Impaired cognitive function (CF) is a common manifestation of brain damage as a target organ of arterial hypertension (AH). The presence of hypertension in middle age increases the risk of developing cognitive impairment (CI) and dementia in old age. At the same time, changes in certain indicators characteristic of AH may serve as predictors of CI and dementia in the future. The review presents data on the effects of endothelial dysfunction and increased arterial stiffness on CF. The small number of papers on the effects of hypertension in middle-aged people on the development of CI emphasizes the importance of investigating this topic, as the incidence of CI in young and middle-aged people has increased in recent years.

Migraine is one of the most common causes of primary headache in the pediatric population. In addition to pain manifestations, episodic syndromes are also found in children, which often lack cephalgic manifestations and are difficult to verify in clinical practice.

Objective: to determine the characteristics of the migraine and episodic syndromes associated with migraine in children of different age groups.

Material and methods. The study included 250 children complaining of headaches (166 girls and 84 boys aged 5 to 18 years, mean age 13 years). The patients were divided into groups: Group 1 – preschool age (5–6 years) and elementary school age (7–10 years) – 20.8% (n=52) of patients; Group 2 – middle school age (11–14 years) – 45.2% (n=113) of patients; Group 3 – high school age (15–18 years) – 34% (n=85) of patients. A structured diagnostic interview was conducted with all study participants (or their parents) and pain and anxiety were assessed using special scales and tests adapted for children (visual analog scale (VAS); Digital Pain Rating Scale (DPS); Verbal Rating Pain Scale (VRPS), Faces Pain Scale (FPS), MIDAS scales, Hands scale, depression scales adapted by T.I. Balashova, Spielberger-Khanin anxiety scale).

Results. The average age at onset of headache in the general structure was 11 [9; 13] years. Migraine was diagnosed in 40.4% (n=21) of the patients in Group 1, in 31.9% (n=36) of the patients in Group 2 and in 29.4% (n=25) of the patients in Group 3. An increase in age by 1 year leads to a 1.17-fold decrease in complaints for headache in combination with vomiting. With an increase in the age of the patients by 1 year, excessive sleep is significantly less likely to be a factor provoking headaches. A statistically significant inverse association was found between age and FPS scores (ρ =-0.13, 95% CI: -0.25; -0.002; p=0.0457), VAS (ρ =-0.13, 95% CI: -0.25; -0.004, p=0.0425) and Balashova scale score (ρ =-0.14, 95% CI: -0.26; -0.01, p=0.0327). The mean values for the intensity and severity of headaches decrease with age. Analysis of the prevalence of episodic syndromes associated with migraine revealed that in the general group, intestinal colic in infancy was found in 49.6% (n=124) of cases, in Group 1 – in 51.9% (n=27), in Group 2 – in 47.8% (n=54) and in Group 3 – in 50.6% (n=43) of patients. In the general group, torticollis was found in 14.4% (n=36) of patients, which increased slightly with age. Intermittent abdominal pain was found in a total of 33.2% (n=83) and spontaneous vomiting in 18% of children, and its prevalence decreased with age.

Conclusion. The prevalence of migraine in children of different age groups suffering from headache varies between 40.4% and 29.4% of cases. Frequency of gastrointestinal symptoms accompanying a headache attack and the provoking effect of sleep decrease continuously with increasing age. Episodic childhood syndromes associated with migraine may vary in their characteristics between different age groups of pediatric patients.

The polymorphism of the clinical manifestations of schizophrenia and bipolar affective disorder (BD), late referral to the doctor, comorbidity with somatic diseases and the use of somatotropic medications by psychiatric patients, as well as the frequent development of adverse events (AEs), require constant analysis and improvement of the methods and means of psychopharmacotherapy.

Objective: to study the characteristics of the use of quetiapine (Seroquel®) in real outpatient clinical practice.

Material and methods. A patient was enrolled in the program if there was a need to prescribe quetiapine (Seroquel®) or to switch from the current therapy to quetiapine. During the program visit, the doctor filled in an individual registration card with information about patient and therapy. The data were statistically analyzed.

Results. Quetiapine is prescribed by practicing psychiatrists in Russia not only according to the official indications, but also for psychopathological disorders of other nosology with similar clinical manifestations, such as dementia, organic and affective (depressive episode, recurrent depressive disorder), as well as psychogenic disorders. Up to 27.3% of physicians consider the effect of quetiapine to be quite sufficient in a mixed affective state within the framework of BD dynamics. Quetiapine is used by physicians to treat patients with varying duration of mental disorder (mean 5.1–13.5 years), severity of current mental state (mean CGI-S score 4.3–4.97) and a wide age range (mean age 34.5–60.8 years). When prescribing quetiapine, physicians note that the drug has antidepressant, anxiolytic, sedative and hypnotic effects, regardless of the type of mental disorder. Quetiapine is mainly prescribed as a monotherapy, either primary or resumed after a break – 815 (64.5%) observations. At the same time, quetiapine is used significantly more frequently as monotherapy for BD (69.4%) and mental illnesses of other origin (64.7%) than for schizophrenia (53.8%; p <0.005).

Conclusion. In real clinical practice, quetiapine is perceived by psychiatrists as a highly effective and well-tolerated antipsychotic with a broad spectrum of activity that goes beyond the official indications. The practical experience of physicians in Russia shows that in addition to sedative, antipsychotic, antimanic and antidepressant effects, the drug also has antinegative, procognitive, anxiolytic, antiresistant and mood-stabilizing properties.

Occlusion of a large cerebral artery in ischemic stroke (IS) is associated with a high mortality rate. Despite the results of studies that have demonstrated the beneficial effect of endovascular therapy on functional outcome in IS, little research has been conducted on its impact on hospital mortality in IS, its timing and structure.

Objective: to investigate hospital mortality in patients with IS and large cerebral artery occlusion, who underwent mechanical thrombectomy (MTE).

Material and methods. The retrospective study included data from 233 patients with IS and confirmed occlusion of a large cerebral artery (internal carotid artery, M1 and M2 segments of the middle cerebral artery, basilar artery) treated at the regional vascular center V.V. Veresaev Hospital, Moscow, 2018 and 2022. A comparison of hospital mortality in the group of patients who underwent MTE and the group of patients who received basic therapy was performed.

Results. MTE was performed in 107 patients (46%); 126 patients (54%) received only basic therapy. The mortality rate of all patients included in the study was 44.2%. Among all deaths, the proportion of patients with MTE was only 7.2%, while the proportion of patients on basic therapy was 36.9% (p<0.001). Mortality in the MTE group was four times lower than in the basic therapy group – 15.8% compared to 68.2% (p<0.001). We observed that certain manifestations were significantly more frequent in the basic therapy group: cerebral edema (42% vs. 18.6%), hemorrhagic transformation (19.9% vs. 12.9%), venous thromboembolism (6.3% vs. 3.7%) and infectious complications (42.8% vs. 14.3%). The mortality of patients in the basic therapy group was higher on the first day, on days 2–3 and also on days 4–7, while no differences in mortality were observed after the first week of the disease.

Conclusion. Admission of a patient with IS within the “therapeutic window” creates the conditions for a significant reduction in hospital mortality and the incidence of stroke complications.

The prevalence of dry eye syndrome (DES) in Parkinson's disease (PD) reaches 87% and leads to impaired quality of life in many patients.

Objective: to evaluate the lacrimal function and the effect of dopaminergic therapy in patients with PD.

Material and methods: 43 patients with stage II–III PD according to Hoehn and Yahr (H&Y) receiving therapy with levodopa (n=17), amantadines (n=13) and dopamine receptor agonists (ADR) (n=28) were assessed using Schirmer's test (to estimate tear flow), sialometry, Unified Parkinson's Disease Rating Scale (UPDRSI-IV), Schwab and England Activities of Daily Living scale (Sch&En), the Parkinson’s Disease Questionnaire Summary Index (PDQ-39), the Mini Mental State Examination Scale (MMSE), the Non-Motor Symptom Questionnaire (NMSQ), the American Urological Association Symptom Scale (AUA), the Gastrointestinal Symptom Rating Scale (GSRS), the Bristol Stool Form Scale (BSFS).

Results. Lacrimal insufficiency was found in 49% of patients. It occurred more frequently (χ²=9.546; p=0.003) in patients taking amantadine and correlated with the daily dose of amantadine (r-S=-0.359). It did not depend on the intake of ADR and levodopa and their doses but correlated with the UPDRS-IV score (r-S= -0.463), namely with the presence and duration of OFF-periods. Lacrimal insufficiency correlated with the Sch&En score (r-S=0.321) and non-motor parameters: UPDRSI (r-S =-0.302), NMSQ (r-S=-0.435), constipation domain of the GSRS (r-S=-0.362), BSFS (r-S=0.363). It was not related to age, gender, stage and duration of PD, motor symptoms of parkinsonism (assessed during the ON-phase) and was not related to salivation (although it was reduced in 39.5% of patients).

Conclusion. Lacrimal insufficiency is observed in half of patients with stage II–III PD; it is related to the presence and duration of OFF-periods, the severity of other autonomic disorders and the use of amantadines, suggesting the role of dopamine dysregulation, neurodegeneration of autonomic centers and anticholinergic therapy in the development of DES in PD.

Latent atrial fibrillation (AF), whose substrate is atrial cardiomyopathy (AC), is considered the main potential pathogenetic mechanism of cryptogenic embolic stroke (CES). Early detection of AC allows to intensify the search for AF in such patients.

Objective: to compare the characteristics of patients with CES in terms of clinical and anamnestic data, echocardiographic parameters, MRI patterns of infarction foci and disease outcomes depending on the presence of the major markers for AC.

Material and methods. We studied 103 patients in the acute phase of CES with a lesion confirmed by MRI data, who were divided into two groups according to the presence (n=17) or absence (n=86) of AC. A comprehensive clinical, laboratory, and instrumental examination was performed and long-term outcomes were assessed. The median follow-up period was 32 months.

Results. The incidence of AC in the CES population was 17%; the most common markers were an increase in left atrial volume index and paroxysms of supraventricular tachycardia. Patients with AC-CES were characterised by older age and a two-fold increase in the prevalence of coronary heart disease. Patients with AC-CES were nine times more likely to have a "black artery" symptom on MRI than patients without AC. The predictive accuracy of this clinical pattern was 84%, the sensitivity was 60% and the specificity was 86%. Patients with AC-CES had a significantly higher risk (odds ratio 3.4; 95% confidence interval 1.1–9.9; p=0.023) for a composite outcome that included the development of recurrent ischemic stroke, transient ischemic attack, myocardial infarction or death.

Conclusion. AC diagnosed by a combination of echocardiographic and electrocardiographic signs is present in 17% of patients with CES. Patients with AC-CES are characterised by elderly age, the presence of atherosclerosis-associated disease, a specific MRI pattern (the “black artery” symptom) and an unfavourable prognosis during the 2.5-year follow-up period.

Histologically, chronic demyelinating lesions in multiple sclerosis (MS) have been shown to include inactive lesions that do not change over time and active or “smouldering" lesions that tend to enlarge over time and are surrounded by pro-inflammatory activated microglial cells that are loaded with iron. To identify “smouldering" foci of demyelination and assess the “latent” inflammatory process in the brain, MRI sequences sensitive to the detection of substances with paramagnetic properties, including iron, must be used. They include an innovative technique such as quantitative susceptibility mapping (QSM).

Objective: to identify, using MRI different types of chronic demyelination foci in MS, based on iron distribution and the degree of damage (myelination) in their structure.

Material and methods. The patterns of iron distribution in demyelinating lesions in 90 MS patients were investigated using QSM. In addition, two lesions with different iron distribution patterns were randomly selected on the QSM map for each patient, in which the magnetic transfer ratio (MTR), indirectly reflecting the degree of myelination, was calculated. The identified changes were also compared with visualization of lesions in standard MRI modes (T1 MPRAGE, T2 FLAIR).

Results. Despite the predominantly identical visualization in T2 FLAIR mode, chronic foci of demyelination show different patterns on the QSM maps, which is due to the peculiarities of iron distribution: some foci are not detected on QSM, while others are visualized either in the form of a homogeneous or a ring-shaped pattern. When comparing QSM data with MTR, it was found that MTR indicators were highest in non-visualized lesions (demyelination is minimal), while damage was most pronounced in lesions with ring-shaped iron distribution.

Conclusion. Different patterns of iron distribution in demyelination foci compared to the degree of myelination in these foci according to MTR were identified using QSM, which is of great importance for the evaluation of latent inflammation and the development of the neurodegenerative process in MS.

Pain and sleep disorders are interrelated problems that significantly affect patients’ quality of life (QoL) and daily functioning.

Objective: to evaluate the efficacy and safety of the use of the combination of diphenhydramine + naproxen (NOVEMA® NIGHT) in patients with acute pain syndrome or exacerbation of chronic pain syndrome and sleep disorders.

Material and methods. The study included 4365 outpatients with acute pain (musculoskeletal pain, post-traumatic pain, headache) and sleep disorders who took naproxen 275 mg, 1 tablet in the morning and diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) for 5 days before bedtime. Pain intensity, using a visual analogue scale (VAS), and sleep disorders were assessed before and after treatment; QoL was assessed after treatment using a five-point scale.

Results. During treatment, a reduction or complete regression of pain was observed in 92% of cases (60 [50; 61] points on the VAS before treatment versus 10 [0; 20] after treatment; p<0.0001) and normalisation of sleep in most patients: faster falling asleep – in 81% (χ²=9650.2; p<0.0001), an increase in total sleep duration – in 75.5% (χ²=7351.2; p<0.0001), a decrease in the number of nocturnal awakenings – in 84% of patients (χ²=10,568; p<0.0001). At the end of treatment course, the majority of patients rated their quality of life as 4 out of 5 possible points (4 [4; 5]): 41% of patients – “high quality of life”; 48% – “above average”; 11% – “average”; 0.09% – “below average”). None of the patients had a low QoL. The therapy was well tolerated and no patient discontinued treatment due to adverse events (AEs).

Conclusion. Short-term treatment (5 days) with naproxen 275 mg and a combination of diphenhydramine 25 mg + naproxen 220 mg (NOVEMA® NIGHT) at bedtime effectively reduces the pain syndrome associated with insomnia. This therapy significantly improves patients’ QoL and has a low risk of AEs, so that we can recommend NOVEMA® NIGHT as an additional analgesic for patients with concomitant sleep disorders.

Mild cognitive impairment (MCI) is an intermediate stage between normal cognitive function (CF) and dementia. In the general population of elderly, it is diagnosed in 10–15% of cases; in patients attending outpatient appointments, the frequency of diagnosis is 70%. In our country, there is positive experience with the inhalation of nitric oxide, using a device that synthesizes it from the air, for pulmonary and cardiovascular diseases.

Objective: to investigate the use of inhaled nitric oxide (Tianox device) in patients with MCI due to cerebrovascular (CVD) and neurodegenerative diseases (NDD) of the brain.

Material and methods. We observed 36 patients (8 men, 28 women, mean age 66±8.9 years, from 50 to 76 years) with MCI that developed on the background of CVD and NDD. In addition to stroke prevention therapy, the patients with MCI received daily inhalation of a nitric oxideenriched air mixture via a Tianox device for 30 minutes. The patients had from 7 to 10 inhalation sessions (the first, experimental – 20 minutes, the following sessions – 30 minutes). Detailed neuropsychological tests were performed at baseline and 3 months after the end of treatment.

Results. The therapy was well tolerated and no adverse events occurred. After 3 months, the average score on the Montreal Cognitive Assessment increased from 23.7±3.5 to 25.6±3.9 points (p<0.001), the ability to memorize 12 words – from 7.5±1.8 to 8.7±2.1 words (p<0.05), categorical associations – from 14.8±5.0 to 16.9±4.6 words (p<0.05), the number of words found in the Munsterberg test – from 14.9±5.8 to 18.1±5.8 (p<0.001).The emotional state of the patients improved, the signs of depression decreased according to the Beck Depression Inventory from 13.65±8.5 to 11.4±6.7 points (p<0.05), on the Hospital Anxiety and Depression Scale – from 8.6± 5.0 to 7.3±4.1 points (p<0.05); anxiety decreased on the Hospital Anxiety and Depression Scale – from 7.0±5.0 to 5.4±4.5 points (p<0.05), Insomnia Severity Index – from 11.1±7.9 to 7.8±6.3 points (p<0.05).

Conclusion. Good tolerability and a positive effect of inhaled nitric oxide on CF and emotional state of patients with MCI against the background of CVD and NDD were found.

In most cases, chronic dizziness is persistent postural perceptual dizziness (PPPD), which is often combined with other diseases of the vestibular system and anxiety disorders. In real-life clinical practice, PPPD and comorbid disorders are rarely diagnosed and effective treatments are rarely prescribed, so the development of modern methods for managing patients with PPPD with comorbid diseases is important.

Objective: to analyze the typical management practices and evaluate the effectiveness of complex therapy in patients with PPPD and comorbid disorders.

Material and methods. We examined 60 patients (mean age – 42.5±13.8 years) with diagnosis of PPPD (according to the diagnostic criteria of the Barany Society) and comorbid diseases. All patients were examined twice: at the beginning and after completion of treatment, which lasted an average of 1 month. Treatment included antidepressants (serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors), anti-anxiety medications, vestibular exercises, an educational program, and cognitive behavioral therapy. Arlevert (a combination of cinnarizine 20 mg + dimenhydrinate 40 mg) was used as a drug therapy for the treatment of vestibular dizziness in 28 patients. A clinical otoneurological evaluation and videonystagmography were performed to assess vestibular disorders; the severity of dizziness was assessed using an otoneurological questionnaire and the Dizziness Handicap Inventory (DHI); the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Spielberger Anxiety Inventory (STAI) were used to assess anxiety and depressive disorders.

Results. None of the 60 patients had previously been diagnosed with PPPD. They were observed with a misdiagnosis of cerebrovascular disease and/or cervical spine pathology and received ineffective treatment. Anxiety and depressive disorders were detected in 32 (53.33%) patients, migraine – in 20 (33.33%) and previous peripheral vestibular disorders – in 8 (13.33%) patients. After one month of treatment in patients with PPPD and comorbid conditions, the severity of dizziness according to DHI decreased from 45.59±15.47 to 29.9±12.56 points (p<0.001), the severity of anxiety according to BAI from 27.50±6.38 to 15.66±4.07 points (p<0.001), the severity of depression according to BDI from 11.91±6.24 to 7.06±4.12 points (p<0.001), the severity of anxiety according to HADS from 13.47±4.16 to 8.60±2.86 points (p<0.001), the severity of depression according to HADS from 6.34±3.72 to 4.31±2.82 points (p<0.001), situational anxiety according to STAI from 50.69±7.13 to 41.26±6.24 points (p<0.001), personal anxiety according to STAI from 54.66±8.21 to 43.78±6.75 points (p<0.001).

Conclusion. It was found that PPPD is rarely diagnosed, and anxiety disorders, migraine and peripheral vestibular disorders are very common in PPPD patients. The integrated approach in the treatment of patients with PPPG, taking into account concomitant disorders, has demonstrated high efficacy.

Clarification of the aetiology of ischemic stroke (IS) in young adults (aged between 18 and 45 years) is an extremely difficult task, as rare causes that are hardly known to neurologists are very common. One of these causes is paradoxical embolism due to pulmonary arteriovenous malformation (AVM), one of the manifestations of hereditary hemorrhagic telangiectasia (HHT). The diagnosis of HHT-associated pulmonary AVMs and IS is a multistep task that requires a personalized multidisciplinary approach using high-tech ultrasound, tomographic and genetic examination methods. This article discusses the clinical case of a young patient with HHT and recurrent IS through the mechanism of paradoxical embolism from pulmonary AVMs; issues of diagnosis, treatment and prevention of both the underlying disease and recurrent vascular events are discussed.

The development of cognitive impairment in old age is often caused by overlapping neurodegenerative and cerebrovascular changes which have a mutually aggravating clinical effect. In recent years, the problem of cerebral amyloid angiopathy (CAA), which is one of the variants of such an interaction, has gained importance. Despite the frequent occurrence of this pathology in the elderly, a unified approach to the treatment of these patients has not yet been developed, especially taking into account the frequent combination with other nosological forms. CAA is a disease associated with both Alzheimer's type neurodegeneration and cerebrovascular pathology. The article presents a clinical case illustrating this situation and discusses the diagnostic algorithm in detail. The characteristics of the pathogenesis and clinical manifestations of CAA and the link between neurodegenerative and cerebrovascular pathologies are discussed.

Transient global amnesia (TGA) is a rare symptom complex characterized by a brief episode of severe fixation, anterograde and retrograde amnesia. The prevalence of TGA increases with age. Risk factors for this disease include physical overexertion, severe emotional stress, exposure to cold or hot water, hypothermia and pain. The diagnosis of TGA is based on the Kaplan and Hodges–Warlow criteria, according to which TGA is characterized by: complete resolution of mnestic disturbances within 24 hours; absence of other neurological and cognitive impairments; absence of previous head trauma or seizures. In cases where the clinical picture of TGA does not meet the criteria for the disease, a differential diagnosis should be performed, especially with cases of ischemic stroke in the vertebrobasilar region and transient epileptic amnesia. If acute ischemia is confirmed by the brain MRI results, further comprehensive diagnostic investigation must be performed to determine the subtype of acute cerebrovascular accident with further appropriate secondary prevention of cardiovascular complications. If a non-cardioembolic stroke type is identified, antiplatelet therapy has a crucial role. The clinical case of a patient with a left-sided hippocampal infarction clinically manifested by a TGA is presented.

Polycythemia vera (PV) is a clonal myeloproliferative disorder that is often associated with neurological symptoms. Rare manifestations of PV may include movement disorders (mainly chorea) and cognitive impairment (CI), which are fully or partially reversible with appropriate treatment. We present a case of chorea with CI in a 69-year-old man with a confirmed с1849G>T (V617F) mutation in the JAK2 gene with no vascular pathology on neuroimaging. In this patient, there is a clear correlation between the regression of the movement disorders with therapeutic phlebotomy and the start of treatment with hydroxyurea, which allows the conclusion that chorea has the secondary form. The cognitive symptoms remained at the same level after the start of treatment and during the one-year follow-up and did not develop further. In view of the patient's age, a concomitant neurodegenerative disease cannot be ruled out. In elderly patients with new-onset chorea and CI, it is therefore important to consider PV as a possible cause of these disorders, as early diagnosis of this condition allows timely initiation of effective treatment and prevention of the development of complications.

A significant proportion of patients who have had COVID-19 continue to suffer from persistent symptoms such as severe weakness, shortness of breath, joint pain, mood swings and memory impairment during the recovery phase. More than half of the patients experienced joint pain for the first time after recovery from COVID-19. Three months after COVID-19 episode, joint pain continued to occur in more than a third of patients. We observed a 47-year-old patient with moderate shoulder pain that occurred for the first time after COVID-19. The examination also revealed changes in the hip joint. The diagnosis was made: post-COVID syndrome with reactive arthritis of the left shoulder joint, deforming osteoarthritis of the left hip joint stage I, degenerative-dystrophic changes in the lumbosacral spine, lower back pain. The therapy was prescribed – Chondroguard® intramuscularly every other day according to the following scheme: the first three injections (day 1, 3, and 5) 1 ml (100 mg), then, from the fourth injection (day 7) – 2 ml (200 mg) every other day, a course of 30 injections. Positive dynamics were achieved. No adverse events were noted during the treatment. The patient continued taking the nutraceutical Chondroguard® TRIO orally for 2 months. During the observational period, no adverse events were noted. Thus, in cases where post COVID-19 musculoskeletal pain is caused by joint involvement, chondroprotective therapy is effective: stage 1 – injections, stage 2 – oral therapy.

Recent research has shown that there are different drainage systems in the brain. During the drainage of cerebrospinal and interstitial fluids, intracerebral (intracranial) lymph is formed, which becomes part of the glymphatic system. Later, the glymphatic system was subdivided into periand paravascular spaces, but their existence has not yet been proven. The article contains data on the anatomy of the lamina cribrosa, its age-related changes, the characteristics of the lymphatic system and the theory of the existence of glymphatic vessels in this area. We also hypothesize that in addition to the classical view, which assumes that viruses enter the central nervous system (CNS) through the blood-brain barrier or with the help of immune cells, there are other routes of pathogen entry, for example through the glymphatic system. Possible routes of movement of cerebrospinal and interstitial fluids through the structures of the nervous system and other systems are considered. The lamina cribrosa is considered a possible portal of entry for viruses into the CNS, in particular for the SARS-CoV-2 virus. In our review, we analyzed the likely mechanisms of SARS-CoV-2 spread in the central nervous system and the possible consequences of previous viral disease.

An increase in the incidence of multiple sclerosis (MS) has been reported over the last decade, possibly due to environmental factors. The purpose of this review article is to summarize current advances in the understanding of the gut-brain axis, which mediates the link between the central nervous system and the gut microbiome. It also summarizes the clinical findings from numerous studies investigating the effects of diseasemodifying therapies on the gut microbiome in patients with MS.

In preclinical and clinical studies, choline alfoscerate (CA) has proven to be highly effective in the correction of cognitive impairment (CI). The clinical effect of CA is seen in the improvement of mental activity, concentration, ability to remember and recall information, cognitive and behavioural responses, elimination of emotional instability and apathy. Experimental studies have shown the effectiveness of CA in preventing atrophic changes in the cerebral cortex. Based on several studies conducted on the use of CA in the treatment of CI, it can be concluded that oral administration of CA at a dose of 600 mg/day can be recommended both as monotherapy and as part of complex therapy in patients with cerebrovascular diseases such as chronic cerebral ischemia. As part of complex therapy for CI in Alzheimer's disease, a combination of CA at a dose of 1200 mg/day with donepezil at a dose of 10 mg/day may be recommended. Several studies have demonstrated the efficacy of CA in the treatment of post-COVID and post-traumatic CI. The efficacy of CA administration in the treatment of CI (including vascular dementia) following ischemic stroke and transient ischemic attacks has been demonstrated. When CA is taken, there is also a reduction in anxiety and depressive disorders, asthenia, the severity of pain symptoms and changes in coordination. The duration of therapy should be 60 to 90 days, depending on the severity of CI, followed by an observation phase of up to 2 years. For successful treatment with CA, it is necessary to carry out repeated courses of CI treatment. Today, a new drug Cerpechol (600 mg/7 ml) has appeared on the Russian market, which has all the effects of CA. The convenience of the new form (oral solution) makes it possible to use it in patients with swallowing disorders.

An important component of the pathogenesis of neuromyelitis optica spectrum diseases (NMOSD) with antibodies to aquaporin-4 (AQP4-IgG) is a classical pathway of complement system (CS) activation with the implementation of mechanisms of complement-mediated cytotoxicity. Eculizumab is a humanized monoclonal antibody that suppresses the final stage of CS activation and has a high affinity for its C5 component. The most important components in the pathogenesis of NMOSD with AQP4-IgG, the role of CS, the results of clinical trials with the drug eculizumab and its place in the treatment of NMOSD are discussed.

Currently, more than 15 molecules are already approved for the treatment of multiple sclerosis, and sometimes physicians encounter problems selecting a drug for therapy when considering patients with the initial equivalent characteristics. When selecting a drug, it is important to consider not only the efficacy and safety of the drug, but also the possibility of further therapy after discontinuation of the initially selected drug. This paper discusses the results of clinical trials on the efficacy and safety of ofatumumab and its potential advantages over other anti-CD20 agents.

A joint conclusion of the Russian-Belarusian Expert Council “New opportunities in the treatment of patients with multiple sclerosis” on the organization of medical care, diagnosis and treatment of multiple sclerosis (MS) and other autoimmune diseases is presented. 12 neurologists from different medical institutions in Russia and Belarus took part in the work of the Council. In the conclusions of the Council, special attention was paid to two new Russian original drugs, modifying the course of MS. The place of these drugs in the healthcare system of these countries was determined. Sampeginterferon beta-1a itself is an effective and safe drug of first choice (first-line treatment) for relapsing remitting MS. Divozilimab is a highly effective and safe second-line treatment indicated for rapidly progressive and highly active MS, even when substituted for a firstor second-line treatment in relapsing remitting and secondary progressive (with exacerbations) MS. The experts emphasized how promising the use of these drugs is in the complex treatment of MS.