Narrowing of the central spinal canal in the lumbar spine (central lumbar stenosis, CLS) is one of the most common causes of lumbar pain, disability and spinal surgery in the elderly. The most common is acquired degenerative CLS, in which the main role play lumen-narrowing medial intervertebral disc herniating with ossification phenomena and marginal bone proliferation on the sides of the vertebral bodies – osteophytes, hypertrophy of the facet joints with their medial displacement, hypertrophy of the yellow ligament. The development of CLS can also be a consequence of spondylolisthesis, postoperative changes, rheumatic diseases and other causes. Both the compression of the cauda equine roots due to narrowing of the spinal canal and their ischemia, caused by compression of the radicular vessels and venous congestion play an important role in the pathogenesis of CLS. CLS develops in elderly age and occurs predominantly in men. The main clinical manifestation of CLS is neurogenic (caudogenic) intermittent claudication, which manifests as pain, numbness and weakness in the legs when the patient walks or stands for a long time but subsides when the patient sits or stands and bends forwards (flexion in the lumbar spine). The diagnosis of CLS is confirmed by magnetic resonance imaging (MRI), which shows a narrowing of the spinal canal and makes it possible to rule out specific causes of lumbar pain. It is important to note that, according to MRI, CLS often occurs at an older age, so its detection in the absence of clinical manifestations does not require an immediate discussion of the prospects of surgical treatment. Pain in patients with CLS according to MRI may be musculoskeletal in nature. Therefore, the diagnosis of CLS should include specific clinical manifestations and stenosis on MRI. In patients without clinical manifestations of CLS, osteoporosis and severe concomitant somatic diseases, only conservative therapy is recommended. Modern conservative treatment of CLS includes an educational program, therapeutic exercises (kinesiotherapy), psychological therapy methods for emotional disorders (cognitive-behavioral therapy), manual therapy and pharmacotherapy. Complex conservative treatment of CLS can reduce pain, improve the patient's condition and in some cases increase the patient's walking distance.

In 1.4–6.5% of patients admitted to the emergency department with suspected stroke, another condition is diagnosed (stroke mimicker, SM). Type of neurological event (stroke or SM) determines further patient management, both in terms of diagnostics and treatment. An error leads to a delay in the treatment of the underlying disease – stroke, epilepsy, Wernicke's encephalopathy, etc. At the same time, differential diagnosis remains primarily a clinical task, facilitated to some extent by instrumental research methods. This article presents approaches to the differentiation of stroke, transient ischemic attack and their mimickers: metabolic encephalopathies, migraine, epileptic seizures, peripheral vestibular diseases and functional neurological disorders.

Cognitive behavioral therapy (CBT) is recommended in the complex therapy of chronic migraine (CM) and medication overuse headache (MOH), but there are few randomized trials to evaluate its efficacy.

Objective: to investigate the efficacy of an interdisciplinary program with CBT in the treatment of patients with CM and MOH.

Material and methods. The study included 156 patients with CM and MOH (61 men and 95 women, mean age 34.1±8.9 years). All patients were clinically interviewed and tested with clinical and psychological methods. Patients were randomized into two groups: group 1 received standard treatment (pharmacotherapy – preventive and for migraine relief; lifestyle recommendations; detoxification therapy in MOB) and CBT, group 2 received only standard treatment. In all patients clinical and psychological parameters were assessed before treatment, and 3, 6, 12 and 18 months after the start of treatment.

Results. After 3 months of treatment, a statistically significant improvement (p<0.05) was observed in group 1: reduction in headache frequency, frequency of taking painkillers (PC), scores on the Pain Catastrophizing Scale, the Spielberger–Khanin Personal and Situational Anxiety Scale, Centre for Epidemiologic Studies Depression Scale, Leeds Dependence Questionnaire (LDQ) and the Migraine Disability Assessment (MIDAS) Questionnaire (p<0.05). The improvement achieved was maintained after 6, 12 and 18 months of therapy. After 3 months of therapy, in group 2 a statistically significant improvement (p<0.05) was observed for four parameters only: decrease of headache frequency, frequency of PC use, scores on the LDQ and MIDAS Questionnaire. However, after 6, 12 and 18 months of therapy in group 2, the achieved improvement was not maintained. After 3 months of therapy, the clinical effect (reduction in headache frequency by 50% or more) was achieved in 74% of patients in group 1 and in 45% in group 2 (p < 0.001). After 18 months of therapy, the clinical effect was observed in 79% of patients in group 1 and in 33% of patients in group 2 (p < 0.001).

Conclusion. The use of CBT in the complex therapy of patients with CM and MOH is effective and makes it possible to achieve stable positive long-term results.

Cerebral small vessel disease (CSVD) associated with age and vascular risk factors has a high prevalence and social significance. Psychoemotional changes are an early manifestation of CSVD that require methods for their correction. Objective: to evaluate and compare the efficacy of biofeedback (BF) at infra-low frequencies and alpha waves frequencies in correcting emotional changes in patients with early CSVD. Material and methods. The study included 71 patients (85% women; mean age 52.8±6.3 years) with early CSVD and 21 healthy volunteers (71% women; mean age 53.2±4.8 years). Patients were randomized into three groups using the envelope method with double-blind placebo control: BF-neurotraining at infra-low frequencies (n=25), alpha waves (n=22) and imitation of BF based on electroencephalography parameters (placebo; n=24). Fifteen 30-minute individual sessions were conducted 2–5 times per week. Clinical symptoms, brain MRI data and psychoemotional status were assessed in all participants before and immediately after the BF course and 6–8 weeks later. Results. Patients with early-stage CSVD were characterized by an medium level of situational and a high level of personal anxiety, mild symptoms of depression and an medium level of alexithymia. Infra-low frequencies and alpha waves BF-neurotrainings were comparable in terms of their efficacy in reducing personal anxiety. Alpha waves training also showed an effect in reducing situational anxiety in the long term. Infralow frequencies training also reduced the level of depression. Placebo training had no effect on the parameters studied. Conclusion. In patients with early CSVD, BF-neurotraining at infra-low frequencies and alpha waves may be one of the methods for correcting the emotional changes associated with CSVD.

Women suffering from a mental disorder are faced with the problem of pregnancy and the realisation of their reproductive rights throughout their lives. The presence of a mental disorder largely determines the onset, course and outcome of pregnancy. A deterioration in mental health is often accompanied by an impairment of menstrual and reproductive function, and an improvement contributes to their recovery.

Objective: to analyse individual indicators of reproductive function in women with various mental disorders and infertility in dynamics according to the follow-up data.

Material and methods. The study included 120 women with various mental disorders and infertility, who were observed for 2 years by a psychiatrist and a gynaecologist on the background of treatment of the existing disorders.

Results. In 70% of cases, mentally ill women have primary infertility, with idiopathic infertility predominating (63.3%), especially in the context of secondary infertility (77.8%; p<0.05). Treatment of infertility by gynaecologists and mental disorders by psychiatrists leads to the normalization of the menstrual cycle and the onset of pregnancy. Pregnancy is usually accompanied by obstetric and somatic complications (fetal growth retardation and miscarriage, placental disorders, hypertension, oedema, lipid metabolism disorders, gestational diabetes mellitus). Reproductive function is impaired mostly in patients with schizophrenia and affective disorders, they account for 80.8% of observed infertility. Fertility is lowest in patients with paranoid schizophrenia: pregnancy occurred in 12.9% of patients, none of them gave birth. In schizoaffective disorder, 43.75% of women became pregnant, but only 20% gave birth. In bipolar affective disorder (BAD) type I, pregnancy occurred in 87.5% of patients (of which 57.1% resulted in a childbirth), in bipolar disorder type II – in 43.75% (of which 42.8% resulted in a childbirth), and in recurrent depressive disorder – in 60% (of which 50% resulted in a childbirth). In these disorders, the duration of infertility correlates with the duration of the disease (p<0.05). In neurotic disorders, fertility suffers to a lesser extent: pregnancy with recovery or significant improvement of the mental condition occurred in 75–100% of cases, but only 66.7% of cases resulted in a child birth. Childbirth was mainly performed by caesarean section.

Conclusion. Reproductive function in mentally ill women depends largely on the type of mental disorder, the characteristics of its course, the efficacy of psychopharmacotherapy, the quality of remission and the degree of social and family adaptation, which must be taken into account in the diagnosis and treatment of infertility.

A complex approach including an educational program, ergonomics, kinesiotherapy and pharmacotherapy is effective in the treatment of patients with chronic non-specific back pain (CNBP). The efficacy of complex treatment with personalized kinesiotherapy in patients with CNBP and comorbid disorders has not yet been sufficiently investigated.

Objective: to evaluate the efficacy of a complex treatment including special kinesiotherapy, standard pharmacological and non-pharmacological methods in patients with CNBP and comorbid disorders.

Material and methods. The study included 60 patients (12 men and 48 women, mean age 38.3±8.7 years) with CNBS and comorbid disorders (neck pain, insomnia, tension type headaches, anxiety and/or depressive symptoms). Patients were randomized into two groups: group 1 received complex treatment, including special kinesiotherapy, standard therapy (educational program, standard kinesiotherapy, non-steroidal anti-inflammatory drugs, muscle relaxers, antidepressants in some patients), group 2 – standard therapy. The clinical and psychological parameters of all patients were analyzed at baseline, and after 1, 3 and 6 months of treatment.

Results. After 1 month of treatment, the clinical effect (CE) in terms of CNBS (reduction of back pain (BP) intensity according to the numerical rating scale and Oswestry questionnaire by 30% or more) was achieved in 80% of patients in group 1, which is statistically significantly (p<0.05) higher than in group 2 (46.7% of patients). By month 3 of observation, the number of patients achieving CE increased to 86.7% in group 1 and decreased to 36.6% in group 2. After 6 months, all patients in group 1 maintained the achieved CE, while in group 2 only 30% of patients maintained CE. In group 1, a complete regression of BP was observed in more than one third of patients at month 3 and 6 of observation (33.3 and 36.6%, respectively). In group 2, no regression of BP was observed in any case. In group 1, in contrast to group 2, a statistically significant (p<0.05) decrease in scores on the Beck Pain Catastrophizing Scale, the Kinesiophobia Scale, Beck Anxiety and Depression Scale, the Insomnia Severity Index, Headache Impact Index and Neck Pain Disability Index was observed. The decrease continued until the 6th month of observation.

Conclusion. A complex treatment comprising special kinesiotherapy, standard non-drug and drug therapy leads to a rapid (after 1 month) positive effect in patients with CNBP and comorbid disorders that lasts over a long period of time (6 months).

Chronic cerebrovascular diseases (CVD) and neurodegenerative diseases (NDD) are the most common causes of cognitive impairment (CI). The development of dementia is preceded by mild CI (MCI) over several years.

Objective: to investigat the effect of inhaled nitric oxide therapy on cognitive function (CF) in patients with MCI due to CVD and NDD.

Material and methods. The study included 94 patients (25 men and 69 women aged 50 to 76 years, mean age 65.3±8.9 years) with MCI due to CVD and/or NDD of the brain. The patients were randomized into two groups: the main group (therapy) and the control group. The control group comprised 22 patients with MCI (5 men and 17 women aged 50 to 76 years, mean age 62.3±8.5 years) who received standard therapy (antihypertensive, antithrombotic and other agents). The main group comprised 72 patients (20 men and 52 women aged 50 to 76 years, mean age 66.2±8.0 years) who additionally inhaled a nitric oxide-enriched air mixture for 30 minutes daily using the Tianox device. Each patient had from 7 to 10 inhalation sessions (the first trial session lasted 20 minutes, the following sessions 30 minutes). Neuropsychological tests, emotional state and sleep quality were examined at the beginning and 3 and 6 months after the end of treatment. Results. In the main group, after 3 and 6 months, a significant (p<0.05) improvement in CF was found according the Montreal Cognitive Assessment (MoCA-test), Frontal Assessment Battery, the Digit Forward and Backward Span Test, the Digit Symbol Substitution Test, the Munsterberg Test, the Literal Association Test and the 12-word Delayed Free Recall Test. A significant (p<0.05) decrease in anxiety and depression according to the Hospital Anxiety and Depression Scale, the Beck Depression Inventory and the Spielberger Anxiety Scale as well as an improvement in sleep quality according to the Insomnia Severity Index were also observed. The therapy was well tolerated, and no serious adverse events occurred. No significant improvement in CF, emotional state or sleep was observed in the control group.

Conclusion. Brief therapy (7–10 sessions) with inhaled nitric oxide improves the CF and emotional state of patients with MCI on a background of CVD and NDD. Further studies on inhaled nitric oxide therapy in patients with MCI in a multicenter randomized trial with sham treatment are needed.

Depression and anxiety are among the most common disorders observed in patients after COVID-19 coronavirus infection.

Objective: to evaluate the antidepressant efficacy and tolerability of agomelatine in patients with a depressive episode (DE) after COVID-19 infection in everyday clinical practice.

Material and methods. The multicenter observational study TELESPHOR included outpatients aged 18 to 65 years who developed DE (Hamilton Depression Rating Scale (HAMD-17) score of 8–24) within 3 months of the resolution of a laboratory-confirmed COVID-19 infection and started monotherapy with agomelatine. Patients were assessed at enrolment and subsequently at weeks 2, 4 and 8 of the observation period. The primary endpoint was the change in HAMD-17 scores by week 8 of the observation in patients taking agomelatine as an antidepressant. The main secondary outcome variables were the dynamics of scores for items 10 (psychic anxiety) and 11 (somatic anxiety) of the HAMD-17 scale, the proportion of responders and remitters (according to the HAMD-17 scale) and the impact on quality of life (QOL) according to the SF-36 questionnaire. The tolerability of agomelatine was assessed at each visit. Data from all patients who participated in the study and took agomelatine at least once were included in the efficacy and safety analysis. The final analysis included data from 103 patients, including 73 women (70.9%).

Results. Treatment with agomelatine was associated with a significant improvement in depression severity: the mean HAMD-17 total score decreased statistically significantly at weeks 2, 4 and 8 from 16.3±4.7 at study inclusion to 13.7±4.5, 9.5±4.9 and 5.4±3.6 points – by 2.6±3.3, 6.7±5.3 and 10.9±4.9 points, respectively, compared to baseline (p<0.0001 for all time points). The average score for item 10 (psychic anxiety) and item 11 (somatic anxiety) of the HAMD-17 scale also decreased significantly from 1.4±0.9 and 1.3±0.8 at baseline to 0.5±0.6 and 0.6±0.6 points by the eighth week of observation (p<0.0001). The indicators of the scales for physical functioning and mental health of the SF-36 questionnaire improved significantly compared to the initial values – from 39.7±8.4 to 50.5±5.7 points (p<0.0001) and from 37.3±8.6 to 58.7±6.9 points (p<0.0001) respectively, by the eighth week. The proportion of responders was 81.4 %, the proportion of remitters was 71.6%. Agomelatine was well tolerated during the entire observation period. No adverse events were recorded that led to discontinuation of the drug. One patient showed inefficacy of the treatment, so he discontinued participation in the study.

Conclusion. The treatment of patients with DE after COVID-19 with agomelatine is characterized by significant antidepressant and anxiolytic efficacy, improved QOL and good tolerability.

The quality of medical care largely depends on the mental well-being of medical staff. One of the most common manifestations of work-related distress is emotional burnout syndrome (EBS). The emotional burnout in psychiatrists is favored by many specific work factors.

Objective: to investigate the relationship between EBS in psychiatrists and the outcomes of the care they provide.

Material and methods. Eighty-two psychiatrists working in psychiatric clinics in Moscow took part in the study. They completed the Maslach Burnout Inventory on their own. Two hundred medical records of hospitalized patients suffering from paranoid schizophrenia were selected. A total of 100 patient records of psychiatrists with emotional burnout and 100 patient records of psychiatrists without emotional burnout were analyzed.

Results. Emotional burnout was found in 25.6% of psychiatrists. In cases of emotional burnout, psychiatrists were more likely to prescribe anticholinergic corrective medication for extrapyramidal symptoms (61% versus 44%; p=0.023). The presence of emotional burnout in psychiatrists correlated with a longer duration of hospitalization of patients they cared for (31.2 versus 29 days; p=0.004) and with more frequent polypharmacy (67% versus 51%; p=0.031).

Conclusion. Emotional burnout in psychiatrists has a negative impact on the quality of care they provide.

Over the past decade, a large amount of data has been obtained on the role of the gut microbiota in the development of diseases of the nervous system. In particular, the literature contains data on the composition of the gut microbiota in multiple sclerosis (MS). However, the body's microbiome is not limited to the gut microbiota. Of particular interest are the body fluids that are in direct contact with the nervous tissue, such as cerebrospinal fluid (CSF). In our previous studies, we have already analyzed the CSF in different variants of MS course and found the markers of different microbes, which confirms the hypothesis of the association of MS with polymicrobial infection. No less interesting is the transitional state – radiologically isolated syndrome (RIS), in which less attention was paid to analyzing the microbiome.

Objective: to evaluate the content of microbial metabolites in the CSF of individuals with RIS and in the control group.

Material and methods. The content of microbial markers in the CSF was determined using gas chromatography-mass spectrometry in 10 individuals with RIS and in 10 individuals in the control group.

Results. We found a statistically significant increase in the content of microbiota markers in the CSF of individuals with RIS, namely a statistically significant increase in the content of markers of Epstein–Barr virus, Propionibacterium acnes bacteria, Pseudomonas, Moraxella and Acinetobacter.

Conclusion. The results of this study are consistent with the hypothesis of a possible association between MS and polymicrobial infection, particularly infection with Epstein–Barr virus.

Multiple sclerosis (MS) and cerebral palsy (CP) are chronic disabling diseases caused by central nervous system affection. The diagnosis of a chronic illness in a child is a psychotraumatic event that disrupts the structure and functioning of the family system, the psychological well-being and the health of family members. In the process of adapting to the stress factor, both parent-child relationships and marital relationships are deformed. In most families raising disabled children, disharmonious parenting styles prevail. Parents report a decrease in quality of life, dissatisfaction with their role and family relationships, experience anxiety, depression, guilt and helplessness and try to compensate for the psychological distress by focusing on the child's problems, often sacrificing their private life and free time. In addition, parents of children with MS are burdened by a sense of insecurity related to the difficult-to-control and unpredictable course of the disease. The lack of a sufficient number of scientific studies on this topic does not allow us to draw clear conclusions about the influence of the type of child's disease progression (progressive, stationary) on the characteristics of the parent-child relationship. In addition, longitudinal studies are needed to assess the dynamics of parent-child relationships and the effectiveness of psychocorrective interventions in families with children with MS and CP. The review is based on a theoretical study of the issues of parent-child relationships in families raising children with CP and MS and the impact of chronic disabling illness on the family system, which was conducted based on a systematic literature search of PubMed, Google Scholar, eLibrary and DisserCat databases.

Regulation of blood nitric oxide (NO) levels is an essential component of maintaining cerebrovascular and cardiovascular blood flow. The production of NO in the vascular endothelium is influenced by numerous factors, including the supply of macro- and micronutrients. This article presents the results of systematization of data on the relationship between NO metabolism and nutrient factors. Particular attention is paid to the effect of group B vitamins (folates, vitamins B1, B2, B7 and B12) and the microbiome on vascular endothelial function, NO synthase activity and the prevention of oxidative-nitrosative stress. The correction of deficiencies in these vitamins (group B, A, C, E, D3), magnesium and calcium is an important part of the prevention of stress and a variety of diseases of the nervous system associated with endothelial dysfunction.

Back pain and headache are the most common pain syndromes and have a significant impact on patients' quality of life. In the process of pain chronification emotional-affective, cognitive and motivational components can be distinguished. Cognitive impairments (CI), such as attention deficits, memory loss, reduced learning and decision-making abilities, are observed in almost one third of patients with chronic pain. The spectrum of CI in patients with chronic back pain is age-dependent. Primary headaches are also associated with the development of CI. An important measure to prevent CI in chronic pain is effective pain relief. Lornoxicam is a non-steroidal anti-inflammatory drug that acts at different levels of pain formation. The mutual influence of back pain and headache on cognitive function and the maintenance of cognitive potential in the complex treatment of patients are discussed.

Depression and sialorrhea are among the most common and distressing non-motor symptoms of Parkinson's disease at all stages of the disease. They impair the patient's quality of life and ability to function and mutually reinforce each other in the context of comorbidity. To date, the exact pathophysiological mechanisms underlying the development of these conditions and the contribution of dopaminergic regulatory system dysfunctions to their development are unclear. Although there are established methods to treat both depression and sialorrhea, there is still no recommended standardized therapeutic approach to correct their combination in Parkinson's disease with the possibility of reducing polypharmacy. Botulinum toxin therapy has several potential advantages and is considered a possible universal remedy for achieving stable remission of these disorders.

Acute vestibular vertigo (AVV) is manifested by the illusion of movement of surrounding objects in front of the eyes or the sensation of movement of one's own body in space. The cause of AVV is in most cases a pathology of the peripheral vestibular analyser, in rarer cases – involvement of the brain stem. Headaches, neck pain, anxiety-depressive disorders, unsteadiness when walking, reduced cognitive abilities and general weakness often complicate AVV, significantly impair quality of life and slow down recovery. Treatment of patients with AVV should include rapid relief of an acute attack to prevent the development of these symptoms, increase patient compliance with vestibular rehabilitation and reduce the risk of developing anxiety-depressive syndrome. As a drug therapy for AVV, a fixed combination of dimenhydrinate and cinnarizine (Arlevert) is effective; it has a minimal sedative effect compared to other vestibular blockers and helps to rapidly reduce the intensity of dizziness and vegetative symptoms. Vestibular gymnastics promotes the processes of natural habituation, reduces the severity of instability and the risk of falling and increases motor activity. All patients with dizziness should have their mental state assessed and existing disorders corrected in collaboration with psychiatrists and cognitive behavioural therapists.

Cognitive impairment (CI) is one of the most common disorders in elderly. As the population ages, the prevalence of cognitive impairment CI is also increasing. The importance of early identification of individuals with mild CI (MCI) lies in the fact that timely diagnosis of these disorders increases the potential for secondary prevention and therapeutic intervention, which can delay or even prevent the onset of occupational and social maladaptation due to the development of dementia. The current principles of classification of the MCI and the criteria for its diagnosis are presented. Current approaches to the treatment of patients with CI are discussed. It is shown that treatment should start as early as possible and include both non-pharmacological and pharmacological approaches to improve cognitive abilities and prevent CI progression. The possibilities of modern neuroprotective and symptomatic therapy of MCI and the role of choline alfoscerate in the treatment of MCI and dementia are presented. The results of the multicenter placebo-controlled ASCOMALVA study are discussed, in which the addition of choline alfoscerate to donepezil therapy in patients with Alzheimer's disease and cerebrovascular disease helped to slow the progression of CI, reduce the severity of the disease, and had a positive effect on the behavioral functions and emotional status of both patients and their caregivers. In addition, a decrease in the progression of cerebral atrophy was observed. A new form of choline alfoscerate (Cerpechol) for oral administration is reported that may increase patients' compliance and can be used in patients with dysphagia.

One of the modern components of complex rehabilitation of patients with spasticity is the use of botulinum toxin type A (BTA) preparations. International experience with the use of botulinum therapy in children spans more than 30 years. Abobotulinum toxin A has been used to treat spasticity since 1994. Clinical studies have shown the high efficacy of abobotulinumtoxin A in relieving spasticity of the lower and upper extremities in cerebral palsy (CP) and other disorders, which is associated with a significant increase in muscle tone, thereby increasing motor skills and achieving individual patient goals. The article presents a consensus of Russian experts on the approach to selecting target muscles and calculating the dose of abobotulinumtoxin A in multilevel injections, and discusses the planning of repeat injections, ethical and legal aspects of botulinum therapy in children, the combination of botulinum therapy with other methods of correcting spasticity in CP, the use of BTA in dystonia and sialorrhea, and factors potentially influencing the effectiveness of botulinum therapy. This consensus summarizes the views of Russian experts on creating an injection protocol depending on individual clinical data and treatment goals, which can be used as a guide for practical work.

In Russian Federation in 2022, the Expert Council adopted the main definitions and terms for neuromyelitis optica spectrum disorders (NMOSD) and proposed a treatment algorithm for patients with NMOSD with antibodies to aquaporin-4 (AQP4-IgG). The publication is intended to present the results of the work of the Russian Expert Council in September 2024. The experts agreed on clarifications of previously published terminology, new definitions, current issues in the therapy of NMOSD, proposed profiles of patients with NMOSD for ravulizumab and a monitoring plan during treatment with this drug, and agreed on an updated algorithm for prescribing medications that prevent exacerbations in patients with NMOSD with AQP4-IgG aged 18 years and older.