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Cerebrovascular diseases (CVP) are an “archive” medical and social problem of modern medicine, as they give the highest indicators for incidence, mortality and disability in almost all countries of the world, which is associated with the aging of the planet and an increase in the number of risk factors. So, for example, on average about 460–560 thousand strokes are recorded annually in Russia, of which up to 200 thousand end in death, and of the surviving patients, at least 80% remain disabled, despite the rapid development of diagnostic and therapeutic medical technologies, hundreds of publications and dissertations about the effective treatment of this pathology.

The problem of cognitive deficiency affects almost every person on the planet, huge socio-economic, ethical and moral losses that society carries are associated with it. In the world, according to WHO, about 47 million people suffering from dementia live. The annual number of new cases of the disease is almost 10 million. The most complex functions of the brain should be understood by the cognitive functions by which the process of rational cognition of the world is carried out. It is the cognitive status that determines the success of a person in society in the profession, in the family. A decrease in cognitive functions is always perceived painfully and significantly worsens the quality of human life.

To date, there are two complementary directions in the management of patients with ischemic stroke: the maximum early blood flow restoration (reperfusion) and the protection of brain tissue from ischemic lesion (neuroprotection). The main goal of neuroprotection is to intervene in the events of the ischemic cascade, block the links of the pathological process, prevent the death of nerve cells in the ischemic partial shade zone and expand the “therapeutic window” for reperfusion therapy. The use of drugs with neurotrophic, antioxidant and neuroregenerative effects is pathogenetically substantiated at all stages of rehabilitation treatment after a stroke. Ethylmethylhydroxypyridine is succinate (Mexidol) is a derivative of amber acid. The drug has antihypoxic, membrane, nootropic, anticonvulsant, anxiolytic effects. When studying the neuroprotective drug, Mexidol in patients with strokes, the absolute majority of researchers, a positive effect was noted in the form of a pronounced regression of neurological deficiency, wider possibilities for subsequent early rehabilitation. In 2017, the results of a multicenter prospective double blind placebo-controlled study of the effectiveness and safety of Mexidol with prolonged consistent therapy in patients in the acute and early restoration periods of the hem-step-mesh stroke (Epica) were published. The results of the study demonstrated the best positive dynamics of the restoration of impaired neurological functions in the early prescription of Mexidol and the continuation of therapy up to 2 months. During the study, the safety of prolonged use of Mexidol was proved.

Keywords: stroke, acute period, neuroprotection, succinate, therapy efficiency, therapy safety.

The existing methods of pharmacotherapy in the recovery period of a stroke used to correct motor, affective and cognitive disorders were carried out. Data on the conditions for the use and effectiveness of botulinum toxin, oral muscle relaxants, selective reversal inhibitors of serotonin, acetylcholinestin inhibitors and a glutamatergic transmission in post -stroke neurorebilitation, recommendations for their rational and safe use are given.
The clinical effectiveness of Mexidol, which has a multimodal effect on a wide range of post -stroke disorders, especially with prolonged consistent therapy, was discussed The integrated use of post -industry rehabilitation agents with the determination of individual tactics on the basis of the clinical picture of the patient and the established rehabilitation goals has been recommended. To solve problems associated with improving motor, cognitive and affective functions, as well as self -care and quality of life, the inclusion of Mexidol in the complex therapy of patients with the consequences of a stroke looks promising. A continuation of high -quality clinical studies is required to assess the effectiveness of pharmacological agents regarding post -industry disorders.

Key words: stroke, hemiparesis, spasticity, depression, dementia, neurorebilitation, pharmacotherapy.

Authors:

AI Fedin

Translated from Zhurnal Nevrologi I Psikhiatrii Imeni SS Korsakova, Vol. 124, no. 10, pp. 35–40, October,
2024. Original Article Submitted September 9, 2024. Accepted September 16, 2024.

Place of publication:
Neuroscience and Behavioral Physiology, Vol. 55, no. 3, march, 2025

Summary: This Report Presents New Data on the Development of Oxidate Stress (OS) In Chronic Headache (HA). The Main Biochemical Characteristics of OS Are Pressented. Changes in Mri Spectroscopy and Biochemical
Marcers Confi Rmsing the Development of OS in Migraine Ar Described. The Absence of Signifi Cant Differences in Measures of OS in Migraine with and Without Aura Is Emphasized. Pathophysiological Differences Between Migraine and Chronic Tension Headache, In Which OS is not Detected, Are Demonstrate. Possible Activation of Trpa1 Ion Channels and Calcitonin Gene-Reled Peptide in OS, Which Provokes Migraine Attacks, IS Discussed. Directions for Drug Correction of OS in Chronic Headache Are Consedered.

Place of publication: a journal of neurology and psychiatry named after S.S. Korsakova / vol. 124, No. 12, issue. 2, 2024

Summary of
acute cerebral circulation disorders (ONMK) occupy the second place among the causes of deaths and are the third most important cause of disability. In the structure of the ONMK, ischemic stroke (AI) takes first place. Damage to the substance of the brain during AI is a complex cascade of pathophysiological reactions, including neo -driving, oxidative stress, exaytotoxicity and apoptosis. One of the most actively developing areas of treatment of patients with AI is reperfusion therapy (RT). The use of neuroimagingalization-CT perfusion and MRI has significantly expanded the indications for the RT. One of the possible directions for expanding the capabilities of the Republic of Tatarstan is its joint use with neurocytoprotective therapy, which would increase the efficiency and safety of the RT. The review is devoted to research on the effectiveness of a combination of neurocytoprotheiation and TLT under AI.

Keywords: ischemic stroke, reperfusion therapy, thrombolytic therapy, mechanical thromboembolectomy, reperfusion damage, neuroprotection, cytoprotection, neurocytoprotheiation.
Information about the authors:
Schukin I.A. - https://orcid.org/0000-0002-6308–9706
I. Koltsov - https://orcid.org/0000-0002–9900-4073
Fidler M.S. - https://orcid.org/0000-0001-6464-521X
Glukhareva A.P. - https://orcid.org/0009-0004-4867–2102
Author responsible for correspondence: I. Schukin -E-mail: ivashchukin@gmail.com
how to quote:
Schukin I.A., Koltsov I.A., Fidler M.S., Glukhareva A.P. The possibilities of neurocytoprotext during reperfusion
therapy. Journal of neurology and psychiatry named after S.S. Korsakova. 2024; 124 (12 Issue 2): 75–88. https://doi.org/10.17116/jnevro202412412275

Place of publication: physical and rehabilitation medicine, medical rehabilitation / vol. 6, No. 4, 2024

Autonomous non -profit organization "Clinical Institute of the Brain", Berezovsky, Russia

Annotation
justification. The study of the use of pharmacotherapy as an adjuvant component of rehabilitation of patients with acute cerebral failure is of scientific and practical interest.

The purpose of the study is to study the effectiveness and safety of consistent therapy with the drugs of the group for the treatment of diseases of the nervous system in a comprehensive rehabilitation program for patients with acute cerebral failure in the aspect of the impact on the severity of emotional and cognitive disorders, mobility, the severity of the syndrome of the consequences of intensive care and the implementation of their rehabilitation potential.

Materials and methods . The randomized intervention prospective study of 60 patients with acute cerebral failure, divided into 2 groups, included five visits. Patients of the main group received standard therapy and the drug ethyl hydroxypyridine serpentine (intravenously 500 mg/day, 10 days),
then ethylmethylhydroxypirinate of the forte 250 (1 tablet 3 times/day, 8 weeks); Patients of the control group during the same period received only standard therapy.
Results. Both groups noted a comparable improvement in cognitive functions on the Mosa scale (p <0.001). The statistically significant superiority in reducing the level of anxiety on the HADS scale is shown on visit 4 in the main group compared to the control: 2 [1; 4] and 5 [2.25; 7] points, respectively (p <0.01). A significant increase in the Rivermide index in both groups at all stages of the study (p <0.001) was determined in excess of the value of the median in the main group by 3 points compared to the control for visit 5 (p <0.001). The tendency to the superiority of the main group over the control in terms of the life of the rehabilitation routing scale (SRM; p = 0.053) was combined with statistically significantly smaller number of disabled patients (≥3 points for scraps) than in the control group, to visits 5 (χ2 Yates = 4; P = 0.045). In patients of both groups, the consequences syndrome were determined by the intensive care therapy of a slight severity with a tendency to reduce the number of patients from the 3rd to the 5th visit in the main group compared to the control (χ2 Yates = 3.491; p = 0.062). At the visit 5, the relationship of indicators on the scrap scale and the Rivermide index in patients of both groups (P <0.05) and the SPRM and MOCA scales in patients of the main group (P <0.01) is established. No undesirable phenomena for the period of research were not noted.
Conclusion. The positive effect of sequential therapy of the group’s drugs for the treatment of diseases of the nervous system in the complex rehabilitation program of patients with acute cerebral deficiency on the state of their emotional-cognitive status, the degree of disability, mobility, the severity of the consequences of intensive care and rehabilitation prognosis was demonstrated. A high degree of safety of the study scheme of therapy has been proved.
Key words: acute cerebral failure; ethylmethylhydroxypyridine succinate; Hads; Moca; MRC; Rivermide index; Scrap; intensive care syndrome; Pits; Rehabilitation potential.
How to quote:
Belkin V.A., Vasilchenko I.E., Belkin A.A. The dynamics of domains of emotional-cognitive and motor disorders in the structure of PIT syndrome
in patients who have undergone acute cerebral failure //

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 11

Summary:
the article is devoted to an important problem of diagnosis and treatment of children with autonomic dysfunction syndrome (SVD). Information about the evolution of views on the pathogenesis of this state is given. The issues of pathogenesis, classification and clinical manifestations of SVD in patients in childhood and adolescence are covered in detail. The high efficiency of the use of the drug Mexidol was demonstrated in the complex correction and prevention of the manifestations of the SVD, as well as the accompanying psychoneurological disorders in children and adolescents. Key words: vegetative disorders, autonomic dysfunction syndrome, children, Mexidol.

Authors:
L.V. Stakhovskaya ¹ , E.A. Mkhitaryan ² , O.N. Tkachev ^1.2 , T.M. Ostroumova ³ , O.D. Ostroumova ^3.4

¹ FGAOU in Russian National Research Medical University named after N.I. Pirogov »Ministry of Health of Russia, Moscow, Russia;
² Russian Gerontological Scientific and Clinical Center of the FGAOU in the Russian National Research Medical University named after N.I. Pirogov »Ministry of Health of Russia, Moscow, Russia;
³ FGAOU in the First Moscow State Medical University named after THEM. Sechenov »Ministry of Health of Russia (Sechenov University), Moscow, Russia;
⁴ FSBEI of DPO “Russian Medical Academy of Continuing Professional Education” of the Ministry of Health of Russia, Moscow, Russia

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2020, T.120, No. 8, Issue 2

Summary:
Purpose of the study. To evaluate the effectiveness and safety of prolonged sequential therapy with Mexidol with a hemisphere ischemic stroke in acute and early recovery periods in patients of various age groups.

Material and methods. The study is an additional analysis of age groups among 150 patients who took part in a randomized double blind multicenter placebo-controlled in parallel groups of the epic study. The entire study of the study (62 men and 88 women) was divided into subgroups by age: under 60 years old, 60–75 years old, 76–90 years. Also, all participants in the study were divided into 2 populations: ITT (Intent to Treat Population, patients who received at least one dose of the drug/placebo drug) and PP (Per Protocol Population, patients who received the drug in accordance with the research protocol). The results were evaluated on the modified Rankin scale (MSHR) at the end of the course of therapy, the Bartel index, the Bek depression scale, and the European questionnaire for assessing the quality of life.

Results. The effectiveness of Mexidol on all the scales used did not differ depending on age. At the time of the end of the therapy, the average MSHR score was lower in patients 76–90 years (in both populations) compared to placebo (p <0.001). The dynamics of reducing the average score in MSHR (1-5th visits) was more pronounced in patients of 60–75 years (p = 0.025), including patients with diabetes. In patients 76–90 years old and patients with diabetes mellitus compared to placebo, the severity of cognitive-affective symptoms of depression (p = 0.049 and p = 0.02, respectively), the share of patients with lack of problems with everyday affairs, increased statistically significant (P = P = P = P = P = P = P = P = P = P = P. 0.007 and p = 0.02, respectively). In patients with diabetes, the level of everyday activity (p = 0.023) has also increased statistically significantly significantly increased and the quality of life has improved (p = 0.045). There were no reliable differences in the frequency of unwanted phenomena in all studied groups.

Conclusion. It is recommended that the use of Mexidol in the acute and early recovery periods of ischemic stroke in all age groups, including patients with diabetes mellitus.

Key words: ischemic stroke, Mexidol, ethylmethylhydroxypyridine succinate, effectiveness and safety, ischemic stroke, acute period, early recovery period, epic.

Place of publication:
New therapeutic magazine "Non Nocera", May 2024

Summary:
Cerebrovascular diseases (CVP) retain in the modern world a leading position in the rating of the incidence and disability of the population of most countries. Metabolic disorders, being important risk factors for the development of CVP, are also widespread in populations regardless of gender and age. The frequent combination of CVP and metabolic disorders, including somatic and abdominal obesity, insulin resistance, hyperinosulinemia, hyperglycemia and dyslipidemia, is a bridgehead for the rapid development of complications. One of the early manifestations of such a comorbid union is the formation of vegetative disorders. It is known that vegetative disorders are most often secondary, that is, they arise against the background of existing somatic or mental diseases, but can also develop when exposed to psychogenic factors (stress reaction, adaptation disorders, psychosomatic diseases, anxious and depressive disorders). The most common causes of the development of autonomic dysfunction are organic diseases of the nervous system and somatic diseases, including metabolic and hormonal.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 4

Summary:
Purpose of the study. Assessment of the effect of the pharmacological modulation of the rehabilitation process with Mexidol with a rehabilitation component of the rehabilitation treatment of cognitive-emotional disorders in patients who have undergone acute cerebral deficiency (scenario) due to acute cerebrovascular impairment or cranial-brain injury. Material and methods. A randomized intervention prospective study was carried out, which consisted of 5 visits. Patients are divided into main groups (OG, N = 30, received standard therapy and Mexidol in/B 500 mg/day 10 days with the subsequent prescription of the drug Mexidol Forter 250, orally, 1 tablet 3 times a day 8 weeks) and comparison (GS, N = 30, received only standard therapy for 66 days). Results. The OG has a comparable to the HS improvement of cognitive functions (p <0.001) (in both groups, improving the results of the Schulte test according to the criteria “Effectiveness of Work” and “The total execution time”, on the Moca scale (for visit 5 - 23.8 ± 2, 6 and 22.9 ± 3.0 points, p = 0.227)). The significant superiority of the OG over the GS is shown in terms of such indicators as a decrease in the severity of anxiety (HADS scale), a visit 4 - 2.6 ± 2.4 versus 4.4 ± 2.4 points (p = 0.004), and depression (Beka scale) , visit 3 - 7.5 ± 4.5 versus 11.4 ± 5.6 points (p = 0.005). The tendency of the superiority of the OG according to muscle power (MRC scale), a visit 4 - 3.3 ± 5.1 versus 2.1 ± 2.2 points (p = 0.051) and the level of vital activity (according to RM), a visit 5 - 2, 9 ± 0.7 versus 3.3 ± 0.6 points (p = 0.053). The statistically significant increase in the mobility of the patients of the OG compared to the GS (the difference in the values ​​of the Rivermid index is 5 - 10.3 ± 2.8 and 8.0 ± 2.8 points, p = 0.006), the average increase in the Rivermide index for visits 5 - 5.4 ± 2.1 versus 3.4 ± 1.6 points (p <0.001). The decrease in the points of the consequences of intensive care (Pets) in both groups was revealed, the statistically significant decrease in the severity of Pits in relation to the previous visit was revealed only in OG (p <0.001). The OG also determined the best, compared to control, indicators of the dynamics of systolic velocity of cerebral blood flow and overshoot coefficient. The study did not record undesirable phenomena (nya). Conclusion. A positive modulating effect of Mexidol was demonstrated with respect to accelerating the restoration of tolerance to cognitive loads, improving the psycho -emotional background by reducing symptoms of anxiety and depression and secondary improvement of motor rehabilitation results in the early recovery period in patients who suffered the scenes, including with Pets manifestations. During the study, Nyu and significant differences in vital functions are not registered, which indicates the comparable safety of therapy in OG and HS. Keywords: acute cerebral failure, Mexidol, ethylmethylhydroxypyridine succinate, Bek scale, modulating effect, Mexidolneuro2023.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 3, Issue. 2

Summary:
ischemic stroke (AI) is an acute life -burning state, its outcome is determined by the degree of damage to brain tissue, the quality and rate of medical care in the first minutes and hours of the disease. An important mechanism for damage to brain tissue both with ischemia and reperfusion is oxidative stress. The review considers the adverse effect of oxidative stress with ischemia and brain reperfusion of AI. The results of preclinical studies are presented that demonstrate the ability of Mexidol to eliminate the effect of free radicals, to activate antioxidant protection. The data of clinical studies of the use of Mexidol in combination with thrombolytic therapy in patients with AI are considered. Key words: ischemic stroke, revascularization, oxidative stress, Mexidol.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 4, Issue. 2

Summary:
arterial hypertension (AG) is a leading risk factor for the development of cardiovascular diseases, including with the development of cerebrovascular complications. The lesion of the brain as an agricultural organ is manifested by a stroke and/or vascular cognitive impairment (SKN) of varying degrees of severity. In order to identify and assess the severity of SKN, patients with AH need to conduct a neuropsychological examination, and to verify the vascular nature of disorders - neuroimaging. For the prevention and treatment of KN, along with antihypertensive therapy, the use of neuroprotectors plays an important role, among which ethylmethydlhydroxypirinate is a serious evidence base (reference drug - Mexol). Keywords: arterial hypertension, cognitive disorders, cerebrovascular disease, neuroprotection, ethyl -methylhydroxypyridine succinate, Mexidol.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 3

Summary:
Purpose of the study. Assessment of the effect of consecutive therapy with Mexidol preparations (injections of 500 mg intravenously for 14 days) and Mexidol Forte 250 (tablets 250 mg 3 times a day for 60 days) for higher cortical functions in patients with moderate cognitive disorders (Ukrainian) in chronic ischemia brain (chem). Material and methods. In a comparative prospective study, 63 patients with Khim with Ukrainian are included. All patients received basic therapy aimed at reducing risk factors (antihypertensive, antitrobotic drugs). Patients of the main group (OG, N = 30, 12 men, 18 women) received Mexidol intravenously 500 mg per 100 ml of a 0.9% solution of NACL once a day for 14 days, then Mexidol Forte 250 to 250 mg 3 times a day for the next 60 days. The comparison group (GS) compiled 33 patients (14 men, 19 women) who received only basic therapy. Investigated the cognitive status (the MOCA scale, the frontal dysfunction battery, the memorization test of 10 words), the severity of asthenia (the MFI-20 scale), anxiety and depression (HADS scale), the patient’s assessment of state dynamics (CGI-Maintenance scale) at 1, 14 and 74 -y ± 5 days. Patients in the 1st and 74th ± 5 days of observation were examined by transcranial magnetic stimulation (TKMS) in order to study the neuronal activity of the cerebral cortex. Results. At the time of completion of treatment, a pronounced regression of UKR was noted (growth on the Moca 3 score scale, the difference with GS 1 point, p <0.0001; the tests of the frontal dysfunction batteries - 4 points, the difference with GS 2 points, p <0.001; the memorization test test 10 words - 2 points, the difference with GS 1 point, p <0.05), emotional (Hadss Alarm scale - 8 points, difference with GS 3 points, p <0.001, hads depression - 3.5 points, difference with GS 1 , 5 points, p <0.01), asthenic (scale MFI-20-30 points, difference with GS 15.5 points, p <0.01), improving the well-being of patients (CGI-speed scale-2 points, difference with GS 1 point, p <0.0001). According to the TKMS, a statistically significant decrease in the central motor time at the level of both motor motor neurons is bilaterally from the moment therapy (p <0.01) is determined. The reverse correlation of the time of the central motor conduct and the results of the tests of the frontal dysfunction battery for left -sided localization of the first motor neuron (p <0.01) was revealed. Conclusion. The results of the study of therapy with Mexidol drugs at 500 mg iv 1 time per day for 14 days, followed by the oral administration of Mexidol Fort 250, 1 tablet 3 times a day for 60 days indicate its clinical efficiency and safety in patients with Khim with UKR , and also confirm its significance for the prevention of the progression of the disease. Key words: chronic brain ischemia, moderate cognitive disorders, Mexidol, MOCA scale, frontal dysfunction, transcranial magnetic stimulation.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 2

Summary:
Purpose of the study. To evaluate the clinical efficiency and safety of the drug Mexidol in patients in the acute period of ischemic stroke in the vertebral-baslar system (IIVBS).

Material and methods. The open randomized comparative study was attended by 52 patients, of which 32 were received by Mexidol (main group, OG) and 20 - standard therapy without the use of neuroprotective drugs (comparison group). Assessment of the severity of the clinical manifestations of IIVBS was carried out using the Hoffenberth scale, the severity of the stroke was estimated on the NiHSS scale, the degree of disability of patients after the stroke used the Rankin scale, a neuropsychological study of patients was carried out using the Montreal scales for evaluating cognitive functions (MOCA), a hospital of anxiety and depression scale (depression ( HADS), asthenication scales (MFI-20), assessment of the quality of life of patients was carried out using the EQ-5D questionnaire.

Results. The use of Mexidol in the form of prolonged sequential therapy in patients of the OG led to a decrease in the severity of the clinical manifestations of IIVBS by 53.3%, a neurological deficit on the NIHSS scale by 59.5%. By the end of the course of therapy by Mexidol, 96.9% of patients coped with their own affairs without outside help, which was accompanied by the regression of emotional disorders and an increase in the quality of life of patients.

Conclusion. The early appointment of Mexidol in therapy of patients with IIVBS can be considered the most justified, since it contributes to an earlier and significant decrease in neurological deficiency and improve the quality of life of patients.

Keywords: cerebrovascular diseases, ischemic stroke in the vertebral-baslar system, vertebral-baslar failure, neuroprotective therapy, Mexidol.

Place of publication:
a journal of neurology and psychiatry named after S.S. Korsakova, 2024, T. 124, No. 1

Summary:
Purpose of the study. Conduct a meta -analysis of the effectiveness of Mexidol therapy in patients with chronic ischemia of the brain (chemical) and mild (moderate) cognitive disorders (KR).

Material and methods. This meta -analysis includes the results of research on the effectiveness of Mexidol with the Kyrgyz Republic, the severity of which was evaluated on the MOCA scale. The assessment of the combined effect included all publications based on the results of independent clinical studies, in which data assessments were presented at the Moca scale at a level sufficient for further statistical analysis. The main result of the meta -analysis was obtained for the final values ​​of the effectiveness indicator in groups of patients receiving Mexidol, in comparison with groups of basic therapy.

Results. The meta -analysis includes the results of 10 prospective clinical studies of the effectiveness of Mexidol against the background of basic therapy in patients with chemical and mild (moderate) cr. The main group was 482 patients, the comparison group was 455. When using the statistical model of random effects, the size of the effect was 2.06 points, 95% of the CI for the difference in efficiency in two groups - [0.98; 3.14 points] (p = 0.0002).

Conclusion. The statistically significant improvement in the cognitive functions of patients with chemicals against the background of the use of Mexidol was demonstrated.

Keywords: chronic brain ischemia, cognitive disorders, ethylmethylhydroxypyridine succinate, mexidol, treatment.