Basic antihypertensive, antithrombotic, and antihyperlipidemic therapies form the basis for the prevention of cardiovascular events after ischemic stroke (IS). It is necessary, if indicated, to perform reparative operations on the brachiocephalic arteries. A package of measures to improve the prognosis of a late poststroke period should include the timely detection and adequate therapy of cardiac pathology and the consideration of the predictors of its increased risk. A prospective follow-up of 133 patients with prior IS was conducted to study the prognostic factors of cardiac events in the late poststroke period. During the follow-up, 12 (9%) patients experienced cardiac events, 5 of them died. The outpatient basic treatment of these patients was inadequate. The predictors of poor cardiac prognosis were elderly and senile age, the presence of coronary heart disease, paroxysmal atrial fibrillation, life-threatening ventricular arrhythmias, and reduced heart rhythm variability.

Parkinson's disease (PD) is a multisystemic neurodegenerative disease with a wide spectrum of not only motor, but also neuropsychic disorders. Depression occurs in an average of 40-50% of patients and it is one of the leading factors that decrease their quality of life. The paper gives the present views of the clinical presentation and pathogenesis of depression, and approaches to its therapy in PD.

Vertigo is the second common complaint next to headache, which makes a patient seek medical care. Neurological, auricular, cardiac, mental, and other diseases may be a cause of dizziness. Since vertigo is interdisciplinary in nature, there are frequently problems of establishing its origin. Vertigo is commonly associated with vascular pathology of the head and neck, which results in the hyperdiagnosis of cerebrovascular diseases. At the same time, little attention is given to the patient's psychoemotional sphere and ENT pathology. Large-scale studies have demonstrated that vertigo most frequently results from psychogenic causes and vestibular apparatus diseases.

Back pain is a topical problem for both a general practitioner and a neurologist because of not only the high rate of this syndrome, but also its differential diagnosis problems. As any clinical syndrome, back pain should be differentiated from very many other diseases. This is primarily determined by the tactics of the management and treatment of a patient with neck-and-chest or low back pain. Today the diagnosis of spinal osteochondrosis may be rather common as that of exclusion. A meticulous neurological examination is of importance when diagnosing back pain. A premium is also placed upon X-ray and neuroimaging studies. When back pain is treated, it is necessary to take into account the intensity of pain syndrome, its proneness to chronicity, the individual personality traits, and concomitant visceral involvement and to use both drug and non-drug treatments, among which remedial exercises and psychotherapy are considered most effective.

The paper deals with a role of muscle dysfunction in primary headache disorders, such as migraine and tension-type headache (TTH). It considers terminology, the contribution of pericranial muscle dysfunction to the clinical picture and chronicity of migraine and TTH, their comorbid association, and the involvement of muscle tension in the pathophysiology of TTN. Approaches to treating muscle tension in patients with primary headache disorders are discussed and a role of myorelaxants in the correction of muscle dysfunction is emphasized.

The annual incidence of new cases of acute cerebral circulatory disorders is noted to be at least 700 per 100 000 population. Chronic brain ischemia leads to the development of encephalopathy with a wide spectrum of subjective and objective neurological disorders worsening memory and other cognitive functions, physical capacities, and quality of life. The pathogenesis of chronic ischemic disorders of blood supply to the brain and the problems of the diagnosis and treatment of acute and chronic ischemia are discussed.

Smoking shows a 2-4-fold increased risk of ischemic stroke. The duration of smoking and the larger number of smoked cigarettes increase this risk, which is to a certain degree true for passive smoking. Smoking contributes to the progression of atherosclerosis, the elevation of blood pressure, and the narrowing of minor intracranial arteries, causing brain blood supply to worsen. After 5-year smoking cessation, the risk of stroke drops to its level observed in non-smokers. There was a 50% reduced vascular risk just 12 months after smoking refusal. Psychotherapy and drug therapy options that help quit smoking are discussed.

Low back pain (LBP) is common; 54 to 80% of the population experience LBP throughout their lives. The authors describe the effect of glucocorticoids (GC) in myofascial pain syndrome, spondyloarthrosis, and sacroiliac arthropathy. Epidural GC is noted to be indicated for persistent pain syndrome. It is concluded that medical blockades using Diprospan in dystrophic-destructive diseases of the lumbar spine are a potent means against one of the major components of manifestations of the disease - pain syndrome - and can achieve a marked therapeutic effect.

The paper gives information on how medical care to patients with chronic pain syndromes (CPS) is organized in developed countries. It considers the pattern and sequence, scope and methods of treatment in the health care facilities of different levels. Examples of drug treatment for neuropathic pain are given on the strength of the data of evidence-based medicine. The benefits of a multidisciplinary approach to treating CPS are discussed.

Frequent episodic tension-type headache (ETTH) is a serious medical problem that is primarily due to its high prevalence. Nonsteroidal anti-inflammatory drugs (NSAIDs) whose efficiency is determined by the rapid and complete regression of cephalgia are primarily used to relieve an ETTH attack. One of the ways to enhance the effect of NSAIDs is their combination with agents that accelerate their absorption or potentiate their action, with caffeine in particular; however, the use of combination agents is limited by a risk for drug-induced headache. A step on the road to the design of effective and safe analgesics has been the development of the combination drug Novigan that contains ibuprofen (400 mg) and the spasmolytics pitofenone (5 mg) and fenpiverinium (0.1 mg).

Objective: to study the efficacy of Novigan versus ibuprofen 400 mg in relieving an ETTH attack.

Subjects and methods. Fifty patients (mean age 37.1±10.9 years) with frequent ETTH that met the criteria of the International Classification of Headache Disorders, 2nd Edition, were examined. For relief of ETTH attacks, 30 patients used Novigan and 20 took ibuprofen in a dose of 400 mg.

Results. There was a significant reduction in the intensity of cephalgia 49.9±35.8 and 68.2±45.9 min after drug administration in the Novigan and ibuprofen 400 mg groups, respectively (p = 0.007). The proportion of respondents was higher in the Novigan group (73.3%) than that in the ibuprofen 400 mg group (60%), which is close to the statistically significant difference (p = 0.085). The efficacy predictors were less pain intensity (p < 0.001) and a shorter time after onset (p < 0.001) in the ibuprofen 400 mg group at administration of the drug and only less pain intensity in the Novigan group at that moment (p = 0.07).

Conclusion. Novigan is a combination analgesic that rapidly and effectively relieves an ETTH attack, including that of high intensity, as well as extended ETTH attack.

Physicians have been found to be inadequately aware of the structure of the causes of headache, vertigo, and their clinical importance in patients with essential hypertension. Incorrect ideas lead to the unfounded application of diagnostic techniques for imaging the great arteries of the head and to extremely simplified approaches to treating cerebrovascular diseases as short-term courses of therapy with vasoactive and metabolic agents.

The authors studied the efficiency of drug therapy using the nonsteroidal anti-inflammatory drug (NSAID) meloxicam (Movalis) for nonspecific back pain and radiculopathy in the outpatient practice (without physio-, reflex, and manual therapies). Examination of 156 patients revealed a specific cause of back pain only in 6 (3.8%). Drug therapy using Movalis in 150 patients with acute, subacute, chronic nonspecific back pain at various sites or radiculopathy resulted in a considerable reduction in pain (as high as 1-3 VAS scores) and its complete regression in 97.3% of cases within 2-3 weeks of treatment. Movalis therapy was found to be well tolerated and caused a low frequency of side effects (1.7%) as mild gastrointenstinal disorders; Movalis used in combination with antiepileptic agents (pregabalin and gabapentin), myorelaxants (Midocalm) and Milgamma in some patents was ascertained to be also well tolerated.

Objective: to study the efficacy of pediatric Tenoten in the treatment of secondary nocturnal enuresis in children. Subjects and methods. A comparative randomized study of the results of treatment was conducted in 36 children aged 5 to 15 years with secondary enuresis, who received pediatric Tenoten (n = 18; Group 1) and fenibut (n = 18; Group 2). Tenoten (pediatric formulation) was given a sublingual tablet thrice daily for 2 months. Therapeutic effectiveness was evaluated by clinical parameters (the number of nocturnal enuresis episodes per month and anxiety scale scores). Results. There was a significant reduction or complete cessation of nocturnal enuresis episodes in the majority of children and a decrease in anxiety levels. Positive clinical changes were accompanied by a trend toward normalization of spectral coherent EEG characteristics. Conclusion. Treatment with pediatric Tenoten results in a reduction in the rate of nocturnal enuresis episodes and, in some cases, in their cessation, positively affects the psychological status of children, and improves the indicators of brain bioelectrical activity. The drug causes no adverse reactions and is well tolerated.

Nootropics are used to treat patients who have sustained concussion of the brain and complain of reductions in memory and working capacity, as well as emotional disorders. The efficacy of ceretone® (choline alfoscerate) was studied in 76 patients (45 men and 31 women whose age was 21-56 years) who had sustained brain concussion and had complaints of headache, easy fatigability, nocturnal sleep disorders, daytime sleepiness, anxiety, and bad mood. Thirty-nine patients received intravenous ceretone® in a dose of 1000 mg/day for 10 days; the other 37 patients formed a control group. A one-year follow-up indicated that ceretone® had a positive effect on health, autonomic, and emotional status and working capacity.

The paper presents the results of a randomized double-blind study of the impact of therapy with celecoxib and a combination of diclofenac and omeprazole in patients with osteoarthrosis and rheumatoid arthritis on a risk for developing gastrointestinal diseases. The study was conducted at health care facilities in 196 centers of 32 countries and covered 18-to-60-year-old patients who belonged to an increased gastrointestinal risk group and had a history of gastroduodenal ulcers and a negative Helicobacter pylori test at screening. The included patients were randomized by a computer program in a 1: 1 ratio to treatment groups receiving celecoxib in a dose of 200 mg twice daily or sustained-release diclofenac 75 mg twice daily + omeprazole 20 mg once daily. The primary efficacy criterion was assessed as the development of clinically relevant changes in the upper or lower gastrointestinal tract (GIT). 4484 patients were randomized to treatment groups (2238 took celecoxib; 2246 received diclofenac + omeprazole). Twenty (0.9%) patients who took celecoxib and 81 (3.8%) who used diclofenac + omeprazole achieved the primary assessment criterion (p<0.0001). One hundred and fourteen (6%) patients who received celecoxib and 167 (8%) who took diclofenac + omeprazole were withdrawn from the study prematurely because of adverse reactions in the GIT (p = 0.0006). The risk of clinically relevant GIT changes was lower in the patients treated with celecoxib, that is a selective cyclooxygenase 2 (COX-2) inhibitor, than in the patients who received diclofenac, a nonselective COX inhibitor, and omeprazole, the proton pump inhibitor. The findings should contribute to the revision of approaches to reducing the gastrointestinal risk in nonsteroidal anti-inflammatory drugs treatment.

The paper presents data on the clinical presentation and pathogenesis of osteoarthrosis (OA), the basis for which is both articular tissue inflammation and degeneration. It provides the ultrasonographic characteristics of synovitis in OA. The author describes anti-inflammatory therapy for knee OA in an exacerbation phase, by using amelotex, a nonsteroidal anti-inflammatory drug with selective inhibition of COX-2, and positive therapeutic results as reduced joint pain and swelling, increased volume of movements, and its good tolerability.