[Diagnosis and treatment of early forms of cognitive impairment: possibilities of influencing neuronal energy metabolism. Resolution of the Council of Experts]. / Diagnostika i lechenie rannikh form kognitivnykh narushenii. Vozmozhnosti vozdeistviya na energeticheskii metabolizm neironov. Rezolyutsiya Soveta ekspertov.

Diagnosis and treatment of early forms of cognitive impairment: possibilities of influencing neuronal energy metabolism. Resolution of the Council of Experts.

[Evaluation of the efficacy and safety of Dolocox in patients with nonspecific back]. / Otsenka effektivnosti i bezopasnosti preparata Dolokoks u patsientov s nespetsificheskoi bol'yu v spine v rutinnoi ambulatornoi praktike.

OBJECTIVE: To assess the dynamics of pain syndrome in patients receiving Dolocox for nonspecific back pain (NBS) in routine outpatient practice, the safety of treatment and satisfaction with its results of the doctor and patient. MATERIAL AND METHODS: The study included 70 patients who received standard therapy for NBS for 14 days. On days 1, 10 and 14, the effects were evaluated using a visual analog pain scale, the Rolland-Maurice scale, FTF test, clinical impression scales and subjective evaluation of the effectiveness of therapy. RESULTS: The results of the study demonstrated comparable indicators of the dynamics of pain syndrome, the level of pain intensity reduction, the tolerability of treatment, as well as a subjective assessment of the effectiveness of therapy on the 10th and 14th day of therapy. There were no serious adverse events during treatment. CONCLUSION: The results obtained allow us to recommend short-term use of Dolocox to reduce the risk of potential side effects and increase adherence to therapy.

[Evaluation of the efficacy and safety of the neuroprotective complex Neurouridin in patients with back pain]. / Otsenka effektivnosti i bezopasnosti neiroprotektivnogo kompleksa «Neirouridin¼ u patsientov s bol'yu v spine.

OBJECTIVE: To study the efficacy and safety of the neurouridin dietary supplement in patients with back pain. MATERIAL AND METHODS: The study included 3179 patients with low back pain. Patients were randomized into the main group and the comparison group who did not receive neurouridin. The Visual Analogue scale (VAS), the Roland-Morris Questionnaire (RMQ) and The Clinical Global Impression (CGI) scale were used. RESULTS AND CONCLUSION: A positive effect of treatment on VAS scores and a greater degree of decrease in the intensity of pain was observed in the main group compared with the comparison group. Signs of improved functional status according to RMQ and CGI are shown.

[The results of a study on the safety of the dietary supplement neurouridine in patients with nonspecific low back pain (MULTINEURO-2)]. / Rezul'taty issledovaniya bezopasnosti biologicheski aktivnoi dobavki Neirouridin u patsientov s nespetsificheskoi bol'yu v spine (issledovanie «MUL''TINEIRO-2¼).

OBJECTIVE: To assess the efficacy and safety of high (300 mg) doses of the biologically active additive neurouridin (Unifarm) as part of complex therapy of patients with nonspecific low-back pain. MATERIAL AND METHODS: Fifty patients (30 in the main group and 20 patients in the control group) were studied using a visual analogue scale (VAS), data from a general clinical analysis of blood and urine, a wide range of biochemical parameters, including liver function tests, glucose levels, creatinine, electrolyte levels. RESULTS AND CONCLUSION: The positive effect of treatment with neurouridin on the dynamics of changes in pain according to the VAS was noted, a dose-dependent effect was revealed: patients at higher doses (300 mg of uridine monophosphate) showed a more significant regression of pain symptoms compared to standard doses. During the study, there were no serious adverse events allergic reactions. No clinically significant deviations of laboratory parameters were recorded.

[The results of an open observational study on multimodal effects of the efficacy and safety of supplement neurouridine in patients with nonspecific low back pain (MULTINEURO-1)]. / Rezul'taty otkrytogo nablyudatel'nogo issledovaniya po otsenke mul'timodal'nykh effektov i bezopasnosti biologicheski aktivnoi dobavki Neirouridin u patsientov s nespetsificheskoi bol'yu v spine (MUL''TINEIRO-1).

OBJECTIVE: The article presents the results of the first observational study in the Russian Federation on the efficacy and safety of high doses of uridine monophosphate (150 mg) in combination with choline (the supplement neurouridine) in the treatment of patients with nonspecific low back pain. MATERIAL AND METHODS: The Visual Analogue scale (VAS), the painDETECT questionnaire (PD-Q), the Roland-Morris Low Back Pain and Disability Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index were used to assess the efficacy of neurouridin in 50 patients with lower back pain. RESULTS AND CONCLUSION: A conclusion was also made about a greater decrease in the intensity of pain in the main group than in the comparison group, a positive effect of treatment on a decrease in the severity of the neuropathic component of pain was not- ed according to the results of PD-Q, revealing signs of improved functional status according to the analysis of the Roland-Morris low back pain and disability questionnaire.

[Adjuvant therapy of pain syndromes: possibilities of using nucleotides]. / Ad''iuvantnaia terapiia bolevykh sindromov: vozmozhnosti ispol'zovaniia nukleotidov.

Despite the variety of treatment options, pain syndromes are widespread in the population. Adjuvant methods, in particular vitamins and vitamin combinations, are widely used, along with nonsteroidal anti-inflammatory drugs, myorelaxants and anticonvulsants, by physicians of different specialties. In recent years, new drugs containing pyrimidine nucleotides (uridine monophosphate) were brought to market. The paper describes analgesic effects of uridine monophosphate and choline, possibilities of their simultaneous use in combination with vitamins to promote the recovery of damaged structured of the peripheral nervous system, including remyelination and neuroplasticity. It has been concluded that nucleotide complexes can be effectively used as adjuvant therapy of pain.

['Point of no return' in diabetic neuropathies: a dangerous delusion]. / 'Tochka nevozvrata' pri diabeticheskikh neiropatiiakh: opasnoe zabluzhdenie.

Polyneuropathy in patients with diabetes mellitus is manifested by a lesion of peripheral sensory, motor and autonomic nervous system. Different severity of damage of sensory, motor and autonomic fibers in typical and atypical forms of diabetic polyneuropathy, requires a differentiated approach to therapy, but not the rejection of its implementation. In an interdisciplinary consensus, consultations are held with physicians from different regions of the Russian Federation, and modern methods of diagnosing and assessing the severity of diabetic polyneuropathies, which determine the algorithm for treating patients, are discussed.

[Questions of the therapy of sleep disorders in hospital practice]. / Voprosy medikamentoznoi korrektsii narushenii sna v usloviiakh statsionara.

The article provides data on the prevalence of insomnia disorders in general medical practice. There is low awareness of both the medical community and the public about sleep disorders. The authors highlight main directions of medical correction of insomnia and present data on the positive and side effects of the main drugs, in particular, on the formation of benzodiazepine addiction in the group with uncontrolled use of these drugs. The problem of non-pharmacological correction of insomnia disorders occurring in patients in hospital conditions is updated. Results of a large-scale study of the efficacy of melaxen in treatment of sleep disorders in patients with chronic cerebral ischemia are presented.

[Multimodality of clinical effects of orexin]. / Mul'timodal'nost' klinicheskikh éffektov oreksina.

The article describes the main biological properties of orexin as a wakefulness hormone and its possible points of application in practical medicine. An example of a drug, which blocks orexin receptors and can be used as a hypnotic drug to treat sleep disorders, is presented.

[Clinical and emotional/behavioral characteristics of acute and chronic low-back pain]. / Klinicheskie i émotsional'no-povedencheskie osobennosti patsientov s ostroi i khronicheskoi poiasnichnoi bol'iu.

AIM: To analyze clinical and emotional/behavioral characteristics of acute and chronic low-back pain that significantly affect quality-of-life. MATERIAL AND METHODS: Fifty-three patients with pain syndromes were examined using the painDETECT questionnaire, the Visual Analog Scale for Pain, The McGill Pain Questionnaire and laboratory and instrumental methods of neurological assessment. RESULTS AND CONCLUSION: A 'picture of the patient with acute and chronic pain' was built, a group of patients with neuropathic component of pain was described. The size of herniated discs was not correlated with VAS assessments and the neuropathic component had a mild effect on pain intensity. The significant correlation was found between the severity of pain and coping strategies for pain. The results indicate the importance of effective and safety pain stopping, in particular at the acute stage, to prevent pain chronification. A drug of choice in case of intensive pain and marked nociceptive component are highly effective and safe nonsteroidal anti-inflammatory drugs, in particular etoricoxib (Arcoxia), a selective COX-2 inhibitor.

[Sleep disturbances - an important factor in combination 'minor' symptoms of multiple sclerosis]. / Narusheniia sna - vazhnyi faktor v kombinatsii 'malykh' simptomov rasseiannogo skleroza.

AIM: To investigate the clinical and neurophysiological features of sleep disorders in patients with different forms of multiple sclerosis (MS) and their impact on life quality, dynamic and prognosis of the disease. Identify the impact of sleep disorders on the formation and maintenance of chronic fatigue syndrome in patients with MS. MATERIAL AND METHODS: General clinical methods of examination like neuropsychological testing (definition of anxiety and depression), the scales of the subjective determination of the quality of sleep, the severity of daytime sleepiness, quality of life, severity of chronic fatigue syndrome) and their subsequent correlation with neuroimaging and neurophysiological data were studied. 54 patients with different forms of MS and 54 healthy volunteers in the control group were selected. RESULTS AND CONCLUSION: Data analysis showed a high level of sleep disorders associated with anxiety disorders, comorbid pathologies, which is significantly higher in the study group.

[Music therapy as an effective method of neurorehabilitation]. / Éffektivnost' muzykoterapii v reabilitatsii bol'nykh s insul'tom.

AIM: To assess the role of music therapy in the recovery of motor, speech and autonomic functions in patients with ischemic stroke (II). MATERIAL AND METHODS: Forty-five patients with II in the middle cerebral artery were examined. The patients were randomized into three groups (main, comparison and control) of 15 individuals each. With patients of the first and the second groups on the 3rd, 5th, 7th and 9th days of the rehabilitation period the special set of exercises with music and without that respectively was fulfilled. The third group received a basic set of physical exercises (a control group).The third group was control. Dynamics of patients' state was estimated by the NIHSS, the Rivermead Mobility Index, the Action Research Arm Test and the modified scale for speech evaluation on the 2nd, 4th, 6th, 8th and 10th day of disease. A study of cardiorespiratory synchronization was conducted since the 6th day of stroke. RESULTS AND CONCLUSION: The statistically significant efficacy of music therapy was shown for all parameters. The authors suggest that neuroplasticity may underlie the mechanisms of the programs used in the study.

[Levodopa-carbidopa intestinal gel in the treatment of patients with Parkinson disease: results of a 12-month open study]. / Levodopa-karbidopa intestinal'nyi gel' v terapii bol'nykh s razvernutymi stadiyami bolezni Parkinsona: rezul'taty 12-mesyachnogo otkrytogo issledovaniya.

AIM: To evaluate the long-term safety and efficacy of intrajejunal levodopa-carbidopa intestinal gel (LCIG) infusion in the treatment of patients with severe stages of Parkinson disease (PD) who did not respond adequately to treatment with oral drugs. MATERIAL AND METHODS: A large-scale international prospective open-label 54-week study of LCIG in patients with PD with severe motor fluctuations was carried out. A total of 48 patients were enrolled in Russia, 46 patients (95.8%) had PEG-J inserted, and 43 of them completed the study. The safety, including adverse events (AEs), infusion system and pump failures analysis, number of patients completely terminated the study, and efficacy (duration of "off" periods, "on" periods with or without troublesome dyskinesias, UPDRS scores, Clinical Global Impression, Quality of Life (PDQ-39, EQ-5D и EQ-VAS) dynamics, an analysis of patient's diaries) were assessed throughout the whole study. RESULTS: The majority of AEs were mild or moderate with most AEs connected with infusion system application (28.3% patients) including procedure pain. Serious AEs were registered in 8 patients (16.7%). 3 patients (6.3%) discontinued their participation in the study due to AEs. Mean duration of "off" periods by the end of the study decreased by 5.35±2.59 hours (p<0.001), duration of "on" periods without troublesome dyskinesia increased by 5.74±3.91 hours (p<0.001), reduction of "on" periods duration with troublesome dyskinesia became statistically significant by week 36 (p=0.020). The statistically significant improvement of UPDRS (generally and in respect to sub-scales), Clinical Global Impression, and Quality of Life scores was observed throughout the study. Levodopa dose remained stable throughout the 54 treatment weeks. Forty-three patients (93.5%) received LCIG monotherapy throughout the whole study. CONCLUSION: LCIG intrajejunal infusion during 54 weeks showed the favorable safety profile, high tolerability, and efficacy in PD motor symptoms correction.

[Epidemiology of sleep disorders in the Republic of Tatarstan]. / Épidemiologiia narushenii sna v respublike Tatarstan.

AIM: To evaluate the variability and severity of sleep disorders in people of the Republic of Tatarstan. MATERIAL AND METHODS: A continuous survey using a questionnaire based on the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale (HADS), sleep apnea risk scale, restless leg syndrome scale was performed. The survey was conducted in a random sample of people (n=1156). RESULTS AND CONCLUSION: A high level of sleep disorders associated with anxiety disorders and comorbid pathologies was shown. Low awareness of patients about methods of tretament sleep disorders and a trend to self-medication (mostly using benzodiazepine drugs) were revealed.

[Anxiety, insomnia, depression--in conjunction with or opposite to functional disorders].

This review presents the data on the prevalence of anxiety disorders, insomnia and depression. General mechanisms of the pathogenesis for these conditions in respect to organism's stress- reactions to the environmental changes are considered. The specific commonality of neurotransmitter reactions, polysomnographic pictures, genetic predisposition is discussed. Specific characteristics of the sleep structure in anxiety disorders, insomnia and depression are noted. A role of comorbidity of anxiety disorders, depression and insomnia and importance of their differentiation, especially in primary care, is emphasized.

[The efficacy of combination therapy with mexidol and cerebrolysin in chronic cerebral ischemia].

OBJECTIVE: To study the impact of combination therapy with mexidol and cerebrolysin on the clinical status of patients with chronic cerebral ischemia (CCI), II stage, in ambulatory conditions. MATERIAL AND METHODS: The study included 36 patients with CCI, II stage. In addition to basic therapy, patients received two courses of the mexidol/cerebrolysin combination during 6 weeks with 3 month-interval between the courses. The dynamics of subjective complaints of the patients and objective clinical signs was assessed after each course. The content of 13 chemical elements in the hair was determined by atomic-emission method after the treatment. RESULTS AND CONCLUSION: Based on the results of clinical and neurological study, the efficacy of combination therapy with mexidol and cerebrolysin as long-term neuroprotection drugs was shown which manifested a significant reduction in the severity of all major symptoms under the influence of the therapy.

[What do the doctors of different specialties know about sleep disorders and their treatment].

OBJECTIVE: To assessdoctor's knowledge on the relevance of the problem of sleep disorders, methods of their diagnosis and treatment. MATERIAL AND METHODS: The survey was conducted among90physicians of different the rapeuticspecialties of Kazan medical institutions. RESULTS: The doctors believe that main causes of sleep disorders are stressors (20%), depression (13%), neurosis (13%), chronic diseases (13%), asthenia (10%), pain (10%). An analysis of treatment prescribed to patients with sleep disorders revealed large differences. CONCLUSION: Physicians are not well informed about the problems of sleep disorders, have a small idea of the methods of sleepresearch and drugs for their treatment as well as of a sequence of operations that should be used to resolve this problem.

[The neuroprotective therapy of outpatient treatment of chronic cerebral ischemia].

AIM: To perform a differential analysis of the efficacy of combination therapy by the drugs with different modalities (mexidol, aescusan, halidorum) in outpatients with chronic cerebral ischemia (CCI), stages I- III. MATERIAL AND METHODS: A study included 50 patients with CCI of atherosclerotic, hypertensive and mixed genesis (stage I - 20 patients, stage II - 20, stage III - 10 patients). In addition to somatic therapy, patients received three courses of mexidol, halidorum and aescusan combination therapy during 6 weeks with a 3 month interval between the courses. The changes in subjective complaints and objective clinical manifestations were evaluated after each course. RESULTS AND CONCLUSION: The therapeutic efficacy after durable complex therapy by repeated courses of antioxidants is supported by the results of clinical and neurological examinations. Mexidol in the combination with aescusan and halidorum contributed to the improvement of cognitive, adaptive, motor functions of the patients with CCI, stages I and II. To increase treatment efficacy in patients with CCI, stage III, we recommend to use the drugs that improve cognitive functions of the patients.

[The multivector nature of relief of acute and chronic pain and necessity of using pain coping strategies].

The paper is devoted to the urgent problem of pain syndromes of multimodal character developed in different pathologies. The diagnosis and treatment of pain is frequently complicated by nociceptive, neuropathic and dysfunctional components. Special attention is drawn to the dysfunctional component and its relation to depression. In this context, the authors consider psychological aspects of pain syndrome formation and methods of treatment using pharmacological medications and pain-coping strategies as well. Different coping strategies of active and passive pain-coping styles depending on sex, personality features, nosologic forms are presented. The necessity of using the active coping-strategies to relieve pain of different genesis is highlighted.