Clinical Neuroscience

[Devic syndrome - case report, diagnostic and therapeutic principles]

ILJICSOV Anna1, BARSI Péter2, VÁRALLYAY György2, TÁTRAI Erika3, SOMFAI Gábor Márk3, BERECZKI Dániel1, RUDAS Gábor2, SIMÓ Magdolna1

SEPTEMBER 30, 2010

Clinical Neuroscience - 2010;63(09-10)

[Neuromyelitis optica (NMO, Devic-syndrome) is a rare, relapsing autoimmun disease of the central nervous system, which is distinguished from other demyelinating disorders by a recently identified, specific autoantibody. By demonstrating the anti-aquaporin-4 IgG in the serum, a heterogenous group of syndromes can be defined, called NMO-spectrum. In the future, optical coherence tomography may support this diagnosis besides the clinical features, imaging examinations and presence of serum antibody. Early recognition and treatment can improve clinical outcome even in serious condition. Long-term immunosuppressive therapy is advised to prevent further relapses and to stabilize or improve clinical status. Hereby, we report a case of a 51-year-old woman, under treatment for 1.5 years. We summarize the up-to-date knowledge about the pathomechanism, diagnostic strategy and therapy of neuromyelitis optica. We review recent findings and the diagnostic value of a new, non-invasive ophtalmological examination, the optical coherence tomography. According to the first results, this method may be helpful in the early differential diagnosis of optic neuritis.]

AFFILIATIONS

  1. Semmelweis Egyetem, Neurológiai Klinika, Budapest
  2. Semmelweis Egyetem, Szentágothai János Tudásközpont, MR Kutatóközpont, Budapest
  3. Semmeweis Egyetem, Szemészeti Klinika, Budapest

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[Background - Bilateral deep brain stimulation of the subthalamic nuclei (STN) is a well-established and cost-effective treatment in advanced PD. Objectives - To quantitatively analyze the change in use of antiparkinsonian drugs one year after subthalamic deep brain stimulator (DBS) implantation in patients with idiopathic Parkinson’s disease (PD). Patients and methods - Eighteen consecutive patients with advanced PD underwent bilateral STN DBS implantation were involved in the study. The stimulation achieved a stable and clear clinical benefit in all of the cases. One year after the implantation, drug usage of patients was analyzed and correlated with the postoperative symptomatic improvement measured by the modified Hoehn-Yahr, Schwab and England, and Unified Parkinson’s Disease Rating Scales. Because none of the investigated variables followed the normal distribution, non-parametric Wilcoxon signed-rank, McNemar and Kendell’s τ tests were applied. Results - Preoperatively, the patients used 12.05±4.57 tablets a day out of 3.19±0.97 different antiparkinsonian drugs, which was significantly reduced by deep brain stimulation to the application of 7.00±2.96 tablets out of 1-3 (1.84±0.76) drugs (p<0.001). Meanwhile, the usage of amantadine, MAO-B and COMT inhibitors was also significantly decreased (p<0.05). The dosage of dopaminerg medication was significantly lowered from 1136 mg to 706 mg expressed in levodopa equivalent dosage (p<0.001) whereas the UPDRS-III also improved by 48.6%. Conclusion - Our study is in accordance with previously published international findings that antiparkinsonian medication can be significantly lowered after bilateral STN DBS. Because not only the dosage, but also the applied number of tablets were decreased, it may have resulted in a better compliance and quality of life.]

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