Generalized myasthenia gravis is a chronic autoimmune disorder characterized by an attack on the structures of the neuromuscular junction and by fluctuating muscle weakness and pathological fatigue, involving the ocular, bulbar, respiratory and skeletal muscles. Modern treatment of generalized myasthenia gravis aims to achieve sustained control of the disease, reduce the risk of exacerbations and myasthenic crises, and maintain the patient's quality of life. Some patients continue to experience a significant burden of disease, reduced daily activity, a need for longterm immunosuppressive therapy, and a risk of developing adverse events. A personalized approach to the treatment of generalized myasthenia gravis should take into account serological status, disease activity, the frequency of exacerbations, comorbidities, tolerance to treatment, the possibility of reducing the dose of glucocorticoids, and the patient's preferences.
The high cost of managing stroke patients is due not only to the care provided during the most acute and acute phases, but also to the subsequent costs associated with rehabilitation and potential disability. Achieving a favourable functional outcome is one of the key factors in reducing the economic burden of stroke on the healthcare system. Objective: to assess the clinical and economic advisability of incorporating ethylmethylhydroxypyridine succinate (Mexidol) or Cerebrolysin into the treatment of ischaemic stroke (IS) during the acute and early recovery phases, compared with standard treatment. Material and methods. Randomized, placebo-controlled trials of Mexidol and Cerebrolysin were included in the model. Efficacy measures for the pharmacoeconomic calculations were derived by conditionally pooling the trial results within the adopted model. Pharmacoeconomic methods such as cost-effectiveness analysis (cost-effectiveness analysis, CEA) with the calculation CER=DC/Ef, budget impact analysis (BIA), a single-factor sensitivity analysis (a 15% increase in the price of Mexidol), and the calculation of the incremental cost-effectiveness ratio (ICER). The cost of drug therapy was determined using the register of maximum retail prices for essential and vital medicines, whilst the costs of treatment/rehabilitation and the consequences of disability were based on Russian data on the socio-economic burden of stroke. Results. The modelling results show that incorporating Mexidol into IS therapy would result in savings of 19.96 per cent of the budget over one year and 27.63 per cent over four years, respectively. According to the cost-effectiveness analysis, the CER for Mexidol was 80,647,447 roubles for a 10-day course and 81,922,447 roubles for a full course. These figures are lower than those for standard therapy (121,608,837 roubles) and lower than those in the one-year model for Cerebrolysin (122,317,082 roubles for the main course and 128,917,082 roubles for the supplementary course). Conclusion. Under the adopted model, the inclusion of Mexidol in standard IS treatment is associated with a reduction in direct costs and a more favourable cost-effectiveness ratio compared with the addition of Cerebrolysin to standard treatment.
An acute demyelinating episode (ADE) is the acute onset of clinical symptoms characteristic of multiple sclerosis (MS) or other demyelinating diseases (DD). Patients with ADE may experience either a monophasic course of the disease, relapses, or transformation to MS (up to 33 per cent). To date, there are no criteria for predicting the transformation of ADE to MS in adults; therefore, identifying prognostic factors for the development of MS in such patients is of significant diagnostic importance. Objective: to identify the clinical and immunological markers of the transformation of ADE into a chronic demyelinating process (MS). Material and methods. The study was conducted from 2023 to 2026. The main group comprised 29 patients: 22 diagnosed with acute disseminated encephalomyelitis (ADEM) and 7 with acute transverse myelitis (ATM); the control group comprised 29 individuals. All patients were followed up for 24 months. The laboratory component of the study, which involved measuring the levels of interleukin-1b (IL-1b), IL-2, IL-6, tumour necrosis factor-a, glial fibrillary acidic protein and C-reactive protein in the patients’ serum, was carried out in the neuroimmunology laboratory of the Institute of Clinical Neurology at the Federal Center for Brain and Neurotechnologies. Results. During the follow-up period, 8 out of 29 patients were diagnosed with MS following ADE according to the 2017 McDonald criteria. The overall rate of transformation from ADE to MS was 28 per cent. Patients in whom ADE progressed to MS were more likely to have the following characteristics: no recent infection (p=0.002), sensory disturbances at disease onset (p=0.021), type 2 oligoclonal bands (OCB) pattern (p<0.001) and lesions in the brainstem on magnetic resonance imaging (p=0.024). Serum IL-6 concentrations in patients with ADE transforming to MS were higher than in patients without transformation to MS during the acute phase and at 3–6 months; however, the differences were not statistically significant (p 1 =0.366; p 2 =0.471). As a result of the multivariate logistic regression analysis, the best combination of predictors for the transformation of ADE to MS included: 1) absence of a pre-existing infection (OR 14.31; 95% CI 1.04–196.3; p=0.046), 2) OCB synthesis type 2 (OR 0.05; 95% CI 0.003–0.832; p=0.037). Conclusion. The results of this study show that certain clinical characteristics (absence of a preceding infection, specific abnormalities at disease onset), laboratory parameters (type 2 OCB synthesis) and neuroimaging findings (foci of demyelination in the brainstem) may help to distinguish patients with a monophasic course of ADE at the early stage of the disease from those who will go on to develop MS.
Neuromyelitis optica spectrum disorders (NMOSD) constitute a group of rare, autoimmune and often disabling diseases of the central nervous system. Despite clear diagnostic criteria for NMOSD, diagnostic errors remain a serious problem, leading to delays in necessary treatment and adverse outcomes. This article presents four clinical cases of NMOSD that illustrate the difficulties in making a timely diagnosis due to an ambiguous clinical, radiological and laboratory picture. In these cases, clinical manifestations typical of NMOSD (optic neuritis, acute myelitis and area postrema syndrome) are described; however, the patients were initially referred to specialists in other fields: ophthalmologists, gastroenterologists and neurosurgeons, which led to a delay in their referral to the Multiple Sclerosis Centre and a late diagnosis. The delayed initiation of pathogenetic therapy in two patients led to the development of persistent severe disability as a consequence of NMOSD exacerbations. Factors contributing to the prolonged time to diagnosis were analyzed, and strategies to improve the early diagnosis of NMOSD to prevent such outcomes were proposed.
Objective: to assess the impact of cyclobenzaprine therapy in real-world clinical practice on the severity of pain, functional capacity and the time taken to return to work in patients with non-specific back and neck pain, as well as to evaluate the drug's safety profile. Material and methods. The multicentre study included 997 patients (full analysis set, FAS) aged 18 years or older, of whom 976 completed the study according to protocol – per-protocol (PP) population. Patients received Reloprim (cyclobenzaprine) at a dose of 5, 7.5 or 10 mg three times daily for up to 14 days. The primary endpoint was the change in functional limitations as assessed by the Roland–Morris Disability Questionnaire (RMDQ). Results. The baseline RMDQ score was 12.52±5.57. By day 5, it had decreased significantly to 7.18±4.53, and by the end of the study to 1.89±2.42 (p<0.001). Pain intensity (baseline 6.79±1.46 points) decreased by 2.98±1.3 points by day 5 and by 5.85±1.72 points by the end of the observation period (p<0.001). The number of patients temporarily unable to work was reduced by almost half (from 10.75 to 5.94). The need for additional doses of non-steroidal anti-inflammatory drugs (NSAIDs) was reduced by more than half. Conclusion. The use of cyclobenzaprine as part of a comprehensive treatment regimen for non-specific back and neck pain in real-world clinical practice is associated with a statistically significant reduction in the severity of pain and functional limitations as early as the first few days of treatment, with the effect continuing to improve by the end of the observation period.
Patients presenting with acute vertigo are often admitted to hospital with a provisional diagnosis of a stroke in the vertebrobasilar system (VBS). The causes of such cases of acute vertigo, as well as the diagnostic value of various otoneurological examination methods (according to the STANDING and HINTS+ algorithms), have been little studied in Russian neurological practice. Objective: to examine and optimize standard practice in the management of patients with acute vertigo in the emergency neurology department. Material and methods. A total of 37 patients with acute vertigo, who were admitted to hospital on an emergency basis with a provisional diagnosis of acute cerebrovascular accident were examined. Clinical otoneurological examinations were carried out using the STANDING and HINTS+ algorithms, along with neuroimaging (DWI MRI), and the dynamics of acute vertigo severity were assessed against a background of comprehensive therapy comprising a fixed combination of 20 mg cinnarizine and 40 mg dimenhydrinate. Results. A stroke was confirmed in 6 (16.2%) patients at the VBS, benign paroxysmal positional vertigo (BPPV) in 19 (51.4%), vestibular neuronitis in 4 (10.8%), vestibular migraine in 5 (13.5%), and Meniere's disease in 3 (8.1%). The factors showing the greatest significance for the diagnosis of VBS stroke were skew deviation, gaze-induced nystagmus and marked cerebellar ataxia (p<0.001), whilst a positive unilateral head-turning impulse test, spontaneous horizontal-rotatory nystagmus, mild and moderate vestibular ataxia, positive positional tests, and unilateral hearing loss were statistically significantly more prevalent in patients with other vestibular disorders (p<0.001). Patients with stroke were significantly older and had higher systolic blood pressure. A significant reduction in the severity of acute vertigo was observed in all patient groups following comprehensive treatment, comprising a fixed-dose combination of 20 mg cinnarizine and 40 mg dimenhydrinate, as assessed at a follow-up examination 7 days later (p<0.001). Conclusion. A stroke in the vestibular system has been identified as the cause of acute vestibular vertigo in a small proportion of patients. BPPV has been identified as the most common cause (more than half of all cases). The tests used in the STANDING and HINTS algorithms have been shown to have varying levels of diagnostic value.
Objective: to assess gender-related differences in age at onset, clinical characteristics, relapse frequency, and disability level in patients with relapsing remitting multiple sclerosis. Material and methods. A retrospective cohort study was conducted using medical records of patients diagnosed with multiple sclerosis and treated at the National Hospital of the Ministry of Health of the Kyrgyz Republic between January 2021 and December 2024. A total of 72 patients with RRMS were included. Clinical parameters analyzed included age at disease onset, neurological manifestations, annual relapse rate, disability status assessed using the Expanded Disability Status Scale (EDSS), and selected risk factors. Statistical analysis was performed using descriptive and comparative methods, with statistical significance defined as p<0.05. Results. The cohort included 16 men (22.2%) and 56 women (77.8%). The mean age at disease onset was higher in men than in women (33.3 vs 28.4 years; p=0.200). Mean EDSS scores were 3.06 in men and 2.87 in women (p=0.610). The annual relapse rate was significantly higher in women compared with men (1.32 vs 0.97; p=0.019). Women more frequently presented with sensory and visual symptoms, whereas men more often exhibited motor and cerebellar manifestations. No statistically significant gender differences were identified for the analyzed risk factors. Conclusion. Gender-related differences were observed in relapse frequency and clinical presentation among patients with RRMS. Other evaluated parameters did not show statistically significant differences. Larger studies are required to confirm these findings.
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) have a complex aetiology resulting from the interaction of genetic predisposition and environmental factors. Analysis of single nucleotide polymorphisms (SNPs) in genes associated with the immune response and neurodegenerative diseases plays a key role in elucidating the mechanisms underlying the development of these conditions, identifying population-level predispositions and discovering new targets for therapeutic intervention. Objective: to determine the frequency of SNPs in genes involved in immune responses and neurodegenerative processes among patients with MS and NMOSD, using the Yaroslavl Region as a case study. Material and methods. This cross-sectional, single-centre observational study included 10 patients with NMOSD (AQP4-IgG+), 63 patients with MS and 47 clinically healthy volunteers, who formed the control group. Genotypes for nine SNPs (IL6, IL6ST, CNTF, SOD2, SIRT1, TP53, PER2, MMP9) were determined using the FastPCR method. Statistical analysis of the data included descriptive statistics, as well as the c2 test and calculation of the odds ratio (OR) with a 95% confidence interval. Results. Significant associations (p<0.05) were identified between carriage of certain alleles/genotypes and the presence of MS and/or NMOSD in the study population. The homozygous G/G genotype of the IL6 C174G polymorphism (rs1800795) was associated with an increased risk of disease (OR=4.00). An association was demonstrated between the minor allele A of the CNTF gene (rs1800169) and NMOSD. Carriage of the alternative allele T of the SOD2 C47T gene (rs4880) was less common in patient groups (OR=0.24). A strong association was identified between the minor allele G of the SIRT1 C(-1411)G gene (rs7069102) and the risk of both diseases (OR=16.45). Heterozygous A/G status of the PER2 A1984G (rs6343159) gene and the homozygous G/G genotype of the MMP9 A249G (rs17576) gene were also significantly more common in MS and NMOSD. Conclusion. The findings confirm the significant role of polymorphisms in the IL6, SIRT1 and MMP9 genes as potential genetic markers of an increased risk of developing MS and NMOSD in the studied population. The findings regarding the associations between SNPs in the SOD2, CNTF and PER2 genes and these diseases are new for this population and require further investigation in a larger sample, particularly for the NMOSD group.
Myasthenia gravis (MG) is a chronic autoimmune disorder of the neuromuscular junction, the clinical burden of which is not limited to fluctuating muscle weakness. Data on the prevalence of sleep disorders in patients with MG vary considerably, which is due to the heterogeneity of clinical approaches and the limited use of objective methods for assessing sleep. At the same time, a number of studies point to specific patterns of sleep disorders in this patient group. For example, in one study, obstructive sleep apnea was detected in 36% of patients with MG, compared with the expected 15–20% in the general population. Restless legs syndrome was also detected more than twice as frequently: in 43.2% of patients with MG and in 20% of the control group. According to a recent systematic review, the prevalence of excessive daytime sleepiness reached 75% in some studies. The impact of treatment deserves special attention: among patients with generalized myasthenia gravis who had been receiving oral glucocorticoids (GCs) for at least one year, insomnia was observed in 23.1%. The development of sleep disorders in MG is likely to be multifactorial. Sleep-related breathing disorders may be associated with weakness of the respiratory muscles and an increased risk of nocturnal hypoventilation and episodes of desaturation, particularly during the rapid eye movement (REM) phase. Difficulties in falling asleep and maintaining sleep may arise against a background of fatigue, anxiety and depressive disorders, and treatment, primarily with GCs. The role of immuno-inflammatory mechanisms is of interest but requires further investigation. The aim of this review is to summarize current evidence on the clinical manifestations, possible mechanisms, diagnosis and management of sleep disorders in myasthenia gravis. Particular attention is paid to insomnia, sleep-related breathing disorders, restless legs syndrome, the impact of treatment and the need for active screening for sleep disorders in clinical practice.
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, the pathogenesis of which is underpinned by a combination of autoinflammatory and neurodegenerative processes. Divozilimab (DIV) is the first monoclonal antibody from the anti-CD20 therapy group to be developed and authorised in the Russian Federation for the treatment of relapsing-remitting multiple sclerosis (RRMS) and secondary-progressive multiple sclerosis (SPMS) with relapses in patients aged 18 years and over. The relatively recent introduction of DIV into clinical practice means that there is a limited amount of published data from real-world clinical practice. Objective: to investigate the efficacy and safety of DIV in real-world clinical practice at a single medical centre. Material and methods. Forty patients with MS (13 with SPMS) living in the Novosibirsk Region received two doses of DIV (data as at 30 May 2026). Patient data were analysed: clinical [gender, age, clinical manifestations at onset and during relapses, score on the Expanded Disability Status Scale (EDSS), use of disease-modifying therapies, comorbidities, infection status], radiological data (new lesions, enlarged lesions, lesions with contrast enhancement) and laboratory data (complete blood count, urinalysis, blood biochemistry). Efficacy parameters were assessed [mean annual relapse rate (MARR), EDSS score, proportion of patients with confirmed disability progression over 6 months (CDP-6), and radiological activity] as well as safety parameters (number of adverse events, including infectious and oncological events). Results. During DIV therapy, there was a reduction in MARR – from 1.0±0.85 to zero – and in the proportion of patients with radiological activity – from 60% to zero (p<0.05). However, no changes were observed in EDSS scores or in the incidence of CDP-6 (p>0.05). No increase in the number of infectious or oncological events was observed during DIV therapy (p > 0.05). Conclusion. DIV therapy, administered at the Regional Centre for Multiple Sclerosis and Other Autoimmune Diseases of the Nervous System at Novosibirsk State Regional Clinical Hospital, has confirmed the high efficacy and safety demonstrated in clinical trials.
Objective: to investigate the volume of the choroid plexuses (ChP) in individuals with radiologically isolated syndrome (RIS) and its impact on conversion to multiple sclerosis (MS), and to assess the level of neuroinflammation in individuals with RIS. Material and methods. A prospective observational study was conducted at the Federal Centre for Brain and Neurotechnologies, in which data from two groups of participants were analysed: individuals with RIS (n=32) and healthy volunteers (control group; n=30). The diagnosis of RIS was established in accordance with the 2017 McDonald criteria. All examinations were performed on a single MRI scanner with a magnetic field strength of 1.5 T. MRI morphometry of the cerebellum was performed on T1-weighted images using manual segmentation in the 3D Slicer software. Intracranial volume was determined using the automated web-based volBrain system. Statistical analysis was performed for both the absolute value of the ChP volume and the value normalized to intracranial volume. Results. No statistically significant differences in age or sex were found between the RIS and control groups (p=0.21 and p=0.20, respectively). No differences in age or sex were observed either among individuals with RIS who subsequently converted and those who did not (p=0.67 and p=0.44, respectively). However, in patients with subsequent conversion, the ChP volume was already higher at baseline. The normalized ChP volume was higher in patients with conversion compared with those without conversion (1.435 [1.188; 1.715] mm3 versus 1.003 [0.918; 1.325] mm3; p=0.015), and the absolute ChP volume was also higher in the conversion group (1,878 [1,724; 2,333] versus 1,368 [1,163; 1,770]; p=0.024). According to the results of logistic regression, the normalized ChP volume was a significant predictor of conversion to MS (odds ratio 18.5; 95% CI 1.67–369.6), and the model’s diagnostic performance was satisfactory (AUC=0.78; 95% CI 0.62–0.94; p=0.016). Conclusion. An increase in ChP volume, as measured by MRI morphometry, may be regarded as a non-invasive marker of neuroinflammation in the central nervous system and a potential predictor of disease progression, detectable in the early stages of the pathological process using standard MRI sequences.
Autoimmune diseases (ADs) are a broad group of phenotypically heterogeneous conditions characterized by both unique and common clinical and immunological manifestations, with varying rates of progression and responses to pathogenetic therapy. More than 10 per cent of the global population suffers from at least one of ADs, and in recent decades there has been a worldwide trend towards an increase in the number of cooccurring autoimmune conditions, particularly in regions and countries with a high level of socio-demographic development. Given their shared risk factors and immunopathological mechanisms, demyelinating diseases of the central nervous system are associated with an increased likelihood of developing a concomitant ADs, which may unpredictably influence the course of the demyelinating process and the choice of optimal treatment. This review examines the co-occurrence of multiple sclerosis and neuromyelitis optica spectrum disorders (NMOSD) with anti-aquaporin-4 antibodies (AQP4) with the most common associated ADs, and summarises the evidence regarding the preferred therapeutic approaches in each specific case.
Objective: to evaluate the efficacy and tolerability of perampanel suspension (Fycompa®) in real-world clinical practice among children and adolescents with epilepsy in a cohort of Russian patients.Material and methods. A retrospective multicenter analysis was conducted of depersonalized data from 80 patients from 27 centres (40 boys, 40 girls) aged between 4–18 years (mean age 8.2 years) with various forms of epilepsy who received perampanel suspension (PER) as adjunctive therapy. Inclusion criteria were a verified diagnosis of epilepsy consistent with the drug's approved indications, and the availability of data on seizure frequency prior to treatment and after 1–3 months of therapy. To assess efficacy after 3–6 months, data were used from patients who continued treatment and had corresponding records. Statistical analysis was performed using descriptive statistical methods. The primary outcome measures were changes in seizure frequency after 1–3 and 3–6 months of therapy, the proportion of responders, the rate of remission, and adverse events (AEs).Results. After 1–3 months of treatment, the highest efficacy was observed in isolated bilateral tonic-clonic seizures (BTCS; remission – 78.5%, overall response rate – 89.2%) and generalised tonic-clonic seizures (GTCS; remission – 71.4%, overall response rate – 100%). For focal seizures (FS) without progression to BTCS, remission was 38%, and the overall response rate was 71%. In FS progressing to BTCS, remission was recorded in 37.5% of patients, with an overall response rate of 62.5%. In patients with a combination of these seizure types and other types of seizures, a reduction in the frequency of concomitant seizures was also observed. At the 3–6-month stage, an additional response (remission or a ≥50% reduction in seizure frequency) was observed in only a small proportion of patients (for example, additional remission in FS without BTCS was observed in 10.3% of patients). The drug demonstrated reasonably good tolerability: AEs were reported in 16.3% of patients after 1–3 months, and the need for discontinuation was 2.5%.Conclusion. The PER suspension is well tolerated and effective in children aged 4 years and older with FS, with or without progression to BTCS, and in children aged 7 years and older with GTCS, including patients weighing less than 30 kg. The liquid formulation allows for precise dose titration and is convenient to administer, particularly in patients with dysphagia.
The question of whether intravenous thrombolytic therapy (ITT) is appropriate for patients with a minor stroke (NIHSS score < 5) remains a matter of debate. Fortelysin is a thrombolytic agent used to treat ischemic stroke. Objective: to assess the safety and efficacy of Fortelyzin in patients who have suffered a minor stroke in real-world clinical practice, based on data from a subanalysis of the FORPI registry. Material and methods. The FORPI registry is an open-label, prospective, non-interventional, observational study of Fortelyzin in patients with acute ischemic stroke. We analyzed the safety and efficacy of Fortelyzin in a group of patients with minor stroke characterized by an NIHSS < 5. Safety outcomes were the number of symptomatic intracranial hemorrhage (sICH) according to ECASS III and SITS-MOST definitions, as well as all-cause mortality at day 90. The efficacy outcome was a functional independence, defined by modified Rankin scale (mRS) score of 0–2 points at day 90. Results. The analysis included 836 patients with an NIHSS < 5 points. The median age was 64 [56; 72] years, and the median NIHSS score at admission was 4 [3; 4] points. SICH according to ECASS III definition was observed in three patients of 836 (0.4 %), and according to SITS-MOST definition, in four patients of 836 (0.5 %). All-cause mortality at day 90 was 2.2 % (18/836). The proportion of patients with functional independence (mSR of 0–2 points) at day 90 reached in 88 % (737/836) of patients. Conclusion. The FORPI registry provides compelling evidence that early intensive rehabilitation using Fortelyzin is characterised by a high level of safety and efficacy in patients who have suffered a minor stroke.
Primary progressive multiple sclerosis (PPMS) is the most severe phenotype of the disease, characterised by a steady progression of neurological deficit from the time of onset. This review presents a comprehensive analysis of the epidemiological, clinical, neuroimaging and socio-economic aspects of PPMS. It is shown that PPMS is associated with accelerated progression to disability thresholds (≥ 6.0 points on the Expanded Disability Status Scale – EDSS, on average within 5–9 years), early loss of working capacity and the creation of a significant burden for patients and their families, which is exacerbated by the need for long-term care. Key pathogenetic differences between PPMS and relapsing-remitting MS (RRMS), as well as current therapeutic strategies, are discussed. The need for early diagnosis, timely initiation of pathogenetic therapy and the development of a multidisciplinary care system to improve patient prognosis and quality of life is emphasised.
Somatic and neurological hereditary disorders, which arise as a result of various genetic mutations and usually manifest from childhood, are often accompanied by various mental health disorders. These may include mental disorders of exogenous-organic origin, personality disorders that are exacerbated or develop against a background of prolonged, severe, disabling illness with reactions of decompensation and maladjustment; endogenous disorders may also occur comorbidity. Mental disorders in themselves complicate the clinical picture, reduce quality of life and exacerbate social maladjustment. Furthermore, mental disorders, particularly those of an anxiety-depressive nature, can aggravate somatic pathology via a psychosomatic mechanism, a factor that must be taken into account when providing care for such patients. To illustrate the above, we present a clinical case of a patient with Ehlers–Danlos syndrome (a hereditary connective tissue dysplasia), which manifests, in addition to musculoskeletal pathology, as pronounced cardiovascular, neurological and mental disorders. The latter are represented by an organic personality disorder of a predominantly hysterical nature with anxiety-depressive maladaptive reactions. The difficulties of differential diagnosis of personality disorders and therapeutic aspects are discussed.
Sulpiride (Eglonil), the progenitor of the substituted benzamide class, has retained its clinical relevance for over half a century thanks to its unique combination of a dose-dependent spectrum of action and a high safety profile. At low and medium doses (100–400 mg/day), the drug, alongside mild neuroleptic effects, exhibits a triple anxiolytic, stimulant and somatotropic effects due to selective blockade of presynaptic dopamine D2/D3 receptors, followed by an increase in dopaminergic transmission in the mesolimbic pathways. This pharmacological profile determines sulpiride's leading role in the treatment of somatoform disorders and generalised anxiety disorder with predominant somato-vegetative symptoms, where the primary complaints are cardialgia, dyspepsia, tachycardia, hyperhidrosis and polymorphic bodily sensations without an organic basis. Sulpiride (Eglonil) is the drug of choice for somatised forms of anxiety, comorbidity with somatic diseases, functional disorders of the gastrointestinal tract and somatoform disorders.
Nonconvulsive status epilepticus (NCSE) is a clinically difficult-to-diagnose form of status epilepticus, often presenting as acute or subacute impairment of consciousness without marked motor symptoms. The limited clinical symptoms and variability of electroencephalographic (EEG) patterns result in a high risk of delayed diagnosis and poor outcomes. There is little data on the frequency of NCSE in patients with impaired consciousness of unclear etiology, its clinical features, etiological structure, and the results of long-term video-EEG monitoring. Objective: to investigate the prevalence of NCSE in patients with altered consciousness of unknown etiology, to describe the characteristics of NCSE from the perspectives of etiology and semiology, and to analyze the results of long-term video-EEG monitoring in this condition. Material and methods. Data from 73 adult patients with suspected NCSE who underwent continuous video-EEG monitoring were analyzed. Diagnosis was made using the Salzburg criteria (2015) in conjunction with the standardised terminology of the American Clinical Neurophysiology Society (ACNS, 2021). The study group included 32 patients with a confirmed diagnosis of NCSE. Results. NCSE was confirmed in 32 (43.8 %) patients. In the vast majority of these (84.4 %), the condition occurred against a background of coma; in 15.6 %, a reduced level of consciousness was observed, mimicking aphasic and cognitive disorders. In 53.1 % of cases, NCSE developed as a transformation from convulsive status epilepticus, whilst in 46.9 % it occurred as a primary event. Only 37.5 % of patients had previously been diagnosed with epilepsy (idiopathic generalized epilepsy – n = 7; focal structural epilepsy – n = 5); in the remaining cases, NCSE was acute and symptomatic in nature, with the most common causes being New-Onset Refractory Status Epilepticus (NORSE), acute cerebrovascular accident, traumatic brain injury, hypoxic and metabolic encephalopathy. Based on EEG analysis, definite NCSE was confirmed in 81.2 % of patients, and probable NCSE in 18.8 %. During treatment, NCSE was controlled with first- and second-line drugs in only 8 (25 %) patients. In the remaining cases (n = 24; 75 %), pharmacological sedation was required. Thus, refractory and super-refractory forms of the condition pre-dominated, with a mortality rate of 21.9 %. Conclusion. NCSE is a common yet under-recognised cause of altered consciousness, particularly in critically ill patients. The timely use of long-term video-EEG monitoring and a active diagnostic approach are crucial for the early detection of NCSE and the optimisation of treatment.
One of the challenges encountered during the diagnostic assessment of patients with chronic disorders of consciousness (DOC) is determining the prognosis for a return to higher levels of consciousness. This situation has prompted new research aimed at identifying additional predictors of the outcome of DOC. This article describes cases in which patients in this group exhibited new behavioural signs (NBS), such as facial reaction to stimulation, subtle motor reactions, and crossing of the legs. The signs under consideration are not currently included in the diagnostic criteria of scales designed to assess the level of consciousness.Objective: to determine the incidence of NBS in patients with DOC and its significance for the prognosis of recovery of consciousness.Material and methods. The study included 44 patients with DOC (of traumatic and non-traumatic origin) who were admitted to the Intensive Care Unit (ICU) of the Brain Institute Clinic rehabilitation center between 2023 and 2025. The time elapsed since brain injury at the time of admission was 123.02±24.82 days. The Coma Recovery Scale – Revised (CRS-R) was used to assess the level of impaired consciousness.Results. Analysis of the CRS-R scale data obtained from the study groups indicates that an improvement in the level of consciousness was observed in both groups. In the group of patients without NBS, the mean score on admission was 8.36±3.46; on discharge, it was 9.04±3.55. In the group of patients with NBS, the mean score on admission was 8.00±2.73, and at the end of hospitalisation – 11.06±3.54. The most common symptom was ‘Subtle motor reactions’ – 15 cases out of 22. In 10 patients, the second group of manifestations was recorded – ‘Facial reaction to stimulation’. The smallest group consisted of the sign ‘Crossing of the legs’ – recorded in two cases (only in combination with other signs). There were noticeable transitions to higher levels of consciousness in patients with recorded NBS – a state of minimal consciousness ‘plus’, as well as the subsequent return to clear consciousness in patients (the number of cases was three times higher than the number of similar recorded cases in the control group).Conclusion. The high reproducibility of ‘new’ behavioural response patterns in patients with initially different levels of consciousness (unresponsive wakefulness syndrome, ‘minus’ minimal consciousness, and ‘plus’ minimal consciousness) suggests that these patterns may be considered as predictors of a positive recovery outcome.
Acute vestibular vertigo (AVV) is one of the most common reasons why patients seek medical advice from doctors of various specialities. Concomitant neck pain (cervicalgia) often leads to a misdiagnosis of 'cervical vertigo' in patients with benign paroxysmal positional vertigo (BPPV). This article presents a clinical case of a 41-year-old patient with concurrent BPPV and cervicalgia. Due to the initial misdiagnosis of 'cervical vertigo', the patient remained unable to work for 6 months. The timely identification of myofascial syndrome and BPPV enabled effective pathogenetic treatment and ensured the patient's rapid return to work. The effectiveness of a fixed combination of dimenhydrinate and cinnarizine (the drug Arlevert) in various aetiological factors of AVV is discussed. This combination has a minimal sedative effect compared with other vestibulolytics and contributes to the rapid relief of the intensity of vertigo and autonomic symptoms.
