By applying the neuropsychological approach, the authors describe the specific features of cognitive activity in normal aging on the brain structural and functional model as described by A.R. Luria. Four variants of normal aging are identified. Clinical and neuropsychological syndromes are shown in presenile (early) and senile (late) types of Alzheimer's disease

According to the results of integrated assessment of cardiological inpatients with depression, the author identified 2 possible variants of psychosomatic ratios: 1) subordinated with the leading role of a somatic disease in the genesis of developing symptomatic somatogenic and psychogenic mental disorders and 2) independent as the coexistence of mental disorders and a somatic disease. Their consideration is of importance for the diagnosis and substantiation of treatment policy.

The paper gives an update on the principles of diagnosis and medical and surgical treatments in patients with low back pain (LBP), by taking into account the clinical phenomenology of pain manifestations. It considers the use of nonsteroidal anti-inflammatory drugs, myorelaxants, anticonvulsants, antidepressants, and other agents. The data of clinical trials of meloxicam used in LBP are presented. The currently available surgical treatments for LBP are described.

The review analyzes reasons for the late diagnosis of ankylosing spondylitis (Bekhterev's disease). Poor awareness about this disease among general practitioners, neurologists, manual therapists is a most significant reason. At the same time physicians of these specialties frequently encounter patients with early ankylosing spondylitis. Early long-term therapy with nonsteroidal anti-inflammatory drugs contributes to the maintenance of good quality of life in patients and to a favorable prognosis.

Objective. To have additional data on the short-term safety and efficacy of sustained-release valproate (Depakine Chronosphera®, Sanofi- Aventis, France) used as both first-line monotherapy and additional therapy in children and adolescents with epilepsy.

Subjects and methods. This open-label, noncomparative, prospective, short-term survey enrolled 1010 patients aged 1 month and 72 years (mean age 10,9±12,4 years). Three hundred (29,7%) patients had unspecified epilepsy; 40 (3,96%) had idiopathic focal epilepsy; 428 (42,38%) had presumptively symptomatic and symptomatic focal epilepsy; 117 (16,93%) had idiopathic generalized epilepsy, 71 (7,03%) had epileptic encephalopathy; 52 (5,15%) had West's syndrome. The starting dose of Depakine Chronosphera® was 10-15 mg/day; the mean therapeutic dose was 20-30 mg/kg/day. When there was no adequate response, the dose might be increased up to 50-60 mg/kg/day, by meticulously monitoring a patient's status. Depakine Chronosphera® was used both alone and in combination with other antiepileptic drugs (AED). The follow-up lasted at least 2 months.

Results. The most common reason for using Depakine Chronosphera® was ineffective previous treatment with AED (24,7% of cases) and easiness to use. Due to the therapy, epileptic seizures ceased in 405 (40,1%) patients; their number reduced by 75 and 50% in 248 (24,55%) and 272 (26,93%) patients, respectively; therapy failed in 55 (5,45%) patients; seizure aggravation was noted in 7 (0,69%); there was no information on changes in the frequency of seizures in 23 (2,28%). Since Depakine Chronosphera® is intended mainly for both preschool children and older patients who have difficulties in taking the drug as tablets, the study group comprised children less than 7 years of age. Nevertheless, the drug was also actively given to children over 7 years and adults. This was associated with not only with the physician's interest in the new formulation of the drug, but also with its easiness to use. Adverse reactions were observed in 8,91% of the patients. The spectrum and frequency of side effects corresponded to those in the similar studies.

Conclusion. The study has indicated that the use of Depakine Chronosphera® as monotherapy and multimodality treatment for epilepsy in adults and children is effective and safe. The low discontinuance rate of the drug suggests its good tolerability and efficacy, as well as easiness to use, in early preschool children in particular. The use of Depakine Chronosphera® is promising in treating epilepsy in adults and children

Headache is an urgent problem of modern medicine. The purpose of the investigation was to study the pattern and clinicopsychological aspects of headache in participants of local military conflicts (LMC). Among the examined participants of LMC (n = 162), 69.8% complained of headache. The clinicopsychological characteristics of posttraumatic and exertion-induced headache are presented depending on the type of LMC.

In growing glial tumors, epileptic seizures are the first and only symptom of the disease in more than a third of cases. The seizure is commonly characterized by only psychopathological disorders that are frequently ignored by both patients and physicians. The deja vu (DV) phenomenon may be one of such symptoms. Its specific feature is that it occurs in both healthy individuals and patients with various brain pathologies. This investigation was undertaken to study the implication of the DV phenomenon in the clinical picture of glial brain tumors (GBT). One hundred and sixty-one subjects (mean age 29,2±6,4 years; males 47%), including 129 healthy individuals and 32 patients with GBT, were examined. In the clinical picture of GBT with seizures, DV is a common symptom that is encountered in the involvement of predominantly the right temporal lobe and accompanied by generalized convulsive attacks and olfactory hallucinations. DV in GBT occurs more than once daily; its duration is a few (as many as 5) minutes; DV is characterized by a negative emotional tinge and attended by fear.

Seventy patients (40 females and 30 males; mean age 46,5±15,0 years) with acute nonspecific back pain at various sites were followed up in the outpatient setting to study the efficiency of drug therapy based on meloxicam (movalis), without using physiotherapy, acupuncture and manual therapy techniques. The patients took movalis in a dose of 15 mg/day orally or 15 mg/day intramuscularly for up to 5 days, then 15 mg/day orally. Most patients (n = 56) also received myorelaxants (predominantly midocalm). As a result of therapy, back pain completely disappeared or was reduced (from 7,8±1,4 to 1,14± 0,95 visual analogue scores), the routine activity reached the baseline level as had been before pain occurrence; the duration of the disease being less than 2 weeks (mean 11 days). Adverse reactions caused by therapy were observed in sporadic cases; these were mild and transient. Case histories of 2 patients in whom movalis therapy was effective when the use of other nonsteroidal anti-inflammatory drugs failed are presented.

The paper considers the pharmacoepidemiological parameters of the use of potent opioids in Saint-Petersburg in 2000-2009. These parameters are compared with those in a number of countries of the world, particularly in the Scandinavian countries that are close to Saint Petersburg in population. The reasons for the differences in the use of potent analgesics are analyzed. Approaches to prescribing the drugs of this group for non-cancer pain caused by neurological diseases in particular are also analyzed.

The paper describes the results of psychopharmacotherapy for obsessive-phobic disorders (OPD) in the structure of schizophrenia spectrum states. It is shown that not only the clinicodynamic features of OPD, but also the course of a schizophrenic process and the pattern of comorbid mental disorders should be borne in mind when therapy is chosen. The OPD variants that are associated with the best and worst prognosis in terms of medical therapy are identified.

Approaches to preventing recurrent stroke by antithrombocytic therapy are shown to be as diverse as its causes. The diagnosis of cardioembolic stroke in patients with atrial fibrillation should not limit the choice of an antithrombocytic agent to only oral (indirect) anticoagulants (OAC). If OAC cannot be used, antithrombocytic therapy, including combined (clopidogrel + ASA) one, may be considered as a reasonable alternative. Approaches to choosing the optimal antithrombocytic drug in noncardioembolic strokes are intricate since atherosclerosis is a systemic vascular disease and the poststroke period is characterized by a higher risk for not only recurrent stroke, but also for coronary catastrophes. It is concluded that an antithrombocytic agent should be chosen, by taking into account the multifocality of atherosclerosis, associated clinical conditions, diabetes mellitus, intravascular interventions and the individual risk of all cardiovascular events.

The review characterizes the role of acetylsalicylic acid in the prevention of stroke in patients with clinical manifestations of atherosclerosis or a potential source of thromboembolism from the left-sided cardiac chambers. It analyzes approaches to preventing the most common complications associated with the use of acetylsalicylic acid.

Citicolin (ceraxon) is used as a neuroprotector in the treatment of acute stroke and vascular cognitive disorders. Experimental animal studies have demonstrated that citicolin reduces the extent of cerebral infarct and increases the degree of functional recovery. A few clinical trials have provided evidence for the efficacy of intravenous or oral citicolin used within the first 24 hours of ischemic stroke or cerebral hemorrhage in recovery of neurological functions. Citicolin is effective in memory and behavioral disorders in elderly patients with chronic cerebrovascular diseases. The use of citicolin has been found to be safe in stroke and vascular cognitive disorders.

High doses of B-group vitamins are currently used to treat a variety of neurological diseases. The performed numerous studies have shown the positive effect of Milgamma and Milgamma compositum on subjective and objective clinical parameters in patients with various nervous system lesions: alcoholic and diabetic polyneuropathy, trigeminal neuralgia, discogenic lumbosacral radiculopathy, etc.

Arterial hypertension (AH) is one of the main causes of the occurrence and progression of different types of vascular pathology. AH-associated functional and morphological impairments of the brain are the severe symptom complexes of hypertensive encephalopathy (HE), which require continuous correction. The measures for the prevention and treatment of all cardiovascular diseases, including HE, involve adequate correction of AH, correction of energy neuronal homeostatic disorders, as well as a harmonious combination of psychotherapeutic and pharmacological exposures.