Background. Pain following combat trauma has been shown to be associated with in-creased rates of posttraumatic stress disorder and depression in over 35% of veterans. The role of psychological factors on outcomes after combat related amputation is increas-ingly acknowledged, the association between neuropathic residual limb pain and symp-toms of mental health disorders in the early rehabilitation period after combat trauma re-mains poorly analyzed. Purpose – To assess the relationship between postamputation pain phenotypes and both PTSD and depressive disorder among military servicemembers after combat-related am-putation during the Russian-Ukrainian war. Materials and Methods. 145 servicemembers with combat related limb loss, treated at the 3rd-4th level Military Clinical Center of the Western Region during the period 2022–2026, were included in the analysis. Pain types assessed were neuropathic residual limb pain (nRLP) and phantom limb pain (PLP) with NRS, DN-4. Psychological distress parameters evaluated were PTSD and depressive symptoms with PCL-M, PHQ-9 questionnaires. Two groups were formed for analysis: a control group (N=51) with a neuropathic pain level of 0–3, and a research group (N=94) with a pain level of 4–10. A correlation, log-binomial analyses of postamputation pain and mental health issues were conducted. Results. The prevalence of clinically significant nRLP (moderate-to-severe) was 64.8% [95% CI: 60.8–68.8] in the cohort of patients with mean 5 months after amputation. Co-morbidity of PTSD was identified in 46.8% [95% CI: 41.7–51.9] of patients with clinically significant postamputation pain, while depressive disorder was observed in 59.6% [95% CI: 54.5–64.7] of pain cases. Across the entire cohort of patients after combat-related limb amputation, clinical signs of probable PTSD were present in 31.7% [95% CI: 27.8–35.6] of individuals, and depressive disorder in 44.8% [95% CI: 40.7–48.9] of cases. A direct moderate correlation was observed between neuropathic RLP and symptoms of both PTSD (r= 0.5±0.1, P level < 0.001) and depression (r = 0.5±0.2, P level < 0.001). PLP demonstrat-ed the weakest association with mental health disorders. Individuals with clinical signs of PTSD experienced nRLP level of 6,0 (5,0-7,0) that was 1.9 times higher [95% CI: 1.5–2.3] (P level < 0.05) than those without PTSD. The relative risk of exacerbating nRLP in patients with depressive symptoms was 1.8 [95% CI: 1.4–2.3] (P level < 0.05). Furthermore, the presence of neuropathic RLP was found to aggravate the severity of PTSD symptoms by RR of 12.1 [95% CI: 3.1–47.6] and depressive disorders by 3.4 [95% CI: 1.8–6.3]. Notably, the comorbidity of neuropathic RLP and phantom limb pain did not further increase the risk of mental health disorder. Conclusions. A bidirectional relationship and high comorbidity rates between neuropathic residual limb pain and mental health issues confirmed to be significant in early rehabili-tation period for servicemembers after combat injury. Nearly twofold increase in the risk of clinically significant nRLP among patients following combat-related psychotrauma un-derscores the mutual aggravation between nRLP chronification and mental health issues 5 months after combat-related amputation. For more effective postamputation pain man-agement followed by successful social readaptation, therapy should include methods and medications for posttraumatic mental health issues.
Background. Parkinsonʼs disease is one of the most common progressive neurodegen-erative disorders of the central nervous system and poses a significant medical and social challenge due to its steadily increasing prevalence, the resulting disability among patients, and a substantial decline in quality of life. Despite significant progress in understanding the pathogenesis of the disease and the development of international clinical guidelines, cur-rent treatments remain predominantly symptomatic and are unable to modify the course of the disease. Early diagnosis of Parkinsonʼs disease poses a particular challenge, given the prolonged prodromal period, clinical heterogeneity, and the predominance of non-motor symptoms in the early stages. In Ukraine, additional factors that heighten the urgency of the problem include uneven access to specialized care, a limited number of physicians specializing in movement disorders, and the impact of chronic psychoemotional stress associated with wartime events, which may contribute to earlier clinical manifestation and faster disease progression. Problem statement. Despite the rapid advances in neuroscience in the 21st century, Parkinsonʼs disease remains challenging to diagnose in a timely manner and manage effectively. The difficulties in clinical assessment stem not only from the variability of motor symptoms but also from the high prevalence of non-motor symptoms, including depression, anxiety disorders, sleep disturbances, autonomic dysfunction, and cognitive impairments, which often mask the early stages of the disease. In Ukraine, the problem is compounded by the lack of a standardized, practical care pathway for patients with Parkinsonʼs disease, leading to the use of outdated or suboptimal therapeutic strategies, delays in treatment escalation, and late referral for neurosurgical interventions, particularly deep brain stimulation. Purpose – to analyze the clinical course of Parkinsonʼs disease using the case of a single patient-from the onset of the disease to the stage of functional neurosurgical treatment-to evaluate the effectiveness and limitations of the therapeutic approaches used, and to compare the findings with current international clinical guidelines and scientific literature. Materials and methods. An analysis was conducted of the current scientific literature and international clinical guidelines regarding the diagnosis and treatment of Parkinsonʼs disease. The medical records of a patient with a long-term course of the disease were reviewed in detail, including data from clinical examinations, neuroimaging studies, and medical and surgical therapy. The clinical case was evaluated in accordance with the diagnostic criteria of the Movement Disorder Society (MDS) and the principles of evi-dence-based medicine. Conclusions. The clinical case presented here demonstrates that the key factors compli-cating the management of patients with Parkinsonʼs disease include delayed presentation for medical care, insufficient attention to prodromal and non-motor symptoms, and the fail-ure to adjust the treatment strategy in a timely manner in accordance with current guide-lines. The use of outdated approaches in the early stages of the disease and unsystematic monitoring of disease progression may contribute to faster progression and early disability in patients. At the same time, experience with functional neurosurgical methods, particu-larly deep brain stimulation, confirms their effectiveness in patients with medication-resis-tant motor fluctuations, provided there is proper patient selection and timely referral. The results obtained underscore the need to implement a standardized patient pathway for Parkinsonʼs disease in Ukraine, to raise physiciansʼ awareness of current diagnostic criteria and therapeutic options, and to develop a multidisciplinary approach to the man-agement of this patient population.
Background. Chronic pain is a heterogeneous condition characterized by diverse etiopathogenetic mechanisms, in which psychological and psychiatric factors play a pivotal role. Anxiety and depression frequently accompany chronic pain; however, their severity and clinical relevance may vary substantially across different pain types. Insufficient differentiation of psychological factors limits opportunities for personalized treatment and timely psychiatric intervention. Purpose – to investigate the prevalence and severity of anxiety and depression in patients with different chronic pain types in order to refine psychological and psychiatric markers of chronic pain heterogeneity and to inform the development of personalized treatment approaches. Materials and Methods. 302 outpatients with chronic pain lasting longer than 3 months were included. Patients were stratified into five groups according to etiopathogenetic mechanisms of pain: primary psychogenic pain (PPP1); primary psychophysiological pain (PPP2); mixed primary psychogenic and psychophysiological pain (PPP3); secondary mixed pain (SMP); and secondary organic pain (SOP). Anxiety and depression levels were assessed using the Hospital Anxiety and Depression Scale (HADS). Correlation analysis, Fisherʼs exact tests, and logistic regression were applied. Results. Clinically significant anxiety symptoms were identified in 64.3% of patients with chronic pain, and clinically significant depressive symptoms in 35.4%. The association between pain phenotypes and anxiety level was strong (Cramérʼs V = 0.52), whereas the association with depression was moderate (V = 0.37). Clinically significant anxiety and depression symptoms were detected in 61.7% of patients in the PPP3 group, 37.5% in PPP1, 17.2% in SMP, and 15.5% in PPP2. Although the SMP group showed a similar overall frequency of anxiety and depression to PPP3, the combined clinical presentation of both disorders occurred 2.2 times less frequently than in PPP3. No clinically significant anxiety or depressive symptoms were observed in the SOP group. Anxiety and depression levels were positively correlated with pain intensity and the number of pain sites. Men exhibited a higher risk of clinically significant depression according to the HADS, and age over 41 years was identified as a predictor of clinically significant depression in the PPP1 group. Conclusions. Anxiety and depression are differentially involved in various types of chronic pain and may be regarded as mental health markers of its heterogeneity, highlighting the need for a stratified and proactive psychiatric approach to the management of patients with chronic pain.
Background. The nervous system plays a key role in mediating adaptive responses of the body to external influences. Under conditions of martial law, particular attention should be given to the impact of chronic stress and combat-related factors on the central nervous system, especially on the development and course of cerebrovascular diseases, which significantly determine functional status and quality of life. Purpose – to investigate the clinical features of the development and course of cerebrovascular diseases under conditions of martial law. Materials and Methods. A total of 60 patients with chronic cerebral circulatory disorders (dyscirculatory encephalopathy stages I–II) were examined and constituted the main group, including 30 civilians and 30 military personnel. The mean age of patients was 45.2 ± 6.6 years. The comparison group consisted of 30 patients with dyscirculatory encephalopathy stages I–II examined in the pre-war period. Clinical and neurological, clinical and psychopathological, psychodiagnostic, and statistical research methods were applied. Results. Asthenic manifestations, neurocognitive impairment, and insomnia syndrome predominated in patients of the main group. Chronic psychoemotional stress and combat-related stress were identified as leading risk factors for the development of cerebrovascular diseases. Differences in disease course were observed depending on social status and the level of psychoemotional burden. Military personnel demonstrated an earlier disease onset, higher frequency of hypertensive crises, more pronounced atherosclerotic changes in the carotid arteries, elevated levels of proinflammatory cytokines, and a higher prevalence of anxiety-depressive disorders, sleep disturbances, and cognitive decline. In the civilian population, chronic forms of cerebrovascular pathology predominated, characterized by cognitive deficits, emotional lability, and asthenic syndrome associated with arterial hypertension and atherosclerosis. Conclusions. Prolonged war-related stress exceeding the adaptive capacity of the body contributes to the development and progression of cerebrovascular pathology combined with psychoemotional and cognitive disorders. The obtained results substantiate the need for differentiated treatment and neurorehabilitation approaches that consider the impact of war-related factors.
Background. Secondary hyperkalemic paralysis (SHP) is a specific and rare manifestation of hyperkalemia characterized by acute (subacute) symmetrical flaccid paresis. If SHP is not recognized promptly, the further progression of hyperkalemia can lead to the development of fatal cardiac arrhythmias and respiratory failure. Purpose – presentation of a clinical case of SHP. Materials and Methods. A clinical case of SHP in the form of transient lower paraplegia in a patient with newly diagnosed multiple myeloma complicated by acute nephropathy is reported. Results. A 53-year-old male patient was admitted to the emergency department complaining of a lack of movement in his lower limbs. About 6 hours ago, he suddenly experienced weakness in both lower limbs, and about 2 hours ago, movement in both legs disappeared. There is no active movement in both lower limbs, but muscle strength in the upper limbs is normal. Muscle tone in the upper limbs is normal, but significantly reduced in the lower limbs. Deep reflexes in the upper limbs are reduced and symmetrical, but absent in the lower limbs. No pyramidal symptoms, sensory and coordination disorders, meningeal symptoms were detected. ECG: sinus bradycardia 51/min, high-pointed T waves, widened QRS complexes. Biochemical blood analysis: creatinine – 3295.3 μmol/L (70–115), urea – 76.4 mmol/L (<8.3), potassium – 9.4 mmol/L (3.3–5.5), calcium – 3.07 mmol/L (2.15–2.55). On the same day, during acute hemodialysis, the patient began to move his lower limbs. The next day, strength in the legs was fully restored, and serum potassium was 6.05 mmol/L. Conclusions. In cases of acute (subacute) tetraparesis or lower paraparesis, SHP should be ruled out, especially in patients with kidney disease.
