The Level of Anti-Viral Antigen-Specific Antibodies to EBNA-1 in the Serum of MS Patients Does not Depend on the Severity of the Disease

Multiple sclerosis (MS) is an autoimmune neurodegenerative disease leading to inevitable disability and primarily affecting the young and middle-aged population. Recent studies have shown a direct correlation between the risk of MS development and Epstein-Barr virus (EBV) infection. Analysis of the titer of EBV-specific antibodies among patients with MS and healthy donors among Russian population confirmed that MS is characterized by an increased level of serum IgG binding EBNA-1 (EBV nuclear antigen 1). The number of patients with elevated levels of EBNA-1-specific antibodies does not differ statistically significantly between two groups with diametrically opposite courses of MS: benign MS or highly active MS. It can be assumed that the primary link between EBV and the development of MS is restricted to the initiation of the disease and does not impact its severity.

[Long-term Efficacy and Safety of Sampeginterferon-β1a in the Treatment of Relapsing Remitting Multiple Sclerosis: a Randomized, Double-Blind Clinical Trial 104-Week Results]

OBJECTIVE

To assess the efficacy and safety of sampeginterferon-β1a (samPEG-IFN-β1a) 180 μg and 240 μg administered once every 2 weeks compared to placebo and low dose interferon beta-1a (LIB) 30 μg administered once weekly.

MATERIAL AND METHODS

Patients with relapsing-remitting multiple sclerosis aged 18-60 years, with Expanded Disability Status Scale score ≤5.5 were randomized at a ratio of 2:2:2:1 to the following groups: samPEG-IFN-β1a 180 µg, samPEG-IFN-β1a 240 µg, LIB, placebo. After 20 weeks, the placebo group completed the study. After week 52, the final analysis was performed, which included the primary endpoint analysis, the LIB group patients completed their participation in the study. The patients in samPEG-IFN-β1a groups continued to receive therapy with samPEG-IFN-β1a 240 µg until week 100 inclusive. The results of the final analysis after 52 weeks have been previously published. The current article presents a long-term efficacy and safety of samPEG-IFN-β1a after 104 weeks of the trial.

RESULTS

The annualized relapse rate over the second year was 0.16 in the samPEG-IFN-β1a 180 μg group and 0.09 in the samPEG-IFN-β1a 240 μg group. By week 104, the proportion of relapse-free patients was 77.0% (87/113) and 83.3% (95/114) in the samPEG-IFN-β1a 180 μg and 240 μg groups, respectively. There were no negative dynamics of MRI markers, neurological deficit parameters and cognitive functions by scales and tests. The safety profile of samPEG-IFN-β1a was consistent with the known safety profile of IFN-β therapy.

CONCLUSION

Treatment with samPEG-IFN-β1a is an effective and safe first-line therapy for relapsing-remitting multiple sclerosis patients.

[The need to validate translations into Russian of objective neurological scales, symptoms and syndromes]

The article discusses the possibility and expediency of validating translations into Russian of objective and subjective neurological scales, the advantages and disadvantages of such translations, which is extremely relevant at the present time. As an example, the expediency of «validating» the translation into Russian of the objective neurological scale for assessing the severity of symptoms of the Expanded Disability Status Scale, which is widely used in patients with multiple sclerosis is discussed. The results of assessing the severity of neurological disorders according to these neurological scales do not depend on translation into other languages and therefore do not need validation.

[Optic neuropathies as an interdisciplinary subject of research]

Despite the wide range of clinical, instrumental and laboratory methods used in modern ophthalmology, the problem of diagnosing optic neuropathy and identifying its etiology remains relevant. A complex multidisciplinary approach involving various specialists is required in the differential diagnosis of immune-mediated optic neuritis, for example in multiple sclerosis, neuromyelitis optica spectrum disorder, and MOG-associated diseases. Of special interest is differential diagnosis of optic neuropathy in demyelinating diseases of the central nervous system, hereditary optic neuropathies and ischemic optic neuropathy. The article presents a summary of scientific and practical results of differential diagnosis of optic neuropathies with various etiologies. Timely diagnosis and early therapy start reduces the degree of disability in patients with optic neuropathies of different etiologies.

[Hereditary optic neuropathy associated with demyelinating diseases of the central nervous system]

Demyelinating optic neuritis and hereditary optic neuropathy (HON) take a leading place among the diseases, the leading clinical syndrome of which is bilateral optic neuropathy with a simultaneous or sequential significant decrease in visual acuity. Optic neuritis can occur at the onset or be one of the syndromes within multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD). HON are a group of neurodegenerative diseases, among which the most common variants are Leber's hereditary optic neuropathy (LHON), associated with mitochondrial DNA (mtDNA) mutations, and autosomal recessive optic neuropathy (ARON), caused by nuclear DNA (nDNA) mutations in DNAJC30. There are phenotypes of LHON «plus», one of which is the association of HON and CNS demyelination in the same patient. In such cases, the diagnosis of each of these diseases causes significant difficulties, due to the fact that in some cases there are clinical and radiological coincidences between demyelinating and hereditary mitochondrial diseases.

[Acute hemorrhagic leukoencephalitis with a subacute onset]

Acute hemorrhagic leukoencephalitis (AHLE), also called Hurst's encephalitis, is a rare demyelinating disease of the central nervous system characterized by rapid progression and acute inflammation of the white matter of the brain and spinal cord. AHLE is currently considered as a rare, most severe variant of acute disseminated encephalomyelitis. Clinically AHLE is characterized by a fulminant course with a rapid development of encephalopathy and multifocal neurological symptoms. AHLE is associated with high mortality rate that requires immediate and aggressive treatment initiation. This article describes a case of AHLE with an atypical course, a subacute form, which is extremely rarely described in the literature, with the progressive symptoms' development over several months. Due to delayed treatment initiation, unfortunately, a fatal outcome has been observed. Subsequent histological examination of the autopsy material confirmed the presence of a subacute form of AHLE in the patient.

[Typical and atypical optic neuritis]

Optic neuritis (ON) is one of the most common neuro-ophthalmic causes of vision loss worldwide. Demyelinating ON can be idiopathic or be one of the symptoms of autoimmune demyelinating diseases of the central nervous system (CNS) such as multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Demographic, clinical and radiological signs of ON in these CNS diseases have differences. In this regard, typical and atypical ON are currently distinguished. Recognizing the clinical features that differentiate typical MS-associated ON from atypical ON in NMOSD and MOGAD is important for choosing the correct disease management and treatment strategy. This review summarizes the data from clinical, laboratory, instrumental methods of management used for the differential diagnosis of optic neuritis.

[Clinical characteristics and short-term outcomes of autoimmune encephalitis in adults]

OBJECTIVE

To characterize clinical, paraclinical features and short-term outcomes in different types of autoimmune encephalitis (AE) in a one-center cohort of Russian patients, as well as to evaluate the frequency and significance of the joint expression of antineuronal and anti-glial antibodies (Abs) in AE.

MATERIAL AND METHODS

Forty-one patients were diagnosed with AE at the Research Center of Neurology from November 2020 to December 2022. Demographic, clinical characteristics, results of laboratory tests, MRI of brain, treatment and outcomes of disease were analyzed. The analysis of Abs to glial antigens (myelin-oligodendrocyte glycoprotein - MOG, glial fibrillar acidic protein - GFAP, aquaporin 4 - AQP-4) was performed by indirect immunofluorescence assay (Euroimmun, Germany).

RESULTS

In 24 (58.5%) patients was established definite AE, confirmed by specific Abs detection; in 2 (4.9%) - definite limbic encephalitis, in 15 (36.6%) - seronegative probable AE (including 3 cases of Hashimoto's encephalitis). GFAP-Abs in cerebrospinal fluid (CSF) were detected only in two patients - with clinical and MRI-picture of autoimmune GFAP-astrocytopathy (A-GFAP-A). GFAP- and MOG-Abs in the blood were detected in 25.7% and 6%, respectively, AQP-4-Abs were not detected. There were no correlations between co-expression with glial Abs and clinical characteristics. Systemic and antithyroid Abs were present in 15% and 31%, respectively. Paraneoplastic AE accounted for 22%. For the first time in the Russian population, 2 cases of A-GFAP-A, 6 cases of AE associated with COVID-19 were described. The most common first syndrome were epileptic seizure (34%), psychiatric (29%) and cognitive (14%) disorders. Relapses of AE was observed in 22%. Inflammatory changes in CSF were detected in 41%, focal changes on MRI in 68%. First-line immune therapy was performed in all patients, 85% of cases received pulse therapy with methylprednisolone. Second-line immune therapy (rituximab or cyclophosphamide intravenously) was performed in 19.5%, 78% of patients achieved significant improvement during treatment (scores ≤2 on the modified Rankin scale).

CONCLUSIONS

The results allow us to consider COVID-19 as a trigger of AE. The absence of detection of GFAP-Abs in CSF in patients with other types of AE contributes to the confirmation of the specificity of GFAP-seropositivity of CSF for the diagnosis of A-GFAP-A. The expression of GFAP- and MOG-Abs in AE can serve as confirmation of the immuno-mediated etiology of the disease, which is especially important for the AE diagnosis in the absence of antineuronal Abs.

Multiple Sclerosis Is Associated with Immunoglobulin Germline Gene Variation of Transitional B Cells

The regulatory functions of the B-cell compartment play an important role in the development and suppression of the immune response. Disruption of their anti-inflammatory functions may lead to the acceleration of immunopathological processes, and to autoimmune diseases, in particular. Unfortunately, the exact mechanism underlying the functioning and development of regulatory B cells (Breg) has not yet been fully elucidated. Almost nothing is known about their specificity and the structure of their B-cell receptors (BCRs). In this research, we analyzed the BCR repertoire of the transitional Breg (tBreg) subpopulation with the CD19+CD24highCD38high phenotype in patients with multiple sclerosis (MS), using next-generation sequencing (NGS). We show, for the first time, that the immunoglobulin germline distribution in the tBreg subpopulation is different between MS patients and healthy donors. The registered variation was more significant in patients with a more severe form of the disease, highly active MS (HAMS), compared to those with benign MS (BMS). Our data suggest that during MS development, deviations in the immunoglobulin Breg repertoire occur already at the early stage of B-cell maturation, namely at the stage of tBregs: between immature B cells in the bone marrow and mature peripheral B cells.

The Role of Inflammasomes in the Pathogenesis of Neurodegenerative Diseases

Abstract—Protein misfolding and accumulation of protein aggregates is a distinctive feature of most neurodegenerative diseases. They lead to disruption of cellular homeostasis, loss of synaptic connections, and therefore cellular apoptosis. It has been demonstrated that some innate immune responses play an important role in the emergence and progression of neurodegenerative diseases. Inflammasomes are components of innate immunity that play a major role in the maintenance of chronic inflammation. Inflammasomes function as intracellular sensors, detecting both exogenous and endogenous stimuli. They also take part in caspase-1 activation and the synthesis of pro-inflammatory cytokines. In the central nervous system (CNS), inflammasomes are predominantly expressed by microglia, the key cells of innate immunity responsible for activation and maintenance of inflammation. In addition to microglia, inflammasomes can be expressed and activated by astrocytes and neurons, as well as infiltrating myeloid cells. Understanding the mechanisms of activation and functioning of inflammasomes is crucial for the development of novel drugs targeted at modulation of the immune response associated with their excessive activation. This review provides up-to-date information on the inflammasome structure and mechanisms of action, the role of protein misfolding, aggregation and the influence of these factors on inflammasome activation, as well as potential therapeutic targets in neurodegenerative diseases.

Toxic Damage to Motor Neurons

Abstract—Amyotrophic lateral sclerosis (ALS) is a multifactor disease in the development of which both genetic and environmental factors play a role. Specifically, the effects of organic and inorganic toxic substances can result in an increased risk of ALS development and the acceleration of disease progression. It was described that some toxins can induce potentially curable ALS-like syndromes. In this case, the specific treatment for the prevention of the effects of the toxic factor may result in positive clinical dynamics. In this article, we review the main types of toxins that can damage motor neurons in the brain and spinal cord leading to the development of the clinical manifestation of ALS, briefly present historical data on studies on the role of toxic substances, and describe the main mechanisms of the pathogenesis of motor neuron disease associated with their action.

[Clinical and epidemiological aspects of neuromyelitis optic spectrum diseases in the russian population]

OBJECTIVE

To present clinical and epidemiological aspects of neuromyelitis optica spectrum disorders (NMOSD) in the Russian Federation.

MATERIAL AND METHODS

We studied 142 patients who met diagnostic criteria of 2015 for NMOSD. Sex, age at disease onset, presence or absence of aquaporin-4 immunoglobulin G antibodies (AQP4-IgG), mail clinical symptoms, oligoclonal IgG, therapy for the treatment of exacerbations and prevention of exacerbations, compliance with 2006 diagnostic criteria were assessed.

RESULTS

The prevalence of women is 4.26:1, the most frequent age at disease onset is 18-29 years (36% of cases). The laboratory aspects of the disease are characterized and approaches to the treatment and prevention of exacerbations of NMOSD in patients of the Russian population are evaluated. Approaches to diagnostics are compared depending on the applied diagnostic criteria (34% of patients do not meet neuromyelitis optica 2006 diagnostic criteria). A prognosis for the prevalence of NMOSD in the Russian population has been proposed: 0.45-4.21/100000.

CONCLUSION

This is the first published data on clinical and epidemiological characteristics of NMOSD in the Russian Federation.

[Rehabilitation of patients with multiple sclerosis]

Multiple sclerosis is a common cause of disability among young and middle-aged people. Despite the modern possibilities of diagnostics and therapy, over time, the disease acquires a secondary progressive character. Rehabilitation of patients at all stages of the disease plays an important role in improving well-being, improving the quality of life, adapting the patient and restoring motor skills. However, there is currently no clear recommendation for the application of specific techniques in each case. The aim of this work was to analyze the available methods of rehabilitation therapy, to highlight the most used and promising ones. Due to the progressive course of the disease, the benefits of rehabilitation measures are usually higher at the initial stages. Nevertheless, nowadays there is a large number of works devoted to rehabilitation measures in patients with moderate and high levels of disability. It has been shown that both inpatient and outpatient rehabilitation has a positive effect on the quality of life and improvement of clinical indicators. Our review describes the main techniques with recommendations for the scheme of application. A comprehensive assessment of the patient's health status, a multidisciplinary team and a personalized approach increase the quality and effectiveness of rehabilitation measures. We also describe our own experience in the treatment of spasticity in patients with a secondary progressive multiple sclerosis.

Variability of the Expression Patterns of Neuroinflammatory Genes in Mononuclear Cells of Peripheral Blood in Amyotrophic Lateral Sclerosis

Abstract—Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with steadily progressing death of motor neurons in the brain and spinal cord. The disease is incurable and results in the patient’s death within 3–5 years on average. The mechanisms of initiation, progression, and spread of the pathological process remain unclear. It seems that inflammatory reactions may be important for disease progression but this is not certain. We performed multiplex analysis of the expression of neuroinflammatory genes in mononuclear cells of peripheral blood from patients with different rates of ALS progression (n = 22) and compared these data with those observed in healthy volunteers. We found that the expression of 14 genes, specifically BAX, CLN3, PLEKHM1, AKT1, LAMP1, RAC2, VAV1, MPG, TFG, BRD2, CSK, MSN, GBA, and VIM, differed between the groups of patients and healthy volunteers (p < 0.05; q < 0.05). Genes associated with autophagia, apoptosis, adaptive immunity, and growth factor cascades prevail among these genes. We did not find any substantial differences in gene expression between patients with rapid and slow ALS progression. We revealed a subgroup of patients who exhibited significantly different expression of 208 or 262 genes compared to other ALS patients or healthy volunteers, respectively (p < 0.05; q < 0.05). Our data show the importance of not only central but also peripheral inflammatory reactions in the development of the pathological process associated with ALS.

[Monoclonal antibody therapies for rapidly progressive and highly active multiple sclerosis in the era of the COVID-19 pandemic]

As the COVID-19 pandemic continues, reducing the risk of infection for immunocompromised patients remains an important issue. Patients with aggressive multiple sclerosis (MS) require immunosuppressive therapy in order to control the overactive autoimmune response. Preliminary international and national trials demonstrate that older age, higher disability status and progressive MS are generally associated with a more severe clinical course of COVID-19. However, uncertainty remains about the effect of disease-modifying therapies on the COVID-19 clinical presentation. In this article, we pay special attention to monoclonal antibodies used for immune reconstitution therapy, which results in significant changes to the T-cell and/or B-cell repertoire. Based on the published data from registries in different countries, we attempted to estimate the benefits and risks of these therapies in a complicated epidemiological setting.

[C9orf72-associated frontotemporal dementia in the Russian population]

OBJECTIVE

To evaluate the frequency of C9orf72-associated frontotemporal dementia (FTD) in the Russian population and to study clinical features of GGGGCC-repeat expansion carriers.

MATERIAL AND METHODS

Twenty-eight patients with FTD are included in the study: 15 with a behavioral variant of FTD (bvFTD) and 13 with a agrammatic/non-fluent variant of primary progressive aphasia (avPPA). The mean age was 62 years (34-80), the mean disease duration was 4 years (1-10). The positive family history was noted in 46% of cases. DNA diagnosis was performed using repeat-primed polymerase chain reaction.

RESULTS

The frequency of the C9orf72 repeat expansion in patients with FTD was 14%, in patients with bvFTD 20%, in patients with avPPA 8%. The mean age of disease onset in the expansion carriers was 63 (55-75) years. The frequency of the C9orf72 repeats expansion in familial FTD cases was 31%, in sporadic cases 7%. bvFTD with parkinsonian syndrome was noted in two out of four cases, bvFTD with amyotrophic lateral sclerosis (ALS) was shown in one case, avPPA with ALS was shown in one case. One female patient with bvFTD with parkinsonian syndrome presented with cognitive fluctuations that required a differential diagnosis with Lewy body disease.

CONCLUSION

This is the first study of the genetic structure of FTD in the Russian population. The prevalence and clinical characteristics of C9orf72-associated FTD were defined, in particular, the spectrum of motor symptoms was shown along with behavioral and aphasic disturbances. DNA diagnosis plays an important role in confirming the diagnosis and selection of patients for potential disease-modifying treatment.

C9orf72 Gene Expression in Frontotemporal Dementia and Amyotrophic Lateral Sclerosis

We studied the expression of C9orf72 gene in pathologies associated with hexanucleotide repeats expansion in this gene: frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). The study included 7 patients with hexanucleotide repeats expansion in the C9orf72 gene and 9 patients of the control group. The expression of C9orf72 mRNA was evaluated in blood leukocytes by real-time PCR. Methylation of CpG-sites in C9orf72 promotor region was evaluated by DNA sequencing after bisulfite conversion. A 2-fold decrease in the C9orf72 gene expression was found in patients with hexanucleotide repeats expansion in comparison with controls, though the difference did not reach statistical significance due to small sample size. The highest expression was shown for ALS in comparison with FTD and FTD-ALS phenotype. A trend to inverse correlation between C9orf72 mRNA level and promoter methylation of this gene as well as between mRNA level and age of disease onset was demonstrated.

[Updated recommendations of the Council of Experts on the use and safety of alemtuzumab (Lemtrada)]

Alemtuzumab (Lemtrada) is a recombinant humanized IgG1 kappa monoclonal antibody to the surface cell glycoprotein, a CD52 differentiation cluster. The drug is approved for use in more than 65 countries, including the Russian Federation. The drug is one of the most effective methods of treating patients with aggressive multiple sclerosis, but the risk management plan should be followed. The safety profile of the drug includes infusion-associated reactions, thyroid dysfunction, immune cytopenia, acute cardiovascular events, infections, and other autoimmune diseases. This publication provides updated practical recommendations for the use of the drug and ensuring the safety of patients treated with alemtuzumab.

[Myelin oligodendrocyte glycoprotein immunoglobulin G-associated encephalomyelitis]

The article discusses the role of myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) in demyelinating diseases of the central nervous system. Clinical phenotypes of demyelinating syndromes associated with MOG-IgG that are currently included into neuromyelitis optica spectrum disorders (NMOSD) are described. However, it has been shown that encephalomyelitis associated with MOG-IgG (MOG-EM) has certain clinical, radiological, immunological and histopathological features that make it possible to single out these syndromes into a separate nosological form. We provide International recommendations that establish indications for testing MOG-IgG using cell-based assay. We discuss epidemiological issues and classification challenges of the disease. Various approaches to treatment and prevention of relapses of MOG-EM are analyzed.

[Experience in designing an electronic multiple sclerosis registry]

OBJECTIVE

To develop an electronic registry of patients with MS in the Russian Federation and to analyze the collected epidemiological and clinical data.

MATERIALS AND METHODS

Patients aged 18 and older with definite multiple sclerosis were included in the study. We designed a specialized electronic individual registration form (registry) to gather information about study participants. This paper presents data collected in the project between September 25, 2017 and March 25, 2020.

RESULTS

We collected information on 2728 patients. This paper presents the results of data analysis from the registry of MS patients, including demographic, clinical and epidemiological characteristics, the type and timing of treatment received. Based on the data obtained, certain issues with primary diagnosis of multiple sclerosis and delayed initiation of disease-modifying therapy can be highlighted, which contribute to the transition of the disease to a secondary progressive course and disability increase.

[Leptomeningeal B-cell follicles in multiple sclerosis: a role in the pathogenesis and prognostic value]

B-lymphocytes play an important role in the development and maintenance of the inflammatory process in multiple sclerosis. Recently special attention has been paid to cell formations that are found in the meninges in patients with multiple sclerosis - the so-called leptomeningeal follicle-like structures that contain not only B-lymphocytes, but also other immunocompetent cells, creating a special environment for clonal expansion, selection and further proliferation of B-lymphocytes. Magnetic resonance imaging (MRI) of the brain with gadolinium-based contrast agents reveals local subarachnoid space contrasting that corresponds to the accumulation of the contrast agent by large lymphoid follicles. This phenomenon is called leptomeningeal contrast enhancement and according to some literature data, its severity correlates with the rate of progression of the disease and functional disability. The review presents the available literature on leptomeningeal follicle-like B-cell structures, as well as prospects of using leptomeningeal contrast enhancement on MRI as a potential biomarker for predicting disease severity in patients with multiple sclerosis.

[Neuromyelitis optica and neuromyelitis optica spectrum disorders]

The review is devoted to up-to-date data on epidemiology, aspects of the pathogenesis of neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD). The authors consider a role of myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) in the syndromes phenotypically similar to NMO and NMOSD. Special attention is drawn to the methods of MOG-IgG antibodies detection and indications for testing. The approaches and management for treatment and prevention of NMO relapses, risks of complications during pregnancy and immediately after delivery, as well as methods for their prevention and treatment, are described.

[Clinical and biochemical characteristics of atypical variants of multiple sclerosis]

AIM

To study the clinical and biochemical features of atypical variants of multiple sclerosis (MS) (tumefactive demyelination (TD), Balo's concentric sclerosis (BCS)) and acute disseminated encephalomyelitis (ADEM)).

MATERIAL AND METHODS

Forty-two patients were studied, including 32 patients with atypical variants of MS (6 patients with BCS and 26 patients with TD) and 10 patients with ADEM. The control group included 20 healthy volunteers. Clinical characteristics and EDSS scores were evaluated. Antibodies to aquaporin 1 (AQP1-IgG), aquaporin 4 (AQP4-IgG), antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) and aquaporin 1 (AQP1) in serum and cerebrospinal fluid (CSF) were detected using ELISA.

RESULTS AND CONCLUSION

BCS and TD occurred both in isolation and comorbid with MS (in 50% of cases with BCS, 50% of cases with TD). Atypical symptoms of MS were detected in 50% of cases of CFS, 15.4% of cases of PD. The levels of CSF cytosis and CSF protein were not significantly different between the groups. The levels of AQP1-IgG, AQP4-IgG, AQP1, MOG-IgG in serum with BCS, TD and ADEM were significantly higher than in the control group. No significant differences were found between atypical variants of MS. A correlation between a high level of MOG-IgG and the EDSS score in BCS was shown. MOG-IgG may have a pathogenetic significance in BCS. Further studies of AQP1-IgG, AQP4-IgG and MOG-IgG in patients with atypical variants of MS are needed.

Clinical recommendations for the use of ocrelizumab in patients with multiple sclerosis

The paper presents a detailed algorithm for the treatment and follow-up of patients with recurrent multiple sclerosis and primary progressive multiple sclerosis in the use of ocrelizumab.

[Clinical characteristics and diagnosis of disseminated encephalomyelitis in adults]

AIM

To analyze clinical, neuroimaging and laboratory characteristics of acute disseminated encephalomyelitis (ODEM) in adults with an analysis of the frequency of diagnostic errors at the initial examination stage.

MATERIAL AND METHODS

The study included 23 patients hospitalized with a diagnosis of ODEM. The analysis of clinical characteristics, MRI results and cerebrospinal fluid (CSF) was performed. The diagnosis of the disease in each case was specified after a full examination and dynamic observation.

RESULTS

The diagnosis of ODEM was confirmed only in 16 cases. In 6 cases, the final diagnosis of multiple sclerosis (MS) was made, and one case of Susak syndrome, primary CNS lymphoma and levamisole-associated multifocal inflammatory leukoencephalopathy was also detected. It has been shown that ODEM in adults is characterized by the acute development of multifocal brain lesions in combination with clinical manifestations of encephalopathy, which in half of cases is preceded by an infectious disease. There were no specific clinical, neuroimaging and laboratory features, which could allow differentiation of ODEM from onset of MS.

CONCLUSION

To make a correct diagnosis in the first episode of acute multifocal brain lesion, a dynamic observation, including repeated MRI, is needed. The development of specific biomarkers may be of great importance for the early differential diagnosis of demyelinating diseases.

[Efficacy, tolerability and safety of the treatment with teberif: the results of a 2-year randomized clinical trial of treatment naïve patients with remitting multiple sclerosis, who have not received DMT, after switching from other interferon β-1a]

OBJECTIVES

To evaluate efficacy, safety, and tolerability of the treatment with teberif/interferon β-1a, to analyze safety, tolerability and dynamics of key efficacy variables after switching from referent drug rebif to biosimilar teberif in patients with remitting multiple sclerosis (RMS).

MATERIAL AND METHODS

During the main period of the international multicenter randomized study patients were randomized to receive treatment with teberif for 52 weeks, or rebif for 52 weeks, or placebo for 16 weeks to evaluate efficacy and safety of treatment. After the main study period, patients were group-independently switched to take open-label teberif treatment during the next 48 weeks.

RESULTS AND CONCLUSION

The analysis of multiple evaluation parameters of the efficiency during the 1st study period (blinded) and the 2^nd study period (open-label) has shown that teberif and rebif demonstrate equivalent efficacy and stable 2-year efficacy of teberif was proven. There were no significant differences between teberif and rebif for all safety, and tolerability parameters. Switching from rebif to teberif didn't influence treatment efficacy. The 2-year study results confirmed a biosimilar teberif's benign tolerability and expected safety profile to other interferons β-1a in patients with RMS.

[Diagnostic value of antibodies to myelin oligodendrocyte glycoprotein in demyelinating diseases of the central nervous system]

AIM

To evaluate the diagnostic value of MOG-IgG antibodies in multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM).

MATERIAL AND METHODS

Twenty-nine patients with definitive MS according to the criteria of McDonald, 2010 (21 with relapse-remitting MS and 8 with secondary progressive MS), 7 patients with ADEM confirmed by clinical and instrumental data and 27 healthy volunteers were included in the study. Serum MOG-IgG levels were evaluated in all patients. MOG-IgG levels in the cerebrospinal fluid (CSF) were evaluated in 22 cases with MS, 6 cases with ADEM, and 8 healthy volunteers using ELISA.

RESULTS AND CONCLUSIONS

Serum MOG-IgG levels are significantly higher in patients with MS and ADEM compared to the control group. No statistically significant differences in the serum MOG-IgG levels were found between MS and ADEM groups. When analyzing the level of MOG-IgG in CSF, no statistically significant between-group differences were obtained. The sensitivity and specificity of the determination of MOG-IgG in serum in patients with MS are 75,8% and 92.59%, respectively. MOG-IgG is detected in serum and CSF in patients with demyelinating diseases that indicates its pathogenetic significance in the development of MS and ADEM. Serum MOG-IgG may be a valuable biomarker for demyelinating diseases. Further research in a large population of patients is required.

[A case of subtentorial progressive multifocal leucoencephalopathy in a patient treated with natalizumab]

This paper presents a case report of subtentorial progressive multifocal leukoencephalopathy (PML) in a 26-year-old female patient treated with natalizumab. The evolution of clinical features, neuroimaging data and treatment as well as the development of immune reconstitution inflammatory syndrome (IRIS) are described. This case emphasizes the importance to keep accurately the risk management plan during natalizumab treatment. This includes performing MRI scans in order to detect changes typical for PML at the earliest (preclinical) stage in time.

[Provision of alemtuzumab safety is one of the main components of pharmacovigilance]

Modern multiple sclerosis therapy with disease-modifying drugs is characterized by the risks of dangerous infectious complications. In the last 5 years, there have been several reports of severe, sometimes lethal, listeriosis infection in patients treated with alemtuzumab. This article presents a clinical case of lethal listeriosis meningoencephalitis, which developed within 7 days after the completion of the first cycle of alemtuzumab therapy. In January 2018, a meeting of the expert Council was held, at which the clinical recommendations published in 2017 were revised and updated.

[The case-report of progressive multifocal leukoencephalopathy in a patient with multiple sclerosis treated with natalizumab]

The article describes the first case of progressive multifocal leukoencephalopathy in a patient with multiple sclerosis, developed during treatment with natalizumab. The causes, possibly, influencing the outcome of the disease, are analyzed.

[Brain atrophy and perfusion changes in patients with remitting and secondary progressive multiple sclerosis]

AIM

To study the relationship of brain atrophy and changes in perfusion with an increase in the level of disability in patients with multiple sclerosis (MS).

MATERIAL AND METHODS

Twenty patients with remitting MS, 20 patients with secondary progressive multiple sclerosis (SPMS) and 20 healthy people were studied. The level of neurological deficit was assessed with EDSS and cognitive status with PASAT. MRI of the brain (standard impulse sequences and 3D-T1-MPR for voxel MRI-morphometry) and perfusion computed tomography with the assessment of visually intact white matter (VIWM) and thalamus were performed.

RESULTS

Compared to the control group, patients with MS had a significant atrophy of subcortical gray matter. Patients with SPMS in addition had an atrophy of some cortical areas which was correlated with EDSS scores (p<0.05). The correlation between cognitive impairment and the volume of the left inferior parietal lobule (r=0.677; p=0.011) and worsening of perfusion of VIWM of frontal and parietal lobes, thalamus on both sides was observed in patients with SPMS compared to those with remitting MS. That was correlated with cognitive performance assessed by PASAT.

CONCLUSION

Patterns of atrophy distribution in different types of MS were determined. The level of disability is correlated with the severity of brain atrophy. Hypoperfusion of VIWM that was correlated with cognitive impairment was found in patients with SPMS.

[An analysis of clinical trials on the registration of similars of the original disease-modifying therapies]

The article discusses the design and results of recently published study of an analog of the original glatiramer acetate. The necessity of the correct planning and analysis of the data of such studies is stressed, showing equal efficacy, tolerability and safety of analog and original drug. The optimal design of such studies, their duration, selection of primary endpoint, adequate assessment of clinical and MRI changes and side-effects are discussed. The authors reckon that it is impossible to plan studies the results of which are based on the design, i.e. the absence of differences from the original drug. The authors invite specialists in MS to participate in the discussion.

[A comparative placebo-controlled clinical study on the efficacy and safety of interferon beta-1a for subcutaneous injections in patients with remitting multiple sclerosis: results of the first year of observations]

AIM

To prove the equivalent efficacy of teberif (BCD-033, interferon beta-1) and rebif (interferon beta-1a) in patients with remitting multiple sclerosis (RMS).

MATERIAL AND METHODS

A multicenter double blind placebo-controlled comparative randomized III phase study included 163 patients with RMS. Patients were randomized into three equal groups (teberif, rebif or placebo).

RESULTS AND CONCLUSION

After 52 weeks, the equivalent efficacy of teberif and the brand drug rebif was shown. The result of assessment of the primary endpoint, which was combined unique active (CUA) lesion (the total of MRI T1-weighted lesions and new or newly enlarging T2-weighted lesions, without double counting of lesions with both activities), showed no significant differences (0.727±1.042 and 0.652±1.059 (p=0.7354, t-Student test) in the teberif and rebif groups, respectively. No between-group differences were found for other MRI indices and clinical parameters related with relapses. Teberif was shown to have a favorable safety and tolerability profile comparable to that of rebif. The results suggest the therapeutic equivalency of the drugs and form the basis for using the bioanalogue of interferon-beta 1 in patients with RMS.

[Clinical guidelines for the use of dimethyl fumarate in relapsing-remitting multiple sclerosis]

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.

[The application of high-frequency and iTBS transcranial magnetic stimulation for the treatment of spasticity in the patients presenting with secondary progressive multiple sclerosis]

Spasticity is considered to be a common manifestation of multiple sclerosis. Muscle relaxants are not sufficiently effective; more than that, some of them often cause a variety of adverse reactions. Transcranial magnetic stimulation (TMS) can be a promising new tool for the treatment of spasticity. The objective of the present study was to compare the effectiveness of the two TMS protocols: rhythmic (high-frequency) TMS (rTMS) and stimulation with the theta bursts (iTBS) in terms of their ability to reduce spasticity in the patients presenting with multiple sclerosis.

PATIENTS AND METHODS

Twenty two patients with secondary-progressive multiple sclerosis were pseudo-randomized into two groups: those in the first (high-frequency) group received the treatment with the use of rTMS therapy at a frequency of 10 Hz; the patients of the second group, underwent stimulation with the theta bursts (iTBS). All the patients received 10 sessions of either stimulation applied to the primary motor area (M1) of both legs. The effectiveness of TMS protocols was evaluated before therapy and after 10 sessions of stimulation based on the Modified Ashworth scale (MAS), the expanded disability status scale (EDSS), and the Kurtzke functional scale (Kfs). In addition, the patients were interviewed before treatment, after 10 rTMS sessions, immediately after and within 2 and 12 weeks after the completion of the treatment using questionnaires for the evaluation of spasticity (SESS) , fatigue, and dysfunction of the pelvic organs (severity of defecation and urination disorders), fatigue.

RESULTS

The study has demonstrated a significant reduction in spasticity in the patients of both groups at the end of the TMS protocol based on the MAS scale. There was no significant difference between the outcomes of the two protocols. Both had positive effect on the concomitant «non-motor» symptoms (fatigue, dysfunction of the pelvic organs).

CONCLUSION

High-frequency transcranial magnetic stimulation (10 sessions of rTMS therapy at a frequency of 10 Hz) and stimulation with the theta-bursts applied to the M1 area in both legs can be an effective alternative treatment of spasticity in the patients with secondary-progressive multiple sclerosis. Further research is needed to detect more accurately the differences between the outcomes of the two stimulation protocols and the development of indications for their application on an individual basis.