Parkinson's disease (PD) is a multisystemic neurodegenerative disease involving different mediator systems, which has a wide spectrum of nervous and mental (emotional, cognitive, psychotic, and behavioral) disorders. Nervous and mental diseases are encountered in most patients with PD, at the same time they substantially lower quality of their life. The paper gives the present views of the pathogenesis and clinical presentation of nervous and mental disorders, and approaches to their therapy in PD.

The paper discusses the topical problem of depression in cerebrovascular diseases. It shows its possible causes, mechanisms of occurrence, clinical picture and negative impact on the course of cerebrovascular disease and recovery of neurological functions. There is a bilateral association between stroke and depression: on the one hand, stroke is a risk factor for the development of depression and, on the other, depression is a both direct and indirect risk factor for the development of stroke. on the other. The vascular depression concept by G.S. Alexopoulos and its main points are discussed. The author gives her own data on the prevalence of depression in dyscirculatory encephalopathy with non-dementia cognitive disorders. She gives prove that a neurologist should diagnose and treat depression and to choose antidepressants for its treatment.

Varying degrees of cognitive disorders are observed in about 70% of patients over 60 years of age. Early detection of cognitive disorders at non-dementia stages contributes to timely pathogenetic therapy. The paper describes diagnostic criteria for moderate cognitive impairment (MCI), its epidemiology, etiology, clinical manifestations, study methods, and therapy in patients with MSI syndrome. Key words: cognitive disorders, dementia, moderate cognitive impairment syndrome, neuroprotector therapy

Vestibular disorders are a frequent abnormality that physicians of various specialties have to encounter. Vestibular and equilibrium disorders are particularly common in elderly patients. In this case they are frequently a cause of falls and various injuries. Vestibular rehabilitation is the most important component of treatment for vestibular and equilibrium disorders. The paper considers the basic mechanisms of vestibular compensation, discusses vestibular rehabilitation procedures by doing routine exercises and by using various biofeedback crunches. In particular, it describes the principle of operation of a posturography platform, a SwayStar system for the diagnosis and therapy of vestibular disorders, and a Brainport device for vestibular rehabilitation. The current methods for drug stimulation of vestibular compensation are discussed. Vestibular rehabilitation used in the complex therapy of equilibrium disorders is stressed to considerably enhance therapeutic effectiveness, to cause a reduction in the risk of falls, and to increase quality of life in patients with vestibular disorders

The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.

The paper describes the current views of the development of back pain and management tactics in patients with this pain that is periodically observed in almost everyone. Back pain may be induced by changes in the vertebral column, diseases of muscles, involvement of the roots and peripheral nerves, pathology of thoracic, abdominal, and small pelvic viscera, and psychogenic disorders. Musculoskeletal disorders are the most common causes of back pain. The mechanisms of development of back pain are presently the subject of active investigations. Back pain is indubitably a multidisciplinary problem, which is especially confirmed by the fact that there are different approaches to revealing the source of pain and there is a great deal of treatments for this condition. Unlike chronic pain, acute musculoskeletal pain in the back is a benign and generally self-limited condition. To set off nonspecific back pain, i.e. pain associated with musculoskeletal disorders without signs of involvement of cervical, thoracic, lumbar, and sacral roots and specific spinal lesions (spondylolisthesis, osteoporosis, tumors, inflammatory spondyloarthropathies, etc.) is convenient and warranted in most cases when a patient with acute back pain is examined by a general practitioner. The paper gives the data of the current guidelines for the management of patients with nonspecific back pain

The first episode comprises one or several fits that first develop in a patient and may recur within 24 hours with a complete consciousness recovery between the fits. In addition to clinical characteristics, general somatic and neurological examinations, biochemical blood study, and brain electroencephalography and computed tomography or magnetic resonance imaging are recommended to define the prognosis of the first epileptic seizure and to elaborate therapeutic tactics. If the first acute symptomatic seizure (metabolic encephalopathy, acute central nervous system injury in patients with eliminable seizure-based condition) occurs, the disease that is a cause of the seizure should be treated. Symptomatic therapy for the first unprovoked seizure is unreasonable if only the seizure is not epileptic.

The paper gives the current views of the role of antithrombotic therapy in the prevention of recurrent ischemic strokes and describes on-going trials of new antithrombotic agents. It is demonstrated that this treatment should be performed in all patients with ischemic disorders in the brain circulation. Long-term therapy with oral anticoagulants is reasonable in cardioembolic stroke caused by atrial fibrillation and a number of other disorders. Therapy with thrombocytic antiaggregants is more advisable in noncardioembolic stroke

Obsessive-compulsive disorder is considered to be a group of similar in appearance, but psychopathologically heterogeneous symptoms. A differential, depending on the psychopathological features of symptoms, cognitive approach, to treating this type of psychic pathology is described.

The purpose of the investigation was to study the clinical value of the deja vu phenomenon in healthy examinees as it may occur in healthy individuals, on the one hand, and is a symptom of a number of psychoneurological diseases, on the other. One hundred and twenty-nine subjects, mean age 25,2±4,4 years, were examined. All the examinees were questioned by the original questionnaire developed by the authors, which was to reveal the characteristics of the phenomenon, and the Cambridge depersonalization questionnaire; standard electroencephalography was also performed. The deja vu phenomenon was detected in 97% of the respondents. In healthy individuals, the phenomenon was most common at the age of 21-25 years; 52,2% experienced deja vu several times a year; 64,5% of the respondents reported the 10-sec state; 85% did not associate the occurrence of the phenomenon with any provoking factor; 66% perceived deja vu with a positive emotional tinge, and only 4% of the respondents were afraid of the onset of this phenomenon. These criteria may be used to rule out pathological deja vu.

The authors studied the causes of vestibular vertigo was studied in 40 patients (9 men and 31 women aged 29 to 83 years, mean age 58,6 years) admitted to the Neurology Department for this condition and the efficiency of betaver (betahistine) used for treatment. The causes of isolated vestibular vertigo in the patients were benign paroxysmal positional vertigo (n = 21), Meniere's syndrome or peripheral vestibulopathy (n = 9), Meniere's disease (n = 5), vestibular neuronitis (n = 4), and vestibular migraine (n = 1). All the examinees took betaver in a dose of 48 mg/day for 30 days. Betaver treatment resulted in cessation of vertigo in all the patients during their hospital stay (15-25 days, mean 21 days). Improvement could be also associated with natural vertigo regression and with the benefits from the rehabilitation maneuver (in benign paroxysmal positional vertigo) made by the patients under advice of a vestibular exercise physician. It was noted that betaver interacted well with other drugs taken by the patients for concomitant disease and there were no changes in clinical and biochemical blood indices.

By using osteoarthrosis as an example, the author proposes a model to analyze the pain syndrome that may comprise intraorgan, paraorgan and comorbidity-associated pains. The implication of synovitis in the pathogenesis is analyzed. By enhancing the degradation and degeneration of the articular cartilage and subchondral bone, synovitis alters cardinally the pain syndrome towards it chronization in osteoarthrosis, drastically lowering a patientXs quality of life. The anti-inflammatory analgesic Amelotex from a group of selective cyclooxygenase 2 inhibitors should be used to combat the pain that underlies the clinical manifestations of osteoarthrosis and largely determines other symptoms. The use of Amelotex in 20 patients with gonarthrosis in a phase of synovitis has demonstrated its rapid anti-inflammatory and analgesic effects. Its adverse reactions are minimal

Acute back pain is one of the main reasons for referrals to a polyclinic. Eighty-seven patients aged 18 to 75 years, who had acute back pain, were examined to study the spread of its principal causes of acute back pain in the outpatient setting. Of them, two thirds (60 patients) were found to have muscle pain syndromes; the others (27 patients) had specific diseases (ischemic heart disease, vertebral fractures, neoplasms, herpes zoster) that were prevalent in chest pain. Among 60 patients with nonspecific back pain, 30 patients were treated with mirlox (7,5- 15 mg/day) and 30 patients received mirlox and mydocalm in a dose of 150 mg thrice daily. As a result of therapy, back pain disappeared or diminished in all the patients, their routine activity normalized, as assessed by the Oswestry questionnaire. The duration of temporary disability was 3 days shorter in the group of patients taking a combination of mirlox and mydocalm. The use of mirlox and mydocalm is effective and safe in various (cervical, chest, and lumbar) pains caused by muscle syndromes, this promotes rapider recovery.

The pathogenetic, clinical, diagnostic, and therapeutic aspects of alcoholic polyneuropathies, the most common nervous system complication in alcoholism, are considered. Two possible pathogenetic mechanisms of polyneuropathy: the direct toxic effect of ethanol and its metabolites and malnutrition with deficiency of B-group vitamins, including thiamine, are discussed. The use of B-group vitamins and α-lipoic acid preparations is recommended as pathogenetic therapy. The adjuvant analgesics - anticonvulsants and antidepressants are used to treat neuropathic pain.

The concepts of the metabolic and vascular mechanisms responsible for the occurrence and progression of neurological complications of diabetes mellitus are presented. The results of some investigations demonstrating the efficacy of actovegin in the treatment of diabetic polyneuropathy, encephalopathy, and diabetic foot syndrome are given.

The paper considers the role of B-group vitamins in nervous system performance and the possibilities of their use in the treatment of nervous system diseases as solo drugs in mono- and polyneuropathies of varying genesis and in pain syndromes. The prospects for using the vitamin complex Neurobin are discussed.