Clinical Neuroscience

[Clinical studies with levodopa/carbidopa intestinal gel]

KLIVÉNYI Péter, VÉCSEI László

JANUARY 30, 2014

Clinical Neuroscience - 2014;67(01-02)

[The motor complications in advanced Parkinson’s disease may interfere with the quality of life. To overcome this disability, a jejunal levodopa pump was developed. In this review we have summarized the published clinical data with this method.]

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Clinical Neuroscience

[The role of sleep in the implicit learning processes]

CSÁBI Eszter, NÉMETH Dezsõ

[The role of sleep in different memory processes is debated. Probably it plays an active role in the memory consolidation or possibly it prevents forgetting by protecting against interference or it makes the memory performance more efficient by facilitating the forgetting. The beneficial effect of sleep in explicit memory is well demonstrated, while the role of sleep in implicit mechanisms has not been comprehensively characterized so far. There are several factors which affect the appearance of sleep effect, such as the structure, the length and the complexity of sequence being used, the awareness of the sequence, the length of the learning blocks and the offline period. Besides the classical sleep deprivation methods with healthy participants, examining patients with sleep disorders could be a new method of the investigation of the sleep effect which enables us to enrich our knowledge not only about the sleep-dependent memory consolidation but also the cognitive dysfunction related to sleep pathologies. This new line of research can help the development of more effective rehabilitation programs.]

Clinical Neuroscience

[Relationship between default mode network and consciousness]

GYULAHÁZI Judit, VARGA Katalin

[Neural correlation with consciousness represents a main topic of neuroscience studies. New results of consciousness researches proved that based on a coherent function in between its components the default mode network activity is the condition for awake consciousness. The subject of consciousness is self. Tasks related with the self were proving a high default mode network activity. Using connections inside the network, results which were related with self, could be considered to represent a polymodal integration system are they are participating in fine processing of the highly integrated associative information. It could be a result of the convergence of cognitive binding. There is a strong connection between the level of consciousness and praecuneal activation. It was proved that the network activity is changing during sleeping (normal condition), trauma or under drug induced altered consciousness. The default network activity can be considered as the neural correlate of consciousness. Further researches are warranted to answer the question: is the activity of the network the cause or is just accompanying the development of human consciousness?]

Clinical Neuroscience

[Multiple disruption of the body representation in neglect]

SNAGY Zita, VERSEGHI Anna, VKOMLÓSI Anna, RÁKÓCZI Balázs, BOROS Erzsébet

[Background and purpose - Neglect related to the body has many symptoms. We suggest that the various symptoms might be associated with the injuries of different cognitive functions referring to the body, which are caused by lesions of different brain areas. Therefore we investigated the injuries of two functions in a group of patients with neglect (N=10) contrary to patients without neglect (N=10) and healthy controls (N=10). These functions are: perception of body location in external space and the perception of body shape. Methods - We applied a novel method (Body Portraying Method), which is suitable for measuring subjective perception of both body location and body shape. Results - 1. Patients with left neglect perceived their bodies with a significant right shift compared to their real body position. In contrast to this, patients without neglect and healthy controls tended to shift the subjective location of their body to the left. 2. Patients with neglect perceived the shape of their bodies significantly more distorted than both patients without neglect and healthy controls. 3. In case of eight patients with neglect, the symptom of shifted body location to the right and the symptom of body shape distortion appeared together. However, injuries of these two functions dissociated in case of two neglect patients. Conclusions - Both the perception of body location in external space and the perception of body shape might become distorted in neglect. Furthermore, the dissociation of these symptoms supports our suggestion, that they might be associated with the injuries of different functions referring to the body. This result has practical issues as well. At the end of the study we discuss the necessity of appropriate tailored physiotherapy (fitted to the injured function) in the rehabilitation of patients with neglect.]

Clinical Neuroscience

[Diagnosis of primary insomnia by actigraphy - Improved results by data selection]

RAJNA Péter, TAKÁCS Johanna

[Study objectives - In spite of the useful information provided by actigraphy in sleep medicine it is still not an independent tool either in the clinical diagnosis or in the follow-up. In the frame of a retrospective study, a simple new method of data reduction was applied with the aim of improving the clinical impact of actigraphy for the diagnosis of primary insomnia. Methods - Actigraphic records with a duration of 1 week produced on 47 subjects who met the inclusion-exclusion criteria. The daily activities during the investigational period were registered by means a self-completed questionnaire. Three parameters (sleep latency, sleep fragmentation and sleep efficiency) and only their three ’worse - as regards insomnia’ daily values were analyzed statistically. The study participants comprised 13 healthy controls, 17 healthy ‘bad sleepers’ and 17 subjects with primary insomnia. Results - The post-hoc tests did not reveal statistically significant difference in the three parameters between the healthy and ‘bad sleeper’ groups, but these two groups differed statistically from the primary insomnia group. Conclusion - The actigraphic analysis of sleep latency, sleep fragmentation and sleep efficacy allows a significant differentiation between subjects with primary insomnia and healthy controls, but not between healthy controls and healthy ‘bad sleepers’. Statistical algorithms indicated ‘models’ for clinically good and bad sleepers. Further studies on large populations are necessary before this method can be introduced in the routine medical care of individuals with primary insomnia.]

Clinical Neuroscience

[Dostoyevsky’s epilepsy in the light of recent neurobiological data]

TÉNYI Dalma, RAJNA Péter, JANSZKY József, HORVÁTH Zsuzsanna, TÉNYI Tamás, GYIMESI Csilla

[Background and purpose -Since the 1960s several theories have developed on the epilepsy of Fyodor Mikhailovich Dostoyevsky. Probably the most exciting and still actual question might be the subject of the „ecstatic aura”, he described in his novels based on his own experiences. During this extremely rare seizure onset the patients experience a strong sense of happiness, harmony and wholeness. The symptomatogenic zone of ecstatic seizures were considered to be of temporal lobe origin for a long time. Lately though this theory seems to be questioned based on the results of SPECT and deep brain EEG monitoring techniques in addition to the enrichment of our knowledge concerning the function of the insular cortex. Methods - Literary and scientific overview on the subject of Dostoyevsky’s epilepsy, with special concern to his ecstatic seizures. Results and conclusion - According to new electrophysiology and imaging techniques ecstatic seizures - including the seizure onset of Dostoyevsky - could rather be connected to the insular cortex.]

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Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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

[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. ]

Lege Artis Medicinae

[Vaccines against COVID-19 pandemic]

FALUS András, SZEKANECZ Zoltán

[The rapidly spreading SARS-CoV2 respiratory virus has evoked an epidemic with serious aftermath around the world. In addition to the health effects, the global economic damage is actually unpredictable. At the same time, the pandemic has launched a series of unprecedented collaborative scientific research, including the development of vaccines. This study summarizes up-to-date information on vaccines, immune memory, and some emerging clinical effects.]

Lege Artis Medicinae

[Diagnosis and treatment of microvascular coronary heart disease. Specialities of conditions in Hungary]

SZAUDER Ipoly

[Invasive investigations show that in two-thirds of patients the myocardial ischaemia persists without obstructive coronary disease and any other heart conditions (INOCA). The underlying cause may be microvascular dysfunction (CMD) with consecutive microvascular coronary disease (MVD) and microvascular or epicardial vasospastic angina (MVA). The modern practice of clinical cardiology while using the developed non-invasive cardiac imaging permits exact measuring of the coronary flow with its characteristic indices. All of these improve the diagnosing of CMD-induced myocardial ischemia and provide opportunity to determine primary MVD cases. Since the recognition and treatment of MVD is significantly underrep­resented in the Hungarian medical care, the primary stable microvascular angina (MVA) is described in detail below with its modern invasive and non-invasive differential diagnosis and treatment, concerning especially its frequency provoked by high blood pressure and female coronary heart diseases. There are highlighted all recommended diagnostic procedures available under domestic conditions.]