No 19 (2017)

The late stages of Parkinson’s disease are characterized by a change in the response to dopaminergic therapy with the formation of motor fluctuations and dyskinesias, the development of pronounced autonomic and cognitive insufficiency. The risk of development of motor fluctuations and dyskinesias after the initiation of therapy with levodopa is 10% per year. Therefore, in the late stages of Parkinson’s disease, it is necessary to modify the antiparkinsonian therapy with the crossover to prolonged dosage forms, and specific treatment of existent autonomic and cognitive disorders. Long-term therapy with amantadine is beneficial, because it reduces the likelihood and delays the development of dementia, helps to reduce the severity of motor fluctuations, and has an antidyskinetic effect.

SAPHO syndrome is an extremely rare disease with an unknown etiology, affecting the musculoskeletal system with the formation of osteitis and hyperostosis, as well as affecting the skin. Its place in the classification of rheumatological diseases, as well as the algorithm of therapy requires clarification. The article presents a clinical observation with a literature review.

The article discusses the causes of pain in osteoarthritis (OA), the role of inflammation in the pathogenesis of the disease, and the limitation of the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The current international recommendations 2014 and 2016, according to which treatment of OA is recommended to start with slow-acting symptom-modifying drugs (SYSADOA - Symptomatic Slow-Acting Drugs in Osteoarthritis), are presented. Data on analgesic and anti-inflammatory effects of chondroitin sulfate (ChS), and its safety are given. It is shown that it is possible to achieve a more rapid effect when using the injectable dosage form of ChS. Data on the mechanism of action, safety and efficacy of hyaluronic acid preparations are discussed.

The evaluation of clinical and laboratory predictors of the effectiveness of combination therapy with methotrexate and infliximab in rheumatoid arthritis (RA) was performed. A 30-week study included 18 patients with RA. It has been established that background anti-inflammatory therapy in combination with genetically engineered biologic drugs leads to a significant improvement in clinical and laboratory indicators (a marked decrease in the of acute phase inflammatory marker levels, normalization of the hemogram) and the quality of life of patients with high RA activity.

The aim of the study was to compare the neurophysiological parameters of segmental (according to electroneuromyography, ENMG) and suprasegmental (according to transcranial magnetic stimulation, TCMS) motor conduction in patients with different timing of spinal cord injuries. Two groups of patients with spinal cord injuries were examined: group 1 - with the duration of the disease less than 1 year (n=50), group 2 - patients with the disease duration 1-2 years (n=48). The stimulation ENMG method was used to evaluate the parameters of conduction to the posterior tibial nerves; the TCMS method was used to the evaluation of the parameters of corticospinal conduction to the muscles of the lower extremities. Patients with positive dynamics in neurological and functional statuses showed a decrease in velocity parameters according to ENMG data, especially in terms of F-wave parameters, and in a relatively short duration of the disease (up to 1 year), and also had the best parameters of corticospinal conduction according to TKMS at baseline. Dynamic observation in patients with positive dynamics reveals signs of resorption of axons inhibiting the regeneration at the site of damage to myelin residues - an increase in the latencies of cortical evoked motor responses and the central motor conduction time. It was concluded that the data of neurophysiological examination of patients with spinal cord injuries, especially with short duration of the disease (up to 1 year), allows to predict the results of rehabilitation measures to a certain extent.

In recent years, the possibilities of rehabilitation of stroke patients have increased due to the use of the “brain-computer neurointerface+hand exoskeleton (BCIHE) technology, which is based on the stimulation of the mechanism of neuroplasticity. The processes of activation of the motor structures arising in the nervous system with the regular kinesthetic imagination of the purposeful movement (hand extension), reinforced by the reverse visual and proprioceptive connections, contribute to the restoration and/ or compensation of the lost motor function. In the study, 89 patients were screened to select patients for rehabilitation, and 75 stroke patients met the inclusion criteria. Active participation of the patient during training with the help of a neurointerface is considered an important aspect of this type of neurorehabilitation. Directive teaching of the patient to the kinesthetic imagination during the training using BCIHE technology promotes the stimulation of the preserved brain regions that are able to control the movement. It is emphasized that the level of cognitive function can serve as a criterion for estimating the reserve of individual ability to imagine the movement. This proposition suggests that stimulation of cognitive functions in stroke patients can contribute to a more successful motor rehabilitation process.

The article presents the results of the analysis of the Russian market of neuroprotectors based on the information demand index of the system of the drug register (Vyshkovsky index), the publication and research activity of brands according to foreign and Russian electronic databases, the sales volume and the share of the pharmaceutical market according to DSM Group, IMS Healh. This analysis allows to determine the regularities of development of the Russian market of neuroprotectors, both from a medical and an economic point of view. The rating of the Russian market of neuroprotectors is determined, including 207 trade names, among which Russian prescription synthetic medicines, oral forms, and generics predominate. The latter provide a significant increase in the share of the Russian pharmaceutical business of neuroprotectors. A detailed complex analysis of the top 10 most popular and marketed neuroprotectors on the Russian market used to treat cerebrovascular diseases is given. It is shown that sales reliably directly correlate with the information demand index, and the length prescription of the medicines. It is established that the number of clinical studies and publications is directly proportional to the growth of financial success. The first lines of the rating are held by brands that exist on the market for more than 20 years and have a rich publication base.