A study of 103 2nd diabetes mellitus inpatients was carried out with the help of the composite test (clinical scales TSS and NIS LL + 7 EMG-characteristics of the leg peripheral nerves’ state) for diagnosing and establishing stages of diabetic polyneuropathy. In 75% of patients distal symmetric sensor-motor diabetic polyneuropathy is detected, from them – in 33% subclinical stage. In 30 patients with subclinical stage of the diabetic polyneuropathy treatment by Actovegin® was conducted for 5 months: 10 infusions 250.00 ml of 20%-solution and then administration of Actovegin® tablets at a dosage 200 mg 3 tpd. At examination after the course of treatment improvement of the capillary blood flow, increase of density of thin fibers in epidermis and skin (punch-biopsy), content of endothelium in the skin, activation of neoanginesis. Discussing the literature data and own findings a conclusion about effectiveness of Actovegin® in the 2nd diabetes mellitus patients with polyneuropathy, including at a subclinical stage.

The article tells about a clinical case of subacute flaccid tetraparesis with peripheral polyneuropathy against a background of dipsomania in a patient who abused alcohol. The pathogenetic mechanisms of subacute development of neuromuscular disorders, differential diagnosis and the treatment approach for patients with alcoholic polyneuropathy and myopathy are discussed.

The article provides a scientifically grounded approach to pharmacotherapy of vascular and combined mental debility. The role and place of memantin, an uncompetitive low-affinity antagonist of NMDA-receptors in regulation of glutamate-dependent links of excitotoxicity in combined mental debilities. The effectiveness of memantin is proved for all stages and in various forms of mental debility, including combined mental debility, as well as compatibility with other drugs in combined therapy, a favourable safety profile and good drug tolerability.

Study objective: to study clinical and laboratory peculiarities of EN depending on the etiological agent as well as to determine disease recurrence risk factors. Materials and methods: the study included 121 patient with EN. Depending on the reason of origin all patients were divided into three groups: EN with sL (66 subjects), EN in pregnant women (23 subjects) and infectionassociated EN (32 persons). The work evaluated peculiarities of the course and outcomes of EN for each of the groups. Results: Clinical and laboratory characteristics was on the whole comparable in groups with infection associated EN and EN in pregnancy, but was sharply different from those observed in sL. In the recent case a considerable increase of inflammatory activity values was noted as well. A characteristic clinical sign of infection-associated EN is a symptom of the “bruise blossoming”. The recurrence in groups of EN in pregnancy and in sL was observed in ¼ of cases. In the infection-associated EN group the recurrence took place in 40% of case, which was due to lower therapeutic effect from antivirals and greater disposition of the viral infection to chronicity.

This review includes results of experimental and clinical studies of new oral drug teriflunomide for pathogenetic treatment of multiple sclerosis (MS). Given the mechanism of action, clinical data of the studies II and III phases of clinical efficacy, tolerability and safety. Discusses the place of teriflunomide in pathogenetic treatment of MS.

There was a whole series of drugs that change the course of multiple sclerosis over the past 20 years. However, a single algorithm of patients of childbearing age has yet been developed. There are new drugs more efficiently, but at the same time with high risk of pathological effects on the fetus, which requires more detail to provide algorithm of this category of patients.

Insomnia is a sleep disorder that significantly reduces the quality of life, affects performance, learning ability, may lead to social maladjustment, personality changes, and is associated with a number of metabolic disorders. The article emphasizes the importance of an interdisciplinary approach to the treatment of sleep disorders, discusses administration of sleeping pills to manage sleep disorders.

The article deals with the experience of tofisopam application in therapy of anxiety disorders in neurologic profile patients of the rehabilitation inpatient therapy. 45 patients with chronic vertebra-basilar insufficiency, consequences of the ischemic stroke, intervertebral discs lesions and spinal column dorsopathies were examined. The structure of psychic disorders was determined by the presence of the generalized anxiety disorder, organic anxiety disorder, emotionally instable disorder by ICD-10. The physiologic problem characterizing these patients was related to pain and mobility disturbance, general somatic state as well as situations preconditioned by a fact of chronic disease and its psychosocial consequences. The effectiveness of tofisopam is shown with use of psychometric scales CGI, HADS and Spielberg-Khanin Anxiety Scale with respect to reactive anxiety preconditioned by external factors as well as its good tolerability, safety and lack of negative effect on the cognitive sphere. A conclusion about the expediency of tofisopam for rehabilitation of neurologic patients is made, especially patients with vertebra-basilar insufficiency.

The history of clinical pain management was analyzed. The main pathogenetic mechanisms of pain in practical surgery and neurology and the use of non-steroidal anti-inflammatory drugs are considered. Nimesulide’s mechanisms of action, the variety of indications, efficacy and safety are summarized wih regard to different treatment duration.

The article presents rules of NSAIDs selection. A practical evaluation of the risk degree at indication of NSAID to a certain patient taking into account concomitant diseases, as well as the age and vicious habits of the patient, is shown within the case study of exacerbation of muscular and skeletal pain. Literature data are provided about the mechanism of action of nimesulide, dosage and duration of therapy.

Myofascial pain is an urgent interdisciplinary medical problem. It is diagnosed in more than half of the young and middle-aged patients, there are no precise data on its prevalence among older people. Currently there is no systematic approach to terminology and nosological affiliation of myofascial pain. The authors have described and assessed the significant factors of myofascial pain and diagnostic criteria of myofascial pain syndrome. In the treatment algorithm the focus is laid on the general principles of therapeutics, mechanisms of action and indications for the sound use of external forms of NSAIDs, in particular of the drug Voltaren Emulgel 12 hours, as an independent method of treatment for mild to moderate pain, and as an addition to the basic therapy aimed at pain suppression.

The main clinical manifestations of osteoarthritis (OA) are a painful articular syndrome of varying intensity accompanied by loss of functionality and impaired quality of life. The pathogenetic links of the degradation are related to violations of the hyaline cartilage structure. Collagen defects are practically not restored, worsening the dysfunction of joints. Alflutop is the cartilage protector, including chondroitin sulfate. In the literature its symptom - and the structure-modifying effect is shown. In the study we conducted in 60 patients the dynamics of painful articular syndrome, functional features and the quality of life of patients in case of complex treatment with alflutop were studied.

In the recent decades rheumatology has been witnessing the marked progress associated with introduction into clinical practice of gene engineering biological drugs. At the same time use of these drugs is associated with the increasing risk of development of infections of various nature and localization including opportunistic (invasive mycoses, pneumocystic pneumonia etc.) as well as the increased risk of reactivation of the latent infection, tuberculosis (TB), first of all. In addition to this, cases of grave infections (pneumonia, sepsis, bacterial arthritis, skin and soft tissue lesions etc.) are registered, including – with letal outcome. This review analyzes the literature data predominantly of the recent 5 years relating to frequency and localization of infections in rheumatoid arthritis patients at therapy by various GIBD. The importance of various infections (TB, pneumonias, chronic viral hepatitis, herpes-viral infections etc.) in the tactics of the specified patients follow-up is characterized. The necessity of a wider use of immunization by various vaccines (first of all, pneumococcal and anti-flu ones) of patients with autoimmune inflammatory rheumatic diseases is underlined.

The article tells about the epidemiological and pathogenetic aspects of osteoarthritis, current treatment approaches, primarily highlighting the slow-acting anti-arthrosis medications, chondroitin sulphate, glucosamine and their combinations. There are results of recent trials which studied the effect of the above mentioned medications on the symptoms and progression of osteoarthritis, as well as several pleiotropic effects of the combination of chondroitin sulfate and glucosamine.

Motor disturbances demonstrating themselves as central hemiparesis is the most frequent reason of disability of patients who suffered a stroke. Activation of a patient makes the foundation of management of patients with post-stroke hemiparesis, the remedial gymnastics is aimed at training of movements in paretic extremities and prevention of contractions. In patients in whom high muscular tonus (spasticity) impairs motor functions, peroral anti-spastic drugs and (or) local injection of botulinic toxin can be effective. Results of the recently published study CARS are provided in which effectiveness of cerebrolysin (30 ml of intravenous injections for 21 day) was studied on 208 patients (mean age is 64 years) as compared to placebo; statistically significant improvement of the paretic hand function restoration was shown in patients who received cerebrolysin as compared to the placebo group. Implementation in the clinical practice of modern therapeutic methods of stroke consequences allows improving restoration and quality of life of patients.

This article is a clinical case description of a young female (37 yrs) with ischemic stroke of unknown origin. Neurologic and cardiovascular investigations failed to find out any potential reason for stroke in this case. Genetic test on prothrombotic mutations helped to identify several genetic abnormalities associated with high thrombotic risk that could lead this patient to ischemic event on the background of dysplasia of one of the brain arteries. The authours suggest an algorithmic approach to diagnose young patients (< 50 yrs) with stroke of unknown origin.

Prevention of ischemic stroke (IS) and cognitive impairment (CI) in patients after IS or transient ischemic attack is discussed.
The efficacy of non-pharmacological methods for the prevention of IS and CI (cessation of smoking and alcohol abuse, balanced diet, losing excess weight, regular physical activity) along with administration of medicines (antithrombotic agents, antihypertensives, statins) is highlighted. The results of a 5.5-year follow-up of 350 patients after stroke are described which demonstrate that non-pharmacological methods and regular drug therapy reduce the risk of recurrent stroke, though they are not effective in preventing the growing CI. The article tells about the widespread use of Divaza in this country in patients with cerebrovascular disease and the results of a multicenter study are demonstrated; a placebo-controlled Divaza study for secondary prevention of IS and CD is planned.

Objective. To evaluate clinical efficacy and tolerability of cellex in the treatment of patients with cerebral stroke. Material and methods. In 2 multi-center researches of Russian clinical sites were involved 178 and 480 patients with acute disturbance of cerebral blood circulation (ADCBC), respectively. The first research was comparative with open inclusion of 146 (82%) patients with ischemic stroke and 32 (18%) – with hemorrhagic stroke at the age of 35-80. In the second research, which was doubleblind, placebo controlled, randomized, patients with ischemic stroke got Cellex or placebo during the standard base therapy.
Results and conclusion. Thus, a statistically significant (р < 0,05) advance of paresis regression (by NIHSS scale) was noted in the Cellex group by the 6th day of observation as compared to the control group. Evaluation of therapy results in patients with total aphasia showed that the value of the mean Questionnaire speech values after Cellex administration (р < 0,05) exceeded the respective control group level by 3 times. In patients who administered Cellex the IPC test result increased by 24%, whereas in the control group – only by 14.8% (p < 0,01). The research showed that in group of the patients under prescription of Cellex marked authentically better result with regress of movement, visual, speech and cognitive disorders.

The evidential base of meldonium in chronic cerebral ischemia is critically reviewed in the article.

The article provides the foreign and domestic experience of amantadine application and PK-Merz use for Parkinson disease as monotherapy and within complex therapy. Data of major placebo-controlled effectiveness and safety studies of drugs of this groups are provided ПК.

The purpose of the study was to examine the effectiveness of the drug of onabotulinumtoxin A (Botox) in complex rehabilitation of patients with post-stroke spasticity of the legs in the early rehabilitation period of stroke. Materials and methods. The study group was comprised 31 patients in the early recovery period after stroke with the presence of equino-varus deformity of the foot with the level of spasticity grade of 3 or more (MAS). All patients received as part of a comprehensive rehabilitation program injections onabotulinumtoxin a (Botox) in a total dose 300 ED. In the process of treatment was evaluated dynamics of neurological status, spasticity, pain, function of walking and everyday activity. Results and conclusion. Proven high efficacy of botulinum neurotoxin type A: reduces the severity of spasticity, the severity of the discomfort in the leg and foot; facilitated the possibility of independent movement of the patient, increases walking speed.