The neurosurgical emergency called postoperative spinal epidural hematoma (pSEH) is a neurological complication that is rare but necessitates early diagnosis and decompression. We describe a case of a 55-year-old hypertensive female patient who presented with progressive acute lower limb weakness on both sides less than 24 hours after a two-level microlumbar discectomy. Emergency magnetic resonance imaging showed a large epidural hematoma between T11 and L5, which was compressing the thecal sac. Hemilaminectomy and hematoma evacuation yielded great neurological improvement in a few hours. The present case highlights the significance of early neurological surveillance after surgery, quick access to imaging, and multidisciplinary care. pSEH awareness, even in the postoperative lumbar case, is crucial for preventing irreversible neurological deficits and maximizing patient outcomes.
Combined craniofacial trauma is frequently accompanied by mild traumatic brain injury; however, concussion may remain unrecognized because clinically apparent facial skeletal injuries dominate the initial assessment and neurological manifestations are often nonspecific. The aim of this review was to summarize current evidence on the role of concussion in combined craniofacial trauma, its diagnostic features, functional consequences, and principles of multidisciplinary patient management. A narrative review of clinical guidelines, systematic reviews, meta-analyses, and clinical studies was conducted. The literature search was performed in PubMed/MEDLINE and the Cochrane Library using terms related to concussion, mild traumatic brain injury, maxillofacial and craniofacial trauma, post-concussive symptoms, and neurosensory disorders. The available evidence indicates that the risk of concomitant brain injury increases in high-energy trauma, whereas fractures of the middle and upper facial thirds may reflect substantial transmission of traumatic energy to the skull and brain. The clinical phenotype includes cerebral, cognitive, vestibular, neuro-ophthalmological, cervicogenic, and psycho-emotional manifestations, which may coexist with trigeminal or facial nerve injury, neurosensory deficits, pain, and functional limitations associated with fractures and maxillomandibular fixation. Failure to recognize concussion may delay recommendations concerning regimen, physical and cognitive activity, follow-up, and rehabilitation and may contribute to persistent headache, dizziness, cognitive difficulties, sleep disturbance, anxiety, and depressive symptoms. Concussion should therefore be regarded as a principal neurological component of combined craniofacial trauma requiring active screening, repeated clinical assessment, and coordinated multidisciplinary care.
Background. Blast injuries are becoming increasingly significant in contemporary settings. The brain is the primary target of affection in this type of trauma, regardless of the specific anatomical site of the initial impact. These impairments lead to decreased work capacity, memory loss, and attention deficits. Similar disorders are observed during prolonged oxygen deprivation occurring in obstructive sleep apnea (OSA) syndrome, which is characterized by repetitive episodes of upper airway obstruction leading to intermittent hypoxia, sleep fragmentation, and sympathetic nervous system activation. Despite a substantial body of research, the nature of cognitive changes depending on the severity of sleep apnea remains a subject of debate. Literature data also suggest a potential role of blast injuries in the onset of OSA. The purpose was to determine the impact of brain injury resulting from blast trauma on the cognitive functions of patients with sleep-disordered breathing. Materials and methods. The study examined 34 male patients who were diagnosed with varying severities of OSA and had a history of acubarotrauma. Cognitive impairment was evaluated using the Montreal Cognitive Assessment. The nature of the changes (linear or non-linear) depending on the severity of the disease was determined using methods of variational statistics. Conclusions. The results obtained suggest a potential staged pattern of cognitive changes in obstructive sleep apnea. Early stages of the disease are dominated by selective memory impairments, primarily delayed recall, which aligns with data regarding early dysfunction of hippocampal structures. In our study, patients with moderate OSA demonstrated a relative stabilization of cognitive parameters, potentially reflecting the activation of compensatory neuroplastic mechanisms or adaptation to chronic intermittent hypoxia. Severe OSA was associated with a multi-domain cognitive deficit involving memory, attention, and executive functions, consistent with current concepts of progressive structural and functional brain damage during prolonged courses of the disease.
Comprehensive treatment for Lyme disease should include not only etiotropic therapy, but also correction of complications, namely neuroinflammation, which can result in cognitive dysfunction, anxiety-depressive syndrome, and focal neurological signs. We examined 100 patients with tick-borne borreliosis, 50 of whom received Ungernia Victoris, Rhodiola rosea, and ginseng root combination as additional therapy. Good tolerability, a more pronounced reduction in clinical manifestations, anxiety-depressive syndrome, and autoimmune processes characteristic of neuroinflammation in Lyme disease were demonstrated.
Background. In a previous study in line with the tensioregulome concept, we found that, firstly, the correlation between changes in systolic and diastolic blood pressure (BP) under the influence of balneotherapy is only of moderate strength; secondly, the correlations between changes in both components of BP, on the one hand, and heart rate variability (HRV) markers of both sympathetic and vagal tones, on the other hand, are on the verge of significance or even insignificant. We assumed that the directionality and severity of the autonomic nervous system influence on BP are determined by concomitant changes in the constellation of parameters of the neuro-endocrine-immune complex and metabolism, and can be predicted by the same or a different combination. The purpose of this study is to test these hypotheses. Materials and methods. Under observation, there were 44 patients with chronic pyelonephritis and cholecystitis in the phase of remission. Testing was performed twice — on admission and after 7–10 days of standard balneotherapy on the Truskavets Spa. The objects of the study were BP and HRV, electroencephalographic, endocrine, immune, and metabolic variables. Results. In the first stage of analysis, the information field of seemingly chaotic (r = 0.25) sympathetic tone/BP diastolic relationships was fragmented into three clusters. The first cluster (n = 16; 36.3 %) demonstrated a classic direct relationship (r = +0.91): changes in sympathetic tone (LFnu) from –17 to +14 % were associated with changes in diastolic BP from –13 to +22 mmHg. The second cluster (n = 19; 43.1 %) showed areactivity (r = 0.24): despite significant fluctuations in sympathetic tone (from –44 to +46 %), diastolic BP remained relatively stable (changes from –4 to +8 mmHg). The third cluster (n = 9; 20.5 %) revealed a paradoxical inverse relationship: changes in sympathetic tone from –19 to +10 % were closely and inverse (r = –0.91) associated with changes in diastolic BP from +17 to –7 mmHg. Discriminant analysis identified 24 concomitant variables (Wilks’ = 0.025; F = 3.48; p < 10–5) and 24 predictors (Wilks’ = 0.019; F = 4.70; p < 10–6) that differentiate these clusters. Classification accuracy reached 97.7 % (100 % for paradoxical cluster). The paradoxical response of BP to changes in LFnu was accompanied by the same inverse correlation with changes in serum IgM (r = –0.85), intensity of E.coli phagocytosis by neutrophils (r = –0.72), serum catalase activity (r = –0.68) and uricosuria (r = –0.61), but with a positive correlation with changes in the amplitude of the -rhythm (r = 0.75) and its spectral power density (SPD) in loci F7 (r = 0.74), C4 (r = 0.71) and P4 (r = 0.70), as well as in the SPD of the -rhythm in locus F7 (r = 0.73) and -rhythm in locus F8 (r = 0.70). The paradoxical reaction was predicted by elevated baseline sympathetic tone (markers: LFnu and LF/HF), decreased vagal tone (marker: HF); increased systolic BP response to brachial artery occlusion during BP registration (markers: Ps3/Ps1 and Ps2/Ps1 ratio); normal basal levels of catalase and calcitonin; reduced basal levels of SPD entropy in loci F3 and C3, as well as SPD of the -rhythm in loci F3 and C4 and -rhythm in loci F8 and T4. Conclusions. The study demonstrates that the apparent weak correlation between sympathetic tone and diastolic BP at the population level masks three qualitatively distinct response patterns, including a paradoxical inverse relationship in 20.5 % of patients. This paradoxical reaction is associated with specific neuro-endocrine-immuno-metabolic profiles and can be predicted with high accuracy (97.7 %) using baseline parameters. The findings challenge the universality of the classical paradigm of sympathetic BP regulation and provide a scientific basis for personalized approaches to cardiovascular assessment and therapy in balneological practice.
Tic disorders are a heterogeneous group of pathological conditions that typically manifest in childhood and are characterized by sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations. Their prevalence is estimated at 0.5–1 % in the general population, with a marked male predominance. A substantial proportion of patients present with comorbidities, particularly attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, and mood disorders, significantly affecting quality of life and adaptive functioning. The article presents the classification of tic disorders according to the International Classification of Diseases, 11th revision (ICD-11), the full transition to its use in medical practice in Ukraine is planned from January 1, 2027. The pathophysiology of tic disorders involves dysfunction of cortico-striato-thalamo-cortical circuits and neurotransmitter imbalance. Dopaminergic system plays a central role, alongside GABAergic, glutamatergic, serotonergic, and cholinergic mechanisms. Neuroimaging studies demonstrate structural and functional abnormalities within the basal ganglia, especially the striatum, as well as the supplementary motor area. Genetic contribution is substantial, with heritability estimates ranging from 0.58 to 0.77 and polygenic involvement of variants such as SLITRK1, HDC, CNTNAP2, and NRXN1. Epigenetic mechanisms and environmental risk factors, including perinatal complications and infections, also contribute to disease development. Diagnosis is based on clinical criteria from DSM-5-TR and ICD-11, considering tic duration, type, and combination. Standardized rating scales are recommended, with the Yale Global Tic Severity Scale recognized as the gold standard. Ancillary investigations such as electroencephalography and magnetic resonance imaging are used primarily for differential diagnosis. Management requires a multimodal, individualized approach. Behavioral therapy constitutes first-line treatment. Pharmacotherapy is indicated when symptoms are severe or refractory and includes dopamine receptor antagonists (e.g., aripiprazole, risperidone), 2-adrenergic agonists (clonidine, guanfacine), and alternative agents such as topiramate in resistant cases. An individualized approach allows you to optimize symptom control and improve patients’ quality of life.
Background. Polyneuropathies are a common group of neurological disorders characterized by variable clinical manifestations and involvement of motor, sensory or autonomic peripheral nerve fibers. The most prevalent variant is diabetic polyneuropathy, which develops in roughly 30 to 50 % of diabetes mellitus patients. Neuropathic pain has a profound negative impact on quality of life or daytime activity, so controlling it becomes an important task for physicians. Conventional treatments such as antidepressants and gabapentinoids often provide only partial relief of symptoms, making doctors and scientists turn to research for other pathogenetic and neuromodulatory therapy choices. The objective of this article is to explore evidence-based strategies for managing diabetic polyneuropathy. Materials and methods. A literature review was conducted in PubMed, Scopus, and Cochrane Library databases over the past 10 years. It includes randomized control trials, systematic reviews, and meta-analyses on the efficacy and safety of metabolic and neuromodulatory therapy for patients with diabetic polyneuropathy. Results. Modern studies show that in addition to first-line drugs (gabapentinoids, selective serotonin reuptake inhibitors, etc.), alpha-lipoic acid, gamma-linolenic acid, acetyl-L-carnitine and B vitamins such as methylcobalamin (B12), pyridoxine (B6) and thiamine (B1), which have neuroprotective and antioxidant properties, are often used in treatment. These substances participate in energy metabolism and remyelination processes, which can lead to reduction and improvement of neurological symptoms. Research data show their effectiveness in reducing the intensity of pain and improving overall nerve conduction in patients with diabetic polyneuropathy, so these agents can be effectively used in combination with antidepressants and gabapentinoids to maximize symptomatic and pathogenetic benefit. Conclusions. An individualized, evidence-based and multicomponent approach contributes to better treatment of diabetic polyneuropathy. The combination of symptomatic therapy (antidepressants or gabapentinoids) with pathogenetic agents is the optimal treatment choice.
Background. Common comorbid conditions, including anxiety-depressive disorder (ADD), play a significant role in the clinical course and prognosis of myelodysplastic syndrome (MDS). The purpose was to study the symptom-modifying effects of paro-xetine and a natural phytocomplex with neuroprotective properties in patients with MDS who have symptoms of depression and anxiety. Materials and methods. Patients in the first study group (n = 30) were prescribed a natural phytocomplex with neuroprotective properties, in the second group (n = 30), participants took paroxetine 20 mg once a day. Before treatment and after 2 weeks, to evaluate the proposed ADD correction regimens, patients were assessed using the Goldberg Anxiety and Depression Scale (GADS), and the presence/absence of the most characteristic clinical manifestations of anxiety-depressive conditions were recorded: sleep disturbance, feeling tired in the morning, tiredness during the day, and feeling depressed. Results. The patients’ responses to the GADS showed a decrease in the severity of anxiety and depression in points. If before treatment various manifestations of anxiety and depression were recorded in both groups, which in terms of score corresponded to the average severity of ADD (group 1 — 10.94; group 2 — 11.88), then a month after therapy, the results corresponded to a mild degree of depression: 6.97 and 7.53, respectively. In the first group after the course of the phytocomplex, there was a relatively smaller proportion of patients with the most characteristic and debilitating symptoms of ADD — a feeling of fatigue in the morning and exhaustion during the day (compared to the results of group 2, p < 0.05). Conclusions. A decrease in the severity of anxiety and depression according to the GADS, as well as the regression of ADD clinical symptoms in the group of patients who took the phytocomplex suggests the possibility of using natural neuroprotective agents as an alternative to antidepressants in patients with MDS.
Background. Damage to the central (CNS), peripheral and autonomic nervous systems are the leading complications of electrical trauma (ET). Evidence collection. A retrospective informative search was performed using a spatial-vector descriptive model, which was supplemented by a manual search of relevant articles. Forty-two modern literature sources were selected over the past 10 years, of which 76.2 % — over the past 5 years. Evidence synthesis. The leading mechanisms of neurological ET are electroporation, vascular injury, demyelination and the release of thermal energy, which causes the destruction of macromolecules. In this regard, theories of causality, alternative and neurohumoral hypotheses have been proposed. There are several types of nerve damage in ET, including circulatory disorders, ischemic encephalopathy, hypoxic encephalopathy, various dystrophic changes in brain cellular structures and intracranial hemorrhages. The greatest neuronal damage is observed in cases with minimal skin damage (the most significant amount of current falls on internal structures). Direct or indirect effects of ET on the brain are possible, when craniocerebral trauma is caused by the passage of current or direct damage to the brain due to blunt mechanical trauma (or a combination of both). Electric shock can lead to ischemic stroke due to circulatory disturbances or to hemorrhagic stroke due to direct structural damage with necrosis and axonal degeneration. Acute CNS complications include changes in mental status, coma, amnesia, quadriplegia and localized paresis. Motor impairment occurs more often than sensory deficits. Delayed neurological syndromes, such as cerebellar ataxia or autonomic dysfunction, may occur weeks or months after the initial injury due to the development of subsequent ischemia, a decrease in the number of Purkinje cells or the presence of hemorrhages. In situations where the path of the electric current crosses the spinal cord, which usually occurs at the level of C4-C8 (i.e. from one limb to the other), the patient is at risk of spinal cord injury. This type of trauma leads to direct damage to the spinal cord, which causes significant neurological disorders. Conclusions. The leading mechanisms of neurological electrical trauma are electroporation, vascular injury, demyelination and the release of thermal energy. Brain damage in electrical trauma is possible even when the head is not in a direct electrical circuit. The mechanisms of the development of delayed neurological complications are currently not fully understood.
Background. Stroke remains the second leading cause of death worldwide, and its prevalence is rapidly increasing among the young working-age population. Acute ischemic stroke accounts for over 80 % of all stroke cases, it has a high mortality rate and leads to disability. The main pathological processes that accompany ischemic stroke include oxidative stress, excitotoxicity, and inflammation. Studying the types of cell death, particularly apoptosis and necrosis, in the body under the influence of reactive oxygen species (ROS) and nitrogen is important for understanding ischemic stroke. Objective: to determine the percentage of viable, early apoptotic, late apoptotic, and necrotic leukocytes in the peripheral blood of patients with acute ischemic stroke depending on disease severity according to the National Institutes of Health Stroke Scale (NIHSS). Materials and methods. Patients with acute ischemic stroke were divided into three groups depending on the severity of the disease according to the NIHSS. The first group included 30 patients with scores from 1 to 5, the second group consisted of 32 participants with scores from 6 to 13, and the third group included 23 people with disease severity scores from 14 to 20. Whole venous blood was collected in a hospital setting within 4.5 hours after the onset of the disease. A leukocyte suspension was prepared according to the protocol. The percentage of viable, early apoptotic, late apoptotic, and necrotic leukocytes in the peripheral blood of patients was determined by flow cytometry using a BD FACSCanto™ II system. Results. In patients with acute ischemic stroke, there is a decrease in the percentage of viable leukocytes depending on the severity of the disease according to the NIHSS compared to healthy individuals. The percentage of early and late apoptotic leukocytes gradually increased depending on the severity of the disease. The percentage of necrotic cells in patients of group I did not change statistically. In the blood of patients from groups II and III, an increase in the percentage was observed by 3.77 and 8.14 times compared to the corresponding indicators in healthy individuals. Conclusions. In patients with acute ischemic stroke, there is a decrease in the percentage of viable cells against the background of an increase in the percentage of early apoptotic, late apoptotic, and necrotic leukocytes, and a correlation between these indicators and the severity of the disease. In our opinion, the activation of blood leukocyte cell death processes occurs under increased ROS generation involving ROS-dependent mechanisms.
Background. In Eastern martial arts, non-contact mental influence on a partner is described, often associated with the concept of energy-informational exchange. The Kyokushin karate kata (KKK) practice is particularly noteworthy in this context. The purpose was to explore the neurophysiological and biophysical mechanisms underlying the effect of KKK on brain activity of the sender and the physiological state of the receiver in both animal models (rat’s hippocampal slice) and non-biological systems (distilled water). Materials and methods. Three experiments were conducted: 1) electoroncefalography (EEG), heart rate variability (HRV), and electro-photonic imaging/gas discharge visualization (EPI/GDV) were recorded in ККК master and Reiki practitioner; 2) synaptic efficacy in rat’s hippocampal slice was measured during remote mental interventions; 3) light activity of distilled water, induced by gas discharge, was analyzed after exposure to KKK and canonical Christian prayer. Data analysis included EEG and EPI signal processing, entropy calculations, correlation, canonical, multiple regression and discriminant analysis. Results. KKK practice, but not Reiki significantly increased EEG delta, alpha and theta spectral power density (SPD), to the greatest extent in temporal and parietal loci, while decreased beta SPD to the greatest extent in frontal, prefrontal and central loci, reduced both spectral and EPI entropy, and enhanced EPI energy characteristics. Remote KKK influence induced a notable increase in rat’s hippocampal synaptic efficacy (+7.5 ± 5.1 %) while Reiki was ineffective (–0.5 ± 4.8 %) (mean ± SD). Strong canonical correlations were identified between sender’s parameters during sessions and changes in rat’s hippocampal synaptic efficacy as the receiver: R = 0.936; 0.931; 0,913, and 0.959 with EEG SPD, EEG entropy, EPI entropy and EEG & EPI in total, respectively. Both KKK and Christian prayer increased the light activity of distilled water, but only in cases where they increased SPD of delta rhythm while decreased EEG entropy and energy of the third virtual chakra. Conclusions. Findings support the proposed hypothesis of a dual-biophotonic (energy-mediated) and negentropic (information-mediated) mechanism underlying KKK effects, observable through objective neurophysiological and biophysical parameters. Compared to other mental practices, KKK demonstrated more pronounced (Reiki) or equal (prayer) systemic influence.
Background. Sensorineural hearing loss (SNHL) has a multifactorial etiology. Nevertheless, the increasing frequency of armed conflicts worldwide and the ongoing war in Ukraine have considerably raised the incidence of SNHL caused by acoustic barotrauma resulting from exposure to firearms and explosions. The study aimed to investigate the specific features of auditory dysfunction in patients with SNHL of different etiologies using brainstem auditory evoked potentials (BAEP). Materials and methods. A total of 100 patients with a mean age of 49.60 ± 1.59 years, predominantly males (71 vs 29 %), were examined from June 2023 to June 2025. Sensorineural hearing loss was caused by acoustic barotrauma in 52 of them and by vascular factors in 48. An acute onset was observed in 60 % of cases, and a chronic course in 40 %. The distribution of acute and chronic forms between the acoustic barotrauma and vascular groups was approximately equal. All patients underwent comprehensive neurological and somatic examinations, otoneurological evaluation, consultation with an audiologist, audiometry, brain neuroimaging, ultrasound examination of the major cervical vessels, and BAEP testing. Conductive causes of hearing loss were excluded. Results. Analysis of complaints and symptoms revealed that hearing loss and tinnitus were the most common complaints across all forms. Vertigo was more characteristic of acute onset than of chronic cases; vomiting occurred only in acute onset, while gait instability was more frequently observed in patients with vascular causes of hearing loss. In the vascular group, a significantly greater decrease in hearing thresholds was observed compared to acoustic barotrauma. In BAEP studies of acute sensorineural hearing loss, interpeak intervals I–III and I–V had diagnostic significance, indicating generalized impairment along the entire brainstem auditory pathway. Conclusions. The study of brainstem auditory evoked potentials is useful for determining the degree of hearing impairment and for objectifying the differential diagnosis of auditory disorders.
Background. Cognitive decline (CD) during the recovery period of ischemic strokes in patients with atrial fibrillation (AF) is associated with left ventricular ejection fraction (LVEF) ≤ 48 %. Objective: to investigate cognitive changes during the recovery period of ischemic strokes in patients with AF and LVEF ≤ 48 % who took sacubitril/valsartan. Materials and methods. Patients with nonvalvular AF and LVEF ≤ 48 % who had an ischemic non-lacunar stroke within the last 6 months were examined. Thirty-nine people in the control group received protocol treatment, and 14 patients additionally took sacubitril/valsartan 100 mg twice daily for 6 months. Cognitive and echocardiographic parameters were assessed at the first examination and after 6 months. CD was diagnosed when the cognitive scores decreased by ≥ 1 point. Results. Both groups of patients at the time of inclusion did not differ significantly in cognitive functioning, socio-demographic, clinical, psycho-emotional characteristics, and echocardiographic parameters. Six-month administration of sacubitril/valsartan was associated with a significant reduction in the relative risk of CD on all used cognitive scales compared to the control group: by 3.18 times (95% confidence interval (CI) 1.42–7.16) on the Montreal Cognitive Assessment, by 2.79 times (95% CI 1.29–6.00) on the Clock Drawing Test and by 2.48 times (95% CI 1.19–5.14) on the Mini-Mental State Examination and the Frontal Assessment Battery. In addition, the sacubitril/valsartan intake was associated with a reliable increase in LVEF compared to baseline (40.3 (38.1–42.4) vs. 40.1 (39.4–42.5) %); in contrast, in the control group, no such pattern was observed. Conclusions. In patients with AF and LVEF ≤ 48 %, sacubitril/valsartan administration in the recovery period of ischemic non-lacunar stroke is associated with a significant improvement in cognitive functioning.
In medical education, preference is given to the use of modern educational simulation technologies that realistically reproduce clinical situations with maximum involvement in it of a future doctor. The purpose of this article is to consider the role of simulation technologies in postgraduate medical education on the example of using the simulator for assimilating and mastering the practical skill of performing lumbar puncture (LP) in the training of future doctors in the specialty “Neurology”. The article discusses definition of simulation and simulation training; historical aspects of the creation of training simulation centers in Ukraine; capabilities of the Andriy Tkachenko Center for Simulation Teaching Methods of the Shupyk National Healthcare University of Ukraine; the possibility of using the simulator to assimilate and master the practical skill of performing LP; algorithm for performing LP; technical characteristics, features and advantages of the Primed simulator for performing LP. The use of the LP simulator allows you to demonstrate LP to the teacher with maximum realistic reproduction, and also to perform LP in the quantity necessary to achieve a highly qualified level. The advantages of using the simulator for performing LP as a technical simulation tool that combines visual, tactile, and reactive technologies for simulation learning are discussed. Disadvantages of the simulator for LP are considered. The use of the LP simulator effectively complements and expands the possibilities of postgraduate medical education, as well as ensures patient safety and meets modern ethical requirements.
Every year in the world, more than 2 million young people suffer ischemic stroke, 40 % of them have no identifiable cause and such cases are classified as cryptogenic. In addition to traditional vascular risk factors for acute cerebrovascular accident, there are also rare and specific etiological causes of the disease in young people. The article describes the risk factors, etiology, clinical and neurological syndromes and neuroimaging findings in young people with ischemic stroke depending on the affected vascular area.
Background. Combined injuries are those in which the action of a single traumatic agent affects different anatomical regions. The severity of the condition of patients with combined craniofacial trauma (injuries to the brain, skull, and facial tissues) may be due to several factors, with craniocerebral trauma being the most significant. Purpose of the study was to assess the levels of anxiety, depression, and pain, as well as neuropsychological changes in patients during the acute period of combined craniofacial trauma (including concussion and maxillofacial bone fractures). Materials and methods. This study involved 50 young and middle-aged patients with combined craniofacial trauma. All participants underwent a detailed neurological examination in the acute period of injury and 7–10 days later to assess the dynamics of their state. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), additional depressive symptoms were assessed with the Beck Depression Inventory, and pain levels were measured on the Visual Analogue Scale (VAS). Results. According to the HADS-A, patients with combined craniofacial trauma had the following anxiety indicators: subclinical anxiety was observed in 12 (24 %) patients, clinical anxiety — in 1 (2 %) case, while 37 (74 %) people showed no signs of anxiety. The mean anxiety score was 5.9 ± 2.6. On the HADS-D, 6 (12 %) participants had subclinical symptoms, 2 (4 %) had clinically significant symptoms, and 42 (84 %) hadn’t notable signs of depression. Correlation analysis revealed a weak relationship between VAS scores and anxiety levels (on the HADS-A), whereas no significant correlation was found between VAS scores and depression levels (on the HADS-D). Conclusions. The results suggest the importance of neurological evaluation and the implementation of both routine and, if necessary, in-depth tests for assessing anxiety and depressive disorders in this group, particularly in those experiencing pronounced pain, to enhance treatment strategies and timely patients’ management.
Background. Anxiety and depression are the most common psychiatric disorders that develop in patients with autoimmune diabetes mellitus (DM). This can be caused by hyperglycemia, dyslipidemia, and vitamin D deficiency. The purpose of the study was to determine the effects of cholecalciferol on anxiety and depression in the comprehensive treatment of patients with different phenotypes of type 1 diabetes mellitus. Materials and methods. In order to assess the effectiveness of treatment, patients with classical type 1 DM and latent autoimmune diabetes in adults (LADA) were divided into 2 subgroups. Subgroup A of each group received cholecalciferol 20,000 IU in comprehensive treatment, 1 capsule per week for 3 months; subgroup B received only basic therapy. All patients were examined for situational and personal anxiety, depression, serum 25(OH)D level and indicators of carbohydrate metabolism in the dynamics of treatment (before and after 3 months). Results. In patients with classical DM, the level of situational anxiety underwent significant changes only when vitamin D was added to the basic therapy — the indicator in this group decreased by 21.5 %. The level of depression in patients receiving basic therapy changed slightly, and when vitamin D was added, it decreased by 15.8 %. In patients with LADA, the situational anxiety decreased by 20.4 %, and depression by 7.5 % when vitamin D was added to the basic treatment. Conclusions. The administration of cholecalciferol contributes to the improvement of carbohydrate metabolism indicators, anthropometric data, and a significant reduction in anxiety and depression, with more pronounced effect in patients with LADA.
The purpose of the review was to examine the connection between epilepsy, migraine, and trigeminal neuralgia through the pathogenetic role of calcitonin gene-related peptide (CGRP) and evaluate the therapeutic potential of lacosamide. A comprehensive literature review was conducted using PubMed, Scopus, and Web of Science databases, covering the period from 1982 to 2024, with a focus on lacosamide’s mechanisms of action on CGRP. According to the literature data, CGRP is a critical mediator in the pathogenesis of migraine and trigeminal neuralgia, inhibiting its release and enhancing inactivation of sodium channels, which allows its use when these diseases are combined with epilepsy. Lacosamide emerges as a promising therapeutic option for epilepsy, migraine, and trigeminal neuralgia due to its dual mechanism of action.
Background. Alcoholic neuropathy is a dominant complication of acute and chronic intoxication due to alcohol abuse. It leads to sensory, motor and autonomic damage to the peripheral nervous system and quantitatively far outweighs da-mage to the central nervous system. The purpose of the work is to investigate the clinical and electrophysiological efficacy of alpha-lipoic acid (ALA) in the experiment and clinic during the comprehensive treatment of alcoholic polyneuropathies (APN). Materials and methods. Experimental alcoholic polyneuropathy (EAP) was reproduced for 10 weeks, during which male Wistar rats were fed alcohol (10 g/kg body weight). After 10 weeks, treatment was initiated with intraperitoneal administration of ALA at a dose of 100 mg/kg, 5 times a week for 8 weeks. Animal groups: 1) control (n = 6); 2) rats with EAP (n = 16); 3) rats with EAP who were administered ALA (n = 16). In the clinical part of the work, 51 patients with APN were examined. Results. The obtained data can be discussed in terms of developing a pathogenetically substantiated treatment regimen for APN. The positive results were evaluated as experimental evidence of the feasibility of testing the clinical effects of ALA in patients with peri-pheral nerve damage. Rats with EAP showed normalization of the functioning of the sensory (from the 5th week, 31st day) and motor (from the 6th week, 40th day) components of the peri-pheral nerves. Based on the obtained experimental data, a series of clinical observations were conducted in which the clinical efficacy of ALA in APN was found. Conclusions. Considering the positive experimental and clinical effects of ALA proven using objective methods of neurophysiological and pathophysiological research, it is likely that the mechanism for achieving them is the restoration of the myelin sheath of the peripheral nerves, since the reverse process is of pathogenetic importance in the development of clinical symptoms of APN. The obtained positive results on the effectiveness of APN treatment using ALA require longer research, as a tendency towards progression of improvement in the condition of patients has been noted, especially with distal mixed (motor-sensory) forms of APN.
