Neurology, Neuropsychiatry, Psychosomatics

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Vol 13, No 6 (2021)
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This literature review covers the diversity of cardioembolic stroke (CES), the heterogeneity of the embolism sources and the morphological characteristics of the embolic substrate. It is emphasized that the determination of the individual tactics of secondary prevention is based on the verification of specific cardiac causes of stroke, for convenience, stratified as pathology of chambers, heart valves and variants of paradoxical embolism (PE). It has been shown that the leading pathology of the heart chambers associated with CES is nonvalvular atrial fibrillation and left ventricular thrombosis, and the main basis for the prevention of stroke in this pathology is oral anticoagulant therapy with direct oral anticoagulants or vitamin K antagonists (warfarin). The main types of heart valve pathology are prosthetic valves and rheumatic mitral stenosis. In this case, oral anticoagulant therapy also serves as the basis for secondary prevention. In the absence of the need to prescribe anticoagulants (mainly in the pathology of natural heart valves) acetylsalicylic acid is the drug of choice. In infective endocarditis (IE), the basic prevention strategies are antibiotic therapy and surgery. Surgical tactics also remain the main one for the prevention of CES in tumors of the left heart. Transcatheter closure of the patent foramen ovale and occlusion of the left atrial appendage are being introduced into the daily practice of interventional medicine in order to prevent ischemic stroke. A balanced individual approach to the patient, a targeted cardiological examination, a comprehensive analysis of clinical and instrumental data and the reasonable use of funds that have proven their effectiveness and safety in the main strategies for stroke prevention, are essential in effective prevention of CES.


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Prolonged release tolperisone hydrochloride 450 mg (PRTH 450) is a dosage form that is convenient for patients, since it reduces the frequency of drug administration per day: from three immediate release tablets of 150 mg (TH 150) to one tablet of PRTH 450.
Objective: to evaluate the therapeutic efficacy and safety of the new dosage form of PRTH 450 (Mydocalm® Long, once a day) in comparison with TH 150 (Mydocalm® administered three times per day) in acute non-specific lower back pain (LBP).
Patients and methods. Study No. 84158 – a multicenter, randomized, double-blind, phase III, active control study of no less efficiency in two parallel groups of adult patients (mean age: 41.3 and 41.88 years) with acute non-specific LBP. From 05.09.2017 to 07.05.2018, 239 patients with acute non-specific LBP were included in the study. The two placebo method was used to mask the prescribed treatment. Inpatients or outpatients were randomly assigned to therapy with PRTH 450 once a day in combination with placebo three times a day or TH 150 three times a day in combination with placebo once a day.
For 14 days, after a meal, patients received oral PRTH 450 once a day as an active drug and placebo three times per day or oral TH 150 three times per day and placebo once a day. Follow-up visits were carried out after 3.7±1 and 14±2 days. Patients in whom the study drugs did not significantly reduce pain were allowed to additionally use diclofenac tablets up to 50 mg three times a day. The primary efficacy endpoint was the percentage change in baseline disability assessed by the Roland-Morris Disability Questionnaire (RMQ) at 14 days (treatment completion). Secondary efficacy endpoints were the percentage change in baseline disability after 3 and 7 days, the difference in pain intensity on the visual analogue scale (VAS) after 3, 7, and 14 days, the patient's overall impression of the daily change in his condition, the time before symptoms began to decrease, change in range of motion, measured by the fingertips to floor distance during an attempt to reach for the floor with the fingertips after 3, 7 and 14 days, as well as the total dose of diclofenac for additional pain relief. Safety indicators and their changes were assessed at each visit and in each treatment group. The presence of adverse events (AEs) was determined based on patient complaints and general examination results, measurements of vital signs (blood pressure, heart rate), 12-lead electrocardiography results, and blood and urine tests throughout the study.
Results and discussion. In 14 days, the limitation of daily activity according to RMQ decreased by 80.5±18.19% in the PRTH 450 group and by 78.9±15.79% in the TH 150 group, after 3 days – by 21.9±17.07 and 19,9±15.72%, respectively. There was a significant decrease in pain at rest and during movement according to the VAS during treatment, as well as an increase in the range of motion in the lumbar spine in both groups. During the follow-up period, patients took an average of 15.1 tablets of diclofenac in the PRTH 450 group and 16.1 tablets in the TH 150 group. At the end of the study, 74.3% of patients in the PRTH 450 group and 70.9% of patients in the TH 150 group noted a «marked improvement» on the scale of the overall assessment of their condition. 21 AEs in 16 (13.4%) patients in the PRTH 450 group and 23 AEs in 21 (17.5%) patients in the TH 150 group were registered. No statistically significant differences were found between the two groups for the primary study endpoint (p=0.475, Fisher's exact test), AEs, and for all secondary study endpoints.
Conclusion. The results of the study showed that in acute nonspecific LBP, PRTH 450 (Mydocalm® Long) administered once daily has no less efficacy and safety than TH 150 (Mydocalm®).

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Objective: to study the effect of sleep duration on the 16-year risk of developing type 2 diabetes mellitus (DM) in an open population of men aged 45–64 years living in Novosibirsk.
Patients and methods. In 2003–2005 during the IV screening (HAPIEE project), a representative sample of men aged 45–69 years (n=781; mean age – 56.48±0.2 years, response rate – 61%) was examined. A standard clinical and epidemiological examination was carried out: sleep duration was assessed using the Jenkins scale, the level of state-trait anxiety (STA) – using the Spielberger self-assessment scale, depression, life exhaustion, family and workplace stress – with MONICA-MOPSY scales. Social support was assessed with Berkman–Syme Social Network Index. The cohort was followed up for 16 years.
Results and discussion. In the studied population of men aged 45–64 years, the most common sleep duration was 7 hours (44.7%), in second place – 8 hours of sleep (27.6%), in third place – 6 hours of sleep (16.4%). Among people with newly diagnosed DM, 7-hour sleep prevailed – 39.2%, 6- and 8-hour sleep – 25.3% each (÷2=7.774; df=5; p>0.05). In men with 5–6 hours of sleep, compared with men sleeping for 7–8 hours, we found a 1.72-fold increased 16-year risk of developing diabetes (95% CI 1.066–2.776; p<0.05), and in men aged 45–54 years – a 1.868-fold increase (95% CI 1.089–3.927; p<0.05). In the Cox-proportional multivariate model, an independent effect on the diabetes risk was observed for: 5–6 hours of sleep at night: hazard ratio (HR) 1.561 (95% CI 1.063–2.83; p<0.001), depression (HR 1.767; 95% CI 1.058–2.952; p<0.05), life exhaustion (HR 1.511; 95% CI 1.266–2.984; p<0.05), and low and medium-1 SNI (HR 1.956; 95% CI 1.074–3.560; p<0.05).
Conclusion. Short and very short sleep duration could be defined as a major risk factor of DM.

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Vaccination of the population is the most essential and decisive measure in overcoming the COVID-19 pandemic that has involved the whole world. The vaccination of healthcare workers and medical students who can spread the infection among patients is crucial.

Objective: to study the attitude towards vaccination among medical students.

Patients and methods. From 18 to 22 June 2021, an anonymous Internet survey of 364 students of medical and technical universities was conducted. The sample included 135 medical students with no immunity to COVID-19 – who had not been ill or vaccinated. Three variants of behavioral strategies related to vaccination were compared: refusal to vaccinate, observation of the situation, consent to vaccination.

Results and discussion. The key factors influencing the choice of a behavioral strategy for avoiding vaccination are the belief that COVID-19 infection is not dangerous for young people and that the vaccine is not studied enough. The willingness to get vaccinated is associated with denial of insufficient knowledge about the vaccine, belief in its safety and effectiveness, fear of infecting loved ones. The observer student group is characterized by an intermediate position on vaccination beliefs.

Conclusion. To increase the willingness for vaccination, it is necessary, first of all, to spread the information about the vaccine, its safety (inability to cause severe complications, death) and effectiveness in preventing infection, reducing the level of anxiety concerning vaccination. It is also important to spread awareness about the danger of infecting loved ones and increase personal responsibility for the health of their loved ones.

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Pathological post-anesthetic changes can be determined by the type and duration of anesthesia, the somatic and neurological status of the patient in the preoperative period, age, etc.
Objective: to assess the severity of cognitive (CI), emotional and motor impairments in patients who underwent spinal surgery.
Patients and methods. The clinical study included 60 patients aged 30-74 years who underwent spinal surgery under general anesthesia. The neuropsychological, emotional, somatic, and neurological status were assessed at the baseline and one week, 3, and 6 months after the surgery. Thirty patients underwent a course of cognitive training (main group), and 30 patients were included in a comparison group.
Results and discussion. In the postoperative period, pain indicators decreased in both groups. There was an improvement in cognitive functions, emotional state, and quality of life (QoL) in the main group 3 and 6 months after surgery. The inclusion of cognitive training in the rehabilitation program for patients undergoing neurosurgical spinal surgery improved cognitive and motor functions and the QoL of patients. Evaluation and treatment of neurosurgical patients are discussed, which are helpful to improve the results of rehabilitation and QoL in the postoperative period.
Conclusion. Additional positive impact of cognitive-motor training for pain regression in patients after spinal surgery was observed.

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Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.
Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.
Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but <6 months have passed since the IS onset. All patients included in the study received physiotherapy exercises, simulator exercises, robotic mechanotherapy, physiotherapy, massage, speech therapy, cognitive training, and secondary IS prevention.
Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.
Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.

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Objective: to study the efficacy, safety and tolerability of agomelatine in mixed anxiety and depressive disorder.
Patients and methods. Agomelatine was administered to 30 patients diagnosed with mixed anxiety and depressive disorder for 3 months. The patients' condition was assessed using a battery of psychometric methods – the Hamilton Depression Scale, the Hamilton Anxiety Scale, and a short form of the SF-12v2 quality of life questionnaire.
Results and discussion. It was shown that agomelatine effectively reduces both symptoms of depression and anxiety, begins to have a therapeutic effect a week after the start of administration, however, the drug shows the best clinical effect when administered for a period of three months or more. The predictors of complete remission on agomelatine therapy in this sample were: the presence of sleep disorders (early and medium, but not late insomnia), a greater severity of somatized anxiety, the presence of complaints of decreased workplace performance and activity.
Conclusion. Our study has shown that agomelatine is an effective, safe and well-tolerated drug in the treatment of mixed anxiety and depressive disorder.

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The involvement of the visual pathway in multiple sclerosis (MS) pathology determines the importance of studying the structures of the retina for earlier diagnosis and monitoring the severity of the neurodegeneration. The introduction of the reference method of optical coherence tomography (OCT) allows high resolution in vivo visualization of the retinal structures.

Objective: to identify changes in various retinal structures in remitting (RMS) and secondary-progressive (SPMS) MS phenotypes.

Patients and methods. The study included 80 patients with RMS (n=48) and SPMS (n=32); the control group included 20 age- and sex-adjusted healthy individuals. Clinical assessment was carried out using the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS). All patients were examined by an ophthalmologist. To assess changes in the retina, OCT was performed using the RTVue XR Avanti apparatus (Optovue, USA).

Results and discussion. We found a significant (p<0.001) decrease in the thickness of the retina of the foveal and parafoveal regions, the thickness of the ganglionic cell complex when comparing the parameters of the retina of the control group and patients with RMS. There was also a significant (p<0.01) decrease in the retinal thickness in the perifoveal region, the thickness of the layer of retinal nerve fibers, the magnitude of focal and global losses. During comparation of the retinal OCT data between patients with RMS and SPMS, we revealed significant differences (p<0.001) in the thickness of the retinal nerve fiber layer, the retinal thickness in the parafoveal and foveal regions, and a significant (p<0.01) decrease in the thickness of the peripheral region, the thickness of the ganglionic cell complex, the volume of focal and global losses. Assessment of the correlations of OCT parameters with the EDSS and MSSS scales in both phenotypes showed a single significant (p<0.05) strong negative correlation (r=-0.70) of the EDSS score and retinal thickness in the foveal region in patients with SPMS.

Conclusion. As a domain of criteria for the MS course without signs of disease activity (No Evidence of Disease Activity, NEDA), it is advisable to use retinal OCT with analysis of the retinal thickness in the foveal region, the thickness of the retinal nerve fiber layer, the ganglion cell complex for dynamic monitoring of the inflammatory process activity in patients with RMS and assessment of its progression in patients with SPMS.

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Monoclonal antibodies inhibiting calcitonin gene related peptide (CGRP) or its receptor have been widely used for migraine prophylactic therapy for the past three years. Evaluation of their efficacy and safety of therapy in real clinical practice is needed.
Objective: to evaluate the efficacy and safety of Erenumab, a monoclonal antibody inhibiting the CGRP receptor during three months of therapy.
Patients and methods. Sixty-eight patients (58 women and 10 men, mean age 37±10.4 years) with episodic or chronic migraine who were treated with Erenumab were observed. Patients were assessed with MIDAS, WPAI, and HADS scales; the presence of cutaneous allodynia was evaluated with ASC-12 questionnaire. Patients kept a headache diary and marked adverse events during the whole treatment period.
Results and discussion. 47 patients (69%) had chronic migraine and 32 (71.9%) had medication overuse headache. In 48 patients (70%) after 3 injections of Erenumab the number of days with migraine decreased by 50% or more. In 7 patients (10%), the reduction in headache days was more than 75%; 20 (29%) did not experience sufficient effect after three months of therapy. Nineteen adverse events were noted in 15 (22%) patients. Severe constipation led to discontinuation of treatment in two patients (3%).
Conclusion. The study showed the efficacy and safety of Erenumab for migraine prophylaxis in both patients with episodic and chronic migraine.

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The novel coronavirus infection pandemic prompted not only the development of vaccines, but also the study of the effectiveness of already known drugs with antiviral activity. These drugs include adamantanes.
Objective: to assess possible mechanisms of antiviral action of amantadine and memantine.
Patients and methods. The study included 75 patients with Parkinson's disease (PD): 49 (65.3%) women and 26 (34.7%) men. The age of the patients ranged from 37 to 88 years (mean age: 65±7 years). The duration of the disease varied from 1 to 25 years (mean 12±7 years). Among the monitored PD patients, 22 (29.3%) had a novel coronavirus infection. Of 22 patients with coronavirus infection, 8 (36.4%) patients received adamantanes (four – amantadine sulfate, three – amantadine hydrochloride, one – memantine) in the complex therapy of PD for at least 3 months. On average, the duration of adamantane administration was 8±5 months.
Results and discussion. PD patients who received adamantanes were less likely to develop COVID-19 than those who did not take adamantanes (p<0.05). At the same time, there were no significant differences in gender, age, duration of the disease and concomitant pathology in the com pared groups (p>0.05). Among patients who received adamantanes, the disease proceeded more easily, the number of cases of pneumonia was 3 times less (odds ratio 3; 95% confidence interval 0.44–20.3). In this group, no lethal outcomes were recorded, however, due to the small sample of patients, the differences between the groups were not statistically significant (÷2=1.99; p>0.05).
Conclusion. The results of a retrospective study showed that the use of amantadine and memantine in patients with PD may have an effect on reducing morbidity and mortality in the novel coronavirus infection. This is consistent with published clinical observations suggesting a possible protective effect of amantadine and memantine against coronavirus infection.

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Migraine is the second leading cause of maladjustment, and the burden of migraine is determined by its impact on work ability, social activity and family relationships.
Objective: to identify the patterns of behavior of Russian patients with migraine, factors affecting their quality of life, and the level of awareness of the disease based on a semantic analysis of messages in Web 2.0.
Patients and methods. The study is based on the results of semantic processing (automated analysis of natural language texts, taking into account their meaning) of anonymized messages from 6566 unique authors (patients and their relatives) from social networks and forums (over 73 thousand messages over 10 years, 2010–2020). In addition, the study was carried out exclusively according to the data indicated in the messages. In this regard, complete data for several parameters was not available for analysis. No personal data about the authors of the messages was collected or used. The sex was determined based on the text of the analyzed message. For the study, only open data from the Internet from social networks and forums was used.
Results and discussion. A landscape of problems of persons complaining of migraine issues was formed. Factors affecting the quality of life were grouped into four main groups (“Lifestyle restrictions by triggers of migraine attacks”, “Loss of opportunity to work”, “Serious psychological problems”, “Family planning issues”); additional, rarer, but acute problems were also identified. The analyzed messages show that the average number of days with migraines is 9.4 per month; 21.8% of patients report daily migraines. Moreover, most patients have been suffering from attacks for 10 years or more, and 9% of patients – for 30 years or more. The analysis of diagnostic patterns showed that in most cases, patients independently resorted to additional examination methods, while only 13.1% of patients had experience of adequate preventive therapy.
Conclusion. The study demonstrated the presence of a wide range of unmet needs, quality of life problems both in patients themselves and their caregivers, as well as a significant social and economic burden of this disease (including a long-term burden on the economy, which can be used as arguments for reimbursing the cost of migraine therapy) based on the text messages on migraine in open sources on the Internet.


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 The ongoing pandemic of the new coronavirus infection COVID-19, the increase in the number of infected with  coronavirus and the number of deaths, the lack of reliable forecasts and the emergence of new circumstances that  complicate people's lives, increases the urgency of this problem  and dictates the need for further research into the causes and  factors contributing to the occurrence of mental disorders. The  review presents data on the causes of mental disorders during  the coronavirus pandemic: the toxic effect of the virus on the  brain and the psychogenic effect of the pandemic and related factors (self-isolation and restrictive quarantine measures, media  escalation, unemployment and economic losses, stigmatization) on the mental state. Predictors of mental  disorders are considered both in people who have not  previously suffered from mental illness, and already have a psychiatric diagnosis. 

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Drug-induced parkinsonism (DIP) is the most common drug-induced movement disorder and is most commonly associated with antipsychotic drugs, monoamine reuptake inhibitors, and calcium channel blockers. DIP manifests as a typical movement disorder, which makes it practically indistinguishable from idiopathic Parkinson's disease (PD) and requires differential diagnosis. DIP symptoms develop fairly quickly (hours to weeks) after the antipsychotic is started or after the dose is increased. Therefore, DIP is predominantly a clinical diagnosis that must be kept in mind when a patient develops typical symptoms during treatment onset or increasing the dose of drugs that most often lead to such an adverse reaction (ADR). DIP evaluation includes using the Naranjo algorithm, which helps assess a causal relationship between drug intake and the development of parkinsonism symptoms. The primary DIP treatment is the reduction of the dose of the inducer drug, or its cancellation, or replacement with another drug. In patients with schizophrenia and antipsychotic-induced DIP, dose reduction, replacement with another medication, or prescription of a drug with anticholinergic activity may be possible. The awareness of the doctor and the patient about the possibility of developing this ADR is crucial in the prevention of DIP. Therefore, choosing a drug with the lowest risk of developing DIP is necessary for pharmacotherapy.

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The review discusses the interchangeability of medications, approaches to the registration of original and generic drugs, and types of their equivalence, as well as problems with generics in clinical practice. Results of pharmacoepidemiological studies, which have been widely carried out recently, speak of insufficient understanding of the impact of generics on remote outcomes of chronic diseases, including mortality. The longterm economic prospects of generic drug administration continue to remain unclear. Among the primary differences between generics and brandname drugs are the differences in active ingredient synthesis methods and the composition of adjuvants and additives. Comparative studies on the therapeutic equivalence of generics with their originals or between themselves are rarely conducted. They are often affected by methodological flaws, which cannot ensure their comparable efficacy and safety. In this regard, automatic replacement of drugs containing the same active ingredient should be avoided without the participation of the attending physician.

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 The review discusses the prospects for the use of chondroitin sulfate and its derivatives for new indications in patients with and myalgic encephalomyelitis/chronic fatigue syndrome after SARS-CoV-2 infection. The epidemiology, clinical  manifestations, main mechanisms of the development of the dysregulation of neuroimmunoendocrine network interactions  in long-term COVID-19 are considered. Modern data on the relationship between mechanisms of neuroprotective effects of  chondroitin sulfate and its derivatives and their chemical  structure characteristics have been analyzed. The position is  argued according to which chondroitin sulfate and its  derivatives can become promising drugs in prevention of the  development of neuroimmunoendocrine network interactions  disorders in COVID-19. 

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Migraine is a nervous system disorder that affects 7.7% of children and can debut before the age of 3 years. As they get older, the incidence of migraine increases, and among adolescents, its prevalence reaches 15%. The disease can significantly reduce the child's daily activity, school performance. Migraine is the most common cause of headache in children and adolescents, but it is not always diagnosed; it is not uncommon for patients with migraine to be misdiagnosed and given ineffective treatment. An effective approach to the diagnosis of migraine in children is presented, diagnostic criteria for migraine according to the 3rd edition of International Classification of Headache Disorders are described. Special disorders in childhood are described – episodic syndromes in children associated with migraine. Migraine treatment in children includes four main approaches: 1) lifestyle recommendations; 2) migraine attack treatment; 3) nonpharmacological treatment; 4) migraine preventive pharmacotherapy. All of the listed approaches for the treatment of migraine in childhood are discussed in detail.

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More than 500 million people worldwide suffer from osteoarthritis (OA). Neck and low back pain (LBP) is one of the most common reasons for visiting a general practitioner to receive primary medical care in different countries. The prevalence of chronic LBP varies from 4% to 20%, and increases linearly from the third decade to 60 years, and stabilizes in the seventh decade of life. According to the latest published clinical guidelines of the Russian Association for the Study of Pain, nonsteroidal anti-inflammatory drugs (NSAIDs) are used in minimally effective doses and a short course to relieve acute musculoskeletal pain. The ratio of the NSAIDs activity associated with cyclooxygenase (COX) – COX-1 / COX-2 – inhibition allows us to evaluate their potential toxicity. The smaller this value, the more selective the drug is against COX-2, and the less toxic it is. Meloxicam belongs to the predominantly selective COX-2 inhibitors. In the Russian market, meloxicam of domestic production - Amelotex® is widely prescribed. Several studies have shown the high efficacy and safety of meloxicam in the treatment of pain syndromes with different localizations (LBP, neck pain of vertebrogenic nature, OA, etc.), it can be recommended for elderly patients, patients with comorbid diseases such as arterial hypertension (AH), diabetes mellitus, gastrointestinal tract pathology. Meloxicam has a good efficacy and safety profile, a pronounced symptom-modifying effect.


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Сervical dystonia (CD) is the most common type of focal dystonia (up to 50% of all dystonia cases). Botulinum neurotoxin (BoNT) injections is the treatment choice for CD. However, the effectiveness and tolerability of botulinum therapy in CD depends on the correct choice of target muscles and the accuracy of the BoNT injection. The publication presents literature data and our own clinical experience regarding the use of navigation in BoNT injections in CD.
According to the majority of authors, the use of navigation equipment, such as ultrasound (US) and electromyography (EMG), definitely increases the effectiveness of CD treatment and reduces the likelihood of adverse events. For the first time, an algorithm for the diagnosis and treatment of CD is proposed, based on the use of the method of «double- (EMG and US) guided navigation», a variant for determining the comparative activity of muscles by the intensity of the EMG signal and the design of an individual «passport» of the CD. The possibilities of analyzing the US of muscles, drawing up an accurate treatment regimen, targeted administration of BoNT, and using a non-injectable EMG electrode are shown. We present 4 clinical cases demonstrating the advantages of the double- (EMG+US) guided navigation method over the EMG-guided navigation for injection. The proposed algorithm for the diagnosis and treatment of CD makes it possible to increase the effectiveness of treatment, optimize the costs of BoNT and diagnostic equipment (injection EMG needle).

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Alzheimer's disease (AD) is the most common neurodegenerative disease, which is caused by cerebral amyloidosis. Noncognitive neuropsychiatric disorders (NСNPDs) include emotional, behavioral disorders, as well as psychotic symptoms. NСNPDs are almost an obligatory manifestation of this disease, accompany cognitive impairment and are detected at all stages of the disease – from preclinical to the severe dementia stage. As an example, we present a case report of a female patient with mild dementia in AD in whom Akatinol memantine administration resulted in the stabilization of a cognitive defect within one year and a decrease in the severity of emotional and behavioral disorders. The article discusses the indications and contraindications for antipsychotic administration in this disease, NСNPDs treatment in AD, which includes nonpharmacological and pharmacological methods. Accurate analysis of NСNPDs allows to predict the disease course, optimize the treatment, and thereby improve the quality of life of the patient and his relatives and caregivers.

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Vestibular migraine is combination of migraine and vestibular symptoms. In clinical examination it can be replaced with benign paroxysmal positional vertigo (BPPV) cupulolithiasis, but also BPPV is common comorbidity in migraine patients. There is also high association between vestibular migraine and Mal de Debarquement syndrome. Patient came to hospital with vertigo that was diagnosed as left PC-BPPV canalolithiasis. After first Epley's maneuver symptoms didn't resolved. Week after, at second Epley's maneuver performed patient developed left PC-BPPV cupulolithiasis. Month after, at third Epley's maneuver BPPV resolved but patient developed Mal de Debarquement syndrome. Laboratory testing showed hyperhomocisteinemia and homozygous MTHFR C677T and PAI, with low vitamin D. After reviewing the vestibular symptoms in the first attack which was misdiagnosed as BPPV canalolithiasis, and history of migraine, patient was diagnosed with vestibular migraine. Patient well responded to migraine diet and supplementation with B complex. Vestibular disorders are similar to each other and they can overlap. More attention in taking detailed medical history should be given to patients with vertigo or dizziness.

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 The article presents a case report of a patient with cardioembolic ischemic stroke (IS), which was the first clinical manifestation of  congenital atrial septal defect (ASD), asymptomatic until adulthood.  The issues of anatomical classification, restructuring of  intracardiac hemodynamics depending on the size and localization  of ASD, its role in the development of IS are discussed. The  diagnostic algorithm in patients with IS caused by paradoxical  embolism is described, the current possibilities of ASD treatment  and prevention of related disorders of cerebral circulation are  discussed. 


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The article presents the chronology of the symposium «How to Deal with Pain in the 21st Century? Experts' opinions», which took place on November 8 during the XII interdisciplinary international congress «Manage Pain». The lectures discussed issues of non-steroidal anti-inflammatory drugs (NSAIDs), including etoricoxib (Atorika tabs), administration on the example of a clinical case, problems of terminology associated with the concepts of «lumbago» and «sciatica», rare clinical syndromes (for example, heavy-purse syndrome) that we need to differentiate nonspecific back pain with, strategies for choosing NSAIDs in patients with osteoarthritis, the importance of timely administration of NSAIDs in the prevention of chronic pain syndromes, the influence of emotional and cognitive factors on the back pain chronization. The benefits of etoricoxib (Atorika) in the treatment of chronic back pain were reviewed, as well as the evidence for its safety.

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