[The first experience of the use the Russian Β-interferon-1b biosimilar (infibeta) in the daily practice of the Moscow Center of Multiple Sclerosis].

We summarized the 1-year experience of using the Russian Β-interferon-1b biosimilar (infibeta) in 123 patients including 65 patients with relapsing-remitting multiple sclerosis (RMS) and 58 patients with secondary progressive multiple sclerosis (SPMS). The significant decrease in the frequency of exacerbations per year was seen during the first year of treatment. We also noted the stabilization of the process of disability without the rise in EDSS scores in more than 50% of patients. Good tolerability comparable to that of the original drug was observed during the first year of treatment. There was no refusal from therapy with infibeta, which indicated sufficiently strong adherence to this type of treatment.

[The first results of a combined all-Russian study on clinical genetics of multiple sclerosis].

Multiple sclerosis is a classic multifactorial disease in which etiology interaction of external factors and structural features of a large number of genes plays an important role. Identifying risk factors for multiple sclerosis and creating an integrated model of pathogenesis are urgent tasks of neurology. Revealing true risk factors is possible only in studies with sufficient statistical power, so with a large amount of samples. We conducted the association study of CD40 gene's polymorphisms and multiple sclerosis among residents of the Russian Federation. The results demonstrated the need to combine data from different researchers in clinical studies to increase the power of the study.

[Acute disseminated encephalomyelitis and multiple sclerosis: open questions of differential diagnosis demonstrated by the example of a clinical case].

Clinical features and MRI-characteristics of two demyelinating diseases: acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are discussed. Despite the seeming obviousness of differential-diagnostic criteria, the individual course of disease can, in some cases, accomplishes the differential diagnosis specifically in cases of recurrent (monophasic) ADEM and the first episode of acute demyelination, resembling ADEM, in MS. A clinical case of MS with acute manifestation resembling ADEM is described.

[Efficacy and tolerability of long-term using of glatimer acetate (copaxone): a 10 year-study in the Moscow Municipal Multiple Sclerosis center].

Experience of 10-year administration of glatimer acetate (copaxone) in 74 patients with active remitting multiple sclerosis is summarized. The significant decrease in the frequency of exacerbations was seen over these ten years. Disease severity on the EDSS was stable and decreased only to the end of the 10-year period. The positive stable clinical dynamics did not depend on the disease severity at baseline. The drug was well-tolerated that allowed to control the course of multiple sclerosis: 64.8% of patients had no more than one exacerbation over 10 years and in 71.6% patients, the disease progression was absent or minimal (less than one score on EDSS). It has been concluded, that the long-term 10-year treatment with copaxone enables to control the development of disease in many patients.

[The comparative study of efficacy and tolerability of intramuscular introduction of beta-interferon-1a in adults and adolescents with remitting multiple sclerosis].

The experience of the treatment of patients with remitting multiple sclerosis (MS) with intramuscular introduction of beta-interferon-1a (avonex) is presented. Seventeen children and adolescents, aged from 11 to 18 years, and 55 adults, aged over 55 years, were treated for at least one-year period. Results revealed a significant reduction of exacerbations in both groups (from 1.35 to 0.06 in average in adolescents and from 0.86 to 0.17 in adults). The changes were accompanied by the stabilization of MS severity index: EDSS scores have decreased in 23.6% of adults and in 17.6% of adolescents. In both groups, good tolerability of the treatment was noted. There was a low probability of side-effects with the exception of increased frequency of a flu-like syndrome (47% cases) in patients younger than 18 years that demands special attention from children neurologists. The high efficacy and good tolerability and safety profile of beta-interferon-1a give grounds for administering this drug to children and adolescents with MS.

[Data of MRI and neuropsychological tests predict the course of typical remitting multiple sclerosis during five years].

A complex study of 50 patients with active typical remitting multiple sclerosis (MS) was carried out. Neuropsychological testing using Wechsler and Stroop tests and MRI of the brain with the morphometric analysis of focal and diffusive changes were used in the study. Patients were stratified into two subgroups by the changes in the performance of neuropsychological tests. The disease course was assessed during five years. In all cases, the natural course of the disease, i.e. when patients did not receive disease modifying drugs, was analyzed. The transition to secondary progressive MS and the marked increase in MS severity on the EDSS were found in the subgroup of patients who demonstrated changes in the neuropsychological test performance. The strongest correlation was observed between EDSS scores and the diffusive atrophy of the brain white matter on MRI. The data of neuropsychological testing and some brain MRI parameters may be recommended as a predictive test in remitting MS.

[The use of rebif in the Moscow Municipal Multiple Sclerosis Center].

We summarized the 3-year experience of using beta-interferon 1a (44 mcg, subcutaneously) in the form of the preparation rebif in 141 patients including 120 patients with active remitting multiple sclerosis (RMS) and 21 patients with secondary progressive MS (SPMS). All patients were examined every three months. The significant decrease in the frequency of exacerbations per year was seen already during the first year of treatment. EDSS scores remained stable in 47.37% of all RMS cases and in 57.14% of all SPMS cases during the first year. A one point and more increase of EDSS was found only in 5.26% patients during three years of treatment. The drug was well tolerated during the long period, adverse effects were found in 16.31%, with a flu-like syndrome in the first place. Only 1.42% of patients refused treatment. All other patients were highly motivated and adherent to treatment.

[Instrumental methods of the rehabilitation of motor disorders in patients with multiple sclerosis].

Motor and coordination disorders are the most prominent clinical presentations of multiple sclerosis. Currently, good results were achieved in the pathogenetic treatment of the disease. However methods of treatment of motor and coordination disorders are not widely used. The positive experience in the treatment of motor disorders using the apparatus Moto-med is presented. The use of this treatment led to positive changes in the state of motor functions, i.e. the decrease of neurologic deficit and improvement of quality of life, of patients.

[Pharmacogenomics of multiple sclerosis: association of immune response genes polymorphism with copaxone treatment efficacy].

Complex association analysis of copaxone (glatiramer acetate) immunotherapy efficacy with allelic polymorphism in the number of immune response genes, which encode interferone beta (IFNB1), transforming growth factor beta1 (TGFB1), interferone gamma (IFNG), tumor necrosis factor (TNF), interferon alpha/beta receptor 1 (IFNAR1), CC chemokine receptor 5 (CCR5), interleukin 7 receptor alpha subunit (IL7RA), cytotoxic T-lymphocyte antigen 4 (CTLA4) and HLA class II histocompatibility antigen beta chain (DRB1) was performed with APSampler algorithm for 285 multiple sclerosis patients of Russian ethnicity. The results show evidence for the contribution of polymorphic variants in CCRS, DRB1, IFNG, TGFB1, IFNAR1, IL7RA and, probably, TNF and CTLA4 genes to copaxone treatment response. Single alleles of CCR5 and DRB1 genes are reliably associated with treatment efficacy. Carriage of allelic variants of other above mentioned genes contribute with reliable effect to copaxone treatment response as part of bi- and three-allelic combinations only. Present investigation may support basis toward the future possibility of prognostic test realization, which can provide a personal choice of immunomodulatory treatment for a patient with multiple sclerosis.

[The results of longitudinal use of copaxone and betaferon in Moscow Multiple Sclerosis Center: issues of efficacy and adherence to therapy].

In last decades, practical neurologists are able to use DMT in multiple sclerosis (MS) in every day practice. This paper presents data of 3-year study of DMT (copaxone and betaferon) treatment of 280 patients with definite diagnosis of multiple sclerosis (MS), 166 patients regularly receiving DMT (104--copaxone and 62--betaferon) for, at least, 3 years. Clinical symptoms of the patients, reasons of treatment withdrawal (48--copaxone and 31--betaferon) and the features of MS course after the withdrawal are analyzed. Patients who received betaferon previously had more severe MS course with frequent relapses, half of them had secondary progressive MS course (SPMS) with relapses. This made impossible a direct comparison of the data of two treatment groups. Treatment with copaxone reduced 5 times annual relapse rate, from 1.45 before DMT to 0.27 during these 3 years (p < 0.001), and this reduction remained stable. For 36 months, 40.4% of patients were relapse-free though all of them had, at least, one relapse per year before the treatment. No EDSS progression was observed in 80% of these patients. Treatment with betaferon caused the reduction of relapse rate from 1,84 to 0,69 per year (2.7 times), 8 patients (26%) with previously active RMS being relapse-free for 36 months. In 31 patients with SPMS, the reduction of relapse rate was also significant, from 1.89 to 0.49 (3.8 times, p < 0.001). Twenty-two patients (71%) with previous SPMS did not have EDSS progression for 36 months that indicate the positive effect of the therapy. Side-effects were moderate and were not the main cause of the treatment withdrawal. The latter was caused mainly by clinical un efficacy, most frequently by the increase of EDSS due to transformation of the MS course to SPMS without relapses and poor understanding by the patient of the goals and the possibilities of DMT. These facts stress the significance of improving compliance, motivation and adherence to DMT in everyday neurological practice.

[The role of the peripheral nervous system damage in clinical picture of multiple sclerosis]. / Rol' porazhenii perifericheskoi nervnoi sistemy v klinike rasseiannogo skleroza.

Multiple sclerosis (MS) was believed to be an autoimmune disease of central nervous system (CNS). Recently, several studies showing early involvement of peripheral nervous system (PNS) in MS pathological process have been published. This review own analyzer and published clinical and paraclinical data on PNS pathology in MS patients and CNS damage in patients with chronic inflammatory demyelinating polyneuropathy. Different mechanisms of the damage of PNS may explain different clinical manifestation of PNS involvement in MS.

[Use of glatiramer acetate (Copaxone) in the treatment of patients with multiple sclerosis. Experience of the Moscow multiple sclerosis center]. / Ispol'zovanie glatiramera atsetata (kopaksona) v lechenii bol'nykh rasseiannym sklerozom. Opyt Moskovskogo tsentra rasseiannogo skleroza.

146 patients with multiple sclerosis are treated by copaxone in the Moscow MS Centre. The relaps exacerbation rate decreased by 72%, the relapse rate reduced by 25.6% during the copaxone treatment. EDSS score did not increase both in group with and without relapses. The condition of 2/3 patients was stable. To achieve the best effect of treatment the program of patient support was successfully used in the Moscow MS Centre.