This review emphasizes modern conceptions in the fundamental and clinical aspects of structural epilepsy. Highly informative neuroimaging, electrophysiological and pathomorphological diagnostic methods contribution to the study of this problem is noted. Current understanding of the pathogenesis and clinical picture of the most common types of drug resistant epilepsy are presented: hippocampal sclerosis, focal cortical dysplasia and their surgical correction methods. We considered perspective directions of fundamental clinical and experimental research, focusing on the study of epileptogenesis mechanisms and developing effective methods for prevention and treatment.

Wernicke encephalopathy is a thiamine deficiency condition that has a wide range of somatic causes in addition to alcohol abuse. Most patients do not have the classical clinical triad — oculomotor dysfunction, ataxia and cognitive impairment at the onset of the disease, which makes timely diagnosis difficult. The disease may manifest as dizziness, unsteadiness, double vision, or cognitive impairment. Key clinical manifestations include symmetrical gaze-evoked nystagmus, truncal ataxia, bilateral abducens paresis, internuclear ophthalmoplegia, bilateral vestibular-ocular reflex reduction, and anterograde amnesia. To make a diagnosis, the presence of a condition leading to thiamine deficiency is required. The diagnosis is confirmed by MRI, but even with clinical suspicion of Wernicke encephalopathy, it is necessary to initiate parenteral therapy with thiamine in an adequate dose. With timely treatment, the disease has a good prognosis.

The review summarizes and systematizes data on the prognostic significance of various biomarkers in determining the effectiveness of pathogenetic therapy for spinal muscular atrophy. The review includes a clinical case of a patient with type 3 spinal muscular atrophy. The case illustrates that a decrease in the level of heavy chains of neurofilaments in the cerebrospinal fluid of the patient during the use of pathogenetic therapy with nusinersen positively correlated with an improvement in motor function, assessed by standard functional scales.

Influence on inflammation is currently becoming a priority target for the prevention of recurrent atherothrombotic events, including stroke. In 2022, we planned the KOLCHIDA study, a two-center, prospective, randomized, open-label, controlled clinical trial with endpoint assessment (ClinicalTrials.gov identifier: NCT06102720). The purpose of this study is to conduct a comparative assessment of the clinical effectiveness of dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel and the combination of ASA with colchicine in patients in the acute period of “minor” ischemic atherothrombotic stroke. The purpose of this publication is to present the basic concept of the protocol, its design and the first intermediate results. Material and methods. The intervention consisted of colchicine 0.5 mg/day in addition to ASA versus dual antiplatelet therapy (DAPT) in patients with non-severe ischemic stroke. 31 patients were included in the colchicine and ASA group, and 34 patients were included in the DAPT group. Results. In the comparison group, 7 (20.6%) recurrent non-fatal strokes were recorded, in contrast to the colchicine group, where acute vascular events were recorded in only two patients (6.5%) [RRR 2.2, NNT = 7, χ2 = 2, 9, p = 0.09]. There were no clinically significant bleeding or other adverse events in both groups. Conclusion. Interim results of the study indicate possible confirmation of the hypothesis that anti-inflammatory therapy with low doses of colchicine in combination with standard therapy is not inferior to the combination of ASA and clopidogrel, and perhaps more effectively reduces the number of early neurological deteriorations and recurrent ischemic strokes in patients in the acute period of mild atherothrombotic stroke with equal security profile.

Functional movement disorders (FMD) are frequently encountered in the clinical practice of a neurologist. They are on the border of neurology and psychiatry, but the pathogenesis of the disease is still an open question. One of the causes of FMD development is considered to be interoception disorder.

Objective. The aim of this study was to investigate interoceptive awareness in patients with FMD and its relationship with the severity of motor, affective, and other somatic disorders and quality of life.

Material and methods. The study included 34 patients with FMD and 31 healthy volunteers, in whom interoceptive awareness was assessed using the MAIA-R scale, quality of life (SF-36), concomitant somatic symptoms (PHQ-15), and affective symptoms (HADS). The severity of FMD was assessed using the PMDRS scale. Results. The findings revealed that patients with FMD exhibit less trust in the sensations of their own bodies and tend to focus primarily on discomfort sensations. Patients with FMD also showed greater expression of concomitant somatic symptoms, anxiety, and depression. Quality of life was reduced due to the physical component of health.

Conclusion. Interoceptive awareness is related to patients’ emotional characteristics and is not associated with the severity of motor impairment. The results demonstrate changes in the processing of an interoceptive information.

Vertebrobasilar stroke (VBS) is 20-25% of the ischemic stroke structure, however, the clinical features and long-term outcome of the disease studied poorly in the domestic population.

The aim of the study was to analyze the clinical features of the acute period of VBS and calculate the 5-year risk of cardiovascular events and death.

Material and methods. We analyzed the data of 1569 patients with ischemic stroke. There were analyses of patient complaints, neurological status, brain imaging, NIHSS and POST-NIHSS. The logistic regression model was built for an integral assessment of predictors of five-year mortality.

Results. 386 (25%) patients with VBS were diagnosed and 147 (9,4%) cases of VBS were diagnosed with CT-scan. The top complaints were dizziness, unsteadiness and blurred speech. 72 (48,9%) patients were low neurological deficit, the most common neurological syndromes were ataxia, prosoparesis, hemiparesis, dysarthria and nystagmus. More than 60% of patients had an unspecified stroke subtype, despite the diagnostic search performed. The 19,4% patients were recurrent ischemic stroke and 37,2% patients died. Predictors of mortality were age and the presence of cardiovascular disease. Conclusion. Patients with VBS are characterized by a predominantly nonspecific clinical picture of the disease, in half of the cases a minor neurological deficit, insufficient information content of the initial computed tomography of the brain, a low frequency of intravenous thrombolysis, difficulties in determining the cause of stroke and a high risk of recurrent stroke and death within 5 years.

The effect of atherosclerotic lesions of the carotid arteries (CA) on the success of the cognitive function recovery procedures in cardiac patients has not been sufficiently studied. This study aims to evaluate the effects of cognitive rehabilitation depending on the presence of CA stenosis in patients after coronary artery bypass grafting (CABG) using neurophysiological indicators.

Material and methods. The cohort prospective study involved 85 patients (16 of them women), aged 45 to 75 years, admitted for elective CABG. All patients underwent standard clinical and instrumental, neurological, extended neuropsychological and neurophysiological examination.

Results. After multi-task training, the patients with CA stenosis had higher levels of high-frequency beta power (13-30 Hz), while the spectral power of the alpha1 rhythm (8-10 Hz) in this group was lower compared to patients without stenosis. In the case of successful cognitive rehabilitation (absence of POCD) at 11–12 days after CABG, compared with the group with POCD, patients without stenoses had higher total power of alpha 1 power and lower — beta power than patients with stenoses CA.

Conclusion. The absence of CA stenosis in the patients with successful completion of multi-tasking training contributed to the optimization of brain activity with an increase of alpha power. Whereas the patients with CA stenosis were characterized by an increase in high-frequency brain activity, both in the case of successful multi-tasking training and in its absence, in the early postoperative period of CABG. This study may serve as a basis for the development of special cognitive rehabilitation programs for patients with atherosclerotic lesions of the carotid system.

The aim of the study was to investigate the effectiveness of including cytoflavin in complex outpatient rehabilitation therapy for patients suffering from lumboschialgia and depression .

Material and methods. 86 patients (38 men and 48 women, average age — 53.2 ± 5.9 years) with lumboschialgia and depression were examined. All patients underwent dynamic somatic and neurological status examination (before and after therapy), laboratory and instrumental studies were performed. To assess the neurological profile, the following were used: digital rating scale (DRS) of pain, Oswestry questionnaire (version 2.1a), hospital anxiety and depression scale (HADS), CGI-S scale, DN4 and SF-36 questionnaires. All patients underwent dynamic diagnostics of spinal mobility using the following parameters: Thomayer test (spinal flexion, distance floor – fingers (FF)), distance fingers legs (FL), backward bend while standing and lying on the stomach. In addition to standard treatment, patients in the main group (n = 44) were prescribed cytoflavin: 2 tablets 2 times a day regardless of food intake, 30-day course. The subjects from the control group (n = 42) received only standard treatment.

Results. Inclusion of cytoflavin in the regimens contributed to a more pronounced reduction in pain syndrome compared to the control group: by 5 times according to the Oswestry questionnaire (version 2.1a), by 1.7 times versus 1.3 times according to the DN4 questionnaire, respectively (p < 0.05). The disappearance or significant reduction of pain syndrome contributed to the expansion of motor activity due to the increase in mobility in the spine — a more pronounced positive dynamics in terms of extension: 34.2 % and 22.9% in the main group versus 15.9% and 17.7% in the control group (p < 0.05). The inclusion of the drug contributed to a more significant reduction in neurological symptomatology disorders than in patients in the control group: anxiety indicators (according to the HADS scale) in the control group decreased by 5.3 times, while in the control group they decreased only by 1.75 times (p < 0.05); signs of depression — by 2 and 1.5 times, respectively (p < 0.05). At the same time, the subjects to a greater extent noted a decrease in fatigue, an improvement in night sleep, an increase in activity and performance. The effectiveness of the presented outpatient rehabilitation scheme was confirmed by the positive dynamics of the patients’ quality of life indicators on all SF-36 scales: the most significant increase on the scales of “role functioning due to physical condition” and “pain intensity” — on average by 25.9 points in the control and 26.3 points in the main, respectively (p ≥ 0.05).

Conclusion. The inclusion of cytoflavin in the complex treatment of patients with this pathology helps to reduce the intensity of pain, increase spinal mobility and eliminate the neuropathic component, which improves the quality of life of patients. The results obtained can serve as a basis for further research in this area.

According to current data, the annual absolute number of strokes and deaths from them increased significantly from 1990 to 2019. In 2019, 12.2 million strokes were registered, while the total number of people who suffered a stroke in the world exceeded 100 million, of whom 6.55 million died. Worldwide, stroke remains the second leading cause of death (11.6%) and the third leading cause of death and disability combined (5.7%). Stroke patients are at high risk of developing malnutrition: its incidence upon admission to the hospital is about 20%, and the overall prevalence of this condition varies widely — from 6.1 to 62%. Both the previous and the resulting malnutrition is the reason for a longer stay in the hospital, deterioration of functional parameters and an increase in mortality 3–6 months after the stroke. Thus, adequate nutritional support for stroke patients should be considered as an integral component of their treatment and rehabilitation. This literature review is intended to summarize the foreign and Russian experience of nutritional support in stroke patients in order to develop an optimal algorithm of actions in the implementation of clinical nutrition in stroke patients and the use of the most effective dietary strategies that improve the prognosis, functional state and quality of life of this category of patients.