Depression is not the only cause of cognitive impairment in chronic migraine

Background. Patients with the chronic migraine frequently present with memory and attention complaints. However, the prevalence and phenotype of such impairment in chronic migraine have not been studied.Objective – to evaluate the prevalence of the objective cognitive deficit in patients with chronic migraine and factors underlying its etiology. Materials and methods. We recruited 62 subjects with chronic migraine and 36 genderand age-matched controls with low-frequency episodic migraine (not more, then 4 headache days per month) aged 18–59. All patients filled in the Hospital Anxiety and Depression Scale (HADS) and Sheehan Disability Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20).Results. In this study 58 % of patients with chronic migraine complained of memory loss. Cognitive impairment was also found with PDQ-20. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rate. In 40 % of subjects with chronic migraine scored lower than 26 points on MoCA. Patients with chronic migraine more frequently had lower DSST rates as compared to episodic migraine (odds ratio 5.07 (95 % confidence interval – 1.59–16.17); p = 0.003). Depression and anxiety did not correlate with performance on cognitive tests. Chronic migraine (frequent headache) and longer headache history, but not depression, anxiety or medication overuse were independent predictors of cognitive impairment.Conclusion. Subjective and objective cognitive deficits are prevalent in the chronic migraine population. Most often memory and attention are impaired. Longer headache history and presence of chronic migraine are independent risk factors for cognitive impairment in patients with chronic migraine

Migraine and neck pain: Mechanisms of comorbidity

Neck pain and migraine are common diseases. Neck pain seldom occurs in a patient with migraine. However, the relationship between migraine and neck pain has been inadequately investigated.Objective: to analyze neck pain in patients with migraine to determine possible comorbidity mechanisms of these diseases.Patients and methods. The investigation enrolled 63 patients with chronic migraine (CM) and 40 with episodic migraine (EM) diagnosed in accordance with the International Classification of Headache Disorders, 3rd edition (ICHD-3). Winking reflex (WR) and nociceptive flexion reflex (NFR) were examined to evaluate the function of antinociceptive systems.Results. In the patients with CM, neck pain was more common than in those with EM (53.03% versus 14.02%); and panful tenderness, sensitivity, and tension of neck muscles were more marked. There was also a significant reduction in WR and NFR thresholds. Neck pain was noted to be an integral component of the pathogenesis of CM in a large number of patients with this condition. The authors proposed several pathophysiological mechanisms of a relationship between migraine and neck pain. Neck muscles and craniovertebral junction areas serve as a source for the arrival of nociceptive pain pulses in the central nervous system (peripheral sensitization), promoting pain chronization. Muscle dysfunction in this area may be, in turn, a reflection of central sensitization and impaired descending pain control

Нарушения памяти и внимания у пациентов с хронической мигренью

Background. Memory and attention deficits are prevalent in the chronic pain population. There are multiple common mechanisms in chronic pain and cognitive impairment. However, the presence, prevalence and clinical burden of such impairment are frequently underestimated.Objective: to evaluate subjective and objective cognitive deficits in patients with chronic migraine (CM).Materials and methods. We recruited 53 subjects with CM and 22 genderand age-matched controls with low-frequency episodic migraine (a maximum of 4 headache days per month) aged 18–59. All patients filled in the HADS (Hospital Anxiety and Depression Scale) anxiety and depression scale and Pittsburg Sleep Quality Inventory (PSQI). Cognitive function was assessed with Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT) and the Perceived Deficits Questionnaire (PDQ-20).Results. 56 % of patients with CM complained of memory problems. Decreased cognitive function was also observed during self-assessment using the PDQ-20 questionnaire. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rates. 44 % of subjects with CM scored lower than 26 points on MoCA. Most frequently we found impairments in attention (75 %), memory/delayed recall (50 %), language (50 %) and executive function (37 %). Depression and sleep quality correlated with only several parameters of cognitive tests.Conclusion. Subjective and objective cognitive deficits are prevalent in the CM population. Most often memory and attention are impaired. Cognitive complaints need to be carefully assessed, and treatment of such impairment may improve quality of life and decrease disability in CM.Введение. Нарушения памяти и внимания широко распространены у пациентов с хронической болью. Когнитивные нарушения и хроническая боль имеют множество общих патогенетических механизмов. В то же время наличие, частота встречаемости и клиническое значение этих нарушений зачастую недооцениваются.Цель исследования – изучение субъективных и объективных когнитивных расстройств у пациентов с хронической мигренью (ХМ). Материалы и методы. В исследовании приняли участие 53 пациента с ХМ и 22 пациента с редкой эпизодической мигренью (головная боль не более 4 дней в месяц) в возрасте 18–59 лет, подобранных по полу и возрасту. Всем пациентам проведены клиническое неврологическое исследование и анкетирование: опросник демографических и клинических характеристик, госпитальная шкала тревоги и депрессии HADS (Hospital Anxiety and Depression Scale), опросник для оценки качества ночного сна PSQI (Pittsburg Sleep Quality Inventory). Также всем участникам выполнено исследование когнитивных функций с помощью Монреальской шкалы оценки когнитивных функций MoCA (Montreal Cognitive Assessment), теста замены цифровых символов DSST (Digital Symbol Substitution Test), теста Рея на слухоречевое заучивание RAVLT (Rey Auditory Verbal Learning Test) и опросника воспринимаемого дефицита PDQ-20 (Perceived Deficits Questionnaire).Результаты. Жалобы на нарушение памяти предъявляли 56 % пациентов с ХМ. Снижение когнитивных функций также выявлено при самооценке по опроснику PDQ-20. При объективном исследовании когнитивных функций в группе ХМ отмечено значимое снижение результатов теста DSST, общего числа запомненных слов, а также ухудшение показателя обучения. У 44 % пациентов с ХМ диагностированы когнитивные расстройства по шкале MоCA. Наиболее часто снижение суммы баллов по шкале MoCA наблюдалось по функциям внимания (75 %), памяти/отсроченного воспроизведения (50 %), речи (50 %) и исполнительной функции (37 %). Отмечена корреляция уровня депрессии и качества сна лишь с отдельными параметрами тестов когнитивных функций.Заключение. У пациентов с ХМ выявлена высокая распространенность субъективных (56 %) и объективных (44 %) нарушений когнитивных функций. В первую очередь отмечается снижение памяти и внимания. Необходимо обращать особое внимание на предъявляемые пациентами соответствующие жалобы, а терапия данных расстройств может повысить качество жизни и трудоспособность пациентов с ХМ

Депрессия – не единственная причина когнитивных нарушений у пациентов с хронической мигренью

Background. Patients with the chronic migraine frequently present with memory and attention complaints. However, the prevalence and phenotype of such impairment in chronic migraine have not been studied.Objective – to evaluate the prevalence of the objective cognitive deficit in patients with chronic migraine and factors underlying its etiology. Materials and methods. We recruited 62 subjects with chronic migraine and 36 genderand age-matched controls with low-frequency episodic migraine (not more, then 4 headache days per month) aged 18–59. All patients filled in the Hospital Anxiety and Depression Scale (HADS) and Sheehan Disability Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20).Results. In this study 58 % of patients with chronic migraine complained of memory loss. Cognitive impairment was also found with PDQ-20. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rate. In 40 % of subjects with chronic migraine scored lower than 26 points on MoCA. Patients with chronic migraine more frequently had lower DSST rates as compared to episodic migraine (odds ratio 5.07 (95 % confidence interval – 1.59–16.17); p = 0.003). Depression and anxiety did not correlate with performance on cognitive tests. Chronic migraine (frequent headache) and longer headache history, but not depression, anxiety or medication overuse were independent predictors of cognitive impairment.Conclusion. Subjective and objective cognitive deficits are prevalent in the chronic migraine population. Most often memory and attention are impaired. Longer headache history and presence of chronic migraine are independent risk factors for cognitive impairment in patients with chronic migraine.Введение. Жалобы на снижение памяти и внимания у пациентов с хронической мигренью широко распространены в клинической практике. При этом частота встречаемости и структура когнитивных нарушений при хронической мигрени практически не изучены.Цель исследования – изучить распространенность и клиническую структуру объективных когнитивных нарушений у пациентов с хронической мигренью, а также факторов, имеющих значение для их развития.Материалы и методы. В исследовании приняли участие 62 пациента с хронической мигренью и 36 пациентов с редкой эпизодической мигренью (не более 4 дней головной боли в месяц) в возрасте от 18 до 59 лет, подобранных по полу и возрасту. Всем пациентам провели клиническое неврологическое обследование и анкетирование с использованием опросника демографических и клинических характеристик, госпитальной шкалы тревоги и депрессии (Hospital Anxiety and Depression Scale, HADS), шкалы нетрудоспособности Шихана (Sheehan Disability Scale). Также всем участникам исследования провели тестирование когнитивных функций при помощи Монреальской шкалы оценки когнитивных функций (Montreal Cognitive Assessment, MoCA), теста замены цифровых символов (Digital Symbol Substitution Test, DSST), теста Рея на слухоречевое заучивание (Rey Auditory Verbal Learning Test, RAVLT) и опросника воспринимаемого дефицита (Perceived Deficits Questionnaire, PDQ-20).Результаты. В исследовании 58 % пациентов с хронической мигренью предъявляли жалобы на нарушение памяти. Снижение когнитивных функций также выявлено при самооценке по опроснику PDQ-20. При объективном исследовании в группе хронической мигрени отмечено значимое снижение результатов теста DSST, общего числа запоминаемых слов, а также ухудшение показателя обучения. Вероятность ухудшения результата по тесту DSST при хронической мигрени была значимо выше по сравнению с эпизодической мигренью (отношение шансов 5,07 (95 % доверительный интервал 1,59–16,17); p = 0,003). У 40 % пациентов с хронической мигренью диагностировали когнитивные расстройства по шкале MоCA. Не отмечена корреляция уровня депрессии и тревоги с показателями тестов когнитивных функций. Наличие хронической мигрени (частой головной боли) и длительность анамнеза цефалгии (но не депрессия) тревога и злоупотребление анальгетиками являются независимыми факторами риска развития когнитивных нарушений.Выводы. У пациентов с хронической мигренью отмечена высокая распространенность субъективных и объективных нарушений когнитивных функций, в первую очередь снижения памяти и внимания. Длительный анамнез головной боли и наличие хронической мигрени являются независимыми факторами риска развития когнитивных нарушений у пациентов с хронической мигренью

Хроническая боль, депрессия и когнитивные нарушения: тесные взаимосвязи

Over a half of chronic pain (CP) patients present with cognitive complaints, which increase their disability and impact quality of life. The paper reviews objective impairments in memory, attention, processing speed and executive function demonstrated in the CP population. The paper also reviews common pathology underlying cognitive impairment and CP: neuroplasticity in the shared brain areas, neurotransmitter and other molecular mechanisms. Common mechanisms in CP and depression precipitating cognitive impairment are also discussed. The paper also compares the potential of different antidepressants to improve cognitive functions in depression and CP.Более половины пациентов с хронической болью (ХБ) предъявляют жалобы на когнитивные нарушения (КН), которые cнижают их трудоспособность и качество жизни. В статье представлен обзор исследований, продемонстрировавших объективные нарушения памяти, внимания, скорости мышления и исполнительной функции при ХБ. Также обсуждаются общие механизмы патогенеза КН и ХБ: нейропластичность в общих зонах головного мозга, нейромедиаторные и другие молекулярные механизмы. Представлен обзор общих патогенетических механизмов депрессии, ХБ и КН. Также приведено сравнение различных антидепрессантов в коррекции КН при депрессии и ХБ

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

Geographical Distribution, Incidence, Malignancies, and Outcome of 136 Eastern Slavic Patients With Nijmegen Breakage Syndrome and NBN Founder Variant c.657_661del5

Nijmegen breakage syndrome (NBS) is a DNA repair disorder characterized by combined immunodeficiency and a high predisposition to lymphoid malignancies. The majority of NBS patients are identified with a homozygous five base pair deletion in the Nibrin (NBN) gene (c.657_661del5, p.K219fsX19) with a founder effect observed in Caucasian European populations, especially of Slavic origin. We present here an analysis of a cohort of 136 NBS patients of Eastern Slav origin across Belarus, Ukraine, Russia, and Latvia with a focus on understanding the geographic distribution, incidence of malignancy, and treatment outcomes of this cohort. Our analysis shows that Belarus had the highest prevalence of NBS (2.3 per 1,000,000), followed by Ukraine (1.3 per 1,000,000), and Russia (0.7 per 1,000,000). Of note, the highest concentration of NBS cases was observed in the western regions of Belarus and Ukraine, where NBS prevalence exceeds 20 cases per 1,000,000 people, suggesting the presence of an “Eastern Slavic NBS hot spot.” The median age at diagnosis of this cohort ranged from 4 to 5 years, and delay in diagnosis was more pervasive in smaller cities and rural regions. A total of 62 (45%) patients developed malignancies, more commonly in males than females (55.2 vs. 34.2%; p=0.017). In 27 patients, NBS was diagnosed following the onset of malignancies (mean age: 8 years). Malignancies were mostly of lymphoid origin and predominantly non-Hodgkin lymphoma (NHL) (n=42, 68%); 38% of patients had diffuse large B-cell lymphoma. The 20-year overall survival rate of patients with malignancy was 24%. However, females with cancer experienced poorer event-free survival rates than males (16.6% vs. 46.8%, p=0.036). Of 136 NBS patients, 13 underwent hematopoietic stem cell transplantation (HSCT) with an overall survival of 3.5 years following treatment (range: 1 to 14 years). Indications for HSCT included malignancy (n=7) and immunodeficiency (n=6). Overall, 9% of patients in this cohort reached adulthood. Adult survivors reported diminished quality of life with significant physical and cognitive impairments. Our study highlights the need to improve timely diagnosis and clinical management of NBS among Eastern Slavs. Genetic counseling and screening should be offered to individuals with a family history of NBS, especially in hot spot regions. © Copyright © 2021 Sharapova, Pashchenko, Bondarenko, Vakhlyarskaya, Prokofjeva, Fedorova, Savchak, Mareika, Valiev, Popa, Tuzankina, Vlasova, Sakovich, Polyakova, Rumiantseva, Naumchik, Kulyova, Aleshkevich, Golovataya, Minakovskaya, Belevtsev, Latysheva, Latysheva, Beznoshchenko, Akopyan, Makukh, Kozlova, Varabyou, Ballow, Ong, Walter, Kondratenko, Kostyuchenko and Aleinikova.We thank all doctors for clinical help for patients. We also appreciate the support of patient and their parents for agreeing to take part in this study. TP thanks Sergey?Nikulshin, Marika Grutupa, and Zanna Kovalova. We thank Joseph Dasso for editing this manuscript, primarily for proper English

Практические вопросы ведения пациентов с хронической мигренью. Рекомендации российских экспертов

The world medicine has achieved considerable advances over the last years in understanding of causes and pathogenesis as well as in specification of diagnostics criteria and studies of therapeutic approaches at chronic migraine (CM). Meantime this widespread disease is badly recognized by the physicians and diagnosed seldom. In addition, there is no generally accepted document, regulating the treatment of patients with CM, who are peculiar by their express deadaptation due to high frequency of severe attacks of the headache (HA), co-morbid psychic and somatic disorders, frequent abuse of analgetic drugs and low adherence to preventive therapy. The specialists of our country, like in other countries, gained their own unique expertise in management of such patients, who are hard to cure, including by botulinum A toxin – representative of the state-of-the-art generation of the registered drugs with the proven efficiency against CM. The article sets out the Recommendation from the Russian specialists as to management of the patients with CM, approved by the meeting of CM Expert Board (on November 12, 2014, Moscow), including with respect to time of treatment, rules of withdrawal and replacement of drugs and some other features, in compliance with modern world concepts on pathogenesis and treatment of such disease and expertise gained in managing patientswith CM in our country.последние годы достигнуты значительные успехи мировой медицины в понимании причин и механизмов развития, а также в уточнении диагностических критериев и изучении терапевтических подходов при хронической мигрени (ХМ). В то же время это широко распространенное заболевание плохо распознается врачами и редко диагностируется. Кроме того, отсутствует общепринятый документ, регламентирующий лечение пациентов с ХМ, отличающихся выраженной дезадаптацией вследствие высокой частоты тяжелых приступов головной боли (ГБ), коморбидных психических и соматических расстройств, частого злоупотребления обезболивающими лекарствами, а также низкой приверженностью к профилактической терапии. В нашей стране, как и в других странах, специалистами накоплен собственный уникальный опыт по лечению таких труднокурабельных пациентов, в том числе ботулиническим токсином типа А – представителем новейшего поколения зарегистрированных лекарственных средств с доказанной эффективностью при ХМ. В статье представлены Рекомендации российских специалистов по ведению пациентов с ХМ, согласованные на Совете экспертов по ХМ (12 ноября 2014 г., Москва), в том числе по срокам лечения, правилам отмены и замены лекарственных препаратов и некоторым другим особенностям, в соответствии с современными мировыми представлениями о патогенезе и лечении данного заболевания, а также накопленным опытом по ведению пациентов с ХМ в нашей стране

Особенности проведения высокодозной внутривенной иммунотерапии у пациентов со сниженным уровнем IgA в неврологической практике: обзор литературы и описание клинического случая

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.Внутривенная высокодозная иммунотерапия – один из высокоэффективных доказанных методов лечения ряда аутоиммунных заболеваний нервной системы. В настоящее время накоплено достаточно знаний о спектре побочных эффектов и подходах к их профилактике и мониторингу. Бόльшая часть из них нивелирована совершенствованием технологии процесса производства, однако анафилактические реакции остаются одной из неконтролируемых, хотя и редко встречающихся нежелательных реакций. Развитие аллергических реакций связывают с наличием у пациента антител к иммуноглобулину класса А (IgA), что проявляется снижением уровня IgA при рутинном иммунологическом исследовании. В статье представлен обзор литературы о распространенности дефицита IgA, его причинах. Описаны современный взгляд на необходимость рутинного исследования уровня IgA перед курсом внутривенной иммунотерапии, подходы к снижению риска развития серьезных нежелательных реакций в таких случаях. Представлен клинический случай лечения пациента с хронической воспалительной демиелинизирующей полинейропатией и сниженным уровнем IgA

Patients with primary immunodeficiencies are a reservoir of poliovirus and a risk to polio eradication

ABSTARCT: Immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) have been isolated from primary immunodeficiency (PID) patients exposed to oral poliovirus vaccine (OPV). Patients may excrete poliovirus strains for months or years; the excreted viruses are frequently highly divergent from the parental OPV and have been shown to be as neurovirulent as wild virus. Thus, these patients represent a potential reservoir for transmission of neurovirulent polioviruses in the post-eradication era. In support of WHO recommendations to better estimate the prevalence of poliovirus excreters among PIDs and characterize genetic evolution of these strains, 635 patients including 570 with primary antibody deficiencies and 65 combined immunodeficiencies were studied from 13 OPV-using countries. Two stool samples were collected over 4 days, tested for enterovirus, and the poliovirus positive samples were sequenced. Thirteen patients (2%) excreted polioviruses, most for less than 2 months following identification of infection. Five (0.8%) were classified as iVDPVs (only in combined immunodeficiencies and mostly poliovirus serotype 2). Non-polio enteroviruses were detected in 30 patients (4.7%). Patients with combined immunodeficiencies had increased risk of delayed poliovirus clearance compared to primary antibody deficiencies. Usually, iVDPV was detected in subjects with combined immunodeficiencies in a short period of time after OPV exposure, most for less than 6 months. Surveillance for poliovirus excretion among PID patients should be reinforced until polio eradication is certified and the use of OPV is stopped. Survival rates among PID patients are improving in lower and middle income countries, and iVDPV excreters are identified more frequently. Antivirals or enhanced immunotherapies presently in development represent the only potential means to manage the treatment of prolonged excreters and the risk they present to the polio endgame. Keywords: Poliovirus eradication, Immunodeficiency-associated vaccine-derived polioviruses, Oral poliovirus vaccine, Humoral immunodeficiency, Combined immunodeficiency, Primary immunodeficienc