A complex study of 50 patients with active typical remitting multiple sclerosis (MS) was carried out. Neuropsychological testing using Wechsler and Stroop tests and MRI of the brain with the morphometric analysis of focal and diffusive changes were used in the study. Patients were stratified into two subgroups by the changes in the performance of neuropsychological tests. The disease course was assessed during five years. In all cases, the natural course of the disease, i.e. when patients did not receive disease modifying drugs, was analyzed. The transition to secondary progressive MS and the marked increase in MS severity on the EDSS were found in the subgroup of patients who demonstrated changes in the neuropsychological test performance. The strongest correlation was observed between EDSS scores and the diffusive atrophy of the brain white matter on MRI. The data of neuropsychological testing and some brain MRI parameters may be recommended as a predictive test in remitting MS.

We assessed effectiveness, safety and tolerability of betahistine in neurologic outpatients with dizziness. We examined 200 patients treated with 48 mg/d of betahistine during 60 days. Common state was assessed on visual and analog scale. Severity of dizziness was assessed with questionnaire and DHI (Dizziness Handicap Inventory) scale. In all groups treatment was associated with positive changes in neurologic status: decrease of nistagm, improvement of digitonasal test and Romberg test. We found a significant decrease in dizziness severity and improvement of common state. Treatment with Betaserc resulted in significantly faster appearance of results vs treatment with Vestibo or Betaver.

Because multiple sclerosis (MS) mostly affects young working-age adults, the search for new effective disease-modifying drugs is extremely important. All the first line MS therapies approved in Russia are injectable medications for continuous subcutaneous or intramuscular self-administration once weekly or once daily. This fact is often a reason for a patient to refuse the treatment. Also it can result in specific side-effects. Natalizumab (Tysabri) is the first of a new class of drugs, alpha4-integrin antagonists, approved in the USA and EU for the treatment of active RRMS. It has shown a significant influence on clinical and MRI-activity of the disease. Natalizumab monotherapy leads to significant decrease in annualized relapse rate, disability progression risk and lesion load. This article reviews recent publications on the mechanism of action, effectiveness and safety of natalizumab, a new promising drug for MS therapy.

Immunomodulatory drugs reduce relapse rate and disease progression In relapslng-remlttlng multiple sclerosis but extensive data are not available on the effectiveness and tolerablllty of these drugs In childhood or adolescence. Interferon beta tolerablllty biased by frequency and method of drug administration. Drug administration has great Impact on treatment compliance and adherence. That's why we discuss moreover Interferon beta la Intramuscular as perspective Immunomodulatlve medication In pediatric MS cohort.

Adherence to long-term therapy is a necessary condition of successful long-term treatment of the such chronic disabling disease as multiple sclerosis (MS). We studied factors associated with the rejection of treatment with disease modifying drugs (DMD) in 153 patients of the Moscow multiple sclerosis center who received or rejected the DMD treatment by their own choice. The groups were compared by neurological, socio-demographic and neuropsychological characteristics. The EDSS, HADS and the original socio-demographic questionnaire have been administered. Patients receiving glatimer acetate rejected the treatment less often compared to those receiving other DMD. The withdrawal of any DMD in the anamnesis predicted the future rejection of treatment. The first four months was the most risky period with respect to the rejection. Lack of family support, absence of work and age were independent factors associated with the rejection of DMD. Marked anxiety, lack of cooperation and lack of compliance were associated with the patient's rejection of treatment. No significant correlations of the treatment rejection, duration and type of MS course with depression were found.

Immunomodulatory drugs reduce relapse rate and disease progression in relapsing-remitting multiple sclerosis but extensive data are not available on the effectiveness and tolerability of these drugs in childhood or adolescence. Interferon beta tolerability biased by frequency and method of drug administration. Drug administration has great impact on treatment compliance and adherence. That’s why we discuss moreover interferon beta 1a intramuscular as perspective immunomodulative medication in pediatric MS cohort.Key words: immunomodulatory drugs, interferon beta, multiple sclerosis, compliance, adherence, adolescence, childhood.

Treatment of multiple sclerosis (MS) remains one of the most serious problems of modern medicine though a significant progress in understanding of disease pathogenesis has been achieved over the last years. Currently there are the ways of modifying the, disease course that improve the remote prognosis. In this review, we present results of studies of drugs modifying the MS course which have been approved for MS treatment and those that are in the stage of clinical trials and expected to enlarge possibilities of MS treatment.

Given a high medical and social significance of multiple sclerosis (MS) and achievements in its treatment, storage of information on patients in registers allows quick entering, modifying and processing of data as well as realizing of longitude prospective large-scale studies. The data on different clinical registers and system driven data bases used for the storage and analysis of information on MS patients are presented. Data bases may be divided into intracentral databases, databases confined to a single center and intercentral databases when users from different medical units work in the common information field. A main shortage of intracentral databases is incompatibility in information delivery with registers from other centers. In contrast to intercentral databases, global databases allow uniform information storage. Advantages and shortages of different registers including the register of the Moscow Municipal Multiple Sclerosis Center characterized by intercentral basis, quick and user-friendly data entering, possibility for analytical information processing and conducting of forced monitoring of information quality are discussed.

An analysis of 5-years experience of treatment of 255 patients with multiple sclerosis drugs (100 patients with betaferon and 155 with copaxone) is presented. Betaferon was assigned to patients with remitted and secondary progressive multiple sclerosis (MS) with exacerbations. Copaxone was administered only in remitted MS with severity up to 6,5 EDSS scores in all cases. Patients were obligatory examined every 3 months. Patients initially switched to betaferon had more active and severe MS course. After 5 years, 147 patients (57,6%) continued treatment with betaferon, 56% - with betaferon and 58,7% with copaxone. During all this period, the stable significant decrease of exacerbation frequency was observed. No exacerbations were found in 26,8% of patients receiving betaferon and in 31,9% of patients receiving copaxone. Nevertheless, frequency of exacerbations did not decrease in 7% patients treated with betaferon and in 6,5% patients treated with copaxone that was a main reason for drug withdrawal. These cases imply the resistance to the used type of drug. Stabilization of disability with EDSS scores increasing by 0,5 score was observed in 48,2% patients treated with betaferon, including secondary progressive MS, and in 75,8% patients receiving copaxone. However, on the 4(th) year of treatment with betaferon and on the 5(th) year of copaxone treatment, EDSS score became significantly higher as compared to the base-line, i.e. the neurodegenerative process was not completely stopped. The main reasons for drug withdrawal were clinical inefficiency and patient's wish. Side-effects caused the drug withdrawal only in 6% in case of betaferon and in 6,5% in case of copaxone that suggests high tolerability of these drugs during long-term use. During 5 follow-up years after withdrawal of the drugs, MS course in patients who did not receive other multiple sclerosis drugs (31% patients after betaferon and 15,5% patients after copaxone) was progressive with the same intensity as it was prior to prescription of betaferon and copaxone, i.e. neither "withdrawal syndrome" nor "consequences" were found. In cases of patients' wish to stop taking these medications, the main reason was not clinical inefficiency but motivation and adherence issues that are discussed in details.

The diagnosis of multiple sclerosis (MS) is a life-altering experience that has far-reaching and diverse implications for newly diagnosed patients and their families. Since the disease is complex and highly variable, it places physical, emotional and social challenges on everyone concerned. A number of responsible decisions must be made, the most difficult one being the consent to long-term therapy. Joint effort of both physicians and patients allow the latter to take up properly new life circumstances, get adequate motivation, right and regular implementation of the long-term treatment plan aiming to prevent the disease progression. The management of many chronic diseases involves medications that must be injected on the frequent basis. In MS, such injections can reduce the frequency of relapses and slow the disease progression. Pretreatment injection self-efficacy expectations, injection anxiety, therapeutic expectations and ability to self-inject are significantly related to adherence. Poor patient adherence to long-term therapy severely compromises the treatment effectiveness.