Прогнозування перебігу розсіяного склерозу на підставі клінічних особливостей дебюту у пацієнтів Полтавської області

Abstract

The purpose of the study was to demonstrate the importance of studying variants of the debut of multiple sclerosis, to reveal the dependence of the rate of progression on the clinical picture of the debut of multiple sclerosis by examining patients and retrospective analysis of clinical data. Materials and methods. The study analyzed 60 cases of relapsing-remitting and secondary-progressive multiple sclerosis in patients who were undergoing inpatient treatment in the neurological department of the communal enterprise “M. V. Sklifosovskyi Poltava Regional Clinical Hospital of the Poltava Regional Council” from 2019 to 2021. Complaints, anamnestic data, results of a complex clinical and neurological examination of patients with multiple sclerosis at the onset and throughout the course of the disease were studied. The diagnosis was established according to Mac-Donald criteria. The severity of clinical manifestations was assessed using the Extended Disability Scale. Results and discussion. The rate of disease progression was assessed retrospectively. The ratio of the number of the Extended Disability Scale points at this moment to the duration of the disease in years was studied. In the group of patients with a monosymptomatic debut, the rate of progression was: 0.64 in women, 1.2 in men. In patients with an acute polysymptomatic onset, the values of the rate of progression were 0.7 and 2.1, respectively. As a result of the retrospective analysis, several options for the onset of multiple sclerosis were identified: monosymptomatic, polysymptomatic, patients with a radiologically isolated syndrome, and patients with a characteristic clinical picture, but without pathological changes on magnetic resonance imaging. One of the most frequent clinical manifestations of the debut in patients in the Poltava region was sensitive disorders. It is worth noting that special attention should be paid to the study of vibration sensitivity. When collecting anamnestic data, it is necessary to clarify the presence of Lhermitte syndrome. The rate of progression of multiple sclerosis was found to be higher in male patients with polysymptomatic onset and motor disturbances, between the first symptoms (patient complaints) and the diagnosis of multiple sclerosis from 3 months to several years. Conclusion. The presented research results can be useful for neurologists, general practitioners, radiologists and doctors of other specialties for early diagnosis, prescribing pathogenetic treatment of multiple sclerosis and predicting its course. Prospects for further research are related to the monitoring of clinical observations of multiple sclerosis with the aim of improving diagnostic, therapeutic and rehabilitation measures