Clinical Neuroscience - 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

[Neuropsychological rehabilitation following acquired brain injury]

TAMÁS Viktória, KOVÁCS Noémi, TASNÁDI Emese

[Neuropsychological rehabilitation or rehabilitation neuropsychology is a field within applied neuropsychology. It originally diverges from applied clinical and functional neuropsychology, although it could not be entirely differed from them. The unique nature of this area over the complexity is given by its process-controlled and system-approach aspects. In Hungary the number of neurorehabilitation centres and departments requiring neurocognitive rehabilitation has been continually increasing. Nevertheless, the number is still low; accordingly in our country this field is relatively young and isn’t well known. Authors of this review would like to draw attention to the importance of rehabilitation of patients with acquired brain injury and improvement of their quality of life with the theoretical and practical knowledge, as well as the necessity of future alterations and challenges emphasizing the need of a significant change of this narrow domain. ]

HUN 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

[The treatment of advanced Parkinson’s disease]

KLIVÉNYI Péter, VÉCSEI László

[The treatment of Parkinson’s disease depends on the symptoms of the patients and obviously the stage of the disease. Several different approaches can be found in the literature. Based on the published data, in this review we try to summarize the different approaches to the disease stages and theirs’ clinical relevance. Actually, one of the most important issue is the recognition of advanced stage and therefore we reviewed the device-aided therapies. ]

HUN 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

Psychoform and somatoform dissociative experiences in migraine: relationship with pain perception and migraine related disability

SENGUL Yildizhan, SENGUL Serdar Hakan, TUNC Abdulkadir

Objective - Migraine is a common and often debilitating disorder. Although the existence of a link between migraine and certain psychological features has long been known, data on dissociative experiences in migraine patients is insufficient. The aim of this study was to evaluate the presence of psychoform and somatoform dissociative experiences among migraine patients without aura and to examine their relationship with pain perception and disability. Methods - A total of 110 outpatients diagnosed with migraine based on the International Classification of Headache Disorders-III (ICHD-III) criteria and 70 healthy subjects were enrolled to this study. Sociodemographic data, Somatoform Dissociation Questionnaire (SDQ), Dissociative Experience Scale (DES), Beck Depression Inventory (BDI), and Beck Anxiety Scale (BAS) scores were recorded for each patient. The Migraine Impairment Disability Assessment Scale (MIDAS) and Visual Analog Scale (VAS) scores were also determined. Results - The mean SDQ and DES scores were significantly higher in migraine patients (p<0.001, p<0.01). According to SDQ, somatoform dissociation disorder, dissociative disorder not otherwise specified, and dissociative identity disorder were considered in 29.4%, 18.3%, and 10.1% of the migraine patients, respectively. Also, 20.9% of the patients had possible psychoform dissociation according to DES. A significant positive correlation was found between DES, SDQ scores, and VAS, MIDAS scores. Patients were found to have statistically significantly higher levels of depression and anxiety symptoms compared to healthy controls (p < 0.001). Higher DES and SDQ scores were associated with increased disability and pain level (p<0.01). Conclusion - Our findings seem to confirm the increased occurrence of somatoform and psychoform dissociative experiences in migraine patients. This study was intended as a beginning towards understanding dissociative experiences in migraine.

ENG 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

[Effects of neural therapy on quality of live in patients with inoperable lower extremity artery disease ]

MOLNÁR István, DEÁK Botond Zsolt, HEGYI Gabriella, KOVÁCS Zoltán, KAPÓCS Gábor, SZŐKE Henrik

[Objectives - Our aim was to evaluate the effects of percutaneous neurolysis of lumbal sympathetic ganglions on pain and the resulting changes in quality of life with validated objective and subjective methods. To follow the adverse effects and complications of the procedure. Materials and methods - A prospective, non-randomized, interventional, clinical cohort study under real life conditons was conducted. The time of the observation was 6 months. Palliative neural therapy was performed to reduce the ischemic pain of the affected leg of the patients involved in the study. Prior to treatment and after 35 days, Visual Analogue Scale (VAS) was used to measure the intensity of lower limb pain. The related changes in the quality of life were followed by a general 36-Item Short-Form Health Survey (SF-36) questionnaire. We measured the changes of the patients’ skin temperature and ankle/arm index. The post-treatment results were compared to the pre-treatment results. We compared the results of objective and subjective measures. We followed the side effects and complications of the pain therapy. Each of the examined subjects had obliterative (Fontaine II/b stage) arterial disease of the lower limbs, in which no revascularization intervention was feasible and their ischemic pain was of VAS≥7. Results - Data of 124 patients (69 male, 55 female) could be evaluated. The decrease in intensity of limb pain in the post-treatment period was significant (p=0.001). Quality of life also indicated a significant improvement (p=0.004). Changes in skin temperature and ankle/arm index demonstrated significant improvement (p≤0.005): skin temperature increased from 27.6°C to 31.2°C, the ankle/arm index inceased from 0.67 to 0.83 on average. Changes in objective and subjective measures correlated with each other. No worthening of symptoms, serious adverse events or complications were observed. Conclusion - The chemical denervation of the lumbar sympathetic ganglions with percutaneous application is a minimally invasive intervention, useful in outpatient care, which can be well tolerated by the patient without any significant side effect or complication. Its hyperaemic effect and the pain reduction of the leg can improve the quality of life of the patients.]

HUN 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

[Comparison of subthalamic nucleus planning coordinates in 1Tesla and 3Tesla MRI for deep brain stimulation targeting ]

JUHÁSZ Annamária, KOVÁCS Norbert, PERLAKI Gábor, BÜKI András, KOMOLY Sámuel, KÖVÉR Ferenc, BALÁS István

[Backgroud - Deep brain stimulation (DBS) involves placing electrodes within specific deep brain nuclei. For movement disorders the most common indications are tremors, Parkinsons disease and dystonias. Surgeons mostly employ MR imaging for preoperative target selection. MR field geometrical distortion may contribute to target-selection error in the MR scan which can contribute to error in electrode placement. Methods - In this paper we compared the STN target planning coordinates in six parkinsonian DBS patients. Each patient underwent target planning in 1T and 3T MRI. We statistically compared and analysed the target-, and the fiducial coordinates in two different magnetic fileds. Results - The target coordinates showed no significant differences (Mann-Whitney test, p > 0.05), however we found significant difference in fiducial coordinates (p < 0.01), in 3T MRI it was more pronounced (mean ± SD: 0.8 ± 0.3 mm) comparing to 1T (mean ± SD: 0.4 ± 0.2 mm). Conclusion - Preliminary results showed no significant differences in planning of target coordinates comparing 1T to 3T magnetic fields.]

HUN 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

Inflammatory biomarkers in benign paroxysmal positional vertigo: A Turkey case-control study

AYSEL Tekeşin, ABDULKADIR Tunç

Objective - Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. Inflammation is a hypothetic etiological factor in BPPV. The aim of this study was to evaluate inflammatory biomarker levels in BPPV patients and compare these with the healthy subjects. Materials and methods - This prospective case-control study was conducted with 114 newly diagnosed BPPV patients and age- and sex- matched 83 healthy subjects. The laboratory investigations included serum hemogram, full biochemistry profiles, vitamin levels, thyroid hormone profiles, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte to HDL-cholesterol ratio (MHR) values were calculated and compared between the patients and healthy subjects. Results - The mean age was 39.1 ± 12.4 years for patients, and 37.0 ± 11.9 for controls. Vitamin B12, hematocrit (Hct), creatinine, urea, and fT4 values, lymphocyte, total bilirubin, direct bilirubin and indirect bilirubin levels were significantly lower in BPPV patients (p ˂ 0.05), while HDL, SGOT, and ESR values were significantly higher. In the BPPV patients the mean NLR, PLR, and mean platelet volume (MPV) values were significantly higher than in the control subjects. Neutrophil, platelet, monocyte, MHR, and CRP values were similar in both groups (p ˃ 0.05). Conclusion - Our result suggests that NLR, PLR, MPV, ESR, and bilirubin levels should be taken into account as potential biomarkers of BPPV. As they are inexpensive parameters and widely available, they can be used in clinical practice for prediction of BPPV. However, further large-scale studies are required to confirm this relationship.

ENG 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

Evaluation of symptom severity, functional status and anxiety levels in patients with carpal tunnel syndrome with different electrophysiological stages

SEVINC Gürses Eftal, TEKESIN Aysel, TUNC Abdulkadir

Objective - The aim of this study was to evaluate the relationship between electrophysiological stage, symptom severity, functional status and anxiety levels in patients with idiopathic carpal tunnel syndrome (CTS). Materials and methods - This study included 130 patients in the 25-79 age group who were classified as clinically and electrophysiologically idiopathic carpal tunnel syndrome in our electromyography (EMG) laboratory. Visual Analog Scale (VAS) was used to assess pain during rest and activity. The Boston Carpal Tunnel Scale (BCTS) was used to evaluate symptom severity and functional status. Symptom Severity Scale (SSS) and Functional Capacity Scale (FCS) were assessed separately as a part of BCTS. Beck Anxiety Inventory (BAI) was used for anxiety assessment. Results - A total of 130 patients (25 males and 105 females) were enrolled to this prospective study. The mean age of the patients was 46.95 ± 10.57 years. When the electrophysiological stage was increased, it was found that SSS score and FCS score were increased (p <0.001). No significant correlation was detected between electrophysiological stage and VAS or BAI score. There was a positive correlation between VAS scores and SSS, FCS and BAI scores (p <0.001). Symptom severity and functional status were correlated with anxiety scores (p <0.001). SSS and FCS values of stage III and above patients were significantly higher than Stage I and II CTS patients (p <0.01). Conclusion - In conclusion, our study showed a significant correlation between symptom severity, functional status and anxiety in CTS patients. This can be interpreted as the mental deterioration of individuals with more severe symptoms. On the other hand, additional psychiatric support options should be recommended in cases of moderate findings but anxious symptoms. Electrophysiological findings shouldn’t be sufficient to measure the effect of the disease on the person.

ENG 2018;71(11-12)

Clinical Neuroscience

NOVEMBER 30, 2018

Pulmonary physiotherapy and aerobic exercise programs can improve cognitive functions and functional ability

TEKESIN Aysel, TUNC Abdulkadir, GÜNGEN Dogan Belma, AVCI Nalan, BAKIS Muhammed, PERK Seyma

Objective - The increasing prevalence of dementia over the previous decades has been accompanied by numerous social and economic problems. The importance of exercise in the prevention of dementia coupled with the impact of aspiration pneumonia on the mortality and morbidity of dementia patients cannot be overstated. This study investigates the effects of pulmonary rehabilitation combined with aerobic stretching exercises on the cognitive function, life quality, effort capacity, and level of depression in patients with mild cognitive impairment (MCI) in the early stages of dementia. Methods - Sixty-nine patients with MCI diagnosis were routinely monitored, and six were excluded because they did not attend the follow-up appointments. The remaining 63 patients undertook pulmonary physiotherapy (PPT) and extremity exercises for six months. The mini-mental state examination (MMSE), six-minute walk test (6MWT), Nottingham health profile (NHP), and Beck depression inventory (BDI) scores were evaluated before and after exercise. Results - PPT plus extremity exercises appeared to significantly improve the MMSE scores and increase the 6MWT (p < 0.001) by an average of 25 m. No significant improvement was observed in the BDI and NHP scores. Conclusion - PPT and aerobic exercise positively affected the cognitive ability of MCI patients and improved their walking distance. These results underscore the importance of combining medical treatment with physical rehabilitation at the onset of dementia, a disease which exerts a significantly negative impact on the economy.

ENG 2018;71(11-12)