Clinical Neuroscience

[Books Review]

ILONA dr. György

MAY 20, 1996

Clinical Neuroscience - 1996;49(05-06)

[On the occasion of the 20th Congress of the Hungarian Society of Pediatric Neurology, Pediatric Neurosurgery, Child and Youth Psychiatry, a handbook entitled Child and Youth Psychiatry, edited by 26 authors, including 6 foreign experts, edited by Ágnes Vetró and William Perry-Jones, was presented.]

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Clinical Neuroscience

[Somatic defects and pain manifested at adults' drawings of a man]

GRYNAEUS Tamás

[The outhor observed that “draw-a-man tests” of mentally retarded or demented adult patients may truly reflect their somatic defects or painful disorders. Drawings of mentally intact patients could also exhibit their somatic illness if it causes pain or the compensating mechanisms are insufficient. A brief discussion is given on the possible mechanisms, in connection with the body-schema.]

Clinical Neuroscience

[Topographic pattern of spike-waves in absence seizures]

CLEMENS Béla

[Topography of generalized ictal spike-wave patterns (absence seizures) have been investigated by voltage mapping analysis. The 31 patients investigated in this study belonged to a wide variezy of epileptic syndromes with absence seizures. Previously described different topographic patterns of the spike and the wave components have been confirmed in this study.]

Clinical Neuroscience

[The effect os levodopa in Parkinson's disease ]

MECHLER Ferenc, DIÓSZEGHY Péter, GLAUB Theodóra, HIDASI Eszter, JOSE Rosa

[The effect of carbidopa/levodopa on clinical signs and laboratory data was studied in 21 patients with Parkinson's disease during a follow-up period of 7-12 months. The Columbia and Webster scales were used for analysis. The improvement was significant already in the first weeks of the treatment. The drug did not influence the laboratory data and the side effects were found to be insignificant. The changes due to the drug were analysed by electrophysiological methods. Certain peak amplitudes and the area of visually evoked responses increased significantly during the treatment suggesting facilitation in the function of visual pathways. On stimulating the motor system by transcranial and spinal magnetic stimulation, the motor latencies and the duration of silent period showed normalization. ]

Clinical Neuroscience

[The prognostic relevance of apoptosis in medulloblastoma]

SCHUBERT EO Thomas, CERVOS-NAVARRO Jorge

[Apoptosis is known to be a phenomenon of prognostic significance in certain neoplasms. Several previous studies have indicated that the prognosis of desmoplastic medulloblastoma is better than that of classical medulloblastoma. We studied 5 desmoplastic and 5 classical medulloblastomas by in situ end labelling of DNA strand breaks to see whether there is any difference in amount or pattern of apoptosis in these subtypes, correlating to the different prognostic behaviour. We found no significant difference neither in amount nor in pattern of apoptosis between the two subtypes. Our results indicate that apoptosis may not be a relevant variable in the prognosis of medulloblastoma.]

Clinical Neuroscience

[Thrombolytic therapy in acute ischemic stroke (preliminary report)]

HAFFNER Zsolt, HORVÁTH Erzsébet, HORVÁTH Éva, PAPP Gabriella, EGERVÁRI Ágnes, LIPÓTH Sarolta, CSÁNYI Attila, TUKA Andrea

[Intravenous stretiokinase infusion therapy was performed on four patients in acute occulsive cerebrovascular disease (hemorrhage was rxcluded by CT scan). The thrombolytic therapy was started not later than six hours after the onset of the first symptoms. Kabikinase (1 250 000 IU) was administered in intravenous infudion during two hours. After thrombolysis no prolonged anticoagulant therapy was applied. Improvement of the neurological symptoms was impressive and convincing: in two cases immadiate. Ino one case we could be observed during the treatment (2 hours) nor after it. The possibility of thromolytic therapy in acute occulsiv stroke should be take into consideration. So far as we are aware this is the first time that thromolysis is occulsive stroke according to a protocol like this has been used in Hungary.]

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Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Clinical Neuroscience

[Dysphagiafelmérések akut stroke-ban]

SZABÓ Pál Tamás, MÛHELYI Viktória, BÉRES-MOLNÁR Katalin Anna, KOVÁCS Andrea, BALOGH Zoltán, FOLYOVICH András

[Stroke associated dysphagia can have serious consequences such as aspiration pneumonia. The Hungarian guideline on nutritional therapy for stroke patients recommends dysphagia assessment, as early screening can optimize disease outcome and hospital cost. Thus far, this may be the first study in Hungarian that has documented a systematic review about the available validated dysphagia assessments of acute stroke. Purpose – The aim of this study was to summarize the instrumentally validated bedside dysphagia screening tools for acute stroke patients, which were published in the last twenty years. Our objective was to describe the characteristics of the validation studies, examine their study design, and sample the sub-tests and the diagnostic accuracy of the assessments. A systematic research was carried out of the literature between 2001 and 2021 in eight scientific databases with search terms appropriate to our objectives. Subjects of the study – 652 articles were found and were reduced to eight. We made a comparative analysis of these. The GUSS test reached a high level of sensitivity compared to the others. In our study sample, the prevalence of instrumentally confirmed dysphagia among acute stroke patients was 56.1%. The focus and the composition of the analyzed studies differed and posed problems such as the ambiguity of the concept of dysphagia, the difference in outcome indicators, or the timing of screening. The GUSS test, which offers domestic management, is a suitable tool for the Hungarian clinical use.]

Clinical Neuroscience

[Treatment and new evidences in neuromyelitis optica spectrum disorder ]

ILLÉS Zsolt

[Treatment and new evidences in neuromyelitis optica spectrum disorder Illés Zs, MD, PhD Ideggyogy Sz 2021;74(9–10):309–321. Neuromyelitis optica spectrum disorder (NMOSD) is associated with antibodies against AQP4 in about 80% of the cases. In about one-fourth of seronegative cases, antibodies against the MOG protein are present in the serum (MOG-antibody associated disease, MOGAD). This article discusses off-label azathioprine and mycophenolate mofetil in the treatment of NMOSD and reviews the evidence-based clinical aspects of B/plasma cell depletion, antagonization of IL-6 signaling and blocking the complement pathway. The review also summarizes basic aspects of NMOSD pregnancy focusing on treatment, and the different therapeutic approach in MOGAD. In the recent two years, phase 3 clinical trials provided class I evidence for the efficacy and safety of rituximab (anti-CD20), inebilizumab (anti-CD19), tocilizumab (anti-IL6R), satralizumab (anti-IL6R), and eculizumab (anti-C5) in combination with other immunosuppressants or in monotherapy. The treatment approach in MOGAD is complicated by the monophasic course in about half of the cases and by the potential disappearance of MOG antibody. The necessity of maintenance treatment in MOGAD should be decided after tapered oral steroid. Immunosuppression is recommended in NMOSD during pregnancy and lactation, and this should be considered for optimal selection of treatment in fertile female patients. The new monoclonal antibodies broadened treatment options NMOSD, and the treatment strategy of MOGAD has become more straightforward.]