Currently, there is an increase in the life expectancy of patients with multiple sclerosis (MS) due to the improvement of their medical care and the use of disease-modifying therapies (DMTs). Due to the increase in life expectancy, the problem of cognitive impairment (CI) in MS patients becomes relevant. It has been shown that the risk of developing Alzheimer's disease in MS patients aged 45 to 64 years is 4–6 times higher than in the general population. The main non-modifiable risk factors for CI in MS are carriage of HLA-DRB1*15:01, PSEN1, PSEN2, APP, APOE ε4 genes, old age (60 years and older), male gender, prolonged course of the disease, high degree of disability according to EDSS. Modifiable risk factors for CI in MS patients are high levels of anxiety and depression, presence of diabetes mellitus, vascular risk factors, smoking, and drug use. The protective factors for MS include the use of DMTs, high cognitive reserve, high level of physical and social activity.

Neuromyelitis optica spectrum disorders (NMOSD) are rare autoimmune diseases of the central nervous system (CNS) that often lead to severe disability. Early diagnosis of NMOSD allows effective treatment to be started as soon as possible. Errors in the diagnosis of NMOSD, which can lead to delayed treatment of patients, may be due, among other things, to incorrect interpretation of diagnostic criteria.

Objective: to investigate the frequency and causes of misdiagnosis of seronegative NMOSD (without antibodies to aquaporin-4 – AQP4-IgG). Material and methods. A retrospective and prospective analysis of data from 144 patients who were referred to the Russian Сenter of Neurology and Neurosciences with a diagnosis of NMOSD without antibodies to aquaporin-4 (AQP4) was conducted. This cohort of patients was tested for compliance with the 2015 NMOSD diagnostic criteria.

Results. NMOSD without AQP4 antibodies was confirmed in 10 patients (6.94%). Alternative diagnoses were: multiple sclerosis – 42 patients (29.17%), non-inflammatory CNS diseases – 29 (20.14%), diseases associated with antibodies to myelin oligodendrocyte glycoprotein – 19 (13.19%), myelitis – 18 (12.5%), optic neuritis – 14 (9.72%), clinically isolated syndrome – 12 (8.33%). Reasons for misdiagnosis: failure to take into account spatial dissemination, non-compliance with additional MRI criteria, ignoring 'red flags' and underestimating anamnestic data.

Conclusion. The frequency of misdiagnosis of NMOSD without AQP4 antibodies was 93.06%. The diagnosis of NMOSD should be established in strict accordance with diagnostic criteria, provided that all alternative causes have been ruled out.

Objective: the aim of the AQUARELLE trial was to evaluate the efficacy of divozilimab compared with a historical control (placebo) and to characterise its safety in patients with neuromyelitis optica spectrum disorder (NMOSD).

Material and methods. The AQUARELLE clinical trial population included patients aged 18 years and older with a diagnosis of NMOSD established in accordance with the international consensus diagnostic criteria for NMOSD (2015). The primary efficacy endpoint was the mean annual rate of confirmed exacerbations (MAR) over 6 months of treatment with divozilimab compared with a historical control, which was the placebo from the N-MOmentum study.

Results. A total of 105 patients received treatment with the investigational drug divozilimab. At the time of analysis, the proportion of patients without confirmed exacerbations was 94.3% (99/105); the ARR was 0.124 (95% CI 0.056–0.276). The ARR ratio for divozilimab /historical placebo was 0.172 (90% CI 0,083–0,359), indicating the superiority of divozilimab compared to historical placebo over 6 months of therapy. During divozilimab therapy, a therapy-related decrease in lymphocyte count was reported in 16 (15.2%) patients, and infusion reactions were reported in 6 (5.7%) patients. The overall incidence of therapy-related infectious events was 6 cases (5.7%).

Conclusion. Within patients with NMOSD, the use of divozilimab reduces the risk of exacerbations. The good tolerability of the drug allows divozilimab to be recommended as a new therapeutic option for patients with NMOSD.

Multiple sclerosis (MS) is an autoimmune demyelinating and neurodegenerative disease of the central nervous system (CNS) that affects young people. It has been established that CD14⁺ monocytes and T-helpers (CD4⁺ T cells) play an important role in both the development and maintenance of autoimmune neuroinflammation in MS. Noradrenaline is one of the key neurotransmitters of the CNS, which, along with regulating neuropsychological functions, also participates in the modulation of cells of the innate and adaptive immune response.

Objective: to investigate the effect of noradrenaline on CD14⁺ monocyte-induced activation of CD4⁺ T cells in patients with relapsing-remitting MS.

Materials and methods. A comprehensive clinical and immunological examination was conducted on 12 patients with relapsing-remitting MS and 12 healthy donors. The effect of noradrenaline on the production of interleukin 6 (IL6) and IL1 β by CD14⁺ monocytes, which are necessary for the differentiation of Th17 cells, as well as on the activation of the PKA–CREB signalling pathway in CD14⁺ monocytes, was assessed. In addition, the effect of noradrenaline on the ability of CD14⁺ monocytes to induce the production of IL17 and interferon γ by autologous CD4⁺ T cells was evaluated.

Results. Noradrenaline suppressed cytokine production by CD14⁺ monocytes in both groups, as well as activation of the PKA–CREB signalling pathway in the group of healthy donors. Noradrenaline also suppressed the ability of CD14⁺ monocytes to induce IL17 production by autologous CD4⁺ T cells in both groups.

Conclusion. Preliminary data indicate that noradrenaline has an anti-inflammatory effect in MS, which may be mediated by its influence on the function of CD14⁺ monocytes.

For a comprehensive study of such a socially significant disease as multiple sclerosis (MS), which occurs predominantly in people of working age and in which neuroinflammation and neurodegeneration go hand in hand, resulting in irreversible damage to the brain and spinal cord, the key point is to decipher the pathophysiological mechanisms of its development and progression. Despite the established relationship between hyperhomocysteinemia and secondary endothelial damage, data on the possible role of homocysteine (Hcy) in disease progression are quite contradictory.

Objective: to investigate the informative value of determining the content of markers of oxidative stress, mitochondrial and endothelial dysfunction in patients with MS.

Material and methods. The study included 63 patients with MS (40 women, 23 men) aged 35 [30; 43] years. The control group consisted of 43 healthy volunteers (22 men, 21 women) aged 37 [32; 44] years. Depending on the therapy received, patients were divided into two groups: those receiving first-line and second-line therapy; patients receiving natalizumab therapy were considered separately. A neurological examination of patients was performed with an assessment of disease severity using the EDSS scale, and the disease progression index was calculated. The following biomarkers were also determined in the blood of patients and volunteers using enzyme-linked immunosorbent assay: intercellular adhesion molecules (ICAM-1), S-adenosylmethionine, S-adenosylhomocysteine, cysteine, cysteinylglycine, glutathione, and Hcy.

Results. A statistically significant correlation was found between disease severity (EDSS disability level) and increased Hcy levels. A statistically significant increase in ICAM-1 levels was also found in patients during periods of disease activity (clinical exacerbation, activity according to MRI data), which allows this molecule to be considered as a biomarker of endothelial dysfunction and inflammation.

Conclusion. The results of the study indicate the need to continue studying the pathophysiological causes of the onset and progression of MS, further identifying new biomarkers for predicting the course of MS, and evaluating the effectiveness of drugs that alter the course of MS.

Neuromyelitis optica spectrum disorders (NMOSD, formerly known as opticoneuromyelitis or Devic's disease) are severe chronic autoimmune inflammatory diseases of the central nervous system (CNS) associated with high disability in the absence of adequate treatment. In Russia, no assessment of the medical and social characteristics of this disease and the quality of life of patients has been conducted, which complicates the assessment of the prognosis and the development of medical and social management strategies for these patients.

Objective: to analyse the medical and social characteristics and quality of life of patients diagnosed with NMOSD (opticoneuromyelitis).

Material and methods. The condition of patients with a confirmed diagnosis of NMOSD or opticoneuromyelitis was assessed using a specially designed questionnaire, which also included questions about patients' attitudes towards their health. The SF-36 international quality of life questionnaire was used to score quality of life. Based on the results of the study, 280 patients diagnosed with NMOSD were surveyed in 21 regions of the Russian Federation.

Results. Most patients with NMOSD who are observed by neurologists receive specialised treatment, but half of all patients with NMOSD currently experience some difficulties in obtaining drug therapy. Over the past year, 28.6% of respondents reported an improvement in their health, 39.6% reported no change, and 31.8% reported a deterioration. Self-assessment of health status declines sharply in patients over 55 years of age. The majority (74%) of patients report a decline in vision. Every second patient noted a decrease in vision at the onset of the disease. Severe movement disorders are characteristic, and for the majority (91%) of patients with NMOSD, strenuous physical activities such as running and weight training are not possible. Patients with disability groups I or II are more limited in their physical and mental resources. Patients receiving treatment significantly better assess changes in their health over the past year, both physical and psychological. Those who receive specialized drug therapy have a much better perception of their own health and its prospects. The SF-36 quality of life indices for NMOSD are significantly lower than normal, primarily in terms of physical condition, but also in terms of psychological well-being.

Conclusion. In NMOSD, there are pronounced changes in the quality of life of patients, both according to the original questionnaire and according to the SF-36 scale. Receiving timely and adequate treatment significantly improves these indicators and the prognosis.

The combination of polyethylene glycol with interferon beta-1a has expanded the therapeutic possibilities for treating multiple sclerosis (MS). By prolonging the half-life of interferon beta-1a and increasing its effect, this new formula provides safe and effective first-line therapy with reduced frequency of administration.

Objective: to investigate the safety and efficacy of intramuscular sampeginterferon beta-1a (SPI) in patients with relapsing-remitting MS, as well as factors influencing discontinuation of treatment.

Material and methods. Data from 14 patients with relapsing-remitting MS with mild activity who received SPI therapy at the Moscow Region Multiple Sclerosis Centre between June 2024 and May 2025 were analysed.

Results. During the year prior to the appointment of SPI, exacerbations of MS were observed in almost half (40%) of patients; during the period of SPI therapy (1 year), there were no exacerbations. The positive effect of SPI was confirmed by brain neuroimaging data and the absence of an increase in neurological deficit on the EDSS scale throughout the observation period. All recorded adverse reactions were of first or second degree severity and did not require discontinuation of SPI. A distinctive feature of SPI use was a significant reduction in the frequency of local reactions, which contributed to increased patient adherence to the therapy.

Conclusion. Preliminary analysis results demonstrate the efficacy and safety of SPI therapy in patients with relapsing-remitting MS. Infrequent injections of the drug contribute to increased patient adherence to pathogenetic treatment and improved quality of life.

Demyelinating diseases (DD) are chronic autoimmune disorders of the central nervous system (CNS) with a high level of disability. The prevalence of pain syndrome (PS) in DD is 66.5%. The most common type of PS is central neuropathic pain syndrome (CNPS), which is difficult to treat. The neurobiological mechanism underlying CNPS remains unclear. Recent studies have shown that neuroinflammation, mediated by pro-inflammatory cytokines and chemokines, plays an important role in the onset and maintenance of neuropathic pain (NP). Determining the level of pro-inflammatory cytokines may be of prognostic value in patients with DD and CNPS for determining further management tactics.

Objective: to study the concentration of proand anti-inflammatory cytokines in patients with DD and concomitant CNPS.

Material and methods. Based on the interferon laboratory of the I.I. Mechnikov Vaccine and Serum Research Institute and the cytokine laboratory of Vector-Best JSC, the cytokine profile was studied in 23 patients with DD (9 patients with MS with lesions of demyelination in the spinal cord and 14 patients with NMOSD). The main group consisted of 13 patients with concomitant pain syndrome, and the comparison group consisted of 10 patients who did not complain of pain. The control group consisted of 13 healthy volunteers. The concentration of cytokines was studied: interferon α (IFNα), IFNγ, interleukin 6 (IL-6), IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, monocyte chemoattractant protein 1, IL-1β, IL-18, tumour necrosis factor α (TNFα), soluble tumour necrosis factor receptor 1 (S-TNF-R1), and vascular endothelial growth factor.

Results. Patients in the main group with CNPS had higher concentrations of IL-8 (p₃=0.016), IL-18 (p3=0.021) and S-TNF-R1 (p₃=0.013) in their blood serum compared to patients in the control group. The concentrations of TNF-α (p₁=0.006; p₂=0.039) and S-TNF-R1 (p₁=0.027) were significantly higher in the groups of patients with DD compared to healthy individuals. With mitogen-induced stimulation, patients in the main group showed increased IL-10 production compared to the control group (p₁=0.002) and the comparison group (p₃=0.003). The nature of IL-18 production (both during spontaneous synthesis and mitogen-induced stimulation) differed significantly in the group of patients with CNPS – both types of production of this cytokine were significantly higher than in other comparable groups (p₁=0.004; p₁=0.006; p₃=0.002).

Conclusion. The results of this study confirm the key role of pro-inflammatory cytokines in the pathogenetic mechanisms of neuroinflammation, which requires further study in clinical practice to develop new effective therapeutic strategies.

Advanced neuroimaging methods can improve the differential diagnosis of neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS). The presence of central vein sign (CVS) in areas of demyelination is a characteristic feature of MS and allows to distinguish this nosology from other diseases accompanied by changes in the white matter of the brain.

Objective: to evaluate the significance of detecting CVS on a 3.0 T MRI scanner during differential diagnosis between NMOSD and MS in real clinical practice.

Material and methods. The clinical picture and neuroimaging data (3.0 T MRI) of 19 patients aged 23 to 60 years (10 men and 9 women) were analysed. including nine patients with highly active MS (HAMS), four with NMOSD with antibodies to aquaporin-4 (AQP4), and six with demyelinating disease of the central nervous system (DD CNS), whose diagnosis required clarification. The average age of patients with MS was 30.6±4.9 years, with NMOSD – 52.3±5.1 years, and with DD CNS – 34.2±7.7 years. The average duration of the disease was 6.8±3.4 years for MS, 8.8±8.3 years for NMOSD, and 5.8±3.1 years for DD CNS. The Expanded Disability Status Scale (EDSS) was used to assess neurological status. In addition to the routine brain MRI protocol, 3D T2-FLAIR and 3D EPI SWI images were obtained. All images were taken before the contrast agent was administered. The data obtained were combined by superimposing T2-FLAIR images on SWI images in the MRViewer application of the Philips IntellispacePortal workstation with visual verification of the correctness of the alignment. Then, a qualitative analysis of the images was performed to identify foci along small venous vessels (CVS). CVS were assessed in lesions with a diameter of at least 3 mm located periventricularly or subcortically. Lesions in the artifact zone, infratentorial and juxtacortical were not evaluated. We used CVS as an auxiliary technique in the differential diagnosis of MS and NMOSD with the absence of AQP4 antibodies.

Results. The highest number of lesions with CVS (15.6±7.5) was observed in patients with MS, while in patients with NMOSD the number of cerebral lesions was minimal, and only one patient had a single lesion with CVS. A significant (p<0.05) difference was noted between the MS and NMOSD groups, as well as between the MS and DD CNS groups (6.5±5.3) in terms of the average number of lesions per patient and the median number of lesions per patient, as well as in terms of the average number of lesions with CVS between the MS and NMOSD groups, MS and DD CNS, NMOSD and DD CNS. As a result of the decision rule applied, the nosological diagnosis of MS or NMOSD was further refined, which made it possible to start pathogenetic therapy in the presented patients.

Conclusion. Within patients with NMOSD, the absence or small number of lesions with CVS may be an auxiliary differential diagnostic criterion with MS and DD CNS.

Depressive spectrum disorders remain one of the most significant problems in modern clinical medicine. Despite the abundance of available treatment methods, a significant proportion of patients do not achieve complete remission, which negatively affects their prognosis.

Objective: to evaluate the antidepressant, anti-asthenic and pro-cognitive effects of Laennec human placenta hydrolysate (hPH) when added to basic psychopharmacotherapy in patients with monopolar depression.

Material and methods. The study was conducted at the Clinic of Psychosomatic Medicine at Sechenov University. It included patients with a verified diagnosis of monopolar depression and indications for the prescription of Laennec hPH (steatohepatitis, recurrent herpes, atopic dermatitis). The sample consisted of 60 patients. Patients were randomised into two groups of 30 people (active and control groups). Both groups received antidepressant therapy in accordance with the current recommendations of the Ministry of Health of Russia. Patients in the active group also received a course of Laennec hPH infusions, while those in the control group received a course of intravenous sham of this drug. The patients' condition was assessed before the start of therapy and 4 and 12 weeks after the start of therapy using the MADRS, MFI-20, DSST and USEFO psychometric scales.

Results. Both groups showed positive dynamics on all scales studied after 4 and 12 weeks of therapy. However, significant differences in antidepressant effect between the groups were recorded only after 12 weeks of therapy (11.2±1.6 vs. 11.5±1.9 after 4 weeks and 5.6±0.9 vs. 10.6±1.0 after 12 weeks; p<0.05). Similar results were obtained with regard to the severity of asthenia symptoms (48.1±3.67 vs. 53.0±3.54 at week 4 and 33.5±2.61 vs. 51.7±3.29 at week 12; p<0.05). Cognitive functioning indicators also showed a slightly greater improvement in the active group on both scales – DSST and USEFO.

Conclusion. The addition of Laennec hPH to basic antidepressant therapy leads to the development of a delayed but significant antidepressant, antiasthenic and pro-cognitive effect against the background of significant positive dynamics in the clinical and laboratory symptoms of diseases that are indications for the use of the drug (steatohepatitis, atopic dermatitis, recurrent herpes).

There is some data on the efficacy of the neuroprotective agent Dimephosphone in chronic cerebral ischemia (CCI), but no comparative studies have been conducted.

Objective: the aim of the study was to conduct a comparative study of the efficacy and safety of Dimephosphon therapy, administered intravenously over a 10-day course, in patients with CCI.

Material and methods. The study involved 52 patients with CCI who were undergoing inpatient treatment in the neurology department of the City Clinical Emergency Hospital No. 1 in Voronezh. The first (main) group included 28 patients with CCI who received basic therapy (antihypertensive, hypolipidemic, antiplatelet or anticoagulant therapy, correction of emotional status) and intravenous Dimephosphone once a day for 10 days. The second (control) group consisted of 24 patients who received only basic therapy. The effectiveness of the therapy was assessed using the asthenia scale (MFI-20), the Hospital Anxiety and Depression Scale (HADS), and the Tinetti scale.

Results. A significant (p<0.05) advantage was noted in the main group compared to the control group in terms of the analysed indicators. On the MFI-20 scale, the initial level of asthenic symptoms was 77.43±1.69 points in the main group and 77.00±1.89 points in the control group, which corresponds to significant asthenia. By the end of treatment, the indicators decreased to 47.96±1.55 and 61.46±1.38 points, respectively. Motor activity on the Tinetti scale was initially 33.21±2.06 points in the main group and 32.46±3.06 points in the comparison group. By the end of the treatment course, the main group showed a 38.51% increase in motor activity (up to 46±2.71 points). No similar dynamics were observed in the control group, and motor activity indicators were 33.62±2.62 points. The decrease in HADS scores at the end of treatment compared to baseline in the main group was 24.5% on the depression scale and 33.12% on the anxiety scale. In the comparison group, these same indicators decreased by 11.13% and 11.23%, respectively.

Conclusion. The results of the study indicate the efficiency and safety of therapy with Dimephosphone in patients with CCI.

When dealing with chronic migraine (CM), it's worth trying a comprehensive personalised treatment that includes cognitive behavioural therapy (CBT) and therapy for comorbid disorders.

Objective: to identify predictors of the effectiveness of comprehensive personalised treatment, including CBT, in patients with CM.

Material and methods. The study included 100 patients with CM (30 men, 70 women; mean age 34.5±7.4 years). All patients received comprehensive personalised treatment, including CBT, migraine pharmacotherapy, lifestyle recommendations, therapeutic exercises and recommendations for physical activity (in the presence of musculoskeletal pain of other localisation), detoxification therapy (in the presence of druginduced headache), and sleep hygiene (in cases of insomnia). Clinical and psychological indicators were assessed before treatment and at 3, 6, 12, and 18 months of follow-up.

Results. At month 3, statistically significant (p<0.05) improvements were achieved: reduction in headache frequency, frequency and number of pain medication (PM) doses, dependence on PM, impact of migraine on daily activities, pain catastrophising, anxiety, depression, severity of insomnia, intensity of pain in other locations, and increased adherence to treatment according to the quantitative assessment of adherence to treatment scale (QAA-25). From the 6th to the 18th month of observation, the trend of improvement in the above indicators continued. Clinical effect (CE) in relation to CM was achieved by 74% of patients at 3 months and 79% at 6 months, and this indicator remained stable at 12 and 18 months of observation. A statistically significant association was established using binary logistic regression at the 3rd and 6th–18th months of observation between CE in relation to CM and the duration of CM up to 24 months, with initial adherence to treatment ≥56% according to QAA-25.

Conclusion. Predictors of the effectiveness of comprehensive personalised treatment, including CBT, are a duration of CM up to 24 months and initial adherence to treatment ≥56% according to QAA-25.

According to clinical and epidemiological data, migraine is one of the most common causes of headaches among children and adolescents. The phenotypic diversity of migraine in children includes a wide variety of episodic syndromes, which are considered to be early manifestations of migraine. Their verification and early diagnosis allow for significant optimisation of management strategies for paediatric patients.

Objective: to identify the clinical and diagnostic characteristics and prognosis of episodic syndromes of childhood associated with migraine (ESAM).

Material and methods. The study was conducted at the Tambov Regional Children's Clinical Hospital from November 2019 to November 2021. The study included 500 patients. All children underwent a comprehensive clinical and clinical-laboratory examination, a standard neurological and somatic examination, and a psychodiagnostic examination. The diagnosis of the form of ESAM was made using the ICGB-3 criteria.

Results. During the study, the clinical and demographic characteristics of the course of ESAM in children of different age groups were analysed. Some forms of ESAM, such as abdominal migraine and benign vertigo syndrome, are significantly more common in the 6–10 age group. These conditions are highly correlated with the further development of migraine in older children, which determines their prognostic significance. Children suffering from any form of ESAM have an increased likelihood of developing true migraine at a later age. Forms of ESAM such as vertigo and cyclic vomiting may be markers for the subsequent development of migraine. Effective management of ESAM in children can serve as a preventive strategy to prevent the transition to more severe forms of migraine.

Conclusion. There is a low level of migraine diagnosis among hospitalised patients, especially those with general somatic profiles. In everyday practice, ESAM is rarely verified in paediatric patients, which prevents adequate treatment and prognosis of the disease.

Despite warnings about the need to use effective contraception during therapy with teriflunomide, a number of patients still plan to become pregnant or inform their doctor that they are already pregnant while taking the drug. According to the drug's instructions, in these cases, therapy should be stopped right away and a procedure should be done to quickly get the teriflunomide down to a safe level in the blood plasma – no more than 0.02 μg/ml. The drug colestyramine, recommended for this purpose, is not registered in Russia. The proposed alternative use of activated charcoal at 50 g every 12 hours for 11 days (400 tablets per day) is fraught with undesirable side effects in the form of constipation, diarrhoea, and impaired absorption of calcium, vitamins and other nutrients, which is unacceptable for pregnant women and may have a negative effect on the fetus. The question arises: what to do in such cases? We have demonstrated a clinical case of accelerated elimination of teriflunomide in a pregnant patient using the drug Polysorb MP. The use of this tactic made it possible to reduce the concentration of the drug in the blood by 50 times within 1 month: from 1.39 to 0.028 μg/ml. As a result, a healthy full-term baby was born without congenital defects or developmental abnormalities.

Generalised anxiety disorder (GAD) is one of the most common anxiety disorders worldwide. Without treatment, GAD is characterised by a chronic course and significantly impairs social and occupational functioning. The main method of treating GAD in clinical practice is psychopharmacotherapy. Despite the fact that psychiatrists have a fairly large number of psychotropic drugs at their disposal, which are used in accordance with international and domestic clinical guidelines for the treatment of GAD, a number of therapeutic aspects remained unresolved until recently.

In the updated clinical guidelines, agomelatine, an antidepressant that acts on melatonergic (MT₁, MT₂) and serotonergic (5-HT_2C) receptors, was included among the first-line drugs for the treatment of GAD. The efficacy of agomelatine in treating GAD symptoms has been demonstrated in a number of randomised clinical trials. This article presents our own observations, illustrating some aspects of the use of agomelatine in real clinical practice.

Given the recent trends and accumulating evidence supporting the advantages of anti-B-cell therapy, early initiation of this treatment modality in multiple sclerosis (MS) has become increasingly relevant for controlling disease activity and reducing the risk of disability progression. The therapeutic landscape for MS continues to expand, with the introduction of a new anti-CD20 molecule – divozilumab – approved in Russia in 2023, which has shown efficacy in patients with MS. When selecting a treatment strategy for MS patients, clinical decisions should be based on the evidence from individual clinical trials and real-world experience, especially for patients with progressive forms of the disease.

Among intravenous anti-CD20 therapies, ocrelizumab currently holds a clinical advantage due to the breadth of real-world experience supporting its use.

The treatment of acute non-specific (musculoskeletal) lower back pain (LBP) is a pressing issue in modern medicine, as LBP is one of the most common causes of temporary disability among the population. In cases of acute non-specific LBP, the patient should be informed in simple terms about the good prognosis and the absence of the need for instrumental examination methods if there are no dangerous symptoms (red flags). It is important to inform the patient about the benign nature of the disease, the high probability of a quick recovery, and the advisability of maintaining an active lifestyle. To reduce pain, the use of short-course non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants is effective. Data on the use of the muscle relaxant thiocolchicoside (Tiplito) in acute LBP are discussed. Thiocolchicoside has been used for a long time to treat LBP, neck pain, and other musculoskeletal pain. The results of placebo-controlled randomised clinical trials (RCTs) demonstrating the efficacy and good tolerability of a short course of thiocolchicoside in acute LBP are analysed. Data from a recent systematic review and meta-analysis of eight RCTs (more than 1,000 patients) on the use of thiocolchicoside for musculoskeletal pain are presented. Thiocolchicoside (Tiplito) is recommended as an adjuvant therapy for painful muscle spasms in acute spine pathology in the form of intramuscular injections (4–8 mg per day) for 5 days. The combination of thiocolchicoside with NSAIDs enhances the analgesic effect of the latter, improves the functional status of patients, and reduces the duration of NSAID use. Issues related to the optimisation of management of patients with acute non-specific LBP are discussed.

Pharmacotherapy for depression is in urgent need of effective and safer drugs. A promising area of research in this field is the use of pharmaceutically standardized saffron extracts containing bioactive substances such as safranal, crocin, bioflavonoids and their derivatives. This paper presents the results of a systematic computer analysis of 3,157 publications on the pharmacology of saffron extracts, with an emphasis on the results of studies of the antidepressant properties of the extracts. Unlike most synthetic antidepressants, which narrowly target a particular neurotransmission system, the molecular components of saffron extracts have a much more complex modulating effect on neurotransmission. In addition, standardised saffron extracts exhibit pronounced antioxidant, anti-inflammatory (NF- κB inhibition) and neurotrophic effects (primarily through increased levels of the brain-derived neurotrophic factor – BDNF), which is also important for the pathogenetic treatment of depressive states. Randomised clinical trials and their meta-analyses show that preparations based on standardised saffron extracts, both as part of complex therapy and as monotherapy, have therapeutic effects comparable to those of known antidepressants (imipramine, fluoxetine, etc.). The available data from fundamental and evidence-based studies suggest that saffron extracts can be used by patients taking various classes of antidepressants without adverse effects. Moreover, the use of saffron extracts may increase the safety of antidepressant therapy. Further research into the combination of saffron extract standardised for safranal with the 'psychobiotic' bifidobacterial strain Bifidobacterium longum 1714 and vitamin B₆ is promising.

The diagnosis and treatment of acute vertigo in emergency neurological practice are among the most pressing issues in modern neurology. The diagnosis of vestibular system disorders remains at a low level. Many patients with peripheral vestibular system damage and vestibular migraine are misdiagnosed with stroke and transient ischaemic attacks, chronic vertebrobasilar insufficiency, and cervical osteochondrosis. Acute vestibular vertigo is in most cases associated with pathology of the peripheral vestibular system and vestibular migraine, and much less often with stroke or transient ischaemic attacks in the vertebrobasilar arterial system. To make a diagnosis, it is especially important to conduct a clinical neurovestibular examination, including positional tests for benign paroxysmal positional vertigo, the Halmagyi (head impulse) test, assessment of oblique deviation, severity of trunk ataxia and hearing impairment, as well as the use of modern neuroimaging methods. Modern treatment regimens have been developed for each of the nosological forms. A low-dose combination drug of cinnarizine 20 mg + dimenhydrinate 40 mg in combination with vestibular rehabilitation has shown high efficacy in the treatment of vertigo.