CLINICAL AND NEUROLOGICAL FOR MULTIPLE SCLEROSIS

CLINICAL AND NEUROLOGICAL FOR MULTIPLE SCLEROSIS

Karpov S.M., Pazhigova Z.B. Vyshlova I.A., Muravjev K.A.

Stavropol State Medical University, Stavropol

Department of Neurology, Neurosurgery and Medical Genetics

To this day, Multiple Sclerosis (MS) is still recognized as an unsolved problem [2, 3, 6, 7, 9, 10, 11]. However, today, there is hope of a possible breakthrough in the treatment and early diagnosis of the disease [5, 8, 9, 10, 12]. MS is very prevalent in today’s society [1, 4, 7]. The course of MS is, in most cases, the aggressive nature of the disease, leading to varying degrees of disability. In this regard, early diagnosis of the disease plays an important role.

Objective: to improve the diagnostic aspect of clinical and neurological characteristics in patients with multiple sclerosis.

Materials and methods: A total of 79 patients (57 women and 22 men) with a diagnosis of multiple sclerosis, a mean age of 34,31 ± 4,7 years, is in the process of clinical examination and under observation in the clinic of the Chechen Republic. Of the total number of patients the following clinical forms of the disease have been identified: remitting (RRMS) - 56.9%, secondary progressive (SPMS) - 18.9%, and primary progressive (APP) to 24.2%. The age distribution of the types of MS are presented in the table. The average duration of the disease, taking into account the clinical form was: PPC - 3,3 ± 2,2 years, SPMS - 9,1 ± 4,2 years PPRS - 2,7 ± 1,9 years.

Results and discussion: As a result of the clinical examination, 29 (36.7%) patients had mild manifestations of MS (Group 1). In all cases, the patients in this group was PPC. In 15 (51.7%) patients the severity of neurological disorders on the EDSS scale score was 2.0, in 11 (37.9%) patients - 2.5 points, 3 (10.4%) patients - 3 points for scale EDSS. The neurological status of these patients revealed a predominance of pyramidal insufficiency such as changes in reflexes and the presence of paresis of varying severity, where the decline in muscle strength varied from 1.5 to 3 points. In 26 (89.7%) cases, we recorded anisoreflexsia along with loss of abdominal reflexes and pathological (jog, Fist) reflexes. In 7 (24.1%) cases the motor disturbances had different characteristics: monoparesis - in 2 (6.9%) patients, paraparesis - in 5 (17.2%). The total clinical score reflecting the severity of motor impairment in the functional scale (FS 1), amounted to 1,4 ± 0,8. In 23 (79.3%) patients cerebellar pathological changes were identified with light coordination disorders such as mild ataxia, intention tremor and dysmetria when performing the tests. The total clinical score reflecting the severity of violations on the coordination functional scale (FS 2) was 1,41 ± 0,9. In 17 (58.6%) cases, there has been a combination of pyramidal and cerebellar disorders, along with hypoesthesia, the presence of paresthesia or numbness in one or both legs. An objective examination revealed "mosaic" areas of infringement surface sensitivity. Disturbances of proprioceptive sensitivity was observed in 5 (17.2%) patients. The total clinical score in this case, reflecting the severity of sensory disorders in the functional scale (FS4), amounted to 1,1 ± 0,8. Violations of pelvic organs in the form of urgency combined with the difficulty in emptying the bladder (detrusor-sphincter dyssynergia) was observed in 6 (20.7%) patients, which were periodic. This corresponded to a total clinical score on the scale (FS 5) 0,41 ± 0,9. In 13 (44.8%) patients abnormalities were identified in the brainstem structures. For example, in 2 (6.9%) cases - violations of the oculomotor nerve, in 5 (17.2%) cases - failure of the central facial nerve, in 4 (13.8%) patients - deviation of the tongue. The total clinical score on the scale (FS 3), reflecting the degree of stem dysfunction was 1,68 ± 1,5.

It should be noted that in this group, symptoms reported were associated with impaired phononastroeniya. So, in 16 (55.2%) patients were noted fononastroeniya light violations, which could not affect the EDSS scale score. In 12 (41.4%) cases, patients reported fatigue, loss of memory, concentration, attention, rigid thinking. The total clinical score (FS 7), which reflects the degree of impairment of mnemonic functions, amounted to 1,11 ± 0,8. In 28 (63.3%) of people with MS medium severity was set (group 2). The clinical manifestations of MS medium severity are characterized by the presence of persistent focal neurologic deficit. In this group, 16 (57.1%) patients had remission, in 8 (28.6%) - secondary progressive, in 4 (14.3%) - primary progressive process. In all cases, in the 2nd group of patients, pyramidal and cerebellar syndromes of varying severity were identified in contrast to the 1st group, where defect of pyramidal and cerebellar systems reported in 24.1%, 79.3% respectively. Pyramid violations were detected in 19 (67.9%) patients in the form of paresis, moderate or elevated. Monoparesis was detected in 4 (14.3%) patients, paraparesis - in 6 (21.4%), hemiparesis - in 4 (14.3%), tetraparesis - in 5 (17.9%) patients. The total clinical score reflecting the severity of motor impairment in the functional scale (FS 1), amounted to 3,7 ± 0,5, in 2.64 times greater relative to the 1st group. The degree of Staten coordination violations in the functional scale (FS 2), the total clinical score was 1,99 ± 0,9, which is 1.38 times more than in the 1st group. In 15 (53.6%) patients had sensory disorders manifested as a reduction in deep sensitivity, which clinically manifested in the form of sensory ataxia, which is 36.4% more than in the 1st group. The total clinical score reflecting the severity of sensory disorders in the functional scale (FS 4) was 2,4 ± 0,7, which exceeds the total clinical score in the 1st group in 2 times. Violations of the pelvic organs were observed in 12 (42.9%) patients, which is 22.2% more relative to the 1st group. The total clinical score scale (FS 5) was 1.05 ± 1.3, 2.56 times greater in comparison to the 1st group. In 8 (28.6%) cases oculomotor disturbances were recognized. Nystagmus was detected in 15 (53.6%) cases, which is almost 2 times the display data on the 1st group. The total clinical score on this scale (FS 3) violations stem functions amounted to 2,2 ± 0,8 a 76% increase in Group 1. Psychopathological changes were detected in 18 (64.3%) cases, which were manifested in the form of mood lability, in 8 patients (28.6%) there was a reduction of cognitive and mnemonic processes, and reduced concentration. The total clinical score reflecting the degree of impairment of cerebral functions (FS 7) was 1.41 ± 0.7, which is 1.41 times greater relative to the 1st group. In 22 (27.8%) cases of severe forms of MS (group 3) , 7 (31.8%) - secondary progressive, 15 (68.2%) - primary progressive type flow. The clinical picture of severe MS included the presence of coarse, and significant focal neurologic deficit. The neurological movement disorder prevailed, which is based on the defect of the pyramidal and cerebellar connections and structures that have been identified in all cases (100%). Impaired function of the pyramidal system manifested in the form of hypertonia, hyperreflexia, pathological reflexes. Tetraparesis, paraplegia or hemiplegia of varying severity, usually combined with a stop or clonus patella. The total clinical score reflecting the severity of motor impairment in the functional scale (FS 1) was 4,4 ± 0,8, 3.14 times greater relative to group 1, and 1.19 more than in the 2nd group. In 6 (27.3%) patients coordination symptoms was presented in the form of expressed intention tremor, and discoordination impairments that significantly reduces the quality of life of the patient. In 4 (18.2%) patients, getting out of bed they experienced head tremor. In seven (31.8%) cases tremor was experienced along with postural. Dysfunction in the cerebellar system is manifested in the form hypermetric, adiadochokinesia, symptom Homs, chanting speech. The total clinical score on the functional scale (FS 2) amounted to 2,4 ± 1,2, which is 1.7 times more relative to group 1, and 1.21 times greater relative to the 2nd group. It should be noted that an objective assessment of cerebellar dysfunction was significantly complicated due to the presence of a number of patients with extremity paresis of more than 3 points. This fact explains why patients of group 3 have been identified as not having a significant increase in clinical score assessment of cerebellar function. The total clinical score reflecting the degree of impairment of stem functions (FS 3) amounted to 2,4 ± 0,6 and has reliably been a similar indicator of the 2nd group. Sensitive areas presented loss of proprioception, which was observed in 7 (31.8%) patients. That percentage had no significant difference from patients in group 2. The total clinical score reflecting the severity of sensory disorders by (FS 4) amounted to 2,4 ± 0,6 and had no significant difference from that of group 2. Impaired function of pelvic organs were detected in 17 (77.3%) cases, which is 34.4% more in comparison to the 2nd group. The total clinical score was (FS 5) 1,6 ± 0,7, 3.9 times more relative to group 1, 1.5 more than the 2nd group. Psychopathological changes were noted in 19 (86.4%) patients and were characterized by euphoric, reducing criticism to his condition, apathy or depression of varying degrees. The total clinical score reflecting the degree of impairment of higher cortical functions (FS 7) amounted to 1,7 ± 0,9, which is more than 1.53 relative to group 1, and 1.21 more than the 2nd group.

Conclusion. The study revealed that in the test groups, patients with remitting MS were dominant, where their clinical score, according to the EDSS scale corresponded to a mild disability. The number of patients with moderate severity prevailed at SPMS, 3 times greater, and with severe, 5.5 times. All groups had coordination and motor disturbances. However, patients with the severe form of the disease had maximum expression of the clinical symptoms and the greatest occurrence of neurological symptoms. As the conditions worsened, the occurrence of pelvic disorders also increased with the greatest dysfunction in patients having the severe form of the disease.

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