Rehabilitation in patients after vertebral and spinal cord injury (VSCI) is one of the most difficult problems in the global world health system. VSCI leads to severe, persistent functional impairment or disability, which causes clinical, psychological, social, and economic challenges faced by patients. The paper presents clinical and psychological ideas and information about adaptation problems in patients with VSCI. It describes in detail a stepwise rehabilitation system for these patients, the role of their personal traits, and social providers. The importance of interdisciplinary cooperation in patient's adaptation to disease is shown. 

Sensorineural hearing loss (SHL) is one of the most common disorders in neurological practice. In our country, many patients with SHL are observed to be mistakenly diagnosed with chronic cerebral ischemia. The paper deals with the current issues of diagnosis and treatment of SHL, Meniere's disease, and acoustic neuroma. It discusses the use of pentoxifylline for SHL of vascular origin. 

Objective: to compare standardized mortality ratios (SMRs) from cerebrovascular diseases (CVD) among populations aged 50 years or older in Russia and the USA; to discuss the reasons for the differences.

Patients and methods. The investigators calculated SMRs from CVD for men and women aged 50 years or older in Russia (2000–2014) and the USA (1999 to 2013), which corresponded to the 3- and 4-digit codes of the International Statistical Classification of Diseases and Health-Related Problems, 10t h edition (ICD-10). The European standard (European Standard Population, ESP-2013) was used to standardize SMRs.

Results and discussion. The SMRs per 100,000 population from all CVD forms for men aged 50 years or older are 1353 in Russia and 185 in the USA; these for women are 1080 and 175, respectively. The CVD SMRs in percentage of SMRs of all circulatory diseases in Russia were 33.5 for men and 39.6 for women and those in the United States are 14.6 and 19.6, respectively. In Russia, the highest death rates due to CVD fall in the category «Other Cerebrovascular Diseases» (I67) are 35.5% for men and 41.3% for women (about 6% for men and women in the USA); those followed by the rubrics «Cerebral Infarction» (I63) (20.1% for men and 19.2% for women (about 6% for both men and women in the USA)); «Stroke, Not Specified as Hemorrhage or Infarction» (I64) (26% for men and women (about 55% for men and women in the USA)). The death rates from non-traumatic intracranial hemorrhage (I61–I62) in the USA are 18.9% for men and 16.3% for women; those in Russia are 9.5 and 8.6%, respectively. As for all 3-digit codes, SMRs are higher in Russia than those in the USA, with the exception of «Other Nontraumatic Intracranial Hemorrhage» (I62).

The reasons for the revealed differences are discussed. The differences in CVD mortality rates in the United States and Russia are linked to a number of reasons, most of which are due to the peculiarities of selecting the underlying cause of death and using the ICD-10 codes. 

The management of patients with chronic (>3-month) nonspecific pain in the lumbar region (low back pain (LBP)) is an actual problem of modern medicine. It is noted in many countries that an integrated approach to treating these patients is effective; however, this approach is not yet applied in our country.

Objective: to clarify the efficiency of combination treatment using cognitive behavioral therapy (CBT), therapeutic exercises in patients with nonspecific chronic LBP (NCLBP).

Patients and methods. Sixty patients (19 men and 41 women; their mean age was 50.3±1.97 years) with NCLP underwent a comprehensive clinical, neurological, and psychological examination and treatment and were followed up for 1 year.

Results. It was ascertained that the frequency of erroneous beliefs about back pain was high in patients with NCLBP and these ideas and concomitant anxiety and depressive disorders, sleep disorders, and headache had a negative impact on treatment outcomes. The integrated approach using therapeutic exercises, CBT was noted to be effective in both the immediate (within 1 month) and late (after 1 year) period. During the follow-up, there was a considerable increase in the proportion of patients performing therapeutic exercises (from 28 to 85% after 3 months); adherence to the latter remained in most (71.7%) patients.

Conclusion. When patients with NCLP are managed, it is important to use therapeutic exercises, CBT (to clarify patients' ideas, to explain the true causes of this disease and its favorable outcome), and to identify and treat concomitant anxiety and depressive disorders, headache, and sleep disorders. 

Citrulline malate that is essential for the biosynthesis of arginine promotes dehydration of ammonium endotoxins, by participating in the urea cycle. The indications for the use of citrulline malate are functional asthenia, asthenic syndrome, overfatigue, increased fatigue, and rehabilitation during recovery following diseases.

Objective: to simulate the biological properties of citrulline malate.

Material and methods. Reliable estimates of more than 2,500 biological activities were obtained for this molecule, which were compared with those of the reference molecules of acetylcarnitine and meldonium.

Results and discussion. The data obtained from chemoreactome simulation may suggest that there are substantial differences between the pharmacological effects of citrulline malate and the reference molecules. Malate anion as a component of citrulline malate significantly enhances the absorption of citrulline molecules in the gastrointestinal tract regardless of gastric acidity. Citrulline malate improves renal bicarbonate anion absorption, which contributes to the overcoming of acidosis. The results of chemoreactome simulation indicate that citrulline malate has antidepressant, anxiolytic, and anti-inflammatory properties, which can make a substantial contribution to the development of anti-asthenic and detoxifying effects of the drug. Citrulline malate can also show anticoagulant, antivasopressor, hypoglycemic, antihypercholesterolemic, and antimicrobial effects. These properties of citrulline malate can contribute to the earliest recovery of patients after asthenia or intensive strenuous exercises as compared to those of the reference molecules (meldonium, acetylcarnitine).

Conclusion. The findings are consistent with the available experimental and clinical data and are indicative of promising clinical applications of citrulline malate. 

Objective: to investigate emotional disturbances in pregnant women with sequels of brain injury (BI).

Patients and methods. A total of 47 pregnant women with a history of BI, who had been admitted to the Department of Obstetric Physiology, Moscow Regional Research Institute of Obstetrics and Gynecology, in 2013-2015, were examined. All the patients underwent a comprehensive neurological and neuropsychological examination using the Miltidimensional Fatigue Inventory-20 (MFI-20), the Hospital Anxiety and Depression Scale (HADS), and the Spielberg-Hanin Situational and Personal Anxiety Scale.

Results. The pregnant women with BI sequels were found to have emotional changes involving asthenic, anxiety, and depressive components. In these women, anxiety symptoms were most common (53.3%); psychoemotional disturbance and asthenic and depressive manifestations were identified in 23.4 and 14.9% of cases. This investigation first verified the structural (situational and personal) components of post-traumatic anxiety syndrome in the pregnant women. It revealed that an increased level of situational anxiety and physical symptoms of fatigue was observed in brain concussion sequels; and after brain contusion (BC), alarm acquired personality traits, asthenia was of a mental nature. In the pregnant women with BI sequels, depression was diagnosed only at the subclinical level and more often noted after BC (p=0.0473). 

Objective: to investigate cerebrovascular reactivity (CVR) and brain matter structural changes in patients with moderate cognitive impairment.

Patients and methods. A total of 385 patients aged 57 to 79 years with moderate vascular cognitive impairment (VCI) were examined. A relationship of the clinical types of VCI and depression to the extent and location of ischemic brain matter damage and to the state of CVR in different vascular beds was investigated at the stage of inclusion into the study and following 20 months.

Results. There was a correlation of the neuropsychological profile and the severity of VCI with the features of brain matter structural damage, but with a greater CVR decrease in the carotid artery (CA) system and a concomitant CVR reduction in the CA and vertebrobasilar bed (VBB). There was an association of the incidence of depression with the location of ischemic damage in the frontal lobes and a CVR decrease in the left CA and with a concomitant CVR reduction in the CA and VBB.

Conclusion. The CVR determined in different vascular beds may serve as an early prognostic indicator of evolving VCI or depression. 

Objective: to investigate the efficiency of an integrated approach to treating craniomandibular dysfunction, by changing the biomechanical tempomandibular joint (TMJ) movement pattern via botulinum toxin type A injection into the masticatory muscles.

Patients and methods. The investigation enrolled 20 patients aged 18-45 years with clinical signs of muscular-articular dysfunction of the TMJ. Before and after treatment, all the patients underwent magnetic resonance imaging of the TMJ and masticatory muscles, as well as ultrasonography and surface electromyography (EMG) of the masticatory muscles.

Results. There was a significant reduction in pain syndrome, an improvement in the relationship of intra-articular TMJ elements, and a change in the structure of the masticatory muscles. The EMG indices were near-normal. Four-six months after treatment, the majority of patients showed an increase in the amplitude of mouth opening (95%), reductions in resting pain (85%) and in the frequency of TMJ clicking (90%).

Conclusion. The management of patients with severe chronic pain syndrome in the presence of muscular-articular dysfunction of the TMJ requires the participation of an orthodontist to correct malocclusion and a neurologist to treat local myofascial pain syndrome. 

Objective: to analyze the interactions that could indicate the potential pharmacological properties of the molecules of thiamin, thiamine disulfide, and others.

Material and methods. The investigators simulated the properties of thiamine disulfide (bistiamin) versus those of the reference molecules of thiamin hydrochloride and benfotiamine. The study was performed using chemoreactomic simulation that is the newest area in post-genome pharmacology.

Results and discussion. Chemoreactomic analysis has shown that thiamine disulfide can inhibit the molecular receptors involved in blood pressure regulation: adrenoceptors, vasopressin receptor, and angiotensin receptor. Thiamine disulfide can inhibit the reuptake of serotonin, increase its levels, inhibit benzodiazepine receptor and dopamine reuptake, and enhance neuronal acetylcholine release to a large extent than benfotiamine. These molecular effects are consistent with the sedative and anticonvulsant action profile of thiamine disulfide. Simulation has indicated that thiamine disulfide has neuroprotective, anti-inflammatory, normolipidemic, and antitumor activities.

Conclusion. The simulation results are confirmed by the available clinical and experimental findings and indicate the virtually unstudied molecular mechanisms of action of thiamine disulfide, benfotiamine, and thiamin hydrochloride. 

The paper considers the key areas of antithrombotic platelet therapy for ischemic stroke (IS). Antithrombotic therapy is shown to be a multistep and multidisciplinary strategy of treatment for patients with IS that begins with the first symptoms of the disease and continues throughout life. Each stage, including fibrinolytic therapy, early administration of antiplatelet and anticoagulant drugs, and personalized antithrombotic prevention of recurrent cerebral disorders, is important in itself and serves a single goal. Untimately, all efforts should be aimed at reducing mortality rates in the acute phase of stroke and the functional dependence of a patient and at preventing venous thromboses, recurrent stroke, and all cardiovascular events to increase the duration and quality of life. Fibrinolytic therapy increases the patient's chances for a full neurological recovery and improves the quality of later life. Antiplatelet drugs reduce the risk of cardiovascular death, early recurrences of stroke, and recurrent noncardioembolic stroke. Parenteral anticoagulants in acute stroke decrease the risk of venous thrombosis/thromboembolism, oral anticoagulants reduce that of recurrent cardioembolic stroke.

Dementia is an etiologically heterogeneous syndrome, the traditional evaluation of the severity of which is based on the degree of cognitive activity reduction and on impairments in functional abilities. In addition to cognitive impairment (CI), non-cognitive neuropsychiatric disorders, the prevalence of which is as high as 50–100%, form the clinical picture of dementia. Non-cognitive impairment is appreciably correlated with the severity, course, and poorest outcome of dementia. Non-cognitive neuropsychiatric impairment is characterized by different symptoms, which is associated with the heterogeneity of dementia. The main symptoms include aggression, agitation, wandering, hoarding, sexual disinhibition, apathy, depression, and anxiety. The paper considers the main clusters of neuropsychiatric disorders and their clinical manifestations. It provides data on the combination treatment of CI and non-cognitive disorders in dementia. 

In recent decades, special attention is given to cognitive impairments (CIs) without dementia, which include moderate (MCI), mild, and subjective ones. Epidemiological studies suggest that the prevalence of CI is high in elderly people (10–15%) and patients at an outpatient reception (as high as 70%). CIs are more frequently caused by Alzheimer's disease, cerebrovascular disease, and their concurrence. In patients with MCI, dementia occurs in 10–15% of cases during a year. Correction of vascular risk factors allows the progression of CI to be curbed. The paper discusses the use of EGB761® in patients with CI. 

The paper considers the psychological factors that influence the course of vertebral and spinal cord injury (VSCI). The factors contributing to psychological growth include psychological stability, an internal locus of control, hope and optimism, low-grade depression, social involvement, good family relationships, and behavioral and cognitive coping. The formation of the optimal psychological trajectory in patients with VSCI assumes that a psychotherapist diagnosing and correcting this condition should participate fully in the rehabilitation process. 

The article reviews foreign and Russian literature on the organization of headache (HA) treatment. The economic burden of HA has been convincingly proven. The medical aid appealability of patients with HA has been established to be low (20–60%). This is frequently due to a lack of confidence in the success of a doctor's advice. The paper considers various models for the management of patients with HA in foreign countries. There is a low reliability of the diagnosis established during questionnaire surveys. Whether the patients can be managed using telecommunications, such as telephone and online counseling, is described. In Russia, there are substantially fewer treatment options for patients with HA; at the same time the available models are inclined to foreign ones. The paper describes world and Russian practices in educating the physicians and underlines the need for patients with HA to have educational classes. The sites where both the doctor and the patient can receive relevant information about HA are considered. 

Only 50% of patients treated for back pain achieve effective relief. This is to some extent due to physicians' insufficient knowledge about the therapeutic strategies recommended in most expert guidelines. The widespread administration of muscle relaxants is traditional in clinical practice because of their high efficacy and long-term experience with their use in different categories of patients. Muscle relaxants are presented in the majority of the current clinical guidelines; their use is indicated when simple analgesics (paracetamol), nonsteroidal anti-inflammatory drugs, or combined and opioid analgesics do not provide sufficient analgesia. Muscle relaxants are characterized by a considerable analgesic effect in the short-term treatment of acute low back pain. It is noted that there is a need for a more thorough analysis of the therapeutic effects of muscle relaxants in patients with common pain syndromes. 

Myofascial pain syndrome (MFPS) is a chronic pain syndrome characterized by the formation of myofascial trigger points (MTP). MFPS most frequently occurs in patients with neck pain. The peripheral and central aspects of the formation of MTP, MFPS diagnostic criteria, piriformis syndrome, fibromyalgia, the impact of MFPS on quality of life and functional activity in patients are discussed.

MFPS is treated according to the international guidelines for the treatment of nonspecific spinal pain, which encompass patient education programs, therapeutic exercises, early mobilization, manual therapy techniques, and nonsteroidal anti-inflammatory drugs as first-line analgesic agents. Meloxicam is noted to be highly effective in treating low back pain, including myofascial pain.

The paper presents current views on the pathogenetic mechanisms of cerebral ischemia. It discusses the role of neurotrophins in the processes of neuroplasticity. Experimental and clinical studies of the neuropeptide drug Cerebrolysin are reviewed. The authors describe in detail the results of the clinical trial and a health economic analysis of the effects of Cerebrolysin on the time course of clinical changes, progression, and risk of exacerbations in patients with chronic cerebral ischemia.