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Traumatic brain injury (TBI) affects about 50 million people in the world every year. Posttraumatic epilepsy (PTE) is a significant complication of TBI of any severity. PTE occurs in 20% of patients with TBI. Treatment of patients with PTE is particularly difficult due to obvious tendency towards drug resistance. Currently, there are no validated predictive biomarkers for PTE. Development of a system of validated predictive markers would improve PTE prediction quality and therapeutic approach for these patients. This review is devoted to the current data on the most perspective predictive biomarkers of PTE for clinical practice.Ежегодно в мире от черепно-мозговых травм (ЧМТ) страдают около 50 млн человек. Опасным осложнением ЧМТ любой степени тяжести является посттравматическая эпилепсия (ПТЭ). ПТЭ развивается у 20% пациентов с ЧМТ. Лечение пациентов с ПТЭ представляет особую сложность, поскольку у них наблюдается выраженная тенденция к фармакорезистентности. В настоящее время отсутствуют валидированные предиктивные биомаркеры развития ПТЭ. Разработка системы валидированных предиктивных биомаркеров позволила бы повысить качество прогнозирования ПТЭ и улучшить терапевтическую тактику ведения указанной группы пациентов. В обзоре проанализированы и обобщены актуальные сведения об имеющихся наиболее перспективных предиктивных биомаркерах ПТЭ в свете их потенциального использования в клинической практике.

Background Severe traumatic brain injury (STBI) is almost always accompanied by movement disorders. The use of electroencephalography (EEG), supplemented by mathematical analysis, in combination with functional magnetic resonance imaging (fMRI) expands the possibilities of studying brain neuroplasticity as a basis for compensation post-traumatic motor disorders. Material and methods Multichannel EEG and fMRI 3T during passive motor test (hand finger clenching by experimenter) were performed in 28 patients with STBI and 17 healthy subjects. The most detailed spectral-coherent analysis of spatial EEG changes was performed in 10 patients with varying degrees of hemiparesis, but similar to the norm fMRI response. Results It was revealed that individual EEG restructurings in a passive motor test in patients with STBI are characterized by significant variability and the inclusion of the brain regions not typical for the norm. Secondary statistical analysis showed that the topography of EEG coherence changes shows the greatest correlation with the degree of hemiparesis: increased reactivity of the frontal-central areas in the ipsilateral hemisphere relative movement with mild hemiparesis and the inclusion of both hemispheres as the motor disorders increase. Localization of these changes is similar to the topography of the fronto-pontine, parietotemporo-pontine and occipito-mesencephalic motor tracts cortical projections. Conclusions This results demonstrate a greater sensitivity of EEG responses to the degree of motor defect compared with hemodynamic (fMRI). They confirm our hypothesis put forward earlier on the possible participation of the extra-pyramidal system in compensating for the post-traumatic motor defect. Supported by RFFI 18-013-00355 .

Objectives The purpose of this study is to estimate the therapeutic potential of transcranial magnetic stimulation (TMS) in patients after traumatic brain injury (TBI) with impaired consciousness and motor activity. Methods Observation groups: (1)19 patients after TBI at the age of 16–50 with a prolonged (from 60 to 360 days) unconscious state in which the rhythmic TMS was performed; (2) Control group: 6 healthy men aged 22–28. Changes of neurological status, indicators of the memory and attention, and N100, N200 and P300 components of auditory ERP hour before and hour after stimulation, the dynamics of diagnostic TMS and bimodal (somatosensory and short latency auditory) EP’s were estimated. Results Therapeutic rTMS of the sagittal premotor cortex areas in both groups concurred with improvement of any attention and normalization of amplitude and latency of all ERP components, especially for P300. rTMS of the frontal lobes facilitated positive clinical dynamics, while rTMS of the parietal lobes did not prove any clear positive effects. Conclusions The obtained data proposes the availability of using rTMS for therapeutic purposes in patients with PUS. The most promising targets for stimulation at the moment seems to be the frontal and sagittal premotor areas of the brain. Further research is required to clarify the areas and parameters of stimulation. Supported by: RFFI N 16-29-08304 .

Objectives Recovery of both mental and motor functions is one of the key problems of neurorehabilitation of patients with traumatic brain injury (TBI), accompanied by posttraumatic unconsciousness state (PUS). The purpose of pilot study is to clarify the diagnostic and therapeutic potential of TMS in patients after TBI with impaired motor activity and consciousness. Methods Observation groups: (1) 15 patients after TBI at the age of 17–56, in which the diagnostic TMS (cortical motor areas (M1) bilaterally, CVII bilaterally, registration of MEPs from musculus abductor pollicis brevis) was performed; (2) 9 patients after TBI at the age of 16–44 with a prolonged (from 60 to 220 days) unconscious state in which the rhythmic TMS was performed; (3) Control group: 5 healthy men aged 22–28. Diagnostic TMS evaluated cortical, radicular latency and amplitude of MEPs,time of central motor conduction. In the second and third groups changes of neurological status, indicators of the memory and attention, and N100, N200 and P300 components of auditory ERP hour before and hour after stimulation were estimated. Results Diagnostic TMS in patients with positive or ambiguous clinical dynamics showed initial difference of conductivity of tracts in comparison with normal data by 20–30% or 30–40%, respectively, with progressive improvement as motor and cognitive functions recovered. In patients with negative clinical dynamics TMS values had significantly larger deviation of cortical latency and amplitudes of MEPs (over 45%), and also the time of central motor conduction. Statistical analysis of acquired data revealed the greatest prognostic significance for determining the level of the amplitudes of MEPs with undeniable importance for the indicators of cortical latency and the time of central motor conduction. Therapeutic TMS of the sagittal premotor cortex areas in groups 2 and 3 concurred with improvement of any attention and normalization of amplitude and latency of all ERP components, as well as indicators of their spatial synchronism, especially for P300. Conclusions The obtained data clarifies diagnostic parameters of TMS and proposes the availability of using rTMS for therapeutic purposes in patients with PUS. Supported by RFFI N16-29-08304 .

Objective In the modern society the low back pain (LBP) is the most common cause of temporary disability with estimated life time prevalence as high as 23–80% (Pedisic et al., 2013). LBP with radiculopathy is considered as the most unfavorable prognostic risk factor for the development of chronic pain syndrome and low quality of life (Konstantinou et al., 2013). The aim of this study is to evaluate the short-term efficacy of repetitive peripheral magnetic stimulation (rPMS) in the treatment of lumbosacral radiculopathy. Methods Patients with pain and sensory symptoms resulting from lumbosacral radiculopathy has been enrolled into the study. All patients received conventional drug therapy. A magnetic stimulator MagProO100 (Magventure, Denmark) with CC-coil Cool-125 was used. We assessed the individual motor evoked potential (MEP) thresholds before the rPMS. Treatment consisted of 10 or 15 sessions, each lasting 20 min, with frequency 1 Hz and intensity of stimulus above the MEP threshold. The duration of rPMS treatment depended on the severity of pain syndrome. Patients were evaluated before, immediately after finalizing the rPMS treatment and one month later. Results Fifteen patients (mean age 41.8 ± 14.5 years, 5 men, 10 women) has been included into the study. All participants reported the improvement in the functional status (confirmed by Oswestry questionnaire): 34.4 ± 11.3% before and 17.6 ± 8% at the end of the rPMS course (primary endpoint). The VAS pain level has been decreased by 50% in comparison to the baseline. Reduction of pain and disability remained unchanged for one month after completion of the combined treatment. Conclusion The preliminary results of our study demonstrate that the combination of traditional drug therapy and the rPMS can have positive short-term effects on functional status and pain in patients with lumbosacral radiculopathy. Further investigations are warranted for development of the individualized rPMS treatment algorithm.

Introduction Repetitive transcranial magnetic stimulation (rTMS) is a promising method in treatment of patients with various neurological diseases not only transcranially, but also at other levels of the nervous system, including peripheral. Currently, there are different protocols for the treatment of patients with neurological disorders at the lumbar level, for the treatment of headache, central pain syndromes and other neurogenic disorders. Objective Goal of this pilot study was to update and adapt existing protocols of rTMS for neurological patients. Methods Therapeutical magnetic stimulation was performed in order to restore lost function or for pain relief between the two groups of observations: patients with the development of compression syndromes in the lumbar level (12 patients) and chronic headache (7 patients) and in two patients with tremor-rigid form of Parkinson’s disease. To avoid terminological confusion, the abbreviation “rTMS” in this paper is applied on the second group of patients and patients with Parkinson’s disease; for the first group, the term “rTMS” is replaced by the already adopted in the literature “rPMS” – rhythmic peripheral magnetic stimulation. After studying international experience (Le Faucheur JP et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014), for the first group of patients, it was decided to carry out a rhythmic low frequency stimulation of the lumbosacral (L3-S1) region, in the projection of the nerve structures, which caused motor deficit, sensory disorders, urinary retention. In the second group was used low (less than 5 Hz) and high (5–15 Hz) frequency rTMS at the nape area and left premotor area, respectively. Patients with Parkinson’s disease carried out high-frequency (8–12 Hz) RTMS to the left and right motor areas of the cerebral cortex (M1). For magnetic stimulation device was used MagPro X100 (“Medtronic”, USA) equipped with a circular coil (mcf-125), in combination with neurosensory analyzer “Viking IV” of “Nicolet” (USA) as a diagnostic system. Stimulation was carried at rates of 5–15 sessions lasting 15–35 min, 1 time per day. Results In the first group of patients after rTMS course most of them (8 of 12) subjectively noted relief of the pain syndrome. In more than 60% of cases the effect was persistent: 1.5 months after stimulation. In the second group of patients it was shown that only low-frequency rTMS of cervical-occipital region was ineffective – for 5 sessions, there was no evidence of any significant changes in patient’s status. The positive effect of reducing the intensity and duration of the headaches was noticed only after joining the high-frequency stimulation of the left premotor area (approximately after 8 sessions), which grew progressively by the end of therapy. During dynamic monitoring of patients with Parkinson’s disease positive changes in the motor functions were manifested by about 6–9 magnetic stimulation procedures (increase in muscle strength in the limbs, improvement of the accuracy of movements and improvement of fine motor skills). Thus, these results suggest a promising therapeutic application of rhythmical MS for patients in all represented groups, but verification and refinement of the effects on a larger sample of observations are required. Supported by grant RFBR # 15–29-08304.

Repetitive transcranial magnetic stimulation (rTMS) is a method in treatment of posttraumatic unconsciousness states. Goal of the study was to analyze the affects on mental and bioelectric activity under low-frequency rTMS in healthy persons and patients with PUS. Two groups of participants were evaluated in view of functional sub-threshold rTMS effects on premotor cortex: (1) 5 healthy volunteers underwent placebo and single rTMS with memory, attention and AERP (N100, N200, P300) assessment prior and 1 h after stimulation; (2) 8 patients with PUS underwent single rTMS with clinical and AEP assessment; 5 of whom underwent 7-day rTMS. Clinical assessment included determination of consciousness recovery stages (Dobrokhotova et al., 1996) and functional activity scale developed by authors with focus on the attention and movement. AERP were recorded by two-stimulus oddball paradigm, in tasks of listening sounds and accounts of the target. Distinct rTMS effects on attention was revealed: (1) activization in healthy volunteers, (2) its restoration in patients. In target stimuli counting tasks (mainly voluntary attention) quantitative changes of N2 and P300 prevailed in the left frontal region. In listening sounds tasks (mainly involuntary attention) the most significant changes were recorded in P300 in the right temporal region.