereditary motosensory neuropathies (HMNP).

Methods and subjects. 58 children, aged 5–16 years, were examined with HMNP: 25 children with HMNP1, 12 children with HMNP2, 21 child with HMNP X-type. The clinical state of children was estimated on the basis of the adapted and modernized scale of neurological violations on NIS LL (1996) with the estimation of musculare force (0–4 bulk-tankers), tendon reflexes (0–2 bulk-tankers); sensory violations (estimation of superficial sensitiveness, to the oscillation sensitiveness are 0–5 bulk-tankers), volume of active motions in talocrural joints (0–5 bulk-tankers), function of walking (0–4 bulk-tankers). To all children with HMNP, being in the register of database of the Donetsk Regional Child Clinical Center of Neuroreabilitation clinical ENMG and EMG-monitoring (1 time per 3–6 months) was conducted during 8–10 years.

Results. Comparative analysis of estimation of the clinical state on the adapted and modernized scale of neurological violations on NIS LL (1996) and exposed ENMG indexes allowed to set links of the stage of clinical displays with weight of neuropathies from data of ENMG. Considering the authentication of involved of myelin or аxon of nervous fiber, on the different stages of illness at HMNP, the method of treatment is selected according to data of EMG and EMG-monitoring. The chosen method should be directed on deceleration of pathological process.

Conclusions. Findings testify that standardization of early diagnostics and selection of demyelinating and axonal denervation for the children of HMNP from data of clinical ENMG and EMG-monitoring, taking into account the estimation of the clinical state on the adapted and modernized scale of neurological violations on NIS LL (1996), is the basis for development of new standards of early presemeiotic diagnostics of HMNP and standardizations of the nosotropic directed treatment with the use of modern medicinal facilities.

Keywords: hereditary motosensory polyneuropathies, clinical and electroneuromyographic diagnostics, treatment.

Цель — на основании паттерна электронейромиографического выделения миелино- и аксонопатий на различных стадиях наследственных мотосенсорных полиневропатий (НМСП) представить селективное медикаментозное лечение с целью замедления патологического процесса.

Материалы и методы. Обследовано 58 детей в возрасте от 5 до 16 лет с НМСП: 25 — с НМСП І типа, 12 — ІІ, 21 — Х типа. Клиническое состояние детей оценивали с помощью адаптированной и модифицированной шкалы невропатических нарушений NIS LL (1996). Всем детям проводили электронейромиографию (ЭНМГ) и ЭНМГ-мониторинг (1 раз в 3—6 мес) в течение 8—10 лет.

Результаты. Сравнительный анализ оценки клинического состояния по адаптированной и модифицированной шкале невропатических нарушений NIS LL (1996) и ЭНМГ-показателей позволил установить связь между стадией клинических проявлений и тяжестью полиневропатии по данным ЭНМГ. С учетом вовлеченности миелина или аксона нервного волокна на разных стадиях болезни при НМСП по данным базисной ЭНМГ и ЭНМГ-мониторинга выбирают метод лечения с целью замедления патологического процесса.

Выводы. Полученные данные свидетельствуют о том, что стандартизация ранней диагностики и выделения миелино- и аксонопатий у детей с НМСП по данным базисной ЭНМГ и ЭНМГ-мониторинга с учетом оценки клинического состояния по адаптированной и модифицированной шкале невропатических нарушений NIS LL (1996) является основой для разработки стандартов ранней досимптомной диагностики НМСП и лечения с использованием современных медикаментозных средств. 

Keywords: наследственные мотосенсорные полиневропатии, клинико-инструментальная диагностика, лечение.

Обсуждаются место ацеклофенака в группе нестероидных противовоспалительных препаратов и его эффективность при остеоартрозе.   

Keywords: остеоартроз, ацеклофенак.

Цель — оценить эффект изоформы ε2 аполипопротеина Е (апоЕ2), синтез которого в нервной ткани индуцирован методом генной терапии, при черепно-мозговой травме (ЧМТ) в эксперименте; на основании данныхлитературы объяснить механизм ее лечебного действия.

Материалы и методы. Структурные и функциональные изменения оценивали у взрослых крыс-самцов линии Вистар на 10-е сутки после тяжелой диффузной ЧМТ, воспроизведенной на модели «ударного ускорения» падающим грузом. После ЧМТ комплекс катионных липосом ДОТАП и 25 мкг плазмидного вектора pCMV

Результаты. Экспериментальное исследование показало, что липосомальная трансфекция геном апоЕ2оказывает протекторное воздействие на сосудистую систему и паренхиму головного мозга, предупреждаетразвитие зон вторичной дезинтеграции в травмированном мозге при ЧМТ у крыс, а также развитие посттравматического функционального дефицита.

Выводы. По данным литературы, возможными механизмами лечебного действия апоЕ2 являются его влияние на нормализацию липидного компонента нервных клеток, роль в регуляции глиальных реакций и воспалительного ответа ЦНС на травму, антиоксидантные эффекты, участие в регуляции процессов клеточной смерти,влияние на экспрессию других генов и регуляция геномного ответа клеток ЦНС на травму.

Keywords: черепно-мозговая травма, генная терапия, аполипопротеин Е, механизм действия.

Цель — изучить информативность ультразвукового исследования мышц для характеристики структурных изменений у больных с врожденными аномалиями развития спинного мозга.

Материалы и методы. Проведено комплексное клинико-неврологическое обследование 17 детей с нижним вялым парапарезом вследствие аномалии развития поясничного утолщения спинного мозга и 40 здоровых детей. Данные клинического обследования были дополнены электромиографией и ультразвуковым исследованием мышц.

Результаты. В группе больных выявлены грубые структурно-функциональные изменения мышц. Данные ультразвукового и электромиографического исследований коррелируют между собой. Полученные с помощью разработанного метода компьютерной оценки тяжести перерождения мышц показатели в группе больных детей достоверно отличаются от аналогичных показателей в группе здоровых детей.

Выводы. Внедрение в практику ультразвукового метода исследования мышц позволит значительно расширить лечебно-диагностические возможности врачей, занимающихся проблемами реабилитации.

Keywords: миелодисплазия, ультразвуковое исследование, электромиография, структура мышц.

Цель — изучить особенности патогенеза психоорганического синдрома в отдаленный период черепно-мозговой травмы (ЧМТ) путем сопоставления с результатами клинико-неврологического обследования пациентов с травматической болезнью головного мозга (ТБГМ), а также исследования гомеостаза нуклеиновых кислот и нуклеаз, уровня эндогенной интоксикации и обмена оксида азота.

Материалы и методы. В основу работы положены данные клинико-параклинического обследования 20 пациентов с отдаленными последствиями черепно-мозговой травмы, у которых в клинической картине ТБГМ доминировал психоорганический синдром.

Результаты. Наряду с клиническими проявлениями болезни у пациентов с ТБГМ отмечены нарушения гомеостаза нуклеиновых кислот и нуклеаз, эндогенная интоксикация. Нарушений в процессах обмена оксида азота не было.

Выводы. При доминирующем в клинической картине ТБГМ психоорганическом синдроме, наряду с клиническими проявлениями заболевания, имеются нарушения гомеостаза нуклеиновых кислот и нуклеаз, эндогенная интоксикация и отсутствуют нарушения процессов обмена оксида азота.

Keywords: отдаленный период черепно-мозговой травмы, психоорганический синдром, нуклеиновые кислоты, нуклеазы, перекисное окисление липидов, молекулы средней массы, оксид азота.

Цель — изучить возможное влияние уровня лептина в крови на возникновение сосудистых когнитивных нарушений (КН) у пациентов с метаболическим синдромом (МС) и хронической недостаточностью мозгового кровообращения (ХНМК). 

Материалы и методы. В исследование включили 30 больных в возрасте от 50 до 74 лет (средний возраст — (63,4 ± 7,6) года) с ХНМК и МС. Все больные прошли клинико-неврологическое обследование с измерением артериального давления, определением индекса массы тела (ИМТ). Пациентам проводили общие лабораторные тесты (общий анализ крови, общий анализ мочи, биохимический анализ крови, липидограмма), инструментальные (компьютерная и/или магнитно-резонансная томография головного мозга) исследования, регистрировали уровень лептина в крови. Для определения степени КН использовали краткую шкалу оценки психического статуса (MMSE). Состояние когнитивных функций больных дополнительно исследовали с помощью нейропсихологических тестов.

Результаты. Установлено, что уровень лептина тесно связан с ИМТ, то есть с выраженностью ожирения, и может быть рекомендован для использования в качестве диагностического критерия при МС. Уровень лептина, в отличие от ИМТ, коррелирует со степенью КН и может считаться одним из потенциальных факторов риска их возникновения у пациентов с МС. В то же время мы не выявили достоверной разницы в уровне лептина у больных с разной степенью тяжести КН.

Выводы. Полученные результаты свидетельствуют о необходимости проведения дальнейших исследований для уточнения роли лептина как прогностического фактора риска развития КН у больных с МС.

Keywords: когнитивные нарушения, лептин, метаболический синдром.