Migraine is a chronic neurological disorder that is associated with considerable disadaptive effect on patients. Despite the development of pharmacotherapy strategies for migraine, only one third of patients are satisfied with their overall treatment. Many migraine patients turn to complementary and alternative medicine (CAM), which is not usually considered a part of conventional medicine and is not always evidence-based. In practise, however, they are often used to improve the effectiveness of standard therapy or to provide alternative treatment. In addition, in CAM methods, the patient is actively involved in the choice of treatment strategies, and they have good adherence. The basic principles and approaches of CAM are increasingly being introduced into clinical practise. This review discusses the principles of CAM in the treatment of migraine as a holistic approach using lifestyle strategies and selected non-pharmacological treatments that have been shown to be effective and rational.

Deforming osteoarthritis is characterized by chronic pain, which is often associated with a wide range of cognitive impairment (CI) due to the involvement of common anatomical structures, similar plastic disorders in brain neuronal systems, depletion of common mediators and neurochemicals, and general neurochemical changes leading to maladaptive neuroplasticity in cerebral systems of pain control and key cognitive functions. In the management of patients with deforming osteoarthritis, it is important to focus on treating chronic pain and CI, as it determines long-term treatment success and significantly affects quality of life and daily, social, and occupational activities. We describe a patient with deforming osteoarthritis, chronic pain, and CI who required an individualized, complex treatment approach. This case report illustrates the reduction in pain severity and the improvement in quality of life and cognitive function achieved with timely initiation of pathogenically targeted treatment. KEYWORDS: osteoarthritis, deforming osteoarthritis, chronic pain, cognitive impairment, maladaptive neuroplasticity, Brainmax. FOR CITATION: Ekusheva E.V., Kalinina N.N., Parkhomenko E.V., Khozhenko E.V. Cognitive impairment in deforming osteoarthritis. Russian Medical Inquiry. 2024;8(2):110–114 (in Russ.). DOI: 10.32364/2587-6821-2024-8-2-9.

On September 29, 2023, a meeting of the interdisciplinary expert council “Cognitive health of a comorbid patient” was held in Vladikavkaz. To reduce the social and economic burden of cognitive impairment, which is increasingly being detected in comorbid patients in the Russian Federation, it is necessary to introduce socially significant initiatives for the timely diagnosis and prevention of these diseases, as well as update modern approaches to treatment, taking into account their multifactorial pathogenesis and the risk of complications. Based on the results of scientific reports and discussions held during the expert council, experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity.

Мигрень – это первичная головная боль, имеющая генетическую природу и значительно снижающая трудоспособность пациентов. В последние годы помимо лекарственных средств применяют различные немедикаментозные методы лечения мигрени, в том числе магнитотерапию. Целью настоящего исследования являлась оценка эффективности аппаратной магнитотерапии в комплексном лечении мигрени. Материал и методы. Мультицентровое слепое рандомизированное плацебо-контролируемое исследование проведено в пяти центрах лечения головной боли. В исследовании участвовали 93 пациента с эпизодической мигренью без ауры: 51 пациент основной группы (43 женщины и 8 мужчин, средний возраст – 39,61 года) и 42 пациента контрольной группы (35 женщин и 7 мужчин, средний возраст – 41,33 года). Группы были сопоставимы по полу и возрасту. Результаты. В основной группе количество приступов мигрени снизилось с 7,71 до 4,34 в месяц на последнем визите, в контрольной группе улучшения не произошло (с 7,55 до 7,52 приступа в месяц). Снижение интенсивности головной боли по визуально-аналоговой шкале в среднем в основной группе составило 33,1% по сравнению с 8,5% в контрольной группе. В основной группе наблюдалось статистически значимое снижение количества принимаемых нестероидных противовоспалительных средств и триптанов с первого по третий визит. В контрольной группе не отмечено значимых изменений в количестве принимаемых триптанов на всех визитах. При оценке нетрудоспособности по тесту HIT-6 к пятому визиту среднее снижение значений показателя составило 18% в контрольной и 0,7% в основной группе соответственно. В ходе исследования не зафиксировано ни одного неблагоприятного события ни в одной из групп. Выводы. Магнитотерапия является эффективным методом лечения эпизодической мигрени, позволяющим уменьшить не только интенсивность, но и частоту приступов. Лечение с использованием магнитотерапии позволило значительно сократить количество применяемых для купирования приступов мигрени препаратов. После курса магнитотерапии снизилась выраженность тревоги и депрессии, а также нетрудоспособность пациентов. Migraine is a primary headache that has a genetic nature and significantly reduces the ability to work of patients. In recent years, in addition to medicines, various non-medicinal methods of treating migraines, including magnetotherapy, have been used. The purpose of this study was to evaluate the effect of the use of magnetotherapy in improving the effectiveness of complex treatment of patients with migraine. Material and methods. A multicenter blind randomized placebo-controlled trial was conducted in 5 headache treatment centers. The study was conducted in 93 patients with episodic migraine without aura: 51 patients of the main group (43 women and 8 men, the average age was 39.61 years) and 42 patients of the control group (35 women and 7 men, the average age was 41.33 years), corresponding to the main group by gender and age. Results. According to the results of the study, the decrease in the number of attacks per month in the main group was from 7.71 to 4.34 attacks/month at the last visit, and there was no improvement in the control group – from 7.55 to 7.52 attacks. The decrease in headache intensity on a visually analog scale (VAS) averaged 33.1% in the main group compared to 8.5% in the control group. When analyzing the decrease in the use of drugs, the following conclusions were made: a statistically significant decrease in the number of NSAIDs taken was observed only in the main group from 1 to 3 visits. A statistically significant decrease in the number of triptans taken by the 3rd visit was observed only in the main group. In the control group, there were no significant changes in the number of triptans taken at all visits. When assessing disability according to the HIT-6 test by the 5th visit, the average decrease in the values of the indicator was 18% in the control and 0.7% in the main groups, respectively. During the work, no adverse events were recorded in any of the groups. Conclusions. Magnetotherapy is an effective method of treating episodic migraine, which allows reducing not only the intensity, but also the frequency of attacks. The treatment carried out with the use of magnetotherapy allowed to significantly reduce the number of drugs used to relieve migraine attacks. According to the results of the course of magnetic therapy, the severity of anxiety and depression decreased, the disability of patients decreased.

Obesity is a chronic disease, heterogeneous in etiology and clinical manifestations, progressing with a natural course, characterized by excessive deposition of fat mass in the body. This pathological condition has taken on the scale of a global epidemic in recent years, which continues to progress steadily, currently affecting more than 2 billion people worldwide. Due to its heterogeneity, obesity has a negative impact on the work of almost all organs and systems of the body, contributing to the emergence of new concomitant diseases and pathological conditions that significantly worsen the quality of life of these patients. Thus, a close relationship between type 2 diabetes mellitus and cognitive impairment has long been known, as well as with a number of other somatic diseases: coronary heart disease, atherosclerosis, non-alcoholic fatty liver disease, dyslipidemia, malignant neoplasms and other associated pathological conditions against the background of overweight and obesity.Currently, the problem of the relationship of cognitive impairment in patients with overweight or changes in the glycemic profile is very relevant, due to the high prevalence and insufficient study of this issue.

OBJECTIVE:The assessment of the clinical efficiency and safety of the drug Brainmax and its influence on the degree of functional recovery in the treatment of patients with non-dementia cognitive disorders with this drug.MATERIAL AND METHODS:An open multicenter randomized study included 60 patients of 18-55 years with light and moderate CI, having complaints of the cognitive spectrum. They used a clinical and neurological study using generally accepted scales and tests (MoCA, MMSE, MFI-20 tests, Schulta, DSST tests and an assessment of the quality of life of SF-36). Patients were randomized in two groups comparable by age and gender. Group 1 was treated with Brainmax per os twice every day for 14 days. After 10-days rest they received same medication for another 14 days. Group 2 was treated with Brainmax per os twice every day for 14 days, without the continuation. The total duration of the study was 40 days, the assessment of their condition was carried out on the 1st day (visit 1), after 15 days (visit 2) and after 40 days (visit 3) using the indicators of the above scales and tests in comparison with the background data. Safety assessment was carried out by the presence and structure of undesirable phenomena.RESULTS:The use of Brainmax led to a significant improvement in cognitive performance according to all generally accepted scales and tests (concentration and maintaining of attention, working memory, visual-constructive skills, volume and speed of attention speed, information processing and executive functions), as well as to the decrease severity of asthenia and improvement of the quality of life.CONCLUSION:Brainmax has shown a good safety profile, tolerability and clinical efficacy in the treatment of young and middle-aged patients with non-demented cognitive impairment. Significant improvement was observed both with single and double course administration of the drug, but a significantly better effect was noted after its repeated course, which reflects, among other things, the cumulative effect of the active substances of this drug and makes longer use of the drug Brainmax justified and appropriate in these categories of patients. The data obtained allow us to recommend the wider use of the drug Brainmax in clinical practice for the treatment of CI in patients of different ages, which will optimize therapy and improve the course and outcome of the disease.

Aim: to study the efficacy and safety of bovine cerebral cortex polypeptides (BCCP) in patients with chronic cerebral ischemia (CCI). Patients and Methods: an open multicenter randomized prospective comparative clinical trial was conducted with the participation of 40 patients with CCI (ICD-10: 167.8) aged 55 to 75 years, having risk factors for cerebrovascular pathology (hypertension, obesity, dyslipidemia or atherosclerosis) and vascular brain damage (according to the data of MRI, the STRIVE v1 protocol). After randomization, main group (n=20) received standard therapy for the underlying disease and Renobrain® СМ 10 mg/day, intramuscularly, for 10 days. Control group (n=20) received only standard therapy of the underlying disease. Clinical and neurological examination was performed using international questionnaires to assess cognitive and functional disorders before and after the therapy course in 30–32 days (Schulte and DSST tests, asthenic state and life quality SF-36 scales). Results: the BCCP, in addition to standard therapy in patients with CCI contributed to a statistically significant (p<0.05) improvement in cognitive functions (volume; refocusing rate; concentration and vigilance; working memory; information processing speed; executive, neurodynamic and regulatory functions), increased exercise tolerance, reduced mental fatigue and improving the life quality. The positive changes that occurred during treatment in the main group were probably related to the GABAergic effect, relationship normalization of the excitatory and inhibitory amino acids and mediators in the central nervous system, which leaded to functional restoration of neuronal cerebral systems. Conclusion: BCCP use in the complex therapy of patients with CCI is pathogenetically justified. Given its neurotrophic effect along with a high safety profile, repeated courses of such a drug and its wider use in patients with vascular brain damage can be recommended. KEYWORDS: chronic cerebral ischemia, cerebrovascular diseases, cognitive disorder, asthenia, bovine cerebral cortex polypeptides. FOR CITATION: Ekusheva E.V., Voitenkov V.B. Efficacy and safety of Renobrain® СМ in patients with chronic cerebral ischemia. Russian Medical Inquiry. 2023;7(10):666–671 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-9.

Encephalitis is a group of acute infectious diseases affecting the substance of the brain. They often lead to disability or death, and, therefore, require urgent medical attention. The article discusses the etiology, pathogenesis, and clinical picture of encephalitis, with special attention to the course of this disease after the COVID-19 pandemic. We note the growing number of encephalitis cases, especially of autoimmune variety and those caused by herpes. The possible reason behind this trend is the disruption of operation of the immune system brought by COVID-19, which manifests as a cytokine storm, neuroinflammation, and autoimmune reactions. There are cases of COVID-19-dependent encephalitis described. The pathways taken by SARS-CoV-2 to penetrate into the cells of the central nervous system have not yet been fully studied, although there are hypotheses that this happens both trans-synaptically through mechanoreceptors and chemoreceptors of the respiratory system into the medulla oblongata, and through receptors of the angiotensin converting enzyme 2.

This article examines promising areas of therapeutic transcranial magnetic stimulation (TMS) for the treatment of diabetic polyneuropathy (DPN) — a common complication of diabetes mellitus, which significantly reduces the life quality of patients. Conservative therapy of this condition is not always effective; therefore, the article discusses alternative treatment methods, including TMS — a method in which magnetic induction is used to affect the brain structures. TMS use for the DPN treatment has shown certain positive results. The article discusses various aspects of the TMS use, including protocols, treatment duration, dosage and safety. A review of existing Russian and foreign studies with recommendations on the TMS use in clinical practice for the DPN treatment is being conducted. These studies demonstrate the potential of using TMS as an additional treatment method of DPN. However, there is a need in further clinical studies for a deeper understanding of the TMS efficacy and mechanisms of action in this disease. TMS use in the DPN treatment may represent a new direction in the field of therapeutic methods that contribute to improving the patient lives with diabetes mellitus. KEYWORDS: diabetes mellitus, complications, diabetic polyneuropathy, neuropathic pain, rhythmic transcranial magnetic stimulation, conservative therapy FOR CITATION: Bobrov M.P., Ekusheva E.V., Voitenkov V.B., Khozhenko E.V. Prospects for the use of therapeutic transcranial magnetic stimulation in diabetic polyneuropathy. Russian Medical Inquiry. 2023;7(10):625–629 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-3.

Parkinson’s disease (PD) is a progressive neurodegenerative disease with various clinical manifestations, its origin not always can be explained only by dopamine deficiency. Long-term treatment with levodopa (especially its intraduodenal administration), as well as clinical manifestations of polyneuropathy, cognitive deficits, postural disorders with freezing of gate, REM sleep behavioral disorders, are more often associated with vitamin B12 deficiency. Several reasons for this association and mechanisms of their development are discussed. Early detection of cobalamin deficiency in PD, especially in patients from high-risk groups, makes it possible to stop this pathological condition timely and prevent irreversible changes. Modern data on the use of high-dose (1000 μ g) oral vitamin B12 are presented, it has comparable clinical efficacy and significant advantages, compared with the parenteral form, in terms of the ease of use and the ability to avoid undesirable postinjection reactions.

Background: the Five-Minute Cognitive Test (FCT) was designed in 2019 by the Chinese scientists to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Aim: to evaluate the efficiency of the Russian FCT version for identifying cognitive impairments (CI) in non-demented patients. Patients and Methods: according to the international requirements and standards, the FCT was translated and adapted and then evaluated in a focus group of non-demented patients (n=62, 60–75 years old) followed by the assessment of its psychometric properties. The FCT results were compared with the MMSE and Montreal Cognitive Assessment (MOCA) scores in two patient groups: the treatment group (n=30) consisting of patients with moderate CI, before after the cognitive rehabilitation course, and the comparison group, consisting of 32 individuals with normal cognitive functions. In addition, the correlation of the hippocampal volume with FCT/MMSE scores was assessed. Results: the average time to complete FCT was 5–6 min. The sensitivity and specificity of PCT for CI screening was 80.6% and 84.11%, respectively. As demonstrated by the study findings, FCT’s diagnostic performance was not inferior to that of other tests used for detecting CI. The neurovisualization data showed that there was a positive correlation between the hippocampal volume and the FCT/MMSE scores. Conclusion: the preliminary results suggest that the Russian FCT version is acceptable and promising for the use in clinical practice as a relevant screening test for identifying CI. KEYWORDS: mild cognitive impairments, moderate cognitive impairments, Alzheimer’s disease, brief cognitive test. FOR CITATION: Tuzhikov K.P., Voitenkov V.B., Ekusheva E.V. Evaluating the efficiency of a five-minute cognitive test for the use in non- demented patients with cognitive declines (a pilot study). Russian Medical Inquiry. 2022;6(10):551–555 (in Russ.). DOI: 10.32364/2587- 6821-2022-6-10-551-555

In this literature review and our own data, we provide information about navigational transcranial magnetic stimulation (TMS). At present, a significant amount of knowledge has been accumulated about the use of TMS, both diagnostic and therapeutic, in real clinical practice. Diagnostic TMS has been studied and developed maximally. Nevertheless, despite the undoubted clinical effect of therapeutic TMS, the question of the need for the most accurate target designation for the greatest effectiveness of treatment remains controversial. A number of publications emphasize and justify the need for such target designation, but others report a positive clinical effect of stimulation regardless of the exact location of the inductor. This undoubtedly makes further research in this area relevant with an assessment of the comparative effectiveness of the most accurate rhythmic TMS with other protocols for its use.

Our aim was to determine parameters of motor evoked potential (MEP) from the tongue in healthy children of different age. Methods . 40 healthy children (age range from 2 years old to 17 years, 14 females & 26 males) were enrolled. All underwent diagnostic TMS, single-pulse protocol, 150-sm round coil, Neiro-MS-D device. Coil was placed on Fz point, registration was performed by the surface electrode on the middle line of the tongue. Results . MEPs were registered in all cases, its average latency was 6,29±0,64 ms, average amplitude – 0,76±0,24 µV. There were neither gender differences nor amplitude. Significant age difference (p<0.001) was registered between young children (age 2–5 years) and two older groups on latency. Conclusion . There is a significant age difference in MEPs’ latency between young children and older group. This may be associated with age elongation of the conductors due to the growth of the nervous system. The obtained normative data can be used as a tool for an objective assessment in children with various pathological speech disorders.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology» will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

On September 30, 2022, a meeting of the interdisciplinary expert council “Prevention and treatment of obesity. How to Achieve a Healthy Metabolic Balance. To reduce the social and economic burden of obesity and its consequences in the Russian Federation, it is necessary to introduce socially significant initiatives to prevent obesity and increase its detection rate, as well as to update modern approaches to the treatment of this chronic disease, taking into account its multifactorial pathogenesis, comorbidity, risk of complications and patient disability. Based on the results of the scientific reports and discussions held during the expert council, the experts made decisions on a further plan within the framework of socially significant initiatives for the prevention of obesity

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (μV2) and amplitude (μV) of the α, θ, and δ rhythms, along with mean power ratios – α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.