[Brain metabolism in multiple sclerosis: effects of neurotrophic therapy]

We studied 15 patients with relapsing-remitting multiple sclerosis (MS) in the state of remission (disease duration 1-5 years, EDSS scores 2.5-5.5) treated with сerebrolysin (Cere) to investigate the rate of brain metabolism changes. All patients continued to receive their disease modified treatment therapy (copaxon or interferons). Patients of the main group (n=10) received i.v. 20 ml of Cere (diluted in 200 ml NaCl 0.9%) for 10 days and vitamins B (pentovit) in tablets. Patients in the control group (n=5) were treated only with pentovit in tablets. All the patients underwent magnetic resonance spectroscopy (MRS) (Siemens Symphony 1.5T) prior to the beginning of treatment and 1-3 days after the end of therapy. Five patients of the main group who had best results according to the data obtained from the 2nd MRS underwent a third MRS investigation after 3 months. After 10 days of Cere treatment, the level of N-acetylaspartate in MS lesions had increased from 2.12 to 2.39 (p<0.001) and the level of lactate had decreased by 4 times (from 0.21 to 0.05; p<0.001). In perifocal lesion areas, the level of lactate had significantly decreased from 0.22 to 0.1 (p<0.05). We have also found the trend towards NAA increase in morphologically intact brain tissues. The positive metabolic changes after Cere therapy remained in some patients for 3 months. In the control group, there was the increase of creatine level in intact brain tissues from 1.16 to 1.30 (p<0.05) without significant changes in other areas. All the patients in the main group reported subjective improvement and one patient had the improvement in EDSS scores by 1.0 point.