SUMMARYPurpose: Double-blind randomized trial to assess efficacy and tolerability of once-daily extendedrelease levetiracetam (LEV XR) tablets (2 · 500 mg) as add-on therapy in patients (12-70 years old) with partial-onset seizures (POS) refractory to one to three antiepileptic drugs. Methods: After an 8-week prospective baselineperiod, eligible patients were randomized (1:1) to once-daily LEV XR 1,000 mg/day or placebo for 12 weeks. Evaluations included changes from baseline in POS-frequency/week, responders ( ‡50% reduction in POS-frequency/week), seizurefreedom, adverse events, laboratory tests, physical and neurologic examinations, vital signs, body-weight, and 12-lead electrocardiogram. Results: Of 188 patients screened, 158 were randomized (intention-to-treat population): LEV XR (n = 79) or placebo (n = 79). Seventy-one (89.9% %) LEV XR and 72 (91.1% %) placebo patients completed the trial. Median POS-frequency/week reduction was 46.1% % on LEV XR and 33.4% on placebo. Estimated reduction with LEV XR over placebo was 14.4% (p = 0.038). Thirty-four (43%) LEV XR and 23 (29.1% %) placebo patients experienced ‡50% % reduction in POS-frequency/week. Eight (10.1% %) patients receiving LEV XR and one (1.3% %) receiving placebo were free of POS during the 12-week treatment period. Forty-one (53.2% %) LEV XR and 43 (54.4% %) placebo patients reported ‡1 adverse event. Adverse events reported with an incidence >5% % and seen more often with LEV XR than with placebo were somnolence, influenza, irritability, nasopharyngitis, dizziness, and nausea. Discussion: Once-daily LEV XR 1,000 mg was effective and well-tolerated as adjunct therapy in patients with POS. Ten percent of patients randomized to LEV XR experienced freedom from POS. These results support the clinical value of this new LEV XR formulation.

20 % of ischemic stroke appear to originate from carotid artery atherosclerotic disease. Serum biomarkers reflecting the activity of atherosclerotic process and may help for estimate risk of acute cerebrovascular events. Several serum inflammatory markers have been proposed for risk assessment, but their prognostic role less known. The aim of this study is to clarify the prognostic value of biomarkers of atherosclerosis lipoprotein-associated phospholipase A2 (Lp-PLA2) and E-selectin in patients with symptomatic and asymptomatic carotid stenosis. Materials and methods. The study involved 106 patients with atherosclerotic carotid stenosis >50 % (74 men and 32 women, mean age 62.6±0.9) from which 76 symptomatic (35 with acute ipsilateral atherothrombotic stroke and 41 after carotid endarterectomy) and 30 asymptomatic patients. The control group consisted of age- and sex-matched 20 healthy subjects. The level of serum Lp-PLA2 and E-selectin was determined using a commercially available enzyme-linked immunosorbent assay kit. Results. The level of Lp-PLA 2 was in general significantly higher (p<0.05) in patients groups than in the control group and most high Lp-PLA2 concentration was in groups of symptomatic patients who underwent carotid endarterectomy. The level of E-selectin in the study patients was significantly higher than in the control group (p<0.05). The correlation of Lp-PLA 2 with E-selectin was significant for total patients (R=0.365664, p=0.00085) and group after carotid endarterectomy (R=0.429143, p=0.01796), but not for asymptomatic group (p>0.05). Receiver Operating Characteristics curves of logistic regression models which takes into joint both indicators was specificity and sensitive for predicting the occurrence of ischemic stroke. Conclusion. Conducted study show that the levels of Lp-PLA 2 and E-selectin have a significant impact on the development of stroke in patients with atherosclerotic carotid stenosis and can be used to predict it. A multidimensional model of the dependence of the probability of stroke on a linear combination of Lp-PLA 2 and E-selectin allows to obtaining significantly higher characteristics of the accuracy of stroke prediction than models with each factor alone.

In this review discussion was focused on edema -the common presentation of internal diseases, neurological disorders and surgical problems. Edema is defined as abnormal accumulation of interstitial fluid, which can be either due to excessive capillary filtration or ineffective lymphatic drainage. There are systemic and local causes of edema, which should be revealed promptly, because specific etiology has significant impact on the approach to treatment. Among common causes of edema chronic venous insufficiency, heart failure, nephritic syndrome, effects of drugs, deep venous thrombosis and etc. were analyzed. Some attention was paid to specific conditions like idiopathic edema and lipidema (which is abnormal fat distribution). Diagnostic procedures and treatment options became the features of consideration regarding its effect on the management of patient with peripheral edema. In addition to the descriptive part of the article, the multi-choice questions were proposed for self-assessment.

Introduction Chronic pain, which usually occurs after traumatic damage to nerves and plexuses, is an additional burden on the patients’ quality of life, which is already impaired due to motor, sensory and autonomic deficits. The aim is to study and clarify changes in immunological parameters and neurotrophic factors in patients with compression, post-traumatic non-gunshot and gunshot neuropathies and plexopathies. Materials and Methods The study included 93 men aged 21 to 59 years with neuropathy and plexopathy of traumatic and non-traumatic origin, which were divided into 3 groups. Patients underwent clinical and neurological examination starting at onset of clinical manifestations and in the dynamics, electromyography, and ultrasound. Immunological examination was performed from 12 to 24 months starting at onset of the disease. Results Differences between the study groups in the concentration of circulating immune complexes and lymphocytotoxicity, decrease in CD4 + T lymphocytes were statistically significant. In the obtained NBT-test results, which characterize the difference between spontaneous and zymosan-stimulated oxygen-dependent phagocytosis, it was found that the cells oxidized granules of nitroblue tetrazolium dye with different degree of intensity, depending on the regenerative capacity of enzymes. We found an increase in the quantitative content of the beta-NGF 303 [35.2; 504.5] pg/ml in the blood of patients of the group III with post-traumatic gunshot neuropathies and plexopathies accompained by chronic neuropathic pain syndrome at a statistically significant level (Kruskal-Wallis test, p=0.0181). Conclusion The study showed a statistically significant (p<0.05) violations of the regulatory link of immune system in patients with post-traumatic gunshot neuropathies and plexopathies, increased circulating immune complexes level, disorders of oxygen-dependent and oxygen-independent phagocytosis, reduced enzymatic regenerative capacity, significant increase in beta-NGF, Thus, as a result of the study, we found statistically significant (p<0.05) violations of the regulatory link of immune system in patients with post-traumatic gunshot neuropathies and plexopathies, increased circulating immune complexes level, disorders of oxygen-dependent and oxygen-independent phagocytosis, reduced enzymatic regenerative capacity, significant increase in beta-NGF 303 [35.2; 504.5] pg / ml, indicating the ongoing process of chronic inflammation, stimulation of the sympathetic nervous system and sensory fibers, which leads to the maintenance and severity of chronic neuropathic pain even after 12 months or more since the injury with damage to nerves and plexuses of the limbs.

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The aim of the research: epilepsy on the background of ischemic stroke. Studied problem: improve of diagnosis of epilepsy on the background of ischemic stroke by establishing the clinical features of epileptic seizures and by detection of brain structural damages The main scientific results: a cross-sectional randomized cohort comparative study with retrospective and prospective stages was performed in 60 patients (men and women) with ischemic stroke aged 65 [57.0; 74.0] years, in 30 of which epileptic seizures were detected. The predominance of generalized single (66.7±38.5 %) variants was found in the structure of epileptic seizures in patients with acute cerebrovascular pathology. A higher frequency of generalized variants of seizures in patients over 60 years of age (maximum at 61–70 years, at descending – 71–80 years, over 80 years) has been revealed. The descending distribution of localization frequency of brain lesions (detected with MRI, CT) in patients with epileptic seizures after ischemic stroke is as follows: dilation of the subarachnoid space (93.3±24.1 %), dilation of the brain ventricles (83.3±34.0 %), subcortical ganglia (76.7±37.0 %), right hemisphere or temporal lobe (60.0±37.9 %), subcortex (56.7±37.3 %), frontal lobe (50.0±35.4 %), left hemisphere or diffuse-atrophic changes in the cortical region (43.3±32.6 %), temporal lobe (20.0±17.9 %), occipital lobe (16.7±15.2 %). The area of practical use of the research results: clinical medicine, especially neurology. Innovative technological product: methodology of diagnosis of epilepsy on the background of ischemic stroke. Scope of the innovative technological product: the evaluation of seizures and brain’s structural damages in patients with ischemic stroke with the development of epileptic seizures may be a means of improving the diagnosis of epilepsy on the background of cerebrovascular disease.