Thе review presents the mechanism of action of a new class of targeted drugs for the treatment of migraine with CGRP gepant receptor antagonists — gepants. Currently, two drugs — ubrogepant and rimegepant are approved by the FDA for the relief of acute migraine attacks in the United States. In the Russian Federation, none of the drugs of this new class is registered, however, this is possible in the near future. The review presents the results of RCTs that demonstrated their effectiveness in comparison with triptans and placebo, as well as good tolerability and safety. Rimegepant and ubrogepant cause minimal side effects and are safe for people with cardiovascular diseases. Gepants may provide an alternative for migraine patients who do not tolerate the side effects observed with triptans, as well as the main therapy.

Atherosclerosis is a chronic disease of elastic and muscle-elastic type arteries, which occurs due to abnormal lipid and protein metabolism and is accompanied by the deposition of cholesterol and certain lipoprotein fractions in the lumen of blood vessels. The article discusses the history of atherosclerosis discovery, various theories of the development of atherosclerosis, main risk factors for the development of the disease. The main groups of biomarkers, their functions and specificity for the diagnosis of atherosclerosis are described, the diagnostic value of such methods as MR angiography, CT angiography and ultrasound is discussed. Different aspects of extra- and intracranial atherosclerosis are outlined. The main possibilities for developing therapeutic strategies to slow the progression and develop targeted therapy are considered, and the portrait of a patient with intracranial atherosclerosis, requiring screening, is described.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most prevalent monogenic cerebral small-vessel disease, but doctor’s knowledge in this sphere is still insufficient. We aimed to introduce the recommendations of the European Academy of Neurology to Russian clinicians because it can help them to discover CADASIL in time and to manage patients with this form of monogenic cerebral small-vessel disease. We present the own case report.

The article is devoted to the clinical polymorphism of mitochondrial diseases by the example of A3243G mutation in mitochondrial DNA. The article also discusses clinical criteria and an algorithm for the diagnosis of mitochondrial diseases.
Material and methods. Тhree families with A3243G mutation in mitochondrial DNA are presented. All patients underwent clinical neurological examination, instrumental examination (ECG, Echo-CG, MRI and CT of the brain, EEG, needle and stimulation electromyography, audiometry), biochemical study of the level of lactic and pyruvic acids in the blood before and after exercise, muscle biopsy.
Results. Аll patients had myopathy, exercise intolerance, sensorineural hearing loss, short stature; other symptoms varied. According to the results of muscle biopsy, the phenomenon of «ragged red fibers» was found in two patients. The diagnosis was confirmed by molecular genetic examination.
Conclusion. Мitochondrial diseases with the same mutation are characterized by significant variability of clinical symptoms. The identification of clinician traits characteristic of a group of mitochondrial diseases should alert the doctors to this pathology.

The leading cause of systemic vascular complications in diabetes mellitus (DM) is partial damage to the vascular wall and hemorheological changes in the lumen of blood vessels against the background of chronic hyperglycemia. Vasoconstriction, edema, ischemia and tissue hypoxia develop as a result of these processes, which, in addition to increasing the risk of cardiovascular diseases, lead to impaired endoneural circulation. The use of a drug with an antihypoxant effect as a pathogenetic therapy in patients with type 2 diabetes mellitus (T2DM) and a subclinical stage of diabetic peripheral neuropathy (DPN1) makes it possible to slow down the progression of micro- and macrovascular complications, along with achieving sustainable compensation for diabetes.
Aim. To assess the effect of a drug with antihypoxic effects (Actovegin®) on the parameters of macro- and microcirculation of the capillary bed, arterial stiffness and endothelial function in patients with T2DM and DPN1.
Material and methods. A comparative study of macro- and microcirculation parameters, arterial stiffness and endothelial function in patients with T2DM and DPN1 before and after treatment with Actovegin® (group “A”, n = 20), and a group of patients with T2DM and DPN1 without Actovegin® treatment (group “B”, n = 20).
Results. An improvement in the parameters of microcirculation was revealed: expansion of the arterial section of the capillaries during treatment with Actovegin®. In patients with reduced endothelial function during treatment with Actovegin®, there is a significant increase in its function, as well as a decrease in perivascular edema. Treatment with Actovegin® does not affect the indicators of central hemodynamics and indicators of arterial stiffness in patients with T2DM and DPN1.
Conclusion. The results of the study clearly demonstrated that the use of a drug with an antihypoxic effect (Actovegin®) in patients with T2DM and DPN1 significantly improves the parameters of microcirculation, and, therefore, can be recommended as pathogenetic therapy at the earliest stages of diabetes development. Integral assessment of microcirculation parameters, as well as a new technology for determining the pulse wave velocity and endothelial function allows to identify patients in need of more intensive monitoring. Conducting this examination before the start of drug therapy can serve as a guideline in assessing the effectiveness of the treatment.

Patients with facial nerve neuropathy (NLN) are often emotionally labile, inadequately assess the severity of symptoms and prognosis of the disease, have low compliance and motivation for treatment and rehabilitation.
The purpose of the study: to develop a screening method for assessing the attitude of a patient with NLN to the disease in order to determine his need for psychological assistance and identify factors affecting compliance and motivation for treatment and rehabilitation.
Material and methods: the study included 80 patients with NLN of various genesis who applied during the first 3 months (group 1, n = 37) and 3 months after the onset of symptoms (group 2, n = 43). All patients underwent a neurological examination, an assessment of the severity of NLN on the House–Brackmann scale and were asked to fill out a questionnaire on screening diagnostics of indicators of emotional well-being.
Results. In Group 1, the severity of the disease was due to weakness of facial muscles and lagophthalmos, in Group 2 — mainly complications in the form of muscle hypertonia (88.4% of patients) and synkinesias on the affected side (89.2%), while strength partially recovered from 6 [3; 6] to 3 [3; 4] points according to According to the House– Brackmann scale, and the frequency of lagophthalmos decreased by 2 times (from 78.4% to 32.6%). The severity of paresis was not correlated with the severity of emotional disorders (p = 0.607) and the presence of lagophthalmos — 3 [2; 6] versus 4 [2; 8] (p = 0.412). The total score of negative questionnaire responses was higher in patients with complications: muscle hypertonicity — 5 [3; 7] versus 3 [1; 5] (p = 0.033) and synkinesia — 6 [3.5; 7.5] versus 3 [2: 6] (p = 0.010). Moreover, the severity of emotional disorders was associated with the number of complications (p = 0.006). Patients believed that the disease made them less attractive (72.5%), others pay too much attention to the face (46.3%) and changed their attitude (18.8%). Since the acute period of NLN, the mood has changed in 65% of patients. Every second patient believed that the disease divided his life into “before” and “after”, every third answered: “this is the worst thing that happened to me in my life.” In three cases, statements of suicidal thoughts were noted. Patients who sought help in the chronic period of NLN are more dysfunctional in terms of emotional state — the total score of negative responses was 6 [3.5; 3] versus 3 [1; 5] (p = 0.001). A third of the patients were convinced that the main responsibility for recovery lies with doctors, so they are at risk of refusing treatment.
Conclusion: in the debut of NLN, every second patient worries about appearance and notes a decrease in mood. Negative thoughts and feelings in patients in the chronic stage of the disease occur in 90% of cases. The developed screening method of psychological assessment of the patient’s attitude to the disease allows to determine the patient’s need for psychological help, to identify indications for consultation with a psychologist or psychiatrist.

Low back pain is a leading cause of disability. Acute and chronic back pain affects 90% of the population.
Objectives — to analyze the risk factors for chronic low back pain.
Material and methods. A prospective study of nonspecific low back pain of 50 patients was carried out in the neurological department of the Emergency Clinic in Ufa. The exclusion criteria were discogenic compression radiculopathy, spinal stenosis, oncological pathology. By gender, men predominated. The average age of the patients was 48.44 ± 15.1 years. All patients underwent clinical neurological, neuropsychological and laboratory-instrumental studies. To study the nature of the pain syndrome, assess the cognitive and emotional spheres, we used diagnostic questionnaires, including the questionnaire of risk and chronicity of pain the Keele STarT Back Screening Tool. Three months after the onset of pain syndrome, all patients were interviewed by telephone in order to identify cases of persistent back pain and analyze its causes, for which a group of patients with chronic pain syndrome was singled out.
Results. 32% of patients had pain syndrome 3 months after inpatient treatment. The following risk factors for chronic pain syndrome were identified: high intensity of pain, its duration, neuropathic component, older age (p = 0.018), depression (p = 0.02), obesity (p = 0.024).
Conclusion. Risk factors for chronic low back pain are diverse, predictors of its development after episodes of acute pain, and should be identified as early as the onset of pain syndrome.

The problem of diagnosis and treatment of the meningovascular form of neurosyphilis in neurology and clinical pharmacology has been actively discussed for over a hundred years. Invasion of pale treponema in the central nervous system occurs in the early stages of the course of syphilitic infection during the period of hematogenic dissemination of the pathogen by perforation of the vascular endothelium. With the discovery of penicillin, which is still the “standard” of syphilis treatment, neurosyphilis has become a fairly rare disease, and therefore difficulties may arise in its diagnosis. The initial phase of infection may be accompanied by an asymptomatic meningeal reaction. The article presents a clinical observation of neurosyphilis manifested by epileptic seizures and extensive ischemic stroke.

Since the description of the first clinical cases of the most common neurodegenerative diseases, numerous hypotheses have been proposed for their development. At the same time, the failure of therapeutic strategies in various directions of clinical research indicates the fallacy of most theories. In this regard, in recent years, various infectious agents are increasingly considered as a trigger of neuronal inflammation and a factor inducing the onset of the neurodegenerative process. Infectious agents differ in their mechanisms of invasion into the central nervous system and can even enter the brain perineurally. Reactivation of latent viral infection induces the production of viral proteins and the accumulation of abnormal proteins that are markers of Alzheimer’s disease and Parkinson’s disease. Both bacterial (chlamydia, causative agents of chronic periodontitis, E. coli) and viral (herpes viruses, noroviruses) infectious agents are considered. However, for the development of neurodegeneration, it is not enough just a simple invasion and reactivation of the infectious process: the genetic characteristics of the main histocompatibility complex also play a huge role. Currently, several studies have been initiated on the possible efficacy of antibacterial and antiviral drugs in Alzheimer’s disease. Data obtained over the past year suggests that the brain may act as a target for SARS-CoV-2. Neurological manifestations of COVID-19 can occur as a result of both the direct cytopathic action of the pathogen and the activation of neuroinflammation, accompanied by a violation of the integrity of the blood-brain barrier. Further study of the molecular and cellular mechanisms of neuroinflammation and neurodegeneration in COVID-19 will form the basis for the development of treatments for neurological complications.