Neurological Practice in the Time of War: Perspectives and Experiences from Ukraine.

The full-scale Russian invasion of Ukraine has significantly impacted the country's healthcare system. Insufficient infrastructure, destruction of medical facilities, and barriers to prevention and treatment efforts hinder the provision of timely, high-quality care to our patients. We aim to describe the impact of the war on neurological care across Ukraine. In this article, leading national experts in stroke, epilepsy, multiple sclerosis, and movement disorders describe their personal experience and efforts in organizing and providing care since the war started in February 2022. A neurologist who cared for patients in Mariupol recounts the first weeks of the war when the city was under constant attacks. An international stroke expert describes the role of Task Force for Ukraine, a European Stroke Organization initiative to support the Ukrainian stroke community. We discuss a series of critical challenges facing Ukraine's neurologists, patients, and healthcare delivery system, including shortages of personnel and medical supplies, disrupted logistics, and lack of funding. In addition, we highlight various interventions and strategies aimed at counteracting these challenges, including international support, collaborations within Ukraine, and initiatives enhancing the resilience of the Ukrainian neurology community. As the war is ongoing, this article emphasizes the pressing need for continuous support and investment in the Ukrainian healthcare system to preserve guaranteed access to high-quality healthcare for the Ukrainian people during the war and in its aftermath. Insights from the essays can inform the development and implementation of effective strategies and interventions tailored to such extraordinary circumstances.

CO-OCCURRING NECK-PAIN WITH MYOFASCIAL DYSFUNCTION IN PATIENTS WITH EPISODIC MIGRAINE.

OBJECTIVE: The aim: To determine the influence of co-occurring neck pain with cervical myofascial dysfunction on the development of psychoemotional disorders and the number of analgesics taken in patients with episodic migraine. PATIENTS AND METHODS: Materials and methods: The study included 92 patients, 24 male and 68 female, mean age 42.5±15.5 years. Three groups were identify based on type headache: 1) both episodic migraine and cervicogenic headache with neck pain; 2) episodic migraine only; 3) neck pain only. Visual analogue scale (VAS) for pain syndrome, Migraine Disability Assessment (MIDAS) score, Headache Impact Test (HIT-6), Neck Disability Index, State-Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI) and numbers days with analgesics intake were assessment. RESULTS: Results: In patients, who suffered on episodic migraine combine with cervicogenic headache and neck pain number days with headache was more (p=0.000052), intensity attack was higher (p=0.003750) and number days with analgesics intake was greater (p=0.000003), compare with group with migraine only. The depression and anxiety state was more significant in patients with migraine and co-occurring neck pain comparable with migraine alone, but we found no significance differences between groups with migraine with neck pain and neck pain only. We observed significant correlation between STAI and Neck Disability Index (r=-0.5155), Neck Disability Index and HIT-6 (r=-0.4819). No correlation found between VAS for migraine, MIDAS and STAI and BDI. CONCLUSION: Conclusions: Our study demonstrate, that co-occurring neck pain in patients with episodic migraine increasing of numbers days with headache, negatively impacts on mood disorders, daily activity and associated with greater acute analgesics use.

LEVELS OF PROINFLAMMATORY CYTOKINES IL-17 AND IL-23 IN PATIENTS WITH ALZHEIMER'S DISEASE, MILD COGNITIVE IMPAIRMENT AND VASCULAR DEMENTIA.

OBJECTIVE: The aim: To research differences of interleukin (IL)-17 and IL-23 serum levels in patients with Alzheimer's disease, vascular dementia and mild cognitive impairment. PATIENTS AND METHODS: Material and methods: Serum levels of IL-17 and IL-23 were measure by ELISA for 15 patients with Alzheimer's disease, 14 with vascular dementia, 30 with mild cognitive impairment and 30 control individuals without cognitive impairment. RESULTS: Results: Serum concentrations of IL-17 were significantly higher in Alzheimer's disease patients (P=0.0023) than control, in vascular dementia no significant differences(P=0.4154). Level of IL-23 was significantly higher than control in Alzheimer's disease patients (P=0.0170) and vascular dementia (P=0.0002), but in Alzheimer's disease it was in 12.5 time higher. In total mild cognitive impairment patients no significant differences in interleukin concentration with control, but significant differences observed for amnestic form in IL-17 (P=0.0436) and IL-23 (P=0.0019). CONCLUSION: Conclusions: IL-17 and IL-23 level significant higher in Alzheimer's disease patients compared with control and vascular dementia. From mild cognitive impairment levels of detectable interleukins was higher in amnestic form that may be early marker of progression in Alzheimer's disease.