The atrial fibrillation  (AF) is the most common disturbance of cardiac rhythm. The AF is associated with an increase in the rate of hospitalization, mortality, stroke development, heart failure. Oral anticoagulants are the basis for prevention of cardiovascular complications in the AF patients. However, the use of anticoagulants increases the risk of intracerebral hematoma. A special group of patients with hemorrhagic strokes are AF patients. Anticoagulant therapy is indicated for this category of patients, on the one hand, due to high risk of development of thromboembolic complications, on the other hand, it is contraindicated in connection with the development of hemorrhagic stroke. The optimum mode of antithrombotic therapy remains unknown. Current approaches to the AF therapy  for patients with hemorrhagic stroke are being discussed.

The article deals with the role of homocysteine in the human body. The amino acid homocysteine is a product of methionine demethylation. When the level of homocysteine increases, it damages the tissue structures of the arteries, initiating the release of cytokine, cyclins and other mediators of the inflammation. Its accumulation results in the loosening of arterial walls, formation of local defects in endothelium, which in turn leads to deposition on the cardiovascular wall of cholesterol and calcium. Hyperhomocysteinemia as a consequence of disturbed homocysteine metabolism is considered an independent factor in the risk of human stroke. The role of neuroprotective therapy in interrupting or decelerating the sequence of damaging biochemical and molecular processes capable of causing irreversible coronary damage to the brain is demonstrated.

The new criteria for diagnosing Alzheimer’s disease (AD) proposed by the United States National Aging Institute and the Alzheimer Association are being discussed. The definition of the preclinical and pre-dementing stages of AD has been introduced. The current issues of diagnostics of the pathophysiological process in AD with the use of biological markers and modern neurovisualization methods, approaches to treatment of AD depending on the stage  of the disease  are considered. The effectiveness  of Memantine  (akatynol  memantine)  and  its  usefulness   at  the  various  stages   of  disease   in  patients  with  AD is  noted. Nonpharmacological methods of AD therapy, including cognitive training, behavioural and psychosocial methods, are considered.

The article presents  modern data on the causes of development, diagnostic  methods  and treatment approaches of Alzheimer’s disease. Special attention is given to pathogenetic and symptomatic  therapy of this disease, as well as non-drug  treatments.

Migraines and cerebrovascular diseases are comorbid disorders that are widespread in the population. The close relationship between these states is demonstrated by epidemiological, clinical studies, as well as by pilot studies of their pathophysiology. Patients with migraines have a clear increase in the risk of ischemic stroke, especially when there are risk factors such as female sex, presence of aura symptoms, smoking, hormonal contraceptive use and high incidence of migraines. Despite the abundance of migraine studies, no strategies have been developed to modify her treatment for patients with attendant pathology so far. In the meantime, some studies have convincingly demonstrated the advantages of some therapeutic approaches, which could be used to optimize management of these patients with these frequently co-existing disorders.

Anxiety disorders are a group of phenomenologic  close  but etiopathogenetically  heterogeneous  psychopathologic states. Modern recognition and correction of anxiety disorders provide a long-term effect and can be seen as a form of primary prevention of cardiovascular and other somatic and neurological diseases. In case of anxiety disorders patients with somatic illnesses should be treated with adequate primary illness therapy. In light and moderate cases of anxiety disorders, especially in the somatoform manifestations and the undesirability of sedation the use of Tofisopam is preferable.

Sleep disorders in patients in the early rehabilitation period of stroke were studied. It was shown the effectiveness of the chronotherapy (phototherapy and drug Melaxen®) on the dynamics of sleep disturbance, cognitive, emotional and movement disorders, quality of life in the rehabilitation of stroke patients. The concentration of brain-derived neurotrophic factor (BDNF) in blood serum and the level of 6-SOMT in the urine were assessed. The purpose of research was to study the effectiveness  of chronotherapy (phototherapy and Melaxen®) on the dynamics of sleep disturbances, cognitive and emotional disorders,  BDNF and the level of secretion of melatonin (6-SOMT) in patients after cerebral stroke in the early recovery periods. Materials and methods. We examined 112 patients in the early rehabilitation period of stroke (mean age of 58.0 ± 9.74 years). The main groups of patients along with standard treatment received phototherapy and Melaxen® 3мг/day for 3 months. Sleep quality, cognitive and emotional status, concentration of BDNF in blood serum and night urinary level of 6-sulfatoxymelatonin were assessed. The results and conclusion. The study demonstrated the high efficacy of chronotherapy with Melaxen® in the rehabilitation of patients in early recovery period of stroke. Chronotherapy significantly increased the concentration of BDNF and 6-SOMT, improved cognitive function and sleep parameters, reduced the level of anxiety and depression in the early recovery period of stroke.

In our country there are many common myths about the causes, diagnosis and treatment of back pain: ostheochondrosis is the main cause of the pain, magnetic resonance imaging is the best method of diagnosis, manual therapy and acupuncture are the basic methods of treatment. Up-to-date data on the causes, diagnosis, treatment of acute and chronic pain in the lumbosacral region (lumbalgia) are provided. The own experience of treatment of patients with acute and chronic back pain is demonstrated.

Basic properties of Levetiracetam (LEV) were described and own experience of its application at the dose of 500–4000 mg/day in 95 patients at the age of 17–69 years (mean age 34 ± 13 years) with various epileptic syndromes was analyzed. The overall effect of LEV made 69.1%, remission at least a year was achieved in 43.6%, in 17% – for 3 years or more. The best result was observed in juvenile myoclonic epilepsy an improvement in 83.3% of patients, remission on LEV monotherapy in 75% of patients. High efficiency was also noted in idiopathic and symptomatic generalized epilepsy – an improvement making up 78.6 and 81.3%, respectively. Idiopathic focal epilepsy LEO showed less efficiency – about 51.5%. Adverse effects were observed in 12 patients (12,8%), of which only in 3 the LEV was replaced because of the development of apathy, fatigue and the appearance of efficiency violations as a result of aggravate focal seizures. In other cases drowsiness, irritability and increased unprovoked aggression were observed, these side effects passed within the first month of treatment. The obtained results confirm the high efficacy and good tolerability of LEV.

Monoclonal antibodies are widely used in various fields of modern medicine, for example, in oncology, rheumatology, gastroenterology, transplantation. Since beginning of this century monoclonal antibodies began to be explored for the treatment of multiple sclerosis (MS). From this period monoclonal antibody also actively introduced in pathogenetic therapy of MS. In this review, we discuss the findings of clinical trials already registered monoclonal antibodies in the Russian Federation, such as Natalizumab and Alemtuzumab.

The article presents general issues of epidemiology, diagnosis, clinical performance of neurotic pain. The possibility of use in patient with painful forms of neuropathiesa of dbiologically active additive Keltikan Complex containing nucleotide uridine monophosphate, vitamin B12 and folic acid to patients with is discussed.

The use of dopaminergic tools, particularly levodopa and dopamine receptors agonists (DRA), for many years allowed to effectively control the major motor symptoms of Parkinson disease, supporting mobility and daily activity, and eventually increasing the survivability of patients. However, a few years after the start of the Levodopa intake the vast majority of patients have motor fluctuations and dyskinesias. The Levodopa action is ensured not only by the short-term but also by the so-called long-term effect of Levodopa, which is developing when the drug is taken regularly. The long-term response provides at least half of the total response  to dopaminergic drugs, particularly, Levodopa. As the disease  progresses, the long-term response  tends to decrease, with a more precise «pulse» of a short-term reaction that does not affect its parameters. It is believed that this is related to the development of the phenomenon of «dose-end exhaustion» and then to «turn on-off». Thus, the task of delaying the occurrence of motor fluctuations must be to keep the long-term dopaminergic effect as long as possible.

Dopaminergic receptors agonists (DRA) are capable of direct stimulating of dopamine receptors on striatal neurons, bypassing degeneration nigrostriatal cells, thus simulating operation of an endogenous mediator.

Agonists of D2-receptors can induce long-term reactions. It is shown that in six weeks after the Ropinirol intake, the subsequent discontinuation of its application results in a slow rise in the motor symptoms during a week. The effectiveness of Ropinirol with the prolonged release at various stages of the PD is confirmed in several placebo-controlled studies. The role of a slow release dosage of Ropinirol in maintaining a long-term response requires special study.

Dystonia is a common extrapyramidal disease. It is characterized by both motor and non-motor manifestations, which include pain, sensory disorders and excessive physical activity. The contribution of disturbing and depressed disorders, sleep disorders during the focal dystonia has been discussed. It is often the non-motor manifestations that are the initial symptoms of dystonia. In some cases, unmotorized manifestations can be isolated diseases that accompany dystonic hyperkinesis and contribute to the deterioration of the quality of life of such patients. Treatment of nonmotor symptoms will improve the effectiveness of dystonia therapy as well as affect the course of the disease.

The survey provides data on the use of the only currently available representative of the so-called «small molecules» of the Janus-kinases Inhibitor Tofacitinibe (TOFA) in rheumatoid arthritis  (RA) in clinical research and real practice. The positioning of TOFA in the strategy of the RA therapy according to Russian and international clinical recommendations was discussed.

Pain is the most common symptom that causes the patient to contact a doctor, and the lower back and joints are the major places where it occurs. To date treatment of OA and lower back pain (LBP) is focused primarily on the symptoms of disease, that is, reducing pain syndrome and improving the functional state of joints and spine. The use of NSAIDs can quickly reduce the intensity of pain and accelerate the recovery of the motor activity in OA and LBP. However, the use of this group of drugs is related to the development of undesirable events on the part of the gastrointestinal tract, cardiovascular system, kidneys and other organs, which is particularly important in the comorbid conditions of the elderly patients. This makes it clear that there is a high level of interest in the slow-symptomatic drug group that approved themselves in the arthrologic practice. This group includes glucosamine (GA), chondroitin sulphate (CS), which have the highest evidentiary basis by efficiency. Numerous clinical studies have shown that CS and GA have anti-inflammatory characteristics contributing to reducing pain syndrome and can be useful in treating OA and LBP.

The article discusses  the  possibility of using the  complex drug Phezam, containing 400  mg of Piracetam and 25  mg of Cinnarizine in neurological practice. The advantage of a combination of nootropic and vasoactive substances is due to a balanced and diversified influence on the different links of pathogenesis  diseases. Piracetam targets the turnover of cell membranes, neurotransmission, has a neuroprotective effect, influences the neuroplasticity, the energy exchange in the cage and the vascular mechanisms (blood cells, cardiovascular wall and coagulation). The second component of the drug Cinnarizine has vasodilatating properties, suppresses the activity of the labyrinth and improves flow blood properties. When discussing the drug-induced parkinsonism, the opposite  effects  of the drug components on the dopaminergic system are described. The Phezam has shown its efficacy in the preventive treatment of migraines (reducing of frequency and intensity of seizures). In patients with chronic brain ischemia Phezam improved a neurological status, cognitive functions, blood flow indicators, and quality of life. The positive effects of Phezam during the recovery period of ischaemic stroke with speech and moderate cognitive disorders are reported. The characteristics of the metering regime are the possibility to use low-and high-dosage therapy. The drug showed good tolerability and economic advantages over the use of active substances separately.

The article discusses pain at the bottom of the back as one of the common musculoskeletal diseases. The characteristics and prevalence of pain syndrome at the bottom of the back of children and adolescents, young, mature and old are demonstrated. The frequency of this syndrome for men and women is examined separately. The treatment of patients with acute and chronic pain at the bottom of the back is considered. Nonsteroid anti-inflammatory drugs in the arresting of pain syndrome are given a separate place.

Chronic non-communicable disorder of the brain epilepsy is one of the most common neurological diseases in the world and characterized by repeated attacks with a variety of clinical manifestations. Epilepsy has significant economic consequences in terms of meeting health care needs, premature mortality and lost ability to work. Epilepsy requires long-term therapy, which plays a crucial role in the patient’s recovery and makes a tangible contribution to the quality of life. In this respect, one of the most studied choices in different variants of both partial and generalized forms of epilepsy is valproates. The article provides an economic assessment of the use of the tablet form of the most common valproic acid drugs, as well as the possible minimization of costs (budget savings) in the transition to the most economically advantageous option of therapy.

Non-specific back pain continues to be one of the leading causes of financial and economic costs in developed countries. The increasing popularity of interventional methods of pain treatment is linked to the high efficiency and rapid arresting of the disease symptoms. However, the use of invasive methods can be fraught with serious complications, especially when doctors do not understand the mechanisms for operation of drugs and make mistakes in the choice of therapy. A comprehensive, personalized approach to treating the patient with back pain requires, above all, the choice of non-invasive and safest methods of prevention, treatment and rehabilitation.

Among the Type 2 Diabetes Mellitus (Type 2 DB) patients obstructive sleep apnoea (OSA) syndrome, which adversely affects the state of carbohydrate exchange and the quality of sleep, is widespread. The standard for the treatment of OSA is CPAP therapy. In this retrospective cohort study, the influence of CPAP-therapy on the level of glycosylated haemoglobin (HbA1c) was assessed in the 34 second-type SR patients receiving sugar-reducing therapy. As a result of 3 months of treatment, there has been a decrease of HbA1c by 0.7%, the disappearance of day sleepiness, and the overwhelming majority of normalization of the quality of sleep. Thus, with the combination of the Type 2 DM and the OSA of medium or heavy degree, CPAP therapy  has an independent beneficial effect on the state of carbohydrate exchange.