Currently, due to the lack of specific etiotropic therapy, rituximab is widely used for the treatment of most autoimmune diseases of the central and peripheral nervous system. Rituximab is a chimeric monoclonal antibody with specificity for CD20, the antigen found on the surface of normal and malignant B-lymphocytes. It is used mainly in hematological practice. It is used off-label for the treatment of neurological diseases. The world literature describes the use of rituximab for the treatment of such pathologies as autoimmune encephalitis, neuromyelitis optica spectrum disorder, multiple sclerosis, primary angiitis of the central nervous system, immune-mediated inflammatory polyneuropathy, myasthenia gravis, refractory to basic immunosuppressive therapy. This article provides an overview of the world literature on the use of rituximab in neurological practice, describes our own experience of its use on the basis of the Department of Neurology № 1 of Pavlov University (Saint Petersburg, Russia).
Introduction. In 2018–2020, a study was conducted in the Russian Federation on the efficacy and safety of highdose immunosuppressive therapy with autologous hematopoietic stem cell transplantation (HDIT-AHSCT) in multiple sclerosis (MS).The aim of the study was to analyze preliminary data on the effectiveness and safety of the HDIT-AHSCT in patients with MS who participated in the clinical approbation of the method.Material and methods. 21 patients were included in a single-center Pavlov University (Saint Petersburg) observational study. In 10 patients (47.6%) the Expanded Disability Status Scale (EDSS) ranged from 1.0 to 4.0, in 10 — from 4.5 to 6.0 points, 1 patient with primary-progressive MS (PPMS) had 6.5 EDSS points. Cyclophosphamide conditioning regimen (200 mg/kg) in combination with rituximab (1000 mg/m2) was used. Neurological assessment (EDSS, SNRS, T25-FW, 9-HPT, PASAT, MoCA, HADS) and brain MRI were performed before and after 12 months. The early and long-term complications of HDIT-AHSCT were also analyzed.Results. One year after HDIT-AHSCT improvement and significant improvement were noted in 10 patients (47.6%), stabilization — in 8 (38.1%), relapse/progression — in 3 (14.3%). A lower effect was observed in patients with spasticity of more than 3 points by the MAS. According to MRI data 18 patients (85.7%) had stabilization of MS with no disease activity after 1 year, that met the No Evidence of Disease Activity (NEDA) criteria. Long-term complications included autoimmune thyroiditis (n = 1) and amenorrhea in two patients older than 38 years. No TRM were registered during the observation period.Conclusion. HDIT-AHSCT is an effective method of treating patients with multiple sclerosis. The results of the research demonstrate the safety and effectiveness of HDIT-AHSCT and it can be used to expanse the opportunities for providing treatment of patients with MS in the Russian Federation.
Background. The review analyzes a possible rare complication of COVID-19 in the form of spondylodiscitis, including with developed epiduritis, in patients who have undergone COVID-19 with severe pneumonia, respiratory failure and systemic inflammatory response syndrome (SIRS). Clinical Case Description. Based on our own clinical observations, an approach to the diagnosis and treatment of three patients is described, each of whom had SIRS, severe fever, a significant increase in laboratory markers of inflammation (C - reactive protein (CRP), leukocytosis, erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin , ferretin), the addition of bacterial pneumonia, pronounced disorders of coagulation hemostasis, the development of spondylodiscitis, despite the wide range of previous antibiotic therapy, acute pain in the lumbar spine (LSP) with features of "red flags". In the first patient, against the background of massive antibiotic therapy, revisions of purulent foci, glucocorticosteroid (GCS) therapy, and surgical treatment, there was a significant positive trend in the form of pain relief. The second patient showed positive dynamics against the background of conservative antibiotic therapy. The third patient, with a paravertebral abscess at the level of developed spondylodiscitis, received massive antibiotic therapy in combination with GCS, and was operated on to decompress the spinal cord. Conclusion. The authors note that spondylodiscitis and epiduritis may be some of the possible complications of COVID-19 and / or the result of the unwanted action of drugs used to treat this disease. In this regard, timely diagnosis and treatment of this pathology in COVID - 19 seems to be very relevant
Neuroblastoma is a malignant tumor derived from the neuroblasts of the sympathetic nervous system, which develop in any region of the nervous system. Usually, neuroblastoma is detected in children aged 1–2 years. About 90% of cases are diagnosed before the age of 5 years. The incidence of adult neuroblastoma is only 0.3 cases per million people per year. The clinical course and biological activity of adult neuroblastoma is different than children neuroblastoma. Early diagnosis of this disease in adults is necessary for timely start of treatment and increasing life expectancy. In this clinical observation, we present a detailed description of the course of this rare disease in the 34-year-old male and literature review on adult neuroblastoma.
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