The article is a review of literature on antiplatelet (antiagregant) therapy in the secondary prevention of ischemic stroke (IS). The latest guidelines (2014) from the American Heart Association and stroke experts are discussed. The efficacy of acetylsalicylic acid (ASA), extended-release dipyridamole in combination with ASA, clopidogrel, a slight superiority of extended-release dipyridamole in combination with ASA and of clopidogrel over ASA in reducing the risk of recurrent ischemic events. The possibility of using clopidogrel in combination with ASA in patients after transient ischemic attack or small IS in the first 90 days of illness is considered. The problems of antiplatelet therapy in clinical practice are analyzed. The authors note that clinical application of the global guidelines for the secondary prevention of IS could reduce the incidence of stroke and the associated mortality.

Over the past years, results of various clinical trials of drugs demonstrating their efficacy in the treatment of cardiovascular diseases have been published. The article discusses the results of clinical use of Mildronate (meldonium) in the treatment of ischemic brain injuries; the results of trials show that the medicine has a cytoprotective effect on a number of pathogenic factors determining ischemic cell death in the brain.

The article highlights the current approaches to the diagnosis of migraine and effective methods for the relief of pain attacks. The focus is on triptans as the most effective specific drugs for the treatment of migraine attacks.

Cognitive impairment is a widespread serious complication of ischemic stroke requiring intensive medication treatment. Citicoline is a medicine with proven efficacy in ischemic stroke and vascular cognitive impairment. The article provides an overview of trials on the use of citicoline in patients with cognitive impairment and vascular dementia.

There is an overview of literature devoted to the early diagnosis and treatment of Alzheimer's disease (AD). Medication and non-medication treatment methods for AD are discussed. The efficacy of psychosocial and behavioral therapies and cognitive training for patients with AD is highlighted. The efficacy of central acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine in improving cognitive function, behavior and activities of daily living in oatient with AD is highlighted. The article tells about the efficacy of donepezil (Alzepil) at different stages of the disease in patients with AD and rationality of its use at 10 mg daily to achieve the best possible effect. Early diagnosis and effective treatment of patients with AD could significantly enhance the quality of life not only for patients but also for their closest relations.

The main manifestation of brain damage in hypertension is cognitive impairment. According to different authors, more than half of patients with hypertension have cognitive impairment beyond the age norm. The presence of causal relationship between cognitive impairment and hypertension is supported by clinical profiles of cognitive disorders and predominantly subcortical impairement: prevaling bradyphrenia, visual-spatial disorders and impaired control functions of the frontal lobes, comorbid emotional disorders. It is recommended for everyday clinical practice to carry out neuropsychological testing of cognitive impairment in patients with hypertension for the timely initiation of therapy. In the treatment of cognitive impairment without dementia, the priority is given to neurometabolic drugs.

The article examines the prevalence, causes and main clinical manifestations of amnestic mild cognitive impairment - a syndrome which in most cases is the first manifestation of the neurodegenerative Alzheimer's disease. Diagnostic approaches and the possibility of differential diagnosis are highlighted. There is data on the effectiveness of the glutamate NMDA-receptors antagonist - memantine - in patients with moderate cognitive impairment. The efficacy and safety of Akatinol Memantine as a medication to improve cognitive function is highlighted.

The article is devoted to pathogenesis and diagnosis of Alzheimer's disease. The possibilities of treatment are discussed. Efficacy data for the basic symptomatic treatment of Alzheimer's disease, the potential and prospects of nootropic therapy are described.

Depression is the third most common cause of disability in the world's population. Depressive disorders are widespread in patients observed by psychiatrists, neurologists, as well as general practitioners. Comorbid depression worsens the course and prognosis of somatic and neurological diseases. Training, psychotherapy and pharmacotherapy form the basis of the current approach in the treatment of depression. Over the past several decades, the common pharmacological treatments for depression have been antidepressants with different mechanisms of action. However, antidepressant therapy has several disadvantages. The therapeutic effect of antidepressants occurs only 2--4 weeks after the start of treatment. Limitations in the use of antidepressants are not seldom due to contraindications or persistent side effects. Meanwhile, about 2/3 of patients taking antidepressants do not achieve the clinical effect, hence the need to find a drug which could be associated with a better antidepressant efficacy. Acetyl-L-carnitine is an active L-carnitine metabolite with antidepressive action, good tolerability and safety. The article tells about pre-clinical trials of acetyl-L-carnitine (ALC) in cell-based models and animal models, the results of randomized, placebo-controlled studies of ALC efficacy in the treatment of depression and depressive symptoms.

The article discusses the main clinical manifestations, diagnostic approaches and current methods of treatment of functional disorders.

The concept of stress as a nonspecific adaptive reaction is supplemented with new findings on the role of the neuroimmune system and mental factors in protecting the organism from adverse effects. There is evidence of adaptive changes in the structure of sleep in stressed individuals which reflect his/her specific reactions. Timely prescription of sleeping pills in acute insomnia would contribute to a better protective function of sleep during stress.

The article is an overview of drugs currently used to treat multiple sclerosis. The article tells about two tactics commonly used in the prescription of MSDMM (multiple sclerosis disease-modifying medications), factors to be considered when choosing a drug, as well as questions related to drug replacement in case of ineffective therapy or intolerance to previous treatment.

The article discusses the prospects for the use of the new drug teriflunomide for the treatment of patients with relapsing-remitting multiple sclerosis. By now, phase II and III clinical trials are completed which demonstrated good tolerability, efficacy and relative safety of teriflunomide. The TEMSO and TOWER trials showed a decrease in the incidence of relapse which was a reason for hospitalization (by 59 and 37%, respectively), as well as in the incidence of exacerbations requiring treatment with corticosteroids (by 34 and 36%, respectively).

This article tells about the treatment of diabetic polyneuropathy - the most common neurological complications of diabetes mellitus. The pathogenesis, diagnosis and current evidence-based treatments are described. Thioctic acid drugs for the treatment of diabetic polyneuropathy which are selling in the Russian pharmceutical market are reviewed, and specific trade names are recommended for use. The results of the authors' own research on the treatment of painful diabetic neuropathy are demonstrated.

Information about retraction of an article

Analysis conducted by the members of the editorial board has revealed the direct borrowing without reference to the specific source of citations in the following articles:

The article by Isaykin A.I., Suslova E.Yu. Diagnosis and treatment of pain in the cervical spine and the article by Isaykin A.I. Pain in the cervical spine // Trudnyy patsient = Difficult patient – 2012 – V. 10 - No. 7, p. 36-44.

Based on the decision of the Editorial Board of the journal Medical Council dated January 17, 2020, the following article has been retracted:

Isaykin A.I., Suslova E.Yu. Diagnosis and treatment of neck pain // Meditsinskiy sovet = Medical Council – 2015 - No. 5 – p. 100-105.

 The article discusses the causes of non-specific neck pain, diagnostic algorithm and current approaches to therapy. The benefits of transdermal dosage forms of non-steroidal anti-inflammatory drugs are highlighted.

As the period of use of genetically engineered biologic drugs (GEBD) in clinical practice is growing, clinicians are faced with new questions: how to switch from one GEBD to another in case of primary or secondary inefficacy, intolerance to previous GEBD therapy; what should be done after low disease activity or remission is achieved. The article highlights the recent findings that are relevant for healthcare practitioners.

In the Russian Federation, as well as in many countries of the world, several botulinum toxin type A (BTA) drugs are licensed for use as injections; these are biological medicinal products derived from Clostridium botulinum. It is highly important to choose the right drug from the available list or prefer one drug over another, as well as to decide on the interchangeability of drugs or lack thereof. Differences between BTA drugs concern production processes, formulation or composition, quantitative assays to measure biological activity and, consequently, interaction of each of the BTA drugs with target tissues in vivo which was demonstrated in preclinical dose-response trials. Differences also include clinical dosage, potency and duration of action, safety and tolerability. Many of the published trials noted differences in the action of certain BTA drugs depending on experimental and clinical conditions, whereas such differences are not always predictable. Moreover, the drugs vary by the number and quality of clinical trials in which they were tested, as evidenced by the reviewed articles. Designed as solutions for tough clinical situations, BTA drugs are highly efficient biological products with a complex structure and individual formulation. It is extremely important to understand that, and that doses and effects of drugs cannot be interchangeable; each BTA drug should be administered in strict accordance with the manufacturer's recommendations.

Summary. We examined the frequency and clinical variety of associated extraintestinal symptoms in 125 IBS patients within the age of 19 - 45 years by using SOMS-2. There was a high prevalence of associated symptoms in IBS patients group. More then 40% of examined patients have had from 16 to 25 nongastroenterologic symptoms in one patient. The most frequent associated symptoms were varied types of pains in different parts of body. Furthermore different vegetative and neuro-endocrine-motivational disorders were observed. More than half of patients in the study reported increased fatigability. Women reported “dyspnoe”, “syncope’s”, “rushes”, “visual fuzziness”, “sense of burning in perineum”, “dyspareunia” and “indifference in sexual life” statistically significant more often then men. Men reported “chest pain” statically significant more often then women. Correlation analysis revealed the predominance of constipation type of IBS in women and diarrhea-type of IBS (IBS-D) in men. In patients with IBS-D type there were statistically significant predominance of “swallowing discomfort”, “poor appetite” and “sence of inner trembling”. The results of the study allow to enter additional arguments in biopsychosocial model of IBS. Nevertheless, it is necessary to compare extraintestinal symptoms in IBS patients with those in healthy control group and in IBD patients to specify these factors.