Clinical Neuroscience

[A novel analgesic made from cannabis]


FEBRUARY 10, 2004

Clinical Neuroscience - 2004;57(01-02)

[Bayer AG has recently announced that it acquired exclusive rights for the marketing of GW Pharmaceuticals´ new medicine Sativex® in Europe and in other regions. Sativex is a sublingual spray on Cannabis extract basis, and is equipped with an electronic tool to facilitate accurate dosing and to prevent misuses. It is standardized for the THC and CBD. The new analgesic is proposed for the treatment of muscle spasticity and pains accompanying multiple sclerosis and as an efficient analgetic for neurogenic pain not responding well to opioids and to other therapies available. The entirely new mechanism of action through the recently discovered cannabinoid receptor system may offer a real therapeutic potential to the drug. Although the Government of Netherlands has authorized the sale of pharmaceutical grade Cannabis herb by pharmacies in the Netherlands, the availability on the pharmaceutical market of the registered preparation may render requests for the authorization of the smoking of Cannabis herb (marihuana) by individuals suffering of multiple sclerosis, neurogenic pain, AIDS wasting syndrome unnecessary. Nevertheless, the ”old chameleon” plant Cannabis appears to gradually regain its previous status in mainstream therapy and pharmacy. As long as the plant Cannabis and its products continue to be classified as narcotic drugs, medical use of the new preparation will need close supervision.]



Further articles in this publication

Clinical Neuroscience

[Effect of mental arithmetic and verbal fluency on the flow velocity in the middle cerebral arteries]


[Introduction - Using transcranial Doppler sonography (TCD), changes in blood flow velocity (BFV) can be measured in the Medial Cerebral Artery (MCA) during cognitive effort. Our goal was to define the time-course and laterality of BFV in healthy vo-lunters during arithmetic and verbal fluency tasks according to handedness. Methods - Twelve subjects (8 right-handed, 4 left-handed) were assessed. The TCD registered BFV in both MCA simultaneously. Heart rate was also recorded using TCD. Finally we included a 16-channel EEG. BFV laterality index (LI) was calculated. Participants were asked to count silently and generate words beginning with a specified letter. To estimate hemispheric differences in BFV, two-tailed Wilcoxon tests were utilized along with correlational analyses. Results - During cognitive effort the BFV changed in a triphasic manner in all participants. A 6-8% elevation of BFV was observed in MCAs without latency at the time of the evoking signal. Laterality of BFV developed after 5-13 seconds during cognitive effort in right-, and several seconds later in left-handed subjects. During tasks the BFV increased in the dominant hemis-phere up to 2.6-4.7% compared to the subdominant one. We also calculated the LI. During the verbal task the LI agreed with the handedness in 9 out of 12 subjects. During the mental arithmetic task, agreement was found in 6 out of 12 subjects. According to LI results we found a discrepancy between verbal and arithmetic tests in 3 out of 12 subjects. Conclusion - Cognitive effort elicites significant bilateral BFV increases in the MCAs, which suggests fast neurogenic regulation. The course of BFV during mental arithmetic proved to be different from course BFV assessed during the word fluency task. Based on the laterality of the BFV, the word-generation task was more sensitive in determining the dominant hemisphere when compared to the mental arithmetic task. The use of LI may help to estimate hemispheric functions even in pathologic circumstances.]

Clinical Neuroscience

[Brachytherapy of brain stem tumours]

JULOW Jenő, VIOLA Árpád, MAJOR Tibor, VALÁLIK István, SÁGI Sarolta, MANGEL László, KOVÁCS Rita Beáta, REPA Imre, BAJZIK Gábor, NÉMETH György

[Introductions - The optimal therapy of brain stem tumours of different histopathology determines the expected length of survival. Authors report 125Iodine interstitial irradiation of brain stem tumours with stereotactic brachytherapy. Case reports - Two patients having brain stem tumours were suffering from glioma or from metastases of a carcinoma. In Case 1 the tumour volume was 1.98 cm3 at the time of planning interstitial irradiation. The control MRI examination performed at 42 months post-op showed a postirradiation cyst size of 5.73 cm3 indicating 65.5% shrinkage. In Case 2 the shrinkage was more apparent as the tumour vo-lume measured on the control MRI at 8 moths post-op was only 0.16 cm3 indicating 97.4% shrinkage of the 6.05 cm3 target volume at the time of brachytherapy with the metastasis practically disappearing. Quick access to histopathological results of the stereotactic intraoperative biopsy made it possible to carry out the 125Iodine stereotactic brachytherapy immediately after the biopsy, resulting in less inconvience for patients of a second possible intervention. The control MRI scans show significant shrinkage of tumours in both patients. Conclusion - The procedure can be performed as a biopsy. The CT and image fusion guided 125Iodine stereotactic brachytherapy can be well planned dosimetrically and is surgically precise.]

Clinical Neuroscience

[Clinical features and molecular diagnosis of spinocerebellar ataxia]


[In the past decade, a great progress has been made in understanding genetic basis of the spinocerebellar ataxia. Based upon the genotypes, more then 20 subgroups of autosomal dominant spinocerebellar ataxia have been identified with different gene mutations. Neither the pathomechanism nor the function of these genes is fully understood. In these disorders the main clinical sign is ataxia. Other symptoms may be present as well, but no speci-fic clinical feature is known for differentiating subgroups. Specific diagnosis can be made by genetic tests. In this review we summarize the clinical features and genetic backgrounds of the most common spinocerebellar ataxias.]

Clinical Neuroscience

[Multiple sclerosis to date: diagnosis, epidemiology, new aspects of the pathomechanism and the therapy]

BENCSIK Krisztina

Clinical Neuroscience

[The role of ventromedial prefrontal cortex in addictological disorders]

KELEMEN Oguz, MÁTTYÁSSY Adrienn, KÉRI Szabolcs

[Recently a significant conceptual change emerged in the interpretation of addictological disorders. Despite this significant progress, the exact neuronal mechanisms of these disorders are still unknown. By the development of cognitive neuroscience novel clinical tests became available which are devoted to the evaluation of more properly defined neuronal structures. These novel approaches are designed to separately investigate memory/attention-related and affective processes in decision- making. These investigations along with animal models and functional neuroimaging approaches suggest the crucial role of a complex neuronal network in the pathomechanism of addictolo-gical disorders, including the ventromedial prefrontal cortex and the amygdala-accumbens system. The aim of this paper is to review these novel findings in order to gain insight into the neurocognitive mechanisms of addictological disorders.]

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Clinical Neuroscience

Isolated hypoglossal nerve palsy due to a jugular foramen schwannoma


Introduction – Although the involvement of the hypoglossal nerve together with other cranial nerves is common in several pathological conditions of the brain, particularly the brainstem, isolated hypoglossal nerve palsy is a rare condition and a diagnostic challenge. Case presentation – The presented patient arrived to the hospital with a history of slurred speech and an uncomfortable sensation on his tongue. Neurological examination showed left-sided hemiatrophy of the tongue with fasciculations and deviation towards the left side during protrusion. Based on the clinical and MRI findings, a diagnosis of hypoglossal nerve schwannoma was made. Discussion – Hypoglossal nerve palsy may arise from multiple causes such as trauma, infections, neoplasms, and endocrine, autoimmune and vascular pathologies. In our case, the isolated involvement of the hypoglossal nerve was at the skull base segment, where the damage to the hypoglossal nerve may occur mostly due to metastasis, nasopharyngeal carcinomas, nerve sheath tumors and glomus tumors. Conclusion – Because of the complexity of the region’s anatomy, the patient diagnosed with hypoglossal nerve schwannoma was referred for gamma knife radiosurgery.

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[Diagnosis and therapy of insect sting allergy]


[Over the past 20 years great progress has been made in understanding the pathogenesis, diagnosis and treatment of allergic reactions caused by insect stings. The incidence of insect sting allergy in a general population is about 0.4- 3% but anaphylaxis to Hymenoptera venom can be fatal. The diagnosis of venom allergy is based on the history suggesting an allergic reaction and on the demonstration of the persistence of specific IgE antibody either by skin tests or RAST. Patients who had a severe allergic reaction and has positive venom skin test or RAST result should be advised to receive venom immunotherapy (VIT). The risk for subsequent life-threatening systemic sting reactions can be significantly reduced with VIT. VIT should be continued for at least 3 to 5 years and provides about 90 % protection from insect sting anaphylaxis.]

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[Medical anthropology - medical students fieldwork experiences]


[The experience gained in teaching medical anthropology at Semmelweis University of Medicine is reported in the study. Very often medical anthropology is identified by the physical anthropology of “Dr. Bone”, although this discipline is a branch within cultural anthropology which deals with applied anthropology. During practices, students following their preclinical studies - that is already not lay but still not doing healing work - had to carry out fieldwork and participate as observants at a medical facility of their choice: inpatient, primary care clinic or alternative medical center/ clinic. The purpose of the field work was the examination and the analysis of the different healing systems, and of the doctorpatient relationship. During the nine years, more hundreds of fieldworks were made. In the study, we attempted to sum up these experiences for a better understanding of pluralism of the Hungarian medical system, the usability and eventual faults of different healing systems, and ultimately the effectiveness of the medical anthropology course.]

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[Antibiotic treatment of intra-abdominal infections, focusing on secondary peritonitis]


[The morbidity and lethality of intra-abdominal infections are still high. Their first-line therapies include surgical or image-guided interventions. Adjuvant therapy with a broad-spectrum antibiotic is crucial for the treatment of polymicrobial infections. As initiation of the therapy is urgent, the antibiotic must be chosen empirically. Pathogens of community-acquired and nosocomial intra-abdominal infections are greatly different. The type of microbes, the general status of the patients, and the severity of their disease determine the choice of antibiotic or antibiotic combination. Using an adequate initial antibiotic decreases postoperative mortality and morbidity. Emerging new pathogens and the resistance of known germs against multiple antibiotics complicates the selection of the antiinfective therapy. Tigecycline is a new tetracyclin-derivative that offers a novel therapeutic option owing to its broad spectrum and efficiency against “problematic bacteria”. The current guidelines facilitate the selection of an empirical therapy, but they do not replace the individualised therapeutic approach.]

Lege Artis Medicinae


SZABÓ János, BALOGH Sándor

[The recovery chances of patients with acute coronary syndrome are substantially affected by the time elapsed before the exact diagnosis is set up, by the standards of professional attendance on the spot, and by the speed of transportation to the most adequate medical institution that can offer the patient optimal definitive treatment. Thus, the responsibility of the physician who first sees the patient, often the general practitioner, is extremely high. In case of typical chest pain a 12-lead ECG should be made on the spot. If acute myocardial infarction is suspected, acetylsalicylic acid, short-acting sublingual nitrate, morphine, beta receptor blocker (if not contraindicated), and oxygen should be administered until the emergency ambulance arrives.]