Currently, it is possible to treat secondary progressive multiple sclerosis (SPMS). This is the most unfavorable type of multiple sclerosis (MS) and the article provides a medical and social analysis of MS course at this group of patients. There is evidence that these patients are highly socialized members of society, usually family members, so their non-participation in socially useful work significantly affects the whole life of society. Many of them receive pathogenetic treatment drugs that do not work at this stage of MS. That is, the large cost of purchasing medicines not only does not help these patients, but also is an irrational expenditure of public funds.

The current outbreak of coronavirus SARS-CoV‑2 (COVID-19) has raised great concern worldwide, but its impact on nervous system still needs more investigation. Thirty per cent of symptomatic patients with COVID‑19 will have symptoms that last longer than the typical two weeks, 10 % have symptoms longer than 3 months and this is called ‘long-COVID’. These symptoms affect not only people with severe disease, but also those with milder cases. Many long-haulers experience the same symptoms they had during their initial fight with COVID‑19, such as fatigue, cognitive impairment (or brain fog), difficulty breathing, headache, depression, insomnia and loss of the sense of taste and\or smell. Treatment of those complications with citicoline, ethylmethylhydroxypyridine succinate and vitamin B improves these symptoms in patients but most of them also need cognitive therapy for dehypochondrisation.

Objective. To conduct a comparative analysis of personality traits, emotional disorders and adaptation of elderly men and women in the early stages of chronic cerebral ischemia (CCI).

Material and methods. We examined 120 patients with early manifestations of CBI – 48 men and 72 women (mean age is, respectively, 64.3 ± 0.5 and 65.0 ± 0.6 years). The study of personality traits was carried out using the method of multifactorial personality research of R. Kettell. Emotional disorders were identified according to ICD-X criteria, insomnia according to ICDS‑2 criteria. The level of general asthenia was assessed according to the MFI‑20 scale, anxiety according to the Spielberger scale, depression according to the Beck questionnaire, the quality of sleep according to the questionnaire of the Federal Somnological Centre. The type of adaptive reactions was determined in the leukocyte blood count by the percentage of lymphocytes and segmented neutrophils, taking into account the representation of other blood cells.

Results. Emotional and insomnia disorders predominated among women with CCI. Female patients were characterized by higher levels of excitation, tension and anxiety compared to men. Male patients were superior to women in terms of emotional balance. According to the analysis of leukograms, unfavorable adaptive reactions (overactivation and chronic stress) were significantly more frequent in women and correlated with a high level of anxiety and depression. The findings may have implications for the individualization of therapeutic interventions.

The purpose of this review was to assess the prevalence of asthenic syndrome (AS) in patients infected with SARS-CoV‑2, and to determine the effect of AS on the process of convalescence and the course of comorbid diseases.

Main provisions. AS is one of the most common manifestations after a COVID infection of varying severity, which in neurological patients can aggravate the course of the underlying disease and reduce the effectiveness of rehabilitation measures. Timely diagnosis allows you to identify AS and correct it with the use of medication and non-drug methods.

Conclusion. Due to the limited number of studies concerning AS in COVID‑19, it is necessary to further study the clinical features of this disease, to develop algorithms for medical rehabilitation, taking into account the clinical polymorphism of AS.

The aim. To characterize the main types of neurological manifestations in inflammatory bowel diseases – Crohn’s disease and ulcerative colitis.

Main concepts. Neurological disorders represent an important aspect of extraintestinal inflammatory bowel diseases (IBD) manifestations. According to publications, the incidence of psycho-neurological syndromes varies from 0.25% to 47.50% that apparently depends on the patient’s selection in studies. Neurological signs are not always associated with IBD activity and may precede the manifestation of intestinal inflammation. The most typical include cerebral thromboembolism, peripheral and cranial neuropathies, demyelinating disorders, and cerebral vasculitis. The incidence of ischemic stroke in IBD can reach 6.4%, with approx. 20% of affected persons under 17 y.o. Hemiparesis is the predominant consequence. The risk of intracranial venous thrombosis is increased depending on the activity of intestinal inflammation; this complication can precede manifestation of IBD. Fifty per cent increased risk of multiple sclerosis in IBD patients was shown. The types of peripheral nerves involvement include mononeuropathy, plexopathy, multiple mononeuropathy, compression neuropathy, polyneuropathy and cranial neuropathy. Peripheral neuropathy may be found in 32–37% of IBD patients with a special examination. Demyelinating type, sensory axonal polyneuropathy with thin and thick fibers damage, and motor axonal polyneuropathy with thick fibers damage are observed approximately in equal proportions. It is important to differentiate ‘primary’ neuropathy with vitamin B12 and folic acid deficient, alcoholic, diabetic and drug-induced neuropathy. Clinical improvement is usually seen in the course of immunosuppressive therapy. Cranial neuropathy (mostly of II, VI, VII, VIII of cranial nerves) is described in IBD. Neurological disorders associated with administration of metronidazole, sulfasalazine, cyclosporin A, antibodies to TNF-α and integrins α4 and α4ß7 continue to be highly actual.

Conclusion. There is a variety of neurologic syndromes in IBD which represents an important part of extraintestinal manifestations. Mild psychoneurological disorders may be not recognized in time. The majority of symptoms and signs may regress in the course of treatment of IBD and nutrients deficiency correction. The special attention should be paid to neurological status control while the biologic and immunosuppressor agents and metronidazole are administered.

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.

Study. The relationship of sleep disorders with anxiety in practicing neurologists in the context of a pandemic. Goals. To assess the quality of sleep, the level of anxiety and their mutual influence in neurologists.

Design. 330 neurologists were interviewed using the GoogleForms service, using the questionnaire "The psychological impact of the coronavirus pandemic on the population is measured using the Psycho-Covid‑19 questionnaire" in partnership with an international group of researchers led by VitoTummino and Dr. FrancoVimercati (Italy).

 Results. Sleep disorders ranging from mild to very severe were detected in 35% of respondents, which indicates that they have a high risk of insomnia. A statistically significant positive correlation of sleep disorders with both the overall indicator of psychological risk and the possibility of developing psychopathological syndromes is shown. Conclusion. The detection and correction of sleep disorders is important as a preventive measure and for the correction of anxiety disorders in medical professionals.

The purpose of the study. To study clinical and neuroimaging features of chronic cerebral ischemia (CCI) in polycythemia vera (PV).

Materials and methods. 66 patients with PV were examined – the main group (43 men, 23 women; mean age 62.0 ± 3.4 years), of which 64 (97.0%) patients were diagnosed with CCI. The comparison group consisted of 85 patients with CCI (34 men, 51 women; mean age 67.7 ± 4.6 years), who developed against the background of cerebral vascular atherosclerosis and arterial hypertension. To identify cognitive disorders, we used Mini Mental State Examination (MMSE). Insomnia was studied in accordance with the criteria of the International Classification of Sleep ICDS‑22005. The quality of sleep was determined using a questionnaire from the Federal Somnological Center. Neuroimaging (MRI of the brain) was performed on Siemens Symphony 1.5 T and GE Signa 1.5 T tomographs.

Results. Subjective symptoms CCI are characterized by a greater representation of asthenic and insomniac disorders. Transient ischemic attacks in patients with PV are significantly more common than in the comparison group, their frequency depends on the duration of PV. The revealed changes in MRI of the brain in the majority of PV patients with CCI are characteristic of multiinfarction vascular encephalopathy; in the comparison group, changes that characteristic for subcortical arteriosclerotic encephalopathy were more often recorded.