The article presents a literature review on the management of patients with Alzheimer’s disease (AD). Psychosocial and behavioural trends form the core of the management of a patient with AD and should be used as early as possible and remain in use for the rest of her/his life. Inhibitors of central acetylcholinesterase (donepizil, galantamine, rivastigmine) and memantine are able to improve cognitive functions. Stroke prevention has been considered the mainstay in reducing the risk of developing AD and the progression of its symptoms. Gradual normalization of arterial pressure in patients with hypertension reduces the risk of various types of dementia, including asthma. The use of a large number of fresh fruits or vegetables, the Mediterranean diet, regular exercise and mental activity are associated with a decrease in the incidence of AD. The article discusses the management of patients with AD in our country, the use of Cerebrolysin and methods of vaccination.

The article presents the results of a study of the efficacy and safety of Cavinton Comforte® (vinpocetine) in patients with initial manifestations of chronic cerebrovascular disease (CСD) in outpatient neurological and therapeutic practice. 4,410 patients with a verified diagnosis of stage I - II discirculatory encephalopathy were enrolled to the program. The study showed high efficacy of therapy with Cavinton Comforte® in terms of both subjective characteristics and neuropsychological tests data. Positive changes in neuropsycological test results, as in patient complaints, were already evident after one month of treatment. The positive trend persisted with continued therapy up to 3 months. More than 90% of doctors and patients evaluated the efficacy and tolerability of treatment as good and excellent. The study proved the expediency of using the drug in patients with early stages of the chronic CCD. A comparative placebo-controlled study is advisable to further study the efficacy of Cavinton Comfort in patients with chronic cerebral ischemia.

The paper presents case report of mild cognitive impairment developed after lacunar infarct of thalamus due to arterial hypertension. Differential diagnosis of post-stroke cognitive impairment and clinical features of cerebral vascular and neurodegenerative diseases with intellectual disturbances is discussed. The paper shows approaches to management of patients with arterial hypertension and discusses common mistakes of it. New data about clinical efficacy of actovegin in post-stroke cognitive impairment get in ARTEMIDA study is also presented.

Medication overuse headache (MOH) is defined as a secondary/symptomatic headache when HA occurs on 15 or more days per month, when the therapeutic agent is used excessively for three or more months. MOH is often combined with chronic forms of primary HA (chronic migraine and chronic tension headache). About 1% of the population periodically receives about 10 tablets of various analgesics per month. Due to high prevalence, high social and economic costs, high rates of recurrence, MOH represents a significant problem for both the health care system and practitioners. The review discusses issues of epidemiology, mechanisms of formation, diagnostic criteria and the most effective approaches to the treatment of MOH.

Melatonin is an endogenous chronobiotic that demonstrated its analgesic potential in an array of experimental and clinical studies. It proved efficient in fibromyalgia, irritable bowel syndrome, back pain and various types of headache. The level of evidence supporting melatonin’s analgesic properties in treating migraine and cluster headache is the highest. This review provides a summary of main papers currently available about the use of melatonin in the treatment of primary headache disorders of various types. It discusses possible mechanisms of melatonin analgesic action and prospects of its use in combination therapy of headache.

The article presents a short literature review on depressive disorders in neurological practice. It summarizes information on the prevalence rates for depressive disorders in the main forms of neurological pathology, their negative impact on the quality of life and the course of a neurological disease, the clinical features of the affective pathology in certain diseases, and modern approaches to the therapy of depression comorbid with neurological disorders. The article is illustrated with a clinical case that confirms the importance of timely diagnostics and treatment of depressive disorders.

Sleep disorders are closely related to both nervous system diseases and mental disorders, but patients with such disorders prefer to visit neurologists. The most common disease is insomnia, which is characterized by violations of the quality of sleep and daily activities of various types. Obstructive sleep apnea syndrome is of great importance for the development and progression of the sleep disorders. The treatment of this syndrome not only improves the outcome of vascular diseases, but also enhances the effectiveness of prevention of new vascular accidents. Behavioural disorder in the fast sleep phase, restless leg syndrome and narcolepsy are also neurological diseases that are manifested by sleep disorders.

The article outlines the current recommendations of experts on the examination and treatment of patients with acute non-specific lumbar pain. It presents a case study of a patient with acute non-specific lumbar pain, which gave rise to the discussion of experts’ recommendations and actual practice. It is noted that the non-specific lumbar pain diagnosis is established on the basis of clinical examination, and in most cases no instrumental examinations, such as magnetic resonance imaging, are required. Information on the high likelihood of rapid recovery, the desirability of maintaining an active lifestyle, social and household activities is of primary importance for the management of a patient with acute lumbar pain. Non-steroidal anti-inflammatory drugs are effective in the alleviation of pain.

The purpose of this scientific review was to analyze and summarize the most relevant and new published scientific data on the effectiveness of antinociceptive action of botulinum toxin type A (BTA). The publications were searched for in the Medline, Pub med, Cochrane Library databases. As a result, high-level evidence was selected (RCT, national clinical guidelines, international clinical guidelines, meta-analyzes, systematic reviews). The article is devoted to the problem of pain syndromes in various neurological disorders, features and efficacy of antinociceptive action of botulinum toxin type A (BTA). Data on the efficacy of onаbotulotoxin (Botox®) in the treatment of pain syndromes are presented in accordance with the recorded indications. Also, based on the analysis, it was shown that BTA therapy is a valuable alternative to traditional therapy for many conditions accompanied by pain syndromes.

The paper proposes a typology of affective disorders in epilepsy, including preictal, ictal, interictal and postictal states. It also discusses various variants of affective states (depressive, dysphoric, manic) in epilepsy. Mild, moderate and severe depression has been identified in patients with epilepsy depending on the degree of severity of depressive symptoms. The paper describes the clinical impressions of patients with epilepsy which showed the efficacy of anticonvulsants in affective disorders.

A total of 2,431 patients with diabetic foot syndrome (DFS) who underwent inpatient treatment in the purulent surgery units of 6 large hospitals in Chelyabinsk were examined. Most patients with DFS suffered from type 2 diabetes (87,8%). Most (69,4%) of patients with purulent necrotic complications of DFS were over 60 years old (55,1% among men and 76,4% among women). The complications were subdivided into predominantly ischemic (gangrene, critical ischemia), predominantly neuropathic (pressure ulcers, osteomyelitis) and predominantly suppurative (purulent wounds, abscesses, phlegmon) according to the nature and the underlying cause for the development of purulent necrotic processes observed in various forms of DFS. The diabetic patients with neuropathy of the feet had pressure ulcers and chronic osteomyelitis lesions of the foot (44,6%) more often than those with ischemia (5,7%, p <0,01) and the mixed form of complications (18,8%, p <0,05). Given the pathogenetic heterogeneity of the DFS, it is recommended to provide multidisciplinary management of patients, an individual program of outpatient management of each patient including for the purposes of preventing the development of purulent-necrotic complications: the patient management protocol, the use of adequate combination drug therapy in accordance with the syndromic model, including thioctic acid derivatives, vitamins C, E, group B, drugs acting on the endothelial surface of microvessels and blood rheology i.e. angiotropic therapy (sulodexide, alprostadil, heparin, aspirin).

This article presents the review of results of clinical trials of drugs for pathogenetic therapy of primary progressive multiple sclerosis, including ocrelizumab.

Nonsteroid anti-inflammatory drugs are the fast-acting medications used widely to treat pain and inflammation for osteoarthritis. The pharmacological activity of most of them is characterized by the chondronegative action on osteoarthrosis cartilage, which manifests itself as inhibition of the chondrocyte metabolic activity and intensification of its apoptosis, which reduces the synthesis of proteoglycans, the main intercellular substance of the hyaline cartilage and thus its degeneration rates. In contrast, nimesulides show a chondronegative action. The article presents the results of a comparative randomized study evaluating the efficacy and tolerability of two Nimesulide generics, Nimesan and Nise. Nimesan was not only inferior to Nise by its characteristics, but also proved to be more efficient by the overall WOMAC index, positive dynamics of the functional capacity of the affected joints and the ESR index. Both drugs showed comparable tolerability and safety results.

Objective/introduction. Evaluation of efficacy and safety of diacerein therapy in patients with knee joint osteoarthritis (OA) and metabolic syndrome (MS). Materials and methods. 55 outpatients (50 women and 5 men) with MS and stage 2-3 OA of knee joint according to Kellgren-Lawrence, with intensity of pain syndrome > 40 mm according to visual analogue scale (VAS) from 4 Russian Federation subjects were enrolled in the study. Average age of patients was 59.7 ± 7.3 years , mean BMI is 33 ± 5,49 kg/m2, the duration of the disease is 8 (5-10 years). Duration of the study was 9 months (6 months of therapy: 1 capsule (50 mg) per day for the first month, 2 capsules (100 mg) per day for the next 5 months, and follow-up for 3 months). Evaluation of the efficacy and safety of the treatment was conducted according to generally accepted criteria. All patients were underwent biochemical tests at the beginning and at the end of therapy. Results. The study resulted in a statistically significant reduction in pain when walking according to VAS as early as in 1 month from the beginning of treatment; the further significant improvement was observed during the entire 6-month therapy. Withdrawal of therapy (the observation period was 3 months) didn’t increase the pain syndrome. Evaluation according to Womac index also revealed identical regularity. A statistically significant improvement in the quality of life according to EQ-5D was also identified during the whole period of observation. By the end of the therapy, 92.5% of the patients were OMERACT - OARSI - responders and 64.2% of patients had completely withdrawn from NSAID. Against the background of the therapy, there was a significant decrease in BMI, LDL, TG, glucose, uric acid levels. Conclusion: The data obtained make it possible to recommend diacerein as a basic therapy for OA in patients with MS. On the background of therapy, the patients showed statistically significantly reduction in pain, stiffness, the need for NSAIDs, improved the quality of life and the function of the joints. In addition, the body weight decreases reliably, the lipidogram, carbohydrate and protein metabolism parameters also improved.

Aceclofenac (Aertal®) is one of the most prescribed non-steroidal anti-inflammatory drugs. It has been used to treat pain in acute and chronic diseases for more than a quarter of a century and has established itself as an effective and relatively safe analgesic and anti-inflammatory drug. Aceclofenac has got a market authorization in 19 states of the European Union. On the world pharmacological market it is presented in the form of standard tablets, sachets, local forms, combination drugs. Aceclofenac can be successfully used to treat any nociceptive pain, but the most important area of its use should be considered the treatment of osteoarthritis.  Given that OA often has comorbid pathology, a low risk of drug complications is especially required here. 14 clinical trials of aceclofenac (Aertal®) (n = 4096) has been conducted in our country for 2005-2016 years, which showed good therapeutic potential of this drug. On the background of therapy with aceclofenac, pain decreased by an average of 52.9 ± 15.9% compared with baseline. The number of undesired reactions averaged approximately 3%. In controlled studies, where aceclofenac was compared with diclofenac, nimesulide, meloxicam, and paracetamol, the number of adverse reactions to aceclofenac therapy averaged 8.8%, and control preparations 20.2%. It is obvious that the Russian clinical studies results confirm the data of Western studies and show a high efficacy and favorable profile of aceclofenac safety.

The article presents the results of a study of the effect of prolonged Alflutop therapy on the arthrosonographic changes in knee joints (sizes of articular cartilage, joint space width, severity of osteophytic disease, local inflammation activity) in patients with gonarthritis. The treatment was prescribed to patients in the early stages of the disease and repeated by regular courses. It was found that prolonged therapy with Alflutop slows down the articular cartilage degradation, the progression of structural changes in knee joints, the local inflammation activity (according to arthrosonography), which reduces the symptoms of osteoarthritis and improves the patient’s quality of life.

Back pain is a common cause of disability and the decline in the quality of life which results in significant economic losses. The paper presents an overview of the new Russian consensus on the general practitioners’ management of patients with back pain and its comparison with the recommendations of experts from Europe and Asia. The introduction of experts’ recommendations into clinical practice can improve the quality of medical care and reduce temporary disability associated with back pain.

Depressive disorders, being the most common psychiatric pathology in general somatic practice, often act as a cause of aggravation of somatic/neurological pathology, increasing the risk of disability and death of patients. There is no uniform clinical pattern to the depressive disorders. Neurotic depression, nosogeny/somatogeny, and somatoreactive cyclothymia are the most common in the general medicine. Due to variety of clinical forms of affective diseases, they should be detected in a timely manner and referred for appropriate differentiated antidepressant treatment. As a prescribed drug, you should opt for an antidepressant that has an optimally balanced effect, fewer side effects and a minimal interaction with other drugs.

The purpose of this scientific review was to analyze and summarize the most relevant and new published scientific data on epidemiology, medico-social significance of transient ischemic attacks (TIA). The publications were searched for in the Medline, Pub med, Cochrane Library databases. As a result, high-level evidence was selected (RCT, national clinical guidelines, international clinical guidelines, meta-analyzes, systematic reviews). Based on the analysis of published data, there is a lack of clear epidemiological data on TIA. A number of studies have established that TIA can be considered an important risk factor for the subsequent development of a more serious cardiovascular event, such as stroke or myocardial infarction. Insufficiently studied socio-hygienic factors characterizing the lifestyle of patients who underwent TIA, there is no consensus on the rehabilitation of this group of patients. At the same time, some studies have shown the presence of cognitive and psychological disorders in patients who underwent TIA, which indicates the need for their psychological and social rehabilitation. Integrated individualized rehabilitation of patients who underwent TIA, correction of risk factors may contribute to the secondary prevention of serious cardiovascular events.

Idiopathic lobular panniculitis (ILP) is a chronic disease with multiple organ dysfunction that is regarded as a clinical and pathomorphological variant of lobular panniculitis with typical clinical symptoms. ILP is characterized by alternating periods of stable state (remissions) and active manifestations (exacerbations). The main task in monitoring patients with ILP is assessment of disease activity and identification of prognostically unfavourable factors. However, the “gold standard” has not been developed yet. Objective of the study is to create a scale of assessment of the inflammatory process activity in ILP on the basis of clinical and laboratory parameters. Patients and methods. A total of 67 patients (9 men and 58 women) with a verified diagnosis of ILP were examined. All of them were followed up by Nasonova Research Institute of Rheumatology FGBNU from 2007 to 2017. The patients were aged between 20 and 76 years, the average duration of the disease was 78.91 months. The medical examination included general clinical examination, chest computed tomography, immunological, tuberculosis tests and pathomorphological study of skin biopsy specimens from the node site, determination of the serum concentration of α1-antitrypsin, amylase, lipase, ferritin, creatine phosphokinase, and a body mass index. Results. Analysis of clinical manifestations made it possible to distinguish four forms of ILP: nodal (30 patients), plaque (10), infiltrative (15) and mesenteric (12), which had clinical and laboratory features. We used the obtained data to develop ILP activity index (AI), which described the state of 7 organ systems. The maximum score for individual systems is from 1 to 3 points, depending on the number of parameters being assessed. Conclusions. The proposed ILP IA is of great practical consequence. Further studies and, probably, a search for new ILP activity parameters are necessary.