Chernenko M. Neuroplasticity as an adaptation basis in neurodegenerative and demyelinating processes (clinical, neurological, pathopsychological, neuroimaging, and neuroimmune comparisons)

The dissertation study uses clinical and neurological, pathopsychological, biochemical, magnetic resonance tomography, mathematical, and statistical methods to investigate adaptability in 120 patients with different types of multiple sclerosis and 53 patients with different forms of Wilson’s disease. Patients with both multiple sclerosis and Wilson’s disease were randomized into groups that did or did not undergo a physical rehabilitation course. Paraclinical examinations included MRT with morphometric analysis and neuroimmune tests with the identification of BDNF and NfL levels in blood serum. It was found that patients with an EDSS score below 6.5 and a UWDRS score below 80, i.e. patients who retain a certain level of physical activity, are the most prospective patients for a physical rehabilitation course. Physical rehabilitation methods can be used for different forms of Wilson’s disease and different types of multiple sclerosis, except for the disease exacerbation stage. The analysis of the level of cognitive functioning in multiple sclerosis and Wilson’s disease indicates its heterogeneity and dependence on the clinical form or the pathological process type. In Wilson’s disease, the worsening of neurological symptoms is mainly associated with a decrease in the patients’ cognitive functions, due to the impairment of the gnosis and praxis functions, low concentration, and low sustained attention. In multiple sclerosis, increased neurological deficit is associated with a decrease in cognitive efficiency, which is chiefly manifested by reduced working memory span, impaired selective attention, and exhaustion. Neuroimmune tests demonstrated a reliable correlation between the BDNF level and the physical rehabilitation course, whereas there was no such correlation for the NfL level. Magnetic resonance tomography with morphometric analysis showed that the degenerative process mostly affects hippocampi in multiple sclerosis, while it is mostly amygdalae and putamen that are affected in Wilson’s disease. The prognosis for both multiple sclerosis and Wilson’s disease can be based on the rate and severity of the degenerative process. The data obtained were used to develop adaptive and maladaptive profiles of patients with multiple sclerosis and Wilson’s disease, which will contribute to therapy personalization.