Treatment of patients with Secondary Progressive Multiple Sclerosis

Observed were 11 patients with secondary progressive multiple sclerosis, among them 6 female patients and 5 male patients. Patients' age varied from 17 to 38, mean age being 31.4±4.32 years. Duration of the diagnosed disease by the beginning of the therapy was 1 to 5.5 years, mean duration being 2.96±0.24 years. This group of patients reported persistent progress of neurological symptomatology from attack to attack and during the periods of remission. 4 cases suffered stable disability and ambulated in a wheelchair.

Clinical symptoms in MS patients were evaluated using the 4-score scale: 0 – absence of sign; 1 – mild sign; 2 – moderate sign; 3 – severe sign; 4 – extremely severe sign. The Table presents the mean score in patients demonstrating a certain sign and the number of such patients (N). The symptoms were evaluated during the remission.

All the patients tolerated the fetal stem cell transplantation well.
Syndrome of early posttransplantation improvements was observed in 7 cases (63.6%).

Table 1. Clinical Profile of Patients with Remitting-Relapsing MS (n=11)

Symptom	N	Symptom intensity, score (0–4)
		Before transplantation	After transplantation, years
			1	2	3	4
Pyramidal symptoms:	8
spasticity	5	3	3	2	2	1
elevation of deep reflexes	7	3	3	2	2	2–1
diminished superficial abdominal reflexes	7	3	2	2	2	2–1
pathological extensor plantar reflexes	5	3–2	2	2	2	2
Ophthalmological symptoms:	8
optic neuritis	6	3	3–2	2	2	2–1
diplopia	5	3	2	2	2–1	1
nystagmus	5	3	2–1	1	0	0
convergence disturbance	4	3	2–1	0	0	0
Sensitivity disturbances:	8
paresthesia	6	4–3	3–2	2	2	2–1
hyperesthesia	3	2	2–1	2–1	1	1
hypesthesia	2	2	2–1	2–1	1	1
Ataxia	4	4–3	2	2	2	2
Coordination tests	5	3–2	2	2–1	2–1	1
Dysarthria	4	3	3–2	3–2	2	2
Dysphagia	2	2	2	1	1	1
Weakness in the extremities	7	3	2	2–1	1	1
Fatigue	8	3–2	2	2	1	1
Cognitive dysfunction:	9
memory decline	7	3–2	2	2	1	1
attention impairment	5	3	2	2	1	1
slowed information processing	5	2	2–1	2–1	1	1
Depression	6	3	2	1	1	1
Dizziness and vomiting	2	3–2	1	0	0	0

This group of patients demonstrated more severe main symptoms on the day of treatment and was more resistant to the applied therapy compared to patients in the remitting-relapsing group, although clear positive dynamics was observed in all the manifestations of the disease.

Treatment effectiveness was different in different symptoms. We noticed the same regularity as in the remitting-relapsing group: ophthalmological, mental and emotional disturbances responded to our therapy better (during the first year after the transplantation) in comparison with the spinal and cerebellar disorders.

This group of patients didn’t report exacerbation or further progression of the disease within the whole period of observations (1 to 4 years).

MRI results showed the decrease of foci following the gadolinium contrast by 42%, reduction in the foci volume by 44%, and decrease of the specific density in T2-regime.