The article presents an adapted translation of the practice recommendations for the preventive treatment of migraine, released in late 2024 by the International Headache Society (IHS). The document contains 16 of the most important practical questions on migraine prevention, the answers to which are obtained from clinical guidelines from different countries, meta-analyses and randomized clinical trials (RCTs).
The main objective of these practice recommendations for migraine prevention is to optimize the use of drugs for effective control of frequent and chronic migraine and to improve the quality of medical care for the greatest number of patients in countries with different levels of economic development. In the Russian Federation (RF), both targeted prophylactic drugs (anti-CGRP monoclonal antibodies, gepants), botulinum toxin type A and most classical oral medications are available. Thus, in our country it is possible to offer preventive treatment of migraine of any level, including the optimal one. In the comments to this article, the authors of the Russian version sought to adapt the answers to the most important questions to clinical practice in the Russian Federation.

The emergence of new botulinum toxin type A (BTA) drugs requires the study of their efficacy and safety in various neurological diseases in order to find the most effective and safe drugs. This article presents clinical cases using the new drug NOVACUTAN-BTA. It has been shown to be effective and safe not only in correcting expression lines, but also in treating neurological conditions such as bruxism, blepharospasm, facial nerve neuropathy and hemifacial spasm, autonomic disorders and pain syndromes. Its unique formulation using a new proprietary strain (CBAT-4), the highest purification rate (98.99 % compared to 95 % for Onabotulotoxin), the use of lyophilization which preserves the activity of the drug, as well as its favourable clinical profile, high treatment response rate, long duration of effect achieved, all combine to differentiate NOVACUTAN- BTA from other currently approved BTA drugs.

Introduction. Stroke has been the leading cause of death worldwide for decades. Despite the improvement of diagnostic methods, for 40 % of patients who have suffered an ischemic stroke, its cause cannot be established. The high incidence of stroke remains a serious problem for the healthcare system, requiring increased attention and the development of new preventive strategies.
Objective: to establish the relationship between some modifiable and non-modifiable factors and the occurrence of ischemic stroke in women in the Republic of Dagestan.
Methods. The study used a cross-sectional continuous study design. The study included 75 women in the acute period of ischemic stroke and 35 women living in Dagestan without a history of acute cerebrovascular accident. The study analyzed the results of laboratory and molecular genetic research methods.
Results. Two genes make a significant contribution to the risk of ischemic stroke in Dagestan. Hyperhomocysteinemia can be regarded as a marker of acute cerebral ischemia in women in Dagestan. A statistically significant higher level of homocysteine was found in patients with the TT variant of the MTHFR gene (p<0.05). Patients with ischemic stroke in the presence of 4G/4G polymorphism of the PAI-1 gene have a statistically significantly higher atherogenic index value compared to patients with 5G/5G polymorphism.
Conclusion. Not all studied modifiable and non-modifiable factors contribute to the development of stroke in women in Dagestan. Molecular genetic methods in modern medicine are becoming routine, and their use as non-modifiable risk factors can become an important component of personalized diagnostics.

Cognitive impairment (CI) is one of the main symptoms of both the acute period of COVID-19 and post-COVID syndrome, manifested by memory, attention and executive functions decline, which may persist or worsen months after infection. Risk factors for developing postcovid CI (PCI) include old age, female gender, low educational and socio-economic status, prolonged social isolation, severe COVID-19, use of certain medications, and concomitant diseases such as dementia and cardiovascular diseases. Vaccination against COVID-19 is considered as an effective way to prevent PCI. Diagnosis of PCI is based on the study of biomarkers in blood and cerebrospinal fluid (CSF), neuroimaging and neurophysiological data. Studies have revealed a link between cognitive impairment and the presence of antineuronal antibodies in the blood and CSF, structural changes in the brain (decrease in gray matter thickness and tissue damage in memory and attention areas), decreased glucose metabolism in key areas of the brain (according to PET scans) and abnormalities in brain electrical activity (according to EEG data). PCI is a serious problem for global health, exacerbated by the COVID-19 pandemic, which requires a comprehensive approach to the study, diagnosis, treatment and rehabilitation of patients.

Focal post-stroke spasticity significantly impairs the functioning and quality of life of patients. Therapy with botulinum toxin type A – hemagglutinin complex is an effective method of stabilizing the level of post-stroke spasticity, reduces the severity of restrictions on self-care and work activity of patients. Purpose of the study: to evaluate the effectiveness of long-term use of botulinum toxin therapy in the rehabilitation of patients with focal post- stroke spasticity.
Materials and methods. The study included clinical data of 24 patients who had suffered a stroke and were receiving treatment within the third stage of rehabilitation. Two groups of patients were identified: the main group (n=12) received treatment with the botulinum toxin type A hemagglutinin complex (the drug «Dysport®») for 12 years (a total of 30–45 courses of injection treatment per patient over 12 years of observation) and symptomatic treatment of focal spasticity, physical rehabilitation courses (therapeutic exercise classes, medical massage, physiotherapy), and the control group (n=12) received physical rehabilitation courses. The research method was a one-time retrospective analysis of medical data, followed by an annual assessment of the degree of limitations in life activities, motor function impairment, dynamics of the level of focal spasticity, and severity of pain syndrome during 12 years of observation. Results. Over 12 years of observation of patients in both groups, there was a significant improvement in the quality of life, a decrease in motor disorders, and a decrease in pain in patients in the main group.
Conclusions. Therapy of focal post-stroke spasticity with botulinum toxin type A – hemagglutinin complex (the drug «Dysport»®) is effective as a therapy for reducing pain syndrome, improving the quality of life and self-care of patients in the long term.

Vascular pathologies, despite the low percentage of prevalence among other etiological factors of epilepsy development, often cause such an important problem today as pharmacoresistance. This phenomenon can lead not only to a decrease in the quality of life of patients, but even to a fatal outcome.In this regard, the main task of this article will be to disclose the etiopathogenesis of epileptic seizures in patients with arteriovenous malformations, aneurysms and cavernomas. It is important to understand that the key role is played by the formation of organic pathology of the brain, the elimination of which should be paramount for the effective relief of epileptic seizures. Studying the issues discussed in this article can help structure the drug and surgical treatment of these patients, and perhaps even develop new algorithms.

Introduction. Subthalamic nucleus deep brain stimulation (STN DBS) is a highly effective method of neurosurgical treatment of Parkinson’s disease (PD), which can significantly reduce the motor symptoms of the disease (rigidity, tremor, hypokinesia). However, the effect of STN DBS postural stability remains contradictory.
The purpose of the study. Evaluation of the dynamics of postural instability in advanced PD patients undergoing bilateral STN DBS during 12 months of postoperative observation.
Materials and methods. The study included 80 patients with PD: 40 patients in the main group who undergoing STN DBS, and 40 patients in the control group who received only drug therapy. Patients in the main group underwent clinical neurological examination a week before surgery, as well as 3, 6 and 12 months after surgery; patients in the control group – at the beginning of the study and after 12 months of observation.
Results. SN DBS in patients of the main group led to a significant improvement in motor performance on the UPDRS-III scale, a decrease in the severity of postural instability during the «OFF» period, and improved confidence in balance on the ABC scale throughout the 12 months of observation (p<0,05). During the «ON» period, the STN DBS did not have a significant effect on the postural instability. After 12 months of follow- up, patients in the control group showed a significant increase in instability, hypokinesia, freezing, walking disorders, and motor deficits on the UPDRS-III scale. After 12 months, SN DBS contributed to a 73,43 % reduction in the daily dose of levodopa in patients in the main group and a decrease in the severity of motor fluctuations and dyskinesias on the UPDRS-IV scale by more than 70 %, while in the comparison group the dose of levodopa increased and the UPDRS-IV scores worsened. In patients with STN DBS, there was a regression of fluctuations in postural instability during periods of «ON» and «OFF» while taking levodopa.
Conclusions. After 12 months, patients undergoing bilateral STN DBS showed a significant decrease in the severity of postural instability during the «OFF» period and no effect on postural functions during the «ON» period. The stabilization of postural functions was revealed at a sufficient level, without fluctuation depending on the «ON» and «OFF» periods.

Epileptic seizures in Alzheimer's disease (AD) represent a significant clinical challenge that substantially affects disease progression and patients' quality of life. This review examines current understanding of the pathophysiological mechanisms underlying paroxysmal activity in AD, including the role of β-amyloid, tau protein, and neuroinflammation. Special attention is given to novel diagnostic approaches, including biomarkers, neuroimaging techniques, and EEG monitoring protocols. The clinical features of epileptic seizures in AD, their classification, and age-related differences in manifestation are analyzed. The review addresses the problem of epilepsy underdiagnosis in AD, which reaches 70% of cases in routine clinical practice. Current diagnostic algorithms and clinical guidelines are presented. The review emphasizes the necessity of an interdisciplinary approach to diagnosis and the importance of early identification of epileptic activity as a potential marker of neurodegenerative process.

The article analyzes clinical cases of two patients with a clinical picture of acute development of memory loss, psychiatric manifestation, seizures in combination with non-structural hyperintensity from the hippocampal region on MRI of the brain, laboratory serological positivity in non-treponemal and treponemal tests and signs of intrathecal immunoreactivity with a preliminary diagnosis of limbic encephalitis. The diagnostic difficulties in establishing a final diagnosis are emphasized and attention is focused on the completeness of the examination. Clinical, instrumental and laboratory features of late neurosyphilis in the form of syphilitic encephalopathy and limbic encephalitis, which have similar manifestations, are considered. The increase in the frequency of false diagnosis of autoimmune encephalitis determines the importance of a demanding attitude to differential clinical and paraclinical studies that help in determining the pathogenesis of these complex pathologies.

Olfactory disorders are more relevant than ever in the era of the pandemic of the new coronavirus infection (COVID-19). According to statistical data, about 60 % of patients complain of olfactory dysfunction (OD) in the acute period, while 6.2 % of patients note that complaints persist for more than a month after recovery from COVID-19. However, no more than 5 % of those with persistent OD seek medical help. Currently, the diagnosis of OD is difficult due to the lack of a single examination protocol. Attempts have been made to compare the MRI data of the olfactory nerve and the severity of OD, based on changes in the volume of the olfactory bulb (OB), at the same time, one should not forget that in addition to the volume of OB, it is possible to assess the morphology of OB, which changes in response to direct respiratory exposure. The article provides up-to-date information, including an assessment of 15 meta-analyses on the features of MRI diagnosis of OD associated with COVID-19, as well as the results of the authors' personal experience.