Functional dizziness (FD) is the most common form of chronic dizziness, accounting for up to 20% of all cases of chronic dizziness and is diagnosed in 40% of patients referred to specialized clinics. This article discusses the pathogenesis, clinical manifestations and diagnostic features of FD. An overview of standard and new methods of drug therapy and methods of vestibular rehabilitation for patients with FD is provided. Experts conclude that FD, currently defined as persistent postural perceptual dizziness (PPPD), is the most common cause of chronic non-rotational dizziness. PPPD is thought to be multifactorial; central and peripheral vestibular disorders, anxiety disorders and traumatic brain injury are noted as possible precipitating causes. The diagnosis of PPPD is based on the presence of a feeling of unsteadiness or non-rotational dizziness occurring more than half of the days over a period of three months or longer, when other possible causes of dizziness have been ruled out. When managing a patient with PPPD, it is necessary to inform the patient about the nature of the disease, provide a patient with an education program and apply psychotherapy and vestibular rehabilitation methods. The use of buspirone prolonged-release tablets (Vespirate®) and vestibular rehabilitation in clinical practice is discussed.

   Post-traumatic cognitive impairment (CI) and asthenia are common, disabling and often obligatory manifestations of traumatic brain injury (TBI). The search for effective drugs against CI and asthenia after TBI is of great importance.

   Objective: to investigate the efficacy and safety of Prospekta in the treatment of post-traumatic CI and asthenia in real-life clinical practice.

   Material and methods. The observational study involved 50 patients of both sexes aged 21–45 years (mean age 41.5 ± 5.9 years) with complaints of CI and fatigue after TBI received within the last 2 years, who were prescribed 1 tablet of Prospekta twice daily for 4 weeks. Cognitive functions, particularly the speed of attention switching, were assessed using the Schulte table method, visual-motor abilities were assessed using the Trail Making Test (TMT). Asthenic syndrome was assessed using the subjective asthenia rating scale (Multidimensional Fatigue Inventory, MFI-20). At the end of treatment, the safety of therapy and TBI outcomes were assessed using Dobrokhotova's differentiated TBI outcomes scale.

   Results. The average time to complete the Schulte table technique after 4 weeks of therapy with Prospekta decreased by 16.2 seconds, part A of the TMT – by 6.6 seconds and part B – by 19.8 seconds (p < 0.0001). The average score on the MFI-20 scale decreased by an average of 8 points after 4 weeks of therapy (p < 0.0001), which was mainly due to an increase in motivation (by 22 %), activity (by 16 %) and a decrease in emotional lability (by 20 %). The average score on Dobrokhotova's differentiated TBI outcome scale at the end of therapy was 3.2 ± 1.2 (mild/moderate asthenia). Treatment with Prospekta halved the number of patients with clinically significant mental asthenia, reduced motivation and reduced activity after TBI. No adverse events were recorded.

   Conclusion. The drug Prospekta can be recommended for monotherapy in patients with TBI to improve cognitive function and reduce asthenic syndrome in real-life clinical practice, contributing to the improvement of quality of life and functional activity of the injured individuals.

   Objective: to evaluate the effect of kinesiotherapy on the intensity of neuropathic pain, physical activity and emotional state of patients with diabetic polyneuropathy (DPN).

   Material and methods. The study included 65 patients with a painful form of DPN who were randomly divided into two groups: the standard therapy (ST) group and the extended therapy (ET) group, in which three to four additional face-to-face sessions were conducted to create a 15-minute individualized exercise program. The type of neuropathic pain was assessed using the Neuropathy Total Symptom Score – 9 (NTSS-9). Pain intensity was assessed using a visual analogue scale (VAS), patients' emotional state was assessed using the Beck Depression Scale and the Spielberger Anxiety Scale (with an assessment of personal anxiety). The examination was carried out at baseline, and after 3 and 6 months. At baseline, patients in the ST and ET groups did not differ (p ≥ 0.05) in parameters such as pain intensity according to VAS (6.65 ± 1.93 and 6.07 ± 1.91 points respectively), neuropathic pain according to NTSS-9 (13.65 ± 4.54 and 11.79 ± 5.09 points respectively), physical activity according to IPAQ-SF (20.1 ± 10.0 and 18.8 ± 9.1 points), personal anxiety according to Spielberger scale (51.00 ± 6.10 and 47.33 ± 9.73 points), depression according to Beck scale (15.75 ± 7.77 and 14.67 ± 8.73 points).

   Results. After treatment, there was a more significant reduction in pain intensity according to VAS in the ET group than in the ST group – to 3.67 ± 2.55 and 6.10 ± 1.41 points respectively after 3 months (p < 0.05) and to 2.60 ± 1.45 and 5.80 ± 1.06 points respectively after 6 months (p < 0.001), reduction in neuropathic pain according to NTSS-9 scale to 4.88 ± 4.39 and 13.13 ± 2.96 points after 3 months (p < 0.001) and to 3.55 ± 2.52 and 13.08 ± 3.86 points after 6 months (p < 0.001), a decrease on the personal Spielberger Anxiety Scale to 42.33 ± 7.66 and 51.30 ± 7.22 points after 6 months (p = 0.01), a decrease on the Beck Depression Scale to 10.07 ± 9.31 and 16.70 ± 4.34 after 6 months (p < 0.05).

   Conclusion. Kinesiotherapy in complex therapy of DPN leads to a reduction in pain and an improvement in functional and emotional state of patients.

   In recent years, the development of instrumental diagnostics has made it possible to identify a subgroup among patients with prolonged disorders of consciousness (PDoC) in which the phenomenon of “covert cognition” occurs, characterized by a dissociation between the clinical assessment and the data of instrumental diagnostic methods. To identify this phenomenon, we used a set of diagnostic paradigms developed at the Scientific Centre of Neurology in collaboration with a group of neuropsychologists from M.V. Lomonosov Moscow State University and tested on a cohort of healthy volunteers (n = 10) under the control of functional magnetic resonance imaging (fMRI).

   Objective: to evaluate the results of applying a set of paradigms to diagnose the phenomenon of “covert cognition” in a Russian-speaking cohort of patients with PDoC.

   Material and methods. In this fragment of a prospective study, after analyzing the medical records of 138 patients, 10 individuals with PDoC of various etiologies were included. Patients underwent a thorough neurological examination and a comprehensive neurophysiological and imaging study with emphasis on fMRI with paradigms.

   Results. When analyzing the fMRI data, significant activation clusters were detected in five patients in response to some passive paradigms, some of which were comparable to those of healthy subjects.

   Conclusion. Using the proposed set of fMRI paradigms, we demonstrated the possibility of identifying the phenomenon of “covert cognition” in a Russian-speaking cohort of patients in vegetative state / with unresponsive wakefulness syndrome (1/6), and confirmed by instrumental methods preservation of individual aspects of consciousness in patients in minimally conscious state “minus” (4/4).

   Ullanlinna Narcolepsy Scale (UNS) is the most widely used scale for primary screening for narcolepsy. It has a high sensitivity (83.5 %) and specificity (84.1 %). However, the length of the scale and the time taken by patients to complete it may limit its use. The shortest scale for primary detection of narcolepsy type 1 is the Swiss Narcolepsy Scale (SNS), which also has a high sensitivity (89 %) and specificity (88 %).

   Objective: to validate the SNS in Russian language and compare it with English and German versions as well as with some other scales.

   Material and methods. 53 patients with narcolepsy type 1 were included. Narcolepsy was diagnosed according to the ICSD-3 criteria. The control group consisted of patients with obstructive sleep apnea (n = 71) and chronic insomnia (n = 31). Sensitivity and specificity of the Russian version of the scale (RU-SNS) were compared with UNS and Epworth Sleepiness Scale (ESS) questionnaires.

   Results. The mean score of the RU-SNS for patients with narcolepsy was – 33.64 ± 5.14. In the control group, the mean score was 29.75 ± 16.68. The sensitivity and specificity were 84.9 % and 95.1 %, respectively. For UNS, the mean score was 32.79 ± 9.87 in the narcolepsy group and 8.35 ± 4.84 in the control group. Sensitivity was 96.2 % and specificity – 84.3 %. For ESS, the mean score in narcolepsy group was 17.75 ± 4.28 and 8.7 ± 5.7 for controls. The sensitivity was estimated at 94.3 % and specificity at 61.8 %.

   Conclusion. The RU-SNS demonstrated high sensitivity and specificity, while the UNS also has high sensitivity but low specificity. ESS has high sensitivity but low specificity as it is only designed to detect pathological daytime sleepiness. Based on these data, the SNS can be used as a valid tool for the early diagnosis of narcolepsy type 1.

   Triptans are a targeted therapy for acute migraine attacks. They are recommended for the treatment of severe attacks when non-specific analgesics are not effective. Four of the seven known triptans with different efficacy and individual tolerability are registered in the Russian Federation.

   Objective: to determine in an open-label non-comparative single center study efficacy and safety of the new Russian generic tableted rizatriptan 10 mg (Relonova) in real-life clinical practice.

   Material and methods. Thirty individuals with migraine took part in the study. Patients took rizatriptan to relieve 4 migraine attacks and filled out self-observation diaries and HIT-6 questionnaire before and after therapy.

   Results. The study involved 30 patients (26 women and 4 men) with mean age of 38.7 ± 9.3 years. Duration of migraine was 19.6 ± 11.4 years, mean number of days with migraine per month was 9.5 [5.25; 16.75]. Most patients (67 %) suffered from episodic migraine and 33 % from chronic migraine; 6 patients (20 %) had migraine attacks with aura; 20 individuals (67 %) received preventive therapy. After taking Relonova medication, pain relief was observed in 86 % of attacks, and in 45 % of cases pain disappeared completely; after 24 hours, pain relief was observed in 87 % of cases, and in 68 % – absence of attacks. A significant decrease in headache intensity was observed within 30 minutes after taking the first dose; in 34 % of attacks the headache returned. Additional analgesic treatment was required in 39 % of cases. Adverse events were observed in 25 % of attacks and were mild. The majority (63 %) of the participants were able to successfully terminate 3 attacks and were responders.

   Conclusion. Relonova is an effective and safe medication for the relief of migraine attacks.

   Pituitary apoplexy (PA) is a rare, potentially life-threatening condition primarily associated with pituitary adenomas. It presents with sudden, severe symptoms due to inadequate blood supply, bleeding, or tissue death in the pituitary gland. This case report describes a case of PA in a 40-year-old female, and reviews the recent literature surrounding the subject. The patient presented with complete bilateral third nerve palsy and dilated non-reactive pupils. Her initial symptoms included retroorbital headache, fever, and double vision, which rapidly progressed to oculomotor nerve palsy. MRI revealed hemorrhagic PA. High-dose steroids were initiated, leading to the resolution of ptosis. Additionally, surgical intervention was performed. PA typically affects older males with known adenomas, making this case unusual due to the patient's age, gender, and absence of prior adenoma history. Differentiating PA from other intracranial pathologies is crucial, and MRI plays a pivotal role in accurate diagnosis.

   Temporal and parahippocampal glial tumors at early morphological stages of their development may mimic the clinical and neuroimaging picture of limbic encephalitis. Delayed diagnosis of glioblastoma can have a negative impact on the prognosis of the disease, which is why there is a need to find approaches for its earlier detection.

   The aim of this paper is to analyze possible difficulties and errors in the differential diagnosis of autoimmune encephalitis (AE) and glioblastoma based on literature data and our own clinical observations.

   Features such as onset of the disease at a young age, subacute development of symptoms, response to immunosuppressive therapy and the MRI imaging of bilateral T2 hyperintense changes in the limbic areas are typical for AE, but do not exclude the diagnosis of a primary tumor of the central nervous system. Therefore, caution should be exercised regarding the likelihood of a primary brain tumor when patients of any age group present with symptoms characteristic of AE, especially if no specific for AE antibodies are detected. To shorten the time to diagnosis, a multidisciplinary approach, critical analysis of clinical data, a shortening of the examination interval and an increase in the frequency of imaging follow-up examinations are required.

   Depression often develops on a background of somatic and neurological conditions, but the relationship and mutual influence of these disorders can be different. Depression can be exogenous-organic in the context of somatic and neurological diseases; it can be a nosogenic reaction to the disease. In somatic and neurological patients, endogenous depression can be observed as a comorbid depressive episode of a recurrent depressive disorder or a bipolar affective disorder. However, patients' somatic complaints often mask the psychopathological picture of the depression and make its diagnosis more difficult. Conversely, depression can trigger or aggravate somatic condition via psychosomatic mechanisms, which is of great importance for the care providers of these patients. To illustrate the above, we present a clinical observation in which a patient with a history of two traumatic brain injuries with subsequent hospitalizations, long-term alcohol abuse, hepatitis B and C, accompanied by antiviral therapy, was diagnosed with recurrent depressive disorder (current episode – depressive hypochondriacal). Difficulties in the diagnosis of depression, aetiopathogenetic and therapeutic aspects are discussed.

   This article presents a clinical case of Gerstmann–Sträussler–Scheinker syndrome (GSS) – a progressive inherited prion disease with an extremely rare phenotype that changed dynamically during the course of the disease and eventually led to the misdiagnosis of a motor neurone disease. An important feature of this case is a progressive myelopathy, probably due to the deposition of prion protein plaques, with the development of symptoms of lower motor neuron involvement (muscle atrophy, areflexia, fasciculations and muscle hypotonia). Clinical, laboratory, electrophysiological and neuroradiological features of this case are presented. The final diagnosis was verified by whole-exome sequencing – a typical mutation p.P102L in the prion protein gene PRNP was identified. It is discussed whether GSS should be included in the differential diagnosis in patients with progressive motor disorders, a family history and unchanged long nerve conduction function according to electromyography.

   A clinical case of a patient with chronic musculoskeletal neck pain (CNP) in combination with tension headache (TH) and increased anxiety is described. The combination of these conditions is common in neurological practice. The disorders mentioned are pathogenetically related and mutually reinforce each other. In this respect, a unified comprehensive approach is required for the successful treatment of patients of this category, which is demonstrated using a clinical case from our own practice. The factors for the development and chronicity of CNP, TH are shown: misconceptions about the disease, catastrophizing the pain, increased anxiety, stress, a sedentary lifestyle, prolonged time spent at the computer, long static postures. Before contacting the Clinic for Nervous Diseases of Sechenov University (СNВ), no effect of the therapy was observed, as the factors for the development and chronicity of the pain were not assessed and not corrected, pharmacotherapy (painkillers, group B vitamins) was used in combination with ineffective non-drug treatment methods (massage, physiotherapy). An educational programme for the patient about the causes of the disease and its prognosis was not implemented, and the patient was not suggested to undergo a course of therapeutic exercise or cognitive behavioural therapy (CBT), the patient was not given any recommendations on ergonomics and physical activity during the day. In the СNB, the patient was offered a comprehensive treatment approach that included educational talks, CBT, kinesiotherapy, taping and Nimesil (nimesulide) administration. CBT is a proven effective psychological method for the treatment of CNP and TH that aims to develop accurate, realistic beliefs about the disease and adaptive behaviour in a patient, as well as skills to overcome pain and increased anxiety. In the treatment of chronic NP, it is recommended to combine CBT with kinesiotherapy, a scientifically proven effective non-pharmacological treatment method. Kinesiotherapy includes therapeutic exercises, education on correct posture and recommendations on ergonomics and lifestyle. Nimesil (nimesulide), a non-steroidal anti-inflammatory drug that is widely used in Russian neurological practice and has proven efficacy and safety in the treatment of musculoskeletal pain, was chosen as pharmacotherapy. It is important to mention that nimesulide was prescribed to the patient from the first days of treatment simultaneously with the start of kinesiotherapy and CBT. Against the background of pharmacotherapy, the patient experienced rapid pain relief, which contributed to adherence to recommendations to increase physical activity, ergonomics and therapeutic exercise, as well as CBT. The complex treatment helped the patient relatively quickly and effectively. After 10 days of treatment, he reported a 50 % reduction in pain and an increase in functional activity. After 2 months, the pain had completely subsided and daily activity and quality of life increased. Six months of follow-up showed the sustainability of therapeutic results achieved.

   In elderly patients, vestibular disorders are often associated with concomitant diseases and lead to falls and injuries. When treating elderly patients, it is necessary to determine an underlying cause of dizziness, and assess concomitant diseases, medications taken and their possible impact on the course of the underlying disease. In elderly patients, vascular dizziness is often misdiagnosed, while peripheral causes of dizziness are not identified, and effective treatment is not provided. Early recognition and prompt treatment of acute dizziness are important to reduce the incidence of residual dizziness, especially in elderly patients at risk of falling. In this article, we present a case of an elderly patient with acute vestibular dizziness due to benign paroxysmal positional vertigo (BPPV) against a background of comorbid orthostatic hypotension. For a long time, the patient's vertigo was mistakenly recognized as a manifestation of cerebrovascular disease. The combination of peripheral vestibulopathy with orthostatic hypotension led to a fall and injury. Recognition and effective treatment of BPPV (Epley maneuver), elimination of hypotension by optimizing antihypertensive therapy and the use of Arlevert resulted in a sustained positive effect. The efficacy of Arlevret in elderly patients is discussed.

   Functional movement disorders (FMD) are frequently encountered in the clinical practice of neurologists. Recently, the interest of specialists in FMD has increased. Based on neuroimaging, neurophysiological and neuropsychological studies, concepts of the pathophysiology of FMD have been proposed. A difficult issue is differentiation of FMD from factitious disorder and malingering. Diagnostic criteria for FMD, factitious disorder, and malingering are currently proposed, including in ICD-11, but they still contain many controversial provisions, the most important of which are discussed in this article.

   Educational programs, psychotherapy (cognitive behavioural psychotherapy – CBP, relaxation methods), selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are effective in anxiety disorders (AD). In a significant proportion of patients with AD, treatment with SSRIs and SNRIs is ineffective and is discontinued due to adverse events, so the search for new drugs is needed. One of the new drugs that have been shown to be effective in AD is Aviandr, which blocks serotonergic 5-HT7, 5-HT2A, 5-HT2C and 5-HT6 receptors, adrenergic 2A, 2B and 2C receptors and histamine H1 receptors. In experimental animal models, Aviander has been shown to have significant anxiolytic and antidepressant effects. The efficacy and safety of Aviandr was investigated in patients with generalized AD (GAD) in a double-blind, placebo-controlled, randomized study conducted in 17 centers in the Russian Federation. Patients with GAD (n = 129; mean age 42.5 ± 13.1 years; 75 % women) were randomized to receive Aviandr 40 mg/day (group 1; n=42) or 60 mg/day (group 2; n = 44) or placebo (PL; group 3; n = 43) for a period of 8 weeks. Efficacy was assessed using the Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D) and Clinical Global Impression Scale (CGI-S). After 8 weeks of treatment, anxiety according to HAM-A scale decreased by 53.7, 47.7 and 16.3 % in group1, 2 and 3, respectively, indicating a significant (p < 0.002) benefit of Aviandr over PL and fulfilling the primary efficacy criterion. A significant (p<0.001–0.009) advantage of the treatment groups over the PL group was also observed for all secondary efficacy criteria (HAM-A, HAM-D, CGI-S, CGI-I). Adverse events occurred more frequently in group 2 (60 mg/day), but not more frequently in group 1 (40 mg/day) than in the PL group. Therefore, treatment of GAD with Aviandr at a dose of 40 mg/day is considered optimal and recommended for the treatment of AD. Currently, Aviandr starts being used in AD in our country, so the results of its use in real-life clinical practice will be available. In AD, the optimal use of Aviandr is at a dose of 40 mg/day for at least 12 weeks in combination with an educational program, if possible with CBP and effective treatment of comorbidities.

   Agomelatine is an antidepressant with a unique pharmacological action that is both a melatonin agonist and a selective serotonin antagonist. The drug's unique pharmacological profile includes the properties of a dual 5-HT2С receptor antagonist as well as the properties of a melatonin MT1 and MT2 receptor agonist. Through its effect on melatonin receptors, agomelatine resynchronizes disturbed circadian rhythms and has a positive effect on sleep architecture. In addition, agomelatine shows a novel and fundamentally different mechanism of anxiolytic action compared to other classes of drugs used to treat anxiety. The article presents studies of agomelatine that demonstrate good treatment results in terms of response rates and remission in major depressive disorder of varying severity and generalized anxiety disorder. Agomelatine in a daily dose of 25–50 mg not only reduces the degree of anhedonia, apathy, anxiety, reduces somatic symptoms of depressive and anxiety disorders, but is also well tolerated, normalizes sexual dysfunctions in patients in psychiatric and general medical networks, it is used in cardiovascular, neurological diseases, and post-COVID-19.

   Every third or fourth ischemic stroke is cardioembolic. Prescribing oral anticoagulants can significantly reduce the risk of recurrent stroke, but this strategy requires the physician to have a firm orientation in the “efficacy – safety” coordinate system. We formulate 10 rules that should help any interested specialist (neurologist, cardiologist, therapist) to decide on the prescription of oral anticoagulants for cardioembolic stroke in daily clinical practice. We discuss issues of selection of an anticoagulant in atrial fibrillation, mitral stenosis and mechanical heart valves, the timing of prescription (also in haemorrhagic transformation of ischemic stroke and after intracerebral hemorrhage), the special features of anticoagulant prophylaxis in comorbid and “fragile” patients are discussed, the development of a stroke while taking an anticoagulant, the timing of discontinuation and resumption of therapy during surgical interventions, the choice of dose and peculiarities of therapy in cognitively impaired patients.