[The brain structures functional activity and aggression patients' multiple sclerosis].

The article is devoted to investigation of unconscious aggression in patients with multiple sclerosis. We carried out comparison of the relative assessments of metabolism speed of glucose (according to positron emission tomography) and indicators of unconscious aggression (in the Hand test). It is shown that an increased tendency to open aggression (unconscious aggression) in patients with multiple sclerosis, is mainly linked with a reduction in the functioning of different departments of the frontal lobes of the brain on the left and with changes of the metabolism speed of glucose in the structures of the limbic system of the left and right hemisphere. With increasing of unconscious aggression we observed decrease of glucose metabolism speed in certain areas of the lower and middle frontal gyrus.

[Factor analysis of brain structure reorganization in patient with multiple sclerosis (based on pet data)].

The goal of present study was to investigate the functional reorganization of brain structures in patients with multiple sclerosis (MS). The patterns of distribution of relative estimations of local cerebral metabolic rate of glucose (ICMRglu) in regions of interest (ROIs), corresponding to anatomo-functional brain areas are obtained in groups of healthy volunteers (n=31 subjects) and patients with relapsing-remitting and progressive types of MS (n=59 and 39 accordingly). The analysis of factor structure of the obtained patterns allowed to make a conclusion about the existence of a common features with the factor structure of the distribution of another functional parameter--a regional cerebral blood flow (rCBF). This indicates that both factor solutions mainly reflect the functional organization of a brain. The differences revealed in factor structures of ICMRglu distribution in groups of patients with various types of MS and healthy volunteers allowed to assume that even at early stages of the disease despite the close anatomic and functional connectivity that normally exists between basal ganglia, MS patients have a functional dissociation of these structures. The bipolarity of revealed factors probably reflects the different directionality of the processes: relative decrease of functional activity in the areas which are directly responsible for performance of broken functions, caused by the deafferentation of the specified areas and its compensatory relative increase in functionally connected zones.

Characteristics of neurological and cognitive status in patients with multiple sclerosis in relation to the location and volumes of demyelination foci and the severity of brain atrophy.

A total of 65 patients with clinically significant diagnoses of remitting multiple sclerosis in the stage of remission were studied. Neurological status was investigated with assessment on the FS and EDSS scales, with neuropsychological testing, and MRI scans (1.5 T). The severity of brain atrophy (in terms of the parenchyma volume) and the total volume of foci on T2 images were assessed as proportions of intracerebral volume. The severity of neurological deficit depended on the volume of intratentorial focal lesions and the level of brain atrophy. Cognitive disorders were identified in 89% of patients, and the severity of these was associated with the level of atrophy and the volume of foci on T2 images in the dominant hemisphere.

[A case-report of Balo concentric sclerosis transformed into definite multiple sclerosis]. / Klinicheskii sluchai kontsentricheskogo skleroza Balo, transformirovavshegosia v dostovernyi rasseiannyi skleroz.

The authors present the results of an 8-year retrospective-prospective follow-up of a patient with Balo concentric sclerosis. The disease meets the diagnostic criteria of remitting-relapsing multiple sclerosis.

[The intestinal microbiota composition in patients with multiple sclerosis receiving different disease-modifying therapies DMT]. / Osobennosti sostava mikrobioty kishechnika u patsientov s rasseiannym sklerozom, poluchaiushchikh preparaty, izmeniaiushchie techenie rasseiannogo skleroza.

AIM: To describe characteristics of the intestinal microbiota in patients with multiple sclerosis (MS) treated with glatiramer acetate (GA) or fingolimode (FG) for understanding causal relationships between gut microbiota and autoimmune processes in MS patients. MATERIAL AND METHODS: The study included 34 patients treated with GA (n=17) or FG (n=17). GA was used in a dose of 20 mg/kg subcutaneously once a day, FG in a dose of 0.5 mg daily. All patients were examined during remission. To assess the composition of gut microbiota, bacteriological and real-time PCR techniques were used. DNA was extracted from feces using DNA-EXPRESS kit. RESULTS AND CONCLUSION: There was a decrease in numbers of Escherichia coli with normal enzymatic activity, which was replaced by atypical forms of E. coli, Enterobacter spp. and fungi of the genus Candida, and, during treatment with GA, by atypical forms of E. coli, Proteus spp., Parvimonas micra. These differences indicate the effect of the therapy on the intestinal microbiota composition.

[The relationship between cognitive impairment and localization of white matter lesions in patients with multiple sclerosis]. / Sviaz' kognitivnykh narushenii s lokalizatsiei ochagov porazheniia belogo veshchestva golovnogo mozga u bol'nykh rasseiannym sklerozom.

Objective. To study a role of parenchymal white matter lesions and lesions of the white matter underlying the cortical grey matter in cognitive impairment in patients with multiple sclerosis (MS). Material and methods. We examined 33 patients with clinically definite RRMS in clinical remission. Cognitive performance was assessed with neuropsychological and psychometric tests. MRI (1.5 tesla) was used to assess volume and localization of focal demyelination in the cerebral cortex. Results. The volume of juxtacortical brain lesions in the white matter had a negative effect on the correct performance on neuropsychological tests. The volume of parenchymal white matter lesions had a negative effect on the speed of task performance. Conclusion. The results suggest that MS patients had multiple cognitive impairments.

[Cortical atrophy in multiple sclerosis]. / Atrofiia kory golovnogo mozga pri rasseiannom skleroze.

Objective. To identify clear patterns of the cerebral cortex atrophy in multiple sclerosis that may provide valuable information for the development of additional paraclinical methods of stages and variants of MS objectification and verification and used for assessing treatment efficacy. Material and methods. The results of morphometric data analysis of 117 patients with different variants of MS and 25 healthy volunteers are presented. The original algorithm for postprocessing MRI images was used. Age, disease duration, type of disease, FS and EDSS scores, morphometric results were the source parameters for the statistical analysis. Results. The correlation analysis showed that the total cortex volume was in inverse correlation with EDSS score, pyramidal and cerebellar dysfunction, but not with disease duration. An analysis of regional changes in 43 bilateral regions of interest (ROI) demonstrated similar results in 7 ROIs in the left (dominant) hemisphere and in 4 ROIs in the right hemisphere. ANOVA revealed atrophic changes in 20 ROIs bilaterally. Deficit of certain functional systems was accompanied by the atrophy of various functional cortex regions. ANOVA of the regional cortical atrophy in groups with varying disease severity showed the presence of significant changes in patients with moderate to severe disability. Duration and type of MS were not predictive for development of atrophy, with the exception of the precuneus bilaterally, the right paracentral lobule and right posterior cingulate gyrus. Conclusion. Regional cortical atrophy is detected in the earliest stages of the disease and increases as the disease progresses. Inconsistency of data across studies can be explained by the lack of generally accepted morphometric standards and pathogenetic heterogeneity of MS. Regional cortical atrophy may be considered as a sensitive neuroradiological biomarker for MS.

[PET-patterns of cognitive impairment in patients with multiple sclerosis].

Neuropsychological and PET-FDG examination and assessment with the EDSS scale in patients with different types (relapsing-remitting or progressive) of multiple sclerosis (MS) were performed in order to determine the relationship between cognitive impairment and changes in the regional cerebral metabolic rate of glucose (rCMRglu) in the brain gray matter. A study included 61 patients with relapsing-remitting (n=38) and progressive (n=23) types of MS. A statistical analysis revealed significant correlations between cognitive impairment and rCMRglu dependent on the type of MS. The changes in the functional activity of the brain gray matter during the progression of the disease and increasing disability were identified.

[Symptoms of circadian desynchronization in patients with multiple sclerosis].

Circadian rhythm of sleep-wakefulness and evacuation function of intestines, symptoms of neuropsychic adaptation were investigated in 36 patients, aged 21-53 years, with multiple sclerosis (MS). Frequencies of circadian rhythm disturbances of brain activity (insomnia in 66% of patients) and circadian rhythm disturbances of intestine evacuation (constipation in 72% of patients) were revealed. Insomnia and irritability in MS patients with bradyenteria occur 1.5 times more frequent than in patients with normal regulative activity of the bowels. The risk of anxiety and depression in MS patients with bradyenteria was 2-3 times higher than in patients with euenteria. The suitability of normalization of circadian desynchronization of MS patients by the restoration of optimal acrophases of circadian rhythms of the brain and bowels is established.

[Current possibilities of the comprehensive diagnostic assessment in the differential diagnosis of inflammation and tumors of the spine cord].

The article discusses the differential diagnosis of transverse myelitis. An algorithm for the assessment of patients was given. The authors present two clinical examples demonstrating the role of the integrated neuroradiological approach in the differential diagnosis of difficult cases.

[The role of brain glucose metabolism in the development of cognitive dysfunctions in patients with remitting and secondary-progressive multiple sclerosis].

To study mechanisms of development of cognitive dysfunctions in multiple sclerosis (MS), brain glucose metabolism has been investigated using PET method. We have studied 61 patients with different types of MS course. Correlations between cognitive dysfunctions and regional glucose metabolic rate were revealed. The authors suggest that metabolic dysfunctions of the grey matter play the important role in the pathogenesis of cognitive disturbances in MS.

[Intrathecal immunoglobulin production in the diagnosis and differential diagnosis of multiple sclerosis].

The evaluation of diagnostic significance of different immunological tests for intrathecal immunoglobulin production is summarized on the historical basis of investigation of patients with inflammatory, demyelinating and other neurological disorders. The assessment of cerebrospinal fluid lost its previous significance in the 2010 revision of diagnostic criteria for multiple sclerosis. Nowadays, it is used only for the diagnosis of primary progressive multiple sclerosis. Nevertheless, the requirements of the analysis of the cerebrospinal fluid are increasing due to subtle, subclinical and atypical cases of multiple sclerosis as well as undetermined demyelinating disorders. Intrathecal humoral immune response may be pathogenic in multiple sclerosis as suggest immunological data and effectiveness of anti-B cells treatment. Based on these tests, it is useful, to differentiate subgroups of patients and to evaluate different effects of treatment in perspective.

[Positron-emission tomography in the diagnosis of middle cerebral artery lesions].

The regional brain glucose metabolism after the intravenous drop-by-drop infusion of saline and 50 mg of cavinton was measured with positron-emission tomography (PET) in the right middle brain artery in 5 patients with ischemic stroke. The increase of glucose metabolism was found in the region of post stroke cystic-focal and perifocal changes as well as in contralateral regions. The dose of cavinton (50 mg) was safe and well-tolerated by patients. The use of PET in evaluating of glucose metabolism changes in the brain helps in prognosis of the disease.

[Brain atrophy and neurological impairment in patients with multiple sclerosis].

An aim of the study was to investigate a relationship between global and local brain atrophy with neurological impairment (motor dysfunction) in multiple sclerosis (MS) patients with different levels of disease severity. Fifty five patients with definite MS (Mc Donald's criteria), aged 18-60 years, disease duration 1-30 years, and 25 healthy age-matched controls have been studied. Neurological assessment (Kurtzke and EDSS scales) was performed in the all patients. The patients were divided into 3 groups: EDSS<3.5 mild disability, EDSS 3.5-6.0 moderate disability, EDSS>6.0 severe disability. In MS patients, the global brain atrophy was accompanied by the local atrophy of subcortical structures (thalamus, basal ganglia) and cerebellum. The processes of cerebral grey matter total and local atrophy were not similar. The progression of MS, neurological impairment is accompanied by the cerebellum and lentiform nuclei atrophy. There was the decrease of brain parenchyma volume, nucleus caudate and cerebellar local atrophy in patients with moderate disability. The severe disability was correlated with the thalamic atrophy and marked basal ganglia and cerebellar atrophy. Thus, we can suppose that the thalamic atrophy is important for the development of severe motor dysfunctions in MS patients.

[Neuromyelitis optica: problems of heterogeneity and systematization].

Prospective-retrospective data on 10 cases of neuromyelitis optica (NO) have been analyzed. Demographic and clinical features of patients with primary NO as well as NO comorbid with other organospecific disorders are discussed. Magnetic-resonance imaging data of the brain and spinal cord are summarized and discussed in the context of its heterogeneity. Positron emission tomography with the functional imaging of the brain performed in 3 patients revealed changes in glucose metabolism in the brain regions corresponding to deficits in motor and sensory functional systems. The issues of additional laboratory analyses, including those of cerebrospinal fluid, are reviewed.

[Pathogenetic treatment of multiple sclerosis: the present and the future].

Treatment of multiple sclerosis (MS) remains one of the most serious problems of modern medicine though a significant progress in understanding of disease pathogenesis has been achieved over the last years. Currently there are the ways of modifying the disease course that improve the remote prognosis. In this review, we present results of studies of drugs modifying the MS course which have been approved for MS treatment and those that are in the stage of clinical trials and expected to enlarge possibilities of MS treatment.

[The peculiarities of plantar pressure distribution during gait in different variants of functional system impairment in patients with multiple sclerosis].

Gait disturbance is a prominent disabling presentation of multiple sclerosis. The data on the distribution of plantar pressure during gait and its relation to the level of neurological deficit in various disturbances of pyramidal and cerebral functions in remitting type of multiple sclerosis are presented.