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Neurology, Neuropsychiatry, Psychosomatics

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Vol 14, No 1S (2022): Спецвыпуск: рассеянный склероз
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https://doi.org/10.14412/2074-2711-2022-1S

ORIGINAL INVESTIGATIONS 

4-8 33
Abstract

Rehabilitation has an important place in the treatment and management of patients with multiple sclerosis (MS). Currently, active research is being carried out in the field of telerehabilitation, extended rehabilitation and staged rehabilitation.
Objective: to study the results of staged motor rehabilitation, which is a combination of methods of inpatient rehabilitation, telerehabilitation and home rehabilitation, as links in a chain to maintain rehabilitation potential for a longer period and, if possible, maintain the level of physical activity and quality of life of patients.
Patients and methods. The study included 53 patients with progressive forms of MS, who were divided into the main (n=28) and control (n=25) groups. Intensive rehabilitation was carried out, supplemented by telerehabilitation and home rehabilitation. The condition of all patients was assessed using validated scales: the Beck questionnaire, the suicide scale, the Multiple Sclerosis Quality of Life-54 Questionnaire (MsQol-54), the Rankin scale, the Rivermead mobility index, the Barthel index. Physical activity tests were performed – Berg's balance test, 25-foot and 6-minute walk test, five squats, nine-hole peg tests. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA test), Symbol Digit Modalities Test (SDMT).
Results and discussion. Statistically significant improvement 12 weeks after the end of intensive rehabilitation was noted in the nine-hole peg test, the five squats test, the Berg balance test, the Rivermead mobility index, and the pain level on the visual analog scale.
Conclusion. The obtained results suggest that the staged rehabilitation of patients with progressive forms of MS helps to maintain the rehabilitation potential for a long time.

9-15 12
Abstract

Multiple sclerosis (MS) is a chronic autoimmune inflammatory demyelinating and neurodegenerative disease of the central nervous system. Now 2.8 million people in the world suffer from MS, since 2000 every 5 years there has been an increase in the number of MS patients by 10%. At the same time, the number of cases with highly active MS (HAMS) is increasing, i.e. cases of MS with two or more exacerbations without taking specific pathogenetic therapy or one exacerbation during taking MS disease-modifying therapies (DMTsMS), which is accompanied by the corresponding MRI data of the brain and spinal cord (presence of new or active lesions). Previously, there were no studies of quality of life (QoL) in this subgroup of patients in the world.
Objective: to compare the QoL indicators of patients with HAMS with those of healthy people and patients with a typical course of relapsingremitting MS (RRMS).
Patients and methods. The study included data on 518 patients from 14 regions of the Russian Federation for 2020–2021 years, in whom HAMS was confirmed during a second examination. We used the results of the analysis of clinical data from neurologists and data from questionnaires filled out by patients with HAMS. Two questionnaires were used in the work – the general (non-specific) Questionnaire for assessing the QoL, SF-36 (The MOS 36-item Short-Form Health Survey) and a special questionnaire for MS patients – MusiQoL (Multiple sclerosis Quality of Life).
Results and discussion. Almost all indicators of QoL in HAMS were below the control. When compared with the typical course of RRMS, a more pronounced decrease in daily activity indicators, a significant impact of clinical symptoms on QoL, a negative attitude of patients towards the healthcare system, and a low overall health index were noted. Pearson correlation analysis revealed a stronger effect on QoL parameters of the frequency of exacerbations in HAMS than in RRMS.
Conclusion. The data obtained in the study indicate the need for more active management of patients with HAMS using second-line DMTsMS.

16-20 18
Abstract

Radiologically isolated syndrome (RIS) is a nosological form in which magnetic resonance imaging (MRI) reveals lesions of the white matter of the brain and/or spinal cord characteristic of multiple sclerosis (MS) in individuals in the absence of clinical symptoms of the disease. Among the studies devoted to RIS, the number of works aimed at studying the molecular mechanisms underlying its formation is very small. Previously, using next generation sequencing (NGS), we for the first time revealed significant differences in the expression profiles of several genes in peripheral blood mononuclear cells (MNCs) of individuals with RIS and healthy controls.
Objective: to conduct a validation analysis of changes in the expression of the CCR2, CX3CR1, and TNF genes that were observed during NGS in the MNCs of individuals with RIS compared with healthy individuals.
Patients and methods. Analysis of the expression of the CCR2, CX3CR1, and TNF genes was performed on independent validation cohorts (in MNCs of 14 subjects with RIS and 14 without RIS) by reverse transcription followed by real-time PCR.
Results and discussion. In MNCs of subjects with RIS, the TNF gene expression was significantly reduced compared to healthy controls (p=0.035; FC=0.78). No significant differences in expression levels were found for other genes.
Conclusion. The obtained data shows that disturbances of TNF gene expression preceding the clinical manifestations of MS, at least in individuals with RIS, which can lead to further dysregulation of several processes.

CLINICAL OBSERVATIONS 

21-28 26
Abstract

Spinal cord affection, according to various sources, is a common complication of a new coronavirus infection. The article describes various variants of spinal cord pathology in COVID-19, their potential mechanisms of development, approaches to treatment and outcomes of the disease. Three patients who were observed at the Research Center of Neurology and represent the most interesting cases of classic transverse myelitis, myelitis with predominant involvement of the lateral and posterior cords, and longitudinal widespread myelitis associated with antibodies to myelin oligodendrocyte glycoprotein (MOG) are considered in detail. These clinical observations demonstrate the importance of early diagnosis and selection of adequate therapy for a favorable outcome of the disease.

REVIEWS 

29-33 17
Abstract

Cerebrospinal fluid (CSF), which bathes the entire central nervous system and is often in direct contact with the site of injury, can serve as a valuable source of biomarkers for various conditions of the nervous system. At the same time, miRNAs, small noncoding RNAs involved in posttranscriptional regulation of the expression of protein coding genes, are known to be present in CSF and can be considered as potential markers. Currently, in the literature several studies have been published on the assessment of differences in the concentration of miRNAs in the CSF of patients with multiple sclerosis (MS) and patients with other neurological diseases (OND), as well as the possibility of using miRNAs as prognostic markers to assess the likelihood of transition from radiologically and clinically isolated syndromes (RIS and CIS respectively) to MS.
An analysis of the existing works on the possibility of using miRNAs for the diagnosis of MS and the prediction of its course was carried out.
The search for articles on the association of CSF microRNA with the development of MS was carried out using PubMed, Elsevier, Medline, Google Scholar resources. The original articles were used for the analysis. In each article, data on miRNAs in the CSF of patients with MS, CIS, and individuals with RIS were selected.
When comparing the content of microRNA in CSF in the MS and OND groups, in patients with MS was found an increase in the content of miR-181c, miR-633, miR-150, miR-328, miR-30a-5p, miR-645, miR-922 and a decrease in miR-21, miR-199a-3p, miR-191, miR-365, miR-106a, miR- 146a; miR-219 was absent in the CSF of patients with MS. In a similar comparison in the CIS and OND groups, patients with CIS showed an increase in the concentration of miR-150; when compared between groups of patients with CIS who subsequently developed RMS – remitting multiple sclerosis, and those who had CIS for a long time, the following results were obtained: for the CIS-RMS group, an increase in the concentration of miR-922, miR-181c was characteristic. When compared in the RIS-MS and RIS-RIS groups, in the RIS-MS group (transition over 5 years of observation), an increase in the content of miR-144-3p, miR-448, miR-653-3p was noted. When compared in the groups of RMS and secondary progressive multiple sclerosis, patients with RMS showed an increase in the concentration of miR-181c, miR-633. When compared in the MS Gd+ and Gd- groups, the MS Gd+ group was characterized by a higher content of miR-21, miR-146a/b. When comparing the groups of RMS and primary progressive multiple sclerosis an increase in the level of let-7b-5p was noted in the RMS group, and when compared in the groups of RMS in the acute stage and RMS in remission, a decrease in the concentration of this miRNA was noted in the group with exacerbations, from which it was concluded that let-7b-5p may be a protective factor in MS. Also of interest is the fact that the therapeutic response of patients with low levels of miR-142-3p in CSF to dimethyl fumarate was higher than in patients with high levels of miR-142-3p.
The data published so far allow us to conclude that miRNA can indeed be a promising marker for diagnosing and predicting the course of MS. However, these studies are currently in their infancy. At the moment, the entire pool of CSF microRNAs (miRNome) has not been studied for MS, including simultaneously using high-throughput methods, in particular the next generation sequencing (NGS) method. It is necessary to expand the microRNA pool, and further study of the subject using larger groups of patients and data from a longer follow-up period.

34-37 10
Abstract

Patient adherence to therapy with multiple sclerosis disease-modifying treatments (MS DMTs) in many cases determine the effectiveness of therapy. The review discusses the reasons for low adherence to DMTs, ways to increase it. Among the most effective ways is to reduce the frequency of administration of the drug while maintaining its high efficiency. To illustrate this, the increase in adherence to treatment with interferon-β drugs due to pegylation is discussed. Without losing its effectiveness, sampeginterferon beta-1a (samPEG-IFN-β1a) administration reduces the frequency of local adverse reactions, partly due to reducing the frequency of injections, which contributes to higher adherence to the treatment.

38-44 13
Abstract

Interferons (IFNs) were first discovered over 60 years ago in a classic experiment by Isaacs and Lindenman showing that type I IFNs have antiviral activity. IFNs are widely used in the treatment of multiple sclerosis, viral hepatitis B and C, and some forms of cancer. Preliminary clinical data support the efficacy of type I IFN against potential pandemic viruses such as Ebola and SARS. Nevertheless, more effective and specific drugs have found their place in the treatment of such diseases. As the COVID-19 (SARS-CoV-2) pandemic is evolving, type I IFN is being re-discussed as one of the main pathogenic drugs, and initial clinical trials have shown promising results in reducing the severity and duration of COVID-19. Although SARS-CoV-2 inhibits the production of IFN-β and prevents a full innate immune response to this virus, it is sensitive to the antiviral activity of externally administered type I IFN. The review presents current data on the classification and mechanisms of action of IFN. Possible options for the optimal use of IFN in the fight against COVID-19 are discussed.



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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)