Consilium Medicum

Background. The course of migraine is characterized by sensitivity to hormonal changes, which is particularly evident in the reduced frequency and severity of attacks during pregnancy and lactation. This phenomenon is attributed to the suppression of the menstrual cycle and the associated changes in estradiol levels. The pathogenesis of migraine in patients with antiphospholipid syndrome and genetic thrombophilia (APS/GT) differs by the predominance of hypercoagulative and platelet components. Consequently, pregnancy might exacerbate the severity of migraine in these patients.

Aim. To assess the course of migraine during pregnancy, lactation and the postpartum period in patients with APS/GT.

Materials and methods. The study included female patients aged 18 to 50 years diagnosed with migraine. Based on the presence of APS/GT, the study sample was divided into two groups: female patients with APS/GT and migraine (group 1) and female patients with migraine without APS/GT (group 2). The disease history and obstetric-gynecological history were assessed. For those with a history of pregnancy, the number of headache episodes per month during pregnancy, breastfeeding, and one year after delivery was recorded. The study included 68 women, with 36 (52.9%) in group 1 and 32 (47.1%) in group 2. A history of pregnancy and childbirth was noted in 54 (87.1%) patients (31 from group 1 and 23 from group 2).

Results. In group 2, pregnancy was associated with a reduction in headache frequency, up to complete remission in most patients during the second and third trimesters and lactation. One year postpartum, headache frequency was comparable to pre-pregnancy levels. In group 1, a reduction in headache frequency was observed during the first, second, and third trimesters, similar to group 2, but with statistically significantly less pronounced improvement in migraine course.

Conclusion. The presence of APS/GT neutralizes the positive effects of pregnancy and lactation on migraine. However, no exacerbation of migraine was observed in patients with APS/GT in this study, which may be attributed to anticoagulant therapy administered during pregnancy.

Cervical radiculopathy (CR) occurs when the cervical spinal roots are compressed due to degenerative changes in vertebral structures. At the cervical level, compression of radicular structures is most often caused not by the "soft tissue" component of the herniated disc in the epidural space but by compression in the radicular opening itself due to spondylosis. CR can present with various clinical symptoms and their combination in the form of not only pain (usually with "distant" radiation) but also symptoms of dysfunction (hypoaesthesia, motor disorders, decreased tendon reflexes) in the innervation zone of the corresponding spinal roots. Challenge tests aimed at increasing root compression and enhancing clinical symptoms (Spurling, Valsalva, and Elvey tests – Upper Limb Tension Tests, ULTT) are used, as well as other tests to reduce the root compression and relieve pain (traction, shoulder abduction). The diagnosis is based on the analysis of clinical presentation. Root compression is unlikely in the absence of focal neurological symptoms. Native magnetic resonance imaging of the cervical spine is the mainstay of neuroimaging for patients with a new or worsening clinical presentation of non-traumatic CR in the absence of "red flags." When assessing radicular compression, neuroimaging data should be interpreted only in the context of clinical presentation. The presence of anxiety, depression, distress symptoms, and high demands at work is associated with a poor prognosis of recovery and a decrease in the quality of life in patients with CR. Most doctors do not pay enough attention to assessing psychosocial factors. To facilitate this assessment, we have developed a telegram bot. The CR has a naturally favorable course and prognosis. In most cases, CR is a spontaneously resolving condition with a full recovery rate of 83-90%. The method of choice is non-surgical treatment. A case of typical CR is presented. A comprehensive multidisciplinary treatment, including clarification, an educational program, physical therapy, manual therapy, as well as drug therapy (non-steroidal anti-inflammatory drugs, gabapentin, Combilipen) is effective in regression of pain, neurological symptoms, improvement of psycho-emotional status, functional abilities, and quality of life.

Periarticular cysts (PAC) at the level of the cervical spine are rare and cause difficulties in diagnosis. The article presents an observation of a 72-year-old patient with spinal canal stenosis at the C7-Th1 level due to a PAC at the C7-Th1 level on the right, compression-ischemic radiculopathy C8 on the right. For 10 months, the cause of radiculopathy at the cervical level was not determined, and there was no effect from the treatment. The patient was prescribed repeated courses of drug treatment, physiotherapy, massage, diagnostic injections and blockages, while not considering the possibility of a PAC in which surgical treatment is most effective. The detection of a PAC, its surgical treatment, followed by kinesiotherapy led to a complete regression of pain syndrome within 3 months. The issues of pathogenesis, diagnosis and treatment of PAC of the cervical spine are discussed.

Background. Chronic neck and low back pain is characterized by high comorbidity with anxiety and depressive disorders, which can exacerbate pain. The usefulness of psychiatrist involvement in the management of patients with chronic non-specific neck and low back pain has been poorly studied.

Aim. To study the effect of anxiety and depressive disorder on pain intensity, physical activity, and quality of life in patients with nonspecific neck and low back pain, as well as the feasibility of involving a psychiatrist in the examination of patients.

Materials and methods. The study included 43 patients (11 men and 32 women, average age 56.2±13.3 years) with chronic nonspecific neck and low back pain, who were diagnosed with increased anxiety or depression using the Spielberg test and/or the Beck depression questionnaire. All patients were consulted by a psychiatrist. A numerical rating scale was used to assess pain intensity, an international questionnaire on physical activity was used to analyze the level of physical activity, a central sensitization questionnaire was used to diagnose central sensitization, and the Spielberger test with an assessment of reactive (RA) and personal anxiety, and the Beck depression questionnaire were used to assess anxiety and depressive disorders. The SF-12 questionnaire was used to assess the quality of life, taking into account the division of this questionnaire into consolidated scales of physical and mental health.

Results. Based on an in-person consultation with a psychiatrist, the following diagnoses were established according to ICD-10: F32 "Depressive episode" in 11 patients, F33 "Recurrent depressive disorder" in 14 patients, F41.1 "Generalized anxiety disorder" in 11 patients, F41.0 "Panic disorder" in 1 patient, F41.2 "Mixed anxiety and depressive disorder" in 4 patients, F41.9 "Anxiety disorder, unspecified" in 1 patient, F40.0 "Agoraphobia" in 1 patient. A negative impact of anxiety and depression on both the intensity of pain and the quality of life of patients was found. A relationship was found between pain intensity and the severity of depression (β=0.048; p=0.008; 95% CI 0.013–0.084) and RA (β=0.052; p=0.007; 95% CI 0.015–0.089). A negative impact of depression (β=-0.424; p=0.004; 95% CI -0.702–-0.144) and RA (β=-0.365; p=0.020; 95% CI -0.688–-0.061) on physical activity was shown. A negative impact on the mental component of quality of life was found for depression (β=-0.414; p=0.005; 95% CI -0.698–-0.129), RA (β=-0.437; p=0.005; 95% CI -0.735–-0.138) and personal anxiety (β=-0.364; p=0.007; 95% CI -0.625–-0.103).

Conclusion. Anxiety and depressive disorders increase the intensity of pain syndrome, reduce physical activity and quality of life in patients with chronic nonspecific neck and low back pain. A psychiatric consultation allows you to diagnose a specific mental disorder.

The review examines practical examples of the use of artificial intelligence in the diagnosis of neurological diseases such as stroke, traumatic brain injuries, neurodegenerative diseases, including Parkinson's disease, Alzheimer's disease, multiple sclerosis, as well as epilepsy and sleep disorders. The basic concepts of AI and machine learning, the problems associated with their implementation, and the prospects for further development of technologies aimed at improving the accuracy and effectiveness of medical care in neurology are discussed.