Traumatic brain injury (TBI) is one of the leading causes of neurological morbidity, disability and mortality in all age groups of the population. As a result of the general increase in the number of cases of brain injuries, there is a significant increase in the consequences of TBI, the dominant part of which is asthenic, vegetative, cognitive, emotional and liquorodynamic disorders. Therapeutic measures in the long-term period of TBI should be carried out intensively as in the first 12 months. after TBI, and in the future, considering the ongoing processes of morphofunctional maturation of the CNS and high brain plasticity, especially in childhood. Syndromic treatment should be differentiated and pathogenetically substantiated. The article covers in detail the modern methods of drug therapy in patients with remote residual effects of brain injury. The high efficiency of the use of the neuroprotective drug Cortexin in the correction of the consequences of TBI was shown.

Objectives. To assess changes in the phospholipid composition of blood plasma in patients with chronic cerebrovascular disease using the neuroprotectors 2-ethyl-6-methyl-3-hydroxypyridine succinate (Neurox) and citocoline (Neipilept), which are natural metabolites and participants in metabolic processes in the body, alone and in combination. Materials and methods. A total of 40 patients (18 men, 22 women) aged 54–72 years took part in the study; patients had chronic cerebrovascular disease in exacerbation on the background of hypertensive crisis and/or impairments to cardiac rhythm. Results. Extraction of lipids from patients’ blood cells revealed significant reductions in the quantities of all (total) lipids after completion of treatment in patients receiving Neurox, Neipilept, and complex treatment using both agents. Studies of the quantitative composition of blood cell phospholipids showed that there were no significant changes in patients taking Neurox, while citicoline, alone and in combination with 2-ethyl-6-methyl-3-hydroxypyridine succinate, led to increases in total quantities. Assessment of the qualitative composition of classes of phospholipids in plasma showed no significant changes in patients taking Neurox, while those receiving Neipilept alone and with 2-ethyl-6-methyl-3-hydroxypyridine succinate showed significant increases in plasma phosphatidylcholine. There were no significant changes in phosphatidylinositol, phosphatidylserine, or sphingomyelin contents.

Objective: to assess changes in the vascular platelet component of hemostasis in patients in different recovery periods of ischemic stroke (IS).Patients and methods. The investigation enrolled 73 patients with prior IS. According to the remoteness of stroke, the patients were divided into two groups: 1) 41 patients with a stroke remoteness of 1 to 6 months (an early recovery period); 2) 32 patients with that of 7 to 12 months (a late recovery period). In addition, a group of patients with recurrent stroke was identified to evaluate the efficiency of secondary prevention. A control group consisted of 30 healthy volunteers. All the patients took acetylsalicylic acid (ASA). Medical history data and laboratory and instrumental findings were analyzed. To assess the vascular platelet component of hemostasis, platelet aggregation with inductors was studied applying optical aggregometry; enzyme immunoassay was used to estimate the concentrations of the inflammatory marker myeloperoxidase and the endothelial dysfunction (ED) markers sICAM-1 and sE-selectin.Results and discussion. The patients were found to have enhanced platelet aggregation with inductors; moreover, this was more pronounced in the patients with recurrent stroke than in those with new-onset IS. This suggests that the vascular platelet component of hemostasis contributes to the progression of the disease and its unfavorable course and necessitates the monitoring of these parameters to choose optimal secondary prevention methods, such as replacement of ASA with clopidogrel or use of its combination with dipyridamol. The activity of chronic immune inflammation processes and ED was ascertained to be enhanced, which can contribute to the aggravation of cerebrovascular insufficiency and to the development of acute cerebrovascular accident.Conclusion. In the recovery period of stroke, the follow-up monitoring of hemostatic parameters and immune inflammatory and ED markers is of importance in evaluating the efficiency of secondary prevention. For the successful prevention of recurrent strokes, it is necessary to prescribe adequate antiplatelet therapy, as well as drugs that have anti-inflammatory properties, affect intercellular interaction processes (ASA, clopidogrel, and statins), and suppress oxidative stress associated with endothelial inflammation (alpha-lipoic acid and succinic acid preparations).

AIMTo assess the changes in the composition of plasma phospholipids in patients with chronic cerebrovascular disease treated with neuroprotectors 2-ethyl-6-methyl-3-hydroxypyridine succinate (neurox) and citicoline (neipilept), the natural metabolites involved in biochemical processes in the body, and their composition.MATERIAL AND METHODSThe study included 40 patients, 18 men and 22 women, aged from 54 to 72 years, with chronic cerebrovascular disease at the decompensation stage complicated with the hypertensive crisis and/or arrhythmia.RESULTS AND CONCLUSIONDuring extraction of phospholipids from blood cells, a significant decrease in the amount of total lipids was found to the end of treatment of patients who received neurox or neipilept or their combination. The study of quantitative composition of phospholipids showed no significant changes in patients treated with neurox, while the use of citicoline or combination of citicoline with 2-ethyl-6-methyl-3-hydroxypyridine succinate resulted in the increase of their total mass. There were no significant changes in the qualitative composition of phospholipid classes in blood plasma in patients treated with neurox. In patients treated with neipilept or with the combination of citicoline with 2-ethyl-6-methyl-3-hydroxypyridine succinate, plasma phosphatidylcholine was significantly increased. No significant changes in the content of phosphatidylinositol, phosphatidylserine and sphingomyelin were observed.

Developing brain ischemia due to cerebral vascularization leads to disruption of brain metabolism. Chronic cerebral hypoperfusion leads to irreversible brain damage and plays an important role in the development of some types of dementia. Early use of antioxidants such as ethyl ether apovincamine acid (vinpocetine) and 2-ethyl-6-methyl-3-hydroxypyridine-succinate in the treatment of this pathology is seen as a real pathogenetically based method of correction of cerebral metabolism with cerebral vascular disorders, demonstrating the increase in cerebral blood flow and also neuroprotective effects. Clinical studies and studies on biological models show that the main mechanisms of action of vinpocetine and 2-ethyl-6-methyl-3-hydroxypyridine-succinate, although have a similar focus, but implementing neuroprotective and nootropic effects via various links in the pathogenesis of ischemic brain damage.

AIM:To study the antioxidant status of patients with chronic cerebral ischemia (CCI) during the individual treatment with 2-ethyl-6-methyl-3-hydroxypyridine-succinate (neurox) and in the combination with citicoline (neipilept).MATERIAL AND METHODS:A study included 40 patients, 18 men and 22 women, aged from 54 to 72 years, with CCI, stage 2, at the decompensation stage complicated with the hypertensive crisis and/or arrhythmia.RESULTS AND CONCLUSION:A significant increase in the serum superoxide dismutase activity after the complex therapy with neurox and neipilept was demonstrated compared to patients treated with neurox. A study of reduced sulfur-hydroxy groups in patients treated with 2-ethyl-6-methyl-3-hydroxypyridine-succinate and patients treated with the combination of 2-ethyl-6-methyl-3-hydroxypyridine-succinate and citicoline, revealed a significant increase in the number of reduced SH- groups after the treatment with neurox compared to the combined use of neurox and neipilept.

High level of glucose in the blood in hypoxic-ischemic states is one of the main factors that complicates the degree of brain damage. An increased level of reactive oxygen species and impaired functioning of the endogenous antioxidant system are the consequences of the hyperglycemic-ischemic condition. Medical treatment is necessary to compensate for the development of cerebrovascular disorders in ischemia comorbid to diabetes mellitus. The use of antioxidants (2-ethyl-6-methyl-3-hydroxypyridine succinate) is the most therapeutically effective.

The disturbances of cerebral circulation results in the violation of phospholipid metabolism. Activation of lipid peroxidation and protein kinase C and release of intracellular calcium leads to disruption of the homeostasis of phosphatidylcholine. The use of cytidine-5-diphosphocholine, which is used as an intermediate compound in the biosynthesis of phospholipids of the cell membrane, helps to stabilize cell membranes, and reduce the formation of free radicals.

Standard use of certain biomarkers with potential diagnostic and prognostic capabilities could significantly improve the therapeutic outcome in patients with vascular diseases of the brain. In the literature there are sufficient data on the role of NR2 peptide and the enzyme myeloperoxidase (MPO) in the development of neuronal injury. It remains unclear whether these biomarkers be factors that reflect current and progression of cerebral ischemia Methods: The study included 85 patients with varying degrees of vascular dementia (mild, moderate, severe). Number of MPO (Human MPO BMS2038INCT) and protein NR2ab (BIOTECH, INC, Cat№: GDI-001) was determined by ELISA. Results: The analysis showed that severity of vascular dementia is not in direct link with concentration of NR2 protein in blood, thus concentration of MPO characterizes process progressing. And size χ2 has the maximum value in "extreme" points: in control group and in group of the expressed vascular dementia. Lack of direct link between quantity of NR2 and weight of a state suggests an idea of a possible inaccuracy of a hypothesis of the autoimmune cascade at brain ischemia. It is known that neutrophils besides production of active forms of oxygen, possess phagocytic function. Perhaps, at violation of a blood-brain barrier the fragments of NMDA of a receptor which got to blood are removed the phagocytosis? Indirectly it is confirmed by high value χ2 in the heaviest stage of a disease. Lack of reliable distinctions of concentration of MPO in groups of patients with easy and moderate degree of vascular dementia testifies in favor of an important role of a chronic inflammation in progressing of ischemia of a brain and possibility of use of MPO as potential predictive biomarker.

A total of 360 patients with different stage of chronic cerebral ischemia (CCI) were studied. Of these, 180 patients, observed for 12 months from initial assessment, were divided into two groups depending on the course of illness – favorable (stable) and unfavorable (progressive or with acute episodes of impaired cerebral circulation). Markers of oxidative stress were assessed in terms of the level of lipid (malondialdehyde) and protein (carbonyl protein oxidation products, plasma SH groups levels, and accumulation of advanced oxidation protein products (AOPP) in plasma. Along with measures of oxidative stress, the binding capacity of albumin was also determined, using the fluorescent probe K-35. Initial values for these markers were measured, along with concentrations after copper ion-induced oxidation of plasma. The greatest increases in measures of oxidative stress were seen in patients with acute episodes of circulatory failure. Significant differences were found in measures of oxidative stress in groups of patients with different clinical variants of the course of CCI and qualitative and quantitative diagnostic criteria suggesting an unfavorable course of illness and the risk of developing stroke were established. The ability to diagnose a prognostically unfavorable course of illness allows appropriate treatment to be started in a timely fashion.

Authors studied 360 patients with different stages of chronic cerebral ischemia (CBI), including 180 patients followed-up for 12 months after the first examination, who were stratified into two groups with regard to disease course - favorable (stable) and unfavorable (progressive or with acute episodes of cerebral blood circulation disturbance). Oxidative stress markers were evaluated by the level of lipid- (malonic dialdehyde) and protein - (carbon products of protein oxidation, the level of plasma SH-groups, the accumulation of the products of deep oxidation of proteins) oxidation. Along with indicators of oxidative stress, we evaluated the binding capacity of albumin using fluorescent probe K-35. Initial level of these markers and their concentrations after the copper ion induced oxidation of the plasma were determined. The highest increase in oxidative stress indicators was seen in patients with acute episodes. Authors identified significant differences in these indicators in the groups of patients with different clinical variants of CBI course as well as qualitative and quantitative diagnostic criteria of unfavorable course and risk of stroke. Our findings suggest that the imbalance of oxidative-antioxidative system contributes to the course of CBI. Prediction of unfavorable course of CBI determines the timeliness of adequate treatment.

Data of literature on the role of inflammation factors in the pathogenesis of stroke are presented. The study of myeloperoxidase level in the early acute phase of ischemic stroke and dynamics of this parameter after the antioxidant treatment with the α-lipoic acid preparation berlition was carried out. It has been shown that the activation of systemic inflammation and related oxidative stress recorded in the early acute phase of brain infarction needs pharmacological treatment. Neuroprotective action of α-lipoic acid related to the prevention of damaging effect of free radicals on cell membranes and reduction of oxidative stress intensity is a pathogenetic explanation for using its preparations in ischemic brain lesions. The decrease in plasma myeloperoxidase content after the treatment with berlition may consider as a criterion of its efficacy.

An article highlights the pathogenetic aspects of treatment of reflex pain syndromes in the degenerative-dystrophic spinal lesions. Attention is focused on a rational combination of medications that may shorten the duration of analgesic and anti-inflammatory therapy to prevent the development of side-effects caused by non-steroid anti-inflammatory medications. The results of own research of analgesic efficacy and tolerability of treatment in 50 patients with chronic skeletal-muscle pain syndromes in the state of exacerbation assigned to the combination of a non-steroid anti-inflammatory medication mesipol (meloxicam) with a central myorelaxant baclosan (baclofen) are discussed. It was found the positive effect of therapy not only on pain syndrome but on comorbid symptoms as well.

We examined lipid peroxidation (LPO) in 130 patients with chronic brain ischemia (CBI). Primary and secondary LPO products, oxidative and antioxidative enzymes were studied in the course of therapy with antioxidant drug cytoflavin and intravenous laser radiation of blood (ILRB). The latter proved to have a normalizing action on LPO and antioxidant defense. With progression of CBI, effects of ILRB on enzymatic activity weakens due to depletion of endogenic antioxidants. This necessitates administration of exogenic antioxidants (cytoflavin) for complex correction of free radical processes. This conclusion allows recommending combined schemes of therapy for patients with CBI stage II and III.

The results of clinical trial of new elaborated by us diagnostics of multiple sclerosis on the basis of analysis of the influence of blood serum on electrical activity of neocortical surviving slices on the background of treatment with low intensive intravenous laser therapy. For comparison, the same patient was subjected to traditional neurological diagnostics on Kurtzke scale (EDSS). Both the diagnostic methods gave similar results showing that the new electrophysiological diagnostics adequately reflects the disease phase and functional state of a multiple sclerosis patient. The present investigation supported successfulness of the low intensive intravenous laser therapy again.

Free amino acids were studied in the blood plasma of 37 patients with multiple sclerosis with different variants of its course. Hypoaminoacidemia and disaminoacidemia in all the patients justified the conduction of the corrective treatment with the Soviet drug polyamine manufactured from balanced crystalline amino acids. The results of treatment of 21 patients with multiple sclerosis are presented. Normalization of the metabolism of free amino acids correlated with the clinical improvement of the patients's status.