Ритмическая транскраниальная магнитная стимуляция в терапии нейропатической боли, сопровождающейся коморбидной депрессией: обзор эффективных параметров лечебных протоколов

Neuropathic pain affects 7 % of the general population worldwide, it is often resistant to analgesic treatments and is complicated with depressive states in 57–65 % of this patients’ cohort. Ongoing research of current therapeutic approaches, including repetitive transcranial magnetic stimulation (rTMS) use in neuropathic pain and depression, grants new data about the details of treatment protocols’ designs. The aim of our literature review was to evaluate those parameters of the treatment protocols which proved significant efficacy in the management of the neuropathic pain with comorbid depression.Focusing on the Scopus, Elsevier and PubMed databases search, we have found 639 peer‑review articles. 23 studies have been included into the data analysis, whereas others were excluded based on their heterogeneous study design. Across the data analysis we evaluated such rTMS parameters as the type of a coil, type of stimulation area, locus of gained evoked motor potential, amplitude of stimulation, duration of session, frequency/number of sessions per day/month, tie duration between sessions, number and frequency of trains, amount and frequency of pulses containing and efficacy of treatment. Those studies that performed repetitive transcranial magnetic stimulation using the figure‑of‑8 coil over the M1 brain area, for 10 or more daily sessions with duration from 7 up to 40 minutes, of 10–20 Hz frequency, intensity 80–90 % of resting motor threshold and total pulses number over 1500 per session demonstrated the greater efficacy in pain level decrease and depression scores reduction among neuropathic pain patients with comorbid depression. Conducting an additional maintenance phase of treatment prolonged the therapeutic effect of the course.Based on the data review, the parameters of the most efficient rTMS protocols’ designs in management of patients with neuropathic pain and comorbid depression have been revealed. Further research requires investigation of other promising indicators of rTMS efficacy use in neuropathic pain with comorbid depression, such as stimulation over multiple brain areas, the duration/timing of additional maintenance phase of treatment, and the figure‑of‑8 coil orientation options.По общемировым данным, нейропатическая боль встречается у 7 % населения и в 57–65 % случаев сопровождается коморбидной депрессией, что, в свою очередь, усугубляет течение болезни и ухудшает качество жизни пациентов. Ритмическая транскраниальная магнитная стимуляция (рТМС) представляет собой неинвазивный нефармакологический метод терапии депрессии,  также способный помочь пациентам облегчить восприятие нейропатической боли. Представлен обзор результатов применения протоколов рТМС, продемонстрировавших эффективность в терапии клинических состояний, сопровождающихся нейропатической болью с коморбидной депрессией.Исследуя базы данных Scopus, Elsevier и PubMed , мы обнаружили 639 статей, из которых в соответствии с критериями включения были отобраны 23. Оценке подверглись данные о клинической эффективности рТМС в терапии нейропатической боли и коморбидной депрессии в зависимости от параметров протокола стимуляции, включая тип катушки, целевую зону мозга, продолжительность сеанса, частоту/количество сеансов в день/месяц, а также межсеансовые интервалы, число и частоту импульсов.Протоколы, показавшие наибольшую эффективность, включали такие параметры, как использование катушки в форме восьмерки, направленной на первичную моторную зону (M1), применение рТМС в течение не менее 10 ежедневных сеансов, использование высокочастотной стимуляции (10–20 Гц) с интенсивностью 80–90 % от порога моторного ответа, с длительностью сессии от 7 до 40 мин и с общим количеством импульсов не менее 1500 за сеанс. Проведение дополнительной поддерживающей фазы лечения продлевало терапевтический эффект курса.Результаты анализа данных литературы предполагают, что определенная комбинация параметров стимуляции может быть более эффективной для терапии нейропатической боли, сопровождающейся коморбидной депрессией, тем самым открывая новые возможности терапии для пациентов с резистентными состояниями, плохо поддающимися фармакологической коррекции. Рассмотрение параметров протоколов рТМС выявило необходимость дальнейшего изучения метода в лечении указанных клинических состояний не только в рамках репликации данных, но и для анализа таких дополнительных параметров, как последовательная или одновременная стимуляция нескольких областей мозга, угол поворота катушки, а также для уточнения времени поддерживающей фазы стимуляции

Bio-Inspired Micro- and Nanorobotics Driven by Magnetic Field

In recent years, there has been explosive growth in the number of investigations devoted to the development and study of biomimetic micro- and nanorobots. The present review is dedicated to novel bioinspired magnetic micro- and nanodevices that can be remotely controlled by an external magnetic field. This approach to actuate micro- and nanorobots is non-invasive and absolutely harmless for living organisms in vivo and cell microsurgery, and is very promising for medicine in the near future. Particular attention has been paid to the latest advances in the rapidly developing field of designing polymer-based flexible and rigid magnetic composites and fabricating structures inspired by living micro-objects and organisms. The physical principles underlying the functioning of hybrid bio-inspired magnetic miniature robots, sensors, and actuators are considered in this review, and key practical applications and challenges are analyzed as well

Complex Neuropsychiatric and Laboratory-Instrumental Diagnostics in Determination of Tactics of Therapeutic Management of Patients with Spinal Muscular Atrophy : Regional Experience

INTRODUCTION: Spinal muscular atrophy (SMA) is a rare hereditary disabling disease and the most common hereditary cause of infant deaths. The timely comprehensive diagnosis of SMA permits to plan therapeutic tactics and preserve the quality of patients’ life. One of the objectives of the given work is a review of the actual literature data on etiopathogenesis, clinical presentation, valid diagnosis and modern effective tactics of SMA management. AIM: To evaluate the management tactics of patients with SMA taking into account neuropsychiatric symptoms, to analyze problems of proposal and organization of measures aimed at improvement of the quality of medical care, on the basis of the practical experience of the Samara region and with consideration of the current state of the problem. MATERIALS AND METHODS: In the work, the data of the archive of Seredavin Samara Regional Clinical Hospital were analyzed, 132 medical histories of 77 patients were processed with discharge dates from January 2008 to February 2022 with the following diagnoses (according to the code of the International Classification of Diseases and Health Related Problem, 10th revision (ICD-10)): G12.0 (spinal muscular atrophy, type I [Werdnig–Hoffmann disease], G12.1 (other hereditary SMA), G12.8 (other SMA and related syndromes) and G12.9 (unspecified SMA). The analysis of the results of clinical, laboratory, instrumental and neuropsychiatric diagnostic methods was performed in comparison with the tactics of therapeutic management of these patients. For statistical processing of the data, methods of descriptive statistics were used. RESULTS: Socio-demographic data. As of February 2022, 58 patients were registered (mean age 38.4 (41.3) years, of them 32 (55.2%) were individuals of female gender including 21 children (mean age 12.3 (7.4) years, 14 (24.1%) girls), with the following diagnoses according to ICD-10: G12.0 (n = 7; 12.0%; only children), G12.1 (children: n = 14; 24.1%; adults: n = 29; 50.0%), G12.8 (n = 6; 10.3%; only adults), G12.9 (n = 2; 3.4%; only adults). Clinical data. Motor disorders from a mild proximal lower paraparesis (n = 13; 22.4%) to pronounced tetraparesis (n = 7; 12.0%). The study of mental status was limited to evaluation of the state of consciousness and effectiveness of contact. Data on therapy. Until 2021, symptomatic therapy of SMA was conducted in the region, since March 2021, 8 children (13.8% of the total sample) aged 7.3 (8.8) years received nusinersen, another 8 children (13.8%) aged 9.5 (6.9) years received risdiplam; parents of 3 more children (5.2%) refused taking drugs. Of adult patients (n = 37; 63.8%; 35.3 (23.6) years) with confirmed SMA 5q (n = 10; 17.2%, 35.3 (19.0) years), 1 patient received nusinersen, the rest 9 patients (15.5%) did not receive therapy, 3 (5.2%) were achieving the right to receive drugs (at the moment of the analysis). CONCLUSION: The data analysis revealed deficit of early SMA diagnosis (at the moment of the diagnosis, all the patients were already having pronounced symptoms), of assessment of affective and cognitive disorders, monitoring of treatment effectiveness (absence of validated scales for motor skills assessment), and also showed low availability of treatment for adult patients, which requires reorganization of care of patients with SMA in the region taking into account the revealed factors).</p