ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ АНТИ-N-МЕТИЛ-D-АСПАРТАТ РЕЦЕПТОРНОГО ЭНЦЕФАЛИТА (СЛУЧАИ ИЗ ПРАКТИКИ)

The article describes the clinical cases of anti-N-methylD-aspartate receptor encephalitis of two patients. An analysis of the dynamics of neurologic symptoms, the results of neurovisualization and neurophysiological examinations was carried out. It was shown that in patients with AntiN-methyl-D-aspartate receptor encephalitis, neurological symptoms are similar in their manifestations with symptoms of virus encephalitis. At the same time, the mechanism of development and etiology of this form of autoimmune pathology is not understood. Also, no pathognomonic changes were detected for MRI of the brain, PET, EEG for Anti-N-methylD-aspartate receptor encephalitis. The authors conclude that the diversity of neurological symptoms in patients with antiN-methyl-D-aspartate receptor encephalitis may be due not only to dysfunction of brain structures due to disruption of NMDA receptor activity, but also to a reversible disruption of functional interrelationships between different parts of the brain. В статье приводится описание клинического течения Анти-N-метил-D-аспарт рецепторного энцефалита у двух пациенток. Проведен анализ динамики неврологической симптоматики, результатов нейровизуализационных и нейрофизиологических обследований. Показано, что у пациентов с Анти-N-метил-D-аспартат рецепторным энцефалитом неврологическая симптоматика схожа по своим проявлениям с симптоматикой при инфекционных энцефалитах. В то же время механизм развития и этиология данной формы аутоиммунной патологии до конца не ясны. Также не выявлено патогномоничных только для Анти-N-метил-D-аспартат рецепторного энцефалита изменений на МРТ головного мозга, ПЭТ, ЭЭГ. Авторы делают вывод, что разнообразие неврологической симптоматики у пациентов с Анти-N-метил-D-аспартат рецепторным энцефалитом может быть обусловлено не только дисфункцией структур мозга в результате нарушения активности NMDA рецепторов, но и обратимым нарушением функциональных взаимосвязей между различными отделами мозга.

Features of the pathogenesis, diagnosis, and treatment of panic attacks in young people

Objective: to investigate the features of the pathogenesis, diagnosis, and treatment of panic attacks (PAs) in young people.Patients and methods. A total of 39 outpatients (27 females and 12 males) aged 19 to 38 years with PAs were examined. The Panic Disorder Severity Scale (PDSS) was used to measure the severity of clinical manifestations of PAs; the Covey Anxiety Scale was employed to identify an anxiety state. In order to exclude depressed patients from being examined, the Montgomery—Аsberg rating scale was applied to assess the severity of depression. All the patients were divided into two groups: 1) 22 patients with PAs who received standard therapy and the alpha-adrenoblocker proroxan (Vegetrox) as a 15-mg tablet thrice daily for 8 weeks; 2) 17 patients who were prescribed only standard therapy. The patients were examined twice before and 4 weeks after the end of an 8-week vegetrox therapy cycle.Results and discussion. In the patients of both groups with PAs, the total score ranged from 3 to 11, with the median PDSS score of 7. According to the Covey anxiety scale, an anxiety state developed in 33 patients; only the symptoms of anxiety were detected in 6. There was a direct significant correlation between the PDSS and Covey anxiety scale values; Spearman's rank correlation coefficient was 0.681 (p<0.01). The PA severity indexes proved to be significantly lower after incorporating Vegetrox into the standard therapy. Comparing the anxiety scale values in the patients of Groups 1 and 2 after the treatment cycle revealed a significant decrease in the level of anxiety in the patients receiving standard therapy and Vegetrox. This effect of the latter may be explained by the fact that it blocks postsynaptic α1-adrenoceptors and presynaptic α2-adrenoceptors and decreases the stimulation intensity of the hypothalamic structures that are closely connected with the limbicoreticular system.Conclusion. The severity of PAs in young people depends on the level of anxiety. Vegetrox has a significant positive effect on the values of PDSS and the Covey anxiety scale in PAs

ANTI-N-METHYL-D-ASPARTATE RECEPTOR ENCEPHALITIS (CASE REPORTS)

The article describes the clinical cases of anti-N-methylD-aspartate receptor encephalitis of two patients. An analysis of the dynamics of neurologic symptoms, the results of neurovisualization and neurophysiological examinations was carried out. It was shown that in patients with AntiN-methyl-D-aspartate receptor encephalitis, neurological symptoms are similar in their manifestations with symptoms of virus encephalitis. At the same time, the mechanism of development and etiology of this form of autoimmune pathology is not understood. Also, no pathognomonic changes were detected for MRI of the brain, PET, EEG for Anti-N-methylD-aspartate receptor encephalitis. The authors conclude that the diversity of neurological symptoms in patients with antiN-methyl-D-aspartate receptor encephalitis may be due not only to dysfunction of brain structures due to disruption of NMDA receptor activity, but also to a reversible disruption of functional interrelationships between different parts of the brain

Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial

Background: Patients with ischaemic stroke or transient ischaemic attack (TIA) are at high risk of recurrent stroke or other cardiovascular events. We compared the selective thromboxane-prostaglandin receptor antagonist terutroban with aspirin in the prevention of cerebral and cardiovascular ischaemic events in patients with a recent non-cardioembolic cerebral ischaemic event. <p/>Methods: This randomised, double-blind, parallel-group trial was undertaken in 802 centres in 46 countries. Patients who had an ischaemic stroke in the previous 3 months or a TIA in the previous 8 days were randomly allocated with a central interactive response system to 30 mg per day terutroban or 100 mg per day aspirin. Patients and investigators were masked to treatment allocation. The primary efficacy endpoint was a composite of fatal or non-fatal ischaemic stroke, fatal or non-fatal myocardial infarction, or other vascular death (excluding haemorrhagic death). We planned a sequential statistical analysis of non-inferiority (margin 1·05) followed by analysis of superiority. Analysis was by intention to treat. The study was stopped prematurely for futility on the basis of the recommendation of the Data Monitoring Committee. This study is registered, number ISRCTN66157730. <p/>Findings: 9562 patients were assigned to terutroban (9556 analysed) and 9558 to aspirin (9544 analysed); mean follow-up was 28·3 months (SD 7·7). The primary endpoint occurred in 1091 (11%) patients receiving terutroban and 1062 (11%) receiving aspirin (hazard ratio [HR] 1·02, 95% CI 0·94–1·12). There was no evidence of a difference between terutroban and aspirin for the secondary or tertiary endpoints. We recorded some increase in minor bleedings with terutroban compared with aspirin (1147 [12%] vs 1045 [11%]; HR 1·11, 95% CI 1·02–1·21), but no significant differences in other safety endpoints. <p/>Interpretation: The trial did not meet the predefined criteria for non-inferiority, but showed similar rates of the primary endpoint with terutroban and aspirin, without safety advantages for terutroban. In a worldwide perspective, aspirin remains the gold standard antiplatelet drug for secondary stroke prevention in view of its efficacy, tolerance, and cost

Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study.

BACKGROUND: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events. METHODS AND RESULTS: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged > or =55 years, having suffered an ischemic stroke (< or =3 months) or a transient ischemic attack (< or =8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2-4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006. CONCLUSIONS: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event.Journal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study.

BACKGROUND: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events. METHODS AND RESULTS: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged > or =55 years, having suffered an ischemic stroke (< or =3 months) or a transient ischemic attack (< or =8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2-4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006. CONCLUSIONS: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event