E. V. Popova

[Atypical multiple sclerosis - Balo's concentric sclerosis: two case-reports and a review].

This article presents two clinical cases of patients diagnosed with Balos concentric sclerosis. Distinctive features of the pathogenesis in the aspect of differential diagnosis from other forms of multiple sclerosis and possible treatment are discussed.

Клинические рекомендации по применению препарата диметилфумарат при ремиттирующе-рецидивирующем рассеянном склерозе

Multiple sclerosis is a chronic demyelinating and neurodegenerative disease of the central nervous system, in which autoimmune inflammation and oxidative stress play essential pathogenetic roles. Activation and infiltration of immune cells in brain tissues, lipid peroxidation products, mitochondrial dysfunction, defective antioxidant protection, and many other pathological factors result in demyelination, axonal injury and death, and apoptosis of oligodendrocytes and neurons, all of which causes constant progression of the disease. The new oral agent for the treatment of relapsing-remitting multiple sclerosis (RRMS), dimethyl fumarate (DMF), helps change the pathogenetic mechanisms of the disease, thus decreasing the rate of exacerbations, slowing down disease progression, and reducing the risk of radiological progression of the disease.

Efficacy and Tolerance of Glatiramer Acid (Copaxone) on Long-Term Use: 10 Years of Experience at the Moscow City Multiple Sclerosis Center

We summarize here 10 years of experience of using glatiramer acetate (Copaxone) in 74 patients with active remitting multiple sclerosis (MS). Significant decreases in the frequency of disease exacerbation over all 10 years were noted. Disease severity on the EDSS was stable and increased significantly only by the tenth year of observations. Positive stable clinical dynamics were independent of disease severity at the moment of treatment initiation. Tolerance of glatiramer acetate was good, allowing us to come close to controlling the course of MS – 64.8% of patients had no more than one exacerbation in 10 years, while 71.6% showed no or minimal progression of disease (up to 1 point on the EDSS scale). These observations lead to the conclusion that 10 years of treatment with Copaxone allows disease development to be controlled in many patients.

Primary-progressive multiple sclerosis in Russia: a medical-sociological study involving patients and neurologists

The main results of a medical-sociological study aimed at the evaluation of the level of satisfaction with treatment in patients with primary progressive multiple sclerosis (PPMS) are presented. The survey was conducted in 19 regions of the Russian Federation and involved 437 patients with confirmed diagnosis of PPMS and 80 neurologists specialized in multiple sclerosis. The research was carried out by the All-Russian Public Organization of Disabled People with Multiple Sclerosis with the participation of the Russian Committee for Treatment and Research in Multiple Sclerosis. This is the first medical-sociological study in the Russian Federation involving patients with PPMS and neurologists. The study revealed typical medical and social problems patients with PPMS faced. A significant decrease in quality-of-life of PPMS patients was shown.

Radiologically isolated syndrome as a possible preclinical stage of primary-progressive multiple sclerosis

The article presents a clinical case-report of transformation of radiologically isolated syndrome (RIS) to primary-progressive multiple sclerosis (PPMS). It also provides a review of international and Russian data on the comparison of clinical and MRI characteristics of PPMS with relapsing-remitting multiple sclerosis and secondary-progressive multiple sclerosis and the review of the current data on the risks of transition of RIS to PPMS.

Atypical Multiple Sclerosis – Baló’s Concentric Sclerosis: Two Case Reports and a Review

We present two case reports of patients with diagnoses of Baló’s concentric sclerosis. The characteristics of the pathogenesis of this disease are considered in relation to the differential diagnosis against other types of multiple sclerosis and potential therapeutic tactics are discussed.

Polymorphic Variants of Immune Response Genes as a Risk Factor for the Development of Primary Progressive Multiple Sclerosis

Objectives. To analyze the involvement of immune response genes in the pathogenesis of primary progressive multiple sclerosis (PPMS). Materials and methods. A representative cohort of 111 ethnically Russian patients with PPMS took part in a multicenter study. The involvement of immune system genes in the pathogenesis of PPMS was analyzed by investigating the associations of variants of cytokines genes and genes involved in antigen processing and presentation by antigen-presenting cells with the disease. Results and conclusions. Carriership of the IL4 genotype (rs2243250)*C/C and CLEC16A (rs6498169)*G/G was found to have a positive association with the development of PPMS in Russian patients. The association described in studies of other populations, HLA-DRB1*15 with a high risk of developing this form of MS, was confirmed.

Experience in the Use of the β-Interferon-1a Biosimilars CinnoVex and Genfaxon-44 at the Moscow City Multiple Sclerosis Center

Objective: To study the efficacy and tolerability of the generic drugs (β-interferon-1a biosimilars) CinnoVex for i.m. administration and Genfaxon-44 for s.c. administration in multiple sclerosis (MS). Materials and methods: A total of 100 MS patients were treated with CinnoVex and 104 patients were treated with Genfaxon, in each case for one year. Status was assessed clinically using several scales, as well as by MRI scanning. Results and conclusions: High frequencies of treatment withdrawal due to lack of clinical efficacy and intolerability were noted. Positive effects in relation to stabilizing the course of MS were seen only in patients who had not previously been treated with MS disease-modifying drugs (DMD). Final resolution of the question of the equivalence of the original and “generic” drugs requires double-blind studies.

Results of a Randomized Open Multicenter Comparative Study of the Tolerability and Safety of Gilenya (fingolimod) in Patients with Remitting Multiple Sclerosis (the GIMN study)

Disease-modifying drugs (DMD) are currently used in the treatment of patients with multiple sclerosis (MS) in accordance with therapeutic standards, with the aim of decreasing the risk of developing exacerbations and thus reducing the rate of development of disability. However, the use of first-line substances is not successful in all cases. Second-line agents are used in this situation, which on the territories of the Russian Federation include fingolimod. Experience in the use of fingolimod in routine neurological practice was obtained by performing the postmarketing GIMN trial.

Quality of Life of Patients Receiving Long-Term Treatment with First-Line Multiple Sclerosis Disease-Modifying Drugs: Results of a Russian Multicenter Study Using the MusiQol Questionnaire *

We present here the results of a multicenter study addressing quality of life (QoL) using the MusiQoL questionnaire in 534 patients with multiple sclerosis receiving glatiramer acetate (GA) at a dose of 20 mg/day s.c. for 12 months. These data were compared with results from multicenter observations using the same questionnaire in 1420 MS patients receiving s.c. β-interferon-1a at a dose of 44 μg three times a week for at least one year. QoL measures were found to depend on gender, age, and duration of MS. Statistically significant improvements in QoL were seen at 12 months of treatment on the background of courses of GA. Treatment with β-interferon-1a produced improvements by 6 months.