JOURNAL OF NEUROLOGY AND NEUROSURGERY RESEARCH
By Resolution of the Presidium of the SAC No. 361/6 dated September 27, 2024, the journal was included in the list of domestic scientific publications recommended for publishing the main scientific results of dissertations in medical sciences. The Journal of Neurology and Neurosurgical Research is a peer-reviewed journal that focuses on the development of science and practice in neurology and neurosurgery through the rapid publication of high-quality original research, systematic reviews, meta-analyses, and clinical case reports. The journal is addressed to specialists in neurology and neurosurgery who are engaged in scientific research and clinical practice. The Journal of Neurology and Neurosurgical Research, with its open access content, provides an opportunity for wide dissemination of research in this field among a worldwide audience.
DEVELOPMENT OF A PERSONALIZED TREATMENT ALGORITHM FOR HEMIFACIAL SPASM BASED ON CLINICAL AND FUNCTIONAL CRITERIA (A LITERATURE REVIEW)
Hemifacial spasm (HFS) is a cranial movement disorder characterized by unilateral, involuntary contractions of the mimic muscles innervated by the facial nerve, and it markedly reduces patients' quality of life. Botulinum toxin type A (BoNT-A) is currently the first-line option for the symptomatic treatment of HFS, providing substantial relief in 85–95% of patients. However, treatment efficacy, duration of effect, and adverse events vary from one patient to another, and no single standardized protocol exists. The aim of this review is to analyze the clinical and functional criteria that influence the efficacy of BoNT-A treatment in HFS and to summarize the scientific basis for a personalized treatment approach. The analysis shows that individualizing treatment according to a patient's clinical and functional characteristics may improve efficacy and reduce adverse events and costs; developing an evidence-based treatment algorithm in this direction remains an important task.
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THE ROLE OF FERROPTOSIS IN THE PATHOGENESIS OF SYMPTOMATIC EPILEPSY: A CLINICAL AND NEUROIMAGING STUDY
Objective: To investigate the role of iron metabolism disorders and ferroptosis mechanisms in the pathogenesis of symptomatic epilepsy. Materials and methods: A prospective controlled cohort study was conducted involving 80 patients with symptomatic epilepsy and 30 healthy individuals. Clinical and neurological manifestations, cognitive functions (MMSE, TMT), iron metabolism parameters, ferroptosis markers (GPX4, ACSL4, MDA), MRI and EEG data were evaluated. Results: Patients with symptomatic epilepsy showed significant cognitive function decline (MMSE: 24.3±2.5 vs 28.7±1.3 points, p<0.01), iron metabolism disorders with elevated ferritin levels (320±25 vs 210±20 ng/ml, p<0.01), decreased GPX4 expression by 1.8-fold (p<0.01), increased ACSL4 by 2.3-fold (p<0.01), and elevated MDA to 6.1±0.5 nmol/mg protein (p<0.001). SWI-MRI revealed iron accumulation in the basal ganglia, hippocampus, and thalamus in 50% of patients. Conclusion: Iron metabolism disorders and ferroptosis activation play a key role in the pathogenesis of symptomatic epilepsy, opening prospects for developing pathogenetically targeted therapy.
VISCERAL SENSITIVITY INDEX IN IRRITABLE BOWEL SYNDROME AND THE EFFECTIVENESS OF SYSTEMATIC DESENSITIZATION THERAPY IN THESE PATIENTS
This study investigated the Visceral Sensitivity Index and the effectiveness of systematic desensitization therapy in 80 patients with Irritable Bowel Syndrome (IBS). The patients were divided into two groups: Group 1 received systematic desensitization therapy combined with sulpiride, while Group 2 received rational psychotherapy combined with sulpiride. The results demonstrated that systematic desensitization therapy was effective in reducing visceral sensitivity as well as anxiety-phobic symptoms in patients with IBS.
AWAKE CRANIOTOMY FOR PATIENTS WITH RECURRENT GLIOMAS. A REVIEW OF LITERATURE
This systematic review was conducted according to the PRISMA 2020 guidelines to identify English-language studies published within the past 5 years (2020–2025) reporting awake craniotomy (with intraoperative mapping) for repeat resection of recurrent glioblastoma in adult patients (≥18 years). PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched. We included retrospective or prospective series with ≥3 patients and excluded techniques performed in a non-awake state, histology other than glioblastoma, non-recurrent resections, and publications not in English. Extracted data included sample size, mapping success, resection extent (EOR/GTR), neurological deficit rate (transient/permanent), PFS, OS, and follow-up duration. Specifically, we focused on articles in which authors evaluated and compared the risk-benefit ratio of awake surgery for recurrent cases. Only articles in English were analyzed. Results: A search of the current literature identified 340 records (original articles and case series). After removing 46 duplicates, 294 records were screened by title/ANNOTATION, of which 250 were excluded. Forty-four full-text articles were assessed for inclusion criteria; 36 were excluded (20 due to non-recurrent glioblastoma, 8 due to insufficient data, 4 due to duplicate datasets, and 4 due to non-English language). Ultimately, 8 studies met the inclusion criteria for qualitative synthesis; of these, 5 provided sufficient data for quantitative synthesis (meta-analysis).
COMPREHENSIVE REHABILITATION OF PATIENTS AFTER REMOVAL OF A POSTERIOR CRANIAL FOSSA TUMOR
Tumors of the posterior cranial fossa are among the most complex neuro-oncological diseases, as they are located in an anatomically confined space in close proximity to the cerebellum, brainstem, fourth ventricle, caudal group of cranial nerves and cerebrospinal fluid pathways. Even after technically successful surgical removal of the tumor, a significant proportion of patients retain coordination, motor, speech, bulbar, cognitive and psychoemotional disorders. The aim of the article is to provide a scientific rationale for comprehensive rehabilitation of patients after removal of posterior cranial fossa tumors, taking into account the early postoperative period, the structure of neurological deficit and functional prognosis. The article discusses the main components of neurorehabilitation: early verticalization, therapeutic physical training, vestibulo-coordination exercises, speech therapy correction, dysphagia therapy, neuropsychological support and occupational therapy. Special attention is paid to the assessment of recovery using the SARA, Berg Balance Scale, Barthel Index/FIM, MoCA and SF-36. It is shown that comprehensive rehabilitation contributes to the improvement of balance, gait, self-care, speech activity, swallowing, cognitive productivity and quality of life; however, in cases of severe posterior fossa syndrome, cerebellar mutism, brainstem involvement and aggressive oncological treatment, full recovery is not always achieved. It is concluded that the effectiveness of treatment of patients with posterior cranial fossa tumors is determined not only by the radicality of resection but also by the quality of subsequent staged neurorehabilitation.
SERUM INTERLEUKIN-6 LEVEL AS AN INTER-NOSOLOGICAL MARKER OF THE "GUT-BRAIN" AXIS ACTIVITY IN DEGENERATIVE AND VASCULAR PARKINSONISM
The article presents the results of a comparative clinical and laboratory study focusing on the systemic inflammatory response in patients with degenerative and vascular forms of parkinsonism. Serum interleukin-6 concentration was investigated as the primary marker of immune activation in relation to clinical manifestations and gastrointestinal triggers, including Helicobacter pylori invasion and subclinical enteral inflammation. The study revealed a qualitative polarity in the architecture of correlation profiles between the examined cohorts. In patients with Parkinson's disease, the level of systemic inflammation demonstrated a tight linkage with the infectious burden of the gastroduodenal zone, the intensity of the local immune response of the intestinal mucosa, and the severity of both motor and non-motor deficits. Conversely, in the cohort of patients with vascular parkinsonism, the cytokine level was completely indifferent to the entire spectrum of the parameters studied, including gastrointestinal triggers.The findings scientifically substantiate the nosological specificity and selective activation of the functional "gut-brain" axis exclusively for the degenerative process in Parkinson's disease. It is concluded that in vascular parkinsonism, cytokinemia has an autonomous vasogenic nature and is determined by chronic cerebral ischemia. Assessing the conjunction of inflammatory and enteral markers is recommended as an informative supplementary criterion for inter-nosological differential diagnosis.
CHARACTERISTICS OF ELECTROMYOGRAPHIC PARAMETERS IN PROGRESSIVE MUSCULAR DYSTROPHIES
To evaluate the specific characteristics of electromyographic parameters in patients with progressive muscular dystrophies (PMD) and determine their diagnostic and prognostic significance. Materials and Methods: Between 2022-2024, 158 patients with PMD were studied: Duchenne muscular dystrophy (45 patients), Becker muscular dystrophy (38 patients), Erb-Roth dystrophy (42 patients), and Landouzy-Dejerine dystrophy (33 patients). Control group consisted of 55 healthy individuals. Needle electromyography, nerve conduction studies, and quantitative EMG analysis were performed using standardized protocols. Motor unit potential parameters, spontaneous activity, recruitment patterns, and conduction velocities were analyzed. All PMD types showed characteristic myopathic changes with significant differences between subtypes. Duchenne type demonstrated the most severe alterations: reduced motor unit potential amplitude (284±89 μV vs 1245±156 μV in controls), decreased duration (6.8±2.1 ms vs 12.4±2.8 ms), increased polyphasia (68.4±12.3% vs 15.2±4.1%), and abundant spontaneous activity. Progressive correlation between EMG severity and clinical disability was observed (r=0.79-0.85). Electromyographic parameters provide valuable biomarkers for PMD diagnosis, subtype differentiation, disease progression monitoring, and therapeutic response assessment. Quantitative EMG analysis enhances diagnostic precision and prognostic accuracy in clinical practice.
SPECIFICS OF CLINICAL MANIFESTATIONS AND NEUROPHYSIOLOGICAL CORRELATES OF AFFECTIVE RESPIRATORY ATTACKS IN CHILDREN WITH IRON DEFICIENCY ANEMIA
Objective. To identify specific clinical features and neurophysiological correlates of affective respiratory attacks (ARAs) in young children with concomitant iron deficiency anemia (IDA). Methods. In a comparative study, 120 children aged 1 to 5 years with verified ARAs were examined, divided into two groups: the main group (n=60, ARA with IDA) and the control group (n=60, ARA without iron metabolism disorders). The clinical picture, neurological status, heart rate variability (HRV) indices, and electroencephalography (EEG) data were analyzed. Results. Children with IDA exhibited a specific clinical phenotype of ARA: predominance of the cyanotic type of attacks (70% vs. 50% in controls, p<0.05), higher frequency of paroxysms (3.3±1.5 per week), and pronounced post-attack asthenia. Neurophysiologically, this correlated with the predominance of theta activity on EEG (index 42±8%) and a decrease in the total power of the HRV spectrum (1245±310 ms²), reflecting functional immaturity of brainstem structures and exhaustion of autonomic reserves. Conclusion. The specificity of ARAs against the background of IDA is determined by metabolic disorders in the CNS, manifesting as vagotonia (cyanosis), slowing of cortical rhythms (theta activity), and decreased adaptive potential. The identified neurophysiological markers allow for the differentiation of "iron-dependent" paroxysms from epilepsy and substantiate pathogenetic therapy with iron preparations.
PREDICTING CLINICAL OUTCOMES OF HEMORRHAGIC STROKE BASED ON ACUTE PHASE BIOMARKERS
Biomarkers of the acute phase of hemorrhagic stroke are objective biochemical parameters that reflect the intensity of pathophysiological processes in the early days of the disease and have the potential to predict long-term outcomes. In this study, a comprehensive analysis of the prognostic value of sICAM-1, sVCAM-1, GDNF, VEGF concentrations at various time points of the acute period was performed to predict mortality, functional outcomes, and the development of complications. The results of the study shoved that in order to predict the outcome of hemorrhagic stroke, it is advisable to determine the levels of these markers in the blood serum, since they have a high prognostic value as an individual. This is also the case as part of combined models, providing accurate risk stratification, early detection of complications, and the possibility of personalization.
CLINICAL AND EPIDEMIOLOGICAL FEATURES OF EPILEPSY IN THE ANDIJAN REGION
The Andijan region, with its combination of geographical, demographic, and sociocultural factors that create a distinctive epidemiological environment, represents a unique setting for studying the epidemiological and clinical features of convulsive syndrome. This region, situated in the eastern Fergana Valley at an altitude of 450-500 meters above sea level, covers an area of 4,300 square kilometers. It borders the Fergana and Namangan regions of Uzbekistan, as well as the Osh region of Kyrgyzstan, creating a unique interregional epidemiological corridor for the spread of infectious and non-infectious diseases of the central nervous system.
THE SEVERITY OF CHRONIC CEREBRAL ISCHEMIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE
62 patients with CKD were examined, 22 of them with CKD stage I-II, 20 with CKD stage III, 20 with CKD stage IV. A questionnaire was conducted to identify limitations in daily activity, neuropsychological testing was performed using the MоСА scale, and a test to assess regulatory functions. To clarify the etiology of chronic cerebral ischemia, magnetic resonance imaging (MRI) was performed. In patients with chronic renal failure (CKD stages III-IV), cerebrovascular insufficiency was detected more often than in patients with chronic kidney disease (CKD stages I-II).
SYSTEMATIC APPROACH TO STUDYING THE FORMATION OF COGNITIVE STATUS AND NON-SPECIFIC SCHOOL MALADJUSTMENT IN CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER
This article examines the mechanisms underlying cognitive development and the phenomenon of non-specific school maladjustment in children with attention deficit hyperactivity disorder (ADHD). The article examines the neuropsychological, behavioral, and emotional-personal components that determine the characteristics of a child's academic performance in the modern educational environment. An analysis is conducted of the relationship between executive function deficits, impaired voluntary attention, decreased information processing speed, and the development of persistent academic difficulties. It is shown that 62–78% of children with ADHD exhibit signs of cognitive disorganization, accompanied by decreased academic productivity, emotional instability, and impaired social adaptation. Particular attention is paid to the phenomenon of "hidden maladjustment," in which a child's intellectual potential is preserved, but academic performance remains fragmented due to dysfunction of the frontostriatal circuits and the insufficiency of regulatory mechanisms. Examples of the clinical and psychological profiles of schoolchildren with various types of cognitive deficits are presented. Cause-and-effect relationships between neurobiological disorders, behavioral characteristics, and decreased academic performance are revealed. The material focuses on an interdisciplinary approach integrating child neurology, clinical psychology, neuropsychology, and special education.
FREQUENCY AND RISK FACTORS OF COGNITIVE IMPAIRMENT IN ISCHEMIC STROKE
The cognitive functions of the brain allow you to know the world, analyze information and make inferences. Cognitive impairment is one of the most disabling complications of ischemic stroke, significantly worsening the patient's adherence to rehabilitation and long-term lifelong treatment, reducing the quality of life of the patient and his relatives. More than half of stroke patients develop CI, and 6–32% of patients develop dementia.
PROBLEMS OF RATIONAL PHARMACOTHERAPY OF CHRONIC HEADACHE IN PRIMARY HEALTH CARE (Review article)
Background. Chronic headache is one of the most common causes of medical consultations in outpatient neurological practice. Despite the availability of international clinical guidelines, pharmacotherapy of chronic headache in primary health care remains heterogeneous and is associated with variability of medical prescriptions, polypharmacy and excessive use of analgesics. Objective. To discuss the main problems of rational pharmacotherapy of chronic headache in primary health care and to analyze organizational factors influencing prescription patterns in outpatient practice. Materials and methods. The article was prepared as an analytical review based on publications devoted to chronic headache, medication-overuse headache, polypharmacy and organizational aspects of outpatient neurological care. International Classification of Headache Disorders, 3rd edition (ICHD-3), international clinical guidelines and publications relevant to primary health care practice were used. Results. The main problems of pharmacotherapy of chronic headache in outpatient practice include excessive use of analgesics, insufficient use of preventive therapy, polypharmacy and variability of medical prescriptions. Medication-overuse headache is considered one of the most important consequences of irrational use of pain-relieving drugs. The potential role of structured decision-support approaches in conditions of limited consultation time and high physician workload is discussed. Conclusion. Problems of rational pharmacotherapy of chronic headache have not only clinical but also organizational aspects. Further investigation of outpatient prescription patterns and organizational approaches to support medical decision-making appears to be a promising direction for improving outpatient neurological care.
EFFECTIVENESS OF PERSONALIZED PREVENTION STRATEGY FOR RECURRENT HEMORRHAGIC STROKE IN PRIMARY HEALTHCARE
Objective: To evaluate the effectiveness of a personalized prevention strategy for recurrent hemorrhagic stroke in primary healthcare settings. Materials and methods: A prospective controlled study was conducted involving 240 patients who had suffered a hemorrhagic stroke. The main group (n=120) received personalized prevention based on a developed risk stratification scale, while the control group (n=120) received standard therapy. The follow-up period was 24 months. The primary endpoint was the frequency of recurrent hemorrhagic strokes, and secondary endpoints included mortality, functional outcomes according to the modified Rankin Scale (mRS), and quality of life. Results: In the main group, the frequency of recurrent hemorrhagic strokes was 8.3% versus 18.3% in the control group (RR=0.45; 95% CI: 0.23-0.89; p=0.021). Mortality was significantly lower in the main group (5.8% versus 14.2%; p=0.032). The proportion of patients with functional independence (mRS 0-2) at 24 months was 67.5% in the main group versus 48.3% in the control group (p=0.003). Conclusion: The personalized prevention strategy for recurrent hemorrhagic stroke in primary healthcare demonstrates high effectiveness in reducing recurrence rates, mortality, and improving functional outcomes.
HE PROGNOSTIC VALUE OF COMORBIDITY IN PATIENTS WITH ISCHEMIC STROKE
Stroke is the culmination of comorbid diseases, and comorbid pathology plays a special role in the clinical picture, diagnosis and course of many diseases. In 2021-2024, at the Tashkent Medical Academy in the Department of Neurology and Intensive Neurology, comorbid diseases of 214 patients diagnosed with cerebrovascular disease were examined and analyzed. Acute ischemic cerebral circulation disorder in the basin of the middle cerebral artery." According to the results of the examination, the most common comorbid combination was hypertension and coronary heart disease (GB+IBD) in group 1 in 31-47.05%, in group 2 in 21-43.8%, in group 3 in 15-30.6% and the highest percentage was detected in group 4 in 27-52.9% of patients. During the study, it was found that the higher the comorbidity scores and the older the patient's age, the postinsult recovery is slower. The comorbidity scale can be used to predict the rehabilitation potential during the transition from the acute period of stroke to the recovery period.
COMPARATIVE PROSPECTIVE STUDY OF THE EFFECTIVENESS OF STANDARD AND INDIVIDUALIZED MEDICAL REHABILITATION IN PATIENTS AFTER SURGICAL TREATMENT OF LUMBOSACRAL INTERVERTEBRAL DISC HERNIATION
A prospective comparative clinical study included 120 patients who underwent microdiscectomy or endoscopic discectomy for L4–L5 and L5–S1 disc herniations. Patients were divided into two groups: a standard rehabilitation group (n=58) and an individualized rehabilitation group (n=62). Outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), SF-36 quality of life questionnaire, neurological examination, timing of mobilization, and return-to-work analysis. The individualized rehabilitation program demonstrated faster pain regression, greater functional recovery, and accelerated social and occupational reintegration. At 6 months of follow-up, VAS scores were 1.1±0.5 versus 1.9±0.7 in the standard rehabilitation group (p<0.001), while ODI values were 13.2±4.9% versus 20.7±6.3%, respectively (p<0.001). Return to work within 3 months was achieved in 88.3% of patients in the individualized rehabilitation group compared to 71.7% in the standard rehabilitation group. The obtained results indicate high clinical effectiveness of the personalized approach to postoperative rehabilitation in patients with lumbar intervertebral disc herniation.
FFECTIVENESS OF REHABILITATION MEASURES IN ISCHEMIC STROKE DEPENDING ON ITS PATHOGENETIC HETEROGENEITY
The article presents the results of a comparative clinical study evaluating the effectiveness of rehabilitation measures in 240 patients with different pathogenetic subtypes of ischemic stroke. It was established that the pathogenetic subtype of stroke has a statistically significant impact on the rate of functional recovery, the severity of neurological deficits, and the degree of disability in the long-term period. The most favorable outcomes were observed in patients with lacunar stroke, whereas the least favorable outcomes were found in patients with hemodynamic stroke
CEREBRAL PERFUSION IN CHRONIC BRAIN ISCHEMIA: CONTEMPORARY CONCEPTS OF PATHOGENESIS, NEUROIMAGING BIOMARKERS, AND VASCULAR COGNITIVE IMPAIRMENT
Chronic cerebral ischemia remains one of the leading problems in modern neurology due to the high prevalence of cerebrovascular pathology and associated cognitive impairment. In recent years, special attention has been paid to cerebral perfusion disorders as a key mechanism in the pathogenesis of chronic cerebral ischemia. Modern neuroimaging techniques allow assessment of cerebral blood flow, microcirculatory disturbances, and structural brain damage. The article reviews current concepts of cerebral hypoperfusion, endothelial dysfunction, neuroinflammation, and microangiopathy in the development of vascular cognitive impairment. The diagnostic value of MR perfusion imaging, arterial spin labeling MRI, CT perfusion, and other neuroimaging biomarkers is discussed.
CONTEMPORARY PERSPECTIVES ON ATLAS (C1) FRACTURES: FROM DIAGNOSIS TO TREATMENT STRATEGY SELECTION
Fractures of the first cervical vertebra (C1, atlas) account for 2–13% of cervical spine injuries and are characterised by variable clinical presentation, diagnostic complexity, and the absence of universally accepted treatment standards. This literature review systematises current data on the epidemiology, diagnostic algorithms, classification systems, and therapeutic strategies for atlas injuries. The evolution of classification frameworks — from morphological systems (Gehweiler, Jefferson) to biomechanical paradigms (Dickman, AO Spine) — is examined. A comparative analysis of conservative and surgical treatment is conducted with reference to the integrity of the transverse atlantal ligament (TAL). It is concluded that a multimodal diagnostic approach and personalised selection of treatment method based on CT and MRI findings are essential for optimal patient outcomes.
CLINICAL AND DIAGNOSTIC ANALYSIS OF NEUROGENIC DEFORMITIES IN CHILDREN AND IMPROVEMENT OF TREATMENT METHODS
Neurogenic deformities in children remain an important challenge in pediatric neurology, orthopedics and rehabilitation medicine. Deformities caused by central and peripheral nervous system disorders lead to motor impairment, disability and reduced quality of life. This review summarizes current data on epidemiology, pathogenesis, clinical manifestations, diagnostic approaches and treatment strategies for neurogenic deformities in children. Special attention is paid to neurological examination, neurophysiological assessment, neuroimaging techniques and multidisciplinary rehabilitation. Modern approaches including pharmacotherapy, orthotic management, botulinum toxin therapy, physical rehabilitation and surgical correction are discussed.
ALGORITHM FOR DIAGNOSIS AND TREATMENT OF CERVICAL VERTEBROGENIC MYELOPATHY
Cervical myelopathy (CM) is a complex clinical syndrome caused by compression or impaired blood supply to the spinal cord in the cervical region due to pathology of the cervical spine. Early diagnosis and adequate therapy are critically important for preventing irreversible consequences and improving the quality of life of patients. The article presents a comprehensive algorithm for the diagnosis and treatment of CM. The algorithm includes a sequence of clinical examination aimed at identifying characteristic neurological symptoms, as well as modern methods of instrumental diagnostics, such as magnetic resonance imaging (MRI) to assess the condition of the spinal cord and spinal structures, and radiography to determine instability. Based on the diagnostic data, a differentiated approach to the choice of treatment strategies is proposed: conservative methods for the compensation stage or in the presence of contraindications to surgery, and surgical treatment. The presented algorithm is aimed at standardizing approaches to managing patients with cervical myelopathy, optimizing the diagnostic search and choosing the most effective treatment tactics to improve the prognosis of the disease.
DISORDERS OF VENOUS DYSCIRCULATION IN PATIENTS WITH VERTEBRO-BASILAR INSUFFICIENCY
В данной статье приведены результаты собственных исследований результатов при дуплексном сканировании сосудов шеи, транскраниальной допплерографии сосудов головного мозга у больных с ВБН. При изучении венозного кровообращения, характерным для пациентов с венозной энцефалопатией, было выявление увеличение диаметра внутренней яремной вены, увеличение скорости кровотока и снижение индекса пульсативности базальной вены Розенталя, увеличение ЛСК и диаметра позвоночной вены.
SYSTEMIC ANALYSIS OF STROKE CARE IN TASHKENT: RESULTS OF A THREE-YEAR OBSERVATION USING THE STROKEMOB.UZ MOBILE APPLICATION
Stroke is one of the leading causes of death and disability worldwide, with the greatest burden falling on low- and middle-income countries. Tashkent lacks a unified stroke registry, and incidence statistics from different sources diverge substantially, which complicates the planning of stroke services. This study examined the clinical-epidemiological and organizational problems in the delivery of care for acute cerebrovascular accident (ACVA), based on a three-year observation in the emergency department of City Clinical Hospital No. 7 using the mobile application Strokemob.uz. The observation revealed pronounced structural and organizational barriers in stroke care and the absence of reliable registry statistics. The developed Strokemob.uz application is proposed as a scalable tool for standardized, real-time epidemiological data collection, applicable in resource-limited settings.
POSTOPERATIVE COGNITIVE IMPAIRMENT IN CHILDREN: THE IMPACT OF SURGICAL PROCEDURE DURATION
This article presents the results of a comparative study of cognitive impairment in children depending on the duration of elective surgical procedures performed under general anesthesia. The study included 120 children aged 7–14 years, divided into three groups according to the duration of surgery: up to 1 hour (Group I), 1–2 hours (Group II), and more than 2 hours (Group III). Cognitive status was assessed before surgery and on the 7th postoperative day using a battery of neuropsychological tests evaluating memory, attention, psychomotor reaction speed, and executive functions. A statistically significant inverse correlation was found between the duration of surgery and cognitive functioning indicators (r = 0.58–0.69; p < 0.001). The incidence of postoperative cognitive dysfunction (POCD) was 12.5%, 30.0%, and 52.5% in Groups I, II, and III, respectively (χ² = 15.87; p < 0.001). According to logistic regression analysis, a surgical duration exceeding 2 hours was identified as an independent predictor of POCD development (OR = 3.84; 95% CI 1.76–8.42). The obtained findings indicate the need to improve perioperative management protocols for children, taking into account neuroprotective strategies.
COMBINED MALONIC AND METHYLMALONIC ACIDURIA WITH EPILEPSY AND MOTOR DISORDERS IN A CHILD BORN FROM A CONSANGUINEOUS MARRIAGE
Combined malonic and methylmalonic aciduria (CMAMMA) is a rare inherited metabolic disorder caused by mutations in the ACSF3 gene. The disease is characterized by neurological impairment, developmental delay, epileptic seizures, and movement disorders. We present a clinical case of a 1.5-year-old child born from a consanguineous marriage with severe epileptic encephalopathy and significant neurological deficits. This case highlights the importance of comprehensive clinical, biochemical, and molecular genetic evaluation in the diagnosis of rare inherited metabolic disorders.
DIFFERENTIAL DIAGNOSIS AND PERSONALIZED THERAPY OF PEDIATRIC MUSCLE SPASTICITY: A PROSPECTIVE STUDY OF 180 PATIENTS
Spasticity is one of the most common motor disorders in children with central nervous system lesions. It is characterized by a velocity-dependent increase in muscle tone, leading to functional limitations and reduced quality of life. Despite advances in treatment, challenges remain in early diagnosis and in selecting the most appropriate therapeutic strategy. The study included 180 children aged 3–16 years: 150 patients with spastic syndrome of various etiologies and 30 conditionally healthy children (control group). Clinical and neurological examination, assessment scales (Ashworth Scale, Barthel Index, GMFCS, MACS, Wechsler Scale), and instrumental methods (electroneuromyography and brain MRI) were applied. A differentiated approach to the diagnosis and treatment of spasticity in children improves therapeutic outcomes and should be considered a basis for personalized rehabilitation.
CHARACTERISTICS OF BONE AND MINERAL METABOLISM IN PARKINSON’S DISEASE AND OPPORTUNITIES FOR ITS MODIFICATION
Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by the degeneration of dopaminergic neurons in the substantia nigra and the development of both motor manifestations (bradykinesia, rigidity, resting tremor) and non-motor symptoms. In recent years, particular attention has been devoted to the systemic complications of PD, among which disorders of bone and mineral metabolism occupy a significant place, substantially worsening patients’ quality of life and increasing the risk of disability. It has been established that patients with PD are significantly more likely to develop osteopenia and osteoporosis, accompanied by decreased bone mineral density and an increased risk of fractures, particularly in the proximal femur. One of the key contributing factors is Vitamin D deficiency, caused by reduced sunlight exposure, limited physical activity, and age-related metabolic changes. Additional contributing factors include disturbances in calcium-phosphorus homeostasis, sarcopenia, as well as alterations in hormonal status, including an imbalance of parathyroid hormone and calcitonin. The pathogenesis of bone disorders in PD is multifactorial. Hypodynamia and postural instability contribute to reduced mechanical loading on bone, leading to suppressed osteogenesis. Neurodegenerative processes and dopamine deficiency may directly influence bone metabolism through neuroendocrine mechanisms. Furthermore, long-term pharmacological therapy, particularly levodopa-based medications, may indirectly affect bone metabolism and homocysteine levels, which are also associated with an increased risk of fractures. Clinically, disorders of bone and mineral metabolism in PD are manifested by decreased bone mineral density, an increased frequency of falls and fractures, as well as delayed recovery following injuries. Diagnostic approaches include densitometry and assessment of Vitamin D, calcium, phosphorus levels, and markers of bone remodeling. Current approaches to management include comprehensive therapy aimed at correcting deficiencies of Vitamin D and calcium, the use of antiresorptive agents, optimization of physical activity, and fall prevention. Promising directions include personalized treatment strategies considering the stage of PD, the patient’s age, and concomitant risk factors, as well as the integration of a multidisciplinary approach involving neurologists, endocrinologists, and rehabilitation specialists. Disorders of bone and mineral metabolism represent an important component of the systemic manifestations of Parkinson’s disease and require timely diagnosis and comprehensive management to reduce fracture risk and improve patients’ quality of life.
IMPROVING THE COMPREHENSIVE DIAGNOSIS OF NEUROLOGICAL AND PSYCHOEMOTIONAL DISORDERS IN TEMPOROMANDIBULAR JOINT DYSFUNCTION AND TREATMENT BASED ON A NEUROLOGICAL APPROACH
This study investigated the characteristics of the clinical-neurological symptom complex, the interrelationship between autonomic and psychoemotional disorders, and the efficacy of complex therapy based on a neurological approach in 40 patients with temporomandibular joint dysfunction (TMJD). All patients underwent detailed neurological, autonomic, and psychometric examination by a neurologist. The study results demonstrated that tension-type headache (95%), dizziness (70%), paresthesias in the facial area (55%), and autonomic dysfunction syndrome (90%) are the leading neurological syndromes in TMJD. A strong positive correlation was found between pain intensity and levels of anxiety (r=0.72) and depression (r=0.65). The developed differential neurological therapy algorithm (neurometabolic agents, autonomic correction, cognitive-behavioral therapy, and post-isometric relaxation) demonstrated statistically significant higher efficacy compared to the control group receiving only dental treatment, reducing pain syndrome by 2.1 points (p<0.001), decreasing anxiety levels by 32% (p<0.01), and restoring autonomic balance.
PSYCHOEMOTIONAL DISORDERS AND FEATURES OF MICRONUTRIENT STATUS IN ATHLETES WITH INTERNET ADDICTION
The article presents the results of a study on psychoemotional disorders and the characteristics of micronutrient status in athletes with different levels of internet addiction. The study involved 96 athletes aged between 16 and 21 years engaged in acyclic (game/team) and cyclic sports. The level of internet addiction was assessed using Kimberly Young’s Internet Addiction Test (IAT). Psychoemotional status was evaluated using the Spielberger–Khanin Anxiety Scale, Beck Depression Inventory, and the emotional burnout questionnaire. In addition, serum levels of vitamins D, B1, B6, and B12 were analyzed. The study revealed that moderate and severe forms of internet addiction were more common among athletes involved in acyclic (game) sports. As the severity of internet addiction increased, significant elevations in anxiety, depressive manifestations, and emotional burnout were observed among the examined athletes (p < 0.01). The most pronounced psychoemotional disturbances were identified in representatives of game sports disciplines. Analysis of micronutrient status demonstrated a decrease in the levels of vitamins D, B1, B6, and B12 with increasing severity of internet addiction. Micronutrient deficiencies were also more frequently detected in athletes involved in acyclic sports. The obtained data indicate a relationship between internet-addictive behavior, psychoemotional disturbances, and changes in micronutrient status among athletes. The study results confirm the necessity of early detection of internet addiction in athletes and the development of comprehensive preventive measures aimed at correcting psychoemotional disturbances and micronutrient imbalance.
NEUROLOGICAL DISORDERS IN HEMATOLOGICAL MALIGNANCIES: A COMPARATIVE ANALYSIS
Objective: To study the frequency and characteristics of neurological disorders in patients with various hematological malignancies. Materials and Methods: A prospective study was conducted involving 111 patients with hematological malignancies: acute lymphoblastic leukemia (ALL, n=64), acute myeloid leukemia (AML, n=28), and lymphoma (n=19). Cognitive impairment, attention deficit, headache, peripheral neuropathy, movement coordination disorders, and autonomic dystonia were assessed. Results: Cognitive impairment was significantly more common in patients with ALL (63.5±6.2%) compared to AML (57.1±8.6%) and lymphoma (38.5±14.6%) (p<0.001). Other neurological manifestations did not demonstrate statistically significant differences between the groups (p>0.05). Conclusion: Patients with ALL have the highest risk of developing cognitive impairment, which requires special consideration when planning therapeutic and rehabilitation measures.
MODERN STRATEGY OF CONSERVATIVE THERAPY OF DEGENERATIVE CERVICAL MYELOPATHY: NEUROPRECOVERY, NEUROREGENERATION AND NEUROMODULATION (LITERATURE REVIEW)
Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord compression and its subsequent degeneration in adults. Despite the fact that surgical decompression is the main method of treatment for severe degrees of compression, conservative therapy plays an important role in the early stages of the disease, as well as in patients with contraindications to surgery or mild compression. The article discusses a modern strategy of conservative treatment of DCM, focusing on the principles of neuroprotection, neuroregeneration and neuromodulation. The evidence base and mechanisms of action of various approaches are analyzed, including medications (neuroprotectors, metabolic activators), physiotherapy, kinesitherapy and the latest methods of non-invasive neuromodulation (transcranial magnetic and electrical stimulation). The possibilities of slowing down the progression of the disease, improving the neurological status and quality of life of patients with the help of complex conservative strategies aimed at maintaining the function of the spinal cord and modulating its excitability are discussed.