The brain is one of the natural target organs of arterial hypertension (AH). According to the data of numerous studies, the most early and common signs of brain damage in hypertension is cognitive disorder (CD). These are usually subcorticalfrontal in nature, which is expressed in reducing the rate of cognitive activity, fluctuations of concentration, lack of planning and control, moderate memory impairment and constructive praxis. Development of more severe and progressive mental disorders, lack of nominative speech function may indicate the accession of a concomitant neurodegenerative process, the risk of which in hypertension is increased as well. Early and correct treatment of the underlying disease significantly reduces the probability of CD progression in patients with hypertension. For the prevention of CD progression non-pharmacological methods are widely used such as cognitive training, systematic exercise, optimization of diet. Medication includes neurometabolic drugs with neuroprotective and neurotrophic properties (Cerebrolysin, etc.), memantine, acetylcholinesterase inhibitors and some other drugs.

The efficacy and tolerability of donepezil (Alzepil) in the treatment of undifferentiated dementia in 52 patients (mean age 77 ± 8,2 years at the time of inclusion) with cerebrovascular disease (CVD) were investigated. Patients were divided into groups based on the genetically determined factor - the rate of passive transmembrane ion transport (PTIT) which determines both the severity of the disease and its response to therapy. PTIT rate was determined by the rate of Na-Li countertransport (NLC) in the erythrocyte membrane. Patients with high NLC rates had more severe dementia and better responded to treatment. Therefore, evaluation of NLC rate is a promising research method in terms of predicting the disease severity and response to treatment. In general, donepezil (Alzepil) demonstrated good efficacy and tolerability in patients with dementia and CVD regardless of the neuropsychological profile, justifying its use in any type of dementia.

Prevention of progression to moderate vascular cognitive disorders (MVCD) in dementia is based on medicinal and nonmedicinal correction of major cardiovascular risk factors, at the same time antidementia, vasoactive and nootropic drugs efficiency is not proven. The own experience of use in 30 patients (22 women and 8 men) with MVCD in age from 46 to 75 years (mean age 67,1 ± 6.6 years) of Naftidrofuryl (Duzofarm) at a dose of 100 mg three times a day for 30 days is provided. After a month of treatment a significant improvement of cognitive function by the Montreal scale assessment of mental functions, the alpha-numeric coding test, and emotional state test is established as measured by the hospital scale of anxiety and depression. Good tolerability, absence of significant side effects when using Naftidrofuryl for MVCD are observed. Longer placebo-controlled studies of the effectiveness of Naftidrofuryl in patients with MVCD are needed.

Cognitive disorder is one of the most disabling complications of ischemic stroke significantly impairing the patient’s commitment to rehabilitation and a life long treatment, reducing the quality of life of the patient and his relatives. This article discusses the epidemiology, etiology, pathophysiology of post-stroke cognitive impairment. Risk factors, classification, treatment and prevention of post-stroke cognitive disorders are discussed. The data of the study ARTEMIDA devoted to the possibility of therapy of post-stroke cognitive impairment and prevention of dementia after stroke with the use of the drug Actovegin are provided.

Vestibular disorders are one of the most common causes of dizziness and loss of stability. Rehabilitation of patients with vestibular disorders is based on identifying the underlying disease and its effective treatment. The most common causes of vestibular disorders are benign paroxysmal positional vertigo, migraine-associated dizziness, Meniere’s disease, vestibular neurons. However, these diseases of the vestibular system often are undiagnosed, which may be due to a lack of awareness of physicians about the possible causes of vertigo, diagnostic methods of vestibular diseases, and failure to comply with the examination protocol of the vestibular system. At present, modern and effective methods of treatment and rehabilitation of patients with various vestibular diseases are developed. We need a comprehensive approach to treatment and rehabilitation of patients with vestibular disorders with a combination of methods of physical rehabilitation with medical drugs that accelerate the process of vestibular compensation. High performance is demonstrated by a method of rehabilitation on stabilographic platform with biological feedback. Possibilities to use Vazobral to treat migraine-associated vertigo are discussed as well as a possibility to use it as a drug accelerating the process of vestibular compensation.

Clinical electroneurophysiological mapping was performed in 30 patients with chronic migraine, in 41 patients with migraine without aura and in 40 patients with chronic headache of tension. In addition to the clinical examination psychological testing and polysynaptic blink reflex were used. It was established that an important neurophysiological phenomenon in chronic migraine is the increase in polysynaptic reflex excitability. It characterizes the failure of central inhibition and inefficiency of antinociceptive control in this disease.

The article analyzes the effectiveness of drugs used for the relief of migraine attacks. A clinical case of a patient with migraine is described.

The article is a review of literature on the prevalence of post-stroke depression, its causes, pathogenesis, clinical patterns and diagnosis of the disease. Depression has a negative effect on the process of post-stroke rehabilitation, quality of life, physical health of patients and increases the risk of death in patients after stroke. The advantages of SSRI antidepressants in the treatment of post-stroke depression are demonstrated; there are results of randomized clinical trials (RCTs) of high safety, tolerability and efficacy of sertraline. Options for prevention of post-stroke depression are discussed.

The article tells about the current understanding and classification of insomnia, the diagnostic criteria and pathophysiology of the disorder. Different pharmacological groups of drugs used in the treatment of insomnia are discussed.

Anxiety disorders, along with asthenic, depressive and hypochondriac ones are often observed in elderly patients in general practice. It is believed that about a third of neurological patients suffer from anxiety. Anxiety disorder is revealed in more than 65% of patients with chronic cerebrovascular insufficiency. In these patients a predominance of somatic symptoms over the mental ones is observed, which may lead to difficulties of differential diagnosis of anxiety and somatic pathology. Anxiety leads to a further reduction of patient’s quality of life, disruption of social activity. In this category of patients the risk of development of some somatic diseases, complicated course and worse prognosis of the existing disease are developed. Depression and anxiety are very often comorbid conditions. Buspirone is one of the drugs of choice for treatment of anxiety disorders in the elderly and patients with concomitant somatic pathology.

The article deals with possibilities of therapy and prevention of sleep disturbances in patients with alcoholic addiction.

Introduction. The multidisciplinary approach, including pharmacological therapy, educational therapy, cognitive-behavioral therapy (CBT) has the leading role in management of patients with diabetic polyneuropathy (DPN). There is no domestic experience in the multidisciplinary treatment of DPN patients. Study purpose – study of efficiency of DPN patients management using a multidisciplinary approach. Patients and methods. The study included 50 patients (29 women and 21 men) aged 20 to 78 years (mean age = 57.6 ± 10.2 years) with diabetes mellitus (DM) of type 1 and 2 and DPN. All patients received multidisciplinary treatment consisting of pharmacotherapy, educational programs, KPT. All patients by Cocarnit (for 9 days). The observation period for the patients was 12 weeks. All the patients underwent assessment of neuropathic and asthenic symptoms. Results. Many patients were newly diagnosed with concomitant neurological (lumboischalgia, cervicalgia, tunnel syndromes, headaches, insomnia) and emotional (anxiety, depression) disorders. Authentically significant reduction in the average positive neuropathic and asthenic symptoms, improvement in average pain sensitivity was observed from Day 10 and persisted until 12 weeks of observation. Best value of effectiveness of interdisciplinary treatment was observed in patients with Stage 2 DPN. Conclusion. There is a low level of diagnostics of combined neurological and emotional disorders in patients with diabetes and DPN. The multidisciplinary treatment allows relatively quickly and firmly to reduce the severity of neuropathic and asthenic symptoms in DPN patients, most effectively – at the Stage 2A of DPN. The use of Cocarnit is effective and safe in complex therapy of DPN patients.

This article presents the results of the immunological profile of CD4+ T cells and Th17 cells and production of interleukin-17 (IL-17) in two groups of patients receiving treatment natalizumab and fingolimod. The results can underpin the justification for the preferred transfer of patients with relapsing-remitting multiple sclerosis after treatment by natalizumab to fingolimod.

Objective. To evaluate the efficacy, tolerability and safety of the drug Diacerein (Artrocker) in patients with osteoarthritis (OA) of the hip joints after continuous administration for 4 months and the duration of the drug effects for 2 months. Materials and methods. The study included 30 patients with significant (by ARA criteria) OA of the hip joints of Stage 2-3 according to Kellgren-Lawrence. The average age of patients was 63.6 ± 5.8 years. Patients took Artrocker for the first 2 weeks by 50 mg (1 capsule), and then by 100 per day (2 capsules). Evaluation of the therapy effectiveness was evaluated by the WOMAC index (pain, stiffness and functional impairment), dynamics of the index in % relative to the initial visit; the health questionnaire EQ-5D; the test «get up and go», assessment of the therapy effectiveness by physician and patient overall assessment of tolerability. Results. The decrease in the intensity of pain and stiffness on the WOMAC index were noted by the end of the first month of therapy and persisted for the whole observation period (245,6 ± 64,3 and 142.5 ± 67,3 and 97.8 ± 35.6 and 64,3 ± 30,1; p = 0,000 respectively). Significant improvement of the functional status of the joints was achieved at the end of the treatment period, which remained until the end of observation (854,6 ± 306,8 and 637,2 ± of 253.7, p = 0.000). The decrease in total WOMAC index was recorded at visit 3 (1182,6 ± 834,2 358,6 and ± 322,1 p = 0,000). Statistically significant improvement of the test «get up and go» assessment of general health and quality of life according to EQ-5D were observed from the third visit to the end of the observation. Evaluation of tolerance to treatment done by a patient and a doctor did not differ from each other: the excellent tolerability was noted for 27.5% of patients, good-65,5%, and satisfactory - for 7% of patients. Only one adverse event – nausea – was noted in the study, which was the reason for the discontinuation of the drug and withdrawl of the patient from the study. 

According to the literature, Leflunomide is comparable in efficacy and safety with methotrexate, including patients with early rheumatoid arthritis (RA). The drug continues to play an important role in the treatment of patients with early RA and may be considered as a main synthetic base anti-inflammatory drug which should be administered in case of impossibility of treatment by effective doses of methotrexate. The combination of Methotrexate and Leflunomide, reducing the need for biological therapy, may be an effective way to overcome tolerance to Methotrexate. The role of this combination treatment strategies for early RA may be underestimated, it is expedient to conduct further research in this direction.

The article is devoted to the treatment of osteoarthritis - one of the most common diseases of the musculoskeletal system, causing pain, reduced quality of life, restricting social activity and disability. Data are provided about the effectiveness of the original drug crystalline glucosamine sulphate (DONA).

Osteoporosis is a significant health problem due to high frequency of occurrence of fractures at a low traumatic impact. Densitometric examination does not allow to fully identify individuals with an increased risk of osteoporotic fractures, because bone mineral density is one of the components of the fracture cause in osteoporosis. Among the alternative methods of predicting the risk of fractures the algorithm FRAX® has become widely used in the world, which can be used to calculate 10-year probability of major osteoporotic fracture based on clinical risk factors that showed an independent effect on BMD and/ or bone strength. A survey in 5 regions of Russia showed that 31% of women and 4% of men had values of FRAX® above the threshold of therapeutic intervention and as a result, needed the indication of antiosteoporotic therapy. The greatest need for treatment and preventive measures as determined using the algorithm FRAX® was detected in women in the Siberian, Uralian and Central region and in men – in the North-Western and Uralian Federal districts.

The article presents the results of a study investigating the effect of prolonged treatment with Alflutop (5-year follow-up) on the radiographic progression of knee osteoarthritis (narrowing of the height of the X-ray articular cavity, osteophytosis, worsening of the radiographic stage of the pathological process). Medication was prescribed to 64 patients (mean age of 47.4 ± 11.6 years) at the early stages of the disease and was carried out by repeated courses. The comparison group consisted of 140 patients (mean age of 46.7 ± 10.4 years). It was noted that long-term treatment with Alflutop slows the progression of structural changes of the knee, which certainly has a positive effect on symptoms of osteoarthritis, the quality of life of patients.

Injections of botulinum toxin type A (BTA) are regarded as one of the basic methods to treat cerebral palsy (CP). The article discusses issues unique mechanism of action of botulinum toxin type A injections, double sensomotor mechanism of action of the drug OnabotulinumtoxinA, noninterchangeability of BTA drugs, evidence of efficacy and safety of the use of BTA for children with cerebral palsy, accuracy control of BTA injections, selection of muscle targets, assess the effectiveness of botulinum toxin therapy, etc. To the therapy used in cases where the manifestations of spasticity in cerebral palsy become significant and negative influence on the functional activity and motor development of the child. Injections of botulinum toxin type A in cerebral palsy are usually applied from the age of 2 years, and this treatment is indicated for 50-75% of patients depending on the level of motor abilities by GMFCS scale. If this treatment is not used in presence of indications, it is possible to say that the treatment is carried out not in full and the patient is deprived of the proven effective therapeutic approach.

Cognitive disorders are a multidisciplinary medical and social problem. The possibility of detecting cognitive disorders by using neuropsychological screening scales in the work of general practitioners defines the continuity of the management of such patients in conjunction with neurologists. The ability of general practitioners to conduct ophthalmological and otolaryngological examination of the patient complements neuropsychological testing. Thanks to the wide pathogenetic mechanism of action, proven efficacy and safety in ischemic and hypoxic conditions, Tanakan is used to treat a wide range of diseases in various fields of medicine on a wide range of diseases, including cognitive impairment and dementia, tinnitus and dizziness, diabetic retinopathy and age-related macular degeneration, peripheral vascular disease. Study of therapeutic potential of Tanakan is continued not only by neurologists, angiologists, ophthalmologists, otolaryngologists, and general practitioners.