Research Center of Neurology

The phenomenon of cross-excitation—interaction between neurons of a dorsal root ganglion (DRG) in intact organism, presents a great challenge since its discovery. It can not be attributed to classical neuron–neuron interactions, as the mentioned neurons are believed to be physiologically isolated by glial sheaths from one another. In this work we test existing hypotheses which explain the phenomenon from both biophysical and statistical perspectives. Our conclusion is that neither each proposed mechanism alone, nor interactions of them can adequately describe cross-excitation in normal conditions. We wish to draw greater attention towards the phenomenon, as it seems to be an important part of normal sensory information processing.

A connection between the symmetry of high-field nuclear magnetic resonance (NMR) spectra, including higher-order spectra, and the properties of the spin system has been established. It is shown that, for a spectrum to be symmetric about the mid-resonance frequency (), two conditions must be satisfied: (1) the resonance frequencies of the spins must be symmetrically positioned about , and (2) there must exist at least one spin ordering with a monotonic increase (or decrease) in resonance frequencies such that the spectrum is invariant under the reflection of the -coupling matrix about its anti-diagonal (one way to satisfy this condition is for the -coupling matrix to be explicitly persymmetric). The results were validated by calculating theoretical spectra for three-, four-, five-, and six-spin systems.

Parkinson’s disease (PD) and multiple system atrophy (MSA) are neurodegenerative diseases characterized by the alpha-synuclein protein pathology, which may be associated with a changed expression of the SNCA gene encoding this protein. We studied the expression of four SNCA transcript variants, encoding the protein isoforms SNCA-140, SNCA-126, SNCA-112, and SNCA-98, in blood leukocytes of 86 PD and 52 MSA patients compared to 50 control subjects without neurological pathology. All SNCA transcript variants were increased in leukocytes in MSA patients (predominantly alternatively spliced short transcripts), especially with parkinsonian type of disease. No significant SNCA expression changes were found in the group of PD patients. The results obtained emphasize the differences in the pathogenesis of these two synucleinopathies—PD and MSA.

INTRODUCTION: Patients with disorders of consciousness (DoC) represent a complex patient cohort requiring a multidisciplinary approach. Despite the availability of modern national clinical guidelines (2023), real-world clinical practice in Russia continues to be challenged by the use of outdated terminology, insufficient implementation of validated diagnostic scales, and a lack of standardized management approaches, including pain assessment and management. This study was prompted by the need to assess the current situation and identify key issues to improve the quality of care for patients with DoC in Russia. OBJECTIVE: To assess the current practices, awareness, and key challenges faced by Russian healthcare professionals in the diagnosis, treatment, and management of patients with chronic DoC. MATERIALS AND METHODS: In 2024, an anonymous online survey of 204 medical and paramedical professionals (anesthesiologists, neurologists, rehabilitation specialists, psychologists, nursing staff) from various regions of Russia was conducted. The 47-item questionnaire covered demographic data, terminology used, diagnostic scales, treatment and rehabilitation methods, as well as approaches to pain assessment and management. RESULTS: Despite modern clinical guidelines, outdated terminology persists in practice: apallic syndrome (13.3 %), vegetative state. Only 62.9 % of respondents use the validated Coma Recovery Scale-Revised (CRS-R) for DoC diagnosis, while 77.1 % still use non-relevant scales (Glasgow Coma Scale, Full Outline of UnResponsiveness — FOUR). 30 % of respondents, including physicians responsible for diagnosis, use exclusively these non-relevant tools. Significant differences in approaches were identified among specialists of different profiles (intensivists, neurologists, rehabilitation specialists). The majority of respondents (83 %) acknowledge that DoC patients experience pain; however, the assessment methods (autonomic signs, grimacing) are not standardized and can be non-specific. CONCLUSIONS: The study results indicate insufficient awareness and fragmented implementation of modern standards for the diagnosis and management of patients with DoC in Russia. The findings highlight the necessity of developing and implementing educational programs for healthcare professionals aimed at standardizing terminology, promoting the use of validated diagnostic scales (CRS-R), and harmonizing approaches to pain management.

Cerebral microangiopathy (CMА), also known as cerebral small vessel disease (CSVD), is characterized by impairment of multiple cognitive functions, including executive functions, processing speed, memory and behavior condition. These impairments are primarily associated with disruption of frontal-subcortical networks resulting from white matter damage. An additional contribution to cognitive deficit is made by vascular lesions of subcortical structures, such as the thalamus and basal ganglia. Citicoline is one of the promising and pharmacologically substantiated drugs for the treatment of cognitive impairment (CI) in СМА. Efficacy of сiticoline is due to impact on key mechanisms of brain damage. Citicoline stabilizes cell membranes by inhibiting the activity of phospholipases – enzymes that trigger apoptosis (programmed cell death) under conditions of ischemia and hypoxia. This effect is particularly important in СМА, as chronic impairment of cerebral blood flow causes the death of oligodendrocytes, which are responsible for myelin formation, and neurons. The results of clinical studies confirm the ability of Citicoline to improve cognitive functions, primarily information processing speed and executive functions. Furthermore, longterm use of Citicoline stimulates endogenous mechanisms of neurogenesis and regeneration of nervous tissue. This article presents a clinical case of CMA with CI. The patient’s main complaints were poor concentration, fatigue and memory impairment. In addition to standard therapy, including antihypertensive, lipid-lowering and antiplatelet drugs, the patient was prescribed сiticoline: initially intravenously at 1000 mg/day for 10 days, then orally at 1000 mg/day for 6 months. After 6 months of taking сiticoline, the patient reported an increase in the ability to work and improvement in memory recall. A follow-up examination also revealed positive dynamics: an improvement in cognitive status measured by the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination (ACE) scales. The obtained data indicate the high efficacy of сiticoline in the correction of CI and allow to recommend its inclusion in the complex therapy of patients with CMA.

A case of inclusion body myositis (IBM) with autoantibodies against cN1A following orchiectomy for seminoma has not been previously described. A 60-year-old man developed slowly progressive, painless paraparesis of the lower extremities and mild hyper-creatine kinase (CK)emia three years after orchiectomy for a unilateral seminoma. Clinical examination 10 years after onset revealed weakness of hip flexion (Medical Research Council (MRC) 5-), knee flexion (MRC 5-), and foot extension (left MRC 4-, right MRC 5-); absent tendon reflexes; and thigh muscle atrophy. Needle electromyography was normal, but contrast-enhanced muscle MRI indicated myositis. Quadriceps muscle biopsy revealed terminally remodeled muscle tissue with fibrosis and adipose tissue replacement, as well as a few residual, markedly atrophic, myopathic muscle fibers and COX-negative fibers suggestive of IBM, primary myopathy, or a neurogenic lesion with secondary myopathy. Myositis antibody testing showed a marked increase in cN1A. In summary, this case demonstrates that cN1A antibody-associated IBM can occur following seminoma, IBM can begin with proximally accentuated paraparesis of the lower extremities, the correct diagnosis can take years, and muscle MRI, biopsy, and antibody testing, but not electromyography, can be diagnostically helpful.

Introduction. Anti-B-cell therapy that prevents clonal expansion of B cells expressing CD20 is a significant achievement in the pharmacotherapy of multiple sclerosis (MS). Randomized studies have shown high efficacy of monoclonal antibodies (mAb), confirmed by a reduction in the annualized relapse rate (ARR), MRI activity, and the risk of disability progression. Divozilimab (DIV) is a humanized afucosylated anti-CD20 mAb with a modified Fc fragment that provides high effector activity. The aim is to evaluate the efficacy and safety of DIV in patients with various MS phenotypes in real-world clinical practice. Materials and methods. The prospective study included 43 patients: 24 with rapidly progressive MS, 9 with highly active MS, and 10 with secondary progressive MS with relapses. All received DIV therapy for 6–12 months. We assessed ARR, MRI activity (lesions with contrast enhancement (T1-Gd+), new/enlarged T2 lesions), changes in the Expanded Disability Status Scale (EDSS), CD19+ B-cell levels, and the safety profile. Data were analyzed before therapy, at 6 months, and at 12 months of treatment. Results. Over 12 months of therapy, ARR decreased from 1.3 to 0.03; the proportion of patients without T1-Gd+ lesions increased from 27.9% to 100%, and new T2 lesions were detected in 6.1%. The median EDSS decreased from 3.0 [2.0; 3.5] to 2.5 [2.0; 3.0]. Profound depletion of CD19+ B cells was noted (0% [0.0; 0.2]); NEDA-3 (No Evidence of Disease Activity-3) status was achieved in 84.9%. Adverse events were limited to mild/moderate infusion reactions (30.2% at the first infusion), and no serious adverse events were recorded. Conclusion. DIV provides rapid and sustained suppression of clinical and MRI activity in MS with pronounced B-cell depletion and a favorable safety profile, justifying its early use in patients with high disease activity.

The aim of the study was to determine the structure and trends of the public-private partnership projects market in the healthcare sector in the Russian Federation. The information and analytical base of the study was data on investment projects implemented on PPP principles and included in the register of the Rosinfra digital platform. Qualitative and quantitative research methods were used. The PPP market in the healthcare sector has been formed and is developing in different areas of industry activity. However, the analysis of the structure and trends showed its imbalance in models, legal forms, and areas of MP. Conditions have not been created for investors in socially significant areas — primary care, medical rehabilitation. The analysis of the structure and trends of the PPP market in the healthcare sector showed that it is necessary to develop mechanisms for attracting investments in the primary care (general therapeutic area) and improve special legislation in terms of PPP agreements in order to replicate infrastructure models in the industry. This will lead to a decrease in the number of low-capital-intensive and short-term projects, which will contribute to more sustainable development of PPP in the healthcare sector.