No 13 (2016)

Experimental and clinical data demonstrate that antiepileptic drugs (AEDs) in addition to anticonvulsive effect can modulate the mood and behavior of the patients with epilepsy. Therapeutic targets may be common - interference with the metabolism of y-aminobutyric acid and neurotransmitters, and also with the function of ion channels of brain. Some AEDs have a specific influence that should be considered for the selection of therapy. Effects on behavior and mood can be multidirectional. Positive effects (for example, with the use of valproate) have long been used not only in neurology but also in psychiatry. Adverse effects (they are regarded as adverse events) can be avoided by awareness on risk groups for their development, or by minimization the degree of severity with decrease in the dose. The review presents modern data on the effect of specific AEDs on the behavior and mood of patients with epilepsy. A more precise definition of psychotropic profile of AEDS will lead to greater individualization of treatment and possibly to the definition of a new strategy of treatment of psychiatric conditions.

The article analyzes the most frequent causes and characteristics of chronic pain phenomenon in the elderly that should be considered when analgesic therapy is provided. It is emphasized that the core task today is to develop the tactics of opioids use in non-cancer patients. While administering opioids for patients with a favorable life prognosis the pain control tactics is dedicated (alongside with getting rid of pain and its persistency prevention) to addiction prevention that dictates the use of opioids only for pain exacerbation control. The classical pain pharmacotherapy scheme should take into account the factors that reduce the risk of tolerance and dependence. Opioids and non-opioids combination should be used. In addition, it is necessary to consider that during analgesic therapy (especially in patients aged 75 years and older) it is difficult to select the optimal dose of opioids and to predict the adverse reactions risk which requires respecting the principle of «start with small doses and increase the dose gradually.» In order to determine the optimum tactics of analgesic therapy in elderly patients the authors have studied the efficacy and tolerability of a combined drug containing low doses of Tramadol Hydrochloride and low doses of Paracetamol (cTP) in these age group representatives. Adequate pain control was achieved in 85.7% patients, including complete and sufficient -in 57.1%, satisfactory - in 28.6% patients. Adverse side effects were observed in 7.2% of patients. Herewith most of them were unbinding. The study results allow recommending cTP as the first line remedy for chronic pain control in the elderly with low pharmacological risks.

Osteoarthritis (OA) became one of the most important diseases of the musculoskeletal system in the twenty-first century. Active, aggressive catabolism of the articular cartilage plays a significant role in the pathogenesis of this disease. Glucosamine is a major modifier of cartilage structural. It has all properties applicable to chondroprotective drugs. 52 patients with OA aged 62-72 years (mean age, 64.6 years) were examined and treated with glucosamine sulfate (Sustaguard Artro). The results of treatment showed a pronounced analgesic and anti-inflammatory effects in patients receiving combination therapy with Sustaguard Artro in combination with traditional drugs.

Inclusion of taurine in a daily dose of 750 mg in the standard therapy in patients with chronic heart failure with preserved ejection fraction improves exercise tolerance, improves the functional class of heart failure and reduces the number of re-admissions due to decompensation. The use of this drug improves diastolic left ventricular function without significant dynamics in the size of the left heart chambers and ejection fraction. The efficacy of taurine in the treatment of patients is confirmed by significant decrease in blood NT-proBNP and galectin 3 levels.

This article analyzes the results of a prospective, randomized, double-blind, placebo-controlled multicenter CARS study («Cerebrolysin And Recovery after Stroke»), which was aimed to the evaluation of the efficacy and safety of use of the drug Cerebrolysin on the background of the rehabilitation measures in the recovery period after a stroke. The study included patients with hemispheric ischemic stroke aged 18 to 80 years. Cerebrolysin or placebo was administered once a day at the dose of 30 ml for 21 days; infusions were started 24 to 72 hours from the stroke onset and lasted for 20 minutes. The results led to the conclusion that the CARS study is the first among the previously conducted clinical trials of neuroprotective agents, in which the primary end point (recovery of motor function) was achieved. These results open up new potentials for the medicamentous support of rehabilitation measures in ischemic stroke patients.

Cognitive disorders occur in 90-95% of patients with Parkinson’s disease (PD). According to population-based studies, dementia occurs in 20-40% of patients with PD, according to longitudinal studies - up to 83% of patients. There is no consensus on the causes of dementia in PD. The article presents the results of evaluation of heterogeneity of dementia in 50 PD patients and the possible reasons for its development. The study allowed to identify several types of dementia in PD: 1) with predominantly frontal-subcortical deficits; 2) with predominantly fronto-subcortical deficits and severe behavioral disorders; 3) with severe visual-spatial and neurodynamic disorders, in combination with fluctuations of severity of cognitive disorders; 4) with primary hippocampal-dependent memory impairment. Factors for unfavorable course of dementia and mortality included severe visual-spatial disorders, primary hippocampal-dependent memory impairment in combination with fluctuations of severity of cognitive disorders.

This article describes an unusual clinical case, requiring rely on own expert’s opinion (and literature data) to get out of the difficult situation as in the present clinical observation - the combination of high risks of thromboembolic and hemorrhagic events.