Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder. According to the Rome IV criteria, IBS is defined as a condition characterized by abdominal pain associated with defecation and changes in stool form and frequency. The onset of the disease is typically acute and associated with stressful events, and subsequently leads to a significant decline in quality of life. This article provides a detailed case report of a patient who developed acute diarrhea and typical manifestations of functional gastrointestinal disorders. Treatment with the SSNRI antidepressant Duloxetine relieved the gastrointestinal symptoms and significantly improved quality of life.

Multiple system atrophy (MSA) is a rare, sporadically occurring neurodegenerative disease with a progressive course. MSA is characterized by a combination of autonomic dysfunction and motor disturbances, including parkinsonian syndrome, cerebellar ataxia, pyramidal symptoms, and other manifestations. Diagnosis of this disease is often challenging due to the diversity of clinical presentations and insufficient awareness among neurologists, which can lead to misdiagnosis or patients being monitored by specialists in other fields. Depending on the predominant symptoms and the localization of lesions in the central nervous system, two main clinical variants of MSA are distinguished: parkinsonian (MSA-P) and cerebellar (MSA-C). This article presents important current preclinical and clinical studies focused on slowing the progression of MSA, including drugs targeting pathological α-synuclein, as well as neuroprotective and anti-inflammatory approaches. Current data on studies of drugs aimed at symptomatic treatment of MSA are also presented.

The article presents a review of the current literature on paraneoplastic Lambert-Eaton syndrome (LES). A case report is provided, illustrating typical diagnostic challenges: initial misclassification as myasthenia gravis, lack of response to acetylcholinesterase therapy, the need to identify the «warm-up» phenomenon and rely on high-frequency repetitive nerve stimulation in the comprehensive electrophysiologic assessment of LES. It emphasizes that sustained oncologic screening is warranted when LEMS is suspected, even if initial imaging is negative, because neurological symptoms can precede tumor detection by months.

The objective of this study was to evaluate the efficacy and safety of combined antithrombotic therapy: acetylsalicylic acid 75–100 mg once daily together with rivaroxaban 2.5 mg twice daily in patients with multifocal atherosclerosis and a history of ischemic stroke of the atherothrombotic subtype.

Materials and Methods. Two groups of patients with multifocal atherosclerosis (main group, control group) were selected, comprising 161 individuals who had suffered an ischemic stroke of the atherothrombotic subtype. The main group included 105 patients receiving acetylsalicylic acid 75–100 mg daily as secondary stroke prevention. The control group consisted of 65 patients receiving combined antithrombotic therapy – rivaroxaban 2.5 mg twice daily together with acetylsalicylic acid 75–100 mg.

Results and Conclusion. In the group of patients with atherothrombotic ischemic stroke who received dual antiplatelet therapy, a statistically significant reduction in the number of recurrent cardiovascular events was observed, compared to the main group receiving monotherapy with acetylsalicylic acid 75–100 mg (p=0.002). These data may indicate the effectiveness of using acetylsalicylic acid 75–100 mg daily together with rivaroxaban 2.5 mg twice daily and confirm the advantages of this combination over monotherapy with acetylsalicylic acid 75–100 mg for secondary prevention of cardiovascular events. The administration of rivaroxaban 2.5 mg twice daily together with acetylsalicylic acid 75–100 mg did not lead to the development of major bleeding, including bleeding requiring hospitalization or resulting in death, which may indicate the safety of this combination.

The determinants of aggressive human behavior and criminal aggression include genetic factors and environmental influences. Experiments have shown that the manifestation of aggressive behavior largely depends on the level of dopamine. The results of studies of the genes of five dopamine receptors DRD1–DRD4, the catechol-O-methyltransferase gene, the monoamine oxidase-A gene, and genes encoding enzymes involved in the synthesis or degradation of dopamine are presented. The results of most studies confirm the relationship of dopaminergic receptor genes with aggression, antisocial behavior, impulsivity. At the same time, a number of studies have not revealed the relationship of genes regulating the function of dopamine with antisocial behavior. The inconsistency of research results on genetic predisposition to antisocial behavior may be associated with a number of methodological problems and errors.

Hereditary neuropathy with a tendency to pressure palsies is a rare form of autosomal dominant hereditary peripheral neuropathy. This article reviews this disease literature. Typical changes based on family history, clinical presentation, stimulation electromyography, nerve ultrasound and genetic testing along with the disease progression and patient management strategies are presented. This article presents clinical case of hereditary neuropathy with a tendency to pressure palsies in a 21-year-old man with 9 months prospective follow-up. Nerve ultrasound, along with stimulation electromyography, has proven to be a key diagnostic method for hereditary neuropathy with a tendency to pressure palsies. The detection of two or more painless tunnel syndromes (including those detected by stimulation electromyography and ultrasound) in young patients may prompt testing for the PMP22 gene, and if detected, family genetic testing.

Cervical dystonia is a chronic neurological condition characterised by involuntary muscular contractions of the neck, resulting in abnormal head posture, pain, tremor, and a substantially diminished quality of life. Whilst the administration of botulinum toxin type A (BoNT-A) remains the established gold-standard intervention, its transient efficacy, typically lasting between two to six months, presents a principal therapeutic limitation. This review provides a critical analysis of current treatment modalities for cervical dystonia, namely BoNT-A therapy, pharmacological management, deep brain stimulation (DBS), surgical interventions, targeted exercise regimens, and transcranial electrical stimulation. Particular emphasis is placed on the emerging field of non-invasive neuromodulation, specifically repetitive transcranial magnetic stimulation (rTMS). This promising approach may hold significant potential for prolonging the therapeutic benefits of BoNT-A through the targeted induction of neuroplastic changes within the cortical circuitry.

Objective. To demonstrate rare and combined forms of polyneuropathies resulting from vitamin deficiencies against the background of exogenous intoxication (nitrous oxide) and pre-existing hereditary pathology (Charcot–Marie–Tooth disease), emphasizing the reversible nature of symptoms with timely etiopathogenetic therapy.

Materials and methods. Two clinical observations of 27- and 29-year-old female patients with newly diagnosed polyneuropathies are presented. A comprehensive analysis of anamnestic data (occupational, toxicological, nutritional, family history), neurological status, laboratory parameters (vitamin B12, thiamine), electroneuromyography, and molecular genetic testing was performed.

Results. In the first case, a patient with occupational exposure to nitrous oxide was diagnosed with B12-deficiency polyneuropathy, confirmed by decreased cobalamin levels and macrocytic anemia. In the second case, against the background of chronic alcohol consumption, thiamine deficiency was detected; phenotypic features (foot deformity) and genetic testing results verified Charcot–Marie–Tooth disease type 1 (17p11 duplication, PMP22 gene). Prescribed replacement therapy (cyanocobalamin, thiamine) led to regression of paresthesia, improved sensitivity, and partial restoration of motor functions.

Conclusion. The presented cases illustrate the necessity of a systematic diagnostic approach for polyneuropathies, including assessment of acquired deficiency states even with confirmed genetic pathology. Timely correction of vitamin deficiency provides a significant clinical response and improves patients‘ quality of life.

Introduction. Vestibular migraine is a clinically significant and underdiagnosed condition, lacking recognized objective biomarkers. Within the predictive coding framework, interoceptive precision dysregulation can serve as a predictor, enabling objective stratification and targeted correction.

The purpose of the study: to evaluate interoceptive precision dysregulation in the predictive coding model as a predictor of vestibular migraine for personalized stratification and correction.

Materials and Methods. Analysis of clinical data from 92 patients with vestibular migraine per ICHD-3 criteria (age 34.2±7.8 years). Interoceptive awareness assessed via MAIA-2 questionnaire («Multidimensional Assessment of Interoceptive Awareness», Noticing subscale cutoff ≤2 points); vestibular impairment severity via Dizziness Handicap Inventory (DHI). Targeted 4–7–8 breathing training (4s inhale, 7s hold, 8s exhale; 3x/day for 21 days) with MAIA-2 monitoring. Predictive validity of MAIA-2 assessed via logistic regression and ROC analysis.

Results. Deficient interoceptive awareness (MAIA-2/Noticing ≤2 points) identified in 78% of vestibular migraine patients, associated with severe dizziness impact (DHI ≥45 points; OR=8.4; [95% CI 4.2–16.8]; p

Conclusions. Interoceptive deficit correlation with vestibular dysfunction established for the first time in vestibular migraine patients; accessible MAIA-2 screening developed for risk stratification; efficacy of targeted breathing rehabilitation confirmed with interoceptive normalization and dizziness mitigation suitable for outpatient application.

Background. Migraine frequently co-occurs with neck pain, but biomechanical impairments of the cervical spine in this phenotype remain underexplored.

Objective. To assess the relationship between cervical spine biomechanical characteristics and clinical manifestations in patients with migraine and unilateral headache.

Materials and methods. This cross-sectional study included 54 patients with verified migraine (77.8% women, mean age 33.2 years). Clinical assessment (neck pain, pain provocation, psychoemotional factors) and goniometry of active cervical movements (flexion, extension, lateroflexion, rotation) were performed.

Results. Mobility restrictions were found in 50% of patients, predominantly in rotation. Neck pain, headache provocation by neck movements, and side concordance correlated with rotation restriction (r=0.323–0.398; p<0.05). Autonomic symptoms and psychoemotional factors showed no significant associations with mobility. Shoulder girdle asymmetry was significantly more frequent in patients with movement restriction (χ²=34.9, p><0.001; OR=156).><0.05). Autonomic symptoms and psychoemotional factors showed no significant associations with mobility. Shoulder girdle asymmetry was significantly more frequent in patients with movement restriction (χ²=34.9, p<0.001; OR=156).

Conclusions. Half of patients with migraine and unilateral headache exhibit a distinct cervical mechanical component characterized by rotation restriction associated with neck pain and its provocation. Assessment of rotation and shoulder position may help identify a subgroup that could benefit from physical rehabilitation.

A comparative analysis of the medical and social characteristics of patients with paranoid schizophrenia who voluntarily sought psychiatric care was conducted in outpatient and inpatient settings. The identified nature of the focus and severity of social maladjustment made it possible to decide on the implementation of a specific type of psychosocial intervention in the form of social skills training and to formulate target and timelines for therapeutic and rehabilitative psychosocial interventions. The primary focus of social skills training was on rethinking deficiencies in social perception and interpersonal interactions, emotional self-regulation, and the inability to perform everyday habits, as well as the specifics and possible solutions to emerging problems with verbal and nonverbal socially acceptable behavior. The implementation of social skills training procedures resulted in significant improvements in personal and social functioning in this patient population.