Knowing the frequency of spasticity patterns in different muscles allows correcting the botulinum neurotoxin (BoNT) administration schemes and creating spasticity models that could predict the drug consumption and treatment cost.Objective: to develop clinical spasticity models based on the frequencies of the spastic syndrome in the muscles of the extremities in post-stroke patients to optimize BoNT administration.Patients and methods. We examined 129 patients of both sexes aged 61.2±8.0 years with post-stroke spasticity (mean time after the stroke – 4.6±2.2). Twenty-seven muscles were tested for spasticity: shoulder girdle (n=3), upper (n=9) and lower (n=15) extremities. We used the original manual testing methods (MTM) of spasticity and the Tardieu scale (TS).Results and discussion. We observed the following frequencies of spasticity in the arm muscles: pectoralis major, brachioradialis, pronator teres, fl. carpi radialis, fl. digitorum profundus et superfacialis, fl. pollicis long. – over 70%, subscapularis – 61%, brachialis – 56.6%, biceps brachii – 35.8%. Frequencies of spasticity in the leg muscles were: semitendinosus, semimembranosus, fl. digitorum long. – 37.5%, gracilis – 21.4%, cap. med. gastrocnemius – 48%, tibialis post. – 39.2%, soleus – 19.6%, fl. halluces long. – 23%. There was no spasticity in the hip adductors; low spasticity incidence was seen in fl. digitorum brev. et fl. halluces brev. (<10%), tibialis ant., rectus femoris (<5%); biceps femoris, teres major, fl. carpi ulnaris, and cap. lat. gastrocnemius (<2%). Based on the frequency of identified spastic patterns, we created four models of patients with arm spasticity and five models – with leg spasticity with the calculation of the necessary doses of BoNT.Conclusion. We propose several spasticity models, which allow calculating the treatment costs, considering the frequency of involvement of specific muscles in spasticity evaluation, and tracking the rehabilitation follow-up of the patient's transition from one clinical model to another.

The aim of the clinical study was to improve prevention of postoperative sialocele and fistulas of parotid glands. MATERIALS AND METHODS The study included 100 patients with tumors of parotid glands treated by superficial parotidecthomy. Fifty patients received incobotulinum toxin A preoperatively, while control group consisted of 50 patients without preoperative injections. RESULTS Salivary fistulas formed in 17% of cases in control group. Discharging of saliva through the postoperative wound for 6 days after surgical treatment were noticed in the control group in 30% of cases. There were no complications such as forming of salivary fistula and sialocele and no saliva flow from the postoperative wound on the 4th day after surgical treatment in the main group. Conclusion. The use of botulinum toxin type A proved an efficient and effective way for prevention of postoperative salivary fistulas and sialocele.

Post-stroke spasticity (PS) occurs in most patients with stroke and contributes to the development of pain syndrome and contractures, which substantially impairs the restoration of lost motor functions (MFs) and the quality of life of the patient.Objective: to evaluate the efficacy of a combination of botulinum toxin A (BTA) and multimodal stimulation in patients with arm PS.Patients and methods. The investigation enrolled 84 patients aged 18 to 85 years with PS, who had experienced ischemic stroke (IS) 1 month to 1 year before. In the study group (n=56), complex rehabilitation treatment was preceded by the use of BTA, while in the control group (n=28), multimodal rehabilitation therapy was performed without using BTA. Before and after treatment, neurological deficit was evaluated using the modified Ashworth scale (MAS), the Fugl—Meyer (FM) assessment scale, the British muscle strength grading scale, the Action Research Arm Test (ARAT), the Barthel index, and the modified Rankin scale.Results and discussion. According to MAS, there was a statistically significantly spasticity reduction after BTA use in the study group compared to the control one (median 1 [1; 2] and 2 [2; 3] scores, respectively; p=0.0003). According to the FM scale, an improvement in arm MFs was noted in the study group compared to the control one (median 29.5 [20; 42] and 21 [13.5; 31.5] scores, respectively; p=0.008) and according to the ARAT scale this was observed in the study and control groups (14.5 [7; 27] and 3 [0; 12] scores, respectively; p=0.0004).In patients with upper limb PS, the use of BTA before a rehabilitation cycle using multimodal stimulation was shown to be statistically significantly more effective than the similar neurorehabilitation cycles without prior BTA therapy. The findings can be used in the routine practice of a neurologist when planning rehabilitation for more effective and well-founded treatment in patients with arm PS.Conclusion. Incorporation of BTA into multimodal stimulation was ascertained to be effective in patients with PS.

Diagnosis, treatment and rehabilitation of patients with spasticity remain a challenge, in which standard methodological approaches have not yet been developed. One of the most promising solutions to this problem is the use of the Modified Tardieu scale (MTS). The article describes the method of working with MTS tested in the examination, treatment and rehabilitation of patients with acute cerebrovascular accident (n=112) and patients with multiple sclerosis (n=17). The original version of MTS has been translated into Russian. The use of MTS assessment system allows the diagnosis of the main elements of the clinical picture of the damage to the central nervous system, such as paresis, spasticity, violation of proprioception, as well as the qualitative and quantitative assessment of the dynamics of rehabilitation and treatment of spasticity with botulinum neurotoxin (BoNT).

AIM:To develop and test a method of examination of patients with lower limb spasticity, to describe lower limb spasticity patterns in patients with brain damage and to assess the efficacy of abobotulinumtoxin A (dysport) in the rehabilitation of patients with stroke.MATERIAL AND METHODS:Spasticity rating scales (MAS and Tardieu), the Barthel index, the Rankin scale , the Rivermead Mobility Index, the Hauser Ambulation Index, a comfortable walking test were used. Treatment satisfaction was assessed with the Visual analogue scale. Abobotulinumtoxin A (dysport) was used for treatment of lower limb spasticity.RESULTS AND CONCLUSION:Two most common patterns (dynamic and static) were identified in patients with post-stroke spasticity and the method of testing spasticity was developed. The prevalence of spasticity in individual muscles of the lower extremity was estimated as well. An analysis of the efficacy of dysport and a sensitive analysis of the scales used in the study were carried out.

5% of all dental pathology account for diseases of the salivary glands. From 3% to 5% of all tumors of the maxillofacial region accounted for tumors of the salivary glands. Among them parotid gland tumors account for up to 92%. The most frequent complications after surgery in the parotid region are salivary fistula and sialocele. There is no single treatment protocol for these complications. The first reports on the successful use of local injections of botulinum toxin for closing of salivary fistula appeared in 1999. For today, foreign colleagues’ studies confirm the efficacy and safety of botulinum toxin in the treatment of salivary fistula. Despite this, still remain to be illuminated following problems: the lack of developed algorithm the prevention and treatment of salivary fistula and sialocele; the lack of comparative assessment of treatment of salivary fistula by using Botulinum and other methods; the lack of long-term observations, the deficiency of information about side effects.

AIM:To study the location and verification of motor points (MP) of the upper limbs for targeting botulinum toxin (BT) type A injections in the treatment of spasticity.MATERIAL AND METHODS:Twenty healthy people were examined. Using electromyography a complete study of the muscles of the upper limbs was conducted.RESULTS:Anatomical localization of MP was performed. The location of MP is identical and does not depend on sex, age and the dominant limb. Tables and maps of MP locations are presented.CONCLUSION:MP in the flexor muscles of the arm were identified. A surface map with MP location was created. This data may improve the clinical efficacy and feasibility of MP targeting, when injecting BT in spasticity.

Background: The most frequent mutation of the gene TOR1A (DYT1) (9q34), that causes type 1 dystonia (DOPA-unresponsive torsion dystonia) is the deletion c.907-909delGAG in the 5th exon of the gene (303delGlu). This mutation has not been found in the Russian population of patients with cervical dystonia.Aim: To elucidate the existence and clinical characteristics of interfamilial polymorphisms in type 1 dystonia patients in the Moscow Region.Materials and methods: Twenty one patients with dystonia underwent molecular genetic tests with DNA sequencing aimed at identification of the DYT1 gene mutation.Results: Sixteen of 21 patients had only cervical dystonia without the DYT1 gene mutation. Among 5 patients with torsion dystonia, 2 cases demonstrated the most frequent mutation of the DYT1 gene, i.e., the deletion of three nucleotides (del1302/303, orс.907_909delGAG). There were specific characteristics in clinical manifestation and onset of the disease in the patients with the mutation. In a 30-year old patient the disease manifested at the age of 14 with torsion dystonia. In a 50-year old patient the disease manifested at the age of 46 from trunk dystonia, which at the age of 48 was followed by cervical dystonia (left-side torticollis), where two courses of botulin treatment (type A botulinic toxin complexed with hemagglutinin, 300 U) were minimally effective.Conclusion: No mutation in the DYT1 gene was found in the population of patients with cervical dystonia in the Moscow Region, which agrees with the literature data. In those with torsion dystonia, the DYT1 gene mutation was found in 2 of 5 (40%) cases. Interfamilial polymorphism of the disease was identified.

We describe a clinical case of a piriformis syndrome in a patient with lumboischialgia. A technique of botulinum toxin therapy is described which was performed under neuroimaging control, i.e., with pelvic computerized tomography, that allowed for an accurate injection of the botulinum toxin into the deeply located muscle. Insufficient accuracy in determination of the injection site based on external reference points was shown.

Autoantibodies toward myelin basic protein (MBP) evidently emerge in sera and cerebrospinal fluid of the patients with multiple sclerosis (MS), as well as in a MS rodent model, i.e., experimental autoimmune encephalomyelitis (EAE). The studies of the last two decades have unveiled somewhat controversial data on the diagnostic applicability of anti-MBP autoantibodies as a disease’ marker. Here, we present the results of new functional analysis of the anti-MBP autoantibodies isolated from MS (in patients) and EAE (in mice) sera, based on their proteolytic activity against the targeted autoantigen. The activity was shown to be the intrinsic property of the IgG molecule. No activity was found in the sera-derived antibody fraction of healthy donors and control mice. Sera of 24 patients with clinically proven MS at different stages of the disease, and 20 healthy controls were screened for the anti-MBP antibody-mediated proteolytic activity. The activity correlated with the scores on the MS expanded disability status scale (EDSS) (r2=0.85, P<0.001). Thus, the anti-MBP autoantibody-mediated proteolysis may be regarded as an additional marker of the disease progression.

Catalytic autoantibodies (abzymes) are autoantibodies that are potentially ready to realize certain effects in the organism, first of all antibody-mediated catalysis and cytotoxicity. Natural abzymes with protolytic (protabzymes) and DNA-hydrolyzing DNA-abzymes) activity are of the greatest interest. The most impressive example of the catalytic activity of protabzymes is hydrolysis of specific proteins, revealed in patients with autoimmune diseases, such as bronchial asthma (vasoactive intestinal neuropeptide), autoimmune thyroiditis (thyroglobulin), multiple sclerosis (myelin basic protein), and autoimmune myocarditis (cardiomyosin). The pathogenic role of DNA-abzymes is not quite clear yet. However, it has been proven that they present a powerful regulator of apoptosis and other cytotoxicity mechanisms in systemic autoimmune diseases and tumors. The most promising is use of abzymes as illness activity markers, and as therapeutic agents capable of catalyzing specific proteins or activating antitumoral chemotherapeutic preparations.

The significance of catalytic autoantibodies abzymes in the pathogenesis of multiple sclerosis was evaluated in patients with different disease patterns and severity of disability.