Despite the development of basic principles and a wide arsenal of therapeutic and preventive agents, the effective treatment of migraine patients in daily practice is associated with some well-identified obstacles. Among many obstacles to effective treatment, several key factors can be identified: low patients' awareness of the nature of the disease, its course and prognosis, methods of treatment and prevention, low rate of patients' referral for medical care and unsatisfactory level of diagnosis in clinical practice, inadequate training of physicians in the field of headache, nonoptimal use of symptom management and preventive treatment strategies. The article discusses the most common problems and strategies to optimize treatment of migraine patients.

Chronic tension-type headache (CTTH) is often associated with mental disorders, especially depressive and anxiety disorders. The efficacy of involving a psychiatrist in the care for patients with CTTH has been little studied.
Objective: to evaluate the efficacy of the interdisciplinary and standard approach in the treatment of CTTH.
Material and methods. The study comprised 97 patients with CTTH and mental disorders who were randomly divided into two groups. The first (main) group (n=45) consisted of patients in whom an interdisciplinary approach was applied with a neurologist and a psychiatrist participating in the treatment. The control group (n=52) consisted of patients who were treated using the standard CTTH treatment protocol involving only a neurologist. The research protocol involved six months of treatment and observation with assessment of efficacy at two time points – 3 and 6 months after the start of treatment. The severity and baseline characteristics of pain were assessed using the visual analogue scale (VAS), pain catastrophizing scale (PCS) and the McGillas questionnaire. The Hamilton scales and the Insomnia Severity Index (ISI) were used to assess the accompanying anxiety and depressive disorders. The SF-36 questionnaire was used to assess quality of life.
Results. Positive dynamics were observed in all patient groups 3 months after the start of treatment, with patients in the main group showing a more significant decrease in the number of headache (HA) days 5.0±1.96 (in the control group 11.0±3.66; p<0.01), pain intensity according to the McGill questionnaire (7.36±4.97 and 12.93±7.49; p<0.01), PCS (8.69±7.4 and 13.7±9.03; p<0.01), concomitant affective disorders according to the Hamilton scale (7.36±4.97 and 10.11±5.42; p<0.01), improvement in sleep indicators according ISI (3.8±3.06 and 6.98±5.02; p<0.01), improved quality of life according to indicators of the SF-36 questionnaire (vital activity 60.5±11.43 and 48.75±18.68; p<0.01; pain intensity 64±13.3 and 31±20.95; p<0.01; role-playing functioning due to emotional state 70.84±15.2 and 54.49±40.71; physical functioning 90,22±11,37 и 83,17±16,66; р<0,01; social functioning 87,5±16,49 и 75±21,36; р<0,05). Similar trends were noted 6 months after initiation of therapy.
Conclusion. An interdisciplinary approach involving a psychiatrist is effective in the treatment of patients with CTTH and mental disorders.

Thorough and early assessment of self-awareness deficits after brain injury is an important problem in neurorehabilitation that requires the development of both qualitative and quantitative methods to assess different levels of self-awareness to increase the efficacy of rehabilitation. Although there is no consensus on the determination and measurement of self-awareness impairment, several quantitative assessment methods have been developed in international practice. The Self-Awareness of Deficits Interview (SADI) technique is one of the most used structured interviews to assess self-awareness impairment in neurological patients.
Objective: to conduct validation study and to develop the official Russian-language version of SADI.
Material and methods. The study comprised two stages: in the first stage (n=17), a direct and reverse translation of the methodology was performed, followed by a pilot test; in the second stage (n=31), the reliability of the inter-rater and test-retest reliability, and the internal consistency of the methodology were evaluated. Three neuropsychological experts and two students took part in the evaluation of the results. Interviews were conducted with patients who were hospitalized to the Research Center of Neurology and N.I. Pirogov National Medical and Surgical Center of Ministry of Health of Russia. Inclusion criteria: verified neurological diagnosis, no pronounced speech disorders, Russian language fluency.
Results. The study resulted in the cross-cultural SADI adaptation, leading to the development of the SADI-RU, the Russian-language version, including a scoring guide and a list of questions for patient's relatives. Pilot tests showed the suitability of the SADI-RU for clinical practice. An analysis of the psychometric indicators of the tool showed a “good” level of inter-rater consistency (ICC=0.81), high test-retest reliability (r=0.92) and internal consistency (α=0.77).
Conclusion. The results of the study have shown that the developed SADI-RU is a reliable tool for assessing the self-awareness deficits, which is suitable for clinical practice and scientific research in neurological patients.

Dysphagia and sialorrhea are common complications of stroke that worsen quality of life and increase the risk of aspiration pneumonia. Botulinum toxin type A (BoNT-A) injections are effective in the treatment of sialorrhea, but there are few data on the use of botulinum toxin in patients with dysphagia in acute stroke.
Objective: to evaluate the efficacy and safety of incobotulinumtoxin A in the treatment of sialorrhea and prevention of aspiration pneumonia in patients with acute ischemic stroke.
Material and methods. Twenty-seven patients with dysphagia and sialorrhea in acute ischemic stroke were included in the study. All patients received an ultrasound-guided injection of incobotulinumtoxin A in a total dose of 100 units, divided into four injections into parotid and submandibular salivary glands bilaterally. Posterior sialorrhea was visually verified by the endoscopic assessment, severity of dysphagia and aspiration risk were assessed at baseline, two weeks and one month post-injection using the Penetration Aspiration Scale (PAS), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and the Clinical Institute of the Brain (CIB) Dysphagia Scale. The control group consisted of 27 retrospectively analyzed patients who were matched for age, gender, stroke severity and dysphagia. Sialorrhea was assessed endoscopically, and dysphagia was assessed using the CIB dysphagia scale. All patients were routinely treated according to local standards of care depending on their condition at the admission. Aspiration complications and adverse events due to incobotulinumtoxin A were recorded throughout the study.
Results. All patients in the main group at baseline had severe dysphagia according to PAS, FEDSS and CIB dysphagia scales (5.88±1.37; 4.73±1.12 and 19.81±6.61 points, respectively) and sialorrhea. After 2 weeks and 1 month after the injection of incobotulinumtoxin A, there was a decrease in the amount of saliva without signs of posterior sialorrhea and a decrease in the severity of dysphagia. Dysphagia scores on the PAS, FEDSS and CIB scales reached a statistically significant difference (p<0.05) within one month compared to baseline (2.86±0.90; 2.57±0.66 and 11.43±2.14 points, respectively). No side effects such as weakness of the mimic and bulbar muscles were observed. In the control group, the severity of dysphagia also decreased according to the CIB scale, comparable to the main group, but sialorrhea persisted in 17 patients after 2 weeks and in 9 patients after 1 month. Aspiration pneumonia was diagnosed in 3 patients in the main group and in 7 patients in the control group.
Conclusion. Injections of incobotulinumtoxin A in patients with dysphagia in acute ischemic stroke are effective and safe in the treatment of sialorrhea and the prevention of aspiration pneumonia. BoNT-A injections could be considered as a routine, safe and cost-effective treatment for patients with dysphagia to prevent aspiration complications after stroke. Further studies are needed to substantiate this statement.

Cognitive impairment (CI) is a common symptom in multiple sclerosis (MS) that significantly impairs quality of life. Severe cognitive impairment with a multidomain phenotype is observed in progressive MS (PMS). Given the limitations of available therapeutic approaches to the treatment of CI in PMS, the investigation of transcranial magnetic stimulation (TMS) for its correction is relevant.
Objective: To investigate the safety, tolerability and efficacy of multitarget navigated TMS in PMS with CI.
Material and methods. A protocol for multitarget intermittent theta-burst stimulation (iTBS) of the left dorsolateral prefrontal and posterior parietal cortex was developed. Fifteen patients with PMS and CI were enrolled in the study: 8 patients received sham stimulation followed by active iTBS, and 7 patients received only active iTBS. Safety and tolerability were assessed by questionnaires, efficacy by neuropsychological testing and questionnaires on subjective CI and fatigue.
Results. No serious adverse events (AEs) or discontinuation of TMS were observed. Mild AEs were recorded during 39.8% of sessions and within 24 hours after 23.3% of sessions, with no statistically significant differences between sham- and active iTBS. Verbal working and short-term memory (p=0.012 and p=0.049) as well as information processing speed (p=0.026), visuospatial perception (p=0.023), subjective CI (p=0.016) and fatigue (p=0.041) improved after the active protocol. Sham-iTBS had no significant effects. Significant differences between the effects of the sham and the active protocol were only observed for verbal working memory (p=0.043).
Conclusion. Thus, this pilot study confirmed good safety and tolerability of the TMS protocol in PMS with CI. It was shown that there is a potential efficacy for verbal working and short-term memory, information processing speed, visuospatial perception, subjective CI and fatigue. The efficacy needs to be confirmed in further large studies.

Botulinumtoxin type A (BoNT-A) has been shown to be an effective proven modern method of treating various neurological conditions. IncobotulinumtoxinA is a purified BoNT-A, free from complexing proteins, a widely used in pediatric and adult practice with proven efficacy and a favorable safety profile. There is little real-world data of long-term use of incobotulinumtoxinA with documented outcomes in our country, which predisposed the current retrospective study.
Objective: to analyze the 12-year routine use of incobotulinumtoxinA in clinical hospitals of the Department of Neurology of the Saratov State Medical University.
Material and methods. Retrospective data of 312 patients with neurological conditions, treated with incobotulinumtoxinA during the period from 2013 to 2024 was analyzed. We analyzed nosological entities, the number of patients and injection cycles, average dosage, number, and types of adverse events (AEs) and reported cases of secondary nonresponse.
Results. BoNT-A therapy was most used for post-stroke spasticity (n=81), cervical dystonia (CD; n=62), and blepharospasm (n=57). The largest number of injections cycles was 263 in patients with CD. The average dose of incobotulinumtoxinA was 200 U. AEs were observed in 68 cases (6.4%) and did not affect treatment outcomes. There were neither serious AEs nor cases of secondary nonresponse reported. BoNT-A injections with electroneuromyography and ultrasound guidance made injections technique more accurate and safer.
Conclusion. Retrospective analysis has shown that incobotulinumtoxinA was most used for post-stroke spasticity, CD and blepharospasm. The low frequency of AEs and no signs of secondary treatment failure were noted.

Objective: to compare microRNA profiles in cerebrospinal fluid (CSF) of patients with remitting multiple sclerosis (RMS) in remission and patients with other neurological diseases.
Material and methods. Eight patients with RMS in remission (4 males and 4 females) and 8 patients with other neurological diseases (4 males and 4 females) were included in the study. We compared the microRNA profiles in the CSF of the patients in the two study groups. Profiling was performed by sequencing small RNAs with the MGISEQ-200 device. The differences in microRNA levels were analyzed using the DESeq2 package for the R programming language. For microRNAs whose levels in CSF differed between the analyzed patient groups, a network of interactions with their target genes was created using the miRNet web service. Common targets were identified from the whole set of targets; for the resulting set of targets, an overrepresentation analysis of the pathways annotated in the KEGG database was performed.
Results. The level of 30 microRNAs differed significantly (padj<0.05; |log₂FC|>1) in the analyzed patient groups, the concentration of 13 microRNAs was higher and of 17 – lower in the CSF of patients with multiple sclerosis (MS). The search for common targets of these microRNAs allowed us to identify 8 protein-coding genes, each of which is a target of at least 5 microRNAs from the selected group: MIDN, MDM2, CDKN1A, TMEM184B, TAOK1, HNRNPA, NFIC and ZNF460.
Conclusion. MicroRNA profiles in CSF distinguish patients with MS from patients with other neurological diseases. The possibility of using changes in the concentration of detected microRNAs in CSF as a diagnostic marker for MS needs to be confirmed in independent samples.

We describe a clinical case of a successful treatment of a 46-year-old female patient with chronic musculoskeletal low back pain combined with a tension-type headache, who did not observe the effect of various methods of therapy. A comprehensive approach to the patient's care was applied, targeting the factors of pain chronification, comorbid disorders, an increase in daily physical activity and improvement of quality of life. It is shown how the formation of the patient's correct perception about the causes and factors contributing to the pain, lifestyle correction (avoidance of low physical activity, prolonged static postures during the day) in combination with individual kinesiotherapy and optimal pharmacotherapy with the drug Nimesil (nimesulide) made it possible to reduce the pain relatively quickly and steadily, normalize sleep and mood. The drug of choice was Nimesil (nimesulide) – a non-steroidal anti-inflammatory drug that is widely used in Russian neurological practice and has proven to be effective and safe in the treatment of musculoskeletal pain. Of great importance in the patient's treatment was kinesiotherapy, which included therapeutic exercises, training of the correct postures and recommendations on ergonomics and lifestyle. It is important to mention that all components of the complex therapy were prescribed simultaneously from the first days of treatment, so that comprehensive treatment made it possible to achieve a short and long-term effect relatively quickly (6 month follow-up), while the earlier treatment without an integrative approach did not have a lasting clinical effect. The issues of optimizing of treatment of patients with chronic musculoskeletal pain are discussed.

The article describes the case of 36-year-old Tatyana, whose clinical case was characterized by an episode of transient amnesia lasting less than a day, without other signs of mental and neurological disorders. The patient was admitted to a psychiatric hospital where she was disorientated in place, time and partly in her own personality. There was an acute onset and an abrupt end to the amnestic syndrome, which was not due to mental trauma. Particular attention is paid to the distinction between amnesic syndrome and depersonalization in the context of the phenomenon of “autobiographical amnesia”. According to the diagnostic criteria, the case in question did not meet the parameters of either transient global amnesia or dissociative amnesia. The article provides an overview of modern literature and an analysis of clinical case. It is pointed out that routine psychopathological examination excludes transient global amnesia from differential diagnosis, which may affect the accuracy of the diagnosis.

The basis of positional vertigo is usually benign paroxysmal positional vertigo (BPPV) associated with damage to the semicircular canals of the vestibular analyzer. The diagnosis of BPPV is based on positional tests that help to determine the affected canal. Central positional vertigo is characterized by nystagmus which, unlike nystagmus in BPPV, does not subside in most cases, has no rotational component and no latency period. Two clinical observations of patients with central positional vertigo caused by a brain tumor and ischemic stroke are presented. The differential diagnosis of BPPV and central positional vertigo and the treatment of acute vestibular vertigo are discussed. The data on the efficacy and safety of the use of a fixed combination of dimenhydrinate and cinnarizine (Arlevert) for the treatment of acute vestibular vertigo are analyzed.

The treatment of chronic non-specific neck pain (NP) is often ineffective due to the lack of a comprehensive approach. We present a case of a 32-year-old patient complaining of NP, mainly on the left side, and pain in the left shoulder with an intensity of up to 6 points on a numerical rating scale (NRS). He had this complains for 4 months, and was repeatedly consulted by neurologists and therapists, magnetic resonance imaging of the neck and other examinations had been performed, diagnosis of osteochondrosis and protrusion of the C_IV–VII discs was proposed, nonsteroidal anti-inflammatory drugs, muscle relaxants and vitamins of group B were prescribed with insufficient efficacy. During previous treatment, no attention was paid to the insufficient episodic physical activity against the background of a sedentary lifestyle and long static postures. We used an integrated approach that included kinesiotherapy and optimal drug therapy with dexketoprofen (Dexalgin). Kinesiotherapy included therapeutic exercises, postural training, ergonomic and lifestyle recommendations and kinesio taping. As a result of the treatment, educational talks (about the cause of pain, chronic factors, treatment methods, prognosis), an individually selected exercise complex and therapy with dexketoprofen (Dexalgin) there was a relatively quick (during a week) reduction of the pain to 2 points according to the NRS. Subsequently, the pain had completely subsided (observation period 3 months), the patient began to follow the rules of ergonomics, performed regular medical exercises and resumed sports. Issues related to the treatment of chronic non-specific NP are discussed.

Drug-induced movement disorders (DIMD) are a significant problem in clinical practice, especially in the context of the use of psychotropic drugs. These disorders can significantly worsen the quality of life of patients and lead to additional difficulties in the treatment of the underlying disease. In recent years, there has been a growing interest in this topic, which is associated with an increase in the number of antidepressants and antipsychotics prescribed and an increasing awareness of possible side effects. Fluvoxamine is one of the most common selective serotonin reuptake inhibitor, and its use is associated with the risk of developing adverse phenomena such as dystonia and tremor. This emphasizes the need for careful monitoring of the patient's condition and assessment of the risk/benefit ratio. The relevance of the problem is also reinforced by the fact that DIMD can manifest differently in different patients, requiring an individualized approach in each case. In this regard, it is important to continue research in this area in order to better understand the mechanisms of occurrence and methods of treatment of DIMD. We describe a clinical case of the development of dose-dependent DIMD in a patient with an obsessive-compulsive disorder who took Fluvoxamin at a dose of 225 mg/day. As a treatment of acute motor disorders caused by Fluvoxamin, the use of amantadine sulfate (PK-Merz) is being considered, which has a complex effect on neurotransmitter systems and has been shown to be effective in stopping this undesirable phenomenon. It should be noted that Fluvoxamin may have a beneficial effect in tardive dyskinesia and chorea, but the mechanisms of this effect are still poorly understood.

In most cases, pain in the lumbar spine is caused by damage to the intervertebral discs (IVD), facet joints and/or sacroiliac joints and in these cases is regarded as non-specific lumbar pain (NLP). The pathogenetic basis of axial discogenic pain (DP) is inflammation and ingrowth of nerve fibers into the structure of IVD. DP is confirmed by the positive effect of epidural administration of local anesthetics and glucocorticoids. One of the little-known DP variants is the rupture of a fibrous ring (RFR), which is detected by magnetic resonance imaging in the T2 weighted mode as a zone with high signal intensity in the posterior segments of a fibrous ring. The recommended first-line treatment for NLP is patient's education, tips for maintaining activity, physiotherapy exercises and manual therapy. For the drug therapy nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers are used. We describe two clinical observations of patients with NLP with RFR. Educational program, Aertal as NSAID and Mydocalm Long as muscle relaxer were effective in terms of therapy. The issues of optimization of treatment of patients with NLP are discussed.

Brain-computer interface (BCI) technology is a promising development for restoring motor functions of the upper limb (UL). The article presents the data of randomized clinical trials from 2016 to 2024 years on the use of BCIs in post-stroke dysfunction of UL, depending on the severity of paresis, the time of starting and length of rehabilitation period, the training mode and the evaluated indicator. BCI stimulates neuroplasticity, which is confirmed by functional magnetic resonance imaging data. The efficacy of BCI in restoring UL function after stroke is shown according to the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT) in patients with moderate and severe paresis. Data on the duration of motor, cognitive and emotional improvement and the impact on functional independence are only available in a limited number of studies and require further investigation.

Strategies against migraine attacks include the use of pharmacological agents that are both non-specific and specific for migraine. Despite the wide arsenal of pharmacological agents, effective pain relief is achieved in only one third of migraine patients. When choosing the optimal analgesics for each patient, several key characteristics of the drug should be considered: not only its analgesic effect, but also its ability to rapidly terminate concomitant symptoms without the need for additional analgesics. One of the justified strategies is the combination of specific and nonspecific agents or the use of ready-made combination preparations that allow a multimodal effect in migraine.

The treatment of patients with cognitive impairment (CI) remains an urgent problem of modern neurology and psychiatrydue to the widespread prevalence of CI and the predicted increase in the number of patients in the future. Among the most common reasons for the development of cognitive deficits in young patients are depressive disorders, and in the elderly – vascular disease of the brain, Alzheimer's disease and their combination. We discuss pathophysiological features of CI in depression, and possible therapeutic options that allow to choose personalized therapy and improve the quality of life of patients.