medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-190medsovet-7638Research ArticleЦЕРЕБРОВАСКУЛЯРНЫЕ ЗАБОЛЕВАНИЯCEREBROVASCULAR DISEASESВозможности нейровизуализационных и нейрофизиологических методов исследования для объективизации реабилитационного потенциала у пациентов, перенесших ишемический инсульт (аналитический обзор литературы)Possibilities neuroimaging and neurophysiological research methods to objectify rehabilitation potential in patients with ischemic stroke (analytical review of the literature)https://orcid.org/0000-0003-0902-348XКостенкоЕ. В.KostenkoE. V.

Костенко Елена Владимировна, д.м.н., главный научный сотрудник; врач-невролог, профессор кафедры неврологии, нейрохирургии и медицинской генетики

105120, Москва, Земляной вал, д. 53 

119571, Москва, Ленинский проспект, д. 117

Elena V. Kostenko, Dr. Sci. (Med.), Chief Scientific Officer; Neurologist, Professor of the Department of Neurology, Neurosurgery and Medical Genetics

53, Zemlyanoy Val, Moscow, 105120

117, Leninskiy Ave., Moscow, 119571

 

ekostenko58@mail.ruhttps://orcid.org/0000-0001-7483-1796КашежевА. ГKashezhevA. G.

Кашежев Алим Гумарович, к.м.н., старший научный сотрудник

105120, Москва, Земляной вал, д. 53 

Alim G. Kashezhev, Cand. Sci. (Med.), Senior Member

53, Zemlyanoy Val, Moscow, 105120

kashezhevalim@gmail.comhttps://orcid.org/0000-0003-3727-6302НахраповД. И.NakhrapovD.  I.

Нахрапов Дмитрий Игоревич, к.м.н., врач-невролог

105120, Москва, Земляной вал, д. 53 

Dmitry I. Nakhrapov, Cand. Sci. (Med.), Neurologist

53, Zemlyanoy Val, Moscow, 105120

ndii@mail.ruhttps://orcid.org/0000-0001-5123-5991ПогонченковаИ. В.PogonchenkovaI. V.

Погонченкова Ирэна Владимировна, д.м.н., директор

105120, Москва, Земляной вал, д. 53 

Irena V. Pogonchenkova, Dr. Sci. (Med.), Director

53, Zemlyanoy Val, Moscow, 105120

pogonchenkovaiv@zdrav.mos.ruМосковский научно-практический центр медицинской реабилитации, восстановительной и спортивной медицины; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияMoscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine; Pirogov Russian National Research Medical UniversityRussian FederationМосковский научно-практический центр медицинской реабилитации, восстановительной и спортивной медициныРоссияMoscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports MedicineRussian Federation20232107202301032–40Copyright © Костенко Е.В., Кашежев А.Г., Нахрапов Д.И., Погонченкова И.В., 20232023Костенко Е.В., Кашежев А.Г., Нахрапов Д.И., Погонченкова И.В.Kostenko E.V., Kashezhev A.G., Nakhrapov D.I., Pogonchenkova I.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7638

Церебральный инсульт (ЦИ) остается важнейшей медико- социальной проблемой. По имеющимся данным, лишь 25% лиц, перенесших инсульт, возвращаются к преморбидному уровню повседневной или трудовой активности, у большинства пациентов остаются резидуальные неврологические нарушения различной степени выраженности. Эффективная реабилитация пациентов с ЦИ требует не только своевременного начала лечения, но и индивидуального выбора реабилитационной программы. Для оптимизации реабилитационной стратегии в каждом конкретном случае необходимо ставить цели и задачи с учетом реабилитационного потенциала (РП) и прогноза восстановления пациента. В настоящей работе приводится определение РП и способы его описания. Рассматриваются существующие нейрофизиологические методы оценки РП функционального восстановления после ЦИ, такие как электроэнцефалография, вызванные потенциалы и диагностическая транскраниальная магнитная стимуляция (ТМС). Представлены сведения о нейровизуализационных методах диагностики – компьютерной (КТ) и магнитно- резонансной томографии (МРТ) в контексте определения РП. Подробно освещены возможности функциональной и диффузионно- тензорной МРТ головного мозга для оценки РП в различные периоды заболевания. Рассматриваются и другие возможные предикторы восстановления нарушенных функций: объем и локализация поражения, возраст пациента, когнитивные функции и лабораторные показатели. Описываются современные комплексные подходы формирования алгоритмов количественной оценки РП. В частности, описаны актуальные алгоритмы оценки РП – PREP2 для верхней конечности и TWIST для прогнозирования восстановления нарушений функции ходьбы. В настоящий момент не существует общепринятых методов для определения и квантификации РП. Предложенные для этого инструменты недостаточно чувствительны и специфичны либо не подходят для рутинной клинической практики.

Cerebral stroke (CS) remains the most important medical and social problem. According to available data, only 25% of stroke survivors return to the premorbid level of daily or work activity, most patients have residual neurological disorders of varying severity. Effective rehabilitation of patients with CS requires not only timely initiation of treatment, but also an individual choice of rehabilitation program. To optimize the rehabilitation strategy in each case, it is necessary to set goals and objectives taking into account the rehabilitation potential (RP) and the prognosis of the patient’s recovery. This paper provides a definition of RP and ways to describe it. The existing neurophysiological methods for assessing the RP of functional recovery after CS, such as electroencephalography, evoked potentials and diagnostic transcranial magnetic stimulation (TMS), are considered. Information about neuroimaging diagnostic methods – computer (CT) and magnetic resonance imaging (MRI) in the context of determining RP is presented. The possibilities of functional and diffusion-t ensor MRI of the brain for assessing RP in various periods of the disease are highlighted in detail. Other possible predictors of the restoration of impaired functions are also considered – the volume and localization of the brain lesion, the patient’s age, cognitive functions and laboratory parameters. Modern complex approaches to the formation of algorithms for the quantitative assessment of RP are described. In particular, the current algorithms for evaluating RP – PREP2 for the upper limb and TWIST for predicting the recovery of walking disorders are described. Currently, there are no generally accepted methods for determining and quantifying RP. The instruments proposed for this purpose are insufficiently sensitive and specific or are not suitable for routine clinical practice.

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The authors declare that there are no conflicts of interest present.