Migraine is a chronic neurological disorder that is associated with considerable disadaptive effect on patients. Despite the development of pharmacotherapy strategies for migraine, only one third of patients are satisfied with their overall treatment. Many migraine patients turn to complementary and alternative medicine (CAM), which is not usually considered a part of conventional medicine and is not always evidence-based. In practise, however, they are often used to improve the effectiveness of standard therapy or to provide alternative treatment. In addition, in CAM methods, the patient is actively involved in the choice of treatment strategies, and they have good adherence. The basic principles and approaches of CAM are increasingly being introduced into clinical practise. This review discusses the principles of CAM in the treatment of migraine as a holistic approach using lifestyle strategies and selected non-pharmacological treatments that have been shown to be effective and rational.

Transient ischemic attack (TIA) in the vertebrobasilar vascular territory (VB) causes difficulties in diagnosis when it manifests only with vestibular symptoms. Issues relating to the differential diagnosis of TIA are discussed, awareness of which is necessary for the selection of informative methods of examination and the prescription of effective stroke prevention in patients with an episode of isolated dizziness. The likelihood of TIA as the cause of dizziness is increased by the patients' high cardiovascular risk, the presence of atrial fibrillation, severe instability during an attack, and head and/or neck pain. If a TIA in VB is suspected, it is advisable to perform a minimal instrumental examination, including computed tomography (CT) of the brain and CT angiography or diffusion-weighted magnetic resonance imaging (MRI) and MRI angiography. In case of doubt, additional information can be obtained by a perfusion CT or MRI as well as a post-contrast MRI. When interpreting the results of these methods of examination, their limitations in terms of application time and resolution should be taken into account. 

Objective: to evaluate the efficacy and safety of the Prospecta drug in the treatment of cognitive impairment (CI) in patients with ischemic stroke (IS) in the carotid vascular territory.

Material and methods. The double-blind, placebo-controlled, randomized clinical trial enrolled 246 patients aged 40 to 75 years with IS in the carotid vascular territory within 72 hours of stroke onset, moderate CI (<26 points on the Montreal Cognitive Assessment, MoCA), full consciousness (15 points on the Glasgow Coma Scale), moderate severity of stroke (8–12 points on the National Institute of Health Stroke Scale, NIHSS), moderate impairment of activity (2–3 points on the – Modified Rankin Scale, mRs). At visit 1, complaints and medical history were collected, vital signs (VS) and laboratory parameters were recorded, CI was assessed according to MoCA and the Glasgow Coma Scale, NIHSS and mRs were filled out. Patients were randomized into two groups: in the first group they received Prospecta for 90 days, in the second group placebo (PL) following a similar regimen. The groups were comparable in terms of demographic and baseline clinical characteristics. After 90 days, complaints, medical history, VS, laboratory parameters and assessment of CI according to MoCA were recorded, and NIHSS and mRs questionnaires were filled out again. The intention-to-treat (ITT) efficacy analysis was performed based on the results of the treatment and follow-up of the Full analysis set (FAS), which comprised 241 patients (122 patients in the Prospecta group and 119 patients in the PL group; 4 patients were excluded from the ITT analysis because they were erroneously included in the study). The results of the per-protocol (PP) analysis are shown in square brackets.

Results. The 90-day use of Prospecta reduced the severity of CI in patients with carotid IS compared with placebo therapy. MoCA scale scores increased from 20.7±3.5 [20.9±3.0] to 24.6±2.9 [25.2±2.5] points in the Prospecta group and from 21.7±2.4 [21.6±2.4] to 24.5±3.0 [24.8±2.8] points in the PL group (p=0.0006 [p=0.0014]). 42 adverse events (AEs) were recorded in 32 (26.0%) patients in the Prospecta group and 37 AEs in 28 (23.0%) patients in the PL group (p=0.656). All AEs in the Prospecta group were not significantly related to the use of the drug. No deaths or recurrent IS were recorded.

Conclusion. Prospecta is an effective and safe treatment for CI in patients with carotid IS

Objective: understanding the problems of depressed children is important, as they may express their issues through painting and storytelling, which can provide insight into their excitability and self-image. This study investigated the psychometric properties of the Draw a Story test in children with depression and normal ones.

Material and methods. The participants of this study included 60 fourth and fifth grade students in Yazd province, who were divided into two groups; depressed and normal. Then, each group was evaluated by drawing a story test (DAS).

Results. The results showed that there was a significant difference between the depressed and normal groups in terms of self-image and emotion content, as determined by a two-way analysis of variance. The normal group significantly demonstrated a stronger self-image and emotional state than the depressed group. There was no significant difference between boys and girls in terms of self-image. However, there was a significant difference in their emotional expression, with girls being more adept at expressing their emotions compared to boys. Convergent validity of the DAS was established by correlating it with the DSRS test for self-image and emotion, resulting in correlations of -0.67 and -0.74, respectively. The reliability of the DAS test was assessed using the test-retest method for self-image and emotion, yielding coefficients of 0.82, 0.90, respectively. Additionally, the raters' agreement coefficient was calculated for self-image and emotion, and was 0.68 and 0.82, respectively.

Conclusions. The results of this study revealed the reliability and validity of the test (DAS) in the group of depressed and normal children. This test can be used to diagnose children with depression.

Objective: to investigate the relationship between the quality and duration of sleep and stress at work and at home in people aged 25–44 years living in Novosibirsk.

Material and methods. The study of a representative cohort of people aged 25–44 years was conducted in 2013–2016 in one of the districts of Novosibirsk (budget topic No. AAAA-A17-117112850280-2). A total of 975 individuals were examined (427 men, mean age – 34±0.4 years, response rate – 71%; 548 women, mean age – 35±0.4 years, response rate – 72%). The general examination was conducted according to the standard methods of the WHO program “MONICA-psychosocial (MOPSY)”. The standard Jenkins questionnaire was used to assess the quality and duration of sleep. Scales to assess stress at home (scale “Knowledge and attitude towards one’s own health”) and at work (Karazek scale) were included in the standard questionnaire.

Results. Men aged 25 to 44 with sleep disorders were more likely to report that they “dislike their work” (52.2%) and that their attitude towards work is “average” (50.7%). It is rare for both men (46.8%) and women (56.6%) to relax and have rest after a normal working day. Women with sleep problems (56.5 %) stated that they are unable to rest adequately at home. Both men and women with sleep disorders confirmed that there had been serious conflicts in the family in the last 12 months: “several” times" (57.1 % and 55.8 % respectively) or “often” (53.3 % and 68.4 % respectively). Women with a sleep duration of 5–6 hours stated that they “never” (36.4 %) or “rarely” (36.8 %) manage to relax and recover after a regular working day; for 33.3 %, responsibilities at work have “increased”; 37.2 % have started to do extra work.

Conclusion. A correlation was found between sleep disturbances and their duration and stress both at work and at home.

Little attention has been paid abroad to the problem of the long-term course of multifocal motor neuropathy (MMN). In our country, catamnestic studies of MMN have not been conducted at all. However, the results of such an analysis are extremely important for understanding the course and prognosis of the disease.

Objective: to analyse the clinical and neurophysiological data of patients with MMN with a disease duration of more than 5 years.

Material and methods. The study included 28 patients with MMN: 9 women (32%) and 19 men (68%); the median age at admission was 50 [44; 56] years; the median disease duration was 10 [8; 13] years. Medical documentation, medical history, complaints, neurological examination results (scored on the MRC and INCAT scales) and results of electroneuromyography (ENMG) of the long nerves of the hands were analysed.

Results. The median time between onset of the disease and diagnosis was 5.5 [2; 10] years. Paresis <3 points on the MRC scale was found in the extensor muscles of the hand and fingers (12/28; 43%), in the median (15/28; 53%) and ulnar (20/28; 71%) muscle groups of the hands, in the extensors (11/28; 39%) and flexors (9/28; 32%) of the feet. The median total score for the degree of disability on the INCAT scale was 3 [2; 3] for the hands and 1 [0; 2] for the legs. The comparative analysis of the severity of the neurological deficits on the MRC and INCAT scales at the onset of the disease and in the long-term catamnesis revealed no significant differences (p>0.05). An objective assessment of sensory disorders revealed no changes when testing tactile, pain and temperature sensitivity, while half of the cases (14/28; 50%) showed a disturbance of vibration sensitivity in the lower extremities. The ENMG examination was consistent with the electrophysiological criteria of the disease, one third of the patients showed significant secondary damage to the axons of the motor fibers of the hand nerves, and in half of the cases a slight impairment of the axons of the sensory fibers was registered.

Conclusion. MMN is a curable disease. Unfortunately, our retrospective analysis showed that in the Russian Federation there are problems with its diagnosis and quality care of this category of patients. Late diagnosis, delayed start of treatment and non-compliance with the schedule of pathogenetic therapy lead to persistent disability of patients.

In response to ischemic stroke (IS) a natural activation of the stress-realizing system occurs. The features of this activation influence the outcome of the acute period and the prognosis of recovery and can be adjusted. At the same time, the role of the stress-realizing system in the pathogenesis of IS is still unexplored.

Objective: to investigate the effect of peripheral blood cortisol concentration on the regulation of apoptosis of neurons of the cerebral cortex in the acute phase of IS.

Material and methods. A prospective clinical and pathological study was performed. It included 9 patients with IS in the left middle cerebral artery territory who were admitted to hospital and died in the hyperacute phase of IS and had no infectious complications, allergic reactions or oncological diseases and who did not undergo thrombolysis. The cerebral cortex was examined. Neuron-specific enolase (NSE), protein 53 (p53), caspase 3, caspase 8, Fas receptor (CD95), and Fas apoptotic inhibitory molecule 2 (FAIM2) were determined on the slices using an indirect immunoperoxidase immunohistochemical staining method. A total of 567 microscopic fields were analysed for the group of patients with IS and 63 fields for the control group (three people). Before death, the blood concentrations of sFas, sFasL, cortisol, adrenocorticotropic hormone, adrenaline and norepinephrine were determined by enzyme immunoassay (the control group consisted of 28 people).

Results. Significant correlation was found between the proportion of casp3-positive neurons and the concentration of cortisol in peripheral blood in zones 2 (r=0.263; p<0.01) and 3 (r=0.383; p<0.01). In the 2nd zone, significant negative correlation was found with the concentrations of sFas (r=-0.177; p<0.05) and sFasL (r=-0.164; p<0.05); in the 3rd zone, significant positive correlation was found with the ratio of the concentrations of sFasL and sFas (r=0.240; p<0.01). The proportion of Fas-positive neurons in the cerebral cortex correlated significantly with the concentration of the soluble form of this molecule (for the 1st zone – r=0.222, for the 2nd zone – r=0.438, for the 3rd zone – r=0.289; p<0.01) and the ratio of the concentrations of sFasL and sFas (respectively: r=0.231, r=0.266 and r=0.281; p<0.01) in the peripheral blood.

Conclusion. Peripheral blood cortisol concentration is a factor that determines the regulation of apoptosis of neurons in the cerebral cortex in the acute phase of IS.

Asthenic syndrome occurs in most chronic diseases, and doctors encounter it in outpatient appointments for both somatic and neurological pathologies. Drugs that normalize energy metabolism, have an antioxidant effect and antihypoxic properties are used to treat asthenia.

Objective: to investigate the therapeutic efficacy of the drug Cytochrome C in patients with asthenia of various origin in an outpatient setting.

Material and methods. The study included 147 outpatients with asthenia who received Cytochrome C 10 mg intramuscularly daily for 10 days. The assessment of the initial level of asthenia manifestations and their changes in dynamics was carried out using the MFI-20 scales, the assessment of daytime sleepiness, the assessment of fatigue (FAS), the severity of symptoms of the disease and the dynamics of the condition according to the doctor and the patient.

Results. By the 10th day of therapy, there was a decrease in the severity of asthenia on the MFI-20 scale from 72.2±12.7 to 41.1±12.3 points (p<0.01), including general (by 45%), physical (by 42%) and mental (by 45%) asthenia according to the MFI-20 subscales (p<0.001), improvement in night sleep and reduction in daytime sleepiness on the Epworth scale by 65% – from 9.1±5.6 to 4.6±4.3 points (p<0.001), reduction in severity of fatigue by 29% (p<0.01). The clinically significant improvement lasted until the 30th day of observation, 3 weeks after the end of the therapy. Overall, a significant reduction in asthenia symptoms was observed in 99% of patients on day 10 of therapy and in 96% of cases on day 30.

Conclusion. Cytochrome C has been shown to be very effective in patients with asthenia as it reduces all manifestations of asthenia, improves night sleep and reduces daytime sleepiness.

Objective: to evaluate the efficacy and safety of fremanezumab in patients with chronic migraine (CM) in real-life clinical practice.

Material and methods. In a 12-week, open-label, prospective study, 27 patients (21 women and 6 men, mean age 41±10 years) with CM were administered with fremanezumab 225 mg subcutaneously monthly or 675 mg once (quarterly). We assessed changes in migraine attack intensity using a visual analogue scale (VAS), a reduction in the number of headache days per month by 50% or more, the impact of headache on daily activities (HIT-6 scale), adverse events (AEs) and tolerability of fremanezumab.

Results. The number of migraine days per month decreased by 50% or more in 52%, 63% and 70% of patients at weeks 4, 8 and 12, respectively. In 26% of patients, the number of days with headaches was reduced by 75% or more by the end of the study. On average, the number of days with migraine decreased by 11.6 per month, with monthly injections – by 12.6 per month (p<0.01). In patients who had negative experience with treatment with two or more groups of preventive therapies, the number of days with migraine was reduced by an average of 10.6 per month (p<0.01). The pain intensity according to VAS decreased from 9 to 5.7 points (p<0.001), the HIT-6 index decreased from 66 to 55 points (p<0.001). AEs occurred in 26% of cases, were transient and did not lead to discontinuation of treatment.

Conclusion. The efficacy and safety of the use of fremanezumab in CM in real-world clinical practice has been demonstrated.

The main goal of epilepsy therapy is to improve the patient’s quality of life (QoL), which is a holistic indicator that reflects satisfaction with life in various areas. Currently existing questionnaires: QOLIE-89, QOLIE-31 and QOLIE-10 are adapted for use in Russia, but require a certain, sometimes considerable amount of time to complete them and then process. The five-point scale for assessing the QoL of epilepsy patients (SCALE 5) requires answering only one question: “Grade your general well-being on a five-point school scale at this moment?” and allows to get the necessary information in seconds, without using special forms and calculation formulas. The QoL is assessed by analogy with a Russian five-point school grading system, where 5 is an excellent grade, 4 is good etc. The resulting score serves as an immediate guideline for the doctor for further treatment of the patient: with a score of 3 (satisfactory), the cause of the reduced QoL should be identified and corrected (whether it is related to the illness, adverse events, anxiety/depression, etc.), and with scores of 2 and 1, immediate intervention is required: correction of therapy, consultation with a psychiatrist, possibly hospitalization. Here we present the results of more than 25 years of using SCALE 5. SCALE 5 is easy for patients to understand and for clinicians to use in the limited time of an outpatient appointment. The typical clinical scenarios and practical recommendations for determining the SCALE 5 score presented in the article are intended to facilitate the work of specialists in the fields of neurology, epileptology and psychiatry.

Autoimmune encephalitis with antibodies against NMDA receptor (anti-NMDA encephalitis) is a relatively newly described disease that occupies a leading position among encephalitis of various etiologies. The article presents diagnostic criteria for this disease and describes a case of an atypical course of confirmed anti-NMDA encephalitis. The peculiarities of this observation are the relatively mild course of the disease with the development of generalized seizures, mental and cognitive disorders at the onset of the disease. The difficulties in diagnosis and possible pathogenetic aspects of the disease are discussed.

The incidence of neurological complications in COVID-19 can reach 8–10% of all cases of new coronavirus infection; acute cerebrovascular accidents (ACA) dominate in their structure, which cause significant social and economic costs due to the high mortality and disability rates in this group of patients. The main pathophysiological mechanism leading to the development of ischemic cerebrovascular accidents (ischemic stroke, transient ischemic attack) is the phenomenon of hypercoagulation, which, together with the systemic inflammatory response to the viral infection, leads to the formation of macro- and microthrombi and the development of ischemic disorders of cerebral circulation. The ischemic stroke associated with COVID-19 is characterized by the onset at a younger age, the predominance of cryptogenic and cardioembolic pathogenetic variants, a more frequent occlusion of large cerebral vessels and thus a more pronounced clinical picture of the disease. The reserves for reducing mortality and disability in patients with cerebrovascular disease, especially stroke, during the spread of COVID-19 lie both in the prevention, treatment and rehabilitation of COVID-19 in patients at high risk of developing cardiovascular diseases and in ensuring specialized medical care for this category of patients.

A review of studies analysing the process of humour perception under normal conditions and its disturbances in brain damage is presented. The perception of humour is considered to be a multicomponent mental activity that occurs through a series of cognitive and affective processes characterized by a specific brain organization. The results of studies on the perception of humour in healthy people and in patients with brain damage are largely inconsistent: neuroimaging studies confirm the important role of structures of both hemispheres of the brain, while clinical data indicate a significant contribution of structures of the right hemisphere to the perception of humour. Studies on humour perception in healthy individuals and clinical studies have found no differences between the neuronal correlates of verbal and non-verbal humour perception. A neuropsychological approach to the study of the structure of the process of humour perception may be important for diagnosis of affective and cognitive disorders in patients with brain damage, as difficulties in the perception of humour may reflect disturbances of the most subtle aspects of the functioning and interaction of cognitive and emotional-personal processes.

Pain in cerebral palsy (CP) occurs in 30–60% of cases. Pain associated with spasticity (PAS) is one of the most common causes of pain syndrome in cerebral palsy, which is often associated with impairment of the child’s daily life. Recently, more studies have been published on the use of botulinum toxin type A preparations to control PAS.
The review article presents the results of a special pooled analysis of data on the analgesic effect of the drug Xeomin (incobotulinumtoxin A) in the treatment of PAS based on data from three phase III multicentre prospective comparative studies in children and adolescents with spastic forms of cerebral palsy. To evaluate PAS and the effect of incobotulinumtoxin A on it, a special questionnaire (Questionnaire on Pain caused by Spasticity, QPS) was used in these studies. The QPS reflects the child's pain associated with spasticity, which can be observed at rest and during various activities of the child.
It was found that the children included in these studies reported the presence of PAS in more than 80% of cases with lower limb spasticity and in almost 70% of cases with upper limb spasticity. Parents or caregivers of these children observed an even higher prevalence of PAS. The use of incobotulinumtoxin A showed not only a pronounced antispastic effect, but also a significant reduction in the frequency and intensity of PAS in children and adolescents with cerebral palsy during normal daily activities, and during strenuous activities such as physical exercise and rehabilitation treatment. With repeated injection cycles of incobotulinumtoxin A, PAS continued to decrease, ensuring a reduction in pain even when physical activity became more difficult.
Nowadays, injections with incobotulinumtoxin A can be considered as a routine therapeutic approach for the treatment of spasticity and increased muscle tone, but it is certainly an innovative method for effective pain reduction in cerebral palsy patients with lower and upper limb spasticity accompanied by PAS.

In periodicals, vitamins and vitamin-mineral complexes (VMCs) are “accused” of having allegedly carcinogenic effects. The results of a systematic review of the literature on B vitamins presented in this paper clearly show that vitamins have at least no influence on tumour risk. When analysing experimental and clinical data on this topic, particular attention should be paid to the dosage of vitamins in monotherapy and when used as part of a VMCs.

Experts discussed the problem of comprehensive medical treatment of vertigo through vestibular rehabilitation. Peripheral vestibular vertigo is most commonly caused by benign paroxysmal positional vertigo, Meniere's disease and vestibular neuronitis, while central vestibular vertigo is caused by vestibular migraine and stroke. Vestibular rehabilitation is one of the most effective areas of treatment for patients with various disorders of the vestibular system characterized by chronic dizziness. Vestibular rehabilitation improves patients' walking and stability and can lead to an improvement in patients' daily activities and quality of life. Currently, in our country medical rehabilitation centres are being established where patients with various causes of vestibular vertigo can receive complex therapy, including vestibular rehabilitation. The Expert Council recommends the comprehensive personalised use of vestibular rehabilitation in the complex treatment of various diseases manifested by dizziness. An educational program is needed for neurologists, ENT specialists and rehabilitation specialists in treatment of patients with different types of vestibular dizziness.