TRЕATMENT OF PATIENTS WITH DYSCIRCULATORY ENCEPHALOPATHY OF ATHEROSCLEROTIC GENESIS

В данной представлены данные о терапевтической эффективности метаболических средств в комплексной терапии больных с дисциркуляторной энцефалопатией атеросклеротического генеза This article presents data on the therapeutic efficacy of metabolic agents in the complex therapy of patients with dyscirculatory encephalopathy of atherosclerotic genesis

Clinical and pathogenetic approaches to early rehabilitation of ischaemic stroke patients

Stroke is the most important medical and social problem, both worldwide and in Uzbekistan, owing to its high morbidity, mortality and disability rates. Uzbekistan's official statistical authorities consider cerebrovascular disease (CVD) to be a single nosological form, without distinguishing it from stroke. Given that the structure of CVDs includes both acute cerebrovascular disorders (ACS) (various types and subtypes of ischemic and hemorrhagic stroke) and chronic CVDs (various forms of so-called dyscirculatory encephalopathy), reliable epidemiological data on stroke prevalence in Uzbekistan are not available. According to the Ministry of Health of the Republic of Uzbekistan, there were 62876 cases of stroke in Uzbekistan in 2019. 15% were fatal, 10-15% relapsed and 55-70% became disabled.

New opportunities in the treatment of patients with chronic brain ischemia

The study was aimed to evaluate the clinical efficacy of Hericium erinaceus extract (Cebrofit) in combination with vinpocetine compared to vinpocetine monotherapy in patients with chronic cerebral ischemia. Two groups of patients were identified — the basic and control, which included 160 patients with stage I and II dyscirculatory encephalopathy aged 30 to 80 years. All subjects underwent basic therapy, during which for 3 months patients of the basic group took Cebrofit 1 capsule 150 mg twice a day and vinpocetine (Vicebrol) 1 tablet 5 mg three times a day, and patients of the control group used only vinpocetine according to the scheme described above. Based on a comprehensive study, it was found that the use of Cebrofit in combination with vinpocetine compared to vinpocetine monotherapy resulted in accelerated regression of subjective and objective manifestations of chronic brain ischemia with an advantage in patients with stage I dyscirculatory encephalopathy. In patients with stage I dyscirculatory encephalopathy, the use of Cebrofit in combination with vinpocetine produced a pronounced neuroprotective effect, which manifested in a significant improvement in general condition, a decrease in the severity of neurological symptoms, a decrease in the manifestations of asthenia and anxiety after 28 days of therapy, and a significant increase in cognitive performance after 7 days of therapy, while maintaining this positive trend until the end of the course of treatment. In patients with stage II dyscirculatory encephalopathy under the influence of Cebrofit in combination with vinpocetine, positive differences in the form of a decrease in the severity of clinical and neurological symptoms, manifestations of asthenia, anxiety, and depression, as well as improvement in cognitive functions were recorded after 84 days of treatment, which allows recommending the use of these schemes in clinical practice.

Dyscirculatory encephalopathy in the practice of a family doctor

The article highlights the issues related to the development of dyscirculatory encephalopathy (DE), in particular, against the background of what diseases this pathology occurs and its social significance. The main issues of its pathogenesis are considered; the parts of the brain that are damaged in the first place and how this affects the manifestations of the disease and the rate of its development are described. The staging of DE development, the main symptoms and problems of its diagnosis are also considered. The basic principles of therapy are presented: the indications for inpatient and outpatient treatment, groups of drugs used to improve the patient’s condition and the mechanisms of their action.

Influence of Hypothermia and Cell Therapy on Structural Changes in Brain Tissues of Rats with Dyscirculatory Encephalopathy of Mixed Genesis

The study examines the morphological changes that occur in brain of SHR rats on the background of developing hypertensive dyscirculatory encephalopathy (DE), complicated by chronic alcohol intoxication (CAI). CAI has been proven to potentiate the progressive aging of brain in rats with hypertensive DE by aggravating its course and to lead to the development of DE of mixed genesis. The effectiveness of a single and combined use of rhythmic craniocerebral hypothermia (rCCH) and the introduction of cryopreserved cord blood nucleated cells (cCBNCs) to reduce the progressive vascular lesions of brain and the effects of chronic ischemia in animals with DE of mixed genesis. It has been proven that the combined use of rCCH and cCBNCs in the rats with a mixed DE had a more pronounced positive effect on morphological structure of brain tissues and vessels than their single use. There was a further decrease in the signs of dystrophic, destructive and pathologically altered compensatory adaptive processes in brain on the background of a significant decrease in neuroglial index, stimulation of angiogenesis, complete or partial absence of signs of smooth muscle cell hyperplasia, acute hemorrhages and ischemic strokes, spasms of arterial vessels’ walls and plethory in veins, that contributed to restoration of brain microhemocirculation and cytoarchitectonics.

Psychopathological disorders in chronic cerebral ischemia: possibilities of prevention

Одними из наиболее важных для уровня социального функционирования и адаптации составляющих клинической картины хронической ишемии мозга (дисциркуляторная энцефалопатия, болезнь малых сосудов) являются психопатологические симптомокомплексы: тревожные, смешанные тревожно-депрессивные, органоневротические (соматоформные), нозогенные расстройства, расстройства приспособительных реакций, неврастения, соматогенная астения. Раннее начало терапии хронической ишемии мозга (ХИМ) является важной задачей по предупреждению прогрессирования не только церебрально-сосудистой патологии, но и широкого круга коморбидных психопатологических расстройств. К пациентам с ХИМ необходим индивидуальный подход с учетом патогенетических факторов и выраженности как когнитивных, так и психопатологических расстройств с привлечением широкого круга средств, включая нейропротекторы. С этой целью в клинической практике используются для самостоятельного или комбинированного применения этилметилоксипиридина сукцинат и цитиколин. На фоне приема этих препаратов пациенты с различными формами ХИМ отмечают субъективное улучшение своего состояния в виде уменьшения утомляемости, общей слабости, эмоциональной лабильности, симптомов психической и соматической тревоги, а также повышения активности и мотивации деятельности, улучшения памяти, внимания и способности концентрироваться, что положительно отражается на их профессиональной деятельности. Anxiety, depression, somatoform disorders, nosogenic reactions, adjustment disorders, neurasthenia, somatogenic asthenia in patient with chronic cerebral ischemia (dyscirculatory encephalopathy, cerebrovascular disease) (CCI) are very important for the level of social functioning and adaptation. Early initiation of CCI therapy is an important task in preventing the progression not only of cerebrovascular pathology, but also a wide range of comorbid psychopathological disorders. Treatment of patients with CCI requires an individual approach taking into account pathogenetic factors and severity of both cognitive and psychopathological disorders. It should involve a wide range of drugs, including neuroprotectors. For this purpose the neuroprotective agents ethylmethyloxypyridine succinate and citicoline can be used for independent or combined use. Patients with various forms of CCI noticed subjective improvement during treatment which includes decreasing fatigability and general weakness, reduction of symptoms of psychic and somatic anxiety, fatigability, emotional lability, increasing activity and motivation, improvement of memory, attention, ability to concentrate that positively influences their professional activity.

Dyscirculatory encephalopathy in general medicine practice

В данной статье затрагиваются вопросы, связанные с развитием дисциркуляторной энцефалопатии (ДЭ). Освещены вопросы распространенности данного патологического состояния на территории РФ. Проведен анализ современных представлений о патогенезе, описаны отделы головного мозга, которые повреждаются в первую очередь, и как это влияет на проявления заболевания и скорость его развития. Рассматриваются стадийность развития ДЭ, основные клинические признаки и проблемы диагностики данной патологии. Представлены основные принципы терапии, показания к стационарному и амбулаторному лечению, группы препаратов, используемых для улучшения состояния пациента, механизмы их действия. В статье указаны современные методы этиологического, патогенетического лечения, направленные на восстановление гемодинамики в сосудистом русле головного мозга, устранение явлений гипоксии, а также очагов церебральной ишемии. This article addresses issues related to the development of dyscirculatory encephalopathy (DE), in particular – against the background of what diseases this pathology arises, its social significance, prevalence of this pathological process in the territory of the Russian Federation are highlighted. We analyzed modern concepts of pathogenesis, described the parts of the brain that are damaged in the first place and how this affects the manifestations of the disease and the rate of its development. The stages of DE development, the main clinical signs and problems of diagnostics of this pathology are considered. The basic principles of therapy, indications for inpatient and outpatient treatment, groups of drugs, mechanisms of their action are presented. The article indicates modern methods of etiological, pathogenetic treatment, elimination of hypoxia, as well as foci of cerebral ischemia.

Neuroenergy Mapping Diagnostic Capabilities in Hypoxic Brain Lesions

Neuroenergy Mapping (NEM) is the topographic mapping of the brain’s energy metabolism by Direct Current Potentials (DCP). It allows an independent cohort of patients (18 children from 3 to 14 years old) with sharply reduced DCP in one or more areas of the cerebral cortex to be identified among children with diagnoses of ASD and other developmental disorders. Considering the experience of working with NEM and general clinical indications for children, there appeared to be a possibility of central circulatory disorders, and patients were referred for additional examinations. These included a Doppler ultrasonography of the brain and neck vessels and X-rays of the cervical spine in three projections. Results confirmed a diagnosis of dyscirculatory encephalopathy (I67.8) for 15 of the 18 patients. For 9 of these, blood circulation disorders were aggravated by identified disorders of the cervical spine. For 3 patients, the decrease in DCP was due to physiological vasospasm.