Clinical Neuroscience

[Electrophysiological changes after local electron irradiation of the brain]

PÁSZTOR András1, TOMKA Imre1, SARKADI Ádám1

AUGUST 01, 1969

Clinical Neuroscience - 1969;22(08)

[The somatosensory area of the cat brain was irradiated with electron beams from a Van de Graaf generator. The electroencephalographic changes following irradiation were studied using chronic epidural and deep electrodes. 1. Within the 50-210 Krad radiation range, the higher the radiant intensity applied, the sooner the irritative phase occurred and the more pronounced the activation of the curves. 2. 3. The excitatory stage was followed by a depressive EEG phase lasting one to two days, characterized by intact occipital alpha activity in addition to local permanent flattening. 4. In 210 Krad dozis, the lesions were irreversible. The EEG picture appeared to be normalized for doses of 50-150 Krad, but electrical activity in the deep structures remained reduced throughout. The animals lost sensation and tactile function and none of them regained it during the 2-month survival period. 5. The reduced electrical activity in the ventrobasal structures of the thalamus was associated with retrograde cell degeneration through thalamo-cortical connections.]

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Clinical Neuroscience

[Study of the antiepileptic effect of Seduxen (Chronic Diazepam treatment)]

HALÁSZ Péter, MOLNÁR Gyula, HIDASI József

[The most striking feature of the clinical and EEG effects of Sx is the initial strong antiepileptic effect, followed by a return of seizures as the EEG deteriorates. Similar experiences were reported by Trolle (1965), who, after a pause in the treatment, observed a return to the initial good effect on renewed administration. The findings of our EEG studies suggest not simply a loss of effect due to chronic use, but that after a while the effect of Sx is reversed and now no longer improves but worsens the epileptic mechanism in the direction of the grand mal mechanism (repetitive spikes). The hypersensitivity to the pharmacological denervation induced by the drug is most likely to underlie such a drug effect. However, further studies on this point are needed. In our experience, in the PM. varians epilepsy mechanism, Sx is very effective in preventing spike-wave paroxysms and the corresponding clinical seizures. However, in all cases of repetitive rapid discharges in sleep, it should be used with caution, as the susceptibility to such discharges is increased by Sx. The best clinical effect was obtained in patients with temporal epilepsy resistant to other medications, despite the fact that EEG foci were not completely suppressed by Sx. Probably just as we have seen with Valium, it abolishes generalisational potentials. The effect of Sx on petit mal epilepsy in 2 patients is of course not established, but the initial good effect seen in other epilepsy types was not seen in both patients and the spike-wave mechanism in both cases shifted towards a grand mal mechanism. Compared with foreign Valium, qualitatively quite similar effects were observed in 6 cases. In some patients, the antiepileptic effect of per os Sx was stronger than that of injected Valium, probably because of the more consistent and sustained blood levels. It can therefore be concluded that in drug-resistant severe epileptic patients, Sx given for about 4 weeks has proven to be a very effective antiepileptic adjuvant. We consider it probable - and this would coincide with the hypothesis of the development of denervation hypersensitivity - that by taking drug breaks, the long-term treatment with S adverse effect on the patient will be prevented. Nevertheless, the indications for diazepam are mainly in the treatment of frequent seizures resistant to other drugs, cumulative seizures or status epilepticus, in the form of i.V. shock therapy.]

Clinical Neuroscience

[Mental hygiene (mental health protection) some questions on the organisation of ]

PANETH Gábor

[We can only talk about modern standards in the psychiatric sector of health care for the population if we set our approach and organisation at the level of mental hygiene. This is a major challenge, partly because of a lack of vision, decades of neglect and serious cadre problems, and partly because of the proliferation of problems in this area. In this overview study, we will discuss in general terms the problems, facts and ideas that the mental hygiene doctor working in this field encounters, and more specifically what is being achieved in Csepel under relatively favourable conditions.]

Clinical Neuroscience

[Distribution of "external" cholinesterase activity in the brainstem and telencephalon of the domestic rabbit based on histochemical studies]

PAPP Mátyás

[According to Gerebtzoff, using the modified Koelle method, it can be shown in the rabbit CNS that the cell clusters with "external" cholinesterase activity are roughly identical to the termination sites of the cholinesterase-containing systems (ascending cholinergic reticular system, cholinergic limbic system) described in Shute and Lewis in the rat. Some bundles of fibres belonging to these cholinesterase-containing systems can be observed without pathological evidence.]

Clinical Neuroscience

[Essential familial myoclonus]

ZONDA Tamás, SZABÓ Endre

[Authors describe the literature on the pathology of essentialis familiaris myoclonus and the evolution of the concept of the pathology. They share their own observed cases within a family. They discuss diagnostic difficulties and differential diagnosis of the syndrome. They describe the hereditary history of their family. ]

Clinical Neuroscience

[The operation of the neurological institutes in 1967 ]

SIMEK Zsófia

[1. The tasks set for the I.I.s can only be achieved if in the coming years local administrations make it possible to have a psychiatrist (in care) for every 40-50 000 inhabitants. Debrecen and Budapest are currently the closest to this, but in most counties (especially those without a mental health bed) it is a major problem to achieve this. To achieve this plan would require about 250 psychiatrists working in the care network. At the beginning of 1968 (including hospital psychiatrists) the number of psychiatrists was 210. Given the need to increase the number of psychiatric beds in the same period, training of specialists is essential. Temporary neurologists working in outpatient clinics, who currently treat neurotic patients for a large part of their practice, could be called in to help. The total number of neurologists at the beginning of 1968 was 292. 2. there is a need to draw up a code of organisation and operation which will enable the psychiatrists working in the I.I. under the present framework to see their tasks clearly and to interpret them uniformly in the care of both the urban and the rural population. 3. To address common professional and other problems in the form of training, methodological letters and other written material. 4. The need to implement close functional cooperation between the I.I.s and hospital departments. 5. Starting from the existing neurosurgeons, prepare for the complex tasks of the future by providing adequate space and specialists.]

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Clinical Neuroscience

Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.