The current observations of the diagnosis and treatment of the multiple sclerosis exacerbation from the point of evidence-based medicine are described in the article. When exacerbation of multiple sclerosis is confirmed, corticosteroids therapy should be initiated as early as possible to minimize the residual disability after relapse. It is evidenced that the duration and severity of exacerbation, severity of residual neurological disorders are in direct dependence of the timeliness of the corticosteroids course in adequate doses. Short courses of corticosteroids in high-dose showed the greatest efficacy in the treatment of exacerbation. However, choosing method of exacerbation treatment, the doctor should first assess the presence of corticosteroids therapy contraindications. Alternative therapies should be considered in patients who have previously had significant side effects or are resistant to treatment with corticosteroids.

Keywords: multiple sclerosis, exacerbation, corticosteroids, pulse-therapy.

Objective — to determine the efficiency of a unified simplified stepped algorithm of antihypertensive therapy for achieving target office and «normal» home (< 135/85 mm Hg) blood pressure (BP), reducing the risk of stroke, and improving adherence to treatment in patients with apparent treatment-resistant hypertension (aTRH) over 55 years compared with patients with blood pressure uncontrolled despite the appointment of 1 — 2 antihypertensive agents in general practice.
Methods and subjects. The proportion of patients over 55 years among 407patients included in the study was 284 (69.8 %). Patients were scheduled into two groups. The first one comprised 84 (29.6 %) patients with TRH who were initially administered 3 agents and more. The second group comprised 200 (70.4 %) patients who were initially administered 1 — 2 agents. On the 1st visit patients received a fixed dose combination of perindopril and amlodipine of 5/5, 5/10, 10/5 or 10/10 mg on physician choice (1st step). Office and home BP was measured by automatic oscillometric devices. Before each subsequent visit (7 days, 1, 2, 3, and 6 months) patients measured BP during 7 days, twice a day. If target office BP was not attained on subsequent visits, the dose of the fixed combination of perindopril and amlodipine was increased to the maximum tolerated (2nd step) and subsequently indapamide-retard was administered 1.5 mg 1 time per day (3rd step), spironolactone 50 mg per day (4th step), moxonidine 0.2 — 0.6 mg of doxazosin per day, or 4 — 8 mg per day (step 5). At the initial and final stage of the study the risk of stroke developing was determined over the next 10 years with the Framingham scale.
Results. After 6 months, the mean systolic office blood pressure decreased from 166.7 ± 15.1 and 166.4 ± 15.2 to 132.8 ± 9.4 and 131.2 ± 9.7 mm Hg, diastolic — from 97.0 ± 11.3 and 94.9 ± 10.2 to 79.3 ± 7.3 and 79.8 ± 7.0 mm Hg respectively (all p < 0.0001). Office BР < 140/90 mm Hg was achieved in 74.7 % and 82.5 % patients, respectively, which was accompanied by normalization of home BP — 68 % and 69.4 %, respectively (all p < 0.05). Appointment of 3 agents was made for 46.7 % and 29.5 %, a maximum dose of the fixed combination of perindopril and amlodipine — 57.4 % and 39.3 % of patients, respectively (p < 0.01). 10-year-old risk of stroke development decreased from 34.3 ± 17.6 to 20.9 ± 12.2 (p < 0.01) and from 26.9 ± 16.1 to 16.7 ± 11.3 (p < 0.001).
Conclusions. Unified simplified stepped algorithm of antihypertensive therapy in patients with uncomplicated uncontrolled hypertension over 55 years has allowed to reach the target office BP by 6 months in 74.7 % of patients with aTRH and in 82.5 % of patients initially scheduled 1 — 2 agents, and to reduce the average 10-year risk of of stroke by the Framingham scale — by 39.1 % and 37.9 %, and the proportion of patients with high risk at 32, 5 and 32.6 %, respectively. After 6 months of a unified algorithmic step treatment for patients older than 55 years, TRH is associated with a 18.7 % higher risk of stroke over the next 10 years by the Framingham scale, compared to patients initially scheduled 1 — 2 agents.

Keywords: essential hypertension, apparent treatment-resistant hypertension, stroke, perindopril, amlodipine, fixed low-dose combination, adherence to treatment.

Objective — studying and manifesting  rating values of structural impairment (content indirectly through auto antibodies (autoAB) to the component of blood cells, myocardium and blood vessels) in patients with initial manifestations of the chronic cerebral ischemia (ChCI).
Methods and subjects. We have examined 55 people of the mean age 51.3 ± 7.0 years: male (17 (30.9 %)  and  female 38 (69.1 %)  with initial manifestations ChCI and 15 healthy volunteers (observation group). Individuals with vascular risk factors (VRF) and relevant clinical manifestations  without signs of cerebral damage of probably vascular genesis according to imaging  composed the group 1. In the case of changes on brain MRI lesions of small vascular genesis probably not without severe signs of cerebral atrophy, such  patients were classified in to the group 2A. Group 2B included  patients with symptoms of mild  cerebral atrophy. All patients were performed general clinical, clinical neurologycal, clinical and instrumental and clinical laboratory tests. Level (autoAB) antigens to platelets, cardiomyocytes and vascular endothelial serum of patients was determined by the method O. B. Poletayeva (Russia).
Results. It was found that  the age range  correlated with  indicators auto-immune reactivity (AIR):average individual level of immunoreactivity (AILI) (r = –0.413; p = 0.002), autoAB level to de-DNA (r = –0.338; p = 0.012), up to COM-02 (r = 0.414; p = 0.002), to cardiomiozyn (r = 0.357; p = 0.008), to c-ANCA (r = 0.371; p = 0.005), to plasminogen/angiostatin (r = –0.404; p = 0.002), to protein PAPP-A (r = –0.338; p = 0.012). Patients with initial manifestations ChCI statistically significantly were different from the observation group on indicators such as AIR, AILI and even auto-antibodies to antigens of endothelium (c-ANCA), membranes of cardiomyocytes COM-02, to the collagen, β1-adrenoceptor rheumatoid factor (β2-GP) and to de-DNA (marker of apoptosis activation process). The extent of structural cerebral damage, probably of vascular genesis in the initial manifestations, was associated with ChCI significant deviations of AILI (χ2(3) = 22.7; VKramer = 0.591, p = 0.000) levels autoAB to DNA (χ2(3) = 9.0 ; VKramer = 0.37, p = 0.029), the COM-02 (χ2(3) = 13.6; VKramer = 0.454, p = 0.004), the в1-adrenoceptor (χ2(3) = 12.4; VKramer = 0.433, p = 0.006).
Conclusions.  Patients with initial manifestations of ChCI as the progression of structural cerebral damage demonstrated the change of the antigenic specificity of certain structural components of the cardiovascular system,  trend towards reducing the ability of sympathetic influences on the myocardium, probably within the compensatory-defensive reactions, as well as change the activity of apoptosis and cardio-dystrophic processes.

Keywords: chronic cerebral ischemia, initial manifestations, auto-immune reactivity, cardiovascular pathology.

Objective — to determine the optimal complex of neuropsychological and neurophysiological methods for detection of cognitive disorders in patients with chronic cerebral ischemia.
Methods and subjects. The study included 110 intellectual workers with chronic cerebral ischemia, aged 40 to 77 years. The following methods were used: ultrasound research of main vessels of the head and neck, electroencephalography, cognitive evoked potentials P300, assessment of the cognitive function by scales: MOS SF-36 (Short Form Health Assessment), Montreal Scale Assessment of Cognitive Functions (MoСA), Hospital Anxiety and Depression Scale (HADS), assessment of professional adaptation.
Results. It was established that in patients with ultrasound signs of obliterating atherosclerosis of brachiocephalic arteries (the first clinical group) compared to patients without these characteristics (the second clinical group) demonstrated the following: possible reduction in the average characteristics of the general health self-assessment (scale MOS SF-36); greater expression of anxiety-depressive disorders; greater deviation frequency of equipment P300; no correlation with the age of the patient within each clinical group was detected. Manifestations of moderate or intensive professional maladjustment were observed in both groups, with frequent detection within the block in patients with obliterating atherosclerosis of brachiocephalic arteries, the reduction of personal achievements.
Conclusions. Designed complex neuropsychological and neurophysiological methods is optimal for testing objectification of cognitive disorders in patients with chronic cerebral ischemia available for practical use in health establishments of Ukraine. Patients with signs of constrictive atherosclerosis in combination with hypertensive angiopathy established a distinct change in the results of scales MOS SF-36, HADS, occupational maladjustment and change the basic parameters of cognitive evoked potentials.

Keywords: chronic cerebral ischemia, cognitive disorders, neuropsychological testing, cognitive evoked potentials.

Objective — to study the affect of different intensity modes of early statin therapy on cognitive function and CRP levels in plasma in patients with persistent and paroxysmal forms of atrial fibrillation.
Methods and subjects. The clinical study included 188 patients aged 56.8 ± 6.2 years. All patients at the beginning of therapy were performed neuropsychological testing to cognitive functions. Later patients along with standard therapy were assigned rosuvastatin or atorvastatin (focus group, n = 116). The control group patients (n = 30) had only standard therapy. We determined level of CRP. On the 14th day of hospitalization and after 6 months we assessed the SLOs and cognitive function.
Results. Mild (52.7 %) and moderate (25.0 %) cognitive disorders were determined. The majority of patients had elevated levels of CRP in the blood (9.7 ± 4.3 mg/l). Patients of the focus group demonstrated increased mental performance and attention levels against the background of statin treatment, which manifested itself in reduction of average time of numbers search when they run the sample Schulte. It was found that statin therapy resulted in improvement of short-term and long-term memory. Statin therapy resulted in a significant decrease in the content of CRP up to 14 days of treatment (5.36 ± 2.64 mg/l) and 6 months (2.22 ± 2.18 mg/l). After 2 weeks marked reduction of mean values of CRP: 6.99 ± 3.12 mg/l was observed in the rosuvastatin subgroup and 5.14 ± 3.06 mg/l in the subgroup of atorvastatin; after 6 months: 2.32 ± 2.18 mg/l in the rosuvastatin subgroup and 1.83 ± 2.07 mg/l in the subgroup of atorvastatin.
Conclusions. The data obtained allow to recommend therapy with statins from the first day of hospital phase of treatment for all patients with cognitive dysfunction against the background of persistent and paroxysmal forms of atrial fibrillation, which reduces the number of complications and improves the prognosis of the disease.

Keywords: atrial fibrillation, cognitive disorder, inflammation, statins.

Objective — to compare a neurological deficit and volume of hemorrhage (haematomas) in the brain hemispheres and basal ganglia at patients with arterial hypertension.
Methods and subjects. 147 patients (87 males and 60 females) were investigated with initial hemorrhage in brain hemispheres and subcortical structures (basal ganglia, thalamus), caused by advanced arterial hypertension. Age of patients consisted from 40 to 90 years, mean — 64.36 ± 9.39 years. Patients were distributed in four groups depending on the volume of haematoma (I group — 0 — 10 сm3, ІІ group — 10 — 20 сm3, ІІІ group — 20 — 30 сm3, ІV group — over 30 сm3). The neurological condition of patients was estimated according to Glasgow coma scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) during the first day of disease.
Results. Hypertensive intracerebral hemorrhage (ICH) in lobes of brain hemispheres was noted in 82 patients (55.8 %), in subcortical structures — in 65 patients (42.2 %). Correlation analysis of data in groups І — ІV with hypertensive ICH showed reliable connection between volume of haematoma and severity of neurological deficit (rs = 0.6; р < 0.05), assessed in the first day of stroke. Most of ICH were localized in temporal lobe and subcortical structures (basal ganglia, thalamus). In 46 patients of І — ІІІ groups with lobar haematomas and in a 31 patient with basal ganglia haematomas of group I the level of consciousness was calculated as13 — 15 points of GCS. Depression of consciousness to 9 — 12 points of GCS was noted at 23 patients with lobar haematomas of ІІІ — IV groups and at 23 patients with basal ganglia haematomas of the І — IV groups.
Conclusions. At patients with hypertensive ICH progression of neurological deficit according to NIHSS at the first day after stroke correlates with the volume of haematoma and its’ localization. Most part of hypertensive ICH was localized in temporal lobe and in subcortical structures (basal ganglia, thalamus) of cerebrum.

Keywords: hypertensive intracerebral hemorrhages, hematoma volume and localization, NIHSS neurological deficiency, GCS consciousness disorders.

Objective — to study the features of cognitive functioning in patients with TBI consequences in relation to the severity of the case history and trauma.
Methods and subjects. Cognitive functioning was assessed using the Montreal Cognitive deficit scale (test MoCA) in 367 patients with mild effects (99), moderate (118) and severe (150) TBI and the case history of injury from 0.5 to 30 years. Neurological status was evaluated with Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI), levels of anxiety and depression — with a scale HADS.
Results. Result MoCA test in patients with TBI consequences of varying severity complied with mild cognitive decline (mild effects — 22.21 ± 0.29, moderate — 21.36 ± 0.33, severe TBI — 21.32 ± 0.28. Consistent significant differences between the values MoCA test at different severity TBI was not observed. Extending case history of trauma (over 6 years) had a negative influence on the cognitive functioning of patients with mild effects and severe TBI in history.
Conclusions. The factors that influence the formation of cognitive deficits in each group have been outlined: educational level (mild effects and severe TBI), anxiety and depression (mild effects TBI case history of 5 years and moderate TBI case history of over 6 years), age (moderate TBI to 5 years), neurological deficiency (severe TBI more 6 years).

Keywords: consequences of traumatic brain injury, cognitive decline, test MoCA.

Objective — to improve diagnostic principles concerning lesions of the nervous system in patients with rheumatoid arthritis (RA), based on data from a comprehensive clinical laboratory and instrumental examination to determine clinical, laboratory and instrumental characteristics.
Methods and subjects. We carried out a comprehensive survey of 108 people, including 88 patients suffered from RA, and 20 persons made up the control group without an existing pathology. The mean age was 45.70 ± 1.29 years. Depending on the serological types of RA course they were divided into 2 groups. All patients underwent comprehensive examination: clinical, neurological, laboratory, neuro-psychological.
Results. Dysfunction of the nervous system is a typical pathological manifestation for RA (78 % cases). The hyporeactivity of the sympathetic division of the autonomic nervous system as well as parasympathetic is typical for RA. Patients with RA demonstrated an increased level of autoantibodies to neuroantigens (antibody to the OBM, NPE, S100 protein, SLMA), which did not depend on the option (seropositive or seronegative) of the inflammatory process.
Conclusions. Patients with RA had the following clinical manifestations of nervous system dysfunction: anxiety, depressive disorders, impaired autonomic function, and cognitive impairment, increased levels of autoantibodies to neuroantigens.

Keywords: rheumatoid arthritis, anxiety, depression, cognitive impairments, autonomic dysfunctions.

Objective — to determine predictors of disability progression in patients with relapsing-remitting multiple sclerosis (RRMS) depending on the clinical and neuroimaging factors.
Methods and subjects. The paper presents the findings of a ten-year follow-up of 180 multiple sclerosis (MS) patients starting with the first clinical signs of the disease. The patients received care in the Kyiv City Center of Multiple Sclerosis based on the Kyiv City Clinical Hospital #4 during 2003 — 2014. The mean patient age was 31.5 ± 1.18. During the study periods, we recorded relapse rates, neuroimaging indicators, and EDSS levels (Expanded Disability Status Scale).
Results. We identified the predictors of disability progression in RRMS patients from onset, depending on the clinical and neuroimaging factors. Reliable (p = 0.021) ratio of the probability to reach moderate level of disability depending on the relapse rate at the disease onset appeared only after 9 years (OR 3.11; 95 % CI 1.16 — 8.32). Neuroimaging predictors of disability progression in RRMS were the presence of the total number of T2-cells ≥ 9 (OR 3.35; 95 % CI 1.73 — 6.50), and periventricular localization of subtentorial cells (OR 1.90; 95 % CI 1.12 — 3.52 and OR 2.25; 95 % CI 1.04 — 4.90), respectively, the number of T2-cells > 3 mm (OR 2.78; 95 % CI 1.10 — 7.02). The high ratio of the probability of reaching EDSS > 3.0 points in the first six years since disease onset is evidenced for T2-cells presence with size > 3 mm (OR 21 46; 95 % CI 9.58 — 48.09).
Conclusions. High relapse rate in the early years of the disease is a significant predictor of reaching a moderate level of disability by EDSS scale in the long term — 9 — 10 years from RRMS onset. Neuroimaging predictors of disability progression in RRMS are the presence of the total number of T2-cells, infratentorial and periventricular localization of lesions, the number of T2-cells more 3 mm in size. During the first six years since the disease onset, one of the most important indicator of reaching EDSS > 3.0 points is the size and number of T2-cells and Gd+-cells.

Keywords: relapsing-remitting multiple sclerosis, clinically isolated syndrome, disability progression, clinical and neuroimaging factors.

Objective — to investigate the effectiveness of anticholinergic drugs, that block muscarinic receptors subtype M3, in the treatment of patients with multiple sclerosis (MS) with disorders of urination compared with the efficiency electro procedures.
Methods and subjects. The study involved 26 MS patients (16 males and 10 females). The average age of patients was 29.1 ± 3.9 years. 16 patients received oxybutynin hydrochloride 2.5 mg 2 times a day for three days, then 5 mg 2 times a day to 21 day in addition to vascular-metabolic therapy (pentoxyfylline or acide nykotinici, nootropil, neurorubine or neurubeks, meldonium, mydocalm). The second group of patients (10 patients) hosted traditional treatment of MS and the electro procedures. All patients underwent clinical neurological examination and questioning by IPSS and EDSS scale.
Results. The treatment showed some improvement in general condition and motor activity in both groups, but patients in the first group showed significant improvement urination.
Conclusions. Use of oxybutynin in MS patients with disorders of urination showed improvement in patients with symptoms of hyperreflexia and  detrusor-sphincter dyssynergia (often urination, compelling urge to urinate, urinary incontinence) compared with patients receiving the electro procedures.

Keywords: multiple sclerosis, urination disorders, treatment, oxybutynin.

Objective — to analyze the effectiveness of treatment patients with idiopathic intracranial hypertension.
Methods and subjects. We analyzed clinical, neuro ophthalmological, MRI, CT and angiographic data derived from observations of 50 patients (women — 37 men — 13, aged 24 to 69) with idiopathic intracranial hypertension, who were treated in the Institute of Neurosurgery in the period 1990 — 2016.
Results. 9 patients with idiopathic intracranial hypertension demonstrated good effect by maintaining drug therapy and serial lumbar punctures. 31 patients had lumbar drainage installed in order to reduce the intracranial pressure and save vision. 7 patients underwent lumbar peritoneal bypass and 3 — transverse venous sinus stenting, including 1 patient — bilateral.
Conclusions. Drug treatment and lumbar puncture are indicated for patients with preserved visual functions or with a slight decrease in visual acuity and initial visual field defects. Setting lumbar drainage against the background of drug therapy is administered in case of ineffectiveness of serial lumbar punctures and a moderate deterioration in visual function. Bypass surgery and stenting operations are obligatory in patients with progressive visual disorders, serious violations of the functions of the optic nerve and stagnant disc atrophy stage. The use of physiotherapy treatment in the early postoperative period improves visual function, visual acuity and field of view.

Keywords: optic atrophy, idiopathic intracranial hypertension, electrotherapy, rehabilitation treatment, lumbar puncture, magnetic therapy, neurosurgical operations.

Objective — to determine the role of maladaptive reactions in the formation of psychosomatic disorders in adolescents.
Methods and subjects. The article presents the assessment of adolescents’ somatic state (18 males and 39 females, mean age — 14.0 ± 2.0 years) of secondary school and boarding school who were hospitalized and treated for psychosomatic disorders in the pediatric department of Khmelnytskyi city children hospital; the results of research were analyzed by means of diagnostic psychological and pathopsychological methods: test questionnaire parental relationship (A. Ya. Varha, V. V. Stolin), assessment of mood, D. Stott’s map observations, the scale thermometer, Eysenck’s test, Spielberg’s test.
Results. Disturbances of personal adaptation mechanisms in adolescent orphans and half-orphans were observed. Such children can often disrupt the behavior and require attention from the teachers and the school psychologist. The features of the formation of maladaptive responses in psychosomatic disorders in adolescents were defined. The best pathopsychological techniques aimed at identifying anxiety, depression, autonomic disorders, assessment of health, activity, mood for diagnosis maladjustment in psychosomatic disorders were detected.
Conclusions. Stressful factors and the state of a patient play a leading role in the origin of psychosomatic diseases.

Keywords: psychosomatic disorders, psychiatric disorders, adolescents, adaptation disorders, maladjustment.

This article based on the analysis of foreign and national literature studies clinical and epidemiological features of enteroviral meningitisis, provides modern methods of its diagnostics and treatment. The most numerous outbreaks of enteroviral meningitisis in different countries of the world are described. The course of enteroviral meningitisis of 46 adult patients, who were hospitalized during the outbreak of 2013, are analyzed using the data of Lviv Regional Infectious Diseases Clinical Hospital Archive.

Keywords: enterovirus, enterovirus disease, outbreak, meningitis.

Objective — to choose the best method for pain assessment in patients with chronic low back pain for effective use in daily clinical practice.
Methods and subjects. The study involved 90 patients with dorsopathy (code M40-M54 for ICD-10). Diagnosis was based on clinical neurological examination and data of neuroimaging. Evaluation of qualitative and quantitative characteristics of pain was performed by means of Visual Аnalog scale (VAS), McGill Pain Questionnaire (MPQ, 1975) and Brief Pain Inventory (BPI, 1994).
Results. A leading syndrome was chronic low back pain of different intensity. The disease was characterized by chronic course with periodic exacerbations. The usage of VAS has demonstrated its following advantages: accessibility, easy in use, short time of performance (1 min). The disadvantages include the determination of only pain intensity and lack of information about its qualitative characteristics. The results of McGill Pain Questionnaire found out not only quantitative but also qualitative characteristics of pain in three areas — sensory, affective and evaluative. The time used for pain assessment according to this scale ranged from 5 to 15 minutes. Among the disadvantages should be noted: questionnaire contains terms that are not always clear and understandable to the general public; some subclasses in scale are very similar, making difficult the choice of correct descriptor; the results of the questionnaire depend on high anxiety and psychotype of the patient. The main advantages of Brief Pain Inventory were availability to patients of different ages and social status and time that was used for its implementation (about 5 minutes). The BPI helped to evaluate not only the intensity of pain, but its influence on quality of life.
Conclusions. The best method of pain assessment in patients with chronic low back pain should be chosen according to the clinical situation and its conditions. This comparative analysis of widely used questionnaires and scales for quantitative and qualitative measurement of pain in patients with chronic low back pain can be used during diagnostic search for effective systematic evaluation of pain, to determine the pattern of its dynamics and effectiveness of treatment.

Keywords: chronic low back pain, Visual Аnalog scale, McGill Pain Questionnaire, Brief Pain Inventory, qualitative and quantitative assessment of pain.

Myofascial violations in the facial muscles are developed by the same mechanisms as in the skeletal and cause 10 — 20 % of face pain syndromes. The mechanism of development of muscle pain is that at the initial stage in the muscle there is residual voltage, and then locally persistent hypertonicity occurs. The combined therapy includes: occlusion correction, load limitation on the muscles of chewing (chewing gum is contraindicated). In the presence of CT in the masticatory muscles the procaine block and dry puncture ensure good results. The postisometric relaxation of the affected muscles, facial massage, physiotherapy, acupuncture are administered. The pharmacological treatment of myofascial pain dysfunction includes muscle relaxants (tizanidine, Baclofen), psychotropic drugs (tranquilizers and antidepressants), nonsteroidal anti-inflammatory drugs, vitamin B (Neovitam).

Keywords: pain, myofascial syndrome, tizanidine.