The article tells about the experience of intra-arterial revascularization in patients with acute ischemic stroke (AIS) in the middle cerebral artery performed at two hospitals of the Republic of Tatarstan (Interregional Clinical and Diagnostic Center in Kazan and Emergency Care Hospital in Naberezhnye Chelny). An algorithm for the selection of patients is suggested which allows to optimize invasive reperfusion therapy in patients with AIS in the MCA in routine clinical practice.

Disorder of higher mental function is one of the most common complications of stroke, including stroke with a minimal and/or transient neurological deficit. Cognitive impairment after stroke indicates that there is a severe organic brain damage associated with both stroke and pre-stroke vascular (or other) cerebral disease. There is a clear association between the presence and severity of cognitive impairment and neuro-rehabilitation prognosis and secondary prevention after stroke. Therefore, it is appropriate to ensure early screening of cognitive disorders in patients with stroke using simple neuropsychological techniques. Treatment of post-stroke cognitive impairment implies frequent use of neurometabolic drugs administration of which results in positive changes in relation to both cognitive and other neurological disorders.

Memory loss and other cognitive disorders are frequent complaints from middle-aged people. Only a small proportion of these complaints are associated with a degenerative and/or vascular brain damage. The middle age group is prevailed by cognitive impairment associated with emotional disorders: pathological mood changes and anxiety disorders. Diagnosis of these disorders requires evaluation of both cognitive and emotional states. Therapy is targeted at managing emotional disorders (depression, anxiety), including psychotherapy and psychotropic drugs (antidepressants and tranquilizers) for more severe disorders. For mild disorders which prevail in clinical practice, EGb 761 (Tanakan) demonstrated efficacy by improving not only the cognitive function but also the emotional state of patients. Own experience showed Tanakan efficacy in patients with vertigo combined with mild cognitive or emotional disorders.

The problem of dementia is acquiring greater social and medical significance in the modern world. According to the WHO, in 2010, the global number of people suffering from dementia was 35.6 million, and today the number is estimated as 44 million. [1] By 2030, the number of patients will double to reach 65.7 million people, and in 2050 - 115.4 million. [2] Among the factors for the development of cognitive deficits, the leading are cerebrovascular and neurodegenerative brain lesions. The most common cause of dementia is Alzheimer's disease (60-70% of cases), while the second place is given to vascular dementia. Given the scale of the epidemic and therapeutic challenges, it is important to consider the factors for the disease. Their management could reduce the risk or delay the onset of disease.

The article presents a current view on pathogenesis, diagnostic methods and treatment of cognitive disorders in patients with arterial hypertension. Choline alfoscerate drugs, precursors for choline drugs, are characterized. Prescription of the drugs for patients with hypertensive encephalopathy is discussed. Results of clinical trials of the efficacy and safety of the national choline alfoscerate under the brand name Cerepro® are demonstrated.

Migraine is one of the most common neurological disease that manifests itself in severe headache attacks. It is one of the most widespread causes of disability in young and middle-aged people. Almost all patients (98%) are in need of relief of migraine attacks. Prescription-free analgesics are most commonly used, with only 9-10% of patients satisfied with the effect of therapy. A much better effect is demonstrated by triptans - anti-migraine medications which, unfortunately, are rarely used in this country. The article discusses the basic principles of the use of triptans. Eletriptan is noted as one of the most effective and well-tolerated triptans in the treatment of migraine. The clinical efficacy and safety of eletriptan are demonstrated.

The lecture is devoted to differential diagnosis of Parkinson's disease and parkinsonian syndrome in other neurodegenerative diseases. Diagnostic criteria and main clinical manifestations of various types of atypical parkinsonism are described; current methods of drug and non-drug therapy are reviewed.

The relevance of the study of insomnia associated with neurotic disorders is explained not only by its high incidence (65--100%). Traditionally insomnia is classified as one of the most frustrating and deconditioning neurotic disorders. Insomnia and neurotic disorder are closely related. On the one hand, sleep disorder associated with neurotic disturbance can be seen as a typical manifestation in a neurotic clinical pattern; on the other hand, if primary insomnia progresses and treatment is delayed, it can often trigger other neurotic disorders. In this regard, the treatment of insomnia associated with neurotic disorders is realized in two aspects: treatment of the underlying disease and insomnia as a leading syndrome. According to the results of numerous studies, in most cases combination therapy uniting drug-based treatment with psychotherapy proved to be the most effective.

The article discusses usage of the new dosage of glatiramer acetate (Copaxone®) for the treatment of relapsing-remitting multiple sclerosis. Results of phase II and III clinical trials are presented. Randomized clinical trials GALA and GLACIER demonstrated high efficacy, good safety and tolerability of glatiramer acetate taken in dosage 40mg/ml 3 times per week.

82 patients diagnosed with remitting multiple sclerosis, (MS) undergoing treatment with fingolimod were followed up for minimum 12 months at the Moscow Multiple Sclerosis Centre. The purpose of the follow-up was to evaluate the effects of fingolimod. 9 of 12 patients were subject to a comprehensive immunological examination to identify subpopulations of circulating T-cells. All patients were in clinical remission at the time of recruitment. All patients showed a significant decrease in the frequency of exacerbations during therapy with fingolimod. The disability status on the EDSS scale did not progress during the whole year of the follow-up. The therapy showed significant decrease in the production of IL-17 and the amount of TH17 cells in comparison with the control group, thus demonstrating a relevant decrease in the the autoimmune process activity. Withdrawal of fingolimod in 6-8 weeks was associated with normalization of the lymphocyte level in the peripheral blood due to drug elimination and wash-out of S1P receptors. However, given that wash-out of S1P receptors results in increased production of IL-17 and, consequently, higher BBB permeability, it is appropriate to name the disease reactivation as "rebound syndrome" which is primarily associated with a sharp increase in IL-17. This raises questions about management of patients who for various reasons need withdrawal of fingolimod therapy.

Traditionally, treatment of pelvic pain is the responsibility of gynecologists and urologists, though even in the developed countries causes of chronic pelvic pain (CPP) are not always clear in most patients. A multidisciplinary approach is imperative for individual-based clarification of CPP pathogenesis and choosing the optimum treatment: pelvic organs are closely interrelated, having common afferent and efferent nerves, blood circulation, muscles and ligaments. Thus, problems in one organ often involve the adjacent organs in the pathogenetic process resulting in cross-sensitization of the peripheral and central nervous systems taking part in the regulation of the pelvic function and pelvic muscular-articular apparatus. Persistent groundless exaggeration of the role of infectious diseases in the pathogenesis of pelvic pain leads to failure of treatment and, consequently, chronic disease. Currently, a significant role in CPP is assigned to hip dysplasia and coxarthrosis, sacroiliac joint dysfunction with secondary myofascial pelvic syndrome and tunnel neuropathies of anterior abdominal wall and perineum. These diseases are largely under the responsibility of neurologists, orthopedists and rheumatologists rather than urologists, gynecologists and even proctologists.

Tofacitinib (TOFA) was the first synthetic small molecule drug which was comparable with genetically engineered biological agents (GIBA) in terms of its therapeutic effect in rheumatoid arthritis (RA). Results of treatment of over 4 thousand RA patients showed that the most common adverse events were nasopharyngitis, upper respiratory infections and urinary tract infections, herpes, diarrhea, nausea, gastritis. Serious side effects were registered in 15.4% of patients, and serious infections in 4.5%. Opportunistic infections occurred in 0.6% of patients, half of which were cases of tuberculosis. Anemia, hemocytopenia, increased lipidemia, a mild temporary decrease in glomerular filtration rate and increased creatinemia were also recorded. There were no anaphylactic or other immediate reactions. TOFA administration results were not different from those after treatment with GIBA in terms of mortality, incidence of infections and cancer.

Traumatic brain injury (TBI) is one of the most common types of brain injuries and is one of the major causes of death and disability among the population. The outcomes for people with TBI vary by degree of severity - from functional to severe neurological disorders also requiring correction and affecting the ability to work. Drug neuroprotection is one of the most promising areass in the treatment of patients with TBI. The article discusses the results of the original study of the effectiveness of neuroprotective drug Cerebrolysin in patients with traumatic brain injury of moderate severity.

Paraproteinemic polyneuropathy accounts for up to 30% of chronic demyelinating polyneuropathies. The aim of this study was to determine the clinical and neurophysiological patterns of the nosology compared with chronic inflammatory demyelinating polyneuropathy (CIDP). We examined 30 patients with PNP against a background of monoclonal gammopathy (16 with monoclonal gammopathy of undetermined significance (MGUS) and 14 with hemoblastosis) and 30 patients with CIDP. The history, neurological status and results of stimulation electroneuromyography were evaluated. A number of significant differences were recorded which suggest paraproteinemia in patients with demyelinating PNP. Nevertheless, immunofixation electrophoresis is currently the only method of the disease verification.