Clinical Neuroscience - 2008;61(05-06)

Clinical Neuroscience

MAY 30, 2008

[Current practice of antithrombotic treatment in ischemic stroke: a survey among Hungarian neurologists (in English language)]

SZTRIHA K. László, VÉCSEI László

[Background and purpose - Large multicenter trials have already evaluated the relative benefit of various types of antithrombotic medication in ischemic stroke. However, the application of the trial results still remains uncertain in some clinical situations. We set out to evaluate the various aspects of antithrombotic treatment use among clinical practitioners. Methods - A virtually nationwide survey was performed among Hungarian neurologists involved in stroke care, who responded to a questionnaire concerning the use of antiplatelet agents and anticoagulation in acute ischemic stroke and for secondary prevention. Results - The response rate was 65%. Most (69%) practitioners always wait for brain imaging before initiating antithrombotic treatment in acute stroke. Aspirin (100 mg/ day) is the most frequently prescribed antiplatelet agent after a first ischemic episode. Common reasons for the prescription of alternative agents instead of aspirin after a first attack include high-risk cases and intolerance or allergy to aspirin. The results of in vitro platelet aggregation studies frequently influence drug selection. If an event recurs during a given antiplatelet treatment, most neurologists change the medication. Some participants reported the administration of anticoagulation, or of the combination of aspirin plus clopidogrel in certain situations that are not cardiological indications. Conclusions - This study provides information on the use of antithrombotic treatment in general neurological practice, including everyday clinical situations where no help is available from guidelines.]

Clinical Neuroscience

MAY 30, 2008

[EFFECT OF EPILEPTIC SEIZURES ON THE HEART RATE]

TÓTH Vanda, HEJJEL László, KALMÁR Zsuzsanna, FOGARASI András, AUER Tibor, GYIMESI Csilla, SZŰCS Anna, JANSZKY József

[Background - Sudden death appears in 8-17% of epilepsy patients non-responding to antiepileptic therapy. Some studies suggest that the most common cause of death is seizure-related cardiac arrhythmia. Aim of study - To analyze the alteration of the heart rate six hours before and after the seizures. Methods - Eighteen patients suffering from focal epilepsy were examined before epilepsy surgery. Video-EEG-ECG was carried out for 2-10 days, and 32 seizures were registered. Analysis of the heart rate was based on the 5- minute-long epochs of the ECGs taken at the 5-10-15- 30th minutes and at the 1-3-6th hours before and after seizures. Results - The heart rate increases (from average 69 beats/min to 92 beats/min, p<0.001) immediately after seizures, tough significantly higher heart rate was observed 3 hours after seizures. There were no patients with severe periictal bradycardia. In one of our patients, ectopic cardiac rhythm occurred after a generalized tonicclonic seizure. Conclusions - We can conclude that the sympathic activity increases while the parasympathic activity decreases after seizures. The observed alterations lasted for a long time and predict to fatal arrhythmias. These suggest that sudden death in epilepsy can be induced by cardiac arrhythmias connected with epileptic seizures.]

Clinical Neuroscience

MAY 30, 2008

[IMPROVING FUNCTIONAL ELECTRICAL STIMULATION DRIVEN CYCLING BY PROPER SYNCHRONIZATION OF THE MUSCLES]

PILISSY Tamás, KLAUBER András, FAZEKAS Gábor, LACZKÓ József, JOHANN Szécsi

[Our aim is to define optimal stimulation patterns for controlling lower limb movements of spinal cord injured patients. Here we report on a study about cycling movements of healthy subjects under regular conditions and spinal cord injured patients whose cycling movement was generated by functional electrical stimulation. The stimulation pattern required for coordinated activities of lower limb muscles of spinal cord injured patients was improved by using the observations what we gained from measuring and analyzing cycling movements of 42 young healthy subjects. Kinematical parameters (joint angles) and muscle activities (EMG) were recorded simultaneously by an ultrasound based movement analyzing system. We replaced the cycling program of the commercially available stimulator with a new one that we developed on the basis of the measured healthy cycling movements. We present that our new stimulation patterns provided a great increase in the performance of our spinal cord injured patients.]

Clinical Neuroscience

MAY 30, 2008

[INTRACEREBRAL STEAL AFTER ACETAZOLAMID ADMINISTRATION]

VASTAGH Ildikó, POZSÁR Melinda, FOLYOVICH András, DEBRECZENI Róbert, PÁLVÖLGYI László, BERECZKI Dániel, SZIRMAI Imre

[Occlusion or high grade stenosis of the internal carotid artery may be asymptomatic depending on the collateral patterns in the circle of Willis and the reserve capacity of the microvascular (arteriolar) system. The distensibility of the cerebral arterioles may be described quantitatively by the vasomotor reactivity. We present three patients with severe stenosis of an internal carotid artery associated with more severe stenosis or occlusion of the contralateral internal carotid artery. We continuously measured blood flow velocity in both middle cerebral arteries by transcranial Doppler ultrasound in rest and for 20 minutes after IV administration of 1 g acetazolamide. Arterial blood pressure was determined with tonometry, end-tidal CO2 was determined by a capnometer. In resting condition the anterior communicating artery, the posterior communicating artery and the ophthalmic artery supplied collateral blood flow towards the side of the more severe internal carotid artery disease. Blood flow velocity decreased after acetazolamide administration in all patients in the middle cerebral arteries on the side of the more severe occlusive carotid disease, while increased on the contralateral side. We assume that the exhausted arteriolar system on the more severely affected side was not able to further dilate and the open collateral system could have driven blood towards the other side with preserved reserve capacity. The reduced blood flow velocity in the middle cerebral arteries after acetazolamide may reflect this intracerebral steal phenomenon.]

Clinical Neuroscience

MAY 30, 2008

[Affective and cognitive decision making in major depression: influence of the prefrontal cortex, serotonin transporter genotype and personality traits]

MUST Anita, HORVÁTH Szatmár, JANKA Zoltán

[Patients with major depressive disorder (MDD) show neuropsychological impairments, including deficient executive functions and suboptimal decision-making strategies, which are mediated by several brain regions. In the development of these symptoms the pathology of the prefrontal cortex (PFC), including the dorsolateral, ventromedial and orbitofrontal regions, may also play an important role. Neuropsychological assessment is a useful tool in detecting and measuring these deficiencies, showing that patients with MDD exhibit altered sensitivity to reward and punishment. However, impairment of emotional decisionmaking strategies in MDD is influenced by genetic variations (5-HTTLPR polymorphism) and personality traits, which seem to have a higher predictive value on decision making performance than the clinical symptoms.]

Clinical Neuroscience

MAY 30, 2008

Clinical Neuroscience

MAY 30, 2008

Clinical Neuroscience

MAY 30, 2008

Clinical Neuroscience

MAY 30, 2008