The article is devoted to the mechanisms of action and effectiveness of the original technology, combining the blockade in accordance with Vishnevsky method and pharmacopuncture with the drug Alflutop.

Materials and methods. 90 patients under 65 years of age with exacerbation of lumbosacral dorsopathy, who signed informed consent form were inсluded in observation. Along with clinical characteristics, the results of psychological tests, thermography and zonal rheovasography were evaluated. Patients were divided into 3 groups in which standard treatment was performed. In the 1st control group, they were limited to it, and in others, local stimulation was additionally performed. Methodically, up to 20 loci in the lumbar zone and 6–8 reflexology points in the lower extremities were selected. At the same time, the anesthetic Lidocaine was injected into the points of the lumbar zone, and the drug Alflutop (2nd group) or physiological solution (3rd) was injected into the distal points. The course of stimulation included 10 procedures performed every other day.

Outcomes. Both variants of local stimulation significantly exceeded the effectiveness of basic therapy. However, despite the comparability of the rate of pain symptomatics reduction in these groups, the final level of pain was significantly lower in the case of Alflutop. These data were consistent with a clear tendency to normalize the mental and vascular background in patients of the 2nd group. This phenomenon can be explained by the points of application of medicines: rapid anesthesia due to blockade by anesthetic and the maximum effectiveness provided by pharmacopuncture.

Sleepwalking (somnambulism, noctambulism) is a form of parasomnia associated with non-REM sleep, which is characterized by the presence of recurring episodes of sleep-congruent simple or complex behavioral manifestations upon awakening from non-REM sleep. Causes of sleepwalking include increased excitability during non-REM sleep, sleep deprivation, a decrease in the severity of inhibitory processes against the background of defects in GABAergic inhibitory influences and suppression of cholinergic neuronal activation. In adulthood, somnambulism is malignant in nature, and can lead to various adverse consequences. Some of the drugs can cause the development of sleepwalking, in addition, in some cases, the drugs that are used to treat this condition can themselves provoke sleepwalking, such conditions are called drug-induced (DI) sleepwalking. To date, about 30 drugs have been verified, the use of which is associated with the occurrence of sleepwalking, primarily benzodiazepine receptor agonists, atypical antipsychotics, antidepressants and other serotonergic drugs, as well as β-blockers. Risk factors for the development of DI sleepwalking include a history of sleepwalking episodes, the combined use of 2 or more drugs that can provoke its development, and the combined use of potential inducer drugs with alcohol. Treatment includes withdrawal of the inducer drug, cognitive behavioral therapy, and psychopharmacotherapy.

Objective. Clinical-neurophysiological and neuropsychological examination of patients with bruxism was conducted to determine the functional condition of the peripheral and central trigeminal nerve and to justify the combined therapy.

Materials and methods. 26 patients (14 women and 12 men) aged 20 to 50 years with complaints and typical neurological symptoms of bruxism were examined. The control group consisted of 30 volunteers in the age from 24 to 35 years, who underwent a comprehensive examination as part of a medical check-up, who did not have severe somatic, neurological or mental diseases and did not have complaints of impaired function of the masticatory muscles. Clinical and neurological, electrophysiological and neuropsychological diagnostic methods were used in the trial. Quantitative sensory testing was performed using TSA II device (Medoc, Israel), and temperature sensitivity thresholds were determined using the Marstok method on symmetrical facial areas according to the Zelder zones. Diagnostics of the functional condition of the masticatory muscles was carried out using a computer neuroelectromyograph M-Test ‘DX-Systems’ and a computer system for analyzingelectromyographic records. Electroencephalography (EEG) was performed using 16-channel computer electroencephalography system. C. D. Spielberger scale adapted by Yu. L. Khanin (C. D. Spielberger, 2010) was used to determine the level of anxiety. The results were processed using Statistica and Microsoft Excel 2015 programs.

Results. Patients with bruxism had a high level of personal anxiety, which was found in 73 % of the participants. Determination of the thresholds of cold sensitivity on the faces of patients with bruxism showed a lower threshold of cold sensitivity in the lateral parts and a higher threshold in the oral parts. Electromyography of masticatory muscles showed an increase in the duration of mastication period, a decrease in the masticatory rhythm, a decrease in masticatory efficiency, and irrational functioning of the masticatory muscles of varying severity in the patients of the examined group. Assessment of brain biopotentials showed an increase in the ascending activating effects of nonspecific median brain structures (72 %). The data obtained helped to obtain a comprehensive assessment of functional condition of the trigeminal nerve in patients with bruxism and to justify pharmaceutical therapy aimed at both the muscular apparatus (muscle relaxants) and the peripheral and central parts of the trigeminal nerve (antiepileptic drugs) in combination with a medicine that has a stabilizing effect on the functional condition of neurons and normalization of bioelectric processes in the central nervous system (correctors of metabolism).

Despite significant advances in the treatment of leprosy in recent years, the treatment of complications of the leprosy process remains an urgent and challenging task for clinicians and researchers. The article presents modern literature data on the treatment and prevention of neurotrophic complications of leprosy patients.

In this literature review and our own data, we provide information about navigational transcranial magnetic stimulation (TMS). At present, a significant amount of knowledge has been accumulated about the use of TMS, both diagnostic and therapeutic, in real clinical practice. Diagnostic TMS has been studied and developed maximally. Nevertheless, despite the undoubted clinical effect of therapeutic TMS, the question of the need for the most accurate target designation for the greatest effectiveness of treatment remains controversial. A number of publications emphasize and justify the need for such target designation, but others report a positive clinical effect of stimulation regardless of the exact location of the inductor. This undoubtedly makes further research in this area relevant with an assessment of the comparative effectiveness of the most accurate rhythmic TMS with other protocols for its use.

Disorder of coronary circulation is one of the most severe complications of COVID‑19. Strokes that develop against the background of coronavirus infection are more often associated with occlusion of large vessels and have a more severe course. The frequency of strokes associated with COVID‑19, according to different authors, ranges from 1 to 6 %.

Objective. To analyze the etiopathogenetic factors, the course of stroke after a coronavirus infection, and to analyze the possible relationship between the severity of COVID‑19 and the severity of stroke.

Materials and methods. Observation of 110 patients of the neurological department of the First Republican Clinical Hospital of Udmurtia for the period from 2020 to 2021 with confirmed ischemic or hemorrhagic stroke associated with COVID‑19. Statistical data processing was carried out in Microsoft Excel 2013, MedCalc.

Results. Hypertension, atherosclerosis, and cardiac arrhythmia predominated in the structure of comorbidities in the examined patients. In 88.0 % of cases, ischemic stroke was observed in patients after infection, mainly the lesion concerned the carotid basin (55.5 %). Patients more often had focal neurological symptoms, among which hemiparesis and hemiplegia prevailed. Features of the results of laboratory diagnostics is the presence of coagulopathy, renal and hepatic insufficiency: increased levels of fibrinogen, D-dimers, creatinine, urea, proteinuria. According to neuroimaging data, in 54.5 % of cases, the stroke focus was more than 15 mm; duplex scanning of vessels in 95.0 % of cases revealed signs of atherosclerosis of the brachiocephalic arteries, carotid arteries in 54.5 % of cases. Correlation analysis revealed the relationship between the severity of COVID‑19 and the clinical manifestations of stroke. Most of the strokes occurred in the subjects within 1–6 months (40.9 %) after suffering COVID‑19.

Conclusion. In the development of stroke after suffering COVID‑19, coagulopathy, renal liver failure, cardiovascular comorbidities, especially hypertension, and atherosclerosis play a significant role. Stroke severity is correlated with the severity of COVID‑19.

The urgency of the problem is caused by the high prevalence of anxiety-depressive disorders in patients with somatic pathology, including tuberculosis. The aim of the study was to study the level of anxiety and depression among patients with pulmonary tuberculosis undergoing treatment in a hospital setting, taking into account the clinical form of pulmonary tuberculosis, age and gender parameters. Screening testing of 500 patients undergoing inpatient treatment for pulmonary tuberculosis was carried out using the HADS scale. The sample consisted of 274 female and 226 male patients aged 18 to 72 years. The study showed the presence of anxiety and/or depression of varying severity on the HADS scale in almost half of the respondents (42.4 %). Approximately 30 % of patients with anxiety symptoms were also diagnosed with probable depression. The prevalence of concomitant depression and anxiety among tuberculosis patients was especially high among patients with an infiltrative form of pathology. The highest rates of anxiety and depression were detected in female and young patients. The study showed that tuberculosis clinics need to develop recommendations for screening, diagnosis and treatment of anxiety and depressive disorders in tuberculosis patients.

This literature review is devoted to the problem of epilepsy caused by pituitary neuroendocrine tumors: their detailed classification with the latest recommendations of the World Health Organization 2022, clinical picture of each variant of pituitary neuroendocrine tumor in a complex multidisciplinary approach are considered. The main feature of the review is a detailed consideration of the epilepsy associated with this condition, which is considered to be a rather rare manifestation of the disease (incidence in patients is 0.5 %), due to which very few cases of epilepsy in patients with pituitary adenoma have been described in the literature. Our work has analyzed the fundamental works of domestic scientists in this field, as well as current information from foreign sources and most of the available clinical cases of epilepsy in this group of patients, revealing in detail the pathogenesis of epilepsy at all levels, including molecular changes. Modern techniques for the treatment approach in this group of patients are also described, the effectiveness of drug and surgical therapy is analyzed according to the criteria of the frequency of long-term persistent remission and recurrence, side effects of drugs and complications of transsphenoidal tumor resection are reviewed, including in terms of possible epilepsy; conclusions about the most rational and effective approach to treatment of various types of hypophysial neuroendocrine tumors are drawn.