Vol 42, No 4 (2023)

Original articles

Antiepileptic therapy algorithms in patients with primary and metastatic brain tumors

Prokudin M.Y., Litvinenko I.V., Rumуantseva K.А., Martynov B.V., Odinak M.M., Tsygan N.V., Klimenkova E.Y., Trashkov A.P., Svistov D.V.

Abstract

Up to date the brain tumors incidence keeps growing worldwide. Epilepsy and epileptic seizures are one of the most common clinical features of brain tumors. The aim of the study was to invent the algorithms antiepileptic treatment of patients with primary and metastatic brain tumors based on literature data. We searched eLIBRARY, PubMed databases by keywords. We concluded, that preventive antiepileptic drugs administration in patients with primary or metastatic brain lesions does not lower the risk of acute symptomatic postoperative seizures or epilepsy incidence, and therefore should not be recommended. Experts’ opinion states that in patients with brain tumors even one unprovoked seizure makes it feasible to initiate antiepileptic drugs therapy as soon as possible. In case of two or more unprovoked episodes (with over 24 hours difference) the diagnosis of “epilepsy” is legitimate and antiepileptic therapy should be started. The treating physician’s choice of antiepileptic therapy is based on type of seizures, age and sex of the patient, the comorbidity and potential antiepileptic drugs pharmacokinetic interactions with other drugs (including chemotherapy), in particular, one should avoid the use of liver microsomal-inducing antiepileptic drugs. The presented algorithms provide the decision-making guidelines in case of intraoperative focal seizures, acute symptomatic seizures and status epilepticus occurrence in early postoperative period.

Russian Military Medical Academy Reports. 2023;42(4):337-347
pages 337-347 views

The method for assessing the severity and monitoring the effectiveness of treatment neuropathic pain syndrome

Kolomentsev S.V., Kolomentseva A.V., Polezhaev P.A., Yaroslavtseva M.S., Kirpichenko A.A., Ryabtsev A.V., Polushina N.Y., Tsygan N.V., Litvinenko I.V.

Abstract

The existing difficulties in objectifying the patient’s complaints about the severity of the pain syndrome create the need to create new practical tools for assessing its intensity, as well as monitoring the effectiveness of treatment. Based on the accumulated experience of providing care to patients with neuropathic pain syndrome of traumatic genesis, the staff of the M.I. Astvatsaturov Clinic of Nervous Diseases of the Kirov Military Medical Academy has developed a method for assessing the severity and monitoring the effectiveness of treatment of neuropathic pain syndrome. The method is based on the patient’s auto-monitoring of his pain sensations during one day with the sequential fixation of the average hourly indicator of the severity of the pain experienced on an 11-point digital rating scale, as well as indicating the duration and quality of sleep in a daily graphic pain diary. The doctor evaluates the average daily and total daily pain indicators, as well as sleep parameters. The developed method has high visibility and reproducibility, has been tested, implemented and is used at the Kirov Military Medical Academy in the treatment of patients with neuropathic pain syndrome.

Russian Military Medical Academy Reports. 2023;42(4):349-356
pages 349-356 views

Features of diagnosis, treatment and curation of patients with neuropathic pain syndrome of traumatic genesis

Kolomentsev S.V., Litvinenko I. ., Tsygan N.V., Bulatov A.R., Gayvoronsky A.I., Kolomentseva A.V., Polushina N.Y., Ryabtsev A.V., Panov V.A., Shermatyuk E.I., Polezhaev P.A., Kirpichenko A.A., Yaroslavtseva M.S.

Abstract

BACKGROUND: The existing international and national clinical recommendations for the treatment of neuropathic pain syndrome are based mainly on the experience of providing care to patients with non-traumatic genesis of neuropathic pain. Approaches to the diagnosis, treatment and curation patients with neuropathic pain syndrome due damage of the nervous system as a result of wounds received during hostilities may differ from those in patients with somatic diseases.

AIM: To systematize the features of medical care and improve the methodological approach of curation patients with traumatic neuropathic pain syndrome.

MATERIALS AND METHODS: The practical experience of providing assistance to the wounded with traumatic lesions of the peripheral nervous system (including patients with phantom pain syndrome) accumulated by the staff of the Department and the Clinic of Nervous Diseases Military Medical Academy for 2022–2023 is summarized.

RESULTS: The features of inpatient routing, diagnosis, treatment and organization of medical care for patients with traumatic neuropathic pain syndrome at the stage of a specialized medical institution are systematized. The practical aspects of the curation patients with neuropathic pain due to wounds received during hostilities, related to the appointment of medications (including narcotic analgesics), regional anesthesia and the provision of neurosurgical care are highlighted. A separate emphasis is placed on the importance of assessing the mental state and quality of sleep of the wounded with neuropathic pain syndrome, the features of drug correction identified disorders. Practical recommendations for the treatment of patients based on the results of assessing the severity neuropathic pain syndrome using a daily graphic pain diary are presented.

CONCLUSION: The revealed differences in therapeutic and diagnostic approaches in providing medical care to the wounded with traumatic neuropathic pain syndrome, the importance of interdisciplinary interaction different specialties doctors (neurologists, surgeons, traumatologists, neurosurgeons, psychiatrists) at the early stages of treatment indicate the need to develop separate recommendations for the treatment of neuropathic pain in victims of armed conflicts.

Russian Military Medical Academy Reports. 2023;42(4):357-367
pages 357-367 views

Epidemiology of pain in spinal cord injury

Ivolgin A.F., Mazur A.S., Litvinenko I.V., Tsygan N.V., Avseitseva T.Y., Yakovleva V.A.

Abstract

BACKGROUND: The original Pain syndrome in spinal cord injury, which by its nature is one of the most severe and debilitating conditions, can lead to a deterioration in the quality of life, depression, sleep disorders and, as a consequence, a decrease in the results of rehabilitation treatment. This article will present epidemiological data of pain syndrome in spinal cord injury.

AIM: To study the structure and features of pain syndrome in patients with spinal cord injury.

MATERIALS AND METHODS: The clinical data on a sample of patients with pain syndrome in spinal cord injury are analyzed (n = 75). The study group was represented by male patients (100%), whose average age was 36 years, undergoing inpatient treatment on the basis of the National Medical Research Center for High Medical Technologies — A.A. Vishnevsky Central Military Clinical Hospital, Ministry of Defense, Russia. The analysis of pain syndrome in this cohort was carried out on 8 indicators at once: neurological level of injury, localization of pain, intensity of pain, motor neurological deficit, degree of damage to the anatomical integrity of the spinal cord, the presence of a neuropathic component, the type of pain syndrome and characteristic pain descriptors.

RESULTS: According to the classification of pain in spinal cord injury, proposed by an international consensus of clinicians and researchers, the prevalence of various types of pain among the study group was presented as follows: neuropathic — 64%, nociceptive — 32, dysfunctional — 4%. Analyzing various subtypes of neuropathic pain, pain below the injury level dominated — 72%.

CONCLUSION: The most common and difficult to stop variant in the structure of pain syndrome in patients with spinal cord injury is neuropathic pain.

Russian Military Medical Academy Reports. 2023;42(4):369-375
pages 369-375 views

Medical and social consequences of confusion syndrome that developed in the acute period of ischemic stroke

Khlystov Y.V., Tsygan N.V., Kolomentsev S.V., Kurasov E.S., Odinak M.M., Litvinenko I.V.

Abstract

AIM: To assess the dynamics of cognitive functions in patients in whom the acute period of ischemic stroke was accompanied by the confusion syndrome, in comparison with patients in whom the acute period of stroke was not accompanied by the development of confusion. To assess the impact of clinical features of confusion syndrome on the development of post-stroke cognitive impairment, mortality, and patient care burden.

MATERIALS AND METHODS: The study involved 99 patients, 55 of whom developed severe confusion during the acute period of stroke, and 44 patients whose ischemic stroke was not complicated by the development of confusion syndrome. The groups were homogeneous in terms of the main etiological factors: age, degree of pre-stroke cognitive impairment. The study assessed the impact of the development of confusional syndrome on the outcome.

RESULTS: Confusion syndrome that develops in the acute period of ischemic stroke significantly increases the risk of developing or worsening existing cognitive impairment, mortality, dependence on care, and the burden on caregivers.

CONCLUSION: Being a serious complication, confusion syndrome requires monitoring of qualitative and quantitative indicators of consciousness in the acute period of ischemic stroke, prevention and, if detected, immediate correction of confusion syndrome.

Russian Military Medical Academy Reports. 2023;42(4):377-382
pages 377-382 views

Features of changes in fractional anisotropy of different brain parts during the progression of Parkinson's disease

Vlasova I.A., Trufanov A.G., Litvinenko I.V., Odinak M.M.

Abstract

BACKGROUND: Parkinson's disease is a neurodegenerative disease, in second place in terms of incidence in the world after Alzheimer's disease. It is currently believed that the presymptomatic stages of Parkinson's disease are mainly associated with degeneration of the subcortical and vegetetive nervous systems, and lesions of the cerebral cortex appear on later stages of the disease, however, it is of interest to study in more detail the involvement of the pathways of the brain in the pathological process in depending the disease progression.

OBJECTIVE: to study features of damage to the brain pathways during the progression of Parkinson's disease by magnetic resonance tractography.

MATERIAL AND METHODS: 88 patients with Parkinson's disease were examined (stage II disease — 42 people, stage III — 46 people according to the Hoehn and Yahr scale). The control group consisted of 35 people who did not differ in gender. All patients included in the study underwent a neurological examination, as well as magnetic resonance imaging of the brain with diffusion tensor imaging.

RESULTS: We found that with increasing stage of Parkinson's disease, there was a significant increase in fractional anisotropy in the hippocampus, insular cortex, and inferior and superior temporal sulcus cortex in patients with Parkinson's disease; we also noted a significant decrease in putamen fractional anisotropy.

CONCLUSION: the tractography study of the brain pathways during disease progression is a promising method that allows us to clarify in the pathogenesis of Parkinson's disease, including the role of extra-nigral pathology in the development of some non-motor disorders.

Russian Military Medical Academy Reports. 2023;42(4):383-389
pages 383-389 views

Comparative assessment of cerebral perfusion and metabolism in patients with Alzheimer’s disease and vascular cognitive disorders

Emelin A.Y., Boykov I.V., Lobzin V.Y., Kolmakova K.A., Naumov K.M., Dynin P.S., Lupanov I.A.

Abstract

BACKGROUND: The high medical and social significance of the problem determines the necessity of the earliest nosological diagnostics of the cognitive disorders. Functional neuroimaging methods such as single-photon emission computed tomography and positron emission tomography play an important role in the early differential diagnosis, allowing to estimate perfusion and metabolism of the cerebral tissue.

AIM: To perform a comparative analysis of perfusion and metabolic abnormalities in different cerebral structures of patients with Alzheimer’s disease and vascular cognitive disorders in small cerebral vessels disease.

MATERIALS AND METHODS: Single-photon emission computed tomography was performed in 13 patients with Alzheimer’s disease and in 21 patients with vascular cognitive disorders; positron emission tomography with 18F-FDG was performed in 17 patients with Alzheimer’s disease and in 15 patients with vascular cognitive disorders.

RESULTS: Patterns of perfusion and metabolic abnormalities differ in patients with Alzheimer’s disease and vascular cognitive disorders. In patients with vascular cognitive disorders due to cerebral small vessels disease, a distinctive feature was a combination of hypoperfusion in subcortical structures, especially in the caudate nucleus and thalamus, with hypoperfusion in the deep parts of the frontal lobe. In Alzheimer’s disease, bilateral pronounced perfusion abnormalities in the parietal and temporal cortex were the most characteristic. Patterns of metabolic disturbances were similar to patterns of perfusion disturbances in different variants of cognitive disorders, but metabolic disturbances were more widespread. Рositron emission tomography was more informative in diagnosing patients with Alzheimer’s disease compared to single photon emission computed tomography. More pronounced perfusion and metabolic disorders were observed in patients with more severe cognitive disorders. Perfusion disturbances in the area of subcortical structures can be considered as an early marker of cognitive impairment development in patients with small vessel disease.

CONCLUSION: Single photon emission computed tomography has sufficient sensitivity and specificity when examining patients with vascular cognitive disorders, while positron emission tomography is more preferable when examining patients with Alzheimer-type dementia.

Russian Military Medical Academy Reports. 2023;42(4):391-402
pages 391-402 views

Optical coherence tomography with angiography in the diagnosis of Alzheimer’s disease

Strumentova E.S., Lobzin V.Y., Mal'tsev D.S., Burnasheva M.A., Mosina M.M., Khasanova A.A., Doronina A.N.

Abstract

BACKGROUND: Alzheimer’s disease is becoming increasingly common and the number of patients with dementia is steadily increasing. Existing diagnostic methods (neuropsychological testing, cerebrospinal fluid examination, magnetic resonance imaging, and positron emission tomography) are either subjective, inaccessible or invasive and expensive, therefore the search for new methods of Alzheimer’s disease diagnosis is necessary. The retina and the human brain share a common embryonic origin. The use of optical coherence tomography with angiography can help in the diagnosis of the disease, especially at an early stage.

AIM: To perform a comparative analysis of the vascular density of the peripapillary region of the human retina with the severity of cognitive impairment and atrophic changes according to MRI in patients with Alzheimer’s disease.

MATERIALS AND METHODS: Thirty patients participated in the study: 20 with Alzheimer’s disease and 10 in the control group. All patients underwent collection of complaints and history, general neurological and ophthalmological examination to evaluate inclusion and noninclusion criteria. Subsequently, neuropsychological testing, magnetic resonance imaging of the brain with assessment according to standardized neuroimaging scales, and optical coherence tomography with angiography according to a standard protocol were performed. The results were processed using the Statistica 10 software package (StatSoft, USA).

RESULTS: Assessment of retinal microvascular bed condition in Alzheimer’s disease patients revealed a significant level of relative vascular density reduction in the upper half of radial peripapillary plexus of the retina due to reduction of small vessel density (p = 0.02). There was a direct correlation between the severity of the decrease in the FCSRT total score and changes in vascular density in the nasal sector of the retina (r = 0.52). There was a significant inverse relationship between vascular density in the temporal sector and the final GCA score for patients with Alzheimer’s disease (r = 0.57). The Fazekas scale score revealed an inverse correlation between its score and the vascular density in the upper retinal half and its upper sector (r = 0.53).

CONCLUSION: Оptical coherence tomography with angiography is a highly informative and promising method for early, including pre-diagnosis of Alzheimer’s disease, which is considerably more accessible and accurate than other techniques.

Russian Military Medical Academy Reports. 2023;42(4):403-411
pages 403-411 views

Case report

Problems of diagnosis and treatment of chronic pain syndrome in patients with variants of the structure of peripheral nerves. A series of clinical cases

Bulatov A.R., Kolesnik T.A., Boykova А.A., Litvinenko I.V., Tsygan N.V.

Abstract

AIM: To assess the presence of variants of the structure of peripheral nerves as possible risk factors for chronic pain syndrome on the example of a series of clinical cases.

MATERIALS AND METHODS: The systematization and analysis of data from domestic and foreign literature on pathophysiology, clinic, diagnosis and treatment of complex regional pain syndrome has been carried out. Research method: system analysis, presentation of a series of clinical cases.

RESULTS: A series of clinical cases is presented. The main risk factors for chronic pain syndrome are presented. The conditions and diseases that need to be differentially diagnosed if complex regional pain syndrome is suspected are systematized: tunnel syndromes (carpal tunnel syndrome), diabetic polyneuropathy, HIV polyneuropathy, postherpetic neuralgia, neurogenic claudication/lumbar stenosis, central post-stroke pain, upper thoracic syndrome apertures.

CONCLUSION: Today, practitioners and neurophysiologists are not sufficiently aware of the existence of interneural anastomoses and features, typical electroneuromyographic signs, as a result of which in most cases the obtained electroneuromyographic data are interpreted erroneously. Variants of the structure of nerves can give an incorrect clinical picture of the condition of peripheral nerves and lead to untimely diagnosis and treatment of chronic pain syndrome, complex regional pain syndrome. Improvements in diagnostic methods, as well as widely introduced high-tech examination methods, in particular electroneuromyography, magnetic resonance imaging and ultrasound, are helping to increase the frequency of detection of abnormalities in the structure of peripheral nerves. In the presented clinical cases, patients had structural variants that gave an incorrect clinical picture of the condition of the peripheral nerves and led to untimely diagnosis and treatment — the development of chronic pain syndrome.

Russian Military Medical Academy Reports. 2023;42(4):413-420
pages 413-420 views

The use of flexible botulinum toxin type A inter-injection intervals after removal of deep brain stimulation due to infection in patient with DYT-THAP1 (DYT6)

Krasakov I.V., Litvinenko I.V., Dyskin D.E.

Abstract

Deep brain stimulation of globus pallidus internus is a safe and effective method of treatment of isolated generalized dystonia. Abrupt discontinuation of stimulation can lead to a sharp increase in the severity of the condition with a significant increase in the risk of dystonic status. Correction of the condition by selecting conservative therapy is often insufficient. Based on the description of a clinical observation, we demonstrated the possibility of effective use of flexible botulinum toxin type A inter-injection intervals after removal of deep brain stimulation due to infection in patient with DYT-THAP1 (DYT6). Due to the high risk of formation of antibodies to botulinum toxin type A when using short intervals, as well as when using high doses, preference was given to a drug with proven low immunogenicity — incobotulotoxin A. Incobotulotoxin A was administered once a month in a total dose of 400 units to various muscle groups (head, neck, trunk, limbs). At the time of publication, the duration of follow-up was six months, six procedures were performed, a total of 2,400 units of incobotulotoxin A. No significant side effects were noted. Evaluation of the effectiveness of the therapy was carried out by calculating the points of the Burke–Fahn–Marsden Dystonia Rating Scale. There was a decrease from 34 points (the indicator at the time of termination of neurostimulation) to 13.5 points (after six months of therapy). The therapy allowed the patient to maintain motor activity during the waiting period for repeated deep brain stimulation.

Russian Military Medical Academy Reports. 2023;42(4):421-426
pages 421-426 views

Nodopathy: clinic, diagnosis, treatment. Clinical description

Bulatov A.R., Litvinenko I.V., Tsygan N.V., Bardakov S.N., Boykova A.A., Kolesnik T.A., Onishchenko L.S.

Abstract

AIM: Evaluation of the significance and possibilities of laboratory-instrumental diagnostic methods in establishing the diagnosis and selection of targeted therapy in patients with nodopathies.

MATERIALS AND METHODS: System analysis of data from foreign and domestic literature with the presentation of a clinical case.

RESULTS: Polyneuropathies are classified as demyelinating or axonal based on electrophysiological studies. However, in 2015, in addition to axonal and demyelinating neuropathies, it was proposed to distinguish a separate pathophysiological group — nodopathies. The pathogenesis of nodopathies may differ depending on the type of ion channels involved in the process, but always leads to a loss of excitability of the axon membrane; in the nodal region the membrane becomes inexcitable. Such neuropathies are characterized by transient conduction blocks followed by the development of axonal degeneration. Typical examples of nodopathies are acute motor axonal neuropathy, as well as multifocal motor neuropathy. Current pathophysiological understanding of specialized nodal regions (nodes of Ranvier) and associated axoglial proteins is growing. Hypotheses have been put forward about their role in the pathogenesis of immune-mediated attack on the peripheral myelinated axon. Recently, high titers of antibodies directed against a number of key adhesion molecules have been identified in both acute and chronic inflammatory neuropathies. These facts add to the differences in differential diagnosis between axonal and demyelinating peripheral neuropathies. New disease classification schemes based on seropositivity, improved electrophysiological and ultrasound classification, and identification of putative underlying pathological targets and mechanisms are being rapidly developed.

CONCLUSION: Using our clinical example, we demonstrated the capabilities of laboratory and instrumental diagnostic methods in establishing a diagnosis in a patient with one of the forms of nodopathies — multifocal motor neuropathy.

Russian Military Medical Academy Reports. 2023;42(4):427-435
pages 427-435 views

Speech disorders in genetically determined forms of epilepsy in children. Clinical observations

Guzeva V.I., Eremkina Y.A., Guzeva O.V., Guzeva V.V., Malekov D.A., Vedernikova V.A.

Abstract

BACKGROUND: Speech disorders in children are one of the pressing problems of child neurology. In recent years, much attention has been paid to studying the genetic aspects of the development of speech disorders in children with epilepsy. Speech function in childhood is vulnerable, and its violation has a number of significant consequences. Specialists from different disciplines focus on specific aspects of speech disorders. Speech therapists consider speech disorders based on linguistic criteria, psychologists evaluate the psychological characteristics of children with speech disorders. The rapid development of genetic research, the availability of many molecular genetic tests, especially such a method as next generation sequencing, allowed us to pay more attention to the study of genetic aspects of the development of speech disorders in children with epilepsy.

AIM: to present options for speech disorders in genetically determined forms of epilepsy in children based on clinical examples.

RESULTS: The article analyzes 3 clinical cases of epilepsy in children, combined with speech pathology (2 boys and 1 girl aged 2 to 5 years). The data of anamnesis of life and disease, neurological examination with assessment of speech function, results of genetic research, electroencephalographic examination and magnetic resonance imaging are presented.

CONCLUSION: All patients are united by a combination of speech disorders, epileptic seizures, and the presence of genetic pathologies that are responsible for speech function. These clinical observations demonstrate the need for a comprehensive, multidisciplinary approach both at the stage of early diagnosis of speech impairment in children with epileptic seizures and at the stage of further treatment of such patients.

Russian Military Medical Academy Reports. 2023;42(4):437-444
pages 437-444 views

Epilepsy, epileptoma, surgery (based on clinical case data)

Mongaleva E.S., Lyubimova P.A., Gyulova E.V., Den'gina N.O., Odintsova G.V.

Abstract

Tumor-associated epilepsy is a comorbid disease with focal symptoms or focal, bilateral tonic-clonic seizures. This paper presents the case of a 36-year-old woman hospitalized due to frequent generalized seizures with focal onset and marked pharmacoresistance. The first epileptic seizure occurred at the age of 23 at night during sleep, manifested by tonic seizures with turning of the head to the right, impaired consciousness. The patient took lamotrigine and lacosamide, which resulted in remissions, but freedom from seizures was not achieved. MRI revealed structural changes in the medio-basal regions of the right temporal lobe. PET-CT revealed signs of metabolically active tumor tissue in the right temporal region.Based on the findings, it was concluded that the patient had a ganglioglioma. The patient underwent selective resection of the area of structural changes in the basal parts of the right temporal lobe. By the time of her discharge from the hospital on the 10th day after the surgical intervention, her general condition had fully recovered, no generalised seizures were noted in the postoperative period. During the evaluation of the catamnesis, an isolated aura occurred once. The presence of the disease significantly impaired the patient’s work activity, quality of life and socialisation and led to a depressive episode. This surgical intervention significantly reduced the patient’s quality of life. Thus, tumor-associated epilepsies caused by epileptomas are characterized by pharmacoresistance. Drug treatment did not have a stable effect and the course of the disease was accompanied by a recurrence of seizures. Surgical treatment is the method of choice. With the development of modern neurosurgery, cognitive functions could be preserved despite the long history of the disease.

Russian Military Medical Academy Reports. 2023;42(4):445-450
pages 445-450 views

Review

Features of blast-induced traumatic brain injury

Nikishin V.O., Litvinenko I.V., Naumov K.M.

Abstract

Traumatic brain injury, despite its prevalence and study, is the most urgent issue of medicine in clinical, social and military-medical significance. In Russia, about 500 thousand people receive a traumatic brain injury every year, and the damage to the country’s economy exceeds 500 billion rubles a year. Traumatic brain injury is damage by mechanical energy to the skull and intracranial contents (brain, meninges, vessels, cranial nerves), accompanied by clinical symptoms and, in most cases, morphological changes. Recently, blast-induced traumatic brain injury has acquired particular importance, which is due to the change in modern tactics of warfare and the predominance of explosive trauma in the structure of all injuries. The features of blast-induced traumatic brain injury are associated with a variety of factors affecting a person (shock wave, light, heat radiation, fragments, etc.). Such a multifactorial effect on a person makes it difficult to identify a blast-induced traumatic brain injury, especially a brain concussion. This is due to a possible combination of damage to different organs and systems of a person during an explosion, which can simulate or mask a brain concussion. When diagnosing a traumatic brain injury, it is especially important to assess the circumstances and information from witnesses of the event, which often presents a certain complexity in the conditions of hostilities. Currently, methods for detecting symptoms of instability, visual and disorders of other sensory systems involved in maintaining balance are considered as a promising direction for the diagnosis of mild traumatic brain injury. It is also important to note that patients who have suffered a traumatic brain injury have a risk of developing neurodegenerative diseases. All this further emphasizes the relevance of traumatic brain injury and the existing need to develop an optimal algorithm for the examination of such patients.

Russian Military Medical Academy Reports. 2023;42(4):451-458
pages 451-458 views

Clinical and pathological features of brain iron metabolism in neurodegerative and demyelinating disorders

Dynin P.S., Litvinenko I.V., Emelin A.Y., Ruban A.V.

Abstract

The results of many modern studies show the significance of the role of changes in iron metabolism and its increased accumulation in the pathogenesis of neurodegenerative and demyelinating diseases. Determining the role of iron metabolism and the characteristics of its distribution in strategically important areas of the brain in diseases of the nervous system is important from a diagnostic point of view, since it can help determine the rate of disease progression and, accordingly, correction of therapy. The article presents modern literature data describing the main disorders of iron metabolism in the structure of the pathogenesis of neurodegenerative diseases (Alzheimer’s disease and Parkinson’s disease), and demyelinating diseases, in particular, multiple sclerosis. Attention is drawn to the role of changes in iron metabolism in the pathogenesis of the process of regulated cell death, ferroptosis, accompanied by depletion of intracellular glutathione, decreased activity of the enzyme glutathione peroxidase-4 and the subsequent process of lipid peroxidation caused by a decrease in the protective antioxidant system of cells and the accumulation of reactive oxygen species. Attention is drawn to the role of the Fenton reaction in the accumulation of free radicals, the oxidation of iron and, as a consequence, its excessive deposition in brain structures. Information is provided on the features of the pathogenesis of neuronal iron accumulation, modern diagnostic capabilities for assessing iron content in strategically important areas of the brain using various methods, and the possibility of various options for therapeutic treatment of these conditions is considered. Attention is drawn to the patterns of iron distribution in normal brain structures depending on age, as well as in the specified nosologies. Data are presented on the connection between an increase in the amount of iron content in brain cells and the severity of clinical manifestations of diseases. Attention is drawn to the relationship between the progression of disease severity and the increase in metal content in the cells of strategically significant areas of the brain. When writing the article, modern materials and meta-analyses were used, containing the results of a significant number of studies devoted to the problem considered in this review.

Russian Military Medical Academy Reports. 2023;42(4):459-468
pages 459-468 views

History of medicine

Event I. The development of oriental medicine in Russia in the XVIII-XIX centuries. The role of scientists of the Imperial Medico-Surgical (Military Medical) Academy

Andreeva G.O., Odinak M.M., Tsygan V.N., Litvinenko I.V., Mamaeva S.A.

Abstract

The article presents the history of nascence traditional oriental medicine in Russia during XVIII–XIX centuries. The first information about oriental medicine was brought to Russia in the XVIII century by doctors, who visited Mongolia and China as members of embassy expeditions. The first decades of the XVIII century can be considered as beginning of a systematic study oriental treatment methods. It was possible thanks to the many years efforts of the employees of the Russian ecclesiastical mission in Beijing. This organization from 1715 to 1864 years served religious, diplomatic and scientific functions. An invaluable contribution to the study of Chinese medicine was made by the leaders of the mission. Major role belongs to Nikita Yakovlevich Bichurin (father Iakinf), archimandrite of the IX mission. He was fluent in Chinese, studied the primary sources of medical literature, translated significant treatises into Russian, and taught Chinese to the mission staff. The head of the X mission, Pavel Ivanovich Kamensky, compiled a Chinese-Russian medical dictionary, reorganized the mission, and insisted on the need to introduce the position of a doctor among the staff. Starting from 1821, doctors O.P. Voitsekhovsky, P.E. Kirillov, A.A. Tatarinov, S.I. Bazilevsky and P.A. Kornievsky, graduates of the Imperial Medical and Surgical (Military Medical) Academy worked as physician of the X–XIV missions. Doctors continued to study the theoretical concepts of Chinese medicine, philosophical and cultural traditions that underlie healthcare. In addition to medical work, in accordance with the instructions of the Medical Council at the Ministry of Foreign Affairs, they explored epidemiology, healthcare organization and the process of training doctors in China, analyzed Eastern approaches in the diagnosis and treatment of diseases, pharmacopoeia, used of herbal remedies, methods of prevention and health maintenance. The scientific approach, knowledge of the Chinese language, and a long stay in the country allowed them to lay the foundations of Oriental medicine in Russian, acquaint medical community with the methods of treatment and prevention of diseases adopted in China, introduce acupuncture, moxa, the use of new types of herbal remedies, enrich the collections of medicinal plants.

Russian Military Medical Academy Reports. 2023;42(4):469-477
pages 469-477 views


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