THE RELATIONSHIP BETWEEN THE DURATION OF REMISSIONS AFTER THE ONSET, THE SEVERITY OF THE RELAPSES AGAINST THE BACKGROUND OF DIFFERENT DURATION OF THE RELAPSING STAGE AND THE NATURE OF THE PROGNOSIS IN SECONDARY-PROGRESSIVE MULTIPLE SCLEROSIS.

Work objective - to study the relationship between the duration of remission after the onset, the severity of relapses against the background of different duration of the relapsing stage (RS) and the nature of the prognosis in the secondary progressive multiple sclerosis (SPMS) using clinical and mathematical analysis. Patients with different prognosis for SPMS; neurological examination using The Expanded Disability Status Scale (EDSS); a survey method. Mathematical methods: 'contingency tables 2x2' (determining the significance of the connection between a pair of two indicators - different duration of remission after the onset and RS in four groups of patients), Yule's Coefficient of Association (determining the magnitude of differences between the group and the studied indicator), a permutation test (defining clinical indicators on RS, which significantly differed in mild and severe relapses). Pairwise comparison in four groups of patients with different duration of remission after the onset and RS in SPMS showed that long-term remission after the onset and prolonged RS delay the transition of RS into secondary progression (SP). Short duration of these indicators revealed the opposite prognostic tendencies, indicating the further progression of the disease. The presence of severe relapses on RS in SPMS is predominantly associated with unfavorable prognostic indicators on RS and indicates the initiation of the transition into SP. Accordingly, the duration of remission after the onset, the severity of relapses against the background of different durations of RS should be regarded as prognostic clinical markers that play a key role in the switch of RS to SPS in SPMS. The results obtained should be used to assess the current clinical situation and timely prescribe an appropriate pathogenetic therapy on RS.

[CLINICAL-MATHEMATICAL ANALYSIS OF INTERRELATIONS BETWEEN A CHARACTER OF THE PROGNOSIS AND PECULIARITIES OF ONSETS IN DIFFERENT TYPES OF MULTIPLE SCLEROSIS COURSE].

Aim of the study- to assess the prognostic value of indicators characterizing the course of the of multiple sclerosis onset (MS) using clinical-mathematical analysis. Patients with MS with different prognosis: good and uncertain for the relapsing-remitting type; uncertain and poor for progressive types of clinical course. A neurological examination using The Expanded Disability Status Scale (EDSS); a questionnaire method; determination of the Yule's coefficient of association (coefficient of colligation), the separating hyperplane method and the correlation analysis. The indicators of the onset with a high correlation, which have a prognostic value, are defined by means of the Yule's coefficient. To rank the onset indicators by the separating hyperplane method, its diagnostic weight was determined for different variants of prognosis in all types of MS. Correlation relations between the onset indices for each type of MS, were calculated and presented in a graphical form. The correlation analysis of the connections between these indicators is built according to a single algorithm that combines alternative programs of patterns of severe and mild onset, which can subsequently compete with each other for the final outcome of the disease. The results of the clinical-mathematical analysis of the onsets in different types of MS, with a high reliability, indicate a diagnostic informativity of the mentioned investigation methods for further prognosis of the MS disease type.

[NEUROPSYCHOLOGICAL ANALYSIS OF DISORDERS OF HIGHER MENTAL FUNCTIONS IN PATIENTS WITH DIFFERENT TYPES OF MULTIPLE SCLEROSIS].

Patients with RR (n=45) and SP (n=24) types of multiple sclerosis (MS) were analyzed using original Luria neuropsychological battery. On the basis of the results obtained, the general characteristics of neuropsychological syndromes were determined: asthenic manifestations; certain violations of the auditory-speech memory; decreased visual memory; disorders of interhemispheric somatosensory transfer; violations of the simultaneous factor of the mental activity organization. It is shown that the progressive type of MS is characterized by a significantly greater degree of severity of the above disorders, as well as their certain qualitative features: a wider range of mnestic disorders; the presence of disturbances in the interhemispheric transfer of motor information; the presence of violations of the assessment of rhythmic sequences by ear; the presence of visual-constructive activity disorders. The factors that determine the neuropsychological syndrome structure in both categories of patients include: the activation factor associated with the work of nonspecific brain systems at all levels of organization, the factor of the simultaneous organization of mental activity associated with the work of the parietotemporal-occipital parts of the cerebral cortex, the factor of interhemispheric interaction. The qualitative differences between the groups of patients consist in the different influence of these factors on the formation of the structure of disorders.