Clinical Neuroscience

[Excerpts of achievements of pharmaceutical cerebro-vascular protection, with especial regard to the statins]


MAY 20, 2011

Clinical Neuroscience - 2011;64(05-06)

[Despite that hypercholesterinemia is not a risk factor of stroke, treatment with statins is able to reduce these events in a clinically relevant degree. Intervention trials suggest that while for primary prevention, statins are effective in conventional dose, after stroke or TIA this is true only if LDL-cholesterol is reduced below 1,8 mmol/L. To reach this goal, usually intensive antilipid treatment is necessary. There are studies showing beneficial impacts of other lipid drugs, beyond statins, i.e. fibrates and fish oil (among the settings of primary, and secondary preventions, respectively). Against cerebro-vascular events, pleitropic effects of some antihypertensive and antidiabetic medications can also be established.]



Further articles in this publication

Clinical Neuroscience

[The role of sleep dynamics and delta homeostasis in cognitive functions]


[The paper is aimed to introduce the neuronal network basis of dynamic sleep processes, including the micro-structure of sleep and the relationship of sleep dynamics with homeostatic regulation and plastic changes during sleep. Newer studies tend to show that beyond the wellknown long-term homeostatic and circadian regulation of NREM sleep, sleep is regulated by a stimulus and arousal dependent flexible defense system, the elements of which participate in sleep delta homeostasis. Within the EEG elements of sleep a more larger amount represents reactible type as it was thought previously.. Both the events of wake state and sensory input during sleep are shaping the sleep EEG in a function- and localisation specific way and the next day cognitive functios are determined by these changes.]

Clinical Neuroscience

[Antinociception by endogenous ligands at peripheral level]

HORVÁTH Gyöngyi, MÉCS László

[It is well known that a multitude of ligands and receptors are involved in the nociceptive system, and some of them increase, while others inhibit the pain sensation both peripherally and centrally. These substances, including neurotransmitters, neuromodulators, hormones, cytokines etc., may modify the activity of nerves involved in the pain pathways. It is also well known that the organism can express very effective antinociception in different circumstances, and during such situations the levels of various endogenous ligands change. Accordingly, a very exciting field of pain research relates to the roles of endogenous ligands. The peripheral action may possibly be extremely important, because low doses of the endogenous ligands may reduce pain without disphoric side-effects, and without the abused potential typical of centrally acting ligands. This review provides a comprehensive overview of the endogenous ligands that can induce antinociception, discusses their effects on different receptors and focuses on their action at peripheral level. We found 17 different endogenous ligands which produced antinociception after their topical administration. The results suggest an important direction for the development of pain strategies that focus on the local administrations of different endogenous ligands.]

Clinical Neuroscience

[Neurology 2009: a survey of the neurological capacities, their utilization and neurologists based on the 2009 reports of the institutions in Hungary]


[A detailed information on the quantitative and qualitative features and the regional distribution of the current neurological services at the national level is necessary for the planning of health care provision for the future. We present the characteristics of the current neurological services analyzing the database of the National Health Insurance Fund for 2009. This database is exceptionally large and detailed compared to similar data sources in Europe. We examine the number of patients and cases treated both in hospitals and at outpatient units, and also present the distribution of major diagnoses based on ICD-10. We discuss the major problems in three groups: the decrease of capacities; the fragmentation of capacities; and the uneven distribution of workload on neurologists. Number of neurological hospital beds, weekly hours of neurological outpatient capacity, and the number of neurologists are presented. In the analysis of the utilization of capacities we give the number of patients, the number of cases and the financing of the professional performance. We characterize the workload of neurologists by the mean daily number of patients seen by a neurologist, by the number of outpatient units served by one neurologist during the year, and by the proportion of the total workload on each neurologist. Neurological capacities significantly decreased in the period of 2004-2009: 12 hospital neurological wards were closed, and with further decreases in bed numbers the original 3733 neurological beds decreased to 2812. In four counties - Bács, Heves, Tolna and Vas - only a single neurological ward survived. The capacity withdrawn from inpatient care was not transferred into outpatient services. In 2009 there were 179 hospitals and 419 independent outpatient centers in Hungary. Of the 179 hospitals 55 had neurological beds and a further 42 hospitals offered only outpatient neurological service. Neurological outpatient service is offered in Hungary altogether by 185 institutions: 97 hospitals and 88 independent outpatient centers. Suboptimal outpatient services (less than 30 hours per week) cover 57% of the outpatient capacities. There is an over fivefold difference among counties in capacities: the number of inhabitants per hospital bed ranges between 2167-13 017, and the number of inhabitants per one neurologist outpatient hour between 495-2663. In 2009 there were 1310 board certified neurologists in Hungary, of these only 834 participated at least once during the year in exclusively neurological service, and there was a large difference in workload among individual neurologists. The gross mean income of a 30-hour-per-week average neurological outpatient practice based on performance reports was 871 thousand HUF (about 4350 USD or 3160 EUR) per month. In recent years the neurological capacities significantly decreased and fragmented, do not correspond regionally to the number of population to be served, and their profitability does not cover the conditions of self sufficient operation. This analysis will help health care providers and decision makers to recognize and address the current problems and design the neurological health care system for the coming years.]

Clinical Neuroscience

[Our clinical experience with zonisamide in resistant generalized epilepsy syndromes]

KELEMEN Anna, RÁSONYI György, NEUWIRTH Magdolna, BARCS Gábor, SZŰCS Anna, JAKUS Rita, FABÓ Dániel, JUHOS Vera, PÁLFY Beatrix, HALÁSZ Péter

[Purpose - Zonisamide is licensed in the European Union for adjunctive therapy for partial epilepsy, but its efficacy in generalized epilepsy was less explored. Methods - This prospective observational study included 47 patients (mean age 29 years, range 3-50) with different resistant generalized epilepsy syndromes: idiopathic generalized syndromes (IGE) 15 patients, (juvenile myoclonic epilepsy four, absence epilepsy four, myoclonic absence two, unclassified IGE five), progressive myoclonic epilepsy type 1 (PME1) four, severe myoclonic epilepsy of infancy (SMEI) three, borderline SMEI three, Lennox-Gastaut syndrome/secondary generalized epileptic encephalopties 23 patients. All patients were followed up for at least six months. The mean dose given was 367 mg/day (range 100-600 mg/day), the patients received at least one and no more than two concomitant AE. Response was defined as more than 50% seizure reduction or seizure freedom. Results - The best effect was achieved in PME one, all the patients were responders. Myoclonic seizures were reduced 80%, none of the patients had generalized tonic clonic (GTC) seizures. In two of the four patients all other antiepileptics were tapered of (including piracetam), so they were GTC seizure and almost myoclonia free on zonisamide only. Responder rates were in GEFS ± SME 62.5%, in resistant IGE 62.5%, and in epileptic encephalopathies 33.3% patients. Tolerance after initial efficacy developed in six patients. Adverse effects were mild: weight loss, somnolence and confusion were repeatedly reported. Three patients reported cognitive improvement. Conclusion - Clinical benefit of a broad spectrum antiepileptic zonisamide extends across seizure types, ages and epilepsy syndromes. The efficacy in PME proved to be excellent.]

Clinical Neuroscience

[Neuropsychiatry - in Hungary and other countries]


All articles in the issue

Related contents

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke


Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Systemic thrombolysis and endovascular intervention in postpartum stroke]


[Introduction - There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. Case presentation - We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. Discussion - There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines - while considering pregnancy as a relative exclusion criterion - do not deal with the postpartum state. Conclusion - As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.]

Clinical Neuroscience

Comparison of hospitalized acute stroke patients’ characteristics using two large central-eastern european databases

ORBÁN-KIS Károly, SZŐCS Ildikó, FEKETE Klára, MIHÁLKA László, CSIBA László, BERECZKI Dániel, SZATMÁRI Szabolcs

Objectives – Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. Methods – In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. Results – The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke. Discussion – In summary, the comparatively analyzed data from the two large databases showed several similarities, especially regarding the high number of modifiable risk factors, and as such further effort is needed regarding primary prevention.

Hypertension and nephrology

[Cerebrovascular diseases in patients with chronic kidney disease]

KISS István, NAGY Judit

[The reason of the unfavourable life expectancy of patients with chronic kidney disease (CKD) is not only the development of end-stage renal failure but the frequent appearance of cardiovascular diseases (CVD). Chronic kidney damage itself is a cardiovascular risk state and the occurrence of CVD/associated diseases is significantly higher in chronic kidney failure. Beside risk stratification and valid treatment of CVD (hypertension, diabetes mellitus, ischemic heart disease e.g.) we and the international nephrological community have left the cerebrovascular diseases of CKD patients out of consideration. However, up to 50% of patients suffering a stroke will die immediately, only 10% of stroke survivors can continue his/her profession, but the others will be permanently disabled. High blood pressure is a strong predictor of stroke and of other CVD in most of the patients. In stroke risk reduction it is particularly important to reach the target blood pressure values. The main object of the “Live under 140/90 mmHg” programme of the Hungarian Society of Hypertension is to familiarize with target blood pressure itself and how to reach target blood pressure. In 2010, prevention, early diagnosis and management of stroke are the most important challenges of this programme (The Brain Control Programme). We think it is advisable to prepare and publish a clinical practice guideline in collaboration with stroke societies which is similar to the guidelines of international societies and of the Hungarian Society of Stroke but specific for CKD patients. This guideline would help to give a uniform, up-to-date treatment for the cerebrovascular diseases of CKD patients.]

Clinical Neuroscience

Utilization of acute vascular imaging and neurointervention for acute ischaemic stroke patients in 20 Hungarian stroke centers

POZSEGOVITS Krisztián, SZABÓ Géza, SZUPERA Zoltán, NAGY Péter, NÉMETH László, KONDÁKOR István, TUSA Csaba, BERENTE László, SALACZ Pál, VÉCSEI László, SAS Katalin, SEMJÉN Judit, NIKL János, SZAPÁRY László, KAKUK Anikó, RÓZSA Csilla, HORVÁTH Melinda, IMRE Piroska, KÖVES Ágnes, BALOGH István, MOLNÁR Sándor, FOLYOVICH András, AL-MUHANNA Nadim, BÉRES-MOLNÁR Katalin Anna, HAHN Katalin, KRISTÓF Piroska, SZÁSZ Attila Sándor, SZŰCS Anna, BERECZKI Dániel

Background - Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. Subjects and methods - We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centres before 31st August 2016. Results - Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. Conclusion - Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro­intervention capacity needing improvement.