bulneur3_02

Å˙΄‡Ò͇ ç‚ÓÎÓ„ËflBulgarian Neurology

àÁ‰‡ÌË ̇ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„ËflOfficial Journal of the Bulgarian Society of Neurology

íéå 2 / Åêéâ 3 ëÖèíÖåÇêà , 2002

VOLUME 2 / NUMBER 3 SEPTEMBER, 2002

ëöÑöêÜÄçàÖ

éÅáéêàçÓÁÓÎӄ˘ÂÌ ‡ÒÔÂÍÚ Ì‡ Ò‚ÂÚÓ‚˙ÚÂʇO. äÓ΂ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

ëΉÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl ÔË ÌflÍÓË ‰Ó·Ó͇˜ÂÒÚ‚ÂÌË ÏÓÁ˙˜ÌË ÎÂÁËËê. ä‡ÎÔ‡˜ÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

ÑËÒÙÓÌËË Ë ‰ËÁ‡ÚËË - ÍÎËÌËÍÓ-Ú‡Ô‚Ú˘ÌË ‡ÒÔÂÍÚË ‚ Ì‚ÓÎÓ„ËflÚ‡É. ÄÌ„Ó‚, é. äÓ΂ . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

éêàÉàçÄãçà ëíÄíààäÎËÌ˘ÌÓ ÔÓÛ˜‚‡Ì ̇ ÂÙÂÍÚË‚ÌÓÒÚڇ̇ Betaferon® ÔË Ô‡ˆËÂÌÚË Ò ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡äÒ. äÏÂÚÒ͇, Ñ. ÉÂÓ„Ë‚, à. åË·ÌÓ‚ . . . . . . . . . . . .80

Ä΄ÓËÚ˙Ï Á‡ ËÁÒΉ‚‡ÌÂ Ë ÏÓÌËÚÓˇÌ ̇ ·ÓÎÌË Ò˙ÒÒÛ·‡‡ıÌÓˉÂÌ Í˙‚ÓËÁÎË‚ ˜ÂÁ ÍÓÌ‚Â̈ËÓ̇Î̇ڇÌÒ͇ÌˇÎ̇ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËflå. äÎËÒÛÒÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒΉ‚‡Ì ̇ ‡ÏÔÎËÚÛ‰‡Ú‡ ËÔÎÓ˘Ú‡ ̇ ÏÓÚÓÌËÚ ÓÚ„Ó‚ÓË ÔË ËÚÏ˘̇ÒÚËÏÛ·ˆËfl (ÌÓχÚË‚ÌË ÒÚÓÈÌÓÒÚË)ë. çÓ‚‡˜ÍÓ‚‡, å. ꇯ‚‡ . . . . . . . . . . . . . . . . . . . . . .85

ã˜ÂÌË ̇ ÂÔËÎÂÔÒËËÚ ‚ ·ÓÎÌ˘ÌË ÛÒÎÓ‚Ëfl -ÔÓ͇Á‡ÌËfl, ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ, ωË͇ÏÂÌÚË

å. ꇯ‚‡, ã. ·ÌÓ‚, Ç. íÓ̘‚‡ . . . . . . . . . . . . .88

î‡ÏËÎ̇ ‡ÏËÓÚÓÙ˘̇ ·Ú‡Î̇ ÒÍÎÂÓÁ‡ëÚ.뇇ÙÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

EFNS announcement燈ËÓ̇ÎÂÌ ÍÓÌÒÂÌÒÛÒ Á‡ ‰Ë‡„ÌÓÁ‡ Ë Î˜ÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ . . . . . . . . . . . . . . . . . . . . . .97

CONTENTS

REVIEWSVertigo - a nosological aspectO. Kolev . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Postoperative epilepsy and benign brain lesions

R. Kalpachki . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Dysarthrias and dysphonias - clinical and therapeutic aspectsG. Angov, O. Kolev . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

ORIGINAL PAPERSEfficacy of Betaferon® in patientswith multiple sclerosis: A clinical studyKs. Kmetska., D.Georgiev, I. Milanov . . . . . . . . . . . . . .80

Algorithm for examination and monitoring of patientswith subarachnoid haemorrhage using conventionaltranscranial DopplerM Klissurski . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Electromyographical study of the amplitude and ‡rea of the motor responses by repetitive stimulation (normative values)S. Novachkova, M. Rasheva . . . . . . . . . . . . . . . . . . . . .85

Epilepsy treatment in hospital conditions - indications, duration, and antiepileptic drugsM. Rasheva, L. Haralanov, V. Toncheva . . . . . . . . . . . .88

Familial amyotrophic lateral sclerosisSt. Sarafov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

EFNS announcementNational consensus for diagnosis and treatment of multiple sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . .97

ISSN 1311-8641

Å˙΄‡Ò͇ ç‚ÓÎÓ„ËflBulgarian Neurology

àÁ‰‡ÌË ̇ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„ËflOfficial Journal of the Bulgarian Society of Neurology

êÖÑÄäñàéççÄ äéãÖÉàü EDITORS

ÄÎÂÍÒË‚ Ä. ëÓÙËfl Alexiev A. Sofia

ŇÈÍۯ‚ ë. èÎÓ‚‰Ë‚ Baykushev S. Sofia

ÅÂÎÓÔËÚÓ‚‡ ã. ëÓÙËfl Belopitova L. Sofia

ÅÓÊËÌÓ‚ ëÚ. è΂ÂÌ Bojinov St. Pleven

LJÒË΂‡ í. èÎÓ‚‰Ë‚ Vassileva T. Plovdiv

ÇÂ΂‡ ëÚ. ëÓÙËfl Veleva St. Sofia

ɇÌ‚‡ É. ëÓÙËfl Ganeva G. Sofia

ÉÂÓ„Ë‚ Ñ. ëÓÙËfl Georgiev D. Sofia

ɇÒËÏÓ‚ Å. ëÓÙËfl Gerassimov B Sofia

ÉË„ÓÓ‚‡ é. ëÓÙËfl Grigorova O. Sofia

ÑÂ΂‡ ç. LJ̇ Deleva N. Varna

ÑÂÌÒÍË Ç Ç‡Ì‡ Drensky V. Varna

á‡ı‡Ë‚ á. èÎÓ‚‰Ë‚ Zahariev Z. Plovdiv

à‚‡ÌÓ‚‡ ã. ëÓÙËfl Ivanova L. Sofia

à¯ÔÂÍÓ‚‡ Å. ëÓÙËfl Ishpekova B. Sofia

âÓÚÓ‚‡ ê. ëÓÙËfl Iotova R. Sofia

äÓ΂ é. ëÓÙËfl Kolev O. Sofia

ä˛˜ÛÍÓ‚ å. ëÓÙËfl Kyuchukov M. Sofia

å‡Ì˜Â‚ à. ëÚ.ᇄӇ Manchev I. St. Zagora

åË·ÌÓ‚ à. ëÓÙËfl Milanov I. Sofia

åË̘‚ Ñ. LJ̇ Minchev D. Varna

çËÍÓ‚ÒÍË ç. ëÓÙËfl Nikoevsky N. Sofia

èÂÚÓ‚ à. ëÓÙËfl Petrov I. Sofia

èÓÔÓ‚‡ å. è΂ÂÌ Popova M. PlÂven

ꇯ‚‡ å. ëÓÙËfl Rasheva M. Sofia

ÂÁÓ‚‡ ã. LJ̇ Havezova L. Varna

ÊË‚ Ñ. ëÓÙËfl Hadjiev D. Sofia

ÊËÔÂÚÓ‚‡ Ö. èÎÓ‚‰Ë‚ Hadjipetrova E. Plovdiv

ñ‡ÌÍÓ‚‡ ñ. ëÓÙËfl Tzankova Tz. Sofia

ñ‚ÂÚ‡ÌÓ‚‡ Ö. ëÓÙËfl Tzvetanova E. Sofia

󇂉‡Ó‚ Ñ. ëÓÙËfl Chavdarov D. Sofia

ó‡ÎχÌÓ‚ Ç. ëÓÙËfl Chalmanov D. Sofia

ó‡Î˙ÍÓ‚‡ ç. èÎÓ‚‰Ë‚ Chalakova N. Plovdiv

òÓÚÂÍÓ‚ è. ëÓÙËfl Shotekov P. Sofia

ü̘‚‡ ë. ëÓÙËfl Yancheva S. Sofia

ÉãÄÇçà êÖÑÄäíéêà EDITORS IN CHIEF

Ñ.ó‡Í˙Ó‚, è. ëÚ‡ÏÂÌÓ‚‡, à. ÇÂΘ‚‡ D. Chakarov, P. Stamenova, I. Velcheva

ëÖäêÖíÄê SECRETARY

å. чÒ͇ÎÓ‚ M. Daskalov

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Ì‚ÓÎÓ„ËflÚ‡. ëÔËÒ‡ÌËÂÚÓ Ò˙‰˙ʇ ÒΉÌËÚ ۷ËÍË:

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éË„Ë̇ÎÌËÚ ÒÚ‡ÚËË ‚Íβ˜‚‡Ú ͇Ú˙Í Û‚Ó‰, ÍÓÌÚËÌ„ÂÌÚ,

ÏÂÚÓ‰Ë, ÂÁÛÎÚ‡ÚË, Ó·Ò˙ʉ‡ÌÂ Ë ÍÌË„ÓÔËÒ.

ᇄ·‚̇ڇ ÒÚ‡Ìˈ‡ Ò˙‰˙ʇ Ô˙ÎÌÓ Ë Ò˙͇ÚÂÌÓ Á‡„·‚ËÂ,

ËÏÂ̇ڇ ̇ ‡‚ÚÓËÚÂ Ò ËÌˈˇÎËÚ ËÏ, ÚÂıÌËÚ ‡Í‡‰ÂÏ˘ÌË

ÒÚÂÔÂÌË Ë ÏÂÒÚÓ‡·ÓÚ‡, ‡‰ÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl Ò ÚÂÎÂÙÓÌ, Ù‡ÍÒ

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ÍÓÌ„ÂÒË Ë ÍÓÌÙÂÂ̈ËË, ÌÓ‚Ë ÍÌË„Ë, ‡ÍÚÛ‡Î̇ ÎÂ͇ÒÚ‚Â̇ ËÌÙÓ-

χˆËfl , Ô‰ÒÚÓfl˘Ë Ò˙·ËÚËfl.

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Ò‡ÌËfl ̇ ÒÎÛ˜‡Ë Ë ‰ËÒÍÛÒËË ÔÓ ‡ÍÚÛ‡ÎÌË ÔÓ·ÎÂÏË .

ëÚ‡ÚËËÚ Úfl·‚‡ ‰‡ ·˙‰‡Ú Ô‰ÒÚ‡‚ÂÌË Ì‡ ‰ËÒÍÂÚ‡, Á‡ÔË-

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ÍÓ Á‡„·‚ËÂ.

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ÚÓ˜ÌˈËÚ ̇ ÍËËÎˈ‡, ‡ ÒΉ Úflı ̇ ·ÚËÌˈ‡. ᇄ·‚ËflÚ‡ ‰‡ ÒÂ

Ô‰ÒÚ‡‚flÚ ËÁˆflÎÓ. Ç ÚÂÍÒÚ‡ ˆËÚˇÌËÚ ‡‚ÚÓË ‰‡ Ò Ô‰ÒÚ‡-

‚flÚ Ò ÔÓ‰ÂÌ ÌÓÏ ÓÚ ÍÌË„ÓÔËÒ‡. чÌÌËÚ ‚ ÍÌË„ÓÔËÒ‡ Ò Ô‰Ò-

Ú‡‚flÚ ÔÓ ÒΉÌËfl ̇˜ËÌ:

ëÚ‡ÚËfl ÓÚ ÒÔËÒ‡ÌË : Ä‚ÚÓ /Ë/. ᇄ·‚Ë ̇ ÒÚ‡ÚËflÚ‡.

ᇄ·‚Ë ̇ ÒÔËÒ‡ÌËÂÚÓ / Ò˙͇ÚÂÌÓ ÔÓ Index medicus/, ÚÓÏ, „Ó‰Ë̇

̇ ËÁ‰‡‚‡ÌÂ, ÌÓÏ ̇ ÍÌËÊ͇ڇ, ÒÚ‡Ìˈ‡ / ÓÚ-‰Ó/. èËÏ :

Andersen, G., Vestergaard, K., Lauritzen, L. Effective treatment of post-

stroke depression with the selective serotonin reuptake inhibitor citalo-

pram. Stroke, 25, 1994, 6, 1099-1104.

äÌË„‡ : Ä‚ÚÓ /Ë/ . ᇄ·‚ËÂ. èÓ‰Á‡„·‚ÌË ‰‡ÌÌË. åÂÒÚÓËÁ‰‡-

‚‡ÌÂ, ËÁ‰‡ÚÂÒÚ‚Ó, „Ó‰Ë̇ ̇ ËÁ‰‡‚‡ÌÂ, ÒÚ‡Ìˈ‡ /ÓÚ-‰Ó/.èËÏ :

Calligaro,K., DeLaurentis, D., Baker, W. Management of Extracranial

Cerebrovascular Disease.Philadelphia-New York, Lippincott - Raven

Publishers, 1997, 217.

èÛ·ÎË͇ˆËË ÓÚ Ò·ÓÌËÍ : Ä‚ÚÓ /Ë/. ᇄ·‚ËÂ: - Ç: ᇄ·‚ËÂ

̇ Ò·ÓÌË͇. àÁ‰‡ÚÂÎ /Ë/. åÂÒÚÓËÁ‰‡‚‡ÌÂ, „Ó‰Ë̇ ̇ ËÁ‰‡‚‡ÌÂ,

ÒÚ‡Ìˈ‡ / ÓÚ-‰Ó/. èËÏ : Binnie, C. , Jeavsons , .M. Photosensitive

epilepsies. In : Epileptic syndromes in infancy, childhood and adoles-

cence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E. Dreifuss, A.Perret ,

P.Wolf. London, John Libbey & Company, Ltd, 1992, 299-305.

Ä‚ÚÓËÚ ÔÓ‰ÔËÒ‚‡Ú ‰ÂÍ·‡ˆËfl, ˜Â Ô‰ÓÒÚ‡‚ÂÌËfl χÚÂ-

ˇΠÌ  Ô‰ÎÓÊÂÌ Á‡ Ô˜‡Ú ̇ ‰Û„Ó ÏflÒÚÓ.

è‰ÓÒÚ‡‚ÂÌËÚ χÚ¡ÎË Ë ÓÔËÒ‡ÌËÚ ‚ Úflı ËÁÒΉ‚‡ÌËfl

Úfl·‚‡ ‰‡ ÓÚ„Ó‚‡flÚ Ì‡ ÂÚ˘ÌËÚ Òڇ̉‡ÚË

èË Ò˙‡‚ÚÓÒÚ‚Ó ÛÚ‚˙‰Â̇ڇ Á‡ Ô˜‡Ú ÒÚ‡ÚËfl Úfl·‚‡ ‰‡

·˙‰Â ÔÓ‰ÔË҇̇ ÓÚ ‚Ò˘ÍË ‡‚ÚÓË.

ê˙ÍÓÔËÒËÚ ‚ ‰‚‡ ÂÍÁÂÏÔÎfl‡ (ËÎË Â‰ËÌ ÂÍÁÂÏÔÎfl Ë ‰ËÒÍÂÚ‡)

ËÁÔ‡˘‡ÈÚ ̇ ‡‰ÂÒ :

ëÓÙËfl 1504, ìÎ. 4 ÅflÎÓ ÏÓ " ‹ 8åÅÄã " ñ‡Ëˆ‡ âÓ‡Ì̇" - ÖÄÑ äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl èÓÙ. è.ëÚ‡ÏÂÌÓ‚‡

INSTRUCTION FOR AUTHORS

Bulgarian Neurology is the official journal of the Bulgarian Society of

Neurology. It will consider for publication papers in neurology and relat-

ed areas in the following categories:

-Editorials, consisting of up to 3 pages, when approved by the

Editorial Board

-Original papers - up to 8 pages, including tables, figures and ref-

erences. An abstract in Bulgarian and English up to 40 rows on a sep-

arate sheet is required. The abstract should contain title, authors,

objective, background, methods, results and conclusions plus up to 6

keywords.

The original papers include short introduction, material, methods

results, discussion and references.

The title page should carry the full title, the short running title,

the authors with their initials, academic degrees, institutional affilia-

tions, address for correspondence, with telephone, fax and e-mail

-Short communications and case reports up to 3 pages

-Review articles up to 10 pages

-Book reviews and information. It includes information for new

books, congresses and conferences, new drugs, future events in neurolo-

gy

-Letters to the Editor with comments on previously published

papers, short case reports and discussion on current problems

-The manuscripts should be submitted on diskette / 3.5 inch/

using Word 6/Windows 96 or Word7/Windows 98 with a printed copy.

The tables should be presented on separate sheets with a short

heading

The illustrations /figures, diagrams, formulas/ should be ready for

reproduction.

Explanatory legends should be provided on a separate sheet of paper .

References should be presented in alphabetic order on a separate

sheet with all authors` names and full title of papers . In the text the

authors should be indicated by the number from the reference list .

The reference should be presented as follows:

Journal paper : (1) author(s), (2)title, (3) journal name ( as abbre-

viated in Index Medicus ). (4) volume, (5) year of publication, (6) jour-

nal number , (7) inclusive pages. Example: Andersen, G., Vestergaard,

K., Lauritzen, L. Effective treatment of poststroke depression with the

selective serotonin reuptake inhibitor citalopram. Stroke, 25, 1994, 6,

1099-1104.

Book : (1) author(s), (2) title, (3) city of publication, (4) publisher,

(5) year of publication , (6) pages. Example : Calligaro,K., DeLaurentis,

D., Baker, W. Management of Extracranial Cerebrovascular

Disease.Philadelphia-New York, Lippincott - Raven Publishers, 1997,

217.

References to books : (1) authors(s), (2) chapter title, (3) title of

book, (4) editor(s), (5) city of publication, (6) publisher, (7) year of pub-

lication, (8) specific pages. Example : Binnie, C. , Jeavsons , .M.

Photosensitive epilepsies. In : Epileptic syndromes in infancy, child-

hood and adolescence , eds. J.Roger, M. Bureau, Ch.Dravet, F.E.

Dreifuss, A.Perret , P.Wolf. London, John Libbey & Company, Ltd,

1992, 299-305.

The articles are considered for publication on the understanding

that the presented material has not been published or is being submitted

elsewhere before appearing in BULGARIAN NEUROLOGY.

Authors should indicate that ethical approval of the study was

granted and that informed consent was given.

All authors should approve and sign the final manuscript.

Manuscript with one copy (or a diskette and a copy) should be

sent to the following address:

Sofia 1504, Bulgaria, 8, Bialo more str.Department of Neurology University Hospital ◊ Queene Jovanna“: Prof. P. Stamenova

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 71‡ÔËÎ, 2002

ëöÑöêÜÄçàÖ

éÅáéêàçÓÁÓÎӄ˘ÂÌ ‡ÒÔÂÍÚ Ì‡ Ò‚ÂÚÓ‚˙ÚÂʇO. äÓ΂ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

ëΉÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl ÔË ÌflÍÓˉӷÓ͇˜ÂÒÚ‚ÂÌË ÏÓÁ˙˜ÌË ÎÂÁËËê. ä‡ÎÔ‡˜ÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

ÑËÒÙÓÌËË Ë ‰ËÁ‡ÚËË - ÍÎËÌËÍÓ-Ú‡Ô‚Ú˘ÌˇÒÔÂÍÚË ‚ Ì‚ÓÎÓ„ËflÚ‡É. ÄÌ„Ó‚, é. äÓ΂ . . . . . . . . . . . . . . . . . . . . . . . .77

éêàÉàçÄãçà ëíÄíààäÎËÌ˘ÌÓ ÔÓÛ˜‚‡Ì ̇ ÂÙÂÍÚË‚ÌÓÒÚڇ̇ Betaferon® ÔË Ô‡ˆËÂÌÚËÒ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡äÒ. äÏÂÚÒ͇, Ñ. ÉÂÓ„Ë‚, à. åË·ÌÓ‚ . . . . . . .80

Ä΄ÓËÚ˙Ï Á‡ ËÁÒΉ‚‡ÌÂ Ë ÏÓÌËÚÓˇÌ ̇ ·ÓÎÌËÒ˙Ò ÒÛ·‡‡ıÌÓˉÂÌ Í˙‚ÓËÁÎË‚ ˜ÂÁ ÍÓÌ‚Â̈ËÓ̇Î̇ڇÌÒ͇ÌˇÎ̇ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËflå. äÎËÒÛÒÍË . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒΉ‚‡Ì ̇ ‡ÏÔÎËÚÛ‰‡Ú‡ ËÔÎÓ˘Ú‡ ̇ ÏÓÚÓÌËÚ ÓÚ„Ó‚ÓË ÔË ËÚÏ˘̇ÒÚËÏÛ·ˆËfl (ÌÓχÚË‚ÌË ÒÚÓÈÌÓÒÚË)ë. çÓ‚‡˜ÍÓ‚‡, å. ꇯ‚‡ . . . . . . . . . . . . . . . . . .85

ã˜ÂÌË ̇ ÂÔËÎÂÔÒËËÚ ‚ ·ÓÎÌ˘ÌË ÛÒÎÓ‚Ëfl -ÔÓ͇Á‡ÌËfl, ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ, ωË͇ÏÂÌÚËå. ꇯ‚‡, ã. ·ÌÓ‚, Ç. íÓ̘‚‡ . . . . . . . . .88

î‡ÏËÎ̇ ‡ÏËÓÚÓÙ˘̇ ·Ú‡Î̇ ÒÍÎÂÓÁ‡ëÚ.뇇ÙÓ‚ . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

ÖÎÂÍÚÓÏËÓ„‡ÙÒÍÓ ËÁÒΉ‚‡Ì ̇ Ô‡ˆËÂÌÚË ÒÏˇÒÚÂÌËfl „‡‚ËÒ Ò ËÚÏ˘̇ ÒÚËÏÛ·ˆËfl ̇n.ulnarisë. çÓ‚‡˜ÍÓ‚‡, Å.à¯ÔÂÍÓ‚‡ . . . . . . . . . . . . . . . . .93

àçîéêåÄñàà à êÖñàçáàà12 Ò¢‡ ̇ E‚ÓÔÂÈÒ͇ڇ ‡ÒӈˇˆËflÔÓ Ì‚ÓÎÓ„Ëfl, ÅÂÎËÌ 2002 . . . . . . . . . . . . . . . .96

EFNS announcement燈ËÓ̇ÎÂÌ ÍÓÌÒÂÌÒÛÒ Á‡ ‰Ë‡„ÌÓÁ‡ Ë Î˜ÂÌË ̇ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ . . . . . . . . . . . . . . . . . . . .97

CONTENTS

REVIEWSVertigo - a nosological aspectO. Kolev . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Postoperative epilepsy and benign brain lesions

R. Kalpachki . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Dysarthrias and dysphonias - clinical and therapeuticaspectsG. Angov, O. Kolev . . . . . . . . . . . . . . . . . . . . . . .77

ORIGINAL PAPERSEfficacy of Betaferon® in patientswith multiple sclerosis: A clinical study

Ks. Kmetska., D.Georgiev, I. Milanov . . . . . . . . .80

Algorithm for examination and monitoring of patientswith subarachnoid haemorrhage using conventional tran-scranial Doppler M Klissurski . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Electromyographical study of the amplitude and ‡rea ofthe motor responses by repetitive stimulation (normativevalues)S. Novachkova, M. Rasheva . . . . . . . . . . . . . . . . .85

Epilepsy treatment in hospital conditions - indications,duration, and antiepileptic drugsM. Rasheva, L. Haralanov, V. Toncheva . . . . . . . .88

Familial amyotrophic lateral sclerosisSt. Sarafov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

Electromyographycal study of patients with myastheniagravis using repetitive stimulation of n.ulnaris

S.Novachkova, B.Ishpekova . . . . . . . . . . . . . . . . .93

INFORMATION AND REVIEWS12th meeting of ENS, Berlin 2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96

EFNS announcementNational consensus for diagnosis and treatment of multiple sclerosis . . . . . . . . . . . . . . . . . . . . . . .97

IN MEMORIAM

Ç èÄåÖí çÄ èêéî. ëÄòé çàäéãéÇ ÅéÜàçéÇ(13.12.1914 - 11.8.2002)

삇ʇÂÏË ÍÓ΄Ë,ç‡ 11.8.2002 „. ÔÓ˜Ë̇ ‚ˉÌËfl ·˙΄‡ÒÍË ÎÂ͇ - Ì‚Ó-

ÎÓ„ ÔÓÙ. ë‡¯Ó ÅÓÊËÌÓ‚, ‰.Ï.Ì., ÓÒÌÓ‚‡ÚÂΠ̇ Ò˙‚ÂÏÂÌ-̇ڇ Ì‚ÓÎӄ˘̇ ¯ÍÓ· ‚ Å˙΄‡Ëfl. ë Ì„ӂ‡Ú‡ ÒÏ˙Ú·˙΄‡Ò͇ڇ ωˈË̇ Á‡„Û·Ë Â‰ËÌ „ÓÎflÏ ËÁÒΉӂ‡ÚÂÎ,Ô‰‡„Ó„ Ë Î˜ËÚÂÎ, ÓÚ‰‡Î ÊË‚ÓÚ‡ ÒË Ì‡ Ì‡È - ıÛχÌ̇ڇÔÓÙÂÒËfl - ωˈË̇ڇ.

èÓÙ. ÅÓÊËÌÓ‚ ·Â¯Â ËÁÍβ˜ËÚÂÎÂÌ ÔÂÔÓ‰‡‚‡ÚÂÎ, ÎÂ-͇-‰Ë‡„ÌÓÒÚËÍ Ë Ò‚ÂÚÓ‚ÌÓ ÔËÁÌ‡Ú Û˜ÂÌ - ‡‚ÚÓ Ì‡ Â-‰Ëˆ‡ ÏÓÌÓ„‡ÙËË Ë Û˜Â·ÌËˆË ÔÓ Ì‚ÓÎÓ„Ëfl. 燉 40 „ ÓÚÒ‚Ófl ÊË‚ÓÚ ÔÓÙ. ÅÓÊËÌÓ‚ ÓÚ‰‡‰Â Á‡ ÔÓ‰„ÓÚӂ͇ڇ ̇ÔÓÍÓÎÂÌËfl ÒÚÛ‰ÂÌÚË ÔÓ Ï‰ˈË̇ Ë ·˙΄‡ÒÍË Ì‚ÓÎÓÁË.íÓÈ ·Â¯Â ‰˙΄ӄӉ˯ÂÌ ˙ÍÓ‚Ó‰ËÚÂΠ̇ ä‡Ú‰‡Ú‡ ÔÓÌ‚ÓÎÓ„Ëfl ÔË å‰ˈËÌÒÍË Ù‡ÍÛÎÚÂÚ Ì‡ Çåà - ëÓÙËfl,ÑÂÍ‡Ì Ì‡ å‰ˈËÌÒÍËfl Ù‡ÍÛÎÚÂÚ Ë á‡ÏÂÒÚÌËÍ ÂÍÚÓ̇ å‰ˈËÌÒ͇ ‡Í‡‰ÂÏËfl Ë ç‡ˆËÓ̇ÎÂÌ ÍÓÌÒÛÎÚ‡ÌÚ ÔÓÌ‚ÓÎÓ„Ëfl.

èÓÙ.ë‡¯Ó ÅÓÊËÌÓ‚  ӉÂÌ Ì‡ 13 ‰ÂÍÂÏ‚Ë 1914 „. ‚Ò.ï‡È‰ËÌ, LJ˜‡ÌÒÍÓ, Á‡‚˙¯ËÎ Ò ÓÚ΢ˠIII å˙Ê͇„ËÏ̇ÁËfl ‚ ëÓÙËfl Ë å‰ˈËÌÒÍËfl Ù‡ÍÛÎÚÂÚ Í˙Ï ëÓÙËÈÒ-ÍËfl ÛÌË‚ÂÒËÚÂÚ ÔÂÁ 1939 „. Ò ÚÂÁ‡-‰ÓÍÚÓ‡Ú "Ç˙ıÛ‡Ì̇ڇ ‰Ë‡„ÌÓÁ‡ ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡", Ò ÍÓflÚÓÁ‡ÔÓ˜‚‡ Ì„ӂ‡Ú‡ ÓËÂÌÚ‡ˆËfl Í˙Ï Ì‚ÓÎÓ„ËflÚ‡. ëΉ‰ËÔÎÓÏˇÌÂÚÓ ÒË Â Û˜‡ÒÚ˙ÍÓ‚ ÎÂ͇ ‚ Ò·ڇ äÓÁ‡ÒÍÓË Å‡Ú‡Í - è¢ÂÒÍÓ. éÚ 1942 - 1946 „Ó‰Ë̇  ‰ӂÂ̇ÒËÒÚÂÌÚ ÔÓ Ô‡ÚÓÎӄ˘̇ ‡Ì‡ÚÓÏËfl Í˙Ï å‰ˈËÌÒÍËflÙ‡ÍÛÎÚÂÚ. éÚ 1946 „. ‰- ë‡¯Ó ÅÓÊËÌÓ‚  ‰ӂÂÌ ‡ÒËÒ-ÚÂÌÚ ‚ ä‡Ú‰‡Ú‡ ÔÓ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl. èÂÁflÌÛ‡Ë 1956 „.  ËÁ·‡Ì Á‡ ‰ӂÂÌ ‰ÓˆÂÌÚ ÔÓ Ì‚ÓÎÓ„ËflË ÒÚ‡‚‡ Ô˙‚ËflÚ ˙ÍÓ‚Ó‰ËÚÂΠ̇ ÌÓ‚‡Ú‡, Ò‡ÏÓÒÚÓflÚÂÎ-̇ ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl ‚ å‰ˈËÌÒÍËfl Ù‡ÍÛÎÚÂÚ Ì‡Çåà. éÚ 1960 „.  ÔÓÙÂÒÓ ‚ è˙‚‡ Ì‚ÓÎӄ˘̇ ÍÎËÌË-͇ Ë ˙ÍÓ‚Ó‰ËÚÂΠ̇ ä‡Ú‰‡Ú‡ ÔÓ Ì‚ÓÎÓ„Ëfl. ëΉ Ò˙Á-‰‡‚‡Ì ̇ å‰ˈËÌÒ͇ڇ Ä͇‰ÂÏËfl Ë Ì‡ ç‡Û˜ÌËfl ËÌÒÚË-ÚÛÚ ÔÓ Ì‚ÓÎÓ„Ëfl, ÔÒËıˇÚËfl Ë Ì‚ÓıËÛ„Ëfl, ÚÓÈ Â˙ÍÓ‚Ó‰ËÚÂΠ̇ ӷ‰ËÌÂ̇ڇ ͇Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl Ë Á‡-ÏÂÒÚÌËÍ ‰ËÂÍÚÓ Ì‡ ËÌÒÚËÚÛÚ‡.

èÓÙ. ÅÓÊËÌÓ‚ ·Â¯Â ÂÛ‰Ë‡Ì Ë Ò‚ÂÚÓ‚ÌÓ ÔËÁ̇ڷ˙΄‡ÒÍË Û˜ÂÌ- Ì‚ÓÎÓ„ Ë Ì‚ÓÔ‡ÚÓÎÓ„. Ç Ì‡Û˜ÌËÚ ÒËÚÛ‰Ó‚Â ÔÓÙ. ÅÓÊËÌÓ‚ Ò˙˜ÂÚ‡‚‡¯Â ÍÓÏÔÎÂÍÒÌÓÚÓ ÍÎË-Ì˘ÌÓÚÓ Ì‡·Î˛‰ÂÌËÂ Ò ÏÓÙÓÎӄ˘ÌËÚ - ıËÒÚÓÎӄ˘ÌË,ıËÒÚÓıËÏ˘ÌË Ë ÂÍÒÔÂËÏÂÌÚ‡ÎÌË, ÂÎÂÍÚÓÙËÁËÓÎӄ˘-ÌË, Ì‚ÓıËÏ˘ÌË Ë ËÁÓÚÓÔÌË ËÁÒΉ‚‡ÌËfl.

ç‡Û˜Ì‡Ú‡ ÏÛ ‰ÂÈÌÓÒÚ Ó·ı‚‡˘‡ ̇‰ 300 ÚÛ‰‡ ÔÓ ÔÓ·-ÎÂÏËÚ ̇ Ò˙‚ÂÏÂÌÌËÚ Â̈ÂÙ‡ÎËÚË, ËÌÚÓÍÒË͇ˆËËÚÂ,ÚÛÏÓËÚÂ Ë ‰ËÒÚÓÙ˘ÌËÚ Á‡·ÓÎfl‚‡ÌËfl ̇ Ì‚̇ڇÒËÒÚÂχ, ÔÛ·ÎËÍÛ‚‡ÌË Ì‡ ·˙΄‡ÒÍË, ÛÒÍË, ÙÂÌÒÍË, ‡Ì„-ÎËÈÒÍË, ÔÓÎÒÍË Ë ÛÌ„‡ÒÍË ÂÁˈË. Ä‚ÚÓ Ë Ò˙‡‚ÚÓ Â Ì‡ 23ÏÓÌÓ„‡ÙËË, ۘ·ÌËˆË Ë ˙ÍÓ‚Ó‰ÒÚ‚‡ ÔÓ Ì‚ÓÎÓ„Ëfl.

èÓÙ. ë. ÅÓÊËÌÓ‚ Ôˉӷ˂‡ ÏÂʉÛ̇Ӊ̇ ËÁ‚ÂÒÚÌÓÒÚÒ ËÁÒΉ‚‡ÌËflÚ‡ ÒË ‚˙ıÛ ÓÒÚËfl Ò˙‚ÂÏÂÌÂÌ Ô‡ÍËÌÒÓ-ÌÓ‚ Â̈ÂÙ‡ÎËÚ, ıËÔÂÍËÌÂÚ˘ÌËfl ÔÓ„ÂÒˇ˘ Ô‡ÌÂ̈Â-Ù‡ÎËÚ, Ò˙‚ÂÏÂÌÌËÚ Ì‚ÓËÌÙÂ͈ËË. éÔËÒ‡ÌËflÚ ÓÚÌÂ„Ó Ò˙‚ÂÏÂÌÂÌ ÓÒÚ˙ Ô‡ÍËÌÒÓÌÓ‚ Â̈ÂÙ‡ÎËÚ (1965 „.)͇ÚÓ ‡Ì‡ÚÓÏÓ-ÍÎËÌ˘ÌÓ Ë ÌÓÁÓÎӄ˘ÌÓ Ó·ÓÒÓ·Â̇ ÙÓÏ‡Ë ‰Ó Ò„‡ Ò ˆËÚˇ ‚ Á‡Ô‡‰ÌË ÒÔËÒ‡ÌËfl ÔÓ Â̈ÂÙ‡ÎËÚÌËflÔÓ·ÎÂÏ.

ᇠÍÓÏÔÎÂÍÒÌËÚ ËÁÒΉ‚‡ÌËfl ‚˙ıÛ ıËÔÂÍËÌÂÚ˘ÌËflÔÓ„ÂÒˇ˘ Ô‡ÌÂ̈ÂÙ‡ÎËÚ Â Û‰ÓÒÚÓÂÌ ÔÂÁ 1969 „. ÒÑ˙ʇ‚̇ ̇„‡‰‡. èÓÛ˜‚‡ÌËflÚ‡ ÏÛ ‚˙ıÛ Ò‡Î‚‡Á‡ÌÓ-‚‡Ú‡ Â̈ÂÙ‡ÎÓÔ‡ÚËfl ËÏ‡Ú ‚‡ÊÌÓ Á̇˜ÂÌË Á‡ ËÁflÒÌfl‚‡ÌÂÙÛÌ͈ËËÚ ̇ Í˙‚ÌÓÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡, ‡ ÚÂÁË ‚˙ıÛÍÓÌ„ÎÓχÚÌËfl ÏÓÁ˙˜ÂÌ ÚÛ·ÂÍÛÎ - Á‡ Ô‡ÚÓ„ÂÌÂÁ‡Ú‡ ̇ÏÓÁ˙˜Ì‡Ú‡ ÚÛ·ÂÍÛÎÓÁ‡. èËÌÓÒÂÌ ı‡‡ÍÚ ‚ ÏÂʉÛ̇-Ó‰ÂÌ ‡ÒÔÂÍÚ ËÏ‡Ú Ì„ӂËÚ ÔÓÛ˜‚‡ÌËfl ‚˙ıÛ ıËÒÚÓ-Ô‡ÚÓÎӄ˘ÌËÚÂ Ë ıËÒÚÓıËÏ˘ÌË ÍÓ·ˆËË Ì‡ ‡Á΢ÌË-Ú ÚËÔÓ‚Â ÏÓÁ˙˜ÌË ÚÛÏÓË Ò Ó„Î‰ ËÁflÒÌfl‚‡Ì ıËÒÚÓ„Â-ÌÂÁ‡Ú‡ Ë ÔÓfl‚ËÚ ̇ ‰ËÙÂÂ̈ˇˆËfl Ë ‡Ì‡Ô·ÁËfl. è‡Í-Ú˘ÂÒÍË ÔËÌÓÒ ËÏ‡Ú Â‰Ëˆ‡ ÌÂ„Ó‚Ë ÏÓÌÓ„‡ÙËË "èÓÎË-Ì‚ËÚË Ë ÔÓÎËÌ‚ÓÔ‡ÚËË", "åËÓÔ‡ÚËË", "íËıËÌÂÎÓÁÂÌÔÓÎËÏËÓÁËÚ", "ëËÌÚÂÚ˘̇ Ì‚ÓÎÓ„Ëfl", "Ñˇ„ÌÓÒÚËÍ‡Ë ‰ËÙÂÂ̈ˇÎ̇ ‰Ë‡„ÌÓÒÚË͇ ̇ Ì‚ÓÎӄ˘ÌËÚ Á‡·ÓÎfl-‚‡ÌËfl", ͇ÍÚÓ Ë ÔÓÛ˜‚‡ÌËflÚ‡ ‚˙ıÛ ÓÒÓ·ÂÌÓÒÚËÚ ̇ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ‚ ‰ÂÚÒ͇ڇ ‚˙Á‡ÒÚ, ‰ÍËÚÂÙÓÏË Ì‡ ÏÓÁ˙˜ÌË ËÌÒÛÎÚË, Ì‚ÓÎӄ˘ÌËÚÂ Ë Ì‚ÓÔ‡-ÚÓÎӄ˘ÌË ‡ÒÔÂÍÚË Ì‡ ÍÓ·„ÂÌÓÁËÚ ̇ Ì‚̇ڇ ÒËÒÚÂ-χ, ÂÍÒÔÂËÏÂÌÚ‡ÎÌËÚ ÂÔËÎÂÔÒËË Ë ‰. óÂÚËËÚ ËÁ‰‡ÌËfl ̇ ۘ·ÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl Ë ˙ÍÓ‚Ó‰-ÒÚ‚‡ ÔÓ Ì‚ÓÎÓ„Ëfl ·flı‡ Ë Ò‡ ̇ÒÚÓÎ̇ ÍÌË„‡ Á‡ Ó·Û˜ÂÌËÂ̇ ÔÓÍÓÎÂÌËfl ÒÚÛ‰ÂÌÚË Ë ·˙΄‡ÒÍË Ì‚ÓÎÓÁË.

èÓÙ. ë. ÅÓÊËÌÓ‚ ·Â¯Â ËÁÍβ˜ËÚÂÎÂÌ Ô‰‡„Ó„, ‡Ú‡Í-ÚË‚ÂÌ ÎÂÍÚÓ, ӷ˘‡Ì ÓÚ ÒÚÛ‰ÂÌÚË Ë ÒÔˆˇÎËÁ‡ÌÚË.íÓÈ ‚˙‚Â‰Â Ë ËÁÔÓÎÁÛ‚‡¯Â Ì‡È - Ò˙‚ÂÏÂÌÌË Á‡ ‚ÂÏÂÚÓ ÒËÙÓÏË Ì‡ ÔÂÔÓ‰‡‚‡ÌÂ Ë Ó·Û˜ÂÌËÂ. ë˙Á‰‡‰Â ·Ó„‡Ú‡ ÍÓÎÂÍ-ˆËfl ÓÚ Û˜Â·ÌË ÙËÎÏË ÔÓ Ì‚ÓÎÓ„Ëfl.

èÓÙ. ÅÓÊËÌÓ‚ ·Â ËÁÍβ˜ËÚÂÎÂÌ ÎÂ͇ - ‰Ë‡„ÌÓÒÚËÍ,ÔÓÏӄ̇Π̇ ıËÎfl‰Ë ıÓ‡ ÔÂÁ ‰˙΄ӄӉ˯̇ڇ ÒË ÍÎËÌ˘-̇ Ô‡ÍÚË͇. ÖÚ˘ÌÓÒÚÚ‡ ÏÛ, ˜Û‚ÒÚ‚ÓÚÓ Á‡ ÓÚ„Ó‚Ó-ÌÓÒÚ, ‚ËÒÓ͇ڇ ıÛχÌÌÓÒÚ Ë ·ÂÁÍÓËÒÚÌÓÒÚ Ò‡ ͇˜ÂÒÚ-‚‡ ÔËÒ˙˘Ë Á‡ ˜Ó‚Â͇ ë‡¯Ó ÅÓÊËÌÓ‚, ‰ÓÒÚÓÈÌË Á‡ Û‚‡ÊÂ-ÌËÂ Ë ÔËÏ Á‡ ̇Ò- ·˙΄‡ÒÍËÚ Ì‚ÓÎÓÁË.ÑÌÂÒ Ò ÔÂÍ·ÌflÏ Ô‰ ‰Ó‡ÈÂ̇ ̇ ·˙΄‡Ò͇ڇ Ì‚Ó-ÎÓ„Ëfl, ̇¯ËflÚ Û˜ËÚÂÎ Ë ÍÓ΄‡ ÔÓÙ. ë‡¯Ó ÅÓÊËÌÓ‚. çÂ-„Ó‚ËflÚ ÔÓÙÂÒËÓ̇ÎÂÌ ÊË‚ÓÚ ·Â¯Â χÍÒËχÎÌÓ ÓÚ‰‡‰ÂÌ̇ ıÓ‡Ú‡, ̇ ωˈËÌÒ͇ڇ ̇Û͇ Ë Ô‡ÍÚË͇.èÂÍ·ÌflÏ Ò Ô‰ ΢ÌÓÒÚÚ‡ Ë ÊË‚ÓÚ‡ ̇ ̇¯Ëfl ì˜Ë-ÚÂÎ, ÍÓ΄‡ Ë ÔËflÚÂÎ.

éÚ Å˙΄‡ÒÍÓÚÓ ‰ÛÊÂÒÚ‚Ó ÔÓ Ì‚ÓÎÓ„Ëfl

SUMMARYVERTIGO - NOSOLOGICAL ASPECT

O. KolevIn many diseases vertigo is a symptom of more or less

importance. Quite frequently the anamnesis will give enoughinformation for a tentative diagnosis to be possible. In othercases the anamnesis suggests the necessary examinations,which can help to unravel diagnostic puzzles. In still othercases sensations in the equilibrium field may be absent thoughthere are obvious disorders in the peripheral or centralvestibular system. Generally vertigo can be differentiated as:I. Paroxismal vertigo: attacks of vertigo separated by freeintervals; II. Acute vertigo, starting abruptly and thereafterslowly decreasing in intensity; III. Chronic vertigo, lesssevere, but continuing over a long period, often periodic orshowing changes in intensity. In some cases the position ofthe patient plays a part in the appearance of the symptoms.Key words: nosology, vertigo, vestibulometry.

êÖáûåÖèË Â‰Ëˆ‡ Á‡·ÓÎfl‚‡ÌËfl Ò‚ÂÚÓ‚˙ÚÂÊ˙Ú Â ÒËÏÔÚÓÏ

ÓÚ ÔÓ-„ÓÎflχ ËÎË ÔÓ-χÎ͇ ‚‡ÊÌÓÒÚ. åÌÓ„Ó ˜ÂÒÚÓ ‡Ì‡Ï-ÌÂÁ‡Ú‡ ‰‡‚‡ ‰ÓÒÚ‡Ú˙˜Ì‡ ËÌÙÓχˆËfl Á‡ ÔÓÒÚ‡‚flÌ ̇Ô‰‚‡ËÚÂÎ̇ ‰Ë‡„ÌÓÁ‡. Ç ‰Û„Ë ÒÎÛ˜‡Ë ‰‡ÌÌËÚ Óڇ̇ÏÌÂÁ‡Ú‡ ‰‡‚‡Ú ÓÒÌÓ‚‡ÌË Á‡ ÌÂÓ·ıÓ‰ËÏË ËÁÒΉ‚‡ÌËfl,ÍÓËÚÓ ÏÓ„‡Ú ‰‡ ‰ÓÔËÌÂÒ‡Ú Á‡ ¯‡‚‡Ì ̇ ‰Ë‡„ÌÓÒÚ˘-ÌËfl ÔÓ·ÎÂÏ. àχ Ë ÒÎÛ˜‡Ë ‚ ÍÓËÚÓ ÏÓÊ ‰‡ ÎËÔÒ‚‡Ú ‚Â-ÚËÊÌË ÛÒ¢‡ÌËfl, χ͇ ˜Â Ëχ Û‚Âʉ‡ÌËfl ‚ ÔÂËÙÂ̇-Ú‡ ËÎË ˆÂÌÚ‡Î̇ڇ ‚ÂÒÚË·Û·̇ ÒËÒÚÂχ, Ú.Â. ÍÓ„‡ÚÓÔÓ„ÂÒ˙Ú Ì‡ ·ÓÎÂÒÚÚ‡  ÚÓÎÍÓ‚‡ ·‡‚ÂÌ, ˜Â ÔÓÁ‚ÓÎfl‚‡ÍÓÏÔÂÌÒ‡ˆËfl ‰‡ Ô‰ÓÚ‚‡ÚË fl‚fl‚‡ÌÂÚÓ Ì‡ ÚÂÁË ÛÒ¢‡-ÌËfl. ç‡È-Ó·˘Ó Ò‚ÂÚÓ‚˙ÚÂÊ˙Ú ÏÓÊ ‰‡ Ò ‰ËÙÂÂ̈ˇ͇ÚÓ: I. è‡ÓÍÒËÁχÎÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, ‡Ú‡ÍË Ì‡ Ò‚ÂÚÓ-‚˙ÚÂÊ Ò˙Ò Ò‚ÂÚÎË ÔÂËÓ‰Ë - ÎËÔÒ‡ ̇ ÓÔ·͇ÌËfl ÏÂʉۇڇÍËÚÂ; II. éÒÚ˙ Ò‚ÂÚÓ‚˙ÚÂÊ, Á‡ÔÓ˜‚‡˘ ‚ÌÂÁ‡ÔÌÓ,ÒΉ ÍÓÂÚÓ ·‡‚ÌÓ Ì‡Ï‡Îfl‚‡ ÔÓ ËÌÚÂÌÁËÚÂÚ; III. ïÓÌË-˜ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, ÔÓ-χÎÍÓ ÒËÎÂÌ, ÌÓ ÔÓ‰˙Îʇ‚‡˘ Á‡‰˙Î˙„ ÔÂËÓ‰, ˜ÂÒÚÓ ÔÂËӉ˘ÂÌ ËÎË ÔÓ͇Á‚‡˘ ÔÓÏÂÌË ‚ËÌÚÂÌÁËÚÂÚ‡. Ç ÌflÍÓË ÒÎÛ˜‡Ë ÔÓÁˈËflÚ‡ ̇ Ô‡ˆËÂÌÚ‡ Ë„-‡Â ËÁ‚ÂÒÚ̇ ÓÎfl ‚ fl‚fl‚‡ÌÂÚÓ Ì‡ ÒËÏÔÚÓÏËÚÂ.äβ˜Ó‚Ë ‰ÛÏË: ÌÓÁÓÎÓ„Ëfl, Ò‚ÂÚÓ‚˙ÚÂÊ, ‚ÂÒÚË·ÛÎÓ-ÏÂÚËfl.

ë‚ÂÚÓ‚˙ÚÂʸÚ, ‚ ¯ËÓÍËfl ÒÏËÒ˙Π̇ ‰Ûχڇ,  ÌÂÔ-ËflÚÌÓ ÛÒ¢‡Ì Á‡ ËÁÍË‚fl‚‡Ì ̇ ÒÚ‡Ú˘̇ڇ „‡‚ËÚ‡-ˆËÓÌ̇ ÓËÂÌÚ‡ˆËfl, ËÎË Ôӄ¯ÌÓ ‚˙ÁÔËflÚË ̇ ‰‚ËÊÂ-ÌË ̇ Á‡Ó·Ë͇Îfl˘‡Ú‡ Ò‰‡ ËÎË Ì‡ ÒÚ‡‰‡˘ÓÚÓ ÎˈÂ.íÓÈ Ì  ‰Ó·Â ‰ÂÙËÌˇ̇ ‰ËÌˈ‡, ‡ ÔÓ-ÒÍÓÓ ÂÁÛÎÚ‡ÚÓÚ ÏÌÓÊÂÒÚ‚Ó Ô‡ÚÓÎӄ˘ÌË Ë ÙËÁËÓÎӄ˘ÌË ÔÓˆÂÒË. èÓ-‡‰Ë ÚÓ‚‡ Ò‚ÂÚÓ‚˙ÚÂÊ˙Ú Ò ÓÔËÒ‚‡ ̇È-‰Ó·Â ͇ÚÓÏÛÎÚËÒÂÌÁÓÂÌ Ë ÒÂÌÁÓÌÓ-ÏÓÚÓÂÌ ÒË̉ÓÏ Ò ÔˆÂÔ-Ú˂̇, ÔÓÒÚÛ‡Î̇, ÓÍÛÎÓÏÓÚÓ̇ Ë ‡‚ÚÓÌÓÏ̇ χÌË-ÙÂÒÚ‡ˆËfl, Ô‰ËÁ‚Ë͇̇ ÓÚ:

- ÌÂÓ·ËÍÌÓ‚Â̇ Ë ÔÓ‡‰Ë ÚÓ‚‡ ̇‰‡ÔÚˇ̇ (‰‚Ë„‡-ÚÂÎ̇) ÒÚËÏÛ·ˆËfl ̇ ÌÂۂ‰ÂÌËÚ ÒÂÌÁÓÌË ÒËÒÚÂÏË,ËÎË

- Ô‡ÚÓÎӄ˘̇ (Ô˘ËÌÂ̇ ÓÚ ÏÓÙÓÎӄ˘̇ ÎÂÁËfl) ‰ËÒ-ÙÛÌ͈Ëfl.

ë‚ÂÚÓ‚˙ÚÂÊ Ë Ì‡Û¯ÂÌÓ ‡‚ÌÓ‚ÂÒË ҇ ˜ÂÒÚË ÓÔ·Í-‚‡ÌËfl Ò‰ Ô‡ˆËÂÌÚËÚ ÓÚ ‚Ò˘ÍË ‚˙Á‡ÒÚË, ÓÒÓ·ÂÌÓ ÔËÔÓ-‚˙Á‡ÒÚÌË ıÓ‡. íÂÁË ÒËÏÔÚÓÏË Ò Ò¢‡Ú ÔË 5-10%ÓÚ ‚Ò˘ÍË Ô‡ˆËÂÌÚË, ԄΉ‡ÌË ÓÚ Î˘ÌËÚ ÎÂÍ‡Ë Ë 10-20% ÓÚ ‚Ò˘ÍË Ô‡ˆËÂÌÚË ÔÂÏË̇ÎË ÔÂÁ Ì‚ÓÎӄ˘ÂÌ ËìçÉ Í‡·ËÌÂÚË. äÎËÌ˘ÌËflÚ ÒÔÂÍÚ˙ ̇ Ò‚ÂÚÓ‚˙ÚÂʇ ¯ËÓÍ (3). èË Â‰Ëˆ‡ Á‡·ÓÎfl‚‡ÌËfl Ò‚ÂÚÓ‚˙ÚÂÊ˙Ú ÂÒËÏÔÚÓÏ ÓÚ ÔÓ-„ÓÎflχ ËÎË ÔÓ-χÎ͇ ‚‡ÊÌÓÒÚ. åÌÓ„Ó˜ÂÒÚÓ ‡Ì‡ÏÌÂÁ‡Ú‡ ‰‡‚‡ ‰ÓÒÚ‡Ú˙˜Ì‡ ËÌÙÓχˆËfl Á‡ ÔÓÒ-Ú‡‚flÌ ̇ Ô‰‚‡ËÚÂÎ̇ ‰Ë‡„ÌÓÁ‡ (̇Ô. åÂÌËÂÓ‚‡ ·Ó-ÎÂÒÚ, ·ÂÌË„ÌÂÌ Ô‡ÓÍÒËÁχÎÂÌ ÔÓÁˈËÓÌÂÌ Ò‚ÂÚÓ‚˙-ÚÂÊ). Ç ‰Û„Ë ÒÎÛ˜‡Ë ‰‡ÌÌËÚ ÓÚ ‡Ì‡ÏÌÂÁ‡Ú‡ ‰‡‚‡Ú ÓÒ-ÌÓ‚‡ÌË Á‡ ÌÂÓ·ıÓ‰ËÏË ËÁÒΉ‚‡ÌËfl, ÍÓËÚÓ ÏÓ„‡Ú ‰‡ ‰ÓÔ-ËÌÂÒ‡Ú Á‡ ¯‡‚‡Ì ̇ ‰Ë‡„ÌÓÒÚ˘ÌËfl ÔÓ·ÎÂÏ. äÓÏ·Ë-̇ˆËflÚ‡ ÓÚ Á‡„Û·‡ ̇ ÒÎÛı‡, ÚËÌËÚÛÒ, ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÍ˙Ï ÒËÎÂÌ ¯ÛÏ Ë Ò‚ÂÚÓ‚˙ÚÂÊ, ÒÓ˜Ë ÔÂËÙÂÌÓ (ˆÂÔ-ÚÓÌÓ) ̇ۯÂÌËÂ. Ç ÒÎÛ˜‡È ̇ Ò‚ÂÚÓ‚˙ÚÂÊ ÍÓÏ·ËÌË-‡Ì Ò „·‚Ó·ÓÎËÂ, ÎÂÁËË Ì‡ ˜ÂÂÔÌÓÏÓÁ˙˜ÌË Ì‚Ë, Ô‡ÚÓÎÓ-„˘ÌË ÂÙÎÂÍÒË, Á‡„Û·‡ ̇ Ò˙Á̇ÌËÂ Ë Ú.Ì. ÔÓ-‚ÂÓflÚÌË Ò‡ˆÂÌÚ‡ÎÌË (ÏÓÁ˙˜ÌË) ‚ÂÒÚË·Û·ÌË Ì‡Û¯ÂÌËfl. àχ ËÒÎÛ˜‡Ë, ‚ ÍÓËÚÓ ÏÓÊ ‰‡ ÎËÔÒ‚‡Ú ‚ÂÚËÊÌË ÛÒ¢‡ÌËfl,χ͇ ˜Â Ò‡ ̇Îˈ ۂÂʉ‡ÌËfl ‚ ÔÂËÙÂ̇ڇ ËÎË ˆÂÌÚ-‡Î̇ڇ ‚ÂÒÚË·Û·̇ ÒËÒÚÂχ. é·flÒÌÂÌËÂÚÓ Ì‡ ÚÂÁËÒÎÛ˜‡Ë Â, ˜Â ÔÓ„ÂÒ˙Ú Ì‡ ·ÓÎÂÒÚÚ‡  ÚÓÎÍÓ‚‡ ·‡‚ÂÌ, ˜ÂÔÓÁ‚ÓÎfl‚‡ ÍÓÏÔÂÌÒ‡ˆËflÚ‡ ‰‡ Ô‰ÓÚ‚‡ÚË fl‚fl‚‡ÌÂÚÓ Ì‡ÚÂÁË ÛÒ¢‡ÌËfl (̇Ô. ıÓÌ˘ÂÌ Î‡·ËËÌÚËÚ, ÚÛÏÓË Ì‡ÒÎÛıÓ‚Ó‚ÂÒÚË·Û·ÌËfl Ì‚).

ë‚ÂÚÓ‚˙ÚÂÊ˙Ú ÏÓÊ ‰‡ Ò ‰ËÙÂÂ̈ˇ ͇ÚÓ:I. è‡ÓÍÒËÁχÎÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ - ‡Ú‡ÍË Ì‡ Ò‚ÂÚÓ‚˙-

ÚÂÊ Ò˙Ò Ò‚ÂÚÎË ÔÂËÓ‰Ë Ë ÎËÔÒ‡ ̇ ÓÔ·͂‡ÌËfl ÏÂʉۇڇÍËÚÂ;

II. éÒÚ˙ Ò‚ÂÚÓ‚˙ÚÂÊ, Á‡ÔÓ˜‚‡˘ ‚ÌÂÁ‡ÔÌÓ, ÒΉ ÍÓÂ-ÚÓ ·‡‚ÌÓ Ì‡Ï‡Îfl‚‡ ÔÓ ËÌÚÂÌÁËÚÂÚ;

III. ïÓÌ˘ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, ÔÓ-χÎÍÓ ÒËÎÂÌ, ÌÓ ÔÓ-‰˙Îʇ‚‡˘ Á‡ ‰˙Î˙„ ÔÂËÓ‰, ˜ÂÒÚÓ ÔÂËӉ˘ÂÌ ËÎË ÔÓ͇Á-‚‡˘ ÔÓÏÂÌË ‚ ËÌÚÂÌÁËÚÂÚ‡. Ç ÌflÍÓË ÒÎÛ˜‡Ë ÔÓÁˈËflڇ̇ Ô‡ˆËÂÌÚ‡ Ë„‡Â ËÁ‚ÂÒÚ̇ ÓÎfl ‚ ÔÓfl‚‡Ú‡ ̇ ÒËÏÔÚÓ-ÏËÚÂ.

ä˙Ï I. è‡ÓÍÒËÁχÎÌËfl Ò‚ÂÚÓ‚˙ÚÂÊ.Ä. åÂÌËÂÓ‚ ÒË̉ÓÏåÂÌËÂÓ‚Ëfl ÒË̉ÓÏ Ô‰ÒÚ‡‚Îfl‚‡ ÍÓÏ·Ë̇ˆËfl ÓÚ

̇χÎÂÌ ÒÎÛı Ë ÚËÌËÚÛÒ Ò ‡Ú‡ÍË Ì‡ Ò‚ÂÚÓ‚˙ÚÂÊ Á‡Â‰ÌÓÒ ÌËÒÚ‡„˙Ï Ë ‰Û„Ë Ó·ÂÍÚË‚ÌË ÔËÁ̇ˆË ̇ ··ËËÌÚÌÓÁ‡·ÓÎfl‚‡ÌÂ Ë Ò ‡‚ÚÓÌÓÏÌË ÒËÏÔÚÓÏË Í‡ÚÓ „‡‰ÂÌÂ, ÒÚÛ‰Â-̇ ÔÓÚ, ÔÓ‚˙˘‡ÌÂ, ÛÔ·ı‡ Ë Ú.Ì.

1. åÂÌËÂÓ‚‡Ú‡ ·ÓÎÂÒÚ (3,7,14) Ò ı‡‡ÍÚÂËÁˇ Ò‡Ú‡ÍË Ò ÓÔË҇̇ڇ ı‡‡ÍÚÂËÒÚË͇ Ë ÒËÎÂÌ ÔÓÎÓÊËÚÂ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 73‡ÔËÎ, 2002

é·ÁÓ

çéáéãéÉàóÖç ÄëèÖäí çÄ ëÇÖíéÇöêíÖÜÄO. äÓ΂

ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl, å‰ˈËÌÒÍË ÛÌË‚ÂÒËÚÂÚ - ëÓÙËfl, ìëÅÄã ÔÓ Ì‚ÓÎÓ„Ëfl Ë ÔÒËıˇÚËfl "ë‚ÂÚË ç‡ÛÏ"

ÎÂÌ ÂÍÛËÚχÌ. ÄÚ‡ÍËÚ ҇ ˜ÂÒÚÓ Ô‰¯ÂÒÚ‚‡ÌË ËÎËÔˉÛʇ‚‡ÌË ÓÚ ÔÓ-ÒËÎÂÌ ÚËÌËÚÛÒ, ÛÒ¢‡Ì ̇ Ô˙ÎÌÓÚ‡ËÎË Ì‡ÔÂÊÂÌË ‰˙ηÓÍÓ ‚ Á‡Ò„̇ÚÓÚÓ ÛıÓ Ë ÔÓÏÂÌË ‚ÒÎÛıÓ‚‡Ú‡ ÓÒÚÓÚ‡ (Ó·ËÍÌÓ‚ÂÌÓ ÔÓ-ÎÓ¯‡, ÌÓ ÔÓÌflÍÓ„‡ÔÓ-‰Ó·‡). çËÒÚ‡„Ï˙Ú Â ÔÓ˜ÚË ‚Ë̇„Ë ıÓËÁÓÌÚ‡ÎÌÓ-Ó-Ú‡ÚÓÂÌ Í˙Ï Á‰‡‚ÓÚÓ ÛıÓ. çflχ Á‡„Û·‡ ̇ Ò˙Á̇ÌË ËÎËÌflÍ‡Í‚Ë ‰Û„Ë Ì‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË. Ä̇ÚÓÏ˘ÌËflÚÒÛ·ÒÚ‡Ú Â ıˉÓÔÒ Ì‡ ẨÓÎËÏÙ‡Ú˘˜ÌËÚ ÔÓÒÚ‡ÌÒ-Ú‚‡ ̇ ··ËËÌÚ‡.

2. Ç Â‰ÍË ÒÎÛ˜‡Ë ··ËËÌÚËÚ˙Ú (3) ͇ÚÓ ÛÒÎÓÊÌÂÌËÂ̇ Ò‰ÂÌ ÓÚËÚ ÏÓÊ ‰‡ Ò ÔÓfl‚Ë Í‡ÚÓ Ô‡ÓÍÒËÁχÎÂÌÒ‚ÂÚÓ‚˙ÚÂÊ. Ç˙Á‰Û¯Ì‡Ú‡ ÔÓ‚Ó‰ËÏÓÒÚ Úfl·‚‡ ‰‡ ÒÂËÁÒΉ‚‡ ÔË ‚ÒÂÍË ÒÎÛ˜‡È ̇ åÂÌËÂÓ‚ ÒË̉ÓÏ.

3. íÛÏÓË Ì‡ ÒÎÛıÓ‚ÂÒÚË·Û·ÌËfl Ì‚ (2,3) Ò˙˘Ó ÏÓ-„‡Ú ‰‡ Ò ÔÓfl‚flÚ, χ͇ Ë fl‰ÍÓ, Ò ‡Ú‡ÍË Ì‡ åÂÌËÂÓ‚ÒË̉ÓÏ. íÛÍ Ó·‡˜Â ÎËÔÒ‚‡ ÔÓÎÓÊËÚÂÎÂÌ ÂÍÛËÚÏ‡Ì ÙÂ-ÌÓÏÂÌ.

4. åÓÁ˙˜ÌËÚ ÚÛÏÓË (8) ÏÓ„‡Ú ‰‡ Ô‰ËÁ‚ËÍ‡Ú Ô‡-ÓÍÒËÁχÎÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ. ç‡ÔËϠωˇÎÌËÚ χÎ-ÍÓÏÓÁ˙˜ÌË ÚÛÏÓË ÏÓ„‡Ú ‰‡ Ô˘ËÌflÚ ‡Ú‡ÍË ÓÚ ÒËÎÂÌÒ‚ÂÚÓ‚˙ÚÂÊ Á‡Â‰ÌÓ Ò „·‚Ó·ÓÎËÂ, ÒËÎÌÓ ËÁ‡ÁÂ̇ ‡Ú‡Í-ÒËfl, ÌËÒÚ‡„˙Ï, ÔÓ‚˙˘‡ÌÂ Ë ÚËÌËÚÛÒ. ãÂÁËËÚ ̇ ˜ÂÂÔ-ÌÓ-ÏÓÁ˙˜ÌË ÌÂ‚Ë Ë Ì‡Î˘ËÂÚÓ Ì‡ ÍÓÌڇ·Ú‡Î̇ ıÂ-ÏËÔ΄Ëfl ÔÓÚ‚˙ʉ‡‚‡Ú ‰Ë‡„ÌÓÁ‡Ú‡. àχ ËÁ‡ÁÂÌ ÔÓ„ÎÂ-‰ÂÌ ÌËÒÚ‡„˙Ï, Ú.Â. ÌËÒÚ‡„˙Ï ÔË ÂÍÒˆÂÌÚ˘ÌÓ Ì‡ÒÓ˜‚‡-Ì ̇ ÔӄΉ‡. èË Ì‡Î˘Ë ̇ ÒË„ÌËÙË͇ÌÚÌÓ Ì‡Ï‡ÎÂÌËÂ̇ ÒÎÛı‡ ‰Ë‡„ÌÓÁ‡Ú‡ ÏÓÁ˙˜ÂÌ ÚÛÏÓ Ì ËÁ„ÎÂʉ‡ ‚ÂÓflÚ-̇. ç‚ÓËÁÓ·‡Áfl‚‡˘ËÚ ÏÂÚÓ‰ËÍË Ò‡ ‚‡ÊÌË Á‡ ‰Ë‡„ÌÓ-Á‡Ú‡.

5. ñ·ÂÎÓÔÓÌÚËÌÂÌ ‡‡ıÌÓˉËÚ, ÍËÒÚÓÁÌÓ ‚˙ÁÔ‡ÎÂ-ÌË ‚ ÔÓÌÚӈ·Â·ÌËfl ˙„˙Î, ÏÓÊ ‰‡ ̇ÔÓ‰Ó·fl‚‡ åÂ-ÌËÂÓ‚‡ ·ÓÎÂÒÚ, ÌÓ Ò Ò˙Ô˙ÚÒÚ‚‡ ̇È-˜ÂÒÚÓ ÓÚ „·‚Ó·Ó-ÎËÂ, ‚˙‚΢‡Ì ̇ Ì. ‡·‰ÛˆÂÌÒ, Ì. Ù‡ˆË‡ÎËÒ Ë Ì. ÚË„ÂÏË-ÌÛÒ, ͇ÍÚÓ Ë ÓÚ ÒËÎÌÓ ÔÓ‚˙˘‡ÌÂ. éÚ‰ËÙÂÂ̈ˇÌÂÚÓÓÚ åÂÌËÂÓ‚‡Ú‡ ·ÓÎÂÒÚ ÔÓÌflÍÓ„‡  ÏÌÓ„Ó ÚÛ‰ÌÓ.

6. àÌÚÂÏËÚÂÌÚÌË ËÒıÂÏ˘ÌË Ì‡Û¯ÂÌËfl (3) ‚˙‚ ‚Â-Ú·ӷ‡ÁË·ÌËfl ·‡ÒÂÈÌ ÏÓ„‡Ú ‰‡ Ô‰ËÁ‚ËÍ‡Ú ‡Ú‡ÍË Ì‡Ò‚ÂÚÓ‚˙ÚÂÊ. íÓÁË Ò‚ÂÚÓ‚˙ÚÂÊ Ó·ËÍÌÓ‚ÂÌÓ Ì  ÓÚ‡-ÚÓÂÌ, ‡ ÔÓ-ÒÍÓÓ ÛÒ¢‡Ì Á‡ ÌÂÒÚ‡·ËÎÌÓÒÚ, ÔËÎÓ¯‡‚‡-ÌËfl ËÎË ËÒÚËÌÒ͇ Á‡„Û·‡ ̇ Ò˙Á̇ÌËÂ. ë‡ÏÓ Ì‡Û¯ÂÌÓ ‡‚-ÌÓ‚ÂÒË fl‰ÍÓ ÏÓÊ ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ÔË ‚ÂÚ·Ó-·‡ÁË-·̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ. á‡ÚÛ‰ÌÂÌ „Ó‚Ó, Á‡Ï˙„ÎÂÌÓ ÁÂ-ÌËÂ, ÔÓÎÓÊËÚÂÎÂÌ ÂÙÎÂÍÒ Ì‡ Ň·ËÌÒÍË, Ò··ÓÒÚ ‚ ͇È-ÌˈËÚ ҇ ÔÓ-˜ÂÒÚ‡ ̇ıӉ͇. éÒ‚ÂÌ Ì‡Û¯ÂÌË ‚ ··ËËÌ-ÚÌËfl ÂÙÎÂÍÒ ÏÓ„‡Ú ‰‡ Ò ÛÒÚ‡ÌÓ‚flÚ ÔӄΉÂÌ ÌËÒÚ‡-„˙Ï, ̇ۯÂÌËfl ‚˙‚ ‚Ë·‡ˆËÓÌÌËfl ÛÒÂÚ Ë ÓÔÚÓÍËÌÂÚË-˜ÂÌ ÌËÒÚ‡„˙Ï. ᇷÓÎfl‚‡ÌÂÚÓ Â fl‰ÍÓ ÔÓ‰ 50 „. ‚˙Á‡ÒÚ.

7. Cogan ÒË̉ÓÏ: åÂÌËÂÓ‚ ÒË̉ÓÏ ÔË Ï·‰Ë ıÓ‡,ÍÓÏ·ËÌË‡Ì Ò ÌÂÒËÙËÎËÒÂÌ ËÌÚÂÒÚˈˇÎÂÌ Í‡ÚËÚ (5).á‡ÔÓ˜‚‡ ÓÒÚÓ Ò ÙÓÚÓÙÓ·Ëfl, ·ÓÎÍË ‚ Ó˜ÌËÚ fl·˙ÎÍË, ·ÎÂ-Ù‡ÓÒÔ‡Á˙Ï Ë Á‡Ï˙„ÎÂÌÓ ÁÂÌËÂ.

Å. åÌÓ„Ó Í‡ÚÍË ‡Ú‡ÍË ÓÚ Ò‚ÂÚÓ‚˙ÚÂÊ1. ë‚ÂÚÓ‚˙ÚÂÊ ‚ ‰ÂÚÒÚ‚ÓÚÓ (16), Ô‰ÒÚ‡‚Îfl‚‡

˜ËÒÚÓ ‚ÂÒÚË·Û·ÌÓ Ì‡Û¯ÂÌË ·ÂÁ ÍÓı·ÌË ÒËÏÔÚÓ-ÏË. èÓfl‚fl‚‡ Ò ͇ÚÓ ÓÚ‡ÚÓÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, Á‡ÔÓ˜-‚‡˘ ‚ÌÂÁ‡ÔÌÓ Ë Ú‡Â˘ ͇ÚÍÓ (̇È-˜ÂÒÚÓ ÔÓ-χÎÍÓ ÓÚÏËÌÛÚ‡); Ìflχ Á‡„Û·‡ ̇ Ò˙Á̇ÌËÂ. é·ÂÍÚË‚ÌË ÒËÏÔÚÓÏËÌ Ò ÛÒÚ‡ÌÓ‚fl‚‡Ú Ò ËÁÍβ˜ÂÌË ̇ ÌËÒÚ‡„˙Ï ‚ ÌflÍÓËÒÎÛ˜‡Ë. ÖÚËÓÎӄ˘ÌËflÚ Ù‡ÍÚÓ Â ÌÂÛÒÚ‡ÌÓ‚ÂÌ.

2. ëË̉ÓÏ Ì‡ Gerlier - ı‡‡ÍÚÂËÁˇ Ò Ò˙Ò ÒËÎÂÌ Ô‡-ÓÍÒËÁχÎÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, ·ÓÎ͇ ‚ ÏÛÒÍÛÎËÚ ̇ ‚‡Ú‡Ë „˙·‡, Ò··ÓÒÚ Ì‡ ÚÂÁË ÏÛÒÍÛÎË Ë ÚÂÁË Ì‡ „ÓÌËfl ÍÎÂ-Ô‡˜. åÓÊ ‰‡ Ò ÔÓ‚Ó͡ ÓÚ ‡‚ËÚ‡ÏËÌÓÁ‡ ËÎË ‚ËÛÒÌËËÌÙÂ͈ËË.

3. ÖÔËÎÂÔÚ˘ÌÓ ‚ÂÚË„Ó - Á‡ÔÓ˜‚‡ ‚ÌÂÁ‡ÔÌÓ Ë ˜ÂÒÚÓڇ ҇ÏÓ ÒÂÍÛÌ‰Ë (11). ç‡È-˜ÂÒÚÓ Ò‚ÂÚÓ‚˙ÚÂÊ˙Ú Â

ÍÓÏ·ËÌË‡Ì Ò˙Ò Á‡„Û·‡ ̇ Ò˙Á̇ÌËÂÚÓ. ÑËÙÂÂ̈ˇÎ̇ڇ‰Ë‡„ÌÓÁ‡ ÏÓÊ ‰‡  Úۉ̇, Ú˙È-͇ÚÓ ‚ÂÒÚË·Û·ÌËÚ‡ÁÒÚÓÈÒÚ‚‡ ÏÓ„‡Ú ‰‡ Ô‰ËÁ‚ËÍ‡Ú ÂÔËÎÂÔÚ˘ÌË ÔËÒ-Ú˙ÔË.

4. åË„ÂÌÓÁÌË ‡Ú‡ÍË Ò˙˘Ó ÏÓ„‡Ú ‰‡ Ò ÍÓÏ·ËÌËÚ‡ÚÒ˙Ò Ò‚ÂÚÓ‚˙ÚÂÊ. éÒ‚ÂÌ ÚÓ‚‡ Ò‚ÂÚÓ‚˙ÚÂÊÌË ‡Ú‡ÍËÏÓ„‡Ú ‰‡ Ò fl‚flÚ Í‡ÚÓ ÏË„ÂÌÌË ÂÍ‚Ë‚‡ÎÂÌÚË (9). ëÎÛ-ı˙Ú Ò Á‡Òfl„‡ ÔÓ-fl‰ÍÓ - ‚ ÓÍÓÎÓ 33%.

5. ÄÚ‡ÍË ÓÚ Ò‚ÂÚÓ‚˙ÚÂÊ ·ÂÁ Á‡Òfl„‡Ì ̇ ÒÎÛı‡ ÒÂfl‚fl‚‡Ú Û Ô‡ˆËÂÌÚË Ò ıËÔÓ„ÎËÍÂÏËfl, ÒÚÓχ¯ÌÓ-˜Â‚ÌËÁ‡·ÓÎfl‚‡ÌËfl Ë ‰.

Ç. èÓÁˈËÓÌÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ Ë Ò‚ÂÚÓ‚˙ÚÂÊ ÔÓ‚Ó-͡˘ Ò ÓÚ ÔÓˆÂÒ‡ ̇ Á‡ÂχÌ ̇ ÔÓÁˈËfl

èË ÚÂÁË ÙÓÏË ‡Ú‡ÍËÚ ÓÚ Ò‚ÂÚÓ‚˙ÚÂÊ Ò ÔÓ‚Ó-ÍË‡Ú ÓÚ ÓÔ‰ÂÎÂ̇ ÔÓÁˈËfl ̇ „·‚‡Ú‡ ËÎË Ò‡ÏÓ ÓÚ ‡Í-Ú‡ ̇ ÔÓÒÚ‡‚flÌ ̇ „·‚‡Ú‡ ‚ Ú‡ÁË ÔÓÁˈËfl.

1. ÅÂÌË„ÌÂÌËflÚ Ô‡ÓÍÒËÁχÎÂÌ ÔÓÁˈÓËÌÂÌ Ò‚ÂÚÓ‚˙-ÚÂÊ (ÌËÒÚ‡„˙Ï)  ÚËÔ˘ÌÓ ÔÓ‚Ó͡˘ Ò ÓÚ ‡ÍÚ‡ ̇ÔÓÒÚ‡‚flÌ ̇ „·‚‡Ú‡ ‚ ÓÔ‰ÂÎÂ̇ ÔÓÁˈËfl (12). ë‚ÂÚÓ-‚˙ÚÂÊ˙Ú Ë ÌËÒÚ‡„Ï˙Ú Ò Ô‰ËÁ‚ËÍ‚‡Ú ̇È-˜ÂÒÚÓ ÔËÎfl„‡ÌÂ Ë ËÁÔ‡‚flÌÂ, ËÎË Ó·˙˘‡Ì ‚ ΄ÎÓÚÓ. ë‚ÂÚÓ‚˙-ÚÂÊ˙Ú Â Ò Î‡ÚÂÌÚÂÌ ÔÂËÓ‰ ÓÚ ÌflÍÓÎÍÓ ÒÂÍÛÌ‰Ë Ë Ò ËÁ-˜ÂÔ‚‡ Ó·ËÍÌÓ‚ÂÌÓ ÒΉ Ì Ôӂ˜ ÓÚ ÏËÌÛÚ‡. èˉÛʇ-‚‡˘ËflÚ ÌËÒÚ‡„˙Ï Â Ì‡È-˜ÂÒÚÓ ÓÚ‡ÚÓÂÌ Í˙Ï ‰ÓÎÛÎÂʇ-˘ÓÚÓ ÛıÓ. åÓÊ ‰‡ Ëχ ıÓËÁÓÌÚ‡Î̇ ËÎË ‚ÂÚË͇Î̇ÍÓÏÔÓÌÂÌÚË. è˘Ë̇ڇ Á‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò Ô‰ÔÓ·„‡,˜Â  ҂ӷӉÌÓ ‰‚ËÊ¢ Ò ‚ ··ËËÌÚ‡ ÓÚÓÎËÚÓ‚ ÍÓÌ„ÎÓ-χÚ.

2. èÂχÌÂÌÚÌËflÚ ÔÓÁˈËÓÌÂÌ ÌËÒÚ‡„˙Ï Ì Ò Ôˉ-Ûʇ‚‡ ÓÚ (ÒËÎÂÌ) Ò‚ÂÚÓ‚˙ÚÂÊ (Ò ËÁÍβ˜ÂÌË ̇ ÌflÍÓˈ·Â·ÌË ÚÛÏÓË). èÓ‚Ó͡ Ò ËÎË ÓÚ ÚÛÏÓË Ì‡ÏÓÁ˙͇ ËÎË ÓÚ ËÌÚÓÍÒË͇ˆËË (̇Ô. ‡ÎÍÓıÓÎ, ·‡·ËÚÛ‡-ÚË). çËÒÚ‡„Ï˙Ú Â ˜ÂÒÚÓ Ì‡ÒÓ˜ÂÌ Í˙Ï „ÓÂÎÂʇ˘ÓÚÓ ÛıÓË ÔÓ‰˙Îʇ‚‡, ‰Ó͇ÚÓ Ì Ò ÔÓÏÂÌË ÔÓÁˈËflÚ‡ ̇ „·‚‡-Ú‡ (1).

3. èÂËÙÂ̇ڇ ‚ÂÒÚË·Û·̇ Ô‡ÓÍÒËÁÏËfl Ò Ô˘Ë-Ìfl‚‡ ÓÚ ‚‡ÒÍÛ·̇ ÍÓÏÔÂÒËfl ̇ ÒÎÛıÓ‚ÂÒÚË·Û·ÌËflÌ‚, ı‡‡ÍÚÂËÁˇ˘‡ Ò ̇È-˜ÂÒÚÓ ÓÚ Í‡ÚÍË ‡Ú‡ÍË̇ ‚˙˘‡ÚÂÎÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, ÌËÒÚ‡„˙Ï, ıËÔÓ‡ÍÛÁËÒ ËÚËÌËÚÛÒ, ÔÓ‚Ó͡˘Ë Ò ËÎË ÏÓ‰ÛΡ˘Ë Ò ÓÚ ÒÔˆË-Ù˘ÌË ÔÓÁˈËË Ì‡ „·‚‡Ú‡ (3).

4. éÚÓÒÚ‡Ú˘ÌËflÚ Ò‚ÂÚÓ‚˙ÚÂÊ Ò Ô˘ËÌfl‚‡ ÓÚËÁÔ‡‚flÌÂ; ÌËÒÚ‡„˙Ï ÎËÔÒ‚‡. Ç ÌflÍÓË ÒÎÛ˜‡Ë ÚÓÈ ÏÓÊ ‰‡Ò ÔÓÒΉ‚‡ ÓÚ ÔËÔ‡‰‡Ì ̇ Ô‡ˆËÂÌÚ‡. è˘Ë̇ڇ  ıË-ÔÓÚÓÌËfl. ñ‚Ë͇ÎÌË Ì‡Û¯ÂÌËfl ÏÓ„‡Ú ÔÓÌflÍÓ„‡ ‰‡ ‰Ó-‚‰‡Ú ‰Ó ‡Ú‡ÍË ÓÚ Ò‚ÂÚÓ‚˙ÚÂÊ, ÚËÌËÚÛÒ Ë ‰ÓË Ì‡Ï‡-ÎÂÌË ̇ ÒÎÛı‡. çËÒÚ‡„Ï˙Ú Ò ÛÒÚ‡ÌÓ‚fl‚‡ ËÎË Ì‡‡ÒÚ‚‡,ÍÓ„‡ÚÓ Ò ËÁ‚Ë ‚‡Ú‡. Ñ‚ËÊÂÌËflÚ‡ Ô‰ËÁ‚ËÍ‚‡Ú Ò‚Â-ÚÓ‚˙ÚÂÊÌË ‡Ú‡ÍË.

ä˙Ï II. ë‚ÂÚÓ‚˙ÚÂÊ ÍÓÈÚÓ Á‡ÔÓ˜‚‡ ‚ÌÂÁ‡ÔÌÓ Ë Ì‡-χÎfl‚‡ ÔÓÒÚÂÔÂÌÌÓ, ÏÓÊ ‰‡ ·˙‰Â:Ä. ÔˉÛÊÂÌ ÓÚ ÒÎÛıÓ‚Ë Ì‡Û¯ÂÌËfl ËÎË Å. ·ÂÁ ÒÎÛıÓ‚Ë Ì‡Û¯ÂÌËfl.

Ä. ë˙Ò ÒÎÛıÓ‚Ë Ì‡Û¯ÂÌËfl1. ㇷËËÌÚËÚ˙Ú ËÎË Í‡ÚÓ ÛÒÎÓÊÌÂÌË ̇ Ò‰ÂÌ

ÓÚËÚ, ÏÂÌËÌ„ËÚ Ë Ú.Ì., ËÎË ˜ÂÁ Í˙‚̇ڇ ˆËÍÛ·ˆËfl,‚Ó‰Ë ‰Ó Ô˙ÎÂÌ åÂÌËÂÓ‚ ÒË̉ÓÏ (3).

2. ։̇ ‰ËÌÒÚ‚Â̇ åÂÌËÂÓ‚‡ ‡Ú‡Í‡ ÏÓÊ ‰‡ Ò fl‚Ë ‚ÒÎÛ˜‡È ̇ Ì‚ËÚ Ì‡ VIII ˜ÂÂÔÌÓÏÓÁ˙˜ÂÌ Ì‚ (‚ËÛÒ̇ËÎË ‰Û„‡ ËÌÙÂ͈Ëfl). çËÒÚ‡„Ï˙Ú Ò ÔÓ‚ÎËfl‚‡ ÓÚ ÔÓÁˈË-flÚ‡ Ë Ì  ÏÌÓ„Ó ‰Ó·Â ËÁfl‚ÂÌ; ͇ÎÓ˘ÌËflÚ ÓÚ„Ó‚Ó Â̇χÎÂÌ Ì‡ ۂ‰Â̇ڇ Òڇ̇ (3).

3. ëË̉ÓÏ˙Ú Ì‡ Ramsay-Hunt ÎÂÒÌÓ Ò ÛÒÚ‡ÌÓ‚fl‚fl,‡ÍÓ Ò fl‚Ë ÚËÔ˘ÌËflÚ Ï‡ÍÛÎÓÔ‡ÔÛÎÓÁÂÌ Ó·Ë‚ ËÎË ‡ÍÓ Ò‡

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 74‡ÔËÎ, 2002

̇Îˈ ÎÂÁËË Ì‡ ÚÓ˘ÌËfl, Îˈ‚Ëfl ËÎË ‰Û„Ë ˜ÂÂÔÌÓ-ÏÓ-Á˙˜ÌË Ì‚Ë. èÓÁËÚ˂ˇÌÂÚÓ Ì‡ ÔÓÎËχÁÌË Â‡ÍˆËËÍ˙Ï ıÂÔÂÒÌË ‚ËÛÒË ÏÓÊ ‰‡ Â¯Ë ‰Ë‡„ÌÓÁ‡Ú‡.

Å. ÅÂÁ ÒÎÛıÓ‚Ë Ì‡Û¯ÂÌËfl1. ÇÂÒÚË·Û·ÂÌ Ì‚ÓÌËÚ (Ì‚ËÚ), ‰ÂÙËÌË‡Ì ÓÚ

ïÓÎÔ‡ÈÍ,  ˜ËÒÚÓ ‚ÂÒÚË·Û·ÂÌ ÒË̉ÓÏ ·ÂÁ ÒÎÛıÓ‚‡ Á‡„Û-·‡, ÔÓ͇Á‚‡˘ 3-Ú‡ ÒÚÂÔÂÌ ıÓËÁÓÌÚ‡ÎÌÓ-ÓÚ‡ÚÓÂÌ ÌËÒ-Ú‡„˙Ï Ë ı‡ÏÓÌ˘ÌË ÓÚÍÎÓÌÂÌËfl ‚ ÒÚÓÂʇ, ÔÓıӉ͇ڇ ËÔÓ͇Á‡Î˜̇ڇ ÔÓ·‡. ëËÏÔÚÓÏËÚ ËÁ˜ÂÁ‚‡Ú ‚ ‡ÏÍËÚÂ̇ ÌflÍÓÎÍÓ Ò‰ÏˈË, ÌÓ ÔË ÌflÍÓË ÒÎÛ˜‡Ë ÔÂÒËÒÚˇÚÏÌÓ„Ó ÔÓ-‰˙΄Ó, ÍÓ„‡ÚÓ Ô‡ˆËÂÌÚ˙Ú Á‡Ú‚ÓË Ó˜Ë. ä‡ÎÓ-˘̇ڇ ‚˙Á·Û‰ËÏÓÒÚ Â Ì‡Ï‡ÎÂ̇ Ë ˜ÂÒÚÓ ÓÒÚ‡‚‡ ڇ͇-‚‡. ë‚ÂÚÓ‚˙ÚÂÊ˙Ú Ó·ËÍÌÓ‚ÂÌÓ Â ÏÌÓ„Ó ÒËÎÂÌ (6).

2. èË ÓÍÓÎÓ 5% ÓÚ ·ÓÎÌËÚÂ Ò ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡Ô˙‚ËflÚ ÒËÏÔÚÓÏ ÏÓÊ ‰‡  ҂ÂÚÓ‚˙ÚÂÊ̇ ‡Ú‡Í‡,ÌËÒÚ‡„˙Ï, ̇ۯÂÌÓ ‡‚ÌÓ‚ÂÒË ÓÚ ‚ÂÒÚË·Û·ÂÌ ÚËÔ ËÒËÎÌÓ ÔÓ‚˙˘‡ÌÂ. ÑÓÒÚ‡ ˜ÂÒÚÓ Â Ì‡Îˈ ÌÂÒ˙ÓÚ‚ÂÚÒÚ-‚Ë ÏÂÊ‰Û ÎÂÍËfl Ò‚ÂÚÓ‚˙ÚÂÊ Ë ÔÓ‚˙˘‡ÌÂÚÓ. ÄÍÓ ÌËÒ-Ú‡„Ï˙Ú Â ˜ËÒÚÓ ÓÚ‡ÚÓÂÌ ËÎË ‚ÂÚË͇ÎÂÌ, ‰Ë‡„ÌÓÁ‡Ú‡Ì  ÏÌÓ„Ó Úۉ̇. ÄÒËÏÂÚËfl ‚ ÓÔÚÓÍËÌÂÚ˘ÌËfl ÌËÒ-Ú‡„˙Ï, ̇΢ËÂÚÓ Ì‡ ÂÙÎÂÍÒËÚ ̇ Ň·ËÌÒÍË Ë ‰Û„ËÌ‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË ÔÓÁ‚ÓÎfl‚‡Ú ̇ ÎÂ͇fl ‰‡ ÔÓÒÚ‡-‚Ë ‰Ë„ÌÓÁ‡Ú‡, ÌÓ Ì ҇ ‰ÍË ÒÎÛ˜‡ËÚÂ, ÍÓ„‡ÚÓ ÒË̉Ó-Ï˙Ú ËÁ„ÎÂʉ‡ ˜ËÒÚÓ ÔÂËÙÂÂÌ Ë Ò‡ÏÓ ÔÓ-̇ڇÚ˙¯ÌÓ‡Á‚ËÚË ̇ Ô‡ÚÓÎÓ„ËflÚ‡ Ô‡‚Ë ‚˙ÁÏÓÊ̇ Ô‡‚ËÎ̇ڇ‰Ë‡„ÌÓÁ‡ (4).

3. ñ·ӂ‡ÒÍÛ·ÌËÚ ËÒıÂÏ˘ÌË ËÌÒÛÎÚË Ò˙˘Ó ÏÓ-„‡Ú ‰‡ ‰Ó‚‰‡Ú ‰Ó ÚÓÁË ÚËÔ Ò‚ÂÚÓ‚˙ÚÂÊË. ëË̉ÓÏ˙Ú̇ Wallenberg  ‰ËÌ ÓÚ Úflı (3). 燷≇‚‡Ú Ò „·‚Ó·Ó-ÎË ‚ ÚË· Ë ıÓÏÓ·Ú‡Î̇ ÚË„ÂÏË̇Î̇ ÎÂÁËfl, Ë ÒË̉-ÓÏ Ì‡ ïÓÌÂ, ÍÓÌڇ·Ú‡ÎÌÓ ‰ËÒÓˆËˇÌÓ Ì‡Û¯Â-ÌË ̇ ÒÂÚË‚ÌÓÒÚÚ‡, Á‡ÚÛ‰ÌÂÌË ‚ „˙ÎÚ‡ÌÂÚÓ Ë ı˙Έ‡-ÌÂ, Á‡Â‰ÌÓ Ò ÓÒÚË ‚ÂÒÚË·Û·ÌË Ì‡Û¯ÂÌËfl. Ç ÒÎÛ˜‡È ̇Á‡ÔÛ¯‚‡Ì ̇ „Ó̇ڇ ˆÂ·Â·̇ ‡ÚÂËfl ÏÓ„‡Ú ‰‡ ÒÂfl‚flÚ ÒËÏÔÚÓÏË Ì‡ ÓÒÚ˙ Ò‚ÂÚÓ‚˙ÚÂÊ, ÍÓËÚÓ ·‡‚ÌÓÓÚÒ··‚‡Ú. Ç ÚÓÁË ÒÎÛ˜‡È ÏÓ„‡Ú ‰‡ Ò ÛÒÚ‡ÌÓ‚flÚ ıÓÏÓ-·Ú‡ÎÌË ˆÂ·Â·ÌË ÒËÏÔÚÓÏË Ë ÍÓÌڇ·Ú‡ÎÌËÒÂÚË‚ÌË Ì‡Û¯ÂÌËfl, Ë ÔÓ ËÁÍβ˜ÂÌË Á‡„Û·‡ ̇ ÒÎÛı.

4. èÓÒÚÚ‡‚χÚ˘ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ, χ͇ Ë ˜ÂÒÚÓÓÚ ÔÂËÙÂÂÌ ÚËÔ Ò ÔˉÛʇ‚‡˘Ë ÒÎÛıÓ‚Ë ÒÏÛ˘ÂÌËfl,ÏÓÊ ‰‡ Ò Ô˘ËÌË ÓÚ Ú‡‚χÚ˘ÌË Û‚Âʉ‡ÌËfl ̇ ‚ÂÒ-ÚË·Û·ÌËÚ ˆÂÌÚÓ‚Â. LJˇˆËËÚ ̇ ‚ÂÒÚË·Û·ÌËÚÂ̇ۯÂÌËfl Ò‡ Ô‡ÍÚ˘ÂÒÍË ÌÂÓ„‡Ì˘ÂÌË. èÓ‰˙ÎÊËÚÂÎ-ÌÓÒÚÚ‡ ̇ ÒËÏÔÚÓÏËÚ ÏÓÊ ‰‡ ÔÓ‰˙ÎÊË ÏÂÒÂˆË ËÎË„Ó‰ËÌË. ÑËÙÂÂ̈ˇÌÂÚÓ ÏÂÊ‰Û Â‰Ì‡ ˜ËÒÚÓ ÙËÁ˘ÂÒ͇ÓÚ Â‰Ì‡ ÔÒËıÓ„ÂÌ̇ ·‡Á‡ ̇ ÓÔ·͂‡ÌËflÚ‡ ÏÓÊ ‰‡  ÏÌÓ-„Ó ÚÛ‰ÌÓ (13). ç‡È-Ó·˘Ó ÎËÔÒ‡Ú‡ ̇ Ó·ÂÍÚ˂̇ ̇ıӉ͇Á‡ ‡ÍÚË‚ÌË ‚ÂÒÚË·Û·ÌË Ì‡Û¯ÂÌËfl ÏÓÊ ‰‡ Ò ÔËÂÏÂ͇ÚÓ Ë̉Ë͇ˆËfl Á‡ ÎÂÍÛ‚‡Ì ̇ ÔÓÒÚÚ‡‚χÚ˘ÌÓ Á‡·Ó-Îfl‚‡ÌÂ.

ä˙Ï III. Ä. ïÓÌ˘ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ Á‡ ‰ËÌ ‰˙Î˙„ ÔÂ-ËÓ‰, Ó·ËÍÌÓ‚ÂÌÓ Ì ÏÌÓ„Ó ÒËÎÂÌ, Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÔË ıÓ-Ì˘ÌË ÔÓˆÂÒË ‚ ÛıÓÚÓ, ͇ÚÓ ıÓÌ˘ÂÌ Ò‰ÂÌ ÓÚËÚ ËÎË··ËËÌÚËÚ. Ç ÚÂÁË ÒÎÛ˜‡Ë ̇ ıÓÌ˘ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ ÂÌÂÓ·ıÓ‰ËÏÓ ‚Ë̇„Ë ËÁÒΉ‚‡Ì ̇ Û¯ÌËfl ͇̇Î.

Å. äÓ„‡ÚÓ Û¯ÌËÚ ͇̇ÎË Ò‡ ÌÓχÎÌË ıÓÌ˘ÂÌ Ò‚Â-ÚÓ‚˙ÚÂÊ ÏÓÊ ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ‚ ÒÎÛ˜‡Ë ̇:

1. íÛÏÓË Ì‡ VIII ˜ÂÂÔÌÓÏÓÁ˙˜ÂÌ Ì‚, ÔÓ͇Á‚‡˘Ë͇ÚË̇ ̇ ÍÓÏ·Ë̇ˆËfl ÓÚ ÒËÎÌÓ Ì‡Ï‡ÎÂÌË ̇ ÒÎÛı‡ ÒÓÚˈ‡ÚÂÎÂÌ ÂÍÛËÚχÌ, ÓÚÒ··Â̇ ‰Ó ÎËÔÒ‚‡˘‡ ͇ÎÓ-˘̇ ‡͈Ëfl, ÓÒÍ˙‰ÌË ‚ÂÚËÊÌË ÒËÏÔÚÓÏË (2).

2. íÛ·ÂÍÛÎÓÁÂÌ ÏÂÌËÌ„ËÚ ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó ÏÌÓ„Ó·‡‚ÌÓ ‡Á‚Ë‚‡˘ Ò ··ËËÌÚËÚ (15). ëËÏÔÚÓÏËÚ ÓÚ··ËËÌÚËÚ‡ Ò‡ ËÁÍβ˜ËÚÂÎÌÓ ÓÒÍ˙‰ÌË. Ň‚ÌÓ Ì‡Ï‡ÎÂ-ÌË ̇ ÒÎÛı‡, Ò··Ë ÓÚÍÎÓÌÂÌËfl ‚ ÔÓıӉ͇ڇ ̇ Ú˙ÏÌÓ ËÁ‡„Û·‡ ̇ ͇ÎÓ˘ÌË Â‡ÍˆËË. ÑËÙÂÂ̈ˇÌÂÚÓ ÓÚ flÚ-

Ó„ÂÌ̇ ÒÚÂÔÚÓÏˈËÌÓ‚‡ ËÌÚÓÍÒË͇ˆËfl ÏÓÊ ‰‡  ÏÌÓ-„Ó ÚÛ‰ÌÓ.

3. ãÛÂÚ˘ÂÌ ÏÂÌËÌ„ÓÂ̈ÂÙ‡ÎËÚ (10,15)  ӷ˘ÓËÁ‚ÂÒ-ÚÂÌ Ò ‰ËÒı‡ÏÓÌ˘̇ Ë ÔÓÚË‚Ó˜˂‡ ÒËÏÔÚÓχÚÓÎÓ-„Ëfl, Ú.Â., ÓÚÒ··ÂÌË ÓÚ‡ÚÓÌË Â‡ÍˆËË, ‡ ÌÓχÎÌË Í‡-ÎÓ˘ÌË Â‡ÍˆËË, ıÓËÁÓÌÚ‡ÎÌÓÓÚ‡ÚÓÂÌ ÌËÒÚ‡„˙Ï ÔËÓÚˈ‡ÚÂÎÂÌ êÓϷ„ Ë ìÌÚ·„ ÚÂÒÚÓ‚Â. çÓ˘Ìӄ·‚Ó·ÓÎËÂ, ÒËÏÔÚÓÏ Ì‡ Ä„ËÎ êÓ·ÂÚÒÓÌ Ë ÒÂÓÎӄ˘ÌËËÁÒΉ‚‡ÌËfl ÏÓ„‡Ú ‰‡ ÔÓÏÓ„Ì‡Ú ‰‡ Ò ‰Ë‡„ÌÓÒÚˈˇıÓÌ˘ÌËfl Ò‚ÂÚÓ‚˙ÚÂÊ.

4. ëËËÌ„Ó·ÛηËflÚ‡ ÏÓÊ ‰‡ ‰Ó‚‰ ‰Ó ÎÂÍÓ Á‡Ï‡È‚‡ÌÂ.è‡ÚÓ„ÌÓÏÓÌ˘ÂÌ Â ‚ÂÚË͇ÎÌËflÚ ÌËÒÚ‡„˙Ï Á‡Â‰ÌÓ Ò ‰Ë-ÒÓˆËˇÌË ÒÂÚË‚ÌË ‡ÁÒÚÓÈÒÚ‚‡, ÎËÔÒ‡ ̇ ÍÓ̇ÎÂÌÂÙÎÂÍÒ Ë ‡ÚÓÙËfl ̇ ÂÁË͇.

5. ïÓÌ˘ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ ÔË ÒÚ‡Ë ıÓ‡ Ò ÓÚ‰‡‚‡Ì‡È-‚˜ ̇ ÏÓÁ˙˜Ì‡ ‡ÚÂÓÒÍÎÂÓÁ‡. ë‚ÂÚÓ‚˙ÚÂÊ˙Ú ÒÂÓÔËÒ‚‡ ͇ÚÓ ˜Û‚ÒÚ‚Ó Ì‡ ÓÔËflÌÂÌËÂ Ë ÌÂÒË„ÛÌÓÒÚ, ÓÒÓ·Â-ÌÓ ‚ ÔÓıӉ͇ڇ. É·‚Ó·ÓÎËÂ, ÚËÌËÚÛÒ Ë drop attacks Ì ҇‰ÍË. è‡ÚÓÎӄ˘ÂÌ ÓÔÚÓÍËÌÂÚ˘ÌËfl ÌËÒÚ‡„˙Ï Â ÔÓ-˜ÂÒ-Ú‡ ̇ıӉ͇ ÓÚÍÓÎÍÓÚÓ ÒÔÓÌÚ‡ÌÂÌ Ë ÔÓÁˈËÓÌÂÌ ÌËÒÚ‡-„˙Ï. ñflÎÓÒÚ̇ڇ ͇ÚË̇ ÏÌÓ„Ó ‚‡Ë‡.

6. ïÓÌ˘ÂÌ Ò‚ÂÚÓ‚˙ÚÂÊ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÔË ‡Á΢-ÌË ‰ËÒÂÏËÌˇÌË Û‚Âʉ‡ÌËfl ‚ ÏÓÁ˙͇ (ÏÌÓÊÂÒÚ‚Â̇ÒÍÎÂÓÁ‡, ‰ËÙÛÁÂÌ Â̈ÂÙ‡ÎËÚ, ‡‚ËÚ‡ÏËÌÓÁ‡, ÏÓÁ˙˜ÌËÚ‡‚ÏË), ı‡‡ÍÚÂËÁˇ˘ ÒÂ Ò Ô‡ÓÍÒËÁχÎÌË ËβÁËË Á‡‰‚ËÊÂÌËÂ; ÔÓÌflÍÓ„‡ Ò ÛÒÚ‡ÌÓ‚fl‚flÚ ÒËÎÌË Í‡ÎÓ˘ÌË‚ÂÒÚË·Û·ÌË Â‡ÍˆËË, ‡ ÔÓÌflÍÓ„‡ ÓÚÒ··ÂÌË Ú‡ÍË‚‡(4,13).

7. èËÒÚ˙ÔË ÓÚ ÔËÎÓ¯‡‚‡Ì Ò ÓÔËÒ‚‡Ú ÔÓÌflÍÓ„‡ ͇-ÚÓ Á‡Ï‡È‚‡ÌÂ: Ì Ò ÛÒÚ‡ÌÓ‚fl‚‡Ú ‚ÂÒÚË·Û·ÌË ÒËÏÔÚÓ-ÏË. í‡Í‡‚‡ ̇ıӉ͇ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ˜ÂÒÚÓ ÔË ÙÛÌ͈ËÓ̇Î-ÌË Ì‚ÓÎӄ˘ÌË Ì‡Û¯ÂÌËfl (3).

ãàíÖêÄíìêÄ

1. Barber, H.O. Positional nystagmus. Otolaryngol Head Neck Surg, 92, 1984, 649-655.2. Berrettini, S., Ravecca, F., Sellari, S., Bruschini, P., Casani, A., Padolecchia, R.Acoustic neuroma: correlation between morphology and otoneurological manifesta-tions. J Neurol Sci, 144, 1996, 24-33.3. Brandt, T. Vertigo: its multisensory syndromes. London, Springer, 1998.4. Bronstein, A.M., Rudge, P.C. Vestibular disorders due to multiple sclerosis,Arnold-Chiary malformation, and basal ganglia disorders. In: Disorders of thevestibular system, eds. R.W. Baloh, G.M. Halmagyi, Oxford, Oxford UniversityPress, 1996, 476-495.5. Cote, N.D., Molony, T.B., Waxman, J., Parsa, D. Cogan's syndrome manifestingas sudden bilateral deafness: Diagnosis and management. South Med J, 86, 1993,1056-1060. 6. Davis, L.E. Viruses and vestibular neuritis: review of human and animal studies.Acta Otolaryngol (Stockh) Suppl, 503, 1993, 700-773.7. Dickins Jr, E., Graham, S.S. Meniere's disease 1983-1989. Am J Otol, 11, 1990,51-65.8. Hirose, G., Halmagyi, G.M. Brain tumors and balance disorders. In: Disorders ofthe vestibular system, eds. R.W. Baloh, G.M. Halmagyi, Oxford, Oxford UniversityPress, 1996, 446-460.9. Kayan, A., Hood, J.D. Neuro-otological manifestations of migraine. Brain, 107,1984, 1123-1142.10. Kobayashi, H., Mizukoshi, K., Watanabe, Y., Nagasaki, T., Iti, M., Aso, S.Otoneurological findings in inner ear syphilis. Acta Otolaryngol (Stockh) Suppl,481, 1991, 551-555.11. Kogeorgos, J., Scott, D.F., Swash, M. Epileptic dizziness. Br Med J, 282, 1981,687-689.12. Lanska, D.J., Remler, B. Benign paroxysmal positioning vertigo: classic descrip-tions, origins of the provocative positioning technique and conceptual develop-ments. Neurology, 48, 1997, 1167-1177.13. Luxon, L.M. Posttraumatic vertigo. In: Disorders of the vestibular system, eds.R.W. Baloh, G.M. Halmagyi, Oxford, Oxford University Press, 1996, 381-395.14. Meniere, P. Memoire sur les lesions de l'oreile interne donnant lieu a des symp-tomes de congestion cerebrale apoplectiforme. Gaz Med Paris, 3, 1861, 16:597-601. 15. Schuknecht, H.F. Pathology of the ear. Cambridge Mass, Harvard UniversityPress, 1974.16. Tusa, R.J., Saada Jr, A.A., Niparko, J.K. Dizzines in childhood. J Child Neurol,9, 1994, 261-274.130-133.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: ÑÓˆ. ‰- é„ÌflÌ äÓ΂, ‰ÏÌ, ìëÅÄã ÔÓ ç‚ÓÎÓ„Ëfl Ë èÒËıˇÚËfl "ë‚. ç‡ÛÏ", ·ÛÎ. "ñ‡Ë„‡‰ÒÍÓ ¯ÓÒÂ" 4 kÏ, ëÓÙËfl 1113ÚÂÎ 70-90-82; Â-mail: [email protected]

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 75‡ÔËÎ, 2002

SUMMARY

POSTOPERATIVE EPILEPSY AND BENIGN BRAINLESIONS

R. KalpachkiThere are epileptic seizures in some of the neurosurgery

patients. They are in connection of operative trauma and theyare postoperative epilepsy. Epileptic seizures before 14-th dayafter operation are early postoperative epilepsy and other arelate. In our study we discuss for incidence of postoperativeepilepsy in neurosurgery patients with some benign brainlesions - meningiomas, cerebral aneurisms and AV-malforma-tions. We consider for this - are there preoperative signs forpostoperative epilepsy and for anticonvulsants used againstsuch seizures.Key words: postoperative epilepsy, benign brain lesions, pro-phylaxis

ÖÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË Ò ̇·Î˛‰‡‚‡Ú ÔË ˜‡ÒÚ ÓÚÓÔ¡ÌËÚ Ì‚ÓıËۄ˘ÌË ·ÓÎÌË. äÓ„‡ÚÓ Ì ҇ ‚ ıÓ-‰‡ ̇ ÂˆË‰Ë‚Ë Ì‡ Ó„‡Ì˘ÂÌ ÏÓÁ˙˜ÂÌ ÔÓˆÂÒ, Ú ҇ ‚ Ôfl-͇ ‚˙Á͇ Ò Ô‰ÓÔ‡Ú˂̇ڇ ÎÂÁËfl Ë ÓÔ‡Ú˂̇ڇڇ‚χ Ë Ô‰ÒÚ‡‚Îfl‚‡Ú ÒÎÛ˜‡Ë ̇ ÔÓÒÚÓÔ‡Ú˂̇ÂÔËÎÂÔÒËfl. ÖÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË Ò Ì‡˜‡ÎÓ ‰Ó 14-Ëfl ‰ÂÌÒΉ ÓÔ‡Ú˂̇ڇ ËÌÚ‚Â̈Ëfl Ò ̇˘‡Ú ‡ÌÌË, ‡ ÔÓ-fl‚ËÎËÚ Ò ÒΉ ÚÓ‚‡ - Í˙ÒÌË. Ç Ó·ÁÓ˙Ú Ò ‡Á„ÎÂʉ‡Ú‚˙ÔÓÒËÚ Á‡ ÚÓ‚‡ ͇͂‡ ˜‡ÒÚ ÓÚ ÓÔ¡ÌËÚ ·ÓÎÌË ÔÓÔÓ‚Ó‰ ̇ ÌflÍÓË ‰Ó·Ó͇˜ÂÒÚ‚ÂÌË ÏÓÁ˙˜ÌË ÎÂÁËË - ÏÂÌËÌ-„ÂÓÏË, ‡Ì‚ËÁÏË Ë ÄV-χÎÙÓχˆËË ‡Á‚Ë‚‡Ú Í˙Ò̇ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl, Ëχ ÎË Ô‰- Ë ÔÂËÓÔ‡-ÚË‚ÌË ·ÂÎÂÁË, ÍÓËÚÓ Ò ËÁ‚ÂÒÚ̇ ‚ÂÓflÚÌÓÒÚ ·Ëı‡ ÏÓ„Îˉ‡ Ô‰ÒÍ‡Ê‡Ú ‚˙ÁÏÓÊÌÓÒÚÚ‡ ÓÚ ‡Á‚ËÚË ̇ Ú‡ÍË‚‡ÔËÒÚ˙ÔË Ë ËÁÔÓÎÁ‚‡ÌËÚ ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌË Ò‰ÒÚ-‚‡ ‚ ΘÂÌËÂÚÓ Ì‡ ÔÓÒÚÓÔ‡Ú˂̇ڇ ÂÔËÎÂÔÒËfl.äβ˜Ó‚Ë ‰ÛÏË: ÒΉÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl, ‰Ó·Ó͇˜ÂÒ-Ú‚ÂÌË ÏÓÁ˙˜ÌË ÌÂÓÔ·ÁÏË, ÔÓÙË·ÍÚË͇

ÖÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË Ò ̇·Î˛‰‡‚‡Ú ÔË ˜‡ÒÚ ÓÚÓÔ¡ÌËÚ Ì‚ÓıËۄ˘ÌË ·ÓÎÌË (1,2,7,9,15,16,17,21,22,23,27,32,34). äÓ„‡ÚÓ Ì ҇ ‚ ıÓ‰‡ ̇ ˆˉË-‚Ë Ì‡ Ó„‡Ì˘ÂÌ ÏÓÁ˙˜ÂÌ ÔÓˆÂÒ, Ú ҇ ‚ Ôfl͇ ‚˙Á͇ ÒÔ‰ÓÔ‡Ú˂̇ڇ ÎÂÁËfl Ë ÓÔ‡Ú˂̇ڇ Ú‡‚χ ËÔ‰ÒÚ‡‚Îfl‚‡Ú ÒÎÛ˜‡Ë ̇ ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl(1,2,17).

ç‚ÓıËۄ˘̇ڇ ËÌÚ‚Â̈Ëfl ‚˙ıÛ „·‚ÌËfl ÏÓ-Á˙Í Â ÔÓÒΉ‚‡Ì‡ ÓÚ ÒÂËÓÁÌË ÔÓÒÚ‡ÌÒÚ‚ÂÌË ÒÚÛÍ-ÚÛÌÓ-ÙÛÌ͈ËÓ̇ÎÌË ÔÓÏÂÌË ‚ ÓÔ‡ÚË‚ÌÓÚÓ ÔÓÎÂ. àÁ-‚ÂÒÚÌÓ Â, ˜Â ÔÂËÎÂÁËÓÌ̇ڇ ÏÓÁ˙˜Ì‡ Ú˙Í‡Ì Ò ÓÚ΢‡‚‡Ò ‚ËÒÓ͇ ÔÓÍÓÌ‚ÛÎÒ˂̇ ‡ÍÚË‚ÌÓÒÚ (10,13). éÚ ‰Û„‡Òڇ̇ ÏÌÓ„Ó ÌÓ‚ÓÓ·‡ÁÛ‚‡ÌËfl ̇ „·‚ÌËfl ÏÓÁ˙Í Ò‡ ÂÚË-ÓÎӄ˘ÂÌ Ù‡ÍÚÓ Á‡ Ô‰ËÁ‚ËÍ‚‡Ì ̇ ÂÔËÎÂÔÚ˘ÌË ÔËÒ-Ú˙ÔË. ë ÔÓÚÂ̈ˇÎÌÓ ÔÓ-‚ËÒÓÍ ÂÔËÎÂÔÚ˘ÂÌ ËÒÍ Ò‡ ÏÂ-ÌËÌ„ÂÓÏËÚÂ, ÄV-χÎÙÓχˆËËÚÂ Ë ‡Ì‚ËÁÏËÚ ̇ ËÌÚ-‡Í‡ÌˇÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË, ‚ÂÓflÚÌÓ ÔÓ‡‰Ë Úflı-̇ڇ ÓÚÌÓÒËÚÂÎÌÓ ÒÔˆËÙ˘̇ ÎÓ͇ÎËÁ‡ˆËfl(1,2,6,9,10,23). íÓ‚‡ Ò‡ Ë Ì‡È-˜ÂÒÚËÚ ·ÂÌË„ÌÂÌË ÌÂÓÔ·Á-ÏË ‚ Ì‚ÓıËۄ˘̇ڇ Ô‡ÍÚË͇ (1,9). ÖÔËÎÂÔÚ˘ÌËÔËÒÚ˙ÔË ‚ ıÓ‰‡ ̇ Ò‚ÓflÚ‡ ÍÎËÌ˘̇ ͇ÚË̇ Ô‰ËÁ‚ËÍ-‚‡Ú Ë ÏÓÁ˙˜ÌËÚ ‡·ÒˆÂÒË, Ô‡‡ÁËÚÌËÚÂ Ë ‰Û„Ë ÍËÒÚË,‡Á΢ÌË ‰ËÁÓÌÚÓ„ÂÌÂÚ˘ÌË ÚÛÏÓË Ì‡ „·‚ÌËfl ÏÓÁ˙Í.

ÇÒ˘ÍË ÁÎÓ͇˜ÂÒÚ‚ÂÌË ÚÛÏÓË Ò˙˘Ó ÍËflÚ ‚˙ÁÏÓÊ-ÌÓÒÚÚ‡ Á‡ ‡Á‚ËÚË ̇ ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË, ÌÓ ˜ÂÒÚÓÚÓ‚‡  Á‡‡‰Ë ˆˉ˂ˇÌÂ Ë Ï‡ÎË„ÌËÁˇÌ ̇ ÚÛÏÓ‡.ÖÚÓ Á‡˘Ó ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË ‚ ÚÂÁË ÒÎÛ˜‡Ë ÓÒÚ‡-‚‡Ú ÔÂ‰Ë ‚Ò˘ÍÓ Ì‚ÓıËۄ˘ÂÌ ÔÓ·ÎÂÏ.

èÓ-„ÓÎflχ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚÂ Ò Í˙Ò̇ ÔÓÒÚÓÔ‡Ú˂̇ÂÔËÎÂÔÒËfl Ò‡ ËχÎË Â‰ËÌ ËÎË Ôӂ˜ ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙-ÔË ÔÂ‰Ë ÓÔ‡ˆËflÚ‡ (1,2,6,9). ÑÛ„‡Ú‡ ˜‡ÒÚ Ò‡ Ú‡ÍË‚‡,ÔË ÍÓËÚÓ ÔËÒÚ˙ÔËÚ Á‡ÔÓ˜‚‡Ú Ò‰ÏËˆË ËÎË ÏÂÒˆËÒΉ ÓÔ‡Ú˂̇ڇ ËÌÚ‚Â̈Ëfl. ÖÔËÎÂÔÚ˘ÌË ÔËÒÚ˙-ÔË Ò Ì‡˜‡ÎÓ ‰Ó 14-Ëfl ‰ÂÌ ÒΉ ÓÔ‡Ú˂̇ڇ ËÌÚ‚Â̈ËflÒ ̇˘‡Ú ‡ÌÌË, ‡ ÔÓfl‚ËÎËÚ Ò ÒΉ ÚÓ‚‡ - Í˙ÒÌË(1,13,22,23,30).

чÌÌËÚ ‚ ÎËÚ‡ÚÛ‡Ú‡ Á‡ ÚÓ‚‡ ͇͂‡ ˜‡ÒÚ ÓÚ ÓÔÂ-ˇÌËÚ ·ÓÎÌË ÔÓ ÔÓ‚Ó‰ ‰Ó·Ó͇˜ÂÒÚ‚ÂÌË ÏÓÁ˙˜ÌË ÚÛ-ÏÓË ‡Á‚Ë‚‡Ú Í˙Ò̇ ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl Ò‡ ÌÂÏ-ÌÓ„Ó·ÓÈÌË Ë ÔÓÚË‚Ó˜˂Ë. 燷≇‚‡ ÒÂ Ë Á̇˜ËÚÂÎ-̇ ‡ÁÎË͇ ‚ ËÒÚÓ˘ÂÒÍË Ô·Ì. ëÔÓ‰ ÌflÍÓË ‡‚ÚÓË(8,9) 30-40% ÓÚ ·ÓÎÌËÚ Ò˙Ò ÒÛÔ‡ÚÂÌÚÓˇÎÌË ÏÂÌËÌ-„ÂÓÏË ËÏ‡Ú ÂÔËÎÂÔÚ˘ÌË ÔËÒÚ˙ÔË Ô‰ÓÔ‡ÚË‚ÌÓ. Ç26,6% ÓÚ ÒÎÛ˜‡ËÚ ÚÓ‚‡  Ô˙‚ËflÚ ÒËÏÔÚÓÏ Ì‡ ·ÓÎÂÒÚ-Ú‡ (20). èË 19.2 ‰Ó 62.2% ÓÚ ÚÂÁË Ô‡ˆËÂÌÚË ÔËÒÚ˙ÔË-Ú ÒÔË‡Ú ÒΉ ÓÔ‡ˆËflÚ‡ (7,21,27,29,35). éÒڇ̇ÎËÚÂÓÍÓÎÓ 33-37% ÔÓ‰˙Îʇ‚‡Ú ‰‡ ËÏ‡Ú ÔËÒÚ˙ÔË, ͇ÚÓ ‚16% ÒÚ‡‚‡ ‰Ûχ Á‡ ÚÂÊ͇ ÂÔËÎÂÔÒËfl, ̇·„‡˘‡ ÒÂËÓÁÌÓωË͇ÏÂÌÚÓÁÌÓ Î˜ÂÌËÂ. éÚ Ô‡ˆËÂÌÚËÚÂ, ÍÓËÚÓ Ì ҇ËχÎË ÔËÒÚ˙ÔË ‰Ó ÓÔ‡ˆËflÚ‡, 17-20% Ò‡ ‡Á‚ËÎË Í˙Ò̇ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl (8,20). èÓ‰Ó·ÌË ‰‡ÌÌË (ÓÍÓÎÓ30%) Ò Ò˙Ó·˘‡‚‡Ú Ë Á‡ ·ÓÎÌË Ò ÓÔ‡ˆËfl ÔÓ ÔÓ‚Ó‰ ͇‚Â-ÌÓÁÌË ÄV-χÎÙÓχˆËË (5,36). èË ÓÔ¡ÌË Á‡ ÏÓÁ˙˜ÌˇÌ‚ËÁÏË ·ÓÎÌË ‚ 7% ÓÚ ÒÎÛ˜‡ËÚ ҇ Ò ̇·Î˛‰‡‚‡ÎË ÔÓ-‚˜ ÓÚ ‰‚‡ ÔËÒÚ˙Ô‡ Á‡ ÔÂËÓ‰ ÓÚ Â‰Ì‡ „Ó‰Ë̇ ÒΉ ÓÔÂ-‡ˆËflÚ‡ (4). ëÔÓ‰ ‰Û„Ë ‡‚ÚÓË Í˙Ò̇ ÔÓÒÚÓÔ‡ÚË‚-̇ ÂÔËÎÂÔÒËfl ‡Á‚Ë‚‡Ú ‰‚‡ 3% ÓÚ ÓÔ¡ÌËÚ ÛÔÚÛ-ˇÎË ‡Ì‚ËÁÏË Ë 4,4% ÓÚ ÌÂÛÔÚÛˇÎËÚ (1). àχÒ˙Ó·˘ÂÌËfl Ó·‡˜Â Ë Á‡ 25% Í˙Ò̇ ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔ-ÒËfl ÔË ‡Ì‚ËÁχÎÌË ëÄï (23).

èÂӷ·‰‡‚‡˘ÓÚÓ ÏÌÂÌË ‚ ÎËÚ‡ÚÛ‡Ú‡ ̇ ÚÓÁËÂÚ‡Ô Â, ˜Â Ìflχ ÓÒÌÓ‚‡ÌËfl Á‡ ·ÂÁÛÒÎӂ̇ ÔÓÙË·ÍÚË͇ ̇Í˙Ò̇ڇ ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl Ò Ï‰Ë͇ÏÂÌÚÓÁÌËÒ‰ÒÚ‚‡ (1,3,13,14,18,25,26,28,31,33). Phenitoin ËCarbamazepine Ò‡ ÔÓ͇Á‡ÌË ÔË ‡ÌÌË ÔÓÒÚÓÔ‡ÚË‚ÌËÔËÒÚ˙ÔË, ÌÓ ÌËÚÓ ÚÂ, ÌËÚÓ Phenobarbital ‚ÎËflflÚ ‚˙ıÛÔÓfl‚‡Ú‡ ̇ Í˙ÒÌË Ú‡ÍË‚‡ (14). Ç ÌflÍÓÎÍÓ ÔÓÛ˜‚‡ÌËfl ̇ԇˆËÂÌÚË Ò ÓÔ‡ˆËfl ÔÓ ÔÓ‚Ó‰ ÏÓÁ˙˜ÌË ‡Ì‚ËÁÏË Ò ÔÓ‰-˜ÂÚ‡‚‡, ˜Â ‡ÌÚËÍÓÌ‚ÛÎÒ˂̇ڇ ÔÓÙË·ÍÚË͇ Ì Ò ÔÂ-ÔÓ˙˜‚‡ Á‡‡‰Ë ÔÓ-„ÓÎflχڇ ˜ÂÒÚÓÚ‡ ̇ ÒÚ‡Ì˘ÌËÚÂÂÙÂÍÚË, ÓÚÍÓÎÍÓÚÓ Ú‡ÁË Ì‡ ÔËÒÚ˙ÔËÚÂ, ÓÒ‚ÂÌ ÔË ·ÓÎ-ÌË, ÔË ÍÓËÚÓ Â ÌÛÊ̇ ÒÂËÓÁ̇ ÏÓÁ˙˜Ì‡ ÔÓÚÂ͈Ëfl. èÂ-ÔÓ˙˜‚‡ Ò ӷ‡˜Â ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌÓÚÓ Î˜ÂÌË ‰‡ Á‡-ÔÓ˜‚‡ ‚‰̇„‡ ÒΉ Ô˙‚Ëfl ÔËÒÚ˙Ô. ë˜ËÚ‡ ÒÂ, ˜Â ÍÓÏÔÂ-ÚÂÌÚÌÓÚÓ Ù‡Ï‡ÍÓÎӄ˘ÌÓ Î˜ÂÌË ‚ ÔÓ‰ıÓ‰fl˘Ëfl ÏÓ-ÏÂÌÚ Â ÔÓ-ÂÙÂÍÚË‚ÌÓ Ë ·ÂÁÓÔ‡ÒÌÓ ÓÚ ‡Ì̇ڇ Ë ÌÂÒË„Û-̇ ÔÓÒÚÓÔ‡Ú˂̇ ÔÓÙË·ÍÚË͇. èÓ‰˜ÂÚ‡‚‡ ÒÂ, ˜Â ÂÌÂÓ·ıÓ‰ËÏÓ ‰‡ Ò Ú˙ÒflÚ ÒÂÎÂÍÚË‚ÌÓ ÔˈÂÎÌË Ô‡ˆËÂÌ-ÚË Ò ‚ËÒÓÍ ËÒÍ Á‡ ‡Á‚ËÚË ̇ Í˙Ò̇ ÔÓÒÚÓÔ‡Ú˂̇ÂÔËÎÂÔÒËfl (13,14,18).

éÒÓ·ÂÌÓ ‚‡ÊÂÌ Â ‚˙ÔÓÒ˙Ú Ëχ ÎË Ô‰- Ë ÔÂËÓÔ‡-ÚË‚ÌË ·ÂÎÂÁË, ÍÓËÚÓ Ò ËÁ‚ÂÒÚ̇ ‚ÂÓflÚÌÓÒÚ ·Ëı‡ ÏÓ„Îˉ‡ Ô‰ÒÍ‡Ê‡Ú ‚˙ÁÏÓÊÌÓÒÚÚ‡ ÓÚ ‡Á‚ËÚË ̇ Í˙Ò̇

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 76‡ÔËÎ, 2002

é·ÁÓ

ëãÖÑéèÖêÄíàÇçÄ ÖèàãÖèëàü èêà çüäéàÑéÅêéäÄóÖëíÇÖçà åéáöóçà ãÖáàà

ê. ä‡ÎÔ‡˜ÍËç‚ÓÎӄ˘̇ ÍÎËÌË͇ ÄÎÂÍ҇̉ӂÒ͇ ·ÓÎÌˈ‡ - ëÓÙËfl

ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl. ç‡Î˘ËÂÚÓ Ì‡ ÓÔ‰ÂÎÂÌËËÒÍÓ‚Ë Ù‡ÍÚÓË ·Ë Ó·ÓÒÓ·ËÎÓ ÔˈÂÎ̇ „ÛÔ‡ Ô‡ˆËÂÌÚË,ÔÓ‰ıÓ‰fl˘Ë Á‡ ÔÓÒÚÓÔ‡Ú˂̇ ‡ÌÚËÍÓÌ‚ÛÎÒ˂̇ ÔÓÙË-·ÍÚË͇ Ë Î˜ÂÌË ËÎË Ì‡È-χÎÍÓ Á‡ ÔÓ-‡ÍÚË‚ÌÓ Ì‡·Î˛‰Â-ÌËÂ. èË ·ÓÎÌËÚÂ, ÓÔ¡ÌË ÔÓ ÔÓ‚Ó‰ ÏÂÌËÌ„ÂÓÏË, ÒÂÓ˜ÂÚ‡‚‡Ú ÌflÍÓÎÍÓ ËÒÍÓ‚Ë Ù‡ÍÚÓ‡ Á‡ ‡Á‚ËÚË ̇ Í˙Ò-̇ ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl (8,9):

1. ‡Ì‡ÏÌÂÁ‡ Á‡ Ô‰ÓÔ‡ÚË‚ÌË ÔËÒÚ˙ÔË2. ̇΢ˠ̇ Ô‰ÓÔ‡ÚË‚ÌË ‡Ù‡Ú˘ÌË ‡ÁÒÚÓÈÒÚ-

‚‡3. Ì¢‡‰fl˘‡ ÂÍÒÚËÔ‡ˆËfl ̇ ÚÛÏÓ‡ (lesionectomy)4. Ô‡ËÂÚ‡Î̇, Ò‡„ËÚ‡Î̇ ËÎË ÍÓÌ‚ÂÍÒ̇ ÎÓ͇ÎËÁ‡ˆËfl

̇ ÏÂÌËÌ„ÂÓχ5. ËÁÔÓÎÁ‚‡ÌÂ Ë ‚ˉ ̇ ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌË Ò‰ÒÚ‚‡

ÒΉ ÓÔ‡ˆËflÚ‡6. ‡Á‚ËÚË ̇ ÔÓÒÚÓÔ‡Ú˂̇ ÌÓÏÓÚÂÌÁ˂̇ ıˉ-

ÓˆÂÙ‡ÎËfl7. ‰ÂÏ Ë ıÂÏÓ‡„Ëfl ‚ ÓÔ‡ÚË‚ÌÓÚÓ ÔÓΠÔÂÁ Ô˙‚Ë-

Ú 7 ‰ÌË ÓÚ ÓÔ‡ˆËflÚ‡ ꯇ‚‡˘‡ ÓÎfl ‚ ÔÓÙË·ÍÚË͇ڇ ̇ ÚÂÁË ÔËÒÚ˙ÔË

Ë„‡flÚ, ‡Á·Ë‡ ÒÂ, ‡ÌÌÓÚÓ ÓÚÍË‚‡ÌÂ Ë Î˜ÂÌË ̇ ÔÓ-ˆÂÒ‡ (9).

éÔ¡ÌËÚ ÒÛÔ‡ÚÂÌÚÓˇÎÌË Í‡‚ÂÌÓÁÌË ÄV-χÎ-ÙÓχˆËË Ò‡ ÒÛÒÔÂÍÚÌË Á‡ ‡Á‚ËÚË ̇ Í˙Ò̇ ÔÓÒÚÓÔ‡-Ú˂̇ ÂÔËÎÂÔÒËfl, ÍÓ„‡ÚÓ Ò‡ ÔÓ-„ÓÎÂÏË ÔÓ‰˙ÎÊËÚÂÎ-ÌÓÒÚÚ‡ Ë ·ÓflÚ Ì‡ Ô‰ÓÔ‡ÚË‚ÌËÚ ÔËÒÚ˙ÔË Ë ÔËÊÂÌÒÍË ÔÓÎ (10). ëÔÓ‰ ‰Û„Ë ‡‚ÚÓË (36) Ò‡ Ó·ÓÒÓ·ÂÌËÒΉÌËÚ ËÒÍÓ‚Ë Ù‡ÍÚÓË:

1. ‚˙Á‡ÒÚ Ì‡ ÔÓfl‚‡ ̇ Ô‰ÓÔ‡ÚË‚ÌËÚ ÔËÒÚ˙ÔËÔÂ‰Ë 30-Ú‡ „Ó‰Ë̇

2. ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ Ô‰ÓÔ‡ÚË‚ÌËfl ÔÂËÓ‰ ̇‰12 ÏÂÒˆ‡

3. ÚÂÏÔÓ‡Î̇ Ë/ËÎË ÒÛÔ‡ÚÂÌÚÓˇÎ̇ ÎÓ͇ÎËÁ‡ˆËfl4. ̇΢ˠ̇ ÍÓÚË͇Î̇ ÂÍÒˆËÁËflåËÍÓıËۄ˘̇ڇ ÚÂıÌË͇ ÔË ÓÔ‡ˆËfl ̇ ÄV-

χÎÙÓχˆËËÚ  ÔÓ-˘‡‰fl˘‡ Á‡ Ô‡ˆËÂÌÚ‡ ÔÓ ÓÚÌÓ¯ÂÌËÂ̇ ‚ÂÓflÚÌÓÒÚÚ‡ Á‡ ‡Á‚ËÚË ̇ Í˙Ò̇ ÔÓÒÚÓÔ‡Ú˂̇ÂÔËÎÂÔÒËfl ÒÔÓ‰ Ori (24), ÌÓ Fenton et al. (10) Ò‡ ̇ ÔÓ-ÚË‚ÓÔÓÎÓÊÌÓÚÓ ÏÌÂÌËÂ.

èË ÓÔ¡ÌËÚ ÓÚ ÏÓÁ˙˜ÌË ‡Ì‚ËÁÏË ·ÓÎÌË ‚Ò˘Íˇ‚ÚÓË Ò‡ ‰ËÌÓ‰Û¯ÌË Ò‡ÏÓ ÔÓ ÓÚÌÓ¯ÂÌË ̇ ÚÓ‚‡, ˜Â‡Ì‚ËÁÏËÚ ̇ Ò‰̇ڇ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl Ò‡ Ò ÔÓ-‚ËÒÓÍËÒÍ ÓÚ ‡Á‚ËÚË ̇ ÔÓÒÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl. ÇÒ˘ÍË‰Û„Ë ËÒÍÓ‚Ë Ù‡ÍÚÓË Ò‡ ÒÔÓÌË (1,2,11,12,13,19,22,23,32).

çÂÁ‡‚ËÒËÏÓ ÓÚ ‚ˉ‡ ̇ ÏÓÁ˙˜Ì‡Ú‡ ÎÂÁËfl ËÒÍ˙Ú Á‡‡Á‚ËÚË ̇ ÔÓ‰Ó·ÌË ÔËÒÚ˙ÔË flÁÍÓ Ò ۂÂ΢‡‚‡ ̇‰ 50-„Ӊ˯̇ ‚˙Á‡ÒÚ. èË ‚Ò˘ÍË ÒÎÛ˜‡Ë ·ÓflÚ Ë ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚ ÔÂ‰Ë ÓÔ‡Ú˂̇ڇ ËÌÚÂ-‚Â̈Ëfl Ò‡ ̇È-‚‡ÊÌËfl Ù‡ÍÚÓ Á‡ ‡Á‚ËÚË ̇ Í˙Ò̇ ÔÓÒ-ÚÓÔ‡Ú˂̇ ÂÔËÎÂÔÒËfl. éÒÓ·ÂÌÓ Ì‡‡ÒÚ‚‡ ËÒÍ˙Ú ÔË̇΢ˠ̇ Ôӂ˜ ÓÚ 5 ÔËÒÚ˙Ô‡ Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ÔËÒÚ˙ÔÌËfl ÔÂËÓ‰ ̇‰ 12 ÏÂÒˆ‡ (5,10). íÓ„‡‚‡ Ì  ÔÓ-͇Á‡Ì‡ Ë ˘‡‰fl˘‡Ú‡ Ì‚ÓıËۄ˘̇ ÓÔ‡ˆËfl (ÎÂÁËÓÌÂÍ-ÚÓÏËfl) (10).

ÇÒ Ӣ Ìflχ ÒË„ÛÌË ÎËÚ‡ÚÛÌË ‰‡ÌÌË Á‡ ÂÙË͇Ò-ÌÓÒÚÚ‡ ̇ ÍÓÂÚÓ Ë ‰‡  ÔÓÚË‚ÓÂÔËÎÂÔÚ˘ÌÓ Ò‰ÒÚ‚Ó‚ Ô‚Â̈ËflÚ‡ ̇ ÔÓÒÚÓÔ‡Ú˂̇ڇ ÂÔËÎÂÔÒËfl. ç¢ÓÔӂ˜ - Ìflχ ‡ˆËÓ̇Î̇ ÓÒÌÓ‚‡ Á‡ ÔÓ‚Âʉ‡ÌÂÚÓ Ì‡ ÔÓÒ-ÚÓÔ‡Ú˂̇ ÔÓÙË·ÍÚË͇ (13). èÓ ÓÚÌÓ¯ÂÌË ̇ ËÁ-ÔÓÎÁ‚‡ÌËڠωË͇ÏÂÌÚË Á‡ ΘÂÌË ̇È-˜ÂÒÚÓ Ò ˆËÚË-‡Ú Phenitoin Ë Carbamazepine (1,2,12,14,31). LJÎÔÓ‡ÚË-Ú Ò˙˘Ó Ì ÓÚÒÚ˙Ô‚‡Ú ÔÓ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ‰ÂÈÒÚ‚Ë ËÔ‰ÒÚ‡‚Îfl‚‡Ú ÒÂËÓÁ̇ ‡ÎÚÂ̇ÚË‚‡ ‚ ÚÂÁË ÒÎÛ˜‡Ë(1,2,13). ä·Ò˘ÂÒÍË Ï‰Ë͇ÏÂÌÚ Â Ë Phenobarbital.

LJÊÌÓ Â ‰‡ Ò ÓÚ·ÂÎÂÊË, ˜Â ÔÓ‚Âʉ‡ÌÂÚÓ Ì‡ ‡‰ÂÍ-‚‡ÚÌÓ Ï‰Ë͇ÏÂÌÚÓÁÌÓ Î˜ÂÌË ÔË ÚÂÁË ·ÓÎÌË Ëχ ËÁ‡-ÁÂÌ ÔÓÎÓÊËÚÂÎÂÌ ÂÙÂÍÚ - Ô˙ÎÌÓ Ó‚Î‡‰fl‚‡Ì ̇ ÔËÒÚ˙ÔË-Ú ‚ ‡ÏÍËÚ ̇ 1 „Ó‰Ë̇ ‚ 71,2% ÓÚ Ô‡ˆËÂÌÚËÚ (20).

ãàíÖêÄíìêÄ. Baker-CJ; Prestigiacomo-CJ; Solomon-RA; Short-term perioperative anti-convulsant prophylaxis for the surgical treatment of low-risk patients with intracra-nial aneurysms.Neurosurgery. 1995 Nov; 37(5): 863-70; discussion 870-1 2. Beenen-LF; Lindeboom-J; Kasteleijn-Nolst-Trenite-DG; Heimans-JJ; Snoek-FJ; Touw-DJ; Ader-HJ; van-Alphen-HA, Comparative double blind clinical trial ofphenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy:efficacy, tolerability, and cognitive effects. J-Neurol-Neurosurg-Psychiatry. 1999Oct; 67(4): 474-80 3. Bidzinski-J; Marchel-A; On epilepsy prevention after intracranial aneurysmsurgery Neurol-Neurochir-Pol. 1995 Mar-Apr; 29(2): 213-204. Bidzinski-J; Marchel-A; Sherif-A Risk of epilepsy after aneurysm opera-tions. Acta-Neurochir-Wien. 1992; 119(1-4): 49-52 5. Cappabianca-P; Alfieri-A; Maiuri-F; Mariniello-G; Cirillo-S; de-Divitiis-ESupratentorial cavernous malformations and epilepsy: seizure outcome afterlesionectomy on a series of 35 patients. Clin-Neurol-Neurosurg. 1997 Aug; 99(3):179-83 6. Casazza M; Broggi G; Franzini A; Avanzini G; Spreafico R; Bracchi M;Valentini MC; Supratentorial cavernous angiomas and epileptic seizures:Preoperative course and postoperative outcome. Neurosurgery 1996; 39:26-34 7. Chan RC; Thompson GB; Morbidity, mortality and quality of life followingsurgery for intracranial meningiomas. J Neurosurg 1984; 60:52-60 8. Chow-SY; Hsi-MS; Tang-LM; Fong-VH; Epilepsy and intracranial menin-giomas. Chung-Hua-I-Hsueh-Tsa-Chih-Taipei. 1995 Feb; 55(2): 151-5 9. Chozick-BS; Reinert-SE; Greenblatt-SH Incidence of seizures after surgeryfor supratentorial meningiomas: a modem analysis. J-Neurosurg. 1996 Mar;84(3):382-6 10. Cohen-DS; Zubay-GP; Goodman-RR Seizure outcome after lesionectomy forcavernous malformations. J-Neurosurg. 1995 Aug; 83(2): 237-42 11. Fenton-L; Hollands-M Postoperative seizures. Aust-N-Z-J-Surg. 1992 Jun;62(6):441-3 12. Foy-PM; Chadwick-DW; Rajgopalan-N; Johnson-AL; Shaw-MD; Do pro-phylactic anticonvulsant drugs alter the pattern of seizures after craniotomy? J-Neurol-Neurosurg-Psychiatry. 1992 Sep; 5(9): 753-713. Hayashi-T; Hadeishi-H; Kawamura-S; Nonoyama-Y; Suzuki-A; Yasui-NPostoperative anticonvulsant prophylaxis for patients reated for cerebral aneurysmsNeurol-Med-Chir-Tokyo. 1999 Nov; 39(12): 828-33; discussion 833-4 14. Janz-D Risk and drug prevention of epileptic seizures after cerebral lesionsZentralbl-Neurochir. 1994; 55(1): 1-8 15. Jennett B; Bond M; Assessment of outcome after severe brain damage: apractical scale. Lancet 1975; 1:480-484 16. Jennett W; Predicting epilepsy after blunt head injury. Br J Med 1965;1:1215-1216 17. Lee ST; Lui TN; Chang CN; Cheng WC; Early postoperative seizures afterposterior fossa surgery. J Neurosurg 1990; 73:541-544 18. Levati-A; Savoia-G; Ranzini-L; D'Angelo-V; Boselli-L; Risk of postoperativeepilepsy in acute surgery of cerebral aneurysms Minerva-Anestesiol. 1992 Apr;58(4 Suppi I): 107-10 19. Levati-A; Savoia-G; Zoppi-F; Boselli-L; Tommasino-C; Peri-operative pro-phylaxis with phenytoin: dosage and therapeutic plasma levels. Acta-Neurochir-Wien. 1996; 138(3): 274-8; discussion 278-9 20. Lieu-AS; Howng-SL; Intracranial meningiomas and epilepsy: incidence,prognosis and influencing factors. Epilepsy-Res. 2000 Jan; 38(1): 45-52 21. Logue V; Surgery of supratentorial meningiomas: a modern series. J NeurolNeurosurg Psychiatry 1974; 37:1277-8 22. Ohman J; Hypertension as risk for epilepsy after aneurismal subarachnoidhemorrhage and surgery. Neurosurgery 1990; 27:578-581 23. Olafsson-E; Gudmundsson-G; Hauser-WA Risk of epilepsy in long-term sur-vivors of surgery for aneurysmal subarachnoid hemorrhage: a population-basedstudy in Iceland. Epilepsia. 2000 Sep; 41(9): 1201-5 24. O'Laoire-SA Microsurgical treatment of arteriovenous malformations in criti-cal areas of the brain. Br-J-Neurosurg. 1995; 9(3): 347-60 25. Ori-C Epileptogenic complications of neurosurgical interventions Minerva-Anestesiol. 1992 Apr; 58(4 Suppi I): 53-8 26. Ori-C Postoperative epilepsy Minerva-Anestesiol. 1992 Apr; 58(4 Suppi I):159-60 27. Penfield W; Erickson TC; Tarlov I; Relation of intracranial tumors and symp-tomatic epilepsy. Arch Neurol Psychiatry 1940; 44:384-386 28. Rabinowicz-AL; Ginsburg-DL; DeGiorgio-CM; Gott-PS; Giannotta-SLUnruptured intracranial aneurysms: seizures and antiepileptic drug treatment fol-lowing surgery. J-Neurosurg. 1991 Sep; 75(3): 371-3 29. Ramamurthi B; Ravi R; Ramachandran V; Convulsions with meningiomas:incidence and significance. Surg Neurol 1980; 14:415-416 30. Ruggiero-C; Punzo-A; Ambrosio-G; De-Marinis-P; D'Arienzo-G; Ambrosio-A; Postoperative epilepsy. 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ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- êÓÒÂÌ ä‡ÎÔ‡˜ÍËç‚ÓÎӄ˘̇ ÍÎËÌË͇ÄÎÂÍ҇̉ӂÒ͇ ·ÓÎÌˈ‡ - ëÓÙËfl1431, ÛÎ. É. ëÓÙËÈÒÍË 1; ëÎ. ÚÂÎ. 9230338

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 77‡ÔËÎ, 2002

SUMMARYDYSARTHRIAS AND DYSPHONIAS - CLINICAL AND

THERAPEUTIC ASPECTSGeorgi Angov, Ognyan Kolev

This article is restricted to the clinics and the therapy forspeech and voice impairments due to damage of nervous ormuscular system in adulthood. The term dysarthria refers toabnormalities, caused by dysfunction of all tree functionalcomponents of the "speech aparatus" - respiration, phonationand articulation. In contrast, dysphonia denotes deficitrestricted to laryngeal level. Damage of lower motor cortex orfrontal operculum may dive rise of fairly consistent syndromeof articulatory and phonatory deficit - apraxia of speech.Spastic dysarthria is associated with bilateral lesions of pre-central girus or corticobulbar tracts. Parkinson disease maygive rise to a variety of speech and voice abnormalities includ-ing reduced vocal intensity, breathy voice quality, tremulousspeech an even speech freezing. Cerebellar dysarthria, result-ing from damage of paravermian regions, is characterized byslowed speech tempo, "scanning" rhytm and articulatoryimprecision. A more rare conditions are spasmodic dysphoniaand essential voice tremor. The therapy of dysarthria includeexercises on three components of speech apparatus and non-speech movements. Specific instrumental aids are used fortreatment of voice disorders - pacing boards, delayed auditoryfeedback, voice masking and voice amplifiers, dental prothe-ses and bite block. Nonverbal communication systems have tobe considered in patients with persistent anarthria. The mini-mal intensity of effective treatment is several hours daily.Key words: clinical picture, dysarthria, dysphonia, therapy

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˜ÂÌËÂÚÓ Ì‡ ̇ۯÂÌËflÚ‡ ̇ „Ó‚Ó‡, Ô˘ËÌÂÌË ÓÚ Á‡·Ó-Îfl‚‡ÌËfl ̇ Ì‚̇ڇ ËÎË ÏÛÒÍÛÎ̇ڇ ÒËÒÚÂχ ÔË ‚˙Á-‡ÒÚÌËÚÂ. ë ÚÂÏË̇ ‰ËÁ‡ÚËfl Ò ÓÁ̇˜‡‚‡Ú ̇ۯÂ-ÌËfl, Ô˘ËÌÂÌË ÓÚ Û‚Âʉ‡Ì ̇ ‚Ò˘ÍËÚ ÚË ÍÓÏÔÓ-ÌÂÌÚ‡ ̇ „Ó‚ÓÌËfl ‡Ô‡‡Ú - ÂÒÔˇˆËfl, ÙÓ̇ˆËfl Ë ‡ÚË-ÍÛ·ˆËfl. èË ‰ËÒÙÓÌËflÚ‡ Û‚Âʉ‡ÌÂÚÓ Â Ó„‡Ì˘ÂÌÓ Ì‡ÌË‚ÓÚÓ Ì‡ ·ËÌ„Ò‡. Ñ‚ÛÒÚ‡ÌÌËÚÂ Û‚Â‰Ë ‚ ‰ÓÎ̇ڇ˜‡ÒÚ Ì‡ ÏÓÚÓ̇ڇ ÍÓ‡ ËÎË ÙÓÌÚ‡ÎÌËfl ÓÔÂÍÛÎÛÏ ‚Ó-‰flÚ ‰Ó ‰Ó·Â Ó·ÓÒÓ·ÂÌ ÍÎËÌ˘ÂÌ ÒË̉ÓÏ Ì‡ ‡ÚËÍÛ·-ÚÓÂÌ Ë ÙÓ̇ÚÓÂÌ ‰ÂÙˈËÚ - ÍÓÚË͇Î̇ ‰ËÁ‡ÚËfl.ëÔ‡ÒÚ˘̇ڇ ‰ËÁ‡ÚËfl Ò ‡ÒÓˆËˇ Ò ‰‚ÛÒÚ‡ÌÌË ÎÂÁËË̇ ÔˆÂÌÚ‡Î̇ڇ „˙Ì͇ ËÎË ÍÓÚËÍÓ·Ûη‡ÌËÚ ڇÍ-ÚÓ‚Â. èË ·ÓÎÌËÚÂ Ò è‡ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ Ò Ò¢‡Ú‡ÁÌÓÓ·‡ÁÌË „Ó‚ÓÌË Ì‡Û¯ÂÌËfl - ̇χÎÂ̇ ÒË· ̇ „Ó‚Ó-‡, ÚÂÏÓ Ì‡ „·҇ Ë ‰ÓË "Á‡Ï˙Á‚‡ÌÂ" ̇ „Ó‚Ó‡. ñÂÂ-·Â·̇ڇ ‰ËÁ‡ÚËfl, Ô˘ËÌÂ̇ ÓÚ ÎÂÁËË ‚ Ô‡‡‚ÂÏËÒ-ÌËÚ ӷ·ÒÚË, Ò ı‡‡ÍÚÂËÁˇ Ò˙Ò Á‡·‡‚ÂÌ ËÚ˙Ï Ì‡„Ó‚Ó‡ Ë ‡ÚËÍÛ·ÚÓ̇ ÌÂÚÓ˜ÌÓÒÚ. èÓ-‰ÍË Ò˙ÒÚÓfl-ÌËfl Ò‡ ÒÔ‡ÒÏӉ˘̇ڇ ‰ËÒÙÓÌËfl Ë ÂÒÂ̈ˇÎÌËflÚ ÚÂÏÓ̇ „·҇. ã˜ÂÌËÂÚÓ ‚Íβ˜‚‡ ÛÔ‡ÊÌfl‚‡Ì ̇ ÚËÚÂÍÓÏÔÓÌÂÌÚ‡ ̇ „·ÒÓ‚Ëfl ‡Ô‡‡Ú Ë Ì„ӂÓÌË ÛÔ‡ÊÌÂÌËfl.àÁÔÓÎÁ‚‡Ú Ò ÒÔˆËÙ˘ÌË ËÌÒÚÛÏÂÌÚ‡ÎÌË ÏÂÚÓ‰Ë - Á‡-·‡‚ÂÌ ÒÎÛıÓ‚ "feedback", χÒ͡˘ ¯ÛÏ Ë „·ÒÓ‚Ë ÛÒË΂‡-ÚÂÎË, Á˙·ÌË ÔÓÚÂÁË, ·ÎÓÍˇÌ ̇ Á‡ı‡Ô͇ڇ Ë ‰. àÁ-ÔÓÎÁ‚‡ÌÂÚÓ Ì‡ Ì‚·‡ÎÌËÚ ÒËÒÚÂÏË Á‡ ÍÓÏÛÌË͇ˆËfl ÒÂ

Ó·Ò˙ʉ‡ ÔË ·ÓÎÌË Ò ÔÂÒËÒÚˇ˘‡ ‡Ì‡ÚËfl. ᇠ‰‡ ·˙‰ÂÂÙÂÍÚ˂̇ Ú‡ÔËflÚ‡ ÌÂÈ̇ڇ ËÌÚÂÌÁË‚ÌÓÒÚ Úfl·‚‡‰Â  ÌflÍÓÎÍÓ ˜‡Ò‡ ‰Ì‚ÌÓ.äβ˜Ó‚Ë ‰ÛÏË: ‰ËÁ‡ÚËfl, ‰ËÒÙÓÌËfl, ÍÎËÌ˘̇ ͇ÚË-̇, Ú‡ÔËfl

Ç ÒÚ‡ÚËflÚ‡ Ò‡ ‡Á„Ή‡ÌË ÍÎËÌË͇ڇ Ë Ú‡ÔËflÚ‡ ̇„Ó‚ÓÌËÚ ̇ۯÂÌËfl, ̇ÒÚ˙ÔËÎË ‚ÒΉÒÚ‚Ë ̇ Û‚ÂÊ-‰‡ÌËfl ̇ Ì‚̇ڇ ËÎË ÏÛÒÍÛÎ̇ڇ ÒËÒÚÂχ ÔË ‚˙Á‡Ò-ÚÌË. ç ҇ ‚Íβ˜ÂÌË ÒÏÛ˘ÂÌËfl ‚ ‡Á‚ËÚËÂÚÓ Ë ÙÛÌ͈Ë-Ó̇ÎÌË ÁÒÚÓÈÒÚ‚‡, ͇ÍÚÓ Ë ‡ÚËÍÛ·ˆËÓÌÂÌ Ë ÙÓ̇ÚÓ-ÂÌ ‰ÂÙˈËÚ, ‰˙Îʇ˘ Ò ̇ ÒÚÛÍÚÛÌË Û‚Âʉ‡ÌËfl ̇„Ó‚ÓÌËfl ‡Ô‡‡Ú.

ç‡È-Ó·˘Ó „Ó‚Ó˙Ú Ò ÔӉۈˇ ÓÚ ÚË ÙÛÌ͈ËÓ̇Î-ÌË ÍÓÏÔÓÌÂÌÚ‡: ÂÒÔˇˆËfl, ÙÓ̇ˆËfl Ë ‡ÚËÍÛ·ˆËfl.Ñ‚Ë„‡ÚÂÎÌËÚ ̇ۯÂÌËfl ̇ „Ó‚Ó‡, ÒÔˆˇÎÌÓ ÔË Ô‡ˆË-ÂÌÚË Ò Ì‡Û¯ÂÌËfl ̇ ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ Ë ÏË-‡ÒÚÂÌËfl „‡‚ËÒ, Ò ı‡‡ÍÚÂËÁË‡Ú Ò˙Ò Á‡Òfl„‡Ì ̇ ‚Ò˘-ÍËÚ ÚË ÍÓÏÔÓÌÂÌÚ‡. íÂÁË Ì‡Û¯ÂÌËfl Ò ÓÁ̇˜‡‚‡Ú ÒÔÓ-Ó·˘Ëfl ÚÂÏËÌ ‰ËÁ‡ÚËfl. ë ÚÂÏË̇ ‰ËÒÙÓÌËfl Ò ÓÁ-̇˜‡‚‡ „Ó‚Ó̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ, Ó„‡Ì˘Â̇ ‰Ó ÌË‚ÓÚÓ̇ ·ËÌ„Ò‡, ͇ÚÓ Ì‡ÔËÏ ÒÔ‡ÒÚ˘̇ڇ ‰ËÒÙÓÌËfl.

äãàçàóçà ÄëèÖäíàÉÓ‚Ó̇ ‡Ô‡ÍÒËfl

ì‚Âʉ‡ÌËflÚ‡ ‚ ‰ÓÎÌËÚ ˜‡ÒÚË Ì‡ ÏÓÚÓ̇ڇ ÍÓ‡ËÎË Ì‡ ÙÓÌÚ‡ÎÌËfl ÓÔÂÍÛÎÛÏ ‚ ‰ÓÏË̇ÌÚ̇ڇ ıÂÏËÒÙÂ-‡ ‚Ó‰flÚ ‰Ó ‰Ó·Â Ó˜ÂÚ‡Ì ÒË̉ÓÏ Ì‡ ÙÓ̇ÚÓÂÌ Ë ‡-ÚËÍÛ·ÚÓÂÌ ‰ÂÙˈËÚ, ‚Íβ˜‚‡˘ Á‡·‡‚ÂÌÓ ÚÂÏÔÓ Ì‡ „Ó-‚Ó‡ Ë Ì‡Û¯ÂÌË ‡ÚËÍÛ·ÚÓÌË ÒÔÓÒÓ·ÌÓÒÚË(6). á‡Ó·ÓÁ̇˜‡‚‡Ì ̇ ÚÓÁË ‚ˉ ̇ۯÂÌËfl Ò ËÁÔÓÎÁ‚‡ ÚÂÏË-Ì˙Ú „Ó‚Ó̇ ‡Ô‡ÍÒËfl. Ç Ì‡È-˜ËÒÚËfl ‚ˉ „Ó‚Ó̇ڇ ‡Ô-‡ÍÒËfl Ò ı‡‡ÍÚÂËÁˇ Ò˙Ò Ò˙ı‡ÌÂ̇ ËÎË Ò‡ÏÓ ÎÂÍÓ Ì‡-Û¯Â̇ ÒÔÓÒÓ·ÌÓÒÚ Á‡ ÔËÒ‡ÌÂ, ÍÓÂÚÓ ÓÁ̇˜‡‚‡, ˜Â ÂÁËÍÓ-‚ËÚ ÙÛÌ͈ËË Ò‡ Ò‡‚ÌËÚÂÎÌÓ Ò˙ı‡ÌÂÌË. íÓÁË ‚ˉ Û‚-Âʉ‡ÌËfl Ò ‡ÒÓˆËË‡Ú Ò ÎÂÁËË ‚ ‰ÓÎ̇ڇ (ÓÔÂÍÛ·̇-Ú‡) ˜‡ÒÚ Ì‡ Îfl‚‡Ú‡ ÔÂÏÓÚÓ̇ ÍÓ‡ Ë Ò ӷÓÁ̇˜‡‚‡Ú ÒÚÂÏË̇ ‡ÙÂÏËfl. àÁÓΡ̇ڇ ÔÓfl‚‡ ̇ „Ó‚Ó̇ ‡Ô‡Í-ÒËfl ËÎË ‡ÙÂÏËfl  ҇‚ÌËÚÂÎÌÓ fl‰Í‡. èÓ-˜ÂÒÚÓ ÚÓÁË ÒËÌ-‰ÓÏ Â ˜‡ÒÚ ÓÚ ÍÓÚË͇Î̇ڇ ÏÓÚÓ̇ ‡Ù‡ÁËfl (‡Ù‡ÁËfl̇ ÅÓ͇). ᇠ‡ÁÎË͇ ÓÚ ‰ËÁ‡ÚËËÚÂ, „Ó‚Ó̇ڇ ‡Ô‡Í-ÒËfl Ò ÔËÂχ Á‡ ̇ۯÂÌË ̇ ‚ËÒ¯ËÚ ÍÓÓ‚Ë ÙÛÌ͈ËË,Ò‚˙Á‡ÌÓ Ò Ì‡Û¯ÂÌÓ Ô·ÌˇÌ ̇ ‡ÚËÍÛ·ÚÓÌËÚ ËÙÓ̇ÚÓÌËÚ ÙÛÌ͈ËË.

ÑËÁ‡ÚËËèӂ˜ÂÚÓ ·Ûη‡ÌË fl‰‡, ÓÚ„Ó‚ÓÌË Á‡ ÔÓ‰Û͈ËflÚ‡

̇ „Ó‚Ó‡, ÔÓÎÛ˜‡‚‡Ú ÍÓÚËÍÓÙÛ„‡ÎÌË ‚·Í̇ ÓÚ ÏÓÚÓ-̇ڇ ÍÓ‡ ̇ ‰‚ÂÚ ıÂÏËÒÙÂË. í‡Í‡ ÔÂÒËÒÚˇ˘ËÚ‡ÚËÍÛ·ÚÓÌË Ë ÙÓ̇ÚÓÌË Ì‡Û¯ÂÌËfl Ò ‡ÒÓˆËË‡Ú Ò‰‚ÛÒÚ‡ÌÌË ÎÂÁËË Ì‡ ÔˆÂÌÚ‡ÎÌËfl „ËÛÒ ËÎË ÍÓÚËÍÓÒ-ÔË̇ÎÌËÚ ڇÍÚÓ‚Â (ÒÔ‡ÒÚ˘̇ ‰ËÁ‡ÚËfl). èË Ì‡È-ÚÂÊÍËÚ ÙÓÏË ÏÓÊ ‰‡ Ò ̇·Î˛‰‡‚‡ ‡Ì‡ÚËfl ËΡÙÓÌËfl, ͇ÍÚÓ ˜ÂÒÚÓ Ò ÒÎÛ˜‚‡ ÒΉ ÚÂÊÍË ˜ÂÂÔÌÓÏÓ-Á˙˜ÌË Ú‡‚ÏË ËÎË Á‡·ÓÎfl‚‡ÌËfl ̇ ˆÂÌÚ‡ÎÌËfl ‰‚Ë„‡ÚÂ-ÎÂÌ Ì‚ÓÌ. Ö‰ÌÓÒÚ‡ÌÌËÚ ۂÂʉ‡ÌËfl Ó·ËÍÌÓ‚ÂÌÓ ‚Ó-‰flÚ ‰Ó ÎÂÍË Ë ÔÂıÓ‰ÌË Ì‡Û¯ÂÌËfl. ëÔ‡ÒÚ˘̇ڇ ‰ËÁ‡-ÚËfl Ò ı‡‡ÍÚÂËÁˇ Ò ÌËÒÍÓ‡ÏÔÎËÚۉ̇, Á‡·‡‚Â̇ ‡-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 78‡ÔËÎ, 2002

é·ÁÓ

Ñàëîéçàà à ÑàáÄêíêàà - äãàçàäé-íÖêÄèÖÇíàóçàÄëèÖäíà Ç çÖÇêéãéÉàüíÄ

ÉÂÓ„Ë ÄÌ„Ó‚, é„ÌflÌ äÓ΂ ìëÅÄãçè "ë‚. ç‡ÛÏ", ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl, åì - ëÓÙËfl

ÚËÍÛ·ˆËfl, ıËÔÂ̇Á‡ÎÂÌ „Ó‚Ó, ÔÓ‡‰Ë ̉ÓÒÚ‡Ú˙˜ÌÓÔÓ‚‰Ë„‡Ì ̇ ‚ÂÎÛχ, Âڇ͈ˇ ̇ ÂÁË͇, Ù‡Ë̄‡Î̇ÍÓÌÒÚË͈Ëfl Ë ıËÔ‡‰‰Û͈Ëfl ̇ ÒÍ˙ÒÂÌËÚ „·ÒÌË ‚˙Á-ÍË (19). èË è‡ÍËÌÒÓÌÓ‚‡Ú‡ ·ÓÎÂÒÚ Ëχ ‡Á΢ÌË Ì‡Û-¯ÂÌËfl ‚˙‚ ÙÓ̇ˆËflÚ‡ Ë ‡ÚËÍÛ·ˆËflÚ‡, ͇ÚÓ Ì‡Ï‡ÎÂ̇‚ËÒÓ˜Ë̇ ̇ „Ó‚Ó‡, Â‰ÛˆË‡Ì ËÌÚÂÌÁËÚÂÚ, ÚÂÏÓ Ì‡„·҇ Ë ‰ÓË "Á‡Ï˙Á‚‡Ì ̇ „Ó‚Ó‡" ÔÓ‡‰Ë ̇ۯÂÌË ̇ÓÓÙ‡ˆË‡ÎÌËÚ ‰‚ËÊÂÌËfl. ᇠ‡ÁÎË͇ ÓÚ ÍÓÚËÍÓ·Ûη‡-ÌËÚÂ Ë ˆÂ·Â·ÌËÚ ‰ËÒÙÛÌ͈ËË, ÔË Ô‡ÍËÌÒÓÌÓ‚‡Ú‡‰ËÁ‡ÚËfl ̇È-˜ÂÒÚÓ Ò ̇·Î˛‰‡‚‡ ÌÓχÎÂÌ Ë ‰ÓË ÛÒÍÓ-ÂÌ „Ó‚Ó (2). ÄÍÛÒÚ˘ÌËflÚ ‡Ì‡ÎËÁ ̇ „Ó‚Ó‡ ÔË ·ÓÎÌË ÒıÓÂfl ̇ ï˙ÌÚËÌ„ÚÓÌ ÔÓ͇Á‚‡, ˜Â ‰‚Ë„‡ÚÂÎÌËflÚ ‰ÂÙË-ˆËÚ Ì‡ „Ó‚ÓÌËfl ‡Ô‡‡Ú  ÔÓ‰Ó·ÂÌ Ì‡ ÚÓÁË, ̇·Î˛‰‡‚‡ÌÔË ‰‚ËÊÂÌË ̇ ͇ÈÌˈËÚ (13)

ñ·Â·̇ڇ ‰ËÁ‡ÚËfl ̇È-‚ÂÓflÚÌÓ Â ÂÁÛÎÚ‡ÚÓÚ Û‚Âʉ‡Ì ̇ Ô‡‡Ï‰ˇÌÌËÚ „ËÓÌË Ì‡ χÎÍÓÏÓ-Á˙˜ÌËÚ ıÂÏËÒÙÂË (3). ç‡ ÔˆÂÔÚÓÌÓ ÌË‚Ó ÚÓÁË ÒË̉-ÓÏ Ò ı‡‡ÍÚÂËÁˇ Ò˙Ò Á‡·‡‚ÂÌÓ ÚÂÏÔÓ Ì‡ „Ó‚Ó‡, Ò‡-͇‰Ë‡Ì „Ó‚Ó Ë ‡ÚËÍÛ·ÚÓ̇ ÌÂÚÓ˜ÌÓÒÚ. 燷≇‚‡-ÌË Ò‡ ÙÎÛÍÚÛ‡ˆËË Ì‡ ÒË·ڇ Ë ‚ËÒÓ˜Ë̇ڇ ̇ „·҇ ‚Íβ-˜ËÚÂÎÌÓ Ë ÚÂÏÓ Ì‡ „·҇. äËÌÂχÚ˘ÌËÚ ‡Ì‡ÎËÁË ÔÓ-͇Á‚‡Ú Á‡·‡‚ÂÌË ‡ÚËÍÛ·ÚÓÌË ‰‚ËÊÂÌËfl ÔË ·ÓÎÌË ÒˆÂ·Â·ÌË Ì‡Û¯ÂÌËfl. ì‚Âʉ‡ÌËfl ̇ fl‰‡Ú‡ Ë ÒÚ‚Ó-ÎÓ‚ÂÚ ̇ ˜ÂÂÔÌÓÏÓÁ˙˜ÌËÚ Ì‚Ë, ͇ÍÚÓ Ë ÏÛÒÍÛÎÌË Á‡-·ÓÎfl‚‡ÌËfl, Á‡Òfl„‡˘Ë „Ó‚ÓÌËfl ‡Ô‡‡Ú, Ó·ÛÒ·‚flÚ Ò˙ÒÚÓ-flÌËÂ, ̇˜ÂÌÓ ‚fl· ‰ËÁ‡ÚËfl. ç‡È-ËÁ‡ÁÂÌËfl ÒËÏÔÚÓÏ ıËÔÂ̇Á‡ÎÌËflÚ „Ó‚Ó ÔÓ‡‰Ë ̉ÓÒÚ‡Ú˙˜Ì‡ Â΂‡ˆËfl̇ ‚ÂÎÛχ. (11)

ëÔ‡ÒÚ˘̇ ‰ËÒÙÓÌËflëÔ‡ÒÚ˘̇ڇ ‰ËÒÙÓÌËfl Ò ı‡‡ÍÚÂËÁˇ Ò Ì‡Ô„̇Ú

Ë ‰ÂÁ„‡‚(?) „·Ò, Ò ÌËÒ˙Í Ó·ÂÏ Ë ÓÒÚÓÚ‡. ç‡Ïˇ Ò ӢÂÚÂÏÓ Ì‡ „·҇ Ë ÌÂÔ‡‚ËÎÌÓ ‡ÁÔ‰ÂÎÂÌË Ô‡ÛÁË. (7). èÓ̇ÒÚÓfl˘ÂÏ Ò ÔËÂχ, ˜Â ÚÓ‚‡ ‡ÁÒÚÓÈÒÚ‚Ó Ô‰ÒÚ‡‚-Îfl‚‡ ‚ˉ ÙÓ͇Î̇ ‰ËÒÚÓÌËfl.

ÖÒÂ̈ˇÎÂÌ ÚÂÏÓ Ì‡ „·҇íÂÏÓ Ì‡ „·҇ Ò ̇·Î˛‰‡‚‡ ÔË ·ÓÎÌË Ò è‡ÍËÌÒÓÌÓ-

‚‡ ·ÓÎÂÒÚ, χÎÍÓÏÓÁ˙˜ÌË Á‡·ÓÎfl‚‡ÌËfl, ÒÔ‡ÒÚ˘̇ ‰ËÒÙÓ-ÌËfl Ë ‡ÏËÓÚÓÙ˘̇ ·Ú‡Î̇ ÒÍÎÂÓÁ‡ (8). éÒ‚ÂÌ ÚÓ‚‡ÏÓÊ ‰‡ ·˙‰Â ˜‡ÒÚ ÓÚ ÂÒÂ̈ˇÎÌËfl ÚÂÏÓ ËÎË ‰‡ ·˙‰ÂËÁÓÎË‡Ì ÒËÏÔÚÓÏ. óÂÒÚÓÚ‡Ú‡ ̇ ÂÒÂÌψˇÎÌËfl ÚÂ-ÏÓ Â 4 - 6 Hz. è‡ÚÓÙËÁËÓÎӄ˘ÌËfl ÏÂı‡ÌËÁ˙Ï Ì‡ ÚÓ‚‡‡ÁÒÚÓËÒÚ‚Ó Ò‡ ËÚÏ˘ÌË ÍÓÌڇ͈ËË Ì‡ ÍËÍÓÚËÂÓ-ˉÌËfl ÏÛÒÍÛÎ Ë Ì‡ Ô‡‚Ëfl ÍÓÂÏÂÌ ÏÛÒÍÛÎ

èˉӷËÚË Ì‡Û¯ÂÌËfl ‚ Ô·‚ÌÓÒÚÚ‡ ̇ „Ó‚Ó‡èˉӷËÚËÚ Á‡ÂÍ‚‡ÌËfl Ò ̇·Î˛‰‡‚‡Ú ÔË ÏÌÓÊÂÒÚ‚ÓÁ‡·ÓÎfl‚‡ÌËfl ̇ ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ ͇ÚÓ ˜Â-ÂÔÌÓ-ÏÓÁ˙˜ÌË Ú‡‚ÏË, ËÒıÂÏ˘ÌË ÎÂÁËË ‚ „ÓÎflÏÓÏÓÁ˙˜-ÌËÚ ıÂÏËÒÙÂË, ÂÍÒÚ‡ÔˇÏˉÌË Á‡·ÓÎfl‚‡ÌËfl, ÄΈı‡È-ÏÂÓ‚‡ ·ÓÎÂÒÚ Ë ‰. (4). Ç ÒÎÛ˜‡ËÚ ̇ Á‡Òfl„‡Ì ̇ ‰ÓÏË-̇ÌÚ̇ڇ ıÂÏËÒÙ‡ Á‡ÂÍ‚‡ÌËflÚ‡ Ò ÔˉÛʇ‚‡Ú Ë ÓÚ‡Ù‡ÁËË.

è‡ÎË·ÎËflÚ‡ ( ÍÓÏÔÛÎÒË‚ÌÓ ÔÓ‚Ú‡flÌ ̇ ÔÓÒΉÌËÚÂÙ‡ÁË ËÎË ‰ÛÏË) Ò Ò¯‡ ÔË ÏÌÓÊÂÒÚ‚Ó Á‡·ÓÎfl‚‡ÌËfl ̇ñçë ͇ÚÓ ÔÓÒÚÂ̈ÂÙ‡ÎËÚÂÌ Ô‡ÍËÌÒÓÌËÁ˙Ï, ÔÒ‚‰Ó·ÛÎ-·‡Ì‡ Ô‡ÂÁ‡, ·ÓÎÂÒÚÚ‡ ̇ èËÍ Ë ‰. (1).

èêàçñàèà çÄ ãÖóÖçàÖíéèӂ‰Â̘ÂÒ͇ Ú‡ÔËfl (‚Íβ˜ËÚÂÎÌÓ 'Biofeedb‡cÍ')

èÓ˜ÚË ‚Ò˘ÍË Á‚ÛˆË Ò „ÂÌÂË‡Ú ˜ÂÁ ÏÓ‰Û·ˆËfl ̇ËÁ‰Ë¯‚‡Ì‡Ú‡ ÓÚ ·ÂÎËÚ ‰Ó·Ó‚ ‚˙Á‰Û¯Ì‡ ÒÚÛfl. éÒÓ-·ÂÌÓÒÚËÚ ̇ ÓÚ‰ÂÎÌËÚ Á‚ÛˆË Á‡‚ËÒflÚ ÓÚ ‡ÍÚË‚ÌÓÒÚ-Ú‡ ̇ „·ÒÌËÚ ‚˙ÁÍË, ÔÓÁˈËflÚ‡ ̇ ‚ÂÎÛχ Ë ÍÓÌÙË„Û-‡ˆËflÚ‡ ̇ ÛÒÚ̇ڇ ÍÛıË̇. èË ÚÂÊ͇ ‰ËÁ‡ÚËfl ÚÂ-‡ÔËflÚ‡ Á‡ÔÓ˜‚‡ Ò ‚˙Á‰ÂÈÒÚ‚Ë ‚˙ıÛ Ë̉˂ˉۇÎÌËÚÂ

ÍÓÏÔÓÌÂÌÚË Ì‡ Á‚ÛÍÓ‚Ëfl ‡Ô‡‡Ú Ë ‰ÓË Ò ÌÂÁ‚ÛÍÓ‚Ë ÛÔ-‡ÊÌÂÌËfl (17). èÓÌflÍÓ„‡ Îfl„‡ÌÂÚÓ Ì‡ „˙· Ë ÏÓÌËÚÓˇ-ÌÂÚÓ Ì‡ ‚‰Ë¯‚‡ÌËfl ‚˙Á‰Ûı ÔÓ‰Ó·fl‚‡ ÂÒÔˇÚÓ̇ڇÍÓÏÔÓÌÂÌÚ‡. Ň‚ÌÓÚÓ ËÁ„Ó‚‡flÌ ̇ ‰ÛÏËÚÂ, Ò ¯ËÓÍÓÓÚ‚ÓÂ̇ ÛÒÚ‡, ÏÓÊ ‰‡ ÔÓ‰Ó·Ë ‚ÂÎÓÙ‡Ë̄‡Î̇ڇ ÌÂ-‰ÓÒÚ‡Ú˙˜ÌÓÒÚ. çÂÁ‚ÛÍÓ‚ËÚ ÛÔ‡ÊÌÂÌËfl ͇ÚÓ ‰Ûı‡Ì ËÁ‡ÒÏÛÍ‚‡Ì Ì ҇ ÂÙÂÍÚË‚ÌË ÔË ‚ÂÎÓÙ‡Ë̄‡ÎÌË ‰ËÒ-ÙÛÌ͈ËË. Ç ÔÓ-Í˙ÒÌËÚ ÒÚ‡‰ËË Ì‡ ΘÂÌËÂÚÓ, ͇ÍÚÓ ËÔË ÔÓ-ÎÂÍÓ Û‚Â‰ÂÌË Ô‡ˆËÂÌÚË, ˆÂÎÚ‡ ̇ ÛÔ‡ÊÌÂÌËflڇ ‰‡ Ò ÔÓ‰Ó·Ë ÍÓÓ‰Ë̇ˆËflÚ‡ ̇ ‚Ò˘ÍË ÙÛÌ͈ËÓ̇ÎÌËÍÓÏÔÓÌÂÌÚË, ͇ÚÓ ÔÓÏfl̇ ‚ ‡ÍˆÂÌÚÛ‡ˆËflÚ‡ Ë ËÚ˙χ.Ç˙‚‰ÂÌË Ò‡ ÒÔˆËÙ˘ÌË Ú‡Ô‚Ú˘ÌË Ôӈ‰ÛË Á‡ ÎÂ-˜ÂÌË ̇ „Ó‚Ó̇ڇ ‡Ô‡ÍÒËfl. èӂ‰Â̘ÂÒÍËÚ ÒÚ‡ÚÂ-„ËË Á‡ ΘÂÌË ̇ Ì‚ӄÂÌÌÓ-Ó·ÛÒÎÓ‚ÂÌËÚ ‡Ô‡ÍÒËË ËÎˉËÁ‡ÚËË ÏÓ„‡Ú ‰‡ ·˙‰‡Ú ÔÓ‰ÔÓÏӄ̇ÚË ÓÚ "biofeed-back" Ôӈ‰ÛË Í‡ÚÓ ‡ÍÛÒÚ˘ÌÓ ËÁÏ‚‡Ì ̇ ÒË·ڇ Ë‚ËÒÓ˜Ë̇ڇ ̇ „·҇, „ËÒÚ‡ˆËfl ̇ ÖåÉ ‡ÍÚË‚ÌÓÒÚÚ‡ÓÚ ‡Á΢ÌË ÏÛÒÍÛÎË Ë ‰.àÁÒΉ‚‡ÌËfl ‚˙ıÛ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ̇ Ôӂ‰Â̘ÂÒ͇ڇÚ‡ÔËfl Ò‡ ÔÓ‚Âʉ‡ÌË ÔË Ô‡ˆËÂÌÚË Ò è‡ÍËÒÓÌÓ‚‡ ·Ó-ÎÂÒÚ - Ëχ ‰ÓÍÛÏÂÌÚˇÌË ·Î‡„ÓÔËflÚÌË ÂÙÂÍÚË ÔË·ÓÎÌË, ÔӉ·„‡ÌË Ì‡ 4 ˜‡ÒÓ‚‡ Ú‡ÔËfl ‚ÒÂÍË ‰ÂÌ, ‚ ÔÓ‰˙Î-ÊÂÌË ̇ 2 Ò‰ÏËˆË (18).

ᇠΘÂÌË ̇ ÛÒÍÓÂÌÓÚÓ ÚÂÏÔÓ Ì‡ „·҇ Ò ËÁÔÓÎÁ‚‡ÒÔˆˇÎÂÌ ËÌÒÚÛÏÂÌÚ‡ËÛÏ. ç‡È-˜ÂÒÚÓ Ò ËÁÔÓÎÁ‚‡"pacing board", ÔË ÍÓÂÚÓ Ô‡ˆËÂÌÚ‡ ËÁ„Ó‚‡fl Ò˙ÓÚ‚ÂÚ-ÌËfl Á‚ÛÍ, ÔÂÏÂÒÚ‚‡ÈÍË Ô˙ÒÚ‡ ÒË ÓÚ Ò„ÏÂÌÚ Ì‡ Ò„-ÏÂÌÚ ‚˙ıÛ ÔÓ‚˙ıÌÓÒÚÚ‡. àÁÔÓÎÁ‚‡ ÒÂ Ë Á‡·‡‚ÂÌ ÒÎÛıÓ‚"feedback" - ˜ÂÁ ÒÔˆˇÎ̇ ‡Ô‡‡ÚÛ‡ ·ÓÎÌËflÚ ˜Û‚‡ ËÁ„Ó-‚ÓÂÌËÚ ÓÚ Ò‡ÏËfl ÌÂ„Ó Á‚ÛˆË, ÌÓ Ò ËÁ‚ÂÒÚÌÓ Á‡·‡‚flÌÂ(14)

çËÒ͇ ÒË· ̇ „·҇: χÒ͡ÌÂ Ë ÛÒË΂‡ÚÂÎËê‰Û͈ËflÚ‡ ̇ Ó·Âχ ̇ „·҇ Ô‰ÒÚ‡‚Îfl‚‡ Á̇˜ËÏ

ÔÓ·ÎÂÏ, ÒÔˆˇÎÌÓ ÔË ·ÓÎÌËÚÂ Ò è‡ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ.èË Ôӂ˜ÂÚÓ Á‰‡‚Ë Îˈ‡, ÔÛÒ͇ÌÂÚÓ Ì‡ χÒ͡˘ ¯ÛÏ‚Ó‰Ë ‰Ó Á̇˜ËÚÂÎÌÓ ÛÒË΂‡Ì ̇ „Ó‚Ó‡ ( ÂÙÂÍÚ Ì‡Lombard). èË Ô‡ˆËÂÌÚË Ò è‡ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ Ï‡ÒÍË-‡˘ËflÚ ¯ÛÏ Ëχ Ò˙˘Ëfl ÂÙÂÍÚ (5). ä‡ÚÓ ‡ÎÚÂ̇ÚË‚‡ÏÓ„‡Ú ‰‡ Ò ËÁÔÓÎÁ‚‡Ú „·ÒÓ‚Ë ÛÒË΂‡ÚÂÎË (11)

ÇÂÎÓÙ‡Ë̄‡Î̇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ: Á˙·ÌË ÔÓÚÂÁË ÇÂÎÓÙ‡Ë̄‡Î̇ڇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ (̇χÎÂ̇ ËÎË

ÎËÔÒ‚‡˘‡ Â΂‡ˆËfl ̇ velum palatini) ÏÓÊ Á̇˜ËÚÂÎÌÓ ‰‡‚ÎÓ¯Ë Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ „Ó‚Ó‡, ÔÓ‡‰Ë ̇χÎfl‚‡Ì ̇ ËÌÚ-‡Ó‡ÎÌÓÚÓ Ì‡Îfl„‡ÌÂ. ëÔˆˇÎÌÓ ÍÓÌÒÚÛˇÌË Á˙·ÌËÔÓÚÂÁË (9) ÏÓ„‡Ú ÒË„ÌËÙË͇ÌÚÌÓ ‰‡ ÔÓ‰Ó·flÚ ÚÓ‚‡Ò˙ÒÚÓflÌËÂ. 臈ËÂÌÚË Ò ‚ÂÎÓÙ‡Ë̄‡Î̇ ̉ÓÒÚ‡Ú˙˜-ÌÓÒÚ, Ô˘ËÌÂ̇ ÓÚ ÎÂÁËË Ì‡ ÔÂËÙÂÌËfl ËÎË ˆÂÌÚ‡ÎÌËfl‰‚Ë„‡ÚÂÎÂÌ Ì‚ÓÌ Ë ‰ÓË Ò Myasthenia gravis, Ò ÔÓ‚ÎËfl-‚‡Ú ‰Ó·Â ÓÚ ÚÂÁË ÔËÒÔÓÒÓ·ÎÂÌËfl. àÌÊÂÍÚˇÌÂÚÓ Ì‡ÚÂÙÎÓÌ ËÎË ‰Û„Ë ÔÓ‰Ó·ÌË Ï‡ÚÂËË ‚ Á‡‰Ì‡Ú‡ Ù‡Ë̄‡-Î̇ ÒÚÂ̇ Ò˙˘Ó ‚Ó‰flÚ ‰Ó ÔÓ‰Ó·ÂÌË ̇ ‚ÂÎÓÙ‡Ë̄‡Î-̇ڇ ̉ÓÒÚ‡Ú˙˜ÌÓÒÚ (11).

éÓÙ‡ˆË‡Î̇ ‰ËÒÍËÌÂÁËfl: ·ÎÓÍˇÌ ̇ Á‡ı‡Ô͇ڇç‚Ó΂ËÚ ‰‚ËÊÂÌËfl ̇ ÓÓÙ‡ˆË‡ÎÌËÚ ÒÚÛÍÚÛË

Á̇˜ËÚÂÎÌÓ Û‚Âʉ‡Ú ÔÓ‰Û͈ËflÚ‡ ̇ ˜ڇ. àÏÓ·ËÎË-Á‡ˆËflÚ‡ ̇ ‰ÓÎ̇ڇ ˜ÂβÒÚ ˜ÂÁ ÒÔˆˇÎÌË ÛÒÚÓÈÒÚ‚‡ÏÓÊ ‰‡ ÔÓ‰Ó·Ë „Ó‚Ó‡ ̇ ÏÌÓ„Ó ÓÚ ÚÂÁË ·ÓÎÌË (11)

Ä̇ÚËfl: Ì‚·‡ÎÌË ÒËÒÚÂÏË Á‡ ÍÓÏÛÌË͇ˆËflàÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ Ì‚·‡ÎÌË ÒËÒÚÂÏË Á‡ ÍÓÏÛÌË͇ˆËfl

Ò ӷÒ˙ʉ‡ ÔË Ô‡ˆËÂÌÚË Ò ÔÂÒËÒÚˇ¯‡ ‡Ì‡ÚËfl, ÔËÍÓËÚÓ Ì Ò Ә‡Í‚‡ ÔÓ‰Ó·ÂÌË ̇ ‡ÚËÍÛ·ÚÓÌËÚ ËÎËÙÓ̇ÚÓÌËÚ ÙÛÌ͈ËË. ÅÓÎÌË Ò˙Ò Ò˙ı‡ÌÂÌË ‰‚Ë„‡ÚÂÎÌËÙÛÌ͈ËË Ì‡È-χÎÍÓ Ì‡ ‰̇ڇ ˙͇ ÏÓ„‡Ú ‰‡ ËÁÔÓÎÁ‚‡Ú

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 79‡ÔËÎ, 2002

Í·‚ˇÚÛ‡. èË Ì‰ÓÒÚ‡Ú˙˜ÂÌ Ï‡ÌÛ‡ÎÂÌ ÍÓÌÚÓÎ, ‡Î-ÚÂ̇ÚË‚‡ Ô‰ÒÚ‡‚Îfl‚‡ ÔÓ͇Á‚‡ÌÂÚÓ Ì‡ ͇ÚËÌË, ‰ÛÏËËÎË ÓÚ‰ÂÎÌË ·ÛÍ‚Ë ˜ÂÁ ÂÎÂÍÚÓÌÌË ÔËÒÔÓÒÓ·ÎÂÌËfl. ÇÁ‡‚ËÒËÏÓÒÚ ÓÚ ÓÒÚ‡Ú˙˜ÌËfl ‰‚Ë„‡ÚÂÎÂÌ Í‡Ô‡ˆËÚÂÚ, Ô‡-ˆËÂÌÚËÚ ÏÓ„‡Ú ‰‡ ÔÓÒÓ˜‡Ú Ò Ô˙ÒÚ ËÎË headstick (ÛÒÚ-ÓÈÒÚ‚Ó, ÏÓÌÚˇÌÓ Ì‡ „·‚‡Ú‡) Ò˙ÓÚ‚ÂÚÌËÚ ÒËÏ‚ÓÎËË Ú‡Í‡ ‰‡ „ÂÌÂË‡Ú Ò‚ÓÂÚÓ ÔÓÒ·ÌË ( Ú. ̇. ëÚ‡ÚÂ-„Ëfl ̇ ‰ËÂÍÚ̇ڇ ÒÂÎÂ͈Ëfl). èÓ-ۂ‰ÂÌËÚ ԇˆËÂÌÚËÓÚ„Ó‚‡flÚ Ò "‰‡" ËÎË "ÌÂ" ̇ ‚·‡ÎÌË ËÎË Ì‚·‡ÎÌËÒÚËÏÛÎË, ÔÓÒÓ˜ÂÌË ÓÚ ‰Û„ ˜Ó‚ÂÍ (ëÚ‡Ú„Ëfl ̇ ÒÍÂÌË-‡ÌÂÚÓ).

å‰Ë͇ÏÂÌÚÓÁÌÓ Î˜ÂÌËÂᇠÌflÍÓË Ì‚ÓÎӄ˘ÌË Á‡·ÓÎfl‚‡ÌËfl, ‚Ó‰Â˘Ë ‰Ó ‡ÚË-

ÍÛ·ÚÓÌË Ë ÙÓ̇ÚÓÌË Ì‡Û¯ÂÌËfl, ͇ÚÓ Ì‡ÔËÏ è‡-ÍËÌÒÓÌÓ‚‡ ·ÓÎÂÒÚ, Myasthenia gravis ËÎË ÂÒÂ̈ˇÎÂÌ ÚÂ-ÏÓ, Ëχ ÛÚ‚˙‰ÂÌË ÂÙË͇ÒÌË Ï‰Ë͇ÏÂÌÚË. ÇÒÂ Ô‡Í ÚÂ-‡Ô‚Ú˘ÌËflÚ ÂÙÂÍÚ Ì‡ ‰ÓÔ‡ÏËÌ„˘ÌËڠωË͇ÏÂÌ-ÚË ‚˙ıÛ Ô‡ÍËÌÒÓÌÓ‚‡Ú‡ ‰ËÁ‡ÚËfl  ÔÓ‰ ‚˙ÔÓÒ (10).ã‚ӉÓÔ‡ ÔÂÔ‡‡ÚËÚÂ Ë ‰ÓÔ‡ÏËÌÓ‚ËÚ ‡„ÓÌËÒÚË ËχڇÁ΢ÂÌ ÂÙÂÍÚ ‚˙ıÛ „Ó‚ÓÌËfl Ë „·ÒÓ‚Ëfl ‰ÂÙˈËÚ ÔËÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ. ÖÒÂ̈ˇÎÌËflÚ ÚÂÏÓ Ì‡ „·҇  ÔÓ-Â-ÁËÒÚÂÌÚÂÌ Ì‡ ωË͇ÏÂÌÚÓÁÌÓ Î˜ÂÌË ÓÚ ÂÒÂ̈ˇÎÌËflÚÂÏÓ Ì‡ ͇ÈÌˈËÚ (16)

ÑÓ͇Á‡ÌÓ Â, ˜Â ËÌÊÂÍÚˇÌÂÚÓ Ì‡ ·ÓÚÛÎËÌÓ‚ ÚÓÍÒËÌ ‚·Ë̄‡ÎÌËÚ ÏÛÒÍÛÎË ÒË„ÌËÙË͇ÌÚÌÓ Â‰ÛˆË‡ ÒËÏÚÓ-ÏËÚ ̇ ÒÔ‡ÒÚ˘̇ڇ ‰ËÒÙÓÌËfl. í‡ÁË Ôӈ‰ۇ ‚Ó‰Ë ‰Ó‰ÌÓÒÚ‡Ì̇ Ô‡‡ÎËÁ‡ ̇ „·ÒÌËÚ ‚˙ÁÍË (ËÌÊÂÍÚˇÌÂ̇ 15 ‰ËÌËˆË Ì‡ Ô˙‚‡Ú‡ ÒÂÒËfl Ë ‰ÓÒÚË„‡Ì ‰Ó χÍÒË-χÎ̇ Ó·˘‡ ‰ÓÁ‡ ÓÚ 60 ‰ËÌˈË, ‡ÁÔ‰ÂÎÂÌË ‚ ÚË ÒÂ-ÒËË) ËÎË ÎÂ͇ ‰‚ÛÒÚ‡Ì̇ Ô‡ÂÁ‡ (2,5 - 3, 75 ‰ËÌËˆË ÓÚ‚Òfl͇ Òڇ̇). í‡Í‡ ‡ÔÎË͇ˆËflÚ‡ ̇ ·ÓÚÛÎËÌÓ‚ ÚÓÍÒËÌÚfl·‚‡ ‰‡ ·˙‰Â Ó„‡Ì˘Â̇ ‰Ó Ô‡ˆËÂÌÚË Ò˙Ò ÒÔ‡ÒÚ˘̇‰ËÒÙÓÌËfl Ë ıËÔ‡‰‰Û͈Ëfl ̇ „·ÒÌËÚ ‚˙ÁÍË. ÖÙÂÍÚ˙ÚÓÚ Î˜ÂÌËÂÚÓ Á‡ÔÓ˜‚‡ ‚ ‡ÏÍËÚ ̇ ˜‡ÒÓ‚Â ‰Ó ‰ÌË ÓÚ ‡Ô-ÎË͇ˆËflÚ‡ Ë ÔÓ‰˙Îʇ‚‡ Ò‰ÏËˆË ‰Ó ÏÂÒˆË. ä‡ÚÓ ÒÚ‡-Ì˘ÌË ÂÙÂÍÚË Ò‡ Ò˙Ó·˘‡‚‡ÌË ‰ËÒÙ‡„Ëfl Ë ‰ÂÁ„‡‚ „·Ò.

ïËۄ˘ÌÓ Î˜ÂÌËÂÖ‰ÌÓÒÚ‡ÌÌÓÚÓ ÔÂflÁ‚‡Ì ̇ nervus laryngeus recur-

rens  ‡ÎÚÂ̇ÚË‚‡ ̇ ·ÓÚÛÎËÌÓ‚‡Ú‡ ËÌÊÂ͈Ëfl ÔË ·ÓÎ-ÌË Ò˙Ò ÒÔ‡ÒÚ˘̇ ‰ËÒÙÓÌËfl. óÂÒÚÓÚ‡Ú‡ ̇ ÛÒÔ‚‡ÂÏÓÒÚ ÏÂÊ‰Û 30% Ë 80%. êˆˉ˂ˇÌÂÚÓ Ì‡ ÒÔ‡ÒÚˈËÚÂÚ‡ÏÓÊ ‰‡ ·˙‰Â ÍÓ˄ˇÌÓ ˜ÂÁ ·ÁÂÌÓ ËÁÚ˙Ìfl‚‡Ì ̇„·ÒÌËÚ ‚˙ÁÍË ÔË ‰ËÂÍÚ̇ ·˄ÓÒÍÓÔËfl (12). ïËÛ-„˘ÌË Ôӈ‰ÛË, ‚Íβ˜‚‡˘Ë Á‡‰ÌË Ù‡Ë̄‡ÎÌË Ô·ÒÚË-ÍË Ò ÔÂÔÓ˙˜‚‡Ú ÔË Ì‚ӄÂÌ̇ ‚ÂÎÓه˄‡Î̇ ̉ÓÒ-Ú‡Ú˙˜ÌÓÒÚ (15).

è‡ÍÚ˘ÂÒÍË ÏÂÌˉÊÏ˙ÌÚä‡ÚÓ Ô‡‚ËÎÓ Î˜ÂÌËÂÚÓ Úfl·‚‡ ‰‡ ·˙‰Â Ë̉˂ˉۇÎË-

ÁˇÌÓ ÔË ‚ÒÂÍË Ô‡ˆËÂÌÚ, ‚ Á‡‚ËÒËÏÓÒÚ ÓÚ ÔÓÙË· ̇‰ÂÙˈËÚ‡ ̇ ‡Á΢ÌËÚ ÔÓ‰ÒËÒÚÂÏË Ì‡ „Ó‚ÓÌËfl ‡Ô‡-‡Ú. èÂ‰Ë ‰‡ Ò Á‡ÔӘ̠ΘÂÌËÂÚÓ Â Ê·ÚÂÎÌÓ ‰ÂÚ‡ÈÎ-ÌÓ ËÁÒΉ‚‡Ì ̇ „Ó‚Ó̇ڇ ÔˆÂÔˆËfl, ‚ÂÌÚÛ‡ÎÌÓ‚Íβ˜‚‡ÌÂÚÓ Ì‡ ËÌÒÚÛÏÂÌÚ‡ÎÌË ËÁÒΉ‚‡ÌËfl ͇ÚÓ‡ÍÛÒÚ˘ÂÌ ‡Ì‡ÎËÁ, ÂÎÂÍÚÓ„ÎÓÚÓ„‡ÙËfl, ÙË·ÓẨÓÒÍÓÔ-Ò͇ ·ËÌ„ÓÒÍÓÔËfl ËÎË ÍËÌÂχÚ˘ÌË ÚÂıÌËÍË. Ç ‰ÓÔ˙ÎÌÂ-ÌË ̇ ‚ˉ‡ Ë ÚÂÊÂÒÚÚ‡ ̇ ÙÓ̇ÚÓÌËfl Ë ‡ÚËÍÛ·ÚÓ-ÌËfl ‰ÂÙˈËÚ, ÔË ËÁ·Ë‡ÌÂÚÓ Ì‡ Ú‡Ô‚Ú˘ÌËfl ÔÓ‰ıÓ‰Úfl·‚‡ ‰‡ Ò ‚ÁÂÏ‡Ú ÔÓ‰ ‚ÌËχÌËÂ Ë ÓÒڇ̇ÎËfl ‰‚Ë„‡ÚÂ-ÎÂÌ ‰ÂÙˈËÚ, ËÌÚÂÎÂÍÚÛ‡ÎÌËÚ ÒÔÓÒÓ·ÌÓÒÚË, ÔÂÒÓ̇Î-̇ڇ ÏÓÚË‚‡ˆËfl ̇ Ô‡ˆËÂÌÚ‡, ͇ÍÚÓ Ë Ó˜‡Í‚‡ÌËfl ıÓ‰ ̇ÓÒÌÓ‚ÌÓÚÓ Á‡·ÓÎfl‚‡ÌÂ.

ä‡ÍÚÓ ÔÓ͇Á‚‡Ú ‰‡ÌÌËÚ ÔÓÎÛ˜ÂÌË ÔË Ô‡ÍËÒÓÌˈË,

Á‡ ‰‡ Ëχ ÂÙÂÍÚ, ËÌÚÂÌÁ˂̇ڇ Ú‡ÔËfl Úfl·‚‡ ‰‡ ÔÓ-‰˙Îʇ‚‡ ÌflÍÓÎÍÓ ˜‡Ò‡ ‰Ì‚ÌÓ.ãàíÖêÄíìêÄ

1. Ackermann, H., Ziegler, W., Oertel, W. H. Palilalia as asymptom of levodopainduced hyperkinesia in Parkinson's disease.Neurol. Neurosurg. Psychiatry 1989,52, 805-807.2. Ackermann,H., Ziegler,W. Articulatory deficits in parkin-soniandysarthria: An acoustic analysis. . Neurol. Neurosurg. Psy-chiatry 1991, 54,1093-1098.3. Ackermann, H., Vogel, M., Petersen, D., Poremba, M.Speech deficits inischaemic cerebellar lesions. Neurol. 1992, 239,223-227.4. Ackermann, H., Hertrich, L., Ziegler, W., Bitzer, M., Bien, S.Acquired dysfluencies following infarction of the left mesio-fronial cortex. Aphasiology in press5. Adams, S. G., Lang, A. E. Can the Lombard effect beused to improve low voiceintensity in Parkinson's disease? Eur. J.Disord. Commun. 1992, 27,121-127.6. Alexander, M. P., Benson, D. F., Stuss, D.T. Frontal lobes and language. Brain and Language 1989, 37, 656-691.7. Aminoff, M. J., Dedo, H. H., lzdebski, K. Clinical aspectsof spasmodic dyspho-nia. /. Neurol. Neurosurg. Psychiatry 1978, 41,361-365.8. Aronson, A. E., Rarnig, L. 0., Winholtz, W. S., Silber, S.R.Rapid voice tremor,or "flutter", in amyotrophic lateral sclerosis.Ann. Otol. Rhinol. Laryngol.1992,101, 511-518.9. Bedwinek, A. P., O'Brien, R. L. A patient selection profilefor the use of speech prostheses in adult dysarthria. /. Commun.Disord. 1985, 18,169-182.10. Clough, C. G.. Parkinson's disease: Management. Lancet 1991,337,1324-132711. Darley, F. L., Aronson, A. E., Brown, R. "Motor SpeechDisorders." Saunders, Philadelphia, Pennsylvania. 197512. Dedo, H. H., Behiau, M. S. Recurrent laryngeal nervesection for spastic dys-phonia: 5- to 14-year preliminary results inthe first 300 patients. Ann. Otol.Rhinol. Laryngol. 1991,100, 274-279.13. Flertrich, 1., Ackermann, H. Acoustic analysis of speechtiming in Huntington's disease. Brain and Language 1994, 47, 182-19614. Hanson, W. R., Metter, E. J. DAF speech rate modification in Parkinson's dis-ease: A report of two cases. In "Clinical Dysarthria" (W. R. Berry, ed.), 1983, pp.231-252. College-Hill, San Diego.15. Johns, D. F., Salyer, K. E. (). Surgical and prosthetic management of neuro-genic speech disorders. In "Clinical Management of Neurogenic CommunicativeDisorders" (D. F. Johns, ed.), 1978, pp. 311-331. Little Brown, Boston.16. Koller, W., Graner, D., Micoch, A. Essential voice tremor:Treatment with propranolol. Neurology 1985, 35, 106-108.17. Netsell, R., Rosenbek, J. C. Treating the dysarthrias. In"Speech and Language Evaluation in Neurology: Adult Disorders"(J. K. Darby, ed.), 1985, pp. 363-392. Grune &: Stratton, Orlando,Florida.18. Robertson, S. J., Thomson, F. Speech therapy in Parkin-son's disease: A studyof the efficacy and long term effects of inten-sive treatment. Br. J. Disord. Commun. 1984, 19, 213-224.19. Ziegler, W., von Cramon, D. Spastic dysarthria afteracquired brain injury: An acoustic study. Br. J. Disord. Commun. 1986, 21,173-187.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:‰- ÉÂÓ„Ë ÄÌ„Ó‚ìëÅÄãçè "ë‚. ç‡ÛÏ"ÅÛÎ. ñ‡Ë„‡‰ÒÍÓ ¯ÓÒ - 4 ÍÏ1113 ëÓÙËfl

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 80‡ÔËÎ, 2002

SUMMARYEFFICACY OF BETAFERON® IN PATIENTS WITH

MULTIPLE SCLEROSIS: A CLINICAL STUDY K. Kmetska, D. Georgiev , I. Milanov

There have been many data accumulated lately in the spe-cialized literature about the results with the Betaferon treat-ment. After the National Health Insurance bank is reimburs-ing the whole amount spent on Betaferon, an open, prospec-tive non-randomized study on the effect of the drug has beencarried out at 8MIU s.c. every other day for 18 months with97 patients diagnosed with clinically definite MS after Poser(77 patients with RRMS and 20 patients with SPMS) at anaverage age of 34,8±8,7. The criteria for including the patientsin the study are those adopted by the National Consensus onMS treatment. Our data confirm the results of the rest of theauthors that Betaferon with RRMS patients reduces signifi-cantly the relapses. It is not only the relapse rate that isdecreasing, but also the severe relapses. The smaller relapserate with RRMS patients being sick for less than 5 years, andEDSS less than 4, supports the opinion that the earlier treat-ment with Betaferon yields to better results, i.e. patient'schances of decreasing the number of the severe relapses arebetter. The Betaferon treatment does not change substantiallythe EDSS (Kurtzke) for both groups of patients. This provesout to be valid with SPMS patients, having in mind that beforethe treatment the EDSS has progressed faster. Side effectshave been described. The reported results are preliminary, thefull course of treatment being underway.Key words: multiple sclerosis - relapsing-remitting, sec-ondary-progressive, Betaferon, relapse rate, EDSS / Kurtzke

êÖáûåÖèÂÁ ÔÓÒΉÌËÚ 10 „Ó‰ËÌË ‚ ÎËÚ‡ÚÛ‡Ú‡ Ò ̇ÚÛ-

Ô‡ı‡ ÏÌÓ„Ó ‰‡ÌÌË Á‡ ÂÁÛÎÚ‡ÚËÚ ÓÚ Î˜ÂÌËÂÚÓ ÒBetaferon. ëΉ ͇ÚÓ çáéä ÂËÌ·ÛÒˇ 100% Betaferon,·Â Ôӂ‰ÂÌÓ ÓÚ‚ÓÂÌÓ, ÔÓÒÔÂÍÚË‚ÌÓ Ì‡̉ÓÏËÁˇÌÓÔÓÛ˜‚‡Ì ̇ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ̇ ÔÂÔ‡‡Ú‡ ÔËÎÓÊÂÌı8MIU s.c., ‚ÒÂÍË ‚ÚÓË ‰ÂÌ 18Ï. ÔË 97 ·ÓÎÌË Ò ÍÎËÌ˘-ÌÓ ÒË„Û̇ ÔÓ Poser åC (77 Ô‡ˆËÂÌÚË Ò ÔËÒÚ˙ÔÌÓ-ÂÏË-ÚÂÌÚÂÌ ıÓ‰ Ë 20 - Ò ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒˇ˘ ıÓ‰) ̇ Ò‰-̇ ‚˙Á‡ÒÚ 34,8±8,7 „Ó‰. äËÚÂËËÚ Á‡ ‚Íβ˜‚‡Ì ‚ÔÓÛ˜‚‡ÌÂÚÓ Ò‡ ÚÂÁË, ‚˙ÁÔËÂÚË ÓÚ ç‡ˆËÓ̇ÎÌËfl ÍÓÌ-ÒÂÌÒÛÒ Á‡ ΘÂÌË ̇ Më. 燯ËÚ ‰‡ÌÌË ÔÓÚ‚˙ʉ‡‚‡ÚÂÁÛÎÚ‡ÚËÚ ̇ ‰Û„ËÚ ‡‚ÚÓË, ˜Â ÔË èêåë Betaferon‰ۈˇ Á̇˜ËÏÓ ÔËÒÚ˙ÔËÚÂ. ç‡Ï‡Îfl‚‡ Ò Ì ҇ÏÓ ÍÓ-ÂÙˈËÂÌÚ‡ ̇ ÂÍÁ‡ˆÂ·‡ˆËfl, ÌÓ Ë ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙-ÔËÚÂ. èÓ-χÎÍËflÚ ÍÓÂÙˈËÂÌÚ Ì‡ ÂÍÁ‡ˆÂ·‡ÁËfl Á‡ „ÛÔ‡-Ú‡ ·ÓÎÌË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ò ÔÓ-χÎ͇ ‰‡‚-ÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (<5„.) Ë Ò ÔÓ-χÎ͇ ËÌ‚‡ÎˉÌÓÒÚ(<4Ú.) ÔÓ‰ÍÂÔfl ÚÂÁ‡Ú‡, ˜Â ÔÓ-‡ÌÌÓÚÓ ‚Íβ˜‚‡Ì ̇Betaferon ‰‡‚‡ ÔÓ-̇‰ÂʉÌË ÂÁÛÎÚ‡ÚË, Ú.Â. ¯‡ÌÒÓ‚ÂÚÂ̇ Ô‡ˆËÂÌÚ‡ Á‡ ̇χÎfl‚‡Ì ̇ ·Ófl Ë ÚÂÊÂÒÚÚ‡ ̇ ÔËÒ-Ú˙ÔËÚ ҇ ÔÓ-„ÓÎÂÏË. ã˜ÂÌËÂÚÓ Ò Betaferon Ì ÔÓÏÂÌflÒ˙˘ÂÒÚ‚ÂÌÓ ËÌ‚‡ÎˉËÁ‡ˆËflÚ‡ (ÓˆÂÌÂ̇ ÔÓ Ò͇·ڇ ̇Kurtzke / EDSS) Á‡ ‰‚ÂÚ „ÛÔË ÎÂÍÛ‚‡ÌË ·ÓÎÌË. íÓ‚‡ Ó·‡-˜Â ÓÔ‡‚‰‡‚‡ ÔË·„‡ÌÂÚÓ Ì‡ Betaferon ÔË ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒ˂̇ڇ ÙÓχ, ͇ÚÓ Ò Ëχ Ô‰‚ˉ, ˜Â ÔÂ‰Ë ÎÂ-˜ÂÌËÂÚÓ ËÌ‚‡ÎˉÌÓÒÚÚ‡  ÔÓ„ÂÒˇ· ÔÓ-·˙ÁÓ. éÔËÒ‡-

ÌË Ò‡ ÒÚ‡Ì˘ÌËÚ fl‚ÎÂÌËfl. ë˙Ó·˘ÂÌËÚ ÂÁÛÎÚ‡ÚËËÏ‡Ú ı‡‡ÍÚ ̇ Ô‰‚‡ËÚÂÎÌË, Ú˙È Í‡ÚÓ Ì  Á‡‚˙-¯ËÎ Ô˙ÎÌËfl ÍÛÒ Ì‡ ΘÂÌËÂ.

äβ˜Ó‚Ë ‰ÛÏË: ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ - ÔËÒÚ˙ÔÌÓ-Â-ÏËÚÂÌÚ̇, ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒˇ˘‡, Betaferon, ÍÓÂÙˈË-ÂÌÚ Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl, ËÌ‚‡ÎˉËÁ‡ˆËfl ÔÓ Kurtzke.

ã˜ÂÌËÂÚÓ Ì‡ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ‚Ë̇„Ë Â ÔÂ-‰ËÁ‚ËÍ‚‡ÎÓ „ÓÎflÏ ËÌÚÂÂÒ Ë ÏÌÓ„Ó ‰ËÒÍÛÒËË Ò‰ Ì‚Ó-ÎÓÁËÚÂ. Ç Í‡È Ì‡ 70ÚÂ Ë Ì‡˜‡ÎÓÚÓ Ì‡ 80Ú „Ó‰ËÌË LarryJacobs Á‡ÔӘ̇ ÔÓÛ˜‚‡ÌËflÚ‡ Ò ËÌÚÂÙÂÓÌ - β (IFN- β).èÂÁ 1986„. ëÚ‡Úˇ ÔËÎÓÚÌÓ ÔÓÛ˜‚‡Ì ‚ ëÄô. èËÔ‡ˆËÂÌÚË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚˇ˘‡ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂ-ÓÁ‡ (èêåë) Ò‡ ÔË·„‡ÌË 4 ‰ÓÁË (0,8; 4;8 Ë 16 MIU) ËÌ-ÚÂÙÂÓÌ- β-1b, ÔÓ‰ÍÓÊÌÓ, ‚ÒÂÍË ‚ÚÓË ‰ÂÌ(8). èÂÁ1988„. IFNB Multiple Sclerosis Study Group Ó„‡ÌËÁˇÏÛÎÚˈÂÌÚÓ‚Ó, ‡Ì‰ÓÏËÁˇÌÓ, Ô·ˆÂ·Ó - ÍÓÌÚÓΡÌÓÔÓÛ˜‚‡Ì ‚ ä‡Ì‡‰‡ Ò ‰‚ ‰ÓÁË IFN-β-1b x1,6MIU Ëx8MIU, s.c. ÔÂÁ ‰ÂÌ. àÌ‚‡ÎˉËÁ‡ˆËflÚ‡ ̇ Ô‡ˆËÂÌÚËÚ ÂÓˆÂÌÂ̇ ÔÓ Ò͇·ڇ ̇ Kurtzke (EDSS). ÇÍβ˜ÂÌË Ò‡ Ô‡ˆË-ÂÌÚË Ì‡ ‚˙Á‡ÒÚ 18-50 „Ó‰. Ò ÍÎËÌ˘ÌÓ ÒË„Û̇ èêåë, Ò ≤ 2 ÔËÒÚ˙Ô‡ ÔÂÁ ÔÓÒΉÌËÚ ‰‚ „Ó‰ËÌË,EDSS≤5,5. ä‡ÍÚÓ ÔË Ô‰˯ÌËÚ ËÁÒΉ‚‡ÌËfl ÍÓÂÙË-ˆÂÌÚ‡ ̇ ÂÍÁ‡ˆÂ·‡ˆËfl Â Â‰ÛˆË‡Ì (Ò 34%) ‚ Ò‡‚ÌÂÌË ÒÔ·ˆÂ·Ó-„ÛÔ‡Ú‡ ÔË ‰ÓÁ‡ x8MIU s.c. ÔÂÁ ‰ÂÌ; ‚ÂÏÂÚÓ‰Ó Ô˙‚‡Ú‡ ÂÍÁ‡ˆÂ·‡ˆËfl  ۉ˙ÎÊÂÌÓ; χ„ÌËÚÌÓ-ÂÁÓ̇Ì-Ò̇ڇ ÚÓÏÓ„‡ÙËfl (åêí) ̇ í2 ÔÓ͇Á‚‡ ̇χÎfl‚‡Ì ̇·ÓÎÂÒÚ̇ڇ ‡ÍÚË‚ÌÓÒÚ (13, 15).

Ç˙Á ÓÒÌÓ‚‡ ̇ ÂÁÛÎÚ‡ÚËÚ ÓÚ ÚÂÁË ÔÓÛ˜‚‡ÌËfl IFN-β-1b  ӉӷÂÌ Á‡ ΘÂÌË ̇ ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚ̇ڇÙÓχ ̇ åë ‚ ëÄô ÔÂÁ ÎflÚÓÚÓ Ì‡ 1993„. íÓ‚‡  Ô˙-‚ËflÚ IFN- β „ËÒÚË‡Ì Á‡ ΘÂÌË ̇ åë, ÔÓÁÌ‡Ú Í‡ÚÓBetaferon® ‚ ëÄô Ë Í‡ÚÓ Betaferon® ‚ ÓÒڇ̇ÎËfl Ò‚flÚ.Ö‚ÓÔÂÈÒÍËflÚ Ò˙˛Á „ËÒÚˇ ËÌÚÂÙÂÓÌ - β -1b ÔÂÁ1995„. ä‡ÚÓ Ì‡È-Û‰‡˜Ì‡ ÓÚ Ú‡Ô‚Ú˘̇ „Ή̇ ÚӘ͇ËχÈÍË Ô‰‚ˉ ÍÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ, ÔÓ‚ÎËfl‚‡ÌÂ-ÚÓ Ì‡ í2 - ÎÂÁËËÚ ̇ åêí Ë ÒÚ‡Ì˘ÌËÚ fl‚ÎÂÌËfl ÒÂÛÚ‚˙‰Ë ‰ÓÁ‡ ı8 MIU Betaferon, ÔÓ‰ÍÓÊÌÓ ÔÂÁ ‰ÂÌ. Ç˙Ô-ÂÍË ÌflÍÓË ‡Á΢Ëfl ‚ ‰ËÁ‡È̇ ̇ ÔÓÛ˜‚‡ÌËflÚ‡ ÏÓÊÂω‡ Ó·Ó·˘ËÏ ÂÁÛÎÚ‡ÚËÚ ‚ ÎËÚ‡ÚÛ‡Ú‡: ÒΉ ‰‚ „Ó-‰Ë¯ÌÓ Î˜ÂÌËÂ Ò Betaferon ÔË èêåë Ò ÒÌËʇ‚‡ ÍÓÂÙË-ˆÂÌÚ‡ ̇ ÂÍÁ‡ˆÂ·‡ˆËfl, Ú.Â. ̇χÎfl‚‡ ÒÚ‡Ú˘ÂÒÍË Á̇˜Ë-ÏÓ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÔËÒÚ˙ÔËÚÂ Ò 34-37%; Û‚Â΢‡‚‡ ÒÂÔÓˆÂÌÚ‡ ̇ Ô‡ˆËÂÌÚËÚ "Ò‚Ó·Ó‰ÌË" ÓÚ ÔËÒÚ˙ÔË ÒÔfl-ÏÓ Ô·ˆÂ·Ó-„ÛÔËÚÂ, ÔÓ˜ÚË Ò ۉ‚Ófl‚‡ ‚ÂÏÂÚÓ (‚ ‰ÌË)‰Ó ÔÓfl‚‡Ú‡ ̇ Ô˙‚Ëfl ÔËÒÚ˙Ô; Â‰ÛˆË‡Ú Ò ÛÏÂÂÌÓ ËÁ-‡ÁÂÌËÚÂ Ë ÚÂÊÍË ÔËÒÚ˙ÔË Ò 49%; ̇χÎfl‚‡ Ò % ̇ Ô‡-ˆËÂÌÚËÚÂ Ò ÔÓ„ÂÒËfl ̇ ËÌ‚‡ÎˉËÁ‡ˆËflÚ‡ ÔÓ EDSS -ÏÂÊ‰Û ÔËÒÚ˙ÔËÚ (4, 5, 7, 9, 10, 12). èË 5 „Ӊ˯ÌÓ ÎÂ-˜ÂÌË ÚẨÂ̈ËËÚ Ò Á‡Ô‡Á‚‡Ú. äÓÌÚÓΡÌÂÚÓ Ì‡·ÓÎÌËÚÂ Ò åêí ‰‡‚‡ ËÌÙÓχˆËfl Á‡ ıÓ‰‡ ̇ ·ÓÎÂÒÚÚ‡.Betaferon® ‰ۈˇ ·Ófl ̇ ÌÓ‚ËÚÂ Ë Ó·˘Ëfl ·ÓÈ Ì‡ ÍÓÌ-Ú‡ÒÚÌÓ-ÛÒËÎÂÌËÚ ÎÂÁËË (13, 16). ëÔÓ‰ ‰‡ÌÌËÚ ÓÚåêí Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÓÚ˜ÂÚÎË‚ ÂÙÂÍÚ ‚˙ıÛ Á‡·ÓÎfl‚‡ÌÂ-ÚÓ, ÌÓ Ô‡ÍÚ˘ÂÒÍË Ìflχ Ò˙˘ÂÒÚ‚Â̇ ÔÓÏfl̇ ̇ ËÌ‚‡-ÎˉËÁ‡ˆËflÚ‡ ÔÓ EDSS (4).

èÓÛ˜‚‡ÌÂÚÓ INCOMIN (2) ÌË Û·Âʉ‡‚‡ ‚ ‰ÓÁÓÁ‡‚ËÒË-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 81‡ÔËÎ, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË

äãàçàóçé èêéìóÇÄçÖ çÄ ÖîÖäíàÇçéëííÄ çÄBETAFERON® èêà èÄñàÖçíà ë åçéÜÖëíÇÖçÄ ëäãÖêéáÄ

äÏÂÚÒ͇ äÒ., ÉÂÓ„Ë‚ Ñ., åË·ÌÓ‚ à‚.ëÅÄãçè "ë‚.ç‡ÛÏ" - è˙‚‡ Ì‚ÓÎӄ˘̇ ÍÎËÌË͇

ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl - åì, ëÓÙËfl

ÏËfl ÂÙÂÍÚ Ì‡ IFN- β: ÔË ÔË·„‡Ì ̇ IFN-β-1b 8MIU,ÔÓ‰ÍÓÊÌÓ ÔÂÁ ‰ÂÌ Ë IFN-β-1‡ 30mcg, ÏÛÒÍÛÎÌÓ ‚‰Ì˙ÊÒ‰Ï˘ÌÓ Ò ÓÚ˜ËÚ‡Ú ÒË„ÌËÙË͇ÌÚÌË ‡ÁÎËÍË Á‡ ̇·Î˛-‰‡‚‡ÌËÚ ÍÎËÌ˘ÌË Ë åêí-Ô‡‡ÏÂÚË ‚ ÔÓÎÁ‡Ì‡ IFN-β-1b.

Betaferon®  ÔÓ͇Á‡Ì Á‡ ΘÂÌË ̇ ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒË-‡˘‡ Ë ÔÓ„ÂÒË‚ÌÓ-ÂÏËÌÂÌÚ̇ åë. ÇÍβ˜ÂÌË Ò‡ Ô‡ˆË-ÂÌÚË ÓÚ 18 ‰Ó 55 „Ó‰., Ò ËÌ‚‡ÎˉÌÓÒÚ ÔÓ Kurtzke 3,0 ‰Ó6,5; éÚ˜ËÚ‡ Ò Á‡‰˙ʇÌ ̇ ÔÓ„ÂÒËflÚ‡ ̇ ËÌ‚‡ÎˉËÁ‡-ˆËflÚ‡ ÔË 62%, ·ÓflÚ Ì‡ ‚ÎÓ¯‡‚‡ÌËflÚ‡ Â Â‰ÛˆË‡Ì Ò31%, ̇χÎfl‚‡ ‡ÍÚË‚ÌÓÒÚÚ‡ ̇ í2 - ÎÂÁËËÚÂ Ë Ó·˘‡Ú‡ÔÓ‚˙ıÌÓÒÚ Ì‡ Ô·ÍËÚ ÔË åêí (3,11).

èÂÁ ÔÓÒΉÌËÚ „Ó‰ËÌË ˜ÂÒÚÓ Ò ÍÓÏÂÌÚˇ ÓÎflڇ̇ ÌÂÛÚ‡ÎËÁˇ˘ËÚ ‡ÌÚËÚ· ÔË Î˜ÂÌËÂ Ò IFN-β.é·˘Ó ‚ÁÂÚÓ Ò ÒÏflÚ‡, ˜Â ‚ËÒÓÍËÚ ÚËÚË Ì‡ NA ̇χ-Îfl‚‡Ú ÍÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ, ÌÓ Ìflχ ÍÓÌÒÂÌÒÛÒÌÓ¯ÂÌË Á‡ ÍÓ·ˆËÓÌ̇ڇ Á‡‚ËÒËÏÓÒÚ. ìÒÚ‡ÌÓ‚ÂÌÓ Â,˜Â ‚ ÏÌÓ„Ó ÒÎÛ˜‡Ë ÍÓ΢ÂÒÚ‚ÓÚÓ ËÏ ÒÔÓÌÚ‡ÌÌÓ Ì‡Ï‡Îfl‚‡ËÎË ËÁ˜ÂÁ‚‡ ̇ ÙÓ̇ ̇ ΘÂÌËÂÚÓ (14).

éÚ Ï.˛ÎË 2000„. á‡ÔӘ̇ 100%ÚÌÓ ÂËÌ·ÛÒˇÌ ̇Betaferon® ÓÚ çáéä Ë Ò Ò˙Á‰‡‰Óı‡ ÛÒÎÓ‚Ëfl Á‡ ̇·Ë‡Ì ̇·˙΄‡ÒÍË ÓÔËÚ ÔË Î˜ÂÌËÂÚÓ Ì‡ ·ÓÎÌË Ò åë.

äéçíàçÉÖçí à åÖíéÑàäà:èӂ‰ÂÌÓ ·Â ÔÓÒÔÂÍÚË‚ÌÓ, ÓÚ‚ÓÂÌÓ, ̇̉ÓÏËÁË-

‡ÌÓ ÔÓÛ˜‚‡Ì ̇ ÍÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡Betaferon® ÔË 97 Ô‡ˆËÂÌÚË Ò ÍÎËÌ˘ÌÓ ÒË„Û̇ ÔÓ PoserÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ (57 ÊÂÌË Ë 40 Ï˙ÊÂ) ̇ Ò‰̇ ‚˙Á-‡ÒÚ 34,8±8,7 „Ó‰ËÌË. ëÔÓ‰ ıÓ‰‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ ·ÓÎ-ÌËÚ ·flı‡ ‡ÁÔ‰ÂÎÂÌË ‚ ‰‚ ÔÓ‰„ÛÔË:

Ä. 77 ‰Û¯Ë ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰Å. 20 ‰Û¯Ë Ò ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒˇ˘ ıÓ‰äËÚÂËËÚ Á‡ ‚Íβ˜‚‡Ì ·flı‡ ÚÂÁË ‚˙ÁÔËÂÚË ÓÚ

European Study Group on MS Ë ç‡ˆËÓ̇ÎÌËfl ÍÓÌÒÂÌÒÛÒ ÔÓåë (Ï.XI.2000):ᇠ„ÛÔ‡ Ä: ÍÎËÌ˘ÌÓ ÒË„Û̇ åë ÔÓ ÍËÚÂËËÚ ̇Poser; ‚˙Á‡ÒÚ 18 ‰Ó 50; ËÌ‚‡ÎˉÌÓÒÚ ÔÓ Kurtzke ÔÓ‰ 5,5;̇΢ˠ̇ ÔÓÌ 2 ÔËÒÚ˙Ô‡ Á‡ ÔÓÒΉÌËÚ 2 „Ó‰. ᇠ„ÛÔ‡Å: ÍÎËÌ˘ÌÓ ÒË„Û̇ ÔÓ Poser åë; ‚˙Á‡ÒÚ 18 ‰Ó 50; ËÌ‚‡-ÎˉÌÓÒÚ ≤6,5 ÔÓ Kurtzke.

Betaferon®  ÔË·„‡Ì 8MIU ÔÓ‰ÍÓÊÌÓ ‚ÒÂÍË ‚ÚÓË ‰ÂÌ‚ ÔÓ‰˙ÎÊÂÌË ̇ 18 ÏÂÒˆ‡.

ᇠӈÂÌ͇ڇ ̇ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ̇ ΘÂÌËÂÚÓ Ò‡ ËÁ-ÔÓÎÁ‚‡ÌË ÍÎËÌ˘ÌË ÍËÚÂËË ÔÓ‡‰Ë Ì‚˙ÁÏÓÊÌÓÒÚÚ‡ ‰‡Ò ̇ԇ‚Ë ÍÓ·ˆËfl Ò åêí ÔË ‚Ò˘ÍË Ô‡ˆËÂÌÚË. èË·ÓÎÌËÚÂ Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ò‡ ÓÚ˜ÂÚÂÌË: ÍÓ-ÂÙˈÂÌÚ Ì‡ „Ӊ˯ÌË ÂÍÁ‡ˆÂ·‡ˆËË, % ̇ ·ÓÎÌË ·ÂÁ ÔËÒ-Ú˙ÔË; ÔÓÏÂÌË ‚ ËÌ‚‡ÎˉÌÓÒÚÚ‡ ÔÓ Kurtzke ÔÂ‰Ë Ë ÒΉΘÂÌËÂ; ÚÂÊÂÒÚ Ì‡ ÔËÒÚ˙ÔÌËÚ ‚ÎÓ¯‡‚‡ÌËfl ÔÓ Ò͇·-Ú‡ ̇ Kurtzke Ë % ̇ ̇·Î˛‰‡‚‡ÌËÚ ÒÚ‡Ì˘ÌË fl‚ÎÂÌËfl.

臈ËÂÌÚË Ò èêåë Ò‡ ÓˆÂÌfl‚‡ÌË Ë ÒÔÓ‰ ‰‡‚ÌÓÒÚڇ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ: 38 ‰Û¯Ë Ò ‰‡‚ÌÓÒÚ ≤5 „Ó‰ËÌË (50,7%) Ë37 ‰Û¯Ë Ò ‰‡‚ÌÓÒÚ >5 „Ó‰ËÌË (49,3%). àχÈÍË Ô‰‚ˉÒÚÂÔÂÌÚ‡ ̇ ËÌ‚‡ÎˉÌÓÒÚ ÔÓ Kurtzke ·ÓÎÌËÚ ҇ Ò‡‚ÌÂ-ÌË ‚ ‰‚ ÔÓ‰„ÛÔË: Ò ËÌ‚‡ÎˉÌÓÒÚ ≤4 Ë Ò ËÌ‚‡ÎˉÌÓÒÚ >4.Ñ‚Â ÊÂÌË ÓÚ „ÛÔ‡Ú‡ Ò èêåë ÓÚÔ‡‰Ì‡ı‡ ÓÚ ÔÓÛ˜‚‡ÌÂ-ÚÓ ÒΉ 6Ï. ÓÚ Î˜ÂÌËÂÚÓ ÔÓ‡‰Ë ÒÚ‡Ì˘ÌË fl‚ÎÂÌËfl(ÒËÒÚÂÏ̇ Ó·˘‡ ÓÚÔ‡‰Ì‡ÎÓÒÚ Ë t0 ) Ë Ò‡ ËÁÍβ˜ÂÌË ÔËÓ·‡·ÓÚ͇ڇ ̇ ‰‡ÌÌËÚÂ.

èË Ô‡ˆËÂÌÚË Ò Çèåë Ò‡ ÓˆÂÌfl‚‡ÌË ÔÓÏÂÌËÚ ‚ ËÌ-‚‡ÎˉÌÓÒÚÚ‡ ÔÓ Ò͇·ڇ ̇ Kurtzke ÔÂ‰Ë Ë ÒΉ ΘÂÌËÂË ÒÚ‡Ì˘ÌËÚ fl‚ÎÂÌËfl.

êÖáìãíÄíà à éÅëöÜÑÄçàü:é·˘Ó Á‡ „ÛÔ‡Ú‡ Ò èêåë ÍÓÂÙˈÂÌÚ˙Ú Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl̇ ÔËÒÚ˙ÔËÚ ÔÂ‰Ë Î˜ÂÌË ÓÚ 1,1±0,4  ÒÚ‡ÚËÒÚË-˜ÂÒÍË Á̇˜ËÏÓ (<0,001) ÒÌËÊÂÌ Ì‡ 0,4± ÒΉ ΘÂÌË ÒBetaferon®.

èË ÓˆÂÌfl‚‡Ì ̇ ‰‚ÂÚ „ÛÔË ÒÔÓ‰ ‰‡‚ÌÓÒÚÚ‡ ̇Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË ÔÓ˜ÚË Â‰Ì‡Í˙‚ ÍÓÂÙˈÂÌÚ Ì‡ÂÍÁ‡ˆÂ·‡ˆËfl ÔÂ‰Ë Î˜ÂÌËÂÚÓ, Ò˙˘ËflÚ Â Á̇˜ËÏÓ ÔÓ-ÌËÒ˙Í Á‡ „ÛÔ‡Ú‡ Ò ÔÓ-χÎ͇ ‰‡‚ÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.èË ÔÓ-χÎ͇ ÒÚ‡ÚÓ‚‡ ÓˆÂÌ͇ ÔÓ Ò͇·ڇ ̇ Kurtzke(≤4), ÍÓÂÙˈÂÌÚ˙Ú Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl ÒΉ ΘÂÌË  ÒÚ‡-ÚËÒÚ˘ÂÒÍË Á̇˜ËÏÓ (<0,01) ÔÓ-ÌËÒ˙Í ‚ Ò‡‚ÌÂÌËÂ Ò „Û-Ô‡Ú‡ Ò ËÌ‚‡ÎˉÌÓÒÚ >4.ìÒÚ‡ÌÓ‚fl‚‡ÏÂ, ˜Â 60% ÓÚ Ô‡ˆËÂÌÚËÚ (=45) Ò èêåë ÌÂ

Ò‡ ÔÓÎÛ˜‡‚‡ÎË ÔËÒÚ˙ÔË ÔÂÁ 18-ÏÂÒ˜ÌËfl ÔÂËÓ‰ ̇ ÔÓ-‚Âʉ‡Ì ̇ ΘÂÌËÂÚÓ Ò Betaferon. èË ÓÚ˜Ëڇ̠̇ % ̇ԇˆËÂÌÚËÚ "Ò‚Ó·Ó‰ÌË" ÓÚ ÔËÒÚ˙ÔË ‚ „ÛÔËÚ ÒÔÓ‰ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò ÛÒÚ‡ÌÓ‚fl‚‡, ˜ÂÔË ‰‡‚ÌÓÒÚ ‰Ó 5„Ó‰. - 72% ÓÚ Ô‡ˆËÂÌÚËÚ ÌflÏ‡Ú ÔËÒ-

Ú˙ÔË, ‡ ÔË ‰‡‚ÌÓÒÚ Ì‡‰ 5 „Ó‰. - Ò‡ÏÓ 46% Ò‡ "Ò‚Ó·Ó‰ÌË"ÓÚ ÔËÒÚ˙ÔË.é·˘‡Ú‡ ÓˆÂÌ͇ ̇ ËÌ‚‡ÎˉÌÓÒÚÚ‡ ÔÓ Kurtzke ÔÂ‰Ë ËÒΉ ΘÂÌËÂ Ò Betaferon Ì ÔÓ͇Á‚‡ ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇-˜Ëχ ‡ÁÎË͇ (3,3±1,1 ÔÂ‰Ë Ë 3,1±1,4 ÒΉ ΘÂÌËÂ).äÓ„‡ÚÓ Ò‡‚ÌËıÏ ÒÚÂÔÂÌÚ‡ ̇ ÚÂÊÂÒÚ Ì‡ ÔËÒÚ˙ÔËÚÂ

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îË„.1 äÓÂÙˈËÂÌÚ Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl (Relapse rate) ÔËÔ‡ˆËÂÌÚË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ ̇ åë

îË„.2 äÓÂÙˈËÂÌÚ Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl ÔË Ô‡ˆËÂÌÚË Òèêåë ÒÔÓ‰ ‰‡‚ÌÓÒÚÚ‡ ̇ Á‡·Îfl‚‡ÌÂÚÓ

îË„.3 äÓÂÙˈËÂÌÚ Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl ÔË Ô‡ˆËÂÌÚË Òèêåë ÒÔÓ‰ ÚÂÊÂÒÚÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ

ÔÂ‰Ë Ë ÒΉ ΘÂÌË ÒÔÓ‰ ‚ÎÓ¯‡‚‡ÌÂÚÓ ÔÓ Ò͇·ڇ ̇Kurtzke ÛÒÚ‡ÌÓ‚ËıÏÂ, ˜Â ÒΉ ΘÂÌË ÂÍÁ‡ˆÂ·‡ˆËËÚ ҇ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜ËÏÓ (<0,01) ÔÓ-ÎÂÍË. èÂ‰Ë Î˜ÂÌË-ÂÚÓ ÔË ÔËÒÚ˙Ô ÓˆÂÌ͇ڇ  ÒÔ‡‰‡Î‡ Ò 2,1±0,8 , ‡ ̇ ÙÓ-̇ ̇ ΘÂÌËÂÚÓ ÔË ÔËÒÚ˙Ô ÓˆÂÌ͇ڇ  ÔÓÌËÊÂ̇ Ò1,2±0,4.

ëÚ‡Ì˘ÌËÚ fl‚ÎÂÌËfl Á‡ „ÛÔ‡Ú‡ Ò ÔËÒÚ˙ÔÌÓ - ÂÏË-ÚÂÌÚÂÌ ıÓ‰ Ò‡ ÓÚ‡ÁÂÌË Ì‡ Ú‡·Îˈ‡ 1.éÚ Ô‡ˆËÂÌÚËÚÂ Ò „ËÔÓÔÓ‰Ó·ÌË ÒËÏÔÚÓÏË Ò‡ÏÓ 5 Ò‡ËχÎË ÚÂÁË fl‚ÎÂÌËfl Ôӂ˜ ÓÚ 2 ÏÂÒˆ‡. èË ÌflÍÓË ·ÓÎ-ÌË Ëχ Ôӂ˜ ÓÚ 1 ÓÔ·͂‡ÌÂ, Á‡ÚÓ‚‡ Ò·ÓÌÓ ÔÓˆÂÌÚË-Ú ҇ >100.

èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ì‡ Ô‡ˆËÂÌÚË-ÚÂ Ò ‚ÚÓ˘ÌÓ - ÔÓ„ÂÒˇ˘ ıÓ‰  10,2±5,4 „Ó‰ËÌË, ‡‰‡‚ÌÓÒÚÚ‡ ̇ ‚ÚÓ˘̇ڇ ÔÓ„ÂÒËfl  2,3±0,9 „Ó‰. ëÔÓ-‰ ÍËÚÂËËÚ Á‡ ‚Íβ˜‚‡Ì ‚ ÔÓ„‡Ï‡Ú‡ Á‡ ΘÂÌË ÒBetaferon ÔÓ„ÂÒËflÚ‡ ̇ ËÌ‚‡ÎˉÌÓÒÚÚ‡  ·Ë· Ò Ôӂ˜ÂÓÚ 1 ÚӘ͇ ÔÓ Kurtzke ÔÂ‰Ë Á‡ÔÓ˜‚‡Ì ̇ Ú‡ÔËflÚ‡.èË Ò‰̇ ÒÚ‡ÚÓ‚‡ ÓˆÂÌ͇ Á‡ „ÛÔ‡Ú‡ 5,4±0,7, ÛÒÚ‡ÌÓ-‚fl‚‡ÏÂ, ˜Â ÒΉ 18-ÏÂÒ˜ÌÓ Î˜ÂÌË Ìflχ ÒÚ‡ÚËÒÚ˘ÂÒÍËÁ̇˜Ëχ ÔÓ„ÂÒËfl ̇ ËÌ‚‡ÎˉÌÓÒÚÚ‡ (5,5±0,6) ÔÓKurtzke.

ç‡ Ú‡·Î.2 Ò‡ ÓÚ‡ÁÂÌË ÒÚ‡Ì˘ÌËÚ fl‚ÎÂÌËfl ÔË ·ÓÎ-ÌËÚÂ Ò ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒˇ˘ ıÓ‰ ̇ ·ÓÎÂÒÚÚ‡.

Ç Á‡Íβ˜ÂÌË ̇¯ËÚ ‰‡ÌÌË ÔÓÚ‚˙ʉ‡‚‡Ú ÂÁÛÎÚ‡-ÚËÚ ̇ ‰Û„ËÚ ‡‚ÚÓË, ˜Â ÔË èêåë Betaferon ‰ۈË-‡ Á̇˜ËÏÓ ÔËÒÚ˙ÔËÚÂ. ç‡Ï‡Îfl‚‡ Ò Ì ҇ÏÓ ÍÓÂÙˈÂÌ-Ú‡ ̇ ÂÍÁ‡ˆÂ·‡ˆËfl, ÌÓ Ë ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ. èÓ-χÎÍËflÚ ÍÓÂÙˈÂÌÚ Ì‡ ÂÍÁ‡ˆÂ·‡ˆËfl Á‡ „ÛÔ‡Ú‡ ·ÓÎÌË ÒÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ Ò ÔÓ-χÎ͇ ‰‡‚ÌÓÒÚ Ì‡ Á‡·Ó-Îfl‚‡ÌÂÚÓ (≤5„.) Ë Ò ÔÓ-χÎ͇ ËÌ‚‡ÎˉÌÓÒÚ (≤4Ú.) ÔÓ‰ÍÂ-Ôfl ÚÂÁ‡Ú‡, ˜Â ÔÓ-‡ÌÌÓÚÓ ‚Íβ˜‚‡Ì ̇ Betaferon ‰‡‚‡ÔÓ-̇‰ÂʉÌË ÂÁÛÎÚ‡ÚË, Ú.Â. ¯‡ÌÒÓ‚ÂÚ ̇ Ô‡ˆËÂÌÚ‡ Á‡Ì‡Ï‡Îfl‚‡Ì ̇ ·Ófl Ë ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚ ҇ ÔÓ-„ÓÎÂÏË (1,12). ã˜ÂÌËÂÚÓ Ò Betaferon Ì ÔÓÏÂÌfl Ò˙˘ÂÒÚ-‚ÂÌÓ ËÌ‚‡ÎˉËÁ‡ˆËflÚ‡ (ÓˆÂÌÂ̇ ÔÓ Ò͇·ڇ ̇ Kurtzke) Á‡‰‚ÂÚ „ÛÔË ÎÂÍÛ‚‡ÌË ·ÓÎÌË. íÓ‚‡ Ó·‡˜Â ÓÔ‡‚‰‡‚‡ ÔË·-

„‡ÌÂÚÓ Ì‡ Betaferon ÔË ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒ˂̇ڇ ÙÓχ,͇ÚÓ Ò Ëχ Ô‰‚ˉ, ˜Â ÔÂ‰Ë Î˜ÂÌËÂÚÓ ËÌ‚‡ÎˉÌÓÒÚڇ ÔÓ„ÂÒˇ· ÔÓ-·˙ÁÓ. 燷≇‚‡ÌËÚ ÒÚ‡Ì˘ÌË fl‚-ÎÂÌËfl Ò‡ ӷ˘‡ÈÌËÚÂ, ÔÓÒÓ˜ÂÌË ‚ ÔÓ‰ÛÍÚÓ‚‡Ú‡ ÏÓÌÓ„‡-

ÙËfl Ë ÓÚ ‰Û„ËÚ ‡‚ÚÓË (7,17). èÓ‡‰Ë ÒÚ‡Ì˘ÌË fl‚ÎÂ-ÌËfl Ò‡ÏÓ ‰‚ ԇˆËÂÌÚÍË (2,01%) Ò‡ ÓÚÔ‡‰Ì‡ÎË ÓÚ ÔÓÛ˜-‚‡ÌÂÚÓ. Ö‰ËÌ Ô‡ˆËÂÌÚ (1,03%)  ËχΠ‚ÂÏÂÌÌÓ ÎÓ͇ÎÌËÌÂÍÓÁË ÔÓ ·Â‰‡Ú‡ Ë ˙ˆÂÚÂ, ÌÓ ÔÓ‰˙Îʇ‚‡ ΘÂÌËÂÚÓÒË. ç ҇ ÛÒÚ‡ÌÓ‚ÂÌË ÚÂÊÍË ‰ÂÔÂÒËË, ̇·„‡˘Ë ‡ÌÚË-‰ÂÔÂÒ‡ÌÚË ËÎË ÒÔˇÌ ̇ ΘÂÌËÂÚÓ.

ë˙Ó·˘ÂÌËÚ ÂÁÛÎÚ‡ÚË ËÏ‡Ú ı‡‡ÍÚ ̇ Ô‰‚‡Ë-ÚÂÎÌË, Ú.Í. Ì  Á‡‚˙¯ËÎ Ô‰‚ˉÂÌËfl ÒÓÍ Á‡ ΘÂÌË ÒBetaferon Ë Ò ÚÓ‚‡ Ò ӷflÒÌfl‚‡Ú ÔÓ-‰Ó·ËÚ ÔÓ͇Á‡ÚÂÎËÓÚ ÚÂÁË ‚ ÎËÚ‡ÚÛ‡Ú‡.

çË ÒÔÓ‰ÂÎflÏ ÏÌÂÌËÂÚÓ Ì‡ Donald W.Paty, ˜Â Á‡ ‰‡ ÓÔ-‰ÂÎËÏ ÂÙÂÍÚË‚ÌÓÒÚÚ‡ ÓÚ Î˜ÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ - β ÔË Ô‡ˆËÂÌÚËÚ Úfl·‚‡ ‰‡ ËχÏ Ô‰‚ˉ Ò‡ÏÓ ÍÎË-Ì˘ÌËÚ ÔÓ͇Á‡ÚÂÎË, ·ÂÁ ‰‡ Ò Ò˙Ó·‡Áfl‚‡ÏÂ Ò Ì‡ıӉ͇ڇÓÚ åêí Ë ÌÂÛÚ‡ÎËÁˇ˘ËÚ ‡ÌÚËÚ·.

ã˜ÂÌËÂÚÓ Ò Betaferon®  ÒÎÓÊÂÌ ÔÓˆÂÒ ËÁËÒÍ‚‡˘ ÓÚ-„Ó‚ÓÌÓÒÚË ÓÚ ÎÂ͇fl Ë Ô‡ˆËÂÌÚ‡ Ë ·ÂÁÒÔÓÌÓ Â ‚˙ÁÏÓÊ-ÌÓÒÚ Á‡ ÔÓ‰Ó·fl‚‡Ì ͇˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ Ì‡ ·ÓÎÌËÚÂÓÚ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡.

ãàíÖêÄíìêÄ

1. Coyle PK and Hartung HP. Use of Interferon beta in multiple sclerosis: ratio-nale for early treatment and evidence for dose - and frequency -dependent effectson clinical resonse. Multiple Sclerosis 2002, 8: 2-9.2. Durelli, L. et al. And the Independent Comparison of Interferon /INCOMIN/.Trial study group. Every other day Interferon beta 1b versus once - weeklyInterferon beta 1a for multiple sclerosis: results of a 2-year prospective randomisedmulticentre study Lancet 2002,359, 1453-1460. 3. European Study Group on Interferon beta-1b in Secondary Progressive MS.Placebo-controlled multicentre randomised trial of interferon beta-1b in treatmentof secondary progressive multiple sclerosis. Lancet 1998; 352: 1491-1497.4. Goodin, D.S., Frohmal, E.M et al. Disease modifying therapies in multiplesclerosis: Report of the Therapeutics and Technology Assessment Subcommitteeof the American Academy of Neurology and the MS Council for the ClinicalPractice Guidelines. Neurology 2002; 58: 169-178.5. Goodkin, D.E. Interferon beta therapy for multiple sclerosis /Commentary/.Lancet 1998; 352: 1486-1487.6. Jacobs, L., Johnson, K.P. A brief history of the use of Interferon's as treat-ment of multiple sclerosis. Arch. Neurol. 1994; 51: 1245-1252.7. Jaohnson, K.P., Calabresi, P.A. Interferon-b-1b: Prophilactic therapy in mul-tiple sclerosis. In: Handbook of multiple sclerosis, eds. S.D. Cook.. New York,Basel. Marcel Dekker, Inc. 2001, 503-518.8. Knobler, R.L., Greenstein, J.I., Johnson, K.P. et al. Systemic recombinanthuman Interferon-b treatment of relapsing-remitting multiple sclerosis: Pilot studyanalysis and six-year follow-up. J. Interferon Res. 1993; 13: 333-340.9. Lublin, F.D., Reingold, S.C. Defining the clinical course of multiple sclero-sis: results of an international survey. National Multiple Sclerosis Society /USA/.Neurology 1996, 46 /4/; 907-911.10. Lublin, F.D., Whitaker, J.N., Eidelman, B.H. et al. Management of patientsreceiving interferon beta-1b for multiple sclerosis: Report of a consensus confer-ence. Neurology 1996; 46: 12-18.11. Miller, D.H., Molyneux, P.D., Barker, G.J. et al. Effect of interferon -1b onmagnetic resonance imaging outcomes in secondary progressive multiple sclerosis:Results of a European multicenter , randomized, double-blind, placebo-controlledtrial. Ann Neurol. 1999, 46: 850-859.12. Paty, D.W. Interferon beta-1b. In: Principles of treatment in multiple sclero-sis, eds. C.P. Hawkins, J.S. Wolinsky, Oxford, Butterworth-Heidemann, 2000, 24-37.13. Paty, D.W., Li, D.K.B., the UBC MS/RMI Study Group, and the IFNBMultiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remit-ting multiple sclerosis: II. MRI analysis results of a multicenter, randomized, dou-ble-blind, placebo-controlled trial. Neurology, 1993; 43: 662-667.14. Rice, G.P.A., Pazner, B., Oger, J. Lesaux, J., Paty, D., Eders, G. íhe evolu-tion of neutralizing antibodies in multiple sclerosis patients treated with interferonb-1b. Neurology 1999; 52: 1277-1279.15. The IFNB Multiple Sclerosis Study Group and the University of BritishColumbia MS/MRI Analysis Group. Interferon beta-1b in the treatment of multiplesclerosis: Final outcome of the randomized controlled trial. Neurology 1995; 45:1277-1285.16. The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective inrelapsing-remitting multiple sclerosis: I. Clinical results of a multicenter, random-ized, double-blind, placebo-controlled trial. Neurology 1993; 43: 655-661.17. Walter, E.U., Hohifeld, R. Multiple sclerosis: Side effects of interferon betatherapy and their management. Neurology 1999; 53: 1622-1627.

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SUMMARY

ALGORITHM FOR EXAMINATION AND MONITORINGOF PATIENTS WITH SUBARACHNOID

HAEMORRHAGE USING CONVENTIONALTRANSCRANIAL DOPPLER

M KlissurskiA practically oriented algorithm for monitoring of haemo-

dynamics changes in patients with subarachnoid haemorrhage(SAH) using conventional transcranial Doppler (TCD) tech-nique has been presented. The algorithm is created accordingto information from current literature and based on own expe-rience from examination of more than 106 patients with SAHfor 5 years. It can be applied as a standard approach for TCDexamination of patients with this socially important disease inBulgaria and for the aims of optimization of diagnosticprocess and therapeutic interventions.

Key words: transcranial Doppler ultrasonography, subarach-noid hemorrhage, blood flow velocities, cerebral vasospasm,Hunt and Hess scale, Fisher scale, Lindegaard's index

êÖáûåÖè‰ÒÚ‚‡ÌÂÌ Â Ô‡ÍÚ˘ÂÒÍË ‡Î„ÓËÚ˙Ï Á‡ ÏÓÌËÚÓË-

‡Ì ̇ ıÂÏÓ‰Ë̇Ï˘ÌËÚ ÔÓÏÂÌË ÔË ·ÓÎÌË Ò˙Ò ÒÛ·‡-‡ıÌÓˉÂÌ Í˙‚ÓËÁÎË‚ (ëÄä) ˜ÂÁ ËÁÔÓÎÁ‚‡Ì ̇ ÍÓÌ‚ÂÌ-ˆËÓ̇Î̇ Ú‡ÌÒ͇ÌˇÎ̇ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl (íÑë).Ä΄Ó˙Ú˙Ï˙Ú Â Ò˙ÒÚ‡‚ÂÌ ‚˙Á ÓÒÌÓ‚‡ ̇ Ò˙ÓÚ‚ÂÚ̇ڇËÌÙÓχˆËfl ÓÚ ÎËÚ‡ÚÛ‡Ú‡ Ë ÒÓ·ÒÚ‚ÂÌËfl ÓÔËÚ ÓÚËÁÒΉ‚‡ÌÂÚÓ Ì‡ ̇‰ 106 ·ÓÎÌË Ò˙Ò ëÄä Á‡ ÔÂËÓ‰ ÓÚ 5„Ó‰ËÌË. íÓÈ ÏÓÊ ‰‡ ÔÓÒÎÛÊË Á‡ Òڇ̉‡ÚËÁˇÌ ̇ íÑëËÁÒΉ‚‡Ì ̇ ·ÓÎÌËÚÂ Ò ÚÓ‚‡ ÒӈˇÎÌÓ Á̇˜ËÏÓ Á‡·ÓÎfl-‚‡Ì ‚ ̇¯‡Ú‡ Òڇ̇ Ë Á‡ ÓÔÚËÏËÁˇÌËÌ ̇ ‰Ë‡„ÌÓÒ-Ú˘ÌËflÚ ÔÓˆÂÒ Ë Ú‡Ô‚Ú˘ÌÓÚÓ Ôӂ‰ÂÌËÂ.

äβ˜Ó‚Ë ‰ÛÏË: Ú‡ÌÒ͇ÌˇÎ̇ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl,ÒÛ·‡‡ıÌÓˉÂÌ Í˙‚ÓËÁÎË‚, ÏÓÁ˙˜ÂÌ Í˙‚ÓÚÓÍ, Ò͇· ̇ï˙ÌÚ Ë çÂÒ, Ò͇· ̇ î˯Â, Ë̉ÂÍÒ Ì‡ ãË̉„‡‡‰

ë˙˘ÂÒÚ‚Û‚‡ ‚Ò ÔÓ-„ÓÎflÏ ÍÎËÌ˘ÂÌ ËÌÚÂÂÒ ÔÓ ÓÚÌÓ-¯ÂÌË ̇ ÏÂÚÓ‰ËÚ Á‡ ÌÂÔÂÍ˙Ò̇ڇ (‚ÂÏ‚‡) ÓˆÂÌ͇ ̇ÏÓÁ˙˜ÌËÚ ÙÛÌ͈ËË Ë ÓÒÓ·ÂÌÓ ÓÌÂÁË, ‡‰‡ÔÚˇÌË Á‡ ËÁ-Ô˙ÎÌÂÌË ÔË Î„ÎÓÚÓ Ì‡ ·ÓÎÌËfl. éÚ ‰Û„‡ Òڇ̇ ÒÂÔ‰ÔÓ˜ËÚ‡Ú ÏÛÎÚËÏÓ‰‡ÎÌËÚ ÚÂıÌËÍË Á‡ ÏÓÌËÚÓË-‡Ì ̇ ‡Á΢ÌË ıÂÏÓ‰Ë̇Ï˘ÌË Ë ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌËÔ‡‡ÏÂÚË, Á‡˘ÓÚÓ Ì‡ÒÓ˜‚‡ÌÂÚÓ Ì‡ ΘÂÌËÂÚÓ Ì‡ ·ÓÎÌËflÒ‡ÏÓ Ì‡ ·‡Á‡Ú‡ ̇ ËÁÏ‚‡Ì ̇ ‰̇ ÔÓÏÂÌÎË‚‡ ˜ÂÒÚÓ Â̇‰ÂÍ‚‡ÚÌÓ (9).

í‡ÌÒ͇ÌˇÎ̇ڇ ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡ÙËfl (íÑë) ‰‡‚‡‚˙ÁÏÓÊÌÓÒÚ Á‡ ÌÂËÌ‚‡ÁË‚ÌÓ ÓÔ‰ÂÎflÌ ̇ ÒÍÓÓÒÚÚ‡ ̇Í˙‚ÓÚÓÍ (ëäí) ‚ ·‡Á‡ÎÌËÚ ÏÓÁ˙˜ÌË ‡ÚÂËË Ë ÓˆÂÌ͇̇ ÏÓÁ˙˜Ì‡Ú‡ ‡‚ÚÓ„Û·ˆËfl (åÄê), ͇ÍÚÓ Ë Ì‡ ‡Á΢ÌËıÂÏÓ‰Ë̇Ï˘ÌË Ò˙ÒÚÓflÌËfl, Ò‚˙Á‡ÌË Ò Ó·ÒÚÛ͈ËË, ÍÓ·-Ú‡ÎËÁ‡ˆËfl, ‚‡ÁÓÒÔ‡Á˙Ï, ıËÔÂÂÏËfl, ÏÓÁ˙˜Ì‡ ÒÏ˙Ú Ë

‰.(2,4,8,9,11,13). çÂÁ‡‚ËÒËÏÓ ÓÚ ÌflÍÓË ÏÂÚӉ˘ÌË Ó„‡-Ì˘ÂÌËfl Ë ÎËÔÒ‡Ú‡ ̇ „ÓÎflÏ ÓÔËÚ Ò íÑë-ÏÓÌËÚÓˇÌ ‚ËÌÚÂÌÁË‚ÌËÚ Ì‚ÓÎӄ˘ÌË ÓÚ‰ÂÎÂÌËfl, ͇ÍÚÓ Ë ÔÓ‡‰ËÔÓ·ÎÂÏË Ò ÔÓ‰˙ÎÊËÚÂÎ̇ڇ ÙËÍÒ‡ˆËfl ̇ ÒÓ̉‡Ú‡ Ë‚˙ÁÌËÍ‚‡˘ËÚ ‡ÚÂÙ‡ÍÚË ÔË ÍÓÏÔ˛Ú˙ÌÓ ‡ÒËÒÚˇ̇̇ÎËÁ, ËÌÚÂÂÒ˙Ú Í˙Ï ‚ËÒÓ͇ڇ ‰Ë̇Ï˘̇ ËÌÙÓχ-ÚË‚ÌÓÒÚ Ë ÔÓÛ˜Â̇ڇ ÍÓ·ˆËflÚ‡ Ò ‰Û„Ë ıÂÏÓ‰Ë̇-Ï˘ÌË ÏÓ‰‡ÎÌÓÒÚË ÓÒË„Ûfl‚‡ ‚Ò ÔÓ-¯ËÓÍ ÔËÂÏ Ë ‡‰‡Ô-ÚˇÌ ̇ Ú‡ÁË ÚÂıÌË͇ ‚ ËÌÚÂÌÁË‚ÌËÚ Ì‚ÓÎӄ˘ÌËÓÚ‰ÂÎÂÌËfl (1,2,3,8,9,13,15,16,17).

Ç˙Á ÓÒÌÓ‚‡ ̇ ̇¯Ëfl ÍÎËÌ˘ÂÌ ÓÔËÚ ÓÚ ÔÂÚ „Ӊ˯ÌÓíÑë ËÁÒΉ‚‡Ì ̇ 106 ·ÓÎÌË Ò˙Ò ëÄä Ë Ì‡Ô‡‚ÂÌËÚ ̇‰7000 Á‡ÔËÒ‡ ̇ ÑÓÔÎÂÓ‚Ë Ò˄̇ÎË ÓÚ ËÌڇ͇ÌˇÎÌËÚ‡ÚÂËË, ͇ÍÚÓ Ë ‚˙Á ÓÒÌÓ‚‡ ̇ ÎËÚ‡ÚÛÌËÚ ‰‡ÌÌË(1-17), Ô‰·„‡Ï ÒΉÌËfl Ô‡ÍÚ˘ÂÒÍË ÓËÂÌÚË‡Ì ‡Î„Ó-ËÚ˙Ï Á‡ ÏÓÌËÚÓˇÌÂ.

ÅÓÎÌËflÚ Ò˙Ò ëÄä Úfl·‚‡ ‰‡ Ò ÔÓÒΉfl‚‡ ÍÎËÌ˘ÌÓ ËıÂÏÓ‰Ë̇Ï˘ÌÓ Í‡ÚÓ ÚÂÍÛ˘‡Ú‡ ËÌÙÓχˆËflÚ‡ Ò ÔÓ-Ô˙΂‡ ‚ ÔÓ‰Ó·ÂÌ Ù˯ Ò „‡Ù˘ÂÌ Ë/ËÎË Ú‡·Î˘ÂÌ ‰ËÁ‡ÈÌÁ‡ ÔÓ-„ÓÎflχ flÒÌÓÚ‡ ̇ ‰Ë̇ÏË͇ڇ Ë Â‚ÓβˆËflÚ‡ ̇ ·Ó-ÎÂÒÚÚ‡ Ë ÌÂÈÌËÚ ÛÒÎÓÊÌÂÌËfl ‚˙‚ ‚ÂÏÂÚÓ. íÂÍÛ˘‡Ú‡ËÌÙÓχˆËfl Á‡ Ô‡ˆËÂÌÚËÚ Ò˙Ò ëÄä ˘Â ‚Íβ˜‚‡ ‚ÂÏÂ-‚‡Ú‡ ÔÓÏfl̇ ̇ ÌflÍÓË ÓÚ Ì‡È-‚‡ÊÌËÚ ÍÎËÌ˘ÌË (äç,ÌË‚Ó Ì‡ Ò˙Á̇ÌË Ò͇· ̇ É·Á„ÓÛ-ãËÂÊ, ‰ÂÌ Ì‡ ÔÓfl‚‡ ËÔÂÒËÒÚˇÌ ̇ Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ, ı‡‡ÍÚ ̇ ‰Â-ÙˈËÚ‡, ‰ÂÌ Ì‡ ÔÓfl‚‡ ̇ ˆˉ˂, ‰ÓÁ‡ ̇ ÌËÏÓ‰ËÌËÌ ËÎË‰Û„Ë Ï‰Ë͇ÏÂÌÚË, ÒÚÂÔÂÌ ÔÓ ëïï,), ··Ó‡ÚÓÌË Ë ıÂ-ÏÓ‰Ë̇ÏË˜Ì‚Ë ÔÓ͇Á‡ÚÂÎË (ëäí ̇ ëåÄ, ÄÇ, ÄÅ, LI,‰Ì‚ÌÓ ÛÒÍÓÂÌË ̇ ÒÍÓÓÒÚÌËÚ ÔÓ͇Á‡ÚÂÎË). íÑë ÏÓ-ÌËÚÓˇÌ  ÓÒÓ·ÂÌÓ ÔÓ‰ıÓ‰fl˘Ó ÔË Í˙Ò̇ ıÓÒÔËÚ‡ÎËÁ‡-ˆËfl ÍÓ„‡ÚÓ ÓÚ äí Ì ÏÓÊ ‰‡ Ò ÔÓ„ÌÓÁˇ ̇‰ÂʉÌÓËÒ͇ ÓÚ äàçÑ Ë Â‚ÓβˆËflÚ‡ ̇ ·ÓÎÂÒÚÚ‡ (ÔË Ù‡Î¯Ë-‚Ó Ì„‡Ú˂̇ äí), ÔË ÒÎÛ˜‡ËÚ Ò˙Ò Ò˙ÏÌÂÌË Á‡ ëÄä,ÔË Ù‡Î¯Ë‚Ó ÔÓÁËÚ˂̇ ‡Ì„ËÓ„‡ÙÒ͇ ̇ıӉ͇. éÒÓ·ÂÌÓËÌÙÓχÚË‚ÌÓ Â íÑë ÏÓÌËÚÓˇÌ ÔÂ‰Ë Ë ÒΉ: ÔÓ-Ïfl̇ ̇ Í˙‚ÌÓÚÓ Ì‡Îfl„‡Ì (ÔË ·ÓÎÌË Ò Ì‡Û¯Â̇ åÄê),ÔË ÚÂÁË Ò˙Ò ÒÔ‡‰ ̇ Í˙‚ÌÓÚÓ Ì‡Îfl„‡Ì (äç) ËÎË Ò ÌËÒÍÓäç; ÔË ÍÓ΢ÂÒÚ‚Â̇ ÔÓÏfl̇ ̇ Ò˙Á̇ÌËÂÚÓ (ÍÓχÚÓÁ-ÌË Ò˙ÒÚÓflÌËfl) Ë ÔË ‚Òfl͇ ÔÓfl‚‡ ̇ ÌÓ‚ Ì‚ÓÎӄ˘ÂÌ ‰Â-ÙˈËÚ; ÔË ÔÓÏfl̇ ̇ Ú‡ÔËflÚ‡ (ÒÔˇÌ ̇ ÌËÏÓ‰Ë-ÔË̇, ÔÂÏË̇‚‡Ì ÓÚ ‚ÂÌÓÁÌÓ Í˙Ï Ó‡ÎÌÓ ÔËÎÓÊÂÌËÂ),Á‡ÔÓ˜‚‡Ì ̇ Ú.̇. 3-ç-Ú‡ÔËfl, (ÔË ÌÓ‚ËÚ ÚÂıÌËÍË ÒËÌÚ‡‡Ú¡ÎÌÓ ÔËÎÓÊÂÌË ̇ Ô‡Ô‡‚ÂËÌ, ‡Ì„ËÓÔ·Ò-ÚË͇ Ë ‰.) ‚Íβ˜‚‡Ì ̇ ËÁÍÛÒÚ‚Â̇ ·ÂÎӉӷ̇ ‚ÂÌÚË-·ˆËfl, ‚ ‡Á΢ÌËÚÂ È ÂÊËÏË; ÔÂ‰Ë Ë ÒΉ ‡Ì„ËÓ„‡ÙËflË Ì‚ÓıËۄ˘̇ ÓÔ‡ˆËfl (ÓÒÓ·ÂÌÓ ‚ ÔÓÒÚÓÔ‡ÚË‚-ÌËfl ÔÂËÓ‰); ÒΉ ˆˉ˂ ̇ Í˙‚ÓËÁÎË‚‡; ÔË ‰ËÙËÂÌ-ˆË‡ÎÌÓ ‰Ë‡„ÌÓÒÚ˘ÌË Á‡ÚÛ‰ÌÂÌËfl; ÔË Ò˙ÒÚÓflÌË ̇ ÏÓ-Á˙˜Ì‡ ÒÏ˙Ú.

éèàëÄçàÖ çÄ ÄãÉéêàíöåÄ(‚ËÊ ÙË„Û‡ 1): 1.) 燘‡ÎÓÚÓ Ì‡ íÑë ÏÓÌËÚÓˇÌ ÒÂ

ÔÓÒÚ‡‚fl Ӣ ÔË ÔËÂχÌÂÚÓ Ì‡ ·ÓÎÌËfl, ͇ÚÓ ‰‡ÌÌËÚÂÒ Ô‰ÒÚ‡‚flÚ ‚ ÎÂÒÂÌ Á‡ ‚˙ÁÔËÂχÌ „‡Ù˘ÂÌ ‚ˉ. ç‡-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 84‡ÔËÎ, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË

ÄãÉéêàíöå áÄ àáëãÖÑÇÄçÖ à åéçàíéêàêÄçÖ çÄ Åéãçàëöë ëìÅÄêÄïçéàÑÖç äêöÇéàáãàÇ óêÖá

äéçÇÖçñàéçÄãçÄ íêÄçëäêÄçàÄãçÄ ÑéèãÖêéÇÄëéçéÉêÄîàü

å. äÎËÒÛÒÍËä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl - åì ëÓÙËfl

‰ Ò˙Ò ÒÌÂχÌ ̇ ÒÓχÚ˘ÌËfl Ë Ì‚ÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ,Ò ËÁ‚˙¯‚‡ ÓˆÂÌ͇ ÔÓ Ò͇·ڇ ̇ Hunt Ë Hess (7, ÔÓ̇Ò-ÚÓfl˘ÂÏ Ë ˜ÂÁ Ò͇·ڇ Á‡ ëÄä ̇ ë‚ÂÚӂ̇ڇ Ù‰‡-ˆËfl ̇ Ì‚ÓıËÛÁËÚ - WFNS, ÍÓflÚÓ Ì Ò ËÁÔÓÎÁ‚‡ ¯Ë-ÓÍÓ ‚ ̇¯‡Ú‡ Òڇ̇), ÓˆÂÌ͇ ̇ ÚÂÊÂÒÚÚ‡ ̇ Í˙‚ÓË-ÁÎË‚‡ ÒÔÓ‰ äí ‰‡ÌÌË ÔÓ Ò͇·ڇ ̇ Fisher (5, ËÎË ÏÓ‰Ë-ÙË͇ˆËflÚ‡ ÔÓ Ljunggren et al - /12/, ÌÓ ÔÓ̇ÒÚÓfl˘ÂÏ ÔË-ÂÚ‡  ÔÓ-ËÌÙÓχÚ˂̇ڇ ÔÓÎÛÍÓ΢ÂÒÚ‚Â̇ ÓˆÂÌ͇ Á‡ÍÓ΢ÂÒÚ‚ÓÚÓ Í˙‚ ‚ 10-Ú „·‚ÌË ÒÛ·‡‡ıÌÓˉ‡ÎÌË ÍÓÏ-Ô‡ÚËÏÂÌÚ‡ ÔÓ Hijdra, van Gijn, et al - /6/, ÍÓflÚÓ Ò˙˘Ó ÒÂÓÔ‰ÂÎfl fl‰ÍÓ ‚ ̇¯ËÚ ÍÎËÌËÍË). éÔ‰ÂÎflÚ Ò ÔÛÎÒ‡,ÚÂÏÔ‡ÚÛ‡Ú‡ Ë äç ̇ ‰‚ÂÚ ˙ˆÂ. àÁÒΉ‚‡Ú Ò Í˙‚-ÌËÚ ÔÓ͇Á‡ÚÂÎË, ÓÚ ÍÓËÚÓ Ò˙˘ÂÒÚ‚ÂÌÓ Á̇˜ÂÌË Á‡ ËÌ-ÚÂÔÂÚˇÌ ̇ ÑÓÔÎÂÓ‚ËÚ ÔÓ͇Á‡ÚÂÎË ËÏ‡Ú ÒÚÓÈ-ÌÓÒÚËÚ ̇ ıÂχÚÓÍËÚ‡, ÙË·ËÌÓ„Â̇, Í˙‚ÌËflÚ ‚ËÒ-ÍÓÁËÚÂÚ, ëé2, ÂÎÂÍÚÓÎËÚËÚÂ, ÚÂÏÔ‡ÚÛ‡Ú‡, ÏÓ-Á˙˜Ì‡Ú‡ ‡ÍÚË‚ÌÓÒÚ Ë ÔËÎÓÊÂÌËÂÚÓ Ì‡ ÌflÍÓË Ï‰Ë͇-ÏÂÌÚË. èË ÚÂÊÍËÚ ÍÓχÚÓÁÌË Ò˙ÒÚÓflÌËfl Ò Ôӂ˯ÂÌÓËÌڇ͇ÌˇÎÌÓ Ì‡Îfl„‡Ì ÔÓ ‚˙ÁÏÓÊÌÓÒÚ Ò ËÁ‚˙¯‚‡ ËËÁÏ‚‡Ì (ËÎË ÏÓÌËÚÓˇÌÂ) ̇ ËÌڇ͇ÌˇÎÌÓÚÓ Ì‡-Îfl„‡ÌÂ, ÓÔ‰ÂÎflÌ ̇ ˛„Û·̇ڇ ‚ÂÌÓÁ̇ Ò‡ÚÛ‡ˆËfl.

2.) íÑë Á‡ÔÓ˜‚‡ Ò˙Ò ÒÍËÌËÌ„Ó‚Ó ËÁÒΉ‚‡Ì ̇ ÂÍÒÚ-‡Í‡ÌˇÎÌËÚ χ„ËÒÚ‡ÎË Á‡ Ô‡ÚÓÎӄ˘ÌË Ò˙‰Ó‚Ë ÔÓ-ÏÂÌË (ıÂÏÓ‰Ë̇Ï˘ÌÓ Á̇˜ËÏË ÒÚÂÌÓÁË, ÚÓÏ·ÓÁË Ì‡ÇëÄ), ÒΉ ÍÓÂÚÓ Ò 2 åHz ÒÓ̉‡ Ò Á‡ÔËÒ‚‡ Ò˄̇ΠÓÚÇëÄ Ì‡ 40 ÏÏ ‰˙ηӘË̇ ÔÓ‰ χ̉˷Û·ÌËfl ˙„˙Î (ÔËÒÚÂÏÂÊ Á‡ ÓÔÚËχÎÂÌ ˙„˙Π̇ ËÌÒÓ̇ˆËfl ÓÍÓÎÓ ~45 „‡-

‰ÛÒ‡) ‰‚ÛÒÚ‡ÌÌÓ Á‡ ‰‡ Ò ËÁ˜ËÒÎË ıËÏËÒÙÂÌËflÚ Ë̉ÂÍÒÁ‡ ‚‡ÁÓÒÔ‡Á˙Ï Ì‡ Lindegaard (11). ëΉ‚‡ ËÌÒÓÌˇÌ ̇ëåÄ (45-60 ÏÏ), ÇëÄ (60-70 ÏÏ), èåÄ (62-70 ÏÏ), áåÄ(65-70 ÏÏ), ÄÇ (65-80 ÏÏ) Ë ÄÅ (85-100 ÏÏ). ᇠÓÔ‰ÂÎfl-Ì ̇ Ë̉ÂÍÒ, ‡Ì‡Îӄ˘ÂÌ Ì‡ ÚÓÁË Ì‡ Lindegaard, Á‡ ‡Á„‡-Ì˘‡‚‡Ì ̇ Çë ÓÚ ıËÔÂÂÏËfl ‚˙‚ ‚ÂÚ·ӷ‡ÁË·̇ڇÒËÒÚÂχ (14 - Soulstiel et al, 2002) Ò Á‡ÔËÒ‚‡ Ë ëäí ̇ ÄÇ̇ ‰˙ηӘË̇ 45-55 ÏÏ Ë Ò˙ÓÚ‚ÂÚÌÓ Ì‡ 3 ÚÓ˜ÍË ÓÚ ÄṦ‰˙ηӘË̇ ̇‰ 90 ÏÏ. Ç Ë̉˂ˉۇÎÌËfl ÔÓÚÓÍÓΠ̇ ·ÓÎ-ÌËfl Ò Á‡ÔËÒ‚‡Ú ‚Ò˘ÍË ÒÚÓÈÌÓÒÚË, ‡ ÓÒÌÓ‚ÌËÚ ÍËÚÂ-ËË Á‡ Çë Á‡ ëåÄ Ë ÇÅë Ò Ô‰ÒÚ‡‚flÚ ‚ „‡Ù˘ÂÌ ‚ˉ(Ò‰̇ڇ χÍÒËχÎ̇ ÒÍÓÓÒÚ Á‡ ëåÄ >120 ÒÏ/ÒÂÍ, LI>3; ‰Ì‚̇ڇ ‡ÍˆÂ·ˆËfl ̇ ÒÍÓÓÒÚËÚÂ, Ë̉ÂÍÒ‡ ̇‡ÒËÏÂÚËfl, ëäí Á‡ ÄÅ >80 cm/ÒÂÍ, Ò˙ÓÚÌÓ¯ÂÌËÂÚÓÄÅ/ÄÇ >2, ÒÚÓÈÌÓÒÚËÚ ̇ RI Ë PI, ÍÓÏ·ËÌË‡Ì Çë).

3.) ëΉ ÔÓÔ˙΂‡Ì ̇ ̇˜‡ÎÌËÚ ‰‡ÌÌË, ÒΉ‚‡ ÚflıÌÓ-ÚÓ ÔÓÒΉfl‚‡Ì ‚˙‚ ‚ÂÏÂÚÓ. Ç Ô˙‚ËÚ 10-14 ‰ÌË Â ÔÂ-ÔÓ˙˜ËÚÂÎÌÓ íÑë ‰‡ Ò ÔÓ‚Âʉ‡ Âʉ̂ÌÓ ËÎË ÔÂÁ ‰ÂÌÔÓ Â‰ÌÓ Ë Ò˙˘Ó ‚ÂÏ ̇ ‰ÂÌÓÌÓ˘ËÂÚÓ, ‡ ÓÚ 3-7-10-fl ‰ÂÌÔË ËÒÍÓ‚Ë ·ÓÎÌË ÏÓÊ ‰‡ Ò ÔÓ‚Âʉ‡ Ë ‰‚Û͇ÚÌӉ̂ÌÓ ÏÓÌËÚÓˇÌÂ. èË ‚˙ÁÏÓÊÌÓÒÚ Â Ê·ÚÂÎÌÓ‰‚ÛÒÚ‡ÌÌÓ ÒËÏÛÎÚ‡ÌÌÓ ÏÓÌËÚÓˇÌ ̇ ‰‚ÂÚ ëåÄ(Á‡ ÔÂËÓ‰ ÔÓÌ ‰Ó 1 ˜‡Ò).

4.) ëΉ‚‡ ÓÔ‰ÂÎflÌ ÒÚÂÔÂÌÚ‡ ̇ ̇ۯÂÌË ̇ ÏÓ-Á˙˜Ì‡Ú‡ ‡‚ÚÓ„Û·ˆËfl (åÄê) ˜ÂÁ ËÁÔÓÎÁ‚‡Ì ̇ ‰ˈ‡ÚÂÒÚÓ‚Â. ç‡È-ÎÂÒÌÓ ÔËÎÓÊÂÌË Ëχ ÚÂÒÚ‡ Á‡ ͇ÚÍÓ‚-ÂÏÂÌ̇ ıËÔÂÂÏ˘̇ ‡͈Ëfl (Ô‡ÚÓÎÓ„Ëfl ÔË Ò˙ÓÚÌÓ¯Â-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 85‡ÔËÎ, 2002

îË„Û‡ 1. Ä΄ÓËÚ˙Ï Á‡ íÑë ÏÓÌËÚÓˇÌ ̇ ·ÓÎÌË Ò˙Ò ÒÛ·‡‡ıÌÓˉÂÌ Í˙‚ÓËÁÎË‚.

(ëäí - ÒÍÓÓÒÚ Ì‡ Í˙‚ÓÚÓÍ, Çë- ‚‡ÁÓÒÔ‡Á˙Ï, ëåÄ - Ò‰̇ ÏÓÁ˙˜Ì‡ ‡ÚÂËfl, åÄê- ÏÓÁ˙˜Ì‡ ‡‚ÚÓ„ÛΈËfl, Ñì -‰Ì‚ÌÓ ÛÒÍÓÂÌË ̇ ÒÍÓÓÒÚËÚÂ, LI - Ë̉ÂÍÒ Ì‡ ãË̉„‡‡‰, RI - Ë̉ÂÍÒ Ì‡ ÂÁËÒÚÂÌÚÌÓÒÚ, SI- Ë̉ÂÍÒ Ì‡ Soulstiel,èàäç - Ôӂ˯ÂÌÓ ËÌڇ͇ÌˇÎÌÓ Ì‡Îfl„‡ÌÂ, àñï - ËÌÚ‡ˆÂ·‡ÎÂÌ ıÂχÚÓÏ, ëçëÄÑï - ÒË̉ÓÏ Ì‡Ì‡‰ÂÍ‚‡Ú̇ ÒÂ͈Ëfl ̇ ‡ÌÚˉËÛÂÚ˘ÂÌ ıÓÏÓÌ, LRP, LRN - ÔÓÁËÚË‚ÌÓ Ë Ì„‡ÚË‚ÌÓ ÓÚÌÓ¯ÂÌË ̇ ‚ÓflÚÌÓÒÚ).

IIIIII

III

II

I

ÌË ÏÂÊ‰Û ÔËÍÓ‚‡Ú‡ ÒÚÓÈÌÓÒÚ Ì‡ ëåÄ ÔÂ‰Ë Ë ÒΉÍÓÏÔÂÒËflÚ‡ <1,09) ÔË ÍÓÏÔÂÒËfl ‚˙ıÛ ËÔÒË·Ú‡Î-̇ڇ ÇëÄ, ͇ÚÓ Ò˄̇Î˙Ú Ò Á‡ÔËÒ‚‡ ÓÚ ëåÄ (10 - Lamet al, 2000).

5.) ëΉ ‡Ì‡ÎËÁ ̇ Ù‡ÍÚÓËÚÂ, ‚ÎËflÂ˘Ë ‚˙ıÛ „·‚ÌË-Ú ÑÓÔÎÂÓ‚Ë ÍËÚÂËË, ‚ ÔÓÚÓÍÓ· ̇ ËÁÒΉ‚‡ÌÂÚÓ ÒÂÓÚ‡Áfl‚‡Ú ËÁ˜ËÒÎÂÌËÚ ÒÚÓÈÌÓÒÚË Ì‡ ‚ÂÓflÚÌÓÒÚÌËÚÂÓÚÌÓ¯ÂÌËfl (LR+, LR-) Ë ÓÚÌÓÒËÚÂÎÌËfl ËÒÍ (RR) Á‡ ‡Á-‚ËÚË ̇ Ò˙‰Ó‚ ÒÔ‡Á˙Ï (16), Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ, ÔÓ‚Ë-¯ÂÌÓ ËÌڇ͇‡ÌˇÎÌÓ Ì‡Îfl„‡ÌÂ, ÏÓÁ˙˜ÂÌ Â‰ÂÏ, ıˉӈÂ-Ù‡ÎËfl ËÎË ˆËÍÛ·ÚÓÂÌ ‡ÂÒÚ Á‡ ÒΉ‚‡˘Ëfl ‰ÂÌ ËÎË Ò˙Ó-Ú‚ÂÚÂÌ ‚ÂÏÂ‚Ë ËÌÚ‚‡Î.

6.) åÓÌËÚÓˇÌÂÚÓ Á‡‚˙¯‚‡ ÔÓ ÔˆÂÌ͇ ̇ ÎÂÍÛ‚‡-˘Ëfl ÂÍËÔ.

ëÏflÚ‡ÏÂ, ˜Â ÚÓÁË ÔÓ‰ıÓ‰ ˘Â ÔÓÒÎÛÊË Á‡ ÔÓ-ËÌÙÓχ-Ú˂̇ ÌÂËÌ‚‡Á˂̇ ÓˆÂÌ͇ ̇ Ô‡ˆËÂÌÚËÚÂ Ë ‚ Ô‡ÍÚ˘ÂÒ-ÍË ‡ÒÔÂÍÚ ˘Â ‰ÓÔËÌÂÒ Á‡ ÓÔÚËÏËÁˇÌ ̇ ÚflıÌÓÚÓÍÎËÌ˘ÌÓ ÚÂÚˇÌ ‚˙‚ ‚ÂÏÂ‚Ë ‡ÒÔÂÍÚ. Ç ÓÔ‰ÂÎÂÌËË̉˂ˉۇÎÌË ÒÎÛ˜‡Ë ÚÓ‚‡ ·Ë ‰ÓÔËÌÂÒÎÓ Á‡ ·Î‡„ÓÔËflÚ-̇ ÔÓÏfl̇ ‚ ͇ÈÌËfl ËÁıÓ‰ ÓÚ Á‡·ÓÎfl‚‡ÌÂÚÓ.

Ç Á‡Íβ˜ÂÌË ˘Â ˆËÚˇÏ ‡‚ÚÓËÚ ÓÚ ˆÂÌÚ˙‡ Á‡ÏÓÁ˙˜ÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡Ì ÔË ‡Í‡‰ÂÏ˘ÌÓÚÓ Ì‚ÓıËÛ-„˘ÌÓ ÓÚ‰ÂÎÂÌË ‚ äÂÏ·Ë‰Ê (9), ˜Â Ò Ì‡ÚÛÔ‚‡ÌÂÚÓ Ì‡ÓÔËÚ ‚ ÏÛÎÚËÏÓ‰‡ÎÌÓÚÓ ÏÓÌËÚÓˇÌ Ú ҇ Ò ̇ۘË-ÎË ‰‡ ‡ÁÔÓÁ̇‚‡Ú ÒËÚÛ‡ˆËËÚÂ, ÔË ÍÓËÚÓ Òڇ̉‡ÚÌË-Ú ÔË̈ËÔË Ì‡ ΘÂÌË ÏÓ„‡Ú ‚ ̇È-‰Ó·Ëfl ÒÎÛ˜‡È ‰‡ ÒÂÓÍ‡Ê‡Ú ÌÂÔÓ‰ıÓ‰fl˘Ë, ‡ ‚ ̇È-ÎÓ¯Ëfl ‰ÓË Ù‡Ú‡ÎÌË.ëڇ̉‡ÚËÁˇÌÂÚÓ Ì‡ ıÂÏÓ‰Ë̇Ï˘ÌÓÚÓ íÑë ÏÓÌËÚÓ-ˇÌ ̇ ·ÓÎÌËÚ Ò˙Ò ëÄä ‚ ̇¯‡Ú‡ Òڇ̇ ÏÓÊ ‰‡ ·˙-‰Â ‰̇ ÒÚ˙Ô͇ ̇Ô‰ Í˙Ï ÓÒ˙˘ÂÒÚ‚fl‚‡Ì ̇ ÌÂÓ·ıÓ‰Ë-ÏÓÚÓ Ò˙‚ÂÏÂÌÓ ÏÛÎÚËÏÓ‰‡ÎÌÓ ÏÓÌËÚÓˇÌ ̇ ·ÓÎÌË-Ú Ò˙Ò Ò˙‰Ó‚Ë, ͇ÍÚÓ Ë Ú‡‚χÚ˘ÌË ËÎË ‰Û„Ë Ì‚ÓıË-ۄ˘ÌË ÏÓÁ˙˜ÌË Á‡·ÓÎfl‚‡ÌËfl.

ãàíÖêÄíìêÄ

1. Aaslid R. Haemodynamics of cerebrovascular spasm. Acta Neurochir [Suppl](Wien). 72: 1995; 47-57.2. Babikian VL, Wechsler LR, eds. Transcranial Doppler Ultrasonography. Mo:BC Decker-Mosby Year Books; St Louis 1993, pp 29-38.3. Boecher-Schwartz HG, G Fries, W Muller-Forell, G Kassel, A Perneczky.

Cerebral Blood Flow Velocities after Subarachnoid Hemorrhage in Relation to theAmount of Blood Clots in the Initial Computed Tomography. Acta Neurochir(Wien). 140: 1998; 573-578.4. Czosnyka M, Gauzzo E, Iyer V, et al. Testing of cerebral autoregulation bywaveform analysis of blood flow velocity and cerebral perfusion pressure. ActaNeurochir suppl (Wien). 60: 1994; 468-71.5. Fisher CM, Kistler JP, Davis JM: Relation of cerebral vasospasm to sub-arachnoid hemorrhage visualized by computerized tomographic scanning.Neurosurgery 6:1980; 1-9.6. Hijdra A, Brouwers PJ, Vermeulen M, van Gijn J. Grading the amount ofblood on computed tomorgams after subarachnoid hemorrhage. Stroke. 21: 1990;1156-1161.7. Hunt WE, Hess RM: Surgical risk as related to time of intervention in therepair of intracranial aneurysms. J Neurosurg 28, 1968; 14-19.8. Jordan KG. Neurophysiologic monitoring in the neuroscience intensive careunit. Neurol Clin. 13, 1995 Aug; (3): 579-626.9. Kirkpatrick PJ, Czosnyka P, Pickard JD. Multimodal monitoring in neuroin-tensive care. J Neurol Neurosurg Psychiartry. 1996; 60:131-139.10. Lam J MK, P Smiliewski, M Czosnyka, JD Pickard, PJ Kirkpatrick.Predicting DID after aneurismal SAH using Transient Hyperemic Response Test ofCerebral Autoregulation. Neurosurgery. 47, 2000; 819-826.11. Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P. Cerebralvasospasm after subarachnoid hemorrhage investigated by means of transcranialDoppler ultrasound. Acta Neurochir (Wien). 42 (suppl) 1988; 81-84;.12. Ljunggren B, Brandt L, Sveland H, et al. Outcome in 60 consecutive patientstreated with early aneurysm operation and intravenous nimodipine. J Neurosurg61, 1984: 864-873.13. Sloan MA. Transcranial Doppler monitoring of vasospasm after subarachnoidhemorrhage. In: Tegeler CH, Babikian VL, Gomez CR, eds. Neurosonology. StLouis: Mosby, 1995:156-171.14. Soulstiel JF, V Shik, R Shreiber, Y Tavor, D Goldsher. Basilar VasospasmDiagnosis. Investigation of a modified "Lindegaard Index" based on imaging stud-ies and blood flow velocity measurements of the basilar artery. Stroke 33: 2002;72-78.15. Sturzenegger M. Monitoring and functional assessment using ultrasound.ENS' 2002 Teaching courses. Berlin 22-26 June 2002.16. Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM. Role ofTranscranial Doppler monitoring in the diagnosis of cerebral vasospasm after sub-arachnoid hemorrhage. Neurosurgery. 44, 1999; 1237-1248.17. Wardlaw JM, Offin R, Teasdale GM, Teasdale EM. Is routine transcranialDoppler ultrasound monitoring useful in the management of subarachnoid hemor-rhage? J Neurosurg. 88, 1998; (2): 272-276.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- å. äÎËÒÛÒÍË, „·‚ÂÌ ‡ÒËÒÚÂÌÚ, åÅÄã "ñ‡Ëˆ‡ âÓ‡Ì̇", äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl,ÛÎ." ÅflÎÓ ÏÓÂ" No 8, ëÓÙËfl 1527ÚÂÎ: (02) 43-44-559/597/516e-mail: [email protected]

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 86‡ÔËÎ, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË

ÖãÖäíêéåàéÉêîëäé àáëãÖÑÇÄçÖ çÄ ÄåèãàíìÑÄíÄ à èãéôíÄ çÄ åéíéêçàíÖ éíÉéÇéêà èêà êàíåàóçÄ

ëíàåìãÄñàü /çéêåÄíàÇçà ëíéâçéëíà/ë.çÓ‚‡˜ÍÓ‚‡, å. ꇯ‚‡

ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl, åÅÄã "ñ‡Ëˆ‡ âÓ‡Ì̇" ÖééÑ, å‰ˈËÌÒÍË Ù‡ÍÛÎÚÂÚ, ëÓÙËfl

SUMMARY

ELECTROMYOGRAPHYCAL STUDY OF THE AMPLITUDE AND ÄREA OT THE MOTOR

RESPONSES BY REPETITIVE STIMULATION /NORMATIVE VALUES/

S.Novachkova, M.RashevaThirty eight healthy persons aged between 16 and 72 years

were examinated by repetitive stimulation according to thescheme. The recording was performed with a surface electrodfrom m.abductor dig.V and n.ulnaris in the wrist was stimu-lated. The average amplitude of the negative peak of the M-response is 10,3 mV, and the average area of the same peak is30.6 mVms. Both of them are rather stabile findings by usingdifferent frequency of stimulation.

This study is an additional parameter helping to avoid diag-nostical mistakes.Key words: repetitive stimulation, motor response, ampli-tude, area.

êÖáûåÖàÁÒΉ‚‡ÌË Ò‡ 38 Á‰‡‚Ë Îˈ‡ ̇ ‚˙Á‡ÒÚ 16- 72„ Ò ËÚ-

Ï˘̇ ÒÚËÏÛ·ˆËfl ÔÓ ÒıÂχ.éÚ‚Âʉ‡¯Â ÒÂ Ò ÔÓ‚˙ıÌÓÒ-ÚÂÌ ÂÎÂÍÚÓ‰ ÓÚ m.abductor dig.V Ë Ò ÒÚËÏÛΡ¯Ân.ulnaris ‚ ÍËÚ͇ڇ. ë‰̇ڇ ‡ÏÔÎËÚÛ‰‡ ̇ Ì„‡ÚË‚ÌËflÔËÍ Ì‡ å- ÓÚ„Ó‚Ó‡  10,3 mV . ë‰̇ڇ ÔÎÓ˘ ̇ Ì„‡-ÚË‚ÌËfl ÔËÍ e  30,6 mV.ms Ë ‰‚ÂÚ ‚Â΢ËÌË ÓÒÚ‡‚‡Ú‰ÓÒÚ‡ ÔÓÒÚÓflÌÌË ÔË ‡Á΢ÌËÚ ˜ÂÒÚÓÚË Ì‡ ÒÚËÏÛ·-ˆËfl. èÓÛ˜‚‡ÌÂÚÓ ‰Ó͇Á‚‡,˜Â ËÁÒΉ‚‡ÌÂÚÓ Ì‡ ÔÎÓ˘Ú‡ ̇å- ÓÚ„Ó‚ÓËÚ  ‰ÓÔ˙ÎÌËÚÂÎÂÌ Ô‡‡ÏÂÚ˙, ÍÓÈÚÓ, Ò˙-

ÔÓÒÚ‡‚ÂÌ Ò ÔÓÏÂÌËÚ ‚ ‡ÏÔÎËÚÛ‰‡Ú‡, ÔÓχ„‡ ‰‡ Ò ËÁ-·Â„Ì‡Ú ‰Ë‡„ÌÓÒÚ˘ÌËÚ „¯ÍË.äβ˜Ó‚Ë ‰ÛÏË: ËÚÏ˘̇ ÒÚËÏÛ·ˆËfl, ÏÓÚÓÂÌ ÓÚ„Ó-‚Ó, ‡ÏÔÎËÚÛ‰‡, ÔÎÓ˘.

èË ÒÚËÏÛ·ˆËfl ̇ ÔÂËÙÂÌËÚ ÌÂ‚Ë ‰Ë‡„ÌÓÒÚ˘ÌÓÁ̇˜ÂÌËÂ, ÓÒ‚ÂÌ Î‡ÚÂÌÚÚÌÓÚÓ ‚ÂÏ ̇ ÓÚ„Ó‚ÓËÚÂ,˜ÂÁ ÍÓÂÚÓ Ò ÓÔ‰ÂÎfl ÒÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡ÌÂ/ëè /ÔÓ Ì‚‡, ËÏ‡Ú Ë ‡ÏÔÎËÚÛ‰‡Ú‡ /Ä /, ÙÓχڇ Ë ÔÓ‰˙Î-ÊËÚÂÎÌÓÒÚÚ‡ ̇ ÓÚ„Ó‚Ó‡. íÓ‚‡ Ò‡ ‚Â΢ËÌË, ÍÓËÚÓ ÓÚ-‡Áfl‚‡Ú Ò˙ÒÚÓflÌËÂÚÓ Ì‡ Ì‚‡,ÏÛÒÍÛ· Ë Ì‚ÌÓ-ÏÛÒÍÛÎ-ÌÓÚÓ Ô‰‡‚‡Ì / çåè /. èË ÌÓχÎÂÌ Ì‚ ëè ‚ ‡Á΢-ÌËÚ ‡ÍÒÓÌË ‚‡Ë‡ ÓÚ 30-60 Ï/ÒÍ Ë ÔÓ‡‰Ë ÚÓ‚‡ Ò Û‚ÂÎË-˜‡‚‡Ì ̇ ‡ÁÒÚÓflÌËÂÚÓ Ò ÔÓÎÛ˜‡‚‡ Ú˙È Ì‡Â˜Â̇ڇ"ÚÂÏÔÓ‡Î̇ ‰ËÒÔÂÒËfl"̇ Ì‚ÌËfl ‡ÍˆËÓÌÂÌ ÔÓÚÂ̈ˇÎ/6 /. ÇÒÂÍË Ô‰ËÁ‚ËÍ‡Ì ÏÓÚÓÂÌ ÓÚ„Ó‚Ó / å / Ëχ ‡ÏÔ-ÎËÚÛ‰‡ /Ä / , ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ , ÙÓχ Ë ÔÎÓ˘. ÉÓÎÂÏË-̇ڇ ̇ å- ÓÚ„Ó‚Ó‡ ÏÓÊ ‰‡ Ò ÏÂË ËÎË Í‡ÚÓ Ä ÓÚ̇È-‚ËÒÓ͇ڇ ‰Ó ̇È-ÌËÒ͇ڇ ÚӘ͇ / ÔËÍ ‰Ó ÔËÍ/ ËÎË Í‡-ÚÓ Ä Ì‡ Ì„‡ÚË‚ÌËfl ÔËÍ ËÎË Í‡ÚÓ ÔÎÓ˘ / 6 /. èÎÓ˘Ú‡ ÂËÌÚ„ˇ̇ڇ ÔÎÓÒÍÓÒÚ ÏÂÊ‰Û Ò˄̇· Ë ËÁÓÂÎÂÍÚ˘-̇ڇ ÎËÌËfl ‚˙ıÛ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ / 7 /. ë ‰Û„Ë ‰Û-ÏË ÚÓ‚‡  ÔÎÓ˘Ú‡ ‚Íβ˜Â̇ ‚ ÓÚ„Ó‚Ó‡ Ò ÓÔ‰ÂÎÂ̇ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ë ‡ÏÔÎËÚÛ‰‡.

ÑÛ„ Ô‡‡ÏÂÚ˙ ̇ å -ÓÚ„Ó‚Ó‡  ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ-Ú‡ ÏÛ, ÍÓflÚÓ Ò˙˘Ó ÏÓÊ ‰‡ ‚‡Ë‡ ÔË ÓÔ‰ÂÎÂÌË ÛÒÎÓ-‚Ëfl Ë ÚÓ‚‡ ‰‡ ‰Ó‚‰ ‰Ó ÌÂÔ‡‚ËÎ̇ ÓˆÂÌ͇ ̇ ÔÓÏÂÌËÚ‚ å-ÓÚ„Ó‚Ó‡ /6/. ìÒÎÓ‚Ëfl Á‡ „¯ÍË, ‚ ÂÁÛÎÚ‡Ú Ì‡ ÔÓ-ÏÂÌËÚ ̇ ÚÂÁË Ô‡‡ÏÂÚË Ì‡ å-ÓÚ„Ó‚Ó‡, ÏÓ„‡Ú ‰‡ ÒÂÔÓÎÛ˜‡Ú ÔË ËÚÏ˘̇ ÒÚËÏÛ·ˆËfl /êë/. åÂÚÓ‰Ë͇ڇ̇ êë Â Ì‡È ˜ÂÒÚÓ ÛÔÓÚ·fl‚‡Ì‡ Á‡ ËÁÛ˜‡‚‡Ì ̇ ̇ۯÂ-ÌËflÚ‡ ̇ çåè /5/. èÓ‡‰Ë ÓÚÌÓÒËÚÂÎÌÓ ÔÓÒÚ‡Ú‡ ÚÂı-ÌË͇, Ì ËÁËÒÍ‚‡˘‡ ÒÔˆˇÎ̇ ‡Ô‡‡ÚÛ‡ Ë ·˙ÁÓ ‰ÓÒÚË-„‡Ì ‰Ó ÂÁÛÎÚ‡Ú‡, êë Ë ‰Ó ‰ÌÂÒ Ëχ ¯ËÓÍÓ ÔËÎÓÊÂ- ÌË / 5 /. Ç˙‚‰Â̇  ÓÚ Harvey Ë Masland ÔÂÁ 1941„ Ë ÓÚÚÓ„‡‚‡ ÒÚ‡‚‡ ÛÚËÌÂÌ ‰Ë‡„ÌÓÒÚ˘ÂÌ ÚÂÒÚ ÔË ÚÂÁË Á‡-·ÓÎfl‚‡ÌËfl / 1, 2, 3, 5 /. èË·„‡Ú Ò ÒÂËfl ÒÚËÏÛÎË Ò ÌËÒ-ÍÓ˜ÂÒÚÓÚ̇ ÒÚËÏÛ·ˆËfl / çóë / Ë ‚ËÒÓÍÓ˜ÂÒÚÓÚ̇ ÒÚË-ÏÛ·ˆËfl /Çóë/ ÔÓ ÒıÂχ. éÚ˜ËÚ‡ Ò ÔÓÏfl̇ڇ ‚ Ä Ì‡å- ÓÚ„Ó‚ÓËÚ ÔË ÚÂÁË ˜ÂÒÚÓÚË Ë ÔË ÔË·„‡Ì ̇çóë /3ıˆ/ ÔÂ‰Ë Ë ÒΉ ÚÂÚ‡ÌËÁ‡ˆËfl Á‡ ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ÔÓÒÚÚÂÚ‡Ì˘ÌË ÙÂÌÓÏÂÌË. ÄÍÓ ÔË ÔË·„‡Ì ̇ êë, ‡Á-ÔÓÒÚ‡ÌÂÌËÂÚÓ Ì‡ ‡ÍˆËÓÌÌËfl ÔÓÚÂ̈ˇΠÔÓ ÔÓÚÂÊÂ-ÌË ̇ ÏÛÒÍÛÎÌËÚ ‚·Í̇ ÒÚ‡‚‡ χÍÒËχÎÌÓ ÒËÌıÓÌËÁË-‡ÌÓ, Ô‰ËÁ‚Ë͇ÌËfl å- ÓÚ„Ó‚Ó Â Ò ÔÓ-͇Ú͇ ÔÓ‰˙Î-ÊËÚÂÎÌÓÒÚ Ë ÔÓ-‚ËÒÓ͇ Ä ÔË ÔÓÒÚÓflÌ̇ ÔÎÓ˘. íÓ‚‡ ÂÚ.̇. "ÔÒ‚‰ÓÙ‡ˆËÎËÚ‡ˆËfl" Ë Úfl fl‰ÍÓ Ò ÔÓÎÛ˜‡‚‡ Ô˘ÂÒÚÓÚË ÔÓ‰ 10ıˆ .íÓ‚‡ ̇‡ÒÚ‚‡Ì ‚ ÌÓχÎÂÌ ÏÛÒÍÛÎ ÏÓÊ ‰‡ ‰ÓÒÚË„Ì ‰Ó 50% ,‡ ÔË Ô‡ÚÓÎӄ˘ÂÌ ÚÓ ÏÓÊ ‰‡Ï‡Ò͡ ‰ÂÔÂÒËflÚ‡ ̇ ÓÚ„Ó‚Ó‡ /5, 6 /.

èÎÓ˘Ú‡ Ò ËÁÏ‚‡ ‚ mV.ms Ë Ì‡È-˜ÂÒÚÓ Ò ÓÚ˜ËÚ‡ÔÓ ÓÚÌÓ¯ÂÌË ̇ Ì„‡ÚË‚ÌËfl ÔËÍ Ì‡ å - ÓÚ„Ó‚Ó‡, ͇Í-ÚÓ Â ÔÓ͇Á‡ÌÓ Ì‡ ÙË„.1 / 5, 6, 7 /.

åÄíÖêàÄã à åÖíéÑñÂÎÚ‡ ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ‰‡ Ò ÓÔ‰ÂÎflÚ ÌÓχÚË‚ÌË

ÒÚÓÈÌÓÒÚË Á‡ ÔÎÓ˘Ú‡ ̇ å-ÓÚ„Ó‚Ó‡,Ò Ó„Î‰ ‚Íβ˜‚‡ÌÂ-ÚÓ Ì‡ ÏÂÚÓ‰Ë͇ڇ ‚ ‰Ë‡„ÌÓÒÚË͇ڇ ̇ ̇ۯÂÌÓÚÓçåè. àÁÒΉ‚‡ÌÂÚÓ Ò ÔÓ‚Â‰Â Ò ÂÎÂÍÚÓÏËÓ„‡Ù DANTEK ÔË 38 ÒÎÛ˜‡ÈÌÓ ËÁ·‡ÌË Ô‡ˆËÂÌÚË, ·ÂÁ ‰‡ÌÌË Á‡Û‚Âʉ‡Ì ̇ ÔÂËÙÂÌËÚ ‰‚Ë„‡ÚÂÎÌË Ì‚ÓÌË Ë çåè .ê‡ÁÔ‰ÂÎÂÌËÂÚÓ Ì‡ ËÁÒΉ‚‡ÌËÚ ÔÓ ‚˙Á‡ÒÚ Â Ô‰ÒÚ‡-‚ÂÌÓ Ì‡ Ú‡·Î.1.

å- ÓÚ„Ó‚ÓËÚ Ò ÓÚ‚Âʉ‡ı‡ Ò ÔÓ‚˙ıÌÓÒÚÂÌ ÂÎÂÍÚ-Ó‰ ÓÚ m.abductor dig.V ÔË ÒÚËÏÛ·ˆËfl ̇ n.ulnaris ‚ÍËÚ͇ڇ Ò˙Ò ÒÛԇχÍÒËχÎÂÌ ÒÚËÏÛÎ Ò ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚ 0,1 ÏÒ. èË·„‡Ì‡  Òڇ̉‡Ú̇ ÒıÂχ Á‡ êë Ò

‡Á΢ÌË ˜ÂÒÚÓÚË, ÔËÂÚ‡ Á‡ ÚÂÒÚÛ‚‡Ì ̇ çåè /1ıˆ,3ıˆ, 50ıˆ, 3ıˆ, ÒΉ 4 ÏËÌÛÚË 3ıˆ,10ıˆ, 20ıˆ, 30ıˆ, 50ıˆ/.éÚ˜Ëڇ̇ Â Ä Ì‡ Ì„‡ÚË‚ÌËfl ÔËÍ Ì‡ I-‚Ë ÓÚ„Ó‚Ó ‚ ÒÂË-flÚ‡ Ë Ì‡ ÒΉ‚‡˘ËÚ ͇ÚÓ % ̇ ̇‡ÒÚ‚‡Ì ËÎË Ì‡Ï‡Îfl-‚‡Ì ÓÚ Ì„Ó. èÎÓ˘Ú‡ ̇ Ì„‡ÚË‚ÌËfl ÔËÍ Ò ӈÂÌfl‚‡ ÔÓÒ˙˘Ëfl ̇˜ËÌ.àÁÏ‚‡ÌË Ò‡ :

1. Ä·ÒÓβÚÌËÚ ÒÚÓÈÌÓÒÚË Ì‡ Ä Ë ÔÎÓ˘Ú‡ ̇ Ì„‡-ÚË‚ÌËfl ÔËÍ Ì‡ I- Ú ÓÚ„Ó‚ÓË ÔË ‚Ò˘ÍË ˜ÂÒÚÓÚË, Ò˙Ó-Ú‚ÂÚÌÓ ‚ mV Ë mV.ms.

2. ë˙ÓÚÌÓ¯ÂÌËÂÚÓ I / V ÓÚ„Ó‚ÓË ‚ % , Ú.Í. ÔÓÏÂÌË-Ú ‚ Úflı Ò‡ ‰ÌË ÓÚ ‰Ë‡„ÌÓÒÚ˘ÌËÚ ÔËÁ̇ˆË ̇ ̇Û-¯ÂÌÓ çåè.

3. èӂ‰ÂÌËÂÚÓ Ì‡ Ô˙‚ËÚ ÓÚ„Ó‚ÓË ÔË 3 ıˆ ‚‰̇-„‡ ÒΉ ÚÂÚ‡ÌËÁ‡ˆËfl Ë 4 ÏËÌÛÚË ÔÓ-Í˙ÒÌÓ.íÓ‚‡ Ò˙˘Ó ‰ËÌ ÓÚ ÓÔÓÌËÚ ÔÛÌÍÚÓ‚Â ‚ ‰Ë‡„ÌÓÒÚË͇ڇ ̇ çåè.4. èӂ‰ÂÌËÂÚÓ Ì‡ ÔÓÒΉÌËÚ ÓÚ„Ó‚ÓË ‚ ÒÂËflÚ‡ ÔÓÓÚÌÓ¯ÂÌË ̇ I- ‚Ë ÔË Çóë.

êÖáìãíÄíàéÚ Ú‡·Î. 2- ‡ Ò ‚Ëʉ‡, ˜Â Ä Ì‡ ÓÚ„Ó‚ÓËÚ  ‰ÓÒÚ‡

ÒÚ‡·ËÎ̇ ‚Â΢Ë̇. ë‰̇ڇ Ä Ì‡ Ì„‡ÚË‚ÌËfl ÔËÍ Â 10,3+/- 2,5 mV /4, 5- 14,9mV/. ë‰̇ڇ ÔÎÓ˘ ̇ Ì„‡ÚË‚ÌËflÔËÍ Â 30,6 mV.ms + /-10,8 mV.ms /퇷Π2-‚/. ÄÏÔÎËÚÛ‰‡Ú‡Ë ÔÎÓ˘Ú‡ ̇ V- ÚË ÓÚ„Ó‚Ó ÔÓ ÓÚÌÓ¯ÂÌË ̇ I-‚Ë Ò ÔÓ-ÏÂÌfl ÔË çóë ‚ ÔÓÒÓ͇ ‰ÂÔÂÒËfl ËÎË Ù‡ˆËÎËÚ‡ˆËfl ‰Ó 13% ÔË ËÁÒΉ‚‡ÌËÚ Îˈ‡. èË Çóë ‡ÏÔÎËÚÛ‰‡Ú‡ ÔÓ-˜ÂÒ-ÚÓ Ì‡Ï‡Îfl‚‡ ‰Ó 12,5 % Ë ÔÎÓ˘Ú‡ Ò˙˘Ó ÔÓ͇Á‚‡ ÚẨÂÌ-ˆËfl Á‡ ‰ÂÔÂÒËfl Ò‰ÌÓ ‰Ó 18%. ç ҇ ÛÒÚ‡ÌÓ‚ÂÌË Ò˙˘ÂÒ-Ú‚ÂÌË ÔÓÏÂÌË ÒΉ ÚÂÚ‡ÌËÁ‡ˆËflÚ‡. ë‡ÏÓ ÔË Â‰ËÌ Ô‡-ˆËÂÌÚ ÒÚÓÈÌÓÒÚÚ‡ ·Â¯Â ÏÌÓ„Ó ‚ËÒÓ͇ Ë ÔË Â‰ËÌ ÏÌÓ„ÓÌËÒ͇. ë‰̇ڇ ÒÚÓÈÌÓÒÚ Ì‡ Ä ÔË 3 ıˆ ÔÂ‰Ë Ë ÒΉÚÂÚ‡ÌËÁ‡ˆËfl Ì ÔÓ͇Á‚‡ Ò˙˘ÂÒÚ‚ÂÌË ÍÓη‡ÌËfl. èÎÓ˘Ú‡ÔË 3ıˆ ÒΉ ÚÂÚ‡ÌËÁ‡ˆËfl Ë 4 ÏËÌÛÚË ÔÓ Í˙ÒÌÓ ÔÓ͇Á‚‡ÎÂ͇ ÚẨÂ̈Ëfl Á‡ ̇χÎfl‚‡ÌÂ..

éÅëöÜÑÄçÖ à àáÇéÑàä‡ÍÚÓ Ò ‚Ëʉ‡ ÓÚ Ô‰ÒÚ‡‚ÂÌËÚ ÂÁÛÎÚ‡ÚË, ‡ÏÔ-

ÎËÚÛ‰‡Ú‡ Ë ÔÎÓ˘Ú‡ ̇ ÏÓÚÓÌËÚ ÓÚ„Ó‚ÓË ÔË êë ̇Ì‚‡ Ò‡ ÒÚ‡·ËÎÌË ‚Â΢ËÌË, ͇ÚÓ ‚‡Ë‡ˆËËÚ ‚ ÔÓÒÓ͇̇ ÎÂ͇ ‰ÂÔÂÒËfl Ì ҇ ÒÚ‡ÚËÒÚ˘ÂÒÍË Á̇˜ËÏË Ë Ò‡ ‡Á-΢ÌÓ ËÁ‡ÁÂÌË ÔË ÒÚËÏÛ·ˆËfl Ò ‡Á΢ÌË ˜ÂÒÚÓÚË.

àÁÏ‚‡ÌÂÚÓ Ì‡ Ä ÔË Ì‡Û¯ÂÌËfl ̇ çåè  ¯ËÓÍÓÔË·„‡Ì ÏÂÚÓ‰ /2, 4, 5 /, Ë ‰‡‚‡ ‰ÓÒÚÓ‚ÂÌË ‰‡ÌÌË Á‡ Û‚-Âʉ‡Ì ÔË 30-89 % ÓÚ Ô‡ˆËÂÌÚËÚ ‚ Á‡‚ËÒËÏÓÒÚ ÓÚÙÓχڇ Ë ÚÂÊÂÒÚÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. çÂÚÓ˜ÌË ‰‡ÌÌËÏÓ„‡Ú ‰‡ Ò ÔÓÎÛ˜‡Ú ‚ ÂÁÛÎÚ‡Ú Ì‡ ‡ÚÂÙ‡ÍÚË, ÍÓËÚÓ‰‡ ÔÓÏÂÌflÚ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍËfl Ó·‡Á / 1, 3, 5, 6, 7/.èË Çóë ÌÓχÎÌÓ ÏÓÊ ‰‡ Ëχ ‰ÂÔÂÒËfl ̇ Ä ‰Ó 40%Ë Ù‡ˆËÎËÚ‡ˆËfl ‰Ó 50%, ÍÓËÚÓ, ÓÒ‚ÂÌ Ì‡ ÔÓ- ‰Ó·‡Ú‡ ÒËÌ-ıÓÌËÁ‡ˆËfl ̇ ÓÚ„Ó‚Ó‡, ‰‡ Ò ‰˙ÎÊ‡Ú Ë Ì‡ ÚÂıÌ˘ÂÒÍËÔ˘ËÌË /6/. íÓ‚‡ ‰Ó ÌflÍ˙‰Â Ò ËÁ·fl„‚‡ Ò çóë , ÍÓflÚÓ ÂÔ‰ÔÓ˜Ëڇ̇ ÓÚ Ôӂ˜ÂÚÓ ‡‚ÚÓË.

àÁÏ‚‡ÌÂÚÓ Ë Ò˙ÔÓÒÚ‡‚flÌÂÚÓ Ì‡ ÔÎÓ˘Ú‡ ̇ ÏÓÚÓ-ÌËÚ ÓÚ„Ó‚ÓË Â ‰ÓÔ˙ÎÌËÚÂÎÂÌ ÏÂÚÓ‰, ÍÓÈÚÓ , ÓˆÂÌfl‚‡ÌÁ‡Â‰ÌÓ Ò˙Ò Ò‡‚ÌÂÌËÂÚÓ Ì‡ ‡ÏÔÎËÚÛ‰ËÚÂ, ÔÓχ„‡ Á‡ ËÁ-·fl„‚‡Ì ̇ Ôӄ¯ÌË Á‡Íβ˜ÂÌËfl , ·ÂÁ ‰ÓÔ˙ÎÌËÚÂÎÌÓ ‰‡ÛÒÎÓÊÌfl‚‡ ËÁÒΉ‚‡ÌÂÚÓ. íÓ‚‡ ËÁÏ‚‡Ì ËÁËÒÍ‚‡ ÒÔˆˇ-ÎÌË ÔËÒÔÓÒÓ·ÎÂÌËfl Í˙Ï ‡Ô‡‡ÚÛ‡Ú‡ Á‡ ‡‚ÚÓχÚ˘ÌÓÓÚ˜ËÚ‡ÌÂ Ë Ì‡È - ÌÓ‚ËÚ ‡Ô‡‡ÚË ‡ÁÔÓ·„‡Ú Ò ÌÂ„Ó . ÇÎËÚ‡ÚÛ‡Ú‡ Ò ÔÂÔÓ˙˜‚‡ ÓÚ˜ËÚ‡ÌÂÚÓ Ì‡ ÚÓÁË ÔÓ-͇Á‡ÚÂÎ /5, 6 /, ÌÓ Ì ̇ÏÂËıÏ Ò˙Ó·˘ÂÌËfl , ͇ÍÚÓ Á‡ÌÓχÎÌËÚ ÒÚÓÈÌÓÒÚË , ڇ͇ Ë Á‡ ÔÓÏÂÌËÚ ÔË ‡Á-΢ÌË Û‚Âʉ‡ÌËfl.

Ç Á‡Íβ˜ÂÌËÂ, ÓÔ‰ÂÎflÌÂÚÓ Ì‡ ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ÏÓ-ÚÓÌËÚ ÓÚ„Ó‚ÓË Ë ÌÂÈ̇ڇ ÔÓÏfl̇ ÔË êë  ‰ËÌ ÓÚÓÒÌÓ‚ÌËÚ ‰Ë‡„ÌÓÒÚ˘ÌË ÏÂÚÓ‰Ë Á‡ ÚÂÒÚÛ‚‡Ì ̇

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 87‡ÔËÎ, 2002

çåè. éÔ‰ÂÎflÌÂÚÓ Ì‡ ÔÎÓ˘Ú‡ ̇ Ò˙˘ËÚ ÓÚ„Ó‚ÓË Â‰ÓÔ˙ÎÌËÚÂÎ̇ ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÓˆÂÌ͇ Ò˙ÒÚÓflÌËÂÚÓ Ì‡Ì‚‡ Ë çåè , Á‡ ËÁ·fl„‚‡Ì ̇ Ù‡Î¯Ë‚Ó ÔÓÎÓÊËÚÂÎÌË Â-ÁÛÎÚ‡ÚË. èÓ- ‚‡ÊÌË ÓÚ ‡·ÒÓβÚÌËÚ ÒÚÓÈÌÓÒÚË Ò‡ÚẨÂ̈ËËÚ Á‡ ÔÓÏfl̇, ÓÒÓ·ÂÌÓ ÍÓ„‡ÚÓ ‰‡ÌÌËÚ ÓÚ Ä‰‡‚‡Ú ÌÂÒË„ÛÂÌ ÂÁÛÎÚ‡Ú.

ãàíÖêÄíìêÄ:1. 퇘‚ ÄÚ.: Ç˙ıÛ ÌflÍÓË ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ÓÒÓ·ÂÌÓÒÚË ÔËÏˇÒÚÂÌËfl„‡‚ËÒ Ë ÏˇÒÚÂÌÓÔÓ‰Ó·ÌË ÒË̉ÓÏË. ä‡Ì‰Ë‰‡ÚÒ͇ ‰ËÒÂÚ‡ˆËfl, ëÓÙËfl,1979.2. Baets M.H., Ooterhuis G.H.: Mysthenia gravis. Boca Raton, London, Tokyo,CRC Rress , 1993.3. Brown W.F., Bolton C. T. : Clinical Electromyography. Boston, Butterworth,1993, 629- 651.4. Lange D.J. : Electrophysiological testing of neuromuscular transmission. Neurology, 1997, 48, Suppl. 5, 18- 22.5. Oh S.J. : The repetitive nerve stimulation test .Metods in clinicalNeurophysiology, 1992, 3, 1- 15.6. Sanders D. B. : Electrophysiologic study of disorders of neuromuscular trans-mission. In Eectrodiagnosis in clinical neurology, eds Aminov M., New York,Edingburg, London, Churchill Livingston, 1992, 327- 353.7. Stolberg E., Falck B. :Clinical motor nerve conduction study. Methods in

clinical neurophysiology, 1993, 4, 61- 80.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- ë. çÓ‚‡˜ÍÓ‚‡åÅÄã "ñ‡Ëˆ‡ âÓ‡Ì̇", äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„ËflëÓÙËfl 1504, ìÎ. ÅflÎÓ ÏÓ N 8

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 88‡ÔËÎ, 2002

퇷Î. 1 : êÄáèêÖÑÖãÖçàÖ çÄ àáëãÖÑÇÄçàíÖèÄñàÖçíà

èé ÇöáêÄëíMINIMUM 16 „Ó‰ËÌËMAXIMUM 72 „Ó‰ËÌËMEAN 44,85 „Ó‰ËÌËST.DEV. 12,99

퇷Î. 2 : ‡. ëíéâçéëíà çÄ ÄåèãàíìÑÄíÄ çÄ çÖÉÄíàÇçàü èàä (mV) çÄ åéíéêçàíÖ éíÉéÇéêà èêà

êÄáãàóçàíÖ óÖëíéíà çÄ ëíàåìãÄñàü

1 Hz 3 Hz' 3 Hz" 3 Hz'" 10 Hz 20 Hz 30 Hz 50 Hz

N OF CASES 34 36 36 32 29 32 34 15

MINIMUM 5,300 5.100 5,200 5,200 4,500 4,200 4,500 6,600

MAXIMUM 14,900 14.800 14,400 14,300 14,500 14,400 13,900 13,400

MEAN 10,629 10,497 10,369 10,344 10,472 10,256 10,353 10,647

ST DEV 2,146 2,195 2.249 2,165 2,424 2,486 2,409 1,946

·. ëíéâçéëíà çÄ èãéôíÄ çÄ çÖÉÄíàÇçàü èàä (mVms) çÄ åéíéêçàü éíÉéÇéê èêà êÄáãàóçàíÖ

óÖëíéíà çÄ ëíàåìãÄñàü

1 Hz 3 Hz' 3 Hz" 3 Hz'" 10 Hz 20 Hz 30 Hz 50 Hz

N OF CASES 36 38 38 33 29 35 36 16

MINIMUM 19,700 18,800 15,500 15,800 13,700 13,700 14,000 15,500

MAXIMUM 67,100 67,100 65,600 65,600 64,000 62,500 62,500 53,400

MEAN 32,894 32,276 31,068 31,976 32,376 30,597 30,594 30,544

ST DEV 9,917 9,936 9,916 10,622 10,787 10,021 9,843 9,122

îË„.1: àÁÒΉ‚‡Ì ̇ Ä Ë ÔÎÓ˘ ̇ Ì„‡ÚË‚ÌËfl ÔËÍ Ì‡ å-ÓÚ„Ó‚ÓËÚ ÔË 3 Ë 30 ı ˆ

SUMMARYEPILEPSY TREATMENT IN HOSPITAL CONDITIONS -

INDICATIONS, DURATION, AND ANTIEPILEPTICDRUGS

M. Rasheva, L. Haralanov, V. TonchevaThe aim of the study is to establish the indications of hos-

pital treatment of the patients with epilepsy, the duration oftreatment and used antiepileptic drugs. The clinical character-istics and etiological factors in 75 patients (mean age 34,4)with epilepsy, admitted to the Clinic of Neurology of"Tzaritza Joanna" University Hospital in 2000-2001, werestudied retrospectively. 1/3 of the cases were treated in emer-gency conditions, 16 percent were in status epilepticus (SE).Generalized tonic-clonic seizures were observed in 50(66.7%), secondarily generalized in 11 of them. Symptomaticepilepsy was determined in 52%. The most common etiolog-ical factors were cerebro-vascular diseases (in 11 of thepatients), cerebral posttraumatic lesions (in 10), cerebraltumors (in 5). Just 6.7% of the cases were with idiopathic gen-eralized epilepsy and 41.3% remained with unknown etiology.Mean duration of hospitalization was 5.8 days, more fre-quently it lasted between 1 and 3 days. There were 76.2% ofthe patients on monotherapy - with carbamazepine, phenobar-bital, valproate, clonazepam. Polypharmacy was conducted in23.8% and in half of them - with new antiepileptic drugs.Twelve out of the patients were without regular antiepilepticdrug treatment. That was one of the reasons of SE, as well asthe drug substitution and sleep deprivation.

In conclusion: the principle indications for hospital admis-sion of patients with epilepsy are therapeutical (frequentseizures, SE) and diagnostical (late beginning of partialseizures, refractory seizures, complications). Duration of hos-pitalization lasts 5.8±4.7 days. There are no much differencesin antiepileptic treatment in our country, except too frequentprescription on Phenobarbital. The authors suggest the epilep-sy to be included in the National Health Insurance Fund as aclinical path. Key words: epilepsy, hospitalization, indications, duration,status epilepticus, antiepileptic drugs

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Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 89‡ÔËÎ, 2002

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ãÖóÖçàÖ çÄ ÖèàãÖèëààíÖ Ç Åéãçàóçà ìëãéÇàü -èéäÄáÄçàü, èêéÑöãÜàíÖãçéëí, åÖÑàäÄåÖçíà

å. ꇯ‚‡, ã. ·ÌÓ‚, Ç. íÓ̘‚‡äÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl, åÅÄã"ñ‡Ëˆ‡ âÓ‡Ì̇", ëÓÙËfl

Ú˘ÌËfl ÒË̉ÓÏ ÒÔÓ‰ åÂʉÛ̇Ӊ̇ڇ Í·ÒËÙË͇ˆËfl̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙ÔË Ë Ì‡ ÂÔËÎÂÔÚ˘ÌËÚ ÒË̉-ÓÏË ( Commission of the Classification and Terminology ofthe International League against Epilepsy, 1989 ), ‰‡‚ÌÓÒÚ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ˜ÂÒÚÓÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ, Ô˘ËÌË Á‡ÔËÂχÌÂÚÓ ‚ ÍÎËÌË͇ڇ, ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ÔÂÒ-ÚÓÈ, ÔË·„‡ÌË èÖë ÔÂ‰Ë ÔËÂχÌÂÚÓ. ÑÓÒÚÓ‚ÂÌÓÒÚ-Ú‡ ̇ ‰‡ÌÌËÚ  ÓÔ‰ÂÎfl̇ ˜ÂÁ ÒÚ‡ÚËÒÚ˘ÂÒÍËÚ ÏÂ-ÚÓ‰Ë Á‡ Ò‡‚ÌÂÌË ̇ ÓÚÌÓÒËÚÂÎÌË ‰flÎÓ‚Â Ë Ì‡ ÓˆÂÌ͇ ̇Ò‰̇ ‡ËÚÏÂÚ˘̇ ˜ÂÁ ‚‡Ë‡ˆËÓÌÂÌ ‡Ì‡ÎËÁ Ò ËÁ˜ËÒÎÂ-ÌË ̇ (t) ÍËÚÂËfl ÔÓ Student.

êÖáìãíÄíàèÓ ÒÔ¯ÌÓÒÚ Ò‡ ÔËÂÚË ‚ ÍÎËÌË͇ڇ 25 ÓÚ ·ÓÎÌËÚÂ

(33,3%), ͇ÚÓ 12 (16%) Ò‡ ‚ ÂÔËÎÂÔÚ˘ÂÌ ÒÚ‡ÚÛÒ (Öë) .ã˜ÂÌË ‚ Ì‚ÓÎӄ˘ÌÓ ËÌÚÂÌÁË‚ÌÓ ÓÚ‰ÂÎÂÌË (çàé) ÒÂ̇·„‡ ÔË 20 (26,7%), ‡ ÔÂı‚˙ÎflÌe ‚ Ì‚ÓıËۄ˘ÌÓÓÚ‰ÂÎÂÌË - ÔË 7 (9,5%). Çˉ˙Ú Ì‡ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒ-Ú˙ÔË, ÂÚËÓÎÓ„ËflÚ‡ ̇ ÂÔËÎÂÔÚ˘ÌËfl ÒË̉ÓÏ Ë ‰‡‚-ÌÓÒÚÚ‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò‡ Ô‰ÒÚ‡‚ÂÌË Ì‡ ÙË„.1, 2 Ë 3.ë „Â̇ÎËÁˇÌË ÚÓÌ˘ÌÓ-ÍÎÓÌ˘ÌË ÔËÒÚ˙ÔË (Éíäè) Ò‡2/3 ÓÚ ·ÓÎÌËÚ , ͇ÚÓ ÔË 14,6% ÓÚ ÚÂÁË Ò Ô‡ˆË‡ÎÌËÔÓÒÚË ÔËÒÚ˙ÔË (èèè) Ë Ô‡ˆË‡ÎÌË ÍÓÏÔÎÂÍÒÌË ÔËÒ-Ú˙ÔË (èäè)  ̇·Î˛‰‡‚‡Ì‡ Ë ‚ÚÓ˘̇ „Â̇ÎËÁ‡ˆËfl.ìÒÚ‡ÌÓ‚fl‚‡ Ò ÔÓ-„ÓÎflχ ˜ÂÒÚÓÚ‡ ̇ èäè ÔË Ï˙ÊÂÚÂ(‚ 22,5%) ÓÚ ÍÓÎÍÓÚÓ ÔË ÊÂÌËÚ (‚ 11,4%) - <0,05.ÖÚËÓÎÓ„ËflÚ‡ ̇ ÂÔËÎÂÔÒËflÚ‡ ̇È-˜ÂÒÚÓ Â Ò˙‰Ó‚‡ (‚14,7%) Ë ÔÓÒÚÚ‡‚ÏÂ̇ (‚ 13,3%) Ë ÔÓ-fl‰ÍÓ ÚÛÏÓ̇,ÔÓÒÚ‚˙ÁÔ‡ÎËÚÂÎ̇ ËÎË ‰Û„‡. ëËÏÔÚÓÏ̇ڇ ÂÔËÎÂÔÒËfl ÂÓÚÌÓÒËÚÂÎÌÓ ÔÓ-˜ÂÒÚ‡ ÔË Ï˙ÊÂÚ ‚ Ò‡‚ÌÂÌËÂ Ò ÊÂÌË-Ú (ÂÒÔÂÍÚË‚ÌÓ ‚ 55,5% Ë ‚ 48,6%). ч‚ÌÓÒÚÚ‡ ̇ Á‡·Ó-Îfl‚‡ÌÂÚÓ ‚‡Ë‡ ‚ ¯ËÓÍË „‡ÌˈË, ͇ÚÓ ÔË 36% Ò ͇-҇ Á‡ ÌӂӉˇ„ÌÓÒÚˈˇÌË ÒÎÛ˜‡Ë Ò ÔËÒÚ˙ÔË Ò ‰‡‚-ÌÓÒÚ ÓÚ 1 ‰Ó 6 ÏÂÒˆ‡ (ÙË„. 3). èË Úflı Ô˘Ë̇ڇ Á‡ÔËÂχÌ „·‚ÌÓ Â ÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ‰Ë‡„ÌÓÁ‡Ú‡. çÓ‚ÓÓÚ-ÍËÚËÚ ÒÎÛ˜‡Ë Ò‡ Ò ÓÚÌÓÒËÚÂÎÌÓ ÔÓ-‚ËÒÓ͇ ˜ÂÒÚÓÚ‡ÔË Ï˙ÊÂÚ ÓÚÍÓÎÍÓÚÓ ÔË ÊÂÌËÚ - 42,5% Í˙Ï 28,6%.óÂÒÚÓÚ‡Ú‡ ̇ ÔËÒÚ˙ÔËÚ  ‚ËÒÓ͇ (îË„.4), ͇ÚÓ ·ÎË-ÁÓ 1/3 ÓÚ ·ÓÎÌËÚ ҇ Ò ÏÌÓ„Ó ˜ÂÒÚË ËÎË ÒÂËÈÌË ÔËÒÚ˙-ÔË, ‡ 16% Ò‡ Ò ÍÓÌ‚ÛÎÒË‚ÂÌ Öë. è˘Ë̇ڇ Á‡ ÔËÂχÌÂÚÓ̇ ÚÂÁË Ô‡ˆËÂÌÚË Â „·‚ÌÓ Ô‰ÔËÂχÌ ̇ ÒÔ¯ÌË Ë‡‰ÂÍ‚‡ÚÌË Ú‡Ô‚Ú˘ÌË ÏÂÍË. ä‡ÚÓ ÔÓ‚Ó͡˘ËÙ‡ÍÚÓË Á‡ ‚˙ÁÌËÍ‚‡Ì ̇ Öë ÔË 6 ÓÚ ÒÎÛ˜‡ËÚ  ÒÏfl̇-Ú‡ ̇ èÖë, ÌÂÒËÒÚÂÏÌÓÚÓ Ë Ò ÌËÒÍË ‰ÓÁË Î˜ÂÌËÂ, ÔË 6- Ò˙Ì̇ڇ ‰ÂÔË‚‡ˆËfl, ÔË 2 - ÁÎÓÛÔÓÚ·‡Ú‡ Ò ‡ÎÍÓıÓÎ,ÔË 2 - ËÌÚÂÍÛÂÌÚÌÓ Ù·ËÎÌÓ Á‡·ÓÎfl‚‡ÌÂ, ͇ÚÓ ÔÓ-˜ÂÒÚÓ Â Ì‡Îˈ ÍÓÏ·Ë̇ˆËfl ÓÚ 2 ËÎË Ôӂ˜ هÍÚÓË.

ë‰ÌËflÚ ÔÂÒÚÓÈ ‚ ÍÎËÌË͇ڇ  5,8±4,7 ‰ÌË, ͇ÚÓÔӂ˜ ÓÚ ÔÓÎÓ‚Ë̇ڇ ·ÓÎÌË (54,7%) Ò‡ Ò ÔÂÒÚÓÈ ÏÂʉÛ1 Ë 3 ‰ÌË. ç Ò ÛÒÚ‡ÌÓ‚fl‚‡ Á‡‚ËÒËÏÓÒÚ Ì‡ Ò‰ÌËfl ÔÂÒ-ÚÓÈ ÓÚ ‚ˉ‡ ̇ ÔËÒÚ˙ÔËÚÂ, χ͇ ˜Â ̇‰ 8 ‰ÌË Ò ÎÂÍÛ-‚‡Ú „·‚ÌÓ Ô‡ˆËÂÌÚËÚÂ Ò Öë Ë ÒÂËÈÌË ÔËÒÚ˙ÔË, Ô˙-‚˘ÌÓ ËÎË ‚ÚÓ˘ÌÓ „Â̇ÎËÁˇÌË. èË ÚÂÁË ·ÓÎÌË ÂÔË-ÎÂÔÚ˘ÌËflÚ ÒË̉ÓÏ Ì‡È-˜ÂÒÚÓ Â Ò˙‰Ó‚Ó Ó·ÛÒÎÓ‚ÂÌ (ÔË4 ÓÚ 9) ËÎË Â Ò‚˙Á‡Ì Ò ÏÓÁ˙˜ÂÌ ÚÛÏÓ (ÔË 2 ÓÚ 9). éÚÒËÏÔÚÓÏÌËÚ ÂÔËÎÂÔÒËË 20,8% ËÏ‡Ú ÔÂÒÚÓÈ Ì‡‰ 8 ‰ÌË,‡ ÓÚ ÚÂÁË Ò ÌÂËÁflÒÌÂ̇ ÂÚËÓÎÓ„Ëfl - Ò‡ÏÓ 1 ·ÓÎÂÌ.

ìÒÚ‡ÌÓ‚fl‚‡ ÒÂ, ˜Â ‚˙ÔÂÍË Ì‡Î˘ËÂÚÓ Ì‡ Ôӂ˜ ÓÚ 2ÔËÔ‡‰˙͇ ‚ ÔÓÒΉÌËÚ 6 ÏÂÒˆ‡, 12 ÓÚ ·ÓÎÌËÚ (16%)Ì ҇ ÔÓ‚Âʉ‡ÎË ÒËÒÚÂÏÌÓ ‡ÌÚËÂÔËÎÂÔÚ˘ÌÓ Î˜ÂÌËÂ,48 (64%) Ò‡ ·ËÎË Ò ÏÓÌÓÚ‡ÔËfl Ë 15 (20%) - Ò ÔÓÎËÚ‡-ÔËfl, ÔÓÎÓ‚Ë̇ڇ ÓÚ Úflı ‚Íβ˜ËÚÂÎÌÓ Ë Ò ÌÓ‚Ë èÖë. éÚ-ÌÓÒËÚÂÎÌÓ ÔÓ-˜ÂÒÚÓ ÔÓÎËÚ‡ÔËfl  ÔÓ‚Âʉ‡Ì‡ ÔË ÒÎÛ-˜‡ËÚÂ Ò èèè Ë èäè - ‚ 27,6% ÓÚ ÍÓÎÍÓÚÓ ÔË Éíäè - ‚15,2%. ç‡ ÙË„Û‡ 5  Ô‰ÒÚ‡‚Â̇ Ú‡ÔËflÚ‡ ÒÔÓ‰ ‚Ë-‰‡ ̇ ÂÔËÎÂÔÒËflÚ‡ - Ô‡‚Ë ‚Ô˜‡ÚÎÂÌË ˜Â ÔË ÒËÏÔÚÓÏ-ÌËÚ ÎÓ͇ÎËÁ‡ˆËÓÌÌÓÒ‚˙Á‡ÌË ÂÔËÎÂÔÒËË ÔÓÎËÚ‡ÔËflÚ‡

 ÔÓ-˜ÂÒÚ‡.ç‡È-˜ÂÒÚÓ ÔË·„‡ÌËÚ ‡Ï·Û·ÚÓÌÓ èÖë Ò‡ ͇·‡Ï‡ÁÂ-ÔËÌ (ÔË 35 ·ÓÎÌË), ÙÂÌÓ·‡·ËڇΠ(ÔË 24), ÍÎÓ̇ÁÂÔ‡Ï(ÔË 17) Ë ‚‡ÎÔÓ‡ÚË (ÔË 12), Ò‡ÏÓÒÚÓflÚÂÎÌÓ ËÎË ‚ ÍÓÏ-·Ë̇ˆËfl, ͇ÚÓ ÔÂӷ·‰‡‚‡Ú Ò˙˜ÂÚ‡ÌËfl ̇ ͇·‡Ï‡ÁÂÔËÌÒ ÍÎÓ̇ÁÂÔ‡Ï Ë Ì‡ ‚‡ÎÔÓ‡Ú Ò ÍÎÓ̇ÁÂÔ‡Ï. èÓÎËÚ‡ÔËfl ÂÔË·„‡Ì‡ „·‚ÌÓ ÔË ÒÎÛ˜‡ËÚÂ Ò ÔËÒÚ˙ÔË Ò „ÓÎflχ ˜ÂÒ-ÚÓÚ‡ (ÙË„Û‡ 6) - <0,01, ͇ÍÚÓ Ë ÔË Ì‡Î˘ËÂÚÓ Ì‡ ÔÓ-ÎËÏÓÙÌË ÔËÒÚ˙ÔË.

ìÒÚ‡ÌÓ‚fl‚‡ ÒÂ, ˜Â Á̇˜ËÏË Ù‡ÍÚÓË Á‡ ËÁ·Ó ̇ ωË-͇ÏÂÌÚ ÓÒ‚ÂÌ ‚ˉ‡ ̇ ÔËÒÚ˙ÔËÚÂ, ̇ ÂÔËÎÂÔÚ˘ÌËfl ÒËÌ-‰ÓÏ Ë Ì‡ ÖÖÉ Ì‡ıӉ͇, Ò‡ Ë ‚˙Á‡ÒÚÚ‡ ̇ Ô‡ˆËÂÌÚ‡, ÒÔÂ-ˆË‡ÎÌÓÒÚÚ‡ ̇ ÎÂ͇fl, ̇Á̇˜ËΠΘÂÌËÂÚÓ Ë ˆÂ̇ڇ ̇ωË͇ÏÂÌÚ‡. ë‰̇ڇ ‚˙Á‡ÒÚ Ì‡ ·ÓÎÌËÚÂ, ÎÂÍÛ‚‡ÌË ÒÙÂÌÓ·‡·ËڇΠ 43,4±7,7 „Ó‰ËÌË, ‡ ̇ ÓÒڇ̇ÎËÚÂ, ÔÓ-‚Âʉ‡˘Ë ΘÂÌËÂ Ò ‰Û„Ë èÖë - 30,1±11,4 „Ó‰ËÌË - <0,05.éÚ ÔÓ‚Âʉ‡˘ËÚÂ Ò ÙÂÌÓ·‡·ËڇΠΘÂÌË ÎÂ͇Ë, ÒÔÂ-ˆË‡ÎËÒÚË Ì‚ÓıËÛÁË Ò‡ 10 (41,7%), Ó·˘ÓÔ‡ÍÚËÍÛ‚‡-˘Ë ÎÂÍ‡Ë Ò‡ 9 (37,4%), Ì‚ÓÎÓÁË Ò‡ 5 (20,8%), ‰Ó͇ÚÓÓÚ ÎÂÍÛ‚‡˘ËÚÂ Ò ‰Û„Ë èÖë ÒÔˆˇÎËÒÚË Ì‚ÓÎÓÁË Ò‡73,2%, ‡ 26,8% - Ó·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ë ËÎË ÎÂÍ‡Ë Ò ‰Û„ËÒÔˆˇÎÌÓÒÚË - p<0,01.

éÚ 7 ·ÓÎÌË, ÔÂı‚˙ÎÂÌË Á‡ ΘÂÌË ‚ Ì‚ÓıËۄ˘ÌÓÓÚ‰ÂÎÂÌËÂ, ÔË 2  ËÁ‚˙¯Â̇ ÛÒÔ¯̇ ÓÔ‡ˆËfl Á‡ ‰Ó·Ó-͇˜ÂÒÚ‚ÂÌË ÏÓÁ˙˜ÌË ÚÛÏÓË, ÔË 1 - Á‡ ‡Ì‚ËÁÏË Ì‡ ÏÓ-Á˙˜ÌË Ò˙‰Ó‚Â, ÔË 1 - Á‡ ıÓÌ˘ÂÌ ÒÛ·‰Û‡ÎÂÌ ıÂχÚÓÏ ËÔË 1 - Á‡ ÚÂÏÔÓ‡Î̇ ÂÔËÎÂÔÒËfl Ò˙Ò ÒÍÎÂÓÁ‡ ̇ ıËԇ͇Ï-Ô‡.

éÅëöÜÑÄçÖêÂÁÛÎÚ‡ÚËÚ ÓÚ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡Ú ‰‡ÌÌË

Á‡ ˜ÂÒÚÓÚ‡, ı‡‡ÍÚÂËÒÚË͇ ̇ ÂÔËÎÂÔÚ˘ÌËÚ ÔËÒÚ˙-ÔË Ë Ì‡ ÂÔËÎÂÔÚ˘ÌËfl ÒË̉ÓÏ ·ÎËÁÍË ‰Ó ‰‡ÌÌËÚ ‚ ÎËÚÂ-‡ÚÛ‡Ú‡ ( 3, 9 ). èÓ-‚ËÒÓ͇ڇ ˜ÂÒÚÓÚ‡ ̇ ÒÎÛ˜‡Ë Ò˙Ò ÒÂ-ËÈÌË ÔËÔ‡‰˙ˆË Ë Ò Öë ‚ ̇¯Ëfl χÚÂˇΠ‚ Ò‡‚ÌÂÌË ÒÍÎËÌ˘ÌËÚ ̇·Î˛‰ÂÌËfl ̇ ‰Û„Ë ‡‚ÚÓË ( 5, 7 )  ҂˙Á‡-̇ Ò ÔÓÙË· ̇ ÍÎËÌË͇ڇ Ë Ì‡Î˘ËÂÚÓ Ì‡ çàé, ‚ ÍÓÂÚÓÒ ̇ÒÓ˜‚‡Ú Á‡ ΘÂÌË ·ÓÎÌË ÓÚ ‚Ò˘ÍË ‡ÈÓÌË Ì‡ ÒÚÓÎË-ˆ‡Ú‡ Ë ·ÎËÁÍËÚ „‡‰Ó‚Â. Ç˙ÔÂÍË ˜Â ÂÔËÎÂÔÒËflÚ‡ Ò ÎÂ-ÍÛ‚‡ „·‚ÌÓ ‡Ï·Û·ÚÓÌÓ ( 4, 9 ), ÚÂÊÂÒÚÚ‡ ̇ ÂÔËÎÂÔ-Ú˘ÌËflÚ ÒË̉ÓÏ Ò „ÓÎflχ ˜ÂÒÚÓÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ, ÒÂ-ËÈÌËÚ ÔËÒÚ˙ÔË Ë Öë ÔË ÔÓ-„ÓÎflχڇ ˜‡ÒÚ ÓÚ ÒÎÛ˜‡-ËÚÂ,  ÓÒÌÓ‚‡ÌË Á‡ ·ÓÎÌ˘ÌÓ Î˜ÂÌË ÔÓ ÒÔ¯ÌÓÒÚ. èÓ-fl‰ÍÓ Ô‡ˆËÂÌÚËÚ ҇ ÔËÂχÌË „·‚ÌÓ Ò ‰Ë‡„ÌÓÒÚ˘̇ˆÂÎ Á‡ ÛÚÓ˜Ìfl‚‡Ì ÂÚËÓÎÓ„ËflÚ‡ ̇ ÒËÏÔÚÓÏÌËÚ ÂÔË-ÎÂÔÒËË Ë Á‡ ËÁ‚˙¯‚‡Ì ̇ ‚ËÒÓÍÓÒÔˆˇÎËÁˇÌË ËÁÒΉ-‚‡ÌËfl, ͇ÚÓ Ì‡ÔËÏ ‡Ì„ËÓ„‡ÙËfl ̇ ÏÓÁ˙˜ÌËÚ Ò˙‰Ó‚Â.èÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ ΘÂÌËÂÚÓ Â Í‡Ú͇ Ë ‰Ó „ÓÎflχÒÚÂÔÂÌ Á‡‚ËÒË ÓÚ Ó·˘ÓÚÓ Ò˙ÒÚÓflÌËÂ, ‚˙Á‡ÒÚÚ‡, ÌÂÓ·-ıÓ‰ËÏÓÒÚÚ‡ ÓÚ ÒÏfl̇ ̇ èÖë, ‰Ë‡„ÌÓÒÚ˘ÌËÚ ÔÓˆÂ-‰ÛË, ÌÂÓ·ıÓ‰ËÏË Á‡ Ô‡‚ËÎÌÓÚÓ Î˜ÂÌËÂ, ÍÓÂÚÓ Ô˘‡ÒÚ ÓÚ ·ÓÎÌËÚ  Ì‚ÓıËۄ˘ÌÓ.

àÁ·Ó˙Ú Ì‡ ωË͇ÏÂÌÚ ÔË ÔÓ‚Âʉ‡ÌÓÚÓ ‡Ï·Û·-ÚÓÌÓ Î˜ÂÌË  ·‡ÁË‡Ì Ì‡ ‚ˉ‡, ˜ÂÒÚÓÚ‡Ú‡, ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ, ËÒ͇ ÓÚ ÒÚ‡Ì˘ÌË fl‚ÎÂ-ÌËfl, ËÁËÒÍ‚‡ÌËfl ‚˙ÁÔËÂÚË Ò äÓÌÒÂÌÒÛÒ Á‡ ‰Ë‡„ÌÓÒÚË͇,ΘÂÌËÂ Ë Ó„‡ÌËÁ‡ˆËfl ̇ ÔÓÚË‚ÓÂÔËÎÂÔÚ˘̇ڇ ÔÓÏÓ˘Û Ì‡Ò (.4.). à ‚˙ÔÂÍË ˜Â ÎËÔÒ‚‡Ú ‡ÁÎËÍË ‚ Ò‡‚ÌËÚÂÎÌË-Ú ÔÓÛ˜‚‡ÌËfl ‚˙ıÛ ÂÙÂÍÚ‡ ̇ ÓÒÌÓ‚ÌËÚ èÖë - ͇·‡-χÁÂÔËÌ, ÙÂÌÓ·‡·ËÚ‡Î, ÙÂÌËÚÓËÌ, ÔËÏˉÓÌ, ‚‡ÎÔÓ‡ÚË( 8 ), ‚‡ÎÔÓ‡ÚËÚ ÓÒÚ‡‚‡Ú ωË͇ÏÂÌÚ Ì‡ ËÁ·Ó ÔËˉËÓÔ‡Ú˘ÌËÚ Éíäè, ‡·Ò‡ÌÒËÚÂ Ë ÏËÓÍÎÓÌ˘ÌËÚÂÔËÒÚ˙ÔË, ‰Ó͇ÚÓ Í‡·‡Ï‡ÁÂÔË̇˙Ú ÓÒÚ‡‚‡ ωË͇-ÏÂÌÚ ÓÚ Ô˙‚Ë Â‰ Á‡ ΘÂÌË ̇ èèè Ë èäè ( 10 ). èÓ-‡‰Ë ÚÂÁË Ô˘ËÌË Ì‡È-¯ËÓÍÓ ÔË·„‡ÌËڠωË͇ÏÂÌ-ÚË ‚ ΘÂÌËÂÚÓ Ì‡ ÂÔËÎÂÔÒËflÚ‡ Ò‡ ͇·‡Ï‡ÁÂÔËÌ˙Ú Ë‚‡ÎÔÓ‡ÚËÚ ( 3, 9, 11 ). èË ÚÓ‚‡ ͇·‡Ï‡ÁÂÔËÌ˙Ú Â ÒÔÓ-‰Ó·˙ ÍÓÌÚÓΠ̇ ÔËÔ‡‰˙ˆËÚÂ Ë ÔÓ-χÎÍÓ ÒÚ‡Ì˘ÌË

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 90‡ÔËÎ, 2002

‰ÂÈÒÚ‚Ëfl ÔË èäè, ÍÓÂÚÓ ·Â¯Â ‰Ó͇Á‡ÌÓ ‚ „ÓÎflÏÓ, ÏÛÎ-ÚˈÂÌÚÓ‚Ó, ‡Ì‰ÓÏËÁˇÌÓ, ‰‚ÓÈÌÓ ÒÎflÔÓ ÔÓÛ˜‚‡Ì ҄ÓÎflχ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ ̇·Î˛‰ÂÌËÂÚÓ ( 10 ), ‰Ó·ÂËÁ‚ÂÒÚÌÓ Û Ì‡Ò, ÍÓÂÚÓ Ó·flÒÌfl‚‡ Ë Ì‡È-„ÓÎflχڇ ˜ÂÒÚÓڇ̇ ÔËÎÓÊÂÌË ̇ ͇·‡Ï‡ÁÂÔËÌ ‚ ΘÂÌË ̇ ÂÔËÎÂÔÒËflÚ‡‚ ̇¯ËÚ ÂÁÛÎÚ‡ÚË. çflÍÓË ‡‚ÚÓË ( 10 ) ÔÓÒÓ˜‚‡Ú, ˜ÂˆÂ̇ڇ ̇ èÖë Ò˙˘Ó ˜ÂÒÚÓ Â Á̇˜ËÏ Ù‡ÍÚÓ, ÍÓÂÚÓ ‚Â-ÓflÚÌÓ Â Ô˘Ë̇ Á‡ ‚Ò Ӣ „ÓÎflχڇ ˜ÂÒÚÓÚ‡ ̇ ÔË-ÎÓÊÂÌË ̇ ÙÂÌÓ·‡·ËÚ‡Î Û Ì‡Ò, „·‚ÌÓ ÔË ÔÓ-‚˙Á‡ÒÚÌËÔ‡ˆËÂÌÚË, Ô‰ËÏÌÓ ÓÚ Ì‚ÓıËÛÁËÚÂ Ë Ó·˘ÓÔ‡ÍÚË-ÍÛ‚‡˘ËÚ ÎÂ͇Ë. ë˙‚ÂÏÂÌÌËÚ ÒÚ‡Ú„ËË Á‡ ΘÂÌËÂ̇ ÂÔËÎÂÔÒËflÚ‡ ÔÓ͇Á‚‡Ú, ˜Â 10-30% ÓÚ Ô‡ˆËÂÌÚËÚ ÒÂÔËÎÂÔÒËfl Ò ÍÓÌÚÓÎË‡Ú ÔÓ-‰Ó·Â Ò ÍÓÏ·Ë̇ˆËfl ÓÚ ‰‚‡ËÎË Ôӂ˜ èÖë ( 1, 2, 6 ), ͇ÚÓ ‡ˆËÓ̇Î̇ڇ ÔÓÎËÚ‡-ÔËfl Ò ·‡Áˇ ̇ ÓÒÌÓ‚ÌËÚ ÏÂı‡ÌËÁÏË Ì‡ ÂÔËÎÂÔÒËflÚ‡ Ë̇ ÔÓÁ̇‚‡ÌÂÚÓ Ì‡ ÔË̈ËÔËÚ ̇ ‰ÂÈÒÚ‚Ë ̇ èÖë.

àáÇéÑà1. èÓ͇Á‡ÌËflÚ‡ Á‡ ·ÓÎÌ˘ÌÓ Î˜ÂÌË ̇ Ô‡ˆËÂÌÚËÚ Ò

ÂÔËÎÂÔÒËfl Ò‡ ÒÔ¯ÌË Ú‡Ô‚Ú˘ÌË - ÔË ÒÂËÈÌË ÔËÔ‡-‰˙ˆË, ÂÔËÎÂÔÚ˘ÂÌ ÒÚ‡ÚÛÒ, ÛÒÎÓÊÌÂÌËfl ËÎË ÒÚ‡Ì˘ÌËfl‚ÎÂÌËfl Ë ‰Ë‡„ÌÓÒÚ˘ÌË - ÔË Ò˙ÏÌÂÌË Á‡ ÒËÏÔÚÓÏÌËÂÔËÎÂÔÒËË, ËÁËÒÍ‚‡˘Ë ÒÔˆˇÎËÁˇÌË ËÁÒΉ‚‡ÌËfl, ‚˙Á-ÏÓÊÌË Ò‡ÏÓ ‚ ·ÓÎÌ˘̇ Ó·ÒÚ‡Ìӂ͇.

2 ë‰ÌËflÚ ÔÂÒÚÓÈ Ì‡ ·ÓÎÂÌ Ò ÂÔËÎÂÔÒËfl ‚ Ì‚ÓÎÓ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 91‡ÔËÎ, 2002

ÏÓÌÓÚ‡ÔËfl

ÔÓÎËÚ‡ÔËfl

˜ÂÒÚË ÔËÔ‡‰˙ˆË-

Âʉ̂ÌË ‰Ó ÌflÍÓÎÍÓ

ÏÂÒ˜ÌÓ

‰ÍË ÔËÔ‡‰˙ˆË- ÌflÍ./„Ó‰

ËÎË ÔÓ-‰ÍË

62,50%

37,50%

87,50%

p<0,01

12,50%

100%

80%

60%

40%

20%

0%

„˘̇ ÍÎËÌË͇  5,8±4,7 ‰ÌË Ë Â ÓÚÌÓÒËÚÂÎÌÓ ÔÓ-ÔÓ‰˙Î-ÊËÚÂÎÂÌ ÔË ÒÎÛ˜‡ËÚ Ò˙Ò ÒËÏÔÚÓÏ̇ ÂÔËÎÂÔÒËfl Ë Öë.

3. éÒÌӂ̇ڇ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚ ÔÓ‚Âʉ‡Ú ÏÓÌÓÚÂ-‡ÔËfl, Ò ÔÓÎËÚ‡ÔËfl Ò‡ 20%, ͇ÚÓ Ò‡ÏÓ ÔË ÔÓÎÓ‚Ë̇ڇÓÚ Úflı Ò ‚Íβ˜‚‡Ú Ë ÌÓ‚ËÚ èÖë. èÓÎËÚ‡ÔËflÚ‡ ÂÔÓ-˜ÂÒÚ‡ ÔË èèè Ë èäè, ÔË ÒËÏÔÚÓÏÌËÚ ÎÓ͇ÎËÁ‡-ˆËÓÌÌÓ Ò‚˙Á‡ÌË ÂÔËÎÂÔÒËË Ë ÔË ÚÂÊÍËÚ ÙÓÏË Ì‡ Á‡-·ÓÎfl‚‡ÌÂÚÓ Ò „ÓÎflχ ˜ÂÒÚÓÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ. ç‡È-˜ÂÒ-ÚÓ ÔË·„‡ÌËfl ωË͇ÏÂÌÚ Â Í‡·‡Ï‡ÁÂÔËÌ˙Ú, ÔÓÒΉ‚‡ÌÓÚ ÙÂÌÓ·‡·ËÚ‡Î, ÍÎÓ̇ÁÂÔ‡Ï Ë ‚‡ÎÔÓ‡Ú.

4. éÒÌÓ‚ÌË Ô˘ËÌË Á‡ ‚ÎÓ¯‡‚‡Ì ̇ Ò˙ÒÚÓflÌËÂÚÓ Ò˙ÒÁ‡˜ÂÒÚfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ ‰Ó Öë, Ò‡ ÒÏfl̇ڇ ËÎË ÒÔË-‡ÌÂÚÓ Ì‡ èÖë Ë Ò˙Ì̇ڇ ‰ÂÔË‚‡ˆËfl.5. ìÏÂÒÚÌÓ Â çáéä ‰‡ ‡Á„Ή‡ ‚˙ÁÏÓÊÌÓÒÚËÚ Á‡‚Íβ˜‚‡ÌÂÚÓ Ì‡ ÍÎËÌ˘̇ Ô˙ÚÂ͇ Á‡ ÂÔËÎÂÔÒËflÚ‡.

ãàíÖêÄíìêÄ1. ÉÂÓ„Ë‚‡ í. Ç˙ÁÏÓÊÌÓÒÚË Ì‡ ÂÎÂÍÚÓÂ̈ÂÙ‡ÎÓ„‡ÙËflÚ‡ ‚ ËÁ·Ó‡ ̇ÎÂ͇ÒÚ‚ÂÌÓ Ò‰ÒÚ‚Ó Ë ÍÓÌÚÓ· ̇ Ú‡ÔËflÚ‡ ̇ ÂÔËÎÂÔÒËËÚÂ".ÑÓÍÚÓÒ͇ ‰ËÒÂÚ‡ˆËfl, 2002.2. ÑËÏÓ‚‡ è. í‡Ô‚Ú˘ÂÌ ÂÙÂÍÚ Ì‡ ÌflÍÓË ÌÓ‚Ë ‡ÌÚËÍÓÌ‚ÛÎÒ‡ÌÚË ÔËÂÔËÎÂÔÒËË ‚ ‰ÂÚÒ͇ ‚˙Á‡ÒÚ. ÑÓÍÚÓÒ͇ ‰ËÒÂÚ‡ˆËfl, 2000.3. á‡ı‡Ë‚ á., ã. ï‡ÌÓ‚. ÖÔËÎÂÔÒËfl, ëÓÙËfl,1999.

4. äÓÌÒÂÌÒÛÒ Á‡ ‰Ë‡„ÌÓÒÚË͇ڇ, ΘÂÌËÂÚÓ Ë Ó„‡ÌËÁ‡ˆËflÚ‡ ̇ÔÓÚË‚ÓÂÔËÎÂÔÚ˘̇ڇ ÔÓÏÓ˘ Û Ì‡Ò. Å˙΄‡Ò͇ Ì‚ÓÎÓ„Ëfl, 2001,1, 29-40.5. Delanty, N., Frenchq J. A., Labar, D.R., Pedley, T.A.,Rowan, A. J.Statusepilepticus arising de novo in hospitalized patients. Seizure, 10, 2001, 116-119.6. Dunkan, J. S. Modern treatment strategies for patients with epilepsy.J.R.Soc.Med., 84, 1991, 159-162.7. änake, S., Rosenow, F., Vescovi, M., Oertel, W. H., Mueller, H. H., Wirbatz,A., Katsarov, N., Hamer, H. M. Incidence of ststus epilepticus in adults inGermany. Epilepsia, 42, 2001, 6, 714-718.8. Levy, R.H., Wurden, C.J. Carbamazepine - interactions with other drugs. In:Antiepileptic drugs (IV edition) eds. R.H. Levy, R.H. Mattson, B.S. Meldrum.Raven Press Ltd, NY, 1995,543-554.9. Majkowsky J. Padaczka. Dyagnostyka, leczenie, zapobieganie.,PZWL,Warszawa,1986.10. Mattson, R.H. Selection of antiepileptic drug therapy.In: Antiepileptic drugs(IV edition) eds. R.H. Levy, R.H. Mattson, B.S. Meldrum. Raven Press,Ltd,NY,1995, 123-135.11. Mattson, R.H., Cramer, J.A.,Collins, J.F.,and the Department of VeteransAffairs Epilepsy Cooperative Study Group. A comparison of valproate withCarbamazepine for the treatment of complex partial seizures and secondarily gen-eralized tonic-clonic seizures in adults. N Engl J Med, 327, 1992, 765-771.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:Ñ- å‡Ëfl ꇯ‚‡ ç‚ÓÎӄ˘̇ ÍÎËÌË͇,åÅÄã ñ‡Ëˆ‡ âÓ‡Ì̇, ÅflÎÓ ÏÓ 8, ëÓÙËflÚÂÎÂÙÓÌ 4344-365

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 92‡ÔËÎ, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË

îÄåàãçÄÄåàéíêéîàóçÄ ãÄíÖêÄãçÄ ëäãÖêéáÄ

ëÚ.뇇ÙÓ‚å‰ˈËÌÒÍË ìÌË‚ÂÒËÚÂÚ; åÅÄã-"ÄÎÂÍ҇̉ӂÒ͇", ç‚ÓÎӄ˘̇ ÍÎËÌË͇

SUMMARYFAMILIAL AMYOTROPHIC LATERAL SCLEROSIS

St.SarafovRetrospective case of familial Amyotrophic Lateral

Sclerosis is discussed. The disease was observed in fivepatients (four male and one female ) allocated in two genera-tions of the family. They all are deceased. The main clinicalfeatures (disease onset and duration, initial involvement, par-ent transmission, sex male to female ratio and other) of thedisease in this family are described and they are comparedwith the available bibliography data. Coincidence for someand discrepancy for others from indicated features is reported.Key words: familial Amyotrophic Lateral Sclerosis

êÖáûåÖê‡Á„ÎÂʉ‡ Ò ÂÚÓÒÔÂÍÚË‚ÂÌ ÒÎÛ˜‡È ̇ Ù‡ÏËÎ̇ ÙÓ-

χ ̇ ‡ÏËÓÚÓÙ˘̇ ·Ú‡Î̇ ÒÍÎÂÓÁ‡. ᇷÓÎfl‚‡ÌÂÚÓ ̇·Î˛‰‡‚‡ÌÓ ‚ ÔÂÚ Ô‡ˆÂÌÚ‡ (˜ÂÚËËχ Ï˙ÊÂ Ë Â‰Ì‡ ÊÂ-̇), „ÛÔˇÌË ‚ ‰‚ ÔÓÍÓÎÂÌËfl. ̇ Ù‡ÏËÎËflÚ‡. ÇÒ˘ÍË Ò‡ÔÓ˜Ë̇ÎË. é·Ò˙ʉ‡Ú Ò „·‚ÌËÚ ÍÎËÌ˘ÌËÚ ı‡‡ÍÚÂ-ËÒÚËÍË (‚˙Á‡ÒÚ Ì‡ ̇˜‡ÎÓ Ë ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚ Ì‡ Á‡·Ó-Îfl‚‡ÌÂÚÓ, ÚËÔ Ì‡ Ô‰‡‚‡ÌÂ, ‡ÁÔ‰ÂÎÂÌË ÔÓ ÔÓÎ Ë ‰Û-„Ë) ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë Ò‡ Ò‡‚ÌÂÌË Ò ‰ÓÒÚ˙ÔÌËÚ ÓÚ ÎË-Ú‡ÚÛ‡Ú‡ ‰‡ÌÌË. éÚ˜ËÚ‡ Ò Ò˙‚Ô‡‰ÂÌËÂÚÓ ÔÓ ÌflÍÓÈ Ë‡ÁÏË̇‚‡ÌÂÚÓ ÔÓ ‰Û„Ë ÓÚ ÔÓÒÓ˜ÂÌËÚ ÔÓ͇Á‡ÚÂÎË.äβ˜Ó‚Ë ‰ÛÏË: Ù‡ÏËÎ̇ ‡ÏËÓÚÓÙ˘̇ ·Ú‡Î̇ ÒÍÎÂ-ÓÁ‡

ìÇéÑî‡ÏËÎÌËÚ ÒÎÛ˜‡Ë ̇ ‡ÏËÓÚÓÙ˘̇ڇ ·Ú‡Î̇

ÒÍÎÂÓÁ‡ (Äãë) Ô‰ÒÚ‡‚Îfl‚‡Ú 5-20%, ̇È-˜ÂÒÚÓ 10%ÓÚ Ó·˘Ëfl ·ÓÈ ÒÎÛ˜‡Ë Ò ÚÓ‚‡ Á‡·ÓÎfl‚‡ÌÂ(2,3,5,7,9,10,11,13,16,17). Ç 10-20% ÓÚ Ù‡ÏËÎÌËÚ Ò ÛÒ-Ú‡ÌÓ‚fl‚‡ ÏÛÚ‡ˆËfl ‚ „Â̇ ÍӉˇ˘ ÒÛÔÂÓÍÒˉ ‰ËÒÏÛÚ‡-

Á‡ 1 (ëéÑ1), ‡ÁÔÓÎÓÊÂÌ ‚˙ıÛ 21 ıÓÏÓÁÓχ(2,4,5,7,10,14,15,16,17). éÒڇ̇ÎËÚ 80% Ò ‰˙ÎÊ‡Ú Ì‡ÏÛÚ‡ˆËË ‚ ‰Û„Ë „ÂÌË (16). Ç Ò‚ÂÚ‡ Ò‡ ˉÂÌÚËÙˈˇÌË121 Ù‡ÏËÎËË Ò ÏÛÚ‡ˆËË ‚ „Â̇ Á‡ ëéÑ1 (13). éÍÓÎÓ 40%ÓÚ ËÁÒΉ‚‡ÌËÚ هÏËÎËË Ò‡ Ò‚˙Á‡ÌË Ò 21q ıÓÏÓÁÓχ(11,17). èӂ˜ ÓÚ 90 ÏÛÚ‡ˆËË Á‡Òfl„‡Ú 40 ÓÚ 153-Ú‡ÏËÌÓÍËÒÂÎËÌÌË ÓÒÚ‡Ú˙͇, ͇ÚÓ Ì‡È-˜ÂÒÚÓ Ò¢‡Ì‡Ú‡ ÂAla4Val (13,16).

èӂ˜ÂÚÓ ÏÛÚ‡ˆËË Ì‡ ëéÑ1 Ò‡ ıÂÚÂÓÁË„ÓÚÌË Ò ÔÂ-‰ËÏÌÓ ‡‚ÚÓÁÓÏÌÓ-‰ÓÏË̇ÌÚÂÌ ÚËÔ Ì‡ Û̇ÒΉfl‚‡Ì ˇÁ΢̇ ÂÍÒÔÂÒË‚ÌÓÒÚ Ë ÔÂÌÂÚ‡ÌÚÌÓÒÚ (100% ËÎË ÌÂ-Ô˙Î̇) ̇ „Â̇, ‰ÓË ‚ ÓÚ‰ÂÎÌËÚ ÔÓÍÓÎÂÌËfl ̇ ‰̇ Ë Ò˙-˘‡ Ù‡ÏËÎËfl. è‰ÔÓ·„‡ Ò Ò˙˘ÂÒÚ‚Û‚‡ÌÂÚÓ Ì‡ ‚˙Á͇ÏÂÊ‰Û ‡Á΢ÌËÚ ÏÛÚ‡ˆËË Ë Úflı̇ڇ ÔÂÌÂÚ‡ÌÚÓÒÚ ÒÍÎË̘̇ڇ ‚˙ÚÂÙ‡ÏËÎ̇ڇ ıÂÚÂÓ„ÂÌÌÓÒÚ. èÓÒΉ̇-Ú‡ Ò ËÁ‡Áfl‚‡ ‚ ‡Á΢̇ ÍÎËÌ˘̇ ͇ÚË̇ ̇ Á‡·ÓÎÂÎË-Ú ‚ ‡ÏÍËÚ ̇ ‰̇ Ë Ò˙˘‡ Ù‡ÏËÎËfl, ÌÓÒËÚÂÎÒÚ‚Ó Ì‡ÏÛÚ‡ˆËflÚ‡ ÓÚ ÍÎËÌ˘ÌÓ Á‰‡‚Ë Ô‰ÒÚ‡‚ËÚÂÎË Ì‡ Ù‡-ÏËÎËflÚ‡, ÒÏ˙Ú Ì‡ Á‰‡‚ ÌÓÒËÚÂΠ̇ ÏÛÚ‡ˆËfl ·ÂÁ ‡Á‚Ë-ÚË ̇ ÍÎËÌ˘ÌË ÔÓfl‚Ë, ıÓ‰ Ë ÔÂÊË‚flÂÏÓÒÚ Ì‡ Á‡·ÓÎfl-‚‡ÌÂÚÓ, ÔÂÒ͇˜‡Ì ̇ ÌflÍÓÎÍÓ ÔÓÍÓÎÂÌËfl, ÂÚ‡Ê˙Ú ÓÚÍÓÈÚÓ Á‡ÔÓ˜‚‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë ‰Ë‡„ÌÓÒÚˈˇÌÂÚÓ Ì‡Ù‡ÏËÎÌË ÒÎÛ˜‡Ë ͇ÚÓ ÒÔÓ‡‰Ë˜ÌË(1,3,7,8,9,10,11,13,14,15,16,17). èËÂχ Ò ̇΢ËÂÚÓ Ì‡‰‚ Ò˙ÒÚÓflÌËfl: Ò ÌËÒ͇ ÔÂÌÂÚ‡ÌÚÌÓÒÚ Ë ‰˙΄‡ ÔÓ‰˙Î-ÊËÚÂÎÌÓÒÚ ; Ò ‚ËÒÓ͇ ÔÂÌÂÚ‡ÌÚÌÓÒÚ Ë Í‡Ú͇ ÔÓ‰˙Î-ÊËÚÂÎÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (9).

è‰ÔÓ·„‡ ÒÂ, ˜Â χÎ˙Í ·ÓÈ ÓÚ ·ÓÎÌËÚ ҇ ÒÔÓ‡‰Ë˜-ÌË ÒÎÛ˜‡Ë ËÎË Ò‡ ıÓÏÓÁË„ÓÚÌË Ò ‡‚ÚÓÁÓÏÌÓ ÂˆÂÒË‚ÌÓÛ̇ÒΉfl‚‡Ì ̇ ÏÛÚ‡ˆËflÚ‡ (1,3,5,7,10,15,16). åÛÚ‡ˆËËÒ‡ ÛÒÚ‡ÌÓ‚fl‚‡Ú ‚ 5% ÓÚ ÒÔÓ‡‰Ë˜ÌËÚ ÒÎÛ˜‡Ë, ‡ ÌflÍÓÈÓÚ Úflı Ò‡ ÓÔËÒ‡ÌË ÔË Ù‡ÏËÎÌË Ë ÒÔÓ‡‰Ë˜ÌË ÒÎÛ˜‡Ë(7,8,10,11,16,17).

äéçíàçÉÖçíè‰ÒÚ‡‚fl Ò ÒÎÛ˜‡È ̇ Ù‡ÏËÎ̇ Äãë. î‡ÏËÎËflÚ‡ ‚Ó-

‰Ë ̇˜‡ÎÓÚÓ ÒË ÓÚ ‡ÈÓ̇ ̇ „.èÂÚ˘. ᇷÓÎfl‚‡ÌÂÚÓ ÂÛÒÚ‡ÌÓ‚ÂÌÓ ‚ ˜ÂÚËËχ Ï˙ÊÂ Ë Â‰Ì‡ ÊÂ̇. ÇÒ˘ÍË Ò‡ ÔÓ-˜Ë̇ÎË. Ç Ô˙‚‡Ú‡ „Â̇ˆËfl Ëχ ‰‚‡Ï‡ ·ÓÎÌË, ÍÓËÚÓ Ò‡

·‡Úfl. ÇÚÓ‡Ú‡ „Â̇ˆËfl Ò Ò˙ÒÚÓË ÓÚ ÚËχ ·ÓÎÌË,‰Âˆ‡ ̇ ‰ËÌfl ÓÚ ·ÓÎÌËÚ ÓÚ Ô˙‚‡Ú‡ „Â̇ˆËfl. ãËÔ-‚‡Ú ҂‰ÂÌËfl Á‡ ‡Á‚ËÚË ̇ Äãë ËÎË ‰Û„Ë ‰Â„Â̇ÚË‚-ÌË Á‡·ÓÎfl‚‡ÌËfl ̇ Ì‚̇ڇ ÒËÒÚÂχ ‚ ÓÒڇ̇ÎËÚ Ô‰-ÒÚ‡‚ËÚÂÎË ËÎË ‚ Ô‰ıÓ‰ÌËÚ ÔÓÍÓÎÂÌËfl.

чÌÌËÚ Á‡ ·ÓÎÌËÚ ҇ ÔÓÎÛ˜ÂÌË ÓÚ ‡‰ÏËÌÒÚ‡ÚË‚ÌË-Ú „ËÒÚË, ωˈËÌÒ͇ڇ ‰ÓÍÛÏÂÌÚ‡ˆËfl Ë ‡Ì‡ÏÌÂÒ-Ú˘ÌÓ ÓÚ ÔÂÍËÚ ӉÒÚ‚ÂÌËˆË Ì‡ Á‡·ÓÎÂÎËÚÂ. è‰Ò-Ú‡‚ËÚÂÎËÚ ̇ ‚ÚÓ‡Ú‡ „Â̇ˆËfl Ò‡ ‰Ë‡„ÌÓÒÚˈˇÌË‚ ÛÌË‚ÒËÚÂÚÒÍËÚ Ì‚ÓÎӄ˘ÌË ÍÎËÌËÍË Ì‡ „.ëÓÙËfl.èÂÊË‚flÂÏÓÒÚÚ‡  ÓÔ‰ÂÎÂ̇ ͇ÚÓ ‚ÂÏÂÚÓ ÓÚ Ô˙‚Ë-Ú ÓÔ·͂‡ÌËfl ‰Ó ÒÏ˙ÚÚ‡ ̇ ·ÓÎÌËfl.

I-‚‡ „Â̇ˆËfl: Ò‰̇ ‚˙Á‡ÒÚ Ì‡ ̇˜‡ÎÓ ‚ „Ó‰ËÌË: 58,3; Ò‰̇ڇ ÔÂÊË‚flÂÏÓÒÚ ‚ ÏÂÒˆË: 10,5 Ò Ó·ı‚‡Ú 9 - 12

II-‡ „Â̇ˆËfl: Ò‰̇ ‚˙Á‡ÒÚ Ì‡ ̇˜‡ÎÓ ‚ „Ó‰ËÌË ËÏÂÒˆË: 47„ Ë 3Ï ;Ó·ı‚‡Ú: 37„+8Ï - 47„+5Ï ; Ò‰̇ ÔÂÊË‚flÂÏÓÒÚ ‚ÏÂÒˆË: 19,7 Ë Ó·ı‚‡Ú: 13 - 26

éÅëöÜÑÄçÖ ëÔÓ‰ Ôӂ˜ÂÚÓ ÎËÚ‡ÚÛÌË ‰‡ÌÌË, ÔÓ‡‰Ë ÍÎËÌ˘-

ÌÓÚÓ ÒË ÒıÓ‰ÒÚ‚Ó Ù‡ÏËÎ̇ڇ Ë ÒÔÓ‡‰Ë˜Ì‡Ú‡ Äãë Ò‡ ÌÂ-ÓÚ΢ËÏË Ë Ôӂ˜ÂÚÓ ·ÓÎÌË ËÏ‡Ú Í·Ò˘ÂÒ͇ڇ ÍÎËÌ˘-̇ ͇ÚË̇ (4,9,10,13,15,17). èË Ù‡ÏËÎÌËÚ  ÏÌÓ„Ó ÔÓ-˜ÂÒÚÓÚÓ Á‡Òfl„‡Ì ̇ ÔÂËÙÂÌËfl ‰‚Ë„‡ÚÂÎÂÌ Ì‚ÓÌ ‚ ̇-˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ (‚ 58%), ÓÒÓ·ÂÌÓ ‚ ͇͇ڇ Ë·˙ÁÓÚÓ ‡Á‚ËÚË ̇ ÒËÏÔÚÓÏËÚ ‚ Úflı (17). Ö‰ÌÓ‚Â-ÏÂÌÌÓ ·ÂÎÂÁË Ì‡ ۂ‰‡ ̇ ˆÂÌÚ‡ÎÂÌ Ë ÔÂËÙÂÂÌ ‰‚Ë„‡-ÚÂÎÂÌ Ì‚ÓÌ Ëχ ‚ 17% (17). 燷Îfl„‡ Ò ̇ ‚˙ÚÂÙ‡ÏËÎ-̇ڇ ıÂÚÂÓ„ÂÌÌÓÒÚ, ÛÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ ‚ 20% ̇ ‡ÚËÔ˘-ÌË ·ÂÎÂÁË (ËÁ‚˙Ì ÚÂÁË Ì‡ ÍÓÓ‚Ó-ÏÛÒÍÛÎÌËflÚ Ô˙Ú) Ë ÍÓÏ-·ËÌˇÌÂÚÓ Ò ‰Û„Ë Ì‚Ӊ„Â̇ÚË‚ÌË Á‡·ÓÎfl‚‡ÌËfl(5,6,12).

èË ÓÔË҇̇ڇ Ù‡ÏËÎËfl ÓÚÌÓ¯ÂÌËÂÚÓ Ï˙ÊÂ:ÊÂÌË Â4:1 Ë Â ‚ ÍÓÌÚ‡ÒÚ Ò ÎËÚÛ‡ÚÛÌËÚ ‰‡ÌÌË. ëÔÓ‰ ÚflıÔË Ù‡ÏËÎ̇ڇ Äãë ÓÚÌÓ¯ÂÌËÂÚÓ Â 1:1 ËÎË Ì Ò ‡ÁÎË-˜‡‚‡ ÓÚ ÚÓ‚‡ ÔË ÒÔÓ‡‰Ë˜Ì‡Ú‡, Í˙‰ÂÚÓ ÔÓ-˜ÂÒÚÓ Á‡Ò„-̇ÚË Ò‡ Ï˙ÊÂÚ (8,13,15,17).

燘‡ÎÓÚÓ Â ‡Á΢ÌÓ Ë Ô˙‚ËÚ ÒËÏÔÚÓÏË ÏÓ„‡Ú ‰‡·˙‰‡Ú ÒÔË̇ÎÌË ËÎË ·Ûη‡ÌË (16). Ç ·ÓίËÌÒÚ‚ÓÚÓ Ù‡-ÏËÎÌË ÒÎÛ˜‡Ë Á‡·ÓÎfl‚‡ÌÂÚÓ Á‡ÔÓ˜‚‡ ÓÚ Í‡ÈÌˈËÚÂ Ë Ò‡-ÏÓ ‚ 20% ÓÚ ‡ÈÓ̇ ̇ ÒÚ‚Ó· Ò ·Ûη‡ÌË Ë ÔÒ‚‰Ó·Ûη‡-ÌË ·ÂÎÂÁË (13,15). èË ‚Ò˘ÍË ·ÓÎÌË ÓÚ Ô‰ÒÚ‡‚Â̇ڇ

Ù‡ÏËÎËfl ̇˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Â ÓÚ ‰ÓÎÌËÚ ͇È-ÌˈË

ë‰̇ڇ ÔÂÊË‚flÂÏÓÒÚ Á‡ ÓÔË҇̇ڇ Ù‡ÏËÎËfl  16ÏÂÒˆ‡, ÍÓÂÚÓ Ò˙˘Ó  ‚ Ò˙ÓÚ‚ÂÚÒÚ‚ËÂ Ò ÌflÍÓÈ ÓÚ ÎËÚÂ-‡ÚÛÌËÚ ‰‡ÌÌË. çflÍÓË ÔËÂχÚ, ˜Â Ù‡ÏËÎ̇ڇ ÙÓÏ‡Â Ò ÔÓ-͇Ú͇ ÔÂÊË‚flÂÏÓÒÚ ÓÚ ÒÔÓ‡‰Ë˜Ì‡Ú‡, ÓÔ‰Â-Îfl˘Ë fl ̇ 2 „Ó‰ËÌË , ͇ÚÓ ‚ 74% ÓÚ ÒÎÛ˜‡ËÚ Úfl  ‰Ó 1„Ó‰Ë̇ Ë 23% ‰Ó 5 „Ó‰ËÌË (13,15,17). ëÔÓ‰ ‰Û„Ë ÔÂÊË-‚flÂÏÓÒÚÚ‡  ÒıӉ̇ Ò Ú‡ÁË Ì‡ ÒÔÓ‡‰Ë˜ÌËÚÂ-ÔË·ÎËÁË-ÚÂÎÌÓ 3 „Ó‰ËÌË, Ò Ó·ı‚‡Ú ÓÚ 0,3 ‰Ó 20 „Ó‰ËÌË (3,10). àχÒı‚‡˘‡ÌËfl ‰ÓÔÛÒ͇˘Ë ÏÌÓ„Ó ·‡‚̇ ÔÓ„ÂÒËfl Ë Â‚ÓβˆËfl̇‰ 10 Ë 25 „Ó‰ËÌË (5,11). ç‡ÔÓÒΉ˙Í Ò ÔËÂχ, ˜Â ÔÓ-‰˙ÎÊËÚÂÎÌÓÒÚ‡ ̇ Ù‡ÏËÎ̇ڇ ALS  ·ËÏÓ‰‡Î̇: χÎ͇˜‡ÒÚ ÓÚ Ù‡ÏËÎËËÚ ËÏ‡Ú ÎÓ¯‡ ÔÓ„ÌÓÁ‡ (< 2 „Ó‰ËÌË),‰Ó͇ÚÓ ‚ ·ÓίËÌÒÚ‚ÓÚÓ ÒÎÛ˜‡Ë ÔÓ„ÌÓÁ‡Ú‡  ÔÓ-‰Ó·‡ ‚Ò‡‚ÌÂÌË Ò˙Ò ÒÔÓ‡‰Ë˜ÌËÚ (Ó·ËÍÌÓ‚ÂÌÌÓ > 5 „Ó‰ËÌË) Ë‚ÓβˆËfl ̇‰ 10 „Ó‰ËÌË Ì  ËÁÍβ˜ÂÌË (5). èÓ „ÓÎflχڇÔÂÊË‚flÂÏÓÒÚ Ò ҂˙Á‚‡ Ò Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔÂ-‰Ë 50 „Ó‰ËÌË, ÓÚÍÓÎÍÓÚÓ ÒΉ ÚÓ‚‡ (26% ÒÂ˘Û 10% ÂÒ-ÔÂÍÚË‚ÌÓ) (13,17). ïÓ‰˙Ú Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ‚‡Ë‡ ÓÚ 1‰Ó 25 „Ó‰ËÌË (5).

艇‚‡ÌÂÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ‚ ÓÔË҇̇ڇ Ù‡ÏËÎËfl ÂÔÓ ·‡˘Ë̇ ÎËÌËfl. èË ÚÓ‚‡ Ô‰‡‚‡Ì Ò ÓÔËÒ‚‡ ‡ÌÌÓ Ì‡-˜‡ÎÓ (ÚÂÚÓ ‰ÂÒÂÚËÎÂÚËÂ) (17). Ç Ì‡¯ËflÚ ÒÎÛ˜‡È ̇˜‡ÎÓ-ÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò ‰‚ËÊË ÓÚ 37„+8Ï ‰Ó 72„ Ë 7Ï. èËÔӂ˜ÂÚÓ Ù‡ÏËÎËË Ò Ì‡Î˘Ë ̇ ÏÛÚ‡ˆËË, ‚˙Á‡ÒÚÚ‡ ̇̇˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ‚‡Ë‡ ÓÚ 24,0-28,0 ‰Ó 61,2-72 „Ó-‰ËÌË (3,5,10,13,15). é·ËÌÓ‚ÂÌÌÓ Â ÒΉ 40 „Ӊ˯̇ ‚˙Á-‡ÒÚ, ÔÓÌflÍÓ„‡ ‚ ÔÓ-Ï·‰‡ Ë Í‡ÚÓ ËÁÍβ˜ÂÌË ‚ ‡Ì̇‰ÂÚÒ͇ ËÎË ÏÌÓ„Ó Ì‡Ô‰̇· ‚˙Á‡ÒÚ (5,13,16). èË Ù‡-ÏËÎÌËÚ ÒÎÛ˜‡Ë Ò ÏÛÚ‡ˆËfl, ‚˙Á‡ÒÚÚ‡ ̇ ̇˜‡ÎÓ ÏÓʉ‡ ·˙‰Â ‰̇͂‡ ËÎË ‰‡ Ò ̇·Î˛‰‡‚‡ ‡ÁÎË͇ Ò‰ÌÓ ÓÚ 15„Ó‰ËÌË (13). éÔËÒ‚‡ÌÓÚÓ ÔË Ù‡ÏËÎËË Ò ÏÛÚ‡ˆËË Ì‡˜‡ÎÓ‚ ÔÓ-‡Ì̇ ‚˙Á‡ÒÚ ‚ ÒΉ‚‡˘ËÚ ÔÓÍÓÎÂÌËfl ÓÚ Ï˙ÊÍËÔÓÎ ËÎË ÔÓ-Í˙ÒÌÓ Ì‡˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ‚ ÒΉ‚‡˘ËÚÂÔÓÍÓÎÂÌËfl  ̇Îˈ ÔË Ì‡¯Ëfl ÒÎÛ˜‡È. (8,13,17) íÓ‚‡ Ò‚Ëʉ‡ ÔË Ò‡‚Ìfl‚‡Ì ̇ ‚˙Á‡ÒÚÚ‡ ̇ ̇˜‡ÎÓ Ì‡ I-1 Ò‚˙Á‡ÒÚÚ‡ ̇ ̇˜‡ÎÓ Ì‡ Ô‰ÒÚ‡‚ËÚÂÎËÚ ÓÚ II-Ú‡ „ÂÌÂ-‡ˆËfl. ë˙˘ÓÚÓ Ò ‚Ëʉ‡ Ë ÓÚ Ò‡‚Ìfl‚‡ÌÂÚÓ Ì‡ Ò‰̇ڇËÏ ‚˙Á‡ÒÚ Ì‡ ̇˜‡ÎÓ Á‡ I-‡ Ë II-a „Â̇ˆËfl, ÍÓflÚÓ ÔË II-Ú‡  ÔÓ-χÎ͇.

ë‰̇ڇ ‚˙Á‡ÒÚ Ì‡ ̇˜‡ÎÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË Ù‡-ÏËÎ̇ڇ ALS e ÔÓ-‡ÌÓ ÓÚ ÚÓ‚‡ ̇ ÒÔÓ‡‰Ë˜Ì‡Ú‡ (46ÒÂ˘Û 50 ÒÔÓ‰ ‰ÌË Ë 56 „Ó‰ËÌË ÒÔÓ‰ ‰Û„Ë ‡‚ÚÓË)(3,5,10,15). èË Ì‡¯Ëfl ÒÎÛ˜‡È  Ò‰ÌÓ 49,5 „Ó‰ËÌË. ëÔÓ-‰ ‰ËÌ ÒÚ‡ÚËÒÚ˘ÂÒÍË ‡Ì‡ÎËÁ ·‡ÁË‡Ì ‚˙ıÛ 149 ÒÎÛ˜‡flÔË 53 Ù‡ÏËÎË ÓÚ ˆflÎ Ò‚flÚ, Ò‰̇ڇ ‚˙Á‡ÒÚ Ì‡ ̇˜‡ÎÓÔË Ù‡ÏËÎÌËÚ  45,7 „Ó‰ËÌË (17).

áÄäãûóÖçàÖOÔË҇̇ڇ Ù‡ÏËÎËfl  ËÁ„‡‰Â̇ ÓÚ 2 ÔÓÍÓÎÂÌËfl Ò Ó·-

˘Ó 5 Ô‰ÒÚ‡‚ËÚÂÎË (Ï˙ÊÂ Ë 1 ÊÂ̇). ᇷÓÎfl‚‡ÌÂÚÓ ÒÂÔ‰‡‚‡ ÔÓ ·‡˘Ë̇ ÎËÌËfl. ÇÒ˘ÍË Á‡·ÓÎÂÎË ËÏ‡Ú Ì‡˜‡ÎÓÓÚ ‰ÓÎÌËÚ ͇ÈÌˈË, ·˙Á ıÓ‰ Ë ÔË·ÎËÁËÚÂÎÌÓ Â‰Ì‡Í‚‡ÌËÒ͇ ÔÂÊË‚flÂÏÓÒ (‰Ó 2 „Ó‰ËÌË). 燷≇‚‡ Ò ̇˜‡ÎÓ Ì‡Á‡·ÓÎfl‚‡ÌÂÚÓ ‚ ÔÓ-Ï·‰‡ ‚˙Á‡ÒÚ, ÌÓ Ò‡ÏÓ Á‡ ÔÓÍÓÎÂÌËÂ-ÚÓ Ì‡ ¨-1. Ç˙Á‡ÒÚÚ‡ ̇ ̇˜‡ÎÓ Á‡ ¨-2  ·ÎËÁ͇ ‰Ó Ú‡ÁË Ì‡¨¨-1, ¨¨-2, ¨¨-3. èÓÚÓÏÒÚ‚ÓÚÓ Ì‡ ¨-2 Ìflχ ·ÂÎÂÁË Ì‡ Á‡·Ó-Îfl‚‡ÌÂÚÓ. ä‡ÚÓ ËÌÚÂÂÒÂÌ Ù‡ÍÚ ÏÓÊ ‰‡ Ò ÓÚ·ÂÎÂÊËχÎÍËflÚ (6 ÏÂÒˆ‡) ËÌÚ‚‡Î ÓÚ ‚ÂÏ ÏÂÊ‰Û ÎÂÚ‡ÎÌËflËÁıÓ‰ ̇ ¨-1 Ë ¨¨-2 (·‡˘‡ Ë ÒËÌ), ÔË ÔÂÊË‚flÂÏÓÒÚ 1 „Ó-‰Ë̇ Ë Á‡ ‰‚‡Ï‡Ú‡. î‡ÏËÎËflÚ‡ Ô‰ÒÚ‡‚Îfl‚‡ ËÌÚÂÂÒ ÔÓÓÚÌÓ¯ÂÌË ‡Á‚ËÚË ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ ‚ ÒΉ‚‡˘ËÚ ÔÓ-ÍÓÎÂÌËfl. ÑÓ ÚÓÁË ÏÓÏÂÌÚ ÎËÔÒ‚‡Ú ÒË„ÛÌË ‰‡ÌÌË Á‡ ‰Û-„Ë Ù‡ÏËÎÌË ÙÓÏË ‚ ̇¯‡Ú‡ Òڇ̇, ÍÓÂÚÓ ÓÔ‰ÂÎflÚÂıÌËfl χÎ˙Í ÔÓˆÂÌÚ. Ç ·˙‰Â˘ ÔÎ‡Ì ÒÚÓË ‚˙ÔÓÒ˙Ú Á‡ÛÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ Ì‡ ‚ÂÌÚÛ‡ÎÂÌ ‰ÂÙÂÍÚ ‚ „Â̇ Á‡ ÒÛÔÂ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 93‡ÔËÎ, 2002

ëıÂχ 1. ëıÂχÚ˘ÌÓ Ô‰ÒÚ‡‚flÌ ̇ Ù‡ÏËÎËflÚ‡ Ò Äãë

ÓÍÒˉ ‰ËÒÏÛÚ‡Á‡ 1 (ëéÑ1) ÔË Ô‰ÒÚ‡‚ËÚÂÎËÚ ̇ڇÁË Ù‡ÏËÎËfl.

Ä‚ÚÓ˙Ú ËÁ͇Á‚‡ ·Î‡„Ó‰‡ÌÓÒÚ Ì‡ äÎËÌË͇ ÔÓ Ì‚ÓÎÓ-„Ëfl åÅÄã "ñ‡Ëˆ‡ âӇ̇" - ÖÄÑ Á‡ Ó͇Á‡ÌÓÚÓ Ò˙‰ÂÈÒÚ-‚Ë ÔË Ò˙·Ë‡ÌÂÚÓ Ì‡ ˜‡ÒÚ ÓÚ ‰‡ÌÌËÚÂ.

ãàíÖêÄíìêÄ1. Andersen P.M. Genetics of sporadic ALS. Amyotrophic lateral sclerosis andothermotor neuron disorders. Vol.2, suppl.1, 2001, 37-41. 2. Bajaj N.P.S., N.G.Irving, P.N.Leigh, C.C.J.Miller. Alzheimer's dosease, amy-otrophic lateral sclerosis, and transgenic mice. J.Neurol., Neurosurg., Psych., 64,1998, 711-715.3. Belleroche J., R.W.Orrell and L.Virgo. Amyotrophic Lateral Sclerosis. RecentAdvances in Understanding Disease Mechanisms. J. Neuropath. and Exp.Neurol.,55, 1996, 7, 747-757.4. Brown R.H. Amyotrophic Lateral Sclerosis. Arch.Neurol., 54, 1997, 1246-1250.5. Camu W., J.Khoris, B.Moulard, F.Salachas, V.Briolotti, G.A.Rouleau,V.Meninger on behalf of the French ALS research group. Gernetics of familialALS and consequences for diagnosis. Journal of the neurological sciences. Vol165, suppl.1, 1999, 21-26. 6. Chow T.W., B.L.Miller, V.N.Hayashi, D.H.Geschwind. Inheritance of fron-totemporal dementia. Arch.Neurol., Vol. 56, 1999, 817-822.7. Gellera C. Genetics of ALS in Italian families.Amyotrophic lateral sclerosis andother motor neuron disorders. Vol.2, suppl.1, 2001, 43-46. 8. Graham A.J., A.M.Macdonald, C.H.Hawkes. British motor neuron disease twinstudy. J.Neurol., Neurosurg., Psych., 62, 1997, 562-569.9. Leigh P.N. Pathogenic Mechanisms in Amyotrophic Lateral Sclerosis and otherMotor Neuron Disorders.In:Neurodegenerative disease,1st Edition, /Ed.D.B.Calve/,Philadelphia, Saunders Company , 1994 , 473-488.

10. Orrell R.W. Amyotrophic lateral sclerosis: copper/zinc superoxide dismutase(SOD1) gene mutations. Neuromusc. Disord. 10, 2000, 1, 63-68.11.Orrell R.W., A.W.King, D.A.Hilton, M.J.Campbell, R.J.M.Lane, J.S deBelleroche. Familial amyotrophic lateral sclerosis with a point mitation of SOD-1:intrafamilial heterogeneity of disease duration associated with neurofibrillary tan-gles. J.Neurol.,Neurosurg.,Psych., 59, 1995, 266-270.12. Qureshi A., G.Wilmot, B.Dihenia, J.A.Schneider, D.A.Krendel. Motor neurondisease with parkinsonism. Arch.Neurol., Vol. 53, 1996, 987-991.13. Radunovic A., P.N.Leigh. Cu/Zn superoxide dismutase gene mutations in amy-otrophic lateral sclerosis: correlation between genotype and clinical features.J.Neurol., Neurosurg., Psych., 61, 1996, 565-572.14. Roman G.C. Neuroepidemiology of amyotrophic lateral sclerosis: clues to aeti-ology and pathogenesis. J.Neurol., Neurosurg., Psych., 61, 1996, 131-137.15. Rowland L.P. Natural History and Clinical Features of Amyotrophic LateralSclerosis and Related Motor Neuron Diseases. In: Neurodegenerative disease.,1stEdition, /Ed.D.B.Calve/, Philadelphia, Saunders, 1994, 507-521. 16. Rowland L.P., N.A.Shneider. Amyotrophic Lateral Sclerosis. The new EnglandJournal of Medicine, Vol. 344, 2001, 22, 1688-1700. 17. Tandan P. Disorders of The Upper and Lower Motor Neurons. In:Neurology inClinical Practice, 2nd Edition, /Eds.:W.G.Bradly, R.B.Daroff, G.M.Fenichel,C.D.Marsden/, Boston, Butterworth-Heineman, 1996, 1843-1852.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl:ëÚ.뇇ÙÓ‚1431 ëÓÙËfl , ÛÎ."ÉÂÓ„Ë ëÓÙËÈÒÍË" ‹1å‰ˈËÌÒÍË ìÌË‚ÂÒËÚÂÚ ; åÅÄã-"ÄÎÂÍ҇̉ӂÒ͇" ,ç‚ÓÎӄ˘̇ ÍÎËÌË͇ , ÚÂÎ.: (02) 51-87-63 , Ù‡ÍÒ: (+359 2) 952-24-72‰ÓÏ.ÚÂÎ.: (+395 2) 31-91-03 , e-mail: [email protected]

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 94‡ÔËÎ, 2002

éË„Ë̇ÎÌË ÒÚ‡ÚËË

ÖãÖäíêéåàéÉêÄîëäé àáëãÖÑÇÄçÖ çÄ èÄñàÖçíàë åàÄëíÖçàü ÉêÄÇàë ë êàíåàóçÄ ëíàåìãÄñàü

çÄ N. ULNARISë. çÓ‚‡˜ÍÓ‚‡, Å.à¯ÔÂÍÓ‚‡

ä‡Ú‰‡ ÔÓ Ì‚ÓÎÓ„Ëfl, å‰ˈËÌÒÍË Ù‡ÍÛÎÚÂÚ , ëÓÙËflåÅÄã " ñ‡Ëˆ‡ âÓ‡Ì̇ " ÖÄÑ, ëÓÙËfl

SUMMARY

ELECTROMYOGRAPHYCAL STUDY OF PATIENTSWITH MYASTHENIA GRAVIS USING REPETITIVE

STIMULATION OF N. ULNARIS S.Novachkova, B.Ishpekova

The aim of this study is to show the diagnostic significanceof the EMG-examination by repetitive stimulation of n.ulnarisin patients with myasthenia gravis /MG/. It is very importantto demonstrate the reliability of the different EMG- phenom-ena during the train of stimuli with low and high frequency/LFS and HFS/. Examination results from 75 patients withproved myasthenia gravis /MG/ are presented. There arepatients with generalized, ocular and bulbar form of disease inthe group. The comparison of I / V response by LFS /1, 3 Hz/shows difference from the norm in 1/3 of the examinedpatients. Posttetanic phenomena, particularly posttetanicdecrement over 8%, is found in 44% of the cases. By HFS /10, 20, 30, 50 Hz / the relation first/last response shows decre-ment over 40% in 4 - 10 % from the examined patients andfacilitation over 50% in 1-16 % of them, using different fre-quency of stimulation.Key words: Mysthenia gravis, repetitive stimulation, decrement, facilitation, posttetanic phenomena

êÖáûåÖñÂÎÚ‡ ̇ ÔÓÛ˜‚‡ÌÂÚÓ Â ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ‰Ë‡„ÌÓÒÚ˘-

ÌÓÚÓ Á̇˜ÂÌË ̇ ÖåÉ- ËÁÒΉ‚‡ÌÂÚÓ Ì‡ n.ulnaris Ò ÏÂÚÓ-‰Ë͇ڇ ̇ ËÚÏ˘̇ ÒÚËÏÛ·ˆËfl ÔË Ô‡ˆËÂÌÚË Ò ÏˇÒ-

ÚÂÌËfl „‡‚ËÒ /åÉ/. åÌÓ„Ó ‚‡ÊÌÓ Â ‰‡ Ò ‰ÂÏÓÌÒÚˇ̇‰ÂÊÌÓÒÚÚ‡ ̇ ‡Á΢ÌËÚ ÖåÉ- ÙÂÌÓÏÂÌË ÔË ÔË·-„‡Ì ̇ ÒÂËfl ÓÚ ÒÚËÏÛÎË Ò ÌËÒ͇ Ë ‚ËÒÓ͇ ˜ÂÒÚÓÚ‡ /çóë Ë Çóë/. è‰ÒÚ‡‚ÂÌË Ò‡ ÂÁÛÎÚ‡ÚËÚ ÓÚ ËÁÒΉ‚‡-ÌÂÚÓ Ì‡ 75 Ô‡ˆËÂÌÚË ‰Ó͇Á‡Ì‡ Ò ‰Ë‡„ÌÓÁ‡ åÉ.Ç „ÛÔ‡Ú‡Ëχ Ô‡ˆËÂÌÚË Ò „Â̇ÎËÁˇ̇, Ә̇ Ë ·Ûη‡Ì‡ ÙÓχ ̇Á‡·ÓÎfl‚‡ÌÂÚÓ. èË çóë / 1 Ë 3 ıˆ/ Ò‡‚ÌÂÌËÂÚÓ Ì‡ I/ VÓÚ„Ó‚Ó ÔÓ͇Á‚‡ ÓÚÍÎÓÌÂÌË ÓÚ ÌÓχڇ ‚ ÓÍÓÎÓ 1/ 3 ÓÚËÁÒΉ‚‡ÌËÚ ԇˆËÂÌÚË. èÓÒÚÚÂÚ‡Ì˘ÌË ÙÂÌÓÏÂÌË, ‚˜‡ÒÚÌÓÒÚ ÔÓÒÚÚÂÚ‡Ì˘̇ ‰ÂÔÂÒËfl Ôӂ˜ ÓÚ 8%,  ÛÒ-Ú‡ÌÓ‚Â̇ ÔË 44% ÓÚ ÒÎÛ˜‡ËÚÂ. èË Çóë / 10,20,30,50 hz/ Ò˙ÓÚÌÓ¯ÂÌËÂÚÓ I /ï ÓÚ„Ó‚Ó ÔÓ͇Á‚‡ ‰ÂÔÂÒËfl ̇‰ 40%‚ 4 ‰Ó 10% ÓÚ ËÁÒΉ‚‡ÌËÚÂ Ë Ù‡ˆËÎËÚ‡ˆËfl ̇‰ 50 % ‚ 1‰Ó 16 % ÔË ‡Á΢ÌËÚ ˜ÂÒÚÓÚË Ì‡ ÒÚËÏÛ·ˆËfl. äβ˜Ó‚Ë ‰ÛÏË: ÏˇÒÚÂÌËfl „‡‚ËÒ, ËÚÏ˘̇ ÒÚËÏÛ·-ˆËfl, ‰ÂÔÂÒËfl, Ù‡ˆËÎËÚ‡ˆËfl, ÔÓÒÚÚÂÚ‡Ì˘ÌË ÙÂÌÓÏÂÌË.

Ö‰ÌÓ ÓÚ Ì‡È-ÓÚ„Ó‚ÓÌËÚ ËÁÒΉ‚‡ÌËfl, ÍÓËÚÓ Ò ËÁ‚˙-¯‚‡Ú ‚ ÍÎËÌ˘ÌËÚ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË Î‡·Ó‡ÚÓËË ÂËÚÏ˘̇ڇ ÒÚËÏÛ·ˆËfl / êë / ‚˙‚ ‚˙Á͇ Ò ÔÓÒÚ‡‚flÌÂ-ÚÓ Ì‡ ‚flÌÓ Á‡Íβ˜ÂÌË Á‡ ̇΢ËÂÚÓ Ì‡ ̇ۯÂÌÓ Ì‚-ÌÓ-ÏÛÒÍÛÎÌÓÔ‰‡‚‡Ì /çåè /. Ç Ôӂ˜ÂÚÓ ÒÎÛ˜‡Ë ÓÔ‰Â-ÎflÌÂÚÓ Ì‡ ‰Ë‡„ÌÓÁ‡Ú‡ ÏˇÒÚÂÌËfl „‡‚ËÒ / åÉ / Ò‡ÏÓ ÔÓÍÎËÌ˘ÌË ÍËÚÂËË Â Á‡ÚÛ‰ÌÂÌÓ Ë Ò˙˘ÂÒÚ‚Û‚‡ ËÒÍ Óډˇ„ÌÓÒÚ˘ÌË „¯ÍË /11/.

ç‡È-˜ÂÒÚÓ ËÁÔÓÎÁ‚‡Ì‡Ú‡ ÂÎÂÍÚÓÙËÁËÓÎӄ˘̇ ÏÂÚÓ-‰Ë͇ Á‡ ‰Ë‡„ÌÓÒÚˈˇÌ ̇ ̇ۯÂÌÓ çåè  ËÚÏ˘̇-Ú‡ ÒÚËÏÛ·ˆËfl /êë / ̇ ÔÂËÙÂÂÌ Ì‚ Ò ÓÚ‚Âʉ‡Ì ̇ÏÓÚÓÂÌ ÓÚ„Ó‚Ó /å/ÓÚ ËÌ‚ˇÌËfl ÏÛÒÍÛÎ / 8, 9/. é˘Â

ÔÂÁ 1895„ Jolly ‰ÂÏÓÌÒÚˇ ÔË Ô‡ˆËÂÌÚË Ò åÉ Â‰ÛÍ-ˆËfl ̇ ÏÛÒÍÛÎÌËfl ÓÚ„Ó‚Ó ÔË ‰ËÂÍÚ̇ Ù‡‡‰Ë˜Ì‡ ÒÚË-ÏÛ·ˆËfl ̇ ÏÛÒÍÛ· Ë ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂÚÓ ÏÛ ÒΉ ÔӘ˂͇.ëÛԇχÍÒËχÎ̇ڇ ÂÎÂÍÚ˘̇ êë  ‚˙‚‰Â̇ ÔÂÁ1941„ ÓÚ Harvey Ë Masland /3, 4, 5/.íÂıÌË͇ڇ ÔÂÚ˙Ôfl-‚‡ ÏÌÓ„Ó ÛÒ˙‚˙¯ÂÌÒÚ‚‡ÌËfl ‚˙‚ ‚ÂÏÂÚÓ, ÌÓ Ì  Á‡„Û·Ë-· Ò‚ÓÂÚÓ ÏflÒÚÓ ‚ ‰Ë‡„ÌÓÒÚË͇ڇ ̇ ̇ۯÂÌÓ çåè‚˙ÔÂÍË ÌÓ‚ËÚ ÏÂÚÓ‰Ë, ÍÓËÚÓ Ò‡ Ô‰ÎÓÊÂÌË. Ç ÔÓÒΉ-ÌËÚ „Ó‰ËÌË Á‡ ̇È-ËÌÙÓχÚË‚ÌÓ ÂÎÂÍÚÓÙËÁËÓÎӄ˘ÌÓËÁÒΉ‚‡Ì ÔË åÉ Ò ÔËÂχ ËÁÒΉ‚‡ÌÂÚÓ Ì‡ ‰ËÌ˘ÌËÏÛÒÍÛÎÌË ‚·Í̇ / SFEMG /, ÏÂÚÓ‰ ÍÓÈÚÓ ËÁËÒÍ‚‡ ÒÔˆË-‡Î̇ ‡Ô‡‡ÚÛ‡, ÏÌÓ„Ó ‚ÂÏÂ Ë ‡ÍÚË‚ÌÓ Ò˙Û˜‡ÒÚË ̇ Ô‡-ˆËÂÌÚ‡ / 3, 4, 5, 10 /.

ä‡ÍÚÓ Ò ÔÓ‰˜ÂÚ‡‚‡ ÓÚ ÏÌÓ„Ó ‡‚ÚÓË, ̇È-ÔÓ‰ıÓ‰fl-˘Ë Á‡ ËÁÒΉ‚‡Ì ҇ ÔÓÍÒËχÎÌËÚ ÏÛÒÍÛÎË Ì‡ ˙ˆÂÚ ËÎˈ‚ËÚ ÏÛÒÍÛÎË, ÌÓ Ì‡È- Û‰Ó·ÌË Ò‡ ‰ËÒÚ‡ÎÌËÚ ÏÛÒÍÛ-ÎË Ì‡ ˙ˆÂÚÂ/ 6, 7, 8/.

äãàçàóÖç åÄíÖêàÄã à åÖíéÑàçÄ àáëãÖÑÇÄçÖ

àÁÒΉ‚‡ÌË Ò‡ ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË 75 Ô‡ˆËÂÌÚ‡ Ò ‰Ó-͇Á‡Ì‡ åÉ. 臈ËÂÌÚËÚ ҇ 28 ÊÂÌË Ë 47 Ï˙Ê ̇ Ò‰̇‚˙Á‡ÒÚ 36,8 „ / 12-75„ /Ò ‡Á΢̇ ‰‡‚ÌÓÒÚ Ì‡ Á‡·ÓÎfl‚‡ÌÂ-ÚÓ / ‰Ó 1„- 45 Îˈ‡; ‰Ó 5„- 20 Îˈ‡; ̇‰ 5„- 10 Îˈ‡ /. èË38 ÓÚ ËÁÒΉ‚‡ÌËÚ Á‡·ÓÎfl‚‡ÌÂÚÓ Á‡ÔÓ˜‚‡ Ò Ó˜ÌË ÒËÏÔ-ÚÓÏË, ÔË 27 ̇˜‡ÎÌËÚ ÔÓfl‚Ë Ò‡ ·Ûη‡ÌË, ‡ ÔË 10 - „Â-̇ÎËÁˇÌË. Ç ıÓ‰‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ 17 Ô‡ˆËÂÌÚ‡ Ì ‰‡-‚‡Ú ‰‡ÌÌË Á‡ „Â̇ÎËÁˇÌ ̇ ÒËÏÔÚÓÏËÚÂ.

àÁÒΉ‚‡ÌÂÚÓ Ò Ôӂ‰ ̇ ÂÎÂÍÚÓÏËÓ„‡Ù SUIBO. èË·„‡ÌË Ò‡ ÒΉÌËÚ ÖåÉ-ÏÂÚÓ‰ËÍË :1.àÁÒΉ‚‡Ì ÔÓ‚Ó‰ËÏÓÒÚÚ‡ ÔÓ n.ulnaris Ë ÓÔ‰ÂÎfl-

Ì ̇ ‰ËÒÚ‡ÎÌÓ Î‡ÚÂÌÚÌÓ ‚ÂÏ / ÑãÇ / Ë ÒÍÓÓÒÚ Ì‡ÔÓ‚Âʉ‡ÌÂ/ ëè / ‚ Û˜‡ÒÚ˙͇ ·Í˙Ú- ÍËÚ͇ ÔË ÓÚ‚ÂÊ-‰‡ÌÂ Ò ÔÓ‚˙ıÌÓÒÚÂÌ ÂÎÂÍÚÓ‰ ÓÚ m.abductor dig.V ËÒÚËÏÛÎˇÌ ̇ n.ulnaris ‚ ÍËÚ͇ڇ Ë Î‡Í˙Ú‡ Ò ÔÓ‚˙ı-ÌÓÒÚÂÌ ÒÚËÏÛΡ˘ ÂÎÂÍÚÓ‰ Ò˙Ò ÒÚËÏÛÎ Ò ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚ 0,5 ÏÒ.

2. êËÚÏ˘̇ ÒÚËÏÛ·ˆËfl /êë /̇ n.ulnaris ‚ ÍËÚ͇ڇÒ˙Ò ÒÂËfl ÒÚËÏÛÎË Ò ÌËÒÍË Ë ‚ËÒÓÍË ˜ÂÒÚÓÚË /çóë ËÇóë/ ÔÓ ÒıÂχ:1, 3, 50, 3, 3, 10, 20, 30, 50 ıˆ, Ò ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚ Ì‡ ÒÚËÏÛ· 0,1 ÏÒ Ë ÒË· 15-20% ̇‰ Ô‡„‡ Á‡ÏÓÚÓÌËfl ÓÚ„Ó‚Ó. éˆÂÌfl‚‡ Ò ̇χÎfl‚‡ÌÂÚÓ Ì‡ ‡ÏÔÎË-ÚÛ‰ËÚ ̇ å-ÓÚ„Ó‚ÓËÚÂ, Ú.̇. ‰ÂÔÂÒËfl Ë Ì‡ Û‚Â΢‡-‚‡Ì ‡ÏÔÎËÚÛ‰ËÚ ̇ ÓÚ„Ó‚ÓËÚ ËÎË Ù‡ˆËÎËÚ‡ˆËfl.

éÚ˜ËÚ‡ıÏ ÒΉÌËÚ ÔÓ͇Á‡ÚÂÎË :1. ÑãÇ , ëè ÔÓ n.ulnaris Ë ‡ÏÔÎËÚÛ‰‡ å- ÓÚ„Ó‚Ó‡ ‚

ÏÇ .2. èË çóë /1 Ë 3ıˆ / ÔÓÏfl̇ ‚ Ò˙ÓÚÌÓ¯ÂÌËÂÚÓ I / V

ÓÚ„Ó‚ÓË, ÍÓÂÚÓ ÒÔÓ‰ ÔËÂÚËÚ ‚ ÎËÚ‡ÚÛ‡Ú‡ ÍË-ÚÂËË Ò ÔËÂχ Á‡ Ô‡ÚÓÎӄ˘ÌÓ ÔË ‰ÂÔÂÒËfl ̇ V-ÚËÓÚ„Ó‚Ó ‚ Ò‡‚ÌÂÌËÂ Ò I-‚Ë Ì‡‰ 8%- 10% /3, 10, 11,12/.

3. èÓÒÚÚÂÚ‡Ì˘ÌË ÙÂÌÓÏÂÌË /èííî/ ÔË Ò‡‚ÌÂÌËÂ̇ ‡ÏÔÎËÚÛ‰ËÚ ̇ Ô˙‚ËÚ ÓÚ„Ó‚ÓË ÔË ÒÚËÏÛΡÌÂÒ ˜ÂÒÚÓÚË 3 ıˆ, 50ıˆ, 3 ıˆ Ë 3ıˆ ÒΉ 4 ÏËÌÛÚË.

4. Çóë Ò ˜ÂÒÚÓÚË 10, 20, 30,50 ıˆ Ë Ò‡‚Ìfl‚‡Ì ̇ ‡Ï-ÔÎËÚÛ‰ËÚ ̇ I/ V Ë I/ X /ÔÓÒΉÂÌ/ ÓÚ„Ó‚ÓË. é·˘ÓÔË-ÂÚÓ Â, ˜Â ‡·ÌÓÏÌË Ò‡ ‰ÂÔÂÒËflÚ‡ ̇ V ÓÚ„Ó‚Ó Ì‡‰ 8- 10% Ë ÔÓÏfl̇ڇ ̇ ÔÓÒΉÌËfl ÓÚ„Ó‚Ó ‚ ÒÂËflÚ‡- Ù‡ˆËÎË-Ú‡ˆËfl ̇‰ 50% ËÎË ‰ÂÔÂÒËfl ̇‰ 40% /10, 11 /.

5. èË 22 Ô‡ˆËÂÌÚ‡  ÔÓ‚Âʉ‡Ì‡ Ë Ú.̇. ÔÓ·‡ Á‡ÛÏÓ‡- ÒÚËÏÛΡÌÂ Ò 20 ıˆ Á‡ 1 ÏËÌ Ë ÓÚ˜Ëڇ̠Ò˙ÓÚ-ÌÓ¯ÂÌËÂÚÓ Ì‡ I / ÔÓÒΉÂÌ ÓÚ„Ó‚Ó.

êÖáìãíÄíàÑËÒÚ‡ÎÌÓÚÓ Î‡ÚÂÌÚÌÓ ‚ÂÏ ÔÓ n.ulnaris  Ò‰ÌÓ

2,97 ÏÒ / 2,1- 5,8 ÏÒ/: ÔË ‰‚‡Ï‡ Ô‡ˆËÂÌÚË Â ÎÂÍÓ Á‡·‡‚ÂÌÓ- 5,2 ÏÒ Ë 5,8 ÏÒ; ÔË 11  ‚ ÒÚÓÈÌÓÒÚË 4,5- 5,0 ÏÒ, ÔË ÓÒ-

ڇ̇ÎËÚ  ‰Ó 4,5 ÏÒ.ëÍÓÓÒÚÚ‡ ̇ ÔÓ‚Âʉ‡Ì ÔÓ Ì‚‡  Ò‰ÌÓ 55, 9 Ï/

ÒÂÍ , ͇ÚÓ Ò‡ÏÓ ÔË 4 Ô‡ˆËÂÌÚ‡  ÔÓ‰ 47 Ï/ÒÍ - ÓÚ Úflı‰ËÌ Â Ò ‰Ë‡·ÂÚ , ‰ËÌ- ̇ ËÁÍÛÒÚ‚Â̇ ·ÂÎӉӷ̇ ‚ÂÌÚË-·ˆËfl, ‡ ÔË ‰Û„ËÚ Ì Ò ÛÒÚ‡ÌÓ‚Ëı‡ ÔˉÛʇ‚‡˘ËÌ‚ÓÎӄ˘ÌË Á‡·ÓÎfl‚‡ÌËfl.

å-ÓÚ„Ó‚Ó˙Ú Â Ò‰ÌÓ 11, 8 ÏÇ / 3, 5- 20, 7 ÏÇ/. èÓ‰10 ÏÇ Â ÔË 23 Îˈ‡ / 30, 6 % /.

êÂÁÛÎÚ‡ÚËÚ ÓÚ ËÁÒΉ‚‡ÌÂÚÓ Ò êë Ò ˜ÂÒÚÓÚË 1 Ë 3ıˆ Ò‡ Ô‰ÒÚ‡‚ÂÌË Ì‡ 퇷Î. 1. ä‡ÍÚÓ Ò ‚Ëʉ‡ ÔË 1 ıˆ ‚30, 7 % ÓÚ Ô‡ˆËÂÌÚËÚ Ò ÛÒÚ‡ÌÓ‚fl‚‡ ‰ÂÔÂÒËfl ̇ ÔÂÚËÓÚ„Ó‚Ó Ì‡‰ 10 % .èË ‰Û„Ë 10,7 % ÓÚ ·ÓÎÌËÚ Úfl  0, 6- 6, 6 %. çÂÓ·ıÓ‰ËÏÓ Â ‰‡ Ò ÓÚ·ÂÎÂÊË, ˜Â ‰ÂÔÂÒËfl ËÔÓ- χÎ͇ ÓÚ 10%, ÍÓflÚÓ ÓÒÚ‡‚‡ ÔÓÒÚÓflÌ̇ ÔË ÔÓ‚ÚÓ-ÌË ÒÚËÏÛ·ˆËË Ë ÔË Ì‡Î˘ËÂ Ë Ì‡ ‰Û„Ë ÔËÁ̇ˆË ̇ ̇Û-¯ÂÌÓ çåè ÏÓÊ ‰‡ Ò ÔËÂÏ Á‡ Ô‡ÚÓÎӄ˘̇ /1, 2, 9, 10,11 /. í‡Í˙‚  ÒÎÛ˜‡flÚ ÔË ÔÓÒÓ˜ÂÌËÚ ‚ Ú‡·Îˈ‡Ú‡ 8 Ô‡-ˆËÂÌÚË. èӉӷ̇  ͇ÚË̇ڇ Ë ÔË ˜ÂÒÚÓÚ‡ 3 ıˆ /ÙË„.1- 1 /.

êÂÁÛÎÚ‡ÚËÚ ÓÚ ËÁÒΉ‚‡ÌÂÚÓ Ì‡ èííî Ò‡ Ô‰ÒÚ‡-‚ÂÌË Ì‡ Ú‡·Î.2. Ç Ôӂ˜ÂÚÓ ÒÎÛ˜‡Ë ‚‰̇„‡ ÒΉ ÚÂÚ‡ÌË-Á‡ˆËflÚ‡ Ò ÔÓÎÛ˜‡‚‡ Ú.̇. ÔÓÒÚÚÂÚ‡Ì˘̇ Ù‡ˆËÎËÚ‡-ˆËfl /èíî/- ̇‡ÒÚ‚‡Ì ̇ ‡ÏÔÎËÚÛ‰‡Ú‡,͇ÚÓ ÂÁÛÎÚ‡ÚÓÚ Û‚Â΢ÂÌÓ ÓÚ‰ÂÎflÌ ̇ Äñï ÒΉ ÔËÎÓÊÂ̇ڇ ÚÂÚ‡-ÌËÁ‡ˆËfl Ò 50ıˆ. èË 80,0 % ÓÚ Ô‡ˆËÂÌÚËÚ Ò „ËÒÚË-‡ èíî Ë ÔË 29, 3 % Úfl  ÔÓÒΉ‚‡Ì‡ ÓÚ ÔÓÒÚÚÂÚ‡Ì˘-̇ ‰ÂÔÂÒËfl /èíÑ/. é·˘Ó ÔË 74,6 % ÓÚ ‚Ò˘ÍË ËÁÒΉ‚‡-ÌË ÛÒÚ‡ÌÓ‚Â̇ èíÑ / 56 ·ÓÎÌË/. èË 58,9% ÓÚ Úflı / 33 ÎË-ˆ‡/ Úfl  ̇‰ 8%.

êÂÁÛÎÚ‡ÚËÚ ÓÚ ËÁÒΉ‚‡ÌÂÚÓ Ò Çóë Ò‡ Ô‰ÒÚ‡‚ÂÌË̇ Ú‡·Î. 3. èË Ò‡‚Ìfl‚‡ÌÂÚÓ Ì‡ I /V ÓÚ„Ó‚ÓË Ì Ò ̇·-≇‚‡ Ò˙˘ÂÒÚ‚Â̇ ‡ÁÎË͇ ÓÚ ÔÓÎÛ˜ÂÌÓÚÓ ÔË çóë.èË Ò‡‚Ìfl‚‡ÌÂÚÓ Ì‡ I Ò ÔÓÒΉÂÌ ÓÚ„Ó‚Ó Ô‡ÚÓÎӄ˘̇-Ú‡ ‰ÂÔÂÒËfl ̇‰ 40% Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÔË Ôӂ˜ ԇˆËÂÌÚËÒ Û‚Â΢‡‚‡Ì ̇ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÒÚËÏÛ·ˆËflÚ‡.èË ÚË-χ Ò Ò¢‡ ÔË 10ıˆ, ÔË 6 ÔË 20 ıˆ Ë ÔË 8 ÔË 30 ıˆ Ë50 ıˆ.èӉӷ̇  ͇ÚË̇ڇ Ë Á‡ Ù‡ˆËÎËÚ‡ˆËflÚ‡ ̇‰ 50%ÔË Çóë /ÙË„.1- 2 /.

èÓ·‡Ú‡ Á‡ ÛÏÓ‡, ÔËÎÓÊÂ̇ ÔË 22 ÓÚ Ì‡¯ËÚ ԇˆË-ÂÌÚË ÔÓ Í‡Ú„Ó˘ÂÌ Ì‡˜ËÌ ÔÓ͇Á‚‡ " ËÁ˜ÂÔ‚‡Ì " ‡ÏÔÎË-ÚÛ‰‡Ú‡ ̇ ÓÚ„Ó‚ÓËÚ ̇‰ 80% /ÙË„. 2 /.

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ç‡È-Ó·˘Ó ̇ۯÂÌËflÚ‡ ̇ çåè Ò Ò „ÛÔË‡Ú ‚ 3ÓÒÌÓ‚ÌË „ÛÔË:

1.èÓÒÚÒË̇ÔÚ˘ÌË, Í˙Ï ÍÓËÚÓ ÔË̇‰ÎÂÊË Ë ÏˇÒÚÂ-ÌËfl „‡‚ËÒ / åÉ/. ífl Ò Ô˘ËÌfl‚‡ ÓÚ Ì‡Ï‡Îfl‚‡Ì ·Ófl ̇ÙÛÌ͈ËÓÌˇ˘ËÚ ‡ˆÂÚËÎıÓÎËÌÓ‚Ë /Äñï/ ˆÂÔÚÓË ‚ÂÁÛÎÚ‡Ú Ì‡ ̇΢ˠ̇ Äñï- ˆÂÔÓÌË ‡ÌÚËÚ·.

2. èÂÒË̇ÔÚ˘ÌË Ò Ì‡È ÚËÔ˘ÂÌ Ô‰ÒÚ‡‚ËÚÂÎ Ïˇ-ÒÚÂÌÌËflÚ ÒË̉ÓÏ Ì‡ Eaton-Lambert. 3. äÓÏ·ËÌˇÌË /4/. èË ÌÓχÎÌË ÛÒÎÓ‚Ëfl ‚ÒÂÍË ÔÓÔ‡„ˇ˘ ÔÓ ÏÓÚÓÌËfl‡ÍÒÓÌ Ì‚ÂÌ ËÏÔÛÎÒ ‚Ó‰Ë ‰Ó ÏÛÒÍÛÎÂÌ ‡ÍˆËÓÌÂÌ ÔÓÚÂÌ-ˆË‡Î. Ç˙Á͇ڇ ÏÂÊ‰Û Ì‚‡ Ë ÏÛÒÍÛ· Ò ÓÒ˙˘ÂÒÚ‚fl‚‡˜ÂÁ Ô‰‡‚‡Ì ̇ Äñï- ÏÓÎÂÍÛÎË ‚ Ì‚ÌÓ- ÏÛÒÍÛÎÌËflÒË̇ÔÒ. èË ÔË·„‡ÌÂÚÓ Ì‡ êë ÔË åÉ Ì‡ÒÚ˙Ô‚‡ ·ÎÓÍË-‡Ì ̇ çåè ‚ ÓÚ‰ÂÎÌË ÒË̇ÔÒË ‚ ÂÁÛÎÚ‡Ú Ì‡ ÔÓχÎ˙Í·ÓÈ ‡ÍÚ˂ˇÌË ÏÛÒÍÛÎÌË ‚·Í̇ ‚ ÓÚ„Ó‚Ó Ì‡ ÒÛÔ‡-χÍÒËχÎÌËfl ÒÚËÏÛÎ, ̇χÎfl‚‡Ì ÔÓÚÂ̈ˇ· ̇ ÏÓ-ÚÓ̇ڇ ÔÎӘ͇ Ë ÔÓÌËʇ‚‡Ì ‡ÏÔÎËÚÛ‰‡Ú‡ ̇ ÏÓÚÓ-ÌËfl ÓÚ„Ó‚Ó /10/.

êÂÁÛÎÚ‡ÚËÚ ÓÚ Ì‡¯ÂÚÓ ÔÓÛ˜‚‡Ì ÔÓ͇Á‚‡Ú, ˜Â ˜ÂÁêë ̇ n.ulnaris Ò ÌËÒÍË Ë ‚ËÒÓÍË ˜ÂÒÚÓÚË ÏÓÊ ‰‡ Ò ÔÓ-ÎÛ˜Ë ÔÓÎÂÁ̇ ‰Ë‡„ÌÓÒÚ˘̇ ËÌÙÓχˆËfl ÔË „ÓÎflÏ ·ÓÈÔ‡ˆËÂÌÚË Ò åÉ. ëÚ‡‚‡ flÒÌÓ, ˜Â ‡Á΢ÌËÚ ÂÚ‡ÔË Ì‡ ËÁ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 95‡ÔËÎ, 2002

ÒΉ‚‡ÌÂÚÓ ‚Á‡ËÏÌÓ Ò ‰ÓÔ˙΂‡Ú. ç‡È-˜ÂÒÚÓ Ô‡ÚÓÎӄ˘-ÌË ÔÓÏÂÌË Ò ÔÓÎÛ˜‡‚‡Ú ÔË èííî Ë Ú Ò ÒÏflÚ‡Ú Á‡Â‰ÌË ÓÚ ÓÒÌÓ‚ÌËÚ ‰Ë‡„ÌÓÒÚ˘ÌË ÔËÁ̇ˆË ̇ ̇ۯÂÌÓçåè ÍÓÂÚÓ Ò ÔÓÚ‚˙ʉ‡‚‡ Ë ÓÚ ‰Û„Ë ‡‚ÚÓË /4, 9/. èíî Ò Ò¢‡ Ë ‚ ÌÓχ /1, 2, 4, 10, 11/. èÓÒΉ‚‡˘‡Ú‡èíÑ 4 ÏËÌÛÚË ÒΉ íÂÚ‡ÌËÁ‡ˆËflÚ‡, Ò ̇˘‡ Ӣ ËÔÓÒÚÚÂÚ‡Ì˘ÌÓ ËÁ˜ÂÔ‚‡ÌÂ Ë Â ÓÒÓ·ÂÌÓ ÔÓ͇Á‡ÚÂÎ̇ Á‡Ì‡Û¯ÂÌÓ çåè. çËÒÍÓ˜ÂÒÚÓÚ̇ڇ ÒÚËÏÛ·ˆËfl  ÔÓ-

Ô‰ÔÓ˜Ëڇ̇ ÓÚ Ôӂ˜ÂÚÓ ËÁÒΉӂ‡ÚÂÎË, ÔÓ‡‰Ë ÚÓ‚‡,˜Â  ÔÓ- ÎÂÒÌÓ ÔÓÌÓÒËχ ÓÚ Ô‡ˆËÂÌÚËÚ /11, 12/. ÖåÉ-ÔÓÏÂÌËÚ ÔË ÌÂfl Ò‡ ÏÌÓ„Ó ı‡‡ÍÚÂÌË Ë Ò ÛÒÚ‡ÌÓ‚fl-‚‡Ú ÔË 30 % ÓÚ ÒÎÛ˜‡ËÚÂ. ÇËÒÓÍËÚ ˜ÂÒÚÓÚË Ì‡ ÒÚË-ÏÛ·ˆËfl ËÏ‡Ú ËÏ‡Ú ËÌÙÓχÚ˂̇ ÒÚÓÈÌÓÒÚ ‚ ̇È- χ-Î˙Í ÔÓˆÂÌÚ ÓÚ ·ÓÎÌËÚÂ, ÌÓ ‚ ÌflÍÓË ÒÎÛ˜‡Ë Ë ÔË Úflı ÒÂÔÓÎÛ˜‡‚‡Ú Ô‡ÚÓÎӄ˘ÌË ÓÚÍÎÓÌÂÌËfl.

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Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 96‡ÔËÎ, 2002

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1. I/V ÓÚ„.ÑÂÔÂÒËfl̇‰ 10% 20 26,7 23 30,7 20 26,7 18 24,0 2. I/X ÓÚ„.‡. ÑÂÔÂÒËfl ̇‰ 40% 3 4,0 6 8,0 8 10,7 8 10,7·. ËÎË-Ú‡ˆËfl̇‰ 50% 1 1,3 6 8,0 10 13,3 12 16,0é·˘ ·ÓÈÔ‡ˆËÂÌÚË - 75

1. ÅÓÈ Ô‡ˆËÂÌÚË Ò Ô‡ÚÓÎӄ˘ÌË ÔÓÏÂÌË ÔË ‡Á΢ÌËÚ˜ÂÒÚÓÚË Ì‡ ÒÚËÏÛ·ˆËfl.2. % ÒÎÛ˜‡Ë Ò ÔÓÏfl̇ ‚ ÓÚ„Ó‚ÓËÚ ÓÚ ˆfl·ڇ „ÛÔ‡ - 75Ô‡ˆËÂÌÚË

îË„.1: PC ÔË Ô‡ˆËÂÌÚË Ò åÉ. 1. ëÚËÏÛ·ˆËfl Ò˜ÂÒÚÓÚ‡ 3 ıˆ Ë ‰ÂÔÂÒËfl ̇ V Ë VI ÓÚ„Ó‚ÓË.

2. ëÚËÏÛ·ˆËfl Ò ˜ÂÒÚÓÚ‡ 20 ıˆ-Ù‡ˆËÎËÚ‡ˆËfl ̇ÔÓÒΉÂÌ éÚ„Ó‚Ó 67,4%

îË„. 2: èÓ·‡ Á‡ ÛÏÓ‡ ÔË ÒÚËÏÛ·ˆËfl Ò 20ıˆ Á‡ 1 ÏËÌÔË Ô‡ˆËÂÌÚ Ò åÉ.

Úfl·‚‡, ͇ÍÚÓ ‰‡ ‰Ó͇Ê ̇ۯÂÌÓ çåè, ڇ͇ Ë ‰‡ ËÁÍ-β˜Ë ‰Û„Ë Û‚Âʉ‡ÌËfl ̇ ÏÓÚÓÌËÚ ‰ËÌˈË, ÍÓËÚÓ „Ë̇ÔÓ‰Ó·fl‚‡Ú Ë ‰ÓÔË̇ÒflÚ Á‡ ÍÎËÌ˘ÌËÚ ÔÓfl‚Ë /7/. éÒ-‚ÂÌ ÚÓ‚‡ ÔË Ì‡Û¯ÂÌÓ çåè  ‚‡ÊÌÓ ‰‡ Ò ÓÔ‰ÂÎË ÌÂ-„Ó‚‡Ú‡ ÚÂÊÂÒÚ ,͇ÍÚÓ Ë ‰‡ Ò ÛÒÚ‡ÌÓ‚flÚ Ó·ÂÍÚË‚ÌËÔÓÏÂÌË ÔË ‚ÎÓ¯‡‚‡Ì ËÎË ÔÓ‰Ó·fl‚‡Ì Ò˙ÒÚÓflÌËÂÚÓ Ì‡Ô‡ˆËÂÌÚ‡.

燯ËflÚ ÓÔËÚ ÔÓ͇Á‚‡, ˜Â ÔË Ô‡‚ËÎÌÓ ÔË·„‡Ì ̇ÏÂÚÓ‰Ë͇ڇ ̇ êë Ò Ï‡ÍÒËχÎÌÓ ËÁ·fl„‚‡Ì ̇ ‡ÚÂÙ‡Í-ÚËÚÂ Ë Ô‡‚ËÎÌÓ Ë ÍÓÏÔÎÂÍÒÌÓ ÓˆÂÌfl‚‡Ì ̇ ÔÓÎÛ˜ÂÌËÚÂÂÁÛÎÚ‡ÚË, ËÚÏ˘̇ڇ ÒÚËÏÛ·ˆËfl ÒË ÓÒÚ‡‚‡ ÏÂÚӉ̇ ËÁ·Ó ‚ ‰Ë‡„ÌÓÒÚË͇ڇ ̇ åÉ.

ãàíÖêÄíìêÄ:1. çÓ‚‡˜ÍÓ‚‡ ë., Å.à¯ÔÂÍÓ‚‡, ç. ÇÂÎÍÓ‚, å. ч„Ë‚: äÎËÌ˘ÌÓ-ÂÎÂÍÚÓ-ÏËÓ„‡ÙÒÍË ÔÓÛ˜‚‡ÌËfl ÔË Ô‡ˆËÂÌÚË Ò ÏˇÒÚÂÌËfl „‡‚ËÒ. éÒÌÓ‚ÌË ÔÓ·ÎÂ-ÏË Ì‡ Ì‚ÓÎÓ„ËflÚ‡, èÎÓ‚‰Ë‚, 1994, 218- 219.2. 퇘‚ ÄÚ.: Ç˙ıÛ ÌflÍÓË ÂÎÂÍÚÓÏËÓ„‡ÙÒÍË ÓÒÓ·ÂÌÓÒÚË ÔË ÏˇÒÚÂ-ÌËfl „‡‚ËÒ Ë ÏˇÒÚÂÌÓÔÓ‰Ó·ÌË ÒË̉ÓÏË. ä‡Ì‰Ë‰‡ÚÒ͇ ‰ËÒÂÚ‡ˆËfl, ëÓÙËfl,19793. Beekman R., Kuks J.. B.,Oosterhuis H.J.: Myasthenia gravis: diagnosis andfollow up of 100 consecutive patients. J.Neurol, 244, 2, 1997,112-118.

4. Brown W. F., Bolton C.T.: Clinical Electromyography . Boston,Butterworth1993, 629- 651.5. Jounger B.B., Worrall B.B., Penn A.S. :Myasthenia gravis:Historical perspec-tive and overview. Neurology, 48, /suppl. 5/, 1997, 48, 1-7.6. Lange D.J.: Eectrophysiological testing of neuromuscular transmission.Neurology, 48, /suppl. 5/, 1997, 18- 22.7. Lisak R.P.: The clinical limits of myasthenia gravis and differential diagno-sis. Neurology, 48, /suppl.5 / , 1997, 36-39.8. Lovelage R.:Mysthenia gravis with Thymoma. Neurology, 48, / suppl.5/,1997, 76-81.9. Oh S.J.: The repetitive nerve stimulation test .Methods in clinicalNeurophysiology, 3,1992, 1- 15.10. Oh S.J., Kim D.E., Kuruoglu R.,Bradley R.J., Dwyer D.: Diagnostic sensitiv-ity of the laboratory tests in myasthenia gravis. Muscle - Nerve,15, 6, 1992, 720-724. 11 Sanders D.B.: Electrophysiological study of disorders of neuromuscular trans-mission. In Electrodyagnosis in clinical Neurology.M. Aminoff eds, New York,Edinburg, London, Churchill Livingston , 1992.12. Sommer N., Sigg B., Melms A.: Ocular myasthenia gravis :response to longterm immunosuppressive treatement. J.of Neurol.Neurosur.,Psych., 62, 1997, 156-162.

ĉÂÒ Á‡ ÍÓÂÒÔÓ̉Â̈Ëfl: ëÓÙËfl 1504, ìÎ.ÅflÎÓ ÏÓ N 8MÅÄã "ñ‡Ëˆ‡ âÓ‡Ì̇ ", ÖÄÑäÎËÌË͇ ÔÓ Ì‚ÓÎÓ„Ëfl- 43-44-525

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 97‡ÔËÎ, 2002

Ñ- ë.çÓ‚‡˜ÍÓ‚‡àçîéêåÄñàü áÄ ÑÇÄçÄÑÖëÖíÄíÄ ëêÖôÄ çÄ ÖÇ-

êéèÖâëäÄíÄ ÄëéñàÄñàü èé çÖÇêéãéÉàü(EUROPEAN NEUROLOGICAL SOCIETY)

éÚ 22 ‰Ó 26 ˛ÌË 2002 „Ó‰Ë̇, ‚ ÅÂÎËÌ Ò Ôӂ‰ ‰‚‡-̇‰ÂÒÂÚ‡Ú‡ Ò¢‡ ̇ Ö‚ÓÔÂÈÒ͇ڇ ‡ÒӈˇˆËfl ÔÓ Ì‚Ó-ÎÓ„Ëfl (European Neurological Society). í‡ÁË Ò¢‡ ·Â¯ÂÓ„‡ÌËÁˇ̇ Ò˙„·ÒÌÓ ÛÒÚ‡ÌÓ‚ÂÌËÚ ‚˜ ڇ‰ËˆËË, ͇-ÚÓ ‰‡‰Â ‚˙ÁÏÓÊÌÓÒÚ Á‡ ÔÓ‰˙Îʇ‚‡Ì ӷۘÂÌËÂÚÓ Ì‡ ÎÂ-͇ËÚ Ì‚ÓÎÓÁË ÓÚ Ö‚ÓÔ‡ ‚ ӷ·ÒÚÚ‡ ̇ ÓÒÌÓ‚ÌËÚ‰ˇ„ÌÓÒÚ˘ÌË ÏÂÚÓ‰Ë ‚ Ì‚ÓÎÓ„ËflÚ‡ Ë Ò˙‚ÂÏÂÌÌËÚÂ̇ÒÓÍË ‚ Ú‡ÔËflÚ‡ ̇ Ì‚ÌËÚ ·ÓÎÂÒÚË. Åflı‡ Ó„‡ÌË-ÁˇÌË 16 Ò˙·ÓÚÌÓ-̉ÂÎÌË Ó·Û˜ËÚÂÎÌË ÍÛÒÓ‚Â Ò ÔÓ-‰˙ÎÊËÚÂÎÌÓÒÚ ÔÓÎÓ‚ËÌ ËÎË ˆflÎ ‰ÂÌ. í ӷı‚‡Ì‡ı‡ ‚Ò˘ÍËÓÒÌÓ‚ÌË Ó·Î‡ÒÚË ‚ Ì‚ÓÎÓ„ËflÚ‡ - Ì‚ÓËÁÓ·‡Áfl‚‡ÌÂ,ËÌÚÂÌÁË‚ÌË „ËÊË ‚ Ì‚ÓÎÓ„ËflÚ‡, ÑÓÔÎÂÓ‚‡ ÒÓÌÓ„‡-ÙËfl, ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Ë ÏÌÓ„Ó ‰Û„Ë Á‡·ÓÎfl‚‡ÌËfl.

Ö‰ÌÓ‚ÂÏÂÌÌÓ Ò ÚÓ‚‡ Ò Ô‰ÒÚ‡‚Ëı‡ Ë ‰ËÒÍÛÚˇı‡ÏÌÓ„Ó Ó„Ë̇ÎÌË Ì‡Û˜ÌË ÔÓÒÚËÊÂÌËfl Ë ÂÁÛÎÚ‡ÚË ÓÚ‡Á΢ÌË ÏÛÎÚˈÂÌÚÓ‚Ë ÔÓÛ˜‚‡ÌËfl. ç‡Û˜ÌËÚ ÔÓÒÚË-ÊÂÌËfl ·flı‡ Ô‰ÒÚ‡‚ÂÌË Í‡ÚÓ ÓÒÌÓ‚ÌË ‰ÓÍ·‰Ë ‚ ‡ÏÍË-Ú ̇ 38 Ó‡ÎÌË ÒÂÒËË, ‚Íβ˜‚‡˘Ë ÏÓÁ˙˜ÌÓÒ˙‰Ó‚Ë Á‡·ÓÎfl-‚‡ÌËfl, ‰ÂÏÂ̈Ëfl, ÂÔËÎÂÔÒËfl, ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡, ÏÓ-ÚÓÌ‚ÓÌÌË Á‡·ÓÎfl‚‡ÌËfl, ÔÂËÙÂÌË Ì‚ÓÔ‡ÚËË, ÂÍÒÚ-‡ÔˇÏˉÌË Á‡·ÓÎfl‚‡ÌËfl, Ì‚ӄÂÌÂÚË͇, ÏÛÒÍÛÎÌË Á‡·Ó-Îfl‚‡ÌËfl, Ì‚ӷËÓÎÓ„Ëfl, Ì‚ÓÓÌÍÓÎÓ„Ëfl, Ì‚ÓËÏÛÌÓÎÓ-„Ëfl, ËÌÙÂ͈ËË Ì‡ ñçë, „·‚Ó·ÓÎËÂ, ·ÓÎÂÒÚË Ì‡ Ò˙Ìfl, Ì‚-ÓÓÙÚ‡ÎÏÓÎÓ„Ëfl Ë ‰. ÑÓÍ·‰‚‡ı‡ Ò ÂÁÛÎÚ‡ÚË ÓÚ ÔÓ-Û˜‚‡ÌËfl Á‡ ΘÂÌËÂÚÓ Ì‡ ‡Á΢ÌË ÙÓÏË Ì‡ ÏÌÓÊÂÒÚ‚Â-̇ ÒÍÎÂÓÁ‡ Ò ËÌÚÂÙÂÓÌ, ÏËÚÓÍÒ‡ÌÚÓÌ, ËÌÚ‡‚ÂÌÓÁÂÌËÏÛÌÓ„ÎÓ·ÛÎËÌ, ͇ÍÚÓ Ë ‚ ӷ·ÒÚÚ‡ ̇ ıËÏËÓÚ‡Ô‚-Ú˘ÌÓÚÓ Ôӂ‰ÂÌË ÔË ÏÓÁ˙˜ÌË ÚÛÏÓË, ΘÂÌË ̇ ÂÔË-ÎÂÔÒËflÚ‡ Ë ‰. Ä͈ÂÌÚˇ Ò ‚˙ıÛ Á̇˜ÂÌËÂÚÓ Ì‡ ÌflÍÓËÌÓ‚Ë ËÌÒÚÛÏÂÌÚ‡ÎÌË ÏÂÚÓ‰Ë ‚ ‰Ë‡„ÌÓÒÚË͇ڇ ̇ ÏÓ-Á˙˜ÌÓÒ˙‰Ó‚ËÚ Á‡·ÓÎfl‚‡ÌËfl, ͇ÚÓ Ò ӷ˙̇ ‚ÌËχÌË‚˙ıÛ ˜‡ÒÚ ÓÚ Ô‡ÚÓ„ÂÌÂÚ˘ÌËÚ ÏÂı‡ÌËÁÏË Ë ‚ÚÓ˘-̇ڇ ÔÓÙË·ÍÚË͇ ̇ ÏÓÁ˙˜ÌÓÒ˙‰Ó‚ËÚ Á‡·ÓÎfl‚‡ÌËfl.é·Ò˙‰Ëı‡ Ò ‡ÒÔÂÍÚË ‚ ΘÂÌËÂÚÓ Ì‡ è‡ÍËÌÒÓÌÓ‚‡Ú‡

·ÓÎÂÒÚ - ÛÌË·Ú‡Î̇ Ô‡ÎˉÓÚÓÏËfl ÔË ·ÓÎÌË ‚ ̇Ô‰-̇ΠÒÚ‡‰ËÈ, ‰˙ηÓ͇ ڇ·Ï˘̇ ÒÚËÏÛ·ˆËfl ÔË ÚÂ-ÏÓ̇ ÙÓχ Ë ÂÒÂ̈ˇÎÂÌ ÚÂÏÓ. ÑËÒÍÛÚˇÌÓ ·Â ΘÂ-ÌËÂÚÓ Ì‡ ÓÒÚ‡Ú‡ ‚˙ÁÔ‡ÎËÚÂÎ̇ ‰ÂÏËÂÎËÌËÁˇ˘‡ ÔÓÎË-Ì‚ÓÔ‡ÚËfl, ͇ÚÓ Ò ‰ÓÍ·‰‚‡ı‡ ÂÁÛÎÚ‡ÚË Á‡ ΘÂÌËÂ-ÚÓ Ì‡ ·ÓÎÌË Ò˙Ò ÒË̉ÓÏ Ì‡ ÉËÎÂÌ-Å‡Â Ò ËÌÚ‡‚ÂÌÓÁÂÌËÏÛÌÓ„ÎÓ·ÛÎËÌ Ë ÏÂÚËÎÔ‰ÌËÁÓÎÓÌ. Ç ÔÓ‰˙ÎÊÂÌË ̇ÔÂÚ ÔÓÒÚÂÌË ÒÂÒËË Ò Ô‰ÒÚ‡‚Ëı‡ Ó·˘Ó 586 ÔÓÒÚ‡. èÓ ‚ÂÏ ̇ ‰‚‡Ì‡‰ÂÒÂÚ‡Ú‡ Ò¢‡ ̇ Ö‚ÓÔÂÈÒ͇ڇ ‡ÒÓ-ˆË‡ˆËfl ÔÓ Ì‚ÓÎÓ„Ëfl Ò ӄ‡ÌËÁˇı‡ Ò‰ÂÏ Ò‡ÚÂÎËÚÌËÒËÏÔÓÁËÛχ. ÉÓÎflÏ ËÌÚÂÂÒ Ô‰ËÁ‚Ë͇ı‡ Ò‡ÚÂÎËÚÌËÚÂÒËÏÔÓÁËÛÏË Ì‡ هχˆÂ‚Ú˘ÌËÚ ÙËÏË BiÓgen,Schering AG, Serono International S.A., Teva-aventis Í˙‰ÂÚÓÒ Ô‰ÒÚ‡‚Ëı‡ Ò˙‚ÂÏÂÌÌËÚ ÚẨÂ̈ËË ‚ ΘÂÌËÂÚÓ Ì‡ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ Ò ËÌÚÂÙÂÓÌ Ë Copaxon. ÑËÒ-ÍÛÚˇı‡ Ò Ô‰ËÏÒÚ‚‡Ú‡ Ë ÓÒÓ·ÂÌÓÒÚËÚ ̇ ‰ÂÈÒÚ-‚Ë ̇ ‡Á΢ÌËÚ ËÌÚÂÙÂÓÌË, ÍÓÂÚÓ ÓÚ Ò‚Ófl Òڇ̇‰‡‰Â ‚˙ÁÏÓÊÌÓÒÚ ‰‡ Ò ÔˆÂÌË ÏflÒÚÓÚÓ Ì‡ ‚ÒÂÍË Â‰ËÌ ‚ΘÂÌËÂÚÓ Ì‡ ·ÓÎÌËÚÂ Ò ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡.

Dear Colleague,In 2001 the EFNS launched a project of Department to

Department Cooperation. This programme of the EuropeanCooperation Committee has made possible 21 and 27 visits ofEast European neurologists in Western departments in therespective years of 2001 and 2002. The training visits foundhigh appreciation among the participants and were also verypositively evaluated by the heads of hosting departments.

Our Management Committee decided to continue this pro-gramme again in 2003. Each selected candidate under theage of 40, fluent in English or in the local language will be

àçîéêåÄñàà à êÖñÖçáàà

awarded by a grant of 1000,- Euro for support of his/heraccommodation and board expenses in the city of his/herpractice. In case of a low budget board (canteen) and accom-modation in a college provided by the hosting institute, oreventually dependent from the visitor’s own financial contri-bution, the participant may spend also more than 1 month inthe hosting department.

Please, help with spreading this information among neu-rologists in your country and with recommendation of mosttalented/dedicated colleagues.

Applications from interested colleagues, accompanied by acurriculum vitae and a list of publications should be sent toour office as soon as possible, not later however than October15th 2002. Consequently a selection will be done on October25th by the Management Committee in Vienna.

With best regards,YoursPavel Kalvach, MD, PhD Prof. Krzysztof Selmaj, MD

EFNS Secretary General EFNS Vice PresidentApplication forms should be asked and sent to:Ing. Magda DohnalovaAdministrative OfficerEFNS Branch Office PragueDepartment of Neurology, FNKVSrobarova 50, 100 34 PragueCzech RepublicTel./fax: +420 2 6716 3563e-mail: [email protected]

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 98‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 99‡ÔËÎ, 2002

àçàñàÄíàÇÖç äéåàíÖí:

ÑÓˆ. Ñ- à‚‡Ì åË·ÌÓ‚, ‰.Ï.Ì.ÑÓˆ. Ñ- ÑËÏËÚ˙ ÉÂÓ„Ë‚, ‰.Ï.èÓÙ. Ñ- èÂÌÍÓ òÓÚÂÍÓ‚, ‰.Ï.Ì.èÓÙ. Ñ- ëÚÓflÌ Å‡ÈÍۯ‚, ‰.Ï.Ì.

èÓÙ. Ñ- 臇ÒÍ‚‡ ëÚ‡ÏÂÌÓ‚‡, ‰.Ï.Ì.èÓÙ. Ñ- Ö͇ÚÂË̇ ÊËÔÂÚÓ‚‡, ‰.Ï.

ÑÓˆ. Ñ- àÂ̇ ÇÂΘ‚‡, ‰.Ï.ÑÓˆ. Ñ- 燉Âʉ‡ ÑÂ΂‡, ‰.Ï.ÑÓˆ. Ñ- ëÚÓflÌ ÅÓÊËÌÓ‚, ‰.Ï.

Ñ- äÒÂÌËfl äÏÂÚÒ͇Ñ- çËÍÓÎ‡È íÓÔ‡ÎÓ‚, ‰.Ï.

Ñ- å‡Ëfl å‡ÌÓ‚‡

24 - 26 ÌÓÂÏ‚Ë, 2000 „. è‡ÏÔÓÓ‚Ó

åÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ (åë)  Á‡·ÓÎfl‚‡ÌÂ, ÍÓÂÚÓÔÓ͇Á‚‡ „ÂÓ„‡ÙÒÍË Ë ‡ÒÓ‚Ë ‡Á΢Ëfl ‚ Ò‚ÓÂÚÓ ‡ÁÔÓÒ-Ú‡ÌÂÌË ÔÓ Ò‚ÂÚ‡. íÓ Ò Ò¢‡ ÔÓ-˜ÂÒÚÓ ‚ Ò‚ÂÌËÚ „Â-Ó„‡ÙÒÍË ÁÓÌË Ë Ò‰ ·fl·ڇ ‡Ò‡.

ÅÓÎÂÒÚÌÓÒÚÚ‡ ÓÚ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ ‚ Å˙΄‡Ëfl 44,5/100 000 ̇ÒÂÎÂÌËÂ, ‰Ó͇ÚÓ Á‡·ÓÎflÂÏÓÒÚÚ‡ Â1,03/100 000 ̇ÒÂÎÂÌËÂ. íÂÁË ‰‡ÌÌË ÔÓ͇Á‚‡Ú, ˜Â ‚ Å˙΄‡-Ëfl ÓÚ åë ·ÓΉۂ‡Ú ÓÍÓÎÓ 3600 ‰Û¯Ë, ‡ ‚Òfl͇ „Ó‰Ë̇ Ò‡Á·ÓÎfl‚‡Ú ÌÓ‚Ë 80 ˜Ó‚Â͇. íÂÁË ÔÓ͇Á‡ÚÂÎË Ò ‰Ó·ÎËʇ-‚‡Ú ‚ „ÓÎflχ ÒÚÂÔÂÌ ‰Ó ·ÓÎÂÒÚÌÓÒÚÚ‡ ‚ Ò˙Ò‰ÌËÚÂÒÚ‡ÌË Ë ‚˙‚ ‚ËÒÓÍÓ-ËÒÍÓ‚ËÚ Ò‰ÌÓ‚ÓÔÂÈÒÍË ÁÓÌË. ᇷÓÎfl‚‡ÌÂÚÓ Á‡Òfl„‡ Ô‰ËÏÌÓ Ï·‰Ë ıÓ‡, ̇È-„ÓÎflÏ Â·Ófl ̇ ·ÓÎÌËÚ ÏÂÊ‰Û 30 - 34 „Ӊ˯̇ ‚˙Á‡ÒÚ (Ò‰̇‚˙Á‡ÒÚ 44 „.) ç‡Îˈ  ·ÎËÁÓ ‰‚ÓÈÌÓ ÔÓ-„ÓÎflχ Ô‰‡Á-ÔÓÎÓÊÂÌÓÒÚ Ì‡ ÊÂÌÒÍËfl ÔÓÎ Í˙Ï Á‡·ÓÎfl‚‡ÌÂÚÓ, ÔË Ò˙ÓÚ-ÌÓ¯ÂÌË ÊÂÌË : Ï˙Ê - 1.9 : 1. åÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡Â ıÓÌ˘ÌÓ Á‡·ÓÎfl‚‡ÌÂ, ͇ÚÓ ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ Á‡-·ÓÎfl‚‡ÌÂÚÓ Â ÏÂÊ‰Û 10 Ë 15 „Ó‰ËÌË (Ò‰ÌÓ 13 „.) Ë Á‡‚Ë-ÒË ÓÚ Ì„ӂ‡Ú‡ ÍÎËÌ˘̇ ÙÓχ.

åë  ‡‚ÚÓËÏÛÌÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÔË ÍÓÂÚÓ Ò Ô‰ÔÓ-·„‡ ̇΢ˠ̇ „ÂÌÂÚ˘ÌÓ Ô‰‡ÁÔÓÎÓÊÂÌËÂ, ÍÓÂÚÓ ‚ÍÓÏ·Ë̇ˆËfl Ò ÌflÍÓË Ù‡ÍÚÓË Ì‡ ÓÍÓÎ̇ڇ Ò‰‡ ‰Ó‚Âʉ‡‰Ó ͇Ò͇‰‡ ÓÚ ËÏÛÌÌË ÓÚ„Ó‚ÓË Ë Ì‡Û¯‡‚‡Ì ̇ Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡. Ç ÂÁÛÎÚ‡Ú Ì‡ÒÚ˙Ô‚‡ ‚˙ÁÔ‡ÎËÚÂÎ̇‰ÂÏËÂÎËÌËÁ‡ˆËfl ̇ ·flÎÓÚÓ ÏÓÁ˙˜ÌÓ ‚¯ÂÒÚ‚Ó ‚ ñçë ÒÛ˜‡ÒÚËÂÚÓ Ô‰ËÏÌÓ Ì‡ í ÎËÏÙÓˆËÚËÚÂ Ë Ï‡ÍÓÙ‡„ËÚÂ.ç‡Û¯‡‚‡ Ò ÔÓ‚Âʉ‡ÌÂÚÓ Ì‡ ËÏÔÛÎÒËÚ ‚ ñçë, ÍÓÂÚÓ‰Ó‚Âʉ‡ ÍÎËÌ˘ÌÓ ‰Ó Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ.

äÎËÌ˘ÌÓÚÓ ÔÓÚ˘‡Ì ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò ı‡‡Í-ÚÂËÁˇ Ò Ô˙Ò̇ڇ ۂ‰‡ ̇ ‡Á΢ÌË Ì‚ÓÎӄ˘ÌËÒËÒÚÂÏË (ÔˇÏˉ̇, ÍÓÓ‰Ë̇ˆËÓÌ̇, ÒÂÚ˂̇ Ë ‰.), ÍÓ-flÚÓ ÏÓÊ ‰‡ ·˙‰Â ÔÂıӉ̇ ËÎË ‰‡ ÔÓ„ÂÒˇ.

ëÔÓ‰ ‚ÂÏ‚Ëfl ÔÓÙËΠ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò ‡Á΢‡-‚‡Ú ‰‚ ÓÒÌÓ‚ÌË ÙÓÏË: ÔËÒÚ˙ÔÌÓ-ÂÏËÚˇ˘‡ Ë ıÓ-Ì˘̇ (èËÎÓÊÂÌË 1). ç‡È-˜ÂÒÚ‡Ú‡ ÍÎËÌ˘̇ ÙÓχ ̇Á‡·ÓÎfl‚‡ÌÂÚÓ ÔË ÓÍÓÎÓ 55% ÓÚ ·ÓÎÌËÚ (Ú. Â. ÓÍÓÎÓ

1700 ·ÓÎÌË Á‡ Òڇ̇ڇ)  ÔËÒÚ˙ÔÌÓ-ÂÏËÚˇ˘‡Ú‡.èË ÔËÒÚ˙ÔÌÓ-ÂÏËÚˇ˘‡Ú‡ ÙÓχ ̇ åë Ëχ flÒÌÓÓÔ‰ÂÎÂÌË ÔËÒÚ˙ÔË, ı‡‡ÍÚÂËÁˇÌË ÓÚ Ì‚ÓÎӄ˘ÌËÒËÏÔÚÓÏË, ÍÓËÚÓ ÔÓ͇Á‚‡Ú ·‡‚ÌÓ Ó·‡ÚÌÓ ‡Á‚ËÚËÂ(Ô˙ÎÌÓ ËÎË ˜‡ÒÚ˘ÌÓ) Á‡ ÌflÍÓÎÍÓ Ò‰ÏˈË. ëΉ‚‡˘ËÚÂÔËÒÚ˙ÔË (ÂÍÁ‡ˆÂ·‡ˆËË) ̇ÒÚ˙Ô‚‡Ú ÔÂÁ ÌÂÔ‡‚ËÎÌË ËÌ-Ú‚‡ÎË ÓÚ ‚ÂÏÂ. åÂÊ‰Û ÔËÒÚ˙ÔËÚ Ì Ò ̇·Î˛‰‡‚‡ÔÓ„ÂÒËfl. Ç Ú‡ÁË ÙÓχ Ò ‚Íβ˜‚‡Ú ÒÎÛ˜‡ËÚÂ Ò ÔËÒ-Ú˙ÔË Ë ÍÛÏÛΡÌË ÔÓÒÎÂ‰ËˆË ÓÚ ÔËÒÚ˙ÔËÚ ÔÓ‡‰Ë ÌÂ-Ô˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ, ÌÂÁ‡‚ËÒËÏÓ ÓÚ ÚÛ‰ÌÓÒÚÚ‡ ‰‡ Ò‡Á΢‡Ú ÓÚ ‚ÚÓ˘ÌÓ-ÔÓ„ÂÒˇ˘‡Ú‡ åë. èË 62%ÓÚ ·ÓÎÌËÚ (Ú. Â. ÓÍÓÎÓ 1100 ·ÓÎÌË Á‡ Òڇ̇ڇ) Ò ÛÒ-Ú‡ÌÓ‚fl‚‡ ËÌ‚‡ÎˉËÁ‡ˆËfl, ÔÓ-χÎ͇ ÓÚ 5 ÔÓ Ò͇·ڇ ̇Kurtzke.

èËÒÚ˙ÔÌÓ ÂÏËÚÂÌÚ̇ڇ ÙÓχ ÏÓÊ ‰‡ ÔÂÏËÌ‚˙‚ ‚ÚÓ˘ÌÓ ÔÓ„ÂÒˇ˘‡ ÙÓχ, ÔË ÍÓflÚÓ Ò ̇·Î˛-‰‡‚‡ ÔÓÒÚÂÔÂÌ̇ ‡ÍÛÏÛ·ˆËfl ̇ Ì‚˙Á‚‡ÚËχ ËÌ‚‡Îˉ-ÌÓÒÚ, Ò ËÎË ·ÂÁ ÓÚ‰ÂÎÌË ÔËÒÚ˙ÔË, χÎÍË ÂÏËÒËË Ë Ô·-Ú‡. ëΉ 6 ‰Ó 10 „Ó‰ËÌË ÓÚ Ì‡˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓÓÍÓÎÓ 41% ÓÚ ·ÓÎÌËÚÂ Ò ÔËÒÚ˙ÔÌÓ ÂÏËÚÂÌÚ̇ ÙÓχÔÂÏË̇‚‡Ú ‚˙‚ ‚ÚÓ˘ÌÓ ÔÓ„ÂÒˇ˘‡ ÙÓχ.

èË Ï‡Î͇ ˜‡ÒÚ ÓÚ ·ÓÎÌËÚ (ÓÍÓÎÓ 10%) Á‡·ÓÎfl‚‡ÌÂ-ÚÓ Â Ò Ô˙‚˘ÌÓ-ÔÓ„ÂÒˇ˘ ıÓ‰. èË Ô˙‚˘ÌÓ ÔÓ„Â-Òˇ˘‡Ú‡ ÙÓχ ̇ åë ÒËÏÔÚÓÏËÚ Ò ‚ÎÓ¯‡‚‡Ú ÔÓÒ-ÚÓflÌÌÓ Ë ·‡‚ÌÓ ÓÚ Ì‡˜‡ÎÓÚÓ Ë ‰ÂÙˈËÚ˙Ú ÔÓÒÚÂÔÂÌÌÓÒ ‚ÎÓ¯‡‚‡ ·ÂÁ flÒÌÓ ÓÚ„‡Ì˘ËÏË ÔËÒÚ˙ÔË ËÎË ÂÏËÒËËÌÂÁ‡‚ËÒËÏÓ, ˜Â ÏÓ„‡Ú ‰‡ Ò ̇·Î˛‰‡‚‡Ú Ô·ڇ Ë ‚ÂÏÂÌ-ÌË ÏËÌËχÎÌË ÔÓ‰Ó·ÂÌËfl. èÓ„ÂÒˇ˘‡Ú‡ åë Ò ı‡-‡ÍÚÂËÁˇ Ò ÎËÔÒ‡ ̇ ÍÎËÌ˘ÌË ÔËÒÚ˙ÔË, Ò ÔÓ-χÎÍÓÎÂÁËË Ì‡ χ„ÌËÚÌÓ-ÂÁÓ̇ÌÒ̇ڇ ÚÓÏÓ„‡ÙËfl (åêí) ËÔÓ-χÎÍÓ ‚˙ÁÔ‡ÎËÚÂÎÌË Ì‡ıÓ‰ÍË ÔË ÌÂÍÓÔÒËfl ‚ Ò‡‚ÌÂ-ÌËÂ Ò ÔËÒÚ˙Ô̇ڇ åë. ìÒÚ‡ÌÓ‚ÂÌË Ò‡ Ë ËÏÛÌÓ„ÂÌÂÚ˘-ÌË ‡Á΢Ëfl, ̇È-‚˜ ÔÂӷ·‰‡‚‡Ì ̇ HLA-DR4 ÔÓÁË-ÚË‚ÌË Ô‡ˆËÂÌÚË ÒÔflÏÓ „ÛÔ‡Ú‡ Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌ-Ú̇ ÙÓχ.

ᇠ‡Á„‡Ì˘‡‚‡Ì ̇ ÔËÒÚ˙Ô̇ڇ åë Ò˙Ò ÒÚ˙Ô‡ÎÓ-‚ˉÌÓ ‚ÎÓ¯‡‚‡ÌÂ Ë ‚ÚÓ˘ÌÓ ÔÓ„ÂÒˇ˘‡Ú‡ Ò‡ Ó·ÓÒÓ-·ÂÌË ÔËÒÚ˙ÔÌÓ-ÔÓ„ÂÒˇ˘‡ Ë ÔÓ„ÂÒˇ˘Ó-ÔËÒÚ˙Ô-̇ ÔÓ‰ÙÓÏË Ì‡ ÔÓ„ÂÒˇ˘‡Ú‡ ÙÓχ.

èÓ„ÂÒˇ˘Ó-ÔËÒÚ˙Ô̇ڇ ÙÓχ ӷ‰ËÌfl‚‡ ÒÎÛ˜‡Ë-Ú ̇ ÍÓÏ·ËÌˇÌ ̇ ÔËÒÚ˙ÔË Ë ÔÓ„ÂÒËfl ӯ ‚ ‡ÌÌË-Ú ÔÂËÓ‰Ë Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÌÓ Á‡ ‡ÁÎË͇ ÓÚ Ô˙‚˘ÌÓÔÓ„ÂÒˇ˘‡Ú‡ ÙÓχ, Ò ̇·Î˛‰‡‚‡Ú flÒÌÓ ËÁ‡ÁÂÌË ÓÒ-ÚË ÔËÒÚ˙ÔË Ò ËÎË ·ÂÁ Ô˙ÎÌÓ ‚˙ÁÒÚ‡ÌÓ‚fl‚‡ÌÂ. èÂËÓ‰Ë-Ú ÏÂÊ‰Û ÔËÒÚ˙ÔËÚ Ò ı‡‡ÍÚÂËÁË‡Ú Ò ÔÓ‰˙Îʇ-‚‡˘‡ ÔÓ„ÂÒËfl. í‡ÁË ÙÓχ  ҂˙Á‡Ì‡ Ò ÔÓ- ÎÓ¯‡ ÔÓ„ÌÓ-Á‡.

èËÒÚ˙ÔÌÓ-ÔÓ„ÂÒˇ˘‡Ú‡ ÙÓχ Ó·ı‚‡˘‡ ÒÎÛ˜‡ËÚÂÒ Ô˙‚˘ÌÓ ÔÓ„ÂÒˇ˘Ó ÔÓÚ˘‡ÌÂ, ÔË ÍÓËÚÓ ÔÓ-Í˙ÒÌÓÒ ÔÓfl‚fl‚‡Ú Ë ÔËÒÚ˙ÔË.

ëÔÓ‰ ÒÚÂÔÂÌÚ‡ Ë ÒÍÓÓÒÚÚ‡ ̇ ‡Á‚ËÚË ̇ Ì‚Ó-Îӄ˘ÌËfl ‰ÂÙˈËÚ åë Ò ‡Á‰ÂÎfl ̇ ‰Ó·Ó͇˜ÂÒÚ‚Â̇ ËÁÎÓ͇˜ÂÒÚ‚Â̇ ÙÓχ. ÑÓ·Ó͇˜ÂÒÚ‚Â̇ڇ ÙÓχ ̇ åëÏÓÊ ‰‡ ·˙‰Â ˉÂÌÚËÙˈˇ̇ ÂÚÓÒÔÂÍÚË‚ÌÓ, ͇ÚÓ ÒÂÔˆÂÌË, ˜Â 15 „Ó‰ËÌË ÒΉ ̇˜‡ÎÓÚÓ Ì‡ Á‡·ÓÎfl‚‡ÌÂÚÓ,˜ÂÒÚÓÚ‡Ú‡ Ë ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ, ͇ÍÚÓ Ë ÔÓ„-ÂÒˇ˘ËflÚ Ì‚ÓÎӄ˘ÂÌ ‰ÂÙˈËÚ, Ò‡ fl‚ÌÓ ÔÓ-Ò··Ó ËÁ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 100‡ÔËÎ, 2002

ÅöãÉÄêëäà ÄãÉéêàíöåáÄ ÑàÄÉçéëíàäÄ à ãÖóÖçàÖ çÄ åçéÜÖëíÇÖçÄíÄ

ëäãÖêéáÄ

èÓ‰ ‰‡ÍˆËflÚ‡ ̇: à. åË·ÌÓ‚, Ñ. ÉÂÓ„Ë‚, ã. óËÔËÎÒÍË

‡ÁÂÌË ‚ Ò‡‚ÌÂÌËÂ Ò ÚÂÁË ÔË ‰Û„ËÚ „ÛÔË. àÌ‚‡ÎˉË-ÁËÁ‡ˆËflÚ‡  Ò··‡ Ë ÔÓÁ‚ÓÎfl‚‡ ̇ Ô‡ˆËÂÌÚ‡ ‰‡ ÓÒڇ̠Ò̇Ô˙ÎÌÓ Á‡Ô‡ÁÂÌË ÙÛÌ͈ËË ‚˙‚ ‚Ò˘ÍË Á‡Ò„̇ÚË ÒËÒÚÂÏË.ÑÂÒÂÚ „Ó‰ËÌË ÒΉ ‰Ë‡„ÌÓÒÚˈˇÌÂÚÓ 1/3 ÓÚ Ô‡ˆËÂÌÚË-Ú ËÏ‡Ú ·ÂÌË„ÌÂÌÓ ÔÓÚ˘‡Ì ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÔÓÔÓ-ˆËflÚ‡ ̇χÎfl‚‡ ‰Ó 1/5 Á‡ 20 „Ó‰ËÌË. íÓÁË Ù‡ÍÚ ÔÓ͇Á‚‡,˜Â ÔË̇‰ÎÂÊÌÓÒÚÚ‡ Í˙Ï ‰Ó·Ó͇˜ÂÒÚ‚Â̇ڇ ÙÓχ ̇ÔÓÚ˘‡Ì  ÓÚÌÓÒËÚÂÎ̇ Ë Ú˙ÔË ÔÓÏfl̇ ‚˙‚ ‚ÂÏÂ-ÚÓ.

áÎÓ͇˜ÂÒÚ‚Â̇ åë Ò ̇Ïˇ ÔË Ï‡ÎÍÓ Ô‡ˆËÂÌÚË, ÍÓ-ËÚÓ ·˙ÁÓ ‡Á‚Ë‚‡Ú ÚÂÊ˙Í ‰ÂÙˈËÚ ‚ ‡ÁÒÚÓflÌË ̇ ÏÂ-ÒÂˆË ËÎË ÌflÍÓÎÍÓ „Ó‰ËÌË.

Ñˇ„ÌÓÒÚ˘ÌË ÏÂÚÓ‰Ë. ÑÓÒ„‡ Ì  ËÁ‚ÂÒÚÂÌ Î‡·Ó‡-ÚÓÂÌ ÚÂÒÚ, ÍÓÈÚÓ ‰‡  ÒÔˆËÙ˘ÂÌ Á‡ åë. èË ÏÌÓ„ÓÁ‡·ÓÎfl‚‡ÌËfl ÏÓ„‡Ú ‰‡ Ò ÓÚÍËflÚ ÏÛÎÚËÙÓ͇ÎÌË ÏÓÁ˙˜-ÌË ÎÂÁËË ÔË åêí Ë ÍÎËÌ˘ÌË ÒËÏÔÚÓÏË Ò ÔËÒÚ˙ÔÌÓ-Â-ÏËÚˇ˘ ıÓ‰ ‚ Ï·‰‡ ‚˙Á‡ÒÚ. çÂÚӘ̇ ‰Ë‡„ÌÓÁ‡ Ò ÔÓÒ-Ú‡‚fl ‚ ÓÍÓÎÓ 5%, ڇ͇ ˜Â 1 ̇ 20 ·ÓÎÌË ÌÂ Â Ò Ú‡ÍÓ‚‡ Á‡-·ÓÎfl‚‡ÌÂ. éÒÓ·ÂÌÓ ‚‡ÊÌÓ Â ‡ÌÌÓÚÓ ÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„-ÌÓÁ‡Ú‡ Ò Ó„Î‰ ̇ Ò˙‚ÂÏÂÌÌËÚ Ú‡Ô‚Ú˘ÌË ‚˙ÁÏÓÊ-ÌÓÒÚË. ê‡ÌÌÓÚÓ ÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„ÌÓÁ‡Ú‡ Ó·ËÍÌÓ‚ÂÌÓ ÂÚÛ‰ÌÓ, Ú˙È Í‡ÚÓ Ô˙‚ËÚ ÒËÏÔÚÓÏË Ò‡ Ó·ËÍÌÓ‚ÂÌÓÌÂÒÔˆËÙ˘ÌË, ÎÂÍË Ë ·˙ÁÓÔÂıÓ‰ÌË.

èË ÓÔ·͂‡ÌËfl ÓÚ Ò··ÓÒÚ ‚ ͇ÈÌˈËÚÂ, Á‡ÎËÚ‡ÌÂ,ÁËÚÂÎÌË Ì‡Û¯ÂÌËfl ‚ÒΉÒÚ‚Ë ̇ ÂÚÓ·Ûη‡ÂÌÌ‚ËÚ, Ú‡ÁÓ‚Ó-ÂÁ‚ӇÌË Ì‡Û¯ÂÌËfl ËÎË ËÁÚ˙Ô-‚‡ÌËfl ̇ ͇ÈÌˈËÚ ÔË ·ÓÎÂÌ ÔË ÍÓÈÚÓ Ì  ‰Ë‡„-ÌÓÒÚˈˇ̇ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ ‰Ó ÚÓÁË ÏÓ-ÏÂÌÚ, ËÎË ÔË ÔÓfl‚‡ ̇ ÌÓ‚Ë ÓÔ·͂‡ÌËfl ÔË ·ÓÎÌË Ò‚Â˜Â ÔÓÒÚ‡‚Â̇ ‰Ë‡„ÌÓÁ‡, Ó·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ëfl ÎÂ͇Úfl·‚‡ ‰‡ ̇ÒÓ˜Ë ·ÓÎÌËfl ÌÂÁ‡·‡‚ÌÓ Í˙Ï Ì‚ÓÎÓ„.

ç‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ ÔˆËÁˇ ‰Ë‡„ÌÓÁ‡Ú‡, ͇ÚÓËÁÔÓÎÁ‚‡ ‰Ë‡„ÌÓÒÚ˘ÌËÚ ÍËÚÂËË Ì‡ Poser (èËÎÓ-ÊÂÌË 2), ËÁ‚˙¯Ë Ò˙ÓÚ‚ÂÚÌËÚ ··Ó‡ÚÓÌË ËÁÒ-Ή‚‡ÌËfl Ë ÍÓÌÒÛÎÚ‡ˆËË ‡Ï·Û·ÚÓÌÓ, ËÎË Í‡ÚÓ ıÓÒ-ÔËÚ‡ÎËÁˇ ·ÓÎÌËfl. ç‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ ÛÒÚ‡ÌÓ‚ËÙÓχڇ ̇ ÔÓÚ˘‡Ì ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡,„Ӊ˯ÌËflÚ ·ÓÈ Ì‡ ÔÓÎÛ˜ÂÌËÚ ÔËÒÚ˙ÔË Ë Úflı̇ڇÚÂÊÂÒÚ.

ㇷӇÚÓÌËÚ ÏÂÚÓ‰Ë ‚Íβ˜‚‡Ú:1. éÙÚ‡ÎÏÓÎӄ˘ÌÓ ËÁÒΉ‚‡ÌÂ: Ó˜ÌË ‰˙̇, ÔÂËÏÂÚË.

íËÔ˘ÌÓ Â ÚÂÏÔÓ‡ÎÌÓÚÓ ÔӷΉÌfl‚‡Ì ̇ Ô‡ÔËÎËÚÂ, ͇-ÚÓ ÒËÏÔÚÓÏ Ì‡ ÔÂ͇‡Ì ÂÚÓ·Ûη‡ÂÌ Ì‚ËÚ.

2. ç‚ÓÙËÁËÓÎӄ˘ÌË ËÁÒΉ‚‡ÌËfl: ÁËÚÂÎÌË, ÒÎÛıÓ‚ËË ÒÓχÚÓÒÂÌÁÓÌË Ô‰ËÁ‚Ë͇ÌË ÔÓÚÂ̈ˇÎË. ë Úflı ÒÂÚ˙ÒflÚ ÎÂÁËË ‚ ˆÂÌÚ‡Î̇ڇ Ì‚̇ ÒËÒÚÂχ (ñçë) ÔË·ÓÎÌË Ò ÓÒÍ˙‰ÌË ÍÎËÌ˘ÌË ÒËÏÔÚÓÏË. ë˙ÓÚ‚ÂÚÌÓ Ò ËÁÒ-Ή‚‡Ú ÚÓÁË ‚ˉ Ô‰ËÁ‚Ë͇ÌË ÔÓÚÂ̈ˇÎË, Ò ÍÓËÚÓ ÏÓ-Ê ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ÒÛ·ÍÎËÌ˘̇ ÎÂÁËfl ̇ ÒËÒÚÂχ, ÍÓflÚÓÌ ÔÓ͇Á‚‡ ÍÎËÌ˘ÌË ÒËÏÔÚÓÏË Ì‡ ۂ‰‡. èÓÏÂÌËÚ ‚Ô‰ËÁ‚Ë͇ÌËÚ ÔÓÚÂ̈ˇÎË Ò ËÁ‡Áfl‚‡Ú ‚ Û‰˙ÎÊÂ̇ ·-ÚÂÌÚÌÓÒÚ, ËÁÏÂÌÂÌË ‡ÏÔÎËÚÛ‰‡ Ë ÍÓÌÙË„Û‡ˆËfl ̇ ‚˙Î-ÌËÚÂ Ë ÏÂʉÛıÂÏËÒÙÂÌË ‡ÒËÏÂÚËË. èËÂχ ÒÂ, ˜Â ̇È-„ÓÎflχ ‰Ë‡„ÌÓÒÚ˘̇ ÒÚÓÈÌÓÒÚ Ëχ ËÁÒΉ‚‡ÌÂÚÓ Ì‡ÁËÚÂÎÌËÚ Ô‰ËÁ‚Ë͇ÌË ÔÓÚÂ̈ˇÎË.

3. ç‚ÓËÁÓ·‡Áfl‚‡˘Ë ËÁÒΉ‚‡ÌËfl - χ„ÌËÚÌÓ ÂÁÓ-̇ÌÒ̇ڇ ÚÓÏÓ„‡ÙËfl  ÏÂÚÓ‰ ̇ ËÁ·Ó. àÁÔÓÎÁ‚‡ ÒÂÚÂıÌË͇ Ò ‡ÍÒˇÎÌË Ë Ô‡‡Ò‡„ËÚ‡ÎÌË í1/í2 ÒÍÂÌˇÌËfl,ÒÂËÈÌË ËÁÓ·‡Áfl‚‡ÌËfl, gadolinium DTPA /Magnevist/ ̇-ÚÓ‚‡ÂÌÓ ÒÍÂÌˇÌÂ. ëÔˆËÙ˘̇ڇ ÎÓ͇ÎËÁ‡ˆËfl ̇ ÎÂÁË-ËÚ  ‚ corpus callosum, ÔÂË‚ÂÌÚËÍÛ·ÌÓ ËÎË ÒÛ·ÚÂÌ-ÚÓˇÎÌÓ ‚ ÒÚ‚Ó·, χÎÍËfl ÏÓÁ˙Í Ë ¯ËÈÌËfl ÓÚ‰ÂΠ̇„˙·Ì‡˜ÌËfl ÏÓÁ˙Í. íËÔ˘̇ڇ ÙÓχ  ӂÓˉ̇, ‡ ‡ÁÏÂ-

˙Ú Ì‡ ÎÂÁËËÚ  ̇‰ 6 ÏÏ ‚ ‰Ë‡ÏÂÚ˙. èÓÌ ÌflÍÓË ÓÚÎÂÁËËÚ Úfl·‚‡ ‰‡ ÔÓ͇Á‚‡Ú ÍÓÌÚ‡ÒÚÌÓ ÛÒË΂‡Ì ÔÓ‰ÙÓχڇ ̇ "ÓÚ‚ÓÂÌ Ô˙ÒÚÂÌ".

4. ãËÍ‚ÓÓÎӄ˘ÌÓ ËÁÒΉ‚‡ÌÂ: Ó·˘Ó ËÁÒΉ‚‡ÌÂ, ÂÎÂÍ-ÚÓÙÓÂÁ‡. ç‡È-ÒÔˆËÙ˘̇ ÎËÍ‚Ó̇ ̇ıӉ͇  ̇΢ËÂ-ÚÓ Ì‡ ÓÎË„ÓÍÎÓ̇ÎÌË Ë‚ËˆË ÔË ‡„‡Ó‚‡ Ë ‡„‡ÓÁ̇ ÂÎÂÍÚ-ÓÙÓÂÁ‡ Ë ÔË ËÁÓÂÎÂÍÚ˘ÌÓ ÙÓÍÛÒˇÌÂ.

ç  ÌÂÓ·ıÓ‰ËÏÓ ‰‡ Ò ËÁ‚˙¯‚‡Ú ‚Ò˘ÍË Î‡·Ó‡ÚÓ-ÌË ËÁÒΉ‚‡ÌËfl ÔË ·ÓÎÌËfl, ‡ Ò‡ÏÓ ÚÂÁË ÍÓËÚÓ Ò‡ ‰ÓÒ-Ú‡Ú˙˜ÌË Á‡ ÔÓÒÚ‡‚flÌ ̇ ‰Ë‡„ÌÓÁ‡Ú‡ ÔÓ ÍËÚÂËË-Ú ̇ Poser, ͇ÚÓ Ò ÔÓ‚Âʉ‡Ú Ò˙Ó·‡ÁÌÓ ‰Ë‡„ÌÓÒ-Ú˘ÌËÚ ‚˙ÁÏÓÊÌÓÒÚË ÔÓ Û͇Á‡Ì‡Ú‡ ÔÓÒΉӂ‡ÚÂÎ-ÌÓÒÚ.

ÑËÙÂÂ̈ˇÎ̇ڇ ‰Ë‡„ÌÓÁ‡ ‚Íβ˜‚‡ ÏÌÓÊÂÒÚ‚Ó Á‡-·ÓÎfl‚‡ÌËfl, ÍÓËÚÓ ÍÎËÌ˘ÌÓ, ËÎË ÔÓ ÂÁÛÎÚ‡ÚËÚ ÓÚ Î‡-·Ó‡ÚÓÌËÚ ËÁÒΉ‚‡ÌËfl ̇ÔÓ‰Ó·fl‚‡Ú åë. ÑËÙÂÂ̈Ë-‡Î̇ڇ ‰Ë‡„ÌÓÁ‡ Ò ԇ‚Ë ÔË ‡Á΢ÌË Á‡·ÓÎfl‚‡ÌËfl:

I. åÓÌÓÒËÏÔÚÓχÚ˘̇ åë:1. éÔÚ˘ÌËflÚ Ì‚ËÚ ˜ÂÒÚÓ Â Ô˙‚ËflÚ ÒËÏÔÚÓÏ Ì‡

åë Ë Ò ̇·„‡ ‰‡ Ò ÓÚ‰ËÙÂÂ̈ˇ ÓÚ ÏÓÌÓÒËÏÔÚÓχ-Ú˘̇ åë. ÅÓÎÌË Ò ÂÚÓ·Ûη‡ÂÌ Ì‚ËÚ, ÍÓËÚÓ ËχÚÎÂÁËË Ì‡ åêí ˜ÂÒÚÓ ‡Á‚Ë‚‡Ú åë ‚ ‡Á΢ÌÓ ‰˙Î˙„ ÔÂË-Ó‰ ÓÚ ‚ÂÏÂ, ‰Ó͇ÚÓ ÚÂÁË Ò ÌÓχÎ̇ åêí ËÏ‡Ú ÔÓ-‰Ó·-‡ ÔÓ„ÌÓÁ‡ Ë ÏÓÊ ÌËÍÓ„‡ ‰‡ Ì ‡Á‚ËflÚ åë. ÍÚÂ-ËÁˇ ÒÂ Ò ·˙ÁÓ Ì‡Ï‡Îfl‚‡Ì ̇ ÁËÚÂÎ̇ڇ ÓÒÚÓÚ‡ ‚‰ÌÓÚÓ ËÎË ‰‚ÂÚ ӘË, ÂÚÓ·Ûη‡Ì‡ ·ÓÎ͇, ÎËÔÒ‡ ̇ fl-ÍÓÒÚ Ë ˆ‚ÂÚÌÓ ÁÂÌËÂ Ë ˜ÂÒÚÓ ˆÂÌÚ‡ÎÂÌ ÒÍÓÚÓÏ. áÂÌË-ÂÚÓ Ó·ËÍÌÓ‚ÂÌÓ Ò ÔÓ‰Ó·fl‚‡ Á‡ ÔÂËÓ‰ ÓÚ ÌflÍÓÎÍÓ Ò‰-ÏËˆË ‰Ó ÌflÍÓÎÍÓ ÏÂÒˆ‡. áËÚÂÎÌËÚ ̇ۯÂÌËfl ÔË ÓÔ-Ú˘ÂÌ Ì‚ËÚ Ò ‰˙ÎÊ‡Ú Ì‡ Ô˙‚˘̇ ‰ÂÏËÂÎËÌËÁ‡ˆËfl ̇Ì‚‡, ÍÓflÚÓ Úfl·‚‡ ‰‡ Ò ‡ÁÎË˜Ë ÓÚ ‚ÚÓ˘̇ڇ ‰ÂÏË-ÂÎËÌËÁ‡ˆËfl ÔË ÁËÚÂÎ̇ Ì‚ÓÔ‡ÚËfl, ÍÓflÚÓ ËÏËÚˇÂÚÓ·Ûη‡ÌËfl Ì‚ËÚ. ç‡È-˜ÂÒÚÓ ‚ÚÓ˘̇ ‰ÂÏËÂÎË-ÌËÁ‡ˆËfl Ò ‡Á‚Ë‚‡ ÔË ÍÓÏÔÂÒËfl, ËÒıÂÏËfl ËÎË ÚÓÍÒ˘̇ۂ‰‡ ̇ ÁËÚÂÎÌËfl Ì‚. éÒ‚ÂÌ ÚÓ‚‡ ‡Á΢ÌË ‚ËÛÒÌË,·‡ÍÚ¡ÎÌË Ë „˙·Ë˜ÌË ËÌÙÂ͈ËË ÏÓ„‡Ú ‰‡ Ô‰ËÁ‚Ë͇ڂ˙ÁÔ‡ÎËÚÂÎÌË ÔÓˆÂÒË ‚ Ì„Ó. éÔËÒ‡ÌË Ò‡ ÔÓÒÚ-‚ËÛÒÌË ËÔÓÒÚ‚‡ÍÒË̇ÎÌË ÁËÚÂÎÌË Ì‚ËÚË, ‡ Ò˙˘Ó ڇ͇ Ú‡ÍË‚‡Ë ÔË ÍÓ·„ÂÌÓÁË. ífl·‚‡ ‰‡ Ò ËÁÍβ˜Ë Ë ı‰Ëڇ̇ڇÓÔÚ˘̇ ‡ÚÓÙËfl ̇ ã·Â.

2. åËÂÎÓÔ‡ÚËflÚ‡ Ò ÔÓ„ÂÒË‚ÌÓ ‡Á‚Ë‚‡˘‡ Ò ԇ‡-ËÎË Í‚‡‰ËÔ‡ÂÁ‡ ÔË ·ÓÎÌË ‚ Ò‰̇ ‚˙Á‡ÒÚ Úfl·‚‡ ‰‡Ò ÓÚ‰ËÙÂÂ̈ˇ ÓÚ åë. çÂÓ·ıÓ‰ËÏÓ Â ‰‡ Ò ËÁÍβ˜Ë͇ÚÓ Ô˘Ë̇ ‚˙̯̇ ËÎË ‚˙Ú¯̇ „˙·Ì‡˜ÌÓ-ÏÓÁ˙˜Ì‡ÍÓÏÔÂÒËfl, ˆÂ‚Ë͇Î̇ ÒÔÓ̉ËÎÓÁ‡ Ò ÏËÂÎÓÔ‡ÚËfl Ë ‰ÂÙË-ˆËÚ Ì‡ ‚ËÚ‡ÏËÌ Ç12. åêí ¯‡‚‡ ÔÓ·ÎÂχ Ò Ì‡Î˘ËÂÚÓ̇ ÒÔË̇ÎÌË Ë ˆÂ·‡ÎÌË ÎÂÁËË ÔË åë.

II. Ä‚ÚÓËÏÛÌÌË1. ëËÒÚÂÏÌËflÚ ÎÛÔÛÒ ÂËÚÂχÚÓ‰ÂÒ ÔË 30% ÓÚ

·ÓÎÌËÚ ̇ åêí Ò ̇ÏË‡Ú ıËÔÂËÌÚÂÌÁÌË ÎÂÁËË Ì‡‰ 6ÏÏ, ‚ ÎËÍ‚Ó‡ ÏÓ„‡Ú ‰‡ Ò ̇ÏÂflÚ Û‚Â΢ÂÌË IgG Ë ÔÓ-ÌflÍÓ„‡ ÓÎË„ÓÍÎÓ̇ÎÌÓÒÚ. èË ÍÎËÌ˘̇ ͇ÚË̇ Ò ÏËÂÎÓ-Ô‡ÚËfl Ë ÁËÚÂÎÌË Ì‡Û¯ÂÌËfl ‰ËÙÂÂ̈ˇÎ̇ڇ ‰Ë‡„ÌÓÁ‡Â Ӣ ÔÓ-Úۉ̇. ç‡Î˘ËÂÚÓ Ì‡ ‡ÌÚËÌÛÍ·ÌË ‡ÌÚËÚÂ-·  ÒÔˆËÙ˘ÌÓ Á‡ ÎÛÔÛÒ‡, ÌÓ Ò ̇Ïˇ Ë ÔË 25% ÓÚ ·ÓÎ-ÌËÚÂ Ò åë.

2. ëË̉ÓÏ˙Ú Ì‡ ë¸Ó„ÂÌ Â ‡‚ÚÓËÏÛÌÌÓ Á‡·ÓÎfl‚‡ÌÂÒ ÔÓ„ÂÒ˂̇ ‰ÂÒÚÛ͈Ëfl ̇ ÒÎ˛Ì˜ÂÌËÚÂ Ë ÒÎ˙ÁÌËÚÂÊÎÂÁË, ÍÓÂÚÓ ‚ 25% Á‡Òfl„‡ Ë ñçë Ò ÍÎËÌ˘̇ ͇ÚË̇·ÎËÁ͇ ‰Ó Ú‡ÁË Ì‡ åë. èÓÚ˘‡ÌÂÚÓ Â Ì‡È-˜ÂÒÚÓ ÔËÒ-Ú˙ÔÌÓ-ÂÏËÚˇ˘Ó, åêí ÔÓ͇Á‚‡ ÏÌÓÊÂÒÚ‚ÂÌË ÔÂË-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 101‡ÔËÎ, 2002

‚ÂÌÚËÍÛ·ÌË ÎÂÁËË, ̇Îˈ  ÓÎË„ÓÍÎÓ̇ÎÂÌ ÎËÍ‚Ó. ç‡-΢ËÂÚÓ Ì‡ ÔÓÏÂÌË ‚ ÊÎÂÁËÚÂ, Ì‚ÓÔ‡ÚËfl, ÏËÓÁËÚË ËÒÂÓÎӄ˘ÌË ‡·ÌÓÏÌÓÒÚË ÔÓχ„‡ ‚ ‰ËÙÂÂ̈ˇÎ̇ڇ ‰Ë-‡„ÌÓÁ‡.

3. ÅÓÎÂÒÚÚ‡ ̇ ÅÂı˜ÂÚ Â ÏÛÎÚËÒËÒÚÂÏÌÓ ‚˙ÁÔ‡ÎË-ÚÂÎÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÍÓÂÚÓ Á‡Òfl„‡ Ë ñçë. óÂÒÚÓ Ò Á‡Òfl„‡ÚÁËÚÂÎÌËÚ ÌÂ‚Ë Ë ÏËÂÎÓ̇. ãËÍ‚Ó̇ڇ Ë åêí ̇ıÓ‰-͇ Ò‡ ÏÌÓ„Ó ÔÓ‰Ó·ÌË Ì‡ ÚÂÁË ÔË åë, ÌÓ ÔË åêí ÏÓ„‡Ú‰‡ Ò ̇ÏÂflÚ Ë ÎÂÔÚÓÏÂÌË̄‡ÎÌË ÔÓÏÂÌË. äÓÊÌÓ-ÎË-„‡‚˘ÌËÚ ÛΈ‡ˆËË ÔÓ ÛÒÚ̇ڇ ÎË„‡‚ˈ‡ Ë ÔÂËÌÂÛχ҇ ÚËÔ˘ÌË Á‡ ·ÓÎÂÒÚÚ‡ ̇ ÅÂı˜ÂÚ.

4. çÓ‰ÓÁÌËflÚ ÔÓΡÚÂËËÚ Â ÏÛÎÚËÒËÒÚÂÏÌÓ ‚˙Á-Ô‡ÎËÚÂÎÌÓ-‡‚ÚÓËÏÛÌÌÓ Á‡·ÓÎfl‚‡ÌÂ, ÍÓÂÚÓ Á‡Òfl„‡ Ë ñçë.

5. éÒÚËflÚ ‰ËÒÂÏËÌË‡Ì Â̈ÂÙ‡ÎÓÏËÂÎËÚ Á‡ÔÓ˜‚‡ÒΉ ÔÂ͇‡Ì‡ ‚ËÛÒ̇ ËÌÙÂ͈Ëfl ËÎË ÒΉ ËÏÛÌËÁ‡ˆËfl.íÓ‚‡ ‚˙ÁÔ‡ÎËÚÂÎÌÓ ‰ÂÏËÂÎËÌËÁˇ˘Ó Á‡·ÓÎfl‚‡Ì Ò ‡Á-‚Ë‚‡ ÔÓ-˜ÂÒÚÓ ÔË ‰Âˆ‡ Ë Ó·ËÍÌÓ‚ÂÌÓ Â ÏÓÌÓÙ‡ÁÌÓ. á‡ÔÓ˜-‚‡ ÓÒÚÓ, Ò Ôӂ˯Â̇ ÚÂÏÔ‡ÚÛ‡, Ó·˘ÓÏÓÁ˙˜Ì‡ ÒËÏÔ-ÚÓχÚË͇, ÏÛÎÚËÙÓ͇ÎÌË Ì‚ÓÎӄ˘ÌË ÒËÏÔÚÓÏË ËÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË.

III. àÌÙÂ͈ËÓÁÌË1. ã‡ÈÏÒ͇ڇ ·ÓÎÂÒÚ ˜ÂÒÚÓ ÔÓÚ˘‡ ͇ÚÓ Ì‚ӷÓ-

ÂÎËÓÁ‡ Ò ÏÂÌËÌ„ËÚ, ͇ÌˇÎÂÌ Ì‚ËÚ, ÏËÂÎÓÔ‡ÚËfl ËÎËÂ̈ÂÙ‡ÎËÚ. èÓÏÂÌËÚ ‚ åêí Ë ÎËÍ‚Ó‡ ÚÛ‰ÌÓ Ò ÓÚ-΢‡‚‡Ú ÓÚ ÚÂÁË ÔË åë. ìÒÚ‡ÌÓ‚fl‚‡Ú Ò ‡ÌÚËÚ·ÒÂ˘Û Borrelia burgdorferi, ÌÓ Ú Ì ҇ ‡·ÒÓβÚÌÓ ÒÔˆË-Ù˘ÌË Ë ÏÓ„‡Ú ‰‡ Ò ̇ÏÂflÚ Ë ÔË ‰Û„Ë ‚˙ÁÔ‡ÎËÚÂÎÌËÁ‡·ÓÎfl‚‡ÌËfl ̇ ñçë, ‚Íβ˜ËÚÂÎÌÓ Ë ÔË åë.

2. ãÛÂÒ˙Ú Á‡Òfl„‡ Ë ñçë Ë ÔÓÌflÍÓ„‡ ÍÎËÌ˘ÌÓ ÏÓÊ ‰‡Ò˙Á‰‡‰Â ‰ËÙÂÂ̈ˇÎÌÓ-‰Ë‡„ÌÓÒÚ˘ÌË Á‡ÚÛ‰ÌÂÌËfl. Ñˇ-„ÌÓÁ‡Ú‡ Ò ÔÓÒÚ‡‚fl ‚˙Á ÓÒÌÓ‚‡ ̇ ÂÁÛÎÚ‡ÚËÚ ÓÚ ÒÂÓ-Îӄ˘ÌËÚ ÔÓ·Ë.

ëèàç ˜ÂÒÚÓ Á‡Òfl„‡ ñçë ‚ ÔÓ-Í˙ÒÌËÚ ÒÚ‡‰ËË, ÌÓ ‚10%, ÚÓ‚‡ ÏÓÊ ‰‡ ·˙‰Â ̇˜‡Î̇ ÔÓfl‚‡. Ñˇ„ÌÓÁ‡Ú‡ ÒÂÔÓÒÚ‡‚fl ˜ÂÁ ÔÓÎÓÊËÚÂÎÌËÚ ÒÂÓÎӄ˘ÌË ÔÓ·Ë Ë ÔÓ‚Ë-¯ÂÌËflÚ Ó·˘ ·ÂÎÚ˙Í Ë ÍÎÂÚÍË ‚ ÎËÍ‚Ó‡, ÍÓÈÚÓ fl‰ÍÓÏÓÊ ‰‡ ·˙‰Â ÓÎË„ÓÍÎÓ̇ÎÂÌ.

IV. ĉÂÌÓ΂ÍÓ‰ËÒÚÓÙËflÚ‡  „ÂÌÂÚ˘ÌÓ Á‡·ÓÎfl‚‡ÌÂÒ‚˙Á‡ÌÓ Ò Ì‡ÚÛÔ‚‡Ì ̇ ÏÌÓ„Ó, ‰˙΄ӂÂËÊÌË Ï‡ÒÚÌËÍËÒÂÎËÌË (VLFA). àÁÒΉ‚‡ÌÂÚÓ Ì‡ VLFA ‚ Ô·Áχڇ ÏÓ-Ê ‰‡ ÔÓÒÚ‡‚Ë ‰Ë‡„ÌÓÁ‡Ú‡, ÍÓflÚÓ Â Úۉ̇, Á‡¯ÓÚÓ ÎËÍ-‚ÓÌÓÚÓ Ë åêí ËÁÒΉ‚‡ÌËfl ÔÓ͇Á‚‡Ú ËÁÏÂÌÂÌËfl ͇ÚÓÔË åë. ï-Ò‚˙Á‡Ì‡Ú‡ ÙÓχ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ò ÔÓfl‚fl-‚‡ ‚ ˛ÌÓ¯ÂÒ͇ Ë ÔÓ-Áfl· ‚˙Á‡ÒÚ Ò ÔÓ„ÂÒ˂̇ ÏËÂÎÓ ËÌ‚ÓÔ‡ÚËfl Ë ÔË ÎËÔÒ‡ ̇ ‡Ì‡ÏÌÂÁ‡ Á‡ Ù‡ÏËÎÌÓÒÚ Ò˙Á‰‡-‚‡ ÒÂËÓÁÌË ‰ËÙÂÂ̈ˇÎÌÓ-‰Ë‡„ÌÓÒÚËflÌË Á‡ÚÛ‰ÌÂÌËfl.

V. åËÚÓıÓ̉ˇÎ̇ڇ Â̈ÂÙ‡ÎÓÔ‡ÚËfl Ò Î‡ÍÚ‡Ú ‡ˆË-‰ÓÁ‡ Ë ËÌÒÛÎÚÌÓ-ÔÓ‰Ó·ÌË Ë̈ˉÂÌÚË (MELAS) Ò ÔÓfl‚fl-‚‡ ‚ ‰ÂÚÒ͇ڇ ‚˙Á‡ÒÚ. íÓ‚‡ ̇ÒΉÒÚ‚ÂÌÓ Á‡·ÓÎfl‚‡Ì ÒÂÔÓfl‚fl‚‡ Ò ‚˙̯̇ ÓÙÚ‡ÎÏÓÔ‡ÂÁ‡, Ò··ÓÒÚ Ì‡ ÔÓÍÒË-χÎÌËÚ ÏÛÒÍÛÎÌË „ÛÔË Ë ÂÔËÎÂÔÚ˘ÌË ÔËÔ‡‰˙ˆË. ãËÍ-‚ÓÌÓÚÓ ËÁÒΉ‚‡Ì ̇ ·ÍÚ‡Ú Ë ÔËÛ‚‡Ú ÔÓÒÚ‡‚fl ‰Ë‡„-ÌÓÁ‡Ú‡.

VI. å‡ÎÙÓχˆËflÚ‡ ̇ Arnold Chiari Ó·ËÍÌÓ‚ÂÌÓ ‚Ó‰ËÌ ҇ÏÓ ‰Ó ËÁÓΡÌË ÒÔË̇ÎÌË ÒË̉ÓÏË, ÌÓ Ë Á‡Òfl„‡Ì ͇̇ۉ‡Î̇ڇ „ÛÔ‡ ˜ÂÂÔÌÓ-ÏÓÁ˙˜ÌË Ì‚Ë, χÎÍËflÚ ÏÓ-Á˙Í, ‡Ú‡ÍÒËfl Ë Ôӂ˯ÂÌÓ ËÌڇ͇ÌˇÎÌÓ Ì‡Îfl„‡ÌÂ. åêíÔÓ͇Á‚‡ ‡·ÌÓÏÌÓÒÚË ‚ ͇ÌËÓ-ˆÂ‚Ë͇Î̇ڇ ӷ·ÒÚ.

VII. å‡ÎÍÓÏÓÁ˙˜ÌËÚ ‡ÚÓÙËË Ò ÓÚ‰ËÙÂÂÌˆË‡Ú Ì‡·‡Á‡Ú‡ ̇ ‰‡ÌÌËÚ Á‡ Ù‡ÏËÎÌÓÒÚ, ÎËÔÒ‡Ú‡ ̇ ÂÏËÒËË ËÌÓχÎÌËflÚ ÎËÍ‚Ó.

VIII. ñ·ӂ‡ÒÍÛ·ÌËÚ Á‡·ÓÎfl‚‡ÌËfl Ë ÓÒÓ·ÂÌÓÏÌÓÊÂÒÚ‚ÂÌËÚ ÂÏ·ÓÎËÁ‡ˆËË ÏÓ„‡Ú ‰‡ Ò˙Á‰‡‰‡Ú ‰ËÙÂ-Â̈ˇÎÌÓ-‰Ë‡„ÌÓÒÚ˘ÌË ÔÓ·ÎÂÏË. í Ò ÓÚ‰ËÙÂÂ̈Ë-‡Ú ̇ ·‡Á‡Ú‡ ̇ ‰ÓÔÎÂ-ÒÓÌÓ„‡ÙÒÍÓÚÓ Ë ÂıÓ͇‰ËÓ„-‡ÙÒÍÓÚÓ ËÁÒΉ‚‡ÌÂ, ͇ÍÚÓ Ë ÌÓχÎ̇ڇ ÎËÍ‚Ó̇ ̇-ıӉ͇.

Iï. CADASIL Ô‰ÒÚ‡‚Îfl‚‡ ˆÂ·‡Î̇ ‡‚ÚÓÁÓÏÌÓ-‰Ó-ÏË̇ÌÚ̇ ‡ÚÂËÓÔ‡ÚËfl Ò˙Ò ÒÛ·ÍÓÚË͇ÎÌË ËÌÙ‡ÍÚËË Î‚ÍÓÂ̈ÂÙ‡ÎÓÔ‡ÚËfl, Ò‚˙Á‡Ì‡ Ò 19 ıÓÏÓÁÓχ. è˙‚Ë-Ú ÒËÏÔÚÓÏË Ò ÔÓfl‚fl‚‡Ú ÏÂÊ‰Û 30 Ë 50 „Ӊ˯̇ ‚˙Á-‡ÒÚ Ò ÔÓ‚Ú‡fl˘Ë Ò ËÌÒÛÎÚÌÓ-ÔÓ‰Ó·ÌË ÂÔËÁÓ‰Ë Ë ÔÓÒ-Ή‚‡˘Ó ‡Á‚ËÚË ̇ ‰ÂÏÂ̈Ëfl. èË åêí Ò ÛÒÚ‡ÌÓ‚fl-‚‡Ú ÏÌÓÊÂÒÚ‚ÂÌË ÒÛ·ÍÓÚË͇ÎÌË ÎÂÁËË. çÓχÎÌËflÚÎËÍ‚Ó Ë „ÂÌÂÚ˘ÌËflÚ ‡Ì‡ÎËÁ ÔÓχ„‡Ú Á‡ ÔÓÒÚ‡‚flÌÂÚÓ̇ ‰Ë‡„ÌÓÁ‡Ú‡.

ï. ë‡ÍÓˉÓÁ‡Ú‡  ÒËÒÚÂÏÌÓ „‡ÌÛÎÓχÚÓÁÌÓ Á‡·ÓÎfl‚‡-Ì Á‡Òfl„˘Ó Ô‰ËÏÌÓ ÎËÏÙÓ-ÂÚËÍÛ·̇ڇ ÒËÒÚÂχ, ÍÓ-ÂÚÓ ‚ 5% ÓÚ ·ÓÎÌËÚ ÏÓÊ ‰‡ ‰‡‰Â ÒËÏÔÚÓÏË ÓÚ ÒÚ‡-̇ ̇ ñçë. ç‚ÓÎӄ˘ÌËÚ ÒËÏÔÚÓÏË ËÁ‡ÁÂÌË ‚ ÎÂÁËË̇ óåç, ÁËÚÂÎÌË ‡ÁÒÚÓÈÒÚ‚‡ Ë ÔˇÏˉÌË ÒËÏÔÚÓ-ÏË, ÏÓ„‡Ú ‰‡ ·˙‰‡Ú Ô˙‚‡ ÔÓfl‚‡ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ÍÓÂ-ÚÓ Ëχ ÔËÒÚ˙ÔÌÓ-ÂÏËÚˇ˘ ıÓ‰. èË ÎËÍ‚ÓÌÓÚÓ ËÁ-ÒΉ‚‡Ì ÏÓÊ ‰‡ Ò ÛÒÚ‡ÌÓ‚Ë ÓÎË„ÓÍÎÓ̇ÎÌÓÒÚ, åêí ÔÓ-͇Á‚‡ ÔÓÏÂÌË Í‡ÍÚÓ ÔË åë, ÌÓ ÔË ÍÓÌÚ‡ÒÚÌÓ ËÁÒΉ-‚‡ÌÂ Ò gadolinium ÎÂÔÚÓÏÂÌË̄‡ÎÌÓÚÓ ÛÒË΂‡Ì  ı‡‡Í-ÚÂÌÓ Á‡ Á‡·ÓÎfl‚‡ÌÂÚÓ.

ᇷÓÎfl‚‡ÌËflÚ‡, Ò ÍÓËÚÓ Ò ԇ‚Ë ‰ËÙÂÂ̈ˇÎ̇ ‰Ë‡„-ÌÓÁ‡ ÏÓ„‡Ú ‰‡ Ò ‡Á‰ÂÎflÚ Ì‡ ÚË „ÛÔË, ÒÔÓ‰ ÚÓ‚‡ ‰‡-ÎË ÔÓ͇Á‚‡Ú Ò‡ÏÓ ÍÎËÌ˘ÌË, ÍÎËÌ˘ÌË Ë åêí, ËÎË ÍÎËÌ˘-ÌË, åêí Ë ÎËÍ‚ÓÓÎӄ˘ÌË ÔËÎËÍË Ò åë.

ᇷÓÎfl‚‡ÌËflÚ‡, ÍÓËÚÓ Ì‡ÔÓ‰Ó·fl‚‡Ú ÍÎËÌ˘ÌÓ åë, ÌÓÒ ‡Á΢‡‚‡Ú ÔË åêí ‚Íβ˜‚‡Ú:

1. ɇÌÛÎÓχÚÓÁ‡ ̇ Wegener2. àÁÓΡÌË ÒÔË̇ÎÌË ÒË̉ÓÏË3. äÓÏÔÂÒË‚ÌË ÎÂÁËË4. ÑÂÙˈËÚ Ì‡ Ç125. àÌڇ͇ÌˇÎÌË ÚÛÏÓË6. å‡ÎÙÓχˆËfl ̇ Arnold Chiari

ᇷÓÎfl‚‡ÌËflÚ‡, ÍÓËÚÓ Ì‡ÔÓ‰Ó·fl‚‡Ú åë ÍÎËÌ˘ÌÓ Ë Òåêí ÍËÚÂËË ‚Íβ˜‚‡Ú:

1. ëèàç2. å‡ÎÍÓÏÓÁ˙˜ÌË ‰Â„Â̇ˆËË3. åËÚÓıÓ̉ˇÎ̇ Â̈ÂÙ‡ÎÓÔ‡ÚËfl 4. ñ·ӂ‡ÒÍÛ·ÌË Á‡·ÓÎfl‚‡ÌËfl5. CADASIL

ᇷÓÎfl‚‡ÌËflÚ‡, ÍÓËÚÓ Ì‡ÔÓ‰Ó·fl‚‡Ú åë ÍÎËÌ˘ÌÓ, ÔÓåêí Ë ÎËÍ‚ÓÌË ÍËÚÂËË Ò‡:

1. LJÒÍÛÎËÚË:ÒË̉ÓÏ Ì‡ ë¸Ó„ÂÌÌÓ‰ÓÁÂÌ ÔÓΡÚÂËËÚÒËÒÚÂÏÂÌ ÎÛÔÛÒ ÂËÚÂχÚÓ‰ÂÒ·ÓÎÂÒÚ Ì‡ ÅÂı˜ÂÚ

2. ã‡ÈÏÒ͇ ·ÓÎÂÒÚ3. ë‡ÍÓˉÓÁ‡4. ĉÂÌÓ΂ÍÓ‰ËÒÚÓÙËfl5. HTLV-16. áËÚÂÎ̇ ‡ÚÓÙËfl ̇ ã·Â7. éÒÚ˙ ‰ËÒÂÏËÌË‡Ì Â̈ÂÙ‡ÎÓÏËÂÎËÚ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 102‡ÔËÎ, 2002

ã˜ÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡. ã˜ÂÌËÂÚÓ Ò‡Á΢‡‚‡ ÒÔÓ‰ ÙÓχڇ ̇ ÔÓÚ˘‡ÌÂ Ë ÒÔÓ‰ ÚÓ‚‡‰‡ÎË Á‡·ÓÎfl‚‡ÌÂÚÓ Â ‚ ÔËÒÚ˙Ô ËÎË ‚ ÂÏËÒËfl. åÌÓÊÂÒÚ-‚Ó ‡Á΢ÌË Ï‰Ë͇ÏÂÌÚË Ò‡ ÔË·„‡ÌË Á‡ ΘÂÌË ̇ÔËÒÚ˙Ô, ËÎË Á‡ Û‰˙Îʇ‚‡Ì ̇ ÂÏËÒËËÚ ÏÂÊ‰Û ÔËÒ-Ú˙ÔËÚÂ, ÌÓ Ï‡ÎÍÓ Ò‡ ‰Ó͇Á‡ÎË ·ÂÁÒÔÓÌÓ Ò‚ÓflÚ‡ ÂÙÂÍ-ÚË‚ÌÓÒÚ.

å‰Ë͇ÏÂÌÚË Á‡ ΘÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ڇÒÍÎÂÓÁ‡

ÖÙÂÍÚË‚ÌÓÒÚ ‚˙ıÛ å‰Ë͇ÏÂÌÚèÓ‰˙ÎÊËÚÂÎÌÓÒÚ ❏ äÓÚËÍÓÒÚÂÓˉË̇ ÔËÒÚ˙Ô‡ - methylprednisolone

-adrenocorticotropic hormone /ACTH/- dexamethasone

óÂÒÚÓÚ‡ ̇ ÔËÒÚ˙ÔËÚ ❏ Beta interferon*❏ Immunoglobulin ËÌÚ‡‚ÂÌÓÁÌÓ ❏ Mitoxantrone ❏ Copolymer-1❏ Myelin ÔÂÓ‡ÎÌÓ

èÓ„ÂÒËflÚ‡ ❏ Beta interferon*❏ Mitoxantrone❏ Azathioprine❏ Methotrexate❏ íÓÚ‡ÎÌÓ ÎËÏÙÓˉÌÓ Ó·Î˙˜‚‡ÌÂ❏ Cyclophosphamide❏ Cyclosporin A❏ Cladribine

*Ó‰Ó·ÂÌ Á‡ Ú‡ÁË Ë̉Ë͇ˆËfl

ã˜ÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ‚ ÔËÒÚ˙Ô.ÖÍÁ‡ˆÂ·‡ˆËËÚ ÔË ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚ̇ڇ ÙÓχ̇ åS Ò‡ Ò˄̇ΠÁ‡ ·˙Á‡ ̇ÏÂÒ‡ ̇ Ì‚ÓÎÓ„‡.

èË ‚˜ ‰Ë‡„ÌÓÒÚËˆË‡Ì ·ÓÎÂÌ, Ì‚ÓÎÓ„˙Ú Úfl·‚‡‰‡ ÛÒÚ‡ÌÓ‚Ë ‰‡ÎË Â Ì‡ÒÚ˙ÔËÎ ÌÓ‚ ÔËÒÚ˙Ô, ËÁÔÓÎÁ‚‡ÈÍËÒ˙ÓÚ‚ÂÚÌËÚ ÍËÚÂËË. èË Ì‡ÒÚ˙Ô‚‡Ì ̇ ÌÓ‚ ÔËÒ-Ú˙Ô Úfl·‚‡ ÌÂÁ‡·‡‚ÌÓ ‰‡ Ôӂ‰ ÍÓÚËÍÓÒÚÂÓˉÌÓ ËÎËËÏÛÌÓ„ÎÓ·ÛÎËÌÓ‚Ó Ë ÒËÏÔÚÓχÚ˘ÌÓ Î˜ÂÌË (èËÎÓÊÂ-ÌË 4) ‚ ‡Ï·Û·ÚÓÌË ËÎË ·ÓÎÌ˘ÌË ÛÒÎÓ‚Ëfl, ‚ Á‡‚ËÒË-ÏÓÒÚ ÓÚ ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙Ô‡.

äËÚÂËËÚ Á‡ ̇ÒÚ˙Ô‚‡Ì ̇ ÌÓ‚ ÔËÒÚ˙Ô Ì‡·ÓÎÂÒÚÚ‡ Ò‡:

● ÔÓfl‚‡ ̇ ÌÓ‚ ÒËÏÔÚÓÏ Ò˙Ò Ò˙ÓÚ‚ÂÚÌË Ì‚ÓÎӄ˘ÌË·ÂÎÂÁË

● ÔÓfl‚‡ ÓÚÌÓ‚Ó Ì‡ ÒÚ‡ ÒËÏÔÚÓÏ● ‚ÎÓ¯‡‚‡Ì ̇ Ò˙˘ÂÒÚ‚Û‚‡˘ ÒËÏÔÚÓÏ Ò > 0,5 ÔÓ

Ò͇·ڇ ̇ Kurtzke (èËÎÓÊÂÌË 3)● Ú‡ÈÌÓÒÚ Ôӂ˜ ÓÚ 24 - 48 ˜‡Ò‡● ÓÚÒ˙ÒÚ‚Ë ̇ Ôӂ˯Â̇ ÚÂÎÂÒ̇ ÚÂÏÔ‡ÚÛ‡● Ô‰ıÓʉ‡˘ ÔÂËÓ‰ ̇ ÒÚ‡·ËÎÌÓÒÚ ËÎË ÔÓ‰Ó·ÂÌËÂ,

̇È-χÎÍÓ 30 ‰ÌË

ÉβÍÓÍÓÚËÍÓÒÚÂÓˉËÚ /Éäë/ Ò‡ Ò‰ÒÚ‚Ó Ì‡ Ô˙-‚Ë ËÁ·Ó ÔË Î˜ÂÌË ̇ ÔËÒÚ˙Ô ÓÚ åë, Á‡˘ÓÚÓ ËχÚÔÓÚË‚Ó‚˙ÁÔ‡ÎËÚÂÎÌÓ, ËÏÛÌÓÒÛÔÂÒË‚ÌÓ Ë ÒÚ‡·ËÎËÁˇ-˘Ó Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡ ‰ÂÈÒÚ‚ËÂ. ã˜ÂÌËÂÚÓ ‚Ó-‰Ë ‰Ó ̇χÎfl‚‡Ì ̇ ‡ÍÚ˂ˇÌËÚ í-ÎËÏÙÓˆËÚË, ͇ÚÓÒ ̇χÎfl‚‡Ú Ôӂ˜ í-ıÂÎÔÂËÚÂ, ÓÚÍÓÎÍÓÚÓ í-ÒÛÔÂ-ÒÓËÚÂ. ëÚ‡·ËÎËÁˇ Ò Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡ Ë ÒÂÔÓ‚ÎËfl‚‡ ͇Ò͇‰‡Ú‡ ÓÚ ËÏÛÌÌË ÔÓˆÂÒË, ‚Ӊ¢‡ ‰Ó ‰ÂÏË-ÂÎËÌËÁ‡ˆËfl. äÛÒÓ‚ÂÚÂ Ò ÍÓÚËÍÓÒÚÂÓË‰Ë Ì ÔÓ‚ÎËfl-‚‡Ú ıÓ‰‡ ̇ ·ÓÎÂÒÚÚ‡ ‰ÓË Ë ÔË ÔÓ-‰˙΄ÓÚ‡È̇ Ú‡-

ÔËfl Ò ÔÓ-χÎÍË ‰ÓÁË.ÉβÍÓÍÓÚËÍÓÒÚÂÓˉËÚ Ò ‡Á΢‡‚‡Ú ÔÓ Ò˙ÓÚÌÓ-

¯ÂÌËÂÚÓ Ì‡ „βÍÓÍÓÚËÍÓˉ̇ڇ Ë ÌÂÊ·ÚÂÎ̇ڇ ÏË-̇ÎÍÓÚËÍÓˉ̇ڇ ‡ÍÚË‚ÌÓÒÚ.

å‰Ë͇ÏÂÌÚ Ì‡ Ô˙‚Ë ËÁ·Ó Á‡ ΘÂÌË ̇ ÔËÒÚ˙Ô ÂMethylprednisolon, Á‡˘ÓÚÓ ·ËÓÎӄ˘ÌËflÚ ÏÛ ÔÓÎÛÊË‚ÓÚ 18 - 36 ˜‡Ò‡, ‡ÌÚË‚˙ÁÔ‡ÎËÚÂÎÌËflÚ ÏÛ ÂÙÂÍÚ Â ÏÌÓ„Ó‰Ó·˙, Ëχ Ò··Ó ÏË̇ÎÍÓÚËÍÓˉÌÓ ‰ÂÈÒÚ‚ËÂ Ë ÏÌÓ„Ó‰Ó·Â ÔÓÌËÍ‚‡ ÔÂÁ Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡. èË·„‡Ò ‚ ‰ÓÁË ÓÚ 500 ‰Ó 1000 Ï„ ‰Ì‚ÌÓ ËÌÚ‡‚ÂÌÓÁÌÓ ‚ serumglucose Á‡ 5 ‰ÌË, ÔÓÒΉ‚‡Ì ÓÚ ÔÓ-ÌËÒÍË ‰ÓÁË, Ú.Ì. "ÓÔ‡¯-͇", ËÌÊÂ͈ËÓÌÌÓ ËÎË ÔÂÓ‡ÎÌÓ. èË·„‡ÌÂÚÓ Ì‡ "ÓÔ‡¯-͇" Ô‰ÓÚ‚‡Úfl‚‡ ÌÓ‚Ó ÓÚ‚‡flÌ ̇ Í˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡·‡Ë‡. ëÌËʇ‚‡ÌÂÚÓ Ì‡ ‰ÓÁ‡Ú‡ ÒÚ‡‚‡ Á‡ 10-12 ‰ÌË Ò ÔÓ10-20 Ï„ ÔÂÁ 3 ‰ÌË, ͇ÚÓ Ò Á‡ÔÓ˜‚‡ ÓÚ 80 Ï„ ‰Ì‚ÌÓ. çfl-ÍÓË Ô‰ÔÓ˜ËÚ‡Ú ÔË·„‡ÌÂÚÓ ÔÂÁ ‰ÂÌ, ͇ÚÓ ÒÏflÚ‡Ú,˜Â Ò ̇χÎfl‚‡ ËÒ͇ ÓÚ ÔÓÚËÒ͇Ì ̇ ıËÔÓڇ·ÏÓ-ıËÔÓ-ÙËÁ‡ÌÓ-̇‰·˙·Â˜Ì‡Ú‡ ÓÒ Ë ÔÓfl‚‡Ú‡ ̇ ÒÚ‡Ì˘ÌË fl‚ÎÂ-ÌËfl. çËÒÍÓ ‰ÓÁˇÌËÚ Éäë ËÏ‡Ú Ì„‡ÚË‚ÂÌ ÂÙÂÍÚ -˜ÂÒÚÓ Ò ÔÓÎÛ˜‡‚‡Ú ˆˉ˂Ë.

ᇠΘÂÌË ̇ ÔËÒÚ˙Ô Â ËÁÔÓÎÁ‚‡Ì Ë Äëíç (ÒËÌÚÂÚ˘-ÌË ‡Ì‡ÎÓÁË Cortrosin, Synacthen), Ú˙È Í‡ÚÓ ÚÓÈ Ëχ ÒıÓ‰-ÌË Ò Éäë ÏÂı‡ÌËÁÏË Ì‡ ‰ÂÈÒÚ‚ËÂ. ÖÙÂÍÚ˙Ú ÓÚ Î˜ÂÌËÂ-ÚÓ Ì‡ÒÚ˙Ô‚‡ ÔÓ-·‡‚ÌÓ ÔË ÔË·„‡Ì ̇ Äëíç (ÒΉ 1 ÏÂ-Òˆ), ÓÚÍÓÎÍÓÚÓ Ì‡ Methylprednisolon (ÒΉ 1 Ò‰Ïˈ‡).éÒ‚ÂÌ ÚÓ‚‡ Äëíç ‰‡‚‡ Ôӂ˜ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË, ‚ÍÎ.‡Î„ËË, ͇ÚÓ, ÒÔˇÌÂÚÓ ÏÛ Ì „Ë ÓÚÒÚ‡Ìfl‚‡, Á‡˘ÓÚÓËχ ÔÓÒΉÂÈÒÚ‚ËÂ.

臂ÂÌË Ò‡ ÓÔËÚË Á‡ ‚Íβ˜‚‡Ì ̇ Cyclophosphamid,ÍÓÏ·ËÌË‡Ì Ò Methylprednisolon, ͇ÚÓ ÒΉ‚‡Ú Ë "ÔÛÎÒÓ-‚Â" ÔÂÁ ‡Á΢ÌË ËÌÚ‚‡ÎË ÓÚ ‚ÂÏÂ Ë ‚ ‡Á΢ÌË ‰ÓÁËÁ‡ 1 - 2 „Ӊ˯ÂÌ ÔÂËÓ‰. Cyclophosphamid ‰ÂÈÒÚ‚‡ ‚˙ıÛí-ÍÎÂÚÍËÚ ÔÓ‚ÎËfl‚‡ Ë ‡ÁÂʉ‡ ÔËÒÚ˙ÔËÚÂ. ÇÒ ӢÂËχ ÒÔÓÓ‚Â Á‡ Ì„ӂ‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ Ë ÔÓÌÓÒËÏÓÒÚ ÔËÔËÒÚ˙Ô Ë Á‡Ò„‡ Ì „Ó ÔÂÔÓ˙˜‚‡Ï ͇ÚÓ ÛÚËÌ̇ ÚÂ-‡ÔËfl.

ëÚ‡Ì˘ÌËÚ ÂÙÂÍÚË ÓÚ ÍÓÚËÍÓÒÚÂÓˉÌÓÚÓ Î˜Â-ÌË ‚Íβ˜‚‡Ú ÒÚÓχ¯ÌӘ‚ÌË ÓÔ·͂‡ÌËfl, flÁ‚‡, ‡ÚÂ-ˇÎ̇ ıËÔÂÚÓÌËfl, ËÚ˙ÏÌË Ò˙‰Â˜ÌË Ì‡Û¯ÂÌËfl, Á‡ı‡-ÂÌ ‰Ë‡·ÂÚ, ‡Á΢ÌË ËÌÙÂ͈ËË, ÓÒÚÂÓÔÓÓÁ‡, ‡ÍÌÂ,ÚÓÏ·ÓÁË, χÌËË, ‰ÂÔÂÒËË Ë ‰.

ã˜ÂÌË ̇ ÔËÒÚ˙Ô Ò ËÏÛÌ„ÎÓ·ÛÎËÌË. àÏÛÌÓ„ÎÓ·Û-ÎËÌËÚ ҇ ωË͇ÏÂÌÚË Ì‡ ‚ÚÓË ËÁ·Ó ÔË Ì‡Î˘Ë ̇ÔÓÚË‚ÓÔÓ͇Á‡ÌËfl Á‡ ÔË·„‡Ì ̇ ÍÓÚËÍÓÒÚÂÓˉË.èË·„‡ Ò Imunnovenin ÔÓ 1 ‚ÂÌÓÁ̇ ËÌÙÛÁËfl ‚ÒÂÍË ‰ÂÌ,ËÎË ÔÂÁ ‰ÂÌ ‚ ‰ÓÁ‡ 200-400 Ï„/Í„, ̇È-χÎÍÓ ÚË ËÌÙÛÁËË.

ã˜ÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ËÁ‚˙Ì ÔËÒ-Ú˙Ô. ã˜ÂÌËÂÚÓ ËÁ‚˙Ì ÔËÒÚ˙Ô Ò ÓÔ‰ÂÎfl ÓÚ ÙÓχڇ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë Ì„ӂ‡Ú‡ ‡ÍÚË‚ÌÓÒÚ.

èË ÎËÔÒ‡ ̇ Á‡˜ÂÒÚfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚÂ, ËÎË Ì‡ÔÓ„ÂÒË‚ÌÓ ‚ÎÓ¯‡‚‡ÌÂ, ̇ ·ÓÎÌËfl Ò ÔÂÔÓ˙˜‚‡ Ò‡ÏÓıË„ËÂÌÌÓ-‰ËÂÚ˘ÂÌ ÂÊËÏ:

● ‰ÓÒÚ‡Ú˙˜Ì‡ ÔӘ˂͇ Ë ËÁ·fl„‚‡Ì ̇ ÙËÁ˘ÂÒ͇ ËÛÏÒÚ‚Â̇ ÔÂÛÏÓ‡

● Ô‰ԇÁ‚‡Ì ÓÚ ÔÂÓı·ʉ‡ÌÂ Ë Ô„fl‚‡ÌÂ● Ô‰ԇÁ‚‡Ì ÓÚ ÔÓÒÚÛ‰ÌË Á‡·ÓÎfl‚‡ÌËfl● ̇χÎfl‚‡Ì ̇ ÊË‚ÓÚËÌÒÍËÚ χÁÌËÌË ‚ ‰ËÂÚ‡-

Ú‡ Á‡ ÒÏÂÚ͇ ̇ ‡ÒÚËÚÂÎÌËÚ ● ‚ÌËχÚÂÎ̇ ÔˆÂÌ͇ Á‡ ÌÂÓ·ıÓ‰ËÏÓÒÚ ÓÚ ‚‡Í-

ÒË̇ˆËË● ãîä

å‰Ë͇ÏÂÌÚÓÁÌÓ Î˜ÂÌË ËÁ‚˙Ì ÔËÒÚ˙Ô Ì‡ ·ÓÎÌËÒ ÔËÒÚ˙ÔÌÓ ÂÏËÚÂÌÚ̇ Ë ıÓÌ˘ÌÓ Ôӄ‰ËÂÌÚ̇ÙÓχ. å‰Ë͇ÏÂÌÚË Ì‡ Ô˙‚Ë ËÁ·Ó Ò‡ ·ÂÚ‡ ËÌÚÂÙÂ-ÓÌËÚÂ. èË Ì‡Î˘Ë ̇ ÔÓÚË‚ÓÔÓ͇Á‡ÌËfl, ωË͇ÏÂÌ-

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 103‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 104‡ÔËÎ, 2002

ÚË Ì‡ ‚ÚÓË ËÁ·Ó Ò‡ ËÏÛÌÓÒÛÔÂÒÓËÚÂ Ë Ì‡ ÚÂÚË ËÁ-·Ó Ò‡ ËÏÛÌÓ„ÎÓ·ÛÎËÌËÚÂ. èË ‚˙Á‡ÒÚ ÔÓ‰ 18 „Ó‰ËÌË, ÍÓ-„‡ÚÓ Ì ÏÓ„‡Ú ‰‡ Ò ÔË·„‡Ú ·ÂÚ‡ ËÌÚÂÙÂÓÌË, ÌËÚÓËÏÛÌÓÒÛÔÂÒÓË, ËÏÛÌÓ„ÎÓ·ÛÎËÌËÚ ҇ ωË͇ÏÂÌÚË Ì‡Ô˙‚Ë ËÁ·Ó.

èË Á‡˜ÂÒÚfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ Ôӂ˜ ÓÚ 2 „Ӊ˯-ÌÓ Ì‡ ·ÓÎÌËfl Ò ÔÂÔÓ˙˜‚‡ ËωË͇ÏÂÌÚÓÁÌÓ Î˜ÂÌËÂ, ÓÒ‚ÂÌ ÒÔ‡Á‚‡ÌÂÚÓ Ì‡ ıË„ËÂ-ÌÌÓ-‰ËÂÚ˘ÂÌ ÂÊËÏ:

● ΘÂÌËÂ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡ - ΘÂÌË ̇ Ô˙‚ËËÁ·Ó

● ËÏÛÌÓÒÛÔÂÒË‚ÌÓ Î˜ÂÌË - ΘÂÌË ̇ ‚ÚÓË ËÁ-·Ó

● ΘÂÌËÂ Ò ËÏÛÌÓ„ÎÓ·ÛÎËÌË - ΘÂÌË ̇ ÚÂÚË ËÁ-·Ó (Ô˙‚Ë ËÁ·Ó ÔÓ‰ 18 „Ó‰. ‚˙Á‡ÒÚ)

● ÒËÏÔÚÓχÚ˘ÌÓ Î˜ÂÌËÂ

●● ç‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ ‚ÁÂÏ ¯ÂÌË Á‡ Á‡ÔÓ˜-‚‡ÌÂÚÓ Ë ‚ˉ‡ ̇ ωË͇ÏÂÌÚÓÁÌÓÚÓ Î˜ÂÌË ̇ ·ÓÎ-ÌËfl ËÁ‚˙Ì ÔËÒÚ˙Ô‡.

●● ã˜ÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡  ̇ Ô˙‚Ë ËÁ·Ó,‡ÍÓ ·ÓÎÌËflÚ ÓÚ„Ó‚‡fl ̇ ÍËÚÂËËÚÂ

●● ã˜ÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡ Úfl·‚‡ ‰‡ ÔÓ-‰˙ÎÊË Ì‡È-χÎÍÓ Â‰Ì‡ „Ó‰Ë̇, ÒΉ ÍÓÂÚÓ Ì‚ÓÎÓ„˙ÚÚfl·‚‡ ‰‡ ÔˆÂÌË Ì„ӂ‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ.

●● èÂÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ΘÂÌËÂÚÓ Ò ‰ÓÔÛÒ͇ Ò‡ÏÓ ‚ÒÎÛ˜‡ËÚ ÔÓÒÓ˜ÂÌË ‚ ÍËÚÂËËÚÂ. Ç ÔÓÚË‚ÂÌ ÒÎÛ˜‡ËΘÂÌËÂÚÓ ÔÓ‰˙Îʇ‚‡ ̇È-χÎÍÓ 5 „Ó‰ËÌË.

äÎËÌ˘̇ڇ Ë ·ËÓÎӄ˘̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ·ÂÚ‡ ËÌ-ÚÂÙÂÓÌËÚ  ‡Á΢̇

●● àÌÚÂÙÂÓÌ ·ÂÚ‡ -1‚ (Betaferon) Á‡ ÔÓ‰ÍÓÊÌÓÔËÎÓÊÂÌË ÔÂÁ ‰ÂÌ ‚ ‰ÓÁ‡ 8 ÏËÎËÓ̇ ÏÂʉÛ̇ӉÌˉËÌËˆË Â Ï‰Ë͇ÏÂÌÚ Ì‡ Ô˙‚Ë ËÁ·Ó.

●● àÌÚÂÙÂÓÌ ·ÂÚ‡-1‡ Á‡ ÔÓ‰ÍÓÊÌÓ ÔËÎÓÊÂÌË 3Ô˙ÚË Ò‰Ï˘ÌÓ ÔÓ 6 ÏËÎËÓ̇ ÏÂʉÛ̇ӉÌË Â‰ËÌˈË(Rebief)  Ï‰Ë͇ÏÂÌÚ Ì‡ ‚ÚÓË ËÁ·Ó.

●● àÌÚÂÙÂÓÌ ·ÂÚ‡-1‡ Á‡ ËÌÚ‡ÏÛÒÍÛÎÌÓ ÔËÎÓ-ÊÂÌË ‚‰Ì˙Ê Ò‰Ï˘ÌÓ ÔÓ 6 ÏËÎËÓ̇ ÏÂʉÛ̇ӉÌˉËÌËˆË (Avonex)  Ï‰Ë͇ÏÂÌÚ Ì‡ ÚÂÚË ËÁ·Ó.

èË ÔÓ„ÂÒË‚ÌÓ ‚ÎÓ¯‡‚‡Ì ̇ Ò˙ÒÚÓflÌËÂÚÓ Ì‡·ÓÎÌËfl Ò Ôӂ˜ ÓÚ 1 ÚӘ͇ ÔÓ Ò͇·ڇ ̇ Kurtzke Á‡1 „Ó‰Ë̇, Ì‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ ‚ÁÂÏ ¯ÂÌË Á‡ Á‡-ÔÓ˜‚‡Ì ̇:

●● ΘÂÌËÂ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ (Betaferon), Ò˙Ó·-‡ÁÌÓ ÍËÚÂËËÚÂ

●● ËÏÛÌÓÒÛÔÂÒË‚ÌÓ Î˜ÂÌË (‡ÍÓ ·ÓÎÌËfl Ì ÓÚ„Ó‚‡-fl ̇ ÍËÚÂËËÚ Á‡ ΘÂÌËÂ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚)

●● ΘÂÌËÂ Ò ËÏÛÌÓ„ÎÓ·ÛÎËÌË (‡ÍÓ ·ÓÎÌËfl Ì ÓÚ„Ó‚‡-fl ̇ ÍËÚÂËËÚ Á‡ ΘÂÌËÂ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ ËËÏÛÌÓÒÛÔÂÒË‚ÌÓ Î˜ÂÌËÂ Ë ÔË ‚˙Á‡ÒÚ ÔÓ‰ 18 „Ó‰ËÌË)

●● ÒËÏÔÚÓχÚ˘ÌÓ Î˜ÂÌËÂ

ã˜ÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ËÁ‚˙Ì ÔËÒÚ˙Ô ÒËÌÚÂÙÂÓÌ ·ÂÚ‡.

àÌÚÂÙÂÓÌËÚ ҇ ËÁÔÓ·‚‡ÌË Á‡ ΘÂÌË ̇ ÏÌÓÊÂÒ-Ú‚Â̇ڇ ÒÍÎÂÓÁ‡, Á‡˘ÓÚÓ Ò  Ô‰ÔÓ·„‡ÎÓ, ˜Â Á‡·ÓÎfl-‚‡ÌÂÚÓ Ëχ ‚ËÛÒ̇ ÂÚËÓÎÓ„Ëfl. èÓÛ˜‚‡ÌËflÚ‡ Ò‡ ÔÓ͇Á‡-ÎË, ˜Â ËÌÚÂÙÂÓÌ ‡ÎÙ‡ Ì ÔÓ‚ÎËfl‚‡ Á‡·ÓÎfl‚‡ÌÂÚÓ, ËÌ-ÚÂÙÂÓÌ „‡Ï‡ ‚ÎÓ¯‡‚‡ Ì„ӂÓÚÓ ÔÓÚ˘‡ÌÂ, ‰Ó͇ÚÓ ËÌ-ÚÂÙÂÓÌ ·ÂÚ‡ ̇χÎfl‚‡ ˜ÂÒÚÓÚ‡Ú‡ ̇ ÔËÒÚ˙ÔËÚÂ. àÌÚÂÙÂÓÌ ·ÂÚ‡  166-‡ÏËÌÓ ÍËÒÂÎËÌÂÌ „βÍÓÔÓÚÂËÌ,ÍÓÈÚÓ Ò ÔÓËÁ‚Âʉ‡ Ò ÓÚ Ù˷ӷ·ÒÚËÚÂ Ë ÌflÍÓË ‰Û-„Ë ÍÎÂÚÍË ‚ ÓÚ„Ó‚Ó Ì‡ ‚ËÛÒÌË ËÌÙÂ͈ËË. ç‡ÚÛ‡ÎÂÌ ·Â-

Ú‡ ËÌÚÂÙÂÓÌ Ò ÔÓÎÛ˜‡‚‡ ÓÚ ˜Ó‚¯ÍË Ù˷ӷ·ÒÚÌËÍÎÂÚÍË, ÌÓ Á‡ ÔÓÎÛ˜‡‚‡ÌÂÚÓ ÏÛ ‚ „ÓÎÂÏË ÍÓ΢ÂÒÚ‚‡  ÌÂ-Ó·ıÓ‰ËÏÓ ËÁÔÓÎÁ‚‡ÌÂÚÓ Ì‡ ÂÍÓÏ·Ë̇ÌÚÌË Ñçä ÚÂıÌÓ-ÎÓ„ËË.

éÚ ˜Ó‚¯ÍËfl ËÌÚÂÙÂÓÌ ·ÂÚ‡ ˜ÂÁ „ÂÌÌÓ ËÌÊÂÌÂÒ-Ú‚Ó Ò‡ Ò˙Á‰‡‰ÂÌË ‰‚ ÂÍÓÏ·Ë̇ÌÚÌË ÏÓÎÂÍÛÎË. àÌÚÂ-ÙÂÓÌ ·ÂÚ‡-1‡ ÓÚ Ó‚‡Ë‡ÎÌË ÍÎÂÚÍË Ì‡ ÍËÚ‡ÈÒÍË ı‡ÏÒ-Ú  „ÎÛÍÓÁËÎË‡Ì Ë ÔÓ-·ÎËÁ˙Í ‰Ó ˜Ó‚¯ÍËfl ËÌÚÂÙÂÓÌ·ÂÚ‡. àÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ ÓÚ E. coli Ò˙‰˙ʇ ÏÛÚ‡ˆËfl̇ ‡ÏËÌÓÍËÒÂÎË̇ڇ ̇ ÔÓÁˈËfl 17, ÎËÔÒ‚‡ ÏÂÚËÓÌËÌ ‚‡ÁÓÚÌËfl ÚÂÏË̇Π̇ ‡ÏËÌÓÍËÒÂÎËÌ̇ڇ ‚ÂË„‡. íÂÁËÔÓÏÂÌË Ò‡ ‚ÌÂÒÂÌË Ò Ó„Î‰ ÒÚ‡·ËÎËÁˇÌÂÚÓ Ì‡ ÏÓÎÂÍÛ-·ڇ Ë Ì Ó͇Á‚‡Ú ‚ÎËflÌË ‚˙ıÛ Ì„ӂ‡Ú‡ ÙÛÌ͈Ëfl.

àÌÚÂÙÂÓÌ ·ÂÚ‡ ÔË ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ ÔÓÚËÒ-͇ ‡ÍÚË‚‡ˆËflÚ‡ Ë ÔÓÎËÙ‡ˆËflÚ‡ ̇ Ô‡ÚÓÎӄ˘ÌÓ ‡‚-ÚÓ‡ÍÚË‚ÌËÚ í ÍÎÂÚÍË Ë Úflı̇ڇ ÏË„‡ˆËfl ÔÂÁÍ˙‚ÌÓ-ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡ Í˙Ï ñçë, Í˙‰ÂÚÓ Û‚Âʉ‡ÚÏËÂÎË̇ Ë ÓÎË„Ó‰ẨӄÎËflÚ‡. ëÚËÏÛΡ ÔÓ‰Û͈Ëflڇ̇ ÔÓÚË‚Ó‚˙ÁÔ‡ÎËÚÂÎÌËfl ˆËÚÓÍËÌ ËÌÚÂ΂ÍËÌ 10 Ë ÔÓ-ÚËÒ͇ ÒËÌÚÂÁ‡ ̇ ËÌÚÂÙÂÓÌ „‡Ï‡ ÍÓÈÚÓ Á‡ÒË΂‡ ËÏÛÌ-ÌËÚ ‡͈ËË. äÎËÌ˘ÌÓÚÓ ÔÓ‰Ó·ÂÌË Á‡ÔÓ˜‚‡ ÒΉ 2 ‰Ó12 ÏÂÒˆ‡.

àÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ (Betaferon)  Ô˙‚ËflÚ ËÌÚÂÙÂ-ÓÌ Ó‰Ó·ÂÌ Á‡ ΘÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇ڇ ÒÍÎÂÓÁ‡ ÔÂÁ 1993 „Ó‰Ë̇ ‚ ëÄô ËÔÂÁ 1995 „Ó‰Ë̇ ‚ Ö‚ÓÔ‡. èË·„‡ Ò ÔÓ‰ÍÓÊÌÓ ÔÂÁ ‰ÂÌ‚ ‰ÓÁ‡ 8 ÏËÎËÓ̇ ÏÂʉÛ̇ӉÌË Â‰ËÌËˆË (IU).

àÌÚÂÙÂÓÌ ·ÂÚ‡-1‡  ӉӷÂÌ Á‡ ΘÂÌË ̇ ÏÌÓÊÂÒ-Ú‚Â̇ڇ ÒÍÎÂÓÁ‡ ÔÂÁ 1996 „Ó‰Ë̇ ‚ ëÄô Ë 1997 „Ó‰Ë̇‚ Ö‚ÓÔ‡. èÓËÁ‚Âʉ‡ Ò ‚ ‰‚ ÙÓÏË: ÙÓχ Á‡ ËÌÚ‡-ÏÛÒÍÛÎÌÓ ÔËÎÓÊÂÌË ‚‰Ì˙Ê Ò‰Ï˘ÌÓ ÔÓ 6 ÏËÎËÓ̇ÏÂʉÛ̇ӉÌË Â‰ËÌËˆË (Avonex) Ë ÙÓχ Á‡ ÔÓ‰ÍÓÊÌÓÔËÎÓÊÂÌË 3 Ô˙ÚË Ò‰Ï˘ÌÓ ÔÓ 6 ÏËÎËÓ̇ ÏÂʉÛ̇Ӊ-ÌË Â‰ËÌËˆË (Rebief).

äÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡ ÔË·ÓÎÌË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚ̇ ÙÓχ ̇ ÏÌÓÊÂÒÚ‚Â̇ÒÍÎÂÓÁ‡  ‰Ó͇Á‡Ì‡ Á‡ Ô˙‚Ë Ô˙Ú Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ÔÂÁ 1993 „Ó‰Ë̇. íÓÈ Ì‡Ï‡Îfl‚‡ Ò 30% „Ӊ˯̇ڇ ˜ÂÒÚÓ-Ú‡ ̇ ÔËÒÚ˙ÔËÚÂ, ͇ÚÓ 31% ÓÚ ·ÓÎÌËÚ Ì ÔÓÎÛ˜‡‚‡ÚÔËÒÚ˙ÔË ÔÂÁ Ô˙‚ËÚ 2 „Ó‰ËÌË, ‚ÂÏÂÚÓ ‰Ó Ô˙‚ËflÚÔËÒÚ˙Ô Ì‡‡ÒÚ‚‡ ‰‚ÓÈÌÓ, ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ̇χÎfl‚‡ Ë ·Ófl ̇ Ò‰ÌÓ ÚÂÊÍËÚÂ Ë ÚÂÊÍËÚ ÔËÒÚ˙-ÔË Ì‡Ï‡Îfl‚‡ Ò 50%. ì‰˙Îʇ‚‡ Ò ‚ÂÏÂÚÓ Á‡ ̇‡ÒÚ‚‡ÌÂ̇ ËÌ‚‡ÎˉÌÓÒÚÚ‡, ̇χÎfl‚‡ ·ÓflÚ Ì‡ ıÓÒÔËÚ‡ÎËÁˇÌË-Ú ·ÓÎÌË Ë Ì‡ ÚÂÁË ÔË ÍÓËÚÓ Ò ̇·„‡ ΘÂÌËÂ Ò ÍÓÚË-ÍÓÒÚÂÓˉË. åêíÔÓ͇Á‚‡ ̇χÎfl‚‡Ì ̇ ·Ófl ̇ ÌÓ‚ËÚÂÎÂÁËË Á‡ ‰̇ „Ó‰Ë̇ Ò˙Ò 75%.

äÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ÚËÚ ‚ˉ‡ ·ÂÚ‡ ËÌ-ÚÂÙÂÓÌË Â ‡Á΢̇, ÔÓ‡‰Ë ‡Á΢ËflÚ‡ ‚ ÔË·„‡Ì‡Ú‡‰ÓÁ‡. èÓ-‰ÍËÚ ‡ÔÎË͇ˆËË Ò‡ ÔÓ-Û‰Ó·ÌË Ë ËÏ‡Ú ÔÓ-χÎ-ÍÓ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË, ÌÓ ÍÎËÌ˘̇ڇ ËÏ ÂÙÂÍÚË‚ÌÓÒÚ ÂÔÓ-Ò··‡. ÉӉ˯̇ڇ ˜ÂÒÚÓÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ, ÚÂÊÍËÚÂÔËÒÚ˙ÔË Ë ·ÓÎÌ˘ÌËflÚ ÔÂÒÚÓÈ Ì‡Ï‡Îfl‚‡Ú ̇È-ÏÌÓ„Ó,‡ ‚ÂÏÂÚÓ ‰Ó Ô˙‚Ëfl ÔËÒÚ˙Ô Â Ì‡È-‰˙Î„Ó ÔË „ÛÔ‡Ú‡·ÓÎÌË ÎÂÍÛ‚‡ÌË Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚. íËÚ ÔÂÔ‡‡Ú‡Ì ҇ ‚Á‡ËÏÓÁ‡ÏÂÌflÂÏË, ͇ÚÓ ÒÔÓ‰ ÂÍÒÔÂÚËÚ ÔË·ÓÎÌË Ò ‡„ÂÒË‚ÂÌ ıÓ‰ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ Ë ·˙Á‡ ÔÓ„ÂÒËflÒ Ô‰ÔÓ˜ËÚ‡ ÔË·„‡ÌÂÚÓ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚.

ÅËÓÎӄ˘̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚,  Á̇-˜ËÚÂÎÌÓ ÔÓ-ËÁ‡ÁÂ̇ Ë ÔÓÒÚÓflÌ̇, ÓÚÍÓÎÍÓÚÓ ÔË ÔË·-„‡Ì ̇ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‡ ËÌÚ‡ÏÛÒÍÛÎÌÓ ‚Â‰Ì‡Ê Ò‰-Ï˘ÌÓ. ÅËÓÎӄ˘̇ڇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ ̇È-‚ËÒÓ͇, ÒΉ‚‡Ì‡ ÓÚ Ú‡ÁË Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‡ Á‡ÔÓ‰ÍÓÊÌÓ ÔËÎÓÊÂÌËÂ Ë Â Ì‡È-Ò··Ó ËÁ‡ÁÂ̇ Á‡ ËÌÚÂÙÂ-ÓÌ ·ÂÚ‡-1‡ Á‡ ËÌÚ‡ÏÛÒÍÛÎÌÓ ÔËÎÓÊÂÌËÂ. ë··‡Ú‡ ·ËÓ-Îӄ˘̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‡ Á‡ ËÌÚ‡ÏÛÒ-ÍÛÎÌÓ ÔËÎÓÊÂÌË Ò ‰˙ÎÊË Ì‡ ÔÓ-Ò··‡Ú‡ ‡·ÒÓ·ˆËfl ̇

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 105‡ÔËÎ, 2002

ÔÂÔ‡‡Ú‡. èÓ-Ò··‡Ú‡ ·ËÓÎӄ˘̇ ‡ÍÚË‚ÌÓÒÚ Ì‡ ËÌÚÂ-ÙÂÓÌ ·ÂÚ‡-1‡ Á‡ ÔÓ‰ÍÓÊÌÓ ÔËÎÓÊÂÌË ‚ Ò‡‚ÌÂÌËÂ Ò ËÌ-ÚÂÙÂÓÌ ·ÂÚ‡-1‚, Ò ‰˙ÎÊË Ì‡ ÔÓ-‰ÍËÚ ‡ÔÎË͇ˆËË Ì‡Ï‰Ë͇ÏÂÌÚ‡. ç‡ÔÓÒΉ˙Í Ò ÔÓÒÚ‡‚fl ÔÓ‰ Ò˙ÏÌÂÌË ‰Ó-ÍÓÎÍÓ ÔË·„‡ÌÂÚÓ Ì‡ ÙÓχڇ Á‡ ËÌÚ‡ÏÛÒÍÛÎÌÓ ÔËÎÓ-ÊÂÌË ̇ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‡ ‚‰Ì˙Ê Ò‰Ï˘ÌÓ Â ‰ÓÒÚ‡-Ú˙˜ÌÓ Á‡ ÔÓ‰‰˙ʇÌ ̇ ÔÓ‰˙ÎÊËÚÂÎÂÌ ÂÙÂÍÚ.

äÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡ ÔË·ÓÎÌË Ò ‚ÚÓ˘ÌÓ ÔÓ„ÂÒˇ˘ ıÓ‰ ̇ ÏÌÓÊÂÒÚ‚Â̇ڇÒÍÎÂÓÁ‡  ‰Ó͇Á‡Ì‡ Ò‡ÏÓ Á‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚. ç‡Ï‡-Îfl‚‡Ú ˜ÂÒÚÓÚ‡Ú‡ Ë ÒË·ڇ ̇ ÔËÒÚ˙ÔËÚÂ, Û‰˙Îʇ‚‡ Ò‚ÂÏÂÚÓ Á‡ ̇‡ÒÚ‚‡Ì ̇ ËÌ‚‡ÎˉÌÓÒÚÚ‡ Ò ÓÍÓÎÓ 12 ÏÂ-Òˆ‡ Á‡ 2 „Ó‰ËÌË, ̇χÎfl‚‡ ·Ófl ̇ ÌÓ‚ËÚ ÎÂÁËË ÔË Ï‡„-ÌËÚÌÓ ÂÁÓ̇ÌÒÌÓÚÓ ÚÓÏÓ„‡ÙÒÍÓ ËÁÒΉ‚‡ÌÂ.

ëÚ‡Ì˘ÌËÚ ÂÙÂÍÚË ÓÚ Î˜ÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ·ÂÚ‡ ‚Íβ˜‚‡Ú ˜ÂÒÚÓ ÎÓ͇ÎÌË ÍÓÊÌË Â‡ÍˆËË, ÒËÏÔÚÓ-ÏË Ì‡ÔÓ‰Ó·fl‚‡˘Ë ÔÓÒÚÛ‰ÌÓ Á‡·ÓÎfl‚‡ÌÂ Ë fl‰ÍÓ ÛÏÓ‡,‰ÂÔÂÒËfl, ‡ÒÚÂÌËfl Ë „·‚Ó·ÓÎËÂ. ëËÏÔÚÓÏËÚ ̇ÔÓ‰Ó·fl-‚‡˘Ë ÔÓÒÚÛ‰ÌÓ Á‡·ÓÎfl‚‡ÌÂ: ÚÂÏÔ‡ÚÛ‡, ÚÂÒ͇ Ë ÏË-‡Î„Ëfl Ò‡ ̇È-ËÁ‡ÁÂÌË ÔÂÁ Ô˙‚ËÚ 24 ˜‡Ò‡ ÒΉ ÔË·„‡-Ì ̇ Ô˙‚‡Ú‡ ‰ÓÁ‡ Ë ËÁ˜ÂÁ‚‡Ú Á‡ 6-7 ‰ÌË. èÓ-ËÁ‡ÁÂÌË Ò‡ÔË ÔË·„‡ÌÂÚÓ Ì‡ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚, ÔÓ‡‰Ë ÔÓ-˜ÂÒ-ÚËÚ ‡ÔÎË͇ˆËË. í Ò ÔÓ‚ÎËfl‚‡Ú ÏÌÓ„Ó ‰Ó·Â ÓÚ ÔË·-„‡Ì ̇ ÌÂÒÚÂÓˉÌË ÔÓÚË‚Ó‚˙ÁÔ‡ÎËÚÂÎÌË Ï‰Ë͇ÏÂÌ-ÚË (ibuprofen, aspirin) ‰ÌÓ‚ÂÏÂÌÓ Ò˙Ò Á‡ÔÓ˜‚‡Ì ̇ ΘÂ-ÌËÂÚÓ. èË·„‡ÌÂÚÓ Ì‡ ibuprofen ÔÂÁ Ô˙‚ËÚ ‰ÌË ÓÚΘÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‚ ̇χÎfl‚‡ ÒÚ‡Ì˘ÌËÚÂÂÙÂÍÚË ‰Ó ÌË‚ÓÚÓ Ì‡ ÚÂÁË, ÍÓËÚÓ Ò ÔÓÎÛ˜‡‚‡Ú ÔË Ò‰-Ï˘ÌÓ ËÌÚ‡ÏÛÒÍÛÎÌÓ ÔËÎÓÊÂÌË ̇ ËÌÚÂÙÂÓÌ ·ÂÚ‡-1‡. ãÓ͇ÎÌËÚ ÍÓÊÌË Â‡ÍˆËË ÒÂ Â‰ÛˆË‡Ú ˜ÂÁ Ó·Û˜Â-ÌË ̇ ·ÓÎÌËfl, ËÎË ÒÂÒÚËÚ ÍÓËÚÓ ‡ÔÎËˆË‡Ú Ï‰Ë͇-ÏÂÌÚ‡ ‚ ‰Ó·‡ ÚÂıÌË͇ ̇ ËÌÊÂÍÚˇÌÂ Ë ËÌÊÂÍÚˇÌ‚ ‡Á΢ÌË Ó·Î‡ÒÚË Ì‡ ÚflÎÓÚÓ ÔÓ ÒıÂχ.

èË 10 ‰Ó 35% ÓÚ ·ÓÎÌËÚ ÎÂÍÛ‚‡ÌË Ò ËÌÚÂÙÂÓÌ ·Â-Ú‡ ÒΉ 1 „Ó‰Ë̇ Ò ӷ‡ÁÛ‚‡Ú ÌÂÛÚ‡ÎËÁˇ˘Ë ‡ÌÚËÚÂ-·, ÍÓÂÚÓ ‚Ó‰Ë ‰Ó ̇χÎfl‚‡Ì ̇ ÍÎËÌ˘̇ڇ ÂÙÂÍÚË‚-ÌÓÒÚ. èÓ-˜ÂÒÚÓ (35%) Ú Ò ̇ÏË‡Ú ÔË ËÌÚÂÙÂÓÌ·ÂÚ‡-1‚ ÔÓ‡‰Ë ÔÓ-˜ÂÒÚËÚ ‡ÔÎË͇ˆËË. ëΉ ËÁ‚ÂÒÚÌÓ‚ÂÏ ÌÂÛÚ‡ÎËÁˇ˘ËÚ ‡ÌÚËÚ· ËÁ˜ÂÁ‚‡Ú Ë ÍÎËÌ˘-̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ ÓÚ ÔË·„‡ÌÂÚÓ Ì‡ ωË͇ÏÂÌÚ‡ Ò‚˙ÁÒÚ‡ÌÓ‚fl‚‡.

ã˜ÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡ ÒÔÓ‰ ÂÍÒÔÂÚËÚÂÚfl·‚‡ ‰‡ Á‡ÔӘ̠‚˙ÁÏÓÊÌÓ Ì‡È-‡ÌÓ ÒΉ ‰Ë‡„ÌÓÒÚˈË-‡Ì ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, Ò Ó„Î‰ Ô‰ÓÚ‚‡Úfl‚‡Ì ̇ ÌÓ‚ËÎÂÁËË. ê‡ÌÌÓÚÓ Î˜ÂÌË ˘Â Á‡·‡‚Ë ÔÓfl‚‡Ú‡ ̇ ËÌ‚‡Îˉ-ÌÓÒÚ Ë Ì‚˙ÁÏÓÊÌÓÒÚ Á‡ ÚÛ‰Ó‚‡ ‰ÂÈÌÓÒÚ, ͇ÍÚÓ Ë ‚ÎÓ-¯‡‚‡ÌÂÚÓ Ì‡ ͇˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ, ÌÓ ÏÓÊ ‰‡ ‰Ó‚Â‰Â‰Ó ËÁÎ˯ÌÓ Î˜ÂÌË ÔË ÌflÍÓË ·ÓÎÌË Ò ‰Ó·Ó͇˜ÂÒÚ‚ÂÌıÓ‰ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. ã˜ÂÌËÂÚÓ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡ ÏÓ-Ê ‰‡ ÔÓÏÂÌË ÂÒÚÂÒÚ‚ÂÌËflÚ ıÓ‰ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ͇ÚÓ̇χÎË ˜ÂÒÚÓÚ‡Ú‡ Ë ÚÂÊÂÒÚÚ‡ ̇ ÔËÒÚ˙ÔËÚÂ, Á‡·‡‚ËÔÓ„ÂÒËflÚ‡, ÔÓ‰Ó·Ë Í‡˜ÂÒÚ‚ÓÚÓ Ì‡ ÊË‚ÓÚ Ë Û‰˙ÎÊËÊË‚ÓÚ‡ ̇ ·ÓÎÌËÚÂ. á‡Ò„‡ Ì Ò ÔËÂχ ÏÌÂÌËÂÚÓ, ˜Â‚Ò˘ÍË ÌӂӉˇ„ÌÓÒÚˈˇÌË ·ÓÎÌË Úfl·‚‡ ‚‰̇„‡ ‰‡Á‡ÔÓ˜Ì‡Ú Î˜ÂÌËÂ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡. ÇÒ Ӣ Ò ÔË·-„‡Ú ÍËÚÂËËÚ Á‡ ÚÓ‚‡ ΘÂÌËÂ, ͇ÚÓ ÔÓ ÔˆÂÌ͇ ̇ÎÂÍÛ‚‡˘Ëfl ÎÂ͇ ÏÓ„‡Ú ‰‡ Ò ̇ԇ‚flÚ ËÁÍβ˜ÂÌËfl Á‡Ï·‰Ë ·ÓÎÌË Ò ÏÌÓÊÂÒÚ‚Ó ÔÓÏÂÌË ‚ åêí.

äËÚÂËË Á‡ ÔË·„‡Ì ̇ ΘÂÌË ̇ ÏÌÓÊÂÒÚ‚Â̇-Ú‡ ÒÍÎÂÓÁ‡ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡

Ä. ÅÓÎÌË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚÂÌ ıÓ‰ ̇ Á‡·ÓÎfl-‚‡ÌÂÚÓ, ÍÓËÚÓ:

1. àÏ‡Ú ÍÎËÌ˘ÌÓ ËÎË Î‡·Ó‡ÚÓÌÓ ÔÓ‰ÍÂÔÂ̇ ÒË-„Û̇ ‰Ë‡„ÌÓÁ‡ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ ÔÓÍËÚÂËËÚ ̇ Poser

2. ç‡ ‚˙Á‡ÒÚ ÓÚ 18 ‰Ó 50 „Ó‰ËÌË

3. àÏ‡Ú ËÌ‚‡ÎˉÌÓÒÚ ÔÓ‰ 5,5 ÔÓ Ò͇·ڇ ̇Kurtzke

4. àÏ‡Ú ÔÓÌ 2 ÔËÒÚ˙Ô‡ Á‡ ÔÓÒΉÌËÚ 2 „Ó‰ËÌËËÁ‡ÁÂÌË ‚ ÔÓfl‚‡ ̇ ÌÓ‚‡ ËÎË ‚ÎÓ¯‡‚‡ÌÂ̇ ÒÚ‡‡ ÒËÏÔÚÓχÚË͇. èËÒÚ˙ÔËÚ Úfl·‚‡ ‰‡ Ò‡ÔÓ‰˙ÎÊËÎË ÔÓÌ 24 ˜‡Ò‡, ‰‡ Ì ҇ Ò‚˙Á‡ÌË Ò ÚÂÏÔÂ-‡ÚÛÌÓ Ò˙ÒÚÓflÌËÂ Ë ‰‡ Ò‡ Ô‰¯ÂÒÚ‚‡ÌË ÓÚ ÔÓÌ 30‰Ì‚̇ ÂÏËÒËfl ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ

Å. ÅÓÎÌË Ò ‚ÚÓ˘ÌÓ Ôӄ‰ËÂÌÚÂÌ ıÓ‰ ̇ Á‡·ÓÎfl‚‡-ÌÂÚÓ ÍÓËÚÓ: 1. àÏ‡Ú ÍÎËÌ˘ÌÓ ËÎË Î‡·Ó‡ÚÓÌÓ ÔÓ‰ÍÂÔÂ̇ ÒË-„Û̇ ‰Ë‡„ÌÓÁ‡ ÏÌÓÊÂÒÚ‚Â̇ ÒÍÎÂÓÁ‡ ÔÓ ÍËÚÂËË-Ú ̇ Poser2. ç‡ ‚˙Á‡ÒÚ ÓÚ 18 ‰Ó 55 „Ó‰ËÌË3. àÏ‡Ú ËÌ‚‡ÎˉÌÓÒÚ ÔÓ‰ 6,5 ÔÓ Ò͇·ڇ ̇ Kurtzkeã˜ÂÌËÂ Ò ËÌÚÂÙÂÓÌ ·ÂÚ‡ Ì Ò ÔË·„‡, ËÎË ‡ÍÓ ÂÁ‡ÔӘ̇ÚÓ Ò ÒÔˇ ÔË:

1. èˉÛʇ‚‡˘Ë ıÓÌ˘ÌË Á‡·ÓÎfl‚‡ÌËfl, ÍÓËÚÓÒÍ˙Òfl‚‡Ú ÔÓ‰˙ÎÊËÚÂÎÌÓÒÚÚ‡ ̇ ÊË‚ÓÚ‡ (‡ÎÍÓıÓÎËÁ˙Ï, ‰ÂÏÂ̈Ëfl, ÁÎÓ͇˜ÂÒÚ‚ÂÌË ÌÓ‚ÓÓ·‡ÁÛ‚‡-ÌËfl).

2. ÅÂÏÂÌÌÓÒÚ3. çÂÁ‡‚ËÒËÏÓ ÓÚ Î˜ÂÌËÂÚÓ Ò  ̇ÎÓÊËÎÓ ÔË·„‡-

Ì ̇ ÔÓÌ 3 ÍÓÚËÍÓÒÚÂÓˉÌË ÍÛÒ‡ ̇ΘÂÌË ‚ ‰ÌӄӉ˯ÂÌ ÔÂËÓ‰

4. ÅÓÎÌË Ò ÚÂÊ͇ ‰ÂÔÂÒËfl Ë ÒÛˈˉËÚÂÚ ÔÓ ‚ÂÏÂ̇ ΘÂÌËÂÚÓ

5. ëÂËÓÁÌË ÒÚ‡Ì˘ÌË Â‡ÍˆËË ÓÚ Î˜ÂÌËÂÚÓ6. ëËÒÚÂÏÌÓ ÌÂÒÔ‡Á‚‡Ì ̇ Θ·̇ڇ ÒıÂχ ÓÚ

·ÓÎÌËfl

●● ç‡Á̇˜‡‚‡ÌÂÚÓ Ì‡ ΘÂÌËÂ Ò ·ÂÚ‡ ËÌÚÂÙÂÓÌËÒ ËÁ‚˙¯‚‡ ÓÚ ÍÓÏËÒËfl ÓÚ ‰‚‡Ï‡ Ì‚ÓÎÓÁË, ÓÚ ÍÓË-ÚÓ Ô‰Ò‰‡ÚÂΠ̇ ÍÓÏËÒËflÚ‡  Á‡‚Âʉ‡˘ Ì‚ÓÎÓ-„˘ÌÓ ÓÚ‰ÂÎÂÌË ËÎË ÍÎËÌË͇ ‚ ÒÚ‡ˆËÓ̇ÌÓ ·ÓÎÌ˘-ÌÓ Á‡‚‰ÂÌËÂ.

●● å‰Ë͇ÏÂÌÚ‡ Ò ËÁÔËÒ‚‡ ̇ ÔÓÚÓÍÓÎ ÔÓ Ó·‡Áˆ̇ çáéä.

ã˜ÂÌËÂ Ò ËÏÛÌÓÒÛÔÂÒË‚ÌË Ï‰Ë͇ÏÂÌÚË. àÏÛÌÓ-ÒÛÔÂÒË‚ÌËڠωË͇ÏÂÌÚË Ò‡ ̇ ‚ÚÓË ËÁ·Ó Á‡ ΘÂÌËÂ̇ ·ÓÎÌË Ò ÔËÒÚ˙ÔÌÓ-ÂÏËÚÂÌÚ̇ ËÎË ıÓÌ˘ÌÓ ÔÓ„Â-‰ËÂÌÚ̇ ÙÓχ ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ. éÔËÚ˙Ú ÔË ËÏÛÌÓÏÂ-‰ËˇÌËÚ ·ÓÎÂÒÚË ÔÓ͇Á‚‡, ˜Â ÂÙÂÍÚ˂̇ڇ ÒÛÔÂÒËflÔÓ‰Ó·fl‚‡ ÔÓ„ÌÓÁ‡Ú‡ ̇ ·ÓÎÂÒÚÚ‡. ÖÙÂÍÚË‚ÌÓÒÚÚ‡ ̇‡Á΢ÌËڠωË͇ÏÂÌÚË Ì  ‰̇͂‡.

●● äÓ„‡ÚÓ Ò ̇·Î˛‰‡‚‡ Á‡˜ÂÒÚfl‚‡Ì ̇ ÔËÒÚ˙ÔË-ÚÂ, ÌÓ ·ÓÎÌËfl Ì ÓÚ„Ó‚‡fl ̇ ÍËÚÂËËÚ Á‡ ΘÂÌËÂÒ ËÌÚÂÙÂÓÌ ·ÂÚ‡ ËÎË ÔÓ‚Âʉ‡ÌÓÚÓ Î˜ÂÌË Ì ÂÂÙÂÍÚË‚ÌÓ, Ì‚ÓÎÓ„˙Ú ÔˆÂÌfl‚‡ Á‡ÔÓ˜‚‡ÌÂÚÓ Ì‡ËÏÛÌÓÒÛÔÂÒË‚ÌÓ Î˜ÂÌËÂ Ë ‚ˉ˙Ú Ì‡ ωË͇ÏÂÌÚ‡,Ò˙Ó·‡ÁÌÓ ÍËÚÂËËÚÂ.

●● ã˜ÂÌËÂÚÓ Úfl·‚‡ ‰‡ ÔÓ‰˙ÎÊË Ì‡È-χÎÍÓ 3-5„Ó‰ËÌË, ÒΉ ÍÓÂÚÓ Ì‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ ÔˆÂÌË ÌÂ-„Ó‚‡Ú‡ ÂÙÂÍÚË‚ÌÓÒÚ.

●● èÂÛÒÚ‡ÌÓ‚fl‚‡Ì ̇ ΘÂÌËÂÚÓ Ò ‰ÓÔÛÒ͇ Ò‡ÏÓÔË ÔÓfl‚‡ ̇ ÒÚ‡Ì˘ÌË ÂÙÂÍÚË, ËÎË ÎËÔÒ‡ ̇ ÂÙÂÍÚ

äÎËÌ˘̇ڇ ÂÙÂÍÚË‚ÌÓÒÚ Ì‡ ËÏÛÌÓÒÛÔÂÒË‚ÌËÚÂωË͇ÏÂÌÚË Â ‡Á΢̇

●● Mitoxantrone ‚ ‰ÓÁ‡ 12 Ï„/Ï2 ËÌÚ‡‚ÂÌÓÁÌÓ ‚ÒÂÍËÚÂÚË ÏÂÒˆ ‚ ÔÓ‰˙ÎÊÂÌË ̇ ‰̇ „Ó‰Ë̇,  Ï‰Ë͇-ÏÂÌÚ Ì‡ Ô˙‚Ë ËÁ·Ó.

●● Azathioprine ‚ ‰ÓÁ‡ 2-3 Ï„/Í„/‰Ì‚ÌÓ ÔÂÓ‡ÎÌÓ ÂωË͇ÏÂÌÚ Ì‡ ‚ÚÓË ËÁ·Ó.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 106‡ÔËÎ, 2002

●● Methotrexate ‚ ‰ÓÁ‡ 7,5 Ï„ ÔÂÓ‡ÎÌÓ ‚‰Ì˙Ê Ò‰-Ï˘ÌÓ Â Ï‰Ë͇ÏÂÌÚ Ì‡ ÚÂÚË ËÁ·Ó.

äËÚÂËË Á‡ ÔË·„‡Ì ̇ ËÏÛÌÓÒÛÔÂÒË‚ÌË ÔÂÔ‡‡-ÚË

I. ÇÍβ˜‚‡˘Ë1. ïÓÌ˘ÌÓ ÔÓ„ÂÒˇ˘ ıÓ‰.2. Å˙ÁÓ ÔÓ„ÂÒˇ˘ ÂÏËÚÂÌÚÂÌ ıÓ‰.3. Ç˙Á‡ÒÚ 18 - 65 „Ó‰ËÌË.4. àÌ‚‡ÎˉÌÓÒÚ ÔÓ Ò͇·ڇ ̇ Kurtzke 4,0-6,5.II. àÁÍβ˜‚‡˘Ë1. ÅÂÏÂÌÌÓÒÚ ËÎË Ô·ÌˇÌ ̇ ·ÂÏÂÌÌÓÒÚ ÔÂÁ

ÒΉ‚‡˘ËÚ ÚË „Ó‰ËÌË.2. íÂÊÍË ÔˉÛʇ‚‡˘Ë Á‡·ÓÎfl‚‡ÌËfl-Ò˙‰Â˜ÌË, ·ÂÎÓ‰-

Ó·ÌË, ·˙·Â˜ÌË, ˜ÂÌÓ‰Ó·ÌË Ë ËÌÙÂ͈ËË.

Mitoxantrone (Novantron)  Ñçä ‡ÍÚË‚ÌÓ Ò‰ÒÚ‚ÓÒ ˆËÚӈˉÌÓ ‰ÂÈÒÚ‚ËÂ Ë ÔÂËÓ‰ ̇ ÔÓÎÛ‡ÁÔ‡‰ 12 ‰ÌË,ÍÓÈÚÓ Ì ÔÂÏË̇‚‡ ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡. éÚ‰ÂÎfl Ò ˜ÂÁ·˙·ÂˆËÚÂ Ë ˜ÂÌÓ‰Ó·ÌÓ-ÊÎ˙˜Ì‡Ú‡ ÒËÒÚÂχ.

ᇉ˙ʇ ÔÓ„ÂÒËflÚ‡, ÔËÒÚ˙Ô̇ڇ ˜ÂÒÚÓÚ‡ Ë ÂÁÓ-̇Ò̇ڇ ‡ÍÚË‚ÌÓÒÚ ÔË ·ÓÎÌË Ò ÂÏËÚÂÌÚÌÓ-ÔÓ„ÂÒË-‡˘ Ë ÔÓ„ÂÒˇ˘ ıÓ‰ ̇ åë.

èË·„‡ Ò ‚ ‰ÓÁË 12 Ï„/Ï2 ËÎË 20 Ï„ ËÌÚ‡‚ÂÌÓÁÌÓ‚ÒÂÍË ÚÂÚË ÏÂÒˆ, ÏÂÊ‰Û Â‰Ì‡ Ë ‰‚ „Ó‰ËÌË. ëÚ‡Ì˘-ÌËÚ ‰ÂÈÒÚ‚Ëfl ‚Íβ˜‚‡Ú ÏËÂÎÓÒÛÔÂÒËfl, ıÂÔ‡ÚÓ Ë Í‡-‰ËÓ ÚÓÍÒ˘ÌÓÒÚ Ì‡‰ 5%. èË 1/3 ÓÚ ·ÓÎÌËÚ Ò ̇ÏˇÚÒÚÓχ¯ÌÓ-˜Â‚ÌË Ì‡Û¯ÂÌËfl,ÔÓ-fl‰ÍÓ ‡ÏÂÌÓÂfl Ë ‡ÎÓÔÂ-ˆËfl.

Azathioprine (Imuran, Imurek)  ÔÛËÌÓ‚ ‡ÌÚËÏÂÚ‡-·ÓÎËÚ, ÍÓÈÚÓ Ò ÂÁӷˇ ‚ 90% Ë Ò ÓÚ‰ÂÎfl ˜ÂÁ ·˙·Â-ˆËÚÂ. íÎËÏÙÓˆËÚËÚ ҇ Ò Ì‡È-‚ËÒÓ͇ ˜Û‚ÒÚ‚ËÚÂÎÌÓÒÚÍ˙Ï ÔÂÔ‡‡Ú‡.

ç‡Ï‡Îfl‚‡ ÔËÒÚ˙Ô̇ڇ ˜ÂÒÚÓÚ‡ ÔË ÂÏËÚˇ˘ ıÓ‰Ë Ëχ ÌÂÁ̇˜ËÚÂÎÂÌ ÂÙÂÍÚ ÔË ÔÓ„ÂÒË‚ÂÌ ıÓ‰ ̇ Á‡·Ó-Îfl‚‡ÌÂÚÓ.

èË·„‡ Ò ‚ ‰ÓÁ‡ 2-3 Ï„/Í„/‰Ì‚ÌÓ ÔÂÓ‡ÎÌÓ, Ò ÍÓflÚÓÒ ÔÓÒÚË„‡ ÒÛÔÂÒËfl ̇È-‡ÌÓ ÒΉ 20 ‰ÌË. ã˜ÂÌË ÒΉ5Ú‡ „Ó‰Ë̇ ÍË ËÒÍ ÓÚ ÌÂÓÔ·ÁÏË. ç‡È-˜ÂÒÚË ÒÚ‡Ì˘-ÌË ÂÙÂÍÚË Ò‡ ÒÚÓχ¯ÌӘ‚ÌËÚ ̇ۯÂÌËfl, ÔÂÓ‰ÓÎË-ÏË ˜ÂÁ ÚËÚˇÌ ̇ ÔÂÔ‡‡Ú‡ Ë ÒËÏÔÚÓχÚ˘ÌËÒ‰ÒÚ‚‡.

Cyclophosphamide (Cytoxan, Endoxan, Sendoxan) eaÎÍËΡ˘, ÌÂÒÔˆËÙ˘ÂÌ ËÏÛÌÓÒÛÔÂÒ‡ÌÚ, ÍÓÈÚÓ ÔÂ-ÏË̇‚‡ ÏÓÁ˙˜Ì‡Ú‡ ·‡Ë‡. ÅËÓÎӄ˘ÌËflÚ ÊË‚ÓÚ ‚ ÒÂÛ-χ  ÏÂÊ‰Û 4 Ë 8 ˜‡Ò‡. åÂÚ‡·ÓÎËÁˇ Ò ‚ ˜ÂÌËfl ‰Ó·, ËÁ-Î˙˜‚‡ Ò ˜ÂÁ ·˙·ÂˆËÚÂ. ÑÓÁÓÁ‡‚ËÒËÏÓ ÒÛÔÂÒˇ ‡ÌÚË-ÚflÎÓÒÛÔÂÒˇ˘ËÚ ÍÎÂÚÍË; ÔÓÚËÒ͇ Ç ÎËÏÙÓˆËÚËÚ ËíÎËÏÙÓˆËÚËÚÂ, ÌÓ ‚ ÔÓ-„ÓÎflχ ÒÚÂÔÂÌ ıÂÎÔÂÌÓ-Ë̉Û-ÒÂÌËÚ ëÑ4+ÎËÏÙÓˆËÚË.

ìÏÂÂÌÓ ‡ÁÂʉ‡ ÔËÒÚ˙ÔËÚÂ, ÒÍ˙Òfl‚‡ ÔÓ‰˙ÎÊË-ÚÂÎÌÓÒÚ‡ ËÏ Ë Á‡‰˙ʇ Ë̉ÂÍÒ‡ ̇ ÔÓ„ÂÒˇÌ ÔËÔËÒÚ˙ÔÂÌ Ë ÔÓ„ÂÒË‚ÂÌ ıÓ‰, Ò‡ÏÓÒÚÓflÚÂÎÌÓ Ë ‚ ÍÓÏ·Ë-̇ˆËfl Ò ÍÓÚËÍÓÒÚÂÓˉÂÌ ÔÂÔ‡‡Ú.

èË·„‡ Ò ËÌÚ‡‚ÂÌÓÁÌÓ ‰Ó 750 Ï„/Ï2. àχ ‰ÓÁÓÁ‡‚Ë-ÒËÏË ÒÚ‡Ì˘ÌË ‰ÂÈÒÚ‚Ëfl: ‚ËÒÓÍ ÔÓˆÂÌÚ ıÂχÚÛËfl,ÂËÚÓ-ÚÓÏ·ÓÔÂÌËfl, ‡ÎÓÔˆËfl. Ñ˙΄ÓÒÓ˜ÌËÚ ÂÊËÏËÍËflÚ ËÒÍ ÓÚ ÒÚÂËÎËÚÂÚ Ë ÁÎÓ͇˜ÂÒÚ‚Â̇ ‰Â„Â̇-ˆËfl.

Methotrexate ÔÓfl‚fl‚‡ ‡ÌÚËÔÓÎËÙ‡ÚË‚ÌÓ ‰ÂÈÒÚ-‚ËÂ, Ô‰ËÁ‚ËÍ‚‡ÈÍË Ì‰ÓÒÚË„ ̇ ÚÂÚ‡ıˉÓÙÓÎË‚‡ÍËÒÂÎË̇. êÂÁӷˇ Ò ·˙ÁÓ Ë Ì‡Ô˙ÎÌÓ, ÓÚ‰ÂÎfl Ò ˜ÂÁ·˙·ÂˆËÚÂ, ÔË Ì‡Û¯Â̇ ÙÛ̈Ëfl ̇ÒÚ˙Ô‚‡ ÍÛÏÛ·ˆËfl.ëÛÔÂÒË‚ÌËflÚ ÂÙÂÍÚ Ì‡ÒÚ˙Ô‚‡ ÒΉ 2-3 ‰ÌË Ë Â ÒËÎÌÓ ËÁ-‡ÁÂÌ ‚˙ıÛ ıÛÏÓ‡ÎÌËÚ ‡͈ËË, ÔÓfl‚fl‚‡ ‡ÌÚË‚˙ÁÔ‡-

ÎËÚÂÎ̇ ‡ÍÚË‚ÌÓÒÚ, ËÌı˷ˇ ÒÂ͈ËflÚ‡ ̇ ΂ÍÓÚË-ÂÌË.

ìÒÚ‡ÌÓ‚ÂÌÓ Â Á̇˜ËÏÓ Á‡‰˙ʇÌ ̇ ÔËÒÚ˙Ô̇ڇ ˜ÂÒ-ÚÓÚ‡ ÔË ÔËÒÚ˙ÔÂÌ Ë ÚẨÂ̈Ëfl Á‡ Á‡‰˙ʇÌ ̇ Ë̉ÂÍ-Ò‡ ̇ ÔÓ„ÂÒˇÌ ÔË ıÓÌ˘ÌÓ-ÔÓ„ÂÒË‚ÂÌ ıÓ‰.

èË·„‡ Ò ‚‰Ì˙Ê Ò‰Ï˘ÌÓ ‚ ‰ÓÁ‡ 7,5 Ï„ ÔÂÓ‡ÎÌÓ,‡Á‰ÂÎÂ̇ ̇ ÚË ÔËÂχ, ÔÂÁ 12 ˜‡Ò‡. ë˙‚ÏÂÒÚfl‚‡ÌÂÚÓÒ ·‡·ËÚÛ‡ÚË, Ú‡ÌÍ‚ËÎËÁ‡ÚÓË Ë ÍÓÌÚ‡ˆÂÔÚË‚ÌËÔÂÔ‡‡ÚË Á‡ÒË΂‡ ÚÓÍÒ˘ÌËÚ ÂÙÂÍÚË, ‡ ‚ ÍÓÏ·Ë̇ˆËflÒ ÍÓÚËÍÓÒÚÂÓˉÂÌ ÔÂÔ‡‡Ú Ò ̇χÎfl‚‡ ÂÙÂÍÚË‚-ÌÓÒÚÚ‡ ÏÛ. ç‡È-‚‡Ê̇ڇ ÓÚ ÌÂÊ·ÌËÚ ‡͈ËË Â ıÂ-Ô‡ÚÓÚÓÍÒ˘ÌÓÒÚÚ‡, ÔË 1/5 ÓÚ ÎÂÍÛ‚‡ÌËÚÂ, ÔÓÌflÍÓ„‡Ô˘Ë̇ Á‡ ˜ÂÌӉӷ̇ ÙË·ÓÁ‡ Ë ˆËÓÁ‡. èÓ-fl‰ÍÓ ÔÂ-‰ËÁ‚ËÍ‚‡ ÒÚÓχ¯ÌÓ-˜Â‚ÌË Ì‡Û¯ÂÌËfl, flÁ‚‡ Ë ÒÚÓχ-ÚËÚ. çflχ ‰‡ÌÌË Á‡ Ôӂ˯‡‚‡Ì ËÒ͇ ÓÚ Ï‡ÎË„ÌÂÌË ÔÓ-ˆÂÒË.

Cyclosporin A  ÙÛ̄ˇÎÂÌ ÏÂÚ‡·ÓÎËÚ, ÓÚÌÓÒËÚÂÎÌÓÒÂÎÂÍÚË‚ÂÌ ËÏÛÌÓÒÛÔÂÒ‡ÌÚ. óÛ‚ÒÚ‚ËÚÂÎÌË Í˙Ï ÔÂÔ‡-‡Ú‡ Ò‡ íıÂÎÔÂÌË ÒÛ·ÔÓÔÛ·ˆËË, Ò··Ó Ò ÔÓ‚ÎËfl‚‡Ú ÒÛÔ-ÂÒÓÌË ÍÎÂÚÍË. ÇÂÏÂÚÓ Ì‡ ÔÓÎÛÊË‚ÓÚ Â 19 ˜‡Ò‡. éÚ‰Â-Îfl Ò ˜ÂÁ ˜ÂÌÓ‰Ó·ÌÓ-ÊÎ˙˜Ì‡Ú‡ ÒËÒÚÂχ.

èË·„‡ Ò ÔË ·ÓÎÌË Ò ÔËÒÚ˙ÔÂÌ Ë ÔÓ„ÂÒË‚ÂÌ ıÓ‰.êÂÁÛÎÚ‡ÚËÚ Á‡ ÛÏÂÂÌÓ Á‡‰˙ʇÌ ̇ Ë̉ÂÍÒ‡ ̇ ÔÓ„-ÂÒˇÌÂ Ë Â‰Û͈Ëfl ̇ ËÌÚ‡ÚÂ͇Î̇ڇ IgG ÒËÌÚÂÁ‡ Ò‡ÔÓÚË‚Ó˜˂Ë. ç Ò ÛÒÚ‡ÌÓ‚fl‚‡ ÍÓ·ˆËfl Ò ‡ÍÚË‚-ÌÓÒÚÚ‡ ̇ åêí, ÌËÚÓ ‡ÁÎËÍË ‚ ÍÎËÌ˘̇ڇ ÂÙÂÍÚË‚-ÌÓÒÚ ‚ Ò‡‚ÌÂÌËÂ Ò azathioprine.

èË·„‡ Ò ÔÂÓ‡ÎÌÓ, 5-7Ï„ /Í„./‰Ì‚ÌÓ ‚ ‰‚‡ ÔËÂχÔÂÁ 12 ˜‡Ò‡ ‚ ‡ÏÍËÚ ̇ ÏÂÒˆË.

èÓfl‚fl‚‡ ÌÂÙÓÚÓÍÒ˘ÌÓÒÚ ‚ 36%, ÍÓflÚÓ Ò Ôӂ˯‡-‚‡ ÔË Ò˙‚ÏÂÒÚfl‚‡ÌÂ Ò ‚‡ԇÏËÎ, ‰ËÎÚˇÁÂÏ, ‰ÓÍÒˈËÍ-ÎËÌ Ë ÍÓÌÚ‡ˆÂÔÚË‚Ë, ‰‡‚‡ ıËÔÂÚÂÌÁËfl ‚ 38%. Cyclosporin A Ëχ Ò··‡ ÂÙÂÍÚË‚ÌÓÒÚ Ë ‚ËÒÓÍ ÔÓˆÂÌÚÒÚ‡Ì˘ÌË, ˜‡ÒÚ˘ÌÓ ÌÂÓ·‡ÚËÏË ÂÙÂÍÚË.

ã˜ÂÌË ËÁ‚˙Ì ÔËÒÚ˙Ô Ò ËÏÛÌÓ„ÎÓ·ÛÎËÌË. àÏÛÌÓ„ÎÓ-·ÛÎËÌËÚ ҇ ωË͇ÏÂÌÚË Ì‡ ÚÂÚË ËÁ·Ó ÔË ‚˙Á‡ÒÚ-ÌË Ë Ì‡ Ô˙‚Ë ËÁ·Ó ÔË ‰Âˆ‡ ÔÓ‰ 18 „Ӊ˯̇ ‚˙Á‡ÒÚ, ÔËÍÓËÚÓ Â ÔÓÚË‚ÓÔÓ͇Á‡ÌÓ ÔË·„‡ÌÂÚÓ Ì‡ ËÌÚÂÙÂÓÌ·ÂÚ‡ Ë ËÏÛÌÓÒÛÔÂÒ‡ÌÚË. èË·„‡ Ò Imunnovenin ÔÓ 1ËÌÙÛÁËfl ÏÂÒ˜ÌÓ ‚ ‰ÓÁ‡ 200 Ï„/Í„.

臈ËÂÌÚËÚ ÏÓ„‡Ú ‰‡ Ò ıÓÒÔËÚ‡ÎËÁË‡Ú ‚Ì‚ÓÎӄ˘ÌÓ ÓÚ‰ÂÎÂÌË ÓÚ Ì‚ÓÎÓ„:

●● ᇠ‰Ë‡„ÌÓÒÚ˘ÌÓ ËÁflÒÌfl‚‡ÌÂ●● èË Î˜ÂÌË ̇ ÔËÒÚ˙Ô●● èË Á‡ÔÓ˜‚‡Ì ̇ ωË͇ÏÂÌÚÓÁÌÓ Î˜ÂÌËÂ

ËÁ‚˙Ì ÔËÒÚ˙Ô●● èË Ì‡Î˘Ë ̇ ‰Û„Ë, Á‡ÒÚ‡¯‡‚‡˘Ë ÒËÏÔÚÓÏË

ç‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ Ô„ÎÂʉ‡ ·ÓÎÌËfl ‚‰Ì˙Ê ÏÂ-Ò˜ÌÓ Ë ÔË ‚ÒflÍÓ ‚ÎÓ¯‡‚‡ÌÂ Ë ‰‡ ̇·Î˛‰‡‚‡ Á‡:

●● ̇ÒÚ˙Ô‚‡Ì ̇ ÌÓ‚ ÔËÒÚ˙Ô●● ÔÓ„ÂÒË‚ÌÓ ‚ÎÓ¯‡‚‡Ì ̇ ÒËÏÔÚÓχÚË͇ڇ Ò

Ôӂ˜ ÓÚ 1 ÚӘ͇ ÔÓ Ò͇·ڇ ̇ Kurtzke „Ӊ˯ÌÓ●● Á‡˜ÂÒÚfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ Ôӂ˜ ÓÚ 2 „Ӊ˯-

ÌÓ●● ÒÚ‡Ì˘ÌË ÂÙÂÍÚË ÓÚ ÔË·„‡ÌÓÚÓ Î˜ÂÌË ËÁ-

‚˙Ì ÔËÒÚ˙Ô●● ÂÙÂÍÚË‚ÌÓÒÚ ÓÚ ÔË·„‡ÌÓÚÓ Î˜ÂÌË ËÁ‚˙Ì

ÔËÒÚ˙Ô●● é·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ëfl ÎÂ͇ Úfl·‚‡ ‰‡ ̇·Î˛‰‡-

‚‡ ·ÓÎÌËfl Á‡ ÒÓχÚ˘ÌË ÛÒÎÓÊÌÂÌËfl, ̇ÒÚ˙ÔËÎË‚ÒΉÒÚ‚Ë ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ËÎË ÔÓ‚Âʉ‡ÌÓÚÓ Î˜Â-ÌËÂ.

●● ã˜ÂÌËÂÚÓ Ì‡ ÒÓχÚ˘ÌËÚ ÛÒÎÓÊÌÂÌËfl Ò ÔÓ-‚Âʉ‡ ÓÚ Ó·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ëfl ÎÂ͇.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 107‡ÔËÎ, 2002

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 108‡ÔËÎ, 2002

ã˜ÂÌË ËÁ‚˙Ì ÔËÒÚ˙Ô Ò ËÏÛÌÓ„ÎÓ·ÛÎËÌË. àÏÛÌÓ„-ÎÓ·ÛÎËÌËÚ ҇ ωË͇ÏÂÌÚË Ì‡ ÚÂÚË ËÁ·Ó ÔË ‚˙Á‡Ò-ÚÌË Ë Ì‡ Ô˙‚Ë ËÁ·Ó ÔË ‰Âˆ‡ ÔÓ‰ 18 „Ӊ˯̇ ‚˙Á‡ÒÚ,ÔË ÍÓËÚÓ Â ÔÓÚË‚ÓÔÓ͇Á‡ÌÓ ÔË·„‡ÌÂÚÓ Ì‡ ËÌÚÂÙÂ-ÓÌ ·ÂÚ‡ Ë ËÏÛÌÓÒÛÔÂÒ‡ÌÚË. èË·„‡ Ò Imunnovenin ÔÓ1 ËÌÙÛÁËfl ÏÂÒ˜ÌÓ ‚ ‰ÓÁ‡ 200 Ï„/Í„.

臈ËÂÌÚËÚ ÏÓ„‡Ú ‰‡ Ò ıÓÒÔËÚ‡ÎËÁË‡Ú ‚ Ì‚ÓÎÓ-„˘ÌÓ ÓÚ‰ÂÎÂÌË ÓÚ Ì‚ÓÎÓ„:

●● ᇠ‰Ë‡„ÌÓÒÚ˘ÌÓ ËÁflÒÌfl‚‡ÌÂ●● èË Î˜ÂÌË ̇ ÔËÒÚ˙Ô●● èË Á‡ÔÓ˜‚‡Ì ̇ ωË͇ÏÂÌÚÓÁÌÓ Î˜ÂÌË ËÁ-

‚˙Ì ÔËÒÚ˙Ô●● èË Ì‡Î˘Ë ̇ ‰Û„Ë, Á‡ÒÚ‡¯‡‚‡˘Ë ÒËÏÔÚÓÏË

ç‚ÓÎÓ„˙Ú Úfl·‚‡ ‰‡ Ô„ÎÂʉ‡ ·ÓÎÌËfl ‚‰Ì˙Ê ÏÂ-Ò˜ÌÓ Ë ÔË ‚ÒflÍÓ ‚ÎÓ¯‡‚‡ÌÂ Ë ‰‡ ̇·Î˛‰‡‚‡ Á‡:

●● ̇ÒÚ˙Ô‚‡Ì ̇ ÌÓ‚ ÔËÒÚ˙Ô

●● ÔÓ„ÂÒË‚ÌÓ ‚ÎÓ¯‡‚‡Ì ̇ ÒËÏÔÚÓχÚË͇ڇ ÒÔӂ˜ ÓÚ 1 ÚӘ͇ ÔÓ Ò͇·ڇ ̇ Kurtzke „Ӊ˯ÌÓ

●● Á‡˜ÂÒÚfl‚‡Ì ̇ ÔËÒÚ˙ÔËÚ Ôӂ˜ ÓÚ 2 „Ӊ˯-ÌÓ

●● ÒÚ‡Ì˘ÌË ÂÙÂÍÚË ÓÚ ÔË·„‡ÌÓÚÓ Î˜ÂÌË ËÁ-‚˙Ì ÔËÒÚ˙Ô

●● ÂÙÂÍÚË‚ÌÓÒÚ ÓÚ ÔË·„‡ÌÓÚÓ Î˜ÂÌË ËÁ‚˙ÌÔËÒÚ˙Ô

●● é·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ëfl ÎÂ͇ Úfl·‚‡ ‰‡Ì‡·Î˛‰‡‚‡ ·ÓÎÌËfl Á‡ ÒÓχÚ˘ÌË ÛÒÎÓÊÌÂÌËfl,̇ÒÚ˙ÔËÎË ‚ÒΉÒÚ‚Ë ̇ Á‡·ÓÎfl‚‡ÌÂÚÓ, ËÎËÔÓ‚Âʉ‡ÌÓÚÓ Î˜ÂÌËÂ.

●● ã˜ÂÌËÂÚÓ Ì‡ ÒÓχÚ˘ÌËÚ ÛÒÎÓÊÌÂÌËfl ÒÂÔÓ‚Âʉ‡ ÓÚ Ó·˘ÓÔ‡ÍÚËÍÛ‚‡˘Ëfl ÎÂ͇.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 109‡ÔËÎ, 2002

èËÎÓÊÂÌË 1. îÓÏË Ì‡ ÍÎËÌ˘ÌÓ ÔÓÚ˘‡Ì ̇ åë ÒÔÓ‰ ‚ÂÏ‚Ëfl ÔÓÙËÎ

èËÎÓÊÂÌË 3.ë͇· Á‡ ÍÓ΢ÂÒÚ‚ÂÌÓ ÓÚ˜Ëڇ̠̇ ۂ‰‡Ú‡ ̇

Ì‚ÓÎӄ˘ÌËÚ ÙÛÌ͈ËË Ì‡ J.F. Kurtzke 1983 „. (EDSS)

Ä.èˇÏˉÌË ÙÛÌ͈ËË0 - çÓχÎÌË.1 - è‡ÚÓÎӄ˘ÌË ·ÂÎÂÁË ·ÂÁ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ (ÌÂ-

ÒËÏÂÚ˘̇ ıËÔÂÂÙÎÂÍÒËfl, ÓÚÒ··ÂÌË ËÎË ÎËÔÒ‚‡˘ËÍÓÂÏÌË ÂÙÎÂÍÒË, ̇΢ˠ̇ Ô‡ÚÓÎӄ˘ÌË ÂÙÎÂÍÒË ÓÚ„ÛÔ‡Ú‡ ̇ Ň·ËÌÒÍË Ë ‰.).

2 - åËÌËχÎÂÌ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ (·ÚÂÌÚÌË Ô‡-ÂÁË).

3 - ãÂ͇ ËÎË ÛÏÂÂ̇ Ô‡‡Ô‡ÂÁ‡ ËÎË ıÂÏËÔ‡ÂÁ‡; ÚÂÊ-͇ ÏÓÌÓÔ‡ÂÁ‡.

4 - àÁ‡ÁÂ̇ Ô‡‡Ô‡ÂÁ‡ ËÎË ıÂÏËÔ‡ÂÁ‡; ÛÏÂÂ̇ Í‚‡‰-ËÔ‡ÂÁ‡; ÏÓÌÓÔ΄Ëfl.

5 - 臇Ô΄Ëfl, ıÂÏËÔ΄Ëfl ËÎË ËÁ‡ÁÂ̇ Í‚‡‰ËÔ‡ÂÁ‡.6 - 䂇‰ËÔ΄Ëfl.V - çÂËÁ‚ÂÒÚÌÓ.

Ç. ñ·Â·ÌË ÙÛÌ͈ËË.0 - çÓχÎÌË.1 - è‡ÚÓÎӄ˘ÌË ·ÂÎÂÁË ·ÂÁ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ

(‰ËÒÍÓÓ‰Ë̇ˆËÓÌÌË ‡ÁÒÚÓÈÒÚ‚‡, ÓÚ˜ÂÚÂÌË Ò‡ÏÓ ÔËÍÓÓ‰Ë̇ˆËÓÌÌËÚ ÔÓ·Ë, ÌÓ ·ÂÁ ̇ۯÂÌË ̇ ÔÓıӉ͇-Ú‡ ËÎË Ì‡ Âʉ̂ÌËÚ χÌËÔÛ·ˆËË).

2 - ãÂ͇ ‡Ú‡ÍÒËfl (ÎÓÍÓÏÓÚÓ̇ ËÎË Ì‡ ͇ÈÌˈËÚÂ).3 - ìÏÂÂ̇ ‡Ú‡ÍÒËfl (ÎÓÍÓÏÓÚÓ̇ ËÎË Ì‡ ͇ÈÌˈË-

ÚÂ).4 - íÂÊ͇ ‡Ú‡ÍÒËfl ̇ ͇ÈÌˈËÚÂ, ÌÓ Ò˙˜Âڇ̇ Ò ËÁ-

‚ÂÒÚÌÓ ÂÙÂÍÚË‚ÌÓ ‰‚ËÊÂÌËÂ.5 - ç‚˙ÁÏÓÊÌÓÒÚ ‰‡ Ò ËÁ‚˙¯‚‡Ú ÍÓÓ‰ËÌˇÌË ‰‚Ë-

ÊÂÌËfl ÔÓ‡‰Ë ‡Ú‡ÍÒËflÚ‡.V - çÂËÁ‚ÂÒÚÌÓ.ï - èÓÒÚ‡‚fl Ò ÒΉ ‚ÒÂÍË ÌÓÏÂ, ‡ÍÓ Ô‡ÂÁËÚ ‚ ͇È-

ÌˈËÚ Ô˜‡Ú ̇ ÚÓ˜ÌÓÚÓ ÓÚ˜ËÚ‡ÌÂ.

ë. îÛÌ͈ËË Ì‡ ÏÓÁ˙˜ÌËfl ÒÚ‚ÓÎ.0 - çÓχÎÌË.1 - è‡ÚÓÎӄ˘ÌË Ì‡ıÓ‰ÍË ·ÂÁ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ

(̇Ô. ÓÚÔ‡‰Ì‡ ÒÂÚ˂̇ ÒËÏÔÚÓχÚË͇).2 - ìÏÂÂÌ ÌËÒÚ‡„˙Ï ËÎË ‰Û„ ÎÂÍ ‰ÂÙˈËÚ.3 - íÂÊ˙Í ÌËÒÚ‡„˙Ï, ËÁfl‚Â̇ Ә‰‚Ë„‡ÚÂÎ̇ Ò··ÓÒÚ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 110‡ÔËÎ, 2002

ËÎË ÛÏÂÂÌ ‰ÂÙˈËÚ Ì‡ ‰Û„Ë óåç.4 - àÁ‡ÁÂ̇ ‰ËÁ‡ÚËfl ËÎË ‰Û„ ËÁ‡ÁÂÌ ‰ÂÙˈËÚ (ÎË-

ˆÂ‚‡ ‰ËÔ΄Ëfl ËÎË ÓÙÚ‡ÎÏÓÔ΄Ëfl).5 - ç‚˙ÁÏÓ„ÌÓÒÚ Á‡ „˙Îڇ̠ËÎË ‡Ì‡ÚËfl.V - çÂËÁ‚ÂÒÚÌÓ.

D. ëÂÚË‚ÌË ÙÛÌ͈ËË.0 - çÓχÎÌË.1 - ëÌËÊÂÌ ‰‚ÛÏÂÌÓ-ÔÓÒÚ‡ÌÒÚ‚ÂÌ ËÎË ‚Ë·‡ˆËÓÌÂÌ

ÛÒÂÚ Ò‡ÏÓ ‚ ‰ËÌ ËÎË ‰‚‡ ͇ÈÌË͇.2 - ç‡Ï‡ÎÂÌ ÒÚ‡‚ÌÓ-ÏÛÒÍÛÎÂÌ ËÎË ‰ËÒÍËÏË̇ˆËÓÌÂÌ

ÛÒÂÚ ‚ ‰ËÌ ËÎË ‰‚‡ ͇ÈÌË͇ ËÎË ÒÌËÊÂÌ ‚Ë·‡ˆËÓÌÂÌÛÒÂÚ ‚ ÚË ËÎË ˜ÂÚËË Í‡ÈÌË͇.

3 - ìÏÂÂÌÓ Ì‡Ï‡ÎÂ̇ ÒÂÚË‚ÌÓÒÚ Á‡ ‰ÓÔË Ë ·ÓÎ͇,Ë/ËÎË Á‡„Û·‡ ̇ ‚Ë·‡ˆËÓÌ̇ڇ ÒÂÚË‚ÌÓÒÚ Á‡ ‰ËÌ ËÎˉ‚‡ ͇ÈÌË͇; ËÎË ‰Û„‡ ÍÓÏ·Ë̇ˆËfl ÓÚ ÒËÏÔÚÓÏË - ÎÂ͇ıËÔÂÒÚÂÁËfl Á‡ ‰ÓÔË Ë ·ÓÎ͇ Ë/ËÎË ÛÏÂÂÌÓ Ì‡Ï‡ÎÂÌË Á‡‚Ò˘ÍË ÔÓÔËÓˆÂÔÚË‚ÌË ÚÂÒÚÓ‚Â ‚ ÚË ËÎË ˜ÂÚËË͇ÈÌË͇.

4 - ᇷÂÎÂÊËÚÂÎÌÓ Ì‡Ï‡ÎÂ̇ ÒÂÚË‚ÌÓÒÚ Á‡ ‰ÓÔË Ë·ÓÎ͇ ËÎË Á‡„Û·‡ ̇ ÔÓÔËÓˆÂÔÚ˂̇ڇ ÒÂÚË‚ÌÓÒÚ, Ò‡-ÏÓÒÚÓflÚÂÎÌÓ ËÎË ÍÓÏ·ËÌˇÌÓ, ‚ ‰ËÌ ËÎË ‰‚‡ ͇ÈÌË͇;ËÎË ‰Û„‡ ÍÓÏ·Ë̇ˆËfl ÓÚ ÒËÏÔÚÓÏË - ÛÏÂÂÌÓ Ì‡Ï‡ÎÂ̇ÒÂÚË‚ÌÓÒÚ Á‡ ‰ÓÔË Ë ·ÓÎ͇ Ë/ËÎË ÒËÎÌÓ Ì‡Ï‡ÎÂ̇ ÔÓÔ-ËÓˆÂÔÚ˂̇ ÒÂÚË‚ÌÓÒÚ ‚ Ôӂ˜ ÓÚ ‰‚‡ ͇ÈÌË͇.

5 - ᇄ۷‡ ̇ ÒÂÚË‚ÌÓÒÚ ‚ ‰ËÌ ËÎË ‰‚‡ ͇ÈÌË͇; ËÎˉۄ‡ ÍÓÏ·Ë̇ˆËfl ÓÚ ÒËÏÔÚÓÏË - ÛÏÂÂÌÓ Ì‡Ï‡ÎÂÌË ̇ÒÂÚË‚ÌÓÒÚÚ‡ Á‡ ‰ÓÔË Ë ·ÓÎ͇ Ë/ËÎË Á‡„Û·‡ ̇ ÔÓÔËÓ-ˆÂÔÚ˂̇ڇ ÒÂÚË‚ÌÓÒÚ Á‡ ÔÓ-„ÓÎflχڇ ˜‡ÒÚ ÓÚ ÚflÎÓ-ÚÓ ·ÂÁ „·‚‡Ú‡.

6 - Ä̇΄ÂÁËfl Ë ‡ÌÂÒÚÂÁËfl ‰Ó ¯ËflÚ‡.V - çÂËÁ‚ÂÒÚÌÓ.

Ö. í‡ÁÓ‚ÓÂÁ‚ӇÌË ÙÛÌ͈ËË.0 - çÓχÎÌË.1 - ãÂ͇ ÌÂÛ‚ÂÂÌÓÒÚ, ËÏÔ‡ÚË‚ÌÓÒÚ, fl‰ÍÓ ÂÚÂÌ-

ˆËfl.2 - ìÏÂÂ̇ ÌÂÛ‚ÂÂÌÓÒÚ, ËÏÔ‡ÚË‚ÌÓÒÚ, ÂÚÂ̈Ëfl

ËÎË fl‰ÍÓ ËÌÍÓÌÚËÌÂ̈Ëfl ̇ ÛË̇ڇ.3 - óÂÒÚ‡ ËÌÍÓÌÚËÌÂ̈Ëfl.4 - çÂÓ·ıÓ‰ËÏÓÒÚ ÓÚ ÔÓ˜ÚË ÌÂÔÂÍ˙Ò̇ڇ ͇ÚÂÚÂË-

Á‡ˆËfl.5 - ᇄ۷‡ ̇ ÍÓÌÚÓÎ ‚˙ıÛ ÔËÍÓ˜ÌËfl ÏÂıÛ.6 - ᇄ۷‡ ̇ ÍÓÌÚÓÎ ‚˙ıÛ ÔËÍÓ˜ÌËfl ÏÂıÛ Ë ÂÍÚÛ-

χ.V - çÂËÁ‚ÂÒÚÌË.

F. áËÚÂÎÌË ÙÛÌ͈ËË.0 - çÓχÎÌË.1 - ëÍÓÚÓÏ Ò˙Ò Á‡Ô‡ÁÂÌ ‚ËÁÛÒ ‰Ó 20/30.2 - ëÍÓÚÓÏ Ë Ï‡ÍÒËχÎ̇ ÁËÚÂÎ̇ ÓÒÚÓÚ‡ ‚ ÔÓ-Û‚-

‰ÂÌÓÚÓ ÓÍÓ (ÍÓ˄ˇ̇) ÓÚ 20/30 ‰Ó 20/59.3 - ÉÓÎflÏ ÒÍÓÚÓÏ ‚ ÔÓ-ۂ‰ÂÌÓÚÓ ÓÍÓ ËÎË ÛÏÂÂÌÓ Ì‡-

χÎÂÌË ̇ ÁËÚÂÎÌËÚ ÔÓÎÂÚ‡, ÌÓ Ò Ï‡ÍÒËχÎ̇ (ÍÓË„Ë-‡Ì‡) ÁËÚÂÎ̇ ÓÒÚÓÚ‡ ÓÚ 20/60 ‰Ó 20/99.

4 - èÓ-ۂ‰ÂÌÓÚÓ ÓÍÓ Â Ò ËÁ‡ÁÂÌÓ Ì‡Ï‡ÎÂÌË ̇ ÁË-ÚÂÎÌÓÚÓ ÔÓÎÂ Ë Ò Ï‡ÍÒËχÎ̇ (ÍÓ˄ˇ̇) ÁËÚÂÎ̇ ÓÒ-ÚÓÚ‡ ÓÚ 20/100 ‰Ó 20/200; ËÁÏÂÌÂÌËflÚ‡ ‚ ÒÚÂÔÂÌ 3ÔÎ˛Ò Ï‡ÍÒËχÎ̇ ÁËÚÂÎ̇ ÓÒÚÓÚ‡ ‚ ÔÓ-Ò··Ó Á‡Ò„̇-ÚÓÚÓ ÓÍÓ 20/60 ËÎË ÔÓ-χÎ͇.

5 - èÓ-ۂ‰ÂÌÓÚÓ ÓÍÓ Â Ò Ï‡ÍÒËχÎ̇ (ÍÓ˄ˇ̇)ÁËÚÂÎ̇ ÓÒÚÓÚ‡ ÔÓ‰ 20/200; ËÁÏÂÌÂÌËflÚ‡, ÓÁ̇˜ÂÌË ‚ÒÚÂÔÂÌ 4 ÔÎ˛Ò Ï‡ÍÒËχÎ̇ ÁËÚÂÎ̇ ÓÒÚÓÚ‡ ̇ ÔÓ-Á‡-Ô‡ÁÂÌÓÚÓ ÓÍÓ 20/60 ËÎË ÔÓ-ÌËÒ͇.

6 - àÁÏÂÌÂÌËflÚ‡, ÓÁ̇˜ÂÌË ‚ ÒÚÂÔÂÌ 5 ÔÎ˛Ò Ï‡ÍÒËχÎ-̇ ÁËÚÂÎ̇ ÓÒÚÓÚ‡ ‚ ÔÓ-Á‡Ô‡ÁÂÌÓÚÓ ÓÍÓ 20/60 ËÎË ÔÓ-ÌËÒ͇.

V - çÂËÁ‚ÂÒÚÌÓ.ï - èË·‡‚fl Ò Í˙Ï ÒÚÂÔÂÌËÚ ÓÚ 0 ‰Ó 6 ÔË Ì‡Î˘ËÂ-

ÚÓ Ì‡ ÚÂÏÔÓ‡ÎÌÓ ÔӷΉÌfl‚‡Ì ̇ Ô‡ÔËÎËÚÂ.

G. èÒËı˘ÌË ÙÛÌ͈ËË.0 - çÓχÎÌË.1 - èÓÏÂÌË ‚ ̇ÒÚÓÂÌËÂÚÓ (ÂÛÙÓËfl ËÎË ‰ÂÔÂÒËfl).2 - ãÂÍÓ ÒÔ‡‰‡Ì ̇ ÏËÒÎÓ‚ÌËÚ ÔÓˆÂÒË ÔÓ ÓÚÌÓ¯ÂÌËÂ

̇ ‡·Òڇ͈ËË ËÎË Ï‡ÚÂχÚ˘ÂÒÍË ÓÔ‡ˆËË.3 - ìÏÂÂÌÓ ÒÌËÊÂÌË ̇ Ô‡ÏÂÚÚ‡, ̇ۯÂÌË ‚ Ò˙Ê-

‰ÂÌËflÚ‡ Ë ÛÏÓÁ‡Íβ˜ÂÌËflÚ‡.4 - èÓ-ÚÂÊÍÓ ÔÒËı˘ÂÒÍÓ Ì‡Û¯ÂÌËÂ Ò ËÁ‚ÂÒÚ̇ ‰ÂÁÓ-

ËÂÌÚ‡ˆËfl.5 - ÑÂÏÂ̈Ëfl.V - çÂËÁ‚ÂÒÚÌË.

ç. ÑÛ„Ë ÙÛÌ͈ËË.0 - çflχ ̇ۯÂÌËfl.1 - àχ Ìfl͇͂‡ ‰Û„‡ ̇ıӉ͇ - ÓÔ‰ÂÎfl Ò ͇͂‡.V - çÂËÁ‚ÂÒÚÌË.

ë͇· Á‡ ÓÚ˜Ëڇ̠̇ Ó·˘Ëfl ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙË-ˆËÚ ÔÓ J.F.Kurtzke (1983)

0 - çÓχÎÂÌ Ì‚ÓÎӄ˘ÂÌ ÒÚ‡ÚÛÒ (‚Ò˘ÍË ÙÛÌ͈ËÓ-̇ÎÌË ÒËÒÚÂÏË Ò‡ ̇ ÒÚÂÔÂÌ 0); ‚˙ÁÏÓÊÌË Ò‡ "èÒËı˘ÌËÙÛÌ͈ËË" ̇ ÒÚÂÔÂÌ 1.

1 - ãËÔÒ‚‡ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ, ÏËÌËχÎÌË ·ÂÎÂÁË ‚‰̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ (îë) (։̇ ÙÛÌ͈ËÓ̇Î̇ÒËÒÚÂχ  ̇ ÒÚÂÔÂÌ 1, Ò˙Ò ËÎË ·ÂÁ "èÒËı˘ÌË ÙÛÌ͈ËË"̇ ÒÚÂÔÂÌ 1, ÓÒڇ̇ÎËÚ ÒËÒÚÂÏË Ò‡ ̇ ÒÚÂÔÂÌ 0).

1,5 - ãËÔÒ‚‡ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ, ÏËÌËχÎÌË ·ÂÎÂ-ÁË ‚ Ôӂ˜ ÓÚ Â‰Ì‡ îë (Ôӂ˜ ÓÚ Â‰Ì‡ ÙÛÌ͈ËÓ̇Î̇ÒËÒÚÂχ  ̇ ÒÚÂÔÂÌ 1; Ò˙Ò ËÎË ·ÂÁ "èÒËı˘ÌË ÙÛÌ͈ËË"̇ ÒÚÂÔÂÌ 1).

2 - åËÌËχÎÂÌ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ ‚ ‰̇ îë (‰-̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ  ̇ ÒÚÂÔÂÌ 2, ‰Û„ËÚ ҇ ̇ÒÚÂÔÂÌ 0 ËÎË 1).

2,5 - åËÌËχÎÂÌ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ ‚ ‰‚ îë (‰‚ÂÙÛÌ͈ËÓ̇ÎÌË ÒËÒÚÂÏË Ò‡ ̇ ÒÚÂÔÂÌ 2, ‰Û„ËÚ ҇ ̇ÒÚÂÔÂÌ 0 ËÎË 1).

3 - ìÏÂÂÌ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ ‚ ‰̇ îë (‰̇ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ ̇ ÒÚÂÔÂÌ 3, ‰Û„ËÚ ҇ ̇ ÒÚÂ-ÔÂÌ 0 ËÎË 1); ËÎË ÎÂÍ ÙÛÌ͈ËÓ̇ÎÂÌ ‰ÂÙˈËÚ ‚ ÚË ËÎË ˜Â-ÚËË îë (ÚË/˜ÂÚËË ÙÛÌ͈ËÓ̇ÎÌË ÒËÒÚÂÏË Ì‡ ÒÚÂÔÂÌ2, ‰Û„ËÚ ̇ 0 ËÎË 1), Ô‡ˆËÂÌÚ˙Ú Â Ì‡Ô˙ÎÌÓ ÔÓ‰‚ËÊÂÌ.

3,5 - ç‡Ô˙ÎÌÓ ÔÓ‰‚ËÊÂÌ, ÌÓ Ò ÛÏÂÂÌ ÙÛÌ͈ËÓ̇ÎÂÌ ‰Â-ÙˈËÚ ‚ ‰̇ îë (‰̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ  ̇ ÒÚÂ-ÔÂÌ 3) Ë Â‰Ì‡ ËÎË ‰‚ îë ̇ ÒÚÂÔÂÌ 2; ËÎË ‰‚ îë ̇ ÒÚÂ-ÔÂÌ 3; ËÎË 5 îë ̇ ÒÚÂÔÂÌ 2 (ÓÒڇ̇ÎËÚ ҇ ̇ ÒÚÂÔÂÌ 0ËÎË 1).

4 - éÚÌÓÒËÚÂÎÌÓ ÚÂÊ˙Í ‰ÂÙˈËÚ, χ͇ ˜Â Ô‡ˆËÂÌ-Ú˙Ú Â Ì‡Ô˙ÎÌÓ ÔÓ‰‚ËÊÂÌ Ë ÒÔÓÒÓ·ÂÌ ‰‡ Ò ҇ÏÓÓ·ÒÎÛÊ‚‡Ë  ̇ ͇͇ 12 ˜‡Ò‡ ÓÚ ‰ÂÌÓÌÓ˘ËÂÚÓ (ÚÂÊ͇ ËÌ‚‡ÎˉË-Á‡ˆËfl, Ò˙ÓÚ‚ÂÚÒÚ‚‡˘‡ ̇ ‰̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ̇ ÒÚÂÔÂÌ 4, ‰Û„ËÚ ҇ ̇ ÒÚÂÔÂÌ 0 ËÎË 1) ËÎË ÍÓÏ·Ë̇-ˆËfl ÓÚ îë ̇ ÔÓ-χÎÍË ÒÚÂÔÂÌË, Ô‚˯‡‚‡˘‡ ÒÚÂÔÂÌ3,5 ÔÓ Ò͇·ڇ. ëÔÓÒÓ·ÂÌ ‰‡ ıÓ‰Ë 500 m ·ÂÁ ˜Ûʉ‡ ÔÓÏÓ˘ËÎË ÔӘ˂͇.

4,5 - ç‡Ô˙ÎÌÓ ÔÓ‰‚ËÊÂÌ ·ÂÁ ˜Ûʉ‡ ÔÓÏÓ˘, ‰‚ËÊË Ò ËÁ-Ô‡‚ÂÌ ÔÂÁ ÔÓ-„ÓÎflχڇ ˜‡ÒÚ ÓÚ ‰ÂÌfl, ÒÔÓÒÓ·ÂÌ ‰‡ ‡·Ó-ÚË ÔÂÁ ˆÂÎËfl ‰ÂÌ (Ò‡‚ÌËÚÂÎÌÓ ÚÂÊ͇ ËÌ‚‡ÎˉËÁ‡ˆËfl,Ò˙ÓÚ‚ÂÚÒÚ‚‡˘‡ ̇ ‰̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ ̇ ÒÚÂ-ÔÂÌ 4, ‰Û„ËÚ ҇ ̇ ÒÚÂÔÂÌ 0 ËÎË 1) ËÎË ÍÓÏ·Ë̇ˆËfl ÓÚîë ̇ ÔÓ-χÎÍË ÒÚÂÔÂÌË, Ô‚˯‡‚‡˘‡ ÒÚÂÔÂÌ 4 ÔÓ Ò͇-·ڇ. ëÔÓÒÓ·ÂÌ ‰‡ ıÓ‰Ë 300 m ·ÂÁ ˜Ûʉ‡ ÔÓÏÓ˘ ËÎË ÔÓ-˜Ë‚͇.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 111‡ÔËÎ, 2002

5 - èÓ‰‚ËÊÂÌ, ·ÂÁ ˜Ûʉ‡ ÔÓÏÓ˘ ËÎË ÔӘ˂͇ ‰Ó 200ÏÂÚ‡, ÚÂÊ͇ ËÌ‚‡ÎˉËÁ‡ˆËfl, ‰ÓÒÚ‡Ú˙˜Ì‡ ‰‡ ÒÏÛÚË ÒÂ-ËÓÁÌÓ Âʉ̂ÌËÚ ‰ÂÈÌÓÒÚË (‰̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒ-ÚÂχ ̇ ÒÚÂÔÂÌ 5, ‰Û„ËÚ ҇ ̇ ÒÚÂÔÂÌ 0 ËÎË 1; ËÎË ÍÓÏ-·Ë̇ˆËfl ÓÚ îë ̇ ÔÓ-χÎÍË ÒÚÂÔÂÌË, Ô‚˯‡‚‡˘‡ ÒÚÂ-ÔÂÌ 4 ÔÓ Ò͇·ڇ).

5,5 - èÓ‰‚ËÊÂÌ ·ÂÁ ÔÓÏÓ˘ ËÎË ÔӘ˂͇ ‰Ó 100 ÏÂÚ‡.èÓÎÓ‚Ë̇ڇ ÓÚ ‰ÂÌfl ÏÓÊ ‰‡ ‡·ÓÚË, ÌÓ ÔË ÒÔˆˇÎÌËÛÒÎÓ‚Ëfl (‰̇ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ ̇ ÒÚÂÔÂÌ 5, ‰Û„Ë-Ú ҇ ̇ ÒÚÂÔÂÌ 0 ËÎË 1; ËÎË ÍÓÏ·Ë̇ˆËfl ÓÚ îë ̇ ÔÓ-χÎÍË ÒÚÂÔÂÌË, Ô‚˯‡‚‡˘‡ ÒÚÂÔÂÌ 4 ÔÓ Ò͇·ڇ).

6 - ïÓ‰ÂÌÂÚÓ Â Ò Â‰ÌÓÒÚ‡ÌÌÓ ÔÓÒÚÓflÌÌÓ ÔÓ‰ÔÓχ„‡ÌÂÒ ·‡ÒÚÛÌ ËÎË Ô‡ÚÂˈ‡, ËÎË Ò ‰‚ÛÒÚ‡ÌÌÓ ÌÂÔÓÒÚÓflÌÌÓÔÓ‰ÔÓχ„‡ÌÂ Ë Â ‚˙ÁÏÓÊÌÓ ‰Ó 100 ÏÂÚ‡ Ò˙Ò ËÎË ·ÂÁ ÔÓ-˜Ë‚͇ (Ôӂ˜ ÓÚ ‰‚ ÙÛÌ͈ËÓ̇ÎÌË ÒËÒÚÂÏË Ò‡ ̇ ÒÚÂ-ÔÂÌ 3+).

6,5 - ïÓ‰ÂÌ ÔË ÔÓÒÚÓflÌÌÓ ‰‚ÛÒÚ‡ÌÌÓ ÔÓ‰ÔÓχ„‡Ì ҷ‡ÒÚÛÌË ËÎË Ô‡ÚÂËˆË Â ‚˙ÁÏÓÊÌÓ ‰Ó 20 ÏÂÚ‡ ·ÂÁ ÔÓ-˜Ë‚͇ (Ôӂ˜ ÓÚ ‰‚ ÙÛÌ͈ËÓ̇ÎÌË ÒËÒÚÂÏË Ò‡ ̇ ÒÚÂ-ÔÂÌ 3+).

7 - çÂÒÔÓÒÓ·ÂÌ ‰‡ ıÓ‰Ë Ôӂ˜ ÓÚ 5 ÏÂÚ‡, ‰ÓË Ò ÔÓ-ÏÓ˘; ÔÓ Ò˙˘ÂÒÚ‚Ó Ó„‡Ì˘ÂÌ Ì‡ Òڇ̉‡ÚÂÌ ËÌ‚‡ÎˉÂÌÒÚÓÎ; Ò‡Ï Ò ÔÂı‚˙Îfl ̇ ÌÂ„Ó Ë Ò‡Ï Ò ‰‚ËÊË Ò ÌÂ„Ó ÓÍÓ-ÎÓ 12 ˜‡Ò‡ ‰Ì‚ÌÓ (ÍÓÏ·Ë̇ˆËfl ÓÚ Ôӂ˜ ÓÚ Â‰Ì‡ ÙÛÌÍ-

ˆËÓ̇Î̇ ÒËÒÚÂχ ̇ ÒÚÂÔÂÌ 4+, ÏÌÓ„Ó fl‰ÍÓ Ò‡ÏÓ "èË-‡Ïˉ̇ ÒËÒÚÂχ" ̇ ÒÚÂÔÂÌ 5).

7,5 - çÂÒÔÓÒÓ·ÂÌ ‰‡ ̇ԇ‚Ë Ôӂ˜ ÓÚ ÌflÍÓÎÍÓ Í‡˜ÍË,ÔËÍÓ‚‡Ì ̇ Òڇ̉‡ÚÂÌ ËÌ‚‡ÎˉÂÌ ÒÚÓÎ, ÌÂÓ·ıÓ‰Ëχ ÂÔÓÏÓ˘ Á‡ ÔÂı‚˙ÎflÌÂÚÓ Ì‡ Ì„Ó; ÚÛ‰ÌÓ Ò Ôˉ‚ËÊ‚‡,Úfl·‚‡ ‰‡ Ò ËÁÔÓÎÁ‚‡ ÏÂı‡ÌËÁˇ̇ ÍÓ΢͇ (Ò ÂÎÂÍÚÓ‰-‚Ë„‡ÚÂÎ ËÎË Ò ‰Û„ ‚ˉ Á‡‰‚ËÊ‚‡ÌÂ); (ÍÓÏ·Ë̇ˆËfl ÓÚ ÔÓ-‚˜ ÓÚ Â‰Ì‡ ÙÛÌ͈ËÓ̇Î̇ ÒËÒÚÂχ ̇ ÒÚÂÔÂÌ 4+).

8 - 鄇Ì˘ÂÌ Ì‡ ΄ÎÓ, ÒÚÓÎ ËÎË ÏÂı‡ÌËÁˇ̇ ÍÓ΢͇,ÏÓÊ ‰‡ ‰‚ËÊË Í‡ÈÌˈËÚ ÒË Ë ÂÙÂÍÚË‚ÌÓ ‰‡ ËÁÔÓÎÁ‚‡˙ˆÂÚ (ÍÓÏ·Ë̇ˆËfl ÓÚ ÌflÍÓÎÍÓ ÙÛÌ͈ËÓ̇ÎÌË ÒËÒÚÂÏË̇ ÒÚÂÔÂÌ 4+).

8,5 - èËÍÓ‚‡Ì ̇ ΄ÎÓ, ËÁ‚˙¯‚‡ ÏËÌËχÎÌË ‰‚ËÊÂ-ÌËfl Ò ˙ˆÂÚ (ÍÓÏ·Ë̇ˆËfl ÓÚ ÌflÍÓÎÍÓ ÙÛÌ͈ËÓ̇ÎÌË ÒËÒ-ÚÂÏË Ì‡ ÒÚÂÔÂÌ 4+).

9 - ç‡Ô˙ÎÌÓ ·ÂÁÔÓÏÓ˘ÂÌ Ô‡ˆËÂÌÚ Ì‡ ΄ÎÓ, ÏÓÊ ҇ÏÓ‰‡ ÍÓÏÛÌË͡ Ë ‰‡ Ô„Î˙˘‡ (ÍÓÏ·Ë̇ˆËfl ÓÚ ÙÛÌ͈ËÓ-̇ÎÌË ÒËÒÚÂÏË ÓÚ ÒÚÂÔÂÌ 4+).

9,5 - 臈ËÂÌÚ˙Ú Â Ì‡Ô˙ÎÌÓ ·ÂÁÔÓÏÓ˘ÂÌ, ÌÂÒÔÓÒÓ·ÂÌ ‰‡ÍÓÏÛÌË͡ Ë ‰‡ Ô„Î˙˘‡ ‰Ó·Â (ÔÓ˜ÚË ‚Ò˘ÍË ÒËÒÚÂÏËÒ‡ ̇ ÒÚÂÔÂÌ 4+).

10 - ëÏ˙Ú ÓÚ åë.

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 112‡ÔËÎ, 2002

èËÎÓÊÂÌË 4. ëàåèíéåÄíàóçé åÖÑàäÄåÖçíéáçé ãÖóÖçàÖ çÄ åçéÜÖëíÇÖçÄ ëäãÖêéáÄ

Å˙΄‡Ò͇ ç‚ÓÎÓ„Ëfl Bulgarian Neurology 113‡ÔËÎ, 2002