Clinical Neuroscience

[Effective, safe stroke prevention with novel oral anticoagulants in patients with atrial fibrillation. Focus on dabigatran]

SZAPÁRY László, FEHÉR Gergely, BOSNYÁK Edit, DELI Gabriella, CSÉCSEI Péter

MAY 30, 2013

Clinical Neuroscience - 2013;66(05-06)

[Non-valvular AF is the most common cardiac arrhytmia. Its incidence increases with age. AF is an independent risk factor for ischaemic stroke, representing a five times higher risk for it, associated with a high mortality rate. Beside AF, there are several other risk factors which influence the risk of stroke. Stroke risk calculator can be used to assess the risk of patient having a stroke. The most endangered group of patients with AF are those who have already suffered from cerebrovascular event. The only effective medication for prevention of stroke due to AF had been the application of vitamin K antagonists (VKA) which considerably decrease the rate of ischaemic event in a patient with AF providing that the INR is in the therapeutic range. VKA have several limitations of use in clinical practice and the fear of bleeding complications results an underusing of these drugs. Only 50% of all patients treated with VKA reaches the therapeutic range of INR. The breakthrough of prevention of stroke in recent years is undisputedly the coming out of novel oral anticoagulants (NOACs, thrombin and Xa-factor inhibitors). Recent studies suggest that these novel drugs prove the same efficacy as VKA drugs, furthermore dabigatran in a dose of 2×150 mg or apixaban in 2×5mg was statistically superior to warfarin in the prevention of stroke. NOACs have shown a large reduction in intracranial hemorrhage compared with warfarin. They are given as a fixed dose and do not require persistent monitoring making them much more convenient. NOACs at guidelines of European Society of Cardiology act as a preferable drugs in case of ischaemic stroke with AF. Probably the extended use of NOACs in clinical practice will be the mainstream of stroke prevention in the future.]

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[Background - Multiple sclerosis (MS) is an autoimmune degenerating disease, where myelin degradation as well as axonal loss is present. Purpose - To asses whether recording the middle-latency components of the median nerve somatosensory evoked potentials (SEPs) increases the diagnostic sensitivity in patients with MS, and to investigate whether any of the abnormalities correlates with the severity of the clinical signs and predicts future outcome. Methods - Twenty consecutive MS patients at early onset were included. Median and tibial nerve SEPs were recorded at the time of the referral. Extended Disability Status Scale (EDSS) and Multiple Sclerosis Severity Score (MSSS) were assessed at the time of the referral and after 5-year followup. Results - Recording the middle-latency components increased the sensitivity of the median nerve SEPs from 50% to 75%. The overall sensitivity of the SEPs (i.e. including also tibial nerve SEPs) modestly increased (from 80% to 90%). The amplitude of the cortical N20 potential of the median nerve was inversely correlated to the clinical severity. None of the parameters could predict the future outcome. Conclusions - Our results provide neurophysiological evidence for the role of axonal lesions in the clinical disability of the patients with MS.]

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[Hypotonia in the neonatal period and early infancy is a common clinical finding. It can be caused by various heterogeneous disorders of different origin which might lead to diagnostic difficulties. Disorders of the neuromuscular junction, such as congenital myasthenic syndromes and neonatal transient myasthenia gravis are among the aetiologies. We report on a case of congenital myasthenia caused by mutation in the long cytoplasmic loop of the epsilon subunit of the acetylcholine receptor and a neonate of a myasthenic mother diagnosed with transient myasthenia gravis.]

Clinical Neuroscience

[Comment]

KOMOLY Sámuel, KOVÁCS Norbert, JANSZKY József, ASCHERMANN Zsuzsanna, DÓCZI Tamás, BALÁS István, DELI Gabriella

Clinical Neuroscience

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[The incidence of neurological diseases increases. The up to date diagnostics and therapeutics approaches require the cost-effective and personalized solutions. The nanomedicine now, - and likely more in the future - opens a new horizon in the treatment of neurological diseases. The nano-size materials have several advantages that make it their use as drug delivery systems, and imaging agent. Very important aspect is that these materials can transfer across the bloodbrain barrier. The functionalization and surface modification of nanomaterials enhances this effect. The authors summarize of neurological application of nanoparticles according to the current data. They provide an overview about the most common used nanomedical materials, targeted drug delivery mechanisms and nano-imaging opportunities.]

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