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Diagnostic transcranial magnetic stimulation (TMS) is a valuable neurophysiological technique. The use of TMS has fundamentally changed the therapy and diagnosis of nervous diseases, introducing the possibility of direct assessment of conduction along the motor pathway in the central region, neuroplasticity, the ratio of central inhibition and excitation, and the effect on neuroplasticity and neurogenesis. The technique is safe, has a low cost and there is no need to purchase expensive consumables, it is applicable for a wide range of diseases in both adult and pediatric practice. The issues of the TMS use in CVA, depression, cerebral palsy and neurodegenerative diseases (amyotrophic lateral sclerosis, parkinsonism) have been studied to the greatest extent. When carrying out TMS in children, it should be borne in mind that signs of incomplete myelination of the motor pathways, which are normally observed, may look like pathological changes (demyelination or axonal disorders). The basic principles of TMS in both adults and children have been established and known, and the age norms have been determined, which makes it possible to widely implement this technique in applied neurophysiological practice. In the rehabilitation process, TMS can be used as a tool for personalizing and monitoring the effectiveness of rehabilitation treatment.

We present a review of the literature and our own data on the management and rehabilitation of impairment or persis‑tent loss of the olfactory function – hypo‑ and anosmia. Approaches for restoring impaired olfactory function can be divided into olfactory training, pharmacological and physiotherapy. Smell training is carried out according to a number of protocols that differ mainly in the used arsenal of smells, as well as in the frequency of their presentation. Pharma‑cologically, it is proposed to use steroids used both topically (intranasally) and systemically; there is no common view on the effectiveness of this approach. Physiotherapy involve electrical stimulation of the olfactory filaments in the area of their exit into the nasal cavity (lateral masses of the ethmoid bone). In our opinion the most rational approach is the use of training methods using different smells.

The purpose. The article is devoted to chronic pain (CP) in elderly patients and the possibilities of various therapeutic strategies for this category of patients.Basic provisions. Chronic pain and the biological aging process have similar pathophysiological (cellular and molecular) mechanisms of development. However, chronic pain is not an inevitable component of the aging process, however, it is much more common in older people, the diagnosis and therapy of which is associated with atypical clinical manifestations of pain in elderly patients and the need for a more attentive, balanced approach when assessing pharmacokinetic and pharmacodynamic changes associated with the aging process. To ensure adequate pain relief, a multidisciplinary approach and appropriate therapies are used.Conclusion. The final result of CP treatment (reduction in pain intensity, restoration of functional activity, autonomy, etc.) depends on polymorbidity, geriatric status and cognitive capabilities of the patient; therefore, it is necessary to take into account all available factors for adequate and complete pain therapy.

The aim of the present work was to evaluate changes in brain bioelectrical activity using electroencephalography (EEG) data in children with acute viral encephalitis. A total of 26 children were studied at the Pediatric Scientific Clinical Center for Infectious Diseases, Russian Federal Medical Biological Agency, with clinically confirmed diagnoses of “viral encephalitis.” Boys dominated the sex ratio of 18:8; mean age was 12 ± 2.1 years. All patients were in the acute period (first 14 days). The reference group for EEG analysis consisted of 10 healthy children. The groups were uniform in terms of sex and age. EEG recordings were made in all patients using a Neuron Spectrum 3 encephalograph (Ivanovo, Russia), with visual analysis of the EEG and spectral frequency analysis. Spectral power was evaluated in the α, θ, and δ frequency ranges, and the α/θ, α/δ ratios were also determined. Visual analysis of the EEG showed that 100% of children in the acute period of viral encephalitis showed diffuse slowing with recording of δ and θ frequencies. Focal changes in the form of sharp waves were recorded in 85% of cases (21 patients). Periodic activity was not recorded in even a single case in the study group of patients. Quantitative analysis of the results of statistical processing identified statistically significant decreases in the α/θ ratio (p = 0.035), maximum α (p = 0.046) and minimum θ (p = 0.044) in encephalitis patients as compared with the healthy children group. These data lead to the conclusion that pediatric patients during the acute period of viral encephalitis show significant impairments to the normal α/θ EEG power ratio. This impairment was apparent as a reduction in the power of the α and θ rhythms. It can be suggested that the cause of this reduction is suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.

Tertiary care centers in Russia were subdivided on two categories during recent COVID-19 outbreak and counter infection measures, undertaken by the government. In the first category were the centers, providing medical care solely to the COVID-19 cases; in second hospitals worked with all other cases, excluding COVID-19 ones. COVID-19-oriented centers are taking strict protective measures against the infection, with medical and other staff working in the individual biohazard protection suits, full disinfection at the border between the clean and unclean zones, thorough medical supervision over the health of all the employees. In the second category centers observation regime was implemented, with the obligatory medical masks and disposable lab coats. wearing, as well as thorough medical supervision over the health of all the employees. These different regimes determine some features of clinical neurophysiology in these centers. In the case of electroencephalography (EEG) main point is the real need of the procedure in the certain clinical situation. In COVID-19 cases all functional tests should be excluded from the protocol; procedure have to be performed in shortest time possible. EEG is performed according to good clinical practice and consensus protocols with thorough and strict disinfection of the devise and all cables, caps etc. If the patient was in the prone position during the procedure, this should be noted for the neurophysiologist. Conduction studies may be performed in the possible coronavirus-associated Guillain–Barré syndrome or critical illness polyneuropathies. Needle myography may be needed only in the rare cases of coronavirus-associated acute myelitis, in all other cases conduction studies are more than enough.

Chronic pain syndromes represent a significant socio-economic problem for health care and society as a whole due to the insufficient effect of the treatment, a pronounced decrease in the quality of life and a significant degree of maladjustment of this category of patients. Treatment of chronic pain syndromes with first-line drugs from the group of anticonvulsants (gabapentin, pregabalin, carbamazepine, valproic acid and topiramate) does not always give the expected effect, and various side and undesirable effects are often observed. This implies the search for opportunities and prospects for the use of other new generation anticonvulsants, one of which is lamotrigine, as a means of pharmacological action. The article discusses a wide range of effective and safe use of Lamitor for various diseases accompanied by chronic pain.

Migraine is one of the most common types of headache, which can lead to a significant decrease in quality of life. Researchers identify migraine with aura, migraine without aura, and chronic migraine that substantially reduces the ability of patients to work and is frequently concurrent with mental disorders and drug-induced headache. The complications of migraine include status migrainosus, persistent aura without infarction, migrainous infarction (stroke), and a migraine aura-induced seizure. The diagnosis of migraine is based on complaints, past medical history, objective examination data, and the diagnostic criteria as laid down in the International Classification of Headache Disorders, 3 rd edition. Add-on trials are recommended only in the presence of red flags, such as the symptoms warning about the secondary nature of headache. Migraine treatment is aimed at reducing the frequency and intensity of attacks and the amount of analgesics taken. It includes three main approaches: behavioral therapy, seizure relief therapy, and preventive therapy. Behavioral therapy focuses on lifestyle modification. Nonsteroidal anti-inflammatory drugs, simple and combined analgesics, triptans, and antiemetic drugs for severe nausea or vomiting are recommended for seizure relief. Preventive therapy which includes antidepressants, anticonvulsants, beta-blockers, angiotensin II receptor antagonists, botulinum toxin type A-hemagglutinin complex and monoclonal antibodies to calcitonin gene-related peptide or its receptors, is indicated for frequent or severe migraine attacks and for chronic migraine. Pharmacotherapy is recommended to be combined with non-drug methods that involves cognitive behavioral therapy; progressive muscle relaxation; mindfulness; biofeedback; post-isometric relaxation; acupuncture; therapeutic exercises; greater occipital nerve block; non-invasive high-frequency repetitive transcranial magnetic stimulation; external stimulation of first trigeminal branch; and electrical stimulation of the occipital nerves (neurostimulation).

Our aim was to determine parameters of motor evoked potential (MEP) from the tongue in healthy persons.Methods. 25 healthy individuals (average age 22.4 ± 6.2 years, range 18–41 years, 12 females & 13 males) were enrolled. All underwent diagnostic TMS, single-pulse protocol, 90-sm round coil, Neiro-MS-D device. Coil was placed on Fz point, registration was performed by the surface electrode on the middle line of the tongue.Results. MEP was registered in all cases, its average latency was 7.14 ± 0.63 ms, average amplitude — 1.79 ± 1.09 μV. There were no gender & age differences.Conclusion. In healthy people aged 18–41 years MEP from the tongue may be registered in 100% of the cases; its average latency is 7.14 ± 0.63 ms, average amplitude — 1.79 ± 1.09 μV; there are no significant age & gender differences. TMS of the tongue according to this protocol is relatively simple, not time-and efforts-consuming & may be widely implemented in clinical neurophysiology.

High prevalence of tinnitus, its negative influence on the quality of life and psychoemotional status of patients support need and extreme urgency of further research of various treatment methods. Rhythmic transcranial magnetic stimulation (rTMS) is an effective method of therapy in patients with chronic tinnitus. The optimal protocol for rhythmic stimulation is low-frequency (1 Hz) rTMS with low-intensity stimuli (below 110% of the motor threshold) with a limited number of stimuli per series. There is evidence that high-frequency rTMS in the area of relatively thin temporal bones can lead to excessive stimulation of the neural structures of the auditory cortex, which is undesirable considering the pathogenesis of this condition. The use of navigation technology in rTMS has no advantage in chronic tinnitus therapy, whereas the combined use of rTMS and transcranial electrical brain stimulation to increase the treatment efficacy is under active study. Considering the attributable favorable clinical safety profile of rTMS, as well as its known positive effects on anxiety and depression that are often seen in patients with tinnitus, we can recommend more widespread use of this method in real-world settings.Широкая представленность тиннитуса в популяции, негативное влияние этого заболевания на качество жизни и психоэмоциональный статус пациентов, определяет необходимость и чрезвычайную актуальность дальнейших исследований различных методов лечения этой категории пациентов. Ритмическая транскраниальная магнитная стимуляция (рТМС) является эффективным методом терапевтического воздействия у пациентов с хроническим тиннитусом. Оптимальным протоколом для ритмической стимуляции является низкочастотная (1 Гц) рТМС стимулами невысокой интенсивности (ниже 110% от моторного порога) с ограниченным количеством стимулов в серии. Есть сведения о том, что высокочастотная рТМС в области относительно тонких височных костей может приводить к избыточной стимуляции нейрональных структур слуховой коры, что нежелательно, учитывая патогенез этого состояния. Применение навигационной технологии при рТМС не имеет какого-либо преимущества при терапии хронического тиннитуса, тогда как вопрос сочетанного использования рТМС и транскраниальной электрической стимуляции мозга с целью повышения эффективности лечения заболевания находится в процессе активного изучения. Учитывая свойственный рТМС хороший профиль клинической безопасности, а также известные положительные эффекты на тревожность и депрессию, которые часто наблюдаются у пациентов с тиннитусом, можно рекомендовать более широкое применение данного метода в клинических условиях.

Objectives. To assess the value of using different treatment schemes in chronic migraine by comparing clinical results and the economic burdens of disease in real clinical practice. Materials and methods. The study included 66 patients attending the Academician Aleksandr Vein Headache and Autonomic Disorders Clinic: 60 women and six men aged 28–51 years with diagnoses of chronic migraine. The patients were divided into three groups: group 1 (n = 22) consisted of patients who received three months of oral prophylactic therapy with topiramate at doses of up to 100 mg/day; patients of group 2 (n = 20) received 12 sessions of acupuncture with three procedures per week; patients of group 3 (n = 24) received injections of botulinum toxin type A (Botox, BTA) at a dose of 155–195 U. The observation period was three months. Treatment efficacy was assessed using the following methods: clinical-neurological assessment, the Headache Impact Test HIT-6 questionnaire, and a subjective points questionnaire assessment for treatment satisfaction and tolerance. Results. BTA was the most effective of the three treatment methods studied in patients with chronic migraine. As compared with oral prophylactic therapy and acupuncture, BTA produced the fastest and strongest actions on the frequency of headache, promoting regression of chronic migraine and recovery of the episodic nature of headache (the numbers of headache days in group 1, 2, and 3 were 16.1 ± 0.1, 18.0 ± 0.02, and 13.9 ± 0.3, respectively, at one month). BTA also produced significantly faster and more effective recovery of quality of life and was better tolerated (good in 51%, 75%, and 85% in groups 1, 2, and 3, respectively; satisfactory in 35%, 25%, and 15% in groups 1, 2, and 3, respectively; poor in 14% in the oral prophylaxis group). Most patients in the BTA group achieved satisfactory treatment results more quickly. Despite the greater direct costs as compared with topiramate, the direct costs associated with the use of BTA (29931.51 and 32085.87 rubles, respectively, the predicted cost per non-headache day in the BTA group was the lowest, at 652.15 rubles (692.86 and 1017.60 rubles in the oral prophylaxis and acupuncture groups, respectively). Conclusions. The efficacy and cost data obtained here for the different methods of prophylaxis of chronic migraine may help specialists and patients select the most optimal therapeutic approaches.

The paper is devoted to the safe use of hormonal contraception in women with migraine, an urgent interdisciplinary problem daily faced by gynecologists, neurologists, and specialists in headache diagnosis and treatment. It gives information on the prevalence of migraine, the risk of ischemic stroke and other cardiovascular disorders in women with different types of migraine, including those receiving contraception and hormone replacement therapy. The paper presents the main provisions of the new interdisciplinary consensus «Hormonal contraceptives and the risk of ischemic stroke in women who have migraine», which are recommended to be taken into account by specialists of any profile when prescribing hormonal therapy to women with migraine in order to avoid cardiovascular events.

Chest pain can be a “mask” of a life-threatening condition, which the practitioner must remember. One of such life-threatening condition is aortic aneurysm, which diagnosis presents significant difficulties in routine clinical practice. Clinical manifestations of thoracic aortic aneurysms are extremely variable and non-specific and are mainly depends on the size of the aneurysmal sac, its localization and extent, as well as the etiology of the disease. Here we present a clinical case report of a 48 y.o. patient who died because of the acute cardiac tamponade as a complication of dissecting thoracic aorta aneurysm. The lack of symptoms and clinical instrumental data, initially suggesting the presence of life-threatening disease did not allow the physician to suspect aortic aneurysm and urgently take action regarding it.

In this review, we discuss different aspects of pain syndrome in patients with amyotrophic lateral sclerosis: etiology, incidence, pathophysiology and main clinical features. Also we review the modern approaches to the treatment of pain in amyotrophic lateral sclerosis. Pain is actually not rare in this condition: it appears in 80% of patients, affecting their quality of life and functional activity, leading to the development of depressive and anxiety disorders. Pain in amyotrophic lateral sclerosis is often overlooked by clinicians, since their attention may focus on the motor symptoms of the disease. Thus, a more careful approach is needed to diagnose and treat pain in amyotrophic lateral sclerosis.

The diagnostics of chronic pelvic pain is a complex interdisciplinary problem. It requires a thorough and detailed clinical examination involving clinicians of various specialties. Neuropathic pain in the structure of chronic pelvic pain is present in 1/3 of patients, which call the need for a close cooperation between the urologist and neurologist at all the stages of the management of these patients. The presented clinical analysis demonstrates an algorithm for such an interdisciplinary interaction, which provides a care for a patient with this complex and debilitating pathology.

PParry–Romberg syndrome, also known as progressive hemifacial atrophy, is a rare clinical entity of unknown origin with atrophy of skin and subcutaneous fat changes. A classic case of Parry–Romberg syndrome in a woman age 43 is presented. Initial facial changes appeared at the age of 20 years amid complete well-being and in the next 21 years a subcutaneous fat atrophy of the left half face developed, resulting in characteristic deformity changes. No other complaints and manifestations of the disease (epileptic seizures, headache, involvement of the other half of the face and/or extremities) were present at the timeof survey. The analysis of blink reflex, galvanic skin reflex, needle electromyography of the m. orbicularis oris from two sides, computed tomography of the skull bones revealed no pathological changes. The face infrared thermography confirmed asymmetric reduction of temperature on the ipsilateral side. Magnetic resonance scan showed hypotrophy of the left masticatory muscle, the left submandibular salivary gland, thinning of subcutaneous fat layer, changes in the white matter of the brain. Despite the typical clinical features the Parry - Romberg syndrome is a diagnostic challenge known and it is necessary to inform doctors about the latest achievements in the study of etiology, management and prognosis of the disorder.

Arterial hypertension, diabetes mellitus, obesity and dyslipidemia continue to be the main risk factors for diseases of the circulatory system and the leading causes of mortality in the world, the combination of these diseases significantly increases the likelihood of the development and more rapid progression of cardiovascular and cerebrovascular pathology. Improving approaches to the diagnosis and treatment of these diseases is a priority problem in modern medicine. Currently, there is no universal drug that can influence all stages of pathological process in both cerebrovascular diseases and diabetes mellitus, and the problem of rational use of drugs in patients with comorbid pathology has not been completely resolved. A difficult clinical task includes not only the timely detection of the disease and the correct diagnosis, but also the choice of the safest and most effective medicine. A number of clinical studies have demonstrated the efficacy of mexidol in the treatment of this category of patients, which is determined by its complex, pleiotropic and multimodal mechanisms of action.Основными факторами риска болезней системы кровообращения и ведущими причинами смертности в мире продолжают оставаться артериальная гипертония, сахарный диабет, ожирение и дислипидемия, причем сочетание этих заболеваний существенно повышает вероятность развития и более быстрого прогрессирования кардио- и цереброваскулярной патологии. Совершенствование подходов к диагностике и терапии этих заболеваний является приоритетной проблемой современной медицины. В настоящее время не существует универсального препарата, позволяющего повлиять на все звенья патологического процесса как при цереброваскулярных заболеваниях, так и при сахарном диабете, и проблема рационального использования лекарственных средств у пациентов с коморбидной патологией окончательно не решена. Непростая клиническая задача заключается не только в своевременном выявлении заболевания и постановке правильного диагноза, но и в выборе наиболее безопасного и эффективного препарата. В ряде клинических исследований продемонстрирована эффективность Мексидола при лечении этой категории пациентов, что определяется его комплексным, плейотропным и мультимодальным механизмом действия.

Ischemic stroke is still leading in terms of primary disability caused by residual neurologic de-fect in the majority of patients. Persistent motor disorders are observed even after timely and ade-quately carried out rehabilitation measures. The article discusses the possibilities of modern instru-mental technologies for diagnostics and further monitoring of the process of restoration of post-stroke deficit, which is based on the phenomenon of neuroplasticity.

In our review, we discuss the inflammatory changes in the pathophysiology of Charcot-Marie-Tooth hereditary polyneuropathy, and this matter is still under further evaluation. Lipid oxidation, inflammatory changes, and blood inflammation agent (e.g., cytokines) concentration changes are important for the pathogenesis of this disorder. Several clinical cases of acute or chronic combination of hereditary and inflammatory polyneuropathies are identified. These clinical cases may be suspected when the typical course of Charcot-Marie-Tooth disease changed to rapid worsening of motor symptoms, inflammatory changes, and pain syndrome. Thus, anti-inflammatory treatment should be considered in these cases.

Background. Unlike parameters of phrenic nerve conduction in healthy adults characterized by stability, in children variations with age are observed. The objective is to investigate the M-wave latency and amplitude in electroneurographic (ENG) examination of the phrenic nerve in healthy children of different ages for development of a normative database of neurophysiological data.Materials and methods. 48 healthy children (28 girls and 20 boys) were examined. Mean age was 9.19 ± 5.43 years (1–18 years). ENG examination of the phrenic nerve was performed with the modified standard procedure of stimulation at the level of the outer margin of the lower third of the sternocleidomastoid muscle with registration of M-wave from standard diaphragm point and parallel registration of the muscle activity from m.deltoideus and m.serratus anterior.Results. Mean values of the M-response latency were 5.64 ± 1.25 ms, amplitude – 0.66 ± 0.34 mV. For age-differentiated subgroups 1–2 years (n = 7), 3–5 years (n = 9), 6–12 years (n = 15), and 13–18 years (n = 17), the latency was 4.96 ± 1.94; 5.01 ± 1.13; 5.42 ± 0.84, and 6.44 ± 1.43 ms, respectively; the amplitude was 1.01 ± 0.37; 0.87 ± 0.31; 0.61 ± 0.24, and 0.45 ± 0.21 mV, respectively. The M-response amplitude values in children aged 1–2 years significantly differed from the values in children aged 6–12 and 13–18 years.Conclusion. ENG examination of the phrenic nerve is a technically uncomplicated procedure, and the obtained data is easy to interpret. During phrenic nerve ENG in children, it is necessary to take age variability of the M-wave latency and amplitude into account. The M-wave amplitude in healthy toddlers (1–2 years old) was significantly lower than in children aged 6–18 years.

Recommendations for the diagnosis and treatment of migraine based on the principles of evidence-based medicine are presented. The latest edition of the International Classification of Migraine is provided. Diagnostic methods and criteria are oriented to discriminating different types of migraine. Recommendations are given on the basis of data on the epidemiology and pathophysiological mechanisms of migraine. The most effective medication-based and non-medication-based approaches to the management of migraine patients are discussed.

Our literature review analyzes the available studies on the effect of long- and short-term lumbo-sacral orthotic (LSO) treatment on the muscles of the back. We reviewed the existing diagnostic approaches to evaluation of muscle changes, including surface EMG, measurements of muscle strength and tolerance, and findings on muscle ultrasound study. It has been revealed that none of the available works confirmed a significant negative effect of LSO, both by shortand long-term application, or atrophic changes in the muscles. Thus, we may conclude that there are no significant data on the effect of the LSO treatment on the main parameters that are measured and reflect spinal muscles weakness and/or atrophy.

The posttraumatic stress disorder (PTSD) is no longer the pathology proper only to military men both over the world and in our country. At the present time there is observed a gain in PTSD patients. The disease has the negative impact both on the psychical and on somatic state of patients. The untimely and unqualified treatment of PTSD patients contributes to the chronicity of a pathologic process, results in social dysadaptation, prevents the return to the working activity. Doctors of very different specialities, most often neurologists, come into collision with PTSD. The article touches up the most urgent questions concerning PTSD, with the great attention paid to the differentiated diagnostics of the disease and methods of the treatment according to the achievements of the clinical practice. The methods of pharmacotherapy and psychotherapy of PTSD patients have been described on a contemporary level.

The aim of the study was to investigate the clinical and neurophysiological features of sensorimotor disturbances in patients at different time periods after ischemic stroke. Methods. The study involved 133 patients with ischemic stroke in the right and left cerebral hemispheres in the late recovery (58) and residual (75) periods. There were 35 controls. Were performed transcranial magnetic stimulation, evoked abdominal reflexes and somatosensory evoked potentials. Results. It was shown that functional recovery processes are continuing with varying degrees of severity in patients and in a year after stroke. Conclusions. Persistence and severity of sensorimotor disturbances, as well as compensatory opportunities, defined afferent component of poststroke deficit, which implies an additional impact in this area to expand the possibilities of neurorehabilitation in patients after stroke.

Our aim was to study efficacy of pathogenetically substantiated rehabilitation of sensorimotor disorders in patients after ischemic stroke. Methods. A total of 119 patients were studied all with hemiparesis following ishemic stroke. There were 35 controls. All patients underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, physical therapy, ergotherapy, massage etc. Before and after the rehabilitation therapy TMS and SSEP parameters were evaluated in all patients. Results. Rehabilitation with the use of a personified, pathogenetically grounded approach contributed to a better recovery of the neurological deficit. In those patients who received personalized therapy significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Conclusions. The effectiveness of the pathogenetically substantiated rehabilitation of patients after ischemic stroke was demonstrated. Were demonstrated more effective in restorative treatment of motor deficits. Somatosensory functions were restored worse, which implies the identification and takes into the account of the sensory deficit, as well as neurophysiological monitoring of the recovery process with the use of TMS and SSEP to improve the effectiveness of ongoing rehabilitation in this category of patients.

Migraine is one of the most common neurological disorders, affecting women. Physiological changes in the hormonal status can modulate the functional status of pain and analgesic systems of the brain and, by involving different pathophysiological mechanisms, change the course of migraine. In addition to an analysis of epidemiological data, the review provides current views on the clinical features of the disease in women population at different periods of life, particular attention was focused on menstrual migraine. It has certain features, such as acute and long attacks and treatment difficulties. One of main issues is the use of oral contraceptives in women with migraine according to the ratio of potential benefit to cardiovascular risk. The problems of treatment headaches in pregnant and breastfeeding women are also considered. An influence of migraine on the course and outcome of pregnancy was shown. The authors analysed the results of the studies on the course of migraine during perimenopause and postmenopause and recommendations for women with migraine attacks and climacteric syndrome. The data presented in the review are useful for clinicians, because this information represents new views on pathogenetic mechanisms, clinical features and treatment of migraine in women.Мигрень - одно из наиболее распространенных неврологических заболеваний, которое существенно чаще встречается у женщин. Физиологические изменения гормонального статуса женщины могут модулировать функциональное состояние болевых и противоболевых систем мозга, и, вовлекая различные патогенетические механизмы, изменять течение мигрени. Наряду с эпидемиологическими данными в обзоре приведены современные представления о клинических особенностях заболевания у женщин в разные периоды жизни; особое внимание уделено менструальной мигрени, отличающейся тяжелыми и длительными приступами и трудностями лечения. Один из важнейших вопросов, поднимаемых в статье, - возможность применения гормональных контрацептивов у женщин с мигренью с учетом соотношения потенциальной пользы и сосудистого риска. Рассмотрены традиционно сложные для врачей проблемы лечения головной боли у беременных и кормящих женщин, а также показано влияние мигрени на течение и исход беременности. Приведен анализ результатов исследований, касающихся течения мигрени в пери- и постменопаузе, рекомендации по ведению пациенток с приступами мигрени и климактерическим синдромом. Представленные в обзоре данные полезны для клиницистов, так как отражают новые взгляды на патогенетические механизмы, клинические особенности и лечение мигрени у женщин.

To evaluate the rationale for different approaches to preventive chronic migraine (CM) treatment by comparing clinical outcomes and financial burden of the disease in the real-world practice.Sixty-six patients with CM were enrolled at the Alexander Vein Headache Clinic (60 women and 6 men, aged 28-51). All patients were divided into 3 groups: group 1 (n=22) received oral preventative treatment with topiramate, up to 100 mg daily, for three months; group 2 (n=20) received 12 acupuncture sessions (3 sessions a week); group 3 (n=24) received 155-195 units of botulinum toxin type A (botox, BTA). The follow-up period in all groups was 3 months. Efficacy was evaluated by clinical examination, the Headache Impact Test (HIT-6) and questionnaires to assess subjective patient satisfaction and treatment tolerability.BTA demonstrated the highest efficacy in this study. Compared to the oral preventative treatment and acupuncture, BTA reduced the frequency of headache faster and more significantly facilitating CM transformation into episodic migraine (headache frequency was 16.1±0.1; 18.0±0.02; and 13.9±0.3 in groups 1, 2 and 3, respectively, after one month of treatment). BTA also improved the quality of life faster and more significantly and was better tolerated (good - 51%, 75% and 85% in groups 1, 2 and 3, respectively; satisfactory - 35%, 25% and 15% in groups 1, 2 and 3, respectively; bad 14% in the oral prevention group). In the BTA group, the majority of patients demonstrated earlier treatment satisfaction. Despite higher (compared to topiramate) direct costs in the BTA group (RUB 29 931.51 and RUB 32 085.87, respectively), the predicted cost of a headache-free day was the smallest and totaled RUB 652.15 (compared to RUB 692.86 and RUB 1017.60 in the topiramate and acupuncture groups, respectively).The data on the efficacy and costs of different CM prevention strategies would facilitate optimal treatment choice for neurologists and patients.Цель исследования. Оценка целесообразности применения различных схем лечения хронической мигрени путем сопоставления клинических результатов и экономического бремени заболевания в реальной клинической практике. Материал и методы. В исследование были включены 66 пациентов Клиники головной боли и вегетативных расстройств им. академика Александра Вейна: 60 женщин и 6 мужчин в возрасте от 28 лет до 51 года с диагнозом хронической мигрени. Пациенты были разделены на три группы: в 1-й группе (n=22) пациенты принимали трехмесячную пероральную профилактическую терапию топираматом в дозе до 100 мг в сутки; пациентам 2-й группы (n=20) проводили 12 сеансов иглорефлексотерапии по 3 процедуры в неделю; пациенты 3-й группы (n=24) получали инъекцию ботулинического токсина типа А (Ботокс, БТА) в дозе 155-195 ЕД. Период наблюдения за пациентами составил 3 мес. Для оценки эффективности лечения использовали следующие методы: клинико-неврологический, анкета 'Индекс влияния ГБ' (HIT-6), а также анкеты субъективной балльной оценки удовлетворенности терапией и ее переносимости. Результаты. БТА оказался самым эффективным из трех изученных методов лечения пациентов с хронической мигренью. По сравнению с пероральной профилактической терапией и иглорефлексотерапией БТА быстрее и сильнее воздействует на частоту головной боли, способствуя регрессу хронической мигрени и восстановлению эпизодического характера головной боли (через 1 мес число дней головной боли в 1-й, 2-й и 3-й группах составила 16,1±0,1; 18,0±0,02; 13,9±0,3 соответственно). БТА также значимо быстрее и эффективнее восстанавливал качество жизни и лучше переносился (хорошо - 51, 75 и 85% в 1-й, 2-й и 3-й группах соответственно; удовлетворительно - 35, 25 и 15% в 1-й, 2-й и 3-й группах соответственно; плохо - 14% в группе пероральной профилактической терапии). У подавляющего числа больных в группе БТА быстрее достигнута удовлетворенность результатами лечения. Несмотря на большие по сравнению с топираматом прямые затраты, связанные с применением БТА (29 931,51 и 32 085,87 руб. соответственно), прогностическая стоимость дня без головной боли в группе БТА оказалась минимальной и составила 652,15 рублей (692,86 и 1017,60 руб. в группах пероральной профилактической терапии и иглорефлексотерапии соответственно). Заключение. Полученные данные об эффективности и стоимости различных методов профилактики хронической мигрени могут облегчить специалистам и пациентам выбор наиболее оптимального терапевтического подхода.

The study was carried out to investigate clinical and neuro-physiological characteristics of sensomotor disorders in patients at different time periods after hemispheric ischemic stroke. The sampling of 133 patients with ischemic stroke in right hemisphere and left hemisphere were examined in late recovering and residual period (58 and 75 patients accordingly). The trans-cranial magnetic stimulation, abdominal reflexes and sensomotor induced potentials were implemented. It is demonstrated that in patients even in one year after stroke processes of functional rehabilitation of various degree of expression continue to be present. The constancy and degree of manifestation of sensomotor disorders and compensatory possibilities as well are determined by afferent component of post-stroke deficiency that supposes long-term effect for broadening possibilities of neuro-rehabilitation of patients after stroke.

The review systematizes data on the role of infectious diseases and systemic inflammation in the pathogenesis of stroke. Various risk factors for stroke associated with pro-inflammatory reactions and their contribution to the pathogenesis of cerebrovascular pathology are analyzed. The interaction of systemic inflammation with hemostasis disturbances and clots formation, activation of autoreactive clones of cytotoxic lymphocytes, the progression of endothelial damage, and other processes is shown. Along with infection, these factors increase the risk of stroke. The key mechanisms of the pathogenesis from the development of acute or chronic inflammation to the preconditions of stroke are presented. The mechanisms of the acting of the infectious process as a trigger factor and/or medium-term or long-term risk factors of stroke are described. A separate section is devoted to the mechanisms of developing cerebrovascular diseases after COVID-19. Identifying an increased risk of stroke due to infection can be of great preventive value. Understanding of this risk by specialists followed by correction of drug therapy and rehabilitation measures can reduce the incidence of cerebrovascular complications in infectious patients.В обзоре систематизированы данные о роли инфекционных заболеваний и системного воспаления в патогенезе развития инсульта. Анализируются различные факторы риска инсульта, ассоциированные с провоспалительными реакциями организма и их вклад в патогенез цереброваскулярной патологии. Показана связь системного воспаления с нарушениями процессов регуляции агрегатного состояния крови, активацией аутореактивных клонов цитотоксических лимфоцитов, прогрессированием эндотелиального повреждения и другими процессами, при сочетании которых риск развития инсульта на фоне инфекции возрастает. Приведены ключевые звенья патогенетической цепи от развития острого или хронического воспаления до возникновения инсульта. Описаны механизмы реализации инфекционного процесса как триггерного фактора развития инсульта на фоне коморбидных факторов среднесрочного и долгосрочного риска. Отдельный раздел посвящен механизмам повышенного риска развития цереброваскулярных заболеваний после перенесенного COVID-19. Выявление состояния повышенного риска инсульта, обусловленного инфекцией, может иметь важное профилактическое значение. Понимание этого риска специалистами различного профиля, своевременное проведение дополнительных обследований, коррекции лекарственной терапии и реабилитационных мероприятий в совокупности могут снизить частоту цереброваскулярных осложнений у инфекционных больных.

Questions of the neurorehabilitation of strokes patients are addressed. The importance of the phenomenon of neuroplasticity, which underlies recovery processes after brain lesions, is emphasized. Particular attention is paid to the question of sensorimotor integration in health and CNS pathology, as well as to the role of afferentation in the processes underlying the recovery of motor impairments. The principles of rehabilitation therapy for stroke patients are discussed.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.Представленные рекомендации по диагностике и лечению мигрени составлены на основании принципов доказательной медицины. Приведена Международная классификация мигрени последнего пересмотра. Методы диагностики и диагностические критерии ориентированы на различные формы мигрени. Рекомендации даны на основе сведений об эпидемиологии и патофизиологических механизмах мигрени. Охарактеризованы наиболее эффективные лекарственные и немедикаментозные подходы к ведению пациентов с мигренью.

The authors review the literature and own data concerning therapeutic use of transcranial magnetic stimulation (TMS) in children and adult patients with pain syndromes of different origins. TMS may act as a tool to excite or inhibit neuroplasticity in the central nervous system, which depends of the therapeutic regime used. TMS induces neurogenesis and synaptogenesis, rhythmic TMS may cause long-lasting after-effects, including pain inhibitory effect. A decrease in the threshold and an increase in the amplitude of motor evoked potentials in TMS are the most frequent changes in pain syndromes in the diagnostic modality. The efficacy of different regimes in the treatment of pain syndromes remains understudied. Despite vast knowledge on clinical use of TMS in pain syndromes in adults, in pediatrics its use is limited to migraine treatment. TMS is a valuable diagnostic and therapeutic tool that should be more often implemented in neurorehabilitation and treatment of neurological diseases in adults and children with pain syndromes.В обзоре приводятся сведения о применении транскраниальной магнитной стимуляции (ТМС) у пациентов разного возраста при различных болевых синдромах. ТМС может модулировать процессы нейропластичности в ЦНС, оказывая в зависимости от выбранного терапевтического режима как тормозное, так и стимулирующее влияние на возбудимость нейронов коры головного мозга. Под воздействием сильного магнитного поля в структурных элементах нервной системы наблюдаются многочисленные процессы, в том числе индукция нейрогенеза и синаптогенеза, причем использование режима ритмической ТМС (рТМС) приводит к долговременным эффектам с выраженным последействием. В диагностической модальности наиболее частым изменением при болевых синдромах является снижение порога и повышение амплитуды вызванного моторного ответа при ТМС. Недостаточно изученным остается вопрос эффективности разных режимов стимуляции в терапии болевых синдромов. Несмотря на большое количество свидетельств успешного применения рТМС у взрослых пациентов, у детей с болевыми синдромами данный метод использовался только при мигрени. ТМС является безопасным и ценным терапевтическим методом, использование возможностей которого открывает широкие перспективы в лечении и реабилитации неврологических заболеваний как у взрослых, так и у детей с болевыми синдромами.

Characteristics of stroke development and processes of restoration of brain function in post stroke period are considered. The dynamics of neuroplasticity and ambiguity of the involvement of the opposite brain hemisphere in the restoration is highlighted. Special attention is drawn to the time from stroke onset and activation of different brain regions in post stroke period. The importance of neurorehabilitation in these patients is emphasized.Рассматриваются особенности возникновения ишемического инсульта и процессы восстановления в постинсультном периоде. Подчеркивается динамичность нейропластических процессов и неоднозначность данных, касающихся вовлечения структур противоположного полушария головного мозга в процесс восстановления. Особое внимание уделено времени от момента начала инсульта и активации различных отделов головного мозга в постинсультном периоде. Подчеркивается значимость нейрореабилитации у данной категории больных.

The objective of the present study was the evaluation and comparison of the effectiveness of the differential approaches to the neurorehabilitation of the somatosensory disturbances in the patients presenting with the spinal cord lesions.A total of 68 patients with spinal cord lesions were enrolled in the study, including 38 suffering from vascular myelopathy, 18 with the consequences of extramedullar meningioma surgery, 12 with the sequelae of acute transverse myelitis. The control groups was comprised of were 55 subjects. All the participants of the study underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, kinesiotherapy, physical therapy, ergotherapy, massage, etc. Transcranial magnetic stimulation (TMS) and evaluation of somatosensory evoked potentials (SSEP) were carried out before and after the therapy.In those patients who received personalized therapy, significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Moreover, the patients who had undergone personalized therapy exhibited better clinical results than in the absence of such treatment.The results of the study gave evidence that neurorehabilitation had produced the more pronounced beneficial influence as regards the correction of motor disturbances even though the disturbances of the somatosensory functions proved to be more resistant to therapy. The data obtained suggest that taking into consideration the afferent deficit has to be mandatory for the purpose of planning the neurorehabilitative treatment of the patients suffering from sensorimotor disturbances associated with the lesions of the central nervous system at the spinal cord level. TMS and SSEP have to be utilized as the tools for the objective evaluation of the effectiveness of the neurorehabilitation process in such patients.Цель — изучить сравнительную эффективность дифференцированных подходов к нейрореабилитации сенсомоторных нарушений у больных с поражением центральной нервной системы (ЦНС) на уровне спинного мозга. Материал и методы. Были обследованы 68 пациентов с нижним парапарезом (38 больных с сосудистой миелопатией, 18 — после удаления экстрамедуллярной менингиомы и 12 пациентов с последствиями острого вирусного миелита), которые были рандомизированы на 2 группы. Все пациенты прошли курс реабилитации, до и после которого применяли транскраниальную магнитную стимуляцию (ТМС) и проводили исследование соматосенсорных вызванных потенциалов (ССВП). Нейрореабилитация включала применение роботизированной механотерапии; стабилографического комплекса; нейро-мышечной электростимуляции; кинезиотерапии, лечебнoй гимнастики, эрготерапии; массажа и иглорефлексотерапии. Кроме того, была выделена контрольная группа, которую составили 55 здоровых испытуемых. Результаты. Реабилитация с применением индивидуального, патогенетически обоснованного подхода способствовала лучшему восстановлению неврологического дефицита. Зарегистрированы достоверно меньшие значения параметров ТМС (время центрального моторного проведения в покое и при пробе с фасилитацией) в отличие от показателей ССВП нижних конечностей у больных, получавших персонализированную нейрореабилитацию. Заключение. Продемонстрирована бóльшая эффективность реабилитации в отношении двигательного дефицита; соматосенсорные функции восстанавливались хуже. Полученные данные предполагают обязательный учет афферентного дефицита при определении реабилитационной программы у пациентов с поражением ЦНС на уровне спинного мозга для расширения возможностей восстановительного лечения и использование нейрофизиологических методов (ТМС и ССВП) в качестве инструмента нейромониторинга в целях повышения эффективности нейрореабилитационного процесса у этих больных.

Despite the great achievements in the field of neurorehabilitation, a significant proportion of patients after an ischemic stroke have persistent motor disturbances even after timely and adequately carried out restorative measures. The article discusses the issues of neuroplasticity, modern diagnostic technologies for studying this phenomenon; prognostic factors for recovery deficit following stroke and determining the effectiveness of ongoing treatment. The principles of neuroprotective therapy in ischemic stroke are considered, which is a pathogenetically justified direction at all stages of restorative treatment after cerebral circulation disorders. One of the most studied original cytoprotectors, demonstrating safety, efficacy and good tolerability, is cytoflavin. The results of numerous clinical trials have revealed a significant positive clinical and morphological dynamics when taking cytoflavin in patients after ischemic stroke.Несмотря на достижения в области нейрореабилитации, значительная часть больных после ишемического инсульта (ИИ) имеют стойкие двигательные нарушения даже после своевременно и адекватно проведенных восстановительных мероприятий. В статье обсуждаются вопросы нейропластичности, современных диагностических технологий; прогностические факторы восстановления постинсультного дефицита и определения эффективности проводимого лечения. Рассматриваются принципы нейропротективной терапии при ИИ, представляющей патогенетически обоснованное направление на всех этапах восстановительного лечения. Одним из наиболее изученных оригинальных цитопротекторов, продемонстрировавших безопасность, эффективность и хорошую переносимость, является цитофлавин. Результаты многочисленных клинических испытаний обнаружили достоверную положительную клинико-морфологическую динамику при приеме цитофлавина у пациентов после ИИ.

A number of patients with primary headaches remain insensitive or refractory to treatment despite correctly selected drugs, adequate therapeutic dose and duration of therapy. The importance of refractory problem is determined by the fact that patients are completely maladjusted, disabled, and keeping these patients is very difficult even for seasoned professionals. Determination of the correct tactics and success of the treatment depends, in the first place, on the correct diagnosis. This article discusses the diagnostic criteria for the most important forms such as refractory chronic migraine or refractory chronic cluster headache presented by experts of the European Headache Federation in two separate Consensus.Ряд пациентов с первичными формами головной боли остаются нечувствительными или рефрактерными к лечению, несмотря на правильно подобранные препараты, адекватную терапевтическую дозу и достаточную продолжительность терапии. Важность проблемы рефрактерности состоит в том, что пациенты полностью дезадаптированы, нетрудоспособны, и ведение их представляет большие трудности даже для опытных специалистов. Определение правильной тактики лечения и его успех в первую очередь зависят от постановки правильного диагноза. В статье рассматриваются диагностические критерии наиболее значимых из них - рефрактерной хронической мигрени и рефрактерной хронической кластерной головной боли, представленные экспертами Европейской федерации головной боли в двух отдельных консенсусах.

Migraine is one of the most common complaints in the majority of pregnant women. Migraine without aura is the most frequent cause of headache. Improvement of this disease is reported in 50-80% of patient. However, about one third of pregnant women have severe prolonged attacks with marked concomitant symptoms and maladaptation that necessarily need treatment. Authors consider the issues of differential diagnosis and principles of management of these patients.Головная боль - одна из самых частых жалоб во время беременности у большинства женщин, при этом наиболее частой причиной цефалгии является мигрень без ауры. В 50-80% случаев отмечается улучшение течения этого заболевания. Около трети женщин во время беременности отмечают наличие тяжелых, длительных приступов с выраженными сопутствующими симптомами и дезадаптацией, требующих обязательного лечения. В статье представлен обзор современной литературы по вопросам дифференциальной диагностики и принципов ведения этой категории пациентов.