Clinical Neuroscience

[Changes in the clinical picture of neurological diseases due to drug therapy]

HORÁNYI Béla1

JANUARY 01, 1967

Clinical Neuroscience - 1967;20(01)

[In our medical practice, we often do not fully and correctly use all the possibilities of drug therapy. Medical thinking tends to be biased towards simple, easy-to-remember, templated treatment procedures. But in any case, we will only exhaust the potential of drug therapy if, on the basis of careful consideration of all the circumstances, we know the mechanism of action of the drug and the pathophysiology of the disease, we give the right drug at the right time, in the most appropriate dose, distribution and manner. Perhaps not enough emphasis is placed in university clinical education on the principles of drug therapy.]

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  1. Budapesti Orvostudományi Egyetem Neurologiai Klinika

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Clinical Neuroscience

[Neuropathological lesions in animal studies of B12-avitaminosis]

LEHOCZKY Tibor, SÓS József, HALASI Margit

[induced central and peripheral nervous system lesions in white rats with B. deficiency. These were essentially identical to the typical neuropathological lesions of anaemia perniciosa (myelopathy, neuronal proliferation). The discrepancy, such as the rare or absent glial reactions and the extensive and severe damage to nerve cells, was explained by the more intense biochemical effects of experimental B12 deficiency. ]

Clinical Neuroscience

[Clinical significance of the Circulus arteriosus Willisi with special reference to hypoplasia]

LEEL-ŐSSY Lóránt

[After a detailed anatomical description of the circulus arteriosus Willisi, the first part of the paper describes the occurrence of hypoplasia in each branch. In the second part, the dynamic characteristics of the blood circulating in the CAW are used to illustrate the crucial regulatory, distributive and collateral role of the formula in the first stage of cerebral circulation. In the third part, the clinical relevance of anomalies (mainly hypoplasia) is highlighted. A study of the brains of 100 cerebrovascular and 100 non-cerebrovascular deceased individuals shows the well-known fact that CAW anomalies are twice as common in cerebrovascular diseases as in non-vascular diseases. It describes the predisposing, preforming, pathoplastic effects of anomalies in emollients, haemorrhages and thromboses. The frequent occurrence of anomalies is known in pituitary aneurysms, and anomalies often allow the development of severe arteriosclerosis in the basal vessels, if the mechanical theory of anteriosclerosis is considered. In relation to general CAW hypoplasia, he lists 19 cases of vascular injury or other disease, functionally modified by the anomaly. Among the latter, he points out the atypical course of three endogenous pathologies in particular. ]

Clinical Neuroscience

[Effect of metopirone on cerebral electrical activity]

FREY Zsuzs, HALMY László

[Authors have studied the effects of Metopiron on brain electrical activity in endocrinology patients. In 5 of 13 patients studied, regularisation of electrogenesis was observed. It is hypothesized that the resulting lesion is due to a direct or indirect effect of Metopirone on the hypothalamus. In their further conclusions, they point to the possibility of a relationship between diurnal fluctuations in ACTH synthesis and the chronometric function of alpha-rhytmus.]

Clinical Neuroscience

[Clinical interpretation of Evipan sleep-activated EEG abnormalities in non-epileptic psychiatric patients]

NAGY A. Tibor, KAJTOR Ferenc, HALÁSZ Péter, KLEININGER Ottó

[Authors search for correlation between activated EEG abnormalities in 86 patients and various non-epileptic psychiatric disorders. They hypothesize organic brain damage and varying degrees of cerebral atrophy as causal factors underlying chronic clinical syndromes classified as neurosis - psychopathy - psychosis. It is not considered acceptable to extend the concept of epilepsy to all those with abnormal EEG findings without clinical epileptic manifestations. Linked to this, the question of the specificity of the seizure potential is raised. They include in the concept of "organic psychopathy" those with EEG abnormalities and PEG findings suggestive of a cerebral dysfunction, which may take other forms besides personality changes, due to pathoplastic factors. ]

Clinical Neuroscience

[Five recurrent subarachnoid haemorrhages from a cerebrovascular arterio-venous vessel]

FORNÁDI Ferenc, SZEGEDY László, HAITS Géza

[The authors describe a 45-year-old female patient who has been clinically treated 5 times in 15 years for recurrent subarachnoid hemorrhages. The clinical interest of the case is given by the good general condition of the patient and her relatively well-preserved personality during the time between each bleeding episode. The bleeding was due to an arteriovenous aneurysm in the upper third of the mesencephalon. Presumably, this aneurysm, in addition to the recurrent bleeding, may have played a role in the development of the very marked cerebral atrophy and the strikingly severe arteriosclerotic vascular lesions by altering the hemodynamic relationships. ]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]