编号 9 (2016)

Migraine in children and adolescents affects the quality of life not only the child, but the family as a whole. The choice of treatment tactics must rely on the age, characteristics of the disease, comorbidities, the patient's individual characteristics, and combine both drugs and non-drug therapies. Preventive migraine therapy is aimed at improvement of patient’s condition, and allows avoiding or reducing the progression of the disease in adulthood. At present, such drugs as amitriptyline, topiramate, valproic acid have sufficient evidence base of effectiveness of prophylactic therapy. Nutraceuticals are alternative prophylactic treatment of migraine in children and can be offered in cases when the parents do not agree to accept traditional medicines. There are publications about the effectiveness of coenzyme Q10 and riboflavin in the prophylactic treatment of migraine in children. Also, the effectiveness of drug therapy in children is increased by the additional use of non-drug methods of treatment.

By the example of Ceraxon® (citicoline), the problems of coexistence of generic drugs (generics) and original medicines on the market are discussed in details. It is emphasized that the process of creating a new drug is very time-consuming, high-tech, expensive and long, that, as a rule, determines its high cost. Generic drugs are much cheaper, but they do not pass the multi-stage procedure for evaluation of the efficacy and safety for humans and animals, which are used for the original drugs. The adequacy of the various methods of evaluation of the equivalence of original and generic drugs is discussed. In the case of citicoline, particularly, correct evaluation of bioequivalence is hard enough to perform because it is a natural compound contained in human body. As part of such research, it is extremely difficult to differentiate between exogenous and endogenous citicoline and determine their concentrations. Comparisons between Ceraxon® and its generics are embarrassed by optical isomerism phenomenon. Obviously, the use of original Ceraxon® allows the physician to be sure of the full implementation of certain pharmacodynamic effects of the drug, and hence in a potentially successful treatment of a wide range of neurological disorders, in which it is indicated and used.

Post-stroke cognitive impairment develops more than half of patients after a stroke, having a negative impact on the course of the underlying disease and is steadily progressing. One of the main factors that determine the severity of cognitive deficit is the amount of damaged brain tissue. It is necessary to use drugs that are effective against cognitive impairment and are able to reduce or prevent the death of neurons outside the ischemic core, and stimulate neuroplasticity processes. Such preparations include memantine (Akatinol) -voltage-dependent, a noncompetitive antagonist of the NMDA-receptors. The results of experimental and clinical studies have shown broad prospects for the use of memantine in the treatment of post-stroke cognitive disorders.

Favorable pharmacokinetic profiles of antiepileptic drugs (AEDs) with linear kinetics, stable blood concentration, absence of clinically significant interactions with other drugs are important for the treatment of epilepsy in children and adolescents in the outpatient settings. Levetiracetam meets all these requirements. The study was aimed to the evaluation of the use of levetiracetam in outpatient neuropediatric practice. The study included 61 patients with various forms of epilepsy, including 31 girls and 30 boys between the ages of 2 and 17 years. 47 patients had concomitant diseases (neurological, somatic, endocrine), and this required particularly cautious approach for the selection of AEDs. Levetiracetam was administered in a therapeutic dose of 30 to 70 mg/kg/day. 23 (37.7%) children were on monotherapy; dual therapy was applied in 33 (54%) cases; and 5 (8.1%) children had received three AEDs. Positive clinical effect was achieved in 53 children - predominantly at 3 months of therapy, and in some cases already at 1-2 months of treatment, including slowing attacks by 25% in 2 children, by 50% - in 11, by 75% - in 3 children, and absence of seizures within 3-5 months in 38 (62.2%) children. Levetiracetam showed a high therapeutic efficacy, good tolerability, including in children and adolescents with comorbidity, so it has the advantage over other AEDs for use in outpatient neuropediatric practice.

The article discusses the problem of nephroprotection in hypertensive patients with renal impairment (cardiorenal syndrome). Pronounced nephroprotective, antihypertensive and lipid-lowering effects of lercanidipine along with its high-safety use have been proven in several clinical studies, that allow to consider this preparation as preferred drug for nephroprotection with blood pressure control in middle-aged and elderly patients with manifestations of advanced atherosclerosis.