Migraine is a common and benign disease that does not shorten the life and does not lead to disability of patients. Migraine complications are extremely rare and in most cases occur in patients suffering from migraine with aura, with the exception of status migrainosus. The International Classification of headaches in 2018 identifies as complications: status migrainosus, persistent aura without infarction, migrainous infarction and migraine aura-triggered seizure; the appendix discusses visual snow and migraine aura status. The article is of an overview nature, which presents diagnostic criteria, features of differential diagnosis, as well as currently available theoretical approaches to migraine complications. Treatment of status migrainosus, clinical features and therapy of persistent aura without infarction, diagnosis and differential diagnosis of migrainous infarction and ischemic stroke of other causes, differential diagnosis of migraine aura status with organic neurological syndromes, as well as clinical features, pathogenesis and comorbidity of «visual snow» described in the article, are important for the clinical practice of neurologists.

Multisystem atrophy (MSA) is a sporadic progressive neurodegenerative disease that is manifested by a combination of autonomic and motor dysfunctions: parkinsonism, cerebellar ataxia, pyramidal syndrome, etc. Given the complexity of the diagnosis, the clinical polymorphism and the ignorance of neurologists about this disease, patients are often followed up by doctors of other profile or are observed with an incorrect diagnosis. There are two main MCA phenotypes – predominant cerebellar ataxia (MSA-C) and predominant parkinsonism (MSA-P), which are determined by the localization of the affected structures and the dominance of certain clinical symptoms. This article presents three clinical cases with different subtypes of MSA. Despite the difference in clinical manifestations, all patients was diagnosed with clinically established MSA. The features of the collection of complaints and anamnesis are described, the analysis of the neurological status and characteristic neuroimaging markers that can help in the differential diagnosis of this rare disease is carried out.

Cervicogenic headache is a secondary headache that still leaves a number of questions in the discussions of representatives of the medical community, specialists in cephalgology. The article provides up-to-date information on the specifics of etiopathogenesis, clinical manifestations of cervicogenic headache, and features of diagnosis and treatment of this nosology.

Monoclonal antibodies targeting CGRP or its receptor have marked a new era in the preventive treatment of migraine, demonstrating high efficacy and good tolerability. However, the optimal duration of such therapy and the factors influencing the maintenance of remission after its discontinuation remain insufficiently studied. The aim of our study was to identify predictors of sustained remission following the cessation of anti-CGRP monoclonal antibody therapy in migraine. The study included 96 patients with migraine who received three or more injections of anti-CGRP mAb and experienced at least a 30 % reduction in headache frequency. The results allowed us to identify key factors associated with maintenance of remission after the end of treatment. The principal predictors were: rapid and sustained onset of therapeutic effect, a lower number of headache days at the end of therapy, a lower level of depression, less marked central sensitization, and minimal impact of headache on daily activities. This study emphasizes the importance of comprehensive patient assessment before discontinuing therapy and highlights opportunities for an individualized approach in the management of migraine, aimed at maintaining long-term remission and improving quality of life.

This article provides an overview of the current state of the problem regarding the comorbidity of multiple sclerosis (MS) and epileptic seizures (ES). Epilepsy occurs in patients with MS 3–6 times more often than in the general population; however, its prevalence and clinical manifestations are variable. The pathogenetic link between the two conditions is bidirectional: demyelination and gray matter atrophy in MS contribute to epileptogenesis, while epileptic activity itself can exacerbate neurodegeneration. The clinical manifestations of ES in MS are heterogeneous and can include both focal and generalized seizures, which often serve as the first manifestation of the demyelinating disease. Electroencephalography and cerebral magnetic-resonance imaging play a crucial role in diagnosis, revealing focal activity and structural changes in the cortex. Treatment requires a comprehensive approach, whereby some disease-modifying therapies for MS and antiepileptic drugs can have a mutually positive influence. Conclusion. The comorbidity of multiple sclerosis and epilepsy is a complex problem due to shared pathogenetic mechanisms and mutual aggravating influence. Diagnosing epileptic seizures in MS can be challenging due to the variable clinical picture and non-specific changes on electroencephalogram. Given the high risk of developing epilepsy in this patient category and its potential impact on the progression of disability, neurologists need to maintain a high index of diagnostic suspicion. Further research in this area should be devoted to optimal treatment strategies aimed at both conditions simultaneously.

In the context of increasing academic workload and active digitalization of education, the problem of the relationship between sleep quality and mental fatigue among schoolchildren is becoming particularly relevant.

The aim of the study was to study the correlation between sleep quality and the level of mental fatigue in schoolchildren in grades 8–11, taking into account age and gender characteristics. The sample included 334 students (average age M=16.28; SD=1.14) from secondary schools in St. Petersburg. The research methods consisted of a set of standardized questionnaires: the author's questionnaire, the «Adolescent Sleep and Wakefulness Scale» (adapted by I. A. Kelmanson) and the questionnaire of acute mental fatigue (Leonova A. B.). Statistical analysis was carried out using Welch's t-test, Pearson's chi-square criterion and linear regression.

The results showed that only 32.4 % of schoolchildren meet the recommended sleep duration, while 21.6 % sleep less than 6 hours. The highest level of fatigue was recorded in girls (13.69±7.71 points versus 11.09±7.20 for boys) and 10th grade students. Significant negative correlations were found between sleep parameters (r up to –0.403) and mental fatigue, as well as a positive relationship between the latter and screen time (r=0.214).

Conclusions. The findings confirm the significant impact of sleep quality on the cognitive functions of schoolchildren. The data obtained have important practical significance for the development of preventive programs in educational institutions. The prospects of the study are related to an in-depth study of the mechanisms of the influence of digital technologies on sleep and the development of personalized approaches to the prevention of mental fatigue in adolescents.

Relevance. During the acute phase of intermittent ischemic stroke, it is virtually impossible to predict the patient's condition over the next 2–3 days. Studying changes in the autonomic nervous system (ANS) during the acute phase of ischemic stroke is crucial, as it can be used for risk stratification and prognostication of the subsequent course of the disease.

Objective. To study the dynamics of autonomic changes in patients in the acute period of ischemic stroke and to evaluate the degree of their influence on the course of the acute period.

Materials and methods. The study initially included 162 patients in the acute period of ischemic stroke. Subsequently, 38 patients with minor stroke, 5 patients with regression of neurological symptoms by 21 days, 42 patients with an intermittent course of the acute period, and 14 people with a severe stroke according to the NIHSS scale were excluded. Of the 63 patients remaining under observation, 2 groups were formed: Group 1–25 patients who experienced a rapid deterioration of clinical symptoms from the 10th to the 20th day of observation in the acute period with subsequent transition of the stroke to a more severe form within 2–3 days; Group 2–38 patients with a stable course of the disease. All patients had their blood pressure, pulse, and respiratory rate measured every morning for 10 days. Based on these data, the Kerdo index and Hildebrandt index were calculated as criteria for assessing autonomic nervous system function. The degree of neurological deficit and stroke severity were assessed daily using the NIHSS scale.

Results and discussion. The study found that assessing changes in autonomic function using the Kerdo index and Hildebrandt index has prognostic value and can be used as a specific marker indicating the potential for a sharp deterioration in the short term (2–3 days) in patients with ischemic stroke. Marked progression of neurological deficit with the transition of stroke to a more severe form is associated with an absolute increase in the Kerdo index of ≥18 units and the Hildebrandt coefficient of ≥9.0 units. The high reliability of this method (82.1 %) justifies its implementation in clinical practice for the timely identification of patients requiring enhanced monitoring and therapy.

Conclusion. Assessing changes in autonomic regulation using the Kerdo index and the Hildebrandt coefficient has prognostic value and can be used as a specific marker of a sharp deterioration in the condition of patients with ischemic stroke in the short term (2–3 days).

Background. Corticobasal degeneration (CBD) is a sporadic disorder of tau protein metabolism with an incidence of approximately 4–7 cases per 100,000 people. CBD is characterized by a gradual onset and steady progression, as well as a combination of various combinations of characteristic clinical signs, such as asymmetric akinetic-rigid syndrome with insufficient response to levodopa therapy, apraxia, aphasia, specific “alien limb” phenomenon, cognitive impairment with asymmetric cortical atrophic changes according to MRI of the brain. Considering that the group of tauopathies, in addition to CBD, includes progressive supranuclear palsy (PSP), Alzheimer’s disease and other diseases, and a combination of this pathology is often observed, as a result of this the clinical picture can be quite variable. Therefore, neurodegenerative changes in the cortical-subcortical structures in combination with various pathologies with a characteristic clinical picture are included in the concept of corticobasal syndrome.

Сlinical Сase Description. The article presents a clinical case of corticobasal degeneration combined with progressive supranuclear palsy syndrome in a 69-year-old woman.

Conclusion. Today, when making a diagnosis, it is necessary to take into account not only the clinical picture as a whole, but also the features of its development. An important problem is that corticobasal degeneration with progressive supranuclear palsy is difficult to diagnose, especially in the early stages of the disease, and treatment with antiparkinsonian drugs is ineffective.

Aim. To identify a group of metabolites potentially characterizing the lack of response to initiated therapy with disease-modifying antirheumatic drugs (methotrexate) after 24 weeks, based on an analysis of the relationship between activity parameters and the baseline metabolic profile.

Material and methods. The study group included 37 patients with RA [age 57.51 [52.63–62.40] years, 12 men (32.4 %)] who were initiated on methotrexate (MTX) therapy; the control group included 31 healthy volunteers [age 41.00 [30.00–44.00] years, 11 men (35.5 %)]. Plasma metabolites of the study participants were analyzed using ultra-high-performance liquid chromatography combined with tandem mass spectrometry. Metabolomic profiling of patients in both groups was performed at the time of study inclusion. After 24 weeks of MTX therapy, patients in the main group underwent a follow-up examination to assess treatment efficacy. Treatment response was defined as achieving low disease activity or clinical remission based on the Disease Activity Score (DAS 28-CRP). Based on this, patients in the main group were divided into «responders» and «non-responders».

Results. Metabolite classes that statistically differed significantly between RA patients and healthy volunteers included branched-chain amino acids, tryptophan metabolites, fatty acids, and urea cycle metabolites. After 24 weeks of MTX therapy, 16 patients achieved remission/low activity based on the DAS 28-CRP scale, and 21 patients achieved moderate/high activity. Moreover, patients who responded to MTX treatment had statistically higher DAS 28-CRP activity levels at baseline compared to patients who did not respond to MTX therapy (4.80 [4.40–5.45] vs. 3.99 [3.32–4.98], p=0.006). At baseline, patients in the «responder» and «non-responder» groups were comparable in age (56.27±16.58 and 54.91±11.03 years, respectively, p=0.766) and gender (4 (25.0 %) and 5 (22.7 %) men, respectively, p=1.000). However, among patients who did not respond to MTX therapy, there were more patients seropositive for both rheumatoid factor (RF) [16 (76.2 %) vs. 10 (62.5 %), p<0.05] and anti-citrullinated protein antibodies (ACP) [16 (76.2 %) vs. 8 (50.0 %), p<0.05], and the ACP level was statistically significantly higher compared to the group of patients who responded to therapy (20.00 [10.00; 422.50] vs. 400.00 [100.00; 520.00] U/ml, p=0.001). Using principal component analysis with a reliable assessment of the VIP-score (variable importance in projection), a panel of biomarkers predicting potential lack of response to MTX therapy was generated. The panel included aspartate (p<0.05), glutamate (p<0.05), betaine (p<0.05), dimethylglycine (p<0.05), tryptophan (p<0.05), quinolinic acid (p<0.05), octanoyl-carnitine (p<0.05), decanoyl-carnitine (p<0.05), asymmetric dimethylarginine (p<0.05), and uridine (p<0.05).

Conclusion. The study of the metabolomic profile of patients with RA demonstrates the potential for predicting therapy response, which in the future will serve as the basis for the development of more effective therapeutic strategies and the creation of targeted therapies aimed at metabolic processes.