On November 23, 2021, the group of experts/specialists set up by the Public Defender paid its third visit to patient (accused/convicted) Mikheil Saakashvili. The patient has been treated at the Giorgi Abramishvili Military Hospital of the Ministry of Defense since November 19, 2021.

The visit was carried out by the following experts: Aida Gozalova, Tengiz Tsuladze, Giorgi Kacharava, Nino Zavrashvili, Grigoli Khurtsidze, Giorgi Papiashvili. The experts talked to Mikheil Saakashvili, assessed his medical condition, talked to doctors and received information about the patient's health data.

After the visit, the group of experts held a remote discussion, in which experts Mamuka Machaidze and Giorgi Grigolia also took part.

The group of specialists rely on the principle of ensuring the best interests of the patient while making evaluations.

I. Evaluation of the patient’s condition

The patient's condition is stable, he still has general weakness, balance problems. Vital parameters are within the norms.

II. Major problems

1. The relative decrease in phosphate levels in the blood is noteworthy: from 3 mmol/L (a few days ago) to 1.08 mmol/L, which corresponds to the predicted refeeding syndrome and requires frequent monitoring of phosphorus as well as other electrolytes and replenishment as needed.

2. Wernicke encephalopathy is not progressing at this stage. After being transferred to the Gori Hospital, refeeding and intensive replenishment of thiamine, no convulsive activity has occurred and the patient's condition has stabilized clinically.

The CT scan of the patinet’s head did not indicate anything abnormal. As for the magnetic resonance imaging, the results of the test showed that within 48 hours after the start of adequate thiamine replenishment, the changes characteristic of the Wernicke syndrome are reversing, and as the patient's condition has stabilized, there is no longer the need for urgent examination.

In terms of the prognosis of Wernicke encephalopathy, ophthalmoparesis is expected to recover soon, with vestibular dysfunction improving within two weeks. However, confusion and weakness may remain for several weeks. Full recovery from ophthalmoparesis may not occur.

Treatment of the syndrome at this stage, in our estimation, is adequate for the condition.

3. Given the combination of the current tough psychological environment and severe Wernicke syndrome caused by starvation, highly qualified specialists should be involved in the treatment process to achieve an appropriate outcome, to adequately diagnose, to determine the course of psychotherapy and pharmacological treatment, and to adequately manage the rehabilitation process.

4. Multivitamins should be continued for the vitamin deficiency.

5. Physical rehabilitation.

Members of the group of specialists/experts:

/Giorgi Grigolia/

/Grigoli Khurtsidze/

/Giorgi Kacharava/

/Giorgi Papiashvili/

/Aida Gozalova/

/Tengiz Tsuladze/

/Nino Zavrashvili/

/Mamuka Machaidze/