[Therapeutic approaches to comorbid pathology in episodic migraine and tension-type headache]. / Terapiya komorbidnoi patologii pri epizodicheskoi migreni i golovnoi boli napryazheniya.

OBJECTIVE: To assess the severity of anxiety, depression, insomnia and asthenia in patients with episodic migraine and tension-type headache before and after treatment. MATERIAL AND METHODS: 104 patients aged 18 to 74 years were examined. Patients were divided into two groups: the 1st - 41 patients diagnosed with episodic migraine, the 2nd - 63 patients with episodic tension-type headache. The intensity of headache was assessed using the visual analog scale (VAS). The Hospital Anxiety and Depression Scale (HADS), the Levin questionnaire, and the Multidimensional Fatigue Inventory scale (MFI-20) were used to identify comorbid affective pathology, insomnia, and asthenia, respectively. RESULTS: Headache severity according to VAS in the 1st group was higher (5.8±1.3 points) than in 2nd (3.8±1.2 points). Clinical anxiety was detected in 66.3% of patients without statistically significant differences between groups. The mean HADS anxiety score was 13.9±3.5 in 1st group, 12.7±3.7 - in 2nd. Clinical depression was detected in 45.2% of patients, more often in the 2nd group - 50.8% than in the 1st (36.6%). The mean depression score according to HADS was 9.0±4.4 and 9.7±3.6 in the 1st and 2nd groups respectively. The intensity of headache was statistically significantly higher in patients with clinical anxiety. Both groups were found to have insomnia and asthenia. The majority of patients - 67.3% had myofascial pain syndrome. When re-evaluating the severity of disorders after treatment (using anxiolytics, antidepressants, muscle relaxants, magnesium and neurometabolics), a significant positive trend was noted. Reducing the intensity of headaches to 3.2±0.9 points (according to VAS scale) was in patients with migraine and 1.9±0.8 points in 2nd group. Relief of anxiety and depressive disorders was observed (HADS) in 1st (4.3±3.9) and 2nd (4.5±3.3) groups, the severity of depression (HADS) - 2.1±2.2 in 1st and 2.8±3.2 in 2nd groups, as well as a decrease in asthenia and normalization of sleep. The decrease in the severity of asthenia during treatment was more significant in patients treated with Cytoflavin. CONCLUSION: Identification and treatment of comorbid pathology leads to positive results in the treatment of primary headaches such as episodic migraine and TTH.

[Neurological aspects of systemic lupus erythematosus in individuals with late ontogenetic debut.]

The review presents an analysis of publications on the features of the manifestation of systemic lupus erythematosus in the elderly. The article reflects the probable causes and mechanisms of the development of neurological manifestations of the disease. The clinical picture in elderly patients is described in detail, the features of immunological indicators are noted. This article discusses various variants of lesions of the nervous system in systemic lupus erythematosus, which differ in a wide range of clinical manifestations. Neuropsychic disorders of systemic lupus erythematosus are among the least studied aspects, and can be both a manifestation of the underlying disease, including those coinciding with the processes of immunosuppression, and undesirable phenomena against the background of ongoing treatment. At the same time, knowledge of the features of neurological manifestations in SLE with a debut in late ontogenesis in comparison with the data of laboratory and instrumental examination methods allows for early diagnosis and timely prescribing adequate therapy to elderly patients.

[Prevention of cognitive disorders in elderly and senile patients.]

The aim of the study was to evaluate the effect of vitamin D on the cognitive functions and quality of life in elderly and senile patients with cerebrovascular disease. 100 elderly and senile patients with cerebrovascular disease were examined: 60 people - level 25 (OH)D in blood serum <20 ng/ml (deficiency, pronounced deficiency), in 40 people this indicator was ≥30 ng/ml (within the normal range). Cognitive functions were evaluated according to neuropsychological scales (MMSE, MoCA, FAB, «clock drawing test¼, Schulte tables). To study the quality of life, all patients filled out a general questionnaire SF-36. The body's vitamin D supply was judged by the content of 25 (OH)D in the blood serum. Patients with low vitamin D levels (25 (OH)D <20 ng / ml) were divided into two subgroups: 30 people were prescribed cholecalciferol at a dosage of 8 000 IU/day for three months and 30 people who were not treated with cholecalciferol. The study showed that patients with low levels of vitamin D [25 (OH)D <20 ng/ml] had significantly worse indicators when assessing both cognitive functions and quality of life. The work proved that cognitive functions affect the quality of life. In patients with extremely low levels of vitamin D [25 (OH)D <20 ng/ml], after taking cholecalciferol at a dosage of 8000 IU/day for three months, there was a normalization of the level of 25 (OH)D (the average level of which was 34,10±7,42 ng/ml) in the blood serum and there was a significantly significant positive dynamics in assessing cognitive functions and quality of life.