The article is devoted to the urgent problem of practical medicine – the treatment of primary cephalgia. The prevalence of chronic tension headache among the population of European countries is extremely high. Primary headaches are on the list of the most common causes of disability in all over the world. At the same time, existing treatment methods are often not able to completely cure this pain syndrome. In this work, the authors conducted a study on a new approach in the treatment of chronic daily headache: a combination of the non-pharmacological approach – stimulation of the trigeminal system using the Cefaly and the medication – the use of Kalmirex myorelaxant.

In 61 patients with chronic daily headache, the effectiveness of the proposed approach was shown both in the relief of pain and in positive changes in the psychoemotional status and quality of life of patients.

Parkinson's disease (PD) is characterized by both motor (hypokinesia, resting tremor, rigidity, postural instability) and non-motor symptoms. It is known that some non-motor manifestations, such as disturbances in smell, sleep, depression, gastrointestinal dysfunction, and others, may precede motor symptoms. Replenishment of dopamine deficiency, which, as known, develops in PD due to the death of dopaminergic neurons of the substantia nigra, makes it possible to influence most motor and some non-motor symptoms of parkinsonism, however many non-motor manifestations remain resistant to this therapy. In addition, it has only a symptomatic effect, and the pathogenetic treatment of PD is currently unavailable, which is primarily due to insufficient knowledge about the etiology and mechanisms of the development of the disease. In particular, it has already been established that alpha synuclein (a pathomorphological marker of PD) begins to be deposited in the intestinal wall, in the enteric nervous system (ENS) long before it appears in neurons of the substantia nigra. Understanding the mechanism of interaction along the axis “intestine – brain”, the role of intestinal wall dysfunction in the onset and development of PD can lead to the development of new directions in the treatment of this disease. Today, the role of microbiota, in particular the intestinal microbiota, in the functioning of the human body, its various systems, including the nervous system, is widely studied in the world. The influence of its imbalance on the activation of inflammatory reactions in the ENS and the possibility of the subsequent development of PD are considered. This review provides some evidence supporting the hypothesis that PD can be initiated in the gut. In addition, the possibilities of influencing the course of BP using pre-, pro-, syn- and metabiotics are considered.

Diagnosis of vertigo and dizziness is a difficult challenge in various fields of medicine practice. In the article the diagnostic algorithm for the patient with dizziness and vertigo is presented. The main signs and symptoms (vertigo, nonspecific dizziness, disequilibrium, and presyncope), which are included in the subjective feeling of dizziness are analyzed. Possible diseases, accompanied with these symptoms, their clinical and instrumental evaluation are discussed. Special aspects of the complaints in peripheral vestibular disorders (benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, bilateral; vestibulopathy, etc.), central vestibular disorders (stroke, etc.), functional dizziness are overviewed and main principals of their treatment are presented.

The role of exogenous factors in the occurrence of neurodegenerative diseases has been shown in many works: on the effects of radiation, neurotoxicants, pesticides and other organic and inorganic substances. One of the interesting and promising areas for studying the pathogenesis of neurodegeneration is the analysis of the composition and ratio of trace elements in various tissues and organs of a person. The influence of trace elements on the development of neurodegenerative diseases, such as Parkinson's disease (PD), Alzheimer's disease (AD), Huntington's disease, amyotrophic lateral sclerosis, is given special attention, since such patients show multiple disorders in the homeostasis of the main endogenous brain biometals (calcium, magnesium, zinc, iron, manganese, copper, etc.). On the one hand, in a cell or its components, where metals play a key role in biological processes, a metal deficiency can occur, on the other hand, metals can accumulate in pathological proteins, causing cell dysfunction and death. Protein aggregation is a common feature of all neurodegenerative diseases. Specific changes in the concentration of biometals in various environments of the body can be considered as early biomarkers of neurodegenerations. And the identification of reliable biomarkers is considered a paramount task for the development of the direction of early therapy and prevention of the disease, in particular PD. A change in the distribution of metal, cell deficiency and sequestration in pathological proteins are abnormalities that must be addressed during neurodegeneration. Currently, approximately 800 compounds are used or tested for the treatment of PD, of which approximately 250 have the expected or established chelation properties of metals (CuII, CuI, FeII, FeIII, MnII, ZnII) that are involved in dyshomeostasis in PD. Today's knowledge of the pathogenesis of the most common neurodegenerations, such as AD and PD, is still not enough to develop clear recommendations for therapy with biometals and other trace elements, but work in this direction is actively ongoing.

Pain syndrome accompanies absolute majority of diseases, therefore problems of adequate anesthesia remain acute not only for urgent conditions but also for everyday medical practice. Modern approaches of anesthetic therapy should consider not only pathogenic mechanisms of evolving pain syndrome by a certain patient but also necessity to administer drug combinations. It allows potentiating an analgesic effect, to decrease effective dosages of individual drugs and minimize adverse effects. The administration of non-steroidal anti-inflammatory drugs together with B vitamins and tolperisone is justified in a marked pain syndrome with a spastic component and/or spasms of skeletal muscles, muscle contractures, myofascial pain syndromes, as well in rehabilitation therapy after orthopedic and traumatology surgeries. The article considers pathogenic details of such combined therapy, discloses mechanism of synergic action of the proposed drug combination.

The article presents the results of a retrospective study of 150 children aged 1 to 6 years old, divided into three groups: 50 children with structural epilepsy with cerebral palsy, 50 children with cerebral palsy without epilepsy, but with epileptiform changes in the electroencephalogram (EEG) and 50 neurologically healthy children with epileptiform discharges in the EEG. All patients performed analyze of medical history, general clinical and neurological examination, EEG, neuroimaging study (CT-scan or magnetic resonance imaging). As a result of the analysis of the obtained data, the risk factors for the development of epilepsy were established: a burdened obstetric history, the threat of abortion, gestosis, prematurity, hardware resuscitation, low Apgar rating, neonatal seizures, diffuse epileptiform activity on the EEG, generalized epileptiform activity, delayed formation of spontaneous electrogen, specific epileptiform patterns, as well as confirmed structural pathology. Effective therapeutic control of seizures was achieved in 18 % of cases.

Coeliac disease and non-celiac gluten sensitivity are disorders whose diagnosis can be delayed for many years from the first clinical manifestations. Typical debut of coeliac disease is an extraintestinal manifestation as gluten-related disorders. One of such impairments is headache. There are currently data about gluten-associated headache including prevalence, clinical manifestations, diagnostic features and treatment results in this paper.