The significance of time stages in different types of multiple sclerosis course for the formation of prognosis

Background. The purpose was to develop a prognosis assessment system based on clinical and mathematical analysis of indicators at different stages in various types of the course of multiple sclerosis. Materials and methods. Clinical (clinical neurological method and survey using a questionnaire developed at the Department of Autoimmune and Degenerative Pathology of the Nervous System of the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”) and mathematical and statistical (permutation test) methods were applied. Using the method of permutation (permutation test) in groups of patients with different types of multiple sclerosis, the differences in the mean values of clinical indicators were evaluated characterizing the type of multiple sclerosis course at different time stages: preclinical stage, the onset, recurrent stage for relapsing-remitting and secondary progressive multiple sclerosis, stage of progression — for secondary and primary progressive multiple sclerosis. On this basis, clinical indicators were identified, which with a high probability (confidence interval of 0.95) at each time stage of multiple sclerosis determine the final prognosis of the disease. Results. We have examined 280 patients: 80 (50 women and 30 men) with a relapsing-remitting course, 140 (80 women and 60 men) with a secondary progressive course and 60 (30 women and 30 men) with a primary progressive course of multiple sclerosis. The nature of prognosis (good and uncertain with a relapsing-remitting course, uncertain and poor with progressive types) was assessed on the basis of clinical and diagnostic criteria developed taking into account the features of the disease course as a whole. The studies have shown that a good prognosis is highly probable with a combination of clinical indicators such as mild onset, complete remission after onset, mild relapses developing rapidly, and long-term remission between relapses at a relapsing-remitting stage; uncertain prognosis — in the presence of moderate onset, stem symptoms at the onset, severe and moderate relapses, and a tendency to aggravate and lengthen relapses at a relapsing-remitting stage. A poor prognosis in a secondary progressive course is reliably associated with the chickenpox at the preclinical stage in a premorbid history, lightning-fast onset development, steady progression proceeding without clinically outlined periods of stabilization; uncertain prognosis — with a fast development of the onset. A poor prognosis in a primary progressive course was closely associated with severe traumatic brain injury at the preclinical stage in a premorbid history, cerebellar symptoms at the onset, formation of the progression stage immediately after the onset, without the stabilization period, steady type of progression at the stage of progression; uncertain prognosis — with herpetic infections at the preclinical stage in a premorbid history, mild onset, the formation of a progression stage after a stabilization period that occurred after the onset, incremental progression at the progression stage proceeding in the form of alternating periods of slow accumulation of neurological deficit, which, as a rule, has a local focus, and stages of stabilization with different duration. Conclusions. Thus, with the help of clinical and mathematical analysis, it was shown that the formation of alternative prognosis variants for different types of multiple sclerosis occurs through a selective involvement in a single pattern of clinical indicators that have diagnostic significance at different time stages of the course of the disease.

Skeletal muscle damage in the course of coronavirus disease (COVID-19) in a pediatric practice. Own supervision: a clinical case

Background. Coronavirus disease (COVID-19) pandemic is still at the heart of healthcare in Ukraine and over the world. The nervous system and other human organs and systems can be affected by pathogenic nature of SARS-CoV-2. We purposed to pay physicians’ attention to the diagnosis of skeletal muscle damage, in particular rhabdomyolysis, to avoid possible complications in COVID-19. Materials and methods. We have examined a group of children with skeletal muscle damage on the background of COVID-19 during 2020–2021. A clinical case from own practice has been presented in the article. Results and conclusions. The patient, a 15-year-old boy, developed general weakness, severe pain in the right thigh and hip joint, fever 33 days after the acute phase of coronavirus disease. The differential diagnosis was carried out between skeletal muscle damage and osteomyelitis. Diffuse connective tissue diseases, oncohematological disorders, and hepatitis were excluded on the basis of clinical data and examinations. The inflammatory changes in m.iliopsoas, m.obturatorius internus and m.piriformis with abscess formation identified during clinical examination and magnetic resonance imaging, along with high levels of blood transaminases indicated the development of rhabdomyolysis. The detected positive IgG to SARS-CoV-2 confirmed the association of this pathological condition with the previous acute phase of COVID-19. Signs of coagulopathy, anemia in the hemogram simultaneously with the clinical symptoms of rhabdomyolysis confirmed the systemic lesions in the course of coronavirus disease in the child. Timely assessment of clinical symptoms (general weakness, muscle pain) and levels of creatine phosphokinase, transaminases, electrolytes, creatinine, blood urea will help make an early diagnosis of rhabdomyolysis, prescribe adequate therapy and prevent the deve-lopment of severe complications.

Antiepileptic drugs with nootropic effect is the best choice if you need a comprehensive treatment for comorbid disorders

The article presents the results of a review devoted to the search for optimal methods of treatment in patients with epilepsy with concomitant cognitive impairments. It has been established that antiepileptic drugs with a nootropic effect are the most optimal choice in terms of compliance with the therapy, as well as reducing the frequency of side effects in the case of monotherapy in comparison with the combined use of nootropics and antiepileptic drugs. Levetiracetam is one of the drugs of choice with proven beneficial effects on cognitive function in patients with epilepsy. Due to high safety profile, it can be recommended for use in elderly patients with epilepsy, including for the termination of status epilepticus, and can also be used in cases of combination of Alzheimer’s disease with epilepsy. A promising direction for further researches is to study the possibilities of using levetiracetam in traumatic injuries of the nervous system.

Nervous system disorders in a patient with Adie syndrome (a clinical case)

Holmes-Adie syndrome, or tonic pupil syndrome, is a condition characterized by a triad of main symptoms: unilateral tonic pupil dilation, accommodative paresis without or with a significant reduction in pupillary light reflex, and decreased tendon reflexes. The disease is based on dysfunction of the parasympathetic nervous system. The syndrome results from damage to the ciliary ganglion, which carries parasympathetic innervation to the m.sphincter pupillae, cornea, and eyeball. Often the condition is accompanied by dysfunction of the spinal ganglia and, as a consequence, autonomic dysfunction in the form of sweating disorders, usually on one side of the body, rarely — by heart rhythm disorders, lability of blood pressure. A frequent sign of Adie syndrome is the absence or reduction in patellar, rarely Achilles, reflexes. The etiology of the disease is not definitively determined, bacterial or viral factors are not excluded. The diagnosis of Adie syndrome is mainly based on a clinical comparison of the symptoms of the disease, as well as on a thorough and comprehensive examination by a neuroophthalmologist with mandatory testing of pupillary responses with low doses of pilocarpine (narrowing of the pupil is characteristic). Despite the positive prognosis for the patient’s life and his ability to work, the condition belongs to the group of difficult-to-treat ones, and the management consists in symptomatic vision correction.

Pathogenetic mechanisms of sensorineural hearing loss in patients with COVID-19 and methods for their correction

The article describes the main pathogenetic mechanisms of acute sensorineural hearing loss, including that caused by infection. Possible risk factors and mechanisms of development of sensorineural hearing loss against the background of coronavirus infection caused by SARS-CoV-2 virus are consi-dered. Cases of hearing loss in patients with COVID-19 have been described. The pathogenetically substantiated therapeutic approach to the treatment of such patients is presented, it is based on the optimization of acetylcholine neurotransmission in the brain structures involved in the conduction and perception of the auditory impulse.

Opportunities of MRI in the early diagnosis of the progression of muscular dystrophies

Progressive muscular dystrophies are a genetically heterogeneous group of disorders characterized by progressive muscle weakness, muscle atrophy, and movement disorders. This is a rare group of pathologies that presents a diagnostic problem in the practice of a neurologist. The combination of clinical, radiological, and laboratory methods of examination plays an important role in making the correct diagnosis. Magnetic resonance imaging of muscles is used to diagnose primary muscle damage based on specific patterns of muscle damage. In this article, we will briefly discuss the opportunities of early diagnosis of muscular dystrophies and note the role of MRI of muscles as a highly informative diagnostic method in progressive muscle diseases.

Venous discirculation and cognitive impairment

This article considers the aging impact on the functional and structural integrity of venous cerebral circulation from the standpoint of potential mechanisms involved in the pathogenesis of neurodegeneration and cognitive decline. It was reported about venous collagenosis in the brain with apparent leukoaraiosis that demonstrates the participation of pathological re-structure of the venous wall in impairment of white matter both in natural aging and in Alzheimer’s disease. It is likely that due to an age-related decrease in elasticity, the internal jugular vein loses its compensatory ability to increase transmural pressure and therefore results in venous hypertension in the cerebral venous system. Diosminum increases the tone of venous and lymphatic vessels, decreases venous and lymphatic stasis, strengthens the capillary walls and reduces their permeability, has anti-inflammatory, antiedemic, and analgesic effects, improves microcirculation and tissue trophicity, prevents thrombosis. Hesperidin strengthens the walls of small vessels that reduces their permeability and therefore decreases the edemas.

Scale of the severity of extrapyramidal tone

It is known that the progression of neurodegenerative diseases significantly limits the daily household and professional activities of patients, greatly affecting the functions associated with movement, self-care and cognitive control. Despite the significant scientific breakthroughs in the field of neuroimaging and pathogenetic therapy, the diagnosis and treatment of this category of patients remains a difficult and sometimes a challenging task. Оne of the basic principles in identifying nervous system diseases is implemented through the use of specialized indices, tests and scales. These diagnostic markers are widely used by neurologists, physical medicine and rehabilitation physician, orthopedists, occupational therapists, physical therapists, hel-ping experts to determine not only the presence of pathology, but also, most importantly in rehabilitation, the evolution of certain signs of the disease with the possibility of further timely dynamic control. Among patients with movement disorders, individuals with extrapyramidal disorders make up a separate group in need of rehabilitation care. Unfortunately, the issues of lapidary diagnosis of extrapyramidal disorders remain relevant today. In the avai-lable specialized scientific and practical literature, we failed to find a convenient scale for measuring the severity of extrapyramidal tone in order to assess the effectiveness of drug and comprehensive non-drug rehabilitation treatment. The scale of the severity of extrapyramidal tone developed by us and recommended for practical use will allow neurologists to master a simple, but at the same time effective tool that facilitates early identification and determination of the stage of development of degenerative diseases of the nervous system accompanied by a specific change in muscle tone, which indicates the accuracy of the chosen ways of rehabilitation treatment.

Cerebrospinal fluid flow impairment in the patients with Chiari malformation: predictors of syringomyeliа cysts development and dynamics of postoperative regression

Background. Chiari malformation (CM) is a defect in the development of the central nervous system, manifested by the mismatch between the size of the posterior cranial fossa and the brain structures located in this area, and, as a consequence, by the descent of the cerebellar tonsils (CM type 1), usually with a caudal dislocation of the lower parts of the brainstem into the foramen magnum (CM type 1.5). As a result of cerebrospinal fluid (CSF) flow disorders, 60–90 % of patients with CM have syringomyelia. Materials and methods. A retrospective analysis was performed of clinical records of 24 patients with Chiari malformation types 1 and 1.5, who had undergone surgeries at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology from December 2006 to December 2017, during which suboccipital decompressive craniectomy, C1 laminectomy, duraplasty were performed. The average follow-up period after the surgery was 5 years. Results. In patients whose symptoms lasted for more than 3 years, the frequency of formation of the associated syrinxes was 57 %. The dynamics of the regression of CSF flow disorders in the postoperative period varies considerably depending on age. Conclusions. The risk of syrinx formation within the spinal cord is higher in patients with CM types 1 and 1.5 who have been ill for more than 3 years. Surgical treatment is an effective method used to correct CSF circulation disturbances. The cyst puncture is not obligatory during surgical interventions.

Local application of non-steroidal anti-inflammatory drugs: advantages and disadvantages

The article presents literature data on the efficacy and safety of dexketoprofen trometamol gel when applied locally and comparative characteristics of this pharmacological agent with other transdermal forms of nonsteroidal anti-inflammatory drugs. It was found that dexketoprofen when applied topically in the form of a gel has a high ability to accumulate in the skin, muscle and nervous (neurons, myelin and hypothalamus) tissues which causes a good anti-inflammatory, anti-edema and analgesic effect of this drug. Dexketoprofen showed a low level of accumulation in the cartilage without stimulating degenerative changes in cartilage tissue, as it does not inhibit the synthesis of proteoglycans by chondrocytes. At the same time, dexketoprofen had a low capacity for accumulation in blood cells and in internal organs demonstrating a low pro-bability of systemic side effects.