There are currently about 15 million women of childbearing age worldwide who suffer from epilepsy. Overall, 0.3–0.4% of newborns are born to mothers with epilepsy, and almost half of these women experience recurrent seizures. The article discusses issues related to pregnancy planning, the prognostic impact of seizure frequency, type and course of epilepsy on pregnancy outcomes, and potential risks associated with this condition. Summarized data from the latest recommendations for correction of therapy and data on changes in the pharmacokinetics of antiepileptic drugs during pregnancy are presented. A classification of antiepileptic drugs according to their teratogenic potential and their effect on the development and behaviour of the child is presented. Various approaches to pregnancy management are discussed. In addition, scenarios for pregnancy management in poorly controlled epilepsy and status epilepticus are discussed as well as adjustment of therapy in the postpartum period and measures for the safe care of newborns.

The relationship between vascular cognitive impairment (VCI) and atrial fibrillation (AF) is mediated by multiple mechanisms, including vascular risk factors associated with a more severe course of COVID-19.

Objective: to investigate the impact of COVID-19 on the dynamics of cognitive status parameters in patients with AF over an observation period of 36 months.

Material and methods. The observational study included 51 patients (19 men and 32 women; age ranged from 46 to 73 years, mean age 57.7 years) who met the inclusion criteria. All study participants were tested at baseline and after 36 months using Montreal Cognitive Assessment (MoCA). The study took place during COVID-19 pandemic, and 25.5% of patients had documented SARS-CoV-2-associated pneumonia. During the observation period, patients received stable background therapy to prevent modifiable vascular risk factors. Two groups were formed: group 1 (n=13) — COVID-19 “+”, group 2 (n=38) — COVID-19 “-”. Patients in group 1 were more likely to have stage IIIarterialhyper-tension (46.2% vs. 17.9% in group 2; p<0.05), had a history of ischemic stroke (38.5% vs. 5.3% in group 2; p<0.05), were not vaccinated with Gam-COVID-Vac vaccine (23.1% vs. 73.7% in group 2; p<0.05).

Results. Patients with AF after SARS-CoV-2 virus infection experienced deterioration of VCI from 22.7±2.1 to 20.2±1.6 points according to MoCA (p<0.05) due to impairments in executive functions, attention, memory and speech. After 36 months of observation, the number of patients with a memory index score <7 points, which indicates a high risk of conversion of mild cognitive impairment to dementia, increased by 30.7% in group 1 and by 5.3% in group 2 (p<0.05).

Conclusion. Patients with atrial fibrillation who had COVID-19 showed a more pronounced progression of cognitive impairment despite the constant use of stable background therapy aimed at correcting modifiable vascular risk factors.

Anxiety and depressive disorders are common in restless legs syndrome (RLS); in some cases, the disease is accompanied by cognitive impairment and a deterioration in quality of life. The most important treatment method for RLS is the use of dopaminergic medications. In some cases, the use of these drugs leads to a complication - the phenomenon of augmentation, which manifests itself in an increase in RLS symptoms as the dose of medication increases.

Objective: to determine the clinical and neurophysiological characteristics of RLS patients with the augmentation phenomenon.

Material and methods. 40 patients with RLS were examined: 20 with augmentation (main group, MG; 5 men and 15 women) and 20 without augmentation (comparison group, CG; 7 men and 13 women). The median age of the patients in the MG was 63.5 [56; 71] years, and 62.0 [43.5; 71.5] years in the CG. Clinical assessment was performed using the RLS Severity Rating Scale (RS), Montreal Cognitive Assessment Scale (MoCA), Beck Anxiety Inventory, Beck Depression Inventory, Quality of Life Scale (SF-36), Insomnia Severity Index (ISI), Trail Making Test (Part A), Trail Making Test (part B), phonemic and semantic speech activity tests. All patients underwent suggested immobilization test (SIT) to assess the urge to move on a 10-point numerical rating scale (NRS) and periodic limb movements (PLM) while awake, as well as a polysomnographic examination.

Results. Augmentation significantly more frequently resulted in an expansion of the area of distribution of the urge to move and other unpleasant sensations over the entire surface of the legs (p=0.01), painful discomfort in the legs (p=0.001), early onset of symptoms (04:00—18:00; p=0.04), shortening of the latency period for the onset of symptoms (p=0.001), twitching in the legs while awake (p=0.04), taking higher doses of dopaminergic medications (p=0.004). In augmentation, the MoCA score is lower (p=0.01), such patients use fewer words in the semantic speech activity test (p=0.049), have a higher score on the RS (p=0.001) and ISI (p=0.02), a greater number of PLMs while awake according to SIT (p=0.01) compared to CG. No significant differences were found between groups in terms of age, gender, ferritin level, total score on the Beck Anxiety and Depression Inventory, SF-36 Quality of Life Scale, Trail Making Test (Part A), Trail Making Test (part B), phonemic speech activity test, polysomnography indicators (including motor activity during sleep).

Conclusion. From a clinical and neurophysiological point of view, the phenomenon of augmentation is not simply a manifestation of a more severe course of RLS but has features that reflect the pathogenesis of this disorder. During augmentation, patients tend to describe the sensations as painful and their involuntary motor activity increases. This reflects changes in the activity of the diencephalospinal tract due to excessive dopaminergic stimulation.

Objective: to determine the sensitivity and specificity of method of determining the concentration of immunoglobulin free light chains (FLCs) in cerebrospinal fluid (CSF) in the diagnosis and differential diagnosis of multiple sclerosis (MS).

Material and methods. 80 patients participated in the study. The main group consisted of 54 patients diagnosed with MS according to the 2017 McDonald criteria. The comparison group (n=26) comprised patients with other diseases of the nervous system. An enzyme-linked immunosorbent assay (ELISA) was used to determine the concentration of FLCs (kappa- and lambda-chains) in the CSF.

Results. In the group of patients with MS, an increase in the concentration of free kappa-chains (к-FLCs) in the CSF was found compared to the comparison group (p<0.001). With an increase in the concentration of κ-FLCs, a decrease in the sensitivity and an increase in the specificity of the method for the diagnosis of MS was observed. The к-FLCs cut-off value of 0.17 μg/ml had a sensitivity of 68.5 % and a specificity of 92.3 %. The cut-off value of 0.22 μg/ml had a sensitivity of 59.3 % and a specificity of 100 %. The concentrations of lambda-FLCs in the CSF in the MS group and in the comparison, group did not differ significantly (p=0.1).

Conclusion. The results obtained indicate an increase in the concentration of к-FLCs in the CSF of MS patients. This biomarker showed a high specificity for this pathology. However, further development of optimal thresholds is required to clarify the diagnostic value of CSF к-FLCs concentration in MS patients.

Objective: to study the pyramidal tract in patients with highly active multiple sclerosis (HAMS) during treatment switching from first-line MS therapy to second-line therapy due to suboptimal response.

Material and methods. 24 patients with HAMS were analyzed. Depending on the severity of pyramidal functional system (PFS) impairment according to EDSS, patients were divided into 2 groups; group 1 — 17 patients with an EDSS score of 0—2.5 points, group 2 — 7 patients with an EDSS score of ≥3 points. All patients underwent MRI of the brain according to the standard protocol. The diffusion tensor images (DTI) were processed using the DTI FiberTrak software.

Results. The volume of the pyramidal tract was decreased in patients in group 2 (p<0.001), asymmetry of the indicator was noted, in several patients a decrease in volume on the clinically intact side, which may indicate visually undetectable signs of damage of pyramidal tract. There was a clear tendency for a decrease in fractional anisotropy and a decrease in pyramidal tract length with increasing pyramidal deficit (p<0.001). Negative correlations were found between indicators of neurological deficit and pyramidal tract volume and length (Spearman's Rho=-0.5246; p<0.001) and a direct correlation between duration of MS and apparent diffusion coefficient (ADC) and inversely — with fractional anisotropy (Pearson's R=-0.290; p=0.039).

Conclusion. The observed decrease in pyramidal tract volume and length, increase in ADC, asymmetry of these indicators, correlations with the degree of pyramidal insufficiency, EDSS and duration of MS can obviously serve as additional criteria for evaluation of disease dynamics and efficacy of therapy.

Cervical dystonia (CD) is a common form of movement disorder with a high incidence of comorbid mental disorders. Rhythmic transcranial magnetic stimulation (rTMS) is effective in depression and other mental disorders, but its efficacy in CD with comorbid mental disorders has been poorly studied.

Objective: to investigate the efficacy of rTMS in CD and comorbid mental disorders.

Material and methods. Seventeen patients with CD underwent a course of 10 rTMS sessions (protocol: 1 Hz, 600 pulses to the left primary motor cortex). The severity of mental disorders, quality of life and severity of cervical dystonia were assessed using the HADS, SF-36 and CDQ-24 scales.

Results. After transcranial magnetic stimulation treatment, a significant reduction in anxiety (from 12.2±4.1 to 6.3±2.1 points; p<0.01) and depression (from 8.4±3.7 to 5.2±3.2 points; p<0.01) on the HADS scale were noted, and a significant improvement in both physical (from 37±15.2 to 45±17.3 points; p=0.017) and mental (from 31±11.2 to 38±9.6 points; p=0.008) quality of life components according to SF-36. The severity of CD according to CDQ-24 also decreased significantly (from 60.2±11.7 to 51±12.4 points; p=0.022), and there were improvements in the subscales of emotional well-being and social and family life.

Conclusion. The efficacy of rTMS in reducing the severity of both manifestations of CD and comorbid mental disorders was established.

The prevalence of drug-induced headache (DIHA) in the population is about 7%, and the relapse rate of DIHA after successful treatment is about 40% within 5 years.

Objective: to analyze the risk factors for recurrence of DIHA and to develop a prognostic model for the probability of relapse after treatment.

Material and methods. The characteristics of 117 patients with DIHA were analyzed on the basis of clinical data and questionnaire data using headache scales (MMAS-8, MIDAS, HALT, HIT-6, mTOQ-5), psycho-emotional profiles (PCS, Spielberger-Hanin Anxiety Scale, PHQ-9, BIS-11, TAS-26, SAGE test, LDQ) that were performed at the time of admission to the clinic and 9 months after the start of therapy. All patients enrolled in the study received a complex treatment that included an educational conversation, “detoxification” and symptomatic therapy during the withdrawal period along with a preventive treatment for chronic migraine (CM).

Results. It was shown that there is still a low level of diagnosing of CM and DIHA. By creating a prediction model for the likelihood of recurrence of DIHA, we were able to identify the most important factors for an unfavorable course and recurrence of excessive analgesics use: frequency of analgesic use per day (OR 15.8; 95% C113.1—23.4), degree of alexithymia (score on TAS-26 scale: OR 11.3; 95% CI 6.3—18.1), frequency of combined analgesic use per month (OR 7.1; 95% CI 4.3—11.7), degree of pain catastrophizing on the PCS scale (OR 4.7; 95% CI 1.2—7.3), duration of symptomatic drug abuse (OR 3.2; 95% CI2.1—5.7).

Conclusion. A high level of concomitant psychoemotional disorders, especially alexithymia and impulsive behaviour, is a significant risk factor for relapse and should be considered in the treatment of comorbid pathologies. It can be assumed that monoclonal antibodies against calcitonin gene-related peptides, botulinum therapy or combined treatment may be the treatment of choice in cases of ineffective prevention and detoxification attempts in the past as well as in cases of prolonged analgesic abuse.

The discovery of antibodies against aquaporin-4 (AQP4) and against myelinoligodendrocyte glycoprotein (MOG) confirmed the existence of two disease entities distinct from multiple sclerosis (MS) — neuromyelitis optica spectrum disorders (NMOSD) and myelinoligodendrocyte glycoprotein-associated disease (MOGAD). Demyelinating optic neuritis (ON) can be either idiopathic (iDON) or a manifestation of MS, NMOSD (AQP4-ON) or MOGAD (MOG-ON).

Objective: to determine the clinical features of ON and to evaluate the diagnostic value of optical coherence tomography (OCT) in demyelinating diseases of the central nervous system.

Material and methods. The study included 43 patients with demyelinating ON who were divided into three groups according to the underlying disease (NMOSD, MOGAD and MS/iDON). We assessed visual acuity (VA) in the acute phase and analyzed VA and average values of retinal nerve fiber layer thickness (RNFL) and retinal ganglion cell complex (RGC) thickness using OCT data 6 months after the onset of ON.

Results. ON was observed in the onset of the disease in 75% of NMOSD patients, 62% of MOGAD patients and 86% of MS/iDON patients. In the MOGAD and NMOSD groups, bilateral ON was predominantly observed. In 65% of patients with MOGAD (MOG-ONr), a recurrent course of ON was observed. VA was significantly lower in patients with AQP4-ON in acute phase and comparable to the MOG-ONr group in the long-term phase. VA in the onset of MOG-ON with a single episode was comparable to that of MS/iDON (p=0.2), but recovery was less pronounced (p=0.03). The most significant thinning of the RNFL and RGC complex was observed in the AQP4-ON and MOG-ONr groups. In AQP4-ON and MOG-ON groups, restoration of VA up to 0.5 and higher was observed significantly more frequently in the group of patients receiving pulse therapy with glucocorticoids (p=0.018).

Conclusion. The study showed the most pronounced structural and functional disturbances in the long-term phase of AQP4-ON and MOG-ONr. MOG-ON was characterized by a high frequency of relapses with the influence of this factor on VA and thinning of the retinal layers in the long-term.

Cladribine is a tablet preparation for the treatment of relapsing-remitting multiple sclerosis (RRMS), which is used as an immune reconstitution therapy. A population-based cohort study was conducted in 54 patients with RRMS who received cladribine tablets.

Objective: to evaluate our own experience of treating patients with highly active MS (HAMS) with cladribine tablets in real-life clinical practice in the MS Centre of the Khanty-Mansi Autonomous Area (KhMAA) — Yugra.

Material and methods. The data source is the register of MS patients of the KhMAA — Yugra. Cladribine tablets at a dose of 3.5 mg/kg of body weight were prescribed in two annual treatment cycles, each comprising 2 weeks with a treatment duration of 4—5 days — at the beginning of the first month and at the beginning of the second month. In 2021—2023, 54patients received therapy with cladribine tablets with an average frequency of exacerbations of 1.2 (62 exacerbations in 48 patients) within 12 months prior to therapy initiation. Before starting therapy and every 6 months thereafter, patients underwent magnetic resonance imaging (MRI) of the brain, cervical and thoracic regions MRI with contrast enhancement, assessment of neurological status using the Expanded Disability Status Scale (EDSS), complete blood count, monitoring of blood lymphocytes level and biochemical blood testing. After the first and second treatment courses with cladribine tablets, the lymphocyte level was assessed after 2 months and after 6 months.

Results. It was found that the average frequency of exacerbations before the start of treatment was 1.2 per year; after treatment with cladribine tablets it was 0.05 per year, i.e. the average annual frequency of exacerbations fell by 92% in the first year of treatment. Before starting treatment with cladribine tablets, only six (11%) out of 54 patients had no exacerbations; after starting the treatment with cladribine tablets, 48 (89.5%) patients had no exacerbations. The results obtained exceed the results of the CLARITY study, in which the proportion of patients without exacerbations in the cladribine group was 79.7%. In addition, all patients had no disease activity on MRI after starting cladribine therapy compared to the baseline data before starting cladribine therapy, when Gd+ lesions were detected on T1-weighted images in 50 (92.5%) patients. There was also no increase in disability. The mean EDSS score remained stable (median 3.0) or decreased by 0.5—1 point. At the end of follow-up period, 49 (92%) out of 54 patients included in the analysis achieved NEDA-3 status. No adverse events were observed during patient follow-up.

Conclusion. The experience with the use of cladribine in KhMAA is consistent with data from real-world clinical practice around the world in terms of efficacy, safety and results of randomized clinical trials. Cladribine tablets are a highly effective and safe treatment for HAMS. Further monitoring of patients is required to assess the long-term benefits and risks of cladribine.

Mutual influence between women's mental health and their reproductive capacity are not clearly understood. In particular, psychogenic factors and mental disorders affect sexual, menstrual and reproductive functions, which in turn can lead to infertility. Improving the mental state of women, on the other hand, helps to restore reproductive function.

Objective: to develop dynamic ideas about the reproductive status of mentally ill and mentally healthy women with infertility based on the results of the follow-up.

Material and methods. The study included 348 patients with infertility over a period of 2 years, 228 were mentally healthy women and 120 women with mental disorders. All women were consulted by a gynecologist, women with mental disorders by a psychiatrists, and treatment of existing disorders was carried out.

Results. Mentally healthy women have a significantly higher number of pregnancies, which is mainly due to the in vitro fertilization procedure. They have a rational approach to pregnancy planning, are characterized by a high referral rate to obstetricians and gynecologists and undergo a large number of gynecological procedures to overcome infertility. Pregnancy occurs spontaneously in mentally ill patients and is associated with an improvement in mental state and normalization of menstrual, sexual and therefore reproductive function, but is characterized by a complicated course (fetal growth retardation, miscarriage, intrauterine infection of the fetus, oedema, hypertension, lipid metabolism disorders, gestational diabetes mellitus, placental disorders) and fewer births.

Conclusion. The reproductive function of women depends on their mental state. In women with mental disorders, disturbances of menstrual and sexual function and family adaptation lead to infertility. Improving the mental state contributes to the restoration of reproductive function and spontaneous pregnancy.

Anti-CGRP monoclonal antibodies (mAb) have been approved and successfully used in Russia since 2020.

Objective: to investigate the efficacy and safety of fremanezumab (FRE) therapy (225 mg monthly or 675 mg quarterly) in real-life clinical practice in patients with migraine who referred to a specialized Russian headache center.

Material and methods. This open-label, retrospective study involved 202 patients (mean age 39.4±12.2 years) with frequent episodic (EM) or chronic migraine (CM) who received at least three injections of FRE 225 mg or three injections with a total dose of 675 mg and regularly completed the Migrebot headache diary one month before starting therapy and throughout the course of treatment.

Results. The mean number of migraine days per month decreased in the whole group from 20.1±8.2 (before treatment) to 8.5±7.9 after 12 weeks (p<0.0001), in the EM group from 10.9±4.1 to 3.6±3.7 (p<0.0001) and in the CM group - from 24.4±5.7 to 10.8±8.3 (p<0.0001). Adverse events were observed in 13 (6.4%) patients (most frequently local reactions: itching, rash, redness, induration at the injection site).

Conclusion. The study showed a favourable efficacy and safety profile of FRE in the Russian population, where anti-CGRP mAbs are considered the first-line treatment for migraine.

Sleep disorders occur twice as often in epilepsy patients compared to healthy people and have a negative impact on seizure control and general quality of life. International and Russian publications on the effect of perampanel (PER) on sleep emphasise the positive effect of the drug on sleep quality, daytime sleepiness and sleep architecture.

Objective: to evaluate the effect of PER (Fycompa®) on sleep quality and daytime sleepiness when used as an adjunct antiepileptic drug (AED) in the treatment of epilepsy in adults.

Material and methods. The study included 106 patients aged 18 to 73 years with absolute predominance of focal epilepsy (n=96) who were prescribed PER as an adjunctive AED when previous therapy was insufficient, regardless of whether or not complaints of insomnia were present. The study was conducted from April 2022 to June 2023. The maximum observation period was 12 months. The study was multicenter (10 Russian clinical centres) and designed as an observational study, with patients being monitored prospectively, but some of the indicators were collected retrospectively, taking into account the conditions of real-life clinical practice. We assessed: sleep quality using the Pittsburgh Insomnia Scale (Ya.I. Levin modification), daytime sleepiness according to the Epworth scale, anxiety/depression level (Hospital Anxiety and Depression Scale, HADS), adverse events (AEs), efficacy/tolerability of combination therapy with PER for epilepsy at baseline, and after 1, 3, 6 and 12 months of therapy based on the number of completed questionnaires at each visit in the real-life clinical practice.

Results. After a follow-up period of 12 months, the retention rate for complex therapy with PER was 84.9%. PER was discontinued in 15.1% of patients and in only 5.7% due to AEs. The most common AE was dizziness, which was observed with a frequency of over 10% (n=21), followed by irritability (n=9) and drowsiness (n=9) with the same frequency. No new, previously undescribed AEs were observed in this study. The use of PER as an additional AED led to a significant reduction in daytime sleepiness and an improvement in sleep quality after the first month of use; by the 12-month follow-up period, the daytime sleepiness index gradually decreased and reached normal levels, and sleep quality improved. The use of PER as part of a complex therapy led to a significant reduction in the initially elevated anxiety level.

Conclusion. The use of PER as an additional AED in adults in dynamics significantly improves sleep quality and reduces daytime sleepiness after the first month of use, regardless of the duration of the disease and the order of PER administration. The use of PER as part of a complex therapy led to a decrease in the initially elevated anxiety level from subclinical to normal.

Treatment of acute non-specific back pain (ANSBP) is one of the current issues of modern medicine, as ANSBP is one of the most common causes of temporary disability in the population. Non-steroidal anti-inflammatory drugs (NSAIDs) are used in ANSBP , with the drug Nalgesin® forte (naproxen 550 mg) being widely used in clinical practice.

Objective: to evaluate the efficacy and safety of the drug Nalgesin® forte in patients with ANSBP.

Material and methods. The observational study “Nalgesin® forte (naproxen) in real-life clinical practice: treatment outcomes in patients with acute non-specific (musculoskeletal) pain” included 12,434 patients (46.51% men, 53.49% women; mean age of patients – 47.3±13.8 years) with ANSBP. Pain in the lumbar region and in the neck prevailed (lumbodynia – 25.5%, lumboischialgia – 26.28%, cervicalgia – 33.03%), less frequently the pain was localized in the thoracic region (thoracalgia – 15.18%). We assessed pain intensity using numeric rating scale (NRS), indicators of the Russian version of the Kiel questionnaire, duration of therapy with Nalgesin® forte, satisfaction with the therapy and tolerability of the treatment. The patients were informed about the benign nature of the ANSBP and took the medication Nalgesin® forte 550 mg 1–3 times a day for pain relief; the medication was discontinued when the pain resolved or decreased significantly.

Results. The majority (75.9%) of patients received Nalgesin® forte at a dose of 550 mg twice daily, 14.3% – 550 mg once daily and 9.8% – 550 mg three times daily. The duration of therapy was 6–14 days in the majority (80.03%) of patients, while it did not exceed 1 week in more than one third of patients (37.2%). During treatment, the average pain intensity decreased from 6.6±1.60 to 1.82±1.32 points according to the NRS (p<0.001), the proportion of patients with initially unbearable pain decreased from 2.79 to 0.28%, with severe pain – from 27.16 to 1.10%, with moderate pain – from 60.42 to 2.82%, and the proportion of patients with mild pain increased from 9.63 to 95.8% (p<0.001). Most physicians (91.7%) were satisfied with the treatment results, and most patients (94.5%) and physicians (95.7%) were satisfied with the tolerability of the treatment. Patients with a high and medium risk of chronic pain according to the Kiel questionnaire required longer treatment than patients with a low risk of chronic pain (p=0.002). A low incidence of adverse events (AEs) was observed when taking Nalgesin® forte; no serious AEs were recorded.

Conclusion. Favourable therapeutic outcomes in ANSBP, efficacy and safety of the drug Nalgesin® forte in ANSBP of different localisations were noted.

Diagnostic hypothesis of Alzheimer's disease (AD) is based on the typical clinical picture of the disease and the exclusion of other diseases manifesting by cognitive and behavioural disorders by MRI scans of the brain and laboratory tests. For an accurate diagnosis of AD and exclusion of other diseases, detection of biological markers (biomarkers) of AD in the cerebrospinal fluid (CSF) is of great importance: a decrease in the level of beta-amyloid (Ав^ -42) and an increase in the level of phosphorylated tau protein. The analysis of AD biomarkers in the CSF of 63 patients (16 men and 47 women, mean age 72±8.7 years) with a typical picture of AD [30 patients in the moderate cognitive impairment (MCI) stage and 33 in the mild dementia stage] allowed us to confirm the diagnosis in 54 cases (85.3%) and to exclude it in the remaining nine patients (14.7%). We present a case of a 59-year-old patient with MCI in whom biomarkers typical of AD were detected in the CSF, confirming the diagnosis of AD. We also present the observations of two patients with possible AD, in whom the results of the CSF examination made it possible to rule out AD and indicated hippocampal sclerosis and tauopathy. At present, an accurate diagnosis of AD based on the study of biomarkers of the disease is of great practical importance, since at the stage of MCI and mild dementia it is possible to prevent the progression of AD with anti-amyloid therapy. Currently, AD is rarely diagnosed in our country, so it is of great importance to inform physicians about modern methods of diagnosis and treatment of AD.

We present a clinical observation of a patient with chronic musculoskeletal low back pain (CMLBP), one of the most common conditions in neurological practice. Common mistakes in the management of such patients are highlighted. The patient had previously been incorrectly diagnosed with "osteochondrosis of the spine", the back pain was by mistake associated with "age-related" organic, degenerative-dystrophic changes in the spine, and only passive treatment methods were used in the treatment — various medications, massages, physiotherapy. The factors for the development and chronification of back pain were not evaluated or corrected, therapeutic exercises were not prescribed, the rules of ergonomics and physical activity during the day were not discussed, i.e. methods that have proven to be effective and are recommended for the treatment of CMLBP. Due to an inappropriate management, the patient developed misconceptions about the disease, catastrophizing the pain and incorrect and ineffective strategies for coping with the pain, which perpetuated the chronic course of the back pain. At the Clinic for Nervous Diseases at Sechenov University, the patient was offered a comprehensive treatment approach that included educational counselling, kinesiotherapy and pharmacotherapy. Based on the patient's medical and life history and the data of an objective examination, factors for the development and chronification of back pain were identified: long-term static postures at work at a computer, physical inactivity, increased body weight, neuro-orthopedic features (“flat back”), anxiety, catastrophizing of pain, pain behavior pattern. During the treatment process, all of the above factors were considered and corrected. Kinesiotherapy included therapeutic exercises, recommendations on ergonomics and daily activity, training in correct posture and kinesio-taping. The patient took dexketoprofen as a non-steroidal anti-inflammatory drug, which is effective and relatively safe for patients with back pain. As a result of the complex treatment, the patient's pain syndrome regressed, daily activity increased and her emotional state improved; observation over 6 months showed a lasting positive effect, increasing working capacity.

Neck and shoulder disorders often occur side by side and reinforce each other in their clinical manifestations. Differential diagnosis of neck and shoulder pain can be challenging due to the close anatomical proximity, innervation of neck and shoulder structures, similarity of symptoms and groups of patients suffering from these conditions. Identifying the anatomical source of pain is the most important clinical task when choosing treatment for patients, which is reflected in two clinical observations. In the first clinical case the main complaint was pain in the shoulder; a neuro-orthopedic examination revealed evidence of radicular involvement in the form of a decrease in tendon reflex, pain provocation in Spurling and tension tests, with no evidence of involvement or pain in the joint structures of the shoulder. MRI of the cervical spine revealed signs of CVI discoradicular conflict consistent with the clinical symptoms. In the second observation, the main complaint was pain in the cervical spine and right shoulder, initially considered as radiculopathy; MRI revealed degenerative changes in the spine with possible compression of the CVI root. Neuro-orthopedic examination revealed no signs of radicular lesions; the main anatomical source of pain was coraco-acromial joint involvement, which was confirmed by diagnostic blockade of this joint. Both non-drug methods (kinesiotherapy, manual therapy, ergonomic measures) and medications (non-steroidal anti-inflammatory drugs — Airtal; muscle relaxants — Mydocalm) were used; therapeutic blockades targeting the main source of pain were performed. The cases presented show that it is impossible to determine the main anatomical source of pain based on the pain pattern. It can be determined by a thorough analysis of medical history and a detailed neuro-orthopedic examination. Neuroimaging methods should only be interpreted in the context of the clinical picture. In controversial cases, diagnostic blockades with local anesthetics can be performed to confirm the diagnosis.

Neuromyelitis optica spectrum disorders (NMOSD) are a group of immune-mediated inflammatory lesions of the central nervous system that primarily cause dysfunction and death of astrocytes, leading to secondary disruption of myelination. The optic nerve, the spinal cord, the brain stem (periventricular and periaqueductal space) and the diencephalon are most frequently affected sites. According to a meta-analysis of 25 studies, the prevalence of cognitive impairment (CI) in 761 patients with NMOSD aged 34 to 53 years was between 3 and 75%, after adjustment this figure was 34%. The most frequently observed CI in NMOSD are decreased attention and working memory function, reduced information processing speed and impaired verbal memory and fluency. A significant influence on the severity of CI in NMOSD have the patient's age, the duration of the disease, the level of education, the degree of disability and the severity of upper and lower limb dysfunction. The data collected suggest that neurodegenerative disorders, including CI, are characteristic of this pathology. The pathogenesis of CI in NMOSD is very complex and involves both mechanisms of direct damage to structures that perform cognitive functions (hippocampus, prefontal cortex) and immunological aspects (microglia, complement, interleukin 6), which requires further investigation.

Psychotic disorders in Parkinson's disease (PD) are common non-motor manifestations that have a negative impact on the quality of life of patients and are associated with an unfavourable prognosis. The development and progression of psychotic symptoms in patients with PD is due to a combination of exogenous and endogenous mechanisms, such as an imbalance of neurotransmitter systems, the effect of antiparkinsonian drugs, individual characteristics of the disease course and structural neurodegenerative changes in the brain. Given the heterogeneity of psychotic symptoms and the lack of standardized diagnostic criteria, issues of timely identification and choice of therapeutic tactics are important and require special attention from neurologists and psychiatrists in clinical practise. This review highlights modern ideas on phenomenology, risk factors, pathogenesis and therapeutic approaches.

The review addresses an approach to the treatment of early stages of Parkinson's disease (PD) and also provides data on the real-life use of different classes of drugs for the treatment of PD in comparison with other countries, as well as data from an all-Russian survey of patients with PD. In our country, dopamine receptor agonists (DRAs) are currently one of the most commonly prescribed groups of drugs in the treatment of early stages of PD. According to international studies, there is still insufficient information on the use of different classes of drugs in practice for the treatment of PD and studies on the real-life practice of prescribing them. Prescribing the first drug for the treatment of early PD should be the result of an informed shared decision between doctor and patient, in which the patient plays a crucial role. Piribedil, one of the oldest drugs for the treatment of PD and still one of the most commonly prescribed drugs for the treatment of early stages of PD, was found to be superior to other DRAs in a recent meta-analysis (2023).

High lipoprotein(a) (LP(a)) level contributes as an independent risk factor to the development of cardiovascular diseases of atherosclerotic origin. The article contains data on the structural features of this particle, the genetic determination of its metabolism and content in blood plasma, and the pathogenic mechanisms of its proatherogenic, proinflammatory and prothrombotic effects. The authors analyzed epidemiological data on the frequency of elevated LP(a) levels in different population groups and its association with the risk of cardiovascular diseases. The data presented concern the indicators of LP(a) as a risk factor for the development of ischemic stroke (including recurrent stroke) and its individual pathogenetic subtypes, as well as the relationship between LP(a) levels and functional outcomes after cerebral accidents. Current recommendations for the treatment of patients with elevated LP(a) levels in the context of primary and secondary prevention of cardiovascular diseases are analyzed.

Isolated head tremor (IHT) is a pathological condition characterized by tremor of the head without dystonic posturing or tremor in other parts of the body. In the past, head tremor was commonly referred to as essential tremor because it is very common in families of patients with essential tremor and may precede hand tremor. Several recent observations cast doubt on this theory. The irregular character of the tremor, the low efficacy of the drugs used for essential tremor and the use of botulinum neuroprotein type A with good response point to the dystonic character of the tremor. Neurophysiological evidence for a relationship between IHT and dystonia includes an altered somatosensory temporal discrimination threshold, metabolic changes according to DAT spectrography (positron emission spectrography to determine changes in dopamine levels) and a change in the blink reflex.