Clinical Neuroscience

[Electrostimulation treatment of rats caused by barbiturate derivatives]

OSZLÁNSZKY Ottó1

NOVEMBER 01, 1959

Clinical Neuroscience - 1959;12(11)

[Based on literature and our experience, we have described the treatment of barbiturate coma. The backbone of modern therapy is the central and peripheral ESt, the methodology and results of which were described and compared with the literature. Theories on the mechanism of action of ESt were outlined. We consider the most probable is the normalization of the reduction of barbiturate block-induced activation of the reticular activating system by extra nociceptive stimuli, and we consider ESt as such a nociceptive stimulus. ]

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  1. Debreceni Orvostudományi Egyetem Ideg-és Elmegyógyászati Klinika

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Clinical Neuroscience

[Neurological complications of congenital vitium]

PÉTER Ágnes, SZUTRÉLY Gyula

[62 patients with congenital vitium were observed. Of these, 41 underwent regular neurological and 28 EEG examinations. Neurological complications were found in more than 50% (23) of the 41 cases, a higher percentage than the average reported in the literature. It is our hypothesis that to understand the pathomechanism of neurological lesions associated with congenital vitium, patients should be divided into two groups : 1) those in whom cerebral lesions are due to altered haemodynamic conditions and 2) those in whom hypoxaemia is the impairing factor. We analysed the clinical signs produced by hypoxaemia in our patient population and inferred the hypoxaemic tolerance of the brain. In our patients with non-cyanotic congenital vitium (4), we observed signs of reversible functional alteration of the nervous system on load, reversal of the shunt. However, this acute hypoxaemia led to irreversible damage in only one patient with vitium associated with sacer. In our neurologically negative cyanotic patients (6), we attributed the absence of symptoms to compensatory factors (vasodilatation, polyglobulia, etc.) for hypoxaemia. We found that polyglobulia does not parallel the degree of hypoxaemia. It is likely that these two compensating factors interact to varying degrees. Our neurologically negative cyanotic patients provide evidence that chronic hypoxaemia does not imply chronic hypoxydosis. We divided our cyanotic neurologically positive patients into 2 main groups, the complicated compensated adapted and the decompensated adapted. The former group includes 2 patients with cerebral abscesses. These are examples of damage caused by factors that confer adaptation. We have also found symptoms of cerebral anaemia as an acute manifestation of adaptations decompensated to exertion in our cyanotic patients. However, in these patients, unlike in non-cyanotic patients with vitium, we detected a certain percentage of irreversible lesions in the form of abnormal EEG even without loss of consciousness. We found two basic types of adverse effects of chronic hypoxaemia. Both are mainly reflected in EEG lesions. One is the consequence of serial loss of consciousness, the other is the cumulative effect of reversible impairment induced by acute hypoxaemia.]

Clinical Neuroscience

[Rare neurological lues: acute onset of Nissl-Alzheimer f. capillaris endarteritis meningoencephalitis]

DOBI Sándor

[The clinical presentation and pathological findings of luesian meningoencephalitis in Heveny and its sequelae were described. This case of luesian meningoencephalitis was based on an older and unclear origin of infection caused by Nissl-Alzheimer f. endarteriitis syphilitica. The luesian origin of the endarteritis in question and the primary nature of the vascular wall proliferation are confirmed by our findings and we emphasize that a similar encounter : acute luesian meningoencephalitis in the context of Nissl-Alzheimer f. endarteriitis is not described in previous reports.]

Clinical Neuroscience

[New data on the clinical and physiological relevance of nocturnal and diurnal epileptic seizures]

KAJTOR Ferenc, NAGY A. Tibor

[In a study of three hundred epileptic patients, the authors found a strong correlation between the occurrence of seizures during sleep (nocturnal) or during wakefulness (diurnal) and the anatomo-functional organisation of the epileptogenic focus. Sleep provides the most favourable association of preeconvulsive conditions for foci of the mediobasal stock of the temporal lobe, the anterior frontal and temporo-parieto-occipital convexity. Posterior frontal, central, parietal and external temporal cortical foci are primarily under the convulsive influence of wakefulness; focal motor or sensory motor seizures are awakened at night. The time of day at which the seizure occurs and the wakefulness it causes is itself a clinical manifestation of the focus, which also reflects some of the physiological functions of the focus, probably its role in inhibiting or facilitating wakefulness, attention and behavioural processes.]

Clinical Neuroscience

[The use of concomitant Tetracor-Evipan in the electroencephalographic diagnosis of epileptic seizures]

SOMOGYI István

[1. concurrent tetracor-evipan combined exercise in 93 predominantly unselected patients. Depth of sleep was deepened to Loomis f. stage C-D. 2. Combined loading was significantly more effective than simultaneous loading in the same patients. There were no cases in which the combined exercise was negative when either tetracor or evipan exercise was positive in the same patient, but there were 22 cases in which tetracor exercise was negative in patients in whom the combined exercise was positive. The same was true, although not as predominantly so because of fewer cases, for evipan loading. 3. No generalised seizures occurred during combined exercise. 4. The curve was not disturbed by artefacts or muscle potentials. The patient had the least "unpleasant" experience. 5. Based on the results, combined tetracor-evipan loading seems to be more effective than simultaneous loading and can be used as a routine method.]

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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

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

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Clinical Neuroscience

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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.

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

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Clinical Neuroscience

Atypical presentation of late-onset Sandhoff disease: a case report

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Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.