Vol 27, No 11 (2025): Neurology and rheumatology

Background. The formation and progression of vascular cognitive impairment (VCI) is multifactorial. Patients with VCI often complain of headaches (HA), which affect daily life activity (DLA).

Aim. To assess the relationship between traditional risk factors (RF) for VCI and the development of cephalgic syndrome and to establish the impact of HA on the patients’ DLA.

Materials and methods. The study included 97 patients (65 women, 32 men) aged 50 to 85 years with an established diagnosis of VCI. All patients were divided into 2 groups. The main group consisted of 64 patients complaining of HA. The comparison group included 33 patients without HA. Patients' adherence to therapy was assessed using the validated Morisky–Green scale. Pain severity was assessed using a visual analog scale. The HIT-6 questionnaire was used to assess the DLA of patients with cephalgia. The degree of brachiocephalic artery (BCA) stenosis was assessed based on ultrasound examination using the NASCET classification.

Results. The following types of cephalgia were established in patients of the main group: tension type headache (TTH) – 43.8% of cases, migraine – 23.4%, combined TTH and migraine – 7.8%; 14.1% met the criteria of cervicogenic HA; 10.9% – HA associated with sleep apnea syndrome. It was found that in the main group, more often than in patients without HA, who made up the comparison group, such RFs as arterial hypertension of the 3rd degree, hemodynamically significant stenosis of the brachiocephalic artery, low adherence to therapy were encountered (p=0.024, 0.047, 0.042, respectively). The influence of HA phenotypes on the DLA was established: the strongest effect was noted in patients suffering from combined TTH and migraine – in 80.0% of cases, among patients with migraine in 60.0%. A direct correlation was established between the intensity of HA and the patients' DLA.

Conclusion. Early diagnosis and timely treatment of HA along with the correction of modifiable RF can significantly improve the prognosis of patients with chronic cerebrovascular disease at all stages of the development of the pathological process.

Background. Transcranial direct current stimulation (tDCS) is discussed as a promising noninvasive neuromodulation method for alleviating symptoms of Parkinson’s disease (PD). However, evidence on the efficacy of tDCS in PD remains limited in our country.

Aim. To evaluate the effect of a course of noninvasive anodal tDCS on the motor symptoms, cognitive function, and emotional state of patients with PD.

Materials and methods. Twenty-nine patients with PD (Hoehn and Yahr stages I–III), aged 45–80 years, received anodal tDCS over the dorsolateral prefrontal cortex (DLPFC) at 2 mA for 20 minutes, once daily, 5 days per week for 2 weeks (10 sessions total). Pre- and post-treatment assessments included motor function (Unified Parkinson’s Disease Rating Scale, Part III [UPDRS-III]), cognition (Montreal Cognitive Assessment [MoCA], Frontal Assessment Battery [FAB], Trail Making Test Parts A and B [TMT-A/B]), and affective measures (Apathy Scale; State-Trait Anxiety Inventory-trait and state; Geriatric Depression Scale [GDS]).

Results. After the tDCS course, there was a statistically significant improvement in cognitive measures (higher MoCA scores and shorter TMT-A/B completion times), a reduction in motor deficit (lower UPDRS-III scores), and a decrease in apathy and trait anxiety (p<0,05). No significant changes were observed on the FAB, state anxiety, or GDS. No adverse events were reported during tDCS in PD.

Conclusion. A course of tDCS appears safe and may improve cognitive, affective (apathy, anxiety), and motor symptoms in PD. Randomized, sham-controlled trials are warranted to confirm efficacy and to determine optimal stimulation parameters.

Background. Spinal muscular atrophy (SMA) and other neuromuscular diseases are severe inherited pathologies characterized by progressive muscle weakness and high disability rates. In Russia, SMA prevalence is approximately 1500 patients, with most cases manifesting in childhood. Modern drugs such as nusinersen, risdiplam, and onasemnogene abeparvovec can slow disease progression; however, their effectiveness requires comprehensive evaluation, including psychosocial aspects of patients' lives. Health-related quality of life (HRQOL) is a key indicator for assessing therapeutic effects, especially in pediatric practice, where not only physical limitations but also the impact of illness on emotional state, social activity, and family well-being are important.

Aim. To conduct cultural-linguistic adaptation and validation of the Russian version of the PedsQL™ 3.0 Neuromuscular Module for objective assessment of HRQOL in children with SMA and their parents, including translation and adaptation of the questionnaire according to international standards, evaluation of its psychometric properties (reliability, validity, sensitivity to changes), and comparison of results with the original English version.

Materials and methods. The study included 25 patients with verified SMA diagnosis (types I–III) aged 2–18 years and their parents. Adaptation was conducted in several stages: forward and backward translation, expert evaluation, cognitive interviewing, and final formulation adjustment. Psychometric properties were evaluated before and after nusinersen therapy using Cronbach's alpha coefficient, ICC, and factor analysis.

Results. High reliability of the Russian version was identified: Cronbach's alpha coefficients were 0.92–0.96 for the child version and 0.93–0.95 for the parent version. Test reproducibility was confirmed by high ICC (0.85–0.92). Factor analysis confirmed the three-factor structure of the questionnaire corresponding to the original, explaining 43.2, 12.1 and 8.7% of variance respectively. Significant improvement in quality of life was noted after nusinersen therapy, particularly in physical well-being of SMA type I patients (+15.4%). Social indicators in adolescents aged 13–18 remained lower than in younger children, related to age-related psychosocial difficulties.

Conclusion. The Russian version of PedsQL™ 3.0 Neuromuscular Module successfully passed validation and demonstrates high psychometric characteristics comparable to the original. The instrument is sensitive to clinical changes and can be used for monitoring quality of life in children with SMA in Russian practice. Study results allow recommending the questionnaire for therapy effectiveness assessment, identification of problem areas, and planning supportive measures. Future work prospects include validation on larger samples and adaptation of the methodology for adult patients.

This clinical case demonstrates a severe, highly active form of psoriatic arthritis with pronounced peripheral arthritis, dactylitis, enthesitis, and widespread skin lesions. The patient had radiographically confirmed signs of sacroiliitis, spondylitis, and significant structural changes (stage III–IV according to the Steinbrocker classification). The course of the disease was complicated by multiple comorbid conditions, including metabolic syndrome with morbid obesity (BMI 46 kg/m²), hyperuricemia, and subsequently clinically established diabetes insipidus. An additional factor that significantly limited the effectiveness of treatment was the patient's low adherence to therapy and repeated refusals to undergo the recommended examinations by related specialists. There was marked resistance of the disease to both the maximum tolerable doses of basic anti-inflammatory drugs and various groups of genetically engineered biological therapies. Despite repeated attempts to optimise treatment, it was not possible to achieve sustained control of the disease: only partial effectiveness of therapy was recorded, accompanied by periodic exacerbations and persistent high activity of the pathological process.

The prevalence of knee osteoarthritis (OA), which has been steadily increasing in recent decades, represents a serious clinical and economic problem. This situation necessitates an active search for effective conservative treatment methods capable of slowing disease progression and delaying the need for total knee arthroplasty (TKA). This article presents a detailed analysis of the current role of intra-articular administration of hyaluronic acid (HA) preparations in OA therapy. The necessity of personalized treatment approach based on OA phenotyping is justified, and consensus recommendations from the European expert group EUROVISCO are provided, defining specific clinical situations for rational use of HA. Special attention is given to cross-linked HA drugs that, due to their prolonged residence time in the joint, provide both long-lasting mechanical (shock absorption) and delayed biological (viscoinduction) effects. Advantages of the innovative CHAP technology implemented in Flexotron Cross® drug are discussed, allowing achieving faster and more pronounced analgesic effect compared to other cross-links. Data demonstrating the impact of course application of HA on significantly postponing TKA timelines are presented, providing patients with opportunities for lifestyle modification, particularly weight loss, which substantially reduces perioperative risks. Additionally, the issue of contralateral joint OA progression after unilateral TKA is addressed, discussing protective role of HA in preventing its damage by reducing pain and normalizing movement patterns.

Asthenia has a wide range of potential biological, psychological, and social causes, and a direct causal relationship cannot always be accurately established. The paper aims to present clinical cases of various categories of asthenia and to summarize experience with Stimol® (citrulline malate). Three clinical cases were presented, demonstrating 1) fatigue associated with social factors; 2) multicausal asthenia associated with drug therapy in a patient with hypertension and cerebral microangiopathy; 3) post-viral (SARS-CoV-2) asthenia with transformation into chronic fatigue syndrome. Despite the different stimuli that trigger the pathological process, a universal body reaction of homeostatic exhaustion is ultimately observed, suggesting that ergogenic drugs can be an important part of the therapy of any asthenia. All patients successfully received complex therapy, including a 10–12-day course of citrulline malate (Stimol®) at a dose of 3 g/day. Thus, ergogenic drugs can be considered an important part of the therapy of any asthenia. Stimol® demonstrates high effectiveness as a convenient and safe agent for correcting energy deficiency in patients with asthenia.