Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery related risk factors play roles in development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS. Cost-effectiveness of SCS still remains unclear. However evidence for SCS role in FBSS is controversial, SCS can be beneficial for carefully classified patients.

Drug-resistance epilepsy (DRE) is a key problem in neurology. It is possible that damage to the blood–brain barrier (BBB) may affect resistance in DRE. The aim of this work was to assess the damage and dysfunction in the BBB in the area of epileptic foci in patients with DRE under conditions of neuroinflammation. The changes to the BBB in temporal lobe epilepsy (by immunohistochemistry and transmission electron microscopy), levels of neuroinflammatory proteins, and cytokine levels in the blood (by multiplex analysis) were studied. Increased levels of vascular endothelial growth factor (VEGF) and growth-regulated protein (GRO), and decreased levels of epidermal growth factor (EGF) in plasma, combined with overexpression of the VEGF-A receptor by endotheliocytes were detected. Malformation-like growths of the basement membrane of the capillaries of the brain complicate the delivery of antiepileptic drugs (AEDs). Dysplasia of the basement membrane is the result of inadequate reparative processes in chronic inflammation. In conclusion, it should be noted that damage to the microcirculatory network of the brain should be considered one of the leading factors contributing to DRE.

Pharmacotherapy is the first-line treatment modality for epilepsy. However, in 20-40% of patients, epilepsy is resistant to pharmacotherapy. These numbers have not changed for decades despite the development and use of antiepileptic drugs with novel mechanisms of action. Drug-resistant epilepsy is now considered a separate pathophysiologic and clinical entity. The existing hypotheses on its pathogenesis could be divided in two groups. Firstly, drug-resistance might be caused by an abnormal pharmacokinetics or pharmacodynamics of antiepileptic drugs as a result of congenital or acquired dysfunction of the transporter or receptor proteins. Secondly, it might be a consequence of inherent features of epilepsy per se, such as the so-called “intrinsic severity” or some disorder of the connectome. Taking into account the complexity of this phenomenon, the issue of drug resistance continues to remain in the focus of the current research efforts.

Objective: to determine the factors influencing quality of life (QoL) in patients with drug-resistant focal epilepsy (DRFE). Material and methods. 111 adult patients with DRFE were included in the study. Quality of life was measured using the Quality Of Life In Patients with Epilepsy – 31 questionnaire (QOLIE-31). The severity of the disease (frequency and subjective assessment of the severity of seizures), the effect of pharmacotherapy (drug load and composition of the treatment regimen), the social status of patients, comorbid conditions (anxiety and depressive disorders, pathological fatigue) were assessed. Results. In the studied sample, a pronounced decrease in QoL was shown, the median of the final QOLIE-31 score was 65.4 points (interquartile range 53.0–72.6 points). A statistically significant decrease in QoL was found in subgroups of patients with seizures during the previous three months; taking carbamazepine or benzobarbital; with anxiety and depressive disorders; with pathological fatigue; and in unemployed patients. A multiple linear regression model (R2=0.66) was developed, which included the following determinants: Fatigue Severity Scale, Liverpool Seizure Severity Scale, and the risk of depression according to the NDDI-E questionnaire. Conclusion. In patients with drug-resistant focal epilepsy, there is a pronounced decrease in the quality of life due to combination of factors associated with the characteristics of the disease, treatment, comorbidities, and social status. The key QoL determinants in patients with DRFE are pathological fatigue, anxiety and depression, and subjective severity of epileptic seizures; employment is a positive factor. The role of epileptic seizures frequency in QoL formation in these patients requires further research.

There is a lot of evidence that a great Russian writer and essayist Fyodor Mikhailovich Dostoevsky suffered from epilep‑ sy. Not only this disease had influence on Dostoevsky’s personality and social life, but also affected his creative work. Dostoevsky is believed to suffer from mesiobasal temporal lobe epilepsy with an ecstatic aura – a form named after him afterwards.

Currently, there are three drugs in the world for the pathogenetic therapy of spinal muscular atrophy 5q: nusinersen, risdiplam and onasemnogene abeparvovek. At the same time, it is still unknown to what extent this treatment is able to change the natural history of the disease, and the development of methods for evaluating the effectiveness of treatment is the subject of active scientific research. This article is a review of studies of laboratory approaches for assessing the disease severity and the response to nusinersen therapy in patients with spinal muscular atrophy 5q in various age groups.