ECONOMIC BURDEN OF MULTIPLE SCLEROSIS IN GEORGIA.

The purpose of this study is to estimate economic burden of multiple sclerosis in Georgia and to compare costs of patients with different course of disease and disability level. Hospital-based cohort study was conducted in the P.Sarajishvili Institute of Neurology and Medical Center Pineo to estimate direct medical costs in patients with MS treated between 2019-2020. The mean annual direct medical cost for MS patient on disease-modifying therapies (DMTs) was statistically higher than for non-DMTs patient and estimated as 23254.7Lari[7382.5$] (SD 9026.3; CIs:21133.7-25375.8) versus 1429.1lari [453.6 $] (SD 861.7, CIs; 1309.5-1548.6) (P<0.0001). MS places a huge economic burden on healthcare model and society in Georgia. DMTs are the main driver of cost.

MODERN ASPECTS OF ETIOPATHOGENESIS, DIAGNOSIS, CLINICAL COURSE AND TREATMENT OF SPORADIC INCLUSION BODY MYOSITIS.

While it is the most common inflammatory myopathy among middle-aged and elderly people, sporadic inclusion body myositis (IBM) presents as the most challenging disease to diagnose. The prevalence of IBM varies greatly depending on geographical, ethnic and age factors. Frequency of the disease incidence among the general population ranges from 1:1,000,000 to 1:14,000. Over the past 50 years, it has tripled. The etiology and pathogenetic mechanisms of IBM have not yet been fully studied and, therefore, the criteria for diagnosis and treatment have not been fully established. A treatment algorithm developed for other inflammatory myopathies is not effective in IBM. Thus, the aim of this work is to review, summarize and analyze the latest medical literature on etiopathogenesis, clinical phenotypes, global prevalence, genetic predisposition, diagnostic criteria and treatment trends for IBM, which will contribute to the improvement and practical application of current diagnostic and therapeutic methods of the disease.

HIGH MICROANGIOPATHY PREVALENCE IN OBSTRUCTIVE SLEEP APNEA COMORBID TYPE 2 DIABETES PATIENTS.

Our aim was to study OSA prevalence in patients with T2DM referred to the ,,Diacor'' and to evaluate the microangiopathy rate among this two groups. Data were obtained from T2DM patients enrolled in a prospective, cohort study. The study was being carried out in the clinic ,,Diacor'' Tbilisi, Georgia. Patients were screened for OSA with the Epworth Sleepiness Scale. Patients scoring more than 11 points were invited to do Nocturnal, laboratory-based polysomnography (PSG) for final diagnoses. The following data were collected: medical anamnesis; demographic and anthropometric data; laboratory (complete blood count, biochemistry, immunology, complete urine test, including microalbuminuria) and instrumental investigation (fundoscophy, laboratory polysomnography) data. From the total 232 patients 54 (23.27%) were diagnosed with OSA. From OSA + patients 12 (22.22%) had coexistence of diabetic retinopathy and microalbuminuria, 19 (35.19%)- coexistence of diabetic retinopathy and chronic kidney disease (CKD). Prevalence of coexisted diabetic retinopathy and CKD and CKD independently was significantly higher in patients with severe than in moderate and mild OSA patients. Our results suggest that it is important to screen all type 2 diabetes patients in Georgia for OSA, as the disease is associated with high prevalence of microangiopathy.

[TRANSFORMATION OF MYASTHENIA GRAVIS INTO AMYOTROPHIC LATERAL SCLEROSIS, OR THEIR CONCOMITANCE? (CASE REVIEW)].

The authors present a case of 75-year-old male patient with typical clinical and electroneuromyographic signs of Amyotrophic Lateral Sclerosis (ALS), manifested in 4 years after a diagnosis of generalized Myasthenia Gravis (MG) had been made. The aim of the article is to assess the possibility of pathogenetic integrated comorbidity of MG and ALS, which may have resulted from a common aberrant immune process and to emphasize the importance of detailed clinical analysis and adequate diagnostic methods essential for correct diagnosis and treatment. Only several cases of coexistence of MG and ALS have been described in medical literature. Exploring the pathogenetic association between MG and ALS may lead to dysregulation of thea immune system. Deficiency of T-regulatory cells, increased activity of atrophy-related atrogenes, anomalies of neuronal nitric oxide synthase can be found in both diseases. Immunoglobulin isolated from ALS patients can affect neuromuscular junction and activate AChRs, which plays an important role in the innervation and re-innervation of muscle fibers. Immunoglobulin also changes the function of Ca2+ channels. Blood level of circulatory Heat Shock Protein 70 (HSP70) antibodies in MG patients is elevated. HSP70 maintains normal conformation of cell proteins. Conversely, HSP70 antibodies cause HSP70's dysfunction and therefore, abnormal protein synthesis, which can be the main reason of neurodegenerative diseases, such as ALS. Experimental evidence indicates, that muscle and neuromuscular junctions may be initial targets of ALS. According to the "dying-back" hypothesis, neuromuscular junction damage and failure in MG patients may precede lower and upper motor neuron loss, and thus increase risk of developing ALS. Pathogenetic mechanisms of MG and ALS are the subjects of further studies. Refining the etiology of these two diseases will answer the question whether it is a transformation or a coexistence of MG and ALS in our case. The presented case demonstrates, that in spite of meeting all diagnostic criteria it is, sometimes, impossible to make the correct diagnosis. Only a detailed clinical analysis and adequate diagnostic methods contribute to correct diagnosis and adequate therapy.

[QUALITY OF LIFE IN CARERS OF PATIENTS WITH MULTIPLE SCLEROSIS TAKING A DISEASE-MODIFYING MEDICATION: A PILOT STUDY].

A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy family member. The aim of our study was to measure the health-related quality of life (QOL) in people caring for patients with relapsing-remitting form of multiple sclerosis (MS) and currently treated with disease-modifying drugs. Eligible patients were selected via Sarajishvili Institute of Neurology database for MS. 25 carers (mean age 40.7; 56% women, 56% partners) and 25 sex and age-matched controls completed 36-item Short Form Health Survey (SF-36), version 2. Carers also completed the Beck depression Inventory (BDI-II). Compared to carers, patients were found to have a lower QOL (P<0.05 for five dimensions). However, no significant difference was observed in SF-36 domains scores between carers and controls except general health score which was lower in carers (63.3 vs 75.6, p=0.016). A strong negative correlation was found between BDI and all SF-36 dimension scores of carers. The association remains unchanged even adjusted to carers other independent variables. Last year relapse rate was the only clinical variable correlated with carers QOL dimensions. Our pilot study demonstrated that QOL in carers of patients with relapsing-remitting MS receiving disease-modifying treatment is minimally affected. Further study with large sample size is warranted.

[DIAGNOSTIC VARIATIONS OF X-LINKED MUSCULAR DYSTROPHY WITH CONTRACTURES].

Case report with review describes X-linked muscular dystrophy with contractures in 28 years old man and his cousin. The disease revealed itself in an early stage (age 5-10), the process was progressing with apparent tendons retraction and contraction, limited movement in the areas of the neck and back of spine, atrophy of shoulder and pelvic yard and back muscles. Intellect was intact. Cardyomyopathy was exhibited. CK was normal. EMG showed classic myopathic features. Muscle biopsy showed different caliber groups of muscle fibers, growth of endo-perimesial connective tissue. Clinical manifestations together with electrophysiological and histological data suggest consistency with Rotthauwe-Mortier-Bayer X-linked muscular dystrophy.

[Local demyelination in amyotrophic lateral sclerosis].

It is well known that the demyelination of peripheral nerves can be diffuse or local. Pathogenesis of acute or chronic inflamentary demyelination polyneurophathy is based on diffuse demyelination. Local demyelination occured by conduction block with electoneuromyographic (ENMG) researches. It is the main characteristic of multifocal motor neuropathy (MMN). Generally it is considered, that conduction block is not usual for amyotrophic lateral sclerosis (ALS). More over, its existance excludes this diagnosis. The article discribes 3 cases of ALS with conduction block verified with ENMG researches. Article also deals with pathogenetic mechanisms of conduction block in ALS and MMN. In addition it observes the issues of differential diagnosis between ALS and MMW.

The role of endogenous antiradical protective system in multiple sclerosis.

Present research aimed at investigation of the role of several inflammatory cytokines and free toxic radicals in Multiple Sclerosis (MS) course and disability progression as well as factors that can assist to the early transition of Relapse Remitting MS (RRMS) in Secondary Progressive MS (SPMS). Totally 22 MS patients, 14 RRMS and 8 SMPS have been investigated. Age at disease onset, disease duration, number of relapses and the Kurtzke Expanded Disability Status Scale (EDSS) scores were collected. Control comprised 10 healthy volunteers matched for age and sex. Brain was visualized by Magnetic Resonance Tomography (MRT- Siemens AVANTO-1.5-Tesla). Blood pro-inflammatory cytokines were detected by Enzyme Linked immunosorbent Assay (ELISA). Blood free toxic radicals and antioxidant enzymes were detected by Electron Paramagnetic Resonance Method (EPR). Statistics was performed using the SPSS-11.0. Blood pro- and anti-inflammatory factors (γ-Interferon, IL-6, IL-10) were elevated in MS patients against control. Increased blood IL-6 and IL-10 found in RRMS as compared to SPMS, while γ-interferon was higher in SPMS (p<0.000). Blood EPR specters of Lypoperoxiradical (LOO-) and superoxide anion (O2-) were increased in SPMS patients compared to RRMS and control. Blood EPR specters of antioxidant enzymes: superoxidismutase (SOD), catalase (CAT) and Glutathione reductase (GR) found elevated in RRMS against SPMS and control. Positive correlation was found between γ-interferon and EDSS (r=+0.52 p<0.05) in SPMS and negative correlation established between SOD and CAT and EDSS (r=-0.84 and r=-0.60 respectively, p<0.05) in RRMS. Multiple logistic regression toward the brain MRI Injury volume proved significance of C reactive protein, γ-interferon and CAT. Present research suggested that the state of endogenous protection system and blood content of antioxidant enzymes (CAT, SOD) in MS patients could play a significant role for early progression of RRMS in SPMS.

Dominated EEG patterns and their prognostic value in coma caused by traumatic brain injury.

Study aimed at investigation of dominated EEG patterns in traumatic coma of different severity and to elucidate their prognostic value for outcome of disease within month. A total of 53 coma patients with severe traumatic brain injury have been investigated. Exclusion criteria comprised the patients needing the neurosurgical intervention due to hemorrhage. Brain injury was visualized by conventional CT at admission. The level of consciousness was evaluated by Glasgow Coma Scale (GCS). Patients were divided in 5 groups according to GCS. Electrophysiological investigations were performed on 5th day from development of coma by application of 16 channel computer encephalography. Outcome of coma (death, vegetative state, recovery) was evaluated within month from disease onset. According to dominated EEG background activity patterns the 1st group (GCS=4) showed the delta EEG pattern in 50 % of patients, the beta EEG pattern- in 33.4% and the alpha EEG pattern - in 16.6%. The 2nd group (GCS=5) revealed the delta EEG in 40%, the beta EEG- in 6.7% and the theta EEG - in 53.3%. The 3rd group (GCS=6) showed the delta EEG pattern in 27.8% and the theta EEG pattern- in 72.2%. In 4th group (GCS=7) the theta EEG pattern found in 77.7% and the beta EEG pattern in 22.3%. The 5th group (GCS=8) revealed the theta EEG activity in 80% and beta EEG activity - in 20%. Positive correlation was found between the GCS and the frequency of theta EEG pattern (r=+0.62; p<0.05). Positive correlation was established between the frequency of delta EEG pattern, death and persistent vegetative state (r=+0.57 and r=+0.16 respectively, p<0.05) within month. Positive correlation was established between the frequency of delta EEG pattern and the size of brain injury (r=+0.3; p=0.04). Multinomial logistic regression revealed the significance of brain lesion size, GCS and EEG pattern for functional outcome of coma. In severe traumatic coma patients the delta EEG pattern is associating with deep coma state and predicts the poor functional outcome within month.

[Acute-phase proteins in patients with primary stroke and prodromal transient ischemic attacks].

A study aimed at investigating of the relationship between concentrations of several acute-phase proteins and clinical course and functional outcome of ischemic stroke in patients with and without prodromal transient ischemic attacks (TIA). Eighty-five patients with baseline moderate severity of stroke (NIHSS=12+/-3,5) have been stratified into 3 groups: 1st group - with first-ever stroke, 2nd - with prodromal TIA two or three months before stroke and 3rd - with prodromal TIA within 4 weeks before stroke. Brain lesions were evaluated on conventional MRI. Clinical course of disease and stroke outcome at 1 month were assessed by the NIHSS - by the Barthel index, respectively. A control group comprised 22 healthy people. Blood free radicals (NO, LOO-) and iron transporting proteins (oxidized ceruloplasmine, Fe3+ transferine), blood nitrate levels (NO2), activity of superoxiddismutase, activity of glutathione peroxidase have been studied. No significant between-group differences in regard to blood NO and LOO- contents, activities of blood erythrocyte antioxidant enzymes were found. Baseline levels of NO2 (p<0,05) and iron transporting proteins (p<0,01) were significantly higher in the 3rd group of patients and were correlated with better clinical course of stroke and better functional outcome (r=-0,31 and r=-0,37 respectively, p<0,05). It can be supposed that the elevated level of protective proteins in the 3rd group is caused by the development of ischemic tolerance.

Als-like syndrome in the patient with chronic hepatitis C.

Amyotrophic lateral sclerosis (ALS) is the most common and most severe form of the motor neuron disease. The etiology of ALS is unknown. Several underlying causes are proposed, including viral infection. There is clinical evidence suggesting that ALS may be associated with Human Immunodeficiency Virus. Besides, enterovirus RNA sequences have been detected in a spinal cord of patients with ALS. We describe a patient with a 9 year history of hepatitis C, with a progressive weakness and atrophy of the right arm. Neurologic examination revealed bilateral hypotrophy and fasciculations of brachial girdle muscles more expressed on the right. No sensory or sphincter deficit was present. Nerve conduction studies and EMG were performed. Local EMG of the right deltoid muscle revealed a 4-5th stage lesion of peripheral neuromotor system, characteristic to neurogenic disease. Viruses can be one of the triggering factors of ALS. HV has never been associated with ALS. However, we found it interesting to describe this case of ALS-syndrome developed on the background of the chronic hepatitis C to draw attention of specialists on the possible role of HCV in ALS.

Probable role of immunological tolerance to ischemia injury in brain.

To address the issues of immunological tolerance to ischemia injury in the brain we have researched ischemic stroke patients with and without prodromal transitional ischemic attacks (TIAs) for several blood acute phase reactants involved in inflammatory reactions in respect to initial infarct size, clinical course of disease and functional outcome at 1 month. The study involved 54 ischemic stroke patients aged 45 to 70 years, 46 female and 38 male admitted within 24 hours of symptoms onset in neurological clinic of Georgian State Medical University during 2000-2006. Exclusion criteria comprised severe somatic pathology, liver and renal dysfunctions. Control subjects were aged-matched 15 healthy volunteers, who did not reveal any significant signs of cerebrovascular disease according to the anamnesis, clinical and instrumental investigations. Etiology of stroke was classified according to TOAST criteria. Patients were divided into three groups: the first group - 22 patients with first-ever stroke, the second -17 patients with prodromal TIAs from one to three months before stroke and the third - 15 patients with prodromal TIAs within 4 weeks before stroke. Initial neurological impairment assessed immediately after admission by NIHSS score. All three groups selected with the same initial severity of stroke with mean NIHSS score = 12+/-3.5; for evaluation of clinical course of disease patients were assessed by NIHSS on 7th day of stroke. In 48 hours from stroke onset the blood levels of (IL-1beta, IL-6, TNF-alpha, IL-10) were significantly elevated against control (p<0.05). At this time, no statistical differences were detected between groups regarding the initial blood levels of IL-1beta and TNF-alpha, while the level of IL-6 was significantly lower in the third group (p<0.05). Blood contents of IL-10 and TGF-beta1 found to be non-significantly elevated in the third group against two other groups, while blood TGF-beta1 was significantly increased compared to control. Significant positive correlation was found between IL-6 blood contents and clinical course of disease (r=+0.32, p<0.05). Multivariate logistic regression found the significance of initial blood IL-6 contents for probability of stroke functional outcome at 1 month. It can be supposed that relatively mild blood inflammatory response in third group can be related to occurring of immunological tolerance.

Proinflammatory reactants as determinants of stroke severity in elderly.

Investigations aimed at studying of peripheral blood levels of free nitric oxide (NO) and proinflammatory cytokines IL-1beta, IL- 6 and TNF-alpha in correlation with initial ischemic lesion size and neurological dynamics during a month of acute brain ischemia. Forty two patients aged 60-75 (26 male) have been investigated. Initial neurological status, later deterioration and functional outcome were evaluated using Glasgow Coma Scale (GCS), National institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI). Patients were divided into two groups: severe stroke (GCS15, BI<16, n=25) and a moderate/mild stroke (GCS>10, NIHSSor=18, n=17). The NO concentration was detected by spectrophotometric and Electron Paramagnetic Resonance (EPR) methods. Cytokine plasma levels were determined applying the Enzyme-Linked Immuno Sorbent Assay (ELISA). Statistical evaluation was performed by SPSS. Mean values calculated using the t-paired test. Pearson correlation ad multivariate logistic regression have been applied. In the first days of stroke onset the plasma levels of IL-1beta and TNF-alpha revealed the slight negative correlation toward the functional outcome, while the elderly patients found to have the significant negative correlation of IL-6 plasma levels toward the functional outcome (p<0.01). The NO plasma concentration within 48 hours after stroke onset more profoundly was reduced in aged patients, while in less severe cases and in relatively young patients it was significantly elevated (p<0.01). The high plasma level of IL-6 in the acute phase of stroke seems to be the strong predictor of poor outcome rather for aged, than for younger patients.

[Clinical-EMG characteristic of myasthenia gravis associated with thyroid pathology].

On the basis of clinical-EMG analyses, the researches have revealed the criteria characteristic of myasthenia associated with thyroid pathologies. The myasthenia process associated with thyroid pathology is mainly characterized as of generalized average intensity. Alongside with mup-s with reduced duration and amplitude characteristic of myasthenia, EMG exposes potentials with comparatively long duration and high amplitude (mainly when the process is associated with thyreotoxycosis). It should also be noted that spontaneous activity is intensively expressed. Considering all the above mentioned, we can conclude that these changes show disfunctioning of mup-s rather than the character of synapses caused by the process associated with the myasthenia. The results of the research will facilitate the timely revelation of the process associated with myasthenia and will lead to the unfailing adequate pathogenetic treatment.

The role of imaging studies in CNS infections.

Recent advances in nervous system imaging techniques have greatly improved the diagnosis and treatment of central nervous system infections. Nowadays, the most useful imaging modalities are harmless to the patient and widely available. Whereas Analysis of CSF, biopsy, and laboratory analysis remain the gold standard to identify the infectious agent for instance in meningitis, neuroimaging is crucial in clearly depicting inflammatory lesions of brain and spine. Notably, in opportunistic disease neuroimaging has a pivotal role not only in diagnosis but also in monitoring therapeutic response. The present review discusses imaging characteristics of bacterial, viral, fungal and prion infections of the central nervous system.

Effectiveness of canalith repositioning manoeuvers (CRM) in patients with benign paroxysmal positional vertigo (BPPV).

BPPV is the most common disorder of the vestibular system affected up to 21% of vertigo patients, characterised by short-lasting episodes of vertigo in association with rapid changes in head position. We have detected, treated and followed up 204 patients with BPPV during two years. 204 patients (163 women 41men) were enrolled in this study, at the time of evolution the duration of symptoms varied from several days to several months. We evaluated idiophatic forms of BPPV in 126 cases and secondary types BPPV in 78 cases. All patients with typical history of BPPV underwent neurological examination, including Dix-Hallpike (to detect posterior and anterior canal BPPV) and Roll Test (to detect horizontal canal BPPV). We treat patients with CRM and followed up them in 48 hours and 7 days, one month, 6 month and one year after initial management. Posterior semicircular canal was involved in 170 patients, remain 34 patients suffered from canalolithiasis of horisontal (31 patients) and anterior (3 patients) semicircular canal. After a single treatment session the symptoms disappeared completely in 139 patients, in 40 patients after twice, 16 patients after 3 times and 9 patients after 4 times maneuver sessions. No effectiveness was found in 5 patients; during follow-up 7 successfully treated patients experienced a recurrence between 1 and 6 months, in two cases after one year; they were retreated and all achieved a positive result. It is concluded that diagnosis of BPPV is simple and save, do not need expensive neuroradiological tests; CRM provides effective and long term control of symptoms in patients with BPPV.

Vertigo syndromes associated with earthquake in Georgia.

Georgia experienced strong earthquake, after this event the amount of patients with vestibular symptoms increased. Study evaluates 60 outpatients (51 females, 9 males) aged from 18 to 85 years old who applied at outpatient clinics with vestibular complaints in the initial weeks following the earthquake. BPPV and PPV are the most common causes of vertigo. "Idiopathic" BPPV is the cause of BPPV in 50-70% of cases. Head trauma, vestibular neuritis, Meniere disease, migraine are the most common causes of "secondary" BPPV. (PPV) syndrome characterized by dizziness, subjective disturbance of balance and by perception of illusory body perturbations, usually triggered by perceptual stimulus. PPV frequently associated with anxiety symptoms in patients with obsessive-compulsive type personality. The study revealed "Idiopathic" BPPV in 49 cases and "secondary" types BPPV in 11 cases. 37 previously documented histories of BPPV patients had features typical for posterior semisercircular canal BPPV and 23 patients experienced subjective disturbance symptoms like BPPV, but there were no abnormal responses in their vestibular testing. It is assumed that earthquake could manifest psychogenic vertigo with panic attacks, anxiety, agoraphobia, PPV and could provoke a transition from organic vertigo to PPV. It is concluded that psychological stress play an important role in occurring "secondary" BPPV, earthquake may trigger exacerbation of "secondary" BPPV and could be provoked factor to developing psychogenic vertigo, mostly PPV.

Comparison of erythrocyte aggregability changes during ischemic and hemorrhagic stroke.

The aim of this work was to perform a comparative investigation of erythrocyte aggregability changes in the peripheral and cerebral circulation during ischemic and hemorrhagic stroke. Subjects of the present study were patients with ischemic brain infarcts (14 patients) and with hemorrhagic stroke (21 patients) from the Intensive Care Unit of the Institute of Neurology and Neurosurgery. The blood samples were obtained from the following blood vessels: the common carotid artery carrying blood to the primarily damaged brain hemisphere, both jugular veins carrying blood from the primarily damaged and the contralateral hemispheres, as well as from the cubital vein to obtain specimens of the systemically circulating blood. Erythrocyte aggregation was evaluated by using the "Georgian technique". We found that the RBC aggregation indices increased in both the regional as well as the systemic circulation of the hemorrhagic stroke patients as compared to ischemic stroke patients. The results of the present study demonstrate different changes of erythrocyte aggregation in ischemic and hemorrhagic stroke patients. Therefore, the role of blood rheological properties in their pathogenesis seems also to be different.

[Unexplained somatic symptoms and underlying psychologic disorders in the neurology clinic].

The aim of our study was to determine pseudoneurological symptoms (PNS) and related mental disorders among patients referred to the neurology clinic. All cases of somatoform disorders (SD) as main discharge diagnosis, made on the basis of neuropsychiatric interview after exclusion of neurological disease, have been retrospectively reviewed. Among 623 patients, hospitallized to the Institute of Neurology between 2000-2001 years, SD prevalence was 3,69%, where conversion disorder accounted for 69,6% and somatization disorder - for 13%. Mean age was 27,8 (+/-10,1) and female/male ratio was 1,55. Results show that PNS appear to be a good marker of SD. We suggest that early detection of PNS would provide a correct management of patients.

Predicting value of cerebrospinal fluid proinflammatory factors in acute phase of ischemic stroke.

Study purposed to establish the correlation between proinflammatory cytokines' initial CSF levels and neurological outcome on 7th day of acute ischemic stroke. 58 patients with acute ischemic stroke have been investigated. Neurological impairment assessed in 48 hours and on 7th day of stroke applying the international scales NIHSS and GCS. Patients divided into two groups: with severe stroke (GCS>9, NIHSS>15) and stroke with moderate severity (GCS=14,15; NIHSS=10-15). On 7th day increase of NIHSS score and decrease of GCS score at least 1 point was considered as deterioration and decrease of NIHSS score and increase of GCS score at least 1 point was considered as amelioration. CSF levels of proinflamatory cytokines determined using the enzyme-linked immunosorbent assay (ELISA). Control consisted with 15 patients, which were taken CSF in relation with vertebral discopathies. Means calculated by t-paired test. Pearson correlation and multivariate logistic regression were used. In 48 hours of stroke onset the CSF levels of interleukine-1beta (IL-1beta), interleukine-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were elevated compared to control. Statistical differences were not found between groups regarding the initial CSF levels of IL-1beta and TNF-alpha (p<0,5), while the significant statistical differences were found in regard with IL-6 CSF levels (p<0,05) between groups and against control. Significant positive correlation was found between initial CSF IL-6 levels and ischemic lesion size and neurological outcome at 1 week as well (r=+0,48 p<0,05 and r=+0,54 p<0,01 respectively). Thus, the IL-6 CSF levels in acute stage of ischemic stroke might be considered as the relatively stable prognostic indicator of clinical course of the disease.