The role of endothelial damage as the main pathological mechanism of a number of diseases has been studied for a long time, but in the context of identifying new risk factors for CVD (viruses, genetic mutations, congenital dysplasia, autoimmune diseases), the problem of personalized cerebroprotection, taking into account the age and state of the endothelium, becomes relevant. Currently, the stage and age dependence of the development of endothelial dysfunction has been proven. Endothelial aging is a predictor of the development of cardiovascular diseases, and it can manifest itself depending on the patient’s age and the presence of comorbidity both in the direction of vasoconstriction and prothrombotic changes, and in the direction of loss of autoregulation of vasodilation and activation of oxidative stress, changes in the concentration of glucose, lipids and immune cell infiltration. Accordingly, drug correction of endothelial dysfunction should be personalized, age-oriented. The use of nicotinoyl gammaaminobutyric acid preparations, including those combined with Ginkgo Biloba extract, can be considered as a model for choosing the correction of age-dependent endothelial dysfunction in patients with cerebrovascular diseases. In young patients, the onset of endothelial dysfunction is characterized by changes in blood pressure (fluctuations from high to low numbers and vice versa), severe asthenia, headaches, mild cognitive and autonomic disorders, so at the initial stage, preference is given to a fixed combination of nicotinoyl gamma-aminobutyric acid with Ginkgo Biloba extract. In middle-aged and older patients with a long history of hypertension, stroke, and TIA in the anamnesis, it is advisable to begin therapy with parenteral forms of nicotinoyl gamma-aminobutyric acid, followed by oral administration, which will provide a prolonged effect and a more pronounced therapeutic effect.

Among the many non-communicable diseases that reduce quality of life, migraine is one of the top three, significantly ahead of cerebrovascular and oncological diseases, injuries and diabetes. A pulsating, intense headache, typical of migraine, is accompanied by a combination of nausea, vomiting, photophobia and phonophobia, and significantly affects daily activity and work capacity. An attack can begin suddenly, sometimes at the most crucial moment, and in the absence of proper therapy can last from 4 to 72 hours. Therefore, the selection of effective abortive therapy for migraine is a priority task in the management of such patients. Triptans are the first specific agents for the treatment of acute migraine attacks, due to their agonist properties in relation to serotonin (5-HT) receptors. Over the half-century of use, 3 generations of triptans have been synthesized, various dosage forms have been developed, from the usual tablet to forms in the form of a spray or orally disintegrating tablet.

With the increasing number of available forms of therapy, treatment approaches require revision and more careful selection based on individual patient characteristics such as attack severity, frequency of occurrence, comorbid conditions, and patient preferences. This article discusses aspects of targeted migraine therapy, as well as approaches to choosing triptans, taking into account modern clinical guidelines and the results of recent studies. The mechanism of action and points of application of triptans, the pharmacokinetic features of individual representatives of the triptan series are described in detail. The results of the latest clinical studies of the effectiveness and safety of triptans in stopping migraine attacks are presented.

Migraine is a common chronic neurological disease that involves different forms of attacks and is characterized by recurring episodes of intense headache. Migraine is a top ten disabling neurological disease and remains the second-ranked cause of disability in adults among noncommunicable diseases. Magnesium deficiency is also a common pathological condition caused by various reasons including insufficient levels of magnesium intake from food sources or increased losses through the gastrointestinal or renal systems. We finally have a sufficient number of studies that demonstrate the frequent comorbidity between migraine and magnesium deficiency, however measured plasma magnesium levels do not always objectively reflect the presence or absence of total body magnesium deficiency, as only 10% of the total body magnisium is extracellular. Other clinical manifestations of hypomagnesemia should also be considered. Magnesium deficiency in patients with migraine has been proven to lead to aggravation of the disease. The reason for this is an effect of magnesium deficiency on the main mechanisms of migraine pathogenesis, including impaired energy supply, cortical spreading depression, neurogenic inflammation and central sensitization. Numerous studies have revealed the potential effectiveness of adding magnesium supplements to the combination therapy of migraine. The article discusses the relationship between magnesium deficiency and migraine, the role of magnesium in the migraine pathogenesis and the feasibility of use of magnesium supplements to prevent and treat migraine.

Introduction. One of the most common symptoms of chronic cerebral ischemia (CCI) is dizziness, which significantly reduces the quality of life of patients.

Aim. Тo evaluate the effects of Vertigoheel® in treatment of patients with dizziness due to CCI in comparison with betahistine and a nootropic drug (choline alfoscerate) after 3 weeks in real clinical practice.

Materials and methods. A prospective comparative observational study was conducted among 30 patients diagnosed with CCI, whose main complaint was dizziness. Patients were divided into 3 groups, 10 patients in each group: the first group received Vertigoheel® in addition to the standard treatment of CCI with choline alfoscerate; the second group took choline alfoscerate and betahistine; the third group – only choline alfoscerate. At the first visit and in dynamics (after 1 and 3 weeks), a neurological examination was performed, testing using the DHI, HADS and VAS scales.

Results. Against the background of combined treatment, a decrease in the degree of dizziness was noted to the absence in the first group (11.4 ± 8.5 points) and mild in the second (22.8 ± 10.3 points) according to the average score on the DHI scale, with an initially lower overall average score in the first group. Positive dynamics were also observed for all DHI subscales in the combined treatment groups on days 7 ± 2 and 21 ± 2. During monotherapy in the third group, no clinically significant decrease in dizziness was found with an insignificant decrease in the average score on the DHI scale and its subscales. A decrease in anxiety and depression was recorded in all groups.

Conclusions. The bioregulatory therapy product has a therapeutic effect comparable to betahistine when used in combination with a nootropic drug in patients with dizziness associated with CCI.

Headache and dizziness are the two most common complaints in patients who see doctors of different specialties. Moreover, an undoubted association between these two symptoms (simultaneous vs sequential occurrence) is identified during the depth patient enquiry. Variability of clinical symptoms together with the widest diversity and ambiguity of vestibular reactions, as well as the lack of instrumental options for adequate diagnosis complicates diagnosis of vestibular migraine (VM). VM is currently diagnosed only on the basis of clinical criteria accepted by the international medical community. The differential diagnosis between VM and Meniere’s disease is no less urgent. Both diseases are only diagnosed using clinical symptoms (based on accepted clinical criteria) and have multiple overlaps in clinical presentation. In many cases, patients with VM are not only treated according to the Meniere’s disease patient management protocol for many years, but also undergo surgical interventions eventually bringing absolutely no relief. However, even a true diagnosis of VM does not guarantee a fast and high-quality choice of preventive treatment due to a large range of groups of drugs used (beta-blockers, calcium channel blockers, anti-CGRP monoclonal antibodies, serotonin and norepinephrine reuptake inhibitors amongst the so-called pain-relieving antidepressants, antiepileptic drugs, some antipsychotic drugs), and their efficacy does not exceed 75%. But the combination of two diseases with interweaving of similar enough and difficult to diagnose VM and Meniere’s disease aggravating the course of each other in one patient represents the most difficult situation.

Introduction. Migraine remains one of the most common forms of headache and is a serious medical problem that requires improved therapeutic strategies. Considering the widespreadprevalence of chronic migraine (CM), taking into account the factors influencing the outcome of treatment can help to create more personalized and, therefore, more effective therapies.

Aim. To study the clinical and anamnestic factors influencing the effectiveness of treatment of patients with CM.

Materials and methods. 54 patients aged 18 to 50 years with CM with and without drug-induced headache (LIGB) were observed. The frequency and severity of migraines were assessed every 2 months for 12 months. The survey of patients took place during each visit and included an assessment of all clinical and anamnestic data regarding headache (GB).

Results. Patients with CM did not significantly differ in clinical and anamnestic parameters from patients with XM and LIGB. The presence of LIGB in migraine is not associated with the frequency of migraine hypertension and does not change the response to therapy (p = 0.072). During treatment, there was an average decrease in the frequency of migraine headaches per month by 2 episodes (β = -2.15, p < 0.001). The initial severity of GB was associated with the number of days with non-migraine GB (β = -0.23, p = 0.003), the provoking effect of tyramine-rich foods (β = 3.91, p = 0.049), physical fatigue (β = 3.51, p = 0.047), and an increase in blood pressure in the migraine pattern (β = 4.14, p = 0.047). However, these factors did not affect the decrease in the frequency of GB and were not associated with the presence of LIGB.

Conclusion. In СM, the number of days with non-migraine GB, the presence of a provoking effect of food rich in tyramine, physical fatigue, and an increase in blood pressure in the migraine attack pattern are associated with the number of days with migraine per month, but do not affect the decrease in the frequency of GB in dynamics and LIGB.

In conditions of increasing life expectancy, its quality is important, regardless of age. Due to the progressive growth of the aging population, the prevention of cognitive decline has become particularly relevant. Presumably moderate cognitive impairment occurs among people aged 60 years and older in 10–36.7% of cases. With age, involutive brain processes occur, which, in combination with microangiopathy, leads to the development of chronic cerebral ischemia (CCI). The core of this pathology is a cognitive disorder in combination with mental, non-cognitive (emotional-affective, behavioral, psychotic) neuropsychiatric manifestations. It is important to maintain cognitive and mental health, and this can be achieved by influencing potentially modifiable risk factors for dementia. Thus, in the report of the permanent commission on dementia prevention, intervention and patient care of the Lancet magazine, in 2024, 14 modifiable risk factors for dementia were identified, the share of which amounted to 45% of all factors: low level of education, hearing loss, hypertension, obesity, tobacco smoking, depression, physical inactivity, social isolation, diabetes mellitus, high LDL cholesterol, alcohol abuse, traumatic brain injury, air pollution and vision loss. To influence them, it is necessary to increase physical activity, cognitive stimulation, normalization of sleep, compliance with dietary recommendations, correction of vision and hearing, control of blood pressure, etc. It is equally important to follow the doctorеs prescriptions for taking the necessary lipid-lowering, antihypertensive, antiplatelet therapy, depending on the concomitant pathology, as well as neurotrophic, vasoactive, antioxidant drugs. 2 clinical cases are given as an illustration. The drugs of choice for the correction of cognitive and neuropsychological disorders should be highly effective drugs with a good safety profile. Combined medicines have advantages due to the synergism of the action of its components, increasing the patient’s adherence to treatment, and eliminating polypragmasia.

Chronic cerebral ischemia is a common condition associated with progressive brain damage that manifests itself in various neurological disorders, including cognitive impairment. One of the etiologic factors of vascular disorders is arterial hypertension. The article discusses types of cognitive impairment and pathogenetic mechanisms of their formation. The role of the glymphatic system of the brain, the role of neuroinflammation in the implementation of cognitive impairment are discussed. The described clinical case shows the need to supplement basic therapy in patients with hypertension with drugs of other groups, in particular pentoxifylline, to improve the effectiveness of therapy. The article reviews the latest clinical and experimental studies of pentoxifylline, which show its positive effect on inflammation, endothelial dysfunction and, as a result, improvement of cognitive functions. The neuroprotective effect of pentoxifylline, which has been confirmed in experimental and clinical studies, is discussed. The possibility of using pentoxifylline in patients with mood disorders, major depressive disorder, bipolar disorder as an adjunct to the main therapy, and in cognitive impairment as monotherapy is discussed.

Back and joint pain occur in 70% of patients aged 60 years and older. The presence of arterial hypertension (AH), cerebrovascular diseases (strokes, heart attacks, chronic heart failure, ischemic heart disease), diabetes mellitus create significant obstacles to the choice of therapy. In 2007, the term “locomotive syndrome” (LS) appeared in world practice, proposed by the Japanese Orthopedic Association to characterize elderly patients with unstable balance, a tendency to fall, due to structural and functional damage to the organs of the nervous and musculoskeletal systems. Chronic musculoskeletal pain in LS has a number of features, such as minor severity (constant nature, exacerbations associated with blood pressure fluctuations). The presence of cognitive impairment complicates the assessment of the severity of pain syndrome, but at the same time triggers a cascade of neuropsychiatric symptoms (anxiety, depressive mood). The problem of treating geriatric patients with LS is a complex task, but knowledge of the basic principles allows you to avoid mistakes in choosing drug therapy and adequately add other non-drug regimens. All patients over 65 years old with chronic pain should be screened for cognitive impairment, anxiety and depression. These syndromes themselves can worsen the patient’s condition and make pain therapy ineffective. Evaluation of the drugs used, especially for pain relief, should be carried out taking into account drug interactions. Compliance with simple rules will help reduce the severity of symptoms, improve functioning and quality of life. Among NSAIDs, preference should be given to the safest ones, having minimal cardiac risks, not causing deterioration in cognitive functions and falling syndrome.

Introduction. Pain is a prominent feature of demyelinating diseases. The identification of potential associations between the size and localisation of demyelinating lesions in spinal cord and the development of central neuropathic pain has scientific and clinical significance.

Aim. To investigate the clinical and radiological characteristics of central neuropathic pain in demyelinating diseases affecting the spinal cord.

Materials and methods. A total of 52 patients with spinal cord involvement in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) were examined. Participants were divided into two groups: with pain (n = 25, including 12 patients with MS and 13 with NMOSD) and without pain (n = 27, including 16 patients with MS and 11 with NMOSD). Standardized interviews were conducted, pain intensity was assessed using a 10-point Visual Analog Scale (VAS), and participants completed the DN4 questionnaire. The degree of disability was assessed using the Expanded Disability Status Scale (EDSS). For lesion localization, CNS MRI data were analyzed (MRI scanners with a field strength of ≥ 1.5 T, with imaging conducted within one year). Statistical analyses were performed using SPSS Statistics.

Results. Pain intensity was higher in patients with NMOSD compared to MS (p = 0.011). Pain was more frequent with dorsolateral localization of demyelinating lesions (p = 0.019) and was not associated with lesion size.

Conclusion. The mechanisms underlying pain syndrome in NMOSD and MS with spinal cord involvement cannot be fully explained by lesion characteristics alone and require further investigation.

Chronic widespread pain is the leading symptom of fibromyalgia (FM). However, it is not unique to FM; other diseases may also manifest as chronic pain syndrome. This requires differential diagnostics. The latter is a difficult task, since, on the one hand, it is necessary to know the clinical picture of FM, modern diagnostic criteria and be able to use them in practice. According to a survey among doctors on knowledge of the diagnostic criteria of FM, only 10% of specialists were able to reproduce the diagnostic criteria. On the other hand, the doctor must remember the list of conditions that mask FM. Diseases that may accompany or imitate FM include rheumatological, neurological, musculoskeletal, endocrine, gastrointestinal, infectious pathology, and may also be associated with medication. Concomitant psychiatric pathology worsens the course of FM. The diagnostic search is complicated by the lack of a clearly defined biomarker for FM to date. The article presents the modern criteria of FM of the American College of Rheumatology (ACR), 2011/2016, which showed greater diagnostic validity compared to criteria AAPT, 2019. According to the modern concept, FM is a diagnosis of exclusion, but this does not exclude the presence of several nosologies at the same time. The main diagnostic points of differential search are also disclosed. Knowledge of differential diagnostics will help to make a timely correct diagnosis and increase the chance of successful treatment of patients with chronic pain syndrome. The purpose of the work is to review the literature on diagnostic criteria and diseases that can imitate FM, and to highlight the signs that can distinguish these various diseases from FM.

Introduction. Panic disorder (PD) and sleep disorders are closely pathologically linked, forming a vicious circle of mutual negative influence. On the one hand, PD, characterized by repeated panic attacks and anxiety, provokes hyperarousal of the nervous system, which disrupts sleeping and sleep maintenance. On the other hand, insomnia aggravates the worrying symptom, increasing the risk of PD recurrence. Published studies demonstrate a correlation between sleep disturbances and anxiety, necessitating a comprehensive approach to therapy.

Aim. To evaluate the dynamics of sleep disorders during the treatment of PD.

Materials and methods. Our study included 50 participants: 30 with PD and sleep disorders and 20 healthy. The Pittsburgh Sleep Quality Index (PSQI) and the Spiegel Scale were used to assess sleep quality.

Results. Testing of patients with PD revealed significant sleep disturbances, statistically significantly different from those of the healthy control group participants. A significant correlation was found between the severity of the primary disorder and the degree of sleep disturbances: in the subgroup with severe PD, sleep quality was significantly worse according to the scales than in the subgroup with moderate PD. After 8 weeks of treatment, including pharmacotherapy for PD and not specifically targeting insomnia, a statistically significant improvement in sleep quality was observed, although it did not reach the levels characteristic of healthy subjects.

Conclusions. Pharmacological treatment of PD is highly effective in addressing comorbid insomnia, but additional methods for correcting sleep disturbances are necessary to achieve better therapeutic outcomes. Further research is needed to optimize treatment approaches and select appropriate therapeutic interventions.

Generalized anxiety disorder and other anxiety spectrum disorders constitute the category of the most common mental disorders. Three lines of pharmacological therapy are used in the treatment of anxiety disorders: 1) selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI); 2) benzodiazepines; 3) antipsychotics. Along with SSRI and SNRI, other groups of antidepressants are used in the treatment of anxiety disorders, and other drugs with anxiolytic properties, such as pregabalin, are being considered as alternatives to benzodiazepines. Drugs in each of the three categories are characterized by both advantages and disadvantages that limit their clinical use, which determines the need to find new treatments for anxiety disorders. One of the most modern and promising treatments for generalized anxiety disorder is Aviandr, which was designated AVN-101 and CD-008-0045 at the stages of development and initial testing. The efficacy and safety of Aviandr in the treatment of generalized anxiety disorder has been proven by the results of randomized controlled trials; in addition, the effectiveness of the drug in improving the condition of patients who have suffered from acute coronavirus infection has been noted. In addition to its anxiolytic effect, Aviandr shows the ability to reduce depressive symptoms and exhibits a number of other additional effects. A notable feature of Aviandr, which gives it advantages over traditional treatments for generalized anxiety disorder with comparable effectiveness, is the absence of daytime sleepiness, which often occurs when benzodiazepines are prescribed, and the side effects that are typical for SSRI.

This work presents a review of the literature using the elibrary.ru, CyberLeninka, PubMed, Scopus and Google Scholar databases with the key terms “Gamma-aminobutyric acid (GABA)”, “GABA agonists”, “GABA antagonists”, “GABA pathophysiology”, “children and adolescents”. The information obtained was analyzed, systematized and presented in three sections: general aspects of GABA, pathophysiology of GABA and GABAergic pharmacology and therapy. Currently, three types of GABA receptors have been identified: two fast-acting GABA-A and GABA-C and one slow-acting GABA-B. GABA is a neurotransmitter and neuromodulator of the autonomic nervous system, a hormone and trophic factor in endocrine organs, including the pituitary gland, pancreas, adrenal glands, uterus, ovaries, placenta and testes. Disturbance of GABA signaling is a pathophysiological link in diseases of the cardiovascular system, gastrointestinal tract, endocrine diseases (diabetes mellitus, diseases of the adrenal glands and reproductive organs). The GABA system of the autonomic nervous, endocrine and immune systems is being intensively studied for drug treatment of functional disorders of these systems. GABA acts not only as a neurotransmitter, its role as a neurohormone, trophic factor and immunomodulator has been established, which makes it a multifunctional molecule. In neurology, GABAergic drugs are used to treat paroxysmal disorders, including periodic syndromes of childhood, sleep disorders, complications of alcoholism, spasticity, acute and chronic pain, anxiety disorders and depression. The authors consider the therapeutic possibilities of aminophenylbutyric acid hydrochloride and its encapsulated form (Anvifen) in the treatment of neurological disorders and especially in pediatric practice. In view of the restrictions on the use of antidepressants and anxiolytics in children and adolescents, aminophenylbutyric acid hydrochloride is an effective and safe drug of choice in pediatric practice. The authors present the results of clinical observations of the drug’s effectiveness and safety.

Scolopendrae represent the best-known genus of centipedes. They are the largest centipedes. There were several reported cases of scolopendra venom poisoning around the world. We report a clinical case of an unusual reaction to a scolopendra bite in Crimea, accompanied by severe acute neurological and articular manifestations and hard-to-diagnose delayed sequela. Despite the full range of medical care provided and active management strategy, the female patient developed allergic and subsequently autoimmune pathologies due to individual immune characteristics, including genetic ones caused by the presence of previously undiagnosed connective tissue dysplasia. The retrospective observation showed how the female patient’s congenital imbalance between humoral and cellular components of the immune system contributed to the more aggravated clinical picture that developed as reaction to the arthropod bite, and it was its venom that initially acted as an allergic, and subsequently as an autoimmune trigger. A review of modern Russian and foreign literature on cases of scolopendra bites was performed. This review highlighted possible complications associated with the effects of the venom. Recommendations on the management strategies for such patients are provided to primary care physicians.

Osteoarthritis (OA) is an extremely heterogeneous disease. Identifying a specific disease phenotype will help the practitioner optimize approaches to diagnosis and treatment. The metabolic phenotype of OA is associated with the greatest polyand comorbidity, which will significantly limit the choice of a number of drugs often used in the treatment of this joint pathology. The presented clinical observation demonstrates the difficulties in the care of a patient with a combination of eleven somatic diseases at the same time, one of which was OA. Care tactics suggest, on the one hand, justified polypragmasy, on the other hand, low adherence to long–term use of a large number of drugs. The presence of many comorbid diseases, in particular coronary heart disease, and history of stroke, suggest a complete rejection of the use of nonsteroidal anti-inflammatory drugs (with the exception of local forms). Regular therapy with a bioactive extract from small marine fish in the last two years has made it possible to achieve clinical improvement and, probably, prevent radiographic progression of knee joint OA and delay joint replacement surgery.

Anxiety disorders represent one of the most common groups of mental illness in the population and in general medical practice. These disorders can manifest in various forms and have a significant impact on the quality of life of patients, leading to increased morbidity and frequent calls for medical help. Psychoemotional disorders play an important role in the development and complicated course of various chronic non-communicable diseases, including cardiovascular diseases. The quality of life of patients significantly deteriorates, which leads to a decrease in physical activity, a deterioration in general well-being and, as a result, an increase in the number of adverse outcomes. On the other hand, there is an insufficient level of awareness among physicians of the risks associated with the psycho-emotional state of patients. Correction of psychoemotional disorders includes different approaches, both drug and non-drug methods of treatment are used. When choosing a drug, special attention is paid to several key factors, among which the most important are good tolerability of the drug, effectiveness and a high safety profile. A drug for the treatment of stress-induced psychovegetative syndrome in therapeutic doses should contribute to the rapid relief of autonomic dysfunction, restoration of sleep, effective reduction of elevated levels of anxiety, and improvement of the patient’s quality of life.