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Neurology, Neuropsychiatry, Psychosomatics

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Scientific and practical reviewed journal

Since 2009 the “Nevrologiya, Neiropsikhiatriya, Psikhosomatika" (Neurology, Neuropsychiatry, Psychosomatics) journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of neurology. The Journal is aimed to provide a forum to discuss etiology and pathogenesis, clinical features, modern diagnostic and treatment approaches to neurology, psychiatrics and its complications, as well as associated conditions.

The journal is intended for a wide range of neurologists, psychiatrists, neuropsychologists, and specialists of related occupations.

Articles from all specialized medical institutions of the Russian Federation and neighboring countries and materials prepared by Western partners are submitted to the journal.

Among editorial board members of the journal there are 24 Russian and foreign doctors of medical sciences and 3 candidates of medical sciences.

Federal Supervision Agency for Information Technologies and Communications registration ПИ № ФС77-35419 from 20.02.2009.

 

 

Current issue

Vol 13, No 2 (2021)
View or download the full issue PDF (Russian)

LECTURES 

4-9 84
Abstract

 Vulvodynia is a chronic persistent pain syndrome that affects the vulvar area and lasts more than 3 months without a clearly identifiable cause. Provoked localized pain in the vulval vestibule is the most prevalent type of vulvodynia and is interpreted as dysfunctional pain. Peripheral and central sensitization contribute to the onset and persistence of  vulvodynia. Chronic pain predictably causes significant issues  for a woman's psychological, sexual and physical health. The  diagnosis of vulvodynia includes an assessment of all the factors  associated with pain. Successful treatment of vulvodynia goes beyond identifying one trigger and prescribing one type  of treatment. Patient-centered interdisciplinary approach is the most promising, including psychotherapy, lifestyle changes,  drug therapy.  

10-18 142
Abstract

 Cerebral sinus thrombosis or cerebral venous thrombosis (CVT) is an important cause of nontraumatic intracranial hemorrhage in younger patients. CVT is associated with multiple risk factors and clinical conditions, is often undetected or verified late, and most importantly, has a relatively good prognosis if the treatment is started early. In this review, we describe CVT epidemiology and risk  factors, analyze its pathophysiology and clinical symptoms and  discuss modern diagnostic approaches to diagnosis, treatment and  secondary prevention. The article emphasizes the hemorrhagic  presentations of CVT, which in clinical settings are difficult to  diagnose and treat. 

ORIGINAL INVESTIGATIONS 

19-25 25
Abstract

Objective: to investigate the association of the polymorphic marker Val158Met in the catechol-O-methyl transferase (COMT) gene with depression in an open population aged 25–44 years.

Patients and methods. A representative sample of the  population living in Oktjabr'skij district of Novosibirsk aged 25– 44 years (427 men, median age – 34±0.4 years, response rate –  71%; 548 women, median age 35±0.4 years, response rate –  72%) was screened in 2013–2016 (budget framework № 0324- 2018-0001, Reg. № AAAA-A17-117112850280-2). In addition to  the standard epidemiological examination, screening participants underwent psychological testing, which determined  the level of depression. Study participants who  underwent COMT Val158Met (rs4680) polymorphism genotyping were randomly assigned to a cohort of 224 men  and 217 women. Pearson's χ2 test was used to test the  statistical significance of differences between these groups;  p≤0.05 was considered statistically significant in all types of  analysis.

 Results and discussion. In an open population aged 25–44 years, the prevalence of severe depression (SD) was 13.2%,  moderate depression – 24.4%. SD was more prevalent in COMT G/G genotype carriers (61.8%), compared to A/A genotype carriers (38.2%; χ2=6.097; df=2, p=0.047); the G allele carriers  also had a higher prevalence of SD (55.3%), compared to A  allele carries (44.7%; χ2=5.408; df=1; p=0.02).  SD was less prevalent among male COMT A/A genotype carriers (15.8%), compared to G/A genotype carriers (84.2%; χ2=4.603; df=1; p=0.032). SD was more prevalent in female G/G genotype  carriers (65.5%), compared to A/A genotype carriers (34.5%;  χ2=4.769; df=1; p=0.029). The G allele was more common among women with SD (58.2%) than the A allele (41.8%;  χ2=6.658; df=2; p=0.01). In a logistic regression model, COMT Val/Val genotype in the studied population [Relative risk (RR) 1.594], as well as G (Val) allele in the studied population  (RR=1.378) and women (RR=1.557), significantly increased the  risk of depression. 

Conclusion. The data allows us to assume that COMT G/G  polymorphism may be linked to a high depression level.  

26-33 55
Abstract

 The Perth Emotional Reactivity Scale – Short Form (PERS-S) is a psycho-diagnostic tool that assesses ease of activation, intensity, and duration of negative and positive emotions.

Objective of the study is to validate the Russian version of the PERS-S and to present its psychometric properties.

Patients and methods. The validation study was performed on a non-clinical sample (268 participants, aged 18–55 years). The factor structure of the scale was verified with confirmatory factor analysis using the robust maximum likelihood estimation. Convergent and divergent validity were assessed based on the  relationship between the PERS-S scales with the Positive and  Negative Affect Schedule, the Perceived Stress Scale and the Emotional Reactivity scale (Formal Characteristics of Behaviour- Temperament Inventory). The Cronbach's alpha (α) was used to evaluate the reliability of the PERS-S. 

 Results and discussion. The structural 6-factors model was consistent [χ2/df=1.77; CFI=0.935; TLI=0.917; RMSEA=0.060 (90% CI: 0.047–0.073); SRMR=0.058]. The 6-factors model with 2 two major factors showed satisfactory results [χ2/df=2.19; CFI=0.894; TLI=0.875; RMSEA=0.074 (90% CI 0.062–0.086); SRMR=0.092]. The reliability of the PERS-S was high for the two  composite scales and five subscales (α>0.70). The reliability of the «Positive-intensity» subscale was satisfactory (α=0.58). The  analysis of psychometric properties of the two tested models  indicated the possibility of using the PERS-S six correlated  subscales as well as the PERS-S with two composite scales, each  of which consists of three subscales, in scientific research and clinical practice.

Conclusion. The Russian version of the PERS-S is a valid and reliable tool for measuring emotional reactivity and its aspects. 

34-39 46
Abstract

 Objective: to assess the possibility of using laboratory biomarkers to objectify psychopathological disorders in patients with depressive spectrum disorders (RSDs).

Patients and methods. The investigation enrolled 63 patients (mean age, 31.7±8.9 years) with new-onset RSDs of different etiologies. Group 1 included 21 patients with a mild to moderate depressive episode (DE); Group 2 consisted of 42 patients with neurotic depressive disorders (adjustment disorders). The severity of anxiety and depression was assessed using the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, and the Hospital Anxiety and Depression Scale. In addition, the investigators studied laboratory  parameters: the levels of cortisol, homocysteine, prolactin,  vitamin B12, cortisol, interleukin (IL)-1β, IL-6, and tumor necrosis  factor-α (TNF-α) in serum and platelet serotonin. They  also estimated changes in the most significant laboratory  parameters in 31 patients with depressive disorders: in 15 with  DE and in 16 with neurotic depression who had received 4-week monotherapy with agomelatine 25 mg/day.

Results and discussion. The differential diagnosis of  psychopathological disorders based on the clinical and  psychopathological method and psychometric assessment of  the patient's condition was shown to be difficult. It was  established that the objectification of these disorders using  known laboratory biomarkers (cortisol and platelet serotonin) did not give an unambiguous answer. At the same time, the  assessment of immunological parameters (the levels of  proinflammatory cytokines, such as IL-6, TNF-α) can help to  solve this problem. The investigation also demonstrated that the use of non-monoaminergic antidepressants (MT1/MT2-type  melatonin receptor agonists) contributed to the reduced level of proinflammatory cytokines, which opens up  opportunities for finding new therapeutic approaches to  treating RSDs. 

Conclusion. Usage of biological markers may contribute not only to improvement in the accuracy of mental disorders  diagnosis but also to the development of new treatment approaches. Simultaneously, the selective use of individual biological markers (biochemical, metabolic, immunological, etc.)  is not very informative; therefore, their comprehensive  assessment is required.  

40-46 46
Abstract

 The vascular depression hypothesis posits that cerebrovascular diseases are a major risk factor for emotional and behavioral disorders (EBD). Arterial hypertension (AH) is one of the main causes of cerebrovascular diseases.

Objective: to assess the relationship between anxiety,  depression and apathy in the patients with AH with case history,  clinical features and neuroimaging.

Patients and methods. 65 hypertensive outpatient were  examined (mean age – 57.17±10.76 years). Cognitive status was  evaluated with MiniMental State Examination, Montreal  Cognitive Assessment (MoCA) and Frontal Assessment Battery.  EBD was assessed with Beck Depression Scale, Spielberger Anxiety Questionnaire, and Robert's Apathy Scale. The Fazekas  scale was used to determine the severity of leukoaraiosis. 

Results and discussion. Significant depression was present in 66.2%, anxiety – in 41.5%, and apathy – in 80% of hypertensive patients. Blood pressure level (p<0.05) and AH duration (p<0,05) were significantly associated with the severity of each  EBD included in the analysis (anxiety, depression, apathy).  Depression, anxiety, and apathy scores were significantly higher  (p<0.01) in patients with hypertension-mediated organ damage or associated clinical conditions. A negative correlation was found between the severity of depression, anxiety and apathy and cognitive scores (p<0.01). Depression, anxiety and apathy were significantly (p<0.05) higher in patients with higher Fazecas score. 

Conclusion. Advanced AH is associated with an increased risk of EBD including depression, anxiety and apathy. These EBD develop together with cognitive impairment and vascular leukoencephalopathy. The study results can emphasize the  pathogenetic impact of AH associated cerebral ischemia in EBD  development. 

47-55 22
Abstract

 Objective: to investigate gender differences in patients with depression and bipolar disorder (BD) and their impact on the clinical course of the disease.

Patients and methods. 50 women and 50 men with bipolar disorder (BD) (F31 according to the International Classification of Diseases, 10th revision – ICD-10) were examined using a specially developed survey. Patients symptoms was assessed in  accordance with the diagnostic criteria of affective disorders  according to ICD-10 and DSM-V, MADRS (Montgomery-Asberg  Depression Rating Scale) and Q-LES-Q-SF (Scoring the Quality of Life Enjoyment and Satisfaction Questionnaire). 

 Results and discussion. Gender differences in the clinical  course of BP were revealed. In men the disease usually starts  with a mania phase followed by a marked mood increase in BD- I, a shorter period before the first mania (hypomania) if the  onset is with the depression phase, mood swings and substance use disorders in puberty, which makes the diagnosis easier. In  women BD diagnosis may be harder due to higher frequency of BD-II, clinical presentation with depression, longer period  before the first mania (hypomania). Therefore the most  important clinical markers of BD in women include the early  onset of the disease, its association with neurohormonal factors,  history of affective variability, substance use disorders, schizophrenia, hereditary or comorbid eating disorder in  puberty or later in life. The most common clinical features  during the depression phase in men include: seasonal fluctuation (worsening of symptoms in autumn and winter) and diurnal variations (improvement of symptoms in the evening), numbed emotions, depersonalization-derealization syndrome, decreased libido, difficulty in falling asleep and increased appetite and/or body mass, comorbid depression, panic attacks and alcohol and substance abuse. The depression in women with BD is characterized by a higher prevalence of apathy, tearfulness, self-harm, body dysmorphic disorder, decreased appetite. Both male and female patients with depression and BD have a high level of anxiety, presence of psychomotor retardation, self-accusation and irritancy, 10% had atypical features according to the DSM-V criteria. Women have a higher proportion of depressive episodes (including rapid cycling BD) and a higher risk of suicidal behavior, and men, due to a higher frequency of manic phases, change partners and have a history of divorce significantly more often.

Conclusion. The revealed features of psychopathological  symptoms, comorbid disorders, the course of the disease and  correlations between individual characteristics and factors due  to gender differences, can be used as markers of bipolarity,  which will allow to diagnose BD earlier and more accurately and prescribe adequate therapy. 

56-64 63
Abstract

 Gait disturbances are a common consequence of stroke. New technologies, such as exoskeletons (ESs), may aid recovery, but their effectiveness has not yet been proven enough.

Objective: to evaluate the effectiveness of medical ESs and spasticity treatment for gait rehabilitation in patients with spastic hemiparesis due to acute stroke.

Patients and methods. The study included 42 patients with spasticity and gait disturbances who has had a stroke 1.5–4 years ago. Clinical assessment included: Tardieu scale (TS), Modified Ashworth scale (MAS), Rankin Scale, Visual Analogue Scale (VAS); 10 Meter Walk Test (10MWT) and Berg balance scale (BBТ), Rivermead Mobility Index (RMI). The patients were  divided into two representative groups (22 and  20 participants). Patients of the 1st group were training in the ES ExoAtlet for 10  days (original method and method of differentiation of efforts were used), the 2nd group was assigned to physical therapy for  the same period. Then all patients received an injection of 300–400 U of botulinum neurotoxin (BNT) under ultrasound control into the spastic muscles of the lower limb. The examination was carried out at three control points (CPs): 1st day (1st), 12th day (2nd), and 33rd day (3rd).

Results and discussion. Comparison of both groups on the 2nd CT showed significantly (p<0.05) better results in the 1st group: 10MWT (0.43 and 0.47 m/s), BBT (42 and 44.5), muscles of the back of the thigh – hamstrings assessed by TS (132° and 137.5°). Gait speed apparently increased due to balance training, correction of postural-phobic disorders, stretching of spastic  muscles, and suppression of the stretch reflex. At the 2nd CPs, injections of incobotulinum toxin (Xeomin®) were performed. On the 3rd CP, significantly (p<0.05) better results were  obtained in the 1st group according to tests: 10MWT (0.49 and 0.56 m/s), BBT (46 and 49), TS (144° and 155°). Comparison of group differences between the 1st and 3rd CPs showed an absolute increase in test results (p<0.01): 10MWT (0.07 and 0.12 m/s), BBT (3.5 and 8.5), TS (14.5° and 22°). Improvement in gait indicators on the third CP demonstrates the potentiating effect of BONT injections and ES exercises.

Conclusion. ES ExoAtlet use is a promising technique for restoring gait: the combined use of an exoskeleton and BONT gives a pronounced potentiating effect. 

65-72 23
Abstract

 Objective: to investigate the effectiveness of long-term oral administration of Actovegin in post-COVID patients with cognitive impairment (CI).

Patients and methods. 444 patients (142 men, 302 women) with COVID-19 and CI participated in the study. One-half of the included participants – 222 patients (70 men and 152 women) – were prescribed with actovegin 400 mg 3 times a day in addition to the baseline therapy; 222 patients (72 men and 150 women) were randomized to the control group. Cognitive functions were assessed with Montreal Cognitive Assessment (Montreal Cognitive Assessment test, МоСA test), fatigue – with Multidimensional Fatigue Inventory (MFI-20), emotional  disturbances – with Spielberger-Hanin test.

Results and discussion. Post-COVID patients with CI in the Actovegin group after 60 days follow-up had higher mean MoCА scores (p<0.05), lower MFI (p<0.05), and Spielberger-Hanin test scores (p<0.05) compared to the control group.

Conclusion. Positive effect of Actovegin on the cognitive  functions and emotional state of post-COVID patients with CI  was observed. 

73-78 35
Abstract

Objective: to compare the clinical efficacy of complex therapy, including a combination of a nonsteroidal anti-inflammatory drug (NSAID) with a muscle relaxant and B vitamins in acute musculoskeletal back pain (MSBP).

Patients and methods. We enrolled 66 patients with acute MSBP, 27 men and 39 women, mean age – 52.8 [29.4; 68.8] years. All patients had different pain localization: 36 (54.5%) – lumbodynia, 22 (33.3%) – cervicodynia, 8 (12.2%) –  thoracodynia. Visual analog scale (VAS) was used to assess pain intensity. Patients in the 1st group (n=32) were prescribed with complex therapy, including Russian drugs meloxicam (Amelotex 15 mg per day), tolperison (Kalmirex), and a neurotropic  multivitamin supplement Compligam B. Patients in the 2nd  group (n=34) received a combination of only two of the three drugs. We assessed pain intensity with VAS, disability duration, and treatment effectiveness from the doctor's and patient's perspectives. 

Results and discussion. After 5 days of treatment, pain regression was noted in both groups; pain reduction by 50% or more from the initial level prevailed in 1st group (p=0.03). A rapid NSAID dose decrease prevailed in the 1st group; from the 5th to the 10th day, all patients switched to the 7.5 mg meloxicam dose. The duration of temporary disability in the 1st group was less than 7 days, in the 2nd group – 9 days (p<0.05). Complex therapy in group 1 was more effective than therapy in group 2, according to doctors and patients (p<0.05). 

Conclusion. The combination of NSAID with a muscle relaxant and B vitamins can reduce the duration and the incidence of  adverse drug reactions of NSAID therapy, and reduce the  duration of temporary disability. 

CLINICAL OBSERVATIONS 

79-85 19
Abstract

 Guillain-Barre syndrome (GBS) is characterized by acute, progressive monophasic course with a predominance of motor disorders in typical cases; it develops due to an aberrant immune response in some viral and bacterial infections. As ganglioside complexes are the direct cause of acute dysimmune neuropathy, it is assumed that the combined damage of peripheral nerves structure, and neurohypophysis and hypothalamus, may be based on similar immunopathogenetic mechanisms. Here we present the first case of a patient with diabetes insipidus and acute  inflammatory dysimmune damage to sensory and autonomic  peripheral nerve fibers due to secondary hypothalamic-pituitary  system lesion. Due to the long-term persistence of arthralgias, accompanied by a low-grade fever and a single positive denatured DNA IgG antibodies test, atypical variant of GBS, hypophysitis, we differentiated the patient's condition with systemic rheumatic diseases, primary and secondary vasculitis. Those nosologies were not confirmed during the examination and observation; porphyrias and thyroid gland damage as etiological factors of nervous system damage were also excluded.
This case report demonstrates the need for a prompt determination of the nature of the pathological process that causes damage to peripheral nerves' fibers and the neuroendocrine system to select an adequate treatment strategy. 

86-90 24
Abstract

 Metachromatic leukodystrophy (MLD) is a hereditary lysosomal storage disease inherited in an autosomal recessive pattern, which occurs across all age groups. Currently, several forms of the disease are established: late infantile (the most common), juvenile (early and late), and adult, which manifests after the age of 16 years. This case report demonstrates an adult MLD in a 24-year-old woman presented with cognitive impairment, including memory deficits, judgement, communication, and self-care skills decline. Magnetic resonance imaging findings revealed massive symmetrical  periventricular white matter lesions without signs of brainstem  involvement and increased lactate level. Whole exome sequencing  revealed two ARSA gene mutations. Clinical and genetic characteristics of the adult MLD and modern treatment approaches are discussed. 

91-96 38
Abstract

 Osmotic demyelinating syndrome (ODS) is a severe complication that occurs due to rapid correction of hyponatremia. Central  pontine myelinolysis (CPM), in which a focus of demyelination  occurs in the pontine region, and extrapontine myelinolysis (EPM),  in which foci of demyelination appear in the white matter of the  cerebral hemispheres, can be distinguished as a part of this  syndrome. We describe two clinical cases of CPM that developed due to hyponatremia and hypokalemia in patients with SARS-CoV-2 infection (COVID-19). Differential diagnosis included acute  disseminated encephalomyelitis, infectious encephalitis, and brain  tumor. In both cases, a significant recovery of the lost functions was noted. The pathogenetic mechanisms of CPM development in  patients with COVID-19 are discussed. ODS development in COVID- 19 necessitates strict control and correction of electrolyte  disturbances in this category of patients in accordance with existing  recommendations, which can reduce the risk of CPM. 

REVIEWS 

97-103 43
Abstract

 Nowadays, infertility is one of the major problems in the reproductive health field: it is estimated that it affects 8 to 12% of couples of reproductive age worldwide, and in 50–80% of cases, the reason is female infertility. Miscarriage occurs in 10–25% of cases, and every fifth pregnancy is terminated, which aggravates the unfavorable demographic situation in general. For a woman, the inability to have children and long-term treatment turns into a psychological problem. An Emotional toll  leads to guilt and inferiority, emotional upheaval, lower quality  of life. Previous studies have shown that despite a good prognosis and funds  availability, the most common treatment discontinuation cause is  psychological distress. The current review aims to analyze an  infertile woman's emotional status and search for possible options  to decrease psychological stress during infertility treatment. 

104-110 41
Abstract

 One of the depression causes is the use of certain drugs, and in this case, the term drug-induced depression (DID), medication-induced or iatrogenic depression is used. Symptoms of DID are similar to those observed in patients with other types of depression. DID is also associated with morbidity and mortality. Its  development leads to a decrease in treatment adherence, and in  some cases, to discontinuation of drugs that have predictive value. The main point in the management of patients with DID is the rapid  detection and correction of symptoms and the application of prompt measures to prevent their development when prescribing  certain drugs. The features of the course of DID, pathogenetic  mechanisms and risk factors for its development, possible approaches to the treatment and prevention are discussed. 

111-116 67
Abstract

 During the examination of post-COVID patients, a direct and indirect negative effect of COVID-19 on the nervous system is found. Among the mediated subjectively significant stress factors of the pandemic, a potential long-term threat to life,  prolonged quarantine measures with selfisolation, lack of stable  immunity, restriction of access to medical services, etc. are of  particular importance.
An increased frequency of depression (up to 53.5%), anxiety (up  to 50.9%), and mixed anxiety/depressive disorders were  reported during the pandemic.
Psychopharmacotherapy in patients with COVID-19 should include drugs not only with minimally expressed undesirable effects and adverse drug interactions but also with the presence of additional therapeutic procognitive and somatotropic properties, similar to those identified in the antidepressant fluvoxamine. 

117-122 40
Abstract

 Daytime somnolence may be a symptom of different somatic,  neurological and psychiatric diseases and develop due to abuse  and/or discontinuation of various medications. Drug- induced hypersomnia (DIH) is defined as hypersomnolence  caused by the intake of multiple drugs. DIH is one of the most frequently reported effects and/or side effects of drugs. DIH  prevalence varies widely and can be as high as 75% in patients receiving specific medications. DIH risk factors include elderly  and senile age, impaired drug metabolism, serum drug  concentration, method and frequency of drug administration, single and daily doses of drugs, etc., as in many other drug- induced diseases and syndromes. DIH can occur both due to sedative agents administration and withdrawal of  psychostimulants and other activating psychotropic  medications. Most often, the development of DIH is associated with the use of levodopa-carbidopa, antipsychotics,  antidepressants. The pathogenesis of DIH is complex and multifactorial and is associated with the mechanism of action of  individual drugs and the presence of concomitant diseases. The  article discusses the risk assessment of DIH development due to  various medications, diagnosis and management tactics of  patients with DIH.  

123-129 71
Abstract

 Cognitive impairment (CI) can be neurological symptoms or complications of coronavirus disease 2019 (COVID-19). Among  the pathogenetic mechanisms, the neurotropicity of the SARS- CoV-2 virus, endothelial dysfunction, coagulopathy, thrombus  formation, systemic inflammatory reaction, the consequences of mechanical ventilation and drug sedation are considered. Treatment strategies  for COVID-19 patients with CI have not yet been developed. The following tactics of patient management is advisable: prevention of  re-infection, assessment and correction of the emotional state,  treatment of cardiovascular diseases. The possibilities of  vinpocetine in the treatment of CI after COVID-19 are discussed. 

130-136 43
Abstract

 Locomotive syndrome (LS) is defined as an unsatisfactory condition in patients after the age of 60 years, in which they require or may require physical assistance soon due to deterioration in the functional state of the musculoskeletal system, including pathology of bone tissue, joints, muscles, and the nervous system. The problem of LS treatment in elderly patients is relevant for all countries over the world. The presence of chronic somatic and neurological diseases in most older adults can complicate LS assessment and reduce treatment effectiveness. The patient's functional status and ability to continue activities of daily living  should be assessed at the first visit to determine the degree of  independence, the level of need for caregivers, and the overall  quality of life. LS treatment should be permanent and include  kinesiotherapy, professional psychological support, and complex  drug therapy. The use of vital micronutrients, which include highly  purified forms of chondroitin sulfate and glucosamine sulfate,  which have a wide range of anti-inflammatory and regenerative  effects, can provide the safety of long-term drug therapy. 

137-143 52
Abstract

 Metabolic disorders associated with nutritional  deficiency/imbalance are common in various psychiatric disorders,  including depression, schizophrenia spectrum disorders, dementia,  and eating disorders. Malnutrition degrees vary in a wide range –  from borderline minerals, vitamins, micronutrients deficiency/imbalance to severe metabolic disorders and cachexia.  We present a review of up-to-date publications, meta-analyses, and  systematic reviews on the subject. The need to introduce  supplemental nutrition as an additional component of a therapeutic  strategy for various mental disorders is discussed. The potential of using the products of the Fresubin line is analyzed in detail. 

EXPERIMENTAL STUDIES 

144-156 16
Abstract

 Objective: to establish the molecular mechanisms of interaction of cytidine-diphosphocholine choline (CDP-choline) with other agents used to treat chronic cerebral ischemia (CCI) to increase the effectiveness of the therapy..

Material and methods. A chemoreactom analysis of CDP-choline, betahistine, ethyl-methyl-hydroxypyridine succinate  (EMHPS), vinpocetine, and nicergoline was conducted using the  computational methods of the theory of topological analysis of  chemographs. 

 Results and discussion. The profiles of the pharmacological action of molecules are described, including the accumulation in tissues, pharmacokinetic and pharmacodynamic parameters, the effect on the metabolome and proteome, the survival of neurons during glutamate stress. The mechanisms of the synergistic action of CDP-choline and EMHPS were discovered,  including: 1) inhibition of the activation of the pro-inflammatory  factor NF-κB; 2) decrease in the procoagulant  profile; 3) decrease in glutamate excitotoxicity secondary to  improved oxygen metabolism. These effects result in  conjunction with at least 25 proteins of the human proteome.

Conclusion. CDP-choline supports cholinergic  neurotransmission and is used in the treatment of vascular  pathologies of the brain. The cholinergic effect of CDP-choline  is enhanced by the anti-inflammatory, anticoagulant, and  neuroprotective action of both the molecule itself and  synergistic molecules (in particular, EMHPS). 

CONSENSUS OF EXPERT MEETING 

157-161 92
Abstract

 The opinion of Russian experts on the possibility of COVID-19 vaccination in patients with multiple sclerosis (MS) is presented. The authors of the consensus, based on an analysis of a large number of domestic and foreign guidelines, conclude that it is possible to use killed and inactivated vaccines. Preliminary recommendations are given for COVID-19 vaccination, taking into account the MS disease modifying therapies. 



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