Vol 26, No 13 (2019)

Migraine and endometriosis have common clinical and epidemiological features that determine their comorbidity. The early age of menarche, the high prevalence among women of reproductive age, the frequent complaint of menorrhagia, as well as the high prevalence of concomitant functional disorders - all this is characteristic of migraine and endometriosis. For preparing a literature review, studies on the comorbidity of migraine and endometriosis from 1975 to 2019 in the international Pubmed database were analyzed. Analysis of the literature showed a high comorbidity of migraine and endometriosis. The relationship between the diseases is attributable to hormonal factors (prevalence in women of reproductive age with an early menarche in history, dependence on fluctuations in estrogen levels), common genes, central sensitization mechanisms, inflammatory mediators (nitrogen nitrate, prostaglandins and cytokines), which play an important role both in the pathogenesis of a migraine attack, and in development of foci of endometriosis. The article highlights the most controversial issues requiring further study, among which the choice of the most effective and safe hormonal drug for the treatment of endometriosis in patients with comorbid migraine is of the greatest practical importance.

The article presents relevant data on the main principles and recommendations for the management and treatment of patients with axial spondyloarthritis (axSpA). Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line drugs prescribed for axSpA. The effect of NSAIDs on the activity and radiological progression of axSpA is described in detail. From the perspective of a balance of efficacy and safety profile of NSAIDs, patients with axSpA can use selective COX-2 inhibitor etoricoxib (Arcoxia®) for a long time; it has been well studied with prolonged use and has a large base of research with a high degree of evidence.

Background. In patients with facial nerve (FN) injury, facial synkinesia and contractures on the affected side against the background of existing mimic muscle weakness can develop 4-6 months after neurosurgical interventions, and it can lead to significant social maladaptation and a decrease in the quality of life. Objective. Evaluation of the effectiveness of botulinum therapy in patients with synkinesia after neurosurgical interventions. Methods. The study included 150 patients with FN neuropathy after surgical treatment of tumors of the posterior cranial fossa and the cerebello-pontine angle, which were divided into two groups. Group I (main group) included 103 (68.7%) patients who had been prescribed botulinum toxin type A (BTA) - Incobotulinumtoxin A starting from the first days after FN injury. Synkinesia correction was carried out according to the following method: BTA was administered in small doses (0,5-1.5 ME per injection point) with symmetrical injection on the unaffected side at 1.5-2 fold higher dosese. Group II (control group) included 47 (31.3%) patients; they received physical therapy courses with special exercises and acupressure of painful muscular bands. The Sunnybrook Facial Grading Scale (SFGS) was used to assess facial symmetry and synkinesia. The quality of life during therapy was evaluated according to the FDI (Facial Disability Index) scale. The total duration of patient participation in the study was 2 years (control points - 6, 12 and 24 months). Results. Six months after the FN injury, synkinesia was detected in 48 (46.6%) and 30 (63.8%) patients, 1 year later - in 28 (27.2%) and 32 (68.1%; p<0.001), and 2 years later - in 14 (13.6%) and 40 (85.1%; p<0.001) patients of groups I and II, respectively. 6, 12, and 24 months after FN injury, the general condition of the facial muscles according to SFGS scale was 2.0, 2.3, and 1.68 fold better in patients of group I compared to the patients of group II (p<0,01). Against the background of the treatment of synkinesia in patients of group I, the severity of clinical symptoms significantly decreased, which was expressed in the form of a decrease in the frequency of involuntary contractions, decreased Chvostek’s sign on the unaffected side, low rate of blinking, as well as a decrease in masseteric hypertrophy on the unaffected side, less dry eye symptom and Bogorad’ symptom at 6, 12 and 24 months of the study compared to the patients of group II. In patients receiving botulinum therapy, the quality of life was also significantly higher during the whole period of the study. Conclusion. In case of synkinesia in patients after neurosurgical interventions for tumors of the posterior cranial fossa and the cere-bello-pontine angle, botulinum therapy is indicated both on injured and unaffected sides, while the dose of the drug on the injured side should be 1/2 to 1/3 of the that on the unaffected side.

Background. Despite the high incidence of tension-type headaches (TTH) among adolescents and the need to find alternative therapies, studies on the non-pharmacological methods of treatment for TTH, in particular, dynamic electric neurostimulation (DENS), are rare. Objective. Evaluation of the efficacy of DENS in the treatment of TTH in adolescents. Methods. In the period from 2013 to 2018, a randomized, double-blind, placebo-controlled study of the efficacy of DENS was conducted; the study included 132 adolescents aged 10 to 17 years suffering from TTH with an attack frequency of >10 per month. Randomization was carried out using the Randomization plan program, 69 children were included in the DENS group, 63 children - in the placebo group. Results. At baseline, there were no statistically significant differences between the DENS group and placebo group in the incidence of TTH attacks (p=0.254), their intensity (p=0.157) and the HALT index (p=0.105). A significant difference was found between the DENS and placebo groups in terms of the frequency of relief of TTH attacks (x2= 10.65; p=0.001). 3 months after the end of the course of therapy, there was a positive trend in the form of a decrease in the incidence of TTH attacks in both groups (p=0.0002 for the placebo group, and p=0.000004 for the DENS group). Significant differences between the DENS and placebo groups in the incidence of TTH attacks 3 months after the course of treatment could not be detected (p>0.05). After the course of treatment, a more significant decrease in the HALT index was revealed in the DENS group (p=0.000049). Side effects were not recorded during DENS sessions. Conclusion. DENS can be recommended as a non-drug method for stopping TTH attack in adolescents. DENS course allows to reduce the impact of TTH on the working capacity of adolescents.

Migraine is a chronic neurological disease characterized by a high prevalence and a significant decrease in quality of life. The combination of these factors leads to a significant negative socio-economic impact. Recently, significant progress has been made in understanding the pathogenesis of migraine, which led to the emergence of new classes of drugs for the treatment of this disease. This review discusses the history of the study of calcitonin gene - related peptide (CGRP) in the pathogenesis of migraine, and the characteristics of new drugs that affect the pathway of CGRP receptor antagonists (“gepants") and monoclonal antibodies against CGRP/CGRP receptor.

One of the extra-articular systemic manifestations of rheumatoid arthritis (RA) is cutaneous rheumatoid vasculitis (RV). Among the reasons for the development of RV, an important place is occupied by the deposition of immune complexes in the walls of blood vessels. This concept is based on the detection of high titers of rheumatoid factor, circulating immune complexes, as well as cryoglobulins in most RA patients with RV. Along with the use of disease-modifying anti-rheumatic drug therapy, topical treatment plays a significant role.

Despite treatment, patients with osteoarthritis (OA) may experience chronic pain and remain unsatisfied with the therapy. The article analyzes the reasons for the lack of effectiveness of OA therapy, including the presence of central sensitization in some patients, high and medium pain intensity, as well as the presence of contraindications to non-steroidal anti-inflammatory drugs (NSAIDs), which are considered a first-line treatment for inflammatory pain. The review presents the results of the use of the opioid analgesic tapentadol PR for the treatment of pain in OA, its high efficiency compared to NSAIDs and oxycodone is shown. A small number of adverse side effects traditional for opioid analgesics, including low percentage of addiction, have been demonstrated. Good tolerability and high efficacy allow recommending tapentadol PR for elderly patients as a conservative treatment in the presence of contraindications or insufficient efficacy of NSAIDs, in high pain intensity, for postoperative pain therapy, for patients undergoing joint replacement, in the postoperative period and as part of rehabilitation.

Cytidine 5-diphosphocholine (CDP-choline, or citicoline) is an essential intermediate substance in the biosynthesis of structural phospholipids in cell membranes, in particular phosphatidylcholine. The review is devoted to the studies of citicoline. The experimental data on its effect on traumatic injury and experimental cerebral edema, as well as the results of clinical use in traumatic brain injury and its consequences, are discussed.