66 research outputs found
ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠΎΠ»Ρ Π°ΡΡΠΎΠ°Π½ΡΠΈΡΠ΅Π» ΠΊ Π³Π°Π½Π³Π»ΠΈΠΎΠ·ΠΈΠ΄Π°ΠΌ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ Π½Π΅ΡΠ²ΠΎΠ²: ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ ΠΈ ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΡΠ΅ Π΄Π°Π½Π½ΡΠ΅
The study of anti-glycolipid antibodies has become available to general practice in Russia. Indications for determining antibodies to gangliosidesare GuillainβBarrΓ© syndrome, Miller Fisher syndrome, Bickerstaffβs encephalitis, chronic inflammatory demyelinating polyneuropathy,Β multifocal motor neuropathy. The indication for measuring anti-MAG antibodies is IgM paraprotein-associated polyneuropathy.Β These immunological tests must be included in diagnostic protocols if the listed dysimmune diseases are suspected.ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π°Π½ΡΠΈΡΠ΅Π» ΠΊ Π³Π»ΠΈΠΊΠΎΠ»ΠΈΠΏΠΈΠ΄Π°ΠΌ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π΅ΡΠ²ΠΎΠ² ΡΡΠ°Π»ΠΎ Π΄ΠΎΡΡΡΠΏΠ½ΠΎ Π΄Π»Ρ ΡΠΈΡΠΎΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ Π²ΠΎ ΠΌΠ½ΠΎΠ³ΠΈΡ
Π³ΠΎΡΠΎΠ΄Π°Ρ
Π ΠΎΡΡΠΈΠΈ.Β ΠΠΎΠΊΠ°Π·Π°Π½ΠΈΠ΅ΠΌ ΠΊ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ΅ΡΡΠ° Π½Π° ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ Π°Π½ΡΠΈΠ³Π°Π½Π³Π»ΠΈΠΎΠ·ΠΈΠ΄Π½ΡΡ
Π°Π½ΡΠΈΡΠ΅Π» ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΡΠΈΠ½Π΄ΡΠΎΠΌΒ ΠΠΈΠΉΠ΅Π½Π°βΠΠ°ΡΡΠ΅, ΡΠΈΠ½Π΄ΡΠΎΠΌ ΠΠΈΠ»Π»Π΅ΡΠ° Π€ΠΈΡΠ΅ΡΠ°, ΡΠ½ΡΠ΅ΡΠ°Π»ΠΈΡ ΠΠΈΠΊΠ΅ΡΡΡΠ°ΡΡΠ°, Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΡΡ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΡΡ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ, ΠΌΡΠ»ΡΡΠΈΡΠΎΠΊΠ°Π»ΡΠ½ΡΡ ΠΌΠΎΡΠΎΡΠ½ΡΡ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ. ΠΠΎΠΊΠ°Π·Π°Π½ΠΈΠ΅ΠΌ ΠΊ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ Π°Π½ΡΠΈ-MAG-Π°Π½ΡΠΈΡΠ΅Π» ΡΠ»ΡΠΆΠΈΡ Π½Π°Π»ΠΈΡΠΈΠ΅ Ρ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ IgM-ΠΏΠ°ΡΠ°ΠΏΡΠΎΡΠ΅ΠΈΠ½Π΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ. ΠΠ°ΡΡΠ±Π΅ΠΆΠ½ΡΠΉ ΠΈ ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ ΠΎΠΏΡΡ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π°Π΅Ρ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ ΡΡΠΈΡ
ΠΈΠΌΠΌΡΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅ΡΡΠΎΠ² Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠΎΡΠΎΠΊΠΎΠ» ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ΠΈΠ΅ΠΌ Π½Π° ΠΏΠ΅ΡΠ΅ΡΠΈΡΠ»Π΅Π½Π½ΡΠ΅ Π΄ΠΈΠ·ΠΈΠΌΠΌΡΠ½Π½ΡΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΒ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ
Motor Cortex Hyperexcitability, Neuroplasticity, and Degeneration in Amyotrophic Lateral Sclerosis
Neuronal hyperexcitability is a well-known phenomenon in amyotrophic lateral sclerosis and other neurodegenerative diseases. The use of transcranial magnetic stimulation in clinical and research practice has recently made it possible to detect motor cortex hyperexcitability under clinical conditions. Despite numerous studies, the mechanisms and sequelae of the development of hyperexcitability still have not been completely elucidated. In this chapter, we discuss the possibilities for detecting motor cortex hyperexcitability in patients with amyotrophic lateral sclerosis using transcranial magnetic stimulation. The potential relationship between hyperexcitability and neuronal degeneration or neuroplasticity processes is discussed using the data obtained by navigated transcranial magnetic stimulation and neuroimaging data, as well as the data of experimental studies
ΠΠ½ΡΡΡΠΈΠ²Π΅Π½Π½Π°Ρ Π²ΡΡΠΎΠΊΠΎΠ΄ΠΎΠ·Π½Π°Ρ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ: ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄Π°ΡΠΈΠΈ ΠΏΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π΄ΠΈΠ·ΠΈΠΌΠΌΡΠ½Π½ΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π½Π΅ΠΉΡΠΎΠΌΠΎΡΠΎΡΠ½ΠΎΠ³ΠΎ Π°ΠΏΠΏΠ°ΡΠ°ΡΠ°
Current publication summarizes main indications and benefits of intravenous high-dose immunotherapy (IHI) in the treatment of variousΒ autoimmune diseases of the peripheral nervous system. Available products of intravenous immunoglobulin (IVIG) on the Russian marketΒ are reviewed. Tactics for choosing optimal medication for IHI based on its effectiveness and safety are analyzed. Dosage calculation andΒ way of administration of IVIG are described, beeing of a high practical value in neurologistβs daily work.Π Π°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ ΠΎΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΡ ΠΊ Π²Π½ΡΡΡΠΈΠ²Π΅Π½Π½ΠΎΠΉ Π²ΡΡΠΎΠΊΠΎΠ΄ΠΎΠ·Π½ΠΎΠΉ ΠΈΠΌΠΌΡΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠΠ) ΠΈ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π° Π΅Π΅ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
Π°ΡΡΠΎΠΈΠΌΠΌΡΠ½Π½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ ΠΎΠ±Π·ΠΎΡ ΠΈΠΌΠ΅ΡΡΠΈΡ
ΡΡ Π½Π° ΡΠΎΡΡΠΈΠΉΡΠΊΠΎΠΌΒ ΡΡΠ½ΠΊΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π²Π½ΡΡΡΠΈΠ²Π΅Π½Π½ΡΡ
ΠΈΠΌΠΌΡΠ½ΠΎΠ³Π»ΠΎΠ±ΡΠ»ΠΈΠ½ΠΎΠ² (ΠΠΠΠ). ΠΠΎΠ΄ΡΠΎΠ±Π½ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π° ΡΠ°ΠΊΡΠΈΠΊΠ° ΠΏΠΎ Π²ΡΠ±ΠΎΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° Π΄Π»Ρ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΠΠ Ρ ΡΡΠ΅ΡΠΎΠΌ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π΅Π³ΠΎ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΈ ΡΡΠΎΠ²Π½Ρ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ. Π ΡΠ΄ΠΎΠ±Π½ΠΎΠΉ ΡΠΎΡΠΌΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΡΡ
Π΅ΠΌΡ ΡΠ°ΡΡΠ΅ΡΠ° ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΎΠ·Ρ ΠΈ ΡΡ
Π΅ΠΌΡ Π²Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΠΠΠ, ΡΡΠΎ, Π±Π΅Π·ΡΡΠ»ΠΎΠ²Π½ΠΎ, ΠΈΠΌΠ΅Π΅Ρ Π±ΠΎΠ»ΡΡΠΎΠ΅ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅Β Π² Π΅ΠΆΠ΅Π΄Π½Π΅Π²Π½ΠΎΠΉ ΡΠ°Π±ΠΎΡΠ΅ Π²ΡΠ°ΡΠ°-Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³Π°
ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΎΡΡΡΠΎΠΉ ΠΌΠΎΡΠΎΡΠ½ΠΎΠΉ Π°ΠΊΡΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π½Π΅Π²ΡΠΎΠΏΠ°ΡΠΈΠΈ Ρ Π±Π»ΠΎΠΊΠ°ΠΌΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π½Π° ΠΏΡΠΈΠΌΠ΅ΡΠ΅ Π΄Π²ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ ΡΠ»ΡΡΠ°Π΅Π²
Introduction. The heterogeneity of the forms and severity of Guillain-Barre syndrome explains the variability of recovery: from rapid and complete (in most cases) to slow with the development of persistent residual deficiency (rarely). It is unclear how effective the Erasmus GuillainβBarre syndrome Outcome Scores and its modified version are for different forms of the disease.The aim of the study β to demonstrate the features of recovery in acute motor axonal neuropathy with conduction blocks on the example of 2 clinical cases; to show the possibilities of Erasmus GuillainβBarre syndrome Outcome Scores and its modified version in predicting recovery in this form of the disease.Materials and methods. Data from 2 patients with acute motor axonal neuropathy with motor conduction blocks were retrospectively analyzed. Calculation of the score and assessment of the prognosis of walking recovery by 6 months from the onset of the disease were performed using the online calculator International Guillain-Barre syndrome Outcome Study Prognosis tool in the acute period.Results. In both patients, the forecast of recovery of walking by half a year from the onset of the disease on the Erasmus GuillainβBarre syndrome Outcome Scores and modified Erasmus GuillainβBarre syndrome Outcome Scores scales in the acute period was erroneous. In the first case, the total score on the Erasmus GuillainβBarre syndrome Outcome Scores and its modification in the acute period was 5 and 10 points respectively (poor prognosis), which foreshadowed a long rehabilitation process and incomplete recovery. However, the regression of disorders was dramatic and complete, and by the second month of the disease, only minimal motor disorders remained. In the second patient, on the contrary, the total Erasmus GuillainβBarre syndrome Outcome Scores and its modification during the period of increasing symptoms was 3 and 7 points respectively (good prognosis), while recovery was delayed β only by 5 months from the onset of the disease, the ability to move with support was restored.Conclusion. The GuillainβBarre syndrome is a disease with a favorable prognosis for recovery. However, the prediction of regression of motor disorders should be approached carefully, because in some cases, generally accepted criteria and prognostic scales may not work. Acute motor axonal neuropathy with conduction blocks is a unique form of the disease that has pathophysiological and clinical-neurophysiological features, which should be taken into account when managing this category of patients.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΠ΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎΡΡΡ ΡΠΎΡΠΌ ΠΈ ΡΡΠ΅ΠΏΠ΅Π½Π΅ΠΉ ΡΡΠΆΠ΅ΡΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° ΠΠΈΠΉΠ΅Π½Π°βΠΠ°ΡΡΠ΅ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»ΠΈΠ²Π°Π΅Ρ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΡ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ: ΠΎΡ Π±ΡΡΡΡΠΎΠ³ΠΎ ΠΈ ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ (Π² Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π΅ ΡΠ»ΡΡΠ°Π΅Π²) Π΄ΠΎ ΠΊΡΠ°ΠΉΠ½Π΅ Π·Π°ΠΌΠ΅Π΄Π»Π΅Π½Π½ΠΎΠ³ΠΎ, Ρ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΡΡΠΎΠΉΠΊΠΎΠ³ΠΎ ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΠΈΡΠΈΡΠ° (ΡΠ΅Π΄ΠΊΠΎ). ΠΡΡΠ°Π΅ΡΡΡ Π½Π΅ΡΡΠ½ΡΠΌ Π²ΠΎΠΏΡΠΎΡ, Π½Π°ΡΠΊΠΎΠ»ΡΠΊΠΎ ΡΠΊΠ°Π»Π° ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ ΠΠΈΠΉΠ΅Π½Π°βΠΠ°ΡΡΠ΅ ΠΡΠ°ΡΠΌΡΡ ΠΈ Π΅Π΅ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ Π²Π΅ΡΡΠΈΡ ΠΏΡΠΈΠΌΠ΅Π½ΠΈΠΌΡ ΠΊΠΎ Π²ΡΠ΅ΠΌ ΡΠΎΡΠΌΠ°ΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β Π½Π° ΠΏΡΠΈΠΌΠ΅ΡΠ΅ 2 ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ»ΡΡΠ°Π΅Π² ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°ΡΡ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΠΎΡΡΡΠΎΠΉ ΠΌΠΎΡΠΎΡΠ½ΠΎΠΉ Π°ΠΊΡΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π½Π΅Π²ΡΠΎΠΏΠ°ΡΠΈΠΈ Ρ Π±Π»ΠΎΠΊΠ°ΠΌΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ; ΠΏΠΎΠΊΠ°Π·Π°ΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΡΠΊΠ°Π»Ρ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ ΠΠΈΠΉΠ΅Π½Π°ΠΠ°ΡΡΠ΅ ΠΡΠ°ΡΠΌΡΡ ΠΈ Π΅Π΅ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ Π²Π΅ΡΡΠΈΠΈ Π² ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ Π΄Π°Π½Π½ΠΎΠΉ ΡΠΎΡΠΌΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 2 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΠΎΡΡΡΠΎΠΉ ΠΌΠΎΡΠΎΡΠ½ΠΎΠΉ Π°ΠΊΡΠΎΠ½Π°Π»ΡΠ½ΠΎΠΉ Π½Π΅Π²ΡΠΎΠΏΠ°ΡΠΈΠ΅ΠΉ Ρ ΠΌΠΎΡΠΎΡΠ½ΡΠΌΠΈ Π±Π»ΠΎΠΊΠ°ΠΌΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ. Π Π°ΡΡΠ΅Ρ Π±Π°Π»Π»ΠΎΠ² ΠΈ ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Ρ
ΠΎΠ΄ΡΠ±Ρ ΠΊ 6 ΠΌΠ΅Ρ ΠΎΡ Π½Π°ΡΠ°Π»Π° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈΡΡ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΎΠ½Π»Π°ΠΉΠ½-ΠΊΠ°Π»ΡΠΊΡΠ»ΡΡΠΎΡΠ° International GuillainβBarre syndrome Outcome Study Prognosis tool Π² ΠΎΡΡΡΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π£ ΠΎΠ±Π΅ΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ ΠΏΡΠΎΠ³Π½ΠΎΠ· Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Ρ
ΠΎΠ΄ΡΠ±Ρ ΠΊ ΠΏΠΎΠ»ΡΠ³ΠΎΠ΄Ρ ΠΎΡ Π½Π°ΡΠ°Π»Π° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΠΎ ΡΠΊΠ°Π»Π°ΠΌ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ ΠΠΈΠΉΠ΅Π½Π°βΠΠ°ΡΡΠ΅ ΠΈ Π΅Π΅ ΠΌΠΎΠ΄ΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Π² ΠΎΡΡΡΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΎΠΊΠ°Π·Π°Π»ΡΡ ΠΎΡΠΈΠ±ΠΎΡΠ½ΡΠΌ. Π ΠΏΠ΅ΡΠ²ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΡΡΠΌΠΌΠ°ΡΠ½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ ΠΠΈΠΉΠ΅Π½Π°βΠΠ°ΡΡΠ΅ ΠΡΠ°ΡΠΌΡΡ ΠΈ Π΅Π΅ ΠΌΠΎΠ΄ΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Π² ΠΎΡΡΡΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 5 ΠΈ 10 Π±Π°Π»Π»ΠΎΠ² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (ΠΏΠ»ΠΎΡ
ΠΎΠΉ ΠΏΡΠΎΠ³Π½ΠΎΠ·), ΡΡΠΎ ΠΏΡΠ΅Π΄Π²Π΅ΡΠ°Π»ΠΎ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΏΡΠΎΡΠ΅ΡΡ ΠΈ Π½Π΅ΠΏΠΎΠ»Π½ΠΎΠ΅ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅. ΠΠ΄Π½Π°ΠΊΠΎ ΡΠ΅Π³ΡΠ΅ΡΡ Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π±ΡΠ» Π΄ΡΠ°ΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈ ΠΏΠΎΠ»Π½ΡΠΌ, ΠΈ ΡΠΆΠ΅ ΠΊΠΎ 2-ΠΌΡ ΠΌΠ΅ΡΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΡΠΎΡ
ΡΠ°Π½ΡΠ»ΠΈΡΡ Π»ΠΈΡΡ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΡΠ΅ Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΡΠ΅ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ. Π£ 2-ΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ, Π½Π°ΠΏΡΠΎΡΠΈΠ², ΡΡΠΌΠΌΠ°ΡΠ½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΏΠΎ ΡΠΊΠ°Π»Π΅ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ΅ ΠΠΈΠΉΠ΅Π½Π°βΠΠ°ΡΡΠ΅ ΠΡΠ°ΡΠΌΡΡ ΠΈ Π΅Π΅ ΠΌΠΎΠ΄ΠΈΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Π½Π°ΡΠ°ΡΡΠ°Π½ΠΈΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΈ Π±ΡΠ»Π° ΡΠ°Π²Π½Π° 3 ΠΈ 7 Π±Π°Π»Π»Π°ΠΌ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ (Ρ
ΠΎΡΠΎΡΠΈΠΉ ΠΏΡΠΎΠ³Π½ΠΎΠ·), ΠΏΡΠΈ ΡΡΠΎΠΌ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅ Π±ΡΠ»ΠΎ ΠΎΡΡΡΠΎΡΠ΅Π½Π½ΡΠΌ β ΡΠΎΠ»ΡΠΊΠΎ ΠΊ 5-ΠΌΡ ΠΌΠ΅ΡΡΡΡ ΠΎΡ Π½Π°ΡΠ°Π»Π° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²ΠΈΠ»Π°ΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΏΠ΅ΡΠ΅Π΄Π²ΠΈΠΆΠ΅Π½ΠΈΡ Ρ ΠΎΠΏΠΎΡΠΎΠΉ.ΠΡΠ²ΠΎΠ΄Ρ. Π‘ΠΈΠ½Π΄ΡΠΎΠΌ ΠΠΈΠ΅ΠΉΠ½Π°βΠΠ°ΡΡΠ΅, Π½Π΅ΡΠΎΠΌΠ½Π΅Π½Π½ΠΎ, ΡΠ²Π»ΡΠ΅ΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ΠΌ Ρ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΌ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΎΠΌ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ. ΠΠ΄Π½Π°ΠΊΠΎ ΠΊ ΠΏΡΠΎΠ³Π½ΠΎΠ·ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΡΠ΅Π½Π°ΡΠΈΡ ΡΠ΅Π³ΡΠ΅ΡΡΠ° Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΠΈΡΡ ΠΎΡΡΠΎΡΠΎΠΆΠ½ΠΎ, ΡΠ°ΠΊ ΠΊΠ°ΠΊ Π² ΡΡΠ΄Π΅ ΡΠ»ΡΡΠ°Π΅Π² ΠΎΠ±ΡΠ΅ΠΏΡΠΈΠ½ΡΡΡΠ΅ ΠΊΡΠΈΡΠ΅ΡΠΈΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠΊΠ°Π»Ρ ΠΌΠΎΠ³ΡΡ Π½Π΅ ΡΠ°Π±ΠΎΡΠ°ΡΡ. ΠΡΡΡΠ°Ρ ΠΌΠΎΡΠΎΡΠ½Π°Ρ Π°ΠΊΡΠΎΠ½Π°Π»ΡΠ½Π°Ρ Π½Π΅Π²ΡΠΎΠΏΠ°ΡΠΈΡ Ρ Π±Π»ΠΎΠΊΠ°ΠΌΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ β ΡΠ½ΠΈΠΊΠ°Π»ΡΠ½Π°Ρ ΡΠΎΡΠΌΠ° Π±ΠΎΠ»Π΅Π·Π½ΠΈ, ΠΈΠΌΠ΅ΡΡΠ°Ρ ΠΏΠ°ΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π½Π΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ, ΡΡΠΎ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΡΡΠΈΡΡΠ²Π°ΡΡ ΠΏΡΠΈ Π²Π΅Π΄Π΅Π½ΠΈΠΈ Π΄Π°Π½Π½ΠΎΠΉ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ²
ΠΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΡΠΉ ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΡΠΉ Π½Π΅ΡΠ²: Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π΅ΠΉΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Ρ Π²Π·ΡΠΎΡΠ»ΡΡ
Background. The study of the sensitive portion of the medial plantar nerve is relevant not only in the examination of patients with tibial nerve mononeuropathy or its branches, but also in the diagnosis of polyneuropathies.Objective: to analyze the normative parameters of the sensory potential recorded during the study of the medial plantar nerve by the orthodromic method in healthy adults.Materials and methods. 126 sensitive fibers of the medial plantar nerves were studied on the Dantec Keypoint G4 device (Denmark) in 63 healthy individuals (31 men and 32 women; age from 20 to 80 years). 3 groups were identified taking into account age: group 1 included healthy people aged 20 to 39 years (n = 23); group 2 consisted of people aged 40 to 60 years (n = 20); and 3 β older than 60 years (n = 20). The parameters of the sensory potential of the medial plantar nerve are analyzed.Results. The sensory potential in the study of the sensitive portion of the medial plantar nerve was registered in all 126 healthy subjects. Comparative statistical analysis did not demonstrate significant differences between groups 1β3 in the values of such parameters of the sensory potential as the latency of the onset, the duration of the negative phase and the rate of propagation of excitation. At the same time, in groups 2 and 3, the magnitude of the amplitude from peak to peak of the sensory potential was significantly lower compared to group 1, and averaged 8.92 and 7.86 MV, respectively.Conclusion. Knowledge of the regulatory parameters will allow expanding the use of electroneuromyography of the sensitive portion of the medial plantar nerve in clinical and research practice.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΡΠΈΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° Π°ΠΊΡΡΠ°Π»ΡΠ½ΠΎ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΡΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΌΠΎΠ½ΠΎΠ½Π΅Π²ΡΠΎΠΏΠ°ΡΠΈΠ΅ΠΉ Π±ΠΎΠ»ΡΡΠ΅Π±Π΅ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° ΠΈΠ»ΠΈ Π΅Π³ΠΎ Π²Π΅ΡΠ²Π΅ΠΉ, Π½ΠΎ ΠΈ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΉ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΠ΅ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ ΡΠ΅Π½ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»Π°, ΡΠ΅Π³ΠΈΡΡΡΠΈΡΡΠ΅ΠΌΠΎΠ³ΠΎ ΠΏΡΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° ΠΎΡΡΠΎΠ΄ΡΠΎΠΌΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ, Ρ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π²Π·ΡΠΎΡΠ»ΡΡ
.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ° ΠΏΡΠΈΠ±ΠΎΡΠ΅ Dantec Keypoint G4 (ΠΠ°Π½ΠΈΡ) ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ 126 ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΡΡ
Π²ΠΎΠ»ΠΎΠΊΠΎΠ½ ΠΌΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΡΡ
ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΡΡ
Π½Π΅ΡΠ²ΠΎΠ² Ρ 63 Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π»ΠΈΡ (31 ΠΌΡΠΆΡΠΈΠ½Π° ΠΈ 32 ΠΆΠ΅Π½ΡΠΈΠ½Ρ; Π²ΠΎΠ·ΡΠ°ΡΡ ΠΎΡ 20 Π΄ΠΎ 80 Π»Π΅Ρ).ΠΡΠ΄Π΅Π»Π΅Π½Ρ 3 Π³ΡΡΠΏΠΏΡ Ρ ΡΡΠ΅ΡΠΎΠΌ Π²ΠΎΠ·ΡΠ°ΡΡΠ°: Π² 1βΡ Π³ΡΡΠΏΠΏΡ Π²ΠΎΡΠ»ΠΈ Π·Π΄ΠΎΡΠΎΠ²ΡΠ΅ Π»ΠΈΡΠ° Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ ΠΎΡ 20 Π΄ΠΎ 39 Π»Π΅Ρ (n = 23), 2βΡ Π³ΡΡΠΏΠΏΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ Π»ΠΈΡΠ° ΠΎΡ 40 Π΄ΠΎ 60 Π»Π΅Ρ (n = 20), ΠΈ 3βΡ β ΡΡΠ°ΡΡΠ΅ 60 Π»Π΅Ρ (n = 20). ΠΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΡ ΡΠ΅Π½ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»Π° ΠΌΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π°.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘Π΅Π½ΡΠΎΡΠ½ΡΠΉ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π» ΠΏΡΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΡΠΈΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° Π±ΡΠ» Π·Π°ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π½ Ρ Π²ΡΠ΅Ρ
126 Π·Π΄ΠΎΡΠΎΠ²ΡΡ
ΠΈΡΠΏΡΡΡΠ΅ΠΌΡΡ
. Π‘ΡΠ°Π²Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· Π½Π΅ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π» Π·Π½Π°ΡΠΈΠΌΡΡ
ΡΠ°Π·Π»ΠΈΡΠΈΠΉ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ 1β3 Π²Π΅Π»ΠΈΡΠΈΠ½ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΡΠ΅Π½ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»Π°, ΠΊΠ°ΠΊ Π»Π°ΡΠ΅Π½ΡΠ½ΠΎΡΡΡ Π½Π°ΡΠ°Π»Π°, Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π½Π΅Π³Π°ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ°Π·Ρ ΠΈ ΡΠΊΠΎΡΠΎΡΡΡ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΡ Π²ΠΎΠ·Π±ΡΠΆΠ΄Π΅Π½ΠΈΡ. ΠΡΠΈ ΡΡΠΎΠΌ Π² Π³ΡΡΠΏΠΏΠ°Ρ
2 ΠΈ 3 Π²Π΅Π»ΠΈΡΠΈΠ½Π° Π°ΠΌΠΏΠ»ΠΈΡΡΠ΄Ρ ΠΎΡ ΠΏΠΈΠΊΠ° Π΄ΠΎ ΠΏΠΈΠΊΠ° ΡΠ΅Π½ΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»Π° ΠΎΠΊΠ°Π·Π°Π»Π°ΡΡ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ Π½ΠΈΠΆΠ΅ ΠΏΠΎ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ Ρ Π³ΡΡΠΏΠΏΠΎΠΉ 1 ΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ 8,92 ΠΈ 7,86 ΠΌΠΊΠ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ.ΠΡΠ²ΠΎΠ΄Ρ. ΠΠ½Π°Π½ΠΈΠ΅ Π½ΠΎΡΠΌΠ°ΡΠΈΠ²Π½ΡΡ
ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ ΡΠ°ΡΡΠΈΡΠΈΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π΅ΠΉΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΡΠΈΠΈ ΠΌΠ΅Π΄ΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄ΠΎΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅
ΠΠ΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠ΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ°ΡΠΊΠ΅ΡΡ ΠΏΡΠΈ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΡΠΎ ΡΠΊΠ»ΠΎΠ½Π½ΠΎΡΡΡΡ ΠΊ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°ΠΌ ΠΎΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΡ ΠΈ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΡΠ°Π΄ΠΈΠΊΡΠ»ΠΎΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ
Background. Today, the issues of differential diagnosis of chronic hereditary and acquired demyelinating neuropathies are still relevant. The variety of phenotypic variants of chronic inflammatory demyelinating polyradiculoneuropathy and hereditary neuropathy with liability to pressure palsies, their remitting course and the non-specificity of neurophysiological changes necessitate the identification of clear markers that can help in the differential diagnosis of the neuropathies under discussion already at the stage of the analysis of the electroneuromyographic study data.Aim. To determine neurophysiological differential diagnostic markers in the manifestation of chronic inflammatory demyelinating polyradiculoneuropathy and hereditary neuropathy with liability to pressure palsies.Materials and methods. A retrospective analysis of the data of neurophysiological examination of 25 patients with hereditary neuropathy with liability to pressure palsies and 25 patients with chronic inflammatory demyelinating polyradiculoneuropathy.Results. A combination of such indicators as the age of the onset of the disease <33 years, the latency of the dM-wave with m.ADM ><3.7 ms and with m.AH ><4.8 ms (AUROC >0.7), the value of the conduction velocity along of the motor fibers of the ulnar nerve at the level of the elbow joint <37.5 m/s (AUROC >0.8), the conduction velocity along of the sensory fibers of the median nerve at the level of the wrist <48 m/s (AUROC >0.8), absence of conduction block along the median nerve in any area, and also the presence along the ulnar nerve at the level of the elbow joint is characteristic of hereditary neuropathy with liability to pressure palsies and allows to exclude chronic inflammatory demyelinating polyradiculoneuropathy.Conclusion. Neurophysiological markers have been identified that can help in the differential diagnosis of two chronic remitting demyelinating neuropathies: chronic inflammatory demyelinating polyradiculoneuropathy and hereditary neuropathy with liability to pressure palsies. However, only a combined analysis of clinical, anamnestic and paraclinical data makes it possible to establish a final diagnosis.Β ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ Π²ΠΎΠΏΡΠΎΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈ ΠΏΡΠΈΠΎΠ±ΡΠ΅ΡΠ΅Π½Π½ΡΡ
Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠΈΡ
Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΉ ΠΏΠΎ-ΠΏΡΠ΅ΠΆΠ½Π΅ΠΌΡ Π°ΠΊΡΡΠ°Π»ΡΠ½Ρ. ΠΠ½ΠΎΠ³ΠΎΠΎΠ±ΡΠ°Π·ΠΈΠ΅ ΡΠ΅Π½ΠΎΡΠΈΠΏΠΈΡΠ΅ΡΠΊΠΈΡ
Π²Π°ΡΠΈΠ°Π½ΡΠΎΠ² Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΡΠ°Π΄ΠΈΠΊΡΠ»ΠΎΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΠΈ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΡΠΎ ΡΠΊΠ»ΠΎΠ½Π½ΠΎΡΡΡΡ ΠΊ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°ΠΌ ΠΎΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΡ, ΠΈΡ
ΡΠ΅ΠΌΠΈΡΡΠΈΡΡΡΡΠ΅Π΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΈ Π½Π΅ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡ Π½Π΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»ΠΈΠ²Π°ΡΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π²ΡΠ΄Π΅Π»Π΅Π½ΠΈΡ ΡΠ΅ΡΠΊΠΈΡ
ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠ΅ ΠΌΠΎΠ³ΡΡ ΠΏΠΎΠΌΠΎΡΡ Π² Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π΅ ΠΏΡΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π°Π΅ΠΌΡΡ
Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡΡ
ΡΠΆΠ΅ Π½Π° ΡΡΠ°ΠΏΠ΅ Π°Π½Π°Π»ΠΈΠ·Π° Π΄Π°Π½Π½ΡΡ
ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π΅ΠΉΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ Π½Π΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ°ΡΠΊΠ΅ΡΡ ΠΏΡΠΈ ΠΌΠ°Π½ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΡΠ°Π΄ΠΈΠΊΡΠ»ΠΎΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΠΈ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΡΠΎ ΡΠΊΠ»ΠΎΠ½Π½ΠΎΡΡΡΡ ΠΊ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°ΠΌ ΠΎΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· Π΄Π°Π½Π½ΡΡ
Π½Π΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ 25 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠ΅ΠΉ ΡΠΎ ΡΠΊΠ»ΠΎΠ½Π½ΠΎΡΡΡΡ ΠΊ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°ΠΌ ΠΎΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΡ ΠΈ 25 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΡΠ°Π΄ΠΈΠΊΡΠ»ΠΎΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠ΅ΠΉ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π‘ΠΎΡΠ΅ΡΠ°Π½ΠΈΠ΅ ΡΠ°ΠΊΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ, ΠΊΠ°ΠΊ Π²ΠΎΠ·ΡΠ°ΡΡ Π΄Π΅Π±ΡΡΠ° Π±ΠΎΠ»Π΅Π·Π½ΠΈ <33 Π»Π΅Ρ, Π²Π΅Π»ΠΈΡΠΈΠ½Π° Π»Π°ΡΠ΅Π½ΡΠ½ΠΎΡΡΠΈ Π-Π²ΠΎΠ»Π½Ρ Ρ m.ADM ><3,7 ΠΌΡ ΠΈ Ρ m.AH ><4,8 ΠΌΡ (AUROC >0,7), Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΡΠΊΠΎΡΠΎΡΡΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠΎ ΠΌΠΎΡΠΎΡΠ½ΡΠΌ Π²ΠΎΠ»ΠΎΠΊΠ½Π°ΠΌ Π»ΠΎΠΊΡΠ΅Π²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° Π½Π° ΡΡΠΎΠ²Π½Π΅ Π»ΠΎΠΊΡΠ΅Π²ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° <37,5 ΠΌ/Ρ (AUROC >0,8), ΡΠΊΠΎΡΠΎΡΡΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠΎ ΡΠ΅Π½ΡΠΎΡΠ½ΡΠΌ Π²ΠΎΠ»ΠΎΠΊΠ½Π°ΠΌ ΡΡΠ΅Π΄ΠΈΠ½Π½ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° Π½Π° ΡΡΠΎΠ²Π½Π΅ ΠΊΠΈΡΡΠΈ <48 ΠΌ/Ρ (AUROC >0,8), ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ ΠΌΠΎΡΠΎΡΠ½ΠΎΠ³ΠΎ Π±Π»ΠΎΠΊΠ° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠΎ ΡΡΠ΅Π΄ΠΈΠ½Π½ΠΎΠΌΡ Π½Π΅ΡΠ²Ρ Π½Π° Π»ΡΠ±ΠΎΠΌ ΡΡΠ°ΡΡΠΊΠ΅ ΠΈ Π΅Π³ΠΎ Π½Π°Π»ΠΈΡΠΈΠ΅ ΠΏΠΎ Π»ΠΎΠΊΡΠ΅Π²ΠΎΠΌΡ Π½Π΅ΡΠ²Ρ Π½Π° ΡΡΠΎΠ²Π½Π΅ Π»ΠΎΠΊΡΠ΅Π²ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°, Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠ½ΠΎ Π΄Π»Ρ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΡΠΎ ΡΠΊΠ»ΠΎΠ½Π½ΠΎΡΡΡΡ ΠΊ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°ΠΌ ΠΎΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΡ ΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΈΡΠΊΠ»ΡΡΠΈΡΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΡΡ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΡΡ ΠΏΠΎΠ»ΠΈΡΠ°Π΄ΠΈΠΊΡΠ»ΠΎΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ.ΠΡΠ²ΠΎΠ΄Ρ. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Ρ Π½Π΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ°ΡΠΊΠ΅ΡΡ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΌΠΎΠ³ΡΡ ΠΏΠΎΠΌΠΎΡΡ Π² Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΌ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π΅ 2 Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅ΠΌΠΈΡΡΠΈΡΡΡΡΠΈΡ
Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠΈΡ
Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΉ: Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΡΠ°Π΄ΠΈΠΊΡΠ»ΠΎΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΠΈ Π½Π°ΡΠ»Π΅Π΄ΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΡΠΎ ΡΠΊΠ»ΠΎΠ½Π½ΠΎΡΡΡΡ ΠΊ ΠΏΠ°ΡΠ°Π»ΠΈΡΠ°ΠΌ ΠΎΡ ΡΠ΄Π°Π²Π»Π΅Π½ΠΈΡ. ΠΠ΄Π½Π°ΠΊΠΎ ΡΠΎΠ»ΡΠΊΠΎ ΡΠΎΠ²ΠΎΠΊΡΠΏΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π°Π½Π°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈ ΠΏΠ°ΡΠ°ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
Π΄Π°Π½Π½ΡΡ
ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΎΠΊΠΎΠ½ΡΠ°ΡΠ΅Π»ΡΠ½ΡΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΠ·.
Phenotypic heterogeneity and diagnostic features of transthyretin amyloidosis with polyneuropathy
Transthyretin amyloidosis (ATTR-amyloidosis) is a systemic progressive fatal disease, for which a modifying therapy has recently been proposed that delays the progression of the disease and improves the patientβs quality of life. The delay in the diagnosis of ATTR-amyloidosis is associated with the heterogeneity of the manifestations of the disease, as well as insufficient awareness of doctors of different specialties about the disease. A review of recent studies on the symptomatology, diagnosis, molecular genetic characteristics of ATTR-amyloidosis and the most common forms of the disease with the predominant involvement of peripheral nerves and the heart, as well as the kidneys, gastrointestinal tract, and eyes is presented. The international consensus recommendations for the diagnosis of suspected ATTR-amyloidosis using modern methods that facilitate early and accurate diagnosis are discussed. The reasons and the most frequent misdiagnoses of ATTR-amyloidosis, which also lead to a delay in the timely appointment of therapy, are considered. Molecular genetic testing should be considered early in the evaluation of a patient with unexplained peripheral neuropathy and cardiomyopathy. A diagnostic algorithm based on the initial symptoms and manifestations of the cardiovascular and nervous systems facilitates the identification of a patient with clinical suspicion of ATTR-amyloidosis by the general practitioner. Early diagnosis is critically important for patients with ATTR polyneuropathy, since the early prescription of Vyndaqel (tafamidis), registered in the Russian Federation in 2017, allows a significant clinical effect to be obtained. Timely administration of Vyndaqel significantly slows down the progression of the disease, improves the prognosis and quality of life in patients with ATTR polyneuropathy
ΠΠ΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ ΠΌΠ°Π»ΠΎΠ±Π΅ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π°: ΠΎΠ±ΡΠΈΠ΅ ΠΏΠΎΠ΄Ρ ΠΎΠ΄Ρ ΠΊ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΈ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ
While compression neuropathies of the nerves of the lower limbs are not a common pathology, peroneal nerve neuropathy is the most common of them. Peroneal nerve compression most commonly occurs at or around the head of the fibula, but can also occur in the lower leg, ankle, or foot. Neurophysiological and neuroimaging methods are effective in diagnosing peroneal nerve compression and determining the type of damage. The first line of therapy is lifestyle modification, avoidance of compressive postures, ankle joint orthotics, treatment of knee joint instability when detected, kinesiotherapy. An important role in the correction of symptoms is played using anticholinesterase drugs, the effectiveness of which in diseases of peripheral nervous system has been shown in a number of domestic studies. If conservative treatment fails, surgical treatment is recommended. The diagnosis of peroneal neuropathy is associated with a good prognosis and most patients experience complete recovery of nerve function.ΠΠ΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ ΠΌΠ°Π»ΠΎΠ±Π΅ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°ΠΌΠΎΠΉ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΠΉ ΠΈΠ· ΠΏΠ΅ΡΠ΅ΡΠ½Ρ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΎΠ½Π½ΡΡ
Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΉ Π½Π΅ΡΠ²ΠΎΠ² Π½ΠΈΠΆΠ½ΠΈΡ
ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΡΡΠ΅ΠΉ. ΠΠΎΠΌΠΏΡΠ΅ΡΡΠΈΡ ΠΌΠ°Π»ΠΎΠ±Π΅ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° ΡΠ°ΡΠ΅ Π²ΡΠ΅Π³ΠΎ ΠΏΡΠΎΠΈΡΡ
ΠΎΠ΄ΠΈΡ Π½Π° ΡΡΠΎΠ²Π½Π΅ Π³ΠΎΠ»ΠΎΠ²ΠΊΠΈ ΠΌΠ°Π»ΠΎΠ±Π΅ΡΡΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΡΠΈ, Π½ΠΎ ΡΠ°ΠΊΠΆΠ΅ ΠΌΠΎΠΆΠ΅Ρ Π²ΠΎΠ·Π½ΠΈΠΊΠ°ΡΡ Π² ΠΎΠ±Π»Π°ΡΡΠΈ Π³ΠΎΠ»Π΅Π½ΠΈ, Π»ΠΎΠ΄ΡΠΆΠΊΠΈ ΠΈΠ»ΠΈ Π½Π° ΡΡΠΎΠΏΠ΅. ΠΠ΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ Π½Π΅ΠΉΡΠΎΠ²ΠΈΠ·ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄Ρ ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠ²Π½Ρ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΠΊΠΎΠΌΠΏΡΠ΅ΡΡΠΈΠΈ ΠΌΠ°Π»ΠΎΠ±Π΅ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° ΠΈ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΠΈΠΏΠ° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ. Π’Π΅ΡΠ°ΠΏΠΈΠ΅ΠΉ 1βΠΉ Π»ΠΈΠ½ΠΈΠΈ ΡΠ²Π»ΡΡΡΡΡ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ ΠΎΠ±ΡΠ°Π·Π° ΠΆΠΈΠ·Π½ΠΈ, ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ° ΠΊΠΎΠΌΠΏΡΠΈΠΌΠΈΡΡΡΡΠΈΡ
ΠΏΠΎΠ·, ΠΎΡΡΠ΅Π·ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π³ΠΎΠ»Π΅Π½ΠΎΡΡΠΎΠΏΠ½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π°, ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡ Π½Π΅ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΠΈ ΠΊΠΎΠ»Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΡΡΠ°Π²Π° ΠΏΡΠΈ Π΅Π΅ Π½Π°Π»ΠΈΡΠΈΠΈ, ΠΊΠΈΠ½Π΅Π·ΠΈΠΎΡΠ΅ΡΠ°ΠΏΠΈΡ. ΠΠ°ΠΆΠ½ΡΡ ΡΠΎΠ»Ρ Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΠΈ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² ΠΈΠ³ΡΠ°Π΅Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ², ΠΈΠ½Π³ΠΈΠ±ΠΈΡΡΡΡΠΈΡ
Ρ
ΠΎΠ»ΠΈΠ½ΡΡΡΠ΅ΡΠ°Π·Ρ, ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΊΠΎΡΠΎΡΡΡ
ΠΏΡΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡΡ
ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ Π±ΡΠ»Π° ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π½Π° Π² ΡΡΠ΄Π΅ ΠΎΡΠ΅ΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ. ΠΡΠΎΠ³Π½ΠΎΠ· Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΠΌΠ°Π»ΠΎΠ±Π΅ΡΡΠΎΠ²ΠΎΠ³ΠΎ Π½Π΅ΡΠ²Π° Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΉ, ΠΈ Ρ Π±ΠΎΠ»ΡΡΠΈΠ½ΡΡΠ²Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π°Π±Π»ΡΠ΄Π°Π΅ΡΡΡ ΠΏΠΎΠ»Π½ΠΎΠ΅ ΠΈΠ»ΠΈ ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ ΠΏΠΎΠ»Π½ΠΎΠ΅ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΈ Π½Π΅ΡΠ²Π°. ΠΡΠΈ Π½Π΅ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΊΠΎΠ½ΡΠ΅ΡΠ²Π°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ΅ΠΊΠΎΠΌΠ΅Π½Π΄ΠΎΠ²Π°Π½Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ
Π‘ΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π°ΡΠΈΠΏΠΈΡΠ½ΡΡ ΡΠΎΡΠΌ Ρ ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ: ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ Π·Π° 8 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Π±Π΅Π· ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ
Introduction. Atypical variants of chronic inflammatory demyelinating polyneuropathy are marked by its clinical heterogeneity and variable disease course.Aim of the study. To describe clinical, anamnestic and neurophysiological features of patients with atypical variants of chronic inflammatory demyelinating polyneuropathy, characterized by benign disease course, minimal motor involvement and not required pathogenic therapy.Materials and methods. 8 patients (7 men (87 %) and 1 woman (13 %) at the age of 52β77 years) with atypical variants of chronic inflammatory demyelinating polyneuropathy were analyzed: 5 patients (62.5 %) with asymmetric variant β multifocal acquired demyelinating sensorimotor neuropathy and 3 patients (37.5 %) with sensory variant. All patients were observed at the Research Center of Neurology for the period of 2016β 2019. In each patient the proper clinical and laboratory evaluation was performed along with nerve conduction study and nerve ultrasound.Results. The disease duration at the time of first visit was 1β8 years. By INCAT disability score 3 (37.5 %) patients had 0 points (normal), 3 (37.5 %) patients β 1 point and 1 patient had 2 (25 %) points. Nerve conduction study showed multifocal, asymmetric demyelinating changes in motor nerves. For the whole period of observation all patients were stable, so no one required pathogenic therapy.Conclusion. Chronic inflammatory demyelinating polyneuropathy is a clinically heterogeneous disorder, required clinical suspicion in all patients over 50 years with features of multiple nerve involvement; nerve conduction study helps to detect typical changes, including subclinical ones. The primary strategy of management typical and atypical disease variants in stable course and minimal symptoms is a case follow-up with precise assessment of advantages and disadvantages of pathogenic therapy.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΡΠΈΠΏΠΈΡΠ½ΡΠ΅ ΡΠΎΡΠΌΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΠΎΡΠ»ΠΈΡΠ°ΡΡΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎΡΡΡΡ ΠΈ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π°Π½Π°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ Π½Π΅ΠΉΡΠΎΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π°ΡΠΈΠΏΠΈΡΠ½ΡΠΌΠΈ ΡΠΎΡΠΌΠ°ΠΌΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ Ρ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΡΠΌΠΈ Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΡΠΌΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡΠΌΠΈ ΠΈΠ»ΠΈ Π±Π΅Π· Π½ΠΈΡ
, Π½Π΅ ΠΏΠΎΠ»ΡΡΠ°Π²ΡΠΈΡ
ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π Π΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΏΡΠΎΠ°Π½Π°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 8 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (7 ΠΌΡΠΆΡΠΈΠ½ (87 %) ΠΈ 1 ΠΆΠ΅Π½ΡΠΈΠ½Π° (13 %) Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ ΠΎΡ 52 Π΄ΠΎ 77 Π»Π΅Ρ) Ρ Π°ΡΠΈΠΏΠΈΡΠ½ΡΠΌΠΈ ΡΠΎΡΠΌΠ°ΠΌΠΈ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ: 5 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (62,5 %) Ρ Π°ΡΠΈΠΌΠΌΠ΅ΡΡΠΈΡΠ½ΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ β ΠΌΡΠ»ΡΡΠΈΡΠΎΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΈΠΎΠ±ΡΠ΅ΡΠ΅Π½Π½ΠΎΠΉ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΉ ΡΠ΅Π½ΡΠΎΠΌΠΎΡΠΎΡΠ½ΠΎΠΉ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠ΅ΠΉ ΠΈ 3 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° (37,5 %) Ρ ΡΠ΅Π½ΡΠΎΡΠ½ΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ, ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
Π½Π° Π±Π°Π·Π΅ Π¦Π΅Π½ΡΡΠ° Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ Π€ΠΠΠΠ£ Β«ΠΠ°ΡΡΠ½ΡΠΉ ΡΠ΅Π½ΡΡ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΠΈΒ» Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2016 ΠΏΠΎ 2019 Π³. ΠΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Ρ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π°Π½Π°ΠΌΠ½Π΅ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅, ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π΅ΠΉΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡ, ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π΅ΡΠ²ΠΎΠ².Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ»ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π½Π° ΠΌΠΎΠΌΠ΅Π½Ρ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ ΠΎΡΠΌΠΎΡΡΠ° ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° ΠΎΡ 1 Π΄ΠΎ 8 Π»Π΅Ρ. ΠΡΠΈ ΠΎΡΠ΅Π½ΠΊΠ΅ Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΡΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΏΠΎ ΡΠΊΠ°Π»Π΅ ΠΈΠ½Π²Π°Π»ΠΈΠ΄ΠΈΠ·Π°ΡΠΈΠΈ INCAT 3 (37,5 %) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΈΠΌΠ΅Π»ΠΈ ΡΡΠΌΠΌΠ°ΡΠ½ΡΠΉ Π±Π°Π»Π» 0 (Π½ΠΎΡΠΌΠ°), 3 (37,5 %) β ΠΏΠΎ 1 Π±Π°Π»Π»Ρ Π² ΡΡΠΊΠ°Ρ
ΠΈΠ»ΠΈ Π½ΠΎΠ³Π°Ρ
ΠΈ Π»ΠΈΡΡ Ρ 1 (25 %) β ΡΡΠΌΠΌΠ°ΡΠ½ΡΠΉ Π±Π°Π»Π» ΡΠΎΡΡΠ°Π²ΠΈΠ» 2 (ΠΏΠΎ 1 Π±Π°Π»Π»Ρ Π² ΡΡΠΊΠ°Ρ
ΠΈ Π½ΠΎΠ³Π°Ρ
ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ). ΠΠ»Π΅ΠΊΡΡΠΎΠ½Π΅ΠΉΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡ Π΄Π²ΠΈΠ³Π°ΡΠ΅Π»ΡΠ½ΡΡ
Π½Π΅ΡΠ²ΠΎΠ² Π²ΠΎ Π²ΡΠ΅Ρ
ΡΠ»ΡΡΠ°ΡΡ
Π²ΡΡΠ²ΠΈΠ»Π° ΠΌΡΠ»ΡΡΠΈΡΠΎΠΊΠ°Π»ΡΠ½ΡΠ΅ Π°ΡΠΈΠΌΠΌΠ΅ΡΡΠΈΡΠ½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΠΎ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎ-Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ΅ΠΌΡ ΡΠΈΠΏΡ. ΠΠ° Π²Π΅ΡΡ ΡΡΠΎΠΊ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΡΡΠ°Π²Π°Π»ΠΎΡΡ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΡΠΌ. Π ΡΠ²ΡΠ·ΠΈ Ρ ΠΎΡΡΡΡΡΡΠ²ΠΈΠ΅ΠΌ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎ Π·Π½Π°ΡΠΈΠΌΠΎΠ³ΠΎ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄Π΅ΡΠΈΡΠΈΡΠ° ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΈ Π½ΠΈ ΠΎΠ΄Π½ΠΎΠΌΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ Π½Π΅ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»Π°ΡΡ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π₯ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½Π°Ρ Π΄Π΅ΠΌΠΈΠ΅Π»ΠΈΠ½ΠΈΠ·ΠΈΡΡΡΡΠ°Ρ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ β Π³Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎΠ΅ ΠΏΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°ΡΡΠΈΠ½Π΅ ΠΈ ΡΠ΅ΡΠ΅Π½ΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ Π±ΡΡΡ Π½Π°ΡΡΠΎΡΠΎΠΆΠ΅Π½Π½ΡΠΌ ΠΏΡΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΡΠ°ΡΡΠ΅ 50 Π»Π΅Ρ Ρ ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎΠΉ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π΅ΡΠ²ΠΎΠ²; ΡΠ»Π΅ΠΊΡΡΠΎΠ½Π΅ΠΉΡΠΎΠΌΠΈΠΎΠ³ΡΠ°ΡΠΈΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π²ΡΡΠ²ΠΈΡΡ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠ½ΡΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΡΡΠ±ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅. ΠΡΠΈΠΎΡΠΈΡΠ΅ΡΠ½ΠΎΠΉ ΡΠ°ΠΊΡΠΈΠΊΠΎΠΉ Π²Π΅Π΄Π΅Π½ΠΈΡ ΠΏΡΠΈ ΡΠΈΠΏΠΈΡΠ½ΠΎΠΉ ΠΈ Π°ΡΠΈΠΏΠΈΡΠ½ΡΡ
ΡΠΎΡΠΌΠ°Ρ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΡΠΈ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΉ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² ΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΠΏΡΠΈ ΡΠ°Π·ΡΠΌΠ½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠ΅ ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ ΡΠΈΡΠΊΠ° ΠΈ ΠΏΠΎΠ»ΡΠ·Ρ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ
Features of high-dose intravenous immunotherapy administration in patients with reduced IgA level in neurological practice: literature review and description of a clinical case
Intravenous high-dose immunotherapy is one of the highly effective proven treatments for a number of autoimmune diseases of the nervous system. Nowadays there is enough knowledge about the spectrum of side effects and approaches to their prevention and monitoring. Most of them are leveled by improving the technology of the production process, but anaphylactic reactions remain one of the uncontrolled, albeit rare, undesirable reactions. The development of allergic reactions is associated with the presence of antibodies to immunoglobulin class A (IgA) in the patient, which is manifested by a decrease in the level of IgA during routine immunological examination. The article provides a review of the literature on the prevalence of IgA deficiency, its causes. A modern view of the need for routine testing of IgA level before the course of intravenous immunotherapy, approaches to reduce the risk of developing serious adverse reactions in such cases is described. A clinical case of treatment of a patient with chronic inflammatory demyelinating polyneuropathy and a reduced level of IgA is presented
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