Post-COVID syndrome (PCS) refers to a constellation of signs and symptoms that develop during or after a coronavirus infection, persist for more than 12 weeks, and cannot be explained by an alternative diagnosis. Neurological manifestations of PCS may include cognitive impairment (CI), dizziness, headaches, and musculoskeletal pain. However, several neurological conditions can mimic PCS, including neurodegenerative diseases with CI, persistent postural-perceptual dizziness (PPPD), chronic migraine (CM), and chronic non-specific back pain.

This article presents case reports of patients with Alzheimer's disease, PPPD, CM, medication-overuse headache (MOH), and chronic musculoskeletal pain (CMSP), who were misdiagnosed with PCS and did not receive effective treatment for their underlying conditions. Targeted therapy for PPPD, CM, MOH, and CMSP led to regression of symptoms and rapid improvement in the patients' condition.

The persistence of cognitive dysfunction, dizziness, and chronic pain syndromes warrants thorough evaluation to identify alternative diagnoses that may be masked by PCS. Early diagnosis and appropriate treatment of these conditions can significantly improve outcomes for many patients who otherwise receive prolonged and ineffective treatment for PCS.

In recent decades, pathogenetic therapy of multiple sclerosis (MS) has advanced significantly due to the development of disease-modifying therapies (DMTs), which are classified into first- and second-line drugs based on their efficacy and safety profiles. Curcumin is being considered as an add-on therapy due to its potential efficacy and favorable safety profile.

Objective: to evaluate the effect of micellar curcumin on clinical and immunological parameters in MS patients receiving interferon (IFN) therapy, as well as to assess the in vitro effects of this polyphenol on cytokine production by macrophages (MFs) and peripheral blood mononuclear cells (PBMCs).

Material and methods. As a result of randomization, MS patients (n=60) with a suboptimal response to IFNβtherapy were divided into two groups, one of which received additional therapy with micellar curcumin for 6 months (IFN-C group). Clinical (relapses, MRI activity, EDSS score, chronic fatigue according MFIS scale, quality of life according SF-36) and immunological (IL-6 and IFNγ levels) parameters were assessed before and after the study. The effect of curcumin on cytokine production by PBMCs and MFs in MS patients and healthy donors was also evaluated.

Results. After 6 months, the IFN-C group showed a decrease in the proportion of patients with relapses (p=0.007), a reduction in the proportion of patients with new/enlarging lesions on T2 MRI (p=0.003), and stabilization of EDSS score (p=0.2), in contrast to the comparison group, which showed increased disability (p=0.03). Hazard ratio for exacerbation in the curcumin group compared to the control group was 0.2 (95% CI 0.09–0.89; p=0.03). This group also showed improvement in chronic fatigue (p=0.002) and quality of life (p=0.008 for physical and p=0.03 for mental components). No adverse events were reported during the observation period. After dietary enrichment, a lower level of IFNγwas detected in the plasma of patients receiving curcumin (p=0.02). In vitro results demonstrated a slight stimulatory effect of curcumin on IL-10 and an inhibitory effect on IL-6 and IFNγ.

Conclusion. Based on the results of this pilot study, micellar forms of curcumin, that have an acceptable safety profile, may be considered as a potential adjunctive method to enhance the anti-inflammatory effect of IFNβin MS patients with suboptimal therapeutic response.

The prevalence of bilateral interictal epileptiform discharges (EDs) in focal temporal lobe epilepsy (FTLE) reaches up to 60%. Some authors classify unilateral and bilateral interictal discharges of temporal localization as neurophysiological phenotypes of FTLE, while others believe these are two groups of diseases differing in etiology, clinical manifestations, and treatment strategies.

Objective: to compare clinical and anamnestic data and magnetic resonance imaging (MRI) results of the brain in patients with unilateral and bilateral interictal EDs of temporal localization.

Material and methods. The study included 130 patients [78 (60%) men and 52 (40%) women aged 21 to 73 years (mean age – 41.7 years)], who underwent video EEG monitoring sessions lasting 10–24 hours (bilateral interictal EDs were recorded in 64 sessions, and EDs originating from one temporal region in 66 sessions). MRI using the HARNESS-MRI protocol for epilepsy was performed on a 3T scanner.

Results. The duration of FTLE in patients with unilateral EDs was 10.5 [5.0; 19.0] years, and in patients with bilateral EDs – 13.5 [5.0; 24.5] years (p=0.307). The onset of FTLE in the group with bilateral EDs occurred at the age of 27.0 [15.0; 38.0] years (in patients with unilateral EDs – 24.5 [14.0; 40.0] years; p=0.911). Unilateral EDs in the left temporal region predominated in 66.7% of patients, and in the right temporal region – in 33.3%. EDs originating from both temporal regions were characterized by the absence of interhemispheric differences (the left temporal region was dominant in 48.4% of patients, the right – in 51.6%).

Conclusion. The obtained results indicate that dividing patients with FTLE into separate groups with unilateral and bilateral EDs is not justified.

Infertility, as an emotionally significant and psychologically traumatic factor that threatens the fulfillment of a woman's fundamental biological need for motherhood, has a negative impact on mental health. In vitro fertilization (IVF), while providing a method to overcome infertility, also entails a few neuropsychiatric challenges.

Objective: to assess the dynamics of mental health and reproductive function in women with infertility undergoing IVF treatment, based on longterm follow-up.

Material and methods. The study included 190 mentally healthy women with infertility undergoing IVF treatment, observed over a two-year period. During this time, IVF led to 144 pregnancies (75.79%), of which 45 (31.25%) resulted in live births, while the majority (76.32%) remained infertile. Emotional state was assessed using the Hamilton Depression and Anxiety Rating Scales, before and after the IVF procedure.

Results. Preexisting depression and anxiety were significant risk factors for unsuccessful IVF outcomes. Initially mild depression (63.6%) and anxiety (65.6%) were more common in women whose IVF procedures failed (p≤0.01), with these rates increasing post-failure to 69.7% and 70.7% respectively (p≤0.01). Among women with successful IVF, preexisting depression and anxiety were present in 26.7% and 33.3% respectively. Successful childbirth led to stabilization of emotional state and depression persisted in 6.7% of women and anxiety in 13.3% (p≤0.01). A successful IVF outcome was also associated with increased marital satisfaction and improved spousal relationships (p≤0.01).

Conclusion. Infertility, the burdensome diagnostic procedures and surgeries associated with it, and the psychological strain of IVF-especially after unsuccessful attempts-contribute to the development of depressive and anxiety disorders. These, in turn, negatively affect the chances of conception and pregnancy maintenance, even with assisted reproductive technologies. These psychosomatic interactions must be considered in the diagnosis of infertility and in selecting appropriate treatment strategies.

Most patients with Parkinson’s disease (PD) experience autonomic cardiovascular dysfunction (insufficiency), which, together with other nonmotor manifestations, negatively affects quality of life and disease progression.

Objective: to assess the relationship between autonomic cardiovascular dysfunction and other non-motor symptoms of PD.

Material and methods. A total of 252 patients with PD Hoehn and Yahr stages I–III were examined. The evaluation included: a questionnaire aimed at identifying symptoms of orthostatic intolerance (OI), orthostatic test, evaluation using the Unified Parkinson’s Disease Rating Scale (UPDRS I–IV), the Schwab and England Activities of Daily Living Scale (Sch&En), the Mini-Mental State Examination (MMSE), the Non-Motor Symptoms Questionnaire (NMSQ), the Beck Depression Inventory, the Spielberger State-Trait Anxiety Inventory, the Glasgow Dyspepsia Severity Score (GDSS), the Gastrointestinal Symptom Rating Scale (GSRS), the Bristol Stool Form Scale (BSFS), and the International Prostate Symptom Score (IPSS). A subset of patients (n=31) underwent heart rate variability (HRV) assessment.

Results. Among patients with OI symptoms (35.3% of all participants) we found the worst non-motor outcomes UPDRS I (p<0.0001), cognitive and affective disturbances, sleep disorders, worse NMSQ scores (p=0.038), MMSE scores (p=0.007), IPSS scores (p=0.006), GDSS scores (p<0.0001), GSRS scores (p=0.004), and greater tendency toward constipation according BSFS (p=0.001; Mann–Whitney U test for independent samples). Significant negative correlations in HRV indices (TP, LF, HF, SDNN, RMSSD) were associated with the same non-motor components of UPDRS, depression and anxiety scales, GSRS, and IPSS.

Conclusion. The data indicate that one-third of stages I–III PD patients exhibit clinical signs of autonomic dysregulation affecting the cardiovascular system, gastrointestinal tract, and bladder. These are closely associated with other non-motor symptoms of PD, forming a unified neurodegenerative process involving both central and peripheral components of the nervous system. We propose that OI symptoms may serve as clinical markers of emerging widespread autonomic failure.

Intravenous thrombolytic therapy (IV TLT) is the main method of reperfusion therapy for ischemic stroke (IS). Almost half of IS patients present with a mild neurological deficit at onset, for which the efficacy of IV TLT remains controversial.

Objective: to assess the efficacy and safety of IV TLT in patients with IS and mild neurological deficit depending on the degree of stenosis of the main arteries of the head (MAH), regardless of the level of disability.

Material and methods. A total of 166 patients with IS and mild neurological deficit (less than 5 points on the NIHSS stroke severity scale) were observed: 82 patients received IV TLT, and 84 patients formed the comparison group.

Results. At hospital discharge, IS patients who received IV TLT showed a lower severity of neurological deficit on the NIHSS scale (U(82,84)=1882; p<0.001) and a better functional outcome according to the modified Rankin Scale (U(82,84)=1854; p<0.001) and the Rivermead Mobility Index (U(82,84)=1795; p<0.001). In the subgroup of patients with significant MAH stenosis, statistically significant advantages of IV TLT were also found according the NIHSS, Rankin Scale, and Rivermead Index. Hemorrhagic transformations occurred in the IV TLT group in 14 patients, and in the comparison group in 6 patients (only a trend toward increased frequency).

Conclusion. IV TLT in patients with IS and mild neurological deficit improves functional outcomes in the acute period of stroke. IV TLT is also effective in the subgroup of patients with significant MAH stenosis.

Endovascular thrombectomy (EVT) is a highly effective method of restoring blood flow in patients with large cerebral artery occlusion. However, it is not uncommon for neurological deficits to persist or even worsen despite successful recanalization.

Objective: to identify factors associated with good and satisfactory functional recovery (mRS 0–3) following successful EVT (defined as achieving TICI 2b/3 reperfusion).

Material and methods. This retrospective analysis included 90 patients with ischemic stroke in the carotid territory who underwent EVT with achieved TICI 2b/3 reperfusion. The prognostic value of clinical, neuroradiological, and periprocedural factors was assessed.

Results. Univariate logistic regression analysis identified several predictors of good or satisfactory outcome after EVT: the degree of neurological disturbances (National Institutes of Health Stroke Scale, NIHSS score) on admission (OR 0.87; 95% CI 0.79–1.02; p=0.005), NIHSS at 24 hours post-EVT (OR 0.70; 95% CI 0.60–0.81; p<0.0005), presence of T-occlusion of the internal carotid artery (OR 0.25; 95% CI 0.06–0.97; p=0.045), hemorrhagic transformation (OR 0.10; 95% CI 0.03–0.34; p<0.0005), the early CT ischemic signs volume (OR 0.97; 95% CI 0.94–0.99; p<0.001), volume with rCBF <30% (OR 0.91; 95% CI 0.87–0.96; p<0.0005), infarct core volume by day 3 (OR 0.95; 95% CI 0.92–0.97; p<0.0005), systemic thrombolysis (OR 5.79; 95% CI 1.24–26.96; p<0.0005), ASPECTS score (OR 2.43; 95% CI 1.67–3.53; p<0.0005), eASPECTS score (OR 1.53; 95% CI 1.18–2.0; p=0.002), T_max/rCBF mismatch (OR 1.09; 95% CI 1.03–1.16; p=0.002). In multivariate logistic regression, three independent predictors of good or satisfactory functional outcome were identified: ASPECTS score, number of thrombectomy passes, and hemorrhagic transformation (model sensitivity – 95.7%, specificity – 70.0%).

Conclusion: The clinical outcome of ischemic stroke following successful recanalization is determined by a combination of factors reflecting both the initial state of brain tissue and the complexity of the procedure, as well as the occurrence of reperfusion-related postoperative complications.

Yakutsk 58, Belinskogo St., Yakutsk 677000, Russia; 4, Sergelyakhskoye Sh., Yakutsk 677010, Russia

The role of medications as risk factors for the development of multiple sclerosis (MS) remains controversial, although there is a limited number of studies addressing the influence of immunomodulatory drugs, contraceptives, and antibiotics on the onset of this disease. One group of medications associated with the development of demyelinating disorders (including MS) is tumor necrosis factor alpha (TNF-α) inhibitors. The limited number of reported cases of demyelination associated with this group of drugs (specifically, adalimumab), both in domestic and international medical practice, prompted the writing of this article. It presents a clinical case of a female patient who was prescribed adalimumab for the treatment of ankylosing spondylitis and developed MS in the fourth year of the disease (second year of therapy). In addition, a systematic review is presented including 13 patients described in the literature as well as our own case report.

Cognitive impairment (CI) is one of the most common causes of disability in the elderly. For several years before dementia develops, it is often preceded by mild cognitive impairment (MCI), which is characterized by reduced memory and/or other cognitive functions without significant decline in daily activities. The most common causes of MCI are Alzheimer’s disease (AD), cerebrovascular disease, or a combination of both. Vascular cognitive impairment caused by cerebral microangiopathy is typically represented by non-amnestic MCI subtypes, whereas AD usually presents as a single-domain amnestic subtype. To establish AD as the cause of MCI, biological markers in the cerebrospinal fluid (CSF) can be used, such as low Aβ₄₂ levels, elevated Aβ₄₀/Aβ₄₂ ratio, increased total and phosphorylated tau protein levels, and positron emission tomography (PET) indicating pathological accumulation of beta-amyloid and tau protein in the brain.

This paper presents case reports of patients with MCI, in whom analysis of AD biomarkers made it possible to diagnose AD in one patient and vascular MCI in another. Prevention of cognitive decline progression involves the correction of vascular risk factors and maintaining regular physical and cognitive activity. In recent years, the efficacy of anti-amyloid monoclonal antibodies has been demonstrated in patients with MCI due to AD. The results of multicenter placebo-controlled trials of the drug Prospekta in vascular cognitive impairment are discussed. Currently, early diagnosis and effective treatment of MCI represent one of the most important areas in neurology.

The steadily increasing aging of the population is accompanied by a growing prevalence of cognitive impairment (CI) of varying severity. The main causes of CI are Alzheimer's disease (AD), vascular impairment, and their combination. It has been shown that establishing the exact etiology of CI is crucial for appropriate patient management and disease prognosis. The paper outlines current principles for the diagnosis and treatment of mild cognitive impairment (MCI) syndrome. It is demonstrated that the nosological structure of MCI generally corresponds to the etiology of dementia in the elderly. Early detection of CI at the MCI stage is important because timely diagnosis broadens the potential for secondary prevention and therapeutic intervention, which can delay or even prevent the onset of dementia.

A clinical observation is presented of a female patient with a polyfunctional amnestic type of MCI syndrome, with both vascular and neurodegenerative mechanisms considered as potential etiological factors. Examination of the cerebrospinal fluid revealed biomarkers of AD, which enabled a diagnosis of late-onset AD at the predementia stage. The paper also analyzes the capabilities of modern neuroprotective and symptomatic therapies for CI, and the role of choline alfoscerate and citicoline in CI treatment.

he discussion includes ways to improve patient adherence to CI treatment using newly available dosage forms such as Noocil (240 ml bottle, oral liquid form of citicoline) and Cerpehol (240 ml bottle, oral liquid form of choline alfoscerate), which can also be used in patients with swallowing difficulties.

In everyday neurological practice, B-cell-depleting therapies are playing an increasingly important role in the treatment of active forms of multiple sclerosis (MS). Among the most well-studied agents are monoclonal antibodies (mAbs) targeting the CD20 receptor on lymphocytes: ocrelizumab (a humanized mAb) and ofatumumab (a fully human mAb), which bind to different extracellular epitopes of the CD20 receptor. In relapsing forms of MS, the pharmacological characteristics of these agents often necessitate switching from the better-known intravenous drug ocrelizumab to the subcutaneous agent ofatumumab.

This review, illustrated through clinical case examples, discusses the primary reasons for such a switch-both objective (such as insufficient efficacy or intolerance) and subjective. Among the latter, an increasingly relevant factor is the phenomenon of "treatment fatigue" associated with regular intravenous infusions, particularly when therapy has been ongoing for a long period. This fatigue may manifest as feelings of exhaustion or low mood, which negatively impact adherence and, consequently, treatment efficacy.

Parkinson's disease (PD) is one of the most common neurodegenerative disorders. Migraine is the most prevalent neurological condition among adults. It has been established that migraine often precedes the development of PD, and with the onset of motor symptoms and/or the initiation of specific therapy, both the frequency and severity of migraine attacks significantly decrease. It is likely that the two conditions share common functional and biochemical characteristics. If brainstem nuclei disintegration and dopaminergic neurotransmission dysregulation are involved in the pathogenesis of migraine, then studying patients with migraine who go on to develop PD may provide important insights into the role of dopamine and/or dopaminergic brainstem regions in the pathogenesis of both migraine and PD. This review focuses on studies addressing epidemiology, the role of dopaminergic system genes in migraine development, mechanisms linking the two diseases, and the impact of pharmacological therapy.

Body dysmorphic disorder (BDD) is characterized by an individual's preoccupation with imagined defects in their appearance that are barely noticeable or completely unnoticeable to others, leading to significant impairments in daily functioning. In BDD, the following have been described: functional disturbances in visual information processing in the fronto-striatal and limbic systems, reduced global efficiency of white matter connectivity, decreased cortical thickness in the temporal and parietal lobes, as well as correlations between neuroimaging findings and clinical manifestations such as symptom severity and level of insight.

MRI reveals increased white matter volume and thalamic volume, decreased cortical thickness in the left temporal and parietal lobes, a reduction in total gray matter volume, and correlations between these abnormalities and clinical symptoms, severity, duration of BDD, and level of insight. Functional MRI demonstrates aberrant functional connectivity within the occipito-temporal network during face processing, hyperactivity of the fronto-striatal system and caudate nucleus, and regional brain hyperactivity during symptom provocation. Studies using single-photon emission computed tomography show perfusion abnormalities in the occipital regions with parietal lobe involvement.

Structural, volumetric, and functional data obtained from neuroimaging studies of BDD may help illuminate the pathophysiology and neurobiological underpinnings of this condition. Future research should further investigate and utilize neuroimaging results as potential prognostic biomarkers for treatment efficacy and disease outcomes.

The subarachnoid lymphatic-like membrane (SLYM), identified through neuroimaging and molecular biology, is an extremely thin fourth subarachnoid meningeal layer that envelops blood vessels within the subarachnoid space. It performs critical functions including immune cell regulation, cerebrospinal fluid (CSF) flow modulation, brain protection, and lubrication. All components of the central nervous system (CNS) drainage system – interstitial fluid, perivascular spaces, CSF, meningeal lymphatic vessels, and cervical lymph nodes – operate in close coordination, providing not only waste and toxin removal from the brain, but also maintaining homeostasis essential for normal neuronal function. SLYM, as part of this complex system, plays a role in transporting and filtering cells and molecules, contributing to the regulation of the CNS immune response. It forms a sheath around the brain through which only very small molecules can pass, thereby separating "clean" CSF from "dirty" CSF.

SLYM may be involved in processes associated with neuroinflammation and neurodegenerative diseases, such as Alzheimer’s disease and multiple sclerosis, potentially opening new avenues for treatment and understanding of the mechanisms underlying immune responses in the CNS. The revised understanding of the critical role of the meninges in brain function regulation, their interaction with other drainage system components, and the role of SLYM as a new selective barrier involved in compartmentalizing the subarachnoid space offer a new perspective on neurological disorders and create opportunities for regenerative therapies targeting neurodegenerative diseases.

Chronic cerebral ischemia (CCI), also known as discirculatory encephalopathy (DE), is one of the most common diagnoses in Russian neurological practice. In patients diagnosed with CCI or DE, assessing cognitive function (CF) is essential for distinguishing between individuals with and without cognitive impairment (CI). If CI is present in a patient with CCI or DE, comorbid Alzheimer's disease (AD) or other neurodegenerative disorders affecting CF should be considered. Neuropsychological assessment (identifying amnestic syndrome) and MRI of the brain (evidence of hippocampal atrophy) can raise suspicion for AD, with definitive diagnosis relying on detection of biological markers of the disease. Unfortunately, many patients with AD are long misdiagnosed with CCI or DE and thus do not receive appropriate treatment. Patients with a diagnosis of CCI or DE and preserved CF often suffer from other neurological or psychiatric disorders, most frequently anxiety-depressive disorders, primary headaches (tension-type headache, migraine, medication-overuse headache), peripheral vestibulopathy, or persistent postural-perceptual dizziness. Managing patients with CI requires controlling vascular risk factors, preventing stroke, applying psychosocial interventions, and encouraging household, social, physical, and intellectual activity. In the dementia stage, cognitive function may be improved by central acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the glutamate receptor antagonist memantine. The efficacy and safety of choline alfoscerate in patients with AD and cerebrovascular disease are also discussed.

Ischemic stroke (IS) affects all population groups, but women bear a greater burden of the disease compared to men. Stroke is the second leading cause of death among women worldwide. Stroke in women is characterized by numerous distinctions from stroke in men, including specific epidemiological and etiological features, different outcomes, and unique pathophysiological mechanisms. IS occurs more frequently in women than in men, which is associated with their longer life expectancy. The risk of IS increases during menstruation, pregnancy, the postpartum period, with the use of oral contraceptives, and during menopause. In older age, women more frequently present with arterial hypertension, diabetes mellitus, and atrial fibrillation. Stroke outcomes are more often unfavorable in women. They are also more likely to develop post-stroke depression.