Хронические нарушения сознания: клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов»

Хронические нарушения сознания (ХНС) представляют собой синдромы тяжелого поражения центральной нервной системы, приводящие к длительной грубой инвалидизации и требующие значительных усилий по лечению и реабилитации, которые ложатся на медицинские учреждения и на плечи близких пациентов. ХНС развиваются у пациентов после комы и характеризуются наличием бодрствования при полном или практически полном отсутствии признаков осознанного поведения. К ХНС относятся вегетативное состояние (ВС) и состояние минимального сознания (СМС). Также для описания начальных стадий этих состояний используется термин «продленное нарушение сознания» (ПНС). Отдельно выделяют выход из СМС — состояние, которое формируется по мере восстановления когнитивных функций. Диагностика ХНС основывается на многократном структурированном клиническом осмотре с применением специализированных шкал при условии исключения обратимых причин нарушения сознания. Лечение пациентов с ХНС включает в себя поддержание жизненно важных функций, обеспечение оптимального питания и борьбу с типичными осложнениями и сопутствующими состояниями (пролежни, спастичность, боль, пароксизмальная симпатическая гиперактивность и др.). У пациентов с ХНС должна проводиться реабилитация с участием мультидисциплинарной реабилитационной команды в объеме, который определяется проблемами и возможностями конкретного пациента. Наиболее эффективной реабилитация является при условии ее раннего начала. На данный момент однозначных доказательств эффективности каких-либо специфических методов, направленных на восстановление сознания, не получено; изучается ряд соответствующих фармакологических и нефармакологических вмешательств, обязательным условием применения которых является максимально возможная коррекция соматических проблем пациента. Важную роль в ведении пациентов с ХНС играет вовлечение близких пациента, которые, в свою очередь, нуждаются в получении объективной практической информации о состоянии своего родственника и о направлениях реабилитации, а также в психологической помощи

NEUROPSYCHOLOGICAL SYNDROMES OF HIGHER PSYCHIC FUNCTIONS IN CHILDREN AND ADOLESCENTS WITH FOCAL FORMS OF EPILEPSY

The paper deals with a study of the concomitance of neuropsychological syndromes characterized by impaired higher psychic functions (HPF) in focal epilepsy forms differing in the site of an epileptic focus in childhood and adolescence. The applied systems approach to analyzing HPF is important in predicting the mental development of children and in developing the adequate methods for psychological correction. The aim of the study was to identify complexes of neuropsychological syndromes characterizing the mental functions in focal epilepsy forms differing in sites. The concept metasyndrome is used to describe the types of concomitances of syndromes that manifest continually in each form of focal epilepsy. The general neuropsychological examination of HPF developed by A.R. Luria and his followers was performed in children and adolescents with focal epilepsy forms: frontal, temporal, occipital, and temporal-occipital. The examination of 82 children and adolescents aged 6-16 years involved an interview, studies of motor functions, gnosis, speech functions, memory, and intellect. The authors describe two major types of the metasyndrome as a regular concomitance of neuropsychological syndromes that occur irrespective of the form and site of focal epilepsies: specific and nonspecific metasyndromes. They single out the concrete types of specific and nonspecific metasyndromes differing in pattern (the composition of its included syndromes). Basic conditions affecting the pattern of the metasyndrome are considered

A.R. Luria's contribution to studies of the brain organization of language

A.R. Luria is one of the most prestigious scientists in neuroscience, neuropsychology in particular. His contribution to aphasiology and neurolinguistics is well known. However, today some researchers believe that A.R. Luria's main ideas have lost their relevance and have little influence on contemporary discussions. The paper presents the views of A.R. Luria on the brain organization of speech and aphasia. Although he developed his concept of the relationship between cognitive processes and brain work several decades ago, scientific and technological achievements in our days largely confirm many of his ideas and hypotheses. A.R. Luria's basic views of the brain and language are considered in this article in the light of modern neuroscience. Two main monographs and some works of A.R. Luria, which are dedicated to the brain organization of speech and to the classification of aphasia, are analyzed. In particular, comparisons are made between his initial assumptions about aphasia and their theoretical rationale in the  book «Traumatic Aphasia» (1947) and his more complex interpretation of the cerebral organization of speech, which is presented in his work «Basic Problems of Neurolinguistics» (1975). The paper discusses differences between these two books and also linguistic issues, which received much attention in his later publication. It considers the concepts of functional systems, systemic and dynamic organization of speech, proposed by A.R. Luria. It is shown that his interpretation of the cerebral organization of speech as a specific contribution of various brain regions to the speech system continues to be widely used, and his significant contribution to neurolinguistics is widely recognized.Many ideas of A.R. Luria have been integrated into contemporary aphasiology, while some questions of his proposed classification of aphasia remain debatable

Neuropsychological syndromes in patients with Parkinson’s disease after deep electric stimulation of pallidar complex structures

The paper provides the results of neuropsychological examinations in 10 patients with Parkinson’s disease who underwent deep electrical stimulation of pallidar complex structures. The general neuropsychological test battery that had been developed by A.R. Luria and allowed the qualitative classification of the cognitive impairment symptoms detectable on examination to be made was used to study cognitive functions. The patients were examined before and just after surgery and in the late period (following 1—2 years). The examinations have shown that the syndromes indicative of dysfunctions in the deep, parietal, and occipital and prefrontal regions of the left hemisphere and in the parietooccipital regions of the right hemisphere are stable components that determine the pattern of cognitive disorders and are preserved throughout all examinations

Psychological structure of written speech in modern foreign neuropsychology

The paper considers the current foreign ideas on the structure of written speech in terms of the principle of the system structure of mental functions. It is shown that written speech is considered as a multicomponent structure within the framework of the presently dominating foreign concept Р a double route model. This structure includes both elements common to other functions and those specific only for writing. The performed analysis allows determination of the theoretical standpoint common to the Russian and foreign neuropsychological concepts of the structure of speech processes

Age at onset in multiple sclerosis as a possible predictor for cognitive impairment in children and adolescents

Pediatric-onset multiple sclerosis (MS) can lead to cognitive impairment (CI). In general, in early-onset MS, there are disturbances in cognitive processes, such as information processing speed, attention, and controlling functions. Also, unlike adults with MS, children show a failure in various spheres of speech activity. The age of onset in MS, its duration and recurrence rate can affect not only the accumulation of a stable neurological deficit, but also the state of the cognitive sphere.Objective: to study of the features of CI in children and adolescents with MS; to assess the relationship of CI to clinical characteristics, such as age at onset in the disease and its duration.Patients and methods. The study involved 45 pediatric and adolescent patients with an established diagnosis of MS, who underwent a general neuropsychological examination of the cognitive sphere (Luria’s tests) with transfer to a point system; in addition, psychometric techniques were used to assess attention, controlling functions, memory, verbal fluency, and various types of thinking. Clinical characteristics, such as age at onset in MS and its duration at the time of the examination, were also taken into account.Results and discussion. The leading factors that combine certain symptom complexes of CI in children and adolescents with MS were established. These factors include attention, controlling functions, auditory-verbal and visuospatial memories, various spheres of speech activity. Early-onset MS (at age of 5–8 years) was ascertained to have a greater impact on the formation of speech and controlling functions than adolescence- onset (at age of 13–16-years).Conclusion. The risk of cognitive deficit and subsequent disability was found to be highest in early-onset MS

Наш друг и коллега Альфредо Ардила

Original manuscript received November 11, 2021. Revised manuscript accepted February 05, 2022. First published online April 11, 2022.Distinguished Professor of Neuropsychology at the Florida International University in Miami and Albizu University (USA, Miami) Alfredo Ardila (4.09.1946–9.01.2021) was President of the Latin American Association of Neuropsychology, member of the Board of Governors of the International Neuropsychological Society and of the Editorial Board of the International publication Lurian Journal. A. Ardila was a leading thinker bringing and developing the ideas of A. R. Luria’s school of neuropsychology to North and Latin America. He joined the community of students and disciples of A. R. Luria in the mid‑1970s while studying at Moscow State University where he earned a PhD degree under the supervision of E. D. Homskaya. In this article, dedicated to the memory of A. Ardila, the authors analyze his contribution to development of the systemic-dynamic approach in neuropsychology, and share personal memories of a lifelong friendship, recalling his memorable charm and personal modesty as well as his renewed scientific cooperation with colleagues from his alma mater in 2008–2020.Профессор Университета Альбизу (США, Майами) Альфредо Ардила (4.09.1946–9.01.2021), президент Латиноамериканской ассоциации нейропсихологии, член Совета управляющих Международного нейропсихологического общества, член редакционного совета международного журнала «Lurian Journal», сыграл большую роль в развитии и популяризации идей школы А. Р. Лурия в Южной и Северной Америке. Он приобщился к сообществу учеников и последователей А. Р. Лурия в середине 1970‑х, когда, обучаясь в МГУ, подготовил диссертацию под руководством Е. Д. Хомской. В статье памяти Альфредо Ардила авторы анализируют его вклад в развитие системно- динамического подхода в нейропсихологии, делятся воспоминаниями о многолетней дружбе с ним и его участии в научном сотрудничестве с московскими коллегами в alma mater в 2008–2020 гг., отмечают его личные качества, незабываемые обаяние и скромность

The clinical and psychological features of mental development in children with opsoclonus-myoclonus syndrome

Objective: to investigate and analyze the specific features of mental development in children with opsoclonus-myoclonus syndrome (OMS) in relation to the number of exacerbations. Patients and methods. A total of 19 infants (8 boys and 11 girls) aged 1 year 7 months to 10 years 7 months with OMS were examined. The investigation included an analysis of medical records, a follow-up of the children with evaluation of their behavior, emotional responses, and mental functions, and an interview with their parents. Pathopsychological and neuropsychological examinations were used separately for children under 5 years and for those over 5 years, respectively. Results and discussion. It was established that a larger number of OMS exacerbations increased the severity of mental developmental disorders in children if they had >5 deteriorations; there was a severe developmental retardation. The children with OMS were found to have the features of an emotional state and motor behavior and a stable set of the most vulnerable mental processes and functions in the presence of the disease: the neurodynamic features of mental processes; impairments in the motor component of mental functions, including speech; visual and spatial deficits. Positive trends in mental development (as general cognitive interest, readiness for communication with adults) are suggestive of the potential compensation resources that should be used for the psychocorrection and rehabilitation of children with OMS. Conclusion. Mental retardation is seen in children with OMS, the severity of which increases with the number of disease relapses. There is a need for further studies of children with OMS