Meniere's disease is one of the most common causes of recurrent vestibular vertigo. Despite its comparatively high prevalence, this disease is frequently diagnosed late and patients do not receive timely therapy. The paper gives current diagnostic criteria for Meniere's disease. Approaches to treating the disease in its attack and an interattack interval are discussed. Emphasis is laid on the role of vestibular rehabilitation in increasing the quality of life in patients with Meniere's disease.

Current surgical and medical treatments for brain contusions are analyzed in terms of the concept of primary and secondary brain injuries

The paper gives the results of the multicenter clinical and epidemiological program CALIPSO (Cavinton in the treatment of patients with chronic cerebral circulatory disorder: dyscirculatory encephalopathy in the presence of essential hypertension). The program covered 4865 patients with chronic hypertension-related cerebrovascular insufficiency from 42 cities and towns of the Russian Federation. The patients received dropwise intravenous Cavinton as infusions within the first week (25 mg on days 1 to 4 and 50 mg on days 5 to 7) then oral Cavinton forte, 30 mg/day, for 90 days. Therapy with Cavinton and Cavinton forte led to improvements in health, balance (the Tinnetti scale), and cognitive functions (the mini mental state examination). This study has provided evidence for the safety of Cavinton.

The paper describes experience with intravenous thrombolysis used in a few vascular centers of the Republic of Tatarstan in the past 5 years. Intravenous thrombolysis with alteplase (actilise) was carried in 300 patients (188 men and 112 women) aged 21 to 79 years (mean age 59.8±13.7 years) who had ischemic stroke (IS). Significant positive changes (a neurological deficit decrease on the NIHSS score by ≥ 4 points) were observed in 67.3% of cases; mortality was 6.7%. Hemorrhagic events as asymptomatic hemorrhagic transformations were found in 19.3% of cases with the neurological disorders being progressive in 4.6%. Recanalization of internal carotid artery occlusion was recorded only in 24.0% of the patients and that of occlusion of the proximal segments of the middle cerebral artery was in 50.1%. Examples of effective intravenous thrombolysis in IS in the carotid and vertebrobasilar beds are given. Whether intravenous thrombolysis can be more extensively used in IS is discussed.

Cardiac rhythm and its structure are indicators of the state of heart regulatory systems. Estimation of heart rhythm variability (HRV) makes it possible to detect cardiac autonomic regulatory impairments and to estimate their magnitude, by providing additional possibilities to examine autonomic disorders and to search for new differential diagnostic distinctions between Levy body dementia (LBD) and Parkinson's disease (PD).

Objective: to analyze autonomic provision of cardiac performance in patients with LBD versus PD patients with and without dementia (PD+D and PD-D).

Subjects and methods. The study enrolled 21 patients with probable LBD and 31 patients with PD (24 patients with PD-D and 7 with PD+D), who were matched for gender and age.

Results and discussion. Resting heart rhythm analysis revealed no normal age-related abnormalities in patients with LBD as compared to those with PD+D who had a marked reduction in HRV. An orthostatic test in both patients with LBD and those with PD (mainly that with dementia) showed inadequate sympathetic effects on heart rhythm, which is suggestive of cardiac sympathetic dysregulation and favors the development of orthostatic hypotension. During the orthostatic test, the patients with LBD were found to have supraventricular premature contractions with the pulse being fixed, which were probably caused by the hypersensitivity of denervated receptors to humoral factors. As the denervation process became longer, receptor sensitivity was decreased, hence supraventricular premature beats and arterial hypertension were absent in the horizontal position in long ill patients with PD+D, in whom the adaptive properties were considerably lower.

Nocturnal sleep disorders are common and clinically significant neuropsychic manifestations of Parkinson's disease (PD).

Objective: to specify the clinical features of sleep disorders in patients with PD and to evaluate the impact of dopaminergic therapy on the basic characteristics of sleep and its related symptoms of the disease.

Subjects and methods. Sixty-seven PD patients without dementia (mean age 63.2±9.9 years; mean PD duration 6.5±4.2 years) were followed up. Forty patients received pramipexole in a daily dose of 2.64±0.6 mg in addition to other dopaminergic agents. The unified PD rating scale (UPDRS), the PD sleep scale (PDSS), the Beck depression inventory and PD fatigue scale (PFS-16), the scales for outcomes of PD-cognition (SCOPA-Cog), and the PD quality of life scale (PDQ-39) were used.

Results. Sleep fragmentation and early morning awakenings are the most common sleep disorders in PD. Pramipexole therapy resulted in a significant improvement in sleep quality, a reduction in the frequency of falling asleep and nocturnal awakenings. The improved characteristics of sleep were favored by a therapy-induced decrease in the severity of motor (hypokinesis, rigidity, tremor, nocturnal and morning dystonia) and nonmotor (restless legs syndrome/acathisia, sensory disorders, nocturia) PD manifestations.

The fact that the unilateral approach to studying panic attacks (PA) is unsound has presently become evident in the context of one specialty - neurology or psychiatry.

Subjects and methods. One hundred and ninety-three patients with PA, among whom 80 (30 men and 50 women; mean age 31.5±9.66 years) fully met the inclusion-exclusion criteria, were examined. A control group comprised 36 healthy individuals (16 men and 20 women; mean age 25.9±6.73 years). The interdisciplinary approach integrating two (neurological and psychiatric) paradigms was applied to investigate PA. Clinical, psychological, and neurophysiological studies were employed.

Results and discussion. The clinical picture of PA and an interattack interval was shown to encompass similar autonomic and different psychopathological manifestations caused by varying pathogenic mechanisms. The clinical manifestations of the latter most frequently correspond to neurotic, specific personality, and schizotypal disorders. It was ascertained that each group of patients with PA, which was identified by the nosological principle, was characterized by the pattern of clinical and psychophysiological characteristics and the trend in PA in addition to general manifestations. The neurophysiological signs of mental disease, in whose picture PA developed, corresponded to the progression of psychopathological and personality manifestations of PA in each consecutive group. The determinant of the pathogenesis and clinical presentation of PA in various mental diseases is psychodynamic processes, the specific features of which need to be taken into account when making diagnostic, therapeutic, prognostic, and expert decisions.

Neuroendocrine reorganization in a menopausal woman is frequently accompanied by the development of the climacteric syndrome with concomitant mental disorders. Furthermore, various mental disorders, depressions in particular, can manifest themselves in this period. The paper presents the results of examining 150 women aged 41 to 65 years who had depressive disorders in menopause. Based on the findings, the author considers depressions of varying genesis occurring in women in the pre- and postmenopausal periods, their association with menopausal symptoms and social factors. She outlines the differential diagnosis of depressions and the basic principles of their therapy, including indications for and contraindications to hormone replacement therapy and the use of psychotropic drugs.

The paper presents the results of an open-label study of ethylmethylhydroxypyridine succinate (Neurox) used as a component of combination therapy in 32 patients with cerebrovascular diseases (CVD): 10 patients have experienced ischemic stroke and 22 have suffered from dyscirculatory encephalopathy. The patients with CVD have been found to have clinical improvement and better cognitive functions and to tolerate the drug well.

The paper gives information on osteoporosis (OP) as a cause of back pain. In OP the latter is stated to be induced by not only osteoporotic fractures, but also other pathological changes associated with bone mineral density loss. Data on the management of back pain due to OP are presented and the efficacies of alendronate and vitamin D3 are noted