Clinical Neuroscience

[Functional magnetic resonance imaging studies in pain research]

ÉDES Andrea Edit1,2, JUHÁSZ Gabriella1,2,3,4

SEPTEMBER 30, 2016

Clinical Neuroscience - 2016;69(09-10)


[Functional imaging studies opened a new way to understand the neural activity underlying pain perception and the pathomechanism of chronic pain syndromes. In the last twenty years several results of functional magnetic resonance imaging (fMRI) studies have been published about examining the different aspects of complex pain experience. The aim of these studies is to understand the functioning of the pain control system, the so-called pain matrix, activated by acute nociceptive stimulus. Another important field of pain research is the investigation of neuronal processes underlying chronic pain, since the pathomechanism of this is still unclear. Our review aims to provide insight into the methods of pain research using fMRI and the achievements of the last few years.]


  1. MTA-SE-NAP B Genetikai Agyi Képalkotó Migrén Kutató Csoport, Magyar Tudományos Akadémia, Semmelweis Egyetem, Budapest, Magyarország
  2. MTA-SE Neuropszichofarmakológiai és Neurokémiai munkacsoport, Magyar Tudományos Akadémia, Semmelweis Egyetem, Budapest, Magyarország
  3. Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
  4. Semmelweis Egyetem, Gyógyszerésztudományi Kar, Gyógyszerhatástani Intézet, Budapest, Magyarország



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Clinical Neuroscience

[Operation - rehabilitation - employment]

MÉSZÁROS Gabriella, FEHÉR Miklós, BORBÉLY Csaba

[In this article we would like to bring the attention to the importance of early rehabilitation, coordinated operation of different subdivisions of rehabilitation and the expanding opportunities after medical care through following a 38- year-old female patient's case who was operated 6 years ago with anaplasticus oligodendroglioma. We find it important that the experts working on the field of health care, social services or labour should be aware of the possibilities of rehabilitation of their patients from the capability assessment, through its development until their placement in integrated labour market. It is important, that even during the medical care both the client and their relatives receive proper information.]

Clinical Neuroscience

[Eating disorders and pregnancy - a review of literature]

DUKAY-SZABÓ Szilvia, VARGA Márta, TÚRY Ferenc

[Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.]

Clinical Neuroscience

Frequency and types of headaches in patients with metabolic syndrome

DEMIRYÜREK Enes Bekir, EMRE Ufuk, KORUCU Osman, BARUT Özen Banu, TASCILAR Nida Fatma, ATASOY Tugrul Hüseyin, DEMIRYÜREK Esra, YAYLACI Selcuk, GENC Bilal Ahmet

Background - Metabolic Syndrome (MetS) and headaches are common public health problems in whole world. The relationship between headaches and the MetS isn’t understood clearly. Purpose - The aim of this study is to determine the prevalence and types of headaches, and evaluate the relationship between headache characteristics and clinical and laboratory parameters analyzed in patients diagnosed with MetS. Materials and methods - Of the patients diagnosed with MetS in Endocrinology outpatient clinics between July 2011 and July 2012, 202 patients were included in the study. Hemoglobin, fasting blood glucose (FBG), total cholesterol, triglyceride, HDL and LDL cholesterol, thyroid function tests and HbA1c values of all patients were recorded. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all patients. The headache severity was assessed by Visual Analog Scale (VAS). Results - The prevalence of headache in patients with MetS was found to be 61.4%. The incidence of headache was higher in female patients (F: 86.4%, M: 13.6%). The distribution of the subtypes of headaches was as follows: Episodic Tension-Type Headaches (ETTH) 24.8%, Episodic Migraine 14.4%, Chronic Tension-Type Headaches (CTTH) 11.3%, Episodic Tension-Type Headaches (ETTH) and Episodic Migraine 7.9%, and other types of headaches (Cervicogenic Headache and Cluster Headache) 3%. No statistically significant relationship was found between headache and non-headache groups in terms of body mass index, waist circumference, and the laboratory parameters (p>0.05). The mean BDI and BAI scores were higher in the headache group (p<0.001 and p<0.001). No significant difference was found between the mean MIDAS scores in the subtypes of headaches (p=0.35). In the headache group, there was a significant relationship only between triglyceride levels and attack frequency, duration and severity. Conclusion - Prevalence of headache in patients with MetS was 61.4%. The incidence of subtypes of headaches was similar to those in the general population. A relationship was found between triglyceride levels and attack frequency and severity. The result may be important to draw attention to the evaluation of triglyceride levels for reducing the frequency and severity of attacks in patients with headaches.

Clinical Neuroscience

[Our experience with the use of Active-C cervical prosthesis]


[Objective - The most widely used surgical procedure in the treatment of cervical spine disc hernias have been the anterior cervical discectomy and fusion for decades. The usage of cervical disc prostheses enabled us to preserve the movements of the affected segments, hereby reducing the overexertion of the adjacent vertebrae and discs. Our goal is to follow our patients operated with Active-C prosthesis (which is used in the Institute since 2010) to gather information about the change of their complaints and about the functioning and unwanted negative effects of the prostheses. Question - Is the usage of Active-C prosthesis an efficient procedure? Methods - Between 2010 and 2013, performing the survey of neurological conditions and functional X-ray examinations. We measured the complaints of the patients using the Visual Analogue Scale, Neck Disability Index and Cervical Spine Outcomes Questionnaire. The control group consisted of patients who were operated in one segment using the fusion technique. Results - In the study group according to the Neck Disability Index scale after 18 months, seven patients had no complaints, while twelve persons reported mild and the remaining six moderate complaints. In the control group, moderate complaints were present in four patients, while twelve patients reported mild complaints. The other eight persons showed no complaints. According to the results of the Visual Analogue Scale in the group of prosthesis, the degree of referred pain decreased from 8.6 to 1.84 one and a half years after the surgery. A decrease was observable in the case of axial pain too, from 6.6 down to 1.92 (p<0.01). In case of three from the twenty-five patients there was no sign of movement in the level of the prosthesis. Conclusions - According to the present short- and mediumterm studies, the usage of the cervical disc prosthesis can be considered as an efficient procedure, but at the same time the advantages can only be determined in the long run, therefore further following and studies are required.]

Clinical Neuroscience

Restless Leg Syndrome/Willis-Ekbom disease in women with iron deficiency anemia

KOLUKISA Mehmet, SOYSAL Pinar, GÜLTEKIN Özdemir Tugce, KARATOPRAK Cumali, BILGEN Rengin Halide, GÜRSOY Esra Azize

Background and purpose - Restless Leg Syndrome (RLS) also known as Willis-Ekbom Disease (WED) is a common condition associated with reduced quality of life and other medical conditions, particularly cardiovascular diseases. Despite its common occurrence, it is widely underdiagnosed and undertreated. Therefore, identification of high-risk individuals for RLS/WED bears diagnostic and therapeutic significance. Iron deficiency anemia has a role in the pathophysiology of RLS/WED and both conditions have been reported to occur higher in females. In this study, the frequency of RLS/WED among women diagnosed with iron deficiency anemia was examined as well as laboratory variables that could guide the clinician in the diagnosis of RLS/WED. Methods - A total of 51 women attending to the department of internal medicine with complaints of fatigue and tiredness and diagnosed as having iron deficiency anemia were evaluated using the International Restless Leg Syndrome Study Group (IRLSSG) diagnostic criteria for RLS. Laboratory variables were recorded. The severity of RLS/WED was assessed using the RLS rating scale in patients diagnosed with RLS/WED. Results - RLS/WED was diagnosed in 41.1% of the women with iron deficiency anemia. There were no significant differences between women with or without RLS /WED in terms of laboratory variables. Also, no correlations were observed between disease severity and laboratory variables. Conclusion - There is an 8 to 10-fold increase in the incidence of RLS/WED among women with iron deficiency anemia as compared to general population. Therefore, a possible diagnosis of RLS/WED should be kept in mind in all women with iron deficiency anemia.

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Clinical Neuroscience

Altered BOLD response within the core face-processing network in congenital prosopagnosia


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Clinical Neuroscience

[The effect of palliative neural therapy on the improvement of chronic pain]

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[Objective - To assess the extent to which pain therapy can improve chronic pain in a heterogeneous group of patients, its impact on their quality of life and the correlation of the changes with their age and the underlying disease. The investigation has its actuality by its impact on public health. Methods - a prospective, non-randomized, interventional, clinical cohort study was conducted under real-life conditions in a general pain clinic, which lasted for 6 months. Changes in pain intensity (VAS) and related quality of life changes (SF-36 HRQoL) were measured using validated internationally accepted questionnaires. The questionnaires were filled out by all patients on their own, so they provided information of self-esteem on their own. All patient post-treatment results were compared to pre-treatment results. The general quality of life changes found in our patients were compared to the representative norms of healthy population in Hungary. Subjects - patients participated voluntarily at their own decision in the survey. The underlying disease of chronic pain, age and gender of the patients did not limit the inclusion into the study. Results - Data of 231 patients were evaluated. After pain therapy, the decrease in intensity of pain was confirmed by VAS at p=0.002. This was linked to a quality of life change that has been shown to be p=0.003 for men, with p=0.002 in women with SF-36 HRQoL. Based on the correlation coefficients, the changes in quality of life improved regardless of the age of the patients and the nature of the underlying conditions causing the pain. Conclusions - Although analgesia is basicly a symptomatic therapy, our findings suggest that the reduction of pain improves the quality of life of patients independently from their, and the curability of the underlying and accompanying diseases. ]

Clinical Neuroscience

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KISS Máté, GÁL Andor Viktor, KOZÁK Lajos Rudolf, MARTOS János, NAGY Zoltán

[Introduction/aim of the study - Pre-surgical functional MRI (fMRI) is an important modality of examinations before brain surgery. There are several artefacts (e.g. motion, susceptibility) which may hinder the evaluation of fMRI data. Physiological artefacts (breathing, pulsation) also affect the sensitivity and specificity of anatomical localization. The aim of this study is to demonstrate the efficiency of physiological artefact identification and removal methods for presurgical evaluation. Materials and methods - Siemens Magnetom Verio 3T MRI scanner was used to collect data. The physiological parameters (breathing, pulse) were recorded with the MRI system’s built-in devices. Data from fourteen patients - with primary brain tumour - were evaluated with SPM12 utilizing the RETROICOR/RVHR tool to detect and decrease the effect of physiological artefacts. We compared the statistical maps obtained with and without the physiological correction using the Jaccard similarity coefficient, and ROI analyses. Results - Significant differences were found in the mean ROI values (p<0.0016) and the extensions of eloquent activations (p<0.0013), when using the physiological correction (RETORICOR/RVHR) based on convolution method. On the other hand, no significant differences were found between the ROIs’ standard deviations (F=0.28). The RETROICOR/ RVHR method helps to define the precise localisation of eloquent areas (p<0.009). The number of irrelevant (non-significant) voxels were increased (p<0.001). Conclusions - Minimising of physiological artefacts in fMRI data calculations, the (RETROICOR/RVHR) method based on convolution has been successfully adapted. This algorithm could be helpful before neurosurgical intervention. The activity pattern became more reliable. ]

LAM Extra for General Practicioners



[In the first part of their review about chronic pain syndromes the authors summarize our knowledge about the etiopathogenesis, pathology, clinical features, diagnosis and treatment of myofascial pain syndromes. It is emphasized that also pain of the internal organs, as well as musculoskeletal and connective tissue diseases may generate myofascial pain syndromes. The correct diagnosis of these syndromes is very important, for they respond poorly to simple analgesics, steroids or non-steroid anti-inflammatory drugs. Exercise, physiotherapy, behavioral treatment, local injections, muscle relaxants, tricyclic antidepressants, serotonin reuptake inhibitors are successful modalities of treatment.]

Clinical Neuroscience

[Functional magnetic resonance imaging for cortical mapping in epilepsy]

KOZÁK Lajos Rudolf, TÓTH Vivien, BARSI Péter, RUDAS Gábor

[It is not only the total curative resection of pathological tissue or the minimization of symptoms to be considered in epilepsy surgery or other neurosurgical procedures, it is equally desirable to maintain the best possible quality of life. Cortical mapping methods can help achieve this goal by delineating eloquent areas, i.e. brain regions that are vital for providing an acceptable quality of life, albeit not prone to compensatory reorganization. These areas include among others the Broca and Wernicke regions for speech, the primary motor, sensory and visual cortices. Functional MRI gained importance in the last decade as a non-invasive clinical cortical mapping technique. This method is capable of localizing cortical areas selectively activated by a given task condition. Thus, selecting appropriate tasks can help mapping eloquent brain regions. Using functional MRI provides information that is complementary to other mapping methods. Moreover, it can replace invasive methods such as the Wada test. Here, we explain the background of functional MRI, compare it to other clinical mapping methods, explain the intricacies of paradigm selection, and show the limitations of the technique while also pointing out alternative uses.]