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Place of publication:
journal neurology, neuropsychiatry, psychosomatics, 1, 2018

Summary:
in elderly patients, dizziness can be caused by various causes, the possibilities of drug therapy are limited, the most commonly used are the betagistine of digidloride. The purpose of the study is to study the effectiveness and safety of complex therapy with Mexidol ^® and betagistin in patients with dizziness according to the global evaluation of the effectiveness of treatment. Patients and methods. The study includes 89 elderly patients (average age - 73.7 years) with chronic cerebrovascular pathology and dizziness complaints. In all patients, neurological, otoneurological (orthostatic samples, with forced hyperventilation, dix - medalpike, tinetti, visual analogue of dizziness), somatic, cognitive and emotional status. Patients were randomized into two groups. The main group included patients who received a betagistin of 48 mg/day, Mexidol ^® 5.0 ml intravenously for 10 days, then 375 mg/day tablets; In the comparison group - patients who used only 48 mg/day betagistine for 60 days. Assessment of the effectiveness of treatment was carried out on a global scale on the 60th day of therapy in both groups, taking into account the opinion of the doctor and the patient. Results. In elderly patients, dizziness in most cases (75%) was caused by several causes. In a group of combined treatment (betagistin + Mexidol ^® ), a more significant (more than doubled) decrease in dizziness symptoms are noted than in the comparison group. Conclusion. In elderly patients with chronic cerebrovascular disease and dizziness, combined therapy with Mexidol ^® and betagistin with neuroprotective properties improves treatment results.

Place of publication:
a journal of neurology and psychiatry, 3, 2017; Ext. 2

Summary:
Purpose of the study. To evaluate the effectiveness and safety of prolonged sequential therapy with Mexidol with patients with hemispherical ischemic stroke (AI) in acute and early recovery periods. Material and methods. In a randomized double-centered placebo-controlled in parallel groups, the study included 151 patients (62 men and 89 women), 150 patients (62 men and 88 women) aged 40 to 79 years were randomized. Patients by simple randomization were distributed to 2 groups: patients of the 1st group received therapy with Mexidol of 500 mg/day intravenously for 10 days, followed by 1 tablet (125 mg) 3 times a day for 8 weeks. Patients of the 2nd group received a placebo according to a similar scheme. The duration of participation in the study was from 67 to 71 days. Results. At the time of the end of the therapy, the average score on the modified scale of Rankin (MSHR) was lower in the 1st group than in the 2nd (p = 0.04). The dynamics of reducing the average score according to MSHR (1-5th visit) was more pronounced in the 1st group (p = 0.023). The proportion of patients who have reached the recovery corresponding to 0-2 points in MSHR (5th visit) was significantly higher in the 1st group (p = 0.039). When testing on a stroke scale of the National Institute for Health to the 5th visit, the average value was lower in the 1st group (p = 0.035). A decrease in the score on the stroke scale of the National Institute for Health at the time of the end of the course of therapy regarding the initial level in patients with diabetes was more pronounced in the 1st group (p = 0.038). In the 1st group in the general population of patients and subpopulation of patients with diabetes, the dynamics of improving the quality of life was more pronounced and was observed from the 2nd visit. The proportion of patients with the lack of problems in space was significantly higher in the 1st group (p = 0.022). There were no reliable differences in the frequency of unwanted phenomena in patients of both groups. Conclusion. It is recommended that the use of Mexidol in the acute and early recovery periods of AI is recommended.

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 purpose of the study.

Studying the structure of an alarming symptom complex in patients of late age with amnestic, disregional and polymodal types of moderate cognitive disorder (UKR) and determining the clinical efficiency of ethylmethylhydroxypyridine (Mexol).

Material and methods.

The selective study included 32 patients with both sexes over 55 years old from UKR (F06.7 according to ICD-10), who applied for medical help for anxiety. The inclusion criteria were compensation for concomitant somatic pathology, the lack of
significant stress events during the year, the lack of depression. They used clinical-psychopathological and psychometric methods: Hamilton's scale for evaluating anxiety (HAM-A), a geriatric depression questionnaire (GDS), a brief scale for evaluating mental status (MMSE), a scale of a general clinical impression (CGI-S, CGI-I), a scale for evaluating stress events. The main criterion for the effectiveness of 4-week therapy with Mexidol (375 mg per day) was the reduction of a common score on the scale of us-a. Results and conclusion. At the time of inclusion in the study,
the average points on the HAM-A and MMSE scales amounted to 39.9 ± 3.18 and 25.7 ± 0.6, respectively. When studying the structure of an alarming state in people with amnestic, dysregulatory and polymodal types of UKR, it was found that the phenomenology of an alarming symptom complex with these types of UKR is different. A re-assessment of anxiety on the HAM-A scale was carried out after 1, 2 and 4 weeks of therapy with Mexidol. Improving the mental state was noted with all types of UKR, but the proportion of people with a significant improvement was higher with amnestic and dysregulatory types compared
to polymodal. The development rate of the anti -aircraft effect was noted more with the dysregulatory type of UKR. In all patients, the use of Mexidol contributed to an increase in the stability of the function of attention and correction of autonomic dysfunction.

Key words: anxiety, moderate cognitive disorder (UKR), neuropsychological types of UKR, Mexidol.

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.

The results of a series of domestic clinical trials are given to study the effectiveness and safety of the drug Mexidol in patients with cerebrovascular disorders, in particular with ischemic stroke (AI). It is emphasized that the use of Mexidol is associated with a more complete and rapid regression of focal neurological deficiency. Good tolerance of treatment with Mexidol and the absence of significant undesirable side effects are noted. It is recommended to use the drug in forms for enteric and parenteral use in patients with AI.
Key words: ischemic stroke, treatment, Mexidol.

The purpose of the study is to study the state of cerebrovascular reactivity (CVR) and structural changes in the substance of the brain in patients with moderate cognitive disorders.

Patients and methods. 385 patients aged 57 to 79 years with moderate vascular cognitive disorders (SKN) were examined. The relationship of clinical variants of SKN and depression with the volume and localization of ischemic damage to the brain substance, as well as with the state of CVR in various vascular pools at the stage of inclusion in the study and after 20 months, has been studied.

Results. The connection of the neuropsychological profile and the severity of the SKN with the features of structural damage to the substance of the brain was revealed, but to a greater extent with a decrease in the CVR in the carbon arteries (SA) system and a combined decrease in the CVR in the CA and the verteba -basial basin (VBB). The association of the frequency of development of depression with the localization of ischemic damage in the frontal lobes and a decrease in the CVR in CA on the left, as well as a combined decrease in the CVR and VBB, has been established.

Conclusion. The state of the CVR, determined in various vascular pools, can serve as an early prognostic sign of developing SKN or depression.

Key words: vascular cognitive impairment; cognitive and emotional disorders; Cerebrovascular reactivity.

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 article based on the results of multicenter clinical research and the experience of leading domestic and foreign experts sets out actual theoretical and practical aspects of therapy and prevention of acute cerebrovascular accident. The pharmacotherapy of patients with strokes is examined in detail. The importance of the use of neuroprotective drugs has been demonstrated, among which Mexidol - Antihyxant with a multimodal action mechanism occupies a special place.

Keywords: stroke, therapy, prevention, neuroprotection, antihypoxants, Mexidol.

The purpose of the study is to determine using the cerebral oximetry of the effectiveness of the antihypoxic effect of Mexidol with carotid endarctomy (CE) in patients with stenosis cerebral atherosclerosis.

Material and methods. In 109 patients with stenosis cerebral atherosclerosis with a degree of stenosis of the internal carotid artery 69 ± 7% and a clinical picture of chronic brain ischemia, clinical and psychineological monitoring was carried out in the pre- and postoperative periods of KE. Cerebral cerebral oximetry was perimetically. In 54 patients, the operation was carried out after the course of Mexidol at a dose of 1000 mg/day for 14-15 days. The other 55 people made a comparison group that did not receive Mexidol. Results and conclusion. The difference in the initial
oxygenation of the brain (RSO2) was revealed: 60.8 ± 5.0 and 47.29 ± 5.5%, respectively, in these groups. During the operation in the same groups of patients, the degree of blood saturation with oxygen decreased to 57 and 41%, respectively. On the 7th day after the KE with patients in both groups of both groups, a reliable improvement was obtained when performing the Shulti test to the group that received Mexidol, when evaluating the effectiveness of work and mental stability before and after surgery, which was not observed in patients who did not conduct antioxidant therapy. The use of Mexidol as
antihyplack of KE in patients with stenosis atherosclerosis of extracerebral arteries significantly reduces the degree of brain hypoxia, reduces the time of surgery, improves the neurological status of patients and the implementation of neuropsychological tests in the postoperative period.

Keywords: cerebral stenosis atherosclerosis, carotid endarterctomy, cerebral oximetry, Mexidol.

Chronic cerebrovascular failure (KHNMK) is the result of cerebral micriangiopathy, most often due to uncontrolled arterial hypertension. At the same time, the brain suffers due to repeated “dumb” heart attacks and/or micro -power without clinical manifestations of stroke and chronic brain ischemia. The main manifestation of a chronic progressive non -navigable vascular brain damage is progressive cognitive disorders with a predominance of insufficient concentration of attention, a decrease in the cognitive activity, a violation of planning and control with the relative preservation of memory.
As a rule, these disorders are combined with changes in the emotional sphere in the form of affective lability and depression. A description of the characteristic clinical case of KHNMK is given, the mechanisms of the formation of neurological symptoms are understood, modern approaches to the management of such patients are stated.

Key words: chronic brain ischemia, discirculatory encephalopathy, vascular cognitive impairment.

The purpose of the study.

To clarify the mechanisms of the anti -stress effect of the antioxidant drug (Mexidol) in patients with chronic brain ischemia (Khim). Material and methods. 67 patients with chemicals, 48 ​​women and 19 men, the average age 48.2 years observed. To assess the state of a multi -level stress system, they studied: the level of anxiety and depression, the degree of vegetative imbalance, adaptive blood reactions and the functional properties of red blood cell membranes, the level of medium mass molecules in the blood plasma. Therapeutic complexes included standard therapy and Mexidol of 500 mg (10 ml) intravenously by a drop of 200 ml of physiological solution 1 time per day for 10 days with the subsequent transition to the oral intake of 1 tablet (125 mg) 3 times a day for 3 months. Results and conclusion. In the group of patients receiving Mexidol, a more pronounced and prolonged positive effect on the clinical symptoms of chemicals was noted. These patients had a persistent decrease in anxiety, a decrease in vegetative imbalance. The dynamics of adaptive blood reactions indicated the activation of the function of the adrenal cortex. There was a decrease in the content of the level of medium mass molecules and the restoration of the sorption capacity of ER Itrocytes. The results indicate a multicomponent multi -level stressful effect of Mexidol in patients with chronic brain ischemia.

Key words: Mexidol, chronic brain ischemia, treatment, stress.

Place of publication:
Journal of Neurology and Psychiatry, 2, 2016

Summary:
The purpose of the study is to determine the effectiveness of Mexidol therapy to optimize the secondary prevention of vascular events through exposure to the indicators of vascular-trombocyte hemostasis and lipid blood spectrum in patients who have suffered ischemic stroke (AI), against the background of type 2 diabetes (SD2). Material and methods. Conducted a study of the content of general cholesterol, low -density lipoproteins, high density lipoproteins, blood -triglycerides in blood serum; The concentrations of the 4-plastic factor (4PF), β-tromboglobulin (βTH) and the villebrand factor in 68 patients with AI and SD2 were determined. Dynamic control of the studied indicators was carried out (1st, 21st day, 3rd and 6th months from the beginning of AI) amid therapy with Mexidol. Results and conclusion. Prolonged Mexidol therapy provides additional opportunities for normalizing the lipid blood spectrum and optimize secondary prevention of vascular events in patients with AI and SD2.

Place of publication:
Journal of Neurology and Psychiatry, 5, 2016

Summary:
Purpose of the study. The study of the influence of the combination of Mexidol and Cerebrolysin as part of complex therapy on the state of the clinical status of patients with chronic brain ischemia (chemical) stage II on an outpatient basis. Material and methods. The study includes 36 patients with a diagnosis of stages II. Against the background of basic therapy, patients received 2 courses of combined therapy with Mexidol and Cerebrolysin for 6 weeks with an interval between courses of 3 months. After each course, the dynamics of patient complaints and objective clinical manifestations were evaluated. After the end of the treatment, the content of 13 chemical elements in the hair is determined by the atomic-emission method. Results and conclusion. Based on the clinical and neurological examination, the therapeutic effectiveness of the appointment of Mexidol and Cerebrolysine as a long neuroprotement in patients with the II stage, which was manifested by a reliable decrease in the severity of all the main symptoms under the influence of the therapy, is shown.

The influence of the nature of the atherosclerotic stenizing lesion on the clinical picture of cognitive impairment (KN) has not been sufficiently studied.

The purpose of the study is to assess the effect of the degree and localization of the atherosclerotic stenosis process on cerebral perfusion and the state of cognitive functions.

Patients and methods. 123 patients were examined (65 men and 58 women) aged 50 to 75 years old, having stenoses of brachiocephalous arteries at least 40%, without arterial hypertension, diabetes mellitus or other systemic vascular pathology. The structural state of the substance of the brain and the state of cerebral blood flow were evaluated using magnetic resonance imaging and magnetic resonance angiography. To determine the changes in the white matter, the P. Scheltens scale et al. The localization and degree of the stenosis process was evaluated by extracronal and transcranial duplex scanning by the method of extracranial and transcranial. Prince was determined using a set of neuropsychological scales. The Hamilton depression was also used.

Ascension and discussion. Most of the brachiocephalous arteries examined against the background of atherosclerosis revealed varying severity of the Prince. The most severe KNs were associated with the defeat of the parietal and frontal lobes. A reliable deterioration of cognitive functions was observed as the percentage of stenosis increases: with stenosis in the carotid system, more severe KNs were observed than with stenosis in the vertebral basin. In addition, in patients with combined stenosis and tandem stenosis, more pronounced KN were noted compared to patients with stenosis of the same artery. It is shown that cerebral atherosclerosis is one of the main risk factors for the development of Prince. The influence of not only degrees is noted, but also to a greater extent localization of stenosis on the occurrence of KN, accompanied by the development of perfusion deficiency in specific vascular pools. Determining the nature of the stenosis process will allow to predict the development of KN in patients with atherosclerosis and choose the appropriate treatment tactics.

Key words: atherosclerosis; stenosis of brachiocephalous arteries; Cognitive disorders.

Place of publication:
Journal of Neurology and Psychiatry, 2, 2015

Summary:
Purpose of the study. Analysis of the effectiveness and safety of the use of Mexidol and its impact on the dynamics of neurological manifestations of the disease, the emotional status and quality of life in patients with chronic brain ischemia (chemical). Material and methods. 45 patients with chemicals received Mexidol of 500 mg iv a drop 1 time per day for 14 days, followed by an oral reception of 500 mg (2 tablets 2 times a day) for 60 days. The comparison group consisted of 30 patients with chemicals, comparable by age, the presence of risk factors and the severity of neurological manifestations that did not accept Mexidol. Patients of both groups received basic therapy, including drugs to achieve the complete correction of their risk factors. Assessed the state of cognitive functions (MMSE questionnaire), motor activity, quality parameters (SF-36). Results. By the end of the study (on the 74th day), patients of the main group compared with the comparison group, the severity of motor activity disorders has significantly reduced, the indicator of the assessment with the recount of utility on the SF-36 scale was normalized, and a reliable improvement of the average indicators of the screening estimate of cognitive functions was noted (MMSE). When analyzing the results of the study, the high efficiency and safety of the treatment of patients with a chemous drug Mexidol was confirmed.