• The prominence of peripheral neuropathy as a cause of the restless legs syndrome in CMT may justify treatment with neuropathic medications as opposed to the more commonly recommended dopaminergic agents. (springer.com)
  • Past medical history: classic migraine, gestational diabetes, peripheral neuropathy. (neuroophthalmology.ca)
  • Family history: Father and son have peripheral neuropathy. (neuroophthalmology.ca)
  • Are there any genes associated with peripheral neuropathy? (leonieclaire.com)
  • As our understanding of genetic disorders increases, many new genes are being associated with peripheral neuropathy. (leonieclaire.com)
  • CMT2 results in peripheral neuropathy through direct axonal death. (cmt.org.uk)
  • CMTX1 is usually mild in women but in men there is moderate-to-severe peripheral neuropathy. (cmt.org.uk)
  • CMT2A2B is a hereditary motor sensory neuropathy that is characterised by onset of peripheral neuropathy in the first years of life. (guidetopharmacology.org)
  • Charcot-Marie-Tooth disease type 2A (CMT2A) is an inherited axonal peripheral neuropathy mainly caused by mutations in the mitofusin 2 (MFN2) gene encoding for the MFN2 protein, a GTPase involved in the mitochondrial dynamics and bioenergetics. (fortuneonline.org)
  • Charcot-Marie-Tooth disease is the most common hereditary peripheral neuropathy in humans, presenting incidence of 1: 2500 people. (arquivosdeorl.org.br)
  • Charcot-Marie-Tooth Disease (CMT) is the most common type of Hereditary Peripheral Neuropathy (1) in humans, together with Hereditary Motor and Sensory Neuropathy(2), affecting around 1 in 2,500 people(3). (arquivosdeorl.org.br)
  • In this article, we are going to discuss HMSN (Hereditary Motor sensory neuropathy) and its ayurvedic treatment. (planetayurveda.net)
  • HMSN (Hereditary motor sensory neuropathy) is caused by a mutation in the genes (especially chromosomes 17 and 1) which leads to the damage of the peripheral nerves. (planetayurveda.net)
  • CMT type 2 (CMT2 - also known as hereditary motor and sensory neuropathy type II (HMSN-II)) is primarily an axonal disorder, not a demyelinating disorder. (cmt.org.uk)
  • Primary peripheral axonal neuropathy (CMT2 or HMSN-II) with onset usually in the second decade, but may not appear until later. (cmt.org.uk)
  • HMSN type I is a demyelinating neuropathy with dominant inheritance. (brainkart.com)
  • HMSN type II is an axonal neuropathy with variable inheritance pattern. (brainkart.com)
  • HMSN type III is an autosomal recessive demyelinating sensory neuropathy with very high CSF protein levels. (brainkart.com)
  • The phenotypic spectrum of GARS1-associated axonal neuropathy ranges from GARS1 infantile-onset SMA (GARS1-iSMA) to GARS1 adolescent- or early adult-onset hereditary motor/sensory neuropathy (GARS1-HMSN). (nih.gov)
  • Inherited peripheral neuropathies (IPNs) are a heterogeneous group of hereditary motor and sensory neuropathies (HMSN), hereditary motor neuropathies, and hereditary sensory neuropathies. (annaly-nevrologii.com)
  • Charcot-Marie-Tooth disease (CMT) also known as hereditary sensory- motor neuropathies (HMSN) is the most common inherited neuropathy, with a prevalence of 1:2500 [1]. (fortuneonline.org)
  • Cmt1d Is also known as hmsn id, hmsn1d, hereditary motor and sensory neuropathy 1d, charcot-marie-tooth neuropathy, type 1d. (mendelian.co)
  • Hereditary sensory and autonomic neuropathy type I (HSAN I) or hereditary sensory neuropathy type I (HSN I) is a group of autosomal dominant inherited neurological diseases that affect the peripheral nervous system particularly on the sensory and autonomic functions. (wikipedia.org)
  • HSAN I is the most common type among the five types of HSAN. (wikipedia.org)
  • HSAN I is characterized by marked sensory disturbances mainly as the loss of pain and temperature sensation in the distal parts of the lower limbs. (wikipedia.org)
  • Hereditary Sensory and Autonomic Neuropathy Type I (HSAN I)." Syndromes: Rapid Recognition and Perioperative Implications, 2e Bissonnette B, Luginbuehl I, Engelhardt T. Bissonnette B, & Luginbuehl I, & Engelhardt T(Eds. (mhmedical.com)
  • Type I is the most common form among the five types of HSAN. (mhmedical.com)
  • Hereditary sensory autonomic neuropathy (HSAN) type II is a rare, autosomal recessive, and early onset sensory neuropathy, characterized by severe and progressive sensation impairment, leading to ulcero-mutilating complications. (univ-tours.fr)
  • This report expands the clinical and genetic spectrum of HSAN type II and emphasizes the phenotype variability even within the same family. (univ-tours.fr)
  • HSAN type 1, also known as hereditary sensory radicular neuropathy, is divided into 6 subtypes based on the gene of inheritance. (logicalimages.com)
  • HSAN type 2, also known as congenital sensory neuropathy (CSN), is autosomal recessively inherited and has 4 subtypes. (logicalimages.com)
  • HSAN type 3, also known as familial dysautonomia (FD) or Riley-Day syndrome, is an autosomal recessively inherited disorder caused by a mutation of the IKBKAP gene. (logicalimages.com)
  • HSAN type 3 almost exclusively occurs in the Ashkenazi Jewish population. (logicalimages.com)
  • HSAN type 4, also known as congenital insensitivity to pain with anhidrosis (CIPA), is an autosomal recessively inherited mutation of the NTRK1 ( TRKA ) gene that causes profound loss of pain and temperature sensitivity that can lead to self-mutilation, especially of the face and mouth, fractures, and osteomyelitis. (logicalimages.com)
  • Fifty percent of individuals with HSAN type 4 are the result of a consanguineous union. (logicalimages.com)
  • HSAN type 5 is caused by a mutation in the NGFB gene that causes congenital insensitivity to pain and temperature sensations with partial anhidrosis. (logicalimages.com)
  • HSAN type 6 is an autosomal recessively inherited disorder due to a mutation of the DST gene. (logicalimages.com)
  • In addition to the acquired causes, inherited disorders like hereditary sensory-autonomic neuropathy (HSAN), familial amyloid polyneuropathy (FAP), Tangier disease, and Fabry disease also exist. (medscape.com)
  • Mutation of this gene results in neuropathy and optic atrophy. (nih.gov)
  • HSMN, type VI, which we believe this patient to have, is an autosomal dominantly inherited axonal sensorimotor polyneuropathy associated with optic atrophy. (neuroophthalmology.ca)
  • Zuchner S, et al: Axonal neuropathy with optic atrophy is caused by mutations in mitofusin 2. (neuroophthalmology.ca)
  • Voo I, et al: Hereditary motor and sensory neuropathy type VI with optic atrophy. (neuroophthalmology.ca)
  • An expanding number of degenerative disorders are associated with mutations in the genes encoding MFN2 and OPA1, including Charcot-Marie-Tooth disease type 2A and autosomal dominant optic atrophy. (centrodinoferrari.com)
  • Skin biopsies demonstrate MPZ splicing abnormalities in Charcot-Marie-Tooth neuropathy 1B. (mda.org)
  • Thomas D Bird M. Charcot-Marie-Tooth Neuropathy Type 2. (mda.org)
  • The small-fiber neuropathies that present with pain, itch, and autonomic symptoms also can be genetic. (leonieclaire.com)
  • Thus, pure small fiber neuropathies may be associated with normal findings on routine electrophysiologic studies. (medscape.com)
  • The risk of progression to bilateral vocal cord dysfunction in CMT and the risk of aspiration with laryngeal neuropathy may limit the therapeutic options available for vocal cord paralysis. (springer.com)
  • With disease progression, loss of these sensory corpuscles occurs. (mhmedical.com)
  • [ 1 ] The typical CMT phenotype involves distal limb muscle wasting and sensory loss, with proximal progression over time. (cmt.org.uk)
  • Patients with familial amyotrophic lateral sclerosis (f-ALS) typically have asymmetric onset weakness, upper motor neuron signs, absent sensory involvement and relatively rapid disease progression with fatality typically in 2-5 years of onset. (bmj.com)
  • 1 In contrast, distal hereditary motor neuropathies (dHMNs) and hereditary motor and sensory neuropathies type-2 (HMSN2) have symmetric length-dependent motor axonal loss and slow disease onset and progression. (bmj.com)
  • We report four patients from two unrelated families who developed during childhood a sensory axonal neuropathy with variable severity and pronounced nociception impairment. (univ-tours.fr)
  • CMT type 2 primarily is a neuronal (ie, axonal) disorder, not a demyelinating disorder. (medscape.com)
  • In the late 1960s, neurophysiologic testing allowed the classification of CMT into 2 groups, one with slow nerve conduction velocities and histologic features of a hypertrophic demyelinating neuropathy (hereditary motor and sensory neuropathy type 1 or CMT1) and another with relatively normal velocities and axonal and neuronal degeneration (hereditary motor and sensory neuropathy type 2 or CMT2). (medscape.com)
  • Mutations in this gene cause Charcot-Marie-Tooth disease type 2A2, and hereditary motor and sensory neuropathy VI, which are both disorders of the peripheral nervous system. (nih.gov)
  • Extension of the phenotype of biallelic loss-of-function mutations in SLC25A46 to the severe form of pontocerebellar hypoplasia type I. Braunisch MC, et al . (nih.gov)
  • Recently, mutations in the mitofusin 2 (MFN2) gene have been associated with HSMN, type 6. (neuroophthalmology.ca)
  • Despite this, we are not aware of any reports of HSMN, type VI associated with mutations in the OPA1 gene. (neuroophthalmology.ca)
  • Mutations in the TRPV4 gene are the cause of spondylometaphyseal and metatropic dysplasia and hereditary motor and sensory neuropathy type IIC. (thermofisher.com)
  • Mutations in the SPTLC1 gene cause hereditary sensory neuropathy type IA. (leonieclaire.com)
  • Mutations in the Small GTP-ase Late Endosomal Protein RAB7 Cause Charcot-Marie-Tooth Type 2B Neuropathy. (mda.org)
  • Glycyl tRNA Synthetase Mutations in Charcot-Marie-Tooth Disease Type 2D and Distal Spinal Muscular Atrophy Type V. (mda.org)
  • Further evidence that neurofilament light chain gene mutations can cause Charcot-Marie-Tooth disease type 2E. (mda.org)
  • CMT3 (also known as Dejerine-Sottas disease) is a rare congenital hypomyelinating neuropathy, which can be an autosomal dominant or a recessive disorder with mutations in several genes, including PMP22 , MPZ , and EGR2 . (msdmanuals.com)
  • Mutations in MME cause an autosomal-recessive Charcot-Marie-Tooth disease type 2. (annaly-nevrologii.com)
  • These types of mutations can spontaneously occur as cells rapidly multiply before or shortly after conception. (worldhealth.net)
  • Mutations in SPLTC1 are also known to cause a different neurological disorder called hereditary sensory and autonomic neuropathy type 1 (HSAN1). (worldhealth.net)
  • The degree of motor disturbances is highly variable, even within families, ranging from absent to severe distal muscle weakness and wasting. (wikipedia.org)
  • in others (eg, certain cases of Charcot-Marie-Tooth disease type 1A (CMT1A) and inherited brachial plexus neuropathy [IBPN]/hereditary neuralgic amyotrophy [HNA]), proximal weakness predominates. (medscape.com)
  • Hereditary motor or sensory neuropathies refer to a group of nerve disorders that lead to weakness and wasting of the muscles generally below the knees, and in the hands, and that may be passed from parents to children. (leonieclaire.com)
  • It begins in childhood with progressive weakness and sensory loss and absent deep tendon reflexes. (msdmanuals.com)
  • Although initially it resembles Charcot-Marie-Tooth disease, the motor weakness progresses more quickly. (msdmanuals.com)
  • Initial manifestations are typically muscle weakness in the hands sometimes with sensory deficits. (nih.gov)
  • In the past, HSP was also classified as type I or type II, based on the patient's age at the onset of symptoms and on the amount of spasticity versus weakness. (medscape.com)
  • Clinically, patients present with distal weakness/atrophy, sensory loss and cavus feet. (fortuneonline.org)
  • or motor symptoms such as weakness and loss of muscle bulk, particularly in the lower leg and feet muscles. (neurologycolorado.com)
  • 1996) [Respiratory disorders in type-1 hereditary motor and sensory neuropathy]. (springer.com)
  • Despite the deliberate exclusion of relatively common groups such as hereditary motor and sensory neuropathy (40/100,000) and mitochondrial disorders (9.2/100,000), the combined prevalence is 37.0/100,000, demonstrating that these disorders, taken as a group, encompass a significant proportion of patients with chronic disease. (nih.gov)
  • The axonal type of Charcot-Marie-Tooth (CMT) disorders is genetically heterogeneous, therefore the causal mutation is unlikely to be observed, even in clinically well characterized patients. (archive.org)
  • Hereditary neuropathies are a group of inherited disorders affecting the peripheral nervous system. (neurologycolorado.com)
  • The NINDS supports research on neuromuscular disorders, such as hereditary neuropathies, aimed at learning more about these disorders and finding ways to prevent and treat them. (neurologycolorado.com)
  • Restless legs and periodic limb movement during sleep are found in a large proportion of patients with CMT2, a type of CMT associated with prominent axonal atrophy. (springer.com)
  • CMT1 is established by the reduction on nervous stimuli conduction velocity and nerve hypertrophy, while CMT2 conduction velocity is normal but there is axonal neuropathy (4). (arquivosdeorl.org.br)
  • CMT symptoms begin between the first and second decade of life(4), but it may vary according to types, CMT1 or CMT2, and genetic mutation associated to them(2). (arquivosdeorl.org.br)
  • Hereditary sensory neuropathy type I (HSN I) is a slowly progressive neurological disorder characterised by prominent predominantly distal sensory loss, autonomic disturbances, autosomal dominant inheritance, and juvenile or adulthood disease onset. (orpha.net)
  • The patient presented severe sensorimotor neuropathy with early onset. (fortuneonline.org)
  • The symptoms of hereditary neuropathies may be apparent at birth or appear in middle or late life. (neurologycolorado.com)
  • CMT type 1 is a disorder of peripheral myelination resulting from a mutation in the peripheral myelin protein-22 ( PMP22 ) gene. (medscape.com)
  • What gene causes neuropathy? (leonieclaire.com)
  • A new variant of Charcot-Marie-Tooth disease type 2 is probably the result of a mutation in the neurofilament-light gene. (mda.org)
  • The IMPC applies a panel of phenotyping screens to characterise single-gene knockout mice by comparison to wild types. (mousephenotype.org)
  • HSP may also be classified as autosomal dominant, autosomal recessive, or X-linked, and each type has several subtypes, which are based on the location of the gene. (medscape.com)
  • A rare type of X-linked HSP, however, has been associated with a myelin protein gene mutation. (medscape.com)
  • These results support the hypothesis that the mutation in the MFN2 gene altering mitochondrial bioenergetics and fusion causes axonal sensory-motor neuropathy. (fortuneonline.org)
  • Nerve conduction studies confirm a sensory and motor neuropathy predominantly affecting the lower limbs. (orpha.net)
  • Pain and temperature sensations usually are not affected because they are carried by unmyelinated (type C) nerve fibers. (medscape.com)
  • Vocal cord dysfunction, possibly due to laryngeal nerve involvement, is found in association with several CMT types and can often mimic asthma. (springer.com)
  • 2000) Phrenic nerve conduction study in demyelinating neuropathies and open-heart surgery. (springer.com)
  • Can nerve entrapment cause neuropathy? (leonieclaire.com)
  • CMT type 3 (CMT3 - also known as Dejerine-Sottas neuropathy) is characterised by marked segmental demyelination, with thinning of the myelin around the nerve. (cmt.org.uk)
  • Patients have relatively normal nerve conduction velocities but low amplitude sensory nerve action potentials and compound muscle action potentials. (msdmanuals.com)
  • Depending on the motor conduction velocity (MCV) found on the median nerve at electrodiagnostic evaluation (EDX), CMTs can be classified into three principal groups, demyelinating (MCV ≤35 m/sec), intermediaries (MCV between 35 and 45 m/sec) or axonal (≥45 m/sec)[2]. (fortuneonline.org)
  • The hereditary neuropathies can be diagnosed by blood tests for genetic testing, nerve conduction studies, and nerve biopsies. (neurologycolorado.com)
  • Quantitative sensory testing (QST) that investigates and discriminates the function of C, Aδ and Aβ fibers is included as an instrumental test to monitor nerve fiber function. (mdpi.com)
  • CMT can be classified as types 1 to 7, X, and intermediate, with many subtypes. (hindawi.com)
  • CMT subtypes and disease burden in patients enrolled in the Inherited Neuropathies Consortium natural history study: a cross-sectional analysis. (annaly-nevrologii.com)
  • Also typical of the hereditary sensory and motor neuropathies is the predominance of motor symptoms over sensory, despite electrophysiological evidence of both motor and sensory involvement. (neuroophthalmology.ca)
  • No motor involvement. (mhmedical.com)
  • Type I features autosomal dominant inheritance and distal sensory involvement. (bvsalud.org)
  • Magnetic resonance imaging (MRI) revealed that in patients with different clinical pictures, a similar involvement existed for the motor, association, and cerebellar white matter pathways and for the cervical cord, in relation to healthy controls. (medscape.com)
  • Backgrounds Hereditary transthyretin amyloidosis (ATTRv) presymptomatic subjects undergo multidisciplinary evaluation to detect, as early as possible, a subclinical involvement of multisystem disease. (mdpi.com)
  • Few peripheral neuropathies are associated with pure or predominantly small fiber involvement. (medscape.com)
  • Painful burning feet is caused by a sensory neuropathy with small fiber involvement in more than 90% of cases. (medscape.com)
  • However, a study by Krajewski et al suggested that neurologic dysfunction and clinical disability in CMT 1A are caused by loss of or damage to large-diameter motor and sensory axons. (medscape.com)
  • Entrapment neuropathies are commonly encountered in clinical practice. (leonieclaire.com)
  • Additionally, either clinical or neurophysiological motor impairment was not uncommon. (univ-tours.fr)
  • HSANs have been classified into at least 8 different disorder types based on their genetic and clinical findings. (logicalimages.com)
  • Clinical features on Charcot-Marie-Tooth disease normally begin between first and second life decade, varying accordingly with disease type, 1 or 2, and the linked genetic mutation. (arquivosdeorl.org.br)
  • These young patients had many of the upper and lower motor neuron problems that are indicative of ALS," said Payam Mohassel, M.D., an NIH clinical research fellow and the lead author of the study. (worldhealth.net)
  • It is more clinically useful, however, to classify this disorder into acute and nonacute types based on the clinical findings. (medscape.com)
  • CMT (Charcot-Marie-Tooth) disease is a heterogeneous group of inherited peripheral neuropathies in which the neuropathy is the sole or primary component of the disorder. (cmt.org.uk)
  • They are caused by the loss of large myelinated and unmyelinated fibers leading to self-mutilation, peripheral sensory loss, and autonomic dysfunction. (logicalimages.com)
  • Although all routine laboratory tests are normal in individuals with CMT disease, special genetic tests are available for some types. (medscape.com)
  • Are there any genetic tests for hereditary neuropathy? (leonieclaire.com)
  • Hereditary motor neuropathies and motor neuron diseases have extremely diverse genetic causes, 1 , 2 and within each group, distinct phenotype-genotype correlations are uncommon for f-ALS, dHMN and HMSN2. (bmj.com)
  • CMT is the most common genetic neuropathy accounting for 80 to 90% of cases 5). (arquivosdeorl.org.br)
  • For a phenotypic description and a discussion of genetic heterogeneity of autosomal dominant Charcot-Marie-Tooth disease type 1, see CMT1B ( OMIM ). (mendelian.co)
  • Charcot-Marie Tooth disease (CMT) encompasses several inherited peripheral motor-sensory neuropathies and is one of the most common inherited neuromuscular diseases. (springer.com)
  • Presence of upper motor neuron signs was also a distinctive feature in two related patients. (univ-tours.fr)
  • OBJECTIVES: Hereditary sensory neuropathy type 1 (HSN1) is a rare, slowly progressive neuropathy causing profound sensory deficits and often severe motor loss. (ox.ac.uk)
  • It results in severe demyelination with delayed motor skills and is much more severe than type 1. (cmt.org.uk)
  • Other types are more severe and are associated with more disabilities. (neurologycolorado.com)
  • Type II is characterized by autosomal inheritance and distal and proximal sensory loss. (bvsalud.org)
  • 2000) The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. (springer.com)
  • Central sleep apnea may be associated with diaphragm dysfunction and hypercapnia, whereas obstructive sleep apnea has been reported as possibly due to a pharyngeal neuropathy. (springer.com)
  • 1987) Diaphragmatic dysfunction in siblings with hereditary motor and sensory neuropathy (Charcot-Marie-Tooth disease). (springer.com)
  • Inherited neuropathies in which autonomic or sensory features predominate, conditions in which the neuropathy is part of a multiple-organ disturbance, and neuropathies with specific metabolic dysfunction are not discussed. (medscape.com)
  • Sensory potentials are usually absent in the lower limbs but are often recordable or even normal in the upper limbs of the patients. (wikipedia.org)
  • Development of MRC Centre MRI calf muscle fat fraction protocol as a sensitive outcome measure in Hereditary Sensory Neuropathy Type 1. (ox.ac.uk)
  • Hereditary sensory and autonomic neuropathies (HSANs) are inherited peripheral neuropathies with variable expressivity often presenting in childhood and early adulthood. (logicalimages.com)
  • As the disease progresses, the sensory abnormalities may extend up to the knees. (wikipedia.org)
  • The signs and symptoms of Refsum disease result from the abnormal buildup of a type of fatty acid called phytanic acid. (medlineplus.gov)
  • In 1968, CMT disease was subdivided into two types, CMT 1 and CMT 2, on the basis of pathologic and physiologic criteria. (medscape.com)
  • [ 5 ] CMT disease is divided into several types, as follows. (medscape.com)
  • Charcot-Marie-Tooth (CMT) disease is a peripheral hereditary neuropathy associated with motor and sensory impairment and can result in profound sensorineural hearing loss (SNHL). (hindawi.com)
  • Charcot-Marie-Tooth disease is the most commonly occurring hereditary motor and sensory neuropathy. (hindawi.com)
  • 2005) Charcot-Marie-Tooth disease type 1A: clinicopathological correlations in 24 patients. (springer.com)
  • 2001) Charcot-Marie-Tooth disease associated with Type 2 diabetes mellitus. (springer.com)
  • Dray TG, Robinson LR, Hillel AD (1999) Laryngeal electromyographic findings in Charcot-Marie-Tooth disease type II. (springer.com)
  • Two hereditary neuropathies are: What is Charcot-Marie-Tooth Disease? (leonieclaire.com)
  • It was used as methodology consults the on line data bases such as Cochrane, LILACS, MEDLINE, OMIM e SciELO, applying the research the terms Charcot Marie Tooth disease, Hereditary Motor and Sensory Neuropathy Type I and Hereditary Motor and Sensory-Neuropathy Type II, to article published between years 1997 and 2007. (arquivosdeorl.org.br)
  • A list of data basis which was searched follows: Cochrane, LILACS, MEDLINE, OMIM and Scielo, applying to the research the terms Charcot Marie Tooth Disease, Hereditary Motor and Sensory Neuropathy Type I and Hereditary Motor and Sensory-Neuropathy Type II, for articles published between 1997 and 2007. (arquivosdeorl.org.br)
  • The most common type is Charcot-Marie-Tooth disease, one of the hereditary motor and sensory neuropathies. (neurologycolorado.com)
  • Proprioceptive sensory loss can cause sensory ataxia and a steppage gait. (cmt.org.uk)
  • Dyck PJ, Low PA, Stevens JC (1983) "Burning feet" as the only manifestation of dominantly inherited sensory neuropathy. (springer.com)
  • Eighteen types of dominantly inherited pure or complicated HSP are known, along with 17 types of recessively inherited HSP and 3 types of X-linked HSP. (medscape.com)
  • Motor examination shows, on inspection, abnormalities of the calf and feet (shown below). (neuroophthalmology.ca)
  • Conditions linked to CMT with comparable symptoms include: HNPP - Hereditary Neuropathy with Liability to Pressure Palsies, GAN - Giant Axonal Neuropathy. (cmt.org.uk)
  • Here, discover the type of medical professionals that can help, tools for finding them, and tips for getting the most out of your care as you navigate to a diagnosis. (nih.gov)
  • How is the diagnosis of entrapment neuropathies made? (leonieclaire.com)
  • That complicates the differential diagnosis of hereditary neuropathies. (annaly-nevrologii.com)