The results of the literature analysis and some of own research related to vertebroneurological constitutional approach are presented in the article. This approach was established as relevant and promising. Constitutional type of a person is a basis to clarify features of the development and course of neurological syndromes, including prevalent pains in the neck, low back and all back. It can contribute to improve the prevention, treatment and rehabilitation.

Keywords: constitutional type of the person (human constitution), somatotype, body composition, temperament, vertebroneurology, spine, pathogenesis, course, prevention, treatment, rehabilitation.

Objective — to study the characteristic of neurological deficiency dynamic and frequency of early lethality in patients with acute stroke subjected to proteasome genes allelic polymorphism which codes the large multifunctional protease LMP2 (Arg60 → His-polymorphism) and core structure proteasome subunit alpha type-6 PSMA6 (С-8 → G-polymorphism).
Methods and subjects. Examination was carried out in 102 patients (54 (52.9 %) male and 48 (47.1 %) female) with an acute stroke, mean age was (70.4 ± 9.9). Control group included 92 patients comparable according to demographical characteristics and stroke risk factors with patients from the main group. All patients underwent clinical and neurological examination and test for proteasome genes allelic polymorphism LMP2 and PSMA6 determination by means of Real Time PCR in DNA extracted from whole blood with the use of NucleoSpin®Blood (USA).
Results. Initial neurological deficiency in patients with major homozygous and heterozygous polymorphism LMP2 types averaged (11.9 ± 2.0) and (11.9 ± 2.5) correspondently. Patients with minor homozygous polymorphism had more clinical apparent neurological deficiency (12.6 ± 1.9) the disparity was uncertain (р = 0.64). Initial neurological deficiency in patient with major homozygous gene PSMA6 averaged (11.8 ± 2,3), heterozygous polymorphism averaged (12.6 ± 1.8), patients with minor homozygous polymorphism had (12.3 ± 1.5) points. Evidenced disparity was not determined in initial neurological deficiency between patients with different PSMA6 polymorphism types (р = 0.40).
Conclusions. Early clinical lethality (within two weeks after stroke) averaged 20.6 %. Patients with minor LMP2 allelic polymorphism had more lethal outcomes (40 %). Patients with minor PSMA6 allelic polymorphism did not have lethal outcomes. Patients with heterozygous LMP2 allelic type demonstrated better neurological functions recovery. Patients with minor homozygous LMP2 allelic type demonstrated worse recover on the 7th (р = 0.003) and 14th (р = 0.0001) days. Differences in neurological deficiency dynamic was not observed in patients with PSMA6 allelic polymorphism type.

Keywords: stroke, allelic polymorphism, LMP2 gene, PSMA6 gene, proteasome proteolysis.

Objective — to study the mitochondrial potential of leukocytes, intracellular reactive oxygen species and apoptosis of white blood cells in the acute period of ischemic stroke (IS).
Methods and subjects. The study involved 86 patients with different subtypes of IS aged from 45 to 75. We determined the number of leukocytes in peripheral blood in apoptosis (ANV+-cells) and necrosis (PI+-cells), white blood cells with a high content of intracellular ROS (ROS+-cells) and leukocytes with reduced levels of mitochondrial membrane potential (Mito+-cells) by flow cytometry Epics XL.
Results. We found that in the acute period of all subtypes of IS mitochondrial dysfunction occurs on 1st day, intracellular oxidative stress, apoptosis and necrosis of white blood cells, which shows an increasing number of ANV+-, PI+-, ROS+- and Mito+-cells, also present. On the 7th day we observed the reduction of PI+-, ROS+- and Mito+-cells in atherothrombotic and hemodynamic IS. At the large atherothrombotic and cardioembolic IS the marked increase of mitochondrial dysfunction (increased number of Mito+- and ROS+-cells) on the 7th day was determined and the related processes of apoptosis and necrosis (increase the level of ANV+- and PI+-cells) were also present. Correlation between the number of Mito+-cells and ANV+-, PI+-, ROS+-cells in the 1st and 7th day of IS were observed. Were found correlation between the severity of atherothrombotic IS and content of Mito+- and ANV+-cells.
Conclusions. The results of the study indicate a role of mitochondrial dysfunction in the pathogenesis of different subtypes of IS. A direct effect of mitochondrial dysfunction and mitochondrial-induced apoptosis in atherothrombotic second course in the acute period was demonstrated.

Keywords: acute period of ischemic stroke, apoptosis, necrosis, reactive oxygen species, mitochondria.

Objective — to determine the content in blood plasma anti-inflammatory cytokine IL-10 in patients with various types of stroke in the acute period for the development of treatment for this disease.
Methods and subjects. We examined 90 patients in the acute phase of stroke with different types: ischemic stroke, hemorrhagic stroke, ischemic stroke with hemorrhagic transformation, and 21 patients of the comparison group (with discirculatory encephalopathy). We measured the anti-inflammatory interleukin-10 (IL-10) in blood plasma on the 1st day of the disease and in dynamics on the 7 — 10th day.
Results. It was determined that the concentration of IL-10 on the 1st day of the disease in patients with stroke was significantly elevated relatively to the comparison group, in the dynamics IL-10 in the blood plasma decreased in patients with ischemic and hemorrhagic stroke and rose in patients with ischemic stroke with hemorrhagic transformation, but was higher than the comparison group. Also found that the more intense inflammatory response was observed in patients with hemorrhagic stroke.
Conclusions. The concentration of IL-10 significantly increased in patients with stroke rather than comparison group. The most marked anti-inflammatory response was observed in patients with hemorrhagic stroke.

Keywords: ischemic stroke, hemorrhagic stroke, ischemic stroke with hemorrhagic transformation, interleukin-10.

Objective — to a study the content and ratio of biogenic amines and correlation of their blood levels and concentrations of 2,3-diphosphogliceratis in red blood cells of young patients with spondylogenic vertebrobasilar insufficiency (SVBI).
Methods and subjects. 65 (42 female and 23 male)patients with SVBI aged from 25 to 40 years old (mean age 28.5 ± 3.8), undergoing treatment in neurological department of Kharkov Regional Clinical Нospital were examined. The content of biogenic amines was determined by thin layer chromatography followed by analysis of fractions using spectrofluorometry. Concentration of 2,3-DPG in red blood cells was determined by spectrophotometry.
Results. Concentration of 2,3-DPG in red blood cells in patients with SVBI was elevated and maximum elevated level was determined in patients with elevated serotonin content. High cross-correlation between the level of noradrenaline and 2,3-DPG (r = –0.75 ± 0.03; р < 0.05), and also between the level of serotonin and 2,3-DPG (r = –0.83 ± 0.02; р < 0.05) was observed.
Conclusions. The obtained results entitles us to conclude that the disbalance in the catecholamins system and high level of serum serotonin play remarkable role in the development of hypoxia in young patients with SVBI.

Keywords: spondylogenic vertebrobasilar insufficiency, 2,3-diphosphogliceratis in red blood cells, biogenic amines.

Objective — to study the influence of body weight index and smoking on clinical characteristics of this disease.
Methods and subjects. The study involved 242 patients (168 female and 74 male) with relapsing-remitting multiple sclerosis in remission (citizens of Ivano-Frankivsk city and Ivano-Frankivsk region) were examined. The patients’ mean age constituted 37.96 ± 0.67, the mean severity on a scale Expanded Disability Status Scale (EDSS) was 4.50 ± 0.08 points. The control group in this study was not provided. Case history and anamnesis were collected from all patients. Clinical neurological examination was carried out.
Results. It was detected that all the examined patients with MS had relapse remitting disease dynamics irrespective of risk factors. Body weight at birth and body weight index at 18 do not influence the age of MS onset. The patient with higher body weight index at 20 had higher possibility of MS initial progressive type. Body weight index at 20 does not influence the age debut and progressing of MS according to EDSS scale. In the patient group with relapse remitting dynamics there were more non-smokers, and in the group with secondary progressing type there were more smokers. The transfer to the secondary progressing dynamics was significantly bigger in the group of smokers.
Conclusions. Such risk factors as overweight and smoking should be considered at MS patients consultation, since it is known that they cause more active disease dynamics. Body weight index at the age of 20 was statically higher in patients with initial progressing dynamics type.

Keywords: multiplesclerosis, etiology, body mass index, smoking.

Objective — to analyze the correlation between ecological and population characteristics and epidemiological indicators of multiple sclerosis (MS) in districts of Volyn region.
Methods and subjects. Volyn registry of patients with MS was created in 2012. Health records of outpatients with multiple sclerosis who are observed in the center of demyelinating diseases of Volyn Regional Hospital and Medical Documentation of local district polyclinics and clinics of Lutsk were analyzed. The ecological passport of Volyn region and the Statistical Yearbook of the Main Department of Statistics in the Volyn region, annual directories performance of health care institutions in Volyn region were used to analyze the correlation of ecological and population characteristics and indicators of MS.
Results. Areas in the Volyn region of the unfavorable environmental conditions and the greatest prevalence of MS were identified. The correlation between ecological and population characteristics and epidemiological indicators (percentage distribution of patients by the type of disease course, age onset, mean age, gender ratio, time from disease onset to diagnosis of MS) in districts of Volyn region were analyzed.
Conclusions. Adverse environmental conditions may be a factor in the realization of high genetic susceptibility to MS. To increase the risk of disease onset the combination of various environmental and population factors and genetic susceptibility to MS are significant. The availability of health care also affects the difference epidemiological indicators in districts. Gender ratio and the distribution of patients by type of course of MS are not under the prevalence of the disease and contamination in the district.

Keywords: multiple sclerosis, unfavorable environmental conditions, epidemiological indicators.

Objective — to study pathogenic and clinical significance of autoantibodies specific to myelin basic protein (MBP) and histone H1 in the development of neuropsychological disorders in patients with multiple sclerosis (MS) and the influence of this parameter on the quality of life of patients.
Methods and subjects. We examined 55 MS patients, men and women of different ages, with different disease course. All patients underwent general clinical, neurological studies, assessed cognitive status and severity of the syndrome of fatigue, depressive symptoms and quality of life. In the serum of patients with MS the content of antibodies (AB), specific to MBP and histone H1 were determined by means of enzyme immunoassay.
Results. It is established that IgG antibodies with affinity to MBP and histone H1 were present in the serum of patients with MS. We found that the affinity of autoantibodies to histone H1 is much higher compared to the affinity of the same samples on MBP. Worsen fatigue syndrome and quality of life were observed as an increase of anti-histone H1 and anti-MBP AB levels. The rise of anti- histone H1 AB affects attention, frontal dysfunction, conceptualization ability in MS patients, whereas increasing of anti-MBP AB affected praxis.
Conclusions. Anti-MBP and anti-histone H1 AB play an important role in the pathogenesis of MS and may serve as markers of clinical course.

Keywords: multiple sclerosis, IgG, histone H1, myelin basic protein.

Objective — to compare efficiency and safety of etodolac (Etol Fort, by Nobel) and diclofenac for treatment of lower back pain.
Methods and subjects. 26 patients aged 45 — 75 years (mean age 60.9 ± 7.7) were examined and treated in SI  «D. F. Chebotarev Institute of Gerontology of NAMS of Ukraine». All of them suffered from lower back pain against the background of lumbosacral spinal column osteochondrosis in exacerbation period. Patients were randomly divided into 2 groups 13 patients in each group. Patients of the main group got etodolac 400 mg twice a day, patient from control group got diclofenac 75 mg twice a day.
Results. Evidenced efficiency of etodolac was proved relatively to abatement of marked vertebral painful syndrome and patients life quality improvement. Number and evidence of side effects in both groups was the same as noted in the literature. Evidenced efficiency of etodolac action relatively to abatement of marked vertebral painful syndrome and functional activity improvement was observed on the 7th day of etodolac therapy.
Conclusions. Etodolac efficiency is comparable to «standard» painful syndromes treatment — diclofenac.

Keywords: lower back pain, osteochondrosis, treatment, etodolac.

Objective — to evaluate the brain-derived neurotrophic factor (BDNF) blood plasma levels in patients with main etiological types of mild cognitive impairments (neurodegenerative, NMCI and subcortical vascular, SVMCI) before and after escitalopram treatment.
Methods and subjects. We enrolled 21 patients with NMCI, according to the Mild Cognitive Impairment (MCI) due to Alzheimer’s Disease Workgroup criteria (2010), 22 patients with SVMCI, according to G. B. Frisoni et al. (2002) criteria and n = 16 persons without cognitive impairments (WCI). Comparison groups were comparable in age and belonged to elderly and senile persons. BDNF blood plasma levels were evaluated through ELISA method in all enrolled persons at baseline and in 10 NMCI patients and SVMCI patients after 2 months of escitalopram therapy (10 mg a day). Clinical protocol included neuropsychological testing (Luria’s tests, MMSE and other valid approaches), psychopathological study (The Neuropsychiatric Inventory), neurological examination, disturbances in daily life activities study (The Bristol Activities of Daily Living Scale).
Results. It is shown that plasma BDNF levels decreased in groups of NMCI (19950.67 ± 9678.80 pg/ml) and SVMCI (25939.55 ± 10410.46 pg/ml) versus control (31581.50 ± 8092.29 pg/ml). Reduction of BDNF level had the highest correlation with severity of memory impairments (r = 0.72, p < 0.05) and the MMSE total score worsening (r = 0.49, p < 0.05) in NMCI group. Escitalopram treatment led to increased levels of plasma BDNF in NMCI (26356.00 ± 8309.11 pg/ml) and SVMCI (30066.00 ± 10796.43 pg/ml) groups. The increase in BDNF levels was significantly related to the improvement in MMSE and The Neuropsychiatric Inventory scores of the patients.
Conclusions. The reduce in BDNF blood plasma concentration can be used for validation of NMCI and SVMCI diagnosis and its increase as a reliable marker of the therapy effectiveness.

Keywords: brain-derived neurotrophic factor, neurodegenerative mild cognitive impairment, subcortical vascular mild cognitive impairment, escitalopram.

It was established that during therapy with valacyclovir (Gerpeval 500), regardless of the type observed immunodeficiencies, there is a normalization of the immune system, as evidenced by the restoration of cellular and humoral units. Gerpeval 500 on the main criteria of efficacy and tolerability compared well with the reference valacyclovir. Reference drugs showed a high safety profile: in patients treatment was well tolerated and there were no any clinically significant adverse effects. Valacyclovir therapy is convenient for patients, as well as to enhance the quality of life and restore social activity.

Keywords: herpes zoster, еtiotropic therapy, valacyclovir, immune system, efficiency, safety.

Обобщены данные литературы о синдроме Герстмана, типичном для процессов, локализованных в теменно-височно-затылочной части левого полушария головного мозга. Приведено собственное клиническое наблюдение пациента-левши, полиглота с этим синдромом, обусловленным правополушарным ишемическим инсультом.

Keywords: синдром Герстмана, аграфия, акалькулия, пальцевая агнозия, аутотопагнозия.

Цель — изучить особенности динамики неврологического дефицита и частоту развития ранней летальности у больных с острым ишемическим инсультом в зависимости от аллельного полиморфизма генов, которые кодируют большую мультифункциональную протеазу LMP2 (полиморфизм Arg60 → His) и α-6-субъединицу корковой части протеасомы PSMA6 (полиморфизм С-8 → G).
Материалы и методы. Обследованы 102 пациента (54 (52,9 %) мужчины и 48 (47,1 %) женщин) с острым ишемическим инсультом, средний возраст которых на момент развития инсульта составлял (70,4 ± 9,9) года. Контрольная группа состояла из 92 лиц, сопоставимых по основным демографическим показателям и факторам риска инсульта с больными основной группы. Пациентам обеих групп, кроме общепринятого клинико-неврологического обследования, определяли аллельный полиморфизм генов LMP2 (Arg60His → ) и PSMA6 (C-8 → G) с применением методики Real Time PCR в ДНК, выделенной из цельной крови, с использованием наборов NucleoSpin®Blood (США).
Результаты. Исходный неврологический дефицит у пациентов с мажорным гомозиготным и гетерозиготным вариантами полиморфизма гена LMP2 в среднем составлял (11,9 ± 2,0) и (11,9 ± 2,5) балла соответственно. У больных с минорным гомозиготным вариантом полиморфизма зарегистрирован несколько более выраженный неврологический дефицит — (12,6 ± 1,9) балла, различия недостоверны (р = 0,64). Исходный неврологический дефицит у пациентов с мажорным гомозиготным вариантом гена PSMA6 в среднем составлял (11,8 ± 2,3) балла, с гетерозиготным вариантом полиморфизма — (12,6 ± 1,8) балла, у больных с минорным гомозиготным вариантом полиморфизма — (12,3 ± 1,5) балла. Достоверных различий в исходном неврологическом дефиците между больными с разными вариантами аллельного полиморфизма гена PSMA6 не установлено (р = 0,40).
Выводы. Ранняя госпитальная летальность (на протяжении первых двух недель после развития ишемического инсульта) составляла 20,6 %.У пациентов с минорным вариантом аллельного полиморфизма гена LMP2 зарегистрирована бо′ль­шая частота летальных случаев (40 %). Среди пациентов с минорным вариантом аллельного полиморфизма гена PSMA6 летальные случаи не зарегистрированы. Лучшую динамику возобновления неврологических функций наблюдали у пациентов с гетерозиготным аллельным вариантом гена LMP2, достоверно худшее возобновление на 7-е (р = 0,003) и 14-е (р = 0,0001) сутки — у пациентов с минорным гомозиготным вариантом гена LMP2. Различий в динамике неврологического дефицита между больными с аллельными вариантами гена PSMA6 не установлено.

Keywords: ишемический инсульт, аллельный полиморфизм, ген LMP2, ген PSMA6, протеасомный протеолиз.