Non-cardioembolic ischemic stroke (IS) of high and very high risk includes three groups of patients: with severe extracranial atherosclerosis, with any intracranial atherosclerosis, and with aortic arch atheromatosis. This risk is also characteristic of patients with aggressive transient ischemic attack (TIA) phenotypes. Effectiveness of secondary prophylaxis can be raised by these strategies: short-term dual antiplatelet therapy using a combination of acetylsalicylic acid with clopidogrel or ticagrelor in minor IS or high-risk TIA; long-term dual antithrombotic therapy with acetylsalicylic acid and low doses of rivaroxaban for multifocal atherosclerosis with low hemorrhagic risk and non-lacunar stroke; early surgical revascularization (carotid endarterectomy or stenting) for non-disabling IS and urgent revascularization for high-risk TIA; intensive, including combined, lipid-lowering therapy with high doses of statins, ezetimibe, PCSK9 inhibitors, or inclisiran to achieve low-density lipoprotein levels <1.4 mmol/L ; antidiabetic therapy using type 2 glucose-sodium cotransporter inhibitors and type 1 glucagon-like peptide agonists with glycosylated hemoglobin level of <7%; prescribing antihypertensive therapy and achieving target blood pressure level.

Periarticular cysts of the facet joints are relatively rare and occur predominantly (95%) in the lumbar spine, the effectiveness of their surgical treatment requires further study.

Objective: to give a detailed description of a case series of patients with periarticular cysts of the cervical spine.

Material and methods. During 10 years (from 2012 to 2022) 8 patients with periarticular cysts of the cervical spine were treated in the neurosurgical department of the Clinic of Nervous System Diseases of Sechenov University. All patients underwent decompressive surgery. The severity of the pain syndrome was assessed by the visual analogue scale (VAS) of pain, the degree of disability – by the disability index (DI) due to neck pain.

Results. After surgical treatment, the pain syndrome decreased from 7.25±1.28 to 2.13±1.12 points according to VAS (p<0.01), disability according to DI decreased from 51.5±8.08 to 21.25± 4.5 points (p<0.01), all patients achieved a significant (50% or more) reduction in pain. None of the patients had complications during surgical treatment.

Conclusion. Microsurgical removal of periarticular cysts at the cervical level can significantly reduce pain and disability.

Objective: to study associations between personal anxiety (PA) and single nucleotide polymorphism rs2278749 of the ARNTL gene among individuals aged 25–64 years living in Novosibirsk.

Material and methods. Under the WHO program “MONICA-psychosocial (MOPSY)”, a random representative sample of the population aged 25–64 years in Novosibirsk was studied (725 men, mean age – 43.4±0.4 years, response – 71.3%; 710 women, mean age – 44.8±0.4 years, response – 72%). The general examination was carried out according to standard methods included in the protocol of the WHO program. To assess PA, a form of Spielberger self-assessment scales was proposed. Every second respondent underwent genotyping of the studied polymorphisms of the ARNTL gene.

Results. The C/C genotype of the ARNTL gene was found in the general population in 60.7% of individuals (in 61.2% of men and 60.5% of women); the C/T genotype was found in 34.1% of individuals (in 35.1% of men and 33.5% of women) and the T/T genotype in the general population was found in 5.2% of individuals (in 3.7% of men and 6% women). The probability of PA development among carriers of the CT+TT genotypes of the ARNTL gene was 2 times higher (p<0.05) in the general population and 2.4 times (p<0.05) among women; among T allele carriers, it was 1.8 times higher (p<0.05) in the population and 2.1 times (p<0.05) among women. Carriers of the C/T genotype of the ARNTL gene were 30.3% more likely to believe that they almost always take everything too personally (p=0.024). Carriers of the C/T genotype (21%) almost always, and carriers of the T/T genotype (27.8%) often would like to be as happy as others (p=0.031). The answer “I often feel satisfaction” prevailed (38.2%) among the carriers of the C/C genotype, and the answer “Almost never feel satisfaction” among the carriers of the C/T genotype (5.9%) of the ARNTL gene (p=0.044) .

Conclusion. It was found that the C/C genotype of the ARNTL gene was the most common in the population; the probability of PA occurrence among carriers of CT+TT genotypes, carriers of the T allele is 2 times higher than in carriers of other genotypes of the ARNTL gene.

The spectrum of diseases manifested by positional vertigo includes benign paroxysmal positional vertigo (BPPV), vestibular migraine, brain tumors, demyelinating and some other diseases.

Objective: to study the common practice of managing patients with positional vertigo.

Material and methods. 64 patients with complaints of positional vertigo were examined. Clinical and neurological examination, otoneurological examination, including positional diagnostic tests, assessment of spontaneous nystagmus in Frenzel video glasses, tests of smooth tracking, saccades, head shaking, Fukuda test were carried out.

Results. In the majority (70%) of cases, the referral diagnoses for vertigo were chronic cerebral ischemia, vertebral artery syndrome, and vegetative-vascular dystonia. However, none of these diagnoses was confirmed as the leading cause of vertigo. The most common mistake (62.5%) was making a diagnosis only on the basis of complaints, without an otoneurological examination and positional tests. The most common causes of vertigo were BPPV (64.6%), vestibular migraine (20.3%) and vestibular neuronitis (12.5%).

Conclusion. In the diagnosis of positional vertigo, the evaluation of clinical manifestations, otoneurological tests and characteristics of positional nystagmus plays a leading role.

Brain lesion studies demonstrated that the right ventral frontal/anterior insular cortex (r-VF/AI) and its functional connectivity (FC) can play an important role in belief evaluation and delusions of various content.

Objective: to test the hypothesis about the associations between the functional characteristics of this region and delusions in patients with mental disorders.

Material and methods. The sample included 16 patients with delusional disorder and paranoid schizophrenia. We analyzed the whole-brain FC of the r-VF/AI as well as the local coherence and amplitude of low-frequency fluctuations of BOLD signal in this region.

Results. The “Conviction” item of the Brown Assessment of Beliefs Scale was positively correlated with the FC between the region of interest and a cluster in the right occipital cortex (located predominantly in the occipital fusiform gyrus and the occipital pole and slightly extending to the lingual gyrus and inferior lateral occipital cortex). Local coherence and amplitude of low-frequency fluctuations in the region of interest were not associated with clinical characteristics related to delusions.

Conclusion. The correlations of delusional conviction with FC between the regions involved in belief evaluation and visual perception may reflect aberrant top-down/bottom-up or cyclic processes described within the Bayesian models of delusions.

Transcranial magnetic stimulation (TMS) is increasingly used in research and clinical practice, therefore, the issues of its safety and tolerability are especially important. Currently, serious adverse reactions (ARs) are extremely rare. The more common mild ARs that can develop during and after stimulation remain less well understood but may affect procedure tolerance and treatment adherence.

Objective: to study the tolerability and safety of TMS in patients and healthy volunteers.

Material and methods. In a retrospective cohort study using standardized questionnaires, ARs were assessed during and within 24 hours after TMS in patients (n=103) and healthy volunteers (n=74).

Results. In total, the data of 1246 sessions were analyzed. ARs were observed during 56.8% of the analyzed sessions and within 24 hours after in 21.5% of the sessions. In most cases, they were mild and did not affect the intent to continue stimulation. TMS withdrawal due to ARs was reported in six cases (3.3% of participants), three of which experienced severe headache (HA) after stimulation. During stimulation, sleepiness (32.4%) and pain in the stimulation area (20.3%) were most often recorded. The most frequent AR within 24 hours after TMS was HA (13.3% of sessions), its characteristics are described and possible diagnostic criteria are proposed.

Conclusion. ARs can occur during and after a TMS session and are mild in most cases. TMS-induced HA, which is the most common AR within 24 hours after TMS, can be considered a distinct type of secondary HA, the pathogenesis of which requires further study.

Multiple sclerosis (MS) is a neurodegenerative disease that leads to multiple focal and diffuse lesions of the central nervous system, resulting in disability of patients. Currently the impact of depression on the quality of life (QoL) of MS patients has been little studied.

Objective: to study the effect of depressive disorders on the QoL of patients with MS, to search for factors influencing the development of depression in patients with MS.

Material and methods. The study involved 203 MS patients aged 15 to 60 years (mean age 39.7±10.91 years). Disability according to the EDSS scale was 2.51±1.45 points, the average duration of the disease was 8.07±7.22 years. The comparison group consisted of 52 healthy people aged 24 to 43 years (mean age 31.86±6.98 years).

Results. Patients with MS in more than half of cases (55.7%) suffer from depressive disorders. In MS patients there was an association of depression with older age, a longer duration of the disease, as well as a higher level of disability and exacerbations (p<0.001). MS patients with depression significantly more often (p<0.01) complained of increased fatigue and had higher scores on the scales of asthenia, situational and personal anxiety, and were also exposed to stressful influences and tolerated them poorly; they were more likely than those of the control group to had depressive episodes earlier. MS patients with depression had lower scores (p<0.001) for all QoL criteria, which further accelerated their disability and social isolation.

Conclusion. Depression in MS patients has a negative impact on all QoL indicators.

Objective: to study the level of inflammatory biomarkers and growth factors in the peripheral blood of patients with chronic cerebrovascular disease (CCVD) and anamnesis of coronavirus infection COVID-19.

Material and methods. The study included patients with CCVD (n=41), 26 of them had a documented anamnesis of coronavirus infection within 4 months before inclusion in the study, 15 people did not have COVID-19. The control group consisted of 20 apparently healthy individuals of the same age. Neuroimaging was performed using a Philips Achieva 1.5 T device. Pro-inflammatory cytokines were determined in blood serum – tumor necrosis factor α (TNF α ), interleukin 6 (IL6), IL18, interferon γ (IFN γ ); chemokines – monocytic chemoattractant protein 1 (MCP-1), IL8; growth factors – vascular endothelial growth factor type A (VEGF-A), transforming growth factor β 1 (TGF β 1).

Results. In patients with CCVD, compared with the control group, an increase in the level of proinflammatory cytokines (TNF α , IL6, IL18), chemokines (MCP1 and IL8), a decrease in the concentration of IFN γ , and divergent changes in the content of growth factors (VEGF-A and TGF β 1) were noted. Patients who recovered from COVID-19 showed an increase in the level of IL6 and a decrease in the level of IFN γ compared with those who had not been ill, which indicates a persistently high activity of immunoinflammatory processes and an insufficient humoral immune response.

Conclusion. Postponed coronavirus infection COVID-19 aggravates the existing endothelial dysfunction and intravascular inflammation in patients with CCVD, which may probably require changes in their treatment and prevention strategies in the future.

Objective: to determine prognostic characteristics of the restoration of swallowing function in patients with ischemic stroke (IS) of various pathogenetic subtypes.

Material and methods. The study included 110 patients (64 men and 46 women aged 44–89 years) with dysphagia in the acute period of IS. The SSS-TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding depending on the severity of dysphagia, a non-linear regression method was used using the least squares method.

Results. Patients with cardioembolic stroke subtype were initially characterized by a greater degree of dysphagia in comparison with patients with atherothrombotic stroke subtype in groups comparable in severity (p<0.05). In the cardioembolic subtype of IS, the probability of switching patients to self-feeding on the 21st day in groups with dysphagia severity from 105 to 135 points on the MASA scale was lower than in the atherothrombotic subtype of IS (p<0.05).

Conclusion. Patients with cardioembolic strokes are characterized by more severe initial dysphagia and a worse prognosis for recovery of swallowing function compared to patients with atherothrombotic strokes.

Objective: to study the clinical features of mental disorders during the COVID-19 epidemic in those who turned to psychiatrist for the first time, as well as in patients with already diagnosed mental illness.

Material and methods. We examined 100 patients who turned to psychiatrist due to deterioration of their mental state on the background of a pandemic. Of these, 50 were new cases (1st group; 23 women and 27 men, mean age 34 years) and 50 were cases with previously diagnosed mental disorders (2nd group; 25 women and 25 men, mean age 37 years). 80% of patients of the 1st group, 54% of patients of the 2nd group had coronavirus infection. Anxiety and depressive disorders prevailed in the 1st group, endogenous diseases prevailed in the 2nd group: bipolar affective disorder, recurrent depressive disorder, schizophrenia. The study was conducted by the clinical method using a specially designed map; the severity of depression was assessed using the Montgomery-Asberg Depression Rating Scale, and the severity of anxiety was assessed using the Hamilton Anxiety Rating Scale.

Results. The clinical picture of primary and recurrent depressive episodes after infection was characterized by the presence of motor and associative retardation, severe apathy, hypersomnia and lack of sleep, fatigue, increased appetite, and complaints of impaired attention and memory. Depression in SARS-CoV-2 survivors was characterized by anxiety, anhedonia, irritability, somatic complaints, and hypochondriacal inclusions. Anxiety symptoms in those who were not ill included severe anxiety, reaching agitation, disturbed sleep with frequent awakenings, irritability, somatic complaints, and hypochondriacal fixation on one’s condition. In recovering patients, anxiety was accompanied by control of somatic functions, cognitive impairments, and fear of retention or even intensification.

Conclusion. The results obtained indicate the existing differences between the mental disorders that first appeared and worsened during the pandemic, as well as the differences in the structure of the depressive and anxiety syndrome depending on the presence or absence of coronavirus infection.

The prolonged release tablets form of alimemazine is seen as a promising agent for the long-term treatment of generalized anxiety disorder (GAD).

Objective: to investigate the efficacy and safety of therapy with alimemazine (Teraligen® retard, prolonged release film-coated tablets) in patients with GAD.

Material and methods. The study design was a multicentre, open-label, non-comparative clinical trial (CT) with two doses of alimemazine 20 and 40 mg (Teraligen® retard, prolonged-release film-coated tablets). 129 patients diagnosed with GAD (criteria according to the ICD-10 classification), 86 women and 43 men were included, mean age 38.0±11.1 years. The level of anxiety, assessed by the Hamilton HARS scale, at Week 0 (Visit 1) was 24.8±7.3 points.

Results. By Week 6, the level of anxiety statistically significantly decreased to a mean score of 10.8±6.6, while the dynamics of the mean score relative to baseline was -14.0±6.27 (p<0.0001). The proportion of patients with a decrease in the total score on the HARS scale by 50% or more compared with the initial value was: after 1 week of therapy – 10.3% (n=13); after 3 weeks of therapy – 60.5% (n=75; compared to baseline, p<0.0001); after 6 weeks of therapy – 69.4% (n=86; compared to baseline, p<0.0001). The therapy was well tolerated, among the adverse events (AEs) patients noted: morning sleepiness (7.8%; n=10); dry mouth (7.8%; n=10); general weakness (4.7%; n=6). Other AEs (dizziness, headache, impaired concentration, muscle weakness, memory impairment, tinnitus, tachycardia) were much less common. From the side of the liver, no AEs were detected, including changes in the activity of liver enzymes.

Conclusion. Prolonged release alimemazine tablets 20 mg and 40 mg for six weeks resulted in a statistically significant reduction in anxiety levels, with at least two-thirds of patients experiencing more than half their anxiety. The effect increases with each week as you continue to take the drug. The prolonged release form of alimemazine is well tolerated, the treatment of GAD with the drug is effective and safe and may represent a rational alternative to antidepressant therapy.

Cefepime is a fourth-generation cephalosporin antibiotic widely used in clinical practice for various organ systems pathology treatment. The article describes the clinical observation of a patient who, 3 days after cefepime administration, had a decrease in the level of consciousness, regarded as encephalopathy. Cefepime-induced neurotoxicity is characterized by toxic encephalopathy, which manifests 2–6 days after the start of the treatment with this drug and disappears 1–3 days after its withdrawal. Electroencephalography (EEG) abnormalities include generalized periodic discharges (GPR) of triphasic morphology or a pattern corresponding to the criteria for non-convulsive status epilepticus (BSES). In our observation, the EEG recorded stimulus-induced GPRs of triphasic morphology with a frequency of 1.5 Hz; a test with intravenous administration of an antiepileptic drug (levetiracetam) was negative. A day after the withdrawal of cefepime, the patient’s level of consciousness returned to the initial level, and on the EEG periodic discharges completely regressed. Thus, cefepime may cause encephalopathy in patients with rhythmic or intermittent EEG activity, especially in the presence of a stimulus-induced component. In some cases, the use of cefepime may develop epileptic seizures and BSES.

Gender Dysphoria (GD) is defined as a marked incongruence between one’s experienced/expressed gender and assigned gender that the individual feels a strong desire for having the sex characteristics of the other gender. Twin studies could be helpful in making decisive conclusion on the relative role of genetics and environment on GD. Therefore, we hereby present a case of monozygotic twins with concordant female-to-male GD. Seventeen-year-old twins are introduced in this case report. The second pair attended to our clinic for psychiatric evaluation. She was suffering from GD by overwhelmed desire for having masculine features, wearing their cloths, and at the same time revolting being a girl. Although she preferred spending time with male friends, she was sexually attracted to females. Although the first pair had similar characteristics of GD, she presented apposite temperament. While temperament has been considered to be genetically inherited, the incidence of GD in our cases with different temperaments raises the question about genetic role in inheriting temperament and GD. Further twin studies will help understanding the extent of genetic influence on these features.

Non-specific low back pain (LBP) occurs in most people at least once in a lifetime. In city polyclinics, every fourth patient complains of LBP. During the COVID-19 pandemic, the prevalence of acute non-specific LBP and chronic LBP have increased due to physical inactivity, chronic stress, and anxiety. Musculoskeletal LBP is the second most common cause of disability. In this regard, it is important to consider modern principles for the diagnosis and treatment of non-specific LBP. Diagnostic algorithms, “red flags” (dangerous symptoms), “yellow flags” (chronification factors) in LBP are discussed. Own clinical cases of patients with LBP with “red flags” are presented. Effective drug and non-drug methods of treatment of LBP are considered: patient education, kinesiotherapy, cognitive-behavioral therapy, manual therapy, the use of non-steroidal anti-inflammatory drugs, muscle relaxants. The role of aceclofenac and tolperisone in the treatment of LBP is discussed, clinical studies data on the efficacy and safety of these drugs in pain syndromes are presented. We present our own clinical observation of the successful management of a patient with chronic non-specific LBP.

The review presents current data on the peculiarities of the neurodegenerative process in the early stages of Parkinson’s disease (PD) and considers the hypothesis of the presence of body-first and brain-first subtypes of the disease onset. The earliest manifestations of the disease include symptoms such as parasomnia, constipation, hyposmia, anxiety-depressive disorder, daytime sleepiness, color perception changes, cognitive dysfunction, and mild motor manifestations. The diagnosis of PD can be made when characteristic motor manifestations occur: hypokinesia, rest tremor, muscle rigidity. Substantia nigra ultrasound, magnetic resonance imaging in SWI mode, and functional neuroimaging methods are used as confirmatory methods. The approach to the treatment of early stages of PD is age dependent. Patients over 70 years of age are recommended to start therapy with levodopa; younger patients – with dopamine receptor agonists (ADR), amantadines, MAO-B inhibitors. The mechanisms of ADR action, the possibility of their influence on the motor and non-motor symptoms of PD are analyzed. A special place is given to piribedil, which, due to the dual mechanism of action, has a positive effect on cognitive functions, depression, apathy, as well as a minimal effect on daytime sleepiness.

The review presents the results of clinical studies of the efficacy and safety of Tenoten and Tenoten children’s in the treatment of anxiety, neurotic, stress-related and somatoform disorders and adjustment disorders. Technologically processed antibodies to the S100 protein in Tenoten and Tenoten children’s drugs change the conformation of the S100 protein, which is considered as a pathological link in the development of anxiety states, as well as neurodegenerative diseases. Tenoten is a well-studied daytime anxiolytic that combines a favorable safety profile with high anxiolytic activity. The efficacy of Tenoten in the treatment of anxiety disorders is comparable to that of benzodiazepine drugs. Tenoten has no inhibitory and muscle relaxant effects, does not cause drug tolerance, addiction, "withdrawal" syndrome, as well as drug interactions. Tenoten for children has been shown to be effective in the treatment of anxiety in children, including those with somatic manifestations, attention deficit hyperactivity disorder, and learning disabilities.

Stroke is second to third most common cause of death in the population and the leading cause of disability. More than 12 million strokes are registered annually in the world. Cognitive impairments (CI) significantly contribute to the disability of patients after a stroke, which limit daily activities no less than movement disorders. The article presents data on the prevalence of post-stroke CI (PSCI), examines the issues of epidemiology, risk factors, the main clinical and pathogenetic data of disorders, the peculiarities of their diagnosis and treatment. The issues of the dipyridamole use for the prevention of stroke and in patients with PSCI are discussed.

Parkinson’s disease (PD) is a progressive neurodegenerative disease with various clinical manifestations, its origin not always can be explained only by dopamine deficiency. Long-term treatment with levodopa (especially its intraduodenal administration), as well as clinical manifestations of polyneuropathy, cognitive deficits, postural disorders with freezing of gate, REM sleep behavioral disorders, are more often associated with vitamin B12 deficiency. Several reasons for this association and mechanisms of their development are discussed. Early detection of cobalamin deficiency in PD, especially in patients from high-risk groups, makes it possible to stop this pathological condition timely and prevent irreversible changes. Modern data on the use of high-dose (1000 μ g) oral vitamin B12 are presented, it has comparable clinical efficacy and significant advantages, compared with the parenteral form, in terms of the ease of use and the ability to avoid undesirable postinjection reactions.

We present the results of a systemic biological analysis of human proteome proteins, biological functions of which are somehow related to the metabolism of B group vitamins and the molecular implementation of nociceptive processes. Among 983 proteins involved in the homeostasis of B vitamins, 21 proteins were involved in the molecular mechanisms of nociception, 91 proteins were involved in the regulation of inflammation processes, and 17 proteins were involved in the neuroprotective and neurotrophic effects of B vitamins. All these groups of proteins are important for the treatment of neuropathic pain associated with the degeneration of nervous tissue.

On March 31, 2023, the first meeting of the Council of Experts was held in Moscow to discuss new options for the treatment of chronic cerebral ischemia (CCI), one of the most common causes of vascular cognitive impairment in middle-aged and elderly patients. The issues of screening, diagnosis and treatment of patients with CCI, including through the interaction of neurologists with related specialists, are discussed.