Acute vestibular syndrome (AVS) is a common reason for seeking emergency care. In real-world clinical practice, patients with AVS are at high risk of delayed diagnosis of both stroke and vestibular neuritis, which has adverse clinical consequences. Among the clinical signs, the most valuable are the characteristics of nystagmus, the results of the Halmagyi head impulse test and the test of ocular lateral deviation, as well as postural function and hearing. Radiological features that facilitate diagnosis include radiological eye deviation, calcification in the projection of the vertebral or basilar artery, and the presence of stenosis or occlusion of these arteries on computed tomography angiography. Magnetic resonance imaging of the brain with thin-slice diffusion-weighted imaging is the optimal modality for visualizing cerebral infarction in patients with central AVS. The quality of differential diagnosis in AVS can be improved by using a combined approach, which involves assessing the most informative clinical and radiological features.

   Transcranial direct current stimulation (tDCS) of the primary motor cortex is being discussed as an adjunct to therapy for Parkinson's disease (PD). The effectiveness of tDCS in PD remains controversial, and there are no data evaluating the efficacy and safety of tDCS in PD in our country.

   Objective: to evaluate the clinical efficacy of a course of anodal tDCS applied to the primary motor cortex as part of a comprehensive treatment regimen for patients with stage II–III PD according to the Hoehn and Yahr scale, including its effects on motor, cognitive and affective symptoms, as well as the safety and tolerability of the method.

   Material and methods. A prospective, randomised, controlled trial was conducted involving 46 patients with idiopathic PD (25 men and 21 women; mean age 63.9 ± 11.2 years). The main group (n = 24) received 10 sessions of anodal tDCS to the M1 region (2 mA, 20 min, daily, for 2 weeks), whilst the control group (n = 22) received sham stimulation. The following parameters were assessed before and after the course: motor (Unified Parkinson's Disease Rating Scale – UPDRS; Activity of Daily Living – ADL), cognitive (Montreal Cognitive Assessment – MoCA; Frontal Assessment Battery – FAB; Trail Making Test, Parts A and B – TMT-A, TMT-B; Cue Sensitivity Index of the free recall test with selective cues – CSI) and affective (Starkstein Apathy Scale; Geriatric Depression Scale – GDS; State-Trait Anxiety Inventory – STAI).

   Results. After covariate adjustment, a statistically significant between-group advantage of active tDCS was found for 8 of 11 assessed outcomes: UPDRS-III (d = -0.49; p < 0.01), ADL (d = -0.59; p = 0.016), apathy (d = -1.07; p < 0.01), depression according to GDS (d = -0.63; p = 0.013), trait anxiety according to STAI (d = -0.67; p = 0.018), state anxiety according to STAI (d = -0.58; p = 0.041), TMT-A (d = -1.00; p = 0.025), and MoCA (d = 0.52; p = 0.024). The most pronounced effects were observed for apathy and TMT-A. No statistically significant between-group differences after adjustment were found for TMT-B (d = -0.39; p = 0.188), FAB (d = -0.25; p = 0.095), and CSI (d = 0.34; p = 0.29). No serious adverse events were recorded throughout the study period.

   Conclusion. Transcranial direct current stimulation (tDCS) of the primary motor cortex has a high safety profile and may be considered as an adjunctive method in the comprehensive rehabilitation of patients with stage II–III PD, with the most pronounced effects observed in the affective domain and in terms of cognitive processing speed.

   In cases of chronic non-specific neck and low back pain (CNLBP), where emotional disorders are identified, the involvement of a psychiatrist in patient management is considered. However, the effectiveness of this approach in patients with CNLBP and a confirmed anxiety or depressive disorder (F41, F33, F32) remains insufficiently studied.

   Objective: To conduct a comparative evaluation of the efficacy of a comprehensive approach (involving a psychiatrist, an educational programme incorporating elements of cognitive behavioural therapy (CBT), and personalised therapeutic exercise) versus a standard approach in the treatment of chronic non-specific low back pain (CNLBP) in patients diagnosed with an anxiety or depressive disorder (F41, F33, F32) by a psychiatrist.

   Material and methods. The study included 55 patients with CNLBP and anxiety (F41) or depressive disorder (F33, F32), who were randomized into two groups. The first group (comprehensive therapy – CT) consisted of patients (n=27) who received a comprehensive (multimodal) approach, including the involvement of a psychiatrist in patient management, 6 sessions of an individualized educational programme incorporating elements of CBT delivered by a certified specialist in chronic pain and emotional disorders, 4–5 individual sessions of therapeutic exercise (TE) with the development of a personalized exercise regimen, and recommendations on workplace ergonomics. The standard therapy (ST) group comprised patients (n = 28) who were treated using a standard therapy protocol (optimisation of drug therapy, a one-off educational programme to improve physical activity, and standard kinesiotherapy). The study protocol involved 6 months of therapy and fol-low-up with efficacy assessments at three time points – 1, 3 and 6 months after the start of treatment. A numerical rating scale (NRS) was used to assess pain intensity; the Spielberger test, which assesses state (ST) and trait (TT) anxiety, and the Beck Depression Inventory were used to assess anxiety and depressive disorders. The SF-12 questionnaire was used to assess quality of life, taking into account the division of this questionnaire into summary scales for physical (PCS-12) and mental health (MCS-12). To determine the impact of neck pain (NP), the Neck Disability Index (NDI) was used; to assess the impact of low back pain (LBP) on daily activities, the Oswestry Low Back Pain Disability Questionnaire was used.

   Results. Against the background of treatment, a more significant decrease in pain intensity according to the NRS was noted in the CT group than in the ST group – respectively, for NP to 1.46 ± 0.75 and 2.92 ± 1.0 after 3 months (p < 0.001) and to 0.69 ± 0.72 and 3.0 ± 1.41 after 6 months (p < 0.001), for LBP 2.04 ± 0.86 and 3.29 ± 1.31 after 3 months (p < 0.001), and to 1.04 ± 0.91 and 3.29 ± 1.48 after 6 months (p < 0.001), a decrease in functional impairment according to the Oswestry questionnaire to 15.57 ± 3.55 and 27.62 ± 3.27 after 3 months (p < 0.001) and up to 10.22 ± 2.54 and 29.67 ± 4.24 after 6 months (p < 0.001), a decrease in functional impairment according to the NDI to 12.54 ± 4.36 and 23.38 ± 4.5 after 3 months (p < 0.001) and up to 8.08 ± 2.81 and 25.23 ± 4.95 after 6 months (p < 0.001), an improvement in the quality of life according to PCS to 46.04 ± 4.31 and 43.21 ± 4.04 after 3 months (p < 0.05) and up to 50.07 ± 3.27 and 43.57 ± 3.17 after 6 months (p < 0.001), an improvement in the quality of life according to MCS to 47.3 ± 4.31 and 44.57 ± 3.13 after 3 months (p < 0.05) and up to 50.56 ± 2.86 and 44.75 ± 2.63 after 6 months (p < 0.001). During therapy, no significant differences were found between the CT and ST groups according to the Beck Depression Inventory, ST and TT, in both groups an improvement in the indicators was observed over time, however, when comparing the survey indicators after 3 and 6 months, the CT group showed a statistically significant improvement according to the Beck Depression Inventory (p = 0.04), while in the ST group no further changes were noted (p = 0.14).

   Conclusion. A comprehensive multidisciplinary approach (involving a psychiatrist) to the treatment of patients with chronic non-specific low back pain (CNLBP) and mental health disorders (anxiety and depressive disorders) leads to a more significant reduction in pain and an improvement in functional activity. Prescribed drug therapy for mental disorders improved the improvement in pain, functional activity and quality of life in the long term.

   Nonconvulsive status epilepticus (NCSE) is a clinically difficult-to-diagnose form of status epilepticus, often presenting as acute or subacute impairment of consciousness without marked motor symptoms. The limited clinical symptoms and variability of electroencephalographic (EEG) patterns result in a high risk of delayed diagnosis and poor outcomes. There is little data on the frequency of NCSE in patients with impaired consciousness of unclear etiology, its clinical features, etiological structure, and the results of long-term video-EEG monitoring.

   Objective: to investigate the prevalence of NCSE in patients with altered consciousness of unknown etiology, to describe the characteristics of NCSE from the perspectives of etiology and semiology, and to analyze the results of long-term video-EEG monitoring in this condition.

   Material and methods. Data from 73 adult patients with suspected NCSE who underwent continuous video-EEG monitoring were analyzed. Diagnosis was made using the Salzburg criteria (2015) in conjunction with the standardised terminology of the American Clinical Neurophysiology Society (ACNS, 2021). The study group included 32 patients with a confirmed diagnosis of NCSE.

   Results. NCSE was confirmed in 32 (43.8 %) patients. In the vast majority of these (84.4 %), the condition occurred against a background of coma; in 15.6 %, a reduced level of consciousness was observed, mimicking aphasic and cognitive disorders. In 53.1 % of cases, NCSE developed as a transformation from convulsive status epilepticus, whilst in 46.9 % it occurred as a primary event. Only 37.5 % of patients had previously been diagnosed with epilepsy (idiopathic generalized epilepsy – n = 7; focal structural epilepsy – n = 5); in the remaining cases, NCSE was acute and symptomatic in nature, with the most common causes being New-Onset Refractory Status Epilepticus (NORSE), acute cerebrovascular accident, traumatic brain injury, hypoxic and metabolic encephalopathy. Based on EEG analysis, definite NCSE was confirmed in 81.2 % of patients, and probable NCSE in 18.8 %. During treatment, NCSE was controlled with first- and second-line drugs in only 8 (25 %) patients. In the remaining cases (n = 24; 75 %), pharmacological sedation was required. Thus, refractory and super-refractory forms of the condition pre-dominated, with a mortality rate of 21.9 %.

   Conclusion. NCSE is a common yet under-recognised cause of altered consciousness, particularly in critically ill patients. The timely use of long-term video-EEG monitoring and a active diagnostic approach are crucial for the early detection of NCSE and the optimisation of treatment.

   The approach to reperfusion therapy for acute ischemic stroke (AIS) in cases of basilar artery occlusion (BAO) remains a matter of debate.

   Objective: to assess the safety and efficacy of Fortelyzin in patients with BAO in real-world clinical practice, based on data from the FORPI registry.

   Material and methods. The FORPI registry is an open-label, prospective, non-interventional observational study of Fortelyzin in patients with ischaemic stroke. An analysis was conducted of the safety and efficacy of Fortelyzin in a group of patients with basilar artery occlusion who underwent intravenous thrombolytic therapy (IVT) and bridging therapy. The safety endpoint was the incidence of symptomatic intracranial haemorrhage (SICH) as defined by ECASS III and SITS-MOST, as well as all-cause mortality at 90 days. The efficacy endpoint was defined as good functional recovery, defined as a score of 0–2 on the modified Rankin Scale (MRS) at 90 days.

   Results. This analysis included 1910 patients who underwent IVT and 53 patients who underwent bridging therapy. The median National Institutes of Health Stroke Scale (NIHSS) scores at admission were 9 and 12 points, respectively (p = 0.01). SICH incidence (ECASS III criteria) was significantly higher in the bridging therapy group compared to IVT group (6 % vs 1 %, p = 0.01). All-cause mortality at day 90 did not differ significantly between the groups (9 % and 7 %, respectively, p = 0.52). Good functional recovery at day 90 was achieved by 69 % of patients in the IVT group and 60 % of patients in the bridging therapy group (p = 0.31).

   Conclusion. The use of Fortelyzin in AIS patients with BAO may be considered an effective and safe form of reperfusion therapy, as well as a component of bridging therapy aimed at increasing the number of favorable functional outcomes.

    The question of whether intravenous thrombolytic therapy (ITT) is appropriate for patients with a minor stroke (NIHSS score < 5) remains a matter of debate. Fortelysin is a thrombolytic agent used to treat ischemic stroke.

   Objective: to assess the safety and efficacy of Fortelyzin in patients who have suffered a minor stroke in real-world clinical practice, based on data from a subanalysis of the FORPI registry.

   Material and methods. The FORPI registry is an open-label, prospective, non-interventional, observational study of Fortelyzin in patients with acute ischemic stroke. We analyzed the safety and efficacy of Fortelyzin in a group of patients with minor stroke characterized by an NIHSS < 5. Safety outcomes were the number of symptomatic intracranial hemorrhage (sICH) according to ECASS III and SITS-MOST definitions, as well as all-cause mortality at day 90. The efficacy outcome was a functional independence, defined by modified Rankin scale (mRS) score of 0–2 points at day 90.

   Results. The analysis included 836 patients with an NIHSS < 5 points. The median age was 64 [56; 72] years, and the median NIHSS score at admission was 4 [3; 4] points. SICH according to ECASS III definition was observed in three patients of 836 (0.4 %), and according to SITS-MOST definition, in four patients of 836 (0.5 %). All-cause mortality at day 90 was 2.2 % (18/836). The proportion of patients with functional independence (mSR of 0–2 points) at day 90 reached in 88 % (737/836) of patients.

   Conclusion. The FORPI registry provides compelling evidence that early intensive rehabilitation using Fortelyzin is characterised by a high level of safety and efficacy in patients who have suffered a minor stroke.

   Impaired hand function is one of the most common clinical manifestations of multiple sclerosis (MS), which has a significant impact on patients' quality of life.

   Objective: to develop a Russian-language version and linguistic and cultural adaptation of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ), which is used to quantitatively assess hand function in patients with MS.

   Material and methods. The process of translating and linguistically and culturally adapting the questionnaire comprised six stages: direct translation by two specialists, synthesis of the translations, back-translation, expert review of the Russian-language version of the questionnaire, pilot testing, and final editing of the text. The pilot study included 18 Russian-speaking patients diagnosed with MS. The questionnaire was completed under the supervision of a neurologist, and its clarity, accessibility of wording and overall perception by patients were assessed. The median age of the pilot study participants was 33 years, the median duration of the disease was 6 years, and the mean EDSS score was 4.0.

   Results. All participants successfully completed the questionnaire without difficulty. The time taken to complete it ranged from 4 to 12 minutes. Following the analysis, the final Russian-language version of the AMSQ questionnaire, adapted to take account of linguistic and cultural characteristics, was approved. The Russian-language version of the questionnaire demonstrated clinical applicability and comprehensibility for patients with MS.

   Conclusion. This questionnaire can be used in routine clinical practice and scientific research as a reliable tool for assessing hand function. The next stage of the validation study will involve evaluating the psychometric properties of the Russian-language version of the questionnaire.

   Somatic and neurological hereditary disorders, which arise as a result of various genetic mutations and usually manifest from childhood, are often accompanied by various mental health disorders. These may include mental disorders of exogenous-organic origin, personality disorders that are exacerbated or develop against a background of prolonged, severe, disabling illness with reactions of decompensation and maladjustment; endogenous disorders may also occur comorbidity. Mental disorders in themselves complicate the clinical picture, reduce quality of life and exacerbate social maladjustment. Furthermore, mental disorders, particularly those of an anxiety-depressive nature, can aggravate somatic pathology via a psychosomatic mechanism, a factor that must be taken into account when providing care for such patients. To illustrate the above, we present a clinical case of a patient with Ehlers–Danlos syndrome (a hereditary connective tissue dysplasia), which manifests, in addition to musculoskeletal pathology, as pronounced cardiovascular, neurological and mental disorders. The latter are represented by an organic personality disorder of a predominantly hysterical nature with anxiety-depressive maladaptive reactions. The difficulties of differential diagnosis of personality disorders and therapeutic aspects are discussed.

   The management of patients with chest pain (thoracalgia) is one of the pressing issues in modern medicine. This paper presents a clinical case study of the comprehensive management of an elderly female patient with thoracalgia, which involved an optimal combination of pharmacological and non-pharmacological methods, with follow-up over a period of 2.5 years. Previously, the patient had not experienced any long-term benefit from treatment; she had developed misconceptions about the condition and effective treatment methods, was not adhering to ergonomic guidelines, and exhibited pain-avoidance behaviour. The comprehensive approach included educational discussions on the causes, factors contributing to chronic pain, and prognosis; individual kinesiotherapy (therapeutic exercises); recommendations on optimal physical activity and ergonomics; and the prescription of the non-steroidal anti-inflammatory drug Nimesil (nimesulide). A sustained reduction in pain was achieved over a period of 2.5 years. A comprehensive approach aimed at correcting identified ergonomic issues and fostering a correct understanding of the causes and prognosis of the condition, combined with individual kinesiotherapy and optimal pharmacotherapy with Nimesil (nimesulide), enabled a relatively rapid and sustained reduction in pain and an improvement in the patient’s functional activity. Issues regarding the optimization of patient management in cases of chronic thoracalgia are discussed.

   Patients with comorbid pain syndromes are frequently encountered in neurological practice. The management of patients with chronic musculoskeletal pain in the neck and back, and primary headaches, requires a comprehensive approach based on a combination of non-pharmacological methods and optimized pharmacotherapy. A clinical case is described of the effective management of a female patient suffering from chronic non-specific cervicobrachialgia, episodic tension-type headache involving the pericranial muscles, episodic migraine without aura, and increased anxiety. A comprehensive approach was used in the patient's management, which included optimal pharmacotherapy and a combination of non-pharmacological methods. Pharmacotherapy consisted of a stepwise course of Dexalgin (dexketoprofen). Non-pharmacological therapy included in-depth educational discussions with the patient about the condition, individual kinesiotherapy, and training in ergonomics. After 3 months of treatment, the patient's neck pain had subsided, tension-type headaches were no longer present, and the frequency of migraine attacks had significantly decreased. The improvements achieved were maintained throughout the one-year follow-up period. The optimization of the management of patients with comorbid pain syndromes is discussed.

   Primary progressive multiple sclerosis (PPMS) is the most severe phenotype of the disease, characterised by a steady progression of neurological deficit from the time of onset. This review presents a comprehensive analysis of the epidemiological, clinical, neuroimaging and socio-economic aspects of PPMS. It is shown that PPMS is associated with accelerated progression to disability thresholds (≥ 6.0 points on the Expanded Disability Status Scale – EDSS, on average within 5–9 years), early loss of working capacity and the creation of a significant burden for patients and their families, which is exacerbated by the need for long-term care. Key pathogenetic differences between PPMS and relapsing-remitting MS (RRMS), as well as current therapeutic strategies, are discussed. The need for early diagnosis, timely initiation of pathogenetic therapy and the development of a multidisciplinary care system to improve patient prognosis and quality of life is emphasised.

   Sulpiride (Eglonil), the progenitor of the substituted benzamide class, has retained its clinical relevance for over half a century thanks to its unique combination of a dose-dependent spectrum of action and a high safety profile. At low and medium doses (100–400 mg/day), the drug, alongside mild neuroleptic effects, exhibits a triple anxiolytic, stimulant and somatotropic effects due to selective blockade of presynaptic dopamine D2/D3 receptors, followed by an increase in dopaminergic transmission in the mesolimbic pathways. This pharmacological profile determines sulpiride's leading role in the treatment of somatoform disorders and generalised anxiety disorder with predominant somato-vegetative symptoms, where the primary complaints are cardialgia, dyspepsia, tachycardia, hyperhidrosis and polymorphic bodily sensations without an organic basis. Sulpiride (Eglonil) is the drug of choice for somatised forms of anxiety, comorbidity with somatic diseases, functional disorders of the gastrointestinal tract and somatoform disorders.

   Based on a review of the literature, this article summarises the findings of original studies on the role of human herpesvirus 6A (HHV-6A) in the development of multiple sclerosis (MS). The review also presents the immunological and pathogenetic rationale for the role of other viruses – Epstein–Barr virus (EBV) and human endogenous retrovirus-W (HERV-W) – in the development of MS. Experimental and clinical data on risk factors for the development of MS are examined in the context of the established presence of the aforementioned viruses in patients.

   Particular attention is paid to the role of HHV-6A as a potential trigger of the inflammatory autoimmune cascade in MS.

   Information on the possible role of the combination of HHV-6A with other viruses (co-infection) in the pathogenesis of MS is summarized and presented. In addition to the viral nature of MS development, the article focuses on endogenous (genetically determined) and other external factors.

   Migraine ranks second among all conditions in terms of its impact on quality of life and work capacity, and is the leading cause of disability among people under the age of 50. Triptans, which have long been the mainstay of acute treatment, have a number of limitations: contraindications in cardiovascular disease, the risk of developing medication overuse headache (MOH) with frequent use, as well as ineffectiveness or intolerance in a significant proportion of patients. The advent of gepants – antagonists of the calcitonin gene-related peptide (CGRP) receptor - has opened up new possibilities for the treatment of migraine. Rimegepant (Nurtec©) is the first representative of this class to be registered in the Russian Federation and the only drug in the world with two indications: acute attack relief and prophylactic treatment of episodic migraine. This review presents current data on the mechanisms of action, efficacy, safety and impact on functional recovery of rimegepant in the acute treatment of migraine. An analysis was conducted of data from clinical trials (randomised controlled trials, open-label long-term trials, and real-world clinical practice studies), systematic reviews and meta-analyses focusing on the use of rimegepant for the relief of migraine attacks. Rimegepant acts via a dual mechanism of antagonism against CGRP receptors and amylin 1 receptors (AMY1), providing effective relief of pain and associated symptoms in a broad population of adult migraine patients. Unlike triptans, the drug does not cause vasoconstriction and has no cardiovascular contraindications. In a 52-week safety study, no cases of MOH were recorded; the frequency of use remained stable with a downward trend. Rimegepant is effective in patients with triptan failure or intolerance (55.9 % vs 32.7 % for placebo; p < 0.0001). The drug provides a rapid onset of action (from 15 minutes), relief of the most debilitating symptom within 2 hours in 40.2 % of patients (compared with 29.2 % in the placebo group; p < 0.0001) and high treatment satisfaction (71.4 % vs 52.0 % for triptans; p < 0.001). According to the WPAI-GH questionnaire, rimegepant significantly reduces presenteeism (by 10.6 %; p = 0.018) and overall work impairment (by 11.3 %; p = 0.021), restoring patients' ability to work. The cardiovascular safety of the drug has been confirmed in a population of patients with cardiovascular risk factors (incidence of serious adverse events 2.4 % in the FRS ≥10 % group vs 2.6 % in the low-risk group). Thus, rimegepant is a highly effective and safe agent for the relief of migraine attacks, offering key advantages over triptans: the absence of vaso-constriction and cardiovascular contraindications, minimal risk of developing MOH, efficacy in patients unresponsive to triptans, rapid restoration of work capacity, and high patient satisfaction. The drug may be considered the treatment of choice in these patient populations.

   The combined use of neuroprotective agents and nootropic drugs with different mechanisms of action represents a promising avenue in the pharmacotherapy of impaired attention and memory, chronic cerebral ischemia, ischemic stroke, senile dementia and other conditions. A comparative chemoreactome study of choline alfoscerate (CA) and ethylmethylhydroxypyridine succinate (EMHPS) was conducted to identify the molecular mechanisms underlying the synergistic effects of these molecules at the level of the human proteome and reactome. The evaluation was carried out by analysing the chemical structures of CA and EMHPS using modern methods of complex data analysis (theories of labelled graph analysis, metric data analysis, combinatorial solvability theory, and topological theory of ill-formalized problem analysis), developed within the framework of an algebraic approach to recognition. Estimates have been obtained of the overall effects of CA and EMHPS on human reactome cascades, as well as of their effects on specific receptors in the human proteome, which underlie the molecules' general reactome effects. To establish the overall profiles of the effects of CA and EMHPS on the human reactome, a study was conducted on the effects of each of these molecules on 255 components of the reactome, including various signaling and metabolic cascades. The degree of effect on the human reactome was more pronounced for CA (0.62 ± 0.17 u.e.) than for EMHPS (0.54 ± 0.17 u.e.). A chemoreactome analysis of the studied molecules with specific receptor proteins of the human proteome included 1,052 target proteins (receptors for various ligands: neurotransmitters, hormones, signaling metabolites, etc.). The analysis showed that significant values for activation (EC50) and inhibition (IC50) constants were found for 67 receptor proteins, of which 20 receptors were activated and 47 receptors were inhibited. Receptors activated to a comparable degree by CA and EMHPS included cannabinoid, opioid, farnezoid and other receptors, which help reduce inflammation and pain, improve insulin secretion and counteract insulin resistance. Receptors activated pre-dominantly by EMHPS exert vasoregulatory, antidepressant, anxiolytic, antidiabetic and antihypoxic effects. Inhibition of proteome receptors by CA and EMHPS molecules (n = 47) corresponds to the anti-inflammatory, neuroprotective, analgesic, insulin-regulating, vasodynamic, antithrombotic and antitumour effects of the 'CA + EMHPS' combination. The identified mechanisms of the pharmacological and proteomic actions of CA and EMHPS indicate that the 'CA + EMHPS' combination exhibits synergistic neuroprotective and cardioprotective effects. The results obtained may be applied to any preparations whose active ingredients are CA and EMHPS, provided that the composition of active and excipient substances is identical.