Elena S. Akarachkova

Background. Despite declining stroke mortality in Eastern European countries, the burden of stroke measured as years lived with disability (YLD) has not shown a decreasing trend, giving rise to the so-called “rehabilitation paradox”. Objective: To assess trends in the burden of stroke in Lithuania, Russia, Moldova, Estonia, and Czechia from 2010 to 2021, and to model neurorehabilitation needs and workforce shortages. Material and methods. A secondary analysis of data from the Global Burden of Disease Study (GBD) 2021 was conducted. Both absolute YLD counts and YLD rates per 100,000 population were examined. The estimated annual percentage change (EAPC) for 2010–2021 was calculated. Based on GBD data, the demand for neurorehabilitation services was modeled and workforce shortages were estimated for the countries under analysis. Results. In 2021, the highest YLD rates per 100,000 population were observed in Lithuania (333.3) and Russia (305.8). A decline in YLD was identified in Estonia (EAPC –0.9%; –9.7% from 2010 to 2021) and Czechia (EAPC –1.6%; –14.6% from 2010 to 2021). In Russia, the absolute YLD burden increased by 2.2% (up to 454.3 thousand individuals). The shortage of rehabilitation professionals was estimated at 14,855 in Russia, 366 in Moldova, and 282 in Lithuania. Sensitivity analysis for 2010–2019 confirmed the observed trends; the impact of COVID-19 was found to be moderate. Conclusion. A rehabilitation gap persists across all five countries. Scaling up neurorehabilitation services in accordance with the standards of the European Stroke Organisation and the World Health Organization is required.

School adaptation disorders are a common multifactorial problem in pediatric and neurological practice, exacerbated in recent years by new psychosocial stressors. Early diagnosis and comprehensive treatment of this condition are key factors in the prevention of severe anxiety and depressive disorders in the future. The review highlights current views on the etiology, neurobiological mechanisms, and comprehensive approaches to addressing adaptation disorders to school stress in children. A review of modern Russian and foreign literature data on the problem of school stress, maladaptation, and the role of emotional competence and executive functions in the adaptation process was conducted. The root cause of school maladaptation is a complex of stress factors (significant life changes, academic stress, social difficulties, and environmental exposures). The development of emotional competence (the ability to recognize and regulate emotions) and executive functions (inhibition control, working memory, cognitive flexibility), which are closely interrelated, play a key role in successful adaptation. A practical care approach should include both non-pharmacological methods (such as psychological and pedagogical interventions, as well as work with the child's family) and adequate pharmacotherapy. The nootropic agent nicotinoyl γ-aminobutyric acid (Picamilon), which has a complex, autonomous, stabilizing, anxiolytic, vasoactive, and neurometabolic effect, is considered a pathogenetically justified and safe pharmacological option. The importance of timely detection of school maladjustment signs and the use of an integrated approach combining psychological support and, if necessary, modern nootropic agents with a favorable safety profile is emphasized. It enhances children's ability to adapt to school and improves their long-term mental health outcomes.

Epilepsy is one of the most common neurological disorders, affecting 51.7 million people worldwide. The International League Against Epilepsy (ILAE) plays a pivotal role in equipping healthcare professionals, patients, government agencies and the general public with the necessary resources to enhance the diagnosis and treatment of epilepsy. In 2025, the ILAE released an updated classification of epileptic seizures, which aimed to address the limitations of previous version and adapt to modern clinical and scientific needs. This publication presents and analyses the ILAE 2025 classification of epileptic seizures, including its development methodology, key changes, and recommendations for clinical application. To develop the document, an ILAE working group was established. This involved conducting a systematic literature review to evaluate the previous version, using a modified Delphi method to reach consensus and implementing a public discussion and peer review process. The updated classification includes four main seizure classes: focal; unknown whether focal or generalized; generalized; and unclassified. Key changes, compared to the previous version include: the removal of the term “onset” from mail seizure class names; introduction of classifiers and descriptors; the term “awareness” has been replaced with “consciousness”; seizures are now described as with or without observable manifestations (basic version) or by the chronological sequence of semiology (expanded version). Epileptic negative myoclonus is recognized as a distinct seizure type. The ILAE 2025 classification of epileptic seizures is a significant step forward in standardizing the diagnosis and treatment of epilepsy, its update helps to improve the quality of medical care and further development of collaboration between epilepsy specialists around the world.

On October 6, 2024, the Council of Experts held a meeting to discuss «The role of the combination of undenatured type II collagen UC-II, vitamin C, and trace elements in recovering and maintaining the function of the musculoskeletal system and preservation of joint health.» New opportunities in preventing and treating osteoarthritis (OA), including in comorbid patients, are considered. Leading experts in rheumatology, clinical pharmacology, neurology, clinical immunology, orthopedics, traumatology, and sports medicine attended the meeting. The OA phenotypes, the mechanism of action of undenatured type II collagen, the data of clinical studies with undenatured collagen UC II, the integrative, interdisciplinary approach in the prevention and treatment of OA, and the prospects for using the VoltaFlex dietary supplement were analyzed. The resolution of the Council of Experts emphasized the importance of an integrated approach to the treatment of OA, including pharmacological and non-drug methods, and recommended using a combination of undenatured type II UC-II collagen, vitamin C, and trace elements to recover and maintain the musculoskeletal system’s function and preserve joint health.

Background. The International League Against Epilepsy (ILAE) has provided recommendations on the terminology of medicines for control of seizure disorders, which should be adapted into different languages.Objective: to evaluate the usage profile of terms describing the effects of medicines used in patients with epilepsy.Material and methods. The search query analysis systems Google Trends and Yandex Wordstat as well as PubMed/MEDLINE, Google Scholar and eLibrary databases were used to evaluate the general public and professional usage profile, respectively.The following terms in Russian and English were studied: “antiepileptic”, “antiepileptic drug”, “antiseizure”, “antiseizure drug”. In order to ascertain a prevailing opinion within professional and patient communities, a questionnaire survey was conducted on the public online resources of the non-profit partnership “The Association of Epileptologists and Patients” carried out via the cloud-based cross-platform social media as well as instant messaging service Telegram and the social media platform VK.Results. In the English-speaking internet segment, the term “antiepileptic” is used more than 5 times frequently than “antiseizure” by the general public. Conversely, in the Russian-language segment, the term “antiseizure” is almost 2.5 times more common. The term “antiepileptic” is more prevalent in scientific community in both segments. This finding aligns with the profile of terminology usage observed among epileptologists and epilepsy patients. The questionnaire survey results revealed that 56.42% of 179 respondents were in favor of the terms “antiepileptic drug”, “AED” and “antiepileptic therapy”, whereas as few as 17.32% of those endorsed the ILAE-proposed terminology.Conclusion. In light of the established practice of terminology use in both professional scientific community and among practicing epileptologists and epileptic patients, as well as the differences in the semantics of English- and Russian-language terms and the identified lack of precision in the ILAE definition of epilepsy, it can be concluded that for the Russian-speaking population, the terms “antiepileptic drug”, “AED” are more preferable rather than the terms “antiseizure medication”, “ASM”. Additionally, it is preferable to use the terms “convulsive ictus” and “epileptic ictus” due to negative connotation with term “seizure” in Russian. The terms “antiseizure” and “antiepileptic” should not be regarded as mutually exclusive in the context of treatment that has a direct impact on epilepsy course. Finally, it is necessary to further refine epilepsy definition and classification.

Background. Long-term chronic diseases, some types of treatment, and individual social factors have a significant stress impact on young patients. Existing rehabilitation methods are aimed at restoring body functional activity and replenishing lost adaptation reserves. However, the key features of children's adaptation to stress loads have not been fully disclosed.Objective: to reveal the key features of adaptation mechanisms to stressful influences in children.Material and methods. The search and selection of publications were carried out according to PRISMA recommendations in the scientific databases PubMed/MEDLINE, ScienceDirect, Google Scholar and the electronic libraries eLibrary, Cochrane Library. Additionally, a search was conducted in the search engines Yandex and Google. In total, 1825 publications were found. After selection, 50 of them were included in the review.Results. Low level of adaptive reserves in children to resist stress effects was identified, the key reasons for which are insufficient amounts of minerals and microelements coming into the body with food. The decrease in adaptive capacity often occurs hidden and requires close monitoring. Recommendations were presented as a means of preventing exhaustion and restoring functional activity, allowing for behavioral and psychological support for the child. Additionally, the effectiveness of magnesium-containing drugs in restoring adaptive reserves in children was shown.Conclusion. Excessive stress loads in children and adolescents have a detrimental effect on their physical and mental well-being, ability to regulate own behavior and can cause a number of chronic diseases in adulthood. Timely psychological support, nutritional control and normalization of biological rhythms will significantly increase the adaptive reserves and reduce the likelihood of chronic diseases in future as well as the burden on the healthcare system in general.

Agomelatine is an antidepressant with a unique pharmacological action that is both a melatonin agonist and a selective serotonin antagonist. The drug's unique pharmacological profile includes the properties of a dual 5-HT2С receptor antagonist as well as the properties of a melatonin MT1 and MT2 receptor agonist. Through its effect on melatonin receptors, agomelatine resynchronizes disturbed circadian rhythms and has a positive effect on sleep architecture. In addition, agomelatine shows a novel and fundamentally different mechanism of anxiolytic action compared to other classes of drugs used to treat anxiety. The article presents studies of agomelatine that demonstrate good treatment results in terms of response rates and remission in major depressive disorder of varying severity and generalized anxiety disorder. Agomelatine in a daily dose of 25–50 mg not only reduces the degree of anhedonia, apathy, anxiety, reduces somatic symptoms of depressive and anxiety disorders, but is also well tolerated, normalizes sexual dysfunctions in patients in psychiatric and general medical networks, it is used in cardiovascular, neurological diseases, and post-COVID-19.

Objective. The review provides an analysis of modern domestic and foreign literature on the role of nutritional support in comorbid patients with asthenia. The problem of dietary deficiency of B vitamins is discussed, including as a result of a decrease in their absorption, which can be considered as an etiological factor in the development of neurological disorders and a wide range of pathological conditions, including immune ones, the aggravation of which is observed in different groups of the population, including the elderly. Results. The growing number of patients with complaints of asthenic manifestations in the symptom complex of their underlying disease cannot but cause alarm, so the authors of the article provide data from scientific studies confirming the general clinical trend – the use of sufficient amounts of B-complex vitamins has a positive effect on physical, mental and energetic results in comorbid patientspatients. Separately, the review presents an analysis of data on the need to include B vitamins in the diet to correct the somatopsychic manifestations of stress both in the long term (impact on worker productivity, reducing the number of days of disability, reducing the level of morbidity and accidents, etc.) and short-term needs. The need for further research into the neurocognitive and physical benefits of not only B-complex supplementation, but also other micronutrients, is particularly emphasized, with overall supporting evidence for the benefits of nutritional support in healthy and at-risk populations in terms of physical, mental and energy outcomes. A detailed analysis of the data in the article revealed the need to consider modern data from experimental and clinical studies, the pathogenetic mechanisms of the development of asthenic phenomena in patients with comorbid pathology, and possible points of application of nutritional support in their correction.

In the article, the authors answered the following questions: How often do anxious patients occur in clinical practice? Why do most patients with anxiety see primary care physicians rather than a psychiatrist? What complaints and manifestations help to suspect anxiety in the patient? How can a non-psychiatrist identify and diagnose anxiety? How to manage a patient with diagnosed anxiety? Short-term and long-term outcomes/prognosis.

The article presents theses of the resolution of the Interdisciplinary Council of Experts in Psychiatry and Neurology (Moscow, 2024) on the issue of comorbid anxiety disorders (AD) in patients with neurological pathologies. The authors highlight the high prevalence of comorbid ADs and their significant negative impact on the course of underlying diseases, such as epilepsy, pain syndromes and post-stroke conditions. Modern approaches to the diagnosis and treatment of ADs in this group of patients are discussed. Special attention is given to the role of etifoxine as an effective anxiolytic in the comprehensive therapy of ADs. Etifoxine, due to its dual mechanism of action on GABA receptors, demonstrates high efficacy in reducing anxiety and has neuroprotective, neurotrophic, neuroplastic, analgesic, and anti-inflammatory properties, making it an important tool in the treatment of comorbid ADs in patients with neurological pathologies. The article also reviews recently published data confirming its efficacy and favourable safety profile compared to traditional benzodiazepines and other anxiolytic drugs.