Cortical Centers Research Articles

Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial

BackgroundHemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem.MethodsThis study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score.DiscussionUltrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function.Trial registrationChinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722.

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Background Urinary incontinence (UI) was an intractable symptom and many efforts had been made to combat this symptom over the past decades. Repetitive transcranial magnetic stimulation (rTMS) was used in many diseases for its focusing on neural network regulation. However, rTMS on the cortical urination center for acting on urination process remained further study. Case report A 67-year-old female farmer suffered from UI over two weeks. She was diagnosed with major vascular neurocognitive disorder. The patient received rTMS on the bilateral paracentral lobule. Stimulation was administered at 20 Hz with 25 stimulation trains of 30 stimuli each with a 30-second intertrain interval. After a 5-day course of rTMS intervention, the patient reported full awareness of her urination, but her neurocognitive decline had not improved at all. Conclusions In this case of UI with major vascular neurocognitive disorder, rTMS on the bilateral paracentral lobule was applied and therapeutic effect on UI was obvious.

Cortical hem signaling center: functions, development, and potential implications for evolution and brain disorders.

Cortical hem signaling center: functions, development, and potential implications for evolution and brain disorders.

Visual Neuroprosthesis - Stimulation of Visual Cortical Centers in The Brain. Design of Non-Invasive Transcranial Stimulation of Functional Neurons.

The purpose of the article is to present the history and current status of visual cortical neuroprostheses, and to present a new method ofstimulating intact visual cortex cells. This paper contains an overview of the history and current status of visual cortex stimulation in severe visual impairment, but also highlights its shortcomings. These include mainly the stimulation of currently damaged cortical cells over a small area and, from a morphological point of view, possible damage to the stimulated neurons by the electrodes and their encapsulation by gliotic tissue. The paper also presents a proposal for a new technology of image processing and its transformation into a form of non-invasive transcranial stimulation of undamaged parts of the brain, which is protected by a national and international patent. The paper presents a comprehensive review of the current options for compensating for lost vision at the level of the cerebral cortex and a proposal for a new non-invasive method of stimulating the functional neurons of the visual cortex.

Features of the influence of emotional state on the implementation of arbitrary purposeful bimanual movements

The emotional state has a significant impact on the autonomic and somatic nervous systems, which give various manifestations. All external manifestations of emotions are strictly determined and begin to be realized when the cortical areas are activated. The leading role in the realization of the emotional state belongs to the frontal lobes of the cortex and the limbic system. The precentral sulcus is the cortical center of complex purposeful movements. The purpose of this work is to study the influence of the emotional state on the implementation of the motor program of bimanual purposeful voluntary movement. The emotional state was determined using the K scale. Izard. The bimanual motor activity of the hands was measured using the method of supportmetry. As a result of the study, it was found that a negative emotional state leads to a decrease in the reaction rate of the reaction to an error, which may be caused by a change in the initial alignment between the motor cortex and the limbic system.

CHANGES IN THE WIDTH OF THE PERIODONTAL GAP OF RATS WITH SUPRAOCCLUSAL RELATIONSHIPS OF INDIVIDUAL TEETH IN THE AGE ASPECT

Introduction. The dentoalveolar apparatus is a complex of complicated interaction of the jaws, masticatory muscles, teeth, and temporomandibular joints. This connection is carried out by the trigeminal nerve system with sensory and motor nuclei closely connected to the cortical and subcortical centers of the brain. Occlusal trauma is a lesion that develops in the periodontium as a result of forces that exceed the periodontal potential for functional adaptation. Occlusal trauma can be classified as primary or secondary. The first one occurs in the pulp and periodontal ligament when the force of the action on the dental structures is greater than usual, under optimal periodontal support conditions. It includes orthodontic movements, "high" restorations, and parafunctional habits such as bruxism. Secondary occlusal trauma occurs when the teeth with previous supporting tissue changes are subjected to the action of normal and excessive forces with supporting tissue changes caused by periodontal disease or previous trauma. The available evidence has demonstrated that bacterial plaque bioactive substances lead to local inflammatory responses in periodontal tissues which contribute to bone tissue resorption through osteoclasts in periodontitis. Excessive functional stress can initiate inflammatory changes in the periodontium and thus, increase destructive bacterial processes. Traumatic occlusion can expand the space of the periodontal ligament and in this way stimulate apical bacterial migration and proliferation. However, few attempts have been made to investigate the molecular mechanisms that trigger bone tissue resorption in traumatic occlusion. The analysis of publications on the studies of morphological changes in periodontal tissues in individual teeth supraocclusion in the age aspect shows the contradictory data. The aim: to determine the morphometric changes of the periodontal gap as a component of the periodontal complex in rats of different age groups in the supraocclusal relationship of individual teeth in the age aspect. Materials and methods of the study. The scientific experiment was conducted on 60 white laboratory rats aged 4 to 22 months and weighing 90 to 330 g. The rats were divided into control (30 animals) and experimental (30 animals) groups. Each group was divided into 3 subgroups (10 animals each) depending on the age of the rats: young, mature and senile. Young animals included rats aged 3–4 months with a weight of 90–100 g; mature animals - aged 6–8 months with a weight of 150–170 g; senile rats – 20–22 months and weighing 200–220 g. The method of modelling the state of supraocclusal relations of individual teeth is described in the previous publication. For histological examination of dental blocks, the following was performed. Fixation in a 10% solution of neutral formalin for two days, dehydration in alcohols of increasing concentration and embedding in paraffin. After preparation, sections were made on a Shandon Finesse 325 rotary microtome with a section thickness of 4-6 µm. The histological sections were fixed on pre-degreased slides and dried. Van Gieson staining was performed. The width of the periodontal gap was determined using the ZEISS ZEN 3.7 program by Carl Zeiss Microscopy. For statistical data processing, the AtteStat v.12.5 software was used to determine the mean value and its standard error (M±m). The probability of a statistically significant difference between the data obtained was assessed using the Student's parametric test (at a significance level of p ≤ 0.05). All samples were tested for normality using the Gupta test. Results of the study. Statistical differences were observed in rats of all groups, as well as between the indicators of all rats of the control and experimental groups (≤0.05). The width of the periodontal gap increased by 34.1% in young rats, by 25.5% in mature rats, and by 21.1% in senile rats. Conclusions The presence of supraocclusal relationships of individual teeth causes an increase in the periodontal gap in rats of all age groups. The greatest expansion of the periodontal gap has occurred in young rats. The width of the periodontal gap in rats decreases with age.

Case Report: Effect of rTMS on urinary incontinence in major vascular neurocognitive disorder

Background: Many efforts had been made to combat the symptoms of incontinence over the past decades, yet difficulties still remain. To stimulate the cortical urination center might theoretically be useful for regulating urination process. In this case of urinary incontinence with major vascular neurocognitive disorder, repetitive transcranial magnetic stimulation (rTMS) on the bilateral paracentral lobule was applied and therapeutic effect was obvious. Case report: A 67-year-old female farmer suffered from urinary incontinence over two weeks. She was diagnosed with major vascular neurocognitive disorder. The patient received rTMS on the bilateral paracentral lobule. Stimulation was administered at 20 Hz with 25 stimulation trains of 30 stimuli each with a 30-second intertrain interval. After a 5-day course of rTMS intervention, the patient reported full awareness of her urination, but her neurocognitive decline had not improved at all. Conclusions: rTMS on bilateral paracentral lobule could be used for treating urinary incontinence in major vascular neurocognitive disorder patients.

Difficulty of Energy Expenditure of Brain When Using Written Speech

The structural organization of the brain matures between 16 and 22 years old when spontaneous contradictions in individual behavior appear with the greatest frequency which is caused by the duality of human consciousness based on the early maturing instinctive-hormonal centers of the limbic system and the late differentiating neocortical fields of voluntary thinking. When creating a written speech, limbic and cortical mechanisms of motivational control are used and individualize the resulting text. Personalization of writing meaningful texts is enhanced by the variability of brain structures involved in this process. We examined evolutionary morphofunctional systems to evaluate their biological value. Depending on individual priorities and motivational choices, written composition was carried out in two strategies. The first was the most general principle of saving the energy expenditure of the brain during any voluntary activity. The second was the mobilization of cortical centers with extremely high energy costs. To identify these differences, a pragmalinguistic analysis technique was developed in this study, supporting both strategies.

Preliminary Observations of Personalized Repetitive Magnetic Stimulation (PrTMS) Guided by EEG Spectra for Concussion.

There are no FDA-approved treatments for the chronic sequelae of concussion. Repetitive magnetic transcranial stimulation (rTMS) has been explored as a therapy but outcomes have been inconsistent. To address this we developed a personalized rTMS (PrTMS) protocol involving continual rTMS stimulus frequency adjustment and progressive activation of multiple cortical sites, guided by spectral electroencephalogram (EEG)-based analyses and psychological questionnaires. We acquired pilot clinical data for 185 symptomatic brain concussion patients who underwent the PrTMS protocol over an approximate 6 week period. The PrTMS protocol used a proprietary EEG spectral frequency algorithm to define an initial stimulation frequency based on an anteriorly graded projection of the measured occipital alpha center peak, which was then used to interpolate and adjust regional stimulation frequency according to weekly EEG spectral acquisitions. PrTMS improved concussion indices and normalized the cortical alpha band center frequency and peak EEG amplitude. This potentially reflected changed neurotransmitter, cognitive, and perceptual status. PrTMS may be a promising treatment choice for patients with persistent concussion symptoms. This clinical observational study was limited in that there was no control group and a number of variables were not recorded, such as time since injury and levels of depression. While the present observations are indeed preliminary and cursory, they may suggest further prospective research on PrTMS in concussion, and exploration of the spectral EEG as a concussion biomarker, with the ultimate goals of confirmation and determining optimal PrTMS treatment parameters.

Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans

Emerging data suggest that post-traumatic stress disorder (PTSD) arises from disrupted brain default mode network (DMN) activity manifested by dysregulated encephalogram (EEG) alpha oscillations. Hence, we pursued the treatment of combat veterans with PTSD (n = 185) using an expanded form of repetitive transcranial magnetic stimulation (rTMS) termed personalized-rTMS (PrTMS). In this treatment methodology spectral EEG based guidance is used to iteratively optimize symptom resolution via (1) stimulation of multiple motor sensory and frontal cortical sites at reduced power, and (2) adjustments of cortical treatment loci and stimulus frequency during treatment progression based on a proprietary frequency algorithm (PeakLogic, Inc. San Diego) identifying stimulation frequency in the DMN elements of the alpha oscillatory band. Following 4 - 6 weeks of PrTMS® therapy in addition to routine PTSD therapy, veterans exhibited significant clinical improvement accompanied by increased cortical alpha center frequency and alpha oscillatory synchronization. Full resolution of PTSD symptoms was attained in over 50% of patients. These data support DMN involvement in PTSD pathophysiology and suggest a role in therapeutic outcomes. Prospective, sham controlled PrTMS® trials may be warranted to validate our clinical findings and to examine the contribution of DMN targeting for novel preventive, diagnostic, and therapeutic strategies tailored to the unique needs of individual patients with both combat and non-combat PTSD.

A blended neurostimulation protocol to delineate cortico-muscular and spino-muscular dynamics following neuroplastic adaptation.

In this paper we propose a novel neurostimulation protocol that provides an intervention-based assessment to distinguish the contributions of different motor control networks in the cortico-spinal system. Specifically, we use a combination of non-invasive brain stimulation and neuromuscular stimulation to probe neuromuscular system behavior with targeted impulse-response system identification. In this protocol, we use an in-house developed human-machine interface (HMI) for an isotonic wrist movement task, where the user controls a cursor on-screen. During the task, we generate unique motor evoked potentials based on triggered cortical or spinal level perturbations. Externally applied brain-level perturbations are triggered through TMS to cause wrist flexion/extension during the volitional task. The resultant contraction output and related reflex responses are measured by the HMI. These movements also include neuromodulation in the excitability of the brain-muscle pathway via transcranial direct current stimulation. Colloquially, spinal-level perturbations are triggered through skin-surface neuromuscular stimulation of the wrist muscles. The resultant brain-muscle and spinal-muscle pathways perturbed by the TMS and NMES, respectively, demonstrate temporal and spatial differences as manifested through the human-machine interface. This then provides a template to measure the specific neural outcomes of the movement tasks, and in decoding differences in the contribution of cortical- (long-latency) and spinal-level (short-latency) motor control. This protocol is part of the development of a diagnostic tool that can be used to better understand how interaction between cortical and spinal motor centers changes with learning, or injury such as that experienced following stroke.

Right hemisphere and metaphor comprehension: A connectionist perspective

Metaphor comprehension is a cognitively complex task, with evidence pointing to the engagement of multiple cerebral areas. In addition, the involvement of the right hemisphere appears to vary with cognitive effort. Therefore, the interconnecting pathways of such distributed cortical centers should be taken into account when studying this topic. Despite this, the potential contribution of white matter fasciculi has received very little attention in the literature to date and is not mentioned in most metaphor comprehension studies. To highlight the probable implications of the right inferior fronto-occipital fasciculus, right superior longitudinal system, and callosal radiations, we bring together findings from different research fields. The aim is to describe important insights enabled by the cross-fertilization of functional neuroimaging, clinical findings, and structural connectivity.

Increased pyramidal and VIP neuronal excitability in rat primary auditory cortex directly correlates with tinnitus behaviour.

Tinnitus affects roughly 15%-20% of the population while severely impacting 10% of those afflicted. Tinnitus pathology is multifactorial, generally initiated by damage to the auditory periphery, resulting in a cascade of maladaptive plastic changes at multiple levels of the central auditory neuraxis as well as limbic and non-auditory cortical centres. Using a well-established condition-suppression model of tinnitus, we measured tinnitus-related changes in the microcircuits of excitatory/inhibitory neurons onto layer 5 pyramidal neurons (PNs), as well as changes in the excitability of vasoactive intestinal peptide (VIP) neurons in primary auditory cortex (A1). Patch-clamp recordings from PNs in A1 slices showed tinnitus-related increases in spontaneous excitatory postsynaptic currents (sEPSCs) and decreases in spontaneous inhibitory postsynaptic currents (sIPSCs). Both measures could be correlated to the rat's behavioural evidence of tinnitus. Tinnitus-related changes in PN excitability were independent of changes in A1 excitatory or inhibitory cell numbers. VIP neurons, part of an A1 local circuit that can control the excitation of layer 5 PNs via disinhibitory mechanisms, showed significant tinnitus-related increases in excitability that directly correlated with the rat's behavioural tinnitus score. That PN and VIP changes directly correlated to tinnitus behaviour suggests an important role in A1 tinnitus pathology. Tinnitus-related A1 changes were similar to findings in studies of neuropathic pain in somatosensory cortex suggesting a common pathology of these troublesome perceptual impairments. Improved understanding between excitatory, inhibitory and disinhibitory sensory cortical circuits can serve as a model for testing therapeutic approaches to the treatment of tinnitus and chronic pain. KEY POINTS: We identified tinnitus-related changes in synaptic function of specific neuronal subtypes in a reliable animal model of tinnitus. The findings show direct and indirect tinnitus-related losses of normal inhibitory function at A1 layer 5 pyramidal cells, and increased VIP excitability. The findings are similar to what has been shown for neuropathic pain suggesting that restoring normal inhibitory function at synaptic inputs onto A1 pyramidal neurons (PNs) could conceptually reduce tinnitus discomfort.

Alterations in Preterm Brain Development: Relation to Developmental Assessment and Prediction.

Infants born extremely preterm are at risk for compromised cognitive and motor outcome. There are various possibilities as to why this occurs. The "two-hit" hypothesis consists of interrelated developmental disruptions and insults. Both specifically affect the transient subplate neuronal layer (SNL) and the early development of brain circuitry. The SNL, analogous to a switchboard, is critical in connecting cortical and lower brain centers and is highly susceptible to disruptions and insults, producing dysfunctional neural networks. Damage to the SNL provides the putative link between atypical early brain development and later cognitive and academic function that require complex neural circuitry. This, in turn, has major ramifications for developmental assessment and prediction. KEY POINTS: · Preterm brains are highly susceptible to disruptions and insults, this being the two-hit hypothesis.. · There is a variation in which low-grade stressors "sensitize" the infant increasing susceptibility to a second stressor-causing brain damage.. · Subplate neuronal layer damage compromises outcome by interfering with thalamocortical connections.. · Combining neuroimaging and developmental testing is the best way to gain insight into these processes.. · Atypical early brain development may not be evident until the network is mature and challenged..

Human heart rate variability under the influence of aromatherapy with sweet orange and pine oils

BACKGROUND: Aromatherapy is one of the simplest and most effective methods of influencing the functional state of a person. It is applicable both for therapeutic purposes in adults and children, and for restoring the psychoemotional and physical state of a person, which requires a detailed study of the psychophysiological mechanisms of the impact of individual aroma oils on the patient. Moreover, a wide choice of oils allows you to determine the necessary spectrum of action of a particular smell, and the activation of the olfactory sensory system causes a number of physiological reactions and affects the body in a complex way. AIM: To study the human heart rate variability under the influence of aromatherapy with sweet orange and pine oils. MATERIALS AND METHODS: The aromatherapy session was conducted for 25 minutes. Before and after the aroma session, the simple visual-motor reaction (sVMR) of the subjects was determined and the heart rate was recorded on the VNS-Micro hardware-software complex (Neurosoft, Russia) in lead II, at rest, sitting, for 5 minutes. Statistical processing of the obtained data was carried out using Excel and IBM SSPS Statistics 26 programs. RESULTS: Maximal RR intervals after rest were significantly higher than at rest before rest. The net regulatory effect (SDNN) increased significantly. The activity of the autonomous regulation circuit (RMSSD), the total wave power (TP), the power of the low-frequency component of the spectrum (LF), the power of the high-frequency component of the spectrum (HF) increased significantly. The centralization index (IC) increased after the rest. Under the influence of the smell of pine, changes in heart rate variability and spectral power are insignificant. Significant changes in the power of the HF component of the spectrum were observed under the influence of the smell of orange it significantly decreased. The centralization index (IC) has increased. After the aroma sessions with pine and orange oil, the time of the subjects' MTMR and their error increased, after the aroma session with pine oil, the error increased to a greater extent. Aromatherapy with sweet orange and pine oils eliminated the significant changes in the parameters of heart rate variability of the subjects, which were observed after a 25-minute rest in the control group. CONCLUSION: After rest, the activity of the sympathetic nervous system decreased, the activity of the autonomous regulation circuit increased, the influence of the vagus and the influence of subcortical and cortical centers of regulation increased. Aroma session with oils of pine or sweet orange reduces the effectiveness of the sVMR of the subjects, while a 25-minute inhalation of pine aroma oil reduces the effectiveness of the sVMR to a greater extent.

The Olfactory Bulb in Companion Animals-Anatomy, Physiology, and Clinical Importance.

The Olfactory Bulb is a component of the Olfactory System, in which it plays an essential role as an interface between the peripheral components and the cerebral cortex responsible for olfactory interpretation and discrimination. It is in this element that the first selective integration of olfactory stimuli occurs through a complex cell interaction that forwards the received olfactory information to higher cortical centers. Considering its position in the organizational hierarchy of the olfactory system, it is now known that changes in the Olfactory Bulb can lead to olfactory abnormalities. Through imaging techniques, it was possible to establish relationships between the occurrence of changes secondary to brain aging and senility, neurodegenerative diseases, head trauma, and infectious diseases with a decrease in the size of the Olfactory Bulb and in olfactory acuity. In companion animals, this relationship has also been identified, with observations of relations between the cranial conformation, the disposition, size, and shape of the Olfactory Bulb, and the occurrence of structural alterations associated with diseases with different etiologies. However, greater difficulty in quantitatively assessing olfactory acuity in animals and a manifestly smaller number of studies dedicated to this topic maintain a lack of concrete and unequivocal results in this field of veterinary sciences. The aim of this work is to revisit the Olfactory Bulb in companion animals in all its dimensions, review its anatomy and histological characteristics, physiological integration in the olfactory system, importance as a potential early indicator of the establishment of specific pathologies, as well as techniques of imaging evaluation for its in vivo clinical exploration.

Cerebello-cortical functional connectivity may regulate reactive balance control in older adults with mild cognitive impairment.

Older adults with mild cognitive impairment (OAwMCI) experience a two-fold increased risk of falling compared to their cognitively intact counterparts. This increased risk could be attributed to impairments in balance control mechanisms (both volitional and reactive), however, the exact neural substrates contributing to the balance impairments remain unclear. While changes in functional connectivity (FC) networks in volitional balance control tasks have been well highlighted, the relationship between these changes and reactive balance control has not been examined. Therefore, this study aims to explore the relationship between FC networks of the brain obtained during resting state fMRI (no visualization or active task performed) and behavioral measures on a reactive balance task in OAwMCI. Eleven OAwMCI (< 25/30 on MoCA, > 55 years) underwent fMRI and were exposed to slip-like perturbations on the Activestep treadmill. Postural stability, i.e., dynamic center of mass motion state (i.e., its position and velocity) was computed to determine reactive balance control performance. The relationship between reactive stability and FC networks was explored using the CONN software. OAwMCI with greater FC in default mode network-cerebellum (r2 = 0.43, p < 0.05), and sensorimotor-cerebellum (r2 = 0.41, p < 0.05) network exhibited lower reactive stability. Further, people with lower FC in middle frontal gyrus-cerebellum (r2 = 0.37, p < 0.05), frontoparietal-cerebellum (r2 = 0.79, p < 0.05) and cerebellar network-brainstem (r2 = 0.49, p < 0.05) exhibited lower reactive stability. Older adults with mild cognitive impairment demonstrate significant associations between reactive balance control and cortico-subcortical regions involved in cognitive-motor control. Results indicate that the cerebellum and its communications with higher cortical centers could be potential substrates contributing to impaired reactive responses in OAwMCI.

COCHLEAR IMPLANTATION AS A WAY TO OVERCOME HEARING PROBLEMS

The ear, as an organ of hearing, can be damaged or have problems during intrauterine development. As a result, hearing is impaired, which negatively affects speech, mental development and the communication process in children. Schoolchildren with special educational needs (SEN), suffer not only from general speech disorders and phonetic speech disorders but are mainly related to the damage of the higher cortical centers of the brain responsible for speech, as well as to hearing problems. The latter can be alleviated by using hearing aids at the early stage or by performing a cochlear implantation process. However, a question suggests itself. Do families that have children with such problems cope with their social and financial problems? An issue requiring public attention and care and is directly related to the improvement of education quality.

Delay in the formation of urination function in children

The control of urine retention and urination function in children is finally established by the age of 4–5 — it is at this age that the type of urination becomes adult. The stages of the formation of urination function are based on many factors — a decrease in the physiological hypersensitivity of the M-cholinergic receptors of the bladder to acetylcholine, an increase in inhibitory supraspinal effects on the parasympathetic reflex arc, which provides a level of intravesical pressure, on the process of myelination of the brain pathways, on the maturation of the higher cortical center of urination and strengthening of connections with subcortical structures. A tabular assessment of the manifestations of delay and impaired bladder function in children allows us to determine the level of maturity of the system responsible for the urination function. The development of control over the urination is greatly hindered by wearing diapers, failure to provide potty training, and improper water intake schedule in children. The authors of the article identified three age groups of children with enuresis and delayed formation of bladder function and determined at what age which disorders are most relevant. Assessment of the maturity of urination in children with enuresis allows us to analyze the stages of delayed bladder function. In the younger age group (6–7 years), the delay in the formation of self-service skills in the implementation of the act of urination prevailed, including the use of a gender-unreasonable posture. At the age of 8–11 years, there was a predominance of delayed formation of emptying reflexes. At the age of 12–14, there were signs of hypoactivity of the bladder.

Case report: Anton's syndrome due to ishemic cerebrovascular disease

Anton's syndrome (AS) describes the condition in which patient deny their blindness despite objective evidence of visual loss, and moreover confabulate to support their stance. It is a rare extension of cortical blindness in which, in addition to the injury to the occipital cortex, other cortical centers are also affected, with patients typically behaving as if they were sighted. This case presents a 76-year-old patient with verified cortical blindness as a result of a stroke. The patient persistently denied vision loss. At the same time, she confabulated to see people and objects in her environment clearly. This syndrome may be unrecognized in routine neurological practice. A suspicion of cortical blindness and AS should be considered in patients with atypical visual loss and evidence of occipital lobe injury. Cerebrovascular disease is the most common cause of AS, as in our patient. Recovery of visual function will depend on the underlying etiology, with cases due to occipital lobe infarction after cerebrovascular events being less likely to result in complete recovery. Management in these circumstances should focus on secondary prevention and rehabilitation.