Paūmėjimo ir imunomoduliuojančio gydymo įtaka išsėtine skleroze sergančių ligonių negaliai

Giedraitienė, N.; Gencevičiūtė, K.; Kizlaitienė, R.; Kaubrys, G.
October 2016
Neurologijos Seminarai;2016, Vol. 20 Issue 4, p212
Academic Journal
Introduction. Most of patients with multiple sclerosis are initially diagnosed with relapsing-remitting form of the disease. It is characterized by clearly defined attacks that are followed by periods of partial or complete recovery (remissions). The presence of a relapse, its clinical presentation, severity, and occurrence rate of relapses are the main indicators of the disease activity as well as the effect iveness of the treatment whereas the rel at ionship between the relapse and its severity, rate of progression, and other indicators of long-term disability is still debatable. Aim of the study. To evaluate the ef-ect of re-apses and immunomodulatory treatment on the neurological disability in multiple sclerosis patients. Materials and methods. We investigated 60 multiple sclerosis patients treated for a multiple sclerosis relapse in Vilnius University Hospital Santariskiu Clinics and 30 multiple sclerosis patients in a remission stage. The disability was assessed using the Extended Disability Status Scale (EDSS). The choice of relapse treatment was based on the international recommendations. Results. The relapse increased the mean EDSS score by 0.49 points assessing EDSS 3 months before the relapse and 3 months after its treatment. 48.3% of patients were treated with methyl- prednisolone, 41.7% with both methylprednisolone and plasmapheresis, and 10% only with plasmapheresis. Pa tients treated with methylprednisolone pulse therapy had EDSS score by 0.92±0.31 points lower than patients treated with methylprednisolone pulse therapy and plasmapheresis (p<0.05). A significant decrease of EDSS score was observed administering 5 g of methylprednisolone while the administration of 3 g and 4 g of methylprednisolone decreased EDSS score by 0.85±0.08 and 0.67±0.21 points respectively (p<0.05). The increase of EDSS score in patients who had used immunomodulatory therapy before the relapse was 1.28±0.61 points compared to 1.91± 1.24 points in patients who had not used immunomodulatory therapy (p<0.05). No significant differences in EDSS scores before, during, and after the relapse were found between the patients who had biologically active interferon beta and the patients who had partly active/ inactive interferon beta (p>0.05). Conclusions. In Vilnius University Hospital Santariskiu Clinics, clinically milder relapse episodes were treated only with methylprednisolone pulse therapy, while more severe cases were treated with methylprednisolone pulse therapy combined with plasmapheresis. More prominent disability regression was observed in patients treated with higher dosages of methyl- prednisolone. Re -apses were milder in patients who had used immunomodulatory therapy before the relapse. Biological activity of interferon beta had no significant effect on the severity of the relapse and the rate of disability regression after the relapse.


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