Effective pathogenetic therapy of ischemic stroke - reperfusion intervention - is largely restricted by mandatory careful selection of patients and availability of specialized care. Pharmacological treatments are therefore becoming especially relevant as they are aimed at maintaining viability of neurons in the ischemic area. The most studied and promising neuroprotectives are citicolines. They improve outcomes in individual groups of patients with acute ischemic stroke, and have beneficial effects on cognitive function in the recovery period. The drug also proved to be effective in the recovery of upper limb function in patients with hemiplegia. Citicoline can be recommended both for acute ischemic stroke and at the rehabilitation stage.

Chronic cerebral ischemia (CCI) is one of the most common diagnoses in the national neurology, which is now completely absent in most countries and to a certain extent corresponds to vascular cognitive impairment (VCI) in modern foreign literature. The literature data and author's findings on the diagnosis and treatment of CCI are presented. Other diseases may often clinically simulate CCI (anxiety and depressive disorders, primary headaches, peripheral vestibulopathy, Alzheimer's disease) which unfortunately are poorly diagnosed in clinical practice, so patients do not receive effective treatment. Treatment of patients with CCI (VCI) should be focused on managing risk factors for stroke (cessation of smoking and alcohol abuse, sufficient physical activity), normalization of blood pressure (antihypertensive agents), reduction of blood cholesterol levels (statins), antithrombotic therapy (antiplatelet agents and anticoagulants), and administration of drugs that enhance cognitive function. There are findings on the use of naftidrofuryl (Dusopharm) in patients with cognitive impairment.

Acute stroke still accounts for a significant proportion in the structure of all cardiovascular diseases. Effective management of acute cerebrovascular disease may be improved by new methods of treatment. Neurotrophic and neuroprotective drugs are among the promising treatment options, represented, for example, by Cerebrolysin. The drug demonstrated a strong metabolic, neuroprotective, neuromodulatory and neurotrophic effect evidenced by numerous experimental and clinical observations.

Early diagnosis and timely rational therapy of DP allow to prevent disability, increase duration and improve the quality of life of patients with diabetes mellitus (DM). The most feasible practical diagnostic algorithm for DP is still a matter of debate. The article focuses on the most common form of DP - diabetic distal symmetrical sensorimotor polyneuropathy (DSSP). Effective non-pharmaceutical methods to improve the course of DP and DSSP include optimum control of blood glucose level, educational programs, lifestyle (diet, maintaining or achieving a healthy weight, therapeutic exercises, maintaining everyday activity) and, when indicated, cognitive-behavioral therapy. Symptomatic treatment of neuropathic pain in DSSP achieved significant success, however it fails to inhibit the damage to the peripheral nerves. The search for therapies aimed at changing the course of DSSP continues. In Russia, alpha-lipoic acid and vitamin B complex are discussed as possible pathogenetic treatments of DSSP. Cocarnit is a combination medicine containing vitamins B and metabolically active substances. Prospects for the use of the drug in the treatment of patients with DSSP are considered.

Parkinson's disease is a serious, widespread and largely paradoxical neurological disease which still has a lot of "white spots" for research. There is not yet a medication which could prevent death of brain cells and suppress progression of the disease. According to the head of neurology department of the Russian Medical Academy of Postgraduate Education, head of Center of Extrapyramidal Disorders, board member of the All-Russian Society of Neurologists, vice-president of the National Parkinson and Movement Disorder Society, member of the Executive Committee of the European Section of the International Movement Disorder Society, MD, Professor Oleg S. Levin, crucial to the success of treatment are early diagnosis and follow-up by a neurologist who specializes in extrapyramidal disorders.

Recently, healthcare specialists have put great emphasis on the relationship between Alzheimer's disease and diabetes. There are many common pathogenic mechanisms underlying both diseases: insulin resistance, hyperinsulinemia, chronic hyperglycemia, acute hypoglycemic episodes, microangiopathy, inflammation, dyslipidemia, etc. It is assumed that there is a direct link between insulin and Alzheimer's disease. Insulin regulates β-amyloid synthesis as well as tau phosphorylation. Cognitive impairment and dementia associated with diabetes can also be mediated through vascular factors including, primarily, development of microangiopathy. Еру vascular and neurodegenerative components can be mutually intensified. One of the key elements in the pathogenesis of cognitive degradation is impaired cholinergic transmission. Acetylcholinesterase inhibitors are the drugs of choice for the treatment of both Alzheimer's disease and vascular dementia. The effectiveness of donepezil (Alzepil) has been proved in numerous trials: it is characterized by the best tolerability compared with other cholinergic drugs and is the only drug in the group recommended for use in severe stages of Alzheimer's disease.

Alzheimer's disease (AD) is the most common cause of dementia. The disease is typically found in people over 65 years. On average, AD patients live for about 8-10 years after the onset of clinical manifestations. AD is conditioned by a number of factors which are subdivided into modifiable (lifestyle) and non-modifyable (sex and age). In most cases, the impact of genetic factors on the risk of developing AD is low. CT, MRI and laboratory tests help exclude other possible causes of dementia. At the moment, there is no cure from AD, though there are plenty of ways to improve the quality of life of patient. Use of drugs can temporarily relieve severity of certain symptoms or inhibit the progression of the disease. Memantine can be prescribed to patients with moderate to severe stage of the disease. In addition to drug therapy, cognitive stimulation is favourable. Multimodal therapy of the disease seems to be the most feasible way.

Arterial hypertension (AH) is an important predictor of cognitive impairment (CI), up to the degree of dementia. The article tells about the relationship between levels of systolic and diastolic blood pressure and cognitive function profiles, the pathogenesis of cognitive impairment in hypertensive patients; therapeutic options are explored. Treatment of CI which develop against a background of vascular cerebral disease is aimed at managing risk factors, eliminating or reducing severity of chronic brain ischemia and involves administration of drugs that improve cerebral blood flow and metabolism and acting on common pathogenic mechanisms of brain damage.

The article considers the multimodal action of the melatonin drug Melaxen®, namely, its adaptogenic, biorythmogenic, hypnotic, heroprotective, immunostimulant, and antioxidant effects. The role of melatonin in the treatment of various diseases of the central nervous system is defined. The results of the author's study of establishing the daily rhythm of cerebral blood flow in case of chronic brain ischemia and recommended regimens for desynchronosis underlying cerebrovascular disturbances are demonstrated.

Most patients who abuse alcohol do not consider their alcoholic habits a problem or deliberately conceal them preferring to visit therapists with somatic complaints. A screening epidemiological study was carried out at neurology centers in Kazan and Yaroslavl. The study included 300 neurology patients (152 men and 148 women) aged 23--75 years. Th patients completed the AUDIT-C and CAGE questionnaires and answered the question: "If you considered yourself having a drinking problem, whose advice would you rather seek: of your physician, a narcologist or yourself?" 19% of women and 78% were screened positive on AUDIT-C. Personal physician was preferred by 39% of men, narcologist by 17%; 25% of women would go to personal physician, and 19% to narcologist. It was found that neurologists underestimated the urgency of alcohol abuse problem among their patients and their involvement in the treatment.

The article tells about occipital epilepsy, comorbidity of occipital epilepsy and headache, key problems of differential diagnosis of migraine and occipital epilepsy. A clinical case of a female patient with symptomatic occipital epilepsy who achieved remission after receiving sodium valproate is described.

New immunomodulatory drugs for the treatment of multiple sclerosis are emerging today in the pharmaceutical market. In Russia, new first line preparation - teriflunomide 14 mg in tablet form - was recently granted approval for the treatment of patients with remitting MS. The drug demonstrated good tolerability, efficacy and relative safety in long-term clinical trials. The article discusses an algorithm for the management of patients with RMS aimed at reducing the risk of adverse events associated with teriflunomide therapy.

81 patients with definite diagnosis of multiple sclerosis (MS) according to McDonald et all. criteria underwent a comprehensive clinical and neurological examination in 2005 and 2010, and their blood serum was measured for the amount of matrix metalloproteinase-9 (MMP9) and von Willebrand factor antigen (vWf) using ELISA. Von Willebrand factor antigen levels were definitely significantly lower in the group of patients treated with alpha-lipoic acid at the time of the study compared with the group without concomitant ALA therapy. There were no significant differences between the groups of patients by the level of MMP9 in this study. ALA therapy for multiple sclerosis has positive effects associated also with a decrease in cerebral vascular endothelial damage, thus making it pathogenetically substantiated.

Dimethyl fumarate (DMF) is dimethyl ester of fumaric acid, a naturally occurring molecule that plays a key role in redox processes of tissue respiration. Results of studies on animal models demonstrate that the drug has an anti-inflammatory and cytoprotective action. Anti-inflammatory effects of DMF could be mediated by several mechanisms, including inhibition of nuclear factor-kappaB-dependent transcription and suppression of cytokine production and cell adhesion molecule expression. 2 years after start of treatment DMF significantly increased the relative number of patients without active disease by clinical, radiological and general criteria in comparison with the placebo group. According to the DEFINE trial, the proportion of patients without active disease in twice daily DMF group was 28% (vs placebo, p = 0,012), and 18% (vs placebo, p < 0, 0001) according to the CONFIRM trial. DMF demonstrated similar efficacy in various subgroups of patients classified according to baseline characteristics of the disease, including frequency of relapses in the past, pre-treatment, level of disability, as well as type and extent of the lesions. In terms of safety profile, DMF was similar to GA and placebo. Adverse effects on the gastrointestinal tract against the background of DMF were mild or moderate, transient and treatable. Administration of DMF did not increase the risk of infections and malignancies.

The article analyzes experience with the original and generic meloxicam in patients with pain in the cervical and lumbosacral areas. The findings demonstrate higher efficacy of the original drug based on perception-based and unbiased assessments of pain in the process of comprehensive treatment of patients with low back pain in the outpatient neurological practice.

Nonsteroidal anti-inflammatory drugs (NSAIDs) represent one of the most popular prescriptions. Selective COX-2 inhibitor nimesulide is a drug of choice for relief of acute pain, especially in elderly patients. The article presents and discusses the results of clinical trials of nimesulide and dexketoprofen in neurological and therapeutic practice.

The article describes the key characteristic features of neuropathic pain, main aspects of diagnosis and algorithms for optimum therapy.

Healthcare and socio-economic significance of back pain is determined by the fact that it is one of the most common complaints of patients in outpatient and hospital settings resulting in temporary disability. In view of the etiological factor, musculoskeletal back pain is subdivided into specific and non-specific. The article discussed neurophysiological aspects of pain, mechanisms of development and clinical manifestations of lumbodynia. As pathogenetic treatment of musculoskeletal back pain, we examined the use of systemic and topical NSAIDs, muscle relaxants, antidepressants, as well as non-pharmacological methods including therapeutic exercises, physiotherapy, and cognitive behavioral therapy.

The article offers recent findings on Vitamin D, D hormone and D endocrine system, types of vitamin D deficiency and their role in the pathology. The questions of pharmacological management of various types of D-deficiency with natural vitamin preparations and its active metabolites are discussed.