Clinical and neurological, neurophysiological, and neuropsychological examination of 50 patients aged 50–65 y. o. with an experience of COVID‑19 infection within the last 3 to 6 months, revealed pathological changes in the central nervous system in the form of cerebrastenic and autonomic disorders, motor disorders, vestibulopathy symptoms, which occurred in various combinations, with astheno-vegetative syndrome as obligate. Cognitive impairments were detected in 26% of patients; the mental fatigability index was 1.055 ± 0.124; a high level of situational anxiety was noted in 35% of patients, and a high level of personal anxiety in 50 % of patients with the experience of COVID‑19. The study of brain biopotentials revealed moderate diffuse changes (18%) and irritative disorders on the part of hypothalamic (69 %) and diencephalic structures (20%). All of the above may indicate that, regardless of the form of coronavirus infection occurred in humans, i. e., latent, mild, moderate or severe, one of the targets of the pathological impact of COVID‑19 virus is the median structures of the brain responsible for autonomic and cognitive functions. Nevertheless, in our opinion, these disorders are associated not with a direct pathological effect, but are mediated mainly by circulatory disorders in the microcirculatory bed due to endothelial damage and are rather functional disorders on the part of the central nervous system. This provides the grounds for the selection of pathogenetic therapy aimed at stabilizing the functional state of neurons, and one of the drugs of choice may be citicoline (Noocyl), the action of which is associated with reinforcing the cell membrane of the neuron and normalizing bioelectric processes.

The article presents an analysis of current data on emergency management of crises in patients with myasthenia gravis, which is supplemented by our own observations of 892 patients with myasthenia gravis. A follow-up study was conducted, which helped us to assess the frequency, nature and course of crises in patients with myasthenia gravis, taking into account the form of the disease, sex and age of patients. It was found that crises were observed in 154 (17.4%) patients, these conditions were significantly more often registered at the age of 20 to 40 and in the first three years of the disease. Myasthenic crises 149 (96.9%) prevailed among the crises and were registered mainly in patients with generalized and pharyngeal-facial myasthenia. Based on long-term follow-up of patients and assessment of the results of emergency management of myasthenic crises we have presented an optimal scheme for prescription of anticholinesterase medicines as a part of combined therapy of crises of varying severity.

Article is devoted to discussion of a clinical case of rather rare form of a multisystem atrophy, namely the olivopontocerebellar degeneration which is combined with signs of a demyelination and an immune inflammation. The need for diagnostic purposes for the use of proton magnetic resonance spectroscopy (H-MRS) is being proved.

Huntington's chorea is a hereditary disease causing progressive degeneration of the central nervous system with the damage to extrapyramidal structures: basal nuclei, striatum, subthalamic nucleus with increased activity of the central dopaminergic pathways, with the development of neurological, psychiatric, and emotional/personality disorders [1, 17]. The inheritance pattern of the disorder is autosomal dominance. The prevalence of Huntington's disease ranges from 3 to 17 cases per 100,000 population, averaging 5–7 cases per 100,000 population in Russia [2]. The development of the disease is associated with the expansion of CAG (cytosine-adenine-guanine) trinucleotide repeats in the frst exon of the HTT gene encoding the huntingtin protein. This expansion of trinucleotides (long sections of glutamine residues) leads to the selective loss of neurons that connect the striatum and the globus pallidus. This leads to a loss of inhibitory activity and an increase in the excitation impulse, which leads to uncontrolled movements.Unfortunately, medical treatment does not slow down the progression of this disease (a lethal outcome occurs within 15–20 years). Improvement of the quality of life of people with Huntington's chorea, with the provision of medical services at an appropriate level, remains an urgent issue. This direction is especially relevant in providing dental care to patients with Huntington's chorea. Due to the pronounced hyperkinetic syndrome and compulsive movements in the muscles of the arms, trunk, neck and face, it is almost impossible to provide dental care for these patients. Currently, general anesthesia is used to enable dental intervention, but patients note that with frequent use of anesthesia, the patient's condition deteriorates, with an increase in hyperkinetic symptoms. Tetrabenazine is known to reduce the severity of hyperkinetic symptoms and is used in many countries [5].However, in our country many specialists are not familiar with it. During the follow-up of a patient with Huntington's chorea, with the selection of a therapeutic dose of tetrabenazine, it was possible to provide three stages of dental care for the patient without the use of general anesthesia. The material presented in the article can provide useful information on the use of tetrabenazine in patients with Huntington's chorea.