Clinical Neuroscience

[EDITORIAL MESSAGE]

KOPNICZKY Zsolt

OCTOBER 05, 2013

Clinical Neuroscience - 2013;66(09-10)

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Clinical Neuroscience

[CONGRESS CALENDAR]

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[The diagnosis of herpesencephalitis - a case-based update]

CSONKA Tamás, SZEPESI Rita, BIDIGA László, MÓZES Péter, KLEKNER Álmos, HUTÓCZKY Gábor, CSIBA László, MÉHES Gábor, HORTOBÁGYI Tibor

[Herpes simplex virus encephalitis (HSVE) is a rare and lifethreatening infection. The clinical signs are diverse and often misleading regarding the aetiology. However, focal seizure with fewer and typical CT/MRI finding should always raise the possibility of HSVE as early diagnosis and antiviral therapy is crucial. Before the advent of molecular techniques and high-tech imaging histological examination from multiple brain biopsies were often necessary. Although nowadays PCR and other molecular methods may provide an aetiological diagnosis some cases need neuropathological verification. Due to the high IgG seropositivity rate in the population the plasma IgG titer is not diagnostic and elevation of its plasma level requires several weeks. We report the case of a 25-years old male patient who initially presented with epileptic fits. There was no final diagnosis and causal treatment in the district general hospital. The patient was admitted to our institution in comatose state on day 9; the initiated diagnostic tests and therapy could not save the patient who died next day. The autopsy and subsequent neuropathological examination revealed HSVE. We present a flowchart on diagnostic work-up and special techniques to aid diagnosis in suspected viral encephalitis.]

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[Report on the scientific session of Környey society in 2013]

KOPA János

Clinical Neuroscience

[The impact of the vitamin D in neurological diseases and neurorehabilitation: from demencia to multiple sclerosis. Part I: The role of the vitamin D in the prevetion and treatment of multiple sclerosis]

SPEER Gábor

[The world-wide incidence of vitamin D deficiency is high, independently of age. Multiple sclerosis is a chronic disorder, occuring in those who possess or are exposed to a combination of genetic and environmental risk factors. One of the environmental factors associated with the development is vitamin D. Vitamin D is an immunomodulatory agent, its role is verified in many of autoimmune diseases. Vitamin D inhibits IL-6, IL-17 and IL-23 secretions which are crucial in Th1 and Th17 differentiation and also decreases proinflammatorical cytokine production. Moreover it enhances the immunosuppressive IL-10 cytokine secretion and inhibits the T-reg cell development. These cytokines and cells are essential for the pathomechanism of multiple sclerosis. Data have shown, that the vitamin D levels above 100 nmol/l (40 ng/ml) is essential for the prevention of multiple sclerosis. Below this level the vitamin D supplementation is reasonable. In pregnancy, the vitamin D deficiency at the last two semester increases the risk for the multiple sclerosis of the infant. The optimal vitamin D level for multiple sclerosis patients is 100-150 nmol/l (40-60 ng/ml). There is no consensus for the role of vitamin D in multiple sclerosis yet, but until the achieving this, the diagnosis and the treatment of the vitamin D deficiency is crucial for scelrosis multiplex patients and in cases of elevated risk. Data shows, that in patient with multiple sclerosis the normal vitamin D level is suboptimal, however the exact role of vitamin D and doses must be clarified by interventional studies.]

Clinical Neuroscience

[The status of neurology and psychiatry at the beginning of 21st century - common origins, similar difficulties, possible solutions]

OSVÁTH Péter

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[While the expected life-time increases dementias will show a pandemic nature. Author analyses the special medical and social concerns of severe states of Alzheimer disease. Having introduced the epidemiologic, diagnostic data and forms of palliatíve therapies he concentrates on the hitherto unsolved problems of patients and caregivers. He belongs to the experts identifying the Alzheimer diseases as a forced aging process. Accepted the theory of L. Hayflick he evaluates the aging process in frame of an evolution model. He states that for aged human beings having already performed the task of reproduction further conditions of living circumstances and even that of death are no more programmed. This hypothesis may have a very negative content at the first sense. But the author rather considers the uncertainty of aging a positive message. He establishes that the occurrence of degenerative processes connecting the aging must be limited by preventive interventions far more efficient than the present possibilities. Concerning these steps we are still on the level of recommendations for preserving our general health and data of relevant science are quite contradictory. Although criteria of “healthy", “qualified” or “assumable” aging are getting defined, we still do not know exactly how we should live optimally and what should we do for this in different epochs of our life. Somatic and psychological parameters are lacking which would be able to signalize the actual level of the aging process in a given person. We, physicians, also do not have exact opinion on the level of severity of dementias at which the patient already lost his her features of personality and individuality on an irreversible way. We have no idea on the phase when the ratio of joy and suffer falls below the value of 1.0 because we still have no tool for its measure. The author pointed the necessity of acceptance of a new preventive attitude and application of new methods in the medical care of the forced or pathological aging, instead of the present approaches based on the “wait and treat” attitude. Because of the intensive increase of the patient population the identification and care of patients can be efficient with a much more involvement of the basic medical network. Financial background can be improved by new theoretical bases of criteria of the palliative treatments. But the direct professional programs can be planned after solution of the existing moral and social dilemmas.]

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[Editorial message]

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[The aim of the author is present a practical MRI guideline for partners clinicians working in general or specialist patient care related to musculoskeletal diseases. The evidence based diagnostic decision-making process requires specific and realistic expectations related to MRI in daily practice. The focus message of the article is that the more exact and specific clinical question arrives, the more accurate and precise answer of the radiologist is achieved. The importance of detailed clinical information based optimal planning is emphasized versus “general” studies based on poor clinical information. It is not less important for the referring physician to prepare and inform the patient prior to the MRI study, with the exclusion criteria and contrast agent application all explained. Very few technical details are presented, only as little as possible to understand the clinically relevant properties of the imaging process.]

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[Medical and supportive tasks for patients with severe dementia ]

RAJNA Péter

[This summarizing paper demonstrates the main elements and tasks of severe dementia care of patients. Dementia care is provided on three levels of competence: level of specialist’s, that of physician’s and of caregiver’s/supporter’s. Because of increasing gravity of tasks during the progression of dementia the caregivers become(s) risk-persons from psychopathological points of views. The most important tasks of the everyday care are summarized in tables and the main factors of predominantly emotional character, which can limit the results are also demonstrated. Application of some up-to-date institutional solutions, which can optimize the patients’ care is also listed. Supposing an ever increasing burden of dementia care, author delivers an important message also for members of the younger generations. ]