When examining a patient with lumbosacral pain (lower back pain), it is necessary to rule out any specific underlying causes. The diagnosis of discogenic lumbosacral radiculopathy (DLR) is based on clinical examination; magnetic resonance imaging (MRI) is useful for ruling out other causes of radiculopathy and assessing the characteristics of a herniated intervertebral disc. There is insufficient justification for early MRI (within the first 4 weeks) unless there are signs of cauda equina syndrome, or epidural glucocorticoid injection or urgent surgical treatment is planned. It is recommended that patients with DLR be informed about the possibility of disc herniation regression and recovery, and the advisability of maintaining physical activity. Non-steroidal anti-inflammatory drugs may be used to relieve pain; if these are ineffective, epidural administration of local anaesthetics and glucocorticoids under X-ray or ultrasound guidance may be considered. During the acute phase, it is advisable to perform therapeutic exercises under specialist supervision and to attend educational sessions on movement ergonomics. For subacute and chronic DLR, therapeutic exercises, manual therapy and psychological therapy are recommended. Consultation with a neurosurgeon regarding a possible microdiscectomy is indicated as a matter of urgency in the presence of cauda equina syndrome, as well as if there is no response to conservative treatment within 4–8 weeks. For preventive purposes, the patient is advised to undertake therapeutic exercises and an educational programme on avoiding excessive physical and static loads.

Obstructive sleep apnea syndrome (OSA) is a risk factor for cardiovascular disease, obesity and other conditions. Recent evidence has emerged regarding the impact of OSA on cognitive function and the severity of cognitive impairment, including in Alzheimer’s disease (AD).

Objective: to assess the prevalence of OSA in patients with asthma and its impact on the severity of cognitive impairment.

Material and methods. A study was conducted involving 47 participants: 25 patients with the amnestic variant of AD (8 men and 17 women; mean age – 71.0 [65.0; 74.0] years) and 22 cognitively intact volunteers (6 men and 16 women; mean age – 60.0 [57.25; 62.5] years). All participants underwent a review of their complaints and anamnesis, neuropsychological testing using the Montreal Cognitive Assessment (MoCA) and the Addenbrooke’s Cognitive Examination-III (ACE-III), a subjective sleep assessment, and polysomnography.

Results. In patients with AD, OSA and excessive daytime sleepiness are significantly more common than in the control group (p=0.027). A statistically significant reduction in total scores on the MoCA and ACE-III scales was observed in the presence of OSA, with a more pronounced reduction in severe cases. A higher apnea-hypopnea index (AHI) is frequently observed in individuals with excessive daytime sleepiness (p=0.033) and in the group of patients complaining of various manifestations of sleep disturbance (p=0.020), in particular early awakening (p=0.013). With an AHI of 15 episodes per hour, excessive daytime sleepiness was more frequently detected and a lower cognitive status was noted based on the total scores of the MoCA and ACE-III scales. Correlation analysis revealed that an increase in AHI is associated with a deterioration in cognitive status, a reduction in total sleep time and sleep efficiency, the duration of stage 3 sleep (deep sleep), and an increase in sleep latency, wake time after sleep onset, the duration of stages 1 and 2 sleep (light sleep), the number and index of microarousals, and the desaturation index.

Conclusion. OSA was diagnosed in 76% of patients with AD, whereas in the control group it was found in only 36.3% of individuals. As the severity of OSA increases, a deterioration in cognitive function is observed.

One of the challenges encountered during the diagnostic assessment of patients with chronic disorders of consciousness (DOC) is determining the prognosis for a return to higher levels of consciousness. This situation has prompted new research aimed at identifying additional predictors of the outcome of DOC. This article describes cases in which patients in this group exhibited new behavioural signs (NBS), such as facial reaction to stimulation, subtle motor reactions, and crossing of the legs. The signs under consideration are not currently included in the diagnostic criteria of scales designed to assess the level of consciousness.

Objective: to determine the incidence of NBS in patients with DOC and its significance for the prognosis of recovery of consciousness.

Material and methods. The study included 44 patients with DOC (of traumatic and non-traumatic origin) who were admitted to the Intensive Care Unit (ICU) of the Brain Institute Clinic rehabilitation center between 2023 and 2025. The time elapsed since brain injury at the time of admission was 123.02±24.82 days. The Coma Recovery Scale – Revised (CRS-R) was used to assess the level of impaired consciousness.

Results. Analysis of the CRS-R scale data obtained from the study groups indicates that an improvement in the level of consciousness was observed in both groups. In the group of patients without NBS, the mean score on admission was 8.36±3.46; on discharge, it was 9.04±3.55. In the group of patients with NBS, the mean score on admission was 8.00±2.73, and at the end of hospitalisation – 11.06±3.54. The most common symptom was ‘Subtle motor reactions’ – 15 cases out of 22. In 10 patients, the second group of manifestations was recorded – ‘Facial reaction to stimulation’. The smallest group consisted of the sign ‘Crossing of the legs’ – recorded in two cases (only in combination with other signs). There were noticeable transitions to higher levels of consciousness in patients with recorded NBS – a state of minimal consciousness ‘plus’, as well as the subsequent return to clear consciousness in patients (the number of cases was three times higher than the number of similar recorded cases in the control group).

Conclusion. The high reproducibility of ‘new’ behavioural response patterns in patients with initially different levels of consciousness (unresponsive wakefulness syndrome, ‘minus’ minimal consciousness, and ‘plus’ minimal consciousness) suggests that these patterns may be considered as predictors of a positive recovery outcome.

Mesial temporal lobe epilepsy (MTLE) is characterised by a high rate of drug resistance; however, it remains difficult to predict an individual’s response to treatment at an early stage. There is a need to optimise approaches to identifying predictors of treatment efficacy not only for MTLE but also for focal epilepsies of other localisation (FEOL).

Objective: to identify clinical, anamnestic and neuroimaging predictors of response to drug therapy in patients with MTLE and FEOL, and to identify factors that do not have independent prognostic value.

Material and methods. A retrospective analysis of a database of patients with focal epilepsy was conducted. Binary logistic regression was used to develop a prognostic model.

Results. In the MTLE group (n=297), remission was achieved in 29% of patients, which is significantly lower than in the FEOL group (n=340) – 38.5% (p<0.05). No significant differences were found in the outcomes ‘improvement’ (31.3% vs 28.8%) and ‘no positive effect’ (39.7% vs 32.7%) (p>0.05). According to binary logistic regression (n=540; 36.1% – no positive effect, 63.9% – positive effect), after stepwise exclusion of non-informative predictors, three independent factors remained in the final model. Rare attacks increased the odds of a positive clinical effect (remission or a reduction in attack frequency by more than 50%): the odds ratio (OR) for the categories ‘several times a month’ – 2.51 (p=0.001), ‘several times a year’ – 3.99 (p<0.001), and ‘less than once a year’ – 6.01 (p<0.001). The presence of a brain tumour (OR 0.385; p=0.068) and the presence of epileptic seizures (focal non-motor with impaired consciousness; OR 0.668; p=0.040) reduced the odds. Nagelkerke’s pseudo-R2 was 0.091. The model demonstrated moderate discriminatory power (AUC 0.649; 95% CI 0.600–0.697; p<0.001), high sensitivity (90.7%) and low specificity (24.6%). The eighteen factors analysed, including all electroencephalography and magnetic resonance imaging parameters, gender, age at onset, aura, febrile seizures, and cognitive and affective impairments, did not demonstrate independent prognostic significance.

Conclusion. A low seizure frequency is a protective predictor of a positive response to drug therapy in patients with MTLE and FEOL, whereas the presence of a brain tumour and dialeptic seizures reduces the likelihood of achieving seizure control.

The main manifestations of amyotrophic lateral sclerosis (ALS) are traditionally associated with progressive motor impairments; however, nonmotor symptoms – in particular, sleep disturbances and daytime sleepiness – play a significant role in the clinical picture of the disease.

Objective: to analyse the prevalence and clinical characteristics of sleep disturbances and daytime sleepiness in patients with ALS.

Material and methods. A total of 53 patients with a confirmed diagnosis of ALS were examined; 64% were men, with a median age of 62 [54; 70.5] years. The quality of night-time sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness using the Epworth Sleepiness Scale (ESS). Disease characteristics were recorded, as well as the severity of symptoms of autonomic dysfunction and urodynamic disorders, psycho-emotional disorders, pain syndromes and hypersalivation.

Results. Impaired night-time sleep quality was observed in 31 patients (58.5%), and excessive daytime sleepiness in 23 (41.1%). The most common causes of night-time awakenings were nocturia (79.2%), thermal discomfort (41.5%) and unpleasant dreams (41.5%). Independent predictors of reduced sleep quality in ALS were the severity of urinary disorders as measured by the UDI-6 (β=0.326; p=0.011) and symptoms of autonomic dysfunction (β=0.275; p=0.036). An independent predictor of daytime sleepiness was the severity of functional deficit as measured by the ALSFRS-R (β=-0.357; p=0.009).

Conslusion. In patients with ALS, sleep disturbances and daytime sleepiness are common and are associated with functional deficits, as well as urodynamic, autonomic and affective disorders. The findings suggest that these conditions should be actively identified as part of a comprehensive clinical assessment of patients with ALS.

Despite the development of diagnostic criteria for spinal cord cavities – syringomyelia and hydromyelia – there remains a degree of uncertainty in this area and a certain ‘grey area’ of intermediate cases. Among these is the enlargement of the central canal of the spinal cord, a condition with insufficiently defined clinical significance, which complicates the prediction of the course of the disease and the choice of management strategies for patients.

Objective: to identify the range of clinical and radiological presentations of central canal cavities of the spinal cord and the characteristics of their progression, and to develop prognostic criteria.

Material and methods. The study included 104 patients with central canal cavities measuring ≤4 mm in diameter, as determined by magnetic resonance imaging (MRI). Depending on the presence of occlusion factors at the craniovertebral junction (CVJ), two groups were formed: without occlusion (n=73) and with cerebellar tonsillar ectopia (n=31). A two-stage clinical-neurological and MRI-based morphometric examination was conducted. The duration of follow-up ranged from 2 to 10 years.

Results. In both groups, the cavities exhibited similar characteristics: a central location, a symmetrical shape, a diameter of ≤4 mm, and stability over time. The clinical picture in both groups was dominated by non-specific pain phenomena and non-progressive scoliotic deformity, requiring interpretation in terms of the myelopathic manifestations of cavitation. At the same time, a significant proportion of the cavities were detected incidentally during MRI scans performed for other indications, and the search for correlations between clinical and MRI characteristics did not reveal any significant associations. In patients without CVJ occlusion factors, the cavities were predominantly located in the thoracic region (65.5%), were characterised by greater length (median 59.9 [33.4; 111] mm) and, in a number of cases, demonstrated a statistically significant reduction in cavity length (17.4%; p=0.005). In patients with ectopic cerebellar tonsils, the cavities were more frequently located in the cervical segment (71%; p=0.008), had a shorter length (median 38.55 [17.0; 68.5] mm; p=0.009) and did not show significant regression.

Conclusion. Distinguishing between central-channel cavities based on the presence or absence of changes at the CVJ level is of fundamental importance for prognosis: the hydromyelia variant is characterised by a favourable course, whereas the syringohydromyelia variant has an uncertain prognosis and requires close, ongoing monitoring.

The high prevalence and tendency to relapse associated with depressive disorders highlight the need to investigate the long-term outcomes of a first depressive episode.

Objective: to determine the prevalence and identify the factors associated with the development of recurrent depressive disorder (RDD) and bipolar affective disorder (BAD) following inpatient treatment for a first depressive episode.

Material and methods. A retrospective cohort study was conducted involving 237 patients hospitalised with a first depressive episode between 2013 and 2017. The follow-up period was up to 12 years.

Results. RDD developed in 20.3% of patients, and BAD in 12.2%. Factors associated with the development of RDD included older age (median 51 years; p=0.034), chronic psychological trauma (p=0.016), episode duration of more than 60 days prior to hospitalisation (p<0.001) and a family history of mental illness (p<0.001). Factors associated with the development of BAD were younger age (median – 35 years; p=0.043), male gender (p<0.001), a disharmonic premorbid personality (p<0.001), a history of mood swings (p=0.002), alcohol abuse (p<0.001) and a family history of mental illness (p<0.001). An early (within 6 months) exacerbation was associated with a short first hospital stay (median – 15 days; p<0.001) and irregular adherence to maintenance therapy (p<0.001).

Conclusion. One in three patients develops chronic affective disorder following their first depressive episode. The identified prognostic markers make it possible to identify high-risk groups for RDD and BAD as early as the first hospitalisation, thereby enabling the personalisation of treatment strategies.

Objective: to evaluate the efficacy and tolerability of perampanel suspension (Fycompa®) in real-world clinical practice among children and adolescents with epilepsy in a cohort of Russian patients.

Material and methods. A retrospective multicenter analysis was conducted of depersonalized data from 80 patients from 27 centres (40 boys, 40 girls) aged between 4–18 years (mean age 8.2 years) with various forms of epilepsy who received perampanel suspension (PER) as adjunctive therapy. Inclusion criteria were a verified diagnosis of epilepsy consistent with the drug's approved indications, and the availability of data on seizure frequency prior to treatment and after 1–3 months of therapy. To assess efficacy after 3–6 months, data were used from patients who continued treatment and had corresponding records. Statistical analysis was performed using descriptive statistical methods. The primary outcome measures were changes in seizure frequency after 1–3 and 3–6 months of therapy, the proportion of responders, the rate of remission, and adverse events (AEs).

Results. After 1–3 months of treatment, the highest efficacy was observed in isolated bilateral tonic-clonic seizures (BTCS; remission – 78.5%, overall response rate – 89.2%) and generalised tonic-clonic seizures (GTCS; remission – 71.4%, overall response rate – 100%). For focal seizures (FS) without progression to BTCS, remission was 38%, and the overall response rate was 71%. In FS progressing to BTCS, remission was recorded in 37.5% of patients, with an overall response rate of 62.5%. In patients with a combination of these seizure types and other types of seizures, a reduction in the frequency of concomitant seizures was also observed. At the 3–6-month stage, an additional response (remission or a ≥50% reduction in seizure frequency) was observed in only a small proportion of patients (for example, additional remission in FS without BTCS was observed in 10.3% of patients). The drug demonstrated reasonably good tolerability: AEs were reported in 16.3% of patients after 1–3 months, and the need for discontinuation was 2.5%.

Conclusion. The PER suspension is well tolerated and effective in children aged 4 years and older with FS, with or without progression to BTCS, and in children aged 7 years and older with GTCS, including patients weighing less than 30 kg. The liquid formulation allows for precise dose titration and is convenient to administer, particularly in patients with dysphagia.

Globally, acute ischemic stroke is a major cause of morbidity and mortality that has a substantial effect on quality of life and public health systems. An increasing amount of data points to the role of circadian rhythms – the endogenous, roughly 24-hour cycles that govern a number of physiological and behavioral processes in humans – in the incidence and severity of acute ischemic stroke.

Objective: to study the relationship between circadian patterns and ischemic stroke onset regarding theischemicstroke subtypes.

Material and methods. This was a cross sectional study included 192 patients diagnosed with ischemic stroke.The data collected were age, gender, past medical history, family history, social history, medication history, symptom onset time, imaging findings, and chronic illness.

Results. The mean age of patients was 64.8±12.5 years. Large-artery atherosclerosis and cardioembolisim were the most common ischemic stroke subtype, accounted for 46.9% and 29.7% respectively, while 23.4% were small vessel occlusion (lacunar). Furthermore, anterior circulation was the most common site of stroke (77%). The most common time of stroke was at morning between 7:00–11:59 AM (36.98%) followed by 1:00–6:00 AM. There is significant association between type and time of stroke where most of large-artery atherosclerosis strokes (72.2%) and cardioembolism strokes (57.9%) were between 12:00–11:59 AM while the small vessel occlusion strokes (lacunar) were mostly between 12:00–11:59 PM.

Conclusion. The observed circadian pattern of ischemic stroke, which shows a peak occurrence in the morning between 7:00–11:59 AM, has been supported by this study. Small vessel occlusion strokes (lacunar) had a less clear pattern than Large-artery atherosclerosis and cardioembolisim type, which showed strong morning predominance. There were no discernible correlations between the time of a stroke and vascular or sociodemographic risk variables.

Chronic pain remains one of the most challenging issues in the management of patients with type 1 neurofibromatosis (NF1), significantly reducing their quality of life. The aetiology of pain in NF1 is multifactorial and not fully understood, which complicates the selection of effective treatment. Current treatment methods – pharmacotherapy, surgical removal of tumours and neuromodulation – do not always provide a lasting analgesic effect and are associated with a risk of complications or recurrence of pain. The clinical case presented demonstrates the successful treatment of severe, drug-resistant pain syndrome in a patient with NF1 using botulinum toxin type A (incobotulinumtoxin). The use of botulinum toxin type A under ultrasound guidance resulted in a significant reduction in pain intensity, a decrease in the frequency of pain episodes, and an improvement in the patient’s quality of life, with no adverse events. Thus, we report for the first time the use of incobotulinumtoxin in NF1 with a positive clinical outcome.

Acute vestibular vertigo (AVV) is one of the most common reasons why patients seek medical advice from doctors of various specialities. Concomitant neck pain (cervicalgia) often leads to a misdiagnosis of 'cervical vertigo' in patients with benign paroxysmal positional vertigo (BPPV). This article presents a clinical case of a 41-year-old patient with concurrent BPPV and cervicalgia. Due to the initial misdiagnosis of 'cervical vertigo', the patient remained unable to work for 6 months. The timely identification of myofascial syndrome and BPPV enabled effective pathogenetic treatment and ensured the patient's rapid return to work. The effectiveness of a fixed combination of dimenhydrinate and cinnarizine (the drug Arlevert) in various aetiological factors of AVV is discussed. This combination has a minimal sedative effect compared with other vestibulolytics and contributes to the rapid relief of the intensity of vertigo and autonomic symptoms.

This article reviews current approaches to the diagnosis and treatment of vascular cognitive impairment (VCI). It outlines the key provisions of the updated diagnostic criteria for vascular cognitive impairment from the international VasCog-2-WSO society (2025) and the STRIVE-2 neuroradiological classification of cerebral small vessel disease (2023). A clinical case report is presented of a 63-yearold female patient with mild VCI against a background of arterial hypertension, type 2 diabetes mellitus and obesity, in whom brain MRI revealed multiple lacunar infarcts and leukoaraiosis. The prescription of ethylmethylhydroxypyridine succinate in a new prolonged-release form (Armadin Long) is justified. The drug’s multimodal mechanism of action (antioxidant, antihypoxic, neuroprotective) corresponds to the key pathogenetic mechanisms of VCI, which justifies the choice of this drug for long-term treatment of cognitive disorders.

Neuromyelitis optica spectrum disorder (NMOSD) with antibodies to aquaporin-4 (AQP4-IgG) is a severe autoimmune disorder of the central nervous system. Of particular clinical interest is the association of NMOSD with systemic rheumatic diseases, primarily systemic lupus erythematosus and Sjögren's syndrome. Data accumulated to date indicate that this association is not coincidental: NMOSD is detected significantly more frequently in patients with Sjögren's syndrome than in the general population, particularly in the presence of neurological symptoms. The pathogenetic basis of this overlap syndrome lies in the commonality of key immune mechanisms – the central role of interleukin-6 (IL-6), dysregulation of the B-cell pathway, permeability of the blood-brain barrier, and the phenomenon of molecular mimicry. The advent of targeted therapies has fundamentally changed treatment options: data from the SAkuraStar and SAkuraSky trials have confirmed the high efficacy of IL-6 blockade with satralizumab in preventing NMOSD relapses, with sustained results over many years. Optimal management of patients with overlap syndrome requires close collaboration between a neurologist and a rheumatologist to select a treatment capable of controlling both conditions and preventing irreversible neurological deficits.

Stroke remains the second leading cause of death worldwide, and post-stroke cognitive impairment (PSCI) is a common complication that ranges from mild impairments to dementia, negatively affecting memory, attention and learning, reducing quality of life and placing a greater burden on family carers. Factors associated with a poor prognosis include severe or recurrent stroke, advanced age, multifocal brain lesions and pre-existing cognitive impairment; pathologically, PSCI is associated with direct structural damage, disrupted neural connections and neurodegenerative changes (neuroinflammation, oxidative stress), making appropriate management of such patients particularly important. PSCI requires a comprehensive approach: secondary prevention, correction of vascular risk factors, and discontinuation of drugs with anticholinergic effects. There are no officially approved drugs for the treatment of PSCI: donepezil, which is effective in Alzheimer's disease, is of limited efficacy in PSCI and is associated with frequent adverse reactions, whereas memantine – a non-competitive NMDA receptor antagonist – reduces neuronal damage, improves cognitive function in ischaemia, slows functional decline and behavioural disturbances (agitation, aggression, irritability), enhances independence in daily living, and causes virtually no side effects. According to a network meta-analysis, memantine demonstrated the most significant effect on the Mini-Mental State Examination scale. The optimal time to start memantine therapy is 3–6 months after a stroke, and its domestic dispersible analogue (Memoritab®) is an effective and safe agent for managing cognitive function, particularly in patients with swallowing difficulties and low adherence to treatment. Memoritab, which is therapeutically equivalent to the original, improves patient adherence to treatment and facilitates their care thanks to its convenient formulation.