Neurology, Neuropsychiatry, Psychosomatics

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Vol 13, No 3 (2021)
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The article describes the current state of evidence of hypertension and diabetes mellitus roles in the pathophysiology of chronic cerebral ischemia (CCI). CCI is mediated by cerebral microangiopathy, which develops due to vascular remodeling, increased arterial stiffness, endothelial dysfunction, impaired cerebrovascular reactivity, and neuroinflammation. All those mechanisms lead to white matter lesions and cognitive impairment. Arteriolosclerosis is the primary morphological process that damages perforating arteries and arterioles. COVID-19 pandemic can modify CCI progression due to similar pathophysiology. In particular, COVID-19-associated coagulopathy can lead to silent lacunar infarctions and lacunar stroke development. Treatment features of patients with CCI during the COVID-19 pandemic are reviewed. It is concluded that special attention in this group of patients should be paid to primary and secondary cardiovascular prevention issues, an essential element of which is the use of dipyridamole since it has a pleiotropic effect.


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Objective: linguistic and cultural adaptation of the original version of Berg Balance Scale (BBS) and assessment its psychometric properties.

Patients and methods. The staff of the Validation Center of International Scales and Questionnaires of the Research Center of Neurology received consent from Katherine Berg to validate the BSS in Russia. We carried out the linguocultural ratification during the validation study and prepared a Russian version of the scale. To assess the psychometric properties of the scale (reliability, validity, and sensitivity), we evaluated 55 patients (30 females and 25 males) aged 22–88 years with different neurological disorders (vascular and demyelinating diseases of the central nervous system, peripheral neuropathy, and movement disorders). We analyzed the differences of the total BBS score and the number of patients with high and low risk of falls at the end of rehabilitation compared to baseline to assess the dynamics of changes.

Results and discussion. We successfully performed the translation and linguocultural adaptation of the BBS. The scale represents a high level of validity (expert score: 8.6 out of 10 points), reliability (Pearson's correlation coefficient r=0.98, р<0.0001; Cronbach's alpha α=0.94 р<0.001; Cohen's kappa κ=0.71, p<0.0001) and sensitivity (р<0.0001). After a two-week rehabilitation course, the risk of falls significantly decreased (χ2 =4.42; р=0.035); however, the level of independence of movement did not change significantly (F=0.94; р=0.636).

Conclusion. The Russian version of the BBS was officially adapted based on the results of the accomplished validation study and is recommended for use both in routine clinical practice and in clinical trials by neurologists and rehabilitologists. The scale is available for downloading by QR code and on the website of Validation Center of International Scales and Questionnaires of the Research Center of Neurology.

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Antipsychotics are often used to treat children and adolescents. Because of their age, there are a lot of off-label prescribed antipsychotics in that population. However, the off-label use of medications is considered to be potentially unsafe.

Objective: to evaluate whether the off-label prescription of antipsychotics outside of the approved age group increased the risk of adverse drug reactions in adolescents experiencing an acute psychotic episode.

Patients and methods. We analyzed 450 charts of adolescents hospitalized due to an acute psychotic episode (only completed cases). In addition, we evaluated adverse drug reactions adjusted by off-label antipsychotics prescription outside the approved age group using the Global Trigger Tool (GTT). We also registered prescriptions with duplicates drug classes and potentially dangerous drug interactions.

Results and discussion. Off-label antipsychotics prescription outside the approved age group was less frequently associated with adverse drug reactions (3.2% vs. 10.5%; p=0.013). The logistic regression analysis did not show any significant associations between the off-label antipsychotic use and increased risk of adverse drug reactions (Odds ratio=0.994 (95% confidence interval 0.572-1.726), p=0.982). Although, patients with off-label use of antipsychotics were more likely to have potentially dangerous drug interactions (35.2% vs. 16.15%; p=0.0001) and prescriptions with duplicates drug classes (39.6% vs. 15.43%; p=0.0001).

Conclusion. Off-label antipsychotic prescription outside the approved age group in adolescents with acute psychotic episode does not increase the risk of adverse drug reactions. However, an increase in potentially dangerous drug interactions and prescriptions with duplicates drug classes frequency could be considered red flags. Therefore, we have concluded that the concerns about off-label antipsychotics prescription outside of approved age groups in adolescents with acute psychotic episodes were overrated.

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Patients with primary headaches are prone to frequent uncontrolled use of analgesics, leading to medication-overuse headache (MOH). One of the most accessible and effective strategies for its prevention is informing patients about the potential danger of its development. For this, training programs («schools») are conducted.

Objective: to evaluate the effectiveness of educational programs in management of patients with MOH and its prevention.

Patients and methods. We included 120 patients (12 men and 108 women, mean age: men – 46.3±3.54 years, women – 41.3±9.5 years) with primary headache and MOH. The follow-up period was 12 months. First, patients were divided into two groups depending on the clinical diagnosis: group I (n=44) – patients with chronic primary headaches without MOH, group II (n=76) – patients with chronic primary headaches and MOH. Then, patients in each group were randomized into subgroups depending on the prescribed therapy. All participants underwent repeated clinical examinations and questionnaires assessment at 1-, 3- and 12-months follow-ups. In addition, all patients kept a headache diary. An educational «school» developed for this study was held in those subgroups where educational programs were specified.

Results and discussion. We observed a significant decrease in mean Headache-Attributed Lost Time (HALT) and Headache Impact Test (HIT-6) scores (р<0,05) at 12-months follow-up in subgroups where headache educational programs were combined with drug therapy, compared to the subgroups without educational programs. At the end of follow-up, we found a mean 1.75-fold increase in patients' treatment satisfaction (compared to baseline) in the subgroups where the «school» was held. Financial costs during the 12-month follow-up period for patients decreased by seven times because most patients stopped taking medications to relieve headaches.

Conclusion. Information and educational programs are an integral part of the management of patients with MOH.

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Timely diagnosis and optimal management of patients with cognitive impairment (CI) without dementia can potentially reduce the risk of their progression to dementia. In our study, we assessed the features of mild CI (MCI) syndrome in patients with neurological disorders based on the specialized outpatient service data analysis.

Objective: to analyze clinical, neuropsychological, and neuroimaging characteristics of MCI syndrome in the Russian population in real clinical practice.

Patients and methods. We enrolled 515 patients (209 men and 306 women, mean age – 71.2±8.0 years) with memory and/or other cognitive complaints. Seventy healthy volunteers (25 men and 45 women, mean age – 69.5±5.71 years) without cognitive complaints and central nervous system or mental disorders were enrolled in the control group. DSM-V diagnostic criteria for mild neurocognitive disorder were used. Participants underwent comprehensive neuropsychological testing with a qualitative and quantitative assessment of the results. In some of them (29.13%), brain magnetic resonance imaging (MRI) was performed.

Results and discussion. The following types of MCI were identified in study participants: monofunctional non-amnestic type (MFNAT) – 1.2%, monofunctional amnestic type (MFAT) – 12.6%, polyfunctional amnestic type (PFAT) – 22.9%, polyfunctional non-amnestic type (PFNAT) – 63.3%. We found a higher prevalence of executive dysfunction and attention deficit in PFNAT, and executive dysfunction, attention deficit, and memory decline in PFAT. Cardiovascular risk factors and signs of vascular leukoencephalopathy on MRI were more frequently observed in PFNAT and PFAT.

Conclusion. The clinical and neuropsychological analysis allows us to assume the pathophysiology of CI before the development of dementia. In the Russian population, cerebrovascular insufficiency plays a significant role in the development of MCI syndrome.

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Objective: to study sleep disorders prevalence and trends among the population of Novosibirsk (age group 25–64 years) in 1988–2018.

Patients and methods. We screened a representative sample of a 25–64-year-old population: in 1988–1989 (II screening: 725 men, mean age – 43.4±0.4 years, response – 71.3%; 710 women, mean age – 44.8±0.4 years, response – 72%); in 1994–1995 (III screening: 647 men, mean age – 44.3±0.4 years, response – 82.1%; 391 women, mean age – 45.4±0.4 years, response – 72.5%); in 2003–2005 (IV screening: 576 men, mean age – 54.23±0.2 years, response – 61%; 1074 women, mean age – 54.27±0.2 years, response – 72%); in 2013–2016 (V screening: 427 men, mean age – 34±0.4 years, response – 71%; 548 women, mean age – 35±0.4 years, response – 72%); in 2016–2018 (VI screening: 275 men, mean age – 49±0.4 years, response – 72%; 390 women, mean age – 45±0.4 years, response – 75%) according to the standard MONICA Psychosocial study (MOPSY) protocol. Sleep disorders in the studied population were assessed with Jenkins Sleep Questionnaire.

Results and discussion. We found a high prevalence of sleep disorders among the 25–64 years old population with the following trends: decrease from 1988–1989 to 1994–1995 (men – 11 and 8.6%, women – 21.8 and 16.6% respectively); increase in 2003–2018 (men – 13.1%, women – 20.5%). An increase in sleep disorders prevalence in 2003–2018 occurred mainly due to older age groups – 45–64 years (χ2 =122.061; υ=16; p<0.001 – men; χ2 =230.626; υ=16; p<0.001 – women). In 1988–2018 there was a 2-fold increase in sleep disorders prevalence among women than men in all age groups. This increase in sleep disorders prevalence was associated with increasing age, reaching its maximum in the 55–64 age group (men: 1988–1989 – 20.8%, 1994–1995 – 12.1%, 2016–2018 – 19.7%; χ2 =41.093; υ=12; p<0.001; women: 35.8; 21.8; 24.9% respectively; χ2 =22.01; υ=12; p<0.001). Different trends were observed in 25–44 years old women in 1988–2018 and in 35–44 years old men in 2013–2016: sleep disorders prevalence decreased (25–44 years old women: in 1988–1989 – 13.7%, in 1994–1995 – 7.9%, in 2013–2016 – 5.7%; χ2 =24.715; υ=8; p<0.001; 35–44 years old women 35–44: in 1988–1989 – 17.9%, in 1994–1995 – 20%, in 2013–2016 – 14.2%, in 2016–2018 – 10.3%; χ2 =21.177; υ=12; p<0.001 respectively; men: in 1988–1989 – 9.5%, in 1994–1995 – 9.3%, in 2013–2016 – 4.2% and in 2016–2018 – 11%; χ2 =12.67; υ=12; p<0.05 respectively).

Conclusion. We found a high prevalence of sleep disorders among the 25–64 years old population with the following trends: a decrease from 1988–1989 to 1994–1995; an increase in 2003–2018 mainly due to older age groups. Sleep disorders prevalence decreased in younger women in 1988–2018. There also was a 2-fold increase in sleep disorders prevalence in women than men in all age groups and with increasing age in 1988–2018.

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Alcohol dependence (AD) and affective disorders (ADs) are serious medical and socio-economic problems of modern society. It is hypothesized that both disorders share a common neurobiological basis. Phosphatidylinositol-4-phosphate-5-kinase type 2 alpha (PIP5K2A) plays an essential role in neuronal phosphoinositide signaling pathways. Nonsynonymous rs10828317 mutation of the PIP5K2A gene leads to conformational changes of the PIP5K2A protein and a decrease in the functional activity of this enzyme. In this study, we assessed the possibility of using the rs10828317 polymorphic variant of the PIP5K2A gene as a marker of AD and ADs.

Objective: to study the associations of the PIP5K2A (rs10828317) polymorphism with AD and ADs clinical course.

Patients and methods. We enrolled 255 patients with AD and 325 patients with ADs. 126 patients with AD and 71 patients with ADs underwent a comprehensive clinical, clinical-dynamic, psychodiagnostic assessment using a set of clinical scales and tests, including Structured Interview Guide For The Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGH-SAD), Alcohol Use Disorders Identification Test (AUDIT), The Obsessive-Compulsive Drinking Scale for craving in alcohol (OCDS).

Results and discussion. PIP5K2A (rs10828317) polymorphism in patients with AD was associated with the OCDS mean score after the inpatient treatment; in patients with ADs - with the severity of atypical depression symptoms assessed by SIGH-SAD at the time of admission.

Conclusion. The results of our pilot study indicate the involvement of PIP5K2A (rs10828317) polymorphism in the AD and ADs pathophysiology.

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Objective: to analyze the diagnostic significance of clinical and phenomenological characteristics of affective disorders in patients with chronic somatic pathology.

Patients and methods. The analysis included the results of a clinical evaluation of 131 patients with chronic somatic pathology, including 96 patients suffering from cardiovascular diseases and 35 patients with cerebral small vessel disease. Clinical assessment included Primary care evaluation of mental disorders (PRIME-MD) and Hamilton Depression Rating Scale.

Results and discussion. Despite the significant frequency and transparent clinical symptoms, general practitioners diagnosed mental disorders in only 30% of patients with depression. We observed a higher prevalence of somatic rather than psychological complaints during the clinical survey. According to the screening using PRIME-MD, 74% of patients were diagnosed with mood disorders, anxiety, and somatoform disorders. We also noted their significant comorbidity with a predominance of a depression and anxiety combination (p < 0.001). Hypertensive patients had the highest depression prevalence (87%) and severity. Moderate depression was the most frequent diagnosis in the study participants, corresponding to major depressive disorder (61.5%).

Conclusion. In general, the symptoms of anhedonia, depression, and anxiety were most pronounced in patients with affective disorders. The high prevalence of somatic symptoms complicates depression evaluation. It is possible to highlight depression and anhedonia as significant symptoms for the detection of depression in patients with somatic disorders.

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Objective: to compare depression treatment efficacy with and without antidepressants (ADs) in men and women with bipolar affective disorder (BAD).

Patients and methods. We enrolled 100 patients with BAD (F31.3–F31.5 according to ICD-10), including 50 women aged 33.0 [23.0; 50.2] years and 50 men aged 37.5 [29.5; 47.2] years using prospective and retrospective methods. Various antidepressants, normothymics, antipsychotics combinations were used to treat depression. We performed a comparative analysis of treatment efficacy with and without antidepressants in men and women subgroups. Clinical assessment at the baseline and the end of 1, 2, 4, 6-th week of therapy (or at discharge) included a specially developed clinical examination chart and the following psychometric scales: Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impression – Severity of illness (CGI-S), Clinical Global Impression – Improvement (CGI-I).

Results and discussion. Women tended to have a slower improvement in the condition compared to men. Maximum reduction in MADRS score and a CGI-I, CGI-S higher frequency of clinical improvement and remission was observed in men and women who did not receive antidepressants than patients who did not receive antidepressants. When BAD type was included in the analysis, in patients treated with antidepressants, transient symptoms of the opposite pole occurred in 24.7% of patients of both sexes with bipolar affective I disorder (BAD I) and in 16.8% with bipolar affective II disorder (BAD II). There were no significant gender differences in patients with BAD I, while women predominated in BAD II group (22.5% compared to 7.8% men). No significant treatment-emergent affective switch was observed with tricyclic antidepressants and selective serotonin and norepinephrine reuptake inhibitors in both groups (21; 16.7; 16.7% in men and 28; 21.8; 12.5% in women, respectively). The assessment of intermission revealed that women were significantly more likely to have shorter periods between phases (42% compared to 22% in men). In addition, women were significantly more likely to have shorter periods between phases (42% compared to 22% in men) when the intermission duration was included in the analysis. In some patients with severe depression and infective first-line therapy (anticonvulsants and atypical antipsychotics), antidepressants prescription can increase treatment effectiveness. However, several factors should be considered, such as BAD type and variant, depression severity, treatment-emergent affective switch in history, and gender.

Conclusion. A decision about antidepressants' dosage and treatment duration requires a dynamic follow-up of the patient in order to discontinue the antidepressants as fast as possible and decrease the risk of treatment-emergent affective switch and shortening of remission period.

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Oxcarbazepine (OXC) is an antiepileptic drug (AED) used in children and adults as initial and adjunctive therapy for focal epilepsy (FE). It has been used in Russia since 2007; however, only a few studies have been published on its use in Russian patients to date.

Objective: to assess the effectiveness and tolerability of OXC as initial therapy for FE in adults and adolescents, as well as to study epileptiform activity index (EAI) changes during treatment and its relationship with treatment effectiveness and tolerability.

Patients and methods. We evaluated treatment effectiveness and tolerability and EAI in 89 adults with newly diagnosed FE aged 15–75 years for 12 months. Patients were divided into three subgroups according to the OXC treatment regimen. Side Effects of Anti-Epileptic Drugs (SIDAED) scale was used to assess treatment tolerability. Retention rate and seizure frequency changes were used to evaluate treatment effectiveness. EAI changes were assessed with video electroencephalography monitoring (4–24 h) during each visit (baseline, after 1, 3, 6, and 12 months).

Results and discussion. The retention rate in patients on OXC monotherapy after 12 months was 71.9%, almost one-half of them (46.1%) achieved sustained remission. More than half of patients (52.9%) were prescribed 1200 mg/day of OXC, 12.3% – <1200 mg/day, and only in 6.7% of patients the dose exceeded 1200 mg/day. Side effects were observed in 9% of the cases. A 2.54-fold reduction in mean EAI index was observed during follow-up representing treatment effectiveness.

Conclusion. OXC, as the initial AED for FE, has demonstrated high treatment effectiveness and tolerability. In addition, total EAI 2.5-fold reduction allows its usage as an additional quantitative marker of OXC treatment effectiveness.

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Objective: to assess the predictors and prevalence of adverse drug reactions (ADRs) associated with antiparkinsonian drugs.

Materials and methods. 18 clinical studies and randomized controlled trials were included in the analysis. We combined all registered ADRs for each drug and made direct comparisons with odds ratio (OR) and 95% confidence interval (95% CI) calculation.

Results and discussion. Levodopa/benserazide (LB) had the best safety profile among levodopa drugs. Levodopa/carbidopa (LC) compared with LB was associated with more frequent development of nausea (OR=2.8; 95% CI: 1.51–5.21), aggravation of parkinsonism (OR=4.44; 95% CI: 2.12–9.28) and dizziness (OR=3.32; 95% CI: 1.5–7.33; p=0.002). Piribedil had the lowest number of ADRs among dopamine receptor agonists. Dizziness was more common with pramipexole and ropinirole than with levodopa (OR=1.82; 95% CI: 1.21–2.74 and OR=1.65; 95% CI: 1.11–2.44 respectively). Increased daytime sleepiness and peripheral edema have also been associated with pramipexole. Arterial hypertension was present in 9.6% of patients prescribed with piribedil. Amantadine compared with pramipexole was associated with a higher risk of hallucinations (OR=2.27; 95% CI: 1.24–4.12) and constipation (OR=2.40; 95% CI: 1.14–5.05). Patients prescribed with selegeline had higher odds of dizziness (OR=3.40; 95% CI: 1.76–6.55) and hallucinations (OR=4.30; 95% CI: 1.83–10.09) compared to rasagiline.

Conclusion. Based on the results, we propose a diagram of the relationship between ADRs and their frequency with antiparkinsonian drugs. We hope that the study will find clinical application and allow neurologists to consider the effectiveness and the expected risks of ADRs in the treatment of PD.


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Hypoparathyroidism is a rare disorder of mineral metabolism, characterized by hypocalcemia as a result of the absence or deficiency of parathyroid hormone. The severity of the condition of patients with this disease is associated with both acute episodes of hypocalcemia due to cardiac arrhythmias, laryngo- or bronchospasm, generalized seizures, and manifestations of long-term complications of the disease, such as kidney pathology. In some cases, the normalization of phosphorus-calcium metabolism due to standard treatment with active metabolites / analogues of vitamin D and calcium salts does not lead to a reduction in clinical symptoms, which requires differential diagnosis with other conditions, including such neuropsychiatric disorders as epileptic seizures and their equivalents, syncope, and psychogenic nonepileptic seizures. We present a case report of a woman with convulsions, which developed due to dissociative (conversion motor) disorder, with chronic postoperative hypoparathyroidism, receiving standard treatment and having normo- and hypercalcemia.

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This article reviews the issues of epilepsy course in patients with COVID-19 and predictors of the worsening of the course of the disease in the context of the COVID-19 pandemic. Risk of seizures associated with COVID-19 is relatively low both in patients with epilepsy and in general population, with the exception of critically and terminally ill patients. Studies that evaluated the impact of the COVID-19 pandemic on the condition of patients with epilepsy are characterized by complex medical, social and pathophysiological approaches to the problem. Predictors of negative epilepsy dynamics in the context of the COVID-19 pandemic include drug interactions between antiepileptic drugs (AEDs) and drugs used to treat COVID-19; disruption of AEDs supply; stress in patients; comorbid somatic pathology.


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In the context of the COVID-19 pandemic, healthcare is faced with several new problems, one of which is a post-covid syndrome. Symptoms in many COVID-19 survivors can persist for a long time, significantly affecting the quality of life and work performance. All of the above makes post-covid syndrome a socially significant disease, requires dynamic follow-up of such patients, and rehabilitation programs development. We are currently at the stage of accumulating knowledge about the SARS-CoV-2 pathophysiology and morphogenesis and its long-term consequences. This article discusses neuropsychiatric aspects of the post-covid syndrome: pathogenetic hypotheses, clinical features, and potentially promising treatment strategies.

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The increase in the number and life expectancy of patients with diabetes mellitus (DM) worldwide determines the high prevalence of late complications of diabetes, including diabetic polyneuropathy (DPN), the most common type of polyneuropathy. Oxidative stress is considered the main reason for the cellular pathology development in diabetes mellitus, which determines the use of antioxidants for the DPN treatment. Alpha-lipoic acid (ALA), a natural fat-soluble antioxidant, is the most effective drug for reducing DPN symptoms. Furthermore, the symptom-modifying effect of ALA has been shown in numerous randomized controlled trials. The article discusses the possible disease-modifying effect of ALA.

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Low back pain (LBP) is one of the most common reasons for a neurologist visit. In 90–95% of cases, LBP is nonspecific (musculoskeletal). The diagnosis of nonspecific LBP based on symptoms, somatic and neurological examination data, the absence of «red flags» (symptoms and signs characteristic of specific causes of back pain, discogenic radiculopathy, or lumbar stenosis). We review the modern principles of acute, subacute, and chronic nonspecific LBP treatment. We also discuss interventional and non-interventional treatment approaches, emphasizing the importance of combination therapy and an interdisciplinary approach.

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Osteoarthritis (OA) is the most common joint disease globally, and its incidence increases with age – up to 80–90% in people over 60 years. There is a high comorbidity between OA and cardiovascular diseases (CVD), such as arterial hypertension (AH), atherosclerosis, and coronary heart disease (CHD). The main objectives of OA therapy include pain reduction, cartilage matrix preservation, safe profile in patients with comorbid diseases, minimal adverse effects. In addition, the drug should be comparable in analgesic effects with nonsteroidal anti-inflammatory drugs (NSAIDs). Such drugs include structural-modifying agents – symptomatic slow-acting drugs for osteoarthritis (SYSADOA), one of which is chondroitin sulfate (CS). According to the 2019–2020 International and Russian guidelines, only pharmaceutical-grade CS is recommended for use. The high efficacy of intramuscular administration of CS in patients with OA, lower back pain, and comorbid diseases (AH, CHD, atherosclerosis) has been proven. CS is prescribed for a long treatment course – up to two months.

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With an increase in life expectancy in the population, the proportion of people with cognitive impairment (CI) increases. Modern neurology focuses on the milder forms of CI: moderate, mild, and subjective CI, which are more promising in terms of successful treatment and slowing down their progression. Age is the leading risk factor for CI, the prevalence of which in the general population of people aged over 65 years reaches 10–15%. The primary role in CI development is played by Alzheimer's disease, cerebrovascular diseases, mixed vascular-neurodegenerative process, and other types of neurodegenerative diseases, and all of them share some pathophysiological mechanisms. Correction of vascular risk factors plays a leading role in the treatment of pre-dementia stages of CI. The possibilities of using nimodipine in the therapy of CI are analyzed.

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Pain is one of the leading causes of decline in quality of life. When pain syndromes occur, a person may experience unpleasant sensory sensations and concomitant disorders, which can lead to pain aggravation and sleep disturbances. According to experimental studies, increased pain sensation with reduced sleep duration occurs due to opioid, serotonergic, noradrenergic, and dopaminergic antinociceptive systems dysfunction. In clinical practice, a reduction in sleep duration is usually associated with insomnia, which is the most common sleep disorder. In pain syndromes, insomnia occurs in 53–90% of patients (for comparison: in the general population – in 7.4%). Non-pharmacological (cognitive-behavioral therapy) and pharmacological approaches are used in insomnia treatment. Some medications (amitriptyline, mirtazapine, trazodone, gabapentin, pregabalin) have both hypnotic and analgesic effects, which allows to use them for pain syndromes with sleep disturbances. It has been shown that the correction of sleep disorders can reduce the severity and frequency of pain.


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The article presents the results of the discussion of the use of anti-B-cell therapy in multiple sclerosis (MS). These cells play a significant role in immunoregulation in MS, not only by producing antibodies to myelin antigens after transformation into plasma cells, but also by presenting the antigen to T cells, producing activation cytokines, and forming laminar follicles. The article provides an expert consensus statement on different drugs of this class in the MS treatment. In addition, the possibilities of determining the disease prognosis for the initially correct treatment choice are highlighted. Undoubtedly, there is a need for confirmation of the MS diagnosis, possible stratification of patients into different risk groups, and evaluation of the response to therapy. Potential additional research methods included evoked potentials and optical coherence tomography, baseline vitamin D3 level as a prognostic marker of the disease course, neurofilament levels in serum and cerebrospinal fluid to confirm neuron damage. However, it takes much time to study, determine the methodology, reference values, and develop a single standard approach to identify and implement a biomarker, which should then be implemented in routine clinical practice.

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)