Purpose: To explore functional connectivity in patients with asymptomatic internal carotid arteries stenosis of more than 60% when using hirudotherapy. Materials and methods: The analysis of the results of the examination of 15 patients aged 60 to 82 years with asymptomatic stenosis of the carotid arteries in the range of 60‒75 % was carried out. The patients underwent a course of hirudotherapy, consisting of 10 sessions. All patients underwent structural and functional magnetic resonance imaging with analysis of statistical data at rest, complaints and neurological status were assessed ‒ before and after the course of hirudotherapy. Results: When using a course of hirudotherapy in patients with asymptomatic internal carotid arteries tenosis, when analyzing the neurological status and complaints, a significant improvement in well-being was noted. During functional magnetic resonance imaging, differences in functional connectivity between the medial prefrontal cortex and other areas of the brain were determined. Activation was noted in the main structures of the network of managerial control and identification of significance. Connectivity between the leading regions of the brain increased, which is a sign of improved brain activity. Conclusion: Connectivity research can be used to study the functioning of brain networks and to determine the effectiveness of therapy. The course of hirudotherapy significantly changed the functional connectivity of the brain regions, the changes correlated with a decrease in the number of complaints. This work is a pilot and will be continued for the further development of treatment-and-prophylactic strategies with the inclusion of hirudotherapy in patients with a high risk of vascular accidents in a treatment.

The aim of the study was to investigate the condition of the connectome in patients with asymptomatic carotid atherosclerotic stenosis of more than 60% when using hirudotherapy. Materials and research methods. The examination results of 15 patients aged 60 to 82 years with asymptomatic carotid atherosclerotic stenosis in the range of 60-75% were analyzed. The patients underwent a course of hirudotherapy of 10 sessions. All patients underwent structural and functional magnetic resonance imaging with statistical data analysis at rest, complaints and neurological status were evaluated before and after hirudotherapy course. Results of the study and their analysis. Within the course of hirudotherapy in patients with asymptomatic carotid atherosclerotic stenosis when analyzing the neurological status and complaints, a significant improvement of well-being was noted. Functional magnetic resonance imaging identified differences in functional connectivity between medial prefrontal cortex and other brain regions. There was activation in the main structures of the network of controlling and revealing significance. The connectivity between the leading areas of the brain increased, which is a sign of the improvement of the brain activity. Conclusion. The study of connectivity can serve for exploring the work of brain networks and for determining the effectiveness of therapy. A course of hirudotherapy significantly changed the functional connectivity of brain areas, the changes correlated with a decrease in the number of complaints. Such work is a pilot and will be continued in order to further develop treatment and prevention strategies with the inclusion of hirudotherapy in patients with high risk of vascular accidents in sanatorium-resort treatment.

УДК 616-073.8ДИАГНОСТИКА НЕЙРОДЕГЕНЕРАЦИИ ПРИ ПРОГРЕССИРУЮЩИХ ТИПАХ РАССЕЯННОГО СКЛЕРОЗА С ИСПОЛЬЗОВАНИЕМ БИОМАРКЕРОВ НА ОСНОВЕ МОРФОМЕТРИЧЕСКИХ ПАРАМЕТРОВ ГОЛОВНОГО МОЗГА И МОЗЖЕЧКА Анпилогова К.С. 1 , Горбунова Е

МАГНИТНО-РЕЗОНАНСНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ УЗЛОВОГО УПЛОТНЕНИЯ ПРОМЕЖНОСТИ У ПРОФЕССИОНАЛЬНЫХ ВЕЛОСИПЕДИСТОВШтенцель Р.Э. 1 , Мащенко И.А. 1 , Кузьмин А

Aims: clinical and neuroimaging comparison of the dynamics of alterations in the functional connectivity against the background of osteopathy in patients who suffered from chronic tension-type headaches. We examined 24 patients with chronic tension headaches in accordance with ICGB-3 (2018), aged 24 to 43 years. Patients underwent functional MRI at rest before, immediately after osteopathic manipulation and after a course of osteopathic correction (3-5 sessions of craniosacral therapy, lasting 2.5 months). Complaints were evaluated and patients were surveyed to assess the intensity of headache and its impact on different areas of life, quality of osteopathic correction in patients with chronic tension headaches provides potentially new approaches to the diagnosis and therapy of chronic pain syndrome. Changes in the FC of the passive mode network and the brain significance network in patients with chronic headaches after osteopathy were found to correlate with a positive clinical picture.

УДК 616-073.8ФУНКЦИОНАЛЬНАЯ И ДИФФУЗИОННО-ТЕНЗОРНАЯ МРТ В ОЦЕНКЕ ИЗМЕНЕНИЙ КОННЕКТОМА ГОЛОВНОГО МОЗГА У ДЕТЕЙ СО СПАСТИЧЕСКОЙ ДИПЛЕГИЕЙ ПОСЛЕ ТРАНСЛИНГВАЛЬНОЙ НЕЙРОСТИМУЛЯЦИИ Чегина Д.С. 1 , Анпилогова К.С. 1 , Ефимцев А

1Национальный медицинский исследовательский центр им. В.А. Алмазова, Санкт-Петербург, e-mail: anna20.04.1994@yandex.ru; 2Научно-исследовательский институт акушерства, гинекологии и репродуктологии им. Д.О. Отта, СанктПетербург Исследование механизмов нейропластичности и выявление изменения коннектома у пациентов с головными болями напряжения актуальны для изучения этиопатогенеза данного вида болей, диагностики развития когнитивных и психоневрологических нарушений, оценки эффективности лечения. На данный момент для лечения головных болей напряжения используют медикаментозные и немедикаментозные методы. Не изучены эффекты остеопатической манипуляции (краниосакральной терапии) при головных болях напряжения с точки зрения парадигмы болевого коннектома. Целью работы являлось изучение изменений коннектома у пациентов с головными болями напряжения при проведении остеопатической манипуляции. Обследованы 24 женщины (в возрасте от 24 до 43 лет, средний возраст 33±0,5 года) с головными болями напряжения. Пациентам проводилась остеопатическая манипуляция и в дальнейшем назначался курс лечения с применением остеопатической коррекции, состоящий из 3–5 сеансов краниосакральной терапии по индивидуальным показаниям. Одним из методов нейровизуализации, который применяется для оценки функционирования головного мозга, является функциональная МРТ. До начала остеопатической манипуляции оценивались жалобы, проводилось анкетирование пациентов. Всем больным была выполнена фМРТ покоя до первой остеопатической манипуляции и сразу после ее проведения. При применении однократной остеопатической коррекции у пациентов с головными болями напряжения были выявлены изменения функциональных связей медиальной префронтальной коры с другими зонами головного мозга. Изучение функциональных связей определяет потенциально новые подходы для исследования интегративного функционирования головного мозга в норме и при головных болях напряжения, для изучения звеньев патогенеза этой патологии. Остеопатическая манипуляция меняла функциональные связи в головном мозге пациентов с головными болями напряжения, т.е. влияла на состояние болевого коннектома. Ключевые слова: головная боль напряжения, остеопатия, функциональная МРТ, коннектом, функциональные связи.

УДК 616.8-009ФУНКЦИОНАЛЬНАЯ РЕОРГАНИЗАЦИЯ НЕЙРОННЫХ СЕТЕЙ ГОЛОВНОГО МОЗГА У ПАЦИЕНТОК С ПОСТМАСТЭКТОМИЧЕСКИМ СИНДРОМОМ Буккиева Т.А. 1 , Поспелова М.Л. 1 , Ефимцев А.Ю. 1 , Фионик О.В. 1 , Алексеева Т.М. 1 , Труфанов Г.Е. 1 , Самочерных К.А. 1 , Иванова Н.Е. 1 , Красникова В.В. 1 , Горбунова Е.А. 1 , Левчук А

ПОСТГИПОКСИЧЕСКАЯ ЭНЦЕФАЛОПАТИЯ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ АОРТОКОРОНАРНОЕ ШУНТИРОВАНИЕ: КЛИНИКО-НЕЙРОПСИХОЛОГИЧЕСКОЕ ОБСЛЕДОВАНИЕ, КОННЕКТОМ И ВОЗМОЖНОСТИ НЕЙРОПРОТЕКЦИИПортик О

Objective. To identify predictive factors of favourable outcomes in children with drug resistant epilepsy (DRE) associated with structural brain changes, who received surgical treatment. Methods. We performed a retrospective analysis of surgical treatment in 239 children with drug resistant epilepsy treated at the Pediatric Neurosurgery Department of the A. L. Polenov Russian Neurosurgical Institute from 2004 to 2014. The age of the patients varied between 2 and 18 years. The follow-up time ranged from 1 year to 10 years (on average 4.3 years). Results. According to magnetic resonance imaging (MRI), 223 (93.3%) patients had different structural brain changes. Among the patients, 47 (21.1%) had cerebral cicatrix, gliosis, cysts and atrophic changes, 33 (14.8%) had malformations of the cortical development, 43 (19.3%) had benign brain tumors, 47 (21.1%) had vascular malformations, 21 (9.4%) had arachnoid cysts, 12 (5.4%) had hippocampal sclerosis, 11 (4.9%) had phacomatosis, 5 (2.2%) had Rasmussen’s encephalitis, and 4 (1.8%) had hypothalamic hamartoma. Positron emission tomography revealed the areas of gray matter hypometabolism in the brain, which correspond to the areas of a metabolic deficiency around the epileptic focus. Favorable long-term outcomes of epilepsy surgery (class I according to Engel scale) were registered in 67.6% of the cases. The most favorable results (class I according to Engel scale) were achieved after lesionectomy (81.9%), temporal resections (78.4%), and hemispherectomy (72.7%).Conclusions. The most important predictive factors of favorable outcomes after epilepsy surgery are as follows: detection of epileptogenic morphological changes of the brain, completeness of resection of an epileptic and epileptogenic areas, and absense of seizures in the early postoperative period.