One of the promising areas in the pathogenetic treatment of multiple sclerosis (MS) is anti-B-cell therapy using ocrelizumab, an anti-CD20 monoclonal antibody. The drug is indicated for primary progressive MS (PPMS), secondary progressive MS (SPMS) and exacerbations, and highly active MS. Objective : to analyze the use of the drug in 32 patients with different types of MS in everyday neurological practice. Patients and methods . The investigation included 32 patients diagnosed with MS using the 2017 McDonald criteria: 12 patients with PPMS, 12 with highly active MS and 8 with SPMS and exacerbations. The median Expanded Disability Status Scale (EDSS) score was 4.0; the most severe course of the disease was observed in patients with SPMS. All the patients received a treatment cycle of 600-mg intravenous ocrelizumab injections (with an infusion pump) every 6 months; the initial dose was by 300 mg every 2 weeks. The follow-up period was 6 to 18 months. Results and discussion. During ocrelizumab therapy, the patients with PPMS showed stabilization of EDSS score; and 6 (50%) had even its slight decrease by 0.5–1.0 scores, which may be caused by compensation for the existing symptoms due to pathogenetic treatment. In highly active MS, only 1 of the 12 ocrelizumab-treated patients had an ongoing exacerbation of the disease. During a subsequent 6–18-month follow-up, magnetic resonance imaging revealed that none of the patients had manifestations of MS activity; the EDSS score decreased in all the patients, indicating their achievement of stable remission. Six (75%) of the 8 patients with SPMS and exacerbations also displayed a decrease in EDSS score in the absence of exacerbations. No adverse events, including infusion reactions, were recorded during drug administration. The drug has a good tolerance and safety profile and ease-to-use. Conclusion . Ocrelizumab therapy with will be able to improve the quality of treatment in patients with different types of MS, which is of great medical and social importance

Disease-modifying drugs (DMD) are currently used in the treatment of patients with multiple sclerosis (MS) in accordance with therapeutic standards, with the aim of decreasing the risk of developing exacerbations and thus reducing the rate of development of disability. However, the use of first-line substances is not successful in all cases. Second-line agents are used in this situation, which on the territories of the Russian Federation include fingolimod. Experience in the use of fingolimod in routine neurological practice was obtained by performing the postmarketing GIMN trial.

We present here the results of a multicenter study addressing quality of life (QoL) using the MusiQoL questionnaire in 534 patients with multiple sclerosis receiving glatiramer acetate (GA) at a dose of 20 mg/day s.c. for 12 months. These data were compared with results from multicenter observations using the same questionnaire in 1420 MS patients receiving s.c. β-interferon-1a at a dose of 44 μg three times a week for at least one year. QoL measures were found to depend on gender, age, and duration of MS. Statistically significant improvements in QoL were seen at 12 months of treatment on the background of courses of GA. Treatment with β-interferon-1a produced improvements by 6 months.

Objective. The evaluation of the dynamics of asthenia, chronic fatigue syndrome, emotional disorders and quality of life of patients with multiple sclerosis (MS) and to explore the possibility of using idebenon (noben) in treatment of these impairments. Material and methods. We studied 35 patients, 18 men and 17 women, with MS (mean age 36.4±8.86 years, mean disease duration 10.33±6.07 years); 83% of patients had remitting type and others - secondary progressive type. Along with neurological examination, we used the Modified Fatigue Impact Scale (MFIS 21), the Hospital Anxiety and Depression Scale and a quality of life questionnaire (EQ5D). Patients had marked asthenia and chronic fatigue at baseline. The old age of the patients and duration of MS and its severity according to EDSS predicted the higher levels of asthenia, chronic fatigue and anxiety with depression and lower quality of life on EQ5D. All patients received noben in dosage 90 mg daily (30 mg 3 times a day) during 6 months. Results and conclusion. Idebenon (noben) reduced the severity of chronic fatigue syndrome, asthenia and depression in MS patients. The dose used in the study may be regarded as the optimal dose that provides best efficacy with minimal side-effects.

Pulse-doses of corticosteroids are actively used in the treatment of multiple sclerosis relapses. Short pulse-treatment is usually well-tolerated by patients though side-effects may be observed. We described a rare case of transient global amnesia after the pulse-treatment with corticosteroids. A complex examination excluded other causes of amnesia.

Teriflunomide is a once-daily, orally administered, disease-modifying drug. The review presents the data concerning the mechanism of action, pharmacokinetics as well as results of clinical studies. Teriflunomide has received the regulatory approval in the USA, Argentina, Australia, South Korea, Chile and EU. The submission of a regulatory dossier is performed in Russia.

We summarize here 10 years of experience of using glatiramer acetate (Copaxone) in 74 patients with active remitting multiple sclerosis (MS). Significant decreases in the frequency of disease exacerbation over all 10 years were noted. Disease severity on the EDSS was stable and increased significantly only by the tenth year of observations. Positive stable clinical dynamics were independent of disease severity at the moment of treatment initiation. Tolerance of glatiramer acetate was good, allowing us to come close to controlling the course of MS – 64.8% of patients had no more than one exacerbation in 10 years, while 71.6% showed no or minimal progression of disease (up to 1 point on the EDSS scale). These observations lead to the conclusion that 10 years of treatment with Copaxone allows disease development to be controlled in many patients.

The aim of the study was to describe the atrophy of the thalamus in young patients with active relapsing multiple sclerosis (MS) treated with cerebrolysin. Eighteen MS patients (mean age 20.10±0.45 years) with disease onset in childhood or adolescence were studied. Neurological examination using the EDSS, neuropsychological testing and MRI were used. At baseline, MRI revealed the hypotrophy of the thalamus that was not correlated with the performance on neuropsychological tests. After treatment with cerebrolysin, there was the decrease in the level of atrophy that suggested the neuroprotective effect of this drug. This effect was more prominent in younger patients with the high frequency of previous relapses.

Clinical features and MRI-characteristics of two demyelinating diseases: acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are discussed. Despite the seeming obviousness of differential-diagnostic criteria, the individual course of disease can, in some cases, accomplishes the differential diagnosis specifically in cases of recurrent (monophasic) ADEM and the first episode of acute demyelination, resembling ADEM, in MS. A clinical case of MS with acute manifestation resembling ADEM is described.