RESEARCH
WORK ON THE TOPIC: "THE PROBLEM OF MULTIPLE SCLEROSIS IN THE
KARACHAI-CHERKESS REPUBLIC"
Tekeeva
B.U., Bairamukova M.A., Shevchenko P.P.
The
Stavropol State Medical University
Department
of Neurology, Neurosurgery and Medical Genetics.
Stavropol,
Russia
Relevance
of the topic. Despite the long history of the study multiple sclerosis (MS) is one of
the leading problems of clinical neurology. [2]
The relevance of the study of
MS and its epidemiological trends is conditioned by the lack of clarity of
etiology, uneven distribution in various countries and regions, affection
mainly of young people and high disability. Epidemiological studies throughout
the world in recent decades have revealed a significant increase in the
prevalence of MS, which is associated with improved detection, increased life
expectancy, urbanization, environmental degradation, the introduction of
pathogenetic methods of treatment, rehabilitation and symptomatic therapy.
[1,2]
At the same time, in many
regions there is a true increase in the incidence of MS. Knowledge of the
epidemiological trends of MS in a particular region allows to estimate the
total number of patients, to plan the amount of diagnostic, therapeutic,
rehabilitative care, and the main thing – to shed light on the etiology and
pathogenesis of the disease. [1,2,16]
The etiology of MS remains
unknown. The most reasonable theory is considered to be multifactorial theory –
the disease occurs in genetically susceptible individuals as a result of
external influences. One of the points that define the medical and social
significance of the disease is steadily progressive nature of the course,
inevitably leading to the disability of patients. The literature deals mostly
with the structure of disability; in different regions the percentage of
disabled people among MS patients reaches 78% or more. Attention is being paid
less to the analysis of the causes that affect the disability. However, the
identification of factors affecting the patient's ability to work can help in
the prevention of early disability in this disease. [16]
Purpose of the study. To perform basic
clinical and epidemiological analysis of the prevalence of MS in the
Karachai-Cherkess Republic in 2016.
Materials and methods. For this purpose,
we reviewed all cases of MS that were diagnosed in the neurology department of
Karachai-Cherkess Republican Clinical Hospital, the bulk of which was confirmed
by the central hospitals of Moscow and St. Petersburg. Archival material has
been worked through for 6 years (from 2010 to 2015).
For clinical assessment of the
functional state of the conductive systems in MS we used a scale composed by
John Kurtzke (FS – Functional Systems), which allows to evaluate in points the
severity of neurological symptoms in the amount of John Kurtzke by seven
systems.
Statistical analysis of the
data was performed using Microsoft Excel computer program. To assess the
significance of differences of samples the Student's criterion was used.
Quantitative characteristics were presented as M ± m, M – arithmetic mean, m -
error of the mean (Glantz S., 1999). The difference was considered significant
at p <0.05.
Results
of the study. Prevalence rate in the study period was 6.6 cases per 100,000
population. The highest incidence of MS is marked in the age group 25-40 years
(79.88%). The lowest incidence rate is established in 2010-2011, the highest –
in 2015, which is probably due to the improvement of the quality of diagnosis
and environmental degradation. The prevalence among women (10,39 ± 1,65) is
slightly higher than among men (7,93 ± 1,59), the ratio of men and women
suffering from MS is 1.3: 1 (p <0.05).
Today, the population of KCR
is 467,617 people. Of these, 41.0% are Karachai; Russians are 31.6%;
Circassians – 11.9%; Abasins – 7.8%; Nogai – 3.3%, and others. The prevalence
of MS among Karachai (32%; 9.9 cases per 100,000 population) prevails over the
other nationalities. By relief the territory of the Republic is divided into
plains, foothills and mountains. The prevalence of MS in the mountainous area
(70%) is higher than in the foothills and plains (p <0.05). The presence on
the territory of the Republic of the four major morphological units allows to
distinguish the following climatic zones: moderately cold climate of alpine
zone, moderately humid climate of middle mountain zone, moderately warm climate
of low mountain areas and temperate continental climate of plain-steppe zone.
In Malokarachayevsky District, which is located in a mountainous area with a
moderately warm climate, the prevalence of MS is significantly higher than in
the others and is 54.8%. Therefore, it can be assumed that the geographic area
may influence the development of MS. [1,2,17]
The work data were compared
with the data of MS prevalence in the ethnic group of the North Caucasus in
1991. The comparison revealed an increased incidence of the MS from 1.45 to 6.6
cases per 100 000 population. [12]
The
clinical picture. In assessing the course: remittent – in 43%; primary
progressive – in 27%; secondary progressive – in 30% of patients.
Motor tract injury symptoms,
cerebellar disorders and signs of CN involvement were dominant. Sensitive
disorders, pelvic and mental disorders were less expressed. In 100% of cases
pyramid disorders were identified that manifested in the form of paresis (more
pronounced in the lower limbs), anisoreflexia, raising of tendon reflexes,
increased muscle tone by spastic type (usually in the lower limbs).
Impaired vision was found in
82.6% of patients.
Symptoms of CN lesion of
varying degree were observed in 62.3% of patients. As a rule, violation of the
deep sensitivity was observed more often than that of the surface one.
Pelvic functions were affected
constantly in 43% of patients, in 35% – occasionally.
Violations of the
psycho-emotional state (depression, irritability, tearfulness, chronic fatigue)
were observed in 96% of patients.
Conclusions:
1. In KCHR prevalence rate of
MS for the period of observation (2010-2015) was 6.6 cases per 100,000
population that can attribute this republic to a medium risk zone.
2. Women fall ill more often
than men (1.3: 1)
3. The highest incidence is in
the age group 25-40 years.
4. In most cases (41.9% - 13
persons) there is a remitting type of the disease and the average severity.
5. During the period from 1990
to the present time, the level of prevalence of MS was significantly increased
(from 1.45 to 6.6 cases per 100 000 population).
6. Impact on the development
of MS is also provided by the geographic location of the Republic:
Ø The prevalence of
MS is more in the highlands (67.7% - 21 cases)
Ø MS prevalence in
Malokarachayevsky District (54.8%) differs significantly from other districts,
which may depend on the climatic conditions of the area.
Ø MS prevalence among
the Karachai (32%; 9.9 cases per 100,000 population) prevails over the other
nationalities.
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