Clinical Neuroscience

[Dementia and related problems '93. an overview]

TARISKA Péter1

MARCH 20, 1994

Clinical Neuroscience - 1994;47(03-04)

[Based on extensive investigations carried out the epidemiology of dementias in the last decade in Europe the methodology has become unified. The most important elements are: two-step screening in two time periods, population of 4000 or more, unified screening and diagnostic methods. The incidence was 1 p.c. established in the population between the ages of 60–64; the proportion nearly doubled in each 5 year period. Regarding the recently published risk factors of Alzheimer's disease (AD) the possible protective role of smoking and the low educational level seem to be very interesting. In the group of AAMI the biological life events as possible causative factors seem to be of importance. The functional assesment scale of Reisberg is reported from psychometric tests. An outline is given about the clinical diagnostic criteria of AD and vascular dementias based on the widely discussed system published on the latter in 1993. The problems of different clinical subtypes of AD with relevance to biochemical markers are discussed as are the diganostic criteria of Lewy body type dementia. A summary on some new etological results (genetic heterogenety, new possible ways of amyloidogenesis, glutamate-theory, etc.) is given. After highlihgting the importance of the different kinds of psychotherapy and mental training, social factors are stressed, and some ethical conflict situations (driving, coercive measures, etc.) are shortly presented.]

AFFILIATIONS

  1. Országos Pszichiátriai és Neurológiai Intézet Memória Klinikája

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Clinical Neuroscience

[The history of Hungarian neurology (Part I)]

BEKÉNY György

[Every nation has its great people of whom it is proud. In our country, intellectuals think that Hungarians are particularly talented in music and mathematics. However, our outstanding geneticist believes that the genetic background of different abilities is equal between nations and that the different results are caused by external circumstances. Indeed, the "accumulation" of great Hungarian conductors and musicians in the United States, and the careers of many Nobel Prize-winning mathematicians and physicists in the United States, were made possible by the fact that they had to leave their homeland for political reasons. Contrary to what is suggested above, the first 50 years of a very successful and internationally respected period of Hungarian neuroscience were hampered by these circumstances. All the more reason to appreciate the neurological output of this period. I would be glad if the readers of this work would share this opinion. I have selected those publications for illustration which appeared in the so-called 'world languages'. The only exceptions are monographs, theses and one or two major works, some of which have already been published in a foreign language. Due to the limitations of space, many areas of neuroscience could not be discussed. Thus, I have not been able to write about international greats in neuroanatomy such as Mihály Lenhossék, Apáthy, Szentágothai; about neurophysiologists, especially those working on the cochleovestibular system such as Hőgyes, Bárány, Békésy; about neuroendocrinology or about many details of neurochemistry. The importance of neurosurgery, which is closely related to our subject, calls for a separate presentation. A small monograph on the history of Hungarian neuroscience was published in 1976 by István Környey, a great teacher and scholar of Hungarian neurology. In 1992, Zoltán Nagy published a history of Hungarian neurology in the last century under the title Hungarian Neurology in The Last Century. These historical summaries were important precursors to my present work. ]

Clinical Neuroscience

[Voltage mapping studies of generalized spike- wave patterns associated with absence seizures]

CLEMENS Béla

[In this retrospective study, scalp electric fields of ictal generalized spike-wave discharges were analized by the so-called topographic voltage mapping method. The 17 patients displaying absences (with or without other seizures) belonged to different age groups and diverse epileptic syndromes. Main results: 1. Maps derived at the points of the spike and the wave components belong to different classes. A-type spikes show frontal, P-type spikes show posterior voltage maxima. Also atypical spike (map) configurations exist. 2. A spike maps frequently show a characteristic modification along the GSW pattern. 3. Waves can display bilateral (L) or medial (M) frontal voltage maxima. 4. At least in the time window of several weeks, the dominant spike map pattern and the pattern of the waveform was characteristic to each patient. Configurations of the different spike and wave components show some relation to a limited set of clinical data. The combination of A- spikes with L-waves was found in children who had , typical" absence- epilepsies. On the contrary, irregular spectrum of different spikes and M-waves was found in elder absence patients showing rather unfavorable course of their illness.]

Clinical Neuroscience

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[Sceletal muscle biopsy specimens from patients with various inflammatory myopathies – dermatomyositis, polymyositis and inclusion body myositis – have been investigated by immunocytochemical methods with the help of monoclonal antibodies. Conclusions about the pathomechanism of these disorders were saught. In dermatomyositis the humoral immunity and the damage of the small vessels of muscle fibres may play an important role. The appearance of class I MHC antigens on diseased muscle may make the affected tissue a target for cytotoxic T8 cells, and may thus have a role in muscle fibre damage in polymyositis and inclusion body myositis.]

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[An attempt is made to establish relationships between CT parameters and the achievements on the Mini Mental State (MMS) scale of patients suffering from various types of dementia. The results suggest that the Mini Mental State scores change together in Alzheimer's type of dementias, referring to the global deterioration of functions in contrast to the vascular type of dementias, where the scores on each item change independently of each other. In the combined examination of the two groups the parietal lobe and the volume of the ventricles showed mainly connection with the neuropsychological functions. ]

Clinical Neuroscience

[Thrombolysis in the treatment of acute ischemic stroke]

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[Stroke is the third common cause of death and the main cause of disability in Hungary. Despite of the intensive preclinical and clinical research on the pathophysiology and therapy of ischemic stroke, there is no treatment to improve the prognosis of brain infarct. Thrombolysis could be hypothetically a causative intervention, what makes the vascular bed patent again (recanalisation hypothesis). The different thrombolysis trials, meta-analysis, and case reports indicated, that the early hospitalisation, well planed diagnostic algorithm including CT and analysis of hemostasis factors are important. The high risk complications like haemorrhagic transformation of the infarct or edema are not dose related. Timing of the lysis therapy is fundamental, therefore the well organised stroke management in our country seems to be a basic factor in the acute treatment of stroke patients.]

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