Clinical Neuroscience

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SZOK Délia

SEPTEMBER 30, 2012

Clinical Neuroscience - 2012;65(09-10)

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Clinical Neuroscience

[Rivaroxaban versus warfarin: results of the ROCKET study]

LIPTÁK Judit

Clinical Neuroscience

[A prospective study evaluating the clinical characteristics of cluster headache]

ERTSEY Csaba, VESZA Zsófia, BANGÓ Márta, VARGA Tímea, NAGYIDEI Diána, MANHALTER Nóra, BOZSIK György

[Introduction - Although cluster headache (CH) is one of the most severe human pain syndromes, its symptoms and therapeutic possibilities may be suboptimally recognised in current medical practice in Hungary. Aim - To present the clinical characteristics of CH based on a prospective study of patients attending the Headache Service of the Department of Neurology, Semmelweis University. Methods - We collected information about the symptoms, diagnosis and previous treatment of CH patients by filling in a 108-item questionnaire during outpatient visits. Results - In the 5-year period between 2004 and 2008 we obtained data from 78 CH patients (57 males and 21 females; mean age: 44.6±14.6 years). The male:female ratio did not change in subgroups based on disease onset (calendar years). Ninety-three percent considered CH the most severe pain state of their life. The pain was strictly unilateral, affecting the territory of the 1st trigeminal division in all patients. The attacks were accompanied by signs of ipsilateral cranial parasympathetic activation (lactimation 83%, conjunctival injection 67%, rhinorrhea 56%, nasal congestion 43%); less frequently, signs of sympathetic dysfunction (ptosis 48%, miosis 7%) were also present. Two patients had attacks showing the typical localisation, severity and time course of CH attacks, but not accompanied by autonomic phenomena. A considerable part of the patients also observed symptoms that are usually ascribed to migraine (nausea 41%, vomiting 18%, photophobia 68%, phonophobia 58%). This may have been instrumental in the fact that, regardless of the characteristic clinical symptoms, the diagnosis of CH took 10 years on average. At the time of their examination 63% of patients were not using adequate abortive medications and 59% did not have an adequate prophylactic measure. Discussion - Cluster headache is characterised by attacks of devastating pain that warrant an early diagnosis and adequate treatment. Our study underlines that information about the diagnosis and therapy of CH should be emphasized on occasions of neurology specialty training and continuing medical education.]

Clinical Neuroscience

[In memoriam Professor Ervin Paraicz (1927-2012)]

GYÖRGY Ilona

Clinical Neuroscience

[Tissue water content determination based on T1 relaxation time of water and quantitative cerebral 1H MRS at 3T using water as an internal reference]

FILE Györgyi, BAJZIK Gábor, DÓCZI Tamás, ORSI Gergely, PERLAKI Gábor, LELOVICS Zsuzsanna, ARADI Mihály, SCHWARCZ Attila

[Objective - Application of a quantitative MR-spectroscopic method for 3T clinical scanners based on tissue water content as an internal reference. Patients and methods - Six (22±2 yrs) volunteers were involved in the study. We performed T1 relaxation time measurements in a particular slice of the brain at 1T and 3T. Based on the validated water content measurement at 1T, the correlation of relaxation time T1 and water content was determined at 3T. The resulting water content served as internal reference for the quantification of localizated MRspectroscopic measurement. Results - At 3T our method resulted in 37.6±0.5 mol/l and 46.4±1.5 mol/l tissue water content in the white and gray matter, respectively. Calibration based on water content led to following metabolite concentrations: N-acetyl-aspartate 7.79±0.67 mmol/l; creatine 3.76±0.28 mmol/l; choline 3.68±0.47 mmol/l; myo-inositol 10.35±3.70 mmol/l in the white matter; and N-acetyl-aspartate 8.20±0.45 mmol/l; creatine 4.76±0.18 mmol/l; choline 2.64±0.35 mmol/l; myo-inositol 8.32±1.42 mmol/l in the grey matter. Conclusions - Tissue water content based on T1 value at 3T shows good accordance with gravimetric or other MR methods in the literature. Using it as an internal reference resulted in white matter metabolite concentrations that are in the range of previously published data. Comparing metabolite values of grey matter is more difficult because data in the literature substantially differ. The presented method is simple and easily applicable on any MR scanner without complicated correction and calibration steps.]

Clinical Neuroscience

[Dear Colleagues!]

RAJNA Péter

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[Interferon-α proved to be the most effective therapy of chronic hepatitis C. Its combination with ribavirin enhances the antiviral activity and this modality has become the therapeutic standard recommended worldwide during the past few years. Metaanalysis of the international studies revealed that only 12-19% of the patients became virus-free following a 48-week long course of α interferon monotherapy. The combination treatment with ribavirin for 48 weeks increased the proportion of sustained responders to 35-45%. The introduction of pegylated interferons resulted in significantly higher response rates. The new therapeutic possibilities are due to the modified pharmacokinetic characteristics of the drug by changing the size and the structure of the molecules. Multicentre studies investigating the clinical effectiveness of the 40 kD sized pegylated interferon α-2a as well as the 12 kD sized pegylated interferon α-2b in combination with ribavirin reported 56% and 54% response rate, respectively. However, there is significant heterogeneity in the results according to the type of drug administered and to the genotype of the hepatitis C virus, as well as in the basal viral level and the stage of hepatic fibrosis, respectively. The message and the conclusion of the viral kinetic studies are worth remembering: if the result of the HCV nucleic acid test is still positive at week 12 or 24, therapy should be ceased due to the patient non-responder status. Since pegylated interferons are also available in Hungary the authors felt useful to give an overview of the current knowledge, summarizing the results of the relevant studies and provide a suggested state-of-the-art therapeutic protocol based on international consensus.]

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RADÓ János

[After the occurrence of varicella viruses remain in a latent condition in the ganglions, but could be reactivated from here causing the disease of herpes zoster. In the years of 1960, we described a herpes zoster „house epidemic” where only the steroid treated patients were infected. Varicella zoster virus was identified by virological methods. Also in a steroid treated patient fatal meningoencephalitis was caused by the generalized herpes zoster. The VZ infection was obviously potentiated by the steroid. Our publications about the interaction between the VZ virus and steroid treatment was echoed – among others – by an editorial of four leading medical journals. Investigators of a NASA medical group also cited our articles. They found during and after spaceflight that in the astronauts symptomless reactivation of the VZ virus, EBV and CMV occurred which was contributed to the stress induced hypercortisolemia. Today we see more worries in the prognosis and outlook in certain cases of the herpes zoster than before. One reason of that is the high number of newly recognized complications. Recently also several new pathway of pathomechanisms has been explored, which led to serious risks. In addition, it turned out that in certain disorders as the artheritis temporalis, where today antivirus antibiotic is the first choice drug, instead of steroid administered alone in the past, inducing further progression in the basic disease and sometimes fatal complications when given too long. Nephrological patients are at special risk in the presence of chronic renal disease, high age and associated diabetes mellitus. The risk may even increase after an otherwise successful renal transplantation in response to the administration of steroids and other compounds. Fortunately in the meantime a vaccine was developed against the VZ virus, studied in large populations and found to be very effective. It probably will be a benediction to the old people with chronic renal disease, after transplantation as well as in others suffering from high risk diseases.]

Clinical Neuroscience

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RAJNA Péter

Clinical Neuroscience

[Editorial comment]

RAJNA Péter

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