Поражение подкорковых структур головного мозга при различных фенотипах рассеянного склероза и их прогностическая значимость

Abstract

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that affects the central nervous system, mainly in young people, and leads to inevitable disability. The purpose of the study is to determine the degree of involvement of subcortical structures in the pathological process in multiple sclerosis and to assess their prognostic significance. 80 patients with relapsing-remitting (n=48) and secondary progressive (n=32) phenotypes of MS were examined; the control group consisted of 20 healthy people of the corresponding age and gender. Clinical assessment was carried out on the following scales: EDSS, MSSS, MMSE, FAB, MoCA, SDMT, Beck’s test and HADS. All patients underwent MRI of the brain and MR-morphometry using the Freesurfer 6.0 software. In patients with multiple sclerosis, the neurodegenerative process is represented by a decrease in the volumes of the caudate nucleus and putamen, an increase in the volume of the third and lateral ventricles, an increase in CSF volume, and the presence of «black holes». The volume of the third and lateral ventricles, as well as the volume of CSF (general neurodegeneration), depends on the duration of the disease. The degree of disability (EDSS) is influenced by the volumes of the caudate nucleus, globus pallidus, nucleus accumbens, and brainstem. In turn, cognitive decline is influenced by the volume of the thalamus, basal nuclei, brainstem, the volume of the lateral ventricles, and a decrease in the volume of the white matter and cerebellar cortex. Thus, dynamic assessment and monitoring of the volume of subcortical structures of the brain using MR-morphometry can act as a prognostic factor in the transition of the relapsing-relapsing phenotype of multiple sclerosis to the secondary progressive phenotype. English version of this article on pp. 404-411 is available at URL: https://panor.ru/articles/subcortical-brain-lesions-in-different-phenotypes-of-multiple-sclerosis-and-their-prognostic-significance/63941.html