Мyasthenia gravis is a common disease, for adequate treatment of which early detection, knowledge of its clinical manifestations and possible methods of therapy is required. This review provides up-to-date information regarding the issues of myasthenia gravis. The aim of the paper: to systematize the latest scientific data on the pathogenesis, genetic characteristics, methods of treatment of myasthenia gravis, as well as to identify the relationship between myasthenia gravis and other diseases. The following databases were used to search for published studies: Pubmed, Web of Science, EBSCOhost and Scopus. The search was carried out in the time period from the date of establishment of the corresponding database until October 2022. Following search terms were used: “myasthenia gravis”, “myasthenia treatment”, “myasthenia epidemiological features”, “myasthenia and thymoma “myasthenia pathogenesis””. Тhe main studies on the epidemiology of myasthenia gravis are indicated, the key clinical forms and their pathogenetic characteristics, the relationship between myasthenia gravis and thymoma, and the main methods of treatment are also given.

Introduction. Diagnosis of patients with facial neuropathy (FN) is challenging because different sources of medical information off er a wide variety of approaches.

Aim. Analysis of the features of diagnosing patients with FN by practicing neurologists.

Material and methods. Anonymous online survey of neurologists adhering to the principles of evidence-based medicine (n = 172, work experience — 6 [3; 11] years), including 10 questions.

Results. In 56.4% of cases, doctors diagnose patients with FN in accordance with “foreign” guidelines, however, older specialists still prefer Russian sources, and doctors with little work experience prefer the experience of colleagues (p = 0.018). Scales of assessment of facial muscles function are used by 28.5% of specialists, the description method is used by 95.9%. The content of the clinical protocol varies considerably. A highly significant correlation was observed: the lower the muscle is located on the face, the less often its function is assessed (r = –0.938, p < 0.000). Less than 1/3 of doctors use tests to assess the function of the facial muscles of the lower third of the face. Doctors significantly more often focus on the manifestations of the disease (decrease in the strength and tone of facial muscles, lagophthalmos, hyperacusis) than on the complications of FN (increased muscle tone on the healthy or affected side, synkinesis, post-paralytic hemispasm), p < 0.000. Magnetic resonance imaging is prescribed by more than 70% of specialists, computed tomography — by 25%, stimulation electroneuromyography — by 38,4% (in 1/4 of cases only on the affected side of the face). More than 95% of neurologists refer patients for consultations to doctors of other specialties, mainly to an otorhinolaryngologist (58.7%) and an ophthalmologist (56.9%), and only 23.2% to surgical specialists. About 2/3 of doctors refer patients for rehabilitation, however, there is no clinical protocol for the rehabilitation of this pathology.

Conclusion. The study showed a greater adherence of the interviewed Russian specialists to evidence-based medicine, as well as a high degree of inter-expert variability of opinions, which dictates the necessity of the development of Russian guidelines.

Background. Cerebral toxoplasmosis (CT) is one of the most common cause of focal neurological defi cit in HIV/ AIDS group of patients. Timely diagnosis of CT and antiparasitic therapy contribute to decrease of lethal outcomes and disability.

Aim. To study neurological manifestations, cognitive functions and neuron-specifi c enolase (NSE) concentration in cerebrospinal fluid (CSF), in HIV/AIDS patients with CT.

Material and methods. The 35 patients (10 females and 25 males) from 28 to 50 years old with confirmed diagnosis of HIV/AIDS-associated CT were included in the investigation group. Neurological status, cognitive function and laboratory CSF changings had been studied in prospective investigation before and during the treatment with control points in the 1st and 10th days of the observation.

Results. The method of neurological manifestation of CT evaluation had been developed and implemented in practice. The association between neurological defi cit severity (movement and sensory disorders), cognitive decline and increasing CSF concentration of NSE in HIV/AIDS-associated CT was determined that demonstrates the activity of encephalitic process.

Conclusion. Dynamic evaluation of NSE concentration in CSF with clinical assessment of neurological manifestation in patients with HIV/AIDS-associated CT may be used for confirmation of specific antiparasitic treatment effectiveness and for increasing clinical criteria significance.

Assessment of patients with intracranial aneurysms in the late postoperative period consists of both determining structural changes in computed tomography (CT) and the neurological and cognitive status of the patient. Meantime, the topic of the relationship between structural pathology in CT and cognitive impairment has not been suffi ciently disclosed.

Objective: to determine CT, functional and cognitive outcomes in the long-term period of surgical treatment of cerebral aneurysms.

Material and methods. The data of CT angiography of 49 patients operated on for intracranial aneurysms were analyzed. 39 patients were examined neurologically for 2.3 years using a range of rating scales.

Results. The residual part of the aneurysm after surgery was found in 50% of patients with complex aneurysms, more often in patients with PMA-PSA aneurysms. The connection between the method of surgery and the preserved cervical part with structural changes in the brain and the development of cognitive impairment in the late postoperative period has not been proven.

Conclusion. CT angiography preoperatively makes it possible to identify a group of complex aneurysms with a high risk of preservation of the cervical part and the development of brain structural changes. The predictors of the development of ischemic changes in the brain, hydrocephalus, and cognitive dysfunctions was the advanced age of patients, the duration of the operation, and a history of hypertension.

Objective. To determine specific diagnostic criteria for detecting the type of the right-to-left shunt by contrast-enhanced transcranial Doppler ultrasound (cTCD) in young patients with paradoxical embolism and ischemic stroke/TIA.

Material and methods. The study included 64 ischemic stroke or transient ischemic attack patients (age 28–44 years) with patent foramen ovale (PFO), atrial septal defect (ASD) or pulmonary arteriovenous malformation (PAVM). cTCD was used to assess the degree of shunting, its change during the Valsalva maneuver (VM), time to the fi rst microembolic signal (MES) detection, and the duration of MES registration.

Results. According to cTCD data, 20% of patients with PFO had no shunt at rest, and 80% had a mild to moderate right-to-left shunt. After VM, a severe shunt was detected in 75% of patients in this group and a moderate shunt in 25%. All patients with ASD and PAVM had a marked shunt at rest. The difference in time to first MES detection from the start of contrast administration was not statistically significant for all groups. The duration of MES registration that indicated shunting was shorter in patients with PFO compared to those with ASD (p < 0.001) or with PAVM (p < 0.001) and it was significantly longer in patients with PAVM compared to those with ASD (p < 0.001).

Conclusion. The key diagnostic criteria to defi ne the right-to-left shunt type are the functional shunt degree at rest and the duration of MES registration. Severe shunting at rest can suggest the presence of ASD or PAVM, while the duration of MES registration > 2 min suggests a PAVM.

Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. Disability and institutionalization in oldest old is associated with an increased risk of cognitive impairment. The relationship between cognitive status and other geriatric syndromes has not been studied sufficiently in institutionalized oldest old.

Objective. To assess the relationship between cognitive status and geriatric syndromes in persons ≥ 90 years, who live in long term care facilities (LTCF).

Material and methods. The study involved patients aged ≥ 90 years, who were examined in the LTCF of Moscow. All patients underwent a neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fluency. A comprehensive geriatric assessment was carried out for all the subjects. To diagnose the frailty, we used the Short Physical Performance Battery (SPPB). The Bartel index was used to assess performance of activities of daily living. Instrumental activities of daily living were assessed using the Lawton scale. Nutritional status was assessed based on the Mini-Nutritional Assessment. The pain intensity syndrome was assessed by visual analogue scale. To detect dinopenia we used dynamometry with manual dynamometer. Statistical data analysis was performed using the statistical program SPSS 23.0 (SPSS Inc., USA). Fischer’s two-sided accurate test was used for two groups comparison. The relationships between the variables were evaluated using binary logistic regression with calculation of the odds ratio (OR) and 95% confidence interval (CI).

Results. Dementia was diagnosed in 69% of patients. According to multivariate analysis, sensory defi ciency (OR 4.23; CI 95% 1.96–9.09; p < 0.001), malnutrition (OR 2.68; CI 95% 1.10–6.52; p = 0.030), fecal incontinence (OR 4.37; CI 95% 2.14–8.90; p < 0.001), frailty (OR 4.23; CI 95%; 1.96–9.09; p < 0.001) are associated with the presence of dementia; an increase in age for every 1 year correlates with an increase in the chances of having dementia by 15%. Urinary incontinence and chronic pain syndrome were noted in more than half of oldest old, constipation syndrome and falls syndrome were detected in more than a third of the subjects, and more than 2/3 of oldest old had dinopenia.

Conclusion. The majority of institutionalized oldest old suffer from dementia, while an increase in the chances of having it is associated with frailty, sensory deficiency, malnutrition and an increase in the age of oldest old.

Emotional-affective disorders often accompany vascular cognitive impairment. Currently, there is insufficient data on the impact of non-drug treatment of cognitive impairment on the emotional sphere.

The aim of the study was to evaluate the effect of non-drug methods (meal planning, exercise, cognitive training) on anxiety and depression in patients with mild cognitive impairment of vascular etiology.

Material and methods. The study included 60 patients aged 45 to 88 years (mean age 63.9 ± 9.7, 26 males and 34 females) with mild cognitive impairment of vascular etiology. 30 patients (study group, 18 women, 12 men, mean age 63.7 ± 8.8 years, Montreal Cognitive Assessment (MoCA) score 22.5 ± 2.4) received a set of non-drug methods for 1 month, including cognitive training, detailed recommendations on physical activity and meal planning. Patients in the control group (n = 30, 16 women, 14 men, mean age — 64.2 ± 10.7 years, MoCA score — 21.7 ± 2.4 points) were once informed by the attending physician about the expediency of a physically and cognitively active lifestyle and the basic principles diets, however, systematic training with them was not carried out. Anxiety and depression were assessed at the stage of inclusion in the study, after 1 month, after 6 months, and one year after the start of observation using the Beck Depression Scale, the Spielberger–Khanin Anxiety Scale.

Results. 1 month after the start of the study, along with a significant (p < 0.05) improvement in cognitive functions according MoCA, a significant decrease in the severity of anxiety was noted in the study group (p < 0.05). In patients with mild and moderate depression (n = 13), a significant (p < 0.05) regression in the severity of depression was recorded after a month of using non-drug methods. However, in the process of long-term follow-up (1 year), the differences with the initial visit for these indicators lost statistical significance. In the control group, a month after the start of the study, there were no significant differences in the MoCA test (p > 0.05), while the indicators of anxiety and depression worsened throughout the entire observation period. The study group significantly (p < 0.05) outperformed the control group in the MoCA test immediately after treatment and after 6 months. Differences of anxiety level were significant only immediately after treatment.

Conclusion. A complex of non-drug methods is effective in the treatment of vascular MCI and reduces anxiety in patients. In patients with mild and moderate depression decrease of depression symptoms was observed also. However the effect of the monthly course was not stable.

Lower back pain is an urgent global problem. Often it is combined with metabolic disorders, which leads to mutual aggravation of both pathological conditions. The aim of the study was a comparative assessment of the complex therapy of patients with exacerbation of chronic vertebrogenic dorsalgia using various methods.

Materials and methods. We examined 60 patients with concomitant metabolic disorders in the form of obesity.

Results. The effectiveness of the use of non-drug methods, namely therapeutic exercises with elements of yoga practice and reflexology in the complex therapy of patients with chronic pain in the lower back in combination with metabolic disorders, has been proven.

Conclusion. The use of these methods allows to achieve a positive effect, which manifests itself in reducing the intensity of the pain syndrome and improving the functionality of patients, as well as correction of concomitant metabolic disorders.

Progressive supranuclear palsy is a sporadic neurodegenerative disease manifested by oculomotor disorders, akinetic- rigid syndrome, early development of postural instability, gradual development of frontal dementia, and pseudobulbar syndrome. Diagnosis of PNP is determined by the specifi c topical distribution of the degenerative lesion in the brain. This article describes a clinical case of a 67-year-old patient with PNP, a feature of which is the complexity of diff erential diagnosis, given the presence of a variety of comorbidities.

Neurological examination plays the main role in diagnostic and management of radiculopathies. In addition, the instrumental methods could be used for diagnosis of the morphological and functional state of paraspinal muscles. Paraspinal muscles are symmetrical back muscles surrounding the spinal column and supporting it. Magnetic resonance imaging (MRI) as well as needle electromyography (EMG) and ultrasound are used for instrumental diagnosis of paraspinal muscles conditions. We provide the review on the current scope of studies on radiculopathies and non-specific back pain. MRI is the principle standard for radiculopathy diagnosis, but other methods such as muscle ultrasound and needle electromyography are also used here. MRI is characterized by a high cost, and it is impossible to carry it out if there are magnetic objects present in the patient’s body. EMG and ultrasound both are not sufficient enough to study the level of the fatty replacement of the paraspinal muscle, while this parameter is quite significant for measuring a radiculopathy outcome. Thus, we consider it rational to recommend using these methods in combination. Indications for the combined examination may be such complex cases as anatomical anomalies of spinal roots, atypical disease pattern.