In patients with multiple sclerosis (MS), chronic pain syndromes (CPS), which vary in terms of their etiology, clinical symptoms and localization, occur with high frequency even in the early stages of the disease. As a rule, these are pathogenetically linked to the underlying disease and result from focal lesions in the central nervous system and/or the neurological disorders developing in patients. CPS significantly reduce quality of life, impair social adaptation and exacerbate disability in patients with MS. This article provides a brief overview of the pathogenesis, clinical manifestations and diagnostic principles of the CPS most commonly observed in patients with MS (central neuropathic pain, trigeminal neuralgia, Lhermitte's sign, painful tonic spasms, spasticity pain). Particular attention is paid to modern approaches to the treatment of CPS in patients with MS, management strategies tailored to the individual characteristics of the course of CPS and the 'response' to therapy, as well as the presence of comorbid psycho-emotional disorders and associated somatic pathology.

Objective: to investigate the volume of the choroid plexuses (ChP) in individuals with radiologically isolated syndrome (RIS) and its impact on conversion to multiple sclerosis (MS), and to assess the level of neuroinflammation in individuals with RIS.

Material and methods. A prospective observational study was conducted at the Federal Centre for Brain and Neurotechnologies, in which data from two groups of participants were analysed: individuals with RIS (n=32) and healthy volunteers (control group; n=30). The diagnosis of RIS was established in accordance with the 2017 McDonald criteria. All examinations were performed on a single MRI scanner with a magnetic field strength of 1.5 T. MRI morphometry of the cerebellum was performed on T1-weighted images using manual segmentation in the 3D Slicer software. Intracranial volume was determined using the automated web-based volBrain system. Statistical analysis was performed for both the absolute value of the ChP volume and the value normalized to intracranial volume.

Results. No statistically significant differences in age or sex were found between the RIS and control groups (p=0.21 and p=0.20, respectively). No differences in age or sex were observed either among individuals with RIS who subsequently converted and those who did not (p=0.67 and p=0.44, respectively). However, in patients with subsequent conversion, the ChP volume was already higher at baseline. The normalized ChP volume was higher in patients with conversion compared with those without conversion (1.435 [1.188; 1.715] mm3 versus 1.003 [0.918; 1.325] mm3; p=0.015), and the absolute ChP volume was also higher in the conversion group (1,878 [1,724; 2,333] versus 1,368 [1,163; 1,770]; p=0.024). According to the results of logistic regression, the normalized ChP volume was a significant predictor of conversion to MS (odds ratio 18.5; 95% CI 1.67–369.6), and the model’s diagnostic performance was satisfactory (AUC=0.78; 95% CI 0.62–0.94; p=0.016).

Conclusion. An increase in ChP volume, as measured by MRI morphometry, may be regarded as a non-invasive marker of neuroinflammation in the central nervous system and a potential predictor of disease progression, detectable in the early stages of the pathological process using standard MRI sequences.

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) have a complex aetiology resulting from the interaction of genetic predisposition and environmental factors. Analysis of single nucleotide polymorphisms (SNPs) in genes associated with the immune response and neurodegenerative diseases plays a key role in elucidating the mechanisms underlying the development of these conditions, identifying population-level predispositions and discovering new targets for therapeutic intervention.

Objective: to determine the frequency of SNPs in genes involved in immune responses and neurodegenerative processes among patients with MS and NMOSD, using the Yaroslavl Region as a case study.

Material and methods. This cross-sectional, single-centre observational study included 10 patients with NMOSD (AQP4-IgG+), 63 patients with MS and 47 clinically healthy volunteers, who formed the control group. Genotypes for nine SNPs (IL6, IL6ST, CNTF, SOD2, SIRT1, TP53, PER2, MMP9) were determined using the FastPCR method. Statistical analysis of the data included descriptive statistics, as well as the c2 test and calculation of the odds ratio (OR) with a 95% confidence interval.

Results. Significant associations (p<0.05) were identified between carriage of certain alleles/genotypes and the presence of MS and/or NMOSD in the study population. The homozygous G/G genotype of the IL6 C174G polymorphism (rs1800795) was associated with an increased risk of disease (OR=4.00). An association was demonstrated between the minor allele A of the CNTF gene (rs1800169) and NMOSD. Carriage of the alternative allele T of the SOD2 C47T gene (rs4880) was less common in patient groups (OR=0.24). A strong association was identified between the minor allele G of the SIRT1 C(-1411)G gene (rs7069102) and the risk of both diseases (OR=16.45). Heterozygous A/G status of the PER2 A1984G (rs6343159) gene and the homozygous G/G genotype of the MMP9 A249G (rs17576) gene were also significantly more common in MS and NMOSD.

Conclusion. The findings confirm the significant role of polymorphisms in the IL6, SIRT1 and MMP9 genes as potential genetic markers of an increased risk of developing MS and NMOSD in the studied population. The findings regarding the associations between SNPs in the SOD2, CNTF and PER2 genes and these diseases are new for this population and require further investigation in a larger sample, particularly for the NMOSD group.

Equinovarus foot deformity is one of the most common orthopaedic sequelae/patterns in patients with spastic paresis of the lower limb following focal lesions of the brain and spinal cord. The effectiveness of comprehensive rehabilitation for patients with spastic paresis of the lower limb and equinovarus foot, incorporating local administration of botulinum toxin type A (BTA) and surgical intervention on the capsuloligamentous and musculotendinous apparatus, has been little studied.

Objective: to develop and evaluate the effectiveness of rehabilitation programmes for patients with spastic paresis of the lower limb following focal lesions of the brain and spinal cord (ischaemic and haemorrhagic strokes and trauma) and equinovarus foot deformity, incorporating intramuscular administration of BTA and minimally invasive surgical correction of the capsuloligamentous and musculotendinous apparatus.

Material and methods. This prospective study included four patients (one man and three women aged between 20 and 63) with spastic paresis of the lower limb resulting from ischaemic and haemorrhagic stroke (two patients) and spinal cord injury (two patients), and with equinovarus deformity of the foot.

Results. A combined rehabilitation strategy for patients, incorporating intramuscular BTA injections and minimally invasive surgical correction of the capsuloligamentous and musculotendinous apparatus, resulted in a statistically significant increase in dorsiflexion of the foot and walking speed, as well as a reduction in foot pronation and toe flexion, in all patients. In all cases, it was possible to reduce muscle tone and spasticity, improve the foot’s weight-bearing capacity, and enhance the functional outcomes of rehabilitation. Two patients were able to completely discontinue the use of assistive devices and restore a virtually normal gait pattern, which made walking safer, reduced the risk of falls, and improved their quality of life.

Conclusion. The use of minimally invasive surgical correction of the capsuloligamentous and musculotendinous apparatus in patients with spastic paresis of the lower limb following focal lesions of the brain and spinal cord, resulting in equinovarus deformity of the foot, and where previous courses of rehabilitation involving botulinum toxin therapy have proved insufficiently effective, represents an effective and safe innovative strategy. It improves the functional outcomes of rehabilitation.

Objective: clinical characteristics of a cohort of patients with myasthenia gravis (MG) included in the city registry, with an assessment of the demographic, phenotypic and therapeutic characteristics of this sample.

Material and methods. A prospective study was conducted using the regional register of patients with MG, established at the clinic of Rostov State Medical University, drawing on data from the city’s polyclinics for the period 2012–2023. The study included 198 patients residing in Rostov-onDon with a confirmed diagnosis of MG, verified on the basis of clinical, pharmacological, electromyographic and immunological criteria. The prevalence, incidence, age and sex distribution, time to diagnosis, clinical forms and nature of the treatment administered were analyzed.

Results. As at 1 January 2024, 198 patients with MG were registered in Rostov-on-Don. The prevalence was 17.36 per 100,000 population, and the incidence was 1.05 per 100,000. Between 2004 and 2024, the prevalence rose from 1.8 to 17.36 per 100,000. The median age at onset was 47.5 years (36 years for women and 59 years for men). The female-to-male ratio was 2:1. The median time from the onset of the first symptoms to diagnosis was 12 months. The generalized form was identified in 85 percent of patients, and the refractory form in 65.7 percent. Thymoma was diagnosed in 9.3 percent of patients. 66.7 percent of patients receive pathogenetic therapy.

Conclusion. A steady increase in the prevalence and incidence of MG has been observed in the Rostov Region, in line with global trends, along with a high proportion of patients with a refractory course of the disease. The findings highlight the need to improve the specialist care system and to enhance patients’ adherence to treatment.

Objective: to assess gender-related differences in age at onset, clinical characteristics, relapse frequency, and disability level in patients with relapsing remitting multiple sclerosis.

Material and methods. A retrospective cohort study was conducted using medical records of patients diagnosed with multiple sclerosis and treated at the National Hospital of the Ministry of Health of the Kyrgyz Republic between January 2021 and December 2024. A total of 72 patients with RRMS were included. Clinical parameters analyzed included age at disease onset, neurological manifestations, annual relapse rate, disability status assessed using the Expanded Disability Status Scale (EDSS), and selected risk factors. Statistical analysis was performed using descriptive and comparative methods, with statistical significance defined as p<0.05.

Results. The cohort included 16 men (22.2%) and 56 women (77.8%). The mean age at disease onset was higher in men than in women (33.3 vs 28.4 years; p=0.200). Mean EDSS scores were 3.06 in men and 2.87 in women (p=0.610). The annual relapse rate was significantly higher in women compared with men (1.32 vs 0.97; p=0.019). Women more frequently presented with sensory and visual symptoms, whereas men more often exhibited motor and cerebellar manifestations. No statistically significant gender differences were identified for the analyzed risk factors.

Conclusion. Gender-related differences were observed in relapse frequency and clinical presentation among patients with RRMS. Other evaluated parameters did not show statistically significant differences. Larger studies are required to confirm these findings.

Objective: development of a machine learning model to predict the inhibitory activity of natural compounds, predominantly of a polyphenolic nature, against Bruton’s tyrosine kinase (BTK), with the aim of identifying potential candidates for the treatment of multiple sclerosis (MS) with a favourable safety profile.

Material and methods. To construct the model, data from the ChEMBL database on BTK inhibitors (CHEMBL5251) were used, containing values for the concentration required to inhibit 50 per cent of the activity (IC₅₀). The IC₅₀ values were converted to the pIC₅₀ format. Molecular structures were represented as ECFP6 fingerprints using the RDKit library. To model the ‘structure–activity’ relationship, the Bayesian Ridge Regression method from the scikit-learn library was applied. Model quality was assessed using the coefficient of determination (R2), as well as Pearson’s and Spearman’s correlation coefficients between the experimental and predicted pIC₅₀ values. The resulting model was used to screen polyphenolic compounds.

Results. A machine learning model was developed to predict the inhibitory activity of compounds against BTK. The Pearson and Spearman correlation coefficients between the experimental and predicted pIC₅₀ values were 0.8; the coefficient of determination (R2) was 0.6. In a virtual screening of 21 compounds, rutin demonstrated the highest predicted activity among the polyphenols (predicted IC₅₀ – 24 nM). High predicted BTK inhibitory activity was also identified for luteolin, baicalein, epicatechin and quercetin.

Conclusion. Machine learning methods represent a promising tool for identifying new BTK inhibitors amongst natural compounds. The results obtained indicate the potential ability of a number of polyphenols to inhibit BTK and confirm the value of further experimental investigation of these compounds as candidates for the treatment of MS.

Objective: to assess the impact of cyclobenzaprine therapy in real-world clinical practice on the severity of pain, functional capacity and the time taken to return to work in patients with non-specific back and neck pain, as well as to evaluate the drug's safety profile.

Material and methods. The multicentre study included 997 patients (full analysis set, FAS) aged 18 years or older, of whom 976 completed the study according to protocol – per-protocol (PP) population. Patients received Reloprim (cyclobenzaprine) at a dose of 5, 7.5 or 10 mg three times daily for up to 14 days. The primary endpoint was the change in functional limitations as assessed by the Roland–Morris Disability Questionnaire (RMDQ).

Results. The baseline RMDQ score was 12.52±5.57. By day 5, it had decreased significantly to 7.18±4.53, and by the end of the study to 1.89±2.42 (p<0.001). Pain intensity (baseline 6.79±1.46 points) decreased by 2.98±1.3 points by day 5 and by 5.85±1.72 points by the end of the observation period (p<0.001). The number of patients temporarily unable to work was reduced by almost half (from 10.75 to 5.94). The need for additional doses of non-steroidal anti-inflammatory drugs (NSAIDs) was reduced by more than half.

Conclusion. The use of cyclobenzaprine as part of a comprehensive treatment regimen for non-specific back and neck pain in real-world clinical practice is associated with a statistically significant reduction in the severity of pain and functional limitations as early as the first few days of treatment, with the effect continuing to improve by the end of the observation period.

Patients presenting with acute vertigo are often admitted to hospital with a provisional diagnosis of a stroke in the vertebrobasilar system (VBS). The causes of such cases of acute vertigo, as well as the diagnostic value of various otoneurological examination methods (according to the STANDING and HINTS+ algorithms), have been little studied in Russian neurological practice.

Objective: to examine and optimize standard practice in the management of patients with acute vertigo in the emergency neurology department.

Material and methods. A total of 37 patients with acute vertigo, who were admitted to hospital on an emergency basis with a provisional diagnosis of acute cerebrovascular accident were examined. Clinical otoneurological examinations were carried out using the STANDING and HINTS+ algorithms, along with neuroimaging (DWI MRI), and the dynamics of acute vertigo severity were assessed against a background of comprehensive therapy comprising a fixed combination of 20 mg cinnarizine and 40 mg dimenhydrinate.

Results. A stroke was confirmed in 6 (16.2%) patients at the VBS, benign paroxysmal positional vertigo (BPPV) in 19 (51.4%), vestibular neuronitis in 4 (10.8%), vestibular migraine in 5 (13.5%), and Meniere's disease in 3 (8.1%). The factors showing the greatest significance for the diagnosis of VBS stroke were skew deviation, gaze-induced nystagmus and marked cerebellar ataxia (p<0.001), whilst a positive unilateral head-turning impulse test, spontaneous horizontal-rotatory nystagmus, mild and moderate vestibular ataxia, positive positional tests, and unilateral hearing loss were statistically significantly more prevalent in patients with other vestibular disorders (p<0.001). Patients with stroke were significantly older and had higher systolic blood pressure. A significant reduction in the severity of acute vertigo was observed in all patient groups following comprehensive treatment, comprising a fixed-dose combination of 20 mg cinnarizine and 40 mg dimenhydrinate, as assessed at a follow-up examination 7 days later (p<0.001).

Conclusion. A stroke in the vestibular system has been identified as the cause of acute vestibular vertigo in a small proportion of patients. BPPV has been identified as the most common cause (more than half of all cases). The tests used in the STANDING and HINTS algorithms have been shown to have varying levels of diagnostic value.

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, the pathogenesis of which is underpinned by a combination of autoinflammatory and neurodegenerative processes. Divozilimab (DIV) is the first monoclonal antibody from the anti-CD20 therapy group to be developed and authorised in the Russian Federation for the treatment of relapsing-remitting multiple sclerosis (RRMS) and secondary-progressive multiple sclerosis (SPMS) with relapses in patients aged 18 years and over. The relatively recent introduction of DIV into clinical practice means that there is a limited amount of published data from real-world clinical practice.

Objective: to investigate the efficacy and safety of DIV in real-world clinical practice at a single medical centre.

Material and methods. Forty patients with MS (13 with SPMS) living in the Novosibirsk Region received two doses of DIV (data as at 30 May 2026). Patient data were analysed: clinical [gender, age, clinical manifestations at onset and during relapses, score on the Expanded Disability Status Scale (EDSS), use of disease-modifying therapies, comorbidities, infection status], radiological data (new lesions, enlarged lesions, lesions with contrast enhancement) and laboratory data (complete blood count, urinalysis, blood biochemistry). Efficacy parameters were assessed [mean annual relapse rate (MARR), EDSS score, proportion of patients with confirmed disability progression over 6 months (CDP-6), and radiological activity] as well as safety parameters (number of adverse events, including infectious and oncological events).

Results. During DIV therapy, there was a reduction in MARR – from 1.0±0.85 to zero – and in the proportion of patients with radiological activity – from 60% to zero (p<0.05). However, no changes were observed in EDSS scores or in the incidence of CDP-6 (p>0.05). No increase in the number of infectious or oncological events was observed during DIV therapy (p > 0.05).

Conclusion. DIV therapy, administered at the Regional Centre for Multiple Sclerosis and Other Autoimmune Diseases of the Nervous System at Novosibirsk State Regional Clinical Hospital, has confirmed the high efficacy and safety demonstrated in clinical trials.

An acute demyelinating episode (ADE) is the acute onset of clinical symptoms characteristic of multiple sclerosis (MS) or other demyelinating diseases (DD). Patients with ADE may experience either a monophasic course of the disease, relapses, or transformation to MS (up to 33 per cent). To date, there are no criteria for predicting the transformation of ADE to MS in adults; therefore, identifying prognostic factors for the development of MS in such patients is of significant diagnostic importance.

Objective: to identify the clinical and immunological markers of the transformation of ADE into a chronic demyelinating process (MS).

Material and methods. The study was conducted from 2023 to 2026. The main group comprised 29 patients: 22 diagnosed with acute disseminated encephalomyelitis (ADEM) and 7 with acute transverse myelitis (ATM); the control group comprised 29 individuals. All patients were followed up for 24 months. The laboratory component of the study, which involved measuring the levels of interleukin-1b (IL-1b), IL-2, IL-6, tumour necrosis factor-a, glial fibrillary acidic protein and C-reactive protein in the patients’ serum, was carried out in the neuroimmunology laboratory of the Institute of Clinical Neurology at the Federal Center for Brain and Neurotechnologies.

Results. During the follow-up period, 8 out of 29 patients were diagnosed with MS following ADE according to the 2017 McDonald criteria. The overall rate of transformation from ADE to MS was 28 per cent. Patients in whom ADE progressed to MS were more likely to have the following characteristics: no recent infection (p=0.002), sensory disturbances at disease onset (p=0.021), type 2 oligoclonal bands (OCB) pattern (p<0.001) and lesions in the brainstem on magnetic resonance imaging (p=0.024). Serum IL-6 concentrations in patients with ADE transforming to MS were higher than in patients without transformation to MS during the acute phase and at 3–6 months; however, the differences were not statistically significant (p₁=0.366; p₂=0.471). As a result of the multivariate logistic regression analysis, the best combination of predictors for the transformation of ADE to MS included: 1) absence of a pre-existing infection (OR 14.31; 95% CI 1.04–196.3; p=0.046), 2) OCB synthesis type 2 (OR 0.05; 95% CI 0.003–0.832; p=0.037).

Conclusion. The results of this study show that certain clinical characteristics (absence of a preceding infection, specific abnormalities at disease onset), laboratory parameters (type 2 OCB synthesis) and neuroimaging findings (foci of demyelination in the brainstem) may help to distinguish patients with a monophasic course of ADE at the early stage of the disease from those who will go on to develop MS.

The high cost of managing stroke patients is due not only to the care provided during the most acute and acute phases, but also to the subsequent costs associated with rehabilitation and potential disability. Achieving a favourable functional outcome is one of the key factors in reducing the economic burden of stroke on the healthcare system.

Objective: to assess the clinical and economic advisability of incorporating ethylmethylhydroxypyridine succinate (Mexidol) or Cerebrolysin into the treatment of ischaemic stroke (IS) during the acute and early recovery phases, compared with standard treatment.

Material and methods. Randomized, placebo-controlled trials of Mexidol and Cerebrolysin were included in the model. Efficacy measures for the pharmacoeconomic calculations were derived by conditionally pooling the trial results within the adopted model. Pharmacoeconomic methods such as cost-effectiveness analysis (cost-effectiveness analysis, CEA) with the calculation CER=DC/Ef, budget impact analysis (BIA), a single-factor sensitivity analysis (a 15% increase in the price of Mexidol), and the calculation of the incremental cost-effectiveness ratio (ICER). The cost of drug therapy was determined using the register of maximum retail prices for essential and vital medicines, whilst the costs of treatment/rehabilitation and the consequences of disability were based on Russian data on the socio-economic burden of stroke.

Results. The modelling results show that incorporating Mexidol into IS therapy would result in savings of 19.96 per cent of the budget over one year and 27.63 per cent over four years, respectively. According to the cost-effectiveness analysis, the CER for Mexidol was 80,647,447 roubles for a 10-day course and 81,922,447 roubles for a full course. These figures are lower than those for standard therapy (121,608,837 roubles) and lower than those in the one-year model for Cerebrolysin (122,317,082 roubles for the main course and 128,917,082 roubles for the supplementary course).

Conclusion. Under the adopted model, the inclusion of Mexidol in standard IS treatment is associated with a reduction in direct costs and a more favourable cost-effectiveness ratio compared with the addition of Cerebrolysin to standard treatment.

Neuromyelitis optica spectrum disorders (NMOSD) constitute a group of rare, autoimmune and often disabling diseases of the central nervous system. Despite clear diagnostic criteria for NMOSD, diagnostic errors remain a serious problem, leading to delays in necessary treatment and adverse outcomes. This article presents four clinical cases of NMOSD that illustrate the difficulties in making a timely diagnosis due to an ambiguous clinical, radiological and laboratory picture. In these cases, clinical manifestations typical of NMOSD (optic neuritis, acute myelitis and area postrema syndrome) are described; however, the patients were initially referred to specialists in other fields: ophthalmologists, gastroenterologists and neurosurgeons, which led to a delay in their referral to the Multiple Sclerosis Centre and a late diagnosis. The delayed initiation of pathogenetic therapy in two patients led to the development of persistent severe disability as a consequence of NMOSD exacerbations. Factors contributing to the prolonged time to diagnosis were analyzed, and strategies to improve the early diagnosis of NMOSD to prevent such outcomes were proposed.

Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP) is a rare condition associated with the presence of antibodies against an intermediate protein located between the finer microfilaments and the larger microtubules in astrocytes. The condition remains poorly understood, necessitating further research to improve diagnosis and treatment. This article presents a clinical case of encephalomyelitis associated with antibodies to GFAP. In a 40-year-old female patient, the disease presented with the onset of numbness and weakness in the lower limbs, accompanied by pelvic organ dysfunction. The detection of antibodies to GFAP in serum and cerebrospinal fluid, the clinical picture of encephalomyelitis, and an MRI pattern of linear radial perivascular enhancement on T1-weighted images, along with an extensive (extending from TI to TXI) hyperintense lesion on T2-weighted images, led to a diagnosis of autoimmune anti-GFAP astrocytopathy. By the time the diagnosis was confirmed, the patient presented with marked gait disturbance requiring the use of bilateral support, as well as neurogenic bladder dysfunction necessitating intermittent catheterisation. No clinical or radiological progression of the disease was observed during anti-B-cell therapy with rituximab. This case report adds to the existing evidence on the clinical features of anti-GFAP astrocytopathy and demonstrates the importance of timely diagnosis and early initiation of pathogenetic therapy for the disease.

Immune thrombocytopenia (idiopathic thrombocytopenic purpura, ITP) and multiple sclerosis (MS) are two autoimmune diseases (AIDs), and their co-occurrence in a single patient is a rare combination. In recent years, there has been an increase in the prevalence of MS, as well as other AIDs; consequently, comorbid autoimmune conditions in individuals with MS are being observed with increasing frequency and are taking on significant scientific and clinical importance. Managing such patients is particularly challenging, as there is currently no established treatment strategy for patients with MS and concomitant ITP. The scientific literature describes isolated cases of the combination of MS and autoimmune thrombocytopenia, which may indicate shared pathogenetic mechanisms underlying these diseases. This article presents clinical cases illustrating two types of relationship between ITP and MS: primary autoimmune comorbidity of the conditions and secondary druginduced ITP. The widespread use in recent years of disease-modifying drugs (DMDs) and the planned expansion of their spectrum necessitate the stratification of the risks associated with this therapy.

Autoimmune diseases (ADs) are a broad group of phenotypically heterogeneous conditions characterized by both unique and common clinical and immunological manifestations, with varying rates of progression and responses to pathogenetic therapy. More than 10 per cent of the global population suffers from at least one of ADs, and in recent decades there has been a worldwide trend towards an increase in the number of cooccurring autoimmune conditions, particularly in regions and countries with a high level of socio-demographic development. Given their shared risk factors and immunopathological mechanisms, demyelinating diseases of the central nervous system are associated with an increased likelihood of developing a concomitant ADs, which may unpredictably influence the course of the demyelinating process and the choice of optimal treatment. This review examines the co-occurrence of multiple sclerosis and neuromyelitis optica spectrum disorders (NMOSD) with anti-aquaporin-4 antibodies (AQP4) with the most common associated ADs, and summarises the evidence regarding the preferred therapeutic approaches in each specific case.

Myasthenia gravis (MG) is a chronic autoimmune disorder of the neuromuscular junction, the clinical burden of which is not limited to fluctuating muscle weakness. Data on the prevalence of sleep disorders in patients with MG vary considerably, which is due to the heterogeneity of clinical approaches and the limited use of objective methods for assessing sleep. At the same time, a number of studies point to specific patterns of sleep disorders in this patient group. For example, in one study, obstructive sleep apnea was detected in 36% of patients with MG, compared with the expected 15–20% in the general population. Restless legs syndrome was also detected more than twice as frequently: in 43.2% of patients with MG and in 20% of the control group. According to a recent systematic review, the prevalence of excessive daytime sleepiness reached 75% in some studies. The impact of treatment deserves special attention: among patients with generalized myasthenia gravis who had been receiving oral glucocorticoids (GCs) for at least one year, insomnia was observed in 23.1%.

The development of sleep disorders in MG is likely to be multifactorial. Sleep-related breathing disorders may be associated with weakness of the respiratory muscles and an increased risk of nocturnal hypoventilation and episodes of desaturation, particularly during the rapid eye movement (REM) phase. Difficulties in falling asleep and maintaining sleep may arise against a background of fatigue, anxiety and depressive disorders, and treatment, primarily with GCs. The role of immuno-inflammatory mechanisms is of interest but requires further investigation.

The aim of this review is to summarize current evidence on the clinical manifestations, possible mechanisms, diagnosis and management of sleep disorders in myasthenia gravis. Particular attention is paid to insomnia, sleep-related breathing disorders, restless legs syndrome, the impact of treatment and the need for active screening for sleep disorders in clinical practice.

Generalized myasthenia gravis is a chronic autoimmune disorder characterized by an attack on the structures of the neuromuscular junction and by fluctuating muscle weakness and pathological fatigue, involving the ocular, bulbar, respiratory and skeletal muscles. Modern treatment of generalized myasthenia gravis aims to achieve sustained control of the disease, reduce the risk of exacerbations and myasthenic crises, and maintain the patient's quality of life. Some patients continue to experience a significant burden of disease, reduced daily activity, a need for longterm immunosuppressive therapy, and a risk of developing adverse events. A personalized approach to the treatment of generalized myasthenia gravis should take into account serological status, disease activity, the frequency of exacerbations, comorbidities, tolerance to treatment, the possibility of reducing the dose of glucocorticoids, and the patient's preferences.

Anxiety and stress-related disorders are characterized by high prevalence, comorbidity and resistance to existing treatments in a significant proportion of patients. Treatment for anxiety spectrum disorders includes an educational program, psychotherapy and the use of medication. The most effective forms of psychotherapy are cognitive behavioural therapy and various relaxation techniques; in recent years, psychological methods have often been used not only in face-to-face sessions but also online. First-line treatments for anxiety spectrum disorders include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). In some cases, patients with anxiety spectrum disorders do not respond to SSRIs and SNRIs, and many patients discontinue their medication due to adverse effects; therefore, the search for new drugs remains a priority.

This article summarises the findings of the Expert Council meeting (April 2026) dedicated to maritupirdine (Aviandr®), a multi-target antagonist of serotonin, a₂-adrenergic and H₁-histamine receptors. Based on preclinical and clinical data, including studies on generalized anxiety disorder and post-COVID-19 adjustment disorder, the drug's anxiolytic, antidepressant and pro-cognitive effects, favourable safety profile and absence of withdrawal syndrome have been confirmed. A pro-cognitive effect of the drug has been observed, consistent with data on the blockade of 5-HT6 and 5-HT7 receptors.

Experts conclude that the restrictions on the use of maritupirdine in patients with organic brain disorders and epilepsy are not sufficiently justified. Further research into maritupirdine in organic mental disorders, including cognitive impairment and dementia, is required. The use of maritupirdine is appropriate for adjustment disorders of various aetiologies. Maritupirdine's favourable tolerability and safety profile is a significant advantage in the treatment of patients with anxiety disorders and those with stress-related disorders.