Movement disorder is a frequent cause of disability after stroke. Effective physical rehabilitation of stroke patients depends on the condition of cognitive functions. The article discusses the basic pathogenetic mechanisms of the development of movement and cognitive disorders after stroke, methods of treatment. Administration of multimodal drugs with several mechanisms of action to increase brain plasticity and enhance rehabilitation potential is substantiated.

Antiplatelet medications are essential in the primary and secondary prevention of stroke. All currently available antiplatelet drugs are platelet aggregation inhibitors acting at various points of application, but they differ in their mechanism of action. Successful treatment and prevention of cerebrovascular diseases with antiplatelet drugs largely depend on the sensitivity and susceptibility of platelets to the impact produced by these medications. Study of changes in platelet functional activity during treatment with antiplatelet drugs allows to monitor the effectiveness of therapy, identify resistance and detect lower reactivity to the drug, as well as to select the proper drug and its dosage. In practice, the approach helps to assess the individual patient response to antiplatelet therapy, choose the effective antiplatelet medication, reduce the risk of long-term complications and recurrent stroke, and, therefore, improve the quality of life and prognosis of the disease.

Post-stroke cognitive impairment and dementia are one of the major causes of the disability and quality of life deterioration following cerebrovascular accident. In this review we cover current views on the prevalence, mechanisms and risk factors of post-stroke cognitive deficit, according to recent publications of leading European opinion leaders in this area. We also focus on the approaches to the pharmacological treatment and the role of neuroprotective agents.

Own experience of managing 50 patients (22 men and 28 women) aged 19 to 76 years with acute nonspecific lumbodynia or lumbar ischialgia is described. As anesthesia, patients received etoricoxib (Arcoxia) 60 mg daily and muscle relaxants (Mydocalmum 150--300 mg daily or sirdalud 2--6 mg daily). Patients were informed of the favorable prognosis of the disease and received advice regarding physical activity. The duration of treatment ranged from 14 to 28 days and averaged 20,0 ± 7,9 days. Against the background of treatment, the intensity of pain based on visual analog scale decreased from 6,68 ± 5,23 to 1,10 ± 1,24 points, and disability based on the Roland Morris Disability Questionnaire - from 8,70 ± 6,21 to 1,44 ± 1.98 points; adverse events were not observed. A patient case is described in which positive effect was achieved more quickly than in the previous period of exacerbation after surgical treatment (discectomy). The results demonstrate Arcoxia efficacy and safety in the treatment of acute lumbodynia and lumbar ischialgia.

In most cases, back pain is caused by inflammation of the spinal muscles and joints, and periarticular soft tissues. The pain is benign, and the patients may experience spontaneous remission (in half of cases within a week, in 90% of cases within a month) even without treatment. Causes of chronic pain and disability of patients lie in inadequate therapy when patients with benign non-specific back pain are exposed to traumatic impact (surgical, traction, pharmacological) and/or acquire mental patterns contributing to disability (nocebo effect). That is why the strategy for the treatment of acute non-specific back pain should be based on using the most harmless non-invasive techniques.

Vertigo and balance disorders are common symptoms which force elderly people seek aid of doctors of various specialties. Results of the studies of the most common causes of vertigo and imbalance in patients older than 60 years are described. It is demonstrated that in the studied patients, the most common causes of vertigo were diseases of the peripheral vestibular systems, dyscirculatory encephalopathy and multisensory insufficiency. Based on the conducted research, an algorithm for clinical evaluation of patients with vertigo is suggested. Peculiarities of treatment of the most common diseases associated with vertigo in elderly patients are considered.

The article is an overview of the prevalence, mechanisms of development, diagnosis and treatment of diabetic neuropathy as a complication of diabetes. It also tells about the pathogenetic aspects of treatment of diabetic polyneuropathy.

The article tells about recent algorithms for diagnosis and treatment of patients with back pain. In primary outpatient care, patients with back pain can be classified into one of two categories: "non-specific" musculoskeletal pain and "specific" pain caused by a potentially dangerous disease. This helps general practitioners to perform adequate diagnostics and prescribe effective therapy.

Post-stroke spasticity considerably limits the ability to move for patients, hinders nursing, and contributes to the formation of pain syndromes. The article tells about the current understanding of the pathogenesis of cerebral spasticity, and discusses baseline treatment and rehabilitation activities. Administration of botulinum toxin type A for managing increased muscle tone in patients with stroke is considered in detail.

The article considers the key issues of the clinical pattern, diagnosis and treatment of chronic cerebral ischemia. The results of the observation program "Thiocetam for focal neurological, mild cognitive, asthenic and emotional disorders accompanying chronic organic disease of the central nervous system - discirculatory encephalopathy." The article demonstrates that Thiocetam has a beneficial effect against mild cognitive impairment, asthenic disorders, light and moderate emotional disorders in the studied population.

Low back pain is one of the most frequent causes of seeking doctor's aid and temporary disability of patients. The leading role in the examination belongs to clarification of complaints, medical history, quick physical and neurological examination which help to exclude presence of a specific disease, and in most cases there is no need for instrumental examination. Information about benign nature of the disease, high probability of quick recovery, benefits of adhering to an active lifestyle, use of pain relieving nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants could be of great value for patients with acute nonspecific back pain. To ensure efficacy, treatment for chronic non-specific back pain should be multidisciplinary and include physical therapy, cognitive-behavioral therapy, optimization of drug therapy. In case of discogenic radiculopathy, epidural corticosteroids and anesthetic could also be effective, and only a small proportion of patients need surgical treatment. The article provides the authors' findings on the efficacy and safety of NSAIDs, such as meloxicam (Movalis), for managing low back pain.

The article tells about the biological role of vitamin D and its metabolites, causes of its deficit among the population and its role in the regulation of normal functioning of the musculoskeletal system. A special focus is on the application aspects of native vitamin D and its active metabolites in the period of age-related changes in the body associated with possible malabsorption of vitamin D in the intestine, changes in receptor sensitivity to vitamin D or abnormalities in vitamin D metabolism in kidneys.

The article discusses the possibility of using symptomatic slow-acting drugs for the treatment of osteoarthritis (OA). There is a review of clinical studies evaluating the efficacy and safety of diacerein in different forms of OA.

The article tells about the results of an open 6-month clinical trial of the innovative drug tofacitinib (trade name Jakvinus), the first oral janus kinase inhibitor, in the treatment of 15 patients with rheumatoid arthritis who failed previous therapy. The study found that a daily dose of 10 mg of tofacitinib (TOFA) has high therapeutic efficacy and good tolerability. TOFA monotherapy (7 patients) and combination treatment with standard baseline medicines such as methotrexate or leflunomide (8 patients) was associated with a significant decrease in mean values of all the analyzed indices of RA activity (DAS28, CDAI, SDAI, RAPID), and a significant clinical improvement of ACR 20/50/70 criteria. The positive dynamics of the basic clinical parameters defining the severity of articular syndrome was combined with decreased levels of immune-inflammatory markers: C-reactive protein and rheumatoid factor in blood, and even resulted in seroconversion in two patients. No critical side effects requiring withdrawal or administration of complementary therapy for managing adverse events were observed in the studied group. The findings allowed to conclude that tofacitinib monotherapy and its combination with traditional disease-modifying drugs enhances RA therapy and thus can be recommended for the treatment of RA after failure of standard baseline therapies or contraindications to their use.

The article shares the current concept of pathogenetic treatment of systemic lupus erythematosus. The commonly used drugs are characterized, as well as their indications for their use and standard doses. The treat to target concept for SLE is discussed. Challenges in the development of a single treatment algorithm are considered.

A study to evaluate the prevalence of various pain syndromes (PS) in patients with chronic and episodic migraine and their potential pathogenetic relationship was carried out. The study involved 61 patients with chronic migraine (CM) and 42 patients with episodic migraine (EM) according to ICD revision 3. Patients with CM demonstrated a higher incidence of various pain syndromes compared with EM patients. The pain syndromes were dominated by temporomandibular joint dysfunction (TMJD) and neck pain. The correlation between the decrease in the daily activity of patients and the number of PS is demonstrated: working disability in migraine patients grows along with the increase in the number of comorbid pain syndromes. The authors concluded that dysfunctional changes in pain experienced by patients due to migraine chronicity create the conditions for occurrence of comorbid pain syndromes which are located primarily in the area of innervation of the trigemino-cervical complex. The fact that problems in everyday activity of patients with migraine are caused by migraine as the primary disease and by comorbid PS should be considered in the process of treatment.