[Chronic inflammatory demyelinating polyneuropathy: report of 15 cases].

15 patients with CIDP (8 men, 7 women) at the age of 39-65 have been observed. The duration of the disease varied from 1 to 9 years. The authors have used in diagnostics the WHO's criteria as well as standards of needle and stimulative electro-neuromyography (ENMG). CIDP was shown in the study to occur more frequently after 50 with male prevalence. ENMG revealed 8 patients with compromised myelin and 7 patients with combined myelin and axon abnormalities, 3 patients with nerve impulse block conduction. The following variants of CIDP were distinguished: motor-sensor--7; motor-autonomic--3; pure motor--2; multifocal mononeuropathy with conduction blocks.

[Clinical instrumental and immunological studies of multiple sclerosis in children]. / Kliniko-instrumental'nye i immunologicheskie issledovaniia rasseiannogo skleroza u detei.

The results of clinical examination, data of analysis of the visual evoked potentials, computer and magneto-resonance tomography allowed to diagnose a reliable multiple sclerosis in 25 children (16 girls and 9 boys). The age of the onset of the disease was from 4 to 14 years, the duration of the follow-up--from 1 to 12 years. Monosymptomatic onset, remittent course with frequent exacerbations and successful recovery of the functions during the remissions prevailed. Purposeful treatment allowed to achieve a stable remission in 2/3 of the cases, while a gradual increase of the neurologic deficit was observed in the other patients. Phenotyping by HLA-system revealed association of demyelinating diseases in children with HLA-B12 (RR = 6.0; p < 0.025), together with the absence of HLA-B18 antigen. The authors made a conclusion that multiple sclerosis may be diagnosed in childhood and that it has some clinical and immunologic peculiarities.

[Histocompatibility antigens in multiple sclerosis in children]. / Antigeny gistosovmestimosti pri rasseiannom skleroze u detei.

A phenotyping was done in respect of HLA system in 14 children with documented multiple sclerosis (MS), 20 children with potential MS, and 42 their near relations. HLA-B12 antigen was recordable with high frequency (RR = 6.29; P < 0.025) while HLA-B18 with low one (P < 0.01) as compared to normal subjects both among patients in the general group and in those with proved MS. The latter showed a tendency toward increase in frequency HLA-B7. Children with significant MS where there was an association in the phenotype of HLA-B12 or HLA-B7 with HLA-A3 ran predominantly an aggravating course while their association with HLA-A2 resulted in a more benign course. The results obtained in respect of HLA antigens in MS in children differ from those of other authors on MS in adults.

[Disseminated encephalomyelitis in children and its differential diagnosis from multiple sclerosis]. / Rasseiannyi éntsefalomielit u detei i ego differentsial'naia diagnostika s rasseiannym sklerozom.

Acute disseminated encephalomyelitis (ADEM) has been studied in a series of 30 children (16 girls, 14 boys) who ranged from 1.5 to 15 years old versus 24 pediatric patients (12 girls, 9 boys) aged 4-15 years with diagnosed disseminated sclerosis (DS). Conducted in the above series were the following investigations: computerized tomography, magnetic resonance imaging, recording of visual evoked potentials, indices for cellular and humoral immunity. ADEM, as distinct from DS, was marked by: an acute onset; the presence of general infectious symptoms together with general cerebral ones; involvement into the process of not only white matter but also of nuclear formations and peripheral nervous system; unidirectional course resulting in residual events. In 16 children a clear distinction was seen between ADEM and DS, while the rest of this pediatric population (n = 14) who had residual events presenting as pyramidal syndrome, might well develop DS in later life. Additional differential-diagnostic tests employed in the above study were found to be of little informative value.

[Magnetic resonance monitoring in the diagnosis of multiple sclerosis]. / Magnitno-rezonansnyi monitoring v diagnostike rasseiannogo skleroza.

The introduction of the method of magnetic resonance tomography (MRT) proved to be very helpful in dealing with the problem of early diagnosis of multiple sclerosis (MS) but has not finally solved it. There have appeared reports about the existence of instrumentally negative forms of MS. We attempted to objectivize with MR method an early stage of MS in 82 patients. Of these, 15 subjects who had a clear clinical picture as a result of a single MR-investigation (the unit "Bruker", Germany) did not reveal any foci of demyelinization. In the above patients, MR-monitoring was conducted over three years 2 to 5 times, as a result of which undertaking we managed to visualize demyelination foci in 12 subjects (81%) with predominant localization thereof in the periventricular area. Clear clinical symptomatology, remitting course confirmed by visualization of multiple demyelinating foci in the central nervous system with the aid of MRT permit making an accurate diagnosis of MS, which fact determines a long-continued immunomodulating therapy of this grave medical condition.

[The intensive therapy of exacerbations in disseminated sclerosis in children]. / Intensivnaia terapiia obostrenii rasseiannogo skleroza u detei.

On the basis of long clinical experience principles are substantiated and schemes are suggested of therapy of childhood disseminated sclerosis (DS), these being as follows: 1) pulse therapy with high dose intravenous corticosteroids, a switch-over to oral intake followed by synacten-depo during the phase of exacerbation; 2) long-term maintenance therapy during transition to the phase of remission. The above algorithm allowed the patients to be helped out of the exacerbation. Analysis of 3-to-11 yr catamnesis permitted assessing the efficacy and outcomes of the proposed therapy in children. Of the 21 cases, thirteen showed stabilization of the process as evidenced by continuing remission of one to 3 years in duration. Eight children showed short-time remission, with neurological deficit slowly progressing, resulting in invalidism in 7 patients. In summary, the proposed therapeutic regimen for DS exacerbation in children permits achieving quick regression of the neurologic symptomatology, returning progression of neurological deficit, which observation was recordable in two thirds of the patients. In 1/2 of children DS runs an aggressive course that does not respond even to intensive therapy; in these, long-term remission was not achievable, this resulting in progression of the neurologic symptomatology and, in the long run, disability under protracted course of the condition.

[The significance of intercellular interrelations in the diagnosis of immunopathological states in patients with chronic neurological infections with a course of allergic disorders]. / Znachenie mezhkletochnykh vzaimootnoshenii v diagnostike immunopatologicheskikh sostoianii bol'nykh khronicheskimi neiroinfektsiiami, protekaiushchimi s allergicheskimi narusheniiami.

As many as 120 patients with different nosological forms of neuroinfections (encephalitis, encephalomyelitis, chorioependymitis and cerebral arachnoiditis) associated with allergic disturbances were examined by clinical and immunological methods. In addition to the common measurements of the relative and absolute content of T, B and 0 cells, cerebral antibodies and circulating immune complexes, the degree of the T component deficiency was calculated as compared to that in healthy persons as were intercellular and populational relations, which characterized individual immune responsiveness. It has been discovered that the populational relations undergo changes in initial manifestations of immune deficiency, becoming more remarkable as the pathological process progresses. The authors point to the necessity of analyzing the immunogram in patients placed under observation with a purpose of early diagnosis of immune imbalance that arises, and of defining the leading immunopathological mechanism to carry out more adequate and goal-oriented correction of immune disorders.

[Independent training of the students in reflexotherapy of nervous system diseases]. / Samostoiatel'noe obuchenie kursantov na tsikle "Refleksoterapiia pri zabolevaniiakh nervnoi sistemy".

Based on many years of experience with the training in reflexotherapy, the authors have worked out staged mastering of the material, with emphasis laid on independent seizing of practical skills. The possibilities of mastering diagnostic instruments employed in acupuncture have been widened. The tests to control the acquired knowledge and practical skills have been suggested.

[Role of T-, B-, null, suppressor lymphocytes and anti-brain antibodies in infectious-allergic disease of the nervous system]. / Rol' T-, B-, nulevykh, suppressornykh limfotsitov i protivomozgovykh antitel pri infektsionno-allergicheskikh zabolevaniiakh nervnoi sistemy.

Clinicoimmunologic studies involving 255 patients with infectious and allergic nervous disorders showed some alterations in their immune homeostasis in association with a certain imbalance in B-cell immunity. These changes were expressed in a decrease in the functional activity and absolute content of T-lymphocytes in the peripheral blood, in a steady increase in O-cells, and in insufficient lymphocyte T-suppressory control. The importance of elevated brain antibody levels for making the differential diagnosis of the autoallergic process in the nerve tissues is demonstrated.