[Registry-based comparison of multiple sclerosis epidemiology trend data in 1999 and 2019: the case of Yaroslavl]. / Dinamika osnovnykh epidemiologicheskikh pokazatelei rasseyannogo skleroza po rezul'tatam sravneniya registrov patsientov 1999 i 2019 gg. v Yaroslavle.

OBJECTIVE: To compare the epidemiological indicators of multiple sclerosis (MS) in Yaroslavl when comparing the 1999 and 2019 registers to study the pathomorphism of the disease in this territory. MATERIAL AND METHODS: During the work, the data of the 1999 and 2019 registers were used, including the age of the debut, the date of diagnosis, the form of the disease, clinical characteristics, the treatment received and its duration. In 1999, 257 patients living in the city of Yaroslavl (155 women and 102 men) were included in the MS registry with a reliable diagnosis of MS according to Poser's criteria with confirmation according to neuroimaging data. In 2019, 479 people living in the territory of Yaroslavl (342 women and 137 men) were included in the register with a diagnosis of MS based on the criteria of MacDonald 2005, 2010, 2017. As of 01.01.19, 970 patients (530 women and 440 men) were included in the patient register of the Yaroslavl region. RESULTS AND CONCLUSION: Clinical and epidemiological review of Yaroslavl MS Registry data in 1999 and 2019 showed significant changes in disease pattern. The prevalence rate increased from 42.6 to 78.5 cases per 100,000 people. The morbidity rate rose from 1.58 to 3.28 cases per 100,000 people. The reasons for the increase are improvement in the diagnostic quality, new diagnostic criteria and the true growth of prevalence and morbidity. The use of disease modifying drugs (DMDs) has extended «the time to EDSS 3,0¼ by 4 years, «the time to EDSS 6,0¼ by 5-8 years.

[The results of an open prospective study of ß-interferon biosimilars (an Yaroslavl' cohort)]. / Rezul'taty otkrytogo prospektivnogo issledovaniya bioanalogov ß-interferonov.

OBJECTIVE: to study safety and efficacy of the biosimilars of disease-modifying drugs (DMDs) in the prospective nonrandomized open long-term study of patients with multiple sclerosis in the Yaroslavl oblast (an Yaroslavl' cohort). MATERIAL AND METHODS: The study included 203 patients treated with DMD biosimilarsduring 30 months according to the instruction for using. The efficacy was assessed by the relapse frequencychanges in EDSS scores, changes of lesions on MRI T2-weighted images (T2-WI). The safety was assessed by the determination of the percentage of patients with side-effects due to the treatment. Results at baseline and month 30 visit were compared. RESULTS: There was a significant decrease in the frequency of relapses in patients treated with biosimilars compared to baseline (cinnovex by 0.03, genfaxon by 0.29, ronbetal/interferon by 0.13, infibeta by 0.36). For all biosimilars, with the exception of infibeta,EDSS scores significantly increased (cinnovex +0.31, genfaxon +0.38, ronbetal/interferon +0.66, infibeta +0.26). MRI results revealed an increase in the number of lesions in patients treated with cinnovex (+16.6%), genfaxon (+14.4%) and ronbetal (+10.6%) and a decrease of lesions on T2-WI in patients treated with infibeta (-14.5%). The most marked generalized reasponses were in the cinnovex group (flu-like syndrome - 66% of the patients), local reactions were most marked in the genfaxon group (82%). CONCLUSION: The differences between some biosimilars and original DMDs in the safety profile and efficacy suggest that attention should be drawn to the thorough study of drug effects in clinical trilas and postmarketing studiesincluding registers of patients treated with DMDs managed independently from pharmaceutical companies.

[Differential diagnosis of late-stage neuroborreliosis with affection of the central nervous system].

Chronic neuroborreliosis is an actual problem in neurology due to its under-investigation in Russia, variety of clinical forms, and the absence of well established diagnostic criteria. We present clinical and laboratory differential diagnostic criteria of chronic borrelial encephalomyelitis in comparison with multiple sclerosis. Distinguishing characteristics of Lyme encephalopathy versus vascular encephalopathy are considered. Problems and possibilities of immunological methods for identification of B. burgdorferi are discussed. The results of the antibiotic treatment of different clinical forms of neuroborreliosis with affection of the central nervous system are described.

[Side-effects of the treatment with disease modifying drugs in patients with multiple sclerosis: an analysis of register data in the Yaroslavl region].

Authors have followed up 230 patients with multiple sclerosis treated with disease modifying drugs (DMD) using the data of the Multiple sclerosis register of the Yaroslavl oblast during 2009-2011. Original drugs and their generics registered in Russia are used. Patients received interferon-beta 1a for intramuscular introduction (avonex - 3.0%), interferon-beta 1a for hypodermic injection (rebif - 19.2%, genfakson - 8.5%), interferon-beta 1b (betaferon - 16.5%, extavia - 18.2%, ronbetal - 18.0%), glatimer acetate (copaxone - 16.7%). Adverse effects were recorded and subjective tolerability of the drug by the patient was assessed. Statistically significant differences in the safety profile between some bioanalogues and original DMD were identified. This finding suggests that effects of different DMD should be studied in depth in clinical and post marketing trials.

[Lyme disease in patients with multiple sclerosis: clinical, diagnostic and therapeutic features].

Lyme disease is one of the most frequent infections in the Russian Federation. In patients with multiple sclerosis, the Borrelia infection may act as a trigger in some cases and also worsens the clinical course of multiple sclerosis. One hundred patients with definite multiple sclerosis were examined including 19 patients with the combination of multiple sclerosis and Lyme disease. The difficulties of diagnosis, clinical features and treatment of Lyme disease in patients with multiple sclerosis are discussed.

[Differential aspects of multiple sclerosis and chronic borrelial encephalomyelitis].

The Yaroslavl region is an endemic area for Lyme disease (LD) with one of the highest levels of morbidity in Russia. Chronic neuroborreliosis can mimic multiple sclerosis and cause considerable difficulties in differential diagnosis. A comparative clinical-instrumental analysis of patients with definite multiple sclerosis (n=65) and chronic borrelial encephalomyelitis (n=11) was carried out. The key differential-diagnostic features of multiple sclerosis and borrelial encephalomyelitis were specified. Migrating erythema and tick's bite in the anamnesis, combined with lesions of the central and peripheral nervous systems, the absence of retrobulbar neuritis in the anamnesis, artralgia and myalgia, the high blood sedimentation rate were not characteristic of multiple sclerosis. A patient with abovementioned findings should be tested for the presence of antibodies to Borrelia burgdorferi in the blood serum and, if necessary, in the cerebrospinal fluid to exclude the diagnosis of Lime disease.

[Multiple sclerosis or recurrent disseminated encephalomyelitis?].

Two cases of acute demyelinization with recurrent course are described. The problem of differentiation between acute disseminated encephalomyelitis and multiple sclerosis is discussed. Clinical presentations with the prevalence of memory and praxis impairment and large MRI lesions in the subcortical white matter support the diagnosis of acute disseminated encephalomyelitis.

State of the cervical section of the spinal cord in patients with remitting multiple sclerosis during immunomodulatory treatment.

MRI scans were obtained of the cervical section of the spinal cords of 30 patients with remitting multiple sclerosis. During the study period, patients received immunomodulatory agents (seven received interferon beta-1a, 13 received interferon beta-1b, and 10 received glatiramer acetate). Total focus volume in brain matter was assessed before and after treatment, along with the linear size of the spinal cord on sagittal sections at the level of the inferior margin of the body of C2. There was a significant (p = 0.002) reduction in focus volume in the group overall, from 10993 mm(3) (8098-13888 mm(3), p < 0.05; Me = 9336) to 5630 mm(3) (7400-3860 mm(3), p < 0.05, Me = 4180). There were also significant decreases in focus volume on the background of treatment with interferon beta-1b and glatiramer acetate (p = 0.026 and 0.027, respectively). Significant differences between groups were found in the magnitudes of increases in spinal cord atrophy: H (2, n = 30) = 8.06; p = 0.0178. Patients given glatiramer acetate showed a significantly smaller increase in atrophy as compared with those treated with interferon beta (p < 0.02).

[Vertebral syndrome in multiple sclerosis: causes, clinical peculiarities and problems of differential diagnosis].

Presented is a review of the literature on the main causes of vertebral syndrome in multiple sclerosis (MS): dystrophic processes in spinal motor segments, disturbance of spinal static, development of functional blockade, osteoporosis, appearance of demyelinization foci in roots and the spinal cord, myelopathy, replacing foci by cavities. The authors report the results of clinical and MRI study of 115 patients with MS and single out some dissimilarities of vertebral syndrome in MS and dystrophic lesion of spinal cord as follows: in MS pain is long-term, non-intensive, without distinct periods of deterioration and improvement; muscle tonic disturbances are less pronounced but present on the level of all spinal compartments; intensity of root disorders is significantly less and location of clinical symptoms often does not correspond to the level of altered spinal motor segments. The Lermitt symptom and its analogs are described, the former being found in 14.7% of patients with remitting course, and their relation to the loci in the cervical part of the spinal cord is revealed. It is stressed that these loci could lead to an earlier onset of vertebral pain syndrome in patients with MS.

[Antiphospholipid syndrome and multiple sclerosis: differential-diagnostic aspects]. / Antifosfolipidnyi sindrom i rasseiannyi skleroz: differentsial'no-diagnosticheskie aspekty.

A comparative study of 5 patients with definite multiple sclerosis who have abnormally high titer of anticardiolipin IgG-antibodies [MS aCL(+)] and 9 patients with antiphospholipid syndrome (APS) aged 22-43 was carried out. The results of this study are reported. The investigation has shown that some clinical and magnetic resonance imaging (MRI) sings in patients with APS imitate the course of MS. This situation makes differentiation of two conditions quite difficult. The peculiarities of course of MS aCL(+) such as progressive myelitic pattern, nontypical for MS articular, cutaneous (livedo, ecchymoses) and vasospastic lesions have been shown. The differential diagnostic clinical, immunological and MRI-criteria of two diseases have been found out. The investigation reveals that APS has not only cerebrovascular manifestation but polyneuropathy (in preference of demyelinating type) and autoimmune myopathy.