[Asthenia in young patients and possibilities for its correction]. / Asteniya u molodykh patsientov i vozmozhnosti ee korrektsii.

OBJECTIVE: To investigate the effect of using the drug Brainmax on various manifestations of asthenic syndrome. MATERIAL AND METHODS: 30 patients, average age 29 years (20-44 years) took part in the study. The duration of treatment was 15 days. Subjective indicators on the asthenic state scale, hospital anxiety and depression scale, daytime sleepiness scale, as well as objective indicators of the corrective test were analysed. RESULTS: It was found that after treating patients with Brainmax, the severity of asthenic syndrome, anxiety, and depression significantly decreased, the quality of sleep increased, and the results of the correction test improved. CONCLUSION: The drug Brainmax can be recommended for the correction of asthenic syndrome in patients with functional diseases of the nervous system.

[Efficiency evaluation of the Neuromidin in the treatment of pain of the patients with discogenic lumbosacral radiculopathy: results of a multicenter post-registration prospective open comparative trial]. / Otsenka effektivnosti Neiromidina pri lechenii bolevogo sindroma u patsientov s diskogennoi poyasnichno-kresttsovoi radikulopatiei: rezul'taty mnogotsentrovogo postregistratsionnogo prospektivnogo otkrytogo sravnitel'nogo issledovaniya.

OBJECTIVE: Evaluation of the effect of Neuromidine on the dynamics of pain syndrome in the treatment of patients with discogenic lumbosacral radiculopathy. MATERIAL AND METHODS: Patients with a confirmed diagnosis of discogenic lumbosacral radiculopathy no more than one year old and moderate intensity of pain syndrome on a visual analog scale were included in the main group (OH, n=62, age - 53.1±15.6 yrs) and the comparison group (HS, n=40, age - 53.7±12.9 yrs). OG patients received Neuromidine (15 mg/1 mL 1 once a day IM for 10 days, then 20 mg 3 times a day for 8 weeks) in addition to the standard drug therapy, HS patients received only standard drug therapy. The duration of the study was 8 weeks. The degree of decrease in the intensity and dynamics of pain syndrome, activity and frequency of pain in the lumbar spine, changes in the level of physical activity, and the severity of emotional disorders were evaluated. The level of inflammatory markers in the blood and the dynamics of monosynaptic spinal H-reflex parameters were evaluated. RESULTS: Before the study, there were no statistically significant differences there were no results of clinical and laboratory-instrumental examination between groups. After 8 weeks, the reduction of pain by VAS in the main group was statistically significant in contrast to the comparison group (p=0.0001). In the main group there was a statistically significant increase in the mean cognitive impairment score (p=0.0029), as well as an improvement in psycho-emotional state with a significant decrease in GAD-7 (p=0.0002) and PHQ-9 (p=0.0096). After 8 weeks of therapy, IL-6 level in the main group was statistically significantly lower (p=0.0027) than in the comparison group. The results of H-reflex study revealed an increase in its amplitude and some shortening of latency at the end of Neuromidine therapy. The drug had no undesirable side effects and was well tolerated. CONCLUSION: Administration of Neuromidine 15 mg/1 ml once a day intramuscularly for 10 days followed by 20 mg 3 times a day for 8 weeks has an effective analgesic effect as adjuvant therapy in patients with discogenic lumbosacral radiculopathy. The inclusion of Neuromidine in the complex treatment of patients with pain syndrome in discogenic radiculopathy is superior in efficacy to standard drug therapy.

[Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts (June 8, 2023)]. / Bioregulyatsionnyi preparat N'yureksan v lechenii trevozhnosti i dissomnii. Rezolyutsiya Soveta ekspertov (8 iyunya 2023 g.).

Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts.

Determination of the Prevalence of Postcovid Syndrome and Assessment of the Effectiveness of the Drug Cortexin in the Treatment of Neurological Disorders in Patients with Postcovid Syndrome. Results of the CORTEX Multicenter Clinical and Epidemiological Observational Program.

Objectives. To study the prevalence and clinical manifestations of postcovid syndrome (PCS) in out-patients and to assess the efficacy of treatment with the drug Cortexin at doses of 10 and 20 mg i.m. for 10 days. Materials and methods. A total of 979 patients with PCS from regions of the Russian Federation, Azerbaijan, Kyrgyzstan, and Kazakhstan were studied; mean age was 54.6 ± 4.5 years; duration of COVID-19 was from one month upwards. Investigations involved three visits. The first was on the day of consultation (assessment of complaints, analysis of scale indicators, prescription of drug Cortexin at a dose of 10 or 20 mg i.m. for 10 days). The second visit (telephone consultation) was on day 10-14. The third visit was on day 30 of out-patient treatment. Assessment of patients' status used an asthenia assessment scale (MFI-20), a brief mental state assessment scale (MMSE), the Schulte test, and the Subjective Treatment Quality Assessment Scale. Results. The proportion of patients with PCS was up to 30% of all neurological admissions. The commonest manifestations were: fatigue, general weakness, decreased memory and concentration of attention, vertigo, sleep impairment, irritability, and aggression; less frequent were breathlessness, pain, increased sweating, anosmia, hyposmia, dysgeusia, paresthesia, hair loss, degradation of vision, tachycardia, allergic reactions, menstrual cycle impairments, erectile dysfunction, panic attacks, suicidal ideation, depression and refusal to eat meat. Conclusions: No associations were found between clinical symptomatology and the severity of COVID-19, the volume of lung tissue affected, or different periods of postcovid syndrome. Cortexin was found to be effective at doses of 10 and 20 mg for correcting the cognitive and asthenic manifestations of PCS. Cortexin was found to have anti-anxiety, antidepressant, and anxiolytic effects, which were more marked at the 20-mg dose.

[Therapy of moderate cognitive impairment and asthenia in patients with cerebrovascular pathology: results of a prospective observational study]. / Terapiya umerennykh kognitivnykh narushenii i astenii u patsientov s tserebrovaskulyarnoi patologiei: rezul'taty mnogotsentrovoi otkrytoi prospektivnoi nablyudatel'noi programmy.

OBJECTIVE: Obtaining additional data on the efficacy and safety of the drug Prospekta in the treatment of moderate cognitive impairment (MCI) and asthenia in patients with cerebrovascular disease (CVD). MATERIAL AND METHODS: A prospective observational study in more than 40 Russian cities enrolled 232 patients (mean age 61.5±10.0 years) with mild cognitive impairment (MCI), asthenia on ongoing basic nootropic therapy. The presence of MCI was confirmed by the Montreal Cognitive Assessment Scale (MoCA), asthenia - by 10-point Visual Analog Scale (VAS). All patients were prescribed the nootropic medication Prospekta 2 tablets 2 times a day for 8 weeks in addition to the therapy they received. Ultrasound Doppler sonography of the main arteries of the head and magnetic resonance imaging (MRI) of the brain were also assessed. At the end of treatment, the Clinical Global Impression Efficacy Index (CGI-EI) was assessed and the safety of the treatment was evaluated. RESULTS: The baseline severity of cognitive impairment according to the MoCA scale was 21.6 points, severity of asthenia according to the VAS was 6.3 points. According to Doppler flowmetry findings, hemodynamically significant stenosis was revealed in 105 (49.3%) patients, and narrowing of the main vessels without changes in hemodynamic parameters was revealed in 108 (50.7%) patients. According to MRI results, single vascular lesions in the brain matter were detected in 102 (44.0%) patients. The medications with nootropic effect were administered to 144 (62.1%) patients. A positive therapeutic response as improvement of cognitive functions was seen in 93.3% of patients after 8 weeks of taking Prospekta, including 39.4% of patients who had cognitive functions restored to the normal level. No side effects were registered during the observational study. CONCLUSIONS: The nootropic medication Prospekta is effective and safe in treatment of MCI in patients with asthenia with CVD, and improves cognitive function in patients with asthenia with CVD, both in monotherapy and in combination with other nootropic agents.

[Neurotrophic therapy in the treatment of a comorbid patient with cerebrovascular pathology and diabetes mellitus]. / Neirotroficheskaya terapiya komorbidnykh bol'nykh s tserebrovaskulyarnoi patologiei i sakharnym diabetom.

OBJECTIVE: To study the use of Cellex in a population of patients aged 45 to 75 years with ischemic stroke and TIA, with a history of type 2 diabetes mellitus (T2DM), with diabetic distal symmetric polyneuropathy. MATERIAL AND METHODS: The study involved 80 patients (men - 52.5%, women - 47.5%) in the rehabilitation period of stroke, including TIA, developed in T2DM. The patients were divided into 2 groups (40 people in each): in the 1st group, patients received Cellex 1.0 ml subcutaneously 1 time per day in addition to routine practice; the 2nd group received only routine practice. Cellex was prescribed in the form of two 10-day treatment courses with a break of 1 month. The range of patients examination during the whole study period (4 visits, 65 days) included an assessment of neurological symptoms (NIHSS, NISLL, DN-4, TSS scales), neurophysiological examination (EMNG), analysis of daily activity (SF-36 questionnaire, the Rivermead Mobility Index, the Modified Rankin Scale), the emotional state assessment on the scale and the effects of therapy on the Clinical Global Impression Scale. RESULTS AND CONCLUSION: The clinical efficacy of the drug was shown in the form of an improvement of clinical parameters and data on EMNG of the lower extremities on the 60th day of the study. Improvement was observed in 17.5% of patients in the 1st group, while in the 2nd group deterioration was observed in 15.0% of patients, as evidenced by the presence of statistically significant differences. The study drug was also shown to be well tolerated and safe. CONCLUSION: The use of the Cellex is effective and safe in patients with T2DM in the recovery period of stroke.

[Determination of the prevalence of postcovid syndrome and assessment of the effectiveness of the drug Cortexin in the treatment of neurological disorders in patients with postcovid syndrome. Results of the multicenter clinical and epidemiological observational program CORTEX]. / Opredelenie rasprostranennosti postkovidnogo sindroma i otsenka effektivnosti preparata Korteksin v terapii nevrologicheskikh narushenii u patsientov s postkovidnym sindromom. Rezul'taty mnogotsentrovoi nablyudatel'noi programmy KORTEKS.

OBJECTIVE: To study the prevalence of clinical manifestations of postcoid syndrome in patients at an outpatient neurological appointment, to evaluate the effectiveness of therapy regimens using Cortexin at doses of 10 mg and 20 mg IM for 10 days. MATERIALS AND METHODS: 674 neurologists from all regions of the Russian Federation, Azerbaijan, Kyrgyzstan and Kazakhstan took part in the study. A total of 979 COVID-19 patients were recruited. The average age is 54.6±0.45 years. The duration of the transferred SARS-CoV-2 days and from 1 month or more 12. 3 visits were carried out: 1 on the day of treatment (assessment of complaints, analysis of scale indicators, prescription of the drug Cortexin in doses of 10-20 mg/m for 10 days). 2 (telephone survey) visit for 10-14 days, 3 visit - for 30 days at the reception. The condition was assessed using the Asthenia Assessment Scale (MFI-20), the Brief Mental Status Assessment Scale (MMSE questionnaire), the Schulte test, and the Subjective Treatment Quality Assessment Scale. RESULTS: The daily proportion of patients with complaints after a previous coronavirus infection was 30% in the total structure of neurological admission. The most common complaints: fatigue, general weakness, decreased memory and concentration, dizziness, sleep disturbance, irritability, aggression, shortness of breath, pain syndromes, excessive sweating, anosmia, hyposmia, perverted taste of paresthesia, hair loss, blurred vision, unstable blood pressure, tachycardia, allergic reactions, menstrual irregularities, erectile dysfunction, apathy, panic attacks, suicidal thoughts, depression, refusal to eat meat. CONCLUSION: There was no significant correlation of clinical symptoms with the severity of COVID-19, the percentage of lung tissue damage, and different periods of postcovid syndrome. The clinical efficacy of the drug Cortexin in dosages of 10 and 20 mg for the correction of cognitive and asthenic disorders has been proven. Revealed anti-anxiety, antidepressant and anxiolytic activity of Cortexin is more pronounced when using a dosage of 20 mg.

[Efficiency of the application of miorelaxants in lower cross myofascial syndrome]. / Effektivnost' primeneniya miorelaksantov pri nizhnem perekrestnom sindrome.

OBJECTIVE: To evaluate the efficacy of the drug Tolperisone (Calmirex) in patients with inferior cross syndrome against the background of standard therapy. MATERIAL AND METHODS: The study involved male and female patients aged 25-55 years with inferior cross syndrome. The main research method was clinical, which was supplemented by biomechanical examination and the use of scales and questionnaires (VAS, Oswestry, McGill). RESULTS AND CONCLUSION: The effectiveness of the use of muscle relaxants in the treatment of the lower cross syndrome has been studied and proved with the identification of the most reliable and effective methods for correcting this pathology. The effectiveness of the use of muscle relaxants in the treatment of lower cross syndrome was studied, with the identification of the most reliable and effective methods for correcting this pathology. The presented clinical study of biomechanical and statodynamic disorders of the musculoskeletal system in myofascial pain syndromes, taking into account the peculiarities of the lesion of the sanogenetic and pathogenetic region, will be useful in prescribing personalized treatment not only for neurologists, but also for primary care physicians, chiropractors, osteopaths, rheumatologists and rehabilitologists.

[New treatment options for piriformis syndrome]. / Novye vozmozhnosti terapii sindroma grushevidnoi myshtsy.

This paper discusses modern approaches to the diagnosis and management of patients with piriformis syndrome. Epidemiological data on the prevalence of this syndrome in neurological practice are presented. The anatomical features of this region, leading to the formation of piriformis syndrome, are described in detail. The authors provide diagnostic criteria based on neurological examination and manual muscle testing and discuss the differential diagnosis of piriformis syndrome. New possibilities of treating this syndrome using a fixed combination of diclofenac and orphenadrine registered in the Russian Federation as a drug for intravenous infusion neodolpasse are discussed in detail. The authors cite materials from their own work, a clinical case of managing a patient with piriformis syndrome using neodolpasse is analyzed.

[Possi bilities of kinesiotaping in neurological patients]. / Vozmozhnosti primeneniya kinezioteipirovaniya u patsientov nevrologicheskogo profilya.

The review provides scientific data on modern aspects of using the kinesiotaping method in neurological patients. Possible clinical taping methods for myofascial pain and post-traumatic disorders of the musculoskeletal system are considered. The important role in the correction of biomechanical disorders and the rehabilitation potential of the taping method in the treatment and prevention of musculoskeletal pathology has been demonstrated. Experimental and clinical studies of Russian and foreign scientists are presented, indicating the promise of therapeutic and preventive possibilities of kinesiotaping. Conclusions are made about the advisability of using kinesiotaping in an interdisciplinary approach in the treatment of patients with neurological disorders.

[Therapy of moderate cognitive impairment in the early recovery period of ischemic stroke]. / Terapiya umerennykh kognitivnykh rasstroistv v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To assess the efficacy and safety of prospecta in the treatment of moderate cognitive impairment in the early recovery period of ischemic stroke. MATERIAL AND METHODS: The study included 275 patients (mean age 64.0±8.1 years) with a history of single ischemic stroke from 3 to 6 months, with moderate cognitive impairment, and moderate activity in everyday life, who were randomized in two groups. During the screening phase, the severity of cognitive impairment was assessed with the Mini-Mental State Examination and Montreal Cognitive Assessment scales; the level of activity in everyday life was evaluated with the Barthel Scale; and quality of life was assessed with the Stroke Specific Quality of Life Scale. Patients took 2 tablets of prospecta or placebo 2 times a day for 24 weeks. The follow-up period was 4 weeks. The primary endpoint of the study was the proportion of patients with improvement in cognitive function (+1 or more on the MoCA test) after 24 weeks of treatment. The occurrence and type of adverse events (AEs), their severity, relationship to the drug, outcome, changes in vital signs, and the proportion of patients with clinically significant abnormality in laboratory tests were analyzed to assess the safety. RESULTS: A clinically significant improvement in cognitive function was obtained in 91.9% of patients in the prospecta group vs 82.,1% in the placebo group, (p=0.02). There were 57 AEs in 37 (27.4%) Prospecta group patients and 53 AEs in 39 (27.9%) Placebo group participants (p=1.00). No AEs were certainly associated with taking the medication. No clinically significant changes in vital signs or abnormal laboratory results were detected during the study. CONCLUSION: Prospecta is an effective and safe treatment option for patients with moderate cognitive impairment in the early recovery period of ischemic stroke.

[Effects of COVID-19 on the central nervous system]. / Porazhenie tsentral'noi nervnoi sistemy pri COVID-19.

This review examines the current data on central nervous system damage in cases of the new coronavirus infection caused by the COVID-19 virus. The pathogenetic mechanisms leading to damage to the brain and spinal cord are considered. The analysis of available research articles and meta-analyzes published up to fall 2020 is carried out. The authors provide the results of their own clinical observations of various forms of damage to the central nervous system in cases of COVID-19 virus disease. Particular attention is paid to certain common forms of damage to the central nervous system, such as encephalitis, cerebrovascular pathology, and headaches. A form of acute hemorrhagic necrotizing encephalopathy is distinguished, which is a rather rare but fatal pathology, comorbid with the COVID-19 virus. The data of our own clinical case of acute necrotizing encephalopathy are presented. The importance of further studying the effect of coronavirus on the central nervous system and possible mechanisms of therapy and rehabilitation for this category of patients is emphasized.

Central Nervous System Lesions in COVID-19.

This review discusses current data on CNS lesions in infections with the new coronavirus that causes COVID-19. The pathogenetic mechanisms leading to infection of the brain and spinal cord are presented. Published studies and meta-analyses published by autumn 2020 are assessed. The authors present results from their own clinical observations of various types of CNS infection in COVID-19 virus disease. Particular attention is paid to certain common forms of CNS lesion such as encephalitis, cerebrovascular pathology, and headache. A form of acute hemorrhagic necrotic encephalopathy is identified, which is a quite rare but fatal pathology comorbid with COVID-19. A description of our own clinical observation of acute necrotic encephalopathy is presented. The importance of further studies of the effects of the coronavirus on the CNS and possible approaches to treatment and rehabilitation of this category of patients is emphasized.

[The use of myorelaxants in the treatment of chronic non-specific pelvic pain]. / Primenenie miorelaksantov v lechenii khronicheskoi nespetsificheskoi tazovoi boli.

Chronic nonspecific pelvic pain is one of the most pressing problems of modern neurology, due to complex interdisciplinary diagnostic and therapeutic studies. The etiology and pathophysiology of pain syndromes are studied from the point of view of each individual medical specialty, but do not consider the relationship and interaction of pathogenetic factors. In many areas, clinical guidelines for the treatment of chronic pelvic pain have been developed, but without taking into account the multidisciplinary approach to this polyetiological disease. OBJECTIVE: To evaluate the efficacy of tolperisone (calmirex) in patients with chronic nonspecific pelvic pain receiving standard therapy. MATERIAL AND METHODS: In the course of clinical work, 61 patients with chronic nonspecific pelvic pain were observed. To identify the dynamics of the study, all patients were assessed for the severity of pain using a visually analogue scale (VAS), the area of pain, muscle-tonic reactions estimated by the index of muscle tension according to Khabirov. Deviations of the biomechanical parameters of the pelvic region and restoration of the musculoskeletal system statics were evaluated. According to the study protocol, the efficacy of tolperisone (calmirex) was studied in patients receiving standard therapy. RESULTS AND CONCLUSION: Myofascial and muscle-tonic reactions play a significant role in the development and maintenance of chronic nonspecific pelvic pain. At the same time, tolperisone (calmirex) together with standard therapy of chronic nonspecific pelvic pain contributes to an effective regression of pain of myofascial and muscular-tonic origin, and creates a favorable restorative background for non-drug treatment.

[Lo-back pain and compression-ischemic neuropathies: strategies for diagnosis, therapy and rehabilitation]. / Bol' v spine i kompressionno-ishemicheskie neiropatii: strategii diagnostiki, terapii i reabilitatsii.

The article discusses such a common pathology as pain syndrome in the lower back and limbs. A variety of etiological causes, anatomical features leading to the formation of this persistent algic disorder lead to therapeutic failures in clinical practice. The authors consider in detail the most common types of compression-ischemic neuropathy accompanying back pain, suggest diagnostic algorithms and practical recommendations. Results of foreign, Russian and own research are presented.

[Dose-dependent effects of cortexin in chronic cerebral ischemia (results of a multicenter randomized controlled study)]. / Dozozavisimoe deistvie korteksina pri khronicheskoi ishemii mozga (rezul'taty mnogotsentrovogo randomizirovannogo kontroliruemogo issledovaniia).

AIM: To study an effect of cortexin on neurological symptoms and oxidative stress as part of the ischemic cascade in chronic cerebral ischemia (CCI), I-II stages. MATERIAL AND METHODS: The multicenter randomized controlled study included 189 patients with CCI, 42 (22.2%) men and 147 (77.8%) women, mean age 64.3±0.5 years. Patients were randomized into three groups. Group 1 received intramuscular injection of 20 mg of cortexin, group 2 received 10 mg of cortexin; group 3 received basic treatment only. The duration of treatment was 10 days, the treatment course was repeated after 6 months. The patients were examined at baseline and during treatment (in total 5 times). Along with clinical and neurological examinations, some scales and tests ('Fedin Outpatient scale of chronic brain ischemia', MFI-20, Spiegel sleep scale, the Zung self-rating depression scale, Spielberger's inventory, the clock-drawing test, the 5-word test) were used. The severity of oxidation stress was assessed by the content of reduced SH-groups and total superoxide dismutase activity. RESULTS AND CONCLUSION: A dose-dependent effect of cortexin on the severity of neurological disorders, asthenia, sleep disturbance was shown. Antidepressant and anxiolytic effects were insignificant and were determined after repeated courses of the drug. The laboratory data confirmed the antioxidant effect regardless of the dose of cortexin. The safety and good tolerability of the drug were shown.

[A case report of Creutzfeldt-Jakob disease]. / Sluchai semeinoi formy bolezni Kreittsfel'dta-Iakoba.

The familial form of the Creutzfeldt-Jakob disease (ffCJD) refers to a group of rare and severe neurodegenerative diseases associated with pathologic prion protein accumulation. The cause of disease is genetically determined. The disease has a continuously progressive course leading to death in 100% of cases. The symptoms of dementia dominate in the clinical picture. The authors describe a clinical case of subacute dementia in a 32-year-old patient. The disease had a progressive course. A preliminary diagnosis of ffCJD was established after neurological, psychiatric, genetic examinations and dynamic observation. The diagnosis met the following criteria of the Center for Disease Control and Prevention, CDC: progressive dementia, extrapyramidal disorders, absence of special EEG complexes, disease duration less than 2-3 years, confirmed genetic mutation in the prion protein gene, bilateral hyper intensive signals in the caudate nuclei region, the thalami on T2-weighted images (a 'honeycomb' symptom), atrophy of the cerebral cortex and cortex cerebelli on diffusion-weighted brain MRI (DWI). The patients died 3 years after the onset of the disease. The pathological signs of neuron spongiform degeneration as important characteristics of the disease were found at autopsy.

[Ways of optimizing the management of patients with migraine in Russia (resolution of the council of experts)]. / Puti optimizatsii vedeniia patsientov s migren'iu v Rossii (rezoliutsiia soveta ékspertov).

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.

[Diagnosis and treatment of migraine: Recommendations of the Russian experts]. / Diagnostika i lechenie migreni: rekomendatsii rossiiskikh ékspertov.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.

[Correction of psychoemotional and autonomic dysfunction in patients with ischemic stroke].

Investigation of 106 patients in the early recovery period of ischemic stroke is conducted. Autonomic nervous system dysfunction and the psychoemotional disturbances are revealed. Efficacy of mexiprim in the correction of the revealed psychoautonomic problems in patients with ischemic stroke is shown.