Vol 50, No 5 (2022)

Cover Page

Full Issue


The role of the fibrinolytic system laboratory markers in the assessment of the cerebral small vessel disease severity

Khutorov D.N., Startseva O.N., Tikhomirova O.V., Zybina N.N.


Background: Small vessel disease (SVD) is a common brain disease causing about 40% of all dementias and about 25% of ischemic strokes, which makes important the study of its pathophysiology and the search for its biomarkers. A number of studies have shown a significant role of endothelial dysfunction and nonspecific inflammation, as well as of some individual parameters of hemostasis disorders in the development of SVD.

Aim: To identify the role of the laboratory markers of fibrinolytic system in the assessment of the severity of white matter lesions in patients with SVD.

Materials and methods: This single center cross-sectional non-controlled observational study included 117 patients with dyscirculatory encephalopathy (chronic brain ischemia), with a mean (± SD) age of 57.7 ± 11.5 years. Laboratory tests of the fibrinolytic system, endothelial dysfunction, markers of inflammation and for an integral assessment of plasma hemostasis were performed in all patients, including XIIa-dependent fibrinolysis, levels of plasminogen, alpha2-antiplasmin, plasminogen activator inhibitor 1 (PAI-1), fibrinogen, von Willebrand factor (vWF) and activity of blood coagulation factor VIII (FVIII), highly sensitive C-reactive protein and parameters of the thrombodynamics assay. In all the patients, brain magnetic resonance imaging was performed with the assessment of the white matter lesions by the Fazecas scale.

Results: Depending on the identified neuroimaging SVD markers (assessed with the Fazecas scale), the patients were divided into the SVD group (n = 54) and no-SVD group (n = 63). Those with SVD were older than those without (65 ± 9 vs 51 ± 10 years; p < 0.001), had higher prevalence of arterial hypertension (p < 0.001), diabetes mellitus (p = 0.029) and past thrombotic events (p < 0.001). The SVD patients, compared to those without SVD, had a higher time of XIIa-dependent fibrinolysis (7.6 ± 2.9 vs 6.5 ± 1.7 min, p = 0.032), higher alpha2-antiplasmin levels (111 [95–117] vs 105 [95–111]%, p = 0.016) and higher clot density (D) (22789 [20567–26411] vs 20627 [18324–22650] U, p < 0.001), although the parameters were within the reference ranges. As far as the thrombodynamics is concerned, the SVD group had higher values for all test parameters, as well as higher levels of the inflammation and endothelial dysfunction markers. Increased time of XIIa-dependent fibrinolysis was associated with higher probability of periventricular and subcortical leukoareosis grade ≥ 2 by the Fazecas scale (odds ratio 1.31 [1.07–1.60], p = 0.009), including an increase in the size and number of gliosis areas. Higher plasminogen levels were associated with a lower probability of leukoareosis by the Fazecas scale (odds ratio 0.97 [0.95–0.98], p < 0.001).

Conclusion: The severity of fibrinolytic and hemostatic abnormalities correlates with the severity of brain SVD, thus forming the hypofibrinolytic and prothrombotic status of the patients with this disorder.

Almanac of Clinical Medicine. 2022;50(5):287-294
pages 287-294 views

Regulators of angiogenesis in chemotherapy-induced peripheral neuropathy

Bazarnyi V.V., Kovtun O.P., Koryakina O.V., Kopenkin M.A., Fechina L.G.


Background: Chemotherapy-induced peripheral polyneuropathy is a major neurotoxicity of treatment for acute lymphoblastic leukemia (ALL) in children. Pathophysiological mechanisms of the injury of peripheral neural system are not fully investigated; however, some studies have shown the involvement of vascular endothelial growth factors.

Aim: To evaluate plasma levels of angiogenic growth factors in children with ALL and to identify their association with the development of vincristine-induced peripheral polyneuropathy.

Materials and methods: This single center prospective study included 41 patients with ALL aged 3 to 17 years. All patients were given the ALL-MB 2015 chemotherapy regimen. Depending on the vincristine-induced peripheral polyneuropathy, the patients were divided into two groups: the main group (n = 22) comprised of the patients with neurological signs and symptoms of peripheral neuropathy and the control group (n = 19), those without clinical signs of the peripheral nervous system involvement. The levels of angiogenic growth factors (VEGF-A, VEGF-D, PlGF-1, and PDGF-BB) were measured in plasma by multiparameter immunofluorescent analysis.

Results: During 3 months of the follow up the chemotherapy-induced signs of peripheral polyneuropathy developed in 53.6% (n = 22) of the children. In 72.7% (n = 16) of the patients the chemotherapy-induced peripheral polyneuropathy was characterized by a combination of neurologic abnormalities with prevailing motor symptoms. The comparative analysis of plasma angiogenic growth factors in children with ALL depending on the presence or absence of the vincristine-induced peripheral polyneuropathy showed that there was a significant decrease of the VEGF-A in those with chemotherapy-induced peripheral polyneuropathy, compared to those without (Me [Q1; Q3]: 178.20 [138.40; 228.45] and 558.50 [160.10; 650.0], respectively, p < 0.017). This parameter had diagnostic sensitivity of 77.7% and specificity of 76.9%.

Conclusion: We have shown a high clinical value of plasma vascular endothelial growth factor (VEGF-A) level, which makes it possible to consider it as a significant biological marker of neurotoxicity in vincristine-induced peripheral polyneuropathy.

Almanac of Clinical Medicine. 2022;50(5):295-303
pages 295-303 views

Time-dependent transformations of the internal image of disorder in patients with chronic back pain

Kotelnikova A.V., Kukshina A.A., Tikhonova A.S., Khaustova A.V.


Rationale: Pain is the most prevalent symptom of any disease, with back pain comprising 12 to 33%. Chronic back pain ranges fourth among the causes of disability. About 60% of patients with chronic pain have symptoms of depression. However, there is paucity of empirical data on psychological aspects of the pain syndrome chronization in patients with back pain.

Aim: To study the temporary transformation of the internal image of disorder in patients with chronic back pain.

Materials and methods: In this observational cohort analytical study, we evaluated the contribution of pain duration into the formation of the internal image of disorder in 84 patients with chronic pain lasting for up to 55 years and caused by dorsopathy. The patients (53 women and 31 men aged 23 to 86 years, with pain intensity of up to moderate degree) were those admitted to an in-patient department for the secondary medical rehabilitation. The internal image of disorder was operationalized with the following psychometric scales: McGill Pain Questionnaire, the Restoration of the Locus of Control Scale, the Tampa Scale of Kinesiophobia, and the Psychological Factors of Attitudes to the Disease and its Treatment Scale.

Results: The sensory level of the internal image of disorder was characterized by mixed (neuropathic and dysfunctional) pain in 29 (34.5%) of the cases and nociceptive pain in 55 (65.5%) of the cases. In the patients with nociceptive pain, the duration of pain was negatively correlated with their perception of self-efficacy towards the disease (the intellectual level of the internal image of disorder). With time, their self-confidence and the ability to get rid of pain was decreasing (R = -0.32, p = 0.02). The decrease looked like waning fluctuations with a maximum decline rate in the second year of the disease.

Conclusion: During the first year from the disease manifestation, patients with nociceptive pain are convinced that they have all necessary resources to cope with the disease; mandatory psychological support should be provided to them in the second year, with a dramatic drop of their self-efficacy. As for patients with mixed types of pain, the inclusion of sessions with a medical psychologist into their individual rehabilitation plan is advisable regardless of the duration of the pain syndrome.

Almanac of Clinical Medicine. 2022;50(5):304-309
pages 304-309 views


Clinical polymorphism of multiple system atrophy: a clinical case series

Andreev M.N., Fedotova E.Y., Konovalov R.N., Illarioshkin S.N.


Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by autonomous insufficiency and motor abnormalities, such as akinetic rigid syndrome and cerebellar ataxia. The diagnosis of this disorder is challenging, and quite frequently the patients are seen by other specialties or with other diagnoses. The paper presents three clinical observations of patients with various phenotypic MSA subtypes. In two of them, the diagnosis of MSA was clinically proven and in the third one, clinically probable. All patients were initially followed up with other diagnoses. The authors describe specifics of complaints and past history registration, neurological examination and typical signs of MSA at neuroimaging.

Almanac of Clinical Medicine. 2022;50(5):310-314
pages 310-314 views

Spinal cord stimulation for freezing of gait in Parkinson's disease and progressive supranuclear palsy: a case series

Kovalev V.V., Bril E.V., Semenov M.S., Seliverstov Y.A., Lepsveridze L.T.


Background: Freezing of gait (FOG) in Parkinson's disease (PD) and progressive supranuclear palsy (PSP) exert a significant adverse impact on the patients’ quality of life, the degree of their disability, and the risk of falls. A specific characteristic of FOG is a poor response to medical treatment. According to the data of open-label clinical trials and clinical case series published in the last decade, spinal cord stimulation (SCS) can be considered as one of the methods to improve this type of movement disorders.

Materials and methods: We present a clinical series of patients with PD and PSP, who underwent implantation of a chronic epidural SCS system at the mid-thoracic level to correct FOG. The efficacy of surgical treatment was assessed at 2 and 5 months with the following scales and questionnaires: part III Unified Parkinson's Disease Rating Scale of Movement Disorder Society (MDS-UPDRS), Freezing of Gait Questionnaire (FOG-Q), Activity-Specific Balance Confidence Scale (ABC), Parkinson's Disease Quality of Life Questionnaire-8 (PDQ-8), Time up and Go Test (TUG), 10 Meter Walk Test. The patients were asked to report possible adverse reactions after the procedure.

Results: The results of a 5-month follow-up were obtained from 4 patients (2 with PD and 2 with PSP). There were no adverse events associated with SCS. Оnly one patient with PD experienced a decrease in the severity of motor symptoms according to the MDS-UPDRS part III scale. An increase in the speed of 10 meters' walking distance and TUG test performance was observed in 3 patients. All patients reported an improvement in the quality of life (according to the PDQ-8 questionnaire) and confidence in maintaining balance (according to the ABC questionnaire) by month 2 after surgery. However, at month 5, a negative trend was noted again.

Conclusion: The SCS method was safe in all 4 clinical cases described. There was a positive effect of SCS on the improvement of FOG and postural balance in PD and PSP. However, the duration of the therapeutic effect may vary.

Almanac of Clinical Medicine. 2022;50(5):315-320
pages 315-320 views


Сognitive rehabilitation methods in multiple sclerosis patients

Moskvina E.Y., Volkova L.I., Koryakina O.V.


The prevalence of cognitive impairment in patients with multiple sclerosis is 40 to 65%. Improvement of cognitive-oriented therapy and search for its new techniques is considered to be promising for slowing the progression or for recovery of cognitive functions. It is related to low efficacy of medical treatment, preserved neuroplasticity in most patients with multiple sclerosis, positive results of studies on selected cognitive rehabilitation techniques in other nervous system disorders. The spectrum of techniques for cognitive training varies from technically feasible methods using a sheet of paper and a pen to the most advanced ones, such as the use of immersive virtual reality. The effectiveness of cognitive rehabilitation in patients with multiple sclerosis with virtual reality technologies has not been studied in large-scale randomized placebo-controlled studies.

Almanac of Clinical Medicine. 2022;50(5):321-328
pages 321-328 views


The Unverricht-Lundborg disease as a part of the progressive myoclonic epilepsies syndrome

Belousova E.D.


The progressive myoclonic epilepsies syndrome (PME) is a heterogeneous group of genetic disorders characterized by myoclonus, progressive motor and cognitive abnormalities, sensory and cerebellar symptoms, abnormal slowing of the basic bioelectrical activity at electroencephalography, and normal cognitive functions and normal development of the patient before manifestation of the disease. Generalized spike-wave complexes at electroencephalography have been also described as an obligatory symptom. The Unverricht-Lundborg disease is a distinct entity within the group with specific age at manifestation (7 to 13 years), as well as slow cognitive and motor decline with stabilization in the adult age. In 90% of the cases, the diagnosis is confirmed by identification of the expanded nucleotide duplicates in the CSTB gene. An adequately tailored anticonvulsant treatment can stabilize and improve the patient's condition. The anticonvulsant therapy should not include sodium channel blockers. Valproate sodium is considered to be the main agent; it is usually combined with levetiracetam/zonisamide/topiramate/benzodiazepins. In the recent years, perampanel has been also used as a part of the combination treatment.

Almanac of Clinical Medicine. 2022;50(5):329-334
pages 329-334 views

The Romberg's sign: from walking in the dark to tests on the force plate

Mezenchuk A.I., Kubryak O.V.


A quantitative assessment of stability (body balance, equilibrium) and sensory support of the upright position, with identification of the "contributions" from various sensory systems, is the basis for the force plate tests similar to the Romberg's test. The purpose of this paper is to describe the Romberg's test evolution from its introduction to objective quantitative force plate tests (stabilometry) in the context of studies into the sensory support of the upright position in humans. The use of force plates for quantitative characterization of the body balance in the upright position with changing sensory conditions has added a higher sensitivity and accuracy to this assessment, providing for a more precise differentiation of various conditions. The tests originating from the Romberg's one but performed on a force plate can be considered as a quantitative investigation into the functioning of the sensory systems participating in the support of the upright position, as well as a tool for the assessment of their isolated contributions and central integration. The value of such tests for clinical medicine is related to a higher level of verification of the body balance abnormalities in various disorders, with an improvement of diagnosis and potential for differential diagnosis. With these assessments being non-invasive, it is feasible to use them for evaluation of changes of the upright equilibrium over time under treatment and rehabilitation procedures in neurology, traumatology and orthopedics, otolaryngology, sports medicine and other areas.

Almanac of Clinical Medicine. 2022;50(5):335-347
pages 335-347 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies