The article deals with trembling hyperkinesia diagnostics and systematization. The differentiated tremor diagnosis, principals of clinical description, tremor etiological classification are issued. The article concerns main clinical rest tremor characteristics, postural and intention tremor and list of diseases accompanied with this syndrome. There are essential, rubral, psychogenic tremor and other forms of trembling hyperkinesia (distonic tremor, rhythmic nodding, orthostatic tremor) diagnostics criteria. Modern approaches to tremor pathology are presented. Detailed information is given about relevant therapy approaches based on world experience.

Keywords: rest tremor, postural tremor, intention tremor, essential tremor, distonic tremor, neuropathic tremor, rubral tremor, psychogenic tremor, treatment.

The article reviews the materials on clinical instrumental methods of detection of demyelination process activity in multiple sclerosis (MS). The changes detectable by MRI in the active form of the disease are analyzed. The article provides the characteristics of the spectra of the major cerebral metabolites detectable by MRI in MS patients. It also defines the main laboratory biomarkers of demyelination process activity in MS.

Keywords: multiple sclerosis, demyelination process activity, MRI, spectra, biomarkers.

Objective – to identify the main clinical determinants of life quality in patients with multiple sclerosis (MS).
Methods and subjects. 149 patients with MS were included in the study (58 male and 91 female). Mean age was 36.26 ± 0.85 years, disease duration was 6.99 ± 0.43 years, average EDSS score amounted to 3.19 ± 1.35. Relapse-remittent forms of MS represented majority of cases (75.84 %). All patients underwent a complete clinical neurological assessment, neuropsychological testing and measuring of Health-related Quality of Life (HRQoL) indices.
Results. The analysis of HRQoL in MS patients revealed a clear pattern of deterioration in HRQoL assessments with the degree of disability. Depression, anxiety and cognitive impairment affected both the physical and the mental QoL components. The degree of disability and the severity of depression defined as the main determinants of HRQoL in MS patients.
Conclusions. Results of the study demonstrated that disability, depression, anxiety level and cognitive impairment deeply interfere with HRQoL in MS patients. These findings prove high importance diagnostic of psychological and cognitive disorders, along with the definition of the disability in clinical neurological examination when solving for patients surveillance approach at improvement of MS patients HRQoL.

Keywords: multiple sclerosis, health-related quality of life.

Objective – to study the efficacy of antiparkinsonian medications in different groups of patients with Parkinson disease (PD).
Methods and subjects. 205 consecutive patients (140 male and 65 female) with idiopathic PD aged 35–88 years (mean age 68.4 years) were questioned at time of routine clinic visits. 20 patients were excluded from the examination as they were not given antiparkinsonian agents. Among 185 patients, who were under the examination, 129 patients got levodopa 200–2600 mg (mean dose – 741.1 mg), 53 patients got levodopa in complex with dopamine agonists (levodopa 200–2000 mg, mean dose – 808.5 mg), 3 patients got dopamine agonists without levodopa. While assessment of antiparkinsonian agents efficacy both objective and subjective data were estimated.
Results.  Antiparkinsonian medications were more effective in PD patients of younger age (under 70 years), in PD patients with younger age at onset (under 60 years) and in patients with long-standing PD (over 10 years). Antiparkinsonian medications were more effective in patients with mild to moderate PD according to the UPDRS, I-III parts of the UPDRS, the Modified Hoehn and Yahr staging, the Schwab and England Activities of Daily Living Scale as well as in PD patients with presence of vivid dreaming. There were no differences with respect to the effectiveness of antiparkinsonian medications between men and women. Antiparkinsonian medications were less effective in PD patients with presence of intellectual impairment, falls, freezing when walking, swallowing difficulties, constipation, and drooling.
Conclusions. Antiparkinsonian medications (levodopa, dopamine agonists) were effective in all patients with PD. Most patients with PD (75.68 %) had excellent or good response to antiparkinsonian medications.

Keywords: Parkinson disease, antiparkinsonian medications, efficacy, levodopa, dopamine agonists.

Objective – to investigate the features of the epidemiology and risk factors of ischemic posterior circulation strokes (PCS).
Methods and subjects. A complex clinical neurological and neuroimaging investigation was carried out in 104 patients (61 men and 43 women) aged 32 to 84 years (mean age – (61.2 ± 1.3) years) with ischemic stroke in different vascular territories. All patients were divided in 2 groups: 1st – isolated or combined PCS (n = 51), 2nd – ischemic ACS (n = 53). The mean age of the patients of the 1st group was 58.9 ± 2.3; 2nd – 63.1 ± 1.6 (p < 0.05) years. Сomputer and/or magnetic resonance image of the brain, triplex Doppler sonography, cerebral angiography, spinal X-ray examination were fulfilled. For detection of patients’ awareness with PCS and anterior circulation strokes (ACS)’ symptomatology we used the special formulary.
Results. Diabetes mellitus was more often revealed in patients with posterior circulation (PC) lesion in comparison with anterior (39 % versus 13 %, p < 0.05), reliable differences between other risk factors, including hypoplasia of the vertebral artery and degenerative disc disease of the cervical spine, between two groups were not revealed. Awareness of patients about principal symptoms of PC lesion was 30 %, while in anterior circulation (AC) – 70 %. Among ischemic PCS the most frequent were strokes of distal territory (55 % patients), rarer – middle (27 %) and proximal (18 %). In 35 (68.6 %) patients the isolated ischemic strokes were revealed and in 16 – combined (31.4 %).
Conclusions. Patients with ischemic PCS were younger, more often with diabetes and their hospitalization was in the period і 12 h from the onset of the first symptoms in comparison with patients with stroke in AC. Distribution of pathogenic subtypes in PCS varies against the affected PC territory: proximal – large vessel disease (LVD) subtype, middle – LVD and small vessel disease and distal – LVD and cardioembolic.

Keywords: ischemic stroke, posterior circulation, vertebral artery hypoplasia, risk factors.

Objective – to asses the thioctic acid impact (Thioctacid, MEDA) as antioxidant and metabolic neuroprotection on the clinical course and structural changes of peripheral nerve in patients with II type diabetes mellitus.
Methods and subjects. 52 patients with II type diabetes mellitus were under the open comparative examination. Criteria of examination involvement are duration of II type DM more than a year; age from 25–70 years; evidenced diagnosis of diabetic polyneuropathy (DPN). Patients were distributed into 2 groups. The first group included 30 patients who got thioctic acid 600 mg daily intravenously with physiologic saline 200 mg during 10 days in combination with basic therapy following drugs administration (Тhioctacid) in the same dosage; the second group included 22 patients without Тhioctacid administration. Groups were compared according to their age and sex. While assessing DPH all complaints and anamnesis, neurological status, laboratory tests results (clinical and biochemical blood count, urine test, lipid test, glycated hemoglobin) and instrumental tests (ECG, renovasography, electromyography) were admitted during the first day after the hospitalization, on the 10-th day, 30 and 90-th days after discharge. The state assessment was carried out according to Wayne’s questionnaire, TSS (Тotal Symptom Score) and NIS-LL (Neuropathy Impairment Score of lower limbs). Peripheral nerve functional status (right and left peroneal and tibial nerves) was assessed by means of simulative electromyography. Velocity of excitement spread, reflexes, amplitude of m-response in distal and proximal segments, distal and proximal latency were analyzed. To determine the activity level of sympathetic and parasympathetic vegetative nervous system the variational pulsometry was used.
Results. The efficacy and safety of thioctic acid was proved for DPN treatment. The agent influenced the sympathetic and parasympathetic balance, electrophysiological data of nerves conduction improved. There was evidenced moderate hypolipidemic effect.
Conclusions. The main advantages of thioctic acid injections are painless introduction and possibility of undiluted injection. Preoral form of medication is HR (quick excretion) that allows quick and optimal absorption and influences the neuropathy symptoms in comparing with other forms of thioctic acid. The medication has moderate hypolipidemic effect. This agent can be recommended for the application for all patients with DPN.

Keywords: thioctic acid, peripheral nerve, diabetes mellitus, diabetic polyneuropathy.

Objective – to identify the main neuroimaging features anomalies of intracerebral (ICAr) and precerebral arteries (PCA) in patients with cerebral ischemic stroke.
Methods and subjects. 107 patients with a diagnosis of ischemic stroke aged from 34 to 59 years were examined. 72 % of patients had abnormalities of cerebral arteries. All patients underwent a complete clinical neurological assessment and neuropsychological testing, instrumental examinations.
Results. Anomalies of the cerebral arteries were detected in 72 % of patients with ischemic stroke. All patients had anomalies of ICAr: full posterior trifurcation of left and right internal carotid artery (ICA), anterior trifurcation of right ICA, hypoplasia of the right posterior cerebral artery and bilateral aplasia of posterior cerebral artery, aplasia of the posterior communicating artery and left anterior cerebral artery, hypoplasia and aplasia of the anterior communicating artery. An examination of the PCA found their defeat at the 83.1 % of patients: kinking of the ICA (S-shaped, loop-like, C-shaped), hypoplasia of the vertebral artery, aplasia of the right vertebral artery. Combination of anomalies of ICAr and PCA were detected in 45.5 % patients.
Conclusions. The main option for the anomalies of cerebral arteries, including the significant role of hypoplasia of the right posterior cerebral artery, aplasia of the posterior communicating, the left anterior cerebral and anterior communicating artery, as well as S-shaped pathological tortuosity of the internal carotid, vertebral artery hypoplasia and their combinations in the development of ischemic stroke predominantly in young adults patients.

Keywords: ischemic stroke, magnetic resonance angiography, anomalies of intracerebral and precerebral arteries.

Objective – to establish efficacy of Neuromidine administration in complex treatment of cognitive and emotional-personal disorders in patients with diabetic encephalopathy.
Methods and subjects. There were investigated 62 patients with diabetic encephalopathy. Patients of the first group (27 persons) received standard treatment for diabetic encephalopathy. Patients of the second group (35 persons) received Neuromidine 60 mg per day during 8 weeks on the ground of standard treatment. There were used test MMSE (Mini Mental State Examination) for establishment of peculiarities of cognitive functions, methods of attention evaluation by the table of Shulte in modification by Gorbov and memory in the test «Remembering 10 words». For evaluation of personal and reactive anxiety there was used the scale of Spielberger–Chanine, depressive disorders – the scale of Beck.
Results. In patients of both groups after treatment the general point of test MMSE reliably increased, in the same time noticeably in patients treated additionally with Neuromidine (11.2 %, p < 0.001).The most statistic important changes were established by subtests of attention and memory investigation with increase of investigated data on 21.7 % and 29.9 % responsibly (p < 0.05).In the basic group the remarkable improvement of speed of sensor-motor reactions and data of short and long memory were notified. Additional administration of Neuromidine assisted essential decrease of data of reactive anxiety by table Spielberger–Chanine (on 7.4 %, p < 0.01) and depression by Beck table (on 10.1 %, p < 0.001), than in comparative group. Favourable influence of Neuromidine on cognitive functions and emotional personal reactions of patients is connected on the one hand with blockage of Potassium membrane penetration, on the other hand – reversible inhibition cholinesterase.
Conclusions. The usage of Neuromidine in complex treatment of patients with diabetic encephalopathy assists effective elimination of cognitive deficit with reliable increase of data MMSE-test. The improvement of cognitive functions in patients with diabetic encephalopathy on the ground of administration of Neuromidine takes place by the mean of speed increase of sensor-motor reactions, attention concentration, optimization of data short and long memory. The usage on the ground of basic treatment Neuromidine in patients with diabetic encephalopathy contributes to decrease of manifestation of emotional personal disorders due to reduce of indices of reactive anxiety and depression.

Keywords: diabetic encephalopathy, cognitive functions, Neiromidinum.

Objective – to study the level of the quality of life (QoL) of persons of dangerous professions, the definition of clinical and psychopathological factors affecting the level of QoL among them, creating a system with this category of persons within the biopsychosocial paradigm.
Methods and subjects. We examined 534 workers of hazardous occupations – 354 patients were selected in our study by inclusion criteria (278 miners and 76 drivers and assistants). All subjects were male, mean age was 37.3 ± 1.7. All patients underwent clinical, psychopathological, psychodiagnostic, clinical survey collected information using the «Questionnaire of a patient with increased risk of self-destructive behavior» and assessed the quality of life using the scales.
Results. Individuals of dangerous professions identified low levels of QoL, most of ratings were 2 and 3, that is «bad» and «fair». We have identified static and dynamic components of QoL, influencing who managed to reach a better QoL. Defined clinical and psychopathological factors that affect the quality of life dangerous professions. Patients underwent combined therapy, namely pharmacotherapy in the acute period, and individual and group psychotherapy in the future, which improved the quality of life of patients.
Conclusions. It was determined that the level of quality of life of hazardous occupations is low. The structure of QoL highlighted its dynamic and static components. Significant changes in the level of quality of life for a short interval were achieved due to the influence on the dynamic components of QoL, and further work on the static components of QoL contributed to a more prolonged and sustained improvement in patients. Marked clinical and psychopathological factors that influence the QoL (well-being, mood, self-care and independence in the actions, performance, and overall perception of QoL, socio-emotional support, and social service support, self-fulfillment and spiritual realization), working on that you can improve the QoL of these individuals.

Keywords: persons of dangerous professions, quality of life, factors that affect the quality of life.

The article deals with diagnosis and treatment of anxiety disoders. Detailed description of drug groups used of treatment of anxiety disoders is given, rational choice of drugs depending on type of anxiety disoders is substantiated.

Keywords: anxiety disorders, symptoms, treatment.

We present our own experience in treating patients with spinal cerebrospinal fluid fistula located in the dural inversion of segmental spinal roots in the thoracic and lumbar spine. Patients underwent open microsurgical intervention, sutured fistula site and glued. After surgery, an improvement was observed in all 10 patients: the disappearance of headaches, complete regression of neurological symptoms. Spontaneous cerebrospinal fluid fistula may be the cause of intracranial hypotension. The optimal treatment for these patients is an open microsurgical cut off the fistula.

Keywords: cerebrospinal fluid hypotension, fistula, surgical treatment.

Objective – to asses the efficacy of enteral and parenteral introduction of vitamins B in complex treatment for patients with vertebral painful syndrome in sacral segment of the vertebral column.
Methods and subjects. The neurological examination of 99 patients (60 females and 39 males) aged 29–63 years was carried out. They presented with discogenic radiculopathy of sacral segment against the background of osteochondrosis. Patients were randomly distributed into three groups. Patients of the first group were treated with Neurovitan: 1 pill 4 times a day in a complex with other pathogenically mediated medications (analgesic, neuromuscular relaxant, nonsteroid anti-inflammatory drugs, antihistamines). Patients of the second group were introduced vitamins B parenteral (В1 – 50 mg, В6 – 50 mg, В12 – 1 mg) in complex with traditional therapy. Patients of the third group were given standard therapy with complex injections containing В1 (100 mg), В6 (100 mg), В12 (100 mkg) intramuscular once a day during 6 days following pills administration: 1 pill twice a day.
Results. The efficacy of complex multivitamin preparation Neurovitan application for discogenic radiculopathy of sacral segment was proved. There was absence of evidenced advantages parenteral introduction of vitamin B in comparison with tablets.
Conclusions. Quantitative and qualitative composition of Neurovitan, non invasive enteral introduction evidence its advantages of application for complex treatment of vertebral radiculopathy of sacral segment against the background of osteochondrosis.

Keywords: vertebral radiculopathy in sacral segment of the vertebral column, Neurovitan, vitamin B.

Освещены современные представления о патогенезе нейродегенеративных заболеваний. Описаны клинические проявления, а также способы лечения  наиболее часто встречаемых заболеваний, в клинической картине которых когнитивные нарушения с исходом в деменцию занимают основное место (болезнь Альцгеймера, деменция с тельцами Леви, фронто-темпоральная дегенерация, болезнь Паркинсона с деменцией). Даны критерии диагностики сосудистой деменции и умеренных когнитивных нарушений. Представлены удобные в использовании, систематизированные тесты для диагностики когнитивных нарушений в рутинной практике.

Keywords: болезнь Альцгеймера, деменция с тельцами Леви, фронто-темпоральная дегенерация, сосудистая деменция, патогенез, лечение.

В лекции освещены вопросы клинической диагностики и систематизации дрожательных гиперкинезов. Обсуждается синдромальный дифференциальный диагноз тремора, принципы клинического описания последнего, а также этиологическая классификация дрожания. Приведены основные клинические характеристики тремора покоя, а также постурального и интенционного дрожания и перечень заболеваний, при которых эти синдромы встречаются. Представлены критерии диагностики эссенциального дрожания, рубрального тремора, психогенного дрожания и других клинических форм дрожательных гиперкинезов (дистонический тремор, ритмическое кивание, ортостатический тремор и другие). Кратко изложены современные представления о патогенезе дрожания. Подробно описаны существующие терапевтические подходы, основанные на мировом опыте.

Keywords: тремор покоя, постуральное дрожание, интенционный тремор, эссенциальное дрожание, усиленный физиологический, дистонический, нейропатический, рубральный, психогенный тремор, лечение.

Приведены данные о клинико-инструментальных методах выявления активности демиелинизирующего процесса при рассеянном склерозе. Проанализированы изменения, которые регистрируют на магнитно-резонансной томограмме при активном течении заболевания. Дана характеристика спектров основных церебральных метаболитов головного мозга, выявляемых при магнитно-резонансном спектрографическом исследовании у больных рассеянным склерозом. Представлены основные лабораторные биомаркеры активности демиелинизирующего процесса при рассеянном склерозе.

Keywords: рассеянный склероз, активность демиелинизирующего процесса, магнитно-резонансная томография, спектры, биомаркеры.