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21.09.2005:
   21.09.2005

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USE OF AMINO ACID COMPOUNDS IN THE TREATHMENT OF MULTIPLE SCLEROSIS PATIENTS.

V.V. Ryazantsev, neuropathologist; N.A. Chernova, neuropathologist
1997

INTRODUCTION

An assessment of the action of central amino acid neurotransmitters has become one of new aspects of clinical neurology in the present stage. Thus, in a number of studies some authors found a disturbed exchange of amino acids in multiple sclerosis (MS) patients. In particular, a metabolic glycine block in demyelinating processes (3), an increased level of glutamic acid, glycine and a diminished GABA content in MS patients' liquor (1, 4) were revealed. In the present phase numerous investigations are conducted to prevent MS and manage it using synthetic peptides and amino acids (2, 5).

Accordingly, the objective of the present study was a clinical evaluation of the therapeutic effectiveness of new amino acid compounds in the management of MS patients.

MATERIAL AND STUDY METHODS

236 patients aged 15-53 years were under study. 174 (73%) of them had cerebrospinal form; 36 (15%) spinal form and 26 (12%) cerebral form. Disease duration varied between 6 months and 18 years. A remitting course was recorded in 166 cases and a progredient course in 70 cases. At the beginning of treatment 144 (61%) patients were in the process exacerbation stage. Severity of the condition was determined by the Kurtzke scale. It should be stressed that patients who were treated with amino acids did not receive other therapeutic drugs.

The following evaluation method was applied to monitor the efficacy of treatment therapy:

Excellent effect (5 points): reduction by 2 points of the severity degree according to the Kurtzke scale;

Good effect (4 points): reduction by 1 point of the disease severity degree;

Satisfactory effect (3 points): stable positive change of single symptoms, improvement of the psychoemotional state and of the ability to work;

Insignificant improvement (2 points): a positive effect refers to 1 symptom only or is not stable;

No effect (1 point): absence of any dynamics;

Deterioration (0 points): further disease development during or immediately after the treatment period.

Treatment effects were considered positive if they were not below satisfactory. Amino acid compounds (Glucaprim, Primavit, Neoprim, Neurovit, etc.) were administered orally, fractionally 4 times a day at a total daily dosage of 50-100 mg per 1 kg of weight. The duration of 1 course of treatment was 30-45 days.

Two groups of patients were isolated, the first group was to take 1 course of treatment, the second one 3 and more courses. The results were evaluated 2 years since commencement of the treatment.

STUDY RESULTS

The majority of patients reported positive changes already on the 5th-7th day once treatment had begun. The subjects noted lesser weakness, an increased volume of movement in the hands and legs, an improved function of the pelvic organs. Concurrently, a reduction of neurologic deficiency could be recorded on the 7th-14th day; during subsequent treatment positive dynamics was retained. A good effect was registered in 50 (21,4%) cases out of 236; a satisfactory result was noted in 90 (38,2%) cases; an insignificant improvement was found in 54 (23%) instances; no effect was observed in 42 (18%) cases. Thus, a positive effect was determined in a total of 140 (59%) patients.

Diminished hypertonicity of cross-striated muscles of lower limbs was identified in 138 (66,9%) cases out of 206; a reduction of pelvic disorders was noted in 140 (75,2%) out of 187 cases and a decrease in coordination disturbances was revealed in 59 (48%) out of 124 cases. The effectiveness of therapy in patients with 2-4 point severity (by the Kurtzke scale) was higher as compared to patients with 5-8 point disease severity. Unsatisfactory findings were recorded: 1) in cases of malign, steadily progredient course; 2) in a long case history (over 10 years); 3) in a prolonged treatment with hormonal steroidal drugs.

In two groups of patients the past history stretching over 2 years was followed up. In the first group (140 subjects) a reduction of progressive disease development, an improved general condition and neurologic status following the treatment, absence of exacerbation within the time under review were recorded in 37 (26,9%) patients.

In 82 (58,7%) cases retention of former progression and exacerbation occurrence were found. An accelerated rate of disablement (according to the Kurtzke scale) was recorded in 21 (14,4%) patients. In practically all the patients, except for the above-mentioned 37, the clinical effect produced by amino acid compounds leveled off 3 months later and the condition returned to what it was prior to treatment.

In the second group made up of 47 patients the absence of disease progression and exacerbation was noted in 29 (62,1%) subjects. The extent of neurologic deficiency in the group of patients went back by more than 30%. The earlier course rate was found in 14 (29,7%) patients. At the same time, patients reported greater strength, lesser spasticity and a normalized function of the pelvic organs. Despite the treatment, in only 4 (8,2%) cases was there an increase in the neurologic deficiency degree.

CONCLUSION

Thus, the catamnesis data have shown that repeated administration of amino acid compounds might alter the nature of the pathologic process and substantially reduce the neurologic deficiency degree.

REFERENCES:

Mikhailenko, A.A.; Korolyova, Ye.M.; Golovkin, V.I. Paper collection "Neuroimmunology on the threshold of the 21st century", 1990, pp. 72-78 (in Russian).

Savchenko, Yu.N.; Zavalishin, I.A.; Khokhlov, A.P.; Schmidt, T.Ye. Proceedings of an inter-regional scientific-practical conference on infectious diseases of the nervous system, 1990, pp. 170-171 (in Russian).

Khokhlov, A.P.; Savchenko, Yu.N. Myelinopathies and demyelinating diseases, Moscow, 1990 (in Russian).

Westall, F.C; Havking, A. et al. J. Neurol. Sci., 1980, v. 47 - No. 3, pp. 353-364.

Winter, A. J. Neurol. Orthopaed. Surg., 1984, v. 5 - No. 1, pp. 39-43.


 
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