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.

Recently, a large amount of evidence has been obtained on the possible involvement of inflammatory processes in epileptogenesis. Thus, in a number of studies, an increase in the synthesis of specific inflammatory mediators in the brain of patients and, accordingly, the activation of some pro-inflammatory pathways in the foci of seizures, as well as the participation of oxidative stress, was found. There was also information that some chronic infections, such as neurocistercosis, HIV and herpes, without causing acute cerebral pathology, can provoke epileptic seizures and even the formation of refractory epilepsy in the future. This review summarizes the experimental and clinical data from studies on the relationship between epilepsy and chronic infectious diseases and neuroinflammation.

The article is devoted to the principles and features of the multidisciplinary team’s activity which are providing the adequate maintaining in stroke patients. The principles of carrying out, advantages and risks of early rehabilitation and early verticalization are considered. The main principles of physical rehabilitation are analyzed also.

The data of patients with reversible cerebral vasoconstriction syndrome (RCVS) who were examined and treated in 2013–2020 are presented. 136 patients were examined (37.3 ± 11.4 years) – 107 (78.7 %) women, 29 (21.3 %) men. Detailed neurological examination, magnetic resonance imaging of the brain, magnetic resonance angiography and magnetic resonance venography were performed. Results. Primary RCVS was detected in 29 (21.3%), secondary RCVS – in 69 patients (50.7%), and a combination of primary and secondary RCVS factors – in 38 (28.0%) patients. In 95 (69.8%) patients (80 women, 15 men; p < 0.05) signs of cerebral artery angiodysplasia were identified. Hypoplasia of venous sinuses (transverse and/or sigmoid) was found in 34 patients (29 women and 5 men). Conclusions. RCVS is developed in women more often than men, but there was no significant difference in risk factors between men and women. Predisposing factors of both primary and secondary RCVS can be revealed simultaneously. Women were more likely to have variants of brachiocephalic artery development. Clarification of angiodysplasia variant influence to the development and severity of RCVS requires further study.

Objective. To study the clinical and psychological features of pain syndrome in multiple myeloma.

Materials and methods. Of 95 patients with multiple myeloma, 75 (79,0%) had pain syndrome, 41 (55,0%) had radiculopathy, 20 (27,0%) had polyneuropathy and 14 (19,0%) had ossalgia. The patients were divided into two groups: the first is with moderate pain syndrome (32 patients), the second is with severe pain syndrome (43 patients). The comparison group consisted of 60 patients with vertebrogenic radiculopathy. The severity of pain was assessed on a visual-analog scale (VAS). To study anxiety, we used the C. Spielberger–Y. Hanin test, and the Zung scale for depression. To determine the type of attitude to the disease, the TOBOL method was used.

Results. In patients with multiple myeloma with severe pain syndrome, in comparison with patients with moderate pain syndrome, reactive anxiety, moderate depression, and maladaptive types of attitude to the disease were significantly more frequently registered. Correlation analysis revealed links between the level of reactive anxiety and the level of pain on the VAS scale, between the frequency of occurrence of maladaptive types of attitude to the disease and the level of depression and anxiety.

Professional sport belongs to those types of activities that are accompanied by high energy costs and requires more than a person needs on average, the amount of sleep. Sleep of professional athletes is important for restoring the brain’s energy expenditure, as well as for the normal functioning of memory and attention, and, consequently, for achieving high sports results. The article analyzes the literature devoted to the study of the role of sleep for athletes, scientific information about the representation, nature and consequences of its violations, summarizes and structures data related to the strategy for optimizing sleep in this population group.

The idiopathic normal pressure hydrocephalus (Hakim – Adams syndrome) is characterized by the expansion of cerebrospinal cavities, which is clinically manifested by triad symptoms: cognitive impairment, impaired gait and urination. In this research the severity and modality of cognitive impairment, the pattern of gait changes and the levels of protein biomarkers of amyloidosis and neurodegeneration and neuroimaging changes was evaluated for idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination. It has been established that for patients with idiopathic normal pressure hydrocephalus the most characteristic is the dysregulatory type of disorders of higher brain functions, while for patients with a combination of Alzheimer's disease and idiopathic normal pressure hydrocephalus, mnemonic disorders are also detected. The specific changes of cerebrospinal fluid in patients with idiopathic normal pressure hydrocephalus are higher levels of amyloid beta, a decrease concentration of tau and phosphorylated tau-protein compared to patients with Alzheimer's disease. In the case of a combination of diseases (comorbidity), it was characterized by intermediate results by cerebrospinal fluid biomarkers. We also revealed patterns of transformation of moderate cognitive impairment into dementia (according to the ratio of tau/Aβ‑42 and ftau /Aβ‑42). The value of evaluating the results of magnetic resonance imaging using special techniques that evaluate both the expansion of the ventricular system and atrophy of the brain parenchyma. Comorbid patients are characterized by a combination of these processes based on the results of neuroimaging. That is why it is necessary to use complex visually analog neuroimaging scales for differential diagnosis and establishing diagnosis. Also, in the course of this work, an algorithm is proposed for mandatory clinical-neuropsychological and laboratory-instrumental examination of patients with cognitive impairment in idiopathic normal pressure hydrocephalus, Alzheimer's disease and their combination.

The aim of the study. To study changes in the substance of the brain according to magnetic resonance imaging (MRI) and their correlation with the neuropsychological profile in men and women of senile age with chronic cerebral ischemia.

Materials and methods. We examined 57 patients with chronic cerebral ischemia of stages 2 and 3, aged from 75 to 93 years. The patients were divided into two groups: group one of men (n = 25), group two of women (n = 32). MRI performed on a GE Medical Systems tomography with 1.5 Tl strength. Investigated the quantitative indicators of MR tomograms in the Ax T2 Flair Propeller mode. Neuropsychological profile was assessed from Mini Mental State Examination, frontal assessment battery– from FAB, clock-drawing test.

Results. Comparison of neuroimaging data with cognitive tests reveals the relationship between the severity of cerebral atrophy, leukoaraiosis and cognitive dysfunction. This data must be taken into account when planning treatment and rehabilitation tactics.

Hereditary neuromuscular diseases are a group of genetic diseases characterized by an onset of the disease in most cases in childhood, having a steadily progressive course of the pathological process, leading to more rapid disability of patients and having a high mortality rate at the age of 18–20 years.

Objective. To study a condition of the intra-organ structure in patients with hereditary muscular atrophy and muscular dystrophy using testing of nerve tissue in the organotypic environment in order to justify the prescription of symptomatic neuroprotective therapy.

Materials and methods. Ninety patients with hereditary neuromuscular diseases (spinal muscular atrophy types 1, 2 and 3 [n = 30], Duchenne muscular dystrophy [n = 60]) were examined; the control group consisted of 30 healthy people. In vitro – explants of sensory ganglia of 10–12-day-old chicken embryos. A comprehensive clinical, laboratory and experimental study was conducted. Concentrations of neurotrophic factors (Brain Growth Factor, Nerve Growth Factor, Ciliary Neurotrophic Factor) were determined by the enzyme immunoassay method in blood plasma samples using RayBiotech kits and in accordance with the manufacturer's instructions. The experimental study included 300 explants of sensory ganglia of 10–12-day chicken embryos cultured in Petri dishes on collagen substrates in a CO2 incubator (Sanyo, Japan) for 3 days at 36.5 °C and 5% CO₂. In order to clarify the biochemical mechanisms involved in pathological cascades in patients with hereditary neuromuscular diseases, a test system was developed that included a sequential analysis of the patient's blood plasma in an organotypic tissue culture at a dilution of 1: 70, followed by an addition of reagents to the medium: synthetic nerve growth factor (NGF) (100 pg/ml). Explant cultivation was carried out according to the method developed at Institute for Physiology n.a. I.P. Pavlov (Saint Petersburg, Russia). Visualization of the objects was made using Axiostar Plus microscope (Carl Zeiss, Germany). The resulting images were analyzed with the help of ImageJ software. A morphometric method was used to quantify the growth of explants. The area index (AI) was calculated as the ratio of the area of the explant growth zone to the initial area. AI reference value was 100%.

Results. Brain Growth Factor concentration was at the highest level in patients with progressive amyotrophy, while in patients with progressive myodystrophy, the blood concentra tion of this factor was at a level comparable to the control data, and in some patients the concentration of Brain Growth Factor was lower than normal. NGF concentration showed the highest values in the group of patients with progressive amyotrophies. Blood plasma of patients with progressive amyotrophy dose dependently inhibits the growth of neurites of the spinal ganglia, and blood plasma of patients with myodystrophy has a neurite-weakening effect on the growth of neurites. Introduction of synthetic NGF (100 pg/ml) to organotypic tissue culture containing blood plasma of patients with myodystrophy increased the area index value of 114.0 [111.0; 116.0]%; in explants containing blood plasma of patients with progressive amyotrophy, increased growth of neurites was not observed AI = 80.0 [74.5; 83.0]%.

Conclusion. The data obtained are indicative of features of neurotrophic regulation in patients with hereditary muscular atrophy and muscular dystrophy, which should be taken into account when conducting symptomatic treatment aimed at stimulating reparative processes in the nervous tissue. We recommend patients with the neurite-weakening effect of blood plasma to have neuroprotective drugs therapy, and in case of patients with neuritis-inhibiting effect on neurites in organotypic culture of nervous tissue we recommend choosing a drug in vitro individually using pharmacological analysis.

The objective. To assess and compare the multi-modal evoked potentials (EP) (flash visual [fVEP], brainstem acoustic [BAEP] and cognitive evoked responses [CER]) parameters in children with cerebral palsy (CP) and healthy ones.

Materials and methods. There are 100 children aged 3–17 years were examined. Experimental group included 55 children with CP, diagnosed according to International cerebral palsy criteria (P. Rosenbaum et al., 2006), and mild motor deficit (levels I–II of Gross Motor Function Classification Scale), undergoing rehabilitation course. Control group was presented by 45 healthy children aged 3–17 years with no neurological signs. Registration of the fVEP, BAEP and CER and their comparative analysis with non-parametric tests was performed. Neurophysiological recording performed on EMG-VP4 system (MBN Scientific Company, Moscow, Russia).

Results. Slowing of maturation and significant delaying of main EP components were observed in experimental group.

Conclusion. Findings in this investigation indicate the retardation of cortical sensory processing in children with CP. Analyzing multi-modal EP may be helpful in early detecting sensory abnormalities as complications of CP.

COVID‑19 is acute respiratory infection caused by the new coronavirus SARS-CoV‑2 (2019-nCoV). Until now, the pathogenesis of the virus has not been fully studied, but the global medical practice is dominated by the theory of systemic inflammation as the main damaging factor of viral infection. A special role is given to the study of the state of the endothelium. Understanding the molecular components underlying functional disorders and vascular damage, together with the ability of new laboratory technologies to determine the effect of endothelial damage on the entire body, provides a key to modern treatment strategies. Antihypertensive, antiplatelet drugs and statins are the drugs whose effect on the functional state of the endothelium has been studied most fully.

We performed a clinical, neurological, neuropsychological and laboratory examination of 30 patients with a confirmed diagnosis of myasthenia gravis, aged 25 to 69 years (49.0 ± 14.6 years), 11 men and 19 women. Among the examined patients, the generalized form of myasthenia was diagnosed in 20 (66.7%) patients: 4 (20.0%) cases of severe and 16 (80.0%) of moderate forms. The ocular form of myasthenia was found in 10 (33.3%) cases. Neuropsychological testing revealed memory impairment in 15 (50.0%), attention – 11 (36.7%), emotional disturbances – 13 (43.3%) patients with myasthenia gravis. A significant decrease in the concentration of brain-derived neurotrophic factor (BDNF) in the blood serum of patients with myasthenia was noted, compared with the control group (p < 0.01). When comparing the data of neuropsychological testing, the level of BDNF and the history of the disease, it was found that patients with a generalized form of myasthenia gravis and a disease duration of more than three years have a lower level BDNF, which has a reliable correlation with lower cognitive function scores.