TO THE QUESTION OF THE NEED FOR THE DEVELOPMENT OF INTEGRATED REHABILITATION MEASURES IN PATIENTS WITH NEURODEGENERATION

Abstract

It is known that sleep disorders adversely affect the processes of brain neuroplasticity. Wakefulness and night sleep are functional states that are closely interrelated and equally mediate and provide the adaptive activity of the individual. Human biological rhythms are hierarchically dependent on the main pacemaker located in the suprachiasmatic nuclei of the hypothalamus. The role of a mediator that delivers regulatory signals to organs is played by the hormone melatonin, which is synthesized by pineal gland cells. Sleep disorders seriously affect a person's quality of life: emotional stress, anxiety, irritation increase and, as a result, stress resistance decreases, the need for communication, entertainment decreases. In the vast majority of cases, insomnia is secondary, that is, it is formed against the background of the development of diseases and/or adverse circumstances. Quite often, sleep disturbances occur in demyelinating/ neurodegenerative diseases of the central nervous system. We examined 30 patients with a diagnosis of multiple sclerosis, which were divided into two groups. The main group received therapy with a melatonin- containing drug in combination with cognitive-behavioral therapy. Patients in the control group received only therapy with melatonin-containing drug. It was shown that cortisol levels in patients of the main group decreased more than in patients who did not receive CBT. Reduction of clinical manifestations, along with improvements in laboratory indices of day and night melatonin expression, as well as cortisol expression, were already observed on the 14th day of treatment, and on the 21st day of the study, these indices improved significantly. Clinical efficacy in the main group was achieved in 86,6 % of cases, in the control group - in 60,0 % of cases. It is planned to use this method in the development of a comprehensive rehabilitation program in patients with neurodegeneration.