The role of frontal-subcortical circuits in the development of obsessive-compulsive disorders

The paper presents a concise review of investigations into the role of impaired frontal-subcortical circuits in the development of obsessive-compulsive disorder (OCD). It gives data on the frequency of neurosis-like symptoms of the OCD spectrum in neurological diseases.The development of OCD is associated with an imbalance between the activity of the direct (activating) and indirect (inhibitory) pathways of the cortico-striatal-thalamo-cortical feedback loop. These data are confirmed by the results of neuroimaging and neuropsychological studies in patients with OCD. The frequency of OCD symptoms is high in organic brain lesions. OCP may be a manifestation of neurological diseases so their timely detection is an important aspect of a neurologist's work. The treatment of patients with neurosis-like disorders of the OCD spectrum within neurological diseases requires a multidisciplinary approach with the participation of a neurologist, a psychiatrist/psychotherapist, and a psychologist. It is necessary to combine pathogenetic treatment of the underlying disease and its neurosis-like manifestations

The symptoms of pathological fatigue, apathy, and depression in patients after stroke

Objective: to comparatively analyze the rate and correlation of the symptoms of pathological fatigue, apathy, and depression in patients in the termination phase of an acute stroke period.Patients and methods. The symptoms of asthenia (pathological fatigue), apathy, and depression were comparatively investigated in 105 patients at 3–4 weeks after stroke. The fatigue rating scale, apathy rating scale, and hospital anxiety and depression (HAD) scale were used to evaluate the symptoms of pathological fatigue, apathy, and depression. The level of anxiety was also estimated using the appropriate HAD subscale and the Epworth daytime sleepiness scale; the magnitude of cognitive impairments was judged from the Montreal cognitive assessment. The type, basin, and recurrence of stroke were registered. The severity of neurological deficit was evaluated using the U.S. National Institutes of Health Stroke Scale (NIHSS); limited functional capacities were estimated by the modified Rankin scale (mRS). The presence of prestroke fatigue was also determined.Results and discussion. The symptoms of asthenia were observed in 56% of the patients and associated with the severity of poststroke disability. The symptoms of apathy were detected in 10.5% of the patients; those of depression were present in 18% and determined by the magnitude of neurological deficit and the degree of poststroke disability and cognitive impairments. All the three phenomena were correlated with the magnitude of anxiety, daytime sleepiness, and between them. This suggests that they may complicate a reciprocal course in some cases. The symptoms of depression, asthenia, and apathy may also develop on their own, which is borne out by their different rates and correlations. Each of these phenomena requires an individual approach to diagnosis and treatment.Conclusion. The symptoms of pathological fatigue are most common and least specific in patients with mild poststroke neurological deficit. Apathy may be also associated with depression or develop on its own. Further investigation of mechanisms for the development of poststroke pathological fatigue and apathy is important for developing effective methods to correct these abnormalities

Mobility deficit – Rehabilitate, an opportunity for functionality

There are many pathological conditions that cause mobility deficits and that ultimately influence someone’s autonomy.Aims: to evaluate patients with mobility deficits functional status; to implement a Rehabilitation Nursing intervention plan; to monitor health gains through mobility deficits rehabilitation.Conclusion: Early intervention and the implementation of a nursing rehabilitation intervention plan results in health gains (direct or indirect), decreases the risk of developing Pressure Ulcers (PU) and the risk of developing a situation of immobility that affects patients’ autonomy and quality of life

Наследственные спастические параплегии

Hereditary spastic paraplegias represent a group of hereditary neurodegenerative disorders predominantly affecting corticospinal tracts which manifest with prominent spasticity and reduced power in the muscles of the lower limbs. According to clinical signs hereditary spastic paraplegias are divided into uncomplicated (classic) and complicated forms, according to the nature of inheritance – into autosomal dominant, autosomal recessive and X-linked. Mechanisms of the development of hereditary spastic paraplegias depend on the form and could be associated with misfolding of the proteins in endoplasmatic reticulum, mitochondrial dysfunction, changes in the cholesterol metabolism etc. Diagnosis is made after exclusion of other disorders of the central nervous system and could be confirmed by molecular genetic methods. Treatment of hereditary spastic paraplegias is symptomatic.Наследственные спастические параплегии – группа нейродегенеративных заболеваний с преимущественным поражением кортикоспинального тракта, которые проявляются выраженной спастичностью и снижением силы в мышцах нижних конечностей. По клиническим проявлениям выделяют неосложненные (классические) и осложненные формы, по типу наследования – аутосомно-доминантные, аутосомно-рецессивные и Х-сцепленные. Механизмы развития наследственных спастических параплегий зависят от формы заболевания и связаны с мисфолдингом белков в эндоплазматическом ретикулуме, митохондриальной дисфункцией, нарушением метаболизма холестерина и проч. Диагноз наследственных спастических параплегий устанавливается при наличии характерных клинико-анамнестических данных, при исключении других заболеваний центральной нервной системы и подтверждается молекулярно-генетическими методами. Лечение наследственных спастических параплегий симптоматическое

CT and Clinical Predictors of Fatigue at One Month after Stroke

Background: Fatigue is a common and distressing consequence of stroke, and the aetiology of post-stroke fatigue (PSF) is poorly understood. It is unclear whether chronic brain changes [cerebral atrophy and white matter lesions (WML)], stroke lesion location or certain clinical features are related to its development. The aim of this study was to identify, in patients with acute stroke, whether features in different brain regions on routine CT imaging or routinely collected clinical features predicted PSF at 1 month. Methods: In total, 107 patients (62% male) with acute ischaemic or haemorrhagic stroke were assessed for fatigue (Fatigue Assessment Scale), anxiety and depression (Hospital Anxiety and Depression Scale) at 1 month. Admission brain CT was rated using a structured scoring system for (i) severity of atrophy and (ii) severity of WML in different regions of the brain, and (iii) site of acute and previous vascular lesions. Results: Cerebral atrophy of mild or greater severity was present in 84 patients (77.5%) and WML of mild or greater severity was present in 54 patients (50.5%) in at least one of the evaluated brain regions. There was no association between PSF and severity of atrophy or WML, or presence of acute or previous vascular lesions. We used the Oxfordshire Community Stroke Project (OCSP) classification to explore the possible influence of lesion location because a minority of the patients (37.4%) had visible acute lesions. Fatigue scores were higher in patients with clinically diagnosed posterior strokes (p = 0.046), in females (p = 0.05) and in those with higher depression and anxiety scores (ρ = 0.52; p 2 = 0.254). Stroke subtype (according to the OCSP classification) was marginally predictive (β = 0.17; p = 0.05) and sex was not statistically significant (β = 0.15; p = 0.08). Conclusions: Features on routine post-stroke CT do not appear to associate with fatigue at 1 month. However, clinically diagnosed posterior strokes as well as female gender, anxiety and depression may be linked with fatigue. Therefore, clinical vigilance rather than CT features should be used to predict fatigue early after stroke. Further research is needed in this area to establish whether biological mechanisms underlie the development of PSF

Опыт применения нусинерсена в качестве патогенетической терапии у взрослых пациентов со спинальной мышечной атрофией 5q в Республике Башкортостан

Background. Spinal muscular atrophy (SMA) affects 1 in 11,000 people. Until 2016, this was considered an incurable disease, but after the approval of nusinersen, the situation has changed. The efficacy of nusinersen therapy is also known in adult patients, although research is limited due to the majority of studies in infants and children. Nusinersen has been included in the list of “Vital and Essential Medicines” since 2021.Aim. To analyze the experience of using nusinersen as a pathogenetic therapy for patients over 18 years of age with SMA 5q in the Republic of Bashkortostan.Materials and methods. We examined eight patients receiving pathogenetic therapy with nusinersen (SMA type 2 – 34.5 %, SMA type 3 – 65.5 %). The Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM) were used for evaluating the effectiveness of therapy.Results. The median increase on the HFMSE scale was +2 points (7.5, with the initial 5.5) and on the RULM scale – +4.5 points (17 points, with the initial 12.5). Clinically, this was expressed in an increase in muscle strength, an increase in daily activity; a decrease in bulbar, respiratory and vegetative disorders can also be noted. Subjectively, positive dynamics was noted in the increase in working capacity, improvement of the emotional background.Conclusion. The use of the drug nusinersen in adult patients with SMA 5q in some cases provides clinical improvement. The presence of an “overall response” is defined as clinically significant change in one assessed measure of motor function. Введение. Спинальной мышечной атрофией (СМА) болеет 1 из 13 тыс. человек. До 2016 г. она считалась неизлечимым заболеванием, но после одобрения препарата нусинерсен ситуация изменилась. Эффективность терапии нусинерсеном известна как у взрослых пациентов, так и у детей. С 2021 г. нусинерсен включен в Перечень жизненно необходимых и важнейших лекарственных препаратов для медицинского применения.Цель исследования – проанализировать опыт применения препарата нусинерсен в качестве патогенетической терапии у пациентов старше 18 лет со СМА 5q в Республике Башкортостан.Материалы и методы. Нами были обследованы 8 пациентов, получающих патогенетическую терапию нусинерсеном (СМА 2-го типа – 34,5 %, СМА 3-го типа – 65,5 %). Для оценки эффективности терапии использовались Расширенная шкала оценки моторных функций больницы Хаммерсмит (Hammersmith Functional Motor Scale Expanded, HFMSE) и Пересмотренный модуль оценки моторной функции верхних конечностей (Revised Upper Limb Module, RULM).Результаты. Среднее количество инъекций – 7,25. Возрастание медианы по шкале HFMSE составило +2 балла (7,5; при исходной 5,5 балла), а по шкале RULM – +4,5 балла (17; при исходной 12,5 балла). Клинически это выражалось в увеличении мышечной силы, повышении повседневной активности пациентов; также можно отметить уменьшение бульбарных, дыхательных и вегетативных нарушений. Субъективно положительная динамика выражалась в увеличении работоспособности, улучшении эмоционального фона.Выводы. Применение препарата нусинерсен у взрослых пациентов со СМА 5q в ряде случаев обеспечивает клиническое улучшение. Наличие «ответа в целом» определяется как клинически значимое изменение 1 оцениваемого показателя двигательных функций.

Clinical and pathogenetic aspects of nervous system impairments in covid-19

Neurological manifestations are reported in 6—36% of patients with COVID-19. They could be divided into direct (viral), secondary (somatogenic) and post(para)infectious (autoimmune) variants according to the pathogenetic mechanisms of their development. The most common type is a secondary impairment of the nervous system presented with encephalopathy of hypoxic, infectious/ toxic or dysmetabolic origin. Its major mechanism is related to the brain edema while clinical presentations include non-specif-ic symptoms such as headaches, dizziness and consciousness impairments. Only single reports exist on coronavirus meningoen-cephalitides. Postinfectious complications of COVID-19 mostly presented with different forms of Gulliane-Barre syndrome. Stroke is registered in 2,5—5% of COVID-19 cases. Their development is associated with hypercoagulation and endothelial dysfunction. Strokes more often develop in elderly with established vascular risk factors and severe COVID-1 but they might also be observed in people younger than 50 years of age and in those with relatively mild forms of the disease. More research is needed in this area