Aim of study was to evaluate functional state of central nervous system motoneurons in patients with inflammatory disseminated small lesions of the brain. Methods : 20 controls (11 boys, 9 girls, mean age 15 years) and 32 patients with ADEM (n = 17) and MS (n = 15) were enrolled. Diagnosis was established by MRI and thorough clinical investigation. Mean age of the group of children with ADEM and MS was 14 years, there were 14 boys & 18 girls. All patients underwent transcranial magnetic stimulation (TMS), single-pulse protocol. Results : TMS showed good tolerability in children with encephalomyelitis and multiple sclerosis. Central motor pathways in patients with relatively small disseminated (multiple sclerosis, ADEM) lesions demonstrated high durability and stable TMS parameters, perhaps due to neuroplasticity. In all groups MEP latencies and amplitudes were comparable with medical normative, there were no significant differences with the controls. But it have to be noted, that in children in both MS and ADEM groups elevation of MEP threshold was seen significantly more often, which may be interpreted as signs of abnormal lowered functional state of motoneurons. As non-invasive, sensitive and relatively safe method, TMS should be more often implemented into the diagnostic protocols in pediatrics.

Objective of our work was to evaluate MEPs characteristics in children with acute inflammatory demyelinating polyneuropathy and evaluate usefulness of TMS as an additional diagnostic method in this disorder. Methods. 20 healthy children (7–14 years old, average 12 years, 7 females, 13 males) without any signs of neurological disorders were enrolled as controls and 37 patients (8–13 years old, average 11 years, 19 females, 18 males) with AIDP were enrolled as the main group. EMG and TMS were performed on 3–7 day from the onset of the first symptoms. Cortical and lumbar MEP`s latencies, shapes and amplitudes and CMCT were averaged and analyzed. Results. Significant differences between children with AIDP and controls on latencies of both cortical and lumbar MEPs were registered. Cortical MEPs shapes were disperse in 100% of the cases, and lumbar MEPs were disperse in 57% of the cases. Amplitudes changes for both lumbar and cortical MEPs were not significant. Conclusions. Diagnostic transcranial magnetic stimulation on the early stage of the acute demyelinating polyneuropathy in children may be implemented as the additional tool. Main finding in this population is lengthening of the latency of cortical and lumbar motor evoked potentials. Disperse shape of the lumbar MEPs may also be used as the early sign of the acute demyelization of the peripheral nerves.

It was determined earlier (G.P. Ivanova, 2012) that a chronic course of leukoencephalitis in teenagers caused by inadequate response of cytokine system to the combination of two herpesviruses (HV) — EBV and HHV-6, leads to the development of multiple sclerosis (MS) in 44% of cases. The research objective was to characterize the cytokine response in children with MS with simultaneous screening of the presence of active HV infections. 39 children with the diagnosis “MS” were under observation, 34 of them had relapsing-remitting (RR) MS, and 5 children had a progressing course of MS (PMS). Concentration of cytokines IL-1 β , IL-6, IL-8, IL-10, IFN α , IFN γ , and IL-4 was identified in blood serum and cerebrospinal liquid (CSF) by enzyme-linked immunosorbent assay, HV DNA was revealed by PCR. Cytokine status in children with MS had some differences depending on the phase of the disease, clinical severity of the relapse and the course of MS. The relapse phase of RRMS was associated with the accumulation of IL-8, IL-10, and IL-6 in the blood, and index IFN γ /IL-4 modulations in accordance with the clinical severity of the relapse. A severe aggravation of the disease in children with PMS was accompanied by the increase of IL-8 system response. HV DNA was revealed in 27 patients from 39 ones (69%) in blood and in 17 patients (44%) in CSF with the predominance of EBV (93%), frequently in combination with HHV-6. During an acute period the frequency of HV DNA identification increased 2–3 times to compare with the remission period. Unlike children with RRMS, a mixed-infection of 3–4 herpes viruses was revealed in all 5 patients with PMS. According to the results summary it is possible to make a conclusion that HV-infection has an important role in MS pathogenesis in teenagers, taking part in the aggravation and progression of the disease by its effect on the cytokine system response. EBV-infection dominates among HV, however the risk of MS development increases to a great extent in the case of EBV association with another lymphotropic virus — HHV-6.

In our review we present data on sleep disturbances in neuroinfections (encephalitis and meningitis), their clinical signs, neurochemistry and neurophysiology. These signs include lethargy, narcolepsy, sleep apnoe, sleep structure disruptions and may appear in acute period and as a sequelae of the disease. Reticular formation involvement seems to be the main reason for such sleep disorders. GABA and orexin systems disruption may play the key role in them. Neurophysiology evaluation of such disorders includes polysomnography, EEG-monitoring, brainstem acoustic evoked potentials and H-reflex investigation.

The article represents the stages of historical development of Scientific and Research Institute of Children’s Infections from the moment of its foundation in 1927. The basic directions of scientific and practical activities are reflected. The priority of the institution and its role in the improvement of medical aid rendering to children with an infectious pathology are defined. The scientific achievements the introduction of which into practical public health service has a social value are described.

The revue includes the contemporary information about the role of resident cells of the CNS (astrocytes, microglia) in development of innate immune response against pathogen (or its products) invasion in the brain. The detection of invading pathogens by pattern-recognition (Toll-like) receptors of neuroglia is described. Also is described the production by these cells of inflammatory mediators, including proinflammatory cytokines, as well as inflammation downregulating factors that protect the CNS from alteration and degeneration.

There was conducted a survey among 65 children aged from 1 year to 17 with varicella encephalitis. There was determined predominance of cerebellar forms of the disease, in 93,9%, that is characterized by the development of the light pyramidal disorders on the contrast to the cerebral that is characterized by the development of convulsivecomatose syndrome. It was determined that the disease is distinguished by the rareness of the detected changes on the MRI, 12,3% only. It was detected that the changes of the evoked potentials could be seen among all the patients and are characterized by the predominance demyelinating changes of the brainstem structures when having a cerebellar form and neuronal disorders of the cerebral hemisphere when having a cerebral form. The outcome of the cerebellar form is recovery in 100% of cases, and in cerebral – the development of epilepsy was detected in 50% and death in 25%.

We present the results of the neurophysiological study in which 95 children with viral encephalitis and 30 children with meningitis (age from 2 up to 17 years) undergo evoked potentials investigation. Some specific features of evoked potentials in neuroinfections have been shown to correlate with the course of disease and the age of the patients. We give a description of a logistic model of predicting outcomes in such patients by complex diagnostic method. We have found that evoked potentials may be successfully implemented in correcting the therapeutic strategies. Study of evoked potentials in neuroinfections in children can define the severity and extent of lesions and help to identify subclinical dysfunction and monitor the recovery processes under the therapy.