Shulha O. Prognostic Criteria of the Course of Multiple Sclerosis: Clinical, Epidemiological, Neuroimaging, Prospective Study

Topical scientific issues of studying the features of multiple sclerosis (MS) and elaboration of pathogenetic concept of the disease prognosis have been solved on the basis of a prospective five-year clinical, epidemiological and neuroimaging study in the thesis. Prospective assessment of the prevalence and incidence of MS has been performed in patients of the Western region of Ukraine (on the example of Volyn' region) according to register data. Factors, influencing on the prevalence of MS, and features of the clinical course of the disease have been determined in various geographical areas. It has been proved that territorial, ecological, industrial and urban indicators affect the prevalence of MS. A highly sensitive prognostic three-factor model of MS prevalence has been elaborated in this region for the first time. Ukrainian version of the Patient Determined Disease Steps scale has firstly been validated considering sensitivity, specificity and reliability for monitoring patients' condition with MS and conducting population studies without requiring special training, financial expenses or time. A prospective study of structural and functional brain changes in dynamics was conducted in patients with clinically isolated syndrome. It has been established that atrophic processes of the brain have already been present at the stage of CIS MS. New data received that violations of the blood-brain barrier were observed in more than two thirds of cases at the stage of CIS. It has been established for the first time that atrophic changes of the brain are combined with patient's emotional response at the stage of CIS MS. It has also been determined that patient's emotional background with CIS affects functional failure in future and emotions as grief and anxiety are the factors of a higher degree of functional inability. The corpus callosum index has been found to be the most sensitive and independent in spite of gender, age, disease duration, and the degree of index failure in the assessment of brain atrophic changes in patients with early MS. Criteria for benign MS have been suggested for Ukrainians. It has been established that the degree of functional failure on the EDSS scale does not always reflect the degree of true neurological deficit in patients with benign MS due to the absence of marked motor deficits and cerebellar disorders with preserved mobility. A 5-year prospective dynamic observation of persons with benign MS has been conducted for the first time. It has been ascertained that progression is observed on at least two functional scales in patients with benign MS. According to determined pattern: progression occurs due to motor manifestations in patients with a lower degree of disability while faster progression of non-motor manifestations of MS is observed with a greater degree of functional incapacity. For the first time it has been defined that the main key factors of benign course of MS are the type of the disease onset in the patient and his age. As the result, a highly sensitive prognostic model based on discriminant analysis has been elaborated to assess patients with benign MS course. A prospective study of exacerbations in MS with an assessment of gender, age and environmental factors has been cunducted. It has been determined that the recurrence rate in men with MS decreases in 2,5 times from young age to elderly, while in women it is stable till the age of 50 with the following sharp rise in indices. For the first time it has been determined in Ukrainians that the frequency of clinical and radiological exacerbations is higher in patients with a shorter duration of the disease. The seasonality of recurrence has been estimated for the first time and the model of multiple regression has been elaborated considering climate factors.