Clinical Neuroscience

[Extension of polynomial analysis of interstitial I-125 brachytherapy for 48 months]


JULY 20, 2011

Clinical Neuroscience - 2011;64(07-08)

[Objective - Previously we described from 20 patients’ data with our new “polynomial prediction approach” the volumetrical changes following gliomas I-125 brachytherapy. The aim of this study is to extend the polynomials for 48 months, and to carry out multivarial analysis of several different aspects. Methods - 20 inoperable low-grade gliomas were followed for a 48-month period after I-125 interstitial irradiation. The delivered dose on the tumor surface was 50-60 Gy. Dose planning and image fusion were done with the BrainLab Target 1.19 software, mathematical and statistical computations were carried out with the Matlab numeric computation and visualization software. Volumes of tumor necrosis, reactive zone and edema referred to as “triple ring” were measured on image fused control MRI and planning CT images. The measured volumes were normalized with respect to the reference volumes. Mean values of volumes were determined, then polynomials were fitted to the mean using the polynomial curve fitting method. The accuracy of our results was verified by correlating the predicted data with the measured ones. Results - We have found that the edema reaches its maximum two times after irradiation during the 48 months follow up period. We have shown that small tumors react more rapidly and creating greater volumes of the “triple ring” than bigger ones. Conclusions - The polynomial prediction approach proposed here reveals the dynamics of triple ring for 48 months. The derived polynomials and the multivarial analysis carried out afterwords help to (i) design the best treatment, (ii) follow up the patient's condition and (iii) plan reirradiation if necessary.]



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Clinical Neuroscience

[Criticism to neurological services and suggestions for improving it based on the article of Dániel Bereczki and András Ajtay]


Clinical Neuroscience

[Modeling of human movements, neuroprostheses]


[Modeling of human movements became very important as modern methods in informatics and engeniering are available to discern human movement characteristics that were hidden before. The construction of models of neural control and mechanical execution of human movements helps the diagnosis of movement disorders and predicts the outcome of clinical intervention and medical rehabilitation. Here I present methods for recording kinematic and muscle activity patterns. Measurements can be compared with predicted movement patterns based on mathematical models. There are an infinity of different muscle activity patterns or joint rotation patterns to perform a given motor task. I present the main approaches that are used to find such solutions from the infinity of choices that might be employed by the central nervous system. I present a practical application of movement modeling: In rehabilitation of spinal cord injured patients we develop and apply artificially controlled neuroprostheses to generate active cycling lower limb movements in the patients of the National Institute for Medical Rehabilitation.]

Clinical Neuroscience

[Congress calendar]

Clinical Neuroscience

[Combined evoked potentials in co-occuring attention deficit hyperactivity disorder and epilepsy]

MAJOR Zoltán Zsigmond

[Background and purpose - Evoked potentials, both stimulus related and event related, show disturbances in attention deficit-hyperactivity disorder and epilepsies, too. This study was designed to evaluate if these potentials are characteristically influenced by the presence of the two diseases, individually, and in the case of co-occurrence. Methods - Fourty children were included, and four groups were formed, control group, ADHD group, epilepsy group and a group with the comorbidity of epilepsy and ADHD. Epilepsy patients were under proper antiepileptic treatment; ADHD patients were free of specific therapy. Brainstem auditory evoked potentials, visual evoked potentials and auditory P300 evaluation were performed. Results - The latency of the P100 and N135 visual evoked potential components was significantly extended by the presence of epilepsy. If ADHD was concomitantly present, this effect was attenuated. Brainstem auditory evoked potential components were prolonged in the presence of the comorbidity, considering the waves elicited in the brainstem. P300 latencies were prolonged by the presence of co-occurring ADHD and epilepsy. Feedback parameters showed overall reduction of the tested cognitive performances in the ADHD group. Conclusion - Disturbances produced by the presence of ADHD-epilepsy comorbidity reveal hypothetically a linked physiopathological path for both diseases, and offers an approach with possible diagnostic importance, combined evoked potential recordings.]

Clinical Neuroscience

[Pseudo abducens palsy]

RÓZSA Anikó, KOVÁCS Krisztina, SZILVÁSSY Ildikó, BOÓR Krisztina, GÁCS Gyula

[In this study, we present two cases of different eye movement disorders with variable case histories but with the same end stage; abduction paresis of one of the eyes, which ceased when the other eye was covered. Our differential diagnosis is that either the ocular form of myasthenia gravis, convergence spasm or ocular myotonia could explain the symptoms. However, we hypothesize that the clinical picture corresponds to pseudo abducens palsy or focal dystonia of the extraocular muscle, which in turn could be the result of impaired inhibition of the tonic resting activity of the antagonistic medial rectus muscle. We offer an explanation for the patomechanism of pseudoabducens palsy and the variants of internuclear ophthalmoplegia.]

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Clinical Neuroscience

[Occurence and molecular pathology of low grade gliomas]


[Background - The WHO grade I. and II. low-grade gliomas represent nearly the 15% of all primary brain tumors. These tumours contain clinically, hisologically and molecularly distinct tumor types. According to their histologic characteristic, grade II glial tumours are the diffuse astrocytoma, oligodendroglioma and oligoastrocytoma subgroups; the ependymal tumors are not included in this study. Methods - In our publication, we analysed the histological diagnosed glioma cases between 2007 and 2011 at our institution. Results - Low-grade gliomas were diagnosed in 127 cases (62 male / 65 female), and the mean ages were 39 years (±20.3). More than half of the cancers were localizated in the frontal lobe, and the second most frequent area was the temporal lobe. Finally, we comlete our report with an overview of major molecular pathways in low-grade gliomas.]

Clinical Neuroscience



[Objective - The aim of this study is to reveal the volumetrical changes in tumor necrosis, reactive zone and edema following low-dose rate I-125 interstitial irradiation of 20 inoperable (partially irresecable, partially inoperable) lowgrade gliomas. Methods - The volumes of the three regions on imagefused control CT/MRI images were measured for a 24- month period with 36 occasions. The delivered dose on the tumor surface (GTV) was 50-60 Gy. Dose planning and image fusion were performed with the BrainLab Target 1.19 software, mathematical and statistical computations were carried out with the Matlab Numeric Computation and Visualization software. The control images with the „triple ring” were fused with the planning images, and the isodose curves were adjusted to them. Results - Relative volumes normalized to volume of the reference dose were calculated and plotted in the time domain. The mean values of volumes were determined from the patients' measured data then a polynom was fitted to the mean values using the polynomial curve fitting method. The accuracy of our results were verified by statistical tools. Conclusions - The new polynomial prediction approach using image fusion analysis of the volume of tumor necrosis, reactive ring and edema caused by interstitial irradiation as a function of time provides valuable information for 1. selecting the best patient’s treatment option, 2. following up patient’s condition and 3. planning reirradiation or reoperation if necessary.]

Clinical Neuroscience

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.